Interruptions in abortion care have a disproportionate impact

“These findings reinforce the importance of developing mechanisms to support pregnant women during emergencies when it is no longer possible to travel to a nearby clinic,” the authors wrote.1

As Louisiana became one of the first hotspots for COVID-19, on March 21, 2020, the state Department of Health issued a directive limiting the provision of medical care to essential services and medical procedures. emergency. This climate created both legal questions about whether abortion was an essential service and logistical obstacles regarding clinic capacity, availability of providers and staff, and procurement of supplies.

Previous research by the same researchers showed that between March and May 2020, service disruptions at Louisiana facilities contributed to a 31% reduction in abortions, as well as a significant increase in abortions in the second trimester (adjusted odds ratio/AOR: 1.91; 95% confidence interval/CI = 1.10-3.33), and a significant decrease in the number of medical abortions.2

In the new study, investigators assessed the impact of geographic patterns of service disruption on all abortions performed for Louisiana residents at the state’s 3 abortion clinics between Jan. May 2020. “In this analysis,” the authors wrote, “we found that observed changes in the number, timing, and type of abortions were concentrated among residents of particular regions of the state.

Calls from “mystery shoppers” made between April 2 and July 8, 2020 revealed that only one clinic (Clinic A) remained open and regularly scheduled appointments. A second clinic was open for 2 of the 6 weeks, while a third remained closed throughout. Clinic A was the only clinic for which the median distance walked increased between the start of 2019 and the start of 2020 — 57 miles versus 102 miles, respectively, with women in central Louisiana being the hardest hit.

The stratified models showed that for residents whose nearest clinic closed, the total number of monthly abortions decreased by 46%; the probability of a second trimester abortion increased significantly (AOR = 2.35; 95% CI: 1.21-4.56); and the likelihood of a medical abortion decreased significantly (AOR = 0.59; 95% CI: 0.39-0.87). “The loss of the nearest clinic, even if not particularly close to home, had a measurable impact on access to abortion care,” the authors wrote.

Although unexpected, the decrease in pharmaceutical abortions occurred because these abortions were less frequent at Clinic A than at the other sites. “The statewide change therefore reflected specific clinical practices, a further indication of how individual clinic closures, whether temporary or permanent, can affect expectant mothers’ ability to fulfill their preferences. in matters of abortion,” the authors said.

Aside from the pandemic, they added, people in rural, Midwestern and Southern communities have long faced increasing distances to reach abortion providers. The recent decision of the Supreme Court of the United States Dobbs v. Jackson Women’s Health Organization decision will likely worsen this trend. “As during the pandemic,” the authors concluded, “postabortion drug availabilityDobbs– in clinics, through telehealth and internet-based self-supply – will be key to providing safe and effective options for people facing service disruptions due to their geographic location.

REFERENCES:

1. Berglas NF, White K, Schroeder R, Roberts SCM. Geographic disparities in abortion care disruptions in Louisiana early in the COVID-19 pandemic. Contraception. 2022;115:17-21. doi:10.1016/j.contraception.2022.07.012

2. Roberts SCM, Berglas NF, Schroeder R, Lingwall M, Grossman D, White K. Disruptions to abortion care in Louisiana during the early months of the COVID-19 pandemic. Am J Public Health. 2021;111(8):1504-1512. doi:10.2105/AJPH.2021.306284

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