Wednesday, October 4, 2017

Lancet article on distance to abortion providers spawns some urbancentric headlines

The Lancet Public Health, the prestigious medical journal, published an article yesterday about the distances women in the U.S. have to travel for abortion care, and lots of mainstream media outlets picked up the story.  What initially struck me about several stories was the focus on this fact:  1 in 5 U.S. women must travel more than 43 miles to get to an abortion provider.  This is a factoid that would have the average rural woman thinking, "no big deal," because rural residents travel distances like that for everyday activities--like getting to work.  What burdens many rural women, you see, are much greater distances.

An opening line of the Guttmacher Institute's press release about the article does acknowledge some other key data points:
Nationally, half of all women of reproductive age lived within 11 miles of the nearest abortion clinic in 2014.  However, a substantial minority of women, particularly those in rural areas, lived significantly farther away.  (emphasis added)
The article was written by three Guttmacher Institute researchers, including lead author Jonathan Bearak.  The map accompanying the article shows a big swath running north to south through the middle of America as the most vast abortion desert.

NPR's coverage did a better job of highlighting what I would say is the more salient fact regarding rural women.  Their headline was "For Many Women, the Nearest Abortion Provider is Hundreds of Miles Away." Sarah McCammon's story features a woman in Sioux Falls, South Dakota who elected to drive 4 hours to Minneapolis for an abortion because the State of Minnesota does not impose a 72-hour waiting period like South Dakota does.

Here's another excerpt from Guttmacher's press release, which quotes Bearak:

Women and abortion clinics are both concentrated in urban areas, so it is not surprising that most women live relatively close to an abortion clinic.  However, distance may be a significant barrier to accessing abortion care for the substantial minority who live farther away, and especially for economically disadvantaged women, who make up the majority of abortion patients.
The title of The Lancet article is "Disparities and Change Over Time in Distance Needed to Travel to Access an Abortion in the U.S.:  A Spatial Analysis."  One of the "over time" findings is that between 2011 and 2014, distances to clinics remained the same in 34 states, while they increased in 7.  Needless to say, the states where the distances have increased include states like Wisconsin, Texas, and Alabama, all of which have passed so-called TRAP laws, Targeted Regulation of Abortion Providers, the constitutionality of which have been litigated in recent years.

CNN's coverage of the article featured a more appropriate headline that pleased me for its focus on the extreme distances facing some women.  The headline is "Some US women travel hundreds of miles for abortions, analysis finds."  That story included this additional information, the first line of which states what should be obvious:
"How far a woman has to travel for an abortion is a key measure of access," Bearak said. Other measures include restrictive laws and financial constraints.

To analyze how far women travel to terminate a pregnancy across the nation, the researchers began with data on the location of abortion providers and women. The information on women was based on census block groups, Bearak said: "That is the smallest publicly available geographic unit." Within states are counties, within counties are census tracts, and within tracts are block groups.
This analysis sounds very similar to what researchers did to quantify abortion availability in Texas following the different stages of implementation of House Bill 2, which was ultimately struck down by the U.S. Supreme Court in Whole Woman's Health v. Hellerstedt in 2016. 

My extensive writing about distance, travel, and abortion access is herehere, and here, along with many posts under the "abortion" label on the Legal Ruralism blog.

In other abortion news, don't miss this story of abortion hypocrisy.

Cross-posted to Legal Ruralism.

1 comment:

Suzanne Connell said...

Professor Pruitt,

Your extensive research into the plight of rural women in obtaining access to abortion has really opened up my eyes to the inherent flaws that still remain in the United States' interaction with women's reproductive rights. In particular I'm moved by the unfairness of the distances many rural women are compelled to travel in order to access abortion, as I can equate it to the treatment women receive in my home country of Ireland when faced with the prospect of needing an abortion.

The illegality of abortion was placed on a constitutional footing in Ireland in 1983, largely as a result of the seemingly 'liberal' holding in Roe v Wade and a fear by the conservative Catholic majority that a liberal crop of judges would waltz in and legalise abortion through caselaw. The eighth amendment directly puts into conflict the right to life of the mother and the unborn, an aspect which was marginally addressed in the landmark case Attorney General v X. Here it was established that a woman would have the right to an abortion in Ireland if there was a "real and substantial risk" to her life, which included suicide but not if there was a risk to her health but not her life. For a woman in Ireland to even hope to rely on this provision of law however, she would need to summersault backwards through flaming hoops.

As a result of my country's inability to deal with this omnipresent problem, Irish women have effectively been banished from our shores in order to lawfully seek abortions in the UK or other jurisdictions. So much so, that based on the UK Department of Health statistics, from 1980 to 2016 168,703 women and girls who accessed UK abortion services provided Irish addresses. Don't forget, this heart-wrenching statistic doesn't include women who may have given UK addresses, sought abortions in other jurisdictions or procured abortions in other illicit ways, such as via contraband abortion pills.

There has been a large amount of anger manifesting itself in Ireland over the past decade in response to our nations draconian abortion laws, with the Repeal the 8th campaign spearheading this anger. The median distance to travel from the Republic of Ireland to England is 490 kilometres via car, plane or ferry. Akin to the rural women of America, not every Irish woman possesses the material means to embark on this Odyssey, with the rural women of America having only the slightest advantages over Irish women in that they won't be criminalised for their abortion. This large-scale displacement of women in both countries is burdensome not only on an economic level but in my opinion also morally wrong on a human level, with thousands of women having to undergo abortions alienated from the security of their respective communities.

I have only been made aware of the difficulties rural women in America face in accessing abortions in this regard in the past few weeks, however I feel that a large portion of the women of Ireland including myself, truly empathise with this struggle of these women and can only continue to hope and fight for a reprieve from both of our situations.