Estimated Travel Time and Spatial Access to Abortion Facilities in the US Before and After the Dobbs v Jackson Women's Health Decision

Abstract

Importance: Abortion facility closures resulted in a substantial decrease in access to abortion care in the US.

Objectives: To investigate the changes in travel time to the nearest abortion facility after the Dobbs v Jackson Women's Health Organization (referred to hereafter as Dobbs) US Supreme Court decision.

Design, setting, and participants: Repeated cross-sectional spatial analysis of travel time from each census tract in the contiguous US (n = 82 993) to the nearest abortion facility (n = 1134) listed in the Advancing New Standards in Reproductive Health database. Census tract boundaries and demographics were defined by the 2020 American Community Survey. The spatial analysis compared access during the pre-Dobbs period (January-December 2021) with the post-Dobbs period (September 2022) for the estimated 63 718 431 females aged 15 to 44 years (reproductive age for this analysis) in the US (excluding Alaska and Hawaii).

Exposures: The Dobbs ruling and subsequent state laws restricting abortion procedures. The pre-Dobbs period measured abortion access to all facilities providing abortions in 2021. Post-Dobbs abortion access was measured by simulating the closure of all facilities in the 15 states with existing total or 6-week abortion bans in effect as of September 30, 2022.

Main outcomes and measures: Median and mean changes in surface travel time (eg, car, public transportation) to an abortion facility in the post-Dobbs period compared with the pre-Dobbs period and the total percentage of females of reproductive age living more than 60 minutes from abortion facilities during the pre- and post-Dobbs periods.

Results: Of 1134 abortion facilities in the US (at least 1 in every state; 8 in Alaska and Hawaii excluded), 749 were considered active during the pre-Dobbs period and 671 were considered active during a simulated post-Dobbs period. Median (IQR) and mean (SD) travel times to pre-Dobbs abortion facilities were estimated to be 10.9 (4.3-32.4) and 27.8 (42.0) minutes. Travel time to abortion facilities in the post-Dobbs period significantly increased (paired sample t test P <.001) to an estimated median (IQR) of 17.0 (4.9-124.5) minutes and a mean (SD) of and 100.4 (161.5) minutes. In the post-Dobbs period, an estimated 33.3% (sensitivity interval, 32.3%-34.8%) of females of reproductive age lived in a census tract more than 60 minutes from an abortion facility compared with 14.6.% (sensitivity interval, 13.0%-16.9%) of females of reproductive age in the pre-Dobbs period.

Conclusions and relevance: In this repeated cross-sectional spatial analysis, estimated travel time to abortion facilities in the US was significantly greater in the post-Dobbs period after accounting for the closure of abortion facilities in states with total or 6-week abortion bans compared with the pre-Dobbs period, during which all facilities providing abortions in 2021 were considered active.

Figure 1.. Travel Time to Nearest US Abortion Facility Before and After Dobbs v Jackson Women’s Health US Supreme Court Decision

Facilities as listed in the Advancing New Standards in Reproductive Health database; 82 892 census tracts included. B and C, States with bans are outlined: Alabama, Arizona, Arkansas, Florida (15-wk gestational limit), Georgia (6-wk limit), Idaho, Kentucky, Louisiana, Mississippi, Missouri, North Carolina (20-wk limit), Oklahoma, South Dakota, Tennessee, Texas, Utah (18-wk limit), West Virginia, and Wisconsin. Maps are shown with US National Atlas equal-area projection to depict the 3D size and shape of each tract proportionally, thus larger areas may have smaller populations.

Figure 2.. Change in Distribution of Travel Time From US Census Tracts to Nearest Abortion Facility Before and After Dobbs v Jackson Women’s Health US Supreme Court Decision

Travel time to nearest abortion site from 82 892 census tracts in the contiguous US by state. Distributions represent the density of census tracts at each respective travel cutoff. The pre-Dobbs period includes travel to all facilities providing abortions in 2021. The post-Dobbs period removed facilities in the 15 states with total or 6-week abortion bans as of September 30, 2022. States with bans (total ban in effect unless otherwise noted) include Alabama, Arizona, Arkansas, Georgia (6-week gestational limit), Idaho, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, South Dakota, Tennessee, Texas, West Virginia, and Wisconsin. Florida (15-week gestational limit), Utah (18-week gestational limit), and North Carolina (20-week gestational limit) were included in the group of states without total or 6-week abortion bans. Distributions are stratified to show census tracts in each state with a total or 6-week abortion ban separately and all census tracts in states without total or 6-week bans in a single distribution. Distributions are ordered along the y-axis by total estimated population of females aged 15 to 44 years. All distributions were weighted by the population of females aged 15 to 44 years. Travel time distributions are smoothed to 3-minute bins. Alaska and Hawaii were excluded due to the unique challenges of spatial access in these states.

Figure 3.. Change in US Females of Reproductive Age Living in a Census Tract More Than 60 Minutes From an Abortion Facility Before and After Dobbs v Jackson Women’s Health US Supreme Court Decision

Percentage and percentage point change (sensitivity interval [SI]) of US females of reproductive age (15-44 years) living in census tracts more than 60 minutes from an abortion facility, estimated from a repeated cross-sectional spatial analysis. The pre-Dobbs period was modeled to assume all facilities providing abortions in 2021 were active. The post-Dobbs period was modeled after removing facilities in the 15 states with total or 6-week abortion bans as of September 30, 2022. Demographic estimates drawn from the 2016-2020 American Community Survey. Median household income from this census was estimated to be $67 521.