Abortion services in rural Washington State, 1983-1984 to 1993-1994: availability and outcomes

Area of Science:

• Reproductive Health
• Public Health Policy
• Rural Health Disparities

Background:

• A decline in the number of rural healthcare providers offering abortion services has been observed over the past decade.
• The impact of reduced abortion service availability on women's pregnancy outcomes, travel burdens, and gestational timing remains unclear.

Purpose of the Study:

• To investigate the effects of decreasing abortion provider availability in rural Washington State.
• To analyze changes in abortion rates, travel distances, and gestational age at abortion for rural versus urban women.

Main Methods:

• Utilized Washington State population, birth, fetal death, and pregnancy termination data from 1983-1984 and 1993-1994.
• Calculated abortion and birth rates, analyzed patient residence and provider location (rural/urban counties), and measured travel distances.
• Employed chi-square tests to compare urban and rural rates and changes over time.

Main Results:

• Both rural and urban abortion rates declined, with a more significant decrease in rural areas (27% vs. 17%).
• Rural women traveled farther for abortions, with a decrease in procedures performed in rural counties (25% to 3%) and an increase in out-of-state travel (8% to 14%).
• The proportion of rural women obtaining abortions after the first trimester increased from 8% to 15%.

Conclusions:

• Rural Washington women face increased travel burdens and delays in obtaining abortions due to declining provider numbers.
• These changes are associated with reduced access to timely abortion care in rural areas.
• Findings highlight significant rural-urban disparities in reproductive healthcare access and outcomes.