The Association Between Distance Traveled for Abortion Care and Abortion Stigma in the Urban Midwest of the United...

To assess the association between distance traveled for abortion care and abortion stigma in an urban, unrestricted area in the pre-Dobbs versus Jackson Women's Health Organization (Dobbs) era in the Midwest of the United States.

We performed a cross-sectional survey of patients seeking abortion care in Chicago, Illinois between July and December 2020. Participants provided information about their commute and residential zip code and completed the Individual Level Abortion Stigma Scale (ILASS). The primary exposure was distance traveled in miles to the clinic. The primary outcome was ILASS total score (range 0-3.5). We used adjusted linear regression to evaluate the association between distance traveled and ILASS total score and subscales.

Among 500 participants, the average gestational duration was 8 weeks and 6 days. Individuals traveling farther had a higher gestational duration at the time of the abortion (9 weeks and 2 days versus 8 weeks and 2 days, p = 0.02). Among participants traveling $\le$  50 miles, the median ILASS score was lower (0.85, 95% CI 0.79-0.90) than those traveling > 50 miles (1.05, 95% CI 0.89-1.21) (p = 0.01). In adjusted regression models, traveling > 50 miles (β 0.19, 95% CI 0.04-0.34) remained associated with an increased ILASS score, which was driven by judgment (from others) and community condemnation subscales.

We found that traveling > 50 miles to obtain abortion care was independently associated with higher individual-level abortion stigma scores in the pre-Dobbs era Midwest.