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At the end of June, the U.S. Supreme Court is expected to issue a ruling that will overturn Roe v. Wade, the Court’s 1973 landmark decision which ruled that the Constitution protects a pregnant individual’s liberty to choose to have an abortion.

The decision will create a patchwork of abortion laws in the US, with 26 states likely or certain to ban abortion. Advocacy groups and corporations like Microsoft and Amazon are already gearing up to help Americans travel to access abortion services.

However, a new analysis from researchers at UC Berkeley School of Public Health, UCSF, and the University of North Carolina at Chapel Hill published today in JAMA Open shows that travel distance to abortion facilities may be an insurmountable barrier to abortion access in the United States.

Currently, though most people seeking abortion have to travel less than 25 miles one way to reach a provider, many have to travel 50 or more miles.

“When people have to travel longer to access abortion care, additional barriers begin to compound. If someone has to drive over 50 miles each way to access medical care, that might mean that they have to take time off of work (potentially missing out on income), find childcare for children they might already have, and gather additional money for gas and a possible overnight stay,” says Alice Cartwright, a trainee at the Carolina Population Center and a doctoral candidate in Maternal and Child Health at the Gillings School of Global Public Health.  “If Roe is overturned, extremely far distances would become the norm for people seeking abortion in large swaths of the South and Midwest. Since North Carolina is currently one of the closest states to many of those in the South that would ban abortion after 6 weeks or outright, we would expect more people traveling extremely long distances to access care in our state.”

The analysis used data from the Google Ads Abortion Access Study—a prospective cohort study conducted to understand barriers to abortion care among currently pregnant people in the US seeking abortion information and services via Google—found that almost half of those considering abortion had obtained one at the four-week follow-up (48%), while 32% were still seeking an abortion, and 20% had decided to continue their pregnancy.

“Given these findings and the known challenges posed to abortion access by long travel distances to reach a provider, we sought to explore the impacts of distance to an abortion-providing facility on abortion attainment in this sample,” said study lead author Elizabeth Pleasants, MPH, a doctoral candidate at UC Berkeley School of Public Health.

In this cohort of individuals looking for abortion services onoline, living 50 miles or more from an abortion facility was associated with still being pregnant four weeks later, indicating that excessive travel contraindicated the successful procurement of abortion services.

“While past studies have explored the importance of travel distance as a barrier to abortion access, none have looked at individual-level data for people living across to U.S.,” said Pleasants. “Additionally, none have explored the impacts of travel distance on people considering abortion prior to them reaching an abortion-providing facility. This study provides novel insights into the impacts of travel distance on access to desired abortion services among this hard-to-reach population of individuals living in states across the U.S. considering abortion.”

The authors hope that their work will lead to “innovative approaches to abortion care, such as making telehealth abortion widely available and integrating abortion into primary care provision, which can help reduce the impacts of distance on access.”

Coauthors include Elizabeth A. Pleasants of UC Berkeley School of Public Health, Alice F. Cartwright of the University of North Carolina at Chapel Hill, and Ushma D. Upadhyay of UCSF.

Read the full paper JAMA NETWORK OPEN: 10.1001/jamanetworkopen.2022.12065