Money and Place: Quantifying the types of obstacles associated with seeking an abortion after 10 weeks’ gestation, 2019-2020

Objective Identify factors associated with presenting for abortion after 10 weeks' gestation in a large, geographically diverse sample. Study Design From October 2019 to March 2020, we surveyed 1,089 patients seeking abortion at 7 U.S. facilities. We identified four domains of barriers: geographic, financial, logistical/personal, and legislative. Using multivariable logistic regression, we investigated the relationship between each domain and presenting for abortion after 10 weeks' gestation, overall and stratified by state policy landscape. Results One-third of participants reported geographic (33.0%), financial (33.3%), and logistical/personal (31.4%) barriers; fewer (4.8%) reported legislative barriers. One-third (30.8%) traveled over 50 miles to the clinic. One-quarter (25.2%) presented after 10 weeks' gestation. In multivariable analyses, financial barriers (adjusted Odds Ratio (aOR)=1.49, 95% Confidence Interval (CI)=1.06-2.09), geographic barriers (aOR=2.05, 95% CI=1.44-2.90) and difficulty meeting basic expenses (aOR=1.47, 95% CI=1.15-1.89) were associated with presenting after 10 weeks' gestation across the 7 clinics. Among participants accessing care at clinics in states with supportive abortion policies (n=178), geographic barriers remained significantly associated with presenting after 10 weeks' gestation. Conclusion In a large, geographically diverse sample, financial and geographic barriers were associated with presenting after the threshold for medication abortion. In supportive states, the association with geographic barriers persisted. Cost and geographic barriers are increasing as more states restrict abortion post-Dobbs, highlighting the urgent need to expand financial and travel support. Implications People seeking abortion faced barriers before the Dobbs decision. Now post-Dobbs, restrictions to abortion have only increased, making barriers to care even more threatening. Providing access to financial resources and transportation for people seeking abortion and expanding telehealth medication abortion is now even more important.