July 31, 2014 — Summary of "Secondary Measures of Access to Abortion Services in the United States, 2011 and 2012: Gestational Age Limits, Cost, and Harassment," Jerman/Jones, Women's Health Issues, July 2014.
"Although access to abortion is primarily defined by the presence of a health care facility that provides abortion care, secondary measures of access can influence women's ability to obtain care at these facilities, and include factors such as fees charged, gestational age limits, and harassment," according to Jenna Jerman and Rachel Jones, both of the Guttmacher Institute.
They explained that women might find it more difficult to obtain abortion services if those services "became more expensive, if fewer facilities were performing abortions at various gestational ages, or if increased harassment made women reluctant to go to a clinic."
They devised a study to document changes in these three measures between 2008 and 2012, and to "assess regional differences in abortion access."
The researchers used data from the Guttmacher Institute's 16th Abortion Provider Census, which collected information via questionnaires that were "sent to all known abortion providing facilities in the U.S." in April 2012, with "data collection efforts continu[ing] through May 2013."
The questionnaire surveyed abortion-providing facilities, including hospitals, about the minimum and maximum gestational age at which they provided "[e]arly medication abortion, surgical abortion, and induction abortion," Jerman and Jones explained. In addition, nonhospital abortion facilities were asked about the "usual charges a self-paying patient would incur for surgical abortions at 10 and 20 weeks and for early medication abortions" and "how frequently they had experienced any of seven types of harassment in 2011: Picketing, picketing with physical contact or blocking, vandalism, picketing of homes of staff members, bomb threats, harassing phone calls, and noise disturbances."
The researchers wrote that they distinguished between four types of abortion facilities: abortion clinics, defined as "nonhospital facilities in which half or more of patient visits were for abortion services"; nonspecialized clinics, defined as "sites in which fewer than half of patient visits were for abortion services"; hospitals; and physician clinics, which perform fewer than 400 abortions per year and "have names suggesting that they are physicians' private practices."
According to the study, the survey resulted in "at least some information on gestational age limits from 54% of all facilities," on cost and charges from 68% of nonhospitals and on exposure to harassment from "80% of clinics."
Gestational Age Limits
The study found that 95% of abortion facilities offered abortions at eight weeks of gestation, 72% at 12 weeks, 34% at 20 weeks and 16% at 24 weeks. Abortions were available at four weeks of gestation or earlier at 46% of facilities.
Gestational age limits varied significantly by facility type, the researchers noted. For example, slightly more than two-thirds of hospitals offered abortion care at 20 weeks' gestation, compared with 36% of abortion clinics.
Further, the availability of abortion care at nonspecialized clinics and physicians' offices dropped sharply after nine weeks' gestation, "perhaps because these types of facilities were more likely to offer only early medication abortion," the researchers suggested.
The researchers found that the median charge for a surgical abortion at 10 weeks gestational age in 2011 and 2012 was $495, "suggesting little to no change" from the $503 median cost of abortion in 2009.
However, they noted that the cost varied depending on "facility type and gestational age," with clinics that had the "largest caseloads charg[ing] the least ($450), and those that performed fewer than 30 procedures per year charg[ing] the most ($650)."
The median charge for an early medication abortion was $500, which varied only slightly depending on facility type, with "smaller facilities charg[ing] slightly more and prices decreas[ing] as caseload increased." The researchers found that the median charge for an abortion at 20 weeks' gestation was $1,350, with individual charges ranging from $750 to $5,000.
According to the study, 84% of clinics experienced "at least one form of antiabortion harassment in 2011," with exposure to picketing (80%) and receiving harassing phone calls (47%) the most common types. A little over one-quarter of facilities reported picketing with physical contact or the blocking of patients.
The researchers found that abortion clinics were more likely than nonspecialized clinics to experience harassment, as were larger facilities compared with smaller facilities. For example, 94% of facilities that performed 1,000 or more abortions per year experienced picketing, compared with about 25% of those with fewer than 30 abortion patients each year.
The researchers also found that harassment varied by region. Ninety-five percent of clinics located in the Midwest were exposed to harassment, followed by 89% of clinics in the South, 79% in the West and 78% in the Northeast.
Overall, the researchers determined that harassment levels increased from 75% of clinics in 2008 to 80% in 2011.
Regional Distribution of Facilities and Abortions
By region, the South accounted for the largest proportion of abortions (34%), although there were more facilities offering the procedure in the Northeast (453) and the West (737) than in the South (357). Hospitals accounted for the largest percentage of abortion-providing facilities in the Northeast (36%) and the West (42%), while abortion clinics comprised the majority of facilities in the South (40%).
Physicians' offices accounted for fewer than one in 10 facilities in the Midwest and the South, compared with one in five facilities in the Northeast and the West.
Across all regions, abortion clinics provided the majority of abortions, while physicians' offices provided the fewest.
"We found relatively few changes in gestational age limits, charges for abortion services or harassment experienced by abortion providing facilities between 2008 and 2009 compared with 2011 and 2012," Jerman and Jones wrote.
However, they noted "it is possible that a number of factors impacting access to services have changed since the study period," citing a Guttmacher report that found that 42 abortion restrictions took effect in 2012, with another 70 enacted in 2013. "As services become more restricted ... and, potentially, more concentrated within facilities vulnerable to anti-abortion harassment and state regulations, barriers may mount," they wrote.
"[O]ngoing monitoring of abortion indicators is necessary to address disparities in access to reproductive health services," Jerman and Jones continued. They urged policymakers to "use this information to remove barriers to abortion care and proactively protect all women's access to reproductive health care."