Abortion patients' decision making about where to obtain out‐of‐state care following Texas' 2021 abortion ban
Objective To assess pregnant Texans' decisions about where to obtain out‐of‐state abortion care following the September 2021 implementation of Senate Bill 8 (SB8), which prohibited abortions after detectable embryonic cardiac activity. Data Source In‐depth telephone interviews with Texas reside...
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| Published in | Health services research Vol. 59; no. 1; pp. e14226 - n/a |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Oxford, UK
Blackwell Publishing Ltd
01.02.2024
Health Research and Educational Trust |
| Subjects | |
| Online Access | Get full text |
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| Abstract | Objective
To assess pregnant Texans' decisions about where to obtain out‐of‐state abortion care following the September 2021 implementation of Senate Bill 8 (SB8), which prohibited abortions after detectable embryonic cardiac activity.
Data Source
In‐depth telephone interviews with Texas residents ≥15 years of age who obtained out‐of‐state abortion care after SB8's implementation.
Study Design
This qualitative study explored participants' experiences identifying and contacting abortion facilities and their concerns and considerations about traveling out of state. We used inductive and deductive codes in our thematic analysis describing people's decisions about where to obtain care and how they evaluated available options.
Data Collection
Texas residents self‐referred to the study from flyers we provided to abortion facilities in Arkansas, Colorado, Kansas, Louisiana, Mississippi, New Mexico, and Oklahoma. We also enrolled participants from a concurrent online survey of Texans seeking abortion care.
Principal Findings
Participants (n = 65) frequently obtained referral lists for out‐of‐state locations from health‐care providers, and a few received referrals to specific facilities; however, referrals rarely included the information people needed to decide where to obtain care. More than half of the participants prioritized getting the soonest appointment and often contacted multiple locations and traveled further to do so; others who could not travel further typically waited longer for an appointment. Although the participants rarely cited state abortion restrictions or cost of care as their main reason for choosing a location, they often made sacrifices to lessen the logistical and economic hardships that state restrictions and out‐of‐state travel costs created. Informative abortion facility websites and compassionate scheduling staff solidified some participants' facility choice.
Conclusions
Pregnant Texans made difficult trade‐offs and experienced travel‐related burdens to obtain out‐of‐state abortion care. As abortion bans prohibit more people from obtaining in‐state care, efforts to strengthen patient navigation are needed to reduce care‐seeking burdens as this will support people's reproductive autonomy. |
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| AbstractList | Objective: To assess pregnant Texans' decisions about where to obtain out-of-state abortion care following the September 2021 implementation of Senate Bill 8 (SB8), which prohibited abortions after detectable embryonic cardiac activity. Data Source: In-depth telephone interviews with Texas residents [greater than or equal to]15 years of age who obtained out-of-state abortion care after SB8's implementation. Study Design: This qualitative study explored participants' experiences identifying and contacting abortion facilities and their concerns and considerations about traveling out of state. We used inductive and deductive codes in our thematic analysis describing people's decisions about where to obtain care and how they evaluated available options. Data Collection: Texas residents self-referred to the study from flyers we provided to abortion facilities in Arkansas, Colorado, Kansas, Louisiana, Mississippi, New Mexico, and Oklahoma. We also enrolled participants from a concurrent online survey of Texans seeking abortion care. Principal Findings: Participants (n = 65) frequently obtained referral lists for out-of-state locations from health-care providers, and a few received referrals to specific facilities; however, referrals rarely included the information people needed to decide where to obtain care. More than half of the participants prioritized getting the soonest appointment and often contacted multiple locations and traveled further to do so; others who could not travel further typically waited longer for an appointment. Although the participants rarely cited state abortion restrictions or cost of care as their main reason for choosing a location, they often made sacrifices to lessen the logistical and economic hardships that state restrictions and out-of-state travel costs created. Informative abortion facility websites and compassionate scheduling staff solidified some participants' facility choice. Conclusions: Pregnant Texans made difficult trade-offs and experienced travel-related burdens to obtain out-of-state abortion care. As abortion bans prohibit more people from obtaining in-state care, efforts to strengthen patient navigation are needed to reduce care-seeking burdens as this will support people's reproductive autonomy. KEYWORDS abortion care, abortion restrictions, decision-making, out-of-state travel, qualitative methods, Texas What is known on this topic * Many pregnant Texans traveled to surrounding states to obtain abortion care after implementation of a restrictive abortion law in September 2021. * People who travel for abortion often consider multiple locations and do not always obtain care at the nearest facility. * Studies of abortion travel have primarily focused on patients' financial, logistical, and emotional burdens. What this study adds * This study illustrates how people seeking out-of-state abortion care evaluate their options with respect to cost, travel distance, appointment availability, and state regulations and the factors they consider most important. * Participants frequently prioritized time to appointment over distance and cost of care, but finding the soonest appointment was often a burdensome process. * These results point to opportunities to strengthen patient navigation to facilitate pregnant people's access to time-sensitive health care. To assess pregnant Texans' decisions about where to obtain out-of-state abortion care following the September 2021 implementation of Senate Bill 8 (SB8), which prohibited abortions after detectable embryonic cardiac activity. In-depth telephone interviews with Texas residents ≥15 years of age who obtained out-of-state abortion care after SB8's implementation. This qualitative study explored participants' experiences identifying and contacting abortion facilities and their concerns and considerations about traveling out of state. We used inductive and deductive codes in our thematic analysis describing people's decisions about where to obtain care and how they evaluated available options. Texas residents self-referred to the study from flyers we provided to abortion facilities in Arkansas, Colorado, Kansas, Louisiana, Mississippi, New Mexico, and Oklahoma. We also enrolled participants from a concurrent online survey of Texans seeking abortion care. Participants (n = 65) frequently obtained referral lists for out-of-state locations from health-care providers, and a few received referrals to specific facilities; however, referrals rarely included the information people needed to decide where to obtain care. More than half of the participants prioritized getting the soonest appointment and often contacted multiple locations and traveled further to do so; others who could not travel further typically waited longer for an appointment. Although the participants rarely cited state abortion restrictions or cost of care as their main reason for choosing a location, they often made sacrifices to lessen the logistical and economic hardships that state restrictions and out-of-state travel costs created. Informative abortion facility websites and compassionate scheduling staff solidified some participants' facility choice. Pregnant Texans made difficult trade-offs and experienced travel-related burdens to obtain out-of-state abortion care. As abortion bans prohibit more people from obtaining in-state care, efforts to strengthen patient navigation are needed to reduce care-seeking burdens as this will support people's reproductive autonomy. ObjectiveTo assess pregnant Texans' decisions about where to obtain out‐of‐state abortion care following the September 2021 implementation of Senate Bill 8 (SB8), which prohibited abortions after detectable embryonic cardiac activity.Data SourceIn‐depth telephone interviews with Texas residents ≥15 years of age who obtained out‐of‐state abortion care after SB8's implementation.Study DesignThis qualitative study explored participants' experiences identifying and contacting abortion facilities and their concerns and considerations about traveling out of state. We used inductive and deductive codes in our thematic analysis describing people's decisions about where to obtain care and how they evaluated available options.Data CollectionTexas residents self‐referred to the study from flyers we provided to abortion facilities in Arkansas, Colorado, Kansas, Louisiana, Mississippi, New Mexico, and Oklahoma. We also enrolled participants from a concurrent online survey of Texans seeking abortion care.Principal FindingsParticipants (n = 65) frequently obtained referral lists for out‐of‐state locations from health‐care providers, and a few received referrals to specific facilities; however, referrals rarely included the information people needed to decide where to obtain care. More than half of the participants prioritized getting the soonest appointment and often contacted multiple locations and traveled further to do so; others who could not travel further typically waited longer for an appointment. Although the participants rarely cited state abortion restrictions or cost of care as their main reason for choosing a location, they often made sacrifices to lessen the logistical and economic hardships that state restrictions and out‐of‐state travel costs created. Informative abortion facility websites and compassionate scheduling staff solidified some participants' facility choice.ConclusionsPregnant Texans made difficult trade‐offs and experienced travel‐related burdens to obtain out‐of‐state abortion care. As abortion bans prohibit more people from obtaining in‐state care, efforts to strengthen patient navigation are needed to reduce care‐seeking burdens as this will support people's reproductive autonomy. Abstract Objective To assess pregnant Texans' decisions about where to obtain out‐of‐state abortion care following the September 2021 implementation of Senate Bill 8 (SB8), which prohibited abortions after detectable embryonic cardiac activity. Data Source In‐depth telephone interviews with Texas residents ≥15 years of age who obtained out‐of‐state abortion care after SB8's implementation. Study Design This qualitative study explored participants' experiences identifying and contacting abortion facilities and their concerns and considerations about traveling out of state. We used inductive and deductive codes in our thematic analysis describing people's decisions about where to obtain care and how they evaluated available options. Data Collection Texas residents self‐referred to the study from flyers we provided to abortion facilities in Arkansas, Colorado, Kansas, Louisiana, Mississippi, New Mexico, and Oklahoma. We also enrolled participants from a concurrent online survey of Texans seeking abortion care. Principal Findings Participants ( n = 65) frequently obtained referral lists for out‐of‐state locations from health‐care providers, and a few received referrals to specific facilities; however, referrals rarely included the information people needed to decide where to obtain care. More than half of the participants prioritized getting the soonest appointment and often contacted multiple locations and traveled further to do so; others who could not travel further typically waited longer for an appointment. Although the participants rarely cited state abortion restrictions or cost of care as their main reason for choosing a location, they often made sacrifices to lessen the logistical and economic hardships that state restrictions and out‐of‐state travel costs created. Informative abortion facility websites and compassionate scheduling staff solidified some participants' facility choice. Conclusions Pregnant Texans made difficult trade‐offs and experienced travel‐related burdens to obtain out‐of‐state abortion care. As abortion bans prohibit more people from obtaining in‐state care, efforts to strengthen patient navigation are needed to reduce care‐seeking burdens as this will support people's reproductive autonomy. To assess pregnant Texans' decisions about where to obtain out-of-state abortion care following the September 2021 implementation of Senate Bill 8 (SB8), which prohibited abortions after detectable embryonic cardiac activity.OBJECTIVETo assess pregnant Texans' decisions about where to obtain out-of-state abortion care following the September 2021 implementation of Senate Bill 8 (SB8), which prohibited abortions after detectable embryonic cardiac activity.In-depth telephone interviews with Texas residents ≥15 years of age who obtained out-of-state abortion care after SB8's implementation.DATA SOURCEIn-depth telephone interviews with Texas residents ≥15 years of age who obtained out-of-state abortion care after SB8's implementation.This qualitative study explored participants' experiences identifying and contacting abortion facilities and their concerns and considerations about traveling out of state. We used inductive and deductive codes in our thematic analysis describing people's decisions about where to obtain care and how they evaluated available options.STUDY DESIGNThis qualitative study explored participants' experiences identifying and contacting abortion facilities and their concerns and considerations about traveling out of state. We used inductive and deductive codes in our thematic analysis describing people's decisions about where to obtain care and how they evaluated available options.Texas residents self-referred to the study from flyers we provided to abortion facilities in Arkansas, Colorado, Kansas, Louisiana, Mississippi, New Mexico, and Oklahoma. We also enrolled participants from a concurrent online survey of Texans seeking abortion care.DATA COLLECTIONTexas residents self-referred to the study from flyers we provided to abortion facilities in Arkansas, Colorado, Kansas, Louisiana, Mississippi, New Mexico, and Oklahoma. We also enrolled participants from a concurrent online survey of Texans seeking abortion care.Participants (n = 65) frequently obtained referral lists for out-of-state locations from health-care providers, and a few received referrals to specific facilities; however, referrals rarely included the information people needed to decide where to obtain care. More than half of the participants prioritized getting the soonest appointment and often contacted multiple locations and traveled further to do so; others who could not travel further typically waited longer for an appointment. Although the participants rarely cited state abortion restrictions or cost of care as their main reason for choosing a location, they often made sacrifices to lessen the logistical and economic hardships that state restrictions and out-of-state travel costs created. Informative abortion facility websites and compassionate scheduling staff solidified some participants' facility choice.PRINCIPAL FINDINGSParticipants (n = 65) frequently obtained referral lists for out-of-state locations from health-care providers, and a few received referrals to specific facilities; however, referrals rarely included the information people needed to decide where to obtain care. More than half of the participants prioritized getting the soonest appointment and often contacted multiple locations and traveled further to do so; others who could not travel further typically waited longer for an appointment. Although the participants rarely cited state abortion restrictions or cost of care as their main reason for choosing a location, they often made sacrifices to lessen the logistical and economic hardships that state restrictions and out-of-state travel costs created. Informative abortion facility websites and compassionate scheduling staff solidified some participants' facility choice.Pregnant Texans made difficult trade-offs and experienced travel-related burdens to obtain out-of-state abortion care. As abortion bans prohibit more people from obtaining in-state care, efforts to strengthen patient navigation are needed to reduce care-seeking burdens as this will support people's reproductive autonomy.CONCLUSIONSPregnant Texans made difficult trade-offs and experienced travel-related burdens to obtain out-of-state abortion care. As abortion bans prohibit more people from obtaining in-state care, efforts to strengthen patient navigation are needed to reduce care-seeking burdens as this will support people's reproductive autonomy. Data Source: In-depth telephone interviews with Texas residents [greater than or equal to]15 years of age who obtained out-of-state abortion care after SB8's implementation. Data Collection: Texas residents self-referred to the study from flyers we provided to abortion facilities in Arkansas, Colorado, Kansas, Louisiana, Mississippi, New Mexico, and Oklahoma. We also enrolled participants from a concurrent online survey of Texans seeking abortion care. * This study illustrates how people seeking out-of-state abortion care evaluate their options with respect to cost, travel distance, appointment availability, and state regulations and the factors they consider most important. Objective To assess pregnant Texans' decisions about where to obtain out‐of‐state abortion care following the September 2021 implementation of Senate Bill 8 (SB8), which prohibited abortions after detectable embryonic cardiac activity. Data Source In‐depth telephone interviews with Texas residents ≥15 years of age who obtained out‐of‐state abortion care after SB8's implementation. Study Design This qualitative study explored participants' experiences identifying and contacting abortion facilities and their concerns and considerations about traveling out of state. We used inductive and deductive codes in our thematic analysis describing people's decisions about where to obtain care and how they evaluated available options. Data Collection Texas residents self‐referred to the study from flyers we provided to abortion facilities in Arkansas, Colorado, Kansas, Louisiana, Mississippi, New Mexico, and Oklahoma. We also enrolled participants from a concurrent online survey of Texans seeking abortion care. Principal Findings Participants (n = 65) frequently obtained referral lists for out‐of‐state locations from health‐care providers, and a few received referrals to specific facilities; however, referrals rarely included the information people needed to decide where to obtain care. More than half of the participants prioritized getting the soonest appointment and often contacted multiple locations and traveled further to do so; others who could not travel further typically waited longer for an appointment. Although the participants rarely cited state abortion restrictions or cost of care as their main reason for choosing a location, they often made sacrifices to lessen the logistical and economic hardships that state restrictions and out‐of‐state travel costs created. Informative abortion facility websites and compassionate scheduling staff solidified some participants' facility choice. Conclusions Pregnant Texans made difficult trade‐offs and experienced travel‐related burdens to obtain out‐of‐state abortion care. As abortion bans prohibit more people from obtaining in‐state care, efforts to strengthen patient navigation are needed to reduce care‐seeking burdens as this will support people's reproductive autonomy. |
| Audience | Trade |
| Author | White, Kari Arey, Whitney Beasley, Anitra D. Dixon, Laura Ogburn, Tony Dane'el, Asha Potter, Joseph E. Whitfield, Brooke |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/37700552$$D View this record in MEDLINE/PubMed |
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54 year: 2018 end-page: 113 article-title: I wouldn't even know where to start”: unwanted pregnancy and abortion decision‐making in central Appalachia publication-title: Reprod Health Matters – volume: 117 start-page: 36 issue: 1 year: 2023 end-page: 38 article-title: A mystery client study of crisis pregnancy center practices in New York state publication-title: Contraception – volume: 119 issue: 109912 year: 2023 article-title: Comparing preference for and use of medication abortion in Texas after policy changes in 2014 and 2018 publication-title: Contraception – volume: 387 start-page: 388 year: 2022 end-page: 390 article-title: A preview of the dangerous future of abortion bans—Texas senate bill 8 publication-title: N Engl J Med – year: 2019 – ident: e_1_2_8_25_1 doi: 10.2105/AJPH.2021.306701 – ident: e_1_2_8_44_1 doi: 10.1016/j.contraception.2017.01.007 – ident: e_1_2_8_13_1 doi: 10.1371/journal.pone.0209991 – volume-title: Counseling and Waiting Periods for Abortion year: 2021 ident: e_1_2_8_22_1 contributor: fullname: Guttmacher Institute – ident: e_1_2_8_45_1 doi: 10.1016/j.socscimed.2021.114468 – ident: e_1_2_8_47_1 doi: 10.1016/j.contraception.2022.08.004 – ident: e_1_2_8_46_1 doi: 10.1016/j.contraception.2014.07.003 – ident: e_1_2_8_9_1 doi: 10.3390/ijerph20043679 – ident: e_1_2_8_36_1 – ident: e_1_2_8_40_1 – ident: e_1_2_8_32_1 doi: 10.3402/qhw.v9.26152 – ident: e_1_2_8_3_1 doi: 10.1016/S2468‐2667(17)30158‐5 – ident: e_1_2_8_29_1 doi: 10.1016/j.conx.2019.100016 – ident: e_1_2_8_5_1 doi: 10.1016/j.lana.2022.100214 – ident: e_1_2_8_26_1 doi: 10.1016/j.contraception.2022.11.003 – volume-title: Even before Roe Was Overturned, Nearly One in 10 People Obtaining an Abortion Traveled across State Lines for Care year: 2022 ident: e_1_2_8_4_1 contributor: fullname: Maddow‐Zimet I – ident: e_1_2_8_28_1 doi: 10.1016/j.contraception.2023.110259 – ident: e_1_2_8_12_1 doi: 10.1080/13691058.2019.1631963 – volume-title: Forced Travel for Later Abortion Care in the United States: Findings and Recommendations year: 2022 ident: e_1_2_8_14_1 contributor: fullname: Ibis Reproductive Health – ident: e_1_2_8_18_1 – ident: e_1_2_8_19_1 doi: 10.1056/NEJMp2207423 – ident: e_1_2_8_37_1 doi: 10.1377/hlthaff.2021.01528 – volume-title: New Evidence: Texas Residents Have Obtained Abortions in at Least 12 States that do not Border Texas year: 2021 ident: e_1_2_8_21_1 contributor: fullname: Jones RK – ident: e_1_2_8_50_1 – ident: e_1_2_8_34_1 – ident: e_1_2_8_48_1 – volume-title: Coverage for Abortion Services in Medicaid, Marketplace Plans, and Private Plans year: 2019 ident: e_1_2_8_23_1 contributor: fullname: Salganicoff A – ident: e_1_2_8_6_1 doi: 10.1001/jama.2022.20424 – ident: e_1_2_8_17_1 – ident: e_1_2_8_20_1 doi: 10.1001/jama.2022.20423 – ident: e_1_2_8_51_1 – ident: e_1_2_8_33_1 – ident: e_1_2_8_7_1 – ident: e_1_2_8_27_1 doi: 10.1016/j.contraception.2021.03.017 – ident: e_1_2_8_15_1 doi: 10.1363/psrh.12024 – ident: e_1_2_8_31_1 doi: 10.1371/journal.pone.0165048 – ident: e_1_2_8_2_1 – volume-title: No Real Choice: how Culture and Politics Matter for Reproductive Autonomy year: 2022 ident: e_1_2_8_42_1 contributor: fullname: Kimport K – ident: e_1_2_8_35_1 doi: 10.1016/j.whi.2012.12.002 – ident: e_1_2_8_41_1 doi: 10.1080/09688080.2018.1513270 – ident: e_1_2_8_11_1 doi: 10.1016/j.contraception.2023.109956 – ident: e_1_2_8_52_1 – ident: e_1_2_8_43_1 doi: 10.1016/j.contraception.2019.07.141 – ident: e_1_2_8_10_1 doi: 10.1016/j.socscimed.2021.114667 – ident: e_1_2_8_8_1 doi: 10.1089/jwh.2018.7496 – ident: e_1_2_8_38_1 – ident: e_1_2_8_39_1 doi: 10.1016/j.whi.2013.03.001 – ident: e_1_2_8_16_1 doi: 10.1177/00221465211044413 – ident: e_1_2_8_49_1 – volume: 2 start-page: 1 issue: 100043 year: 2020 ident: e_1_2_8_24_1 article-title: Abortion service delivery in clinics by state policy climate in 2017 publication-title: Contracept X contributor: fullname: Witwer E – ident: e_1_2_8_30_1 doi: 10.1016/j.contraception.2022.09.134 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| Snippet | Objective
To assess pregnant Texans' decisions about where to obtain out‐of‐state abortion care following the September 2021 implementation of Senate Bill 8... To assess pregnant Texans' decisions about where to obtain out-of-state abortion care following the September 2021 implementation of Senate Bill 8 (SB8), which... Abstract Objective To assess pregnant Texans' decisions about where to obtain out‐of‐state abortion care following the September 2021 implementation of Senate... Data Source: In-depth telephone interviews with Texas residents [greater than or equal to]15 years of age who obtained out-of-state abortion care after SB8's... Objective: To assess pregnant Texans' decisions about where to obtain out-of-state abortion care following the September 2021 implementation of Senate Bill 8... ObjectiveTo assess pregnant Texans' decisions about where to obtain out‐of‐state abortion care following the September 2021 implementation of Senate Bill 8... |
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| SubjectTerms | Abortion abortion care Abortion policy abortion restrictions Abortion, Induced Analysis Autonomy Bans Beliefs, opinions and attitudes Bills, Legislative Data collection Decision analysis Decision Making Female Government regulation Health care Health care industry Health Services Accessibility Humans Laws, regulations and rules Legislatures Louisiana Market trend/market analysis Medical personnel Medical referrals Methods Navigation New Mexico Oklahoma out‐of‐state travel Patients Political activity Political aspects Pregnancy Pregnant women qualitative methods Qualitative research Sacrifices Sympathy Texas Travel Travel-Related Illness |
| Title | Abortion patients' decision making about where to obtain out‐of‐state care following Texas' 2021 abortion ban |
| URI | https://onlinelibrary.wiley.com/doi/abs/10.1111%2F1475-6773.14226 https://www.ncbi.nlm.nih.gov/pubmed/37700552 https://www.proquest.com/docview/2911023157 https://www.proquest.com/docview/2864618238/abstract/ |
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