State policies shape the landscape for abortion service provision and access, according to a new analysis by Guttmacher researchers Rachel Jones, Meghan Ingerick and Jenna Jerman. Supportive states increase access to abortion care by expanding the options available to clinics and patients alike, while hostile states decrease access to care by limiting these options. In 2014, 57% of U.S. women of reproductive age lived in states that were hostile toward abortion rights. These states accounted for the same share of abortions nationwide as supportive states—44% in each group—but were home to only 25% of abortion-providing facilities.

The authors analyzed data from the Guttmacher Institute’s 2014 Abortion Provider Census to examine differences between hostile, middle-ground and supportive states in key measures of service delivery, including type of clinic and type of abortion procedures offered, provision of abortion by advanced practice clinicians and how much patients paid for abortions. They found that abortion service delivery is more limited and isolated from the provision of other reproductive health care in hostile states than in supportive states.

“We know that state restrictions are designed to make it harder for individuals to access abortion services,” says Rachel Jones, lead author of the analysis. “Our new findings demonstrate that state policies also shape the type of abortion services that can be provided, whether they take the form of supportive policies that allow providers to expand their services or restrictions that limit provision of care.”

In 2014, 37% of clinics in supportive states provided only medication abortion, compared with 8% of clinics in hostile states. Medication abortion requires less equipment and provider specialization, so clinics providing only early medication abortion have fewer overhead costs. However, 35 states have passed restrictions that make it more challenging for clinics to offer medication abortion, in turn making it more costly and difficult for patients to access this abortion method.

Nationwide, 40% of clinics reported that advanced practice clinicians provided abortions at their facility in 2014. This included 65% of clinics in supportive states, but only 3% of clinics in hostile states. Many hostile states allow only licensed physicians to perform abortions; however, other qualified medical providers known as advanced practice clinicians—including nurse practitioners, nurse-midwives and physician assistants—have become increasingly integrated into the U.S. health care system, and several supportive states explicitly authorize these types of providers to perform abortions. Expanding abortion provision to advanced practice clinicians may increase access to care, and particularly to medication abortion.

“State policies are key to ensuring that individuals seeking abortion can obtain the care they need,” says Elizabeth Nash, Guttmacher state policy expert. “States that implement abortion restrictions have fewer abortion-providing facilities and offer fewer options to patients compared with states that are supportive of abortion rights.”

Differences in Abortion Service Delivery in Hostile, Middle-ground and Supportive States in 2014,” by Rachel Jones, Meghan Ingerick and Jenna Jerman, is currently available online and will appear in a forthcoming issue of Women’s Health Issues.