National Study Provides Baseline Data on Experiences of People Seeking Abortion Care Prior to the Overturning of Roe v. Wade

Findings emphasize the additional financial barriers that individuals living in states with restrictive laws face in accessing abortion

The Guttmacher Institute released findings from the sixth Abortion Patient Survey providing baseline data about the experiences of people seeking abortion care in the 12 months before Roe v. Wade was overturned in June 2022. The data shows that, even before the fall of Roe, individuals living in restricted states, defined as those that were likely to ban abortion in the absence of constitutional protections, faced substantial financial barriers to obtaining an abortion.

The study, published in the journal Perspectives on Sexual Health and Reproductive Health, compares the demographic and situational profiles of people who were living in the 24 restricted states to those living in the 26 states where abortion was likely to remain legal even without the Roe decision in place (“protected states”).

Originally launched in 1987, the Abortion Patient Survey is one of the Institute’s landmark research initiatives that has provided vital data on who gets abortions in the United States for more than three decades.

The 2021–2022 Abortion Patient Survey uses data from a national sample of more than 6,600 individuals who obtained an abortion at a health care facility in the United States from June 2021 to June 2022, right before the US Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization. Previous iterations of the survey provided nationally representative data; however, since the data collection for this study occurred when it was clear that Roe was in danger of being overturned, the study team prioritized recruiting participants who obtained an abortion in states categorized as restricted.

“Understanding the background and life circumstances of people who get abortions is critical for policymakers, public health officials, health care providers and advocates who are working to mitigate the devastating impact of Dobbs,” says Guttmacher Institute Principal Research Scientist Rachel Jones. “Our findings shed light on the characteristics of pregnant people who are most directly impacted by existing and impending abortion bans.”

Three-quarters of all respondents had incomes below 200% of the federal poverty line, and respondents from restricted and protected states had similar characteristics in terms of age, sexual orientation and number of prior births. The study found significant differences between the two groups related to their insurance coverage, payment for abortion and other measures.

  • Respondents from restricted states were more likely than those from protected states to have paid out of pocket for an abortion (87% vs. 42%) and to have relied on financial assistance, such as subsidies from abortion funds or clinic discounts (22% vs. 11%).
  • More than two-thirds of respondents from both restricted and protected states would have preferred to have their abortion earlier than they did, but respondents from restricted states were more likely to report that financial barriers delayed their care (37% vs. 19%).
  • Respondents from restricted states were less likely to have been enrolled in Medicaid than those in protected states (35% vs. 52%) and were much less likely to have used such coverage to pay for their abortion care (1% vs. 42%).
  • While a higher proportion of respondents from restricted states than protected states had private health insurance (30% vs. 25%), they were less likely to have used it to pay for abortion care (7% vs. 14%). 
  • Only 6% of respondents in restricted states reported paying $0 for abortion care, compared with 50% of those in protected states.
  • Respondents in restricted states were more likely than those in protected states to indicate that it was difficult to pay for their abortion (54% vs. 28%).

Additional findings: 

  • The majority of all respondents were in their 20s (60%), were Black (33%) or Latinx (26%), and had one or more prior births (56%).  
  • Sixteen percent of respondents identified their sexual orientation as something other than heterosexual or straight.
  • Twelve percent of respondents from restricted states crossed state lines to obtain an abortion, and the majority (59%) traveled to another restricted state.

“These data show that even before the fall of Roe, individuals living in restricted states faced additional financial barriers in obtaining an abortion,” says Jones. “We know that the draconian restrictions implemented following the Dobbs decision, including near-total abortion bans in 12 states and no providers currently operating in an additional two, have further eroded access to abortion care for those living with low incomes.”

The authors conclude that the findings point to the need for policies aimed at protecting access to abortion, including:

  • Passing the Women’s Health Protection Act (WHPA), federal legislation that would establish a nationwide right to abortion.
  • Enacting additional measures to defend access to abortion in protective states, including codifying the right to abortion in state constitutions, dedicated state funds to subsidize the cost of abortion care, and passing shield laws that prevent health care providers from prosecution for providing abortions to people from states with bans.

The full report, including interpretation of data and methodology, is available here.

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