Distance to an abortion provider and source of post-abortion care: Evidence from the Medi-Cal program
Awarded 2014
Large Research Grants
Ushma Upadhyay, PhD, MPH
University of California, San Francisco

Objectives: This study aimed to examine the distance that low-income women travel to obtain an abortion in California, and how the distance they travel influences their post-abortion care – both follow-up and emergency department visits. Methods: We utilized a dataset from California’s state Medicaid program, Medi-Cal, containing claims from every fee-for-service abortion covered in 2011 and 2012 (N=39,747), as well as any claims up to six weeks following. We calculated distance travelled to an abortion provider and used two separate mixed effects logistic regression models, with beneficiary as a random effect, to examine the associations between distance travelled and both follow-up visits and emergency department visits. Results: The average distance travelled to obtain an abortion by fee-for-service Medi-Cal beneficiaries was 24 miles, with 4% travelling more than 100 miles for the procedure. Among all abortions, 7% had a follow-up care visit at the abortion location and 3% had a subsequent emergency department visit for abortion-related care (not mutually exclusive). Women travelling further for their abortion were significantly more likely to seek emergency department care and less likely to return to their abortion site for follow-up, controlling for other factors. Conclusions: Strategies to increase the number of rural providers who accept Medicaid payments for abortion care would likely improve continuity of care and reduce state costs. Strategies include ensuring that abortion training is part of OB/GYN medical education, integrating abortion provision into primary care settings, expanding the kinds of providers that can provide early abortion, and to increase Medi-Cal reimbursement rates.