(961) Association between distance travelled for abortion care and abortion stigma

Friday, February 10, 2023

3:30 PM – 5:00 PM

Objective: To evaluate the association between distance travelled for abortion care and abortion stigma.

Study Design: Prospective survey study of individuals presenting for abortion care at an urban abortion clinic between July and December of 2020 was performed. Prior to abortion services, participants provided demographic factors, residential zip code, and self-reported abortion stigma using the validated Individual Level Abortion Stigma Scale (ILASS). The primary outcome was ILASS total stigma score, which ranges from 0 to 3.5. Secondary outcomes included the validated ILASS subscales of perceived judgment, isolation, self-judgment, and community condemnation. Primary exposure was distance travelled in miles to the abortion clinic, defined as high (>50 miles) vs low. Bivariate analyses evaluated baseline differences by distance. Adjusted linear regression was used to evaluate the association between distance and ILASS total score and subscales, with covariates chosen using reverse stepwise selection and model fit metrics. Beta coefficients (β) and 95% confidence intervals (CI) are reported.

Results: 500 participants completed the survey, with baseline characteristics given in Table. Of these, 65 (13.0%) travelled >50 miles. Among participants travelling < 50 miles, median ILASS score was lower (0.75, IQR 0.45-1.1) than those travelling >50 miles (0.95, IQR 0.55-1.4) (p=0.01). Reasons for pursuing abortion care did not differ based on distance travelled. In regression models, distance travelled >50 miles (β 0.18, 95%CI 0.04-0.33) was associated with increased ILASS. Other individual factors including age (β -0.02, 95%CI -0.02-0.01), Bachelor’s degree education (β 0.27, 95%CI 0.10-0.43), and Hispanic/LatinX ethnicity (β 0.35, 95%CI 0.20-0.51) were independently associated with total ILASS score. The association between distance travelled and increased total ILASS score was driven by increases in judgment (from others) and community condemnation subscales (Figure).

Conclusion: Travelling >50 miles to obtain abortion care is independently associated with higher individual-level abortion stigma scores.

Primary & Presenting Author(s)

Carly Dahl, MD (she/her/hers)
Maternal Fetal Medicine Fellow
University of Utah Health
Salt Lake City, Utah, United States

Coauthor(s)

AT
Ashley Turner, MD, MS
Northwestern University
Chicago, Illinois, United States
Ashish Premkumar, MD
Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
Bethesda, Maryland, United States
CB
Cayla Bales, BS
Northwestern University
Chicago, Illinois, United States
LC
Lindsay Cheu, MD
University of Washington
Seattle, Washington, United States
AS
Avni Singh, BS
Northwestern University
Chicago, Illinois, United States
LM
Leanne McCloskey, MD, MPH
Northwestern University
Chicago, Illinois, United States
AC
Allison Cowett, MD, MPH
Northwestern University
Chicago, Illinois, United States
Michelle P. Debbink, MD, PhD
Assistant Professor
University of Utah Health
Salt Lake City, Utah, United States