As of 2014, half of all women in Daniels County, Montana, lived more than 300 miles from an abortion clinic. The same was true in Teton County, Wyoming; Dewey County, South Dakota; Lubbock County, Texas. In Burke County, North Dakota, half of women had to travel more than 393 miles if they wanted to get an abortion.
These are some of the findings of a study conducted by Jonathan M. Bearak, Kristen Lagasse Burke, and Rachel K. Jones of the Guttmacher Institute, whose results were published on Tuesday in the journal The Lancet Public Health. The study is the first to use census data to paint a detailed picture of how far women of reproductive age around the country live from the nearest abortion clinic.
The research reveals huge disparities. For many women in America, especially in urban areas, the nearest abortion provider is relatively close by — in Brooklyn, New York, (Kings County), for instance, half of women live within about 2 miles of a clinic. But in large parts of Wyoming, the Dakotas, Texas, and elsewhere — as well as some surprising places, like eastern California — someone seeking an abortion would have to travel more than 180 miles.
The study reinforces concerns reproductive rights advocates have long had about abortion access in rural areas. It also shows the real-life impact of restrictive laws that make abortion a completely different prospect in some parts of the country than in others.
When it comes to abortion access, a lot depends on where you live
Nationwide, the median distance a woman has to travel to an abortion clinic is about 11 miles, according to the study. That relatively short distance isn’t especially surprising, Bearak said, since “women and clinics are both concentrated in urban areas.”
The nationwide median, however, doesn’t tell the whole story. Bearak and his co-authors also found that one in five American women has to travel more than 43 miles for an abortion. And many women had to travel much farther.
The longest distances were in Alaska. In the Nome Census Area, in the western part of the state, half of women live more than 760 miles from an abortion clinic. But since much of Alaska’s population is concentrated in cities, half of Alaskan women still live within about 9 miles of a clinic.
The states with the highest median distance to a clinic were Wyoming (where half of women live more than 168 miles from a clinic), North Dakota (about 152 miles), and South Dakota (about 92 miles). In some counties within those states — and, indeed, in pockets throughout the country — the median distance was even farther.
The greatest distances were generally in the Midwest and the South — the map above shows a band of counties stretching unbroken from North Dakota to Texas in which half of women live more than 180 miles from a clinic. But several counties in the Western United States have a similar distinction — in Inyo County in eastern California, for instance, half of women live more than about 216 miles from an abortion clinic. In general, counties where women have to travel more than 180 miles tend to be rural. (An interactive map of the study results is available here.)
Women who have to travel hundreds of miles to an abortion clinic also have to travel hundreds of miles back home, Bearak noted. And if their state imposes a waiting period for an abortion, they may have to repeat the process all over again. “Women who want to access reproductive health care face obstacles that have no basis in science, health, or safety,” he said. Even though half of American women are relatively close to an abortion clinic, many people “have to travel really far, for no good reason, to access health care.”
Bearak and his co-authors also measured how the distance to clinics changed between 2011 and 2014. The greatest state-level decreases in distance were in Kansas, where a new clinic opened, and Maine, where two clinics took on higher caseloads. The greatest state-level increases were in North Dakota, Montana, and Missouri. In Texas, Missouri, Iowa, and Montana, many counties showed an increase in distance of more than 30 miles. All of these states except for Iowa passed new abortion restrictions between 2011 and 2014, the study authors note.
In Texas in particular, the authors say the increase in distance is probably due to a 2013 law requiring abortion doctors to have admitting privileges at hospitals, which led to the closure of more than half the abortion clinics in the state. “Although some of the more onerous restrictions were struck down by the Supreme Court in June, 2016,” they write, “most clinics have not yet reopened, and the distance to the nearest provider has probably not improved.”
In general, the researchers found a much greater variation in distance within states than between them. “Although policies are implemented at the state level, the consequences of restrictive legislation might not be felt equally across counties within a state,” they write.
Clinics in rural areas face a number of threats in addition to restrictive laws. They may have trouble finding staff, in part because of stigma against abortion. As Megan Donovan, a senior policy manager at the Guttmacher Institute, told me last month, “it’s difficult to find providers who are willing to practice, particularly in hostile and sometimes dangerous environments” — and being isolated in a rural area may strike some would-be providers as unacceptably risky. It’s also true, as the study authors note, that “women in rural counties are likely to be most adversely affected by clinic closures” — the closure of the only clinic within 100 miles of your home matters more than the closure of one of three clinics nearby.
The bottom line is that in places where clinics are already scarce, each new restriction hits providers and patients especially hard. As Bearak put it, “access to reproductive health care just becomes more and more contingent on a woman’s ZIP code.”