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Distance to an abortion provider and source of post-abortion care: Evidence from the Medi-Cal program

Ushma Upadhyay, PhD, MPH, University of California, San Francisco

Project abstract

Background: This proposal aims 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 routine follow-up and treatment for complications. Little is understood about care-seeking behavior after an abortion in the United States. Preliminary evidence from our previous analysis suggests that many women experiencing symptoms or complications seek follow-up care at an emergency department. This study would provide needed information on the sources of care for treatment of complications and symptoms. It would also improve our understanding of how distance influences where women seek post-abortion care.

Methods: For this study we will use data from California's state Medicaid program, Medi-Cal. We will use a new dataset from California's Department of Health Care Services containing claims from every fee-for-service abortion covered in 2011 and 2012. We will use Medi-Cal beneficiary zip code data to calculate the distance travelled to an abortion provider using TRAVELTIME3, a Stata module that uses Google maps to calculate distance via road.

Outcomes: We will publish two peer-reviewed journal articles on the distances women travel for abortion care, and on how the distance influences whether and where women seek care. If our hypothesis—that increased distance to a provider is associated with increased use of emergency departments—is confirmed, our results would suggest that increasing abortion facilities, particularly those in rural areas, would reduce the burden on health care systems.

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