Abortion services in rural Washington State, 1983-1984 to 1993-1994: Availability and outcomes

Context: Fewer rural health providers offer abortion services than a decade ago. It is unknown how the reduction in service availability has affected women's pregnancy outcomes, the extent to which they must travel to obtain an abortion or whether abortions are delayed as a result Methods: Population, birth and fetal death data, as well as pregnancy termi nation reports, obtained from Washington State were used to calculate abort ion rates and ratios and birthrates for Washington residents in 1983-1984 a nd in 1993-1994. Residence of abortion patients was classified by county on ly and location of providers was recorded as large urban county small urban county large rural county or small rural county. Distances that women trav eled to obtain an abortion were calculated Chi-square tests were used to co mpare urban and rural rates and ratios within time periods, and to compare changes that occurred between time periods. Results: Birthrates and abortion rates decreased for both rural and urban W ashington women between 1983-1984 and 1993-1994 but the magnitude of the de crease was greater for rural women. The rural abortion rate fell 27%, from 14.9 abortions per 1,000 women to 10.9 per 1;000, while the urban rate drop ped 17%, from 21.8 to 18.2 per 1,000. The decline in the abortion rare was larger for adolescents than it was for other age-groups. In rural areas, th e abortion rate decreased from 16.5 per 1,000 adolescents aged 10-19 in 198 3-1984 to 10.8 per 1,000 in 1993-1994, while it declined from 23.3 per 1,00 0 to 16.9 per 1,000 in urban areas. From the earlier to the later time peri od, rural women traveled on average 12 miles farther each way to obtain an abortion, and the proportion who obtained the procedure in a rural county d ecreased from 25% to 3%. In the earlier time period, 62% of rural women tra veled 50 miles or more to obtain an abortion, compared with 73% in 1993-199 4. From 1983-1984 to 1993-1994, the proportion of rural women who traveled out of state far an abortion increased from 8% to 14%. The proportion of ru ral women terminating their pregnancy after the first trimester increased f rom 8% in 1983-1984 to 15% in 1993-1994. Conclusion: Rural Washington women are traveling farther and more often to urban and out-of-state locations for abortion services, and are obtaining t heir abortions at a later gestational age, which is associated with a decad e-long decline in the number of abortion providers.