Abortion Decision-Making and the Impact of the 72-Hour Abortion Waiting Period in Missouri

Background and Purpose: The rate of unintended pregnancy (UIP) in the U.S. (45%) is higher than that of all industrialized countries. Over 40% of abortions are the result of UIPs. Abortion restrictions are increasingly being put on women and abortion providers in the U.S., resulting in barriers to accessing safe abortions. In 2013, 70 anti-abortion measures were enacted across 22 states in the U.S.  This study examined one of these laws, the increase in the abortion waiting period in Missouri from 24 to 72-hours. Because the 72-hour abortion waiting period in Missouri went into effect in October 2014, the present study occurred at a critical time for Missouri women. The impact of restrictive legislation such as waiting periods needs to be fully understood.

Methods:  This study is a mixed methods design that consisted of (1) formative research, (2) baseline surveys, (3) follow-up surveys, and (4) the examination of retrospective data in order to understand the impact of this new restriction. The formative research was conducted to inform the development of the baseline and follow-up surveys. The baseline surveys were conducted in-person with women seeking abortions at Missouri’s only abortion provider. The follow-up surveys were administered over the phone or via email approximately three weeks after the baseline. The retrospective data were analyzed from two time periods: 1) when Missouri had a 24-hour abortion waiting period, and 2) during the first year of the 72-hour waiting period. The Integrated Behavioral Model (IBM) provided a theoretical framework for understanding a woman’s intention to return for an abortion after the waiting period.

Results: One hundred and thirty-two women completed the baseline survey in the clinic while only 52 (39.4%) of them completed the follow-up survey over the phone or via email approximately three weeks later. Of the 132 women who completed the baseline survey, 124 (94%) of them returned to the clinic after the 72-hour waiting period to obtain an abortion. An exact logistic regression found that self-efficacy is a statistically significant predictor (p = .0122) of a woman’s intention to return to the clinic after the 72-hour waiting period. For the retrospective data, Mann Whitney U tests were run between the numbers of days waited under the 24-hour waiting period and the number of days waited under the first year of the 72-hour waiting period, with statistically significant results: u(1) = 6564095.500, z = -21.936, p = .000

Conclusions and Implications: Findings will be useful to policy makers and women’s health advocates as they try to understand and lessen the effects of abortion restrictions on women. While the 72-hour waiting period in Missouri did not deter the women who participated in this study from seeking abortion services, it did create an undue burden. Although abortion is legal, the qualitative results of the survey indicate that women desire accessibility as well. In the words of one 22-year-old participant, “just the drive. it's so far and inconvenient . . . it makes it harder to obtain in rural areas."