(see Poster Gallery) Perceptions of Abortion and Accessibility in Appalachia

Background and Purpose: The Appalachian region in the eastern United States (US) stretches from New York to Mississippi and encompasses 25 million residents across sections of 13 states. While not monolithic, Appalachia is thought to share an overall place-based culture, with regional subregions and subcultures, which are considered factors in the region’s documented health disparities. Abortion care, which carries its own unique set of constraints above and beyond those encountered when seeking other types of healthcare, may be particularly difficult to access in Appalachia due to place-based culture and place-based structural barriers to access. The small body of Appalachian-specific abortion literature indicates that Appalachians who become pregnant may perceive abortion as unattainable and stigmatized, but limitations to these studies constrain our understanding of these perceptions and their effects.

The purpose of the current exploratory study was to examine individual and community-based perceptions of abortion and abortion access in Appalachia, identify factors associated with these perceptions, and assess the relationship between abortion perceptions and state-level restrictions. Our research questions were as follows: 1) How is abortion perceived among individuals in Appalachia in relation to its acceptability and accessibility?; 2) How do individuals perceive their community’s attitudes towards abortion attitudes (related to acceptability and accessibility)?; 3) Which sociodemographic factors are associated with select abortion perceptions?; and 4) What is the relationship between abortion attitudes and restrictive state abortion policy?

Methods: Residents of Appalachia between 18-49 years of age were sampled via advertisements on Facebook and groups specific to Appalachia (N=608). Participants were routed to an electronic survey, presented with statements regarding abortion and abortion accessibility, and asked to respond “yes/no/don’t know” or to indicate their level of agreement using five level Likert-scale responses. States were categorized as having ‘hostile’, ‘very hostile’, ‘supportive’, or ‘middle-ground’ abortion policy, using metrics from the Guttmacher Institute. The demographic variables included reflect those found in the abortion literature. Relationships between abortion perceptions, sample demographic characteristics, and state-level abortion restrictions were analyzed via chi-square tests of association and two-sided Fischer’s exact tests (when expected cell counts <5).

Results: Results indicate abortion is perceived as unaffordable, geographically inaccessible, of unknown legality, and as occurring uncommonly in the region, in part due to religiosity, shame, and fear of judgement from others. Income, rurality, religiosity, and hostility of state-level abortion policy were each associated with select abortion perceptions.

Conclusions and Implications: Results suggest the need for widespread community-level educational efforts regarding abortion legality, abortion services and abortion-related resources, such as abortion funds. Additionally, efforts to de-stigmatize abortion that are tailored for Appalachian residents are essential. Repealing restrictive state-level abortion policy and continued work to promote evidence-based, state-level reproductive health policies are also recommended.