A Preliminary Analysis of Healthcare Barriers Among Women Living in Appalachia Who Attempted or Considered Self-Managed Abortion

Background/purpose: The purpose of this poster is to present preliminary results from a study of barriers to healthcare access in a sample of Appalachian women/pregnancy capable people who considered or attempted self-managed abortion.

Methods: A community-partner informed, anonymous survey, distributed electronically through social media, was designed to collect information from women/pregnancy-capable people ages 18 and older living in Appalachian zip codes (as defined by the Appalachian Regional Commission) who had considered or attempted a self-managed abortion. Survey questions enquired about demographics and access issues surrounding health and reproductive health care. Respondents were compensated with a $10 gift card for their time.

Results: Participants in this study (N = 177) either considered (n = 35, 19.8%) or attempted (n = 137, 77.4%) a self-managed abortion (SMA). In terms of demographics, on average, participants were 28.6 years old, primarily White (54%) or Black (35.5%), with a bachelor’s degree (42.9%) and a stated religious affiliation (80.8%). Religiously affiliated (p = .010) and younger (p = .044) participants were more likely to have attempted or succeeded in self-managing an abortion. In relation to health care access and barriers, respondents report an average distance in estimated travel time of 30 minutes to 1 hour to get to a general healthcare provider (44%), gynecological care (45.6%), and sexual health services (39%). Respondents also report that they experience several barriers to seeking or receiving healthcare due to burdensome travel distances to medical providers (37.4%), lack of transportation (32.1%), not knowing where to go to seek care (20.9%), fear of being judged by medical providers (51.9%), lack of privacy (22.5%), financial cost of medical care (39%), lack of health insurance (23.5%), difficulty getting an appointment (27.8%), hospital closures (7.5%), lack of available providers (9.6%), need for multiple appointments (17.1%), lack infrastructure for telehealth (2.1%), employment responsibilities (20.3%), and difficulty getting childcare (7.5%). Additional analyses of the aspects of health access that are associated with attempting to self-manage an abortion will also be provided.

Conclusion: Preliminary results from this study indicate that respondents who are religious and younger are more likely to attempt a SMA rather than just consider one. Among Appalachian respondents who attempt or consider self-managing an abortion, a variety of health and reproductive health access barriers are reported, indicating that problems surrounding health equity are perceived to exist in the region and these findings are consistent with those from other studies with Appalachian samples. While more research is needed to better understand how health access issues may contribute to abortion decision-making in the Appalachian region, the current and rapidly evolving political and legislative landscape may further exacerbate health access issues in Appalachia in the context of abortion seeking and access.