It is taking longer to get an abortion in America. Doctors fear riskier, more complicated procedures


A woman whose fetus was unlikely to survive called more than a dozen abortion clinics before finding one that would take her, but she was put on a weeks-long waiting list. A teenage girl had to wait seven weeks for an abortion because it took so long for her mother to get an appointment for her. Others seeking the procedure faced waits as they struggled to travel hundreds of miles for care.

Doctors and researchers say such barriers have become more common since Roe v. Wade was overturned in June 2022, leading to delays that could lead to abortions that are more complicated, expensive and, in some cases, riskier. Is - especially as the pregnancy progresses.

Nearly half of US states now have laws that ban or restrict abortion. Because of this, many clinics do not offer this procedure, leading to increased demand for appointments at the remaining providers.

According to the results of a periodic survey led by Middlebury College economics professor Caitlin Myers and recently provided to The Associated Press, the wait in many states since Roe has lasted two or three weeks, and some clinics have had no Appointment was not available. Doctors and researchers say that even though wait times have gone down, people still face other challenges like planning and paying for travel, taking time off from work and providing child care.

"All of these things can contribute to delay, and then it becomes kind of a vicious cycle," said Dr. Daniel Grossman, an obstetrician-gynecologist at the University of California, San Francisco, who is a co-author. research report Anecdotes from health care providers were compiled after Roe was overturned earlier this year.

People may be able to afford a medication abortion, which is not typically offered until after 10 to 11 weeks of pregnancy. As people enter the second trimester, starting at 13 or 14 weeks, a decreasing number of clinics provide abortions. The cost of the procedure also varies from $800 in the first trimester to $2,000 or more in the second trimester.

“Abortion is safe at all points in pregnancy,” said Dr. Colleen McNicholas, chief medical officer of Planned Parenthood of St. Louis, “with an overall complication rate of 2%,” adding that “it becomes more complicated as the pregnancy continues. " Area. “There are additional risks as well.”

Increasing demand increases wait times

At least 66 clinics in 15 states According to an analysis last year, abortions were halted in the 100 days following Roe's coup Gutmacher InstituteA research group that supports abortion rights.

The need for people to travel out of state is at the root of abortion delays.

Clinics run by Planned Parenthood of the Rocky Mountains, which operates in Colorado, New Mexico and southern Nevada, saw out-of-state patients more than double after Roe. And Planned Parenthood of the St. Louis Area Health Center in Fairview Heights, Illinois saw a 715% increase in patients from outside Illinois or Missouri in the year after Roe.

"We know that abortion restrictions have had a widespread impact and increased wait times, even in states where access is safe," McNicholas said.

The ongoing Myers abortion appointment availability survey polled more than 700 facilities across the United States. Its latest survey, conducted in September, found that the average appointment wait time in 11 states was more than five business days and in four states the wait was at least eight business days, not counting weekends or holidays. The longest wait was in Iowa: 12 business days.

A year earlier, the survey found that the wait in Iowa was an average of 13 business days, and six other states had waits between 12 and 15 business days.

Planned Parenthood of Rocky Mountain told the AP that the wait time reached 28 days shortly after the U.S. Supreme Court decision, though it later decreased. Before June 2022, the average wait at area Planned Parenthood clinics was 17 days, reflecting restrictions Texas imposed in 2021.

In the report from Grossman's team, a health care worker described how it took seven weeks for a mother to get an appointment for her pregnant teenager, who was by then almost 17 weeks old. Another patient described in the report also had an abortion after struggling for six weeks to get an appointment. She drove 10 hours to another state to get care.

latest statistics Data from the US Centers for Disease Control and Prevention are from 2021 and show that about 7% of abortions occurred at or after 14 weeks.

Although there is no way to know for sure whether the delay has led to more abortions in the second trimester, several providers said they have seen numbers increase in their own clinics. Planned Parenthood of the St. Louis area, for example, saw a 35% increase in the number of patients seeking abortions at or after 14 weeks at its Southern Illinois Health Center in the year following the Supreme Court decision.

Dr. Rebecca Cohen, an obstetrician-gynecologist at a hospital-affiliated clinic in Colorado, said her team has cared for a growing number of patients seeking abortions near the end of their pregnancies, some of whom have visited "many Have experienced weeks of delays". ,

Jilleen St. Michel had to fight her way to an abortion late last year after she learned that her 20-week-old fetus had multiple genetic and developmental problems and might not survive. She lives in Idaho, where abortion is banned, so St. Michelle and her husband called about 15 out-of-state clinics, eventually getting on a three-week waiting list in Denver and a two-week waiting list in Seattle.

St. Michel, 37, said she is concerned about crossing the abortion deadline: Colorado allows abortion at all stages of pregnancy, while Washington state allows the procedure up to viability, as long as the fetus is outside the womb. Can survive. some kids can survive With medical help at 22 or 23 weeks.

A chance cancellation four days after the call to get on the list left a spot open in Seattle. Still, she said, "We absolutely felt short of time."

dealing with floods

Clinics have taken several steps to reduce waits, such as adding more telehealth appointments for medication abortions, staying open longer and adding more staff. This has generally reduced wait times for appointments and has also helped people get other types of fertility care to clinics in a timely manner.

"If someone is sexually active and doesn't want to get pregnant, we want to get them on birth control," said Adrienne Mansanares, president and CEO of Planned Parenthood of Rocky Mountain. "If they're experiencing symptoms of a sexually transmitted infection ... we want to get them treated."

But providers said streamlining appointments is only part of the answer to reducing abortion delays. Personal issues like child care problems, canceled flights and financial worries can be difficult to overcome — even when clinics try to help by connecting patients to abortion funds, for example.

This is especially difficult as travel distances become longer. Research by Myers and colleagues found that the average driving distance to the nearest clinic increased significantly in some states after Roe. From March 2022 to September 2023, it increased from 34 to 160 miles in Alabama and from 43 to 499 miles in Texas.

The clinic where St. Michel, a chiropractor, had her abortion is about 500 miles from her home. She and her husband immediately came up with plane tickets, a rental car, three nights' lodging, and about $4,000 for the procedure, since the clinic was out-of-network for their insurance. The couple decided not to turn to the abortion fund because they felt others needed it more, instead they took it out of their savings.

In hopes of helping other families, she joined the Lawsuit filed by Center for Reproductive Rights, an organization of lawyers and advocates that supports abortion rights. The lawsuit asks state courts in Idaho and Tennessee to block abortion laws.

"I personally can't imagine that most people would be able to do this," said St. Michelle, who is pregnant again. “This is not how we should be receiving health care.”

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute's Science and Educational Media Group and the Robert Wood Johnson Foundation. AP is solely responsible for all content.



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