ABORTION-RELATED COSTS AS CATASTROPHIC HEALTH EXPENDITURES AND THEIR ASSOCIATIONS WITH IN-STATE OR OUT-OF-STATE TRAVEL TO ABORTION CARE

Objectives

We aimed to estimate the proportion of people seeking abortion whose out-of-pocket abortion-related costs constitute a catastrophic health expenditure (CHE) and whether these are associated with in-state or out-of-state travel for care.

Methods

In 2019, we surveyed people aged 15–45 seeking abortion in four clinics located in abortion-supportive states that serve many out-of-state patients. We calculated participants’ out-of-pocket abortion-related costs (procedure, transportation, accommodation, childcare, previous appointments, missed work, and other expenses) and assessed whether these costs were financially catastrophic by applying a 40% threshold to their estimated non-subsistence monthly household income, based on published methods (Zuniga et al, 2020). Using multivariable Poisson regressions, we examined associations between traveling in-state or out-of-state for care and experiencing abortion-related costs as CHE.

Results

784 people (of 1,092 approached) completed the survey; 675 responded to the abortion-related costs questions. We found that 42% of participants experienced out-of-pocket abortion-related costs as financially catastrophic. Patients who traveled out-of-state for care were significantly more likely to experience abortion-related costs as CHE (65%, adjusted Prevalence Ratio (aPR) 2.24, 95% confidence interval (CI) 1.67-3.00) than in-state patients (32%). Individuals who resided more than 100 miles from the clinic (aPR 2.05, 95% CI 1.54-2.74) or sought abortion beyond 13 weeks’ gestation (aPR 1.80, 95% CI 1.30-2.51) were also significantly more likely to experience abortion as CHE, compared to their counterparts.

Conclusions

Out-of-pocket costs for abortion care are financially catastrophic for many abortion patients, especially those traveling out-of-state. The adverse impact on people’s financial well-being is likely exacerbated post-Dobbs v Jackson Women’s Health Organization, where more people are traveling for abortion care.