185037 Can second trimester abortion providers be rationally distributed?

Tuesday, October 28, 2008: 5:30 PM

Angel M. Foster, DPhil, MD, AM , Ibis Reproductive Health, Cambridge, MA
Susan Yanow, MSW , Reproductive Health Consultant, Cambridge, MA
Eduard Niesten, PhD , Conservation International, Cambridge, MA
Introduction: As the overall number of abortions has declined steadily since the early 1990s the proportion of terminations performed at or beyond 16 weeks' gestational age has remained relatively constant. These approximately 75,000 abortions are performed each year by a small and decreasing number of providers. Although providers, in general, are not evenly distributed across US regions and between metropolitan and non-metropolitan areas, evidence suggests that second trimester abortion providers are even more geographically “clustered.” However, there is currently no consensus as to the number and distribution of providers required to meet women's needs. The aim of this study is to explore the applicability of rational distribution models to second trimester abortion services.

Methods: We compare the distribution of second trimester abortion providers to providers of procedures of comparable number and complexity. We explore several rational distribution models based on factors such as population density, socioeconomic and demongraphic variables, egal constraints, training facility location, and cost.

Results: The temporal, medical, legal, economic, and training issues conditioning second trimester abortion undermine comparisons to procedures of similar volume and complexity. However, our research suggests several candidate models which may increase access to second trimester services within current legal and resource constraints.

Conclusion: Of the 1,787 facilities offering abortion services in 2005 only 20% and 8% offered services beyond 20 weeks' and at 24 weeks' gestational age respectively. Both the declining number of second trimester providers and their geographic distribution impacts access to services. Establishing evidence-based targets for the distribution of second trimester abortion providers is warranted.

Learning Objectives:
* Describe different models of rational distribution * List three factors impeding the rational distribution of second trimester providers * Recognize the importance of establishing evidence-based standards for distribution

Keywords: Abortion, Health Care Access

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an Associate at Ibis Reproductive Health where I direct a program of research dedicated to the Middle East and North Africa and lead a number of studies dedicated to abortion access and training in the US. I received my DPhil from Oxford with disciplinary training in medical anthropology and public health and I received my MD from Harvard. I have conducted national level health systems research in the Tunisia and Palestine and have conducted a number of mixed methods studies on comprehensive reproductive health issues in the US. I have authored or co-authored more than two dozen articles, book chapters and reports on reproductive health in the Middle East and the US. In the last three years I have given oral presentations at the scientific sessions of NAF, ARHP, APHA, MESA, SMA as well as at international conferences such as women deliver and the World Congress of Middle Eastern studies.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.