“Left without a choice”: Which women are most affected by abortion restrictions?

Background: Limitations on who is eligible for Medicaid and restrictions on abortion coverage in public and private insurance plans may impede many women's ability to access abortion care.

Purpose: To describe abortion providers' experiences facilitating funding for abortion care for low-income women.

Methods: We conducted over sixty semi-structured in-depth telephone interviews with abortion providers in 15states from October 2007-February 2010. Interviews were recorded and transcribed verbatim. We conducted a thematic analysis of the interviews using Atlas.ti.

Results: Providers reported that traditionally marginalized groups of women face numerous and overlapping obstacles to obtaining abortions. Undocumented immigrants, migrant workers, young women, homeless women, and sex workers who either don't qualify for Medicaid or experience gaps in their coverage have a particularly hard time accessing services due to limited financial resources and lack of access to insurance coverage. However, providers also reported that women with public or private insurance also face barriers to securing coverage for abortion care due to restrictions on abortion coverage, not being able to afford deductibles, and a desire not to use insurance to protect their privacy in circumstances such as domestic violence.

Conclusion: Delays in accessing abortion care while women work to find funding increase the cost and risks of the procedure. Continued efforts to expand public funding for abortion and remove public and private insurance restrictions on abortion are needed to ensure equitable and timely access to abortion for all women in the US.