Framing access to abortion care as a health disparities issue

Minority and low SES women have persistently and disproportionately higher rates of unintended pregnancy and abortion than their white and more affluent counterparts. Despite these statistics, these same populations face geographic and financial barriers to abortion care. Research has demonstrated that limited geographic and financial access to abortion services result in women who are the most vulnerable having abortions at later gestational ages, significantly increasing their medical risks. The public health response to these disparities in abortion has focused solely on decreasing the number of abortions and has not addressed this as a health disparities issue. This analysis seeks to build an understanding of how the increased need for abortion services by vulnerable populations can be understood from a health disparities perspective, and how use of this framework can build a more positive public health approach to this issue. Through a review of the research on abortion disparities, this work presents a description of the epidemiology of abortion and abortion access with respect to race/ethnicity and socioeconomic status. Through discussion of the political and public health response to these disparities, we establish the need for a health disparities framework to address abortion disparities. We propose a new public health approach that would consider multiple aspects of undesired fertility - preconception care, pregnancy prevention, contraceptive services, as well as abortion and prenatal care - as interconnected aspects of women's reproductive health care.