Rural women's access to abortion: A literature of Appalachian reproductive health needs and access

Background: Currently, there is no data directly supporting the claim that rural women have restricted access to abortion. There are grounds for this hypothesis, specifically: (1) nonhospital abortion providers estimate that 19% of their patients travel 50–100 miles, and 8% travel more than 100 miles (Jones et al, 2008); (2) women in rural areas are less likely than urban women to receive contraceptive services (Chandra et al, 2005); and (3) demographic risk factors associated with abortion at later gestation are prevalent in rural communities, specifically poverty and unintended pregnancy at younger ages (Finer et al, 2006). However, rural women's access to abortion is discussed in the current literature is uniformly assumed to be poor (Bennett, 2003). A more conservative inference is that access to abortion for rural women may be different than access to abortion for urban women. Methods: This structured literature review explores ancillary areas of research that may inform the understanding of rural women's access to abortion, focusing on Appalachian women's access to reproductive health services. Results: The infrastructure to support reproductive health care in rural communities faces similar health workforce barriers as more specialized rural health services (e.g. dental and vision). However, literature suggests that access to stigmatized services (e.g. HIV/AIDS, mental health and substance abuse) is strained. Conclusions: The intersection between specialized and stigmatized care may uniquely shape women's access to abortion in Appalachia. Data collection directly exploring rural women's experience is needed to understand and respond to access in these communities.