Rural-urban differences in clinic capacity for referrals and proximity to abortion services among Title X family planning clinics

Background

Federal statutes allow Title X providers to offer factual and nondirective options counseling to its pregnant clients, but scant published data exist on the practice of options counseling in Title X clinics.

 

Methods

Referral and proximity data were analyzed from a larger study which surveyed 558 Title X family planning clinics in 16 Great Plains and Midwestern U.S. states from June-September 2012 regarding clinic accessibility, contraceptive methods provided, and perceived barriers. Descriptive analyses were performed to examine the proportion of clinics that provided counseling on abortion and adoption services and the proximity of abortion services to clinics by rural/urban status.

 

Results

While 97% of surveyed clinics reported referring patients to adoption services upon request, 84% of clinics reported referring clients to abortion services upon request. Rural clinics were more likely than urban clinics to report the closest 1^st trimester provider (47% vs. 7%, p<0.001) and the closest 2^nd trimester provider (40% vs. 13%, p<0.001) to be located 101 or more miles away. Rural clinics were more likely than urban clinics to report not knowing where the closest 1^st trimester (15% vs. 6%, p<0.001), 2^nd trimester (38 vs. 22%, p<0.001) and medication (35% vs. 22%, p<0.001) abortion providers were located.

Conclusions: Major differences in abortion referral capacity exist by rural/urban status of Title X clinics. These findings may reflect the increasingly restrictive environment for abortion services in the Midwest. Potential interventions include: better education about abortion referral for family planning providers and telemedicine services for rural providers.