Abortion services in rural Washington State, 1983-1984 to 1993-1994: availability and outcomes.
BACKGROUND
Fewer rural health providers offer abortion services than a decade ago. It is unknown how the reduction in service availability has affected women's pregnancy outcomes, the extent to which they must travel to obtain an abortion or whether abortions are delayed as a result.


METHODS
Population, birth and fetal death data, as well as pregnancy termination reports, obtained from Washington State were used to calculate abortion rates and ratios and birthrates for Washington residents in 1983-1984 and in 1993-1994. Residence of abortion patients was classified by county only, and location of providers was recorded as large urban county, small urban county, large rural county or small rural county. Distances that women traveled to obtain an abortion were calculated. Chi-square tests were used to compare urban and rural rates and ratios within time periods, and to compare changes that occurred between time periods.


RESULTS
Birthrates and abortion rates decreased for both rural and urban Washington women between 1983-1984 and 1993-1994, but the magnitude of the decrease was greater for rural women. The rural abortion rate fell 27%, from 14.9 abortions per 1,000 women to 10.9 per 1,000, while the urban rate dropped 17%, from 21.8 to 18.2 per 1,000. The decline in the abortion rate was larger for adolescents than it was for other age-groups. In rural areas, the abortion rate decreased from 16.5 per 1,000 adolescents aged 10-19 in 1983-1984 to 10.8 per 1,000 in 1993-1994, while it declined from 23.3 per 1,000 to 16.9 per 1,000 in urban areas. From the earlier to the later time period, rural women traveled on average 12 miles farther each way to obtain an abortion, and the proportion who obtained the procedure in a rural county decreased from 25% to 3%. In the earlier time period, 62% of rural women traveled 50 miles or more to obtain an abortion, compared with 73% in 1993-1994. From 1983-1984 to 1993-1994, the proportion of rural women who traveled out of state for an abortion increased from 8% to 14%. The proportion of rural women terminating their pregnancy after the first trimester increased from 8% in 1983-1984 to 15% in 1993-1994.


CONCLUSIONS
Rural Washington women are traveling farther and more often to urban and out-of-state locations for abortion services, and are obtaining their abortions at a later gestational age, which is associated with a decade-long decline in the number of abortion providers.
Dobie
S A
SA
Department of Family Medicine, University of Washington School of Medicine, Seattle, USA.
Hart
L G
LG
Glusker
A
A
Madigan
D
D
Larson
E H
EH
Rosenblatt
R A
RA
D000029:Abortion, Legal / Q000706:statistics & numerical data / Q000639:trends*; D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D002648:Child; D005260:Female; D005865:Gestational Age; D006297:Health Services Accessibility / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D019035:Rural Health Services / Q000706:statistics & numerical data / Q000639:trends*; D014195:Travel; D019037:Urban Health Services / Q000706:statistics & numerical data / Q000639:trends; D014861:Washington