Accessibility of Pregnancy Termination: A Pilot Study of Genetic Counselors and Abortion Providers Throughout the United States

Recent literature suggests that availability and accessibility of pregnancy termination services affects patient care and decision-making. Because of this, there is a need to evaluate the impact of new legislation on accessibility. This study evaluated the accessibility of pregnancy termination throughout the United States by surveying prenatal genetic counselors and abortion providers. 116 responses from currently practicing prenatal genetic counselors and 30 responses from abortion providers within the United States were used in data analysis. Accessibility of pregnancy termination was assessed using the variables of cost, time, and distance. The degree of legislative impact was estimated using Guttmacher Institute’s Policy Trends in the States 2017, which categorizes states into four regions: supportive, middle-ground, hostile, and extremely hostile, based on the number of abortion restrictions enacted. Overall, the findings show some evidence indicating that access to abortion is more limited in states with increased legislation. Genetic counselors in hostile states were more likely to refer patients to outside providers at every evaluated gestational age range than counselors in supportive states, with 89.9% of counselors referring to providers greater than 4 hours away for referrals over 24 weeks gestation compared to 56.5% in supportive states. Counselors in hostile states were also more likely to report factors such as insurance coverage, out of pocket costs, wait times, travel, and the availability of appointments as having an impact on patients’ decisions to terminate a pregnancy than counselors in supportive states