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Community, Health, and Family

Abortion Incidence Across the Rural-Urban Divide in Four States Shelley Clark*, Shelley Clark, Heide Jackson, Michael Rendall,

In both the pre- and post-Dobbs era, states have largely determined abortion laws creating a patchwork of more and less restrictive states across the United States. Less attention, however, has been paid to geographic divisions within states despite potentially large rural-urban differences with respect to abortion. In this paper, we examine cumulative lifetime abortion incidence of over 8,500 rural and urban women who participated in the Survey of Women (2017-2019) in four states (Alabama, Iowa, Ohio, and South Carolina). We measure lifetime abortion incidence using a double list experiment method to minimize reporting bias. Multivariate regressions are used to adjust for demographic, socioeconomic, and religious characteristics of respondents. We find that, on average, rural women in Alabama, Ohio, South Carolina are 6.2 percentage points (CI: 0.8, 12.1) less likely than urban women to have had an abortion. However, the rural-urban gap is reversed in Iowa with 11.9% (CI: 5.6, 18.2) of rural women reporting having had an abortion compared to only 5.9% (CI: 1.3, 10.5) of urban women. This unexpected finding of higher abortion incidence in rural Iowa is not explained by differences in individual characteristics, but it may reflect greater access to telehealth medication abortion. In 2008, Iowa was the first state to introduce telehealth medication abortion, which substantially increased access for women living further from urban-based abortion clinics. These findings highlight the need to examine geographic cleavages within states to understand how changing policies and new delivery methods impact abortion experiences.