Women living below the federal poverty level are being disproportionately affected by tightening antiabortion regulations, particularly as clinics across the country have been closing in recent years.

Poor women of childbearing age are more likely than other women to have to drive more than an hour to reach the closest abortion provider, according to drive-time analysis by The Washington Post.

Poor women of childbearing age who must drive

from the closest abortion clinic.

Areas within

1 hour of an

abortion clinic

200,000

50,000

15,000

5,000

Poor women of childbearing age who must drive

from the closest abortion clinic.

Areas within

1 hour of an

abortion clinic

200,000

50,000

15,000

5,000

Poor women of childbearing age who must drive

Areas within

1 hour of an

abortion clinic

from the closest abortion clinic.

200,000

50,000

15,000

5,000

La Crosse

Lexington

Greenville

Lubbock

College Station

Laredo

Poor women of childbearing age who must drive

Areas within

1 hour of an

abortion clinic

from the closest abortion clinic.

200,000

50,000

15,000

5,000

Seattle

Grand Forks

Portland

Billings

Boise

Minneapolis

State

College

Detroit

New York

Chicago

San Francisco

D.C.

Denver

Topeka

Columbia

St. Louis

Lexington

Las Vegas

Greenville

Santa Fe

Los Angeles

Memphis

Oklahoma City

Phoenix

Atlanta

Lubbock

Dallas

Jackson

El Paso

College Station

Austin

Fairbanks

San Antonio

Houston

Tampa

Anchorage

Honolulu

Laredo

Miami

Poor women of childbearing age who must drive

Areas within

1 hour of an

abortion clinic

from the closest abortion clinic.

200,000

50,000

15,000

5,000

Seattle

Portland

Billings

Boise

Minneapolis

Detroit

New York

South

Bend

Chicago

San Francisco

D.C.

Denver

Columbia

St. Louis

Lexington

Las Vegas

Greenville

Santa Fe

Los Angeles

Memphis

Oklahoma City

Phoenix

Atlanta

Lubbock

Dallas

Jackson

El Paso

College Station

Austin

Fairbanks

Houston

Lafayette

Tampa

Anchorage

Laredo

Honolulu

Miami

Research shows that women below the poverty level account for about half of the abortions in the United States.

What’s more, a majority of the 2.5 million women below the poverty limit who must drive farther are also subject to state laws that require at least two days to get a procedure, so two trips — or an overnight stay — are needed.

The cumulative effect of greater need, longer drives and extra days raises the question of whether the restrictions rise to the level of “undue burden” that the U.S. Supreme Court has said cannot be imposed on women exercising what the court has ruled a constitutional right to an abortion.

“Being low income comes with even greater challenges,” said Ushma Upadhyay, a researcher at Advancing New Standards in Reproductive Health located at the University of California at San Francisco.

“Many poor women don’t have a car,” she said. “They don’t have money for gas. They don’t have money for buses or trains. That also means time off of work, which is an even greater burden for lower-income women.”

In upholding Roe v. Wade, the Supreme Court has allowed state restrictions on abortion as long as they do not constitute an “undue burden.” The question of burden, however, may be very different for women in poverty. Access is consistently more difficult for poor women, with the divide more pronounced in regions where access is already most restricted.

In nine states, a majority of poor women of reproductive age live more than an hour from the nearest facility, either in their state or a neighboring one.

In 14 states, the travel burden is greater because abortion regulations require multiple visits over more than one day, according to data from the Guttmacher Institute. A majority of the poor women who must drive more than an hour to a clinic live in those states.

Share of women in poverty more

than an hour away from a clinic

0%

10%

30%

50%

87%

Wyoming

(highest)

States that require

multiple clinic visits

NH

WA

VT

ME

MT

ND

MN

OR

MA

ID

NY

SD

WI

RI

WY

MI

CT

PA

IA

NE

NJ

NV

OH

IN

IL

UT

DE

CO

WV

CA

VA

KS

MO

MD

KY

NC

TN

OK

AZ

AR

NM

SC

AL

GA

MS

LA

TX

AK

FL

HI

Share of women in poverty

more than an hour away from a clinic

0%

10%

30%

50%

87%

Wyoming

(highest)

States that require

multiple clinic visits

NH

WA

VT

ME

MT

ND

MN

OR

MA

ID

WI

NY

SD

RI

WY

MI

CT

PA

IA

NE

NJ

NV

OH

IN

IL

UT

DE

CO

WV

CA

VA

KS

MO

MD

KY

NC

TN

OK

AZ

AR

NM

SC

AL

GA

MS

LA

TX

AK

FL

HI

Share of women in poverty more than an hour away from a clinic

87% Wyoming

(highest)

0%

10%

30%

50%

States that require multiple clinic visits

NH

WA

VT

ME

MT

ND

OR

MN

MA

ID

WI

NY

SD

RI

WY

MI

CT

PA

IA

NJ

NE

NV

OH

IN

IL

DE

UT

CO

WV

CA

VA

MD

KS

MO

KY

NC

TN

OK

AZ

AR

NM

SC

AL

GA

MS

LA

TX

AK

FL

HI

Share of women in poverty more than an hour away from a clinic

87% Wyoming (highest)

0%

10%

30%

50%

States that require multiple clinic visits

NH

WA

VT

ME

MT

ND

OR

MN

MA

ID

WI

NY

SD

RI

WY

MI

CT

PA

IA

NJ

NE

NV

OH

IN

IL

DE

UT

CO

WV

CA

VA

MD

KS

MO

KY

NC

TN

OK

AZ

AR

NM

SC

AL

GA

MS

LA

TX

AK

FL

HI

Missouri, which has some of the worst drive-times for poor women and also requires multiple visits, may soon lose it’s only open clinic if a dispute over licensing is not resolved. Even with that clinic operational, Missouri already has the greatest drive time disparity between poor and non-poor women. Fifty-five percent of women below the poverty level live more than an hour’s drive away, while 42 percent of non-poor women do.

The Post found that nationwide there were a total of 11 million women ages 15 to 44, or 18 percent, who had to drive more than an hour to get to a clinic, according to the latest data. That compares with 2.5 million, or 22 percent, of women in poverty who have to drive more than one hour.

Those differences among women in poverty and those who are not vary greatly across the country. Access is consistently better in the Northeast and Southwest, and more difficult in the Midwest and Plains states and in the South. In each region, women in poverty are more likely to have to drive farther.

Regional differences in percentage of poor and non-poor women who are more than an hour from a clinic

Less than

1 hour away

More than

1 hour away

Northeast

Poor: 8%

Non-poor: 6%

Southwest

9%

6%

Northwest

17%

14%

midwest & plains

28%

25%

South

31%

24%

Regional differences in drive times for poor and non-poor women

Northeast

Southwest

Northwest

midwest & plains

South

31%

28%

More than

1 hour away

25%

24%

17%

14%

8%

9%

6%

6%

Less than

1 hour away

Poor women

Non-poor women

Share of women in poverty more than an hour away from a clinic

 

Regional differences in drive times for poor and non-poor women

Northeast

Southwest

Northwest

Midwest & plains

South

31%

28%

25%

More than

1 hour away

24%

17%

14%

8%

9%

6%

6%

Less than

1 hour away

Poor women

Non-poor women

Regionally, the greatest disparity in access is in the South, where almost 1 in 3 poor women have to drive more than an hour, while less than 1 in 4 non-poor women have to drive that far. In the Midwest and Plains, a greater share of women overall have to drive farther because of greater open spaces. Outside the contiguous states, in Alaska, 45 percent of poor women have to drive an hour each way, and in Hawaii, 38 percent do.

Activists trying to eliminate abortion say poor women are being exploited by abortion providers and benefit when laws dissuade them.

“Life is life whether you’re rich or poor,” said Arkansas state Sen. Jason Rapert (R), who described meeting the adoptive parents of a boy who was born after extra counseling requirements stopped a woman from having an abortion. “This is not a rhetorical, theoretical discussion for me. It is truly life.”

Advocates for access say that laws that make it harder to get to clinics and counseling requirements that delay procedures are not just a deterrent, they also affect patient safety for a woman seeking an abortion.

“Pushing out the time increases the complication rate,” said Upadhyay, the California researcher. “It’s in the woman’s interest to have the abortion sooner. Poor women should be able to have the children they want with the timing they want. All women should have access to abortion care, including low-income women.”

Methodology: Analysis used 2018 list of providers from researcher Ushma Upadhyay at Advancing New Standards in Reproductive Health at the University of California San Francisco. The analysis measured the time to the nearest facility, regardless of state boundaries. Drive time analysis done with ESRI ArcGIS Online. Age, gender and poverty demographics from Census Bureau American Community Survey tract-level table B17001 for 2013-2017. Drive time was calculated from Zip code of clinic to center of census tract. Map shows populations aggregated up from tract to contiguous portions of county that are closer or farther than an hour from a clinic. Information on women who receive abortions and laws requiring multiple visits from Guttmacher Institute. All figures cited are for women of reproductive age between 15 and 44.

Lauren Tierney contributed to this report.