Evidence map›Paper›PMID 39514227›Full record

ArticleJAMA network open2024

Catastrophic Health Expenditures for In-State and Out-of-State Abortion Care.

Ortal Wasser, Lauren J Ralph, Shelly Kaller, M Antonia Biggs

Abstract read
In one paragraph

Article in JAMA network open, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed.

  1. Article
  2. Article
  3. Observational
  4. Article
  5. Article
  6. Article
  7. Review
  8. The harms of imposing barriers to abortion care on people's psychological well-being.World psychiatry : official journal of the World Psychiatric Association (WPA) · 2025
    Article
  9. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Ortal WasserSilver School of Social Work, New York University, New York.
Lauren J RalphAdvancing New Standards in Reproductive Health, University of California San Francisco, Oakland.
Shelly KallerAdvancing New Standards in Reproductive Health, University of California San Francisco, Oakland.
M Antonia BiggsAdvancing New Standards in Reproductive Health, University of California San Francisco, Oakland.

Funding

Engaging University of California Stakeholders for Biorespository ResearchUL1TR000004 · NCATS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI GRANDIS, JENNIFER RUBIN · 2012 to 2015
$78.0M
UCSF/Kaiser-DOR Program for Developing Independent Women's Health ResearchersK12HD052163 · NICHD · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI ADLER, NANCY E, BRINDIS, CLAIRE D. · 2005 to 2023
$9.3M
NCATS NIH HHS UL1 TR000004NICHD NIH HHS K12 HD052163
6 · The paper itself

Abstract

Importance: Most US individuals who access abortion care pay out of pocket due to insurance coverage restrictions on abortion. More research is needed on the financial and psychological burdens of abortion seeking, particularly for those traveling across state lines for care. Objectives: To estimate the proportion of patients seeking abortion who incur abortion-related catastrophic health expenditures (CHEs), assess whether CHE differs between those seeking care in state vs out of state, and examine the association of CHE with mental health symptoms. Design, Setting, and Participants: In this cross-sectional study conducted before the Dobbs v Jackson Women's Health Organization decision, surveys were administered between January and June 2019 among individuals aged 15 to 45 years seeking abortion in 4 clinics located in abortion-supportive states (California, Illinois, and New Mexico). Participants completed self-administered questionnaires while awaiting their abortion appointment. Analyses were conducted from November 2023 to April 2024. Exposure: Travel for abortion care, categorized as either out of state or in state based on participants' state of residence and the clinic location. Main Outcomes and Measures: Self-reported abortion care costs and additional non-health care costs (eg, transportation, accommodation, and missed work), which were considered catastrophic if they were 40% or greater of participants' ability to pay (defined as monthly income remaining after meeting subsistence needs). Multivariable regression analyses were conducted to examine associations between CHE, out-of-state travel for abortion care, and mental health symptoms including stress, anxiety, and depression. Results: Among the 675 participants included in the analytic sample, mean (SD) age was 27.33 (6.27) years; most were in their 20s (374 [55%]), and all but 196 (29%) sought abortion before or at 12 weeks' gestation. A total of 285 participants (42%) were estimated to incur abortion-related CHEs, which was associated with anxiety (APR, 1.13; 95% CI, 1.07-1.19) and depression (APR, 1.25; 95% CI, 1.12-1.39). Of people traveling from out of state (212 [31%]), more were likely to incur CHEs (138 [65%]) compared with those seeking care in state (147 of 463 [32%]) (APR, 2.24; 95% CI, 1.67-3.00). Conclusions and Relevance: In this cross-sectional study of US patients seeking abortion, many individuals and their households were estimated to incur CHEs, particularly those traveling from out of state. The financial and psychological burdens of abortion seeking have likely worsened after the Dobbs decision, as more people need to cross state lines to reach abortion care. The findings suggest expansion of insurance coverage to ensure equitable access to abortion care, irrespective of people's state of residence, is needed.

Indexed as

Abortion, InducedHealth ExpendituresAdolescentAdultCaliforniaCross-Sectional StudiesDepressionFemaleHealth Services AccessibilityHumansIllinoisInsurance CoverageMiddle AgedNew MexicoPregnancyUnited States

Identifiers

PMID39514227
PMCPMC11549660

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.