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If you or someone you knew needed an abortion, where would you go?

Ideally, you’d find an abortion provider nearby, schedule your appointment, and get your care. But in Massachusetts, a state known for having among the best health care in the world, abortion deserts create insurmountable hurdles.

Many people who live on the Cape and Islands live in an abortion desert — an area where the nearest abortion provider is 100 or more miles away. Residents of the Cape & Islands often have to travel great distances to access basic care, and that barrier is compounded when they are seeking time-sensitive, stigmatized care. This abortion desert has the harshest effects on those already struggling to make ends meet.  On the Cape and Islands, those who are seasonal workers, tipped workers, uncontracted workers, or people with low incomes are less likely to be able to afford the costs and take time off of work for an unforeseen trip. 

If traveling 100 miles one way sounds like a reasonable trip to access for health care, let’s play out what that travel distance actually looks like.

If you have a driver’s license and access to a car, you could drive up to the nearest abortion provider. Here’s what that looks like:

  • Two hours or more to drive a hundred miles, especially if you might hit traffic,

  • $18 to $20 in gas round trip assuming average gas mileage, around 25 miles to a gallon, with February 2021 gas prices on the Cape (around $2.29/gallon),

  • Finding and paying for parking: $2 to $3 if you park on the street for two hours, $15-30 for a parking garage,

  • Meals: you can pack a meal or buy one when you arrive (anywhere from $10 to $50 to more),

  • Child care: If you already have a child at home, you’ll have to pay for a babysitter or an extra day at daycare, which can easily add up to $50 to $100. 

A four-hour round trip, plus the time spent with your provider, means you’ll miss a full day of work or school, have to find child care, and spend $40 to $50 before you’ve even paid for your appointment.

If you don’t have a driver’s license or access to a car, you may run into additional costs: 

  • Bus tickets cost $50-60 for a round trip from Hyannis to Boston in February 2021. 

  • A ferry trip from Nantucket or Martha’s Vineyard costs $39 round trip for a 2 hour and 15 minute crossing, $75 for the faster one-hour crossing.

  • If you have any sedation during an in-clinic abortion, someone else has to accompany you, as is standard practice for medical procedures involving any level of sedation. So two bus tickets — $100 to $120 — and two ferry tickets — $80 to $150. 

  • Some abortion procedures happen over two days, so you either have to make two round trips in two days ($250 in bus tickets) or stay overnight at a hotel ($100 to $300).

  • Meals while you’re away from home — anywhere from $10 to $50, double for two people

  • Someone to watch your child, if you already have one, and the cost of child care

Each one of these logistics in traveling even for a day means that the distance to an abortion provider can be a serious, even prohibitive barrier to care. 

Whether or not someone can get an abortion should never depend on where they live or how much money they make, but all too often, it does. So what’s the solution? 

Telehealth can help connect people with providers from a distance. Patients should be able to get medication abortion at a nearby pharmacy, without being required to travel or risk their health. Researchers are studying the feasibility of expanding access to medication abortion through the mail, which is currently only available through their study. This would involve all the same steps and procedures as in-person medication abortion but without the burden of traveling to a distant health center. There are other solutions, too: more abortion providers, not only in abortion clinics but also at OB/GYN offices and reproductive health care departments; better public transportation infrastructure so that people don’t have to depend on cars; and more education and less stigma around abortion. Abortion is health care, and everyone should be able to get the care they need.

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Tags: Massachusetts, Abortion, abortion access, desert, provider