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Abortion after-care costs driven up by scarcity of nearby clinics, new study finds

The Red River Women's Clinic is pictured in downtown Fargo, North Dakota in this file photo taken July 2, 2013. The North Dakota Supreme Court upheld on Tuesday a state law that restricts medication abortion, saying it was constitutional. The Red River clinic, North Dakota's only abortion provider, has said they have stopped providing medication abortions effective immediately, according to news reports. REUTERS/Dan Koeck/Files

The absence of a nearby abortion clinic drives up healthcare costs, a study of California's poor has found.

Women who seek follow-up care but who don’t have a local clinic often feel compelled go to an emergency room to confirm that their pregnancy is over, a practice that typically increases the abortion bill by 76 percent.

More clinics in rural, underserved areas and better alternatives for follow-up care - such as consultations via phone, video or the internet - could dramatically reduce that extra expense, said the team, lead by Dr. Ushma Upadhyay of the University of California, San Francisco.

The risks associated with abortion may be low, Upadhyay told Reuters Health by phone, but the need by some women to seek care after the procedure reflects "wanting to have someone to talk to about their symptoms and not being sure if it was successful. They want to get reassurance, if they're experiencing cramping and bleeding, that those are normal side effects after an abortion. Some women are unsure how much bleeding is normal and how much is a warning sign."

The study, released by the journal Obstetrics and Gynecology, comes at a time when state efforts to block abortion, combined with more-effective long-term birth control, have dramatically reduced the number of abortion clinics in the United States, with states such as Mississippi, Missouri, Wyoming and North and South Dakota each having only a single facility.

Not only does the requirement to travel long distances pose practical problems that make it harder to arrange for the procedure," Dr. Upadhyay said, it can potentially reduce the quality of any after-procedure treatment as well.

"If they need follow-up care, they are seeking it from local hospitals that might not be familiar with signs and symptoms of abortion, so there's less continuity of care for those women," she said.

The result could be unnecessary prescribing of antibiotics or an unwarranted attempt to redo the abortion, the team said.

To gauge the effect of travel time when women are seeking after-abortion care, usually to confirm that the procedure was successful, the Upadhyay team looked at data on nearly 40,000 abortions in 2011 and 2012 covered by California's Medicaid program for the poor.

Women who had to travel at least 100 minutes to a clinic were 2.3 times more likely to show up at an emergency department for follow-up care than women who lived within 25 miles of a clinic. The trend was seen whether or not they received a conventional aspiration abortion or a drug-induced abortion.

The median cost to Medicaid for the emergency department visit: $941. The cost was $536 if the woman went back to the clinic.

Among all abortion recipients, only 3 percent ended up in the emergency department and 25 percent went back to the clinic. In most cases, the return visit was made by women who had been given an abortion pill and they wanted to confirm that the pill had done its work.

Upadhyay, an associate professor of obstetrics, gynecology and reproductive sciences at UCSF, said the ability to have video or phone conferencing with a clinic should help reduce the need for those follow-up visits.

"I think we would see emergency department visits decline if patients could get their follow-up questions taken care of," she said.

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