Barriers to Abortion Access for Young Southerners: A Qualitative Analysis of Case Notes from ARC-Southeast Open Access

Abstract

Restrictive abortion laws in Southeastern U.S. states increasingly obstruct access to abortion for young people. Abortion funds have intervened to ensure young people can access safe, compassionate abortion care. Access Reproductive Care-Southeast (ARC-Southeast) is an abortion fund providing financial and logistical support for abortion services in the Southeast. An estimated 1 in 10 of the organization’s cases are people under the age of 22 years. Therefore, analysis of ARC-Southeast's Healthline data offers an opportunity to address a gap in the literature for understanding youth experiences seeking abortion in the Southeast region. We seek to identify barriers and understand youth experiences with abortion fund support for abortion care from ARC-Southeast.

The research team extracted a dataset containing demographic information and case notes managed by ARC-Southeast from cases involving people ages 21 and under who resided in six Southeastern states (Alabama, Florida, Georgia, Mississippi, Tennessee, and South Carolina) and who contacted the Healthline between May 2016 and May 2021 (n=2,278). A qualitative analysis of case notes managed by ARC-Southeast was designed to describe the barriers to access which impede the lives of youth seeking abortion fund support from ARC-Southeast between 2016 and 2021.

The secondary data analysis revealed young Southerners encounter a multitude of barriers to abortion access in the Southeast, within four primary categories: structural barriers, financial barriers, personal barriers, and COVID-19 pandemic. The analysis also exposed common experiences and barriers to abortion access for youth seeking abortion care support which are scarcely documented in abortion access literature, such as the consequences of pre- existing conditions, intimate partner violence, and immigration status. To address these challenges, possible recommendations include engaging young Southerners in a full range of intersectional care and urging legislators in the South to repeal restrictive abortion policy. Study findings inform abortion provision for young people in the U.S. Southeast and serve as a foundation for future research to address barriers to access abortion for young Southerners.

Table of Contents

CHAPTER 1 – INTRODUCTION 1

Introduction and Rationale 1

Problem Statement 3

Purpose Statement 3

Research Objective 3

Significance Statement 4

Definition of Terms 4

CHAPTER 2 – LITERATURE REVIEW 5

Abortion Policy in the United States 5

Supreme Court of the United States Decisions 5

Targeted Regulation of Abortion Providers Laws 7

Trigger Laws 9

Abortion Access in the U.S. Southeast 9

Structural Barriers 9

Socio-Cultural Barriers 14

Young Southerners Access to Abortion 15

Parental Involvement Laws 15

Judicial Bypass 16

Consequences of Abortion Decision 17

The Role of Abortion Funds 19

National Abortion Federation 19

National Network of Abortion Funds 20

Access Reproductive Care – Southeast 21

Reproductive Justice Framework 21

CHAPTER 3 – METHODOLOGY 23

ARC-Southeast Data Collection 23

ARC-Southeast Case Notes 24

Operationalization of Abortion Barriers for Youth 27

Methodological Limitations 29

CHAPTER III – RESULTS 30

1.     Structural Barriers 30

1.1.       Parental Involvement Laws 31

1.2.       Distance Traveled 31

1.3.       Gestational Limits 32

1.4.       Mandatory Counseling and Waiting Periods 32

1.5.       Insurance Coverage 33

1.6.       Abortion Fund Resources 33

1.7.       Family Planning Provision 35

2.     Personal Barriers 36

2.1.       Concealment 36

2.2.       Parenting 37

2.3.       Social Support 38

2.4.       Confidants 39

2.5.       Anti-Abortion 40

2.6.       Pre-existing Health Conditions 40

2.7.       Caregiver 41

2.8.       Language 41

2.9.       Immigration Status 42

2.10.     Abortion Type 42

2.11.     Violence 43

3.     Financial Barriers 44

3.1.       Student Status 44

3.2.       Employment Opportunity 45

3.3.       Rescheduling Appointments 45

3.4.       Recurrent and Unexpected Expenses 46

3.5.       Homelessness 46

4.     COVID-19 Pandemic 47

5.     Conceptual Framework: Challenges, Impacts and Opportunities 47

Conceptual Framework 49

CHAPTER 5 – DISCUSSION 50

Implications and Recommendations 54

Dismantle Restrictive Abortion Policy 54

Comprehensive Sexual and Reproductive Health 55

Intersectional Reproductive Health Care Delivery 56

Strengths 56

Limitations 57

Directions for Future Research 59

CHAPTER 6 – CONCLUSION 60

Literature Referenced 61

Appendix 69

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Women's Studies
Keyword	Sexual Health Access U.S. Southeast Abortion Reproductive Health
Committee Chair / Thesis Advisor	Roger Rochat, Emory University
Committee Members	Whitney S. Rice, Emory University

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