Home > Burns My Shorts, Naming Experience, Race Matters, Resources, That's So Class-y, Why Aren't You Reading This? > How Many U.S. Counties Today Provide Abortion Services?

How Many U.S. Counties Today Provide Abortion Services?

I’m visiting with mom this week, taking her to a number of doctor appointments and dealing with some minor medical issues. No time for stuff I promised you like the second post on Chapter 1 of The Gender Knot.
So what I want you to do, to pass the time while you wait for me to show up again, especially those of you who consider yourselves to be white, is go and read this: Shinin’ the Lite on White Privilege. I promise it will shake up your thinking. It sure made me look differently on my experience as a beneficiary of the land-grant university system. See if you can figure out why, also if you can pick out the answer to the blog post question.
If you are too frickin’ lazy to click and read, here’s a take home message:

…when oppressed whites protest against their own oppression, while refusing to simultaneously challenge racial oppression and white privilege, they can win short term victories (a union, legislative reform, a constitutional amendment, etc.) But when they organize in this way, they themselves become oppressors of people of color. Their silence is consent to racial oppression and white privilege.
And they sacrifice the possibilities for building coalitions with activists of color which could challenge the power of the descendants of the slave owners — the capitalist power which oppresses all of us today.

But you cannot possibly understand the real meaning and import of that quote without reading the full text of the link I provide above. So I urge you to click and read. Then come back here and discuss if you like.

  1. June 4, 2009 at 10:00 am

    I think the figure on the website is out of date, my 2007-2009 “managing contraception” handbook (by Mimi Zieman) says the figure has risen to 87% of counties w/out abortion services. It also says 47% of women in the US have had 1 or more elective abortions.

  2. becca
    June 4, 2009 at 12:23 pm

    I think the 87% is a 2001 figure (Henshaw SK, Finer LB. The accessibility of abortion services in the United States, 2001. Perspect Sex Reprod Health. Jan-Feb 2003;35(1):16-24.)
    Possibly it hasn’t changed since then, but I wouldn’t count on it.
    My gut-intuition guess was 93% though. But then, this *is* Pennsyltucky.
    I felt a compulsive need to fact check after the statement about “toxics and cancer” (*shudder*).
    Also, if you find benefiting from land-grants creepy, just think of how the Stanford, Rockefeller or Carnegie fortunes were amassed and all the universities that benefited from those. Really, perhaps Gates and the exploitation of the poor geeky classes by thievery of intellectual property (with the ultimate beneficiaries being struggling K-12 schools and kids with malaria) truly *is* progress. Unless there’s a pernicious self-interest in such philanthropy akin to setting up universities as justification for the inequalities in the system to provide the illusion of a meritocracy?
    /extreme cynicism

  3. June 4, 2009 at 12:25 pm

    Thanks for the link Zuska. A lot of stuff I’ve heard before but certainly bears repeating.
    One point I found interesting because I hadn’t thought about it in that context before:
    Colonial rulers used the existence of these privileges to convince poor white people that the little they had was due to their racial superiority, rather than to preferential treatment combined with hard work. The impact of white privilege on white people’s daily lives reinforced the ideology of white arrogance and “legitimized” their dehumanization of people of color.
    It seems so obvious now that I read it, but I guess I was just previously assuming that white privilege originated as a function of being able to own non-white slaves. I hadn’t previously considered the position and privilege granted to lower-class white people within that dynamic as it emerged, and how that privilege helped to perpetuate white privilege as we know it today.

  4. D. C. Sessions
    June 4, 2009 at 3:57 pm

    Perhaps someone could enlighten a rustic Westerner, but wrt the 87%:
    How does “counties” map into “greater than XX miles away from” in this case? Around here, a “county” covers more land than several Eastern States, so if (for instance) Graham County doesn’t have something the people who live there are in for a serious trip. In contrast, I know that the common Eastern “county” covers less area than some of our ZIP codes.
    A low proportion of covered counties in that case could either indicate “nothing within a day’s drive” or “a half-hour away in the next county.” It’s just not a very useful metric, so I’d love to see something more appropriate. (And suspect that it’s not readily available.)

  5. June 4, 2009 at 7:43 pm

    Alas D.C., to the minimal extent of my knowledge, not available.
    I suspect that some small part of the issue is completely aside from prochoice/pro life considerations. In rural michigan, there are counties with no ob/gyn doctors at all. I suspect (without confirmation) that the same can be said for some in rural ohio or indiana. While not having an ob/gyn does not technically stop one from having an abortion (some surgeons, and I’ve heard, some family practioners learn the technique as well), it certainly makes it much much less likely.

  6. June 4, 2009 at 7:47 pm

    I should add that I have no proof of the OB/GYN doctors numbers, merely heard it from a grad student doing some research in that area.

  7. June 4, 2009 at 7:52 pm

    This is the source for the 87% of counties number:
    Jones RK et al., Abortion in the United States: incidence and access to services, 2005, Perspectives on Sexual and Reproductive Health, 2008, 40(1):6–16. (pdf)
    It doesn’t break down the numbers by zip code, but it does give more details on a state-by-state basis. It includes the percentage of women aged 15-44 who live in counties with no provider – 35% overall, but with great variation (0%-96%). They do address the distance issue:

    Nonhospital providers estimate that 8% of their clients travel more than 100 miles to access abortion services, 19% travel 50–100 miles and 73% travel less than 50 miles. These figures are comparable to those for 2001. Providers in the Northeast report women traveling the shortest distances; only 3% of clients were estimated to travel more than 100 miles, and 86% less than 50 miles. Women in the South and the Midwest have to travel the farthest: Providers estimate that 10% and 9% of clients, respectively, travel more than 100 miles to access services. Finally, providers in the West estimate that 5% of clients travel 100 or more miles to obtain services, and 18% travel 50–100 miles.

    Notice that’s “of their clients”, so it obviously doesn’t include women who couldn’t make the trip. I don’t think of 100 miles as being that far, but I’m privileged to have a car, have time to travel and to live in an area where most 100 mile trips would be at freeway speeds. There are many women who simply don’t have the means to travel to a clinic.

  8. D. C. Sessions
    June 4, 2009 at 8:30 pm

    Thanks, Peggy. That’s in a form that makes a lot more sense to me than counties do.
    The 9% and 10% numbers don’t sound nearly as scary as the 87%, but then as you point out that’s a very biased denominator so it’s not a useful comparison. The availability of transportation issue is also regional; around here, no wheels means you’re grounded because there isn’t any meaningful public transportation. Ten miles is as bad as 100.
    Bottom line? As WCT points out above, access to womens’ health services sucks in lots of places, and abortion services aren’t the whole of the story.

  9. June 5, 2009 at 1:12 am

    Those 9% and 10% numbers may not sound “nearly as scary” if, perhaps, you do not possess ovaries and uterus, and have never had to worry about unwanted pregnancies. Sure, they aren’t as terrible as 87% of women having to travel 100 miles, say, but they are gruesome numbers, and Peggy makes clear why.

  10. D. C. Sessions
    June 5, 2009 at 8:13 am

    Those 9% and 10% numbers may not sound “nearly as scary” if, perhaps, you do not possess ovaries and uterus, and have never had to worry about unwanted pregnancies.

    Zuska, there’s no need to go ad hominem on this one — I’m agreeing with you. If the question were any other, such as “counties without a hospital” vs. “travel time to a hospital” the comparison would stack up the same.
    It’s just bad data, in the sense of “poor instrumentation of an obviously bad problem.” Not, “made-up problem with data doctored to make it look bad.” Better data would take away one of the denialist excuses.

  11. June 5, 2009 at 7:59 pm

    What, exactly, is ad hominem in what I said?

  12. D. C. Sessions
    June 5, 2009 at 8:39 pm

    What, exactly, is ad hominem in what I said?

    What I wrote above either has merit or not, regardless of my internal plumbing.
    The availability of medical care in the USA has serious uglies. Some (like the distance to definitive emergency care) is scary for the major stakes involved; some is ugly for what it tells us about the process for allocating resources. The lack of nearby abortion services is bad, but the “bad” that it is is colored by whether abortion services stand out in the “lack” department. When the nearest abortion services are two hours away, the take-away message is somewhat different depending on whether:
    * they’re being provided by the nearest doctor, period
    * they’re being provided by the nearest GYN despite plenty of other specialists nearby
    * They’re being provided by the nearest abortion provider despite lots of GYNs in the neighborhood.
    Each of those cases illustrates a different social pathology. All three are tragically common in the US today, but telling them apart is important for several reasons. Obviously, it helps to know the nature of the problem in planning the fix but also, as I mentioned, it’s a good idea to know what the opposition is going to be using against you.
    You have no particular reason to trust me on any of this (and I don’t see why trust should enter into it, for that matter) — but I would appreciate it if you would take the words as written rather than attempting to deduce my thoughts.

  13. Peggy
    June 6, 2009 at 6:13 pm

    The lack of nearby abortion services is bad, but the “bad” that it is is colored by whether abortion services stand out in the “lack” department.
    […]
    * they’re being provided by the nearest doctor, period
    * they’re being provided by the nearest GYN despite plenty of other specialists nearby
    * They’re being provided by the nearest abortion provider despite lots of GYNs in the neighborhood.

    Your first hypothetical is pretty unlikely, since I’m pretty sure that more than 13% of US counties have doctors or medical facilities. And in some states (like
    If you look at the report I linked to, there are 381 specialized abortion clinics in the US, and those perform 65% of the abortions. As it says “many hospitals provide abortions only in cases of fetal anomaly or serious risk to the woman’s health”. And there are only 367 physicians’ offices in the US that provide abortions at all – and those that do, don’t perform many (only 2% of the total).
    Many Americans lack easy access to general medical care, but the fact is that abortion services do stand out in the “lack” department.
    You also need to factor in that many states have mandatory 24 hr+ waiting periods for abortions after the initial consult. That means that a woman seeking an abortion may not only may have to travel more than 100 miles, she may have to make the trip more than once. The strategy seems pretty clear: make abortions so inconvenient that women won’t have them, at least not legally.

  14. D. C. Sessions
    June 6, 2009 at 8:00 pm

    Many Americans lack easy access to general medical care, but the fact is that abortion services do stand out in the “lack” department.
    You also need to factor in that many states have mandatory 24 hr+ waiting periods for abortions after the initial consult. That means that a woman seeking an abortion may not only may have to travel more than 100 miles, she may have to make the trip more than once. The strategy seems pretty clear: make abortions so inconvenient that women won’t have them, at least not legally.

    Which would be a set of facts supporting what you and I both know to be true: that the lack of abortion services is due at least in part to “enemy action.” However, as WCT pointed out above, there are also areas where the nearest physician of any kind is hours away (I spend a lot of time on the Navajo and White Mountain Apache reservations. This isn’t speculative.) The first order of business there would be to get medical services, period — for lots of reasons, but also including the fact that it’s a practical prerequisite to abortion services.
    What we don’t want to do, for tactical reasons if nothing else, is assume that the problem in the remoter parts of the Southwest as though they were due to enemy action like downtown Wichita. Different problems, different approaches.

  15. June 7, 2009 at 3:51 am

    It’s important to consider these as two separate problems.
    1) As a healthcare system, we have huuuuge underserved areas. Period. Women’s health, separate from abortion, is among the areas that is severely underserved. The fact is that the incentives we med students see make us lean away from rural practices, inner city practices, and primary care practices. This correlates well to D.C.’s first two comments.
    Please note, it’s not a hypothetical. It is the case that some women have limited access to women’s services. Noone is claiming that this is the majority of women. Just that they exist.
    2) A vocal minority have, through a variety of political, very unethical tricks, managed to severely reduce our ability to provide abortion services. This is D.C.’s 3rd situation.
    I suspect if we ran the numbers, 2 is preventing far more women from receiving abortions. This doesn’t mean they aren’t both important problems.
    I hope noone is claiming that lack of healthcare access isn’t a problem. Because it is. It’s generally a huge problem.
    This doesn’t mean that 2 isn’t a problem. It is, and I’d say the evidence points to it being a bigger problem.
    It’s just important to separate the two when we discuss these issues, because the solutions to 1 won’t be solutions to 2, and vice verse.
    We all have a tendency to point to these numbers and declare them all or nothing situations with one cause. In healthcare, the causes are generally multifactorial. Let’s not oversimplify the issue.
    Many americans lack access to healthcare, and women’s services stand out among those lacks.
    Abortion stands out, even among the lack of women’s services.

  16. Isabel
    June 7, 2009 at 4:51 am

    “The privileges of whiteness were first granted by the colonial ruling class only to the poor and servant class of Europeans. Colonial rulers did not need privilege. They had power.”
    Correct. The whole white supremacy thing was a smokescreen from it’s very beginnings. Incidentally, the blacks were chosen to swing toward the ‘slave’ side while the white ‘servants’ slowly got their little privileges, for practical reasons – the blacks were easier to keep track of, eg recapture when they ran away because of their dark skin.
    “In a few generations, the institutional privileges for the white poor would wipe out the material basis for unity with oppressed Africans, as their daily lives grew further apart.”
    REALLY?? Wipe out the material basis for unity? The poor whites were doing so great were they?
    “(Bacon’s Rebellion was the last multi-racial revolt of the oppressed during the colonial era.)”
    not by coincidence. The writer seems to miss the significance of the chain of events! Even though she practically spells it out below:
    “Colonial rulers used the existence of these privileges to convince poor white people that the little they had was due to their racial superiority, rather than to preferential treatment combined with hard work.”
    Wow the preferential treatment those poor whites were getting sounds better and better all the time! If we just keep calling oppression, exploitation and abject poverty “privilege” over and over and over, it will start to sound like a good thing. And it will color all treatment of poor white people as some sort of positive; here’s the writer on the pathetic stories of her own Russian grandparents:
    “My mother’s father worked in a shoe factory. He worked under unsafe conditions, and eventually suffocated from asthma caused by leather dust. But at the turn of the century, the Massachusetts shoe industry was booming. The leather came from the South West on railroads built by Chinese and Mexican laborers. The cows were herded by Mexicano vaqueros who had been robbed of their historical lands after the Treaty of Guadelupe Hidalgo transformed half of Mexico into “Occupied America.” And so my maternal grandparents became the direct beneficiaries of the U.S. colonial war against Mexico, and the national oppression of Chicano people. ”
    She concludes
    “In summary…the complementary systems of white privilege and racial oppression maintain the system of white power for ruling class whites. ”
    This should read The illusion of white privilege and racial oppression maintains the system of power for ruling class whites. In other words as long as we are focused on race, we are not paying attention to class. It worked in Virginia, and it’s working now.

  17. becca
    June 11, 2009 at 6:57 pm

    On the note Isabel established:
    “”Affirmative action was designed to keep women and minorities in competition with each other to distract us while white dudes inject AIDS into our chicken nuggets.”

  18. Isabel
    June 12, 2009 at 2:40 am

    I don’t get it, I guess you are mocking me. Whatever. My point is reality and history are way more complicated than we pretend. We like things in neat, easy to understand compartments. White people bad, come to america, kill all the red people, need workers so go kidnap some black people and make them build the country.
    The article Zuska links to is so filled with lies and distortions I couldn’t even begin to address them all.
    The overall point is worthy, that exploited people need to join forces. But without realization of the true history, and with the internalized prejudices resulting from the above just so story, this idea will go nowhere.
    What we have now are upper middle class, at least 50% Jewish and the rest mostly atheist, white activists sympathetically trying to reach out to “people of color” while simultaneously ignoring, mocking, and blaming everything on the poor and lower middle class whites, who have little power and who have to do the actual economic competing with the “people of color” and who are alienated by the christian-hating elitist upper class whites.
    Just as we need to look at the roots and structure of the patriarchy, we need to look at the real way the US was built and that is a totally different story than the popular just so story.
    But scapegoating feels so good doesn’t it?

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