Women living below the federal poverty level are being disproportionately affected by tightening anti-abortion regulations, particularly as clinics across the country have been closing in recent years.

Poor women of childbearing age are more likely than other women to have to drive more than an hour to reach the closest abortion provider, according to drive-time analysis by The Washington Post.

Research shows that women below the poverty level account for about half of the abortions in the United States.

What’s more, a majority of the 2.5 million women below the poverty limit who must drive farther are also subject to state laws that require at least two days to get a procedure, so two trips — or an overnight stay — are needed.

The cumulative effect of greater need, longer drives and extra days raises the question of whether the restrictions rise to the level of “undue burden” that the U.S. Supreme Court has said cannot be imposed on women exercising what the court has ruled a constitutional right to an abortion.

“Being low income comes with even greater challenges,” said Ushma Upadhyay, a researcher at Advancing New Standards in Reproductive Health at the University of California San Francisco.

“Many poor women don’t have a car,” she said. “They don’t have money for gas. They don’t have money for buses or trains. That also means time off of work, which is an even greater burden for lower-income women.”

In upholding Roe v. Wade, the Supreme Court has allowed state restrictions on abortion as long as they do not constitute an “undue burden.” The question of burden, however, may be very different for women in poverty. Access is consistently more difficult for poor women, with the divide more pronounced in regions where access is already most restricted.

In nine states, a majority of poor women of reproductive age live more than an hour from the nearest facility, either in their state or a neighboring one.

In 14 states, the travel burden is greater because abortion regulations require multiple visits over more than one day, according to data from the Guttmacher Institute. A majority of the poor women who must drive more than an hour to a clinic live in those states.

Missouri, which has some of the worst drive times for poor women and also requires multiple visits, may soon lose its only open clinic if a dispute over licensing is not resolved. Even with that clinic operational, Missouri already has the greatest drive-time disparity between poor and non-poor women. Fifty-five percent of women below the poverty level live more than an hour’s drive away, while 42 percent of non-poor women do.

The Washington Post found that nationwide, there were a total of 11 million women ages 15 to 44, or 18 percent, who had to drive more than an hour to get to a clinic, according to the latest data. That compares with 2.5 million, or 22 percent, of women in poverty who have to drive more than one hour.

Those differences among women in poverty and those who are not vary greatly across the country. Access is consistently better in the Northeast and Southwest, and more difficult in the Midwest and Plains states and in the South. In each region, women in poverty are more likely to have to drive farther.

Regionally, the greatest disparity in access is in the South, where almost one in three poor women have to drive more than an hour, while fewer than one in four non-poor women have to drive that far. In the Midwest and Plains, a greater share of women overall have to drive farther because of greater open spaces. Outside the contiguous states, in Alaska, 45 percent of poor women have to drive an hour each way, and in Hawaii, 38 percent do.

Activists trying to eliminate abortion say poor women are being exploited by abortion providers and benefit when laws dissuade them.

“Life is life whether you’re rich or poor,” said Arkansas state Sen. Jason Rapert, R, who described meeting the adoptive parents of a boy who was born after extra counseling requirements stopped a woman from having an abortion. “This is not a rhetorical, theoretical discussion for me. It is truly life.”

Advocates for access say that laws that make it harder to get to clinics and counseling requirements that delay procedures are not just a deterrent, they also affect patient safety for a woman seeking an abortion.

“Pushing out the time increases the complication rate,” said Upadhyay, the California researcher. “It’s in the woman’s interest to have the abortion sooner. Poor women should be able to have the children they want with the timing they want. All women should have access to abortion care, including low-income women.”

Methodology

Analysis used 2018 list of providers from researcher Ushma Upadhyay at Advancing New Standards in Reproductive Health at the University of California San Francisco. The analysis measured the time to the nearest facility, regardless of state boundaries. Drive-time analysis done with ESRI ArcGIS Online. Age, gender and poverty demographics from Census Bureau American Community Survey tract-level table B17001 for 2013-17. Drive time was calculated from Zip code of clinic to center of census tract. Map shows populations aggregated up from tract to contiguous portions of county that are closer or farther than an hour from a clinic. Information on women who receive abortions and laws requiring multiple visits from Guttmacher Institute. All figures cited are for women of reproductive age between 15 and 44.

The Washington Post’s Lauren Tierney contributed to this report.