Geospatial Analysis of Abortion Access for U.S. Servicewomen After Dobbs

OBJECTIVE: To quantify geographic accessibility to abortion services for servicewomen in the continental United States after the Dobbs v. Jackson Women's Health Organization decision.

METHODS: We extracted ZIP code of residence for 203,139 servicewomen (18-49 years of age) from the Military Health System Data Repository in December 2024. We performed point density analyses and spatiotemporal network modeling of servicewomen's locations and distance to 389 geocoded abortion clinics using ArcGIS Pro. We calculated travel times to abortion clinics by state-level legal restrictions (most restrictive, restrictive, and somewhat/protective based on the Guttmacher Institute state abortion restriction categories) and geographic region. We estimated mean driving times and the proportion of servicewomen within 30-, 60-, and 90-minute travel-time thresholds.

RESULTS: Mean driving time to the nearest clinic for the 193,029 successfully geocoded servicewomen was 164.1 minutes. More than half (55.5%) required more than 90 minutes of travel time, and 8.5% lived within 30 minutes. Mean driving time was significantly higher in the most restrictive states (381.7 minutes) compared with restrictive states (118.9 minutes, difference of means 262.8, 95% CI, 260.1-265.5) and to somewhat/protective states (68.7 minutes, difference of means 313.1, 95% CI, 310.7-315.4). Of 47,672 servicewomen stationed in most restrictive states, 99.7% required travel times exceeding 90 minutes compared with 60.1% (n=41,811) in restrictive states (odds ratio [OR 0.51], 95% CI, 0.50-0.53) and 23.5% (n=17,846) in somewhat/protective states (OR 0.27, 95% CI, 0.26-0.28). Servicewomen in Western Interior and South regions averaged almost 3 and more than 7 hours of travel time for care, respectively. Travel time exceeded 90 minutes for over 99% in the South and for the majority in the Western Interior (90.1%), East Coast (62.7%), and Midwest (54.7%).

CONCLUSION: Over half of reproductive-aged servicewomen in the continental United States face significant travel burdens to access abortion services. One-quarter reside in banned states with nearly universal geographic constraints. Current legal and policy environments create substantial structural differences that may affect servicewomen's reproductive health.