DOI: 10.1177/24731242261472700 ISSN: 2473-1242

Racialized Economic Segregation and Timing of Abortion Care: A Retrospective Study of Abortion Encounters in Washington State

Taylor Riley, Asha Hassan, Anuj Khattar, Lyndsey S. Benson
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Background:

Structural racism is recognized as a fundamental cause of health inequities, but there is limited quantitative evidence on how structural racism influences abortion care. This study evaluates the relationship between racialized economic segregation—a commonly measured manifestation of structural racism—and timing of abortion care.

Methods:

Data included all abortions among non-Hispanic Black and White patients provided at a high-volume clinic network in Washington state from January 1, 2017, to April 30, 2025 ( n = 12,268). We used American Community Survey data to calculate the index of concentration at the extremes (ICE race-income ) to measure racialized economic segregation at the zip-code level. We reverse-coded and categorized ICE race-income into quartiles of spatial concentrations of racial and economic (dis)advantage, with higher quartiles indicating structural disadvantage and lower quartiles indicating structural advantage. We used generalized estimating equation models with an independence working correlation structure to estimate the association between ICE race-income and gestational duration (days) and time to abortion (days), controlling for sociodemographic and clinical factors.

Results:

Individuals living in the most structurally disadvantaged neighborhoods generally received care later in gestation and had a longer time to abortion than those in structurally advantaged neighborhoods. Associations were primarily null among first-trimester abortions, and effect sizes were larger in the second trimester and among Black individuals.

Conclusion:

These findings suggest that racially and economically segregated communities experience greater delays to abortion care, particularly in the second trimester. Efforts aimed at expanding abortion access in protective states must address structural racial and economic barriers.

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