The following blog post was written by our summer 2022 Masters of Public Health (MPH) intern Abigail O'Keefe

Becoming a young adult can be an invigorating time for many. It is a time in our lives where we may leave our childhood homes and go off to college, we may start our professional careers, or explore new found freedoms that we may not have had before this point in our lives. This point in time can also be extremely challenging and burdensome for many.  It is a point in our lives where we may have more responsibilities than we have ever had, we may experience career struggles with being new to the workforce, and we may face financial troubles. Regardless of the experiences a person has, being a young adult can demand a lot out of us. However, in the midst of trying to navigate the world as a young adult, we shouldn’t have to worry about whether or not we can access basic, reproductive healthcare. 

In North Carolina, over 28% of the total number of abortions that occurred during 2019 were from young adults between 20-24 years of age¹, and young adults are strongly supportive of abortion being legal². Abortion is legal in North Carolina, but there are many restrictions in place that have created an environment in which having an abortion is burdensome³. While these restrictions have an effect on anyone who attempts to have an abortion in North Carolina, restricting access to abortions has an disproportionate effect on the young adults and on their ability to receive abortion services⁴. 

Currently there are only 14 abortion clinics in North Carolina, leaving over 90% of  counties without an abortion clinic that its residents can easily access⁵. When there is a lack of places that are able to provide abortion services, this leads to long trips a person will have to take  in order to have an abortion⁶. When I was a college student, I wasn’t able to own a car on campus because of the limited number of permits my college would give out and the expensive fees for having a car on campus. Because of this, I used public transportation frequently or relied on my friends who had cars if I needed groceries, to go to the doctor’s, or just wanted to spend time off campus. Many young adults also have a similar experience with transportation, as young adults between 18-29 are more likely to travel around via public transportation  than people older than 30⁷, and account for a very small percentage of car owners in the United States⁸. Between working, staying caught up with all my homework, and participating in different campus organizations, I barely had any free time as a college student. Even missing one class to have some extra time was difficult, due to the strict attendance policies that all my classes had. Considering that there is a large number of university students in North Carolina⁹ and young adults are likely to be employed¹⁰, many young adults in North Carolina may also have limited free time. With there only being 14 clinics in North Carolina, many young adults who need an abortion may face the burden of having to find transportation that will take them to an abortion clinic, paying any expenses associated with traveling, and spending hours trying to reach a clinic that will provide an abortion ^4,6,11.

In North Carolina, there are restrictions in place that limit which health plans are able to cover the cost of abortion services, such as restrictions on Medicaid and health plans of state employees^13-15. If abortion is not covered by the health plan that a person has, they may face having to cover the cost of abortion services themselves. Being a college student who didn’t have many work experiences and didn’t own a car, I was only able to secure minimum wage jobs on my college’s campus in order to pay for my rent, groceries, and all my college expenses. Whether they are in college or not, many young adults also face the reality of not earning much from jobs they have, as the “median usual weekly earnings” for people between 20-24 in the United States is $684, which is hundreds of dollars less than the weekly earnings for people over the age of 25¹⁶. Given that having an abortion can be as expensive as $750¹⁷, the cost of an abortion procedure can pose a great financial challenge to young people^4. While some young adults may have health insurance to cover the costs of abortion services, whether that be their own or their parents¹⁸, many young adults in North Carolina will be covered by health plans that the state doesn’t allow to cover abortion services^13-15 and many won’t have health insurance at all, as young adults between 19-34 compromise over 30% of the people who are not insured in the state¹⁹. This leaves many young adults in North Carolina at risk of burdening the cost of having an abortion procedure if they don’t have any financial assistance. 

While having an abortion in North Carolina is not banned, the restrictions that are in place contribute to abortion stigma²⁰.  For example, many of the restrictions on abortion in North Carolina, such as required counseling and the 72 hour delay before an abortion procedure⁵, are only applied to abortion procedures and no other medical procedures that happen in North Carolina. Restrictions like these instill the idea that abortion is not basic or normal healthcare if it has to be restricted in such a way²⁰, and can instill harmful misbeliefs about abortions, the people who offer abortion care, the people who support and advocate for abortion access, and the people who want or need to have an abortion^{4,20- 21}. Abortion stigma can impact people in different ways²¹, but abortion stigma can cause distress for people attempting to have an abortion or asking for help in getting an abortion because of  how they may be viewed and treated for trying to have an abortion ^20-22. Young adults already face many physical and economic obstacles when it comes to needing abortion services in North Carolina, and abortion stigma only creates more emotional and psychological burdens for the young adults who need or want to have an abortion in the state^4,20-22.

Considering the implications that abortion restrictions and stigma can have on young people, it is extremely important to protect access to abortion in North Carolina for young adults. We can advocate for the removal of medically unnecessary and intrusive restrictions on abortion, and we can speak to our state representatives about protecting the right to have an abortion in North Carolina. Everyone deserves the right to have the abortion, and we need to fight to ensure that there is equitable access to abortion services in North Carolina.

References:

1. Kortsmit K, Mandel MG, Reeves JA, et al. Abortion Surveillance - United States, 2019. MMWR Surveill Summ. 2021;70(9):1-29. Published 2021 Nov 26. doi:10.15585/mmwr.ss7009a1 
2. Pew Research Center. America’s Abortion Quandary. Pew Research Center. Published May 6, 2022. Accessed June 12, 2022. https://www.pewresearch.org/religion/2022/05/06/americas-abortion-quandary/ 
3. Center for Reproductive Rights. North Carolina. Center for Reproductive Rights. Accessed June 8, 2022. https://reproductiverights.org/maps/state/north-carolina/
4. Bridges E. Abortion and Young People in the United States. Advocates for Youth.  Accessed June 10, 2022. https://www.advocatesforyouth.org/resources/fact-sheets/abortion-and-young-people-in-the-united-states/
5. Guttmacher Institute. State Facts About Abortion: North Carolina. Guttmacher Institute. Accessed June 9, 2022. State Facts About Abortion: North Carolina | Guttmacher Institute 
6. Gerdts C, Fuentes L, Grossman D, et al. Impact of Clinic Closures on Women Obtaining Abortion Services After Implementation of a Restrictive Law in Texas. Am J Public Health. 2016;106(5):857-864. doi:10.2105/AJPH.2016.303134
7. Anderson M. Who relies on public transit in the U.S. Pew Research Center. Published April 7, 2016. Accessed June 15, 2022. Who relies on public transit in the U.S. | Pew Research Center 
8. Hart M. Car Ownership In The US: The Ultimate Guide In 2022. AxleWise. Updated June 4, 2022. Accessed June 15, 2022. How Many Cars Are In The US: Car Owneship Statistics [2022] (axlewise.com) 
9. North Carolina Colleges Student Population. UNIVSTATS. Accessed June 15, 2022. Enrollment Statistics at North Carolina Colleges | UnivStats
10. U.S. Bureau of Labor Statistics. Employment and Unemployment Among Youth - Summer 2021. United States Department of Labor. Published August 18, 2021. Accessed June 15, 2022. EMPLOYMENT AND UNEMPLOYMENT AMONG YOUTH — SUMMER 2021 (bls.gov)
11. Baker CN, Mathis J. Barriers to medication abortion among Massachusetts public university students. Contraception. 2022;109:32-36. doi:10.1016/j.contraception.2021.12.010 
12. Upadhyay UD, Cartwright AF, Johns NE. Access to Medication Abortion Among California's Public University Students. J Adolesc Health. 2018;63(2):249-252. doi:10.1016/j.jadohealth.2018.04.009 
13. N.C. Gen. Stat. Ann. § 143C-6-5.5 (Enacted 2011).
14. All* Above All. Fact Sheet: About the Hyde Amendment. All* Above All. Accessed June 3, 2022. https://allaboveall.org/resource/hyde-amendment-fact-sheet/
15. N.C. Gen. Stat. Ann. § 58-51-63 (Enacted 2013).
16. U.S. Bureau of Labor Statistics. Table 3. Median usual weekly earnings of full-time wage and salary workers by age, race, Hispanic or Latino ethnicity, and sex, first quarter 2022 averages, not seasonally adjusted. United States Department of Labor. Updated April 15, 2022. Accessed June 15, 2022. Table 3. Median usual weekly earnings of full-time wage and salary workers by age, race, Hispanic or Latino ethnicity, and sex, first quarter 2022 averages, not seasonally adjusted - 2022 Q01 Results (bls.gov)
17. Planned Parenthood. How much does an abortion cost? Planned Parenthood. Published April 29, 2022. Accessed June 16, 2022. How much does an abortion cost? (plannedparenthood.org)
18. Getting covered if you’re under 30. HealthCare.gov. Accessed June 16, 2022. People under 30 | HealthCare.gov
19. Riley B. Profiling North Carolina’s Uninsured: How Expanding Medicaid Can Make a Difference. North Carolina Justice Center. Published January 29, 2019. Accessed June 16, 2022. HAP-Report_How-Expanding-Medicaid-Can-Make-a-Difference.pdf (ncjustice.org)
20. Turan JM, Budhwani H. Restrictive Abortion Laws Exacerbate Stigma, Resulting in Harm to Patients and Providers. Am J Public Health. 2021;111(1):37-39. doi:10.2105/AJPH.2020.305998. 
21. Norris A, Bessett D, Steinberg JR, Kavanaugh ML, De Zordo S, Becker D. Abortion stigma: a reconceptualization of constituents, causes, and consequences. Women's Health Issues. 2011;21(3 Suppl):S49-S54. doi:10.1016/j.whi.2011.02.010
22. Ipas. Abortion stigma ends here: A toolkit for understanding and action. Chapel Hill, NC: Ipas; 2015. Accessed June 15, 2022. Abortion-stigma-ends-here-ABSTTKE18.pdf (ipas.org)