Does tennessee’s mandatory waiting period law systematically prevent residents of the most economically disadvantaged zip codes from accessing abortion? An exploratory analysis

Background. In 2015, Tennessee enacted a law requiring a 48-hour wait and two clinic visits to obtain an abortion. Methods. Using data from a Tennessee clinic in 2016, we explore whether abortion seekers from the most economically disadvantaged ZIP codes and those who lived farther from the clinic were less likely to return for the abortion procedure at the second visit. Results. Rates of non- return were 44%- 91% higher among residents of neighborhoods in which ≥25% of the population was below federal poverty level, ≥25% of the female population was below federal poverty level, and median annual household income was <$35,000. Mean clinic distance was also consistently greater among those who did not return. Conclusions. Residents of the most economically disadvantaged ZIP codes may be disproportionately burdened by Tennessee’s waiting period law, rendering them less able to return for the abortion procedure than residents of less economically disadvantaged ZIP codes. Furthermore, greater clinic distance may also impede access under this law.