Abstract
IMPORTANCE: Limited evidence exists concerning access to abortion facilities from Native lands. To address this gap, travel times from Native lands to abortion facilities before and after the Dobbs v Jackson Women's Health Organization (Dobbs) decision were compared. OBJECTIVE: To compare travel times to abortion facilities from Native lands before and after the Dobbs decision. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study, conducted from July 1, 2023, to September 30, 2025, measured the proportion of Native lands served by abortion facilities (coverage) and the minimum travel times to abortion facilities. For coverage, the census-designated Native lands (N = 650) within and outside 30-, 60-, and 90-minute drive times to an abortion facility were quantified. For minimum travel, the drive times from Tribal headquarters (N = 577) and Native land population-weighted centroids (N = 650) to the nearest facility were estimated. MAIN OUTCOMES AND MEASURES: The primary outcomes were the estimates of the median travel time from Native lands to the nearest abortion facility and the pre- and post-Dobbs differences in the contiguous US. Primary analyses compared median drive times in the contiguous US before and after Dobbs. The pre-Dobbs period included facilities active in 2021, while the post-Dobbs period excluded facilities in states with total abortion bans (n = 14) or total or 6-week bans (n = 16) in effect as of October 31, 2023. For Alaska and Hawaii, Euclidean distance was estimated to account for varied travel modes; because no such bans were imposed, pre- and post-Dobbs differences were not examined. RESULTS: Across 650 Native lands, with an estimated 950 991 female residents of reproductive age (15-44 years), less than half (289 [44.5%]) were within a 90-minute drive of any abortion facility after Dobbs. In the contiguous US, the median drive time significantly increased from 65.5 minutes (IQR, 31.9-103.1 minutes) before Dobbs to 72.3 minutes (IQR, 32.5-147.3 minutes) (total bans only) and 74.0 minutes (IQR, 32.6-152.4 minutes) (total and 6-week bans) after Dobbs. The median distance was 470.1 km (IQR, 270.7-665.9 km) in Alaska and 63.1 km (IQR, 22.9-179.1 km) in Hawaii, where 56.4% of Native lands (31 of 55) required travel to a different island. CONCLUSIONS AND RELEVANCE: This cross-sectional study of access to abortion facilities from Native lands found that individuals on Native lands faced disproportionately long travel times to abortion facilities, which became longer after Dobbs. Addressing these inequities is critical for advancing health equity for Indigenous communities.