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IMPORTANCE: Although abortion is common in the United States, patients face substantial barriers to obtaining an abortion. Recently enacted abortion restrictions pose such barriers. OBJECTIVES: To assess the association between a state legislative climate that is highly restrictive toward abortion provision and the abortion rate and to evaluate whether distance to a facility providing abortion care mediates the association between legislative climate and the abortion rate. DESIGN, SETTING, AND PARTICIPANTS: This cohort study examined county-of-residence abortion rates from all states that publicly provided them and used data on abortion restrictions, facility locations, and county demographic characteristics for the years 2000 to 2014. The association between legislative climate and abortion rates was evaluated using propensity score–weighted, linear regression difference-in-difference analysis. All models included state and year fixed effects and standard errors adjusted for state-level clustering. EXPOSURES: Highly restrictive legislative climate, defined as having at least 3 of 4 types of abortion restrictions; distance to a high-volume facility providing abortion care (ie, performing ≥395 abortions per year) in miles. MAIN OUTCOMES AND MEASURES: County-level abortion rate, defined as abortions per 1000 women per year. RESULTS: Abortion rate data were obtained from 1178 counties in 18 states for a median of 12.5 years (range, 5-14). The median abortion rate was 2.89 per 1000 women (interquartile range, 1.71-4.46 per 1000 women). A highly restrictive legislative climate, when compared with a less restrictive one, was associated with 0.48 fewer abortions per 1000 women (95% CI, −0.92 to −0.04 abortions per 1000 women; P = .03). Adjusted for distance to a facility providing abortion care, a highly restrictive legislative climate was associated with 0.44 fewer abortions per 1000 women (95% CI, −0.85 to −0.03; P = .04). Each mile to a facility was associated with 0.02 fewer abortions per 1000 women (95% CI, −0.03 ...

Although women are the focal point of abortion care, a woman's male partner may accompany her to the abortion appointment. Using Connell's "hierarchy of masculinities" framework, this study examines how male partners negotiate their identity and role in an unfamiliar setting while their female partners undergo an abortion. Twenty-seven in-depth interviews with male partners of women obtaining abortions at a community-based and a university-based abortion clinic were conducted. The interviews reflected the tension male partners felt while attempting to maintain characteristics of hegemonic masculinity (e.g., dominance, stoicism, ambition, and fatherhood) in an environment where their female partner's needs were prioritized. Some male partners expressed distress about their inexperience with the process and procedure as well as their inability to participate or better care for their partners. Others negotiated alternative definitions of masculinity, emphasizing a duty and/or desire to provide support during his female partner's pregnancy decision-making and abortion experience.