By Alexandra Sifferlin
October 3, 2017
TIME Health
For more, visit TIME Health.

Abortion is a legal medical procedure in the United States, but whether a woman has access to the procedure depends largely on where she lives.

A new report published Tuesday in The Lancet Public Health journal found that American women travel an average of 11 miles to receive an abortion and about 20% will travel more than 43 miles for the procedure. Areas where U.S. women had to travel more than 30 miles for an abortion were largely in Iowa, Texas, Missouri and Montana. The latter three states have adopted more abortion restrictions during the study period.

The researchers looked at the Guttmacher Institute’s Abortion Provider Census and other national datasets to estimate average travel times for women seeking abortions in the United States. In the U.S., it’s estimated that 45% of pregnancies are unintended and 42% will end in abortion, according to the report.

Women living in cities had closer access to abortion clinics, the report found, but women living in rural counties in Montana, Texas, Wyoming, North Dakota, South Dakota, Nebraska and Kansas had to travel more than 180 miles.

Overall, the researchers say that how far women have to travel to clinics remained largely unchanged from 2011 to 2014, the time period the researchers studied. In seven states, distances to clinics have grown, and in nine states, distances have gotten shorter. Since many states have laws that require women to have 18- to 72-hour waiting periods after in-person counseling about abortions, significant travel time becomes a barrier, since women have to travel to abortion clinics more several times.

MORE: Nearly Half of Abortions Around the World Are Unsafe

“How far a woman has to travel for an abortion is a key measure of access, alongside stigma, restrictive laws and financial constraints,” said author Dr. Jonathan Bearak, a senior research scientist at the Guttmacher Institute in a statement. “Our findings illustrate the vast differences in access to abortion mapped across the US, with women in remote, rural areas facing the longest journeys for an abortion.”

Women’s access to abortion remains a contentious topic in 2017. The House of Representatives is set to vote Tuesday on legislation that would ban abortions after 20 weeks of pregnancy.

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