Geographical Distance, Socioeconomic Deprivation, and Educational Level Shape Access to Voluntary Termination of Pregnancy in a Southern Region of Italy ^†

Background: In Italy, voluntary termination of pregnancy (VTP) is a legally protected healthcare service. However, in Apulia, a southern region, access remains uneven due to ongoing healthcare rationalization, which has reduced service availability, particularly in decentralized areas. Conscientious objection among providers may also contribute, although the number of VTPs per provider has decreased over time. This study examines whether women access VTP services outside their healthcare catchment area (CA) and how socioeconomic deprivation and individual factors may influence mobility. Methods: We applied a ranking method, based on spatial and temporal distance between hospitals and municipalities to define the catchment area (CA) around hospitals of the Apulia region that offers VTP service. A Poisson multivariable clustered model was applied to evaluate the association among demographic and socioeconomic factors and the choice of the VTP service. Results: The analysis revealed that 54.7% of VTPs were performed outside the women’s catchment area. This mobility was significantly more frequent among women from medium and low socioeconomically deprived areas compared to very low deprived areas (RR = 1.20; 95%CI: [1.02–1.42]) and (RR = 1.28; 95%CI: [1.03–1.57]). Higher education level (RR = 1.09; 95% CI: [1.04–1.14]) and employment (RR = 1.09; 95%CI: [1.03–1.14]) were also associated with higher rates of undergoing a VTP outside of CA, with variations observed across local health authorities. Conclusions: These findings have shown the influence of socioeconomic conditions and educational level on women's access to VTP services, suggesting that structural inequalities continue to shape healthcare choices and mobility.