Though distance to care is known to affect abortion access, a comparison of abortion rates by geography may be complicated by cultural differences in rural populations, such as fertility preferences, attitudes towards abortion, and abortion stigma, which may cause differences in the utilization of abortion beyond those caused by increased distance alone . One of the earliest studies of distance traveled for abortion post Roe v. Wade found that the greater the distance from an abortion clinic, the lower the abortion rate, but acknowledged that lower abortion rates may be a function of women in more rural areas far from abortion clinics preferring not to terminate a pregnancy as well as a lack of knowledge of the availability and location of abortion providers . Rural populations are less likely to support abortion under a range of circumstances than their urban counterparts  and studies have shown higher fertility rates paired with lower abortion rates among rural women compared to urban women in specific contexts . Although rural women are underrepresented among abortion patients , the reasons for this are not well understood.