Last year the Family Planning of Martha’s Vineyard clinic administered 333 pregnancy tests; 22 were positive. Of those, roughly half the women chose to terminate.

But for Vineyard women looking to terminate a pregnancy, the only option is to travel off-Island. The closest clinic is in Attleboro. The second closest is in Boston.

For some years, the Martha’s Vineyard Hospital has not offered abortions. Dr. Daniel Pesch, an obstetrician/gynecologist who is vice president of the hospital medical staff and chairman of the equality committee, said that was the case when he joined the staff seven years ago.

“There were other practitioners here who weren’t comfortable providing that service as well,” he said. “And if we can all be on the same page, it’s better.”

Dr. Pesch said for some women who use his practice, going off-Island is the preferable route.

Dr. Daniel Pesch, hospital obstetrician/gynecologist. — Jeanna Shepard

“No one has expressed a huge concern to me because it’s not available on Island,” he said. “Fortunately we’re in Massachusetts where there are options, we’re not forced into a situation where we can’t provide options. Potentially there are certainly psychological pressures [of having to go off Island]. Other people will say, ‘I’m leaving the Island to have this done.’ It’s a small Island, they will see people who they know.”

The hospital is participating in a needs assessment survey about reproductive health by the Rural Scholars this month, and abortion access is one of the topics.

The scholars are expected to present the results of the work next week.

“If it turns out [abortion] is something felt to be needed, we’re going to have to look at this much more closely,” said Dr. Pesch. “One of those things is institutional inertia. I joined a practice that had a policy and this was where we were. There’s the feeling it was something we didn’t have a lot of demand for, but if people know we don’t do it, they will look elsewhere.”

In 2014, half of all American women of reproductive age lived within 11 miles of the nearest abortion clinic, according to an analysis by Guttmacher Institute researchers published early this month. One out of five women traveled at least 43 miles to reach the nearest abortion clinic. Island women must travel twice that distance.

Cape Cod’s only abortion clinic closed in 2008, following the death of a patient. The Cape Cod Times reported that the clinic performed about 80 abortions a month the year before it was closed.

Now the closest clinic is Four Women in Attleboro. In 2016, that clinic provided 1,840 abortions according to state Department of Public Health data. Four Women does not keep records of where patients are from.

In 2016, Planned Parenthood in Boston provided 5,955 abortions, by far the most of any provider in the city.

Last year the Family Planning of Martha’s Vineyard clinic administered 333 pregnancy tests; 22 were positive. Of those, roughly half the women chose to terminate. — Jeanna Shepard

Taylor Leininger, a nurse in the hospital obstetrician/gynecology department, said most women who come in for abortion counseling end up going to Boston — often they are familiar with the city and with Planned Parenthood. But traveling to the city comes with its own hurdles.

“I had someone go to Boston and they ended up leaving because of all the protesting in front of [the clinic],” Ms. Leininger said.

Dr. Jennifer Childs-Roshak, president and chief executive officer of Planned Parenthood League of Massachusetts and Planned Parenthood Advocacy Fund of Massachusetts, said geographical barriers to abortion care can affect women in multiple ways.

“Those barriers delay care, make it more costly, reduce options, for example, a medical abortion is available up to 10 weeks, after 10 weeks . . . there is a decreased ability to have a choice,” she said. “If it’s an abortion or any kind of health care, the closer the health care is delivered to where a patient lives or work, the better.”

Ms. Childs-Roshak said her group has no plans to open a clinic on the Island but is working with Family Planning, the reproductive health care clinic in Vineyard Haven owned by Health Imperatives.

“We’re impressed with the work that they do, and the commitment to the community,” she said.

Because it is federally funded, Family Planning does not provide abortions. It does provide counseling on options for women who are pregnant.

Elizabeth Torrant, vice president of health intervention and prevention programs at Health Imperatives, said the Vineyard clinic focuses on sex education and long-term birth control.

“We do as much as we can in prevention work, to prevent people having to make this very difficult decision and possibly go off Island,” she said.

A Vineyarder in her 20s who did not want her name used, found herself with an unplanned, unwanted pregnancy four years ago. She made an appointment at Family Planning.

“They walked me through my options,” she told the Gazette. “It was surprising to me that I was going to have to go off-Island.”

She scheduled an appointment at a clinic in Holyoke. The arrangements were complicated; she couldn’t miss work, she needed a doctor who accepted her health insurance and wanted to spend the night in the area. Luckily, she had friends who lived near the clinic and let her stay with them. She booked a ferry ticket for her car, herself and her boyfriend. On the ferry she faced an uncomfortable situation.

“You know how the boat is — you run into everyone you know and they ask where you’re going,” she said. “That first level of social taboo is massively amplified through the ferry.”

The following day at her appointment, she was informed that the one doctor who accepted her insurance had not come in that day.

“The options were pay out of pocket, or come back next week,” she said. “I thought, I can’t just come back next week, that means another round-trip ferry ticket, more time off work . . . we wound up paying out of pocket.”

An abortion can cost anywhere from $420 to $3,450 according to a list of in-state abortion providers from NARAL Pro-Choice America, a nonprofit that advocates for abortion access. Vineyard women add to that the cost of taking their car over on the ferry or a bus ticket. Financial assistance is available through the Eastern Massachusetts Abortion fund, which helps match providers with insurance and also helps with money for transportation, child care and translation services.

In Massachusetts, women under 18 must obtain parental consent to receive an abortion. A judicial bypass can be granted by a superior court judge, but the process can take time. Also, the Edgartown courthouse does not always have a superior court judge sitting.

Cape and Islands Rep. Dylan Fernandes has co-sponsored a bill that would remove the requirement for parental consent or court order for women under 18. The bill is currently in joint committee.

“Many women discuss the decision to have an abortion with their parents, but some simply cannot for various reasons,” Mr. Fernandes said.

Mr. Fernandes was on the Island in late September to hold open office hours. He said abortion access on the Island was raised by some constituents. There are no providers in his district, or the other five Cape house districts.

“If you look at a map of abortion providers, you see a large dark spot, I think it’s a real problem,” he said. Mr. Fernandes said he has had conversations with Planned Parenthood and NARAL about the possibility of a clinic, but the relatively small population is a factor.

“They were concerned about whether it would be feasible to open up locally on Cape and Islands,” he said. “My argument back is, in the summertime there is a huge influx of young adults in the region.”

The majority of abortions provided in the commonwealth in the last three years have been for women aged 20 to 29, according to data from the state DPH.

On the Island, there has been some talk about the prospect of teleconference medical abortions, where a provider guides a trained medical professional and patient through the process of taking mifepristone and misoprostol, medications used in tandem to terminate pregnancy. The idea is to expand access to a place where the population may not sustain a full-time clinic.

Dr. Pesch said medical abortion by teleconference has been a subject in recent trade journals.

“I think it would be a viable option,” he said, noting the mounting volatility nationwide around abortion. “Most of these services are under attack, which is not a great thing. Our access to all these things is going to be more difficult.”

Dr. Pesch, who also sits on the board of Family Planning, said there is a vocal group of anti-abortion advocates on the Island who protest whenever Friends of Family Planning tries to fundraise, even though Family Planning does not provide abortions. But he also said there is a significant group of people who support open access. He said the question comes down to whether there is a demand, and whether health care providers on the Island feel comfortable providing the service.

“It is an issue,” Dr. Pesch said. “There is always the question of should it be done on the Island, and then does it have to be done on the Island. First is the should we, then the could we.”