A few weeks ago, Jessica Marchbank got a call from a woman whose abortion had just been canceled. The woman had driven more than two hours from Louisville, Kentucky, to Indianapolis, leaving three children at home. “She’s crying, saying, ‘How am I going to make this work?’” said Marchbank, who is the state programs officer at All-Options Pregnancy Resource Center in Bloomington, Indiana. “She barely had the gas to get home that day.”
Marchbank has talked to hundreds of people who want an abortion each month since the Supreme Court overturned Roe v. Wade in June 2022. Her organization helps provide abortion funding for women who live in or are traveling to Indiana. Before the decision in Dobbs v. Jackson Women’s Health Organization, All-Options would typically help about 70 patients per month; after Dobbs, it jumped to closer to 70 per week. And as the call volume increased, Marchbank’s job has gotten exponentially harder. Clinics across Indiana have weeks-long waits and patients there are legally required to make two trips to the clinic. Some choose to drive to Illinois, where they only have to visit the clinic once.
In the end, the woman from Louisville went home and scheduled a separate, 10-hour round trip journey to Chicago. “A lot of people are just driving up to Chicago,” Marchbank said. “Somehow, it ends up being easier.”
Tens of thousands of Americans navigated similar complications as they sought abortions in the six months following the Dobbs decision. Around 66,510 people were unable to receive a legal abortion in their home state between July and December of 2022, according to a data set shared exclusively with FiveThirtyEight by #WeCount, a national research project led by the Society of Family Planning, a nonprofit that supports research on abortion and contraception. That number includes more than 43,830 people who were unable to receive an abortion because their home state had banned the procedure, and an additional 22,680 whose home states restricted or reduced access to abortion — a list that includes Arizona, South Carolina, Ohio, Georgia, North Dakota and Indiana.
A FiveThirtyEight analysis of the #WeCount data shows that since July 2022, the number of abortions have spiked dramatically in states like Illinois, a pattern that suggests people in states where abortion is banned are driving hundreds or even thousands of miles to reach the nearest state where abortion remains legal. Of the 66,510 people who couldn’t get an abortion near home, an estimated 35,330 seem to have traveled to obtain one. But the data also shows 31,180 people were seemingly unable to get a legal abortion at all. We don’t know whether those people remained pregnant, or got an abortion some other way.
All told, the #WeCount data, plus additional data gathered by FiveThirtyEight from state health departments, abortion providers and abortion funds, shows that there has been both a reduction in the total number of abortions and a reshuffling in the location and methods of abortion in the months since the Dobbs decision. The data also highlights that, while providers and advocates have tried to adapt to these changes — opening new clinics, helping to fund people crossing state borders and shifting toward telehealth — the Supreme Court’s ruling has made those solutions precarious. For example, abortion access in the South now heavily depends on Florida — a state that is poised to pass a ban on abortion after six weeks of pregnancy. And a recent court ruling in Texas invalidating the government approval of one of the two drugs used in medication abortion could seriously hamstring legal telehealth services and drastically reduce capacity at in-person clinics as well.
This data isn’t a perfect real-time snapshot of how abortion numbers are changing — it includes data from 77 percent of the country’s providers, while data from the clinics that didn’t report is an estimate. The researchers noted that numbers may shift in the future as they get more data — in fact, some numbers were revised between the first wave of the research published last fall and this new report. Meanwhile, many people are also ordering abortion pills online, through international pharmacies or groups like Aid Access, which ship medication abortion to places where it’s illegal. These abortions are not counted in #WeCount’s data, and they could make up a significant number of abortions — in addition to the ones that happen within the health care system.
But the overall trends are clear. “Based on the magnitude of what we’re seeing, we should be confident concluding that [abortion] bans have been a tremendous disruption,” said Caitlin Myers, a professor of economics at Middlebury College who was not involved in the research, but reviewed a copy of the report at FiveThirtyEight’s request. “While many people are finding a way to travel, it appears that a very substantial number of people aren’t.”
The shock of the Supreme Court decision, and the cascade of state bans that followed, had a big impact on abortion access across the country. Dr. Alison Norris, a professor of epidemiology at Ohio State University and a co-chair of the #WeCount project, told us that she had initially hoped that clinics would adapt and abortion numbers would quickly rebound. But that has not happened. Instead, each month between July and December had 5,197 fewer abortions on average compared to the average number of abortions in the two months immediately preceding the Dobbs decision.
The bulk of those reductions came from states that had completely banned the procedure. These states often neighbor each other, creating large regions of the country where abortion can only be accessed through arduous and expensive travel. The Chicago Abortion Fund, a nonprofit that helps patients cover the costs of abortion nationwide, told us that their average grant for wraparound services — which includes travel expenses and related costs like childcare — rose from $120 pre-Dobbs to $375 after.
States like Illinois, Colorado and Kansas saw large increases in patients, many coming from out of state. According to preliminary data from the Colorado Department of Public Health & Environment, 28 percent of abortions in the state were performed on nonresidents, double what it was in 2021. Trust Women, a clinic in Wichita, Kansas, reported that, post-Dobbs, three-quarters of its patients came from states that ban abortion. The #WeCount data shows that patients are traveling to the nearest states that still allow abortion, and some clinics say this is happening in such numbers that residents of states where it is legal are having trouble getting their own appointments.
Just two months after CHOICES, a Memphis-based reproductive health organization, opened a new clinic in Carbondale, a city in southern Illinois, 98.5 percent of patients at the clinic were coming to Illinois from a state with an abortion ban, according to Jennifer Pepper, the group’s president and CEO. “When you’re sitting in front of a patient [who] had to drive 12 hours one way to get to your clinic — it makes it real in a whole different way, the way these laws are impacting people,” Pepper said.
#WeCount data shows that, nationally, the number of monthly abortions rose a little from July to August, only to fall every month through November — then rise again in December. Under normal circumstances, that pattern would make no sense. Because more pregnancies are conceived during the winter holidays, abortion numbers tend to rise in the spring and decrease later in the year. But in a post-Dobbs world, so many people are traveling for abortions — and clinics in destination states are so strapped for appointments — that the numbers are much more volatile. Abortion providers across the country told us that they’re no longer seeing seasonal trends in demand for abortion, because their appointment calendars are always full.
One big impact of those fully-booked calendars seems to be an increase in the number of patients who cannot receive their abortions until the second trimester, at which point abortions are more complicated, more expensive and even less likely to be available close to home. The preliminary Colorado data show later abortions on the rise, with 487 abortions after 20 weeks of pregnancy last year, up from 170 in 2021. “People wind up waiting for so long, by the time they get to their appointment, they’re too far along to be seen in the first-trimester clinics,” said Dr. Warren Hern, a Colorado abortion provider who specializes in abortions later in pregnancy.
Patients who live in states that still allow abortion and are facing long delays seem to be turning to a relatively new option in abortion access: medication abortions from virtual clinics. For people in the first 11 weeks of pregnancy, getting abortion pills this way can be as simple as filling out a form and responding to a few text messages, or doing a quick video call with a clinician. The medication typically arrives in less than a week.
The #WeCount researchers found that the average monthly number of abortions prescribed this way increased by 76 percent between the pre-Dobbs period and post-Dobbs period, and that’s not including patients using telehealth services provided by brick-and-mortar clinics. This is part of a pattern of increased pill use spurred by the growing rise of telehealth, which accelerated during the pandemic. By 2020, medication abortion made up half of all the abortions in the U.S., according to the Guttmacher Institute. Now, those pills are providing people with wider options at a time when abortion access is contracting.
But those options are under threat, too. On April 7, a Texas judge issued a ruling that suspends the Food and Drug Administration’s approval of mifepristone, one of the two drugs used in medication abortion. It’s not clear yet what effects this ruling will have or when. It’s not scheduled to go into effect until Friday and a different judge has already issued a competing ruling blocking the FDA from pulling mifepristone off the market. Whatever happens in the courts, this news is likely to increase confusion among the public about what is and is not legal, something researchers and advocates have told us affected abortion numbers long before these rulings.
“Sometimes we have to break things down for callers because they will either say, ‘Well I can’t get an abortion in Indiana because there is a ban,’ or sometimes they’ll think they’re not allowed to leave the state for an abortion,” Marchbank said. That uncertainty is visible in the #WeCount data, where we see the number of abortions falling in states where abortion bans were enacted and then blocked by courts — such as Indiana — and in some states where abortion remained technically legal, but highly restricted — such as Georgia. These patterns demonstrate that states don’t have to fully ban abortion to drastically reduce the number of procedures or to make long-distance travel the more appealing option.
And this creates big vulnerabilities in an already weakened system. Depending on how the courts and the FDA respond to last week’s ruling, access to legal telehealth abortion services could be threatened. Meanwhile, in-person patients are increasingly reliant on a handful of close-to-home abortion hubs where demand is increasing. One ban or severe restriction in a key state could easily isolate large swaths of the country. Travel complications and clinic wait times would increase. All of the trends visible in the #WeCount data would come together and people seeking abortions would struggle to get one — or not get one at all.
That’s exactly the scenario that could happen if Florida cuts off access. Surrounded by states that have already banned or heavily restricted abortion, it was one of a handful that saw significant increases in the last six months of 2022 despite having onerous restrictions of its own — like two mandatory appointments with a 24-hour waiting period in between. But Florida is poised to pass a six-week ban similar to the ones that nearly halved abortions in Texas in 2021 and Georgia last summer. That law will likely turn a state that saw one of the biggest post-Dobbs upticks in abortion into yet another place where a long drive — or pills bought on the gray market — are the only options for people who want an abortion.
“[The six-week ban will have] devastating consequences,” said Amber Gavin, vice president of advocacy and operations with A Woman’s Choice, a network of abortion clinics that has a location in Jacksonville, Florida. “Not just for Floridians, but for everyone in the southeast.”
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