Earlier this month, Indiana became the 15th state to nearly totally ban abortions after Roe v. Wade was overturned by the Supreme Court in June 2022. In the ripple effects of the court case, laws restricting abortion access were proposed and are still being contended in states like Texas, Iowa and Utah.
As abortion access dwindles in certain states, people are traveling more than 1,000 miles to seek care in states without restrictive abortion policies. According to a study published yesterday in JAMA Network Open, the number of out-of-state residents seeking abortions in Massachusetts, for example, rose 37% in the four months after the Supreme Court ruled on Dobbs v. Jackson Women's Health Organization. Some patients traveled from as far away as Texas.
There have been observed increases in the number of people traveling to states like Minnesota or Illinois because they border states with abortion bans or even extreme restrictions on reproductive care — but this study demonstrates people seeking abortions are traveling much further distances to get care. Sometimes they must trek across nearly half the country, said study author Elizabeth Janiak, ScD, an assistant professor at obstetrics at Brigham & Women's Hospital and Harvard Medical School.
"I would hypothesize that some of the increase in funding might also be because more folks are having later abortions, which tend to be more expensive."
The study also found the proportion of out-of-state travelers who received charitable funding to help defray the cost of abortion care rose from 8% pre-Dobbs to 18% post-Dobbs. That could be because of higher costs associated with greater distances traveled to receive care, Janiak said.
"I would hypothesize that some of the increase in funding might also be because more folks are having later abortions, which tend to be more expensive than earlier abortions," Janiak told Salon in a phone interview. "I would hypothesize that's happening because delays in accessing care force them [to seek abortions] later in pregnancy than they might have if they accessed abortion in their home state."
The Dobbs ruling that overturned Roe left the power to regulate abortions in states' hands. Even before Dobbs in 2014, 20% of pregnant individuals had to travel about 50 miles to access abortion care in most states. But this ruling effectively "opened the floodgates," for states to increase abortion restrictions, implementing legal penalties for patients and doctors providing abortions, said Seema Mohapatra, a law professor at the SMU Dedman School of Law. As a result, some abortion providers fled states with restrictions and clinics shuttered.
"What we're seeing after Dobbs is states that have conservative legislators taking the opportunity to almost abolish abortion care or restrict it so much that essentially, people in that state don't have access to abortion care anymore," Mohapatra told Salon in a phone interview.
The Turnaway Study found women who went on to give birth after not being able to access an abortion experienced increases in poverty, debt and evictions compared to women who were able to access abortions. The study also linked unintended pregnancies to increased rates of pregnancy complications, domestic violence and child development issues.
"There's a whole host of both economic and personal issues that go along with people that are forced to carry to term when they are seeking an abortion — and we're going to have more and more people [facing those issues]," Mohapatra said.
People seeking abortion have been shown to be disproportionately low-income and already parenting children. Restrictive bans on abortion care have also been shown to have a disproportionate impact on people of color, low-income patients and younger people, Mohapatra said. Many seeking an abortion may not be able to take multi-day trips to reach an abortion clinic.
"There is a big financial burden, and only certain people can take that," Mohapatra said. "As a result, you're going to see who can access this kind of care to be very limited to people who can afford it."
"You're going to see who can access this kind of care to be very limited to people who can afford it."
Another study also published in JAMA Network Open last week found telehealth could mitigate some of the disparities in abortion care, providing healthcare for people who cannot travel long distances to seek an abortion. However, even in that study, people with limited access to abortion care — like younger people, those with health conditions or people who spoke languages other than English — accessed telehealth at lower rates for abortion care.
"Efforts to educate patients about telehealth procedures and improve availability of language support are needed to make telehealth medication abortion services feasible for diverse populations," the authors wrote.
Another new study published in the Journal of Policy Analysis and Management projects how additional bans in other states will continue to shape the post-Roe landscape of abortion care in the coming months or years. The Guttmacher Institute is tracking which states enact abortion bans and in January 2023, predicted that 24 states have or will soon ban abortions. In this scenario, people seeking abortions could have to travel hundreds of additional miles to receive care — but many won't have the means to and will end up giving birth instead, the study found.
Abortions were projected to decrease by 8.5% and births to increase by 1.5%, equating about 79,126 fewer abortions and 56,000 more births per year.
Specifically, the research found one-quarter of people seeking abortions would be unable to get one due to distance should abortion bans take effect in 24 states, with three-quarters of those people trapped giving birth as a result, according to study author Caitlin Myers, an economics professor at Middlebury College. Overall, abortions were projected to decrease by 8.5% and births to increase by 1.5%. That equates to about 79,126 fewer abortions and 56,000 more births per year.
"When distance to a brick and mortar abortion facility goes up, there are a lot of people who end up trapped and can't get there and give birth as a result," Myers told Salon in a phone interview.
To forecast how distances to abortion clinics would change as a result of legislation, Myers looked at policies enacted in the past decade leading up to Dobbs that caused abortion clinics to close. She extrapolated what could happen if states enacted similar restrictions in the future using records of how the rate of abortions and births in the region changed after bans went into place.
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In Myers' study, the first 100-mile increase in distance had a larger effect on access than greater distances. Prior research involving patients on California Medicaid showed 12% of people seeking an abortion will travel 50 miles to get care whereas just 4% will travel 100 miles or more.
As Myers explained: "In some places, distances have gone up even more than we've ever seen before, but I'm not sure in some ways that matters because the people who get trapped mostly get trapped within the first 100 miles."
Myers' study doesn't account for alternative ways to access abortion services, such as people increasingly ordering abortion pills online. That could mean some instances in which people accessed abortions would not have been included and Myers' projections could be overestimated, she said.
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On the other hand, the study assumes people living within reach of an abortion clinic are able to secure an appointment, which may not be the case as centers struggle to meet the demand of people flooding in from states with abortion bans. In this case, Myers' projections may have underestimated the number of people trapped, she added.
Regardless, one measurement in the study is closely monitored and serves as a reliable way to demonstrate the impact of shuttered abortion clinics: live births. And in this study, those rose.
"Nobody has a perfect crystal ball, but what I would say is, I think this is probably about as good as we could do at reliably forecasting what's to happen," Myers said.
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