Leaving the state for abortions doubled in first half of 2023, report shows
According to a report from the Guttmacher Institute, a research and policy organization focused on sexual and reproductive health, almost a fifth of abortion seekers — over 92,000 people — left their home state in the first half of 2023 to obtain abortion care and support reproductive health rights. This was a stark contrast to less than one in ten individuals traveling out of state in the first half of 2020, before the Dobbs Supreme Court decision, which overturned federal abortion protections.
Isaac Maddow-Zimet, a data scientist at the Guttmacher Institute and principle investigator for the new report, stated that the figures likely underestimate the impact of the Dobbs decision. The growing number of people seeking abortion care is leading more individuals to travel, often spanning multiple state boundaries — particularly as many states with abortion bans and restrictions are neighboring each other.
For example, people from Texas might have previously traveled to Oklahoma in 2020. Now, in 2023, these individuals still travel but cannot go to Oklahoma any longer. According to Zimet, this causes people to cross multiple state lines and cover long distances, leading to increased costs. Higher financial and logistical burdens result in greater financial cost and complexity for individuals attempting to access abortion care.
The changing clinical needs for individuals seeking abortion care has led clinics to adapt their services.
Dr. Adarsh Krishen, Chief Medical Officer at Planned Parenthood of Greater Ohio, noted that clinics are now treating a greater number of patients in the later stages of pregnancy, even as medication abortions remain the most common method. An increasing number of patients seeking out-of-state abortion care are also choosing to undergo later-term procedures to ensure that their visit is successful.
Krishen emphasized that their goal is to provide each patient with the necessary healthcare and respect their individual needs, even as complexity increases.
The patient support experience outside the examination room is also changing.
Amy Hagstrom Miller, founder and CEO of Whole Woman's Health, a provider of abortion services and clinics, explained that when a patient arrives for their appointment, a multitude of factors come into play. Some individuals may be under time pressure, requiring a flight or long car trip. Others may be accompanied by family, including children and older adults.
To meet the needs of these individuals, Whole Woman's Health has adapted their waiting rooms. In New Mexico, for example, clinics offer separate waiting areas with toys, snacks, and comfortable seating for patients and their families, especially those traveling long distances.
The Guttmacher Institute's new report indicates that nearly three quarters of abortions in New Mexico are performed on patients who travel across state lines, representing over 8,200 procedures in the first half of 2023. Only Illinois and North Carolina performed a higher number of out-of-state procedures.
Hagstrom-Miller noted that the diversity of individuals traveling for abortion care is vast in both literal and figurative senses. Despite potential exhaustion and uncertainty, individuals are typically resolute in their decision to seek abortion care.
The revised data from the Guttmacher Institute is based on monthly surveys of abortion providers and incorporates historical trends into models used to estimate abortion rates at the state level. The data pertains to legal, medical procedures, including clinics attending to private patients and telemedicine services, though excludes self-administered abortion methods, such as medication-based procedures provided by AidAccess.
Earlier reports suggested that the number of abortions in the US rose following the Dobbs decision, particularly in states adjacent to states with restrictions on the procedure.
The abortion landscape in the US remains uncertain, with the potential for further limitations in access in the South.
The Guttmacher Institute's report notes that South Carolina has emerged as a reliable source of abortion services for the region since the Dobbs decision, with over 40% of abortions in the first half of 2023 performed on individuals coming from out-of-state, as compared to close to 3% in 2020. However, a six-week abortion ban went into effect in August, resulting in a significant drop in monthly abortion numbers. Guttmacher data shows that the reductions amounted to a fifth of the previous month's total and were even less than when similar bans in Texas and Georgia were in effect.
Maddow-Zimet stated that a future Supreme Court decision in Florida could lead to similar restrictions, potentially having more significant impacts. "Access to medical care is becoming increasingly unreachable for many individuals — and that presents a formidable barrier," he said.
The Guttmacher Institute's data shows that abortion bans and restrictions in states where abortion is legal have contributed to an increase in demand for abortions, though not all the increase in demand can be attributed to out-of-state patients.
In Illinois, for example, the number of abortions performed in the first half of 2023 was over 18,000 higher compared to the first half of 2020. The increase in out-of-state patients accounted for about 70% of that rise, which means that roughly 30% of the state's population is seeking medical care.
Maddow-Zimet explained that many of the policies and support measures enacted by states, or other forms of support for abortion patients, tend to initially focus on helping individuals from out-of-state, but ultimately improve access for local residents as well. "We've seen clinics in Illinois expanding their capacities, increasing their financial support, and this has undoubtedly helped address the influx of patients," he said. "But it has also improved overall access to healthcare in Illinois."
