A new report reveals the reality of the United States post-Dobbs: abortion deserts, especially concentrated in the southeast, forcing women to flee to nearby states that provide care.
“The Monthly Abortion Provision Study shows that many states that are in close proximity to states that banned abortion saw much sharper increases in monthly abortion numbers than would likely be explained by a continuation of earlier trends,” read the report from the Guttmacher Institute, considered the gold standard in abortion research. “Much of the increase is likely attributable to out-of-state patients who were forced to travel for abortion care, reflecting the reality that states that ban abortion are neglecting the health care needs of their residents.”
The researchers compared the data with that from 2020, the year of their last annual provider survey, when abortions were starting to tick up mostly without the burden of comprehensive gestational bans (though also amid a global pandemic). The report is based on a survey of clinics and providers, and uses a statistical model to create abortion estimates from that data plus historical data on the caseload of every provider in the country.
The overall uptick in abortions so far in 2023 likely reflects the reaction of blue states to abortion bans, along with their proximity to states under restrictive regimes. Abortions in Colorado, Illinois, Washington and New Mexico have risen significantly — all places where Democratic-led state governments have expanded access to abortion and bolstered accompanying protections.
But in a state like Texas, where abortion is now virtually illegal, there were just 14 reported abortions in the first three months of 2023 compared with a monthly average of 4,800 abortions in 2020, per the report. It highlights the huge numbers of women who have been displaced, forced to travel vast geographic distances to clinics often already overwhelmed with increased need.
The report also highlights the precarity of certain abortion oases.
Abortions in South Carolina, for example, increased 124% from 2020, as it’s surrounded on all sides by states with extreme gestational bans. But the doors have swung shut there too as of late last month, after the (all-male) state Supreme Court upheld a six-week ban.
As the report points out, the overall uptick in abortions doesn’t reflect improving conditions for women’s health care. Some women have been forced to carry unwanted or unviable pregnancies to term. Abortion bans inevitably hurt the most vulnerable women — young women, women of color, LGBTQ women, hourly workers, women who can’t easily take time off work and pay for travel, lodging and meals — the most.
“These findings indicate that all aspects of the abortion infrastructure — including facilities, funds and support networks — require sustained support to serve increased patient caseloads,” the report read.
The report does not speak to “self-managed abortions,” where women obtain abortion drugs — usually misoprostol and mifepristone — outside the formal health care system.
Medication abortion has become a critical piece of reproductive care in a post-Dobbs world, and the Biden administration’s lifting of the restriction against prescribing and delivering mifepristone via telehealth has upended that part of the landscape. Clinics and providers have developed new means of getting the pills to women living under bans, including by sending them to a blue state and having them forwarded from there.
Accordingly, anti-abortion activists have shifted their attention to trying to get mifepristone un-authorized by the FDA and yanked from the market, spawning many major cases currently working their way through the federal courts.
To me the most troubling part of this article is not that women had to travel out of state to get abortions but the women who are unable to travel out of state and had to carry an unwanted pregnancy to term.
I also wish TPM had discussed the fact that the same states that are taking away reproductive rights are also the worst states for child care, health care as many have refused ACA expansion, education, and basic services for children and especially poor single mothers.
One wonders if Samuel Alito, et al, lacking in any medical knowledge or training, ever ponders their actions in the light of “unintended consequences.” I kid, I kid.
There is no war on women.
Yes, generally, abortion access becomes a class issue, a fact that I doubt was far from the minds of the generally well-to-do legislators who supported tightening restrictions on the care.
There is a corollary to this: Texas reports 17 abortions during January- April of 2023.
In 2020, there were more than 6.1 M females of reproductive age (17- 44) in Texas.
The idea that during that period only 17 women of reproductive age in Texas experienced a pregnancy that resulted in medical crisis that required an abortion doesn’t even begin to pass the giggle test. So, what’s happening:
Abortions are happening, but the women are traveling out of state for them. Now, running up from El Paso to Las Cruces is 30 or 40 miles on I-10. No big deal. But going from Midland-Odessa to Las Cruces is a significant trip, and I doubt that Clovis or Carlsbad are viable alternatives to Las Cruces or Albuquerque for that sort of care.
Abortions are happening on the down-low in Texas. Some Ob/Gyns are practicing medicine rather than politics and risking running afoul of the law and ignoring good clinical practice by not documenting everything they do.
Pregnant women are self-managing abortion care.
Women are just dying from pregnancy complications.
I suppose there are other possibilities, but none of these are good public health practice. We are also unlikely to know which of the above are operative, other than the certainty that the first is working. That’s already documented in the abortion numbers for states near-ish Texas where abortion remains legal, like New Mexico and Kansas.
ETA: Alternative #2 was fairly widely practiced in many places pre-Roe. I don’t know that it’s being practiced in Texas now, but I’d not be surprised to learn that it is.