The Dobbs Divide | FiveThirtyEight

Texans making 4,000-mile round-trip journeys for abortions. Weeks-long waits for appointments at clinics across the Midwest. Desperate calls to abortion funds asking for help with procedure costs, flights and gas. One year after last summer’s decision in Dobbs v. Jackson Women’s Health Organization, this is the new reality of abortion in the U.S., as thousands of people are unable to obtain abortions in their home states or nearby — and tens of thousands more travel farther and farther to end their pregnancies. 

New estimates provided exclusively to FiveThirtyEight by #WeCount — a national research project led by the Society of Family Planning, a nonprofit that supports research on abortion and contraception — indicate that there were 24,290 fewer legal abortions between July 2022 and March 2023, compared to a pre-Dobbs baseline. These people might have remained pregnant or obtained an abortion outside the legal system, which would not be captured in #WeCount’s data.

But the overall decline in abortions is just one part of the story. #WeCount’s estimates, which were collected by contacting every abortion clinic in the country multiple times over a period of twelve months, shows the Dobbs ruling has created intense turmoil for tens of thousands of Americans across the country. There were an estimated 93,575 fewer legal abortions in states that banned or severely restricted abortion for at least one week in the nine-month period after Dobbs. The number of legal abortions in states where abortion remained mostly available did rise by 69,285 in the same period, signaling that many people did travel and successfully obtain an abortion within the U.S. health care system. “But a significant number of people are trapped and can’t get out of places like Texas,” said Caitlin Myers, a professor of economics at Middlebury College who studies abortion policy and reviewed the #WeCount data at FiveThirtyEight’s request. “And for the people who are traveling, we’re talking about enormous distances. Some people are likely getting delayed into the second trimester.” With more bans on the horizon in big states like Florida — and abortion clinics and funds struggling to keep up in other states — abortion access seems likely to erode further in the second year after Dobbs.

#WeCount’s monthly estimates show volatile, sometimes confusing shifts as the country reeled from the aftershocks of the decision. After a peak in June — likely caused by a rush of people trying to get appointments before the Supreme Court ruled — abortions fell throughout the autumn, only to rise again in December. After that, abortion numbers mostly continued to rise, with monthly figures in March 2023 topping the high point from the previous June.

It’s possible, of course, that the uptick in March is just a blip. But some of these national shifts make sense from a seasonal perspective. People are more likely to get pregnant late in the year, which means that abortions tend to be more common in the late winter and early spring. That could be part of the reason the numbers rose in the first three months of 2023 — although it doesn’t explain the abrupt uptick in abortions in December, which runs counter to seasonal trends.

Other factors could also be affecting the relative magnitude of the increase. Something as seemingly random as the timing of Thanksgiving (which fell relatively early last year) could have made it harder to get an appointment for an abortion in November because people were traveling for the holiday or clinics were closed. And that, in turn, might have meant more people ended up getting abortions in December. Another important consideration, according to Ushma Upadhyay, a professor and public health social scientist at the University of California, San Francisco, and a co-chair of the #WeCount project, is that the national abortion rate has been slowly but steadily rising since 2017, so there was reason to think that abortions would continue to go up even with all the post-Dobbs disruption. And the earliest #WeCount data, gathered in April 2022, also does not fully account for the impact of Texas’s six-week ban, which went into effect in September 2021 and resulted almost immediately in a 50 percent decline in abortions in the state, according to researchers at the University of Texas at Austin. If those “missing” abortions had been included, the totals for April, May and June 2022 would have been higher, perhaps making the increases in the first three months of 2023 appear less dramatic.

Underneath these topline trends, meanwhile, is a huge amount of variability by state. Some parts of the country, like the Northeast and the Pacific Northwest, have seen relatively small changes. But a handful of states bordering the large swath of the South where an abortion is almost impossible to obtain are absorbing large numbers of new patients. There were 12,460 additional abortions in Florida in the nine months after Dobbs, 12,580 additional abortions in Illinois and 7,975 additional abortions in North Carolina.

#WeCount doesn’t collect data on patients’ state of residence, but data published by state public health departments confirms that more people are traveling in the wake of Dobbs. In Colorado, the share of out-of-state patients doubled in one year, from 14 percent in 2021 to 28 percent in 2022, when 17 percent of Colorado’s abortion patients were from Texas alone. In Florida, 9 percent of abortions that happened in the first three months of 2023 were performed on out-of-state residents, up from 8 percent in 2022 and 6 percent in 2021. Bree Wallace, a case manager at the Tampa Bay Abortion Fund, said those increases are in line with what her fund is seeing. She added that most of the fund’s out-of-state callers are from Louisiana, but they’ve recently assisted patients from Georgia, Alabama and Texas.

These shifts are creating a taxing and expensive situation for many people who live in states where abortion is banned. “It’s important to not just look at the numbers and think, oh these people are getting abortions — we have to consider everything they’re going through to get these abortions,” said Upadhyay.

Abortion providers and outside groups are working to meet the demand. A few new clinics opened in key states like Illinois and New Mexico in the past six months to accommodate the surge in travel. Other providers expanded their hours and hired more staff to accommodate the uptick in patients. Abortion funds, which provide financial and practical support for people seeking abortions, received an influx of donations in the wake of Dobbs that they used to help people travel increasingly long distances. Anna Rupani, executive director of Fund Texas Choice, which pays for travel and logistical costs for people traveling out of state, said that in March and April 2023, her organization’s average grant per person was around $1,000, up from around $550 in January 2022. The fund pays for flights; for hotel rooms; for childcare; for gas; for companions to travel and support patients who can’t make the journey on their own. “This is not a quick, 24-hour trip,” she said. “A lot of our callers are first-time travelers. They may never have gone through an airport security system. And now because all of the states around Texas have banned abortion too, they are taking these two, three, four-day trips to the other side of the country.”

And the landscape could be poised to change yet again, thanks to a raft of new abortion restrictions passed during this year’s legislative sessions. In the first five months of 2023, seven states passed full bans or first-trimester abortion restrictions, including Florida and North Carolina. (None of those restrictions were in effect while the #WeCount data was being collected.) The new gestational limit that is slated to become law in North Carolina on July 1 bans abortion after 12 weeks, which theoretically gives many people who want an abortion enough time to get one. But other changes to the law, like the requirement that patients receive an in-person state-mandated script about abortion risks 72 hours before their appointment, could pose a significant barrier to people traveling from out of state. “I just don’t think many patients are going to be traveling to North Carolina for care if they have to be here for several days,” said Amber Gavin, vice president of advocacy and operations at A Woman’s Choice, a network of clinics with locations in Florida and North Carolina.

And then there’s the Florida law, which will ban abortion after six weeks of pregnancy if the state Supreme Court upholds the 15-week ban currently being litigated. It’s impossible to say definitively how much abortions in Florida would decline under this scenario, but a FiveThirtyEight analysis suggests that it could result in many fewer legal abortions in the state. So far, Texas, Georgia, South Carolina and Ohio have implemented six-week bans since the fall of 2021. FiveThirtyEight found a remarkably consistent decline in all four states in the aftermath of the bans — in each, the number of abortions declined between 50 and 60 percent in the two months after the ban was implemented, compared to the two months before the ban went into effect. If the same pattern holds true for Florida, the impact could be massive, with a sudden decline of thousands of abortions in the state each month.

It’s possible that pregnant people in Florida will adjust — to a certain extent — if the ban goes into effect. In the wake of other six-week bans, abortion providers have reported that people started making appointments even before they had a positive pregnancy test, because they understood how difficult it can be to get an abortion prior to six weeks. Kari White, an associate professor at the University of Texas at Austin’s Steve Hicks School of Social Work who has studied reproductive health trends in Texas for years, saw a similar pattern in the data, but cautioned that the effect of Florida’s six-week ban is particularly hard to predict. “What happens in Florida might look different, because people who are traveling to Florida may be showing up in the state further along in pregnancy,” she said.

That means the decrease in Florida could end up being larger, if the people traveling to the state are mostly arriving after six weeks of pregnancy because of travel delays or difficulty raising money. Gavin said that a majority of the patients at her Jacksonville location are more than six weeks pregnant, which would mean that many of them could no longer receive services in Florida if the ban goes into effect. The abortion fund in Tampa Bay, for its part, said that nearly all of their clients are more than six weeks pregnant — and so far this year, they’ve helped more than 1,300 people.

Other parts of the country’s abortion infrastructure are fraying too, which makes the future of abortion access even more uncertain. Rupani’s fund, along with other funds in Texas, had to stop providing support for months after the Dobbs ruling because of threats of criminal charges. They were able to resume in the spring, when a judge ruled that Texas’s attorney general likely did not have the authority to enforce the state’s abortion laws outside Texas, but that litigation is ongoing. And other funds are struggling to accommodate all the people who are reaching out for help. Jessica Marchbank, the state programs officer at the All-Options Pregnancy Resource Center in Bloomington, Indiana, said that her fund will soon face hard choices about which patients to prioritize. “People don’t seem to view the situation with abortion as an ongoing crisis, so the donations have dropped off,” she said. “But meanwhile more clinics and more people seem to be aware that funds exist, so the demand has not dropped off at all. It’s just not a sustainable situation.” 

Providers in states like Indiana, too, are struggling with worker shortages and other barriers to keeping their doors open. For a while this year, none of the Planned Parenthood health centers in Indianapolis were scheduling appointments, according to Marchbank, although a Planned Parenthood spokesperson said that abortions resumed at one Indianapolis location this week after training new staff. And data collected by Myers in late April found that of the eight remaining clinics in Iowa and Nebraska, four had no available appointments, three had wait times between four and five weeks, and one had an appointment available in one to two weeks.

“There’s so much uncertainty right now,” Gavin said. “We’re not sure what things will look like in a few months or a year but I do anticipate that it’s only going to be harder for folks to access care.”

Nadine El-Bawab contributed reporting. Additional contributions from Holly Fuong. Story editing by Maya Sweedler. Copy editing by Cooper Burton.