Americans scramble for abortions in states that have banned it

Demand for pills that end pregnancy has skyrocketed in states that have restricted abortion since the Supreme Court decision last month, and abortion clinics are reporting a rush for appointments in towns bordering those states.

Aid Access, a virtual abortion clinic based in the Netherlands, saw a 256 percent increase in people coming to its site in the 24 hours after the court’s June 24 decision.

Online pharmacy Honeybee Health recorded a 50 percent rise in orders for medication abortion the week after the decision compared to the previous week.

And the number of patients at online abortion clinic Hey Jane, which can prescribe and ship abortion pills, more than doubled since the court overturned Roe v. Wade.

All told, telehealth abortion websites had more than a 25-fold increase in traffic, according to digital intelligence platform Similarweb. The dramatic increase highlights a post-Roe nation where patients seeking abortions in states that ban the procedure are beset by logistical hassles and worries about legal consequences at a time when many doctors are trying to adjust to the new terrain.

"People's main option is going to be either finding a way to travel out of state or being able to self manage,” said Abigail Aiken, an associate professor of public affairs who focuses on abortion at the University of Texas at Austin. “The discrepancy that we already lived with — in terms of access to abortion and in particular medication abortion being so zip code dependent — is really just getting more and more stark.”

In some cases, those patients are traveling hundreds of miles to states that permit abortion. They are setting up forwarding addresses to receive abortion medications, or finding mobile clinics staffed with traveling doctors.

“We have people just going right over the border into New Mexico from Texas and parking there for their virtual visit and waiting for the medication to be mailed to them,” said Amy Hagstrom Miller, founder of Whole Women’s Health, which is in the process of shutting down its Texas abortion clinics, where abortion is now banned, and setting up one in a New Mexico border city.

Demand shift

The Supreme Court decision is spurring big changes for the health care workforce, with abortion providers in restrictive states losing work while those in states with liberal laws are scrambling — relocating health centers or setting up mobile clinics — to meet demand. In the short run, the legal flux means some people will not be able to get abortions. The long run picture is less certain.

“We're really trying to just look at innovative models that still are within full legal compliance, but allow folks to access care,” said Leah Coplon, director of clinical operations at Abortion on Demand, which provides medication abortion.

The group is boosting its capacity for telehealth visits in Pennsylvania as the state prepares for an increase in demand from Ohio, which bars abortion when a fetal heartbeat is present or about six weeks, and West Virginia, which has a 19th century law banning abortion.

More patients are coming to Hey Jane in recent months citing long wait times getting care elsewhere, CEO Kiki Freedman said. The group has seen four times as many patients as it had by this time last year and Freedman has doubled its clinical team in response.

Reproductive online health clinic Choix expanded recently to New Mexico — a state that is poised to handle many abortions from Texas and the South — and aims to be in every state where abortion is legal by the end of next year, CEO Cindy Adam said.

Doctors who support abortion rights are galvanized, said Christie Pitney, a midwife who works for Aid Access. Their willingness to adjust could alleviate the demand crunch over time.

More than 200 clinicians have reached out to Pitney about joining the organization and providing care online. “I suspect that having seen two-plus years of telehealth abortions going well and research showing that it's safe and effective has also helped,” she said.

Tele-abortion

Tele-abortion, which involves meeting with a doctor online who then can write a prescription for abortion pills that can be used to end a pregnancy up to 10 weeks, gained popularity during the pandemic.

But providers subject to state laws — in contrast to those overseas like Aid Access — can only prescribe and dispense medication from states where abortion is legal. So patients have to travel for virtual appointments.

The state-by-state patchwork of bans and restrictions means that people may have to travel long distances to get a medication abortion, said Melissa Grant, chief operations officer of carafem, which operates women’s health clinics in 14 states.

For example, Texas bans abortion outright. South Carolina bans it after six weeks, while Florida does after 15 weeks. How far a person seeking an abortion in those states has to travel depends on how far along they are in their pregnancy and how quickly they can get an appointment.

“When you're living in the deep South or in the middle of the Midwest and everybody around you is also restricted, it means you're driving further and further,” said Grant. People in Texas pregnant less than 20 weeks now have to travel an average of 250 miles each way, according to data from the Guttmacher Institute, a research and policy group focused on reproductive health and abortion rights.

Because of that, people are delaying abortions. That can risk pushing them past the 10 weeks when a medication abortion is an option.

Logistical concerns can also be a factor in where people go. Their choice may have less to do with proximity and more with where they can stay while waiting for medication to arrive. Some people may not feel comfortable ending a pregnancy in a state where it’s illegal and want to stay in one where it’s not until the process is over.

People don’t always need to travel, though. Aid Access, which is sheltered from state prosecution because it is based overseas, sends pills to all 50 states. Additionally, it can mail medication to addresses in states where abortion is legal that is then forwarded to a home address in a state where it’s illegal.

Still, there are potential drawbacks to using Aid Access. For states where abortion is illegal, the organization sends prescriptions to a pharmacy in India and they can take a week or more to arrive, a potential problem for people further along in their pregnancies.

Crossing state lines

Demand is also flowing to traditional abortion providers in states where it’s legal.

The Mount Sinai Hospital in New York City, which deals with complicated pregnancies, saw a big increase in people seeking abortions from out of state even before the Supreme Court decision. Adam R. Jacobs, system director of the Complex Family Planning Division at the Icahn School of Medicine there, traces the uptick to September, when Texas imposed a ban on abortions after six weeks.

Since then, he said his division has seen one patient a week from Texas. In the last month, his doctors have seen five patients from Texas and are starting to take patients from other states that have restricted abortion.

“What we were finding is a lot of patients were coming to New York because they had a family member who lived in the area” with whom they could stay, he said. “That’s cost taken off the table.”

UCLA’s Center on Reproductive Health, Law, and Policy estimates that between 8,000 and 16,100 people will travel to California each year for an abortion with Roe overturned.

To help provide more in-person care, some telehealth providers are offering mobile surgical clinics in states where abortion is likely to stay legal, near a border with a restrictive state.

Just The Pill, a telemedicine abortion group, is sending mobile clinics to Pennsylvania, New Mexico, Illinois and Colorado, states that border regions which restrict abortion. The clinics in Colorado launched the week after Roe fell.

“Our mobile clinics can quickly adapt to the courts, state legislatures and the markets, going wherever the need is greatest,” said Julie Amaon, the group’s medical director, in a statement. “We are undaunted.”