Overturning Roe Has Meant At Least 10,000 Fewer Legal Abortions
Filed under Abortion
The same day the Supreme Court overturned Roe v. Wade in June, Alabama’s law banning abortion took effect. The next morning, phones began ringing in Georgia.
“We got nearly 100 calls the day after the Dobbs decision from patients in Alabama,” said Kwajelyn Jackson, executive director of the Feminist Women’s Health Center in Atlanta. In states where abortion remains at least partially legal the phones haven’t stopped ringing.
Since June, thousands of Americans have crossed state lines seeking abortion, like a pressure wave spreading out from a blast zone. A data set shared exclusively with FiveThirtyEight shows that in the two months after the Supreme Court decision, there were 10,670 fewer abortions as compared to pre-Dobbs estimates. That figure is a net, counting both declines in some states and increases in others, and it shows how a few states are absorbing some — but not all — of the demand for abortions in states where it’s now banned.
The results suggest that in July and August, there were more than 10,000 people who “felt they had no options,” said Ushma Upadhyay, a professor and public health social scientist at the University of California, San Francisco. Along with Dr. Alison Norris, a professor of epidemiology at the Ohio State University, she co-chairs #WeCount, a national research project led by the Society of Family Planning, a nonprofit that supports research on abortion and contraception. “They couldn't travel, and they had to figure out what else to do,” Upadhyay said.
Data compiled by #WeCount is designed to capture state-level information on abortion access in the wake of the Dobbs decision. This first data release compares the number of legal abortions — including surgical and medication abortions — in each month from April to August 2022, showing how the Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision in June has reshaped the abortion landscape.
That topline number conceals an enormous amount of fluctuation between states. In all states that saw declines in their abortion numbers — which include the 15 states in which abortion was banned or severely limited over the summer — the number of abortions fell by about 22,000. Some of those women appear to have traveled out of state, because in other states, the number of abortions rose by an aggregate of about 12,000.
But nationwide, the movement of abortions from states with bans and restrictions to those with fewer restrictions on access wasn’t enough to make up the shortfall. Between April and August, the number of abortions declined by 6 percent, and it’s likely that the decline in abortions represents thousands of women who sought abortions illegally or didn’t get one at all. If these trends persist, there could be at least 60,000 fewer abortions in the next year as a result of the Dobbs decision.
Even before the Dobbs ruling, getting an abortion was often an arduous, time-consuming and expensive process — particularly in Southern and Midwestern states that passed hundreds of restrictions on abortion in the past decade. In 2018, researchers at UCSF identified 27 “abortion deserts” — cities with populations of more than 50,000 where the nearest abortion clinic was more than 100 miles away. Those preexisting reductions in access mean, Norris said, that their data shows a “decline from a very diminished place already.”
The Supreme Court’s decision, though, turned entire regions of the country into abortion deserts. By the end of August, 11 states had banned abortion completely and four more had restricted it early in the first trimester. According to the Guttmacher Institute, at least 66 clinics closed between the Dobbs decision and the end of October.
The #WeCount data suggests that thousands of Americans traveled long distances to obtain abortions in July and August. In just those 15 states where abortion was either banned or became illegal after six weeks in the wake of Dobbs, there was a reduction of approximately 21,000 abortions relative to April and May. In some states with total bans, like Alabama and Mississippi, the number of abortions fell to zero in July; in others, the numbers were drastically reduced but clinics were able to serve reduced numbers of patients due to court orders or slightly less stringent restrictions. Clustered together across the South and Upper Midwest, these states formed blocs where obtaining an abortion required leaving the region, rather than crossing a single border.
That trend began nearly a year earlier, after the Supreme Court allowed Texas to enforce a ban on abortion after about six weeks of pregnancy in September 2021. Patients from Texas are now regularly seen in clinics as far away as Minnesota, and clinics in the lower Plains states began to see a domino effect in appointment scheduling. “Texas was going to Oklahoma and then Oklahoma started coming to us,” said Ashley Brink, director of the Trust Women clinic in Wichita, Kansas. After Oklahoma banned abortion in May, a full month before the Dobbs ruling, Brink said that her clinic ended up with more than 50 percent of the patients coming from out of state.
This kind of pattern has drastically increased wait times nationwide, especially in states — like Kansas — that have picked up the spillover from neighboring states that banned abortion. Caitlin Myers, an economics professor at Middlebury College who studies abortion, has since March been monitoring wait times at clinics in states where abortion remained legal. She found that by early August, only two of Kansas’s five abortion clinics were scheduling appointments, and the first available times were eight and 13 weekdays away. That month, the median wait time in Colorado and New Mexico was over two weeks. Waits for appointments at abortion clinics in southern Illinois were also higher than they were earlier in the summer. In August, 74 percent of patients at Planned Parenthood’s clinic in Asheville, North Carolina, came from outside the state, and the average wait time for a medication abortion was three weeks, according to a recent legal filing.
“Someone who lives three minutes, three miles from our clinic, is struggling to get an appointment and is now getting displaced to Colorado or Illinois,” Brink said. Travel comes with a different set of difficulties: A Texas study conducted in the aftermath of the state’s six-week ban found that some women who left the state delayed rent or bills to cover the cost, or were even fired because of their extended time away from work. And some states, like Kansas and Pennsylvania, still require prospective abortion patients to comply with waiting periods and other logistical hurdles.
A likely consequence of longer wait times and travel distances is more abortions later in pregnancy. The Centers for Disease Control and Prevention estimate that only 7.7 percent of all abortions happen between the 14th and 20th week of pregnancy. But between 20 and 30 percent of current patients are in the second trimester at Whole Woman's Health of Minnesota, a clinic located in a state where abortion is legal until the point of fetal viability around 25 weeks, according to Sean Mehl, Whole Woman's assistant director of clinical services.
Despite the traffic jams backing up service in clinics, the #WeCount data shows that the number of abortions nationwide did briefly increase in the weeks before the Dobbs ruling, as clinics across the country crammed patients into their schedules, accomodating as many as possible while abortion remained legal nationwide. Although abortion rates usually dip a bit during the summer, the number of abortions this year rose 4 percent from May to June.
In Georgia, where there was no trigger law but where restrictions were almost certainly imminent, clinics kept up that pace after Dobbs for as long as they could. According to the #WeCount data, abortions in Georgia declined only 6 percent from June to July, despite the fact that a federal court allowed the state’s six-week abortion ban to go into effect on July 20. The number of abortions dropped by more than 50 percent from July to August.
Where abortion remains legal, some abortion providers have been able to increase capacity. Staffing wasn’t an issue for Whole Woman’s Health in Minnesota or Trust Women in Kansas — by the summer, they were flying in doctors from across the country to fill in their schedules, with more people reaching out to see if they could volunteer. “Since Dobbs, our Minnesota clinic has seen about a 50 percent increase in overall patients,” Mehl said. Virtual abortion providers, which can prescribe abortion pills online in the states where it’s legal to do so, also ramped up their medication abortion services. The #WeCount researchers found that the number of abortions offered through online-only clinics — not counting telehealth abortions offered through brick-and-mortar facilities — increased by 33 percent between April and August.
Some women may also be getting abortions without any clinic or doctor being involved — although those numbers are hard to track. The #WeCount data counts only legal abortions, which means it’s almost certainly underestimating the total number. Even before Dobbs, activist groups and online pharmacies were providing abortion pills directly to consumers through the mail. By July, Mexican activists were already reporting that they were inundated with requests for abortion pills from women all over the U.S.
But it’s also likely that some people who might have gotten an abortion in the pre-Dobbs era are simply carrying their pregnancies to term. And while that is a victory for anti-abortion advocates, the #WeCount researchers noted that there is substantial evidence that being denied a wanted abortion puts people at an increased risk of poverty, physical abuse and certain health problems. They’re also keeping an eye on whether maternal and infant mortality will increase in states with abortion bans — particularly since those states tend to have higher-than-average rates of deaths from pregnancy complications.
And Norris said it’s possible that out-of-state travel might get more difficult as time goes by. Abortion funds raised millions of dollars in the aftermath of Dobbs, which may have made it more possible for women to travel than it was in the past. But over time, volunteers’ enthusiasm or financial support to organizations like abortion funds might start to ebb. “We don’t know if it’s sustainable,” Norris said. And with more states poised to implement abortion bans in the next few months, the numbers from this report are just an early signal of a future where abortions could be even more scarce.
UPDATE (Nov. 1, 12:23 p.m.): After publication, #WeCount updated its topline estimate for the change in how many people were able to obtain abortion care in the two months following the overturning of Roe v. Wade. The number is now 10,670, not 10,570, after the organization accounted for rounding in state-level estimates.