Abortion providers work to shift services to sanctuary states

“They may not have even taken a pregnancy test at home, but the fear, especially — such a monumental potential ruling as this that has a lot of devastating impacts, people really jump to that as soon as they can.”

With this cold, hard look at the potential future, providers are making plans now for how to connect their clients with the services they need, even if that means sending them out of state. Clinics in states that have safeguarded abortion access are adding staff and space to accommodate demand. In fact, they’ve been doing so for some time.

Texas has one of the most restrictive abortion laws in the nation, which prohibits abortion after about six weeks of gestation. The law is enforced through an unusual mechanism that encourages private citizens to sue anyone who “aids and abets” an abortion. Successful lawsuits may be rewarded with $10,000. It was written to be resistant to legal challenges, and courts have refused to strike it down. Other states, including Idaho and Oklahoma, have recently passed similar laws.

On top of these restrictions, Texas and 12 other states have passed so-called trigger laws that go into effect if Roe v. Wade is overturned. The Texas law is set to ban all abortions — except those necessary to prevent serious injury or death to a pregnant person — 30 days after Roe is overturned. Still other states have pre-Roe abortion bans on their books that have not been enforced for the past 50 years but could be if the ruling is stricken.

The reproductive health research organization Guttmacher Institute estimates that 26 states are certain or likely to ban abortions if Roe falls.

“I think we kind of see where this is heading, and as devastating as it is, it is not entirely a surprise, because this has been chipped away over the years,” Mehl said.

Clinics gear up to help people travel

Anticipating new restrictions, Whole Women’s Health launched the Abortion Wayfinder program, which helps people who can’t access services in their states. It turns clinics into de facto travel agencies, as case workers help each client figure out where they can go and how to pay for it.

“We’re able to get them an appointment where they need to go. And we can work closely with both state and national organizations that can help coordinate and, in many cases, fund the actual travel and procedure costs involved,” Mehl said.

Since launching the program in March, Whole Women’s Health has helped about 70 women through the Wayfinder program, the organization said.

Sometimes, if a pregnant person has transportation and can get time off from work, that might mean getting them an appointment at the new Whole Women’s Health clinic in Minnesota. It serves local clients but is also close to the Minneapolis/St. Paul airport and to Interstate 35, which runs from Texas to Minnesota. It’s a 14-hour drive to Minneapolis from Dallas by car and about 21 hours by bus.

The clinic opened in February, and about 30% of the clients there have come from out of state, the organization says.

Most people who seek abortions — 59% — have other children, according to statistics from the Guttmacher Institute, and this kind of travel may not be feasible with young kids in tow. Three-quarters of US abortion patients are poor or low-income and may not be able to afford gas, hotel rooms or time off work.

In those cases, Mehl says, they look for other options, like telemedicine appointments to get abortion pills — which sounds like it might be more convenient but sometimes isn’t.

In 2021, the US Food and Drug Administration eased access to medical abortions by removing requirements that abortion pills be dispensed at in-person appointments, clearing the way for people to get them by mail. The same year, however, Texas made the practice a crime punishable by jail time and a $10,000 fine.

So if a Texan wants a prescription for abortion pills, Mehl says, his group will sometimes help them arrange travel just for a telemedicine appointment.

“If we’re, for example, only able to offer telemedicine services in New Mexico, the patient would need to be in the state of New Mexico to receive those services. So there is an element of travel there in many cases,” he said.

“We’ve had patients from Texas that have driven, sometimes overnight so that they’re not missing any work. They will have a telemedicine visit, and they might drive right back to get back to work. They might have children with them,” Mehl said.

They also have to pick up the pills in New Mexico, so Mehl says people may opt to extend their stay in New Mexico for two or three days, the time it typically takes to get the medicine. “Or some do go and come back, depending on what really makes sense for them.”

Other times, Mehl says, people who are closer to the border with Mexico will go there.

“People actually do look to Mexico, even for being currently more favorable or more accessible even than their own country, which I think really highlights how devastating that access to care really is,” he said.

Abortion providers in so-called sanctuary states like Oregon say more programs like Wayfinder will be needed if the leaked opinion becomes final.

“That’s one of the things I think we need to help facilitate for people is some kind of traffic control,” said Dr. Maria Rodriguez, an obstetrician-gynecologist at Oregon Health Science University and director of the state’s Title X program. Title X is a federal program that offers family planning services to low-income individuals through grants to nonprofit clinics.

“It’s a health condition, people are stressed, and then they’re having to add in all these logistics of financial concerns as well as logistical concerns about travel. It’s a lot. It’s a lot to go through, and it’s a lot of support people need,” she said.

Oregon borders Idaho, which has passed a Texas-style abortion law that prohibits the procedure after about six weeks of pregnancy.

That ban has already increased traffic to clinics in Oregon. It’s one of 16 states, along with the District of Columbia, that have protected abortion rights.

These sanctuary states have been preparing for an influx in people traveling for abortions. Oregon, for example, has created a $15 million fund to help cover the costs of travel and care. The Guttmacher Institute estimates that the state will see a 234% increase in pregnant people traveling there for abortion care.

Rodriguez thinks that figure sounds realistic. “We have people coming in from Texas. We have people coming in from all across the country,” she said.

To prepare, she says, her clinic has added two or three days of operating room time each week.

“We’ve almost probably increased our procedure capacity by 40%, and that’s being filled,” she said.

Her clinic has also been coordinating with independent abortion providers like Planned Parenthood and the Lilith Clinic. Their health-care providers have been getting additional medical licenses in other states so they can offer more telehealth care.

Harms from unwanted births

Rodriguez knows that as much as organizations are trying to ease access, they will not be able to help everyone who needs it. That fact guts her.

“When I was an intern, I used to listen to the attending physicians who are older, talking about what it was like during their training, before Roe v. Wade passed, and they were taking care of just literally wings of women with septic abortions or complications from it in county hospitals. And I always found it kind of like the 1700s, to me, something medieval,” she said. “I can’t believe that now we’re going to experience that again. And I feel terrible that this is the legacy we’re passing on to the next generation.”

Diana Greene Foster, director of research for the Advancing New Standards in Reproductive Health program at the University of California at San Francisco, studied the effects of having or being denied an abortion in nearly 1,000 women over 10 years.

Her research, called the Turnaway Study, was designed to delve into the claim that abortions hurt women. She said it found the opposite to be true: Not getting an abortion when they wanted one increased household poverty and economic insecurity, tethered women to violent partners or increased the likelihood that they would be raising children alone. Women who gave birth were also more likely to have mental and physical harm from the experience than those who had an abortion.

Based on her research, she says, some women won’t be able to clear the hurdles that may soon be in place to access an abortion.

“That’s pretty guaranteed,” Foster said. “It’s just not the case that people always find a way. When it’s illegal, some people won’t be able to get it. And some people won’t successfully order pills online or do something terrible to themselves. They’ll carry that pregnancy to term.”