Interstate Abortion Travel Is Already Straining Parts of the System

The reversal of Roe v. Wade did not affect the legal status of abortion in New Mexico, where seven clinics are still operating. But that does not mean an abortion is easy to obtain there.

The wait times for abortions at five of the clinics have been at least three weeks because of an influx of women from nearby states that have banned or restricted abortion. Some clinics were so full they couldn’t book new appointments. Of the other two, one serves only patients seeking medication abortion before the 11th week of pregnancy, and the other is on the border with Texas, a drive of more than six hours from some parts of New Mexico.

Of all the states, New Mexico has been most affected by interstate abortion travel in making appointments, according to a nationwide survey of clinics by a research team led by Caitlin Myers, a professor of economics at Middlebury College who studies the effects of reproductive policy. But the data suggests that as more bans go into effect, women who need to travel to another state for an abortion may have more difficulty getting appointments. It may even become hard for those living in some states where it remains legal.

In most of the country, the average wait time for abortions before the overturning of Roe was around five days. That has increased only slightly, according to the survey, conducted July 11-14. In cities near states with bans, though, wait times were already starting to get longer, the survey found. Twenty-two percent of such clinics were booking appointments more than three weeks out. In cities farther from states with bans, 8 percent were. Thirteen percent of clinics still openwere unreachable or were so full they were not taking new appointments.

“Even assuming patients can overcome the navigational barriers to get to states where abortion is legal, it is going to be incredibly difficult to provide that care to everyone,” said Dr. Katherine Farris, the medical director for a Planned Parenthood affiliate in the Southeast. On a recent day in Roanoke, Va., she saw patients from six states.

Overbooked clinics could mean patients have to drive farther to find a clinic with an opening, and a variety of research has found that long driving distances decrease abortions, especially for poor women, who may struggle with the costs and complications of long journeys.

But long wait times also mean that more abortions may be done later in pregnancy, a concern for people on both sides of the issue.

Before Roe was overturned, eight in 10 abortions in the United States were done in the first nine weeks of pregnancy — more than half of those in the first six weeks. That is likely to increase as wait times rise, providers and researchers said.

Many abortion opponents say abortions later in pregnancy are more problematic than early ones, one of the drivers behind bans that prohibit abortion after a certain number of weeks. Abortion rights proponents say that forcing women who want abortions to delay having one can be harmful.

For one, as pregnancies progress, there are fewer abortion options. Medication abortion is approved in the United States only for use in the first 10 weeks of pregnancy. Abortions become costlier, more medically complicated and harder to obtain in later pregnancy. Georgia, South Carolina, Tennessee and Ohio now ban abortion after six weeks. The earliest that women generally find out they’re pregnant is four weeks, so long wait times can mean an abortion is unavailable.

Continuing an unwanted pregnancy for weeks can also take a physical and emotional toll on women, said Dr. Lisa Hofler, clinical vice chair for the department of obstetrics and gynecology at the University of New Mexico Center for Reproductive Health, where patients now have to wait six weeks or can’t make appointments at all.

“The goal for patients and for the health care system, from a public health standpoint, is people should be able to access their abortion care as early as possible,” she said.

Mike Seibel, the senior counsel at Abortion on Trial, a New Mexico anti-abortion litigation group, said he worried the long waits could lead to later abortions.

But he says the stream of out-of-state women into his state may help his side persuade the public to consider abortion restrictions in a state where the government has recently expanded abortion rights. “I’m watching the general public of New Mexico,” he said. “And they are not happy about this abortion deluge.”

The Middlebury researchers have contacted every clinic in the country three times this year — in March, June and July, asking for the soonest available abortion appointment for a six-week-pregnant woman. In the latest round, they found availability at 650 of the 701 open clinics (some never answered the phone). Dates were obtained online or by phone. The researchers recorded the date but did not schedule appointments. A week later, The New York Times contacted several of the clinics with long wait times, finding similar trends.

In some states, the strain is concentrated in specific clinics near states with bans. Most Illinois clinics have not yet seen increased wait times. But Dr. Erin King, the executive director for the Hope Clinic for Women near the Missouri border, said wait times there grew to around three weeks — from one or two days — immediately after Roe was overturned. And the clinic has been forced to turn away patients.

“Long term, we can’t all be working 12- or 13-hour days every week,” she said. “We’re all really tired. We’re trying to add new staff, and we’re trying to be mindful that this is a long haul — years, at least.”

The Planned Parenthood affiliate that operates abortion clinics in Nebraska, Iowa and Minnesota expects a 25 percent increase in patients once more bans go into effect, but so far wait times for abortions are the same as they were before Roe was overturned: around three weeks.

In states like these, wait times have always been longer than elsewhere in the country, because many doctors work part-time, and some fly in from other states. When the doctor at the Planned Parenthood in Lincoln, Neb., retired in June, the clinic had to pause services temporarily while it found and credentialed new providers, just as travel from other states increased.

“This is a problem that predates Dobbs,” said Emily Bisek, a Planned Parenthood spokeswoman for the region, referring to the Supreme Court case that resulted in the overturning of Roe. “It is historically difficult to hire physicians in red states like Nebraska, and with the uncertainty about what’s going to happen, we think it may be harder.”

Adrienne Mansanares, the chief executive of the Planned Parenthood affiliate in New Mexico, Nevada and Colorado, said her organization had planned for the surge, yet it was still struggling to meet demand in New Mexico, and she worried about the future in Colorado if more states imposed bans.

“If we don’t expand care and we don’t protect care in the other states around us, it will become completely unbearable over time,” she said.

In New Mexico, though, wait times may improve: Several providers have announced plans to relocate clinics or open new ones. Among those newcomers are Whole Women’s Health, which operated four clinics in Texas, and Jackson Women’s Health Organization, the clinic that brought the initial suit against Mississippi’s state health officer, Thomas E. Dobbs.

Methodology: Professor Myers’s team included 30 college students who tried to contact every clinic in the country on a Monday during each month. They first looked for appointments online and called if there was no online booking tool. When they were unable to speak to a scheduler on a Monday, they made follow-up calls later in the week. The researchers counted five weekdays as a week and 15 weekdays as three weeks. For states that require more than one visit, they added days to the date of the first available appointment to correspond to the state’s waiting period. The students requested appointments for a woman who was six weeks pregnant, and never booked abortion appointments after determining the date of the first available option. Some of the March data was collected by the Texas Policy Evaluation Project at the University of Texas at Austin.