In 2015, the year that Sharon discovered she was pregnant, the landscape of abortion access in the United States was incredibly bleak. Sharon was living in Texas as an international student from Central America. She had no friends or family in the area, and she didn’t know that the emergency contraceptive she’d taken had failed.
In search of help, Sharon, who asked to be referred to by only her first name, landed at a crisis pregnancy center where staff members lied to her about Texas state law and made her look at ultrasound pictures, despite her repeated requests not to see them. The mandatory waiting period and other restrictions forced her to seek care in New Mexico, the nearest state with available appointments.
“The cost [of an abortion] often starts at around $500, and insurance usually can’t help. Not everyone knows about our funds. They are scrambling to raise money, and they might not make that deadline. Fifteen weeks go by in a blink of an eye.”
“I was so desperate to try to raise the money. I was so scared,” Sharon says. The flight, travel, and procedure cost Sharon thousands of dollars, which she frantically worked to secure through hours of phone calls to abortion funds across the country. “I had no friends or support system,” she adds. “It was so difficult.”
After Texas passed S.B. 8 last year, more residents went to Oklahoma for abortion care than any other state. But earlier this month, Oklahoma Governor Kevin Stitt signed a law that will criminalize most abortions once it goes into effect in August. Oklahoma also has a trigger law that will automatically ban abortions if Roe v. Wade is overturned, pending the outcome of the U.S. Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Organization, which is expected to be announced in June.
In the meantime, Republican lawmakers in states across the country have produced a whirlwind of anti-abortion bills. The Guttmacher Institute reports that, since the beginning of this year, at least 536 anti-abortion restrictions have been introduced in forty-two states. Wyoming, for example, recently became the thirteenth state to pass a trigger law similar to Oklahoma’s.
Christine Lichtenfels, a board member of Chelsea’s Fund, a nonprofit organization in Wyoming that helps provide funding for people who need abortions, says the state’s harsh winters and road closures can sometimes impact travel for up to six months. These conditions would create additional hurdles for people seeking abortion care out of state if Roe is overturned.
“It adds to the complications and obstacles people already face, like taking time off of work, organizing childcare and rides,” Lichtenfels says. “The weather factor is incredibly real—it can make it impossible to travel and be terrifying to drive on the roads, even if they are open.”
Wyoming currently has no clinic that offers procedural abortion; the only choice to end a pregnancy is with medication available from a Women’s Health and Family Care in Jackson or via telehealth—which just became possible within the last six months when it was authorized at the federal level. At-home abortion in the state is only available up to ten weeks into a person’s pregnancy, a point at which many people are still unaware that they are pregnant.
Julie Burkhart, founder of Circle of Hope Health Care Services, says 96 percent of Wyoming women live in a county without an abortion provider. In efforts to address this enormous gap of services, Burkhart’s organization is aiming to open a new clinic in Casper by June. “As of now, people in Wyoming seeking an abortion after ten weeks of pregnancy must leave the state to access care,” she says. “People in Casper are currently forced to travel hundreds of miles to places like Fort Collins, Colorado, (about 220 miles from Casper) to get the care they need.”
In Kentucky, lawmakers passed a fifteen-week abortion ban that includes clinic reporting and examination requirements before receiving abortion pills. But on April 21, a federal judge temporarily halted its implementation.
“We were planning to send people to other states, which was our only option prior to the judge issuing the order to halt the ban,” says Erin Smith, executive director of the Kentucky Health Justice Network. “We know it’s going to be a long legal fight and are still very much aware that this is a war going on against abortion access not just in Kentucky but nationwide.”
Additionally, Kentucky lawmakers passed a constitutional amendment that will outlaw abortion, which is slated to appear as a ballot measure in November. Four other states—Alabama, Louisiana, Tennessee, and West Virginia—have also amended their constitutions to prohibit any protections for abortion rights.
Some states are also trying to ban or limit abortion pills, an important option in the absence of clinic access. According to the Guttmacher Institute, 54 percent of abortions in 2020 were by pills. Two states—Indiana and Texas—prohibit the use of medication for abortion during specific points in pregnancy, and nineteen states require the clinician providing the medication to be physically present when it is administered, prohibiting the use of telemedicine.
In the last two months, Louisiana and South Dakota have both advanced bills that criminalize aspects of distributing abortion pills. In Georgia, the state senate recently approved a bill to ban the mailing of pills altogether and require an in-person visit with a physician to perform an ultrasound, something that the U.S. Food and Drug Administration has reiterated is unnecessary.
Fran Sachs, president of the Florida-based abortion fund Emergency Medical Assistance, anticipates that helping Floridians obtain abortions once the state’s fifteen-week abortion ban takes effect on July 1 will be difficult and expensive. “I know firsthand what the impact will be,” Sachs says, “and it’s going to be enormous.”
Only seventeen of Florida’s sixty-seven counties have clinics that provide abortion care.
Legislators in states bordering Florida are just as opposed to abortion, if not more so. As a result, leaving Florida for abortion access would require traveling hundreds, and possibly thousands, of miles, presenting a challenge for aid organizations. “We can’t just send people over the border,” Sachs explains. “We are assuming we will be flying people.”
“The cost [of an abortion] often starts at around $500, and insurance usually can’t help,” she adds. “Not everyone knows about our funds. They are scrambling to raise money, and they might not make that deadline. Fifteen weeks go by in a blink of an eye.”
On the other side of the country, Arizona’s Republican governor, Doug Ducey, signed a bill nearly identical to Mississippi’s fifteen-week ban at the center of the Supreme Court case. The bill explicitly does not overrule Arizona’s currently unenforceable pre-Roe abortion ban, which could be resurrected if Roe is overturned.
Eloisa Lopez, executive director of the Abortion Fund of Arizona, indicates their organization’s preparedness for either outcome. “We already help patients leave the state whenever they need care beyond the current limit or if they have complications,” they say. “We are anticipating a higher volume of patients that are going to need to go out of state.”
With telemedicine prohibited, Arizonians frequently travel 100 miles or more for abortion care. “It’s an astronomical expense as it is,” Lopez says. “With this ban, we are going to make people journey further. Many people will not be able to do that.”
Many of the states that they would typically be sending patients to are currently overwhelmed with patients from Texas. “In the bigger picture, there are many states that are going to have to send folks farther, and that gets really expensive,” Lopez says. “It’s a really tragic thing to think about how many people will be forced to continue an unwanted pregnancy, or those at high risk for complications.”
The new Florida bill allows exceptions through written certifications if two different physicians attest that the termination of a pregnancy is necessary to save the mother’s life or prevent severe injury. An exception can also be made if the fetus has a “fatal fetal abnormality.” This does not cover all serious and life-threatening fetal conditions.
Sachs, who had a wanted pregnancy with a fetal anomaly, expresses how any restrictions still harm pregnant people. “To tell people who are facing those situations that they now have to wait longer and fly out of state and then have to fly home to recover, it’s just mind-boggling,” she says. “I had everything going for me. I can’t imagine how much more difficult it is for the people who don’t.”
Other states that are trying to push through anti-abortion legislation include Ohio, Idaho, West Virginia, and Tennessee. In Kentucky, Smith expects “ripple effects that will impact all pregnant people, families, and communities. I don’t think the public quite understands how serious this will be. This is about reproductive justice, not just abortion.”
This year is shaping up to be a devastating time for abortion rights. As Lopez puts it, “We are moving toward a mass public health crisis for abortion and health care in this country.”