The average travel time to an abortion facility increased significantly for women in the United States after the Supreme Court overturned Roe v. Wade and repealed the federal right to abortion, according to a new study published Tuesday in JAMA.
More than a dozen states enacted complete or partial abortion bans following Dobbs v. Jackson Women’s Health Organization, and researchers found abortion facilities in those states to be inactive, reducing the number of active facilities by one-tenth.
This drop in active facilities means that one-third of women of reproductive age in the United States live more than an hour from the nearest abortion facility, more than twice as much as before the bans were enacted. And the average travel time to get an abortion more than tripled, from less than half an hour to more than an hour and a half.
“No one should have to travel outside their community to get the health care services they need,” said Rachel Hardeman, a researcher and professor at the University of Minnesota School of Public Health who focuses on reproductive health equity but was not directly involved in the investigation. “Certainly, the complexity of having to travel up to an hour away from your home to receive health care is a significant burden.”
For women in Texas and Louisiana, the average travel time to the nearest abortion facility was seven hours longer, adding almost a full workday to an abortion.
“When the Dobbs decision came down, I think a lot of people thought, ‘Oh, they can go to another state to get an abortion.’ travel to make these long journeys,” said Ushma Upadhyay, a professor at the University of California, San Francisco’s Bixby Center for Global Reproductive Health.
Barriers such as extra time at work, childcare arrangements, travel costs and the procedure could be “insurmountable”, she said. “It means abortion care will be impossible for many people.”
Overall, the Supreme Court’s decision adds the most significant barriers to access for black, Hispanic, and American Indian women. With more facilities inactive, 1 in 4 black women and 1 in 5 Hispanic and American Indian women have to travel more than an hour to an active abortion facility. Uninsured women and those with lower incomes also continue to have little access to abortion facilities, according to the study.
“The United States is the only industrialized nation with a rising maternal mortality rate, and black people are at greater risk, three to four times more,” Hardeman said.
“We can’t separate that data and reality from abortion bans. It’s important to think about the ripple effects.”
A separate analysis released Friday by #WeCount, a research project led by the Society of Family Planning, a nonprofit that supports abortion and contraception research, found that there were at least 10,000 fewer abortions in the two months after decision of the Supreme Court to annul. Roe v. Wade: A 6% drop in August compared to April.
In states that implemented a ban or severe restrictions, legal abortions dropped by 95%. But in states where abortion remained legal, abortions increased by only 11%.
“Increases in protected access states were not enough to offset losses in no-access states,” said Upadhyay, who co-authored the JAMA study and the #WeCount analysis. “Together, these results point to a large unmet need for abortion care.”
The women who fall into this gap are the ones who have the least ability to travel, she said. They are more likely to be teenagers, immigrants, people who suffer intimate partner violence and people with young children.
“It is more likely that they will self-manage their abortion or delay their care and others will be forced to carry their unwanted pregnancy to term against their will.”
Another study published in JAMA on Tuesday similarly suggested how abortion care patterns may change after the Supreme Court decision.
In September 2021, nearly a year before the Supreme Court’s Dobbs decision, Texas restricted abortions after detection of heart activity in the embryo or fetus.
In the month after this law was enacted, abortions in the state dropped more than 50%, and five times as many Texas residents had abortions across state lines, most often in Oklahoma. But even with the increase in Texas residents seeking out-of-state abortions, abortions overall still declined.
Abortion facilities in neighboring states had more limited capacity and “saw the challenge of absorbing a sudden increase in patients, which could have contributed to long waits for appointments and pregnant Texas residents seeking abortions later in pregnancy.” , the researchers wrote.
“We know that when people decide they want an abortion, they are safe and want an abortion as soon as possible,” Upadhyay said.
In 2020, medical abortion was used in more than half of abortions in the United States, according to an analysis by the Guttmacher Institute, a reproductive rights advocacy group. But federal guidance only approves the use of medical abortion up to 10 weeks of pregnancy.
“Time is of the essence,” Upadhyay said.
But many clinics in states where abortion is still legal now have at least a two-week waiting list, he said. And people who live in those states where abortion is still legal have to delay their care, too.
Before the Supreme Court’s ruling, about one in 10 patients Planned Parenthood of the Rocky Mountains saw for abortions were from out of state, according to data shared with CNN. But now, more than one in three are from out of state, and most are from Texas.
In all of 2021, about 1,500 out-of-state patients traveled to the region for abortion care. By late summer 2022, more than 300 out-of-state patients had scheduled abortion appointments each week.
Average wait times for first-trimester abortions went from less than two weeks to more than three weeks. And local Colorado residents had an additional four days added to their average wait times.
“Seeing the magnitude of the number of lives that this data represents is truly devastating,” Upadhyay said. “These are human lives that will be affected forever.”