All people deserve access to quality health care—including abortion services—in or near their communities. However, fewer and fewer Americans are able to get abortion care in their own state. According to the latest data from the Guttmacher Institute’s Monthly Abortion Provision Study, the proportion of patients traveling to other states to obtain abortion care has doubled in recent years, reaching nearly one in five in the first half of 2023, compared with one in 10 in 2020.* This surge in travel has largely been driven by post–Roe v. Wade abortion bans and restrictions.
The Monthly Abortion Provision Study data are the first to quantify the extent to which people are traveling across state lines for abortion care, following the June 2022 Dobbs v. Jackson Women’s Health decision that ended Roe and led to the complete banning of abortion in more than a dozen states. The findings show large increases in patients traveling to states that border those with abortion bans and minimal increases in people traveling to states in regions of the country where abortion access remains largely protected.
Many states have passed policies to protect and expand abortion access in the wake of the Dobbs decision, and providers and support networks across the country have made heroic efforts to meet the needs of the growing numbers of people traveling for abortion. However, it will be an ongoing challenge for clinics and support networks to extend their capacity to meet this need. Urgent and sustained policy interventions are required to protect abortion access and meet patients’ needs as states continue banning and restricting abortion.
A Stark Increase in Patient Travel
Prior to Dobbs, patients traveled for abortion care for an array of reasons, including legal barriers, like bans later in pregnancy or parental involvement requirements; practical barriers, such as a lack of nearby providers in their state; and simple geographic proximity to clinics just across state lines. In 2023, however, the increase in interstate travel for abortion is largely due to the bans and restrictions that took effect in the wake of Dobbs: Patients have been increasingly forced to travel to get care because abortion services within the formal health care system are no longer available in their home states.
Practical support efforts have facilitated the increase in interstate travel for abortion by helping individuals overcome financial and logistical challenges to care. Grassroots abortion funds that help people cover the direct and indirect costs of abortion care have reported that need for financial support has increased substantially in recent years—both in states that do and do not have severe abortion restrictions. For example, the Baltimore Abortion Fund distributed almost three times the funds in 2022 as in 2021, and the National Network of Abortion Funds also estimated that their disbursements to callers seeking support tripled in the year after Dobbs. Other types of support networks—offering services such as transportation to appointments, pro bono legal support and abortion doula care—were started or expanded in communities across the country during the same period. These networks are a huge part of making it possible for people to travel, and yet this largely volunteer-based model is not sustainable without large shifts in financial support.
The data on out-of-state travel do not capture the experiences of people for whom abortion bans or increased restrictions have proven impossible to navigate. Travel for abortion may not be tenable for a host of often interrelated reasons—including financial hardship, disability, fear of repercussions, and systemic challenges related to persistent racial and economic oppression. Those who can neither obtain an abortion in their home state nor travel for care are forced to either remain pregnant or self-manage their care (for instance, by procuring abortion pills by mail). Although self-managed medication abortion is safe, effective and preferred by some people, no one should be forced to go outside the formal health system to obtain care. And although the method is legal in nearly every state, individuals—particularly those from communities that are already disproportionately targeted by the criminal justice system—may nonetheless face the threat of criminalization by police and prosecutors who misuse existing laws.
States Patients Are Traveling To
Nationally, the number of people who crossed state lines to obtain abortion care more than doubled, reaching 92,100 in the first six months of 2023, compared with 40,600 in half of 2020. People traveling for care are mainly traveling to states that border states with total abortion bans or bans that begin early in gestation. The following examples illustrate how that pattern has played out in several states† that have seen increases in interstate travel for abortion in the first half of 2023, as compared with a similar period in 2020:
Illinois experienced the largest increase, by far, in the number of patients traveling from out of state for abortion care. The state, which borders three states with total abortion bans (Indiana, Kentucky and Missouri), permits abortion prior to fetal viability and allows a range of qualified health care professionals, not just physicians, to provide abortion care. Illinois has also implemented a “shield law” that protects abortion providers in the state from investigations and criminal prosecution from other states.
Number of patients traveling from out of state who obtained care in Illinois, January–June 2023: 18,870
Increase since 2020 in patients coming from out of state: 13,300 (from 21% in 2020 to 42% in 2023)
Increase since 2020 in abortions provided in the formal health care system: 18,700 (71% of which is attributable to increased travel from out of state)
New Mexico experienced one of the largest increases in interstate travel for abortion. The state, which borders two states with total abortion bans (Oklahoma and Texas), does not restrict abortion based on gestational age, allows a range of qualified health care providers to provide abortion care and has implemented a shield law.
Number of patients traveling from out of state who obtained care in New Mexico, January–June 2023: 8,230
Increase since 2020 in patients coming from out of state: 7,100 (from 38% in 2020 to 74% in 2023)
Increase since 2020 in abortions provided in the formal health care system: 8,200 (87% of which is attributable to increased travel from out of state)
Colorado is another state that experienced an increase in interstate travel, likely because of its protective policies and proximity to restrictive states: Nebraska, which bans abortion after 12 weeks; Oklahoma, which completely bans abortion; and Utah, which bans abortion after 18 weeks and requires patients to make two trips to the clinic 72 hours apart. Colorado has no abortion restrictions based on gestational age, allows a range of qualified health care professionals to provide abortion care, has a shield law, and has protections against physical harm and harassment for individuals entering abortion clinics.
Number of patients traveling from out of state who obtained care in Colorado, January–June 2023: 3,990
Increase since 2020 in patients coming from out of state: 3,100 (from 13% in 2020 to 31% in 2023)
Increase since 2020 in abortions provided in the formal health care system: 6,200 (50% of which is attributable to increased travel from out of state)
Florida represents a unique situation: Although abortion access is quite difficult within the state, the state nonetheless saw an increase in the number of out-of-state patients because access is much worse in surrounding states: Abortion is banned in the nearby states of Alabama, Arkansas, Louisiana and Mississippi, and is banned after six weeks in Georgia. In Florida, however, abortion is allowed up to 15 weeks, although restrictions, including mandatory counseling that requires patients to make two trips separated by a 24-hour waiting period, also complicate access. A case currently in front of Florida’s state Supreme Court will soon determine whether a six-week ban can go into effect; if it does, such a ban could drastically reduce abortion access for the entire Southeast.
Number of patients traveling from out of state who obtained care in Florida: 5,780
Increase since 2020 in patients coming from out of state: 3,700 (from 5% in 2020 to 13% in 2023)
Increase since 2020 in abortions provided in the formal health care system: 5,700 (65% of which is attributable to increased travel from out of state)
Ohio, another state that experienced an increase in out-of-state travel, borders three states with complete bans (Indiana, Kentucky and West Virginia). In November 2023, Ohio residents demonstrated unwavering support for reproductive freedom by passing constitutional protections for reproductive decisions, including abortion. This contrasts with a policy environment that restricts abortion rights in a number of ways, including by banning abortion after 22 weeks and necessitating two clinic trips by requiring counseling 24 hours prior to an abortion.
Number of patients traveling from out of state who obtained care in Ohio, January–June 2023: 1,610
Increase since 2020 in patients coming from out of state: 1,000 (from 6% in 2020 to 14% in 2023)
Increase since 2020 in abortions provided in the formal health care system: 700 (100% of which is attributable to increased travel from out of state)
Some states that have protective abortion policies have seen little or no increase in out-of-state patients—likely because they border other protective states. Still, their policies have proven pivotal in this post-Dobbs reality. For example, although New York had 13,600 more abortions in 2023 than in 2020, increased travel from out of state accounted for only 7% of that increase. Similarly, in California, abortions increased by 15,200, and just 16% of these were attributable to out-of-state travel. Both states have enacted protective policies that have increased access to and availability of care within these states.
Impact of New Bans in South and North Carolina
Abortion bans not only decrease abortion access within a state; they ensure that people who would have traveled from other states for care no longer have that option. The harm of abortions bans is amplified in parts of the United States, such as the Southeast, where most states have enacted bans and other severe restrictions. Recent Monthly Abortion Provision Survey data from South Carolina and North Carolina help to illustrate the compounding effects of bans on neighboring states.
In South Carolina, the number of abortions provided in the formal health care system decreased by 79%—from 750 in August 2023 to 160 just one month later—after the state started enforcing a ban on abortions after six weeks’ gestation on August 23, 2023. South Carolina had become a reliable source for abortion care in the region in the post-Dobbs era: The proportion of abortions provided to patients traveling from out of state increased from 3% in 2020 to 42% in the first six months of 2023. Overall, there were 3,200 more abortions in South Carolina during that time, and the increase in interstate travel accounted for 75% of that increase. Unfortunately, the new six-week ban not only severely restricts access to abortion for South Carolina residents, but it also limits what care is available to neighbors who live in bordering states where abortion has been totally banned.
This South Carolina ban comes on the heels of new restrictions in North Carolina that went into effect on July 1, including a ban on abortions occurring after 12 weeks’ gestation and a requirement for in-person counseling at least 72 hours before an abortion. After the ban, the number of facility-based abortions in North Carolina declined sharply, by 31% from June to July, a decline that was sustained through August. In September, however, the number of abortions then rose slightly by about 600. The increase is likely due to the recent restrictions in South Carolina, which are more severe than the restrictions in North Carolina, where even with a waiting period as a barrier, people can generally access care a bit later into their pregnancies.
Restrictions across Southeastern states—including these new bans—make it particularly hard for residents of the region to travel for abortion care. Travel to Virginia and Florida remain options for now, but if Florida’s impending court decision allows that state’s six-week ban to go into effect, access to abortion care in the formal health care system will be all but eliminated across huge swaths of the Southeast.
Policy Action to Shore Up Access
The large increase in people traveling across state lines to obtain an abortion underscores the great efforts people will put forth to obtain the care they need, and these data prove that many people are successful in getting care in the face of restrictive abortion policies that endanger their health and well-being. At the same time, the data help to quantify the damage done by restrictive policies: Pregnant people are being forced to travel across state lines to get an abortion because access has been eroded or eliminated in their state.
And while many pregnant people are successful in getting the care they need, access to care for millions of people hangs by a thread. Anti-abortion activists are seeking to further restrict access to abortion services, and many are doubling down on restrictive policies to prevent or interfere with travel for abortion. For example, a number of localities in Texas have attempted to ban travel for abortion care. Although it is unlikely that these bans could be effectively enforced or pass legal challenge, they dissuade patients from seeking care, especially as criminalization of pregnancy outcomes continues to increase. Policies that seek to curb travel will become even more dangerous if the current model of grassroots support for people seeking abortion care is not fully supported and sustained so that it can continue to meet demand.
From state policy solutions to executive actions and Congressional support for the Women’s Health Protection Act, the EACH Act and the Abortion Justice Act, strong public policies are a critical step on our path forward. As long as travel rates remain high, states receiving large numbers of out-of-state abortion patients must actively ensure they can welcome those who need care. Policymakers at all levels must do what they can to remove any existing restrictions, expand and strengthen the provider pool, ensure public and private insurance coverage of abortion care, enact shield laws, ensure data privacy for patients, provide funding and financial support for providers and clinics, and promote public awareness of the abortion care and supportive services that are available.
At the same time, proactive policies can never overcome the fact that states banning abortion have actively eroded the health and rights of their residents. People crossing state lines to get care face financial and emotional costs that cannot become the new normal. We must reimagine legal, policy and movement-building solutions that ultimately ensure abortion accessibility for all.