Updated on April 23, 2020:

Added Arkansas, Louisiana and Tennessee to the Individual States section; added new section on the impact of simultaneous bans in multiple states.


Updated on April 8, 2020:

Added a table with state-level data on the potential impact of state-wide clinic closures.

First published April 2, 2020:

As states around the country grapple with the COVID-19 pandemic, some antiabortion politicians are callously exploiting the current crisis to try to shut down access to essential and time-sensitive abortion care. These states have a long history of trying to shut down abortion care by implementing a variety of restrictions and are considered hostile to abortion.

Leading medical experts, including the American College of Obstetricians and Gynecologists, have made it abundantly clear that abortion is essential health care. Abortion cannot be delayed without risking the health and safety of the patient.

Using the current public health crisis to target abortion is a ruthless move that reveals just how far some politicians will go to limit reproductive freedom and autonomy. Court challenges are underway in several states to block these unconstitutional attacks from going into effect.
 

Increases in Driving Distances

Our new analysis for states that are potentially affected reveals one dramatic impact of these actions: If allowed to stand, they would force people to travel much further to reach the nearest abortion clinic. This creates a significant new barrier to obtaining care, further compounding the web of other barriers and restrictions those seeking an abortion already have to navigate. It would undoubtedly prevent some individuals from obtaining an abortion and, for some people still able to access care, it would result in more second-trimester abortions.

The burdens imposed by these COVID-19 abortion bans would be further compounded if the state to which someone travels has an in-person counseling requirement followed by a waiting period, which could require patients to make multiple trips or arrange for multiday stays out of state. If the second state also has few abortion clinics, patients may be delayed in accessing care because of a lack of capacity.

The greater the increase in travel distance, the greater the hardship it causes, and the more likely it becomes that some individuals will not be able to get abortion care at all.

Under ordinary circumstances, the burdens of extended travel can be difficult for people seeking abortion care to overcome. Such burdens include time away from work, lost wages, and the added costs and challenges of securing child care, lodging, and adequate and accessible transportation, to name just a few. Forcing people to overcome these challenges places unconscionable burdens on their access to constitutionally protected care, and the consequences are felt the most by people already struggling to make ends meet and those who are marginalized from timely, affordable health care.

Of course, these are not ordinary circumstances. Extended travel, or any travel, during the COVID-19 crisis flies in the face of basic public health recommendations and, in some cases, legal orders. In addition, the above challenges are all exacerbated by unprecedented financial constraints, school closures and limited child-care options. For some populations, like young people or those who experience violence in their home, extended travel may be impossible now that family members and housemates are at home full time.

The states listed below are ones where policymakers have attempted to shut down abortion clinics because of COVID-19, and the analyses below are based on the most recent Guttmacher data available. Additional methodological details are provided at the end.

The data included in the attached table show the increase in average (median) one-way driving distance to an abortion clinic that would result if all abortion clinics in the state were closed and patients were forced to drive to out-of-state clinics. The table also provides data on the driving distance for patients living in the county in each state that would be farthest from a clinic and the percentage of women aged 15–44 in the state needing to drive more than 100 miles, if all clinics in the state were to close. Finally, the table includes contextual information about the number of women of reproductive age (15–44) in the state, the number of abortion clinics in the state, and whether the state is considered hostile to or supportive of abortion rights, based on Guttmacher’s analysis of state policies.

Individual States

 

Alabama

  • The average (median) one-way driving distance to an abortion clinic for a woman of reproductive age (15–44) in Alabama would increase from 26 miles to 108 miles (or 315% longer) if legal abortion care in the state were shut down.
  • There were 953,000 women of reproductive age in Alabama in 2018.
  • There were five abortion clinics in Alabama in 2017, down from six clinics in 2011.
  • Alabama is considered “Hostile” to abortion rights.

 

 Arkansas

  • The average (median) one-way driving distance to an abortion clinic for a woman of reproductive age (15–44) in Arkansas would increase from 48 miles to 128 miles (or 167% longer) if legal abortion care in the state were shut down.
  • There were 585,000 women of reproductive age in Arkansas in 2018.
  • There were three abortion clinics in Arkansas in 2017, the same number as in 2011.
  • Arkansas is considered “Very Hostile” to abortion rights.

 

Iowa

  • The average (median) one-way driving distance to an abortion clinic for a woman of reproductive age in Iowa would increase from 28 miles to 139 miles (or 396% longer) if legal abortion care in the state were shut down.
  • There were 597,000 women of reproductive age in Iowa in 2018.
  • There were eight abortion clinics in Iowa in 2017, down from 17 clinics in 2011.
  • Iowa is considered “Leans Hostile” to abortion rights.

 

Kentucky

  • The average (median) one-way driving distance to an abortion clinic for a woman of reproductive age in Kentucky would increase from 69 miles to 109 miles (or 58% longer) if legal abortion care in the state were shut down.
  • There were 852,000 women of reproductive age in Kentucky in 2018.
  • There was one abortion clinics in Kentucky in 2017, down from two clinics in 2011.
  • Kentucky is considered “Hostile” to abortion rights.

 

Louisiana

  • The average (median) one-way driving distance to an abortion clinic for a woman of reproductive age in Louisiana would increase from 41 miles to 172 miles (or 320% longer) if legal abortion care in the state were shut down.
  • There were 926,000 women of reproductive age in Louisiana in 2018.
  • There were four abortion clinics in Louisiana in 2017, down from seven clinics in 2011.
  • Louisiana is considered “Very Hostile” to abortion rights.

 

Ohio

  • The average (median) one-way driving distance to an abortion clinic for a woman of reproductive age in Ohio would increase from 15 miles to 120 miles (or 700% longer) if legal abortion care in the state were shut down.
  • There were 2.2 million women of reproductive age in Ohio in 2018.
  • There were nine abortion clinics in Ohio in 2017, down from 18 clinics in 2011.
  • Ohio is considered “Hostile” to abortion rights.

 

Oklahoma

  • The average (median) one-way driving distance to an abortion clinic for a woman of reproductive age in Oklahoma would increase from 14 miles to 155 miles (or 1,007% longer) if legal abortion care in the state were shut down.
  • There were 775,000 women of reproductive age in Oklahoma in 2018.
  • There were four abortion clinics in Oklahoma in 2017, an increase from three clinics in 2011.
  • Oklahoma is considered “Hostile” to abortion rights.

 

Tennessee

  • The average (median) one-way driving distance to an abortion clinic for a woman of reproductive age (15–44) in Tennessee would increase from 26 miles to 119 miles (or 358% longer) if legal abortion care in the state were shut down.
  • There were 1,324,000 women of reproductive age in Tennessee in 2018.
  • There were eight abortion clinics in Tennessee in 2017, down from nine clinics in 2011.
  • Tennessee is considered “Hostile” to abortion rights.

 

Texas

  • The average (median) one-way driving distance to an abortion clinic for a woman of reproductive age in Texas would increase from 12 miles to 243 miles (or 1,925% longer) if legal abortion care in the state were shut down.
  • There were 6 million women of reproductive age in Texas in 2018.
  • There were 21 abortion clinics in Texas in 2017, down from 46 clinics in 2011.
  • Texas is considered “Hostile” to abortion rights.
  • Also, see this March 2020 Texas Policy Evaluation Project research brief that analyzes the impacts of a statewide ban on abortion care in Texas.

State Clusters

The burdens imposed by a COVID-19 abortion ban are compounded when more than one state is taken into account. If other states, particularly adjoining states, also exploit the COVID-19 crisis by seeking to stop abortion care, the harmful impact would increase significantly and women of reproductive age in each affected state would face even longer travel distances to reach the nearest abortion clinic.


Alabama, Arkansas, Iowa, Kentucky, Louisiana, Ohio, Oklahoma, Tennessee and Texas

Some states have spent the weeks since statewide closures were announced in litigation over their attempts to ban abortion during this pandemic. If legal abortion care were shut down in eight states where lawsuits have been filed to oppose a COVID-19 abortion ban—as well as in Kentucky, which has also been public in its efforts to ban abortion—the average (median) one-way driving distance to the nearest abortion clinic for a woman of reproductive age from each respective state would change as follows:

  • Alabama: Increase from 26 miles to 134 miles (or 415% longer).
  • Arkansas: Increase from 48 miles to 265 miles (or 452% longer).
  • Iowa: Increase from 28 miles to 139 miles (or 396% longer).
  • Kentucky: Increase from 69 miles to 144 miles (or 109% longer).
  • Louisiana: Increase from 41 miles to 189 miles (or 361% longer).
  • Ohio: Increase from 15 miles to 122 miles (or 713% longer).
  • Oklahoma: Increase from 14 miles to 182 miles (or 1,200% longer).
  • Tennessee: Increase from 26 miles to 208 miles (or 700% longer).
  • Texas: Increase from 12 miles to 447 miles (or 3,625% longer).

Methodology


We computed one-way driving distance from county population seats to the nearest health facility providing abortion care for all U.S. counties. We weighted each county by the number of women aged 15–44 living in it to compute state medians. Roughly half of the women within a state live within, and roughly half live farther than, this distance from the nearest provider. Data for 48 states are available here.

The analysis was carried out in R 3.6.2 and Open Source Routing Machine 5.22.0 using data from OpenStreetMap, the Guttmacher Institute’s 2017 Abortion Provider Census and the U.S. Census Bureau.