By Lisa Jarvis / Bloomberg Opinion
The number of abortions slightly increased in the U.S. in the first year after the Supreme Court overturned Roe v. Wade and allowed a wave of strict bans to go into effect across the country.
The modest rise could be interpreted in many different ways, depending on someone’s political leanings. An abortion rights supporter might view the data as clearly showing that bans on abortions don’t eliminate the need for them. A states’ rights proponent might think the outcome proves their point: People are free to go elsewhere to seek care, and the data show they did. And, of course, a staunch abortion opponent might look at the results as evidence that a nationwide ban is needed.
Yet none of those simplistic views reflects the reality of what it took to maintain abortion access in the U.S. after the Dobbs v. Jackson ruling in June 2022. The data belie a gargantuan and potentially unsustainable effort to connect women with providers. And the story on access is still being written in legal battles across the country.
According to a new report from the #WeCount project at the Society of Family Planning, the number of abortions in the U.S. increased by about 2,000 between June 2022 and June 2023 compared with the prior 12-month period.
“Someone could superficially look at the data and say, ‘There’s no problem here,’” says Ushma Upadhyay, a professor at the University of California, San Francisco, and chair of the #WeCount project. But the data don’t show the intense work going on behind the scenes to ensure women in states with bans can still access health care.
Take, for instance, the massive effort to help women travel for abortion care. Illinois, which saw the biggest increase in abortions in that first post-Dobbs year, has become the obvious destination for women in the Midwest and South. But the incredible logistical and financial task of getting people to the state may not be sustainable; nor a reasonable substitute for access to care in one’s own town.
Planned Parenthood of Illinois, for example, says that average per-patient travel costs have nearly doubled from $250 to $475, and that it has provided some $2.1 million in financial support for patients since the Dobbs decision.
The Chicago Abortion Fund has fielded more than 14,000 support requests since the Dobbs decision, dispensing more than $4.5 million to people who need help with everything from train or plane tickets to hotels, meals and child care. “That’s a staggering amount when our organizational budget five years ago was about $270,000,” says CAF Executive Director Megan Jeyifo.
Travel is only likely to get more expensive as some of last year’s “refuge states” impose bans. North Carolina, for example, performed an extra 11,830 abortions in the first 12 months post-Dobbs. But in July, a ban on abortions after 12 weeks of gestation went into effect, along with more onerous requirements for earlier abortions that make it harder for out-of-staters to receive care there. Provisional data from the Guttmacher Institute show that in the first month following the ban, facility-based abortions declined by 31 percent, amounting to about 1,310 fewer abortions.
If the Florida Supreme Court upholds that state’s 15-week ban, Gov. Ron DeSantis has promised to put a more draconian six-week ban into effect within weeks. Florida saw nearly as big of a post-Dobb bump in abortions as Illinois, thanks to its position in the Deep South.
For Illinoisans, a six-week ban in the Sunshine State would create a daunting number of people seeking care in the Land of Lincoln. “We haven’t had to turn anyone away since summer of 2019 and that’s what keeps you up at night: How much longer can we do that?” Jeyifo says.
Meanwhile, states with total bans are passing laws to punish anyone who helps a woman travel out of state for an abortion. This week, Lubbock became the largest county in Texas to introduce an ordinance that would allow private citizens to file civil suits against someone who assists in abortion-related travel. Some states are threatening criminal prosecution for aiding someone seeking an abortion. While the legality of such measures is in question, their mere existence has a chilling effect.
The ripple effects that abortion bans can have on other areas of health care also can’t be ignored. Researchers from Boston Children’s Hospital recently found that states with the most restrictive stance on abortion had higher county-level rate of infant deaths; a conclusion drawn from pre-Dobbs-era data. The authors fear that rate could worsen with the wave of restrictive laws. Early data out of Texas show that after infant mortality rose by 11.5 percent after it instituted a six-week ban on abortions, upending an eight-year decline in deaths.
Another thing that bans could worsen is the country’s abysmal rate of maternal mortality. One report found that before Dobbs, the maternal death rate was 2.4 times higher in states with abortion restrictions than in those without. That gap could easily widen. The Dobbs ruling is already driving some OB-GYNs out of states that have introduced draconian bans. That’s making all reproductive health care — including obtaining birth control, getting pap smears, and giving birth — increasingly hard to find in rural areas.
All of this means that the next post-Dobbs year, and the ones after it, could look a lot different than the first one; not just for abortion care, but for women’s overall health.
Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.
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