Abortion providers in California and Virginia are preparing for a prolonged increase in the number of out-of-state patients they see as the latest near-total abortion bans take effect across the country.
Interstate abortion travel has grown in the aftermath of the US Supreme Court’s 2022 decision in Dobbs v. Jackson Women’s Health Organization as states implemented gestational limits and other abortion restrictions.
The percentage of out-of-state patients jumped in Virginia after Florida’s six-week abortion ban took effect earlier this month. With the possibility that Arizona’s 1864 law criminalizing nearly all abortions could temporarily go into effect in the fall, California officials and health facilities are taking measures to allow Arizona abortion providers and patients to practice and receive abortion care in California.
Planned Parenthood and other providers say they’ve prepared for this situation by increasing telehealth services, hiring more staff, and developing services to help patients locate legally available abortion care. Medical professionals and policy researchers, however, say the longer that some US regions are dependent on a small number of states for abortion care, the more likely it is to overwhelm health systems, worsen maternal health outcomes, and exacerbate existing health-care access disparities.
States like California and Virginia are “definitely stretched as far as having enough providers and just having enough time in the day to see the number of patients that they’re receiving from out of state,” said Brittni Frederiksen, an associate director for women’s health policy at KFF.
California
California abortion providers have their eyes on September, when many of the more than 1,000 patients who seek abortions each month in Arizona could have to cross state lines to receive care.
The Arizona Supreme Court ruled in April that the state can implement a Civil War-era abortion ban, but issued a stay May 13 on the law’s enforcement through Aug. 12. Due to this and an additional 45 days stipulated in a separate case, the earliest the 1800s law could take effect is Sept. 26, Arizona Attorney General Kris Mayes (D) said.
The Arizona legislature voted to repeal the 1864 law, but this won’t take effect until 90 days after the state legislative session’s end—a date that’s up in the air due to ongoing budget negotiations. This means there could still be a window where the 19th century law is in effect, leaving abortion care largely unavailable in the state.
In California, abortion is a protected right in the state constitution until fetal viability, or roughly 24 weeks into pregnancy.
California Gov.
The Los Angeles County Board of Supervisors also recently approved a motion to extend reproductive health services to Arizona residents.
Pratima Gupta, a San Diego-based OB-GYN and fellow at the health advocacy group Physicians for Reproductive Health, sees Arizona abortion patients almost daily.
Gupta said she and other California abortion providers “are grateful that there is a pause on the Arizona abortion ban,” but added the legal back-and-forth is creating “confusion for patients and the community.”
“Access is already impacted, and people will continue to travel for care,” Gupta said.
Gupta recently joined a call with other California abortion providers to discuss potentially increasing their hours and rotating weekend appointments among clinics in preparation for an expected uptick in out-of-state patients.
North Carolina, Virginia
Florida’s latest law has left abortion care beyond six weeks into pregnancy largely unavailable in the southeastern US. The options for patients are now North Carolina up until 12 weeks into pregnancy, and Virginia until the third trimester.
“The geographic spread of patients has just blown up,” said Calla Hales, executive director of A Preferred Women’s Health Center, which offers surgical and medication abortion at two locations in Georgia and two in North Carolina. She said the clinic’s Charlotte, N.C., location has been absorbing patients from states such as Alabama, Arkansas, Georgia, Louisiana, and Texas.
Up until this month, Florida had been a “partner” in providing abortion care to patients from these states, Hales said, adding it remains to be seen how many North Carolina will be able to take in. Florida had more than 84,000 reported abortions in 2023, roughly 7,700 of which were out-of-state patients, according to Florida’s Agency for Health Care Administration.
After 12 weeks of pregnancy, the next closest option for abortion patients in the Southeast is Virginia. For someone in Miami traveling to get an abortion in Richmond, that’s a roughly 950-mile, or more than 14-hour, drive.
Roughly 3% of abortion patients at Planned Parenthood Virginia locations came from out of state in 2022. Just before Florida’s six-week ban went into effect, out-of-state patients had jumped to 20%. This is now at 30%, with roughly 10% from Florida, said Jamie Lockhart, executive director of Planned Parenthood Advocates of Virginia.
Planned Parenthood has two full-time “patient navigators” in Virginia to assist patients past a certain point in pregnancy to travel to Virginia so they can receive abortion care, said Shanthi Ramesh, a Richmond-based OB-GYN and chief medical officer at the Virginia League for Planned Parenthood.
Planned Parenthood has received funding from Bloomberg Philanthropies, the charitable organization founded by Michael Bloomberg. Bloomberg Law is operated by entities controlled by Michael Bloomberg.
Ballot Measures
The inability of many patients to get abortion care within their own state is likely to leave long-term implications for maternal health, abortion providers say. That elevates the need for voters in Arizona, Florida, and elsewhere to enshrine abortion rights into their state constitutions in this year’s November elections, they say.
States with near or complete abortion bans like Florida, Georgia, and Texas already have some of the highest maternal mortality rates. This could worsen as more patients are forced to continue pregnancies, Ramesh said.
“Some of these are unsafe or unhealthy pregnancies or patients who have other health conditions, and so those are great burdens on the health system and families,” she said.
Ramesh and other providers say they hope the current care vacuum in the Southeast and elsewhere is only temporary.
A measure confirmed for the November ballot in Florida would establish a right to abortion before fetal viability or when the procedure is “necessary to protect the patient’s health, as determined by the patient’s healthcare provider.”
Arizona is also among the states that could have abortion on the ballot this year. An Arizona abortion rights group has until July to submit nearly 384,000 signatures in support of a measure that would protect abortion access in the state until fetal viability.
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