How Abortion Bans Will Ripple Across America

At the start of the month, nearly all women in America lived within a few hours’ drive of an abortion clinic. But with Roe v. Wade overturned, and the constitutional right to an abortion ended, clinics will quickly close in huge swaths of the country.

And then a new set of political fights will begin, playing out in state legislatures and courthouses across America. By the time they are done, more than a quarter of U.S. women of reproductive age would have to travel more than 200 miles to obtain a legal abortion.

Under the farthest-reaching scenarios, that number could rise to nearly half.

The longer the distance to the nearest clinic, the fewer women make the trip, research has shown.

The new analysis of clinic closures — performed by Caitlin Myers, an economist at Middlebury College — underscores how the effects of each state’s decisions will spill over borders.

In the post-Roe world, a woman’s ability to get a legal abortion will depend not only on what is happening in her state, but what happens in surrounding states, too.

[Click here for more coverage on the Supreme Court’s decision to overrule Roe v. Wade.]

Jim Olsen, a Republican legislator in Oklahoma who has helped pass several abortion restrictions this year, said that even if some women would still leave the state to seek abortions, many would not. “Our laws will still save lives,” he said.

Abortion may also become harder to obtain even in states where it remains legal, because clinics may be overwhelmed with out-of-state patients. And states like Colorado, Kansas and Illinois — which will be surrounded by states with bans — could become major destinations, seeing a surge of patients. “We’re going to see enormous numbers of women funneling into these states,” Professor Myers said.

In interviews with clinics that expect to remain open across the country, doctors worried about how they would manage.

“I think we will end up over the next months with waiting lists and more patients than we can schedule,” said Dr. Erin King, executive director of Hope Clinic for Women in Granite City, Ill.

Where Abortion Access Will Decline

Currently, 716,000 women of reproductive age — or about 1 percent — live more than 200 miles from the nearest abortion clinic. But in the coming months, that number will be multiplied many times.

Thirteen states already have laws on the books, known as trigger bans, to outlaw abortion now that Roe is overturned:

Once those trigger bans are in effect, the number of women who are that far from a clinic will rise to 9 million.

Some of those bans take effect immediately. Others are designed to start 30 days after Friday’s court decision, or require a government official to sign off.

Even under Roe, some states had restrictions that made it hard for clinics to operate. But until recently, each state had at least one clinic. That changed after a draft Supreme Court opinion leaked in May indicating that the court intended to overturn Roe. Clinics in Oklahoma, South Dakota and elsewhere stopped offering abortion in anticipation of the decision.

An abortion ban is seen as probable in another 11 states, either because of laws still on the books from before Roe that could now be enforced, or because they have legislatures that have already passed stringent abortion restrictions:

Bans in these states would raise the number of women more than 200 miles away from a clinic to 17 million.

Some of these states will ban abortion immediately. Wisconsin’s abortion clinics have said they will close after the decision because of an 1849 law that’s still on the books. Alabama’s more recent ban was paused by a court because of its now-irrelevant conflict with Roe.

In other states in this group, abortion may remain legal for some time, but their legal and political histories suggest that bans are more likely than not to go into effect eventually. In Iowa and Arizona, the legal status of their older anti-abortion laws may take months of court battles to resolve. In Nebraska, a recent effort to ban abortion failed by two votes, but legislators there are poised to try again after one of the legislators who voted no was replaced after his death.

And then there are three states that could have an outsize impact, where abortion’s future is uncertain:

If these three states banned abortion, the number of women far from a clinic would rise to 24 million.

In this new post-Roe world, each of these three states could become linchpins of access, making their legislatures’ choices particularly consequential. The legal uncertainty could also make it harder for clinics to expand capacity for out-of-state patients; providers may be wary of investing in larger clinics or new staff if they don’t know for how long they’ll be allowed to operate.

Florida recently passed a law outlawing most abortions after 15 weeks of pregnancy, but some legislators want to go further. Abortion in Virginia seems safe for now with Democrats in control of the state Senate, but it might not be if Republicans retake control in the next election. The Kansas Supreme Court has found that abortion is protected under the state Constitution, but a constitutional amendment to change that is up for a vote this summer.

Tory Marie Blew, a Republican legislator in Kansas who has led efforts to pass a constitutional amendment to end abortion protections, said she was partly driven by the fact that women around the Midwest may turn to Kansas if their states ban abortion. During the early months of the coronavirus pandemic, when several nearby states closed abortion clinics for public health reasons, out-of-state women flooded into Kansas, increasing the number of abortions provided in the state in 2020 by nearly 10 percent.

“​​I personally don’t want Kansas to be an abortion destination state, as it currently is,” she said, adding that her district was peppered with purple signs saying “Value Them Both” — referring to mothers and children — in support of the amendment.

Interactive: See How Each State’s Ban Affects Driving Distances in Nearby States

Use the tool below to see the effect of any state ban on driving distances.

Measuring the Impact

As clinics start to close, having just one nearby may not always be enough to ensure that a woman can get an appointment, because abortion is time-sensitive and surges in demand are expected.

Even before the decision, the closest clinic for many women in the South had been American Family Planning, in Pensacola, Fla. It was the only abortion provider in the Florida Panhandle, and regularly served patients from six states. But at the end of May, the state closed the clinic after three women in a year were hospitalized for complications from second-trimester abortions, with the state saying the clinic did not file the requisite paperwork. For now, the next nearest clinic is around 180 miles away, in Tallahassee.

“If it doesn’t reopen, all those women are going to have to travel that much further,” said Julie Gallagher, the clinic’s lawyer.

Even in very large cities, there may be only a few clinics within a six-hour drive once bans go into effect:

Research has shown that when clinics close and driving distances increase, there are corresponding drops in the number of women obtaining abortions.

Professor Myers estimated that an increase of 100 miles of driving distance reduced abortion rates by 20 percent:

Most of the reductions would be among poor women who are unable to travel long distances, because they are less able to overcome the obstacles of cost, transportation, child care and other logistics, research shows.

The number of legal abortions may fall further if the remaining clinics cannot meet the demand of women traveling from states where abortion is banned. There is no precedent for closings in more than a dozen states at once.

Still, abortions may not decline as much as it might appear. Some women will find other ways to end their pregnancies, including illegal ones, and those abortions will be harder to count. One main alternative is pills that can safely end a pregnancy, which can be illicitly purchased online from another country or sent in the mail from a state where they remain legal. After Texas banned all but the earliest abortions last year, around 1,100 women a month began ordering pills from overseas, three times as many as before.

But in the end, there will almost certainly be fewer abortions, the long-term goal of the anti-abortion movement.

“​​We’ve always been very hopeful,” said Kristan Hawkins, the president of Students for Life of America, adding that it would result in “thousands of lives saved.”

For the Clinics That Remain, Surging Demand

Even before Roe was overturned, the consequences of declining abortion capacity were apparent. When the restrictions in Texas went into effect in the fall, patients left for neighboring states, mostly Oklahoma. Oklahomans then had trouble getting appointments, so some went to other states. In late May, Oklahoma banned abortion.

“Think of a pond when you throw a rock in it and you see those ripples — that’s what’s happening,” said Dr. Kristina Tocce, the medical director for Planned Parenthood of the Rocky Mountains, which operates clinics in Colorado, New Mexico and Nevada, and is already treating a growing number of patients from out of state. “You have so many patients competing for a finite number of appointments.”

Some clinics in Illinois already had a majority of their patients coming from Missouri, where abortion has been nearly inaccessible since 2019. Now those Illinois clinics are seeing patients daily from as far as Texas.

“We have been preparing for this for a long time,” said Dr. Colleen McNicholas of Planned Parenthood in Fairview Heights, Ill., just across the border from St. Louis. “We opened it with the need to serve Missouri, but we really did so with an eye toward this moment.”

The clinic plans to operate 10 hours a day instead of eight, and open one or two Sundays a month. Nearby, Hope Clinic for Women in Granite City, Ill., hired twice as many doctors and reworked the clinic’s space to build more exam rooms. Together, the two clinics created an informational center staffed with people who can help patients with the logistics of getting to Illinois, including hotels and child care. Neither clinic will turn away women who can’t pay.

“Do I think that’s going to be enough to see all the patients who need to come?” said Dr. King, the director at Hope. “No, but we had to start somewhere.”

In parts of the country where opposition to abortion runs strong, doctors have begun considering this new future. Dr. John Lee, who has been practicing obstetrics and gynecology at the Santa Rosa Women’s Center in Milton, Fla., for 33 years, says when patients ask about abortion, he first suggests counseling and talks to them about other options. But if they choose to proceed, he directs them to the clinic. Now, he said, he’s not sure where to send them.

He’s most concerned about those who cannot travel, for economic or logistical reasons. “Will you have these backwoods deals people used to do?” he said. “I hope not, because people would get hurt. But you have the old adage: Desperate people will do desperate things. What I would want to do is if they’re still adamant about going the abortion route, counsel them to do it in a safe way.”