Out-of-state patients spur abortion increase in North Carolina

This story was originally published by NC Policy Watch on Nov. 1. Story by Lynn Bonner.

Many more people are seeking abortions in North Carolina since June, when the U.S. Supreme Court rescinded the constitutional right to abortion and neighboring states began outlawing or severely restricting abortions.

Fifty-three percent of the people coming to A Woman’s Choice North Carolina clinics are from out of state, spokeswoman Amber Gavin said in an interview. At least one person has come as far away as Missouri.

Getting to North Carolina from out of state is a “complicated balancing act,” for patients, Gavin said, that depends on whether they are flying in or driving, where they can get an appointment, and where the physicians they need to see are located. “We are really seeing folks from all over the South,” she said.

North Carolina is one of the states that has experienced the biggest increase in abortions since April, according to a report released last week by WeCount, a group led by the Society of Family Planning. The WeCount report takes a state-by-state look at abortion access since the Supreme Court decision.

North Carolina, which borders or is relatively close to states that outlawed or severely restricted abortion, saw a 37 percent increase in August compared with April. At 36 percent and 33 percent, Kansas and Colorado had similar percentage increases, according to the report.

Nationwide, abortions declined by about 6% between April and August.

Planned Parenthood in North Carolina has also seen a substantial jump in out-of-state patients since June. Some of the impact is described in a motion Planned Parenthood South Atlantic filed this month related to a 2020 lawsuit challenging North Carolina abortion laws.

Abortion is legal in North Carolina, but requires a 72-hour waiting period, bans telehealth for people who take abortion pills, and prevents certified nurse midwives, physician assistants and nurse practitioners from providing abortions, among other restrictions.

Planned Parenthood health centers in the state have seen an overall increase in out-of-state patients since June, according to the court documents, with some of the biggest jumps at its clinics closest to the state border.

Planned Parenthood in Asheville is the closest clinic for hundreds of miles for people from several states. At that clinic, 74% of the patients were from out-of-state in August, compared to 37% in August of last year.

At the Planned Parenthood clinic in Charlotte, 52 percent of patients in August were from out-of-state compared to 14 percent in August 2021.

“Abortion is time sensitive,” said Molly Rivera, communications director at Planned Parenthood South Atlantic. “Days and weeks matter.”

In 2020, 5,310 of the 30,004 abortions performed in North Carolina, or about 18%, were for non-state residents.

Only some North Carolina’s metro regions have abortion clinics, so even some state residents must travel more than 100 miles to get to one. Clinics are located in the Triangle, Charlotte, Asheville, Wilmington, Winston-Salem, Greensboro and Fayetteville.

In its latest legal motion, Planned Parenthood South Atlantic asked the court to allow advanced-practice clinicians to provide pills for medication abortions to help reduce patient waiting periods. Those same medical practitioners are already allowed to prescribe the same medications for miscarriage management.

Waiting periods for medication abortions have gotten longer since 2020, despite Planned Parenthood’s efforts to increase availability. The waiting period for medication abortion appointments at Asheville was 12 days in the summer of 2021. That's increased to two to three weeks since July 1, according to the court filing.

Nationally, about three-quarters of abortion patients in 2014 had low or very low incomes, according to the Guttmacher Institute, an organization that supports abortion rights. Most had at least once child.

Nonprofit abortion funds help people pay for the cost of the medical procedure, travel, childcare and lodging. But those funds are stressed by high demand, higher costs, and in some cases, fear of prosecution.

The Yellowhammer Fund, an abortion fund in Alabama, stopped offering help to people seeking abortions when that state law banning abortion went into effect in June.  The Alabama law includes an "aiding and abetting" clause that forced the organization to stop helping people travel to other states.

“The way we used to operate is no longer legal after the erosion of Roe versus Wade and the Dobbs decision,” said Kelsea McLain, Yellowhammer Fund deputy director.

Telephone calls to the organization reduced to a trickle after the Dobbs decision, she said. “People are fearful to say the word ‘abortion,” McLean said. “The Dobbs decision really did terrify people into thinking abortion is no longer an option for them.”

McLain suspects that more people in Alabama will “self-manage” abortions by obtaining pills by mail. Aid Access, an online telemedicine service, delivers pills.

The Mississippi Reproductive Freedom Fund is still working to help people obtain abortions in other states, said Laurie Betram Roberts. Costs have multiplied as people travel to North Carolina, New York, California, Washington, D.C., and even to Mexico to obtain abortions, Roberts said.

“Our funding budget is $15,000 a month,” she said. “Fifteen thousand, $20,000, that’s not even remotely enough.”

People want to go where they have some connection, such as family or friends, she said, but factors such as travel time and appointment availability also help determine destinations.

Despite the financial pressures, Roberts was preparing to announce that the Mississippi Reproductive Freedom Fund would begin helping people from Alabama to help fill the void.

“We’re still here on the ground, still funding abortion,” she said. The Mississippi fund is also helping people who were forced to stay pregnant, with prenatal classes, doulas, and baby supplies. “We know of several already,” she said.

North Carolina’s position as a state where abortion services remain available is precarious. The Republican-controlled legislature passed abortion restrictions in recent years that have not been able to withstand Democratic Gov. Roy Cooper’s vetoes. Republicans need to pick up only a handful of seats in the state House and Senate to be able to regain veto-proof majorities that could render Cooper’s vetoes irrelevant.

NC Policy Watch is a project of the North Carolina Justice Center, is a news and commentary outlet dedicated to informing the public — including elected officials as they debate important issues — and ultimately to improving the quality of life for all North Carolinians.