The end of Roe, one year later

It’s been nearly one year since the Supreme Court overturned Roe v. Wade, eliminating the constitutional right to an abortion via the Dobbs vs. Jackson Women’s Health decision. In the months since, abortion access has been mostly banned in 14 states, stringent gestational limits have been put in place in several others, and the approval of medication abortion has been challenged in the federal courts.

Such policies have left both patients and providers scrambling to navigate harsh new restrictions and penalties. For many patients, these policies have meant traveling out of state, incurring serious risks to their own health, and in some cases, carrying unwanted pregnancies to term. For providers, the end of Roe has meant fears of being punished for providing abortions, possible discipline from state medical boards, and, in states where abortion remains legal, an influx of patients from other places.

“We hear stories of doctors who are afraid to provide care, who don’t know what the legal implications might be,” says Morgan Hopkins, the president of All Above All, a reproductive rights advocacy group. “We hear the same thing from patients, confusion about what the law might be, and needing to travel.”

Overall, Dobbs has made it harder for people to obtain an abortion in many states. Here’s a look at how a year of abortion restrictions have affected people’s lives, by the numbers:

Over 25 million women between the ages of 15 to 44 live in states with new abortion bans or restrictions post-Dobbs, meaning 40 percent of American women in that age group have limited or no access to an abortion, according to PBS. 

The impact of such policies is substantial: Data from the Society of Family Planning showed that the number of legal abortions went down 6 percent in the six months following the Dobbs decision compared to the months prior, amounting to more than 32,000 fewer legal abortions nationwide.

Those statistics suggest that some women likely carried unwanted pregnancies to term because they were unable to obtain an abortion. A Guardian story examining some of these cases included the experience of a 29-year-old Texan named Samantha Casiano, who was forced to carry her pregnancy to term even though her baby had been diagnosed with anencephaly, a condition that meant the baby would die shortly after birth.

Denials of abortions can have harmful consequences for women’s health such as childbirth complications and chronic pain, as well as negative economic outcomes for their children like an increased likelihood of living in poverty, the influential Turnaway Study found. Beginning in 2007, that study followed the experiences of women who were able to obtain abortions and those who were forced to carry their pregnancies to term, and concluded that denials of abortions had a major adverse effect on women who endured one.

The average travel time for an abortion is now 3 times longer, up from less than 30 minutes to more than an hour and a half, per a 2022 study published in the Journal of the American Medical Association. 

Forcing people to travel further to obtain abortions poses a high cost. Not only does it mean that abortion is more expensive, it also means that people have to budget significantly more time for such procedures.

Particularly in the South — where several states including Alabama, Louisiana, and Mississippi have near total bans — people have had to travel extensively to find care. Alison Dreith, the director of strategic partnerships at the Midwest Access Coalition, an abortion fund, says they’ve seen a major jump in people from Texas calling for help obtaining an abortion outside the state. Those patients have had to travel as far as Illinois to receive care. The JAMA study found that for women in Texas and Louisiana, the average travel time for an abortion was 7 hours longer than prior to the Dobbs decision.

Black, Hispanic, and American Indian women were among the groups disproportionately affected by the increases in travel time, the study also determined.

Given the added need for travel and other expenses, the cost of obtaining an abortion has increased for many patients: According to a September 2022 New York Times analysis, the average expenses abortion funds are covering per patient are more than two times higher than prior to the Dobbs decision. 

In 2021, for example, the average spending the New Orleans Abortion Fund covered per patient was $308; that went up to $729 in 2022. “The distance people are traveling changed really rapidly. Flight prices are up, hotel prices are up,” Megan Jeyifo, the executive director of the Chicago Abortion Fund, told Vox.

Abortion funds have become a major resource for people who are unable to afford care on their own, though added costs and logistical barriers might deter some from seeking out the procedure at all. These funds have also faced the pressures of growing costs, and have relied on donations as one source of financial support.

Clinics in states where abortion is legal are seeing a huge uptick in out-of-state travelers: In a press release shared with Vox, one Illinois Planned Parenthood clinic claimed it’s seen a 35 percent increase in patients seeking an abortion overall, including a massive jump of patients coming from outside either Illinois or Missouri, the two states it previously primarily served. 

That increase has meant clinics and doctors in states where abortion remains legal are dealing with much higher caseloads than previously. “We’ve had hospitals in Chicago expand their days that they do procedures because they’re not only carrying the Midwest, they’re carrying much of the South,” says Jeyifo.

The surge of patients has also meant longer wait times for abortions in certain places, a delay that could come with major health risks, including infections and heavy bleeding, for the people involved. “That wait time is so critical for gestational limits, for the cost of the procedure, for people’s safety and security,” says Dreith.

Health care providers also overwhelmingly say the fallout from the Supreme Court decision has made maternal care worse. Sixty-eight percent of OB-GYNs surveyed by the Kaiser Family Foundation say the Dobbs decision has made the management of maternal health emergencies worse, and 64 percent said it’s had negative effects on maternal mortality as well, according to the Washington Post. 

Providers are finding it more difficult to deal with emergencies because there can be uncertainty about whether an abortion is allowed: in states with exceptions for a woman’s life, for example, there’s ambiguity about which conditions qualify.

As a result, providers might be hesitant to perform an abortion or related care if they don’t know for sure that it’s legal to do so. This has been evident in cases in which women were denied vital care for ectopic pregnancies and miscarriages due to physician worries about violating recent abortion restrictions in states like Tennessee and Texas.

Due to the confusion that some state laws have raised about when it’s acceptable to perform an abortion, some physicians fear that these restrictions could contribute to an already devastating maternal mortality crisis in the US. Ahead of Dobbs, US maternal mortality was already the highest of any developed country, affecting 32.9 people per 100,000 live births in 2021. Now, some providers worry the legal ramifications of performing an abortion could leave people forced to go through unnecessarily risky pregnancies, or absent the immediate care they need in an emergency.

“Without abortion care, we’re going to see maternal mortality go up,” Tennessee physician Nikki Zite told ProPublica.