Travel for abortions, mainly from states like Kentucky, has doubled following Supreme Court decision, and can pose many difficulties

OPINION By Katelyn Jetelina
Your Local Epidemiologist

This week, Kate Cox got an abortion, but had to leave Texas, where she lives, to get it. She joined more than 9.3 million Americans who got a legal abortion in the past 10 years, of which 8,300 (0.9%) got one after 20 weeks of gestation. (Texas and Kentucky have similar, near-total bans on abortion.—Editor.)

I’ve seen many on social media wonder: What’s the big deal? She found the health care she needed after all; and this cross-state journey is rare, right?

Forced abortion travel has doubled following the U.S. Supreme Court's Dobbs ruling. And if you’re one of the lucky few who can travel, this journey isn’t without very real challenges that may not be apparent to the unseen eye.

The journey for an abortion looks very different depending on who you are. In general, though, many challenges could be prevented if we, as a society, accepted abortion as health care.

First, many people’s journeys stop before they begin. It can take a lot of cash—plane tickets, rental car, hotel rooms, food, and procedure. This adds up to about $10,000 to $30,000. As you can imagine, many people can’t afford this, and often, insurance doesn’t cover it. Half of all abortion seekers live below the federal poverty level—an income of less than $13,000 a year. This is especially true for adolescents and teens (who make up a big number of later abortion patients), undocumented people, and parents.

If they make the journey, it’s not without other hard realities:

• Pain meds are available. For those later in pregnancy, though, it doesn’t do much. You may not have access to an epidural, depending on the state’s regulations, because you’re at an outpatient clinic. This is unimaginable pain—in all senses of the word.
• Your partner can’t be there to support you during labor, like hold your hand, or coach you through pain. You can’t have a phone, either. Tight security is required at abortion clinics. In the same vein, you walk past protesters yelling at you every morning and every night for a week. You wish, with all your heart, you could enjoy the same level of ignorance.
• Recovering in a hotel room means a cold, unfamiliar place. Without your slippers, without your bed, without your cat, and without access to the comfort food you crave. All you want to be is at home.
• The journey means needing time off from work and getting your Family Medical Leave Act form signed by a physician in another state. All you hope is that your employer won’t ask questions because you don’t have any energy to explain.
• The journey may include carrying the baby’s ashes on an airplane. This requires holding back a flood of emotions in public—exhaustion, grief, anxiety, pain, a strong desire for privacy.
• People who have abortions are no more likely to struggle with mental health than the people who do not—in fact, not getting a needed abortion has been found to increase anxiety and depression in the first 12 months. But there are emotional costs in needing to travel, and much of that is driven by stigma and ostracization of abortion care. Also, recognizing when you need help (remember you don’t have a follow-up appointment with your OB) and finding the right clinician or therapist, given the unique circumstances and the trust required, is hard.

Two things help. First, confidence in making the right decision: 95% of people who have an abortion say it was the right decision for them. The most common emotion reported afterward is relief. Second, health-care workers—literally angels on earth—at the abortion clinic ensure moments of human connection, empathy, and support. You feel cared for, which helps tremendously. And the rare souls you trust with your story like family, friends, and clinicians thereafter also help tremendously.

This journey is becoming more common. Before Dobbs, 1 in 10 women having abortions had to travel. Now the rate has doubled, to 1 in 5. We see increased travel from many angles. While the number of abortions across states has greatly shifted post-Dobbs, the national average hasn’t budged.

Calls to the National Abortion Hotline for travel services, like hotel rooms and plane tickets, have tripled post-Dobbs and remain high.

Map from National Abortion Federation, based on data from its National Abortion Hotline

Scientists who measured distance to abortion facilities found average travel time also tripled post-Dobbs.

This speaks to why we see increases in self-managed abortion (i.e., medication abortion). It’s also why colleagues in Latin America, for example, have been supporting people to self-manage with pills up to 24 weeks of pregnancy, which is safe and effective.

An increasing number of women are traveling out of state for reproductive health care. This journey isn’t without very real obstacles. The most tragic part is much of the associated trauma is preventable if we had access to local health care.

It may be hard to understand, but it’s harder for people to live through. Trust women. Listen to their stories. Trust their voices. It is, after all, their lives and their livelihoods.

(A big "thank you" to Dr. Heidi Moseson, a reproductive epidemiologist who helped immensely with much of this piece’s research.)

If you want to support travel for abortions, here are some great options: The Brigid Alliance supports people who are traveling for abortions at 15+ weeks. The National Network of Abortion Funds a collective of over 100 abortion funds across the U.S.

“Your Local Epidemiologist” is written by Dr. Katelyn Jetelina, MPH, Ph.D.—an epidemiologist, data scientist, wife, and mom of two little girls. During the day, she works at a nonpartisan health policy think tank and is a senior scientific consultant to a number of organizations. At night she writes this newsletter. Her main goal is to “translate” the ever-evolving public health science so that people will be well-equipped to make evidence-based decisions.