In the past two decades, anti-abortion activists have strategically dedicated most of their resources toward state-level restrictions, sometimes even targeting individual abortion providers. Events in South Dakota stand out as an example of this tactic: The state legislature attacked the state's single abortion provider, a Planned Parenthood in Sioux Falls, by requiring a 72-hour waiting period and a consultation with an anti-abortion crisis pregnancy center before a woman can have an abortion. Additionally, states such as Oklahoma, Indiana, and Nebraska passed bans on abortion after 20 weeks, in direct violation of Roe v. Wade.
These state-specific anti-abortion efforts have been so successful lately that a few prominent voices have suggested ceding certain embattled states—like South Dakota—to anti-choice forces. Terry O'Neil, the president of NOW, suggested onThe Rachel Maddow Show that pro-choice groups might shy away from challenging the bans on abortions after 20 weeks for fear that a conservative Supreme Court might use the occasion to overturn Roe. There have been such murmurs for years: Pro-choice men Benjamin Wittes and Jeffrey Rosen have argued against Roe v Wade on the theory that withdrawing abortion access in some states would be worth it if it meant ending the abortion wars. Anti-choice terrorism compelled Megan McArdle of the Atlantic to wonder if the price of abortion rights in all 50 states was far too high.
Folding up shop in the reddest red states is a provocative suggestion. It could be a way to de-escalate the abortion wars, which have grown only more heated in recent years. But if clinics close in South Dakota or other red states like Mississippi, what will happen to the abortion patients who would otherwise use these clinics? I took the question to those who know the issue most intimately—abortion providers—as a thought experiment. After considering their experiences with women who must overcome heavy restrictions and geographical limitations, the consensus seems to be that while some women in states that have no clinics will travel long distances for abortions, others will find themselves forced to have children or will attempt self-abortion or turn to illegal abortionists. And for the women who do successfully manage to travel to an abortion provider, the costs are likely to be punishingly high and physically risky.
Of the three options, providers suggested most women would opt for traveling great distances to obtain safe abortions if clinics in their states closed. CDC statistics show an unusually high incidence of women crossing state lines to obtain abortions in regions of the country that have few providers. Over 35 percent of abortions in North Dakota are for women from other states, a direct result of how poor abortion access already is in South Dakota.
Tammi Kromenaker, who runs the Red River Clinic of North Dakota, anticipates women will double the amount of travel time to drive to her clinic in Fargo. Stopping abortion provision in Sioux Falls could mean more clients who need at least two days, maybe more, to get a first trimester abortion.
Traveling long distances creates a major financial burden for patients, especially as the majority of women seeking abortions make less than 200 percent of the poverty line. Many clinics work with nonprofit abortion funds to help women pay for their terminations, but these funds currently cover only part of the clinic's fee, and would be unlikely to have more money to pay for gas and hotel.
Raising the money for hotel and travel takes time, pushing a woman later into her pregnancy, which can create greater health risks. A Missouri provider, who preferred to remain anonymous for safety reasons, explained, "With the later pregnancy, the complication rate goes up." He referenced a patient of his who discovered a fetal abnormality at 18 weeks, but because of the travel expenses, wasn't able to abort until 20 weeks. "The difference between [aborting] an 18-week and a 20-week pregnancy is significant for risk of complications."
Renee Chelian, the CEO of the Northland Family Planning Centers in Michigan, dealt with travelers to New York in the pre-Roe days, and she raised other concerns about health. "If you get to the other state and can get your abortion, then there's the whole situation of when you get home and there's a problem, who's going to take care of you? Where do you get a follow-up exam?" The Missouri physician concurred, arguing that abortion is safest when integrated into regular health care.
Of course, no matter how determined some women are to abort, the obstacles can overwhelm and force them to have unwanted children. Already, according to the Guttmacher Institute, one in four women on Medicaid who want to terminate carry to term because they can't afford abortion, which is not covered by federal Medicaid. Recent Guttmacher research also finds that states that heavily restrict abortion tend to pay much higher medical-care costs for childbirth and infant care for families on public assistance, indicating that the abortion restrictions do work to keep low-income women from obtaining abortions.
Faced with escalating travel costs to obtain abortions, more women would likely look to unsafe but affordable illegal methods. As Belinda Luscombe of Time pointed out, unethical abortionists like the recently arrested Kermit Gosnell of Philadelphia continue to get business by charging desperate patients less than quality providers. While most abortion providers I spoke with doubted that many women would attempt unsafe self-abortions if they lost a nearby clinic, all agreed the number women seeking black-market methods would rise. Chelian suspected that the increasing restrictions on abortion have already compelled more women to look for unsafe methods before turning to clinics. "Sometimes they tell us [that they took something to self-abort], and we ask them what they've taken, and they don't know." She worried that clinic closures will drive more women to buy random drugs with the hope that they induce abortion. Unfortunately, reliable statistics on black-market abortion remain nearly impossible to obtain, as women who try these methods are notoriously reluctant to admit to anyone, even their doctors, what they've done.
Abandoning the pro-choice movement's 50-state strategy has a pragmatic charm to it on the surface. But the potential for collateral damage should put even the most practical pro-choicers off this strategy. Even the best-case scenario, where women are able to travel great distances to obtain abortions, there is an unacceptably high and unnecessary cost, and often for women who were already struggling to pay for the basic necessities. Throwing the most vulnerable women in our society overboard should not be considered a workable compromise.