Sep 9, 2022 - Health

Clinics forced to push abortions later in pregnancy amid state bans

Illustration of a red suitcase with a medical cross on the side

Illustration: Natalie Peeples/Axios

A crush of out-of-state patients at abortion clinics is causing backlogs in care and forcing some to have the procedure later in their pregnancies, when treatment is more intensive and costs are higher.

The big picture: It's a byproduct of more people traveling across state lines in the post-Roe landscape and testing reproductive health providers in states that don't have abortion bans.

  • Experts believe that as clinics struggle with demand, the number of abortions performed after the 13th week of pregnancy — which is around the end of the first trimester — might increase.
  • The procedures can be harder to obtain, because "as pregnancy progresses, the number of people who are skilled to provide that care further goes down," Colleen McNicholas, chief medical officer at Planned Parenthood of the St. Louis Region and Southwest Missouri, told Axios.

By the numbers: About 93% of reported abortions in 2019 were performed at or before 13 weeks of pregnancy, 6% were conducted between 14 and 20 weeks and 1% were performed at or after 21 weeks, per the Centers for Disease Control and Prevention.

  • At an Illinois clinic, patients from states other than Missouri and Illinois have risen to 40% of cases, compared to 5% before the federal right to abortion was struck down.
  • Wait times for an abortion appointment increased from two to three days to two to three weeks.
  • McNicholas said an increase in abortion patients who are further along than the first trimester could also be related to longer wait times, adding that the clinic tries to attend to as many patients "as quickly as we possibly can."

In Colorado, Michael Belmonte, a Denver OB-GYN, told Axios that the clinic he works in had already been overwhelmed with out-of-state patients since Texas' six-week abortion ban took effect.

  • Wait times for the clinic are around two to three weeks. While Belmonte said it's "certainly possible" that could grow to five to six weeks with higher demand, the clinic has recruited additional providers and made other contingencies.
  • The clinic has seen more out-of-state patients who are further along in their second trimester with severe fetal conditions who are unable to access abortion care in their states.

At the Trust Women clinic in Wichita, Kansas, the number of abortions performed increased from 800 in the first six months of 2021 to over 1,300 during the same period in 2022, and the number of out-of-state patients grew sevenfold, clinic staff told NPR.

  • The clinic's director, Ashley Brink, said that as a result of out-of-state demand, wait times are at around two or three weeks, meaning patients might be later on in their pregnancies and need more complex abortions.

Worth noting: Funds that give financial and logistical support to people seeking the procedure are also feeling the shift.

  • The Colorado-based Cobalt Abortion Fund saw a major increase in the financial help it provided to out-of-state patients seeking abortion: Between June 24 — the day the Dobbs decision overturning Roe was released — and Aug. 14, travel-related costs amounted to $103,081. There were no such costs for the comparable period in 2021.
    • Costs covering the procedures rose from $17,839 during that June-August period in 2021 to $51,355 in 2022.
  • The Chicago Abortion Fund saw its weekly service budget increase from approximately $16,000 to $25,000 after a draft of the Roe decision leaked in May, and then to between $40,000 and $45,000 in the post-Roe era, according to the clinic's director, Megan Jeyifo.
    • Jeyifo said that as wait times for appointments get longer, potentially pushing pregnant people into a different trimester, they might need more financial help to cover more complex abortions.
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