The leaked release of a US Supreme Court draft opinion on May 2 confirmed what many in the US have long feared: Roe v. Wade is likely to be overturned, erasing the federally-protected right to an abortion.
Thirteen states would immediately ban abortion through laws trigged by the overturn of Roe, and up to 26 are expected to outlaw the practice based on recent actions lawmakers have taken to limit abortion. That would cut off access to abortion for 36 million women ages 13 to 44 who live in these states. Abortion clinics are now preparing for a surge of new patients traveling across state lines seeking their services as a last resort.
A handful of abortion clinics in cities on or near state borders exist for this exact purpose. Clinics in these border cities are especially important because of the way abortion access tends to be clustered in the US. States with the most open access to abortion tend to be on both coasts—think, California, Washington, New York, and New England— while some of the tightest restrictions on abortion exist in the Southeast and throughout the Midwest. For that reason, clinics that are right on the edge of low-access and high-access areas such as Illinois, Kansas, Virginia, and New Mexico will become vital as regional hubs if nearly half of US states ban abortion entirely.
But these clinics are already threatened by lawmakers working to pass legislation that would punish those seeking an abortion across state lines.
People are already traveling to get abortions
Thousands of people travel across state lines seeking abortions every year. A recent study of data collected by the Centers for Disease Control found 65,000 people received out-of-state abortions in the US, nearly 8% of all abortions performed in 2017. Residents from states with restrictive or “hostile” abortion laws represented 71% of those cases. In four states with some of the most restrictive abortion laws—Mississippi, Missouri, South Carolina, and Wyoming—more than half of people who had an abortion left the state to do so.
The most recent spate of strict abortion laws drove more women to seek abortions out-of-state. In 2021, after Texas passed a ban on abortion after roughly six weeks of gestation, Planned Parenthood locations in neighboring states saw a nearly 800% increase in patients from Texas in just four months. Researchers now expect that if Roe v. Wade is overturned, even more people will go out-of-state for abortion services, and they’ll have to travel further distances as well. An analysis from Middlebury College published in the New York Times estimates the average distance women must travel to an abortion clinic will rise from 33 miles (53 km) to 282 (454 km).
Abortion clinics on the edge
Hope Clinic for Women is one of the clinics straddling two different realities for abortion access. It’s located in Granite City, Illinois, where state lawmakers have passed legislation explicitly protecting abortion rights. But the clinic sits just six miles across the Mississippi river from St. Louis, Missouri, where abortion is limited. Missouri has a mandatory 72-hour waiting period, currently only has one abortion provider in the state, and will ban most abortions if Roe v. Wade is overturned.
“The reality is that Missourians have been living in a post-Roe world for a long time,” said Hannah Dismer, the education and research coordinator at Hope Clinic. “Things are just getting worse and worse.”
In addition to people from Missouri, Dismer says, the clinic increasingly sees patients from Indiana, Kentucky, Tennessee, Arkansas, and Mississippi, all of which restrict abortion access. The clinic is already hiring more staff in anticipation of the Supreme Court’s decision on Roe in the coming months. Dismer also expects women to make appointments further in advance, though they hope to be able to maintain the capacity to see people on short notice. Similarly, an abortion clinic in Duluth, Minnesota expects to see a 25% increase in patients from out of state, especially from neighboring Wisconsin, and Planned Parenthood locations in southern New Mexico have already seen a surge of patients from Texas.
The push to outlaw out-of-state abortions
Lawmakers in Missouri are already crafting legislation that would criminalize Missourians who go to Hope Clinic for an abortion. Republicans in the state legislature introduced a bill in March that would allow private citizens to sue anyone who assists a Missouri resident obtain an abortion in another state, including the physician performing the procedure or anyone assisting with transportation. The law is modeled after similar legislation in Texas which allows private citizens to sue over abortion and has effectively ended most abortions in the state for the time being.
The bill is up for a vote during the legislative session this spring. If it passes in Missouri, other states are sure to follow, though the state’s ability to enforce the law is in question. Legal scholars doubt states can punish residents for obtaining a legal abortion outside state boundaries given the constitutional limits on restricting interstate travel or commerce. Courts have yet to weigh in on the matter.
But Dismer says that even if it does pass, this law won’t stop them from serving patients at Hope Clinic. “In my opinion, this bill is just yet another scare tactic to dissuade us from providing care and patients from seeking it,” says Dismer. ” I will not allow bullies in government to make me compromise the ethical practice of social work and medicine. I want people to know that yes, they can cross state lines to get a legal abortion and that there are people who will help them safely end their pregnancies.”