NC abortion providers brace for influx of patients from the South

NC abortion providers brace for influx of patients from the South

By Rachel Crumpler

A six-week abortion ban taking effect today in Florida will usher in a significant shift in abortion access in the South. The new restrictions position North Carolina as one of the last places in the South that allows abortion past six weeks of pregnancy — a point at which many women do not yet know they are pregnant.

Florida’s four dozen-plus abortion clinics provided about 86,340 abortions up to 15 weeks gestation in 2023 — representing 1 in 12 abortions nationwide — according to data from the Guttmacher Institute, a national organization that tracks trends in reproductive health. 

However, the number of abortions provided in the state will drop significantly with the new six-week restriction in place. By comparison, in the month after South Carolina implemented its six-week ban on Aug. 23, abortions dropped by about 71 percent and have remained at a reduced volume, according to data from Guttmacher.

Katherine Farris, medical director at Planned Parenthood South Atlantic, said people in states with bans do not stop needing abortion care; restrictions just push patients to travel out of state for care or go outside the medical system.

“Every time there’s a change, every time there’s a legal decision, every time there’s a new law, we have a whole ’nother bout of chaos,” Farris said.

North Carolina abortion providers are scrambling to accommodate the additional patients. But clinic capacity is already strained, with some patients needing to wait weeks before the next available appointment — a wait that could grow longer from the looming surge of patients. 

North Carolina’s 14 abortion clinics provided an estimated 44,820 abortions last year — just over half the volume of Florida — according to Guttmacher data.

“Our clinics are going to be maxed to capacity,” said Amber Gavin, vice president of advocacy and operations at A Woman’s Choice, an abortion provider with three clinic locations in North Carolina and one location in Florida. “There’s going to be a strain on the [abortion care] ecosystem.”

An increased load

It won’t be new for North Carolina to serve large numbers of out-of-state patients. After the Dobbs decision in June 2022 handed states the power to regulate abortion, many Southern states quickly moved to ban abortion or enact strict restrictions. North Carolina lawmakers did not tighten restrictions until July 2023, and the restrictions they approved still offer more access than in surrounding states — making North Carolina a destination for people seeking the procedure in the South.

In 2023, 35 percent of total abortions in North Carolina, or nearly 16,000, were provided to out-of-state patients, according to Guttmacher data. The out-of-state patients contributed to North Carolina’s increasing tally, a 41 percent increase in abortions from 2020 to 2023.

Abortion providers in North Carolina say they took immense efforts to rework processes and expand capacity to accommodate these patients. Abortion funds and practical support networks also stepped up to facilitate access to people seeking the procedure.

Now, they are at it again. 

Abortion providers in North Carolina are preparing the best they can to accommodate an expected influx of out-of-state patients. 

“​​There’s nowhere that can absorb the amount of patients that we see in Florida,” Gavin said. “It’s just not possible.” 

Jenny Black, CEO and president of Planned Parenthood South Atlantic, said the organization’s North Carolina clinics are working to make more appointments available. However, the North Carolina clinics already have wait times of about two weeks.

“Planned Parenthood health center staff in North Carolina are doing their level best to quickly expand capacity and increase appointment availability ahead of the near-total ban in Florida taking effect,” Black said in a statement. “But it will not be enough to stem the tide of patients from across the South who have few options left.”

A Planned Parenthood spokesperson told NC Health News last week that Planned Parenthood is adding five to seven days of abortion services to their existing clinic schedules across North Carolina and Virginia. That expanded capacity is possible in some locations because clinics will have more than one doctor providing abortion care.

Gavin said A Woman’s Choice is also working to recruit providers to expand appointment offerings.

A ruling Tuesday by U.S. District Judge Catherine Eagles in Greensboro striking down some of North Carolina’s rules on dispensing medication abortion pills that exceeded what the U.S. Food and Drug Administration requires — such as requiring only doctors provide the medication and provide the pill to the patient in person — may also help with capacity issues.

In addition to the increased patient load coming to North Carolina, Gavin said that Florida’s increased abortion restrictions take an option away from North Carolinians seeking an abortion after 12 weeks of pregnancy. Gavin explained that since Senate Bill 20 took effect in July, patients who have been too far into their pregnancy in North Carolina have been able to be referred to their Jacksonville, Florida, clinic for care up to 15 weeks of pregnancy. But now that option is gone.

Barriers to access

Even as North Carolina abortion providers work to meet demand from North Carolinians and from others across the South seeking abortions, the state will not be an option for some people due to the state’s rules.

In addition to limiting most abortions after 12 weeks of pregnancy, North Carolina’s law requires patients to attend an in-person appointment for state-mandated counseling at least 72 hours before the procedure. This means many patients need to drive long distances — twice — to reach one of the state’s 14 abortion clinics spread over nine counties. It necessitates extra time off work, travel, hotel stays and child care costs.

“We regularly see patients who come in for their consent visit thinking they’re getting their abortion,” Farris said. “It can be devastating, especially when they’ve traveled really long distances to get there or used every last resource they have to get there to then explain, ‘No, you can’t legally have your abortion today. This is a medically unnecessary consent that the state is making you go through so that you can come back and get your abortion next time.’”

Farris said about 10 percent of patients who come in for the first counseling appointment don’t make it back for that second appointment.

The additional in-person appointment required by Senate Bill 20 also puts an increased burden on clinics and their staff members to schedule and have the physical space to accommodate more traffic; before Senate Bill 20, state-mandated counseling could be completed over the phone. Providing abortion care under Senate Bill 20 requires staff to complete twice as many appointments to provide abortion care to the same number of people.  

Another effect of the in-person counseling requirement is related to timing. Farris said that she sees patients who come in and by the time the 72 hours is up, they will have surpassed the time limit to have a medication abortion, which can be provided up to 11 weeks of pregnancy. That means patients must opt for a surgical procedure instead. 

In other scenarios, Farris said the 72-hour wait has made patients too late to receive services in the state.

Just within the last month or two, Amy Bryant, an abortion provider in North Carolina, said a mother of two who spoke very little English came to the clinic thinking she was well within the timeframe to have an abortion in North Carolina, but she was actually two days beyond the legal limit. 

“She was very surprised,” Bryant said. “She didn’t have regular periods. She just didn’t know how far along she was. That was just a terrible situation for her because we gave her all the information [to get care in another state], but I don’t know if she was going to be able to navigate getting another five-hour drive there and back to get to another appointment.”

Bryant said she regularly has to tell patients she can’t offer them care. Despite having the skills and providing abortion care up to 20 weeks less than a year ago, her hands are now tied.

And Bryant said it is difficult to deliver that news to patients, particularly when options for abortion care in the South are severely limited.

“I’ve definitely had people cry and just be distraught over their situation,” Bryant said. “I’m sure some of them make it [to another state], and I’m sure some of them don’t.”

Crossing state lines

Nationwide, traveling across state lines for abortion is a growing phenomenon, largely due to post-Dobbs abortion bans and restrictions. In 2023, nearly one out of five women seeking an abortion in the U.S. had to travel to another state to get the procedure, compared with one in 10 in 2020, according to Guttmacher data

Although North Carolina will be the closest option for many people in the South, some people may keep heading North to states farther away, such as Virginia or Maryland where there are fewer restrictions. Still, these destinations have waits. Planned Parenthood said its two Virginia clinics have an average wait time of about five to 10 days.

Recognizing that abortion access is much more open a state away, A Woman’s Choice opened its first clinic in Danville, Virginia, in February. Gavin said the organization considered opening another location in North Carolina but ultimately determined that it wouldn’t provide many more options for patients.

“We’re trying to remain close to North Carolina because obviously North Carolinians are very important to us and we want to be able to provide them care,” Gavin said. “We opened as close as we could — a place where we hoped it was accessible to North Carolinians.”

The Danville clinic location is 47 miles from the Greensboro clinic. For driving 50 more minutes, care can be delivered in one day, up to 20 weeks gestation at the clinic. Virginia does not have a waiting period and allows abortion up to 26 weeks.

The new location is already making a difference, Gavin said. She said the clinic is seeing a mix of patients, including North Carolinians — even those not yet beyond 12 weeks of pregnancy — who are making the decision to cross state lines. 

“If they have the ability, then they’ll drive the additional mileage to get their care on the same day,” Gavin said. “Most people can’t take a week off from work to get basic health care.”

Tell us your story about abortion access

NC Health News will be continuing to cover the effects of increased abortion restrictions in the months ahead and the best way for us to do that is with your help — hearing concrete examples of how you are navigating the new law. Have you been affected by new abortion restrictions as a medical professional or a patient? NC Health News is interested in hearing your experience.

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