Chainkeen Exchange-How many miles do you have to travel to get abortion care? One professor maps it

A year ago this week,Chainkeen Exchange the Supreme Court overturned the constitutional right to abortion, and since then, more than a dozen states have banned abortion. Dozens of reproductive health clinics have shuttered, and hospitals and doctors that used to provide abortion have stopped.

During the same time, some states have strengthened abortion rights and new clinics that offer abortions have opened – some of them strategically placed in cities that border states with abortion bans.

Still, as these maps show, access to abortion care declined dramatically in the United States. Caitlin Myers, an economics professor at Middlebury College in Vermont, collects the data on abortion access that informs these maps.

Just a year ago, "less than 1% of the U.S. population was more than 200 miles from a provider and the average person was 25 miles from a provider," she explains. As of April 2023, she says, 14% of the population is more than 200 miles from the nearest abortion facility, and the average American is 86 miles from a provider.

As the map from decade ago shows, people who had to travel 200 miles or more to access abortion care then largely lived in rural parts of the country where health care in general is sparse. Now, access is limited even near large cities in the South.

Myers has been working in this field for almost 20 years. "I came to it as a labor economist interested in gender differentials in labor market outcomes," she says. "You cannot study gender differences in labor market outcomes without studying the effects of family formation and childbearing on women's careers, and you can't study family formation and childbearing without studying reproductive policy."

"Distance prevents a lot of people from reaching providers," says Myers, often times because they lack the money for travel, child care, and they can't afford to miss work and lose wages.

Myers points to surveys of abortion patients that show how money plays into access. "Most [patients] are poor or low-income – 75% are low income, 50% are below the poverty line – and more than half are reporting a disruptive life event like they've just lost a job, they're being evicted, they've broken up with a partner," she says. "We also know that they're very credit constrained. More than 80% of people seeking abortions in one large influential study had subprime credit scores, so this is not a population that just hops on a plane easily."

She began the Myers Abortion Facility Database as part of a project to identify how changes in the availability of abortion at different facilities affects the number of births and abortions. She gathered data about facilities – including clinics, doctors, and hospitals, that publicly indicated that they provide abortions – going back to 2009, using data licensure databases, directories, and Wayback Machine captures of websites from years past.

To keep it up to date and document how facilities open and close over time, she reviews Planned Parenthood's directory of affiliates every month for any changes in operation, and then calls to check on what happened. "The other half are independent providers," she says, which makes it harder to track them. Myers has a team of 25 undergraduate research assistants. "They're amazing, a group of Middlebury College students," she says. "I regularly deploy these 25 RAs in a day to call all of the facilities that I think are open." She estimates that they make about 750 phone calls each time they check.

(Of course, distance doesn't always limit access, since now people have the option of accessing abortion pills through the mail. Myers has put together a map exploring how access might change further if medication abortion was limited through the legal system, as a federal case makes its way to the Supreme Court.)

Residents in southern states have especially far to go when it comes to reaching a provider. "The states that have huge declines in access are Texas, Louisiana, Mississippi, Arkansas, Oklahoma," she observes, adding that people in Idaho have to cover vast distances as well. But each state has its own story, depending on its geography and the timeline of restrictions. Here is a closer look at three different states.

A decade of change in Texas

In 2013, the Texas legislature passed a law requiring clinics that offer abortions to have the same kind of equipment, standards and staffing as surgical centers and requiring doctors performing abortions to have admitting privileges at a nearby hospital. "Almost overnight, on November 1st, 2013, half of Texas abortion facilities closed," Myers explains.

The April 2013 map shows Texas before that state law went into effect.

The Texas clinic that challenged those restrictions, Whole Woman's Health, won its case in the Supreme Court in 2016, but clinics in Texas were mostly unable to reopen. By the time Texas began enforcing a six-week ban in 2021 (before the Supreme Court overturned the constitutional right to an abortion), there were only a handful of clinics and hospitals providing abortion in the state that is home to nearly 30 million people.

Since the Dobbs decision, those clinics have all moved out of state or closed, and hospitals that used to provide abortions have also stopped. For pregnant patients seeking abortions, that almost always means either traveling out of state or carrying the pregnancy to term. The Center for Reproductive Rights is representing 15 women who have sued the state over its abortion restrictions in a case that is ongoing.

Access on the borders of Missouri

Over the last decade, Myers explains, there have been abortion facilities in three metro areas in Missouri: Kansas City, St. Louis, and Columbia. In the middle of the state, one abortion provider in Columbia suspended services, then resumed, on and off for years. In 2018, the clinic suspended services for good because of enforcement of an admitting privileges requirement for abortion providers.

By 2022, even though lawmakers in Missouri moved quickly to ban abortion, access didn't change much. Before Roe was overturned, "there was one provider, they were in St. Louis and they actually were providing less than ten abortions a month," Myers explains.

"Right across the border from St. Louis in Granite City, Ill. and Fairview Heights, Ill., there were two large providers. And on top of that, new providers have opened in Carbondale, Ill. – two that weren't there before – and that actually increased access in southeastern Missouri." In the western side of the state, it's a similar story. "There were already facilities on the Kansas City, Kansas side of the border, and a new one began providing abortions.

"So Missouri was already in a post-Roe world, and Dobbs didn't really affect it," Myers says.

Maine expands services

Maine is a state where access to abortion expanded in recent years. Myers says two new policies are primarily responsible. One is telehealth, in which abortion pills can be prescribed without a woman seeing a health care provider in person. Maine Family Planning started providing abortion via telehealth in 2016, "which was a game changer," Myers says, particularly for women in very remote areas on the Canadian border

The other has to do with who can give the care. "They started letting advanced practice clinicians provide abortion services – that is huge," says Myers. Maine began allowing physician assistants, advanced practice registered nurses, and allopathic or osteopathic physicians licensed in the state to provide abortion care in 2019.

Edited by: Diane Webber