What Happens When Regional Access to Abortion Is Cut Off?

As Republican legislatures pass bills limiting reproductive rights, women are being forced to travel farther from home to obtain the care they need.
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A protest against recently passed abortion ban bills at the Georgia State Capitol building, on May 21st, 2019.

A protest against recently passed abortion ban bills at the Georgia State Capitol building, on May 21st, 2019.

If women across large swaths of the South have their access to abortion cut off as a result of draconian legislative bans, Laurie Bertram Roberts' nightmare isn't that they'll start drinking poison to self-terminate their pregnancies; it's that they will continue to do so, with increasing frequency.

"When you start talking publicly about abortion, people start telling you their stories," says Roberts, the co-founder and executive director of the Mississippi Reproductive Freedom Fund. "People will just message you online and be like: 'Hey, I have a friend, can you help her? Her boyfriend told her to drink bleach." Or, 'I have a friend and she drank turpentine three times, that's how she terminated three of her pregnancies, and she told me to just water down some turpentine and add sugar and that'll work.'"

MRFF is an abortion fund, which, along with approximately 70 other non-profits, falls under the parent umbrella of the National Network of Abortion Funds. In addition to turning donations from strangers into logistical support for women trying to access an abortion—linking them to the money for bus and plane tickets, gas, medication, food, hotel rooms, rental cars, and child care—the fund also provides diaper assistance, period supplies, and parenting resources to struggling caregivers, who, as Roberts points out, are often the same people in need of abortion services.

While abortion funds have long been helping women clear financial hurdles to access care, funding travel has become increasingly central to their mission as state legislatures have continued to systematically whittle away at abortion access in the decades since the landmark Roe v. Wade decision. By passing restrictions that target or limit abortion providers' ability to provide care—including mandatory waiting periods, anti-abortion counseling practices, and forced ultrasounds—Republican lawmakers have diminished access and stoked anti-abortion sentiment so successfully that it is increasingly likely that a woman seeking an abortion in the South or the Midwest will have to travel far from home in order to obtain one.

Those efforts have ramped up recently along with the sitting of a majority-conservative Supreme Court. On May 29th, Louisiana became the eighth state to pass legislation outlawing abortions at the six-week mark, after what's referred to as a "fetal heartbeat"—an untechnical term used to describe electrical activity in a fetal pole—can be detected. The laws are part of a broad slate of legislative packages being passed across the country as conservatives endeavor to force the high court to consider overturning Roe.

Although a federal judge recently issued a temporary block of Mississippi's own six-week abortion ban on the grounds that it ran afoul of "a woman's free choice, which is central to personal dignity and autonomy," the state remains one of six where only one abortion clinic remains open. According to Roberts, that lack of local access frequently leaves women with no other option but to travel out of state to receive care or be forced to turn to more precarious in-state alternatives. And with other, neighboring states facing similarly limited resources, the problem has quickly become one of increasing scarcity.

"People think that you can just send people to another state and that'll be the solution, but there's not enough capacity in other states to support that demand," she says. "You're really looking at, what will resistance look like on the ground as far as access to self-managed abortion?"

The scenario is not an entirely unfamiliar one to the local networks and advocates working on the ground to ensure abortion care. After Texas passed House Bill 2 into law in July of 2013, cementing a new set of requirements for abortion providers that forced a majority of clinics to shut their doors as they struggled to find ways to bring their facilities up to code, the precipitous drop in access sent women fanning out across the region in order to obtain the procedure.

"When those clinics closed in Texas, that impact was felt all around Texas," Roberts says. "That impact was felt in Oklahoma, in Kansas, because those patients had to go up into there, all the way over into Mississippi and Alabama because people from Texas started to go to Louisiana and that then meant that Louisiana's schedules were full, so that pushed some people from Louisiana into Mississippi, and then pushed some people from Mississippi into Alabama."

Amy Irvin, executive director of the New Orleans Abortion Fund, says that the chaos of clinic scarcity has created "a regional crisis as well as a national crisis"—one that will continue to be shouldered by women and abortion seekers across the country.

"It really is impacting the south," Irvin says. "People are already having to travel great distances to access what is safe and still legal abortion care, and they're incurring a lot of money on top of the fees for the procedure itself, to ensure that health care."

While the wealthy will always have the option to travel for abortion care when necessary, abortion remains a procedure disproportionately sought by low-income women: According to a 2004 survey from the Guttmacher Institute, a non-profit reproductive health think tank based in Washington, D.C., 73 percent of respondents said that they had sought abortions because they could not afford another child.

That regional clinic scarcity will be hardest-felt by poor women means that they will also be the group most likely to turn, as Roberts fears, to unsupervised and unsafe home abortion methods, such as ingesting herbs or toxins or subjecting themselves to blunt force traumas in order to end a pregnancy.

"We will continue to do our job to fundraise and assist people as best we can, but it means that ultimately people are going to be forced into carrying unplanned pregnancies to term, into having children that perhaps they aren't able to fully provide for or support," Irvin says.

In states like Louisiana, which leads the nation in maternal mortality, and Mississippi, which has the highest infant mortality rate in the United States, that will mean that women and children will continue to suffer: "By forcing women into being parents when they're not ready, for some women it's a risk to their lives," Irvin says.

While Roberts stresses that access to abortion care has long been an issue in the South, even before Republicans began their latest salvo against reproductive health-care providers, she is careful to note that not all forms of self-managed abortion deserve the stigma they carry.

Prescription drugs like mifepristone and misoprostol, medications that can be used to induce the shedding of the uterine lining to cause abortion, are used widely and safely in countries outside of the U.S. where abortion is not legal. With the proper education, Roberts says, the pills could one day be seen as an effective harm reduction alternative in areas where access to clinics has become prohibitively limited.

"My fear isn't that people will use misoprostol effectively; I know that it's safe for people to use if they know what they're doing, that does not scare me," Roberts says. "What scares me is people not even having that to access and just hearing whatever will work, or throwing themselves down stairs."

"When you're desperate and you don't wanna be pregnant, you don't wanna be pregnant," she adds. "You will do anything—that's just the reality."

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