What abortion in America looks like 50 years after Roe v. Wade

The Trust Women Wichita abortion clinic is busier than ever since the U.S. Supreme Court overturned Roe v. Wade last June. Its patient load has more than doubled, staff more than tripled and it went from offering abortions part-time to five days a week, most weeks.

Still, it’s nowhere near meeting demand.

One Monday in December, the clinic got 16,000 calls; some patients try the line up to 200 times before getting through. Even then, they might be told there’s no available appointments there, or at any of Kansas’s five other abortion clinics.

On the 50th anniversary of Roe, which falls this Sunday, Trust Women is emblematic of the new abortion landscape in America. The landmark ruling that legalized abortion across the U.S. is no longer the law of the land. Since June, states have had the power to severely limit abortion, and around a dozen have passed near-total bans. A few more, like Georgia and Florida, have restrictions beyond what would’ve been allowed under Roe.

Almost immediately, the number of legal abortions fell by 6% nationwide, according to an analysis of data from July and August by the Society of Family Planning. But in pockets of America — including states like Kansas, where abortion up to 22 weeks remains legal — demand surged as people traveled from nearby states with newly restrictive laws.

Over the summer, Kansas saw a 36% increase in the number of abortions provided. North Carolina, Colorado and Illinois saw similarly big jumps.

“We cannot absorb all the patients from Texas, from Oklahoma,” said Ashley Brink, Trust Women Wichita’s director. “There’s nothing that we could do to meet the need.”

When the court made its landmark Roe ruling in January 1973, the New York Times called it an “historic resolution of a fiercely controversial issue.” The intervening 50 years have shown that the matter is anything but resolved, and still extremely divisive.

As legal abortion clinics started popping up across the country, anti-abortion legislators and activists went to work pushing back against the change. Over the past five decades, U.S. states passed more than a thousand laws that aimed to make it difficult for clinics to operate as they tried to get the court to reconsider Roe.

At the same time, clinics became the target of violence. From 1977 through 2021, there were 11 murders, 42 bombings and 196 arson attacks targeting abortion providers, patients and volunteers, data from the National Abortion Federation shows. Just this week, a Planned Parenthood clinic in Illinois was intentionally set alight.

The 2022 Supreme Court ruling overturning Roe hasn’t settled things, either. A state-by-state legal fight is playing out in courtrooms around the country and in some places, like Arizona and Georgia, back-and-forth court rulings have changed what’s permissible from week to week.

Amid the uncertainty, Desert Star Family Planning, a Phoenix-based clinic that’s been operating for almost 10 years, has had trouble hiring and retaining nurses and medical assistants. Owner DeShawn Taylor has cut appointments at the clinic down to two or three days per week, from five days a week and a few extra Saturdays each month. She’s also started a consultancy business to make up for lost income from the clinic.

“It was really a day-by-day scenario for a while,” Taylor said.

While the ruling has made it harder to get an abortion in the U.S., it’s not 1972 again. Back then, just four states allowed legal abortion, while 46 states had total or near-total bans. Tens of thousands of women would travel to California, New York, and DC to get procedures each year. Those unable to make or afford long trips underwent illegal procedures, which sent thousands to the hospital each year and killed hundreds more.

Now, many more patients are likely to have access to safe and legal abortions, but they have to travel much farther to get to them than a year ago.

The average American now lives 275 miles further from an abortion facility than before the decision, according to Caitlin Myers, a researcher at Middlebury College who helps run an abortion access dashboard. In Texas alone, which borders Kansas to the south and prohibits almost all abortions, there are 7 million women of reproductive age. They live an average of 7.4 hours drive from the nearest abortion facility, according to the Middlebury data, up from less than an hour last March.

One woman drove 18 hours from Texas to Colorado to get care for an ectopic pregnancy, a potentially life-threatening emergency when a fertilized egg implants outside of the uterus. A Planned Parenthood in St. Louis said 50% of patients are coming from states other than Missouri or Illinois.

“I have patients from five different states that I provided care for who have traveled up to seven hours on a plane to take four pills, which feels really absurd to me,” said Mollie Nisen, a family medicine physician and abortion provider based in Washington.

Organizations like the National Abortion Federation have stepped in to help defray the increased costs. The group said it helped 257 people with hotel rooms from July to September, a six-fold increase over the same period in 2021. It also supported 200 trips by plane or bus, compared to just 23 a year earlier. A number of abortion funds have had to close their applications for weeks at a time, often to replenish donation stores.

Still, more than 10,000 people were unable to get legal abortions in July and August, according to the Society of Family Planning. There’s evidence that at least some of them sought care outside the traditional health-care system. But because of the advent of the abortion pill, so-called “self managed” abortion is a much safer experience than 50 years ago.

“We don’t live in the specter of the coat hanger and unsafe abortions, the reality is different,” said Nisen.

Approved by the U.S. Food and Drug Administration in 2000, the abortion pill has become an increasingly popular option for people in their first trimester of pregnancy. While states and the FDA have put regulations on where it can be prescribed and dispensed, online pharmacies that ship from overseas will send the medication anywhere, regardless of U.S. law.

Aid Access, a group that helps people order such pills, saw an almost 120% spike in sales in the two months after the end of Roe.

Even so, people who want or need abortions are increasingly unable to get them, just as having a child in the U.S. has become more dangerous. After hovering around historic lows in the 1980s and 1990s, the maternal mortality rate in the U.S. has reached rates not seen in other wealthy countries. By some estimates, it’s worse than before Roe.

Health-care providers worry that new abortion restrictions will further worsen outcomes. Already there have been reports of people not getting the medical care they need.

A Texas woman got sick with sepsis, a life-threatening infection, after doctors wouldn’t perform an abortion on her nonviable fetus. An Ohio cancer patient had to delay treatment she couldn’t undergo while pregnant because no doctors would perform an abortion. And in Wisconsin, a woman bled for more than 10 days after an emergency room wouldn’t remove fetal tissue following an incomplete miscarriage.