BALTIMORE — Erin Case has put thousands of miles on her car as a manager at the Baltimore Abortion Fund, which supports those seeking the procedure by helping foot the cost and offering rides to and from the clinic.
Often, she drives women who, for privacy reasons, don’t want to ask a friend or relative to take them. But on a recent day, her passenger was someone in town from Texas, among the many who leave that state for abortions because of a new law known as SB 8, which lets any individual sue those who perform the procedure after six weeks of pregnancy or even help a patient get to a clinic.
Roughly half of the people the nonprofit Baltimore fund helps are already from out of state, and Case is among those who see the number rising as abortion faces its most serious legal threat in decades. Not only did the U.S. Supreme Court allow the Texas law to go forward last month, it is poised to rule this summer in a case from Mississippi that many say could overturn the court’s landmark Roe v. Wade ruling.
Overturning Roe, which marks its 49th anniversary Saturday and established the constitutional right to abortion, would likely create a domino effect of perhaps 26 states banning or restricting it, by one projection. While observers say Maryland is among the states most protective of abortion rights and surely would not be one of those enacting a ban, it would feel ripple effects nonetheless.
“A lot of folks will be needing to travel. We’ve already seen folks coming to Maryland from Texas because of SB 8,” said Case, who has driven people who are from as far away as Washington state to Maryland providers.
Activists and legislators in Maryland are ramping up efforts for an anticipated greater demand for the procedure, which could strain existing capacities and resources.
Activists on both sides of the issue hosted events, as they do every year, to mark the Jan. 22, 1973, anniversary of Roe. Hovering over all was the prospect that this could be the last year with Roe as the law of the land.
“Roe’s turning 49,” said Kristie Hamrick, a spokeswoman for the Students for Life group. “It may never turn 50.”
In Maryland, as elsewhere, the fight is ongoing. Abortion rights became part of Maryland law in 1992 via a referendum that voters approved by a wide margin.
Proponents say they need to continue improving access and affordability, particularly given the national climate.
“If Roe falls, I’m horrified about what that means for abortion access in Maryland,” said Lily Bolourian, executive director of Pro-Choice Maryland.
“We always thought of abortion as settled law,” said Del. Ariana Kelly, a Montgomery County Democrat. “But there’s a big difference: Just because you have a right, doesn’t mean you can access it.”
Kelly said she plans to introduce a bill, perhaps in the coming week, that would allow nurse practitioners, nurse midwives and physician assistants to perform abortions. In Maryland and most other states, only doctors can do them.
The physician-only provision is “outdated,” Kelly said, at a time when nurse practitioners and others known collectively as “advanced practice clinicians” handle much of patient care. Additionally, physician-only laws were enacted before the advent of medication abortions, she said, and these clinicians generally are allowed to write prescriptions.
Expanding who can perform abortions is among the measures that states have enacted as shifts in the control of governors’ mansions and state houses lead to new laws. In 2019, noting seven other states had similar laws, Maine Gov. Janet Mills proposed and ultimately signed legislation allowing advanced clinicians to perform abortions. In 2020, Virginia Gov. Ralph Northam, a Democrat like Mills, reversed a series of abortion restrictions that had been previously enacted, and allowed nurse practitioners to perform abortions in during the first trimester of a pregnancy.
Groups like the American College of Obstetrics and Gynecology and the American Public Health Association have called for the repeal of physician-only laws as a way of increasing access to the procedure.
Kelly’s bill would also require insurance companies in Maryland to cover abortions and eliminate deductibles for them.
Those opposed to abortion will fight the bill, promised Hamrick, who decried “outsourcing” the procedure to nonphysicians.
Michele Hendrickson, a Sykesville resident who is director of strategic initiatives for Students for Life, said abortion opponents are gearing up to make sure women know there are resources out there to support them as they continue their pregnancies.
“There’s a real pro-life energy in Maryland,” she said. Even in a state that has protected abortion rights, Hendrickson said, “we can still change hearts and minds.”
As Republican President Donald Trump appointed conservative justices to the Supreme Court during his recent term, some Maryland Democrats suggested including a right to an abortion in the state constitution. That would give it greater protection than state laws that can be repealed or altered by the legislature. However, others felt Maryland had settled that abortion is legal, and the idea of “enshrining” abortion in the constitution has not advanced.
The Supreme Court cases have spawned other efforts across the country in the last year: Some states see an opportunity to enact abortion restrictions along the lines of what Texas and Mississippi have done. More liberal states, by contrast, are seeking to “shore up protections” to keep abortion accessible and affordable, said Elizabeth Nash, the lead state policy analyst for the Guttmacher Institute, a research and policy organization that supports reproductive freedom.
Nash said the number of states that could ban abortion would place many women in a bind: Either continue an unwanted pregnancy or travel hundreds or even thousands of miles to another state. Travel requiring an overnight hotel stay, taking time off work or arranging for child care, she said, could put the procedure out of reach.
“Each of these costs adds up,” Nash said. “And these costs may be insurmountable.”
That could make abortion something available only to those of a certain affluence, advocates fear.
“This is an equity problem,” said Karen Miller, a consultant for Planned Parenthood Maryland.
Already, she said, there are jurisdictions in Maryland where there are no clinics, something that could be helped by expanding who can perform abortions.
“If you allow other medical professionals who already deal with miscarriages and prenatal [care], you increase the number of people who can perform abortions safely,” Miller said.
Groups like the Baltimore Abortion Fund were working to scale up their operations even before the Supreme Court heard oral arguments last month in the Mississippi case that poses a direct threat to Roe, Dobbs v. Jackson Women’s Health Organization. Also at stake is a case that followed Roe, Planned Parenthood v. Casey, which reaffirmed that states cannot ban abortion before the point when a fetus can’t survive outside the womb. That generally is around 24 weeks into a pregnancy, but Dobbs bans most abortions past 15 weeks.
Maryland allows abortions after viability under certain circumstances, which advocates say is part of the reason it has become a destination for women from out of state. Some people don’t discover, for example, fetal anomalies or develop health problems until past the point when their states allow abortion, activists said. Or, it takes time to arrange or gather money for the trip, pushing the procedure to later in the pregnancy, they said. In any event, according to the Centers for Disease Control and Prevention, less than 1% of U.S. abortions are performed at or after 21 weeks of gestation.
With the possibility of abortion becoming more restricted elsewhere in the country, advocates in Maryland want to be prepared.
“The idea is to be proactive,” said Lynn McCann, co-director of the fund.
The fund, supported by donations, provided about $250,000 last year to help people get abortions in Maryland clinics, with about half those assisted coming from out of state, she said. That is more than double the prior year’s $100,000 outlay, McCann said.
And this year, she said, “We’re intentionally doubling funding again.”
The Baltimore fund is part of the National Network of Abortion Funds. It and funds in Washington D.C., Virginia and the Carolinas form a pilot program for the national network’s “Operation Scale Up” that will increase staffing, resources, and collaboration.
“The question for us has been access, not legality,” McCann said. “Our main reason for being is to remove barriers to access.”
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