States across the western US have seen a surge in women traveling for days and spending thousands of dollars to access abortion care in the five months since the supreme court overtuned Roe v Wade.
Providers and advocates are coping with the influx through a patchwork of groups providing financial and practical assistance to patients from the south, midwest and south-west, where more than a dozen states have banned or restricted abortion access.
With the midterm elections just days away, those on the frontlines of this network describe daily fatigue and concern for the future. They say their ability to fortify a “sanctuary” of care in the west is at stake, as states across the country decide whether to safeguard abortion rights or vote for conservative lawmakers who could further restrict access, sending even more desperate patients their way.
In Colorado, ‘a safe haven and a swing state’
The fight has become especially urgent in Colorado, which, along with New Mexico, is encircled by Republican-controlled states that have implemented near total bans on abortion.
In 2021, roughly 1,500 patients traveled to the state for abortion care, according to the Colorado health department. Since the supreme court ruling, that number has risen dramatically; in the first two weeks of October alone, Planned Parenthood reported seeing 900 out-of-state patients, more than half of whom were from Texas.
Jennifer Linhorst, an independent obstetrician-gynecologist based in the Denver-metro area, has seen a tenfold increase in patients seeking abortions and sterilizations over the past four months. For the vast majority of women traveling from Texas and Oklahoma, the combined cost of the trek and the procedure is prohibitively high.
At the same time, the wave of new patients is pushing the clinic’s capacity and leaving staff burned out.
“We’re definitely seeing more people facing more wait times,” she said, noting that providers often have to skip lunch. “We try to fit everyone in but there’s only so many hours in the day.”
Jack Teter, the regional director of government affairs at Planned Parenthood of the Rocky Mountains, described Colorado as a special access point for people living in the center of the country.
But its position as a sanctuary is precarious. While the state’s Democratic leadership has taken steps to protect care access, Republicans here have a history of trying to make abortion a crime – Democrats defeated two such proposals just this year.
“We’re both a safe haven and a swing state,” Teter said.
Ahead of the midterms, Colorado abortion advocates are campaigning for Democratic candidates so the party can retain control of the state legislature and expand on this year’s Reproductive Health Equity Act, which enshrined the right to abortion into the constitution, and expand other protections such as requiring private insurers to cover abortions and reversing a ban on state funding for abortions.
Keeping control of the state legislature next month, Teter said, is the difference between losing or preserving the lone abortion refuge in the American heartland. Many women in the midwest and south, Teter said, are already making extraordinary sacrifices to get treated in Colorado – their choices would be even more grim should they be forced to travel to coastal states.
“We’ve seen patients who have driven 1,000 miles one way,” he said. “We’ve seen women come with kids sleeping in the backseat because they can’t find day care or take a day off work.”
A western coast abortion ‘alliance’
Some western states have banded together in their efforts. After the supreme court ruling in June, the Democratic governors of California, Oregon and Washington vowed to make the west coast a refuge for abortion access, freeing up millions in funding to help subsidize travel costs for out-of-state patients.
That pledge is being tested in Oregon, where the number of abortions performed rose by 18% over the summer, according to recent data from the Society of Family Planning. Montana Pindell, an abortion patient navigator for Planned Parenthood Columbia-Willamette, which covers eastern and northern Oregon, said health centers have seen an explosive rise in patients from Idaho and Texas, as well as Arizona and Florida.
Some face extreme financial hardship: a Planned Parenthood clinic in Bend, Oregon, recently helped reimburse a woman who spent $1,200 on a cab ride from Idaho. Planned Parenthood is also opening new clinics across the state, including one in Ontario, a city on the Idaho border.
“People have always faced hurdles even before Roe fell because of the stigma and politics around this type of care,” she said. “It’s just really heartbreaking.”
For most cases, Pindell said, Planned Parenthood would partially cover the cost of the procedure, while partnering with mutual aid groups to procure funds for travel, accommodation and other logistical needs. Many abortion clinics also work closely with local charities that have been inundated with requests for assistance.
The cost to organizations can be exorbitant. The Denver-based Cobalt Abortion Fund, which works with Linhorst’s clinic, spent $6,000 in 2021 covering travel and boarding and roughly $200,000 covering procedures, spokesperson Laura Chapin said. Since Roe fell, spending on travel has soared: the fund has already used $160,000 on practical expenses – $74,000 on hotels and $40,000 on flights – nearly all of which came in the aftermath of the Roe decision. That’s in addition to $250,000 spent on more than 1,000 procedures, two-thirds of which are for patients from Texas.
California, meanwhile, has in many ways emerged as ground zero of the anti-abortion resistance. Over the past few months, Planned Parenthood leaders across the country have been meeting in the state’s capital to map out a national strategy, which Hicks said includes legislation shoring up data and legal protections for patients and providers.
In September, California lawmakers passed 15 bills aimed at bolstering abortion access, including making the procedure cheaper for women with private insurance, creating scholarships for students studying to perform abortions and shielding providers from out-of-state prosecution. Voters will get a chance on Tuesday to amend the state constitution to guarantee the right to abortion.
“We got over $200m in investment to ensure people can get care no matter what their zip code is,” said Jodi Hicks, the president and CEO of Planned Parenthood Affiliates of California, one of the groups that helped shape the state’s new abortion laws.
But despite the progress, advocates say they are watching Tuesday’s vote with nervous anticipation.
“This election is a choice between keeping abortion legal and making it a crime,” said Teter.
