Seeking Abortion Care Across State Lines After the Dobbs Decision

TL;DR

This study explores the challenges people face when traveling across state lines to access abortion care in the US after the Dobbs decision.

Contribution

The study provides new insights into the barriers and facilitators of interstate abortion travel in a post-Dobbs landscape.

Findings

Participants faced long delays in finding clinics and navigating state laws.

Financial, geographic, and social support significantly influenced access to abortion care.

Restrictive policies in home states increased abortion stigma and limited information access.

Abstract

This qualitative study investigates the experiences of people traveling from states with abortion restrictions or bans after the US Supreme Court Dobbs v Jackson Women’s Health Organization decision to identify common barriers and facilitators of interstate travel for abortion and obstacles to abortion care.

What are the experiences of people traveling for abortion care from states with abortion restrictions or bans to Illinois, where abortion is legal, after Dobbs?

This qualitative study using semistructured interview data from 33 participants revealed extraneous and heterogeneous paths to obtaining abortion care after Dobbs. Participants encountered long delays in information-gathering, searching for clinics, and navigating complex laws between states, with common facilitators and barriers to obtaining care including an individual’s financial, geographic, and social circumstances.

Findings suggest that people in states with abortion bans face limitations to obtaining abortion care out of state and should be supported through policy change, visible information and resources, and charitable and interpersonal social support systems.

State-level abortion restrictions in the US enforced after the June 2022 Dobbs v Jackson Women’s Health Organization Supreme Court decision have worsened geographic, racial, and socioeconomic inequities in abortion access, warranting investigation of experiences for individuals who travel out of state to seek abortion care.

To highlight the obstacles abortion seekers must overcome to obtain care, to identify common barriers and facilitators of interstate abortion travel, and to offer recommendations for abortion organizations, policymakers, and advocates to expand access for individuals living in states with abortion bans.

This qualitative study analyzed data obtained from out-of-state participants collected as part of a larger cross-sectional, mixed-methods study. All English- and Spanish-speaking patients from out of state who were at least 16 years of age and medically cleared for research attending 2 abortion clinics in Illinois between September and November 2023 were eligible.

Participants completed a self-administered survey and a semistructured interview. Directed content analysis was used to identify emergent and crosscutting themes.

In total, 33 individuals (all self-identified as female or a woman) completed the survey and interview. Most participants were between 20 and 24 years of age (n = 12 [36%]) or 30 years or older (n = 12 [36%]), and from southern US states with a total abortion ban (n = 25 [76%]). From the time participants decided to terminate their pregnancy to the day of the abortion appointment, they experienced a median of 14.0 days of delay, with a mean (SD) of 29.6 (36.5) days of delay. Patient journeys of seeking abortion were categorized into 3 phases: information gathering, planning finances and travel, and traveling and completing the appointment. Participants reflected on how restrictive policies in their home states deepened abortion stigma and stifled access to accurate information. Most participants encountered their longest delays in the information-gathering phase, as they had to find legitimate clinics, often without any referrals, and navigate the complex web of laws between states. When patients had personal financial security, strong social support, or were in geographic proximity to a state in which abortion was legal, their journeys were facilitated.

In this cross-sectional qualitative study of participants traveling across state lines for abortion, the policy landscape and abortion stigma of the home state, information and resource availability, and interpersonal support shaped their journeys in the post-Dobbs landscape. To improve cross-state abortion access for individuals in states with abortion restrictions or bans, policy change should be coupled with increased visibility of accurate information, charitable funding, and abortion stigma reduction. Abortion support organizations and the public should continue to enable access through social support services, such as volunteer drivers and abortion doulas.

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