Patients seeking abortion care travel hours, often crossing state lines, to reach Board-Certified Family Nurse Practitioner Rachel Kashy and her colleagues at the Women’s Health Center of Maryland.
“Why are we forcing people to flee their homes to get essential health care?” Kashy asked Capital News Service in an interview. “I can’t answer that.”
The Western Maryland clinic provides sexual and reproductive health care services. It’s also the only abortion provider for 70 miles.
Since Roe v. Wade was overturned by the Dobbs v. Jackson Women’s Health Organization decision in June 2022, Maryland providers are seeing more patients from other states.
There has been at least a 27 percent increase in out-of-state patients receiving abortion care in Maryland since 2019, the last pre-Dobbs year with available data. In 2023, about one in five abortion patients in Maryland lived out-of-state.
That’s according to a Capital News Service analysis of estimates on clinician-provided abortions by state from the Guttmacher Institute, a research organization working to expand reproductive health care.
When West Virginia banned abortion in 2022, the last provider in the state, Women’s Health Center of West Virginia, had to stop providing abortions. One year later, the center opened its sister clinic near Cumberland, Maryland.
The clinic exemplifies Maryland’s role as an abortion access state, with strong legal protections for patients and providers. It’s also home to two of the few clinics in the country providing abortions later in pregnancy.
Marylanders approved Question 1 this year, adding “an individual’s right to reproductive freedom” to the state constitution.
“I’m really proud of Maryland right now,” said Planned Parenthood of Maryland President Karen Nelson. “Maryland is a leader in reproductive health care and reproductive health care legislation.”
Abortion bans have forced hundreds of patients to come to Maryland from as far as Texas and Louisiana for care.
In 2023, the first full year after the reversal of Roe v. Wade, Maryland providers performed nearly 38,500 procedural and medication abortions. More than 7,000 of those patients were from out-of-state.
“It was shocking to us, because when Florida enforced their six-week ban, the next week our Florida patients tripled,” Nelson said. “The landscape changes every time a new ban goes into effect.”
These numbers are likely an underestimate. To protect patient privacy, the Guttmacher Institute only publishes data on states of origin if more than 100 patients travel from that state in a given year.
Data from Planned Parenthood of Maryland shows clinics in the state have treated patients from 38 different states, including Alaska and Hawaii, since Roe v. Wade was overturned.
Ramping up access
Maryland was a hub for reproductive health care in the country even before Roe was overturned. Now, it’s the best option for many abortion patients from the South and Southeast.
The state has expanded access since Dobbs, enacting a 2023 shield law protecting medical records for out-of-state-patients and medical professionals providing care.
Data from the Guttmacher Institute shows the number of abortions performed have increased nationwide, despite bans and restrictions put in place in 21 states after the Dobbs decision.
That’s true for Maryland as well, which saw an increase of nearly 7,000 abortions for in-state residents and about 1,600 for out-of-state patients per year between 2019 and 2023.
Nelson said Planned Parenthood of Maryland has seen a 75 percent increase in abortions since the Dobbs decision. She credits this to greater capacity and expansion of telehealth services, like providing abortion medication by mail.
However, some Maryland residents still struggle to get care.
“Having a legal right to something does not mean that it is accessible,” said Lynn McCann-Yeh, co-executive director of the Baltimore Abortion Fund, a nonprofit that helps cover abortion costs. “It’s a very common experience, even here in Maryland, to still not be able to get your abortion without additional support.”
At Planned Parenthood of Maryland, abortions cost between $500 and $800 for first- and early second-trimester abortions. Later procedures at all-trimester clinics can cost upwards of $15,000.
While interstate travel for abortions is increasingly common, some states have tried to prevent it. No states have successfully passed travel bans, but Texas and Oklahoma criminalize people “aiding and abetting” patients who get an abortion in another state.
Abortion funds react to increased need
Although receiving abortion care has become more complicated for many, organizations like the Baltimore Abortion Fund have stepped up support.
Abortion funds help patients overcome mounting hurdles, whether that’s finding the nearest clinic or making travel plans.
The Baltimore Abortion Fund saw its call volume increase by over 60 percent in the year after the Dobbs decision, McCann-Yeh said.
“People are basically trying to piece together enough money,” McCann-Yeh said. “Sometimes up until the day before their appointment.”
The fund supports between 2,000 and 2,500 people each year, half of whom are out-of-state patients.
“It’s not just the visit, it’s everything else leading up to it,” Kashy, of Women’s Health Center of Maryland, said. “When you take a group of people that are already facing hardships, and then add that on top, it seems insurmountable.”
What’s next?
Abortion providers are reeling from the results of the 2024 election and the expected fallout of conservative control of the federal government next year.
“It’s been a lot of hard conversations and crying and then also getting back to work,” Kashy said. “Why do we have to protect people in their states against their lawmakers?”
Photo Gallery by Caitlin Kelley
While measures supporting abortion access passed in seven states in the 2024 election, similar measures failed in Nebraska, South Dakota and Florida.
Ingrid Duran, the state legislative director for the National Right to Life Committee, the oldest and largest anti-abortion organization in the country, said travel bans are not on the committee’s state legislative agenda because they would be unconstitutional.
“[The National Right to Life Committee] has consistently aimed to enact effective protections for unborn children,” Duran said. “Implementing those types of strategies, the travel bans – they will not achieve that goal.”
However, Idaho successfully passed legislation based on the organization’s model legislation meant to prevent minors from accessing abortion care without parental approval, in their state or elsewhere.
Duran said reducing the total number of abortions hasn’t yet been achieved, but she is optimistic that will change over time.
“I am hopeful that… moving forward with educational campaigns, with life-affirming legislation and continuing to support and protect both the mother and her unborn child, we are going to see a shift in those numbers,” Duran said.
However, providers and care coordinators say they’re more determined than ever to help patients receive reproductive health care.
“This is not a moment for us to give in to despair, but a moment for us to get to work,” McCann-Yeh said.
As volunteers, employees and providers collaborate to support patients, community support for organizations like the Baltimore Abortion Fund is critical, McCann-Yeh said.
“That is how we will survive this next chapter,” she said, “and it’s going to really, genuinely take all of us to get there.”
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