Amber Pugh got a call recently from a pregnant woman who was crying and desperate.
“She shared with me that the partner involved with the pregnancy was refusing to assist her; he was verbally abusive,” said Pugh, who helps Florida residents access abortions as a care coordinator for the National Abortion Hotline.
“She's already struggling to provide for her two children,” Pugh continued, “She can't afford another child at this time because she's already behind on her rent payments."
This woman had been pregnant nearly six weeks and wasn't going to have time to get a legal abortion in Florida, Pugh said. By then, it would be too late.
The state has outlawed most abortions after six weeks, But even before that period lapses, patients must visit a clinic twice at least 24 hours apart before undergoing the procedure.
The woman was eventually able to obtain an abortion, said Pugh. But she had to travel hundreds of miles to the Washington, D.C., area.
“It's been incredibly difficult to watch care be decimated to this point in Florida,” said Pugh.
Demand for travel support soars
Though abortions have declined in Florida since a six-week law went into effect May 1, that doesn’t necessarily mean fewer people are seeking them. Many are traveling out of the state, while others are using telehealth to get abortion medications in the mail.
The National Abortion Hotline is reporting a dramatic increase in demand for travel support. It’s the largest patient assistance fund for abortions in the country.
In May and June, there was a 575% increase in people helped by the hotline travel out of the state, compared with the same period in 2023, data show. Then, abortion in Florida was available until 15 weeks of pregnancy, and many patients from other Southeast states with stricter bans were coming to Florida for care.
“Florida really served as a critical hub for abortion access, not just for Floridians, but for the entire Southeast of the country,” said Brittany Fonteno, president and CEO of the National Abortion Federation, which runs the hotline.
Now Floridians and others are turning to places like D.C., Virginia and Illinois.
“We've certainly seen a significant increase already,” said Dr. Allison Cowett, an OB-GYN who serves as medical director for Family Planning Associates in Chicago.
The health center served twice as many abortion patients from Florida and nearby states in June of this year compared to 2023. Making the trip can be costly, in more ways than one.
The journey can be tough
Patients may have to get time off work or arrange child care. They typically fly in and must spend at least one night in a hotel. Some tell Cowett that they've never been to a big city like Chicago, while others have never flown.
"We are taking care of these people who are traveling for, you know, already a stressful situation wanting to exercise their right to an abortion and needing support and care, and really being more traumatized by having to travel these long distances," she said.
Abortion funds are helping many of these patients plan and pay for their trips, Cowett said.
But even with financial help, not everyone can drop everything and travel to get an abortion right away, said Chelsea Souder, co-owner of Hope Clinic in southern Illinois. The clinic reported 1,200% and 600% increases in Florida patients for June and July of this year, respectively, compared with last year.
"The further that people have to travel, the more likely people are getting pushed further in pregnancy, and what we've seen at Hope since the Dobbs decision is that folks who are trying to access abortion in the second trimester have increased 2½ fold," said Souder.
The later in pregnancy someone gets an abortion, the more expensive it is and the higher the risk for complications.
Hope Clinic is just over the border with Missouri, which has banned abortion since the U.S. Supreme Court overturned Roe v. Wade in its 2022 ruling for Dobbs v. Jackson Women's Health Organization.
Clinic personnel are experienced in working with out-of-state patients, said Souder, and they applied lessons learned over the past two years to prepare for the aftermath of Florida’s six-week law. Those include building capacity and strengthening relationships with groups that can provide travel support.
Abortion opponents urge women seeking them to reconsider
Pregnant women have a legal right to travel to places with fewer abortion restrictions, said John Stemberger, an Orlando attorney and president of Liberty Counsel Action. The group opposes abortion.
Stemberger wants women to pursue parenthood or adoption instead.
“It's not just about changing the law; it's about changing the hearts and minds of people,” he said. “So when a pregnant woman who doesn't have resources or is scared or is ‘abortion-minded,’ that she thinks differently because people around her – society, the media – think differently. And there's resources there to support that woman, especially if finances are the issue, that should never be the issue to have an abortion.”
Stemberger cites the roughly 160 pregnancy centers in Florida, which get millions of dollars in state funding, along with programs that provide women with free baby supplies, such as formula and diapers, as examples.
Abortion rights advocates argue carrying a pregnancy to term isn't an option for some people.
Telehealth allows some patients to get abortion care from home
Travel isn't the only way Floridians are working around the state's law. There's been a nationwide surge in people getting abortion medications through the mail. Medical professionals in places without abortions bans prescribe the pills mifepristone and misoprostol online and patients take them at home.
It's illegal in Florida to use telehealth or mail pills for abortions, though the bans apply to doctors, not pregnant women. And several states have passed what are known as shield laws to protect doctors from punishment for treating residents in states with abortion restrictions.
A recent report from the Society of Family Planning's #WeCount project found that between October and December 2023, nearly 8,000 telehealth abortions were provided each month under shield laws to people in states with severe restrictions on telehealth abortion.
Authors of the report only included data on telemedicine abortions provided by licensed clinicians in the U.S. and note additional people are ordering the medication online outside the traditional health system, known as “self-managed” abortion.
Research shows self-managed abortions are safe and effective when patients take the medications as prescribed. This method is also usually less expensive than visiting a clinic and could be a good option for some people unable to travel, said Cowett of Family Planning Associates.
"So we're hoping people will get the appropriate instructions and medication from a reputable source, whether it's through telemedicine or several of the online medication abortion providers that have popped up and who have become more important in the abortion provision ecosystem in the last two years,” she said.
Still, the FDA only approves the use of abortion pills in the first 10 weeks of pregnancy. Some patients may also prefer to visit a clinic in person or need to for health reasons.
Amendment 4 is on the ballot
The barriers to care may be too much for some Floridians, said Qudsiyyah Shariyf, deputy director of the Chicago Abortion Fund.
The group has helped hundreds of residents from Florida and nearby states access abortions in Illinois since May 1.
But Shariyf suspects others are continuing pregnancies they don't want.
"Rich people are always going to be able to travel across the country to get the medical care that they need, but people who don't have access to resources, don't have safe people in their communities that they can go to for support, continue to be disproportionately impacted," Shariyf said. “Those are the people that are making the decisions to not get the care that they need because they feel like no resources are available to them.”
Abortion funds are available to help patients in need, said Shariyf, but she stressed they need more money to keep up with the growing demand.
Abortion access in Florida could change again if voters choose to protect it in the state's constitution.
Amendment 4 is on the November ballot and would allow abortions until fetal viability, which is usually around 24 weeks, or when a health provider deems that it’s necessary. The measure needs 60 percent approval to pass.
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