The Dobbs Decision and the Burden of Interstate Travel

On June 24, 2022, the day the U. S. Supreme Court announced the Dobbs decision that overturned Roe v. Wade, I was in Montana, on my way from Spokane, WA to Chestertown and retirement. Although the opinion had been leaked on May 2, the decision to overrule a nearly-fifty-year precedent shook the country. On my trip, I crossed into nine different states, thinking only that I was one state closer to Maryland. Now, for pregnant persons seeking abortion care in a post-Dobbs world, state borders loom large, as they did in a pre-Roe world. Borders matter now more than ever.

The states I sped across represent a variety of state government reactions to Dobbs. Having lived next door to Idaho for several years (think Ruby Ridge, Aryan Nation, and now New Apostolic Reformation), it is no surprise that Idaho quickly banned abortion with extremely limited exceptions—to save the pregnant person’s life and in the case of rape and/or incest. And Idaho will be in the U. S. Supreme Court this term in a case involving the rights of emergency room doctors to make decisions to protect the health of a pregnant person.

South Dakota, on the very day Dobbs was announced, implemented an abortion ban, the only exception being to save a pregnant person’s life. South Dakota’s neighbor, Minnesota, is a stark contrast. It is a “sanctuary state,” with no ban on abortion, codifying the right last January, and, in April, the governor signed legislation protecting those who travel to Minnesota to get an abortion. (Article here) Ohio permits abortion up to “viability” ; after that point there are limited exceptions. In November, Ohio voters decided that the state constitution should be amended to include the right to make autonomous reproductive decisions. But challenges await.

(Article here) In Pennsylvania, abortion is legal up to 23 weeks and 6 days with exceptions after that. (For current laws in each state see https://www.abortionfinder.org/)

In December, the Guttmacher Institute released new data regarding the rise of interstate travel since Dobbs. In 2020, one out of ten patients had to travel to another state for an abortion; in the first half of 2023 “nearly one in five” traveled to another state . . . Nationally, the number of people who crossed state lines to obtain abortion care more than doubled, reaching 92,100 in the first six months of 2023, compared with 40,600 in half of 2020. People traveling for care are mainly traveling to states that border states with total abortion bans or bans that begin early in gestation.” (Study here) Fourteen states do not have any clinics that provide abortions—Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, and West Virginia.

For West Virginia residents seeking abortion care, Maryland is on their radar. In Forbes, Judy Stone, a practicing physician in Cumberland, Maryland (Allegany County) wrote about the opening of an abortion clinic there that originally had been in Charleston, West Virginia. Not only will it provide abortion care for patients from West Virginia, but will serve the needs of residents of western, rural Maryland. (Article here) In May, Governor Moore signed several bills that make Maryland a place where those seeking abortion care can be protected. For example, “judges are prohibited from requiring individuals to provide testimony or evidence in other states’ cases that allege a violation of criminal law for receiving or assisting with health care that is protected in Maryland.” (Article here) And, in June, Maryland Attorney General Anthony Brown signed a letter of comment, along with 24 other attorneys general, asking that the Department of Health and Human Services stiffen rules so that it would be “illegal to share a patient’s private health information if that data is being sought for certain criminal or civil investigations and proceedings against someone in connection with a legal abortion or reproductive care.” (Article here)

Laws might protect patients traveling out of state, but interstate travel costs money, a huge challenge for many. The Guttmacher Institute  notes that the increase in interstate travel has been accompanied by more of a demand for assistance. For example, “ the Baltimore Abortion Fund distributed almost three times the funds in 2022 as in 2021.” (Article here) The Fund has described the realities of interstate travel for those seeking abortion care: “Our average out-of- state caller has an abortion that costs $8,347, an expense that 87% of people living in restricted states will pay for out-of- pocket. This is especially shocking when you consider that more than half of Americans are unable to afford an unplanned expense of $1,000 or more. Many of our clients will have to call multiple sources of financial support . . . They also need to arrange travel, accommodation, meals, and time off from work, which is often unpaid. Travel expenses can range from $50 for a bus ticket, to over $1,000 for flights and hotels. Many of our clients have never left their hometown before — let alone their state — and are suddenly forced to board a plane or drive across the country for the first time.”  (https://www.baltimoreabortionfund.org/2306_sun_guest_commentary)

While patients are crossing state borders this winter and coming spring the Supreme Court will be hearing two important abortions cases, one regarding the prescription and distribution of the abortion drug, mifepristone, and the other regarding the rights of healthcare providers to provide emergency care to pregnant patients. And in November, Maryland voters will vote on a referendum which would enshrine reproductive rights in the state constitution.

In Dobbs, states’ rights came back with a vengeance. Tragically, the power given to states over decisions related to pregnancy means that one’s zip code determines even more one’s autonomy to make some of the most important decisions of one’s life. To paraphrase Justice Ginsburg, when government action causes a person to travel to another state to gain the healthcare they need, to save their lives, then those people are being treated “less than a fully adult human responsible for [their] own choices.”