As lawmakers in North and South Carolina work to impose new restrictions on abortion, options for women seeking to end a pregnancy in the South are diminishing quickly.
In North Carolina, a ban on abortions after 12 weeks of pregnancy goes into effect on July 1. Gov. Roy Cooper had vetoed the legislation, but the state's Republican-led Assembly voted Tuesday to override that veto.
Also on Tuesday, the South Carolina House of Representatives approved a six-week abortion ban, which now advances to the state Senate. And last month, Florida Gov. Ron DeSantis signed a bill that would ban most abortions after six weeks. The law will take effect if Florida's Supreme Court upholds its current 15-week ban in an ongoing legal challenge.
"We’re going to see many people forced to continue pregnancies against their will,” said Amy Hagstrom Miller, the founder and CEO of Whole Woman’s Health, which operates two abortion clinics in Virginia, along with clinics in Indiana, Maryland, Minnesota and New Mexico.
Miller said she was bracing for more women who are seeking abortions to travel to Virginia, which will likely soon be the last Southern state without abortion restrictions.
North Carolina’s ban makes exceptions for rape, incest and “life-limiting” fetal anomalies. Proponents of the legislation argue that it offers a compromise on abortion.
"The things in this bill are not obstacles to abortion. They’re safeguards. We seek to balance protecting unborn babies while ensuring the safe care of mothers," North Carolina House Speaker Pro Tempore Sarah Stevens said in floor remarks Tuesday night.
Even before North Carolina's 12-week ban passed, Miller said her Virginia clinics were seeing patients from across the South. Since January, her call center has received more than 6,000 phone calls from people out of state seeking care in Virginia, she said.
Not all of those people make it to her clinics: Miller said that every day, a patient cancels an appointment, often after multiple attempts to reschedule, because of factors that prevent the patient from traveling, such as a child getting sick or a ride falling through.
"They say to us, 'It’s just going be easier for me to have a baby. I can’t figure out how to get there,'" she said.
The time it takes to schedule an appointment and arrange travel also prompts some patients to delay abortions until the second trimester (on average, women don't learn they're pregnant until between five and six weeks' gestation). In many cases, that will entail a surgical abortion, since abortion pills are approved for use only up to 10 weeks of pregnancy.
The forthcoming ban in North Carolina could exacerbate those issues, Miller said.
Amber Gavin, the vice president of advocacy and operations at A Woman’s Choice, which operates three abortion clinics in North Carolina, said her clinics were already seeing wait times of about 10 days.
Gavin said those waits may get longer once the 12-week ban takes effect — even if patient volume decreases — because the new law requires an in-person visit three days before an abortion and mandates that all abortions, even those done using pills, be administered in person.
"It just adds more administrative tasks to our physicians and our medical staff than necessary," Gavin said.
She added that her North Carolina clinics frequently see patients from Alabama, Florida, Georgia, Louisiana, Mississippi, South Carolina and Texas. Come July 1, the clinics will start referring women who are more than 12 weeks pregnant to providers in Virginia, Maryland, Illinois and Washington, D.C., she said.
"It’s just going to have devastating effects to the entire South," Gavin said.
One remaining option is The Brigid Alliance, a service that provides travel, food, lodging, child care and other logistical support for people seeking abortions across the U.S.
Clinics and providers can refer people to the service, which receives funding from private donors. The group's typical client travels more than 1,300 miles round trip and has travel expenses of nearly $1,400.
"A lot of our clients haven’t even left their county," said Serra Sippel, the alliance’s interim executive director. "Many have never been on an airplane before."
In the long term, medical experts and political leaders also fear an exodus of physicians from states with abortion bans, which could limit access to both abortions and maternal health care more broadly in the South.
"The North Carolina ban will harm patients and threaten doctors for providing essential care," White House press secretary Karine Jean-Pierre said in a statement on Tuesday.
Dr. Catherine Kuhn, associate dean for graduate medical education at Duke University School of Medicine, said residents who are training in obstetrics, gynecology or family medicine will likely need to travel to other states to learn how to administer abortions after 12 weeks.
North Carolina might also struggle to attract new medical talent if the state is seen as hostile to reproductive health care, Kuhn added. A survey of medical students, published this week, found that nearly 60% said they were unlikely or very unlikely to apply to a single residency program in a state with abortion restrictions.
"I'm worried that, particularly in women's health and reproductive health care, we'll see a decrease in applications and interest," Kuhn said.