Florida’s six-week ban changes the nation’s abortion map, leaving many women in the South with few options beyond traveling far out of state.

By Liz Crampton and Alice Miranda Ollstein

05/02/2024 05:00 AM EDT

Florida has been a refuge for abortion access in the South.

Not anymore.

Florida’s six-week abortion ban went into effect Wednesday, making the procedure nearly impossible to access for many would-be patients throughout most of the southern United States. Women from Florida to Texas are cut off from obtaining abortions either entirely or beyond the very beginning stages of pregnancy — unless they have the time and means to travel across states to a place where appointments are available, an option many women will not have.

The shift away from abortion access in Florida opens a new phase in the post-Roe v. Wade world, with severe new limitations on abortion in place across a vast and unbroken stretch of the country. The new landscape further limits access to care for women and is guaranteed to strain reproductive health care services in nearby states that still allow for broad access to the procedure.

“Our patients are screwed,” said Robin Marty, executive director of the West Alabama Women’s Center — a former abortion clinic that transitioned to providing a broad range of reproductive health services after Roe was overturned. “This is the point where it all starts to crumble.”

More than 80,000 people receive abortions in Florida annually — a number that has ticked up slightly since Roe was overturned. Since that landmark court decision, over 12,000 out-of-state patients have had an abortion in Florida, according to state data.

Now, for someone living in Miami seeking an abortion beyond the first six weeks, the closest option is traveling to North Carolina, an 11-hour drive. But if that person is more than 12 weeks pregnant, disqualifying them from care under North Carolina state law, or unable to abide by the state’s 72-hour waiting period, they must travel at least another four hours further north to Virginia.

Before the six-week restriction, women could receive abortions up to 15 weeks, establishing Florida as a destination to receive care. The vast majority of abortions are performed at or before that stage in pregnancy. The new law includes exceptions for victims of rape, incest, human trafficking and for serious medical complications — though similar exemptions in other states have proven difficult or impossible for many pregnant people to navigate.

Anti-abortion-rights groups have been eagerly waiting for the law to go into effect since it was signed by Republican Gov. Ron DeSantis last year. They too are mobilizing in light of the six-week ban. Broward County Right to Life Executive Director Tewannah Aman said the group is leveraging their network of churches and affiliated groups to counsel women who are considering getting abortions.

“We’re saying to the people that are banding together, whatever the need is, we’re here for them,” Aman said. “However they need help and support, we’re here for them.”

Whole Woman’s Health, a pair of clinics in northern Virginia, is exploring opening more locations along the southern border in preparation for the influx of patients, said Amy Hagstrom Miller, the organization’s CEO. More than a quarter of current patients are coming from out of state, and they expect that share to increase, she said.

“My phone staff have really become travel agents,” Hagstrom Miller said. “They’re talking about gas cards and the best highways to take and which hotels are the nicest, where to go and who’s going to treat them right, which airlines cancel their flights less often and which flights have less connections.”

Yet providers in some other Southern states are afraid to do this patient navigation work, as some Republican attorneys general threaten to charge anyone who helps someone obtain an abortion out of state with criminal conspiracy.

“Let’s say somebody comes in and gets an ultrasound that proves that they’re pregnant and they tell us that they don’t want to be pregnant,” Marty explained. “We can say, ‘You can go to our website —there are resources there.’ But that’s it. If they say, ‘Well, where is the closest legal abortion clinic?’ I can’t tell them.”

Marty added that many of her low-income patients in Alabama, who were already struggling to make it to Florida, will likely not be able to travel further. And even if they can, Marty worries clinics in states like Virginia and North Carolina will be overwhelmed and not able to offer an appointment in time.

Current wait times for abortions at some of Planned Parenthood South Atlantic’s clinics are about two weeks and likely to increase as demand grows, said Katherine Farris, chief medical officer of Planned Parenthood South Atlantic, which serves South Carolina, North Carolina and Virginia. Clinics are seeing more patients further along in their pregnancies because they’re encountering more obstacles to seeking care, she said. Abortions later in pregnancy are not only more expensive but carry a higher — though still low — risk of complication. Facilities in North Carolina and other neighboring states are working on increasing the number of available appointments, but it is challenging planning staffing when travel times are hard to predict, she said.
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“The reality is that there aren’t enough appointments for every patient in the South who will need an abortion,” Farris said.

The legal landscape across the country, and particularly in the South, remains in flux.

A court ruling Tuesday night, for example, could help ease the bottleneck in North Carolina. U.S. District Judge Catherine Eagles sided in part with an OB-GYN who challenged the state’s restrictions on dispensing abortion pills as unlawfully preempting federal regulation of the drugs. The ruling, if upheld, will mean nurse practitioners and other non-physician medical providers can prescribe the pills in the state, and patients will no longer have to attend a mandatory, in-person follow up appointment — changes that will make access far easier for patients coming from out of state.

But the ruling also left some restrictions in place, including a mandatory ultrasound, blood test and in-person counseling before taking the pills.

Yet access to the pills remains in jeopardy. The U.S. Supreme Court heard arguments in late March on a lawsuit brought by anti-abortion doctors that could roll back patients’ ability to obtain the pills nationwide, and allies of former president Donald Trump are drafting plans to restrict use of the pills through executive action should he win in November.

To the west of Florida, the closest states with broad abortion access are Illinois, Kansas and Colorado. Providers in those states are worried about the “ripple effect” on patient care beyond abortion services, warning that the flood of patients from Florida and other Southern states could impact appointments for other reproductive health services like obtaining birth control.

“To take a whole section of the country and eliminate access — it’s very harmful,” said Karen Middleton, president of the Colorado abortion access nonprofit Cobalt. “The notion that states are somehow going to make these decisions by themselves as if it doesn’t affect other states, it’s really thoughtless and cruel.”

Ahead of the ban going into effect, Florida abortion funds were already fielding significantly more requests from women seeking assistance: Florida Access Network said it received more than 220 requests in April compared with 93 in the same month last year. FAN gave $400,000 to 1,500 people in 2023, including people in neighboring states, and will begin to direct people to more expensive out-of-state care. This will cause the organization to meet its spending caps much sooner than usual, said Stephanie Loraine, executive director of FAN.

“Regardless of what happens in November, people need abortion access, today, tomorrow, next week,” she said. “The reality is as a nonprofit organization without unlimited resources, there’s no way to be able to serve every single person who needs abortion access. The resources just don’t exist.”

Florida’s ban and its implications across the South has ratcheted up the stakes for the ballot referendum voters will consider in November in the state to establish a constitutional right to abortion up until viability, which is generally considered to be around 24 weeks into a pregnancy. Abortion would also be legal later in a pregnancy under undefined “health” circumstances.

Abortion has given reproductive rights advocates plenty of momentum at the ballot box: in every statewide referendum, the pro-abortion rights side has won, even in red states like Ohio and Kansas.

But this will be the biggest test in the South. And Florida requires ballot measures to get over a 60 percent threshold to pass — a bar that was not met in some states that approved their own measures, like Michigan.

Still, Democrats and abortion advocates are hopeful that Florida’s unique politics from the rest of the region will help them in the election — and that living under the abortion ban for six months will convince voters to take their side.

“Nobody will be able to look away from the reality of what the GOP legislature has done,” said state Senate Minority Leader Lauren Book. “It is extreme, it is not supported by the majority of Floridians, and I believe that come November we will be victorious.”

Megan Messerly and Arek Sarkissian contributed to this report.