For continuing coverage of how COVID-19 is affecting reproductive health, check out our Special Report.
We will not find out for a few months how the recently argued U.S. Supreme Court case, June Medical v. Russo, will be decided. But lurking behind the Court’s first abortion case since President Donald Trump appointed two anti-abortion justices is an underappreciated aspect of abortion care in the United States: the extent to which abortion providers serve as de facto travel agents for patients.
If the Supreme Court rules against abortion rights in this case, an already challenging situation will become much worse. But even before the Court rules, the COVID-19 crisis is already complicating abortion care and putting more pressure on providers to troubleshoot travel issues.
At issue before the Supreme Court is whether a Louisiana law requiring abortion doctors to get medically unnecessary hospital admitting privileges is constitutional. If the Court allows the law to go into effect, the ruling will leave Louisiana with just one abortion facility. Under the rule, people in Louisiana seeking abortion care will have to depend on health-care professionals and pro-choice allies to help them navigate the complexities of long-distance travel to assure access to care.
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We know this because abortion travel is already a reality for many patients in the United States. For our recently released book on barriers to abortion care, providers told us stories of helping patients navigate the difficulty of abortion travel. For many people today, the difference between getting an abortion and forced childbirth comes down to long-distance travel.
If, as many fear, the Supreme Court continues to chip away at abortion rights, these challenges will grow, and the time providers spend arranging travel will only increase. The spread of COVID-19, of course, will only further complicate the efforts to get patients to clinics safely and efficiently, as anti-choice state officials target abortion access as part of their COVID-19 response and clinic escort services are curtailed to slow the spread of the virus.
The problem arises for some patients because many have to rely on other people to drive them, either because of a lack of their own car or because some clinics use sedation, and therefore patients are not allowed to drive themselves home. Poignantly, several providers told us of patients who were driven to the clinic by a male partner and then were abandoned. In these cases, clinics either pay for transportation or staff would drive patients home.
This is beyond a medical staff’s normal responsibilities, but as one New England clinic director told us, even she periodically does this. “You do what you’ve got to do,” the director said.
We heard stories of old, barely functioning cars breaking down on the long drive to the clinic, forcing the clinic to scramble for a solution.
One provider told us of a panicked patient’s harrowing experience. “She was driving to see us with her boyfriend, and the car broke down,” the provider said. “She called us and said she was going to be late, and then called some friends who were able to meet her and provide another car. When she got to our clinic, she said to us, ‘I felt like, oh my God, I’m going to have a child because my car broke down!’”
With clinics few and far between—six states have only one clinic—it’s common for bus rides to take a half-day or longer. Many providers told us of patients, sometimes with their children and other family members in tow, sleeping in cars in the clinic parking lot after a long drive because they could not afford a motel. Even worse, a provider in the Midwest told us about a young woman who was home for the summer in a remote area of the state when she found out she was pregnant: The woman had no help because her boyfriend was in New York and her parents were unsupportive. So, as the provider told us, “she rode 15-plus hours from the northern part of the state on a bus down to our clinic the night before her abortion. When she came to us the next morning, she was covered in mosquito bites because she had spent the night in the bus station. Outside the bus station, actually.”
Even when patients are able to initially present at a clinic, some find out they have to travel to yet another facility because the clinic can’t treat them if they are too far in pregnancy or have special health issues.
One of the most extraordinary travel stories we heard was of a woman in a Southern state who was unable to be seen locally and was driven, over a three-day odyssey, by a volunteer in her mid-60s to a clinic in Washington, D.C., and then to a third clinic in New York, where she finally received care. But the challenge didn’t end there, as the 12-hour ride home was the trickiest part. The volunteer told us, “It was a hair-raising ride with storms, torrential downpours, and high-wind advisories. We made it to her home at one minute past midnight on Christmas Eve, so it was technically one minute into Christmas Day.”
The volunteer had promised to get the patient back home for the holiday, so she was relieved. “I kept my promise to her.”
Research backs up the stories providers and patients tell about the restrictive reality of abortion care in the United States. An estimated one-fifth of people in the United States seeking an abortion travel more than 50 miles to get an abortion. Scholars have identified “abortion deserts,” the 27 cities in the country, spread out among 15 states mostly in the South and Midwest, that are more than 100 miles from an abortion clinic.
These stories and statistics paint a rarely captured picture of abortion access in this country. Many people are familiar with the obstacle that the cost of abortion creates, especially given the federal ban on Medicaid covering abortion care. What is less commonly understood is the way poverty creates travel difficulties—just getting to an abortion facility adds costs and logistical challenges for patients. And of course the lost wages many will experience as a result of COVID-19 shutdowns will only exacerbate this poverty.
Jumping in to alleviate some of these burdens is an unheralded army of abortion providers and volunteers stepping up to help conquer the travel challenges facing abortion patients. These travel agents disburse gas cards, arrange volunteer rides, coordinate bus rides, pay for flights, and reserve hotel rooms. One such volunteer told us of a somewhat clandestine network in the South of relay drivers: “I’ve got people in place along the interstate that can say, ‘OK, I can drive her this far. Someone else can pick her up here.”
How COVID-19 will affect flight travel, presumably making it harder for patients to access the specialized care only available in a few states, not to mention the ability of traveling doctors to reach clinics, remains to be seen.
Those who care about abortion rights need to be prepared for this coming reality and work to support providers as they handle the even-greater flood of need that is likely to come. In an ideal world, trained medical professionals should be focused on delivering health care, not acting as travel agents.
David S. Cohen is a professor of law at Drexel University and Carole Joffe is a professor of obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco. They are the authors of Obstacle Course: The Everyday Struggle to Get an Abortion in America.