Massachusetts has emerged as a safe haven for reproductive health care, following the Supreme Court’s reversal on Roe v. Wade, but there are wide swaths of the state, some densely populated, where it’s impossible to schedule an abortion.
No one provides routine abortion services on Cape Cod, Martha’s Vineyard, Plymouth County, or the entire South Coast, which includes two major gateway cities, New Bedford and Fall River. That’s an area that’s home to nearly 1 million people and numerous hospitals and medical centers. Abortion providers are even more scant in Western Massachusetts, which has lower and more dispersed populations and greater distances to reach services.
Statewide, only nine hospitals routinely offer the procedure, seven of them in Boston and Cambridge, according to a directory created this year by a leading abortion rights group. Data from the state’s Registry of Vital Records and Statistics, which tracks all abortions performed in Massachusetts, shows that only one provider in Southeastern Massachusetts performed abortions last year — Four Women Health Services in Attleboro.
That means that from Provincetown, at the tip of Cape Cod, pregnant people would have to travel about 120 miles to reach the nearest abortion provider in Boston, Attleboro, or Providence. From Hyannis, they would have to travel about 65 miles to Attleboro, a city on the Rhode Island border, and 75 miles to Boston or Providence.
The logistical barriers pose a challenge to those who rely on public transportation, cannot easily take time off work, or have limited resources to act in a time-sensitive situation. Advocates say the limited access undercuts the state’s staunch support for abortion rights at a time they are under unprecedented attack nationally.
“We continue to say that legality is not synonymous with accessibility,” said Taylor St. Germain, a spokeswoman for Reproductive Equity Now. “We believe anyone who wants to access in-person care should be able to do so.”
An analysis published late last year in the journal Contraception tracked how far students had to travel from public university campuses in Massachusetts to reach abortion clinics, and how long it would take them on public transportation. The study found that it would take students at Massachusetts Maritime Academy on Cape Cod more than six and a half hours, while a trip from University of Massachusetts Dartmouth would take three hours. UMass Amherst students would travel 25 miles, more than two hours on public transit.
State Senator Julian Cyr, a Democrat who represents the Cape and Islands, said the lack of abortion providers in his district has been a longstanding problem.
“This becomes a significant hurdle for a number of reasons,” Cyr said. “Particularly in those busy summer months, we have a real influx of young, single workers,” and people with seasonal work visas. “The process of going to Boston without traffic is a four-hour round trip.
“There’s an absolute need for access,” he said, suggesting a collaboration between existing providers to make abortion accessible on the Cape.
Under one provision of the abortion law enacted in July, the state Department of Public Health and Reproductive Equity Now are tasked with identifying areas of the state that are more than 50 miles away from abortion care. The new state law also expanded abortion access and aimed to shield Massachusetts abortion providers and patients who travel here for care from prosecution in other states that have outlawed abortion.
Clinics in Massachusetts are seeing some patients from those states but not a huge influx, and demand for in-person services — even in areas where access is limited — has been somewhat suppressed due to other trends. Abortion numbers have been declining for years (though cases increased slightly last year), particularly with the rise of long-acting reversible contraception. Medication abortion has also become far more prevalent, lowering the number of surgical abortions in traditional clinics and making the proximity irrelevant. (The Food and Drug Administration began making medication abortion available by telehealth and mail during the pandemic, though the protocol is only approved through the first 10 weeks of pregnancy.)
Clinics handled more than 80 percent of all abortions in Massachusetts last year, a Globe review of data from the state’s Registry of Vital Records and Statistics found. Patients might turn to a hospital if her obstetrician is there, if she develops complications, or if she seeks to terminate a later pregnancy.
All hospitals that offer emergency care are expected to perform abortions if necessary to stabilize a pregnant patient in crisis, and all Massachusetts hospitals are believed to be compliant, according to the Massachusetts Health and Hospital Association.
But hospitals and medical providers are not required to provide abortion as a regular service to their patients. The Department of Public Health encourages, but does not require, the programs it funds to offer abortion.
Southcoast Health, for instance, a not-for-profit community health system with hospitals in Fall River, New Bedford and Wareham, does not offer routine abortions, a spokesman said.
South Shore Hospital, which describes itself as the leading provider of emergency care in Southeastern Massachusetts, generally refers women with unintended pregnancies to other providers, though state data show that the Weymouth hospital performs a small number of abortions — four in 2021 and a dozen in 2020.
“If a service is not urgent, we may refer patients to providers with a greater degree of expertise,” a hospital spokeswoman said. “We will provide appropriate care for patients, as indicated by their clinical condition, including under emergent circumstances.”
Mass General Brigham performed hundreds of abortions in its hospitals last year. But its affiliated hospital on Martha’s Vineyard does not offer abortion “due to lack of consistent staffing for this service,” according to a spokesperson.
“It’s a problem,” said Dr. Terry F. Kriedman, who runs a private gynecology practice on Martha’s Vineyard but who doesn’t perform surgeries. For the occasional patient she sees who wants to terminate a pregnancy, she makes appointments for them in Boston, a logistical challenge for a working person on the island.
“You have to get a boat,” she said. “You have to take time off of work.”
The two hospitals on Cape Cod — Falmouth Hospital and Cape Cod Hospital in Hyannis — refer pregnant patients for abortions elsewhere unless the need is urgent, according to a statement from Cape Cod Healthcare, the parent company.
“Although we have never offered abortions among our services, CCHC does perform abortions when a woman’s life is in jeopardy,” the company said. “We always do whatever is necessary to preserve the health of the mother, which includes offering abortion services.”
Cape Cod Healthcare noted it has an affiliation with Beth Israel Deaconess Medical Center, which provides abortion services in Boston. But Beth Israel also has a much closer hospital in Plymouth, and the ob-gyn department there said it refers patients to the abortion clinic in Attleboro.
Likewise, Outer Cape Health Services, which runs health centers in Harwich, Wellfleet, and Provincetown, may refer patients to other providers but does not provide on-site abortion services, a spokesman said.
Health Imperatives, a nonprofit, runs seven clinics in Southeastern Massachusetts with a focus on family planning. None provides abortion.
President and CEO Julia Kehoe said that with resources for low-income and vulnerable patients already spread thin, Health Imperatives has focused on areas of greatest need — including long-term contraception, which reduces the need for abortion — and cancer screenings that are also not readily accessible in remote areas they serve.
“We have to analyze every potential new service we offer on a number of factors, including adequate resources,” she said.
Instead of offering abortion, she said, Heath Imperatives centers connect patients with other providers for telehealth visits or in-person appointments and with abortion funds that help patients with logistics and financial support to get there.
“While people have to travel sometimes longer than is ideal, there is a great network of service providers who provide assistance,” she said.
It’s unclear whether the region could support another freestanding clinic. Four Women in Attleboro, the sole abortion provider in Southeastern Massachusetts, only schedules surgical abortions one day a week because of limited demand, said Dr. Marcus Gordon.
“It’s not really profitable,” he said. “It would be hard to have another one in the southeast. There were a couple years it looked like we were barely able to survive.”
Instead, abortion providers and advocates are eyeing partnerships and encouraging abortion services at existing medical facilities. A community outreach specialist for Planned Parenthood is working with community organizations on Cape Cod to help patients travel to Boston for appointments and has advertised its telehealth services through social media and digital ads.
Dr. Jennifer Childs-Roshak, president of the Planned Parenthood League of Massachusetts, said access to abortion should not be restricted based on someone’s zip code or income level.
“PPLM remains committed to working with existing reproductive health care providers on the Cape and across Southeastern Massachusetts to establish and expand abortion services, because everyone deserves access to care close to home,” she said.
Stephanie Ebbert can be reached at Stephanie.Ebbert@globe.com. Follow her on Twitter @StephanieEbbert.