In the months after the Supreme Court revoked the nation’s constitutional protection for abortion, Massachusetts Planned Parenthood locations saw an influx of people from outside New England arriving for the procedure.
A new study, by researchers at Brigham and Women’s Hospital, the Harvard T.H. Chan School of Public Health, and the ASPIRE Center for Sexual and Reproductive Health at Planned Parenthood League of Massachusetts, showed the number of patients from out of state seeking abortion care in Massachusetts grew an estimated 37.5 percent in the first four months after the Dobbs decision compared with what would have been expected had Roe v. Wade not been reversed. That increase, researchers said, was driven largely by people from outside New England.
The study, published Wednesday in the journal JAMA Network Open, looked only at abortions performed at Planned Parenthood and compared that to expected trends, factoring in annual changes in clinic visits, seasonality, and the COVID-related decrease in pregnancies. Data was compiled from the three Planned Parenthood locations in the state that perform the procedure.
“It was hard to predict before Dobbs what the impact would be, in part because the Dobbs decision affected such a large number of people,” said Dr. Elizabeth Janiak, assistant professor of obstetrics and gynecology at the Brigham and director of social science research at Planned Parenthood League of Massachusetts, who co-led the project. “It’s been 50 years since we’ve had this number of people in the US not have access. How people would decide where to go was an open question.”
The Dobbs v. Jackson Women’s Health Organization decision came down in late June 2022. From July 2022 through October 2022, an estimated 45 additional abortions were performed on people from out of state compared to what would have been expected without Dobbs, bringing the total number in that time period to 155.
Though the number of out-of-state patients seeking Massachusetts abortions was greater than expected, such abortions still represented only 5 percent of the 3,237 that took place at Massachusetts Planned Parenthood locations in the study’s time period. The overall number of abortions increased an estimated 6.2 percent, according to the study.
Those numbers are higher than ones released last month by the Department of Public Health, which found a 16 percent increase in the number of people from out of state receiving abortions here in 2022 compared with 2021. However, the state compared actual visits for multiple providers over two years, whereas the Planned Parenthood data looked at expected trends versus actual numbers.
The state data also don’t capture where patients are coming from. According to the Brigham research, not only are more people coming to Massachusetts for abortion care, but more people are traveling farther for it since the Dobbs decision.
Janiak said 285 people came to Massachusetts from other New England states for abortions in 2021, compared to 87 people from non-New England states, according to unpublished full-year data from the Planned Parenthood League of Massachusetts.
In 2022, 146 people from non-New England states sought such care.
Janiak said there were a notable number from Texas, a trend that may reflect the size of the state’s population but also the fact that Texas had limitations on abortion earlier than other states.
The study also found that larger numbers of out-of-state travelers were receiving funding from charitable organizations for their abortions. While the estimated percentage of in-state residents receiving abortion funds increased from 1.9 percent to 3.1 percent in the months after Dobbs, the share of out-of-state travelers receiving funding increased from 8.4 percent to 18.3 percent.
The funding comes from different sources, both local and national. In all cases, researchers tracked funds used for abortion care, rather than funds used to travel to the clinic.
“Lots of folks have no insurance coverage for their care,” Janiak said, noting that though Massachusetts’ Medicaid program offers such coverages, many other states’ Medicaid programs do not. “They receive support from these funds to defray the cost.”
Whether existing funding is sufficient for all the women trying to access abortion is an open question. Because of the distances people are now traveling, individuals are likely getting an abortion later in their pregnancies, which often means they are more expensive.
“Even though there’s been a surge of people wanting to support this care, there is a huge surge in need,” she said.
Dr. Erika Werner, chair of obstetrics and gynecology at Tufts Medical Center, and chair of the Society of Maternal Fetal Medicine’s health policy and advocacy committee, said there is a huge equity disparity in who can currently access abortions, given the need to travel to get the care.
“Access to funds that cover the services or travel help to mitigate the inequities, but you have to know those funds exist,” Werner said. “[As] we see time and time again in other things, you have to know how to access grants to get them.”
The increase in patients coming from out of state did not surprise Rebecca Hart Holder, president of Reproductive Equity Now, a Massachusetts-based advocacy group, who said that it validates anecdotal stories the organization has heard from providers.
“This data is hugely important, and it’s the tip of the iceberg,” she said. “Independent clinics across the state are also seeing increased numbers of patients, especially with complexities. Hospitals are seeing patients seeking later abortion care. This is an important snapshot of a problem we can expect to grow as the fallout from the Dobbs decision comes to fruition.”
The data is also proof that the investments the state has made to bolster access to abortion were needed. The state last November passed $16.5 million in its economic development package for abortion access, security, and infrastructure, and an additional $1 million for a public education campaign on the dangers of crisis pregnancy centers, antiabortion organizations that work to persuade women to keep their pregnancies. Abortion access and funding was supplemented with $2 million in the budget that ended June 30 and another $2 million in this year’s fiscal budget. The state also passed a law after Dobbs protecting in-state abortion providers from professional licensure consequences and the reach of out-of-state investigations and legal actions.
But more still needs to be done, Hart Holder said. Location data firms have offered heat maps showing where people visiting Planned Parenthood abortion clinics live. Advocates worry that location data from people’s phones can also track them leaving an abortion-restrictive state for the procedure. Such data are relatively easy to de-anonymize. The data could also be used to track providers that perform abortions.
Pending state legislation would ban the sale of cellphone location information.
“People are traveling here for care and there is a digital trail they will leave that nefarious third party actors can purchase and use to track patients,” Hart Holder said. “We have to be bold and vigilant and continue to meet this crisis head on.”
The study provides an early look at the impacts of the shifting abortion landscape, even in a place that does not border an abortion-restrictive state. The influx is likely less than what other states experienced, particularly those closer to states that have limited access to abortion.
“This is the beginning of what ends up being a larger increase over time,” Janiak said. “There are other states like Illinois, Minnesota, states getting 30 to 40 percent increases in overall abortion volume. Those are the states I worry about abortion access for local folks. Massachusetts isn’t there yet. It’s an open question as to whether we will ever be.”