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PUBLISHED Mar. 8, 2023, at 6:00 AM

What Happens If North Carolina Bans Abortion? Or Ohio? Or Florida?

For the past eight months, Utah has been an unexpected haven for people seeking to end their pregnancies. After the Supreme Court overturned the constitutional right to abortion in their ruling on Dobbs v. Jackson Women's Health Organization in June 2022, nearby Idaho banned the procedure. Wyoming already only had one clinic left. But Utah’s handful of clinics kept serving patients up to 18 weeks of pregnancy — keeping abortion somewhat accessible in the wide-open spaces of the mountainous, rural West.

But it won’t last.

On March 3, Utah’s Republican governor said that he’ll sign a ban on abortion clinics that was recently passed by the Legislature, which means there will be no abortion clinics in the state starting next year. And the effects will then spread out across the multiple states whose residents were depending on Utah as the nearest place to get an abortion. This very thing could happen in other parts of the country where lawmakers in other red states that have turned into regional centers for abortion rights — like Florida — are looking to pass their own restrictive laws.

New bans will have outsized impacts on who can get an abortion, how far they have to drive for it and how long they have to wait for an appointment. A new analysis by Caitlin Myers, an economics professor at Middlebury College who studies abortion, illustrates how abortion access could continue to dwindle this year if key states like Florida and North Carolina pass additional restrictions.

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What happens if more states ban abortion?

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National average is calculated by averaging the distance of each county to its nearest facility, weighted by county population. Some counties have an abortion facility, but their population centroids are closer to a facility in another county or city.
SOURCE: Caitlin Myers

Using Myers’s data, we created a scale that shows abortion access by using two key factors: the driving distance to the nearest clinic and the number of reproductive-age women that each clinic serves, which serves as a rough stand-in for appointment availability. In some areas of the country, like large chunks of Oklahoma, Louisiana, Texas, Mississippi and Arkansas, distance and congestion are high because abortion is banned, leaving a handful of faraway clinics to serve a massive population. But banning abortion doesn’t necessarily increase both distance and congestion, at least not in the same place. For example, banning abortion in Utah and Wyoming would shift congestion to the surrounding states of Montana and Colorado while dramatically increasing distance for many Utah and Wyoming residents. This means that even if they don’t have as far to drive, residents of Montana (where abortion remains legal in this hypothetical) would likely have more trouble getting an appointment if abortion were banned in Utah.

Bans in some states would have a much bigger impact than bans in others. Data shows bans that went into effect post-Dobbs didn’t stop all abortions; for many, the bans merely shifted the location of the procedure, with people traveling from states with bans to those without. Back in October, we reported on the first release of data from #WeCount, a national research project led by the Society of Family Planning that is tracking the number of abortions being performed in each state in the months after Dobbs. #WeCount found several of the states with the largest post-Dobbs increases in abortions were those that retained relatively open abortion laws but bordered states that had implemented bans — places like North Carolina and Illinois, where abortion remains legal but are next to states like Missouri, Kentucky and Tennessee, where it is banned.

The shift in accessibility has led to longer wait times, and it means access is precarious: A new ban in one key state will have a ripple effect, impacting people living in clusters of nearby states.

Lawmakers in Utah and Wyoming, for instance, have both passed new bans on abortions or abortion clinics, but Utah’s would have a much broader effect if the governor signs it into law, as is expected. If Utah indeed bans abortion clinics, driving distances would increase dramatically for women in northern Utah, western Wyoming and southern Idaho. For example, in Box Elder County, Utah, which sits in the state’s northwest corner, the distance to the nearest clinic would increase from roughly 30 miles to more than 220 miles. Abortion clinics in Salt Lake City and the college town of Logan, Utah, are currently serving women from all three states (and others), so there would be an enormous amount of pressure on Wyoming’s lone abortion clinic if Utah’s had to close. If a ban happened in just Wyoming, the remaining clinics in Utah would experience increased demand for appointments, likely leading to longer wait times for those who can get to a clinic. If both states banned abortion, it could dramatically increase the volume of patients seeking abortions in Colorado and Montana.

In the interactive, we focused on states where additional abortion bans could pass in the next few years.1We excluded North Dakota because there are no abortion clinics in the state, although abortion is currently legal until 22 weeks of pregnancy. This categorization is somewhat subjective — not everyone agrees on the likelihood that North Carolina, where Republicans are one vote shy of a legislative supermajority, will place new limits on abortion in the near future — but we opted to be over-inclusive rather than under-inclusive. Myers’s analysis also considers what would happen only if a state were to enact a full ban on abortion, which is why Georgia — which currently bans abortions after about six weeks of pregnancy — is listed. It’s important to note that full bans haven’t been introduced in most of these states so far this year. Lawmakers in Nebraska, for example, are pushing for a six-week ban, and Florida Gov. Ron DeSantis signaled in early February that he would support a similar approach.

The analysis illustrates how pivotal a handful of red states have become in supporting the country’s fragile abortion infrastructure. For example, if Florida banned abortion, driving distances and clinic congestion would rise precipitously in not only Florida but also the southern parts of Georgia and South Carolina. A six-week ban would have a less dramatic impact for women very early in their pregnancies, but the next best option for a Floridian seeking an abortion after six weeks of pregnancy would be South Carolina, which has only three clinics. And if abortion access was cut off in Florida, Georgia, South Carolina and North Carolina, much of the South would look like Texas, where for many women the nearest abortion clinic is more than an eight-hour drive away.

This data also highlights how many states could still see large changes in abortion access over the coming year or two. As the chart below shows, some states have already seen access plummet, such as Texas and Louisiana, where the average minimum driving distance to the nearest abortion facility increased by nearly hundreds of miles after the Dobbs decision. These states went from median travel times of around 15 minutes to more than six hours, according to a study published last fall. Travel distance didn’t increase nearly as much in other states, but that’s because a handful of geographically important states were unable to enforce their bans for long. For example, Indiana and Ohio have had a near-total ban and a six-week ban, respectively, tied up in the courts since the fall.

How the Dobbs decision changed abortion access

Change in average driving distance to nearest abortion facility for every continental state, from May 2022 to February 2023

Click on a state for more info

Change in minimum congestion and driving distance by county for every continental state, from May 2022 to February 2023

State averages are calculated by averaging the distance of each county to its nearest facility, weighted by county population. States showing a reduced average distance after the Dobbs decision have seen new abortion providers open since then. “Pre-Dobbs” data as of May 1, 2022; “post-Dobbs” data as of Feb. 11, 2023. Bans as of 5 p.m. Eastern on March 7, 2023.
SOURCES: Caitlin Myers, Guttmacher Institute

An impending ruling from a federal judge in Texas could complicate matters even further. In that case, a group of anti-abortion plaintiffs have asked Judge Matthew Kacsmaryk to revoke the Food and Drug Administration’s approval for mifepristone, one of the two drugs commonly used to induce abortions. If Kacsmaryk — a judge with anti-abortion views who was appointed by former President Donald Trump — yanks mifepristone from the market, the effects would reverberate in blue states as well as red states. About 40 percent of the county’s abortion clinics provide only medication abortion. Depending on the scope of the ruling, those clinics might be able to switch to a different drug regimen for medication abortion. But if those clinics closed, the effects would be dramatic, particularly in the upper Midwest and Mountain West, where driving times and appointment congestion would increase.

How removing a common abortion drug from the market could change access

Change in minimum congestion and driving distance by county for every continental state, with and without abortion clinics offering medication abortion, which is often via the drug mifepristone

Current access with mifepristone
Potential access without mifepristone
SOURCE: Caitlin Myers

While 2022 was a historically disruptive year for abortion access, the fight over abortion’s legality is far from over in many Republican-controlled states — and in the courts. By the end of this year, abortion access could be even more limited in large swathes of the country.

Only continental U.S. is included.
The included clinics, facilities or providers are those that publicly advertise their services. The terms “clinic,” “facility” and “provider” are used synonymously in this article.
Distance is measured by the number of road miles between the population centroid of each county and the geographic coordinates of the nearest abortion provider. When road networks between a county and its nearest provider were unavailable, direct distance was used.
Congestion is measured by the “average service population,” calculated as the total number of women ages 15 to 44 in a set of counties where the nearest provider is in a shared commuting zone, divided by the number of providers in that zone.
Abortion provider data as of Feb. 11, 2023, unless otherwise noted.
Research for the data sets used in this story was led by Caitlin Myers of Middlebury College, with assistance from Middlebury students Rashmi Bajaj, Chujun Chen, Sophia Cole, Rose Evans, Katie Futterman, Senna Gardner, Constance Laranja Gooding, Julia Joy, Carinna Kinnaman, Elsa Korpi, Emily Kuperstein, Sascha Leidecker, Queenie Li, Chloe McNamara, Anthony Marinello, Gabryail Meeks, Awa-Victoria Morel, Audrey Peiker, Kayley Porter, Kate Ratcliffe, Emily Ribeiro, Laura Rivera Martinez, Anabel Sesek, Grace Sokolow, Shay Soodak, Ethan Sorensen, Frieda Violet Thaveethu and Kamryn You Mak.