JACKSONVILLE , Fla. - She learned she was eight weeks pregnant at a crisis pregnancy center near her South Georgia home.
So on a recent day, she and her mother got up early and drove three hours to Jacksonville, Florida, to a Planned Parenthood clinic that has seen more patients from other states than Floridians in the past year.
The woman said crossing state lines for an abortion banned in Georgia was “heartbreaking.”
”This feels like I don’t have a right to my own body anymore (in Georgia), and that lack of autonomy, it makes me feel like less of a person for what I’m doing today,” she said.
The Atlanta Journal-Constitution is not using the names of patients or those who accompanied them to clinics to protect the identities of those who had abortions.
In the year since abortion restrictions took effect in Georgia, many patients have traveled to states with more permissive laws to end their pregnancies. But as the laws in neighboring states shift, their options have narrowed and uncertainty has taken hold.
Georgia’s law, which took effect July 20, 2022, bans most abortions once a doctor can detect fetal cardiac activity, typically about six weeks into a pregnancy and before many know they are pregnant.
Under the new law, the number of abortions performed in Georgia dropped by nearly half, from about 4,000 per month to nearly 2,200, according to May data from the Department of Public Health. It’s unclear how many Georgians have traveled out of state for abortions since then. Local nonprofits, and some clinics that report the data, tally thousands in the past year, but the count is incomplete.
It’s also not clear how many Georgians have ordered abortion pills in the mail from distributors that send them from other countries without prescriptions.
The clinics taking Georgians have been inundated with patients from other states across the Southeast that imposed tight restrictions on abortion after the U.S. Supreme Court last year overturned constitutional protections for the procedure in its decision in Dobbs v. Jackson Women’s Health Organization. Many clinics operate in Florida and North Carolina, where abortion is legal at later stages of pregnancy than in much of the South.
But North Carolina this month changed its law to ban most abortions after 12 weeks of pregnancy, down from 20, and impose a requirement that patients seeking abortions visit the provider twice, 72 hours apart. Florida’s law bans abortions after 15 weeks of pregnancy, but many expect a six-week ban now tied up in courts to take effect this fall.
More than half, and sometimes as much as 80%, of abortion patients at the Planned Parenthood Jacksonville Health Center come from other states, Health Center Manager Jessica Wannemacher said. Out-of-state travel spikes on the weekends: On a recent Friday, 10 patients came from Georgia, five from Mississippi, one from South Carolina and one from Texas.
The clinic offers other services, such as contraception and gynecological care, but since the Dobbs ruling, the greatest demand is for abortions, she said.
“A tidal wave of patients just started coming and it happened very rapidly,” she said.
When the Georgia woman found out she was pregnant, she says the employees at the South Georgia crisis pregnancy center pressured her to keep the baby. It took her a couple of weeks to decide.
“I knew that I was not mentally or financially prepared for it, just because I am so young,” she said. She declined to share her age. “My mother had me really young. She was in my position and didn’t have the chance to do anything other than keep me.”
The woman said her mother gave up school and much of her personal life. Many relatives shunned her for getting pregnant at her age. She ended up raising three children by herself.
The young woman said she spent a lot of time calling and researching to figure out where she could go for an abortion.
Florida’s abortion law requires two in-person clinic visits. On the first visit, patients get an ultrasound and choose between abortion pills or a surgical procedure. Most out-of-state patients at the Planned Parenthood Jacksonville Health Center choose surgical abortions because they do not require follow-up appointments to confirm the procedure’s success.
Patients must come back for the procedure at least 24 hours after signing their consent.
The woman took unpaid time off from work for both days of her appointments. She could not afford the abortion but said she qualified through Planned Parenthood for financial aid that paid for everything. Only her mother knew what she was doing.
She and her mother spent the first day driving between their home and the consult at a Planned Parenthood in Gainesville, Florida, where abortions are not performed. She chose the surgical option over pills, some of which she’d have to take at home. They drove the next day to Jacksonville for the procedure.
“I knew that if I went home and did it, I wouldn’t have been able to go through with it,” she said. “I’m confident in my decision, but it’s nerve-racking. I never thought I would be in this position.”
In the past year, the Jacksonville clinic hired more doctors and other staffers so it could offer abortions five days a week instead of two, Wannemacher said. The facility coordinates with another Planned Parenthood in Tallahassee, which also absorbs patients from Georgia and other Southern states.
On a recent day, the clinic had 28 first-day consults, 21 surgical abortions and six medication abortions. The count included overflow from Tallahassee, where an air conditioner was broken. Doctors, nurses and ultrasound technicians hopped from room to room as Wannemacher sat in a hallway directing them. Doctors occasionally worked in an office decorated with abortion rights slogans and thank-you notes from patients.
Outside, palm trees stood motionless in the still, hot air. Five protesters held signs on the sidewalk outside a high wall around the clinic, shouting to women with offers of help and information. They hoped to direct people to First Coast Women’s Services, a local network of crisis pregnancy centers that do not provide abortions.
Alan Stevenson’s sign read, “What about your baby?” And on the other side, “Children are being exterminated here today.”
He said an unexpected pregnancy 52 years ago led to the birth of his daughter, now an elementary school teacher with a son of her own.
“I think we made the right choice,” Stevenson said, “so it gets real personal for me.”
If Florida’s six-week ban takes effect, Planned Parenthood will help more people find abortion appointments in other states, Wannemacher said. The facility will also expand other services, such as those for vasectomies, early prenatal exams and, to the extent legally possible, gender-affirming hormone therapy, she said.
Dr. Shelly Tien, who also practices in other states, doesn’t see herself coming to the Jacksonville clinic as frequently under a six-week ban because she would have fewer patients. Sometimes she is the only doctor, with 40 to 45 patients in a day, but of the 27 abortions scheduled for that day, none were below six weeks of pregnancy and 11 were beyond 13 weeks.
According to the U.S. Centers for Disease Control and Prevention, about 79% of abortions in 2019 were performed in the first nine weeks of pregnancy. But in Florida, Tien says she is seeing an increasing number of patients who are between 11 and 15 weeks because traveling has delayed their care. Many other patients are forced to see through unwanted pregnancies because they are not able to leave their state, she said.
“Patients have to physically travel and find time away from work and raise the funds to pay for an abortion because abortion is not covered by insurance and find somebody to care for their children,” Tien said.
The clinics of Planned Parenthood of South, East and North Florida see about 80 Georgia patients a month, up from an average of 30 per month before Georgia’s law took effect, spokeswoman Michelle Quesada said. Most of the affiliate’s out-of-state patients are from Georgia, she said.
The affiliate’s overall out-of-state patient volume has quadrupled since the Dobbs decision, Quesada said. At some of the busiest Florida clinics, Planned Parenthood has doubled the number of abortion providers, she said. The affiliate has hired and trained other additional staffers and expanded clinic hours. Patient navigators, who help people find appointments, are working around the clock, she said.
Claire Bartlett, executive director of the Georgia Life Alliance, said her organization is still strategizing for the next General Assembly session and is not ready to say whether it will propose legislation that aims to restrict patients from crossing state lines for abortions. A few states have passed laws prohibiting people from helping others travel out of state for the procedure, but they are so far untested in court, according to The Associated Press.
“Our big concern is for the health and safety of women and girls,” Bartlett said. “We know some providers are less than scrupulous, so we have concerns for our residents and citizens in Georgia if they go somewhere.”
After the Georgia law took effect, Planned Parenthood Southeast delayed implementing a patient navigator program while working with lawyers to determine what was allowed. The affiliate serves Georgia, Alabama and Mississippi.
The Alabama attorney general has said anyone who helps someone get an abortion can be prosecuted under that state’s conspiracy and accessory law, so Planned Parenthood Southeast in October deployed patient navigators only for residents of Georgia and Mississippi.
Credit: NATRICE MILLER
Credit: NATRICE MILLER
The navigators have helped about 300 patients, said Vivienne Kerley-de la Cruz, the organization’s Georgia campaigns director. About 90% of those patients were sent away from Georgia and Mississippi, which has a near-total ban, for abortions.
The navigators help people work through the barriers to abortion, including their estimated gestation time and, largely, costs — of travel, meals, lodging, child care and the abortion appointment. Most choose to go to Illinois, North Carolina, South Carolina or Virginia, Kerley-de la Cruz said.
ARC-Southeast said it has helped about 1,500 Georgians get abortions since the Dobbs ruling. The organization spent more than $420,000 in the past year on abortion costs for Georgians, but Georgia clients spent a total of about $1.6 million on those abortions, highlighting the financial gap that callers experience, ARC-Southeast spokesperson Musa Springer said.
ARC-Southeast takes clients from Georgia, Alabama, Florida, Mississippi, South Carolina and Tennessee. Many had been going to North Carolina, but that started to change in the days after the new law took effect there, said Elsie Vazquez, the organization’s healthline manager.
“Southerners who are in the Deep South keep having to go further north or farther west as bans keep getting passed,” she said. “It’s just heartbreaking speaking to people on the phone. There’s a lot of discouragement in people’s voices just the past few days.”
Callers are in need of more money — more are flying now, to faraway appointments, than ever before, Vazquez said. Some are heading to major cities, such as Washington or New York, where everything is more expensive. Others are opting for the two appointments in North Carolina and need help affording the child care and unpaid time off work, Vazquez said.
After the Dobbs ruling, North Carolina experienced the highest increase of any state in terms of the percentage of people seeking abortions, according to the Society of Family Planning. But the new waiting period could change that, said Molly Rivera, a spokeswoman for Planned Parenthood South Atlantic.
“You’re likely looking at overnight stays, at least two nights, maybe three nights?“ she said. “Just that extra in-person appointment alone is going to add a lot of cost and logistical hurdles that we think will be insurmountable for a lot of people.”
Planned Parenthood South Atlantic covers North Carolina, South Carolina, Virginia and West Virginia. Of all its locations, the Asheville, North Carolina, clinic has seen the greatest increase in the number of abortion patients in the past year, Rivera said. That clinic is the affiliate’s closest to metro Atlanta and other restrictive Southern states, including Tennessee.
Although abortion is legal in South Carolina through 22 weeks of pregnancy, the state has seen less out-of-state demand due to its relatively limited number of clinics, Rivera said. Planned Parenthood operates in Charleston and Columbia, while an unaffiliated clinic is located in Greenville.
South Carolina Gov. Henry McMaster signed a law similar to Georgia’s in May, but it has since been tied up in litigation.
A Woman’s Choice, another network of clinics, has been seeing about 100 abortion patients from Georgia per month in Jacksonville, Florida, and close to 200 per month in three North Carolina locations, said Amber Gavin, vice president of advocacy and operations. The network has patient navigators, who find that people who can’t get abortion appointments in Florida or North Carolina tend to try Virginia first, Gavin said.
Diane Derzis, who owned the Jackson Women’s Health Organization at the center of last year’s U.S. Supreme Court ruling, said its sister clinic in Columbus, Georgia, is just as busy as before Georgia’s law took effect. She guessed that women, faced with tighter bans, could be taking steps to find out earlier that they are pregnant and get abortions before the cutoff.
Those past the gestational limit in Georgia are referred to another of Derzis’ clinics in Bristol, Virginia, on the Tennessee line. Derzis thinks the new North Carolina law will drive more patients to Bristol.
“This is all a big game that women are being forced to play to take care of themselves,” she said.
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