Out-of-state travel for abortions increases among Georgia women

This was the reality three women faced when they decided to leave their homes in Georgia and travel to New York City, Chicago and Washington, D.C., for abortion services.

They are among the thousands of women who have left the state for elective or medically necessary abortions since Georgia enacted one of the country’s strictest abortion laws, state data shows. The law, which took effect in 2022, bans the procedure after fetal cardiac activity is detected — typically around six weeks of pregnancy and before many know they are pregnant.

The number of Georgia women traveling for abortions spiked from 250 in 2021 to more than 9,000 in 2023. That’s just a snapshot from the four states — Kansas, North Carolina, South Carolina and Virginia — that willingly shared data with Georgia, and it is likely an undercount of the pregnant women who traveled out of state for the procedure. The changing political landscape and patchwork of abortion laws across the country will continue to shift where — and if — women are able to travel for care.

State Sen. Ed Setzler, an Acworth Republican who sponsored what became Georgia’s abortion law, said he’s not surprised to learn that residents are going elsewhere to get abortions.

“It’s no surprise that when we’re finally able to stand up for the helpless, there’s a residual effect of people who think abortion is a solution,” he said.

Alexis McGill Johnson, president and CEO of the Planned Parenthood Federation of America, said the country’s changing laws make it difficult for women to know where they can go for an abortion or if they have the financial resources to get there.

“States’ rights are not sufficient for freedom,” she said. “Every time I land, I have a different set of rights. I’ve got to check the weather, and then I’ve got to figure out what I can do with my body.”

The three women who spoke to The Atlanta Journal-Constitution had differing reasons for traveling, but they faced many of the same barriers of cost, time and child care, as well as the physical and emotional toll that needing to travel took on their bodies.

Roadblocks to care in Georgia and elsewhere

When Frida Simpson learned she was pregnant, the mother of two knew she could not take on the cost or responsibility of raising another child.

The 33-year-old Chicago native said she and the man she’d been dating were using condoms, so she was surprised when she realized her menstrual cycle was late. Simpson moved to Atlanta in 2021 to help care for her father, who has cancer. She is also a single mother of children ages 7 and 4.

“I’ve been taking care of my father; he’s in home hospice,” she said. “I’m raising children and going through a busy life. I had recently lost my job. Not at all did it occur to me that I missed my period.”

By the time she could see a doctor, she was more than 10 weeks pregnant. Simpson said she would have preferred to take medication to terminate her pregnancy, but even if it was legal for her to get an abortion in Georgia, the federal Food and Drug Administration only approves the use of the pills up to 10 weeks of pregnancy. Simpson said she searched the internet and that’s when she realized she was going to have to leave the state if she wanted to get an abortion.

Credit: arvin.temkar@ajc.com

Credit: arvin.temkar@ajc.com

Simpson was able to get time off work and stay with family in Chicago while other family members in Georgia cared for her children. Her flight cost $300, and she needed to pay for the procedure.

“When I called around in Chicago, they (let) me know that they didn’t accept out-of-state health insurance,” Simpson said.

By the time she made it to Chicago, she was more than 12 weeks pregnant and surgery was the only option. Simpson said she’d had two previous abortions — one when she was 19 and another when she was 30 and getting out of a relationship in 2021, both using abortion pills — and then a miscarriage in 2022.

Of all her experiences, the trip to Chicago this year was the most traumatizing, Simpson said. What she thought would be a two-week recovery turned into four when she said she was bleeding heavily and in serious pain.

“I didn’t know where I could go to say, ‘Hey, I went to Chicago,’ and tell someone I got an abortion,” Simpson said of experiencing complications when she returned to Atlanta.

Despite Georgia’s law not being designed to punish those seeking abortions, Simpson said she feared the consequences if she went to a hospital in the state for medical help and told doctors that she had traveled for an abortion.

“I just didn’t know what the repercussions of that would be.”

Traveling for care

Dr. Nisha Verma, a Georgia obstetrician and gynecologist, tells her patients about their options to travel out of state or to self-manage an abortion with medication. More than before, these conversations also include a discussion of the legal risks of both, Verma said.

“I start by saying, ‘I’m so sorry this sucks. You should be able to get care in our state,’ ” Verma said.

Verma said she directs her patients to AbortionFinder.org, which uses the patient’s ZIP code, last period and age to recommend medical facilities where they can legally get a medication or surgical abortion. She also directs patients to AidAccess.org, where patients can order abortion pills by mail.

Online resources such as these help women navigate the patchwork of laws and restrictions across the nation that make the decision about where to travel more complicated than where the nearest clinic is located.

“North Carolina is close, but they have a 72-hour waiting period and (require) multiple in-person visits, which might be prohibitive for certain patients,” Verma said. “If you think about all the things that need to go into travel — taking the time off work, getting child care and traveling — it does create disparities in care.”

She noted that national abortion funds from groups that offer financial or logistical help to people seeking abortions aid some patients in covering the cost of the procedure. Simpson took advantage of a similar fund since her Georgia insurance was not accepted in Illinois.

Thousands more Georgia women traveled to nearby states in 2022 and 2023 for abortions, data shared by states with the Georgia Department of Public Health show. About 130 women traveled annually to North Carolina for abortion care between 2018 and 2021, and that number increased to 3,300 in 2022 and 6,300 in 2023, data shows.

Callie Beale Harper, 37, originally thought she would travel from Fayetteville, Georgia, to North Carolina after she found out that one of the twins she was carrying had multiple severe, life-threatening medical conditions. Then the law changed.

In July 2023, North Carolina changed its law from allowing abortions up to about 20 weeks of pregnancy to banning them after 12 weeks and six days. South Carolina passed a law last year similar to Georgia’s that bans the procedure once fetal cardiac activity is detected. That law took effect in August 2023.

Harper’s maternal-fetal medicine specialist in Georgia had advised her to travel for the procedure “as soon as possible,” Harper said. Still, it took nearly four weeks to work with her insurance company, find a place for her and her husband to stay and arrange care for her 3-year-old son before she was able to travel to Mount Sinai Hospital in New York City to terminate the pregnancy of her sick son.

“I was grieving at the same time that I was trying to seek out the best care for me and my daughter,” Harper said.

Credit: Justin Taylor for The Atlanta Journal-Constitution

Credit: Justin Taylor for The Atlanta Journal-Constitution

Harper underwent a “selective reduction” procedure, which was supposed to allow her son to be absorbed by his placenta and delivered when his twin sister was born. Harper began to leak amniotic fluid before leaving New York. She developed a fever a week later when she returned to Georgia, sending her to the emergency room.

Because Harper was about 19 weeks pregnant, she was initially turned away by the labor and delivery unit at the hospital. After multiple complications and hospital admissions, she gave birth to her daughter, Kit, at 27 weeks.

The family celebrated Kit’s first birthday on Oct. 2, but Harper said there were multiple times that she felt the state’s laws delayed her care.

“Mothers should be able to decide how, when and where we care for our bodies and our children. There are so many people that love and want their babies that end up in situations that require prompt care,” Harper said. “The current laws, how they’re set up, do not allow for that.”

Narrow exceptions send women on long journeys

The state’s Public Health Department clarified earlier this year that providing lifesaving treatment to pregnant women doesn’t violate the law. That clarification came in response to reporting by the nonprofit news organization ProPublica about two Georgia women who died from complications after receiving abortions. The state told health care facilities and providers that the law does not require death of the mother be imminent for a doctor to determine a medical emergency exists.

Verma said the state’s guidance is not helpful because it did not clarify the biggest questions doctors have. For example, the law says abortions may occur if a pregnancy is “medically futile,” but that is not a medical term and it’s unclear whether the child must be likely to die at birth, within an hour or months later. The law’s exception for a “medical emergency” is also difficult for doctors to interpret because there is no bright line between a person being fine and at risk of death, she said.

“Doctors don’t know when legally under the law they can intervene, even though medically we know what the right thing to do is,” Verma said.

Doctors would carry the brunt of the punishment if they misinterpret the law and can lose their license and face up to 10 years in prison.

Credit: Natrice Miller/AJC

Credit: Natrice Miller/AJC

Setzler, who sponsored the legislation that became Georgia’s abortion law, said he disagrees that it is vague. He said lawmakers worked to strike a balance between protecting the life of the child and caring for the life of the mother.

Some states only allow exceptions to their abortion laws if the mother’s life is at risk, Setzler said. But he said Georgia went further to include language to allow abortions when a doctor determines a woman’s pregnancy would cause “substantial and irreversible physical impairment of a major bodily function of the pregnant woman.”

“We did that as an extension of openness and accommodation, and that very accommodation is being leveraged by abortion-minded doctors who want to be able to commit abortion at will for any reason to make a statement on this,” Setzler said.

Georgia law allows later abortions in limited instances: if there is a medical emergency threatening the life of the mother, if the pregnancy is medically futile or if the pregnancy is the result of rape or incest and the victim has filed a police report.

“The exceptions are incredibly narrow,” Verma said. “A ton of people don’t qualify.”

About one-half of 1% — or about 300 — of the nearly 70,000 abortions that have been performed in Georgia since August 2022 were done under one of the law’s exceptions.

Mackenzie Kulik, 39, and her husband, Mark, traveled 650 miles from their home in Brookhaven to Washington, D.C., after she lost nearly all her amniotic fluid early in her pregnancy but was told she still did not qualify for an exception to the law.

Amniotic fluid is critical during pregnancy because it cushions the baby in the uterus. The fluid helps the baby’s lungs grow and muscles and bones develop as the baby moves around in it. Kulik was 16 weeks pregnant when her doctor discovered that she had almost no amniotic fluid left.

Kulik had earned a master’s degree in public health at Emory University, so she went on PubMed and read the research on her condition.

“I remember sitting in the hospital room and starting to read and looking for positive outcomes and realizing that most of the time people terminate for medical reasons,” Kulik said. “Your heart just drops.”

Before her 20-week appointment, Kulik and her husband had a serious discussion. If the next scan looked bad, Kulik would bring up the possibility of an abortion to her doctor. Looking at the screen as the technician performed the scan, they both could tell the situation was worse. The room went quiet.

“I was trying to hold back tears — basically crying and trying to talk at the same time — and I asked, ‘Do we need to consider terminating?’ ” Kulik said.

Credit: arvin.temkar@ajc.com

Credit: arvin.temkar@ajc.com

Kulik recalls her doctor saying that their next conversation would be “off the record” and there would be no record of it in her visit notes. The doctor told her she would not be able to send messages with questions about what they discussed.

Kulik said, looking back at the situation now, that the laws in Georgia may have kept her doctor from telling her about the severity of her situation and advising her about the option to seek an abortion.

“They try to say that there are these exceptions and those exceptions work. Well, they don’t work. The exceptions don’t work, and the law is written to make sure they don’t,” Kulik said.

Instead, Kulik spent the next two days on the phone with her insurance company trying to schedule an appointment out of state at a hospital covered by her health insurance. She would need to travel to Washington, D.C., and stay there a minimum of three days. The only flights available were two tickets for $1,200 each.

The hospital billed her insurance more than $20,000 for the abortion, which after many more phone calls, her insurance approved along with their travel expenses, Kulik said.

If Kulik could have had her abortion in Georgia, she would have tried to get it done at Northside Hospital, which is a 10-minute drive from her house, she said.

“It’s very hard to accept that we didn’t have to go through that,” Kulik said.

Georgia law has several exemptions that allow a pregnancy to be ended after fetal cardiac activity is detected.