WA abortion clinics scramble to care for out-of-state patients. How far are they traveling?

Two years after the U.S. Supreme Court struck down the constitutional right to abortion, Washington remains one of 21 states where abortions are protected.

But the court’s decision is nevertheless shaking up abortion services in Washington state.

For decades patients have come to Washington for abortions from other Northwest states, including those where rural residents might not have had access close by to abortion services.

But since the 2022 Dobbs v. Jackson Women’s Health Organization decision, the number of abortions performed in Washington has increased as more people from out-of-state seek services. And there is some data that shows it now takes longer on average to get an abortion in Washington .

“Just because the state of Washington protects an abortion right, it doesn’t mean that we’re immune from the impacts of the Dobbs decision,” Sen. Maria Cantwell, D-Wash., said in a recent news conference on the second anniversary of the decision.

The Guttmacher Institute released data in late May that looked at the change in travel patterns as the number of people traveling out of state for abortions nationwide doubled from 81,000 in 2020 to 166,000 in 2023.

“What’s striking about this new data is how often people are traveling across multiple state lines to access abortion care,” said Isaac Maddow-Zimet, a Guttmacher data scientist.

Out-of-state patients in Washington

The largest number of out-of-state patients came to Washington from not only nearby Oregon, Idaho and Alaska, but also Texas following the Dobbs decision, according to the Guttmacher Institute.

Idaho and Texas are both states that criminalized abortion following the Dobbs decision. Until last year, Eastern Oregon had no facility offering in-clinic, procedural abortions, making the Tri-Cities at 25 miles across the Oregon and Washington state line the nearest clinic for many in Eastern Oregon, according to AbortionFinder data .

The Kennewick clinic in Eastern Washington also was the closest clinic offering procedural abortions, in addition to abortions with medications, for Idaho’s largest population center when Idaho banned abortions in August 2022.

The drive to Kennewick from Boise — part of the five Treasure Valley counties that are home to about 750,000 people — takes more than four hours.

In the first five months of 2023, the Kennewick clinic saw 91 patients from Idaho , up from just two for the same time period a year earlier, according to data compiled by Cantwell’s staff.

Planned Parenthood responded by opening a clinic in Ontario, Ore., that offers procedural and medication abortions in the spring of 2023. It is about a 50-minute drive from Boise.

Planned Parenthood also launched a campaign in 2023 to make sure people in Idaho knew where they could go to get a legal abortion. Hot pink billboards dotted the Boise area and Northern Idaho, saying “Abortion is legal in Oregon and Washington.”

Despite the additional clinic in Ontario to provide services for the Boise area, the number of abortions in Eastern Washington still increased 10% in 2023, with 17% of patients from out-of-state.

A UW Medicine study of abortions performed at Cedar River Clinics — in Seattle, Tacoma, Renton and Yakima — found that its out-of-state patients had increased 50% since the Dobbs decision, from 4% to 6% of abortion patients.

While previously just over half of out-of-state abortion patients had come from Alaska, Cedar River Clinics reported post-Dobbs patients are:

• 27% from Texas
• 26% Alaska
• 8% Idaho
• 6% Louisiana
• 6% Florida

However, the number of out-of-state residents traveling to Washington for abortions may be undercounted.

It is not in the best interest of abortion providers and patients for providers to press for information about where patients live, said Sarah Dixit, organizing director of Pro-Choice Washington .

Some patients may be hesitant or fearful to give that information, instead listing their address as their hotel or giving a friend or relative’s address.

Washington enacted a shield law in 2023 that protects people in Washington from civil and criminal actions in states that restrict abortions, including prohibiting law enforcement from arresting people, with or without a warrant, for violating the laws of states where abortions are banned.

It also prohibits state and local agencies and law enforcement from providing information or complying with subpoenas related to bans on abortion in other states.

Emergency abortions in Washington

The strict Idaho abortion ban included even medical emergencies that threatened the pregnant patient’s life until a U.S. Supreme Court ruling in late June.

The court did not decide whether Idaho’s ban conflicted with a federal emergency room law requiring care, instead sending the issue back to the U.S. 9th Circuit of Appeals.

Emergency abortions in Idaho have been allowed to resume, at least temporarily, while litigation on the issue continues.

Cantwell said on the two-year anniversary of the Dobbs decision that Washington has “had to step up and be the maternal emergency provider from pregnant women from Idaho and around the country.”

Her snapshot report said that some obstetricians in Idaho have recommended that their pregnant patients purchase air ambulance insurance. One Idaho patient was airlifted every week to hospitals in Washington, Oregon and Utah, the report said.

They may be flown out of Idaho because the fetus is not viable or the life of the mother is at risk, Dr. Edward McEachern, co-chairman of the Idaho Physician Well-Being Action Collaborative , was quoted as saying in the Cantwell report.

“They’re not able to find someone to provide them care in Idaho,” McEachern said. “That helicopter ride can cost over $70,000. That bankrupts families.”

Air ambulance services, such as the Life Flight Network , cost about $85 a year to subscribe.

Lilith Clinic in Seattle has seen a surge in patients who are experiencing fetal anomalies or other medical emergencies that require later pregnancy terminations, according to Cantwell’s report.

One patient flew from Texas to Florida because she had a medical complication with her pregnancy, only to discover that she couldn’t get an abortion in Florida and had to fly to Seattle, the report said.

Idaho lost 22% of its obstetricians 15 months after its abortion ban took effect, according to the Idaho Physician Well Being Action Collaborative.

“Without enough OB/GYN care, women will lose out on access to reproductive care, something that may actually help them keep a pregnancy, if they just got the right care,” Cantwell said.

WA abortion delays

The increase in demand for abortions for out-of-state patients in Washington, appears to be putting pressure on some clinics offering abortions in Washington.

A UW Medicine study published in “JAMA Network Open” at the end of May tracked the number of abortions at Ceder River Clinics in Washington and found an average one-week delay for all patients seeking abortions. The study compared pre-Dobbs data back to 2017 to data after Dobbs through July 2023.

“While one week delay does not sound significant, any delays in receiving abortion care are problematic because it adversely affects the health of the pregnant person,” said Dr. Emily Godfrey , a UW Medicine family medicine doctor and obstetrician gynecologist, and the paper’s senior author.

Later abortions pose an increased risk of complications and negative mental health impacts and are more expensive, she said.

UW Medicine researchers also found that post-Dobbs a higher proportion of out-of-state patients sought procedural abortions, rather than medication abortions, compared with in-state patients.

Godfrey said that out-of-state patients may choose procedural abortions over medication abortions “in order to be 100% certain that they are no longer pregnant when they return home, especially if they live in a state that now criminalizes abortion.”

Planned Parenthood clinics in Western Washington, which have seen three times as many patients from Texas as from Idaho, also are reporting longer wait times for all patients due to the increase from out-of state patients, according to Cantwell’s report.

Oregon Health and Science University is seeing many patients from Idaho, but also is seeing patients from California and Washington where there are no abortion bans because they are struggling to get timely appointments, said OHSU Dr. Maria Rodriguez, according to Cantwell’s report.

Abortions also may be later in pregnancies because of the need of out-of-state patients to figure out logistics to travel to Washington at an already stressful time in their lives, Dixit, of Pro-Choice Washington, said.

Patients may be confused about where they can obtain an abortion. And then if they decide to travel out of state they have to find transportation and a place to stay, get time off work or from school, and possibly arrange child care for while they are gone, Dixit said.

Programs are in place to help them.

Planned Parenthood of Greater Washington and North Idaho created a Hospitality Fund after the Dobbs decision to support patients traveling to Washington. It also has hired patient navigators, primarily to work with out-of-state patients, and help them with expenses that travel may cause.

The increasing number of abortions and out-of-state patients has left Washington in need of increased investment in and resources for abortion services, according to the UW Medicine study authors.