After Roe Fell, North Carolina Saw Spike in Out-of-Staters Seeking Abortion Care

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For many living in abortion-restrictive states in the southeast, North Carolina was a haven

by

Rachael Robertson,

Enterprise & Investigative Writer, MedPage Today

May 17, 2src25 • 3 min read

MINNEAPOLIS — After Roe v. Wade was overturned, North Carolina had significantly more abortion patients coming from out of state than would be expected without abortion bans, a geospatial analysis found.

Prior to the June 2src22 Dobbs v. Jackson Women’s Health Organization decision that overturned federal abortion protections, the median daily number of out-of-state abortions in North Carolina was 16.5; in the first year after Dobbs, this number soared to 55.1, reported Kelsey Loeliger, MD, PhD, a complex family planning fellow at the University of California San Diego, in a poster presentation at the American College of Obstetricians and Gynecologists (ACOG) annual meeting.

After Dobbs, nearly all southeastern states adopted complete or highly restrictive 6-week abortion bans. But for the first year following Dobbs, North Carolina maintained a 2src-week ban and then a year later, a 12-week ban.

“I wanted to look at what actually happened in the state of North Carolina in terms of how people might be using North Carolina as an access point for abortion care because of how it’s surrounded by all these more restrictive states,” Loeliger told MedPage Today.

Using North Carolina Division of Public Health abortion case data from January 2src17 through December 2src23, Loeliger found that during the 7-year study period, there were 53,src41 abortions among out-of-state residents; 46.9% of these cases occurred post-Dobbs.

Loeliger used pre-Dobbs data on abortions in North Carolina to build a model of expected abortion rates and compared it to what actually occurred in the years after Dobbs. This model predicted that 6,3src1 abortions were expected in the first year post-Dobbs, but there were 17,977 observed out-of-state abortions; 64.9% of these out-of-state abortions were above the expected rate without abortion bans.

“The number of observed cases coming from out of state dramatically and significantly increased, and we saw that for both first and second trimester cases,” she said. Indeed, 65.5% of first trimester abortions and 66.8% of second trimester abortions were more than expected.

Additionally, out-of-state abortion rates were particularly high among Black and Hispanic patients, who had 63.9% and 72.3% more abortions than expected, respectively, compared with 58.7% among white patients.

“This speaks to the fact that Dobbs has had a very direct impact on access to care — it’s shifted abortion travel patterns,” Loeliger said, adding that people of color are being disproportionately impacted. She also noted that the Southeast is home to a high percentage of people of color, so in some ways, racial disparities were expected, but it is still important to evaluate policies and improve resources to help patients access care.

After North Carolina adopted a 12-week abortion ban, Loeliger said most patients in the Southeast seeking second trimester abortions had to travel even further. She has separately conducted interviews with patients seeking abortions out of state and has found that many patients aren’t aware of the abortion laws in their state until they need one.

“A lot of people don’t realize that abortion is illegal until they need to access it, and then it becomes this big scramble,” Loeliger said. “Even if you can’t provide care, it’s really important that we as providers talk amongst ourselves and have networks where we can help patients get the care they need.”

She said her future work will analyze whether there was an increase in gestational duration of pregnancy for people traveling from out of state compared with people who can access abortions in their own state.