Getting an abortion is a safe and legal procedure in this country, but it’s becoming harder and harder to access one. If you’re reading this, you’re probably very aware of the many obstacles that can stand in the way of someone getting an abortion. And those barriers just keep piling up.
At least 378 abortion restrictions were introduced in the first half of 2019 alone, according to the Guttmacher Institute. The intention behind these restrictions is clear: to effectively ban abortion by outlawing the procedures after six weeks of gestation (the time since your last period), which is usually before most people even find out they’re pregnant. Lawmakers in Georgia, Kentucky, Mississippi, Ohio, Louisiana, and Missouri voted in favor of such six-week bans. Alabama intends to outlaw abortion unless the life or health of the pregnant person is endangered.
But remember this: None of these extreme bans have actually gone into effect. What’s more, groups like the American Civil Liberties Union (ACLU) and Planned Parenthood Federation of America (PPFA) are fighting these unjust proposals, which are ultimately meant to challenge Roe v. Wade in the Supreme Court with the hopes of overturning it. There are also plenty of groups doing intense advocacy work at the national level to safeguard abortion, like All* Above All, the National Latina Institute for Reproductive Health, the National Asian Pacific American Women’s Forum, and In Our Own Voices.
But we know—and you probably know, too—that abortion is already really difficult to access in many parts of the country, especially for people living in rural areas or in states with laws that forced some abortion-providing health centers to close. Five states (Kentucky, Mississippi, Missouri, North Dakota, and South Dakota) have just one abortion clinic left. In 2014, 90 percent of U.S. counties had no clinics providing abortion care, according to the Guttmacher Institute’s most recent Abortion Provider Census.
As a result, many people needing abortions “are forced to delay care and travel hundreds of miles or even out-of-state to access a procedure,” Gillian Dean, senior director of medical services at PPFA, tells SELF. According to a 2017 analysis of census data published in The Lancet Public Health, 20 percent of U.S. people would have had to travel 42 miles or more to get an abortion in 2014. And people living in vast swaths of middle America states like Montana, Wyoming, North Dakota, South Dakota, Nebraska, and Kansas would have had to trek at least 180 miles to the nearest clinic, according to the report. If any of the recently proposed abortion bans go into effect, even more people will be forced to travel across state lines to access an abortion.
All of this is to say that it is a particularly scary and frustrating time to be someone who is pregnant and doesn’t want to be, especially if you’re not in a position to quickly and easily access an abortion. Your mind is probably filled with questions like, Where do I go? How am I getting there? And how am I paying for all of this? It’s an overwhelming logistical nightmare that no one should have to sort through.
We know there’s already a lot on your mind if you’re up against these arbitrary obstacles. So, we put together a list of some of the most important considerations for anyone who needs to travel to get an abortion. Plus, some resources you can rely on along the way. Hopefully, this will make it all a little bit easier.
1. Find out how far along you are.
Your gestational age will likely inform where you can go to get an abortion. So the first thing you’ll want to do is find out how far along you are in your pregnancy and how far along you will be by the time you are able to get an abortion.
Forty-three states have laws prohibiting abortion after a certain point in the pregnancy, according to the Guttmacher Institute. Most are set at 20 to 24 weeks or fetus viability (the point at which a fetus can survive outside the uterus, around 24 to 28 weeks) and typically provide for exceptions when the pregnant person’s health is endangered. If you are past the cutoff in your state, you’ll have to travel to another one to get a safe and legal abortion. (Since around 90 percent of abortions happen in the first trimester, this won’t apply to most people looking to end a pregnancy now—but it could if the aforementioned restrictive bans went into effect.) Find out the gestational limits in your state and nearby states here.
How long you’ve been pregnant also determines which of the two kinds of abortions you can get. The first is called a medication or medical abortion (i.e., “the abortion pill”), which is approved by the Food and Drug Administration (FDA) until the 10-week mark of gestation. After this point, you will need to get an in-clinic (i.e., surgical) abortion, the American College of Obstetricians and Gynecologists (ACOG) explains. Here’s more detail about exactly how each type of abortion works.
If you’re at the point where you can get either abortion, talking to a doctor can help you make the best choice for you, The Very Reverend Katherine Ragsdale, interim president and CEO of the National Abortion Federation (NAF), tells SELF.
Whichever type you choose, know that abortion is a safe medical procedure as long as it’s performed by a licensed medical professional. As ACOG notes, an abortion in the first trimester is one of the safest medical procedures you can get.
2. Consider if telemedicine abortion is an option for you.
Theoretically, the wonders of modern medicine mean that anyone eligible for a medication abortion via telemedicine should be able to get one. In this scenario, you would typically go to a local clinic, meet with an on-site staffer to confirm the pregnancy, and have a virtual consultation with a medical professional who is licensed to perform abortions. They would explain the process, answer your questions, and you would receive the medication to end your pregnancy. You can read more about what telemedicine abortion can look like here, but the gist is that it could eliminate the need for further travel and hassle. Telemedicine abortion has also been shown to be just as safe and effective as a traditional medication abortion, as SELF previously reported.
The problem is that 17 states require the health care provider administering the medication abortion to be physically present, according to the Guttmacher Institute, effectively outlawing telemedicine abortion in those states. And even if medication abortion via telemedicine is legal in your state, clinics may not offer it. Take a look at the Guttmacher Institute’s chart outlining the laws state-by-state and get in touch with your local abortion-providing health center to learn if you have access to telemedicine abortion.
3. Know that your state may have laws on mandatory counseling.
Thirty-four states require people seeking an abortion to receive some kind of counseling prior to the procedure, either in-person or in the form of written or digital materials, according to the Guttmacher Institute. Twenty-nine of these states also dictate exactly what information must be included. Keep in mind that a lot of this information is intended to provide you with inaccurate information that has zero basis in scientific evidence and that can influence your decision.
For instance, five states require that the patient is given inaccurate information about what the National Cancer Institute has determined is a nonexistent link between abortion and breast cancer, according to the Guttmacher Institute. When Nicole S., 34, had a medication abortion at 8.5 weeks gestation in December 2017, her doctor was legally required to tell her that personhood begins at conception, which ACOG notes is trying to place a legal definition on a medical situation. (Medically, pregnancy does not begin until a fertilized egg implants into the uterine lining.) Nicole, a consultant, PPFA hotline volunteer, and bartender traveled from her home in Kentucky to an abortion clinic in Indiana because the procedure was considerably cheaper there. Between the mandatory counseling and the required ultrasound, the overarching message Nicole got, she tells SELF, was that she should continue the pregnancy. She decided to move forward with her abortion.
The Guttmacher Institute makes it easy to read up on the counseling requirements in the state you’re going to so that you’re prepared for what you’re going to hear, including the possibility of being fed biased, false information under the guise of medical advice.
4. Your state may also have a mandatory waiting period.
Twenty-seven states require people seeking abortions to wait a certain amount of time (usually 24, 48, or 72 hours) between receiving mandatory counseling and getting the procedure, according to the Guttmacher Institute. (All 50 states waive the mandatory waiting period in the case of a medical emergency or when the patient’s life or health is threatened.)
If you’re able to get the written materials ahead of time, you may only have to make one trip. (Some states allow you to get the materials beforehand in the mail, over the phone, digitally, or even via fax.) But in 14 states, the laws require both in-person counseling and a waiting period, which means you’ll have to either travel twice or stay in that area for a decent amount of time. Nicole, for instance, made the seven-hour round-trip from Kentucky to Indiana (where the waiting period is 18 hours) two times.
If you’re trying to figure out what your timeline will look like, call the clinic to find out their scheduling flow depending on local laws, staffing, and other factors. “Clinics have different routines set up to make this as smooth as possible for both [the patients] jumping through hoops and the providers,” Ragsdale says.
Waiting periods can also change your decision about where to go for your abortion in the first place, Ragsdale explains. If you could go to two different states, waiting periods (or a lack thereof) in each one might help you make your choice.
5. Consider how you’re getting there and whether you’re staying overnight.
The mode of transportation that makes the most sense time- and money-wise depends on where you live and where you’re going. If you live in one of those 14 states that require you to visit the clinic twice over a certain timeframe, it might make sense for you to stay in the area overnight based on various factors.
If you need help locking in transportation or housing, Ragsdale says that NAF counselors can try to connect you with volunteers that will give you a ride or let you stay in their homes, as well as local hotels that provide reduced rates for people in town to get an abortion. The National Network of Abortion Funds (NNAF) may also be able to connect you with travel and lodging resources through local abortion funds, Dr. Dean says.
One thing to note on the safety front: You might see individuals and small local groups volunteering their time and homes for people coming into town for abortions. These people could very well be good Samaritans, but if you go this route, you run the risk of encountering someone who is anti-choice and/or affiliated with a crisis pregnancy center (CPC), Ragsdale cautions. It’s best to go through major, reputable pro-choice organizations that have already vetted their resources, like The Yellowhammer Fund, which works to remove barriers to access for anyone looking to get an abortion in any of Alabama’s abortion clinics.
6. Keep in mind that you may need to take time off work and coordinate childcare.
Generally you’ll want to take the day of the procedure off work if you can, and maybe the day after, too. (For a medical abortion, that means at least not working the day you take the second pill, which is when symptoms like cramping and bleeding begin.)
A few states have laws on mandatory paid sick days, which can usually be used for an abortion procedure and recovery, according to the NNAF. The National Partnership for Women & Families has a fantastic chart rounding up those statutes. Hotline counselors at resources like PPFA and the NAF should be able to help you figure out local laws, too. If taking paid time off is not an option for you, Dr. Dean recommends reaching out to the NNAF to see if they can help you figure out how to offset the cost of lost wages.
If you have kids (as 59 percent of people seeking abortions do, according to the Guttmacher Institute), there’s the issue of arranging childcare. If you can’t find a friend or family member or afford a babysitter, PPFA and the NAF might be able to connect you with local resources, while the NNAF might be able to help you cover the costs of childcare, Dr. Dean says.
7. You may need or want to bring someone with you.
Some clinics require you to have a companion to escort you home after the procedure, Dr. Dean says. (If you get general anesthesia, you’ll definitely need that.) Or maybe your child is too young to leave at home, so you need someone to travel with you and look after them.
If a companion is not necessary (or you’re having a medication abortion), then bringing someone is totally up to you, Ragsdale says. Some people want to have an abortion all alone, while other people like having a friend, family member, or loved one by their side.
If you want someone there but can’t find the right person, you might be able to have a volunteer (from PPFA or the NAF, for instance) or abortion doula come with you. (The online resource Radical Doula has a list of volunteer organizations in different states, and some NNAF member organizations provide this service, too.) You can always ask your clinic as well if they know of local options.
8. Plan how you’re paying for it.
The exact cost of an abortion varies widely depending on your clinic, location, type of abortion, gestational age, and insurance situation. A 2014 study published in Women’s Health Issues looked at all known abortion-providing facilities in the United States and found the median cost for a surgical or medication abortion at 10 weeks was about $ 500. (Then you have to add the cost of factors like transportation and childcare.)
If you have insurance, call them to find out if abortion is covered and in what capacity. Twenty-six states ban abortion coverage on Affordable Care Act Marketplace plans, and some ban abortion on private plans as well, according to the Guttmacher Institute (often with exceptions for life endangerment of the pregnant person, rape, or incest). Medicaid funds generally can’t be used to cover abortion except for in cases of rape, incest, or life endangerment, according to the Guttmacher Institute. This disproportionately impacts women of color, those with low incomes, and other marginalized groups who may need Medicaid for health care.
If you don’t have insurance and cannot afford the cost of an abortion out-of-pocket, you have options. Some clinics will charge less depending on factors like your income, Dr. Dean says. There are also forms of financial assistance available from organizations that work with the NNAF and NAF. “Our counselors will help you access the funds we have and connect you with local funds and organizations, depending on where you are and what’s available,” Ragsdale says. “We can help piece together a package to help get you over the finish line.”
Nicole, whose Kentucky Affordable Care Act plan wouldn’t cover her abortion, was just barely able to scrape together enough money by splitting the cost with her boyfriend. Her best advice when it comes to paying for your abortion? “Don’t wait to make your appointment until you have the money,” Nicole says. “Make the appointment, ask how much it is, and you can figure it out from there.” Ragsdale agrees. “By the time [some people have] dealt with managing to get all those resources together, they’ve passed the [gestational] limit in their state or the next state over,” she says.
9. Make sure you’re able to take care of yourself afterward.
Plan to take it as easy as possible for a few days if you can. Most people will experience side effects like cramping, bleeding, and fatigue after either kind of abortion, Dr. Dean says, and a medication abortion can also cause side effects like chills, fever, nausea, and vomiting, per ACOG.
Stocking up on items like pads, heating pads, and over-the-counter pain relievers can help, Dr. Dean says, as can comfort food, hydrating beverages, and anti-nausea meds or remedies. Here’s more information about exactly what might be helpful when you’re recovering from an abortion, including any unlikely red flags that signal you should call the doctor, such as excess bleeding. Talk to your medical providers about all of this, too.
“I received a concierge level of information from the doctors and nurses about what was going to happen, what to expect, and what to know about something going wrong,” Nicole says. “The doctor, nurses, and staff really handheld me.”
It’s a national disgrace that what is at its core a safe and effective routine health care service became an unnecessarily complicated ordeal due to the logistical barriers that stood in Nicole’s way. “It took so much planning and making appointments and confirming them. All that money and time and driving,” she says. “And it was around the holidays … That stuff piles up.”
Even with the advantages she had—background knowledge of how things worked in her state thanks to her volunteer work, a supportive partner and friends, a car, financial means, and a flexible work schedule—Nicole, like so many, had to jump through far too many hoops to make the right decision for herself and her future.
“It’s really frustrating,” Nicole says. At the thought of these mounting threats to abortion access making things even harder, Nicole sums it up perfectly: “It’s just infuriating.”