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Out-of-state abortions have increased by 50% in Washington post-Dobbs, UW study finds

Protesters who support and oppose abortion rights stand in front of the Supreme Court on April 24, 2024, before the court heard oral arguments in Idaho v. United States and Moyle v. United States, a consolidated case arising from the Biden administration’s challenge to Idaho’s near-total abortion ban. A recent University of Washington study shows that more people are coming from out-of-state to Washington to have abortions in the aftermath of the 2022 Supreme Court decision that allowed states to restrict abortion.  (Orion Donovan Smith/The Spokesman-Review)

Out-of-state abortions have increased by 50% in Washington since the Supreme Court ruled the procedure is not constitutionally protected, according to a new University of Washington study.

Researchers found the number of patients seeking abortions in Washington from other states increased from 4% of abortions to 6% of abortions in the state. Much of that increase comes from Texas patients and other states that have restricted abortion since the ruling, known as the Dobbs decision.

“It’s an important study, because we need to continue to monitor who is getting abortions at what state to ensure that there’s health equity through this very distressing time,” said Emily Godfrey, the study’s senior author and UW Medicine family medicine doctor.

Despite the increase in patients, the study did not find the level of care had decreased.

“It doesn’t appear to have negatively impacted care in Washington. Patients are still getting appointments at the same rate that they did before Dobbs,” Godfrey said.

The study only looked at abortions that occurred at Cedar River Clinics, whose three clinics perform about 15% of the abortions in Washington. The clinics are located in Tacoma, Renton and Yakima, and a Seattle clinic was studied until it closed. According to Godfrey, the clinics’ data is generally representative of the state as whole, but she hopes to conduct another study that more holistically looks at all abortion providers in Washington state.

Decided in the summer of 2022, the Dobbs decision overturned Roe v Wade and allowed states to individually restrict abortion. While abortion remains legal in Washington, many other states enacted much tighter restrictions on their residents.

Researchers compared the number of abortion procedures at Cedar River Clinics between Jan. 1, 2017, through June 23, 2022, to those procedures conducted between June 24, 2022, through July 31, 2023. Over 3,300 abortions have been conducted at the clinics since Dobbs – out of 18,379 abortions that have occurred since 2017.

Before Dobbs, high proportions of out-of-state patients were from Alaska (52%), Montana (9%), Idaho (8%), Oregon (6%) and Texas (6%). But after Dobbs, out-of-state patients were largely from Texas (27%) and Alaska (26%), followed by Idaho (8%), Louisiana (6%) and Florida (6%).

Of these states, only Alaska has not added further restrictions to abortion since Dobbs. Florida restricts abortions after six weeks, and the other states ban all abortions with limited exceptions.

While waiting times have not increased once an appointment has been made, patients are on average presenting to the clinic a week later in their pregnancy than before Dobbs. This is an effect seen in all patients, not just those coming from out of state.

“We don’t know why Washington state residents are showing up a week later, but they’re clearly affected by kind of the bigger milieu of what’s going on nationally,” Godfrey said. “The abortion law has not changed in Washington state. But patients may believe that Dobbs has affected their state. So there may be some confusion.”

The study found these delays were even more pronounced among Black and Latina patients. According to Godfrey, a later procedure “adds to the cost and distress” of an abortion.

Researchers also found a higher rate of procedural abortions post-Dobbs, compared to medicated abortions. The total weekly number of procedural abortions increased by an average of 6.35 following Dobbs, while the number of medicated abortions remained static. Godfrey believes this change is because out-of-state patients do not feel safe taking abortion medications in their home state.

“Out-of-state patients are choosing uterine aspiration procedures over medication abortion 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,” she said.

Godfrey also noted that the increasing demand for procedural abortions may eventually outstrip the capacity of abortion providers trained in the procedure in Washington.

“The increasing number of abortions, out-of-state patients and delays to care points to the need for increased investment in and resources for abortion care in Washington,” study co-author and University of Washington graduate student Taylor Riley said in a statement. “This could include expanding the number of abortion-providing facilities and strengthening existing primary care and telehealth accessibility, financial support and referral systems within the state.”