North Carolina has emerged as a vital access point for abortion care in the South in the wake of a wave of restrictions in neighboring states since the U.S. Supreme Court overturned Roe v. Wade in June 2022.
Nationwide, the Tar Heel state served the second highest number of out-of-state patients in 2024 — behind only Illinois — a new report on national abortion volumes found.
Of the nearly 46,000 abortions provided by clinicians in North Carolina in 2024, more than one in three — 36 percent — were to patients traveling from a state where they were no longer able to access care, according to data estimates released this month from the Guttmacher Institute, a national organization that tracks trends in reproductive health.
This amounted to 16,660 abortions obtained by out-of-state residents — mostly from South Carolina and Georgia. This proportion of patients has more than doubled since 2020 — when about 17 percent of patients came from out-of-state.
“North Carolina is a really major source of care in the Southeast,” said Guttmacher Institute data scientist Isaac Maddow-Zimet, who leads the organization’s Monthly Abortion Provision Study. “I think that speaks to the efforts of North Carolina providers who are really trying to make care accessible but also to the paucity of options in the region.”
North Carolina’s load of out-of-state patients far exceeds the 37 other states in 2024 that do not have a total abortion ban, where out-of-state patients, on average, account for about 15 percent of abortions provided.
That’s because North Carolina is the closest option for many people in the South that allows abortion past six weeks in pregnancy — a point at which many women do not yet know they are pregnant.
As a result of a six-week ban that took effect in May 2024, Florida experienced the largest decrease in abortion volume in 2024, according to Guttmacher data, providing 12,100 fewer or a 14.1 percent decline in abortions in 2024 from 2023. North Carolina providers have absorbed part of the load.
The increased travel to North Carolina for abortions comes even after state lawmakers enacted increased abortion restrictions that took effect in July 2023 that limit most abortions after 12 weeks of pregnancy and require patients to attend an in-person appointment for state-mandated counseling at least 72 hours before the procedure. Fewer than half of states have a waiting period — with most being a shorter time period — restrictions that abortion providers describe as onerous and unnecessary.
“It is a deterrent, but it does not stop people from getting the care they need because desperate people will find a way, and we do everything we can to assist them,” said Katherine Farris, chief medical officer at Planned Parenthood South Atlantic.
Despite the increased restrictions, abortion volume in North Carolina has increased substantially since 2020, which saw 31,850 procedures. Last year’s numbers were up nearly 45 percent from 2020 — to 45,940 clinician-provided abortions. The Guttmacher numbers are also an undercount because they do not include self-managed abortions — people using medications at home without initiating contact with the health care system.
“North Carolina, despite its drawbacks as a place to travel to because of that 72-hour waiting period in particular, remains the best option for some folks,” Maddow-Zimet said. “Somebody traveling from Florida to get to North Carolina might be 500 miles or more. To travel yet another state farther to Virginia or even farther to Illinois might just be out of reach.”
Serving more patients
The swell of patients from other states hasn’t come as a surprise to Amber Gavin, vice president of advocacy and operations at A Woman’s Choice, an abortion provider with three clinic locations in North Carolina. All it took was looking at a map to see how North Carolina would be the closest point of access for many abortion seekers in the region.
To practice under the state’s new abortion law and respond to the influx of out-of-state patients, abortion providers say they reworked processes, patient flow and schedules to expand capacity. They also hired and trained additional staff to extend their hours and appointment slots.
“We've been basically hitting it from all angles in order to increase access for patients,” Farris said.
“We now provide abortion six days a week across the state of North Carolina to really make sure that patients have access on whatever day works for them,” she said. “It may not be their closest clinic, but if a Monday is the best day, we have a clinic they can go to on a Monday. Same thing on a Saturday.”
Despite the expansion of care wherever possible at abortion clinics across the state, the increased demand for care has affected wait times.
“The wait times are a little longer than they were previously,” Gavin said. “When patients go to make an appointment, sometimes their care gets pushed out a week, maybe sometimes two weeks before they can get an appointment.”
To sustain the increased patient volumes for going on two years, abortion providers have had to keep making adjustments based on the needs of their clientele. For example, in 2024, Planned Parenthood started offering medication abortion — a regimen where a patient takes two pills to terminate a pregnancy — at two additional clinic locations: Greensboro and Durham.
Due to the patchwork of post-Roe laws that increasingly drive people across state lines, Farris said it often takes more time and resources to access abortion care.
“We are seeing a number of patients who are pushed much later in pregnancy simply because of the bans,” Farris said. “By the time the patient shows up, for example in South Carolina, they're too far for [the state’s six-week restrictions]. And then by the time they can make it up to North Carolina, jump through all the hurdles here, arrange childcare and do all of the things that they need to do, they may be too far for North Carolina. Then they're trying to get to Virginia … By the time they can come up, several weeks may have passed, and now they're much further along in their pregnancy before they can access their abortion.”
Patients have more logistical factors to juggle as they cross state lines for care — from extra time off work, travel, hotel stays and child care costs. Abortion clinic staff also have to spend more time helping patients sort through the maze of details of which location abortion seekers can legally access the procedure based on their gestational age.
Since North Carolina’s abortion law requires at least two in-person appointments to obtain the procedure — the first being for in-person counseling by a North Carolina licensed provider, and the second visit at least 72 hours later for the actual procedure — it takes twice as many appointments to serve the same number of people in the state.
And Farris said a handful of patients continue to show up to clinics thinking they are getting an abortion that day, and they are devastated to learn they can’t.
To give patients more flexibility, Planned Parenthood and A Woman’s Choice said they do not require both appointments occur at the same clinic.
“They walk out the door with everything they need to prove that they have had their consent visit, and then they can take that to any clinic that makes sense for them,” Farris said.
North Carolinians travel out of state
North Carolinians are also traveling out of state for abortion care, according to the Guttmacher data. Some are past the state’s gestational limit of 12 weeks. Others can’t navigate the state’s two-appointment requirement and waiting period or would rather cross state lines to Virginia where there are fewer hoops to jump through.
Virginia does not have a waiting period and allows abortion through the second trimester of pregnancy.
Recognizing that access to abortion is much more open just miles away, A Woman’s Choice opened a clinic in Danville, Virginia, in February 2024. The decision was driven, in part, Gavin said, by the number of people they were having to turn away from care in North Carolina.
The Danville clinic is 47 miles from the Greensboro clinic. A drive of only 50 more minutes means care at that specific clinic can be delivered in one day, up to 20 weeks gestation.
“It's been really beautiful to see that we've been able to make warm handoffs from our other clinics to our Virginia clinic for folks that are no longer able to access care in North Carolina,” Gavin said.
In the year since opening, Gavin said the Danville clinic has seen a mix of patients, but people coming from North Carolina and South Carolina make up the majority of patients served.
Guttmacher data shows that in 2023, a total of 1,260 North Carolinians obtained abortions in Virginia — the most frequent out-of-state choice. The number of North Carolinians who sought care there in 2024 has not yet been released, though abortion providers say that the travel trend has continued.
Overall, Virginia experienced the largest increase in the number of abortions provided from 2023 to 2024 compared to all other states — a swell of 5,500 patients, according to the latest Guttmacher data. The spike in volume was driven almost entirely by out-of-state patients, said Maddow-Zimet, the Guttmacher researcher.
Even with this increase, Virginia’s abortion capacity is below North Carolina’s; 38,920 abortions were provided by clinicians in Virginia in 2024, compared with 45,940 in North Carolina. That’s even as Virgina had five more abortion clinics than North Carolina as of March 2024, according to a June Guttmacher report on the prevalence of brick-and-mortar clinics across the nation.
Abortion funds and practical support networks have stepped up to help facilitate access to people seeking the procedure, particularly those traveling long distances.
However, Maddow-Zimet said, he’s closely watching the sustainability of this interstate travel for abortion access.
Already, in 2024, there was a slight decrease in people in the United States who traveled across state lines for an abortion — down to about 155,100 people last year from 169,700 the year before. Still, the number of people traveling to receive care is nearly double what it was in 2020 — before the overturning of Roe v. Wade.
“We're really concerned about what the sustainability of that travel looks like in the long term precisely because we know so much support is needed for people to be able to make that travel happen,” Maddow-Zimet said.
Stability — at least for now
While the national abortion landscape continues to be in flux, North Carolina abortion providers are in a period of stability. The abortion law in the state hasn’t changed since July 2023, when the time frame for seeking most abortions was cut from 20 weeks gestation to 12.
When Republican lawmakers introduced the 12-week restrictions, they called it a “common sense, reasonable approach to restricting second- and third-trimester abortions.” But there’s been lingering uncertainty if state lawmakers would look to enact more restrictions during the legislative session that began in February.
On April 7, Rep. Keith Kidwell, R-Chocowinity, who leads the House’s right-wing Freedom Caucus, filed a bill seeking to replace North Carolina’s current abortion law with a significantly more restrictive law that would prohibit abortion from the moment of conception, with an exception only to save the mother’s life. Exceptions in cases of rape, incest and fetal anomolies — as currently permitted — were not included.
That bill has not moved, and Senate leader Phil Berger (R-Eden) and House Speaker Destin Hall (R-Lenoir) told reporters they don’t anticipate pursuing any legislation relating to abortion this session.
However, in late March, Berger gave the caveat that “members have ways of doing committee substitutes and amendments and that sort of thing.”
North Carolina abortion providers said they will keep their eyes peeled for any ripple effects from changes in other states or policies at the national level that could affect access. They all expressed determination to help patients overcome any barriers that present.
“[North Carolina] is a crucial access point, and it's so important to the entire South that abortion remains accessible in the state,” Gavin said. “So many people depend on the care.”
This article first appeared on North Carolina Health News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.
