鈥淚 don鈥檛 know how I鈥檓 gonna afford this.鈥�
鈥淚 don鈥檛 know how I鈥檓 gonna find a babysitter. Who鈥檚 gonna take care of my kids?鈥�
鈥淢y car is not running well.鈥�
Kell Rippy said they frequently hear patients express these challenges and a list of others while working as a patient navigator at . Rippy鈥檚 job is to help abortion seekers sort through logistical challenges to care, whether in their home state or if they need to seek care in another state.
Since North Carolina鈥檚 increased , imposing additional hurdles to accessing abortions, Rippy said that work has picked up. The , a national organization that鈥檚 long tracked trends in reproductive health, says in North Carolina.
The new limits most abortions after 12 weeks of pregnancy and requires two in-person appointments for anyone seeking an abortion. This means many patients need to drive long distances 鈥� now twice 鈥� to reach one of the state鈥檚 14 abortion clinics spread over nine counties. Others must journey out of state for care later in pregnancy. It necessitates extra time off work, travel, hotel stays and child care costs.
鈥淭hat鈥檚 really, really stressful, especially for folks who are low income or who are already working to make ends meet,鈥� Rippy said.
Navigating careAccessing abortion can quickly feel overwhelming for patients, Rippy said 鈥� even insurmountable.
That鈥檚 where Rippy steps in as part of the at Planned Parenthood South Atlantic. Rippy and one other patient navigator make dozens of calls every week, working with patients to try to find ways around barriers to abortion care.
鈥淚 have a master鈥檚 degree [in health care],鈥� Rippy said. 鈥淚f I鈥檓 having a hard time figuring it out, then patients have got it even worse 鈥� especially if they have low health literacy, which a lot of our country does.鈥�
The patient navigators have established connections with local partners as well as clinics and support networks across the country. They鈥檝e accumulated a wide knowledge of public transportation options, knowing essentially where every bus station on the East Coast is. They鈥檝e created guides that can help people seeking out-of-state care navigate frequently visited cities like Roanoke, Virginia.
Though Planned Parenthood has seen fewer patients in recent months, they said the amount of time spent with patients has dramatically increased, including working through coordination of appointments and travel arrangements.
And despite best efforts to keep abortion accessible to those who seek it, Rippy knows some people are falling through the cracks, unable to overcome logistical hurdles.
鈥淭he hardest thing for me is knowing the number of patients that we are able to help is only a fraction of the number of patients that actually need the help,鈥� Rippy said. 鈥淭here are some people who are able to get through to us who are able to go online and make an appointment. Then there are some people who have no idea where to even start. They live in Mississippi, and it鈥檚 like, 鈥極kay, well, abortion is illegal in my state. So I guess I鈥檓 screwed, right?鈥� 鈥� I think about the people that we鈥檙e not able to help that would greatly benefit from the care.鈥�
Biggest barrierOne of the biggest barriers to abortion access is cost, said Justine, a staff member, who requested that NC Health 瓜神app only use her first name for security reasons.
Carolina Abortion Fund , helping patients pay for part of their procedure, and demand keeps growing.
Justine said calls for financial help surged after the Dobbs decision, and it has bumped up even further since North Carolina increased restrictions. In addition to more people calling, Justine said they are also often requesting more money than in the past.
The cost of an abortion varies based on factors like how far along someone is in their pregnancy, the location of the procedure and how much their insurance will cover.
In 2021, the median for people paying out of pocket in the first trimester were $568 for a medication abortion and $625 for a procedural abortion 鈥� an amount people for unexpected expenses.
Nonmedical costs for gas, flights, hotels, child care and lost wages also accumulate. Particularly in the , where people often have to travel farther distances for care, Justine said she鈥檚 seen the tally of costs swell for folks.
鈥淎ll of it kind of snowballs together,鈥� Justine said.
Justine estimated that about 80 percent of callers are asking for money to cover practical support to get to their appointments: things such as gas, flights and child care. That鈥檚 an uptick from before North Carolina鈥檚 law took effect, she said, when about half of folks expressed that need. Although Carolina Abortion Fund does not collect data on where callers are traveling from, Justine said the bigger requests for practical support indicate that people are traveling farther for care.
In response, Carolina Abortion Fund鈥檚 allocations per caller have gone up since July 1. On average, Carolina Abortion Fund provided around $175 per caller before July, and now that number is around $300 per caller, though each recipient鈥檚 amount is based on their specific situation.
The organization鈥檚 total distribution of funds has also surged. Since June, Carolina Abortion Fund has distributed around $65,000 per month to callers 鈥� nearly double the amount disbursed in earlier months.
Justine said the organization鈥檚 available funding isn鈥檛 enough to meet the flood of requests.
鈥淓ach month, we unfortunately have to close the line, and it does feel like we鈥檙e reaching that point earlier than we did prior to the law,鈥� Justine said.
After Carolina Abortion Fund reaches the point each month where it has no more money to give out, volunteers and staff members still work with callers to help figure out funding, referring them to other funds and resources.
鈥淭his is a need that鈥檚 been around for so long, and the calls don鈥檛 change depending on who鈥檚 in office and what laws are on the books,鈥� Justine said. 鈥淭hings can just be made more difficult for people.鈥�
Crossing state linesTraveling across state lines for abortion has doubled in recent years, largely due to post-Dobbs abortion bans and restrictions. During the first half of 2023, nearly one in five patients traveled to another state to obtain abortion care, compared with one in 10 in 2020, according to the from the Guttmacher Institute鈥檚 .
In the wake of the Dobbs decision in June 2022, North Carolina experienced a surge of patients coming from other states with more restrictive laws, making the state a . During the first half of 2023 鈥� before North Carolina implemented its stricter abortion law 鈥� about 36 percent of patients traveled from out of state to receive care in North Carolina. This amounted to 8,920 out-of-state patients finding care in North Carolina 鈥� a substantial increase from the 2,730 out-of-state patients in 2020.
But with this year鈥檚 legislation, North Carolina is no longer the abortion destination it once was. As a result, Guttmacher data scientist Isaac Maddow-Zimet said it鈥檚 likely the number of people coming to North Carolina for care from other states has declined fairly precipitously in the second half of the year as folks bypass the state for places with fewer restrictions, such as Virginia and Maryland.
For some folks, though, North Carolina may still be the best option, such as for South Carolinians who have a .
After North Carolina鈥檚 restrictions took effect, the number of medication and procedural abortions provided in the state . The released this week by the Guttmacher Institute shows September abortion volume inching higher, but still down 15 percent from June.
Maddow-Zimet cautioned considering the September bump in volume a rebound in access for North Carolinians; he said it鈥檚 likely many of the around 600 more abortions provided in September in North Carolina were due to an influx of South Carolinians.
鈥淚t may have become again kind of the best of a buffet of bad options for folks trying to access care,鈥� Maddow-Zimet said.
Rippy, the Planned Parenthood patient navigator, said before Senate Bill 20, it was rare for North Carolinians to need to seek care out of state as the procedure was . Now, cases come up every week where North Carolinians can鈥檛 receive care close to home, Rippy said.
Maddow-Zimet said practical support efforts have facilitated the increase in interstate travel, but he鈥檚 uncertain that the rate of travel can continue.
鈥淚t鈥檚 tricky to know whether that will be sustainable鈥� as options narrow in the Southeast, Maddow-Zimet said. 鈥淧art of the reason is because each additional ban that passes has cumulative effects on what came before it.鈥�
