New York City has long been a haven for people who want an abortion, and new city programs and policies aim to make sure it remains one since the Supreme Court reversed Roe v. Wade and tossed abortion regulation back to the states.

In 1973, before Roe legalized abortion nationwide, New York was the only state that generally allowed abortions without a residency requirement or medical restrictions before fetal viability, according to the Guttmacher Institute. A year earlier — 1972 — more than 100,000 women traveled to New York City for a legal abortion.

“New York wasn’t convenient, but it was the only option in the continental United States,” said Mary Ziegler, who is the Martin Luther King Jr. Professor of Law at the University of California-Davis and a leading historian on abortion in the United States.

Now, following last summer’s high court ruling in Dobbs v. Jackson Women’s Health Organization, which reversed the landmark law, a dozen states ban nearly all abortions and many others severely restrict them. But as abortion access contracts, people may have other options closer to home, which would be cheaper than traveling to the Big Apple. New York and other emerging abortion hubs are critical to keeping abortion accessible across the country, advocates say. Yet traveling out of state can present intractable financial and personal obstacles for many people.

Last month, Mayor Eric Adams announced that New York City would begin offering free medication abortions at four sexual health clinics, in addition to the 11 public hospitals that already provide abortion pills and surgical abortions in the city.

The program will be funded as part of a $1.2 million package for sexual health services, according to Rachel Vick, a spokesperson for the city health department. The city will provide free pills used to terminate pregnancies to up to 10,000 patients annually.

The move is the latest effort by the city to become a destination, connecting residents and anyone else interested in getting an abortion to medical care as well as financial and logistical aid through a toll-free number.

Last summer, the mayor signed a package of bills that expand abortion access for New Yorkers and for “outsiders seeking reproductive asylum” in the city. The bills also protect abortion providers and increase public outreach and education about abortion services.

“New York City continues to make efforts to increase access to abortion within the region, and it has put its money where its mouth is,” said Sarah Moeller, director of resource development at the Brigid Alliance, which provides logistical support — including travel, lodging, food, and child care — for people seeking abortions.

Helping to meet these needs is important, say activists, because they are part of what makes travel a serious, sometimes insurmountable barrier.

According to a 2021 survey of 856 people considering an abortion, those who lived 50 or more miles from an abortion facility were significantly more likely to still be pregnant four weeks after answering the initial inquiry than those who lived less than 5 miles from one. Among the obstacles they cited were arranging for child care and covering the cost of travel. The findings were published in JAMA Network Open.

“A lot of times when I work with people, they’ve never left their home state or their hometown,” said Renee Bracey Sherman, executive director and founder of We Testify, which provides information about abortion and a platform for people to tell their abortion stories.

Traveling for an abortion creates more than logistical hurdles, said Katie Glenn, state policy director at Susan B. Anthony Pro-Life America, an advocacy group that opposes abortion.

“What if she has an abortion and has complications and has a big medical bill?” said Glenn, noting why such travel is a bad idea. Following a medication abortion, the FDA recommends that patients follow up with the provider a week or two later, Glenn noted. If they’ve returned to their home state, does that appointment happen? “There are all these other considerations that don’t get addressed,” she said.

Coastal states like New York and California — the latter has also made strong efforts to expand abortion care and protect abortion providers — are often expensive destinations for people in regions like the South where abortion is largely banned, say advocates. Illinois and New Mexico, both of which have relatively few abortion restrictions but are an easy drive from states with bans or severe limitations, have become increasingly popular destinations for abortion seekers, said Melissa Fowler, chief program officer at the National Abortion Federation, which represents abortion providers.

The District of Columbia, which places no restrictions on how late in a pregnancy an abortion can be performed, is a destination for people from West Virginia, where nearly all abortions are banned, and other Southern states, said Bracey Sherman.

The Choices Center for Reproductive Health opened its doors in Memphis, Tennessee, in 1974, a year after the Roe decision, to fill a need left by local doctors and hospitals refusing to perform abortions despite the ruling, said Jennifer Pepper, Choices’ president and CEO. In time, in addition to abortion services, the center offered contraceptives, general wellness services, LGBTQ+ health care, and a birth center staffed by midwives.

“We realize people make different choices, and we want to take care of them,” Pepper said.

When a trigger law criminalizing abortion took effect in Tennessee after the Supreme Court reversed Roe last June, Choices was ready with an option for those who could make a trip. The center was nearing completion on a clinic in Carbondale, Illinois, a few hundred miles away, where abortion is protected by the state’s constitution. The clinic, which will eventually offer a full menu of reproductive health care services, welcomed its first abortion patients in October.

In addition to serving Choices patients from Tennessee, people have driven to the Carbondale clinic from Arkansas, Mississippi, Texas, and a few other states with restrictive laws, Pepper said.

Medication abortions at the Carbondale clinic cost $550 and abortion procedures cost between $700 and $1,000. The center doesn’t accept insurance at this time. Travel, lodging, child care, and lost income from work add more to patients’ costs. Even though the clinic staff refers patients to organizations that provide financial help with medical and logistical needs, many people can’t make the trip.

“Those that we see have the ability to travel and take off work,” Pepper said. “The folks with the least amount of resources are going to be least able to travel.”

State laws that permit or restrict abortion aren’t the only legal issues that may affect people who are considering traveling for an abortion.

In general, if people travel to a state where abortion is legal, they can legally receive one there.

Likewise, state laws that require minors to get parental consent to have an abortion don’t apply once someone leaves the state, said Leila Abolfazli, director of federal reproductive rights at the National Women’s Law Center.

“We don’t support any type of penalty for an adult who is freely traveling from state to state,” said Glenn, of the Susan B. Anthony organization.

Travel across state lines is protected by the U.S. Constitution, as Supreme Court Justice Brett Kavanaugh noted in his concurring opinion on the Dobbs’ decision. “For example, may a state bar a resident of that state from traveling to another state to obtain an abortion? In my view, the answer is no, based on the constitutional right to interstate travel.”

The tricky part is once people return to their home state, where abortion may be banned or restricted, could they be prosecuted for having an abortion?

If someone receives abortion pills in New York, for example, and then travels home to Ohio, where most abortions are banned, to take one or both doses of the medication, will they be in legal jeopardy?

“That might be considered committing a crime,” said Katharine Bodde, assistant policy director at the New York Civil Liberties Union.

By Michelle Andrews
Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.