It Can Already Take Weeks To Get An Abortion

It Can Already Take Weeks To Get An Abortion

Last week, Oklahoma Gov. Kevin Stitt signed a law outlawing abortion in the state. If it isn’t blocked by the courts, the legislation — which has no exceptions for rape or incest — would be one of the harshest measures to become law at a time when anti-abortion lawmakers are all but competing with each other to pass new restrictions. 

But in a sense, Oklahoma legislators who want to end abortion don’t have much more to do in their state. New data exclusively analyzed by FiveThirtyEight shows that it’s already very difficult to get an abortion appointment in Oklahoma — and it has nothing to do with the state’s new ban. Ever since the Supreme Court allowed a highly restrictive abortion law to go into effect in Texas last September, Oklahoma’s four abortion clinics have been overrun with demand from out-of-state patients. When a team of academic researchers posed as pregnant people and called the Oklahoma clinics at the beginning of March, all four told the callers they couldn’t schedule them for an appointment. 

As is the case for all the data, it’s possible that someone calling at another time would have gotten a different answer. When FiveThirtyEight reached out to the four Oklahoma clinics last week, one administrator said in an email, “Our wait times at the beginning of March for the [abortion] pill was about 3 weeks and for surgical procedure about 3-4 weeks. … We did not stop scheduling at any point.”

Regardless, the impact of the Texas ban isn’t just being felt in Oklahoma. According to the research, waits of two or three weeks for an abortion appointment are common in eight states surrounding Texas — much longer than the waits in states further away.

It’s a snapshot of what’s in store for the rest of the country if the Supreme Court upholds Mississippi’s ban on abortions after 15 weeks later this year. Doing so would open the door for many more states to restrict abortion and would likely overwhelm the facilities in neighboring states — clinics that are often overburdened as it is. A ruling that limits or overturns abortion rights would disturb the fragile equilibrium abortion providers have created, throwing the entire system into chaos. 

FiveThirtyEight analyzed wait-time data for hundreds of abortion providers collected by Middlebury College economics professor Caitlin Myers and researchers from the Texas Policy Evaluation Project at the University of Texas at Austin.1 To get a comprehensive picture of how long people must wait for the procedure, Myers and a team of student researchers at Middlebury called 737 abortion facilities in 44 states and the District of Columbia, which represent most of the country’s providers that publicly advertise abortion.2 Data for 42 additional providers in the remaining six states came from researchers at the Texas Policy Evaluation Project, who have been conducting similar surveys of abortion providers in these states since Texas’s ban went into effect.3 In the calls, the researchers posed as potential patients, saying they were about six weeks pregnant and wanted the soonest possible appointment for an abortion.4

The data shows that while clinics in the states surrounding Texas are particularly taxed right now, wait times of a week or more are already fairly common in other parts of the U.S., even in deep-blue states like California and New York.5

“If Roe is overturned, huge numbers of women are going to be met with busy phone lines, long waits, no available appointments or appointments that can’t be scheduled for weeks and weeks,” Myers said. People in red states won’t be the only ones affected if Roe v. Wade is overturned. “States where abortion is still legal will become destinations for people seeking abortions, and the residents of those states will find it hard to get appointments too,” she said.

For now, some abortion providers could get patients in quickly — but not many. Only 19 percent of the providers had appointments on the same day or the next weekday.6 More providers were able to offer an appointment between two and five weekdays (42 percent). But one-third (32 percent) of clinics had a wait time of at least a week, including 12 percent where the first available appointment was more than two weeks away.

There are some factors that may not be captured in the data. In addition to the fact that availability can shift from day to day, it’s possible that clinics might have worked to squeeze in a patient further along in her pregnancy, which means that waits might have been shorter in some cases. On the other hand, more than a dozen states require an in-person counseling appointment before an abortion, and some clinics gave the researchers a date for the consultation but not a date for when the abortion would take place. So there might be even more of a delay if the procedure couldn’t be scheduled right away. Other unpredictable changes can also have an effect — for example, a spokesperson for several clinics in Delaware said waits were longer that week because various doctors’ vacations and leaves coincided.

But it was clear that many of the country’s abortion providers are already stretched thin. Myers told me that it surprised her “how much time [the researchers] spent dealing with busy phone lines, returning dropped calls, being on hold for half an hour or more, being told to try back later.” Those challenges — much like a state’s abortion restrictions — are especially burdensome for low-income people.

Even a delay of a week can have a serious impact on a person seeking an abortion, according to Liza Fuentes, a senior research scientist at the Guttmacher Institute, a research organization that supports abortion rights. For one thing, medication abortion is available at many clinics through the 10th week of pregnancy — after that, patients can get only an in-clinic procedure, which might not be their preference. And it seems likely that if delays mount, more patients will get abortions in their second trimester. That’s relevant because the price of an abortion also generally goes up as the pregnancy progresses, particularly after the first trimester, as the procedure gets more complicated. And although abortion is extremely safe overall, the risk of complications is a little higher later in pregnancy. “By delaying the procedure, we’re forcing pregnant people to take on additional risks,” Fuentes said.

Many of the clinics with the longest wait times are in states where abortion is heavily restricted. The first available appointment at Missouri’s lone clinic, for example, was more than a month away. In Arkansas, where there are only two clinics, the earliest appointment was nearly three weeks away. That’s a huge increase from September, when, according to the Texas Policy Evaluation Project’s data, a person seeking an abortion in Arkansas could get an appointment the next day. “It was already hard to provide abortion those states,” said Amanda Stevenson, a sociology professor at the University of Colorado at Boulder who has previously worked on research related to abortion wait times. She reviewed a summary of the analysis before publication. “The fact that the waits aren’t even longer is the result of herculean efforts on the part of providers around Texas to accommodate the increased demand.”

Lori Williams, the clinical director of Little Rock Family Planning Services in Arkansas, said that since Texas’s ban went into place, her clinic has been struggling to deal with the surge in demand from out-of-state patients. “It’s been difficult just to have enough people to answer the phone,” she said. “We’re seeing lots of people from Texas but also patients from Louisiana and Oklahoma, since they’re calling their clinic and hearing that there’s a two- or three-week wait, so they’re looking at other options.”

It took a few months after the Texas ban went into effect, but Williams’s clinic is now stretched far beyond its normal operating capacity, she said. Like many abortion providers in the South and Midwest, Little Rock Family Planning Services isn’t open every day. Abortion is highly regulated in Arkansas, so adding more appointments means more work to ensure the clinic is in compliance, and it’s hard to find and train more staff in a short time, particularly in the midst of broader shortage of health care workers. And then there are physical-space limitations. “There are only so many people you can fit in the building,” Williams said, adding that the whole situation is profoundly stressful for her, the clinic staff and the people they’re trying to serve. “It’s this ever-increasing thing that you’re chasing,” she said. “There’s just not enough appointments to service the patients who are needing care.”

If Roe is overturned or restricted this year, many abortion providers will find themselves in a similar position. After all, abortion clinics are businesses built around the demand they expect to have. A sudden, unpredictable influx of patients isn’t easy to accommodate, even in states less restrictive than Arkansas. “There’s a lot of science that goes into the appointment-making,” said Amy Hagstrom Miller, the CEO of Whole Woman’s Health, which has clinics in Indiana, Maryland, Minnesota, Texas and Virginia. “We don’t want to make people have a super long wait time. We don’t want to have people sitting on the floor. You want to maintain a commitment to health care with dignity and respect.” Finding a new space to see patients can be difficult. Some providers are expanding their services through telemedicine, but that still takes time and additional personnel. Nothing about offering more abortions is easy.

The uncertainty of what the Supreme Court will do — and how many patients will need care — adds another layer of complication. “It feels like without knowing what’s coming, you’re behind,” said Dr. Kristina Tocce, medical director of Planned Parenthood of the Rocky Mountains. “Because you can’t build out elaborate plans without knowing what’s actually needed.”

Further restricting abortion will affect people all over the country, including in blue states. In fact, that may already be happening. Even in states where abortion access is protected, there were clinics with long waits in the data we analyzed. Thirty-one percent of clinics in New York and 67 percent of clinics in Oregon, for example, had a wait time of more than a week. This was particularly pronounced for clinics in rural areas, but more densely populated areas weren’t immune. In seven metropolitan areas — about 3 percent of metro areas with clinics — there were no abortion clinics scheduling an appointment at the time researchers contacted them. In an additional 30 metropolitan areas — about 13 percent — the earliest appointment was more than two weeks away. 

In Chicago, the median wait time for an appointment was almost a week, and three of the city’s 14 abortion providers didn’t have an opening for more than two weeks.7 Dr. Hillary McLaren, an abortion provider in Chicago, told me that her clinic has seen an uptick in patients from Texas over the past few months. These days, she said, it’s common for the earliest appointment to be two weeks away. “Chicago is a big city with a lot of abortion access, but we’re surrounded by states where it’s restricted — Missouri, Indiana, Wisconsin, Michigan,” she said. As more people travel to Chicago for abortions, that means fewer appointments for local patients. “We’re already seeing that ripple effect — patients who are based here are less able to get care,” she said.

In Colorado, the competition for appointments was even more intense. Two of the state’s 21 clinics had no openings at all, and the median wait for an appointment was over a week. This is almost certainly related to the Texas ban. According to data shared with FiveThirtyEight, Planned Parenthood’s Colorado clinics saw 44 patients from Texas between September 2020 and March 2021. During the same period a year later, they saw 506 Texas patients. For clinics that see a couple dozen patients per day, that kind of increase can be very hard to handle, and the lag in appointment availability is likely affecting Colorado residents too, potentially even forcing them to seek care outside their state. “I’ve had colleagues in other states telling me that for the first time in their careers, they’re seeing patients from Colorado coming to their clinics,” Tocce said.

The turmoil that the Texas ban has caused underscores just how messy things could get, depending on what the Supreme Court does in a few months. Many more states will outlaw abortion, given the chance. And if that happens, long waits are likely to become the new normal, adding to the difficulties that people trying to get an abortion will face. Some people may not be able to get an abortion at all. “There’s just no way that 20 states can care for the people that currently are getting care in 50 states,” Hagstrom Miller said. “Providers can do as much as we can to jump through all the hoops, open our doors, build capacity — but we cannot fix this problem.”

Research for one of the datasets used in this story was led by Caitlin Myers of Middlebury College and conducted by Middlebury students Rashmi Bajaj, Chujun Chen, Sophia Cole, Rose Evans, Constance Laranja Gooding, Katie Futterman, Elsa Korpi, Queenie Li, Chloe McNamara, Anthony Marinello, Gabryail Meeks, Audrey Peiker, Kayley Porter, Kate Ratcliffe, Ethan Sorensen, Frieda Violet Thaveethu and Kamryn You Mak.

Art direction by Emily Scherer. Copy editing by Andrew Mangan. Story editing by Chadwick Matlin.

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