What Happens If Abortion in the South Vanishes?

Alyx Carrasquel works at an organization that helps fund people’s abortions. She tracks her period, which she describes as “very, very regular,” closely. She has long known that she has zero interest in having children and that, if she ever got pregnant, she would get an abortion.

So, when the 27-year-old Floridian realized she was pregnant in January, she booked an appointment at a clinic where she used to work that very same day. Had her abortion taken place a few months later, that may have been too late—because Florida is almost certain to pass a six-week abortion ban in the coming weeks. Many people don’t even know they’re pregnant by that point.

“It’s almost impossible, in my opinion, to be able to track a pregnancy before five weeks. It’s rare. It just makes no sense, because it doesn’t give the person enough time to not only figure out that they’re pregnant but also figure out the appointment dates—sometimes clinics don’t have availability within the same week,” Carrasquel said. “It’s just not enough time for most people.”

After the Supreme Court’s overturning of Roe v. Wade last year wiped out abortion clinics across the South, Florida, along with North Carolina, emerged as the last bastions of Southern abortion access. In the months after Roe fell, Florida providers performed 10 percent more abortions. North Carolina performed almost 40 percent more. 

Then, last week, the Florida state Senate advanced the six-week abortion ban and a North Carolina Democratic state legislator announced that she would become a Republican and hand the GOP the votes it needed to enact a ban. Abortion rights supporters widely expect that North Carolina will end up outlawing abortion after 12 or 13 weeks of pregnancy. (Many fetal abnormalities can only be detected after that point.)

Now, abortion rights supporters in Florida and North Carolina are battening down the hatches—and questioning whether the rest of the nation is prepared, both logistically and emotionally, for abortion clinics in half the country to go dark. There may simply not be enough northern clinics to absorb all of the Southerners who will be forced to flee their homes.

“There is no stopping this bill,” Annie Filkowski, policy director for the Florida Alliance of Planned Parenthood Affiliates, told VICE News of Florida’s proposed six-week ban. “We are going to continue within the bounds of the legislation to provide the care that we can provide. But we understand there's going to be a significant amount of people who will no longer be able to get abortions in Florida. And we are going to do everything we can to work with other states to get them out of state.”

Already, about half of the people who reach out to the abortion fund Emergency Medical Assistance in Palm Beach County, Florida, are out-of-state patients looking for abortions in Florida, according to the fund’s executive director, Jessica Hatsem. Another quarter of patients are Floridians who need to leave the state for abortions because Florida currently bans abortion past 15 weeks of pregnancy. Hatsem tends to send patients up the East Coast—to Maryland, New Jersey, New York, and Washington, D.C.

“The cost to pay for their procedures is going to increase,” Hatsem said. “And then the practical support to send patients out of Florida is easily going to double, because way more people are going to have to leave.”

Three-quarters of all abortion seekers qualify as low-income or poor, according to the Guttmacher Institute, which tracks abortion rights. Before the overturning of Roe, the Emergency Medical Assistance spent about $10,000 to $15,000 per month on funding people’s abortions and all the costs that can go along with the procedure, such as travel and lodging. (The fund doesn’t track the exact number of abortions they fund for security reasons.) In the first three months of 2023, the fund has spent $57,000—meaning it’s now pouring out almost $20,000 per month.

The Tampa Bay Abortion Fund has also seen an enormous jump in costs in the last year. In 2021, when Roe was the law of the land, the fund spent about $8,000 funding abortions; by the end of 2022, they spent about $60,000. Between January and the end of March of this year, the fund has spent about $22,000 helping more than 600 people get abortions. 

Just eighty of those people went out of state, but McKenna Kelley, a board member for the fund, expects that number to dramatically increase under a six-week ban. Each out-of-Florida person who leaves Florida for an abortion—or to support someone getting an abortion—costs about $1,000 to $1,200, when factoring in travel.

“We've already spent a third of our yearly total from last year, just in three months this year, so already we're seeing the need increase. And we're only dealing with a 15-week ban at this point,” Kelley said. “The costs are just already enormous and they're just going to multiply if a six-week ban goes into effect.”

To prepare for such restrictions, Kelley and Hatsem’s organizations have started reaching out to more out-of-state clinics and building relationships, in anticipation of needing to quickly dispatch patients to them, as well as trying to spread awareness of the funds within Florida.

“So six months down the road, a year down the road, when they can no longer access abortion at the clinic down the street, because they find out that they're pregnant at eight weeks,” Kelley said, “they can fill out our intake form or they can give us a call. And they know that we can help them get out of state and get the care that they want.”

Southern patients may soon find themselves at The Women’s Centers, a group of abortion clinics with locations in Georgia, Pennsylvania, New Jersey, and Connecticut. Since Roe, the clinics have started seeing a few Southern abortion patients each week, Director of Public Affairs Roxanne Sutocky told VICE News. Many of them are seeking abortions later on in pregnancy.

“We have extended our hours. We're hiring on additional staff. We've extended the gestational age offerings, to the extent that we can and all the places that we can, to make sure that we can accommodate additional patients who are in need of our services,” Sutocky said. “And so we stand really ready and well-prepared to see an influx of people, should they need us.”

Despite Sutocky’s confidence, though, it is impossible to know if abortion clinics in the North can really absorb all patients who would otherwise get abortions in Florida and North Carolina.

In North Carolina, Hales’ clinics, A Preferred Women’s Health Center, provide abortions up to 16 weeks and six days, because they’re too overwhelmed with patients to perform abortions later than that point. Before Roe was overturned, “We generally saw people from five states. We saw North Carolina, South Carolina, Georgia, the occasional Tennessee, the occasional Virginia,” Hales said. Now, they have patients arriving from 25 states across the South and Midwest. People regularly stream in from Alabama, Arkansas, Louisiana, Mississippi, and Texas—which is more than 1,000 miles away.

If Florida enacts its six-week abortion ban, “I think we're going to see even more people or more requests for appointments,” Hales said. But, she added, “I really don't know how the capacity can increase anymore in North Carolina, I really don’t. [Not] without opening new clinics—and I don’t know who would want to try to open new clinics right now, considering we’re also facing bans.” 

The Florida funds are also currently trying to hold onto every dollar they can. When Roe was overturned, their donations surged—“It was just sums of money that I have never seen coming in, all at once,” Kelley recalled—and then slowed as abortion faded from the news. Now, with Florida back in the headlines, more people are making “rage donations” to the funds, as Hatsem put it. 

But it’s still nothing like last summer. And that could prove to be a problem in the coming months, as the public’s attention span shortens and abortion seekers’ need increases.

“People are starting to get a little bit of fatigue on the abortion issue,” Sutocky admitted. “People are burnt out when it comes to their charitable giving. We've even talked to people who told us that they've stopped tuning in to the news about the different changes, or stopped keeping up with the changes, because they feel discouraged.”

Abortion rights activists who spoke to VICE News said that they, too, are struggling to stay positive after nearly a year of constant turbulence, chaos, and attacks on abortion rights. 

“I’m tired. I’m really tired,” said Carrasquel, who works as a network building coordinator at the Florida Access Network. If a six-week ban goes into effect, more than half of the people who get help from the abortion fund would be forced to go out of state for abortions. “I’m trying not to lose hope and I’m trying to remind myself that we are doing good work.”

But the attacks have not stopped. 

In addition to the news about Florida and North Carolina last week, a Texas judge ruled to suspend the Food and Drug Administration’s approval of an effective and safe drug commonly used to induce abortions. In a decision late Wednesday night, the U.S. Court of Appeals for the 5th Circuit ruled to preserve the FDA’s approval, but agreed to reinstate other restrictions on the drug that will dramatically limit patients’ ability to use it. The case will likely end up at the Supreme Court. (Sutocky said that The Women’s Centers plan to use a different drug to induce abortions if necessary, while Hales said that her team “will talk about it together with the physicians and go from there.”) 

“I'm taking my emotions out of it right now. I can't. I cannot think about how I will personally feel [if North Carolina bans abortion],” Hales said. “I just have to put my nose down and go. Because if I sit down and start thinking about the unethical nature of all of this and the emotions and processing all the emotions we're having from our patients, I'm just going to break down and I don't have time.”

“We’re pretty good at adapting on the fly, I guess,” she added. “You can say that about abortion providers.”