By Rachel Crumpler
The number of abortions provided in North Carolina has dropped significantly after the implementation of increased restrictions in the state on July 1, according to data estimates from a national organization that tracks trends in reproductive health.
During the first month operating under North Carolina’s new law that limits most abortions after 12 weeks of pregnancy and requires two in-person appointments for anyone seeking an abortion, the Guttmacher Institute reported that medication and procedural abortions provided in the state in July dropped by 31 percent from the previous month. A new round of data released this week demonstrates how the state’s restrictions hinder access to abortion care.
While the Guttmacher Institute found that the number of abortions provided in August increased slightly from July, the total was still down 28 percent from June, before the restrictions took effect.
The new data shows about 3,000 abortions were provided in August, about 1,200 fewer than the more than 4,200 documented in June. The numbers do not account for self-managed abortions in the state — those occurring without in-person or virtual contact with the health care system.
Guttmacher Institute data scientist Isaac Maddow-Zimet, who leads the organization’s Monthly Abortion Provision Study project, said the additional month of data suggests that the decline in North Carolina is more than an “isolated shock” to the health care system.
“Unfortunately, what we see in August is really not much of a recovery,” Maddow-Zimet said. “That suggests to us that this ban and the addition of the in-person counseling requirement is too much of an obstacle for many folks in North Carolina and those traveling to North Carolina to be able to overcome to receive care.”
Furthermore, Maddow-Zimet said Guttmacher data showed no increases in abortions provided in nearby states like Virginia, the District of Columbia or Maryland that would offset the decline in North Carolina.
Despite best efforts by abortion care providers to nimbly adapt to the new law, Maddow-Zimet said the initial data emerging indicates a sustained impact will likely be faced in North Carolina as abortions are harder for patients to obtain and providers to offer.
What’s driving the decline?
The decline in volume isn’t surprising, said obstetrician-gynecologist Matt Zerden, Planned Parenthood South Atlantic’s associate medical director and an abortion provider. He said Republican state lawmakers passed the 47-page bill to make it harder to access the procedure, and that’s the reality playing out.
Abortion access significantly diminished as the time frame for seeking most abortions in the state dropped from 20 weeks of pregnancy to 12 weeks on July 1. Cutting weeks of access makes turning patients away from care a more frequent occurrence.
“Very commonly patients booked — they think they're 9 or 10 weeks based on their last menstrual period — and it turns out they're 13 weeks and 3 days or they’re 12 weeks and 4 days, and we can't consent them,” Zerden said. “They will be above the limit. We see those situations all the time.”
Zerden explained that patients beyond 12 weeks of pregnancy — often ones with irregular periods or adolescents who realize that they are pregnant later on — still need care, but he can no longer use his skills to provide it in their home state. Instead, Zerden said these patients who fall outside of North Carolina’s legal limit are left to self-manage their abortion, travel out of state for care or carry their pregnancy to term.
The reduced time frame is curtailing access, Maddow-Zimet said, but he doesn’t think the gestational limit is the primary driver of the monthly declines experienced in North Carolina.
That’s because nearly 90 percent of the almost 27,000 abortions provided in North Carolina in 2021 occurred up to 12 weeks of pregnancy, according to the latest available data from the state health department. About 1,800 abortions in 2021 occurred in North Carolina after 12 weeks of pregnancy — procedures that are no longer permitted in the state.
The gestational limit alone does not account for the significant monthly volume declines in July and August of 1,300 and 1,200 fewer abortions than before the law took effect. Rivera said North Carolina’s new abortion law creates additional hurdles for patients — even early in pregnancy.
In particular, she said the requirement to receive state-mandated in-person counseling at least 72 hours before an abortion — something that could previously occur by telephone — is making it harder for people to access the procedure.
Many North Carolinians need to drive long distances — now twice — to reach one of the state’s 14 abortion clinics spread over nine counties. The two-visit requirement necessitates extra time off work, travel, hotel stays and child care costs that are not always feasible.
Zerden said there are a number of patients who have come in for their first appointment at a Planned Parenthood South Atlantic clinic for state-mandated counseling and an initial ultrasound but have not made it to the second scheduled appointment.
“I'm guessing life came up — their other children needed them, they couldn't get out of work, couldn't secure transportation,” Zerden said. “I don't know what happens to them. Is that a situation with a forced birth? They decide to drive to another state where they can just get everything in a day? Are they going to come back to us a little bit farther once they are able to?”
Abortion providers know they are practicing in a challenging, increasingly restrictive environment where the level of access to the procedure can’t be the same as before the law. Still, they say they remain dedicated to adjusting their processes to comply with increased restrictions and minimize the resulting declines in access to care as much as possible.
“We've done a lot, and we're continuing to adapt and optimize our clinics — figure out how to do things efficiently, minimize wait times, structure things throughout the week, throughout the day for our various clinics so that patients have as streamlined of a process as possible,” Zerden said.
“But we can't change the fundamentals of an unnecessary two-visit process that is twice the checking in, twice making someone come in and go through all the steps, twice the administrative burden,” he continued. “That ends up in inefficiencies, and at a time when health care is strained.”
Tell us your story about abortion access
NC Health News will be continuing to cover the effects of increased abortion restrictions in the months ahead and the best way for us to do that is with your help — hearing concrete examples of how you are navigating the new law. Have you been affected by new abortion restrictions as a medical professional or a patient? NC Health News is interested in hearing your experience.