Immediately, the phones were ringing off the hook. Hundreds of desperate patients left voicemail messages from their homes, their cars, even from clinics in other states where they had just learned they could not receive the care they were promised. Where could they get an abortion now? How would they get there? How would they pay for it? Could they get their money back for the abortion services they’d paid for but wouldn’t receive?
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That was the situation at Allegheny Reproductive Health Center last June, where the wait time just to get a return call was three to four business days as the clinic saw its client load double, and then triple, according to CEO Sheila Ramgopal.
The days immediately following the Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision, which overturned Roe v. Wade, were “like a total shit show” for Western Pennsylvania abortion providers, Ramgopal said.
The call volumes have since slowed down, but the number of out-of-state abortion patients in the region remains heightened at Allegheny Reproductive as well as Planned Parenthood of Western Pennsylvania, the only other abortion clinic on this side of the state. Clinics have been forced to adapt, largely by expanding their funding and staffing, to accommodate the demand.
The Dobbs decision struck down half-century-old constitutional abortion protections across the country, allowing state legislatures to restrict abortion access. One year later, 14 states have completely banned elective abortions, with six more banning abortion after 20 weeks of pregnancy or less.
West Virginia banned abortion with very few exceptions in September. Adult victims of rape or incest can acquire an abortion until eight weeks gestation, while victims under 18 have until 14 weeks, though all such victims must report to law enforcement authorities 48 hours beforehand. The ban also includes exemptions for medical emergencies.
The ban also requires these abortions to be performed by a physician at a hospital, putting an end to nearly 50 years of abortion services at the Women’s Health Center of West Virginia, the state’s only abortion clinic. While the Charleston-based clinic cannot provide abortion services, it continues to refer patients to resources and funds that will help them get an abortion out-of-state — including a lot of patients that end up traveling to Pittsburgh.
“West Virginians are still calling us asking where they could get abortion care,” said Katie Quinonez, executive director of the Women’s Health Center. “Just because abortion was banned within our state borders does not mean that the need for abortion stops whatsoever.”
Nine other states have attempted to ban abortion only to have the legislation blocked in court — at least for now. Ohio’s ban on abortion after the sixth week lasted from the day of the Dobbs decision until October, when a preliminary injunction halted the law pending court proceedings.
In Pennsylvania, abortion rights have remained stable over the past year and are likely to stay that way under Gov. Josh Shapiro. As a result, many seeking the procedure from Ohio and West Virginia — and even farther away — have turned to the state for access.
Before last June, Allegheny Reproductive averaged around 800 abortion procedures per quarter, but that surged to 1,352 after Dobbs before settling to around 1,000 now, according to quarterly reports to the Pennsylvania Department of Health.
Even after the initial wave of patients died down and Ohio’s ban was blocked in court, the proportion of out-of-state patients remained elevated. Before Dobbs, Ramgopal said roughly 15% of patients at Allegheny Reproductive would come from across state lines. After Dobbs, that number surged to 50% in the third quarter of 2022 but has settled at around 20% for the first quarter of 2023. According to Sydney Etheredge, CEO of Planned Parenthood of Western Pennsylvania, Planned Parenthood has seen growth from roughly 16% to 25% out-of-state patients.
Reproductive care patients are also traveling to Pittsburgh from farther south and west, both Etheredge and Ramgopal said. Prior to Dobbs, Planned Parenthood saw patients from six states, but that number has now grown to 19 — as far west as Texas and as far south as Florida. Ramgopal said Dobbs brought patients to Allegheny Reproductrive from states like Tennessee, Texas, Louisiana, Florida, Alabama and even Virginia, where abortion is still legal.
“Virginia actually has good access, but I’m assuming that people from other states are coming in,” Ramgopal said. “So it’s actually pushing other people who are in states that are legal to go other places that they still have access. It’s really shifting how people access abortion, and it’s just gonna get worse.”
In Pa., clinics are legal, but scarce
For Etheredge, it’s not just the number of traveling patients that’s concerning — it’s also the number who can’t travel.
“That’s what keeps us all up. It’s like, what are those patients who couldn’t get a doctor? Like who couldn’t get child care or didn’t have reliable transportation to get to another state or to get 500 miles within their state to the only provider?” Etheredge said. “Because we know that we’re missing a swath of people who just aren’t able to get in or aren’t able to travel.”
While abortions are available in Pennsylvania, abortion access in the state isn’t strong enough to serve even the needs of in-state patients, let alone patients across state lines, Etheredge said. Decades ago, more than 100 clinics provided abortion care across the state, but today, there are just 18. The state’s laws surrounding the procedure are restrictive, both at the patient level and the provider level.
Opening a new abortion clinic is an expensive ordeal, thanks to a 2011 state law that requires abortion clinics adhere to the same regulations as ambulatory surgical facilities. Clinics must be equipped with hospital-grade elevators, for example, and meet specific standards for the size of their operating rooms and hallways.
“An ambulatory surgical facility is like a mini hospital and can accommodate medical procedures of up to four hours, with four hours of recovery time. An abortion takes between seven and 10 minutes,” said Susan Frietsche, senior staff attorney at the Women’s Law Project. “So it is inappropriate to require a procedural abortion to be in an ambulatory surgical facility-level clinic.”
It’s an example of what Frietsche calls a “TRAP law” — targeted restrictions on abortion providers.
“TRAP laws exist in order to serve two different purposes. One is to perpetuate the myth that abortion is a complex and dangerous procedure — it is not,” she said. “The second is to make it so expensive and difficult and complicated to actually provide abortion care that you drive abortion providers out of the field. And that has been very successful.”
Maria Gallagher, legislative director of the Pennsylvania Pro-Life Federation and a proponent of the regulations, rejected this characterization. Gallagher pointed out that the use of ambulatory surgical facility standards at abortion clinics originated from the “horrible” Kermit Gosnell case, and said they are “for women’s health and safety, period.”
“It just seems to be common sense that if you inspect abortion facilities, it’s more likely that the abortion facilities are going to be maintained at the proper health and safety standard so that women can be protected,” Gallagher said.
While the creation of new abortion clinics is illegal in West Virginia and burdensome in Pennsylvania, the Women’s Health Center of West Virginia has found another way to boost access in the region. It’s set to open a new location in Maryland — less than an hour away from the West Virginia border — this summer.
The Women’s Health Center of Maryland “will really help to not only reduce the burden on abortion clinics that are in Pennsylvania and Maryland and Virginia, who are now taking on the care of folks beyond their states’ borders, but it will also serve as a regional abortion access point” for Western Maryland, Quinonez said.
Staff are stressed, but growing
Remaining abortion clinics have bolstered their operations to keep up with the increase in demand, starting with their personnel. Allegheny Reproductive expanded its staff by 30% between 2019 and 2021 to prepare for the possibility of losing constitutional abortion rights, and again by 20% around the time of the Dobbs decision, Ramgopal said.
Planned Parenthood brought on new staff including a patient navigator to help patients understand the landscape of Pittsburgh — how to get there, where to park, where to stay — and answer questions about appointments. Not only does this help patients from far away feel more comfortable traveling for an abortion, but it also helps other staff focus on facilitating and providing care.
“We’re seeing more patients, but we don’t want to burn out the staff that we have,” Etheredge said. “That is so important since they are really our connection to our patients and the community and they’re the ones providing this care.”
Even amid a staffing shortage, both Etheredge and Ramgopal had no problem finding new hires.
“We saw a lot of people interested in wanting to work in the space, which was really exciting,” Etheredge said. “Being able to recruit and staff and bolstering our HR infrastructure to make that a much more seamless process [was] something that was a big focus of mine when I came on board, and we’re seeing the impact of that now.”
Increased staffing has allowed Planned Parenthood to stay open five days per week more consistently. Allegheny Reproductive opens five and a half days weekly — almost twice the availability it had in 2017, when the clinic opened three days per week.
In the wake of Dobbs, “there’s been a massive increase in people donating to these various national funds and local funds to actually support people’s direct costs of care as well as covering their costs of travel.”
Sheila Ramgopal, CEO of Allegheny Reproductive Health Center
Heightened levels of fundraising — not only for clinics, but for patients — have also helped keep abortion accessible in Western Pennsylvania.
In the wake of Dobbs, “there’s been a massive increase in people donating to these various national funds and local funds to actually support people’s direct costs of care as well as covering their costs of travel,” Ramgopal said. “So for a lot of our clients, they’re able to get their abortions low-cost or no-cost, especially if they’re coming from out of state and having to go through these additional barriers.”
Quinonez said this surge in fundraising and support has allowed the Women’s Health Center of West Virginia to not only keep its doors open, but also to retain a full staff, despite that revenue from abortion services comprised about 40% of its operating budget pre-Dobbs.
“We’re committed to keeping all staff on because we did not only provide abortion care, we provided a full scope of reproductive health care that our community has come to depend on us for,” Quinonez said.
As Ohio teeters, Pittsburgh prepares
The future of abortion care across the state and the country is uncertain. Ohio’s six-week ban could be ruled unconstitutional in court or it could be reinstated, pushing more patients across state lines. Federal judges could curb use of the pregnancy-ending drug mifepristone, utilized along with misoprostol in more than half of Pennsylvania abortions. In the years to come, if power dynamics shift in Harrisburg, the state legislature could try to further restrict the procedure through a state constitutional amendment.
Abortion providers and advocates are preparing to roll with the punches. At Planned Parenthood, informed consent forms and staff training have already been updated to allow for misoprostol-only medication abortions, in case mifepristone is banned. And last year, Mayor Ed Gainey and Pittsburgh City Council enacted several bills aimed at protecting abortion access in Pittsburgh.
One of the bills prohibits city officials or employees from assisting in any out-of-state investigation of an abortion provider for providing legal reproductive care in Pennsylvania. The law aims to prevent states that have banned abortion from criminalizing providers in the case of travel abortions. At the time of council’s vote, such laws didn’t yet exist, but earlier this year, Idaho’s governor enacted a law against “abortion trafficking,” or helping a minor travel out of state for an abortion. So far, Frietsche said, no one has been prosecuted for traveling to Pennsylvania for abortion care.
“Everybody is in this for the long haul. There is plenty of fight in this movement. And, you know, we’re actually feeling somewhat optimistic about the really difficult future that the Supreme Court handed to us.”
Susan Frietsche, senior staff attorney at the Women’s Law Project
“The threat is real. The threat is not imaginary,” Frietsche said. “I give credit to Mayor Gainey and to Pittsburgh City Council for being forward thinking and taking preventive measures ahead of time so if someone tries that, we have some level of protection at the local level from it.”
“Everybody is in this for the long haul,” she added. “There is plenty of fight in this movement. And, you know, we’re actually feeling somewhat optimistic about the really difficult future that the Supreme Court handed to us.”
Alexandra Ross is an editorial intern with PublicSource and a recent graduate of the University of Pittsburgh. You can reach her at aross@publicsource.org or @AlexandraNRoss on Twitter.
Elizabeth Szeto is a data storytelling intern at PublicSource and can be reached at elizabeth@publicsource.org.
This story was fact-checked by Sean Lord.
