A pregnant woman, whose fetus had a low chance of survival, contacted multiple abortion clinics before finally finding one that would accept her request. However, she was then placed on a waitlist that lasted for weeks. A teenager had to wait seven weeks for her abortion because her mother took that long to secure an appointment for her. Many others who sought the procedure also experienced delays due to the difficulty of traveling long distances for care.

According to doctors and researchers, there has been an increase in barriers since the decision of Roe v. Wade was reversed in June 2022. These barriers have resulted in delays, which can result in more complicated, expensive, and potentially risky abortions, particularly as pregnancies progress.

Approximately 50% of states in the United States currently have legislation prohibiting or limiting the availability of abortion services. As a result, numerous clinics are no longer offering the procedure, leading to a rise in demand for appointments at the remaining facilities.

After the Roe decision, there have been times when people had to wait for two to three weeks in certain states. A survey conducted by Middlebury College economics professor Caitlin Myers, shared with The Associated Press, revealed that some clinics had no available appointments during these lengthy waits. Despite wait times improving, individuals still face obstacles such as arranging and financing travel, taking time off from work, and finding childcare.

Dr. Daniel Grossman, an OB-GYN at the University of California, San Francisco, who co-authored a research report earlier this year, stated that various factors can lead to delays in healthcare services, creating a cycle of negative consequences. The report collected accounts from healthcare providers following the overturn of Roe v. Wade.

It is possible for individuals to miss the timeframe for medication-induced abortions, as they are typically not available after 10 to 11 weeks of pregnancy. As individuals progress through the second trimester, which starts at 13 or 14 weeks, there are fewer clinics that offer abortion services. The cost of the procedure also increases, going from up to $800 in the first trimester to $2,000 or more in the second trimester.

According to Dr. Colleen McNicholas, the chief medical officer at Planned Parenthood of the St. Louis Region, abortion is considered safe throughout pregnancy with a 2% complication rate. However, as the pregnancy progresses, there is a higher likelihood of complications and increased risks associated with the procedure.

According to a study conducted last year by the Guttmacher Institute, a pro-choice research organization, at least 66 clinics in 15 states ceased offering abortion services within 100 days after the overturning of Roe.

The primary cause of delays in obtaining abortions lies in the requirement for individuals to travel outside of their state.

Planned Parenthood of the Rocky Mountains, serving Colorado, New Mexico, and southern Nevada, experienced a significant increase in out-of-state patients following Roe. Similarly, the health center in Fairview Heights, Illinois run by Planned Parenthood of the St. Louis Region saw a 715% surge in patients from outside of Illinois or Missouri in the year after Roe.

According to McNicholas, restrictions on abortion have led to a domino effect, resulting in longer waiting periods even in states where the procedure is legally available.

The Myers Abortion Appointment Availability Survey has been continuously contacting over 700 facilities in the US. In their most recent survey in September, it was discovered that 11 states had an average wait time of more than five business days for appointments, while four states had a wait of at least eight business days (excluding weekends and holidays). Iowa had the longest wait time of 12 business days.

Last year, the study discovered that Iowa’s median wait time was 13 business days, while six other states had wait times ranging from 12 to 15 business days.

Planned Parenthood of the Rocky Mountains told the AP that wait times peaked at 28 days shortly after the U.S. Supreme Court decision, though it later fell. Before June 2022, waits in the region’s Planned Parenthood clinics averaged 17 days, reflecting restrictions in Texas that were put into place in 2021.

The report by Grossman’s group included a testimony from a healthcare professional who shared the experience of a mother who had to wait seven weeks to secure an appointment for her pregnant teenage daughter, who was already 17 weeks along. Another patient mentioned in the report also faced challenges, as it took her six weeks to find an appointment for an abortion, and she had to travel 10 hours to a different state for care.

According to the most recent data from the U.S. Centers for Disease Control and Prevention, approximately 7% of abortions occurred at 14 weeks or beyond in the year 2021.

It is difficult to determine if delays have resulted in more second trimester abortions, but some providers have observed an increase in their own clinics. For example, Planned Parenthood in the St. Louis area reported a 35% rise in the number of patients receiving abortions at 14 weeks or later at their Southern Illinois health center in the year following the Supreme Court ruling.

Dr. Rebecca Cohen, a gynecologist at a clinic affiliated with a hospital in Colorado, stated that her team has seen a rise in the number of patients seeking abortions during later stages of pregnancy. She mentioned that some patients have faced significant delays in finding appropriate care.

Jillaine St.Michel faced difficulties in obtaining an abortion at the end of last year upon discovering that her 20-week old fetus had various genetic and developmental complications and was not expected to survive. As she resides in Idaho, where abortion is prohibited, St.Michel and her spouse contacted approximately 15 clinics outside of their state. They eventually secured appointments after waiting for three weeks in Denver and two weeks in Seattle.

St. Michel, a 37-year-old woman, expressed her concern about exceeding the time limit for having an abortion. In Colorado, abortion is permitted at any point during pregnancy, whereas in Washington state, it is only allowed until the fetus is viable, meaning it can survive outside of the womb. Some infants can survive with medical assistance at 22 or 23 weeks.

A last-minute cancellation resulted in an available spot in Seattle just four days after she had requested to be put on the list. However, she stated that they still felt the pressure of limited time.

Medical facilities have implemented various measures to decrease wait times, including increasing the availability of telehealth appointments for medication-induced abortions, extending operating hours, and hiring additional staff. These efforts have generally resulted in shorter wait times for appointments and facilitated timely access to other types of reproductive healthcare services at these clinics.

“If an individual is engaging in sexual activity and does not wish to conceive, we aim to provide them with birth control,” stated Adrienne Mansanares, the president and CEO of Planned Parenthood of the Rocky Mountains. “In cases where they are displaying symptoms of a sexually transmitted infection, our goal is to ensure they receive proper treatment.”

However, according to providers, simplifying appointments is just one aspect of addressing the issue of abortion delays. Personal challenges such as difficulties with childcare, canceled transportation, and financial struggles can still pose obstacles even if clinics attempt to assist by connecting patients with abortion funds.

It becomes increasingly challenging as the distance of travel increases. A study conducted by Myers and his team revealed a significant increase in the average distance individuals had to drive to reach the nearest clinic after the passing of Roe. In Alabama, the average distance rose from 34 miles in March 2022 to 160 miles in September 2023, and in Texas, it went up from 43 to 499 miles during the same time period.

St. Michel, a chiropractor, had an abortion at a clinic located 500 miles away from her home. She and her husband were able to gather approximately $4,000 for travel expenses, a rental car, three nights of accommodation, and the procedure itself, as the clinic was not covered by her insurance. The couple chose not to seek assistance from an abortion fund, as they believed it should be reserved for those in greater need, and used their own savings instead.

In an effort to assist other families, she became a part of a legal case initiated by the Center for Reproductive Rights, a group of attorneys and activists who advocate for abortion rights. The lawsuit seeks to temporarily block abortion laws in Idaho and Tennessee through state court orders.

St.Michel, who is currently pregnant again, stated that she finds it difficult to believe that the majority of people would be able to successfully navigate this system. She believes that this is not the ideal way to access healthcare.

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The Health and Science Department of the Associated Press receives funding from the Science and Educational Media Group of the Howard Hughes Medical Institute and the Robert Wood Johnson Foundation. The AP holds full responsibility for all published material.