Patients already routinely travel into the state for abortion care. Clinics expect those numbers to grow.
With the U.S. Supreme Court considering a major challenge to Roe v. Wade, abortion providers in Washington state are preparing for a future without the landmark constitutional protection for reproductive rights — one in which patients could soon travel into the state in unprecedented numbers for care.
“We are expecting a significant increase in patient volume,” said Paul Dillon, vice president of public affairs at Planned Parenthood of Greater Washington and North Idaho.
According to projections from the Guttmacher Institute, a reproductive health policy research organization, Washington could see a 385% increase in patients from out of state seeking care, if Roe is overturned through the Supreme Court consideration of Mississippi’s 16-week abortion ban.
The number of women 15 to 49 years old whose nearest abortion provider would be in Washington could increase from 110,000 to 510,000, with up to 400,000 of those women traveling from Idaho, Montana and Oregon. Unlike Washington, where state law protects the right of women to get an abortion even if the federal law changes, Idaho and Montana do not offer the same protections in state law; Oregon does, but has no abortion clinics east of Bend.
The surge could be especially acute east of the Cascades in Washington, where there are only five abortion clinics, all operated by Planned Parenthood, and where clinicians already routinely see out-of-state patients. (Cedar River Clinics operates a site in Yakima, where patients can receive telehealth counseling from doctors in Western Washington, but it isn’t a full-service clinic.)
Much of the need for care is concentrated at three health centers within 20 miles of the Idaho border. At Planned Parenthood’s Spokane Valley location, for example, Dillon said 43% of abortion patients already come from Idaho.
“That’s already a very high volume, because patients in north Idaho already can’t access abortion,” he said. “We’ve seen patients from western Montana. And” — after Texas’ restrictive Senate Bill 8 went into effect in 2021 — “we’ve already seen patients flying up from Texas to our Eastern Washington health centers.”
Even if the Supreme Court guts Roe or overturns it altogether, abortion rights will be upheld in Washington through existing state-level protections. But they may not be in Idaho, where the state Legislature is advancing a copycat bill modeled on Texas’ SB 8. Idaho also has a so-called “trigger” ban, which would criminalize abortion immediately if Roe is overturned. If the trigger ban goes into effect, Dillon said he expects to see even more patients traveling from Idaho into Washington.
Projections from the Guttmacher Institute suggest a maximum of 230,000 women of reproductive age in Idaho would have to travel to Washington state to find their nearest abortion provider. That’s about two times the number of women whose nearest abortion provider is currently in Washington.
“We want to have the ability to be there for our out-of-state patients,” he said. “It’s become really challenging, I think, to know what the impacts are going to be and what that 385% increase looks like if the dominoes fall for these other states and patients lose access.”
And patients in Washington could also be impacted. Abortion access in the state has already been complicated by developments like the passage of SB 8, which in September brought an influx of patients from Texas to Seattle clinics. Patients from Texas also sought care in California, and procedures were delayed in states surrounding Texas because of high demand.
Riley Keane, a practical support lead for the Northwest Abortion Access Fund, which provides financial and travel assistance to people seeking abortion care across the Northwest, said the organization had seen “a ripple effect” from SB 8. When patients left Texas for care elsewhere, it created a backlog at clinics across state lines. Especially for patients seeking second-trimester abortions, said Keane, clinics were booked two to three months out. Many of them needed to travel to the Northwest for care.
A Roe reversal would multiply that impact. With increased demand on abortion providers in Eastern Washington, Dillon said, local patients would likely face longer wait times.
In the meantime, clinics and abortion funds are working to scale up their operations to meet the increased need they expect to come with the loss of protections enshrined by Roe v. Wade. The Supreme Court is expected to rule this term on the case it heard in December involving the Mississippi ban on abortion after 15 weeks of pregnancy. During oral arguments, five of the court’s six conservatives implied they might be willing to completely eliminate the constitutional right to abortion.
The Northwest Abortion Access Fund, whose funding comes from donations and whose travel coordinators are all volunteers, has experienced an increase in calls from outside its service area. It expects that to continue if Roe v. Wade is overturned; the group is currently developing strategies on how to respond.
“Typically, abortion funds support callers in their geographic region, but we, of course, don't want to turn anyone away from seeking abortion services,” said practical support lead Meg Chappell.
The organization has considered setting limits on its spending in response, Chappell said, but has not made any formal decisions yet. The fund has also recently fielded calls and received donations “from people who didn’t consider themselves supportive of abortion,” said Chappell’s colleague Keane. “I’m hoping there is a way we can find more middle ground with those people.”
Planned Parenthood, like many abortion providers, pivoted to telehealth options to administer medication abortion remotely during the COVID-19 pandemic. This program was enabled by the Food and Drug Administration’s decision to lift dispensing restrictions on mifepristone, part of the drug regimen commonly prescribed to induce abortion, said Dillon. Telehealth medication abortion may help stave off some demand from within Washington and for travelers from other states in the coming year.
But it won’t be a universal solution, said Dr. Sarah Prager, professor of obstetrics and gynecology at the University of Washington. Medication abortion is effective only in ending pregnancies of up to 11 weeks’ gestation, but “when patients are having to travel longer distances, they are much more likely to end up later in their gestation,” she said. That “might time them out of being a good candidate for a medication abortion.”
A larger pool of providers would be a more systemic solution, she said, especially east of the Cascades: “I think we would want to ramp up access in the eastern part of the state.”
But due to the ubiquity of hospitals affiliated with religion, which often follow a set of religious guidelines limiting reproductive health care, she said, “There is an extremely limited number of hospitals that will actively do abortion — the University of Washington being one of them — and that can receive patients who have had complications and be able to manage them effectively.”
Sara Ainsworth, senior legal and policy director at the reproductive justice law group If/When/How, said the increase in barriers to abortion enabled by the Supreme Court might push pregnant people seeking abortions to turn away from the medical system altogether.
“We are expecting that more and more and more people will self-manage abortion by necessity now, not necessarily by choice,” she said.
In Olympia, Planned Parenthood and other reproductive rights organizations are supporting House Bill 1851, the Affirm Washington Abortion Access Act. The measure would officially recognize that advanced-practice clinicians, including physicians assistants and nurse practitioners, can provide abortion with proper training if it falls within their scope of practice. The bill, which has passed the House, could potentially expand the state’s pool of providers.
“We are training staff to really be prepared, so we can build our capacity in the event Roe v. Wade does fall,” said Dillon.