Echoing history, reliance upon travel rises for abortion care post-Dobbs

When the U.S. Supreme Court issued its Dobbs decision one year ago, people of childbearing age in states across the country suddenly faced what seemed like a new prospect — having to travel hundreds or even thousands of miles from home to get an abortion.

But historians say it is merely continuing a long tradition of pregnant people seeking out the sometimes lifesaving care they need wherever it can be found, and other people helping them along the way.

In the Midwest, Dr. Josephine Gabler operated an abortion clinic that served tens of thousands of people in Illinois, Indiana, Michigan and Wisconsin between 1930 and 1940. Patricia Maginnis kept a list of trusted physicians in Mexico, Japan and Sweden through the 1950s and ‘60s where people could be referred from California for safe abortion care.

The Clergy Consultation Service, made up of 3,000 religious figures across 38 states, helped 7,500 women find abortions from 1967 until 1973, when the U.S. Supreme Court ruled in favor of Roe and legalized the procedure nationwide.

Today, with 14 states that have implemented near-total bans on abortion, one organization called Elevated Access has recruited more than 1,200 volunteer pilots to privately fly those in need of an abortion to states where it is accessible.

Since the Dobbs ruling, states with abortion access have experienced an increase in out-of-state patient volume. In Illinois, nearly one-third of Planned Parenthood patients came from other states, compared to an average 6% prior to Dobbs. Similarly, clinics in Colorado reported out-of-state patients doubled from 14% in 2021 to 28% in 2022, with a large share coming from Texas, which has a strict abortion ban. At least one state, Idaho, has passed legislation aimed at restricting out-of-state travel for an abortion for minors who don’t have parental permission, but it’s unclear how that law will be enforced. Other states with bans have not successfully implemented any laws aimed at restricting travel.

“This is part of a long history of people seeking out ways to end their pregnancies and to get abortions, or ‘get their menstruation back,’ as they called it then, that often included travel,” said Leslie Reagan, a historian who wrote “When Abortion Was a Crime” and scholarly articles about women traveling for abortion throughout the 19th and 20th centuries. “They could be coming by train, driving, or taking a bus, depending on what time period we’re talking about and their circumstances.”

Groups across America ran underground networks that kept organized lists of trusted physicians who would provide abortion care. Sometimes those physicians operated covertly in communities within the U.S., but often they were located across the border in Mexico, or across oceans in Puerto Rico, Europe and Japan.

Overseas, people have also traveled where abortion was illegal. Irish citizens traveled to the United Kingdom for abortion care for many decades, and still do for pregnancies beyond 12 weeks’ gestation. Canadians traveled to U.S. cities like New York City and Chicago and Washington state prior to legalization in 1988. Between 2001 and 2017, Dutch Dr. Rebecca Gomperts used ships to ferry women from cities in Ireland, Poland, Portugal, Spain, Morocco, Guatemala and Mexico to international waters, where they could terminate their pregnancies legally aboard the ship and then return home.

“Sometimes people can’t control when they’re going to get pregnant, or if the timing is right, or you’re going to get kicked out of school,” Reagan said. “And really what I saw was not only were women doing it, they had a lot of support. There’s really a lot of moral support for this even though the laws might say it’s illegal.”

Volunteer pilot raised $15,000 to buy small seaplane 

A Midwestern pilot who goes by Mike Bonanza started Elevated Access three days before the leaked draft opinion overturning Roe was released on May 1, 2022. He volunteered for the Midwest Access Coalition, an abortion access fund in Chicago, and his background as a pilot led him to put the two together to help more people. The organization also flies those who need gender-affirming care, which is quickly becoming a larger need. As of June 1, 21 states have banned gender-affirming care for minors, including all 14 states with abortion bans.

One of Elevated Access’ volunteer pilots is Adrian, who asked only to be identified by his first name, as all Elevated Access volunteers and staffers do to protect themselves from harassment and potential legal scrutiny. But he is one of the most outspoken individuals affiliated with the organization, and one of the only people who willingly shows his face on social media — his TikTok account has more than 115,000 followers.

“I stopped counting donations (to Elevated Access) once we crossed over $150,000,” he said.

When asked why he volunteers, Adrian speaks plainly about his mother, who was raped by an older man when she was 13 years old. Her parents, he said, were members of the Church of Jesus Christ of Latter-Day Saints in Utah and did not allow her to seek an abortion. She was forced to give birth to Adrian and his identical twin brother at the age of 14.

For the first eight years of their lives, Adrian and his brother lived with his grandparents, until his mother returned and took the boys to Georgia to live on a military base with her and a man she was dating. From that time until he left home, Adrian and his brother frequently experienced food insecurity and other abuse.

Now that he is married and living in Wisconsin, Adrian said he doesn’t have a relationship with his mother, stepfather or his brother, who has also struggled with substance abuse.

“A lot of people will say, ‘Oh well, my god, he’s doing so much for his mom,’” he said. “No, it’s not about my mom. Yes, my mom is an individual that perfectly embodies the individual that should have access to reproductive health care. It doesn’t mean I like her.”

His plane is a model from the 1980s, and one of less than 50 left in operation around the country. He opted for an amphibious plane for its versatility, especially after rumors that states with strict abortion laws such as Texas might try to interfere with people trying to leave the state for the procedure. According to the National Oceanic and Atmospheric Administration, about 2.1 million of Wisconsin’s 5.7 million people live in coastal areas of the state, or nearly 37%, and he could taxi through the water right up to their docks if needed.

Although Elevated Access has many volunteer pilots, Adrian said they need more who own their own planes.

“That’s our biggest hurdle, is actually pilots with planes,” he said.

Word of mouth spreads easily in the internet age

Some of the circumstances surrounding abortion access today are easier to navigate now than they were prior to 1973, according to historians. Katrina Kimport, a researcher at the Bixby Center for Global Reproductive Health at the University of California, San Francisco, said travel has historically been limited to those with the means and resources to do it. Wealthier people had the financial backing as well as more connections who could help lead them to the right people. In the internet age, information is readily available to many more people, she said, and there is often more financial support for those who can’t afford it.

Christabelle Sethna, a professor at the University of Ottawa who wrote a book called “Abortion Across Borders,” said the information network that exists today is an essential difference from history.

“In the past it was sort of underground, whispered information; you’d have to ask a whole number of people and maybe one would come through for you with the name of a doctor,” Sethna said. “It was much more disparate in the past, and now it’s much more organized because of the internet and the vast reach of the internet.”

That includes being able to access abortion medication through websites, Sethna said, which is another option that wasn’t available in the past. Another significant difference is that the procedure is legal at various stages of pregnancy in 36 states rather than banned nationwide, as it was between the late 1890s and 1973.

Despite those changes, Kimport said her research shows there are still many logistical, emotional and financial burdens placed on those forced to travel because of a lack of access in their own state. She pointed out that prior to the Dobbs ruling, abortion after 24 weeks was still heavily restricted, which provided a preview of what pregnant people are experiencing now at a much broader scale.

“Putting aside the cost of the procedure, travel itself is an additional cost,” Kimport said. “There’s also the logistical burden of having to seek out child care or pet care, time off work, getting reservations. Some people don’t have credit cards, some don’t have a car. This is a time and resource and organizational burden.”

Emotional costs are difficult to measure, she said, but are some of the most heightened effects, especially for someone leaving a rural area and traveling to an urban area if they have never traveled before.

“Even for people who have experience in travel, going to an unknown place can be extremely stressful and unsettling,” Kimport said.

Abortion access funds rely on each other to cobble together funds for travel

While Elevated Access is responsible for the pilots and the actual flights, it is partner organizations large and small that refer clients to them and help arrange lodging and other logistics, often providing additional financial support for meals and other expenses.

One of those partners is New River Abortion Access Fund, which started in 2019 in rural Virginia, where it can take hours to drive to the nearest clinic. Sophie Drew, interim director of the fund, said barriers to access already existed prior to the Dobbs ruling, but at a much smaller scale. The initial budget for the fund was about $600 per week, she said, with maybe five calls for help during that week.

Now, the fund averages $20,000 per week with 60 to 70 calls on average in one week.

Gianna G., an intake coordinator for New River, said that might sound like enough funding, but with an average cost of $300 to $500 for first-trimester abortion care and as much as $20,000 for abortions later in pregnancy, abortion funds around the country rely on each other to cobble together enough dollars from donations each week to help all of their callers.

“Right now, we just don’t have the money we need in order to make this sustainable,” they said. “I think a lot of people support abortion care, but they don’t know the monetary need behind it.”

The vast majority of those who call New River seeking help can travel by car where they need to go, Drew said, but there are still instances when a flight is the best option.

Gianna G. said much of their job is identifying barriers, like someone who doesn’t have a car or driver’s license, or doesn’t have a support person who can come with them for a long car ride.

Both commended Elevated Access, and said the fact that the flights don’t come at additional cost, including for a support person, is incredibly helpful.

“We’ve gotten feedback from some callers about their experience and it’s been exclusively positive,” Drew said. “Even if someone was nervous about flying. Elevated Access has been a great support both logistically and emotionally.”

Pilots use their own funds to gas up their planes, which Adrian said typically burn 10 to 25 gallons per hour. With the typical average cost of fuel, it can range from $60 to $120 per hour in gas alone. Sometimes Elevated Access can help offset those costs, but that funding is limited.

“Any of these pilots actually volunteering their time and resources, they’re losing money,” Adrian said.

Most patients who need flights come from the South and Midwest

Elevated Access has a policy of not asking many questions about the patient or their circumstances to respect their privacy as much as possible, especially because the situations can be complicated and emotionally difficult. Some flights have even been one-way trips, for those fleeing abusive situations or other dire circumstances.

“By the time they get to Elevated Access, they have tried many, many approaches,” said Fiona, who acts as a volunteer media relations coordinator. Elevated Access volunteers and staffers go by their first names only to protect themselves from harassment and potential legal scrutiny. “We are often the end of a long road for them. They are often very desperate at that point. They know that they can’t carry the pregnancy to term for many reasons.”

The organization does not disclose how many flights it has completed through volunteers over the past year to avoid becoming a target of anti-abortion advocates. But it now has three full-time staff members, including the executive director and two flight coordinators, and nearly 2,500 people have donated in the past year, even without active fundraising campaigns.

The requests for flights come from all states with abortion bans, Fiona said, but the largest share come from the South and the Midwest, where 13 of the 14 states with abortion bans at any stage of pregnancy are located.

“There are states where we will get requests where technically there is access, but it’s eight weeks out to get an appointment, or it’s a very specialized need for care,” Fiona said. “That’s more the exception.”

Researchers: Stigma from community adds to stress

The stigma surrounding abortion remains, presenting an added burden, according to Kimport’s research. She interviewed 30 women who traveled for abortion prior to the Dobbs decision about their experiences and said many of them felt forced to disclose their situation to people before they were ready or lied because they had to explain their absences.

Being away from support networks, including children, family, pets, neighbors and friends is another difficulty, she said.

Those who have to travel for an abortion, especially if it is by plane, are often in more advanced stages of pregnancy, Kimport said. Sometimes that is because a lethal fetal anomaly was discovered and sometimes it’s because the person did not know of the pregnancy until it was advanced — or, in today’s environment, an appointment could take weeks to obtain, depending on the demand at available clinics.

Whatever the reason, Kimport said those late-term abortion seekers face added emotional, physical and logistical burdens, since the procedure itself is more intense and requires more time to recover.

“People with third-trimester abortions had to travel because their state said that care was not allowed, and they talked about how that particular fact made things additionally emotionally stressful,” Kimport said. “One woman said she felt cast out from her community, that the law was saying what she was doing was deviant and she felt stigmatized.”

One benefit of Elevated Access and its volunteer pilots, according to the organization’s leadership, is that it offers a private method of flying to a destination. Kimport said those who have traveled for later-term abortions are more visibly pregnant and have to interact with strangers who will compliment and congratulate them and offer unsolicited advice. For someone whose wanted pregnancy went wrong, she said, that can be devastating.

‘We shouldn’t get used to it being complicated’

At the moment, as is in the case in so many states, the reproductive rights landscape in Wisconsin is complicated. The state is currently operating under a criminal abortion ban that went into effect in 1849, banning all abortions except to save the pregnant person’s life. But it’s unknown if a law that dated can still be enforced, particularly since Roe was in effect for 50 years in between. The law passed to comply with Roe allowed abortions at any stage of pregnancy.

The question of enforceability is currently under consideration in one of Wisconsin’s circuit courts, after Democratic Attorney General Josh Kaul filed a lawsuit against the three district attorneys who would prosecute cases in the counties with abortion clinics.

“Whichever party loses, I anticipate they would file a notice of appeal to the court of appeals and then it would go up to the (Wisconsin) Supreme Court,” said Michelle Velasquez, director of legal advocacy and services for Planned Parenthood of Wisconsin. “But the circuit court’s decision is an important first step to potentially restoring abortion access.”

The state’s governor is also a Democrat, but Republicans have a majority in both chambers of the legislature, creating a split, stalemated government. Unlike other states that are using citizen ballot initiatives to try to codify abortion access, Wisconsin only allows the legislature to propose ballot referendums.

Even before Roe fell, access to abortion was restrictive. Only three of the state’s 72 counties had a health center that offered abortion care, and using telehealth for abortion medication was prohibited by law. To obtain mifepristone and misoprostol, the two-drug regimen used to terminate early pregnancies, an individual is required to complete two in-person visits with the same physician present.

But Wisconsin is an island in the upper Midwest in terms of access — its border states, including Minnesota, Michigan, Illinois and Iowa all continue to allow abortions.

By plane, Adrian can fly from Wisconsin’s eastern peninsula to a Minnesota clinic in about 45 minutes, but it would take someone living on the peninsula four hours to make the drive.

“That’s kind of how ridiculous this is,” he said. “I couldn’t imagine what it feels like to be told, ‘No, you can’t get the care you need.’ It’s also going to permanently rearrange your body, and you’re never going to be the same all because some a— h—- assaulted you or some tech bro didn’t want to wear a condom.”

Although the people working to connect pregnant people with abortion care are passionate about the work, New River’s Interim Director Sophie Drew said she hopes having to drive for hours or take a private flight to get an abortion doesn’t become normalized. In her ideal world, none of these resources would need to exist.

“People should be able to access abortion in their communities without all these hoops to jump through,” she said. “That’s the main thing I wish people knew, is that it can be a complicated process, and we shouldn’t get used to it being complicated.”

When Roe was overturned, Adrian posted a video to promote Elevated Access and recruit more pilots. His presence as “cheesepilot” on TikTok is how the leadership at Elevated Access found him and asked for his help in May 2022. The organization had barely started in April, and only had a few volunteers. He made a quick video on a break from his job as a pilot for a regional airline and came back several hours later to nearly 500,000 views and hundreds of people asking how to donate. The seaplane he bought last year was made possible with a $15,000 down payment raised by his TikTok followers.