Post-Dobbs abortion access in North Carolina shows delays, increased out-of-state travel, and disparities

Post-Dobbs abortion access in North Carolina shows delays, increased out-of-state travel, and disparities | Image Credit: © Pete – stock.adobe.com.

New research presented at the 2025 American College of Obstetricians and Gynecologists (ACOG) Annual Clinical and Scientific Meeting highlights the shifting abortion landscape in North Carolina following the Supreme Court’s 2022 Dobbs v. Jackson Women’s Health Organization decision. Researchers analyzing state-level data reported an increase in out-of-state patients, later gestational age at time of abortion, and disparities by race and ethnicity.¹

The study examined 114,709 abortions that occurred in North Carolina between January 2021 and December 2023 using data from the North Carolina Division of Public Health. Of these, 49,366 were performed before Dobbs and 65,343 after. Researchers used regression, time series, and geospatial analyses to evaluate changes in abortion utilization and access in the state.

Increase in interstate abortion travel

Following Dobbs, North Carolina became a key destination for patients from surrounding states with more restrictive abortion laws. The proportion of patients traveling from out of state increased from 17% pre-Dobbs to 38% post-Dobbs (P<.001). This shift reflects the state’s temporary role as a regional access point for abortion care, including second-trimester procedures, through much of 2023.

“Preliminary findings demonstrate a new pattern of abortion travel to North Carolina from other states in the Southeast, with significant racial and ethnic disparities,” wrote the study authors.

This finding aligns with national data showing a rise in interstate travel for abortion care. Between 2020 and 2023, the rate of interstate travel for abortion nearly doubled. North Carolina, along with Illinois, New Mexico, and Kansas, reported the highest volumes of out-of-state patients in 2023.²

Delays and racial disparities in care

The study also found that abortions occurred later in pregnancy after Dobbs. The average gestational age at time of abortion increased by three days (P<.001), with longer delays for patients traveling from out of state (P<.001). Black and Latinx individuals experienced longer delays compared with White patients (P<.01 for both comparisons), and the overall proportion of Black and Latinx patients receiving abortion care in North Carolina rose significantly post-Dobbs (P<.001).

These findings point to disproportionate burdens on patients of color and those required to travel farther for care, including increased wait times and logistical challenges.

Context of national trends and policy shifts

Despite the initial drop in abortion volume following Dobbs, national data show a net increase in abortions over the past two years. More than 1 million abortions occurred in the United States in 2023, compared with 930,160 in 2020. This increase is attributed to several factors, including expanded access to telehealth, the ability to receive medication abortion by mail, and lower costs associated with virtual abortion services. As of June 2024, medication abortions provided via telehealth accounted for 20% of all abortions in the U.S.

States that maintained or expanded access to abortion have also contributed to the rising national volume. Some states passed laws to protect in-state and out-of-state patients, expanded Medicaid and private insurance abortion coverage, and implemented shield laws to reduce legal risks for providers. These policies have helped offset the effects of abortion bans in other states by enabling cross-border access to care.

Ongoing analysis underway

Researchers from the North Carolina study noted that additional analyses are in progress. These will examine how changes in state policies, travel distances, and time periods affected abortion access. The findings are expected to provide further insight into how policy changes have shaped abortion utilization patterns across the Southeast.

Taken together, the data from North Carolina contribute to a broader understanding of how the post-Dobbs environment has impacted abortion access, particularly for patients navigating restrictive laws and systemic inequities.

References:

1. Loeliger KB, Averbach H. Abortion Access in a Post-Dobbs Southeast United States: Changing Geospatial Patterns, Disparities, and the Experience of Traveling for Care. Abstract. Presented at: 2025 American College of Obstetricians and Gynecologists (ACOG) Annual Clinical and Scientific Meeting. May 16-18, 2025. Minneapolis, Minnesota.
2. Diep K, Castillo Sanchez B, Ranji U, and Salganicoff A. Abortion Trends Before and After Dobbs. February 27, 2025. Accessed May 18, 2025.