Dr Angela Marchin stares at a US map on the wall of the Denver Planned Parenthood where she works. The map is overwhelmed by pushpins, each representing the location from which a patient has traveled to the clinic for an abortion.
“Colorado is in the middle of an abortion desert. It feels like a stampede closing in all around us,” says Marchin, pointing out locations as far away as North Dakota and Florida.
The clinic had already been experiencing an influx of patients in recent months – many traveled from Texas, which banned abortions after six weeks last September, and Oklahoma, which banned nearly all abortions at fertilization in June. Now, in the wake of Roe’s overturning, Dr Marchin and her colleagues – who provide abortions for between 300 and 400 patients a month – are bracing for an even greater onslaught.
In April, reacting to the leaked draft opinion, Colorado state lawmakers enacted a statutory protection for abortion as a fundamental right. Its abortion laws are some of the least restrictive in the nation. States with severely restrictive abortion laws – Wyoming, Texas, Nebraska, Oklahoma, Arizona, Utah – form a ring around it. This means Colorado’s abortion clinics (there are estimated to be fewer than 18) will be the closest providers for 1.2 million women from surrounding states.
The flood of out-of-state patients has pushed many Colorado providers to their limits. Interviewed last week, coming off a night shift at the hospital where she works, Marchin was heading into another long shift at Planned Parenthood. Along with many of her fellow abortion providers, she has recently increased her hours at the clinic.
“The more patients we have on the schedule who are getting procedural abortions, the longer our day is going to be,” Marchin says of the process, which can be done only in a doctor’s office and is the only method suitable for later-term pregnancies. “We feel grateful to be in a state where abortion access is protected and so we’re galvanized to continue this work. But at the same time, we’re trying to be cautious about not becoming burnt out.”
Clinics in Colorado were already overbooked, leaving patients facing weeks-long wait times for appointments. Now, such clinics are expecting an 80% increase in abortion care patient volume, according to stats from Planned Parenthood of the Rocky Mountains. All of them have seen an increase in out-of-state patients around the 12-week stage of pregnancy, the point at which providers can no longer offer medication abortion, which is lower-risk and less invasive than a procedural abortion and can be done at home by taking two pills.
To prepare for overwhelming demand, the staff at Denver Planned Parenthood are planning to expand telemedicine and mail order services for medication abortion. They’re also thinking about how to stay resilient in an era of abortion prohibition, developing support programs for staff and sharing recommendations for therapists for its staff.
Having to travel for an abortion – scrambling to get an appointment at an overbooked clinic, securing money for transportation, lodging, childcare and the procedure itself, getting time off work and flying or driving for hours – has been proven to take a significant toll on patients’ mental health. For many women, crossing state lines to access care amplifies the stigma surrounding abortion. In a 2017 qualitative study, women variously described the experience of forced abortion travel as “nerve-racking”, “so much extra stress”, “a nightmare” and “making you feel like you’re doing something bad”.
More than half of respondents reported mental health consequences. Some had considered or attempted self-induction. In a 2020 study of patients seeking abortions, women who encountered logistical difficulties, including having to travel, were more likely to report symptoms of stress, anxiety and depression.
Every week, the clinic where Marchin works sees patients enduring unimaginable traumas. In early June, a mother arrived from Texas with her 11-year-old daughter who was more than 20 weeks pregnant as a result of rape. (The Texas abortion ban makes no exceptions for rape or incest.)
“This was a child who maybe just barely got her first period and probably has no idea what’s going on in her body,” Marchin says. On top of helping her daughter cope with the trauma of rape and carrying a pregnancy as a child, the mother, who spoke no English, had to find financial help through an abortion fund, then take time off work and pull her daughter out of school to travel hundreds of miles.
“They had never been on a plane before,” Marchin says. “They didn’t know how to book a flight. If she could’ve stayed in Texas for her care, she could’ve at least accessed it a little bit earlier.”
Many of Dr Marchin’s out-of-state patients are facing desperate situations. Some are trapped in abusive relationships. Some have drained their bank accounts to pay for the trip to Colorado. Some have chronic health conditions that would have become life-threatening had they been forced to continue their pregnancies. In most cases, after discharging them from the clinic with aftercare instructions and wishing them the best on their journeys home, Dr Marchin will never see these patients again. While she doesn’t worry about the physical or psychological effects of the procedure itself – research shows that getting an abortion overwhelmingly leads to feelings of relief, not regret – she’s often left with lingering concerns about how her patients will fare in states that deny their rights to bodily autonomy.
“I struggle with not being able to know what happens to these people after they leave. We do our best – we take very good care of these patients – but we don’t get to follow up with them,” Marchin says. “Abortion is extremely safe, and I’m not worried about medical complications, but I don’t know the answer to what psychological toll [forced travel] is having.”