What To Know About Traveling Out Of State For Abortion Medications

When Roe v. Wade — a case that established the constitutional right for women to have abortions — was overturned by the United States Supreme Court in June 2022, women and girls suffered the consequences almost as soon as the decision was made. Trigger laws saw the cancellation of abortion appointments in states across the country, specifically in red states that tend to vote Republican, leaving patients stranded with unwanted pregnancies. Such trigger laws ensured that patients with no other means to terminate their pregnancies would be forced to give birth. This disregarded all potential dangers to the patient, all nuances of abortion, and of course, all considerations of whether or not the pregnancy was wanted. 

There is no silver lining to this ruling, which has consequences not just for the right to an abortion, but also for the right to bodily autonomy. Now, individual states are determining abortion laws, with blue states that tend to vote Democrat continuing to allow and protect abortion as red states continue to restrict access. In fact, many of these states have decided to outright ban and criminalize abortions. According to a report by the Columbia Law Review, this staunch discordance between states means that "the interjurisdictional abortion wars are coming" (via The New York Times).

Back in 1873, the Comstock Act made it illegal to mail both contraceptives and abortifacients through the U.S. Postal Service. It was not until 1936 that the U.S. government struck down part of the Comstock Act, effectively legalizing birth control.

Usually, two pills containing mifepristone and misoprostol are prescribed to induce an abortion, per Planned Parenthood. It's legal to receive abortion pills through the postal service as of December 2021, when the FDA lifted a restriction that required patients to receive the pills in person from certified health providers. However, 19 states enacted trigger laws disallowing the use of telehealth to obtain an abortion pill in a state that bans abortion, per Politico. This means patients have no other option but to leave the state for legally-sanctioned care. 

Per Dr. Julie Amon, medical director of Just The Pill, "The way it will work is if your state of residence bans access to medication abortion, you can travel to another safe state to have a telehealth appointment," she told The New York Times. From there, the medication could be mailed to a mobile clinic or a pick-up location such as a pharmacy. 

In December 2022, the Justice Department declared that it is within legal limits for postal service workers to transfer abortion pills to states that ban abortion, as it relates to the Comstock Act. Because Roe v. Wade made access to abortion legal at the federal level by default, there was never a need to clarify this previously. 

"For the past half-century, courts have not had the occasion to elaborate further on the meaning of the Comstock Act as it relates to abortion, including regarding the sources of law that inform whether an abortion would be 'unlawful' for purposes of the established construction of the Act," the document reads. They ruled that postal service workers could not have the knowledge to determine whether anything they carry will be used contrary to the law, including abortion pills. 

While the potential risks for postal service workers have been addressed, there are still significant legal risks involved for those who choose to circumvent state laws by knowingly mailing the pills in states where abortion is banned. For example, being convicted of mailing an abortion pill in Tennessee could land you a $50,000 fine and 20 years in prison, per Axios. State officials can also seek to ban abortion pills altogether, per the ACLU. 

Thus, a robust black market has formed in which patients are buying abortion pills from overseas, or buying abortion pills online without a prescription, risking the chance that the pills could be a scam, and thus risking their health. 

Traveling to a "safe" state where abortion is allowed is the sole legal option for those who seek to have an abortion and live in a state where it is banned. Even that, however, is being tested. Missouri introduced legislation last year that would allow a civil lawsuit to be brought against anyone who helps a Missouri resident have an abortion, per Politico. The move came after the mayor of St. Louis created a fund using federal dollars that would help Missouri residents with costs including travel when seeking an abortion out of state, per the Missouri Independent. 

Even before Roe v. Wade was passed, there were significant barriers to receiving an abortion both in and out of state. According to a report from the Guttmacher Institute, 27 states were deemed "hostile" to abortion access in 2014, and 75% of abortion patients were low-income. Paying for travel, taking time off of work, navigating particular legal and medical systems, and paying for childcare are not easy for most seeking an abortion, meaning many struggle to get the procedure they so desperately sought. 

Clinics in safe states close to the borders of states where abortion is banned have seen an uptick in business, while other clinics have begun cropping up nearby to meet the demand, per Politico. 

According to Self, there are several ways to prepare for having an abortion out of state, should a patient need one. First, a patient should know their "gestational age," or how far along in their pregnancy they might be. After 12 weeks, abortion pills are no longer approved by the FDA for an abortion, though the World Health Organization says they can be used safely until this point, per The Atlantic. A patient would likely need to find a clinic that can offer a surgical abortion if they are out of this range. Second, the patient should consider arrangements they need to make at home, for example, childcare or an absence from work. Abortion patients should also find out whether they need to be accompanied to the clinic, which can be a requirement. 

Arranging travel should be the next task on the list. Debasri Ghosh, the managing director of the National Network of Abortion Funds, told Self that it's not just the cost that prohibits patients from getting an abortion but the means to get to clinics that offer the service, especially when they're several states away. 

That being said, cost is a major factor to consider. As the cost of an abortion varies based on the kind of procedure, the patient's gestational age, and insurance, among other factors, abortion patients should have a financial plan and understand the range of financial expectations when it comes to paying for care. If they're struggling, NNAF can provide support. 

Patients around the U.S. have been significantly impacted by the bans and restricted access to abortion. Anecdotal reports by Condé Nast Traveler reflect the extensive trappings of fake crisis pregnancy centers, judgment and fear surrounding abortions, language barriers, the nuances of pregnancies that are no longer viable, and the costs of the procedure. Harrowing realities have been faced: Children who have suffered sexual abuse are forced to travel for abortions, as have cancer patients who cannot receive care for their illnesses. Many patients are even suicidal, per the Ohio Capital Journal.

Per Business Insider, restoring Roe v. Wade is perhaps possible, but highly unlikely in the current political environment. In the meantime, some states that allow abortions have codified the right to abortion in their state constitutions, including California, Vermont, New York, and Alaska. 

As Paris Hatcher, the executive director for Black Feminist Future, told Oprah Daily, "These times require that we don't just do what is legal. We have to do what is moral and what is just. We can't depend on courts or the government to protect us." 

If you or anyone you know is having suicidal thoughts, please call the National Suicide Prevention Lifeline​ by dialing 988 or by calling 1-800-273-TALK (8255)​.