As out-of-state patients pour into Pennsylvania seeking abortion care, the volume of demand is making it difficult to find an open appointment. This has serious implications for Black patients and other marginalized groups.
Getting an abortion was already a complicated process for many people as it can require travel, finding child care and taking off work. Now, the strain out-of-state patients are placing on area providers has created another barrier to care. Physicians, public health experts and advocates agree this will result in Black patients and those from other marginalized groups experiencing the most significant loss of access to abortion.
"We know that particularly Black folks are going to need to travel but do not have the resources to do so," said Kelly Davis, executive director of Pittsburgh-based New Voices for Reproductive Health, which advocates for the health and wellbeing of Black women, girls and gender-expansive people.
Surging demand
Abortion providers in Pittsburgh were already serving the western half of the state. Now that West Virginia and Ohio have all but eliminated access, people are waiting much longer for care at the city's two main providers.
And at Allegheny Reproductive Health Center, "We are now seeing triple the number of clients," said Dr. Sheila Ramgopal
, the health center's chief executive officer.* "About 60% or 70% of people from out of state."
As a result, Ramgopal says it takes health center staff one to three days to return patient calls, and then it might be another two weeks for an available appointment. While most come from neighboring states, Ramgopal said people have traveled to their medical center from as far away as Kentucky, Mississippi and Texas.
The University of Pittsburgh Black maternal health researcher Dara Mendez warns that systemic stressors created by the overturning of Roe will disproportionately harm Black patients, some of whom will carry unwanted pregnancies to term.
"It's damning," said Mendez. "When we talk about the systems that are in place to help support health and wellbeing and when those are broken already, we add this, it only makes it worse."
The pregnancy-related mortality rate for Black Americans is three times that of white Americans. In Allegheny County, a 2016 analysis found that it's 3.7 times as high.
The impacts might even be direr in West Virginia and Ohio. A University of Colorado study found Black maternal mortality rates in states that ban abortion could jump between 18% and 39%.
The American College of Obstetricians and Gynecological says that while abortion is among the safest medical interventions – childbirth is far riskier – the chances of complications increase the more advanced the pregnancy.
Dr. Aasta Mehta, the secretary for the Pennsylvania sector of ACOG, said that's because the further along in a pregnancy, the larger the uterus and the fetus grows, making it more technically difficult to perform.
"The people that do those procedures are specially trained to do so," she said. "So there's less providers that are able to offer those kinds of procedures."
Therefore, terminating a pregnancy as early as possible allows a person to have more providers to choose from and greater access. The longer someone must wait for an appointment, the less likely they will be able to find a doctor to perform the procedure.
"It will certainly disproportionately impact Black and brown birthing people," said Mehta, noting that people of means will always find ways to access abortion, even if it means leaving the country. "It's about safe abortion, safe choice."
Building networks
As a queer- and minority-run organization that serves a large number of patients who are queer and people of color, Ramgopol says Allegheny Reproductive Health Center is acutely aware of the increased disparities caused by the recent abortion ruling.
Therefore, the clinic wants to eventually offer abortions seven days a week and aims to accommodate up to 10,000 patients a year.
Allegheny Reproductive Health is also working with a number of abortion funds that help pay for the costs associated with accessing an abortion.
"Those funds cover the cost of the abortion," said Ramgopal. " They cover travel costs…staying at a hotel in this area. They cover childcare costs…food costs. We give out gas cards with these funds. I mean, it's limitless."
One of the organizations includes a volunteer-run effort that transports people within 100 miles of Pittsburgh, which includes Cleveland, where nearly half the population is Black and just under a third lives in poverty.
Another partner of Allegheny Reproductive Health Center is Kelly Davis at New Voices, which also has an office in Cleveland and is helping people there cross into Pennsylvania for abortion care. She likens this work to that of abolitionist Harriet Tubman, who helped people escape slavery via the underground railroad.
"For hundreds of years, we have been really creating tunnels, literally and figuratively," Davis said, "to get folks from one state to another so that they have more access to liberation."
