Every morning, Dr. Nancy Fang and the staff of the Comprehensive Women’s Health Clinic gather to discuss the day ahead.
The staff goes over what procedures they have that day and who the patients will be. But in the last year or so, those conversations have changed.
“We've been talking about where the patient is coming from,” Fang said. “And then other pieces of information that we used to not really focus too much on are how long are they staying in town, when their flight is, or whether they're driving home.”
When Texas passed an abortion law last year, Senate Bill 8, banning all abortions after six weeks — about when fetal cardiac activity can be detected — Colorado saw an uptick in patients from out of state. And when Roe v. Wade was overturned, that number began spiking.
Out-of-state patients arrive in droves
As of September, 2,477 people from out of state have received abortion care in Colorado, according to provisional data from the Colorado Department of Public Health and Environment, which is nearly 1,000 more people than Colorado saw last year. It’s the highest number of out-of-state patients Colorado has seen since in recent years. In 2019, for example, fewer than 1,000 out-of-state patients received abortion care in Colorado.
In fact, with the exception of January, every month of 2022 has seen a double or more increase in the number of out-of-state patients compared with last year. In July, out-of-state patients accounted for about 40 percent of all the abortions performed in Colorado — 425 patients traveled to Colorado for the procedure that month. The data from the state health department, which tracks abortions every year, is through September.
Earlier this year, in anticipation of the Dobbs v. Jackson Women’s Health Organization Supreme Court ruling, the Colorado legislature passed the Reproductive Health Equity Act, protecting the right to a legal abortion and contraceptives.
Since the Dobbs decision that ended the constitutional right to an abortion in the U.S. by overturning Roe v. Wade, abortion is now illegal in 12 states and severely restricted in another 15 states. As expected, patients from states like Texas, Oklahoma and Missouri are traveling to Colorado to access abortion care.
Providers grapple with increased demand
Expected or not, the influx of patients is straining clinics in Colorado, and there’s no end in sight.
Planned Parenthood of the Rocky Mountains alone has seen an 18 percent increase in patients across its clinics in Colorado, New Mexico and Nevada this year compared to last year. Patients traveling from out of state make up 38 percent of PPRM’s patients for abortion care compared to 11 percent prior to Dobbs and Texas’ SB-8.
“That increase obviously is felt at all levels of clinical care from checking in to the actual procedural care or the consultation needed. We have basically fuller schedules, obviously more patients are seen in a day. We have been able to expand some opportunities, expand some services at additional days of service at additional hours to accommodate that,” said Dr. Kristina Tocce, medical director of PPRM. “But it means there are very busy days in our health centers.”
Sharon, the health center manager of the Planned Parenthood in Cortez, a town of fewer than 9,000 people in the southwest corner of the state has experienced first-hand how busy patient scheduling and care has gotten. CPR News is only using her first name. Sharon said she’s fielded calls from people all over the country.
“I personally have scheduled patients from Louisiana, South Carolina, many from Texas,” says Sharon. “And not just Northern Texas, but Corpus Christi, Texas and it's a thousand miles for them to travel.”
To complicate matters even more, the Cortez clinic doesn’t currently offer abortion services. They offer the rest of the services that Planned Parenthood offers — such as contraceptives, patient education and testing and treatment for sexually transmitted diseases.
The closest clinic is in Durango, which offers medication abortion services, and from there it’s Glennwood Springs before residents from that part of the state can access a surgical abortion. If not Glenwood, then patients have to make their way to the Front Range or into New Mexico.
Wait times complicate appointments
PPRM has worked to expand and accommodate the influx, but there are still complications in patient care. The average wait time for a first-trimester abortion is about 22 days, up from 16 pre-Dobbs and 12 before SB-8, according to data from PPRM. For a second-trimester abortion, the wait is even longer: 41 days, which up from 28 pre-Dobbs and 25 pre-SB-8. Even Colorado residents have seen an increase in wait times to 13 days for any appointment, three more days than prior to Dobbs.
“Hundreds and hundreds of calls a day come in for that and sometimes we're not able to get them in in a timely manner and appointments are being pushed out further and further because we're just, we're at capacity,” Sharon said. “We've been making shifts and changes to be able to accommodate, but we can only do so much.”
Longer wait times for an appointment means pregnancies progress. In Denver, Fang said the clinic is seeing more second-trimester abortions than in the past, but many clinics in the state and in places where abortion is still legal have gestational cut-offs, so patients later in pregnancy have even more limited options to access care.
Additionally, multiple days in a clinic for a second-trimester abortion means patients have to take off more time from work and away from the family’s they already have. They have to spend more money on travel, hotels and meals.
“I think some patients are frustrated at having to wait or realizing that if they're traveling from out of state that they may have to be seen for two or three days, because it does take so much resource to do that,” Fang said.
Support services see impact, too
Abortion funds, like Cobalt, have stepped in to help patients with the costs associated with accessing care. Cobalt provides funding for the procedure itself and what they call "practical support," such as plane tickets, lodging, gas cards and child support.
Last year, Cobalt provided $6,000 of practical support. So far this year, they have provided more than $115,000. More than 330 people, traveled to Colorado from Texas this year and received support from Cobalt.
Last year, between January and the end of July, Cobalt provided just over $100,000 to pay for procedures; through July of this year, they’ve paid out double that amount.
‘This is just part of everyday health care’
Providers said for patients who travel, the process can be frustrating and demoralizing. Fang, at the clinic in Denver, said one patients told her she felt like she was doing something wrong because her home state banned abortions.
“It makes me angry because the stigma surrounding abortion is still so high,” Fang said. “There's so much misunderstanding about what abortion care is and what it means to individuals and families.”
Fang is glad she can provide care for people who need it, but she’s frustrated by the state of reproductive healthcare in the country. She testified at the Colorado legislature in support of the Reproductive Healthcare Act.
“I feel like I'm a part of Colorado history and protecting the right to access abortion,” she said. “But on the other side, it feels strange that we have to do that through legislation. This is just part of everyday health care that everyone should have access to.”
Colorado protects the right to an abortion, and providers like Fang and PPRM will continue to do what they can to treat those from states where abortion is legal, but they worry about the people who won’t be able to travel.
“There are going to be people who die because they're not able to access this care,” Fang said.
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