Just how far people in the South will have to travel to access abortion care will be defined by legal challenges unfolding in Louisiana and Georgia.
Almost every state in the Southeast bans the procedure or limits it to all but the earliest stages of pregnancy – with laws that were allowed to go into effect with the Supreme Court’s reversal this summer of Roe v. Wade. But abortion rights advocates are fighting in state court for orders blocking those restrictions.
Both Louisiana’s so-called trigger ban – which outlawed the procedure outright, with no exemptions for rape or incest – as well as a Georgia ban for abortions after about six weeks into the pregnancy are currently in force. Providers have asked the Louisiana Supreme Court to reinstate a judge’s order blocking that ban, after an appeals court suspended it and revived the prohibition. A judge in Atlanta, meanwhile, will consider on Monday whether to temporarily halt the enforcement of the six-week ban while the next steps in the legal challenge proceed.
“Georgia – Atlanta, Georgia, specifically – was a hub for abortion access for people across the southeast,” said Jalessah Jackson, the interim executive director of Access Reproductive Care-Southeast, an abortion fund that provides financial support for abortion-seekers in several southern states.
“Georgia was really that space where people could come and have options for where they want to have their abortion,” Jackson told CNN. “And so, with the sort of limited scope that we have right now because of the six-week ban, that has really impacted people’s ability to access care in the entire region.”
The Supreme Court’s ruling cleared the way for states across the South and Midwest to try to enforce six-week bans or outright prohibitions on abortion that were on their books. Dozens of abortion clinics have closed since, with one analysis from July showing that, in the month since the ruling, the number of clinics offering abortion had shrunk from 71 to 28 in the 11 states seeking to implement those extreme restrictions.
The seven states where no clinics remain open – Alabama, Arkansas, Mississippi, Missouri, Oklahoma, South Dakota and Texas – accounted for 80,500 abortions in 2020, according to the analysis, which was done by the reproductive rights think tank the Guttmacher Institute.
In this landscape, abortion seekers will have to travel hundred of miles to obtain the procedure. For many women in the South, particularly if bans in Georgia and Louisiana are enforced, the closest clinic may be in Kansas, Illinois, North Carolina, or elsewhere – potentially across several states’ borders.
Supporters of the restrictions say that courts should follow the US Supreme Court’s lead and let legislatures decide what abortion policy looks like at the state level.
“The careful, thoughtful studied approach as the Georgia legislature took before and during the 2019 session is the way it needs to be addressed,” said Republican state Rep. Ed Setzler, a sponsor of the 2019 Georgia law, which prohibits abortion after fetal cardiac activity is detected.
“We recognize life begins at conception but we balanced that with these difficult circumstances and to land where there’s a protection of a child that has a beating heart, that seems to be reasonable sound middle ground,” he said.
The “significant role” Georgia and Louisiana have played
Even before Roe fell – allowing abortion bans in Mississippi, Alabama, Arkansas and elsewhere in the South to take effect – abortion seekers were traveling to Louisiana and Georgia to obtain the procedure, in part because of the other ways states were able to complicate access, even with Roe on the books.
Georgia in particular had clinic infrastructure more expansive than what’s usual in the South; right now, 11 abortion providers are open in the state, according to the National Abortion Federation. Atlanta being an airline hub also makes Georgia clinics accessible for those with the resources to fly to obtain the procedure.
Isaac Maddow-Zimet, a senior research associate with the Guttmacher Institute, which favors abortion rights, said he expects to see “huge increases” in people traveling to seeking abortions in the wake of the US Supreme Court’s decision in the recent case, called Dobbs v. Jackson Women’s Health Organization.
“Many of the states to which patients have historically traveled to obtain abortions have now restricted or eliminated access entirely, which means people seeking care have to travel even farther to obtain it,” he said.
With a Democratic governor, North Carolina does not have extreme limits like a six week or outright ban” on the procedure at the moment, while in Florida, a 15-week ban is in force while a legal challenge to it continues.
After the Dobbs decision came down, Georgia’s six-week abortion ban remained on hold for several weeks due to a pre-Dobbs federal court order. Travel from out-of-state patients spiked, according to Kwajelyn Jackson, executive director at the Atlanta-based Feminist Women’s Health Center, who told CNN that just from one clinic in Alabama, nearly 100 abortion patients were referred to Georgia providers in the days immediately after the Dobbs decision.
Even after the six-week ban was allowed to take effect on July 20, traffic from out-of-state patients has continued, she said, in part because early-pregnancy abortions are allowed under it and in part because Georgia’s law has a rape exemption not present in Alabama’s outright ban, nor in the six-week bans in Kentucky and Tennessee.
“When the six-week ban was allowed to go into effect, it certainly has changed how significant a role we can play in the southeast supporting care for neighboring states, but it has not completely eliminated that need,” said Jackson of the Feminist Women’s Health Center.
A Texas six-week ban that was allowed to go into effect last September was a preview of the role Louisiana will play for access if its ban is blocked by courts there. At the Hope Medical Group for Women clinic in Shreveport, Louisiana, Texas patients made up nearly two-thirds of the clinic’s patients compared to just 18% of patients before the Texas law was in effect.
“Louisiana had been this kind of stalwart, it had been providing care to people in the entire region,” said Jenny Ma, a senior staff attorney at the Center for Reproductive Rights, who is involved in the challenge to the Louisiana trigger ban.
Louisiana and Georgia “were incredibly important, and continue to be really important,” she told CNN, “and that’s why these lawsuits are so pivotal as they continue to try to preserve access for as long as possible.”
Racial disparities for maternal health
The lawsuits challenging Louisiana and Georgia’s abortion laws cite those states’ constitutions for why those laws should be struck down.
In Georgia, the challengers are leaning on the state constitution’s privacy and liberty protections, which ACLU attorney Julie Kaye says have long been interpreted as more expansive than the US Constitution’s.
“For over a century the Georgia Supreme Court has strictly protected an individual’s right to be free from political interference into their private decisions about their body, health and life,” said Kaye, who is involved in the challenge of the Georgia law.
A spokesperson for Georgia Attorney General Chris Carr, who is defending the law in court, declined CNN’s request for an interview. A spokesperson for Louisiana Attorney General Jeff Landry did not respond to CNN’s inquiries.
Louisiana Right to Life spokesperson Sarah Zagorski told CNN that the anti-abortion group “highly” doubts plaintiffs would be successful in their lawsuit. But if the trigger laws are blocked, Zagorski said it’s likely that Louisiana Right to Life would work with the state legislature again “to tighten our laws.”
The complaints filed against Louisiana and Georgia’s laws both highlight the maternal health risks of forced pregnant – risks that are exacerbated by socioeconomic disparities in the South and risks that are disproportionately faced by Black women.
“Louisiana ranks second to last, or 48th among states when it comes to the health of women and children,” says an affidavit filed by Dr. Janifer Tropez-Martin. She noted the state’s maternal mortality was increasing at a rate that exceeds the national average while pointing to a study showing that it had increased 28% since 2016.
The affidavit adds that “Black individuals are 3.3 times more likely to experience maternal death than white individuals.”
According to the Georgia complaint, “the pregnancy-related mortality ratio was 2.3 times higher for Black Georgians than it was for non-Hispanic white Georgians.”
Asked about Louisiana’s high maternal mortality rate, Zagorski, of Louisiana Right to Life, said that it was “a tragedy that Louisiana has a high mortality rate among pregnant women, but legal abortion does not improve those rates.”
Across the South, most states have declined to expand Medicaid under the Affordable Care Act, but several states, including Louisiana and Georgia, have temporarily allowed or are planning to allow low-income women to remain enrolled in Medicaid for up to 12 months after childbirth.
“Hopefully as time goes on, culture will change and the question will be how do we reach maternal patients better, how do we support them better, before and after they have their baby,” Zagorski said.
CORRECTION: This story has been updated to correctly describe how one study characterized Louisiana’s maternal mortality rate.