On the border: How abortion access could shift at the North and South Carolina line

When Kelly Simpson became pregnant unexpectedly, the choice for her was straightforward.

The Wilmington native had been taking birth control for more than eight years when she got the surprise, and she knew she wasn't ready for a child.

"I thought about it for two seconds," Simpson said. "But for where I was in my life I knew it wasn't the right time."

While the decision was easy for her, the process wasn't.

From facing anti-abortion protesters to managing time off work, even living in North Carolina — comparatively a pro-abortion haven in the South —  the barriers she faced almost made her rethink her decision.

Related: Wilmington abortion rights advocates react to Supreme Court overturning Roe v. Wade

Read this: What does the Supreme Court abortion ruling mean for NC? 3 things you need to know

"I was fortunate to have a lot of support through that whole time," she said.

Now what was already a difficult process is becoming nearly impossible for people seeking reproductive healthcare in the South.

In the wake of the Supreme Court Dobbs v. Jackson Women’s Health Organization decision, overturning Roe v. Wade and leaving abortion access decided at the state level, pro-abortion organizations and healthcare providers have been preparing for a wave of abortion restrictions and bans to be enacted across most southern states.

And in places like North Carolina, where abortion access has the best chance to survive, pro-abortion advocates are expecting an incoming surge in need from residents from South Carolina — where an abortion ban recently came into effect after six weeks — among other neighboring states.

Some health clinics are already feeling the demand.

'More desperate than ever'

In the hours after the decision was announced, health centers across the South were inundated with calls. Planned Parenthood South Atlantic President and CEO Jenny Black said call volume has since doubled throughout the organization, which operates in North Carolina, South Carolina, West Virginia and western Virginia.

“People are scared and worried and more desperate than ever,” Black said.

For years, abortion rights organizations across the South have been fighting back against abortion restrictions and preparing for the possibility of statewide bans.

Black said before the draft Supreme Court decision was leaked, pro-choice advocates throughout the region had been working to create a shared ecosystem, working with abortion funds, patient support networks and other abortion clinics to center patient needs.

“We have folks who are able to get on the phone with patients and figure out how to navigate all of these complicated logistics,” she said.

The staff are able to see which clinic, even outside the Planned Parenthood network, is the closest provider with the soonest available appointments. By working with abortion funds and support networks, they’re then able to connect patients with resources to make appointments possible.

Health centers have also been expanding staffing, hours and increasing their capacity to see more patients. But abortion rights supporters say the reproductive healthcare system in North Carolina has long been strained, both inundated by demand from more restrictive states and stilted by draconian regulations for clinics and procedures.

The state is already a destination for out-of-state abortion in the South, according to CDC data. In 2019, nearly one-fifth of North Carolina’s 28,000 abortion procedures were provided to out-of-state patients.

Black said before Roe’s overturn, patients were coming from as far as Texas seeking care. With abortion likely to be banned in surrounding states, she expects the trend to become more common, testing North Carolina’s 14 health clinics.

In South Carolina, abortion access has become virtually nonexistent as a six-week abortion ban that was held up in the courts before the Roe decision has now taken effect. Pro-choice advocates say the restriction amounts to an outright ban, outlawing the medical procedure before most people would even know they’re pregnant.

With the ban enacted, people in South Carolina population centers like Greenville, Columbia, and Charleston, which each have one abortion clinic, would have to travel hours away to health centers in Charlotte, Fayetteville or Wilmington.

“You might even be calling from Wilmington but the soonest appointment is in Chapel Hill,” Black said. “Even in North Carolina where it’s still safe and legal, we’re anticipating that patients will have to travel great distances to get the care they need.”

Previous coverage: Grassroots coalition of Wilmington activists protest 'attack on a woman's right to choose'

Roe v. Wade: Supreme Court overturns Roe v. Wade, eliminating constitutional right to abortion

A strained healthcare system

According to the Guttmacher Institute, a reproductive health research organization that tracks abortion access and legislation, 26 states are certain or likely to enact abortion restrictions.

Half of those restrictions would come through trigger laws, which took effect upon Roe's overturn. That includes nearby states like Kentucky, Tennessee and Louisiana, where the closest provider would be hundreds of miles away in North Carolina.

The ruling has been challenged in a handful of states with trigger laws and in places like Utah and Louisiana, they’ve been temporarily blocked from being enacted by the courts but are expected to eventually take effect.

For patients in North Carolina and surrounding states, that’s likely to mean less available appointments, more distance to travel, higher costs and more difficult logistics.

Organizations like the Mountain Area Abortion Doula Collective seek to help patients in the Asheville area navigate these challenges, from funding procedures to finding transportation and giving emotional support.

“We're having to help people wade through not only the stigma and shame, but there's a lot of misinformation too,” said Ash Williams, an abortion doula with the collective.

“Anytime there's a shift, a legal or a policy shift with abortion access, it causes additional fear in the community and we're talking about an issue that's already so stigmatized.”

Williams said in the weeks leading up to the Roe decision, it was a challenge for the collective helping patients through the added confusion and anxiety, on top of the simple logistical obstacles like finding child care or paying for a hotel.

"They're having to coordinate so many different facets of their life," Williams said. "That can be the difference for someone between getting care or not."

Then there are the legal barriers, like a mandatory 72-hour waiting period in which people seeking abortions must have counseling before their procedure, adding on unnecessary time and expenses to the process.

Black said targeted restrictions on abortion providers, or TRAP laws, have intentionally priced out providers from getting their license, having little to do with patient health and safety.

“These are restrictions that apply only to abortion care, which is already one of the safest procedures in medicine,” she said. “Regulations like hallways have to be wide enough to allow two gurneys to pass side by side, even though there’s no scenario in which that would be (necessary).”

With fewer providers able to meet requirements, even with abortions safe and legal in the state, care is still difficult to find. And though the state’s Democratic Gov. Roy Cooper has vetoed anti-abortion legislation in the last two years, abortion access advocates say that can quickly change with the upcoming election.

"In North Carolina, everything depends on the election this fall," said Molly Rivera, communications director for Planned Parenthood South Atlantic. "If anti-abortion legislators regain a supermajority in the General Assembly, then we expect them to pass more restrictions on abortion care if not entirely ban it next year."

Republican General Assembly members are already eyeing a previously struck down 20-week abortion ban that could soon be reinstated.

Grassroots organizations like the abortion doula collective have been gearing up for the overturn of Roe by bolstering their networking and resource-sharing with other collectives and abortion funds, as well as "skilling up" on information that will become in demand like self-managed abortions.

"If it becomes a situation where you won't be able to access abortion in the state of North Carolina, we're going to be ready to help people navigate that," Williams said.

"We believe that this is the time to be ungovernable. This is a time to show up for people in our community and that's what we're going to do."

Reporter John Orona can be reached at 910-343-2327 or jorona@gannett.com.

This article originally appeared on Wilmington StarNews: Abortion access in the Carolinas: What will be the landscape post-Roe?