In June 2022, the U.S. Supreme Court reversed Roe v. Wade, returning jurisdiction over the regulation of abortion to the states. A U-M team assessed the driving distance between each Michigan county and the closest abortion clinic if abortion remains legal and in the potential scenario of an abortion ban being enacted in Michigan.
Potential Impact of an Abortion Ban in Michigan on Driving Distance for Services
On June 24, 2022, the United States Supreme Court reversed the landmark Roe v. Wade ruling that legalized abortion nationwide. As a result, jurisdiction over the regulation of abortion has been returned to the states. About half of states are expected to enact bans or place gestational age limits on the procedure.1
As of October 2022, abortion is legal in Michigan, pending legal review of a 1931 abortion ban that would criminalize abortion at any gestational age and criminalize clinicians providing abortion care.2–3 If the ban is ultimately enforced, Michigan residents trying to access abortion care face options that primarily include traveling to another state, seeking a medication abortion via telehealth, or continuing their pregnancy. In the surrounding region, abortion is legal in Illinois, Minnesota, Pennsylvania, and Canada, and access has been restricted or banned in Indiana, Ohio, and Wisconsin.4
Prior studies of restrictive abortion policies in other states have shown that increases in travel distance to abortion care are associated with decreased abortion rates, increased costs, delays in care, and added mental health burden.5–6
For this analysis, a team at the University of Michigan assessed the minimum distance that Michigan residents would travel for out-of-state care if the 1931 abortion ban were upheld.
28,409 MI residents
had an abortion in the state in 20217
23 clinics
currently provide abortion care in Michigan8
Michigan residents seeking abortion services within the state currently travel an average of
55 miles for care
Takeaways from our research
The research team analyzed the driving distance between the geographic center of each Michigan county and the closest abortion clinic 1) in-state, in the current scenario when abortion is legal in Michigan, and 2) out-of-state in Illinois, Minnesota, or Pennsylvania, if abortion becomes illegal in Michigan.
Average driving distance if abortion is legal in Michigan, compared to the distance if abortion becomes illegal:
- If abortion is legal: 55 miles (range: 2–141 miles) to the closest in-state abortion clinic
- If abortion is illegal: 271 miles (range: 93–426 miles) to the closest out-of-state abortion clinic in Illinois, Minnesota, or Pennsylvania*
In 2021, 4 out of 5 Michigan residents who received abortion care lived in counties that were less than 15 miles from an abortion clinic. If abortion becomes illegal in Michigan, residents in those counties seeking abortion care would then drive between 147–330 miles to access this service out-of-state.
If an abortion ban is upheld, an estimated 87% of Michigan residents seeking abortion care would live more than 200 miles from an out-of-state abortion clinic that can provide care.**
* Abortion is legal in Canada. Assuming U.S. citizens are able to receive care in Ontario, Canada, the new average driving distance would be 221 miles (range: 87-368 miles). However, Canada was excluded from the main analysis because there are additional barriers to care such as arranging and paying for care in another country, needing a passport or an Enhanced Driver’s License, and completing the border patrol interview.
** Estimates based on county of residence among Michigan residents who had an abortion in 20217
What does this mean for health policy discussions?
If abortion becomes illegal in Michigan, residents seeking abortion care out-of-state will travel much farther than today to access services, increasing from an average driving distance of 55 miles in-state to an average of 271 miles out-of-state. A round trip that currently takes 2 hours could take nearly 7 hours to access services out-of-state.
Michigan residents seeking abortion care out-of-state will also incur additional travel-related expenses such as the cost of transportation (gas, parking, a taxi or a rental car, or bus, plane, or train fare), lodging, meals, childcare, and missed work. Many people may also need a travel companion for support, which will increase costs as well.
These added costs may exacerbate existing disparities in health care access, especially for people with a lower socioeconomic status. An abortion itself can cost an average of $500 to $900 or more.9 The Federal Reserve Board estimates that one-third of adults did not have enough in their savings accounts to pay for a $400 emergency expense in 2021, meaning that for many individuals, the costs of care and travel could be prohibitively expensive.10
If seeking abortion care out-of-state is prohibitively expensive, some people may decide to forgo an abortion and continue with their pregnancy instead. Prior research has shown this can lead to long-term financial impacts, as there are large and persistent negative effects on a childbearing person’s emotional and financial well-being when they want to access abortion care but are not able to.11–12 There is also a direct relationship between abortion access and an increase in women’s participation in the workforce.13
Finally, states where abortion remains legal will likely see an influx of out-of-state patients, potentially placing a strain on their abortion clinics and increasing appointment wait times for all patients. Depending on the increase in wait times, some patients may not be able to access medication abortion (available through the first 10 weeks of pregnancy) and would need surgical abortion care. As the logistics of accessing the procedure become more complex, people may reach care later in their pregnancies, which in turn will increase the cost and complexity of an abortion.
REFERENCES
1. 26 States Are Certain or Likely to Ban Abortion Without Roe: Here’s Which Ones and Why. Nash E. Guttmacher Institute. Accessed July 8, 2022. https://www.guttmacher.org/article/2021/10/26-states-are-certain-or-likely-ban-abortion-without-roe-heres-which-ones-and-why.
2. Whitmer Statement on Ruling in Dobbs v Jackson. Michigan Gov. Accessed July 8, 2022. https://www.michigan.gov/whitmer/news/press-releases/2022/06/24/whitmer-statement-on-ruling-in-dobbs-v-jackson.
3. Michigan’s Abortion Ban Is Blocked For Now. Press TA. National Public Radio. Accessed August 19, 2022. https://www.npr.org/2022/08/19/1118441960/michigan-abortion-ban-blocked-judge.
4. Interactive Map: US Abortion Policies and Access After Roe. Guttmacher Institute. Accessed July 8, 2022. https://states.guttmacher.org/policies/.
5. Association Between Distance to an Abortion Facility and Abortion or Pregnancy Outcome Among a Prospective Cohort of People Seeking Abortion Online. Pleasants EA, Cartwright AF, Upadhyay UD. JAMA Network Open. 2022;5(5):e2212065. doi:10.1001/jamanetworkopen.2022.12065.
6. How Far Is Too Far? New Evidence on Abortion Clinic Closures, Access, and Abortions. Lindo JM, Knowles Myers C, Schlosser A, et al. Journal of Human Resources, University of Wisconsin Press. 2020;55(4):1137-1160. doi:10.3386/w23366.
7. Characteristics of Michigan Abortions. 2021. Accessed July 8, 2022. https://vitalstats.michigan.gov/osr/abortion/Tab_B.asp.
8. Abortion In Michigan: Verified Abortion Providers Serving Michigan. Abortion Finder. Accessed August 15, 2022. https://www.abortionfinder.org/abortion-guides-by-state/abortion-in-michigan/providers.
9. Trends In Self-Pay Charges and Insurance Acceptance For Abortion In The United States, 2017–20: Study examines trends in self-pay charges for abortion in the United States, 2017-20. Upadhyay UD, Ahlbach C, Kaller S, et al. Health Affairs. 2022;41(4):507–515. doi:10.1377/hlthaff.2021.01528.
10. Economic Well-Being of US Households: Dealing with Unexpected Expenses. Board of Governors of the Federal Reserve System. Accessed October 3, 2022. https://www.federalreserve.gov/publications/2022-economic-well-being-of-us-households-in-2021-dealing-with-unexpected-expenses.htm.
11. The Economic Consequences of Being Denied an Abortion (NBER Working Paper No. 26662). Miller S, Wherry LR, Foster DG. National Bureau of Economic Research. 2020. http://www.nber.org/papers/w26662.
12. What Happens after an Abortion Denial? A Review of Results from the Turnaway Study. Miller S, Wherry LR, Foster DG. AEA Papers & Proceedings. 2020;110:226–230. doi:10.1257/pandp.20201107.
13. The Economic Effects of Abortion Access: A Review of the Evidence. Bernstein A, Jones K. Institute for Women’s Policy Research. 2019. https://iwpr.org/iwpr-issues/reproductive-health/the-economic-effects-of-abortion-access-a-review-of-the-evidence/.
CONTRIBUTORS
Lauren Owens, MD, MPH1; Vanessa Dalton, MD, MPH2,3; Sarah Compton, PhD, MPH3,4; Lauren Oshman, MD, MPH2,3; Rieham Owda, MD2; Faelan Jacobson-Davies, MS2; Jennie Scheerer, MPH, MPP Candidate5,6
Affiliations: 1 Obstetrics and Gynecology, Medical School, University of Washington; 2 Obstetrics and Gynecology, Medical School, University of Michigan; 3 Institute for Healthcare Policy and Innovation, University of Michigan; 4 Family Medicine, Medical School, University of Michigan; 5 Gerald R. Ford School of Public Policy, University of Michigan; 6 School of Public Health, University of Michigan.
ACKNOWLEDGMENTS
This policy brief was supported by the IHPI Policy Sprint program, which provides funding and staff assistance to IHPI member-led teams in undertaking rapid analyses to address important health policy questions and develop products that inform decision-making at the local, state, or national level.
FOR MORE INFORMATION
Please contact Eileen Kostanecki, IHPI’s Director of Policy Engagement & External Relations, at ekostan@umich.edu.