Hannah Schoenbaum/AP Photo
North Carolina state Rep. Tricia Cotham announces she is switching her affiliation to the Republican Party, at a news conference on April 5, 2023, at the North Carolina Republican Party headquarters in Raleigh.
RALEIGH, NORTH CAROLINA – Earlier this month, North Carolina state Rep. Tricia Cotham, a longtime Democrat, announced she was switching to the GOP. Cotham’s decision gives Republicans a legislative supermajority in a state that is often split between the agendas of the two parties. But with that supermajority, Republicans can override vetoes from Democratic Gov. Roy Cooper. One of the first things Republicans have proposed to do with that power is to radically tighten the state’s abortion laws.
In a post-Roe nation, this seemingly local news has the potential to affect a significant swath of the country’s health care system, because North Carolina is one of the few states left in the southern United States where an abortion can be obtained.
Liberals and pro-choice activists warned that the end of Roe’s protections would cause chaos. Eight months later, that chaos is in full swing, and multitudes of women are suffering for it. A report by the Society of Family Planning (SFP), WeCount, calculates that approximately 77,000 abortions have been performed in the country per month after Dobbs, compared to more than 82,000 that were performed every month leading up to the decision. According to WeCount, in the six months following Dobbs, over 43,000 people were unable to obtain abortion care in states that had bans. This pain is clustered in the South, where the Dobbs decision opened the door for severe abortion restrictions nearly everywhere.
Even for the states that managed to secure some modicum of reproductive sanctity, the effect of no longer having a protected right to abortion can be seen across their counties. But they have managed to provide reproductive services. North Carolina, for example, has a 20-week restriction for the procedure, the most generous allowance in the South. According to WeCount, in the six months after the Dobbs decision, there was an increase of nearly 5,000 abortions in the state. Florida, which had a 15-week restriction up until just a week ago, saw over 7,000 abortions performed in that same time.
North Carolina has become something of a safe haven for abortion-seekers in the South, with the least restrictive laws outside of South Carolina and Virginia. SFP’s WeCount report from October calculated a 37 percent increase in abortions in the state from April to August 2022. Months later, the situation has gotten more tense, with clinics stretched to capacity across the state.
But Cotham’s party switch means all of that could change, leading abortion-seekers with few options in this region of the country.
North Carolina has 14 abortion clinics, which are concentrated in metropolitan areas such as Raleigh, Charlotte, and Asheville. Among these clinics, appointments are nearly full, and wait times are increasing. Amber Gavin, vice president of advocacy at A Women’s Choice, Inc., an abortion clinic in the state, estimates that 15 percent of clinic traffic in 2022 came from out-of-state patients—and they have expected that number to increase this year.
Molly Rivera, spokesperson for Planned Parenthood South Atlantic, which encompasses North Carolina, told the Prospect that the Asheville clinic is now seeing a majority of out-of-state patients, and that the number of out-of-state patients has generally increased from 15 percent to over a third of clinic traffic across the covered region. These patients are coming from Georgia, Tennessee, Mississippi, sometimes Florida, and even Texas.
North Carolina has become something of a safe haven for abortion-seekers in the South, with the least restrictive laws outside of South Carolina and Virginia.
This month, Florida Gov. Ron DeSantis signed a six-week restriction into law in Florida. While this restriction is currently on hold, if it does go into effect, traffic to North Carolina clinics is likely to increase, unless changes in the law result from the Republican legislative supermajority.
“There’s a definite possibility that we’ll see more patients from Florida,” Calla Hales, executive director for A Preferred Women’s Health Center, said. But that would stretch an already strapped network of service providers to the limit. “I don’t think it’s possible for the state of North Carolina to expand access to abortion care any more than it already has,” Hales said.
“If [Florida’s six-week ban] is allowed to go into effect, we do expect people will have to travel as far away as North Carolina and maybe even further north to get an abortion,” Rivera told the Prospect. “This is really creating a crisis in this region.”
With Rep. Cotham’s party switch, the situation has the potential to become even more tenuous. As The New York Times and others have reported, the North Carolina GOP has been attempting to implement more severe abortion restrictions for years. Their efforts were only staved off by Gov. Cooper’s promise to veto any such legislation. Without that power, a more severe restriction could be passed, and the governor—not to mention the public, a majority of whom support abortion rights in North Carolina—would be powerless to stop it.
Rivera points out that the GOP supermajority is nothing new, nor is the party’s agenda against reproductive choice. “[In] every single legislative session under the current leadership, they have tried to restrict abortion even further than it already is,” Rivera said. “This legislature has been extremely hostile to reproductive health care, women’s hospitals, and to abortion rights for more than a decade. That has not changed.”
What has changed is that the legal system can no longer be counted on to stop these bans. It might do so, but without Roe protecting the general right to an abortion, it also may not. And as these decisions get kicked around legislatures and judicial chambers, patients and providers are suffering.
“Our providers are really frustrated,” Gavin said. “When politicians and courts start interfering with health care decisions, it’s really alarming.” Patients are frustrated as well, but there’s an added layer of pressure, fear, and confusion. A University of California, San Francisco study from January of this year found shame and distress are also prominent emotions for abortion-seekers forced to travel. Often, a financial burden is included as well.
And the strain on the system cannot be understated. “This is one of the biggest crunches and crushes for care that I’ve truly ever seen,” Hales said.
