One year after the US Supreme Court overturned Roe v. Wade, the number of out-of-state patients seeking abortions in Michigan has tripled, according to Planned Parenthood of Michigan (PPMI.)
The state became a destination for abortion patients in the wake of the Dobbs v. Jackson decision last June, with people from other states now making up an average of 10-15% of PPMI abortions each week. (The Michigan Department of Health and Human Services has only published data through 2022, when 27,359 Michigan residents received an abortion, and 30,120 abortions occurred in the state overall. That’s “a less than 1% increase in abortions performed in the state last year,” an MDHHS spokesperson says, but it doesn’t include the past six months of 2023.) That’s nearly 2,000 out-of-state abortion patients in the past year, according to a PPMI spokesperson.
"People in states where abortion care has been banned wake up and wonder, am I going to have to carry forward a pregnancy that I do not want at this time?” said Paula Thornton Greear, Planned Parenthood of Michigan’s President and CEO. “Am I going to have to seek an illegal alternative? And how am I going to get to a haven state like Michigan to get the care that I need?"
Abortion rights in Michigan were initially thrown into question last spring, when a draft version of the Dobbs decision leaked. That triggered multiple lawsuits over whether the state’s 1931 abortion ban could be enforced, resulting in a series of sometimes conflicting court rulings that created confusion and concern among abortion providers and patients.
Then, in November, Michigan voters overwhelmingly passed Proposition 3, a ballot measure that enshrined abortion rights in the state constitution. The measure secured abortion access in Michigan for both residents and patients from other states, and led to an overall uptick in the number of abortions performed.
But while abortions increased in states like Michigan, the nation saw a cumulative 25,000 fewer abortions in the nine months since the court’s decision, according to a report from #WeCount, a research group that’s part of the Society of Family Planning.
That means the year overall has been a victory for anti-abortion advocates, said Genevieve Marnon, the legislative director for Right to Life of Michigan.
“So we need to stop and celebrate and be grateful for the fact that the Dobbs decision happened, and that over 25,000 lives have been saved,” Marnon said. “That being said, Michigan is obviously not one of the states that are extending legal protection to the unborn child. And we are looking at ways in which we can reach out to women in need, and remind them that while it may be a choice in Michigan, we hope that we can help you make the choice for life.”
More abortion patients using virtual appointments
About 10% of abortion appointments done with PPMI are now through the organization’s “virtual health center,” which allows patients to meet with a provider online and receive medication abortion pills through the mail.
The mailing address must be in Michigan, and patients have to attest that they are physically in Michigan during the virtual appointment, Thornton Greear said. “We wanted to ensure that we are continuing to address health care disparities faced by people in medically under-served communities, people that have limited access to transportation, and limited access to trusted providers.”
The virtual appointment options do appeal to out-of-state patients, she said. “It does allow flexibility for out-of-state patients to travel to Michigan, to a community that's convenient for them. So where you may have family or friends, for example.”
The ability to mail one of the abortion pills, mifepristone, was thrown into doubt earlier this year. In April, a federal judge in Texas issued an order completely revoking the FDA’s authorization of mifepristone. That order was partially blocked by the Fifth Circuit Court of Appeals, which said it would allow some restrictions on the drug, including not allowing it to be sent by mail. But the Supreme Court intervened, at least temporarily restoring full access to mifepristone while the case continues to play out in court.
Future battles on abortion access in Michigan
Despite the passage of Proposition 3, the state still allows certain restrictions on abortion, including a mandatory 24-hour waiting period. Minors are also required to get a parent’s consent before obtaining an abortion, or obtain a court waiver known as a “judicial bypass.”
Abortion advocates argue those restrictions are unfairly burdensome, and puts teens at the mercy of a judge’s discretion, citing cases like the one in Florida last summer where a judge denied a teenager’s request on the basis that she was not “sufficiently mature to decide whether to terminate her pregnancy.”
According to the Guttmacher Institute, private insurance companies in Michigan cover abortion (which can cost hundreds to thousands of dollars) “only in cases of life endangerment, unless individuals purchase an optional rider at an additional cost.” The state also requires abortion clinics to “meet unnecessary and burdensome standards related to their physical plant, equipment and staffing,” also known as TRAP laws.
These restrictions “really limits the access to procedural care,” Thornton Greear said, and are the future of the fight over abortion in Michigan in the coming year.
“During this second year, we all need to not only continue to stand up, but continue to move forward in this renewed fight for reproductive freedom. Michigan is very fortunate. Prop 3 was fantastic. But often, as we said that Roe was the floor and not the ceiling; Prop three is a wonderfully shiny, fantastic, necessary foundation that we must build upon.”
But Marnon says abortion opponents will use these same issues to rally supporters, especially surrounding the issue of parental consent, with an eye to the 2024 elections.
“Leading up to the passage of Proposal 3, the idea that parental rights were on the chopping block was something that we were banging the drum on. And we were told over and over and over…that don't you worry, that Prop 3 is only going to restore the Roe protections,” Marnon said. "We've had parental consent laws under Roe for 30 some years, and that was always constitutional and lawful under Roe. So we know the hypocrisy there, that ‘No no no, don't you worry, parental rights are going to remain uneroded.’ We are now seeing a call to exactly that, to take away parental rights with regard to a minor's abortion decision. So, yeah, we will be mounting a fight on that.”