It’s been almost three years since the overturn of Roe v. Wade (the Dobbs decision) reversed the constitutional right to abortion in the U.S., paving the way for states to self-regulate. Since then, 12 states enacted total bans on abortion, including neighboring state West Virginia.
As Pennsylvania continued to offer abortion with some restrictions, experts braced for a possible total ban in Ohio, and initially said they anticipated an influx in patients traveling to Pennsylvania from other states.
“Right after Dobbs, Ohio shut down entirely,” explained Susan J. Frietsche, executive director of the Women’s Law Project. “We were slammed. Western PA got a lot of Ohio’s patients.”
But in the next year, data showed a reverse trend. According to the Pennsylvania Department of Health’s Abortion Statistics Study, while the total number of abortions in the state increased from 34,838 in 2022 to 35,412 in 2023; abortions performed on out-of-state patients in the same span decreased from 3,311 to 2,962. Patients traveled from Ohio, Delaware, West Virginia, New Jersey, New York, Maryland, and “other territories.”
Additionally, an estimated 5,230 abortion seekers left Pennsylvania in 2023, with the highest number traveling to New Jersey (2,990), according to The Guttmacher Institute’s Monthly Abortion Provision Study.
Low availability
Frietsche said she believes Pennsylvania’s high patient outflow can be explained by two factors: a limited number of providers and facilities, and tight restrictions built into existing laws.
While neighboring states like New Jersey and New York allow for abortion to be performed by all licensed physicians and advanced practice clinicians (including physician assistants, nurse practitioners, and some approved midwives), Pennsylvania requires a “rigorous” state licensing for abortion, which is only available to licensed physicians and excludes advanced practice clinicians.
“You can’t even dispense a pill unless you’re a registered abortion provider in the state,” Frietsche said, “and the laws make it very, very hard to be an abortion provider.”
Similar disparities apply to facilities providing abortion. According to AbortionFinder.org, Pennsylvania has a total of 30 verified abortion providers– 21 in-person and nine virtual.
Frietsche said abortion seekers in Pennsylvania often get put on a waitlist due to low availability of appointments. Licensed facilities are mostly located in highly-populated areas like Philadelphia, Pittsburgh, Harrisburg, York, Lancaster, and the Lehigh Valley.
“For the vast, rural areas, there’s no provider at all.”
She believes out-of-state patients taking a portion of the already limited appointments available could be a contributor to the high volume leaving the state.
Legacy of limitation
Pennsylvania’s Abortion Control Act, established in 1982, sets legal protection for abortion with restrictions including spousal consent, parental consent for minors, and counseling followed by a 24-hour waiting period.
“We’re thought of as an abortion access state,” Frietsche said. “And I suppose we are because it’s still legal here. But our laws make it very hard.”
Planned Parenthood Keystone performed 88 abortion-related visits for out of state patients in the past six months – a combination of in-person and telehealth. That number is down from 195 in the same time frame two years ago, said President and CEO Melissa Reed.
Reed said her organization sees patients choosing neighboring states with fewer barriers like New Jersey, New York, and Maryland.
READ: Expanding Abortion Access Strengthens Democracy, While Abortion Bans Signal Broader Repression
“They don’t have a mandatory delay,” Reed said. “They don’t have lab testing.”
Current PA law requires all abortion seekers to receive state-directed counseling for family planning. They are then required to wait 24 hours before a procedural or medication abortion.
“On paper it looks like it’s only 24 hours,” Frietsche said. “But in reality it can be much longer [due to availability of appointments].”
“Pregnancy care is extremely time sensitive,” Frietsche continued. “Delaying pregnancy care at any stage is extremely harmful. The state should not be imposing additional delays on a time sensitive procedure.”
Pennsylvania’s battleground
In recent years, groups and lawmakers throughout PA have pushed for updates to the restrictions set by the Abortion Control Act.
Representative Kristine Howard (D-167), sponsor of House Bill 26, also referred to as the “Reproductive Freedom Act,” has expressed her goal for this legislative session to amend large portions of the act. She stated in her December 2024 memo:
“[Since the Abortion Control Act] Pennsylvania’s innovation sadly became the standard for restricting access to abortion throughout the country, and far too many states followed our lead. By making abortion expensive, inconvenient, and stigmatized…
Even here in Pennsylvania, touted as a haven, we only have 20 operational clinics in a state of nearly 13 million people, the result of an unfairly burdensome and discriminatory legal regime designed to restrict women’s free exercise to their rights.”
As the House of Representatives prepares for debate, the Commonwealth Court in Pittsburgh is currently reviewing a case that challenges the prohibition of state Medicaid funding for abortion care. Arguments began Feb. 5 for Allegheny Reproductive Health Center v. Pennsylvania Department of Human Services.
READ: Battle over Pennsylvania’s Medicaid Abortion Restrictions Returns to Court
Since 1985 the precedent has been that Medicaid funding secured by Pennsylvania’s Equal Rights Amendment does not apply to abortion. In January 2024 the PA Supreme Court determined that the restriction for abortion could be challenged as sex discrimination, determined it would be “presumably unconstitutional,” and remanded it back to the lower court.
Legal considerations
Frietsche said as Pennsylvania’s reproductive health battle unfolds, the Women’s Law Project is working hard to stay on top of legal considerations for both providers and patients.
“We’re in a time when there are a lot of legal threats, and the laws are in flux,” Frietsche said. “Unfortunately, we no longer have the back stop of a federal constitutional right to abortion protection.”
Frietsche said in recent years, states with abortion bans have “threatened to come after” providers who perform abortions for out-of-state patients. She noted a recent case in which a New York doctor was indicted by a grand jury in Louisiana for allegedly mailing an abortion pill to a patient there. Louisiana, which has a near-total ban, called for the doctor to be extradited.
New York has a shield law in place, while Pennsylvania does not, though it has a “shield executive order.” The executive order, issued by the former governor Wolf, prohibits any member of Pennsylvania’s executive branch from cooperating with other states’ criminal investigations of abortion providers.
“It’s wonderful that we have protection there, but it only applies to executive branch personnel,” Frietsche said. “We probably should have a state shield law. It may be extra important now that we’ve finally seen the first attempt at prosecution [in New York].”
“Generally, states respect each other’s laws,” she continued. “Generally, states stay within their own boundaries. But this is creating an atmosphere of anxiety for abortion providers, abortion funds, and practical support networks.”
Preparing for the future
As the states continue to debate, Reed said her organization is also preparing for challenges it may face at the national level.
“The fall of Roe has placed a serious burden on patients seeking abortion care,” she said. “Certainly, we expect a lot of devastating setbacks from the Trump administration.”
One concern Reed noted is that Planned Parenthood Keystone and similar organizations could lose access to federal Title X funding for contraception, cancer screenings, and other services “because we provide the option for abortion as part of our family planning [counseling].”
She also noted concern that the administration could block access to mifepristone, an abortion medication that “has been provided safely to tens of thousands of women” since it was approved by the FDA in September 2000.
READ: Amnesty International: Abortion Bans and Restrictions Cause Extensive Harm, Violate Human Rights
Echoing Reed’s concern, Frietsche said from a legal perspective she is closely monitoring the Trump administration’s recent pardons of alleged violators of the Freedom of Access to Clinic Entrances (FACE) Act, and dropping ongoing related cases within the Department of Justice. The FACE Act, established in 1994, prevents protestors from using force, or the threat of force, to block access to abortion care facilities.
“One thing I am very chilled by is the pardoning of people who have committed crimes against abortion providers,” Frietsche said.
While the environment appears uncertain, she wants people to know there is “a lot of fight in this movement.”
“We are not backing down,” she said. “We think the ability to make autonomous reproductive decisions is really at the heart of liberty, and this is not a right we’re going to give up.”
Reed said she wants pregnant people in Pennsylvania and other states to know that abortion is “available and accessible” here, and that funds are available to assist with medical and travel costs.
Patients can apply for assistance through Planned Parenthood Keystone’s “Fund for Choice” during an in person or virtual visit.
Assistance is also available through the National Abortion Hotline: 800-772-9100; and the Repro Legal Helpline: 844-868-2812.
