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Abortion was increasingly limited in the South even before the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, a case stemming from a Mississippi abortion ban.

June’s ruling ending a federal right to an abortion meant total or near-total bans went into effect in many states, with a specific concentration in the South. Now access is on the verge of tightening further in at least one of the few Southern states where it has been available: Lawmakers in Florida on Thursday passed a bill, signed by Republican Gov. Ron DeSantis that night, banning most abortions after six weeks. It is likely to take effect later this year. Republicans may push for more restrictions in North Carolina and South Carolina, where the procedure is legal for now. And a recent ruling on abortion pills jeopardizes access in all states. 

Jenny Black, CEO of Planned Parenthood South Atlantic, counts her ability to provide abortions not in months or weeks, but in days. 

“We have a live dashboard on a daily basis that we look out to see, ‘Where’s the soonest available appointment?’ she said. “And if we’re booked out too far, we try to add appointments sooner. It’s just a very complex algorithm to navigate.”

The states in her region, which include North Carolina, South Carolina and Virginia, have seen an influx of patients coming from nearby states that banned abortion after the Supreme Court overturned Roe v. Wade. The region’s limited infrastructure of clinics is already strained and overextended, a problem exacerbated by a shortage of providers. 

“We’re out here fighting for our patients and for our ability to meet their needs,” she said of South Carolina specifically. “But the reality is, we’re counting success in terms of days.”

Florida passes six-week ban

Florida’s six-week ban would end its long-standing status as an abortion haven and strike a “devastating” blow to the Deep South especially, said Michelle Colon, executive director of SHERo Mississippi, a Black women-led reproductive justice organization. Clinics in Florida, she noted, continued providing abortions after fatal shootings targeting doctors at two Pensacola clinics in the early 1990s and years of mounting restrictions imposed by Republican lawmakers.   

“Florida is to the abortion rights movement what Mississippi and Alabama are to the civil rights movement. We owe so much to Florida,” Colon said. “Florida could have shut down years ago, but they haven’t.” 

Florida’s numerous clinics, particularly those in the northern part of the state, have made the state a critical access point for abortion care for the rest of the South. State health data shows that 82,291 people got abortions in Florida in 2022, an increase of 2,375 abortions over 2021. And over 6,500 patients in 2022 traveled to Florida from another state, a 38 percent increase over 2021. 

The bill will go into effect if and when the Florida Supreme Court, now dominated by conservative appointees, upholds the legality of a 15-week abortion ban the legislature enacted last year, a decision expected sometime this summer. 

Other parts of the legislation will go into effect immediately, including a ban on state-funded organizations supporting out-of-state travel for an abortion and a $25 million allocation of state funds to anti-abortion counseling centers.

The bill also deletes a provision in state law that bars the state’s health agency from levying regulations that would place an undue burden on a woman seeking an abortion. If the six-week ban goes into effect, providers like Planned Parenthood will be largely limited to providing abortions up to six weeks, before many patients even know they’re pregnant. The six-week ban and additional restrictions could make it much harder for smaller independent clinics to stay open. 

“We could see immediate impacts when that goes into effect when it comes to how [the Florida Agency for Health Care Administration] implements this law and regulates abortion providers,” said Annie Filkowski, policy director for the Florida Alliance of Planned Parenthood Affiliates.  

Stephanie Loraine Piñeiro, executive director of the Florida Access Network, an abortion fund, said the organization made the decision to aid only Floridians when the 15-week ban went into effect. She said the organization plans to fully comply with the six-week ban and will shift its focus to helping patients in Florida travel to other states, as Colon and SHERo did when Mississippi banned abortion last summer. 

“We truly believe that anybody who wants an abortion should be able to get one, but the resources are never going to be enough,” Piñeiro said. “We’re battling multiple crises in Florida.”

The Florida bill’s ban on telemedicine and possible nationwide restrictions on obtaining medication abortion through the mail imposed by courts would also cut off access for those with less ability to travel.

Jessica Wannemacher, health center manager for Planned Parenthood’s clinic in Jacksonville, said the clinic will continue to provide abortion care up to six weeks while expanding its patient navigation program and helping nurses get licensed to practice in North Carolina, where abortion is legal. But she acknowledged that sending Florida patients elsewhere will increase the burdens on states that lack a similar infrastructure of clinics and providers. 

“They’re going to be overrun and overfilled,” she said. “There they’re gonna have to take on the tsunami effect that we had to when Roe fell…hopefully they’re preparing for it right now.”

North Carolina GOP has a new supermajority

Since the Dobbs ruling, North Carolina has also taken in patients from other states but has a less robust infrastructure of clinics than Florida’s. Abortion in the state is currently legal up to 20 weeks, but the state’s 72-hour waiting period, counseling and ultrasound requirements, and restrictions on abortion providers present obstacles for patients, Black said. Providers in North Carolina performed an estimated 1,820 more abortions in July and August of 2022, after the Dobbs decision, than the two months prior to the ruling in April and May, according to #WeCount and the Society of Family Planning. 

She’s preparing to increase her existing appointment-monitoring capacity in her region if a six-week ban goes into effect in Florida. But, Black said, some patients will need to travel as far as Maryland, D.C., Virginia and New Jersey for care. 

“And what that means, in reality, is there are going to be very many forced pregnancies in the South because people just can’t overcome those barriers,” she said. “It will be impossible for a lot of people to get the care they need. We’re doing our level best, but the ecosystem is what it is. And the constraints already are very real.”

North Carolina’s politics recently shifted: Republicans also now have a legislative supermajority after a former North Carolina Democrat’s unexpected party switch. That makes it easier for them to override Democratic Gov. Roy Cooper’s veto on future legislation that could affect health care, LGBTQ+ rights and abortion — though it’s unclear what they might pass and whether the party would stick together for an override.  

State Rep. Tricia Cotham joined the Republican Party just months after being elected on a progressive platform to a safely blue Charlotte-area district in November. It stunned political observers and infuriated Democrats in the state, who slammed the move as a betrayal. Cotham attributed her party switch to what she described as bullying and disrespectful treatment from her Democratic colleagues. 

“It’s maddening that we lost this for a seat that should absolutely, by virtue of its makeup, be represented by someone who believes that things that Rep. Cotham said she believed in,” said Christina Reynolds, vice president for communications at Emily’s List, which backs Democratic women candidates who support abortion rights. “It’s devastating to have those things put at risk by someone deciding they’re going to flip parties.”

Cotham has supported abortion rights throughout her political career and ran on the issue in her 2022 campaign. She previously shared her personal abortion story on the House floor in 2015 and, as recently as January, co-sponsored legislation to make abortion a legally protected right in North Carolina. 

North Carolina Republicans haven’t coalesced around a single abortion bill, but the leader of the House Republican Caucus recently said they’ll most likely settle on a 12-week ban. Cotham, flanked by her new GOP colleagues in an April 5 news conference, didn’t say what, if any, future abortion restrictions she would support, saying she would “follow her conscience.”  

“Well, what has really changed? I still am going to stand strong on my convictions, but I’m not going to be pigeonholed into any one particular issue,” Cotham said. “And I made that very clear in our conversations that there are just some things I’m not changing on.”

South Carolina may try again

Abortion remains legal through 22 weeks in South Carolina after the state Supreme Court in January struck down the state’s previous six-week abortion ban, but with a new all-men high court, abortion rights advocates say they are watching for another abortion ban to make its way to the court. 

The state’s two legislative chambers remain at a stalemate over proposed abortion bans. Republicans in the state Senate approved another six-week ban with exceptions up to 12 weeks for rape, incest, fatal fetal anomaly and significant harm to the health of the pregnant patient. House Republicans, meanwhile, cleared a total ban on abortions that includes exceptions for only rape, incest and imminent death of the pregnant patient up to 12 weeks. 

“We’ve got two dueling bills. There are 15 legislative days left in this session,” Vicki Ringer, the director of public affairs for Planned Parenthood South Atlantic in South Carolina, said Monday. Ringer said no hearings have been scheduled on the conflicting proposals, but if the impasse is resolved, patients in the state would go from “being able to have bodily autonomy to suddenly in some dystopian universe.”

Advocates in South Carolina are also watching a proposal that would protect pregnant people seeking abortions from criminal prosecution, as well as one that would decriminalize self-managed abortions. Last month, a Greenville woman was arrested for allegedly using a pill to terminate a pregnancy in 2021.

“Republican leadership has gone on the record saying they don’t believe in arresting women,” said state Rep. Heather Bauer, a freshman Democrat who introduced the bill in the House but says it’s not seen much engagement so far. She noted that the Senate supported decriminalization as an amendment to its abortion ban.

“I’m going to keep pushing, but Republican leaders have been clear they don’t want to poke the bear — they don’t want to have the abortion debate again.” 

The state only has three clinics in operation, Black noted, and she isn’t “celebrating yet” that the legislature hasn’t passed another ban.  

“Women’s lives are being played with as these legislators go back and forth,” Ringer said. “It’s like we’re a toy that they’re batting between them. It’s very confusing. It’s very disheartening.” 

Shefali Luthra contributed to this report.