JACKSONVILLE, Florida — Anna’s period was only three days late when she took a pregnancy test just over a week ago. When she saw the positive result, she knew she wanted an abortion.

A hospitality worker in north Florida, Anna earns barely $2,000 a month. She had only recently returned to work after the birth of her son. She was so sure they could not afford another child that she’d begged her partner to get a vasectomy. He declined, so they relied on condoms. 

“After my last baby, I knew I didn’t want to have any more kids,” said Anna, who The 19th is referring to by her middle name because of her concerns about abortion stigma. “There’s no way — absolutely no way we can afford it. We’re finally getting on our feet to get him into day care, for me to actually have a job and start my career again.”

She texted a coworker, who told her about A Woman’s Choice in Jacksonville. Anna would have to make two visits to the clinic, separated by 24 hours, thanks to a law that took effect in the spring of 2022. The first is a state-required consultation in which physicians must tell patients about options other than abortion, and the second is the actual procedure. She waited an hour on the phone to hear that the first available appointment wasn’t until April 30. 

Anna was originally scheduled to have her abortion Thursday, May 2, the next day the clinic was supposed to be open. Then during her ultrasound, the technician told her she was five weeks and six days pregnant — and that meant she was running out of time. Starting today, Florida is enforcing a strict ban on abortions after six weeks.

If she waited until Thursday, it would be too late to get an abortion in Florida; the staff would have to send her to North Carolina. Anna started praying, whispering please to herself. 

The staff told her they’d see what they could do — they’d talk to the doctor and see if he might be able to come in and care for her on Wednesday, typically his day off.

He agreed, and Anna came in for her second visit on May 1, just as the ban went into effect. She was exactly six weeks pregnant. She was the only patient to receive an abortion in a clinic that, the day before, had been standing room only.

It was a dramatic shift from the start of the week, when the state still allowed abortions up to the 15th week of pregnancy. On Monday, almost 60 people came to the clinic; about half for their abortions, and half for the preliminary consults. A third were from somewhere other than Florida, and the vast majority were past six weeks of pregnancy. Staff fretted about whether they’d have enough parking spaces for everyone, and patients filling out paperwork sat on the tiny waiting room floor. When told that day just how many patients he’d be seeing — all of them — Dr. Herman Miller, the clinic’s primary OB-GYN, almost laughed: “That’s ridiculous.” 

But by Wednesday morning, it was all over. Outside, half a dozen abortion opponents chanted prayers. Inside the clinic was quieter. When patients started to trickle in around 8:45 a.m., there was easily room for all of them: Anna, for her surgical abortion, and nine patients who showed up for state-mandated consults. 

The contrast and cause were obvious. In a matter of days, the nation had lost one of the South’s last meaningful options for legal abortion. 

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After Roe v. Wade was overturned in June 2022, Florida – the third largest state in the country — became one of the only realistic options for Southerners seeking abortions. In the next 18 months, Florida recorded the nation’s second-largest increase in abortions, even as the state enforced what was then a 15-week limit, substantially earlier in pregnancy than what was guaranteed under Roe. In 2023, about 84,000 abortions took place in Florida’s 60-some clinics, according to state health department data. 

At A Woman’s Choice, clinicians said they have treated close to 400 abortion patients per month since the end of Roe. Between a third and half came from somewhere else in the South: mostly Georgia, but also Louisiana, Alabama, Mississippi and Texas. Most patients arrived when they were somewhere between eight and 12 weeks pregnant. 

With the six-week ban in effect, Kelly Flynn, the president of the clinic, estimates the number of patients they see — virtually all of them people seeking abortions — will fall by more than half. Her clinic is scheduling only a handful of abortions per day; staff think that maybe they’ll see 20 to 30 patients in a single week, instead of a single day. 

On Wednesday morning, all but one patient seeking a consultation came from Florida. Three of the nine who showed up were already past six weeks, one only by days. Clinic staff offered to help them make appointments in North Carolina, the closest option. One of the physicians on staff is licensed in both North Carolina and Florida, and could do North Carolina’s first mandated visit from Jacksonville.

Of the three states whose strictest limit is a six-week cutoff — South Carolina and Georgia also outlaw abortion after that point — Florida is the only one to require patients make two separate in-person visits for an abortion. It makes a tight timeline even tighter: Patients need to discover their pregnancies early enough for both appointments and make sure they have time off from work two days in a row.

Even by Tuesday, the day before the law took effect, its effect was visible; the 24-hour rule meant that in preparing patients for Wednesday, clinicians could only see people who were at or earlier than 5 weeks and 6 days. With such a short timeline, the patients seeking their preliminary abortion consults hailed exclusively from Florida. It was the first time in months that had been the case, Miller said.

“You ladies are lucky you got in here this week,” he sighed that morning. “Something happens tomorrow, you’re going to be traveling.”

Miller has been providing abortions since he became a physician in the 1970s. He is almost ready to retire — he hopes to make it one more year at the clinic. His arthritis means he can only do so many abortions in a day, especially surgical ones. Standing for too long is painful. 

But he worries about what will happen when he leaves the clinic, and who will be left in Jacksonville to care for a dwindling number of patients. An alumnus of the Civil Rights Movement, Miller has started telling patients not only about the new six-week law, but also encouraging them to vote in November for a ballot measure that would enshrine abortion rights in the state constitution. 

Getting that passed is an uphill battle: Florida requires 60 percent of voters to approve ballot-initiated constitutional amendments, the highest threshold in the country. Since June 2022, abortion rights measures have consistently won at the ballot box, but only two — California’s and Vermont’s — got support from more than 60 percent of state voters. 

Miller, clad in a green scrubs shirt and blue jeans, handed out pills for patients so they could start their medication abortions. “Make sure that you vote,” he told them. “If the six-week ban — if it’s not voted out in November, they also plan to go after IUDs or implants.”

Most patients said they hadn’t heard about the ballot measure. Anna, for one, said she would start telling everyone she could, posting about it on social media, encouraging them to vote in favor.

“Women should be voting for these things. It’s not about your views on whether you’re against abortion or not,” she said. “It’s just about, it is your body. You get to choose whatever you want. Nobody’s telling men, ‘You need to have a vasectomy after four kids.’”

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Staff saw patients rushing to the clinic as soon as they learned they were pregnant: One woman who showed up Monday had tested positive the night before. The staff couldn’t schedule her that day; instead, they said, she’d have better luck phoning the clinic’s call center across the street, trying to get on the books for Tuesday, and hoping she would still be within the limit by Wednesday.

Those who already had appointments said they felt lucky to be there. One woman came Tuesday from Louisiana. She is almost 40 years old, with a teenager at home. Another, who had come from Alabama, was 14 weeks pregnant. When she got her abortion Tuesday, she only just made the deadline. 

The clinic doesn’t track patient demographics, but employees said that anecdotally, most of the people they see aren’t White. It’s unsurprising: Research suggests that 60 percent of Black women now live in states with abortion bans. Black women and Latinas have historically been more likely to get abortions than White women, a trend reflective of the fact that they are more likely to have lower-paying jobs and face more barriers in getting contraception.

A Woman’s Choice has started directing patients to leave Florida for care. Now, the closest option for an abortion after six weeks is North Carolina, which allows it until the end of the first trimester — 12 weeks. But that state requires patients to make two in-person visits to the clinic 72 hours apart, which can make the trip prohibitively expensive. After North Carolina is Virginia, where the procedure is legal until 27 weeks of pregnancy. Danville, home to the closest Virginia clinic, is about 500 miles away from Jacksonville.

Jacksonville is only about an hour’s drive from the state border. The journey out of state will be even more burdensome to people coming from further south in Florida. By Tuesday, Dr. Chelsea Daniels, an OB-GYN who practices primarily at a Planned Parenthood outside of Miami — 850 miles south of  Danville, or 12 hours driving — said she already had to tell scores of patients that they were too far along to qualify for an abortion. 

She worries the journey north will be too cumbersome and expensive for most patients. Abortion funds in Florida, nonprofits that help patients cover the cost of leaving the state for a procedure, say they do not have enough money to help support every Floridian who will need out-of-state care.

“We are going to have these difficult conversations with just about every single patient coming in for their first day physicians consult,” Daniels said Wednesday morning. “We’re going to be having dozens of those conversations today, just like we did yesterday.”

Pregnant Floridians could also have the option to order pills online through services like Aid Access, in which physicians practicing in other states mail abortion medication to patients in states that have outlawed the procedure. It’s a process that’s medically safe but legally tenuous — Anna, for one, said she wouldn’t feel comfortable getting pills from a physician potentially hundreds of miles away.

Even though she was able to secure her appointment, the process felt almost unbearably isolating. Her husband is the only person she has told about her decision. She is Latina, and most of her family isn’t in the United States. She isn’t sure many of her older relatives would have supported her in getting an abortion – maybe just her mom and her sister.

Holding back tears, she tried to imagine what she would have had to do if she hadn’t been able to get in on Wednesday. Still, she said, she would have done whatever it took, even if that meant driving eight hours out of state and charging the trip over multiple credit cards, hoping someday she’d be able to pay it back. Already, she had prepared for this trip to cost her what felt like a small fortune: $375, because she qualified for financial support from the clinic. It was close to a fifth of her monthly pay.  

The night before her abortion, she lay awake in bed until 4 a.m. thinking through what might happen when she came into the clinic. But for all her anxiety, she was certain about her decision.

“I cannot have a baby. I just know that,” she said. “I know what I want. What I want is — I just want this to be over.”