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It's taking longer to schedule abortions in the US. Doctors fear riskier, more complex procedures

A woman whose fetus was unlikely to survive called more than a dozen abortion clinics before finding one that would take her, only to be put on weekslong waiting lists. A teen waited seven weeks for an abortion because it took her mother that long to get her an appointment. Others seeking the procedure faced waits because they struggled to travel hundreds of miles for care.

Such obstacles have grown more common since Roe v. Wade was overturned in June 2022, doctors and researchers say, causing delays that can lead to abortions that are more complex, costly and in some cases riskier — especially as pregnancies get further along.

About half of U.S. states now have laws that ban or restrict access to abortion. Because of that, many clinics don't offer the procedure, which has increased demand for appointments at the remaining providers.

At various points since Roe, waits in several states stretched for two or three weeks, and some clinics had no available appointments, according to results of a periodic survey spearheaded by Middlebury College economics professor Caitlin Myers and recently provided to The Associated Press. Doctors and researchers say even as wait times have lessened, people still encounter other challenges, like planning and paying for travel, taking time off work and finding child care.

“All of those things can contribute to delays, and then it kind of becomes like this vicious circle,” said Dr. Daniel Grossman, an OB-GYN at the University of California, San Francisco, who co-authored a research report earlier this year that compiled anecdotes from health care providers after Roe was overturned.

People may miss the window for medication abortions, which are not generally offered past 10 to 11 weeks gestation. A dwindling number of clinics provide abortions as people move through the second trimester, which begins at 13 or 14 weeks. Costs for the procedure change, too, from up to $800 in the first trimester to $2,000 or more in the second trimester.

“While abortion is safe at all points in pregnancy,” with an overall complication rate of 2%, it “does get more complicated as the pregnancy continues,” said Dr. Colleen McNicholas, chief medical officer at Planned Parenthood of the St. Louis Region. “It does carry additional risks.”

Rising demand pushes up waits

At least 66 clinics in 15 states stopped providing abortions in the 100 days after Roe was overturned, according to an analysis last year by the Guttmacher Institute, a research group that supports abortion rights.

The necessity for people to travel out of state is at the root of abortion delays.

Clinics run by Planned Parenthood of the Rocky Mountains, which operates in Colorado, New Mexico and southern Nevada, saw out-of-state patients more than double after Roe. And Planned Parenthood of the St. Louis Region's health center in Fairview Heights, Illinois, saw a 715% increase in patients from outside of Illinois or Missouri in the year after Roe.

“We know that abortion bans have caused a ripple effect and increased wait times even in states where access is protected,” McNicholas said.

The ongoing Myers Abortion Appointment Availability Survey called more than 700 facilities across the United States. Its latest survey, conducted in September, found that 11 states had median appointment wait times of more than five business days and four states had waits of at least eight business days, not counting weekends or holidays. The longest wait was in Iowa: 12 business days.

A year earlier, the survey found Iowa had a median wait of 13 business days, and six other states had waits between 12 and 15 business days.

Planned Parenthood of the Rocky Mountains told the AP that wait times peaked at 28 days shortly after the U.S. Supreme Court decision, though it later fell. Before June 2022, waits in the region's Planned Parenthood clinics averaged 17 days, reflecting restrictions in Texas that were put into place in 2021.

In the report from Grossman’s team, a health care worker described how it took one mom seven weeks to get an appointment for her pregnant teen, who was about 17 weeks along by then. Another patient described in the report was also that far along by the time she got an abortion after struggling for six weeks to find an appointment. She drove 10 hours to a different state for care.

The latest statistics from the U.S. Centers for Disease Control and Prevention are from 2021 and show that about 7% of abortions took place at 14 weeks or later.

While there’s no way to know definitively whether delays have pushed more abortions into the second trimester, several providers said they’ve seen the number rise in their own clinics. The St. Louis region's Planned Parenthood, for instance, tracked a 35% increase in the number of patients getting abortions at 14 weeks or later at the Southern Illinois health center in the year after the Supreme Court decision.

Dr. Rebecca Cohen, an OB-GYN at a hospital-affiliated clinic in Colorado, said her team has cared for an increasing number of patients seeking abortions later in pregnancy, some of whom “have experienced several weeks of delays" trying to find care.

Jillaine St.Michel struggled to find somewhere to have an abortion late last year after learning that her 20-week fetus had multiple genetic and developmental problems and probably wouldn’t survive. She lives in Idaho, which has a ban on abortions, so St.Michel and her husband called about 15 out-of-state clinics, finally getting on a three-week waiting list in Denver and a two-week waiting list in Seattle.

St.Michel, 37, said she worried about passing abortion time limits: Colorado allows abortion at all stages of pregnancy, while Washington state allows the procedure up to viability, the point a fetus may survive outside the womb. Some babies can survive with medical help at 22 or 23 weeks.

A chance cancellation opened up a spot in Seattle four days after she called to get on the list. Still, she said, “we absolutely felt the time crunch."

Dealing with a deluge

Clinics have taken numerous steps to reduce waits, such as adding more telehealth appointments for medication abortions, staying open longer and adding more staff. That's generally brought appointment wait times down and also helped people obtain other types of reproductive care at the clinics in a timely fashion.

“If someone’s sexually active and they don’t want to become pregnant, we want to get them on birth control,” said Adrienne Mansanares, president and CEO of Planned Parenthood of the Rocky Mountains. “If they are experiencing symptoms of a sexually transmitted infection … we want to get them treated.”

But streamlining appointments is only part of the answer to reducing abortion delays, providers said. Individual issues like child care problems, canceled flights and financial concerns can be tough to overcome — even when clinics try to help by connecting patients to abortion funds, for instance.

This is especially difficult as travel distances grow longer. Research by Myers and colleagues found the average driving distance to the nearest clinic rose substantially in some states after Roe. From March 2022 to September 2023, it shot up from 34 to 160 miles in Alabama and from 43 to 499 miles in Texas.

The clinic where St.Michel, a chiropractor, had an abortion is about 500 miles from her home. She and her husband quickly came up with about $4,000 for airplane tickets, a rental car, three nights of lodging and the procedure, since the clinic was out of network for her insurance. The couple decided not to turn to an abortion fund because they thought others needed it more, instead taking it out of their savings.

Hoping to help other families, she joined a lawsuit filed by the Center for Reproductive Rights, an organization of lawyers and advocates that supports abortion rights. The suit asks state courts in Idaho and Tennessee to place holds on abortion laws.

“I personally can't imagine that most people would be able to make this work,” said St.Michel, who is pregnant again. “This is not how we should have to seek health care.”

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

Laura Ungar, The Associated Press