Patients Are Arriving "Later and Sicker" at Abortion Clinics

Diane Horvath has a phrase for what she's watching happen at Partners in Abortion Care, the Maryland clinic she co-founded. Patients are arriving "later and sicker."

Not because they waited carelessly. Because there was nowhere else to go.

The national network narrows sharply for patients needing later care. All-trimester access for every patient is now confined to clinics in just four states and Washington, D.C. Thirteen states have full abortion bans in place. Others have gestational limits that cut off access well before patients can navigate the financial, logistical, and legal hurdles standing between them and care.

"There's no place to go," Horvath said.

The DC Abortion Fund has recorded a marked increase over the past two years in requests from patients at 30 weeks or later. The group helps pay for at least 20 patients at 28 weeks or later during an average week. Those aren't people who casually delayed a decision. Those are people who spent weeks or months trying to find care, secure funding, arrange travel, and navigate a system that has become increasingly hostile to them.

The Insurance Crisis Making It Worse

The abortion ban problem and the insurance problem are separate crises that have merged into one.

More than 20 million people have lost Medicaid coverage since 2023. An estimated 3 million to 5 million people have lost or dropped coverage purchased through ACA exchanges in recent months. Horvath directly linked those losses and rising premiums to patients postponing care — not because they wanted to wait, but because without insurance, the cost of an earlier procedure became impossible to manage, and by the time they'd scraped together resources, they were further along.

Partners itself stopped accepting Medicaid for later abortions in 2025 after reimbursement rules left the clinic losing thousands of dollars on each procedure. It hasn't turned patients away — it works with about 40 abortion funds and often secures full funding — but the financial pressure on clinics providing this care is significant and growing.

Beyond Abortion: The Ripple Effects on All Reproductive Care

The consequences of abortion bans have spread well beyond abortion itself — into miscarriage treatment, ectopic pregnancy care, and cancer treatment for pregnant patients.

A 2026 study found that states with abortion bans saw an increase of 2.8 percentage points in patients told to wait for their miscarriages to occur naturally, and a 2.2 percentage point decrease in patients receiving medication for their miscarriages. Waiting for a miscarriage to complete on its own — called expectant management — is a legitimate option in some situations. Being told to wait when intervention is appropriate is a different matter entirely.

"We can't restrict one area of reproductive health care without there being far-reaching impacts," said Dr. Maria Rodriguez, professor of obstetrics and gynecology at OHSU. "Patients are having to wait longer to receive treatment, and when they arrive, they have fewer choices."

Physicians in non-reproductive specialties have reported changing how they prescribe certain medications to patients who could become pregnant — out of concern about what would happen if those patients needed to end a pregnancy in a state where care isn't available. The chilling effect is reaching into oncology, rheumatology, and other fields that have nothing to do with abortion directly.

Who Bears the Heaviest Burden

The patients arriving latest and sickest are not a random cross-section of the population.

Black women in the United States are over three times more likely to die from pregnancy-related causes than white women. That gap has widened since the Dobbs decision, as abortion bans have forced delays in emergency care, driven providers out of states, and stripped pregnant patients of the right to make basic medical decisions.

Patients with lower incomes, patients in rural areas, patients without stable housing or reliable transportation — these are the people for whom the distance to the nearest provider isn't an inconvenience but an insurmountable barrier. They're the ones waiting the longest. They're the ones arriving in the worst condition. And they're the ones with the fewest resources to navigate a system that has become extraordinarily difficult to navigate.

Four years after the Supreme Court's Dobbs decision returned abortion policy to the states, the downstream effects are showing up in the data, in the stories doctors are telling, and in the patients arriving at the remaining clinics — later, sicker, and with fewer options than ever before.

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