Michigan abortions for out-of-state patients jumped 66 percent last year

• Michigan saw a steep rise in out-of-state patients seeking abortion services
• But the overall number of reported abortions remained about the same, puzzling providers 
• With more patients turning to online abortion services, some wonder if all these cases are reported to the state  

Michigan doctors performed nearly 1,100 additional abortions on out-of-state residents last year than in 2021 — as neighboring states tightened restrictions or banned the procedure.

But even as abortions for out-of-state patients spiked 66 percent, the overall number of abortions in Michigan remained stable, for reasons providers say they don’t fully understand. And in the final months of last year, abortion demand — from local and out-of-state patients — fell significantly, according to at least two major providers.

“It went crazy those months after Dobbs,” Renee Chelian, founder of Northland Family Planning Centers, said of the influx of patients from other states immediately following the U.S. Supreme Court decision in June of last year that struck down federal abortion protections. 

“We were overwhelmed, especially with Ohio patients.”

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Michigan doctors performed 2,761 abortions on out-of-state patients last year — compared to 1,665 in 2021, according to new data Bridge Michigan obtained from the Michigan Department of Health and Human Services. That amounted to 9.2 percent of the roughly 30,000 abortions recorded in Michigan last year. That’s the first time out-of-state patients accounted for more than 6 percent of Michigan procedures. 

Michigan quickly gained favor as a refuge for people seeking abortions after the U.S. Supreme Court dismantled decades of federal protections by overturning Roe v. Wade in June of last year. 

The ruling effectively cut off abortion access in states that passed “trigger laws” in anticipation of the decision. In Ohio, for example, the Supreme Court’s ruling allowed a 2019 so-called “heartbeat law” to stand, banning abortions after six weeks of pregnancy, a stage in which many women don’t yet realize they are pregnant.

By October, 13 states had banned abortion with two more states, including Wisconsin, poised to do the same. That forced 66 clinics to end abortion services in 15 states, including Wisconsin and Kentucky, according to research by Guttmacher Institute, an abortion-rights research group. 

To the south of Michigan, Ohio and Indiana moved to restrict access to abortion, with Kentucky, West Virginia and Tennessee banning it with few exceptions. As the Ohio law took effect, phone lines lit up at Michigan abortion providers and wait times increased, though — as it turned out — some patients had booked multiple appointments in the post-Dobbs confusion. 

As other states limited access, Michigan voters last November passed a ballot measure that enshrined abortion rights in the Michigan Constitution, while reelecting Democratic Gov. Gretchen Whitmer and putting Democrats in charge of the Legislature, leading to a raft of legislation supportive of abortion and reproductive rights. 

At the 14 clinics run by Planned Parenthood of Michigan, 10 to 15 percent of the patient load now comes from out of state, said Paula Thornton Greear, the group’s executive director. That’s roughly triple the rate of a year ago.

The numbers are “a stark reminder” of the barriers — travel, hotel stays, child care costs, time off work — some patients face to get care, and that may be worse as more states further restrict abortion access, Thornton Greear said. 

“We’re one of the few Midwestern states where patients can get abortion care uninterrupted, and we are happy to open our doors and offer that care,” she said. “But let’s be honest: Is that sustainable? Is that a long-term solution?”

Women in many states face hurdles. From July of last year to this March, more than 80,000 people in states where abortion is banned fully or at six weeks “encountered disruptions” seeking care, including having to travel to other states to receive care, according to a June report by the Society of Family Planning, a research organization.

Chelian, representing the independent clinics, and Thornton Greear, representing Planned Parenthood’s network, said Ohio residents made up the majority of their out-of-state patients.

Right to Life Michigan, which opposes abortion, suggested in an email to Bridge Michigan that the increase from other states was “undoubtedly the result of Governor Whitmer touting abortion tourism,” referring to a phrase sometimes used by abortion opponents to describe when women leave their state or country to get an abortion. 

Whitmer has framed reproductive freedom not only as a fundamental right but as an economic development issue during the gubernatorial race last year against Republican challenger Tudor Dixon. And earlier this year, the Whitmer administration drafted ads to encourage out-of-towners to move to Michigan, touting “EV and Plan B” — references to electric vehicles and the pill that prevents pregnancies.

A mysterious drop

But then last fall, overall demand for appointments waned, not only at Northland but at other clinics, too, said Chelian, who is part of regular phone calls with a handful of independent clinics as well as Planned Parenthood of Michigan. For reasons not fully known, appointments at Planned Parenthood clinics “plateaued” at the end of 2022, Thornton Greear told Bridge.

Even as the number of overall abortions remained flat, last year marked the first decline in the state’s abortion rate — to 14.4 abortions for every 1,000 women aged 15 to 44 — since 2009. That’s a fall from the 15.1 rate in 2021. 

Chelian said she and others are perplexed by the drop in patients seeking in-clinic abortions, especially since several clinics sought to boost staff to meet an expected spike in demand, but didn’t end up needing to.

“We’ve all talked about it and we’re trying to figure out what it is,” Chelian said.

All this makes predictions on future demand for abortion uncertain, as neighboring states continue to debate abortion rights and restrictions, which could continue to drive patients to Michigan. 

In Ohio, voters may put abortion rights on the ballot this November, while Indiana’s Supreme Court ruled last week that that state’s abortion ban — temporarily blocked by a lower court judge since September— doesn’t violate the state constitution.

Are online patients being counted? 

Some experts say the late-year decline in appointments at Michigan clinics may be due to more women seeking medication abortions from out-of-state telehealth providers. 

It’s possible some Michigan residents are bypassing brick-and-mortar clinics or even a new centralized virtual clinic by Planned Parenthood of Michigan.

Abortion providers note an increase in telehealth services, specifically services from online out-of-state providers and wonder whether they are reporting medication abortions to the state of Michigan.

Planned Parenthood said it reports its cases. It began providing telehealth services in 2020, the first year of the pandemic, and last month launched a virtual clinic, which it said provides details of every abortion to the state, including the age of the patient and type of procedure. 

Chelian said Northland and other independent clinics do not yet provide telehealth medication abortions. But it’s unclear if telehealth providers from out of state provide those numbers to Michigan and if so, how frequently Michigan residents use those types of providers. 

Nationally, medication abortions provided by virtual clinic telehealth providers increased after the Dobbs decision from about 5 percent of all abortions to about 9 percent, according to the #WeCount report last month by the Society of Family Planning.

Several telehealth services provide medication abortions, but it’s not clear if they report their work to any state, said Dr. Alice Mark, interim medical advisor for the National Abortion Federation, which represents the nation’s abortion clinics, 

“We don’t know how robust that reporting is,” Mark told Bridge.

She speculated that a slight dip in Michigan’s rate may also reflect a national downward trend in fertility rates, despite a temporary bump in births during the pandemic.

If telemedicine providers aren’t reporting cases, that’s a cause for worry, said Chelian, who says patients seeking care may not be working within Michigan’s laws that require, for example, an appointment with a doctor, or parental consent for minors seeking abortions.

Indeed, one online company, Abuzz, said it provides abortion care as an “asynchronous” service, “meaning that there’s no phone call or video visit required.” 

Abuzz did not respond to a Bridge request for comment. Neither did two other websites, New Jersey-based Maitri Wellness and AidAccess, a European-based organization that mails abortion pills to all 50 states.

Telemedicine abortion services offered by Michigan-based providers are supposed to be included in data reported to the state as outlined by state law, said Lynn Sutfin, spokesperson for the Michigan Department of Health and Human Services.

But, she acknowledged, the law was written before telemedicine abortion care was available. 

Right to Life suggests another possibility for the drop in demand: “The data demonstrates that women in Michigan increasingly believe that abortion is not a preferred choice for themselves,” spokesperson Anna-Marie Pluymert told Bridge in an email.

Genevieve Marnon, the group’s legislative director, said she too found the decline “noteworthy,” given the enormous attention paid to Dobbs and its aftermath, with abortion “front and center in the media, in politics, and at the ballot box.” 

Bridge data reporter Mike Wilkinson contributed to this report.