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Description
This project examines abortion-related travel burdens as a critical public health policy problem, using the Multiple Streams Framework to link lived experience, health inequities, and policy responses across levels of governance. Anchored in the problem and policy streams, the analysis treats post-Dobbs interstate travel for abortion as a population-level determinant of health that amplifies existing social and structural inequities.
The project employs a qualitative thematic policy analysis drawing on two data sources: a key informant semi-structured interview with a reproductive justice leader and a targeted review of contemporary opinion and commentary articles from leading public health and health policy outlets. Using open coding, the interview transcript and documents were systematically analyzed to identify recurrent policy-relevant issues, which were iteratively grouped into themes and sub-themes. These themes were organized around: structural and legal barriers; logistical and financial burdens; emotional and psychological effects; systemic strain and access state responses; demographic and equity implications; and policy and practice gaps.
From a public health policy perspective, the findings highlight how the post-Dobbs legal environment has produced a fragmented “policy patchwork” in which state-level decisions drive profound differences in exposure to risk and access to essential reproductive healthcare. Restrictive states generate legal, financial, and psychosocial harms that extend beyond their borders, while access states attempt to offset these harms through shield laws, telehealth expansion, and financial supports. This geographic and jurisdictional fragmentation functions as a structural driver of health inequities, concentrating the heaviest burdens on low-income populations, people of color, rural residents, and those with precarious immigration or employment status. For these groups, long-distance travel is often financially or logistically impossible, effectively foreclosing access to timely, evidence-based care.
The analysis also surfaces the downstream system effects of increased cross-state travel. Clinics and support infrastructures in access states are absorbing rapid surges in patients, leading to longer wait times, constrained capacity, and increased reliance on overextended abortion funds and volunteer-based networks. These conditions create new barriers for both local residents and travelers, undermining continuity of care and threatening quality and timeliness of services. Emotional and psychological harms—fear, stigma, isolation, and anxiety about criminalization—are compounded by separation from local support systems and uncertainty about legal risk, further impacting mental health and help‑seeking behavior.
By applying the Multiple Streams Framework, the project explicitly links these empirical themes to the policy process. In the problem stream, escalating travel burdens are understood as a public health emergency that manifests through delayed care, elevated clinical risk, financial strain, and psychosocial distress. In the policy stream, the study maps emergent solutions—including shield laws, telehealth reforms, expanded funding for abortion travel, and enhanced privacy protections—while identifying critical gaps in scalability, coordination, and equity. The analysis emphasizes that current responses are largely reactive, state-specific, and heavily dependent on unstable charitable funding, leaving health systems and communities without durable, long-term infrastructure.
This project offers three key contributions. First, it reframes abortion travel not merely as an individual access issue, but as a structural determinant of health that interacts with race, class, geography, and immigration status. Second, it provides a detailed thematic map that can guide the design of multi-level interventions, including federal protections for interstate travel, state-level shield and funding policies, and local investments in patient navigation, transportation, lodging, and psychosocial support. Third, it underscores the need for coordinated, data-driven, and equity-focused policy approaches that move beyond piecemeal state reforms toward more harmonized systems capable of sustaining access during prolonged legal and political volatility.
Faculty Advisor(s)
Mary Lou Ciolfi
Publication Date
2025
Preferred Citation
Titus, Kelsey D., "State Travel Burdens for Out-of-State Abortion Care in the Wake of the Dobbs Decision" (2025). Integrative Learning Experience (ILE) Theses. 12.
https://dune.une.edu/ph_ile/12