Surge in out-of-state patients seeking abortion reported in Colorado

Surge in out-of-state patients seeking abortion reported in Colorado | Image Credit: © Song_about_summer - © Song_about_summer - stock.adobe.com.

An increase in the rate abortions performed for out-of-state residents has been observed from 2020 to 2023 in Colorado, according to a recent study published in JAMA Network Open.¹

Abortion access has significantly changed at a national and state level, including a 6-week gestational limit passed by Texas state legislators in 2021. Research has evaluated the effects on residents in states where restrictions have been implemented, but investigators have noted minimal data for residents in states with legal abortion access.

There are no restrictions to abortion access in Colorado. Therefore, investigators conducted a cross-sectional study to determine whether the abortion legislation in Texas led to changes in abortion for Colorado residents.

Abortion count data between January 2014 and June 2024 was obtained from the Colorado Department of Public Health and Environment for assessment. This data included patients’ residence state and gestational week at abortion.

Rates before and after new laws were implemented were compared using generalized linear quasi-Poisson regression interrupted time series models. Long-term and seasonal trends were evaluated, with September 2021 considered the interruption point.

Time was the only cofounder for the analysis. The R statistical software version 4.3.1 (R Project for Statistical Computing) was used to perform all assessments in the study.

The rate of abortions rose to 30% in 2023, compared to 13% in 2020. Following implementation of the abortion legislation in Texas, a significant increase was reported in the rate of Texas residents traveling to Colorado to receive abortion care.

Similarly, second-trimester abortions increased among Colorado residents with a temporal match with the demand for procedures by Texas residents. The peak of this trend was observed 6 months after the Texas abortion legislation was implemented.

Overall, increased rates of 11% and 86% were reported for Colorado residents to have abortion in the first and second trimester, respectively, following the legislation. This highlighted a significant increase among Colorado residents linked to the Texas abortion bill, matching reports from area clinicians about increased patient demand.

“The increase found in second trimester abortions for Colorado residents appears to have resolved, offering reassurance of health care capacity to adjust to increased demand,” noted investigators. “Expanded access to telehealth services, increased self-managed abortion, or care in other protective states may also be alleviating strain on the system.”

This alleviation may help clinicians who have reported increasing moral distress following the implementation of abortion restrictions.² Fourteen states have implemented nearly full abortion bans since the Supreme Court’s Dobbs vs Jackson Women’s Health Organization decision, and 11 have implemented severe restrictions.

A 2024 study assessed moral distress among clinicians performing abortion in states with near bans or restrictions using the Moral Distress Thermometer (MDT). MDT scores ranged from 0 to 10, with higher scores indicating increased distress.

The median score among respondents was 5, but an over 2-fold increase was reported for clinicians practicing in states with abortion restrictions vs protections, at 8 vs 3, respectively. Surge states also reported higher median scores vs stable states, at 7 vs 5, respectively.

This data highlights the increase in moral distress among clinicians providing abortion in restrictive states. Investigators recommended structural changes to address these issues.

References

1. DeBie KA, Gutilla MJ, Keller KP, Peel JL, Neophytou AM. Abortion changes among residents of an abortion rights protective state. JAMA Netw Open. 2025;8(2):e2460460. doi:10.1001/jamanetworkopen.2024.60460
2. Krewson C. Study reports increased clinician moral distress from abortion restrictions. Contemporary OB/GYN. August 5, 2024. Accessed February 20, 2025. https://www.contemporaryobgyn.net/view/study-reports-increased-clinician-moral-distress-from-abortion-restrictions