Terry Sallas Merritt has noticed an increase in recent years in the number of people traveling from surrounding states to receive abortion care at one of the North Carolina clinics she helps operate.

As a member of the executive team for A Woman’s Choice, Inc., Merritt has served patients who drove as much as five hours across state lines to access abortion in North Carolina.

“These are people who are desperate to find access,” Merritt told Rewire.News.

As Republican-controlled state legislatures across the country, particularly in the South and Midwest, continue to pass increasingly restrictive laws targeting abortion, thousands of people are crossing state lines in search of abortion care. At least 276,000 people terminated pregnancies outside their home states between 2012 and 2017, the Associated Press reported. In 2017, North Carolina had one of the highest shares of out-of-state abortions in the country at 18.5 percent.

Although North Carolina has several abortion restrictions on the books, including a requirement that patients receive state-directed counseling containing medically inaccurate information, advocates have been able to keep 15 clinics in North Carolina running even as many providers in other states shut down, said Tara Romano, executive director of NARAL Pro-Choice North Carolina.

“The General Assembly did pass new regulations, but they weren’t the kind of regulations that would shut down clinics like we’ve seen in other states,” Romano told Rewire.News.

Since 2013, 148 independent abortion clinics across the United States have closed. While a handful of new clinics have opened, the total number of independent clinics decreased by 28 percent between 2012 and 2018, according to the Abortion Care Network.

North Carolina is one of six states with a forced 72-hour waiting period—the longest in the United States. But patients in North Carolina can receive counseling from a nurse over the phone, so they do not have to make two separate visits to the clinic, as they would in states with onerous waiting periods that make patients receive counseling in person and then come back for the procedure.

A Woman’s Choice Inc., which provides a wide spectrum of reproductive health care including pregnancy testing, abortion care, and adoption counseling, operates three clinics in North Carolina (in Raleigh, Greensboro, and Charlotte) and one in Jacksonville, Florida. Patients traveling from Tennessee, Virginia, Kentucky, and Georgia make up the largest shares of out-of-state patients, Merritt said.

“When you’re desperate and you’re traveling a great distance, you think: Oh maybe it’s just me, I’m probably the only person who has had to do this,” Merritt said. “They think they’re the exception, not the rule. But more and more they’re becoming the rule.”

Extreme abortion bans, like the near-total abortion ban passed this year in Georgia’s Republican-majority legislature, are contributing to the increased number of people traveling across state lines for abortions, Merritt said. Although Georgia’s ban is not yet in effect and is being challenged in court, it has contributed to confusion among patients.

“Every time legislation is introduced or passed, all people hear is ‘ban,’” Merritt said. “So all of a sudden they think abortion is illegal in their state, so there is a lot of confusion and desperation.”

New Mexico, which does not has a waiting period or any limits on publicly funded abortion, saw its rate of out-of-state abortions double from 2012 to 2017, according to AP’s analysis. In that same time period, half of the abortions performed in Kansas—which does impose restrictions such as a 24-hour forced waiting period and a ban on private insurance coverage for abortion except in cases of life endangerment—were for residents of Missouri, where abortion care is even less accessible.

Missouri has only one abortion provider and a 72-hour mandatory waiting period, forcing many people in search of abortion care to travel across state lines. Just over the border in Illinois, Missouri residents make up more than half of the patient base at Hope Clinic for Women in Granite City, said the clinic’s deputy director Alison Dreith. In 2017, 16.5 percent of all reported abortions in Illinois were performed on out-of-state patients.

“For quite some time every state touching us has had a mandatory waiting period on top of gestation limits …. But here in Illinois we go up to 24 weeks,” Dreith told Rewire.News.

From January to June 2019, 58 percent of Hope Clinic patients were Missouri residents, 37 percent were Illinois residents, and about 5 percent came from other states. Hope Clinic is just ten minutes from St. Louis, the site of Missouri’s sole abortion provider, but many St. Louis patients travel to Illinois to avoid Missouri’s 72-hour forced waiting period, Dreith said.

“The promise of Roe is not a promise for everyone. Access has always been minimal for certain populations, especially those with low incomes, trans and immigrant populations,” Dreith told Rewire.News. “Certainly under a Trump administration we are going to continue to see more [restrictions] on the federal and state level as the anti-choice movement is emboldened.”

Merritt has worked in abortion rights for 30 years. Seeing people travel long distances to receive abortion care has made her more committed to speaking out about the ways abortion restrictions harm patients and the importance of preserving access to care.

“When you think about all the details someone has to consider to get to a clinic for abortion care, it can feel insurmountable,” Merritt said. “I’m always telling people, I know it seems like we fought for this forever ago, but yes, we have to fight again.”

Correction: A previous version of this story stated North Carolina has 16 abortion clinics.