Abortions performed by Nebraska doctors crater following state’s 12-week ban

The couple put their toddler to bed, but they weren’t winding down. They were driving into the unknown night south to Kansas City.

While in the car, Zoe played “It’s Quiet Uptown” from Hamilton, a song depicting the founding father’s grief of losing a son. 

“There are moments that the words don’t reach. There is suffering too terrible to name. You hold your child as tight as you can. You push away the unimaginable,” the lyrics speak to her pain, she said. And at the heart of the song, forgiveness.  

After a fitful six hours in bed in a hotel, they drove to a parking lot and entered a waiting room, where they sat inside an Overland Park abortion clinic three hours from home.

It was, Zoe says, the worst day of their lives. 

Zoe, not her real name, had to travel to another state to terminate her pregnancy because she was 16 weeks pregnant, and Nebraska lawmakers banned abortion after 12 weeks a year ago. 

New data released by the Nebraska Department of Health and Human Services Friday suggest that she’s one of an increasing number of Nebraskans who aren’t getting an abortion in Nebraska following the state’s more restrictive ban.

In the seven months following the more restrictive 12-week ban, abortions provided by Nebraska doctors dropped by 24%, from an average of 158 abortions per month, down from 209 in the same period in 2022.

In 2023, Nebraska doctors performed a total of 2,325 abortions, according to the DHHS report. The annual count has dropped to its lowest point since 2019. 

Part of the drop can be attributed to patients like Zoe, who crossed state lines to seek abortion care. Part of it may be people carrying a pregnancy to term. And advocates suspect it’s tied to patients using mail-in abortion pills that aren’t accounted for in the state report. (Learn more about mail-in abortion pills here.)

Zoe’s pregnancy seemed normal at first. She was overjoyed to be a parent again. But she developed a rash around eight weeks into the pregnancy. After multiple visits to different doctors, she learned she had contracted a rare virus that could pass to her fetus and lead to hearing loss and developmental diseases.

Zoe spoke with her doctor and her husband daily about what to expect after the childbirth, and the potential to abort the pregnancy, even though “the options were unimaginable,” she said. The 12-week mark had passed, meaning she couldn’t get an abortion in Nebraska. She continued to debate it, until they made a decision.

“I couldn’t live with the possibility of him being stillborn or dying in my arm shortly after being born. I couldn’t live with that. … We didn’t want him to have a life of just pain and suffering,” she said.

In Kansas, where Zoe traveled to, abortions shot up by more than 30% in the second half of 2023 when compared to the year prior. That’s according to #WeCount, a Society of Family Planning program that surveys providers. 

Kansas voters upheld its constitutional protection of abortion rights through a ballot initiative in 2022. 

Colorado, Illinois and Minnesota, the top three states Nebraskans travel to for an abortion, all witnessed a rise in their abortion numbers, according to the Guttmacher Institute and #WeCount data.

The drop in the number of abortions performed in Nebraska was welcomed by anti-abortion advocates. 

“Nebraska’s new 12-week protection law saved the lives of 222 boys and girls in just a few months. We are grateful,” said Marion Miner, a lobbyist representing the Nebraska Catholic Conference in an email after the state released the newest abortion numbers. 

Sandy Danek, executive director of Nebraska Right to Life told the Flatwater Free Press in an interview earlier this year that anti-abortion activists had hoped the new restrictions would “offer protections to about 10% of the babies this year versus prior to the bill passed.”

On the other side of this issue, Nebraska Abortion Resources, the state’s main abortion fund, said the ban does not eliminate the need for abortion and instead forces pregnant people to seek care elsewhere.

“With the additional influx of patients from other states where access has been restricted alongside Nebraska residents needing to travel to escape our own ban, it is clear that these bans are both ineffective and inhumane,” said Shelley Mann, its executive director.

Some 20% of patients aided by NEAR since 2022 have been more than 11 weeks pregnant when they first contacted the fund, Mann said. 

Two groups of people make up a big chunk of those who terminate their pregnancy after 12 weeks, Mann said: Patients who discover pregnancy complications later than that, and Nebraskans held back by their economic realities. 

“They’re waiting to get the money they need to get their appointment. And by the time they get there, our clinics are full,” she said. 

Out-of-state patients are actually helping to crowd Nebraska’s abortion clinics – they now make up 21% of patients who received an abortion in Nebraska last year, according to the DHHS. 

Almost 500 patients traveled from other states to get an abortion in Nebraska last year, according to the DHHS. Close to half of them traveled from Iowa and Kansas.

In the latter half of 2022, after the Supreme Court overturned Roe v. Wade, Nebraska briefly became a so-called “destination state” that allowed abortions up to about 22 weeks gestation, while neighboring states enacted trigger bans.

That dismayed anti-abortion activists. 

“We want a Nebraska where abortion is unthinkable, because women know they have all the support and love they need to carry their unborn child to term and will continue to be supported as they raise their child,” said Miner.

But the numbers then dipped by 24% in the seven months following the 12-week ban last May. 

“This is a tremendous start to ending abortion in Nebraska,” said Gov. Jim Pillen in a press release Friday. “The result is more than 220 lives saved which is a victory for our culture of life and love in Nebraska.”

David Cohen, a Drexel University law professor, said Nebraska’s abortion restrictions are undoubtedly responsible for the drop in clinic-provided abortion numbers, consistent with the effects of bans in other states. 

“You’ve cut 10 weeks off of the gestational limit, and of course that’s going to decrease the number of abortions …” said Cohen. “This is exactly what they wanted to happen. … The numbers show that it’s happening.”

Following the state restrictions, only two Omaha-area clinics specializing in elective abortion remain in Nebraska. Appointments quickly fill up. 

And the end of Roe v. Wade has also caused many more people to travel like Zoe and her husband. Nationally, more than 17,000 patients went out-of-state to obtain abortions last year, more than twice of the number in 2019, the Guttmacher Institute estimated. 

“Planned Parenthood has worked diligently to ensure every patient that comes through our doors can receive the essential health care they need, whether they are from Nebraska or have traveled from out of state,” said Ruth Richardson, president and CEO of Planned Parenthood North Central States, in a statement Friday.

Abortion restrictions can create a chilling effect for providers in the face of uncertainty and result in them offering less care than permitted by law, said Alison Norris, professor at Ohio State University’s College of Public Health who co-chairs the Society of Family Planning’s survey.

The result is patients being denied care, she said.

Sarah, a Lincoln woman, discovered during her 24-week check-up last November that one of her twins conceived through IVF had a potentially fatal fetal condition.

Sarah, who agreed to be identified by her first name, made an appointment to terminate her pregnancy in Colorado.

She eventually decided against it, to ensure her son was born safely, but felt “forced into” the decision, fearing prosecution against her and her family.

She carried both twins to term. The baby girl lived three weeks before she died. Her son is healthy.

Had Nebraska had more lenient abortion laws, she would probably have considered terminating the nonviable fetus, she said. Insurance would come into play differently, and she would have more support and less fear.

“If I did carry her … to term, if she was the only baby I was carrying, it would just make that suffering so much harder and longer,” she said.

Forced pregnancies can lead to worse birth outcomes like birth defects, which cause more harm to communities of color, said Jessica Ehule, former birth justice program director of reproductive justice organization I Be Black Girl. 

The 12-week ban, and laws like it, disproportionately hampers abortion access for people of color, members of the LGBTQ+ community, rural residents, and those who may not be aware they’re pregnant until later in their pregnancy, especially teenagers, advocates and experts say. 

“Our new reality has made it harder for Nebraskans to receive the health care they need and deserve,” said Richardson of Planned Parenthood.

Zoe knew she had more resources than many Nebraskans. She was able to pay the $1,900 for the abortion procedure. She didn’t feel right to ask for assistance from abortion funds. 

Despite that, she needed to travel quickly. The further along the pregnancy, the longer and more expensive the operation becomes. 

Just before she left for Kansas City, she asked her Nebraska doctor for sonogram photos of her baby — a boy she had named Skye a few days prior. The Isle of Skye in Scotland is a place she feels safe, and a place to keep Skye safe, she said. The name conjures a mental image of the rugged terrains and the swaying green grass she remembered from a hike. 

She made arrangements with her closest friend — the only one she told  — who would stay at her house and drop her son off at daycare. 

On her way back home after the two-part procedure, Zoe and her husband sat in silence. They queued up a podcast her therapist hosted. She wanted to hear her therapist’s voice.  

“It just didn’t feel real yet that Skye was gone,” she said in an interview.

She had just come out of sedation, during which she thought she was going to die of hemorrhage.

“I was asking them to not let me die because I have to go home to (my son),” she recalled. 

She came home to her son, who her friend had picked up from daycare. She hugged him. 

They also brought home something precious in a heart-shaped urn. They put Skye’s ashes on a shelf, surrounded by stuffed animals. 

“Skye’s life has a purpose, he came to our life for a reason,” Zoe said. She and her husband want to start helping other grieving families with the cost of cremation to honor the lost children’s memories. 

They are still hoping to get pregnant, but said they’re “hypervigilant” and make sure her virus is clear before trying to conceive. 

“I know if something happened again, we’ll manage. My heart breaks for those who don’t have those privileges and can’t manage,” she said.

Additional Reporting

• A year in, Nebraska doctors say 12-week abortion ban has changed how they care for patients
• ‘I’m really sorry’ – Nebraska lawmaker tells woman he failed her during abortion ban negotiations
• One year after abortion law, fewer med students applying to become doctors in Nebraska
• Nebraska abortions, uncounted by state, likely happening by pill, mail
• More people are traveling to Nebraska to get abortions. Only one surgical abortion clinic remains.