The Road Not Taken: How Driving Distance and Appointment Availability Shape the Effects of Abortion Bans

We use difference-in-differences research designs to estimate the effects of abortion bans on births at the county level, leveraging data on changes in driving distance to the nearest facility and appointment availability at facilities in the destination city. We find that the effects of abortion bans operate mainly through distance. In counties where the closest abortion facility was 50 miles away pre-Dobbs, a total ban is estimated to increase births by 0.8-1.0% if distance does not change, but by 2.1%-2.2% if distance rises to 300 miles—corresponding to the increase experienced by the average resident of a ban state. We also find that 6-week gestational age limits are nearly as impactful as total bans, underscoring the substantial burden these regulations impose. Limited appointment availability in destination cities modestly amplifies these effects. We do not observe evidence that the effects of bans on fertility have diminished over time, despite expansions in logistical, financial, and telehealth abortion support, underscoring the persistent role that geographic barriers play in abortion access.