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 and appointment availability at the nearest facility where abortion remains legal. We find that bans alone increase births, but their total impact depends on geographic barriers to access. Even in counties where distance and appointment availability remain unchanged, a total ban leads to a 1.0% increase in births, suggesting a chilling effect—potentially due to legal uncertainty, misinformation, or logistical hurdles—that is independent of measurable barriers. However, the effects grow substantially with travel burdens. In counties where the nearest abortion facility was 50 miles away pre-Dobbs, a total ban increases births by 2.8% when distance rises to 300 miles. Limited appointment availability in destination cities further amplifies these effects, resulting in an additional 0.4 percentage point increase in births. The largest increases occur among Black and Hispanic women, those without a college degree, and unmarried women. We do not observe evidence that the effects have diminished with time despite expanded logistical, financial, and telehealth abortion support, underscoring the persistent role that geographic barriers play in abortion access.