North Carolina has become a critical access point for abortion care in the Southeast, as surrounding states enact stricter bans and the Trump administration rolls back federal protections for emergency abortion services.
Dr. Beverly Gray, an OB-GYN and associate professor at Duke University, says she regularly sees high-risk patients who travel from out of state—often in emergency situations—to receive life-saving abortion care.
“Over these past couple of years, we’ve already seen patients who have had emergency or urgent situations have to leave their state for care, and I think that’s probably going to continue to happen,” Gray said. “I would say a couple of times a month, there are patients that we see or who are referred to our center, that have these conditions where abortion care can save their lives.”
That already fragile landscape has grown more uncertain in the wake of a recent decision by the Trump administration to rescind a 2022 directive issued under President Biden. The original guidance required hospitals to provide abortion care in emergencies under the Emergency Medical Treatment and Labor Act (EMTALA).
While EMTALA itself remains in effect, the now-revoked guidance had clarified that abortion must be included in stabilizing care when necessary to protect a patient’s life or health.
“If there’s an emergency situation and an abortion is necessary to stabilize the patient, then that care should be provided,” said Gray. “So whenever new guidance comes out, it can create confusion, even in states where there are protections.”
North Carolina’s current law bans most abortions after 12 weeks, with exceptions for rape, incest, life-threatening emergencies, and certain fetal anomalies. The law also requires in-person counseling and a 72-hour waiting period—barriers that advocates say can delay urgent care, especially in rural parts of the state where providers are scarce.
The rollback of the Biden-era EMTALA guidance has raised concerns among doctors who fear hesitation or legal ambiguity could slow critical decision-making in emergency situations. Governor Josh Stein called the move “profoundly troubling,” stating, “Abortion care is medical care, and hospitals and doctors need to be able to provide life-saving care if a woman’s health is at risk.”
The Trump administration’s action also comes as Republicans in the North Carolina General Assembly continue to push for even more restrictive abortion policies. House Bill 804, introduced earlier this year, would ban nearly all abortions from the moment of conception, with only narrow exceptions. While the bill is currently stalled, reproductive rights advocates warn it could be revived in future sessions.
The consequences of these shifting policies are already being felt. According to a 2025 report by the Guttmacher Institute, more than 45,000 abortions were performed in North Carolina in 2024—about 16,700 of them for out-of-state patients. That makes the state the second-highest provider of out-of-state abortions in the country, after Illinois.
“We know that the vast majority of states in the Southeast have little or no access to abortion,” said Dr. Katherine Farris, Chief Medical Officer for Planned Parenthood South Atlantic. “If people can’t get it close to home, they will travel wherever they can.”
Planned Parenthood South Atlantic has expanded its staffing and clinic hours to meet increased demand, offering appointments six days a week and extending hours at high-traffic locations. “What we did is we looked at the location that had the highest demand and we said, ‘How can we offer more appointments?’” Farris said.
Patients are coming not only from neighboring states like South Carolina, Georgia, and Florida—where abortion is banned after six weeks—but also from as far away as Texas and Tennessee, where bans are even more restrictive.
Reproductive rights advocates say the Trump rollback only compounds the uncertainty patients and providers face. “The Trump administration has sent a clear message: We are willing to let pregnant people die rather than affirm a person’s right to receive a life-saving abortion,” said Jillian Riley, North Carolina Director of Public Affairs for Planned Parenthood South Atlantic.
As abortion access continues to shift rapidly nationwide, North Carolina remains both a battleground and a refuge—caught between legal uncertainty, medical necessity, and a growing demand from patients with nowhere else to turn.
