This story has been updated.

When the Supreme Court on Friday overturned a landmark 1973 ruling that had provided constitutional protections for abortion access, abortion rights activists in Maryland were prepared.

They have been planning for this moment for years, creating a network of volunteers, donors and abortion providers to help an expected onslaught of women traveling here to terminate a pregnancy. As one of 13 states with strong laws that protect the right to an abortion, Maryland will play a key role for those in other states looking to end a pregnancy.

“Maryland has been and continues to be a really crucial state for abortion access,” said Lynn McCann, director of development and communications for the Baltimore Abortion Fund, which helps people obtain and pay for abortion care. “It’s the farthest south state on the Eastern Seaboard that has the strongest state-level legal protections. There has been a need for our work and our organization even before this urgency around Roe.”

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In light of the high court’s stunning 6-3 decision, 26 states are expected to outlaw or sharply limit access to abortion, according to the Guttmacher Institute, which tracks access to reproductive healthcare. Thirteen of those states have so-called “trigger laws” on the books which allow them to quickly bar access to abortion following the court’s decision. The future of abortion rights in the remaining 11 states is unclear.

“This isn’t a drill,” said Karen Nelson, executive director of Planned Parenthood of Maryland. “There are about 35 million women of reproductive age who live in states that are poised to outlaw abortion. That means about half of the women in this country who could become pregnant will no longer be able to get an abortion in their home state.”

The high court’s six conservative justices backed efforts to overturn Roe v. Wade, the 1973 ruling that had provided constitutional protections for abortion.

“The Constitution makes no reference to abortion, and no such right is implicitly protected by any constitutional provision,” wrote Justice Samuel Alito, who was joined by Justices Clarence Thomas, Neil Gorsuch, Brett Kavanaugh and Amy Coney Barrett. The latter three were appointed by former President Donald Trump. In a concurring opinion, Thomas proposed that the court should reconsider past rulings, including those on contraceptive access and same-sex marriage.

Chief Justice John G. Roberts Jr., supported upholding a restrictive Mississippi abortion law that was before the court, though he criticized his fellow conservative justices for going further and ending the abortion right. Liberal Justices Stephen Breyer, Sonia Sotomayor and Elena Kagan dissented.

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Planned Parenthood has been working in recent years to refurbish and expand its nine clinics in Maryland, Nelson said. The organization also lobbied on behalf of laws passed by the Maryland General Assembly this year to expand access to abortion. One law enables nurse practitioners, midwives and physician’s assistants to perform abortions (previously, only a physician could do the procedure). Lawmakers also funded a program to train medical professionals in abortion care.

Maryland’s chapter of Planned Parenthood is working closely with branches of the organization in nearby states, said Nelson. While West Virginia appears poised to outlaw abortion access, it is unclear what will happen in Virginia and North Carolina. “Part of this is preparing and part of this is being willing to pivot quickly,” Nelson said.

Planned Parenthood works closely with the Baltimore Abortion Fund, a nonprofit that helps women, trans and nonbinary people with every aspect of procuring an abortion. Someone who calls the fund’s confidential hotline might need help with airfare to Maryland or a ride from a rural part of the state to an abortion clinic in a more populous area.

“Seventy percent of Maryland counties don’t have an abortion provider,” said McCann. “Clinic access is really an issue in Western Maryland and the Eastern Shore. It can be a three hour drive to get to the nearest abortion provider.”

The Baltimore Abortion Fund also helps people cover childcare or a hotel room while they are recuperating. Many people who need assistance are in the second trimester of pregnancy, when the procedure costs an average of $3,500 in Maryland, McCann said. (A first-term abortion costs about $500.) Insurance plans often cover only a portion of the charges. Medicare and Tricare, the health insurance used by most members of the military, provide no coverage for most abortions. The Baltimore Abortion Fund provides an average of $4,500 in assistance to each pregnant person, McCann said.

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The Baltimore Abortion Fund was founded as a small, grassroots organization in 2014, McCann said. For the first six years, the fund relied on private donors, had a budget of about $100,000 and was run by a board of volunteers. However, in 2021, the organization took part in an initiative led by the National Network of Abortion Funds that increased its funding to $750,000, enabling the hiring of five full-time staff members. The local abortion fund works closely with counterparts in nearby states, especially those where abortion access is threatened.

“We receive around 2,000 calls for support each year, and we expect our call volume to nearly double post-Roe,” said McCann. “Already there has been an uptick in calls with Roe being threatened.”

Baltimore Mayor Brandon M. Scott announced Friday that his office would provide $300,000 in grants to organizations that offer abortion and family planning services.

Anti-abortion activists celebrate victory

While advocates for abortion access decried the court’s ruling, anti-abortion activists quietly celebrated a huge and rare victory. ”Generations have fought for life and generations have died over this,” said Laura Bogley of Maryland Right to Life. The court’s decision, she said, “marks a monumental victory for women and children in America.”

The organization, however, did not plan any rallies or celebrations, concerned that such events might be unsafe to hold, Bogley said.

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Abortion care remains legal in Maryland under a law that was passed and approved by voters in 1992. Since then, efforts to abolish or limit abortion access have failed in Maryland’s General Assembly, which is led and dominated by Democrats, who are largely in favor of keeping abortion care legal. Anti-abortion bills are introduced every year and promptly set aside without any action.

Bogley said Maryland’s “radical abortion policies” will lead to the state becoming “a hotspot for abortion tourism.” Bogley said she believes that abortion providers “traffick women and girls across state lines” into Maryland for abortions. Now with the high court ruling, Bogley is hopeful that Marylanders will be empowered to press their legislators for more regulations governing abortion.

Meanwhile, Dr. Carolyn Sufrin, a Johns Hopkins OB-GYN who provides abortions, said that organizations have been working to increase awareness of and access to abortion pills, which can be safely taken at home during the first 10-11 weeks of pregnancy. “Self-managed abortion through pills has shown to be safe when done with appropriate counseling,” she said.

Sufrin noted that many of the states expected to ban or severely restrict abortion access are also those with the worst track records on prenatal care, child care and assistance for parents. “This will disproportionately impact people in states that already don’t have a good track rate in supporting families,” she said.

She pointed to the Turnaway Study, which tracked 1,000 women over a decade. Half of the women were able to obtain an abortion; the others were unable to get an abortion and were forced to continue a pregnancy they did not want to keep. The women who had unwanted pregnancies were more likely to be unable to pay for housing or food, were more likely to be raising children alone in five years, and were more likely to develop chronic health conditions, the study found.

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Plans for a new abortion clinic

One person working to expand access to abortion services in Maryland is Dr. Diane Horvath, who is planning to open a standalone clinic in College Park this fall. Horvath, an OB-GYN, has been an abortion provider for 16 years, working in hospitals, Planned Parenthood locations and private clinics. She also teaches other physicians to perform abortions.

“I decided that abortion care was where my heart was,” she said. “A lot of health providers are committed to the idea of abortion care being safe and accessible, but don’t do them. If I don’t do abortions, there might not be someone there to do them. I can’t not do this.”

When Horvath and her business partner, nurse midwife Morgan Nuzzo, open their clinic, they plan to provide abortions to people in all trimesters of pregnancy. Maryland laws permit abortions until the point of viability, but make an exception for fetal abnormalities or if the pregnant person’s health is threatened. Horvath and Nuzzo previously worked at a Bethesda clinic that provided abortions through the third trimester, but the clinic ceased doing so last fall.

“Since November, the capacity for [third trimester abortion] care has decreased dramatically in this state,” said Horvath. “

Of the four clinics in the country which provide third-trimester abortions, two are in Maryland, said Baltimore Abortion Fund’s McCann. Horvath noted that laws restricting abortion access often lead to people to wait longer to terminate a pregnancy, since they have to travel further or visit a clinic multiple times before they can obtain the procedure. Moreover, states near those that have limited abortion access find that their clinics are overwhelmed with more patients.

For example, after Texas imposed in September a ban on abortions after the sixth week of pregnancy — a time when many do not even realize they are pregnant — clinics in neighboring Louisiana and Oklahoma were flooded with new patients and many local patients had to wait longer to end a pregnancy.

“The clinics are going to be filling up with people from out of state,” said Horvath. “People are going to have to wait two or three weeks to schedule an abortion.”

Horvath recently has been traveling to Tuscaloosa, Alabama to provide abortions for patients at a clinic there. Patients drive for hours to reach the clinic, including many from Louisiana, Mississippi and Florida, and then must pass through a bevy of aggressive anti-abortion protestors.

Alabama has a trigger law on the books, meaning it will likely be impossible to procure an abortion there after the court’s ruling. “The last time I left the clinic, I started to say, ‘See you next time,’ but then we realized there would not be a next time,” Horvath said.

Yet despite the challenges, Horvath feels more committed than ever to providing abortion care.

“I don’t think I can live in a world where I am watching abortion access being destroyed in front of me and not do anything about it,” she said before the ruling was handed down. “I have a daughter and I want her to grow up in a world in which she has the same access to reproductive care that I have had.”

Baltimore Banner reporter Pamela Wood and the Associated Press contributed to this report.

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