How Abortion Policy in Neighboring States is Reshaping North Carolina
By Dr. Mark Creech
Director of Government Relations
Return America
When the U.S. Supreme Court overturned Roe v. Wade in 2022, it did not outlaw abortion nationwide. Instead, it returned the constitutional authority to regulate abortion to the states. Each state was left to decide how it would address the abortion question.
In 2023, North Carolina made its choice.
That year, the General Assembly passed legislation limiting most abortions after 12 weeks of pregnancy, with specified exceptions. The law replaced a regime that had allowed abortion essentially through viability and was described at the time as a middle course – more protective than the old standard, but less restrictive than the laws adopted in many other states.
For many North Carolinians, that moment marked the end of the debate. The issue, they assumed, was settled. The law had changed. Time would tell how well it worked.
Time has now told us something important.
A Law that Worked – Until Demand Came from Elsewhere
In the months immediately following implementation of the 12-week law, abortions among North Carolina residents dropped sharply by roughly one-third. Over the course of the full year, however, that initial decline was partially offset, resulting in a more modest net reduction in resident abortions.
This matters a great deal. It demonstrates that gestational limits, informed-consent requirements, and enforcement provisions do affect behavior and do save lives.
At the same time, however, the total number of abortions performed in North Carolina increased.
The apparent contradiction has a straightforward explanation: North Carolina has become a destination state for abortion.
A rapidly growing share of abortions performed here are obtained by women traveling from out of state, often from jurisdictions that now prohibit abortion earlier in pregnancy or altogether. In 2023, more than one-third of abortions in North Carolina were obtained by non-residents, a dramatic increase from prior years. National estimates indicate the trend continued through 2024.
The point here: North Carolina’s law was intended to reduce abortion demand, but instead absorbed demand from elsewhere.
This is not conjecture or rhetoric. It is the predictable outcome of uneven gestational limits across state lines.
The Current Political Posture: “No Appetite” and a Veto Promise
Despite these developments, state leadership has signaled that no further action on the abortion issue is forthcoming anytime soon.
On the anniversary of Roe v. Wade, Governor Josh Stein reiterated that he will veto any legislation that further restricts abortion (no surprise there), declaring that such decisions should be made by women, and not politicians. Early in his term, he also issued an executive order directing state agencies not to cooperate with investigations involving providers of legal abortions.
Legislative leaders, for their part, have taken a more cautious posture. House Speaker Destin Hall and Senate leader Phil Berger have both indicated little appetite within their caucuses for additional abortion legislation, citing the unlikely passage of a veto-proof majority vote on abortion legislation, and a desire to “give more time” to the 2023 law.
Taken together, these statements suggest that, for now, state leaders believe the issue has been addressed as sufficiently as possible.
But policy consequences do not pause for political timelines.
NC Limits Have Become Accommodation
North Carolina’s 2023 law did several important things. It strengthened reporting and enforcement requirements. It addressed coercion and parental consent concerns, particularly for minors. It paired abortion limits with expanded support for pregnancy care and maternal health. This is all good – very good!
What it did not do, however, was to adjust the gestational threshold enough to prevent the state from becoming a regional abortion hub.
Because other states surrounding North Carolina have enacted stricter abortion limits, a 12-week law no longer functions as effectively as intended. Instead, it has become comparatively permissive. When neighboring states draw firmer lines, the practical effect is that abortion providers, advocacy networks, and referral systems redirect later-gestation demand into states like our own.
To North Carolina’s south and west, states such as South Carolina and Georgia now prohibit most abortions after approximately six weeks, often before a woman even knows she is pregnant. Tennessee and West Virginia have enacted laws that largely prohibit abortion altogether, with only narrow exceptions. In contrast, North Carolina’s 12-week limit allows abortions well beyond the point permitted in most of the region, making the state one of the few remaining destinations where later first-trimester abortions remain broadly available. The result is predictable: as access closes elsewhere, North Carolina increasingly absorbs abortion demand displaced from surrounding states.
A state that becomes an abortion destination is no longer merely regulating abortion access for its own citizens. It is facilitating abortions that other states, through their own democratic processes, have chosen to restrict.
“Give It Time” Is Not a Policy Answer
Supporters of the status quo argue that NC’s 12-week limit on abortions requires more time for evaluation. However, the destination effect is not speculative; it is already visible, measurable, and, sadly, accelerating.
Waiting does not neutralize this reality – it only entrenches it. Clinics expand to meet imported demand. Travel assistance networks are maturing. Abortion becomes further normalized as a regional service industry rather than acknowledged as a profound moral issue involving two lives, not just one.
If a law’s unintended consequences are clear, prudence demands correction – not resignation.
Why Further Legislation Remains Necessary
It would be disingenuous to suggest that abortion at any stage of pregnancy is morally acceptable. Nevertheless, at the very least, public policy should reflect coherence when full justice is politically constrained.
North Carolina has already recognized the importance of enforcement, transparency, parental rights, and alternatives for women. What it has not yet addressed is the structural incentive created by its gestational limit – an incentive that draws later-term abortion demand from beyond its borders.
So long as this disparity remains, North Carolina will continue to function as a pressure valve for abortion policy in the Southeast, regardless of how carefully its leaders avoid the subject.
The Question Before the State
The question today is not whether women face difficult circumstances. They do, and they deserve compassion, care, and genuine support.
The question is whether North Carolina’s laws should be allowed to transform the state into a regional abortion destination, absorbing the moral consequences of abortion policies other states have chosen, in good faith, to reject.
Leadership may say there is no appetite for further debate. Lawmakers in caucus may be saying, not now. The Governor may be promising vetoes. But laws are not judged by political expedience. They are judged by their effects.
And the effects of North Carolina’s current policy are no longer theoretical; they are already apparent, and it is not good.
Silence is not neutrality. Inaction is not wisdom. It is consent.
