An estimated 5,600 South Carolina women terminated their pregnancies somewhere outside the state in 2015 — a number higher than anywhere else in the country — an analysis by The Post and Courier found. 

The Centers for Disease Control and Prevention reported in November that the U.S. abortion rate has been steadily declining. But numbers attached to that report, and others provided by the state health department, indicate that decades' worth of legislative attempts to reduce abortions in South Carolina have not stopped women from terminating their pregnancies. In fact, the rate of South Carolina women who had abortions last year was exactly the same as it was 20 years ago. Increasingly, though, it appears women are getting the procedure done outside the state. 

Last year, almost 11,000 women who claimed a South Carolina county as their residence had abortions, but fewer than half that many procedures were performed by providers across the state, according to numbers published online by the S.C. Department of Health and Environmental Control.

What has changed dramatically in South Carolina in recent decades is the number of procedures performed by in-state providers. In 1998, 8,801 abortions were performed in South Carolina. Last year, that dropped to 5,112.

These numbers are cited by pro-life group South Carolina Citizens for Life as proof that legislation to restrict abortions in this state is working. 

"South Carolina Citizens for Life is responsible for South Carolina, not for any other state where women who claim to be from South Carolina abort their children," said Holly Gatling, the group's executive director. 

She referenced a timeline that shows in-state abortions have plummeted alongside the passage of more than a dozen abortion-related laws since 1988.

"All we can do is work to reduce the number of abortions occurring in South Carolina, and we have done that and continue to do so," Gatling said.

But the group's primary focus on one set of numbers disguises the rate and frequency of women who live in South Carolina and get abortions somewhere else. Gatling characterized the premise that thousands of women in this state travel outside South Carolina for the procedure as "invalid" because the state health department has no way of verifying a patient's real address. 

"It is completely contrary to the DHEC data clearly showing the number of abortions occurring in South Carolina is declining," she said. 

Meanwhile, other experts said they have no doubt South Carolina women are traveling outside the state for abortions.

"What we’re seeing is that when women need an abortion, they’re going to go get one," said Ashley Lidow, the associate director of policy and government relations for the Women's Rights and Empowerment Network, a group that opposes abortion restrictions.

Lidow said South Carolina's abortion laws force women to spend more money and travel farther for the procedure. But these laws do not ultimately stop them from terminating pregnancies, she said.

"When their decision is made, it’s going to happen."

Tracking abortions

The CDC and public health agencies in most states, including South Carolina, track abortions in two ways: by residence and occurrence.

The number of abortions by "residence" refers to the number of women who claim to live in any given state and seek an abortion during the year. "Occurrence" refers to the number of abortions performed by providers in that state.

In some states, those numbers generally match. A patient decides to get an abortion and goes to a nearby provider to get one.

But that isn't always the case. Some women cross state lines to get abortions — for a variety of reasons. A woman in Rock Hill, for example, would likely drive to a clinic in Charlotte because it's closer than an abortion provider in Columbia or Greenville. A female solider stationed out-of-state may not return home for the procedure. A woman in Charleston might bypass the Planned Parenthood clinic in West Ashley for a provider in Savannah to avoid crossing paths with someone she knows. 

But residence and occurrence numbers don’t always match for other reasons, too, including states' differing rules governing abortion. Some have placed more restrictions on the procedure than others.

In South Carolina, for example, doctors are almost always prohibited from performing the procedure during the second half of a woman's pregnancy, even in cases of rape or incest. 

Dr. Amy Crockett, a Greenville doctor and vice chair of the South Carolina section of the American College of Obstetricians and Gynecologists, said some of her patients have been faced with "heartbreaking" decisions when their unborn infants have been diagnosed with fatal defects past the 20-week point of their pregnancies. In South Carolina, those women must travel out of state for abortions or carry the baby to term knowing it will almost certainly die, Crockett said. 

"That’s a very small number of patients," she said. 

Medical University of South Carolina spokeswoman Heather Woolwine said the state's 20-week abortion ban adversely affects both women and doctors because it prevents patients from receiving comprehensive care in their own community. Some of them are forced to leave South Carolina to terminate a pregnancy. Others may not have the financial resources to do so, she said. 

"The result is that they are not truly able to make their own medical decision based on their personal ethics and morals in consultation with their health care provider," Woolwine said. 

Crockett, of the Greenville Health System, said women travel outside South Carolina for other reasons, too. Some of them, for example, find lower prices in larger markets like Atlanta, she said. 

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"Most insurance companies don’t pay for abortion," Crockett said. "It’s easy to shop around for prices."

The CDC report published last month shows that abortion providers in both North Carolina and Georgia performed thousands more procedures in 2015 than women who lived in those states requested. In Georgia, 14.5 percent of all abortions performed that year were given to out-of-state patients. In North Carolina, the percentage was 17.5. (In South Carolina, the percentage of out-of-state patients seeking abortions was much lower in 2015 — 5.9 percent.)

A spokesman for the state health department explained there is no way for DHEC to verify that an address given to an abortion provider by a patient is accurate. Some women may provide false addresses, he acknowledged, which may skew the number of abortions by residence. 

Gatling, with Citizens for Life, said she only trusts the accuracy of DHEC's abortion data as it pertains to the number of procedures performed by providers in this state. She called the agency's other numbers "essentially useless." 

For its part, the CDC said in its November report there are limitations to tracking abortions by a woman's state of residence. These numbers likely result in "an underestimation of abortions for states where residents frequently obtain abortions out of state," the report's authors noted. 

'Heartbeat Bill'

In 2016, after then-Gov. Nikki Haley signed South Carolina's 20-week abortion ban into law, she held a ceremonial second signing at an Upstate school for children with disabilities.

“I’m not pro-life because the Republican Party tells me,” Haley said at the event. “I’m pro-life because all of us have had experiences of what it means to have one of these special little ones in our life.”

Early next year, lawmakers in Columbia will attempt to revise that 20-week ban with a more restrictive "Heartbeat Bill." The proposal, if signed into law, would prohibit doctors from performing an abortion on any fetus after a heartbeat has been detected. Typically, doctors are able to detect a heartbeat during the first trimester of pregnancy. 

"I believe that all life is sacred, that an unborn child has a right to life, just like a child that has already experienced birth," said Sen. Larry Grooms, a Charleston Republican and one of the bill's primary sponsors. A similar proposal was filed last week in the S.C. House of Representatives, as well as a "dismemberment" bill that would prohibit an abortion procedure known as "dilation and evacuation."

Three outpatient clinics — in Charleston, Columbia and Greenville — are licensed to provide abortions in South Carolina. Some hospitals also terminate pregnancies if the medical need arises. CDC data shows more than 99 percent of women who sought abortions in South Carolina in 2015 did so before the 14th week of their pregnancy. 

Grooms said there's no real way to prevent South Carolina women from traveling outside the state for the procedure. Laws in other states are different, he said, and politicians here can't change that. 

"The General Assembly of South Carolina can’t control what other states do," Grooms said. "We can control what we do."

He expects Right to Life, the Baptist Convention and the Catholic Diocese of South Carolina to support the Heartbeat Bill. 

Post and Courier reporter J. Emory Parker contributed to the data analysis for this article. Reach Lauren Sausser at 843-937-5598.