Trey Kay, Amy Eddings, Matthew Hancock Published

Us & Them: The Geography Of Abortion

The image above is taken from a graphic that accompanied a 2023 NPR report about abortion access in the United States. The darker the color, the farther the distance residents have to travel to access abortion services.

State borders are the new front lines in the nation’s abortion battle. On this episode of Us & Them, host Trey Kay looks at the evolving geography of abortion. 

Since a 2022 U.S. Supreme Court decision overturned federal abortion rights, 21 states have either banned or restricted abortion access, including West Virginia. Meanwhile, West Virginia’s neighbor, Maryland, is one of 22 states that are protecting abortion rights and expanding access. 

Kay follows the decision of Women’s Health Center of West Virginia to move its abortion services from Charleston to a new clinic just over the border near Cumberland, Maryland. The move was intentional, because Western Maryland, like West Virginia, is a so-called abortion desert. The two regions have some deep political and cultural similarities. Western Maryland Republicans say they feel ignored by the overwhelmingly liberal, Democratic legislature in Annapolis. They say the new abortion clinic is not wanted or needed in their part of Maryland, and they blame the clinic’s presence on the fallout from Roe v. Wade’s defeat.  

This episode of Us & Them is presented with support from the West Virginia Humanities Council and the CRC Foundation.

Subscribe to Us & Them on Apple Podcasts, NPR One, RadioPublic, Spotify, Stitcher and beyond.

A young woman stands in a colorful waiting room. There are flowers painted on the wall.
Katie Quiñonez stood in the waiting room of the Women’s Health Center of Maryland, located about 10 miles south of Cumberland, Maryland. Quiñonez is executive director of this health center. She is also the executive director of the Women’s Health Center of West Virginia, which is located in Charleston and was West Virginia’s only abortion clinic until that state banned abortion in September 2022. The West Virginia center still provides reproductive health services, but in the summer of 2023, the Women’s Health Center relocated its abortion services to the Maryland clinic which is less than two miles from the West Virginia border.

Credit: Trey Kay/West Virginia Public Broadcasting
A large man sits in a chair wearing formal attire. Next to him, in a lower chair, is an English Bulldog.
Subsequent to the Dobbs v. Jackson Women’s Health Organization ruling in June 2022, Gov. Jim Justice signed a measure into law that banned abortions in West Virginia, with limited exceptions. Justice called the signed bill the “protect life” law. The law bans abortions in West Virginia except in cases when the mother’s life is in danger, or instances of rape and incest that are reported to law enforcement in a timely manner. Any abortion must be performed in a hospital within eight weeks for adults and 14 weeks for minors.

“I believe wholeheartedly that it does one thing that is absolutely so important. It does protect life.” — West Virginia Gov. Jim Justice

Credit: Trey Kay/West Virginia Public Broadcasting
A promotional image for Gov. Wes Moore.
Abortion access in the U.S. varied widely even during the Roe v. Wade era. Some states had lots of clinics, others had just a few. But every state had at least one. That changed when Dobbs ended the federal right to an abortion and let states come up with their own regulations.

Now, abortion access has become even more fragmented and deeply polarized. Fourteen states, including West Virginia, have essentially banned abortion. They have become what some call “abortion deserts.” Seven states have imposed stricter legal limits, while 22 states have moved to protect abortion rights and expand access. Maryland is one of those states.

In May 2023, Maryland Gov. Wes Moore approved laws that do several things. They allow a wider range of medical professionals to perform abortions. They maintain the privacy of abortion-related medical records. And they shield doctors and others from criminal investigations by states with more restrictive abortion laws.

“I’m very proud to sign legislation that will protect access to abortion in Maryland. In this moment of serious consequences for women and for all Marylanders, Maryland can and will lead on this issue of abortion access. And I want to say to all women who are out there who are wondering what will happen. Who are worried about their future. Please hear me loud and clear. Maryland will always be a safe haven for abortion access and abortion rights.” — Maryland Gov. Wes Moore

Credit: Gov. Wes Moore’s X (Twitter) Post
An adult woman in a blue dress and black cardigan poses for a photo while sitting in an orange chair.
Maryland Democrats, who control the state’s legislature, want abortion rights written into the state constitution. The General Assembly has placed a reproductive rights amendment on the ballot for November 2024. Democratic Del. Joseline Peña-Melnyk chairs the House Delegates’ Health and Government Services Committee, where the amendment was first considered. She said an abortion rights amendment is necessary, even though Maryland has been a reliably blue state for a long time.

“It’s necessary because we feel very strongly that we want Maryland to remain a state that protects abortion access. On the ballot this November, Maryland voters will once again be able to affirmatively and resoundingly say their reproductive freedom should be a constitutional right. It is the highest protection that we can give our constituents.” — Maryland Del. Joseline Peña-Melnyk

Credit: Maryland Del. Joseline Peña-Melnyk (D), MD 21
A photo of an adult woman wearing a white doctor's coat and a pink shirt. Her hair is dark, and she is smiling.
Maryland’s drive to protect abortion rights and access has attracted OB-GYNs to the state including Dr. Anne Banfield. She moved her practice to a hospital system in Southern Maryland after working for 13 years at a hospital in Elkins, West Virginia.

“I had spent a lot of years trying to recruit to our practice there and working a lot of shifts, taking a lot of calls. And then on top of that, you know, trying to advocate within the state, trying to advocate at the state government level to protect reproductive rights in West Virginia. And I got this great opportunity in Maryland, which is a very friendly and protective state from a women’s health and reproductive health standpoint. And we saw the writing on the wall, and I knew I was coming here and I was going to have to work less in a more friendly environment, and I just couldn’t pass that up. I don’t think I would have left otherwise.” — Dr. Anne Banfield, OB-GYN

Credit: Dr. Anne Banfield/MedStar St. Mary’s Hospital
An adult man and woman embrace in a side hug and pose for a photo.
Cresta Kowalski is the president of the Mountain Maryland Alliance for Reproductive Freedom. She said prior to the opening of the Women’s Health Center of Maryland, her group had been exploring how to bring an abortion clinic to Western Maryland.

“We were like, okay, a five to 10 year goal would be an indie clinic out here in mountain Maryland. And then in January, I get an email saying, ‘Hi, I’m Katie Quiñonez and my friend Ramsie Monk and I work with the Women’s Health Center of Charleston and we’d like to speak with you.’ And they had already found the location and it was perfect. It was made for the operation … I was relieved that we could have options for people that didn’t have options.” — Cresta Kowalski

Credit: Cresta Kowalski/Facebook
Michael Mudge, wearing a plaid button up shirt and a black hat, stands before a stained glass window in Bethany House of the Lord Church in Cumberland, Maryland.
Michael Mudge is the pastor and founder of Bethany House of the Lord, an evangelical Christian church. He and several other anti-abortion advocates from Western Maryland came together to form Abortion Free Allegeny. He said their goals are to let people know about the clinic, organize demonstrations against it, and raise awareness about pregnancy support centers and other abortion alternatives. Mudge said he and others opposed to abortion do not like having a clinic in their backyard, but he knows it has a right to be there.

“What we’re dealing with here in Allegheny County, Maryland, is a direct result of the Dobbs decision. The West Virginia Legislature took the opportunity after the Dobbs decision to pass legislation effectively banning abortion. And the Maryland state legislature, as in many other states, has responded to the Dobbs decision by radicalizing even more their pro-abortion legislation. So, we’re caught up in the middle of that. It’s just that here, we’re in a part of Maryland that doesn’t fit well in Maryland.” — Michael Mudge

Credit: Trey Kay/West Virginia Public Broadcasting

Mudge referred to the political segregation that has deepened in Maryland as it has across the country. 

There’s the rural, conservative, Republican Maryland of the western panhandle, the eastern Chesapeake Bay, and the counties north of Baltimore. And there’s the urban, liberal, Democratic Maryland of Baltimore City, Annapolis and the D.C. suburbs that dominates state politics.

David Karol, an associate professor of government and politics at the University of Maryland, said it wasn’t always like this.

Karol said his students were surprised to learn that in the presidential election of 1988, Republican George H. W. Bush won Maryland while Democrat Mike Dukakis won West Virginia.

“Which, you know, is just shocking to students, because that’s a complete reversal of the alignment that we see today,” Karol said.

A photo of a balding man wearing a blue button up shirt. He's smiling and posing for a photo.
“The [Maryland] legislature has been Democratic for about 100 years. The governorship has occasionally gone to Republicans, but seldom. And in presidential elections, Maryland has voted Democratic consistently since 1992.” – David Karol

Credit: David Karol/University of Maryland
An adult man with salt and pepper colored hair smiles for the camera while standing in front of a poster of his Maryland district.
Republican Mike McKay has represented Western Maryland in the Maryland General Assembly since 2015, first as a delegate and, for the last year, as a senator. He said his constituents have felt out of step with their overwhelmingly liberal Democrat fellow Marylanders. In 2021, then-Del. McKay and five other Republican lawmakers floated the idea of Garrett, Allegeny and Washington counties seceding from Maryland to become a part of West Virginia. They wrote a letter to the Republican leaders of West Virginia’s legislature to gauge their interest. It was a very, very long shot.

“We sent a letter and it became a dumpster fire, to be perfectly honest,” said McKay. “Everybody went crazy – ‘How are you leaving?’ Yada yada yada. And two of our members backed out. And the rest of us out of respect really just went our separate ways.”

McKay said his constituents are more aligned with West Virginia on abortion, too. He described himself as “pro-life” and said the Women’s Health Center of Maryland is not wanted or needed.

“I had a reporter from the Washington Post call me and do an interview, and she asked me, ‘How do you feel about this abortion clinic just moving across the state line, across the Potomac?’ I said, there’s never been a need for it. If there was a need for Planned Parenthood to move here, if there was actually this need, they would have been here by now. We have had women’s health clinics here for years. Probably 90 percent of everything that Planned Parenthood provides for women. And it’s important. That 90 percent is important to urban and rural women. It’s the abortion part that I say has been forced on our community, because Annapolis and Charleston had totally two different views, and our community has had to deal with the aftermath.” — Sen. Mike McKay

Credit: Trey Kay/West Virginia Public Broadcasting
Katie Quiñonez stands before a framed quote by Audra Lord, which hangs on the wall of the Women’s Health Center of Maryland. The quote reads, "Caring for myself is not self-indulgence. It is self-preservation, and that is an act of political welfare."
Katie Quiñonez said she’s not forcing anything on Western Maryland.

“We did a market analysis and looked at what health care was available in those counties in mountain Maryland. And we found that not only was there not an abortion provider, the nearest abortion providers for the people living in mountain Maryland were at least 100 miles away in any direction. But there was also a real lack of reproductive health care, outside of a hospital system located in Cumberland. And then beyond that, we met directly with folks on the ground living and working in those communities to determine that, yes, there is a need here. Not only do we need abortion access, we need reproductive health care.” — Katie Quiñonez

Credit: Trey Kay/West Virginia Public Broadcasting

This is what abortion care has become after the fall of Roe: a state-by-state fight over access, where abortion rights are determined by the lines on a map. The state line that divides West Virginia and Maryland runs through mountain communities that are alike in their topography, their culture and their political affiliations. 

But on one side of that state line, abortion is legal, while on the other side, abortion is a criminal offense.