A third of South Carolina women who responded to a nationwide survey said they’ve gone without reproductive health care since the U.S. Supreme Court ruled in 2022 that the Constitution does not guarantee a woman’s right to an abortion.
“It is sad that the number (of underserved women) is that high,” said Dr. Kari Allen-Harrington, a Columbia doctor who consults women on fertility options. “That is a large (group) of women who need care in one of the richest nations in the world, and they aren’t able to get it,” she said.
The Urban Institute, a nonprofit research organization in Washington, D.C., found 31% of the 2,780 women, ages 18 to 49, in South Carolina did not receive one or more types of reproductive care in 2024 and 2025, according to responses to its Reproductive Health Experience and Access Study (RHEA).
Reproductive health care includes pelvic exams and screenings for cervical cancer, care for irregular or painful periods, fertility assistance, gender-affirming and menopause symptoms care.
Some of the barriers to care, according to an Urban Institute press release, includes the cost of services, lack of medical insurance and difficulty securing a doctor’s appointment.
In South Carolina, the survey responders with the highest rate of unmet needs were: disabled, 48%, don’t have a college degree, 33%, no health coverage, 39%; low-wage earners, 38%; identify as other sexual orientations and gender identities, 49%.
About two dozen Lowcountry women, who were contacted via email, declined a Charleston City Paper request to comment about the survey.
Barriers to care
Emily Johnston, the study’s co-principal investigator, said the research did not attempt to determine what caused the challenges to reproductive health care. “The estimates reflect a point in time from 2024 to 2025 when South Carolina had more restrictive abortion policies in place following the Dobbs v. Jackson Women’s Health Organization decision,” she said. “We can’t attribute the data that we are observing to that decision.”
The survey was mailed to each state, but 50,000 people in 13 states responded to it, she said. After the surveys were collected, the research team met with focus groups in each of the 13 states, including South Carolina. The focus groups were held in Southern, Northeastern, Midwestern and far West states.
South Carolina’s overall average of 31% is 1 percentage point above the national average, according to the survey.
Three focus groups were organized in Columbia and Orangeburg in fall 2025, Johnston said. During the visits, the research team met with 32 people, including policymakers, health care providers and advocates. The results of those discussions with people ranging from 18 to 49 will be released on Aug. 24.
Focus group participants said South Carolina has a shortage of OB-GYN providers with many counties lacking obstetricians, Johnston said. People who were interviewed “expressed concern that providers were leaving the state or choosing not to complete medical training in South Carolina because of the restrictive abortion policies that were implemented following the Dobbs decision,” she explained.
South Carolina has not expanded Medicaid eligibility to childless adults under the Affordable Care Act, Johnston noted. Researchers have observed people who are uninsured are more likely to experience unmet needs to care and barriers to health services, she explained.
Using the data
The Supreme Court’s Dobbs decision overturned Roe v. Wade. In South Carolina, the Fetal Heartbeat Act bans abortions after the sixth week of pregnancy. A South Carolina woman has joined with Planned Parenthood to sue for a longer time period.
Allen-Harrington, the Columbia physician, said she has many patients “who don’t know they are pregnant at five weeks or six weeks.” And when they are told they are pregnant, then suddenly some women have to make a quick decision to find care, she said.
Allen-Harrington said it is curious that the percentage of women in South Carolina who went without care closely mimics the national average of 30%. In a state with the most restrictive abortion laws, the state’s average should be higher, she said. “There is some other force at work keeping that number from being even higher,” she added.
There are groups throughout South Carolina “who have decided that women’s health is still a priority,” she said. “They are filling the gap to meet the needs even when we see major federal and state cuts to” budgets for medical services.
The study does not show outcomes by race. Allen-Harrington said she expects reproductive health care barriers to be higher for Black women. “We know that Black women are the canaries in the coal mine,” she said.
In Columbia, Allen-Harrington practices general family medicine. She also has a nonprofit group, Sanctuary Birth and Fertility, with her husband, Dr. Jay Harrington, that offers infertility, birth and postpartum services “We try to cover the reproductive spectrum, but we focus on infertility,” she said.
Sanctuary Birth and Fertility partners with Lowcountry birth and childcare workers, she said. The practice has plans to expand to the Hollywood area.
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