The Washington PostDemocracy Dies in Darkness

Opinion Clinics where abortion is legal are at a breaking point. They need help.

Signs are displayed in the window at the Hope Clinic for Women, an abortion care provider in Granite City, Ill., on July 1. (Whitney Curtis for The Washington Post)

Coverage of the post-Dobbs v. Jackson Women’s Health Organization landscape has rightly focused on the states that have banned or severely restricted abortion. There, the lives, health and futures of women are in peril.

But there’s another critical story underway: Large numbers of women are traveling to states where abortion is still legal. Clinics and doctors in those places are stressed to the breaking point and in need of help.

NPR reports, “Already, clinics in states like Colorado and Illinois, which have less restrictive laws, have been reporting an influx of patients from neighboring states.”

Multiple OB/GYN doctors and abortion researchers tell me that clinics in states such as New Mexico (servicing a wide swath of the Southwest) and Illinois (providing services for states such as Missouri and Tennessee) have patient loads that are three times what they were before Dobbs. Worse, wait times at clinics now can be weeks, meaning women who might have been able to obtain early-term medical abortions will need later-term abortion procedures. Some clinics are operating seven days a week with extended hours and still cannot keep up with the influx of patients.

This provides further proof that forced-birth policies are largely ineffective at reducing abortions; instead, they only add cruel burdens to women who must travel long distances for care. Abortion restrictions that Missouri put in place in recent years resulted in the number of abortions provided there dropping significantly between 2017 and 2020. “During the same period,” NPR reports, “the abortion rate for residents increased by 18% when out-of-state abortions were taken into account.”

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For a long time, places where abortions remain accessible have been referred to as “havens.” But abortion providers have stopped using that term, which suggests these states are aberrations from the norm, rather than places that simply abide by medical standards of care.

Consider, for example, the case of a membrane rupture in the second trimester, which would make the fetus no longer viable. If this happens in a state that does not permit abortion, the woman — who is at risk of infection and hemorrhaging, but might not be in imminent risk of death — would have to wait for an appointment in another state and potentially travel long distances for an abortion.

Telemedicine is only a partial solution. In Illinois, for example, a patient doesn’t need a preexisting relationship with a doctor to have a virtual visit. She can also receive a medical prescription via telemedicine. But the patient can only pick up the medicine at a clinic in the state or have the pharmacist ship it to an Illinois address or P.O. box. Melissa Grant, the chief operations officer of the abortion provider Carafem, told me that telemedicine appointments at her clinic in Skokie, Ill., have increased 20 percent compared to last year. In-person appointments, by contrast, have soared 130 percent.

The problem will get worse when injunctions on certain state bans lift or when state legislatures reduce access to abortions. Indiana’s legislature began its special session on Monday to consider a draconian ban that would prohibit all abortions except in cases of rape, incest or “substantial permanent impairment” to the life of the mother. (Moderate impairment is not enough, apparently.) Clinics there will likely need to send their own patients elsewhere soon.

Colleen McNicholas, a practicing OB/GYN who serves as the chief medical officer of Planned Parenthood of the St. Louis Region and Southwest Missouri, tells me that abortion service providers are already overwhelmed. Only 11 of Illinois’s 102 counties have an abortion provider. In five of those counties, in-clinic procedures are not available; providers only offer medication abortion that is limited in its usage to the first 11 weeks of a pregnancy.

McNicholas told me that an estimated 14,000 additional patients are expected to seek abortion care in southern Illinois. If Indiana’s ban goes through, that number will rise. On average, $1,500 is needed to care for each patient, meaning the total funding needed to support abortion access in southern Illinois — including logistics, travel and child care — is $21 million.

States that still offer abortions might need to act to prevent forced-birth states from harassing doctors and patients who travel for care. For example, in New Mexico, the Associated Press reports, “Gov. Michelle Lujan Grisham signed an executive order that prohibits cooperation with other states that might interfere with abortion access in New Mexico, declining to carry out any future arrest warrants from other states related to antiabortion provisions. The order also prohibits most New Mexico state employees from assisting other states in investigating or seeking sanctions against local abortion providers.” The governors in Maine and Nevada have issued similar orders.

Poor women and women of color will feel the brunt of new abortion bans. They will have to jump through hoops and often travel long distances. The result will be more sick women, more maternal deaths (during and immediately after pregnancy) and more forced births that women are economically, emotionally or physically unable to handle. As always, it is the most vulnerable women who will suffer the most.

Roe v. Wade and abortion access in America

Roe v. Wade overturned: The Supreme Court has struck down Roe v. Wade, which for nearly 50 years has protected the right to abortion. Read the full decision here.

What happens next?: The legality of abortion will be left to individual states. That likely will mean 52 percent of women of childbearing age would face new abortion limits. Thirteen states with “trigger bans” will ban abortion within 30 days. Several other states where recent antiabortion legislation has been blocked by the courts are expected to act next.

State legislation: As Republican-led states move to restrict abortion, The Post is tracking legislation across the country on 15-week bans, Texas-style bans, trigger laws and abortion pill bans, as well as Democratic-dominated states that are moving to protect abortion rights enshrined in Roe v. Wade.

How our readers feel: In the hours that followed the ruling in Dobbs v. Jackson Women’s Health Organization, Washington Post readers responded in droves to a callout asking how they felt — and why.