This article is part of a larger series titled “The End Of Roe.” Head here to read more.
The looming U.S. Supreme Court decision on abortion is expected to upend access to the procedure as we know it, leaving in its place a patchwork of states where the legal right to abortion varies and bottlenecking patients in places where the procedure remains safe and accessible.
“This will truly be a public health crisis like this country has never seen before,” said Dr. Colleen McNicholas, who serves as the chief medical officer for reproductive health services of Planned Parenthood of the St. Louis Region, or PPSLR.
“We are now going to be mass mobilizing tens of thousands ― perhaps millions ― of people for basic reproductive health care,” she said of the patients in the 22 states that will automatically outlaw or severely restrict abortion if the court strikes down Roe v. Wade ― which a bombshell leaked draft indicates the justices are planning to do.
McNicholas’ Planned Parenthood branch operates the sole remaining abortion clinic in Missouri and one just over the border in Illinois, which it opened in 2019 as the fight over abortion in Missouri began exploding. Abortion providers across deep-blue Illinois, meanwhile, are gearing up to operate as a so-called “abortion island” surrounded by a sea of states ready to outlaw the procedure as soon as the court strikes down Roe.
“This will truly be a public health crisis like this country has never seen before.”
- Dr. Colleen McNicholas of Planned Parenthood of the St. Louis Region
For people in Missouri ― where Republican Attorney General Eric Schmitt said an all-out abortion ban would go into effect “immediately” if Roe falls ― Arkansas, Tennessee, Kentucky, Indiana, Wisconsin and beyond, Illinois may soon be their closest destination for an abortion.
“We feel like we have a responsibility as an abortion oasis in this vast desert from care in the Midwest,” said Jennifer Welch, the president and CEO of Planned Parenthood of Illinois. She’s anticipating anywhere from 20,000 to 30,000 additional out-of-state abortion patients a year if the court strikes down Roe ― a massive leap from the roughly 60,000 people the provider has seen annually for all reproductive health care needs in recent years.
There’s a similar feeling at Planned Parenthood of the Rocky Mountains, or PPRM, which operates in several mountain west states, including two that are poised to become abortion safe havens: Colorado and New Mexico.
Dr. Kristina Tocce, PPRM’s medical director, spoke frankly when asked if she’s confident they’ll be able to meet the demand. “Not at all,” she said. “I feel confident that we are going to deliver excellent, safe, compassionate abortion care to as many patients as we can, which will be more patients than we have served in the past, but if you just look at the numbers ... it’s just such an exponential increase.”
There are more than 30 million women and girls of reproductive age in the U.S. at risk of losing access to legal abortion in their states, Tocce emphasized. Realistically, she said, “there are going to be patients that simply cannot access care.”
If Roe falls, abortion providers in Colorado and New Mexico will be the closest abortion destinations for many people in several states likely to cut off access, including Utah, Arizona, Wyoming and Nebraska. They’re already seeing a major influx in patients from Texas, which enacted a six-week abortion ban last September, and Oklahoma, which followed suit with an even more restrictive law.
Expanding telemedicine services is essential to keep up with demand, Tocce said, noting that PPRM had already begun broadening those systems in recent years because of the COVID-19 pandemic. For much of the first trimester, pregnancy may be terminated with a series of prescribed pills that don’t necessarily require a clinic visit.
“If we can take care of as many patients as we can outside of the brick-and-mortar facilities, that’s going to be so instrumental in getting more patients who need in-person visits into those centers,” she said.
In Illinois, Welch said, they’ve been preparing for the fall of Roe since the day former President Donald Trump was elected in 2016.
“Every time that president got another nominee on the Supreme Court, we knew that it was over,” she said of abortion protections.
Since then, the Illinois branch has embarked on a big fundraising campaign, doubling the size of some existing clinics and building new ones along the borders of states that are hostile to abortion, including one near Indiana in 2018 and one near Wisconsin in 2020. They’re welcoming any out-of-state clinic staff who want to start assisting with the surge in Illinois.
“Clinics have been turning every available space into procedure rooms, and it hasn’t been enough to meet the need.”
- Elizabeth Nash, state policy expert at the Guttmacher Institute
The additional capacity for abortion care has already proven essential in recent years as nearby states whittled away at access with mandatory waiting periods, medically unnecessary ultrasounds and other barriers. The abortion bans in Texas and Oklahoma ― which relied on a legal loophole to proceed without the Supreme Court’s approaching ruling ― have only compounded that need in recent months.
Elizabeth Nash, a state policy expert at the Guttmacher Institute, said it’s not unusual for clinics to schedule appointments two to four weeks in advance right now, due in part to absorbing patients from Texas and Oklahoma and to the national health care worker shortage.
If the court strikes down Roe as expected, Nash said, “I am anticipating that the influx of patients will be such that the wait times will increase beyond that.”
“Clinics have been turning every available space into procedure rooms, and it hasn’t been enough to meet the need,” she said of blue states’ efforts to absorb new patients.
Having to wait longer for an abortion may mean patients need a more involved procedure and have a longer recovery time. One clinic in Colorado, another abortion island state, told Kaiser Health News in March that it had recently purchased equipment enabling staff to perform abortions up to 20 weeks into pregnancy in anticipation of longer wait times.
PPSLR has seen a 50% increase in abortions after 15 weeks of pregnancy since the Texas ban went into effect compared to the year prior.
Alongside staffing needs, McNicholas’ biggest concern is ensuring practical support for patients who must leave their home states for abortion care.
“We could add another 150 clinics to Illinois, but if patients cannot get to them, then it doesn’t matter,” she said.
Key to that undertaking, McNicholas said, is a regional logistics center that PPSLR opened in January in partnership with Hope Clinic, another Illinois abortion provider near the Missouri border. There, case workers have been helping patients make sure the cost of their treatments is covered by abortion funds and connecting them with practical support organizations focused on helping patients travel for abortion care.
That can be an expensive endeavor. Fund Texas Choice, a group that’s been assisting patients traveling for abortions since 2013, told HuffPost last year that out-of-state trips can add at least $800 to the cost of an abortion. That includes transportation, lodging, food, medication and child care.
“The health care part is the easy part,” McNicholas said, adding that she believes PPSLR and the Hope Clinic can manage the annual 15,000 new patients they’re expecting to come to southern Illinois for abortions. “But we really have to be able to manage the navigation piece and the logistics piece that folks are going to be facing.”
The logistics center has four case workers on staff right now who are trained to help navigate more than 50 different abortion funds, McNicholas said, adding that it hopes to hire up to 14 additional employees.
Simply informing people that abortion will remain legal in some states in the event Roe falls is also important at this juncture, Welch said.
“We’ve had patients call asking, ‘Can I still come in to my appointment? Is it illegal yet?’” she said. “It’s never going to be illegal in Illinois; not if we have anything to say about it.”