When we talk about the wave of proposed abortion restrictions sweeping the nation, we often focus on people in the states where those bans would go into effect. Those in Alabama who wouldn’t be able to access abortion unless their health or lives were in danger. People in Georgia, Kentucky, Louisiana, Mississippi, and Ohio who would be barred from getting an abortion after six weeks of pregnancy. Those in Missouri who would be beholden to a law outlawing abortion after eight weeks’ gestation. The doctors who could face criminal charges if they were to perform certain types of abortions anyway.
This might make it sound like we’re living in a dystopic horror show, but remember that abortion is still legal in all 50 states. None of these restrictive laws are actually in place. According to a policy analysis by the Guttmacher Institute, the goal of these bills is to eventually reach the Supreme Court and overturn Roe v. Wade, the court case that legalized abortion in 1973. With a decidedly more conservative Supreme Court, many anti-choice state lawmakers feel there’s an opening to repeal the law, which is why there’s been a cascade of restrictive abortion bills passed this year.
It’s unlikely that all (or even any) of these restrictions will actually go into effect. Organizations like In Our Own Voices and All* Above All are advocating for abortion rights nationwide, and the American Civil Liberties Union and Planned Parenthood Federation of America are tirelessly fighting these proposed bans in court. But the improbability of these bans going into effect doesn’t provide as much comfort as one would hope.
These bans are simply the latest in a long line of attacks on abortion access. They represent a steady onslaught that could essentially strip some states of safe and legal abortion, even if the specific restrictions above are never enacted. Abortion providers across the country are preparing for the possibility that certain states will effectively ban the practice more than they already have, forcing more people to travel across state lines to receive abortions. For instance, Missouri’s last remaining abortion clinic almost closed in June due to a TRAP (Targeted Regulation of Abortion Providers) law that made it harder to get the clinic’s license renewed, not because of a statewide abortion ban.
Far too many people already have to travel to get abortions. Not only does this place an undue burden on them, but it can also impact clinicians and patients in the states they travel to.
“[Some] states are shifting the responsibility of ensuring women can exercise their constitutionally protected right to safe, accessible abortion care onto their neighboring states,” The Very Reverend Katherine Ragsdale, interim president of the National Abortion Federation (NAF), tells SELF.
NAF offers financial assistance to people who have trouble accessing abortions, and they also provide things like legal or financial aid and continuing education to abortion providers. Fittingly, NAF is already working to help prepare clinics in states like Arkansas, Oklahoma, Tennessee, Illinois, Florida, and Kansas for a possible influx of patients due to possible clinic closures in neighboring states, Ragsdale tells SELF.
Abortion providers only expect this shifting burden to increase if anti-choice politicians are successful in reducing—or even ending—safe, legal abortion access in some states.
“We’ve seen people come from as far away as Mississippi for care at our Kansas and Oklahoma centers,” Julie Burkhart, CEO of Trust Women, a health clinic with locations in Wichita, Oklahoma City, and Seattle, tells SELF. “If states around us are allowed to put more restrictions, I can’t tell how many people we would be serving, but it would be more.”
Here’s what abortion providers in states close to those with the most restrictive proposed bans are anticipating—and how they’re preparing to fight back.
Finding more doctors and staffers is one of the biggest concerns for clinics in states near to those trying to put these bans into effect, Ragsdale says.
Burkhart and her team at Trust Women’s Kansas clinic know this well, she says. According to a preliminary report from the Kansas Department of Health, it’s estimated that in 2018, about 47 percent of people seeking abortion care in Kansas traveled from Missouri. If that out-of-state number goes up significantly, the number of providers will need to go up, too.
Burkhart says some of her Trust Women staffers are trying to figure out how they can get physicians from nearby states licensed by Kansas or Oklahoma medical boards quickly in order to practice and provide abortions in those states. (Washington, where Trust Women also has a clinic, had more than 50 abortion-providing facilities as of 2014, according to the Guttmacher Institute, so access there isn’t as much of a dire issue.) This could be helpful if, say, a doctor is based in Missouri but can realistically commute to Kansas sometimes to help manage the extra caseload of Missouri patients forced to travel.
The Kansas and Oklahoma medical boards both explain that this process can take an average of up to eight weeks, but in Burkhart’s experience, it can often take longer.
“I was trying to license a physician from Colorado, and there’s an interstate compact with Kansas, which is supposed to make getting doctors certified to practice across state lines easier,” Burkhart says. “But it didn’t go through. So, we have to start all over again. Meanwhile, pregnancy doesn’t stop.” As Burkhart explains, they’re also trying to quickly find and onboard other staffers, like people who can work at clinic front desks.
Burkhart has been through this before. The Trust Women Oklahoma City clinic saw a “larger than predicted” increase in the number of patients after about half of Texas abortion clinics closed a few years ago, she says.
In 2013, Texas passed House Bill 2, which banned abortion after 20 weeks and also put various TRAP laws into effect. A 2016 study in the American Journal of Public Health surveyed 398 people who were seeking abortions at 10 different abortion clinics in Texas in mid-2014, finding that, for those who had been closest to the now-defunct clinics, the mean one-way trip to an abortion clinic became 85 miles. Naturally, some Texans who needed abortions wound up in other states.
“People in North Texas and the Texas Panhandle kept getting pushed to us in Oklahoma,” Burkhart says, explaining that this was informative in bracing for this new wave of possible abortion restrictions. Even though some abortion clinics in Texas have reopened, “we really haven’t seen our [numbers] in Oklahoma City slow down,” Burkhart says.
In addition to clinics trying to increase their own capacity, organizations like NAF are trying to think more creatively about nationwide staffing, Ragsdale explains. “Are there ways for clinics in states with the bans to do some of the prep work beforehand, like the necessary paperwork and pre-abortion counseling? There are huge legal teams trying to figure all of this out right now,” Ragsdale says.
Longer waiting times
Corinne Rovetti is a certified family nurse practitioner with the Knoxville Center for Reproductive Health, one of Tennessee’s handful of abortion clinics. Rovetti estimates that around a quarter of the center’s patients travel from outside the Knoxville metro area, including from other states. Overall, 20 percent of abortions performed in Tennessee in 2015 were on out-of-state patients, according to the Centers for Disease Control and Prevention (CDC). Rovetti is imagining that number will increase if states like Mississippi further slash abortion rights.
“Our biggest [patient] complaint is on the waiting time, even though we do try to prepare patients for that,” Rovetti tells SELF. “Each visit could be four to six hours [between] the pre-abortion counseling and the procedure itself. It can be nuts.” (Tennessee is one of the states that requires a person seeking an abortion to first get mandatory counseling.)
Rovetti says the waiting room can feel a bit cramped on the busiest days, but most people are generally grateful to have made it there in the first place. While staffers try to cut down on the waiting time long-term, in the short-term they’re trying to make it easier for patients who have to spend hours in the center, like by allowing them to go get food without losing their spot, Rovetti says. She has also heard that some of the highest-volume clinics in the region are considering extending their operating hours to accommodate an increased caseload, she adds. There’s a precedent for this; some Michigan clinics reportedly expanded their hours to accommodate an influx of patients after Ohio closed a rash of clinics in 2013, Rachel Jones, Ph.D., a principal research scientist with the Guttmacher Institute, tells SELF.
When a clinic extends its hours to accommodate more patients, that impacts more than just doctors. Everyone from front desk staff to nurses has to prepare for possible longer work hours and more hectic days.
“When the phones are ringing and there’s a lobby full of people, it can get quite chaotic,” Burkhart says. “At Trust Women, we emphasize cross-training, so everyone knows how to answer the phone and get a patient’s information so the care coordinator can call them back to schedule if need be.”
Things like longer hours, an increased workload, and a lack of sufficient staffing could eventually start to wear on providers, though many are currently determined to stick it out. “Everyone is fired up at the moment,” Rovetti says. “It fuels your fire for a little bit, but does it sustain you? I’m not sure.”
It’s not cheap to make moves like hiring more doctors or expanding clinic hours, and that money has to come from somewhere. Also, as Burkhart notes, legislative threats can make it even more difficult for abortion-providing facilities to make ends meet: “When you’re also paying for litigation and you have restrictive laws that increase your costs, it makes it hard to do business.”
But there are some bright spots.
Ragsdale says resources like NAF can help clinics navigate new state laws, consult with them on how to handle extra patients, and match providers with clinics that need them the most.
Rovetti and Burkhart both say they are in contact with other providers about how they can all help each other, either by potentially sending providers to clinics that need the extra hands, or referring patients to other clinics if they’ll be able to get in more quickly. “Everyone is thinking regionally right now, and [about] how we can best connect patients with the right providers,” Rovetti says.
There are also reports that donations to abortion providers in states that recently passed bans have increased. For example, The Yellowhammer Fund—a grassroots organization in Alabama that pays for abortion care and travel logistics for people with low incomes—reportedly received more than $2 million in donations in the first two weeks after the state passed its ban on abortion. Access Reproductive Care-Southeast, an Atlanta-based abortion fund, reportedly raised $18,000 in just over a week after Georgia’s ban passed.
If you live in a state with just a couple of abortion providers, you can consider donating to one of them. NAF has a list of providers you can choose from. But all the money in the world won’t immediately fix the issues we’ve mentioned above.
Public health ripple effects
Health centers that offer abortions typically do much more than that. They are often trusted community clinics where people get their yearly check-ups, receive screening or testing for sexually transmitted infections, and gain access to birth control. When these resources aren’t as readily accessible, people lose the ability to best look after their sexual and reproductive health.
After Texas closed many clinics in the wake of House Bill 2’s passage, there were reports of an uptick in STI cases in some areas, like Ector County. This region of west Texas reported treating around 300 more patients than usual for STIs in 2012 after the local Planned Parenthood closed. To be fair, STI rates are increasing in general across the nation, but experts do believe some of the patterns they’re seeing come down to health clinic closures.
And perhaps most ironic of all is the effect that clinic closings can have on birth control use and, as a result, unplanned pregnancies. A 2016 study in the New England Journal of Medicine looked at all health insurance claims in Texas’s family planning program between 2011 and 2014. Researchers found that after the 20-week abortion ban went into effect, the birth rate among Texans on Medicaid in counties with Planned Parenthood centers increased by 27 percent, and there was a 36 percent drop in claims for long-acting reversible contraceptives like IUDs.
The bottom line
If you do find yourself needing to travel to a neighboring state for abortion care (or to a far-flung area of your own state), resources exist to help you. Here’s SELF’s guide on what to expect and what to consider before you travel for an abortion, and here’s another SELF guide on how to prepare for your abortion whether or not getting it involves taking a trip.
“You shouldn’t assume that services aren’t available to you. We have a hotline that hooks people up with local resources,” Ragsdale says. “Don’t despair and give up.” You can contact NAF’s hotline at 1-800-772-9100.
That’s a lot of information to digest. But one major thing to consider is that if you’re reading this, you might be in the relatively fortunate spot of being able to access resources even in the wake of restrictive abortion bans or clinics near you shutting down. Those who are most vulnerable might not be so lucky. The New England Journal of Medicine research suggested that people with low incomes (who are more likely to be people of color) bear the brunt of these laws since they are less likely to have the ability to take days off of work and travel across state lines, sometimes for extreme distances.
So, while people with the resources to travel will, others are essentially forced to continue pregnancies when they may not want to or be financially, mentally, or emotionally prepared to take on that responsibility. Even though neighboring states might be able to absorb some of the shock of restrictive laws, they can’t fix everything. Preserving the right to safe, legal, and truly accessible abortion all across this country has become even more urgent than ever.
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