The spine of the United States’ abortion clinic network has started to fracture—and the pandemic is threatening to make it much worse.
Over the last eight years, more than 100 independent abortion clinics in the U.S., or more than a third, have closed their doors, according to a Wednesday report from the Abortion Care Network, a membership organization for independent abortion clinics, or clinics that don’t belong to Planned Parenthood. These types of organizations make up roughly a quarter of the nation’s abortion-performing facilities, but they provide 58 percent of all abortions. The vast majority of clinics that offer abortion past the first trimester are independent.
In 2012, there were 510 open independent clinics, the report found. By November 2020, that number had shrunk to 337. This year alone, 14 independent clinics closed or stopped performing abortions.
Now, under the coronavirus pandemic, independent clinics are facing what the report calls an “unprecedented strain.”
“We don’t really know what the long-term impact is gonna be on independent providers,” said Nikki Madsen, the Abortion Care Network’s executive director. “They’ve just adapted, so that people could continue accessing abortion care, but they are struggling financially.”
In Texas, three clinics run by a national company named Whole Woman’s Health have had to pare back their services to focus primarily on offering abortions. Clinics are open in 12-hour shifts, instead of eight, to see the same number of patients, thanks to distancing measures. Sometimes, the clinics have had to stop flying in the doctors who perform abortions; in one case, they even temporarily relocated a doctor to make sure they could see abortion patients.
It’s all expensive.
“It’s absolutely a struggle. I don’t think that we have felt the full effect yet,” said Marva Sadler, director of clinical services for the Texas clinics. “One thing I know about independent abortion providers in the United States is that we often make business decisions that are not best for the business.”
Five states that have just one abortion clinic left standing, and three of those clinics are independent; Louisiana and Wyoming, with three and two clinics, respectively, only have indie clinics. In Arkansas, Nevada, and Georgia, the only abortion clinics that perform surgical abortions are independent. (Unlike medication abortions, which involve pills, these procedures can be performed later on in a pregnancy.)
Madsen said that her group was unable to verify how many clinics may have shuttered due to the pandemic, but said that tight finances frequently lead clinics to close their doors. In late March, the Abortion Care Network asked its 150-plus member clinics how much money they anticipated losing every month. Nearly 27 percent said they faced losing between $50,000 and $99,000; 10 percent anticipated losing upwards of $100,000.
In total, 92 percent of the responding clinics “indicated a need for financial support to continue providing care during the pandemic,” in the words of that March survey. They said that they’d had to add telemedicine services, as well as pause or reduce services like STI treatment or birth control. Although some clinics had started offering more abortions, others had been forced to reduce the number they’d performed or stop them entirely.
For abortion providers, political opposition to their work has compounded the public health and financial crisis of the pandemic. Over the spring, public officials in 11 states cited the pandemic as a reason for abortion providers to stop offering the procedure. For days, access to abortion flickered in multiple states, including Texas.
“There were couple of days in our clinics that we were not able to see patients at all and then there were some days that we were only able to see medication abortion patients,” recalled Sadler, who said some patients had to have their appointments rescheduled up to three or four times. “There was also a time that our three Whole Woman’s Health clinics, along with another independent provider, were the only clinics that were seeing patients at all.”
Eventually, the orders expired or were halted by court orders. But for many, the damage had been done. Patients were forced to travel out of state, at potentially high costs and incalculable public health risk, for the procedure. Sadler’s clinics tried to help, sometimes by sending patients to Whole Woman Health’s sister clinics in Virginia. Clinics from Seattle to Washington, D.C. told the Abortion Care Network that they were taking in patients from Texas.
“You had many women [who] … had to make the decision on what the risk factors were for them and their family and doing the travel,” Sadler said. “In some instances, it just was not an option.”
More recently, abortion providers have had to contend with another political blow: the October confirmation of conservative Amy Coney Barrett to the Supreme Court. Although Republicans may portray Planned Parenthood as the American abortion bogeyman, independent clinics were responsible for bringing the last two abortion cases to the Supreme Court. In both cases—including a 2016 decision brought by the Whole Woman’s Health organization in Texas—the abortion providers have triumphed in 5-4 rulings.
Now, with a comfortable 6-3 conservative majority on the Supreme Court, the next provider to bring a case to the nation’s highest court may not be so victorious.
“It is hard to put a positive spin on things right now,” Madsen said. “We are in a really challenging time for abortion rights—the most challenging time I’ve ever seen in my lifetime, frankly.”