Missouri’s sole abortion clinic, a Planned Parenthood in St. Louis, teetered on the brink of ceasing abortion services last Friday, when a judge issued a temporary restraining order on the state within hours of the clinic’s license expiring. Hearings earlier this week brought Planned Parenthood and the state of Missouri to an “impasse,” according to a lawyer defending the clinic.
With this uncertainty looming, clinics in neighboring states like Illinois, Kansas, and Tennessee are preparing to absorb thousands of additional patients from Missouri, who soon may have no choice but to cross state lines for abortion care.
At Illinois’ Hope Clinic, director Alison Dreith has hired new staff, recruited volunteers, fine-tuned clinic workflow, and extended the office’s hours of operation in anticipation of a court’s ruling on whether the Planned Parenthood located just across the river can continue to offer abortion services.
Over the last two weeks, she said there has been a a spike in Missouri patients at the clinic, many of whom are confused by the implications of an eight-week abortion ban the Missouri governor signed into law in May, as well as the recent news about Planned Parenthood of St. Louis.
Dreith said the clinic had 90 patients scheduled for abortions on Tuesday—a significant increase from the 40 to 50 patients the clinic typically sees for abortion care in a day. “It gave the staff a lot of anxiety to see 90 names on the schedule that day,” Dreith said. “Everyone was wondering, 'How late are we going to be here tonight?'”
It’s not the first time nearby clinics have had to accommodate Missouri patients seeking abortion. In the last decade, anti-abortion laws have shuttered four other abortion providers in the state, which means Missouri residents have long been traveling to Illinois and Kansas for abortion care: Kansas Department of Health and Environment data showed that half of all abortions performed in Kansas in 2018 were for Missouri women.
The Illinois Department of Public Health doesn’t track patients’ home states, but according to the Hope Clinic’s numbers, 55 percent of its patients have been from Missouri over the past decade, and Dreith says that percentage has steadily risen in recent years. In March, the clinic even bought a billboard along the interstate connecting St. Louis to Illinois, which tells approaching drivers: “Welcome to Illinois, where you can get a safe, legal abortion.”
“That’s when the crisis management at Hope Clinic really started,” Dreith said, referring to the 2017 law. “We started making sure we were coordinating with Missouri to serve an increased number of patients.”
Missouri may be the latest target of attacks on abortion, but other states have dealt with sudden threats to abortion access, and the subsequent displacement of patients seeking care. Amy Hagstrom Miller, the president and CEO of the Texas clinic network Whole Woman’s Health, said more than half of the state’s clinics—including many of the ones affiliated with Whole Woman’s Health—shuttered after a state law requiring abortion providers to obtain hospital admitting privileges went into effect in 2013. Hagstrom Miller said the mass closures overwhelmed the state’s remaining clinics with an influx of patients.
“There was congestion at many clinics, in Austin and Houston, but especially in the Dallas area,” Hagstrom Miller said. “Because of the closures and waits, people had to travel farther, stay more days, [which] increased costs, and many were pushed further into their pregnancies.”
A 2017 study from the National Bureau of Economic Research (NBER) examining the impact of the Texas closures found that increased travel distance Hagstrom Miller mentions caused some women to forgo abortions completely. Congestion also meant delays in care that resulted in more patients receiving second-trimester abortions. These conditions reverberated throughout Texas for years, until the landmark 2016 Supreme Court decision that deemed the law unconstitutional.
"In the immediate aftermath of those clinic closures, and continuing in the next year, wait times increased to as much as two to three weeks,” said Caitlin Myers, a professor of economics at Middlebury College who co-authored the NBER study. “It’s likely the explanation is that the remaining clinics didn’t have the capacity to absorb women from the facilities being closed.”
Hope and other Illinois clinics are not just preparing to absorb women from Missouri, but from across the region, as abortion bans begin to blanket large swaths of the country. Illinois has also taken steps to increase abortion protections, most recently passing the Reproductive Health Act, which the state legislature sent to the governor’s desk last week to repeal abortion restrictions that remain on the books.
Dreith says she and other Illinois providers have been in talks about expanding their bandwidth to accommodate a vast increase in patients, even before recent events in Missouri. “These have been theoretical conversations between abortion providers and clinics since the Trump administration took over,” she said. “But as we have seen bans signed into law across the country in 2019, I think we’re feeling the urgency to work together regionally as well as nationally to talk about how we can continue to best serve patients.”
While the clinic may be able to adapt to the rise in patients, Dreith said it’s important to remember that many still won’t be able to get to their services, particularly low-income women and those in more rural parts of the state. “There's no public transportation where our clinic is located,” Dreith said. “For patients who don’t have their own mode of transportation that’s a huge burden. On top of travel barriers, many patients are already mothers and have problems finding child care so they can seek out our services.”
“These are huge barriers,” she continued, “and states like Missouri are only making accessing abortion much more difficult.”