Illinois Abortion Clinics Prepare for Rush of Patients After Roe

FAIRVIEW HEIGHTS, Ill. — Illinois is quickly emerging as an island of abortion access for people in the Midwest and the South, as neighboring states move to ban the procedure after the Supreme Court’s decision to overturn Roe v. Wade, ending the constitutional right to an abortion. Providers in the state had been preparing for a surge of people seeking abortion services, but many said this week that they were still overwhelmed by patients’ reactions to the decision.

There were roughly 50,000 abortions performed in Illinois in 2020, and around one in five was for a patient traveling from out of state. There are currently 29 abortion providers in Illinois, but as clinics in surrounding states stop providing abortions or close altogether, these providers say they may not be able to meet the demand.

Four of Illinois’s neighbors immediately banned abortion after the court’s decision on Friday, and two others — Ohio and Tennessee — now restrict the procedure to six weeks into a pregnancy. A ban in Michigan is temporarily blocked by a court there, and lawmakers in Indiana and Iowa are expected to consider abortion bans in the coming months.

Without Roe, more than half of American women of childbearing age could live in a state where abortion is banned or the procedure is restricted. In 2020, the latest year of available national data, almost as many abortions occurred in the states poised to restrict the procedure as in those where it is likely to remain legal.

If clinics in those states go dark, it would represent a major victory for the anti-abortion movement. Yet demand for abortion services is not expected to fall by very much. Instead, many patients may seek care elsewhere, driving up demand for appointments in the states where abortion remains legal.

In Illinois, in particular, the demand will be intense. The state is uniquely situated geographically among states likely to limit abortion and broadly allows the procedure until later in pregnancy. Since 2017, state funds have covered the cost for residents enrolled in Medicaid.

Many clinics had been preparing for an influx of patients by working to extend clinic hours and increase staffing. And at least two new clinics in Illinois are set to open later this summer. But in interviews this month, many providers in the region said they were far from ready for what the end of Roe would bring.

“People are calling who have appointments with us and want to know if abortion is still legal, people are calling from surrounding Midwest states to see if they can come to us because their appointments have been canceled and people are calling from states further away that we usually don’t hear from,” said Dr. Allison Cowett, the medical director of Family Planning Associates, a Chicago-based provider.

Before Friday, the clinic was typically able to offer patients an appointment within one week. Now it is booking appointments two weeks out.

“We’ve been preparing for months, but to have it actually be reality, you’re never prepared for that,” Dr. Cowett said.

A new clinic, and a program to help women get there

In the back of the Planned Parenthood facility in Fairview Heights, Ill., a team of phone operators and case managers has created a first-of-its-kind call center to direct abortion patients to one of the two providers in southern Illinois. A third provider in the area, across the border with Missouri in St. Louis, stopped providing abortions on Friday when a state ban went into effect immediately following the Supreme Court’s decision.

Not all of the patients who reach out require assistance, but anyone who raises a concern about getting to an appointment — “I don’t have a car.” “I can’t afford the procedure.” “Who will watch my kids?” — is connected with a case manager.

Kawanna Shannon, the director of patient access who oversees the case management program, and her staff work to schedule flights; book bus tickets, ride shares and hotels; find child care for patients; and help them figure out how to pay for it all.

“We wanted to take the pressure off of the patients having to look and hunt and figure out who can help them,” Ms. Shannon said.

A significant portion of the case management work is connecting patients with national and local abortion funds, nonprofits that help cover the cost of the procedure and travel. Rarely does one fund cover the entire cost, and each has different criteria, such as a patient’s income and where she lives.

Since the program started in January, it has helped 1,300 patients from both in and out of state obtain an abortion in southern Illinois. Patients typically receive between $900 and $1,500 in assistance to cover the cost of travel and the procedure.

The Fairview Heights facility opened in 2019 to accommodate an influx of patients from Missouri. It has seen roughly 8,000 patients each year for abortions, and it anticipates an additional 14,000 patients will seek services in the region now that Roe has been overturned, a representative for the Planned Parenthood affiliate said.

The call center has streamlined the process not only for patients but also for providers, who already were scrambling to accommodate hundreds of women traveling to southern Illinois from Texas and Oklahoma after those states enacted strict limits on abortion in the past year.

At the Hope Clinic for Women, an independent clinic in nearby Granite City, Ill., “the logistics of actually getting patients to their appointment was becoming too onerous on clinic staff,” said Dr. Erin King, the organization’s executive director.

Hope Clinic was seeing between 30 and 35 patients a day, about two-thirds of whom required practical or financial help. Before the call center in Fairview Heights was up and running, Dr. King’s staff had to coordinate with more than 30 abortion funds in the region. Now, that work is overseen by Ms. Shannon’s team.

“The reason it works so well here is because our patients are getting support from the same funds, coming to the same area, using the same airport, following the same directions to our clinics,” Dr. King said.

Hanz Dismer, the clinic’s education and research coordinator, said the facility had experienced six times the normal call volume in recent days, and nearly all staff members had taken a shift answering phones. The wait time for an appointment for a medication abortion has now stretched to three weeks.

“We opened the regional logistics center earlier this year in preparation for this exact moment, for the moment where we can’t handle everything ourselves,” Mx. Dismer said.

Pills offer a ‘pressure release valve’

In anticipation of higher demand, lawmakers who favor abortion rights in some states, including Maryland, have pushed legislation to allow non-physician health providers to perform abortions. Others, like those in Connecticut, have introduced legal protections for providers and for patients who seek services in their states but live in states that prohibit abortion.

In Illinois, providers are also expecting increased interest in medication abortion, which does not require a clinic visit. Out-of-state patients can cross the border into Illinois and meet with a provider virtually, and then have pills mailed to a post office box or a friend at any address within the state.

“Telehealth can work as a pressure relief valve in Illinois,” said Melissa Grant, the chief operations officer of Carafem, an organization that offers telemedicine appointments and sends abortion pills through the mail. Carafem also runs a clinic in Skokie, Ill., just outside Chicago.“We have had people take virtual appointments in their car, in coffee shops, in libraries or just on a quiet corner with a set of headphones,” she said.

Ms. Grant said more than 500 people had called on Friday, some of whom were seeking appointments, and others who were seeking clarity on the legality of abortion. About half the patients the clinic typically sees opt for virtual appointments, but Ms. Grant said she expected this share to grow as in-person appointments became harder to come by.

Family Planning Associates, the Chicago provider, is able to see a high volume of patients by having nurse practitioners and physician assistants oversee medication abortions, while physicians handle surgical abortions.

But even with what she called a “very efficient model,” Dr. Cowett was still concerned about the number of patients calling.

“It will take folks more time to get through to us, and people will at some point be further along than the gestational age limit,” she said. Abortion is legal until viability in Illinois, typically around 24 weeks into pregnancy. Procedures at more advanced stages of a pregnancy take longer and have a higher risk of complications, in addition to being more expensive, she said.

“I’m optimistic that we will meet the need, but I’m not optimistic that they will get it in an efficient and timely manner,” she said.