The Supreme Court appears poised to overturn Roe v. Wade this summer.
That spells a very different future for abortion clinics, depending on where they are in the country.
Some will shut down. Some will need to dramatically expand their capacity. Some will pivot to other services, such as referring patients to clinics where the procedure is still legal. Some will build new facilities in states less hostile to abortion rights. Some already have.
And for many, it means beefing up security in anticipation of the elated anti-abortion activists planning to show up at their clinics. Eric J. Scheidler, executive director of the Pro-Life Action League, told TPM that his association alone will be planning more than 70 “celebration rallies” at court houses, state capitols and abortion clinics throughout the country.
“I was at a conference hotel with the rest of the National Abortion Federation staff when a member came running in to tell me the news,” Melissa Fowler, chief program officer of the National Abortion Federation, said of the draft majority opinion leak. “Providers were all around, and I was able to be with them as they heard this and absorbed it and started planning. Some immediately called law enforcement to ask for increased patrols.”
Reading Tea Leaves In Missouri
The Planned Parenthood clinic in St. Louis, Missouri is accustomed to constant attack from the ultra-conservative segment of its legislature and other elements of state government.
In 2019, Missouri’s Department of Health and Senior Services announced that it wouldn’t renew Planned Parenthood’s license, citing “serious and extensive” issues found during the clinic’s annual inspection. The clinic won that battle, with a state commission finding that it provides “safe and legal abortion care.”
Around that time, the clinic’s leaders started reading the writing on the wall.
“Our planning for a post-Roe future started a couple of years ago,” Bonyen Lee-Gilmore, vice president of communications and strategy at Planned Parenthood of the St. Louis Region and Southwest Missouri, told TPM. “The first thing we did was we scaled up and built an 18,000 square foot center in Illinois. We knew from our experience operating in Missouri that abortion access was narrowing at a rapid pace, and we saw it happening in every state surrounding Illinois.”
The Illinois center, less than 15 miles from the Missouri border, is one of the nation’s largest abortion clinics. There’s also a regional logistics center within the building, helping to fund patients’ travel and lodging from a seven-state radius.
The center exists in a state with legal protections for abortion access, a blue oasis in a sea of red.
If Roe is overturned, the St. Louis clinic will have to stop providing abortions, Lee-Gilmore said. The state already has an eight-week ban waiting in the wings, on top of many other state restrictions including a required pelvic exam that pushed the clinic’s providers to stop offering medical abortions.
“The state said we’re gonna now mandate you to assault your patients, and that was an ethical violation for our providers,” Lee-Gilmore said. “That’s the environment we’ve been living in for two decades.”
Many patients have opted to go to the Illinois center already, she added. There are no onerous wait times there, or state-mandated counseling to dissuade women from getting an abortion. Last year at the St. Louis clinic, she said they only saw about a dozen patients a month.
“All of that planning started two years ago,” she said. “The Texas ban in September escalated everything, and made it move much quicker.”
Hitting The Campaign Trail In Kansas
The Trust Women Foundation operates two clinics, one in Oklahoma City and one in Wichita, Kansas. The Oklahoma clinic has already stopped providing abortions amid a slew of new laws: a six-week ban, another law making it a felony to perform the procedure and yet another law adding a total ban except to save the life of the woman or when the pregnancy is a result of rape or incest that has been reported to law enforcement.
“Last Friday would have been last day we saw any patients for abortion care, and we only saw 10,” Zack Gingrich-Gaylord, communications director for the Trust Women Foundation, told TPM. “All of those 10 were under the still very new six-week ban. We didn’t really have the opportunity to do much under that new regime before they went even further.”
The change for the Oklahoma clinic was sudden. Just months earlier, it had been inundated with desperate Texans seeking care after the Supreme Court let the state’s bounty hunter-style law stand.
“It’s been a very strange couple of weeks down there,” Gingrich-Gaylord added. “Once that Texas ban went into effect, we were getting 500 phone calls a day. Some days it was as high as 100 calls in an hour. When the six-week ban passed here, the phones all but stopped ringing.”
Trust Women is now figuring out how best to use the former abortion clinic — whether for patient referrals or educating local women on their rights or starting the uphill battle to relegalize abortion in the state.
All the while, Gingrich-Gaylord said, they’re trying to figure out how to retain staff whose experience providing abortions may get them blackballed elsewhere in the deep red state.
“What does that look like in terms of staffing, how do we keep providing services in a time when most of what we do most of is illegal?” he asked.
For the Wichita clinic, the work will be different.
The Kansas Supreme Court ruled in 2019 that the state constitution guarantees a right to abortion. But a full-scale campaign is underway to pass a ballot amendment taking away that right, which will come to a head at the polls in just over two months.
The so-called “Value Them Both Amendment” would declare that there is no state constitutional right to abortion or requirement for government funding, and give the legislature power to regulate abortion “including, but not limited to, in circumstances of pregnancy resulting from rape or incest, or when necessary to save the life of the mother.”
The ballot text for voting no on the amendment describes the choice as one that would “restrict the people, through their elected state legislators, from regulating abortion by leaving in place the recently recognized right to abortion.”
Trust Women has become part of the coalition battling the amendment.
“If Roe were to fall, we would be the closest provider to 7.7 million people in the region,” Gingrich-Gaylord said. “Obviously that’s untenable, but it’s also why constitutional protection is so important.”
Blue States Brace For Influx
The National Abortion Federation, an organization working to help abortion clinics with funding for patients, security and other logistical needs, is also handling operations on the opposite side of the spectrum: clinics in blue states soon to be overrun with patients from red ones.
“We are working with members in those states to look at how they can scale up operations or increase their capacity,” NAF’s Fowler said. “Some clinics only provide abortions two or three days a week, and are looking expand. That entails additional staff, so we’re helping match clinicians and other frontline staff with clinics that have openings.”
Many blue states have recently passed laws to become abortion safe havens, expanding access to the procedure and offering protections for providers and patients.
Providers across the country have tracked the growing hostility towards Roe and made contingency plans, often while contorting themselves to comply with local restrictions and sometimes without extensive resources. Roe’s fall is coming, and they are prepared.
“Our on-the-ground post-Roe reality occurred long ago,” Missouri’s Lee-Gilmore said. “Roe is basically a symbol in states like ours.”