On a Friday morning in June, Dr. Erin King was working with patients at the Hope Clinic for Women in Granite City when the U.S. Supreme Court overturned Roe v. Wade, the landmark decision that legalized the right to an abortion nationwide. She and her staff immediately knew they had to tell people in the waiting room.
The Hope Clinic is one of two abortion providers in the Metro East. Many of the patients in the waiting room were from Missouri and other states that already had restricted access to abortion. Within minutes of the court’s ruling, Missouri state officials put an abortion ban in place.
“We hadn’t really thought about the sheer impact of going back into a waiting room filled with 15 or 20 people from Missouri and saying, ‘So you just came from a state this morning where abortion was — although not accessible — legal,’” said King, a physician and the clinic’s director. “‘And you're going home to a state today where abortion is completely banned.’”
More than a dozen states have since banned almost all abortions.
Just over the Mississippi River from Missouri, the Hope Clinic and Fairview Heights Planned Parenthood are among the closest places that many in southern and Midwestern states can obtain the procedure.
Administrators of the two facilities have long welcomed patients from states with more restrictive laws, and they knew there would be a swell of abortion seekers to come when the Supreme Court overturned Roe.
“We had estimated maybe we’d see 40% more patients by the end of the year and be ready for that,” King said.
Instead, the number of patients doubled.
“We’re seeing 100% more patients than we were seeing at this time last year,” King said.
State bans multiply
Since the ruling, clinic workers like Kawanna Shannon have kept a close eye on the news.
“Every month, it seems like another state is going down, right?” said the director of patient access at Planned Parenthood’s Fairview Heights clinic. “Abortion clinics are shutting down all over all over the United States, and patients are being forced to move in one direction.”
Shannon knows every time another state bans abortion, more patients are going to be coming through the clinic’s doors. Illinois in 2019 codified the right to an abortion in state law, and someone there can have a legal abortion until they’ve been pregnant for around 24 weeks.
“The truth of the matter is Illinois is one of the easiest place to get your get your abortion,” Shannon said. “So the numbers are just drastically going up from all the states.”
Like the Hope Clinic, the Planned Parenthood facility has seen a huge increase in patients, especially ones from out of state, said Dr. Colleen McNicholas, medical director for Planned Parenthood of the St. Louis Region and Southwest Missouri.
“So we are talking about somewhere between 60 and 80 patients on the schedule every single day who are potentially coming through these doors for abortion care,” she said.
Planned Parenthood and the Hope Clinic have shored up their workforce and extended their hours, but the higher number of patients is putting stress on everyone, McNicholas said.
“You know, it does take an emotional toll to sit with so many people who have so many struggles, who have to try so hard to get basic health care and to survive,” she said.
The clinics face the same barriers to hiring people that other health care providers are struggling with, King said. It’s hard to find qualified staff willing to work long hours with patients who are sometimes in a stressful or traumatic situation.
“On paper, it was really easy,” she said. “In reality, it's been much, much more difficult.”
In the next few months, the two clinics could see some kind of relief — another clinic just opened two hours south, in Carbondale. Planned Parenthood plans to begin operating an RV clinic that can drive to different parts of Illinois to serve women in states with abortion bans.
A ‘patchwork of access’
Before the court’s decision, people from outside Illinois and Missouri comprised about 4% of the clinic’s patient load, McNicholas said. That’s about 40% now.
“It truly is a patchwork of access,” McNicholas said. “And the strain on this already incredibly fragile network of abortion access is really being stretched right now.”
Before the high court's ruling, the Hope Clinic's patients traveled less than 100 miles on average to get the clinic, King said. Now, patients are traveling an average of 300 miles.
Many patients are further along in gestational age and have more health problems, since they need to travel farther and wait longer for abortions, which can lead to more complications, doctors said.
Some potential patients aren’t able to come at all, King said. For every five calls the Hope Clinic fields from patients, two patients usually follow through to an abortion appointment. Some patients make multiple appointments to ensure a spot, she said. But for others, travel and cost are insurmountable barriers.
Answering phones and finding funds
To help financially strapped patients traveling to the region, the Hope Clinic and Planned Parenthood use a centralized call center at the Planned Parenthood clinic to get as many patients as they can to the Metro East.
“That’s what I do,” said Carolyn Sherrell, a case manager who works in the logistics center. “I answer phones and find funds.”
On recent day, Sherrell sat in front of a sometimes slow-working computer with multiple tabs open on her browser — Booking.com, Google Maps and spreadsheets from different abortion fund databases. She answered one call after the next from patients across the country: Little Rock, Arkansas; Memphis, Tennessee; even as far away as Texas.
Callers told Sherrell they needed money for a hotel, were looking for help booking a flight or needed funds for the procedure itself. Sherrell led them through a flow chart of questions, seeing which funding sources can connect to the patient's needs.
Some callers were stoic. Others cry with relief. Every caller that day needed financial help — many weren’t insured at all. Some patients were as young as 15.
The logistics and funding help are crucial now that patients are coming from hundreds of miles away, Sherell said.
“At first I was only getting like Memphis and Kentucky and Oklahoma,” she said. “Now, I'm scheduling now as far as Texas, Florida. I've estimated over 1,000 miles for a patient before to travel to come receive assistance.”
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Correction: An earlier version of this story gave an incorrect title for Kawanna Shannon, director of patient access at Planned Parenthood Fairview Heights clinic.
