FAIRVIEW HEIGHTS — The call came into the southern Illinois abortion clinic on a recent weekday: A young woman from Missouri was on the line, frantic because she no longer had the money to pay for her $470 procedure, which was scheduled for the next day.
The caller panicked because she assumed she’d have to cancel and reschedule later, whenever she could come up with the money. The prospect of delaying such a time-sensitive procedure was terrifying.
But a calm voice on the line asked a few questions about the patient and how much she could afford at that moment.
The woman said she had just started a new job and would be getting her first check soon but was in the middle of a pay period. She also mentioned that she has a child and an unexpected bill came up, swallowing the money she had set aside to pay to terminate the pregnancy.
“I don’t want you to commit something you don’t have,” said the woman who took the call, Kawanna Shannon, director of patient access at the new Regional Logistics Center, which is housed in the Planned Parenthood Health Center in Fairview Heights.
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Shannon spent a few minutes successfully searching various abortion funds to help cover the cost of the procedure. Then she went over a few instructions for the caller’s appointment, which would continue as scheduled the next day.
“Thank you, ma’am,” the patient repeated several times, her panicked tone melting into relief.
Calls of this sort from women throughout the Midwest and South were pouring into the clinic all day — and they’re expected to become even more abundant soon.
With the U.S. Supreme Court poised to overturn Roe v. Wade, Illinois is preparing for a massive rise in out-of-state patients traveling here to terminate a pregnancy. If Roe were to crumble, providers have predicted an additional 14,000 patients each year will cross state lines to terminate pregnancies in southern Illinois.
The Planned Parenthood Fairview Heights Health Center is seen on May 6.
Facing this imminent influx, the two abortion providers in the region partnered to open the Regional Logistics Center in January. The center is operated jointly by Reproductive Health Services of Planned Parenthood of the St. Louis Region and Hope Clinic for Women, an abortion clinic in Granite City.
Dedicated case managers there assist traveling patients with overcoming various common barriers to abortion access: finding lodging, booking transportation and securing child care, as well as navigating various funding sources to help pay for abortions.
Gov. J.B. Pritzker visited the Planned Parenthood in Fairview Heights on Wednesday to champion reproductive rights, calling the agency’s work “lifesaving and life-changing.” He noted that more than 75% of the clinic’s patients already come from other states.
“Let’s be crystal clear about one point: Abortion is health care,” he said. “By the time many of these out-of-state patients make it to Fairview Heights, Illinois, they have traveled further than anyone should have to, physically and emotionally. People should not have to endure trauma after trauma to be in control of their own bodies. But that’s exactly the burden this right-wing Supreme Court and anti-choice governors and state legislators increasingly put on the backs of millions of women.”
For almost half a century, the landmark Supreme Court case Roe v. Wade has affirmed the right to terminate a pregnancy nationwide. But a stunning draft opinion leaked earlier this month indicated that a majority of justices intend to strike down the 1973 decision, leaving the matter of abortion rights to individual states.
The official ruling in the case, Dobbs v. Jackson Women’s Health Organization, is expected to come over the summer.
In the absence of Roe, experts anticipate roughly half of all states would prohibit abortion, including Missouri and almost all of the Midwest. And states with strong reproductive rights protections like Illinois are preparing to take on the burden of patients from all the states where abortion would be outlawed.
Brian Westbrook, executive director of the organization Coalition Life, which is based in St. Louis, said he and other abortion opponents have been confident for a while that Roe v. Wade would eventually fall.
“It’s not a matter of if it will be overturned,” he said. “It’s a matter of when. The pro-life movement will only do more as a result. This is not necessarily a victory — it’s a shifting of work from the federal level down to the state level.”
Not going back
The after-hours phone line rang at around 3 a.m. on a winter morning, just a few weeks after the Regional Logistics Center was established.
The caller was a woman from Louisiana who was desperate to book a ride to the airport that instant, to get to her appointment the next day, said Shannon, who took the call.
“I didn’t tell people this, but I’m in a very abusive relationship and he just left,” Shannon recalled the woman saying. “I don’t know if he’s gone for a minute or what, but I just want to leave right now.”
The Louisiana woman said her partner did not know she was pregnant. Shannon recalled scrambling to book the Uber in the middle of the night and then staying on the phone with the caller until the ride came, fearful her partner would return before the Uber’s arrival.
“I’m literally packing now,” Shannon remembered the woman saying.
The woman from Louisiana flew in and had a surgical abortion. Afterward, Shannon asked the patient if she needed a return ride to the airport.
“No,” she recalled the patient saying. “I’m not going back.”
“Where are you going?” Shannon said she replied, surprised. “What are you doing?”
She said the patient told her she wanted to leave her partner and start a new life. Shannon contacted as many services and nonprofits as she could find and passed on the pamphlets and phone numbers. Before leaving, the woman from Louisiana said she was going to a shelter, Shannon recalled.
“She was like, ‘Ms. Kawanna, I’m good. I’m going to be fine,’” Shannon said. “That sticks with me. Sometimes I wish she’d call, so I know she’s good. I really wholeheartedly believe she’s never going back”
Kawanna Shannon, director of patient access at the Planned Parenthood Fairview Heights Health Center, an abortion clinic a few miles from the Missouri border in Fairview Heights on May 6.
In 2020, nearly 10,000 patients crossed state lines to have an abortion in Illinois, according to the latest data from the Illinois Department of Public Health. The number has increased every year since 2014.
The rise in out-of-state abortions comes as many nearby states increasingly restrict the procedure by legislating gestational limits, mandating waiting periods before having an abortion and implementing stringent regulations on clinics and providers.
Illinois, on the other hand, has eliminated every major restriction on the procedure. In 2019, Gov. Pritzker signed the Reproductive Health Act, which declared terminating a pregnancy a “fundamental right” in Illinois.
Planned Parenthood in late 2019 opened the 18,000-square-foot Fairview Heights site where the Regional Logistics Center operates; the location on the cusp of Missouri was chosen strategically to serve patients traveling from that neighboring state and beyond.
The facility includes a family room designed for children, equipped with beanbag chairs, books and toys, as well as extra diapers and wipes. So many patients had child care constraints and were bringing their kids into the regular waiting room, so staff decided to set aside a more comfortable space for families, said Bonyen Lee-Gilmore, a spokesperson for Planned Parenthood of the St. Louis Region.
One patient from Missouri recently couldn’t find anyone to watch her three children, so Shannon said she took the kids to the family room and, for about two and a half hours, she watched the baby, toddler and 6-year-old during the procedure.
The oldest, a little boy, watched TikTok videos on a laptop and performed some of the dances featured in them.
“I even did a couple with him — at least, I was trying to,” Shannon said, laughing a little.
She added that sometimes patients stay with their children in the family room and receive services and information sessions there, until it’s time to go into a procedure room.
The room is not a day care, she stressed.
“But if you happen to come with your child, you have a safe place to go with your child,” she said.
‘Obstacle course’
One day in February, an 18-wheeler semitruck pulled into the Planned Parenthood parking lot, quite conspicuous alongside all the regular cars and SUVs that typically park there, Gilmore said.
A patient, who drove the truck for a living, traveled more than a thousand miles from Arizona to southern Illinois to pick up abortion pills, an appointment that typically takes about 90 minutes, according to staff.
While medication abortion has been available in the United States since 2000, 19 states have restrictions mandating the provider be present when the pill is taken, barring access via telemedicine; 32 states have laws requiring physicians administer the medication, as opposed to other types of clinicians like advanced practice nurses and physician assistants, according to the Guttmacher Institute, a research group that supports abortion rights.
Illinois has none of these restrictions.
“We get a lot of people who will drive hundreds of miles for a medication abortion,” Gilmore said. “This scheme that politicians have set up is literally a game they put people on. It is an obstacle course.”
Westbrook, of Coalition Life, called the Regional Logistics Center a “media ploy.”
“Quite frankly, it’s nothing more or less than what they’ve always done, which is provide abortions and take the life of unborn children,” he said.
Missouri is one of about a dozen states with a so-called trigger law that would ban abortion in all or most cases if Roe were to be overturned.
The state has one remaining abortion clinic, a Planned Parenthood in St. Louis, largely due to stringent regulations on clinics and providers. In contrast, Westbrook said there are 75 anti-abortion pregnancy resource centers statewide.
“With all of that help and assistance for pregnant women, they don’t feel like they have to get an abortion,” he said.
‘Crunchtime’
Last month, one young woman traveled about 800 miles round trip from rural Mississippi to southern Illinois.
The hardest part of coordinating her trip was scrambling to find a ride from her home to the closest Greyhound station, about 45 minutes away in Memphis, said Kenicia Page, Regional Logistics Center manager.
“It was just very difficult trying to find transportation in the area,” she said, noting that there’s often a dearth of taxis, Ubers and public transit in rural communities. “It was really crunchtime. I think it was 24 to 48 hours to her appointment.”
Eventually, the patient found a ride through a nonprofit organization that offers transportation for those in need in the Mississippi Delta region.
The young woman was in her second trimester and had a two-day surgical procedure. The patient was unemployed and needed food and sanitary items during her travels, Page recalled. So the Regional Logistics Center sent her an electronic gift card and booked her an Uber to take to a Dollar General store, so she could pick up a few items before heading back to her hotel.
“It was just making her feel comfortable while she was here and keeping her uplifted, because she was just so discouraged from having to go through all the hoops,” Page said. “But she was able to get everything done and then return home safely afterward.”
The Regional Logistics Center has seen an increase in callers each month, from serving 183 patients in January to 329 patients in April, Shannon said.
“In May, it will be more,” she said. “It’s constant. People, they need the help.”
Each Regional Logistics Center case costs on average $900 to $1,500, depending on how many services the patient requires, Gilmore said. With reproductive rights in jeopardy, she’s concerned about how the center will handle the rising need and make sure funding lasts long term.
“The thing that I worry about is when the headlines die down,” she said. “When there’s breaking news like this we see an outpouring of support. And we have seen that outpouring. But I worry about what happens six months after, a year later. … Is it sustainable over time?”
What a Roe v. Wade reversal could mean for abortion access across America
What a Roe v. Wade reversal could mean for abortion access across America
A leaked Supreme Court draft ruling that would overturn Roe v. Wade, dated in February and published May 2 by Politico, was confirmed as authentic by Chief Justice John Roberts on May 3.
Votes can change between initial drafts and final rulings, and abortion is still legal in all 50 states and Washington D.C. Still, the leaked document sparked shock, outrage, and protests among those who see the document as a harbinger of what’s to come when the final ruling is announced in June or early July. The publication of the court’s initial draft is unprecedented in history and has been compared by some to the release of the Pentagon Papers.
To explore what overturning Roe v. Wade might mean for abortion access across the United States, Stacker analyzed data from the Guttmacher Institute’s driving distance dataset that aggregates population data at a geographic unit between 600 and 3,000 people. This dataset further determines the median distance from abortion clinics for women of reproductive age—defined in this analysis between the ages of 15 and 49—across 26 states likely to ban or severely restrict abortion access should Roe be overturned. Although Guttmacher’s data relies on census data, which collects gender data as binary, abortion access impacts people beyond those who identify as women.
The landmark 1973 Roe v. Wade decision put federal protections for abortion rights in place for the first time in U.S. history, marking a major victory for reproductive freedom. But the integrity of Roe eroded over the last few decades. Particularly in recent years, states like Mississippi and Texas have brought legal challenges to the decision by imposing increasingly restrictive abortion laws. These challenges coincide with a new, 6-3 conservative majority on the Supreme Court.
Between 2012 and 2017 alone, at least 276,000 people received abortions outside their home states. And while restrictive bans are still unenforceable right now, some legal experts warn conservative states may next attempt to criminalize traveling to other states for abortion services should Roe be overturned.
An estimated 26 states would certainly or likely move to ban abortion if Roe is overturned, according to the Guttmacher Institute. This would disproportionately impact abortion access for those with limited financial resources. The most commonly cited reason for seeking an abortion was “socioeconomic concerns,” according to a 2017 study of people who got abortions across 14 countries, including the U.S. Abortions in the U.S. can cost up to $750, depending on the state, clinic, and health insurance coverage, a number that does not include the additional costs associated with crossing state lines, including travel and lodging.
Christie Citranglo contributed reporting for this story.
Current bans limit abortion access and set precedent for more barriers
Until a decision is reached by the Supreme Court this summer, abortion will remain legal in all 50 states and Washington D.C. Overturning Roe v. Wade would not immediately outlaw abortion across the U.S., but it would give states the right to determine the legality of the procedure.
Under current conditions, at what stage and under what circumstances abortions can be performed varies from state to state. In those with the tightest restrictions, multiple bans exist to limit access now and potentially in the future should Roe fall. Bans on abortions after six weeks of pregnancy are enacted in 13 states and are among the most restrictive laws on the books.
Thirteen states have trigger bans that effectively signal intent and establish preemptive legislation to ban abortion in the event that Roe is overturned. If a reversal ruling is reached—acting as the trigger—then the proactive laws established in these states would take effect almost immediately.
Near-total bans include laws that restrict all abortions with certain exceptions like saving the life of the parent or cases of rape.
Some states had abortion bans in place prior to the Roe decision, which became unenforceable after 1973. If Roe falls, these states could seek to reinforce these bans assuming they were never declared unconstitutional.
Four state constitutions have amendments that declare they are not obligated to protect a right to abortion.
Travel distance for abortion access could increase by hundreds of miles
A person seeking a legal abortion in the U.S. travels on average 25 miles to reach a clinic. If Roe v. Wade is overturned, that average distance could increase to 125 miles as clinics in states with abortion bans would likely be forced to close, according to the Myers Abortion Facility Database.
This travel burden becomes more severe in regions experiencing disproportionately low access to reproductive health care and states with restrictive anti-abortion legislation. The north-to-south corridor between North Dakota and Texas, for example, has a high concentration of counties already traveling roughly 250 miles to reach an abortion provider. Some even travel up to 350 miles.
Disparities in abortion access similarly exist in the southern U.S. In the possible reversal of Roe, travel distances in Louisiana could increase from 37 miles, or around half an hour of driving time, to 666 miles just one way—representing more than 11 hours of nonstop driving, and the largest increase in distance of any state.
Residents could have to travel as far as Maryland for legal abortions, according to Michelle Erenberg, director at reproductive health advocacy group Lift Louisiana, in an email interview with Stacker.
“Lawmakers have become much more radicalized in their views on abortion,” Erenberg said, “which has led to more radical policies.” She pointed to new legislation up for review in her home state, HB813, or “The Abolition of Abortion in Louisiana Act of 2022.”
“Under this law, Louisiana can refuse to comply with decisions of the U.S. Supreme Court,” Erenberg said. “Abortion would be considered a homicide, and attempting to get an abortion could be prosecuted as attempted murder or criminal battery.”
Increased travel distances bring increased travel costs, potentially longer wait times to receive care, and time away from work and familial responsibilities. These barriers will disproportionately affect low-income Americans' access to safe and legal abortions.
A 2021 study published in the Journal of the American Medical Association revealed that increases in distance to the nearest abortion care facility were associated with significant reductions in legal abortion rates. Conversely, when travel distances were reduced, legal abortion rates increased. Researchers estimate there would be more than 70,000 additional legal abortions each year if disparities in travel distances were eliminated.
It should be noted determining the exact number of illegal abortions and pregnancies reluctantly carried to term due to a lack of care is difficult to quantify as this data on this is often not reported or logged.
Clinic states brace for an influx of abortion patients
The influx of abortion seekers to so-called clinic states—or states that have legal protections for abortion in place—is predicted to be large should Roe v. Wade be overturned. Projecting which states will see the largest increases has everything to do with geography.
A large influx of abortion-seekers is projected to look for services in North Carolina due to its proximity to many southeastern states where abortion is certain or likely to be banned if Roe is overturned. But unlike Illinois, the legal status of abortion in North Carolina is tenuous and highly dependent on whether anti-abortion candidates are successful in the state’s midterm elections over the coming months. The debate over abortion rights in North Carolina will likely be decided, at least for the time being, in 2023.
Clinics in North Carolina have already seen an increase over the past year of out-of-state abortion seekers, with some coming from as far as Texas in search of services, according to Amber Gavin, the vice president of Advocacy and Operations at A Woman’s Choice, a group of North Carolina and Florida-based abortion clinics. And if Roe is overturned, Gavin expects those numbers will keep climbing.
“I do think we’re going to see probably well over 50% to 80% [more] patients than what we’re currently seeing,” she told Stacker in an interview.
Gavin also said A Woman’s Choice clinics are considering hiring more staff and physicians to accommodate the influx. “We’re working really hard with our staff, with abortion funds, with advocates on the ground to make sure that people who need and want that care are able to get it,” she said.
Illinois has long been a reproductive care hub for Midwesterners. Out-of-state patients seeking abortions rose from 2,970 in 2014 to 9,686 in 2020, according to Illinois Department of Public Health data. These numbers are projected to continue to rise as people come from Michigan, Indiana, Wisconsin, Ohio, Missouri, and even some Southern states. To increase access, two Planned Parenthood clinics have opened in recent years along the Illinois border. The state is one of the few in the Midwest where the right to abortion is certain to be protected long-term.
Many clinic states have made moves since 2019 to fund abortion services and codify abortion. Vermont, for instance, passed Act 47, which preserves the right to reproductive choice, including abortion, in the year following the appointment of Justice Brett Kavanaugh to the Supreme Court. Several other states followed suit, including California, Connecticut, Oregon, Maine, and Illinois. The subsequent appointment of Amy Coney Barrett to the Supreme Court in 2020 cemented the court’s conservative supermajority and encouraged legal challenges to Roe v. Wade in 2021.
Some states have already taken steps to ensure access to safe abortions for people crossing state lines.
In 2019, New York funded the New York Abortion Access Fund, intended to help low-income abortion seekers from other states travel to New York for services. In March 2022, California passed SB 245, an act that eliminates out-of-pocket costs for abortions for those who have private insurance, as well as those on California’s Medicaid. In Oregon, legislators passed the Reproductive Health Equity Fund, which allocates $15 million to expand abortion services, including helping to cover expenses of those traveling to Oregon for abortions. And Connecticut Governor Ned Lamont is planning to sign a bill that would shield Connecticut abortion providers and out-of-state patients from being sued by states where abortion—even outside the state—is illegal.
