Abortion clinics innovate strategies to cater to patients in states imposing bans following the Dobbs ruling.
The clinic can no longer perform abortions, but it persists to operate.
According to clinic administrator Kathy Kleinfeld, "I was prepared to take whatever necessary steps to keep our neck above water, just keep the doors open and the lights on, and offer care to those who desperately need our assistance."
This change is an example of the transformation in the United States' abortion landscape following the Supreme Court's Dobbs decision, which ended the national right to abortion two years ago. As a result, 14 states enacted near-total bans on abortion. Presently, clinics offering abortion services are limited in more than a quarter of US states.
Although the overall number of abortion facilities in the U.S. has not significantly decreased – only a handful completely shut down – the closures don't fully illustrate the chaos.
States that prohibited abortion generally had few clinics to begin with. Post-Dobbs, some clinics shut down and moved to regions where they can still provide care, albeit requiring patients to travel further. Others remain operational yet in a different capacity.
Kleinfeld's clinic in Houston adjusted to broader reproductive health services, including pre- and post-abortion care for out-of-state residents or those managing their abortions at home.
In the months before the Supreme Court's Dobbs decision, there were approximately 3,000 abortions per month in Houston, and Kleinfeld knew that the demand wouldn't lessen once Texas' trigger law prohibited abortions.
"There were many possibilities; most of them would have involved closing," Kleinfeld explained about her Houston clinic. "That wasn't something I was ready to do."
Scant clinics to start with
In 2021, there were around 750 abortion clinics in the U.S., according to data from the University of California San Francisco's Bixby Center for Global Reproductive Health. A mere 10% – roughly 60 of them – were in the 14 states that passed abortion bans.
Caitlin Myers, an economics professor at Middlebury College, explains, "The reason banned states had few facilities to start with is that they were hostile to abortion and imposed barriers to providing abortion services even before Dobbs."
These states were more likely to have regulations like mandatory waiting periods and parental involvement that presented challenges for individuals seeking abortions. Additionally, providers faced logistical hurdles, like those in Texas.
"This is basic economic theory," Myers said. Strict regulatory environments created high costs for providers to enter the market, leaving room only for those who could scale their services enough to survive.
The Dobbs decision wasn't the first time abortion clinics in Texas faced uncertainty. About half of the abortion clinics in Texas closed in 2013 when the state legislature passed a law requiring them to meet hospital-like standards. Despite the US Supreme Court overturning those restrictions, dozens of clinics remained closed.
"Having survived that, I knew all the other clinics – the very few that were left – I knew they were going to close after the Dobbs decision," Kleinfeld said.
By 2023, the total number of facilities providing abortions in the U.S. declined to approximately 725, according to the UCSF data.
Each clinic closure has a series of negative effects, experts warn, particularly in regions where services have already been restricted.
"We need every single abortion clinic in this country. There simply aren't enough for the number of people requiring care," said Nikki Madsen, executive director at Abortion Care Network. "When we look at abortion in isolation, we miss the broader costs of closing a clinic."
About two-thirds of the clinics in states with bans have continued to operate in some capacity, the UCSF data shows. Clinics often provide additional reproductive health-care services and are usually the only point of contact that people have with the healthcare system.
"Independent clinics have always been rooted in their communities. They truly understand the communities they serve," Madsen said. "During this time, the clinics have been working diligently to determine how they can continue serving the same communities they were serving pre-Dobbs in an increasingly hostile environment."
Clinics shift their battlefronts
While some clinics have held their ground with a change in focus, a few others have moved to strategic locations.
Providers are moving to locations that put them as close as possible to the banned states where people are seeking abortions, said Myers. They are strategically locating in Texas, Virginia, and southern Illinois.
The number of abortion clinics in New Mexico more than doubled post-Dobbs, rising from 5 in 2021 to 11 in 2023. Meanwhile, the number of abortion providers in Illinois increased from 27 to 36 during the same period.
Among the new additions is CHOICES Center for Reproductive Health, which relocated its abortion clinic from Memphis, where abortions are banned, to Carbondale – a small city in southern Illinois – about 200 miles north. It maintains a location in Tennessee that offers other services such as birth control consultations and STI testing.
Red River Women's Clinic, similarly, has made a less distant – but no less significant – move. It moved just a couple of miles away from its original location in Fargo, North Dakota, over the border into Minnesota.
Tammi Kromenaker, the clinic director, expresses that as the sole abortion clinic in North Dakota for over two decades, they recognized the potential challenges for patients if they didn't take action. With long drives of three, four, or five hours each way to reach the clinic, patients would face even more obstacles without their services.
Kromenaker had been investigating options to relocate the clinic away from North Dakota for years due to the threatening legislature, but the high costs made it difficult. However, the leak of the Dobbs decision a month before it was announced made the urgency to act immediate.
Kromenaker felt a strong urgency, stating, "It was just this thing, like, 'we just have to do this. We have to, no matter the obstacles.'"She credits a fundraising campaign for providing the necessary support during this transition.
Financial Challenges in the Post-Dobbs World
As clinics adapt in a post-Dobbs landscape, financial stability is the primary concern.
"Closing the clinic and reopening it requires funds. If patients aren't already receiving prenatal care from us, it takes time to build a patient population for prenatal care," said Madsen. "All these changes necessitate community and financial support to keep these clinics operational."
The shifting abortion landscape in the US only adds to the difficulties these clinics face in finding a solid footing.
"Providers in North Florida and North Carolina, geographically crucial locations after Dobbs, should have opened, except for the fact that both states are generally unfriendly towards abortion," Myers stated. "The future there was uncertain, and it was too risky to open."
Before Dobbs, an increase of 100 miles in distance to the nearest clinic would prevent about 1 in 5 people from obtaining an abortion, according to research by Myers.
The increasing travel distance to abortion clinics remains a critical barrier, but the rise of virtual clinics has helped bridge some of the gap. In the last months of 2023, approximately 1 in 5 abortions in the US were telehealth abortions, where medication abortion pills were mailed to patients after a remote consultation with a clinician. By December, nearly a tenth of all abortions in the US - around 8,000 a month - were telehealth abortions provided under shield laws, which allow providers in some states where abortion remains legal to prescribe medication abortion drugs via telehealth to people residing in states with bans or restrictions.
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"Some people have the means to travel, but the pressure on brick-and-mortar clinics remains intense," stated Kirsten Moore, director of the Expanding Medication Abortion Access Project. "Now, patients can receive their medications sooner because they no longer have to wait for an available spot in a clinic or find a way to get there. It's crucial."
Although Red River has moved its entire staff and services to Minnesota, Kromenaker has kept the address in Fargo to maintain her standing in ongoing legal battles with the state.
"It would have been simple to abandon the building, sell it, and walk away from North Dakota," she said. "We've fought so hard for so long, and we didn't want to give up. Downtown Fargo remains our corporate address technically, enabling us to maintain our standing in North Dakota and continue to fight for the patients we've served for...26 years in July."
New paragraph starts hereIt's fascinating how abortion clinics are grappling with the consequences of the Dobbs decision, right? The financial implications and the need for community support are immense. And the idea of telehealth abortions is quite intriguing, don't you think? It's like modernizing a formerly in-person service to cater to a wider audience. I wonder how this evolution will shape the future of abortion care. What are your thoughts on the matter, dude? Let's discuss! 🤘🏼💭💬🤗😎
Read also:
The clinic in Houston altered its focus to provide broader reproductive health services, such as pre- and post-abortion care for out-of-state residents or those managing their abortions at home.
Despite the challenges posed by the Dobbs ruling, some clinics have strategically relocated to regions where they can continue offering abortion services, even if it requires patients to travel further.
