ST. LOUIS — Jenna and her boyfriend were a week away from starting their freshman year in college and moving into their dorms in Murray, Kentucky, when they learned her birth control had failed and she was pregnant.
Jenna, who requested to be identified only by her first name, couldn’t get an abortion appointment in Louisville near where they lived before the move.
Before Jenna started classes, she found herself sick with COVID-19 and had to quarantine for 10 days. She fell behind in her studies. While trying hard to catch up, she had to desperately search for an abortion appointment.
She wanted a medication abortion, which must be performed before 11 weeks gestation. It was $470, but still cheaper than a surgical abortion. She had one week.
She tried her closest options in Nashville and Memphis, Tennessee — still two to three hours away — but could not get anything in time. Tennessee also requires two office visits at least 48 hours apart.
Jenna and her boyfriend ended up getting an appointment three-and-a-half hours away at a Planned Parenthood clinic in Fairview Heights, Illinois. They left an afternoon class early to make the 5:50 p.m. appointment and drove back that night.
“It was upsetting and frustrating,” she said. “I didn’t see myself having to go to Illinois when I decided to wait until I got down (to college) and moved in.”
Abortion providers serving southern Illinois expected to see an increase in patients from Texas after that state’s restrictive abortion law went into effect in early September. But doctors are also seeing patients coming from states between Illinois and Texas as wait times for appointments grow.
“They are telling us that wait times are sometimes weeks. One clinic told them they did not have an appointment until November,” said Dr. Colleen McNicholas, chief medical officer for Reproductive Health Services of Planned Parenthood.
In the first month since the Texas law took effect on Sept. 1, officials with the Planned Parenthood facility, located about 15 minutes from downtown St. Louis, say they have seen a 47% increase in patients coming from outside its normal service areas — including Louisiana, Arkansas, Kentucky, Tennessee and Kansas.
“That is really the impact in this immediate six weeks since the Texas decision, that we are starting to see more of those patients from those states in between who can’t wait weeks for an abortion in their own state,” McNicholas said.
More than 55,000 abortions were performed last year in Texas, which has almost 7 million women aged 15–49, accounting for one in 10 U.S. women of reproductive age.
At Hope Clinic for Women in Granite City, also about 15 minutes from downtown St. Louis, calls have been coming in “nonstop” from women confused about how to navigate the complex laws in Texas and surrounding states, said Dr. Erin King, the clinic’s director. But appointments there have only increased slightly.
States across the South and Midwest already have a myriad of abortion restrictions and facility regulations in place that have shuttered clinics and greatly reduced access.
“It feels like there are patients reaching out, but then they are not able to get to us,” King said. “The fact that we’ve seen all these phone calls but not seeing patients is, I think, the most concerning thing. Are patients getting care? Are they feeling so desperate that they feel they can’t leave and get care? What is happening with those patients? Where are they?”
Waiting in the wings
Texas now bans abortions once fetal cardiac activity is detected, which is usually at six weeks and often before women even know they are pregnant. Other Republican-led states, including Missouri, have enacted similar bans, but those have been blocked by courts.
The Texas law has proved durable because enforcement is not up to the state but is left to private citizens, who can collect at least $10,000 if they successfully sue abortion providers or those who help a woman obtain an abortion.
Abortion rights groups had asked the U.S. Supreme Court to stop the law from going into effect, but the justices voted 5-4 not to intervene. The Biden administration subsequently sued to block the law last month, arguing it is unconstitutional. A federal judge on Oct. 6 ordered Texas to suspend the law; the 5th Circuit Court of Appeals on Oct. 9 temporarily reinstated it, and reaffirmed its ruling on Thursday. The Biden administration said Friday it will ask the Supreme Court to block the Texas law while the case winds its way through the courts.
Court filings in the case, which the Supreme Court will ultimately decide, have already provided examples of how the near-total ban has played out.
Texas abortion clinic officials described turning away hundreds of patients. Those in nearby states said care for their own residents is being delayed in order to accommodate Texans making long trips. Patients have included rape victims, as the Texas law makes no exceptions in such cases.
According to an Oct. 7 PBS NewsHour report, at least 300 Texans have already sought care in Oklahoma, straining providers.
Advocates for abortion rights say the impact from the Texas law gives a glimpse of what is to come should other states copy it or a Mississippi law banning abortion after 15 weeks, which is currently before the Supreme Court. A decision is expected in that case in June.
“The bottom line is, although Texas is at the core of what his happening right now, it isn’t just about Texas,” McNicholas said. “There are many more places and states in the wings waiting to do the same thing.”
If the Supreme Court decides to gut abortion protections provided in the 1973 Roe v. Wade decision, 26 states are expected to ban the procedure, according to the Guttmacher Institute, a research group that supports abortion rights. Missouri is one of those states.
That means up to 35,000 more women each year will turn to Illinois for an abortion, including 14,000 heading to southern Illinois, according to estimates by the Planned Parenthood Federation of America. And the system is already stretched.
“If more than one state goes down, that burden is going to be felt in an exponential degree,” McNicholas said. “It won’t just be figuring out where to move Texas patients, it will be figuring out where to move patients that account for nearly a quarter to half of the United States.”
A post-Roe world
The Metro East abortion providers say they have been preparing for the scenario. Just this year, states have enacted a record-breaking 97 abortion restrictions, surpassing the highest count from 2011 when 89 restrictions were passed, according to Guttmacher.
In total, states have enacted 1,327 restrictions since Roe v. Wade was decided.
The mounting restrictions in Missouri — including two appointments 72 hours apart and a pelvic exam for medication abortions — have all but made abortions nearly nonexistent in the state. The rules left the state with just one abortion provider in St. Louis, so many patients decide to drive the extra 15 minutes to avoid the requirements.
“We have long known and been helping patients navigate these intricate webs of restrictions,” McNicholas said. “Missourians face substantial difficulty navigating abortion access. We have a lot of experience in helping folks jumping through each of those hoops to access care. We are now just translating that to folks from different states.”
King said the calls Hope Clinic has been getting lately sound exactly the same as the calls they got from Missourians two years ago when the state health department tried unsuccessfully to close the Planned Parenthood clinic in St. Louis by refusing to renew its license.
“The desperation in people’s voices, the confusion that we are hearing. This is not new,” King said. “Every barrier makes patients more and more scared and adds more stigma to their care, and more desperation and fear that they won’t get the care that they need and they won’t know where to go and who to see.”
The doctors say their staffs help women connect to abortion funds that help with travel logistics as well as the cost of the procedure, child care, travel expenses and hotel stays.
“Part of our job is going to be reassuring folks that they can still access abortion care. It may not be immediately in their community, but they can — and we and others are here to help them figure that out,” McNicholas said.
Abortion funds have long been a mainstay in helping women who can’t afford the costs of the procedure or travel. But those services — often small nonprofits with few employees — are also stretched thin.
One abortion fund is the Midwest Access Coalition, which helps people traveling to and from the Midwest access abortion. Headquartered in Chicago, the nonprofit relies on a network of 200 volunteer hosts, drivers and others to help with travel, lodging, food, child care and emotional support.
Executive Director Diana Parker wrote in an email that she was too busy to talk to a reporter about how the organization has been affected: “Right now we aren’t doing phone interviews based on our capacity with many more clients traveling right now (it’s almost 24/7 work currently).”
McNicholas said providers in states like Illinois are preparing for a post-Roe world by connecting with organizations across the country that work to help patients access abortion. “So that if access goes down, they have a point person in southern Illinois that they can call and say we are really struggling,” she said.
The clinic is also considering adding employees and opening seven days a week instead of six. They are trying to build staff resiliency. Nearly every patient outside of Illinois calling for help is low-income and facing serious struggles at home, McNicholas said. “That can be heavy for staff.”
Jenna said while she plans to have a family some day, she can’t right now.
“I just started college. I’m fresh out of high school. I’m doing my life the correct way — graduating high school, going to college and getting my degree,” she said. “I accidentally got pregnant. It’s kind of embarrassing. I haven’t told my family about it. I’m not going to tell my family about it. It’s a private thing. I’m young. I’m too young.”
The Associated Press contributed information to this report.