Since the 2022 Dobbs v. Jackson decision that overturned Roe v. Wade, women seeking abortions have been forced to travel out of state for care. As some states impose stricter abortion laws, clinics in nearby states have been overwhelmed by the sudden increase in patients.
One such clinic is Hope Clinic, located in Granite City, Illinois, just across the border from Missouri. Before the Supreme Court ruling, Hope Clinic primarily served patients from Missouri and Illinois. However, after the Dobbs decision, the clinic saw a 700% increase in patients from other states, jumping from 6% to 40% of all patients. This surge is due in part to Illinois’ constitutional protections for abortion rights, unlike many neighboring states like Indiana and Kentucky, which have imposed total bans.
As abortion bans and restrictions increase in neighboring states, more women from Arkansas, Oklahoma, and other regions are seeking care at clinics in protective states. For instance, over half of the populations in Arkansas and Oklahoma live in maternity care deserts, where obstetric services are unavailable. This only adds to the strain on healthcare systems in states that remain abortion-accessible, with patients traveling long distances to find care.
In response to the growing demand, Hope Clinic has made significant changes to their operations. They added another clinic day, extended their hours, and increased staff by about 40%. The clinic has also partnered with various abortion funds to ensure that no patient is turned away due to financial limitations. As a result, the clinic can now accommodate patients within two days, a crucial service considering the increasing financial and logistical barriers for many patients.
Dr. Michele Landeau, the Chief Operating Officer of Hope Clinic, explains the importance of removing financial barriers to care. “If you have to wait a week or two, the cost could go up,” she says. “There’s a lot of financial barriers in place, so we don’t want to add more.”
The clinic not only serves elective abortion patients but also those in need of care for lethal fetal anomalies. In states like Indiana and Iowa, where exceptions for lethal anomalies are only allowed up to 22 weeks, these patients often face additional complications. For example, doctors in states with abortion bans are fearful of legal repercussions even when providing medical care for life-threatening conditions.
Hope Clinic’s work has been complemented by organizations like the Chicago Abortion Fund, one of the largest abortion funds in the U.S. Serving as a crucial lifeline, the Chicago Abortion Fund supports patients by covering the costs of travel, accommodation, and other logistical needs. In 2020, the fund spent about $300,000 helping patients. By 2024, that number skyrocketed to $5 million. Megan Jeyifo, the Executive Director, points out that despite Illinois’ protections, the state is facing increasing strain. “At a certain point, Illinois is not going to be able to handle all these increases,” she says.
New York, despite not being in a bordering state with restrictive abortion laws, has also seen an increase in out-of-state patients. Choices Women’s Medical Center, located in Queens, has been a critical resource for women seeking care. The clinic has expanded to accommodate more patients and currently sees a 46% increase in out-of-state patients from 2023 to 2024. The clinic, led by Merle Hoffman, has long been an “oasis in the storm” for patients from restrictive states.
Although New York does not face the same level of restrictions as its neighboring states, it has become one of the most accessible locations for patients seeking abortions. Dr. Joseph Ottolenghi, the medical director at Choices Women’s Medical Center, explains that many women are drawn to New York due to its greater availability of appointments. However, the clinic is also facing strain as the number of out-of-state patients grows.
To meet the increasing demand, Choices Women’s Medical Center has adopted a policy that ensures no patient is turned away due to financial limitations. Merle Hoffman runs a nonprofit to help cover costs and also works with abortion funds across the country. But she worries about the sustainability of this model. “You’re funding your own oppression,” Hoffman says, reflecting on the financial strain on abortion funds.
Chicago Abortion Fund, working alongside Hope Clinic, is one of the organizations struggling to meet the growing needs of patients. With a weekly influx of 150 to 200 calls, the Fund has stretched its resources thin. While institutional support accounted for much of the Fund’s financial backing before the Dobbs ruling, by 2024, individual donations have played a more significant role in sustaining their operations.
Even as clinics work tirelessly to support patients, many face emotional and psychological burdens. Dr. Ottolenghi and other providers note that the tension in their clinics is palpable as many patients are afraid to return to states where abortion care is restricted. Some even fear prosecution for seeking care, despite the legal protections in place in states like New York.
Rebecca Glassman, the director of counseling at Choices Women’s Medical Center, discusses the emotional strain that patients face, particularly those traveling alone or hiding their situation from others. “It is easy for morale to drop,” Glassman admits. “Having support from colleagues and being clear on your mission is essential.”
As abortion clinics and funds scramble to meet the needs of the growing number of out-of-state patients, questions about the sustainability of the system arise. While providers like Merle Hoffman and Megan Jeyifo remain committed to their mission, the long-term challenges of providing care for an increasing number of patients in states with protective laws remain uncertain.
Despite the challenges, those involved in providing abortion care remain resilient. “We’re all relying on the same places,” Jeyifo says. “We’re not slowing down. We are going to be relentless.”
Conclusion
As out-of-state travel for abortion care continues to rise, clinics and abortion funds are struggling to meet the growing demand. With no immediate solution in sight, the sustainability of this model remains in question. However, as long as the need exists, providers and supporters are committed to ensuring access to safe and legal abortion care for those who need it most.
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