Dozens of independently owned reproductive health clinics shuttered in 2023, the year after the US supreme court overturned Roe v Wade, according to a new report from the Abortion Care Network.
The group found that 23 independently owned clinics closed this year, on top of the 42 that shuttered in 2022, leaving over a dozen states, mainly in the American south and midwest, without a single brick-and-mortar clinic that provides abortion.
“Even before Roe fell, we were the only abortion clinic in a very rural, very underserved state with limited access to health care, and now that’s all been exacerbated,” said Katie Quinonez-Alonzo, executive director of Women’s Health Center of West Virginia.
Like most independent clinics in the United States, the Women’s Health Center of West Virginia struggled to keep its doors open after the supreme court decision paved the way for the state to ban abortion last year. The clinic still provides other reproductive and sexual health services, like gender-affirming care for transgender patients.
“We want to stay here in our community and help the patients that are still counting on us, but it’s been one uphill battle after another,” Quinonez-Alonzo told the Guardian.
The Women’s Health Center of West Virginia is an especially crucial lifeline for low-income, uninsured people in the state, who rely on the clinic for routine gynecological check-ups. Those services became harder to offer after West Virginia banned abortion, slashing the clinic’s revenue by roughly half a million dollars.
This year, Quinonez-Alonzo anticipates a roughly $350,000 budget deficit.
Independently owned clinics – in contrast with bigger players like Planned Parenthood – provide the majority of abortions in the United States. According to the ACN report, “indie” clinics make up the majority of clinics operating in states that are most hostile to abortion, and offer the broadest range of options for patients seeking the procedure. ACN researchers found that 73% of indie brick-and-mortar clinics offer both medical and surgical abortions, compared with just 42% of Planned Parenthood affiliates – so as they dwindle in number, so do options for women seeking care.
Before the supreme court overturned Roe, the West Alabama Women’s Center provided over half of the abortions in the state.
“In the deep south, it was always indie providers that were the ones providing abortions. Very few Planned Parenthoods existed in our region,” said Robin Marty, executive director of West Alabama Women’s Center.
“Alabama used to have three Planned Parenthoods, we have just one now, the others have closed,” Marty said. “We’re still here, though.”
After Alabama enacted a sweeping ban on abortion, the Tuscaloosa clinic refocused on protecting newly pregnant people’s access to affordable prenatal healthcare.
But Alabama is one of 10 states that has not expanded Medicaid, leaving roughly one in seven women of childbearing age without any form of health insurance. The state allows newly pregnant women to apply for Medicaid, but that requires a doctor’s letter confirming the pregnancy.
“But of course, as these people do not have insurance, they can’t get into a doctor in order to get this letter for Medicaid,” Marty said. “This is why we’re seeing so many people in Alabama who don’t have prenatal care in the first trimester.”
Even after a patient receives a doctor’s letter confirming their pregnancy, it can take four to six weeks for the state to approve coverage. To help care for uninsured and pregnant people in Alabama, Marty said her clinic provides free prenatal care until a patient’s Medicaid coverage is approved. If financial trouble forces the clinic to close, a bad maternal health landscape will get worse.
“The people in our community need prenatal care and birth control and STI testing just as much as they need abortion,” Marty said. “For these patients, there isn’t another healthcare provider here for them.”
