June 24, 2022, was a devastating day for Jennifer Welsch, the president and CEO of Planned Parenthood of Illinois. That was the day the Supreme Court’s Dobbs v. Jackson decision overruled Roe v. Wade, clearing the way for states to ban or severely restrict abortion.
Welsch was infuriated, but not surprised. She’d been preparing for that moment since 2016, when Donald Trump was elected president. Welsch, like many people involved in abortion care in Illinois, saw the writing on the wall. She realized then that Illinois would likely become a vital destination for women seeking reproductive health care.
Their years of planning have paid off — Illinois has indeed become a haven for women who need abortions. Its experience shows the herculean efforts needed to coordinate care with providers in other states; open new clinics in underserved areas; and pass laws that protect providers from prosecution.
Over the past few years, PPIL has doubled the size of its health centers in Chicago and Champaign. It opened a facility in Waukegan, about a 20-minute drive from the Wisconsin border, and formed a partnership — the first of its kind — with Planned Parenthood of Wisconsin to allow patients to easily shift back and forth across the border for care.
Since the Dobbs decision came down, nearly 25% of PPIL’s clients have come from out of state, up from 7% the year before. The nonprofit has seen a 54% increase in abortion care patients compared to the prior 12 months. “We have seen patients from 34 different states—more than half the states in the country that have forced their patients to travel here, like health care refugees,” Welsch says.
As abortion access recedes across the country, more haven states need to take a page from Illinois’s playbook. That means ensuring there is capacity to support the influx of out-of-state patients, passing laws that allow doctors to operate without fear and, critically, thinking ahead about new challenges to reproductive health.
If you were to unfurl a map of the country and consider states where abortion is still legal, Illinois might seem like less of an island. After all, Kansas voters preserved the right to abortion care. Bans in Indiana, Iowa, Ohio and South Carolina have been blocked, at least temporarily, by courts.
But look deeper and you’ll find that legal does not necessarily mean possible. Some states require multiple visits before allowing a patient to get an abortion, a strong disincentive for out-of-state travelers. Others require parental permission or require patients to get counseling meant to persuade them against their decision to have an abortion. Clinics, already scarce, have disappeared in the last year.
New bans in other states have heightened the pressure on Illinois as a sanctuary state. Before Florida’s draconian six-week ban, Florida had been an obvious destination for pregnant people in the South. North Carolina’s recently-passed 12-week ban, which requires multiple in-person visits for first trimester abortions, goes into effect in July, sharply limiting another option.
For women in much of the country, all roads now lead to Illinois.
That’s also true of some clinics. After Wisconsin banned abortion, a group of doctors moved their clinic from Milwaukee to Rockford, just over Illinois’s northern border. And a Memphis-based clinic decided to move some services just over Illinois’s southern border.
That clinic, the Choices Center for Reproductive Health knew their days were numbered as soon as the Supreme Court agreed to hear the Dobbs case. Given Tennessee’s trigger ban, “we knew we would lose abortion in the next 12 months,” says Jennifer Pepper, the nonprofit’s president and CEO.
Choices kept open its clinic in Memphis for key services aside from abortion, but quickly identified Carbondale, Illinois, as a good spot for a satellite clinic. A college town, Carbondale was a tiny liberal bubble in the generally conservative swath of southern Illinois, nestled between Missouri and Kentucky. It’s about a three-hour drive from Memphis and Nashville, and a stop on an Amtrak route that runs from New Orleans to Chicago. A clinic there could become a critical node in the state’s network of abortion access.
Choices started providing medication abortion, or pills that can be used up to 11 weeks of a pregnancy, in October 2022 and in January began offering procedure abortions. About 80% of the 350 to 400 patients Choices sees in Carbondale each month come from Tennessee, Mississippi and Arkansas. But the clinic has also seen patients from Kentucky, Indiana, Missouri, Oklahoma and even west Texas.
Illinois’s network of clinics is one thing; actually connecting women with health care is another. Coordinating the comprehensive services needed to help someone travel for an abortion is a gargantuan effort.
Even with all of PPIL’s prep work, Welsch says she wouldn’t have predicted that the organization would one day have direct accounts with hotels and bus companies, or offer taxi and food vouchers. Patients might need financial assistance to cover childcare while they’re away, or defray the lost pay that comes with missing work. “We’ve gotten deeper into patient navigation than we anticipated because it’s very complicated for patients to travel for care,” she says.
It's also expensive. In the last year, PPIL has spent more than $1.5 million to help pregnant people access care, with the average cost of support doubling to $500. Similarly, philanthropy has been critical for Choices, which has been able to provide many abortions at minimal or no cost, with over two dozen abortion funds around the country providing practical support.
Illinois abortion providers say they are preparing for whatever new legal twists come along. For example, with medication abortion at risk, both PPIL and Choices are working to expand the number of days when they can offer procedure abortions. Doctors are currently only available to perform those on certain days, but the hope is that that soon those services can be offered five days a week — a goal helped by a 2021 state law that allows some nurses and physician assistants to provide early-stage abortion care.
Underpinning all of this is a state government that has codified Illinois’s status as a sanctuary state — not just for abortion care, but for other forms of medical care that seem likely to come under attack, such as access to IUDs, gender-affirming care, and drugs that can prevent HIV. Every haven state should be looking ahead to what else could be on the line.
These providers understood what was at stake back in 2016. We should listen to them when they’re warning us about what’s at risk in 2023 and beyond.
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This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.
Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.
