Since the US Supreme Court overturned constitutional abortion protections in Dobbs v. Jackson Women’s Health Organization in June 2022, abortion access has splintered nationwide.
Thirteen states now ban the procedure with limited exceptions, and seven states limit it to between six and 15 weeks gestational age as of October 7, according to the New York Times’s abortion ban tracker.
But that could soon change: Abortion protections will be on the ballot in 10 states this November, including five—Arizona, Florida, Missouri, Nebraska, and South Dakota—where there are abortion restrictions or bans in place, according to KFF. The measures propose an amendment to the respective state constitution that would protect abortion or allow it up to fetal viability, when the fetus can survive outside the womb. This varies by pregnancy but typically can’t happen until after 23 weeks gestation, according to the American College of Obstetricians and Gynecologists.
“These ballot measures are a critical strategy to restoring and regaining access in some of these states,” Olivia Cappello, associate director of state advocacy communications for the Planned Parenthood Federation of America, told Healthcare Brew.
Clinics are struggling
Yet some clinics in states where abortion is on the ballot, like Florida, are fighting to stay open until then.
Florida has had a six-week abortion ban with limited exceptions since May 1. Sixty percent of voters must approve the proposed referendum in November to amend the state’s constitution and protect abortion access up to fetal viability.
But leaders at the Center of Orlando for Women, one of two licensed abortion providers in the 326,000-person city, worry the clinic can’t stay afloat in the meantime.
“We’re grasping at straws and doing the very best that we can,” Julie Murano, human resources director of the clinic, told Healthcare Brew.
About one in five people don’t realize they’re pregnant until after six weeks because of irregular menstrual periods, University of Wisconsin–Madison and National Institutes of Health researchers estimated in 2021. As a result of the ban, patient visits are down. The clinic had to do layoffs and cut some full-time staff to part-time, Murano said.
Clinic leaders started a GoFundMe crowdsourcing campaign in June that has raised more than $11,000 as of October 7, but the money only covered “one payroll,” Murano said. Medical staff also provide counseling, birth control, and preventative services like pap smears to screen for cervical cancer, she added, which means these services are on the line, too.
A 2019 study found restrictive abortion laws to be “associated with adverse effects on women’s health,” such as an observable decrease in services like screenings for cervical cancer as well as later diagnoses of cervical cancer and higher mortality rates in states that saw a loss in abortion clinics from 2010 to 2013. The biggest differences occurred in certain groups, including Hispanic patients, uninsured patients, and women ages 21–34.
“We’re doing everything we can to stay afloat and prevent closure,” Murano said.
Ripple effects
Clinics in states where the procedure is legal are also struggling to sustain themselves.
The Guttmacher Institute, a reproductive health research and policy organization, estimates one in five patients traveled out of state for abortion care in the first half of 2023 compared to around one in 10 in both 2019 and 2020.
Abortion funds, which provide logistical and financial support for women seeking care, are also receiving more pleas for help. From July 2022 to May 2023, the National Abortion Federation (NAF), for instance, paid for 1,090 hotel rooms compared to 369 during the same period in the previous year and 982 trips by plane, train, or bus compared to 293 over the same period one year prior.
Navigate the healthcare industry
Healthcare Brew covers pharmaceutical developments, health startups, the latest tech, and how it impacts hospitals and providers to keep administrators and providers informed.
The NAF has a record $55 million budget this year, but in July, the organization shrunk the amount of financial assistance it can offer per person from 50% to 30%, the Associated Press reported on September 25. Other funds have put caps on spending as well.
Lucy Font, manager of patient advocacy and coordination at the College Park, Maryland-based Partners in Abortion Care, told Healthcare Brew that the independent clinic has discounted about $80,000 in abortion costs since July 1 because an increasing number of patients can’t afford the full price. It’s “a massive financial hit,” she said.
“Right now, our top concern is staying financially solvent. Our clinic, and other later abortion clinics, simply cannot afford to continue providing discounted care to the growing number of patients that need it,” she said.
Independent clinics not associated with national organizations like Planned Parenthood have long been at risk of closure, Brooke Thomson, development director at Abortion Care Network, a nationwide membership organization for independent abortion providers and supporters, told Healthcare Brew.
The Abortion Care Network counted 139 independent abortion clinics that closed or stopped providing abortion nationwide between 2018 and October 2023 in its 2023 report. At least 74 of those ended care prior to the Dobbs ruling.
Patients panic
Meanwhile, some clinics report seeing more patients struggle due to the restrictions.
“A lot of patients, when we do a sonogram and find out that they are further than six weeks along, they pretty much break down,” Murano said.
Patients who are too far along in a pregnancy to receive care in their state are increasingly turning to telehealth for mifepristone and misoprostol—the drugs used to help induce abortions in the US—in states with “shield laws” that protect providers from prosecution.
From January to March, an average of 9,200 telehealth abortions were provided monthly via shield laws, according to the Society of Family Planning’s August #WeCount report, representing a 28% increase from a year before. Telehealth abortions are defined in the report as abortion medication prescribed by a clinician after a remote consultation and sent through mail.
The World Health Organization deems self-managed medical abortion safe through the first trimester—up to 12 weeks of pregnancy—but Planned Parenthood, the largest provider of reproductive care in the US, only offers the pills for medication abortion up through 11 weeks of pregnancy in states where abortion is legal, according to the reproductive health service’s website.
Sujatha Prabhakaran, an abortion care physician for Planned Parenthood of Illinois, told Healthcare Brew she has seen a huge toll on patients who come to her in person.
Planned Parenthood clinics in Illinois, for example, where abortion is protected up to viability, treat patients who have traveled from surrounding states like Wisconsin, Indiana, Iowa, Tennessee, Kentucky, and Missouri, as well as people from as far as Georgia or Florida, she said.
One patient, she said, drove about five hours to Illinois from Iowa, which currently bans most abortions after about six weeks into a pregnancy. She came alone, received the procedure, then drove back home the same day.
“She didn’t want anyone else at home to know about the care, and didn’t have someone who could take off [work] to support her,” Prabhakaran said. “We put people in this situation where there’s so much stigma around this care, and then it’s so hard to access.”