Some days, the phones at the Trust Women Wichita clinic ring nonstop, and staff are unable to keep up.
Since the U.S. Supreme Court ended federal protections for abortion last summer, the clinic has had a math problem: too many patients desperate for care with limited time and resources to see them.
“We are averaging about 500 patients a month, give or take,” said Ashley Brink, a clinic director at Trust Women Wichita. “We're located in Kansas, but we only see about 100 patients a month that are actually from Kansas, the other 400-plus are from other states.”
In the six months after the fall of Roe v. Wade, it’s been up to each state to set its own abortion laws. In Kansas, abortion access was saved by a ballot vote. But more than a dozen other states issued bans or severe restrictions.
The legal patchwork that ensued has turned some states into destinations for abortion care while others went dark due to new abortion bans and restrictions.
The overall impact of these changes is spelled out in a new report by the Society of Family Planning, which supports abortion rights. The authors found a more than 6 percent drop in the number of legal abortions nationwide in the months after Roe was overturned June 24, 2022.
Researchers tracked legal abortions between July and December 2022, collecting abortion counts from 83 percent of clinics, hospitals and telehealth providers across the country. That data was compared to numbers from the months preceding the Dobbs decision. For the missing pieces, the authors made estimates based on historical trends and nearby clinics.
One of the report’s big takeaways for states in the Midwest and surrounding areas: The uptick in legal abortions in states like Kansas, Illinois and Michigan was not enough to make up for the decrease in states that passed post-Roe restrictions, like Ohio, Indiana, Kentucky.
“The overall picture is one of a somewhat chaotic environment in which we know that the people who have the least resources are the most burdened and will find it the most hard to get the care that they need,” said Dr. Alison Norris, an epidemiologist at Ohio State University and co-author of the We Count report.
Providers and patients forced to adapt to a new reality
Trust Women clinic in Wichita has become an abortion haven for women in states like Texas, Missouri, Kentucky and Oklahoma where abortion is banned.
“We had to change literally everything about our organization,” Brink said.
They tripled their staff, added more work days, and made some difficult cuts to OB-GYN services and gender-affirming care.
“Because we felt like we are one of the only clinics in the area that can provide abortion care, it was really important to us to shift that gear into doing 100 percent abortions,” she said. “And that's great for now, but is it sustainable, long term? Probably not.”
Other states in the Midwest where abortion is protected, like Michigan and Illinois, saw similar spikes in the number of abortions provided, many for out-of-state patients who traveled hundreds of miles for care, according to the latest WeCount data.
But contrary to some earlier predictions, states on the West Coast and in the Northeast where abortion is protected did not see significant surges in abortion numbers, according to the report, “showing that for most people who needed to travel for abortion care, driving was the more preferred method or the more available path to them,” Norris said.
The increased capacity in states like Kansas only made up for about a quarter of the decrease in abortions in states with bans or restrictions in the six months after Roe fell, Norris said. During that time, 43,000 fewer abortions took place in states with bans or severe restrictions, compared to 11,000 more abortions in states where abortion remained accessible.
“This means that some people have been forced to stay pregnant and will have a birth that they didn't intend to have,” Norris said.
The data also suggests that the number of medication abortions happening via telemedicine has increased by more than 130 percent in December 2022 compared to April 2022. Telemedicine abortions now account for 11 percent of all legal abortions compared to just 4 percent in April — a new reality that abortion providers have had to adapt to.
Planned Parenthood Great Plains shut down clinics in states where abortion got banned or severely restricted and started telehealth services in a new clinic out of Kansas.
“We are doing our best to expand and adapt and we've been really truly jumping from fire putting out fire to fire to fire,” said Dr. Iman Alsaden, the clinic’s medical director.
Seeking abortion care outside of the health care system
It’s been really difficult, Alsaden said, because laws keep changing. Some states have yo-yoed back and forth between a ban and a stay on abortion access and that has left patients confused about where to safely seek care.
In Indiana, a near-total ban took effect for only one week before being halted by the courts. Still, abortions dropped every month after Roe fell: 940 abortions took place in Indiana in April, and by December, the number had dropped to 550.
While nearly all abortion restrictions and bans target providers with potential legal penalties, the precarious legal landscape leaves patients worried as well. This may compel some to look outside of the health care system and self-manage their abortions using mifepristone and misoprostol pills obtained online from overseas clinics.
The new report doesn’t account for self-managed abortions and the authors recognize that limitation. They say that while requests for abortion pills from overseas pharmacies are up, it’s hard to know whether all requests are filled, whether the pills people obtain are used to terminate a pregnancy or whether they order the pills just to have them on hand.
Self-managed medication abortions early in pregnancy are very safe, said Alison Case, an Indiana-based abortion provider. But she worries that abortion restrictions may make some patients reluctant to seek help in the event they need it.
“If they do have a complication with a self-managed abortion, you want to make sure they can get help and know to seek help,” Case said.
Social media is flush with anonymous posts from people looking for guidance on self-managed abortions. Some say they’re alone and scared. At times, the only solace they have comes from other anonymous social media users who share advice.
Norris, the co-author of the WeCount report, said the logistical and financial barriers make it impossible for some women to travel for hundreds of miles, which means self-managed abortions are sometimes the only option they have.
“From a health care equity standpoint, it's insufficient to somehow feel that people managing their own abortions is okay and it's the end of the story,” Norris said. “It's still really important that people have access to a health care provider if they wish to see one and in-person visit if they wish to have one.”
This story comes from a collaboration between Side Effects Public Media, based at WFYI, and the Midwest Newsroom — an investigative journalism collaboration including IPR, KCUR 89.3, Nebraska Public Media News, St. Louis Public Radio and NPR.
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