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Across the United States, health clinics that offer abortions are preparing for a massive relocation of patients from more than two dozen states that are likely to ban abortions if the U.S. Supreme Court overturns them. Rowe vs. Wade.
Some warn that they will not be able to cope with the surge in demand.
The country’s highest court will soon rule in a Mississippi case that could overturn a nationwide right to abortion. A leaked opinion from the court – only a draft – has already signaled a possible outcome.
If that happens, the healthcare landscape may change in a matter of days and weeks. The abortion ban could be effective across a large part of the country. Millions of women will be forced to travel hundreds or even thousands of miles to the remaining states where abortion is expected to be legal.
“The current infrastructure – the clinics – does not have the capacity to exploit these patients,” said Melissa Fowler, chief program officer for the National Abortion Federation, which represents all types of medical providers in the United States and Canada.
An indication of what’s going to happen … Texas
There is no precedent for a coup to take place as a result of an upheaval Rowe vs. Wade Decision
But clinics that offer abortions have an indication of what’s already happening – since Texas banned 6-week abortions last fall. Almost immediately, Texas women began meeting in waiting rooms in both near and far states.
“We know we’re a pioneer in what we want to happen across the country,” said Amy Hagstrom Miller, CEO of Whole Women’s Health, which operates clinics in five states.
At their Minneapolis Clinic, he said about a third of patients come from Texas. One patient recently traveled all the way from McAllen, Texas – on the Texas-Mexico border – to their clinic in North Virginia.
The wave’s effects are also being felt in western states such as Colorado, Nevada and New Mexico, where waiting times for some clinics have increased significantly since last year.
“Sometimes patients have to wait 2 to 3 weeks – and abortion care is extremely time sensitive,” said Dr. Christina Tox, Medical Director of Rocky Mountain Planned Parenthood.
Extended strain does not only affect people from outside the state. It is also displacing patients who live locally and are now waiting for an appointment, he says.
Some states may very well end up as an island of abortion access, surrounded by states that have imposed bans.
In Granite City, Ill., The Hope Clinic for Women has largely dealt with this dynamic on a small scale over the years. That clinic is in St. Louis, Md. Sitting on the other side of the river, where prohibition laws have already made abortion challenging for most women.
Dr. Erin King, executive director of the Hope Clinic, said most patients come from outside Illinois – and not just Missouri, but states like Mississippi, Louisiana and Texas.
“These aren’t the states that you really think are closest, but they are closer than many other options, and really, one of the last options for all these people,” he says.
Already, it can be difficult to find a doctor available for those who need an abortion in the second trimester. Currently, only 10% of abortions in the United States take place in the second trimester.
Dr. Charlie Brown, who practices in Seattle and Las Vegas, already sees patients in Texas and across the country where existing laws make it difficult, if not impossible, to obtain the procedure.
“It’s difficult for many people in many states to access these services now,” Brown said, noting that many doctors are not trained to perform second-trimester abortions.
If many states prohibit abortion altogether, more women may have to delay due to longer travel and waiting times. Brown concerns that more people may have a second trimester abortion.
“It’s going to be more difficult for these patients to find places where they can get those services, because we can only accommodate so many patients.”
What can they keep?
While the leaked draft surprised many, it does not come as a complete shock to abortion providers.
“We’ve been preparing for this worst case scenario for many years,” Fowler said.
Many healthcare providers have long considered this possibility and are taking increasing steps to increase their capacity: adding staff, creating new locations and offering telehealth to expand their services.
“This is full court news,” said Talks of Planned Parenthood in the Rocky Mountains. “We are going to face a tremendous influx of patients.”
It is still difficult to know the full effects, but they can be profound: according to the latest nationwide data collected in 2017 by the Gutmachar Institute, about one-third of all abortions occurred in states that are expected to make it illegal.
If Rowe In the fall, Hope Clinic expects an increase of about 40% in patients seeking an abortion by the end of this year alone. The clinic has doubled its number of doctors in recent years, but its expansion plans have not been affected by the epidemic and current labor shortages, especially in the healthcare sector.
“We’re trying to find qualified people,” King said.
Despite their best efforts, he hopes they won’t be able to see everyone who needs care: “We’re not going to tell many patients.”
Julia Strasser, a senior research scientist at the Fitzgerald Mulan Institute for Health Workforce Equity at George Washington University, says there are many outstanding questions about exactly how the workforce will adapt to changes in state law.
“The workforce that can provide this care will be dramatically reduced,” he says. “What we still don’t know is how much the providers will be completely excluded from the workforce, or whether they will leave a state that is restricted and go to practice in another state that is less restricted.”
Although some parts of the country feel better equipped to cope with the growth of patients.
“We have a lot of potential to increase our capacity,” said Dr. Laura Dalton, medical director of Parenthood Mar Mont, the largest affiliate plan in the United States, with more than 30 clinics in California and Nevada.
“When women come to California, we will be able to take care of them – absolutely,” she says. “But there will be many women who will not be able to travel and perhaps more importantly, who will not have to travel.”