Abortion Access in the Midwest: A Complicated Situation
This is in addition to the 14 states that have banned abortion completely, and four more who have made their laws more restrictive since the overturn of Roe v. Wade in 2022.
That’s not to mention all of those restrictions on abortion that were already in place before Dobbs v. Jackson Women’s Health Organization. Most are still present today. This is in addition to the 14 states that ban abortion entirely, and four more that have made their laws more restrictive since the overturn of Roe v. Wade in 2022.
That’s to say nothing of the abortion restrictions that were already in place in many states prior to the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, most of which remain in place today.
Hardest hit is the Southeast, where abortion was already largely inaccessible prior to Dobbs, especially beyond the first trimester. In almost all of the region, abortion has been banned completely or after six weeks. Others, primarily those from Texas and Oklahoma, are traveling west to states like Colorado and New Mexico. Others–particularly those from Texas and Oklahoma–are traveling west to states like Colorado and New Mexico.
But many are also traveling to the Midwest, a region with a complex patchwork of abortion laws and longstanding access challenges for its own residents.
Abortion providers and funders in the Midwest say they’re prepared to support Iowans who need to travel out of state, along with all the out-of-state patients they care for already. Money is the only way to ensure abortion access in a world where women are forced to travel further and farther away from their homes or purchase abortion pills online. As the post-Dobbs bump in donations disappears, Midwestern clinics and abortion funds told Rewire News Group that the biggest challenge is to ensure the money does not dry up. (Shutterstock)
When it comes to the legal status of abortion across the Midwest, it’s complicated.
The region is home to several states with total abortion bans, including Indiana, Missouri, and North and South Dakota. It is also home Minnesota, Michigan, which has some protection for abortion rights. Illinois is another state with protective laws that is a popular destination for travel abortion seekers. In Wisconsin, the criminal abortion ban that existed before the Dobbs ruling was used to quickly outlaw abortion after the Dobbs case. However, a September 2023 court decision restored the pre-Dobbs status quo and abortion care resumed–though that status quo is still restrictive.
Ohio’s constitution, too, now protects abortion rights after a successful ballot campaign in 2023. The constitutional amendment didn’t automatically remove the many restrictions on abortion in the state, so abortions are still available only until 22 weeks. Kansas, where voters defeated a ballot measure that would have banned abortions after 12 weeks, has kept it legal up to 22 weeks. In May, Kansas abortion access suffered a setback when Wichita’s Trust Women Clinic, one of six in the state shut down unexpectedly after the board removed the entire senior management team. Trust Women told Rewire News Group it will reopen in the next week.
A number of Kansas abortion restrictions have been overturned by the state supreme Court, but many remain.
Iowa is in a dire situation.
As far as we know, there are only two abortion clinics in Iowa. (Shutterstock)
IAAF is ready to help people travel out of state if needed. And IAAF is prepared to help people travel out of state as needed.
“We’re the second-oldest abortion fund in the nation,” Lenz said. “We are not going anywhere.”
IAAF has already seen a 27 percent increase in requests for funding since 2021 and a 7 percent increase compared to last year in just the first half of 2024, said Lenz, who added that many people were already traveling out of state due to Iowa’s restrictive abortion laws.
But abortion bans affect all reproductive and sexual health care. OB-GYNs are leaving abortion ban states across the country and medical residents are increasingly refusing to train there. A March of Dimes study from 2023 found that a third of Iowa counties were maternity deserts. In Iowa, more than a third of the population lives in rural regions, yet 61 percent rural hospitals do not offer labor and deliveries. Earlier this year, a major Des Moines hospital had to shut down its gynecologic oncology program because it couldn’t find a doctor to run it.
And should the state’s six-week ban cause more doctors to flee, the burden will fall most heavily on the state’s most marginalized populations, said Ashley Garrin, vice president of the Iowa Black Doula Collective.
It’s challenging already for Black Iowans–who make up about 4 percent of the state’s population–to receive high-quality, culturally competent care, Garrin said.
“I’m in Des Moines, the capital city, which is the most diverse in the state,” she said. “And we have only two Black female OBs that exist throughout the different medical systems here.”
“Across the nation, Black women are three to four times more likely to die in childbirth compared to their white counterparts,” Garrin added. Garrin said that pregnancy dating is confusing, and that many people who could potentially access legal abortion care in Iowa may not have the health literacy to get there. But pregnancy dating is confusing, and Garrin pointed out that many people who could potentially access legal abortion care in Iowa may not have the health literacy to get there.
“I have a daughter who’s 13, and if I think about the sex education that she’s been exposed to at school, it doesn’t cover those kinds of things,” Garrin said.
Providing care to an influx of out-of-state patients
Minnesota has legal protections for abortion access. (Shutterstock)
Most Iowans who need to travel out of state will likely go east to Illinois or north to Minnesota, with some possibly traveling to Nebraska or farther afield where they have personal connections.
According to Dr. Iman Alsaden, medical director at Planned Parenthood Great Plains (PPGP), Midwestern abortion providers are adept at caring for traveling patients. They have been doing this since before Dobbs. For example, PPGP has clinics in Arkansas Kansas Missouri and Oklahoma. But patients from Missouri had long traveled to Kansas for abortion care due to the restrictive environment in their home state.
Historically, abortion restrictions that send a flood of patients traveling from one state to another tend to displace the residents of that “destination” state.
“When SB 8 went into effect in Texas
, everyone from Texas went to Oklahoma City and Tulsa,” Alsaden said. Then, all of a suddenly, in Kansas City we saw people from Oklahoma even though abortions were legal in Oklahoma during that time. It’s partly because several new abortion clinics opened in the state. CHOICES is a Memphis, Tennessee-based abortion provider who began working on opening a clinic in Carbondale, a Southern Illinois college town, in 2021. CHOICES’ Carbondale clinic opened in October 2022. Its Memphis location remains open, offering a variety of sexual and reproductive health services, even though they can no longer provide abortion care. Most of the patients were from the South. The majority came from Tennessee, Mississippi, Arkansas and Kentucky. In total, the clinic saw patients from 21 states, mostly across the South and the Midwest.
Absorbing patients who would need to travel north for abortion care was precisely the goal.
“We wanted to take care of the same communities that we had been taking care of for the last 50 years,” Pepper said. I think that most people in Illinois and other states knew their abortion providers, who have been serving their communities for many years. And so I think folks in Illinois are continuing to go to those colleagues of ours, and we are really taking care of folks, primarily, that are having to travel outside of their communities to access care.”
Expanding capacity
Other longtime abortion providers in Illinois have expanded their staff and capacity to handle the influx of out-of-state patients and avoid displacing locals. Illinois’ oldest independent clinic, Hope Clinic in Granite City–just across the border from Missouri–has increased its staffing by 40 percent and added an additional clinic day to handle increased patient volume, Chief Operating Officer Michele Landeau said.
Caring for out-of-state patients–particularly Missourians–is nothing new. “A lot of them are coming from the Southeast, but a lot of folks are coming from other states in the Midwest.” “A lot of them are coming from the Southeast, but a lot of folks are coming from other states in the Midwest.”
Hope Clinic has also increased its capacity to offer care up to 27 weeks, six days of pregnancy.
“We have seen a 250 percent increase in the number of people who are seeking care in their second trimester at Hope Clinic,” Landeau said.
CHOICES President and CEO Jennifer Pepper noted the critical importance of clinics that remain open in states that ban abortion … so patients will have safe places to go for follow-up care if needed once they return home, or if they self-manage their abortions.
Family Planning Associates (FPA) in Chicago is the Midwest’s largest independent abortion clinic, and it’s another one of the few outpatient providers for later second trimester abortions in the state. To accommodate the additional demand, Medical Director Dr. Allison Cowett said FPA has hired 20 additional staff members to bring its staff up to 60 people in total, and increased the size of its physical space.[in 2021]”Somewhere between 10 and 12 percent of our patients were from out of state prior to Dobbs, and most of those folks were from Indiana and Wisconsin,” Cowett said. “Now, over 30 percent of our patients are coming from outside of Illinois.”
FPA sees about 30 Texans per month, she said, with a growing number from the rest of the South since Florida’s six-week ban went into effect.
Pepper also noted the critical importance of clinics that remain open in states that ban abortion, such as West Alabama Women’s Center, Feminist Women’s Health Center in Atlanta, and Women’s Health Center of West Virginia, so patients will have safe places to go for follow-up care if needed once they return home, or if they self-manage their abortions.
Cowett said she had a patient recently whose experience points to this need. She said that a patient who had traveled from the Deep South for an abortion in Chicago was worried about her bleeding when she got home. The staff at Family Planning Associates determined that it was best to have her seek medical attention. She didn’t even tell the police that she had an abortion. Luckily, they did not feel obliged to take action in this situation. She left the emergency room, but without receiving any care.”
A growing demand for hospital-based healthcare
Abortion restrictions are known to cause patients to wait longer to seek treatment, forcing them to do so later in their pregnancy. And when patients have more complex medical needs, they sometimes need care in a hospital rather than in a clinic setting.
“Sometimes that is because the pregnancy is further along, but it might be because of a health condition,” said Qudsiyyah Shariyf, deputy director of the Chicago Abortion Fund (CAF). There are certain health conditions that would not require hospitalization if the patient had access to stable health care. But so many people, particularly from the South and Midwest, and in rural areas, don’t have access to health care, and so when they’re showing up to get an abortion, that might be the first time in a long time that they’re seeing a doctor.”
To help facilitate access to hospital-based care, the state of Illinois set up the Complex Abortion Regional Line for Access (CARLA), a referral line that helps people secure appointments and access funding through CAF.
Illinois’ state government has been proactive and supportive, Pepper said. Some gaps still remain. Landeau explained that when a patient with a complex medical case arrives at Hope Clinic, they are referred to hospitals five hours away in Chicago, despite the fact there are many hospitals in Southern Illinois. Just last week, Gov. J.B. Pritzker signed a new slate of abortion and birth justice protections into law, including a requirement that Illinois-based insurance plans cover abortion with no copays or deductibles.
A regional hub for abortion support
In July, Illinois Gov. J.B. Pritzker has signed the Birth Equity Act into law, which strengthens abortion care and birth equality protections. (Shutterstock)
It has partnered with several smaller abortion funds, helping them to streamline and scale up their operations. For example, CAF partnered with Wisconsin Abortion Fund while abortion was inaccessible there. And it currently partners Nebraska Abortion Resources and Arkansas Abortion Support Network. It has partnered with several smaller abortion funds, helping them to streamline and scale up their operations.
For example, CAF partnered with Wisconsin Abortion Fund while abortion was inaccessible there, and it currently partners with Nebraska Abortion Resources and Arkansas Abortion Support Network, Shariyf said.
With Iowa’s six-week ban now in effect, IAAF becomes the latest fund to enter into such a partnership.
“The only thing that’s going to change on our end is the phone number that people call,” IAAF’s Lenz said. We are still raising funds and providing money to Iowans in need of abortion care. In the partnership, CAF will take on all the case management duties for IAAF’s clients, allowing IAAF to focus its efforts purely on raising and distributing funds.
According to Shariyf, this just makes sense: In addition to Illinois being a safe haven for abortion care, CAF is a larger fund with a mix of volunteer and paid staff, as opposed to smaller funds like IAAF, which are typically all-volunteer. It also allows smaller funds to access CAF’s more robust infrastructure and reduces administrative burden on clinics, Shariyf said. It also gives smaller funds access to CAF’s more robust infrastructure and reduces the administrative burden on clinics, Shariyf said.
Will the money run out?
“The biggest problem right now is the funding,” Cowett said.
“Abortion funds have done an amazing job raising money and helping people understand how important it is for outside philanthropic efforts to meet the needs of these people who are traveling,” she continued. The money and resources are limited. There will be a time where it’s difficult to provide funding for these people to travel.”
That’s especially true given the growing number of patients who need care later in pregnancy–when procedures take longer and are more expensive–or in hospitals.
“Our hospital patients make up about 2 percent of our callers and over 20 percent of our budget,” Shariyf said.
For months, abortion funds and clinics alike have sounded the alarm that post-Dobbs “rage” donations are drying up. It’s been a difficult situation, made worse by the National Abortion Federation, which is the largest player in abortion funding. They confirmed to Rewire News Group that they have cut their assistance per patient, from 50 percent to 30 percent. “Even so, the growth in our services after Dobbs cannot be sustained without longer-term policies.”
