Jurisprudence

“This Doesn’t Have to Send Us Back to the 1970s.”

How one clinic in Illinois is preparing to deal with an influx of patients from states that have banned abortion.

Photo illustration by Slate.
Photo illustration by Slate. Photos by phive2015/iStock/Getty Images Plus and Hope Clinic

This as-told-to essay is part of a short series exploring abortion access in Illinois, which is preparing to become an abortion ‘island’ as surrounding states have banned or have signaled that they will ban abortions in the wake of the end of Roe v. Wade.

The first installment in our series, Dispatches From An Abortion Island, is a conversation with Dr. Erin King, the executive director of the Hope Clinic for Women in Granite City, IL. 

Even before the Supreme Court decision three weeks ago overturning Roe v. Wade, we had Missouri, which is right next door to our clinic. The state essentially has almost no abortion care happening because their restrictions had gotten so difficult to comply with for patients and for providers. We’d seen the state go from 6,000 or 7,000 abortion procedures a year to maybe a couple hundred.

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So over the past few years, our national ally organizations and membership organizations were all really pushing hard for all of us to really be thinking about how providers and groups that are doing funding and logistical support were going to work together. They wanted to make sure we were thinking about what an unfavorable Supreme Court decision would look like and how that would directly affect our clinic. In the last couple of years, we’ve been doing a lot of work around increasing capacity. But you can’t really increase the capacity until the patients are coming.

We’re a small healthcare organization. We have about 4,000 to 5,000 appointments a year. We’re obviously going to see a significant increase this year, probably more in the 6,000, 7,000 range. We have a pretty big staff, between 30 and 40 staff members at any given time. It’s a 15,000-square-foot building, and we are able to accommodate a lot of staff and a lot of patients at the same time.

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After the Dobbs decision, we had planned to be able to increase our capacity to see about 40 percent more patients, by the end of the year. We had a whole plan to kind of slowly ramp that up, and not really change our schedule right away.

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But the last three weeks have shown that even the best-laid plans do not always come through.

What has absolutely changed is the patient’s show rate. We went from a show rate that was all about 60 percent, and now our show rate’s 80 and 90 percent. In the last three weeks, we’ve seen the number of patients we usually see in about a month and a half.

We also couldn’t control our call volume. This was a really big oversight on our part, it seems so obvious as I say it out loud in hindsight. We had planned on an increase in call volume and had good messaging on our website, but we couldn’t anticipate we were going to go from 100 phone calls to 600 in one day.

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We also realized if patients are traveling several hundred miles, they don’t just need help with funding for their procedure that day, but they need help with not just funding for travel, but actual help with travel. So making a hotel reservation, making a plane flight.

These are things that some people in this country do all the time. And some people in this country may not have access to a working credit card, and without a working credit card, you can not make a hotel reservation. In the last couple of years, we have built up what we called a “patient navigation” kind of internal system. There are lots of organizations that have specialized in this and are doing a really good job, so we connect the patients with those organizations and the organizations with the patients.

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Something we really weren’t expecting is such a dramatic shift in the makeup of our patients. In the last couple of years, about 65 percent of our patients were from out of state. In the last few weeks, it’s been 85 percent. So there are days when we literally do not see a patient from Illinois, who lives in Illinois. That obviously is not great for access for patients who live literally down the street. And to be honest, we’re squeezing those people in. We’re squeezing anyone we can in. We don’t want our patients who are our neighbors, where this is their community healthcare provider, not being able to access care.

We’re seeing more patients from Arkansas and Tennessee right now than we’re seeing from Missouri and Illinois. And part of that is the aftermath of the decision. There were patients scheduled in Arkansas and Tennessee and Mississippi and Louisiana and Texas who already had appointments in those states. I saw a patient on Tuesday that had an appointment on Friday, June 24, when the Supreme Court decision came out, and she had an appointment in Memphis, Tennessee and they said, “Sorry, we can’t see you.” And she got moved.

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It’s been really interesting and really sad. We were already extremely sad about the patients that can’t get to us. I think that we’ve been in kind of emergency mode for three weeks and the sadness and grief is really settling in now for the patients that we know just aren’t either getting appointments or aren’t getting to us.

The sadness is intertwined with this feeling of all-hands-on-deck that happens during a crisis.  The scary thing about this crisis is there’s no end in sight at the moment.

Yes, there is a lot of good advocacy work going on and political organizations and lawyers and legal people that are involved in changing this, but it won’t be tomorrow. It probably won’t be for several years.

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I think we’re now realizing ‘This is our new normal and the country’s new normal. And what can we do to be the best providers that we can be? And see the most patients we can see, but also be available as a local community provider.’

We’ve been adding staff. In the last three weeks, we’ve hired four new staff members. We’ve been really making sure that all lines of communication are available. We’re really working on expanding services we can do in Illinois that isn’t in the clinic, like telehealth and medication abortion. We’re also adding time to our schedule for people to come to be seen in the clinic.

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I think one of the scary messages that everyone is getting and I keep hearing over and over from our patients is they think that abortion is illegal in the country. And so that when they travel and get an abortion at a provider that’s providing it, that they’re doing something illegal. And right now they are not. There are lots of states in the country where it is still legal. And there are lots of people trying to get you in a safe way to those appointments.

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This is a big tragedy. But this doesn’t have to send us back to the 1970s. We have the technology, we have resources. We know how disproportionately low-income people of color will be impacted. And we don’t want to go back to that space.

There are people pushing really hard to try to support patients to still get healthcare. Whether that’s, you know, medication abortion that patients are mostly self-managing, without directly seeing a provider, or getting to an actual provider for a procedure, those things are safe. They’re doing it in any way that they safely and legally can, and the same for them. I really want the message to be clear: care is out there, and there are people to do it, and it can be done safely.

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