Independent Clinic Closures Put Abortion Access at Risk

While most pro-choice mainstream organizing centers around protecting Planned Parenthood from defunding, independent abortion clinics like Choices in Memphis, Tennessee, are also under serious threat from anti-choice laws that threaten their continued operation. (Photo: Lisa Buser Photography)

Note: Stats that are not cited to a source such as Guttmacher came directly from the report itself.

A report released yesterday by the Abortion Care Network, the national association for independent community-based, abortion care providers and their allies, details an alarming trend of mass independent reproductive health clinic closures that is threatening access to care across the country.

According to “Communities Need Clinics,” 145 independent abortion clinics have closed since 2012, reducing the total number of independent providers by nearly one-third to 365. Ten clinics have closed already this year. Sixty percent of people who have abortions seek out that care at independent clinics (non-Planned Parenthood, standalone facilities not housed in a hospital that specialize in reproductive health care). Without access to independent providers, access to non-hospital abortion care after 16 weeks would drop by 76 percent.

The explosion in state-level restrictions that began in 2010 continued last year, with an additional 50 measures enacted in 18 states, bringing the total to 338. In the first quarter of 2017, 431 additional restrictions were proposed; legislators in 28 states have introduced 88 measures that would ban abortion completely or under certain circumstances (typically past a certain point in the pregnancy). The burden and cost of challenging these laws typically fall to independent providers, like Whole Woman’s Health, the plaintiff in last year’s landmark Whole Woman’s Health v. Hellerstedt Supreme Court case. In many cases, the burden is too high and clinics are forced to close their doors, leaving communities without access to affordable care as hospital procedures are exponentially more expensive and rarely covered by insurance.

“Independent abortion care providers are integral to abortion care access in the United States,” Caitlin Gerdts of Ibis Reproductive Health said in a statement. “Without them, access to abortion care after 19 weeks would be nearly non-existent.”

Independent abortion clinics are the only providers of the full range of abortion care in nine states — Arkansas, Georgia, Kentucky, Mississippi, Nevada, North Dakota, Oklahoma, West Virginia and Wyoming. In five of those states — Kentucky, Mississippi, North Dakota, West Virginia and Wyoming — independent clinics are the only provider of any abortion care services. Because they don’t have the name recognition and fundraising infrastructure of Planned Parenthoods and hospitals, emergency resources are less likely to flow in as they fight state-level regulations created to close their doors, and the erosion of their funding does not make national news. Meanwhile, these providers continue to be the first line of care for the majority of people in need of abortions.

“Communities needs clinics and these providers need their communities’ support,” Abortion Care Network executive director Nikki Madsen told Truthout. “Abortion was brought into clinics in the first place by physicians and feminists to help reduce the cost for patients.”

Rachel K. Jones, principal research scientist at the Guttmacher Institute, a sexual and reproductive health and rights nonprofit, told Truthout that while separating out abortion care may have put clinics at risk of targeting by anti-choice elected officials, it has been vital to making abortion accessible over the past four decades.

“The price of health care is exorbitant in a hospital setting, so it’s good that most abortions don’t take place there — very few women would be able to afford them,” Jones said. “This model of independent clinics evolved pretty quickly after Roe v. Wade, in some cases through feminist groups who wanted to make sure that women had access to quality abortion care since it didn’t seem like any other health care facility was stepping up to the plate. And it just kind of evolved from that.”

Independent clinics are important for a variety of other reasons, as Kwajelyn Jackson, community education and advocacy director at Atlanta’s Feminist Women’s Health Center, told Truthout.

“Being an independent provider allows us a lot of flexibility to be responsive to the needs of our community and really make that a center point of the way that we approach our work,” said Jackson. “It allows us to evolve and adapt over time and we’ve really seen that over our 40-year history. What we really want to achieve is being a space that feels really rooted and place-based.”

While her clinic in Atlanta has weathered multiple state laws targeting abortion providers — often called TRAP (targeted regulation of abortion providers) laws — by creating unnecessary waiting periods, bans on procedures after 20 weeks and restrictions on insurance coverage, Jackson has watched others close their doors. She told Truthout that the patients who rely on the clinics in their communities for preventative care expect that those clinics will still be there should they need to terminate a pregnancy; it can be a huge blow to reach out in a time of need and find out that elected officials have legislated one’s necessary medical care out of existence. Patients in this situation often end up needing to travel greater distances and pay higher costs.

The “Communities Need Clinics” report details those costs:

When clinics close, patients are forced to travel farther, find overnight lodging, take additional time away from work (often unpaid), and find childcare, increasing both medical and personal out-of- pocket costs. Patients are also forced to wait longer to access care, may not be able to access the method of their choice, and in some cases, may not be able to obtain an abortion at all. Additionally, when clinics close and fewer providers remain in each state, it becomes increasingly easy for anti-choice extremists — including politicians — to concentrate their efforts on a single clinic, at times terrorizing the last remaining lifeline in a given state.

Marginalized communities are hit hardest by these closures, starting with low-income and generationally or systemically impoverished peoples.

“We have seen time and time again that wealth and privilege equal access,” said Jackson. “Community clinics are the only option for people who are under-insured, under-employed, and don’t have a multitude of options. We’ve also seen that communities of color in particular, because of compound oppression, are also especially vulnerable when clinics close.”

The reduced access to later abortions is a particular problem as 43 states have limits on how late into a pregnancy an abortion can be performed (typically with exceptions for the life of the pregnant person). While 89 percent of terminations are performed in the first trimester, patients beyond 12 weeks have the same constitutional right to care as those who seek abortions early on in pregnancy.

“Access to abortion at 16 weeks and later, even though it counts for a very small proportion of abortions, it’s vital to the women who need it,” said Jones. “Sometimes it’s due to fetal anomalies or health problems, sometimes women don’t recognize they’re pregnant until later in the pregnancy, sometimes things in their lives change — they lose their jobs, they lose their partner. They still need to be able to have access to abortions at 16 weeks and even later.”

Warren M. Hern, director of the Boulder Abortion Clinic, and one of the handful of providers who sees patients beyond 24 weeks, explained in the report why the availability of care later is so crucial.

“Women who seek abortion after 20 weeks of pregnancy are almost always in desperate situations that require expert care in a setting devoted to their needs. Some are carrying wanted pregnancies but facing fetal anomalies; others are navigating the trauma and barriers resulting from sexual assault,” said Hern. “It is essential that practitioners are free to give these patients total medical, emotional and social support in a place that protects them from the harsh and sometimes violent hostility directed toward them by anti-abortion fanatics, social stigma and anti-abortion political leaders.”

Madsen told Truthout that ending this trend requires action from the constituents whose legislators are enacting the laws that close clinics.

“People must get more involved in both local and state politics specific to abortion and women’s health care in order to block or remove barriers to accessing abortion,” she said.

Jackson saw just such an increase start right after the election.

“Since November, [people are] newly activated and newly angry,” she said. “[They] take to social media and are looking for places they can put action to that feeling and that sentiment.”

Jackson and Madsen both encourage people to share their concerns with those in power at the local, state and federal levels. They also suggest that people volunteer at their local clinics and at the organizations that provide support to independent providers in their state.

As the report concludes, “Without these courageous providers, meaningful access to abortion throughout pregnancy is merely a right in name alone.”