{"id":2179,"date":"2024-06-24T15:22:41","date_gmt":"2024-06-24T15:22:41","guid":{"rendered":"https:\/\/healthyretirementnews.com\/index.php\/2024\/06\/24\/post-dobbs-abortion-clinics-find-new-ways-to-serve-patients-in-states-with-bans\/"},"modified":"2024-06-24T15:22:41","modified_gmt":"2024-06-24T15:22:41","slug":"post-dobbs-abortion-clinics-find-new-ways-to-serve-patients-in-states-with-bans","status":"publish","type":"post","link":"https:\/\/healthyretirementnews.com\/index.php\/2024\/06\/24\/post-dobbs-abortion-clinics-find-new-ways-to-serve-patients-in-states-with-bans\/","title":{"rendered":"Post-Dobbs, abortion clinics find new ways to serve patients in states with bans"},"content":{"rendered":"

In the last couple years, Houston Women\u2019s Reproductive Services scaled down from nearly 5,000 square-feet to an 800-square-foot location. The Texas clinic cut more than a dozen full-time employees down to a medical director and three part-time staff members. <\/p>\n

It\u2019s no longer able to provide abortions, but it changed its focus and stayed open. <\/p>\n

\u201cI was willing to make whatever sacrifices needed to be made to keep our head above water, just keep the doors open and the lights on, and be able to provide care to these people who desperately need our help,\u201d said clinic administrator Kathy Kleinfeld. <\/p>\n

It\u2019s one example of the shift to the the country\u2019s abortion landscape since the Supreme Court\u2019s Dobbs decision ended the federal right to abortion two years ago. Since then, 14 states have near-total bans on abortion. Clinics can no longer provide abortions in more than a quarter of US states. <\/p>\n

Although the total number of facilities that provide abortions in the United States hasn\u2019t changed that much \u2013 only a couple dozen clinics have closed completely \u2013 the number of closures doesn\u2019t always capture the upheaval. <\/p>\n

States that enacted abortion bans generally had few clinics to start with. Since Dobbs, some packed up and moved to places where they can still provide care, but may require patients to travel further. Still other clinics remain open, but in a different capacity. <\/p>\n

Kleinfeld\u2019s clinic in Houston pivoted to broader reproductive health, including pre- and post-abortion care for those who travel out of state or self-manage their abortions. <\/p>\n

In the months before the Supreme Courts\u2019 Dobbs decision, there were about 3,000 abortions a month in Houston and Kleinfeld said she knew that need wouldn\u2019t stop once Texas\u2019 trigger law banned abortions. <\/p>\n

\u201cThere were a lot of different ways it could have gone; most of all would have involved closing,\u201d Kleinfeld said of her clinic in Houston. \u201cThat was just not something I was willing to do.\u201d <\/p>\n

Few clinics to start with<\/h2>\n

In 2021, there were about 750 abortion clinics in the United States, according to data from the University of California San Francisco\u2019s Bixby Center for Global Reproductive Health. Less than a tenth \u2013 only about 60 of them \u2013 were in the 14 states that have since banned abortion. <\/p>\n

\u201cThe reason that banned states did not have many facilities to begin with is that they were hostile to abortion and put up barriers to providing abortion services even before Dobbs,\u201d said Caitlin Myers, an economics professor at Middlebury College. Her research focuses on the US abortion landscape, and she has been tracking travel distances to abortion facilities. <\/p>\n

These states were more likely to have regulations like mandatory waiting periods and parental involvement that created challenges for people seeking abortions, as well as logistical hurdles for providers, such as those in Texas. <\/p>\n

\u201cThis is basic economic theory,\u201d Myers said. Strict regulatory environments created high costs to entry for providers, leaving space for only the few that could effectively scale their services up enough to survive, she said. <\/p>\n

The Dobbs decision wasn\u2019t the first time abortion clinics in Texas confronted their fate. About half of the abortion clinics there closed in 2013 when the state legislature passed a law that required them to meet hospital-like standards. The US Supreme Court overturned those restrictions, but dozens of doors closed remained shuttered. <\/p>\n

\u201cHaving lived through that, I knew all the other clinics \u2013 the very few that were left \u2013 I knew they were going to close\u201d after the Dobbs decision, Kleinfeld said. <\/p>\n

By 2023, the total number of facilities providing abortions in the US was down to about 725, the UCSF data shows. <\/p>\n

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But each clinic closure has a ripple of negative effects, experts say, especially in regions where services have already been suppressed. <\/p>\n

\u201cWe need every single abortion clinic in this country. There really aren\u2019t enough for the number of people who need care,\u201d said Nikki Madsen, executive director at Abortion Care Network, a national association for independent abortion care providers and other stakeholders. \u201cWhen we treat abortion in an isolated way, we miss the broader cost of closing a clinic.\u201d <\/p>\n

About two-thirds of the clinics in states with bans have stayed open in some capacity, the UCSF data shows. Clinics often provide other reproductive health-care services and are sometimes the only touchpoint that people have with the health-care system. <\/p>\n

\u201cIndependent clinics have always been based in their communities. They really understand the communities where they\u2019re located and the people that they serve in those communities,\u201d Madsen said. \u201cSo over this time, the clinics have been really working to figure out how they can continue to serve the same communities that they were serving pre-Dobbs in an increasingly hostile environment.\u201d <\/p>\n

Clinics move to the front lines<\/h2>\n

While some clinics have held their ground with a shift in focus, a handful of others have relocated into key access states or opened new locations. <\/p>\n

\u201cProviders are going to locations that place them as close as possible to the places where people are coming out of banned states in search of abortion,\u201d Myers said. \u201cThey are primarily locating in places that put them on the front lines to receive patients, very strategically in southern Illinois, in New Mexico, in Virginia.\u201d <\/p>\n

The number of abortion clinics in New Mexico more than doubled post-Dobbs, rising from five in 2021 to 11 in 2023, according to the UCSF data. And the number of abortion providers in Illinois grew from 27 to 36 in that time frame. <\/p>\n

Among the new additions is CHOICES Center for Reproductive Health, which relocated its abortion clinic from Memphis, where abortion is banned, about 200 miles north to Carbondale, a small city in southern Illinois. It still has a location in Tennessee that offers other services including birth control consultations and STI testing. <\/p>\n

Red River Women\u2019s Clinic had a much less distant \u2013 but no less significant \u2013 move. It popped just a couple miles away from its original location in Fargo, North Dakota, over the border into Minnesota. <\/p>\n

\u201cWe were the only abortion clinic in North Dakota for over 20 years,\u201d said Tammi Kromenaker, the clinic director. \u201cWe knew that if we didn\u2019t do something, those patients who already drive three, four, five hours one way just to get to our clinic would face even bigger hurdles.\u201d <\/p>\n

Kromenaker says she had been exploring options to move the clinic out of North Dakota years before the Dobbs decision as a conservative state legislature threatened the clinic\u2019s work, but options felt out of reach, mainly because they were too expensive. <\/p>\n

But when the Dobbs decision leaked a month before it was handed down, the need to act instantly outweighed those concerns. <\/p>\n

\u201cIt just was just this thing, like, \u2018we just have to do this. We have to, no matter the obstacles,\u2019\u201d Kromenaker said, and she was thankful for a fundraising campaign that buoyed the clinic in that leap. <\/p>\n

Struggle for solid financial footing<\/h2>\n

As clinics weigh their options in a post-Dobbs world, finances are the greatest determining factor. <\/p>\n

\u201cIt costs money to close the clinic. It costs money to reopen the clinic. If patients have never gone to you for prenatal care before, it\u2019s going to take time to develop a patient population who comes to you for prenatal care,\u201d Madsen said. \u201cAll of these shifts really require community support and financial support from the community to continue to keep these clinics open.\u201d <\/p>\n

And constant changes to the abortion landscape in the US exacerbate clinics\u2019 struggle for solid footing. <\/p>\n

\u201cI would have expected to see providers open in North Florida and North Carolina, which were both geographically important destinations after Dobbs, except for the fact that both states are fairly hostile to abortion,\u201d Myers said. \u201cThe future there was so uncertain, and I think it was too risky to open.\u201d <\/p>\n

Before Dobbs, a 100-mile increase in distance to the nearest clinic could prevent about 1 in 5 people who wanted an abortion from being able to reach a facility to get one, her research shows. <\/p>\n

Travel distance to abortion clinics continues to be a critical barrier to access, but a surge in virtual clinics has helped fill some of that gap. <\/p>\n

In the last few months of 2023, about 1 in 5 abortions in the US were telehealth abortions, where medication abortions pills were mailed to a patient after a remote consultation with a clinician, according to a recent report from #WeCount, a research project led by the Society of Family Planning. By December, nearly a tenth of all abortions in the US \u2013 about 8,000 a month \u2013 were telehealth abortions provided under shield laws, which allow providers in some states where abortion remains legal to prescribe medication abortion drugs via telehealth to people living in states with bans or restrictions. <\/p>\n

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      \u201cSome people have resources to travel, but the pressure on brick-and-mortar clinics continues to build,\u201d said Kirsten Moore, director of the Expanding Medication Abortion Access Project. \u201cNow, patients can get their medications sooner because they don\u2019t have to wait for a spot to open up in a clinic or find a way to get there. It\u2019s vital.\u201d <\/p>\n

      A Supreme Court ruling last week maintained broad access to medication abortion, but other ongoing legal challenges and ballot measures that will be on the table in a few states during this year\u2019s election leave policies and planning very much in flux. <\/p>\n

      Although Red River has moved all of its staff and services to the Minnesota, Kromenaker has kept the address in Fargo to maintain standing in ongoing legal battles with the state. <\/p>\n

      \u201cIt would have been easy to just walk away and say, \u2018OK, we\u2019re going to sell this building. We\u2019re done with North Dakota. We\u2019re out,\u2019\u201d she said. \u201cWe have fought so long and so hard, we just didn\u2019t want to give up. We\u2019re just one little clinic, but downtown Fargo is still, technically, our corporate address so that we can maintain that standing in North Dakota and continue to fight for those patients we\u2019ve served for \u2026 <\/strong>26 years in July.\u201d <\/p>\n<\/p>\n

      This post appeared first on cnn.com<\/div>\n

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