Fairview Heights, Illinois
On a winding road just off Interstate 64 in southern Illinois, past a Holiday Inn, an antiques mall and a TGI Fridays, the squat brick Planned Parenthood clinic is a window onto a post-Roe v. Wade America.
The clinic’s call center – less than 20 miles from Missouri’s lone abortion provider – has been abuzz since a draft opinion leaked earlier this month suggested that the US Supreme Court could soon strike down the landmark 1973 decision guaranteeing a constitutional right to abortion.
“Patients immediately were calling, wondering, ‘What does this mean? Can I still come to my appointment tomorrow? Is abortion still legal?’ ” said Dr. Colleen McNicholas, Planned Parenthood’s chief medical officer for the region, which includes the clinic in Fairview Heights and one just across the Mississippi River in St. Louis.
“There’s lots of confusion around what does this mean today and what does it mean in the coming days and weeks.”
Already, more than 75% of the Illinois clinic’s patients come from throughout the Midwest and South, Illinois Gov. JB Pritzker, a Democrat, said during a visit to the 18,000-square-foot health center on Wednesday. Thousands more are expected to travel for hours from places like Oklahoma, Missouri, Texas and Kentucky if Roe is struck down.
“Illinois is going to be ground zero,” said David S. Cohen, a professor at Drexel University’s Thomas R. Kline School of Law in Philadelphia. “Illinois is just closer to more people who are going to be in states where abortion is going to be banned.”
An island in ‘abortion access desert’
The Fairview Heights clinic – and a partner facility in nearby Granite City, Illinois – expect the number of abortion patients in southern Illinois to double to about 14,000 per year if Roe falls.
In the parking lot of the Fairview Heights clinic there are usually several cars with plates from Southern states. Overall, Illinois could see up to 30,000 out-of-state abortion patients per year, according to McNicholas. The Guttmacher Institute, a reproductive rights think tank, said there were 40 facilities – including 25 clinics – providing abortions in the state in 2017.
“Illinois certainly is an island in what will be an incredible abortion access desert,” McNicholas said. “An oasis for so much of the country.”
At the clinic gates, young people in reflective safety vests try to stop entering cars and hand out pamphlets offering information on parenting support and adoption services in a bid to discourage the patients from getting abortions.
The abortion debate could get more confrontational in the coming weeks if the high court overturns Roe. The battle lines are already being drawn by lawmakers in both red and blue states.
In Jefferson City, Missouri’s capital, the House last month passed a bill that would ban abortion drugs being sent via mail to people’s homes in the state and defund Planned Parenthood clinics in the state. It would also allow family members to file wrongful death lawsuits in cases of a live birth during or after an attempted abortion when the baby is injured or subsequently dies as a result of the abortion.
While the leaked Supreme Court draft has no immediate effect on abortion access across the country, the preliminary opinion – confirmed to be authentic by the high court – would overturn Roe if a majority of justices decided to join. That would leave state legislators to weigh their own abortion policies.
Roe affirmed the right to receive an abortion under the 14th Amendment, ruling that the procedure was constitutionally protected up until about 23 weeks of pregnancy when a fetus could be able to live outside the womb.
GOP legislators seek to protect existing laws
Many Republican-led state legislatures have already moved to limit abortion access. Others are poised to enforce restrictive laws that have remained unenforced since Roe was passed. In total, an analysis by the Guttmacher Institute finds that 23 states have laws aiming to limit abortion access, including some states with multiple provisions.
And 13 state legislatures – including Missouri – have “trigger laws,” which are bans designed to go into effect if Roe is overturned. In some cases, the law requires an official such as an attorney general to certify that Roe has been struck down before the law can take effect. The bans would kick in almost immediately.
“If we’re successful and Roe v. Wade is overturned, I’m prepared to immediately issue the opinion that would protect the unborn in Missouri,” Missouri Attorney General Eric Schmitt, a Republican, said in a statement released the day after the high court’s leaked opinion was reported on May 2.
Mary Elizabeth Coleman, a Republican state representative, said Thursday “the first priority if Roe does fall” is protecting existing state laws.
“For states like Missouri that are largely already operating in a post-Roe environment, it does shift for me my focus from addressing abortion tourism to looking at how do we protect the laws that are on the books in our state courts,” Coleman said.
Still, Coleman has been pushing a measure that would allow state residents to file lawsuits against anyone who “aids and abets” a Missourian seeking an abortion out of state.
Cohen believes others states will pursue similar legislation should Roe be overturned.
“They’re not going to rest knowing that they’ve banned abortion in their state,” he said. “They’re going to want to ban it as widely as possible or stop it as widely as possible.”
Poised for ‘mass mobilization crisis moment’
In St. Louis, Missouri’s last Planned Parenthood clinic is open from only 8 a.m. to 4 p.m on Wednesdays. State law requires that patients receive counseling – including information to discourage an abortion – and then wait 72 hours before the procedure.
“We’re telling patients, ‘Yes, I can schedule your abortion appointment for Missouri next week. However, although we fully intend to keep that appointment if we can, the truth is that any day now, the landscape may change,’ ” McNicholas said.
Many patients from Missouri and other red states have been calling and traveling to health center in Fairview Heights, where case workers at its Regional Logistics Center coordinate funding for their procedures and other expenses from a vast network of member organizations. The case workers help with transportation costs, including booking flights and hotel rooms, child care services and even rides to and from the airport.
“It’s much more than just saying, ‘Do you have a car,’ right?” McNicholas said. “It’s understanding, ‘Will your car make it 800 miles here and 800 miles back?’ It’s really sort of nuanced, individual, deep conversations with patients about what their reality looks like.
“And that not only takes a lot of people power but financial resources that we are going to have to put towards navigating people from across the country in this sort of mass mobilization crisis moment. It’s going to be astounding. Right now we’re looking at an average of $1,500 per patient we navigate. Some need less, but some need much more.”
Abortion providers in other states that have severely restricted abortion access are taking similar steps to connect clients with the necessary services. Three-quarters of US abortion patients are poor or low-income and may not be able to afford gas, hotel rooms or time off work, according to the Guttmacher Institute.
“The people that are hurting the most are low-income people, young people, people of color, specifically from brown and Black communities and those who live in rural areas,” said Yamelsie Rodriguez, president and CEO of Planned Parenthood for the St. Louis region and southwest Missouri.
Rodriguez said the doctors, nurses and staff at the Fairview Heights clinic have been preparing for the post-Roe era since 2019 – when Missouri and other states passed a slew of bills restricting abortions. At the time, Missouri was on the verge of becoming the first state in the country with no abortion clinics.
The massive Illinois clinic – which also provides annual exams, cancer screenings, birth control, testing for sexually transmitted diseases and HIV prevention services – was practically built in secret across the Mississippi River from St. Louis. It opened in the fall of 2019 – the same year a federal judge in Missouri blocked a law banning most abortions after eight weeks.
“We needed to make sure that contractors were not going to get harassed by politicians … that word would get out, and then we would have protesters outside the construction (site),” said Rodriguez, who would not comment on how the construction was kept largely under wraps. “We’ve seen it before where they go to contractors’ homes and protest in front of their homes.”
Clinic staff are ‘here for a purpose’
Since the draft decision leak, a number of elected officials have visited the clinic to show support. The governor of Illinois visited on Wednesday.
“Let’s be crystal clear about one point: Abortion is health care,” Pritzker said. “By the time many of these out-of-state patients make it to Fairview Heights, Illinois, they have traveled further than anyone should have to, physically and emotionally.”
Pritzker in 2019 signed the Reproductive Healthcare Act that declared abortion a “fundamental right” in the state.The law was part of a wave of Democratic states that opted to codify abortion protections in response to steps by a number of Republican states to restrict access.
“People should not have to endure trauma after trauma to be in control of their own bodies,” the governor said Wednesday. “But that’s exactly the burden this right-wing Supreme Court and anti-choice governors and state legislators increasingly put on the backs of millions of women.”
Missouri Rep. Cori Bush, a Democrat, toured the clinic days after the leaked draft opinion.
As she was greeted outside by McNicholas and Rodriguez, a woman in her early 30s stepped up to a security window and said she hoped she had not missed her appointment.
“I’m not too, too late. But I came all the way from the airport because they don’t take my insurance in Missouri. This is a real important procedure,” she said before being allowed inside.
The fallout from the leaked Supreme Court decision left some staff members alternating between tears and anger to moments of hope and joy. When Bush visited one week ago, as two or three patients sat with nurses behind curtains in the pre- and postoperative area, the congresswoman, McNicholas, nurses and others shot a TikTok dance video to Dorrough’s “Walk That Walk.”
“From the front desk to the physicians to the nurses to the case managers to the call center, everyone involved is here for a purpose,” Kawanna Shannon, the clinic’s director of patient access, said of the moment.
“What we do for a living … is for the patients, and we’re not going to allow anybody to stop that. …There will be no head hanging. There will only be fight.”