FAIRVIEW HEIGHTS, Ill. — The call came into the southern Illinois abortion clinic on a recent weekday: A young woman from Missouri was on the line, frantic because she no longer had the money to pay for her $470 procedure, which was scheduled for the next day.
The caller panicked because she assumed she’d have to cancel and reschedule later, whenever she could come up with the money. The prospect of delaying such a time-sensitive procedure was terrifying.
But a calm voice on the line asked a few questions about the patient and how much she could afford at that moment.
The woman said she had just started a new job and would be getting her first check soon but was in the middle of a pay period. She also mentioned that she has a child and an unexpected bill came up, swallowing the money she had set aside to pay to terminate the pregnancy.
“I don’t want you to commit something you don’t have,” said the woman who took the call, Kawanna Shannon, director of patient access at the new Regional Logistics Center, which is housed in the Planned Parenthood Health Center in Fairview Heights.
Shannon spent a few minutes successfully searching various abortion funds to help cover the cost of the procedure. Then she went over a few instructions for the caller’s appointment, which would continue as scheduled the next day.
“Thank you, ma’am,” the patient repeated several times, her panicked tone melting into relief.
Calls of this sort from women throughout the Midwest and South were pouring into the clinic all day — and they’re expected to become even more abundant soon.
With the U.S. Supreme Court poised to overturn Roe v. Wade, Illinois is preparing for a massive rise in out-of-state patients traveling here to terminate a pregnancy. If Roe were to crumble, providers have predicted an additional 14,000 patients each year will cross state lines to terminate pregnancies in southern Illinois.
Facing this imminent influx, the two abortion providers in the region partnered to open the Regional Logistics Center in January. The center is operated jointly by Reproductive Health Services of Planned Parenthood of the St. Louis Region and Hope Clinic for Women, an abortion clinic in Granite City.
Dedicated case managers there assist traveling patients with overcoming various common barriers to abortion access: finding lodging, booking transportation and securing child care, as well as navigating various funding sources to help pay for abortions.
Gov. J.B. Pritzker visited the Planned Parenthood in Fairview Heights on Wednesday to champion reproductive rights, calling the agency’s work “lifesaving and life-changing.” He noted that more than 75% of the clinic’s patients already come from other states.
“Let’s be crystal clear about one point: Abortion is health care,” said Pritzker, a Democrat. “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. People should not have to endure trauma after trauma to be in control of their own bodies. 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.”
For almost half a century, the landmark Supreme Court case Roe v. Wade has affirmed the right to terminate a pregnancy nationwide. But a stunning draft opinion leaked earlier this month indicated that a majority of justices intend to strike down the 1973 decision, leaving the matter of abortion rights to individual states.
The official ruling in the case, Dobbs v. Jackson Women’s Health Organization, is expected to come over the summer.
In the absence of Roe, experts anticipate roughly half of all states would prohibit abortion, including Missouri and almost all of the Midwest. And states with strong reproductive rights protections like Illinois are preparing to take on the burden of patients from all the states where abortion would be outlawed.
Brian Westbrook, executive director of the organization Coalition Life, which is based in St. Louis, said he and other abortion opponents have been confident for a while that Roe v. Wade would eventually fall.
“It’s not a matter of if it will be overturned,” he said. “It’s a matter of when. The pro-life movement will only do more as a result. This is not necessarily a victory — it’s a shifting of work from the federal level down to the state level.”
Not going back
The after-hours phone line rang at around 3 a.m. on a winter morning, just a few weeks after the Regional Logistics Center was established.
The caller was a woman from Louisiana who was desperate to book a ride to the airport that instant, to get to her appointment the next day, said Shannon, who took the call.
“I didn’t tell people this, but I’m in a very abusive relationship and he just left,” Shannon recalled the woman saying. “I don’t know if he’s gone for a minute or what, but I just want to leave right now.”
The Louisiana woman said her partner did not know she was pregnant. Shannon recalled scrambling to book the Uber in the middle of the night and then staying on the phone with the caller until the ride came, fearful her partner would return before the Uber’s arrival.
“I’m literally packing now,” Shannon remembered the woman saying.
The woman from Louisiana flew in and had a surgical abortion. Afterward, Shannon asked the patient if she needed a return ride to the airport.
“No,” she recalled the patient saying. “I’m not going back.”
“Where are you going?” Shannon said she replied, surprised. “What are you doing?”
She said the patient told her she wanted to leave her partner and start a new life. Shannon contacted as many services and nonprofits as she could find and passed on the pamphlets and phone numbers. Before leaving, the woman from Louisiana said she was going to a shelter, Shannon recalled.
“She was like, ‘Ms. Kawanna, I’m good. I’m going to be fine,’” Shannon said. “That sticks with me. Sometimes I wish she’d call, so I know she’s good. I really wholeheartedly believe she’s never going back.”
In 2020, nearly 10,000 patients crossed state lines to have an abortion in Illinois, according to the latest data from the Illinois Department of Public Health. The number has increased every year since 2014.
The rise in out-of-state abortions comes as many nearby states increasingly restrict the procedure by legislating gestational limits, mandating waiting periods before having an abortion and implementing stringent regulations on clinics and providers.
Illinois, on the other hand, has eliminated every major restriction on the procedure. In 2019, Pritzker signed the Reproductive Health Act, which declared terminating a pregnancy a “fundamental right” in Illinois.
Planned Parenthood in late 2019 opened the 18,000-square-foot Fairview Heights site where the Regional Logistics Center operates; the location on the cusp of Missouri was chosen strategically to serve patients traveling from that neighboring state and beyond.
The facility includes a family room designed for children, equipped with beanbag chairs, books and toys, as well as extra diapers and wipes. So many patients had child care constraints and were bringing their kids into the regular waiting room, so staff decided to set aside a more comfortable space for families, said Bonyen Lee-Gilmore, a spokesperson for Planned Parenthood of the St. Louis Region.
One patient from Missouri recently couldn’t find anyone to watch her three children, so Shannon said she took the kids to the family room and, for about 2 1/2 hours, she watched the baby, toddler and 6-year-old during the procedure.
The oldest, a little boy, watched TikTok videos on a laptop and performed some of the dances featured in them.
“I even did a couple with him — at least, I was trying to,” Shannon said, laughing a little.
She added that sometimes patients stay with their children in the family room and receive services and information sessions there, until it’s time to go into a procedure room.
The room is not a day care, she stressed.
“But if you happen to come with your child, you have a safe place to go with your child,” she said.
‘Obstacle course’
One day in February, an 18-wheeler semitruck pulled into the Planned Parenthood parking lot, quite conspicuous alongside all the regular cars and SUVs that typically park there, Gilmore said.
A patient, who drove the truck for a living, traveled more than a thousand miles from Arizona to southern Illinois to pick up abortion pills, an appointment that typically takes about 90 minutes, according to staff.
While medication abortion has been available in the United States since 2000, 19 states have restrictions mandating the provider be present when the pill is taken, barring access via telemedicine; 32 states have laws requiring physicians administer the medication, as opposed to other types of clinicians like advanced practice nurses and physician assistants, according to the Guttmacher Institute, a research group that supports abortion rights.
Illinois has none of these restrictions.
“We get a lot of people who will drive hundreds of miles for a medication abortion,” Gilmore said. “This scheme that politicians have set up is literally a game they put people on. It is an obstacle course.”
Westbrook, of Coalition Life, called the Regional Logistics Center a “media ploy.”
“Quite frankly, it’s nothing more or less than what they’ve always done, which is provide abortions and take the life of unborn children,” he said.
Missouri is one of about a dozen states with a so-called trigger law that would ban abortion in all or most cases if Roe were to be overturned.
The state has one remaining abortion clinic, a Planned Parenthood in St. Louis, largely due to stringent regulations on clinics and providers. In contrast, Westbrook said there are 75 anti-abortion pregnancy resource centers statewide.
“With all of that help and assistance for pregnant women, they don’t feel like they have to get an abortion,” he said.
‘Crunchtime’
Last month, one young woman traveled about 800 miles round trip from rural Mississippi to southern Illinois.
The hardest part of coordinating her trip was scrambling to find a ride from her home to the closest Greyhound station, about 45 minutes away in Memphis, said Kenicia Page, Regional Logistics Center manager.
“It was just very difficult trying to find transportation in the area,” she said, noting that there’s often a dearth of taxis, Ubers and public transit in rural communities. “It was really crunchtime. I think it was 24 to 48 hours to her appointment.”
Eventually, the patient found a ride through a nonprofit organization that offers transportation for those in need in the Mississippi Delta region.
The young woman was in her second trimester and had a two-day surgical procedure. The patient was unemployed and needed food and sanitary items during her travels, Page recalled. So the Regional Logistics Center sent her an electronic gift card and booked her an Uber to take to a Dollar General store, so she could pick up a few items before heading back to her hotel.
“It was just making her feel comfortable while she was here and keeping her uplifted, because she was just so discouraged from having to go through all the hoops,” Page said. “But she was able to get everything done and then return home safely afterward.”
The Regional Logistics Center has seen an increase in callers each month, from serving 183 patients in January to 329 patients in April, Shannon said.
“In May, it will be more,” she said. “It’s constant. People, they need the help.”
Each Regional Logistics Center case costs on average $900 to $1,500, depending on how many services the patient requires, Gilmore said. With reproductive rights in jeopardy, she’s concerned about how the center will handle the rising need and make sure funding lasts long term.
“The thing that I worry about is when the headlines die down,” she said. “When there’s breaking news like this we see an outpouring of support. And we have seen that outpouring. But I worry about what happens six months after, a year later. … Is it sustainable over time?”
