Even When a State Bans Abortion, Their Communities Still Need Abortion Clinics

Until a few weeks ago, EMW Women's Surgical Center in Louisville, Kentucky, founded in 1981, continued to operate its phone line. Even after the state began enforcing its total, criminal abortion ban in 2022, the independent reproductive health clinic was available to offer accurate medical information and help abortion seekers navigate their options, among other key reproductive health services. Ona Marshall, co-owner of the clinic, told Jezebel that callers with unwanted pregnancies often expressed “a wide range of emotions — some were still unaware abortion is illegal, just desperate and seeking help and guidance of any kind, angry and distraught. Many are terrified and don’t know where to turn.”

Around mid-November, due to a shortage of funding, resources, and staffing after over two years under Kentucky's ban, EMW was forced to pause its phone line indefinitely. Without revenue from abortion services, all while facing ever-increasing rent costs and lacking sufficient donations and financial support, the clinic struggled to stay afloat. Now, they face an uncertain future, and Marshall says this highlights the stakes of supporting independent clinics — especially in states where abortion is banned.

Independent clinics — including clinics that operate as small businesses or nonprofits, family planning clinics, and physicians’ offices and offer community-based care — provide about three-fifths of all abortions in the country. They also provide the majority of abortions in the second trimester or later, help patients access miscarriage management services and birth control, and are often the primary providers of gender-affirming care in their communities. Crucially, they also have legal standing to challenge abortion laws in court to potentially repeal these laws — without clinics, advocates lose a key avenue to fight back against anti-abortion state governments. Through all of these vital services, independent clinics are sustained through donations and the costs of their services.

However, according to Abortion Care Network's latest annual report, between 2022 and 2024, 76 independent abortion clinics closed — 42 in 2022, 23 in 2023, and, as of November, 11 in 2024. Per ACN’s tracking, the overall number of brick-and-mortar independent clinics in the U.S. has decreased by 29% since 2012. (Even before Dobbs, 90% of counties had no abortion provider in 2020.) Right now, 14 states have no clinics providing any abortion services at all thanks to total abortion bans. And as clinics continue to shutter, so, too, could reproductive rights advocates’ chances of legal recourse in abortion-banned states.

Before Dobbs v. Jackson Women's Health, on several occasions, EMW served as a key plaintiff in challenging anti-abortion restrictions that otherwise would have shuttered abortion access years before Kentucky's total ban took effect, Marshall said. Then, in 2023, Kentucky’s state Supreme Court ruled that only pregnant patients, not clinics, have standing to file these lawsuits, which severely limits avenues through which advocates in Kentucky can challenge these laws. (In other states, clinics still have legal standing to challenge abortion laws.) 

In the immediate aftermath of Dobbs, abortion funds received a surge in one-time "rage donations," as one organization supporting abortion funding told Jezebel earlier this year. Many people consistently donate to Planned Parenthood, whose name has become synonymous with reproductive rights. But independent clinics have largely been left to fend for themselves.

Of the 11 closures this year, eight were in states where abortion rights are protected, Nikki Madsen, deputy director at ACN, told Jezebel. This is because, even in states where abortion remains legal, the significant barriers to operating independent clinics persist. Specifically, as demand for their services surges due to an increase in out-of-state patients, their already limited resources are stretched ever thinner.

14 states currently have NO clinics providing abortion care. That means people are forced to leave their homes & travel to get the abortion care they need & deserve.

Learn more about the effects of clinic closures in @AbortionCare Network's new report: https://t.co/MxBxqT0AEf pic.twitter.com/28fdtamUNz

— Center for Reproductive Rights (@ReproRights) December 10, 2024

Independent clinics also serve to combat the growing wave of anti-abortion crisis pregnancy centers, which are facilities that often pose as abortion clinics to lure people with unwanted pregnancies, only to subject them to torrents of anti-abortion disinformation. Post-Dobbs, CPCs are receiving more state funding than ever. In Texas, CPCs went from receiving $5 million in state funding in 2005 to now receiving a $140 million annual budget, ProPublica reported earlier this year.

“There’s a misconception that after abortion bans take effect, these clinics aren’t still active in their communities,” Madsen said. Even in a state like Florida where abortion is banned at six weeks, if patients come to clinics and are past six weeks pregnant, staff will help connect them to abortion access in other states. That's a significant amount of labor, “and they’re not getting reimbursed for this care,” Madsen explained. “The amount of staffing you need, the amount of labor, the rent and costs of operating don’t change [under abortion bans], but the revenue changes exponentially.” The “cost to adapt to abortion bans is exponential,” and independent clinics in these states are shutting down as a result.

In addition to the majority of all abortions in the U.S., independent clinics also “represent 67% of all clinics that provide care at and after 16 weeks of pregnancy, 71% of clinics providing care at and after 19 weeks of pregnancy, and 88% of clinics that provide care at or after 22 weeks of pregnancy,” per ACN’s report. After 26 weeks of pregnancy, the report states, the only clinics in the U.S. that provide abortion care are independent. Abortions at this point often stem from extreme scenarios like medical emergencies. But, as abortion bans severely delay when people are able to access abortion, the demand for abortion later in pregnancy will only rise.

Did you know that independent abortion clinics like ours provide the majority of abortion care nationwide? Learn more fun facts & stats about independent aka indie clinics by reading @AbortionCare's recent report: https://t.co/WXlicHXhX9 #IndiesProvide #CommunitiesNeedClinics pic.twitter.com/RT2UhDqoH2

— Cedar River Clinics (@CedarRClinics) December 10, 2024

Since 2022, 32 new independent clinics have opened in 10 states, per ACN's report. Each new clinic is cause for celebration — but Madsen stressed that overcoming all the obstacles to open is just the first step and that “violence can delay or shut down independent clinics altogether." In 2023, the Affirmative Care Solutions abortion clinic was set to open in Danville, Illinois, to help serve an influx of out-of-state abortion seekers. But a vandal destroyed the clinic, and well over a year after it was supposed to open, it's still unable to serve anyone. LaDonna Prince, director of the clinic, told reporters on a press call last week that some repairmen, plumbers, and electricians have declined to work on an abortion clinic.

Post-Dobbs, and in a country that just re-elected the man who takes credit for killing Roe, the future of abortion access is more uncertain than ever. But the way forward requires some level of optimism. “Abortion may well be legal again at some point, in Kentucky or other states,” Marshall said. Recall that in September, a judge blocked North Dakota’s total abortion ban and reinstated a right to abortion... but thanks to the ban, there are no clinics left in the state.

Should that happen, we’ll still need clinics to actually exist and have facilities to provide care, to have standing to challenge the range of other abortion restrictions in addition to bans. “That will need us to stay open.”

You can donate to independent clinics through the Keep Our Clinics campaign or the Fund Later Care initiative. Also, check out Jezebel's donation guide for other ways to support abortion access.