How Providers Are Innovating Around Abortion Access Deserts

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Analysis Abortion

How Providers Are Innovating Around Abortion Access Deserts

Garnet Henderson

The country needs more abortion clinics, especially ones accessible to people traveling across state lines. Meet the providers aiming to fill these gaps.

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After the Supreme Court overturned Roe v. Wade, nine states moved quickly to ban abortion, and at least a dozen more are expected to completely ban or heavily restrict it soon. Though some, and perhaps many, people in those states will choose to self-manage their abortions, others will need or want in-clinic care.

Their only option will be to travel to a clinic in a state where abortion is legal, which in some cases could be more than 600 miles away.

In addition to the massive barriers to interstate travel—the cost of transportation and lodging, time off work, and childcare needs, to name a few—states where abortion remains legal aren’t necessarily prepared to handle an influx of patients. Many clinics have worked to scale their operations, but it’s likely that appointments in these states will be hard to come by, as has been the case in the states near Texas since SB 8 went into effect last September.

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The country is in desperate need of more abortion clinics, especially ones more accessible to people traveling across state lines.

Many abortion providers have been finding ways to fill these gaps. For example, CHOICES, a longtime abortion provider in Memphis, Tennessee, announced in May it would open a new clinic in Carbondale, Illinois. According to CHOICES, the Carbondale location will be the southernmost abortion clinic in the state, making it more accessible for patients traveling up from the Southeast to a destination for access. CHOICES in Memphis will remain open to continue offering all of the other reproductive and sexual health services, including birth and prenatal care, gender-affirming care, and no-cost birth control.

Another organization is taking this idea of a “border clinic” and running—or, rather, driving—with it: Just the Pill, which offers medication abortion services to people who live in or can travel to Colorado, Minnesota, Montana, and Wyoming. Through its Abortion Delivered initiative, Just the Pill has been establishing mobile clinics that can deploy to the borders of states where abortion is illegal. The clinics will remain in states where abortion is legal but position themselves as close as possible to state lines to cut down on patients’ travel time.

This was the original idea behind the organization’s founding in 2020, said Dr. Julie Amaon, a family medicine physician and Just the Pill’s medical director. However, when the Food and Drug Administration relaxed medication abortion restrictions during the pandemic, allowing pills to be sent by mail rather than dispensed in person, Just the Pill seized that opportunity and began offering medication abortion via telemedicine. They also drove around Minnesota, offering in-person pill pickup.

“We drove about 1,200 miles per week,” Amaon said. “We know that one of the many stresses patients face in accessing abortion is that they have to drive very long distances. So we tried to get to where they could reach us within an hour or two.”

Should states begin to criminalize self-managed abortion, traveling out-of-state to pick up pills and returning home with them could pose a risk, particularly for people of color.

The enactment of Texas SB 8 in the Lone Star State, followed by the leaked draft of a Supreme Court opinion overturning Roe v. Wade, prompted Just the Pill to return to its idea of mobile clinics. The nonprofit fundraised and built two mobile clinics. One is being used for in-person pill pickup, and the other for first-trimester abortion procedures. The mobile clinics first traveled to Colorado, a state with a relatively easy-to-navigate regulatory environment for abortion providers, as well as proximity to several states that have recently abortion (or, in the case of Oklahoma, have banned it since late May).

Abortion Delivered already has clinics up and running in Minnesota. Part of the original dream was for these mobile clinics to bring a full spectrum of reproductive health care into underserved areas, including birth control, pregnancy support, cancer screenings, and more. Amaon hopes that may become part of the mission in the future, but given the immense need for abortion services, the clinics will focus on that for now. In particular, Abortion Delivered wants to make in-clinic abortion services available to people who might be unable to access them otherwise.

Though medication abortion is increasingly popular and many patients express a strong preference for it, others want an in-clinic abortion procedure.

“Not everybody wants to do this at home,” Amaon said. The fact that many people may be forced into having medication abortions simply because that is the only option accessible to them “hurts,” Amaon added. “This is a medical process where patients should have options.”

In-clinic abortion procedures may also be a safer option for many patients—not medically, but legally. As Amaon points out, as should states begin to criminalize self-managed abortion, traveling out-of-state to pick up pills and returning home with them could pose a risk, particularly for people of color.

“They are more likely to be searched and criminalized,” Amaon said. In-clinic procedures may also more discreet for folks who live with family members or partners that they don’t want to involve in their abortion decision.

The first Abortion Delivered mobile clinics are relatively small, Amaon said. They are equipped with everything you’d expect to see in a regular clinic, such as an exam table, a sink, a refrigerator, and seats for taking vital signs and recovering after procedures. Their small size allows them to be discreet, but it also limits the number of procedures the clinic can be used for in one day, since each patient has to stay in the clinic for recovery.

“We’re fundraising for larger, two-room clinics that would have recovery rooms in the center,” Amaon said. This would allow Abortion Delivered to serve more patients in one day and possibly expand to offer second-trimester procedures, which are likely to be in higher demand once abortion is banned in roughly half the country.

Amaon added that the organization is also fundraising for a fleet of vans. “We hope to be able to go to all the safe states and drive around to offer access,” Amaon said.

The logistical challenges are significant, but Amaon said it’s also giving her hope.

“If I wasn’t working for Just the Pill, I don’t know what I’d be doing with myself right now,” she said.