Health

Abortion clinics are opening near airports and state borders


OneAfter more than 5 years working together at reproductive health clinics in the Washington, DC area, nurse-midwife Morgan Nuzzo and Dr. Diane Horvath realized they could do it better. They began to fantasize about a clinic of their own, where clinicians from different backgrounds would provide compassionate, high-quality care; staff will be paid fairly and patients are respected; and abortion will be considered essential medical care that everyone will be able to access.

Partners in Abortion Care, their all-three-month clinic, will open this fall in College Park, Md., a location they hope will be convenient not only for themselves as a family for residents of the DC area, but also for patients in Maryland and beyond. After a leak a draft decision hinting that the Supreme Court could soon overturn Roe v. WadeThis could lead to a substantial ban or restriction of abortion in 26 statesThat position becomes more important than ever.

College Park is within 40 miles of the three main airports and close to several highways, making it a relatively easy destination for travelers. And if neighboring states like West Virginia and Ohio crack down on abortion as intended, Maryland could become a magnet for those who need to travel for care — even more so if the country Neighboring Virginia enacts more stringent policies in the future, such as Some supporters fear it will happen. Unlike those states, Maryland is expanding access to abortion. It allows abortions until the fetus is alive (about 24 weeks old) and allows later procedures if the parents’ health is at risk or the fetus is diagnosed with a serious health problem. Additionally, starting July 1, nurses-midwives, nurse practitioners and physician assistants – in addition to doctors – can perform abortions there, which will expand the pool of potential providers. capacity and thus can increase the number of patients the clinic can serve.


Horvath and Nuzzo’s mirror image is seen in an empty space where they plan to start an abortion clinic in College Park, MD.

Shuran Huang in TIME

“We know that the number of patients is going to increase in Maryland,” Horvath said. “There is no viable way to increase capacity at existing clinics to accommodate the number of people anticipated to have a travel need.”

Many people have had to go to abortions, due to state restrictions and the decreasing number of clinics. In 2017, 74% of abortion patients in Wyoming, 57% in South Carolina, and 56% in Missouri left their state for care. a study found. But if the Supreme Court’s draft decision resembles the final one, that inconvenience is about to affect more people. Across the South, Midwest, and Southwest, people will have to travel out of state or find access to abortion pills if they need to end the pregnancy. Clinics in “abortion islands” like Illinois — states with strong abortion protections, but surrounded by people who are likely to ban abortions — have prepared for an parcel-Roe new patient attack.

Caitlin Myers, a professor of economics at Middlebury College studies access to abortion. The new facility “will improve appointment availability. They will reduce the travel distance. They will have an impact,” says Myers. “But there will be women who want an abortion but can’t because of these bans, no matter how many clinics open.”



Nuzzo and Horvath store the furniture and equipment they purchase at a storage unit.

Shuran Huang in TIME

Cost of abortion, by medication or procedure, can range from hundreds of dollars to more than 1,000 dollars. If someone also has to travel for that care, they have to shoulder the financial and logistical costs of travel, accommodation, missed work and childcare. Local abortion funds have long provided practical assistance such as travel and child care assistance. (At Partners in Abortion Care, a local investor is considering buying an apartment near the clinic to use as an “abortion Airbnb,” says Nuzzo, where people can stay for free before and after work. tips.)

But even with this form of support, research shows that travel is a deterrent for many people seeking abortions. In an article published last yearMyers estimates that about one-fifth of people seeking abortions in the United States won’t get an abortion if they have to travel 100 miles to do so. Her research suggests about 100,000 people in the United States will not be able to have the desired abortion in the year after the abolition of the theory Roe v. Wade due to increased distance with suppliers.

“Middle- or affluent people, especially whites, living in states where it’s banned can still get abortion care,” said Liza Fuentes, senior research scientist at the Guttmacher Institute. ,” as long as they can get on a plane, said Liza Fuentes, senior research scientist at the Guttmacher Institute, a reproductive rights nonprofit. For the many others in need of an abortion — those, Guttmacher’s research shows thattend to be lower earners and already parents – it’s not that simple.

Some doctors are moving out of states that are likely to ban abortions and opening shops elsewhere to help reduce the distances that patients have to travel. Shannon Brewer, director of Mississippi’s last surviving abortion clinic — at The heart of the case led the Supreme Court to reconsider the issue of abortion-recently speak she can start practicing in New Mexico, a large abortion-free state in the middle of Texas (which is already ban most abortions after about six weeks of pregnancy) and Arizona (one of the states expected to crack down on abortion if Roe rolled).


Nuzzo and Horvath stand for a portrait in an empty exam room

Shuran Huang in TIME

Jennifer Pepper, executive director at CHOICES Memphis Center for Reproductive Health, is also planning to open a clinic in a new state if and when she is forced to stop providing abortion care. (Tennessee has a “trigger law”, which bans most abortions within a month of Roe overturned.) She and her team found an empty space in Carbondale, a city in southern Illinois, a few miles from St. Louis is about a two-hour drive and a three-hour drive from Memphis and Nashville. They are preparing to open in August.

CHOICES delivered 3,900 abortions at the Memphis clinic last year and is expected to surpass that number in Illinois. But they cannot serve everyone. If Roe turned upside down, many clinics in Tennessee would have to stop offering abortions, and there’s no way CHOICES could take on all of those patients with a new facility. “It was just a failed math problem,” says Pepper. Modeling that Myers did for TIME shows that the Carbondale facility could reduce travel requirements for about 3 million women, mainly in Kentucky, Tennessee and Arkansas.

Other supporters are also eyeing Illinois. Dr. Douglas Laube, an abortion provider in Wisconsin, tell the local news outlet that he was thinking of opening a new clinic just across the state border. Planned Parenthood is also expanding into Illinois, like Washington parcel reported.

Julie Burkhart, a longtime reproductive health advocate and founder of the nonprofit Wellspring Health Access, is fighting hard to keep abortion further accessible in the West — but not the There are no significant objections.

In 2020, Burkhart began talking to local advocates who wanted an abortion clinic in Casper, Wyo. At the time, Wyoming had few regulatory barriers to abortion care and there was clearly a need for more providers. Abortion services are only available in Jackson, just across the border from Idaho, so opening one in Casper, a city less than 200 miles from Nebraska and South Dakota, would expand reach throughout the region. . “Wyoming is just a state of perfection,” says Burkhart.

Then, in March 2022, Wyoming Governor Mark Gordon signed into law banning most abortions within five days of the Supreme Court’s decision. Roe v. Wade. With the Casper clinic opening around the same time the Supreme Court makes its final ruling, Wellspring may only be able to provide abortions for a few days or weeks — if it’s fully open.


Horvath consulted with contractor Reuben Pemberton about renovating the clinic.

Shuran Huang in TIME

At the end of May, The clinic’s building was damaged in a suspected arson. The damage is still being assessed, but it may be necessary to gut the inside of the building and replace its electrical system, possibly forcing Wellspring into a temporary space.

Burkhart says she knows moving forward despite these obstacles sounds crazy, but she’s doing it anyway. “These things cannot go unchecked,” she said. “It’s important that good people, who want social justice and equality, stand up even higher.”


New clinics can make abortion accessible, but more tools are needed. Abortion pill—A drug that can be prescribed remotely, then mailed to a patient for use early in pregnancy — may be an alternative for some, but legal status Their regulations vary by state. Some states do not allow over-the-counter prescriptions telehealthrestrict their utility to those who do not live near the abortion provider, and legislators in 22 states there are advanced bills that would ban or restrict access to drugs. However, for now at least, the reproductive rights group OLD plan helps people across the states and territories of the United States find information on how to get medication.

Appointment capacity is another big issue. Myers research shows that patients have had long waits at clinics across the country, even in abortion-friendly states like New York and California. To help ease those backlogs, Myers says more states should allow non-physician providers to provide abortion care, as states like Maryland, Connecticut and Delaware are doing.

For Nuzzo, that point is personal. As a nurse-midwife, she says she has long been suspected by the medical community or seen as inferior to a doctor. “My job is this punching bag, and people are punching down,” Nuzzo said. For example, Governor of Maryland, Larry Hogan, vetoed legislation allowing non-physicians to provide abortions in Maryland, citing concerns that it would reduce the quality of care. (He was held in high esteem by state legislators.)

Nuzzo and Horvath are determined to show that doing things differently can improve care. They believe their only mid-trimester abortion clinic will be a woman-owned clinic, as well as the only one run by a doctor and midwife, in one of the few states that actually expanded access to abortion — unrestricted.


Horvath and Nuzzo during a stroll through their future clinic space.

Shuran Huang in TIME

Getting their clinic ready to open is no easy feat. Horvath and Nuzzo contributed thousands of their own and bought a vintage ultrasound machine and test bench on Craigslist and Facebook Marketplace, to keep them until they could afford a newer version. They are constantly concerned about the security of the clinic and their prospective patients, even in the face of aversion to abortion and having enough community support to community resources nearly $260,000. Living in uncertainty about their professional future has also taken a toll on morale.

But if their model works, they hope to work with other abortion providers and lobby to open clinics in other parts of the country, with the goal of keeping care as accessible as possible even afterRoe reality. “We wanted to start from a place of excess,” says Horvath, “and think about what abortion care might look like even in a time when things are so bad.”

Other must-read stories from TIME


Write letter for Jamie Ducharme at jamie.ducharme@time.com.



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