Abortion clinics are springing up at border crossings and airports, extending…

Abortion clinics are springing up at border crossings and airports, extending access as far as it can go

Morgan Nuzzo, a nurse-midwife and ob-gyn Dr. Diane Horvath, an ob-gyn, decided they could do it better after working together in reproductive health clinics in the Washington, D.C. area for more than five years.

They began fantasizing about their own clinic, where clinicians from various backgrounds would provide compassionate, high-quality care; employees would be fairly compensated; patients would be treated with respect; and abortion would be treated as a necessary medical procedure that everyone should have access to.

Their all-trimester clinic, Partners in Abortion Care, is planned to open this autumn in College Park, Md., a location they believe will be convenient not only for themselves as D.C. residents, but also for patients throughout Maryland and beyond.

That location became more important than ever after a draft judgment indicating that the Supreme Court could soon overturn Roe v. Wade, which would likely result in the ban or major restriction of abortion in 26 states.

College Park is only 40 miles from three major airports and is adjacent to multiple highways, making it a convenient travel location. And, if adjacent states like West Virginia and Ohio pass harsher abortion laws, Maryland might become a magnet for people who need to travel for care—even more so if Virginia enacts stricter laws in the future, as some activists fear.

Maryland, unlike those states, is expanding abortion access. It enables abortions up to the point of fetal viability (about 24 weeks of pregnancy) and later procedures if the mother’s or father’s health is jeopardized if the fetus is diagnosed with a major health problem.

Also, as of July 1, in addition to doctors, nurse-midwives, nurse practitioners, and physician assistants will be able to do abortions there. This could increase the number of people the clinics can serve by giving them more options for providers.

A reflection of Horvath and Nuzzo seen in an empty space where they plan to start their abortion clinic in College Park, MD. Shuran Huang for TIME

“We anticipate an increase in the number of patients in Maryland,” Horvath says. “There is no way to enhance capacity at existing clinics to accommodate the estimated number of individuals who will need to travel.”

Due to state-level restrictions and diminishing clinic numbers, many people already have to travel to receive an abortion. According to one survey, 74% of abortion patients in Wyoming, 57% in South Carolina, and 56% in Missouri left their native states to seek care in 2017.

However, if the Supreme Court’s draft judgment is comparable to the final decision, the inconvenience will be felt by a much larger number of people. If people in the South, Midwest, and Southwest needed to stop a pregnancy, they would have to fly out of state or find a way to get abortion pills.

Clinics in “abortion islands” like Illinois, which have robust abortion laws but are bordered by states that are likely to outlaw them, are already preparing for an influx of new patients after Roe.

New clinics like Partners in Abortion Care, which are located in strategically located areas to accommodate as many patients as possible, may help alleviate the bottleneck, but they’re not likely to be enough on their own, according to Caitlin Myers, an economics professor at Middlebury College who studies abortion access.

“Appointment availability will improve” as a result of the new facilities. They will shorten travel times. “They’ll have an effect,” Myers predicts. However, no matter how many clinics operate, there will be women who want abortions but can’t receive them because of these laws.

Nuzzo and Horvath store furniture and equipment they purchase at a storage unit. Shuran Huang for TIME

Abortion costs can range from a few hundred dollars to over $1,000, depending on whether it is done with pills or a procedure. If someone needs to travel for that care, they must cover the cost of transportation, hotel, missed work, and child care on top of the financial and logistical expenditures.

Local abortion funds have historically offered practical aid such as travel costs and child care assistance. (A local investor is considering buying an apartment near Partners in Abortion Care to operate as an “abortion Airbnb,” where people might stay for free before and after their procedures, according to Nuzzo.)

Even with such assistance, data shows that travel is a disincentive for many people seeking abortions. Myers predicted in research released last year that one out of every five people seeking an abortion in the United States would not receive one if they had to travel 100 miles to get one.

According to her research, approximately 100,000 people in the United States will be unable to have an abortion in the year following a hypothetical repeal of Roe v. Wade because of increasing distance from providers.

According to Liza Fuentes, senior research scientist at the Guttmacher Institute, “middle-income or rich people, particularly white people, residing in forbidden states will always be able to receive abortion treatment,” as long as they can jump on a plane.

It’s not that simple for many other people who require an abortion—who, according to Guttmacher, are more likely to be low-income and already parents.

Some doctors are relocating to states where abortion is expected to be prohibited in order to reduce the distance that patients must travel.

Shannon Brewer, who runs Mississippi’s last abortion clinic and is at the center of the case that made the Supreme Court look at abortion issues again, recently said she might start practicing in New Mexico, which is between Texas, which already bans most abortions after six weeks of pregnancy, and Arizona, which is expected to crack down on abortion if Roe is overturned.

Nuzzo and Horvath stand for a portrait in an empty exam room. Shuran Huang for TIME

Jennifer Pepper, executive director of CHOICES Memphis Center for Reproductive Health, likewise plans to start a new clinic if and when hers is compelled to stop providing abortion services.

(Tennessee has enacted “trigger legislation,” which prohibits most abortions within a month of Roe v. Wade being overturned.) She and her crew were able to find a location near Carbondale, Illinois, which is roughly a two-hour drive from St. Louis and three hours from both Memphis and Nashville. They are getting ready to open in August.

Last year, CHOICES performed 3,900 abortions in its Memphis clinic, and it plans to do so again this year in Illinois. However, they are unable to serve everyone. If Roe is reversed, several Tennessee clinics would be forced to stop providing abortions, and Choices would be unable to absorb all of those patients with a single new facility.

Pepper explains, “It’s just a math issue that doesn’t work out.” According to Myers’ modeling for TIME, the Carbondale facility may save roughly 3 million women’s travel time, largely in Kentucky, Tennessee, and Arkansas.

Others are looking at Illinois as well. Dr. Douglas Laube, a Wisconsin abortion practitioner, informed local news sources that he is considering building a new clinic just across the state line. According to the Washington Post, Planned Parenthood is expanding its operations in Illinois.

Julie Burkhart, a long-time reproductive health advocate and the founder of the group Wellspring Health Access, is working hard to keep abortion available in the West—but she’s not alone.

Burkhart began engaging with local abortion clinic advocates in Casper, Wyoming, in 2020. Wyoming had few legal hurdles to abortion treatment at the time, and there was an obvious need for more providers.

Abortion services were previously only offered in Jackson, Idaho; therefore, establishing one in Casper, a community less than 200 miles from Nebraska and South Dakota, would broaden access throughout the region. “Wyoming was the ideal condition,” says Burkhart.

Then, five days after the Supreme Court overturned Roe v. Wade, Wyoming Governor Mark Gordon signed a trigger law prohibiting most abortions. With the Casper clinic expected to open around the same time as the Supreme Court’s decision, Wellspring may only be able to provide abortions for a few days or weeks, if at all.

Horvath consults with contractor Reuben Pemberton about renovating the clinic. Shuran Huang for TIME

The clinic’s building was damaged in a suspected arson fire in late May. Still being figured out is how bad the damage is, but it’s possible that the inside of the building will have to be gutted and the electrical system will have to be replaced, which would force Wellspring to move.

Burkhart admits that moving forward despite the obstacles sounds crazy, but she’s doing it anyway. “These atrocities can’t be allowed to happen,” she says. “It’s critical for good people who care about social justice and equality to rise even higher.”

New clinics may make abortion more accessible, but more resources are required. For some people, abortion pills—which may be prescribed electronically and then mailed to patients for use early in a pregnancy—might be a workaround, but their legal status varies by state.

Some states don’t allow the tablets to be prescribed through telehealth, restricting their usefulness for those who don’t live near abortion doctors, and legislators in 22 states have introduced proposals to ban or restrict access to the medications. For now, though, the reproductive rights group Plan C helps people in all 50 states and territories get information about how to get the pills.

Another key concern is appointment capacity. According to Myers’ research, patients already face long waits in clinics across the country, even in abortion-friendly states like New York and California. To help alleviate the backlogs, Myers believes that more states, like Maryland, Connecticut, and Delaware, should allow non-physician practitioners to provide abortion services.

That is a personal point for Nuzzo. She claims that as a nurse-midwife, she has long been questioned by the medical establishment and treated as a second-class citizen. Nuzzo explains, “My profession is this punching bag, and everyone is punching down.”

Governor Larry Hogan of Maryland, for example, vetoed a bill that would have allowed non-physicians to perform abortions in the state, citing concerns that it would lower the quality of care. (State legislators overruled him.)

Nuzzo and Horvath are adamant about demonstrating that doing things differently can lead to better treatment. They believe theirs will be the only all-trimester abortion clinic in the country, as well as the only one run by a physician and a midwife in one of the few states that is actually expanding rather than restricting abortion access.

Horvath and Nuzzo during a walk-through of their future clinic space. Shuran Huang for TIME

It hasn’t been easy getting their clinic ready to open. Horvath and Nuzzo have put up thousands of dollars of their own money to purchase a vintage ultrasound machine and exam table on Craigslist and Facebook Marketplace to tide them over until they can afford newer models.

Even in an abortion-friendly state with enough community support to crowdsource nearly $260,000, they’re constantly concerned about the security of their clinic and future patients. Living in fear of their profession’s future has taken its toll on their mental health.

If their model proves successful, they hope to collaborate with other abortion providers and advocates to open clinics across the country, with the goal of keeping care as accessible as possible even after Roe. “We want to start from a place of abundance,” Horvath says, “and imagine what abortion care could look like even in these dire times.”