The Future of Abortion Care Depends on Independent Providers

Today, there are 34 percent fewer independent clinics across the country than there were in 2012. The threats independent clinics face are harsh—which is why now more than ever, they need our support to continue meeting this moment.

Outside the Supreme Court during oral arguments for June Medical Services v. Russo on March 4, 2020. (Courtesy of Abortion Care Network)

The toll of the COVID-19 pandemic has been devastating for families and communities across the country, including my own. But when I reflect back on 2020, amid all of the heartache, a moment of absolute joy stands out.

In early March, just days before the nationwide cascade of shutdowns and uncertainty, I stood arm-in-arm outside the Supreme Court with reproductive health, rights and justice advocates as we cheered on the fierce clinic staff at Hope Medical Group for Women, the Louisiana-based independent abortion care provider at the center of this year’s Supreme Court abortion case. Like other independent clinics (indies) before them, Hope was fighting for all of us that day.

In the years that I’ve supported independent clinics as director of Abortion Care Network, I’ve seen the resilience of independent providers like Hope in action time and again. Indies are known for their grit, rising up for their communities in the face of a seemingly endless barrage of attacks by state anti-abortion politicians, protesters right outside their doors—and today, a public health crisis like none we’ve seen before.

Through it all, independent clinics are there for their communities, whatever comes their way, because without them, there is no meaningful access to abortion care. 

Nikki Madsen of Abortion Care Network.

People from all walks of life, in every part of the country, seek the compassionate care of independent providers to make fundamental decisions about their bodies and lives.

In fact, indies serve three out of five people who seek abortion care, and in some regions that are especially hostile to abortion, independent clinics are the sole or primary abortion providers.

Notably, indies are the only clinics remaining in Mississippi, North Dakota, West Virginia, Louisiana and Wyoming, and the only providers of in-clinic (sometimes referred to as surgical or aspiration) abortion in Arkansas, Georgia and Nevada—some of which hold the most restrictive abortion laws in the country.

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Today, there are 34 percent fewer independent clinics across the country than there were in 2012, making it increasingly costly and difficult for patients to get the care they need in their communities, or even in their own states.

This troubling trend threatens access to all abortion care, but especially care throughout pregnancy. Of all the clinics in the U.S. that provide abortion care after the first trimester, 62 percent are independent. Of the clinics that provide care at or after the 22nd week of pregnancy, 81 percent are independent.

And nearly all independent clinics provide both medication abortion care as well as in-clinic care, to meet the varied needs and preferences of their patients.

Amid political threats, indies have weathered the storm of this year with the courage and determination they’re known for.  Like health care providers across the country, they adapted to new, often difficult realities, implemented social distancing guidelines and scrambled to get personal protective equipment.

They also supported their patients in navigating heightened barriers to abortion care as a result of the pandemic and subsequent economic recession—from increased out-of-pocket costs, reduced appointment availability, and lack of transportation, lodging and child care options. And in true indie form, they fought back in court, and won, as state politicians tried to exploit the pandemic by banning abortion care. 

The threats independent clinics face are harsh, which is why now more than ever, they need our support to continue meeting this moment. It’s on each of us to speak up, organize and stand with clinics whose service is often made possible by small donations from community members. We must demand policy change that protects our clinics and their patients, and an end to abortion coverage bans that hit patients of color and those struggling financially the hardest. 

When I’m feeling downtrodden by the pandemic and our uncertain future, I channel the heart and unwavering determination of independent abortion providers, who have faced unforeseen challenges before. I remember the vibrant energy of that bright March morning and know that together, we can build a future where independent providers thrive.

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Nikki Madsen is the executive director of Abortion Care Network (ACN).