When the majority of patients seek out independent clinics for their abortions, a high rate of closure becomes more than concerning—it becomes an emergency.
Independent abortion clinics—also called indie clinics or indies—are shutting down at alarming rates all across the country, despite 60 percent of abortion-seeking patients obtaining care at these facilities, according to the Abortion Care Network’s annual report, “Communities Need Clinics.” This rate of closure is more than concerning; it’s an emergency.
While abortion care is provided at many different locations—such as hospitals, private doctor’s offices, hospitals, chains like Planned Parenthood, and independent clinics—the role of indie clinics cannot be overstated: While indies make up only 25 percent of facilities, they provide 58 percent of all abortion procedures across the country. In fact, out of the six states with only one remaining abortion provider, five of those providers are independent clinics.
Independent abortion providers exist in just about every state, providing local, compassionate, community-centric care to their clients.
“My favorite part of being an independent clinic is being able to design care that fits our envisioned mission,” says Rosemary Codding, executive director of the Falls Church Healthcare Center, an independent clinic in Falls Church, Va. “Sometimes, when you’re a part of a big hospital, for example, you don’t get to design the care and implement it. For me and I think for some of our staff, that is the greatest joy—that we can envision the care that a woman really wants from her provider.”
Indies are also able to foster individual relationships with patients in an affirming way.
“Often, the person that makes the appointment over the phone is going to be the same person to greet you when you arrive,” Francine Thompson, the executive director of the Emma Goldman Clinic, told Ms. “They may even be the one to do your ultrasound.”
Yet despite the high level of care that independent clinics are able to supply to patients, 41 independent clinics have shut down over the last two years alone. (In comparison, 40 of clinics closed in 2013; 23 closed in 2014; 33 closed in 2015; 22 closed in 2016; 17 closed in 2017; 11 clinics closed in 2018; and 26 closed in 2019, according to the 2018 Communities Need Clinic report.)
First Trimester Abortion Providers
For the first trimester of pregnancy, the Abortion Care Network study found that independent clinics are able to offer more options to patients than Planned Parenthood, a chain of clinics—many of which do not provide abortions at all. In fact, 80 percent of independent clinics offer both medication abortion and procedural abortion. On the other hand, only 48 percent of Planned Parenthood locations are able to offer patients both options for termination, with 52 percent of clinics only offering medication abortion.
“If we were to close, patients would lose options,” said Thompson. “There aren’t other independent clinics in the state of Iowa. Not only would patients lose the choice of clinic, but they would also lose their choice of the type of abortion method. There is something very feminist about having a choice.”
Abortion Later in Pregnancy
Another alarming consequence of the shuttering of independent clinics is the lack of options for those seeking abortion later in pregnancy. According to the report, 61 percent of all abortion clinics in the U.S. that provide abortion after the first trimester are independent clinics.
And while very few people actually obtain an abortion past 22 weeks of gestation, for those who do, the service can be life-saving. Yet 81 percent of all the abortion clinics in the U.S. that provide abortion care after 22 weeks are independent clinics.
If indie clinics continue to decline in numbers at this rate, the already arduous tasks of obtaining an abortion later in pregnancy will become more out of reach for the patients who desperately need them.
The irony is strong here, too. Anti-abortion opponents work tirelessly to pass TRAP Laws (targeted restrictions on abortion providers) designed to close clinics. But when clinics that provide abortion in the first trimester are shuttered, patients are forced to wait longer to access the care they need, due to having to raise more money, requesting more time off of work, arranging childcare, and traveling farther distances—sometimes cross country—to obtain care. This pushes back the time in pregnancy when a person can have an abortion, often out of the first trimester. The same abortion opponents that revile abortion later in pregnancy are the direct cause of forcing patients into obtaining them.
The Resiliency of Indie Clinics
“Those who oppose us see us as vulnerable because we don’t have big resources like clinics with national offices or name recognition,” said Tammi Kromenaker, the executive director of the Red River Women’s Clinic—the last remaining abortion provider in the state of North Dakota for 20 years. “We’re nimble and we’re flexible because we’re independent.”
The ability to provide community-centered abortion care is crucial given that many independent clinics operate in abortion deserts.
“Patients have high expectations of us,” says Codding. “Patients are not okay with waiting for long periods of time for their appointments. They expect—and deserve—high levels of care from the minute they walk in. And we can provide that.”
What Can Supporters of Independent Abortion Clinics Do?
All three providers interviewed for this story encouraged the same thing: “Read the report!”
Another way that folks can get involved is to turn to independent clinics for care. Many clinics provide services in addition to abortions, including STI treatment, gynecology, hormone-affirming therapies for trans patients, birth control and family planning, and more.
Additionally, consider where your dollars are going when you donate to pro-choice organizations. Independent clinics receive little public support and monthly donations, no matter how small, can go a long way.
But there are still legislative assaults on abortion care that cut deeply as well.
“North Dakota has a trigger law on the books,” said Kromenaker. “If Roe were to fall, there would be no abortion provider in the state of North Dakota.”
In fact, in the U.S., 10 states—Arkansas, Idaho, Kentucky, Louisiana, Mississippi, North Dakota, Missouri, Tennessee, South Dakota and Utah—have trigger laws that would automatically ban abortion in the first and second trimesters if the landmark case Roe v. Wade were overturned.
Robust, comprehensive and affirming pro-abortion legislation is needed to continue to protect abortion care across the country and the medically-unnecessary and politically motivated bans on abortion and abortion providers must be repealed.
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