Abortion Clinics in Crisis
Since the Supreme Court ruling in Dobbs v. Jackson Women’s Health in June of 2022 upended abortion service delivery in this country, abortion clinics have been innovating, adjusting, refocusing, and scrambling to continue staying in business and offering safe, compassionate abortion and reproductive health care. But, the assaults have come from all fronts and are relentless. From violence to legal challenges to patient care, abortion clinics are feeling the pressure.
“A confusing mess.”
“A step backwards.”
“Providers bend over backwards.”
“The market is erratic.”
Immediately after Dobbs, abortion became illegal in 14 states, and a patchwork of legality and availability was carved out of the other states that to this day is still in flux. Many clinics closed, and some moved across state lines. Abortion Funds sprang up to help women with travel and other abortion costs. And clinics deleted some services and added others. Although the numbers of abortions hasn’t changed, clinics are currently in jeopardy of extinction because of a multitude of factors discussed below.
A Bit of History
To put the significance of the rise of abortion clinics after the Roe v. Wade and Doe v. Bolton Supreme Court cases in 1973 made the procedure legal into perspective, it’s important to know that at that time, there was no such thing as outpatient surgery. Virtually all surgery was performed in hospitals requiring an overnight stay. Most hospitals wouldn’t allow abortion, so emerging providers had no choice but to figure out performing the procedure in their doctor’s offices or specialty clinics. These specialty abortion clinics became the model for outpatient surgicenters that are prevalent today. They gave rise to legitimate entities and to state licensing and inspections to ensure quality care.
Abortion clinics also led the way in patient education and informed consent. Most hospital consents still today are very general and don’t give much information about the exact steps of the procedure. Not so with abortion clinics. Abortion consents are very detailed and are reviewed with patients by trained counselors who explain everything and offer support.
Medical fees in 1973 were also very inexpensive. An abortion cost about $150. It had to be affordable for patients because most insurance companies would not cover the procedure. In the 50 years since then, the procedure in the early stages now ranges from $650 and $926. Because clinics couldn’t manipulate the health insurance reimbursement system, there was little room for massive price increases. Not so with the rest of medicine where fees for procedures have skyrocketed out of control. Abortion clinics should be charging over $3000 if their fees had kept up with inflation and the greedy medical industrial complex.
After chiropractors, clinics were some of the first medical entities to advertise. It was thought to be inappropriate and medical societies frowned on such exploitive behavior to solicit business.
Abortion clinics had no choice but to advertise their services through newspaper and magazine ads, radio, and even television. Clinics ushered in an era of medical advertising that is standard today.
The positive public health implications of the legalization of abortion in 1973 have been repeatedly proven, but now that is gone.
What’s Happening Now?
So today clinics are feeling the pinch in unprecedented ways. Patients are elusive and costs for supplies and professional staffing are soaring. Phones at clinics in even safe states aren’t ringing like they should be to absorb the patients in other states with few options. Clinics are looking for innovative ways to preserve their business and remain open and viable.
The reality is that in closed states even if the laws change and clinics could reopen, that would take 6 months to a year to fully accomplish. Therefore, clinics in banned states are struggling to stay open by providing other services until the laws can be reversed.
The Internet
Today, the biggest source for patients to find information about clinics is the internet which didn’t come along until about 1995 with the creation by me of Abortion Clinics Online. At that time, a clinic could get a website and listing on the directory for $300/year. Now the costs for a website and related online advertising can run over $10,000 a month for a clinic. Even the internet can be ineffective because it’s cluttered with government subsidized ads for Fake Clinics, or Pregnancy Crisis Centers, who trick women into thinking they are real clinics, but provide false and misleading information. The promise of AI can only optimize the online confusion.
Currently women are accessing the internet mostly on their laptops. Before Dobbs, about 90% of abortion patients found a clinic on their mobile phone. Now because of security issues with phone searches, only 50% of women search on their phones. Law enforcement has threatened to use mobile phone data to incriminate women for accessing abortions. Therefore women are turning to their laptops instead of their phones.
Increased State Interference and Surveillance
Many States have enacted laws making it a crime to get an abortion, search for a clinic, get help going to a clinic, or receiving the abortion pill by mail.
Prospective patients are cautioned to NOT use period trackers for fear of governmental interference and possible legal repercussions from being tracked on their phone. In their zeal to attack abortion on all levels, many State and Federal agencies regularly inspect and harass clinics.
On a good note, one of the most egregious anti-abortion extremist bills was just defeated in South Carolina.
Rise of the Abortion Pill
About 25 years ago, the abortion pill became legal in the United States. It had been available safely in Europe since the 80’s. Over the years, several drugs have been used in “abortion pill” regimens including Methotrexate, Misoprostol, and Mifepristone. The current most popular regimen is Mifepristone followed 36-48 hours later by Misoprostol. This is available up to 14 weeks of pregnancy at Aid Access.
