Half a century ago, after the Supreme Court ruled that abortion was a constitutional right, Choices became the first clinic to open in Memphis, Tennessee. She has had abortions in the country’s capital ever since. With the judges overturning Roe v Wade will stop doing that. Tennessee is one of 13 states that have a law that comes into effect on Roe’s death. Instead Choices will transfer women to a new clinic that will open this summer in neighboring Illinois province, where abortion will remain legal.
The Memphis clinic will not close, however. In recent years, as Roe’s end has been seen to increase, the clinic has expanded its services. It now provides transgender health care (provides transgender hormones), HIV testing and birth control. In 2020 it opened a maternity ward, thus becoming the first nonprofit clinic in America to accommodate both abortions and births.
Jennifer Pepper, the clinic’s chief executive officer, says she hopes to set an example for other private abortion clinics in the post-Roe America area. Planned Parenthood, the largest abortion provider in the United States, has long provided other health care services, but most private ones — that is, non-compliant with Planned Parenthood-clinics, which provide about 60% of abortions in the United States, tend to focus on them. abortion (although some offer contraceptives).
That has been the strength and the weakness. It has helped clinicians become powerful advocates for abortion rights. The Dobbs v Jackson Women’s Health Organization, the Supreme Court case used to overthrow Roe, was involved in a war between Mississippi and its last abortion clinic. The clinic has opposed public efforts to close and end abortions in the province. Two previous cases of abortion considered by the Supreme Court were won by clinics.
But focusing on abortion has left clinics at risk. Many, including some in friendly states and abortion rights, have been banned. The Abortion Care Network, which represents private clinics, estimates that in 2012 the United States numbered 51,000. In 2021 they were 358. As of 2016, it says, 113 private clinics have been closed. Of these, 18 were in California, six in New York and a few in other states widely supported abortion rights, including New Jersey, Massachusetts and Pennsylvania.
Robust or Roe-bust?
The biggest pressure clinics face, no matter where they are, is financial. In the American for-profit health care market, the provision of abortion is complex. While most clinics work to make a profit, payment is a challenge. Many patients are poor. Federal Medicaid funds cannot be used to pay for abortions without exceptional circumstances. Even in regions that spend their Medicaid money on abortions, rebates are often low and delayed. Not all provinces continue to offer Medicaid abortion. Clinics have had to keep prices low despite rising costs. In districts that follow pernickety rules designed to close clinics have that effect.
Additional positive changes, however, have made the business of the abortion clinic a challenge. The American abortion rate dropped dramatically, reaching almost half of what it was in the 1980’s, though it has increased slightly in recent years. Some abortion providers claim that since 2010 the improved contraceptive method offered by the Affordable Care Act (“Obamacare”) has contributed to the dramatic decline in demand.
Another development, the effects of which are still to come, is the increasing use of abortion drugs. During the epidemic, the Food and Drug Administration reduced the requirement for women to collect the first two doses used in a personal health care provider. Women can now be given pills through telemedicine consultation and receive them at the post office. A few telemedicine startups run by doctors and nurses, but not affiliated with clinics, now offer abortion pills at a lower cost than clinics.
One of the first, Abortion on Demand, is so concerned about the effect that abortion medicine can have on clinics that it offers 60% of its benefits to the Abortion Care Network. “We did not want to start a business that puts at risk brick and mortar clinics,” said Leah Coplon, director of medical services. The nurse, previously worked at a private abortion clinic in Maine, where abortions have been covered by Medicaid since 2019. It was still financially viable for many, he says, but sometimes there was a problem with the costs incurred by some health care providers. you should not think, like security. There were protests at the clinic every day for abortions, she said.
Ms Coplon says that although the use of abortion drugs is increasing, some women will still need to use clinics. She thinks Post-Roe, women in provinces where illegal abortion may choose to go for surgery to avoid the risk of needing medical attention that might put them in trouble or a doctor. Abortion drugs are very safe, but the bleeding may last for a few days. And some women, she says, “just want to go into an abortion clinic and get out and find out they’re pregnant”.
In theory, Roe’s demise should mean that the increase in women looking for provinces where abortion is legal should transfer funding to the remaining American clinics. But funding will always be a problem. Many patients traveling on state lines will lack Medicaid or insurance. And the costs may be higher if more women are required to have an abortion later in life, as it seems possible. Currently, only private clinics offer abortions after 26 weeks.
Other costs, too, are likely to increase. Amy Hagstrom Miller, founder and chief executive officer of Whole Women’s Health, who runs clinics in Indiana, Maryland, Minnesota, Texas and Virginia, says anti-abortion activists will now face districts where abortion is legal. This is likely to increase security costs. It can make it difficult to hire and retain staff. Clinics are available