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Crossing state lines: traveling for abortion care in post-Roe southern Kentucky

 The Hope Clinic for Women in Granite City, Illinois is a little over 4 hours from Bowling Green
Alana Watson
The Hope Clinic for Women in Granite City, Illinois is a little over 4 hours from Bowling Green

With Kentucky’s abortion ban in effect, pregnant patients can’t get an abortion in the state unless their lives are at risk and that’s forcing some to seek care elsewhere.

Out of Kentucky’s seven bordering states, Illinois is one that has abortion protections. In Virgina, there are currently no abortion protections, but the procedure is still legal.

In an effort to better understand what the process is like for those seeking care, I decided to make the journey to an out-of-state abortion provider myself.

Many journeys start with finding a provider, like someone would do with any other medical procedure or service. Only this time, people may not feel uncomfortable asking for recommendations from their friends, family, colleagues, or even a doctor depending on where they live.

I started researching which out-of-state providers still offered abortion services and it seemed straight forward at first. I typed in “nearest abortion clinic”, thinking that I’d be shown the closest clinic to south central Kentucky. The first clinic on the list was called Pregnancy Matters. The website was quite inviting. They offer free pregnancy testing, ultrasounds, and workshops, but I couldn’t find anything about abortions until I scrolled to the very bottom of the webpage.

Pregnancy Matters turned out to be an emergency pregnancy center in Carbondale, Illinois, that doesn’t perform the procedure, but according to the website, does “provide you with a safe, non-judgmental place to learn about all of your options.”

I scratched that one off the list.

Finding A Clinic

Eventually I did found a website for an abortion provider within driving distance, the Hope Clinic for Women, in Granite City, Illinois.

The Hope Clinic is four hours and 18 minutes from Bowling Green, making it one of the closet clinics to residents in southern Kentucky.

Finding the clinic was just one of the first hurdles. There would still be a handful of questions that someone would have to answer.

From Bowling Green to the Hope Clinic for Women was 280 miles
Alana Watson
From Bowling Green to the Hope Clinic for Women was 280 miles

A pregnant patient would have to figure out far along they are in their pregnancy. They’d have to figure out if they’d be able to take an abortion pill, or if they’d need a surgical procedure. A patient would have to determine the cost and figure out if the clinic would accept their insurance. Depending on the procedure, a patient might have to stay close to the clinic, so they’d have to get hotel. Some patients would probably have to take off work as well.

It’s a lot to figure out in a short amount of time, but once those questions are answered, it’d be time to schedule the appointment.

As of right now, the Hope Clinic doesn’t have online scheduling, meaning patients have to call their office to schedule an appointment.

Those appointment times can vary based on the procedure. Most appointments will take three to five hours, while some can take up to two to three days.

Once the appointment is scheduled, the hotel is booked, and time off from work has been requested, it’s time to get on the road.

Hyperaware of my surroundings

My drive started off nice. I listened to music, called family and friends, listened to the latest news headlines, and tried not to think too much about the destination. If I did, I’d start to feel anxious, nervous, and on edge. Those distractions allow those feelings to be manageable, until I crossed over into Indiana.

The number of billboards and messages opposing abortion once I got into the Hoosier state was unexpected. I passed a “Graveyard of the Innocent,” while I was on Interstate-64. There were white crosses lined up in a corn field that were placed there to represent the number of aborted fetuses in Indiana.

It was hard to determine if I was hyperaware of my surroundings while I was driving through Indiana or if there were truly that many anti-abortion messages. Regardless of which was true, how would someone actually getting the procedure feel? Would they change their mind and head back home? Or would they feel uncomfortable and vulnerable?

After driving for over four hours, I made it to my hotel, grabbed some dinner, and got some sleep before getting up the next morning to head to the clinic.

The Hope Clinic For Women

When I arrived at the clinic around 7:50 the next morning, there were only two protesters outside. One man held a sign that said, “God hates the hands that shed innocent blood.” There was a picture of small hands on a dime on the poster.

 Protesters outside of the Hope Clinic
Alana Watson
Protesters outside of the Hope Clinic

The protesters spoke softly at me as I got out the car and they stared as I walked into the clinic. There were already a few cars in the parking lot with people waiting. The clinic didn’t open until 8:30.

As you walk into the clinic, you’re greeted by someone at the first desk who will check you in. In my case, it was Francis who has worked for the clinic for a year. She only gave her first name.

Francis’ job goes beyond just checking patients in and answering phones. She assesses how patients are feeling and becomes a sounding board for those who encountered protesters as they walked in the building.

“We can just sit there and talk to them and let them know how irrelevant those people are and just remind them that this is their choice and your body and that we’re here to support them in any way. Regardless of if they come in and decide that they don’t want to do it. Okay, that’s fine—call us if you need us,” Francis explained.

She went on and said that some people come in feeling very angry.

“They’re just mad about the situation,” Francis said. “And it’s like, ‘I know. I’m sorry. And I’m sorry you feel like this is the option that you have to have and I’m sorry this isn’t an option that you ever wanted’”.

Reception area at the Hope Clinic for Women
Alana Watson
Reception area at the Hope Clinic for Women

Once a patient checks in, they’ll fill out paperwork, get an ultrasound and then sit down with a member of the education staff at the clinic.

Comforting those who come through the door

Hanz Dismer, who uses they/them pronouns, is a licensed clinical social worker and is the education and research coordinators for the clinic.

They manage the education staff at the Hope Clinic who are either trained peer educators or social workers.

The education staff meets with patients to assess how they’re feeling before their procedure.

“Most people feel a little nervous. Some people are really nervous or really scared,” Dismer said.

“Ever since the end of June, I think there’s more people in general distress, but less people in distress about having an abortion, and more people in distress because of all the hurdles they’ve had to jump through to get an abortion.”

Dismer explained that a huge part of an educator’s role is to simply comfort patients that come through the door. They assure those patients that they’re safe and that they can do what they want with their body.

“The vast majority people are pretty or very sure when they come here. We do have a small portion of folks who aren’t and with those folks we meet with longer. We offer pregnancy options, counseling, and we really talk about what their needs and wants are,” they said.

After meeting with an educational staff member, patients have the choice of moving forward with their procedure, or picking another option, including giving birth. Out-of-state patients can get a medicated abortion up to nine weeks at the Hope Clinic. Surgical procedures can be done up to 24 weeks. Dismer said procedures over 16 weeks can take two to three days for proper cervical dilation.

The Hope Clinic says 86% of patients who visit their Illinois operation are from out-of-state, with some patients traveling over ten hours to receive abortion care.

 Painting rock outside of the clinic that says, "empowering people to make their choice"
Alana Watson
Painting rock outside of the clinic that says, "empowering people to make their choice"

“I don’t think anyone should have to travel any more that 30 minutes to an hour for any health care, let alone something as time sensitive as pregnancy care and abortion care,” Dismer said.

They explained that wait times at the clinic are going up because of the influx of patients but they don’t turn anyone away.

“We want to serve everybody in a timely manner. Once you decide that you don’t want to be pregnant, you want your abortion right away, you want it within the next couple of days,” Dismer said. “You don’t want two or three weeks of continuing pregnancy symptoms. Maybe you have hyperemesis, maybe this is just a really distressing situation and that compounds those feelings.”

Once a patient is free to go following their procedure, it’s time to leave and make the trip back home. But getting past the protesters and finding aftercare and support back home is another part of the journey.

Wearing headphones on the way out

Protesters aren’t allowed on the Hope Clinic’s property, but they do line the sidewalks and chant and yell at patients as they enter and leave the Southern Illinois based clinic.

The Hope Clinic often recommends patients wear headphones to drown out what’s being said to them as they leave following their procedure.

But once a patient is past the protesters and travels home, what comes next?

The Hope Clinic gives patients an aftercare instruction sheet and a 24/7 on call number once they leave. Dismer explains that aftercare depends on the procedure.

“If they’re doing a medication abortion, we review warning signs...things like hemorrhage, or infection, or incomplete or failed abortion. If they’re doing a procedure we review warning signs like again infection, hemorrhage, perforation, and incomplete abortion thought that one is a lot less likely for a procedure,” they said.

There are also specific symptoms to look out for, such as: what is too much bleeding? What is too much pain? What are warning signs of an infection?

Abortion procedures are safe, and complications don’t happen often, according to Dismer. In the first trimester, there’s less than a 1% complication rate.

“Most folks are very nervous about complications and most folks have a lot of misinformation about it, thinking that ‘maybe I won’t be able to get pregnant in the future,’ or maybe ‘I’ll be depressed,’ or ‘I’ll get breast cancer.’ Or any of these other lies that have been intentionally peddled by anti-abortion activists to just convince people to continue pregnancies that they aren’t ready for,” Dismer said.

Most Kentucky counties don’t have an OB-GYN

So, what happens when a Kentucky patient comes back home following an abortion procedure?

Who can they turn to if they have questions or concerns about aftercare or if they’re in need of mental health support?

Tamara Weeder, the Kentucky state director for Planned Parenthood Alliance advocates, said many Kentuckians who are travelling out of the state for abortion care most likely are already in contact with their primary obstetrician-gynecologist. Weeder says some OB-GYNs in Kentucky are working to connect their patients to abortion providers in Illinois, but this isn’t always the case.

“For those who have scraped every penny and used every day off of work if they have it, you know they may already be coming from communities where there aren’t providers,” she said.

According to 2020-2021 data from the U.S. Health Resources and Services Administration, at least 70 of Kentucky’s 120 counties didn’t have a single practicing OB-GYN.

Jacob Ryan

“So, within those communities there’s maybe a lot of fear about going to the provider and having discussions and fear about what would be disclosed to the state,” she said. “As the law stands right now, there should be no ramifications for seeing your provider.”

Weeder said if the Commonwealth’s abortion ban remains in effect, the lack of OB-GYNs could worsen in the state and cause what she calls a “chilling effect.”

“We’re already seeing providers and pharmacist across the state not sure of the laws and afraid to give full spectrum healthcare,” she explained. “We’re also seeing residency programs in Louisville and Lexington starting to be hit because providers don’t want to come here.”

If a Kentucky resident does have an OB-GYN, Weeder suggests having conversations about what’s important to their specific reproductive healthcare.

“But if you are one of the many Kentuckians without a general practitioner or a gynecologist. These laws are really going to drastically impact your care moving forward because we’re not going to see more providers coming. We’re already seeing providers leaving the state or not coming here.”

The Commonwealth’s near-total abortion ban will remain in effect until the state Supreme Court hears oral arguments over litigation of the ban in November.

Those oral arguments won’t be heard until after the November 8th general election, when Kentuckians will vote on a constitutional amendment deciding whether or not the state constitution provides any right to an abortion.

Copyright 2022 WKU Public Radio. To see more, visit WKU Public Radio.

Alana Watson rejoined WKU Public Radio in August 2020 as the Ohio Valley ReSource economics reporter.
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