Abortion providers and advocates experience déjà vu as Roe v. Wade is threatened

When the draft opinion signaling the Supreme Court was poised to overturn Roe v. Wade was leaked this week, many abortion providers and advocates had just attended the National Abortion Federation conference.

Just how the moment felt is hard to capture, according to Odile Schalit, the director of the Brigid Alliance, a group that helps women connect with abortion services.

"It was a combination of being feeling stunned and mad and also a sense of resignation and acceptance that this is something that we knew was coming for a long time," Schalit said. "And gratitude that, unlike many other moments that had been quite similar to this one in this one, we got to actually some of us be together."

Schalit said the providers who had hung around following the conference quickly realized "the world is going to wake up in a big way," and that this decision was going to dominate their work for the next several years – if not longer.

Many abortion providers and advocates have been preparing for this moment, though, and now that it seems all but certain that Roe will be overturned, the conversations have turned to what their work will look like in the future.

"How can we steady ourselves through this? How can we use this as an important opportunity to engage our communities, our donors, our allies, our friends to be with us for a long-term commitment, which is what this necessitates?" Schalit said. "And how can we sustain ourselves as people a part of this movement which has a tendency to push and pull you around quite drastically?"

For others though, the news of the leaked opinion felt like déjà vu. Kathaleen Pittman runs an abortion clinic in Shreveport, La. When Pittman heard the news, she canceled the plans she had and started talking to her attorneys and reassuring her staff and patients.

"You know, we have overcome so many obstacles. We'll see this through. We'll do what we need to do," Pittman said. "And to my staff's credit, the concern was about the women. Not a single employee expressed concern for themselves or their livelihood. Everybody has been worried about the women."

Pittman's clinic, the Hope Medical Group for Women, is one of only three in the entire state of Louisiana. When Texas banned abortion for pregnancies past about six weeks, things got extremely busy. Now she's steeling herself for a similar influx in patients and trying to help people sort out confusion surrounding the draft opinion.

Schalit, Pittman and Dr. Erin King, the executive director of the Hope Clinic for Women in Granite City, Ill., spoke with NPR's All Things Considered about what the past few days have been like and what comes next.

This interview has been edited for length and clarity.

Interview Highlights

Dr. Erin King, your clinic is in Granite City, Ill., just about 10 minutes from the Missouri border, where abortion access has already been quite restricted. Illinois is surrounded by states that have trigger laws, meaning automatic bans would go into effect if Roe is overturned. How is your clinic preparing for this possible outcome?

King: About 60% of our patients are from Missouri. They are coming from out of state. And we have watched over two years as Missouri has restricted abortion so much that there are just a couple hundred abortions happening in Missouri right now where there used, you know, to be over 5- to 6,000 at least per year.

And so we are extremely worried about the Supreme Court decision that the same thing is going to happen in more states around us. And pretty much every other state that borders Illinois will immediately or, over this next several months after a Supreme Court decision, will have significant restrictions on abortion if not a complete ban on abortion.

So we've actually been preparing for several years. We are optimistic all the time. We want the best for our patients. But we also are realistic. And to be prepared to even be able to see a small portion of the patients that will need access out of their own states, we've had to add staff. We've added nurses. We've added doctors. We've added appointment types. We have the capacity to expand pretty quickly hours and appointments, and have been able to even though we've seen influxes of patients on and off from surrounding states. But no one will be ready for the number of patients that can't access care if the decision from the Supreme Court is anything like the draft that's come out.

I imagine you've been getting a lot of phone calls in the last few days. Tell me about who's calling and what they're saying to you.

King: We had patients immediately calling, asking were we canceling their appointment because they thought abortion was now illegal in the country. There was a lot of confusion around what access and care was available just the next morning after the leak of a draft. So I can't even imagine the amount of confusion that's going to happen and concern when the real decision comes down.

We were also getting calls from — luckily from supporters, saying, what can we do? How can we help? Who can we fund? What funds can we help? What patient support organizations should we turn our attention to? And unfortunately, we also had a very strong protester presence outside of our office for the next several days. We've seen almost double the number of protesters, and a lot more anger and really angry, mean words towards patients and staff entering the building.

Kathaleen in Louisiana, are you making plans to scale up your clinic, or are you kind of taking a wait-and-see approach because of the pending restrictions that Louisiana's legislature might pass soon?

Pittman: There is no possibility of scaling up. We have a trigger ban in Louisiana. Should Roe be reversed, we would cease to exist – all three clinics in Louisiana. You have to understand — none of the clinics that provide abortion care in Louisiana offer any other type of care. Because we are dealing with some of the poorest of the poor, there would be issues with, say, if we were to attempt to provide routine GYN care. How is that cost going to be covered? Most of the patients that come to us would qualify for Medicaid because of their income. However, in Louisiana, it's against the law to provide any type of funding, Medicaid or otherwise, to clinics that provide abortion care.

So in Louisiana, it's all or nothing. We can't do more than abortions. We can't even relocate to expand, should we need to, without having to apply for a new license, which would not be forthcoming, I assure you. There's a Planned Parenthood in New Orleans that, years ago, had a new facility, applied for an abortion clinic license, and that has never come to fruition and probably never will.

Odile, your organization, the Brigid Alliance, is a practical support organization. You help people get across state lines all over the U.S. Describe some of the logistics of that for me. What does it look like to help someone get across state lines to find an abortion that might not be available where they live?

Schalit: We cover a wide range of logistical needs. So that can include anything from transportation, like flights, bus tickets, train tickets, gas, cash for parking, cash for a rental car service. It can also include lodging, reimbursements for childcare. And critically, we coordinate these things for our clients. As you can imagine, having to access an abortion, having to travel for that, having to negotiate the disruption that that causes to your life is significant enough. Having to then plan a whole trip, especially if you've never traveled out of your state before, which is the case for many folks who – a lot of people who travel from rural areas – that can be a significant hindrance to whether someone even tries to travel.

Kathaleen, in Louisiana, where you are, what kind of patients are you expecting are going to be most affected by this potential forthcoming ruling?

Pittman: I think what we will be seeing most affected would be the marginalized communities, which actually makes up the majority of our patient roster. Most of the women we see here at Hope are living at or below the federal poverty level. The majority are persons of color. The majority already have one or more children at home and are trying to decide what's best for them. We're seeing them having to navigate just to get to our clinic – issues with transportation, issues with child care, time off work, time off school. Again, it's going to be those who have the least that will suffer the most.

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