With the decision in Dobbs v. Jackson Women’s Health Organization in June, the Supreme Court eliminated the constitutional right to an abortion nationwide. Now, a new kind of abortion-rights archipelago has formed. Though 21 states and the District of Columbia have laws guaranteeing the procedure as a right, there are 17 states—mostly in the South and Midwest—that now ban or restrict abortions. Within the first month of the SCOTUS ruling, dozens of clinics were forced to close or to stop offering abortions.
But at one clinic in southern Illinois, the dynamics of the post-Roe era are visible in profound ways. Just a few miles from the border of Missouri, where abortion is punishable by up to 15-years in prison, Planned Parenthood’s Fairview Heights Health Center is sandwiched between an antique mall and an office building. The clinic has increasingly become a destination for people seeking abortion from states across the country, with 40 percent of patients living outside Illinois or Missouri.
In Illinois, abortion is permitted up to fetal viability—around 24–26 weeks—with the right preserved through a state constitutional amendment passed by a democratic supermajority in 2019. There are 32 abortion clinics in the state, but only three in southern Illinois. The clinic can serve upwards of 80 patients a day, and is visited by people from not just neighboring Missouri but also Indiana, Ohio, Arkansas, Louisiana, Mississippi, Alabama, Kentucky, and Texas.
According to the Guttmacher Institute, 75 percent of people seeking an abortion are considered poor or low-income. For many, traveling all the way to Illinois is out of the question. “When a person has to cross hundreds of miles to receive health care, the cost of a procedure can become astronomical when they also have to figure out food and lodging. And since so many people who have abortions are already mothers, figuring out child care as well is an additional challenge,” explained Brenda Boudreau, a professor at McKendree University and an abortion researcher.
Once the patients make it to the Fairview Heights clinic’s gates, they face another problem. On one late August day outside the clinic, two young women stood on a strip of grass, waving and smiling at any cars pulling in. Wearing orange reflective vests and carrying clipboards, they certainly looked professional. “The role of an escort is really important because they provide a buffer between the patients who are coming in for reproductive health care, and the anti-choice activists,” said Debra Knox Deiermann, a longtime abortion-rights activist in the Greater St. Louis area.
But the two women in vests were not clinic escorts—they are employees of a Missouri-based organization, Coalition Life. The clinic’s proximity to Missouri has made it an easy target for anti-abortion activists operating out of the state. “Because Fairview Heights has become a regional hub for abortion following the Dobbs decision, this location is now on the frontline of the fight for life,” reads the Coalition Life website. The group has since expanded its efforts to Cook County, the second-most-populous county in the country, around 300 miles away from its headquarters. “Over 3,100 women have left the abortion facilities with their children alive because of our heroic counselors and client care specialists.”
Since 2010, Missouri has allocated $44 million for pregnancy resource centers. Because they aren’t actual hospitals, they are free from regulatory oversight, and can also refer to themselves as “crisis pregnancy centers,” “alternative pregnancy centers,” or simply “pregnancy centers.” Recently, Missouri has drastically increased the funding to these organizations, allocating $8 million for this fiscal year alone. A 2021 law also increased the tax credit available to Missouri residents and businesses, who can donate to the 74 centers and receive a 70 percent—up to $50,000—reimbursement on their donation. In just the first quarter this year, the state permitted $7 million in these tax credits, more than all of their 2021 PRC tax credits combined.
Advertising from these centers is deliberately misleading and obfuscatory, with patients often having trouble telling just what they offer. “Their mission is to prevent abortions by persuading women that adoption or parenting is a better option,” according to the AMA Journal of Ethics. A cheerful-looking pamphlet Coalition Life members offer to visitors of the Fairview Heights clinic claims that there are “organic alternatives to artificial birth control” and that the abortion pill can be reversed. Though Coalition Life has targeted the clinic since it opened in 2019—even setting up its own center across the parking lot—the Dobbs decision has motivated it to go further. “Roe is finished, but our work is not done yet. Wherever you live, you can seize this historic moment and help end the greatest human rights crisis in history.”
According to a PRC map tracker, around 2,500 of these clinics operate across the country, while only 800 clinics offer abortion. In August, a Missouri woman facing a life-threatening pregnancy complication asked her Republican state senator for help. Instead, his office referred her to an anti-abortion crisis pregnancy center, wasting valuable time before she was finally able to received life-saving care from an Illinois clinic.
Employees and volunteers at the Fairview Heights clinic have witnessed countless deceptive acts by these fake escorts. “I’ve experienced a couple times where we’ve had patients who didn’t speak English as their first language. When we finally were able to connect them with translation services, they told us that the protesters had handed them a phone with someone speaking broken Spanish who told this patient that the clinic was closed today; they should try out the van instead,” said Maggie Olivia, who has worked as a clinic escort for the past two years and is a policy manager at Pro-Choice Missouri.
The van is the “mobile ultrasound unit,” a fixture of the anti-abortion activists. It is run by another Illinois-based anti-abortion organization called Mosaic Health, which calls itself a “pregnancy resource and help center,” but does not recommend or perform abortions. “The van is something that a lot of protesters will use to park just outside of the clinic property to try and deceive people and direct them away from actual medical services,” explained Olivia.
With the increased presence of anti-abortion activists, these escorts have become even more crucial to the clinic’s operation. Even before Dobbs, there was a heightened fear among patients. Last year saw an 128 percent increase in assaults against abortion providers and patients compared to the year before.
In 2021, Texas successfully passed a six-week abortion ban. “I saw a family from Texas who had driven hours on end to reach the Southwest Illinois Clinic and had actually pushed themselves farther along into pregnancy so they could save up enough money to access a rental car,” said Olivia. “They were so afraid to leave Texas and drive to an abortion clinic with Texas license plates.” Since the overturning of Roe v. Wade, millions more are now afraid for their health and safety. “Armed demonstrators and extremist groups have increasingly gathered at abortion-related protests,” according to Time.
In late October, Biden announced that the first bill in the next legislative session under a Democratic majority would codify Roe v Wade. The future of national abortion access now hinges on whether Democratic candidates can perform above expectations. “As escorts, we would love to be doing something else with our day, but you know, we’re only out there because of the level of harassment that patients are experiencing for no reason,” said Olivia. “We hope one day that our program can become obsolete because it’s ridiculous that anybody should be harassed while trying to access health care and take care of themselves in whatever way they need to.”