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New Illinois Abortion Clinic Anticipates Post-Roe World

A regional clinic across the river from Missouri reflects how both sides of the abortion divide are looking toward a landscape in which some states might ban abortions outright.

A new Planned Parenthood clinic in Fairview Heights, Ill., is scheduled to open on Wednesday with the potential to serve a large out-of-state population.Credit...Whitney Curtis for The New York Times

FAIRVIEW HEIGHTS, Ill. — When it opens just across the river from St. Louis this week, the new Planned Parenthood clinic in Illinois will be one of the largest abortion clinics in the Midwest, set up to serve around 11,000 women a year with various health services, double the capacity of the clinic it is replacing.

Its size says as much about the future as the present: With the Supreme Court’s shift to the right, activists on both sides of the abortion divide are adjusting their strategy, anticipating that Roe v. Wade, the 1973 Supreme Court decision that extended federal protections to abortion, might eventually be overturned and that some states would jump at the chance to ban abortions.

For abortion rights advocates, one response is already taking shape: centers like this one that could provide services to women throughout their region — who could come from states where abortion is legal and states where it is not.

“The idea is that we are creating a regional abortion access hub,” said Yamelsie Rodriguez, president of Planned Parenthood of the St. Louis Region and Southwest Missouri. “In a post-Roe world, this is crucial to our mission.”

The clinic is 15 miles from downtown St. Louis in Missouri, a state whose Legislature has restricted abortion so significantly that only one abortion clinic remains. And it is close to highways that connect to cities like Louisville, Indianapolis and Cincinnati — all in states where abortion access has narrowed significantly.

“These are conversations we’ve been having for years, but they are certainly ramped up now,” said the Very Rev. Katherine Hancock Ragsdale, interim president of the National Abortion Federation. “What are the transportation routes out of haven states? What are their capacity in terms of sheer provider hours? How well-positioned are they to receive folks from places that are likely to lose access?”

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A procedure room in the new Planned Parenthood clinic in Illinois, across the river from St. Louis.Credit...Whitney Curtis for The New York Times

Anti-abortion activists in nearby states said they were aware of the clinic but were not changing their strategy because of it.

“Our focus in Indiana is on dismantling Roe, then ending abortion here first,” Mike Fichter, president of Indiana Right to Life, said in an email. “Nothing in Planned Parenthood’s strategy changes our focus on these goals.”

Mallory Quigley, a spokeswoman for Susan B. Anthony List, a national anti-abortion group, said the clinic’s existence showed the importance of federal legislation, like the bill that would ban abortion after 20 weeks gestation that has passed the House three times since 2013.

“It’s sickening to see Planned Parenthood set up these mega-centers,” Ms. Quigley said. “There’s no doubt that places like Illinois, California and New York are unlikely to change in the near future.”

She added, “The pro-life movement has a lot to do.”

The nation’s abortion map has grown ever more divided since 2010, when the Republican Party swept statehouses and sped the passage of abortion restrictions. In many red states, access has declined substantially, a victory for abortion opponents. In six states, there is one clinic left. Many blue states, including Illinois, have passed new protections.

In June, Gov. J.B. Pritzker, a Democrat, signed into law the Reproductive Health Act, which removed prohibitions on some late-term abortions and scrapped rules such as felony penalties for doctors who perform abortions. While Missouri has a 72-hour waiting period before a patient can get an abortion, Illinois has none. The state is one of the few that pays for abortion through Medicaid for residents covered by it.

Here in Fairview Heights, the new clinic, in a low-slung brick building that looks a bit like a bank, is “strategically located” next to several budget hotels and a large shopping center with “a lot of food options,” Ms. Rodriguez said. “We know women will travel across state lines and across the country,” she said. It is about 18,000 square feet, six times the size of the current clinic.

Randall K. O’Bannon, director of education and research for National Right to Life, said Planned Parenthood had opened many large clinics over the years. Fairview Heights is simply the latest.

“This is not some brand-new surprising thing and it’s not necessarily just about the laws,” he said. “It’s also about how there is competition going on. Planned Parenthood is competing for business.”

Ms. Ragsdale, of the National Abortion Federation, argued it was, in fact, about laws. The more restrictive they become, the more likely clinics will be to close, she said, regardless of how many women go.

“People are not getting rich off providing abortion care,” she said.

She said her office was talking with abortion providers every week about the timing and placement of new clinics, but said she could not give specifics.

“We are prepared to take an influx from places that could lose access altogether,” she said, citing Georgia, Alabama and Texas as examples.

Erica Sackin, a Planned Parenthood spokeswoman, said the organization tracked how many patients it served by state, but not by individual health center. She said it had 600 clinics nationwide that served more than 2 million patients.

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The recovery area in the new Planned Parenthood clinic in Illinois.Credit...Whitney Curtis for The New York Times

The clinic, in the works for more than two years and part of Planned Parenthood of the St. Louis Region and Southwest Missouri, was built in secret. Dr. Colleen McNicholas, chief medical officer for the affiliate, said it was done that way because there had been difficulties with contractors in the past. At one clinic in Springfield, Mo., a company that was supposed to install fiber-optic lines dragged its feet for more than a year, she said. At another, cabinetmakers walked off the job, leaving the clinic without any cabinets.

“There have been many examples where the politics of providing reproductive health care has really delayed the project,” Dr. McNicholas said.

Missouri women have been traveling out of state to get abortions for years. In 2009, nearly half of abortion patients in Kansas came from Missouri, roughly the same as in 2017. Illinois is another destination. Out-of-state residents accounted for about 14 percent of abortions in Illinois in 2017, double the percentage in 2012, according to data from Illinois and the federal government.

Many of those patients are from Missouri. At the Hope Clinic for Women, a private clinic in Granite City, Ill., not far from downtown St. Louis, about half of all abortion patients are from Missouri.

Planned Parenthood itself drove some of the movement into Illinois. In the spring of 2018, it began sending women seeking abortion through medication rather than through a surgical procedure across the Mississippi River to a small storefront clinic it operated in Illinois. Doctors had balked at a Missouri rule to conduct pelvic exams for medication abortion patients, saying it was medically unnecessary.

Medication abortion happens early in pregnancy — up to 11 weeks gestation — and involves two sets of pills, one taken at the clinic and one at home. It was approved by the federal government in 2000, and by 2017, accounted for more than a third of abortions in the country, according to the Guttmacher Institute, which tracks abortion statistics.

Samuel Lee, an abortion opponent in St. Louis, who helped push Missouri lawmakers to pass a sweeping abortion restriction bill this spring, said he thought the anti-abortion movement was too focused on physical clinics at a time when a rising share of abortions are done through medication, with some women ordering pills online.

“Between the increased use of medication abortion and of self-managed abortion, should focusing on the clinic itself really be our primary goal?” he said. “We need a progression in our thinking. It’s not enough to make abortion unlawful. We need to make it unthinkable. We need to reverse Roe v. Wade in our hearts.”

Mr. Lee also argues that Roe is unlikely to be overturned anytime soon, a view that some legal scholars share. The best way forward for the movement, he believes, is a focus on smaller requirements — for example, that doctors have admitting privileges in local hospitals.

“Overturning any Supreme Court decision requires time and a series of cases where the court questions, probes, explains and distinguishes from precedent,” said James Bopp, a conservative lawyer who was the architect of the Citizens United case about campaign spending by corporations. “With this court, that process has not even begun.”

Ms. Rodriguez, formerly the chief operating officer of Planned Parenthood of Illinois, said it was not unusual for new clinics to open. She opened three surgical abortion clinics in the state between 2015 and 2019.

Red states have seen new clinic openings, too, said Elizabeth Nash, a researcher at Guttmacher. From 2014 to 2017, Oklahoma and South Carolina each went from three clinics to four, Tennessee went from seven to eight and Utah from two to three.

Sabrina Tavernise is a national correspondent covering demographics and is the lead writer for The Times on the Census. She started at The Times in 2000, spending her first 10 years as a foreign correspondent. More about Sabrina Tavernise

A version of this article appears in print on  , Section A, Page 12 of the New York edition with the headline: ‘Strategically Located’ Abortion Clinic Anticipates a Post-Roe Landscape. Order Reprints | Today’s Paper | Subscribe

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