People are flocking out-of-state for abortion care. Clinics are fighting to keep up.
On an early morning Zoom call, Michele Landeau is working from her home in St. Louis. But most mornings, she drives across the state border to Granite City, Illinois.
Landeau is the chief operating officer at Hope Clinic, an abortion clinic that has tripled its intake of out-of-state patients since the 2022 Supreme Court case Dobbs v. Jackson, which overturned Roe v. Wade and the constitutional right to abortion. Bordering five restrictive abortion states – including two with total abortion bans (Indiana and Kentucky) – the Illinois Supreme Court embedded protections into the state’s constitution, making it a popular destination for women seeking abortions.
The vast majority of patients at Hope Clinic pre-Dobbs came from Missouri and Illinois, but after Dobbs, they experienced a 700% increase in patients from other states – from 6% of all patients to now 40%.
Studies have shown that states with the strictest abortion laws already have the weakest maternal health care support, with 52.5% of the Arkansas and 49.2% of the Oklahoma populations living in maternity care deserts ‒ areas where there are no obstetric providers or birth centers ‒ as of 2022. Both states have total abortion bans with limited exceptions. A new 2025 study also found that infant mortality rates are higher than expected in states after implementing abortion bans, and these increases were larger among infants who were Black, had congenital anomalies, or were born in southern states. As more physicians are deterred from practicing medicine in states with abortion bans, researchers warn of implications for workforce sustainability and the availability of timely and accessible health care.
As the need for out-of-state care rapidly increases, abortion clinics and funds caution that even in protective states, the infrastructure is under strain. With fewer health care centers to turn to, people have to travel further for care, more resources are depleted from abortion funds, and providers are stretching their bandwidth to support the influx of patients. With no end in sight, are their efforts sustainable?
After Dobbs, Hope Clinic added another clinic day to remain open six days per week, and increased their staff by about 40%. They’ve also implemented a policy that no patient gets turned away for the lack of ability to pay; the clinic works with abortion funds throughout the state and country, such as the Chicago Abortion Fund, to provide financial assistance. Now, they're able to see patients within two days.
“Not only is it just against our values to make people stay pregnant for longer than they want to be or have to be, but if you have to wait a week or two, that could mean that your cost goes up,” Landeau explains. “There's a lot of financial barriers in place that people have to overcome initially, so we don't want to put more financial barriers in the way of them being able to access care.”
Not all patients are seeking elective abortions. For instance, in Indiana and Iowa, lethal fetal anomaly exceptions (when the fetus is unlikely to survive outside the womb or will die shortly after birth) are only applicable up to 22 weeks from an individual's last menstrual period. Even if the anomaly is discovered within the gestational age limitation, Iowa only has two abortion clinics, and Indiana has no abortion clinics. Doctors in restrictive states also fear legal repercussions for providing abortion care or counseling, even in cases where the patient's life is at risk. In 2021, a Texas mother died after doctors in the state delayed treating her miscarriage for 40 hours. She told her husband that her medical team couldn't act until the fetal heartbeat had stopped due to Texas Senate Bill 8, according to reports from ProPublica.
Clinics in New York see increases, despite not bordering extremely restrictive states
Over in New York City borough of Queens, Choices Women’s Medical Center has been serving patients seeking abortion care for 54 years. Merle Hoffman, founder, president and CEO, calls the clinic an “oasis in the storm” for many of their young patients.
Just a five-minute walk from the Jamaica subway station and AirTrain, which takes travelers to JFK-Airport in under 15 minutes, Choices Women’s Medical Center rests in a quiet alleyway off a bustling avenue. Inside the clinic, an expansive waiting room seats about 40 patients per day, Hoffman says. After checking in, patients are led into a separate, security-guarded waiting room and seen by the medical director, Dr. Joseph Ottolenghi, and the director of counseling, Rebecca Glassman.
The total number of out-of-state patients seen at Choices Women’s Medical Center increased by 46% from 2023 to 2024. Though New York City does not border extremely restrictive states, they are often the most accessible for out-of-state patients.
“A lot of those clinics (on border states) were already sort of operating at capacity,” Ottolenghi says. “Because we have two operating rooms and more space than a lot of other places, we're able to accommodate more. So we may not be the first place that patients call necessarily, but we may have the best availability or the soonest appointment.”
Choices Women’s Medical Center also has a policy that no patient will be turned away if they can’t afford care. Hoffman has her own nonprofit to front the cost and works with abortion funds nationally, but she has always worried using abortion funds to provide care is not sustainable. When she co-founded Rise Up 4 Abortion Rights in 2022, she says her fellow organizers proposed fundraising to fly people to New York or other states where abortion would remain legal if Roe v. Wade was overturned.
“I kept saying, ‘This is not sustainable, and you’re funding your own oppression,’” she says.
'We’re all relying on the same places': Chicago's largest abortion fund spent $5 million in 2024
Hope Clinic works closely with Chicago Abortion Fund, Illinois’ statewide abortion fund and one of the largest funds in the country. The fund receives between 150 to 200 calls per week and works with over 75 clinics and providers across the Midwest, according to Executive Director Megan Jeyifo.
Costs covered by Chicago Abortion Fund can include flights, ride-hailing service, lodging, food and “whatever they need to get from A to B,” even if that means extra clothing.
In 2020, the fund spent $300,000 supporting patients’ financial needs. By 2024, that skyrocketed to $5 million. "It does kind of make your head spin," Jeyifo says.
Many people who aren’t immersed in this line of work, Jeyifo explains, assume that being in a protective state means there aren’t barriers to care.
“What we always talk about,” she says, “is that those protections mean nothing without support in our ability to access them. Legal protections don’t mean anything if you don’t have money in your bank account or gas in your tank, or if you can’t afford to pay for a babysitter while you go to the clinic.”
The Chicago Abortion Fund is still assisting patients from Chicago alongside those from cities like Memphis, Tennessee, New Orleans and Miami. Jeyifo hopes their work can be a blueprint for other protective states to follow because “at a certain point, Illinois is not going to be able to handle all these increases.”
“People in states where you feel protected, know that the lines have been obliterated,” she says. “We’re all relying on the same places.”
Before Dobbs, the majority of their funding came from institutional support foundations, and now it’s 50/50 between those foundations and individual donors. They also hired a director of development in 2024 to ramp up their fundraising efforts, and receive funding from the city of Chicago and the state of Illinois.
“We are trying to use each moment as a catalyst to get to the next moment to be here and support people for the long haul,” Jeyifo says. “If you had told me five years ago that we would have been able to help 15,000 people last year, I would’ve laughed in your face. We know how high the stakes are and we are not slowing down. We are going to be relentless.”
Providers are discouraged as patients fear returning home
At Choices Women’s Medical Center, Ottolenghi says there’s more tension in the air.
“It takes more time to sit and talk with those patients and talk about why this is safe and why they should feel secure,” he says. Recently, an anesthesiologist told Ottolenghi he had a patient who was more nervous than expected. When Ottolenghi told him she was an out-of-state patient, it clicked.
“He didn't quite understand why she was as anxious as she was until he knew that she was from out of town,” he explains.
It can be angering, he adds, to learn about people’s situations in other places and not be able to do anything about it. But knowing he can help patients come to the clinic brings comfort.
Landeau says another major issue is misinformation around legislation, and that some patients are fearful about being prosecuted for traveling to get abortion care after hearing about bills that get introduced and pick up traction in the media or on social media. Even though these bills ultimately haven’t gone through the legislative process, the fear sticks.
At Choices Women’s Medical Center, Ottolenghi has patients ask if they can get arrested in their home states. “These people are going back to states in which there are penalties for what they've done," he says. "And there's nothing illegal about what they've done, because getting health care in New York is not restricted, but they're very scared."
“I think these are preventable drains on the infrastructure,” says Rebecca Glassman, Choices Women’s Medical Center’s director of counseling. If a patient feels safe obtaining abortion care in New York, she explains, but then goes home to a state like Texas, they may not know where to turn for follow-up care. Instead of flying back to New York, Glassman says abortion funds and referral networks can redirect them to nearby states where they can access the care they need with less wear on the system.
But for every patient who is afraid to return home, Glassman has another who is simply exhausted and can’t wait to get back. Many of her patients have other kids or had to take off work to obtain care.
The burden can be greater when patients are going through the process alone, as some of Glassman’s patients don’t want to tell someone else what’s going on, or are traveling alone regardless ‒ whether it be “across the city or across the country.”
Glassman admits that it is "easy for morale to drop" as providing abortion care becomes increasing "difficult and discouraging." Having support from colleagues and being clear on your mission, she adds, is essential.
And despite the strain on the system, Hoffman says abortion providers are “very good at pivoting and meeting the moment,” and will keep trudging forward. “Existing is resisting,” she says. She doesn’t expect to “win” when it comes to the fight for abortion rights, instead, she sees it as “a power struggle that'll go on for a very long time.”
Likewise, Jeyifo “doesn’t know what sustainability looks like.” To her, it’s just about “putting one foot in front of the other” and getting the work done.