How Roe's fall is making Illinois an abortion haven in the South and Midwest

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GRANITE CITY, Ill. ― One by one, the women walked into the Hope Clinic past a shouting man at the edge of the parking lot, past the security guard booth and through the code-secured front door.

Most made their way in the July heat up a flight of stairs and through another secured door before checking in for their appointment in a brightly lit waiting room decorated, in part, with rainbow and transgender pride flags.

Downstairs in the recovery room, where patients stay anywhere from 30 minutes to an hour after their procedures, each wall bears encouragement ― an artistic portrait of the late Supreme Court Justice Ruth Bader Ginsburg and signs that read: "Inhale courage, exhale fear," "All you need is love" and "Women are angels. When someone breaks our wings we continue to fly."

Outside, about 10 protesters lined the sidewalk in the summer sun. Most were silent. One woman held a sign that simply read: "I regret my abortion." Others paced the sidewalk, offering anti-abortion pamphlets to potential patients.

Granite City is less than a 20-minute drive from St. Louis, and as a border facility, Hope Clinic has long served Missourians seeking abortions. But now, patients from about 19 states have descended on the Southern Illinois location, including from Texas, Oklahoma, Louisiana, Arkansas, Kentucky and Ohio.

Illinois' rising profile as an "oasis in the Midwest" for those seeking abortion care threatens to place it squarely in the crosshairs of anti-abortion supporters, who, fresh from their victory in the right-leaning Supreme Court, will increasingly turn their attention to border clinics.

Julie Burkhart, co-owner of Hope Clinic and a longtime abortion-access advocate, said the facility is and will be a “point of refuge” going forward for Southern and Midwestern states. 

The patient census has doubled since the June 24 court decision. The clinic is now serving 40 to 50 people a day, Amy Redd-Greiner, the front-desk supervisor at Hope, said in between handing patients their intake forms and answering the ringing desk phone.

And that patient demand is only expected to rise in the weeks and months ahead.

“I am grateful that right now, at this point in time, we're able to serve people and take care of people from other places, if they can get to us, who otherwise would go without,” Burkhart said. “I'm glad that we can be here. But I'm sad and I'm angry that people are having to travel.”

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The day Roe v. Wade fell

On the day Roe v. Wade fell, hundreds of people called the Hope Clinic. The staff described it as "panic, panic, panic."

And in the abortion recovery room downstairs, in the middle of the uncertainty that day brought on, patients had one thing to tell staff: “Thank you.”  

Front-desk employees of the Granite City abortion clinic usually field no more than 200 calls a day.  But when the U.S. Supreme Court overturned the federal right to abortion on that day in June, more than 600 people called the office seeking help.

For many in the surrounding region, the Land of Lincoln suddenly became the only place to legally access abortion, following a series of state "trigger" laws banning or severely limiting the procedure.

Redd-Greiner said the “vast majority” of patients coming into the clinic since the Roe decision have traveled from out of state. The no-show rate among patients is also down.

In fact, the entire state of Illinois is gearing up to see an increase in out-of-state patients seeking abortions, with Paula Thornton Greear, head of external affairs for Planned Parenthood of Illinois, predicting their clinics "could see as many as 30,000 abortion patients a year."

Indeed, Illinois already has seen out-of-state patients triple between 2015 and 2020 ― from 3,200 to 9,700. Providers in the state performed 46,000 abortions overall in 2020, according to the Illinois Department of Public Health.

Meanwhile, Burkhart worries about the people who will travel to protest Hope Clinic’s work.  

“Targets on us just got bigger,” she said.  

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'Either help or quit'

Daniel and Angela Michael have protested outside Hope Clinic for 29 years.  

They estimate they’ve turned more than 6,000 potential patients away from the clinic. Two of the couple’s 13 children were adopted from people who had initially come to the clinic for abortions, Daniel said.  

They run an organization called Small Victories, which provides things such as ultrasounds, formula and diapers to people. They commute from Highland, Illinois — about 40 minutes away — several times a week in a purple RV that advertises “Mobile Medical Unit” and “Real Hope ... Real Help."

The Michaels, who identify as Christian, oppose abortion but criticized protesters who name-call and berate patients headed into the clinic as hypocritical.

“They always scream and yell at people and talk them out of abortion, but they won't help them after that,” Daniel said, his voice breaking as he spoke.

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The couple raises about $100,000 annually and uses the money to drive to the clinic, as well as provide supplies for mothers through the first year after birth, Daniel said.  

Both he and Angela feel like a lot of crisis pregnancy organizations make it too difficult for people to get assistance, such as requiring classes in exchange for supplies.  

“You can’t make it hard for these girls,” Angela said. “You can’t selectively help women. That's where the hypocrisy comes. Either help or quit ...”  

Despite their efforts, they don’t think Illinois will ever ban abortion, Daniel said, adding he supports the decision to put it in the hands of the states.

“So, what's the solution? Be here to offer women real hope and real help,” he said.  

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'Our fight in Illinois'

Nearly five hours north of Granite City in northern Illinois, the story is similar: Clinics near Chicago expect to see an influx of patients, many from Wisconsin, and not everyone is pleased.  

Eric Wallace, co-founder of the Freedom’s Journal Institute, a Black-led, Christian, conservative group, has spoken out against the Planned Parenthood clinic in the village of Flossmoor since it opened in 2018.  

“You don’t want your state or your village to be known as a place where you can go and get ‘the procedure,'" he said. “But it is what it is right now. And people will go out there, and we’ll protest and put up signs, and we’ll try to get people to go to Aid for Women.” 

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Eric and Jennifer Wallace, his wife and institute co-founder, said they helped establish the Aid for Women crisis pregnancy center in the building next to Planned Parenthood.  

“That was in direct response to us finding out we would have Planned Parenthood in our backyard,” Jennifer said. “The unfortunate thing is that for far too many people, they cloak the Planned Parenthood centers as health care alternatives for women …"

“We don’t consider the idea of terminating your pregnancy to be health care,” Eric added. “Health care is to keep people alive.”  

For the Wallaces, there’s a deep sense of sadness that there’s an abortion clinic in their community and that their governor is “very pro-abortion.” That Illinois could become a destination for abortions is ridiculous, they said.

The Wallaces see abortion as an unfortunate reality in Illinois for the foreseeable future. Instead of a total ban on the procedure, they’re planning to push for incremental change: restoring the parental notification requirement and shortening the timeframe in which abortion is allowed. 

“Even if we’re not able to make it illegal, maybe we can make it rare,” Eric Wallace said. “That’s where, I think, our fight in Illinois begins.” 

Another kind of fight: Expanding access

Jennifer Welch, president and CEO of Planned Parenthood of Illinois, calls the state an “oasis of care as millions of patients are stranded in a vast abortion desert.” She welcomes people in need to seek care from one of the 17 locations open around the state.  

The Illinois and Wisconsin Planned Parenthood chapters have also partnered to allow abortion providers from the Badger State to be licensed to work at the Waukegan Health Center, which opened in 2020 just south of the Illinois/Wisconsin border, in anticipation of Roe’s fall.  

Tanya Atkinson, president and CEO of Planned Parenthood of Wisconsin, said in a July 14 virtual press conference that sites in the state were forced to end all abortion care immediately when Roe was overturned.  

“This dangerous abortion ban has had devastating consequences on people in Wisconsin,” Atkinson said, “forcing people to travel sometimes hundreds of miles for health care at great costs, great disruption to their personal lives or has forced them to remain pregnant.” 

Wisconsin already faced severe restrictions before federal protections for abortion were removed, Atkinson said, with 96% of counties in the state having no abortion provider.  

Since the Roe decision, calls for care to PPWI doubled, and all patients are being diverted out of state, mostly to Illinois.

“Many of our patients seeking abortion care are already struggling,” Atkinson said. “They're struggling with poverty or trauma or abuse, the devastation of unexpected pregnancy complications or simply the complexities of traveling outside of the state for the first time to access essential health care.”  

Dr. Allison Linton, PPWI associate medical director, is one of the people who will be traveling to Illinois to provide abortion care in addition to her OBGYN work in Wisconsin. 

“The patients I see who have abortions are your friends, your family, your neighbors and members of our community, and they deserve access to safe, timely medical care,” Linton said.  

The Wisconsin staff who will work in Illinois have allowed Waukegan Health Center to double abortion services and expand other work including telehealth and family planning, according to PPIL Chief Strategy and Operations Officer Kristen Schultz.  

Waukegan 8th Ward Alderman Lynn Florian supported the health center when it quietly opened two years ago, saying she was grateful Planned Parenthood would bring its resources to their community. Two years later, Florian remains grateful the center is available to those in her community — and beyond. 

“In some people’s minds, Planned Parenthood is just about abortion, but they provide obstetric care to women that may not otherwise have access to care,” Florian said. “I felt like a community like ours, that’s minority, somewhat impoverished, needs to have services like those for the women in our community.” 

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In recent years, Illinois lawmakers have pushed through several bills protecting abortion as a legal right.  

“I remember at the time thinking: ‘This is kind of overkill. Roe is settled law,’” Florian said. “But now, I am so grateful that Illinois has solidified the right for a woman to choose. I am so grateful to live in Illinois, and I am so proud that Waukegan has Planned Parenthood and has a place where women can make these difficult decisions.” 

Florian said the clinic consistently draws protesters, but to her knowledge, there’s been no physical safety concerns. The city’s police chief has assured Florian the department will continue to protect Planned Parenthood’s patients, she said. 

And to the patients who can’t access abortion in their home states, Florian says: “I’m sorry you can’t access this care right where you live. You shouldn’t have to travel to Illinois, but because you do, we’re here for you.”  

Elaina Dixon is among the community members who will help both Illinois patients and those from other states. She's been volunteering as a clinic escort for about five years. She works with the Illinois Choice Action Team, which takes a “non-engagement” approach to escorting, where they don’t interact with the anti-abortion activists. 

There have been large groups that have protested outside the clinic where Dixon volunteers, but she anticipates there could be an increase in “anti-tourism.” 

“I do anticipate, certainly as these laws go into effect, that these groups will begin to target the states that still do have abortion access and abortion laws on the books," she said. "Roe getting overturned is their stepping-stone toward a national abortion ban, and as they say, an abortion-free America. So, I think they believe it’s a huge victory, but it’s certainly not the end of the road for the antis, so nor will it be for the escorts.” 

Dixon said in recent years, escort training has grown to include more preparation for how to handle violent situations should they arise outside clinics. 

After the leaked Dobbs opinion and then the official opinion, “Initially, I felt very beaten down,” Dixon said, “but then I actually felt very grateful that I already have an actionable way to continue doing something that I feel is really important.” 

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'It was a good decision'

Lindsay Cashion knows firsthand how complicated abortion health care can be.

When she was 19, the Du Quoin, Illinois, woman got pregnant. It was unplanned, she said, but she still wanted the baby and wanted a normal life with him. 

Then, at her 20-week checkup, doctors discovered the baby had one nonworking kidney and another working only at 50%.

He was diagnosed with Potter’s Syndrome, which the National Library of Medicine says is a “fatal congenital disorder” that is “incompatible with life.”

The news “was horrible,” Cashion said. “I didn't know what to do. I was 19. I was young. I didn't know hardly anything about pregnancy, babies. Just very shocking.”

Doctors estimated the fetus had a 3% chance of life, with the likelihood of being born stillborn. A specialist in St. Louis couldn’t help, and a week later, nothing had improved.

“He was losing weight because there was no amniotic fluid,” said Cashion, now 26, who was raised anti-abortion. “They told me I could have an abortion in Missouri, or I could come back to Illinois and just deliver him.”

A day shy of her 24-week mark, Cashion was induced and went through 19 hours of labor to deliver the boy she named Mason, who weighed just 1 pound.

The hospital classified the delivery as an abortion. She and her family did not.

Cashion faced immediate pushback and attacks from people she knew for not trying to carry to term. 

“They said that I was horrible, that I should have delivered him to term and if he died, then he should have just died, that it wasn’t my decision. They said I was a monster for doing what I did,” Cashion said while sitting at a picnic table in Carbondale’s Attucks Park.

Nearby, children ran through the water fountains to get cool in the stifling heat. Shell casings and chicken bones near the grill under the park's picnic shelter offered a glimpse into the night before.

The insults over Cashion's choice had “a lot of emotional impact” on her, she said, and left her with PTSD as well as depression for a while after the birth. 

“I went to a counselor and talked to them because … I felt like I did something wrong after all of those people told me that,” she said. “And now I see that it was a good decision.”

Cashion said she was “very upset” to learn about Roe being overturned: "If it wasn't for the abortion laws … I would have never been able to make that choice. 

“If there's anything wrong with the mother or the child, they should be able to have an abortion, they should have that choice,” she said. “If someone got pregnant and a mother or a baby is in danger, I feel like they should have that choice to abort that baby.”

And if those patients come from other states for the care they can get in Illinois, she won't stand in their way. 

“I fully support them if they want to make that decision …," she said.

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Tennessee-based CHOICES plans to help make that decision easier by bringing a new clinic to Carbondale sometime in August.  

For safety reasons, CHOICES hasn’t disclosed the exact address of the new clinic, which will be the southernmost abortion facility in Illinois when it opens. The clinic will go into an existing building in Carbondale and is located on the Amtrak line from New Orleans to Chicago.  

About 400 miles north, Lake County Board Member Gina Roberts shared her abortion story for the first time since the Supreme Court's decision.

Roberts said she was raped by a relative in California at 19 and became pregnant from the assault.

She chose to have an abortion. 

“I don’t talk about it,” Roberts said tearfully. “So, when people tell me abortion should be illegal, it makes me so angry because until you live in the footsteps of other women, how dare you.” 

Her heart aches for the women who will now be faced with the same situation she was decades before. 

“Women," she said, "should not have to be in that position."

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'I can see people flocking' to Carbondale

Cashion said she’s already seen social media chatter about protests once the CHOICES clinic opens. She thinks locals will protest, as well as people from out of town.

“I can definitely see a lot of people flocking here,” she said. “I think they should be able to do it. As long as it's a peaceful protest.”

Nancy Maxwell, the outreach manager at Carbondale's Survivor Empowerment Center, has sat with hundreds of rape survivors in the last 10 years. 

She said rape-induced pregnancy "can be devastating" for survivors.

"It can be continuous PTSD," she added. "Everybody that experiences a sexual assault has a different reaction and a different way to deal with it. And I can't imagine how that will go for someone to be reminded consistently of this horrible day in your life where something horrific happened."

That's part of why Maxwell and the center are partnering with CHOICES and will even offer beds at their rape crisis center to patients who come into town for abortion care and need to stay overnight. Her center has 45 beds in 17 rooms and will offer whatever excess space is available to CHOICES patients. 

Maxwell said she's preparing for protests as well, especially once the Carbondale clinic is open. 

"Of course … I can see a possibility of people traveling to Illinois to (protest)," she said. "In a perfect world, I see it playing out that we might have one or two protesters."

But, she said: "I don't know. We're a smaller city. This is the Bible Belt. So, it's kind of … up in the air." 

Sandy Pensoneau-Conway sits on the board of Rainbow Café LGBTQ+ Center in Carbondale and is also an associate professor in communications and gender studies at Southern Illinois University. 

Sitting on a couch inside the center Giant City Road location, she described the day Roe was overturned as "heavy." 

"I really just had to close my office door and let it sit … for a minute," she said. "I felt angry. I felt sad. I felt scared. You know, I felt really a feeling of disbelief that this actually was real and was happening in my lifetime." 

But since then, she said, she's focused on the future. 

"We're ready to fight. We're ready to to take that energy, that anger, that sadness, that rage, that despair, and do something with it." 

The immediate fight in Illinois, said Pensoneau-Conway, will have to focus on solidifying the state's reproductive freedoms. 

"What is the possibility that in Illinois, our abortion and other reproductive health care rights will be taken away?" she asked, adding that it's "some comfort to know that the Illinois constitution does protect those rights." 

However, "even though it's constitutionally protected, that still can change," she said. "And so we need to make sure that we're voting for people who will make sure it doesn't change." 

Meanwhile, a byproduct of the changes happening in Illinois and the country will be a likely economic boost to the region, she added.  

“People who are coming, whether they're patients or support people, will need a place to stay. They'll need to eat, they'll need to buy goods and use services here,” Pensoneau-Conway said. “And so that will have an economic impact.”

Burkhart, with Hope Clinic, said the immediate impact of Roe falling ― from an economic boost to protests ― isn't fully known and, "we'll know more after several months to, I think, a year.”  

Reach health reporter Sarah Ladd at sladd@courier-journal.com. Follow her on Twitter at @ladd_sarah.