Many Independent Abortion Clinics Are Closing, Permanently

Dr. Yashica Robinson is an optimist—and that, she says, is fortuitous. As one of the last abortion providers in Alabama, a willingness to see the bright side is practically a job requirement.

For much of the past year, Robinson, who is the medical director at the Huntsville-based Alabama Women’s Center for Reproductive Alternatives, and her staff have fought to overcome the challenges posed by COVID-19, while simultaneously battling a state effort to suspend all abortion services during the pandemic. “We will continue to be innovative and be creative and find ways that we will make this work,” she says, with characteristic resolve.

But there’s one topic that clouds Robinson’s confident disposition: her clinic’s limping finances. The truth, Robinson says, is that the economic fallout resulting from the coronavirus, combined with Alabama’s increasing restrictions on abortion, has hurt the clinic’s financial stability “tremendously.” When Alabama suspended “elective” medical procedures, including abortions, in late March, the Alabama Women’s Center cancelled a week of appointments. Even after a federal appeals court ruled that Alabama couldn’t block all abortions, Robinson had to file paperwork to justify each abortion she provided for the month the state’s emergency public health order was in place, adding time and costs to every appointment.

Most independent abortion clinics across the country are in a similar boat. Keeping clinic doors open during COVID-19 has required spending much more money—on on cleaning and personal protective equipment, and on hiring more staff to facilitate social distancing rules that also reduced the number of patients who could be seen. At at the same time, 11 states temporarily suspended abortion services this spring, amid the growing pandemic. While all of those orders were blocked by courts or expired, the temporary closures and legal battles were financially devastating for independent abortion clinics. Meanwhile, as layoffs have spiked and businesses have gone under, patients have been less able to pay for their care, putting clinics even more in the red.

The result of this confluence of factors is that a growing number of independent clinics have closed their doors, according to a new report from the Abortion Care Network, a national association for independent abortion providers. This wave of shutterings continues a longer-term national trend. The number of independent abortion clinics in the U. S. has fallen 34% in recent years, from 510 in 2012 to 337 as of November. A total of 41 clinics have closed in the past two years alone. These closures have significant consequences for abortion access, as 58% of people seeking abortions get them at independent clinics.

While large, national abortion providers, like Planned Parenthood, are buffeted by similar headwinds, they typically have more resources and flexibility than independent clinics. Planned Parenthood, for instance, is a nonprofit organization, and so it’s eligible for some grants that independent clinics, which often operate as businesses, are not. National organizations also employ lawyers and lobbyists to influence politicians, while many independent clinics worry about meeting payroll for their frontline staff.

“There’s a lot of financial challenges to being a small business and being a small health care provider that is serving people with few resources,” says Nikki Madsen, executive director of the Abortion Care Network. “And those financial challenges were exacerbated as part of the pandemic.”

Abortion providers are accustomed to legal battles and restrictions imposed largely by Republican lawmakers. But with Roe v. Wade potentially vulnerable before an especially conservative Supreme Court, providers argue that now is the time that states must maintain access to abortion. The pandemic is making that nearly impossible.

In addition to some states’ efforts to restrict abortion during the pandemic, independent abortion clinics have faced a host of other financial hardships.

Scheduling and travel changes spurred by COVID-19, for example, have also added to clinics’ costs this year. Whole Woman’s Health has seen several of its abortion clinics move from regular business hours to providing services 12 hours a day, split between two staff shifts, according to Marva Sadler, the group’s director of clinical services. Travel restrictions were posing difficulties for Whole Woman’s Health doctors in Texas, many of whom usually travel to provide abortions, so one doctor temporarily relocated from California to McAllen, Texas to keep that clinic running this year. When Texas temporarily banned abortions during its initial coronavirus order this spring, Whole Woman’s Health also spent time and money helping patients fly to abortion clinics in other states. Those resources could have been used to help more patients, Sadler notes. “It’s a really proud moment for me that we were able to work with those women to get them the services that they... (Read more)

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