When we talk about the wave of proposed abortion restrictions that capture the nation, we often focus on people in the states where these prohibitions would come into effect. Those in Alabama who would not have access to abortion if their health or their lives were not in danger. People in Georgia, Kentucky, Louisiana, Mississippi and Ohio who would not get abortion after six weeks of pregnancy. Those in Missouri who, after eight weeks of pregnancy, would be part of a law prohibiting abortion. The doctors, who could be prosecuted anyway if they were to perform certain types of abortions.
This might sound like we're living in a dystopian horror show, but remember that abortion is still legal in all 50 states. None of these restrictive laws is actually in force. According to a political analysis by the Guttmacher Institute the purpose of these bills is to reach the Supreme Court and to convince Roe V. Wade, the legal case that legalized abortion in 1973. With a decidedly more conservative Supreme Court, many anti-electoral legislators believe that there is an opening to repeal the law, which is why a cascade of restrictive abortion laws was passed this year.
It is unlikely that any (or none) of these restrictions will actually come into effect. Organizations such as Our Own Voices and All * Above All are campaigning for abortion rights nationwide, and the American Civil Liberties Union and the Planned Parenthood Federation of America are tirelessly fighting these proposed bans , However, the improbability of the entry into force of these prohibitions does not offer the hoped-for comfort.
These bans are simply the latest in a long series of attacks on access to abortion. They represent a constant onslaught that could essentially deprive some states of safe and legal abortion, even if the specific limitations mentioned above never come into force. Abortion providers across the country are preparing for the possibility of certain states banning practice more effectively than they have already done, forcing more people to cross state borders to get abortions. For example, Missouri's last remaining abortion clinic was nearly closed in June as the Law on Targeted Regulation of Abortion Providers (TRAP) made it more difficult to renew the clinic's license than a nationwide abortion ban.  Far too many people have to travel to get abortions . Not only does this put an excessive burden on them, it can also affect doctors and patients in the countries they travel to.
"[Some] States shift responsibility for allowing women to exercise their constitutionally protected right to safety. Accessible abortion care for their neighbors, "says the venerable Katherine Ragsdale, Interim President of National Abortion Federation (NAF), to SELF.
The NAF offers financial support to people who have difficulty accessing abortions. and they also offer things like legal or financial help and training for abortion providers. Appropriately, the NAF is already working to prepare clinics in states such as Arkansas, Oklahoma, Tennessee, Illinois, Florida, and Kansas for a potential influx of patients, possibly closing clinics in neighboring states, Ragsdale told SELF.
Abortion Providers Only Expect that this shift will increase if some state states allow electoral politicians to reduce or even terminate access to legal abortions.
and Oklahoma Centers, "says Julie Burkhart, CEO of Trust Women, a health clinic based in Wichita, Oklahoma City and Seattle, opposite SELF. "If states around us can impose more restrictions, I can not say how many people we serve, but it would be more."
Here's what abortion providers in states near those with the most restrictive proposed prohibitions expect – and how they prepare to fight back.
Low Patient Hospitals
Finding more doctors and staff is one of the biggest problems for state clinics near those trying to enforce these prohibitions, Ragsdale says.
Burkhart and her team at Trust Women's Kansas Clinic know that well, she says. According to a preliminary report by the Kansas Department of Health an estimated 47 percent of Missouri people seeking abortion in Kansas arrived in 2018. If the number of out-of-state members increases significantly, the number of providers must also increase.
According to Burkhart, some of their Trust Women employees are trying to figure out how to get doctors from nearby states with a license from medical associations in Kansas or Oklahoma to practice and perform abortions in these states. (According to the Guttmacher Institute, Washington, where Trust Women also has a clinic, had more than 50 abortion facilities as of 2014. Access to these facilities is therefore less of a problem.) This could be helpful if a doctor is based in Missouri, but can sometimes realistically commute to Kansas to cope with the increased workload of Missouri patients.
Kansas and Oklahoma Medical Councils Explain That This Process Can Take an Average of Eight Weeks On Average But Burkhart's experience can often take longer.
"I've tried to admit a doctor from Colorado, and there's a interstate contract with Kansas that's supposed to allow doctors to practice for practice across state lines," says Burkhart. "But it did not go through, so we have to start from scratch, and in the meantime, the pregnancy does not stop." Burkhart explains that people are also trying to find and get other people on board, such as People who can work at the clinic's front desk.
The Trust Women Oklahoma City Clinic reported a "larger increase" in patient numbers after about half of the Texas abortion clinics had been closed several years ago .
Im Year 2013 Texas passed House Bill 2 which banned abortion after 20 weeks and also enacted various TRAP laws, a study from 2016 in the American Journal of Public Health (19659019) surveyed 398 people Looking for abortions in 10 different abortion clinics in Texas in mid-2014 The average one-way trip to an abortion clinic was 85 miles a few Texans who needed abortions were arrested in other states.
"The people of North Texas and the Texas Panhandle have been repeatedly rushed to Oklahoma," Burkhart explains, adding that this was an informative preparation for this new wave of possible abortion restrictions. Although reopened some abortion clinics in Texas "we did not really see our [numbers] in Oklahoma City slower," says Burkhart.
In addition to clinics trying to increase their own capacity, organizations like NAF are trying to think more creatively about nationwide recruitment, Ragsdale explains. "Are there any options for state clinics that are banned from doing some preparatory work in advance, such as the necessary documentation and pre-abortion counseling? Currently, huge legal teams are trying to find all that out, "says Ragsdale.
Corinne Rovetti is a certified nurse at the Knoxville Center for Reproductive Health, one of the few abortions in Tennessee clinics. Rovetti estimates that around a quarter of the center's patients are from outside the Knoxville metropolitan area, including those from other states. A total of 20 percent of Tennessee abortions in 2015 were non-state patients, according to the Centers for Disease Control and Prevention (CDC). Rovetti expects this number to increase as states such as Mississippi further restrict abortion rights. "Our biggest complaint concerns the waiting time, although we try to prepare the patients for it." Rovetti tells SELF. "Each visit could take four to six hours [between] the consultation before the abortion and the procedure itself. It can be crazy. "(Tennessee is one of the states where a person seeking a termination of pregnancy is required to first receive a compulsory consultation .) But most people are generally thankful that they are there at all have done. As employees try to reduce the waiting time in the long run, they try to make it easier for patients who need to stay in the center for hours at a time, allowing them to get food without losing their place, says Rovetti. She also heard that some of the highest-volume clinics in the region are considering extending their operating hours to accommodate an increased number of patients, she adds. There is a precedent for that. Some clinics in Michigan have reportedly expanded their working hours to accommodate an influx of patients after Ohio shut down clinics in 2013 said Rachel Jones, Ph.D., a senior scientist at the Guttmacher Institute, opposite SELF.  When a clinic extends its working hours to accommodate more patients, it does not just affect doctors. Everyone, from front desk staff to nurses, may have to adjust to longer working hours and more hectic days.
"When the phones ring and there are a lot of people in the lobby, it can get pretty messy," says Burkhart. "At Trust Women, we value cross-training so everyone knows how to pick up the call and retrieve patient information so that the care coordinator can call them back when needed."
Things like longer working hours, increased workload, and Lack of sufficient staff could eventually begin to burden suppliers, although many are currently determined to defend against it. "Everyone is fired up right now," says Rovetti. "It kindles your fire a bit, but does it keep you upright? I am not sure.
It's not cheap to hire more doctors or expand the clinic hours and the money has to come from somewhere, according to Burkhart, legal threats can make it even more difficult for abortion facilities to make ends meet "If you also pay for litigation and have restrictive laws that increase your costs, it's difficult to do business."
But there are some bright spots.
According to Ragsdale, resources like NAF clinics can do that Help to pass new state laws, discuss with them how to handle additional patients, and allocate providers to clinics that need them most.  Rovetti and Burkhart claim to be in touch with other providers to find out how they can help each other by either sending vendors to clinics that need extra hands, or Pati transfer ducks to other clinics if they are able to get help in faster. "Everybody thinks regionally and [about] how best to connect patients to the right providers," says Rovetti.
There are also reports that donations went to providers of abortions in recently deceased states. The bans have increased. For example, the Yellowhammer Fund – a grassroots organization based in Alabama for the abortion and travel logistics of low-income people – reportedly received more than $ 2 million in in donations first two weeks after the state passed its abortion ban. Access Reproductive Care-Southeast an Atlanta-based abortion fund has reportedly collected $ 18,000 after the ban of Georgia in just over a week .
If you live in a single state state You may consider donating to some of these providers of abortions. NAF has a list of providers to choose from. However, all the money in the world can not solve the problems mentioned above immediately.
Impact on Public Health
Health centers that offer abortions typically perform much more than that. These are often trusted community hospitals where patients are screened annually for sexually transmitted infections are studied or tested and have access to birth control . When these resources are not readily available, people lose the ability to take best care of their sexual and reproductive health.
After Texas had closed many clinics after the passage of House Bill 2, there were reports . from an uptrend in STI cases in some areas, such as Ector County. This West Texas region reported that in 2012 it treated around 300 more patients than usual with sexually transmitted diseases after the local planned parenthood had been closed. To be fair, STI rates are generally rising across the country, but experts believe that some of the patterns they observe are due to the closure of health clinics.
And perhaps the most ironic of all is the impact that clinic closures may have on contraception and, as a result, on unplanned pregnancies. A 2016 study in the New England Journal of Medicine (19659041) examined all health insurance claims in the Texas Family Planning Program between 2011 and 2014. The researchers found that after the 20-week abortion ban, the birth rate among Texans on Medicaid in districts with planned parenting centers increased by 27 percent, and long-acting reversible contraceptives such as IUPs saw a 36 percent decline.
If you need to travel to a neighboring state (or a faraway area of your own state) for abortion, there are resources to help you. Here is SELF's Guide What to Expect and Respect Before an Abortion, and here's another SELF Guide on how to prepare for your abortion, regardless of whether you have one Abortion is required or not trip.
"You should not assume that you have no services available. We have a hotline that connects people with local resources, "says Ragsdale. "Do not despair and give up." You can call the NAF hotline at 1-800-772-9100.
That's a lot of information to digest. However, one important consideration is that you may be in a fortunate position to access resources when reading this document even after restrictive abortion prohibitions or clinics have been closed in your area. Those who are the most vulnerable may not be so lucky. The New England Journal of Medicine study found that people on low incomes (who are more likely to be colored) bear the brunt of these laws, as they are less likely to be able to take days off work and travel across national borders, sometimes over extreme distances.
So while people with the necessary travel resources are forced to continue their pregnancy, if they are not prepared financially, mentally, or emotionally or do not want to be on that responsibility. While neighboring states may be able to absorb part of the shock of restrictive laws, they can not fix everything. Ensuring the right to safe, legal and truly accessible abortion across the country is more urgent than ever.