WICHITA — It was the beginning of September when the phone calls began to swamp Trust Women here. Panicked women from nearby states rushed for appointments at the abortion clinic.
“It was like the floodgates opened,” said Ashley Brink, the clinic’s director. “Almost every line on our phone system was lit up.”
A new Texas law effectively banning abortions before most women know they’re pregnant was taking effect. The law created an instant bottleneck of patients in Oklahoma — and then in Kansas.
The online submission form to request an appointment at Trust Women’s Wichita and Oklahoma City clinics temporarily shut down because the facilities didn’t have enough workers to process the requests.
The number of Texans who got abortions at the Wichita clinic jumped from one in August to 51 in September, and the clinic started to see more Oklahoma patients — spillover from the full clinic in Oklahoma getting inundated by Texans.
Prospective patients called in saying, I don’t know what to do. I don’t know where to go. This is the first thing that came up that was closest to me, Brink said. Some Texas patients planned to travel to Kansas from cities like Austin and Houston — hundreds of miles south.
The routine five- to 10-minute scheduling appointment became a 15- to 20-minute triage.
“It wasn’t just making an appointment at that point,” Brink said. “Our staff were counseling people at that point who were in an actual crisis.”
Trust Women staff took on the role of social workers helping patients navigate complex travel and child care schedules while offering them options of affordable hotels and organizations that could help foot the bill for travel and procedure costs ranging from $700 to $2,300.
By the end of September, it became obvious that Kansas — a red state with its own litany of regulations to restrict abortion — had become an unlikely sanctuary for women across the Midwest and the South with evaporating access to abortion.
But its longevity as an abortion safe haven may be threatened next year when Kansans vote on whether to change the state constitution to say there’s no right to an abortion. Or by action pending in the U.S. Supreme Court.
Already, 2020 had become the first year since 1973 when more abortions in the state were performed on out-of-state residents than Kansans. That was largely because the pandemic prompted Texas and Oklahoma to deem abortion an elective procedure.
In Kansas, Democratic Gov. Laura Kelly maintained women’s reproductive health care was an “essential need.” That kept the Kansas clinics open. And it turned Kansas into what the powerful anti-abortion group Kansans for Life dubbed a “regional destination for abortion.”
Kansas Department of Health and Environment records show that last year 289 patients from Texas and 277 patients from Oklahoma got abortions in Kansas, compared to 25 from Texas and 85 from Oklahoma in 2019.
“In one weekend, we saw almost 100 people, the vast majority of them from Texas,” said Dr. Abbey Hardy-Fairbanks, who regularly travels to Wichita from Iowa to perform abortions.
Physicians at Trust Women treated the bulk of patients from Texas and Oklahoma who flocked to Kansas for care.
One of their patients, “had appointments at three clinics before making it to us,” the doctors wrote in a subsequent opinion piece for Ms. Magazine, “but they were all cancelled due to state government restrictions of abortion care during the coronavirus.”
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“Each time she got to a clinic, her appointment was cancelled,” they wrote, “and as her gestational age increased, the possible places for her to go to receive care narrowed.” That’s because most states have a slightly different legal definition of viability — when a fetus can survive outside of the uterus and when an abortion is permitted or banned.
Both physicians know that Kansas has some of the highest numbers of abortions provided to out-of-state residents in the country. That’s driven by the Kansas City population. Missouri has only one abortion clinic — in St. Louis.
But this was different. They caught a glimpse of the role Trust Women, and the state of Kansas, would play if access to abortion completely dried up in neighboring states.
Pandemic-era abortion in Kansas could offer a peek at what the future of abortion across the Midwest and South could look like if states regain an ability to ban at ever earlier stages in a pregnancy. And an increasingly conservative U.S. Supreme Court could be poised to overturn the landmark Roe v. Wade case. That could mean states, including conservative places like Kansas, might enact outright bans on abortion.
In one version of the future, Kansas could become an increasingly busy abortion refuge for women in Missouri, Oklahoma, Texas and other nearby states.
Yet the Guttmacher Institute, a reproductive health research organization that supports abortion rights, classified Kansas as “leans hostile” to abortion rights in 2020.
“Kansans,” said Kansans for Life spokeswoman Danielle Underwood, “don’t want Kansas to become a destination for abortion.”
So in another version of the future, a ban here would shut off one of the last places in the region to get an abortion. It would also send Kansas women on the same kind of out-of-state journeys that have been bringing women to the state for the procedure.
If the high court undoes the federal guarantee to abortion rights, 21 states are poised to restrict or outright ban abortions. That includes states surrounding Kansas like Iowa, Missouri, Arkansas, Oklahoma and Texas.
“Imagine that people would actually be traveling to a state like Kansas,” Nash said, “because Kansas hasn’t yet adopted one of these very early abortion bans, but still is considered very hostile to abortion rights.”
Kailey Voellinger, who operates Trust Women’s Oklahoma City clinic, says that’s already the reality. Her clinic is booked out for a month.
“We had a patient here in Wichita (who) lives 15 minutes from the Oklahoma City clinic,” Voellinger said. “She drove all the way here when we have a clinic that’s 15 minutes from her house.”
With the current patient volume, she’s now forced to book a month out. That often changes the type of procedure a patient can get. Patients who tried to get care during the first 10 weeks of their pregnancy — when an abortion pill might be an option — end up getting second-trimester abortions.
“A quarter of our patients, since (the new Texas law took effect) have been second-trimester patients,” Voellinger said. “People are being forced to wait (when) they would have these abortions sooner.”
Trust Women providers is also seeing more cases where an abortion is necessary because the pregnancy would not survive, or the mother would not survive, in addition to more cases involving domestic violence and minors.
“So people who are very, very desperate to receive this care and are willing to travel, you know, however many hours they need to,” said Rebecca Tong, co-executive director of Trust Women’s nonprofit arm.
In the past several months, it’s also become more common to see patients who could’ve ended their pregnancy with a pill being forced to have a more invasive procedure after progressing in their pregnancy.
“You shouldn’t have to worry about scheduling people so far out that that’s pushing them into another price bracket or another gestational age,” Brink said.
In some cases, scheduling delays prevent women from even being seen by a doctor in Kansas. With rare exceptions, the state allows abortions up until 22 weeks into a pregnancy. If Trust Women can’t treat them, Brink said, she’s forced to send them to clinics even farther away in other states, including Colorado, New Mexico, Washington and New York.
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“(That) really puts the squeeze on the entire system that’s already so limited,” Nash said.
But there’s an alternate path as well. Kansas could lose its status as a deluged refuge and become part of the wider abortion desert across the Midwest and South.
Kansans will vote on a constitutional amendment in August of 2022. It would rewrite the Kansas Constitution to say there’s no right to an abortion and give the Legislature the ability to regulate it.
Underwood frames the amendment as a direct response to the 2019 court ruling that solidified the right to an abortion in Kansas.
“We knew we had a situation on our hands,” Underwood said, “We knew that all 20-plus laws we had on the books that were protecting women and babies in our state (that) were presumed unconstitutional.”
Yet a majority of the state’s laws regulating abortion weren’t struck down. To date, only two of the 20 laws in Kansas that KFL touts have been struck down.
One got tossed out with the 2019 ruling that would have blocked the most common second-trimester procedure — the dilation and evacuation abortion. The other fell recently when a judge overturned a 2011 law that required clinics to have additional inspections that other medical providers weren’t subject to. That created what the judge called unnecessary staffing requirements that infringed upon women’s access to the procedure.
Recent national polls indicate that a majority of Americans still support Roe v. Wade. But a June Associated Press/NORC poll reported that while 61% of Americans believed abortion should be legal in all or most cases during the first three months of pregnancy, support falls to 34% during the second trimester. Kansans for Life has done polling on the matter but declined to share the results.
Anti-abortion rights groups and state lawmakers in the Republican-controlled Legislature have been quiet about what additional regulations could follow the amendment. Other states with Republican-controlled legislatures, including Missouri, Alabama and Arkansas, have been eager and open about plans to introduce copycat legislation mirroring the Texas law banning abortions at six weeks.
Yet Underwood was adamant.
“It’s not a gateway to a ban to abortion,” she said. “It is correcting a very specific legal decision that was an overreach.”
Nash said she’s dubious of that claim because four other states — Alabama, Louisiana, Tennessee and West Virginia — have rewritten their state constitutions to specify there’s no right to an abortion. Of those states, Tennessee and Louisiana have since passed six-week abortion bans and Alabama passed a near-total abortion ban.
But all those states’ actions have been blocked by the courts. If Kansas didn’t go on to pass a ban, it would join West Virginia in being the only state that has changed its state constitution but passed no new bans on abortion.
Trust Women is already preparing for a post-Roe future. And one where the constitutional amendment passes in Kansas.
Brink is part of a regional coalition of abortion funds, clinics and reproductive care organizations making contingency plans facing down some questions.
“Are we going to be meeting people at the border to drive them in a car?” she said. “There are people who are on the ground, trying to figure it out … to ensure that people can still access this care come hell or high water.”
Brink said it’s possible we’re moving toward a future where abortion could essentially be restricted to hubs, places where abortion is protected through state law and people become more reliant on medication abortions.
But even though the Food and Drug Administration relaxed rules on getting pills to facilitate abortions and miscarriages by mail in mid-December, the doctors at Trust Women aren’t able to prescribe pills to patients unless they set foot in a clinic.
Kansas is one of 19 states where there’s a ban on getting Mifepristone via telemedicine. The legality of prescribing abortion pills via telemedicine is currently murky following dueling state court decisions.
That meant Rachel, a 22-year-old from Wichita who requested she not be identified by her real name, had to come into the clinic for her abortion. She called in after she took a pregnancy test at six weeks. She’d have to wait two weeks to get in.
Then she missed the form from the clinic that kickstarts the 24-hour waiting period required by law in Kansas. At eight weeks into her pregnancy, which only her sister and ex-boyfriend knew about, she had to reschedule and wait an additional two weeks.
By the time she had her appointment at the clinic in mid-December, she was 10 weeks pregnant. The window for her to get a medication abortion had nearly closed.
“I tried to get (them) online,” Rachel said, “but it takes four to 10 weeks for the pills to get here because they’re from India.”
“By that time,” she said, “it might be too late.”
When Rachel learned about the constitutional amendment next year in Kansas she thought about how difficult it was just for her to jump through the hoops to get this appointment: the online research about pills mailed internationally, rescheduling at the clinic and nearly having a surgical procedure as her only option.
When she drove in that day, she passed between protesters who heckled the women entering the clinic. Later, she was escorted outside by a security guard when she crossed over into the clinic’s ambulatory surgical center even though she was taking a pill.
“It’s hard just to get an abortion,” she said, “And it’s just crazy that people don’t understand places like this.”
If the constitutional amendment passes next summer, and Roe falls, getting an abortion could get harder.
“Regardless of what happens legally, we will be here providing care,” said Tong, “even if it’s not abortion care.”
Because Oklahoma has a trigger law that would ban access to abortion in the state if federal protections are overturned, that abortion rights coalition is discussing making the Oklahoma City clinic a call center and staging ground for the Kansas clinic where people could make appointments, do pre-operative care, and return for any necessary follow-ups.
Tong said the team has even discussed pivoting to help women get money to pay for their procedures and travel, or getting commercial driver’s licenses to ferry women to states where abortion is freely accessible.
“We will then work on re-legalizing abortion in our states,” she said. “So, regardless of the outcome, we’ve got Plan A all the way to Plan Z.”
As far as any predictions on whether the constitutional amendment will pass in Kansas, many said they weren’t willing to speculate. But Voellinger, who’d spent three days at her Oklahoma City clinic that week before traveling 140 miles north to work three more days at the clinic in Wichita, said we’re already living in the future where many Americans don’t have access to abortion, inside and outside of Texas.
If she can’t send her patients in Oklahoma to Kansas, she’ll have to send patients from Texas, Louisiana, Arkansas or Oklahoma to the next nearest states: Colorado, New Mexico or Illinois.
“We’ve accepted that,” Voellinger said. “So why wouldn’t people accept where we’re going? Because they’ve already accepted and said that this is OK.”
Abigail Censky is the political reporter for the Kansas News Service.