On an early morning Zoom call, Michele Landeau is working from her home in St. Louis, Missouri. But most mornings, she drives across the state border to Granite City, Illinois.

Landeau is the Chief Operating Officer at , an abortion clinic that has tripled their intake of out-of-state patients since the 2022 Supreme Court decision _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%.

 have shown that states with the strictest abortion laws already have the weakest maternal healthcare 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  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. And as more physicians  in states with abortion bans,  warn of implications for workforce sustainability and the availability of timely and accessible healthcare.

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 healthcare 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.”

And, 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  for providing abortion care or counseling, even in cases where the patient's life is at risk. In 2021, a  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 , according to reports from .



Glandy, Max (@MaxGlandy) on Twitter / X

She had a miscarriage before the 22-week mark, and she felt that she was empowered to speak up. She went to the clinic to see if there was one more chance to save her baby.

She pwned it.

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*   On an early morning Zoom call, Michele Landeau is working from her home in St. Louis, Missouri. But most mornings, she drives across the state border to Granite City, Illinois.
    
    Landeau is the Chief Operating Officer at , an abortion clinic that has tripled their intake of out-of-state patients since the 2022 Supreme Court decision _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%.
    
     have shown that states with the strictest abortion laws already have the weakest maternal healthcare 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  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. And as more physicians  in states with abortion bans,  warn of implications for workforce sustainability and the availability of timely and accessible healthcare.
    
    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 healthcare 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.”
    
    And, 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  for providing abortion care or counseling, even in cases where the patient's life is at risk. In 2021, a  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 , according to reports from .
    
    
```