Morgan Nuzzo, nurse-midwife, was able to work together for more than five decades in Washington, D.C. area reproductive health clinics. Dr. Diane Horvath, ob/gyn, saw that there were better ways. It was their dream to open their own clinic, with clinicians from diverse backgrounds providing compassionate and high-quality care. Patients would be respected and employees would be paid fairly. And abortion would be considered an essential medical service that every person should have.
Partners in Abortion Care is opening in College Park this fall. They hope it will prove convenient for D.C. residents and patients from Maryland. A draft decision that was leaked suggests the Supreme Court may soon reverse the ruling. Roe V. WadeThis would most likely lead to the banning or substantial restriction of abortions in 26 states. That location was more important than ever.
College Park is located within 40-miles of three major international airports. There are also several highways that lead to the city. College Park makes for an ideal destination for visitors. And if nearby states like West Virginia and Ohio crack down on abortion as expected, Maryland could become a magnet for people who need to travel for care—even more so if neighboring Virginia enacts stricter policies in the future, as some advocates fear will happen. Maryland has expanded abortion access, which is different from other states. It allows abortions up to the point of fetal viability (around 24 weeks of pregnancy) and permits later procedures if the parent’s health is at risk or the fetus is diagnosed with a serious health issue. Plus, starting July 1, nurse-midwives, nurse practitioners, and physician assistants—in addition to doctors—can perform abortions there, which will expand the pool of potential providers and may therefore increase the number of patients clinics can serve.
In an empty space they are planning to build their College Park, MD abortion clinic. This is a reflection of Horvath/Nuzzo.
Shuran Huang for TIME
“We know that the volume of patients is going to go up in Maryland,” Horvath says. “There is no possible way to increase capacity at existing clinics to take on the number of people who are anticipated to need to travel.”
Due to restrictions at the state level and shrinking numbers of abortion clinics, many people have to travel for an abortion. One study showed that 74%, 57%, and 56% of Wyoming’s abortion patients travelled to Missouri in 2017 in order to receive care. But if the Supreme Court’s draft decision is similar to the final one, that inconvenience is about to affect a lot more people. If they wanted to terminate a pregnancy, then people will need to go out of their states or look for a route to obtain abortion pills. Clinics in “abortion islands” like Illinois—states with strong abortion protections in place, but surrounded by those likely to ban it—are already bracing for a post-RoeOnslaught of new clients
New clinics like Partners in Abortion Care, situated in geographically strategic areas where they can absorb as many patients as possible, may help ease that bottleneck—but they’re not likely to be enough on their own, says Caitlin Myers, an economics professor at Middlebury College who studies abortion access. New facilities “will improve appointment availability. They’ll reduce travel distances. They will have an impact,” Myers says. “But there are going to be women who want abortions and can’t get them because of these bans, no matter how many clinics open.”
Nuzzo and Horvath sell furniture and other equipment at storage units.
Shuran Huang for TIME
An abortion can cost anywhere from hundreds to over $1,000, whether it is via pills or procedure. Travel costs, including lodging and missed work, can be a significant financial burden for those who travel to receive the care. The local abortion fund has been providing practical assistance such as travel money and help finding child-care. (At Partners in Abortion Care, a local investor is considering buying an apartment near the clinic to use as an “abortion Airbnb,” Nuzzo says, where people could stay for free before and after their procedures.)
Research suggests that even with the aid of travel, abortion seekers are still discouraged by it. Myers published a paper last year that estimated about one fifth of Americans who seek abortions in America would be denied if they were forced to travel more than 100 miles. Myers’ research shows that around 100,000 U.S. citizens will not be eligible for the desired abortion in the first year of a hypothetical repeal. Roe V. Wade Due to the increased distance between providers.
“Middle-income or wealthy people, particularly white people, living in banned states will always still be able to get abortion care,” as long as they can hop on a plane, says Liza Fuentes, senior research scientist at the Guttmacher Institute, a reproductive rights nonprofit. For many other people who need an abortion—who, Guttmacher research shows, tend to be lower-income and already parents—it’s not that simple.
Some doctors are moving to states where abortion is not permitted and opening new clinics to reduce the travel distance for patients. Shannon Brewer, the director of Mississippi’s last remaining abortion clinic—which is at the heart of the case that caused the Supreme Court to reexamine abortion issues—recently said she may start practicing in New Mexico, a state with no major abortion limits that is sandwiched between Texas (which already bans most abortions after around six weeks of pregnancy) and Arizona (one of the states expected to crack down on abortion if Roe is being rolled back
Nuzzo and Horvath represent a portrait of a doctor in an empty examination room
Shuran Huang for TIME
Jennifer Pepper is the executive director of CHOICES Memphis Center for Reproductive Health. She also plans to open a new clinic in a different state if her current one is closed. (Tennessee has a “trigger law” in place, which would ban most abortions within a month of Roe being overturned.) The team she was working with found a location in Carbondale, Illinois. This is a small city in south Illinois that’s about a 2-hour drive away from St. Louis. They are also only three hours drive from Memphis and Nashville. They’re preparing to open in August.
CHOICES performed 3,900 abortions at its Memphis clinic in 2013 and plans to increase that figure in Illinois. But they can’t serve everyone. But they can’t please everyone. Roe is overturned, multiple Tennessee clinics would have to stop offering abortion services, and there’s no way CHOICES could absorb all of those patients with one new facility. “It’s just a math problem that doesn’t work out,” Pepper says. TIME’s Myers model suggests that the Carbondale facility would reduce travel costs for around 3 million women in Kentucky, Tennessee and Arkansas.
Others are also interested in Illinois. Douglas Laube from Wisconsin is an abortion provider who told local media outlets that he was considering opening a clinic near the border. Planned Parenthood also plans to expand operations in Illinois. Post Report.
Julie Burkhart, a longtime reproductive health advocate and founder of the nonprofit Wellspring Health Access, is fighting hard to keep abortion accessible further West—but not without significant opposition.
Burkhart met with Wyo. advocates to open an abortion center in Casper. Wyoming was at the time free of legal restrictions for abortion and had a need to have more providers. Jackson was the only place where abortion services are available. Casper is a small city located less than 200 mi from Nebraska, South Dakota and South Dakota. “Wyoming was just a perfect state,” Burkhart says.
After a Supreme Court decision, Wyoming Governor Mark Gordon issued a trigger bill in March 2022 that banned most abortions. Roe V. Wade. With the Casper clinic set to open around the same time the Supreme Court makes its final ruling, Wellspring may only be able to offer abortions for a matter of days or weeks—if it opens at all.
Reuben Pemberton is consulted by Horvath regarding the possibility of renovating his clinic.
Shuran Huang for TIME
In late May, the clinic’s building was damaged in a suspected arson. The damage is still being assessed, but it may be necessary to gut the building’s interior and replace its electrical system, possibly forcing Wellspring into a temporary space.
Burkhart says she knows it sounds crazy to move ahead despite these obstacles, but she’s doing it anyway. “These things cannot go unchecked,” she says. “It’s important for good people, people who want social justice and equality, to stand up even taller.”
While new clinics are a good way to keep abortion free, more resources are required. Abortion pills—which can be prescribed remotely, then sent to patients by mail for use early in a pregnancy—could be a workaround for some people, but their legal status varies by state. Some states don’t allow the pills to be prescribed via telehealth, limiting their utility for people who don’t live near abortion providers, and legislators in 22 states have advanced bills that would either ban or restrict access to the drugs. For now however, Plan C, a reproductive rights group, helps individuals in the United States and their territories locate information on how to obtain the pills.
The issue of appointment capacity is also a major concern. Patients already face long waits in clinics across the country, even in abortion-friendly states like New York and California, Myers’ research shows. Myers believes that states need to allow abortion services by non-physician providers in order to alleviate these backlogs. States like Maryland and Connecticut have this policy.
Nuzzo views this as a personal point. As a nurse-midwife, she says she’s long been doubted by the medical community or treated as lesser than a doctor. “My profession is this punching bag, and everybody’s punching down,” Nuzzo says. For example, Larry Hogan (Maryland Governor) vetoed a law that would allow non-physicians in Maryland to perform abortions. He cited concerns that this could reduce quality care. (He was overthrown in the end by state legislators.
Nuzzo and Horvath want to show that different approaches can make care better. They believe theirs will be the only all-trimester abortion clinic in the country owned by women, as well as the only one operated by a physician and a midwife together, in one of the few states actually expanding abortion access—not restricting it.
Horvath & Nuzzo during a tour of the future clinic.
Shuran Huang for TIME
Getting their clinic ready to open hasn’t been easy. Horvath, Nuzzo and others have donated thousands and purchased a used ultrasound machine and an exam table through Craigslist or Facebook Marketplace to keep them going until they are able to purchase newer models. They’re constantly worried about the security of their clinic and of their future patients, even in an abortion-friendly state and with enough community support to crowdsource almost $260,000. Their mental state has been affected by uncertainty regarding the future of their profession.
However, if the model proves to be successful, the advocates hope to partner with abortion providers and advocates in opening clinics elsewhere in the country. The goal is to make care affordable even for those who have lost their health insurance.Roe reality. “We want to start from a place of abundance,” Horvath says, “and think of what abortion care could look like even in this time where everything is so dire.”
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