By Sofi LaLonde
Medill Reports
A blue state among red states in the Midwest, Illinois is often considered an “oasis” for reproductive health care when it comes to access to abortion. But even with less-restrictive abortion policies, clinics in the state are concentrated in Chicago, leaving gaps in access for women statewide, particularly in southern parts of the state.
For the women who travel from all parts of the Midwest to Chicago for easy abortion access, paying for an abortion can be expensive. According to the Guttmacher Institute, 75 percent of abortion patients in the United States are low-income.
But a Chicago nonprofit aims to make abortions more affordable for those who trek long distances to get one in the city.
Midwest Access Coalition, an entirely volunteer-run organization, helps clients with the costs of traveling to Chicago for an abortion and connects them with volunteers who put them up in their homes. The organization serves both Illinois residents and out-of-state patients traveling to Chicago.
Illinois bans abortion at “viability,” or 24 weeks. The neighboring states of Indiana and Wisconsin ban abortions at 20 weeks. In Missouri the law is more opaque. At 20 weeks, a doctor is required to determine whether the fetus is viable; abortion is illegal after viability.
“I think that Chicago is a really great area to get an abortion in,” said Dr. Carolyn Ross, M.D., a second-year family planning fellow at Northwestern University’s Feinberg School of Medicine. “We’re a blue state surrounded by red states, and, in Chicago, there are a ton of options for women to get abortion.”
Lending a Hand
Midwest Access Coalition has a network of about 90 volunteers who host women in their homes and drive them to and from appointments, with abortions often involving multi-day procedures.
Second-trimester abortions, or terminations after 12 weeks, can take up to three days, requiring multiple visits and the need to stay in the city for several days.
Midwest Access Coalition can also cover costs of transportation, gas, food and any necessary prescription medication for women who need financial assistance.
“While access to abortion services should not become a socioeconomic and a race issue, it ends up becoming that when we see these individuals that need this assistance that they are not able to get,” said Marie Khan, director of operations at Midwest Access Coalition.
“And they’re waiting longer to get the procedure done to scrape the money together because they can’t get the time off work, because they don’t have the disposable income available or savings available to do this.”
Since May 1 2017, Midwest Access Coalition has served 39 clients from the nearby states Indiana, Iowa, Ohio, Kentucky and Wisconsin.
Women have also traveled from states as far as Alabama, Arkansas, North Carolina, North Dakota and Texas.
Micaella Verro started volunteering as a host for Midwest Access Coalition in January 2017. She lives with her husband in Logan Square and has a guest bedroom for hosting traveling patients.
“I wish Illinois didn’t have to be an oasis. If they were just able to do it in their hometowns, they wouldn’t be missing work, they wouldn’t have the added expenses of the travel and figuring out insurance across state lines,” Verro said. “It just makes it so much harder when women have to travel here. I’m glad we can help, but I wish they could just do it where they lived with their existing support networks.”
Volunteers go through a mandatory orientation to learn about any necessary medical care and what to do in the case of an emergency while they are hosting a patient.
Volunteers are “on-call” for one week every other month, and are assigned patients based on their hosting profile, including location, number of bedrooms and any other people living in the apartment.
Verro has hosted two out-of-state patients since September. One patient stayed four nights for a second-trimester abortion that had some medical complications.
And they’re waiting longer to get the procedure done to scrape the money together because they can’t get the time off work, because they don’t have the disposable income available or savings available to do this.” –Marie Khan, director of operations for Midwest Access Coalition
Adrienne Guldin, another coalition volunteer, lives in Oak Park, Ill. with her husband and two kids. Like Verro, she started volunteering in January 2017.
Guldin has hosted four patients this year, and said she leaves a journal for them to read the experiences of other women who have stayed there, and to possibly share their own stories for future women.
One woman brought her two-year-old son on the trip to Chicago.
“I think my house was ideal for that because I have two children,” said Guldin. “Her son could play with my kids and she got to relax and take care of herself as she needed to.”
Guldin said another guest was from out of state and brought two companions with her. One of the companions told Guldin they had all planned to sleep in their car for several nights outside a police station throughout the multi-day procedure.
It wasn’t until they got in touch with Midwest Access Coalition after arriving at the appointment that they had a place to stay.
“The idea of anyone having to do that is horrifying to me,” said Guldin.
State Landscape
Abortion clinics and providers can be unevenly distributed throughout the state. In Illinois, 92 percent of counties do not have an abortion clinic, and women in southern counties have to travel farther to reach an abortion provider.
Indiana, Missouri and Wisconsin have similar uneven clinic distribution. Most counties in these states do not have an abortion clinic, reaching 93 percent in Indiana, 96 percent in Wisconsin and 97 percent in Missouri.
Wisconsin and Indiana ban abortions at 20 weeks and have a mandatory delay between the appointment and the actual abortion procedure, according to NARAL Pro-Choice America.
In addition to mandated counseling and a 72-hour delay, Missouri states that no abortion may be performed “post-viability,” unless necessary to save the woman’s life.
Illinois allows abortions up to 24 weeks, meaning women can get abortions later in the pregnancy. The state does not mandate any counseling or delays between appointment and procedure.
Women who seek second-trimester abortions commonly experience delays resulting from logistical or medical complications, according to Guttmacher Institute. It can take time to arrange travel, raise funds or find a provider. And sometimes women discover a fetal abnormality or medical condition later in the term.
Dr. Amanda Schmehil is an OB-GYN in Madison, Wisc. One of her patients chose to have a second-trimester abortion after she discovered a fetal skull abnormality with a 100 percent fatality rate. She was about 21 weeks pregnant.
The hospital’s ethics board reviewed her patient’s case and ruled that she was too far along in the gestational period to have the procedure performed legally at the hospital in Madison, Schmehil wrote in an essay for Glamour magazine.
Because of Wisconsin’s 20-week abortion ban that passed in 2015, the patient traveled to Chicago for the procedure. The ban outlaws abortion after 20 weeks even in cases of rape, incest, or fetal anomalies.
Schmehil said her patient’s three-day procedure alone cost around $2,500.
The patient and her husband also had to afford to take time off work, transportation expenses, housing and child care for their young child staying at home in Madison. To help cover the cost, Schmehil started a GoFundMe campaign for her patient.
Costs vary per state and per individual clinic, and private insurance companies can deny coverage for an elective abortion.
Illinois law does not ban or require private insurance coverage of abortions, according to state analysis from the Guttmacher Institute.
Starting in 2018, Illinois will expand insurance coverage for abortions for state employees and Medicaid recipients. The state already covers abortions in the case of rape, incest or risk to the health or life of the mother.
Indiana bans private insurance coverage of abortion except in the case of rape, incest, severe health risks or risk to the life of the mother, unless the patient buys an insurance “rider,” or additional benefits for abortion coverage, at an additional cost.
Missouri bans private insurance coverage of abortion in all cases except risk to the life of the mother, unless the patient purchases a rider.
However, it is unclear if these riders exist.
“There is no market for abortion coverage insurance,” said Elizabeth Nash, senior state issues manager at the Guttmacher Institute.
“It seems like false hope to say, ‘oh you can go buy a rider,’” said Nash. “There is no evidence that health plans are offering riders, and there’s no evidence that women are buying them or know that they exist.”
Looking Forward
Medicaid expansion of abortion coverage in Illinois will start on Jan. 1, 2018, and Khan and others at Midwest Access Coalition are unsure of how it will impact the women that typically seek their help.
While the expansion will help cover the cost of the procedure, Khan said there are also little things that are often forgotten that can pose a major hurdle in getting an abortion.
Access to the internet, having a phone with enough minutes and even having a bank account and debit card are things Khan says many people take for granted.
“All of those factors come into play, not to say that those factors are all exclusive to someone’s race or socioeconomic standing,” said Khan. “But for certain groups, we see them end up being compounded and compounded and it turns into this vicious recurring set of hurdles and barriers certain groups end up facing.”
It’s unclear how the Medicaid expansion will impact Midwest Access Coalition’s future coverage, but until then, they will continue to serve women in need throughout the Midwest get access to abortions.
Khan said her hope is that individuals that would normally be seeking this procedure are going to “feel more empowered and more supported by elected officials to pursue the bodily autonomy” they should have already have.
“Hopefully that means that more people are reaching out to us for assistance,” Khan said.
