Even When a State Bans Abortion, Their Communities Still Need Abortion Clinics

Until a few weeks ago, EMW Women’s Surgical Center in Louisville, Kentucky, founded in 1981, continued to operate its phone line. Even after the state began enforcing its total, criminal abortion ban in 2022, the independent reproductive health clinic was available to offer accurate medical information and help abortion seekers navigate their options, among other key reproductive health services. Ona Marshall, co-owner of the clinic, told Jezebel that callers with unwanted pregnancies often expressed “a wide range of emotions — some were still unaware abortion is illegal, just desperate and seeking help and guidance of any kind, angry and distraught. Many are terrified and don’t know where to turn.”

Around mid-November, due to a shortage of funding, resources, and staffing after over two years under Kentucky’s ban, EMW was forced to pause its phone line indefinitely. Without revenue from abortion services, all while facing ever-increasing rent costs and lacking sufficient donations and financial support, the clinic struggled to stay afloat. Now, they face an uncertain future, and Marshall says this highlights the stakes of supporting independent clinics — especially in states where abortion is banned.

Independent clinics — including clinics that operate as small businesses or nonprofits, family planning clinics, and physicians’ offices and offer community-based care — provide about three-fifths of all abortions in the country. They also provide the majority of abortions in the second trimester or later, help patients access miscarriage management services and birth control, and are often the primary providers of gender-affirming care in their communities. Crucially, they also have legal standing to challenge abortion laws in court to potentially repeal these laws — without clinics, advocates lose a key avenue to fight back against anti-abortion state governments. Through all of these vital services, independent clinics are sustained through donations and the costs of their services.

However, according to Abortion Care Network’s latest annual report, between 2022 and 2024, 76 independent abortion clinics closed — 42 in 2022, 23 in 2023, and, as of November, 11 in 2024. Per ACN’s tracking, the overall number of brick-and-mortar independent clinics in the U.S. has decreased by 29% since 2012. (Even before Dobbs, 90% of counties had no abortion provider in 2020.) Right now, 14 states have no clinics providing any abortion services at all thanks to total abortion bans. And as clinics continue to shutter, so, too, could reproductive rights advocates’ chances of legal recourse in abortion-banned states.

Before Dobbs v. Jackson Women’s Health, on several occasions, EMW served as a key plaintiff in challenging anti-abortion restrictions that otherwise would have shuttered abortion access years before Kentucky’s total ban took effect, Marshall said. Then, in 2023, Kentucky’s state Supreme Court ruled that only pregnant patients, not clinics, have standing to file these lawsuits, which severely limits avenues through which advocates in Kentucky can challenge these laws. (In other states, clinics still have legal standing to challenge abortion laws.) 

In the immediate aftermath of Dobbs, abortion funds received a surge in one-time “rage donations,” as one organization supporting abortion funding told Jezebel earlier this year. Many people consistently donate to Planned Parenthood, whose name has become synonymous with reproductive rights. But independent clinics have largely been left to fend for themselves.

Of the 11 closures this year, eight were in states where abortion rights are protected, Nikki Madsen, co-executive director at ACN, told Jezebel. This is because, even in states where abortion remains legal, the significant barriers to operating independent clinics persist. Specifically, as demand for their services surges due to an increase in out-of-state patients, their already limited resources are stretched ever thinner.