World News – AU – Many independent abortion clinics are closing permanently

Dr. . Yashica Robinson is an optimist – and that is a coincidence. As one of the last remaining abortion providers in Alabama, willingness to see the good side is practically a professional requirement.

Robinson, the medical director of the Huntsville-based Alabama Women’s Center for Reproductive Alternatives, and her staff have spent much of the past year addressing the challenges posed by COVID-19 while battling government efforts to support all abortion services during the Suspend pandemic. « We will continue to be innovative and creative and find ways we can do this work, » she says with characteristic determination.

But there’s one issue that tarnishes Robinson’s confident outlook: her clinic’s limping finances. The truth, says Robinson, is that the economic fallout from the coronavirus, coupled with Alabama’s mounting restrictions on abortion, has « hugely affected » the clinic’s financial stability. When Alabama suspended « elective » medical procedures, including abortions, in late March, the Alabama Women’s Center canceled a week of appointments. Even after a federal appeals court ruled that Alabama couldn’t block all abortions, Robinson had to file records to justify each abortion it scheduled for the month that the state’s Emergency Public Health Order was in effect, which is each appointment time and added cost.

Most independent abortion clinics across the country are in a similar boat. Keeping the clinic’s doors open during COVID-19 required a lot more money to be spent – on cleaning and personal protective equipment, as well as hiring more staff to simplify social distancing rules that also reduced the number of patients who were seen could become. At the same time, 11 states temporarily suspended abortion services this spring amid the growing pandemic. While all of these orders have been blocked or expired by the courts, the temporary closings and litigation for independent abortion clinics have been financially devastating. Meanwhile, as layoffs have risen and businesses have gone under, patients have been able to pay less for their care, making clinics even more in the red.

The result of this confluence of factors is that a growing number of independent clinics have closed their doors. This comes from a new report by the Abortion Care Network, a national association of independent abortion providers. This wave of formwork continues a longer-term national trend. The number of independent abortion clinics in the U. . S.. . has fallen 34% in recent years, from 510 in 2012 to 337 in November. In the last two years alone, 41 clinics have closed. These closings have significant ramifications for abortion access as 58% of people seeking abortions receive them in independent clinics.

While large national abortion providers like Planned Parenthood face similar headwinds, they typically have more resources and flexibility than independent clinics. For example, Planned Parenthood is a nonprofit and therefore may receive some grants that independent clinics that often operate as businesses do not. National organizations also employ lawyers and lobbyists to influence politicians, while many independent clinics are concerned that payrolls for their frontline workers will be done.

« It’s a lot of financial challenges to be a small business and a small healthcare provider that serves people with limited resources, » said Nikki Madsen, executive director of the Abortion Care Network. “And these financial challenges have intensified in the context of the pandemic. ”

Abortion providers are used to litigation and restrictions, largely imposed by Republican lawmakers. But with Roe v. Potentially vulnerable before a particularly conservative Supreme Court, vendors argue that the time has come for states to maintain access to abortion. The pandemic makes that almost impossible.

In addition to efforts by some states to restrict abortion during the pandemic, independent abortion clinics have faced a number of other financial difficulties.

Planning and travel changes, for example triggered by COVID-19, have also increased the costs of the clinics this year. According to Marva Sadler, the group’s head of clinical services, several of their abortion clinics have moved from regular business hours to providing services 12 hours a day, split between two staff shifts. Travel restrictions put difficulties for Whole Woman’s Health doctors in Texas, many of whom usually travel to perform abortions. So a doctor temporarily moved from California to McAllen, Texas to keep the clinic up and running this year. When Texas temporarily banned abortions during its first coronavirus order this spring, Whole Woman’s Health also spent time and money helping patients fly to abortion clinics in other states. These resources could have been used to help more patients, Sadler notes. « It is a really proud moment for me that we were able to work with these women to give them the services they needed, » she says. “But wow, what a waste. ”

As these costs have increased, revenue has decreased. Most states limit Medicaid funding for abortions and some also prohibit private insurance from covering them, meaning many patients cannot afford an abortion in a normal year. With so many Americans unemployed due to the pandemic, that has only gotten worse. Abortion funds outside of groups, which typically raise money to help patients cover the costs of their care, have also been performing. Robinson says her Alabama clinic received memos from abortion funds saying they must limit how much money they can give to patients at each clinic. « As long as I’ve been a vendor, I’d never heard of it, » says Robinson.

If independent abortion clinics close due to these increasing barriers, it could result in patients in some parts of the country having severely limited access to abortion and other health services. Five states now have only one abortion clinic, according to the Abortion Care Network report, and a few others rely entirely on a small number of independent abortion clinics. And while most abortions occur in the first trimester of pregnancy, independent clinics are more likely to offer these services if someone needs an abortion later. Independent clinics make up 66% of all clinics that perform abortions after 16 weeks and independent clinics make up 81% of the supervising clinics after 22 weeks.

Once abortion clinics are closed, they rarely reopen. The startup costs and hurdles, including applying for credit, finding a room to rent to an abortion clinic, and complying with many states’ strict abortion laws, are especially difficult for independent abortion clinics to overcome, says Madsen of the Abortion Care Network. Without these clinics, patients face scaffolding obstacles. They may have to travel further, devote more time to work, find more money to pay for a more complicated procedure – or they may just have to be forced to give birth to a child they didn’t want.

Alabama has only four abortion clinics left, 50 to 100 miles apart. The Alabama Women’s Center is the only one that offers abortions up to the state legal limit of 20 weeks of gestational age and frequently provides care for patients from Georgia, Florida, Louisiana, Mississippi, and Tennessee. « Losing one of these clinics could mean there are patients for whom the right to have an abortion means absolutely nothing because they have no provider, » says Robinson.

To address some of these financial challenges, the Abortion Network has launched what it believes is the first centralized fundraiser for independent abortion clinics. The « Keep Our Clinics » campaign raised around 220. Raised $ 000, but Madsen says this is nowhere near enough. When the association surveyed its members at the end of March, the clinics expected an average loss of around 50. $ 000 per month. Members of the Abortion Care Network have now asked more than $ 1 million for assistance.

These funds would help with running costs, including purchasing PPE and cleaning supplies, paying salaries, providing hazard payments and paid vacations to help clinic staff look after their children, and covering government bills the court battles that many abortion clinics have fought this year. Finding PPE has been particularly challenging for some independent clinics as they have less purchasing power than hospitals and providers sometimes still have restrictions on the types of facilities they can prioritize. Robinson says she was able to get N95 masks when the National Abortion Federation brought together clinics to place a group order earlier this year. In other cases, orders for items as simple as Clorox towels and gloves have failed or come unexpectedly, making it difficult to establish a consistent budget.

With coronavirus cases growing across the country, Robinson says there is an imminent danger that her clinic and similar facilities will close or be unable to provide services to women on low incomes. In the nearly 20 years that the Alabama Women’s Center has been open, one patient has never turned it down because she couldn’t pay, says Robinson. It is now unclear how long she can continue this tradition. « It is possible, » she says, « that we will reach a day when we can no longer provide services to patients. « . ”

Currently, Robinson’s optimism is at war with the reality of her clinic’s bottom line. She says she knows her staff are dedicated and promises they will fight to keep the clinic going. But « if things go on or get worse than now, » she adds, « I don’t know how we’re going to do it. ”

In the original version of this story, the number of abortion clinics in Alabama and their distance from one another were misrepresented. There are four clinics, not three, and they’re 50 to 100 miles apart, no more than 100 miles apart.

Abortion Clinic, Latin America, Healthcare, America, Planned Parenthood