Emily found out when she was around 22 weeks pregnant that her unborn son didn’t have kidneys and his lungs wouldn’t develop.
If her baby survived the pregnancy, he would be born unable to breathe, and would die a few hours later.
Emily had a crushing decision to make: continue to carry a baby who would not survive, which could be a risk to her health and having children in the future, or have an abortion.
“I don’t think I stopped crying for an entire two weeks,” said Emily, who asked WBEZ not to use her real name to protect her privacy and safety. “The whole world felt heavy. … It’s not something anybody should have to go through. It’s not easy losing somebody you love.”
Emily said doctors told her her life wasn’t in immediate danger, but they also pointed out the risks. Emily’s family has a history of hemorrhaging. If she started to bleed, doctors said she might lose her uterus, too. Emily said this was devastating. She’s a young mom who said she wants more children.
“It was really scary,” Emily recalled. “The doctors told me the baby could die tomorrow. He could die next week. But it’s very unlikely that he’ll make it full term.”
She said she wanted a more peaceful death for her son. She chose to get an abortion. She said her doctors told her it was the safest option — but they wouldn’t provide one.
She lives in Missouri, which has one of the strictest abortion bans in the nation. So Emily had to leave and found her way across the border to Illinois, a haven for abortion rights.
SinceRoe v. Wadewas overturned in June of last year, who can get an abortion and where has been complicated by vague laws and fear: fear among doctors who practice in states where abortion is banned or heavily restricted that they could lose their medical licenses or wind up in jail. There’s fear among abortion patients that they could be prosecuted for traveling across state lines. All of this is what drives many physicians in Illinois to fill the void and treat as many patients as they can.
The “life of the mother”
Many states that ban abortions have exceptions to save the life of the mother, according to providers and new research from the health policy non-profit KFF.
But just when the mother’s life is at risk appears to be open to interpretation.
“These exceptions are exceptions in name only,” said Alina Salganicoff, director of women’s health policy at KFF. “It’s very, very difficult to get an exception. … It’s like, how imminent is this threat. And in many cases, patients can’t wait until they’re about to die before they get an abortion.”
The patchwork of confusion and uncertainty around where abortion is legal in the U.S. has helped fuel an uptick of patients headed to hospitals — illuminating the role hospitals play in a post-Roe world. While in the past only 3% of abortions typically occurred in hospitals, OB-GYNs in regions across the U.S. that protect abortions rights including Chicago tell WBEZ more out-of-state patients are showing up.
And along with more hospital stays comes more patients who need help covering the expensive price tag of the procedures, as well as plane tickets and hotel stays to journey far from home, abortion funds and providers say.
Some patients prefer getting an abortion in a hospital because they can blend in with patients getting all types of procedures.
But many patients who get abortions at hospitals are high-risk to begin with, need more medical resources and typically can’t go to a clinic like Planned Parenthood. These patients might have heart issues, conditions that make anesthesia more risky, or have a history of hemorrhaging.
Some patients have had multiple C-sections, and doctors are concerned the placenta in the new pregnancy is stuck on the C-section scar. That could result in an emergency that not only requires an abortion but also a hysterectomy to remove the patient’s reproductive organs.
In other cases, providers say patients are waiting so long to find a clinic to treat them that they end up in the hospital.
In May, a team of researchers documented what’s happened to patients since Roe fell. Doctors anonymously described how their patients have suffered.
In one case, a patient’s water broke early, yet she was denied an abortion because of a new state law, sent home and developed a severe infection that landed her in intensive care. According to the report, a physician wrote, “‘The anesthesiologist cries on the phone when discussing the case with me — if the patient needs to be intubated, no one thinks she will make it out of the OR.’”
Emily made her way to Dr. Laura Laursen, an OB-GYN at Rush University Medical Center in Chicago, in May. The number of out-of-state abortions at Rush has quadrupled since Roe overturned.
Laursen received Emily’s consent to discuss her case with WBEZ. The doctor remembers Emily was quiet and distraught when they first met. Emily was frustrated about having to jump through so many hoops to get the abortion, and she was stressed about the cost of being in a hospital.
“The biggest thing was just making space for her to express those emotions,” Laursen said. “So going very slowly with her, making sure the counseling was done slowly, making sure the procedure was done slowly, making sure that she felt comfortable with all the decisions she was making. And trying to make her feel as empowered as possible.”
Laursen agrees with Emily’s doctors in Missouri that her life wasn’t in immediate danger, but says there were still risks to her ability to have more children, and it was safer for her to have an abortion than to remain pregnant. But she adds just what qualifies as an immediate danger is really hard for physicians to figure out.
“I’m constantly hearing stories from my partners across the country of trying to figure out what counts as imminent danger, because our job is do no harm,” Laursen said. “We’re trying to prevent danger. We’re not trying to get to the point where someone’s an emergency.”
Sending their patients away
While Laursen is seeing more and more patients crossing the border, Dr. Jennifer McIntosh, who specializes in high-risk patients, is increasingly referring them out. She works in Wisconsin, a purple state with a Democratic governor who supports repealing an 1849 abortion ban that has essentially ground procedures to a halt despite an exception to save the life of the mother.
“It’s really awful,” McIntosh said of having to send patients away. “It feels terrible for me to say, ‘Hey, I’m going to tell you this really hard information that your baby is not going to survive, or it’s going to have some sort of really limiting scope of life.’ ”
“I’m going to tell you all this, but this is a desired pregnancy. But now I’m going to tell you, ‘Yes, it’s very reasonable to get an abortion. But oh, by the way, it’s illegal in your own state.’ So now on top of this terrible news, I’m going to tell you that you have to figure out how to leave the state to get an abortion.’”
McIntosh said in some cases she’s able to offer abortions, including if a woman’s water breaks too early. That risk is significant enough to satisfy the life of the mother exception, the doctor said. But even that carries possible legal risk.
“Am I worried that someone might think that it doesn’t satisfy that?” McIntosh said. “Absolutely, that terrifies me.”
She said she’s forced to operate in a narrow channel of whether she’s breaking Wisconsin’s 19th century law versus committing malpractice if she doesn’t provide the standard of care for her patients.
In other words, politics has seeped into her job. It’s not just about providing health care anymore.
She finds herself in many cases handing other pregnant patients a list of places to call across the border in Illinois to set up their abortions. It’s up to the patients to navigate what comes next.
The dangers of the wait
Dr. Jonah Fleisher’s phone is often ringing and buzzing with texts. An OB-GYN who specializes in abortion and contraception at UI Health on the Near West Side near Rush, he’s frequently asked to see how quickly he can squeeze in another patient from another state.
Since Roe fell, Fleisher estimates the health system is treating at least three times more patients who are traveling from other states for abortion care.
He said he carries the stress he sees in these patients. Sometimes he’s the third or fourth stop after a person was referred from clinic to clinic — each one uncomfortable providing the abortion — then wound up at the hospital because there was something worrisome about their pregnancy.
“They are often calling us from the parking lot (of a clinic) saying, ‘What do I do now?’ ” Fleisher said.
These patients ask if they should go home, be with their kids, then come back in a week or two for the abortion. But Fleisher knows that each week they delay increases their risk because of their medical condition. Sometimes, he said, they try to cobble child care and sick time so they can stay in Illinois.
He worries about the “invisible” patients, the ones who live in banned states and have a medical problem that complicates their pregnancy, yet aren’t showing up in his exam room. Patients with medical conditions have a higher risk of serious injury or death while pregnant, Fleisher said.
“I know that some number of those women are not going to make it through birth and postpartum,” Fleisher said. “More than the stress of somebody who’s actually making it to see me, that’s the thing that causes me more stress.”
Statistics show the rates of death from pregnancies is greater than the risk of death from legal abortions, Fleisher said. From 2013-19, there were .43 deaths per 100,000 legal abortions, the most recent federal data from the Centers for Disease Control and Prevention show. Far more pregnant people died in 2019 — when there were 20.1 deaths per 100,000 live births. This rate was highest for Black people, the data show.
Gaps in data
Just how many more patients are traveling to other states for abortions at hospitals is hard to quantify. The CDC tracks some abortion data, but doesn’t collect it based on the type of facility they’re performed in, a spokeswoman confirmed.
Rachel Jones, who has been researching abortion at the nonprofit Guttmacher Institute for more than 20 years, calls hospitals a “black box.” Even before Roe fell, it was hard to get through the bureaucracy of hospitals to understand more comprehensively how abortion care was provided, Jones said. Guttmacher has tracked hospital-based abortions in the past, but doesn’t have updated figures post-Roe.
WeCount, which is believed to have perhaps the best snapshot of shifts in abortion care after Roe v. Wade overturned, doesn’t break out hospital data separately. WeCount co-chair Ushma Upadhyay said the data would have gaps anyway. She said it’s been difficult to get providers in banned states to report what’s happening.
But there are other ways to understand what’s at stake. Providers say one of the biggest barriers for high-risk patients to get abortions at hospitals is the price tag. Emily’s hospital stay cost around $6,000, Laursen said, paid for by local and national abortion funds. Depending on how far along a person’s pregnancy is, an abortion in a clinic can cost around $500 to $1,000, Laursen said, while some hospital bills can reach into the tens of thousands of dollars for more complicated procedures.
Abortion funds, which help patients cover everything from meals to hotel stays to the abortion procedure, have largely been footing the bill. Only four hospitals in Illinois — all in Chicago — regularly perform abortions for people with complex medical needs, providers said.
Meghan Daniel, director of services at Chicago Abortion Fund, known as CAF, underscores the big swing in need. In the year before Roe was overturned, from July 2021 through June 2022, CAF helped cover just over $11,000 in bills at Illinois hospitals for around 30 patients. About half of them lived in Illinois. The fund helped provide another $1,600 for other types of services patients needed, from meals to transportation and child care.
Fast forward to a year after Roe, from July 2022 to June 2023, those figures have soared. CAF has pledged to cover at least $410,000 in hospital bills for about 220 patients, and another more than $65,000 in support for patients. The majority of patients came from other states, Daniel said. Indiana and Wisconsin sent the most patients to Illinois, but other patients have come from as far away as Alabama and Arizona.
Hospital bills now make up about 20 percent of all the services the fund covers, Daniel said — up from 1.5 percent before Roe fell.
The National Abortion Federation, which has a large patient assistance fund and supports patients across the U.S., has seen similar trends. There was a 50% jump in the number of abortions the federation helped to pay for at hospitals in the first three months of this year, compared to the same time frame in 2022, a spokesperson said.
In many cases, patients are having a hard time accessing abortion care, and the delays push them into needing the procedure in a hospital, said Melissa Fowler, chief program officer at the federation.
“We’re seeing more cases right now (of) people who are later in gestation,” Fowler said. “More adolescents who are later in gestation who are showing up at hospitals because this is really their last resort. They’ve been referred all over. And this is where they’re ending up for care.”
Some hospitals on the East Coast could take on more patients, Fowler said, but the cost of an abortion is just too expensive for some patients. Dr. Peggy Ye said an abortion at the hospital she works at in Washington, D.C. costs just over $9,000 — a steep price tag for federal employees in the region whose insurance won’t cover the cost.
All of this raises questions about how long these funds can afford to help.
“The current financial way in which people are paying for their abortions I fear is not sustainable,” Fleisher said.
Non-profit hospitals could help. In return for getting tax breaks, they have financial assistance policies for people who are uninsured or can’t afford their medical bills. But UI Health’s policy, for example, only covers Illinois residents. A spokeswoman said the hospital offers other discounts to out-of-state patients.
Post-Roe, Rush has set up a payment package to help make abortions more affordable, with 50% discounts on pills for medication abortion to the procedure in the hospital.
Laursen argues out-of-state Medicaid plans and insurance companies should be picking up the tab.
“Whose responsibility is this?” Laursen questions.
Not ready to let go
Back in Missouri, Emily has a special room dedicated to her unborn son. She brought home a recording of his heartbeat and keeps his remains in a heart-shaped casket. She talks to her son, tells him how much she loves him.
“I’m just not ready to let him go,” Emily said. “Even though they’re not here on Earth anymore, you still see them in your dreams.”
She’s healing emotionally and physically. She said she’s thankful she was able to travel to Illinois for care, but this experience has made her angry with her home state. She said she doesn’t feel she can live as freely as she’d like.
“I am not wanting to be like political or anything, but there’s a lot of good people out there who go through a lot of unfortunate situations like me who need abortion care and to have that taken away by the government … It just doesn’t feel right,” Emily said. “It feels scary and frightening and unsafe because you can’t choose that option for yourself.”
Kristen Schorsch covers public health and Cook County for WBEZ.