Opening a new abortion clinic involves first jumping through a series of hoops, especially in Republican-controlled states where legislators and state officials have made it increasingly difficult to be a provider. From abortion restrictions that make running a clinic more and more expensive, the prospect of protesters, and administrative hurdles that make getting a license difficult, many abortion providers are finding that building a new facility is, for all intents and purposes, out of reach.
The lengths that Planned Parenthood was forced to go to open a new clinic in southern Illinois is instructive. As CBS News reported, despite being in a state that has recently liberalized its abortion laws, the organization was still compelled to operate in secret in order to construct their new facility:
Since August 2018, Planned Parenthood has used a shell company to construct the facility, leaving no public trace that the former medical office would become one of the largest abortion clinics in the country. CBS News first visited the site in August, while it was still being built.
Colleen McNicholas, the chief medical officer of Planned Parenthood of the St. Louis Region and Southwest Missouri, said the facility was built in secret to avoid protestors and delays. Other Planned Parenthood projects had run into problems once the public realized the construction was for an abortion provider. In one instance, a communications company had refused to install telephone and data lines; in another, a cabinet maker never delivered an order, McNicholas said. In Birmingham, Alabama, protestors targeted Planned Parenthood’s suppliers, flooding their social media accounts with fake negative reviews.
It’s common for new clinics to try to fly under the radar during construction. As Vice reported earlier this year, when Planned Parenthood began building a new clinic in Charlotte, North Carolina in 2016, staff kept the details firmly under wraps, all in an effort to avoid the harassment and roadblocks that had affected other clinics. “When we built our Asheville health center, there were obstacles,” Marcie Shealy, the philanthropy director for Planned Parenthood South Atlantic, told Vice. “It was very public, and the people that opposed what we were doing would picket the contractors. They would harass their families, and it slowed construction down.”
But it’s not just protesters and leery contractors that are the only challenges that abortion providers confront when attempting to open a new clinic. The costs of building and running a new clinic have also jumped in recent years, thanks in part to restrictions like TRAP laws. And the anti-abortion political climate has made it harder to get needed loans. According to Bloomberg, when Julie Burkhart opened the South Wind Women’s Center in Wichita, Kansas, she was repeatedly rejected by lenders. “I spent two years talking to different financial institutions,” Burkhart told Bloomberg. “I went from small, very local banks to regional banks to Bank of America, Wells Fargo.”
And getting a license from the state can be a challenge, as one clinic in Indiana found. Per Vice:
In Indiana, for example, a new Whole Woman’s Health Alliance (WWHA) clinic that offers abortion care was delayed from opening in South Bend for almost two years because of issues with licensing. WWHA first applied for a state-required license in late 2017. A few months later, the state health department denied the application, noting the nonprofit failed to meet its requirements of having “reputable and responsible character,” among other factors.
After a few exchanges with the department, WWHA finally asked a federal district court to step in in March. (WWHA also filed a civil lawsuit challenging Indiana’s abortion regulations; the case starts next year.) What is essentially paperwork had delayed the clinic’s opening by 18 months at that point.
“These layered restrictions like licensing laws, construction requirements, mandatory delays and so many more, work to create an environment where it is nearly impossible to open a facility or even to run one sustainably,” Whole Woman’s Health Alliance CEO Amy Hagstrom Miller told Vice. “This, of course, is by design, not by default, as a tactic of those who oppose safe and legal abortion care.”
All of this has created a situation that has exacerbated disparities in regional access to abortion. As the Guttmacher Institute found, while the number of abortion providers between 2014 and 2017 went up slightly in the northeast and the west, it dropped in the midwest and the south. Running an abortion clinic is now, as Hagstrom Miller told Bloomberg, “the most difficult business you could ever run.”