SOUTH BEND, Ind. — A prospective patient called a northern Indiana abortion clinic on Tuesday afternoon, hoping to schedule an appointment to terminate her pregnancy.
The manager said the health center could provide a pregnancy test but not an abortion. In a matter of hours, terminating a pregnancy would be nearly outlawed across the state of about 6.7 million people.
“On Wednesday night at midnight, abortion becomes illegal in Indiana,” Stacie Balentine, clinic manager at Whole Women’s Health of South Bend, explained to the caller. “For that reason, we don’t have any more appointments available here at this clinic. There is information I can give you for other places you can contact.”
The caller asked if she would have to go to neighboring Illinois, where abortion is still legal and highly protected by state law.
“Illinois … Chicago is a good choice,” Balentine responded.
The clinic opened in June 2019 under highly unusual circumstances: The Indiana Department of Health had refused to issue a license to Whole Woman’s Health of South Bend, but a federal judge granted a preliminary injunction permitting its health care practitioners to provide medication abortions, even as the clinic remained unlicensed.
The legal battle made headlines across the country, in part because the unlicensed abortion clinic was championed by then-Democratic presidential candidate Pete Buttigieg, South Bend’s mayor at the time and the current U.S. secretary of transportation.
Buttigieg had cited the need for abortion access across the country as well as in South Bend, a college town adjacent to the University of Notre Dame, where conservative U.S. Supreme Court Justice Amy Coney Barrett had received several distinguished professor of the year awards as a law school faculty member.
Whole Women’s Health ultimately won its fight for an abortion clinic license when the state health department granted the license in January, after about 2 ½ years of the clinic operating under court order.
The framed document decorates the wall near Balentine’s desk.
But the clinic’s victory was short-lived. A few months later, the U.S. Supreme Court overturned Roe v. Wade, the 1973 ruling that legalized terminating a pregnancy nationwide.
The watershed decision left the matter of abortion rights to individual states, half of which were expected to either highly restrict or ban terminating a pregnancy. Some of these states had so-called trigger laws or preexisting bans on the procedure, which went into effect after the fall of Roe.
But in August, Indiana became the first state to pass a near-total abortion ban after Roe was overturned. The measure outlaws abortion except in very narrow circumstances, including cases of rape and incest before 10 weeks post-fertilization; instances that endanger the life and physical health of the pregnant patient; or pregnancies where the fetus has a lethal anomaly.
All seven of the state’s clinics had to cease performing abortions, according to the law.
On Aug. 30, the state health department sent a letter to Whole Woman’s Health of South Bend stating that the law eliminates the state licensure of abortion clinics; from now on, any pregnancy terminations that are permitted must be performed in a hospital.
“Therefore, effective at 12 a.m. (Eastern Standard Time) on Sept. 15, the abortion clinic license issued by the Indiana Department of Health to Whole Woman’s Health of South Bend will be rendered void,” the letter stated.
Several Indiana abortion providers, including Whole Woman’s Health, sued in August to try and block the state’s ban from taking place. The lawsuit claims the ban “strips away the fundamental rights of people seeking abortion care,” violating the Indiana Constitution.
The case is expected to be heard Monday, several days after the ban took effect.
Antonio Marchi, executive director of Right to Life Michiana, hopes the ban perseveres. He lamented that “abortion advocates are using stall tactics to block the law.”
“Right to Life Michiana is encouraged by the thought of up to 95% of abortions being eliminated in the state, and we are continuing work to build consensus around the value of human life,” he said in an email.
Whole Woman’s Health of South Bend provided its last abortion on Sept. 10, in anticipation of the ban. The abortion clinic plans to remain open, offering non-abortion services like follow-up appointments, ultrasounds, pregnancy tests and other medical needs, according to the staff.
After hanging up the phone with the pregnant patient, Balentine appeared despondent. She said she’s been receiving around five dozen calls a week for abortion care, evenly divided between in-state and out-of-state residents.
“That’s the worst part of the job — telling people no, we can’t help,” she said. “That’s kind of all that’s left at the moment, so it’s not great.”
Last year, 8,414 pregnancies were terminated in Indiana.
The number has increased every year since 2019, according to statistics from the Indiana Department of Health. The vast majority of abortions in 2021 took place at seven clinics across the state, as opposed to a hospital, the data showed.
After the state ban went into effect, some Illinois abortion providers predicted many Indiana patients would be traveling here to terminate a pregnancy.
To plan for this influx, Planned Parenthood of Illinois announced on Thursday that the agency added space and expanded abortion services at its Champaign Health Center, which is about two hours from Indianapolis and less than an hour from the Indiana border.
That clinic will now offer abortion procedures as well as medication abortions. The health center was also renovated to add 5,000 square feet, which includes more procedure rooms, waiting rooms, ultrasound rooms, a recovery room and a lab.
“We anticipated Indiana residents losing access to abortion care, so we decided to expand our care in Champaign,” Jennifer Welch, president and CEO of Planned Parenthood of Illinois, said in a news release. “Indiana’s draconian abortion ban does not stop people from having abortions, it only makes it more difficult for people to access abortion in a safe and timely manner.”
Since the end of Roe, Planned Parenthood of Illinois said, the Champaign clinic has seen abortion patients from 11 states besides Illinois, with the largest number of out-of-state patients coming from Indiana. Before Indiana’s ban went into effect, 11% of patients at the Champaign location were from Indiana, according to the agency.
“This number is expected to increase now that the Indiana abortion ban is in effect,” Planned Parenthood of Illinois said in the news release.
In 2018, the agency also opened a 12,000-square-foot clinic in south suburban Flossmoor, about 10 miles from the Indiana border.
Abortion opponents protested the new clinic, in part because the location would facilitate travel from other states, namely Indiana.
“Planned Parenthood deliberately chose to place their new abortion center only a few miles from the Indiana border,” Pro-Life Action League Executive Director Eric Scheidler had said in a news release. “Illinois is fast becoming the abortion dumping ground of the Midwest.”
Planned Parenthood of Illinois has estimated that 20,000 to 30,000 additional patients will travel here to terminate a pregnancy each year after Roe’s demise. As almost every other state in the Midwest restricts or outlaws abortion, Illinois has increased access: In 2019, Gov. J.B. Pritzker signed the Reproductive Health Care Act, which ensconced the right to terminate a pregnancy in state law.
Nearly 10,000 abortion patients came to Illinois from other states in 2020, and the number has risen every year since 2014, according to the latest Illinois Department of Public Health statistics available.
Almost 1,900 patients came here from Indiana to terminate a pregnancy in 2020, the data showed.
The property of Whole Woman’s Health of South Bend was conspicuously quiet on Tuesday.
Three years ago, around this time, the public right of way out front was a tumultuous mix of anti-abortion protesters, volunteer clinic escorts and patients driving to and from their appointments.
Some of the protesters would pray. Others carried signs reading “Abortion takes a human life” and “It’s a child, not a choice.”
Several clinic escorts in bright pink vests walked alongside the patients as they arrived or exited. Sometimes the escorts would unfurl brightly colored umbrellas and hoist them over their shoulders, creating a barrier between the patient and abortion opponents outside, until the patient drove away.
More than 1,100 patients have had an abortion at Whole Woman’s Health of South Bend since the clinic opened in mid-2019, according to the clinic’s staff.
In recent weeks, the number of out-of-state patients coming there had increased, as bans and restrictions in other states went into effect.
“We would see even more patients from other states where it was more restrictive,” said Sharon Lau, Midwest advocacy director for Whole Woman’s Health Alliance. “Right after Roe in June, we were getting patients from Ohio, because they had a trigger law. We were having patients coming from Texas. It was one after another, as the different avenues that were available are falling.”
She believes many of the patients who would have come to the South Bend clinic will now travel to Illinois. The roughly 1,900-square-foot red brick medical building is about 90 miles from downtown Chicago.
The clinic expanded its parking lot in the spring to accommodate more cars. Earlier this week, the lot was nearly empty, except for the vehicles driven by a few staff members.
In April, the clinic received a provisional license to begin providing surgical abortions. But a few days later, a draft copy of the Supreme Court decision leaked, indicating the high court’s plan to overturn Roe. So, the clinic never offered in-clinic procedures, although medication abortions were still available.
The space that would have been a recovery room for patients after a procedure holds a few cardboard boxes with packed items. The medical instruments that would have been used to provide aspiration abortions are being sent to other Whole Woman’s Health clinics in states where terminating a pregnancy is still legal.
A few years ago, Women’s Care Center, an anti-abortion pregnancy center, tried to open next door to the clinic.
But a zoning request by the nonprofit was vetoed by then-South Bend Mayor Buttigieg, whose campaign for president included a pro-reproductive rights platform.
In a letter to other city leaders, Buttigieg said the area wouldn’t benefit from adjacent organizations with “deep and opposite commitments on the most divisive social issue of our time.”
Clinic officials thanked him in a written statement “for standing up for what is right and putting women and families of South Bend first.”
The pregnancy center soon found a different site that didn’t require zoning change: a property just across the street from Whole Woman’s Health.
Women’s Care Center has 34 locations across the country, including one in west suburban La Grange and another in Peoria, according to its website.
“Our locations are very important to us,” Jenny Hunsberger of Women’s Care Center had told the Tribune in 2019. “So we have opened up next to, across the street, close to abortion clinics. … Often if we are next door to an abortion clinic, women come to us — not because they are coerced, not because they’re tricked, not because they don’t know — rather because they’re unsure or they want a second opinion.”
Hunsberger would not answer any new questions about the Indiana ban or Whole Woman’s Health of South Bend ceasing abortions, because “Women’s Care Center is an oasis away from politics.”
The University of Notre Dame Center for Ethics and Culture in 2019 recognized Women’s Care Center as the recipient of “the nation’s most important lifetime achievement award for heroes of the pro-life movement.”
Notre Dame’s president, the Rev. John Jenkins, also serves as a board member of the Women’s Care Center Foundation. In a 2018 statement, Jenkins said he was deeply disappointed by Buttigieg’s veto.
“Far from enhancing the harmony of the neighborhood, it divides our community and diminishes opportunities for vulnerable women to have a real choice,” he said.
Supreme Court Justice Barrett, who was among the majority who voted to overturn Roe, has deep roots in the South Bend area and at Notre Dame, where she graduated from law school and served as a faculty member.
In 2006, Barrett signed an ad opposing “abortion on demand,” which was part of a two-page spread in a local newspaper around the anniversary of Roe. Her name was included on another “right to life” advertisement while she was on the faculty at Notre Dame Law School and a member of the University Faculty for Life group, which sponsored the ad in the student newspaper. This ad was not dated but did mention the 40th anniversary of Roe.
“We renew our call for the unborn to be protected in law,” said that ad, which was signed by dozens of university faculty and staff members.
The property next door to Whole Woman’s Health that spurred so much controversy a few years ago now has a new owner — Right to Life Michiana.
The anti-abortion group uses the property adjacent to the clinic “for sidewalk advocacy to help women in crisis, connecting them with alternatives and support in the community,” Right to Life Michiana said in an email.
The clinic is still open, providing follow-up visits, ultrasounds, pregnancy tests and other services. Lau said Whole Woman’s Health is looking into opening a clinic in Illinois, but that’s still in the planning stages.
Chicago Tribune editors’ top story picks, delivered to your inbox each afternoon.
Staff members can also help patients access medication abortions by mail, but patients must be able to travel for a telehealth visit and use an out-of-state address, either in Illinois or several other states where abortion is legal.
Whole Woman’s Health also started a program to assist patients traveling to other states for abortion care, so the staff at the South Bend clinic will help folks access those resources, Lau added.
“What we’re going to see in Indiana is people forced to carry a pregnancy against their will that they don’t feel ready for or healthy enough for,” said Whole Woman’s Health Alliance President and CEO Amy Hagstrom Miller. “Or people are going to have to figure out how to travel to another place to get the abortion that, honestly, they should be able to get in their community.”
She added that the drive to Illinois or Michigan to terminate a pregnancy is “more risky than the abortion itself.”
“It’s been a huge fight, but we’ve had so much support from the community, and we’ve served a need for that part of Indiana,” she said. “So that part of it has been heartbreaking.”
The Associated Press contributed.