FILE - Abortion-rights protestors march between the Indiana Statehouse and the Indiana State Library where Vice President Kamala Harris was meeting with Indiana legislators to discuss reproductive rights in Indianapolis on July 25, 2022. Indiana’s high court will not immediately take up a religious-freedoms challenge to the state’s abortion ban, leaving that decision for now with an appeals court, documents from Monday, Jan. 30, 2023 show. (AP Photo/Michael Conroy, File)
Maribel G’s at-home pregnancy test came back positive near Labor Day last year, days before Indiana’s abortion ban briefly went into effect.
She was 20, lived with her parents in Delaware County, and worked in retail. And she was dating a man whom she said hit and verbally abused her.
“I think deep down we did both love each other. … That’s why we stayed together. But it was never going to be a long-term relationship, I think I knew that,” Maribel told the Capital Chronicle.
The then-couple agreed on an abortion, but accessing the procedure around the time of the ban’s effective date – Sept. 15 – proved “to be a nightmare.”
“I didn’t have any idea how complicated it would be — I didn’t understand all the seriousness around the ban and places not knowing if they could help, and I’m making all these phone calls, overwhelmed,” she said.
Maribel said she tried to make appointments with clinics in Indianapolis and got nowhere. Instead, she turned to an online consultation for mail-order abortion pills, but learned on the call of the required in-person examination and administration — in Chicago.
During the last week of September, Maribel made the journey. She was just under the pills’ 10-week pregnancy cutoff.
“I never planned pregnancy. I did not want to get pregnant … in that situation, and not until I was older, and more ready,” Maribel said. “I also never wanted to get an abortion, but I felt like I didn’t really have a choice, because the only other thing I could do was have the baby, and I just couldn’t do that.”
She told her parents the trip was for fun: socializing and shopping. She asked to keep her last name anonymous out of fear they’d disown her.
The U.S. Supreme Court rolled back federal-level rights to abortion nearly a year ago on June 24, in Dobbs v. Jackson. Indiana was the first state in the nation to approve abortion-restricting legislation, passing a near-total abortion ban during a heated, two-week special session that concluded last August.
The ban was in effect for just a week before a Monroe County judge granted a preliminary injunction – reverting to the state’s previous abortion law allowing abortions up to 20 weeks. But the Indiana Supreme Court is expected to rule on that lawsuit any day.
The tenuousness has complicated abortion access for Hoosiers — as abortion clinics struggle to retain staff and comply with the state’s existing snarl of regulations and health care providers reexamine their careers in Indiana.
“The ban hasn’t completely taken effect yet, but we are seeing the shadow effects,” said Dr. Alison Case, a family medicine physician who has worked with Planned Parenthood in Bloomington and Whole Woman’s Health Alliance in South Bend. The latter closed the South Bend clinic – its only one in Indiana – this month, citing “politically driven and medically unnecessary abortion restrictions.”
“One year ago the U.S. Supreme Court put the power of addressing abortion back into the hands of the people in each state – via their representative government,” Indiana Right to Life President and CEO Mike Fichter said in a news release Wednesday. “And while our lawmakers to some degree fulfilled the will of the people to stop abortion in our state, the lower judiciary has allowed abortion to go unabated in Indiana. Every day that passes is a day when pregnant moms and their babies might otherwise have been protected from the pain and often life-long trauma of abortion.”
Abortions down, but Indiana remains semi-haven
Indiana is performing fewer abortions despite the injunction, as clinics struggle with staffing. But residents of states with bans in force increasingly travel to the Hoosier State to access the procedures.
Indiana abortion clinics and hospitals recorded a steep drop in procedures after the ban’s week in effect. They submitted 1,030 terminated pregnancy reports in September 2022, and just 446 the month after, according to Indiana Department of Health data.
Abortions remain down this year as well, with providers filing 3,087 reports from January through May. Over that time period in 2021 — the most recent annual report available — they filed 3,668 reports.
Multiple physicians said clinics have struggled with staffing due the injunction’s uncertainty. While physicians typically perform abortions at clinics in addition to another full-time job, clinic work is increasingly precarious primary employment for other staff members.
That’s meant scaled-back operations.
The Planned Parenthood location that has performed the most abortions in Indiana in recent years — Indianapolis’ Georgetown clinic — has not offered abortion procedures for six months. All other services have continued.
“Planned Parenthood is not telling people at the time they schedule their appointment that where they’ve scheduled their first appointment is almost certainly not going to be where they will have their actual abortion,” said Jess Marchbank, who directs state programs for the All-Options pregnancy resource center.
Marchbank recalled a Louisville woman who had her first appointment at the Georgetown clinic but didn’t know — until told by Marchbank — that the site wasn’t performing abortions. Instead, the woman would need to find a way to Merrillville.
And Indiana requires an 18-hour waiting period, which necessitates a second appointment. More than half the time, Marchbank said, people choose to go to Illinois rather than deal with the hassle of abortion in Indiana.
Chicago has a walk-in clinic where the maximum price for a procedure is $360. At Planned Parenthood in Indiana, the process will likely cost somewhere between $800 and $900, and will take two visits under state law.
Planned Parenthood spokeswoman Nicole Erwin maintained that patients are told that they’ll need two appointments and that second will likely be at a different location. Just four of the group’s locations have state licenses to perform abortions, leaving three available during Georgetown’s pause on the procedure.
Erwin said the organization regrouped in the wake of the Supreme Court ruling.
“Indiana has emerged as a pivotal state for preserving abortion access in the region as patients struggle to navigate bans in nearby states,” Erwin said. “Because of an anticipated surge in demand for care, our Georgetown center worked to train new staff and temporarily scheduled abortion patients at our Bloomington, Merrillville, and Lafayette locations.”
But with training completed, she said, the Georgetown location is again performing abortions.
The website for the facility, however, still mentions only abortion referrals as a service.
Fewer Hoosiers sought abortions in-state from Planned Parenthood even as the number of out-of-state clients surged. The organization said 25% of its non-Hoosier clients are from Kentucky, which has a near-total ban in place.
“States around us are sending people here, which means less access for people here,” Case said. “The volume is high, with fewer appointments available. Most of the people I see in Bloomington are from Kentucky or Tennessee, not Indiana.”
Doctors worry
Some have expressed fear for physicians and patients as members of the profession navigate the state’s looming abortion ban and aggressive enforcement of the remaining 20-week law.
Several pointed to the Indiana Medical Licensing Board’s admonishment of Indianapolis obstetrician-gynecologist Dr. Caitlin Bernard last month. Indiana Attorney General Todd Rokita filed a complaint against the doctor after she publicly discussed a 10-year-old Ohio rape victim seeking an abortion in Indiana.
“Even when providers comply with the law, we’ve seen abortion providers like our own Dr. Caitlin Bernard targeted and threatened by politicians just for providing legal medical care,” Planned Parenthood’s Erwin said in a statement. “The most recent attacks have come from Attorney General Todd Rokita, who used a 10-year-old’s tragedy as an excuse to intimidate abortion providers. This fear is paralyzing health care providers across the country who are scared that simply following their Hippocratic oath could make them pawns in a political attack.”
Physicians say the restrictions could limit options for patients.
“When (doctors) are afraid of legal consequences for practicing medical care … I think (doctors) pull back and they do less because they’re afraid of being punished. They’re confused and they don’t know what to do,” said Dr. Carolyn Rouse, a maternal and fetal medicine physician.
Rouse, who cares for some pregnant Hoosiers at high risk of complications, said abortion is a “necessary component of comprehensive reproductive health care” and requires the same skills as miscarriage management.
As current physicians track the changing legal landscape, so are medical students and residents. Indiana University runs the nation’s largest medical school.
Dr. Tracey Wilkinson, an associate professor of pediatrics at IU, whose research focuses on young people’s access to reproductive health services, often works with residents.
“The constant question is from residents that are in training, is ‘I don’t know if I can stay,’” she said. “Which is really scary, because a vast majority of our primary care providers in Indiana train here.”
Wilkinson said that she advises residents, “Leaving is not going to fix the problem. And it’s a fallacy that you’re safe anywhere.” Instead, she said she encourages them to stay in the state and advocate.
Future doctors look elsewhere
But some prospective physicians aren’t willing to compromise.
Lucy Brown starts her OB-GYN residency in Maryland next month.
She made the move alone, leaving behind family in central and southern Indiana, and a significant other in Chicago. That’s because, Lucy said, her top priority in location was a state with minimal restrictions on abortion.
Accredited OB-GYN residency programs must provide training in abortions, which sometimes means flying residents from states where the procedure is largely illegal to states where it’s not. Brown said she found “some solace” in the Accreditation Council for Graduate Medical Education requirements.
“But the problem is that abortion is such an integral part of your everyday practice, especially on labor and delivery, when you’re on triage,” Brown said. “Like if someone is pregnant, you have to offer them full resources.”
Brown had planned to finish her training in Indiana and practice in the state, but she’s reconsidering.
“Almost my entire extended family is in Indiana. And that was something I had kind of banked on, like when I wanted to settle down, was to have them nearby,” Brown said. “But … I’m not going to compromise my career to live in a state that doesn’t respect my job.”
Cloudy outlook on family support, contraceptives
As lawmakers last August hashed out the details of the state’s abortion ban, they simultaneously approved legislation providing $75 million in direct appropriations and discretionary funding for social service programs – meant to support Indiana’s new post-ban families.
And this legislative session, they passed bills allowing some pharmacists to prescribe hormonal contraceptives, and letting providers transfer unused long-acting reversible contraceptives to new Medicaid recipients.
“Those are both bills … that we have been trying to get passed in Indiana for years and couldn’t even get a hearing,” Wilkinson, the IU researcher, said. “It wasn’t until they banned abortion that they were even willing to have that conversation.”
But lawmakers walked back a novel — and legally dubious — attempt to begin child support payments at conception and rejected a bill requiring that hospitals offer birthing patients long-acting reversible contraceptives.
Despite the General Assembly’s overtures at support, some physicians say other factors might narrow access to contraception, abortion ban or not.
Wilkinson also runs PATH4YOU, a grant-funded program providing free access to and removal of all forms of birth control to anyone within Indiana.
The initiative also takes questions from fellow providers – including, recently, a group of health care providers in southern Indiana who’d had a religiously affiliated medical institution acquire their hospital and practices.
“Overnight, nobody was allowed to prescribe birth control in their community,” Wilkinson said. “And they were reaching out to us because they were like, ‘We don’t know what to do. Like, can we send patients to you?’”
Nearly 100,000 Hoosier women already live in counties without access to a single health center that provides access to a full range of contraceptive methods, according to nonprofit Power to Decide.
Wilkinson was skeptical lawmakers would continue to open contraceptive access.
But more organizations are expanding already legal services. Planned Parenthood recently began offering vasectomies at its Hammond location and plans to offer the procedure at more.
All hinges on highly anticipated ruling
Meanwhile, Hoosiers of all strands await legal decisions that will determine the future of abortion in Indiana. The state’s supreme court is expected to weigh in on a challenge, rooted in arguments of privacy, before the end of its fiscal year.
“We are hopeful the Indiana Supreme Court will soon confirm what is clear: There is no right to abortion in the Indiana Constitution,” Indiana Right to Life’s Mike Fichter said. “As we await the day when Indiana’s new law can fully take effect, we will continue to work as we always have — providing love and support for pregnant moms and their babies.”
And while the appeal in a second lawsuit plays out, both parties have asked for a pause on the underlying religious freedom-based case. The Marion County Superior Court granted that motion in a brief ruling on Wednesday.
“Make no mistake: Planned Parenthood providers will not be intimidated. We have the majority on our side in support for access to abortion,” Erwin said. “… Together, we can create a future where our reproductive rights are guaranteed — not vulnerable to whoever has power at the moment.”
By Leslie Bonilla Muñiz, Casey Smith and Whitney Downard. The Indiana Capital Chronicle is an independent, not-for-profit news organization that covers state government, policy and elections.
