Nikki Madsen is the Executive Director of Abortion Care Network, a national member-based nonprofit dedicated to supporting the well-being of Independent Abortion Care Providers. Nikki was born, lives, and works in Minnesota, and is honored to work every day to ensure that all people in need of abortion care can access the health care they need, when and where they need it.
My grandmother was a strong Midwestern woman with a laugh that would fill the room. She escaped a violent childhood home and later raised five children after losing her husband in a car accident. She also had an abortion prior to 1973, the year when the U.S. Supreme Court legalized abortion with the historic Roe v. Wade decision. Her abortion left her hospitalized in a place where the staff refused to care for her due to her abortion — with the exception of one nurse who saved her life. Although she died 12 years ago, I carry my grandmother’s experience with me every day in my work supporting independent abortion care providers, facilities which provide the compassionate quality care that my grandmother deserved but was unable to get because abortion was illegal in her home state of Minnesota and she couldn’t afford to travel.
Now, almost 46 years after Roe v. Wade legalized abortion in the United States on Jan. 22, 1973, our country is faced with an anti-abortion majority on the Supreme Court and the very real possibility that abortion will be illegal once again, depending on what state someone lives in.
For nearly five decades, independent abortion care providers have made it possible for people to get the abortion care they need, when they need it — but they are now threatened like never before.
Today, independent abortion care providers, which are providers not affiliated with a national organization or hospital system, are where most people in the United States go for abortion care, providing care to three out of every five people who have an abortion. And I’m continuously inspired by their courage and their commitment to providing patients with compassionate, dignified care. Many independent clinics — like Abortion Care Network member clinics Women’s Health Center of West Virginia and Jackson Women’s Health Organization in Mississippi — provide care when and where others do not. There are six states with only one abortion clinic, and independent providers operate the last remaining clinics in four of those states: Kentucky, Mississippi, North Dakota, and West Virginia. In Wyoming and Louisiana, the only remaining clinics are independent, and in four others — Arkansas, Oklahoma, Georgia, and Nevada — they are the only providers of in-clinic abortion care. Without independent clinics, people living in large swaths of the South and Midwest could have to travel across state lines, hundreds of miles one way to access care. Even so, in some states like Missouri, individuals seeking an abortion must wait up to three days before their abortion as required by law.
The attacks and threats to abortion care have reached catastrophic levels.
Forty-three states place varying limits on how far into pregnancy a patient can get an abortion, but independent providers, which make up 83 percent of clinics providing abortion care after 19 weeks, keep abortion as pregnancy progresses a reality. While recently visiting Camelback Family Planning clinic in Phoenix, Arizona, where abortion is legal up to the 24th week of pregnancy, I met Angela* and David*, a couple terminating a very much wanted IVF pregnancy after receiving the heartbreaking news that the pregnancy they’d planned wasn’t viable. The clinic staff supported both their medical and emotional needs with patient-centered, compassionate care that can be seen every day at independent abortion clinics across the country.
As the future of legal abortion care is poised to become a state-by-state issue, independent providers become even more critical. By some counts, more than a dozen U.S. states could outlaw or severely restrict abortion if Roe v. Wade were overturned, which will undoubtedly lead to clinics closing. If that happens, more people will be forced to travel farther and save up more money to get care — pushing them further into pregnancy and delaying care for those who will be able to access abortion at all. The effects would be worst on low-income and otherwise marginalized individuals, who might be prevented from accessing abortion at all. Without independent clinics, abortion would be nearly nonexistent for patients who are delayed by these politically motivated hurdles, as well as for people like Angela and David, who face unexpected diagnoses with wanted pregnancies.
This is a defining moment for abortion in the United States.
The attacks and threats to abortion care have reached catastrophic levels under the Trump administration — from the heightened rhetoric of anti-abortion politicians, like Oklahoma state Rep. Justin Humphrey, who called pregnant women a “host” for a fetus, to the confirmation of Supreme Court Justice Brett Kavanaugh, whose confirmation hearings sparked conversations about how to handle sexual assault allegations and left many concerned about his previous suggestions that Roe could be overturned. This on top of the more than 400 state-level abortion restrictions passed over the last decade, including so called Targeted Regulation of Abortion Providers (TRAP) laws which seek to needlessly regulate abortion providers and are designed to shut down clinics and push abortion care out of reach. For many people living in communities from rural North Dakota to the shores of Mississippi, abortion is already a right in name alone. People who seek abortion care to ensure the well-being of their health and their families are denied their right to care simply because of where they live or how much money they make.
This is a defining moment for abortion in the United States. The federal government and politically hostile states continue to pass restrictions that force clinics to close and push care out of reach. And now, this country is closer than ever to a future without legal abortion.
Forty-six years after Roe v. Wade, allies must continue our fight undeterred. I think about my grandmother and the progress of the last five decades; it is in part because of her that I refuse to go back. I know that the freedom our country seeks is only possible when people can make the decision when and whether to become parents, and independent abortion clinics are able to keep their doors open and thrive.