A person protesting, holding a cardboard sign that says "My Body My Choice"
Cover photo: Derek French for Pexels

In the year since the landmark Dobbs decision overturned abortion as a constitutional right, the landscape of reproductive justice has continued to evolve with access to abortion varying greatly from state to state. Abortion remains legal in Illinois, serving as a travel hub for those seeking reproductive care. This is just one piece of the puzzle as many factors contribute to the overall health and wellness of women’s bodies and the human right to bodily autonomy.  

In 2020, Rebellious Magazine examined the environment surrounding reproductive healthcare during the COVID-19 pandemic. Now, three years later, we sought to understand how the aftermath of a global pandemic and nationwide shifts in abortion access, among other changes, have affected how we access healthcare. 

Mifepristone Still Restricted, Case Expected to Head to Supreme Court

On Wednesday, August 16, the U.S. Court of Appeals for the Fifth Circuit ruled to restrict access to mifepristone, part of the two-drug regimen which is the standard in medical abortion. The court stated that the Federal Food and Drug Administration did not follow the required procedures when altering its regulations in 2016.

The ruling limits mifepristone use at seven weeks and will no longer allow the drug to be prescribed and sent by mail. These changes are not effective immediately, as the case is now expected to head to the U.S. Supreme Court

“Medication abortion remains safe, effective, and legal in Illinois. Creating restrictions does not stop people from having abortions. Instead, it creates unnecessary obstacles to care. This ruling is yet another politically-motivated attack to confuse millions of people trying to access essential sexual and reproductive health care,” Jennifer Welch, President and CEO of Planned Parenthood of Illinois, said in a statement to Rebellious. 

Back in April, mifepristone remained legal as the case to remove its 20-year FDA approval moved through the courts.

Though the second drug, misoprostol, can be administered alone to produce a safe medical abortion, practitioners say that the mifepristone-misoprostol combination produces the best success rate. Many have been outspoken about the impending danger should mifepristone be banned.

“It [would be] really taking away an important medical option. It would be setting a horrible precedent for having medical treatment that is safe and effective, based on high-quality science, overturned by a court, based on an anti-abortion ideology rather than based on the science of what works,” said Dr. Debra Stulberg, Professor and Chair of Family Medicine at University of Chicago.

On May 1, a coalition of 13 organizations, including The American College of Obstetricians and Gynecologists, submitted an amicus brief to the U.S. Court of Appeals for the Fifth Circuit regarding Alliance for Hippocratic Medicine v. FDA, defending its medical legitimacy and reminding the courts that this drug is used for more than ending unwanted pregnancies. 

“Pregnancy can cause hemorrhaging, infection, dangerously high blood pressure, and many other critical physiological conditions. These dangers directly impair the health and well-being of pregnant patients, often in material ways. Abortion, including medication abortion involving mifepristone, is an essential component of reproductive care that is protected in many states—including for the management of miscarriage,” it reads.Neither drugs have been legally available in some states with bans since the fall of Roe. Mifepristone remains legal and available in Illinois, with the Illinois Department of Financial and Professional Regulation releasing a statement in May stating that they would not “discipline physicians who prescribe or pharmacists who fulfill prescriptions of Mifepristone.”

Thousands Flock to IL Seeking Abortion Care

Softer restrictions surrounding abortion in Illinois have caused the state to become a hub for those in need of care in places with full or partial bans. In fact, it is one of the only states in the Midwest with expanded access to abortion care, an island completely bordered by neighbors that outlawed abortion.

Indiana’s near-total abortion ban went into effect on August 1, only allowing abortion before 22 weeks if the person’s life is in serious danger, and up to 12 weeks in rape and incest cases.

Planned Parenthood of Illinois (PPIL)’s Champaign Health Center, located near the Indiana state border, has experienced an 800% increase of patients seeking abortion from other states. According to PPIA, half of them come from Indiana.

“It’s tragic that Indiana is again imposing a draconian abortion ban and denying Hoosiers access to the health care they need and deserve,” said Welch. “Abortion care in Illinois remains legal and we have already seen a dramatic increase in abortion and gender-affirming patients traveling from Indiana. We have a team of navigators working closely with patients and the Hoosier Abortion Fund to help people, forced to travel, receive the health care they can no longer access where they live.”

AP News reported on the influx of abortion-seekers causing clinic wait times to jump from two days to three weeks as a result of abortion bans in the South. About 1,140 abortions now take place in the state per month, according to The University of Chicago.

Cost and ability to travel across state borders are already barriers that could deter one from receiving treatment, but those with health conditions that require hospital-based care are often left to navigate an unfamiliar system in a place where they do not live. Enter CARLA, the Complex Abortion Regional Line for Access. This initiative, launching in August, aims to connect patients with complex medical needs directly with Chicago hospitals to schedule care.

“By addressing barriers to seeking an abortion and supporting providers who meet patients’ needs, these cross-agency initiatives demonstrate what it means to stand on the right side of history in the fight for reproductive justice,” said Lt. Gov. Juliana Stratton.

The state also announced a call for proposals for a navigation hotline built to cater specifically to out-of-town abortion seekers, allocating $10 million for the program. More on this and other reproductive healthcare announcements initiated by the state here.

Several Programs Target Root Causes of Black Maternal Mortality

Maternal mortality has flashed through the headlines as providers and advocates seek to rectify disparities among maternal health outcomes. The number of deaths have continued to rise over the last several years, with Black women in the U.S. being three times more likely to die during  or immediately after pregnancy than white women.

According to a report by the Chicago Department of Public Health, the pregnancy-mortality rate for Black women in Chicago is six-times higher than for white women, and twice as high as Latinas.

Infrastructure, lack of resources, and barriers to healthcare that affect Black communities – like the South Side’s maternal healthcare desert – are exacerbated during pregnancy. 

“We don’t have adequate housing so if you’re not stably housed, and you’re trying to also deal with pregnancy, and you’re having to deal with other kids, and you don’t have good access to food and access to pharmacies…. There’s so many intersecting issues,” said Dr. Arden Handler, Director of Center of Excellence in Maternal and Child Health at University of Illinois-Chicago (UIC).

Local Black health providers are initiating their own solutions to serve Black mothers and birthers, like Chicago South Side Birth Center. 

Melanated Midwives at UIC, a study backed by a $7.1 million grant, seeks to improve pregnancy outcomes for Black women by matching patients with a team of Black midwives, nurses and doulas. It will provide 435 patients with in-home care up to a year after delivery.

“We were really trying to be intentional about diversifying the midwifery practice, making the practice reflect the population we serve,” said Karie Stewart, CNM, MPH, and UI Health midwife. “If we’re really serious about addressing Black maternal health in Chicago, we have to lay the groundwork for a new model of care, and that means having the providers and facilities for this relatively radical shift in healthcare delivery.”

The city offers a similar program, Family Connects Chicago, which offers free, in-home nurses to new parents in Chicago, including adoptive and foster parents.

“It’s gradually going to be – in the next few years – in all the hospitals in Chicago… You can get triaged to what you need. Do you need long term home visiting? Do you need diapers? Do you need a pack and play for safe sleep for your child?” explained Dr. Handler.

She also shared her thoughts on the importance of the type of care available. 

“I think midwifery care is totally underutilized in this country. OB-GYNs are fabulous, and if you are a high risk person, we certainly need a maternal fetal medicine specialist, but we should start out with the most basic care which has been midwifery care.”