KANSAS CITY, Kan. — When Planned Parenthood decided four years ago to open a new clinic in a medically underserved working-class neighborhood here, it envisioned a place that would save women living nearby from having to take hourslong bus rides to obtain birth control, testing or an abortion.
The U.S. Supreme Court’s June decision overturning Roe v. Wade — four days before the clinic opened — changed all that. Because Kansas is one of the few states in the region where abortion remains legal, the clinic soon found itself inundated with calls not just from panicked patients in Kansas and nearby Missouri, but also in Arkansas, Oklahoma, Texas — even as far away as Louisiana.
This clinic and other Planned Parenthood centers in Kansas have been doing their best to help by lengthening hours, hiring staff and flying in physicians. Still, they have only been able to take about 10% to 15% of the patients seeking abortions.
"The ecosystem, it’s not even fragile. It’s broken,” said Emily Wales, president and CEO of Planned Parenthood Great Plains. “I think there’s a perception that if you are seeking care, you can find it somewhere. And that’s not true.”
Haley Ruark, of Platte City, Missouri, was able to get an appointment on a recent Wednesday after a two-week wait — longer than she wanted but better than driving hundreds of miles west to Colorado.
Ruark had panicked after a series of birth control mishaps. First a condom broke and then, despite using the morning-after pill, a pregnancy test came back positive. Missouri bans abortion in all cases but medical emergencies.
“It was just idiotic for a law to be put in place that you can’t do what you feel is necessary for your body and not even your body, but your mental health also,” Ruark said.
She already balances working 12-hour shifts as a patient care technician at a hospital with caring for her 2- and 6-year-olds.
“The two kids, like they’re good, you know, ends are met,” she said. “Bringing a baby into that, I just don’t think that that would be a good idea right now.”
Ruark walked past shouting protesters to get inside the new clinic. It took her almost two hours to get the abortion pill after meeting with Dr. Elizabeth Brett Daily. By law, Daily only needed to wait 30 minutes after Ruark's arrival to dispense the medication, but the clinic was busy.
Thousands of patients likely aren't getting appointments at all, according to a national tracking effort called #WeCount, which is led by the Society of Family Planning, a nonprofit organization that promotes research on abortion and contraception.
The society's report, released in October, found 6% fewer abortions were administered nationwide in August — when many of the more-restrictive bans on abortion had taken effect — compared with the number of abortions administered nationwide in April, before Roe was overturned.
Some of the states with bans saw the number of abortions drop from as many as 2,770 in April to below 10 in August, while bordering states that still permit the procedure saw their abortion numbers ramp up, the survey found. In Kansas, Colorado, Montana, Nebraska and North Carolina, the number of abortions administered in August was at least 30% higher than the number administered in April. In Illinois, 28% more abortions were administered in August than in April.
The study had some limitations, including that only 79% of all identified abortion providers — including clinics, private medical offices and hospitals — provided data. The society says the figures represent an estimated 82% of all abortions provided nationwide.
Few outside Kansas anticipated the state would take on this larger role providing abortions, said Elizabeth Nash, principal policy associate for state issues for the Guttmacher Institute, a research group that supports abortion rights.
“It’s a pretty conservative place. You know, it’s not like Colorado or Illinois where people have been thinking these will definitely be access points," Nash said.
Abortion opponents have been influential in Kansas politics since the 1991 Summer of Mercy protests in Wichita, when thousands of anti-abortion activists gathered in Wichita, sparking protests that led to nearly 2,700 arrests.
The picture may be changing. Voters continue to elect large anti-abortion majorities to the Legislature, but in August they overwhelmingly rejected a constitutional amendment that would have cleared the way for tougher abortion restrictions or a ban.
Abortion demand in Kansas promises only to grow. While the procedure remains legal in neighboring Iowa and Nebraska, both are conservative and Nash described the states as “bans in waiting.”
Routinely, staff are turning away patients seeking appointments at the new clinic and the two other abortion clinics Planned Parenthood operates in Kansas, telling them they don’t keep a waiting list, and if they can get an appointment in Colorado or New Mexico to take it.
But there are no guarantees in those two states either, said Dr. Kristina Tocce, medical director for Planned Parenthood of the Rocky Mountains.
“I hypothesize that for every patient that can get to us and that we can see there are many patients who are not able to access care," Tocce said, adding that the number of out-of-state patients has soared.
Getting an appointment in Kansas City is luck of the draw. Local patients aren’t prioritized, but have an advantage because it is easier for them to make it to mid-week consultations. Planned Parenthood leaders said adding a fourth clinic is among the options under consideration to increase access, but they haven't released details.
Daily, of the new Kansas clinic, said she was drawn to the work after a stint with the Peace Corps in the West African nation of Togo. She saw sexual assault victims and “many, many" women and their babies die during childbirth.
The doctor sees horrific stories here, too. A recent abortion patient was 13, her face so bruised from the assault she endured that she could barely open one of her eyes in the waiting room.
Daily likens getting an appointment for an abortion these days to winning the lottery.
“Think about our current health care system and how hard it is just to get like a primary care visit," she said. “Times that by a thousand because that’s how hard it is for abortion care nowadays."
Among the patients Daily saw recently was a 29-year-old mother of two who asked that her name not be used because she didn't want her family and acquaintances to know. The woman said she initially had planned to carry her pregnancy to term. But then her 3-year-old daughter had a terrifying 40-minute seizure, which temporarily paralyzed her. It was her 13th major seizure in the past year.
Doctors intubated the little girl, and the woman hastily arranged for her 9-month-old son to be with his father. The couple had separated, so she sat by her daughter's bedside alone.
“I thought to myself, ‘It’s not fair, you know, to not be able to give another child my full attention."
She knows some people won’t understand her decision.
“People are just quick to judge," she said. “A lot of people have religious beliefs. ‘Oh, no. You can’t do that.' But for me, I just don’t think people take the time to get to know somebody and realize what their situation really is."