Protesters and clinic escorts gathered outside EMW Women’s Surgical Center in Louisville last year before abortion was banned in Kentucky. (Photo by Deborah Yetter)

LaDonna Prince’s new reproductive care clinic in Illinois was supposed to be open more than a year ago.

Prince and her staff were prepared for Indiana to ban abortion, and started trying to move operations to Danville, Illinois, in 2023. It’s about 90 minutes across the border from her old clinic in Indianapolis, which provided abortion care for more than 40 years before the U.S. Supreme Court overturned Roe v. Wade in 2022 and allowed states to regulate abortion access. Today, 12 states — including Indiana — have a near-total ban on abortion, and four states have a six-week ban, before many people know they are pregnant.

Now that abortion access nationwide may be threatened by the second administration of President-elect Donald Trump and Republican-controlled chambers of Congress, Prince is determined to open the clinic at the beginning of 2025.

“It’s scary, to be honest with you,” Prince said during a press conference in early December. “It’s just really frightening.”

Prince’s clinic, Affirmative Care Solutions, is one of a few independent clinics in the country that will open while many others have closed their doors for various reasons. According to a new report released by the Abortion Care Network, 76 brick-and-mortar independent abortion clinics closed between 2022 and 2024, 11 of those in 2024 alone.

The report also showed that 70% of the closures in that two-year period were in the South or Midwest. Besides those forced out because of a statewide ban, the report said staffing issues and lack of funding have been the driving factors for others to close their doors.

That lack of funding is widespread for abortion care. Planned Parenthood affiliates across the country have reported a downturn in donations and cuts in state funding that have put them in precarious positions. The Abortion Care Network reported in August that their donations decreased by one-third. The Network provides grants for infrastructure projects that help keep clinics afloat, such as building repairs, supplies, equipment and security.

Approximately 58% of all abortions in the United States take place at independent clinics rather than a Planned Parenthood affiliate or a hospital, the report said, and more than 60% of clinics that provide abortions after the first trimester are independent. The only clinics in the country that provide terminations after 26 weeks are independent as well. The vast majority of abortions take place in the first trimester, but third trimester care is sometimes necessary.

Kentucky clinic co-owner tries to keep pieces together to quickly open again

While Illinois has some of the most liberal abortion laws in the country, Prince quickly met resistance from the local government, including the mayor, who cast a tie-breaking vote to pass a city ordinance meant to block the clinic from providing abortion services in Danville. Mayor Rickey Williams Jr. told local news outlet WCIA at the time that the ordinance was in response to the clinic moving in, saying, “This is not any kind of comprehensive health for women. This is literally just an abortion clinic.”

The ordinance is unenforceable because of state law, Prince said, but that hasn’t changed the attitude among local government officials. All of that preceded an attack on the clinic by a 73-year-old man who crashed his truck into the building and tried to set it on fire as it was under renovation in May 2023, causing more than $500,000 in damages and further delaying the clinic’s opening.

Earlier this month, Prince tried to hire a plumber, only to have him tell her he wouldn’t do any work for her because he didn’t believe in abortion.

“It’s not easy to find people who are even willing to do the work, and it’s a business that’s not even open yet,” she said.

The Abortion Care Network provides grant funding for infrastructure needs at independent abortion clinics, and in the report, the organization laments all of the recent clinic closures — because once a clinic closes, it is often exceedingly difficult to reopen, even in a state with laws that allow broad access.

For that reason, at least one independent clinic in a state with a near-total abortion ban is trying to retain its existing infrastructure so that opening would be easier if abortion becomes legal again. Ona Marshall, co-owner of EMW Women’s Surgical Center in Louisville, Kentucky, said the center provided medication and procedural abortion care for 43 years before it was forced to close, and it provided the vast majority of abortions in the state.

Marshall cited a new lawsuit filed in Kentucky in November seeking to overturn the state’s ban, saying that was good news that could ultimately allow the clinic to reopen someday, but those court proceedings can take years. In the meantime, she is trying to keep the pieces of the clinic together to be able to quickly open again if that day comes.

“Once you give up a license in a hostile state, depending on whether there’s an anti-abortion governor, they may deny you a license for no valid reason, which requires months of additional court challenges with no guarantee of winning,” Marshall said during the press conference. “You are taking a large personal and financial risk in a highly unstable and politically charged environment, so it’s just critical to try to keep as many clinics open as possible.”

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