Around two days a week, Natalee Hartwig leaves her home in Madison, Wisconsin, before her son wakes up, to travel across the border into Illinois.
"Luckily it's summer," said Hartwig, a nurse midwife at Planned Parenthood of Wisconsin. "For now he can sleep in. But any getting ready that has to happen will be on my spouse."
She drives at least two hours each way, immersed in audiobooks and podcasts as she drives to a clinic in the northern Illinois suburb of Waukegan. She spends her days in the recovery room, caring for patients who had abortions and checking their vitals before they go home. She also got licensed in Illinois and trained to provide medication abortion, something she'll be able to do virtually through telehealth with patients across Illinois.
Hartwig is essentially working part time in Illinois because when Roe v Wade was overturned in June, a Wisconsin law immediately took effect that bans nearly all abortions, except to save the life of the pregnant person. Wisconsin providers want to preserve access for patients, while those in Illinois – long an oasis for abortion rights – need more staff to help treat a surge of people arriving from across the U.S.
The Waukegan clinic is Planned Parenthood of Illinois' busiest for out-of-state abortion patients. After Roe fell, 60% of patients came to this clinic from outside the state – mostly from Wisconsin. In fact, the organization opened in Waukegan two years ago with Wisconsin in mind, knowing that if Roe v. Wade did fall, access to abortion in that state would greatly diminish.
After Roe was struck down, Planned Parenthood organizations in both states announced their partnership. More than a dozen employees from Wisconsin – including doctors, nurses and medical assistants – now commute to Waukegan to help provide care.
"It really required this perfect pairing of supply and demand," said Kristen Schultz, Planned Parenthood of Illinois' chief strategy and operations officer. "They had capacity without local demand, and we had the opposite."
In the month after the U.S. Supreme Court overturned the landmark decision, Illinois became even more of an oasis for people seeking abortions. Dozens of clinics closed across the nation as 11 states in the South and Midwest implemented bans, according to the Guttmacher Institute, a nonprofit that supports abortion rights and tracks the issue.
The influx of patients into Illinois has had another impact. For years, abortion providers have been traveling once or twice a month to other states like Kansas, Mississippi and Oklahoma, where their help was badly needed.
Chicago OB-GYN Dr. Laura Laursen was one of them.
"Now the script is totally flipped," said Laursen, a fellow with Physicians for Reproductive Health. "This is where you are needed more than anywhere else."
Anti-abortion groups oppose the Planned Parenthood partnership and are preparing for a marathon effort to restrict abortion rights in Illinois. In a statement after the organization's announcement, Amy Gehrke, executive director of Illinois Right to Life, called it "particularly tragic."
Helping to treat the surge
Inside the Waukegan clinic, there are typical exam tables, ultrasound machines and hardwood floors throughout. There are also signs of what the space used to be – a big bank on a busy retail strip – such as the shiny vault in the staff break room.
Some of the Wisconsin providers commute to Waukegan a few times a week; others a few days a month.
For Hartwig, associate director of clinical services at Planned Parenthood of Wisconsin, she's able to do more for patients in Illinois than she could back home. Even as a nurse with an advanced degree, she wasn't allowed to provide medication abortion in Wisconsin. But she can in Illinois, according to the state Department of Financial and Professional Regulation.
"This was really just what I was always supposed to do," Hartwig said. "There's nothing that's going to keep me from helping our patients."
Dr. Kathy King, Planned Parenthood of Wisconsin's medical director, said while her staff is dedicated to providing these services, it comes at a cost.
"It is a burden on our clinicians and nurses and medical assistants who have young children at home," King said. "It sounds great. Sure, we'll all just travel down to Waukegan five days a week. But the logistics of that and the sacrifice of doing that on just people's day-to-day lives takes a toll."
Still, this sacrifice has helped. With staff from Wisconsin, the Waukegan clinic now has doubled the number of abortion appointments available, and they're still ramping up. This also frees up other staff to treat patients who come for other needs, like birth control and cancer screenings.
There has been a burst of patients from Wisconsin for abortion appointments at all Planned Parenthood of Illinois clinics — a tenfold increase in the month after Roe was overturned, from about 35 patients a month to 350, King said. That doesn't include Wisconsin residents who might have sought abortions with other providers.
A potential model
The Waukegan clinic has ignited interest from abortion providers in other nearby states. Planned Parenthood of Illinois is fielding calls from those in Indiana, Kentucky and Ohio, for example, Schultz said.
What Illinois needs is more staff to treat more patients. But where will those additional employees come from? The commute from Wisconsin to Waukegan is relatively short compared with providers in Ohio who'd have to cross Indiana to get here.
Across the nation, there are other conversations happening among providers. The National Abortion Federation, which has about 500 facility members including independent abortion clinics and hospitals, is pairing up people who are looking for jobs at clinics with those that need workers, said Melissa Fowler, chief program officer at the federation.
Still, she acknowledged moving isn't a realistic option for everyone.
"People have lives," Fowler said. "They have families. They're deeply rooted in their communities. ... And so a situation like you're seeing in Illinois and Wisconsin is great because people are able to stay connected to their community, not have to move their family and still be able to provide care."
In southern Illinois, many people who work in a clinic in Fairview Heights live across the border in St. Louis. It's a roughly 30-minute commute for Dr. Colleen McNicholas, chief medical officer of Planned Parenthood of the St. Louis Region and Southwest Missouri.
During her career, she's traveled to Kansas and Oklahoma to provide abortions. Now she's seeing whose expertise she can bring to Fairview Heights, such as doctors and clinic managers in Arkansas who in a post-Roe world now work in a state that has banned nearly all abortions. There's been a big uptick in patients seeking abortions in Fairview Heights recently coming from Arkansas, Tennessee and Mississippi.
"Who's going to provide those services?" McNicholas asked.
Before the June decision, patients in Fairview Heights typically waited three days for an appointment to get an abortion. Now they wait around three weeks — at a clinic that provides abortions six days a week, eight hours a day.
Within the year, McNicholas said the clinic might open its doors seven days a week, 12 hours a day.
She worries even that might not be enough to give quick access to patients.