“Practically non-existent": In the eight months since the doors of Indiana’s clinics closed, the aftermath has posed questions about women’s health and reproductive accessibility.

Indiana’s Abortion Center Directory website sits practically defunct. Beyond sparse text and static links, the site offers nothing more than a “Home” header, navigating visitors to a gray-and-white map of Indiana.

All 92 Indiana counties are labeled on the map, directing site visitors to click on their desired county for abortion clinic information. Each takes the navigator to a page displaying the same message: “No facilities exist in this county.”

It’s been more than half a year since Indiana abortion clinics ceased providing abortions after the state’s near-total ban on the procedure. Following the Supreme Court ruling on Dobbs v. Jackson Women's Health Organization in June 2022 — which overturned Roe v. Wade — the state enacted legislation terminating licensure for abortion clinics, as well as setting guidelines for the few legal instances of abortion care.

Indiana’s four Planned Parenthood clinics and two additional Indianapolis health clinics were stripped of licensing and forced to halt abortion services, according to the Associated Press (AP). Whole Woman’s Health of South Bend, a non-profit that provided reproductive education resources and abortion care, permanently closed its doors.

According to Indiana Senate Bill 1 (SB1), abortion would only be permitted in certain cases, such as when the pregnancy poses a “serious health risk” to the woman, a “lethal fetal anomaly” is detected or a pregnancy of up to 12 weeks is a result of rape or incest.

With abortion legislation in the hands of the states, Indiana is one of 14 states that have complete bans with limited expectations. While women in Indiana face restrictions at home, neighboring states have implemented abortion legislation that provides care for those able to cross state lines.

Indiana State Representative Sue Errington, who served as the Public Policy Director for Planned Parenthood of Indiana and Kentucky for 17 years, said she continues to work on “ways to overturn” the ban.

“Only hospitals and ambulatory clinics can now provide abortion under limited circumstances,” Errington said via email. “Indiana will no longer be an option for people from other states seeking abortions.”

Abortion_01 — A Planned Parenthood clinic in Indianapolis, Indiana, located on Georgetown Rd., is photographed March 26. While the clinic halted abortion care following Indiana's Senate Bill 1, it still provides other reproductive health services. Kate Farr, DN

Neighboring states like Illinois and Ohio have become abortion havens, providing care to patients who can afford to make the trip over state lines.

Ohio is one of the few states that updated its constitutional protections for abortion access following the Supreme Court ruling. It was the only state to have an abortion rights question on its ballot in 2023, according to AP.

Illinois enacted comprehensive abortion rights legislation in 2019. In 2023, Gov. JB Pritzker signed House Bill 4664, which protects Illinois reproductive health providers, as well as their patients, marking a win for many out-of-state travelers seeking abortion care in the state.

“[Planned Parenthood of Illinois]’s Champaign Health Center near the Indiana border has experienced an 80 percent increase in out-of-state abortion patients, with 50 percent of those patients coming from Indiana,” Errington said.

According to data from the Guttmacher Institute’s Monthly Abortion Provision Study, nearly one in five patients traveled to other states to obtain abortion care in 2023 — double the amount recorded in 2020.

The surge, according to experts from the institute, is driven by post-Roe v. Wade bans and restrictions sweeping the United States.

The Guttmacher Institute’s report is based on a survey of brick-and-mortar abortion clinics, as well as telehealth and virtual providers. The institute, which supports abortion rights, relies on a sample from each state to estimate the number of abortions.

Based on the institute’s findings, Illinois experienced the largest increase in the number of patients traveling from out of state for abortion care. The state saw a nearly 20 percent increase from 2020 to 2023 in patients coming from other states.

Illinois, which borders three states with near-total abortion bans (Indiana, Kentucky and Missouri), permits abortion before fetal viability and allows qualified healthcare professionals, not just physicians, to provide abortion care.

Jean Marie Place, an assistant professor of health promotion and education at Ball State University, specializes in women's health, as well as maternal and child health. In her eyes, women are leaving Indiana and seeking abortions elsewhere out of necessity.

“They are desiring freedom and self-determination for their lives,” Place said via email.

The United States has the highest maternal mortality rate among developed countries and is the only developed nation in which that rate is rising. Indiana has the third-highest maternal mortality rate among all reporting states, according to a maternal mortality brief from Indiana University.

“Put simply, lack of healthcare access hurts health,” Place said. “You can see that play out.”

According to a 2023 study on the maternal mortality crisis in the U.S., states with abortion restrictions had a 62 percent higher proportion of individuals dying during pregnancy or up to one year after childbirth, typically due to the pregnancy or a pre-existing condition that was worsened by pregnancy.

Notably, the rate of maternal and infant death is disproportionately higher among minority populations. The study cited that the 1973 Roe v. Wade decision reduced maternal mortality rates by 30 to 40 percent for people of color, attributing the decline to increased access to safe and legal abortions.

Infogram

“Abortion access is healthcare, so when healthcare is limited, unfortunately, women may have to get their needs met in ways that ultimately end up hurting their health,” Place said. “I believe it’s a human rights issue … There is no freedom for women without reproductive freedom to decide what is best for their lives and to have access to the resources to aid in those reproductive decisions without coercion.”

Chelsea McDonnel, who serves on the state board for the National Organization for Women (NOW) and as a Muncie chapter president for East Central Indiana NOW, echoes Place’s stance.

“Minority women have much higher rates of maternal and infant mortality than white women, and we have to address that,” McDonnel said via email. “None of us can move forward if we don’t first make sure all our sisters are rising with us toward justice.”

McDonnel started MADVoters — an organization that promotes voter registration and works to educate voters on legislation in Indiana — with other advocates. McDonnel said that she and other advocates spend time at the Indiana Statehouse during legislative sessions, “advocating for access to abortion, as well as birth control and much-needed medical services for pregnant Hoosiers.”

“I was at the statehouse when the [Supreme Court] ruling came down,” McDonnel. “I had been there for weeks supporting others and standing with them. I sat down on a bench and I cried. I have had the honor and privilege of working with so many people across our state, and they have shared so many of their stories and experiences with me. Knowing access to abortion was practically non-existent was absolutely terrifying to me for others.”

Infogram

Beyond the scope of Indiana’s current abortion restrictions, there’s another question on the table: the future of reproductive healthcare. While the Roe v. Wade decision was a hit to comprehensive abortion access, the fate of a commonly used abortion method is before the Supreme Court.

More than a year and a half after the court passed off the matter of abortion to elected officials, the availability of the abortion pill mifepristone is at stake. The U.S. Court of Appeals for the Fifth Circuit ruled in August 2024 that the pill should remain legal in the U.S. but only with “significant restrictions” on patients’ access to it, according to court records.

Despite the lower court ruling, the Supreme Court on March 26, signaled that it was “unlikely” to limit access to mifepristone. According to a report from Reuters, the justices appeared “skeptical” that anti-abortion groups and doctors challenging the drug have the “needed legal standing to pursue the case.”

Haley Bougher, the Indiana State Director of Planned Parenthood Alliance Advocates (PPAA-IN), works with the organization to implement legislative and reproductive advocacy.

“Anti-abortion extremists have been clear, they will not stop until all access is stopped, including medication abortion,” Bougher said via email. “Abortion bans and restrictions have grave consequences, particularly for pregnant individuals. They make pregnancy less safe and increase the risk of maternal mortality. Moreover, they disproportionately impact marginalized communities, including rural residents, people of color, LGBTQ+ individuals and young people. These bans not only limit reproductive rights but also threaten lives by restricting access to essential health care services.”

There is work being done to try to repeal Indiana’s SB1. Senator Shelli Yoder introduced Senate Bill 208 in January 2024, which would reestablish the licensure of abortion clinics, change statutes concerning when an abortion may be performed and remove the eight-week limitation on the use of certain abortion-inducing drugs.

It would also allow — rather than require — the revocation of a physician's license for the performance of an abortion in violation of the law. The bill is currently pending after being referred to the Senate Health and Provider Services Committee.

“No matter what extremists try to do in the political corridors and courtrooms of Indiana, [we’ll] keep providing Hoosiers with birth control … and referrals to abortion care in other states where it is protected,” Bougher said. “By advocating for transparency and fighting against healthcare deception, we strive to ensure that everyone has access to the care they need and deserve.”

RELATED: Listen to Representative Sue Errington about Senate Bill 1 and its effects on abortion in Indiana and the reporter of this story Kate Farr discuss her approach to reporting on this story on the Ball State Daily News Podcast.