A world without rights: Wisconsin abortion programs navigate how to provide care where still legal

With abortion now unavailable in Wisconsin, Wisconsin’s second largest county announced Thursday plans to expand its reproductive health clinic and step up contraceptive services, including providing long-acting contraception.

Meanwhile, the Wisconsin and Illinois affiliates of Planned Parenthood are teaming up to expand abortion availability in Illinois where the procedure’s legality remains secure — and deploying Wisconsin-based doctors and nurses to help do that work.

At Planned Parenthood of Illinois’ clinic in Waukegan, 10 miles south of the Wisconsin state line, “We’ve seen a tenfold increase in patients from Wisconsin,” said Jennifer Welch, president and CEO Planned Parenthood of Wisconsin.

Elsewhere in Wisconsin, local health departments and private agencies that offer reproductive health care have also seen increased demand for contraceptive services since the U.S. Supreme Court canceled a nationwide right to abortion.

The high court’s 6-3 ruling in late June that overturned the 1973 decision Roe v. Wade legalizing abortion effectively criminalized the procedure in Wisconsin under an 1849 law. While Wisconsin Attorney General Josh Kaul has gone to court to challenge the pre-Civil War statute, abortion providers have stopped working in the state.

Long-acting contraception

In light of the ruling, Dane County Executive Joe Parisi said he was asking the Dane County Board to allocate money to expand staffing and hours for the county’s reproductive health services program.

“The Supreme Court’s decision to overturn Roe v. Wade has created a health care emergency for every woman and person who gives birth in Dane County,” Parisi said at a news conference. “Public health already provides many reproductive health care services, including education, birth control and contraception, but the need to expand those services has never been more urgent.”

Parisi said he will seek $360,000 from the county’s general fund so that Public Health Madison & Dane County can increase personnel and add hours for its sexual health program. With the additional funding, the health department will offer long-acting reversible contraception in the form of intrauterine devices (IUDs) or other long-term birth control measures.

The health department is a partnership of the city and the county. In 2023, Parisi said, the two governments plan to budget an additional $1 million to continue the added services.

The additional resources will allow the health department to extend the hours at its Madison East Side clinic from the current 16 hours a week to 24 hours, said Janel Heinrich, the health department director. The clinic offers testing for sexually transmitted infections and provides low- or no-cost birth control and emergency contraception.

“This expanded capacity will help us reach hundreds more people each year,” Heinrich said. “We will also be able to dedicate more time and focus on reproductive health care, outreach, education and services.”

In an interview, Heinrich said that the Madison-Dane County department has focused more on caring for pregnant mothers and managing sexually transmitted infections and less on providing contraception. But while Madison has a “robust” array of reproductive and sexual health services, she said, “we also know that it’s insufficient, because capacity doesn’t always make things accessible.”

Madison Mayor Satya Rhodes-Conway said that expanding the availability of long-acting contraception has been shown to improve health outcomes elsewhere. In Colorado, after their use among 15- to 24-year-olds increased from 5% to 20%, “teen birth rates declined more rapidly than in any other state” — by 40%, she said.

Rhodes-Conway said the expanded contraceptive services alone was not enough.

“We need access to a full range of equitable and evidence-based reproductive health care, including safe and legal abortion, to have healthy and thriving women, people that may become pregnant, children, families, and indeed our entire community,” she said.

Crossing state lines

The Illinois-Wisconsin Planned Parenthood partnership that the organizations’ leaders unveiled on July 14 has long been in the works. Planned Parenthood of Illinois opened its Waukegan facility in 2020. Discussions began the next year with the Wisconsin affiliate about how they might work together if Roe was rolled back, said Kristen Schultz, chief strategy officer of the Illinois organization.

Welch, the Illinois Planned Parenthood executive, said the Wisconsin staffers began training in Illinois earlier this year, and clinicians and medical staff were licensed to practice in Illinois.

When the rollback became clear after a draft of the court decision leaked in early May and attempts to repeal Wisconsin’s 1849 ban failed, the two groups moved ahead with their plans.

A majority of Wisconsin staff involved in abortion procedures, from doctors and nurses to clerical workers and other assistants, agreed to come to Illinois to work, said Schultz. “Because of this partnership, we have been able to double our abortion provision at the Waukegan Health Center,” she added.

As an example of how the affiliates work together, Schultz cited the case of a Wisconsin patient who had a medical visit, ultrasound exam and lab work in Wisconsin, then traveled to Waukegan for her abortion. Navigators for the Illinois agency worked with the Wisconsin agency to help with transportation and funding.

Even before the end of Roe, abortion in Wisconsin “was already extremely limited and heavily restricted,” said Tanya Atkinson, president and CEO of Planned Parenthood of Wisconsin.

Until the ruling, the organization offered abortions at four centers in Milwaukee, Madison and Sheboygan. “So 96% of Wisconsin counties had no abortion provider, and 63% of Wisconsin women live in those counties,” Atkinson said.

Planned Parenthood of Wisconsin provided 5,000 abortions in 2021. Since the court ruling, “our call volume has doubled, and we’re referring all of our abortion patients out of state for care,” Atkinson said, with the majority going to Illinois.

Contraceptive demand rising

Reproductive health providers elsewhere in Wisconsin have also seen the effects of the court’s ruling. HealthFirst Network, based in Wausau, is a nonprofit provider of reproductive health services in nine north-central Wisconsin counties. It provides contraception of various kinds, diagnosis and treatment for sexually transmitted infections and other forms of sexual health care, including providing long-acting reversible contraception. In addition to IUDs, the other form of long-acting contraceptive is a plastic implant that slowly releases hormones to prevent conception.

In June, the network’s clinics placed twice as many long-acting reversible contraceptives in patients as it did in May, according to Jessica Scharfenberg, the network’s CEO. “There was an instant uptick as soon as the leak [of the draft opinion] came out, and then that just compounded once the actual decision was made,” she said.

Scharfenberg is also president of the Wisconsin Family Planning and Reproductive Health Association. The organization represents independent nonprofit private clinics as well as local and county health departments with family planning and reproductive health programs. Planned Parenthood is also a member.

She said she has heard reports from providers throughout the association of increased demand for long-term contraception.

Some reproductive health clinics serve people covered by a special Medicaid program that provides family planning coverage for families with incomes of up to 300% of the poverty level. But increased demand for those funds led to smaller grants for the clinics that applied, Scharfenberg said, “so clinics are working hard to do more with less.”

Building ‘something better’

Professor Tiffany Green, a health economist at the University of Wisconsin who studies health equity, particularly in the area of obstetric and reproductive care, calls expanding access to reproductive health services “crucial and important in helping people to exercise their right to reproductive autonomy.”

At the same time, “it is not a substitute for abortion care access,” she said, adding that she believes that Madison and Dane County officials understand that as well.

Green said it will be important as agencies expand their services that they do so in ways that reach out to the communities they serve and take time to understand and respect their needs and preferences. That will include being careful about scheduling times when they provide their services. It will also include being culturally responsive and respectful to people of color and to other marginalized groups, including transgender and gender-non-conforming people, she added.

It will also include heeding and respecting the contraceptive choices that their patients want to make, rather than “pushing a kind of contraception on them they do not want,” Green said. “There is a history of doing that with Black people.”

As the state enters a new and more difficult era for reproductive health, there’s an opportunity to avoid repeating past wrongs, she said.

Even before Roe fell, “we didn’t have a society where Wisconsinites could fully exercise their reproductive autonomy,” said Green. While that is even worse now, “perhaps we can build something better — not reproducing the same mistakes as we all try to get through this.”