New Chicago clinic provides ‘all-trimester' abortions up to roughly 34 weeks in pregnancy

Chicago Tribune

2 days ago

A new Chicago clinic is providing abortions to patients up to roughly 34 weeks into pregnancy — the only standalone clinic in the Midwest to offer often-controversial terminations in the third trimester and among only a handful that do so nationwide.
Hope Clinic, a longtime abortion provider in southern Illinois, opened a second location in the Uptown neighborhood June 2 advertising 'all-trimester' abortions.
'Hope Clinic is now open in Chicago, IL, expanding our care through all trimesters! (And OMG we couldn't be more excited),' the clinic's Instagram page announced. 'Everyone deserves access to abortion care, whenever they need it. Because deciding and acting on what's best for you shouldn't be on anyone else's timeline.'
Clinic officials say abortions performed there — including those in the late second trimester and third trimester — will comply with the 2019 Illinois Reproductive Health Act, which allows terminations up to fetal viability, when a fetus has a significant likelihood of survival outside the womb without extraordinary medical measures. After that point, an abortion can only be performed to protect the life or health of the pregnant person, according to the law's exemptions.
But the clinic intends to offer patients as much access to abortion as possible within the bounds of those regulations, said Dr. Erin King, Hope Clinic chief medical officer.
'I want people to know that we are absolutely following the law, but that we make a really careful determination,' she said. 'And we want to provide access to as many people as we can within the law.'
As the third anniversary of the end of Roe v. Wade approaches, a new local clinic specializing in abortion services later in pregnancy underscores the extreme polarization in reproductive health laws from state to state, a disparity that continues to grow nationwide.
Since the U.S. Supreme Court's June 24, 2022, decision to overturn federal abortion rights, many conservative states have all but banned terminating a pregnancy except in the narrowest of circumstances, often involving health or life emergencies.
Even in endangerment cases, there is no national consensus: The day after Hope Clinic Chicago opened, the Trump administration announced it would be revoking a guidance directing hospitals to terminate pregnancies during medical emergencies. Those guidelines were an attempt by the Biden administration to preserve some access in states with bans on the procedure, particularly in cases where pregnant patients faced organ loss or severe hemorrhaging, among other potentially grave complications.
At the same time, more liberal states, including Illinois, have in the past few years eliminated many of the legal obstacles to abortion access, often in direct response to mounting constraints on reproductive rights in other parts of the country.
The one major restriction remaining in Illinois is a limit on terminations past fetal viability, which is generally considered somewhere around 24 to 28 weeks in pregnancy, though the law cites no specific gestational age. After viability, an abortion can be performed if the pregnant person's life or health is at risk, including mental health conditions.
Abortion opponents decried the arrival of Hope Clinic Chicago.
Eric Scheidler, executive director of the Chicago-based Pro-Life Action League, said while abortion at any point is unconscionable, terminations later in pregnancy are particularly abhorrent.
'Almost everyone recognizes the brutality of an abortion that late in pregnancy,' he said. 'I think it's a common ground area we have with a lot of people. As alarming as it is for someone like me who cares about fetal life, life in the womb, and who cares about the fate of women who participate in the demise of their child, on another level I appreciate the honesty and openness. Because it allows us to have a frank conversation about what late-term abortion really is.'
A Gallup poll in 2023 found that support for legal abortion drops later in pregnancy: More than two-thirds of Americans said ending a pregnancy should be legal in the first trimester but only 37% supported legal abortions in the second trimester; less than a quarter of respondents favored legal terminations in the third trimester.
'The overarching issue is that Illinois law is intentionally vague,' said Mary Kate Zander, president of Illinois Right to Life. 'Illinois state legislators don't want to say that third trimester abortion is legal in Illinois. … But the reality is, (elected leaders) want women to be able to come to Illinois in the third trimester and get an abortion.'
The clinic has the support of the Illinois attorney general and Gov. JB Pritzker's administration, which has vowed to make Illinois a reproductive rights haven.
Attorney General Kwame Raoul said that lllinois law 'recognizes the fundamental right to abortion and affirms that decisions about abortion, as with any health care, are between a patient and their medical provider in accordance with the provider's professional judgment and standards of care.'
He added that fetal viability is determined on a case-by-case basis.
'Illinois law permits abortion care after a determination of fetal viability if, in the professional judgment of the provider, such care is necessary to protect the life or health of the pregnant patient,' he said in a statement to the Tribune. 'My office has fought to secure Illinois as an oasis for safe and effective abortion access. I welcome and will work to protect the providers who provide safe and lawful health care to any patient seeking care here.'
Hope Clinic Chicago will be 'an additional resource to much-needed critical reproductive health care in the region,' Melissa Kula, spokesperson for the Illinois Department of Healthcare and Family Services, said in an email.
'The state continues to prioritize access to comprehensive reproductive and maternal health care services, including supporting abortion providers,' she said.
Hope Clinic Chicago expects to see eight to 10 patients a week, focusing primarily on second and third trimester abortions as well as a handful of early pregnancy medication abortions, King said.
The clinic offers abortions at the latest gestational age of any freestanding clinic or health center in Illinois.
Hope Clinic's Granite City location, which was established in 1974, provides abortions up to 27 weeks and six days. Equity Clinic in Champaign advertises terminations up to 25 weeks and six days. A Planned Parenthood in Fairview Heights near St. Louis goes up to 26 weeks, according to its website.
Hope Clinic Chicago's Instagram page lists some of the reasons patients might seek an abortion late in pregnancy: Fetal anomalies are often diagnosed far later than the first trimester. New maternal health conditions can develop. Patients might have to delay care due to barriers to accessing abortion or a lack of resources.
Sometimes patients don't realize they've conceived until far into their pregnancy, according to the social media post.
'They just don't want to be pregnant,' is another reason on the Instagram page. 'You get to change your mind and make decisions that are right for you. And they don't have to be on anyone else's timeline.'
There is no mention on Hope Clinic's website or Instagram page of the viability restriction in Illinois law or its health and life exemptions.
'It would be impossible to list for folks every single … criteria to meet a health exception. It would be an untenable list of things on a website or Instagram,' King said. 'We absolutely do a very careful review of medical history, just like we would for any medical patient. History, both physical and social history, all the very things that go into seeing a patient.'
King said that if patients past the point of fetal viability don't meet a health exception then 'we do not see them,' and they would have to be referred to another provider.
There are other states with no gestational limits or viability restrictions, including New Mexico, Alaska, Colorado, Maryland, Minnesota, Michigan, New Jersey, Vermont and Oregon, as well as Washington, D.C., according to the Guttmacher Institute, a pro-reproductive rights research group.
But only a few clinics nationwide offer abortions in the third trimester, including DuPont Clinic in Washington, D.C., VAG Clinic in New Mexico and Partners in Abortion Care in Maryland.
'Right now, if you're looking at all-trimester providers, there's very few across the country and patients have to (travel) very long distances to get there,' King said.
The physician anticipates that more than half of the patients at the new Uptown clinic will be traveling from other states.
Since the demise of Roe, a surge of out-of-state patients have been coming to Illinois to have abortions, sometimes later gestationally because of longer travel distances and wait times for appointments.
In 2024, Illinois provided roughly 35,000 abortions to patients from other states, ranking as the state with the highest number of out-of-state abortions for the second year in a row, according to the Guttmacher Institute.
'Abortion bans themselves deny people access to care on the timeline they desire, furthering the need for abortion care later in pregnancy,' said Megan Jeyifo, executive director of the Chicago Abortion Fund. 'More abortion seekers are being pushed further into pregnancy before they can access appointments, which is why expansions like this are so critical.'
Illinois abortion providers have also reported a spike in patients with complicated medical issues requiring hospital care that freestanding clinics can't offer.
In response, Illinois in 2023 launched the Complex Abortion Regional Line for Access, which includes a hotline staffed by a nurse to help patients schedule abortion appointments in local hospital systems.
King said the new clinic is trying to ease that burden by treating patients later in pregnancy who are appropriate for outpatient-based care, so hospitals can focus on the most medically complicated cases.
But Zander of Illinois Right to Life said she doesn't believe most Illinois voters intended for the law to permit abortions so late in pregnancy.
'The state of Illinois is trying to do some sort of work-around where they're saying OK, elective third trimester abortion is not legal because we know that Americans don't really like that and that's not palatable even for pro-choice people,' she said. 'But we'll allow so many excuses … they make the definition of medical reasons so incredibly vast and vague that any woman could find herself in a doctor's medical office convincing that doctor she has a medical reason to have an abortion … even if the threat to her life does not exist. And that's political.'
For nearly a half-century, the concept of fetal viability was a cornerstone of Roe until roughly three years ago, when the landmark 1973 case was overturned by Dobbs v. Jackson Women's Health Organization.
'With respect to the State's important and legitimate interest in potential life, the 'compelling' point is at viability,' the high court ruled in Roe. 'This is so because the fetus then presumably has the capability of meaningful life outside the mother's womb.'
The original version of the Illinois Reproductive Health Act included no gestational limit or viability restriction, leaving the decision of when during pregnancy an abortion can be performed to the patient and medical provider.
Around the same time, President Donald Trump targeted abortions late in pregnancy during his February 2019 State of the Union Address.
'To defend the dignity of every person, I am asking the Congress to pass legislation to prohibit the late-term abortion of children who can feel pain in the mother's womb,' he said. 'Let us work together to build a culture that cherishes innocent life.'
In March 2019, throngs of abortion opponents protested the Illinois measure, filling the state capitol to blast the bill. Several anti-abortion groups warned in a joint news release that if the legislation were enacted, 'Illinois would become a third-trimester abortion destination.'
Yet there was a simultaneous groundswell in favor of the measure, which enshrined abortion as a 'fundamental right' in Illinois law. The support came amid a wave of conservative states passing so-called heartbeat bills limiting abortion to about the first six weeks, before many know they're pregnant.
Reproductive rights supporters protested these abortion bans at Federal Plaza in May 2019, some holding signs calling for 'abortion on demand.'
Before Pritzker signed the Reproductive Health Act in June 2019, legislators amended the language to include the viability restriction.
But medical experts say fetal viability can be a complicated concept in practice.
The American College of Obstetricians and Gynecologists opposes using viability as a standard in the legislation or regulation of abortion.
'Viability is just one factor that patients and health care professionals use when considering whether to proceed with or end a pregnancy, and gestational age is only one factor considered when estimating viability,' the organization said in a statement. 'Legislative bans on abortion care often overlook unique patient needs, medical evidence, individual facts in a given case, and the inherent uncertainty of outcomes in favor of defining viability solely by gestational ages.'
While King said she complies with Illinois law, she is critical of viability restrictions as well as gestational limits.
'Any restriction around abortion access disproportionately affects people that already have difficulty accessing any health care … the most marginalized folks,' she said. 'People who have lower incomes. People from health deserts. People experiencing inequities in health care due to their race.'
Terminations later in pregnancy tend to be rare, with 79% performed at nine weeks or earlier and 93% occurring in the first 13 weeks, according to the Centers for Disease Control and Prevention data from 2022. Only 1% were performed at or after 21 weeks, though some criticize the CDC data as incomplete because it includes limited areas that report abortions by gestational age and excludes major states such as California and New York, according to KFF, formerly the Kaiser Family Foundation.
While abortions later in pregnancy are uncommon relative to earlier terminations, 'that doesn't mean it's not essential health care,' said Sarah Garza Resnick, president and CEO of the reproductive rights advocacy group Personal PAC.
'At no point in any pregnancy does the government know more about my body than me or my doctor,' she said. 'People need later care and they need trusted clinics, like Hope, to provide that care.'
On the other end of the spectrum, abortion opponents argue that fetal viability is a moving target because, with advancing medical interventions, babies are born at earlier gestational stages compared to when Roe was decided.
'We regularly see babies born at 24 weeks who go on to live,' Zander said.
During an interview with the Tribune after Roe fell, Dr. Karen Deighan recounted how ultrasounds and other technology have ameliorated over the years, solidifying her belief that life begins at conception.
'You can see very early the heart, all the organs, the head, the eyes, the movement. You can see the baby inside,' said Deighan, then an associate professor of obstetrics and gynecology at Loyola University Medical Center. 'I struggle sometimes, because some of my colleagues will work so hard to protect and save a 22-week peri-viable pregnancy. … And then don't see a problem with someone choosing to end that pregnancy.'
Scheidler of the Pro-Life Action League called the new Chicago clinic an example of the 'increasing radicalization of abortion advocates.'
'We used to hear talk about abortion being safe, legal and rare. Being an anguished decision,' he said. 'The way our state has been going, it's going to become the abortion capital of the United States. That's what's happening.'