The cars and pickup trucks from Missouri, Tennessee, Arkansas, Louisiana, Indiana and Mississippi started arriving early in the morning at the Alamo Women’s Clinic in Carbondale, Ill. Men were not allowed inside, so most waited in the parking lot, scrolling or dozing, exhausted after driving through the night.
Abortion is legal in Illinois, but the state is surrounded by others that have largely banned the procedure in the three years since the Supreme Court overturned Roe v. Wade. As a result, Illinois now leads the nation in out-of-state abortion patients. Carbondale, a college town in Illinois’s southern tip within driving distance of 10 states with abortion bans, has become a major abortion hub.
Last year three clinics in this city of 21,000 provided close to 11,000 abortions, almost all for women from other states. The numbers, provided by the clinics, account for nearly a third of all out-of-state abortions in Illinois.
Carbondale is an example of how the Supreme Court’s decision, in Dobbs v. Jackson Women’s Health Organization, to end a woman’s constitutional right to abortion has made geography an all-important factor in access to the procedure. After the decision, 14 states effectively banned abortion, a seismic shift that placed Carbondale, a liberal enclave in a deeply conservative region, in a complicated position.
People in the city are generally supportive of its status as a safe harbor. But the sheer number of abortions has also created some unease, and worry about a backlash.
“We’ve had some community members who were not in favor of the clinics, but as a city there was nothing we could do to not allow them,” said Carolin Harvey, Carbondale’s mayor, a Democrat, although the office is nonpartisan.
She welcomes the clinics but said she worries that the number of abortions could be leveraged by opponents to lobby for a national ban. The clinics have already drawn protests as well as intervention efforts from Coalition Life, a St. Louis-based anti-abortion group that stations “sidewalk counselors” outside Carbondale’s clinics.
Jennifer Barrett, a real estate paralegal who lives in Carbondale, supports abortion rights but said she was concerned about the high numbers in the city “attracting negative attention to a quiet community.”
“I am very happy that we want to care for and protect women, but we don’t want to be singled out as the only place where this is happening, or it’s the only thing we do,” she said.
Nationally, there were 1,038,100 clinician-provided abortions in 2024, according to the Guttmacher Institute, a research organization that supports abortion rights. The number includes 155,000 abortions for patients who had crossed state lines. Overall, the number of abortions in the country has slightly increased since the Dobbs decision, largely because of medication abortions.
Will Stephens, a Republican, an abortion opponent and the mayor of nearby Murphysboro, a nonpartisan position, said the proliferation of clinics in Carbondale was “entirely predictable.” He attributed their arrival in the city to Gov. JB Pritzker and the Illinois legislature, which passed multiple measures after the Roe reversal that expanded abortion access as well as legal protections for the state’s health care workers.
Mr. Stephens said he believed that many people in the area, which has been represented in Congress by a number of anti-abortion Democrats, likely agreed with a Clinton-era slogan that abortion should be “safe, legal and rare.”
“I think that’s probably where a lot of people on all sides fall,” he said.
The clash over abortion in Carbondale also has an economic dimension. Brian Westbrook, the founder of the anti-abortion group Coalition Life, asserted that city officials early on had embraced plans for the three clinics as potential moneymakers for a city laid low by declines in industry and university enrollment.
To bolster his claim, he used an open records request to find an email exchange two months after Roe v. Wade was overturned in 2022 in which Gary Williams, the city manager at the time, said that “just these three clinics alone should result in probably 15,000 patients visiting Carbondale annually,” according to copies of the emails viewed by The New York Times. “So, in spite of the controversy surrounding this issue there is an economic opportunity for our community.”
In an interview this week, Mr. Williams took a different position.
“Whatever I at the time had written to the council, I think if someone were to suggest that we were proactively trying to utilize abortion clinics as an integral part of our development strategy is just silly,” Mr. Williams said. “It was our duty to ensure that anybody that comes to Carbondale, regardless of the reason, needs to be safe and welcome.”
The current city manager, Stan Reno, who took the job in early 2024, said that he had “never been involved in any internal or external discussions of the clinics’ economic impact.”
Jeffrey Davis, Carbondale’s finance director, said the city had no accurate way to measure the clinics’ economic impact. Clinic officials say most women arrive in Carbondale shortly before their abortions, leave immediately afterward and rarely linger to spend money in town.
‘I’m Always Ready for a Backlash’
Two of Carbondale’s three clinics offer a range of health services, but Alamo Women’s Clinic only does abortions, both procedural and medication, all on-site. It does not dispense abortion pills through the mail, a practice targeted by anti-abortion groups and conservative states.
Fewer than five percent of Alamo patients are from Illinois. Some women come by train, but most drive, traveling with partners, family or friends. Like women who seek abortions nationwide, many of them already have children and need to return home on the same day.
On one recent Saturday, the clinic’s busiest day, three patients were from Georgia, a trip of more than 700 miles. Interstate traffic jams or a flat tire can make patients hours late for appointments, but no one is turned away.
Outside the clinic, an anti-abortion sidewalk counselor named Regina, who declined to give her last name, stood at the entrance to the parking lot, waving and smiling into the windows of each vehicle. She was from Coalition Life and said that she lives for slow days at the clinic, “because no children are being killed.”
On this day Regina spoke to a woman whose pregnancy was near the clinic’s 24-week limit. She offered a brochure about free ultrasounds and “abortion pill reversal,” hormone treatments purporting to thwart a medication abortion that the American College of Obstetricians & Gynecologists has said are “not based on science and do not meet clinical standards.”
Sydney Shelton, who volunteers as an Alamo patient escort, rushed to intervene when she saw that the patient was upset. “I saw tears before I could get down to the car,” she said. Once inside the clinic, the woman decided not to have an abortion that day. “I think that will stick with me for awhile,” Ms. Shelton said.
Ms. Shelton, 24, is a Southern Illinois University graduate student from Goreville, a village in the conservative area outside of Carbondale. Only her immediate family knows about her work.
“I have been like, fighting with myself,” Ms. Shelton said. “Do I post this out there because I’m very, very proud of myself for doing this? Or what type of backlash will I get from my neighbors or individuals that I know care very, very strongly about anti-abortion?”
She said she never talks about the number of abortions in Carbondale. “When it comes to conversations around here, I think the best way you can go about it is just advocating for individuals,” she said.
Ms. Shelton and others at the clinic said they spoke to The Times because they were proud of helping women in need and to discuss what they said was a positive experience in Carbondale.
Inside the clinic a young woman sat in a waiting room decorated in soothing colors and plaques with affirming messages. Her mother handed a roll of bills through the window at reception, then fished out a credit card for the balance. Alamo charges what it calls a flat fee of $600 for an abortion. The clinics guide women to nonprofits like the Chicago Abortion Fund that can help pay, but many take care of the fee on their own.
Alamo is managed by Andrea Gallegos, whose father is Alan Braid, a Texas physician who has provided abortions since the Roe ruling in 1973. Ms. Gallegos is not a doctor, but grew up admiring her father’s determination to provide care despite opponents who threatened his life and displayed signs printed with his photograph and the word “murderer.” Until Dobbs, father and daughter operated clinics in their hometown, San Antonio, and in Tulsa, Okla.
After the ruling and Texas and Oklahoma’s subsequent ban of nearly all abortions, they closed those locations and opened a clinic in New Mexico. They also began looking for a place in Illinois, “this kind of beaming light, the only place people from so many states would be able to get to,” Ms. Gallegos said.
She opened in Carbondale, “a blue smudge in the middle of lots of red,” in November 2022. She had planned to open in August but was delayed when some contractors learned the purpose of the clinic and refused to work on its renovation.
There had been protests and lawsuits in Carbondale even before then, when Choices, another clinic, first announced it was exploring coming to the city.
“I can’t tell you for sure if everybody wants us here,” Ms. Gallegos said. “But I think everyone respects that it’s legal in Illinois and if we’re here, we’re here. The priority I’ve always felt from the city is that they just want everybody to be safe.”
Stevelasher (pronounced Sta-laysha) Simpson traveled four hours by car to Alamo from Oxford, Miss., last month. She has an 8-year-old son and a 3-year-old daughter. She works 12-hour shifts at Amazon, training new employees on the packing line, a job she aims to turn into a career.
When she discovered she was pregnant, “I was like ‘Oh, I’m going to have to keep the baby,’ because down here if you say anything about abortion they are on your neck,” she said. But her cousin told her about Alamo, and accompanied her there.
“I didn’t know Illinois was so close to us,” she said. “They keep saying that north people have no hospitality but they did.” The doctor assured her that she would be able to have more children in the future, which is important to her.
“I support any choices that a woman makes,” Ms. Simpson said. “Some people really can’t afford a baby, and we’re not getting any help out here.”
Alamo employs six staffers and doctors from as far away as Montana, who travel to Carbondale to work on-site during three- or four-day rotations. Ms. Gallegos has planted roots in Carbondale after relocating her family.
“I feel good here,” she said. “If we had tried to open even 20 miles down the road in another city we would have had a harder time.”
But, she said, “I’m always ready for a backlash.”
‘Face to Face Conversation’
One hundred miles northwest of Carbondale, Mr. Westbrook of Coalition Life runs the organization from an office park in St. Louis. Abortion is banned in Missouri, and many of Carbondale’s patients come from there.
Mr. Westbrook, 41, was working in a local engineering firm when the eldest of his eight children fell ill. With his son near death, Mr. Westbrook, then 24, said he pledged, “God, take care of my little boy and I’ll rededicate my life to you.”
His son recovered and in 2011 Mr. Westbrook quit his job and founded Coalition Life. His staff of 50, half of them sidewalk counselors, operates in Overland Park, Kan.; Carbondale; and two other cities in Illinois.
For women traveling in from out of state, Mr. Westbrook said, “you really just need to have a conversation, a face-to-face conversation with them.”
The counselors try to persuade women who arrive at a clinic to first get a free ultrasound at an affiliated outlet nearby. By showing them cardiac activity, they try to dissuade them from having the procedure.
Ms. Gallegos — whose clinic provides an ultrasound before every abortion but leaves it up to the woman to decide if she wants to see the image — said the sidewalk counselors sometimes deceive patients by telling them they need an ultrasound at their affiliated outlet before they can enter the Alamo clinic.
Mr. Westbrook responded that “we never tell a woman she can’t enter an abortion facility. Our role is simply to offer compassion, clarity, and support.” But he also called ultrasound “an amazing tool in the toolbox.”
“We do our work from top to bottom with the premise that every woman at some level, deep down inside, knows that abortion is wrong,” he said.
Coalition Life offers financial help and baby supplies for women who decide against an abortion, a decision the group tallies as a “turnaround.” Mr. Westbrook said his group was responsible for 211 turnarounds in Carbondale since 2022. “One child is worth it,” he said. “And so 211 is even more worth it.”
Choices, the first clinic to offer abortions in Carbondale, talked with city, community and church leaders for months before its opening in October 2022. “We wanted them to support the clinic, because that means greater safety for patients and staff,” Jennifer Pepper, Choices’ chief executive, said in an interview. “We told people our vision was to be more than an abortion provider,” but that post-Dobbs, Southern Illinois “was going to be an important part of abortion access.”
After Choices opened, she said, “I think people were really proud that Carbondale was going to be this progressive hub.”
But, Ms. Pepper added, “I’m sure there were people worried about the opposite.”
Julia Rendleman contributed reporting from Carbondale, Ill.
Audio produced by Patricia Sulbarán.
Elizabeth Williamson is a feature writer for The Times, based in Washington. She has been a journalist for three decades, on three continents.
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