A 19-year-old girl walks up to the clinic’s front desk, a couple of her friends trailing behind. Everyone is yawning after the eight-hour overnight drive from eastern Arkansas to Wichita, Kansas. After a wait, the woman is ushered into a private room and greeted by Dr. Jennifer Kerns, an abortion provider, who relays the encounter.
Kerns, too, arrived that morning after an eight-hour journey of her own, via several flights from San Francisco to Kansas.
It’s a trip Kerns makes every month from San Francisco, where she’s a professor of obstetrics and gynecology at the University of California, San Francisco. At Wichita’s Trust Women clinic, she’s one of two doctors on-site who will perform abortions. She will see some 70 patients over a 48-hour period.
“The landscape has been bleak for a while,” said Kerns. “Doctors have been traveling to perform abortions as long as I’ve known.”
She and another colleague, Dr. Jody Steinauer, are two of three UCSF doctors who use their work time as roving providers. They’ve been part of a nationwide network of hundreds, if not thousands, of doctors traveling to provide abortion care around the country since early 2022, when the fall of Roe v. Wade was imminent.
In Kansas, abortion is legal up until 22 weeks, but states on its southern border — Texas, Oklahoma, Missouri, Arkansas and Louisiana — have total abortion bans that kicked in when Roe v. Wade was overturned on June 24, 2022. Thirteen states have such a ban.
Kerns said doctors come in from mostly coastal areas, where abortion restrictions tend to be looser, to help support clinics near states with bans. Laws in many states make it nearly impossible to access abortion training, and the possibility of jail time forces most doctors to refuse patients seeking abortion at any trimester — even in life-threatening circumstances.
Clinics like Trust Women wouldn’t be able to handle the influx of patients from banned states without outside help. So, doctors like Kerns and Steinauer make the trip.
Since Texas’ Senate Bill 8 passed in 2021, the clinic has quadrupled its patient volume. The Texas bill limits abortion to the weeks before a fetal heartbeat, and allows lawsuits against anyone who “aids and abets” the procedure.
“These days, we see around 650 to 750 women a month,” said Zach Gingrich-Gaylord, a spokesperson for Trust Women.
That’s in contrast to around 100 women a month at Zuckerberg San Francisco General Hospital’s Women’s Option Center, a highly secured and trusted clinic for women who need an abortion. People travel from around the country seeking specialized care at the reproductive health center.
The same goes for the clinic in Wichita. “Something like 70 percent of women who come to Trust Women come from out of state,” said Gingrich-Gaylord. “Of those, around 70 percent come from Texas.”
Across Kansas, more than 75 percent of all women who sought an abortion in 2022 — including travelers and locals — were women of color, a majority of them Black women.
16,000 abortion calls in a day, most unanswered
The 19-year-old from Arkansas, said Kerns, was around 19 weeks pregnant. In her state, abortion is now banned, unless the mother’s life is in danger. But even then, doctors said, the simple procedure is rarely performed.
Once the young woman realized she was pregnant, she spent 12 of the previous 19 weeks getting organized: Constant phone calls to clinics to see who would respond, gathering funds, coordinating a carpool to commute and arranging care for her brothers and sisters (the young woman’s mother worked two jobs, leaving her the sole caretaker of four younger siblings).
Many women don’t know they’re pregnant until after their first missed period, a duration that can range from five to six weeks, or, just under the national legal limit for medicated abortion.
Around that point, women in states with bans are advised to travel for treatment so they don’t face charges for disposing of fetal remains. This was recently the case with a Nebraska 19-year-old sentenced to 90 days in jail and two years’ probation for burying her fetus, which she self-aborted using medication when she was 17.
Trust Women fields some 12,000 calls a day. “We’ve got three or four people answering phones,” said Gingrich-Gaylord. “Of the calls, we might be able to pick up 40 or 50.”
Before last year, the clinic was only receiving fewer than 500 calls a week. But, since the fall of Roe, and the passage of Texas’ bill allowing lawsuits against anyone who facilitates an abortion, clinics across the South and Midwest have closed.
Kerns said on one recent clinic day, receptionists recorded 16,000 calls. Most went unanswered.
“When I think about those 16,000 people who called; what happened?” she asked. “Did they find another clinic? Were the hurdles too many to overcome?”
At the clinic, she said, most people are relieved to feel seen, and not judged, for their decision.
“Sadly, a lot of people are really surprised at being treated well and with compassion along the way,” said Kerns. “Blatant and internalized stigma is brought into the clinic with many people.”
Weeks of work for an outlawed pill
According to Steinauer, a professor and obstetrician/gynecologist at San Francisco General Hospital, a lot of her patients in Wichita are in early stages of their pregnancy.
“It’s upsetting. So many of our patients require very simple procedures. Often, we will see people briefly, give them pills and they drive back.” That’s after sometimes waiting weeks just to get an appointment.
Steinauer is familiar with the issues of the area. She grew up in Omaha, Nebraska, only a four-hour drive from the clinic, and recalls a prevailing sense of conservatism around abortion in her youth. But, she said, her mother and grandmother had grown up staunchly pro-choice, and were unabashed about their views.
“My mom lives in Oklahoma,” she said; another state with a complete ban on abortions. “When they dropped the abortion limit to six weeks, it was my obligation to give back to the Midwest and support access.”
Steinauer, who has two daughters, ages 19 and 21, said that one day she hopes to land back in the Midwest for good.
Kerns, originally from Sacramento, has a similar story of a lifelong commitment to women’s health. She has three children, ages 12, 16 and 19.
“I benefit so much from the support and acceptance around what I do here in the Bay Area,” Kerns said. “It feels like a responsibility to provide my services in a part of the country where they are so needed.”
‘Tiller the Baby Killer’
On most days, a truck and a small number of regular protesters are posted outside the clinic.
“It has huge, disturbing and violent pictures,” said Kerns. “It’s pretty visceral.”
Trust Women exists on a legacy of care for women at any cost. The clinic was founded by Dr. George Tiller, a Wichita native and a man whose legacy transcends the medical world.known throughout pro- and anti-abortion circles.
“I do a private prayer for George every time I go to the clinic,” said Steinauer. Tiller took over the clinic from his father when he died in 1970, when Tiller was 29.
“Women coming in for appointments would ask him: ‘Are you going to help women like your father did?’” Which, Steinauer said, is how he learned that his father was covertly performing abortions. After that, Tiller began to offer the service, too — including late-term abortions when the mother’s life was compromised.
Tiller’s services made him a target around the country: In 2006, Bill O’Reilly dubbed him “Tiller the Baby Killer” on national television, amplifying hostility toward him. In 2009, Tiller was shot and killed by a vehement anti-abortion activist while ushering at a church service.
Kerns and Steinauer both agree that they feel safe, at least for now. If laws in Kansas change, they will have to keep it moving on to another clinic. UC San Francisco and Trust Women provide ample support, and national abortion funding networks supporting their work cover the gamut of expenses: Travel costs, hotels and hours in-clinic.
Still, the realities of life away from home hit both doctors hard.
“So many of these patients tell me, ‘I live really close to Planned Parenthood in Houston and had to come all the way here,’” said Kerns. The stories of patients will stay with her for a long time.
“They’ll say, ‘I have three kids already.’ She’ll want a picture of the ultrasound. But she knows it’s the right thing for her family.”