And he’s been on a journey for four years.

Once a week, the transgender teen injects testosterone into his body. He’s had his eggs frozen in case he wants to have his own biological children one day. He talked with his parents and his psychologist and decided he was ready for the next step of treatment: top surgery to remove breast tissue.

“Getting this treatment isn’t fixing something that’s wrong with me,” the teen said. “It’s just helping me grow more into who I want to be and who I can feel most comfortable existing as.”

Â鶹ŮÓÅ Health News and NPR are not identifying the teen by name or using his mother’s last name because both are concerned he could be targeted for being transgender.

The teen’s mom, Jane, waited for a call to schedule the surgery at of Chicago. Then, she received a voicemail from the hospital. She said she knew what the message would be even before she listened to it: The surgery wouldn’t happen.

She had already read on social media that Lurie Children’s, located near downtown Chicago, would for people younger than 19 in the wake of an from President Donald Trump.

Jane called Lurie back to confirm that , then told her son when he got home from school that day.

“I said, ‘Hey, we are going to take care of you,'” she recalled. “‘We will make it through this.'”

It was devastating, Jane said.

“We are being threatened,” she said. “The trans community is being threatened, and parents are being threatened.”

Her son said he feels hurt and confused. His doctors told him after Trump was elected in November that they would fight as hard as they legally could to support him, he recalled. But then Lurie’s leaders decided to cancel pending surgeries and stop scheduling new ones.

“I know that it’s not like a personal thing, like they didn’t look at me directly and go, ‘Yeah, you don’t deserve that,'” the teen said. “But it kind of feels like it sometimes, especially when a lot of what the sentiment has been, in general, towards trans people in society.”

, a Lurie Children’s spokesperson confirmed the hospital would pause gender-affirming surgeries.

Â鶹ŮÓÅ Health News and NPR spoke with 10 patients or their parents in the Chicago area about how this affects their lives. They described their disappointment, their loss of hope for one day having a procedure, and their anger at the timing, when they by around the country.

These families fear that they eventually could lose access to all gender-affirming care, such as therapy, puberty blockers, and hormones. They’ve also questioned why Illinois officials who have vowed to protect transgender rights have been quiet on what’s happening at Lurie Children’s and elsewhere. in Chicago for minors, families told Â鶹ŮÓÅ Health News and NPR.

Lurie Children’s decision came after Trump’s executive order on Jan. 28 threatened to cut federal funding to health care providers offering gender-affirming medical care.

“Across the country today, medical professionals are maiming and sterilizing a growing number of impressionable children under the radical and false claim that adults can change a child’s sex through a series of irreversible medical interventions,” according to Trump’s order. “This dangerous trend will be a stain on our Nation’s history, and it must end.”

Another patient, a 16-year-old boy from Chicago, had a surgery date for a double mastectomy procedure — until Lurie Children’s canceled it. Â鶹ŮÓÅ Health News and NPR are not identifying him because he fears for his personal safety.

The teen felt betrayed by the cancellation, he said. He has been binding his chest for more than five years, but doing so causes rib and back pain.

Every morning, he faces a choice: bind his chest to fully “pass” as male, or skip that and experience a day without pain. He avoids sports because he can’t breathe as well when his chest is bound. A large part of his gender dysphoria is centered on having breasts, he said.

Lurie Children’s deemed the teen’s surgery “medically necessary,” according to medical documents his family shared with Â鶹ŮÓÅ Health News and NPR.

“Lurie’s decision set a precedent not only for other care providers but also for their patients,” said the teen. “They have established that they are no longer the safe haven they have claimed to be for so many years.”

Many of Lurie Children’s patients were referred for surgery to Northwestern Memorial Hospital, a prominent research hospital nearby. Their initial Northwestern appointments were later canceled. A Northwestern spokesperson declined repeated requests to comment.

Parents whose transgender children are receiving other types of medical care at Lurie Children’s, such as hormone therapy, worry about what the hospital might stop providing next.

“If we can’t get estrogen in a year, what do we do?” says the mother of a 15-year-old transgender girl. Â鶹ŮÓÅ Health News and NPR are not naming her because she fears retaliation against her daughter if she is identified. “Parents with means are talking about leaving the country.”

The Politics of Pausing Surgeries

In a statement, physician said he hears and understands the frustration. He is the founding director of the at Lurie Children’s.

“My life’s work has been devoted to these children, adolescents, and their families,” Garofalo wrote. “As someone who has spent his entire career at Lurie Children’s, I can assure you these kids and these families matter to this institution. It’s important to know that this decision was painstakingly difficult, and it was made amid unprecedented circumstances and external pressures.”

The hospital’s decision, Garofalo wrote, was based on the belief it could help safeguard most of the clinical services offered by his program.

, researchers have found.

After Trump’s executive order, and 14 of his peers in other states vowed to protect access to treatment. , Raoul said the Illinois prohibits health care providers from discriminating against patients because of their gender identity.

But recently he told Â鶹ŮÓÅ Health News and NPR that it would be that Lurie and Northwestern are violating state law.

“I don’t look at Lurie or Northwestern as a bad actor here,” Raoul, a Democrat, said after an event on April 1, at which he told a packed room of civic leaders in a restaurant near downtown Chicago to by the White House. It’s not discrimination, Raoul said, “when the federal government is holding a gun to your head.”

When Â鶹ŮÓÅ Health News and NPR asked whether Lurie Children’s is violating the Human Rights Act, Democratic Gov. didn’t answer. But he did say hospitals are being “blackmailed” into limiting care.

“This is not the hospitals’ fault,” Pritzker said. “Believe me. I know the people at Lurie Children’s Hospital, I know the people who run most of these hospitals, and I can tell you that they want to do the right thing for their patients.”

Lurie Children’s and some hospitals across the country have paused surgeries or other types of gender-affirming treatment despite federal judges who issued rulings .

A Hospital Confronts an Uncertain Legal Future

Lurie Children’s has one of the oldest gender-affirming care programs in the country, launched in 2013, and still offers hormone therapy, puberty blockers, and behavioral health services.

Medical providers, patients, and parents that underscores the crucial and even that transgender medical care can provide, such as helping . Access to gender-affirming care is supported by the and the .

The transgender community is small, and families say they feel targeted because of this. In 2023, around 3% of high school students in the U.S. identified as transgender, and an additional 2% identified as questioning, according to a from the federal Centers for Disease Control and Prevention.

Transgender youths experience more violence, bullying, and suicidal thoughts than their non-trans peers, the CDC study found. About 1 in 4 students who were transgender or questioned their gender identity attempted suicide in the past year, the study found.

In recent years, many states have to gender-affirming care for minors, according to Â鶹ŮÓÅ, a health information nonprofit that includes Â鶹ŮÓÅ Health News. Just over half the country — — ban or restrict access. Recently, Iowa took the step of from people who are trans or nonbinary.

Elizabeth Mack, a pediatric critical care physician in South Carolina, has witnessed the consequences of a ban in her state. She has treated several children who attempted suicide or died by suicide because they couldn’t access treatment, according to conversations she had with the patients or family members.

“It’s just one of those things that leaves a mark that I can’t unsee,” Mack said of her experience.

This Teen Already Had His Surgery but Still Worries

Ben Garcia, 18, a Chicago high school senior, offers a glimpse into life post-surgery. In 2023, he had a double mastectomy. He believes that without the medical care he’s received for the past several years, he would be a different person, likely more withdrawn and less confident.

“This care has allowed me to be a lot more comfortable in who I am, in the way that I present myself to the world,” Garcia said.

Garcia and his mother, Michelle Vallet, emphasized that his path to surgery was a slow process that proceeded with care and deliberation. Once puberty started, Garcia started to have questions and wanted to explore what it would mean to delay the changes occurring in his body. At that time, he was around 10 or 11 years old.

Vallet reached out to Lurie Children’s Hospital and booked a first appointment for Garcia. It lasted three hours, she said.

Much of the public misunderstands the process, Vallet said, and transgender kids have become some of the most scrutinized patients in America.

“I think they feel like trans kids are just one day waking up saying, ‘I want to be a boy,'” Vallet said. “They go to the gender clinic, wham bam. That’s not how this care happens.”

She, her son, and the medical staff at Lurie Children’s talked through the risks of treatment, the possible side effects, and the next steps.

Garcia went through mental health evaluations over multiple appointments before he could take puberty blockers to stop his body from going through changes. Then he started taking low doses of testosterone, a hormone. Gradually, his voice dropped, and he grew facial hair.

Garcia still takes testosterone shots every week and gets checkups at Lurie Children’s to monitor his hormone levels. He’s now nervous this care could also be affected. His mother is worried that the hospital might suspend all types of gender-affirming care.

“It’s heartbreaking to see hospitals as big as Lurie comply in advance,” Vallet said, referring to the executive order’s threats to cut hospital payments. “It feels like a betrayal. … There’s federal dollars on the line, but at a certain point in the environment we’re in, you have to say, ‘No, I’m not doing this.'”

The suburban 17-year-old who never got a surgery date is waiting to hear back from other hospitals. He has a preliminary appointment booked at one hospital in May, but there’s a waitlist. Surgery is likely months away.

He’s convinced that the medical care he’s already received has saved his life and given him hope for his future. He thinks about studying medicine in college, inspired by the care he’s received.

His mom, Jane, said he’s thriving.

“I’m really proud of him, because he just makes sense,” Jane said as her son described all that’s involved in being able to have surgery. “He makes sense, and people are listening to him make sense and giving him what he needs to exist.”

This article is from a partnership that includes , , and Â鶹ŮÓÅ Health News.

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

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Y ha estado en proceso de transición durante cuatro años.

Una vez por semana, este adolescente trans se inyecta testosterona. Ha congelado sus óvulos por si algún día quiere tener hijos biológicos.

Conversó con sus padres y con su psicóloga y decidió que estaba listo para el siguiente paso en su tratamiento: una cirugía en su pecho para remover tejido mamario.

“Recibir este tratamiento no es arreglar algo que esté mal en mí”, dijo el adolescente. “Solo me está ayudando a convertirme más en la persona que quiero ser y con la que me siento más cómodo, más a gusto”.

En este artículo, Â鶹ŮÓÅ Health News y NPR no revelan su nombre ni el apellido de su madre por temor a que puedan ser blanco de ataques por su identidad de género.

La madre del adolescente, Jane, esperaba una llamada para programar la cirugía de su hijo en el . Pero lo que recibió fue un mensaje de voz del hospital. Jane aseguró que sabía lo que diría, incluso antes de escucharlo: la cirugía no se iba a realizar.

Ya había leído en redes sociales que, luego de , el hospital ubicado cerca del centro de Chicago, había decidido

Jane llamó al hospital para y se lo dijo a su hijo ese mismo día, cuando llegó de la escuela.

“Le dije: ‘Vamos a cuidarte. Vamos a superar esto’”, contó Jane. “Pero fue devastador”.

“Estamos siendo amenazados”, afirmó Jane. “La comunidad trans está siendo amenazada, y los padres también”.

Su hijo le dijo que se siente herido y confundido. En noviembre, después que Trump fuera elegido, sus médicos le habían asegurado que, dentro de la legalidad, lucharían con todas sus fuerzas para apoyarlo, recordó.

Pero los directivos del Lurie decidieron cancelar las cirugías pendientes y dejar de programar otras nuevas.

“Sé que no es algo personal, sé que no me miraron directamente a mí y me dijeron: ‘Sí, no te lo mereces’”, dijo el muchacho. “Pero a veces lo siento así, sobre todo cuando veo el sentimiento general hacia las personas trans en la sociedad”.

El un vocero del hospital confirmó que se pausarían las cirugías de afirmación de género.

En el área de Chicago, Â鶹ŮÓÅ Health News y NPR hablaron con diez pacientes o con sus padres sobre cómo este cambio afectaba sus vidas.

Todos describieron su decepción, su pérdida de esperanza de tener la cirugía algún día, y su enojo por el momento en que se produce, cuando ya se sienten por la que se respira en todo el país.

Estas familias temen que, con el tiempo, también se les niegue el acceso a toda la atención sanitaria relacionada con la reafirmación de género, como la terapia, los bloqueadores de la pubertad y las hormonas.

También se preguntan por qué los funcionarios de Illinois, que se habían comprometido a proteger los derechos de las personas transgénero, no han dicho nada sobre lo que está sucediendo en el Lurie Children’s y en otros lugares.

El de Chicago también , según informaron las familias a Â鶹ŮÓÅ Health News y NPR.

La decisión del Lurie Children’s se produjo después que la orden ejecutiva de Trump del 28 de enero amenazara con recortar los fondos federales a los proveedores que ofrecieran atención médica de afirmación de género.

“En todo el país, los profesionales médicos están mutilando y esterilizando a un número cada vez mayor de niños influenciables bajo la afirmación radical y falsa de que los adultos pueden cambiar el sexo de un niño mediante una serie de intervenciones médicas irreversibles”, sentencia la orden de Trump. “Esta peligrosa tendencia será una mancha en la historia de nuestra nación y debe terminar”.

Otro paciente, un joven de 16 años de Chicago, tenía fecha para una doble mastectomía, hasta que el Lurie Children’s la canceló. Â鶹ŮÓÅ Health News y NPR tampoco revelan su identidad porque el joven teme por su seguridad personal.

El adolescente contó que se sintió traicionado por la cancelación. Lleva más de cinco años vendándose el pecho, lo que le causa dolor en las costillas y la espalda.

Cada mañana se enfrenta a una elección: vendarse el pecho para “pasar” completamente por hombre, o no hacerlo y vivir un día sin dolor. Evita los deportes porque no puede respirar bien cuando tiene el pecho vendado. Gran parte de su disforia de género se centra en tener pechos, dijo.

El Lurie Children’s consideró que la cirugía del adolescente era “médicamente necesaria”, según los documentos que su familia compartió con Â鶹ŮÓÅ Health News y NPR.

“La decisión de Lurie sentó un precedente no solo para otros proveedores de atención médica, sino también para sus pacientes”, dijo el adolescente. “El hospital ha demostrado que ya no es el refugio seguro que han afirmado ser durante tantos años”.

Muchos de los pacientes de Lurie Children’s fueron derivados al Northwestern Memorial Hospital, un destacado hospital de investigación cercano, para tener sus cirugías. Pero sus citas iniciales en Northwestern fueron canceladas posteriormente. Un vocero de la institución rechazó responder a los repetidos pedidos de comentarios.

A los padres cuyos hijos transgénero reciben otros tratamientos médicos en Lurie Children’s, como terapia hormonal, les preocupa que el hospital también deje de proporcionar esos servicios en el futuro.

“Si no podemos conseguir estrógenos en un año, ¿qué haremos?”, se pregunta la madre de una niña transgénero de 15 años. Â鶹ŮÓÅ Health News y NPR tampoco revelan su nombre por el mismo temor que los otros. “Los padres que tienen recursos para hacerlo están discutiendo la posibilidad de marcharse del país”, afirma.

La política de suspender las cirugías

En un comunicado, el doctor aseguró que escucha y comprende la frustración de los pacientes y de sus familias. Es el director y fundador del del Lurie Children’s.

“He dedicado mi vida a estos niños, adolescentes y sus familias”, afirmó Garofalo. “Como alguien que ha pasado toda su trayectoria profesional en el Lurie Children’s, puedo asegurarles que los jóvenes y sus familias son fundamentales para esta institución. Es muy importante que dejemos en claro que esta decisión ha sido muy difícil y se ha tomado en circunstancias sin precedentes y bajo presiones externas”.

Garofalo escribió que la decisión de pausar las cirugías se basó en la creencia del hospital de que de ese modo podría ayudar a salvaguardar la mayoría de los servicios clínicos que ofrece este programa.

Los investigadores han comprobado que .

Luego de la orden ejecutiva de Trump, el y 14 de sus pares de otros estados se comprometieron a proteger el acceso al tratamiento.

En , Raoul afirmó que la de Illinois prohíbe a los proveedores de atención médica discriminar a los pacientes por su identidad de género.

Sin embargo, recientemente el fiscal declaró a Â鶹ŮÓÅ Health News y NPR que que Lurie y Northwestern están infringiendo la ley estatal.

“No considero que Lurie o Northwestern sean los malos de la película”, afirmó Raoul, demócrata, tras un acto celebrado el 1 de abril en un restaurante cerca del centro de Chicago. Allí, Raoul le pidió a una sala repleta de líderes cívicos que de la Casa Blanca.

Raoul opinó que la decisión de los hospitales no puede considerarse discriminación, “cuando el Gobierno federal te apunta con una pistola a la cabeza”.

Cuando Â鶹ŮÓÅ Health News y NPR le preguntaron el gobernador demócrata JB Pritzker si el Lurie Children’s estaba infringiendo la Ley de Derechos Humanos, el centro . Pero sí dijo que los hospitales están siendo “chantajeados” para limitar la atención.

“No es culpa de los hospitales”, afirmó categóricamente Pritzker. “Créanme. Conozco a la gente del Lurie Children’s Hospital, conozco a la gente que dirige la mayoría de estos hospitales y puedo decirles que quieren hacer lo correcto por sus pacientes”.

A pesar de que han emitido sentencias que bloquean la orden ejecutiva de Trump, el Lurie Children’s y hospitales de todo el país han suspendido las cirugías y otros tipos de tratamientos de afirmación de género

Hospital enfrenta un futuro legal incierto

El Lurie Children’s Hospital tiene uno de los programas médicos de afirmación de género más antiguos del país, lanzado en 2013, y todavía ofrece terapia hormonal, bloqueadores de la pubertad y servicios de salud conductual.

Los proveedores de servicios médicos, los pacientes y sus padres aluden frecuentemente a las que subrayan el papel crucial e incluso que puede tener la atención médica transgénero. Por ejemplo, ayudando a .

El acceso a la afirmación médica de género cuenta con el aval de la (Asociación Americana de Pediatría) y la (Asociación Médica Americana).

La comunidad transgénero es pequeña y las familias sienten que esa es una de las razones por las que son atacados.

, alrededor del 3% de los estudiantes de escuela secundaria en el país se identificaron como transgénero, y un 2% adicional declaró que estaba cuestionando su identidad de género, según un estudio de los Centros para el Control y la Prevención de Enfermedades (CDC).

Los jóvenes transgénero experimentan más violencia, acoso y pensamientos suicidas que sus compañeros no trans, afirma el estudio de los CDC que agrega que, en el último año, aproximadamente 1 de cada 4 estudiantes que eran transgénero o cuestionaban su identidad de género intentó suicidarse.

En los últimos años, muchos estados en el acceso de los menores a la atención de afirmación de género, informó Â鶹ŮÓÅ, una organización sin fines de lucro de información sobre salud que incluye a Â鶹ŮÓÅ Health News.

Un poco más de la mitad del país —— prohíbe o dificulta el acceso a esos tratamientos. Recientemente, Iowa dio un nuevo paso en esa dirección al para las personas trans o no binarias.

Elizabeth Mack, médica especialista en cuidados intensivos pediátricos en Carolina del Sur, ha sido testigo de las consecuencias de esa prohibición en su estado. Ha tratado a varios niños que intentaron suicidarse o murieron por suicidio porque no pudieron acceder al tratamiento, según surgió de las entrevistas que mantuvo con los mismo pacientes o con sus familiares.

“Es una de esas situaciones que te dejan una marca que no olvidarás, imborrable”, dijo Mack sobre su experiencia.

Tuvo su cirugía, pero sigue preocupado

Ben García, de 18 años, estudiante de último curso de secundaria en Chicago, ofrece una visión de su vida después de la cirugía. En 2023, tuvo una doble mastectomía. Cree que sin la atención médica que ha recibido durante los últimos años, sería una persona diferente, probablemente más retraída y con menos confianza en sí mismo.

“Esta atención me ha permitido sentirme mucho más cómodo con quien soy y con la forma en que me presento ante el mundo”, explicó García.

García y su madre, Michelle Vallet, destacan que el camino hacia la cirugía fue un proceso lento, que se llevó a cabo con gran cuidado y mucha conversación.

Una vez que comenzó la pubertad, García empezó a tener dudas y quiso explorar qué significaría retrasar los cambios que se estaban produciendo en su cuerpo. En ese momento, tenía unos 10 u 11 años.

Vallet se puso en contacto con el Lurie Children’s Hospital y programó una primera cita para García. Contó que ese primer encuentro duró tres horas.

Según Vallet, gran parte de las personas malinterpreta el proceso, y los niños transgénero se han convertido en algunos de los pacientes bajo más escrutinio del país.

“Creo que la gente piensa que los niños trans se despiertan un día y dicen: ‘¡Quiero ser un niño!’”, dijo Vallet. “Entonces van a la clínica de género y, ¡pum! Así no es cómo funciona este tratamiento”.

Vallet, su hijo, y el personal médico del Lurie Children’s hablaron largamente sobre los riesgos del tratamiento, los posibles efectos secundarios y los siguientes pasos.

García se sometió a evaluaciones de salud mental en varias citas antes que pudiera tomar bloqueadores de la pubertad para evitar que su cuerpo experimentara cambios. Luego comenzó a recibir dosis bajas de la hormona testosterona. Poco a poco, su voz se volvió más grave y le creció vello facial.

El joven sigue recibiendo inyecciones de testosterona cada semana y va a revisiones en el Lurie Children’s para controlar sus niveles hormonales. Ahora lo preocupa que esta atención también se vea afectada. A su madre le inquieta que el hospital suspenda progresivamente todo tipo de atención para la reafirmación de género.

“Es desgarrador ver que hospitales tan grandes como el Lurie obedecen por adelantado”, dijo Vallet, refiriéndose a la orden ejecutiva de Trump que amenaza con retirar los fondos federales que reciben los hospitales. “Se siente como una traición. … Hay dinero federal en juego, pero en un momento dado, en la situación en la que nos encontramos, hay que decir: ’No, no voy a hacerlo”’.

El joven de 17 años que vive en los suburbios y nunca consiguió una fecha para la cirugía, está esperando respuesta de otros hospitales. Tiene una cita preliminar con un hospital en mayo, pero hay lista de espera. Probablemente pasarán meses antes que pueda operarse.

Está convencido de que la atención médica que ya ha recibido le ha salvado la vida y le ha dado esperanzas para el futuro. Piensa en estudiar Medicina en la universidad, inspirado por la atención que recibió durante todo este proceso.

Su madre, Jane, dice que el muchacho está saliendo adelante.

“Estoy muy orgullosa de él, porque todo lo que dice y hace tiene sentido”, dijo mientras su hijo explicaba todo lo que implica poder operarse. “Tiene claridad, y la gente lo está escuchando, lo entiende, y le está proporcionando lo que necesita para vivir”.

Este artículo es parte de una alianza que incluye a ,Ìý, yÌýÂ鶹ŮÓÅ Health News.

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).

The patient had a crushing decision to make: continue the pregnancy — which could be a risk to her health and her ability to have children in the future — or have an abortion.

“I don’t think I stopped crying for an entire two weeks,” she said. “The whole world felt heavy. … It’s not something anybody should have to go through. It’s not easy losing somebody you love.”

Â鶹ŮÓÅ Health News is not disclosing the woman’s name or the name of the community where she lives, because she fears harm if her identity becomes known. She lives in Missouri, which has in the nation. Â鶹ŮÓÅ Health News confirmed details of her experience.

After the fetal diagnosis, the patient’s Missouri doctors told her that her life wasn’t in immediate danger, but they also pointed out the risks of carrying the pregnancy to term. And in her family, there’s a history of hemorrhaging while giving birth. If she started to bleed, her doctors said, she might lose her uterus, too. The patient said this possibility was devastating. She’s a young mom who wants more children.

So she chose to get an abortion. Her Missouri doctors told her it was the safest option — but they wouldn’t provide one.

The patient had to leave Missouri and cross the border to Illinois, which has become a . Because of her complicated pregnancy, she received the abortion in a hospital.

Since the Dobbs decision on June 24, 2022, determining who can get an abortion and where has been complicated by medically ambiguous language in new state laws that ban or restrict abortion. Doctors in those states fear they could lose their medical licenses or wind up in jail.

Amid these changes, physicians in abortion havens such as Illinois are stepping up to fill the void and provide care to as many patients as possible.

But getting each medically complex patient connected to a doctor and a hospital has been logistically complicated. In response to the growing demand, Illinois , a Democrat, recently with a goal to get patients who show up at clinics, yet need a higher level of abortion care, connected more quickly with Illinois hospitals. Providers will call a hotline to reach nurses who will handle the logistics.

There is little concrete data on how many more patients are traveling to other states for abortions at hospitals. The Centers for Disease Control and Prevention regarding out-of-state patients but doesn’t collect it based on the type of facility they’re performed in.

Hospitals are a “black box” for abortion-related data, according to , a longtime researcher at the nonprofit Guttmacher Institute.

Even before Roe fell, it was hard to wade through the hospital bureaucracy to understand more comprehensively how abortion care was provided, Jones said. Guttmacher has tracked hospital-based abortions in the past but doesn’t have updated figures since Dobbs.

#WeCount, widely considered a of shifts in abortion care over the past year, doesn’t break out hospital data separately. #WeCount co-chair said the data would have gaps anyway. She said it’s been difficult to get providers in banned states to report what’s happening.

The Uncertainties Behind Life Exceptions

All 15 states that ban abortions to save the life of the pregnant person, according to tracking from the health policy nonprofit Â鶹ŮÓÅ. But exactly when the person’s life is considered at risk is open to interpretation.

“It’s very, very difficult to get an exception,” said , director of women’s health policy at Â鶹ŮÓÅ. “It’s like, ‘How imminent is this threat?’ And in many cases, patients can’t wait until they’re about to die before they get an abortion.”

The latest ban — — took effect at the end of August.

In 2020, when Roe was still the law of the land, of abortions typically occurred in hospitals. Now, OB-GYNs in Chicago and other places across the U.S. that protect abortion rights say out-of-state patients are increasingly showing up to get abortion care at hospitals.

Those more complex procedures and hospital stays often bring higher medical bills. More patients now need help covering the expensive price tag of the procedures, according to medical providers and abortion funds that provide financial assistance.

The patient from Missouri made her way to , an OB-GYN at Rush University Medical Center in Chicago, in May. The number of out-of-state abortions at Rush has quadrupled since Roe was overturned, Laursen said.

Laursen received the patient’s consent to discuss her case with NPR and Â鶹ŮÓÅ Health News. She recalled the patient was frustrated about having to jump through so many hoops to get the abortion, and stressed about the cost of being in a hospital.

“The biggest thing was just making space for her to express those emotions,” Laursen said. “Making sure that she felt comfortable with all the decisions she was making. And trying to make her feel as empowered as possible.”

The patient’s life wasn’t immediately threatened, but it was safer for her to have an abortion than remain pregnant, Laursen said.

“I’m constantly hearing stories from my partners across the country of trying to figure out what counts as imminent danger,” Laursen said. “We’re trying to prevent danger. We’re not trying to get to the point where someone’s an emergency.”

Sending Patients Over State Lines for Care

Jennifer McIntosh is an OB-GYN in Milwaukee who specializes in high-risk patients. Because of , she’s referring more patients out of state.

“It’s really awful,” McIntosh said, recalling difficult conversations with patients who wanted to be pregnant, but whose babies faced dire outcomes.

She would tell them: “Yes, it’s very reasonable to get an abortion. But oh, by the way, it’s illegal in your own state. So now on top of this terrible news, I’m going to tell you that you have to figure out how to leave the state to get an abortion.”

In some cases, McIntosh can provide an abortion if the medical risk is significant enough to satisfy Wisconsin’s life-of-the-mother exception. But it feels legally risky, she said.

“Am I worried that someone might think that it doesn’t satisfy that?” McIntosh said. “Absolutely, that terrifies me.”

‘s phone is often ringing and buzzing with texts. An OB-GYN who specializes in abortion and contraception at the University of Illinois health system, near Rush hospital in Chicago, Fleisher is frequently asked to see how quickly he can squeeze in another patient from another state.

Since Roe fell, Fleisher estimated, the health system is treating at least three times as many patients who are traveling from other states for abortion care.

He worries about the “invisible” patients who live in states with abortion bans and never make it to his hospital. They may have medical problems that yet don’t know how to navigate the logistics required to make their way over state lines to his exam room, or don’t have the financial resources.

“I know that some number of those women are not going to make it through birth and postpartum,” Fleisher said. “More than the stress of somebody who’s actually making it to see me, that’s the thing that causes me more stress.”

Medical costs, in addition to travel, are a big obstacle for high-risk patients seeking abortion care at hospitals. The patient from Missouri owed around $6,000 for her hospital stay, Laursen said. Her bill was covered by local and national abortion funds. Some hospital bills can reach into the tens of thousands of dollars for more complicated procedures, according to the funds.

The pledged to cover just over $440,000 in hospital bills for 224 patients in the year following Dobbs, according to Meghan Daniel, CAF’s director of services. Those bills were primarily for out-of-state patients. By comparison, in the year that preceded Dobbs, CAF helped cover just over $11,000 for 27 patients.

This increase in patients needing financial help for out-of-state abortion care is happening across the nation.

In many cases, patients have a hard time accessing abortion care, and the delays push them further into their pregnancies until they need to have the procedure in a hospital, said Melissa Fowler, chief program officer at the . And that costs much more.

“We’re seeing more cases right now [of] people who are later in gestation,” Fowler said. “More adolescents who are later in gestation, who are showing up at hospitals because this is really their last resort. They’ve been referred all over.”

All of this raises questions about how long these funds can afford to help.

“The current financial way in which people are paying for their abortions I fear is not sustainable,” Fleisher said.

Nonprofit hospitals could help. In return for , they have financial assistance policies for people who are uninsured or can’t afford their medical bills. But the policy at UI Health in Chicago, for example, covers only Illinois residents. UI Health spokesperson said that for other patients, including those who live in other states, the hospital offers discounts if they don’t have insurance, or if their insurance won’t pay.

Laursen argues out-of-state Medicaid plans and insurance companies should be picking up the tab.

“Whose responsibility is this?” she asked.

Not Ready to Let Go

Back in Missouri, the patient has a special room dedicated to her son. She brought home a recording of his heartbeat and keeps his remains in a heart-shaped casket. She talks to her son, tells him how much she loves him.

“I’m just not ready to let him go,” the patient said. “Even though they’re not here on Earth anymore, you still see them in your dreams.”

She’s working on healing emotionally and physically. And while she’s thankful that she was able to travel to Illinois for care, the experience made her angry with her home state.

“There’s a lot of good people out there who go through a lot of unfortunate situations like me who need abortion care,” the patient said. “To have that taken away by the government, it just doesn’t feel right.”

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“Luckily it’s summer,” said Hartwig, a nurse midwife at Planned Parenthood of Wisconsin. “For now, he can sleep in. But any getting ready that has to happen will be on my spouse.”

She drives at least two hours each way, immersed in audiobooks and podcasts as she heads back and forth from a clinic in this northern Illinois suburb. She spends her days in the recovery room, caring for patients who have had abortions and checking their vitals before they go home. She is also licensed in Illinois and trained to provide medication abortion, something she’ll be able to do virtually through telehealth with patients across Illinois.

Hartwig is essentially working part time in Illinois because , a state law immediately took effect that bans nearly all abortions in Wisconsin, . Wisconsin providers want to preserve access for patients, while those in Illinois — long an oasis for abortion rights — to help treat a surge of people arriving from across the U.S.

The Waukegan clinic is Planned Parenthood of Illinois’ busiest for out-of-state abortion patients. After Roe fell, 60% of patients came to this clinic from outside the state — mostly from Wisconsin. In fact, the organization opened in Waukegan two years ago with Wisconsin in mind, knowing that if Roe v. Wade did fall, access to abortion in that state would greatly diminish.

After Roe was struck down, Planned Parenthood organizations in both states . More than a dozen employees from Wisconsin — including doctors, nurses, and medical assistants — now commute to Waukegan to help provide care.

“It really required this perfect pairing of supply and demand,” said Kristen Schultz, Planned Parenthood of Illinois’ chief strategy and operations officer. “They had capacity without local demand, and we had the opposite.”

In the month after the U.S. Supreme Court overturned the federal landmark decision, Illinois became even more of an oasis for people seeking abortions. across the nation as 11 states in the South and Midwest implemented bans, according to the Guttmacher Institute, a nonprofit that supports abortion rights and tracks the issue.

The influx of patients into Illinois has had another effect. For years, abortion providers have been traveling once or twice a month to other states like Kansas, Mississippi, and Oklahoma, where their help was badly needed.

Dr. Laura Laursen, an OB-GYN in Chicago, was one of them.

“Now the script is totally flipped,” said Laursen, a fellow with Physicians for Reproductive Health. “This is where you are needed more than anywhere else.”

Anti-abortion groups oppose the Planned Parenthood partnership and are preparing for a marathon effort to restrict abortion rights in Illinois. In a statement after the organization’s announcement, Amy Gehrke, executive director of Illinois Right to Life, called it “particularly tragic.”

Some of the Wisconsin providers commute to Waukegan a few times a week; others a few days a month.

For Hartwig, associate director of clinical services at Planned Parenthood of Wisconsin, she’s able to do more in Illinois for patients than she could back home. Even as a nurse with an advanced degree, she wasn’t allowed to provide medication abortions in Wisconsin. But she can in Illinois, according to the state Department of Financial and Professional Regulation.

“This was really just what I was always supposed to do,” Hartwig said. “There’s nothing that’s going to keep me from helping our patients.”

Dr. Kathy King, Planned Parenthood of Wisconsin’s medical director, said that while her staff is dedicated to providing these services, it comes at a cost.

“It is a burden on our clinicians and nurses and medical assistants who have young children at home,” King said. “It sounds great. Sure, we’ll all just travel down to Waukegan five days a week. But the logistics of that and the sacrifice of doing that on just people’s day-to-day lives takes a toll.”

Still, this sacrifice has helped. With staff from Wisconsin, the Waukegan clinic has doubled the number of abortion appointments available, and it is still ramping up. The support frees up other staffers to treat patients with different needs, like birth control and cancer screenings.

There has been a surge of patients from Wisconsin for abortion appointments at all Planned Parenthood of Illinois clinics — a tenfold increase in the month after Roe was overturned, from about 35 patients a month to 350, King said. That doesn’t include Wisconsin residents who might have sought abortions with other providers.

The partnership at the Waukegan clinic has ignited interest from abortion providers in other nearby states. Planned Parenthood of Illinois is fielding calls from Indiana, Kentucky, and Ohio, for example, Schultz said.

What Illinois needs is more staff to treat more patients. The commute from Wisconsin to Waukegan is relatively short compared with abortion providers in Ohio, for example, who’d have to cross Indiana to help relieve the staffing need.

Across the nation, other conversations are happening among providers. The National Abortion Federation, which has about 500 facility members including independent abortion clinics and hospitals, is pairing up people looking for jobs at clinics with those that need workers, said Melissa Fowler, chief program officer at the federation.

Still, she acknowledged moving isn’t a realistic option for everyone.

“People have lives,” Fowler said. “They have families. They’re deeply rooted in their communities. … And so a situation like you’re seeing in Illinois and Wisconsin is great because people are able to stay connected to their community, not have to move their family, and still be able to provide care.”

This story is part of a partnership that includesÌý,Ìý,Ìýand KHN.

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).