As states across much of the South and Midwest banned or further restricted abortions after the U.S. Supreme Court overturned Roe v Wade in 2022, they fueled a wave of people with high-risk pregnancies traveling to hospitals in Chicago.
The prohibitions also spurred a group of doctors, hospitals, a nonprofit and the state of Illinois to try to make a challenging and expensive journey a little easier.
“We’re really viewed as … one of the places of last resort,” said Dr. Laura Laursen, an OB/GYN at Rush University Medical Center who helped start what’s known as the Complex Abortion Regional Line for Access, or CARLA, in 2023 to help women with high-risk pregnancies get abortion care in an Illinois hospital.
Even before Roe fell, Dr. Jonah Fleisher, an OB/GYN at UI Health, said women had to navigate a dizzying array of logistics to find an appointment.
He would field calls from panicked patients in parking lots of abortion clinics. They had just learned ending their pregnancies there would be too risky. They were handed a list of hospitals to call.
“They had already planned for weeks and sometimes even months to get that appointment, raise the funds, arrange for child care, time off of work, transportation — all the things to get to that appointment, whether from in state or out of state,” Fleisher said.
Hoping to streamline that process after Roe fell, Gov. JB Pritzker’s administration helped launch CARLA. Three years later, the need has remained steady, said Fleisher, who co-directs the program with Laursen.
CARLA receives about 40 referrals a week from around the country — around 1,500 referrals total over the past three years, including from Illinois. Women have come from more than 25 states.
The nonprofit Chicago Abortion Fund has pledged about $3 million for medical expenses and other support, such as travel costs.
Illinois is considered a haven
Illinois has some of the strongest legal protections in the nation for patients seeking abortions and for doctors who provide them.
More people travel to Illinois than to any other state for an abortion, according to the Guttmacher Institute, a nonprofit research and policy organization that tracks abortions and supports reproductive rights. In 2025, just more than 140,000 women traveled to other states to end their pregnancies; nearly 1 in 4 came to Illinois, according to Guttmacher.
A small percentage of women seek abortions in hospitals, data shows. They’re typically higher risk — they have heart issues, conditions that make anesthesia more risky, or have a history of hemorrhaging — and need more medical resources than they can get at an outpatient clinic, doctors say.
Several patients who are referred to CARLA have a condition where the placenta grows too deeply into the wall of the uterus. It’s more common for women who have had a previous C-section, Fleisher said. A person can have serious bleeding during an abortion, and sometimes the only way to control the bleeding is a hysterectomy, he said.
Through CARLA, doctors from around the country call a hotline and refer patients to a team of nurses and physicians in Chicago, who help coordinate appointments for patients at four health systems. They are UI Health, Rush, Northwestern Medicine and UChicago Medicine.
The Chicago Abortion Fund, known as CAF, can pick up the cost if patients can’t afford to. Since CARLA started, CAF has pledged to cover nearly $2 million in medical expenses for patients with complex medical needs, such as doctor appointments, hospital procedures and advanced ultrasound imaging.
The average hospital bill for patients seeking abortions is a few thousand dollars but can be far more expensive depending on the level of care. That’s compared to $500 to $1,000 for an abortion at an outpatient clinic.
Just 4% of CAF callers are people with complex medical needs who receive care in a hospital. But hospital bills make up about 25% of all of CAF’s spending on abortion care, compared to about 1.5% before Roe was overturned, said Meghan Daniel, senior director of programs at CAF.
The organization also pledged to cover another $1 million related to logistics for these patients, from airplane tickets to childcare.
In the first year of CARLA, about 40% of referrals were for out-of-state patients, compared to about 50% now, Fleisher said. More patients later in their pregnancies are being referred to the program, he said. It’s a sign that patients can’t get access in their home state, or something might have changed during their pregnancies, from a fetal diagnosis to losing their home or job, he said.
“I think people, to some degree, always had this need,” Fleisher said. “There just wasn’t access.”
Kristen Schorsch is a senior reporter covering public health for WBEZ.