Abortion was a hot topic in the 2022 midterms. Here's how an abortion clinic in Ohio plans to move forward after the end of Roe v. Wade.

• The overturn of Roe v. Wade was followed by an influx of pro-choice protests and increased voter turnout.
• In fact, 24% of voters say the issue was the single most important factor in their vote.

The US Supreme Court's decision to reverse the constitutional right to abortion this summer sparked protests, political activism, and high voter turnout in the months that followed.

In fact, nearly 40% of voters overall said the reversal had a major impact on their decision about whether to vote in this year's election, and 24% say it was the single most important factor in their vote, according to analyses by the nonprofit Kaiser Family Foundation. The 2022 midterms ended on December 6 with a Democratic majority in the Senate, after Senator Raphael Warnock defeated his Republican challenger in a runoff election.

Still, people around the country are struggling to find support in their pursuit of bodily autonomy. At the same time, abortion clinics are navigating the new normal.

For example, clinics in Texas have shut down, while those in Pennsylvania — where abortion remains legal for up to 24 weeks after the last menstrual period — prepare for an influx of patients from states with more restrictive laws. One clinic in Ohio is sitting in the in-between.

As of October, an Ohio law banning virtually all abortions will remain blocked while a state constitutional challenge proceeds. Instead, a judge ruled that Ohio will allow pregnancy terminations through 20 weeks' gestation to continue for now.

While abortion access is temporarily restored in Ohio, limited timelines mean the viability to run an independent clinic is shrinking. However, the pressure to support the state's community remains.

Sri Thakkilapati, the interim executive director at the Cleveland independent abortion clinic Preterm, is trying to balance the two realities. Preterm opened in 1974, one year after the landmark Roe v. Wade decision. Today, it's one of just nine providers in the state.

Since the Dobbs decision ruling, Preterm has returned to some pre-Roe tactics, like out-of-state referrals and fundraising, to sustain the nonprofit.

Insider spoke with Thakkilapati about her experience running the clinic, the importance of independent abortion clinics, and how Preterm is preparing the nonprofit for a post-Roe world.

The following is an as-told-to essay based on an interview with Thakkilapati. It has been slightly edited for length and clarity.

A mission to fight stigma and provide support

I started at the clinic more than 20 years ago. Since then, the national conversation surrounding abortion has become more public, but the stigma hasn't gone away. This Supreme Court ruling is just one example.

Before the draft opinion leaked, we knew the national conversation was leaning toward overturning the 1973 decision, so we had been preparing.

"Crisis emergency centers" (which pose as abortion clinics but use scare tactics and false medical information to deter those seeking abortions) were popping up and becoming more aggressive. And there's been an influx of younger, more vocal, and aggressive protesters outside our clinic. We have a security guard on-site and robust safety measures in place, but it's hard to know what violence or protesting to prepare for next to keep our patients safe.

Even though we knew the anti-abortion side had built strength, it was still disheartening to think about what overturning Roe might do to the abortion-rights movement. Then, when we got the final decision last month, it felt like a brutal defeat.

The importance of independent clinics around Ohio and the country

Preterm is committed to the whole-person care model, addressing the complexity of people's experiences and giving them some control over their medical experience. In fact, the purpose of independent clinics around the country goes far beyond completing abortions: We provide information, accurate education, and support to anyone seeking reproductive-health services.

Independent clinics are at the forefront of the abortion-rights fight. Since we don't have the same kind of constraints as places like Planned Parenthood, we can be nimbler. And we can be more up front with our abortion-rights stance. That makes our jobs, and the livelihood of the clinics, crucial to maintain.

As soon as the Supreme Court started asking about these precedents, we knew it was a bad sign. We were hoping that it would just be restricted to 15 weeks, giving more leeway than a total overturning. But when the Dobbs ruling was released, and Ohio's "heartbeat bill" was put into effect, it instantly decreased the number of patients we could help.

Because of the short time span, our clinic isn't preparing for out-of-state patients. In fact, some Ohio residents are having to leave the state, including a pregnant 10-year-old who was forced to cross state lines because of their pregnancy timeline.

When Roe fell, 40 patients were scheduled for abortion procedures the following day. More than 90% of them had to be canceled.

Last year, only 2% of our abortion procedures were within the pre-six-week period of access. The ruling is a sweeping rejection of this right for the vast majority of abortion seekers. Those numbers make it nearly impossible for the clinic to stay open as is.

Staying open for those who need us

For those who do come through our doors, our immediate strategy is to get our clients in as quickly as possible.

We are fundraising to cover as many preliminary services as possible, like ultrasounds. We rescheduled any procedures that needed to be done sooner. But long hours and extremely hard work by our staff to accommodate the changes won't be enough to sustain us.

With the drastic decline in patients, and therefore revenue, our goal is to diversify how we make money so that we can remain open for those who need us.

Preterm is building out education services, including a website called abortionislegalinohio.com — which informs users on abortion regulations in Ohio. And we are implementing other kinds of OB-GYN care to sustain us. In the past, we've offered general sexual-health services like pap smears and STD screenings, so we are communicating with our clients to determine which services are in the highest demand.

It's always been our mission to destigmatize abortion and support patients through whatever reproductive-health decisions they make. So no matter what services we can offer to continue providing that support, it's crucial that we, and all other independent clinics, do so.