Maine abortion clinics are gearing up for an influx of out-of-state patients seeking abortions in the dwindling number of states where they are still legally available – as well as protesters trying to stop them.

Maine is now one of just 32 states in the nation where abortion is still legal, but more states are moving to adopt bans and others have imposed restrictions so severe it can be difficult or impossible to get an appointment early enough in a pregnancy to get the procedure legally, according to the Guttmacher Institute, a research organization that tracks abortion. A total of 26 states are expected to impose bans soon, it says.

The U.S. Supreme Court’s ruling Friday ending the nationwide constitutional right to abortions is going to force millions of American women to travel to states such as Maine where abortion remains legal under state laws, said Nicole Clegg, vice president of public affairs at Planned Parenthood Maine Action Fund.

“As the map goes dark, those states that still have the right to legal abortion, states like Maine, are going to have to step up to help women in those states that don’t,” Clegg said. “It’s already happening. Our out-of-state numbers are up. Without Roe, those numbers will only go higher.”

By end of the business day on Friday, within hours of the ruling coming out, Planned Parenthood of Northern New England had already fielded calls from three women living in a so-called “dark state” in search of an abortion appointment in Maine, Clegg said.

The local call center for the organization, which is Maine’s largest abortion provider and serves Vermont and New Hampshire, was also swamped with calls for vasectomy and birth control appointments, Clegg said, especially long-acting reversible contraception methods like IUDs.

The regional Planned Parenthood chapter has been preparing for the abortion decision since the Supreme Court announced it would be taking up the case about a year ago, Clegg said. Anticipating a change in state laws, the organization has provided extra training to its call center staff to begin accepting calls from across the country.

That preparation went into overdrive in September, when the so-called Heartbeat Act went into effect in Texas that bans abortions after six weeks, Clegg said. Texas women who realized they were pregnant after missing a period found it virtually impossible to get an abortion appointment within that window.

Since then, Planned Parenthood medical professionals have performed eight abortions in Maine clinics for Texas women who were unable to land one of those coveted six-week appointments in their state of residence, Clegg said. They expect that number to increase exponentially in a post-Roe v. Wade world.

Each woman had their own reason for coming to Maine for an abortion, and the overall number is not big enough to draw any statistical conclusions, Clegg said. But some had a personal connection to Maine and knew people they could stay with and who would help them recover from the procedure.

Planned Parenthood of Northern New England is one of the few providers that allow patients to book an abortion appointment online, which is appealing to many people, especially those coming from states in which abortion care is now illegal, Clegg said.

Some are likely to pick Maine because they believe it will be cheaper to secure lodging here, or because it has a reputation as a rural state, similar to the one where they live, as opposed to the urban feel of either a Boston or New York, Clegg said.

Planned Parenthood staff works with out-of-state abortion seekers and the group’s nationwide network of providers to help women find appointments near where they live, when possible, to cut down on their travel expenses and stress, Clegg said. But that is not always possible.

Out-of-state residents typically arrive at their destination clinic seeking a second-trimester abortion because of the extra two to four weeks it takes them to find and book an appointment, arrange a hotel and travel to the clinic, and raise the funds to pay for it, Clegg said.

That can turn a $500 procedure into a $3,000 expense, something that many low-income women can’t afford, Clegg said. It gets even more expensive if the woman has to take time off from work or arrange a sitter for their children.

“That is why so many low-income women are forced to carry unwanted pregnancies to term,” she said.

People seeking abortion care in Maine can apply for financial assistance from three funds designed to help cover some or all abortion costs and some travel expenses – SAFE (Safe Abortions for Everyone), Planned Parenthood’s Laura Fund, and the National Network of Abortion Funds.

Given its place on the map, and the fact that most women prefer to drive to an abortion appointment, it is likely that Maine will see the most out-of-state patients traveling from Ohio and West Virginia, two of the closest states with pre-existing bans or time-limited abortions, Clegg said.

It’s impossible to know what a post-Roe world is going to look like, or how abortion bans in other states might affect Maine. But the laws of supply and demand could have a trickle-down effect on even smaller Maine abortion providers that lack the national name recognition of a Planned Parenthood.

Maine Family Planning, which performs surgical abortions out of its Augusta clinic, is not anticipating a significant influx of out-of-state patients, said Mareisa Weil, the agency’s vice president of development and community engagement. But there could be a cascade effect that results in more patients seeking care.

States such as New York, Massachusetts and Connecticut are more likely to become regional abortion havens than Maine, said Weil. But such pressure in those states could force Massachusetts people in search of a timely abortion to travel to Portland for care, which could in turn put pressure on Maine’s other clinics.

“What may occur is that Portland may see an influx of patients because of the compression effect,” Weil said. “Which may push folks from the Portland metro area to our rural clinics, which would then have a ripple effect on Mainers’ ability to access abortion care within the timeframe that is needed.”

That doesn’t mean an influx of out-of-state patients would prevent Mainers from getting abortion care, Weil said. About two-thirds of the abortions that Maine Family Planning does in a typical year are now medication abortions, which do not require an office visit.

Medication-based abortions – usually a two-pill treatment taken about two hours apart – make up about 65 percent of all abortions performed by Planned Parenthood of Northern New England and 50 percent of abortions performed by Maine’s other provider, Mabel Wadsworth Center in Bangor.

Clinicians can only prescribe the medication used in such abortions in states where they are licensed, so Maine providers could not send medication abortion pills to residents who live in so-called “dark states.” But such medication abortions are always an option for Mainers.

“Abortion pills are going to play a large role in how we keep our systems of care running in the face of increased demand and decreased access,” Weil said. “Years ago when Roe was decided, we didn’t have medication abortion like we do today.”

Maine abortion providers are also prepping for a possible surge in out-of-state birth control requests, Clegg said. Some reproductive health clinics rely on abortion fees to finance their business model and stay afloat. In dark states, women will lose access to birth control and abortion at the same time.

One of the unexpected impacts of the Supreme Court ruling may be the influx of out-of-state protesters who can declare victory in the states where abortions will now be illegal and focus their time and effort demonstrating at abortion clinics in states like Maine, Clegg said.

Protesters from Pro-Life Missionaries of Maine demonstrate outside of Planned Parenthood’s clinic in Portland almost every Friday, lining Congress Street holding signs with photographs of unborn fetuses to urge women who walk into the building that hosts the clinic to reconsider their actions.

The demonstrations can rattle patients and even trained clinic staff and leave some women in tears, she said. The addition of professional out-of-state protesters could increase the potential for violence to patients, staff and even protesters, Clegg said, and would likely drive up clinic security expenses.

The changing political landscape and the court decision, which was foreshadowed by the draft opinion leak last month, also generated a lot of positive response from donors and supporters, and even medical providers, who are eager to protect the right to abortion in Maine, Clegg said.

“It’s coming at a high price, of course, but there’s been so much support,” Clegg said. “And that’s good, because we’re going to need it. We’re going to need every call, every letter, every dollar and then some.”