How the death of one woman brought an independent abortion clinic to its knees

Around dawn on any given Saturday morning in 2022, the sidewalk in front of the squat building that housed Bronx Abortion transformed into a tense ecosystem of people with signs, masks, rosaries, and colorful vests.

Anti-abortion protestors gathered outside the small, independent clinic in Morris Park to disrupt the women who sought its services. Chelsea, the clinic escort coordinator, would wake up at 4:15 to get to the clinic before it opened. By the time she arrived, the protestors usually had, too.

Sometimes it was just a few. Sometimes, it was more than 40. Some would kneel and pray the rosary or hold signs with "pray to end abortion" printed in capital letters. Others would block car doors or shout through megaphones. Designated "sidewalk counselors" wove in front of patients, trying to convince them not to enter the clinic. In a neighborhood with a high Catholic population, patients might see a priest or members of their congregation telling them they were committing a sin.

But the clinic escorts always came back, guiding patients to the door. In the freezing darkness of winter, the pouring rain of spring, and the sweltering heat of summer, they waited until the last protestor left.

"We are out there to ensure that somebody who is facing judgment as they enter an abortion clinic also receives support and kindness," said Chelsea, who began volunteering as a clinic escort at Bronx Abortion in 2017. (She asked to be identified only by her first name, citing safety concerns.)

Bronx Abortion was established in 1969, around the time New York State legalized the procedure. The red stucco corner building on Eastchester Road became a place people could go for safe abortions even before the Supreme Court's 1973 Roe v. Wade ruling.

Managed by a small staff, the independent clinic provided between one and two thousand abortions per year to mostly Black and Latinx patients. Clinic escorts said it was deeply loved by those who saw it as a pillar of reproductive justice.

Over the decades, employees came and went. Laws changed. But the clinic never stopped providing abortions to the patients who arrived at its doors — until last year, when one woman's sudden death brought Bronx Abortion to its knees.

On Saturdays, while protestors and clinic escorts took their positions outside, a petite blond woman in her 80s named Irene Sylvor delivered steaming coffee to the staff inside.

Sylvor's official title was clinic director. In reality, she was "the heart, soul, everything of Bronx Abortion," Chelsea said. Born and raised in the Bronx, with a thick New York accent, Sylvor was sharp, funny, and generous.

The clinic's owner, Moshe Hachamovitch, founded Bronx Abortion while he was a trainee at Albert Einstein College of Medicine. "Whenever I went to the emergency room," he recalled, "it was cluttered with patients who had illegal abortions and were actually dying."

In its first few years, the clinic saw hundreds of patients. Eventually it grew, and Hachamovitch expanded and established abortion clinics across the country, from Long Island to Arizona to Texas.

While Bronx Abortion was expanding, Sylvor was a single mother juggling two kids and occasional stints selling art supplies. She cared about her neighborhood and its people. Her daughter, Aimee Anderson, remembered her tipping the doorman and superintendent of their building in the Bronx's Riverdale neighborhood generously every year.

But Sylvor also knew how to get her way. Once, Anderson said, after a rude driver cut her off, she parked right behind his car and blocked his exit. "She did that kind of stuff," Anderson said.

When Sylvor saw a job opening at Bronx Abortion, she applied without hesitation. A firm believer in a woman's right to choose, she had her work cut out for her. When Sylvor began working at the clinic about four decades ago, she became the "organizer, the leader, the mother of the clinic," said Destiney Kirby, a clinic escort. Hachamovitch described her as a "force." According to Sarah McNeilly, another clinic escort, Sylvor took on a workload proportional to multiple employees "to keep the lights on."

Clinic escorts said she managed to knit together a precarious system of staffing and resources to continue serving the community.

"She was like this little bird of a thing who would stand up to the biggest protester," Chelsea said. "When she spoke, you listened to her."

Unlike other clinics that offered a range of sexual health services, Bronx Abortion only provided medical and surgical abortions. The clinic advertised both scheduled appointments and walk-ins. A patient could arrive unannounced at 7:30 am on a Saturday and be out before noon.

Anderson remembered a small space that was often packed with patients. Tiffany Quiles, a resident of the nearby Westchester Square neighborhood, said she accompanied her friend to an appointment at Bronx Abortion in 2018. Quiles said that while the protestors outside were aggressive, it was a different story inside. The space was clean and the staff was pleasant, she said. It was like any doctor's office, a space "where people needed some medical care."

While there is also a Planned Parenthood and multiple hospitals in the Bronx, they come with certain obstacles to access.

Kirby, who is also a medical student in the Montefiore Hospital system, said that many people seeking abortions are not yet registered patients in the hospital system. "If you call and try to make an appointment for a new provider, you have to wait around six months," she said. "And when you're thinking about abortion care, you can't wait six months."

"Cost continues to be a prohibitive factor to access abortion care," said Elizabeth Estrada, the New York Field and Advocacy Manager at the National Latina Institute for Reproductive Justice. In a borough where the poverty rate is around 25% and the median annual household income is around $45,000, a procedure that could cost up to $2,800 can be out of reach. While insurance sometimes covers abortions, a relatively high percentage of residents are uninsured or underinsured.

The process is all the more difficult for non-English speakers, those without internet access, those who are unfamiliar with public transportation routes punctuated by multiple transfers and at risk of long delays, those without childcare, and those whose jobs make it difficult to take time off.

Bronx Abortion was easy, fast, and affordable.

The clinic was grounded in the community and understood its people, said Chelsea. It also took Saturday walk-ins, unlike Planned Parenthood and hospitals. According to Hachamovitch, patients who could not afford an abortion did not have to pay. And patients could always reach out with questions and concerns to Sylvor. Anderson said her mother always had her phone and notepad beside her, even during Christmas and Thanksgiving. She took calls from patients at any hour of the night, scribbling down notes in messy handwriting.

"It felt like this deeply rooted communal space that people trusted and respected," said Chelsea. Staff members were usually born and raised in the same neighborhoods that patients were coming from. They chatted with patients to make them feel comfortable. Sylvor tried to keep the atmosphere bubbly and uplifting.

Chelsea believes that patients felt more comfortable going to a place they had driven or walked past. They knew what to expect, even if there were protestors outside. If patients had to travel to a new clinic far away, the unknown territory presented yet another layer of anxiety.

Advocates say that independent clinics — in 2022, Bronx Abortion was one of two in a borough of about 1.4 million people — are essential to providing abortion care. They offer an outsize share of abortion services across the country. Even though they represent only a quarter of facilities providing abortion care, they provide nearly two thirds of procedures nationwide.

But even in New York, a state that has committed to protecting and supporting abortion rights, independent clinics are at risk. Since 2015, a third of the independent clinics in the country have closed their doors. According to the Abortion Care Network, "threats to these clinics are a threat to abortion access overall."

Part of the risk is financial. Clinics that exclusively provide abortion care often struggle to stay afloat. Although Title X federal funding is designated to provide affordable reproductive healthcare, the Hyde Amendment bars the use of federal funds for abortion care. Desiree Caro, a Title X Coordinator at the non-profit organization Public Health Solutions, said she tried to find additional financial support for Bronx Abortion over the years. Federal laws, she said, made it practically impossible.

On January 7, 2023, clinic escorts showed up in front of Bronx Abortion for their usual Saturday morning shifts, only to find the doors locked. This had never happened before. The volunteers had a close relationship with Sylvor, and she always told them in advance about schedule changes.

Confused, they waited in the cold in their bright rainbow vests. Patients walked up. Volunteers reluctantly told them that they needed to find somewhere else to go.

Two days later, Chelsea learned that Sylvor had died suddenly.

Anderson, Sylvor's daughter, said her mother was taking patient calls until two days before she died of pulmonary disease on January 8. "No matter what was going on in her personal life, she didn't let that stop her," Anderson said.

The Bronx Abortion community was devastated. Anderson called the two women who worked in administration in the clinic with her mother to share the news. "They were both screaming hysterically in the office," she recalled. "It was horrible."

Bronx Abortion immediately paused all operations. Clinic escorts kept coming back for the next several Saturdays, waking up early and braving the cold to make sure people showing up for care were not left alone without explanation. "We were turning away a lot of people," said Kirby. Some patients were angry. Others were scared. "It was so emotionally taxing to see these patients come in to get an abortion and we had to tell them 'we can't provide that for you today,'" she said.

But the loss of its director would prove fatal to the clinic itself.

After Sylvor's death, no one knew what would happen. In his 80s, Hachamovitch was ready to retire and expressed interest in selling to another clinic. But after one clinic conducted an appraisal, its owners said it would cost too much. They backed out.

"There was this feeling of betrayal, but also I wasn't shocked," said Kirby, pointing to the repeated divestment of healthcare providers from low-income communities in boroughs like the Bronx. "We are a very marginalized, oppressed community that is unfortunately not going to bring [healthcare providers] a lot of money. There's really no buy-in from them."

Eventually, Hachamovitch sold the property to commercial developers. Its new owners said they plan to turn the building into a restaurant or a storefront.

Anderson could imagine her mother's reaction to the news. "I know that she would be heartbroken," she said.

With its closure — its website calls it temporary, but Hachamovitch and clinic escorts confirmed it was permanent — the Bronx is left with only one independent abortion clinic: Dr. Emily Women's Health Center, located in the South Bronx. The protestors who targeted Bronx Abortion have migrated to the sidewalk in front of Dr. Emily, joining others who already showed up there every week. Theresa Chong, Dr. Emily's director, said the group has "more than doubled" in number and become "more aggressive." (The clinic escorts have followed as well to help patients avoid them.)

The borough's only Planned Parenthood can have long wait times. It takes about an hour to travel there or to Dr. Emily on public transportation from where Bronx Abortion once was. From neighborhoods further north, the time increases to upwards of an hour and a half.

Longer travel times and wait times can delay the termination of an unwanted pregnancy, making it more expensive after a certain number of weeks and causing emotional distress to the pregnant person.

In other parts of the country, particularly states that ban abortion altogether, pregnant people must travel hundreds of miles for access. New York's landscape can seem comparatively rosy. But difficulties of any kind can mean the difference between receiving abortion care and carrying an unwanted pregnancy to term.

"People see New York City as a safe haven for abortion care," said Kirby. "That's not the truth because it doesn't go into the details of what access really looks like." As access to abortion diminishes across the rest of the country, abortion providers in New York City are even more overburdened trying to serve every patient, whether they're coming from one or several hundred miles away.

Elizabeth Estrada said she has recently seen the cost of abortion rise and the wait times grow. People have to leave the borough or even the city to get timely care, and some people are unable to do so. And with a looming Supreme Court decision about access to mifepristone, a pill commonly used for medication abortions, that care may become still further out of reach.

"The long term impacts are innumerable," said Caro, of the closing of Bronx Abortion. "We see folks going into deeper levels of poverty than they already are in. And the cycle continues from there."

Today, the building that once housed Bronx Abortion stands empty. A forest green awning hangs off the side of the building. Dark water stains decorate the walls. Discolored balloon ribbons blow in the wind. The sidewalk in front has no rosaries, no rainbow vests, no patients — only the occasional passerby who barely gives the building a second glance.

The clinic escorts and anti-abortion activists don't agree on much regarding abortion. But they agree on one thing: At any given moment, a small independent clinic like Bronx Abortion might be forced to shut down.

"We're one of the lowest income counties in the country," said Tiffany Quiles. "The last thing women who cannot afford to feed themselves need is another child."

"We need to be asking, how many independent clinics are one core person away from closing?" Chelsea said. "Even in places that we think are safe havens for abortion, we can't take for granted that providers are secure."

Read the original article on Business Insider