In Arizona, Dr. DeShawn Taylor had been preparing for the fall of constitutional abortion rights for months ahead of the Supreme Court’s June 24 decision to overturn Roe v. Wade.
“I started working through the process of grief and reconciliation, honestly, when the Supreme Court took up the case to begin with,” said Taylor, the founding OB/GYN of Desert Star Family Planning in Phoenix. “This whole time I’ve been working through what’s going to happen to my clinic.”
When it became clear that the Supreme Court planned to overturn Roe in its decision in the case Dobbs v. Jackson Women’s Health Organization, she began moving patients with July abortion appointments into June.
Currently, Arizona has a law dating prior to Roe that bans abortion, while another law permitting abortions up to 15 weeks into pregnancy was signed by the governor earlier this year. That’s led to uncertainty in what doctors can and cannot provide patients. After the decision came down, Taylor, like most abortion providers in the state, opted to halt procedures and cancelled all abortion appointments for the rest of June, “until the state clarifies if and how we can safely proceed,” she said.
But even before the fall of Roe, Taylor—and her patients—have been navigating a web of bureaucratic layers that delay and make it difficult to access reproductive care: ultrasound requirements, 24-hour waits following a consultation, and a requirement that physicians obtain admitting privileges to nearby hospitals. Barriers like these, known as “TRAP,” or Targeted Regulation of Abortion Providers, laws implemented under the guise of patient safety, add an additional layer of “invisible labor” on abortion providers who are trying to “minimize the burden on [patients] and preserve abortion access,” researchers say.
“Basically, every year [since 2009] there has been something,” Taylor said. Now, that has only worsened due to the 6-3 ruling. “For the people who really didn’t start to process the reality until now, then they’re behind the eight ball, honestly.”
Abortion providers who spoke with Prism anticipate that patients will increasingly cross state borders to access care. They worry about a burgeoning labor force crisis as new doctors struggle to access reproductive health training. And with Roe gone, they expect more dangerous delays for patients as laws impede medical ethics.
“That’s so separate, so distant from anything medical.”
In Texas, a six-week abortion ban under SB 8 has already forced Dr. Stephanie Mischell, a family physician in Dallas and a Physicians for Reproductive Health member, to refer patients out of state—if that is even a financially attainable option for patients. She finds herself explaining what kinds of ID are required to take a flight and other assistance unrelated to medicine. “That’s so separate, so distant from anything medical, but it’s the reality of what’s needed for a lot of people to get abortions now.”
For the patients who met the strict requirement under SB 8 and had appointments the day of the decision, her clinic scrambled to finish their appointments before 9 a.m. CST, when they anticipated Supreme Court decisions would start rolling in. Once the news broke, clinic staff began calling patients to cancel appointments. Abortion clinics, including Mischell’s, sued, but a state Supreme Court judge ruled over the weekend that the state’s pre-Roe 1925 abortion can be enforced while the case is heard, the Texas Tribune reported. This followed a brief period where abortions were permitted at the clinics who filed the lawsuit based on a Houston judge’s ruling, but that was overturned.
Mischell says that she and her co-workers had been expecting the outcome and the SCOTUS decision was hardly a surprise. “That really didn’t make it hurt any less. It was still absolutely devastating for me, for my colleagues, but most of all for the patients.”
Anti-abortion laws obstruct what providers have spent years studying and training to do. Basic medical ethics, patient privacy protections, and autonomy are contradicted by laws restricting abortion, according to Mischell, putting unscientific laws between patients and their health care team.
Communities of color will be disproportionately harmed by worsening abortion access. Abortion patients are disproportionately Black (28%) and Hispanic (25%) in comparison to their population in the U.S., according to 2014 data from the Guttmacher Institute. White people make up 39% of abortion patients, despite non-Hispanic white people making up about 62% of the population. Additionally, nearly six in 10 abortion patients had previously given birth, and three-fourths were low-income. Research has also found that states with more restrictive abortion laws have higher maternal mortality. Advocates fear maternal health will worsen now that Roe has been overturned.
“That is going to create harm, and that is going to put patients at risk,” Mischell said.
Dr. Josephine Urbina, a graduate of the complex family planning fellowship at the University of California, San Francisco, says it’s frustrating and makes her angry to watch abortion bans go into effect across the country—putting people at risk of prosecution.
“I believe this is a race and power issue,” Urbina said. “And those who will be criminalized for abortion or miscarriage will be the same that are criminalized for everything else.”
Safety concerns at clinics, even in “haven” states
Providers are also dealing with an increasingly hostile atmosphere against their work, even in “haven” states like California, where abortion remains protected under state law. Back in March, San Francisco District Attorney Chesa Boudin’s office alleged anti-abortion protesters “barged” into the UCSF hospital, filming patients and hospital staff, the San Francisco Chronicle reported. The Chronicle reported that anti-abortion activists specifically targeted a doctor by posting stickers with information including the doctor’s name and photograph near the hospital and in the doctor’s neighborhood.
The incident, which is where Urbina works, made “the dangers of providing abortions a reality,” she said.
“I’m a mom of two little girls, and with another one on the way, and these protesters seeing me—a pregnant person—offering abortions I’m sure is something that they probably can’t deal with,” said Urbina. Even so, as a Chicana provider, Urbina feels it is especially important to continue her work to normalize and destigmatize abortion within the Latinx community, she said. “It’s something that I don’t take lightly when I continue to choose to do this work and continue to be there for my community because I think it’s definitely important.”
Dr. Ashley Jeanlus, a current complex family planning fellow at UCSF, said the hospital held security trainings for abortion providers about digital security and best practices when entering the building.
“I don’t know what other specialities [in medicine] in terms of their training and their education get that talk, as to how to protect yourself, how to make sure that you’re not providing your information or details about your location on the internet, how to park away from your clinical site, not to wear your scrubs to the clinic,” Jeanlus said.
A looming labor force crisis
In California, doctors at the University of California, San Francisco, told Prism they’d already been seeing patients from Texas as a result of SB 8, and patients often arrived later in pregnancy than other patients. Without Roe, “the wait time to get in to have a termination is going to be prolonged,” said Urbina.
Abortion providers have a limited number of patients they can see per day, and doctors like Urbina also see patients from abortion clinic deserts in California—even with state leaders’ commitment to protecting abortion rights.
Dr. Tania Serna, another gynecologist as well as associate professor at UCSF, said doctors are still catching up on appointments people put off during earlier waves of the COVID-19 pandemic.
“It’s been worsened due to the COVID pandemic,” Serna said. “We’re feeling a lot of strain.”
Training options for budding medical professionals will likely also drop. Nearly 44% (2,638 of 6,007) future OB/GYNs who are currently in their residency are either certain or unlikely to access in-state abortion training, according to an April paper in the scientific journal Obstetrics & Gynecology.
That amounts to thousands of fewer future gynecologists who won’t have equal access to necessary training on how to remove pregnancy tissue, for example—a procedure doctors carry out to complete an abortion or to stop excessive bleeding and prevent infection after a miscarriage.
“There’s not really going to be the bandwidth for training in post-Roe America, so that’s going to be a significant concern,” added Taylor, the Arizona abortion provider.
Where abortion providers can legally work is also uncertain. Jeanlus had been waiting on the Dobbs decision to determine what state she’ll find a job in after she finishes her fellowship at UCSF.
“The question I get a lot is, ‘Oh, hey Ashley, what are you going to do next year?’” she said. “I essentially tell them [that I was waiting] to learn what the Dobbs decision is because that will dictate which states I [will] be able to work in, which is horrendous.”
Serna said her hospital is training emergency medicine health care workers in post-abortion care and self-managed abortion to mitigate the damage. “We are not backing down, we are still here and prepared for all [who] come into our clinics seeking care, to all seeking training, and to all who wish to learn about ways to support access to evidence-based, patient-centered care,” she said.