Arizona just joined one of the narrowest and strictest abortion regimes in the country. In a 4-2 decision led by Justice John R. Lopez, Planned Parenthood Arizona v. Mayes/Hazelrigg has reinstated an 1864 zombie law banning nearly all abortions—a law so outdated it was created before scientists understood how ovulation worked.
The Civil War-era law mandates two-to-five years in prison for anyone aiding an abortion, including medical providers. It offers exceptions for “the life of the mother” but not for rape or incest. The ban is slated to go into effect in early June.
Like so many states across the country, Arizona was thrown into upheaval when Dobbs overturned Roe v. Wade. The 160-year-old zombie abortion law reared its head, but six months in the wake of Dobbs, the Arizona Court of Appeals ruled to allow doctors to provide abortion care up to 15 weeks of pregnancy, even without the protection of Roe v. Wade. Then, local gynecologist Dr. Eric Hazelrigg inserted himself in the case, fighting for the rights and interests of fetuses in Arizona. Conservative pro-life organization Alliance Defending Freedom took up Hazelrigg’s mantle and brought a case demanding that the Arizona Supreme Court override the new protections in favor of a near-total ban.
“Today’s Arizona Supreme Court decision to enforce a total ban on abortion is cruel and unjust,” said Dr. Atsuko Koyama, an abortion provider at Camelback Family Planning in Phoenix. “Infant mortality and maternal mortality are rising in states with abortion bans. Pregnant people are being denied essential health care because of these ever-changing state laws.”
“Physicians are now on notice that all abortions, except those necessary to save a woman’s life, are illegal … and that additional criminal and regulatory sanctions may apply to abortions performed after fifteen weeks’ gestation,” the ruling reads. “The legislature has demonstrated its … unwavering intent since 1864 to proscribe elective abortions absent a federal constitutional right.”
Eloisa Lopez, executive director of Pro-Choice Arizona and the Abortion Fund of Arizona (AFAZ), says this is a direct pushback against the swell of momentum for the abortion ballot in November—abortion advocates say they’ve successfully collected 506,892 signatures (120,000 more than necessary) to support the initiative. But halting abortion care for eight months could prove disastrous in the meantime.
“Come November and we vote this into our constitution, we might not even have clinics,” Eloisa said.
Since Roe was overturned, AFAZ has spent $521,000 in abortion funding on 1,540 people traveling for care, covering everything from flights and drives to lodging, meals, medication, and child care. And that was when abortion was legal at 15 weeks.
There were about 13,900 abortions performed in Arizona in 2021, according to the Arizona Department of Health Services.
“That’s a lot of people to get out of state,” Eloisa said. “We need to raise a significant amount of money—way more than $300,000. Government is not doing it, and private insurance is not doing it … ‘Do I pay my rent, or do I go pay for my abortion?’ That’s the choice our callers are constantly faced with. A first-trimester abortion costs $700. People take out personal loans. It’s a really hard financial stress for people.”
This cliff of care that Arizonans are careening toward is accompanied by fear and chaos inside and outside the hospital.
“The point of the legislation is cruelty and to confuse physicians and patients,” Koyama said. “The back-and-forth of abortion restrictions is causing chaos. Abortion is legal one day but not the next, or there are restrictions that are not based on science but on partisan politics.”
Koyama says part of the ongoing struggle in the fight for meaningful reproductive justice is preserving the patient-physician relationship and a holistic approach to what that decision-making looks like. Surveillance, over-policing, and the omnipresent shadow of law enforcement in doctors’ offices exacerbate gaping disparities in health care—racially and socioeconomically—and threaten to erode trust irrevocably.
“[Abortion advocacy] can’t be in a silo,” Koyama said. “When we define reproductive justice, it’s the ability to have children or not have children and to raise your children in a safe and sustainable community. If we’re going to work toward improving reproductive lives, we have to do all of that. We can’t just say, ‘Oh, we need to get rid of these abortion bans.’”
We need to examine our mandated reporting laws, explained Koyama, and consider whether we need to screen pregnant women for substance abuse. Who are these reports serving when these agencies are already overburdened and under-resourced, especially in states where marijuana is legal?
Part of the most detrimental fallout of the recent ban is the exponential toll it will take on communities already facing deep and abiding inequities—racism runs rampant in health care. Koyama said that while she feels confident Camelback provides “excellent services” that are patient-centered and trauma-informed, “when it comes to people of color, do they have a reason to trust us? Medical people? Not really!”
Koyama pointed to a recent story where she sent a patient to the ER for a likely ectopic pregnancy. The woman was given the medical runaround for days, bouncing between her home and the hospital, stomach pains and ultrasounds. The ER couldn’t find what was an admittedly more rare ectopic in her ovary—until Koyama insisted on a follow-up with a colleague.
“Finally, my patient got treated, and it’s just really frustrating because she happens to be a Black woman, and I fear that is not a coincidence. Despite telling providers she hadn’t had any vaginal bleeding, they told her she likely had a miscarriage. Research has shown that Black women are often not listened to, and this plays a role in the higher Black maternal mortality rates,” Koyama said. “Serena Williams and Beyonce spoke out about their own childbirth experience and feeling like they were not listened to, and these are strong women with economic means to speak up for themselves.”
The cascading effects of this ban will be devastating, placing ER doctors in the crosshairs of being potentially prosecuted and pulling care from places it’s desperately needed.
“The ER physician is stuck,” Koyama said. “They are thinking, ‘I’m trying to get my patient life-saving surgical intervention.’ But the one doctor who usually does it and who used to do it without batting an eye—pre-Dobbs—is refusing. So now they have a trauma surgeon who is willing to do it.”
Koyama encouraged people from across professions that are directly and indirectly impacted to get involved.
“That person needs to be up there at the state Capitol being like, ‘This is what your law led to!’” Koyama said.
While Arizona has joined 16 other states in near-total bans and what increasingly feels like a hopeless situation, Eloisa and Koyama emphasize that for now, abortions are available, and so is funding to leave the state for care. Awareness of the services available and education on what the laws prohibit—and don’t—are vital to galvanizing and protecting patients and providers alike.
“We need to get more people out there talking about it,” Koyama said. “It can’t just be those of us doing the abortions.”
