Abortion is now banned in 10 states, severely limited in another four, and threatened in about half of the country, in total. In states where exceptions may be made in cases of rape or incest, or for the sake of a patient’s life or well-being, guidelines are vague about what kind of abortion or abortion-adjacent care is still legal. This has left providers to decipher the unclear exception rules—and contend with the potential for prosecution, should they guess wrong. Abortion funds and practical support organizations have mobilized to provide resources to abortion seekers however they can. But, of course, they’re unable to offer many of the crucial in-person abortion services that so many patients continue to seek.
VICE spoke with five abortion providers whose work has been hit hard in states with varying levels of abortion restrictions triggered by the Dobbs v. Jackson Women’s Health Organization decision.
Interviews have been edited for length and clarity.
Hanna Peterson (she/her), 30, Louisville, Kentucky
The Dobbs decision triggered an abortion ban in Kentucky, making abortion a felony offense with exceptions to protect the life of the pregnant person. An ACLU-helmed restraining order blocked this trigger ban, as well as a “heartbeat ban,” from taking effect for several weeks. On August 1, an appeals court ruled to reinstate the so-called heartbeat bill, which is a near-total ban on abortion. Hanna Peterson, an OB/GYN, has been dealing with these constant legal changes while treating patients.
It’s been legislative whiplash in Kentucky since the Dobbs decision. Prior to the trigger ban, we were able to provide abortions up to 21 weeks and six days. Immediately after the Dobbs decision, we had to turn everyone away from our abortion clinic, including patients who were scheduled to get abortions that day.
After an ACLU restraining order came through on June 30, we were able to provide abortions up to 14 weeks and six days, which was much better than a total ban. Now, an appeals court reinstated the trigger law that bans abortion at about six weeks. For a lot of people, even a matter of a couple of days makes or breaks their situation, so this is devastating.
After the Dobbs news leaked, we began doing cross-training with our colleagues in the emergency room. There are rarely complications with medication abortion when abortion care is legal. However, I believe my emergency medicine colleagues will see more complications from self-managed abortions. Patients will be seeking abortions without guidance of a medical professional. Some may not be suitable candidates for medication abortion if they’re too far along in the pregnancy (meaning, past 10 weeks), which is hard to know without an ultrasound, or they have medical conditions that make medication abortion unsafe for them, like severe anemia, heart problems or ectopic pregnancy.
As much as we’ve tried to prepare ourselves and our colleagues, nothing can prepare you for the feeling of being totally helpless, or for having to turn patients away.
We trained emergency room staff on how those patients might present; how to manage a septic abortion; and how to provide support for those patients in a way that is non-judgmental and comprehensive. Emergency room providers are pretty used to seeing miscarriages. But patients may increasingly come in with catastrophic bleeding that needs to be stopped surgically. So, for our colleagues who are at facilities that don’t have OB/GYNs, we’re looking at training them on how to do bedside D&Cs, or manual vacuum aspiration (MVA) procedures, which can be provided at 12 weeks of gestation or less. They’re very simple. They require a large syringe that is a highly pressurized system that needs to be special-ordered in advance, because not all hospitals stock them.
As much as we’ve tried to prepare ourselves and our colleagues, nothing can prepare you for the feeling of being totally helpless, or for having to turn patients away. As a physician, you have this very unique skill set where you can help people. All of a sudden, we have to say, “I would do this in a heartbeat if I could—but I can’t.”
Jonathan Reese* (he/him), Boise, Idaho
When Roe v. Wade was overturned, trigger laws in Idaho banned all abortions except in the case of rape and/or incest or to protect the life of the pregnant person. The Department of Justice is currently suing Idaho on the grounds that its severe abortion restrictions will endanger patients’ lives and cause them significant bodily harm. Jonathan Reese, a doctor in Idaho who asked to use a pseudonym because of safety and privacy concerns, wears many hats in the medical field, including inpatient and outpatient medicine, obstetrics/pediatrics. Before the ban, he provided abortions.
I’ve been providing abortions for about seven years. With Roe overturned, I will no longer be able to provide this vital service in the state, except in cases of rape or incest, or when there is risk of death to the patient.
I foresee a lot of problems with these restrictions. In a case of rape or incest, according to the law, you’re required to have a police report. As we know, very few people actually go to the authorities when these cases arise. If they do have a police report in hand, the provider then has to review it and ensure its legitimacy before they proceed, which could cause a huge delay to abortion care.
There’s a lot of vagueness about what an exception for risk to the patient means. There’s no steady guidance. There are a lot of risks that evolve throughout the pregnancy that we can detect early on, where—before the Dobbs decision—we provided patients with options for treatment, which included termination of the pregnancy before complications arose.
People who would have lived before are now going to die because doctors will be too worried about providing them with care.
For example, if someone’s amniotic sac ruptured prematurely, and that person were to give birth, then that fetus, if pre-viable, would not survive. Before Dobbs, there was the option of inducing that pregnancy, knowing that that would most likely result in a non-viable fetus. The other option would be to try and continue the pregnancy to viability. But that has a huge risk of infection, and the patient could become septic. They could die. So: Is the rupture of the membrane considered reasonable enough to terminate? Or do you have to wait until a patient is septic?
In Idaho, which has criminalized abortion, doctors are going to be incredibly risk-averse. People who would have lived before are now going to die because doctors will be too worried about providing them with care.
Our stance, as physicians, is that these decisions need to happen between a patient and their provider. Legislators are not medical professionals. There are a lot of things that lawmakers just don’t understand that make these decisions very complicated. Now, we don’t know what to do about them, and by restricting us from providing the highest standard of care, people will die.
Not being able to perform abortions in the state of Idaho anymore is difficult. It’s weighing on me very heavily. That procedure is a very safe outpatient procedure that we do. But it’s a skill that we use in a lot of other things: The biggest example would be miscarriage management through aspiration for someone that has a fetal demise. That is the same way that we would evacuate the uterus for an abortion. Now, this skill that I’ve been trained in, I won’t be able to use. That’ll be detrimental to our patients, too—that providers that are going to lose those skills.
DeShawn Taylor (she/her), 47, Phoenix, Arizona
Arizona has had two trigger bans: a pre-Roe total abortion ban, as well as a 15-week ban that took effect after Roe was overturned. The governor said the 15-week ban supersedes the original ban, but the attorney general said that the 1901 total abortion ban is enforceable. Clinics stopped providing abortions after Dobbs. DeShawn Taylor is an OB/GYN in the state who provides full-spectrum OB/GYN care and gender-affirming care. Before the ban, she provided abortions, and she has also trained providers in abortion care.
As long as I’ve been a doctor, I’ve been an abortion provider. In my intern year, I realized a large number of OB/GYNs that I trained with were ideologically against people receiving abortions, so I started to consider making abortion care a very prominent part of my work.
Right now, there’s a pool of abortion providers traveling from state to state because there is no local person who provides the care. That will only get worse.
When I started my practice, my goal was integrating abortion care with other types of general care. I created an environment where people seeking abortions could feel comfortable and safe. Over nine years, I also fostered this really cool pro-choice group of patients who know that their doctor does abortions. And there are people now coming to me for their GYN care, because they know I provided abortions, and because I added gender-affirming care last summer.
Right now, there’s a pool of abortion providers traveling from state to state because there is no local person who provides the care. That will only get worse. As someone who has dedicated a significant amount of time to training the next generation of providers, I’m very concerned about that. Opportunities for training were already dwindling prior to the decision. I had to cancel trainees coming from Vermont and New Jersey for this month when we decided to pause care. They would have been the 19th and 20th states from which people have traveled to receive abortion training from me, not including Canada. The public discourse is, “Of course, someone should be able to get an abortion if they’re raped, or if there’s a tragic fetal diagnosis.” So who’s going to do them? How will they get the skills to provide those types of abortions, when they don’t ever do them?
Abortion service was essentially a cash-pay service because of Arizona’s insurance restrictions. The loss of revenue has been worse than I had anticipated. Keeping the doors open is a very big struggle, but I’m fundraising. I’m committed to staying in Arizona and keeping my clinic open. However, I want to continue training abortion providers, so I’ve started to consider the possibility of co-partnering with a facility out of state where abortion is legal. If a facility is not currently providing surgical abortion services, I would be able to provide services for them there while continuing my hands-on abortion training program.
Catherine Romanos (she/her), 43, Columbus, Ohio
In Ohio, a six-week ban took effect after Roe was overturned. This translates to about two weeks after a missed period. Catherine Romanos is a family doctor who provides abortions in Ohio.
We’d prepared for this since December, when the oral arguments for the Dobbs case were heard. After the decision, I learned that no matter how much you prepare for grief, you can’t prevent it.
How do I not abandon the people here and continue to practice somehow? I don’t know.
The decision made me reevaluate my life. I started applying for Illinois and Michigan medical licenses. But I think I want to stay in Ohio, because if I left, I would feel an intense survivor’s guilt about abandoning people here. But I also feel like I am forgoing a skill set that’s not very common that might be needed in other places. How do I not abandon the people here and continue to practice somehow? I don’t know.
I’m fielding a lot of calls from colleagues in other fields such as emergency medicine, who used to say to patients, “Just go online and find the abortion clinic.” And now they don’t even know what to tell patients. Everyone’s scared to break the law, but at the same time, they’re trying to make sure that their patients are getting care where they can.
Who wants to practice in a place where they could go to jail?
An after-effect that I anticipate is that people with higher-risk pregnancies will have to carry to term. I saw a patient for an abortion a couple of weeks before the Dobbs decision. She had a cardiac arrest during her vaginal delivery last year. She didn’t want to have another delivery, especially because of her previous traumatic and dangerous birth—she has a kid to take care of. Now, she wouldn’t have been able to get a surgical abortion in Ohio.
My colleagues are going to be really busy taking care of a lot of really sick patients while also worrying about retaining students, residents, and doctors: Who wants to practice in a place where they could go to jail?
It’s so striking to me that we still have a 24-hour waiting period in Ohio after Roe’s overturn. That waiting period was ostensibly put into place to give people time to think about it, right? But everyone is now feeling very rushed to decide before cardiac activity develops. So what do they want? Do they want to rush people? Or do they want to give people time to think about it? Because more than one patient has said to me, “I wish I had a couple of weeks to sit with this before I went ahead.”
Diane Horvath (she/her), 43, College Park, Maryland/formerly traveling to Alabama)
Alabama has a total abortion ban from 2019 that went into effect. Abortion is protected in Maryland. Diane Horvath was a traveling abortion provider who visited Alabama once a month to provide care where there would otherwise have been no or very few providers. She has not been able to continue working in Alabama since Roe was overturned.
My commitment to providing abortion was one of the reasons I chose OB/GYN as a specialty and sought out a residency providing that training.
In January, I began working as a traveling abortion provider. I went once per month to two independent clinics in Alabama which had a physician-only restriction even pre-Dobbs, which meant nurse practitioners and midwives couldn’t provide abortion care there. The pool of physicians who are willing and able to travel is limited, so it was really challenging to find coverage, particularly at the Montgomery clinic which relied entirely on traveling physicians.
During my time working in Alabama before the Dobbs decision, I saw patients for both procedural and medication abortions. Many of the patients traveled long distances due to the lack of clinics and available appointments. We saw patients from Louisiana and Mississippi who were unable to get appointments at the clinics in their home states because of the fallout from SB 8 in Texas.
I said, “However many times you need us, we’ll be here for you”—and then we realized that this wasn’t true anymore.
On my last trip to a Montgomery clinic in mid-June, you could feel the anticipatory grief in the air. When I left, one of the wonderful staff members said, “Until next time, doc!” Then we looked at each other and knew there probably wasn’t going to be a next time. On that same trip, I spoke with a patient who was there for her second abortion and feeling a lot of shame about it. We talked about how we spend 30 or more years trying not to get pregnant, and that it’s really normal to get pregnant when we don’t want to be sometimes. I said, “However many times you need us, we’ll be here for you”—and then we realized that this wasn’t true anymore.
People in Alabama are still going to need gynecological care, including pregnancy ultrasounds and follow-up after self-managed abortion (or abortions they obtained out of state), so the clinic in Tuscaloosa I worked with is working on staying open to continue these services. They’re planning to provide a wider range of routine reproductive care, like annual exams, contraceptive visits, and gender-affirming care. But while they’re working on a plan, they have to turn patients away, and they’re feeling a ton of grief.
I’ve only become more committed to providing abortions because I’ve been able to witness countless times how important abortion is as a normal part of healthcare. Opening Partners in Abortion Care is one of the things that has kept me from despairing in the last few months. My business partner, Morgan Nuzzo, and I had already started planning last fall to open the clinic sometime in late 2022, because there already wasn’t enough capacity to care for all the people who need later abortion. This was before the draft decision leaked, and of course we feel a much greater sense of urgency now that the abortion landscape has changed so dramatically.
The existing all-trimester clinics have significant waiting lists (four to five weeks at some clinics) and what this means, in practical terms, is that there are a significant number of people who just won’t get the care they need. We are so fortunate in Maryland to have enough legislative support to allow us to provide evidence-based care in a welcoming environment. We are able to see patients in all trimesters because our state recognizes that abortion is normal healthcare that needs to be accessible.
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