In the year since the U.S. Supreme Court eliminated the constitutional right to abortion, the decision has sent shockwaves well beyond the states with bans or restrictions on terminating a pregnancy.
In states where abortion remains legal, groups working to preserve access are being stretched precariously thin as they see an influx of demand from other states and rising costs due to delayed care and more complex logistics. New research, meanwhile, shows how abortion bans and restrictions are affecting not just those who might seek to terminate a pregnancy but also anyone who might become pregnant and the doctors who care for them, while also worsening racial inequities and economic inequality.
One in five office-based OB-GYNs nationwide, for example, say that since the Supreme Court’s decision they have felt constraints on their ability to care for patients with miscarriages and other pregnancy-related medical emergencies, and seven in 10 say the decision has worsened racial and ethnic inequities in maternal health, according to a survey released this week by KFF, a health-policy nonprofit.
From the archives (December 2022): High-income Black mothers and their newborns have worse health outcomes than their less-wealthy white peers
The Supreme Court’s opinion in Dobbs v. Jackson Women’s Health Organization, which was issued one year ago this Saturday and overturned the landmark 1973 Roe v. Wade decision, left states to set their own abortion restrictions or protections. Abortion is now banned in 14 states, and subject in several other states to strict gestational limits that can make abortion unavailable even before many people know they are pregnant.
Between July 2022 and March of this year, more than 25,000 people were unable to get an abortion from a provider, while more than 80,000 people in states with abortion bans or six-week gestational limits faced disruptions in accessing abortion care, according to a study led by the Society of Family Planning, a nonprofit that funds research on abortion and contraception.
Such restrictions are driving many people across state lines to seek abortion care — putting new pressures on groups like the New York Abortion Access Fund, which supports people traveling from other states to get an abortion in New York as well as in-state residents.
In the year since the Dobbs decision, the organization has committed about $1.7 million to help cover abortions for more than 2,000 people from 29 states as well as several other countries, said Chelsea Williams-Diggs, the group’s interim executive director. The organization is on track to spend more than $2 million this calendar year, quadruple the amount spent in 2021 — and at this rate, the fund could run out of money by October, Williams-Diggs said. The group is working to cut expenses and raise more money, she said, but “we might have to start turning folks away.”
Nationwide, abortion access could become even more precarious — and pricey — depending on the outcome of a court case involving mifepristone, a drug widely used in medication abortions. A federal appeals court in New Orleans is set to rule in a case brought by anti-abortion advocacy groups and doctors challenging the Food and Drug Administration’s approval of mifepristone. Medication abortions now account for more than half of all U.S. abortions, and if access to mifepristone is cut off nationwide, more people will be struggling to obtain surgical abortions, which can be far more expensive.
Much more legal upheaval and confusion may be on the way, as roughly 700 abortion bills have been introduced in state legislatures so far this year, according to the Guttmacher Institute, a reproductive-rights research and policy group that supports abortion access. The bills are about evenly divided between those that would restrict access and those that would expand it, such as by protecting abortion providers from legal action originating in states that ban such care, according to Guttmacher.
Read more: Chelsea Clinton ‘really f—ing angry’ one year after Roe v. Wade overturned
One thing that hasn’t changed, some reproductive-rights advocates say, is the stigmatization of abortion. Planned Parenthood Action Fund, which advocates for reproductive rights, sent out an invitation Tuesday to a reception to be held Friday afternoon with President Joe Biden, Vice President Kamala Harris, First Lady Jill Biden and Second Gentleman Douglas Emhoff. The invitation, which was reviewed by MarketWatch, did not include the word “abortion,” although it cited the anniversary of the Dobbs decision and called the event “an opportunity for our supporters, partners, and political leaders to gather in community.”
The omission of the word “abortion” is “embarrassing,” said Renee Bracey Sherman, the founder and co-executive director of We Testify, a group that supports representation of people who have abortions. “How are you being complicit and complacent in the stigmatization of your own issue?” Bracey Sherman and other abortion-rights supporters have issued similar criticisms of Biden in the past, arguing that using the word would show full-throated support for abortion access and help remove stigma.
The White House and Planned Parenthood did not respond to requests for comment.
Anti-abortion activists and conservative lawmakers, meanwhile, have celebrated the one-year anniversary of Roe’s reversal as a historic victory.
“This year’s anniversary of Dobbs is a moment to embrace how far we have come in this movement to protect the sanctity of life,” Rep. Elise Stefanik, a top-ranking House Republican from New York, said during a speech Tuesday at the National Press Club. “Protecting life and defending the unborn are not extreme positions; they are fundamental to [human] rights and the American dream.”
‘The most disadvantaged people’ are hardest hit
While many people have been able to circumvent state abortion restrictions implemented over the past year, those left behind are “the most disadvantaged people, the people with the least money, the least information, least access to resources and least ability to travel,” including people who are hospitalized, incarcerated or under court supervision, said Diana Greene Foster, a professor at the University of California San Francisco.
Foster’s research, including her Turnaway Study, has shown that people denied a wanted abortion suffer long-lasting financial consequences, including increased household poverty relative to those who received an abortion, lower credit scores, and increased bankruptcies and evictions.
As people are forced to travel longer distances to get abortion care, there are also financial repercussions for the abortion funds that directly support people seeking abortions. At the D.C. Abortion Fund, for example, the average amount spent per caller has jumped to $710, from $260 prior to the Dobbs decision, as higher travel costs, inflation and layoffs have compounded callers’ problems and left them with bigger financial gaps that the fund seeks to fill, said Devin Simpson, a fund board member.
As people struggling to access and afford abortions delay their care, their financial problems tend to get worse, because abortions later in pregnancy can be much more expensive, reproductive-rights advocates say. Surgical abortion in New York, for example, generally starts around $600 for a first-trimester procedure, said the New York Abortion Access Fund’s Williams-Diggs, but can cost as much as $28,000 later in pregnancy.
While abortion funds got a rush of donations after last year’s leak of the Dobbs decision, fundraising has since tapered off, the funds say.
“Abortion funds are shouldering this rapidly growing need while experiencing a steady decline in donations since the Dobbs decision,” Oriaku Njoku, the executive director of the National Network of Abortion Funds, said on a call with reporters last week. “Yes, abortion funds receive a burst of support when a ban or court case makes the headlines, but long-term sustained investment is essential to ensure they have the support they need.”
From the archives (July 2022): ‘We need people in it for the long haul’: Abortion funds have raised more than $6 million since Roe v. Wade reversal
‘A gross violation of common sense’
A patient who was about five months pregnant recently went to the emergency room with obstetric complications, in extreme pain and advanced labor — but because of her state’s abortion ban, multiple medical professionals at the hospital refused to get involved with her care, according to a report by Advancing New Standards in Reproductive Health (ANSIRH), a research program based at the University of California San Francisco.
Anesthesiologists refused to give the patient an epidural for her pain, believing it might be a violation of state law. One provider at the hospital told a nurse that even helping a patient who was in the midst of miscarriage onto a gurney could be considered “aiding and abetting an abortion,” according to the report.
“Best to not so much as touch the patient who is miscarrying,” a doctor involved in the patient’s care wrote in a summary of the case submitted to the ANSIRH researchers, calling the incident “a gross violation of common sense and the oath I took when I got into this profession to soothe my patients’ suffering.”
That doctor was so upset by the patient’s treatment that they considered leaving the state, the report said.
“The consequence of banning abortion is putting the health and safety of anyone who can become pregnant at risk,” said Katrina Kimport, a professor at UCSF and co-author of the report. Doctors’, nurses’ and hospital administrators’ worries about violating the law can delay needed care, she said, causing physical harm, damaging fertility and inflicting emotional distress.
While abortion laws are structured in black and white, Kimport said, “medicine is fundamentally gray.” The number of ways pregnancy can go wrong is “incalculable,” she said, “and the law can never create a list that adequately captures all of them to ensure that all these patients can receive the standard of care without delay and fear of criminalization.”
Between September 2022 and March of this year, Kimport and her fellow researchers collected 50 narratives from healthcare providers documenting cases where patients did not get the usual standard of care due to new abortion restrictions. The cases include ectopic pregnancies, which are never viable; medical conditions that made a continued pregnancy dangerous; and other issues.
In states with abortion restrictions, many doctors are confused about where the legal limits lie, recent research shows. Less than half of OB-GYNs in states with gestational limits, for example, say they have a good understanding of the circumstances in which abortion is legal in their state, according to the KFF survey.
Hospitals could reduce some confusion by having clear policies on treatment for certain conditions, like ectopic pregnancies, Kimport said.
The threat of legal repercussions — or even violence and intimidation — is “causing a paralyzing effect on our healthcare system,” said Dr. Jamila Perritt, the president and CEO of Physicians for Reproductive Health and an OB-GYN practicing in the Washington, D.C., area. The situation has “pitted patients against providers,” Perritt said, when doctors are forced to focus on legalities and their own personal risks rather than just patient care.
“That’s not care and not how anyone wants healthcare to be delivered, and certainly not in line with the oaths we all took,” Perritt said.
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