1973: The right to have an abortion
A health-care experiment is underway in the United States. Because Roe v. Wade was struck down, potentially millions will now need to cross state lines for abortion access. Providers and activists are worried about the complex logistics and stress of traveling to end a pregnancy in a short time frame, and of the money spent on gas, flights, lodging and child care before patients even arrive.
More than a dozen states have banned abortion, and others have bans tied up in the courts. States like Colorado have seen an influx of patients seeking legal abortions, with abortion funds spending more and more to help people seeking care. (Cobalt, a Colorado abortion fund, spent $6,000 in 2021 helping patients get to and from their appointments. This year it spent $152,534 on the same services from June through the end of September alone.)
In states where abortion is still legal, clinics are reporting lengthy wait times, anywhere from two to six weeks for an appointment. Abortion is a time-sensitive procedure. A few weeks could mean the difference between ending a pregnancy with medication, which patients can use through 10 weeks of gestation, or with surgery. The further along a pregnancy, the more risks and time and expense are involved in an abortion.
Below, patients and providers talk about their experiences since the reversal of Roe. One woman, who is using her middle name to protect her privacy, spoke with me by phone from the Women’s Med Center in Dayton, Ohio, where she went for a surgical abortion. Another, who is using only her first name for her safety, spoke to me nearly two months after she received a medication abortion from a family physician in Colorado.
Interviews have been edited and condensed.
‘I hadn’t missed my birth control’
Traveled from Kentucky, which has implemented a near-total abortion ban, to Ohio for a surgical abortion
I have five children. I go to school and work full time. I’ve grown up my whole life with my mom and my grandmother, and I lost them in the past seven years. It’s just me by myself with my kids, and it’s been really, really hard. And I know that financially, and with work and school, there’s absolutely no way that I could have another child, and I wouldn’t have any help to do it.
My pregnancy was a total shock. I had been on birth control ever since my last one was born 2½ years ago and hadn’t had any problems. I got really sick. I mean, so sick that I couldn’t even get off the couch. And I thought, I’ve been saying for two weeks I’ve got a horrible stomach virus; it’s not going away. I’m going to take this pregnancy test to rule that out. When it came out positive, I took three more. I went to the doctor and they confirmed it. All this time, I was being really careful. I hadn’t been on any new medications. I hadn’t missed my birth control.
I kept telling myself, There’s no way that you can do this. I’m so busy every day trying to make sure that my kids are taken care of and have everything that they need. To think about bringing along another one, an infant at that? I had someone mention adoption to me and give me information about it. I didn’t feel like I could carry out a pregnancy and give birth to a child and then just hand them away.
I got on the internet one day and found an abortion fund. I started talking to a lady that worked for them and kind of talked to her daily. She was giving me information and trying to help me with the whole process. And the Ohio location was picked because it’s closer to me.
My kids were able to be with their dad. We separated a couple of months ago. A friend of my mom’s drove me the 2½ hours. Thankfully, the abortion fund helped with the cost. We had to stay overnight in a motel because it was two different appointments. If it wasn’t for them, then I wouldn’t have even been able to do any of that.
The clinic said I was 13 weeks. I never thought I would be in this situation. But I did always think that when it came to anything to do with our bodies, this should be our choice.
‘To preserve the families that they do have’
Certified nurse midwife and chief clinical officer of Choices Center for Reproductive Health, which has two locations: one in Memphis, where a statewide total abortion ban has been in place since August, and one in Carbondale, Ill., where abortion is legal
It’s been very hard to turn people away from our Tennessee clinic for abortion care. We provide prenatal care and birth services as well. We had a patient who came for a Day 1 appointment, but when she came for Day 2, we couldn’t provide her with an abortion due to cardiac activity. [Tennessee required two back-to-back appointments for abortion services and implemented a “heartbeat” ban in June. That measure was replaced by a total ban in August.] Now she is with us for our midwifery services, and she’s having a baby that she didn’t plan to have. She is making alternative plans in terms of seeking out adoption agencies or doing a private adoption, so we’re having those conversations with her.
This is very different than caring for people who want to be pregnant. Carrying a pregnancy to term and parenting is already mentally hard for a lot of people, which is why we see such high numbers of people experiencing postpartum depression. And there are very few mental health services available. It is not a simple solution to say, “Okay, well, just give your baby up for adoption.” That’s not an easy decision to make.
It’s also not as simple as saying, “Okay, all a child needs is love.” No, they need more than that. A lot of the people that we were caring for experience hardships — and resources are not plentiful. Many of them are single parents who already have other children at home and really can’t afford to parent another child. The decision to terminate a pregnancy is made to preserve the families that they do have.
I don’t think that the legal landscape in Tennessee will change anytime in the future. My hope is that they will at least be able to revisit the law and make some exceptions. Choices is really focused on growing midwifery in the South, particularly Black midwifery, to address the maternal health crisis that we are experiencing, and that will only be exacerbated by these archaic abortion laws. Unfortunately, some of the states that have the most restrictive abortion laws are also those that have the worst maternal outcomes.
With these pregnancies they’re carrying to term, they’re at greater risk of dying. We know that. I mean, what is the solution? You know, the public says they care about babies and all of those things, but we have not expanded any of the social services that are needed for these families to be successful. As a clinic, we’re not just working to provide abortion care. We are working to provide people with the reproductive health-care services that they need and treat them with the dignity that they deserve.
‘I’d still be trapped’
Traveled from Arizona to Colorado for a medication abortion. Arizona reverted to an abortion ban from 1864 in September, before it was lifted by a judge in October
I was trying my best to see if the marriage was salvageable. I knew deep within me that it wasn’t and that I was going to be unsafe if I went through another pregnancy with my husband. During my pregnancy with my son, who is 20 months now, I was physically abused and almost strangled to death.
There were red flags, but I was so naive. It was my first relationship. We eloped impulsively after nine months. He was the one with the idea, and I was just so in love that I said yes. One month after we got married, that’s when the abuse started happening.
My husband didn’t want me to use any form of birth control, but I secretly got an IUD in 2021. He would refuse to wear condoms, any sort of protection, or do anything I asked. He would completely ignore it. He eventually found out that I had the IUD and got extremely mad. I didn’t want him to be mad, so I got it out.
That’s how I got pregnant again in 2022. I felt extremely nauseous, and I had a strong feeling that it wasn’t normal nausea. I went to Walmart real quick, told him I needed to get something. Even me going to the store was really hard because he would be calling constantly, asking if I was with someone else or what I was doing or why I was taking so long. When I told him that it was positive, I said I wasn’t ready to have another one. He told me, “There’s no way you’re going to have an abortion.” And the physical abuse started so badly again.
I had to figure out a way to get to my parents in Colorado because I knew it was safe there to get an abortion. I had absolutely no money. He was in control of all the money. All the thoughts about how I could give myself an abortion started, and I was like, I can’t do that to myself. Like, I’ll probably really hurt myself. I was so, so nervous. I was full of anxiety.
I got a one-way ticket with help from my brother-in-law, who knew I was being abused. We got on a plane, me and my son. It was on Aug. 20, and my mom picked us up and we haven’t gone back since. My doctor in Colorado had an appointment open, so I went in, and when I told him a little bit of the story, he jumped right in to figure out how to help me. Another doctor in the practice ended up figuring out how to get me the funds to be able to pay for the medication to have the abortion. I was seven weeks. I knew it was something I had to do. I feel like if I would’ve had another baby right now, I wouldn’t be able to move on with my son as easily. I feel like I’d still be trapped.
‘It’s bad for the patients, bad for the provider’
OB/GYN in Denver and the Colorado section chair for the American College of Obstetricians and Gynecologists
The day that the Dobbs decision came out, we got 10 phone calls for tubal ligation consults from our patients, which is very unusual. More women are seeking permanent contraception in the last three, four months. Other women are wanting to exchange their IUD sooner. We’re having more women wanting hysterectomies. They’re like, I don’t ever want to have an unwanted pregnancy.
A common phrase I use with my patients is: Pregnancy usually can be rainbows and unicorns, but when it isn’t, it isn’t. And things can go drastically wrong, and it can lead to the life of the mother being in danger. The challenge with laws that do have an exception for the life of the mother is: Clinically that has no meaning. It’s a judgment call. And when you have laws that have bounties or prison sentences for providers or caretakers, there’s this fear from the medical community of: At what point is the life of the mother in danger? Like, is it when we’re doing CPR? Is it if I clinically think she’s bleeding enough?
That’s the challenge with non-medical people trying to legislate medicine. Medicine isn’t black and white. It’s years of experience and training and sometimes making a gut decision. I frequently tell patients, “I need you to be a mom for the kids that you have.” Not to devalue the pregnancy, but sometimes the pregnancy is the most harmful thing to that family.
I recently performed an abortion, and it was her first pregnancy but it was a fetal anomaly. She’s very conservative herself and she was like, “I never thought I would be here.” I’m like, nobody wakes up and says, “You know, I think I’ll just go have an abortion today.” It’s just not how it works.
We had a gal who traveled 18 hours by car to Denver from Texas with her husband and her kid. She knew she had an ectopic pregnancy, but she didn’t feel comfortable being treated in Texas because of their laws. Not that she distrusted the doctors. She distrusted the system and that they would be able to offer her, medically, everything that she should be able to get. I think about how she drove through rural America — Texas and rural Kansas, Oklahoma, Colorado. If that ectopic would’ve ruptured, she could’ve bled to death in the car without emergency services nearby.
It’s bad for the patients, bad for the provider. Quite frankly, I don’t think you should have to cross state lines to get health care. You should be able to go down the street. We already have a maternal mortality crisis here in the U.S. This is only going to exacerbate that. I think unfortunately that what it’s going to take is women dying before the general public or politicians wake up and say, We actually did something really bad here.
Tiffany Stanley is a writer in Washington.