Abortion doctors’ dilemma after Row: move, stay, or cross state lines

The National Abortion Federation has created an online marketplace where doctors who have been fired or expect to be able to sell their ultrasound machines, speculums and other equipment.

“We all ask the question: “At what point should I move?” says Ashley Brant, an ob/gyn at an academic institution in Northwestern Ohio and a member of the nonprofit group Physicians for Reproductive Health. “What will be my personal line in the sand?”

While the number of abortion providers in the nearly two dozen states that have banned abortion or are expected to ban abortion soon is small—about 10 percent of the nation’s total, according to the Guttmacher Institute, an abortion rights think tank—their exit is likely , will have a huge impact.

Health experts warn that this potential migration could be devastating. for patients, leaving them without access to contraceptives, prenatal care and other reproductive health services. They also fear that in some communities there will be no doctor left to perform emergency abortions in life-threatening circumstances that are not covered by most government bans.

“If you see medical workers fleeing states that have severely limited their ability to practice in accordance with their moral compass and medical ethics, it will be a huge loss to the public and public health,” said Jamila Perritt, an abortion specialist in Washington. , DC, and President and CEO of Physicians for Reproductive Health. “We don’t have to guess what will happen. We already see high rates of maternal mortality and incidence in places like Louisiana and Mississippi. But we will see much more as these bans continue to sweep the country.”

Among health care providers that POLITICO spoke to in states that have registered abortion bans, no one said they were willing to offer illegal abortions, realizing that this could lead to loss of medical license and, in some states, long prison terms.

Instead, many plan to travel across state lines several days a week or month to have abortions, while maintaining the practice in their home state in case the bans are lifted. Some intend to use telemedicine to consult with their patients and prescribe abortion pills in states where it is legal. And others, especially those whose current jobs focus primarily on abortion rather than the full range of obstetric and gynecological services, are moving to other states.

At the same time, more progressive states fear that as they become abortion destinations for millions of patients, they will not be able to staff quickly enough, potentially causing delays in care that push people into later pregnancy. Activists in California and elsewhere are calling on lawmakers to make it easier for doctors to get licensed if they move to other states or travel part-time, or provide incentives like student loan forgiveness to attract more providers.

But that may not be enough to convince enough doctors to give up their lives.

“If I could move freely, I would have many great opportunities right now,” said Zevida Vickery, an Ohio-based abortion provider who changed jobs instead of moving out of concern for her son. “[Abortion] my professional identity. It was my reason to be over 20 years old. But I am also a single mother of a ten year old who has been with me every step of the way. So I just can’t move. And I can’t describe it any other way than to say that I went through a period of mourning making this decision.”

National Abortion Federation in addition to the online marketplacelace for hardware, also recently set up a bulletin board.

“We are seeing a surge of interest following the leak of the Supreme Court decision,” said Melissa Fowler, chief program officer for the National Abortion Federation. “People were hopeful, but after that, they started moving forward and accelerating their plans to find work in other states.”

Fowler says they are currently seeing more doctors, nurses and other frontline healthcare workers looking for part-time work on business trips rather than moving permanently.

“People are deeply rooted in their communities and it’s hard to pack up and move to a completely different region of the country,” she said. Besides, travel is not uncommon in the healthcare industry. We already have a lot of traveling nurses, especially during Covid. This is a life that provides a lot of flexibility, and some abortion providers have long chosen it for safety reasons.”

Several abortion providers in Texas, Ohio, Indiana and other states that have banned or are about to impose a ban have told POLITICO they do not plan to move for many of the same reasons, even if it means they have to stop work that is important to them.

“I’m just going to keep having abortions until the last day I can,” Brant said. “I could look for work elsewhere. But part of me remains optimistic that people will be so outraged that the pendulum will swing back.”

On Friday, a court allowed Ohio’s six-week abortion ban to go into effect, and lawmakers expect a full ban in November or December.

Brant is one of hundreds of healthcare providers now considering how best to serve their patients in states where their work is, or may soon become, illegal. Under a six-week Ohio state ban, she could face a criminal conviction and up to a year in prison for “knowingly and purposefully” performing a procedure, even in cases of rape or incest.

However, Brant said, she wants to stay to help deal with the post-Caviar fall out.

Follow-up care will be required for people who have had abortions outside the healthcare system,” she explained, using pills ordered online or riskier methods. “And we still hope that there will be exemptions for maternal health threats. If someone has an emergency at 20 weeks, then few people know how to quickly terminate a pregnancy. That’s why I want to be here for it.”

But Brant remains worried that the skills she’s spent years developing are “atrophying” because of the ban, so she’s talking to clinics in Michigan and Illinois and all over the East Coast and debating whether to embark on the complicated and costly the process of applying for a license elsewhere. so she can continue her part-time job while traveling.

Other red state doctors grapple with similar dilemmas, afraid of criminal charges but also afraid of abandoning their patients.

Caitlin Bernard, an abortion provider and professor at the Indiana University School of Medicine, noted that while providers may have the resources and savvy to hop across state lines to practice, many low-income patients don’t.

“For a lot of people in Indiana, if I tell them to leave the state, I might as well tell them to go to the moon,” she said. “They have to pay for clinic care, time away from children, time away from work. Gas prices are also on the rise.”

Texas banned all abortions after six weeks of pregnancy last fall. threatens offenders with up to life imprisonment, providers have more time to deal with their future. But that didn’t make the decision any easier.

“It was incredibly heartbreaking. Every day I saw patients and I had to turn away some because they were too far into their pregnancy,” said Sam Dickman, an abortion specialist from San Antonio who recently moved to Montana. “I also watched my patients collapse with relief when I told them during the ultrasound that they came to me early enough to have an abortion in Texas instead of going to New Mexico.”

Others on staff, including Lauren Thaxton, abortion provider and assistant professor women Health the University of Texas plans to stay even if abortion is outlawed. Enforcement of Texas LawCaviar the ban has been temporarily blocked by the court and the state law has yet to take effect.

However, she knows that many of her fellow doctors will move and is worried about how this will affect patients in Texas who already struggling access to reproductive health services such as contraception, prenatal care and management of miscarriages.

“We are few now,” she said. “And because Texas is such a big city, whenever a person leaves their community, they may be the only person to have received that kind of training for hundreds of miles.”

Medical experts are concerned not only about the immediate loss of medical services in the red states once the bans go into effect, but also about the long-term consequences of a generation of OB/GYNs shunning those states in the future.

“People graduating from medical school now, where are they going to look for residency? Not in a state that doesn’t allow them to practice freely,” warned Tracey Wilkinson, assistant professor of pediatrics at Indiana University School of Medicine and board member of Physicians for Reproductive Health. “Oddly enough, we are already hearing residents who are currently here say they don’t want to stay in Indiana. We already have several counties without OB/GYN care and this will have consequences.”

Blue state clinics, already seeing an influx of patients and expecting to be more dependent on red state workforces in the future, are also on the brink.

We are reaching out to doctors who don’t necessarily want to relocate because they know they will still be needed in their communities for contraception and family planning, but who can work with us because we will have an influx of patients. ” said Jody Hicks, president of Planned Parenthood of California. “But we’re concerned that the generation of doctors who are trained in these states aren’t really trained in abortion.”

Megan Messerli contributed to this report.