One year after the Supreme Court's Dobbs decision that overturned Roe v. Wade, women across the United States are feeling the effects. There are 25 million American women living in states with abortion bans or tighter restrictions. 

But even in states where abortion is legal, abortion providers are seeing patients who have traveled, sometimes great distances, to access reproductive care.

In one Women's Health Services clinic in Brookline, Massachusetts, the staff hung a corkboard map on the wall. You can see pins from all over New England and a number of southern states. Dr. Lolly Delli-Bovi told WBUR that in her work at the clinic she "rarely saw patients from beyond New England. ‘But then the minute the leaked opinion came out and then the Dobbs decision,’ she said, ‘we started seeing people from basically everywhere in the South.’”

Nationwide, the number of abortions in states where it remains legal has risen, especially in states that border states where it is illegal, but the nationwide numbers have not made up for the precipitous drop seen in states where abortion is banned, suggesting that many people — tens of thousands by some estimates — who might have wanted abortions were not able to get them. 

“It’s the patients with resources who come, especially from out-of-state,” Dr. Delli-Bovi told WBUR. “That's what makes me eternally sad,” she said, “who's not coming.”

Ethical Obligations vs. Legal Repercussions

We've all read the horror stories from women who found themselves in emergency rooms with complications stemming from their pregnancies and were refused care or told they had to wait for their symptoms to get worse before an abortion could be performed to save their lives.

As American Medical Association President Dr. Jack Resnick said in a speech at a November meeting, "I never imagined colleagues would find themselves tracking down hospital attorneys before performing urgent abortions, when minutes count, [or] asking if a 30% chance of maternal death or impending renal failure meet the criteria for the state's exemptions, or whether they must wait a while longer until their pregnant patient gets even sicker."

Decreasing Access to OB-GYNs

In states with restrictions, Lucy Tu writes in Scientific American magazine, the Dobbs ruling has caused "collateral damage" to women's health care generally, including declining standards of care and a lack of ob-gyns. “Even before Roe fell, reproductive health care in the U.S. was a sprawling patchwork—one third of all counties lacked a single obstetrician,” she writes.  

“In a recent survey, 68 percent of current ob-gyns reported that the Dobbs ruling has worsened their ability to manage pregnancy-related emergencies, and more than one third said their ability to practice within the accepted standard of care has deteriorated. A separate report by the Association of American Medical Colleges found that ob-gyn applications in states with abortion bans dropped by 10.5 percent during the 2022–2023 application cycle. While these data represent the preferences and not the eventual placements of medical residents, the decrease in applications suggests that states with new abortion restrictions could face increasing shortages of ob-gyns.”

Dr. Jody Steinauer, director of the Bixby Center for Global Reproductive Health at the University of California, San Francisco, told Scientific American that “prospective doctors face a daunting decision: either practice in states where restrictive measures threaten their livelihood and the quality of care they can provide or abandon people in dire need of reproductive health services.” 

According to a December 2022 study by the Commonwealth Fund, “states that have banned, are planning to ban, or have otherwise restricted abortion have fewer maternity care providers; more maternity care ‘deserts’; higher rates of maternal mortality and infant death, especially among women of color; higher overall death rates for women of reproductive age; and greater racial inequities across their health care systems.” 

Additionally, in states where abortion is legal that border states where it is not, traveling patients are impacting in-state patients' access to health care. Blogger Jessica Valenti writes in her "Abortion, Every Day" newsletter that “in Colorado, Karen Middleton, president of the abortion rights group Cobalt, writes in the Denver Post about how the decision has thrown Colorado’s healthcare system ‘into chaos’:

“Patients, many of them in medical, emotional, and financial distress, are flooding Colorado from abortion ban states. Statewide, patients here are seeing delays in the full spectrum of reproductive health care because of the time-sensitive nature of abortion care. Routine screenings and procedures are getting pushed back and moved around because we have a crisis created by the Supreme Court and anti-abortion ideologues.”

Valenti tracks local news stories about how the Dobbs decision is playing out across the country in her "Abortion, Every Day" Substack and podcast. She says she does it because "we are living through one of the most important moments in history for American women. …What we do now will determine what our granddaughters’ lives—and the lives of their children—look like. We can’t afford to be overwhelmed or confused. We can’t watch as women’s experiences, their very lives, are written off as post-Roe statistics."

I couldn't agree more. As we read these one-year anniversary stories about the Dobbs decision, let's keep in mind that each and every number represents a person who has lost the autonomy to make decisions about what is happening in their own body. It's a right that has been taken away. It's a right that every human being deserves.

Get political. Make no mistake — Dobbs isn't the end-game for many on the far right in America. All of the Republican presidential candidates support abortion bans for the states that want them, and some are advocating for a federal ban. Last week, former Vice President Mike Pence challenged all the other GOP candidates to endorse a national ban on abortions after 15 weeks. Earlier this year, Florida Gov. Ron DeSantis signed that state's 6-week ban into law. 

The good news is that in the 12 months since Dobbs, polls indicate that Americans increasingly support legal abortion. In addition, The New York Times reported over the weekend that “more voters than ever say they will vote only for a candidate who shares their views on abortion, with a twist: While Republicans and those identifying as ‘pro-life’ have historically been most likely to see abortion as a litmus test, now they are less motivated by it, while Democrats and those identifying as ‘pro-choice’ are far more so."

A lot of the shift in public opinion, experts theorize, has to do with abortion bans and the stories of women undergoing miscarriages or other complications who have suffered as a result of the laws. Many Americans have become more nuanced in their understanding that reproductive health care is health care.

Let's hope that understanding leads to a restoration of women's rights at the ballot box next November.

Onward!

- Pat

Download the ‘Don’t Ban Equality’ Toolkit

From The McPherson Memo

In 2019, our firm helped found Don’t Ban Equality, a coalition that has now grown to represent close to 1,000 U.S. businesses of all sizes and across all industries. These companies are stepping up to protect their workers by committing to mitigate the harm that state laws have inflicted on citizens. Businesses have become a critical firewall in helping to preserve access to abortion care.

With increased media interest anticipated around this 12-month commemoration, the coalition has created this toolkit for your own advocacy.