June 24 marks nearly three years since the Dobbs v. Jackson Women’s Health Organization decision that overturned the constitutional right to abortion in the US.
To date, 19 states have banned or restricted abortion before fetal viability across the country, according to the NYT abortion law tracker. Independent abortion clinics in some states are struggling to stay open, while companies offering telehealth have seen a rise in demand. At the same time, maternal mortality rates have risen, and stories have emerged about pregnant patients dying due to delayed care.
We spoke with reproductive health experts around the US to learn more about how maternal care has changed in the last three years. Here’s what they told us.
These interviews have been edited for length and clarity.
Melissa Simon, ob-gyn at Northwestern Medicine in Chicago, where abortion is legal
In states that are supportive of reproductive care and health, care hasn’t changed with respect to the quality of care. It’s more volume based. The volume of care has increased with patients coming from other states, and some of them travel very long distances from all over the country.
Any clinician who’s trying to get trained in reproductive health of any form can’t get trained well—or let alone at all—in states where they passed restrictive laws as a result of the overturning of Roe v. Wade. That leaves half the country pretty much unavailable for access to training, which is a real problem when about 50+% of the US population is female.
People get triggered or emotional around the word abortion, and they connect it to so many other things, but in reality, women’s health care is being completely demolished and undermined because of emotion connected to a word.
Monica Ruehli, clinical director of reproductive and gender-affirming health at Blue Cross Blue Shield of Massachusetts, where abortion is legal
We developed our own internal reproductive health and gender-affirming team just after the Dobbs decision, and that was one of the factors that led us to really concentrate and think more about women’s health. Luckily, here in Massachusetts, we have a huge commitment to reproductive health and gender-affirming care by our governor and at the state level.
There are still a lot of people who are traveling to Massachusetts for abortion care and that the state has seen a huge number of people coming in, especially initially after the Dobbs decision. There’s a law that shields providers and allows providers from Massachusetts to provide access to patients in other states.
We were lucky because even before the Dobbs decision, there was a contraceptive access law that got passed. It required insurers to cover access to contraception with no cost share. And then immediately after the Dobbs decision, that same bill had a provision for mandating coverage for abortion and abortion-related care without cost share.
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Alice Crisci, co-founder and CEO of Ovum Health, which provides virtual reproductive care in states with and without bans
In the state of Idaho, we have one of the most restrictive laws in America that prevents even a dilation and curettage (D&C) procedure from being performed. If you perform a D&C procedure, even if it’s to save a woman’s life because she had a partial miscarriage, it is a criminal offense, and a physician can lose their medical license.
In some of these really restrictive states, it’s nerve-wracking to deliver care to high-risk patient populations. Ob-gyns are one of the most sued medical professions out there. We’re concerned about medical malpractice rates rising in some of these states where these restrictive laws could cost someone’s life.
When Roe v. Wade was overturned, I can say that I was terrified, I was disappointed, but I can’t say that I was surprised.
Beverly Gray, ob-gyn at Duke Health in North Carolina, which has a 12-week ban
We’ve had a lot of changes over time in North Carolina. Initially, right after Roe v. Wade was overturned by the Dobbs decision, many southern states had a trigger ban that went into place, and so access to reproductive care was dramatically curtailed very quickly. Many of those folks would travel to North Carolina for care. Approximately a year after the Dobbs decision, North Carolina enacted a very strict abortion ban that has restrictions after 12 weeks, with multiple different layers of exceptions. But there are also many other components of the law that make it very challenging to care for patients day to day, including an in-person, 72-hour biased mandated counseling by the state.
Many patients are traveling, and North Carolina was one of the top four states for receiving travelers for care. Let’s say you needed some type of urgent surgery, and you were told, “Well, no one in your state does this surgery. You need to go to another state. And I’m not going to give you a referral—good luck finding somebody to care for you.” Even for someone who is very well resourced and knowledgeable, that’s a really hard barrier to overcome. Many patients seeking care are receiving Medicaid for their insurance coverage, and Medicaid doesn’t cover [abortion] care, and so they’re paying out of pocket.