Dr. Mimi Zieman
With abortion-related legislation on or proposed for the ballots in at least 11 states this year, it’s become impossible to ignore the ripple effects of the Dobbs v. Jackson Women’s Health Organization decision and women’s growing need to leave their states to find basic health care.
As an OB-GYN in the South, I check a patient’s address before reviewing her medical history. That’s not normal.
Before, I would simply read a patient’s chart to learn about her medical needs. Now the first thing I do is figure out where she lives: Is she local, from Georgia, where I work and am familiar with our strict abortion laws? Or is she from Alabama, Tennessee or Mississippi, where abortion restrictions are even harsher?
Each day, I mentally sift through the latest developments in our neighbors’ abortion restrictions. Are the bans in effect – or are they being blocked by a court? Do they allow exemptions for rape, incest or the mother’s health? Could I face legal repercussions for treating a woman who traveled from her state to receive care here?
The uncertainty often has devastating consequences. I brace myself for the possibility of sending yet another young woman back to her car to return home because her insurance won’t cover treatment here for her ectopic pregnancy, a condition that comes with the possibility of a life-threatening fallopian tube rupture. I hope I won’t see another sexual assault survivor struggle with paperwork that must be filled out perfectly to qualify for the state’s exception for rape. Or worse, that I won’t see another woman turned away by several providers because her nonviable molar pregnancy – a premalignant condition that requires surgical termination – was said to have a heartbeat.
In those and other cases, the word “heartbeat” can be misleading. The American College of Obstetricians and Gynecologists explains that the fluttering seen on an early ultrasound is not a heartbeat – it’s “the ultrasound machine translating electronic impulses” in embryonic tissue that will eventually form the heart. Yet in practice, that so-called heartbeat halts abortions in Georgia around six weeks of pregnancy, even though many women don’t even know they are pregnant at the time.
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Abortion numbers rise, despite bans
The irony of the situation is stark. Despite abortion bans in 14 states and restrictions in 27 others, the number of abortions has actually increased post-Dobbs, according to the latest data from #WeCount, the Society of Family Planning’s ongoing survey of abortion numbers. This is partly due to greater provision by telehealth, now accounting for 20% of abortions nationally. It’s also from increased support by nonprofits helping patients travel for care.
The Guttmacher Institute estimates that nearly 1 in 5 patients seeking abortion care in 2023 traveled out of state, double the rate from 2020.
Even with increased donations, nonprofits have not been able to keep up with that demand. A day doesn’t go by when we don’t have a patient in tears after learning we cannot help her and she must travel for care.
How can I take off work?
Who will watch my kids?
I didn’t want to tell anyone about this.
I don’t have the money.
The burden of these restrictions falls hardest on low-income women and women of color who are often forced to carry unwanted pregnancies to term.
Their suffering affects us as providers because we promised to help people.
When I graduated from medical school, I took an oath to serve patients according to the core principles of medical ethics: to act justly, respect patients’ autonomy, protect their privacy and – above all – do no harm. But every day in this post-Dobbs landscape, we are harming people.
Doctors are leaving states with abortion bans
This is driving health care providers away. A recent survey of OB-GYNs in 13 states with abortion bans found that many physicians are distressed by delays in care, the threat of legal action and the harm being done to their patients. Some plan to leave their states to practice where they can provide full-spectrum care.
That is a serious problem because women forced to carry an unwanted pregnancy can face major health risks, and they need doctors. Recent data estimates that remaining pregnant for them is 35 to 39 times deadlier than having a desired abortion.
And yet, the states with the highest rates of maternal mortality – like Alabama and Georgia – are losing OB-GYNs at alarming rates. According to the American Association of Medical Colleges, applications to OB-GYN residency programs saw a staggering 21.2% drop in Alabama and 16.4% in Georgia.
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Many people don’t realize how these restrictions affect them. A friend calls me whenever abortion is in the news, asking what I think. While he opposes reproductive restrictions, he doesn’t see the issue as personally relevant.
“Well, I’m lucky I have two sons, so I don’t have to worry about all this,” he said recently.
“What about their future significant others?” I asked. “And, what if there will be fewer OB-GYNs to treat your wife’s fibroids, endometriosis or gynecological cancer?”
We’re at a turning point for women’s health in this country. The decisions we make now – such as in the voting booth – will shape the future of reproductive care. Women deserve access to health care that respects their safety, autonomy and privacy. This isn’t just about abortion. It’s about human rights and our shared responsibility to protect them.
Mimi Zieman, M.D., is the coauthor of “Managing Contraception” and author of “Tap Dancing on Everest.” Her writing has appeared in Newsweek, Salon, Ms. Magazine, NBC News’ THINK and other publications. She is the former director of Family Planning for Emory University School of Medicine and worked on the Centers for Disease Control and Prevention guidance for U.S. contraceptive care.
