Health

The Post-Roe Dilemma of Abortion Doctors: Moving, Staying, or Crossing State Lines

The National Abortion Federation has created an online marketplace where doctors who are closed or waiting to work can sell their ultrasound machines, speculators and other equipment.

“We all argue with the question, ‘Which moment did I move on to?’ “What will my personal line be like in the sand?”

Although the number of abortion providers in nearly two dozen states that have banned or are expected to ban abortion quickly is small – about 10 percent of national integrity, according to the Guttmacher Institute for Abortion Rights Research – is likely to go away. Has a big impact.

Health experts warn that this potential migration could be devastating For patients who are left without access to birth control, prenatal care and other reproductive health services. They also fear that in some settlements none of the providers will be left to perform emergency abortions in life-threatening circumstances that are exempt from most state bans.

“If you see providers fleeing from states that have severely limited their ability to practice in accordance with their moral compass and medical ethics, it would be a huge loss to public and community health,” said Jamila Perritt, an abortion provider in Washington. , DC, and President and CEO of Reproductive Health Physicians. “We do not have to guess what will happen. We have already seen it High rates of maternal mortality And morbidity in areas such as Louisiana and Mississippi. But we will see much more of that as these bans continue to apply in the country. “

Among the providers POLITICO spoke of in states where abortion is banned on their books, none said they were willing to offer illegal abortions – knowing that doing so would risk losing their medical license and serving a long prison sentence in some states.

Instead, many plan to travel across the state for a few days a week or a month to have an abortion while maintaining the practice in their home state if the bans are lifted. Some plan to use telemedicine to consult patients and prescribe abortion pills in states that allow them. And others – especially those whose current job is primarily focused on abortion rather than the full range of OB-GYN services – are moving to other states.

At the same time, more progressive states fear that when they become an abortion site for millions of patients, they will not be able to recruit quickly enough. Causes delay in care, which pushes people to further pregnancies. Activists in California and elsewhere are urging lawmakers to make it easier for doctors to obtain licenses if they move to other states or travel part-time or provide incentives such as student loan forgiveness to attract more providers.

But that may not be enough to convince a sufficient number of doctors to uproot their lives.

“If I were free to move, I would have a lot of great opportunities now,” said Zeida Vickery, an Ohio-based abortion provider who changes the field instead of moving because of her child. “[Abortion] Is my professional identity. This is the reason for my existence for more than 20 years. But I am also the single mother of a minor who has been with me every step of the way. So I just can’t move. And I can not describe otherwise than to say that I went through a period of mourning in making this decision. “

National Abortion Federation, in addition to its online marketplaceL.For a hundred pieces of equipment, I also recently created a worksheet.

“We have seen an increase in interest since the Supreme Court ruling was leaked,” said Melissa Fowler, chief program officer for the National Abortion Federation. “People were hoping, but then they started moving forward and accelerating their job search plans in other states.”

Fowler says that so far, they are seeing more doctors, nurses and other front-line health workers looking for part-time travel instead of permanent relocation.

“People are deeply rooted in their communities and it is difficult to choose and move to a completely different region of the country,” he said. “Plus, traveling to the healthcare space is not unheard of. We already have a lot of traveling nurses, especially during Covid. “It’s a life 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 ban told POLITICO that they are not going to move for the same reasons – even if it means they have to stop working, which is important to them. .

“I’m going to continue aborting until the last day I can,” Brant said. “I may be looking for a job elsewhere. But I am optimistic that people will be so angry that the rock will come back. “

A court on Friday allowed a six-week ban on abortion in Ohio to take effect, and lawmakers say they will lift the full ban in November or December.

Brant is one of hundreds of providers now thinking about how to serve their patients in states where their work is or may soon become illegal. He could have been sentenced to six weeks in Ohio Threatens criminal conviction And up to one year in prison for conducting the proceedings “knowingly and intentionally”, even in the case of rape or incest.

Still, Brant said he wants to stay on to help manage the postRoe Knocked down.

“Further care will be needed for people who have had an abortion outside the health care system,” he explained. “And we still hope that there will be exceptions to the threat to the mother’s health. If someone has an emergency in 20 weeks, not many people know how to terminate a pregnancy quickly. That’s why I want to be here for that. “

But Brant still worries that the skills he has developed over the years are “atrophied” under the ban, so he talks to clinics in Michigan and Illinois and up and down the East Coast and debates whether to begin the difficult and expensive application process for a license elsewhere. So he can carry out part-time travel work.

Doctors in other red states struggle with similar dilemmas, are afraid of being prosecuted, but are also afraid to leave their patients.

Caitlin Bernard, an abortion provider and professor at Indiana University School of Medicine, noted that while providers may have the resources and savvy to cross state lines in practice, many low-income patients do not.

“For a lot of people in Indiana, if I tell them to go out of state, I can also tell them to go to the moon,” he said. “They have to pay for care at the clinic, time away from their children, time away from work. The price of gas is also rising. “

In Texas, which banned all abortions after six weeks of pregnancy last fall and Violators face life in prison, Providers had more time to occupy their future. But this did not simplify the decision.

“It was incredibly heartbreaking. “Every day when I saw patients, I had to bypass some because they were too far away during pregnancy,” said Sam Dickman, an abortion provider in San Antonio who recently moved to Montana. “I was also watching my patients relax when I told them on an ultrasound that they had come in early enough to see me for an abortion in Texas, instead of going to New Mexico.”

In other states, including Lauren Thaxton, abortion provider and assistant professor Women’s Health They plan to stay at the University of Texas even if abortion is completely banned. Texas Pre-EnforcementRoe The ban has been temporarily blocked by the court and the current law of the state has not yet come into force.

However, he knows that many of his fellow doctors will move in and are concerned about the impact on Texas patients who Already fighting Access to reproductive health services such as contraception, prenatal care, and spontaneous abortion management.

“We are already few,” he said. “And because Texas is a very big place when a person leaves the community, he may be the only person who trains for hundreds of miles.”

Medical experts are concerned not only about the immediate loss of health care services in the Red States when the bans take effect, but also about the long-term effects of the generation of OB-GYNs that will prevent these conditions in the future.

“Now where are the people graduating from the medical faculty looking for residency? “Not in a state that does not allow them to exercise freely,” warned Tracey Wilkinson, a professor of pediatrics at Indiana University School of Medicine and a member of the Board of Reproductive Health Physicians. “Anecdotally, we already hear residents who are currently here saying they do not want to stay in Indiana. “We already have several countries without the care of occupational gynecologists, and this will have downstream effects.”

Blue State clinics that are already seeing an increase in patients and expect to be more dependent on staff in the Red States in the future are also making progress.

“We hear from doctors who are not going to move at all because they know they will still be needed in their communities for contraception and family planning, but who can rotate with us as we receive the flow. Patients, ”said Jodi Hicks, president of Planned Parenthood, California. “But we are concerned that the generation of physicians trained in these states will not actually receive abortion training.”

Megan Messerley contributed to this report.

The Post-Roe Dilemma of Abortion Doctors: Moving, Staying, or Crossing State Lines

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