18 Months After “Dobbs,” Here’s How Abortion Providers and Activists See Things

After the Supreme Court’s June 2022 Dobbs decision eviscerated the already limited federal right to abortion, 14 states — Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas and West Virginia — banned the procedure.

In some of these states, clinics closed. According to The Guardian, 42 U.S. clinics shuttered in 2022, plus 23 more in 2023. But as disturbing as this is, it is not the full story. Despite financial, legal and political obstacles, many clinics in states that have banned abortion have pivoted, continuing to provide essential reproductive health services such as contraceptives, STI testing and treatment, and routine gynecological exams, with some expanding to deliver prenatal and gender-affirming care. In addition, new clinics have opened in states like Wyoming and Maryland where abortion remains legal.

Robin Marty, the author of Handbook for a Post-Roe America and executive director of the West Alabama Women’s Center in Tuscaloosa, has helped steer that clinic in a new direction since abortion was outlawed in the state. She told Truthout that nearly a quarter of the city’s population — 23.1 percent — is impoverished, and 1 in 7 residents of child-bearing age don’t have health insurance. What’s more, Marty says that 34 percent of Alabamans who become pregnant get no prenatal care during the first trimester, something the West Alabama Women’s Center is determined to change.

“Before Dobbs, when we were still providing abortions, we set aside $300,000 because we knew that if we could no longer offer abortion care, we’d have to navigate the state bureaucracy to shift to other work,” she said. “During that time, we expected to have no income.”

In the 18 months since the Supreme Court decision, Marty and her colleagues have provided pregnancy verification letters to Medicaid and offered free or low-cost prenatal care, IUD and implant removal, birth control counseling and dissemination, STI diagnosis and treatment, and postpartum checkups to more than 1,500 patients.

“We’ve raised about $1 million in small-dollar donations and grants from the Abortion Care Network and Abortion Bridge Collaborative Fund of the Women’s Donor Network since Dobbs,” Marty said, “and we are just now beginning to get reimbursements from Medicaid and other health insurers.”

Although this sounds like an unqualified success, Marty makes clear that the transition from abortion provider to ob-gyn provider has involved jumping through innumerable hoops. It has also included deflecting the anti-abortion stigma that continues to surface. This stigma has kept the clinic’s physicians from receiving hospital admitting privileges in Tuscaloosa — a turn that, in effect, penalizes clients when they go to the hospital to birth their babies.

In addition, the clinic’s inability to perform abortions has also taken a toll, something that is being felt in every region of the country.

Roadblocks to Care

The Guttmacher Institute estimates that 22 million people who can become pregnant currently live in states where abortion is restricted or completely unavailable. And even in states where it remains legal, longstanding restrictions are in place to stymie access. For example, 28 states have a mandatory waiting period between counseling and the procedure; 16 require the counseling to be done in person; five require that the pregnant person be told that fetal personhood begins at conception; and 35 do not allow Medicaid to cover the cost of the procedure.

The Guttmacher Institute estimates that 22 million people who can become pregnant currently live in states where abortion is restricted or completely unavailable.

The result has made the U.S. an uneven patchwork, with the availability of care dependent on where you live. Not surprisingly, Guttmacher reports that in the first six months of 2023, 20 percent of abortion patients — approximately 92,000 people — had to travel out of state to end a pregnancy they did not want or could not carry to term.

This, of course, ramps up both the emotional and financial costs.

Serra Sippel is the interim executive director of the Brigid Alliance, a five-year-old referral-based service that provides logistical and material support to people needing to travel to have an abortion. “In 2023, we assisted 69 providers located all over the U.S.,” Sippel told Truthout. “We prioritize pregnancies at 15 weeks and beyond, and assist clinics that serve that gestational age. In some cases, we provide funding for airfare and arrange travel for someone.”

Sippel says the Brigid Alliance talks through each case with clients to determine what they need. “Some have never flown before. Some have not even left their home states before. Other people don’t want to fly at all. In one instance, we paid for four new tires so that the woman could drive from Texas to New Mexico. In other situations, we pay for child care during the one or two days that the person will be away from home. We’ve paid for meals, and for warm clothing for people from the South who need to get to New York in winter.”

Clients are traveling an average of 1,300 miles round trip, and the average cost of support — the funding to pay for travel, food, child care, and other nonmedical needs — has risen to approximately $2,300 per person.

It’s arduous, and the need to raise significant sums of money to assist clients is constant.

Since Dobbs, Sippel reports that clients are traveling an average of 1,300 miles round trip, and estimates that the average cost of support — the funding to pay for travel, food, child care, and other nonmedical needs — has risen to approximately $2,300 per person, excluding the cost of the procedure.

Meeting Patients’ Needs

What the Brigid Alliance provides, of course, varies from person to person, but Sippel says that the group’s 17 staff members bring “a model of virtual accompaniment” to everyone they serve. “The fact that we take the time to be respectful, caring and compassionate during the abortion journey resonates,” she told Truthout. “We are not a travel agency. Our task is enormous and made more difficult by the fact that the reduced number of clinics means that clients often have to wait four or five weeks for an appointment. The clinics are overwhelmed.”

Julie Burkhart, owner of Wellspring Health Services in Casper, Wyoming, and co-owner of the Hope Clinic in Granite City, Illinois, knows this reality well. She opened Wellspring in March 2023, more than a year after HB 152, a near-total abortion ban, was stayed by the Wyoming courts, and nearly a year after arson caused $300,000 worth of damage to the still-under-construction building.

The clinic’s opening, Burkhardt says, was a huge victory since Wellspring is the only clinic providing abortions in Wyoming and provides both medication and procedural care up to 23 weeks and six days of pregnancy.

“At this point, we see people coming from throughout Wyoming and from North and South Dakota, Nebraska, Montana, Idaho and Utah,” Burkhardt told Truthout. “Between 70 and 75 percent require funding. We work with a number of national and local abortion funds and don’t turn anyone away,” she explained. “Instead, we try to raise whatever money is needed, whether it’s for a night or two in a hotel, travel, meals, child care support, or something else. There’s also the cost of the abortion, which can run from $600 to about $4,000.”

On top of this, she continues, there’s Wyoming politics. “The political landscape in Wyoming is difficult. After Trump was elected in 2016, the people who got elected shifted to the right. But the electeds do not seem to reflect the population, and there is a disconnect between the people and the politicians on reproductive health issues,” Burkhart said. “In Granite City, it’s different. Illinois is generally more supportive of reproductive rights, and we have doubled the number of patients we’ve seen since Dobbs.” During 2023, she explains, patients came from 26 states — many in the South. “I’m happy we’re able to be there for them,” she adds, “but it’s maddening that the U.S. is so dysfunctional and unequal.”

Aiding, Abetting and Funding Abortion

Oriaku Njoku, executive director of the 30-year-old National Network of Abortion Funds (NNAF), agrees, but stresses that the political impact of the work is empowering. NNAF is a loose coalition of groups that raise money to help people seeking abortions. “It takes a lot of heart and a lot of love to provide mutual aid,” she told Truthout. “At the same time, the 100 funds that are part of the network have seen the joy of resistance. When we answer the phone and hear a sigh of relief from someone who is getting the help they need, it’s energizing.”

“There’s also been more picketing, more hostile and aggressive verbal harassment of patients and staff, and more threatening behavior, including four letters that contained dangerous chemicals.”

But the work also includes some negatives. NNAF’s motto, Njoku says, is “Fund Abortion, Build Power,” and the message asks everyone involved to consider what is required to move from where we are to where we want to be as a community and as a society. “This is not easy work,” she said, especially since the goal — collective liberation — comes up against fear that providing an abortion, or aiding and abetting someone to get an abortion, can result in criminalization. “We see that our opponents are trying to erase all access to abortion,” she said. “They seem intent on banning all abortions, everywhere.”

That said, Njoku recognizes that while Dobbs invigorated reproductive justice activists, the decision also invigorated their opponents.

Melissa Fowler, chief program officer at the National Abortion Federation, a 46-year-old professional organization for providers, told Truthout that since Dobbs, clinics have seen a spike in vandalism, with anti-abortion extremists traveling — or even moving — to states where abortion is legal. “There’s also been more picketing, more hostile and aggressive verbal harassment of patients and staff, and more threatening behavior, including four letters that contained dangerous chemicals,” she said. “We didn’t expect the antis [abortion opponents] to give up after Dobbs, and they haven’t. A new group, the Progressive Anti-Abortion Uprising, has revived so-called ‘rescues,’ and as clinics have settled into their new realities, they’ve had to deal with the threat of violence while also doing unprecedented fundraising and working to maintain their own survival.”

It’s a fraught time, Fowler says. The Supreme Court will hear a case on mifepristone, one of two FDA-approved medications used to terminate pregnancies, now used in 53 percent of all domestic abortions. And abortion opponents are attempting to invoke the 150-year-old Comstock Act to ban sending abortifacients by mail. What’s more, 65 cities in six states — Florida, Illinois, New Mexico, North Carolina, Texas and Utah — have declared themselves Sanctuary Cities for the Unborn by banning abortion outright, and they are working to expand that number, even in states where abortion is legal.

On the flip side, a number of states have passed shield laws to protect providers, patients and support organizations from being investigated or extradited for helping someone terminate a pregnancy — and several, like Ohio, have enshrined abortion in their state constitutions.

And there are other positive developments, as well.

Robyn Powell, associate professor of law at the University of Oklahoma and a disability justice activist, says Dobbs contributed to pushing more disabled activists to address abortion. “There’s always been tension between abortion rights proponents and disability rights proponents because of eugenics and because many people want to use abortion to avoid having a disabled child,” she told Truthout. Up until recently, she says, many in the disability community “avoided conversations on the topic.”

Now, Powell continues, the community is talking about reproductive justice and discussing the high rates of maternal mortality, unintended pregnancy and interpersonal violence, as well as inaccessible gynecological care, poverty, and the general ignorance of medical personnel about the sexual agency of disabled patients. “We’ve fought for bodily autonomy for decades,” she said, “but our families continue to be scrutinized more than the families of nondisabled people. This is a reproductive justice issue. Guardianship is another reproductive justice issue. Reproductive justice is about far more than abortion. It’s the right to decide when and whether to have children, and it’s the right of every person who has children to parent in safety and dignity.”

Moreover, the states that provide the fewest services to people with disabilities and the poor, Powell continues, are also the states with the most abortion restrictions, weakest sex education programs and most unequal access to prenatal care. “We have to point this out,” she says, “and do something to change it.”