Fall of “Roe” Caused Unemployment for Some Clinic Workers, Overwork for Others

The moment the Supreme Court overturned Roe v. Wade, it became inevitable that many abortion clinics would close. Over half of U.S. states were expected to ban all or most abortions, and over a dozen moved quickly to do so. In the first month alone following the Court’s decision, at least 43 clinics in 11 different states stopped offering abortion care.

Obviously, those most affected by this catastrophic loss of access are the people who need abortions. But clinic workers are also facing untenable conditions. Many workers in states with bans have already lost their jobs and are faced with a choice: They can relocate to new states in order to continue working in abortion care, or remain in their communities and transition into different careers. In some in-between states — where clinics have opened and shut multiple times as abortion bans are litigated, or where most but not all abortions have been banned — workers don’t know how many hours they will work from one week to another, or whether their jobs will exist next month, let alone in six months or a year. Finally, there are the workers in so-called “safe haven” states, many of whom say they were already burned out and underpaid, and are now caring for a tidal wave of out-of-state patients without enough help.

Across the country, some abortion care workers say they feel abandoned by national organizations, many of which they say took no discernible steps to prepare for this labor crisis.

“The lack of a plan was incredibly disappointing, even if not entirely surprising. Larger organizations with multimillion dollar budgets had the staff capacity and budget bandwidth to build out a plan for this, especially since we knew this was a potential for years, and it was confirmed after the leak in May. Yet, here we are scrambling, with workers and people seeking abortions left behind,” said the workers behind ReproJobs in an anonymous interview with Truthout. ReproJobs is an organization that advocates for better working conditions within the reproductive health, rights and justice movements. Its founders remain anonymous, their website says, “to de-center ourselves and instead, focus on what we’re here to do: push organizations, foundations, and even individual hiring managers in our movement to live their values.” A representative of Planned Parenthood Federation of America, whose network of affiliates is the largest single provider of abortion care in the United States, did not respond to a request for comment by the deadline for this article.

In an effort to help where larger, better-established organizations did not, ReproJobs began organizing a Repro Worker Aid Fund before the Supreme Court issued its decision, opening up applications in early July. The fund was initially established with a $200,000 gift from an anonymous donor. Since then, additional support has come from individual donors, a foundation, and a movement organization. To date, ReproJobs has received 119 applications from workers who lost their jobs following the Dobbs v. Jackson decision. The majority of applicants come from Texas, Georgia, Ohio and Tennessee.

Of course, anyone working in an abortion clinic has plenty of experience that could transfer to other health care settings. However, stigma and legal restrictions have effectively siloed abortion care from the rest of medicine for decades now; people who work in abortion clinics have often pursued that training and experience at personal cost, and are deeply dedicated to the work.

“I genuinely do not think I could ever go into a different field of health care now that I have experience and have learned how to care for somebody who is having an abortion,” Abigail Brick told Truthout. Brick was laid off from her job at an Ohio abortion clinic in August. Days after the Supreme Court’s ruling, an Ohio law banning abortion once embryonic cardiac activity can be detected, around six weeks of pregnancy, went into effect. The clinic where Brick worked remained open, but its patient volume has decreased dramatically. In the weeks leading up to her layoff, Brick said she saw as few as five patients during shifts in which she would have seen up to 30 before Roe’s overturn.

Brick volunteered to be laid off because she was already planning to go back to nursing school in January. “A lot of my former coworkers are single parents,” she said. “I felt fortunate to be in a position where I could volunteer to be laid off so that hopefully I could save one of my amazing coworkers their job.” Because she was employed at one of only a handful of unionized abortion clinics in the country, Brick left her job with three months’ severance pay and fully covered COBRA — an unusually generous severance package. Still, she has taken on another job outside the field to spot her until she starts nursing school in January. “But that’s not what I want to be doing,” she said. “I want to help people who want abortions.”

Brick’s goal after pursuing her nursing degree is to return to working in abortion care. She would like to do that in Ohio, but with lawmakers poised to ban abortion entirely, she’s not sure if that will be possible. And this uncertainty will persist: “Every time there’s an election now, a state could flip to having completely different abortion laws,” said Brick.

Remaining staff are grappling with similar dilemmas, said Colleen Damerell, a former coworker of Brick who remains employed at the clinic. Damerell isn’t sure how much longer her job will exist — but she doesn’t want to leave Ohio. “I think that people need to stay in states like this. There’s a lot of work that needs to be done,” she said. Abortion clinics are well-positioned to provide contraception, general reproductive and sexual health care, and treatment for pregnancy complications even when abortion is illegal. However, many clinics that are trying to remain open for these purposes are struggling to stay afloat. And if clinics close or downsize, no one will be there to provide abortion care even if restrictions are lifted.

On September 14, a judge granted Ohio abortion providers’ request for a temporary restraining order against the ban, making abortion legal through 21 weeks of pregnancy again, at least temporarily. But following the layoffs, Damerell worries that her clinic won’t be as prepared for an increase in patient volumes as they’d like. “We’ve never really turned people away, even when we had long wait times. We do our best to try to see everybody who needs to be seen,” she said. “Now we’re thinking, are we going to be able to do that [when] we are able to go back to what our normal was before?”

Meanwhile, clinics in safe haven states are drowning in the flood of patients coming in from ban states. Crystal Grabowski, a unionized abortion care worker in Western Pennsylvania, said the clinic where she works is currently booked as many as six weeks out. “Patients call us and they’re only ten weeks along, but then we end up having to book them at 16 weeks so that they unnecessarily become second trimester procedures,” Grabowski told Truthout.

Underpayment and chronic understaffing, among other problems, led Grabowski and her coworkers to begin organizing a union in 2019. Though their union, UE Local 696, won recognition in March 2021, contract bargaining has dragged on ever since. Wages are a major sticking point. The starting wage for medical assistants is just $16 per hour, and management has been reluctant to offer more than $17, according to Grabowski.

“So, it’s $16 and $17 an hour for a job where you are absolutely being traumatized. It’s just an incredibly difficult job. You get harassed by protesters going into work. You can’t even talk about your job when you’re out going about your daily activities, like getting a haircut or getting in an Uber and they ask you what you do. And on top of that, you’re so understaffed and you don’t even know if your clinic is going to be open in a year,” she said.

Understaffing is so severe that Grabowski said she often fills what should be three or four different roles in one shift: For example, managing the flow of patients through the clinic, doing intake and medical histories, assisting doctors during procedures, and washing instruments. Since Roe’s fall, Grabowski said only one new medical assistant has been hired.

Damerell is disappointed that more reproductive health, rights and justice organizations aren’t proactively trying to hire clinic workers. She points to the Ohio Repro Reemployment Job Board, a project of Ohio Women’s Alliance, as a model for what national organizations could be doing. Abortion care workers who want to remain in their communities could be hired for jobs they can do remotely, and any who would be willing to relocate could be connected with clinics in safe haven states, where their expertise is clearly in demand. But while some individual organizations have worked to facilitate moves such as these, there has been no coordinated, national effort to do so.

“We had a bunch of what were called ‘Roe contingency planning meetings,’ but none of that ever came to fruition,” said Grabowski. Interventions that would have made a difference, she said, include hiring more call center staff, medical assistants and doctors trained in the clinic’s procedures and electronic medical records system ahead of time. None of that happened.

Despite the struggles, Grabowski said her coworkers are “more committed than ever.” Damerell agreed. “This is historic. It’s a crisis. It’s like working in disaster response,” she said. “As much as you might need a break, as much as you might need to take care of yourself, you’re also in this mode of, if not now, when? We have to do this.”

But resolve can carry workers only so far. Not surprisingly, more abortion care workers are looking to unionize. Most recently, over 400 workers across five states voted to unionize at Planned Parenthood North Central States.

“These are human rights abuses. And I want to acknowledge the moral injury of it, to people seeking health care and people providing that health care. It’s inhumane. It’s violent. And we need to be paid more to be doing it,” Grabowski said.