Abortion providers detail mounting external difficulties, profound rewards of serving patients in post-Roe America
For some patients and providers, ideologically and politically motivated restrictions on abortion have long been the status quo. But in the months since the Dobbs decision this June, the situation has become fraught with new legal and logistical uncertainties. At this year’s Jing Lyman Lecture, the Stanford community heard from those most intimately acquainted with the status of reproductive justice after Dobbs v. Jackson Women’s Health Organization overturned the landmark 1973 Roe v. Wade decision: what has changed in the post-Roe world, and what has stayed the same?
Three physicians and abortion providers, Bria Peacock, Katherine Brown, and Colleen McNicholas, joined the Clayman Institute and the wider Stanford University community to talk about their work on the front lines of abortion care in an event titled “From the Front Lines: Abortion Post-Roe.” Their conversation was the latest contribution to the Institute’s Jing Lyman Lecture series, an event featuring leading feminist visionaries and commemorating the life and contributions of Jing Lyman, a key ally in the Institute’s founding. The session was moderated by Moira Donegan, a a writer covering the intersection of gender, politics, and the law who is currently a columnist at The Guardian covering gender in America.
For Bria Peacock, it is pre-existing structural barriers to abortion care which are front and center in Georgia, where she grew up and attended medical school. “Half of the counties in Georgia don’t even have an ob/gyn, let alone an abortion clinic,” she explained. To address gaps in patient advocacy and care, she founded SIHLE Augusta (Sisters Informing, Healing, Living, Empowering) to bring reproductive education to Black adolescent girls in Augusta whose autonomy in choosing to end or continue pregnancies is often denied. “For adolescents, the barriers to reproductive justice and reproductive healthcare were already there pre-Dobbs,” she said. The decision to overturn Roe is only one of the challenges facing Black women and girls in Georgia.
Colleen McNicholas, chief medical officer of Planned Parenthood of the St. Louis Region and Southwest Missouri, spoke of the “post-Roe reality” that her patients were already living prior to June. The Supreme Court’s decision has made abortion care in the Midwest even more logistically and legally prohibitive, causing patients to overwhelm clinics in areas where abortion is still legal. McNicholas practices in southern Illinois and Missouri and has previously provided abortions in Kansas and Oklahoma. When abortion became illegal in several of the states surrounding Illinois, she and her colleagues were prepared for an influx of patients at their door. The clinic used to care for roughly 350 abortion patients per month. The number of monthly patients is now 1,000.
It’s such simple care from a healthcare standpoint, but makes such a profound impact on each one [of our patient’s] lives.
In California, where reproductive rights are often touted as exceptionally good by state politicians, professor Katherine Brown sees a more complicated picture. In her work teaching obstetrics and gynecology at the University of California San Francisco, Brown emphasized how lack of abortion access exacerbates existing racial and economic inequalities in the state and beyond. “There have always been access issues,” she said. “Even in California, I have patients who travel five to six hours to come to get their abortion. They take time away from their job, they have to have people take care of their kids, they have to pay to stay at a hotel in the Bay Area.” These access issues have worsened in recent months, as abortion care in other parts of the United States has become less accessible. Since Dobbs, Brown has seen patients travel to California from places as far away as Oklahoma and Tennessee.
For all three providers, new administrative question marks and additional bureaucracy around abortion access are placing fresh demands on their organizations and widening the scope of their work to areas far beyond providing medical care. Providers now find themselves additionally being called upon to give medical opinions on scientifically inaccurate legislation, advocating for patients to their family members or insurers, and coordinating funding for basic services. These kinds of new demands on organizational capacity have multiplied for doctors around the country. The providers spoke about the difficulty of navigating a complicated legal and logistical terrain, including “TRAP” laws,legal bans on billing abortions to insurance, and restrictions on medical students’ ability to receive high quality training in abortion care.
“The care piece is easy,” said McNicholas, who has testified in Congress and challenged several state and federal regulations to continue providing reproductive healthcare to her patients. “Ninety-nine percent of the difficulty is external to the actual work we do.”
The enforced focus on additional, externally imposed difficulties sometimes overshadows the deep sense of meaning that abortion providers derive from their work. “There’s such a richness in what we do,” said Brown, describing the life-changing power that abortion often has on her patients. Peacock and McNicholas agreed. “It is such rewarding work with each and every individual patient,” said McNicholas. “It’s such simple care from a healthcare standpoint, but makes such a profound impact on each one [of our patient’s] lives.”
Donegan asked panelists to speak to the “low bar” of limited abortion rights that Roe previously had protected. Simply returning to the legal dispensation in place for half a century before the Dobbs decision reveals only a sliver of the broader vision that Brown, McNicholas, and Peacock share for the future of reproductive care in the United States. Brown hopes to see a wider range of professionals and clinics able to provide abortion, including nurse practitioners and physicians’ assistants. Peacock envisions a world where abortion carries no stigma or shame. “Every person should be able to decide when and if they want to reproduce,” she told the audience. Despite the challenges, the devotion of Peacock, Brown, and McNicholas to their vision for the future of abortion care has only increased since the Supreme Court’s decision.
As the event drew to a close, Donegan read out a question card that had been submitted by an anonymous audience member. “I’m not sure I even have a question,” it read, “I just want to say thank you. Thank you. Thank you.”