Certified nurse midwife Jennifer Love recalls a scene from a training course she did many years ago in Cartagena, Colombia, where abortion was illegal at the time.
If women presented with complications after a miscarriage or voluntary abortion, they had to wear a marked shirt and sit in a special area of the obstetric emergency department, where Love worked.
“The trauma and the stigma,” she said, “I never thought we would go where our patients would feel that same sense of fear and shame. It’s awful. It breaks my heart.
Love, who now works at Planned Parenthood of Southern New England (PPSNE), says for her that the potential end of the federal right to abortion care is a frightening prospect. That could happen in weeks if the U.S. Supreme Court releases a version of the majority opinion in the Mississippi abortion case Dobbs v. Jackson that leaked in May.
The 1973 court decision Roe v. Wade asserted the right to have an abortion under the 14th Amendment, ruling that abortions are constitutionally protected until about 23 weeks, when a fetus can live outside the womb. Last year, the Supreme Court agreed to hear a challenge to Mississippi’s 15-week abortion ban in Dobbs v. Jackson, setting up the court to review decades of precedent set by Roe.
“It’s really disheartening to go through this, but I’m really proud to be on the front line doing this job,” Love said. “And I’ve never been prouder to work at Planned Parenthood or to be an abortion provider.”
Love and his fellow clinicians at Planned Parenthood’s 14 clinics in Connecticut are also preparing for now.
“If Roe falls and all of these trigger bans go into effect, I think it will be pretty quick for patients to be left without access in their home state,” said medical assistant Amina Carter, referring to the States where lawmakers have passed so-called “trigger laws” restricting abortion almost immediately if Roe is overturned. “And so, it will be up to places like Connecticut and other safe states to open our doors and open access to people seeking care.”
“An abortion ban is going to disproportionately affect women of color,” Carter said. “I think we’re going to see a big impact, a negative impact on black maternal health. We’re going to see maternal mortality skyrocket, I think, as these bans come into effect.
Clinics have already seen people come from Texas since that state banned abortion after six weeks of pregnancy. Zari Watkins, chief operating officer of PPSNE, says the number so far is low, likely less than 10. But she said the organization’s branch in Oklahoma has seen an increase of 2,500. % of visitors since Texas restriction went into effect. Now, Oklahoma’s recent ban will force those patients to seek care elsewhere.
“We are currently working to ensure that we can provide seamless abortion navigation for out-of-state patients,” Watkins said. “It wasn’t something that happened often before, so we never really had to make sure we had a formal structure and workflow in place.”
This could mean connecting a patient to the financial resources of an abortion fund, arranging travel and accommodation, or ensuring they can get an appointment in a timely manner.
Clinics are preparing by improving their online appointment booking platform. They also see what they could do for women for whom traveling is not an option.
“We’ve been working with our lobbyists and lawyers to understand what the next steps are to implement medical abortion via telehealth,” Watkins said.
Telehealth as a tool
Telehealth is also an outreach method being considered by the Hartford GYN Center, Connecticut’s only independent abortion clinic. Hartford GYN is part of Women’s Centers, a multi-state network that includes clinics in New Jersey, Pennsylvania, and Georgia, among other states.
“We’re just thinking of creative ways to see as many people as possible to meet the demand,” said Dr. Lisa Perriera, chief medical director of the Women’s Centers. This may include getting doctors in states like Connecticut licensed to practice in abortion-banning states so they can provide a telehealth visit and abortion medication by mail.
“It’s still up in the air,” she said. “Telehealth law varies from state to state. Most of the time, if you were doing a telehealth visit, the doctor or clinician must be licensed in the state the patient is sitting in during the telehealth visit.
Because of its network, The Women’s Centers already has a good track record with women who cross state lines for treatment.
“We have a centralized appointment center,” Perriera explained. “Patients call and we determine which center is closest to them, what their resources are. Some places have patient support networks where people will help them sleep on couches or drive them to the clinic.
She expects the travel support network to be tested in the coming months as the ripple effect of abortion bans spreads to states like Connecticut.
“New York is a centralized place where people can fly in and out,” she said. “People from Texas can fly to New York to have an abortion. People who live in New York won’t have as much access to abortion, so they could go to Connecticut, which is close.
Shortage of doctors
Pregnant women up to 11 weeks may be offered a medical abortion, which can be managed at home. This accounts for the majority of proceedings in Connecticut. Of those who sought treatment at Connecticut’s Planned Parenthood facilities in the 12 months to July last year, 67% received medical abortions.
The remaining 33% would have seen a doctor for an in-clinic procedure, which can delay care.
Carter, of Planned Parenthood, said doctors are “really exhausted,” sometimes forcing patients to travel to another clinic or wait a week before they can have the procedure.
“So it’s just extra time, extra transportation for our patients,” she said. “Another day where they have to take off and find daycare. It puts a lot of burden on that patient.
The shortage of clinicians available for in-clinic procedures in Connecticut is expected to ease just as demand from other states is expected to increase. Connecticut’s new law to expand abortion access goes into effect July 1. Love and Carter are among the clinicians who will be trained to perform vacuum aspiration abortions at the clinics where they provide health care. Under the legislation, advanced practice registered nurses (APRNs), nurse midwives and physician assistants will be eligible for training. According to PPSNE, of its current staff, 60 people could potentially undergo the training.
“We already safely provide many other procedures, like IUD inserts, colposcopies,” APRN Colleen Taylor told APRN, “and a first-trimester aspiration abortion is another part of the healthcare we can provide in safely and that we should provide safely.
The new law will also protect patients who travel to Connecticut for abortions and prevent Connecticut providers from being sued in states from which patients traveled.
The potential end of federal protections under Roe has stirred many emotions among those who work most closely in this area.
“Honestly, for me, it raised anger that everyone who’s not in this job is so surprised,” Perriera said. “I knew in my heart, even though I didn’t want to believe it was true, that the Supreme Court was going to go down this road. We anticipated this, and the fact that everyone is so outraged is kind of infuriating.
“I feel a sense of urgency,” Watkins said. “I want to make sure patients understand that our doors are open, that we are here for them, and that we will continue to work to find ways to meet patients where they are.”
This story was reported through a partnership with the Connecticut Health I-Team, a nonprofit news organization dedicated to health reporting.