1). “Kamala Harris’ Abortion Speech Broke New Ground: The vice president talked about abortion as a normal part of life”, Sep 21, 2024, Jessica Valenti, Abortion, Every Day, at < https://jessica.substack.com/
2). “The New Era of Deadly Back-Alley Abortions Is Here: At events in Michigan and Georgia, Harris raises alarms about access under Trump by remembering women who died ending pregnancies”, Sep 20, 2024, Pema Levy, Mother Jones, at < https://www.motherjones.com/
3). “The Hell of Providing Health Care in a Post-Dobbs America: A year after the right to abortion was gutted, doctors and patients are still terrified”, Jun 22, 2023, Ariel Ramchandani, Mother Jones, at < https://www.motherjones.com/
4). “Care Post-Roe: How post-Roe laws are obstructing clinical care”, Sep 9, 2024, Daniel Grossman, MD et. al., ANSIRH website, at < https://www.ansirh.org/
~~ recommended by dmorista ~~
Introduction: Jessica Valenti in Item 1)., Made an important point. She opened up her article pointing out that Kamala Harris stated:
“In a speech channeling the anger of millions of American women, Vice President Kamala Harris laid into Republicans and Donald Trump today, blaming them for our post-Roe nightmare and the deaths of two Georgia women. Blasting what she called “arcane and immoral laws,” Harris called the November election not just a fight for the future of the country, but “a fight for freedom.”
“But this wasn’t just any old campaign speech about abortion. Her remarks came on the heels of an event with Oprah, where Amber Nicole Thurman’s family spoke about her life and death, begging Americans to not see her a statistic. Harris speech today seemed determined to keep that promise—shining a light on who Thurman was, and why her life mattered so much.
“More than that, Harris said something in her remarks that no one running for president ever has: She spoke about abortion as a normal part of a person’s life. Not a tragedy or an impossible choice, but a decision a young woman made in service of the life she wanted for herself. (Emphasis added)
“ 'She was excited, she was working hard. She was a medical assistant. She was going to nursing school, raising her 6 year-old son. She was really proud that she had finally worked so hard that she gained the independence…that she was able to get an apartment in a gated community with a pool for her son to play in. She was so proud, and she was headed to nursing school. And her name, and we will speak her name: Amber Nicole Thurman. Amber Nicole Thurman. And she had her future all planned out. And it was her plan. You know, pause on that for a moment. She had her plan. What she wanted to do. For her son, for herself, for her future. And so when she discovered she was pregnant, she decided she wanted to have an abortion.' (Emphasis in original)
“This may seem like a small thing, but it’s actually quite remarkable. Too often, the abortion stories that politicians feel comfortable sharing are those that were medical necessities or the result of a tragic diagnosis. But here, Harris spoke plainly about the most common kind of abortion—one that’s done simply because a woman doesn’t want to be pregnant anymore. Because it doesn’t fit in with what she wants, or has planned for her life.”
Harris certainly is not some shining champion of all we need to substantively improve our socioeconomic order, but she has clearly begun to address abortion as a normal health care right; and forthrightly points out that the far-right in the U.S. has successfully greatly reduced access to abortion for the 1/3 of all American Women living in the 24 Red States, that passed Trump Abortion Bans. It is no wonder that Jessica Valenti, who certainly knows other issues are important, has strongly endorsed Harris / Walz in the imminent Presidential Election.
Item 2)., “The New Era of Deadly ….”, Item 3)., “The Hell of Providing Health Care ….”, and Item 4)., “Care Post-Roe: ….”, all address the horrific record, that is just getting illuminated by the first glimmer of statistics, of the vast harm visited on American Women since the Dobbs Decision. Items 2 & 3 are popular media accounts, from Mother Jones, very effectively discussing the terrible outcomes from a lack of abortion care that was visited on women and their families over the past 2+ years. Item 4 is a professional / academic publication that reviews 86 cases of very poor quality medical care delivered by medical professionals due to the strictures of varioujs Trump Abortion Bans, the document is linked to above is its PDF form. Trump and his campaign advisors know full well that his history and role in getting Roe v. Wade overturned is a major electoral handicap that will cost him millions of votes from women. He is responding to this situation by trying to obscure his actual position with references to other issues and vague grandiose statements about women. He posted this absurd material on his website Truth Social.
Donald J. Trump's Posts From His site Truth Social @TrumpDailyPosts
WOMEN ARE POORER THAN THEY WERE FOUR YEARS AGO, ARE LESS HEALTHY THAN THEY WERE FOUR YEARS AGO, ARE LESS SAFE ON THE STREETS THAN THEY WERE FOUR YEARS AGO, ARE MORE DEPRESSED AND UNHAPPY THAN THEY WERE FOUR YEARS AGO, AND ARE LESS OPTIMISTIC AND CONFIDENT IN THE FUTURE THAN THEY WERE FOUR YEARS AGO! I WILL FIX ALL OF THAT, AND FAST, AND AT LONG LAST THIS NATIONAL NIGHTMARE WILL BE OVER. WOMEN WILL BE HAPPY, HEALTHY, CONFIDENT AND FREE! YOU WILL NO LONGER BE THINKING ABOUT ABORTION, BECAUSE IT IS NOW WHERE IT ALWAYS HAD TO BE, WITH THE STATES, AND A VOTE OF THE PEOPLE - AND WITH POWERFUL EXCEPTIONS, LIKE THOSE THAT RONALD REAGAN INSISTED ON, FOR RAPE, INCEST, AND THE LIFE OF THE MOTHER - BUT NOT ALLOWING FOR DEMOCRAT DEMANDED LATE TERM ABORTION IN THE 7TH, 8TH, OR 9TH MONTH, OR EVEN EXECUTION OF A BABY AFTER BIRTH. I WILL PROTECT WOMEN AT A LEVEL NEVER SEEN BEFORE. THEY WILL FINALLY BE HEALTHY, HOPEFUL, SAFE, AND SECURE. THEIR LIVES WILL BE HAPPY, BEAUTIFUL, AND GREAT AGAIN! Donald Trump Truth Social 11:42 PM EST 09/20/24
@realDonaldTrump 11:32 PM · Sep 20, 2024 3.7M Views
Nobody should fool themselves. We face a years (decades?) long struggle to replace the current highly exploitative regime in the U.S. with a peoples' Socialist State that actually takes care of people. Harris will not lead that fight, her views on some issues are a bad or even worse than Trump's. But she will not be inflaming the heavily armed far-right to attack us on the left, win or lose we can be sure Trump and other far-right operatives will be doing just that. Abortion rights, that were taken for granted by the American people, particularly by American Women, have now been exposed to as being completly vulnerable to attack. But hopefully this extremely personal and widely political issue has energized people who care about the issue unlike anything else has in years. We must lead the fight and connect to dots so that the American People understand that Abortion access and Reproductive Health Care rights are part and parcel of the overall operation of the society.
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Kamala Harris’ Abortion Speech Broke New Ground
In a speech channeling the anger of millions of American women, Vice President Kamala Harris laid into Republicans and Donald Trump today, blaming them for our post-Roe nightmare and the deaths of two Georgia women. Blasting what she called “arcane and immoral laws,” Harris called the November election not just a fight for the future of the country, but “a fight for freedom.”
But this wasn’t just any old campaign speech about abortion. Her remarks came on the heels of an event with Oprah, where Amber Nicole Thurman’s family spoke about her life and death, begging Americans to not see her a statistic. Harris speech today seemed determined to keep that promise—shining a light on who Thurman was, and why her life mattered so much.
More than that, Harris said something in her remarks that no one running for president ever has: She spoke about abortion as a normal part of a person’s life. Not a tragedy or an impossible choice, but a decision a young woman made in service of the life she wanted for herself.
“She was excited, she was working hard. She was a medical assistant. She was going to nursing school, raising her 6 year-old son. She was really proud that she had finally worked so hard that she gained the independence…that she was able to get an apartment in a gated community with a pool for her son to play in. She was so proud, and she was headed to nursing school. And her name, and we will speak her name: Amber Nicole Thurman. Amber Nicole Thurman. And she had her future all planned out. And it was her plan. You know, pause on that for a moment. She had her plan. What she wanted to do. For her son, for herself, for her future. And so when she discovered she was pregnant, she decided she wanted to have an abortion.”
This may seem like a small thing, but it’s actually quite remarkable. Too often, the abortion stories that politicians feel comfortable sharing are those that were medical necessities or the result of a tragic diagnosis. But here, Harris spoke plainly about the most common kind of abortion—one that’s done simply because a woman doesn’t want to be pregnant anymore. Because it doesn’t fit in with what she wants, or has planned for her life.
That kind of abortion is as moral and important as any other, and Harris spoke about it as such. There’s no overstating how important that is. In a moment when anti-abortion activists and legislators are creating a hierarchy of good and bad abortions, good and bad women—those deserving of care, and those who aren’t—Harris threw that standard out the window.
By refusing to play into Republicans’ noxious dichotomy—speaking with disdain about Trump and his insistence that he believes in ‘exceptions’ for women’s lives—Harris reminded Americans of something obvious that misogyny has long shrouded: The punishment for wanting to set your own course in life should not be death.
In response to Harris’ speech, Trump’s campaign insisted that the disgraced former president has “has always supported exceptions for rape, incest, and the life of the mother.” That kind of statement has always rung hollow, but even more so today. Because Trump thinks women will accept the bare minimum—a government that allows us, maybe just maybe, to live. But as Kamala Harris’ speech made clear, we’re not willing to be ‘exceptions.’ Not anymore.
Like all of us, Amber Nicole Thurman had a plan and a life that she wanted for herself. But Georgia’s law stole both.
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Kamala Harris is raising alarms about a new era of deadly back-alley abortion
Kamala Harris arriving in Georgia for a Friday event highlighting abortion access.Brynn Anderson/AP
Kamala Harris‘ campaign is highlighting the preventable deaths of two women who would be alive if not for Georgia’s abortion ban. This week reporting from ProPublica proved out the warning that abortion bans could be deadly, by bringing forward the names and faces of two Georgia women, Amber Thurman and Candi Miller, who died in 2022 but would be alive today if not for the state’s ban.
“Amber’s mom shared with me that the word over and over again in her mind is ‘preventable,'” Harris said Thursday evening at a Michigan campaign forum hosted by Oprah Winfrey. Thurman’s mother and two sisters were in the audience. “This story is a story that is sadly not the only story of what has been happening since these bans have taken place.”
“There is a word: preventable. And there is another word: predictable.”
Amber Thurman and Candi Miller both died after medication-induced abortions failed to expel all the fetal tissue, resulting in fatal infections, ProPublica reported. They were among the first women to die from what could be called a modern back-alley abortion: abortions that have been pushed underground and exiled from the safety of expert medical supervision.
In the days since ProPublica broke the news of these preventable deaths, anti-abortion activists have sought to blame the women. “Abortion killed Amber Thurman,” anti-abortion activist Lila Rose posted on X, shifting blame from the ban to the procedure and, implicitly, Thurman herself. The stories are complicated for advocates fighting to keep abortion medication on the market, as their stories highlight the rare times in which medication abortions require emergency follow-up care. (Such episodes are at the center of a current lawsuit to take one of the drugs, mifepristone, off the market.) But from the beginning to the end of their tragic stories, it’s clear that both women died for one reason: Georgia’s strict abortion ban.
It’s a story the Harris campaign is continuing to tell, with a Friday rally in Atlanta, where she delivered a warning: “If [Trump] is elected again, I am certain, he will sign a national abortion ban.” And with it, more people will die. “There is a word, preventable, and there is another word, predictable,” Harris said. “And the reality is, for every story we hear of the suffering under Trump abortion bans, there are so many of the stories we’re not hearing.”
On the debate stage last week, Trump would not rule out signing a national abortion ban. And his allies who crafted Project 2025 have laid out how to ban abortion, including those conducted with medication, nationwide. It’s a message her campaign has sounded from the start, as it leans on the health crisis caused by the overturning of Roe to motivate voters. But it’s also the sad truth.
The two women’s stories are eerily reminiscent of ones from over 50 years ago, when women died either from obtaining illegal abortions from doctors or others ill equipped to perform them, or from torturous attempts to induce one at home. When the Supreme Court overturned Roe two years ago, physicians, historians, and politicians warned that women would die. We now know that it took less than two months before at least one did.
“I fear that their situations are not unique,” Dr. Daniel Grossman, the director of a research group on reproductive health at the University of California, San Francisco, posted on X. “I think it’s very likely that other women and pregnant people have died due to their care being denied or delayed or due to being too scared to seek care—all because of the bans on abortion.” As evidence, Grossman cited a new study in which patients and providers reported on the near-death scenarios they have encountered under post-Roe abortion bans, cases very similar to those of Thurman and Miller. In 86 narratives, the report describes patients whose pregnancies, miscarriages, and post-abortion complications threatened their life. And yet doctors refused to treat them.
Soon after the Supreme Court overturned Roe v. Wade in June 2022, Georgia instituted a six-week ban. Like other draconian laws that popped up around the country that summer, its language was medically vague but legally punitive. Doctors and hospitals were left to guess what procedures were actually prohibited and when exactly exceptions for the life of the mother kicked in. If a prosecutor and jury second-guessed their decision, possible prison sentences loomed over their decisions. Almost immediately, in Thurman’s case, doctors chose a path that led to her death.
Hospitals’ refusal to treat women suffering complications jeopardize women from all walks of life.
Thurman was a healthy 28-year-old single mother of a six-year-old when she learned she was pregnant with twins. Thurman wanted a surgical abortion, but as ProPublica reported, Georgia’s six-week ban had just taken effect. Thurman drove to North Carolina for the procedure, but after traffic caused her to miss her appointment, she was offered a medication abortion instead. As happens in rare instances, not all of the fetal tissue was expelled, leading to sepsis. If Thurman were in North Carolina, she could have returned to the clinic and received a dilation and curettage, a common procedure that would have saved her life. But she was stuck in Georgia. Again, the state failed her. When Thurman was admitted to an ER in Georgia, it was clear that she needed a D&C to clear away the tissue that was poisoning her. But the hospital delayed surgery for 20 hours. By then, it was too late. A statewide maternal mortality review committee, which operates on a two-year lag and is only now examining post-Roe cases, deemed her death preventable.
In the fall of 2022, Candi Miller discovered she was pregnant. Because the 41-year-old mother of three had diabetes, hypertension, and lupus, doctors warned that another pregnancy might kill her. But Georgia’s abortion ban made no exceptions for people whose chronic conditions made pregnancy a deadly proposition. Abandoned by her state, Miller ordered abortion pills online and took them at home. As with Thurman, her body did not expel all the tissue, spawning an infection. She suffered for days until her husband found her unresponsive in bed, her three year old daughter by her side.
She hadn’t sought out a doctor, her family said, “due to the current legislation on pregnancies and abortions.” Tragically, as Thurman’s death suggests, it’s not clear that it would have helped if she had.
“It is exactly like what it was before it was made, open, available and legal,” says Leslie Reagan, a historian at the University of Illinois, Urbana-Champaign and the author of the book When Abortion Was a Crime. Reagan recalls reading coroner reports of women just like Miller, only decades earlier, who died because they were afraid of being arrested or prosecuted if they went to the hospital.
If Roe were still in place, Miller could have sought a surgical abortion or taken the pills under supervision of a doctor, who could have intervened when she needed further care. But that’s not how it works in Georgia anymore. Again, the same panel, which finally reviewed her case last month, immediately deemed her death preventable. ProPublica reported that the panel is reviewing additional deaths involving abortions after the ban was passed.
History seems to be repeating itself. Both Thurman and Miller were Black, and both died of sepsis.
When doctors and historians warned that people would die from post-Dobbs abortion bans, they weren’t being hyperbolic, they were looking at the facts. In one study, economists found that maternal death rates for nonwhite women plummeted after states began legalizing the procedure in the late 1960s and early 1970s, leading up to Roe in January 1973. Legal abortion reduced non-white abortion-related mortality by 30-60 percent.
“These are two black women,” says Reagan, noting that before Roe, Black women were far more likely to die trying to obtain an abortion. “This just, again, accentuates and replicates the past. And you know, frankly, the people passing these laws do not care about that.”
Further, deaths due to abortion-related infection were the most common fatal complication. “Over 1960 to 1980, legal abortion has been suggested as a major contributor to the decline in maternal deaths, primarily from abortion-related sepsis,” according to the report. In an account quoted in the study, an obstetrician from the period recalls that “complications of illegal abortion were so common that a septic ward was set aside for the infections. Surgery for hemorrhage was a common night duty.”
But for all the historical echoes, there are key differences. Rather than an abortion from an unqualified doctor or an attempt to induce an abortion by harming themselves, both Thurman and Miller took safe medication greenlit by the Food and Drug Administration. Both had the rare occurrence of failure to expel all fetal tissue, resulting in the need for medical attention.
While it’s clear that poor women and women of color will bear the brunt of the new wave of abortion-related fatalities, hospitals’ refusal to treat women suffering complications from abortion and miscarriage jeopardize women from all walks of life. Just ask Amanda Zurawski, a white woman from Texas who faced the imminent loss of her pregnancy but was told to go home and wait for the onset of sepsis. She ended up fighting for her life in the ICU. Indeed, it appears that under today’s abortion bans, doctors and hospitals are forcing women into septic shock and, in some cases, even delaying care once sepsis has already arrived.
Poor women and women of color will bear the brunt of new abortion-related fatalities.
This is not an accident. In fact, the lawsuit against mifepristone launched by the hard right Christian group Alliance Defending Freedom was premised on the idea that doctors should be able to refuse to treat patients in the exact position as Thurman and Miller. Their lawyers argued that the doctors’ personal opposition to abortion meant they should never have to save a woman’s life if she was suffering complications from taking mifepristone, even if the fetus was not living. As the group’s attorney, Erin Hawley, said during oral arguments before the Supreme Court, an anti-abortion doctor’s conscience is harmed by “completing an elective abortion,” meaning “removing an embryo, a fetus, whether or not they’re alive, as well as placental tissue.”
It was a shocking courtroom moment, but also a revealing one. The Alliance Defending Freedom doesn’t just represent doctors—it has also been instrumental in crafting and defending state abortion bans. They are not only willing to let women die, but it is in keeping with their beliefs. The lawmakers who wrote laws like Georgia’s—and refused to amend them despite warnings—seem similarly inclined to allow preventable deaths. Louisiana is about to limit access to misoprostol, a drug that is part of the medication abortion regimen but is also a life-saving anti-hemorrhage drug used in postpartum care, by categorizing it as a controlled substance. Again, people could die.
Just as the pre-Roe era saw unnecessary death, so now are we. And it’s easy to see, from the vague yet strict laws to the fear instilled in both doctors and patients, that it’s all by design.
In Atlanta, Harris presented a stark choice. She would restore Roe, he would usher in more bans. “He brags about overturning Roe v Wade,” Harris said of Trump on Friday. “He says he is proud. Proud that women are dying?”
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The hell of providing health care in a post-Dobbs America
In her 32 years as an advanced heart failure and transplant cardiologist, Mary Norine Walsh has seen very sick patients and many deaths. “We’re not like orthopedists who only see one in their entire career,” says Walsh, a physician at a Catholic hospital system in Indianapolis and the former president of the American College of Cardiology. Among those very sick patients are pregnant people. Over the decades, Walsh made caring for these types of patients her specialty. She became known for it, and began to receive referrals from other providers for whom pregnancy was too challenging a complication.
Walsh describes pregnancy as “nature’s stress test.” A person’s blood volume more than doubles, which can worsen preexisting conditions and expose countless new ones, such as heart disease. For instance: If a woman develops peripartum cardiomyopathy, a rare type of heart failure, she is in danger of her heart muscle weakening—a condition that could threaten her life, even in future pregnancies. Though cardiovascular issues affect only a small percentage of pregnancies, they are responsible for more than half of postpartum maternal deaths in the United States, making them the leading cause of death among pregnant people.
So when Walsh meets with sick women who are of reproductive age, she brings up contraception. If a patient is already pregnant, Walsh raises the idea of abortion. “The usual recommendation that we have with a very high-risk cardiac condition is a termination,” she says. Without one, says Walsh, her patients could die. Since Walsh doesn’t perform abortions herself, she refers women to a maternal-fetal medicine specialist to receive further care and discuss options, including termination. Walsh has spent years developing her expertise to save women’s lives—a specialty of extraordinary value given that most cardiology studies have been done on men. In some cases, her patients successfully go on to deliver babies, navigating complicated heart conditions with her help. In others, they come back to her pregnancy free, having avoided a possibly lethal health crisis.
But after the Supreme Court’s Dobbs ruling nullified the nearly 50-year-old Constitutional right to an abortion and handed the responsibility for its regulation back to the states, what was often a black and white decision to protect the life of the mother is now a grueling calculus of legal risk for doctors like Walsh.
In September, Walsh’s home of Indiana became the first state post-Dobbs to pass a near-total ban on abortion. The law makes exceptions for pregnancies resulting from rape or incest, those that pose “any serious health risk of the pregnant woman,” and those necessary “to save the pregnant woman’s life.” But the ban requires that such abortions take place in hospitals or surgical outpatient centers, effectively shuttering the freestanding clinics that have typically performed almost all terminations in the state. It also requires that every pregnancy that doesn’t result in birth be documented to justify what took place. Feticide is already a felony in Indiana, which also has an “aiding and abetting” clause, meaning that anyone even tangentially involved in an abortion, outside the bounds of the law’s exception, could be liable—even if their connection is only that they know about it. “We call it the girlfriend rule,” because if the person’s friend knows the crime is being committed, they could be liable, says Faith Alvarez, a personal injury attorney in Indianapolis. “The act of opening the door is enough to prove criminal conspiracy.”
This sweeping liability is especially terrifying when matched with the vagueness of the exception. What exactly constitutes a “serious health risk”? It’s something Walsh grapples with. “We don’t really know what’s okay,” she told me when we met in Indianapolis. “Is it me saying the health of the mother is at risk: Is that enough? Or do I have to sign an affidavit? Do I have to produce a scientific paper?”
She doesn’t have to answer all of those questions quite yet; for now, the ban is on hold as it winds its way through various court challenges. Which means that, for at least a little while longer, Walsh can provide care the way she always has, guided by her expertise and her patient’s wishes—and not by the whims of lawmakers. But even so, the impending ban means that she must also operate in a state of perpetual uncertainty—unclear what repercussions she might one day face for her work. The state attorney general investigated a doctor who spoke publicly about providing abortions, creating a climate of fear. Around her, the landscape is already shifting to accommodate the possible ban, as patients are seeking fewer abortions, partially out of confusion about the procedure’s legality. As this new future unfolds, Walsh has found herself urging patients to figure out their birth control plans and to consider IUDs, and telling members on her team to do the same.
Pregnancy doesn’t happen in a vacuum. People who are pregnant get in automobile accidents. They have psychological disorders. They get heart disease and cancer. Before Dobbs, doctors may have told their patients in some of these situations that pregnancy could worsen whatever condition they may have and suggest the option to terminate. But because of Dobbs, abortion access all over the county has become limited and fraught with uncertainty for pregnant people and their doctors. Today, fourteen states have outlawed abortion under most circumstances, some with no exceptions, and some with unclear language around caveats to preserve the mother’s life and criminal penalties for physicians who perform the procedure. A handful of states have laws like Indiana’s that explicitly criminalize aiding and abetting abortions, making it a felony to help, while in others, providers could still potentially be liable under laws that make it illegal to help someone commit a crime. Two states have even included vigilante enforcement clauses that allow citizens to file civil lawsuits against anyone suspected of even tangential involvement in an abortion (in Oklahoma, the state Supreme Court recently struck down vigilante anti-abortion laws).
Over the last year, I have spoken with medical specialists all over the country about how Dobbs has upended their patient care. Even in specialties far from obstetrics, the end of Roe has forced healthcare providers to waste precious time on added bureaucracy and to work in ways that deprioritize patient’s best interests.
A rheumatologist in Wisconsin who regularly prescribes the tetratogenic drug methotrexate (which can cause harm to fetuses) to treat rheumatoid arthritis is now required to certify each prescription with extra internal paperwork lest the state come to investigate an illegal abortion. “I wouldn’t be surprised if they say, ‘You cannot give it to patients between this and this age,” she told me, which means she would be forced to prescribe less effective, harder to access, or more expensive treatments. A dermatologist in Pennsylvania said she’d observed discussions in her discipline about whether there would be new regulations around the common acne drug Accutane, which can cause birth defects.
Emergency departments have also become battlegrounds. Despite a decades-old federal law protecting emergency care of all sorts, in a handful of states, ER doctors face the prospect of criminal charges for assisting in a termination that they’ve deemed necessary to save a patient’s health or life, or even for making a referral to an outside abortion provider; if they treat a patient that is miscarrying, they could be investigated for the emergency treatment they offer. Last year, hospitals in Kansas and Missouri refused to provide life-saving care to a woman whose water broke at 17 weeks of pregnancy. In Texas, more than a dozen women sued after being denied abortions in life-threatening situations—one woman had gone into septic shock and almost died. This situation creates, as one obstetrician in New Hampshire put it, endless “moral hazard,” where doctors fear the consequences of providing needed care, making them unable to help patients and sometimes causing active harm.
Michele Stanchina, an hematology and oncology fellow at the University of Miami, recalls a patient who was in her first trimester when she was diagnosed with lymphoma, making her among the one in 1,000 pregnant women every year who get cancer. Her patient decided to terminate her pregnancy so she could receive treatment, and she survived. Stanchina’s next pregnant patient might not be so fortunate: Two abortion bans, at six and fifteen weeks, are winding their way through the Florida courts now. “It is really not hard to imagine a similar situation,” Stanchina said, “where this would have led to the demise of the patient.”
Even as courts put new abortion restrictions on hold in some states, the precarity of what might happen next is already hurting doctors and the patients they care for. “Any day could be our last providing abortion,” said Dr. Katie McHugh, an obstetrician and abortion provider at clinics in Indiana and Ohio. Before Dobbs, Indiana already had myriad abortion restrictions in place. The new uncertainty has compounded this: In the past year she has had to rearrange her schedule constantly and has struggled to keep staff as her clinics have closed and reopened again in rapid succession, to keep up with the ongoing court case challenging Indiana’s ban. “We are still struggling with the uncertainty around the ban,” she said. “People don’t know if it is in effect, will be in effect, or what the consequences are or will be for pursuing an abortion.” This means that she, her staff, and her patients are operating in a state of constant hurry mixed with fear.
The day I met McHugh, her Indiana center, Women’s Med, had fewer patients than she had been expecting, so she was done early for the day. We sat crunching the peppermints usually left out for patients in her office. Although abortion is still legal in her state, a recent study found that they are down almost 50 percent. This is partly because patients are seeking abortion care in nearby states where they can be sure that the procedure is legal and they’ll get the care they need. “Pregnant people are scared and confused, understandable in light of the intentional deception and misinformation put out by the state,” McHugh says.
“I get the question repeatedly,” says Carrie Rouse, a maternal-fetal medicine doctor in the Indiana University health system who I spoke to in August. “‘If something happens, are you going to be able to take care of me?’” Her specialty involves caring for women with fetal anomalies and serious health risks to the mother’s life. Under Indiana’s law, an abortion should be legal if there’s a serious health risk. But because the standards are unclear, and untested, doctors and the hospitals where these abortions would be performed are left to figure out what qualifies. “I have met with more hospital lawyers in the last two months than in the entire rest of my life,” she says of her 13-year career. Creating those new hospital standards and enforcing them becomes an additional burden on doctors’ already overtaxed time.
That’s especially true given that the government of Indiana has made clear that it will try to find ways to prosecute doctors—even without an abortion ban. In July, state Attorney General Todd Rokita began an investigation into Dr. Caitlin Bernard for an abortion she provided to a 10-year-old rape victim who had come to Indiana from Ohio, where a six-week ban had just gone into effect. Rokita claimed that Bernard failed to report the child abuse that led to the pregnancy and violated patient privacy by speaking to the media about the case. He appeared on Fox News, calling Bernard an “abortion activist acting as a doctor.” Bernard filed a lawsuit alleging that Rokita had drummed up false consumer complaints against her as a way to unseal her patients’ medical records and that he violated the privacy of her patient by discussing details of her case on national television. (Bernard also says she satisfied all reporting requirements about the abortion and child abuse.) The case was moved out of court and in front of the state medical licensing board, which questioned Bernard for hours and eventually issued her a reprimand and a $3,000 dollar fine.
The potential implications of the litigation have reverberated throughout the medical community. “My goodness, this could open up all kinds of medical records [requests],” Alvarez, the personal injury lawyer, says. “Imagine a cardiologist, and they start subpoenaing their records based on some obscure complaint—it’s a slippery slope.” Rokita’s investigation also made clear that the state is eager to make examples out of doctors—even those who are carefully following the law.
This has contributed to an atmosphere of fear and distrust among health care providers. At the end of last summer, when I visited McHugh’s Women’s Med, for instance, I met a pregnant, diabetic woman who was experiencing ketoacidosis, a serious diabetic complication, that seemed to be getting worse, even while she was on medication: At night she fell out of bed from convulsions, and she was unable to keep food down. She’d ended up at Women’s Med thanks to a rather covert referral process. At a visit with her primary care provider about her condition, the doctor hadn’t said anything about abortion. But when she returned home, she found that her provider had sent her a Facebook message with the number for Women’s Med.
Hers was just one example of how the narrow restrictions in these bills don’t allow for the preventative care of patients who are not yet in life-threatening situations but could be. Doctors may be scared or unable to make referrals, and they must operate under constraints made by lawmakers with little medical knowledge of the latitude doctors need to save lives. “There is little general understanding that women with chronic medical conditions, and those who develop new medical conditions during pregnancy, are at very high risk,” Walsh says. “Saving the life of the mother often requires decisions early in pregnancy, not just near the time of delivery. This is not well understood.”
Medicine has long been seen as operating outside political life. But Dobbs has forced this to change: Doctors who have typically considered themselves at a remove from the abortion debate now realize that this is about them, too. But as they’ve begun to advocate over the last year, some have faced censure and scrutiny.
In Indiana, Gabriel Bosslet, an associate professor and pulmonologist at the Indiana University School of Medicine, began organizing his medical community around the issue of abortion back in May, 2022, when Politico leaked the Supreme Court ruling that would go on to gut national abortion access. An energetic man at home in a fast paced critical-care environment, Bosslet always thought of his work as unrelated to politics, let alone abortion care. But then came the state-sanctioned anti-vaccine rhetoric during the pandemic, forcing Bosslet to consider, for the first time in his 20-year career, the dangerous implications of government interference in how he offers care. “If you look at vaccines, gun safety, abortion, all three of these things lead directly to the hospital,” he told me. And yet, lawmakers without medical expertise were dictating how he and his fellow doctors should handle critical emergencies.
When the Politico leak made clear the Supreme Court was about to enable even more lawmaker meddling in his care for patients, Bosslet took to Twitter: “If you are a clinician in Indiana and you are fed up with the political landscape, DM me as I am getting some folks together for some good trouble.”
Some 40 people from different specialties attended the first Zoom call, including Women’s Med’s McHugh. Overall, the group was distraught over Roe’s impending reversal, and McHugh spoke about what could come next for abortion access in Indiana. Bosslet said it was the first time many of them realized how serious it could be. After the Supreme Court formally issued its Dobbs decision in June, but before lawmakers had introduced the bill banning abortion, the 12-person steering committee of the group, which named itself the Good Trouble Coalition, drafted an open letter in support of reproductive rights and got signatures from more than 1,800 healthcare practitioners. Bosslet and his team raised $20,000 in small donations to place the letter as full-page advertisements in eight newspapers around the state. The letter, which was replicated from a physicians group in Ohio, ended: “Protecting reproductive autonomy protects patients. The lives of Hoosiers depend on it.” The next month, the state legislature called a special session to pass the new abortion ban. Members of Good Trouble, plus some of the open letter signatories, testified in hearings about the bill, successfully persuading lawmakers to include exceptions for rape, incest, and the health of the mother.
One of the people testifying was Tracey Wilkinson, a pediatrician in Indianapolis and a member of Good Trouble. Wilkinson had testified against abortion restrictions before, often among the only doctors wading into the political fray. But on the day of the public hearing, the entire front row of the chamber was a sea of white coats. She was stunned. “I’ve never seen a dermatologist or gastroenterologist testifying with us because this has always been considered someone else’s problem,” she told me later “It was mind-blowing but heartbreaking.” That so many more doctors feel moved to wade into politics is indicative of just how dire patient care could become in the post-Roe landscape.
Good Trouble is doing its best to stave off this dangerous future for women. After Dr. Bernard’s medical hearing, the Good Trouble Coalition published another open letter in the Indianapolis Star. They wrote that the moral and ethical obligations of their profession have compelled them to fight back against the new landscape of abortion bans. “Physicians have an ethical responsibility to seek change when they believe the requirements of law or policy are contrary to the best interests of patients,” they wrote, quoting the American Medical Association’s ethics code. They have successfully fought for legislation that would ensure continued access to pharmacist-prescribed birth control. The group is also turning its attention to next year’s elections, where it plans to focus on ensuring that “science-minded folks,” as Bosslet calls them, win seats in the statehouse, and to encourage healthcare workers to vote. With the protection of a national right to abortion now gone, local lawmakers and courts will hold the keys to what restrictions—or protections—Indiana’s women will now face.
Around the country, other doctors are doing similar work in their own states. In neighboring Ohio, there’s a physician’s group for reproductive rights, and in South Carolina, a pediatrician, Annie Andrews, ran for congress. The obstetrician I spoke with in New Hampshire, who often testifies at her state legislature about reproductive justice, says that since Roe fell she has been asked specifically to mentor others who want to become involved in advocacy.
Some face censure for speaking out, especially when they are associated with an academic institution or are early in their careers. They are not paid for the advocacy work, which must happen on top of demanding jobs at the exact moment that those jobs have already been made harder by politics. Many are tired from slogging through the last year of uncertainty since Dobbs’ passage, and apprehensive about what new misery their legislatures might impose. But they find new fuel in the prospect of bringing medicine towards a model of patient-centered, politician-free care. As Wilkinson put it: “Nothing fuels me more than rage and the dream of one day making this moment seem far away.”
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Care Post-Roe: How post-Roe laws are obstructing clinical care
An updated report presents findings from the Care Post-Roe Study, and shows how health care providers have been unable to provide the standard of care in states with abortion bans since the Supreme Court struck down Roe v. Wade over two years ago, leading to harm and negative health outcomes for patients in the United States.
More than two years after the fall of Roe, researchers at ANSIRH have released a new report detailing how health care providers are still unable to provide standard medical care in states with abortion bans, leading to more delays, denials of care, and worsened health outcomes.
Care Post-Roe: Documenting cases of poor-quality care since the Dobbs decision documents a wide range of harm occurring among pregnant people in states with abortion bans, including increased morbidity, and complications that could result in serious impairment and risk of death. The report notes that longer-term effects could include loss of fertility, chronic pelvic pain due to infection or surgery, or heart attack and stroke related to uncontrolled hypertension, as well as effects on mental health. This has impacted both patients and providers and has deepened the existing inequities in the health care system for people of color. years to come.
Stories From Real Patients and Providers
The report provides a view over time into how patients have been impacted since the fall of Roe through 86 narratives submitted by their providers, from September 2022 to August 2024. The report also includes quotes highlighting the types of complications that providers observed.
These stories paint a stark picture of a post-Roe clinical landscape, detailing harm not only to patients, but also to health care providers who are now being forced to follow medically unnecessary laws that negatively impact their patients’ health.
One physician described their management of a patient at 20-22 weeks in a state with an abortion ban:
“Patient presented with [preterm prelabor rupture of membranes] (PPROM), was admitted. Due to laws, we can only provide expectant management until fetal demise or immediate threat to patient life. Despite her desire for a termination, we were forced to manage expectantly until she developed an intraamniotic infection, which progressed to sepsis requiring IV antibiotics for multiple days.”
The narratives also provide insight on the cost and logistical issues that patients encountered, including cases where patients would have been covered by their insurance in their home state but had to cover these costs out of pocket when they traveled to another state. The logistical challenges were particularly acute for those who had to arrange care for their children, get time off work, or pay for travel to a distant state.
A reporting physician wrote:
“If [the patient] had seen [a] provider in [her home state] when bleeding started…, she would have had the ectopic diagnosed about 6 weeks earlier, potentially eligible for [methotrexate] and therefore potentially avoided surgery, and even if [she] needed surgery [it] would have been at home with her family and support. Instead [she] had to… recover alone in a hotel room in a random state she had never been to before.”
The Impact of Abortion Restrictions on Medicine
It's clear that abortion bans and tying providers’ hands impacts every aspect of care. The report underscores the emotional and professional impacts on the health care workforce. Providers expressed moral distress at being forced to follow medically unsound practices, where they knew how to correctly manage a patient, but institutional or governmental policies prevented them from doing so. Some felt this distress so acutely that they were considering relocating to a state where abortion remained legal.
“In the two years since the fall of Roe, medical care for pregnant people has become dangerously warped as providers remain hamstrung in states with abortion bans. This research shows that every pregnant person in these states is at risk of being denied the care they need,” said Dr. Daniel Grossman, ANSIRH Director and lead report author. “Instead of policy band aids and exceptions that don’t work, we need abortion bans repealed so that clinicians can do the job they were trained for – to provide high quality health care to their patients.”
Key takeaways from the Care Post-Roe report suggest that abortion bans have fundamentally altered how pregnancy-related care—and even other medical care for people with the capacity for pregnancy—is delivered. As a consequence, patients’ health and wellbeing are being compromised. Given that reproductive harms disproportionately affect people of color in the US, it is also notable that patients described as Black or Latina/Latinx/Hispanic, as well as those who primarily speak Spanish, account for about half of all cases in our analysis.
To learn more, read Care Post-Roe: Documenting cases of poor-quality care since the Dobbs decision and our press release. Health care providers can submit a narrative about a case through this brief survey.
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