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Abortion doctors’ post-Roe dilemma: Move, stay or straddle state lines

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The National Abortion Federation has set up an online marketplace where doctors who have closed or expect to be sold their ultrasound machines, speculums, and other equipment.

“We all struggle with the question, ‘At what point would I move?’” said Ashley Brant, an OB-GYN at an academic facility in Northwestern Ohio and a colleague at the nonprofit Physicians for Reproductive Health. “What will be my personal line in the sand?”

While the number of abortion providers in the nearly two dozen states that have banned or are expected to ban abortion soon is small — about 10 percent of the national total, according to the Guttmacher Institute, an abortion rights think tank — their departure is likely to have an inordinate impact. .

Health experts warn this potential migration could be devastating for patients, depriving them of access to contraception, prenatal care and other reproductive health services. They also fear that in some communities no health care provider will be left behind to perform emergency abortions in the life-threatening conditions exempt from most state bans.

“If you see a flight of health care providers from states who have severely limited their ability to practice in accordance with their moral compass and medical ethics, it will be a huge loss to public health and the community,” said Jamila Perritt, an abortion provider in Washington, DC, and the president and CEO of Physicians for Reproductive Health. “We don’t have to guess what’s going to happen. We’re already seeing high rates of maternal mortality and morbidity in places like Louisiana and Mississippi. But we’ll see a lot more of that as these bans continue to flood the country.”

Of the providers POLITICO spoke to in states with abortion bans on their books, none said they were willing to offer illegal abortions — aware that doing so risks losing their medical license and, in some states, a long jail term to sit out.

Instead, many plan to travel across state lines for a few days a week or month to perform abortions while maintaining a practice in their home state in case the ban is overturned. Some plan to use telemedicine to consult their patients and prescribe abortion pills in states that allow it. And others — especially those whose current work focuses primarily on abortion rather than the full range of OB-GYN services — are moving to other states.

At the same time, more forward-thinking states fear that as they become abortion destinations for millions of patients, they won’t be able to get enough staff quickly, possibly create delays in care that push people later in their pregnancy. Activists in California and elsewhere are calling on lawmakers to make it easier for doctors to get licensed if they move to other states or travel part-time, or to provide incentives such as student loan forgiveness to entice more providers.

But that may not be enough to convince a sufficient number of doctors to get their lives out of the way.

“If I were free to move, there would be a lot of great opportunities right now,” said Zevidah Vickery, the Ohio-based abortion provider who is changing fields rather than moving out of concern for her son. †[Abortion] is my professional identity. It has been my raison d’être for over 20 years. But I am also a single mom of a preteen who guided me every step of the way. So I just can’t move. And I can only describe it as saying that I went through a period of mourning when I made this decision.”

The National Abortion Federation, in addition to its online marketplaceIace for equipment, has also recently set up a job board.

“We’ve seen a surge in interest since the Supreme Court ruling leaked,” said Melissa Fowler, chief program manager for the National Abortion Federation. “People had held out hope, but then they started to accelerate and accelerate their plans to find work in other states.”

Fowler says they are seeing more doctors, nurses and other frontline health professionals looking for part-time travel work, rather than moving permanently.

“People are deeply rooted in their communities and it is difficult to pick up the thread and move to a completely different region of the country,” she said. “Moreover, travel is not unheard of in healthcare. We already have a lot of traveling nurses, especially during Covid. It is a life that offers a lot of flexibility, and some abortion providers chose it for safety reasons a long time ago.”

Several abortion providers in Texas, Ohio, Indiana and other states that have banned or are about to enact bans told POLITICO they don’t plan to move for many of those same reasons — even if it means moving. they have to stop working that is important to them .

“I’ll just keep having abortions until the last day I can,” Brant said. “I could look elsewhere for work. But part of me remains optimistic that people will be so outraged that the pendulum will swing back.”

A court on Friday allowed Ohio’s six-week abortion ban to go into effect, and lawmakers expect to introduce a blanket ban in November or December.

Brant is one of hundreds of providers now considering how best to help their patients in states where their work is illegal or could soon become illegal. Under the six-week ban in Ohio, she could face a felony conviction and up to a year in prison for “knowingly and purposefully” carrying out the procedure, even in rape or incest cases.

Still, said Brant, she wants to stayroe precipitation.

There will be a need for aftercare for people who have arranged their abortion outside of health care,” she explains. “And we still hope there will be waivers for threats to maternal health. If someone has an emergency at 20 weeks, not many people know how to end the pregnancy quickly. That’s why I want to be here.”

But Brant remains concerned that the skills she’s developed over the years will “die” under a ban, so she’s talking to clinics in Michigan, Illinois and along the East Coast and debating whether to go through the complicated and expensive process of applying for a permit. need to start elsewhere so she can pursue part-time travel work.

Other doctors in the red state grapple with similar dilemmas, fearing criminal charges but also fearing leaving their patients behind.

Caitlin Bernard, an abortion provider and professor at Indiana University’s School of Medicine, noted that while providers have the resources and knowledge to jump across state lines to practice, many low-income patients don’t.

“For a lot of people in Indiana, when I tell them to get out of the state, I might as well tell them to go to the moon,” she said. “They have to pay for the care in the clinic, the time they are not with their children, the time they do not have from work. Gas prices are also rising.”

In Texas, which last fall banned all abortions after six weeks and threatens offenders with life imprisonment, health care providers have had more time to grapple with their future. But that didn’t make the decision any easier.

“It was incredibly heartbreaking. Every day I saw patients, I had to reject some because they were too far along in their pregnancy,” said Sam Dickman, the San Antonio abortion provider who recently moved to Montana. “I also saw my patients collapse with relief when I gave them during their ultrasound told me they came to me early enough to have an abortion in Texas instead of having to travel to New Mexico.”

Others in the state, including Lauren Thaxton, an abortion provider and assistant professor of women’s health at the University of Texas, plan to stay even though abortion is completely banned. Enforcement of Texas’ pre-roe the ban has been temporarily blocked by a court and the state trigger law has not yet come into effect.

However, she knows that many of her fellow doctors will move and is concerned about the impact on Texas patients who already struggle to access reproductive health services such as birth control, prenatal care and miscarriage management.

“We are already few,” she said. “And because Texas is such a big place, when someone leaves their community, they may be the only person with that training for hundreds of miles.”

Medical experts are concerned not only about the immediate loss of health services in red states when the bans go into effect, but also about the long-term effects of a generation of OB-GYNs avoiding those states in the future.

“The people who study medicine now, where do they look for residencies? Not in a state where they can’t practice freely,” warned Tracey Wilkinson, an assistant professor of pediatrics at Indiana University School of Medicine and a board member with Physicians for Reproductive Health. “Anecdotally, we’re already hearing residents who are currently here say they don’t want to stay in Indiana. We already have several counties without OB-GYN care, and this will have downstream effects.”

The blue state clinics that are already seeing an increase in patient numbers and expect to rely more heavily on staff from the red states in the future are also on edge.

“We’re hearing from doctors who don’t necessarily want to move because they know they will still be needed in their communities for birth control and family planning, but who may be doing rotations with us because we’re going to have an influx of patients,” said Jodi Hicks, the president of Planned Parenthood of California, “But we’re concerned about a generation of doctors in training in those states who aren’t really being trained in abortion.”

Megan Messerly contributed to this report.

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