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Pressure and Stress Intensify for Abortion Providers Post-Roe

Wmc features Kwajelyn J Jackson Melissa Alexander 112922
Kwajelyn J. Jackson, executive director of the Feminist Women’s Health Center in Atlanta; a six-week abortion ban has gone into effect in Georgia. (Photo by Melissa Alexander)

Since the Supreme Court overturned Roe v. Wade in late June, providers of abortion care have been dealing with emotional devastation, managing severe staff burnout, the possibility of facing criminal charges, and increased harassment from protestors.

Some providers also contended with the prospect of losing their jobs when abortion became illegal in their state, at times within hours of the decision, forcing their clinics to close down. By October, 66 clinics across 15 states had been forced to stop offering abortion care or had closed down entirely. Before the June 24 Dobbs decision, those 15 states had 79 clinics that provided abortion care; by October 2, that number had dropped to 13, all located in one state, Georgia.

“The post-Roe reality is heartbreaking for those of us closest to it,” said Anamarie Rebori Simmons, director of communications and marketing at Planned Parenthood Great Plains, which operates health centers in Arkansas, Kansas, Missouri, and Oklahoma. “As abortion bans took effect and patients were driven further from home to receive care, our dedicated providers worked longer hours to help fill the gap in care. That alone has taken a toll. Patients often arrive at our health centers after driving through the night for 10 or 12 hours with no sleep. Once they leave our care, and head back out on the road, we worry for their health and safety.”

Providers in states where abortion access has become severely limited or been banned are dealing with “a lot of grief,” said Angelica Perez, technical assistance manager at the Abortion Care Network, the national association for independent community-based abortion care providers and their allies. “The vibrant communities they’ve built over decades of providing abortion care are gone — and not without a real fight to stay in their communities either. This pain and loss are felt not only by the providers and residents in these states, but also shared by the providers in states where abortion access is maintained. They feel responsible for providing abortion care for the entire country. This sense of immense responsibility isn’t always a realistic expectation, so burnout is another issue prevalent in our community.”

While the Dobbs decision was expected, “it was still devastating,” said Kelsea McLain, deputy director of the Yellowhammer Fund, an abortion fund in Alabama. “I felt numb and actual physical agony and just how cruel the people in power could be.” An abortion ban went into effect in Alabama the same day. “We found out that we only had hours before we had to cease operation and that we weren’t going to be able to help the people that we said we would.”

In addition to abortion providers facing the possibility of felony convictions in Alabama, state law also bans access to abortion pills through telehealth and by mail. Assisting someone getting an abortion, even in another state, may also lead to criminal charges. While the Yellowhammer Fund still provides information and emotional support to people seeking abortion care, they can’t do direct referrals and instead share relevant media coverage. McLain has had to contend with having her home address and other personal information shared online by anti-abortion protestors who have become much more aggressive and have shown up armed outside clinics that provide abortions in North Carolina, where McLain does escort training. “Some of the people getting abortions are also coming armed. We now have to do trainings about treatment for gunshot wounds — it feels really damn dark. But fundamentally, I can’t let the government do this and I feel so much obligation to my community.”

The Dobbs decision enabled states, including Tennessee, to enact six-week abortion bans, which had previously been blocked in the courts. “I’m used to seeing patients looking relieved when they leave our lobby,” said Jennifer Pepper, president and CEO of CHOICES: Center for Reproductive Health, which had been providing abortions in Memphis for 48 years. “Seeing them leave in tears when we were forced to turn them away after the six-week ban went into effect was more emotionally difficult than we ever could have imagined.”

Tennessee banned abortion in late August, and subsequently two clinics in the state closed entirely. “It’s easier to do the work we’re doing and have an impact if I don’t think too much about the big picture,” said Pepper. “When I think too much about the countless individuals impacted by this ban, and all the negative consequences for real people in Tennessee, it’s really difficult to keep going. I keep myself moving forward by asking myself, ‘What is CHOICES doing to help? What is our role? What does my staff need to be successful and make an impact?’ I think about our new clinic in Carbondale, Illinois, and all the hard work our team put in to opening its doors to patients. That lifts me up. That’s how I get through the day.”

When states enact restrictions and abortion bans, it forces providers into an untenable position. “Turning patients away for basic health care is really tough,” said Dr. Meera Shah, co-medical director of the Whole Woman’s Health clinic in South Bend, Indiana. Indiana’s abortion ban went into effect in September, and although it has been temporarily blocked by the state Supreme Court, “the back and forth gets really exhausting, and it’s frustrating not to be able to provide health care for political reasons. Politics shouldn’t dictate whether or not we can provide health care. I’m pregnant myself, so the Dobbsruling was especially emotional for me. This is a wanted pregnancy, but forcing someone to go through this is completely unethical.”

Even providers who are in states where abortion remains legal are impacted by Dobbs, especially if the surrounding states have enacted abortion bans. “Because of our geographic location, we are seeing many more people from out of state,” said Ashley Brink, clinic director of Trust Women’s Wichita, Kansas, clinic, who described realizing one day just how many cars in the clinic parking lot had license plates from Texas, Louisiana, and Oklahoma. “It felt really dystopian. Now we are not only helping people get abortions, but we are also case managing how they get here. It’s really hard on our staff. We all signed up to provide abortions; we didn’t sign up to provide abortions during the apocalypse.”

The deluge of new patients from neighboring states has meant managing potential burnout of staff. “Our immediate challenge was how to respond to people from the states around us where abortion was suddenly heavily restricted,” said Kwajelyn J. Jackson, executive director of the Feminist Women’s Health Center in Atlanta, which first opened in 1976. “We had a three-week window before the six-week abortion ban went into effect in Georgia and the staff were trying to see everyone. Our phone center staff were very, very affected by this and felt that they couldn’t take a break. My directive to them was that they needed to take care of themselves and their well-being and that it wasn’t their job to throw their bodies on this problem that is not of our making. I am trying to make sure we don’t have to close or lay off staff, and I feel responsible for the people who work here and have devoted their lives to this work. This work has always been hard. There are protesters still outside clinics that don't even provide abortions anymore. The amount that my staff has to go through to just stay on their feet — I wish I was able to provide the care that both my staff and our patients deserve.”

The thought of what will happen to people who can’t get a needed abortion weighs heavily on providers. “I feel rage, absolute rage,” said Diane Derzis, who is on the board of the Pink House Fund, an abortion fund, and is the former CEO of Jackson Women’s Health Organization in Jackson, Mississippi. That clinic has closed, but Derzis is still the CEO of clinics in Columbus, Georgia; Richmond and Bristol, Virginia; and Las Cruces, New Mexico. “This has been my career for 50 years. And having seen women who come in for our services who won’t be able to get them and to think about women who are poor in one of those states — it’s life-changing for all of us. And it’s clear now that [women] are seen as nothing more than vessels when there is something in our uteruses — that’s where the rage comes in. I’ve seen the people protesting in front of our clinics for years, and they have hate with a capital H for women. [The Dobbs ruling] makes our jobs harder, but it also makes it more rewarding. The fact that our doors are open keeps me sane. And we will continue to be here and we will help you, no matter how many hoops you have to jump through to get here.”

Clinic closures as a result of the Dobbs decision have meant not only facing unemployment but also potentially being forced into a whole new sector. “A majority of our staff had to take work in other industries, and that’s really hard,” said Lori Williams, board chair of the National Abortion Federation and the former clinical director of the Little Rock Family Planning Services, which was forced to shut down when the Dobbs decision triggered an abortion ban in Arkansas. “The Dobbs decision also destroyed people’s careers — if you don’t have a degree and you have worked your way up in a clinic and been there for a long time, you may not have transferable skills. We knew it was coming and we tried to be prepared. But having the clinic close down has been emotionally upsetting and much harder than I expected. We had prepared the staff for decision day, and the last weeks before, it was awful for us. We had patients scheduled two weeks in advance and for them it was an absolute struggle to get care. I was monitoring the SCOTUS blog and seeing patients at the same time. We had hoped we would have another week. After the decision came, we took turns speaking to patients and calling people who had upcoming appointments to help them find another place and looking through Google Maps to try to help them. I was lucky to find work at another clinic, and I can still do the work. But we all still worry about our patients, and that is especially draining on us all.”

The Supreme Court ruling, however, has also motivated people to make career changes and become providers for the first time in their lives. “I applied for this job when I first heard about the Dobbs ruling and it inspired me to take it, as a feminist, as a mother of two daughters,” said Jinelle M. Hobson, who has been the executive director of Equality Health Center in New Hampshire since July. “This spoke loud and clear to me as the next chapter of my life.” However, the new position includes “a weekly Monday night call with providers from around the country, and it’s heart-breaking to hear about a clinic closing down and to think about the ripple effect that will have” as well as “protesters holding signs that say ‘babies are murdered here.’”

At the same time, providers in some parts of the country report that the Dobbs decision has yielded additional attention and financial support. “As an Indigenous-led and -centered abortion fund, we’ve gained a lot of new support in the past few months,” said Jennifer Lim, communications and media director of Indigenous Women Rising, an abortion fund open to all Indigenous people in the U.S. and Canada. “We have received an influx of donations to expand our abortion fund budget, as well as hire new staff and plan for the future of our organization. We need this support long term though.”

Many providers have gone into the work of providing abortion care for deeply personal reasons, hoping to ensure that someone else would have a better abortion experience than they did, and are determined to keep going, no matter what. However, those in management positions are well aware that their staff might need more than taking a day off here and there, the free therapy that many places are now providing, or an extended vacation. “I always tell the staff that if they wake up one day and decide they can’t do this work anymore, that it’s OK, because it takes such an emotional toll on each of us,” said Brink. “People don’t always realize the sacrifices we’re making to do this work, specifically the emotional labor to help people through such a desperate time.”

Providers are constantly reckoning with how to keep abortion clinics open while also maintaining their own self-care. “We are doing what we can now to take care of ourselves,” said Julie Burkhart, founder and president of Wellspring Health Access, a clinic in Casper, Wyoming, which was supposed to open in June but was attacked by an arsonist on May 25; when it does open, it will be the first one in the state to offer both medication and surgical abortion care. “It’s a fine balance, when you have a goal, which is opening the clinic, to balance that with the self-care that might be needed or desired. We cannot allow ourselves to be ruled by fear and intimidation. I am heartened when I hear from people how appreciative they are of our work. Those words of encouragement are inspiring and keep me and the whole team going.”



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