For reproductive health workers, a big change since the Dobbs ruling

MEMPHIS, Tenn. —These days, half of what was the first nonprofit clinic in the nation to house a birthing center and provide abortions is empty.

The clinic is CHOICES – Memphis Center for Reproductive Health and it opened in 1974, in the aftermath of the Supreme Court’s Roe v. Wade ruling.

But now its abortion patient clinical rooms and recovery area are used for storage. The call center room is going unused. Many staff have been let go, and others have had to navigate a new career path.

More than two and a half years after the Supreme Court overturned the constitutional right to an abortion in the Dobbs v. Jackson Women’s Health Organization case, that decision has had a powerful impact.

It’s been daunting for reproductive health professionals. Health workers struggle to determine what is permissible under state law, worrying about medical education and job security in an ever-changing landscape. The complexities have caused some to avoid a career in reproductive health.

Lily Picard is among those who have had to navigate a new career path since Dobbs.

Picard was originally hired three years ago as an abortion doula to support patients during and after procedures at CHOICES. Since the ban took effect, she’s moved to a different department.

Now she helps patients with appointments.

CHOICES still has a birthing center and administers birth control. Those who need abortion care are referred to a branch of the clinic in Carbondale, Ill.

“I still have a hard time and I miss it so much all the time getting to do that work,” said Picard, who volunteers outside of her job to do virtual abortion doula support. “I still get people here that call here just wanting to talk about it.”

It’s not ideal. But she’s grateful there was still a place for her to be involved.

“They just haven’t had room for me up in the midwifery, I guess,” said Picard, who is also certified as a doula for birthing, death and postpartum care.

In September, a federal judge temporarily paused parts of Tennessee’s 2024 law limiting adults from helping minors travel for an abortion out of state. On Oct. 17, a state trial court temporarily paused part of a separate Tennessee law that prohibits providers from performing most abortions. That law specifically excluded mental health emergencies as a justification for emergency abortions.

The uncertainty weighs heavily on Picard.

“If I didn’t have my son, who’s only 5 now, I would absolutely have moved somewhere else,” said Picard. “I do hope to do that sometime in my future when my son is older and we aren’t so dependent on family.”

Pregnancy centers

For an anti-abortion center across town, things haven’t changed as dramatically.

“We’re still doing the same thing because they’re [abortion patients] being sent out of state,” said Susie Lovato, director of outreach and development at Memphis Coalition for Life, which opposes abortion. The group’s office is across the street from the Planned Parenthood – Memphis Health Center – Midtown, which can no longer perform abortions.

Lovato said the coalition uses the continuum of care model — common in substance use treatment — to connect pregnant women with a broader set of mainly faith-based social support resources. That might mean connecting them with mental health counseling, mentoring, parenting resources, nutrition classes, transportation or even housing.

“What happens is, there’s a crisis,” said Lovato. “And what we seek to do is say, ‘hey, mom, what is it that you need to not be in crisis? Can we help you find a new trajectory for your life?’ Because often, it’s not the pregnancy that’s the crisis. Life is already in crisis.”

Lovato said most of the group’s funding comes from private individuals and, to a lesser extent, from churches.

“We don’t have any governmental assistance at all, but that’s okay. You know, we’ve been fine for five years,” she said.

But data provided by the Tennessee Department of Finance and Administration shows that 41 groups received funding for a $20 million Tennessee Strong Families Grant program that provides resources to nonprofits and pregnancy centers that work with crisis pregnancies, including Confidential Care Mobile Ministry Inc., which is part of the six-member Memphis Coalition for Life.

In Congress, lawmakers are also beginning to throw support behind what anti-abortion groups call crisis pregnancy centers. At least four measures introduced this year back such centers. Two resolutions, which have not yet been adopted, recognize the role of pregnancy centers and two bills would grant tax credits for donations to pregnancy centers.

Providers

The broader national issue of what is legally required of providers and health facilities in obstetric emergencies is still unclear, and the complexity appears to be impacting the future health care workforce.

In June, the Supreme Court said Idaho should allow emergency abortions for now, but left the larger issue unresolved. And in October, the court declined to take up the Biden administration’s appeal in a similar Texas case, leaving a lower-court ruling in place.

If former President Donald Trump is elected again, the executive branch interpretation of whether abortion can be classified as emergency medical care could also change.

That uncertainty troubles providers.

Jeff Gardere, a board-certified clinical psychologist and associate professor and course director at the Touro College of Osteopathic Medicine in New York City, said that fewer medical students ask to discuss or request recommendations for OB-GYN residency programs since Dobbs.

“I just don’t see that enthusiasm as much anymore,” he said.

An October study from Manatt Health of the Texas OB-GYN workforce found that 29 percent of respondents said they were confused about the abortion law and 60 percent were fearful of legal repercussions for their practice.

Pratima Gupta, an assistant professor of obstetrics, gynecology, and reproductive sciences at UC San Diego Health, said that moral distress isn’t limited to providers in states outlawing abortion.

“I don’t think anyone in this day and age, no matter where they are, no matter what state they’re living in, no matter what state they’re providing care [for], can be cavalier,” said Gupta, who ticked off a list of safety precautions she takes to protect herself and her family.

Her program also trains Utah residents who travel to California for abortion-related experience because of litigation over Utah’s ban.

The moral distress in navigating vague laws runs contrary to the medical ethics that physicians are taught, she said.

“How sick is sick enough? How close to sepsis do I have to let this patient go?” said Gupta. “It’s really very stressful to us and really morally challenging to people who provide abortion care.”

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