A big change for reproductive health care workers since the Dobbs ruling

MEMPHIS, Tenn. — Today, half of what was the nation’s first nonprofit clinic to house a birth center and offer abortions sits empty.

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

But now the clinical rooms for abortion patients and the recovery room are used for storage. The call center space remains unused. Many employees have been fired and others have had to choose a new career path.

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

It is a huge challenge for reproductive health professionals. Healthcare professionals struggle to determine what is allowed under state law, and worry about medical education and job security in an ever-changing landscape. The complexity has led some to avoid a career in reproductive health care.

Lily Picard is among those who have had to follow 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 came into effect, she has moved to another department.

Now she helps patients with appointments.

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

“I’m still struggling and I really miss being able to do that work,” said Picard, who volunteers outside of work to provide virtual abortion doula support. “I still get people calling here just to talk about it.”

It’s not ideal. But she’s grateful there was another place she could be involved.

“They just didn’t have room for me in obstetrics, I guess,” says Picard, who is also certified as a doula for labor, death and postpartum care.

A federal judge will appear in September temporarily interrupted parts of the 2024 Tennessee law that restrict adults from helping minors travel out of state for an abortion. On Oct. 17, a state court temporarily suspended part of a separate Tennessee law that bans providers from performing most abortions. That law specifically excluded mental health emergencies as justification for emergency abortions.

The uncertainty weighs heavily on Picard.

“If I didn’t have my son, who is now only five, I would absolutely have moved somewhere else,” Picard said. “I hope to do that someday in the future when my son is older and we are no longer so dependent on family.”

Pregnancy centers

For an anti-abortion center on the other side of town, things haven’t changed so dramatically.

“We’re still doing the same thing because they (abortion patients) are being sent out of state,” said Susie Lovato, director of outreach and development at Memphis Coalition for Lifewho is against abortion. The group’s office is across the street from Planned Parenthood – Memphis Health Center – Midtown, where abortions can no longer be performed.

Lovato said the coalition uses the continuum of care model — common in substance use treatment — to connect pregnant women to a broader range of primarily faith-based social support sources. That could mean connecting them with mental health services, mentorship, parenting resources, nutrition classes, transportation or even housing.

“What’s happening is there’s a crisis,” Lovato said. “And what we’re trying to do is say, ‘Hey mom, what do you need to not be in crisis?’ Can we help you find a new trajectory for your life?’ Because it is often not the pregnancy that causes 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 have no government support at all, but that’s OK. You know, we’ve been doing well for five years,” she said.

But data from the Tennessee Department of Finance and Administration shows that 41 groups received funding totaling $20 million Tennessee Strong Families Grant program that provides resources to nonprofits and pregnancy centers working 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 support what anti-abortion groups call crisis pregnancy centers. At least four measures introduced this year support such centres. Two resolutions, which have not yet been adopted, recognize the role of pregnancy centers and two bills would provide tax breaks for donations to pregnancy centers.

Providers

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

In June, the Supreme Court said Idaho should allow it emergency abortions for the time being, but left the larger problem unsolved. And in October, the court refused to hear the Biden administration’s appeal in a similar case in Texas, with a lower court ruling remaining in effect.

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

This uncertainty worries providers.

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

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

A survey from October from Texas Gynecology Services Manatt Health found that 29 percent of respondents said they were confused about abortion law and 60 percent feared legal ramifications for their practice.

Pratima Gupta, assistant professor of obstetrics, gynecology and reproductive sciences at UC San Diego Health, said moral distress is not limited to providers in states that ban abortion.

“I don’t think anyone today, wherever he or she is, whatever state he or she lives in, whatever state he or she provides healthcare in, can be arrogant,” says Gupta. who has ticked off a list of safety measures she is taking to protect herself and her family.

Her program also trains Utah residents who travel to California for abortion-related experiences due to lawsuits over Utah’s ban.

The moral distress of navigating vague laws conflicts with the medical ethics doctors are taught, she said.

“How sick is sick enough? How close to sepsis should I let this patient go? said Gupta. “It’s really, really stressful for us and a real moral challenge for people who provide abortion care.”