After the Supreme Court’s June 2022 Dobbs decision eviscerated the already limited federal right to abortion, 14 states — Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas and West Virginia — banned the procedure.
In some of these states, clinics closed. According to The Guardian, 42 U.S. clinics shuttered in 2022, plus 23 more in 2023. But as disturbing as this is, it is not the full story. Despite financial, legal and political obstacles, many clinics in states that have banned abortion have pivoted, continuing to provide essential reproductive health services such as contraceptives, STI testing and treatment, and routine gynecological exams, with some expanding to deliver prenatal and gender-affirming care. In addition, new clinics have opened in states like Wyoming and Maryland where abortion remains legal.
Robin Marty, the author of Handbook for a Post-Roe America and executive director of the West Alabama Women’s Center in Tuscaloosa, has helped steer that clinic in a new direction since abortion was outlawed in the state. She told Truthout that nearly a quarter of the city’s population — 23.1 percent — is impoverished, and 1 in 7 residents of child-bearing age don’t have health insurance. What’s more, Marty says that 34 percent of Alabamans who become pregnant get no prenatal care during the first trimester, something the West Alabama Women’s Center is determined to change.
“Before Dobbs, when we were still providing abortions, we set aside $300,000 because we knew that if we could no longer offer abortion care, we’d have to navigate the state bureaucracy to shift to other work,” she said. “During that time, we expected to have no income.”
In the 18 months since the Supreme Court decision, Marty and her colleagues have provided pregnancy verification letters to Medicaid and offered free or low-cost prenatal care, IUD and implant removal, birth control counseling and dissemination, STI diagnosis and treatment, and postpartum checkups to more than 1,500 patients.
“We’ve raised about $1 million in small-dollar donations and grants from the Abortion Care Network and Abortion Bridge Collaborative Fund of the Women’s Donor Network since Dobbs,” Marty said, “and we are just now beginning to get reimbursements from Medicaid and other health insurers.”
Although this sounds like an unqualified success, Marty makes clear that the transition from abortion provider to ob-gyn provider has involved jumping through innumerable hoops. It has also included deflecting the anti-abortion stigma that continues to surface. This stigma has kept the clinic’s physicians from receiving hospital admitting privileges in Tuscaloosa — a turn that, in effect, penalizes clients when they go to the hospital to birth their babies.
In addition, the clinic’s inability to perform abortions has also taken a toll, something that is being felt in every region of the country.
The Guttmacher Institute estimates that 22 million people who can become pregnant currently live in states where abortion is restricted or completely unavailable. And even in states where it remains legal, longstanding restrictions are in place to stymie access. For example, 28 states have a mandatory waiting period between counseling and the procedure; 16 require the counseling to be done in person; five require that the pregnant person be told that fetal personhood begins at conception; and 35 do........