Women’s health doctors say they feel increased scrutiny amid abortion bans

(NEW YORK) — Dr. Caitlin Bernard, an obstetrician-gynecologist in Indiana, has spoken publicly about the negative repercussions she’s faced for providing abortion care to a 10-year-old girl after the Supreme Court overturned Roe v. Wade, giving states the power to regulate abortion.

“It’s very fulfilling to serve people who need urgent medical help and to answer calls by saying, ‘Yes, of course we’ll take care of her,'” Bernard wrote in a recent Washington Post op-ed. “But for the past few weeks, life has been hard — for me and for my family.”

She continued, “I’ve been called a liar. I’ve had my medical and ethical integrity questioned on national television by people who have never met me. I’ve been threatened. And I haven’t been able to talk and explain what I stand for.”

Women’s health doctors across the country say they feel similarly threatened.

“She is literally the same as myself and so many of my colleagues,” Dr. Sujatha Prabhakaran, an abortion care physician in Southwest Florida, told ABC News. “We all could have been in her place. We all would have taken care of that patient and then faced those attacks.”

In Florida, where Prabhakaran is based, nearly all abortions are now banned after 15 weeks, with exceptions allowed to save the mother’s life and if the fetus has a deadly abnormality. Violators can face prison time, as well as, for doctors, the loss of their medical license.

Earlier this year, Florida also instituted a mandatory 24-hour waiting period between an initial doctor’s visit and the abortion procedure.

Prabhakaran described the strain those requirements have put on physicians and patients. She said one patient, who was just past 15 weeks pregnant, had what she described as a “fetal anomaly that was definitely not compatible with the quality of life that this mother wanted for her child” and had to travel to New York state for abortion care.

“A few weeks ago, she could have had her care in Florida,” Prabhakara said. “I’m highly trained and skilled and to not be able to use those skills for somebody who is right in front of me, it tears at your core as a physician.”

Prabhakaran, a board-certified OBGYN, said as a doctor who provides reproductive health care in a state with abortion restrictions, she feels the pressure of each decision, weighing what’s best for patients with what will allow her and her colleagues to keep providing care.

“More than anything, what we’re thinking about all the time is if we make a decision that causes prosecution of one of our physicians, then it means that lots of other patients can’t access care,” she said. “So we’re really, really careful in weighing those decisions about how we ensure we’re complying with the law and then also trying to not overanalyze the law and restrict care more than it needs to be.”

In nearby Tampa, Dr. Rachel Rapkin, a board-certified OBGYN, said she feels patients in Florida are getting “substandard care” because of the new abortion restrictions.

“After seeing what’s happened to doctors like Caitlin Bernard in Indiana who are being so intensely scrutinized … doctors are really scared to provide what should be standard of care to our patients,” Rapkin told ABC News. “And patients are getting substandard care now.”

Rapkin cited as an example the care of a pregnant patient whose water had broken after 15 weeks, prior to fetal viability.

“The standard of care for that is to offer termination because they have a really high risk of getting sick, becoming septic and dying,” said Rapkin, adding that with the new 15-week abortion restriction in place, some doctors out of caution are telling patients, “They just have to go home and wait until they’re sick and then come back.”

As a women’s health doctor operating in a post-Roe world, Rapkin said she feels like her “hands are tied.”

“I went to a lot of years of school and then extra training to be able to provide abortion care to all of my patients … and all of these bans in some way or another threaten our patients’ livelihood,” she said.

In Ohio, where the 10-year-old patient whom Bernard cared for is from, Dr. Ashley Brant, a board-certified OBGYN at Cleveland Clinic, said she and her colleagues are coping with seeing the state’s abortion law impact instances of miscarriages and pre-term deliveries.

Abortion is banned in Ohio as soon as a fetal heartbeat is detected, according to Brant.

“Sometimes when a miscarriage is happening the pregnant person has started to bleed heavily, has started to cramp and the cervix has started to open and the pregnancy hasn’t passed yet and there might still be a detectable fetal heartbeat,” Brant told ABC News. “In those cases, in Ohio, if we intervene, we’re being forced to call those abortions, so you can imagine how distressing it is for a patient who is miscarrying, who is losing a wanted pregnancy, to have to be told…, ‘If we’re going to intervene you need to sign this paperwork saying it’s an abortion and we’re going to report it to the state as an abortion.'”

Further in the second trimester, according to Brant, if a fetal anomaly is diagnosed that is not compatible with life, doctors in Ohio are no longer able to give their patients the option to end the pregnancy.

“It’s morally distressing to not be able to provide the full scope of evidence-based care here and to have to say to our patients, ‘I’m sorry. You’re going to have to go out of state even though I have the skills and I’m willing to provide this care, my hands are tied by the law,'” Brant said. “We just had a moral distress reflective debrief exercise for our women’s health care providers because of how distressing the ban has been for us.”
 
Dr. Jill Gibson, also a board-certified OBGYN and medical director of Planned Parenthood of Arizona, said this is the “hardest time” of her career as she and other doctors are forced to make decisions that she says go against their medical training.

“It’s just been the toughest part of my career thus far because doctors have been put in this really completely impossible situation of having to choose between their ethical oath and obligation to take care of their patients with all of the tools that they have and all of the training and skills that they know, and the potential consequences of being criminally prosecuted for exercising those skills and offering that care,” Gibson told ABC News.

Planned Parenthood of Arizona paused all abortions, surgical and medical, on June 24, the day of the Supreme Court’s decision, according to Gibson. She described the on-the-ground impact of Arizona’s abortion restrictions as “more far-reaching” than she imagined.

“Doctors I think are, out of fear, making patient care decisions that they would not have made one month ago,” she said, describing one instance in which she said a patient had to go through labor with a non-viable fetus so the provider would not be considered assisting the patient in an abortion.

“That patient had to endure labor for much longer than was necessary,” Gibson said. “We have doctors that are really worried that their actions will be interpreted as providing or assisting in care that could be considered abortion.”

Gibson described feeling her medical career has been “derailed,” adding of doctors like herself, “I feel that we are we are being sidelined and the people who have not had any medical training are making decisions for us.”
As of the end of July, at least 13 states have ceased nearly all abortion services.

In Texas, one of those 13 states, Dr. Stephanie Mischell, a family physician who provides abortion care, said she not only cannot provide care to her patients, but also sees them having to travel farther and father for care.
 
“For a lot of Texans, the place that they used to go was Oklahoma and now you can’t go to Oklahoma, so they go to Louisiana and now you can’t go to Louisiana,” Mischell told ABC News, citing two states where trigger bans took effect after the Supreme Court’s ruling. “It’s becoming increasingly hard for patients to access this care, and it’s really hard to watch patients struggle.”

Mischell said she is still figuring out what to do next herself, whether to move states to be able to provide abortion care or to continue to serve patients in Texas in other ways.

She said her work in the weeks since abortion was banned in Texas has focused on answering patients’ questions on things like where they can travel to access abortion and whether or not they still have access to contraception.

“Right now I’m really focused on the patients and trying to get them the care that they need,” she said. “We provide some other kinds of services, so sometimes people come in for other things, for pregnancy tests or for a miscarriage or something else, but a lot of our focus now is just getting accurate information out into the community.”

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