ATLANTA -- Nearly a year ago, women across the country learned they no longer had a guaranteed right to get an abortion if they wanted. And in Georgia, it meant it was only a matter of time until access was vastly limited.
The U.S. Supreme Court on June 24, 2022, decided there is no constitutional right to abortion when it ruled in Dobbs v. Jackson Women’s Health Organization, overturning a nearly 50-year-old decision saying the opposite.
Weeks later, a federal appeals court allowed a Georgia law to take effect that bans most abortions once a doctor can detect fetal cardiac activity, typically about six weeks into a pregnancy and before many know they are pregnant.
States across the South and Midwest have enacted laws either vastly limiting access to abortion or banning the procedure completely in the past year.
The effects of the state law have been immediate and powerful in Georgia. Abortions have dropped by nearly half, according to data from the Georgia Department of Public Health. And abortions after six weeks of pregnancy have all but ended.
Getting the ‘number to zero’
Claire Bartlett, executive director of the anti-abortion group Georgia Life Alliance, said she is “delighted” to see the numbers decreasing.
“We’d like to see the number at zero, but we have generations of people who have a different understanding of things,” she said. “Now we want to work on an education campaign to get it where we are changing hearts and minds. That’s a taller ask, honestly.”
In the first seven months of 2022, before Georgia’s law took effect, an average of about 4,000 abortions were performed each month. Since the law took effect in late July 2022, abortions are being performed at an average of about 2,176 per month through April, according to DPH data.
It’s unclear how many people have been told they can’t get an abortion because they are too far along in their pregnancy. Nor is it easy to determine how many have left the state to get an abortion.
Kwajelyn Jackson, executive director of the Feminist Women’s Health Center, said the clinic tries to do thorough questioning during pre-screening phone calls to make sure that people aren’t making an unnecessary trip. Still, she says that while the numbers dropped immediately after the Dobbs decision, the clinic is now performing between 55 and 60 abortions per week across the three days the procedure is offered, which is nearly as many as before the ruling.
During a recent Saturday at the Brookhaven clinic, only one of the 23 patients who arrived for their scheduled abortions was turned away after the ultrasound technician detected fetal cardiac activity. She was six weeks and one day into her pregnancy.
Georgia law allows later abortions in cases of rape, incest, if the life of the woman is in danger or in instances of “medical futility,” when a fetus would not be able to survive. As of June 8, there have been 199 abortions performed after a doctor could detect fetal cardiac activity since the Georgia law took effect.
Limited options
Women seeking an abortion after a doctor can detect fetal cardiac activity are faced with a choice: carry and deliver a child they didn’t initially want to have or, for those with the financial ability, travel to another state where abortion is still legal. Those who give birth have to decide whether they want to keep the baby or place it for adoption.
A 21-year-old Georgia woman told The Atlanta Journal-Constitution that when she learned she was pregnant, she sought an abortion but found out she was too far along in her pregnancy to get one in Georgia. Before her unexpected pregnancy, she said, she had been firmly against abortion.
The AJC is not using the name of the woman, her husband or son to avoid them being harassed.
The Columbus-area woman then arranged a trip to Illinois, where abortions are allowed up until viability — or about 25 weeks of pregnancy — but when her family learned she was pregnant they persuaded her to have the baby.
“It made me realize how selfish I was in that moment,” she said. “Then I was relieved I wasn’t going to have to have an abortion. ... And I was happier with myself because I knew I wasn’t going to do something that was going to traumatize me and hurt the people I love.”
A few months after deciding not to have an abortion she married the child’s father and now has a nearly 2-month-old son.
Traveling for abortions
Those with the means to do so can travel to another state where abortion access is less restrictive. The nearby places they can travel, however, have become more limited.
Earlier this year, Florida, North Carolina and South Carolina passed laws that are similar to Georgia’s statute. South Carolina’s law is being challenged in court and a judge put its enactment on hold, meaning abortion will remain legal in that state up until 22 weeks of pregnancy while the state’s Supreme Court reviews the case. Abortion is banned at all stages of pregnancy in Alabama and Tennessee.
Those who don’t have the financial ability can seek help from groups such as Access Reproductive Care-Southeast, a nonprofit that provides money to those who need it in order to get an abortion.
Planned Parenthood Southeast, which serves Alabama and Mississippi as well as Georgia, waited until it got approval from legal counsel to let “patient navigators” connect abortion patients with clinics in other states. Alabama’s attorney general has said that a person who assists anyone in getting an abortion can be prosecuted under that state’s conspiracy and accessory law, so Planned Parenthood does not offer patient navigators there, said Vivienne Kerley-de la Cruz, the Georgia state and campaigns director.
Since October 2022, the patient navigators have helped 289 people get abortions, she said. Ninety percent of those were directed to clinics outside Georgia and Mississippi. Most chose clinics in the Carolinas, Virginia and Illinois, she said. The rest came to Georgia.
Planned Parenthood’s clinics in north, east and south Florida used to average about 30 Georgia patients per month but now average 80, said Michelle Quesada, spokeswoman for Planned Parenthood of South, East and North Florida. Most of the organization’s out-of-state patients come from Georgia, she said.
Earlier this year, Florida passed a law banning abortion once a doctor can detect fetal cardiac activity. The law, which has exceptions for instances of rape, incest or to save the life of the mother, will take effect only if the state’s current 15-week ban is upheld in an ongoing legal challenge that is before the Florida Supreme Court.
Jackson, the executive director of the Feminist Women’s Health Center, said it was “heartbreaking” that the patients who are turned away from her clinic because they are too far along in a pregnancy may no longer have the ability to travel to a state where later abortions are legal.
“We have seen that people are making a way out of no way — and they’re persistent,” Jackson said. “People are acting quickly, as soon as they have a positive pregnancy test, and making decisions to make sure they’re able to get the care they want.”
Medical ‘predicament’
Georgia’s law has also caused some confusion and concern in the medical world.
Since the restrictive abortion law went into effect, Dr. Jeffrey Marcus with the North Atlanta Women’s Specialists gynecological and obstetrics practice, said he’s experienced very difficult situations including instances when there is still fetal cardiac activity but the woman’s water has broken too early for the pregnancy to be viable.
He said doctors must wait hours — sometimes days — for an infection or another complication putting a woman’s health at risk before they can medically intervene by giving treatment that causes labor to begin. The abortion law prevents them from inducing labor otherwise.
“It’s a predicament,” he said. “You have to wait for something to happen that makes it such that the mother is at risk. But it’s a very, very difficult situation and doctors are very, very worried and concerned about getting prosecuted and being reported by somebody on staff because you did something that was not exactly what they agreed with. It’s gotten very, very touchy.”
Before the abortion law changed, Marcus said, “you would use your clinical judgment and make a decision of what you thought was right. You don’t have that luxury anymore.”
“You know, I understand all sides,” he said, “but I think it’s taken a lot of autonomy away from the patient and it’s really gotten in the way of the patient-doctor relationship to allow it to be respectful of what the patient wants.”
Future of abortion in Georgia
Lawmakers on both sides of the issue have introduced bills that would either completely ban or completely allow abortions in Georgia. None of them gained any traction this year.
Georgia’s abortion law remains a matter of the courts, including a challenge in the state Supreme Court. In November, a Fulton County Superior Court judge threw out the state law, allowing abortions past the detection of fetal cardiac activity to resume. About a week later, the state Supreme Court said the law should be in effect throughout the court process.
Justices will soon decide whether the law should remain in effect — or if, as attorneys for abortion providers argue, it was illegal from the start because Roe v. Wade, which guaranteed the constitutional right to an abortion, was the law of the land in 2019 when the state law was passed.
State Sen. Ed Setzler, an Acworth Republican who in 2019 sponsored what became Georgia law, said he is “delighted” with the drop in the number of abortions that has occurred in the state since last year.
“The (abortion law) carefully balanced the difficult circumstances women find themselves in with the basic rights of the child,” he said. “I think people are seeing the value of life in a way that perhaps, under the callousness and the death grip of Roe v. Wade, people were able to ignore in years past. ... There are children who are in the world today who are here — I think we can say that they’re here because of the impact of the law.”
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(Staff writers Alia Malik and Helena Oliviero contributed to this article.)
