With Roe v Wade overturned, abortion is now banned in 13 states and subject to restrictions and litigation in more than a dozen others. In some states, courts are embroiled in an on-off battle that can see abortion banned in a state one day, unbanned the next, and back off the table two weeks later.
Doctors are on the frontlines of this chaotic landscape, fearful of running afoul of ever-changing law, in some cases struggling to provide life-saving care. In most cases, doctors have stayed in abortion-restrictive states, because despite restrictions on their medical practice, they have ties to their patients, their communities, their families.
But others have decided to leave. What do they leave behind? In a country where, according to an analysis from the March of Dimes, nearly half of all counties lack a single obstetrician, what care will remain? And what do their predicaments tell us about what it is like to work in reproductive health in much of the US?
Here are five of their stories.
Alireza Shamshirsaz, 48
Alireza Shamshirsaz had a house in Houston, Texas. In the backyard was a small pool, where his kids learned to swim. He met his wife in Texas, built his family there, and felt it was his home. But after Texas passed its six-week abortion ban late last year, a decision he faced at work would sour things for him.
A couple whose pregnancy was not going to be viable came to him for care, but because of Texas’s abortion ban, he had to send them hundreds of miles away.
The mother was 21 weeks pregnant with identical twins, which shared one placenta. One of the twins was almost certainly going to die, which would most likely have killed the other twin without intervention.
Shamshirsaz wanted to use a selective, lifesaving procedure: by stopping the blood flow to the unhealthy twin, he could save the other’s life.
In Texas, he didn’t have that option.
“They were just crying, crying in the middle of my office,” says Shamshirsaz.
The worst bit for him was knowing how urgent the situation was.
“They needed to get all the way to the east coast or west coast before they would find a doctor who could help them, and they needed to do it in the next 24 or 48 hours. Even in the best scenario I don’t think 99% of people could have made that trip in the time they had,” he says.
Shamshirsaz doesn’t know what happened to the couple, but their case deeply affected him.
“Most people don’t have the option to travel to other states. The rich people can travel,” he says, but others can’t.
Waiting is the new norm in abortion-restrictive states: even in cases where foetal survival is an impossibility, doctors often must wait to intervene until the last moment, at huge risk to pregnant people.
“If we wait to the edge, we have more near misses. In medicine, when you have too many near misses, eventually, you actually miss. That means ending up with a dead mother,” says Shamshirsaz.
Shamshirsaz now works in Boston. Since Roe fell, he is relieved not to be in an abortion-restrictive state surrounded by other restrictive states. But he fears for Texas.
“If you can’t do a termination, who will support these kids after the birth? Who will pay the bills they will need for medical care? Nobody. We destroy these families,” he says.
Catherine Romanos, 43
When Catherine Romanos was 28, she fell in love with the idea being an abortion provider. In medical school, she signed up to train as part of a movement to get younger people trained in providing abortions, and after her first job at a Planned Parenthood, she decided to stick with it. She loved the way she was able to build trust with patients, supporting them at an intimate moment in their lives, sometimes soothing their shame.
But in June 2022, Ohio’s six-week ban went into effect. Romanos, now 43, went from working in a Dayton office that performed 40 to 50 abortions a day to seeing less than a handful of patients daily.
“I went from feeling really needed, to almost three months where I really couldn’t do my job at all. It was very demoralizing,” she says. “It was worst for people answering the phones. They were taking hundreds of calls a week from people trying to figure out where they could go.”
The day the Dobbs decision came down, Romanos ordered licenses to practise elsewhere – in Michigan and Illinois. Ohio’s abortion ban has since been blocked.
Nearby, Indiana’s near-total ban is also on hold due to legal challenges. In November, Michigan will decide whether to protect abortion in its state constitution or to ban it using a 1931 law.
“It’s really hard to plan your life when the judge’s orders come in 14-day increments,” says Romanos.
Romanos sees the impact of these seesawing laws on her patients: in late September, she helped a Hoosier patient, who found out she was pregnant on the first day abortion was illegal in Indiana. In the time it took the patient to drive to Ohio, then back to Indiana for her mandatory 24-hour waiting period, and back to Ohio again for the abortion, the ban in Indiana had been temporarily lifted.
“It’s so insulting to her,” says Romanos.
Zevidah Vickery, 51
Zevidah Vickery was never supposed to be an OB-GYN. She studied feminist theory, and thought she’d be an academic or a sociologist one day. Then she started working as a medical assistant at an abortion clinic in Seattle, and everything changed.
Her first cases were difficult. She saw patients forced to engage in sex work, leave their children with neighbors, or travel from Alaskan villages without support from their families to find an abortion provider .
That’s when she decided she on her career . “I was just blown away by the courage and the desperation of patients,” says Vickery. “Suddenly, writing some feminist take on social phenomena seemed less immediately useful.”
What followed was 15 years of study to be the kind of provider she dreamed of: Vickery took night classes in math, went to med school, and did another four years of residency and two more years in fellowship to become an expert in abortion and contraception.
In 2020, she landed her dream job in Ohio as a full-time abortion provider who also taught students. She finally had weekends to herself, which meant she could spend time with her son.
“I loved the people. I loved the organization, I loved my boss,” she says.
Then, Vickery saw the leaked draft judgment suggesting the constitutional right to abortion would soon fall. She knew abortion bans would come quickly in Ohio, an already restrictive state. So she made a decision. After years of moving her son around for her career, she was going to stay put.
“I’m his only family really,” she says. “I couldn’t move him any more,” she says.
Now, Vickery is a retraining to be an addiction specialist. She describes leaving the job she loved as a long process of mourning.
“It really is exactly like grief. [I’m doing] all of the things you have when you’re grieving – like suddenly you’re sobbing on your way home,” she says. “I’m not married, my career is my husband. I invested everything into getting where I was.”
The most difficult thing for Vickery to think about is what her patients have lost.
“There aren’t enough of us as it is,” she says. “People don’t even want to practice in red states any more. So it’s not just the loss of one person who’s an expert in abortion care. It’s the ripple effect of that.”
Leilah Zahedi-Spung, 34
Leilah Zahedi-Spung has spent her career zigzagging around abortion-restrictive states. She started out in Georgia, just before a 22-week abortion ban went into effect in 2019. She moved to Missouri later that year, when the state passed an eight-week ban (which didn’t go into effect as Roe v Wade’s protections still stood). Last year, she moved to Tennessee, where the state recently banned abortion without any exceptions. That was the last straw.
Zahedi-Spung is exhausted. She is fed up with sending every patient who comes to her for an abortion out of state and wondering if she is putting their lives at risk. One patient she sent out of state had to travel in deteriorating condition. After crossing a border five hours away for care, the patient’s kidneys had started to fail. The patient was OK, but Zahedi-Spung wished she could have intervened earlier.
“I am now complicit in a system that is making me harm people,” she says. “It’s a gut punch every time I have to tell someone, ‘I’m sorry, your foetus and this child you so desired is not going to survive outside of this pregnancy, because it has some awful anomaly. And there are no exceptions to the law in Tennessee, and you now need to travel out of state to get the care that you deserve.’”
She is a maternal foetal medicine specialist and is horrified by the number of women who will be forced to give birth – especially considering the states with the tightest abortion restrictions are those with the worst maternal mortality rates. (Tennessee ranks fourth worst in the country.)
“There’s guilt that I’m leaving patients in a community that I care about deeply,” she says.
But she looks forward to practicing in Colorado, where she will be moving. She feels relief to be starting over in a new state “where I’m not under a microscope. That someone isn’t gonna turn me in to the cops, or show up at my house and arrest me for doing my job,” she says.
Anne Banfield, 44
Anne Banfield is glad she left Elkins, West Virginia, in April 2022 to practice as an OB-GYN in Maryland. Shortly after she left, the state brought in a near-total abortion ban. She thinks often about the decisions she won’t have to face now she doesn’t live there any more. She doesn’t have to worry about whether her patients will be able to access care or whether she can provide appropriate advice to them without running afoul of the law. She doesn’t have to worry about them getting needlessly sick or maybe even dying from preventable issues.
In 2013, while she was still in West Virginia, she saw a patient in the emergency room who was 17 weeks pregnant when her water broke. The patient’s partner, a US army vet, was out of the country while she grappled with terrible news: without a termination, her baby was unlikely to survive, and if it did, it would probably have significant problems. The patient was at risk of a life-threatening infection, kidney damage, even death.
She was able to terminate the pregnancy with Banfield as her doctor. In a post-Roe America, she would have needed to travel out of state or wait until her own condition deteriorated.
“I don’t want to tell [people] in a horrible situation, they can’t receive the healthcare they need in their home state, because of the law,” says Banfield.
Having practiced in the state for almost 14 years, she still has friends working in West Virginia under the abortion ban. Every time one tells her about another patient they had to send across state lines, Banfield is relieved she no longer works there.
But she worries about her two nieces and what the future will look like for them.
“I don’t want them ever to be in a situation where they don’t have choice,” says Banfield.
Now, her biggest concern is that people in the state she loves will suffer from avoidable conditions, and die avoidable deaths from ectopic pregnancies or haemorrhaging because they would be scared to get treatment for a miscarriage that may fall under suspicion.
“If you’re afraid your local emergency department is going to investigate you for a miscarriage, or to turn your information in to the police because of some crazy restriction in your state, then people are going to delay care. That scares me,” she says.
