Two years ago, the Supreme Court’s decision in Dobbs v. Jackson ripped away a right women across America had known for nearly five decades. Since then, a patchwork of abortion access has emerged, leaving many women scrambling for care.
The right to choose has vanished almost entirely in 14 states, forcing women to carry pregnancies to term with few exceptions. Others have slammed the door shut after just six weeks, a time when many women haven’t even realized they’re pregnant.
This seismic shift has sparked outrage, with protests erupting nationwide and clinics in states with access facing a surge in demand. While some women can travel to states with fewer restrictions, the journey is often fraught with logistical nightmares and financial burdens.
The number of abortions performed overall may not have dropped significantly, but that doesn’t tell the whole story. Behind the statistics are countless women facing impossible choices, their health and well-being hanging in the balance.
Dr. Donna Adams-Pickett, a leading voice in Black maternal health, spoke to the Defender to discuss the ripple effects of this decision, particularly on women of color, and offer guidance on navigating this new reality.
Defender: How have the health outcomes for women changed in the two years since the overturning of Roe vs. Wade, particularly regarding complications from restricted access to essential health care services?
Dr. Donna Adams-Pickett: While we don’t have hard numbers now, we have projections. We see a projected decrease in the number of medical students and residents choosing obstetrics as a field of interest.
The projection is that in the next five years, we’ll have 3000 fewer OBGYNs than we have now. Most medical students and residents have cited their concerns with the decision’s reversal, making them vulnerable to litigation. They need to learn to navigate some of these laws to provide the best care possible to these patients.
So, because most of the women in this country, at least a third, live in maternal healthcare deserts already. To decrease those numbers even further is catastrophic to women. When we have people who don’t want to go into OBGYN, we have fewer individuals who are there to care for women, just even for gynecological issues like cervical, endometrial, ovarian cancer, and fibroid disease. Many people look at this through the lens of obstetrical care, but it also impacts caregivers.
Defender: Can you discuss the financial impact on women unable to access reproductive health care services? How are these financial burdens affecting their overall quality of life?
Adams-Pickett: Too often, when we discuss this issue, we discuss it through the framework of the determinations of undesired pregnancies. No one truly discusses that. Often, the large majority of the time, these are terminations of unsafe pregnancies. People who have health conditions that, if they were to become pregnant, could be deadly to them or significantly worsened. Individuals who are in domestic violence situations, who, if they’re forced to move forward with a pregnancy, do not feel safe in the household already, often will connect their abuser to them further. Individuals who are barely able to make ends meet to take care of their health concerns before becoming pregnant are now forced to continue a pregnancy that may have financial implications if there are any complications.
When they are down in the South, or South Carolina on down, there’s hardly anywhere where a woman could access reproductive services. When you have people who are already strained financially, they’re placed in a position where they may have to go as far as Virginia or Illinois, and most individuals don’t have the resources to be able to do that. They are forced to carry pregnancies that are not safe for them physically, emotionally, or financially.
Defender: What emotional and psychological effects have you observed in women navigating these new restrictions? How are OB/GYNs managing the increased emotional trauma among their patients?
Adams-Pickett: In 23 years of practicing, I have seen over 10,000 patients and delivered over 6,000 babies. I have yet to meet someone who made this decision before the overturning and was not tormented by it.
It’s a very difficult decision to make, to be forced to make, whether it is elective or other circumstances dictate. The conversation has been solely on these elective procedures. The people who don’t care about the life that they’re carrying have been demonized. The fact that they’re even having to think about moving forward means they’re now facing a moral crisis because they have been demonized.
More of the role of validation that there is nothing wrong with you spiritually from making this decision or even thinking about this decision. This does not make you morally bankrupt in any way. This does not make you spiritually anemic because you are even considering this. I know this is not a decision you’re entering into lightly; you’re trying to do what’s best for you medically.
Defender: What support systems and resources are available to women who are struggling with the physical, emotional, and financial challenges posed by these restrictions?
Adams-Pickett: Many private donor organizations are working with organizations like Planned Parenthood to provide grants and resources that allow women to travel to states for more reproductive help.
In our community, this information may not be readily available. People would have to know to speak with someone who can direct them to the right person to get that information. The average person in our community is not going because of the demonization.
They’re not going to be open with just anyone about asking for those resources. And then when they do, it’s almost like an underground railroad of whispering. If you go here, they may be able to get you a phone number and an email there. Then, the barriers just continue to increase.
Defender: What changes or actions would you like to see implemented to better support women’s autonomy and health?
Adams-Pickett: I want federal protection for women to maintain autonomy over this medical decision. Outside of that, we should try more educational initiatives to educate women on how to protect themselves best. We know that contraceptive failure is a real thing, and sometimes, we are in this climate are concerned that contraception is on the table next in terms of removing autonomy.