El objetivo es aumentar la educación digital para la comunidad de trabajadores agrícolas en Carolina del Norte.

La entrada ¿Cómo es el programa gratuito que enseña a trabajadores agrícolas a utilizar herramientas digitales? se publicó primero en Enlace Latino NC.

Luego de casi un mes de ocurrida la inundación, algunas familias pudieron regresar a sus casas pero necesitarán repararlas, mientras que otras deberán encontrar un nuevo lugar para vivir debido a las condiciones en que quedaron sus hogares.

La entrada Asistencia a familias afectadas por inundaciones en Kannapolis   se publicó primero en Enlace Latino NC.

Las elecciones locales se estarán realizando este año en 90 condados de Carolina del Norte.

La entrada Elecciones municipales en 90 condados de Carolina del Norte se publicó primero en Enlace Latino NC.

Sin la aprobación del presupuesto bienal 2023-2025., la expansión de Medicaid en Carolina del Norte se encuentra en el limbo.

La entrada En el limbo, expansión de Medicaid en Carolina del Norte se publicó primero en Enlace Latino NC.

By Rachel Crumpler

Beverly Gray, an OB-GYN at Duke Health who provides abortion care, expects that turning away people seeking abortions in North Carolina will be a daily occurrence beginning tomorrow, when the state’s new restrictions passed by Republican lawmakers take effect.

Overnight, abortion access will significantly diminish as the time frame for seeking most abortions in the state drops from 20 weeks of pregnancy to 12 weeks. 

Gray said cutting weeks of access in the state will make turning patients away from care — which already happened under the 20-week ban — more frequent. 

That’s devastating to her, to her colleagues and to many women, she said. 

“I think about when we turn someone away, will they be able to make it to another state?” Gray asked. “And if they can’t, what is their life going to be like? What is their child’s life going to be like?”

It’s not lost on Gray why she will be turning more people away — timelines set by North Carolina lawmakers over the objections of medical professionals and a veto by Gov. Roy Cooper. Gray still has the same skills to help patients in an array of situations, but her hands will be newly tied — taking previously available options for reproductive health care off the table.

Amy Bryant, another OB-GYN and abortion provider, knows the new North Carolina law will put care out of reach for many patients, such as a 17-year-old whom she treated a few weeks ago. The teen, who was just finishing high school, sought an abortion when she was 13 weeks and one day pregnant. Tomorrow, that patient would be left to carry the pregnancy to term or travel out of state.

“That’s just going to happen so much more,” Bryant said. “It’s just unfair.”

While most abortions occur before 12 weeks, Bryant said, there are plenty of scenarios when that’s not possible. At least 1,878 North Carolinians obtained abortions after 12 weeks of pregnancy in 2021 out of a total 27,305 who had abortions, according to the latest data available from the state health department.

North Carolina’s new law does provide some exceptions — for rape, incest, fetal anomalies and risk to the mother — that allow an abortion after 12 weeks. Still, Bryant said, some of the most vulnerable patients will be outside the window of care, such as teenagers with irregular periods who often identify pregnancy later, or those who need more time to pull resources together.

Gray has similar concerns about access to care. 

“There are a lot of complex social reasons that impact why people need care,” Gray said. “I think a lot of those patients don’t fall into the exceptions — patients who may be living in poverty, who are working multiple jobs, who already have kids, who have delays in care because they at baseline don’t have access to health care.”

As a result of the new restrictions, Bryant anticipates that North Carolina will face increased birth complications and elevated maternal and infant mortality rates — trends seen in other states with restrictive abortion policies.

“My colleagues and I want to abide by the laws, and we want to provide the best possible care,” Bryant said. “There are times where that really does come into conflict, and it’s gotten worse.” 

New era of care

Since the Supreme Court’s Dobbs decision in June 2022 handed the authority to regulate abortion back to states and their elected officials, North Carolina providers working in reproductive health care have faced a challenging year navigating the shifting legal landscape. Tomorrow, they will enter a new era, adjusting their practices to conform to the added constraints on their work.

In addition to cutting by eight weeks the time window allowed for most abortions, lawmakers placed more requirements on women seeking abortions and on their providers.  

One of the biggest changes is requiring an in-person appointment for state-mandated counseling at least 72 hours before an abortion. Previously, this pre-procedure counseling could occur over the phone or online. Gray said for patients and providers, this will be one of the most difficult requirements to adjust to and, she emphasized, it’s not medically necessary.

As a result, patients will be required to visit clinics at least twice — many needing to travel long distances to reach one of the state’s 14 abortion clinics spread over nine counties. The additional appointment will necessitate extra time off work, miles driven, hotel stays and child care costs.

“We expect that to be a significant barrier for many patients, and probably an insurmountable one,” Molly Rivera, Planned Parenthood South Atlantic spokesperson, told NC Health News in May. “Especially for folks in rural parts of the state who have to already drive hours to get to an abortion clinic. Especially for folks that don't have paid time off of work. Especially for people who already have kids at home.”

For providers and clinics, adding an extra appointment to an already busy workload will create another layer of complexity to scheduling. There also are new reporting requirements that physicians say will be burdensome.

“I would rather spend that time with my patient and their family,” said Caledonia Buckheit, an OB-GYN in the Triangle. “I don't want my time and effort to be towards paperwork and legal — these things that are not patient-centered.”

Several other provisions in Senate Bill 20 are being challenged by Planned Parenthood South Atlantic and Gray in a lawsuit that was filed June 16 in U.S. District Court. The health care providers argue that specific provisions are so vague or contradictory that doctors are uncertain about what’s lawful.

After the lawsuit was filed, lawmakers at the General Assembly revised several of the challenged abortion provisions this week by passing amendments to a separate bill. For example, one revision clarified that medication abortions are permitted up to 12 weeks in the state. Previously, language in Senate Bill 20 stated in one place that the age of the fetus could be “no more than 70 days,” or 10 weeks.

Gov. Cooper signed the revised provisions into law Thursday afternoon, less than 48 hours before the new restrictions take effect.

"In addition to being dangerous for women, the rushed abortion ban was so poorly written that it is causing real uncertainty for doctors and other health care providers,” Cooper wrote in a statement about signing House Bill 190. “This bill is important to clarify the rules and provide some certainty, however we will continue fighting on all fronts the Republican assault on women’s reproductive freedom."

At a federal court hearing for the lawsuit heard in Greensboro on Wednesday, the plaintiffs and defendants agreed that the new language resolves issues with several provisions. However, the passage does not resolve the entirety of the lawsuit. The remaining differences likely will be addressed through future legal proceedings.

“Our lawsuit was never going to be able to give North Carolinians the bodily autonomy that they deserve,” Rivera said after the court hearing. “This law passed. It's happening. But we did come to the court to get clarity so that we know how to comply with this sweeping law so that we can help patients navigate this reality.”

Other portions of the bill, such as the mandate that any abortion after 12 weeks be provided in a hospital and the implementation of any new, potentially stringent licensing rules on the state’s abortion clinics, will not go into effect until October. 

How sick is sick enough?

The new law about abortion does provide some exceptions for rape, incest, fetal anomalies and risk to the mother that allow abortions later in pregnancy, but physicians have concerns about how workable those are in practice.

Lisa Carroll, a high-risk pregnancy OB-GYN worries about her patients — many of whom have chronic illnesses that are exacerbated by pregnancy. Many conditions are not immediately life-threatening, but pregnancy could cause long-term health risks.

For example, Carroll recently treated a pregnant patient with kidney disease. Carrying the pregnancy caused significant dysfunction to the woman’s kidneys, for which she required dialysis. Carroll had a long conversation about her options to continue the pregnancy or terminate. The patient chose to continue the pregnancy, but Carroll said she’s unsure if the same situation presented next week would be considered life-threatening enough to meet the law’s exception.

‘Particular wording’

Carroll spends most of her time screening for and diagnosing fetal anomalies in pregnancies, and the law allows abortions up to 24 weeks in cases where a “life-limiting” anomaly is found. 

Medical professionals have voiced concern over the phrase “life-limiting” anomaly, calling it broad and open to interpretation. 

“What is life-limiting?” Carroll asked. “Does that mean that the fetus isn't expected to live a month after birth? Isn't expected to live a year after birth? Isn't expected to live to the age of 10?”

Rachel Veazey, a reproductive genetic counselor in the Triangle, agrees that “life-limiting” is ambiguous. 

“It’s ​​really particular wording that, I think, is going to throw our field for a loop,” Veazey said.

Veazey explained that very few conditions are considered definitively lethal — or always causing a newborn baby to die. Many fetal anomalies are a spectrum that often catch expecting parents by surprise. Often, she said, they result in a child with such profound disabilities that their quality of life is severely diminished. 

“With a lot of families, we end up having conversations about quality of life versus life-limiting,” Veazey said. “There's a lot of anomalies or genetic conditions that very much alter the picture of what families imagine when they enter into a pregnancy that is not compatible with their life, and they would view it as life-limiting. But we know that's not what the rough definition of what the law is going for.”

‘Counseling conundrum’

In some ways, though, Carroll said not having a definitive list of conditions is helpful because individual physicians and health care institutions can determine what they are comfortable deeming life-limiting based on the context of each individual case.

Operating in this gray area is also problematic, she said. 

“It is good to allow for physician judgment, but the problem is that physician judgment is now open to criminalization,” Carroll said. “If there are other physicians who disagree, or who say that it's not life-limiting, or it's not life-limiting in all cases, or wasn't life-limiting in that particular case — then I may be criminalized for that individual judgment. 

“That is not something that is normal or appropriate or fair in the practice of medicine, and it may lead physicians to be counseling patients based not on the patient's best interest or the fetus’ best interest.”

Veazey said the patients she counsels with identified fetal anomalies regularly choose to terminate the pregnancy. While she expects a good portion of fetal anomalies to be detected by 24 weeks, it will not encompass all conditions, nor necessarily account for those who are delayed starting prenatal care or who face delays due to the state’s new abortion restrictions. That’s why she believes her job may become more focused on grief counseling in the months ahead as she sees more patients who may be carrying pregnancies to term who would have — in a different legal landscape — opted for abortion.

“A lot of the conversations we have with families that are continuing with pregnancy are helping them understand what the health care management looks like for that child or individual with a birth defect or genetic condition,” Veazey said. “Imagining doing that with or for someone who wouldn't have on their own volition decided to continue a pregnancy is a different kind of counseling.”

Although medical professionals see potential ambiguity with other conditions, the law does make one thing clear in regard to fetal anomalies: New language bans abortions at any gestational age due to the identification of the fetal abnormality of trisomy 21, known as Down syndrome — one of the most common genetic differences in a human embryo.

“It's going to create a very strange counseling conundrum for high-risk OB doctors, for all general providers, anybody who provides prenatal care,” Carroll said.

Loss of options

Tomorrow North Carolina will join the ranks of about 20 other states across the country that have banned or increasingly restricted abortion access since Dobbs. Before this legal change, the state served as one of the last remaining abortion access points in the South.

In states with new restrictions, there were fewer abortions, while the numbers show that many women traveled to other states for procedures. In sum, though, the Society for Family Planning has collected data on abortions across the country and found that in the first nine months after the Supreme Court overturned Roe, there were a cumulative 25,640 fewer abortions in the U.S.  

“We know that bans or restrictions on abortion care don't stop abortions from happening,” Rivera from Planned Parenthood South Atlantic said. “They just make it harder for people to do it, which inevitably pushes them further into their pregnancy. 

“So even a patient who has decided long ago that not only did they realize they were pregnant but they decided they didn't want to be, they are not able to get an abortion right away. They first have to figure out whether or not they can get it in their home state. And if they learn that they cannot, they have to figure out where to get it next. And that's complicated.” 

Gray wishes that lawmakers would trust women to make their own reproductive health decisions.

“Patients are really the experts of their lives, and they know what they're able to handle and not able to handle,” Gray said. “I think they make really thoughtful decisions, and this law makes it harder for them to be thoughtful. It makes it harder for us to provide evidence-based care and just creates chaos for an already busy and taxed medical system. It doesn't improve care.”

The post NC’s new abortion restrictions take effect tomorrow. Here’s what to expect. appeared first on North Carolina Health News.

The new requirement, considered part of a larger trend of voter suppression efforts in North Carolina, has drawn criticism from civil rights groups, experts, and nonprofit voting organizations in the state, as it is believed to make it more difficult for minority voters to cast their votes.

New voter ID rule in North Carolina sparks worries about fairness for Black and Latino voters is a story from Carolina Public Press, an award-winning independent newsroom. Our breakthrough journalism shines a light on the critical overlooked and under-reported issues facing North Carolina’s 10.4 million residents. Please consider making a contribution to support our journalism.

By Will Atwater

In early May, it’s possible to find fields of wheat and lavender-colored straw flowers bordering two-lane roads that wind through Gaston County. This part of Cherryville Township lies roughly 35 miles northwest of Charlotte and about 82 miles southwest of Black Mountain. 

The picturesque rural scene embodies the tagline attached to the logo on nearby Lincolnton’s website: “Near the City. Near the mountains. Near Perfect.”

Continue driving, and one quickly discovers white signs lining county roads revealing what many locals see as a threat to the pastoral lifestyle that drew them here. The message in bold, black letters reads: “Gaston County Pit Mine,” enclosed in a red circle with a line drawn through the middle.

Hugh and Libby Carpenter, both in their 80s, live on 5 acres between South Fork and Beaver Dam creeks in Cherryville Township near Lincolnton. It’s been nearly 51 years since the couple moved to the land, where they raised two daughters. 

Hugh Carpenter said the property, which has been in his family since the early 1900s, was once part of a 50-acre farm that produced wheat, oats, corn and other vegetables.

The Carpenters’ property is about 2,000 feet from one of the sites of a proposed mine to extract lithium, a vital element necessary to create everything from batteries that power cell phones to those that power motor vehicles.  

They’re determined not to let the lithium mining conversation upset their lives. 

“God’s going to take care of us. If we move, we move. We don’t want it to happen, but we don’t always get our way,” said Libby Carpenter.

Many questions remain, including whether the N.C. Mining Commission will approve Piedmont Lithium’s application.

David Miller, the state’s mining specialist, sent Piedmont Lithium a 4-page letter on May 30 outlining things that need addressing in the company’s permit application. The company has 180 days to address the issues. If Piedmont Lithium receives a mining permit from the state, the final hurdle will be securing a permit from Gaston County. 

Modern-day gold rush?

The Tin-Spodumene belt is a lithium-rich mineral deposit in western North Carolina that runs southwest to northeast, into Gaston County through farm country. The deposit could play a significant role in the Biden administration’s energy plan, which races to curb CO2 emissions. That includes establishing domestic sources of lithium to support the nation’s expanding electric car fleet. 

Specifically, the Biden administration has set a goal to have 50 percent of car sales to be electric by 2030. To accomplish that goal, the U.S. needs the lithium batteries that power electric cars.

In 2022, the administration pledged $675 million to beef up the nation’s domestic Critical Materials Research Program, according to a release by the Office of Energy Efficiency and Renewable Energy.

“We can follow through on President Biden’s clean energy commitments and make our nation more secure by increasing our ability to source, process, and manufacture critical materials right here at home,” U.S. Energy Secretary Jennifer Granholm said in a partial statement.

After a glance around the streets and parking lots of Cherryville Township, one may get the impression that the EV car craze has yet to catch on in the area. NC Health News saw a single Tesla parked nearby when the council voted to grant Piedmont Lithium’s relinquishment request.

Yet, nations and large multinational corporations are scouring the globe for minerals needed to fuel the emerging green economy. One unanswered question is whether rural communities such as Gaston County will help shoulder the nation’s green energy goals without damaging its natural environment or quality of life.  

All in the name of progress.

Emerging partnership

In April, North Carolina Health News reported on Piedmont Lithium’s efforts to establish a mining operation in Gaston County. At that time, Cherryville’s council members elected to postpone a vote on the mining company’s extraterritorial jurisdictional relinquishment request. 

A month later, on May 8, the council voted unanimously to grant the request. Now, the 15 parcels at the center of the request are under the county’s jurisdiction, and Cherryville no longer has any right to regulate what happens on the land. And any taxes from the land will flow to the county, not Cherryville.

Nonetheless, Cherryville will provide water infrastructure, such as water lines and municipal water service, to the mining operation for 20 years. In exchange, Piedmont Lithium proposed to contribute $1 million toward establishing a parks and recreation office and to support “specifically identified parks and recreation projects,” according to the agreement.

In the latest chapter of Piedmont Lithium’s quest to establish a mining operation in Gaston County, Cherryville’s City Council accepted this Community Development Agreement presented by Piedmont Lithium at the May 30 council work session.

After securing the first load of lithium hydroxide from the mining operation, Piedmont Lithium agrees to contribute $500,000 annually to the city of Cherryville for 20 years for a total of $10 million.

Agreement fuels distrust

Despite vocal opposition to establishing an open-pit lithium mine in Gaston County, the Cherryville council has twice cleared hurdles, which helped advance Piedmont Lithium closer to its goal and has increased distrust among locals who opposed the mine.

And in the way of small towns, where everyone knows everyone, people talk. 

Once he reviewed the agreement, Gaston County resident and business owner Brian Harper, in response to the financial details, echoed what many in the area have been saying about the relationship between Piedmont Lithium and the Cherryville City Council.

“You can tell it’s a tit-for-tat thing,” Harper said. “Now we know why they were all in favor [of the ETJ request], threw their hands up, and it passed.”

His suspicions were fueled by the fact that the May 30 meeting where the council accepted Piedmont Lithium’s community agreement was open to the public, but didn’t allow for public comment. 

Harper owns Stine Gear and Machine Co. near Bessemer City, a few miles from the Carpenter’s home. In May, Harper invited NC Health News to his shop to see how the operation works. 

Because his business relies on precise, computer-guided movements by machines to produce made-to-order gears and other products, Harper doesn’t believe it could successfully coexist with a nearby mining operation that uses controlled explosions as part of the open-pit mining process.

“These pretty shiny parts you see here, the tolerance on this bore is to the tenth of a thousandth. That’s one inch divided into 10,000 parts,” he said. “That’s how close those bores have to be. So if you’ve got a machine that’s turning this part, and it jumps, there’s no way to hold those bores. The machines are not meant to run in unstable environments,” Harper said.

Harper has spoken with Piedmont Lithium about his concerns. He said communication stopped once the two parties reached an impasse regarding selecting an independent party to conduct an impact study. 

Another primary concern is a potential drop in the water table in a county where most residents rely on wells for their drinking water. Increased traffic and poor air quality also rank high on the list.

Safety and quality-of-life concerns

During Cherryville’s May 8 City Council meeting,more than 70 people packed the town’s community building to witness the council’s unanimous vote to grant Piedmont Lithium’s Extra Territorial Jurisdiction – or ETJ – request. 

Tension filled the room as stakeholders stepped to the podium and urged the council to vote against the request during the public comment period. 

All eyes were on Dennis Bean, pastor of Oak Grove Missionary Baptist Church, which is across the road from the five parcels owned by Piedmont Lithium listed in the relinquishment request. Bean made several points, including reminding the council of the role of zoning.

“We came up with the idea of zoning to protect our property from something being built next to us that would destroy either our quality of living or would destroy the value of our property,” Bean said. 

Bean has been a vocal critic of Piedmont Lithium’s efforts and is concerned that the mining company’s production process will jeopardize the safety of children who attend the church’s on-site childcare program. Before he sat down, Bean urged the council to support the church and deny the relinquishment request.

“I plead with you on behalf of 1,500 members at Anthony Grove Baptist Church that you protect our property, our school that has children in it,” Bean said.

“We have a preschool and a daycare with over 100 children. Would you release the ETJ for them to build a chemical plant across from Cherryville Elementary School? If you wouldn’t, why would you do it at our school?”

The relinquishment gives sole governing authority of the five land parcels (156 acres) to Gaston County instead of splitting it between the county and Cherryville. After the vote, Bean and others gathered in the parking lot and voiced displeasure about the council’s decision.

“From a public hearing standpoint, nobody was in favor of [the ETJ relinquishment],” said Bean. “Nobody.”

Looking for a new way to mine 

In an emailed response to the criticism, Erin Sanders, Piedmont Lithium’s senior vice president of? corporate communications and investor relations, said the community development agreement was in response to a request by the city of Cherryville and its residents to demonstrate how the project would “directly benefit the Cherryville community.” 

“These agreements are becoming more common in industrial projects,” Sanders said. “We will be required to create a development agreement with Gaston County as part of the greater rezoning process; we felt it was only fair to create a separate development agreement that would directly benefit Cherryville.” 

Miller, the state’s mining specialist, said that while community mining agreements don’t always happen, he agrees that they are not uncommon.

In a 2022 report by the Nature Conservancy and the University of California, Los Angeles, researchers looked at the different types of mining extraction procedures and explored the potential environmental impacts of each. One of the takeaways is that communities and organizations should employ a mining method that is the least impactful to the environment, and that the location is a key determinant.

Open-pit mining in Gaston County will require disturbing the environment to build a conveyor system to haul lithium deposits from the extraction site, among other infrastructure needs.

But some industry insiders, including representatives from Piedmont Lithium, argue that procedures and technology have improved to the point that, when done correctly, modern mining is less intrusive than the process used to be.

Well water equals liberty

 Gaston County residents are more suspicious. Mining companies’ track records for environmental stewardship have not been positive in the past, so for many locals, the company’s promises ring hollow.

Piedmont Lithium says the company will use the most up-to-date technology in the mining process, demonstrating its commitment to being good stewards of the land and good neighbors. They also say no significant vibrations from explosive charges will occur during mineral extraction. 

Miller, the state mining specialist, said that no matter the improvements in mining technology and closer public scrutiny, there’s no convincing some who live near proposed mining sites. 

“[NCHN] is at the point in the process where you’re going to watch people throw anything and everything, and hope something sticks.”

But people feel like they have good reason to be incredulous. Will Baldwin, Hugh and Libby Carpenter’s grandson, remembers hearing stories growing up about a local mining operation that was in production when his mother and his aunt were children. His grandparents also commented on how at certain times, on a given day, they could feel the vibrations from an explosive charge used in the mining process. 

A large percentage of Gaston County residents rely on well water for drinking. And although Piedmont says it is prepared to assist homeowners in connecting to the county water supply if needed, the possibility that the water table may diminish due to the mining process is a non-starter for many who opposed the mine, including Baldwin and his grandparents.

The Carpenters have two wells on their property. One is a shallow well, which they use for drinking and cooking, the other is a deeper well that has a high concentration of iron that will stain the laundry and other surfaces, so they only use it for non-cooking purposes, unless required.

Beyond supplying people with needed drinking water, wells also seem to represent a sense of independence, a major theme in the lives of rural folks. Several have said they don’t want to trade their well water for a municipal water line and monthly water bill.

Baldwin said the area cattle, dairy and apple producers, specifically, prefer untreated well water for their production needs. 

“[These farmers] require a particular type of water pressure and water quality,” he said.  “[Because] of the water requirement, it’s not feasible that people are going to be OK  [switching to municipal water] in the long run.” 

The article is the second of two about Piedmont Lithium’s proposed mining operation in Gaston County, NC, that received funding from Kozik Environmental Justice Reporting Grants, funded by the National Press Foundation and the National Press Club Journalism Institute.

The post Lithium mining debate: Can Gaston County embrace green energy without sacrificing rural life? appeared first on North Carolina Health News.

By Rachel Crumpler

After graduating from a medical school in the Northeast, Caledonia Buckheit came south to Duke University Hospital to complete her obstetrics and gynecology residency. She finished up last June and found work in North Carolina — ready to provide comprehensive reproductive health care to patients, including abortion.

Just weeks after finishing, the Supreme Court overturned Roe v. Wade. The June 24 decision in Dobbs v. Jackson Women’s Health Organization eliminated the constitutional right to abortion that had existed for nearly half a century.

“Controlling women’s bodies has always been a topic but I didn’t really think it would get to this,” Buckheit said.

Suddenly, working in reproductive health care got a lot more complicated. 

The Dobbs decision handed the authority to regulate abortion back to states and their elected officials, ushering in a seismic change in access to the procedure nationwide. Lawmakers in dozens of states — including North Carolina — pursued greater restrictions.

On top of the challenges that come with entering a new profession, Buckheit — like everyone else working in reproductive health care — has spent the past year navigating a shifting legal landscape and all the questions and unknowns that come with continuing to provide care.

It’s a dynamic that will continue to be part of the job for the foreseeable future as North Carolina’s new restrictions limiting most abortions after 12 weeks take effect July 1 and access to the abortion pill mifepristone is being contested in court.

“It’s just been really disheartening, feeling like my patients have less autonomy,” said Buckheit, a general OB-GYN working at a private practice in the Triangle.

Adjusting practice

Even for those who have been practicing for years, like OB-GYN Amy Bryant, it’s unquestionable that the past year has been the most challenging and exhausting time to be in the reproductive health care field.

Since the fall of Roe, the legal landscape has been continuously shifting. Abortion providers across the nation and in North Carolina have had to adjust their practices to stay within the bounds of the law.

“When I think back to the early days after the Dobbs decision after Roe v. Wade was overturned, I just really think about the chaos and the uncertainty and the difficulties that we confronted, like, almost instantaneously with this new law of the land,” Bryant said. “It was truly just kind of scary.” 

Beverly Gray, another long-time OB-GYN who works with many high-risk and complicated pregnancies, said she was startled by how quickly some neighboring states took action to cut access to abortion. For months, North Carolina — and its 14 abortion clinics located in nine counties — became a critical abortion access point in the Southeast, providing care to an increased number of out-of-state patients.

In August, North Carolina physicians had to adjust their practices for the first time following the Dobbs decision when a federal judge reinstated North Carolina’s 20-week abortion ban, citing the disappearance of constitutional protections on the procedure. The ruling cut the window of time pregnant people had for seeking abortions in the state from fetal viability, which typically falls between 24 and 26 weeks of pregnancy. 

The loss of those weeks was palpable for abortion providers like Gray who had to turn patients beyond 20 weeks away — patients she could previously care for. In her practice, she said those patients mainly consisted of people who received a diagnosis of severe birth defects. 

Then it was a waiting game. Republican state lawmakers expressed their intentions to pursue greater restrictions on abortion shortly after Roe was overturned, but no one knew the speed at which they would move or what if any restrictions would entail. 

The uncertainty spanned many months.

“We didn’t know when the law might change and how we were going to respond if somebody was already scheduled and ready to go and they’d come from eight hours away,” Bryant said. “We didn’t know if we would still be able to care for them or not. That was just not a good way to practice medicine.” 

Ultimately, North Carolina lawmakers brushed aside medical providers’ pleas against adding more restrictions this past May. They passed a ban on the procedure after 12 weeks with exceptions for rape, incest, fetal problems and risk to the mother in May, and overrode a subsequent veto from Gov. Roy Cooper.

Next month, once again, a change in law will necessitate people who work in reproductive health care to alter their practices to conform to new constraints on their work.

Even a month after Senate Bill 20 was passed and the veto overridden, there are still more changes, as just this past week, the state Senate added an amendment to a separate bill that clarifies some of the timing of restrictions.

Gray said it’s not normal for physicians to have to significantly rethink how they practice, especially so many times over the span of one year. She emphasized that practice changes are being dictated by an arbitrary change in law, not as a result of improved medical guidelines.

“It’s completely disruptive to our practice, to our lives, to our day-to-day,” Gray said.

‘Exhausting on so many levels’

In addition to Gray maintaining a busy schedule providing patient care, the year has been full of trips to the legislature to voice opposition to increased abortion restrictions, conversations with lawyers to understand new rules, internal meetings to adjust practices to be legally compliant and media interviews explaining what changes mean to the public.

She’s even filed a federal lawsuit along with Planned Parenthood South Atlantic challenging several provisions of the new state law banning most abortions after 12 weeks, arguing they are unclear or unconstitutional.

It’s a heavy load to carry — added stresses and tasks that Gray said most other physicians don’t have to experience.

“It’s really just exhausting on so many levels because I’m doing all that and at the same time still providing care, still doing all the other work that’s required as a physician and now it’s just all these extra layers,” Gray said. 

When Gray decided to go to medical school, she never thought her role as an OB-GYN would involve so much advocacy and parsing new laws, but that’s what it’s turned into in the post-Dobbs period.  

Bryant agrees that the role has changed significantly over the past year.

“I have spent so much time poring over the legal issues related to my work,” she said. “It is not what I would like to be doing. 

“I think that pregnancy is just far too complicated to be legislated. And when nonmedical professionals start to try to legislate it, it becomes even more complicated to really understand the nuance — to be able to address the nuances in the individual situations that arise when a person becomes pregnant. This is not in any way what I expected my life to become.” 

Buckheit, the new OB-GYN, didn’t expect lawmakers would be dictating how she can do her job, either. And she believes they may have written the law differently if they interacted with pregnant patients on a daily basis.

“I truly feel that if lawmakers spent a week at Planned Parenthood or spent a week in a high-risk OB-GYN office, they would have a really different take,” Buckheit said. “There’s so much complexity and nuance to what we see and what patients and families are going through.”

For example, she’s had to read the state-mandated counseling script 72 hours before an abortion to patients whose babies have serious fetal anomalies.

“It’s like, adoption is an option, parenting is an option,” Buckheit said. “I’m saying this to someone whose baby doesn’t have a brain. It’s just so cruel.” 

The work, particularly in an environment of tightening restrictions, also takes an emotional toll.

“Living in this world now where basic health protections are no longer in place is very difficult,” Bryant said. “Obviously, for patients and also for providers who experience a whole lot of moral distress, knowing that you can care for someone yet not be able to because lawyers, legislators, the courts are telling you that you can’t. It’s a really uncomfortable and distressing place to be.”

Gray and Bryant can’t help but think about the patients they’ve cared for recently and consider whether the same options will be available after July 1.

It’s a devastating reality, Gray said, to know she still has the same skills to help patients in an array of situations but her hands will soon be tied by new rules where she will have to turn some people away she could previously care for.

“I think every single patient that we’re able to care for is meaningful and important, and we’re able to help change the trajectory of people’s lives,” Gray said. “I worry about all of those people that didn’t make the exceptions [to the new rules], but still have really important things that are happening in their lives and the lack of compassion for the people that didn’t make these arbitrary exceptions. It’s heartbreaking.”

Despite the more burdensome and taxing legal landscape, those providing reproductive health care remain committed to providing as much access as possible. The patients are the motivation.

“I feel this immense responsibility to get it right and to still be able to provide care for people,” Gray said. “There’s a huge stress and responsibility.”

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