North Dakota this year adopted one of the strictest abortion bans in the country, with narrow exceptions for rape and incest victims in the first six weeks of pregnancy and to save the life of the mother.

Although abortions-rights advocates haven’t given up the fight, abortion opponents are moving ahead with the restrictions and placing a heavier emphasis on supporting new mothers through legislation and services, such as maternity homes for pregnant women and teens.

One of those teens is Molly Richards, who was just 13 years old when she learned she was pregnant.

She remembers feeling both “excited and oblivious” when she got the results at a clinic on the Pine Ridge Reservation in South Dakota, where she grew up. The community is home to the Oglala Sioux Tribe, of which Richards, now 17, is a citizen.

“It was a very happy time for me,” she recalled.

Then the reality of carrying and raising a child began to sink in. But Richards didn’t view abortion as an option.

“Abortion was not on my mind. That was a big no-no for me.”

Seeking resources, Richards and her family connected with Mary Pat Jahner, director of Saint Gianna & Pietro Molla Maternity Home in the small, unincorporated community of Warsaw.

The picturesque brick home – four stories tall and trimmed with ornate gold crosses – is an institution within the North Dakota anti-abortion movement.

Originally a convent for nuns and a boarding school, the home now serves young pregnant women – most from nearby Native American reservations. In addition to food and shelter, the facility provides counseling services, help completing high school, clothing, job training and parenting classes to mothers.

The facility houses two to four residents at a time. Richards was four months into her pregnancy when she arrived at the home.

“Our main purpose is just to provide a choice for moms who …might need a place to stay or might need a family,” Jahner said. “Most of the moms don’t have a safe place to be, they might be living couch to couch. They’re not living on the street per se, but they might not have their own place to call home.”

With abortions essentially unavailable in the state, where religion is deeply ingrained and diverse, efforts to support mothers and their children have taken on new prominence.

After the U.S. Supreme Court overturned Roe v. Wade in 2022 and returned abortion decisions to the states, researchers predicted the number of births would increase, as would the need to support pregnant people, young mothers and their children.

An analysis by the Johns Hopkins Bloomberg School of Public Health estimates that nearly 9,800 additional live births occurred in Texas from April 2022 through December 2022 after a six-week abortion ban took effect in that state in fall 2021.

The federal Congressional Budget Office has said it anticipates an increase in births because of the end of Roe but that contraceptive use and other abortion methods, such as medication abortion, will largely offset that increase.

Kathy Hirsh-Pasek, a psychology professor at Temple University and senior fellow at the Brookings Institution, doesn’t think the United States is prepared for an influx of births – and that policies nationwide aren’t doing enough.

“We are right now not a family friendly country. We may be pro-life, but we’re not pro-family. And if you’re going to make decisions that put more babies into the market, we need to support those babies,” she said. “I don’t care if you’re pro-Roe or anti-Roe, support children. They’re your future.”

Supporting pregnant people through legislation

State Sen. Sean Cleary, R-Bismarck, has been at the forefront of pushing for additional help for mothers and babies amid North Dakota’s abortion ban.

“There was an understanding that women are navigating a very difficult time in their lives, that the state could be doing more to support them and empower them,” Cleary said. “We wanted to be a state that was known for supporting families and supporting mothers.”

Gov. Doug Burgum, a Republican, signed bills this year to eliminate taxes on diapers; expand Medicaid and Temporary Assistance for Needy Families benefits for pregnant individuals; and provide additional funding to the state’s “alternatives-to-abortion” program, which gives funds to child-placement agencies, anti-abortion counseling centers and maternity homes – including Gianna & Pietro.

Cleary co-sponsored the diaper tax and Medicaid bills, as well as failed efforts to create a paid family leave program, a tax credit for child care expenses and a program to increase pay for child care workers.

The 31-year-old said being a father helped him see the need for this type of legislation. He has a toddler and another child on the way.

“Families can’t afford to send their kids to child care, and the workers can’t afford to work there,” he said.

Abortion-rights activists doubt the effectiveness of the few measures that made it through the Legislature.

“None of them are actually adequate to address fully supporting a pregnant person bringing a child into the world and raising a child to adulthood,” said Cody Schuler, advocacy manager for the American Civil Liberties Union of North Dakota.

“If you’re going to have a near-total ban on abortion and you’re going to force people to carry pregnancy to term, you have to do more than give a tax break for diapers.”

Katie Christensen, North Dakota state director for Planned Parenthood, emphasized the problematic funding of the alternatives-to-abortion program.

Christensen has criticized the program for providing $1 million in state funds to mostly religious ministries with little to no government oversight. State funding for so-called “crisis pregnancy centers,” which aim to dissuade people from getting abortions, is especially concerning to abortion-rights advocates.

There are at least seven such centers in the state, according to the Crisis Pregnancy Center Map, which provides nationwide tracking of these facilities and is maintained by University of Georgia professors.

“We’re putting thousands of public dollars into programming that aims to seek out people who want abortions and try to persuade them away from that,” Christensen said. “They’re still allowed to promote their religion while using these dollars.”

Despite this criticism, Sen. Tim Mathern, D-Fargo, one of only four Democrats in the 47-member state Senate, co-sponsored the alternatives-to-abortion funding bill, claiming that it “sort of became a litmus test between pro-choice and pro-life people.”

Although he supports abortion access, Mathern backed the bill in an attempt to change the tide of Democrats in North Dakota being seen as “the anti-religion and anti-God people and the people who kill babies.”

However, if concerns over these “crisis pregnancy centers” are legitimate, Mathern said, their practices should be evaluated and “the state’s attorney should be investigating.”

‘Small government’ approach to helping mothers

North Dakota’s Legislature meets for 80 days during odd-numbered years only. Legislators, who don’t have staff, work at their desks on the floor of the Senate or House. This model can mean less government funding for programs, something Republican state Sen. Janne Myrdal supports.

Myrdal represents far northeastern North Dakota, where the Gianna & Pietro home is located. She sponsored the state’s strict new abortion ban and co-sponsored the bill that beefed up funding to the state’s alternatives-to-abortion program. She warns that such funding comes with some strings attached.

“If you ask for that much support, then the government’s going to come on top of it and go, ‘We’re going to regulate you,’” Myrdal said. “You can’t pray for people, you can’t hug people, you can’t share Jesus with people who come in, because the government can’t do that.”

Gianna & Pietro, which is a nonprofit organization, receives the majority of its funding – about $500,000 to $600,000 each year – from individual donors, but it also has received funds from the state’s alternatives-to-abortion program.

In this year’s bill, about $100,000 was earmarked for the home; Jahner said the money will go toward updating vehicles and other needs.

In the nearly two decades of the home’s operation, more than 300 people have lived there, and over 100 children have been born as part of the program.

During a recent visit, three women who were either pregnant or young mothers, including Richards, lived at the home. Staff members stay on site, too, to provide support and help.

Jahner, her daughter, whom she adopted from a former resident, and several other children of former residents live on the property, as well, in a two-story home behind Gianna & Pietro.

Richards’ initial stay in 2019 only lasted a month. Feeling homesick, she returned to South Dakota to give birth. But after struggling to parent on her own and dropping out of school, Richards returned to Gianna & Pietro over a year and a half ago, with her son, Bernard, in tow.

Richards is now in the process of having her son adopted by a family in southern Minnesota, because, she said, “I wanted something more and better for my son.”

There is a clear religious aspect to Gianna & Pietro. Residents must attend Sunday Mass, take part in nightly prayer and participate in grace before meals. A stained glass chapel is located on the first floor of the home, and delicate religious paintings are scattered throughout. Across the street sits a steepled red brick church where residents may also attend Mass.

Although residents are not required to be Catholic or religious to live at the home, a question about religious preference is included on the admission application form and participation in religious activities is required.

“I didn’t become religious until I actually came here, so my family isn’t religious,” Richards said. “I was baptized (Catholic) a year and a half ago.”

Schuler, of the ACLU, and other abortion-rights advocates worry such religious requirements could lead to “coercing individuals into religion” with the help of government funding.

“When it comes to a maternity home, it’s being operated as a religious ministry. I don’t think state dollars should be paying for that,” Schuler said. “But at the same time, I know that there are individuals who are religious who might be looking for what that center might provide.”

Expansion of reproductive care in Minnesota

With limited capacity in homes like Gianna & Pietro, abortion care across the Red River in neighboring Minnesota remains essential, abortion-rights advocates say.

“The amount of pregnant people who are having their abortions today across the river would fill up those homes fivefold today – unless they’re going to open up huge apartment complexes to house all of these pregnant people,” said Destini Spaeth, board chair of the North Dakota Women in Need Abortion Access Fund.

Abortion is legal in Minnesota up to fetal viability, which is 24 to 26 weeks, and exceptions are granted to save the life or protect the health of the mother. Surrounded by states that have completely banned abortion or are in court fighting to prevent access, Minnesota has become a key state for abortion access in the Upper Midwest.

For nearly 25 years, Red River Women’s Clinic operated in Fargo and was the only abortion clinic in the state for two decades. Every Wednesday, when the clinic was open, protesters gathered with graphic signs outside the front door.

Then last year, after word of the Supreme Court’s likely end to Roe was leaked, its operators began looking for a new location. Last August, they reopened less than 3 miles away – across the river in Moorhead, Minnesota.

Each Wednesday, the clinic provides 25 to 30 abortions up to the 16-week mark of pregnancy. After that time, patients are referred elsewhere for a multiday procedure that the independent clinic lacks capacity for.

Since the move, the clinic has seen its patient load increase 10% to 15%, said Tammi Kromenaker, the facility’s director. And with fewer overall restrictions on abortion care in Minnesota, Kromenaker said she believes access has actually increased for women in North Dakota.

But the fear her patients feel has also gone up, she said.

“Every week, mostly patients from North Dakota will say: ‘Is it even legal for me to come here? Will I get legally prosecuted for this health care?’

Kromenaker continues to fight for abortion rights back across the river in North Dakota. Her clinic is one of the plaintiffs in a lawsuit over the state’s near-total abortion ban.

“We didn’t want to give up on North Dakota. We didn’t want to leave,” she said. “But our hand was forced.”

News21 reporters Trilce Estrada Olvera and Cassidey Kavathas contributed to this story. 

This report is part of “America After Roe,” an examination of the impact of the reversal of Roe v. Wade on health care, culture, policy and people, produced by Carnegie-Knight News21. For more stories, visit https://americaafterroe.news21.com/.

The post Post-Roe, North Dakota puts resources into alternatives to abortion appeared first on Buffalo’s Fire.

Defying the predictions of abortion advocates, providers and state lawmakers, the number of out-of-state patients who traveled to Vermont to obtain abortions did not increase, but in fact dropped, in the year after the U.S. Supreme Court overturned Roe v. Wade case precedent, according to preliminary data from the state Department of Health.

When the court’s conservative majority issued its Dobbs v. Jackson Women’s Health Organization decision last June, the country became a patchwork of disparate reproductive health laws. In states with so-called trigger laws, abortion was severely restricted or outright banned once the decision was issued. Other state legislatures, emboldened by the court ruling, worked quickly to impose new restrictions on the procedure in their respective states.

Vermont lawmakers had seen a post-Roe future coming, and proactively worked to expand access to abortion within Vermont’s boundaries — not only with Vermonters in mind, but also for out-of-state patients who they foresaw traveling from their respective states to obtain the procedure.

Experts never expected a tsunami of out-of-state patients, largely because Vermont is a remote, rural state that can be difficult or cost-prohibitive to travel to from far distances. When the high court issued its Dobbs decision, Planned Parenthood of Northern New England predicted a modest 10% increase in out-of-state patients.

But according to preliminary data that VTDigger requested from the Vermont Department of Health, even that didn’t come to pass. As of this week, the department reports that from June 24, 2022 — the day of the Dobbs decision — through early June 2023, a total of 925 abortions were completed in Vermont. Of those, 154 were performed on non-Vermont residents — roughly 17%. (Due to reporting lag time, the department was unable to provide data from the latter portion of June 2023.)

By comparison, in all of 2021, 215 out-of-state patients obtained abortions in Vermont, representing nearly 21% of the 1,033 abortions completed in the state that year.

Since 2018, the proportion of out-of-state patients who obtain abortions in Vermont has remained relatively stable, hovering between 17 and 22% every year. But mirroring national trends, the total number of abortion patients in the state — both those who hail from Vermont and those who don’t — has trended downward.

In the year since Roe fell, a handful of patients traveled to Vermont from far-flung states where an abortion is difficult to obtain: Alabama, Louisiana, Tennessee and Texas, to name a few. But most out-of-state patients traveled from nearby states, where access to abortion is, in theory, about on par with Vermont: Connecticut, Maine, Massachusetts, New Hampshire, New York and Rhode Island. More than half of all out-of-state patients came from New Hampshire, mirroring past years’ trends.

Vermont’s clinics had anticipated such a trend, according to Lucy Leriche, vice president of Vermont public affairs for Planned Parenthood of Northern New England. “There are a lot of reasons why people from out-of-state are getting an abortion in our region,” she said, speaking of Vermont as well as New Hampshire and Maine.

Sometimes northern New England is where the patient has a family member or support system to assist in the process, Leriche said. Perhaps they are fleeing a domestic violence situation. They could be attending college here, but a legal resident elsewhere. Maybe they just want more privacy. Or perhaps, if they hail from a nearby state that has more patients, such as New York or Massachusetts, they couldn’t get an appointment at home. A domino effect in appointment availability can ensue, Leriche said.

Planned Parenthood — the largest provider of abortions in Vermont, and nationwide — declined to provide state-specific data on its own out-of-state patients, citing concerns over patient privacy and safety. But in Maine, New Hampshire and Vermont combined, the organization earlier this month reported a 12.5% increase in out-of-state patients “seeking abortion at our health centers,” according to a June press release.

Beyond patient data, Leriche said the impact of the Dobbs decision was palpable in other ways. Planned Parenthood of Northern New England’s call center was “inundated” immediately after the ruling was made, she said. Online, the organization’s website had its largest one-day spike in web traffic on June 24, 2022, the day of the court’s ruling. “That is, I think, a really strong indicator of the response,” Leriche said.

The Dobbs decision “is very destabilizing and very anxiety-producing, and causes a lot of confusion and anxiety and fear and panic,” Leriche said.

Leriche said the organization is trying to keep its messaging on target, emphasizing that abortion remains legal in Vermont. This legislative session, state lawmakers passed landmark shield laws protecting Vermont-based abortion providers — and to some extent, patients who travel to the state — from out-of-state abortion prosecutions or investigations.

Read the story on VTDigger here: In the year after Roe fell, out-of-state abortion patients did not flock to Vermont.

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.”

The post After the fall of Roe, physicians confronted their toughest year working in reproductive health care appeared first on North Carolina Health News.