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Patients struggle to navigate abortion with changing laws and provider confusion


The rules around abortion have shifted dramatically from state to state. That makes it hard for patients to navigate what's legal and where. Consider these numbers - 43 states ban abortion at some point. Two states ban it at six weeks, another two states at 12 weeks, four states at 22 weeks. Adding to the confusion, a newly published study in the Annals of Internal Medicine finds it's even difficult to know which hospitals offer this kind of reproductive care. Katia Riddle reports.

KATIA RIDDLE, BYLINE: The state of Oregon now has some of the strongest protections for reproductive rights in the country. People seeking an abortion come here from all over. Dr. Alyssa Colwill is an obstetrician at Oregon Health & Science University. She describes one woman who recently traveled to her clinic from a state with a near-total ban.

ALYSSA COLWILL: We had a long conversation because we were just talking about how difficult it was for her to figure out the logistics in order to get to Oregon to be able to get the abortion that she needed.

RIDDLE: The woman had multiple children at home. The pregnancy was threatening her health. Colwill says it's not just logistical challenges like travel and child care. Many of her patients struggle with an even more basic question.

COLWILL: We have patients that tell us that they've been trying to figure out where they can go for sometimes multiple weeks at a time.

RIDDLE: That's why Colwill and her colleagues make it very clear on the hospital's website that they do offer abortion.

COLWILL: I think we're pretty proud of it. And we've spent a lot of time just updating it so that people are aware.

RIDDLE: She pulls up the site and reads aloud.

COLWILL: The OHSU Center for Women's Health provides abortions in a specialized clinic. We do not require a waiting period to begin care.

RIDDLE: Not all hospitals take this approach, according to Aaron Schwartz, a doctor and researcher from University of Pennsylvania. He reads from a Florida hospital's website listing the many reproductive services they offer.

AARON SCHWARTZ: The Women's Hospital at Jackson Memorial features brand-new labor and delivery unit with wireless fetal monitoring.

RIDDLE: The list includes a half-dozen procedures related to pregnancy and childbirth. There is no mention of abortion.

SCHWARTZ: Abortion is being treated differently than other health services on these websites.

RIDDLE: This hospital, Jackson Memorial, is one of the biggest in Florida. A representative said in an email that the hospital does not provide elective abortion. Schwartz points out even that information would be helpful for patients.

SCHWARTZ: We specifically look to see whether websites that didn't say they offered abortion nonetheless provided resources to tell a person where they might go to obtain abortion services, and that was pretty rare in our data.

RIDDLE: Schwartz and his colleague, Dr. Ari Friedman, also at University of Pennsylvania, got interested in this topic when they were chatting after the Supreme Court's ruling overturning Roe v. Wade. They started wondering how patients in states with abortion bans would figure out where to go.

SCHWARTZ: This was one of those you go to lunch with a colleague, and by the end of the lunch, you happen to have a new research idea that you're working on.

ARI FRIEDMAN: (Laugher) It's true, it's true.

RIDDLE: Their team analyzed more than 200 hospital websites in states where the procedure is legal and found that there was no mention of abortion on nearly 80% of them. The researchers didn't look at why hospitals don't like talking about abortion. One possible reason is security. But Friedman says hospitals can offer a lot of anonymity for patients.

FRIEDMAN: If you're worried about protests, well, it is a lot harder to boycott every single patient walking into the doors of a hospital - only, you know, 1 in 1,000 of whom might be seeking abortion care - than it is to target every single patient walking into a Planned Parenthood.

RIDDLE: Nonprofits like the group Plan C help patients figure out how to access abortion services. The website offers information for people in every state about abortion pills. Their online traffic has doubled since the Supreme Court decision in June of 2022. Angie Jean-Marie is a spokesperson for Plan C.

ANGIE JEAN-MARIE: For us, one of our values is de-medicalizing abortion care.

RIDDLE: Women have been having abortions for hundreds of years, only relatively recently in hospitals. Now, in some countries, Jean-Marie points out, abortion pills are available without a prescription. Her group welcomes partnerships from hospitals, but she says they are figuring out other paths to access.

JEAN-MARIE: I mean, we certainly have a vision of folks being able to self-manage and self-direct their abortion care.

RIDDLE: Maybe someday, she says, hospitals won't need to make their services known to those seeking safe abortions because abortion seekers won't need hospitals.

For NPR News, I'm Katia Riddle.

(SOUNDBITE OF EL BUHO AND BARRIO LINDO'S "ORINOCO") Transcript provided by NPR, Copyright NPR.

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Katia Riddle
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