Abortion access in post-Roe v. Wade North Carolina: Providers face big challenges

Editor’s note: As a result of the recent U.S. Supreme Court ruling that reversed the 1973 Roe v. Wade decision, millions of Americans capable of becoming pregnant now reside in states that have banned (or are expected to soon ban, or even criminalize) abortion. As the map compiled by journalists from the States Newsroom network shows, North Carolina remains both a) one of 27 states in which the procedure remains lawful, and b) a likely destination for people seeking care — particularly those who reside in other southeastern states.

Notwithstanding, however, the advantages that North Carolina’s current state law and geography provide, other important factors could stand in the way of it becoming a true sanctuary for people seeking a full range of reproductive healthcare.

First, as the map also notes, North Carolina’s pro-choice statutory framework is fragile. Abortion opponents are expected to seek reinstatement of a 2015 statute, invalidated by courts in 2019 and 2021, that would ban most abortions in the state after 20 weeks. And while the current Republican-dominated majority in the state legislature lacks the votes to override a promised veto from Democratic Gov. Roy Cooper of any new anti-abortion legislation, polls indicate that they could win veto-proof supermajorities in both legislative houses in the November 2022 election.

And second is the status of the state’s abortion provider community. In addition to the challenges that have long confronted providers (like constant harassment and threats of violence and a lack of funding and facilities to serve all people who need care), other factors conspire to limit their capacity.

Indeed, as the following essay by a North Carolina physician (who asked to be identified only as “Dr. K” so that they could be better protected from harassment) explains, even those physicians in the state who desire to provide abortion services can encounter significant roadblocks in getting the training they need.

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By “Dr. K”

As a family medicine physician in training, I have been closely following the news about Roe v. Wade. I am training to be an abortion provider because it is fundamental to how I comprehensively care for pregnant people and their families. Abortion is safe, normal and essential. The recent reversal of Roe poses a direct threat to my training and to the patients I serve here in North Carolina.

As a family doctor in training, I learn my craft in many ways – scientific articles, books, lectures, and of course through patient care. Common conditions like diabetes, high blood pressure and arthritis are topics I can discuss without controversy. I can ask my mentors about these diagnoses, access lots of online resources and attend regular lectures about the latest in these fields.

One in four birthing persons will have an abortion during their lifetime. That is more common than diabetes, more common than breast cancer. And yet abortion is not a required part of any medical school or residency training. Nor is management of miscarriage, which is also incredibly common – one in four pregnancies ends in a miscarriage. Often for overlapping reasons, both are surrounded in silence, shame and stigma. Management of a miscarriage is the same as management of an abortion; we use the same medicines, and perform the same procedures. Limiting access to abortion training means limiting access to miscarriage training. If I can’t learn about abortion, I can’t help patients across the spectrum of pregnancy outcomes.

Learning about abortion can be difficult and scary given the intense political and social controversies surrounding the topic. It can also be difficult to find an abortion provider, a direct result of the restrictions that have been placed on abortion access nationally and right here in North Carolina.

As laws get more restrictive, fewer and fewer physicians are able to maintain their skills, a key part to offering excellent care. For example, at my premier training program, there are currently no faculty members in my department providing abortions. This is unacceptable and potentially life threatening. Families who need abortion management, regardless of the reason, need it in a timely, safe and effective manner. As national and local restrictions mount, the education pipeline continues to be limited. Already there are too few skilled providers available to educate and mentor physicians in training. This would be inconceivable for diabetes or high blood pressure. It should be the same for abortion care.

“Dr. K” is a family medicine physician in North Carolina.