‘This can’t be the new normal’: What abortion care in Michigan looks like since Roe fell

One year later, patients and abortion providers are still navigating a new world post-Dobbs decision, but Michigan doctors at Planned Parenthood told the Michigan Advance ahead of the anniversary that the “new normal” is not one anyone should be OK with.

Dr. Sarah Wallett, chief medical operating officer for Planned Parenthood of Michigan, said every other state she’s ever provided abortion care in now has banned abortion following the Dobbs decision overturning Roe v. Wade. She worries about the people who won’t be able to travel to Michigan, Illinois or other states that still allow abortions.

“So many people aren’t able to figure it out, and it unfortunately has become the new normal — and I really don’t want people to accept it as the new normal,” Wallet said in an interview in May. “It is a horrible tragedy for so many and us accepting this as the new status quo has very negative health consequences.”

The number of abortions to out-of-state patients Planned Parenthood has provided has tripled since the Dobbs decision, Wallett said. Facilities, specifically those nearest the southern border of Michigan, have multiplied their efforts and staffing to accommodate the demand for care.

“I have to emotionally distance myself from it sometimes, because when I really stop to think about this year, it has been so overwhelming, that I’m not even sure what to do — other than keep showing up to work and to keep taking care of the patients that need me,” Wallett said.

Although most out-of-state patients have come from neighboring states, including Indiana and Ohio, Wallett said she’s seen patients in the last year from Kentucky, Texas, Oklahoma, Florida and Alabama.

“That’s the difference, like we always saw people from Ohio and Indiana, because our clinics are close to the border. Maybe we had a shorter waiting period,” Wallet said. “Ohio and Indiana have different laws that are even more difficult to comply with so sometimes it’s easier for patients to come here, but I never saw patients from Kentucky or Texas.”

Care providers in Kentucky, which currently bans all abortions except those to save the life of the pregnant patient, have had to turn away thousands of patients in the last year, according to facility estimates. Many of those calling facilities don’t know there is a near total ban.

‘Reproductive care is health care’: Doctors, nurses react to Roe overturned

And even the exception to save the life of the mother isn’t enough to qualify for an abortion in Kentucky, Wallett said. One patient she received from Kentucky — who had had an organ transplant and been told by her providers in Kentucky that remaining pregnant put her at risk of organ rejection meaning she could die — could not receive an abortion in Kentucky.

“Logistically, trying to figure it out in a state that has banned abortion, even when there’s exceptions, still means people travel because exceptions generally don’t work. They’re usually so narrow and so hard to meet and it’s so scary for providers and patients to try to meet the needs of exceptions,” Wallett said, referring to exception like rape, incest or the health of the patient. “Exceptions are there on paper, but … the exceptions don’t work to actually get people care even when they really really need it.”

Even Ohio, which currently allows abortions for up to 22 weeks, is not a viable option for receiving care, one patient at the Ann Arbor Planned Parenthood Health Center told the Advance in May.

The patient, who is remaining anonymous due to the fear that people in her small town in Ohio would cause harm to her family, had just graduated college when she realized she was pregnant. She is one of hundreds of Ohioans who chose to travel to Michigan rather than try to navigate Post-Roe Ohio since the Dobbs decision overturned Roe v. Wade

“Yes it’s legal in Ohio, but it’s not provided anywhere,” the 22-year-old said. “There’s so many scare clinics and scams. … I decided to come up here, because I just knew I’d be a lot safer and be in better care.”

And the laws surrounding abortion in Ohio are changing. Ohio had a six-week “heartbeat” ban on abortion from June to September 2022. Currently, abortion rights advocates are gathering signatures to enshrine the right to an abortion in the state constitution, just as Michigan did in the 2022 November election, but are facing obstacles from the GOP-controlled legislature.

The patient, who was able to make a choice in her reproductive health care, counts herself lucky. She says she was fortunate to be able to make the drive to Michigan and stay with girlfriends, some of whom knew what to expect from the experience.

“I came from my college house and went [to Planned Parenthood], took the first pill here in the clinic and then I took the second pill at my friend’s house in Ann Arbor. And the girls came to Ann Arbor and we went shopping during the day; we made it somewhat of a positive day,” the patient said.

Her and her friends had told each other in the past that they would have each other’s backs no matter what, the patient said, but it meant a lot that they made good on that anecdotal promise so many women make to one another, “If you ever needed help, if you need a ride to a clinic, I’m here for you. We’re all here for you.”

Dobbs decision day

It was a Friday. 

Wallett says she vividly remembers when the Dobbs decision was announced last year. She was with a patient in the Kalamazoo Health Center when her smartwatch started to vibrate with notifications “over and over again.”

“I didn’t look, but I knew in my heart what it was. I stepped out of the patient room and cried and talked to the staff,” Wallett said. “But the thing is, we got to go back to work. I didn’t have to go tell the patient who was in the room that I walked out of, ‘I’m sorry, I can no longer care for you.’ I didn’t have to send away the people in the waiting room.”

When Roe fell, Michigan had a nearly century-old abortion ban on the books, with no exceptions for rape or incest. However, abortion remained legal in Michigan as there were lawsuits filed by both Planned Parenthood and Gov. Gretchen Whitmer and an injunction to make the law unenforceable was granted before the decision.

Dr. Gillian Schivone is director of abortion services who came to Planned Parenthood this year after providing care in Missouri for six years. Missouri is another state with an almost entire ban on abortion since the Dobbs decision.

“There was one patient that we adjusted to take care of the evening before and otherwise, you know, I was taking care of patients that had … miscarriages so it wasn’t quite providing abortion care, per se, but I was on labor and delivery and people were really sad. They were crying. We were hugging each other. It was a very scary feeling. I didn’t let my emotions go because I was so anxious,” Schivone said.

There were a variety of reasons for Schivone to move to Michigan from Missouri, she said, but the hostile environment for receiving health care in Missouri was one of them. From the time she started working there to the time she left, the ability to provide abortion care was slowly collapsing. 

Dobbs was the final blow.

Schivone remembers it took only a few minutes after the release of the decision for Gov. Mike Parson to ban abortion in Missouri. 

The ban caused mass fear, not only for patients in Missouri, but also to medical providers who were left to figure out what still fell within federal requirements to provide emergency medicine.

“It’s hard to explain, like how scared everybody was and there was so much difference in how different people would manage care. So one hospital would say, ‘We’re not going to take care of an ectopic pregnancy unless someone has a complication from it’ or ‘We can’t provide emergency contraception,’”Schivone said. “It really highlights how problematic it is for legislators to make healthcare politicized. When they do, it doesn’t actually make any medical sense and it doesn’t account for all the different possibilities that can come up.”

As a provider, it’s problematic to have to make clinical decisions worrying about legal ramifications, Wallett said. No one should want their doctor to have that even enter into their head. Their doctor should be worried about the individual, their circumstances, the best clinical evidence guidelines from health care leaders, Wallett said. 

“What a politician is going to do about it shouldn’t enter in, but in this post-Dobbs world, unfortunately, in many places, that’s what’s happening: ‘I can’t make the right decision medically.’ ‘I can’t make the right decision ethically.’ ‘I have to worry about going to jail or facing sanctions or losing my medical license,’” Wallett said. “That’s not a way that anyone should have to practice health care. It’s not how patients should have to receive health care.”

A year later

Although the Dobbs decision was a palpably devastating blow to reproductive rights the moment it was released, the U.S. won’t know the full extent of the damage until years later, Wallett said. 

The first group of people who were denied abortions after Dobbs are now having children and figuring out what that means for their lives. 

“I feel really lucky that in the past year, I’ve been able to keep caring for my patients. I have never been afraid that the work that I do would impact my family or my career in the way that other providers across the United States cannot say the same,” Wallett said.

After Roe fell, Schivone said she had to refer people to Chicago for abortion care, a roughly four-and-a-half hour drive if patients lived in the St. Louis area. She fielded questions caused by all the confusion Dobbs brought, including patients asking to be sterilized, a permanent decision that should be made with complete clarity, Schivone said, but people were asking out of fear.

She said if she was going to remain in OB-GYN, she needed to be in a facility and state where she can openly advocate for abortion care and transgender care, or else they may “be taken away without fanfare.”

“There’s guilt when you leave a place behind and there were a variety of reasons why I left, but you do feel guilty about leaving people because those people still can’t get care or they still have to travel very far to get care,” Schivone said. “Unfortunately, there wasn’t anything that I could do to make that happen or make that change. Which is really hard.”