One year into new abortion limits, N.C. patients and providers struggle to shoulder the load restrictions bring
By Rachel Crumpler
Katherine Farris has been an abortion provider for more than 20 years, and she says that this past year has been the hardest of her career — by a long shot.
Not her first year of practice when everything was new. Not the year she stepped into the role of chief medical officer at Planned Parenthood South Atlantic to supervise clinic operations across North Carolina, South Carolina, Virginia and West Virginia. Not the years she navigated COVID protocols to keep her staff and patients safe.
The last year stands out above all the rest, as challenges escalated to a new level.
That’s because a year ago today, North Carolina’s new stricter abortion law took effect, significantly diminishing abortion access in the state. The time frame for seeking most abortions dropped from 20 weeks of pregnancy to 12 weeks, and the law added an in-person requirement for state-mandated counseling at least 72 hours before an abortion.
Farris has had a front-row seat to the upheaval caused by the change in law: Clinic staff frantically reworking operations to comply. Physicians stretching themselves thin to see as many patients as possible — knowing they can never meet the full demand. Patients desperately pulling resources together to book an appointment — often driving hours for care. Clinics turning patients beyond the state’s limits away without knowing whether they will be able to travel elsewhere.
“These aren’t just numbers to us,” Farris said. “These are real human beings that sit in front of me in my office, and I see the burden this has put on them.”
The waiting room at Planned Parenthood’s Winston Salem clinic. North Carolinians and people from out of state travel here and to the state’s other 13 abortion clinics for care. Credit: Rachel Crumpler/NC Health News
No longer providing care beyond 12 weeks or practicing to her full capabilities has been a seismic shift that’s been difficult for Farris to adjust to. She gets a glimpse of the more weeks of care she used to be able to provide in North Carolina when she practices in Virginia, which allows abortions up to 26 weeks.
“Depending on where my feet are planted, that’s what determines the care I can give,” Farris said. “It’s not my skills. It’s not the support staff. It’s not the equipment. And it’s certainly not what the patient needs. It’s just where my feet are planted.”
Despite the new restrictions, abortion volume in North Carolina has not dropped significantly since Senate Bill 20 took effect a year ago on July 1. In large part, that’s due to the efforts of abortion clinics, providers, abortion funds and other support networks that have worked to keep abortion accessible. Patients themselves have also gone to great lengths to overcome the increased obstacles to access care.
“Patients are incredibly resilient and resourceful,” Farris said. “But every day, I am angered that they have to be. They should not have to be so resilient. They should not have to be so resourceful. They should be allowed to get this care from a provider they already know and trust in their own community.”
Frantically adjusting
Calla Hales, executive director at A Preferred Women’s Health Center, which operates two abortion clinics in North Carolina, tries not to think about the day a year ago when abortion access in the state changed.
Newly gained Republican supermajorities in the state General Assembly — a result of one Democrat’s abrupt party defection — swiftly passed the state’s stricter abortion law, Senate Bill 20, over the objections of medical professionals and Gov. Roy Cooper’s veto.
Health care providers stand behind Gov. Roy Cooper in support of his veto of Senate Bill 20 at a rally in Raleigh on May 13, 2023. Credit: Rose Hoban
Hales said the first weeks were particularly tough and frantic.
“I really remember most like not sleeping for days on end,” she said. “To be quite honest, there is a stretch of time that last week of June and the first couple weeks of July where I was probably sleeping like five hours a week.”
She knew the stakes were high. The clinic needed to quickly change its operations to comply with the law and serve as many patients as possible.
Physicians and abortion clinic staff reworked processes, patient flow and schedules. They trained staff. They learned the new state-mandated counseling script and reporting requirements.
“You’re having to figure it out on the fly,” Hales explained. “Patients don’t stop needing care to provide you with the time to stop and figure out how to address practices to better change to the scope of these new rules.”
Amber Gavin, vice president of advocacy and operations at A Woman’s Choice, an abortion provider with three clinic locations in the state, said clinics grappled with how to accommodate twice as many appointments to provide abortion care for the same number of patients. Patients coming in for two in-person appointments strains the physical space within the clinic and the staff’s time.
Even now, with processes worked out, it continues to be an intricate balance of accommodating the increased volume of people in and out of the clinic, especially given the ramped-up pressure of the reduced time frame that abortion procedures can take place in North Carolina, Gavin said.
As a result of the new requirements, abortion volume in the state dropped substantially during the months immediately after the implementation of Senate Bill 20, according to data from the Guttmacher Institute, a national organization that tracks trends in reproductive health. However, the number of abortions provided each month has since ticked back up, returning to volumes in line with pre-Senate Bill 20 numbers. In March, North Carolina provided about 4,030 abortions — the highest monthly volume since the law took effect last July — according to the latest data available from Guttmacher.
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