The Dilemma Faced by Doctors in States with Restrictive Abortion Laws

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Dr. Kylie Cooper finds herself emotional when thinking about the patients she had to leave behind in Idaho.

One patient, Kayla Smith, stands out in her mind. Smith made the difficult decision to terminate her much-desired pregnancy last year after discovering severe fetal abnormalities. However, due to Idaho’s near-total abortion ban following the overturning of Roe v. Wade, she had to travel to Washington state for the procedure. Cooper deeply regrets being unable to provide the care she normally would have offered.

This experience is one of the reasons why Cooper, a maternal-fetal specialist, made the difficult choice to relocate to Minnesota in April, a state that upholds broad abortion rights. She explains that it was a challenging decision for her and her family, but they needed to be in a place where reproductive healthcare was protected and ensured.

Following the post-Roe era, many maternal care doctors in states with restrictive abortion laws face a similar dilemma: whether to stay or leave. They are forced to consider complex questions about medical ethics, the well-being of their own families, and whether they can continue to provide optimal care without jeopardizing their careers or risking legal consequences, including imprisonment. They are well aware that their patients’ well-being is also at stake, particularly given the current and projected shortage of maternal care providers in the United States.

However, not all doctors make the same decision as Dr. Cooper. OB-GYN Dr. Alecia Fields returned to her native Kentucky around the time news about the Supreme Court’s ruling on abortion restrictions began to surface. She now practices in a conservative rural county and can no longer perform abortions part-time in Louisville, as she once did.

Fields feels deeply connected to her home state and hopes to bring about change from within. Additionally, she recognizes the significant need for healthcare providers in terms of reproductive health services. The March of Dimes reported that nationally, 44% of counties have limited or no access to obstetric providers. In states like Kentucky, Idaho, and others with restrictive abortion laws, this percentage increases to over 50%.

Federal projections indicate a growing gap between the supply and demand for OB-GYNs nationwide until 2035. Among the 24 states that have implemented abortion restrictions, all except Ohio are expected to face even greater shortages by then, as analyzed by The Big Big News based on federal data.

Dr. Amy Domeyer-Klenske, Chair of the Wisconsin section of the American College of Obstetricians and Gynecologists, warns that the combination of abortion restrictions and the challenges of practicing in rural areas may result in the expansion of “maternal care deserts.” This issue not only affects individuals seeking abortions but has broader ramifications for every woman and family desiring to have children.

CHOOSING TO STAY IN KENTUCKY

Under the midday sun reflecting off Lake Cumberland, Dr. Fields kneels down to feed her backyard chickens. She and her husband, who is a stay-at-home dad, recently purchased a house and barn on three acres to raise their two young boys.

Fields cherishes her childhood memories of growing up in Kentucky, shuttling between her parents’ house in Lexington and her grandparents’ house in the countryside. She describes a close-knit community where everyone knew each other, and the warm atmosphere fostered a sense of belonging.

During her time at the University of Kentucky and in medical school, Fields became an advocate for reproductive rights. She served on the board of Medical Students for Choice and received training in abortion care during her residency in Rochester, New York. While working at a health center in Indianapolis, she made monthly trips to Louisville to provide abortions at Planned Parenthood.

Last spring, Fields received a job offer from a health center in Somerset, Kentucky—an opportunity to serve a county where nearly 20% of the population lives in poverty and some individuals have to travel long distances for medical care.

Although the news of the potential abortion ban raised many fears for Fields, she decided to take the risk.

Now, she does her best to provide quality care within the limitations imposed by the restrictions. Her objective is to create a safe and non-judgmental environment where patients can freely express their thoughts about their pregnancies, including their plans and desires. If necessary, she guides them to information about out-of-state abortion providers and available travel assistance. Fields also offers contraception and permanent sterilization, as an increasing number of her patients seek these options.

In cases where the mother’s life is endangered, abortion is still allowed. However, Fields acknowledges that waiting until such critical moments puts the patient at significant risk.

Despite the constraints on her practice, Fields regularly receives gratitude from her patients at the clinic or even during chance encounters at Walmart. One patient publicly expressed her appreciation on Facebook, recounting how she experienced severe bleeding during childbirth, and Fields saved both her and her baby’s lives.

Fields proudly displays her love for Kentucky in her dining room, adorned with a wooden cutout and colorful picture of the state, a horse statue, and a framed sign that reads “home sweet home.” She envisions staying in Kentucky for a long time, caring for generations of local families, and establishing deep roots.

LEAVING BEHIND IDAHO

Similarly to Fields, Dr. Cooper desired to practice where her expertise was most needed and make a substantial impact.

She relocated to Boise in 2018 and found her work to be incredibly fulfilling. Cooper managed complex cases, supporting women through the challenges of pregnancy complications and helping others successfully deliver healthy babies. She formed deep connections with her patients, their families, and her colleagues.

Idaho, along with its beauty, offered her family a wonderful life. They resided in a great neighborhood, had a close group of friends, and their children were thriving in school.

“We were content and had no intentions of leaving,” Cooper, 39, said. However, everything changed when Idaho implemented the abortion ban. According to state law, doctors who perform abortions can be charged with a felony and have their medical licenses revoked.

For some of Cooper’s patients, abortion was the only way to preserve life and health, making the idea of not being able to help them immensely terrifying. She was already seeking legal advice for some cases, fearing that she might soon face the agonizing decision between her patients’ well-being and her own freedom. Cooper realized that if she ended up in prison, her children might go without a mother for years, and the family’s financial security would vanish.

“All we talked about was abortion care, my job, and the stress it caused,” she lamented.

A recent poll conducted by KFF, a nonprofit specializing in health care research, found that 61% of OB-GYNs in states with abortion bans are somewhat or very concerned about the legal risks involved in making decisions about patient care and the necessity of performing abortions.

Cooper’s colleague in Idaho also decided to leave, and when surveyed, numerous other maternal care professionals expressed their intention to move out of the state within the next year.

Cooper’s family has now settled into a new house in Minnesota, though they are still adjusting. They are unpacking boxes, adapting to new routines, and seeking new friendships. Cooper mentioned that they are essentially trying to recreate the sense of home they had in Idaho.

She continues to worry deeply about her former patients, shedding numerous tears for them and their struggles.

Kayla Smith also misses Dr. Cooper greatly. Smith, who terminated her second pregnancy after learning that her fetus was unlikely to survive, recalls the doctor crying alongside her during that difficult time. Cooper provided essential support during the loss of baby Brooks, who lived only a few moments after induced labor.

When Smith discovered that Cooper was leaving, she made a special visit to her office, expressing her gratitude and offering flowers and a heartfelt embrace.

“I’m just really sad. She was so kind. She changed our lives,” said Smith, who is now contemplating a move herself. “I don’t blame her for leaving, but it’s tough for everyone here.”

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Note: The text has been rewritten to provide a similar narrative while incorporating some paraphrasing and rephrasing for improved readability and coherence.

Frequently Asked Questions (FAQs) about Restrictive abortion laws

More about Restrictive abortion laws

• March of Dimes
• American College of Obstetricians and Gynecologists
• KFF (Kaiser Family Foundation)