Abortion providers in the South face many challenges, including being outed online, fired from hospitals, and ostracized in professional and social circles, according to the results of a recent study.1
Targeted restrictions on abortion providers (TRAP) impede their ability to work. As demonstrated by the recent arson at a Planned Parenthood in Knoxville, TN, there is the ever-present risk of violence.2
“There is a dearth of abortion providers across the country, especially in the South,” says Pari Chowdhary, MPH, lead study author and researcher for Emory University's Planned Parenthood Southeast partnership at the time of the study.
Chowdhary and colleagues interviewed 12 abortion providers practicing in Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, and Texas. Stigma, lack of privacy, fear for their families, and ostracization are among the reasons reproductive health providers might choose not to practice in the South.
For example, one abortion provider told Chowdhary that protestors found her identity, posted it online, and then showed up at her child’s elementary school, holding posters that said the child’s mother was a murderer.
“The provider said, ‘I had to have a conversation with my kids about what I do for a living,’” Chowdhary recalls. “That parenting decision was taken away.”
Other providers recalled losing their church communities when their identities as abortion providers were revealed online.
“They talked about experiencing loneliness, stress, and adverse mental health consequences, and then isolation happens,” Chowdhary says. “In some circles, they were painted as heroes, and they felt that was damaging because that made them feel like they’re doing impossible work, and it would discourage future providers from coming in because it looks like a very challenging space.”
The Southern abortion providers would try to keep their identity private for their family’s safety, but they felt conflicted. “Not coming out continues to perpetuate the idea that abortion providers are immoral,” Chowdhary says. “They would say, ‘Am I going to be true to myself and make myself known? Or am I going to be stay safe by not coming out?’”
In many other countries, these concerns are not an issue. In Canada, for example, people can engage in productive discourse about the good of society without engaging in passionate debates about abortion, Chowdhary notes.
In eight Southern states, including Florida, Georgia, and Texas, only 302 abortion providers are available, meaning 93% of counties do not have an abortion provider or abortion clinic.
Only one abortion clinic is left in Mississippi to serve the 584,000 women of reproductive age in the state.
“Unfortunately, that clinic has been under legislative action for the last six years,” Chowdhary says. “The new case against them [in the Supreme Court] and their future are uncertain.”
Because of the six-week abortion ban in Texas, the Mississippi clinic is providing services to many out-of-state women, too.
“It’s truly a dire situation in many places,” Chowdhary says. “The Texas abortion ban and the U.S. Supreme Court’s decision [to allow the Texas abortion ban] are making it difficult to access what I believe is part and parcel of women’s healthcare.”
As difficult as it is now to access abortion care in the South, it likely will worsen over the next year.
“All of the providers I spoke to fear it will only get [harder] because of these laws and the culture created in the South, which is disincentivizing future providers because it makes their lives really challenging,” Chowdhary says. “It’s sad because the policies have wide impacts.”
Chowdhary wanted to highlight providers’ voices on abortion care because too often their thoughts and experiences are left out of the conversations.
“We take them for granted,” she explains. “To have abortion be accessible, you have to have qualified and willing providers, and that’s why I was so intent on doing this research.”
Providers shared their experiences and concerns, wanting to be seen and heard. “I kept hearing from providers about how alone they felt and how isolated they were,” Chowdhary says. “Many of them said that even though it feels hopeless, they were quick to identify opportunities and strategies that would bolster their ability to do their work.”
The interviewees said that TRAP laws requiring abortion physicians to maintain admitting privileges at hospitals were the biggest barriers to their ability to practice.
“They were saying that as a result of being in the South, several hospital institutions don’t want to engage in abortion politics,” Chowdhary says. “Even if actual physicians were pro-choice, the institutions would not take that stance. It’s not just Catholic hospitals; it includes public and private facilities.”
One physician reported that she maintained privileges at a hospital for years while providing abortions at a local clinic. The chairperson of the hospital was fine with her abortion work — until the physician’s identity was posted online and protestors showed up at the hospital.
“The hospital terminated her employment, saying they didn’t want to be in the public spotlight around abortion,” Chowdhary says. “What I was seeing in the interviews with providers was that their individual ability to provide care was influenced by institutional decisions, and those were influenced by the community — protestors showing up.”
Abortion providers offered several suggestions:
• Allow advanced practice providers (APPs) to give abortion care. “My interviewees told me that exclusion of APPs from abortion care is a disservice to patients in need of access in the United States,” Chowdhary says. “APPs receive the kind of training that would make them well-served in being an abortion provider. Their exclusion in the South is not sensible.”
• Alleviate the paperwork burden. It often is difficult for abortion providers to manage the paperwork on their own. As one provider told investigators: “With patients all day, I can’t get to paperwork until the evening. There isn’t another provider. Staff can’t do counseling or procedures. I do it all. It’s exhausting.”1
• Offer more opportunities for training. “Every single one of the providers said that the location of your training is so strongly correlated to the place of your practice as an OB/GYN,” Chowdhary says. “Their largest recommendation was to increase training opportunities in places where you want people to provide abortions.”
The goal is to bring in medical students interested in OB/GYN and incentivize them to stay. “But we talked with medical students in unpublished research, and they said Southern academic institutions did not offer abortion training. That’s a massive problem,” Chowdhary says. “If you don’t offer local training opportunities, you won’t have a regional workforce.”
• Offer regional networking events. “So many providers said they felt alone in what they’re doing,” she says.
Providers would benefit from a regular networking opportunity to connect with others in the area.
• Provide a one-stop clearinghouse. A clearinghouse could offer providers assistance with licensing, credentialing, and concierge-type services. They also could provide doctors with information about where to find malpractice insurance and how to select the most effective electronic privacy management services.
“Specific to the South, if professional organizations could cover the costs of internet privacy protection, they would think that is helpful,” Chowdhary says.
• Engage in more abortion advocacy. “One thing they said was that professional organizations needed to do a better job of engaging in abortion advocacy,” she says. “They need to make a case in the South, saying we’re all doing this together and destroying pervasive stigma in these environments and convincing legislators to see the light of what needs to happen to protect reproductive healthcare.”
Southern abortion providers especially need support from the abortion rights community.
“They said there are very few other jobs where your entire identity is what your profession is — and if you’re an abortion provider in the South, this is all people see about you,” Chowdhary says. “One direct quote was, ‘There’s more to me than abortion, but that’s all I’m ever labeled as.’”
REFERENCES
- Chowdhary P, Newton-Levinson A, Rochat R. “No one does this for the money or lifestyle”: Abortion providers’ perspectives on factors affecting workforce recruitment and retention in the Southern United States. Matern Child Health J 2022;Jan 8. doi: 10.1007/s10995-021-03338-6. [Online ahead of print].
- Le T. A fire that destroyed a Planned Parenthood building was intentionally set. NPR. Jan. 7, 2022.
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