Alabama’s abortion ban doesn’t stop abortion demand, say physicians, advocates

Before the Supreme Court allowed Alabama’s near-total abortion ban to go into effect last year, a business owner in Birmingham sought an abortion. 

The person, who asked to remain anonymous and uses they/ them pronouns, went to a Planned Parenthood clinic in Birmingham.

From realizing they were pregnant to completing the abortion, the whole process took around three weeks. They had an ultrasound and met the state’s criteria, so they had an abortion without too many questions being asked.

“It was really great care while it was around,” they said.

The Planned Parenthood is no longer able to provide abortions. And with a handful of health-related exceptions, there has been no legal abortion in Alabama since the Supreme Court’s ruling in Dobbs v. Jackson Woman’s Health Center, just over a year ago.

Hard data on abortions in Alabama is difficult to come by. But physicians and women’s rights advocates say they have heard a steady stream of stories of Alabamians seeking abortions.  

“We know right now that people are probably leaving the state we know that because we do occasionally hear from other clinics or people who have said that they’ve gone to other clinics in other states in order to obtain an abortion and sometimes come back to us if they want some sort of follow up,” said Robin Marty, operations director at the West Alabama Women’s Center, a reproductive health clinic that provided abortions until last year.

Challenges before Dobbs

In 2021, the last full year before Dobbs, Alabama residents had 8,294 abortions, according to the Alabama Department of Public Health.

But even before Dobbs, it was a difficult medical procedure for many in the state to access, said Dr. Leah Torres, an OB/GYN.

“It doesn’t matter what’s on paper, abortion was always in this state, at least treated as a criminal act,” she said.

Prior to Dobbs, Alabama required women seeking an abortion to wait 48 hours. A woman needed to have an ultrasound.  If a doctor prescribed an abortion pill, it needed to be handed from the doctor to the patient and taken in front of a doctor. People seeking an abortion were given a resource guide for resources during pregnancy, which Marty said was never provided otherwise to people.

“That interestingly enough, only existed for people who were seeking out abortions and this document did not ever exist or go to anybody who actually wanted to continue to have a child and wasn’t seeking an abortion,” she said. “It was not available online. It was not available through the Alabama Department of Health. It was specifically a resource to talk people out of abortions rather than a resource for all people who are pregnant and parenting.”

They have since uploaded the guide to their website.

Patients also received resources of “informed consent,” Marty said. Those resources included alleged harms that could come to people who went through abortions, as well as a photo guide that showed images of fetuses at certain stages of development. Marty said that those photos were “slightly off.”

Abortion clinics also needed admitting privileges to local hospitals and to be certified ambulatory surgical centers, Marty said. Hallways had to be certain widths and there had to sinks in every room.

Some clinics closed if they couldn’t meet those requirements. 

“If you’re going to have standards for procedures, that’s fine, but then you have to have them for all procedures,” Torres said about the hallway widths.

The regulations took their toll on abortion access. In the early 1980s, there were 45 places in Alabama where a woman could get an abortion. By the time Dobbs was decided, there were only three. 

“Dobbs gave them permission to do what they always wanted to do, which was make it impossible to access healthcare,” Torres said.

A continuing need

The need for abortion services did not end with Alabama’s near-total abortion ban. Marty pointed to a recent story by the news outlet Five Thirty Eight, which showed a greater year over year decrease in abortion in states where it is outlawed than increases in states where it is still legal. A director of a Tampa Bay abortion fund they have gotten calls from people from Alabama. 

The West Alabama Women’s Center is unable to point people who need abortions where they may need to go. Marty said they receive one to two calls every day asking about abortions, but those people are not all necessarily seeking an abortion for themselves.

“We’re still stuck, basically, pointing at our website and saying that’s all we can do for you,” she said.

But, she said, she knows that abortion is happening because she has not heard of an influx of babies being born across the state. By now, she said, that should be the case.

In 2021, Alabama had 56,610 births; in 2022, 56,665 and in 2023 (as of June 20), 24,471. ADPH spokesperson Arrol Sheehan said the 2022 and 2023 numbers are preliminary.

“So, that tells me that as we always suspected it doesn’t matter if abortion is legal or not,” she said. “People are going to find ways to have abortions.”

One way abortions may be taking place is medication. Mail-order abortion medication has become a source for women around the country. The U.S. Department of Justice wrote last December that the act of mailing abortion drugs is not sufficient reason to conclude they are being used unlawfully.  

In January, according to Al.com, Attorney General Steve Marshall said he wanted to prosecute women who used abortion pills, though he later backtracked on those comments.

“I believe that medication abortion is extremely safe,” Marty said.

The impact

“The irony is that the people who are being affected the most by abortion laws, in all honesty, are the people that were the ones who never were supposed to be in the middle of it in the first place,” she said.

Those with complications may go to the emergency room, but many emergency rooms may not be equipped to help. 

Emergency room doctors are not necessarily obstetricians, Marty said. A pregnant person might come in with pain that indicates an ectopic pregnancy, where a fertilized egg is outside the uterus. An emergency room doctor might not recognize the symptoms and either need to consult another doctor, or they might be triaging patients.

“A lot of times doctors will feel that ‘Here’s a heart attack that I have to deal with right away. Here is a gunshot wound I have to deal with right away so the pregnant person who just seems to be in some pain, and you can be in pain for a while, let’s give them some pain medication which will then mask their symptoms, and we won’t necessarily monitor them and we send them along their way’ and that’s how people will die,” she said.

The clinic also sees patients who come to them in early weeks of their pregnancy, who cannot see other doctors because of insurance. Insurance companies might not allow doctors to see patients until they are halfway through their first trimester. The West Alabama Women’s Center has a commitment to providing prenatal care whether or not they get reimbursed by insurance.

“So, this is a standard of care that allegedly anti-abortion activists want for people who are going to terminate a pregnancy because they don’t seem to think is necessary for people who are going to continue a pregnancy and give birth,” she said.

She also said that people can visit them at the West Alabama Women’s Center. She said they understand the lines of law there.

“We know that an unviable pregnancy is supposed to not be considered an abortion and if there’s a non-viable pregnancy we are going to help you,” she said. “We have ways that we can do it. We have ways that we can make sure that we’re following protocols to prove that that’s not a viable pregnancy.”

Alabama has also used chemical endangerment laws to prosecute pregnant people. Marty said that those laws are making it so that people miscarrying are afraid to get medical attention in case they are questioned or accused of intentionally ending their pregnancy.

“That’s what all of these policing of pregnancies do is it makes it terrifying for a person to be able to get follow up care but also to get prenatal care in general,” she said.

The Birmingham business owner said that they want to have children someday, but they could not have had a child at the time with the partner they had. They said the whole process was more emotionally intense than they expected, and they do still have some grief, but they are happy that they had the care and resources at the time.

“I luckily have a family that I’m really close to and knew I was pregnant, knew I was seeking an abortion, and we all decided this was not my time,” they said. “And just because I’m pregnant doesn’t mean that it’s a child. Like, luckily, it was so early on that there wasn’t a heartbeat. It was just a little group of cells.”