By Emmy Trivette
From the vast pool of institutions and post-grad matchups, Dr. Rachel Jensen was placed in North Carolina for her OB-GYN fellowship.
She moved from Baltimore to N.C. just a week after a state law went into effect banning abortion procedures later than 12 weeks into pregnancy.
Jensen already encountered a slew of issues intertwined with state gynecology practices, which inclined her to tell her already large collection of disheartening stories – many of them turning desperate women away because of the law — via an op-ed in the Charlotte News and Observer.
“There are certainly other places that have waiting periods, but this is a very, very long while and it’s intended to prohibit patients from being able to get the care that they need,” Jensen said.
In North Carolina clinicians like Jensen are now more restricted in providing the standard of care that they’re accustomed to.
Under the “Care for Women, Children and Families Act,” which took effect in July, abortions are now restricted from happening after 12 weeks. In addition, in-person consent is now, followed by a 72-hour waiting period before the procedure.
For N.C. women, finding a clinic that accepts the right insurance, making the time to get an appointment and accountING for the 72-hour wait period before the procedure can be daunting. Even if they can arrange all of this, at that point, they might be past 12-weeks pregnant.
Many in public health worry the restrictions will discourage doctors, both local and from out-of-state, against working in North Carolina.
“Though we conflate it with socio-political issues,” Jensen said. “It’s also, at its core, a medical issue and deeply impacts the health care of the patients that we serve in terms of health and well being.”
Precisely a year since the Supreme Court overturned Roe v. Wade – which until then, decriminalized abortion nationwide. The N.C. legislation goes even further than in the 1980s when funding restrictions prevented abortions later than three and half months.
“It’s very confusing, the language is obscure, because it’s intended to make us feel as uncomfortable as possible, so that’s why we’re really relying on our colleagues to help us to interpret what things mean,” Jensen said
And it’s not just impacting OB-GYNs.
“Let’s say we have a pregnant patient who has a heart failure, and then you also have a cardiologist saying, continuation of this pregnancy is not safe for you,” Jensen said.
Then the cardiologist can’t do their job.
Many N.C. doctors, not just OB-GYNs, have to decipher this bill. Any pregnant woman who has to abort a pregnancy to undergo and survive a procedure or other intensive medical practice, has also to meet this new 12-week mark for pregnancy restrictions and the 72-hour consent period.
Since the bill’s enactment, the combination of fewer practicing OB-GYNs and much higher patient spike in North Carolina, has accumulated a backlog of too many patients in clinics across the state.
“I will say the change that we saw is that we ended up seeing a lot more patients,” Dr. Amy Bryant said. “I mean, we had a surge – we were a surge state, and saw lots more patients than we had in the year prior.”
Practitioners, the ACLU and Planned Parenthood South Atlantic filed a lawsuit challenging the more limiting provisions of SB20. The suit was led by a Duke health provider a month after SB20’s passing.
Even before the more recent suit against SB20 bill, Bryant filed a suit against legislators for restricting access to the abortion pill, mifepristone, which stops pregnancies of less than 10 weeks.
“I have a colleague that says if you want to practice medicine in the South like you have to get – or you know, complex family planning in the South – you have to get a mini law degree,” Bryant said.
Complex family planning is the sub-specialty intensive OB-GYN cases like abortion and contraception fall under. And while the web of laws affecting complex family planning in N.C. could be why the top tier med school saw another drop in residency applicants this year, the interest in complex family planning from students is as high as ever.
Bryant co-teaches the Abortion Care and Policy at UNC Gillings School of Global Public Health. Sometimes experts in the field will attend, sometimes the students will rotate through with Bryant and colleagues in their abortion clinics.
“It’s a very popular course that we’ve been doing for like eight years in the School of Public Health,” Bryant said. “It’s not required, it’s an elective, but it’s usually quite full and students seem to get a lot out of it.”
According to a study done by the Association of American Medical Colleges, published a month before the law was passed, medical residency applicants for OB-GYN in N.C. dropped by eight percent in the last year. The tighter restrictions have OB-GYN practitioners worried for the quality and longevity of the state’s overall health system.
“This is potentially a problem because people really do often stay in the states where they train,” Bryant said. “And so if we have fewer applicants, we have fewer, you know, or lower quality applicants that’s going to have long term effects on our state’s health system.”
Bryant spent time in Uganda while studying gynecology. She said this was the first time she was truly exposed to the dire consequences of no abortion or contraception access.
“It became very obvious that there was a lot of need here in North Carolina as well,” Bryant said.
So she stayed.
“This law has really had some very, very unfortunate consequences for a lot of people who haven’t been able to access the care they need,” Bryant said. “I think we’ll see that play out more, and it’s going to affect how we long term are able to train our workforce.”
Kristel Black, a third-year at UNC School of Medicine, finds herself drawn to complex family planning classes and the OB-GYN portion of her rotation, and she hopes to work in women’s reproductive health once she graduates. Just not in North Carolina.
“I want to go to a different state to just get that training without feeling limited, and not feeling like I have to be over here fighting over people’s basic human rights,” Black said.
After completing her undergrad in sociology at Duke, she trained as a birth doula, working in both Durham and Philadelphia through most of the COVID-19 pandemic and a year after. It was Black’s job to aid anytime before, during and after the birth. Sometimes she helped the mother through all of it.
Like a birth doula, someone who coaches, soothes and protects a woman in the process of pregnancy and birth, it is also the job of OB-GYNs to help both pregnant women and hospitalized women. The life and safety of women relies on OB-GYN’s ability to perform the full scope job to protect women experiencing any part of that process.
For many like Black, it’s daunting to watch roadblock after roadblock appear before their careers have even begun.
“But I see hope for North Carolina, I do want to settle down in Durham eventually — I just don’t want to sound like we’re giving up on people in North Carolina,” Black said.
