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Tar Heel Trouble

The End of One of the South’s Last Abortion Havens

North Carolina’s new 12-week ban institutes new obstacles to getting the medical procedure.

Erik S. Lesser/EPA/Bloomberg/Getty Images
Attendees at a June abortion-rights rally in Charlotte, North Carolina

Calla Hales was overwhelmed and overcaffeinated. It was Wednesday, just a few days before a new state law banning most abortions after 12 weeks of pregnancy would go into effect in North Carolina. Hales, the executive director of A Preferred Women’s Health Center, which has abortion clinics in Raleigh and Charlotte, had three empty cans of Diet Coke, two cans of Red Bull, and a milkshake arrayed on her desk.

“I have not slept in about a fucking week,” Hales told me. The Republican-led state legislature overrode Democratic Governor Roy Cooper’s veto of the law in May, but the state Department of Health and Human Services had only provided guidance on the law’s administration a week and a half before, Hales said.

“It’s changing our operational flow. It’s changing how we schedule patients, it’s changing how we staff the clinics, and a lot of this is going to be trial and error until we figure out the best flow,” she continued. “For lack of better words, this bill passing just guarantees pretty much six months of the most frustrating fuckery you can imagine.”

The new law, set to go into effect on Saturday, July 1, will dramatically restrict access to the procedure in a state that had become somewhat of an abortion rights safe haven in the South. It takes effect one week after the first anniversary of the Supreme Court decision that overturned Roe v. Wade.

“It’s devastating and detrimental to abortion access in North Carolina for North Carolinians, and people of the Southeast,” said Amber Gavin, the vice president for advocacy and operations at A Woman’s Choice, which operates abortion clinics in Charlotte, Greensboro, and Raleigh. “The majority of the states around us in the South have either total or partial bans on abortion, so [North Carolina] was a huge crucial access point for abortion in the South.”

North Carolina’s new law is not as restrictive as some others across the South, such as the complete ban in neighboring Tennessee or the six-week ban under review by South Carolina’s state Supreme Court. But Tar Heel State providers fear that it will complicate care for individuals seeking abortions after the first trimester, including those who may suffer life-threatening health complications in their pregnancies.

According to a recent report by the Society of Family Planning, North Carolina was one of several “surge states” that saw an increase in the number of abortions provided after the Supreme Court struck down Roe v. Wade. This in turn increased wait times for patients to access abortion care, said Tara Romano, the executive director of Pro-Choice North Carolina. With abortion access now restricted to 12 weeks, a lengthy wait time could mean a patient is unable to obtain care in that window.

“If somebody discovers that they are pregnant and need an abortion closer to 12 weeks, they might not be able to schedule an appointment,” Romano said. The law “was designed to make sure that people really had a hard time accessing care, even if the care they’re trying to access is still legal,” she added.

Along with largely banning abortion after the first trimester, the new law makes several other changes to abortion access in North Carolina. It includes exceptions for rape or incest through 20 weeks of pregnancy, as well as an exception for “life-limiting” fetal anomalies through 24 weeks. A preexisting exception for when a pregnant person’s life is in danger remains in place. State law already mandated that patients meet with their doctor and then wait 72 hours before having an abortion, but while that consultation could previously occur over the phone, the new law requires them to make an appointment in person.

Even though the law technically does not go into effect until Saturday, abortion clinics began in-person consultations on Wednesday in order to comply with the new requirement. “We’ve had a lot of patients this week trying desperately to get in before Saturday, so they don’t have to necessarily do the in-person counseling,” Hales said. “Obviously that’s no longer an option.”

Providers say that adding the in-person consultations to the existing waiting period will impose an additional burden on those seeking care: People who will need to take time off from work, minors who will miss school, parents who must find childcare, and out-of-state residents who will have to extend their stay.

“Unfortunately, I think our underserved population with limited resources may not have the ability to travel and take that kind of time off of work, [and] will be forced to have that pregnancy, which would put a further strain on their family, if they weren’t planning to have another pregnancy,” said Clayton Alfonso, an assistant professor at Duke University and ob-gyn who specializes in complex family planning. He also worries that people who are unable to easily obtain abortions—either because they are past the first trimester or because they cannot take the required time—would turn to illegal, self-managed abortions.

The new law will add to the strain on providers, who now have to make twice as many appointments with patients to include those in-person consultations. Moreover, as in other states that have recently restricted or banned abortion, health providers and physicians may find it difficult to determine at what point the pregnant person’s life may be in danger after they pass that 12-week threshold in the pregnancy.

“I think there’s going to be a portion of our patient population that unfortunately, we don’t know whether or not they will legally fall into those exceptions, and how do we appropriately care for them?” Alfonso said.

It’s possible that the law may also affect miscarriage management, even though it explicitly states that it is not intended to affect the treatment of miscarriages and ectopic pregnancies. Doctors in other states that have enacted restrictive abortion laws, for example, have been hesitant to treat miscarriages because they worried about the overlap with abortion care.

Because the law was written so quickly, it included some contradictions, prompting a last-minute lawsuit aimed at blocking it entirely. The North Carolina legislature on Tuesday hastily approved some last-minute changes to address some of the suit’s complaints. Attorneys for the Republican leaders in the legislature argued that the issues raised by the lawsuit were now moot, having been amended by state lawmakers. But those changes would need to be approved by Cooper, who may choose to block the revisions.

The legislature could override a veto to the amendments again, although it likely could not occur for two to four weeks, according to an attorney for the Republican lawmakers. A lawyer for Planned Parenthood South Atlantic, one of the plaintiffs in the lawsuit, argued that unless the proposed amendments were signed into law by Saturday, the “need for a temporary restraining order would be unchanged.” The state’s attorney general, a Democrat running for governor, has said that he would not defend the parts of the law he deemed unconstitutional in court.

U.S. District Judge Catherine Eagles heard the motion for a temporary restraining order on Wednesday, and said she would likely make a decision on whether to grant it on Friday, in part based on whatever action Cooper takes. However, Eagles added that she would not strike down the entire law, as that would be “over-broad relief.”

“It’s a miracle we haven’t had more confusion today,” Eagles joked after hearing the complicated arguments over whether the law should be implemented, The Raleigh News & Observer reported.

As North Carolina had previously banned abortion after 20 weeks without exceptions for rape or incest, Republican lawmakers in the state legislature had pitched the 12-week law as a sort of compromise because it included those provisions. But abortion advocates argue that the lawmakers reached this ostensible middle ground by negotiating with themselves, inside the Republican caucus—not with the input of Democratic lawmakers or health experts outside of the legislature. “This law was really very intentional about making it as hard as possible, while masquerading as compromise,” Hales argued.

Beyond the everyday ramifications for patients seeking abortions, the political effects of the law are still uncertain. Polling shows that North Carolinians are divided on the 12-week ban: A May poll by Carolina Forward/Change Research showed that 54 percent of likely voters in the state strongly or somewhat opposed the law, compared to 40 percent who strongly or somewhat supported it. The poll also found that only 15 percent of likely voters believed abortion should be banned after 12 weeks—although 8 percent said it should be limited to six weeks and 18 percent said abortion is never acceptable.

Romano said that it was important to connect abortion to other issues for people to truly understand its salience. For example, she said, a person may not want to have a child because they can’t afford childcare or don’t have access to paid sick leave, or because the minimum wage is $7.25 per hour for a non-tipped employee. (North Carolina recently voted to expand Medicaid but has yet to implement the chnge, which could be another factor for childcare considerations.)

“What you need is to be able to talk to a candidate and ask them, ‘Where do you stand on all these issues that impact how I think about raising and creating my family?’” Romano said.

Still, the law’s long-term effects may take some time to manifest on both a political and societal level. Providers are just focusing on managing the problems in front of them. Gavin said that their clinic staff would be “asking everyone to give us a little grace” as they contend with the new regulations.

“As we all learn and adjust, I think the patients are going to be really frustrated. And I think we just need to remember to show each other empathy and compassion because these folks really want the care; we want to provide it and obviously still be in compliance with the law,” Gavin said.

Update: Cooper approved the revisions on Thursday, June 29 calling it “important to clarify the rules and provide some certainty.” On Friday, June 30 Eagles permitted nearly all of the revised law to take effect, but temporarily blocked a rule requiring that abortion providers document the existence of a pregnancy within the uterus before proceeding with a medication abortion. This injunction expires in two weeks.