Reproductive health care in Arizona is fractured, post-Roe

Reproductive health care in Arizona since Roe was toppled has been fractured and intermittent, and abortion advocates fear women will continue to suffer the consequences until access is restored, which may take some time. 

Dr. DeShawn Taylor has headed Desert Star Family Planning, one of a handful of private abortion clinics in the Valley, for a decade. Last year the clinic swung between open and frozen as Arizona officials vied over whether to enforce an 1864 near-total abortion ban — which includes a prison sentence of 2 to 5 years for providers — or a 2022 law that severely restricts access past 15 weeks of gestation. The latter is currently in effect, after a drawn out court battle. 

But, while legal clarity allows Taylor to continue helping some women, she worries that accessing the procedure is still fraught with hurdles for many. 

Multistate dominoes: increased wait times, limited access

“There are still providers who are not fully operating, there are still very long waits for people to get in for abortion care,” Taylor said, during an online news conference hosted by the National Institute for Reproductive Health on Wednesday. 

Desert Star is also struggling with increased wait times, due to staff shortages and elevated demand from patients who traveled from other states, like Texas, which has a 6-week ban in place. Arizona women are traveling, too, whether because of overbooked clinics or pregnancies discovered past the 15 week mark. Even women who discover their pregnancy before the gestational deadline are in danger of being forced to seek help elsewhere. State law mandates an initial consultation and a 24-hour waiting period before a patient can be scheduled for a procedure. After the deadline, only women facing imminent threats to their lives can receive an abortion.

“It is very easy for someone to realize they’re pregnant, and then (become) too far along to have an abortion in our state,” Taylor said. “Fifteen week bans are not reasonable.” 

The result has been strained health care systems across multiple states, with ongoing domino effects for residents hoping to make appointments at their local doctor’s offices. Katherine Riley, policy director for the Colorado Organization for Latina Opportunity and Reproductive Rights, shared on Wednesday that out-of-state demand jumped from 10% to 40% after the constitutional right to abortion was struck down. Locals seeking care for sexually transmitted infections or basic contraception are experiencing wait times of as much as three weeks. 

“Our state infrastructure is unable to handle the impact,” Riley said. 

Post-Roe plunge: AZ procedures fall, placing women at risk

Advocates sounded the alarm over initial reports detailing the harm caused by the fall of Roe, and warned that they’re only the beginning. 

Taylor pointed out that, despite having one of the more permissive abortion bans, Arizona saw one of the highest impacts on abortion services in the last year. The state department of health services found that 13,896 abortions were performed in Arizona in 2021, the most recent year for which data is available. That number is on par with previous years; abortions haven’t fallen below 12,000 in the past decade. But in the months following the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, abortions in Arizona plummeted. 

Research from nonprofit Society of Family Planning estimates that the number of abortion procedures provided in the Grand Canyon State were consistently lower than pre-Dobbs levels every month from June 2022 through March of this year. The most precipitous drop occurred in July, when abortions plunged by 83% to just 230 procedures, compared to 1,410 provided in April. 

And reproductive rights advocates fear the dearth of procedures will mean increases in maternal mortality rates. Maternal deaths in the U.S. have long outstripped those in other developed nations, climbing steadily over the past three decades and spiking during the COVID pandemic. A January report from the Gender Equity Policy Institute asserted that abortion bans compound that danger. Women living in states that ban abortion are three times more likely to die during pregnancy or childbirth than women who don’t have to contend with restrictions. 

“The reality is that these states that have abortion bans, where we’re seeing these terrible trends, have had decades to address (maternal mortality) and they’ve failed to do so,” said NIRH President Andrea Miller on Wednesday. “What they’ve done instead is double and triple and quadruple down on trying to eliminate access to reproductive healthcare.”  

Advocates launch response, but success may be a long time coming 

The high court sent the issue of abortion back to the states, and abortion advocates are responding in kind. The National Institute of Reproductive Health is launching a 17-state initiative to advance abortion friendly policy in regions affected by a lack of access, like Arizona, as well as encouraging pro-choice states to continue outreach and aid efforts. 

“The predictable and devastating harm playing out in nearly half the states where abortion is banned or severely restricted is a reminder of the critical role of state and local governments,” said Miller. “They are where rights and freedoms start and stop, and why NIRH remains committed to pushing forth policies at these seats of power to expand just and equitable access to reproductive health care, including abortion.” 

But, Taylor warned, restoring access in states like Arizona is likely to be a long-term endeavor. Arizona’s reproductive health care landscape has weathered decadeslong assaults that make the task more difficult. In 2013, 26 facilities performed abortions in the state, but as lawmakers continuously enacted restrictive policies around the procedure, the responsibility has been increasingly carried out by Arizona’s nine abortion clinics. The fall of Roe didn’t create lack of access in Arizona, but it did drastically exacerbate it. That reality is particularly keen for Taylor, whose clinic, Desert Star, is still struggling after the 15-week limit and last year’s legal uncertainty pushed it to the brink of closure. 

“The proactive work we’re doing won’t see real gains until 2025,” she said. “Until then, our patients are not able to get care (in state) and are leaving the state if they have the means to do so, self managing or otherwise remaining pregnant.”