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Reproductive Care and Abortion in Alabama

If you have been reading this series, you know that abortion access and laws differ greatly across the United States, especially in the aftermath of the Supreme Court of the United States (SCOTUS) decision on the Dobbs versus Jackson Womens Health Organization abortion case this past June. The Dobbs case involved Mississippi’s Gestational Age Act, which prohibits all abortions subsequent to 15 weeks gestation, with very few exceptions. In the case, the Mississippi law was upheld by the SCOTUS 6-3. Of the six SCOTUS justices voting in favor of the Mississippi law, only one, Chief Justice Roberts, did not favor overturning the 1973 Roe v Wade decision. The other five justices that voted in favor of Mississippi’s 15 week ban, voted to overturn the entire Roe framework in a majority opinion written by Associate Justice Samuel Alito. As a result, the US now is a patchwork of different legal environments when it comes to abortion, reproductive rights, and access to reproductive health care. There are many states, such as New York, Connecticut, Illinois, Oregon, and Washington that are so supportive of abortion rights that they are becoming destinations for abortion seekers from other US states.

Today, our focus is Alabama, also called the Yellowhammer State and the Cotton State. Sadly, this state is hostile to abortion, having passed a law in June 2022 prohibiting just about all abortions within the state’s borders. No exceptions are allowed in cases of rape or incest. This means that Alabama will now treat victims like the ten year-old rape victim from Ohio who had to travel to Indiana for an abortion this past summer the same way that Ohio treats them. They will be forced to continue the pregnancy, or to travel out of the state for care. The only exceptions to this statewide abortion ban in Alabama are cases when the mother needs an abortion to save her life or to avoid severe bodily harm. Because the wording of the law is vague, healthcare providers will be under pressure to hold off on terminating pregnancy, until the mother is unstable, making it more likely that she will die. This is because prosecution for providing abortion care that is not deemed to be necessary to save the mother’s life could result in the loss of one’s license to practice medicine, or even a prison sentence, either way preventing the practitioner from helping other patients. Doctors and other providers (physician assistants, nurse practitioners will be under pressure to consult with attorneys before providing abortion care, which a terrible way to practice medicine.

The only positive aspect of the Alabama abortion situation is that the new law does not make trouble for abortion seekers who travel outside the state for their care, whether that care is a medication abortion (which you can obtain up to 77 days gestational age) or a procedure abortion, meaning abortion requiring instruments. One such procedure is called a D&C, which stands for dilatation and curettage. Curettage is a kind of scraping of the inner lining of the uterus. Extracting a pregnancy, either viable or not, is only one of several reasons for performing a D&C. D&Cs can be performed for diagnostic reasons, such as when there’s a suspicion of abnormal cell growth in the endometrium. Therapeutic D&Cs can be performed for removing products of conception, but also for removing overgrowth of the uterine lining. D&C by itself is adequate only early in pregnancy, so after a certain point the next option is dilatation and suction. This means that, after the cervix is dilated, the doctor suctions out the products of conception. Sometimes this can be done with a syringe, but often it requires power suction. A tube called a cannula is inserted through the opened cervix. Cannulae come in a range of sizes that are chosen based on how far along the pregnancy is, or was before it became inviable. In some cases, following suction, the doctor may then perform some curettage to extract any remaining products of conception.

States that are receiving abortion seekers from Alabama include North Carolina (which permits abortions up to 20 weeks, 6 days) and Illinois, where laws follow closely to the Roe framework, meaning that there are no restrictions on abortion until you reach about 24-26 weeks, when the fetus becomes viable (able to survive outside the womb). At the time of the writing of this post, Alabama’s neighboring state, Florida, still permits abortion up to the 15th gestational week, but this can change as a much more restrictive law is under review in Florida’s courts. Numerous, more distance states, also welcome out-of-state abortion seekers. Some such states, such as Oregon, have funds budgeted to help such out-of-state abortion seekers with travel and lodging expenses. Additionally, you can obtain assistance in the form of funding to travel by contacting the National Network of Abortion Funds.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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