By Rachel Crumpler
Katherine Farris has been an abortion provider for more than 20 years, and she says that this past year has been the hardest of her career — by a long shot.
Not her first year of practice when everything was new. Not the year she stepped into the role of chief medical officer at Planned Parenthood South Atlantic to supervise clinic operations across North Carolina, South Carolina, Virginia and West Virginia. Not the years she navigated COVID protocols to keep her staff and patients safe.
The last year stands out above all the rest, as challenges escalated to a new level.
That’s because a year ago today, North Carolina’s new stricter abortion law took effect, significantly diminishing abortion access in the state. The time frame for seeking most abortions dropped from 20 weeks of pregnancy to 12 weeks, and the law added an in-person requirement for state-mandated counseling at least 72 hours before an abortion.
Farris has had a front-row seat to the upheaval caused by the change in law: Clinic staff frantically reworking operations to comply. Physicians stretching themselves thin to see as many patients as possible — knowing they can never meet the full demand. Patients desperately pulling resources together to book an appointment — often driving hours for care. Clinics turning patients beyond the state’s limits away without knowing whether they will be able to travel elsewhere.
“These aren’t just numbers to us,” Farris said. “These are real human beings that sit in front of me in my office, and I see the burden this has put on them.”
The waiting room at Planned Parenthood’s Winston Salem clinic. North Carolinians and people from out of state travel here and to the state’s other 13 abortion clinics for care. Credit: Rachel Crumpler/NC Health News
No longer providing care beyond 12 weeks or practicing to her full capabilities has been a seismic shift that’s been difficult for Farris to adjust to. She gets a glimpse of the more weeks of care she used to be able to provide in North Carolina when she practices in Virginia, which allows abortions up to 26 weeks.
“Depending on where my feet are planted, that’s what determines the care I can give,” Farris said. “It’s not my skills. It’s not the support staff. It’s not the equipment. And it’s certainly not what the patient needs. It’s just where my feet are planted.”
Despite the new restrictions, abortion volume in North Carolina has not dropped significantly since Senate Bill 20 took effect a year ago on July 1. In large part, that’s due to the efforts of abortion clinics, providers, abortion funds and other support networks that have worked to keep abortion accessible. Patients themselves have also gone to great lengths to overcome the increased obstacles to access care.
“Patients are incredibly resilient and resourceful,” Farris said. “But every day, I am angered that they have to be. They should not have to be so resilient. They should not have to be so resourceful. They should be allowed to get this care from a provider they already know and trust in their own community.”
Frantically adjusting
Calla Hales, executive director at A Preferred Women’s Health Center, which operates two abortion clinics in North Carolina, tries not to think about the day a year ago when abortion access in the state changed.
Newly gained Republican supermajorities in the state General Assembly — a result of one Democrat’s abrupt party defection — swiftly passed the state’s stricter abortion law, Senate Bill 20, over the objections of medical professionals and Gov. Roy Cooper’s veto.
Health care providers stand behind Gov. Roy Cooper in support of his veto of Senate Bill 20 at a rally in Raleigh on May 13, 2023. Credit: Rose Hoban
Hales said the first weeks were particularly tough and frantic.
“I really remember most like not sleeping for days on end,” she said. “To be quite honest, there is a stretch of time that last week of June and the first couple weeks of July where I was probably sleeping like five hours a week.”
She knew the stakes were high. The clinic needed to quickly change its operations to comply with the law and serve as many patients as possible.
Physicians and abortion clinic staff reworked processes, patient flow and schedules. They trained staff. They learned the new state-mandated counseling script and reporting requirements.
“You’re having to figure it out on the fly,” Hales explained. “Patients don’t stop needing care to provide you with the time to stop and figure out how to address practices to better change to the scope of these new rules.”
Amber Gavin, vice president of advocacy and operations at A Woman’s Choice, an abortion provider with three clinic locations in the state, said clinics grappled with how to accommodate twice as many appointments to provide abortion care for the same number of patients. Patients coming in for two in-person appointments strains the physical space within the clinic and the staff’s time.
Even now, with processes worked out, it continues to be an intricate balance of accommodating the increased volume of people in and out of the clinic, especially given the ramped-up pressure of the reduced time frame that abortion procedures can take place in North Carolina, Gavin said.
As a result of the new requirements, abortion volume in the state dropped substantially during the months immediately after the implementation of Senate Bill 20, according to data from the Guttmacher Institute, a national organization that tracks trends in reproductive health. However, the number of abortions provided each month has since ticked back up, returning to volumes in line with pre-Senate Bill 20 numbers. In March, North Carolina provided about 4,030 abortions — the highest monthly volume since the law took effect last July — according to the latest data available from Guttmacher.
All three abortion clinic providers in the state that NC Health News spoke with said they’ve added days of abortion care to their schedules. They’ve also gotten creative with some of the appointment offerings, adding some later in the day, as they recognize that some patients can’t make it to morning appointments with the travel distances they are facing. Planned Parenthood has even expanded the locations where it provides medication abortion; the Durham health center started the service last month, and the Greensboro location is scheduled to start in mid-July.
A year later, some days can still be just as frantic as those early days, Gavin said. Phones ring off the hook. Patients’ emotions boil over — and staff’s can too. Clinic staff increasingly have to expand beyond providing medical care, doing more coordination to help patients navigate to other states to receive care past the 12-week North Carolina limit.
The abortion law also remains in flux, with two lawsuits challenging certain requirements that lawmakers implemented. That keeps abortion providers on their toes awaiting any decisions that further affect how they can provide care.
For instance, last month, U.S. District Judge Catherine Eagles in Greensboro issued a judgment that struck down several of North Carolina’s rules on dispensing medication abortion pills. Lawyers for Republican legislative leaders promptly appealed the judge’s decision.
Increased patient hurdles
Abortion providers say the most burdensome part of the law is the requirement that a patient go to an in-person appointment for state-mandated counseling at least 72 hours before an abortion. Previously, this pre-procedure counseling could occur over the phone or online.
The new requirements mean that patients must visit clinics at least twice — and many need to travel long distances to reach one of the state’s 14 abortion clinics spread over nine counties. The additional appointment means extra time off work and more travel, hotel stays and child care costs.
“People don't have extra money lying around that they can just stay in a hotel for three days,” Farris said. “They don't have someone to watch their kids for three days. They can't get time off of their job for three days. It's really incredibly cruel, especially because it is so medically unnecessary.”
Katherine Farris, chief medical officer at Planned Parenthood South Atlantic. She stands at an ultrasound machine. Credit: Rachel Crumpler/NC Health News
One of the biggest barriers to abortion access is cost, said Justine, a Carolina Abortion Fund staff member who requested that NC Health News only use her first name for security reasons. Garnering the resources for a two-visit process under Senate Bill 20 can be even more of a challenge as nonmedical costs for gas, flights, hotels, child care and lost wages accumulate. That’s reflected in the sizable uptick in the number of callers seeking financial assistance to cover these practical support costs to get to their appointments, Justine said.
Justine said Carolina Abortion Fund, which helps patients pay for part of their procedure, is distributing more funding per month than before Senate Bill 20, but it is only able to meet about 40 percent of caller demand. In March, the latest data Carolina Abortion Fund could share with NC Health News, the organization distributed more than $70,000. In comparison, in March 2023, the organization distributed about $45,000.
Every month — typically after around 10 business days, depending on call volume — Carolina Abortion Fund exhausts its monthly funding, Justine said. When that happens, volunteers and staff members work with callers to help figure out funding, referring them to other funds and resources.
Farris says the financial and logistical challenges caused by the increased restrictions are pushing abortion care later in pregnancy. For example, Farris said she recently saw a North Carolina patient who came in for her initial appointment at 11 weeks pregnant. But by the time the patient could obtain her abortion procedure, she was 15 weeks pregnant — past the 12-week limit. Ultimately, she took a bus to Virginia, where Farris provided her abortion care.
Guttmacher data shows that in 2023, a total of 1,720 North Carolinians obtained abortions in Virginia — the most popular out-of-state choice.
“When they write this law, they just assume everyone will magically know they're pregnant sooner and come in right away,” Farris said. “But the human body doesn't work that way, and people's life circumstances don't work that way. So instead, what happens is while some people are coming in much sooner, we also, on the other end of the spectrum, see people push later and later in pregnancy by the time they can get the resources.”
Others may be unable to pull the needed resources together. Clinics say a number of people don’t make it back for another appointment after the in-person counseling.
The patient check-in window at Planned Parenthood's Winston Salem clinic. More so than the narrowed gestational limit for seeking an abortion in the state, abortion providers say the most burdensome part of the law is the requirement that a patient go to an in-person appointment for state-mandated counseling at least 72 hours before an abortion. As a result, patients are required to visit clinics at least twice. Credit: Rachel Crumpler/NC Health News
The additional logistical hurdles can also create a more trauma-filled experience, said Simran Singh Jain, an abortion doula in Durham. Over the past year, she’s worked with about 30 people seeking abortions. The time crunch is forcing people to move more swiftly to access care, potentially neglecting their own emotions as they stay hyperfocused on navigating the logistics.
“We're having much more of those logistical conversations, and so people don't really have the opportunity to actually process what is a very vulnerable moment in their lives,” Jain said. “Because of that, I'm finding a lot of people are reaching out to me months later for the support that they were not able to take at the time because they were so focused on that logistical piece — just how challenging it is to get an abortion fundamentally — versus being able to actually take the time to navigate their own emotions about it.”
And a handful of patients continue to show up to clinics thinking they are getting an abortion that day, and they are devastated to learn they can’t — caught off guard by the two-appointment requirement.
Hales said these people often assume it’s a clinic policy rather than state law. She’s seen people plead to have the abortion on the same day — saying that they’ve already put much thought into the decision and don’t need another waiting period — but her hands are legally tied.
In other cases, said Rachel Jensen, an abortion provider in the Triangle, she’s cared for patients with nonviable pregnancies who have questioned why they have to wait 72 hours — the longest waiting period in the country.
“I don't have a good answer,” she said. “It's because of the state law. And it's a really sad thing to say that your medical practice is dictated not by medical best practices, but by essentially arbitrary policies.”
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