What Abortion Providers in Anti-Abortion States Will Do Post-Roe

On June 24, the U.S. Supreme Court overturned Roe v. Wade, undoing the constitutional right to abortion that has been in place for nearly 50 years. The reversal paves the way for states to ban or limit abortions, and many are expected to do so soon.

Four abortion providers who live in states that severely restrict or are likely to soon criminalize abortion spoke with TIME about what they plan to do now. Some say they’ll shift care across state borders, while others resolve to amp up their activism in a post-Roe America. Yet all four providers say they dread the way new laws will endanger pregnant people seeking abortions. Their interviews have been lightly edited for length and clarity. [time-brightcove not-tgx=”true”]

Dr. DeShawn Taylor

Ob-gyn in Phoenix

Taylor founded her Phoenix clinic, Desert Star Family Planning, in 2013. Earlier this year, Arizona enacted a 15-week abortion ban that was going to take effect later this summer, but it’s now possible that the state may pass an even stricter ban. Arizona also has a “pre-Roe” ban on the books—a law enacted before Roe and never removed—but whether or it will be enforced is unclear.

Those moments when I tell somebody that they’re too far along—the wailing and the emotion—are so heart-wrenching. I don’t want people to experience that if I can help it. Having my hands tied is hard.

I made up my mind some time ago that I was going to stay in Arizona and be a resource to the community. My clinic provides general gynecology, well-woman sexual health, gender-affirming care, and miscarriage management. The idea that once abortion is illegal in the state—that abortion providers potentially will leave the state—that doesn’t sit well with me, and it’s not in alignment with my values.

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I intend to be a resource for my community, a safe space. A place for the community as they’re mobilizing to help each other get what they need, where they can get accurate information. I also anticipate that the people of Arizona are going to need a safe place to receive miscarriage care, without being interrogated about whether they self-induced or not. People are going to be afraid to help.

Post-Roe does not look the same as pre-Roe. People are safely self-managing their abortions already. What concerns me is people are going to attempt self-managed abortion later in pregnancy. I’m concerned about bleeding complications and incomplete processes not being identified and treated, potentially causing infections. We may see people die.

Right now, I’m just really in a mode of determination. I’m a problem solver. The biggest issue is the criminalization piece. And what my limits are—what level of risk I’m comfortable taking, considering that most people who get criminalized in this country around these things are people of color. The pre-Roe law has an exception for the life of the pregnant person. The biggest question for me is, at what point can you intervene? Does the person have to literally be dying? If someone presents to me with a miscarriage, I’m not going to be interrogating people about how they got to this place. I’m just going to provide the care. And I suspect that those types of instances will be scrutinized closely as well.

I am a very spiritual person, and I consider my practice my ministry. It’s deeply gratifying, and I know I am changing people’s lives for the better. I’m just trying to stay open, to continue to provide as long as possible. Making sure I have staff, and that I’m resourced to provide abortion care all the way up until I can’t.

I believe that the pendulum will swing back, which is why keeping my clinic open is very important. We’ve seen over the course of the years that once independent abortion clinics close, they generally don’t open back up again.

Dr. Colleen McNicholas

Chief medical officer for Planned Parenthood of the St. Louis Region and Southwest Missouri

Until Roe v. Wade was overturned, McNicholas saw abortion patients in both Missouri and Illinois. But a “trigger” ban—a law that will take effect nearly automatically now that Roe is overturned—in Missouri means that abortions in the state will likely soon be outlawed (with an exception for pregnant people whose lives are in danger). McNicholas plans to split her work between Illinois, where the legality of abortion is not directly affected by the recent Supreme Court decision, and Missouri.

Missouri has long been the leader in eliminating abortion access. It’s passed nearly every single restriction and law that other states have, and did so a long time ago. Illinois will serve as an oasis and will be the nearest location for tens of thousands of people who will be seeking care. Now that Roe is repealed, we have two enormous responsibilities: to step up and fill gaps for states that have lost or will lose access, while simultaneously working within Missouri to fight back and build back some access.

We can’t abandon places. We know that over time, it will change, but we need the people here who are committed to that change to stay here and work for it.

Read More: What It’s Like to Be an Abortion Clinic Escort

Abortion is an act of love and an act of humanity for people who are pregnant and their families. It provides some hope and the opportunity to meet their potential, to get out of poverty. I think the elimination of abortion says to people: we don’t care about you. We don’t care that you’re struggling. The real, on-the-ground implication for patients is that life gets harder. But people should know that there are lots of folks out there trying to make a difference, to address this, and to eliminate the barriers.

The reason why I continue this work is that I get to sit with patients every single day and see the impact of a very simple procedure. Sometimes it’s as simple as me handing you a medication. There are very few medical services that, with such little time and education and skill, can make such a profound impact on somebody’s life.

Dr. Carol Wanna

Ob-gyn in Macon, Ga.

Wanna has provided abortions part-time at Planned Parenthood for about two years. The reversal of Roe v. Wade will likely clear the way for Georgia to begin outlawing abortions after about six weeks of pregnancy.

Most of us have accepted what would happen this summer. You pretty much could see what was coming. But the cruelty of the decision still makes me feel sadness and depression.

Atlanta, Augusta, and Savannah are the only places in Georgia that abortions are provided, so there’s really nothing around where I live. I commute almost two hours to Atlanta and almost three to Savannah to be able to work with Planned Parenthood. I just so strongly believe in the right for women to choose their destiny. All of my patients are making a very difficult decision, but they’re deciding what’s right for their life at that time. The thought that women cannot have power over their destiny and be forced to continue a pregnancy they don’t want just horrifies me. Medically, abortion is extremely low risk; it’s lower risk than continuing the pregnancy.

Read More: Inside the Small Group of Doctors Who Risked Everything to Provide Abortions in Texas

I’ll definitely stay in Georgia, just because it’s my home. I will probably continue to work at Planned Parenthood, at least doing family planning and other services. I’m not ready to uproot my whole life, but if there are opportunities to go to states where abortions are legal, I would certainly consider traveling to provide services.

We’re going to have to change our services to try to enable women to get into clinic as quickly as possible, so that it can be done early. I worry that women are going to have to jump into having the abortion even though they’re not completely comfortable with their decision. That seems horrible. It might become a situation where even if a woman’s not completely sure, they know it’s now or never.

Tammi Kromenaker

Clinic owner and director of Red River Women’s Clinic in North Dakota

North Dakota has a “trigger” ban in effect that clears the way for the state to outlaw abortion soon after Roe v. Wade is overturned. Kromenaker is in the process of moving the clinic from North Dakota to Minnesota.

We’re very fortunate that we are on a border with Minnesota, which is considered a politically protected state for abortion. After the Supreme Court leak, we looked at what it would take to relocate the clinic over to Minnesota, because it was important for us to not change access. We already have patients who drive four, five, six hours just one way to get to our clinic.

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We don’t want to have to move. We’ve established amazing community connections, and it’s going to be like starting over. North Dakota law and Minnesota law are also very different. I’m going to have to learn the court system there and learn what judges are favorable and which ones might be hostile—all of those things that in North Dakota, we’ve got down.

We have a huge target on our back; we have for a very long time. We’ve basically been in litigation with the state of North Dakota pretty much continuously for over a decade. They tried everything with us, and we have met the challenge and worked really hard to be able to provide this care. It’s been challenge after challenge after challenge here, whether it’s the legislature or litigation or the protesters. So we’re ready to take on this next challenge.