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'Roe' has been gone for a year. Here's how it has changed things for doctors daily

JUANA SUMMERS, HOST:

Tomorrow marks one year since the Supreme Court overturned Roe v. Wade. Justice Samuel Alito delivered the court's majority opinion in the case, an opinion that barely mentions doctors. But it's doctors who have been subject to many of the state laws that ban abortion. Those who perform an abortion in Texas could face life in prison. They also face fines and the loss of their medical license. So one year in, how has the new reality of reproductive health care changed life for doctors? NPR's Selena Simmons-Duffin has been reporting on this. Hey there.

SELENA SIMMONS-DUFFIN, BYLINE: Hi, Juana.

SUMMERS: So, Selena, what do physicians say about how these laws affect what happens in the exam room?

SIMMONS-DUFFIN: Well, a survey of OB-GYNs came out this week from the health policy group KFF. And a large majority, 68%, said the Supreme Court ruling allowing states to ban abortion has worsened their ability to manage pregnancy-related emergencies. So we're not just talking about abortions. This is any emergency that comes up in pregnancy. In states that ban abortion, about 4 in 10 OB-GYNs said that they were constrained in caring for miscarriages and pregnancy emergencies. And 6 in 10 were worried about legal risks when making decisions about care. So most of the state bans include some language that giving a patient an abortion is legal if they're in serious danger. But those exceptions don't capture how these conditions often play out.

SUMMERS: Tell us more about that. How does this often play out?

SIMMONS-DUFFIN: OK. So let me give you an example of what doctors call PPROM, which stands for preterm premature rupture of membranes. That's when someone's water breaks too early for the fetus to survive. So we're saying before 22 weeks or so. When this happens, the pregnancy can't continue. And the pregnant patient is at high risk of developing an infection. But many doctors and hospitals in states that ban abortion won't provide an abortion procedure unless the fetal heart has stopped - so it's miscarriage management - or the pregnant patient gets really sick. I talked to Dr. Nisha Verma. She's an OB-GYN, and she consults with ACOG, the American College of OBs. And she also practices in Georgia, where there's a six-week abortion ban.

NISHA VERMA: A lot of institutions have said, like my institution has said, in stable PPROM, even though their risk of getting sick is super-high, we can't provide care until they get sick. And that's what we've seen in many places.

SIMMONS-DUFFIN: NPR reported on this very thing happening to a woman named Elizabeth Weller in Texas. She was told to leave the hospital and wait at home until she showed clear signs of an infection, like a fever over 100.4 degrees. Verma says there have been many stories like this. Some patients have even testified to lawmakers about what happened to them.

VERMA: And it's really easy for the legislators to look back at a case where something bad does happen and say, oh, you could've provided care there. But there's - like, literally every single patient we take care of - it's, like, an individual situation with individual risks.

SUMMERS: And, Selena, I mean, most abortions aren't in the second trimester and aren't complex medical situations. So how do these laws we're talking about affect everyday care?

SIMMONS-DUFFIN: You're right. So 90% of abortions happen in the first trimester. And many are self-managed with people taking medications at home. They're not happening in hospitals. Surveys show many times, people are deciding to get abortions because of a mix of several reasons. A lot of times, finances play a role, not wanting to lose a job or interrupt education. There might be unsupportive family members. There are a million reasons. Verma told me several times a week, she has to turn people away because she can't legally give them an abortion in Atlanta after six weeks.

VERMA: I'm from the South. I was born and raised in the South. I always wanted to practice in the South. This is my community. This is my home. I want to be here. But it's hard. Like, it's hard to every day have to turn people away that you know you have the skills and the ability to care for. We're the ones - right? - that are sitting with these people, hearing about their lives and then having to say, we can't do this. I'm so sorry.

SIMMONS-DUFFIN: She says some doctors will tell patients that they turn away, that they can't treat in their state that there are other states they could travel to, and they can get abortions legally elsewhere. But some doctors won't even do that. One doctor I spoke to in Texas earlier this year told me she has colleagues who say cryptic things like, the weather's really nice in New Mexico right now, or, I've heard traveling to Colorado is really nice this time of year, to hint that they can travel out of state to get an abortion.

SUMMERS: I mean, Selena, that's stunning. What is making these physicians - some physicians - afraid to even say the word abortion?

SIMMONS-DUFFIN: Well, some states have these civil aiding and abetting laws. So sometimes they're called bounty hunter laws. So doctors are afraid if you say to a patient, hey; you know, you can travel and get an abortion, a partner might find out and get mad and sue you. I should emphasize those cases haven't really materialized in the past year. And neither have cases of prosecutors going after doctors for violating an abortion ban. Verma thinks that's in part because institutions and hospitals have been so careful and so conservative in this first year. And that includes her own institution. But she thinks that's been changing.

VERMA: Now we're figuring out, like, how much can we push the envelope? But it's scary, right? And, like, no one wants to be the test case.

SIMMONS-DUFFIN: She does think at some point, maybe in this coming year, there will be a test case.

SUMMERS: A test case. Can you explain what that is and how it might play out?

SIMMONS-DUFFIN: Well, since the Dobbs decision last year, no doctor has been charged for providing an illegal abortion. So people are really waiting for that. What will it look like? What state will it happen in? And how will the decision on that case shape how medical care is provided? There are so many unanswered legal questions still. People are really in the dark. The other thing that's happening in the courts that's really relevant in this coming year is that the Supreme Court is likely to hear the case about mifepristone. You've probably heard about this. Yeah. A group in Texas is challenging FDA's approval for mifepristone, which is one of two medications used for medication abortions. That decision could have an enormous impact.

SUMMERS: NPR's Selena Simmons-Duffin. Thank you so much.

SIMMONS-DUFFIN: Thank you. Transcript provided by NPR, Copyright NPR.

Selena Simmons-Duffin reports on health policy for NPR.