Opinion: A year since Supreme Court’s abortion ruling, there’s a real human cost

Editor’s Note: Dr. Samuel Dickman, MD, an abortion provider and primary care physician, is the Chief Medical Officer of Planned Parenthood of Montana. The views expressed here are his own. Read more opinion on CNN.

One year ago, the Supreme Court eliminated the federal constitutional right to abortion in their Dobbs v. Jackson Women’s Health Organization decision. Since then, lawmakers in 20 states — primarily in the South and Midwest — have banned some or all abortions. I often think about how these politicians have taken away patients’ freedom to choose their own medical care, making their personal opinions the most important presence in the exam room.

If they had actually been present in my health center in Montana this year, here’s what they would have seen:

One recent patient traveled nine hours from North Dakota. Last year, she went to a hospital there to replace her contraceptive implant. The religiously-affiliated hospital happily offered to remove the implant for her, but refused to place a new one. When she became pregnant, she had no choice but to spend two full days driving across state lines.

An Idaho patient had to travel with her whole family — four generations piled into a minivan — to get an abortion after she received a devastating diagnosis that meant her fetus would have no chance of survival after birth. She couldn’t get an abortion in Idaho, which has banned all abortions, with no exceptions, and caused an exodus of providers from the state.

A patient from Texas was absent from high school for weeks so she could get to Montana for an abortion. Minors are especially hurt by abortion bans.

When I moved to Montana last year, I knew what was coming. I had already seen the consequences of banning abortion in Texas, where I worked for years as an abortion provider.

In 2021, Texas enacted Senate Bill 8, restricting abortion after six weeks, and giving us a glimpse of what was to come. Under SB 8, we were forced to turn away almost every other patient because they were too far along in their pregnancy, which meant they were left with nothing but bad options: to drive eight or more hours each way to the closest health center in New Mexico, or to try to get medications outside of the formal health care system. Or, of course, they could — and many were forced to — carry a pregnancy to term.

After SB 8 took effect, the joy I felt practicing medicine — a career I had spent years training for — started to drain away. Before that, I felt lucky; every day I got to see firsthand the positive impact my colleagues and I had in our patients’ lives, simply because we were there to help them end a pregnancy safely. In Texas, abortion had become so culturally and politically charged that patients seemed to walk into my clinic expecting to be judged or dismissed. Just a little human decency was enough to elicit over-the-top expressions of gratitude.

And as I tried to settle into a new post-SB 8 routine, the job satisfaction I previously felt was replaced with what psychologists call “moral distress” — the despair that comes from being prevented from providing my patients with the kind of medical care that they sought.

After the Supreme Court’s ruling last year overturning Roe v. Wade, abortion was completely banned in Texas, cutting off what little access remained. Doctors there have been forced to turn away patients, and are not only unable to provide medical care, but are faced with the threat of jail time, fines and potentially losing their medical license.

A friend in Texas, privileged enough to move her family, left the state when she became pregnant because she was worried she would get subpar care if there was a complication. She was right to be concerned: researchers have documented dozens of cases where patients’ health has been compromised in the past year due to abortion bans.

Thousands of people in Texas, and millions in other states who have been robbed of their ability to decide whether to continue a pregnancy, will never have their stories told. The consequences in the lives of these women and their families — their health, financial status, emotional state and ability to access essential care — will be felt for generations.

These laws worsen the existing health inequities in a country that already has the worst maternal mortality rate among developed countries. Abortion bans and restrictions disproportionately harm marginalized communities. Patients from rural and Indigenous communities, and patients who face barriers like language, immigration status, income, the ability to take time off work, find child care and more, suffer the harshest consequences of abortion bans. Survivors of sexual assault are re-traumatized as they try to overcome obstacles to get abortion care or are forced to remain pregnant.

In Montana, where I moved with my family last year, my patients may often have to travel hundreds of miles for care, but at least I’m able to help them get abortions. Montanans value personal liberty, and the state constitution protects the right to individual privacy and patients’ ability to make decisions with their health care providers without government interference — a bulwark against politicians’ continued attempts to restrict abortion access. And as a result of a preliminary injunction from a Montana court, Medicaid in Montana still covers medically necessary abortions — a lifeline for patients and families who are already just barely getting by.

This spring, a woman came to my health center for an abortion. A colleague who had done an intake interview with her stopped me before I walked into the exam room: “She doesn’t want to talk.” This was an understatement. She had been raped, and when I walked into the room, she seemed both hypervigilant and terrified. She was grateful that I could help her end the pregnancy safely.

As providers, we will continue to do everything possible to make sure patients can get the care that they need — but it will take all of us to address this public health crisis and restore, protect and expand abortion access for future generations.