The day Mayron Hollis found out she was pregnant in the spring of 2022 was the same day doctors gave her terrible news: the pregnancy could be fatal to both her and the unborn child.

Hollis had given birth to another child earlier in the year via C-section, and doctors were concerned that she would experience a C-section scar pregnancy, a rare type of ectopic pregnancy in which a fertilized egg implants and develops in the cesarean section scar. May cause fatal internal bleeding.

That left Hollis with a difficult choice: terminate the pregnancy or risk her own death and the death of the fetus.

“It’s like Russian roulette,” Hollis said.

Hollis decided to seek an abortion. But by the time her appointment arrived in August, it was too late: She lived in Tennessee and the state’s abortion ban had gone into effect, making the procedure a felony for the doctors involved. The law does not offer exemptions for life-threatening pregnancies, although doctors can use the threat to the mother as a defense in criminal trials.

Hollis is among the 65 million women and girls of childbearing age in the US who have been caught up in the fragmented landscape of abortion policy since the Dobbs v. The Supreme Court’s Jackson struck down federal abortion protections in June 2022. Since the ruling, more than one-quarter of states have banned abortion entirely, and several more have severely restricted access.

For women and their families, access to abortion is now highly dependent on financial and geographic circumstances. For abortion providers, the year has brought influxes of out-of-state patients and a barrage of legal challenges. Meanwhile, opponents of abortion are enjoying their success. Some say they expect to see national restrictions.

Data on access to abortion reveal an increasingly unequal health system for women, in which those with fewer resources are less likely to abort.

distance and division

Abortion is prohibited, with few exceptions, in 13 states, and care is also not available in Wisconsin, where there are no official abortion providers. Seven states restrict abortions based on the number of weeks a woman has been pregnant, with some bans going as far as six weeks: before many women know they are pregnant. More than 28 million women of reproductive age live in states where abortion is prohibited, not available, or restricted, with 2 million more in the two states where abortion is available but restrictions are pending.

Planned Parenthood Society Estimates — a non-profit research organization focused on reproductive rights and abortion — suggest that the 13 states that banned abortion had more than 7,000 fewer abortions in the six months after Dobbs.

The bans and restrictions mean that many women seeking an abortion have to travel long distances. Before Dobbs, less than 15% of women of reproductive age lived more than an hour’s drive from the nearest abortion center, according to a study by researchers affiliated with Boston University, which compared the population distribution to the locations of abortion clinics across the country. By September, just three months after the Dobbs decision, that figure had more than doubled, to 33%.

Research from Boston University found that the impacts of travel time were particularly acute for women of color: the proportion of black women who are more than an hour’s drive from an abortion facility increased from 15% to 40% %, and for Hispanic women, the proportion increased from 8.6%. at 30.3%.

Estimates from the Planned Parenthood Society indicate that during the first nine months after the Dobbs decision, more than 80,000 people who sought abortions in states where abortions are banned altogether or after six weeks faced obstacles.

Women who abort are usually 20 years old and already have children, according to the Guttmacher Institute, a research-focused nonprofit that supports abortion rights. Almost half live below the poverty line.

“This is a story of inequality and poverty,” said Caitlin Myers, an economics professor at Middlebury College who researches reproductive politics. Her work includes a study that found that mandatory waiting periods disproportionately affected young women and women of color.

Myers said that often those who carry babies to term who would otherwise have finished are «the poorest, the most vulnerable of an already poor and vulnerable population.»

In all, estimates from the Family Planning Society suggest that more than 25,000 women were unable to have an abortion between July and March. Many were unable to overcome financial and logistical barriers, including travel, childcare, or insurance policies that do not cover out-of-state abortions the same way they would in-state.

“The people who get trapped are often poor women who don’t have jobs, who work shifts and don’t have benefits,” Myers said.

After Tennessee’s abortion ban went into effect on August 25, Hollis learned that her abortion had been cancelled.

“I got the call on August 26, my birthday, that there was not going to be a surgery,” he said. “It was unbearable the day I received the news.”

Then, at 25 weeks pregnant, Hollis began bleeding uncontrollably, blacking out and losing consciousness. Her daughter Elayna was born 14 weeks premature and is still struggling with a variety of health issues. Hollis required a hysterectomy.

Mayron Hollis’s daughter, Elayna, weighed 1 pound 12 ounces as a newborn.Mayron Hollis

protections and shelter

Many states have instituted abortion protections in the wake of the Dobbs decision. Voters in Vermont, California and Michigan enshrined abortion rights in their state constitutions during the midterm elections. Minnesota codified abortion rights into law in January. Meanwhile, voters in Kentucky have rejected an effort to amend the state constitution to explicitly say there is no right to abortion.

The flurry of protections turned those states into havens for those seeking abortions. Data from the Planned Parenthood Society survey shows abortion rates rising after Dobbs in Illinois, Minnesota, Nevada, Maryland and other states.

“Front-line providers receiving patients from banned states are mostly overwhelmed,” Myers said. For example, she said that in Kansas, it’s typical for none of the state’s providers to have appointments available within two to three weeks.

Dr. Raegan McDonald-Mosley, an obstetrician from Maryland, said many of her patients are not from the state.

“I have seen many patients who have to travel significant distances from out of state,” said McDonald-Mosley, executive director of the nonprofit abortion advocacy group Power to Decide. “I have seen patients from Wisconsin, from Texas.”

The patients McDonald-Mosley worries the most, she said, are the ones she doesn’t see because they’re hampered by roadblocks similar to those Hollis faced.

The fights ahead

Hey Jane, which operates virtual clinics that provide patients with medical abortions, said the number of patients it has treated has more than doubled since Dobbs’ decision. In Illinois, the numbers after her to Dobbs quadrupled.

Medical abortion accounted for more than half of all abortions in the US in 2020, according to the Guttmacher Institute. The regimen consists of a combination of two drugs, mifespristone and misoprostol, to terminate pregnancies up to 10 weeks. Currently, access to medical abortion is legal in some form in 36 states and Washington, DC

However, a federal court is considering a lawsuit seeking to overturn the Food and Drug Administration’s approval of mifepristone and will likely head to the Supreme Court.

The momentum is undeniable, say leaders of anti-abortion groups.

“There is a sense of relief, because our hands are no longer tied,” said Carol Tobias, president of National Right to Life. “We would pass legislation that we thought was helpful to mothers and babies, and the abortion industry would take her to court, where she would be beaten up, now we have a chance.”

However, Tobias said, activists must continue to defend anti-abortion laws against legal challenges and legislative changes.

Kelsey Pritchard, director of state public affairs for Susan B. Anthony Pro-Life America, said her group hopes for a national ban on abortion after 15 weeks gestation.

“We are happy with the progress we have made in just one year. But we’re not satisfied with the end point we’re at,” Pritchard said. “We are not done. We’re not even close to finishing.»

Other groups continue to work at the local level.

Brian Westbrook, executive director and founder of Coalition Life, an anti-abortion group that intervenes in front of abortion clinics in Missouri and Illinois, said that a «culture change» on the issue is the «first and foremost goal» of the group, adding that «They will certainly follow abortion laws.»

In Tennessee, Hollis said she is grateful for her daughters, despite the ongoing complications.

Their daughter Elayna was born weighing 1 pound 12 ounces, well below the 7 pounds of a typical full-term baby. Today, at 6 months, she is still receiving oxygen and a feeding tube.

That has strained the finances of the Hollis family. “We maxed out on credit cards,” Hollis said. “We had a business, but with Elayna in ICU, she got really sick and I couldn’t afford to drive back and forth, so I had to sleep in my car. Some days I showered at Planet Fitness.»

“God made happen what was supposed to happen,” Hollis said. «But he should have been able to have that option.»