It used to take three days to get an appointment at the Planned Parenthood in Southern Illinois. Since the Supreme Court overturned Roe v. Wade, that wait has grown to three weeks. At the same time, the clinic’s daily patient load has more than tripled. “Folks from Mississippi, Arkansas, Kansas, Texas, and Oklahoma are making their way to us,” Dr. Colleen McNicholas, chief medical officer at Planned Parenthood of St. Louis and Southwest Missouri tells Rolling Stone.
On Tuesday, McNicholas appeared before the Senate Judiciary committee to offer testimony about the fallout she has witnessed first-hand these last few weeks. “I come before you tired, frustrated, and angry,” McNicholas said. “Those of us on the front lines — the abortion activists president Biden’s team, just this weekend, referred to as ‘out of step’ — are the very ones who are holding back the public health crisis that’s about to sweep this country.”
As of this writing, abortion is unavailable in 14 states: Eight have total bans in effect, three have six-week bans; clinics are closed in three others because the law is so unclear. And overburdened providers, like McNicholas, are growing increasingly frustrated with a Biden administration that seems to have very little to offer them in terms of help.
On Monday, Xavier Becerra, Biden’s secretary of Health and Human Services, touted “new” guidance for health care providers: a clarification that doctors’ duty to provide emergency medical care to patients, including abortion, if a woman’s pregnancy threatened her life. “Today, in no uncertain terms, we are reinforcing that we expect providers to continue offering these services, and [reminding providers] that federal law preempts state abortion bans when needed for emergency care,” Becerra said in a statement announcing the guidance.
This is what passes for meaningful action by the Biden administration: reminding health care providers of their responsibility to try to save patients’ lives. The announcement is somewhat blunted by the fact that even the most rabid rightwing states already include an exception to protect the life of the person carrying the pregnancy in their abortion bans. (Although the shared desire to keep pregnant women alive shouldn’t be taken for granted: Doug Mastriano, Republican candidate for governor in Pennsylvania, has advocated for a ban on abortion with no exceptions — including to save the life of the mother.)
Even as it seems, on its face, as the absolute bare minimum the Biden administration could offer, there is the additional fact that this rule applies to a vanishingly small number of people. In Florida in 2020, for example, less than one quarter of one percent of abortions were performed to save the life of the mother.
But even this tiny gesture by the Biden administration is being welcomed by advocates desperate for action. “The states that have banned abortion, they all do have an exemption for life, but the way that has been interpreted has been extremely conservatively — where providers are essentially calling their lawyers before they’re treating patients” says Elizabeth Nash, state policy analyst at the Guttmacher Institute. “There’s real fear from providers that their diagnosis and their treatment plan may not be accepted by the authorities [as a valid justification for performing an abortion]. And I think having the federal backing is very helpful for those providers.”
McNicholas echoed that sentiment. “There’s nothing new about the regulation that wasn’t in existence two months ago,” she says. But, she adds, it is “helpful.”
“The guidance makes clear that the determination of whether an abortion is necessary is truly tied to the medical assessment made by the physician.” And that’s important, McNicholas says, because in many states, including Missouri, where she works, “in order for doctors to avoid prison time, instead of treating a patient before their health becomes life threatening, doctors now must contemplate how sick is sick enough before providing life-saving abortion care.”
Jessica Arons, senior policy counsel with the ACLU, agrees. “The so-called life exceptions in many state abortion bans are construed so narrowly, and threaten health care providers with such severe criminal penalties, that a patient may literally be dying on the table before health care professionals intervene, and by then it might be too late to save the patient’s life or prevent major damage to their health,” Arons says. “Hopefully the Administration’s directive will provide clarity to hospitals about their obligations and protections under federal law and ensure that pregnant patients are able to get the emergency care they need, including abortion, in a timely fashion.”
“I know it feels like a small thing,” Nash says of the Biden administration’s move. “But that — that is where we’re at.”