'A massive public health crisis': How overturning Roe v. Wade could harm Arizonans

Stephanie Innes
Arizona Republic

Reproductive rights advocates in Arizona are preparing for the possibility that abortion will be illegal here in most circumstances. Such a scenario would cause serious health problems for pregnant individuals and their families, they say.

The leak Monday of a draft U.S. Supreme Court ruling on a Mississippi abortion law indicates the country's top justices will overturn the landmark 1973 decision Roe v. Wade, which protected a pregnant person's right to choose to have an abortion.

Some members of the health community are raising funds and pooling resources so that in the event abortion is outlawed in Arizona, they'll be able to connect pregnant individuals with the care they need, including sending them out of state, said Dr. Gabrielle Goodrick, owner and medical director of Camelback Family Planning in Phoenix, a private clinic that provides abortions, among other health care services.

But the need will be tremendous and those who suffer most will be minorities, and pregnant individuals with low incomes and transportation issues, she predicted.

Gabrielle Goodrick

"It is not good for women's health. All you have to do is look to countries where abortion is illegal and look at the maternal mortality rates. Look at Africa, terrible maternal mortality, it's very anti-abortion there," Goodrick said.

"I think we have a hint of what's to come by what's happened in Texas. Basically in Texas, abortion has practically been outlawed from six weeks on and most women don't even find out they are pregnant until they are five to six weeks."

Goodrick already has seen patients from Texas come to Arizona to get care, including one woman who drove 20 hours each way for a consultation and appointment to get an abortion pill.

While it's unknown how the justices will decide Dobbs v. Jackson Women's Health Organization, and whether they actually will overturn Roe v. Wade, public health and reproductive rights advocates have long known it was a possibility.

In an interactive report titled "What If Roe Fell," the international Center for Reproductive Rights predicts that if the U.S. Supreme Court overturns Roe v. Wade, Arizona will likely try to prohibit abortion altogether. It includes Arizona as one of at least 26 states in the "hostile" category for protecting reproductive rights.

Arizona has taken numerous steps to inhibit reproductive freedom and access to abortions in the state have declined in recent years, said Eloisa Lopez, executive director of Pro-Choice Arizona and the Abortion Fund of Arizona.

"If this (Roe v. Wade) were to be overturned and the power is returned to states to decide, with our current anti-abortion state Legislature, I would anticipate seeing our abortion protections severely eroded here, if not banned altogether," Lopez said. "Pregnant people will still access abortion care. It will just become more dangerous for them."

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Arizona has 9 licensed abortion providers

Arizona has nine licensed abortion providers, according to the Arizona Department of Health Services. The providers are concentrated in metro areas, with six in the Phoenix area, two in Tucson and one in Flagstaff. Twelve of Arizona's 15 counties do not have any abortion providers, the latest state information shows.

"Our access here has already been severely limited. There used to be more (abortion) providers," Lopez said. 

During the 2020 reporting year, the total number of reported abortions performed in Arizona was 13,273, compared with 13,097 in 2019, the state's most recent abortion report says.

"Could you imagine forcing 13,273 people to travel out of state?" Lopez asked. "People are going to be forced to remain pregnant. … Forcing people to remain pregnant is inhumane. It is destroying families. It is keeping people in poverty."

Arizona's restrictions that already limit access to abortions include a mandatory minimum 24-hour waiting period after a required in-person consultation/information session before a patient can obtain either a surgical or medication abortion.

The waiting time to get an appointment for that initial consultation can be three to four weeks, Goodrick said. Because her clinic takes walk-ins for a consultation, lineups outside her clinic typically begin at 5 a.m. on weekdays, she said.

"We're in a crisis right now," she said. "Women have to stand in line, get on the list and then they wait all day sometimes."

A medication abortion, sometimes referred to as the abortion pill, is a two-drug combination for use up to 10 weeks of pregnancy that accounts for more than half of all abortions in the U.S. If Arizona chooses to ban abortion altogether, reproductive rights advocates predict it would prohibit both medication and surgical abortions.

Arizona Gov. Doug Ducey last year signed a law that criminalizes abortions based solely on genetic conditions such as Down syndrome or cystic fibrosis. The law qualifies fetuses and embryos as people at the moment of conception, which could end up being used to criminalize people who self-manage an abortion, Lopez said.

And this year, Ducey signed a bill banning abortions after 15 weeks of pregnancy in almost every circumstance.

The Abortion Fund of Arizona works to help pregnant individuals with logistical and financial support in obtaining an abortion, which typically costs $500 to $600, and is not typically covered by health insurance.

In the event that abortions in most circumstances are outlawed in Arizona and other states, organizations such as the Abortion Fund will be important in helping people to navigate their care, Lopez said. The need will be huge, she said.

"It's a massive public health crisis we're moving towards," she said. "The biggest barrier to the majority of people who access our fund is the lack of financial resources to even pay for their abortion. ... We don't have the infrastructure to help people around the clock and that's really the direction we need to go towards."

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'Abortion doesn't have anything to do with religion. ... It has to do with public health'

Scientific evidence has proven that access to abortion is better for overall population health, said Dr. Ricardo Correa, president of the Maricopa County Medical Society.

"Maternal mortality was very high prior to establishing abortion as a legal decision of the female," he said. "Abortion doesn't have anything to do with religion or belief or politics. It has to do with public health."

Correa, a Phoenix endocrinologist and volunteer medical director of a clinic for underserved people called PACH, Phoenix Allies for Community Health, said abortion is an essential part of comprehensive health care. The people who suffer most from abortion restrictions are underserved communities, including minorities and people with low incomes.

Correa has prepared himself for a Roe v Wade reversal, and said he's certain a reversal will result in a ban on nearly all abortions in Arizona. Correa said banning most abortions would be terrible for Arizonans' overall health.

Ricardo Correa

"We should be in agreement that health is health and evidence is evidence. People die more in places where abortion is illegal," he said. "Whenever you put religion and politics into a decision with medicine you get what we got with COVID. … Everyone has the right to believe what they want to believe but our personal belief is different from what public health is."

Goodrick, the Phoenix abortion provider, said if most abortions are prohibited in Arizona, many women will end up trying to order pills for a medication abortion online. She fears those women will be hesitant to seek medical care if there are complications.

"Women may not know how far along they are and do it too far along in the pregnancy. And women will not feel safe going to emergency rooms or even probably calling their own gynecologist," Goodrick said.

Even if most abortions are outlawed, Goodrick said her clinic will continue its work in a different way. She predicts many doctors will be fearful of treating patients who have obtained abortions illegally or out of state.

"We will help with their coordination of care if they have to go out of state. We will be busy," she said. "We will possibly be seeing them before they leave the state to evaluate their care, do their ultrasound etc. And if they do leave the state for part of their abortion or all of their abortion, they are going to need follow-up care."

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Doctor: Need for abortion care will remain the same

Goodrick said the need for abortion care will remain the same regardless of the law. 

"All of it's going to happen, it's just going to happen illegally. I won't be doing it but there are many organizations that are going to be mailing medicine to women all over the country," she said. 

"It's a public health issue and that is what led to the legalization in 1973. The medical community, and the other community that wanted this was clergy. The clergy and the doctors wanted this for the safety and the health of families and women," Goodrick said. "The Supreme Court justices in 1973 knew what they were doing."

Arizona has several strict anti-abortion laws that are blocked by Roe v Wade. The oldest, a 1901 territorial law, requires mandatory prison time for abortion providers.

The law provides for a minimum two years in prison, and a maximum of five years, for anyone who helps a woman obtain an abortion by drugs or "other means whatever, with intent thereby to procure the miscarriage of such woman, unless it is necessary to save her life."

Although it's old, the law is still on the books but is not being enforced because of Roe v. Wade, said Jennifer Piatt, deputy director for the Western Region Office of the Network for Public Health Law.

"Nothing will be there to stop the enforcement of it, if the executive branch chooses, if Roe is gone," she said.

The 1901 law could be interpreted to include Plan B, which is emergency contraception intended to prevent pregnancy within 72 hours after a contraceptive accident or unprotected intercourse and is available over-the-counter, said Will Humble, executive director of the Arizona Public Health Association.

"These 13,000 abortions don't include anything with the Plan B, which is why we've seen a big decrease in teen births, without seeing an increase in teen abortions," Humble said. "If the courts say Plan B is covered under the territorial law then pharmacies couldn't even sell it in Arizona. Then you'd have a lot more teen births."

One of the most serious public health issues in Arizona is intergenerational poverty, Humble said, and having a child before one is financially ready to afford that child is a major risk factor. 

"That poverty ends up resulting in a cascade of really bad public health outcomes," he said. "If you are living in a state that is going to outlaw abortions, is there going to be a commensurate increase in the safety net to help those new families? You have to say the track record for doing that in Arizona is not good."

Republic reporter Ray Stern contributed to this article.

Reach the reporter at Stephanie.Innes@gannett.com or at 602-444-8369. Follow her on Twitter @stephanieinnes.

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