Even before the overturn of Roe v. Wade, abortion access was no guarantee in the United States. Prior to Dobbs v. Jackson Women’s Health Organization, the Supreme Court decision that overturned Roe, 11 million women of reproductive age in the US lived more than one hour from an abortion clinic—not exactly easily accessible. Further, from 2017 to present, 133 independent abortion clinics closed due to excessive regulation, lack of funds, or other government interference. In a post-Roe world, it’s only getting worse.
The rise of reproductive care deserts—regions where comprehensive reproductive healthcare has disappeared—is a stark geographic indicator of the dismantling of reproductive autonomy taking place across the country. The womb-bearing persons who find themselves in such deserts are in as much danger as a person stranded in an actual desert without water.
Banning Abortion Is About More Than Abortion
Independent abortion clinics like mine do not provide abortion services only. They also offer prenatal care, contraception, miscarriage management, other OB/GYN services, and gender-affirming care. Through them, womb-bearing people can access the full range of reproductive healthcare. Now that is getting increasingly difficult, with access depending largely on geography.
Since Roe was overturned in 2022, 14 states have enacted abortion bans broad enough to force all independent clinics in those states to stop providing abortions or to close completely. Of the clinics forced to close, 70% were in the South or Midwest. Many of the clinics that have closed served marginalized communities. As abortion bans spread post-Roe, these communities continue to lose access not only to abortion services but also to prenatal and birth services, postpartum care, contraception, and miscarriage care.
The Dangers of Reproductive Care Deserts
To escape these deserts of reproductive care, womb-bearing persons must travel, much like a person in an actual desert seeking an oasis of life-giving water. However, for many, traveling isn’t a realistic option. It requires taking time off work, lining up child or elder care, and paying for gas. If a person has to go even farther afield, say, out of state, there are additional expenses to consider, like hotel stays, not to mention more time off work, more care support, and airline flights.
Ultimately, this results in womb-bearing persons not getting the care they need. In some cases, the results can be deadly. Post Roe, we are seeing increases in maternal and infant mortality rates. The state of Mississippi—where abortion is now completely banned—has seen such a significant spike in infant mortality rates that it has declared a public health emergency.
Data from states like Mississippi further makes it clear that people of color have been disproportionately affected by abortion bans. These disparities are nothing new. For example, Black maternal and child mortality rates are the highest in the country when compared with other racial and ethnic groups. The closure of reproductive care centers will worsen these numbers.
Acts of Deliberate Obstruction: The Arizona Example
Since I started providing abortion care in Arizona in 2009, every year but one had seen a new abortion restriction signed into law until a Democratic Governor was elected in 2022. Each restriction increases operational costs, creating a scenario in which independent clinics like mine operate on thin margins, without a financial cushion to absorb them.
Currently, all eight of Arizona’s clinics are concentrated in Phoenix or Tucson. Those who are not in these cities must travel to them, which, as discussed, is not always feasible. While telemedicine could be a viable solution, Arizona years ago enacted laws to ban telemedicine for abortion, making it impossible to send or receive Mifepristone (the medication used in the majority of abortions in the US) by mail. So if a person wants an abortion, they are forced to find a clinic.
Arizona has even taken steps to destroy the training pipeline for abortion care providers. In 1974, when approving revenue bonds to fund a $5.5 million expansion of the University of Arizona’s football stadium, legislators added a stipulation. In exchange for the money, the university’s medical school was prohibited from training students to do abortions. Amazingly, the state’s supreme court upheld the rider, and to this day, University of Arizona medical students and OB/GYN residents get their abortion training from the local Planned Parenthood.
Abortion is not banned in Arizona as of now. Nonetheless, the state’s approach to abortion care shows how it’s possible to restrict access through targeted decisions impacting legislation and funding, impeding access to the point that this essential healthcare service becomes virtually impossible to obtain.
The Post-Roe Reality: Individual Clinics Can Only Do So Much
Reproductive care deserts are no accident. They are intentionally created. Post Roe, state legislators and decision-makers have been given free rein to eliminate reproductive care completely. As well-designed hurdles make reproductive healthcare insurmountable for those without resources, the most vulnerable are those who are targeted first and harmed most.
Community clinics like mine are doing what they can to keep their doors open and provide womb-bearing individuals with the full spectrum of care they need. However, we need empathetic law- and policy-makers to help by expanding people’s access to all types of healthcare for all types of reproductive outcomes. That is the only way to eliminate reproductive care deserts and the dangers they pose.
