For activists, advocates and providers working on the ground in New York, the day the Supreme Court overturned Roe v. Wade was one they’d expected, even before Politico published a leaked draft of the opinion in May.
People like Niharika Rao, an organizer with NYC for Abortion Rights, have long understood the obstacles pregnant people — both in and out of state — face in affording and securing a safe abortion.
Their dedication to that mission has only grown as they navigate a new legal landscape that could prove risky to abortion-seekers crossing state lines.
“Now we’re not only fighting for New Yorkers, we’re fighting for the massive increase in abortion patients we’re going to be seeing coming from all over the country,” said Rao, who is also a co-founder of the Reproductive Justice Collective, based at Columbia University.
“This is the opposite of the moment to sit on our laurels and be like, ‘We codified Roe in 2019, but we’re fine!’ It requires thinking about things like responsibility and privilege to access,” Rao added. (In 2019, New York become one of the first states to codify the right to an abortion.)
While abortion is legal in New York, the overturning of Roe in the ruling for Dobbs v. Jackson Women’s Health Organization opens the door for more than half of states to outlaw or severely restrict abortion.
Lawyers, doulas, hosts with extra bedrooms, medical professionals and grassroots organizers are all working to increase access to both medical and surgical abortions, as well as provide educational, legal, financial and emotional support.
This comes as the New York legislature on Friday approved a measure to add abortion rights in the state constution through amending the Equal Protection Clause to bar discrimination based on sexual orientation, gender identity, gender expression, pregnancy, pregnancy outcomes, reproductive healthcare and autonomy.
Officials and reproductive health advocates expect to see an influx of people seeking abortion coming to New York City from states where abortion procedures are banned or limited. Out-of-state residents accounted for 9.4% of abortions performed in New York City in 2019, according to CDC data.
Judith Plaskow, a retired professor who lives in Washington Heights, nearly a decade ago began volunteering with the Haven Coalition, an organization that pairs hosts with people who travel to the city for abortions. Before the pandemic, she offered her guests — who had driven down from upstate, taken a 22-hour bus from the Midwest and flown in from the South — an extra room and a meal. She plans to start up again soon.
“What we’re really going to see is an escalation of stigma and reproductive control and the surveillance of pregnant people.” — Rafa Kidvai, director of the Repro Legal Defense Fund
“Most of the time they haven’t been in New York that many times. It’s an overwhelming city,” Plaskow, 75, said. “It’s been a very positive experience to be able to give people a comfortable welcome, to point out some [iconic] New York sites as we walk out of the clinic so the abortion isn’t the only thing they’re experiencing.”
A nonprofit called Elevated Access has begun lining up volunteer pilots to transport for free people who live in restrictive states to states where they can access abortions and gender-affirming healthcare procedures. A pilot flew the first passenger through the program this past June. At least one pilot in New York state has signed up to fly patients so far, according to the nonprofit.
New York may also welcome doctors to train them to provide abortion care, as nearly half of obstetrics and gynecology residents in other states wouldn’t be able to learn abortion care.
Since the leak of the draft opinion, Dr. Antoinette Danvers, assistant professor of obstetrics, gynecology and women’s health at Albert Einstein College of Medicine and the director for complex family planning division at Montefiore Health System, has been having conversations with out-of-state institutions. They’re trying to figure out how they might be able to send medical residents and those who’ve completed their residencies to The Bronx for further training in abortion care.
“We’re trying to ensure that there is a future where we have clinicians who are still able to do this procedure,” Danvers said, warning against the “devastating long-term impact” on patients — especially women of color — that will result from a lack of training.
Offering training for doctors from out-of-state will mean figuring out several logistical complexities, like license and insurance requirements, developing partnerships with distant clinics — and ensuring efforts stay within legal bounds.
“We’re working through those different challenges and barriers, but we are very committed to finding a solution and working with a program,” said Danvers. “It’s really heartbreaking to think about the patients that are going to lose access to abortion care, and being in the clinical environment, we have a picture of what it looks like to take care of someone where pregnancy is harmful to their health, and needing a life-saving procedure that you can’t offer seems devastating.”
Recently, the doctor noted, a patient at Montefiore experienced a pregnancy complication and began bleeding. To stop the hemorrhaging, she needed an abortion, which helped prevent an even more tragic outcome.
People in areas with limited access to legal procedures will have little choice but to increasingly rely on abortions induced by medications, experts say. Those accounted for more than half of abortions in the United States in 2020, according to the Guttmacher Institute, a nonprofit which advocates for reproductive and sexual rights.
The pills, which are FDA-approved, can be sent via mail. People can take them alone or with the help of a provider. The pills induce an abortion that is indistinguishable from a spontaneous miscarriage — in fact, some people who miscarry must ensure the process completes through taking the same pills.
This summer, the New York City-based Doula Project, which supports outcomes ranging from birth to miscarriage or the elected end of a pregnancy, will launch a virtual program that will enable people to remotely receive doula care while self-managing abortions.
Jess Byrne, 44, who works as one of about 40 volunteer doulas on the project, said the virtual program was originally aimed to meet a need borne of the pandemic, when the doulas could not be present in clinics to chat with patients and make them more comfortable during and after procedures.
“Regardless of how people end up getting an abortion or getting access to medication, they still deserve care and support,” Byrne said.
Groups like NYC for Abortion Rights and Fund Abortion Not Police have and will continue to host workshops on how to get abortion pills delivered by mail, how they work, and how to inform others about what’s available — encouraging participants, for example, to speak in the third person, not in the second person, to avoid possible liability.
“Everyone needs to be prepared to make themselves a resource to other people,” said Bleu Grano, who started Fund Abortion Not Police to raise money for abortion funds. Grano also volunteers for a Spanish-language hotline based in Texas. “Because I’ve been volunteering in the south for all these years, I know how hard it is for people to get abortions. That has made me less susceptible to that giving-up mindset that I know a lot of people in safe states may be more inclined to.”
Grano, a 31-year-old Bushwick resident, has also been working with the group Feminist Collages NYC to wheatpaste messages onto walls in Brooklyn and Manhattan that include websites where people can learn more about abortion pills or get them from abroad. The messages, painted in block letters on white paper, are often near places where Grano has seen anti-abortion billboards. She thinks of it as free advertising.
Rao, in her work through the Reproductive Justice Collective, wants institutions of higher learning to provide abortion pills on campus, as California requires public colleges to do.
A bill at the state level for that was first introduced in Albany in 2019 but again did not pass this most recent legislative session.
When There’s No Other Help
Some states have already been limiting — and will increasingly do so — people’s access to abortion pills, even attempting to bar seekers from crossing state lines, noted Terry McGovern, a lawyer and professor of population and family health at Columbia University’s Mailman School of Public Health.
“There’s a lot of questions about how the legality of any of this will play out,” McGovern said. “Before this particular SCOTUS [U.S. Supreme Court] majority, I would have said none of these things could be legal, you can’t prosecute people across state lines, and bounty hunt across state lines when they’re complying with the laws of another state, but it’s all crazy now.”
States like Idaho, Oklahoma and Texas passed laws that allows lawsuits against abortion providers or helpers. McGovern believes New Yorkers will be shielded from prosecution thanks to a package of laws Gov. Kathy Hochul signed to protect providers and people from out-of-state seeking abortions in New York.
Few states have laws that specifically criminalize self-managed abortion, yet research from If/When/How, a network of lawyers for reproductive justice, found that least 60 people nationwide from 2000 to 2020 were criminally investigated, arrested, or convicted for allegedly ending their own pregnancy or helping someone else do so, according to a spokesperson for the group.
Rafa Kidvai, director of the Repro Legal Defense Fund, a national organization that offers money for bail and legal expenses in cases where people are investigated, arrested or prosecuted for self-managed abortions, expects more people to face legal consequences as access to clinics shrinks.
Such cases can look like a Texas district attorney charging a woman for murder when she self-managed her abortion. (The case was later dismissed.) People who miscarry or deliver a stillbirth can and have been prosecuted, as well.
“What we’re really going to see is an escalation of stigma and reproductive control and the surveillance of pregnant people,” Kidvai said. “We’re seeing criminalization of people directly for their pregnancy outcomes.”
If/When/How also runs a helpline to provide information on legal rights around self-managed abortion. Last week, New York Attorney General Letitia James launched a hotline that offers legal guidance to out-of-state patients seeking abortions, healthcare providers and those who support in other ways.
“A lot of the fear that people have right now is that the helpers and advocates and activists that are working around this will also be criminalized,” added Kidvai.