No Choice

What Florida's New Abortion Restrictions Mean for Patients and Providers

"There is a real threat to people having access to care."

By Elizabeth Djinis April 29, 2022

When Texas’ heartbeat abortion ban went into effect last year, Florida lawmakers were already buzzing about what restrictions might come next in their own state.

Republican state Sen. Joe Gruters, R-Sarasota, who has repeatedly filed anti-abortion legislation and calls himself one of the Legislature’s “biggest lifers,” was skeptical that Florida would pass something as strict as Mississippi’s 15-week ban or Texas’ legislation. But his tentative predictions were proven wrong.

By early March, Florida lawmakers had passed a ban on abortions after 15 weeks, and Gov. Ron DeSantis signed the bill into law in mid-April. Only a few exceptions exist to the 15-week hard line. The abortion must be necessary to “save the pregnant woman’s life or avert a serious risk of substantial and irreversible physical impairment of a major bodily function,” or the fetus must have a “fatal fetal abnormality.” There is no exception for cases of rape or incest.

On top of the new restrictions, earlier this month, a Florida judge approved a requirement first passed in 2015 that people seeking an abortion wait 24 hours before undergoing the procedure. That law had been in legal purgatory since its passage. The Supreme Court will also rule this summer in a case that could overturn Roe v. Wade and have long-term implications for reproductive rights in the United States.

Leaders from Planned Parenthood of Southwest and Central Florida, the region’s most prominent abortion provider, have spent the last few months in a state of urgency.

“The first place my mind goes is just the realization that we have a governor and a majority of legislators who are ignoring what Floridians have told them and what they want,” says Stephanie Fraim, the organization’s president and chief executive officer. “I don’t know how many people we had testify to legislators, and they basically said, ‘We don’t care about your lived experience.’”

Fraim approaches the topic with an eyes-wide-open mentality. Planned Parenthood plans to use “every single option available to us” to delay the 15-week ban’s implementation and ultimately stop it, she says.

But, as of now, the law is slated to go into effect Friday, July 1. Planned Parenthood is working with patients potentially affected by the new restrictions to help them navigate their changed circumstances. That includes connecting patients with abortion providers in other parts of the country, like Washington, D.C., and New York.

In the past, this navigation system has functioned the opposite way. Florida, at times, has acted as a haven for people who lived in states like Texas, where, for almost a year, abortions have been banned at around six weeks. Now Florida is in a strange in-between: able to provide care to those living in even more restricted states and yet having to refer out local patients who no longer meet the state’s requirements.

Part of working at a place like Planned Parenthood is having to expect the unexpected. In the weeks leading up to the 24-hour waiting period ruling, employees had to call patients and explain that they may need to come in for an additional appointment before their abortion—or not.

“We have to be very resilient and on our toes,” says Fraim. “On the Friday they told us it had to happen, we had to listen to the tears of the patients saying, ‘I can’t take another day off.’”

Almost every day, patients struggle to make the 24-hour waiting period work with their schedules. The law requires that a physician be “physically present in the same room” at least 24 hours before the procedure, meaning that the first appointment pre-abortion cannot be virtual, which poses a problem for patients who have to miss work or find child care. Others must lie to cover up where they really are, says Dr. Sujatha Prabhakaran, Planned Parenthood's chief medical officer.

“It’s just awful for patients and it’s awful for us to say to them that there’s no medical reason for this visit,” says Prabhakaran. “It is truly just the state saying that they don’t trust you to make a decision about your health care.”

In Prabhakaran’s experience, an abortion is a well-reasoned and personal decision. A patient doesn’t need more time to think it over.

“Any single one of us who works here knows that a person doesn’t need another 24 hours,” she says. “This is one of the most considered decisions they’ve ever made in their life.”

Prabhakaran tells many stories of patients whose lives might have been different had the 15-week ban or the 24-hour waiting period been in effect at the time. One patient, a homeless woman, only learned she was pregnant after an ultrasound in the emergency room. By the time she was able to schedule an abortion through Planned Parenthood, she was 19 weeks pregnant. Even mundane elements—like staying in a hotel and using a rideshare service—were stressors, so having to travel out of state could have been “insurmountable” for her, says Prabhakaran.

Another patient learned that her child had a rare condition that made it impossible for the fetus to survive. The patient already had to struggle with this realization. Now, the 24-hour waiting period meant she had to sit for not just one, but two, appointments to discuss her abortion.

“When you have a pregnancy like this, it’s so complicated,” says Prabhakaran. “Now she has to come in for her counseling visit, and she’ll come back next week to have her care. It’s an extra week that’s prolonged coping.”

Hospitals also occasionally conduct abortions when a patient or fetus is diagnosed with a condition that make a healthy pregnancy unlikely, like anencephaly, in which a fetus is missing parts of its brain or skull. According to Sarasota Memorial Health Care System spokesperson Kim Savage, the organization performs approximately one dozen “medically complex abortions” each year.

“Most of these circumstances are identified early in a pregnancy and we do not anticipate the legislation impacting our ability to care for patients in these often life-threatening situations,” says Savage.

Last year, almost 5,000 patients in Florida received an abortion at 14 weeks or later, according to federal data. Because the new rules don't go into effect until July, it’s the people who don’t even know they’re pregnant right now who are going to be most affected.

“Say you’re a physician with a high-risk patient and they’re 14 weeks pregnant when you diagnose their fetal anomaly and it’s the last week in June,” says Fraim. “Now you’re going to say to them that if you’re even considering this procedure, you don’t have time to think about it. You must hurry or you’ll have to fly out of state.”

For independent abortion providers who don’t have the institutional support of Planned Parenthood, says Fraim, it becomes even harder to manage the shifting landscape and provide for their patients.

When it comes to the future of reproductive rights in Florida, Prabhakaran doesn’t mince words. She’s concerned. In the past, she’s seen restrictions around counseling or ultrasounds or brochures, still “unnecessary and stigmatizing,” but patients could still get an abortion. Now, things are different.

“There is a real threat to people having access to care,” she says. “I’ve sort of been soldiering on here in Florida. We keep figuring out how to help our patients manage, but this is a really different time.”

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