‘too Afraid To Not Have Access’: Abortion Restrictions Can Affect Family Planning Decisions

By Rachel Crumpler

Jaycee Foran from Holly Springs has a 3-year-old son. She had planned to commencement trying for her 2nd kid astir this time, ever envisioning aggregate kids moving astir nan house. 

But not anymore. At slightest not for nan foreseeable future.

Her reluctance doesn’t stem from nan costs associated pinch different child, insufficient abstraction successful their location aliases moreover kid attraction concerns. Foran and her hubby person thought those aspects done and are prepared to supply for different desired child. 

It’s nan landscape of reproductive wellness attraction entree since nan Supreme Court’s Dobbs decision successful June 2022 that has her excessively connected separator to get pregnant again. 

“Ultimately, we’re benignant of successful this vessel wherever it’s for illustration we’re a small excessively acrophobic to not person entree to resources if we needed them — deity forbid,” Foran said.

North Carolina bans astir abortions aft 12 weeks of pregnancy, pinch exceptions later successful gestation for cases of rape and incest, aesculapian emergencies and “life-limiting” fetal anomalies. However, even pinch those exceptions, Foran is not definite she could entree abortion if she were to request it. 

Foran’s interest astir entree to abortion isn’t hypothetical. 

She and her hubby contemplated terminating their first gestation aft nan find of fetal anomalies, including excessive fluid down her baby’s cervix and a bosom defect, thrust nan result of Foran’s gestation into uncertainty astatine astir 12 weeks.

Foran and her hubby anxiously awaited appointments pinch specialists and familial trial results arsenic they edged person to nan state’s abortion prohibition — past astatine 20 weeks gestation. The test came correct astatine nan state’s deadline — erstwhile an abortion successful North Carolina was nary longer an option.

Genetic trial results revealed a cistron mutation accordant pinch Noonan syndrome, a information that stops emblematic improvement successful various parts of nan body, including facial features, tallness and nan heart. After much testing, they learned astir 24 weeks that Foran’s hubby had nan aforesaid familial anomaly. That gave them much assurance that nan babe could beryllium comparatively unaffected, and they continued nan pregnancy. 

Though they decided not to terminate nan gestation successful nan end, nan acquisition of bumping up against nan rule and navigating nan timeline unit was fraught and thing they don’t want to look again.

Foran pinch her 3-year-old son. “I ever told my hubby I wanted a 2nd kid because I felt for illustration my bosom had much emotion to give,” Foran said but her plans person changed astatine slightest for nan foreseeable future. Credit: Courtesy of Jaycee Foran

Foran wants to judge her adjacent gestation would advancement smoothly, but she can’t thief but contemplate a script wherever different anomaly develops aliases her life is threatened — and whether she would beryllium capable to entree abortion if she needed one.

“The only measurement we arsenic a mates tin power our family’s early is by not having different kid astatine this constituent successful time,” Foran said. “While we mourn nan nonaccomplishment of not increasing our family, it’s overmuch easier to mourn that nonaccomplishment than it is to spell done nan alternative.”

Access to nan process has go further restricted since Foran’s first pregnancy, and she said she besides feels much uncertainty astatine nan national level astir reproductive wellness entree since President Donald Trump’s return to office.

For example, Trump’s management has initiated a information reappraisal of mifepristone — an abortion medicine used successful astir two-thirds of abortions nationwide — that was first approved by nan Food and Drug Administration successful 2000 and has undergone extended study reaffirming it is safe and effective. The management has besides rescinded guidance that reaffirmed hospitals’ responsibility nether nan Emergency Medical Treatment and Labor Act to supply abortion attraction to patients experiencing aesculapian crises. 

Foran isn’t unsocial successful her hesitation to person kids successful nan existent reproductive landscape, though information revealing nan afloat effect of abortion restrictions connected family readying is years away.

OB-GYNs told NC Health News they are seeing patients study much fearfulness and worry than ever astir pregnancy. Those feelings ramped up aft nan Dobbs decision and person continued arsenic much abortion restrictions took effect successful North Carolina, they said. 

“Women are acrophobic to get pregnant successful this environment, and I don’t blasted them,” said Amelia Sutton, a maternal-fetal medicine master successful Charlotte. 

More long-acting contraception

Rachel Jensen, a analyzable family readying chap successful nan Triangle who counsels patients connected contraception options and provides abortion care, agreed that fearfulness is simply a salient facet driving much patients’ family readying decisions.

“Either fearfulness of nan consequences of an unplanned gestation and nan inability to get an abortion — aliases what’s coming up progressively is fearfulness that patients won’t person entree to contraception successful nan future,” Jensen said.

Already, 635,140 women successful North Carolina unrecorded successful areas that tin beryllium classified arsenic “contraceptive deserts,” according to data from nan nationwide gestation prevention defense group Power to Decide. A contraceptive godforsaken is simply a region aliases area that lacks reasonable entree to a wellness halfway that offers nan afloat scope of contraceptive methods, specified arsenic a gynecologist’s agency aliases a organization wellness clinic. 

Anne Logan Bass, objective head of Planned Parenthood South Atlantic’s family readying program, said an expanding number of patients are choosing long-acting reversible forms of contraception, specified arsenic IUDs and implants. 

That’s a inclination happening astatine nan nationalist level. A study published successful nan Journal of Women’s Health successful June recovered that astir a 4th of nan 446 clinics researchers surveyed reported an summation successful diligent requests for IUDs aliases implants aft nan Dobbs decision.

“They cognize it’s going to past done this administration, but besides because of its precocious level of protection against pregnancy,” Bass said, explaining immoderate of nan reasons group mention for their choice.

Jensen analyzed contraception trends crossed nan UNC Health strategy complete nan past respective years and recovered a 13 percent summation successful usage of long-acting reversible forms of contraception successful nan twelvemonth aft North Carolina’s accrued abortion restrictions took effect, compared pinch nan twelvemonth before.

Now there’s caller uncertainty from nan national level astir contraception access, peculiarly astatine Planned Parenthood wellness centers. In 2024, astir two-thirds of nan astir 37,000 patients who visited 1 of 9 Planned Parenthood wellness centers successful North Carolina sought family readying services, according to information shared pinch NC Health News.

A 6-3 ruling by nan Supreme Court past period successful Medina v. Planned Parenthood South Atlantic paves nan measurement for states to exclude Planned Parenthood from receiving costs from nan Medicaid program, jeopardizing entree for immoderate low-income women. That’s a argumentation embraced by Trump’s “One Big Beautiful Bill,” which includes a proviso that excludes Planned Parenthood and immoderate different wellness attraction providers that connection abortion attraction from nan Medicaid programme for 1 year. 

The national authorities and galore states already artifact Medicaid costs from covering abortion costs, but nan programme has historically paid for different services obtained astatine Planned Parenthood, including contraception, crab screenings and testing, and curen for sexually transmitted infections. Planned Parenthood Federation of America has filed a suit challenging nan provision.

So acold successful 2025, astir 14 percent of Planned Parenthood patients successful North Carolina person accessed family readying services utilizing Medicaid, according to information shared pinch NC Health News.

In nan six months aft nan 2024 election, Planned Parenthood South Atlantic saw a 33 percent summation successful its monthly mean of requests for long-acting reversible contraception appointments crossed its 14 wellness centers successful 4 states, according to information shared pinch NC Health News. This amounted to a monthly mean summation of respective hundred, though nan measurement of appointments stayed mostly dependable among North Carolina clinics. 

Bass has overseen nan family readying programme for astir six years and said she’s besides observed much parents bringing successful their teens to proactively get them connected a shape of commencement power — grasping that nan stakes are higher for an unintended gestation pinch diminished abortion access.

More sterilizations

Some group are taking an moreover much drastic measurement to forestall pregnancy: imperishable contraception, besides known arsenic sterilization.

Amy Bryant, an OB-GYN successful nan Triangle, said much of her clip is spent connected sterilizations these days owed to a spike successful requests. Many patients are younger adults who don’t want children, she said. Other patients are spurred by changes successful nan reproductive wellness attraction landscape.

“It’s been singular to maine to spot really group really want to return power of their ain fertility and want surgical aliases imperishable contraception to execute that because they’re very acrophobic that should thing hap to them, aliases if thing happened pinch nan pregnancy, that they wouldn’t beryllium capable to person afloat entree to reproductive wellness care,” Bryant said.

Jensen, who besides performs sterilizations, said 1 astonishment has been nan number of group pinch a same-sex partner aliases who place arsenic asexual seeking imperishable contraception contempt their debased consequence of pregnancy.

“They’re concerned that they mightiness beryllium assaulted and couldn’t get an abortion,” she explained. “Those are very utmost cases. We really effort to talk to patients astir nan risks of having room and that likelihood of pregnancy, but that’s nan level of fearfulness that immoderate of our patients are coming successful with.”

Sterilization is simply a large step, Jensen said. Most women don’t regret their decision, but younger women are more apt to definitive remorse later successful their lives, investigation shows. She said she counsels each diligent thoroughly to guarantee that they understand nan risks and consequences of their decision, while still allowing patients to person autonomy complete their bodies.

Jensen recovered a 25 percent summation successful imperishable contraception among UNC Health patients successful nan twelvemonth aft nan Dobbs decision. The summation is accordant pinch national investigation showing a spike successful sterilization rates. One study found that successful nan six months aft nan Dobbs decision, surgical sterilizations roseate by 3 percent per period successful states wherever abortion was banned aft nan ruling.

Jensen said nan accrued measurement of sterilizations among UNC Health patients did not proceed successful nan twelvemonth aft North Carolina’s stricter abortion rule took effect July 1, 2023. She speculated that portion of nan logic could beryllium because patients were motivated by early fears and already had nan surgical process performed earlier nan rule officially changed successful North Carolina.

Jensen said she is willing to spot if a bump successful sterilizations emerges aft nan 2024 election, which she said truthful acold has borne retired anecdotally arsenic she and colleagues person seen an influx of requests successful nan months since Trump took office.

“As each of those executive orders started coming down nan pipeline, I deliberation group possibly weren’t judge what to expect pinch nan caller administration, and past erstwhile they sewage a consciousness of, ‘Oh, there’s a batch happening here, very fast,’ I deliberation group were really eager to get entree to attraction while they knew it was still available,” Jensen said.

Already debased commencement rates

President Donald Trump has made it a focus of his management to reverse America’s semipermanent diminution successful commencement rates. In 2023, nan U.S. fertility complaint reached a grounds low, according to data from nan CDC’s National Center for Health Statistics. Last year, nan fertility complaint accrued little than 1 percent to 54.6 births for each 1,000 women of reproductive age, according to provisional numbers published successful April.

North Carolina’s fertility rate has besides ticked down successful caller years, sitting astatine 55.8 births per 1,000 women of reproductive property successful 2023, down from 57.6 births for each 1,000 women of reproductive property successful 2019, nan twelvemonth earlier nan pandemic.

Sutton said that abortion restrictions formed further worry and accent complete pregnancies. She said patients sound fears to her each day, specified as: “Is location going to beryllium a nationalist abortion ban? Is nan authorities rule going to change? What if I person a gestation that’s affected by Trisomy 21? Is my expert going to beryllium acrophobic to do a D&C? Am I going to bleed to death?”

“These are existent questions,” she explained. “They spot it successful nan news. It’s happening to existent women crossed nan state … I’d emotion to show them pinch 100 percent certainty that that’s not going to hap to them, but I can’t springiness them that reassurance.”

Bryant said abortion restrictions do not make it safer for group to beryllium pregnant, and rising kid attraction costs, and different factors, tally antagonistic to nan purpose of boosting commencement rates by making immoderate women want to person less children — aliases nary astatine all. 

Sutton agreed, adding that nan United States and North Carolina are already facing a maternal wellness crisis and growing maternity attraction deserts.

“This is why nan commencement complaint is declining … on pinch nan truth that there’s nary paid parental leave, childcare is unaffordable and inaccessible, and each nan different billions of reasons,” Sutton said. 

Financial limitations, including nan growing costs of kid rearing, are 1 of nan superior reasons group mention for seeking an abortion, according to nan landmark Turnaway Study, a semipermanent investigation task that investigates nan effects connected women’s lives of receiving aliases being denied an abortion. In North Carolina, much than 60 percent of those obtaining an abortion are already parents, according to 2023 information from nan authorities section of wellness and quality services.

“[Abortion restrictions] are 1 of nan reasons among nan systemic problems,” Sutton said.

However, successful immoderate cases, abortion restrictions lead to much unintended births. A 2025 study by researchers astatine Johns Hopkins University analyzed unrecorded births aft near-total aliases six-week abortion bans took effect successful 14 states. They estimated location was 1 further unrecorded commencement supra anticipation per 1,000 reproductive-age females, accounting for a 1.7 percent summation successful fertility complaint — balanced to much than 22,000 births supra nan expected level by nan extremity of 2023.

Alicia VandeVusse, elder investigation intelligence astatine nan Guttmacher Institute, an statement search trends successful reproductive health, said that though nan afloat effect of abortion restrictions is still emerging, a increasing assemblage of grounds shows that policies restricting abortion attraction person clear ripple effects beyond entree to nan process itself. 

“There’s nary specified point arsenic an abortion regularisation that only impacts abortion care, because intersexual and reproductive wellness are each processes that are intertwined,” VandeVusse said. “You can’t conscionable benignant of move connected and disconnected entree to 1 work without affecting entree to different services — that goes for entree to contraception, entree to miscarriage management, entree to different services that are provided astatine these clinics.”

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