Dr. Caitlin Bernard couldn’t hold back tears Friday morning at her office in between patient appointments after she heard about the Supreme Court’s decision to overturn Roe v. Wade. She is an OBGYN who performs abortions at clinics in Indiana.

Like many providers across the country, she’s been dealing with a lot of pent-up stress from an expanding workload over the past few weeks ever since a draft opinion was leaked in May indicating that the decision was likely. But her tears are mainly because an already bleak picture is about to get a lot worse for many of her patients, she said.

“I just know how hard it’s going to be, you know, very soon. I mean, we’ve already been doing so much work, you know, over the past few weeks trying to get ready,” she said. “And now that it’s here, it’s just gonna get so much harder.”

Indiana has one of the worst maternal mortality rates in the country. And the mortality rate for Black women in Indiana is higher than the national average, according to the most recent Indiana Maternal Mortality Review Committee report. The report showed that while Black women represented 13 percent of births in 2018, they represented 18 percent of maternal deaths.

Providers like Bernard worry that the Supreme Court’s decision to overturn Roe v. Wade will worsen outcomes for Hoosier women –– especially the most vulnerable ones.

Abortions laws are more restrictive in Indiana than many other states, but abortion is not banned. This can change as early as next month when the Indiana General Assembly will reconvene in a special legislative session. 

Gov. Eric Holcomb and top Republican lawmakers who control the Statehouse say they want to address abortion during the session that starts July 6.

Senate President Pro Tem Rodric Bray (R-Martinsville) said legislation should restrict abortion rights.

“With the final decision in hand, we can begin to formulate a policy that is right for Indiana that protects unborn children and cares for the health and lives of mothers and their babies,” he said in a statement.

And so, for many women who may need an abortion, there is a clock ticking.

“I’ve had patients scheduled – how do I explain this to them? You know, if I have a patient who I’m supposed to see in the next few days and they’re not sure, I have to tell them that they need to make a decision right now. They may not have this choice very soon,” Bernard said. “And I don’t know how to tell a patient, how to tell a person, a human being, that the difficult choice that they’re facing right now is one that they will not have the opportunity to make.”

Several studies show that there is an association between more restrictive abortion laws in states and higher total maternal morality rates –– defined as a death during pregnancy or within one year following the end of a pregnancy. 

A study published in the American Journal of Public Health shows that among individual abortion policies, states with a licensed physician requirement had a 51 percent higher total maternal mortality and a 35 percent higher maternal mortality, and restrictions on state Medicaid funding for abortion was associated with a 29 percent higher total maternal mortality.

‘Will I lose my license if I do this?’

Before the overturn of Roe v. Wade, many states have imposed policies and regulations restricting access to safe abortion care. In 2015, nearly 400 abortion-restriction provisions were considered in 46 states, with 17 states enacting a total of 57 new abortion restrictions, according to a report by the Guttmacher Institute. Access to safe abortion care varies widely by state, and Indiana is closer to the end of the spectrum.

Bernard said even without total bans, a more restrictive abortion climate makes providers reluctant to perform the procedure, even when the patient’s life may be at stake. She recounts many times when other providers would call her and say that they know what is right from a clinical standpoint, but they are unsure what to do for fear of losing their license.

“I get people calling me all the time [saying]: ‘Well, this is the medical situation, and this is what I know is right. But is this an abortion? Does this count? Will I lose my license if I do this?’ You know, and that’s going to be much worse,” she said.

National anti-abortion rights group agree

Anti-abortion groups see it differently, however.

Marc Tuttle, the Indianapolis Right to Life president, celebrated the high court’s decision to strike down the right to an abortion during a Saturday rally at the Statehouse.

He expects Indiana lawmakers to make decisions on how to “best protect innocent human life” and support pregnant women and mothers.

“This is a great day for preborn children and their mothers. The Court has correctly decided that a right to abortion is not in the constitution, thereby allowing the people, through their elected representatives, to have a voice in this very important decision,” said Carol Tobias, president of National Right to Life (NRLC).

The group had proposed a “model law” that they said “would first protect the lives of unborn children from abortion except when necessary to prevent the death of the mother, which has been the accepted policy of the pro-life movement since 1973 and for many years before,” according to a press release.

But providers like Bernard question how this can be applied in practice.

“How close to death do they need to be? Is it imminent? Is it within a day, within an hour, within a minute? We as physicians cannot tell you how long it’s going to be before you die, or how bad it’s going to get before you die. And so we cannot separate this idea of health from life,” she said.

Preparing for the worst

Indiana Director for Planned Parenthood Alliance Advocates LaKimba DeSadier said that until state lawmakers decide otherwise, abortions are still accessible. But she and her colleagues are preparing for the worst.

“If it’s banned, we will give [pregnant women] the support they need. If it’s financial resources, travel supports, anything logistically. Planned Parenthood is a reproductive health care organization and we are still going to be servicing and providing access to resources and support,” DeSadier said.

They are coordinating with clinics in Illinois to increase capacity and working on expanding resources for travel, accommodation and child care for women who need to go out of state to receive the care they need. But according to WBEZ, Illinois clinics are already facing staffing shortages and overworked providers, and that’s likely to get worse with an increased influx of out-of-state patients.

DeSadier said that the ones who will be most impacted are going to be racial minorities and women with limited socioeconomic resources.

This story comes from a reporting collaboration that includes the Indianapolis Recorder and WFYI. Contact Farah at fyousry@wfyi.org. Follow on Twitter: @Farah_Yousrym.