Jaycee Foran from Holly Springs has a 3-year-old son. She had planned to start trying for her second child around this time, always envisioning multiple kids running around the house.
But not anymore. At least not for the foreseeable future.
Her reluctance doesn’t stem from the costs associated with another child, insufficient space in their house or even child care concerns. Foran and her husband have thought those aspects through and are prepared to provide for another desired child.
It’s the landscape of reproductive health care access since the Supreme Court’s Dobbs decision in June 2022 that has her too on edge to get pregnant again.
“Ultimately, we’re kind of in this boat where it’s like we’re a little too afraid to not have access to resources if we needed them — god forbid,” Foran said.
North Carolina bans most abortions after 12 weeks of pregnancy, with exceptions later in pregnancy for cases of rape and incest, medical emergencies and “life-limiting” fetal anomalies. However, even with those exceptions, Foran is not certain she could access abortion if she were to need it.
Foran’s concern about access to abortion isn’t hypothetical.
She and her husband contemplated terminating their first pregnancy after the discovery of fetal anomalies, including excessive fluid behind her baby’s neck and a heart defect, thrust the outcome of Foran’s pregnancy into uncertainty at about 12 weeks.
Foran and her husband anxiously awaited appointments with specialists and genetic test results as they edged closer to the state’s abortion ban — then at 20 weeks gestation. The diagnosis came right at the state’s deadline — when an abortion in North Carolina was no longer an option.
Genetic test results revealed a gene mutation consistent with Noonan syndrome, a condition that stops typical development in various parts of the body, including facial features, height and the heart. After more testing, they learned around 24 weeks that Foran’s husband had the same genetic anomaly. That gave them more confidence that the baby could be relatively unaffected, and they continued the pregnancy.
Though they decided not to terminate the pregnancy in the end, the experience of bumping up against the law and navigating the timeline pressure was fraught and something they don’t want to face again.
Foran wants to believe her next pregnancy would progress smoothly, but she can’t help but contemplate a scenario where another anomaly develops or her life is threatened — and whether she would be able to access abortion if she needed one.
“The only way we as a couple can control our family’s future is by not having another kid at this point in time,” Foran said. “While we mourn the loss of not growing our family, it’s much easier to mourn that loss than it is to go through the alternative.”
Access to the procedure has become further restricted since Foran’s first pregnancy, and she said she also feels more uncertainty at the federal level around reproductive health access since President Donald Trump’s return to office.
For example, Trump’s administration has initiated a safety review of mifepristone — an abortion medication used in nearly two-thirds of abortions nationwide — that was first approved by the Food and Drug Administration in 2000 and has undergone extensive analysis reaffirming it is safe and effective. The administration has also rescinded guidance that reaffirmed hospitals’ obligation under the Emergency Medical Treatment and Labor Act to provide abortion care to patients experiencing medical crises.
Foran isn’t alone in her hesitation to have kids in the current reproductive landscape, though data revealing the full impact of abortion restrictions on family planning is years away.
OB-GYNs told NC Health News they are seeing patients report more fear and anxiety than ever around pregnancy. Those feelings ramped up after the Dobbs decision and have continued as more abortion restrictions took effect in North Carolina, they said.
“Women are afraid to get pregnant in this environment, and I don’t blame them,” said Amelia Sutton, a maternal-fetal medicine specialist in Charlotte.
More long-acting contraception
Rachel Jensen, a complex family planning fellow in the Triangle who counsels patients on contraception options and provides abortion care, agreed that fear is a prominent factor driving more patients’ family planning decisions.
“Either fear of the consequences of an unplanned pregnancy and the inability to get an abortion — or what’s coming up increasingly is fear that patients won’t have access to contraception in the future,” Jensen said.
Already, 635,140 women in North Carolina live in areas that can be classified as “contraceptive deserts,” according to data from the nationwide pregnancy prevention advocacy group Power to Decide. A contraceptive desert is a county or area that lacks reasonable access to a health center that offers the full range of contraceptive methods, such as a gynecologist’s office or a community health clinic.
Anne Logan Bass, clinical director of Planned Parenthood South Atlantic’s family planning program, said an increasing number of patients are choosing long-acting reversible forms of contraception, such as IUDs and implants.
That’s a trend happening at the national level. A study published in the Journal of Women’s Health in June found that nearly a quarter of the 446 clinics researchers surveyed reported an increase in patient requests for IUDs or implants after the Dobbs decision.
“They know it's going to last through this administration, but also because of its high level of protection against pregnancy,” Bass said, explaining some of the reasons people cite for their choice.
Jensen analyzed contraception trends across the UNC Health system over the past several years and found a 13 percent increase in use of long-acting reversible forms of contraception in the year after North Carolina’s increased abortion restrictions took effect, compared with the year before.
Now there’s new uncertainty from the federal level around contraception access, particularly at Planned Parenthood health centers. In 2024, around two-thirds of the roughly 37,000 patients who visited one of nine Planned Parenthood health centers in North Carolina sought family planning services, according to data shared with NC Health News.
A 6-3 ruling by the Supreme Court last month in Medina v. Planned Parenthood South Atlantic paves the way for states to exclude Planned Parenthood from receiving payment from the Medicaid program, jeopardizing access for some low-income women. That’s a policy embraced by Trump’s “One Big Beautiful Bill,” which includes a provision that excludes Planned Parenthood and some other health care providers that offer abortion care from the Medicaid program for one year.
The federal government and many states already block Medicaid funds from covering abortion costs, but the program has historically paid for other services obtained at Planned Parenthood, including contraception, cancer screenings and testing, and treatment for sexually transmitted infections. Planned Parenthood Federation of America has filed a lawsuit challenging the provision.
So far in 2025, roughly 14 percent of Planned Parenthood patients in North Carolina have accessed family planning services using Medicaid, according to data shared with NC Health News.
In the six months after the 2024 election, Planned Parenthood South Atlantic saw a 33 percent increase in its monthly average of requests for long-acting reversible contraception appointments across its 14 health centers in four states, according to data shared with NC Health News. This amounted to a monthly average increase of several hundred, though the volume of appointments stayed mostly steady among North Carolina clinics.
Bass has overseen the family planning program for nearly six years and said she’s also observed more parents bringing in their teens to proactively get them on a form of birth control — grasping that the stakes are higher for an unintended pregnancy with diminished abortion access.
More sterilizations
Some people are taking an even more drastic step to prevent pregnancy: permanent contraception, also known as sterilization.
Amy Bryant, an OB-GYN in the Triangle, said more of her time is spent on sterilizations these days due to a spike in requests. Many patients are younger adults who don’t want children, she said. Other patients are spurred by changes in the reproductive health care landscape.
“It’s been remarkable to me to see how people really want to take control of their own fertility and want surgical or permanent contraception to achieve that because they’re very afraid that should something happen to them, or if something happened with the pregnancy, that they wouldn't be able to have full access to reproductive health care,” Bryant said.
Jensen, who also performs sterilizations, said one surprise has been the number of people with a same-sex partner or who identify as asexual seeking permanent contraception despite their low risk of pregnancy.
“They’re concerned that they might be assaulted and couldn’t get an abortion,” she explained. “Those are very extreme cases. We really try to talk to patients about the risks of having surgery and that likelihood of pregnancy, but that’s the level of fear that some of our patients are coming in with.”
Sterilization is a big step, Jensen said. Most women don’t regret their decision, but younger women are more likely to express remorse later in their lives, research shows. She said she counsels every patient thoroughly to ensure that they understand the risks and consequences of their decision, while still allowing patients to have autonomy over their bodies.
Jensen found a 25 percent increase in permanent contraception among UNC Health patients in the year after the Dobbs decision. The increase is consistent with national research showing a spike in sterilization rates. One study found that in the six months after the Dobbs decision, surgical sterilizations rose by 3 percent per month in states where abortion was banned after the ruling.
Jensen said the increased volume of sterilizations among UNC Health patients did not continue in the year after North Carolina’s stricter abortion law took effect July 1, 2023. She speculated that part of the reason could be because patients were motivated by early fears and already had the surgical procedure performed before the law officially changed in North Carolina.
Jensen said she is interested to see if a bump in sterilizations emerges after the 2024 election, which she said so far has borne out anecdotally as she and colleagues have seen an influx of requests in the months since Trump took office.
“As all of those executive orders started coming down the pipeline, I think people maybe weren't sure what to expect with the new administration, and then once they got a sense of, ‘Oh, there’s a lot happening here, very fast,’ I think people were really eager to get access to care while they knew it was still available,” Jensen said.
Already low birth rates
President Donald Trump has made it a focus of his administration to reverse America’s long-term decline in birth rates. In 2023, the U.S. fertility rate reached a record low, according to data from the CDC’s National Center for Health Statistics. Last year, the fertility rate increased less than 1 percent to 54.6 births for every 1,000 women of reproductive age, according to provisional numbers published in April.
North Carolina’s fertility rate has also ticked down in recent years, sitting at 55.8 births per 1,000 women of reproductive age in 2023, down from 57.6 births for every 1,000 women of reproductive age in 2019, the year before the pandemic.
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Sutton said that abortion restrictions cast additional anxiety and stress over pregnancies. She said patients voice fears to her every day, such as: “Is there going to be a national abortion ban? Is the state law going to change? What if I have a pregnancy that’s affected by Trisomy 21? Is my doctor going to be afraid to do a D&C? Am I going to bleed to death?”
“These are real questions,” she explained. “They see it in the news. It’s happening to real women across the country … I’d love to tell them with 100 percent certainty that that’s not going to happen to them, but I can’t give them that reassurance.”
Bryant said abortion restrictions do not make it safer for people to be pregnant, and rising child care costs, and other factors, run counter to the aim of boosting birth rates by making some women want to have fewer children — or none at all.
Sutton agreed, adding that the United States and North Carolina are already facing a maternal health crisis and growing maternity care deserts.
“This is why the birth rate is declining … along with the fact that there’s no paid parental leave, childcare is unaffordable and inaccessible, and all the other billions of reasons,” Sutton said.
Financial limitations, including the growing cost of child rearing, are one of the primary reasons people cite for seeking an abortion, according to the landmark Turnaway Study, a long-term research project that investigates the effects on women’s lives of receiving or being denied an abortion. In North Carolina, more than 60 percent of those obtaining an abortion are already parents, according to 2023 data from the state department of health and human services.
“[Abortion restrictions] are one of the reasons among the systemic problems,” Sutton said.
However, in some cases, abortion restrictions lead to more unintended births. A 2025 study by researchers at Johns Hopkins University analyzed live births after near-total or six-week abortion bans took effect in 14 states. They estimated there was one additional live birth above expectation per 1,000 reproductive-age females, accounting for a 1.7 percent increase in fertility rate — equivalent to more than 22,000 births above the expected level by the end of 2023.
Alicia VandeVusse, senior research scientist at the Guttmacher Institute, an organization tracking trends in reproductive health, said that although the full impact of abortion restrictions is still emerging, a growing body of evidence shows that policies restricting abortion care have clear ripple effects beyond access to the procedure itself.
“There’s no such thing as an abortion restriction that only impacts abortion care, because sexual and reproductive health are all processes that are intertwined,” VandeVusse said. “You can’t just sort of turn on and off access to one service without affecting access to other services — that goes for access to contraception, access to miscarriage management, access to other services that are provided at these clinics.”
This article first appeared on North Carolina Health News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.