More women are putting off having children or deciding not to have them at all. And it’s not just because of the rising cost of child care and other expenses. It’s also because of growing concern over access to reproductive health care following the Supreme Court’s decision three years ago overturning Roe v. Wade. That prompted states to quickly tighten rules on abortions. Reporter Rachel Crumpler wrote about that growing concern in North Carolina for NC Health News. She joins WFAE's Marshall Terry to discuss.
Marshall Terry: OK, so what are the abortion rules in North Carolina now versus before the Supreme Court decision three years ago?
Rachel Crumpler: Abortion is now banned after 12 weeks in North Carolina, except for rape and incest, life-limiting fetal anomalies, and medical emergencies. Before this, North Carolina allowed abortions up to 20 weeks for any reason.
Terry: What are some of the concerns you found that women have about abortion access that’s factoring into their decision about having kids?
Crumpler: So women just seem pretty concerned about whether they will even have access in the first place if they were to need it, even in desired pregnancies. I spoke with one woman who had some challenges with her first pregnancy a couple years ago after some fetal anomalies were discovered. She ultimately got the diagnosis right at the state's abortion deadline when the procedure would no longer be an option. They got some testing and continued with the pregnancy and the child was healthy, but just that experience of bumping up against the state law and navigating that timeline pressure was just really fraught and something she doesn't want to go through again. So now she told me she's just really too afraid to get pregnant in the current landscape, which has become even more strict.
There's also kind of additional uncertainty at the federal level around reproductive health access since President Donald Trump took office. They've done some actions about reviewing mifepristone. So, just a lot of moving parts that are giving some women kind of pause on whether they want to have kids right now.
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Terry: One thing I found surprising in your reporting is that even when women are within the legal timeframe, it can still be difficult to actually get an abortion. Can you explain that?
Crumpler: Sure. North Carolina's new law added requirements on getting the procedure. This included a mandatory in-person counseling at least 72 hours prior, something that could previously be done over the phone. So this means now to access abortion in North Carolina, you have to have at least two appointments. So this requires extra time off work, travel, more logistical hurdles that can be difficult for some patients to navigate. The law also now requires any abortions after 12 weeks to be performed in hospitals. So this means the state's 14 abortion clinics are not an option for patients getting care under the exceptions.
Terry: Another thing you found is that it can be hard to obtain an abortion when a fetus is found to have serious or fatal abnormalities, even though the law makes exceptions for that. Why is that?
Crumpler: North Carolina's law allows abortions for life-limiting fetal anomalies during the first 24 weeks in pregnancy, but several OBGYNs told me that life limiting remains broad and open to interpretation, which can lead to variability in patient care. One doctor may tell you this would qualify and be willing to provide an abortion. And another may think, ‘Oh, that isn't life limiting’ and may say you have to go to Virginia, where abortion is allowed through the second trimester.
And another factor is legal risk. Even providers following their best medical judgment maybe can't help but weigh the legal risk of ‘Is somebody going to look at this? Is it going to be OK? Are they going to question my judgment,' and what would that mean for them and their practice?
Terry: Now this is coming amidst a decline in the birthrate nationwide. It reached a record low in 2023 according to CDC data. There is a push by the Trump administration to reverse that, but with all these concerns, could it continue to decline?
Crumpler: I do think for at least some people, abortion restrictions are having a chilling effect on their decisions to have kids. But data revealing that full impact is definitely years away. If the birth rate does continue to decline, I think reproductive health access could be a factor, but there's certainly other ones that may contribute to that, such as continued high cost of childcare, growing maternity care deserts, and many others.
