Doctors race against Florida’s six-week abortion ban

With just days until Florida’s six-week abortion ban takes effect on Wednesday, providers are rushing to perform as many abortions as possible while planning contingencies for a future where they will need to turn thousands of women away.

Clinics have expanded hours, prioritized ultrasounds and added appointments in these final weeks. They’ve fortified their patient navigation efforts and strengthened relationships with abortion fund groups like the Florida Access Network that provide financial and logistical support to people seeking to terminate pregnancies.

The ban has limited exceptions for rape, incest, human trafficking, the mother’s health and for fatal fetal abnormalities.

“Planned Parenthood’s motto has always been ‘care no matter what.’ And we don’t turn patients away. So this is a very devastating and tragic situation for our staff, who have to say, ‘we can’t take care of you, we have to send you someplace else,’” said Planned Parenthood of Southwest and Central Florida’s interim CEO Barbara Zdravecky.

Patient panic

As medical providers race against the clock, many patients are unaware their time is running out, said Dr. Chelsea Daniels, a fellow with Physicians for Reproductive Health and an abortion provider in South Florida. When she tells patients about the imminent ban, she’s mostly met with shock.

“We have signs up all over the clinic, we’re having conversations with patients … But I imagine that when May 1 comes we’re going to have patients coming in farther along than six weeks and having no clue that they’re not able to get an abortion. And I think that it’s really hard to overstate the panic that people are going to feel,” said Daniels.

Florida performed over 84,000 abortions last year, including over 7,000 for women who came from elsewhere, according to state data.

The six-week ban, one of the strictest in the nation, was passed by the Legislature and signed by Gov. Ron DeSantis in 2023 but was only recently ruled constitutional by the state Supreme Court. Six weeks of gestation is about two weeks after a pregnant woman misses her first period.

Florida also requires two in-person visits at least 24 hours apart before someone can get an abortion. Some providers say these requirements will effectively prevent some people from getting the procedure at all.

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Pursuing alternatives

Zdravecky and other Planned Parenthood leaders are preparing now for a future where the number of abortions performed in Florida dramatically decreases.

To compensate, the clinics will continue to offer and expand their other services.

Clinics in Southwest and Central Florida will start offering vasectomies again, and focus on expanding access to birth control and the Plan B pill, which can be taken within 5 days after unprotected sex to prevent sperm from fertilizing an egg, Zdravecky said.

After the ban takes effect, those who can find the funds will travel to other states. For most Floridians, and most of the southeast U.S., the closest state to get an abortion past 6 weeks will be North Carolina. The closest place to terminate a pregnancy past 12 weeks will be Virginia or Illinois.

Many others will turn to the internet to order abortion pills, either illegally or through telemedicine appointments with out-of-state doctors, who can prescribe them due to “shield laws” that protect them from out-of-state prosecution, even in states like Florida where doctors are not allowed to prescribe the pills via telemedicine.

The pills are widely considered safe to use up to about 10 weeks. Florida clinics can still offer follow-up exams to those who obtained the abortion pills online.

“We want to be able to assist anyone with any type of care that we legally can do in order to make sure they have the care that they need to stay healthy,” Zdravecky said.

Florida law also bans people from obtaining the pills via mail, but the U.S. Justice Department ruled in January 2023 that the postal service can continue to deliver abortion pills to states where the pills are banned. This ruling supersedes state law.

Legal quagmire

The law offers exceptions for rape, human trafficking and incest up to 15 weeks of pregnancy but requires documentation like a police report or a restraining order.

It also has exceptions for the mother’s health and for fetuses with a “fatal fetal abnormality,” a nonclinical term defined as a condition where the baby will die at birth or immediately after.

“I’ve asked three attorneys: What does immediately mean? And one told me one day, one told me one week, and one told me a month. How am I supposed to interpret this?” said a Central Florida abortion provider who asked to remain anonymous because she was not authorized to speak to the press.

Anyone who helps someone terminate their pregnancy in violation of the law could lose their medical license and be charged with a third degree felony, punishable by a maximum of five years in prison.

“These exceptions are incredibly difficult to decipher and define and to follow,” Daniels said. “Physicians and the lawyers advising us, we are afraid to make medical decisions that could put us in legal jeopardy, even if we understand that our medical decisions are based in the science.”

But providers and hospitals that are overly conservative in granting exemptions can face consequences too.

In 2023, Memorial Regional Hospital in Hollywood refused to provide an abortion for a woman whose water broke because she was past Florida’s 15-week limit, even though she was at risk of infection. The Centers for Medicare and Medicaid services concluded the hospital violated a federal law that required it to provide emergency care, threatening in a letter obtained by The Washington Post to take away hundreds of millions of dollars in federal funding if the system didn’t take corrective action.

AdventHealth Central Florida and Orlando Health, Central Florida’s two main hospital systems, did not immediately respond when asked how they will determine what conditions qualify for exceptions under the six-week ban.

The fallout

Zdravecky is optimistic that, in November, Floridians will vote to reverse the six-week ban and protect abortion up to the age a baby can survive outside the womb.

Even then, she said clinics anticipate months of legal challenges before the ban is undone, and many women who want abortions will not be able to get them during that time.

“It’s going to be a very dramatic situation in the lives of Floridians. It’s truly a healthcare crisis,” she said.

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Planned Parenthood does not plan on closing any clinics in the meantime, Zdravecky added, though smaller independent clinics may not be able to generate enough funds to stay open.

“Abortion service is the majority of their business and it will put an economic hardship on them if they don’t have patients and revenue while we wait this out, trying to get the ballot initiative passed,” Zdravecky said.

Overall, abortions have increased in the U.S. since the fall of Roe v. Wade, which The Guttmacher Institute attributes to increased efforts by clinics, abortion funds, support organizations and the rise of networks to order pills online.

But pregnancy terminations fall in states where they are restricted. The Guttmacher Institute found that in South Carolina, the number of abortions provided in the formal health care system decreased by 71% the month after the state started enforcing a six-week ban on abortions in 2023.

Ccatherman@orlandosentinel.com

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