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“When I think back on the last year, I think about the chaos, and the fear,” says Dr. Alhambra Frarey, assistant professor of obstetrics and gynecology at the University of Pennsylvania. She sketched an environment of heightened fear and stigma among her patients and colleagues since Dobbs v. Jackson ended the federal right to abortion, one year ago this Saturday, June 24, 2023.
“The impact of all these politics and all these headlines is crystal clear in my exam room,” Frarey said. PEACE, where Frarey provides abortion care, sees medically complex patients who often have an urgent health-related reason for their abortion. But since Dobbs, Frarey’s patients wrestle with uncertainty and shame around their decisions. “I didn’t see the [patients] struggle like this before. It was very rare,” she says.
A love letter in a moment of crisis
There is no panacea for this undue burden. The fear and stigma provoked by our highest court is not going anywhere anytime soon. But those on the front lines of abortion care knew Dobbs was coming for years. Hannah Matthews’s You or Someone You Love (YOSYL), was written before the decision came down. It reads like a love letter to future patients, providers, and their families in this moment of crisis.
Matthews organizes YOSYL around a list of things abortion can represent: “Abortion Is Care,” reads one chapter title. “Abortion Is Pain,” another. An abortion doula, she weaves both her own abortion story and her experience as a provider throughout the book. Importantly, this is not a book that attempts a layered, academic argument for the right to abortion. The need for and legitimacy of such care is assumed, not debated.
YOSYL instead serves readers who have had abortions: this is a book you could buy a friend or family member with an appointment at the clinic next week, trusting that it will have something to offer them. Matthews also takes implicit aim at the reader who may be on the fence about abortion as an abstract concept, but remains reachable through storytelling, lightly scaffolded by data.
Reaching such readers has become ever-more urgent. States with abortion bans or severe restrictions recorded fewer abortions over the last nine months: an estimated drop of about 93,500. Providers in safe states have absorbed as much demand as they can. But they are not superhuman, and the time off, travel, and childcare needed to travel out of state for an abortion remain out of reach for the most vulnerable.
Abortion care in Pennsylvania
For now, Philadelphia remains relatively insulated from the worst ripple effects of Dobbs. Unlike Western Pennsylvania, we are not a hub for patients who must travel for their abortions. The city has multiple local providers offering care up to the legal limit—23 weeks and 6 days—in Pennsylvania. Our local abortion fund, ALF PA, received $500,000 from the city of Philadelphia last August. Three of our large teaching hospitals—Penn, Jefferson, and Einstein—proudly provide abortion care, rare in a country where hospitals provide about 3% of all abortions.
Philadelphia is not perfect, of course. Pennsylvania forces those who need care after 24 weeks to travel or seek unsafe, illegal care that may cost them their lives. We require condescending counseling and a 24-hour waiting period before a patient may obtain care. And we impose many restrictions on when and how insurance may cover abortion care (get the facts on abortion in Pennsylvania here).
After a year of her patients expressing fear and shame in the exam room, Dr. Frarey felt compelled to leave Penn for a position as the chief medical officer of Planned Parenthood Southeastern Pennsylvania, where she feels she will be better positioned to serve the reproductive health needs of all Philadelphians. Like every provider I’ve interviewed over the past 12 months, she has too much in front of her to do to dwell overmuch on the weight of Dobbs’s first anniversary.
The right to grieve
But this is where Matthews excels, writing from before “the transition, the crossing from one side of your life to another.” I flipped open to a page in Matthews’s chapter, “Abortion Is Grief,” this week. “Grief is normal,” she writes. “Grief is sacred. You have the right to experience your own unique and evolving blend of emotions about your abortion(s), including grief in whatever forms it may take. Your grief belongs to you. You have the right to embrace it and accept it. It is part of your story like any other.” She means any grief, for any ordinary abortion, but stretch it for a moment to this larger cultural transition, from a country where we once had this freedom, however flawed, to one where we don’t.
This year, and the next, our grief—and our action—belong to us. As abolitionist Mariame Kaba writes, “Let this radicalize you, rather than lead you to despair.”
Above: Image via Simon & Schuster.
What, When, Where
You or Someone You Love: Reflections from an Abortion Doula. By Hannah Matthews. New York: Atria Books, May 2, 2023. 352 pages, paperback; $18.99. Get it here.
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