North Carolina’s 12-week abortion ban was introduced and passed within 48 hours. “That’s actually shorter than a person has to wait after they receive their state-mandated counseling in order to get an abortion,” said Amber Gavin. “That irony is not lost on us.”
On May 16, North Carolina’s GOP-controlled legislature enacted a 12-week abortion limit, after Republican supermajorities in both houses of the state legislature overrode Democratic Gov. Roy Cooper’s veto of SB 20, which prohibits any licensed physician from performing abortions after the 12th week of pregnancy.
The bill purports to provide exceptions for pregnancies resulting from rape and incest through 20 weeks of pregnancy and for a “life-limiting” fetal anomaly through 24 weeks of pregnancy—but these exceptions are narrowly drawn. The bill has no exception for preserving the health of pregnant women, allowing abortion only necessary to avert death, “not including psychological or emotional conditions.” Physicians violating the law face dire consequences, including loss of license, civil litigation and criminal prosecution, leading to jail time or fines. The law is slated to take effect beginning July 1.
Amber Gavin is the vice president of advocacy and operations for A Woman’s Choice, an independently female-owned and operated abortion clinic with three locations in North Carolina and one in Jacksonville, Fla. They specialize in first- and second-trimester abortion care, and offer miscarriage management, pregnancy testing, ultrasounds and STI testing.
Ms. spoke with Gavin about the impact of the North Carolina abortion ban, slated to take effect on July 1.
This interview has been lightly edited for clarity.
Carrie Baker: How will the new law impact your clinics?
Amber Gavin: SB20, which we’ve been referring to as a monster abortion ban, is extreme and sweeping legislation that imposes significant barriers for folks accessing abortion in North Carolina. It bans abortion after 12 weeks of pregnancy. Republican lawmakers have claimed that the bill allows for exceptions up to 24 weeks of pregnancy, however, any abortion under those limited exceptions would have to be provided in a hospital, which we know is not necessary.
One of the problems when people say that there are exceptions, is that it’s really at the hospital’s discretion. We already know hospitals say medically-inaccurate things or refuse to provide abortion. The problem with the exceptions in my experience is that they’re not really workable in actuality.
It’s really cruel: We’re talking about survivors of assault, rape, fetal anomalies, but they have to plead their case to judges, lawyers and potentially hospital administrators to prove that their abortion is necessary and worthy, and that’s really cruel and unjust. I don’t think that’s really a workable solution. And forcing people to have abortions in a hospital also feeds into the misinformation around what abortion actually is. We know it’s safe and it can be done safely in our clinic.
Baker: Are there any health exceptions?
Gavin: It’s my understanding that there is no gestational limit for a medical emergency to save the life of a patient. But based on our experience and what we’ve been seeing with other states that ban abortion, we know that folks have to get pretty close to dying before they can get the care they need. Patients are being sent home. I’m fearful that will happen in North Carolina as well.
We’re talking about survivors of assault, rape, fetal anomalies, but they have to plead their case to judges, lawyers and potentially hospital administrators to prove that their abortion is necessary and worthy, and that’s really cruel and unjust.
Amber Gavin
Baker: If somebody develops a condition after 12 weeks that would harm their health but not necessarily cause them to die, can they get an abortion under the new law?
Gavin: No. The exception is only to save a life. This could have devastating effects on maternal health. We know already that North Carolina has high maternal mortality and morbidity rates. I think this ban could lead to an increase in that.
Baker: What limitations does SB 20 place on medication abortion?
Gavin: It cuts off access by a week. We have years of providing medication abortion care to patients backed with evidence through 11 weeks of pregnancy but the new law requires an in-person visit with the physician to confirm the pregnancy is less than 70 days or 10 weeks of pregnancy. So, while we know it’s safe and effective to use mifepristone and misoprostol up to 11 weeks, SB 20 effectively limits it to 10 weeks.
Baker: What other barriers to abortion does SB 20 create?
Gavin: This new law requires all of our patients to come in person for a consultation, which includes a state-mandated script and paperwork to be done in person, and this has to be done at least 72 hours before they can come back for their abortion appointment. Right now patients are able to do this over the phone. SB 20 completely eliminates that.
So SB 20 requires an in-person consult, a second in-person visit for their actual abortion appointment, and then potentially an in-person follow-up visit 7 to 14 days later, which we have to “take all reasonable effort to ensure they return.” That’s potentially three visits that patients will be forced to do, which is an astronomical barrier to care.
North Carolina already has the longest waiting period in the entire country: 72 hours. We know that patients don’t need that, but at least over the phone they could receive it and then come in for their care in one visit. This is potentially requiring three visits. That’s just not needed.
Baker: Will the law increase waiting times for appointments?
Gavin: North Carolina clinics were already facing a waiting period for folks to get access to care. Typically, when a patient calls, it takes about 10 days at our clinics for them to get an appointment. I think this law is just going to push a lot of people outside the limits to access care in North Carolina.
Baker: Who is likely to be harmed by this new law?
Gavin: Folks often forget about minors. When we’re young, our bodies go through all these changes. Our periods may not be regular. We may not know that we are pregnant. Also, this law requires at least two to three days out of school. That’s really hard, and frankly it’s unacceptable.
Also, folks who are already disproportionately marginalized in healthcare—so, Black folks, Latina folks, people living in rural communities where healthcare is already super inaccessible, and poor people, who can’t afford two to three days off from work, and travel and a hotel room if they don’t live close enough.
I think that ultimately this bill is completely eliminating choice for so many people. We’re going to have a lot of people forced to carry an unwanted pregnancy to term.
In other states that ban abortion, folks have to get pretty close to dying before they can get the care they need. Patients are being sent home. I’m fearful that will happen in North Carolina as well.
Amber Gavin
Baker: Do people in North Carolina have to travel long distances to get abortion healthcare?
Gavin: There are only [16 clinics] in the state, and 91 percent of counties in North Carolina do not have an abortion provider. I think what’s going to happen is the law is going to push people later into their pregnancy so they may not be able to access abortion in North Carolina.
Baker: Will people in North Carolinians have to start traveling up to Virginia or to other parts of the country to get the care they need later in pregnancy?
Gavin: Yes. North Carolina was one of the last states in the South to have access to abortion after 15 weeks, so the closest options for patients in the South will be Virginia, Maryland, and even Illinois.
Baker: Have you been seeing a lot of patients from out of state?
Gavin: We’ve been seeing patients from Alabama, Mississippi, Texas, Louisiana, Georgia, etcetera. We’ve had some folks from Texas driving 16 hours one way and then back to receive a medication abortion. They have to take time off from work, pay for child care and all the costs of travel, but now they have to do that and then stay three days in order to actually then get their care. So, it’s just pushing it completely out of reach for so many patients.
Baker: Does the law have new reporting requirements that could compromise the privacy of patients?
Gavin: We already have a lot of reporting requirements in North Carolina. We are in consultation with our attorneys about what impact this bill could have on our patients and on our staff. We’re fearful and it seems likely that our physicians and our medical staff are going to be spending a lot more time on administrative tasks rather than focusing on patient care, which is really frustrating for everybody involved.
Baker: I notice the bill has a provision that’s like SB 8 in Texas that allows citizens to sue people for talking about abortion pills. Will that impact you?
Gavin: I think that is focused on advertising for a medication abortion. I think they’re trying to limit folks from accessing abortion outside of the clinic or hospital setting. What we all know is that women and folks who can get pregnant have been having abortions since the beginning of time and they will continue to do so by any means necessary. And if that’s outside of the healthcare system, folks are going to access that, whether that’s procuring pills online or other methods. What this says to me and what we’ve always known is that this is really not about the health and the safety of pregnant North Carolinians, this is about controlling our lives and our families and our futures, and I think that is unacceptable.
Baker: The bill also has $3.5 million for long acting reversible contraption (LARCs) for “underserved, underinsured, and medically indigent patients” and $10 million for paid family leave for employed women.
From the outside, this looks like they’re trying to discourage poor women from having children and pressure middle and high-income women to have more children. How do you understand the fact that they’re pumping money towards low-income women to use contraception and funding time off work for women with jobs to stay home and take care of the children they will be forced to bear?
Gavin: If Republican lawmakers really wanted to improve access to reproductive healthcare, including contraception, they would actually work with providers like us and advocates to actually develop real, effective laws.
Funding LARCs can be beneficial but it’s not enough. Every single North Carolinian deserves access to education on all types of contraceptive methods and the ability to choose what’s best for them and their families and should never be forced into or coerced into a method that’s not right for them. Instead we need to focus on actual healthcare options like reducing maternal mortality and narrowing these inequalities by providing and making sure folks have access to all forms of contraception and family planning.
Baker: The National Abortion Federation recently released a clinic violence and disruption report showing a sharp increase in arsons, burglaries, stalking, bomb threats, invasions and assault and battery.
Are you worried that SB 20 will inflame more clinic violence?
Gavin: To be really frank, since the overturn of Dobbs, we have seen an increase of harassment and intimidation outside of our clinics. This is not new to us.
A couple years ago we had a man who brought a firearm outside of our clinic to protest, which he accidentally discharged and shot himself. There are folks stopping vehicles in traffic circles trying to prevent them from coming into our clinic. That is a danger to our patients and our neighbors. It’s a huge safety issue. At our Raleigh office, there’s a thief that is specifically targeting our president and CEO. Our lead escort actually had drone footage taken of their house and their car.
These are huge violations of our safety and security. We’re afraid that things are only going to be exacerbated by this abortion ban. It just encourages them.
This bill is completely eliminating choice for so many people. We’re going to have a lot of people forced to carry an unwanted pregnancy to term.
Baker: Do you think this law is going to shut down any of the clinics in North Carolina?
Gavin: It’s too early to tell. The law gives the Department of Health the opportunity to create new standards for clinics to be ambulatory surgical centers, and we’re not sure exactly what that means. There could be costly requirements facilities that could potentially shut down clinics for a short period of time, or it may be that not everyone can afford these changes.
Baker: Will you be able to remain open?
Gavin: We are going to remain open and continue to provide care. We are still providing the best quality care until 20 weeks in our clinics we possibly can, and then figuring out what’s next and what we can do to keep abortion accessible here in North Carolina.
Baker: Many have criticized the way Republicans passed the law. Can you explain that?
Gavin: This bill was introduced outside of the typical democratic process. The Republicans didn’t even follow their own procedures on how to introduce a bill. It was introduced and then passed through the House and the Senate within 48 hours. That’s actually shorter than a person has to wait after they receive their state-mandated counseling in order to get an abortion. That irony is not lost on us.
When Gov. Cooper, he received the bill, he held it as long as he possibly could before vetoing it, and in the lead up to vetoing it, he held round tables in three different counties where these lawmakers work to educate them and to hear from providers, patient advocates, and the folks on the ground who are saying how harmful this ban could be.
Governor Cooper has been an incredible advocate in trying to help folks understand what will happen and what could happen if this bill goes into effect. He was working really hard to put pressure on Republicans to vote against the bill.
Baker: Were you surprised that not one Republican voted against the override, not even the one that recently switched from being a Democrat and claims to be pro-choice?
Gavin: I’m disappointed and angry. It’s very much a betrayal. A few of these Republican legislators, including Tricia Cotham, ran campaigns saying that either they wouldn’t change the status quo or they would protect reproductive freedom and abortion in North Carolina. They blatantly lied.
Baker: Do you think there’ll be political repercussions in the 2024 elections, particularly for these Republicans that said they would protect abortion rights and didn’t?
Gavin: I do. I think what we’ve seen across the U.S. is that abortion is winning. People are angry. People are paying attention. I think these lawmakers who voted against the people of North Carolina and the South are going to be held accountable. I think we were seeing that abortion wins and I think it will win in North Carolina.
Baker: A recent Meredith College poll shows that 57 percent of people in North Carolina support abortion rights. What are you seeing on the ground?
Gavin: Abortion is incredibly popular. The majority of Americans and North Carolinians believe that folks should have access to it. They believe it’s a really personal and private decision that should remain between a patient and their physician, and that politicians make really bad doctors and shouldn’t be meddling.
Baker: What are you most worried about for the future?
Gavin: I’m sorry, I’m getting really emotional. North Carolina has been a crucial access point to care in the South because so many surrounding states have partial or complete abortion bans. I am fearful and sad about folks not having the access to make decisions that are best for their lives and their futures. I think it’s unconscionable to take away essential healthcare from our communities, to take away their choices and options. That’s really bad healthcare and it’s going to lead to devastating consequences. Folks could be forced to carry pregnancies detrimental to their health. We know that childbirth is more dangerous than abortion.
I’m fearful for minors who can’t access care, Black folks and people in rural communities. I think frequently about the Turnaway Study showing that when people are denied abortion, they get stuck in abusive relationships, economically it’s a hardship, they just can’t get even footing. We know the majority of folks who have abortions are already parenting. We know it’s going to be a huge strain on families.
Personally, the day the Dobbs decision came out, I was seeing an OB oncologist because I had a molar pregnancy [a tumor that develops in the uterus as a result of a nonviable pregnancy]. It was devastating. It was a very much wanted pregnancy. I needed to have a D&E procedure. I think about the folks who aren’t going to have that care, who aren’t going to be able to go to a hospital or a clinic in states with bans, where the clinics have closed down. I had really, really compassionate care. They actually saved my life. I’m fortunate because I lived in a state where I could access the care that I needed, but I am fearful for folks who have pregnancy complications and can’t access the care that they need. Hopefully people aren’t shamed and the providers and hospitals aren’t scared to provide that care. I hope things like a molar pregnancy aren’t a death sentence for folks.
Baker: Is the legislature going to try to do anything more to limit reproductive health services?
Gavin: They want to completely ban abortion in the entire state and they’re not going to stop with abortion. They’re going to come for our birth control. They’re going to come for any part of our lives that they can control. They are not going to stop here.
A Woman’s Choice is a part of Floridians Protecting Freedom, a coalition of advocates pushing for a referendum to protect abortion rights in Florida. Floridians can sign the petition here.
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