Despite the fact that in November 2022 Michigan voters passed Proposition 3, enshrining abortion rights in the state Constitution, getting access to care remains a challenge for patients — both those who live in Michigan and those who are coming to the state from across the nation.
“This week, I took care of a patient from Georgia, where there is a six-week ban. I took care of a patient from Texas, where there is a complete ban. And that has unfortunately been our reality since the Dobbs decision, that we see people from places I had never taken care of before,” Dr. Sarah Wallett, the chief medical operating officer at Planned Parenthood Michigan, tells the Michigan Independent.
Michigan has several restrictive laws on the books that patients are required to follow in order to obtain abortion care. One includes a rule requiring that patients receive counseling 24 hours before obtaining an abortion: They must fill out, sign, and print a form that has a time stamp on it and then wait for 24 hours from the stamped time before having an abortion. The form expires two weeks after it is issued.
“I would say I certainly, almost every day I’m in clinic providing abortion care, have to turn someone away, if not multiple patients, because their 24-hour consent is not valid,” Dr. Halley Crissman, a Michigan obstetrician and gynecologist, tells the Michigan Independent. “And that includes people who’ve driven five hours, who are facing complications in pregnancy, who have really limited means. It includes people who have flown from other states but didn’t realize there was this paperwork or got the printing on the paperwork wrong. I mean, this is something that those of us who are in clinic see every day.”
Crissman says the so-called informed consent of a 24-hour waiting period is actually a barrier to care.
Reading information that is stigmatizing of abortion care is not informed consent. This would not change the fact that a health care provider needs to review things like, what are the risks of complications? What are the alternatives? What is the procedure, etc., with a patient? It would simply eliminate the barrier to getting to that point in care, which is what we expect from all health care providers when we’re having any procedure or making any medical decision.
Michigan law does not allow private insurance or Medicaid to cover the cost of abortion care.
The state requires that all clinics providing abortion care meet the same standards as ambulatory surgical centers – building standards that could cost millions of dollars to implement. The Guttmacher Institute refers to such laws as Targeted Regulation of Abortion Providers or TRAP laws.
“The laws in Michigan are even further barriers that prevent us from doing everything that we could to see patients, things like TRAP laws that regulate what type of buildings we can provide care in, things like the 24-hour waiting period, which is obviously absurd when people are already waiting sometimes two to three weeks for an appointment, to throw in an extra 24 hours doesn’t make any sense,” Wallett says. “Abortion, while it’s very, very safe, it is time-sensitive, and the sooner someone can have an abortion, the better for them. We know people want abortions earlier in pregnancy, and delays can harm their mental and physical health.”
Crissman says TRAP laws are particularly dangerous for people living in rural areas, where renovating clinics is cost-prohibitive: “It means that in Michigan, there are no clinics offering abortion procedures north of Saginaw to the entire northern third of the Lower Peninsula, and the Upper Peninsula has to travel for care.”
On Oct. 19, Michigan Senate Democrats announced the passage of four out of a package of 21 Senate bills called the Reproductive Health Act. Democratic lawmakers have vowed to repeal outdated restrictions on abortion care in the state. Passage of the act has stalled due to dissension within the Democratic Party: Democratic Rep. Karen Whitsett has consistently opposed the use of Medicaid funds to pay for abortion care and supports the 24-hour waiting period.
In September, Planned Parenthood announced the abrupt closure of its Heritage Clinic for Women in Grand Rapids, leaving its Kalamazoo Health Center as the only procedural abortion provider in West Michigan.
“This crisis happening in West Michigan highlights what is a reality in public health and medical literature: Where there are abortion restrictions and bans in place, outcomes for people are worse,” Wallett says.