Managing barriers to abortion access in the context of new laws: Perspectives from providers in North Carolina

Background: Laws governing the provision of abortion are proliferating throughout the United States and increasingly regulate specific aspects of clinical care. Little is known about how these laws affect abortion providers and their clinical practice.

Methods: We conducted a qualitative study to investigate the experiences of abortion providers in North Carolina practicing under the 2011 Women’s Right to Know Act (WRTK), which mandates that women receive counseling with specific, state-prescribed information at least 24 hours prior to an abortion procedure. Thirty-one abortion providers and clinic managers from 11 of 16 NC abortion clinics participated in a semi-structured, in-person interview. Interviews were digitally recorded and transcripts coded using Dedoose software and an inductive, iterative analytic approach.

Results: Most providers indicated that WRTK had not imposed a substantial burden on women. However, providers devoted significant labor and resources to minimizing the impact of WRTK on patients, including hiring additional staff and reassigning job duties, reorganizing clinic procedures, seeking legal counsel, and performing state-mandated counseling during non-business hours. The impact of WRTK on providers varied depending on practice context. Providers in freestanding clinics that offered only abortion care experienced more difficulties complying with the law.

Discussion: Providers play a key role in adapting to legislative changes and preserving abortion access. These findings suggest that research focused on abortion rates and patient impact does not account for the significant “behind-the-scenes” work providers undertake to mitigate the harmful effects of new abortion laws.