Abortion-rights advocates in the 13 trigger law states refuse to give up post-Roe

On the morning of May 25, Julie Burkhart got a call that her soon-to-open clinic, Wellspring Health Access, was on fire.

The clinic would have become the second in Wyoming to provide abortions and the only one to provide the surgical procedure for people who were past being able to end a pregnancy through pills. The clinic was set to begin patient services on June 13, according to Burkhart. But the destruction made that impossible.

Almost immediately, officials concluded that the fire had not been caused by an accident or electrical malfunction. It was arson.

A woman — described as white and wearing jeans, a dark hoodie and a mask — had broken into the clinic carrying a large red gasoline container and had set the place ablaze.

"It was a terrorist act. There's no other word for it," Burkhart told NPR.

"It's heartbreaking but also appalling that someone so recklessly would come in and start a fire when you could almost touch the wall of the apartment building next door where people were sleeping in their beds."

She added, "It just showed me that there is this grave disregard for the lives of the people right there in the neighborhood."

Burkhart notes that the clinic would likely have been in operation for only a few weeks, given what she read in May's leaked Supreme Court draft opinion on Dobbs v. Jackson Women's Health Organization, a case that last Friday resulted in the overturning of Roe v. Wade.

"We knew with this decision coming down that we probably wouldn't have long, but it would be something," she said.

It's not lost on Burkhart that the extremist violence of the arson serves as a painful metaphor for the situation that reproductive health advocates currently find themselves in. With every state legislature that passed tight abortion restrictions over the last few decades and with every win by conservatives who gained greater influence over presidents and other elected leaders, it has been like watching a raging fire get closer and closer — putting innocent people's lives at risk — and all while equipped with a measly fire extinguisher.

That's especially true for abortion-rights supporters in the 13 states that preemptively passed "trigger laws" designed to immediately ban or severely limit abortion in the event of Roe's reversal.

In the week after six conservative judges undid a half-century of legal protections for people seeking an abortion, NPR spoke with a handful of reproductive rights supporters — activists, doctors, abortion clinic escorts and women who made the choice to end a pregnancy — to gauge how they're feeling and what their plans are, moving forward in a post-Roe world.

What we found is a group of people bound together by immense grief, frustration and outright fury, but who are all committed to continuing to fight in whatever ways they can. They say the battle over what they believe is the fundamental right of people to choose an abortion is far from over, only now it will be fought in courtrooms and legislatures at the state level.

Already they see a few glimmers of hope — or at least temporary reprieves. As of the publication of this story, a half-dozen states have challenged the new restrictive abortion laws, arguing they are in violation of state constitutions. And some courts have already responded, issuing stays or restraining orders against them.

Arkansas — Rachel Marsala

As an abortion clinic escort in Little Rock, Ark., Rachel Marsala willingly endured months of harassment.

The 28-year-old volunteered at Little Rock Family Planning Services for nearly a year, walking pregnant people across the parking lot and into the clinic. During those months, she heard what she described as vile things from the anti-abortion protesters who would gather outside the clinic every day.

"They would say things like, 'Don't kill me, Mama!' " Marsala said.

In the days after the Supreme Court's draft opinion overturning Roe v. Wade was leaked, the protesters became even more aggressive, she said. And last Friday, when the court's official decision came down and Arkansas' trigger ban kicked in, at least one man went from protester to vigilante.

"He was copying down the license plate of every single vehicle that drove in and out of the clinic so he could then turn them in to the police so they could be prosecuted," Marsala said.

Since last week, abortion is banned statewide, except for cases in which a patient's life is in danger.

At the moment, Marsala said, she is focusing on her breathing and remembering to exhale. She's also in therapy, which she recommends for everyone, especially activists like her who may feel defeated over the court's ruling and the people who will suffer as a consequence.

"[Last] Friday, we had to turn away a woman who had rescheduled her procedure because she couldn't afford to pay the first time she came in," Marsala said. "That's just one devastating story."

She offers this advice for beleaguered reproductive rights advocates fighting anti-abortion activists: "These people are out there and they are mobilized and they're ready to go. We as defenders of choice have to match their energy. We've got to be ready to show up!"

— Vanessa Romo

Idaho — Loren Colson

Loren Colson, a physician specializing in family medicine, is worried about the many ways a ban on most abortions in Idaho could risk the health and safety of his patients. He also has legal questions.

"There are just so many scenarios in pregnancy that are not straightforward that the legislators did not think of when they created this law," he told NPR, referring to a trigger ban that will likely take effect sometime in August.

If it does, it will replace the state's current law, which allows most abortions up to about 24 weeks, with one that will allow abortion only in cases of rape or incest — so long as the victim can prove they've filed a police report — or when the pregnant individual's life is at risk.

Colson provides "comprehensive reproductive health care," including "options counseling" — that means he talks to patients about ending their pregnancies. He said he's outraged by the burden Idaho's new laws place on victims of assault. But it's the lack of clarity about what constitutes a "risk to life" that he says will likely affect most people seeking an abortion in the future.

In many cases, a pregnant individual might have an issue that doesn't put their life in immediate danger but that could be a life-threatening complication later in pregnancy. Should they wait until that happens? he asks. That's the type of complex legal gray area that legislators still need to hash out, Colson said.

He added: "Pregnancy is in itself a risk and carries a higher mortality rate to it than abortion."

More personally, he and his wife are trying to have a child. They have been undergoing fertility treatment that has produced embryos they hope to use.

"If we don't use all of those embryos, are they protected under this law — and what do we do about those?" he wondered. "The state hasn't defined what is considered viable, what is considered a fetus in cases where it's not a straightforward pregnancy."

— Emma Bowman

Kentucky — Miranda Cisneros

Miranda Cisneros frequently participates in protests in Louisville, Ky. But when she heard the news that the Supreme Court had overturned Roe v. Wade, it took her a bit before she was ready to go out.

"When I first heard the news, I was completely numb," she told NPR.

"Usually when we hear things, we're just automatically ready to spring into action, but I really had to take a moment," she said, adding that by the following day she was "feeling a lot of anger."

Much of that anger goes back to the election of Donald Trump, when many people told her she was overreacting, Cisneros said.

"I felt so gaslit in the 2016 election. So many people were telling us that we were overreacting and it was not going to be a big deal, but we're really seeing the aftereffects," Cisneros said, in part referring to Trump's legacy, which includes Supreme Court Justices Neil Gorsuch, Brett Kavanaugh and Amy Coney Barrett, who all voted to strike down Roe.

Kentucky moved swiftly to enact state laws prohibiting nearly all abortions. But on Thursday, a state judge ordered a temporary restraining order on them, allowing abortions to resume for now.

When looking at who is going to be most affected by the decision, Cisneros said it is not necessarily the same people, specifically women, who voted for Trump. She said she's worried about the Black, trans and disabled communities.

"I mean, the health care system is already designed to work against disabled folks," she said. "What about disabled folks who now become pregnant? You know, that is also a conversation I think a lot of people aren't having either."

Cisneros said she wants to see more of these conversations happen. She also wants to see people get uncomfortable and have conversations with their family members or friends, in addition to protesting.

— Wynne Davis

What does Friday's landmark decision overturning Roe v. Wade mean for Kentucky?

Preparing for a fight: Kentuckians react to the overturn of Roe v. Wade

Louisiana — Arséne DeLay

Arséne DeLay is done crying.

The 42-year-old New Orleans-based musician and activist says she ran out of tears lamenting conservatives' steady gains against abortion access years ago.

"I shed my tears in 2016," she told NPR, adding that loss of abortion rights was the inevitable outcome of Donald Trump's victory in the election that year. With disdain, DeLay added, "We did this to ourselves as far as the societal thing goes."

Moments later she continued: "As a Black woman living in the South, this is nothing new."

Louisiana's trigger law, which went into effect immediately last Friday following the Supreme Court's decision overturning Roe v. Wade, is now on hold. A state judge has issued a temporary restraining order blocking Louisiana's abortion bans from being enforced.

However, if the trigger law does go back to being enforced, it will limit abortion to cases in which the pregnant individual's life is in danger. Anyone who is in violation could face a felony punishable by up to 10 years in prison and a fine of $100,000, according to the Guttmacher Institute, a reproductive health research organization that supports abortion rights.

For DeLay, it leaves only one path forward: civil disobedience.

"At the end of the day, the Supreme Court depends on society's agreement of this construct, and quite frankly, I have no business or interest in following laws that are unjust and laws that put women in harm's way, especially Black, brown, Indigenous," she said. "I'm talking from my own experiences — in times when these situations have come up."

DeLay also said the fight for abortion rights comes down to access.

"No one needs to go and invent the wheel — look for the helpers and you support them if there needs to be some kind of a setup to get people the access that they need," she said.

"At the end of the day, that's what all of this is about."

— Shauneen Miranda

New Orleans protesters ready to 'fight like hell' for abortion rights after SCOTUS ruling

Mississippi — Rebecca Meador

The story of Rebecca Meador's abortion begins with the story of the pregnancy that came before it. When she was 19 years old and living in Mississippi, she gave birth to a baby boy with her then boyfriend, she told NPR.

She couldn't afford to raise the baby and she didn't want to have an abortion, so she chose to place the baby for adoption.

"Carrying a child and growing it in your womb, knowing the entire time that you wouldn't be a part of its life, is traumatic and incredibly stressful, and I did the best I could to continue to work and go to school while pregnant," she said.

She developed severe postpartum depression and agoraphobia following the birth and adoption of her baby boy. That led her to get an abortion a year later when she found out she was pregnant again.

"I knew that I wouldn't survive the possible postpartum depression and agoraphobia again after delivering another baby, and the shadow I lived in of the grief of losing a child to adoption — being a mother just wasn't an option. It would cost me my life," she said.

This week, Mississippi Attorney General Lynn Fitch certified the Supreme Court's decision overturning Roe v. Wade. Doing so triggered a state law that bans almost all abortions in Mississippi. It goes into effect this month. Meador now fears that women will have to live through the same pain she did.

"Taking away abortion care is nothing less than violence towards women," she said. "The lack of access to health insurance, the inequality of pay for women, the continued victim blaming when a woman is assaulted and the condemnation of a woman's soul to hell for being in an impossible situation in life are clear indicators of the devaluation of women's lives."

— Jaclyn Diaz

Experts raise concerns on implementing the exceptions to Mississippi's anti-abortion trigger law

Missouri — Hanz Dismer

Every day when Hanz Dismer goes to work, they have to leave Missouri, the state they live in, and drive across the Mississippi River to the Hope Clinic for Women in Granite City, Illinois.

Dismer is the education and research coordinator at the clinic and a licensed clinical social worker. Before the Supreme Court's decision overturning Roe v. Wade came down, Dismer said it was something that they and many other abortion providers knew was coming — which is why they started preparing way before last Friday's decision.

"In 2021, we saw patients from 19 different states already, so we're not new to having patients travel from all across the Midwest and South to access care," Dismer said. "We know that's going to get worse."

Dismer said that a lot of telehealth protocols instituted to mitigate COVID-19 are helping to streamline things today and that the Hope Clinic is working with a Planned Parenthood location in Illinois to better serve the influx of patients.

Even so, Dismer said some conversations are still tough as patients go back to their home states and wonder about post-abortion care.

"These are things that, of course, we want you to be honest with your health care providers, if you can. And we acknowledge that sometimes that's not safe," Dismer said. Sometimes it's not safe to tell your health care provider that you had an abortion because they may judge you or they may report you or they may compromise the care you're getting.

— Wynne Davis

What comes next for Missouri after the end of Roe? Here are 3 key takeaways

North Dakota — Sarah Haeder

When Sarah Haeder was growing up, her summer vacations were not the most traditional. Instead of picking a place to visit based on an attraction, Haeder's Irish Catholic family chose their destinations based on clinics offering abortion, specifically so they could protest outside them.

"So most of my life I grew up reinforcing the stigma and telling people abortion was wrong," Haeder told NPR. "And then I came to college and I took a women's studies class and I read a bell hooks novel and it changed my life."

Haeder, who lives in North Dakota, said she realized not everything she grew up learning was what it seemed to be. Then when she found herself pregnant in a brand-new relationship, she decided to get an abortion — something she never thought she would do.

"I had an abortion here at Red River Women's Clinic, and that was in 2006," she said. "Ever since coming into this clinic and having that abortion care, I wanted to work here."

Eventually, Haeder got a job as a patient educator and quit her full-time job to work at the clinic. But she didn't stop there. She was inspired to go back to school for a nursing degree.

"Now I am the head nurse here, and I couldn't be more proud of where I'm at or what I do," she said.

But amid that pride, the Supreme Court's decision to overturn Roe v. Wade has been weighing on her.

"Of course, I feel it is a travesty," she said. "If a human being doesn't have autonomy over their own body, how do they have autonomy over their own life?"

"I'm just thinking about all the women who already have so many obstacles and then to have this one put up is just — it's like a really big blow and it's really hard to keep emotions in check."

— Wynne Davis

Oklahoma — Alan Braid

Dr. Alan Braid provided abortion care before the 1973 Roe v. Wade decision, back when abortion was widely illegal.

"I was an intern in 1972 before Roe and saw injured women and women who died from back alley or botched abortions," he explained to NPR.

Braid, an OB-GYN, said he must now reconsider his clinic in Tulsa, Okla., after the state's trigger ban.

The trigger ban, which comes after a separate Oklahoma anti-abortion law that was at one point the strictest in the nation, now makes it a felony to provide an abortion and includes a penalty of up to five years in prison. The only exception is if the pregnant patient's life is in danger.

Braid is not sure what's next for his Oklahoma clinic or his practices in San Antonio, Texas. That's where he currently lives, and there he is facing two lawsuits for performing an abortion in defiance of the state law enacted there last year that bans most abortions after about six weeks of pregnancy.

In addition to being sued, he's also suing. "I've been a part of [opposing] almost every lawsuit challenging the right for women to choose their options," he said. At the moment, he's one of several challengers seeking to nullify the Oklahoma ban.

But it's clear he's exhausted by the fight he has been waging in the 50 years he has been in reproductive health care. In some respects, it seems a burden has been lifted from his shoulders now that Roe has been overturned, even if it goes against his beliefs.

"I don't want to desert the women in Texas and the people [who] work for me," but, he added, he will feel some relief "not having to worry about the next session of the Texas legislature, which has plagued this state since 1978, when they started passing all the [targeted regulation of abortion providers] laws."

— Shauneen Miranda

South Dakota — Evelyn Griesse

Evelyn Griesse traveled to New York to get an abortion decades ago.

Now, the abortion-rights activist and co-founder of South Dakota Access for Every Woman faces a new challenge after the state's trigger ban went into effect hours after the Supreme Court's decision overturning Roe v. Wade was announced last Friday.

"We will do the best we can," Griesse told NPR.

"We have already been, for years, encouraging and helping women across South Dakota state lines because access has been so limited, so restrictive and so punitive, that there is no reason for us to have any kind of loyalty to this kind of law," she said.

South Dakota Access for Every Woman has been around since 1985, and last year more than 140 women got abortions with financial help from the organization.

She has always felt a duty to the women whose lives were lost in illegal abortions and to the doctors and nonmedical professionals who risked their own lives performing them.

"Women now are still feeling that sense of desperation," Griesse noted.

"It is primarily that sense of desperation that continues to go forward in women's lives and that obligation to others before me who gave so much of their energy and their lives to helping women in need," she said.

Now that South Dakota's trigger ban is in effect, anyone who provides or attempts to provide an abortion will face a felony charge, according to the Guttmacher Institute.

There are no exceptions for pregnancies resulting from rape or incest. The only exception to the ban is if the pregnant individual's life is in danger.

South Dakota Gov. Kristi Noem praised the new ban. "We have prayed for this day, and now it's here," Noem tweeted last Friday, adding that legislators have plans "for a special session to save lives and help mothers later this year."

— Shauneen Miranda

Tennessee — Aaron Campbell

Dr. Aaron Campbell always knew he wanted to be an OB-GYN — so much so that when he was 14, he dressed as one for Halloween.

Campbell had been inspired by his father, who was an OB-GYN and worked as the medical director of the Knoxville Center for Reproductive Health in Tennessee before experiencing a stroke that ultimately led to his death.

With his father gone, Campbell returned to Knoxville to continue the work his father had started. Now, Campbell has taken his place as the director of that same clinic.

"From the perspective of someone who just finished OB-GYN residency right over a year ago, this is going to amount to a public health crisis," Campbell told NPR in reference to the Supreme Court's decision overturning Roe v. Wade.

"From the perspective of someone who does this work regularly, it's a disaster and devastating for people who might need these services. And from my personal perspective, it's very disappointing and frustrating."

Even before the Supreme Court's decision came down, Campbell had started making plans to travel and continue his work in reproductive health care in areas adjacent to those impacted by the decision. He said his goal is to provide safe abortions to those who need and want them.

"The people that are going to be hurt from this decision are not the policymakers or any political elites. The people who are going to get hurt from this are the people who don't have the resources to obtain an abortion elsewhere," Campbell said.

He is worried about the long-term effects for those who will now be denied access to abortion, including lasting physical and mental health damage, as well as potentially life-long financial consequences.

"So this is not a decision that just affects them in real time. This decision or the denial of that decision truly has long-term consequences not just for their health but for their entire life."

— Wynne Davis

Texas — Adiana Vega

Even before the overturning of Roe v. Wade last week, Adiana Vega knew what it was like to live in a post-Roe world.

Texas' restrictive SB 8 law, which prohibits abortion after the detection of embryonic or fetal cardiac activity, or about six weeks into a pregnancy, and which requires several state-mandated interim steps, made it all but impossible for Vega to end her pregnancy in the state, despite the fact that she found out she was pregnant unusually early.

"I was about four weeks," the 26-year-old Dallas native told NPR. But even that was too late to get an abortion before the deadline, she explained.

While Texas lawmakers have moved to reinstate a nearly century-old abortion ban, a court has issued a temporary restraining order that blocks its enforcement. But that has left SB 8 in place.

"On paper, it sounds like I would have been able to get it, but a pregnant person is mandated to look at their ultrasound and then is required to enter a waiting period," Vega said. "Basically, all of that would have taken more than two weeks. Plus, on top of that, I had COVID at the same time."

But Vega is among the lucky group of people who have the means and resources to access abortion outside the state. So she called her boyfriend, who lives in Washington, D.C., and together they bought a plane ticket for her to get an abortion at the Planned Parenthood clinic there.

"We get to sweep it under the rug and move on with our lives simply because we have the means to make it go away and then we don't have to talk about it," she said, noting that many women who seek abortions are not so fortunate.

Vega said when considering where to go, she had to factor in cost, the amount of time she'd have to take off work and where she'd face "the least humiliating process."

When she eventually arrived in D.C. — a place she has always associated with progressive values — she was stunned to be confronted by the same type of anti-abortion activists she'd seen in Dallas.

"It's just more evidence that there's no place where pregnant people are completely safe," she said.

— Vanessa Romo

Utah — Angela Romero

Angela Romero, a Democratic state representative in Utah, used to be against abortion.

Raised Catholic in the small town of Tooele, Utah, she grew up in an environment in which women were made to feel ashamed of their decision to end their pregnancy.

"I've had women who have had abortions in my family, and it was very hush-hush — it was very secret," she told NPR.

Her outlook changed by the time she earned a bachelor's degree in political science at the University of Utah.

"Once I was exposed to just other thoughts and other worldviews, it just really changed the way I view the world," she said.

As a college student without health insurance, Romero had relied on the services provided by Planned Parenthood. Now, the politician said, she's worried about what will happen if people, especially those in poor and marginalized communities, lose that kind of "lifesaving" care under Utah's trigger law banning abortion.

The law, which makes inducing an abortion a felony, took effect last Friday, the same day Roe v. Wade was overturned. It has exceptions, including if the pregnancy is the result of rape or incest, though sexual assault victims must report the crime before seeking an abortion. The ban has since been put on temporary hold, however, as courts prepare to hear challenges to the trigger law.

Romero noted she's speaking up to ensure that vulnerable women "are not left behind."

"I have women come up to me all the time, saying, 'Thank you for saying what I wish I could say.' "

Romero said no one should need to file a police report to show that they were raped or violated by someone within their family.

"This goes back to trusting women and the decisions they make," she said. "It's problematic for them to jump through all those hoops, and also a person might be in a situation where it's dangerous and they don't want their partner to know that they're seeking an abortion."

— Emma Bowman

Wyoming — Julie Burkhart

Even after reading the Supreme Court's leaked draft opinion, which indicated that the court would overturn Roe v. Wade, Julie Burkhart still had plans.

Burkhart, the founder of Wellspring Health Access, runs clinics in Kansas and Oklahoma that offer abortion. Up until about a month ago, she was on track to open a facility in Wyoming — a state with only one existing clinic that offers abortion, until a trigger law will likely take effect this month.

The planned wellness center had been about two years in the making and was set to begin patient services on June 13. But on May 25, it all turned to ash.

"In the early morning hours, someone broke into the clinic and set it on fire," she calmly told NPR.

The hope, she said, had been that they'd have at least a few weeks to help women in and around Casper get abortions without having to travel all the way to Jackson, which is about a five-hour drive west of Casper.

"We knew with this decision coming down that we probably wouldn't have long, but it would be something," she added.

That was before a woman set fire to the clinic. Police have not captured the culprit, but they have released video footage of the suspect — described as a medium-build white woman about 5 feet, 6 inches tall — and are asking the public for help.

Meanwhile, a trigger law is poised to be enacted in a few weeks, effectively banning abortion in all circumstances except rape, incest or if the mother is at serious risk of death or injury.

Burkhart noted the political shift that has taken place in Wyoming, a traditionally libertarian state.

"Here you've had this small government staying out of people's private lives and their business, and then you fast-forward to when Trump was elected and that is when the real s*** began," she said.

Looking to the future, Burkhart is determined not to quit.

"We're going to be fighting tooth and nail to provide reproductive health care services in Wyoming," she said.

— Vanessa Romo [Copyright 2022 NPR]