In the summer of 2022, when news broke that Governor Eric Holcomb was preparing to sign a bill banning abortion in Indiana, Hancock County resident Sarah Corum discovered she was pregnant.
She and her husband already had two children, aged 2 and 5 at the time. Corum had suffered from post-partum depression after both births.
“I just didn’t feel like with another one, I could be the mom I wanted to be,” Corum said.
Although a lawsuit would eventually delay the legislation from taking effect for a year, Corum only knew about the imminent ban. Scared to talk to her doctor and unsure if Planned Parenthood clinics remained open, she turned to the internet for help. She found solace in Reddit, a discussion-based platform offering more anonymity than other social media sites.
There, she discovered she could have an abortion pill delivered to her house for about $100 under the medical oversight of a doctor in Europe. In late August, she ordered the pills.
The use of medication to end pregnancies accounts for nearly two out of every three abortions, according to the Guttmacher Institute, a New York-based organization monitoring reproductive rights issues, including abortion access. While there’s no data on abortion pills delivered through mail, initial research suggests these cases have increased since the U.S. Supreme Court issued the Dobbs ruling two years ago, opening the door for states to increase restrictions on abortion or ban the practice altogether.
The Legal Battle and Immediate Effects
The 2022 law signed by Holcomb faced multiple court challenges, keeping abortion legal in Indiana for most of 2022 and the first half of 2023. However, in late June 2023, the state Supreme Court upheld the near-total ban, stating it would take effect on August 1.
A year later, the ban has had multiple effects. Hoosiers who do not want to keep their pregnancies have been driving to other states to seek abortion care or self-managing their abortions through online pill delivery services. Doctors at major hospitals have had to rely on lawyers rather than their medical expertise to decide which medical cases require abortions to save lives. This, in turn, has depressed recruitment for obstetrician-gynecologists and maternal specialists, leaving families wondering if they can safely deliver their wanted children in Indiana.
Has the Ban Prevented Abortions?
Hoosiers who support the ban see the last year as a significant success, nearly ending all abortions, according to Mike Fichter, President of Indiana Right To Life.
“Indiana’s law actually helps to safeguard women from these exposures and the life-long trauma women suffer after abortion, and it strives to protect innocent unborn babies whose lives have immeasurable value,” Fichter said in a statement commemorating the Supreme Court Dobbs ruling that allowed Indiana to pass its ban.
Indiana recorded 45 abortions in the first three months of this year, compared to nearly 2,000 in the same period last year.
A New York Times analysis published in 2023 showed that abortion did not decrease in the first year after the Dobbs ruling despite bans or restrictions in some two dozen states. While abortions decreased in states with bans, they increased in states where the procedure remains legal. Abortion clinics in states just outside of Indiana saw out-of-state visitors spike after the ban.
Fewer Specialists and Trouble for Maternal Health
The ban may worsen Indiana’s already poor maternal mortality rate, especially among Black women, said Rebecca Gibron, the president of a regional Planned Parenthood that includes Indiana. Hoosiers have long struggled to get good maternal care. Some lack access because they live in rural areas where maternity wings and hospitals are closing. Others don’t have the insurance or money to see doctors. Gibron worries the statistics will worsen if women with complicated pregnancies requiring abortion care do not have access to it and doctors are stuck in a gray area about what constitutes a legal abortion under Indiana law.
“There is a very, very narrow and very, very vague health exception in the current law, which is intentionally written that way to have a chilling effect on providers and to confuse patients about their ability to get this care,” she said.
Dr. Tracey Wilkinson, a pediatrician at IU Health, is also concerned the ban will impact rural areas already struggling to recruit obstetricians and gynecologists.
“We know that those obstetrical deserts are going to get worse as we have less obstetrical access, as more people choose not to live and work in our state, and as it’s harder to recruit people with certain expertise to work within our state,” she said.
While applications for ob-gyn medical residents increased by 7.8% across Indiana in the 2021 school year, that figure decreased by 9.3% in 2022, around the time the ban became law, according to the Association of American Medical Colleges.
Indiana University Health’s ob-gyn training program has seen applications drop around 10-15% in 2022 and 2023 from previous years, said Dr. Nicole Scott, the director of the program.
“They’re wanting to practice in states without restrictions,” she said. “…So not everyone is going to get the training they want.”
Inside Maternity Wings
While healthy pregnancies may make life-threatening pregnancies seem rare, local doctors say they often see risky complications. Dr. Hannah Locke, an inpatient obstetrician-gynecologist at Community North, regularly deals with emergencies: preeclampsia, miscarriages, ectopic pregnancies—all situations that can endanger the life of the pregnant person.
The abortion ban has made her job much more uncertain. The ban makes exceptions in cases of rape, incest, and to save the life of the mother. But Locke and other ob-gyns say the law undermines their authority to determine if an abortion is necessary to save a life.
“The biggest thing is that the ban made it very difficult to feel like we can do what we do to take care of patients without worrying it’s illegal,” Locke said.
Patients should be allowed to interpret risk in the event of a complicated pregnancy, said IU Health maternal-fetal medicine specialist Dr. Carrie Rouse. Some people may want to carry pregnancies to term despite multiple chronic health issues, while others may not.
“[The ban] attempts to make very black and white an issue that just has a ton of gray,” she said. “Every issue is unique. Every pregnancy is unique.”
Real-Life Impact
Blythe Potter, a 42-year-old Army veteran in Johnson County, has done this calculation with her husband. After she and her daughter nearly died during a difficult labour four years ago, she doesn’t want to carry a pregnancy to term again.
“Do I risk having another child? Risk dying? Leaving my husband and daughter because I can’t have an abortion?” said Potter, who is running for Johnson County Council.
Doctors and abortion advocates in Indiana are fighting to expand and clarify the allowable exceptions through multiple legal challenges making their way through the courts. One lawsuit aims to make it clear that the phrase “life of the mother” includes chronic illnesses and mental health problems.
Potter knows this too well. When she got pregnant in her mid-20s despite being on birth control, she was divorced and recovering from post-traumatic stress disorder from her time serving as a combat soldier and bodyguard in the military. She was already on Wellbutrin for depression and Prozac for anxiety and did not think she could handle a pregnancy and child. So, she had an abortion at a Planned Parenthood clinic in Indianapolis.
Poor mental health is a common cause of death among mothers, according to the state’s Maternal Mortality Review Committee, a group of experts assembled by the Indiana Department of Health to study why Indiana has such a high rate of mothers who die in the first year of their children’s lives.
Many of the mothers who died struggled with addiction, which can make pregnancy challenging. In 2021, the most recent year for which data is available, 80 people in Indiana died within one year after giving birth. The top cause of death, as in previous years, was overdoses.
Abortion Pills as an Alternative
With most abortions now prohibited by law in Indiana, more people may wind up following Corum’s path. She ordered medication from Aid Access, an organization started by a Dutch doctor that mails abortion medication to people who don’t have access to abortion care. Even in states where abortion remains legal, some women may opt for mail delivery because of the convenience, discretion, and affordable price.
The medications, mifepristone and misoprostol, are safe and effective for people in their first trimester, according to the Food and Drug Administration. However, patients should have a doctor they can go to if they experience any complications, Gibron said.
For Corum, the ordeal was straightforward. A pharmacy in India sent a pill packet to her house with instructions. She took a few days off of work. Soon after taking the pills, she had a period and her pregnancy was done.
Like many others in her situation, she was scared to talk about handling an unwanted pregnancy for fear of losing friendships or facing criticism.
“You always hear of these hypotheticals of why people might need abortions, but there are so many more reasons,” Corum said. “And it’s not just because people carelessly have sex when they’re in high school. It could be people who are in marriages that already have families established or heaven forbid somebody can’t afford to have a family.”
Conclusion
The abortion ban in Indiana has had a profound and chilling effect on providers and pregnancy care. Abortion access remains a contentious and deeply personal issue. As legal battles continue and the landscape of reproductive rights shifts, the stories of individuals like Sarah Corum and Blythe Potter highlight the complexities and real-life impact of these laws on women’s health and choices.
Learn more: Planned Parenthood, Guttmacher Institute, Aid Access, FDA
