"Right across the border from St. Louis in Granite City, Ill. and Fairview Heights, Ill., there were two large providers. And on top of that, new providers have opened in Carbondale, Ill. – two that weren't there before – and that actually increased access in southeastern Missouri." In the western side of the state, it's a similar story. "There were already facilities on the Kansas City, Kansas side of the border, and a new one began providing abortions. "So Missouri was already in a post-Roe world, and Dobbs didn't really affect it," Myers says.

During the same time, some states have strengthened abortion rights and new clinics that offer abortions have opened

Just a year ago, "less than 1% of the U.S. population was more than 200 miles from a provider and the average person was 25 miles from a provider," she explains. As of April 2023, she says, 14% of the population is more than 200 miles from the nearest abortion facility, and the average American is 86 miles from a provider.

By 2022, even though lawmakers in Missouri moved quickly to ban abortion, access didn't change much. Before Roe was overturned, "there was one provider, they were in St. Louis and they actually were providing less than ten abortions a month," Myers explains.

As the map from decade ago shows, people who had to travel 200 miles or more to access abortion care then largely lived in rural parts of the country where health care in general is sparse. Now, access is limited even near large cities in the South.

A year ago this week, the Supreme Court overturned the constitutional right to abortion, and since then, more than a dozen states have banned abortion. Dozens of reproductive health clinics have shuttered, and hospitals and doctors that used to provide abortion have stopped.

In much of the world, normative barriers may further complicate access to safe abortion care. Despite the commonality of abortion (approximately 56 million abortions are performed globally every year)

Women who have induced abortions may strive to keep their procedure a secret to avoid the associated social costs, which contributes to the paucity of reliable data as well as sustaining the illusion that induced abortion is rare, deviant, and against the norms of a community.

The Democratic Republic of the Congo (DRC) has signed and, in 2008, ratified the Protocol to the African Charter on Human and People’s Rights on the Rights of Women in Africa (Maputo Protocol), a legally binding treaty which authorises abortion in cases of rape, incest, foetal impairment and to preserve the mental or physical health or life of the woman.Citation24 Although ratification suggests agreement with the Protocol’s standards, necessary changes to national law have not yet been made. In March 2018, DRC published the Maputo Protocol in the official journal, initiating a legislative process to align national law with the Protocol’s standards. However, Congolese law is generally interpreted to permit abortion only to save the life of a woman, resulting in limited access to safe abortions. In addition to legal and structural barriers, abortion is also highly stigmatised in DRC.Citation25

In the eastern regions of DRC, nearly two decades of conflict and instability have contributed to a weakened health system, unable to adequately respond to health needs. Since 2009, CARE, the International Rescue Committee (IRC), and Save the Children have collaborated with the Reproductive Health Access, Information and Services in Emergencies (RAISE) Initiative at Columbia University to support the Congolese Ministry of Health (MOH) to provide good quality contraceptive and PAC services in North and South Kivu. Technical assistance to the MOH included capacity building and supportive supervision of health workers, provision of necessary equipment and supplies, and community mobilisation activities

The transcripts were first read by the research team to identify overarching themes for the creation of draft codebooks organised by general themes and sub-themes. After discussing the draft codebook, electronic files containing the French transcripts were uploaded to NVivo (QSR International Pty Ltd) for coding. Several transcripts were coded separately by two to three researchers using the draft codebooks and the results were discussed to revise the codebooks, adding, deleting or collapsing codes as necessary.Once codebooks were finalised, coding was performed independently by three researchers. The consistency of coding was assessed by inter-coder reliability; disagreements were discussed and resolved until the inter-rater agreement was in the 90th percentile range. All transcripts were coded by two researchers, and selected transcripts were coded by a third researcher to ensure reliability and validity of the coding. Finally, using a thematic analysis the data were interpreted and presented using the respondents’ own words as illustrations. Themes were then compared across the group demographics to explore potential differences between age or gender groups.

In this document, we use the phrase transgender and gender diverse (TGD) to be as broad and comprehensive as possible in describing members of the many varied communities that exist globally of people with gender identities or expressions that differ from the gender socially attributed to the sex assigned to them at birth. This includes people who have culturally specific and/or language-specific experiences, identities or expressions, which may or may not be based on or encompassed by Western conceptualizations of gender or the language used to describe it.

The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and for guiding treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria put forth in this document for gender-affirming interventions are clinical guidelines; individual health care professionals and programs may modify them in consultation with the TGD person.

The goal of gender-affirming care is to partner with TGD people to holistically address their social, mental, and medical health needs and well-being while respectfully affirming their gender identity. Gender-affirming care supports TGD people across the lifespan—from the very first signs of gender incongruence in childhood through adulthood and into older age—as well as people with concerns and uncertainty about their gender identity, either prior to or after transition.

While Gender Dysphoria (GD) is still considered a mental health condition in the Diagnostic and Statistical Manual of Mental Disorders, (DSM-5-TR) of the American Psychiatric Association.

One of the main functions of WPATH is to promote the highest standards of health care for individuals through the Standards of Care (SOC) for the health of TGD people. The SOC-8 is based on the best available science and expert professional consensus. The SOC was initially developed in 1979, and the last version was published in 2012.

The overall goal of the World Professional Association for Transgender Health’s (WPATH) Standards of Care—Eighth Edition (SOC-8) is to provide clinical guidance to health care professionals to assist transgender and gender diverse (TGD) people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. This assistance may include but is not limited to hormonal and surgical treatments, voice and communication therapy, primary care, hair removal, reproductive and sexual health, and mental health care. Healthcare systems should provide medically necessary gender-affirming health care for TGD people: See Chapter 2—Global Applicability, Statement 2.1.

Prine knew that to pass, a bill needed support from medical and abortion rights groups. It became clear that some were more open than others to the legal uncertainty of a telemedicine shield law.

These clinicians, too, could be arrested or sued or lose their medical licenses. To protect themselves, they may have to give up traveling to certain parts of the country — and it’s still no guarantee.

Prine asked Gomperts how she could help, and with another doctor, she created the Miscarriage and Abortion Hotline, to answer questions from Aid Access patients and anyone else ending a pregnancy at home.

There were seven Americans in the group, between the ages of 32 and 74. They saw reproductive health as endangered in the United States, and that propelled them. Erika Bliss in Washington State and another doctor in the Hudson Valley (who asked me not to name her for security reasons) had practices that included end-of-life care. Ruchi Kaul integrated Eastern and Western medicine in her primary-care practice in New Jersey. Christie Pitney and Robin Tucker were nurse midwives from the Washington, D.C., area. Razel Remen, a family-medicine doctor in Michigan, credited her activism to the progressive talk radio she listened to with her mother while growing up in Brooklyn. Suzanne Poppema, a 74-year-old reproductive rights leader in Washington State, joked that when people warned her she could lose her medical license, she told them that she was retired and didn’t care.

That same year, the Food and Drug Administration approved a combination of two pills — mifepristone and misoprostol — for medication abortions, and Prine saw another way to make abortion care more accessible.

For example, she says, a state like Alabama could retaliate by shielding Alabama therapists who use telemedicine to provide conversion therapy for L.G.B.T. patients in New York, where it’s illegal.

Outsourcing the procedure made little sense to Prine. “We did maternity care,” she says. “We delivered babies. Why wouldn’t we do abortions, which were so much less complicated? It seemed like we were swallowing the stigma.”