Dr. Kristin Lyerly no longer feels safe practicing as an OB-GYN in Wisconsin. Last fall, she had to make the difficult decision to leave her job in Sheboygan. Lyerly is one of three physician plaintiffs on attorney general Josh Kaul’s lawsuit to strike down Wisconsin’s 1849 abortion ban. According to the Wisconsin Department of Justice, Kaul filed the suit mere days after the fall of Roe v. Wade in June 2022 to try and stop Wisconsin’s ban from going into effect. As a plaintiff, Lyerly’s name shot into the public eye with terrifying speed. While she has used her newfound platform to fiercely advocate for the right to abortion and contraception, the dangers of the spotlight are not lost on Lyerly. 

 

“I don't feel that it's safe for me to work in Wisconsin where the political environment is really hostile … So because of that, I am now working in Minnesota and Arizona,” said Lyerly.

 

Over the past year, health providers around the U.S. have been wrestling with similar anxieties over their safety and the safety of their patients. Their fears are not baseless. Lyerly cited the case of Dr. Caitlin Bernard, an OB-GYN in Indiana who also chose to publicly speak out in support of abortion care. NBC reported that in one interview, Bernard shared the harrowing story of treating a 10-year-old girl. The girl had been raped and was pregnant; doctors in Ohio legally could not end her pregnancy. In Indiana, Bernard was able to save the girl’s life with an abortion. 

 

The story went viral; Biden cited it in a pro-choice speech, while Fox News accused Bernard of making it up. Indiana’s attorney general took Bernard to court for “violating patient privacy law” by discussing the case publicly. Despite support for Bernard from the medical community, she ended up being charged and fined. The whole affair served as a message to other reproductive health providers; no matter how careful you are, speaking out in support of abortion puts a political target on your back.  

 

Even physicians who keep a low public profile are facing new anxieties after the fall of Roe v. Wade. According to a recent Kaiser Family Foundation poll, 61% of OB-GYNs in states with abortion bans are concerned about their own legal risk when making decisions about patient care and the necessity of abortion.

 

While Wisconsin’s 1849 ban makes an exception for abortions that would save the mother’s life, this distinction is often unclear in practice. Lyerly recalled that immediately after the ban went into effect, she and other OB-GYNs around the state were deeply concerned that meeting the standard of care for all patients would no longer be possible. 

 

“[A pregnant person’s] status can change within minutes. And we don't have time at that point to call a lawyer. Or to call a colleague to come in and assess the patient. We often have to act very quickly,” said Dr. Lyerly. 

 

While some cases are clearly life-threatening, like an ectopic pregnancy in which the fetus is growing outside of the uterus, many others are more complicated. If a pregnant patient gets diagnosed with cancer, determining whether an abortion would be life-saving could be difficult. Lyerly believes that legislators should hold no power in the doctor’s office during these challenging decisions, yet this is the new reality that Wisconsin physicians and patients are facing. 

 

Lyerly emphasized that abortion is woven into nearly every aspect of gynecological care. 

 

 “From contraception to infertility care, to managing a miscarriage, to helping somebody deal with a complicated pregnancy. All of those things have some piece of abortion care,” detailed Lyerly. 

 

While medical professionals have a nuanced understanding of abortion, many legislators do not. Wisconsin’s 1849 ban on abortion has no exceptions for nonviable fetuses or miscarriages. According to the American College of Obstetricians and Gynecologists, nearly 26% of all pregnancies end in a miscarriage. The additional legal uncertainty that Wisconsin doctors now face is a barrier to quality care for these patients. 

 

In states where abortion is banned, the KFF poll found that 40% of OB-GYNs have personally felt constraints on their ability to provide care for miscarriages and other pregnancy-related medical emergencies. 55% of those same physicians said that their ability to practice within the standard of care has become worse. In a post-Roe world, doctors’ fears are becoming reality. 

 

Increased legal anxiety and fear of harming patients is not exclusive to physicians. A Green Bay midwife who wished to remain anonymous told NBC News that many of her miscarrying patients were unable to pick up prescribed misoprostol at their local pharmacies. Misoprostol is a medication that induces abortion; doctors can use it to help patients more safely miscarry with reduced physical and emotional trauma. The midwife suspected that pharmacists were trying to enforce Wisconsin’s abortion ban. According to the midwestern chapter of ACOG, however, most pharmacists do not see themselves as enforcers; rather, they fear prosecution for dispensing any drugs that have the potential to be used for abortion. 

 

Reduced access to key medications is not unique to Wisconsin. Politico reported that across the U.S., pharmacists are delaying or refusing to dispense a wide range of drugs for chronically ill patients on the off chance that the drugs could be misused. According to Jack Resneck, president of the American Medical Association, drugs that treat lupus, arthritis, acne and more could potentially abort a pregnancy. The majority of pharmacy refusals and delays are falling on women of reproductive age. 

 

In a confusing legal landscape, it can be difficult for patients to find accurate and consistent information about their rights. Since last June, some providers in Wisconsin have made it their mission to provide patients with all-options counseling about pregnancy.

 

Dane County’s Reproductive Health Nurse Navigator program began last fall. Their mission is to provide pregnant people with free, confidential all-options counseling. According to a nurse navigator who wished to remain anonymous for safety, the program started in response to an uptick of panicked calls from pregnant people who didn’t know what the fall of Roe v. Wade meant for their care. 

 

“We knew of folks that were sitting in [Planned Parenthood] when the decision came down and they were sent away,” remembered the nurse. 

 

As navigators, the nurses can help pregnant people find health insurance, understand their options, find abortion funds and find the nearest out-of-state clinics. As state employees, they can only provide information to patients seeking abortion; making recommendations or calls on behalf of patients is no longer allowed. 

 

The nurse navigator has been witnessing the inequitable impacts of Wisconsin’s ban. Many callers already have a child and cannot afford another; others are worried about their immigration status if they seek an abortion. The nurse navigator has had to expand her understanding of abortion laws in surrounding states, federal immigration law, health insurance policies and the exact costs of medications without insurance (up to $800 for misoprostol, according to Planned Parenthood). While she did not go into the field to learn about policy, she has come to understand that it is crucial to her work. 

 

The same is true for Dr. Lylerly. She looks forward to the day that she can return to her home practice in Wisconsin. The Associated Press reported that on July 7, a Dane County circuit judge allowed Kaul’s lawsuit to proceed. Lyerly hopes it will continue to the Wisconsin Supreme Court and overturn the abortion ban. In the meantime, she remains committed to speaking out in support of the right to choose. While getting involved in politics feels antithetical to her nature, she believes that it is her obligation to use her expertise to protect human rights. 

 

“Politics is in everything we do," said Lyerly, "if you are not at the table, you’re on the menu."