"For as long as we are able, we will continue to provide the full range of women's health care," Dr. Yashica Robinson, medical director at the Alabama Women's Center in Huntsville, told reporters Friday, two days after the state's Republican governor signed a law that could subject doctors who perform the procedure to 10 to 99 years in prison.
Organizations representing more than half a million US physicians and medical students quickly condemned the measure and similar anti-abortion proposals in other states, saying they "inappropriately interfere with the patient-physician relationship" and "endanger our patients' health."
Alabama abortion providers share those ethical concerns. But their priorities also have become more practical and immediate as they continue to treat patients while clarifying misconceptions about the law, which goes into effect in six months and is expected to be challenged in court.
"This has been majorly confusing to all of our patients," said Kari Crowe, co-director of People Organizing for Women's Empowerment and Rights (POWER) House, which assists with services at Reproductive Health Services in Montgomery.
Patients and doctors aren't sure how to pursue care
The clinic in the state capital began getting calls Wednesday, the morning after the Alabama Senate passed the House-approved bill, Crowe said.
"Patients were calling like, 'I just had an appointment yesterday, what do you mean I can't come back and have my abortion on Friday?'" she said, referring to the restriction that requires women in Alabama to wait 48 hours before getting an abortion.
Phones also have been ringing at Planned Parenthood Southeast, which covers Alabama, Georgia and Mississippi. It's been fielding so many calls that the organization set up an automated phone line with more information, a spokesperson said.
And patients aren't the only ones who are confused, Robinson said.
"We had physicians that just didn't understand what this meant and therefore did not know how to direct their patients appropriately," she said.
For the time being, getting abortions in Alabama is business as usual, Crowe said, but that doesn't mean it's necessarily simple.
Providing abortions in Alabama was already hard
Even before Gov. Kay Ivey signed the near-total ban into law, inadequate abortion training in local medical residency programs meant a dearth of abortion providers, Robinson said.
And because the state's three independent clinics all are located at least a hundred miles from the next closest, their patient volume is huge, she added. Besides the clinics in Huntsville and Montgomery, the West Alabama Women's Center operates in Tuscaloosa.
Patients often deal with transportation, child care and lodging costs, because the process of obtaining an abortion in the state can take several days, she said. Navigating gaps in insurance coverage also makes things difficult for doctors and patients.
If the law does go into effect, Robinson said she remains committed to helping her patients get the care they need, including potentially offering financial support for women to travel to other states to access services and identifying places where they can stay for free.
"I will continue to try to find resources to get my patients to areas where they can be cared for," she said. "But again, we are focusing right now on doing everything we can so that the law does not have the opportunity to go into effect."
Physicians say they would face an unfair choice
Alabama's law may be unenforceable under the Supreme Court's 1973 Roe v. Wade ruling, and the ACLU and others have vowed to challenge it in court.
Medical professionals say the law's criminal penalties would force physicians to choose between doing their jobs and violating the law.
"I am enraged that the state of Alabama would force me to choose between what is ethical and medically appropriate care and breaking the law," Robinson wrote in an op-ed for CNN. "I am appalled that I could get a more severe penalty (up to 99 years in prison) for providing safe abortion care than someone who commits second-degree rape."
Six professional organizations, including the American Academy of Family Physicians and the American Psychiatric Association, also condemned efforts to criminalize physicians.
"These laws force physicians to decide between their patients and facing criminal proceedings," they said in a statement. "Physicians must be able to practice medicine that is informed by their years of medical education, training, experience, and the available evidence, freely and without threat of criminal punishment."
"The insertion of politics between patients and their physicians undermines the foundation of trust this relationship is built on and inhibits the delivery of safe, timely, and comprehensive care," the groups said. "Outside interference endangers our patients' health by limiting, and sometimes altogether eliminating, access to medically accurate information and to the full range of health care."
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