“I had a patient just this week who, as I was about to give her intravenous sedation, said, ‘Isn’t this illegal? Didn’t they stop abortions?’”
Forty-nine years passed between Roe v. Wade, a Supreme Court case that upheld access to abortion as a constitutional right, and Dobbs v. Jackson Women’s Health Organization (often referred to as Dobbs), which overturned it.1 Let us not be fooled into believing that Roe v. Wade recognized abortion care as a medical right on its own merit. Any legality given to abortion prior to fetal viability in that intervening half-century was based on the right to privacy found in the Fourteenth Amendment.2
It is the Due Process Clause which states, “No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.”3 Though the language can be difficult to parse, essentially this clause protects an individual’s right to make certain personal decisions without government interference. The choice to have an abortion was considered a private matter, and therefore not one the government could control. There was no ruling on whether abortion was moral or immoral. In short, the heart of the matter was never resolved.
Thus a powerful social stigma persists, even worsens, despite legal efforts to repair what was broken in the wake of Dobbs. November 2024 saw the passing of legislation in Arizona–Proposition 139–which blocked a state-wide abortion ban after 15 weeks by enshrining the right to abortion up to fetal viability in the Arizona constitution.4 Still, every single time I say ‘abortion’ to a patient, I experience a small internal hesitation that I try to ignore, as I believe I am duty-bound not to shy away from hard conversations. Few people, few physicians, know this better than Dr. Paul Isaacson, an Obstetrician/Gynecologist (OB/GYN) who exclusively provides abortion care in Arizona and Nevada.
“When Prop 139 became part of the Arizona constitution, it didn’t erase existing restrictions,” said Dr. Isaacson. “At the moment we have an administration—a governor and an attorney general—who have made it clear that they will not enforce these restrictions. But we can’t say that the next administration would not choose to prosecute somebody three, four, five years from now.”
A Deep Dive Into Arizona’s Anti-Abortion Statutes
The existing restrictions encompass multiple statutes limiting how easily and under what circumstances an abortion can or cannot be obtained.5 Arizona statute (A.R.S) §36-2153 requires physicians to meet with the patient at least 24 hours prior to the abortion to provide “informed consent,” which includes describing not only “the nature of the proposed procedure or treatment,” but also “the probable anatomical and physiological characteristics of the unborn child.”6
Dr. Isaacson explained how this interferes with patient care: “Parts of [the 24 hour notice requirement] are much the same as a standard surgical consent conversation in which we discuss how the procedure is accomplished, what the risks are, what the alternatives are, etc. But then there are other parts that require us to describe the state of development of the fetus, to remind the patient that the father is liable to support the child, that they can get help paying for prenatal care, that they can withdraw their consent at any time, etc. I believe this is, by design, trying to make women feel guilty about having an abortion. We are happy to provide, without a state law, any information that a patient asks us. I don’t feel we should have to provide information that’s not immediately relevant and is meant to be coercive.”
This is why Dr. Isaacson does not consider the fight for abortion rights in Arizona anywhere near finished despite the passing of Prop 139: “We are in the midst of a lawsuit against the state in which we are challenging the requirement for the 24 hour waiting period.”
He is also fighting bans on abortions for non-lethal genetic abnormalities like Down Syndrome (A.R.S. § 13-3603.02) and telemedicine abortions (A.R.S. § 36-2160), i.e. medication abortions prescribed without an in-person office visit.7,8
“Arizona is a gigantic state with abortion providers only in Tucson and Phoenix, and occasionally there’s somebody in Flagstaff. So for [a patient] from Yuma, telemedicine would be a much easier way for them to access abortion.”
Approximately 66% of Arizona’s population lives outside Phoenix, Tucson, and Flagstaff.9,10 According to the US Department of Health and Human Services, around 47% of Arizonans belong to a racial or ethnic minority group, while “the highest rates of poverty are in Apache (33.9%) and Navajo (25.5%) counties” and “2021 estimates show that poverty in rural Arizona (22.5%) far exceeded the rate in urban areas of the state (12.4%).”11
Dr. Isaacson believes it is our duty as medical providers to stand up for patients like these, as many do not comprehend the legal battles currently being waged. He explained, “There has definitely been an increase in the number of patients coming in for an abortion [since Prop 139 passed].” But he noted that this doesn’t mean public understanding of abortion laws has increased: “As an abortion provider, I am rabid about reading news about abortion, but I don’t think the average citizen of Arizona is keeping exact tabs on that. Most people, I’m assuming, don’t really think about [abortion] until they need it.”
He added, “I had a patient just this week who as I was about to give her intravenous sedation, said, ‘Isn’t this illegal? Didn’t they stop abortions?’ I think there’s been so much happening since Dobbs that it’s hard for the average person to keep track of what’s going on.”
Demystifying How to Perform an Abortion
Legality or illegality aside, abortion is a common procedure, with over 1 million performed in the US in 2023.12 According to Pew Research Center, about 93% of abortions occur in the first trimester, i.e. prior to 14 weeks gestation, with only 1% occurring after 21 weeks gestation.13
The negative impact of restrictions on abortion likely falls most heavily on already marginalized groups. Though recent research suggests rising maternal mortality rates in the US may be a result of misclassification and incorrect definitions of what constitutes a pregnancy-related death, the maternal mortality rates for non-Hispanic Black women are “disproportionately high” compared to other groups.14 Direct obstetric deaths per 100,000 live births can be calculated as either 7.05 or 5.82 depending on the method, whereas the national case-fatality rate of legal induced abortion is 0.46 per 100,000.14,15 This represents a 12- to 15-fold fatality difference, and explains why many consider abortion a life-saving procedure even outside of emergency situations.
Medication and surgical abortions are a routine part of the work day for many physicians. Per the Guttmacher Institute, 63% of abortions are induced with medication.12 Dr. Isaacson noted a similar rate in his clinic, stating, “We do slightly over 50% medication abortion, so we administer the mifeprex and dispense the misoprostol. Administering means we hand the patient the pill and they swallow it in front of us. Dispensing means we give it to them to take later.”
This is important because Arizona has a ‘conscience clause’ (ARS § 36-2154) which allows hospitals, pharmacies, health professionals, and their employees to decline participation in abortion.8 Pharmacists cannot easily withhold a statin or GLP-1, but they can withhold mifepristone or misoprostol as long as they physically write out their objection.
The process of getting an abortion begins with state-mandated information. “At that visit, we do an ultrasound to assess gestational age,” said Dr. Isaacson. He also reviews the patient’s medical history and orders a hemoglobin and Rh factor. The next step comes 24 or more hours later.
“If it’s a surgical abortion, [the patient] meets with the counselor who goes over the procedure, post-procedure care, discusses options for birth control with them, discusses their decision and whether they are being coerced by anyone to have an abortion, how sure they feel about their decision to have an abortion, things like that. Then they go to the procedure room and we give them conscious sedation in most cases,” described Dr. Isaacson.
I would hazard a guess that the majority of my peers have not witnessed a surgical abortion outside the setting of an active miscarriage. I certainly haven’t. I asked Dr. Isaacson to explain the steps so that myself, my peers, and the general public could have the process demystified.
He continued, “After that we place a speculum in the vagina and give them local anesthetic in their cervix. Then under ultrasound guidance, we use dilators to dilate the cervix. For the majority of abortions, we would be dilating less than a centimeter. And then we use a suction device. They come in different sizes and in general we use a cannula that is equal in millimeters to weeks of pregnancy. So a 7-millimeter cannula for a 7-week pregnancy. Then we use that cannula to suction out the contents of the uterus. That’s really the whole procedure. Once the actual procedure starts, it generally takes under five minutes to complete. Then they go to our recovery room where we monitor their bleeding and vital signs and let the peak effect of the sedatives wear off and then they go home. For surgical abortion, we don’t require them to come back for a follow up visit, but we offer the opportunity at no cost if they would just like to be reassured everything is okay. And of course we are always available for them if they have a complication. They have a number to reach us 24 hours a day.”
As the gestational age increases, Dr. Isaacson said, “The main difference is that we need one or two days to prepare the cervix. So in our biggest cases, we want to achieve 3 centimeters dilation. We do that by using osmotic dilators—little sticks that we place in the cervix overnight. They absorb moisture and expand and gradually stretch the opening of the cervix. The main difference between the two procedures is that the later cases are done predominantly with forceps rather than with suction, although we use suction at the end of the case to clean out the uterus.”
The Perils of ‘Opting-out’ of Lifesaving Care
I look forward to performing abortion procedures someday because I agree with Dr. Isaacson that they are necessary and important, yet I look toward my future education as an OB/GYN with trepidation. The Accreditation Council for Graduate Medical Education (ACGME) requires abortion training in my chosen field, but allows residents to opt-out of performing elective abortions, and allows programs in restrictive states to find educational alternatives.1 This directly contradicts recommendations by the American College of Obstetricians and Gynecologists (ACOG), which state that all OB/GYN physicians are ethically responsible to provide abortions in an emergency.1 How can a doctor carry out an emergency (i.e. life-saving or health-saving) procedure, via a technical skill they have not mastered outside of a SIM room?
Dr. Isaacson gave me his perspective on the matter: “Abortion training is invaluable to an OB/GYN whether they ever do another abortion or not. One of our most basic skills is being able to safely and competently dilate a cervix and use instruments inside the uterus without harming it. I did General OB/GYN for about 10 years before I devoted myself full-time to abortion care. At one point I worked in a practice where I was the medical director, and whenever we hired a new doctor, I would observe their first several surgeries. It struck me how uncomfortable a lot of physicians felt dilating the cervix because without abortion training, it’s really only a handful of cases that they’ll do in residency. But in an abortion rotation, they will do many more.”
Notice Dr. Isaacson used the term ‘abortion rotation/training’ rather than its oft used alias, ‘family planning.’ I asked him why he doesn’t use the latter.
“I think one of the reasons Dobbs occurred is a general shift in people’s ability to discuss abortion openly—discomfort with even using the word among patients and among physicians. I try not to use euphemisms like ‘family planning.’ Physicians, I find, are more comfortable saying ‘pregnancy termination,’ but there’s a shorter word for all of that.”
He ended our discussion on a poignant note, stating, “I think people’s silence has led to all of these restrictions we’ve had. There are so many women who are just absolutely sure they are going to be judged by all the people around them, but statistically, someone in their family, someone at their workplace who they are friends with, has had an abortion.”
Physicians like Dr. Isaacson, and medical students like myself, refuse to stop saying the word abortion. We refuse to hide because we know there is nothing to be ashamed of, nothing to conceal, and that our silence would speak volumes.
References
- Obern C, Morhe E, Gemzell-Danielsson K, Steinauer J. The importance of abortion training for obstetrician-gynecologists: A comparison of the United States, Sweden, and Ghana. Int J Gynaecol Obstet. 2024;167(2):598-603. doi:10.1002/ijgo.15733
- Roe v. Wade, 410 U.S. 113 (1973). https://supreme.justia.com/cases/federal/us/410/113/.
- U.S. National Archives and Records Administration. 14th Amendment to the U.S. Constitution: Civil Rights (1868).Milestone Documents. Accessed November 13, 2025. https://www.archives.gov/milestone-documents/14th-amendment
- American Civil Liberties Union. Arizona 15-Week Abortion Ban Permanently Blocked Under Arizona Abortion Access Act. Press release. March 5, 2025. https://www.aclu.org/press-releases/arizona-15-week-abortion-ban-permanently-blocked-under-arizona-abortion-access-act. Accessed November 13, 2025.
- Arizona Attorney General’s Office. Arizona Abortion Laws. https://www.azag.gov/issues/reproductive-rights/laws. Accessed November 13, 2025.
- Arizona Legislature. Arizona Revised Statutes § 36-2153: Informed consent; requirements; information; website; signage; violation; civil relief; statute of limitations. Phoenix, AZ: Arizona State Legislature; accessed November 13, 2025. Available from: https://www.azleg.gov/ars/36/02153.htm
- Arizona Legislature. Arizona Revised Statutes § 13-3603.02: Abortion; sex and race selection; genetic abnormality; injunctive and civil relief; failure to report; definitions. Available from: https://www.azleg.gov/ars/13/03603-02.htm. Accessed November 13, 2025.
- Arizona Legislature. Arizona Revised Statutes § 36-2154: Right to refuse to participate in abortion; abortion medication or emergency contraception. Available from: https://www.azleg.gov/ars/36/02154.htm. Accessed November 13, 2025.
- World Population Review. Arizona Cities by Population 2025. Available from: https://worldpopulationreview.com/us-cities/arizona. Accessed November 13, 2025.
- United States Census Bureau. QuickFacts: Arizona. Available from: https://www.census.gov/quickfacts/fact/table/AZ/PST040224#:~:text=Table_title:%20Table%20Table_content:%20header:%20%7C%20Population%20%7C,poverty%2C%20percent%20%7C%20:%20%EE%A1%80%EE%A0%BF%2012.4%25%20%7C. Accessed November 13, 2025.
- Health Resources & Services Administration. Title V Maternal and Child Health Block Grant – Narrative Overview – Arizona – 2025 0 III.B. Overview of the State. TVIS Data. https://mchb.tvisdata.hrsa.gov/Narratives/Overview/1b5e6d75-2e45-473f-80a0-97ac744f21a6. Accessed November 13, 2025.
- Guttmacher Institute. Medication Abortions Accounted for 63% of All U.S. Abortions in 2023; Increase From 53% in 2020. March 19, 2024. Available from: https://www.guttmacher.org/news-release/2024/medication-abortions-accounted-63-all-us-abortions-2023-increase-53-2020. Accessed November 13, 2025.
- Pew Research Center. What the Data Says About Abortion in the U.S. March 25, 2024. Available from: https://www.pewresearch.org/short-reads/2024/03/25/what-the-data-says-about-abortion-in-the-us/#:~:text=The%20vast%20majority%20of%20abortions,gestation%2C%20according%20to%20the%20CDC. Accessed November 13, 2025.
- Joseph KS, Lisonkova S, Boutin A, et al. Maternal mortality in the United States: are the high and rising rates due to changes in obstetrical factors, maternal medical conditions, or maternal mortality surveillance?. Am J Obstet Gynecol. 2024;230(4):440.e1-440.e13. doi:10.1016/j.ajog.2023.12.038
- Centers for Disease Control and Prevention. Abortion Surveillance — United States, 2022. MMWR Surveillance Summary. 2024;73(7):1-28. Available from: https://www.cdc.gov/mmwr/volumes/73/ss/ss7307a1.htm. Accessed November 13, 2025.
Sarah Brady is a member of The University of Arizona College of Medicine – Phoenix, Class of 2026. She was born in Georgia, raised in Florida, and currently lives in Arizona. She graduated from Arizona State University with consecutive degrees in English Literature and Biomedical Engineering. She loves to garden and particularly enjoys attempting to grow plants that are entirely unsuited to the Arizona climate.
Image © Ashley Lorraine Baker