Just days earlier, the Alabama Supreme Court had ruled that frozen embryos are children and those who destroy them can be held liable. The results called into question the hopes and plans of countless women. The state's largest IVF clinic had already announced it would suspend embryo creation.
“What will happen if these clinics close?” asked Goidel, a 26-year-old property manager. “How many women will be left without care?”
The court's ruling is just the latest in Alabama's increasingly strict restrictions on women's reproductive health care, which experts say are forcing doctors out, delaying treatment and putting lives at risk. It states that
The state's abortion ban is one of the strictest in the country, with no exceptions for rape or incest. The attorney general has threatened to prosecute anyone who assists a woman seeking an out-of-state abortion. Alabama law enforcement also has a history of secretly administering drug tests and accusing pregnant women of endangering their unborn children if the results are positive.
Care options are often limited for people with babies. According to the 2023 March of Dimes report, more than 2 million women of childbearing age (one-third of Alabama's population) live in obstetric care deserts, areas where they do not have access to birthing facilities or providers. live in The closure of 14 hospitals since 2000 has led to significant delays in prenatal appointments and a shortage of health care providers, especially outside of the Birmingham, Huntsville, Mobile and Tuscaloosa locations.
The state Legislature recently extended Medicaid coverage for women up to one year after giving birth, but without a statewide Medicaid expansion, many women would struggle to qualify or find a provider. . This disorder is especially acute for women in the black belt, named after the black soil and where the people settled. Descendants of enslaved people. They face the longest drives to receive treatment.
One tragic result: Alabama has one of the highest maternal mortality rates in the country, according to a Milken Institute report last year.
“Anyone who may become pregnant now or in the future is extremely vulnerable,” Robyn Marty, executive director of the West Alabama Women's Center in Tuscaloosa, said Thursday. “No one knows what the rules are anymore.”
Marty's clinic sees women who are bleeding at local hospitals after waiting hours and not being tested. “We care for many patients who cannot go to an OB/GYN and receive the care they need until the second trimester,” she said. “Just because some doctors are afraid to practice here, that's not going to change the situation.”
Doctors across the state echoed those concerns this week. Heather Skens, a Birmingham obstetrician-gynecologist who sees about 100 to 200 patients each week, is concerned about the knock-on effect of parliamentary restrictions on abortion and court rulings on in vitro fertilization.
“Women's health care is comprehensive, so if you take it away or cut it at any point, it affects the whole thing,” she says. “Empowering women to decide whether they want to become pregnant, how to prevent pregnancy, how to terminate the pregnancy if they wish to do so, and how to continue the pregnancy if they decide to continue.” Comprehensive laws and regulations need to be in place.”
“Without that, everything falls apart,” Skens added.
Sanithia Williams, tough on the Tennessee border 100 miles to the north, is similarly worried.
“People talk about IVF as if it's completely different than abortion care or pregnancy care. They're all the same people, just at different times in their lives,” said Williams, an obstetrician-gynecologist in Huntsville. Told. “Having access to abortion is just as important as pregnant people being able to decide where and how they give birth, and people having access to and rights to fertility services. All of that is very connected. .”
She predicts other obstetricians and gynecologists will leave Alabama because of the IVF ruling, just as they left after the abortion ban. “The idea that we could potentially lose even more maternal care providers is potentially devastating,” she says. “It's just going to make it harder for people to get the care they need. It's going to make pregnancy care less safe here.”
This has obvious implications: The court's Feb. 16 decision came during the second week of the 2024 Alabama legislative session. Some lawmakers have proposed measures to overturn abortion bans and protect extracorporeal surgeries. Despite national Republican groups urging party candidates to support IVF (a position echoed by President Donald Trump on Friday), the bill is unlikely to pass in the Republican-controlled Alabama House and Senate. is opaque.
The court's decision is supported by conservatives like Natalie Brumfield of Birmingham, a longtime anti-abortion speaker and crisis pregnancy center volunteer. She empathizes with women undergoing IVF who are suddenly at a loss, as nearly every clinic in the state has now ceased IVF work or disposed of embryos. ing. But Brumfield, who is pleased with the abortion ban, said the state also needs to impose restrictions on in vitro fertilization to protect embryos.
“When you're in the middle of something, it's devastating. But at some point you have to reinvent yourself,” she said. “We need people to stand up for childhood frozen embryos.”
Brumfield always wanted a large family, but suffered several miscarriages early on. She and her husband adopted her three children from a foster care home before resorting to IVF. Given their belief that pregnancy begins at fertilization, they imposed their own limits on the process and committed to using every embryo they created, up to a maximum of 10. They got three, resulting in two litters.
She believes there should be government restrictions on IVF, not only for patients but also for doctors. “They encourage as many pregnancies as possible to have a live birth,” she says. “Saying, 'No, this is a human life,' helps couples understand the weight of their choice to conceive.”
After days of emotional turmoil in Alabama and with the state in the crosshairs of an explosive national debate, Attorney General Steve Marshall's office announced Friday that it will file charges against an IVF family. announced that it had “no intention'' to take advantage of the Supreme Court's ruling. or provider. Gov. Kay Ivey (R) also said she is “working on solutions” with lawmakers to protect IVF treatments in the state.
Their assurances came too late for Goidel. She had wanted a child for a long time, but since getting married in 2021, she had already had three miscarriages. After the first one happened when I lived in Texas. She remembers her doctor praying for her after she balked at a procedure often performed to cleanse her uterus after a miscarriage.
She hopes genetic testing during IVF will help her conceive. And she doesn't think it's necessary to limit the number of embryos you create, because making more embryos increases the chance of a successful pregnancy. Goidel works for Child Protective Services in Texas and says, “I've seen firsthand how difficult adoption and foster care can be, and I just can't do that right now. For us. This is the only way to build a family.”
The IVF process is a big part of her life. She had to wait two months to see her gynecologist, who took her to one of her seven IVF clinics in Alabama. I introduced her. Her health insurance didn't cover her doctor's visits, injections or procedures, so she and her husband, Spencer, an assistant professor of political science at Auburn University, paid $20,000 upfront.
She began her first 10-day IVF cycle just hours after the court ruling.
Doctors advised her to inject her with a drug that stimulates her ovaries at the same time every night. Ms. Goidel decided on 8 p.m., and tried to gather her gear at that time and not be disturbed by the unfolding controversy. Although she wasn't normally averse to needles, she soon realized that it was more comfortable for her husband to give her the injections.
Wednesday night was day 6. She felt bloated due to hormones, and in each of her shoots she wore a loose-fitting black and white tunic that easily exposed her stomach.
Out of the refrigerator came a zippered pouch of medicine decorated with rhinestones. Alcohol pads, needles, Band-Aids and other supplies are neatly organized on Goidel's table, which she keeps in a pink toolbox that matches the rest of her farmhouse-style home. It was neatly arranged.
She was keen to control the process as much as possible.
Earlier in the day, Goidel had seen the news that the University of Alabama at Birmingham clinic had suspended in vitro fertilization research. When she called her doctor's office, the staff messaged back: “Please take it one day at a time. We'll let you know if anything changes.”
“I'm worried about the delays and the money that's been put into this,” she said. Spencer was standing nearby, a worried look on his face.
The next morning, the clinic sent a new message. They said, “We're also canceling in vitro fertilization.''
But Goidel had no intention of relinquishing control of her fertility to the state. “We'll try other states.” she insisted. “If you can't do it in other states, try other countries. Surprisingly, this cycle they are retrieving eggs. ”
She called Emory University's clinic in Atlanta. She had seen a doctor before, but she declined because of the distance and the high cost. Staff said she had liability issues which meant they could not help her finish her cycle.
Spencer said it felt as if Alabama officials were saying, “What's not to like?” Get out. “
“That's a terrible message,” he added.
But what they did was tell them to get out.
Goidel made more calls to find an IVF doctor to work with. Finally, one person said yes. She started packing her things.
By Thursday night, she was on a plane to Texas.
