‘How do you treat a person who isn’t the standard in this post-Roe world?’

A sign outside a clinic that provides abortions in Richmond, Va. (Sarah Vogelsong/Virginia Mercury)

Nisa* knew her third pregnancy was a non-starter. She didn’t know that she would fear death for 18 days while trying to get an abortion. 

“I felt like I had a ticking time bomb inside of me,” she said.

This is because Nisa has Von Willebrand Disease, a genetic blood disorder that prevents clotting. It puts her at higher risk for bleeding to death during things like injuries, surgeries, or if she were to have a miscarriage. 

Her first two pregnancies had been challenging and once she had been diagnosed with the blood disorder, she’d decided not to have more children for fear of complications or passing the disease onto others. By the time she became unexpectedly pregnant last summer, she was also in the throes of Stage 4 endometriosis symptoms — a diagnosis that would later lead to her having a hysterectomy. She’d also had an endometrial ablation to treat endometriosis symptoms before finding out she was pregnant last summer — placing her in a more at-risk pregnancy. 

Under 10 weeks of gestation at the time, Nisa said she otherwise would have been able to take abortion medication. With her disease, she couldn’t. Surgical abortions also posed challenges because she needed to have specific medications and extra blood on standby. The procedure was denied by her local providers in coastal Virginia, she said, and the local Planned Parenthood facilities didn’t have the resources. A hospital was her best bet for completing the procedure, but it took 18 days to sort out an abortion at VCU Health in Richmond.

Despite Virginia’s status as the least-restrictive Southern state for abortion access, Nisa wonders how many others may be falling through health care gaps as she did. 

“Virginia is not safe. We think we’re safe, but we’re not,” she said. “How do you treat a person who isn’t the standard in this post-Roe world?”

Since the U.S. Supreme Court overturned Roe v. Wade two and a half years ago, states around the country have shored up their protections or enacted various bans and restrictions. And though Virginia is the least restrictive Southern state — and a bastion for out-of-state patients — a new report indicates some hurdles. 

In Virginia, abortion is legal for any reason until around 26 weeks, with limited exceptions for later abortions. In those cases, three physicians must attest that someone’s physical or mental health would be “irremediably impaired” if a pregnancy were to continue. Conversely, surrounding states have near-total bans or limits as low as 6 weeks on the procedure. 

Key findings from the RAND Corporation report noted how abortion law is currently housed in Virginia’s criminal code (a Class 4 felony for unlawfully conducted abortions), the three-physician threshold for some abortions, and lack of clarity on the “ability to provide second-trimester abortions in non-hospital settings.”

Dr. William Fitzhugh, who runs clinics in Richmond, Newport News and Roanoke, said he’s seen a flux of out-of-state patients over the past two years. But sometimes, he’s had to refer patients elsewhere. For example, by the time a Tennessee patient had made it to one of his clinics, she was 28 weeks along, he said, so he referred her to Maryland where there are no gestation limits. 

“I worry for other women in gray areas like mine,” Nisa said. “I had family that could help watch my kids and I didn’t have to travel far, but I still had to travel in my own state. There are women who can’t take time off work or have childcare.”

North Carolina resident Kishia* ended up having to take time off work and her children had to miss school for a few days so they could travel to Fitzhugh’s Richmond clinic for her 14-year-old daughter to get an abortion. 

She called the experience “H-E-double-L.” 

More important, Kishia said, is the fact that her daughter Myasia has been in pain. 

At 19-weeks of gestation, she couldn’t legally obtain an abortion in North Carolina and being further into gestation means a more invasive abortion procedure. In these cases, small rods are typically placed in the cervix to prepare it for an abortion to occur the next day. Kishia said the family would have sought an abortion sooner if they could have. 

Myasia has had regular menstrual cycles, her mother said, and with bleeding in early gestation common in 15% to 25% of pregnancies, Myasia hadn’t realized right away that she was pregnant. By the time she did and told her mother, when they visited a clinic in Charlotte they were told she was too far along for the state’s 12-week limit. 

“People get abortions for different reasons,” Kishia stressed as she noted that people can have medical issues, or be young and not emotionally or financially ready to care for an unplanned child. In Myasia’s case, she is still technically a child herself. 

With a smile, Kishia said that she is grateful her family was able to connect with an abortion fund to offset travel costs. She said she doesn’t plan on having to go through their ordeal again. 

Kishia said she’s somewhat tuned in to state, congressional, presidential and gubernatorial elections. As her chance to vote in North Carolina this fall approaches, she’ll be thinking about abortion access and other reproductive rights. 

“I don’t think this should ever be banned,” she said. 

Another finding in the RAND report noted local-level abortion hurdles  when it comes to city, town and County governments in the state. Such is the case in  parts of Southwest Virginia, where local governments have ordinances to deter the establishment of abortion clinics. A clinic in Bristol has been embroiled in lawsuits with its building’s landlords that threaten its existence. Conversely, Alexandria passed an ordinance to make it easier for clinics to open and Richmond recently transferred land for cheap to Planned Parenthood to set up another clinic in town. 

At the state level, democratic  lawmakers still plan to strengthen Virginia’s abortion access laws. In 2025, they plan to introduce a proposed constitutional amendment. It will need to pass two years in a row with a House of Delegates election in between before appearing on statewide ballots for voters to approve or reject. Placing protections in the constitution would make them less susceptible to partisan shifts in the legislature over time. Even Republican-leaning states have approved similar ballot measures in recent years, showing that it is not a totally partisan issue. 

It wouldn’t be the first time Virignia has tried to enshrine abortion access in its constitution. Similar proposals have failed in the two previous legislative sessions. A sticking point had been language that GOP lawmakers alleged was too broad and would go further than Roe’s legal framework.  

The language, much like language in other states’ passed amendments, would declare people have a right to abortion unless there is a “compelling state interest.” 

Where Roe balanced the right to obtain an abortion and health of the pregnant person with the potential life of a fetus, constitutionally protecting access within a state would operate similarly. 

It’s unclear what the language of the next attempted abortion amendment  would be but Sen. Ghazala Hashmi, D-Chesterfield — who plans to co-sponsor it again — said there will be more to discuss later this year. 

“We are still working on the language to ensure that our constitutional amendment effectively protects safe and legal access to abortion in Virginia.”

*Editor’s note: Nisa declined to share her last name in this story due to privacy concerns. Kishia and Myasia declined to share their last names in this story due to Myasia being a minor. The accounts of all three women have been verified with medical records and by a medical professional with knowledge of their experiences.