Speaker 1: Welcome to Go, Ask Ali, a production of Shonda Land
Speaker 1: Audio and partnership with I Heart Radio. When I have
Speaker 1: been with friends and that happened and I paid my pants,
Speaker 1: I did lose the room, they did leave. I saw
Speaker 1: her light up and I was like, I'm just going
Speaker 1: to work. But we are here until one of our
Speaker 1: last briefs, I was just the one that was meant
Speaker 1: to take care of mamma. It's for me to remember
Speaker 1: every single day is that I always have a choice.
Speaker 1: Everyone always has a choice. Whenever somebody says no, you can't,
Speaker 1: or there's no rules for you, or you have to
Speaker 1: look like this, I go. I'll show you. I'll show you.
Speaker 1: Welcome to Go, ask Allie. I'm Alli Wentworth and today
Speaker 1: I'm discussing the landscape of abortion rights. I'm going to
Speaker 1: read a quote from the book Lady Justice by Dahlia Lithwick.
Speaker 1: In three the U. S. Supreme Court handed down is
Speaker 1: seven to two opinion in Roe v. Wade, and the
Speaker 1: American public has been in a heated civil war over
Speaker 1: women's bodies ever since. This one issue. Abortion has been
Speaker 1: at the heart of every Supreme Court confirmation hearing for decades.
Speaker 1: Either explicitly or by way of secret signals and codes.
Speaker 1: Abortion providers have been gunned down, clinics have been closed,
Speaker 1: and state legislatures with the highest maternal death rates have
Speaker 1: passed laws that make it all but impossible to terminate
Speaker 1: at pregnancy. There As of June, Rob Wade is overturned
Speaker 1: and in half the states abortion is illegal or soon
Speaker 1: will be. My guest today is Dr Colleen McNicholas. She
Speaker 1: is the chief medical officer of Planned Parenthood St. Louis Region,
Speaker 1: which also includes southern Illinois and southwest Missouri. She testified
Speaker 1: in front of the Senate Judiciary Committee this summer sounding
Speaker 1: the alarm for what medical professionals and their patients are
Speaker 1: facing since Roe was overturned in June. Dr McNicholas has
Speaker 1: a unique insight guarding both sides of this issue, as
Speaker 1: Missouri is a banned state in Illinois is a protected state,
Speaker 1: and her work has been tireless. Welcome Dr Colleen McNicholas
Speaker 1: in St. Louis, Missouri, right now, that's right. I'm happy
Speaker 1: to be here. I'm so happy to have you. So
Speaker 1: we're going to just do a gentle dive into this
Speaker 1: world of women's reproductive health for my listeners to get
Speaker 1: a real sense of what the landscape looks like right now. So,
Speaker 1: with the overturn of Roe versus Wade by the U. S.
Speaker 1: Supreme Court in June, abortion policies and reproductive rights are
Speaker 1: in the hands of each state. So half of the U. S.
Speaker 1: States are expected to ban abortion, taking away the constitutional
Speaker 1: right to a women's choice. Am I saying this correctly? Doctor?
Speaker 1: I would add that the constitutional right, the federal protection
Speaker 1: to abortion has been eliminated, um, no matter where you live,
Speaker 1: and so you're right now, it's really left in the
Speaker 1: hands of the states. So I'm going to ask you, um,
Speaker 1: just to quickly define some terms for people so that
Speaker 1: when we use them, people will understand what we're talking about.
Speaker 1: The first term is trigger laws. If you could explain
Speaker 1: trigger laws or we say trigger bands. So many states,
Speaker 1: my state included, had passed laws prior to this jobs
Speaker 1: decision that essentially said, if ever the Federal Protection the
Speaker 1: Road decision goes away, then in that state abortion would
Speaker 1: immediately become illegal. And in fact, that's exactly what happened
Speaker 1: in Missouri. Within minutes of the DABS decision being handed down.
Speaker 1: Our Attorney general invoked our trigger band um and Missourian's
Speaker 1: lost access to abortion, right, Okay, So that is a
Speaker 1: trigger ban or trigger law. So what is a pre
Speaker 1: viability gestational ban? So after the Road decision, there had
Speaker 1: been a couple of other cases that came before the
Speaker 1: Supreme Court. Maybe the most notable following Row was the
Speaker 1: Casey decision, which really set up a framework for allowing
Speaker 1: states to restrict or regulate abortion based on points of
Speaker 1: pregnancy and viability was was the point that they chose.
Speaker 1: And so there are states across the country, and I'll
Speaker 1: give Florida as an example who currently have implemented a
Speaker 1: pre viability ban. In Florida, you cannot get an abortion
Speaker 1: after fifteen weeks. And so what we know is that
Speaker 1: fifteen weeks is well before the point in which a
Speaker 1: pregnancy could survive outside of the person carrying that pregnancy,
Speaker 1: which makes it a pre viability ban. Um Okay. Method bands.
Speaker 1: Method bands means that states specifically target a type of procedure.
Speaker 1: So it would be like saying, we are going to
Speaker 1: ban hysterectomyse for the purpose of um eliminate bleeding problems. Right,
Speaker 1: But in this case, there's specifically targeting a kind of
Speaker 1: abortion procedure. So if somebody needs an abortion, for example,
Speaker 1: in the second trimester, abortion a little bit later in pregnancy,
Speaker 1: there are only a handful of ways that we can
Speaker 1: do that, and by eliminating those possibilities, you then by
Speaker 1: de facto eliminate the access to that procedure or that
Speaker 1: point of pregnancy altogether. And those are most commonly like
Speaker 1: dilation and extraction procedures. Correct, well, the most common way
Speaker 1: to do an abortion the second trimester is a dilation
Speaker 1: and evacuation UM a little bit different than a dilation
Speaker 1: and extraction, but what we know is that it's the
Speaker 1: safest way to accomplish pregnancy termination later in pregnancy. And
Speaker 1: so there's lots of ironic things about the laws that
Speaker 1: states pass and anti abortion extremists past, but by and large,
Speaker 1: most of the restrictions and laws that they passed the
Speaker 1: band's targeting either justesational agor procedure type really make abortion
Speaker 1: less safe and and don't don't change anything about how
Speaker 1: common it is. Okay, and s B A copycats. So
Speaker 1: Texas was, as everyone knows, allowed to enact and implement
Speaker 1: um essentially a type of law that is unique UM
Speaker 1: in the world of abortion regulation. They essentially allowed any comer,
Speaker 1: anybody in the whole state could target anyone that they
Speaker 1: thought was having an abortion or helping someone get an abortion,
Speaker 1: and an sp A was really focused on civil penalty,
Speaker 1: So you could be sued for helping your granddaughter get
Speaker 1: to the abortion clinic. Your church could be sued if
Speaker 1: you were counseling folks or driving them to their to
Speaker 1: their appointment. But the penalty was really money. Right that
Speaker 1: there was a sort of a bounty hunter component to it,
Speaker 1: And since that has been allowed to go into effect,
Speaker 1: many states have tried to copy that and or build
Speaker 1: on that. In Missouri, UM last year are one of
Speaker 1: our most extreme legislators introduced a piece of legislation that
Speaker 1: took the framework of that sort of all comers can
Speaker 1: attack anyone having or assisting an abortion, but extended it
Speaker 1: beyond our borders to say, it doesn't matter if a
Speaker 1: Missouri and is having a legal abortion outside of the
Speaker 1: outside of Missouri's borders, we're going to attack you too.
Speaker 1: So we're gonna have to look out for some more
Speaker 1: of those kinds of bills UM in these coming legislative sessions.
Speaker 1: To okay so and and the High Amendment. The High
Speaker 1: Amendment UM is a longstanding federal regulation which really, um,
Speaker 1: it's quite honestly a racist way of targeting the most
Speaker 1: marginalized and most vulnerable. So what it says is that
Speaker 1: no federal dollars UM Medicaid dollars can go towards paying
Speaker 1: for abortion services. And we know that abortion bands impact
Speaker 1: the most marginalized poor folks, black and brown community is
Speaker 1: the hardest, and so by eliminating that funding stream for
Speaker 1: folks to pay for this basic health care, we are
Speaker 1: putting that population at it even larger disadvantage. Okay, so
Speaker 1: those are these are kind of terms we're going to
Speaker 1: be discussing during this conversation. UM. Basically, Now, am I
Speaker 1: being extreme if I say only wealthy women in blue
Speaker 1: states can terminated pregnancy? Well, I think that for folks
Speaker 1: who are not wealthy women in blue states, it is
Speaker 1: incredibly difficult and has gotten exceedingly more difficult. There is
Speaker 1: an incredible network of abortion funds and practical support organizations
Speaker 1: and abortion providers who are doing their damnedest to make
Speaker 1: sure that UM, people of color, people in these communities
Speaker 1: where abortion has been banned still have access but it's
Speaker 1: pretty bleak, and I think to your point, the only
Speaker 1: people who have easy access are are folks who don't
Speaker 1: live at those margins. And by the way, I've been
Speaker 1: reading over the past few months about how in Mexico
Speaker 1: UM they're even trying to get sort of morning after
Speaker 1: pills and you know, abortion care through their network into
Speaker 1: America Last Libres I think they're called. So even other
Speaker 1: countries are trying to help us. You know, if you
Speaker 1: look at the last fifty years, unmistakably the globe is
Speaker 1: moving towards liberalization of abortion. There are only two countries
Speaker 1: that are moving backwards towards criminalization ours UM, and we're
Speaker 1: joined in that by Nicaragua. But truly across the globe
Speaker 1: there are probably since almost forty countries that have liberalized
Speaker 1: their abortion laws because they understand the public health crisis
Speaker 1: that results when you don't have access to safe and
Speaker 1: legal abortion. I'm curious what you know when I said,
Speaker 1: I actually saw my internist this morning and I said
Speaker 1: I was doing this podcast and we were going to
Speaker 1: be talking about abortion rights, and she goes, I don't
Speaker 1: say abortion anymore. I say women's reproductive rights. Because even
Speaker 1: the word abortion is so triggering to people, and it's
Speaker 1: so much more than that, And I thought, you're right,
Speaker 1: it is women's reproductive health. I mean, that is the
Speaker 1: umbrella of all of it. So I'm curious you are
Speaker 1: embedded there in Missouri fighting the fight. What are some
Speaker 1: of the biggest concerns you have right now? I know
Speaker 1: there are many, You're right, there are There are an
Speaker 1: endless number. But here here's the thing. You know, having
Speaker 1: practiced in Missouri for the ten years before the dab's decision,
Speaker 1: nothing about this moment was shocking to me. But you know,
Speaker 1: we've been preparing for this moment um. So there are
Speaker 1: a couple of things that I worry about. Um, you know,
Speaker 1: there's short term problems, right, and the short term problem
Speaker 1: we we talked about a little bit already, right, which
Speaker 1: is the mass migration of people for basic health care. Right.
Speaker 1: We are staring down a reality where states will have
Speaker 1: abdicated it's basic responsibility for this very common health care.
Speaker 1: And when you overlay that with other public health crisises
Speaker 1: that are happening at the same time, So maternity shortages, right,
Speaker 1: So there are huge swaths of the country where you
Speaker 1: can't get reliable o b g y N care. Right,
Speaker 1: So we're talking about forcing people to stay pregnant in
Speaker 1: places where there is no O B G y N
Speaker 1: in a country that has one of the highest, if
Speaker 1: not the highest, maternal mortality rate for developed world. And
Speaker 1: so the overlay of those three things really causes I mean,
Speaker 1: we should be terrified about what the ultimate consequences of
Speaker 1: those things will be. I mean, the the other thing
Speaker 1: is that we won't really know the full public health
Speaker 1: consequences of this decision for probably decades, but we do
Speaker 1: know every single day, and we are sitting with patients
Speaker 1: every single day who are traveling hundreds of miles from
Speaker 1: all across the south in the Midwest to our Illinois facility.
Speaker 1: And the infrastructure that is in place now is not
Speaker 1: going to be able to sustain moving that many people
Speaker 1: who need so much resource for this care. And so
Speaker 1: I'm really worried that the existing network of abortion providers
Speaker 1: that are left are going to really struggle to be
Speaker 1: able to absorb the millions of people who are now
Speaker 1: going to be traveling for this care. You know, one
Speaker 1: of the things I keep thinking about with Missouri and
Speaker 1: Texas and so many of these states that have banned
Speaker 1: abortion is they see it in a, in my opinion,
Speaker 1: in a very microscopic way. And I think about how
Speaker 1: we are trying to communicate the crisis that as women
Speaker 1: were in. And sometimes there's a part of me that
Speaker 1: wants to say, hey, by the way, if your son
Speaker 1: gets my daughter pregnant, he has to drop out of
Speaker 1: college and go work at the seven eleven because he
Speaker 1: now has to buy diapers, which are very expensive. Like
Speaker 1: I sometimes think that we need to pivot even the
Speaker 1: way we think about it. And you know, sometimes I
Speaker 1: want to say, of Texas, you know, the white women
Speaker 1: in Houston, they're going to get abortions. It's the people
Speaker 1: that you demonize so much that aren't going to have
Speaker 1: the access. So there's to me, there's there's communication things
Speaker 1: that I feel aren't being penetrated through all the talk
Speaker 1: about like, oh, women abortions, Oh you're killing a baby,
Speaker 1: like that seems to be the conversation over and over again. Yeah,
Speaker 1: I think what you're verbalizing is that you know their goal,
Speaker 1: their intent really has nothing to do with public health
Speaker 1: or the outcomes of families and how we build sustainable
Speaker 1: and healthy families. Right And and to your point, we
Speaker 1: also in the movement have not done a great job
Speaker 1: of helping folks understand that abortion truly is an intersectional issue. Right.
Speaker 1: It's an economic justice issue, it is a racial justice issue. Um.
Speaker 1: You know, if we look, you know, carefully at why
Speaker 1: folks choose to have abortions, it's not because they don't
Speaker 1: want children. In fact, most of them are parents, most
Speaker 1: of them will have future children. It's really because despite
Speaker 1: being the country with some of the most consolidated wealth
Speaker 1: in the globe, we are also a country with the
Speaker 1: highest levels of poverty. Right, And so if you want
Speaker 1: to impact the reason that people are having abortions, we
Speaker 1: really have to start looking outside of the actual act
Speaker 1: of abortion. We have to look at how much childcare costs,
Speaker 1: and how much of our population is still uninsured, Um,
Speaker 1: how many people are living in communities where the schools
Speaker 1: are not accredited. Right. We really have to think about
Speaker 1: an abortion as not just a reproductive health care issue,
Speaker 1: but also as as an issue that touches so many
Speaker 1: different intersecting aspects of people's life. Yeah, it's just very
Speaker 1: hard to get that messaging out because you are met
Speaker 1: with you know, it's anti Christian. You're going to go
Speaker 1: to hell and you're a murderer. I mean, the terms
Speaker 1: that are thrown back are so severe and so strong
Speaker 1: long it dilutes any messaging you know about women's healthcare,
Speaker 1: I find, you know, I think one of the real
Speaker 1: ways to combat that is to to do some hard
Speaker 1: work around stigma. We know that there are lots of
Speaker 1: religious folks who both have abortions and support abortion, So
Speaker 1: we have to do some work of taking back some
Speaker 1: of that language, right, Um, And that's hard because the
Speaker 1: stigma of abortion, having abortion, supporting abortion, providing abortion has
Speaker 1: been so ingrained in folks that sometimes it feels really
Speaker 1: risky and hard to take that step and say, actually,
Speaker 1: I'm a person of faith and I've had an abortion,
Speaker 1: or I am a person of faith and I support abortion,
Speaker 1: or I was about to die in the hospital and
Speaker 1: I had to get an abortion. Absolutely. The other thing
Speaker 1: we have to do is help people realize that because
Speaker 1: abortion is healthcare. You know, I can't tell you how
Speaker 1: many people say, after I talk through what an abortion
Speaker 1: is or the many many scenarios in which people come
Speaker 1: to abortion care, they say, well, I did that, but
Speaker 1: that wasn't an abortion. Yes, yes, my friend, it was
Speaker 1: an abortion. UM, and so abortion isn't just one thing.
Speaker 1: Even the basic reproductive health care they got was actually
Speaker 1: abortion care. Let's take a quick break and we're back.
Speaker 1: So walk us through a sixteen year old girl who's
Speaker 1: pregnant in Missouri and she needs and wants to get
Speaker 1: an abortion. What is she up against right now in Missouri? Well,
Speaker 1: she has to leave the state, um SO, she would
Speaker 1: have to one final place to to have that care.
Speaker 1: And depending on where she went, because she's a minor,
Speaker 1: there may be some additional regulation and rule around accessing
Speaker 1: that care. I'm sorry, Well, she need parental concern. It
Speaker 1: depends on where she goes um SO, which now, obviously
Speaker 1: we are no longer providing abortion care in our St. Louis,
Speaker 1: Missouri facility, but we do provide abortion care across the
Speaker 1: river in UM in Illinois. And in Illinois is one
Speaker 1: of the states. I would say that if Missouri had
Speaker 1: spent the last decade making sure that abortion was eliminated.
Speaker 1: On the flip side, there are places like Illinois who
Speaker 1: were doing some real work to make sure that abortion
Speaker 1: access was UM was solidified and so UM. Just this
Speaker 1: past year, the last remaining regulation in Illinois was overturned,
Speaker 1: and so no longer do folks who are seeking care
Speaker 1: in Illinois. Miners who are seeking care in Illinois need
Speaker 1: any sort of parental consent. Having said that, most of
Speaker 1: our miners come with a trusted adult um that they've
Speaker 1: already disclosed, you know, their their need for care too.
Speaker 1: So this individual, depending on where they ended up, may
Speaker 1: or may not need parental involvement, which, as we all know,
Speaker 1: is sometimes okay and sometimes not safe. She would need
Speaker 1: to have money to pay for her procedure, so Missouri,
Speaker 1: like many states, has banned both public and private insurance
Speaker 1: from covering the cost. So it doesn't matter if you
Speaker 1: are privately insured. If your insurance is through a company
Speaker 1: in Missouri, even if it wanted to, it couldn't cover
Speaker 1: the cost of your abortion care. And how much would
Speaker 1: that cost her, Well, it depends on how far along
Speaker 1: she is, but it's probably in the first timemester is
Speaker 1: somewhere around five to seven dollars. Okay. Now, of course,
Speaker 1: if she's um, if she's coming to us, we help
Speaker 1: sort of pair her with things like abortion funds and
Speaker 1: those sorts of things to help reduce the cost in
Speaker 1: some of those barriers. Then she has to figure out
Speaker 1: how to get there? Right? Um. You know, one of
Speaker 1: the things that we are learning, lots of our work
Speaker 1: in this sort of post jobs time frame has been
Speaker 1: around helping folks navigate those logistics. And so you know,
Speaker 1: we're finding that there is some real nuanced questions and
Speaker 1: surround navigation. Right, not just do you have a car
Speaker 1: to get to us? It's can your car drive nine
Speaker 1: miles here and nine miles back? Right? Does anybody else
Speaker 1: in your house rely on that car to get to work?
Speaker 1: Because although we know you're going to lose wages for today,
Speaker 1: we don't want to eliminate the possibility that your entire
Speaker 1: family loses wages for this day, right. Um. So she's
Speaker 1: got to figure out how to find the place. Does
Speaker 1: she need any additional support from or is there requirements
Speaker 1: around parental involvement? How is she going to get here?
Speaker 1: How is she going to pay for it? Um? And
Speaker 1: you know, the constellation of those things makes it just
Speaker 1: impossible for some folks to to get there, even when
Speaker 1: we can provide them some support and managing those logistics.
Speaker 1: So what are what are you seeing right now this week?
Speaker 1: Dr McNicholas, What are you finding to be the biggest obstacles,
Speaker 1: you know, besides the obvious ones, what what are you
Speaker 1: you know, frontline fighting right now? I would say hardest
Speaker 1: thing for us is really UM demand. UM. So before
Speaker 1: the decision, we were we could get folks in within
Speaker 1: two to three days, and now it's two to three weeks.
Speaker 1: And that's even on top of moving some operational things.
Speaker 1: We've gone to six days a week and ten hour
Speaker 1: days UM and occasionally adding some Sundays into the mix
Speaker 1: to try and provide some more space for these folks
Speaker 1: UM utilizing every resource we can, telehealth and UM. But
Speaker 1: you know, the increase in demand, despite increasing hours and days,
Speaker 1: we haven't really been able to to move that needle
Speaker 1: at all. Folks are still waiting two in three weeks,
Speaker 1: which means they're also presenting for care later in pregnancy
Speaker 1: when cost more, when they might need to stay overnight. Right,
Speaker 1: So it just compounds the barriers and the burdens that
Speaker 1: folks are navigating when trying to get this care. And
Speaker 1: how effective do you think it's going to be to
Speaker 1: have an abortion pill so that you can do the
Speaker 1: tell health element with the pill? Do you think that
Speaker 1: that's sort of going to come to be the way
Speaker 1: women terminate pregnancies. But we have definitely seen in the
Speaker 1: last couple of years that the utilization of medication abortion
Speaker 1: has gone up dramatically. It is super safe, but it's
Speaker 1: not a method that everybody loves, right. It's a little
Speaker 1: bit unpredictable. Um. It takes a couple of days for
Speaker 1: the whole process to sort of go on. Some folks
Speaker 1: have some privacy concerns around having to do something at home,
Speaker 1: so it's not a perfect solution for everybody, um, but
Speaker 1: it is an excellent option for many people, and absolutely
Speaker 1: we should be thinking innovatively about how to use technology
Speaker 1: and other things to keep the folks who can have
Speaker 1: care outside of the traditional brick and mortar health centers
Speaker 1: out of those centers, so that the folks who really
Speaker 1: want to have procedural care or have to because either
Speaker 1: a medical co morbidity or because they're too far along
Speaker 1: for medication abortion, that they too have some highly access
Speaker 1: to care. By the way, I didn't know I was
Speaker 1: pregnant until got three or four months in, so you know,
Speaker 1: when you're pregnant, the days, the weeks go by pretty quickly. Um.
Speaker 1: What are the biggest fears you're hearing, are you hearing
Speaker 1: I'm afraid of being imprisoned. You know, Yes, some folks
Speaker 1: are worried about criminalization when they go back to their
Speaker 1: their home states. Um. But the truth is that most
Speaker 1: folks come to this appointment understanding that it is a
Speaker 1: health care service that they need, and they need it now,
Speaker 1: and they're willing to take risks and do whatever they
Speaker 1: can um to be able to access that care. That's
Speaker 1: been true for all of history, right, Um. I oftentimes
Speaker 1: say that the legality of abortion doesn't drive the necessity
Speaker 1: of it, right, and that folks are gonna do what
Speaker 1: they can because it is such an important decision for
Speaker 1: them and the health of their family, and and sometimes,
Speaker 1: as you said, even themselves, right that we s only
Speaker 1: know that pregnancy is not a health neutral event. Do
Speaker 1: you actually do you actually have any data about how
Speaker 1: many women who try who try to self abort, how
Speaker 1: many women die in our country a year? Well, I
Speaker 1: would say that in our unlike in the pre road
Speaker 1: days when self managed abortion was unsafe, right, where folks
Speaker 1: were using um substances or chemicals or physical violence sometimes
Speaker 1: or trying to um sort of procedurally induce their own abortion.
Speaker 1: I think we're in a different space now, and I
Speaker 1: think in terms of sort of the safety of self
Speaker 1: manage abortion, there are sort of what I think are
Speaker 1: three things that people need to be able to do
Speaker 1: that correctly and safely. The first is they need the
Speaker 1: right medication right. Um, If they can get the right medication,
Speaker 1: then we're you know, we're more than halfway there. They
Speaker 1: have to know how to use it, and they have
Speaker 1: to know when something might be abnormal. Now, medication abortion,
Speaker 1: whether you sit with me in a room or across
Speaker 1: the screen, or or where you just get the medication
Speaker 1: online and you have instructions you know, to read yourself.
Speaker 1: There's nothing unsafe about that, so long as you know
Speaker 1: the parameters of when to seek extra care. So I
Speaker 1: think that self managed abortion will be a little bit
Speaker 1: different in this time frame than it was pre row.
Speaker 1: Having said that, just as we know that not everybody
Speaker 1: will be able to travel for abortion care, in this reality,
Speaker 1: not everybody will be able to get medication abortion, either
Speaker 1: via telehealth or some other way. And so there's still
Speaker 1: going to be a proportion of folks who we either
Speaker 1: forced to stay pregnant. And then you know, as we know,
Speaker 1: will some of those at least will suffer significant pregnancy
Speaker 1: complications and maybe even die when really what they wanted
Speaker 1: was to not be pregnant um or perhaps they you know,
Speaker 1: some portion of folks will will turn to some other
Speaker 1: methods to terminate their pregnancy. And what are your thoughts
Speaker 1: and what are you hearing about mobile abortion trucks. So
Speaker 1: we just announced last week that our affiliate is getting
Speaker 1: ready to roll out the first in the planned parent
Speaker 1: head system, certainly not the first across the country, but
Speaker 1: the first in the planned parent Head system mobile abortion clinic.
Speaker 1: And you know, for us, it is an important innovative
Speaker 1: strategy in how we're addressing this access problem. Right, So,
Speaker 1: there's only so much we can do to help get
Speaker 1: people to us. The other component is moving our care
Speaker 1: closer to them, right And so we, as I said,
Speaker 1: we already know that particularly medication abortion is so safe
Speaker 1: and does not require in person care for most people,
Speaker 1: and so mobile abortion care is a real opportunity to
Speaker 1: just get closer to them. If we can reduce their
Speaker 1: trip from four hundred miles to two miles, we might
Speaker 1: be able to get them back to work even that day, right,
Speaker 1: Or we might be able to get a childcare visit
Speaker 1: for them in a way that now makes this more accessible.
Speaker 1: So walk me through how these mobile abortion units work logistically. Yeah, well,
Speaker 1: I'm not sure how Just the Pill is. The other
Speaker 1: organization I know who runs a mobile abortion clinics, so
Speaker 1: I'm not entirely sure how the operations for for that
Speaker 1: organization works. But for us, the process is going to
Speaker 1: be very similar to what happens when you call us
Speaker 1: for an abortion in either in our health care facility
Speaker 1: or via telehealth. So folks call, we will be able
Speaker 1: to call and make an appointment. UM, will do the
Speaker 1: same screening that we do for folks now to make
Speaker 1: sure that medication abortion is a safe option for them,
Speaker 1: that they understand what the process is like UM, and
Speaker 1: then then we will work with them to figure out,
Speaker 1: you know, what is the closest place for them, are
Speaker 1: the most convenient place for them to be able to
Speaker 1: either have that visit or pick up their medication. And
Speaker 1: for us, you know what we're in the process of
Speaker 1: doing right now is you know we are now three
Speaker 1: months post jobs and in a whole lot more months
Speaker 1: post s B eight. Right, that really was the beginning
Speaker 1: of us seeing folks doing a lot of this traveling,
Speaker 1: So we actually have some data now to say where
Speaker 1: are folks coming from, what is the route in which
Speaker 1: they travel, Where is the most convenient place for those folks, right,
Speaker 1: And so we're looking at those travel patterns, were sort
Speaker 1: of drawing those geographic circles to say, Okay, it looks
Speaker 1: like we could have the most impact if we bring
Speaker 1: the mobile unit to this area. And when you go
Speaker 1: in these units, is it just pillformed abortion for us?
Speaker 1: Right now? We're starting with medication abortion, but we have
Speaker 1: plans for and we have outfitted the unit to be
Speaker 1: able to give first trimester procedural abortion as well. Got it?
Speaker 1: And I'm assuming that these units are not huge right there, Like, well,
Speaker 1: I don't know. Ours is pretty big. It's a thirty
Speaker 1: seven ft r V. Oh that's big, okay, And it's
Speaker 1: pretty big. Yeah. It has two full exam rooms in
Speaker 1: a lab in it. So, oh my god, that's wow.
Speaker 1: And we'll be right back and we're back with more.
Speaker 1: Go ask Galley. You must be worried about criminalization of
Speaker 1: the unit. Certainly there must be fears about sort of
Speaker 1: being out in the world unprotected, so to speak. How
Speaker 1: are you taking care of yourselves. Yeah, so it has
Speaker 1: always been true that antis are going to continue to
Speaker 1: try and attack regardless of what we do, and so
Speaker 1: I think that can't be a deterrent for us in
Speaker 1: moving forward to expand access. So, as you said, UM,
Speaker 1: you know, although we are pushing boundaries and being innovative,
Speaker 1: we're going to do so in a legal framework. Um.
Speaker 1: If if we're in jail, we can't provide care, so
Speaker 1: that's not helpful, right, So the unit will will be
Speaker 1: operationalized throughout southern Illinois and we're going to get close
Speaker 1: to those borders so that we can help folks reduce
Speaker 1: the burden and the travel. But for us, it's going
Speaker 1: to be you know, within the Illinois Illinois borders. But again,
Speaker 1: you know, as we look at the next legislative cycle
Speaker 1: on session, we fully expect that folks are gonna look
Speaker 1: at things like the mobile unit and try and find
Speaker 1: ways to attack that that kind of care too. You know,
Speaker 1: I'm curious. I think it's important to ask you this
Speaker 1: question because of what we talked about before about not
Speaker 1: only the stigma of abortion, but what everybody, certainly in
Speaker 1: a lot of these states that have banned abortion believe, Um,
Speaker 1: that it's you know, the murder of a child. But
Speaker 1: would row versus way to protect besides abortion? Yeah, So, UM,
Speaker 1: the foundation of that decision was really rooted in privacy.
Speaker 1: And there have been many other decisions since then, unrelated
Speaker 1: to abortion that use that same framework, UM, marriage equality
Speaker 1: being probably the most recent and most relevant. And so
Speaker 1: I think there lots of concern, and there should be
Speaker 1: lots of concern that other rights that are afforded to
Speaker 1: us based on protections of privacy are now up for grabs, UM,
Speaker 1: trans rights, UM, access to contraception right. So it wasn't
Speaker 1: all that long ago that folks could only access contraception
Speaker 1: if they were married. Um. And so you know, we
Speaker 1: should be thinking about what is next because now so
Speaker 1: many things are up for debate. I mean, what happens
Speaker 1: if they do a federal ban on birth control? Well,
Speaker 1: is everybody going to get a vasectomy? I mean, how's
Speaker 1: that going to work? Well? I really, I have yet
Speaker 1: to see any mass movement in pregnancy prevention from male
Speaker 1: body folks. Now. Having said that, UM, I will tell
Speaker 1: you that one of the services that we have seen
Speaker 1: the biggest increased demand for in the post jobs decision
Speaker 1: is for vast sectomy. Um. We have seen lots of
Speaker 1: folks coming forward for permanent sterilization, both both tubal sterilization
Speaker 1: for for female bodied folks and for vas sectomy, because
Speaker 1: folks know, right they abortion today and birth control next,
Speaker 1: and you know, this is a way that they, at
Speaker 1: least at the moment, can have some reproductive autonomy. Those
Speaker 1: are expensive procedures a vassectomy or getting your tubes tied well,
Speaker 1: certainly for uninsured folks. You know, it's out of reach
Speaker 1: for them for sure, and it's permanent, right, So it
Speaker 1: does although I fully believe that people are capable of
Speaker 1: making the decision to become permanently sterile. Um, we've now
Speaker 1: gone from uh, there are a whole host of reversible
Speaker 1: methods of contraception to I just want to skip all
Speaker 1: that because I'm that worried that I'm not going to
Speaker 1: be able to control my own fertility. So, you know,
Speaker 1: the past few months there, I mean, women have been
Speaker 1: marching there on text threads with each other. A lot
Speaker 1: of women, not all women, A lot of women are
Speaker 1: upset by the overturn of Roe versus Wade, and I
Speaker 1: feel and I've talked to a lot of women that
Speaker 1: feel like they don't know what to do. So a
Speaker 1: lot of people feel, well, I'm gonna go. I'm gonna
Speaker 1: help people vote. That's the only thing we can do.
Speaker 1: We gotta we gotta help women vote. Um. Other women
Speaker 1: are giving a lot of money to abortion clinics. Um.
Speaker 1: And I think overall people are trying to do and
Speaker 1: trying to help in any any way they can. But
Speaker 1: for the women listening to this podcast, what is the
Speaker 1: most productive thing that women can do to help scaffold
Speaker 1: this fight and help with women's reproductive rights? What can
Speaker 1: we do? I think there's actually two things, and the
Speaker 1: first is pretty simple but maybe the most scary, and
Speaker 1: that's talk about it. So I oftentimes say, in every
Speaker 1: single conversation, you have say the word abortion. Right. Um.
Speaker 1: Oh so say okay, sort of a running joke in
Speaker 1: my family. My my wife is also a position and
Speaker 1: so uh not an O, B, G, I N. But
Speaker 1: so when we're in spaces for her work, she it's
Speaker 1: sort of like, can you wait like three minutes before
Speaker 1: you talk about abortion? Um? But but the truth is,
Speaker 1: you know, say it because saying it normalizes it, right.
Speaker 1: It allows people to feel like they have permission to
Speaker 1: also share their support. Um. We talked about earlier that
Speaker 1: so much of this is rooted in the stigma around abortion.
Speaker 1: So I should say I started this podcast by saying
Speaker 1: that my intern has said call it women's reproductive rights,
Speaker 1: and you're saying, say abortion, So I should be saying abortion.
Speaker 1: I think saying abortion helps reduce the stigma around it.
Speaker 1: And you could say abortion is healthcare, um, but I
Speaker 1: do really think it's important to say the word because
Speaker 1: the word has become dirty somehow right and bad, and
Speaker 1: it's not bad, it's healthcare, right, and so I do
Speaker 1: feel strongly that we need to be talking about it.
Speaker 1: And the other thing I would say, and this is
Speaker 1: sort of you know, bigger picture, is to take some
Speaker 1: steps back and when you are in other spaces, meaning
Speaker 1: when you are you know, marching against racial injustice, bring
Speaker 1: abortion to that table. And when you're thinking about democracy reform.
Speaker 1: You know, we didn't get to this place just because
Speaker 1: of abortion. Right. The reason that we had a failed
Speaker 1: pandemic response was because you know, anti abortion extremists, the
Speaker 1: same ones who were anti vacts and anti PANDEMICUM, they
Speaker 1: had perfected the sort of silo wing of public health,
Speaker 1: creating this um situation where folks don't trust science, right,
Speaker 1: this is this is all part of the same picture.
Speaker 1: And so UM, I would say my second sort of
Speaker 1: ask is that you're involved in sort of the broader
Speaker 1: work of democracy and social justice issues because they really
Speaker 1: are all intertwined. That's that's great. What about donating to
Speaker 1: abortion clinics and abortion care? Is that helpful? Have you
Speaker 1: found an influx of that? Absolutely? So. You know, I
Speaker 1: talked a little bit about our work to help manage logistics.
Speaker 1: You know, when Texas Spate was first allowed to be implemented,
Speaker 1: we rolled out what's called our Regional Logistics Center, And
Speaker 1: our Regional Logistics Center really is a case management style
Speaker 1: operation where every person who's coming to southern Illinois for
Speaker 1: abortion care, either with ourselves set Planned Parenthood or with
Speaker 1: our independent clinic partner, Hope Clinic, UM, is offered a
Speaker 1: case manager who walks them through all of the logistics.
Speaker 1: How are you getting here? Who's watching your kids? Do
Speaker 1: you need a hotel? Um? And it's sort of it's
Speaker 1: twenty four hours a day service. How help folks get
Speaker 1: to this? Right? That cost a lot of money, UM,
Speaker 1: And so we have done a lot of work to
Speaker 1: pair with abortion funds. Donating to abortion funds is it
Speaker 1: critically important? They're an important tool and being able to
Speaker 1: help folks navigate this work. Um, But looking at places
Speaker 1: and organizations who are doing this work, the Regional Logistics Center,
Speaker 1: abortion funds, practical support organizations, that's really the short term.
Speaker 1: I think financial support that that the movement needs. Right now,
Speaker 1: what do you think the next generation of doctors is
Speaker 1: going to look like? I'm worried. Um, you know, I
Speaker 1: think as I think about sort of these long term consequences.
Speaker 1: What we know is that about almost fifty of our
Speaker 1: O B, G, I N trainees are training and states
Speaker 1: where abortion is either already illegal or will soon be illegal.
Speaker 1: Which means a couple of things. Right. It means we're
Speaker 1: going to have a workforce that doesn't have the technical
Speaker 1: skills to take care of some obstetric emergencies. Right. It
Speaker 1: means we're going to go back to a time where
Speaker 1: people are required to have hysterectomys or major abdominal surgery
Speaker 1: for ebstetric complications that could have been fixed with a
Speaker 1: D n E procedure. More importantly, I I will say
Speaker 1: I think that we are going to create a workforce
Speaker 1: of O B G I N s who did not
Speaker 1: have an opportunity to really understand the therapeutics and empathy.
Speaker 1: You know, UM, I spent the first part of my
Speaker 1: career in academic family planning training residents to be competent
Speaker 1: O B G y ns. Not all of them went
Speaker 1: on to provide abortion care, but they all got to
Speaker 1: sit with hundreds of patients who are accessing abortion care
Speaker 1: to understand their stories, to understand how they come to
Speaker 1: this decision. And I fully believe that that opportunity to
Speaker 1: develop that empathy makes them better physicians no matter what
Speaker 1: they go on to do, whether they provide abortion care
Speaker 1: or not. And that is going to be lost for
Speaker 1: you know, the next generation of providers. Oh my god,
Speaker 1: empathy is such an important word for this, um, You know,
Speaker 1: Empathy to me seems like the ingredient missing from every
Speaker 1: single horrific piece I read about this, from civil rights
Speaker 1: to abortion rights, all of it. Maybe we're losing empathy
Speaker 1: as a as human beings. I don't know, it feels
Speaker 1: a little bit like that right now. Well, it's really
Speaker 1: easy to demonize things that you don't really have a
Speaker 1: personal connection to, right and so we're in your stand
Speaker 1: or understand that's right, and you know it's um. You
Speaker 1: know it is really a privilege and honor and and
Speaker 1: certainly fuels for those of us who provide abortion care.
Speaker 1: Fuels are continued work in this space to have the
Speaker 1: opportunity to sit with folks and to see the impact
Speaker 1: that abortion has on their lives. Um. For so many people,
Speaker 1: you know, whether it's me handing them a pill or
Speaker 1: it's a procedural abortion that takes three minutes. Truly, you
Speaker 1: can see in just that short amount of time that
Speaker 1: folks feel like, Okay, now I have a chance. I
Speaker 1: can get my feet back under me. Right. I might
Speaker 1: be able to get my family out of poverty. I
Speaker 1: might be able to pay my bills next week. Right,
Speaker 1: I might be able to go to school. I might
Speaker 1: be able to finish school. Right. Um. And when you
Speaker 1: don't have those stories or those experiences, and for many people,
Speaker 1: they just choose not to engage with it. Um. But really,
Speaker 1: when you fill in the picture with all of the
Speaker 1: grade that exists in the middle, it's really difficult to
Speaker 1: demonize folks who want to need abortion. Thank you so
Speaker 1: much for talking to me about this. It's always tricky
Speaker 1: and scary to talk about this because you want to
Speaker 1: talk about the right things, um, and there's so much
Speaker 1: to it. I mean, this would be like a three
Speaker 1: day podcast if I got into the weeds of everything.
Speaker 1: But thank you for talking to me so honestly, and
Speaker 1: thank you for the work that you're doing. And I
Speaker 1: really appreciate it. Well, I appreciate the opportunity. As I said,
Speaker 1: it's so important that we elevate the conversation and so
Speaker 1: you're doing your part two and thanks for that. Absolutely,
Speaker 1: thank you calling, Thank you for listening to Go ask Ali.
Speaker 1: For more info and what you've heard in this episode,
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