Abortion Providers Share Their Reflections on a Post-Roe America

Two years after the overturning of Roe v. Wade, abortion providers across the United States are sharing their reflections on the current state of abortion access, how to take action, and their visions for the future.

Guests include:

Dr. Rachel Chisausky, family medicine physician in the Northwest and fellow with Physicians for Reproductive Health

Dr. Keemi Ereme, OB/GYN and abortion provider in Seattle, Washington and fellow with Physicians for Reproductive Health

Dr. Miriam McQuade, abortion provider in Albuquerque, New Mexico and fellow with Physicians for Reproductive Health

Dr. Jessica Rubino, family medicine physician and abortion care provider in Washington, D.C. and fellow with Physicians for Reproductive Health

Links from this episode

Physicians for Reproductive Health
Physicians for Reproductive Health on Facebook
Physicians for Reproductive Health on X
National Network of Abortion Funds

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Transcript

Jennie: Welcome to rePROs Fight Back, a podcast on all things related to sexual and reproductive health, rights, and justice. [music intro]

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Hi rePROs! How's everybody doing? I'm your host Jennie Wetter, and my pronouns are she/her. So, the big news right now is that we have a decision in the first of two abortion cases in front of the Supreme Court. This term, the Supreme Court ruled that the anti-abortion doctors and dentists, please, we cannot forget the dentists, who were suing the FDA over the approval of mifepristone do not have standing in this case. So, it is being remanded back to Judge Kacsmaryk. So, what that means, it means today we can celebrate a little bit. Abortion access is not getting worse. It means if last week you had access to mifepristone, you still have access to mifepristone. It also means if last week you didn't have access to mifepristone, you still don't have access to mifepristone. So, you know, I saw a lot of reporting talking about this as a huge win for abortion rights, and, and I don't really see it that way. I see it as keeping the status quo. So that means there are still so many people who want and need access to abortion who do not have it, who cannot access medication abortion legally. So, this doesn't change that, right? It just means that it prevents more people from being unable to access it at this moment. I think my other thought about this case, I think there was a really great piece written by Mark Joseph Stern and Dahlia Lithwick over at Slate talking about why we basically, why we should have never been here, right? And that we should not be giving the Supreme Court a gold star for their ruling in this case, because it was like the bare minimum, the standing ruling in this case was wild. Like, there is no reason that these doctors should have been able to argue for standing. It should not have gotten to where it did. So, the Supreme Court does not get gold stars for doing the bare minimum, but again, it means access is not getting worse. So, that is good news. I think the other really big concern is that it's going to, this case doesn't die, right? It's going back to Judge Kacsmaryk's courtroom where this case is gonna proceed with new plaintiffs. You had states, I think it was Kansas, Missouri, and Idaho asking to be able to proceed with this case. So, you have states that are gonna try to be the plaintiffs replacing those anti-abortion doctors, and that means that they're gonna have a much easier time making a standing argument. So, I really see this as like, this ruling is just like extending the ability for people to access medication abortion a little longer until any Comstock challenges come up until this new round with the states as plaintiffs comes up, and that people could still really lose access. And so, it is really concerning. And so, seeing it reported as a huge abortion rights win is just, it's not true y'all. It is not true. Yeah, not good. And we're also waiting on the Tala case about if states can say that there are no life and health exceptions to their abortion bans. And so, preventing people from accessing abortion when their health is failing, and an abortion is the emergency treatment for it. We're still waiting on that decision. And y'all, I'm not gonna lie, like I was really worried before this unanimous decision on mifepristone, but I am just, I am so worried for a really terrible decision in this EMTALA case. So, celebrate the win, not win. Sorry, it is not a win. Celebrate mifepristone not being further restricted today. We should celebrate, but know it's tenuous at best, right? We are, they're just waiting for a better plaintiff who can make a standing argument before they really can go after medication abortion. And there's one teed up. So, we're talking like a year or two where access is, is protected a little bit and then also be ready for this really what I think is gonna be a bad EMTALA ruling. So, you know, this fight goes on. And I think another thing that I really have also been thinking about, I think since our last episode, there have been a couple Senate votes that are worth mentioning. You know, we've talked about on the podcast that they're not just coming for abortion rights, they're coming for birth control. And so, Senate Democrats put a bill on the floor to protect the right to contraception, and most Republicans voted against it. And so, it died on the floor. So y'all, they are coming for your birth control. And when I'm recording this, Senator Duckworth also put a bill on the floor about protecting access to IVF. And same, like, it was blocked. While Republicans are out there saying that they support IVF, they all voted...not all, I think there were like two who didn't...they mostly voted against this provision to protect IVF. So, like, be vigilant. Don't let the, like, a little bit of warm feels right now around the mifepristone case make you blind to all of these other attacks that we really do need to worry about. And then just so I'm not, like, all doom and gloom, I think there's one other thing that is really worth mentioning and that is the great Supreme Court decision out of Florida, this fight for sexual and reproductive freedom. Like we can celebrate this little bit of a, again, not win, this little bit of protecting medication abortion today, and stay in the fight tomorrow because we know that it's tenuous at best and we know there's another decision coming that is, I just feel like in my bones is gonna be bad. So, just be ready for the fight. It's ongoing and we need to keep, keep going y'all. Okay, I think that's enough of, like, a little bit of doom and gloom for me. I'm really excited for today's episode of the podcast. And first I have to say I'm so grateful for everybody at Physicians for Reproductive Health for making this happen, particularly Kelsey Rhodes. Kelsey, thank you so, so much for all of your help in making this episode happen and all the coordination you did to make this happen. Kelsey helped connect us with five doctors to talk about two years post-Roe and share some of their thoughts. So, I am very excited to turn the rest of the episode over to five wonderful physicians to talk about what they're thinking about two years post-Roe.

Dr. Jessica Rubino: Hey there, I'm Dr. Jessica Rubino. I use she/they pronouns. I'm a family medicine physician and an abortion care provider. I am now in the Washington DC area. The last couple of years have been pretty tough for me and my family. We left Texas where I was providing abortions, sold our house and picked up and moved across the country. We're really happy with where we landed and I'm gonna be helping open up a new abortion clinic. So, things are starting to turn around for me, but you know, there's still the pain of having left behind a community of people I used to serve. It is a bit uplifting to focus on a new community of people to take care of, but I know that even here I'm gonna be taking care of people from very far away. I'm sure patients from the same communities that I used to take care of. I'm really looking forward to getting back to that. But on the other hand, I'm anxious. I know that the patients are gonna be really having struggled to get to us. And the more that this becomes a problem, the more desperate people are and the more stressed everyone is. And abortion care can really be a really affirming experience for patients and really a calm experience and not trauma filled. But when everyone is forced to leave their own communities to get the care that they deserved, when they're forced to prove that they're desperate enough to want it, or they have to find funding and they have to get childcare and get time off work, the more and more desperate people are, the worse the experience is. And the same, maybe they would've made the same decision and it's just so much worse for everyone.

Dr. Keemi Ereme: This is Keemi Ereme. My pronouns are she/her. I am an OB/GYN, an abortion provider in Seattle, Washington. And here are some of my reflections on where we are two years after the Dobbs decision. I first wanna make it very clear that Roe v. Wade did not afford the protection of abortion and the access to abortion for everybody. It definitely lacked in providing the equal access, especially to communities of color and LGBTQ communities. However, ever since the Dobbs decision, those communities have been even further impacted and their ability to access basic repro healthcare has been further diminished. I practice in the Seattle, Washington area and even in a state like Washington that is protective, I still see the effects of the Dobbs decision playing out every day when people have to travel very far, even within the state, just to get access and care to abortion, where people are coming from out of state at later gestational ages because it takes 'em so long to find care because they don't have any access in their own states. This is not the future I thought I would be living in. I never thought we would slide backwards so quickly. And we are now seeing the repercussions of those actions. And the people who are most affected and most devastated by these actions are the people who have always been most affected by these actions. They're the people who have been historically marginalized and the people who continue to face many barriers to basic healthcare and basic rights. And the Dobbs decision has just made that worse. I've also noticed as an abortion provider that ever since the Dobbs decision, I think all across the country, you see this giant rollback on basic human rights, basic rights to reproductive healthcare, basic rights to LGBTQ gender affirming care, basic rights to express yourself outside of a very tight, normative, white normative lens. But we knew that the Dobbs decision wasn't gonna be the only thing that was going to happen. We knew there would be continued attacks on people's freedom to live the lives that they wanna live and the way they wanna live them. And we have seen that continue in the two years after the Dobbs decision. And I'm afraid it will continue in the near foreseeable future. But I think that now we are realizing that we need to be much more active and much more proactive in our advocacy and our involvement in politics and governmental policies to make a bigger impact and to make sure that the voices of the majority, which is where we stand, are heard, and not the voices of the continued minority that continue to change the way in which most people can access their basic human rights. The Supreme Court decision to continue to allow mifepristone to be used for medication abortion is a hopeful moment for me. I am excited by that news and happy for a little bit of good news after such a long trail of bad news. But I think we as reproductive healthcare providers, we as abortion providers, we as people who are advocating for the basic human rights to determine when and if people want to have children. We need to do more to be proactive and vocal about what our patients need, what we're advocating for and what we wanna see in the country and spaces that we live in. So, I think that now even more than before, there's a call to action to get involved in your local politics, get involved in national politics, be that person that is advocating in local and really getting your point across and demonstrating that we are a majority and we stand with the majority of people in this country who believe that everyone should have access to abortion. And we need to continue fighting on that front and not allowing the voices of the minority to continue to dictate policies and laws that restrict access to so many people. And we need to continue centering people in the most marginalized groups because if we center those people, then we can really attain something that's much better than Roe v. Wade afforded us. We can attain a policy, a law that truly covers full access, equity of access to abortion care for all people and not just a select few.

Dr. Miriam McQuade: My name is Miriam McQuade. I'm an abortion provider in Albuquerque, New Mexico. I wanna talk about what it's been like for us since the Dobbs decision happened and give a little bit of background around that as well. We know that there's states where abortions are banned. They have fewer maternal healthcare providers and more maternal healthcare deserts and higher rates of maternal mortality and even infant death, especially among women of color or people of color that can have pregnancies and higher overall death rates for people of reproductive age as well. And there's a lot more greater racial inequities across healthcare systems in New Mexico. It's a really unique place to work and really unique way to provide care for people. A third of our counties are maternity healthcare deserts. 18% of people have no birthing hospital within 30 minutes, and about a quarter of people receive no or inadequate prenatal care. So, we already exist in a healthcare desert, particularly our reproductive healthcare desert. That was all before we had all the restrictions start. So, in Texas, all of our restrictions started with Senate Bill 8, which went into effect in 2021. This prohibited anyone from providing abortion after detection of embryonic cardiac activity, which is around five or six weeks from a person's last period. It also prohibited anyone from aiding and abetting abortion in Texas after embryonic cardiac activity. This law was interesting and scary for lots of people from Texas because it was enforced by private citizens and not state agencies. So, a person who was found to have violated the law could pay up to $10,000 in the cost of legal fees. This was one of the first bans on abortion before 20 weeks since 1973 when Roe v. Wade went into effect. This law had caused significant harm for Texans and left abortion patients and providers with very limited access to abortion at all within the state. We saw that only about 16% of patients who were looking for abortions in the state of Texas were able to actually see and receive an abortion at that time, once SB8 went into effect. Just from this one law, just from one state law alone, us in New Mexico, we saw a huge increase in patients coming from Texas for abortion care here. In this same three-month period before SB8 and after SB8, we saw an increase, a tenfold increase for people traveling for care. We also know that SB8 is not the end to all of our Texas laws. In 2022, Roe v. Wade or the Dobbs decision, which is the law that protected abortion nationally was overturned. After Dobbs, we saw worsening restrictions in Texas, but also other places surrounding New Mexico patients in Texas. Abortion became pretty much illegal at that point, and they're having to travel extreme distances to get any sort of care. Texas, like I said, wasn't the only state that had increased restrictions. Oklahoma enforced two criminal bans including a pre-Roe ban to prohibit abortion entirely, with only the exception to save the life of the pregnant patient in a medical emergency. They also enforce an SB8 like aid and abet clause as well. And Arizona has had really interesting fluctuating laws, leaving a lot of Arizonans very confused about whether or not they can seek abortion in their state. So, because of all of that, New Mexico left us as a surge state since 2021 when SB8 went into effect. Our access to abortion in New Mexico has always been really limited. 91% of our counties don't have any provider or clinic that provides abortions and about 50% of New Mexican people who can experience pregnancy live in a county without abortion access or care. Additionally, New Mexico has one of the highest rates of abortion providers to out-of-state patients and one of the highest rates of abortions greater than 21 weeks. This is all because New Mexico is in a very unique and interesting place. We have been a surge state, like I said, since SB8, in a state that's already under-resourced and underfunded. We have many patients from New Mexico that are uninsured and already have to travel to get basic healthcare, but particularly reproductive healthcare, poor and low income people that live in these rural areas are often hit the hardest by state restrictions that are exacerbating longstanding inequities to abortion access already in our state. Also, the laws around abortion in New Mexico are incredibly lenient when it comes to abortion. We have no parental notification laws and no gestational age restrictions in the state. Because of all of this, our clinic alone had a 500% increase in the patient volumes and stops. That is even with the opening of three or four other clinics within the state that are providing abortion care, which was not happening before. So, it's been really challenging and really interesting for us to experience differences in abortion care here in New Mexico. And we've seen lots and lots of patients having to travel huge amounts of distances every single day. We are confronted with ethical decision-making that we have to do for patients who are traveling for care. We know that patients are struggling to get to us. We get calls from maternal fetal medicine providers or other providers, OB/GYNs and family medicine providers from Texas primarily, but also from places like Oklahoma, Arizona, and honestly Louisiana that patients can't get to us. The thing that I'm most scared about right now is that a lot of the abortion funds that are helping patients travel and cover the cost of abortion as well as cost of travel and places to stay, et cetera, are not having enough money to be able to help patients. Every single day, we have a patient who can't afford to pay for an abortion and it's really scary for me to be able to have to have to talk to patients about: how do we make this sustainable in the long run? Additionally, I get really concerned about the medically complex patients, patients who should have an OR procedure. And yet lots and lots of hospitals are making patients pay before they have a procedure because they're not able to cover the costs. And what does that look like in the long run for patients when patients aren't able to pay for something that's gonna be safe for them? And finally, the thing I'm actually the most concerned about is: for patients who can't make it to us, what is happening? There must be a huge number of patients who don't even have the resources to figure out how to make it to us, let alone get the coverage that they need once they get here. All of this has made me really concerned about what we're able to provide for patients here. New Mexico is always gonna be here. We're always gonna continue to provide abortion care for anyone that needs it. And yet how do we make this sustainable for patients that need to travel to get to us?

Dr. Rachel Chisausky: Hello, my name is Rachel. I'm a family doc in the Northwest and a fellow with Physicians for Reproductive Health. And I have spent the past couple years after the Dobbs decision initially in a restrictive state and now in a more supportive state. And has been really interesting to see the changes in the reproductive healthcare landscape. Obviously, access is a huge issue. We're currently- being in a supportive state, we're seeing patients who are having to travel so much further, creating a huge financial barrier, a huge time barrier, and forcing them to come in later when an abortion procedure is more complex when they don't have the choice of a medication abortion, when they're at more risk of pregnancy related complications like preeclampsia, things like that rather than all abortion is very safe, much safer than birth, but not being able to have the option of a super safe, super early abortion or choice between medication and procedural abortion. On the other side, when I was in a restrictive state, I would say the dominant change was fear. Patients had fear, they didn't know who they could ask what was safe, and providers had- have so much fear on what we can do, what is safe. Even something that is like a patient coming in likely having a miscarriage, unless it meets definitive criteria, couldn't really offer any management options. And even in the case of complications, seeing providers, nurses, staff hesitant on when we can act forcing patients to undergo uncertainty, plan changes, not knowing when we can intervene on complications and other things that we've seen change. I think aside from just reproductive healthcare procedures themselves, we're seeing the kind of anti-choice sentiment extend further and further--restrictions on emergency contraception, concerns around access to contraception in general, access to things like IUDs. And of course, we're seeing transgender healthcare rights be decimated in many of the states that are also decimating other reproductive health rights. And I do worry as a human and as a provider how far this will go, how many things that the state will decide they can make a better decision than us providers on, and how many patients that are going to suffer in the process. I will say over the past couple years, positive changes, it has been really heartening to see so many people spurred to action both in the general community and among providers and healthcare workers be really shocked and shook and want to take action. As a family doc, I do a lot of primary care treating the whole person is near and dear to my heart and it's been really neat to see a lot more interest in medication abortion, even early procedural abortion in primary care offices. Places that don't sometimes don't always necessarily do routine pregnancy care, wanting to offer, being able to offer medication abortion. Even talking about it more in emergency settings and being able to give people options right then and there has been really exciting to see. And I think that there's a lot of progress that can be made there. As we look back, I think it's important that while we know that Roe was critically important for protecting rights, Roe was not built on a reproductive justice framework. Roe never considered the most marginalized in our communities. So, I think it's important that we don't talk about reinstating Roe, making Roe constitutional. We need to really talk about going beyond Roe, really look at access and think how do we get everyone access to abortion legally and safely when and where they need it? Under Roe, many people, particularly those who relied on state insurance or didn't have insurance, didn't have access to abortion. The Hyde Amendment limits any federal spending on abortion, which affects a lot of our Medicare and Medicaid patients limiting their ability to access abortion, which disproportionately affects BIPOC folks, low-income folks, disabled folks. So, we really need to get past row and look at a framework that brings access for all care for all people. So, as we go forward, I think as healthcare providers, we know many of the things that we can do for our listeners. I think there's lots of different ways we can get involved. We are seeing so many more people have to travel and travel so much further that abortion funds are doing an amazing job but don't have the resources to help every single person out there who needs it. So, donating to your local abortion fund or donating to the National Abortion Federation's Abortion Fund, or even, if you have the ability, volunteering with those funds, volunteering with your local clinic to transport people to help patients get to and from appointments, things like that. I also would love to see us have medication abortion access in all of our primary care clinics. So, if you're in a spot that's safe to do it, ask your provider, ask your main doctor if they're providing medication abortion and see if that's something that they might be interested in. There's lots of resources there for clinics to start incorporating that if they want.

Jennie: Okay, y'all, I hope you enjoyed listening to the wonderful doctors talk about what their thoughts are. Two years post-Roe I really enjoyed listening to those voice memos and they gave me all a lot to think about. And again, like I said, let's enjoy the continued access to medication abortion today and stay in the fight and know that the fight continues, that this is not the end. This case is gonna come back and we are still waiting in EMTALA. So, just keep fighting, y'all, just keep fighting. And if you can, it's important to make sure that we're supporting local abortion funds. We are also supporting places where people are going to get information. So, OARS is a great place. The Online Abortion Resource squad, I am a monthly donor there. I'm also a monthly donor to a number of abortion funds, but it's really great to support those people who are doing the ground work. So, yeah, and again, I know I've said this a couple times, I've talked about donating, but, like, being even a small dollar monthly donor is, it's amazing for them because they know that every month they get that $10, $5, whatever, that they can expect it every month and it's makes it easier for them to plan their year. So, if you're thinking about donating to your local abortion fund or to OARS or to wherever, if you can work out a monthly donorship, that makes a huge difference to them. Okay, with that, I will see y’all next week. [music outro].

Jennie: If you have any questions, comments, or topics you would like us to cover, always feel free to shoot me an email. You can reach me at jennie@reprosfightback.com or you can find us on social media. We're at @RePROsFightBack on Facebook and Twitter or @reprosfb on Instagram. If you love our podcast and wanna make sure more people find it, take the time to rate and review us on your favorite podcast platform. Or if you wanna make sure to support the podcast, you can also donate on our website at reprofightback.com. Thanks all!