Abortion Access is a Health Equity Issue

Abortion access does not look the same for everyone in the United States. That’s because whether or not someone can access an abortion is often tied to factors like income, transportation, insurance coverage, ability to find childcare, and more. COVID-19 has highlighted the inequities in the U.S. system. Dr. Bhavik Kumar, Medical Director for Primary and Trans Care at Planned Parenthood Gulf Coast and National Medical Spokesperson for Planned Parenthood Federation of America sits down to talk with us about those inequities and how they span across the full spectrum of healthcare.

Because abortion access coincides with one’s socioeconomic resources, barriers to abortion care (such as Targeted Regulation of Abortion Provider laws) oftentimes disproportionately impact who are already marginalized. This includes Black Americans, people of color, low-income folks, the LGBTQ+ community, and young people. In the recent California Turnaway Study of almost 1,000 people, researchers found that people who were denied access to an abortion had 4x greater odds of living below the federal poverty level. Clearly, when people are forced to carry a pregnancy to term, they are more likely to live in poverty.

 In the midst of the pandemic, Texas (where Dr. Kumar’s practice is located) made accessing abortion care even more difficult, enacting policies that ended up forcing patients to come into clinics five to six times before being able to have the procedure. COVID-19 has further underscored existing inequities in the U.S.’ healthcare system, especially when it comes to Black and brown people. This is unacceptable, given that equitable access to care (including sexual and reproductive health care) is a human right. It is also important that inclusive and culturally-competent care be given to LGBTQ+ patients; Planned Parenthood has recently expanded their ability to provide care to transgender and gender nonconforming folks.

Links from this episode

Planned Parenthood
Planned Parenthood Gulf Coast on Facebook
Planned Parenthood Gulf Coast on Twitter
The Turnaway Study

Transcript

Jennie: Welcome to RePROs Fight Back, a podcast where we explore all things reproductive health, rights and justice. I'm your host, Jennie Wetter, and I'll be helping you stay informed around issues like birth control, abortion, sex education and LGBTQ issues and much, much more-- giving you the tools you need to take action and fight back. Okay, let's dive in.

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Jennie: Welcome to this week's episode of RePROs Fight Back. I'm your host, Jennie Wetter, and my preferred pronouns are she/her. So this week has been a bit of a week. Nothing like, major has happened. I mean, there was the birth control decision that was not great, but my head has just not been in it this week. I have been just really distracted and not able to focus on the things I've needed to do. And with everything that's happening in the world with COVID still raging and spreading so much, make sure you're wearing your masks. If you're going out the fight for black lives and making sure Black Lives Matters is still ongoing, and it's going to be a long fight to make sure that we reach equality and equity in America. So, you know, we need to be prepared for again, a marathon and not a sprint. This is going to be a lot of work for a long time. And so that means also being kind to yourself. So this week I didn't get a lot accomplished that I wanted to do. That's okay. I had really productive Friday. I feel a little better about that, but like the rest of the week, wasn't super productive. I got some things done, but nowhere near as much as I would like, especially because I have two books sitting here staring at me that are going, “read me! read me!” for interviews I want to do on the podcast. But I would like to read the books first, so I need to make time to get it done. And I just have been so distracted and focused on so many other things that my head just hasn't been in it. And it's okay. Like I think we all need to take time and figure out ways to be kind to ourselves and what we need to do and know that not every week is going to be super productive with everything going on right now. Like sometimes you're just going to have a bad week where you're not going to get the things done you want and forgive yourself for it. So that's where I'm at right now. I am forgiving myself for having a bad week. I'm recording this on Friday and I'm looking forward to the weekend where I can hopefully rest, recharge, reset my brain and get a lot accomplished next week. So with that, I think we'll get into maybe a couple of housekeeping things. I usually put this at the end, but I'm sure not everybody makes it to the very end, but I want to make sure people are hearing it one. If you like the podcast, please make sure to rate and review, particularly on Apple podcasts, it helps people find the podcast. So that would be awesome. But too, if you have topics you want us to cover or issues you want us to talk about or a person you want us to talk to always feel free to reach out. You can email me jennie@reprosfightback.com or you can reach out to us on social media. We're on Facebook and Twitter at repros fight back and on Instagram at reprosfb… always feel free to reach out. We're happy to take suggestions or topics that people would really like us to talk about. And I think those are the big, main things. I just wanted to make sure that people were hearing that. Cause I think sometimes it gets buried at the end and I would love to hear what y'all think that I'm sure you have things that you would like us to talk about that we haven't discussed yet. So for this week's episode, I had a really great conversation with Dr. Kumar with Planned Parenthood. He is a provider in Texas and we talked about abortion access and health equity and the things we can do to ensure that everybody is getting access to the care they need. It was a really wonderful conversation and I hope you all enjoy it. So with that, I will take you to my interview with Dr. Kumar. Hi, Dr. Kumar. Thank you so much for being here today.

Dr. Kumar:Thanks for having me.

Jennie: So before we get started, do you want to do a quick introduction and include your preferred pronouns?

Dr. Kumar: Sure. My name's Dr. Bhavik Kumar, and I'm the Medical Director for Primary and Trans Care at Planned Parenthood Gulf Coast in Houston, Texas, and I'm also the National Medical Spokesperson for Planned Parenthood Federation of America.

Jennie: Great. So do you maybe want to tell a little bit about what brought you to this work and to work in Texas?

Dr. Kumar: Yeah, so I grew up in Texas, my family and I moved here when I was about 10 years old, and Texas is home to me-- my family and my friends live here. I went to school including college and medical school here. So, you know, if you know anyone from Texas, a lot of Texans tend to have pride about their state and I'm starting to be one of those people. There's a certain culture about Texas. And so I consider myself a Texan. I grew up here and, you know, I, I'm a brown-skinned gay man, cis-gendered man, my family and I are immigrants. And we were also undocumented for about 11 years. And so I think a lot of that fed into my outlook on life. And at some point, I decided I wanted to help people. And, you know, part of that was wanting to help people to make the world a better place. And, you know, for people like me who have lived experiences that are different from perhaps what we see in the mainstream that we deserve better. And so when I was in medical school, I started to get involved with an organization called Medical Students for Choice, where I learned a lot about abortion and how common it is, how safe it is, but how do you providers that were in the country, especially in places like Texas. And that just hit home for me. I said, “Whoa, that is not right. Somebody's got to do something about it.” And you know, sort of theoretically, I was like looking around thinking, “who's going to do that?” and thought, well, if nobody else is going to do it, I have to do it. I feel strongly about this. And so my whole career since then has really been about showing up for people who need medical care and the places where it's most restricted and best part of why I ended up in Texas providing abortion and also providing primary care and trans care and being out about it, meaning, you know, sharing my experience, sharing my story, talking about the work I do, showing my face and my name and being unapologetic about it.

Jennie: So one of the things you touched on was access and, you know, there was the Supreme Court case a week or two ago now for the June Medical Services. So it was a victory, but that didn't solve all the access issues. Do you want to talk about that a little bit?

Dr. Kumar: Yeah. The Supreme Court ruling was definitely a great decision to have, I personally had a lot of anxiety, you know, several weeks before.

Jennie: Right.

Dr. Kumar: And if it had not gone the way it did things could have been a lot worse. I'm very happy and relieved to have had that. But you know, at the end of the day, how awful that the Supreme Court has to decide what rights a person has and doesn't have in states like Texas, there are so many restrictions that are already in place, right? And we can go through the numerous restrictions, like the mandatory delay and the restrictions on young people trying to access care restrictions on use of Medicaid and private insurance, especially. And I think what's important when we talk about abortion access is yes, there aren't a lot of restrictions yet there are high profile cases. So it's like the one that was just decided. But ultimately what I see day to day when I'm taking care of people, is that a lot of people I see will tell me, “you know, I never thought I would need an abortion. I never thought I'd be here.” I hear that all the time. And I think that's, what's really unique about abortion is that, you know, those of us who do this work, think about it and talk about it a lot. But so many people across the country don't think about it. Maybe have heard about it in passing. And don't think that they'll be somebody who will need an abortion at some point in the lifetime. So it oftentimes feels very distant for some people, especially for folks that I take care of. And then when they come to the point where they do need access to an abortion, and they realize how many restrictions there are, how many that they have to go through, how difficult it can be, how expensive it is in states like Texas, where you can't use your insurance and you do have to come up with the money on your own, it can be really, really difficult. And then I think it's also important to talk about how, when you have to access an abortion, you're not doing it in isolation from all the other things in your life, right? So how much money you make, how many kids you may already have taking care of those children, the logistics of making an appointment coming back again, because there is a delay and all the other laws that are in place are only compounded for folks that are already marginalized, right? And so that's going to be black folks, people of color, folks that have a low-incomes, LGBTQ+ folks who are already facing barriers to accessing healthcare. And so what I see every day is a lot of folks who make it to the health center, aren't able to get the care they need, but the folks who have to wait several weeks, the folks who have to, you know, wait a couple of paychecks to save up the money or the folks who are black people of color, folks who are low-income. And so all of these things are just compounded. And then the folks that never come back, right, or the folks that are not able to get care in my state of Texas and have to go elsewhere. And I know that some of them weren't able to get the care that they needed. A lot of them weren't able to access abortion and were probably forced to carry the pregnancy to term, there's not that many other options out there. And so access looks very different for different people, especially based on where you live.

Jennie: So one of the things that, you know, we were talking about people not being able to get the care they want because of abortion restrictions. I think this might be a really good time to talk a little bit about the Turnaway study. Do you maybe want to mention a little bit about what the results of that were?

Dr. Kumar: Yeah, sure. The Turnaway study is a really groundbreaking study that came out of California from Diana Foster. And I think one of the most important and impactful findings was that folks that were denied access to an abortion and the study, which included almost a thousand people, was that when they weren't able to access an abortion, they had four times greater odds of living below the federal poverty level. And I think it's important for folks to understand what the federal poverty level is. So right now, for a family of four, it's about $26,000 annual income for the entire household. So when we talk about access to abortion and being able to access it or not, it's so clear that when folks are not able to access an abortion and they're forced to carry a pregnancy to term, it's not just that pregnancy. It's not just that person, and then they go on and they're fine. They're more likely to live in poverty-- when somebody is living in poverty, their children are more likely to live in poverty. When you look at the folks in our country who live at or below federal poverty line, its mostly black people followed by Latinx folks. And so when we think about how does this impact somebody, how does the restriction play out in somebody's life when they're not able to access abortion? What’s it doing? And the research is showing us what it's doing is it's keeping people in poverty and that's mostly Black and brown people. So these restrictions and conversations about access to abortion is not just in that silo of whether or not they can access it. And that's it, it's all connected. It's connected to income. It's connected to your ability to have an education; it's connected to your ability to parent. It's connected to multigenerational trauma. That is very difficult for a lot of people to come out of. And I think for me, it's very clear that abortion restrictions are inherently racist because the consequences of them are what I just described. It keeps people in poverty, it directly impacts Black and brown people uniquely in a very different way. And each of these restrictions on their own may not do much, but it's that layering effect. And in reality, when it's impacting those folks in those and governments, mostly white men continue to pass these laws that impact folks, Black and brown communities in a very specific, unique way that takes generations to come out of. Then it's clear how racist things are. And I see it playing out and the lives of my patients, the stories that they tell me every day. And so I feel very strongly about it, but I think it's been very difficult for us to get people to understand what it means and were lucky to have a study, like the Turnaway study that now gives us a lot of that research and evidence to say, here it is, right. This is what's happening to people. This is the research.

Jennie: And, you know, it's so like with the Supreme Court case, right? You're talking about one law in isolation and not necessarily discussing this whole picture, like you just painted where they're all kind of interacting to put obstacles in the way of people's access to care.

Dr. Kumar: Yeah, exactly. And I think that's, what's so difficult for so many people to understand, you know, when I was talking to folks about this Supreme Court case, when we talk about admitting privileges, it's just such an obscure sort of thing. Right? So even folks that do know a lot about healthcare and know a lot about abortion access, it just seems so silly to be talking about admitting privileges, especially a couple of years after the Supreme Court already decided on an identical case. And, you know, I would see a lot of people sort of scratching their head. Like why are we here? And we're sort of not recognizing that this is by design. They're making a stink about admitting privileges in Louisiana as if it's the most important thing. And for a little bit of time, it was. But in reality, this is a long-term game. All of these restrictions playing together and restrictions on abortion access aren't in isolation, right? And each person's lived experience, they're experiencing oppression from so many different places, all compounded at the same time. And it plays out in people's lives in a very different way. And when we talk about restrictions

Jennie: Yeah. And you also had the restrictions that were in place in Texas during COVID, where they were basically a ban on accessing abortion. And there were court decisions that kind of kept going back and forth.

Dr. Kumar: Yeah. Texas is very unique. I think compared to a lot of other states when it comes to abortion access and you know, a lot of folks would say that Texas is sort of the place where a lot of things get tried when it comes to restricting abortion access. Some folks will say things that happened in Texas don't stay in Texas. And most recently the governor of Texas issued an executive order, which then our attorney general decided to specifically name abortion and say that as this pandemic was starting and there was a lot of uncertainty, we weren't sure what this virus was going to do. People weren't sure how to respond to it. A lot of people were being laid off their jobs, folks were being asked to stay at home, not travel as much, right? And then the government of Texas decided you cannot access abortion. But right now we're going to completely say, you're not able to and forced all of us to then engage in this back and forth through the courts that went on for several weeks and folks were coming to us needing care. We couldn't give them answers. We didn't have answers for them. We had to tell them to either wait or to travel out of state again when you're not supposed to be traveling. And some folks that I saw in the health center came maybe five or six times until they were able to get an abortion, which is absurd. Right? If the government was truly interested in protecting people from COVID-19, you wouldn't make somebody come to the health center five or six times to get healthcare. He wouldn't stop in the middle of a day from taking care of people when they're signing consent forms…or about to take the medication, that doesn't make sense. And none of these abortion restrictions are designed to make sense. And I think the most recent Supreme Court ruling is another example of that. We spend so much time thinking about, well are admitting privileges needed? What is the purpose of them? It's just really about health and safety. Abortion is extremely safe. We've been doing this for centuries and it's only gotten safer. It is extremely sensitive. It has nothing to do with health and safety. It has to do with oppressing people.

Jennie: Another thing that the COVID epidemic really pointed out was the lack of health equity currently in the system and how COVID was disproportionately impacting Black and brown people.

Dr. Kumar: Yeah. I think COVID-19 has really brought a lot of this to the forefront. And we're seeing that many different parts of the country in different ways. I think what we've learned since the COVID pandemic started is that Black and brown people are the large majority of our frontline workers. Whether it's the folks in the grocery stores, whether it's the folks stocking our shelves, or even healthcare workers, we depend on them to provide the services that we need. But when it comes to accessing healthcare, there is a lot of difficulty in access in that care. There's a history of racism. There's a history of bias within the health system that uniquely impacts the Black and brown community. And when it comes to looking at how things are playing out in the pandemic, we see that we expect folks to show up for us when we need them for our central services, like our groceries and pharmacies and also healthcare. But then the systems that are supposed to be protecting them are not showing up or not protecting them. And they aren't more risks than anybody else. And then we also see that the, uh, transmission, then the rate of hospitalization, and more importantly, the rate of deaths are higher among Black communities and brown communities. And we've known all of these things all along, but what the pandemic is doing is servicing in a different way and showing us exactly what's happening beneath the surface. And I think because people maybe have a different capacity to engage with all of this, it's coming out in a different light. And I think people are paying more attention, which is a great, because we need that attention. We need things to change, but it's always been there. This is not new. We're just seeing it in a different light.

Jennie: Yeah. And then inequitable access to care includes sexual and reproductive health care as well.

Dr. Kumar: Yeah, absolutely. So at Planned Parenthood, we provide sexual reproductive health care—we’re a leader in providing that care. And a lot of people depend on us. They trust us. They come to us knowing that we are able to provide that care. And also we are expanding the types of care we provide. So I'm a family medicine physician. I provide primary care here. And that's really based on knowing what our communities need. The people that we take care of absolutely have a need for sexual reproductive healthcare, including abortion, but also have other problems like high blood pressure. They need medicine for their diabetes and so much more, right? Colds and coughs. And we need to respond to that. And Planned Parenthood is doing exactly that. Some of our health interests have been providing primary care for more than 10 years. Some are a little bit newer, but it's all in response to what our communities need, what our patients need. And I think Planned Parenthood has done a great job at showing up and being responsible for that. And we're doing the best we can for the people who depend on us.

Jennie: So another area where you definitely see disparities and lack of access to care is talking about inclusive and culturally competent care for LGBTQ+ patients.

Dr. Kumar: Yeah, absolutely. So Planned Parenthood is one of the leading providers for LGBTQ+ patients as well, especially for trans patients. So one of the most recent services that we've expanded is trans care and specifically gender affirming hormone therapy for trans people and gender nonconforming folks. And I'm proud to be the medical director for that care here. And you know what I see in Texas and Louisiana, a lot of folks that have not been able to find a provider who offers this kind of care and will say that they, you know, were looking on the internet. Some of them have bought things to help manage their transition on their own simply because they haven't been able to find a provider. And so it's great that Planned Parenthood is able to offer these services for folks and that folks trust us for this. And, you know, again, when we think about all of the things that are happening in people's lives, accessing healthcare doesn't happen in a silo, right? They are having to deal with so much discrimination, whether it's homophobia or transphobia and accessing health care is included in all of that. People have anxiety about being misgendered or having their dead name used on their ID or perhaps their insurance card, or perhaps the provider just not getting it, or maybe somebody at the health center, you know, not treating them with respect. And at Planned Parenthood, we were lucky because all of our centers are very aware and keen on making sure we have a welcoming space for people that people feel comfortable in, that we offer our pronouns as well as welcome theirs and provide the care that people need. And we also elicit feedback. “What else do you need? What can we be doing differently?” And I think that's really important. And that is a type of partnership where we partner with our patients, we partner with our communities through various educational engagement and activities. And we try to show up for the people who need us.

Jennie: Yeah. It's so important to have places, you know, you can trust to get that care because recently there was the Supreme Court case where they ruled you couldn't be fired because of who you were. But the Friday before, there was also a ruling out of HHS saying that it expanded the rights of doctors and physicians to discriminate against people they provide healthcare to. So it's so important to have providers that the LGBTQ community knows they can trust.

Dr. Kumar: Yeah, absolutely. The Supreme Court has given us some good rulings and also some not so great rulings, but again, it goes back to how awful that, you know, people have to depend on the Supreme Court for their dignity, for their humanity and the court decides such basic things for people. And I think it's important to point out just the blatant disregard for human beings lives when they're not, you know, what other people have respect for, you know, and that includes trans people and all LGBT folks and so many other folks as well. Right? And I think a lot of the decisions point to that, and it's also, you know, again, the decision on job discrimination is great and I'm appreciative of it, but how unnecessary that we even have to like be thankful that, you know, we can't be fired from our jobs. Like that is such a basic right that we should have, but here we are fighting over several years just to have that basic need met. And you know what, it reminds me of the difference between survival and thriving. We're being, given the ability to survive, to work and not be fired from our jobs or to seek healthcare or not seek healthcare in this example, right? Those are all elements of survival and we're not able to thrive, unfortunately.

Jennie: That's all very true. So let's talk about what we can do. What are things that Planned Parenthood is doing and what we personally can do?

Dr. Kumar: Yeah. I think the first thing is to, you know, assess the status quo and be informed. I think a lot of this information, like I mentioned, especially coming from the court can be confusing. And I think a lot of us are now more engaged. And so staying engaged and being informed is one of the most important things. The other thing that I've been telling everyone to do is to center Blackness and that can happen in so many different ways and so many different spaces. So whether it's in your personal life or in your professional life, every space you navigate, every person you interact with everything that you're doing, I'm asking everyone that I know to center Blackness. When you look around and you see Black people, whether it's in your workplace, in your neighborhood, in your home, you know, your friend circle, your social media circles, whatever, everything you should analyze with a lens that says why aren't there more Black people here, who's being left out, and then expand that, why are there not more brown people? Why are there not more trans people? And what are you going to do to make a change with that? I think sometimes even though it seems simple to just call that out and name it, that's how you start. And it takes champions to bring that forward, especially in spaces where it can be a little bit more hostile to do that. And I personally, as a brown person, depend more on white people to carry that work forward. And I think that's very important. So one of the things that I think we can all do is to center Black people. [We should also be] showing up and doing the work that we need to do both internally and externally. Like I said, we're expanding a lot of the care. We provide health centers, whether it's trans care or primary care, where thinking about how we can interact with our communities in different ways, we are partnering with various organizations knowing when we need to show up and be present and join forces with folks. And also recognizing when we may need to take a step back and let others see, I think collectively we're all trying to go in the same direction and doing the best we can. That also requires that we take a moment to reflect on what we are bringing to the table and where we may be falling short and that we start working on that. So all of things are important, but I think it's most important in this moment to show up for Blackness and center that, and also to show up for trans folks, especially Black trans folks, and to center them in a lot of the conversations we're having.

Jennie: Great. Are there things, so you already kind of touched on this with, you know, looking around at your friend groups and everywhere you're going in, centering black people. Are there any other actions that listeners should be taking?

Dr. Kumar: You know, for abortion access, connecting with your local abortion funds and donating. There is always a great thing to do. People who need access to abortion oftentimes cannot afford it. That tends to be the number one reason why they have difficulty accessing abortion. So connect with your local abortion fund, work with them, volunteer with them. If they need you donate, if you can donate to Planned Parenthood, support the work we're doing as well, stay engaged. And you know, it's also 2020. This is an election year here in Texas. Right now we are in a runoff election… make sure you vote in your state when you're able to definitely in November. And it's not going to be immediate that we'll see change. Um, after the November election, if things go the way I hope they do. But I think that is also very important that we all get out and have our voices heard and make sure that we change the way things are and how they are now.

Jennie: Well, Dr. Kumar, thank you so much for being here and talking with us today.

Dr. Kumar: Thanks so much for having me.

Jennie: Thanks for listening everyone. And we'll see you on our next episode of RePROS Fight Back. For more information, including show notes from this episode and previous episodes, please visit our website at reprosfightback.com. You can also find us on Facebook and Twitter at RePROS Fight Back, or on Instagram at reprosfb. If you like our show, please help others find it by sharing it with your friends and subscribing, rating and reviewing us on iTunes. Thanks for listening.

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