Not Everyone is Impacted Equally by Abortion Bans-- Dobbs Made it Much Worse

People’s ability to access healthcare and achieve positive health outcomes should not depend on who they are, but unfortunately, and all too often, it does. In the United States, this is particularly true for Black, brown, Indigenous, and low-income individuals. Abortion is healthcare, and it is just as difficult to access for disproportionally impacted people as other forms of healthcare. Liza Fuentes, Senior Research Scientist with the Guttmacher Institute, talks to us about health inequities in the current healthcare system and how abortion is unequally accessed around the country

 Even before Roe v. Wade was overturned, there were health inequities in abortion care, which has been true since the founding of this country. Resources that people need to decide if, when, and how to become pregnant and give birth include safe and affordable housing and communities, food and living wages, health insurance, and other elements of reproductive justice. Health disparity data exists mostly for Black, brown, Indigenous, and low-income women, AND it is important to note that anyone who cannot realize their sexual and reproductive health care—including transgender folks, non-binary folks, people living with disabilities, and young people—will then have disparate access to resources, services, and family planning care.

This translates into abortion restrictions. Almost 70 abortion clinics in the U.S. have closed since Dobbs overturned Roe, mostly in the South and Midwest. Thousands of people are now in a position where they have to spend thousands of dollars to leave their state, or self-manage an abortion in their state, or continue their pregnancy.  Those who are still able to get an abortion in these states include those with high incomes, with access to the most resources (including credit cards, savings account, support systems, time). What are the social identities that define the spectrum along which that money is distributed? Age, class, race, disability, immigration status, and income. The Hyde amendment, one of the most pervasive, restrictive, and disruptive amendments to abortion care, targeted low-income women outright.  

There are a few examples of protections post-Roe. Many governors and state legislatures—including Illinois, Oregon, New York, and Connecticut— have incorporated abortion rights at into the state constitution. Cities and counties are carving out budgets for abortion access, and even providing medication abortion in public health clinics and departments.

Links from this episode

Guttmacher Institute on Facebook
Guttmacher Institute on Twitter
Inequity in US Abortion Rights and Access: The End of Roe Is Deepening Existing Divides
Keep Our Clinics
Plan C
Abortionfinder.org
Ineedana.com
Repro Legal Helpline
Repro Legal Defense Fund
Digital Defense Fund

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 pronouns are she/her. So y'all, this last week, I've been a little bit on the struggle bus. I just, you know, I feel like I've talked about this before on the podcast. I have like these inner hecklers, this is like how my imposter syndrome anxiety, I have like these inner hecklers, honestly, I view 'em as like Statler and Waldorf in the back of my head who are all, you know, “you're not good enough, you don't know what you're doing,” blah, blah, blah. All the, all the normal, stuff right? Usually I'm pretty good at just like ignoring them and drowning them out. Uh, but, but the last week for some reason they were being extra loud and annoying and were getting to me. And so it was a little bit of a struggle. Um, now when I'm, when I'm talking about this, I'm actually doing better. I, it was just a rough week and, you know, I just really tried to be open about these things. Cause you know, I know I'm not the only person who goes through this. And, and I know we all struggle at times and, you know, it's nice to put it out there once, so you know, you're not alone. And it, it was, it's always nice. And, you know, I definitely had friends who I, I tweeted and I was just saying, “you know, Statler and Waldorf are being, you know, extra loud right now and it's distracting and, you know, the, the messages of love and support are always helpful.” And they, they came just when they were needed. And I just, yeah, I was, I was on my way out on my way through at that point and it was really great to have people being like, “no, seriously, they're, your, those voices are just being mean like, just ignore them, tell them to go touch grass.” And it, it was helpful. And I am just really grateful for my support system and for just like all of my great friends, cuz I, I just needed that little bit of like, “dude, you know, those voices are being ridiculous. Come on.” And I do know those voices are being ridiculous, but sometimes they get loud and a little distracting. So I think I might just kinda end it there. I have kind of a long interview this week. Um, it's really amazing. But it's, it's a little long cuz we just had a lot to talk about. So let's go ahead and turn to the interview. I had a wonderful conversation, um, with Liza Fuentes at the Guttmacher Institute. I have her on to talk about this great new, uh, uh, paper she wrote talking about inequity and abortion rights and access and that how post-Dobbs, that's only getting worse. And it's a really wonderful conversation. I hope y'all enjoy it. Uh, so here is my conversation with Liza.

Jennie: Hi Liza. Thank you so much for being here today.

Liza: Hi. Thank you so much for having me on the podcast. It's really exciting to have this conversation. Um, even if a little grim at the moment.

Jennie: Yeah. Uh, we're recording this right after what would've been the 50th anniversary of Roe. And so it's kind of a heavy time to like think through all of the things at the moment.

Liza: Yes, for sure. I mean, yesterday it was just like a Sunday, I was doing my laundry, working out and just thinking about what people in this country would've been thinking 50 years ago. And yeah. Um, what a difference it made for pregnant people, anyone who could have become pregnant at that time, people who had recently had abortions and how much things have turned around. But also there, there are many ways in which, you know, the landscape for abortion access is quite different. Uh, but as we'll talk about the bigger infrastructures, the bigger structural determinants of health that organize, you know, the privilege of healthcare access in this country. Many of those things remain the same. And I think those are, that's an important narrative and facts to dry out if you wanna continue to protect and advance abortion rights.

Jennie: Let me catch myself before we get like, too excited and get talking. Do you wanna take a second and introduce yourself and include your pronouns? Because I have definitely done that before and forget to have people do introductions.

Liza: Thank you very much. My name is Liza Fuentes. I'm a Senior Research Scientist at Guttmacher Institute, and Guttmacher Institute is a nonprofit organization based in New York City and Washington DC. Um, and we work through, public health and social science research, policy analysis and public communications to advance sexual and reproductive rights in the United States and really throughout the world; really taking the perspective that understanding people's experiences and, um, looking at the science and facts around reproductive health is the key basis for forming policy, and my pronouns are she/her.

Jennie: Thank you. Yeah. Y'all are always my first go-to when I need some factoid or data or any number of things. Like Guttmacher is the first people I turn to.

Liza: Well, I'm really glad to hear that. And it we're very thrilled to, um, be of service to, you know, our colleagues in the movement who are really building so many of the arguments and doing so much of the organizing and storytelling around the key issues that we work on.

Jennie: Okay. So let's turn to this amazing paper that you just put out talking about inequalities and inequities in, um, healthcare and an abortion specifically and how the loss of Roe is gonna exacerbate them. So maybe let's start at the very beginning cuz it is, it's a lot. And talk about some of the existing inequities in abortion access?

Liza: Yeah, well that's, uh, that's an important point to start at because I think if you're someone who really wants to understand more about what it means to overturn Roe and what we're looking at in the future, you might be looking around, especially social media or even the news and, um, see that people are talking about how the overturn of Roe is gonna disproportionately have negative effects on certain communities, certain groups of people. And, you know, for anyone who tracks health inequities and disparities, you know, that's like really what we're talking about when we talk about health inequities. That health access to the resources to take care of oneself, to access healthcare. And then those health outcomes are not the same for different groups of people. And in particular in the United States, we often are talking about race because race and racism is such an organizing principle of privilege in society. Um, and we talk about income and wealth because access to those types of material resources are directly needed to access healthcare. So, you know, just to get to your question, I wanted to give that background, right. Abortion is, is not different.

Jennie: Super important context.

Liza: Yeah. Abortion in, in many ways is not different from how we understand how health and wellbeing get distributed in society. Um, along lines of system is oppression like racism and classism. The first thing to know is that even before Roe was overturned, we had inequities in abortion access. Not everyone who needed abortion care, or let me back up even further. Not everyone, which who needs to be able to plan if, when and under what circumstances to become pregnant and have children have the same resources to be able to do that. And that's been true for, um, since the founding of this country. But understanding how that gets embedded in the way abortion access manifests, sort of one of the motivations that we had written, you know, the very, very first thing is what are the resources that people need to decide if one, and how to become pregnant and give birth. And you know, in the paper we highlight a couple of really primary examples. Um, but, you know, any range of things including safe and affordable housing, you know, communities that, where people feel safe, where they have the resources to be in community, right? Spend time together safely, you know, be able to access food and living wages, you know, where they live. All of these things are foundational principles for general public health and the concept of reproductive justice, right? Which, you know, is this really invaluable framework that frankly Black women scholars and activists have been using for centuries in this country. But the term that came about in the nineties was that simply accessing contraception healthcare is not adequate to describe the ways that our social structures are harming and failing to serve the health and wellbeing of communities of color, and particularly women of color. And so when we talk about reproductive justice, we talk about the foundational inequities, um, by which people don't even have the ability, or at least the full ability to be able to decide, you know, if, when, and how to become pregnant. We only, we highlight a couple of really key things that really have to do with healthcare access. So number one is income. And, you know, that might seem obvious, you know, different people have different incomes cause we have different jobs. But, there is an economic justice framework that we have to look at, which is that there is a profound wage gap in this country by race and gender. And at the intersection of race and gender, we know that Black women and Latinas in particular earn wages that are half that of white men. So on the face of it, but we know that things like healthcare services, contraception, contraceptive devices and methods cost money. Um, we see that women of color are already in a position where they simply don't have the same level of resources. Income is just one example. And then we get into health insurance. Why does health insurance matter? Well, health insurance really is the dominant way that people access healthcare in the United States of which family planning, contraception, abortion, and abortion, you know, are, are part of those healthcare services. And women, and particularly Black and brown women are much less likely to have any health insurance coverage at all on the order of almost 50% to almost two times the proportion of white women that don't have health insurance. [A large] percent of Latinas have no health insurance. 13% of Black women in this country of reproductive age, have literally no health insurance. And, um, we're talking about when we're 12 years out from the Affordable Care Act, which profoundly expanded healthcare access to many people, we still are living in a country where those gaps exist and that their, the burdens are falling on, on Black and brown women.

Liza: So then you just have a landscape where reproductive of health from the very beginning, right, sexual health is not enjoyed at the same level by different groups of people. And that background I'm talking a lot, is important. Cause the question often comes up about inequities in abortion in particular, people are incredibly interested in this as they should be, right? Because first of all, we know historically that even when abortion is highly restricted, um, wealthy people, frankly will always get abortion care. This is really well documented. And so when we talk about restricting abortion, including banning abortion, we're not really talking about taking away abortion access for an entire population. We're not really talking about a country coming together on a cultural and moral level and deciding that this is what we want. What we're talking about is carving out a world for people who don't have as many resources to be struggling to access abortion care and getting abortions later, or being denied abortion care. Whereas wealthy people will always get that. And we know that that's the case. So the key part of this background is this, that for the very same reasons that, uh, particular communities in this country, you know, and in the paper we highlight, um, Black and brown women, indigenous women and people with low incomes because we have the most data about those communities. But it's important to note that anyone who is denied the right the dignity, and the resources to take care of themselves, take care of their sexual work of health, including trans people, non-binary people, people living with disabilities, young people, anyone for who they are in this world interfaces with a policy that says you don't deserve to have the same rights and privileges as other people are going to be in a very particular bind. Which is we don't have the same access to resources and services to be able to plan whether or not we wanna be become pregnant and have children. And at the same time, uh, we also, those same lack of resources make abortion inaccessible, right? So we may be more likely to need abortion, but at the same time, we may have greater burdens in accessing it, which means further delays in abortion care, abortion later than we wanted it or maybe denied abortion care at all. And it's a wordy way to pull together a picture that a lot of people have a lot of questions about, which is, if abortion rates are higher among Black, indigenous and Latina women, um, how can we say that they have less access to abortion? Cause you have to look at the context in which the resources, the privilege, and the dignity to decide about pregnancy in general and parenting in general are informing the story of being able to prevent pregnancy and obtain an abortion.

Jennie: Yeah. I feel like a lot of anti's interest in that data point really stop is like they get more abortions full stop, and there's no like questioning of the like, okay, well they have less access to contraception or more effective methods of contraception, or they don't have access to healthcare to even think about crossing that next step. They don't like take it back to the beginning and see how all the inequities started way before that moment.

Liza: Precisely. I mean, certainly not, and I'm not an anti, so I can't necessarily speak to motivation, but what I can say is that the fundamental obvious glaring gap that, that they have to leverage to even able to tell that story is for the dignity, autonomy of the person themselves being the central metric of whether or not their wellbeing is being served. Right? So it's easy to say that, okay, you know, abortion rates are higher among Black and Latina women. And then spin really sort of tales about what that could mean, including, you know, really horrific things like thing that Black and brown women are targeted for abortion. But if you bring in the stories and the voices of people for whom they're making decisions about their body, that kind of, it doesn't, it doesn't really hold water, right? Everyone should be able to decide for themselves with no coercion, whether or not they wanna become pregnant, and if they're pregnant, whether or not they want to have an abortion. But simplistically taking something like, you know, abortion rates, um, by race or by any other group of people and telling any tale about it without understanding the bigger picture, means that, you know, the humanity of the people we're talking about who, who, who represent those rates, um, has to be erased. And that's what I think they're doing.

Jennie: It was also interesting, you, you know, you brought up, um, coercion a little bit in thinking of another data point you talked about was more Black and brown people being pushed into using birth control or different methods of birth control. And like that is also a form of reproductive coercion that is, um, put on that community.

Liza: For sure. I mean, again, to that point, I think even further that maybe we could have gone further in this paper, but we had to kinda, you know, make it readable within 15 minutes. Is that certainly, um, many people are pretty familiar, especially, you know, who pay attention to these issues on the, on a daily basis, are pretty familiar with well documented cases of immigrant women, brown women, Black women being subject to coercion around contraception and sterilization. And that's not, but those are not simply historical, right? We can't say, “oh, you know, in the seventies, Mexican immigrant women were coerced into accepting sterilization and cause we know about that, it's giving us insight into how we should behave today.” That's not really, um, the way to look at it. What we know is that throughout the history of the United States, Black women, indigenous women, immigrant women, disabled women with living with disabilities have been subject to coercion in some cases forced use of contraception and sterilization. And when we look at the fact that we are now providing healthcare in a system that was built on the belief that for some people they can't be trusted with decisions about their body, that helps us understand why total bans on abortion are being accepted today and being advanced in the United States, right? The underlying belief that some people, some human beings who may become pregnant before are pregnant, do not have the same level of humanity, dignity, and right to make a decision about whether or not they should become pregnant. That's a through line, right? You can't simply separate it out. And that's also what we kind of try to highlight in the paper. You know, contemporary public health, social science, and medical research have shown that the experience of Black women, immigrant women, Latina women at, at the clinical encounter, you know, today in recent times also includes being given advice, being encouraged, being directed towards either not becoming pregnant or certain types of contraception. And based on really a system of organizing society in which social problems are conceived of as being really born of Black and brown women, right? And clinicians are not, um, exempt from those embedded beliefs because they were also born and raised in the same society. And we have to highlight those realities if we wanna understand what it would take to protect and advance abortion rights. Because all reproductive, all reproductive coercion in this country, and, you know, writers and scholars like Dorothy Roberts have said this, all reproductive coercion, um, has to be seen from the lens of, to advance white supremacy. Not just misogyny and sexism, reproductive coercion, gender oppression you will absolutely fail to comprehend and therefore address the way that reproductive coercion works in this country, right? Certainly, white women in many ways are collateral damage of policies, both informal and formal to control the reproduction of Black and brown bodies. White women are subject to coercion based on their whiteness, right? We hear about white women being denied sterilization, for example. Maybe they'll regret it. That bigger picture is the foundation for understanding, um, why we have abortion restrictions in abortion bans and why they fundamentally, people have stickers now, oh, “abortion bans are racist.” It's a soundbite that makes sense to people who've who, who sort of lived the racism of abortion bans. But for someone who thinks, “oh, abortion's, you know, not about race, abortion's, you know about pregnancy,” you have to understand the history of this country and the, the ways that reproductive coercion is actually the tool of maintaining white supremacy. If you wanna understand the motivation behind things like abortion bans and also the effect that they'll have on communities…

Jennie: Oh yeah, that's like the most perfect segue ever into, um, the inequitable effects of abortion restrictions. You know, you really talked about it, the abortion bans are racist campaigns and like trying to make, get people to understand that point. So let's dig into a little bit about how there are inequitable impacts that we are seeing.

Liza: I think now we're at like 12 states have banned abortion outright completely. Another couple have banned abortion at six weeks pregnancy, or more or less at six weeks pregnancy, which is before many people know that they're pregnant. And I'll just note before I talk about the inequitable effects, just the immediate landscape is that almost 70 abortion clinics in this country have closed in in the past six months. You know, we calculated in first 100 days after the decision that overturned Roe, 66 abortion permits closed in this country. So we have thousands of women in this country, thousands of trans men, non-binary people, anyone who could become pregnant are now in a position where they either need to spend thousands of dollars if they have it to leave their state they need to. Or if they cannot do that, they can try to still obtain an abortion where they live by self-managing their abortion, or they can continue their pregnancy if you, if you, we have to start with that is the option that is the scenario here, right? And for some states where abortion is banned, we're talking about traveling hundreds of miles, right? Thinking about, think about living in the middle of Texas, the middle of Mississippi states, where every other single state around you has also banned abortion, right? This isn't about going over to the next state or crossing a state line. This is traveling across multiple states, right? That takes number one and foremost time and money, right? In this country we have a network of abortion funds and practical support networks that are doing unfathomably effective and heroic work, connecting people to resources to be able to travel. And in fact, I've been doing that for a few dozen years. Obviously they've had to, um, scale up. And so their existence has maybe mitigated the impact for some people. But, you know, we're talking about the entire population of entire states having no abortion access. They're not going to be able to meet the needs of every single person. So that's the scenario. Then we can talk about the inequitable effects, right? Who is gonna be able to still get an abortion in those scenarios? We're talking about people who have the most amount of resources, right? A lot of, you know, high incomes and not just a high income. Many people with, with jobs are still living paycheck to paycheck, right? We're talking about having access to the types of resources, um, that really only the most resources people have. We're talking about credit cards, we're talking about savings accounts, we're talking about people in your life that can also have access to that kind money and lend it to you. We're talking about time, right? If you live in Texas and you have to go across two or three states, we may be talking about two days, three days, four days a week, two weeks where your life is on hold cause you have to travel, stay overnight somewhere. And then what? Find someone to keep your kids, right? The alternative in, in a world where abortion is a normal part of everyday healthcare is maybe you have an appointment for an abortion, you need a babysitter to watch your kids for an afternoon. That's appropriate. We're talking about finding someone to watch your kids for a week. There are very few people in this country who have somebody in their life who can drop everything and watch their kids for a week, right? We're talking about an extraordinary amount of resources that it takes. So right there, the inequitable effect is that really, you know, wealthy people are gonna be able to still get abortions, you know, and, um, people are living paycheck, struggling to make ends meet, or frankly are just regular middle-class people at this point, right? We're talking potentially thousands of dollars. So we're already talking about the difference between someone being able to get timely abortion care and someone who's gonna be severely delayed, therefore have to have an abortion later, which then costs more money.

Liza: And even though abortion is incredibly safe, safer than childbirth at any stage, still being delayed in having an abortion is not high quality care. There's still added risk the further along you are. And frankly, why do we live in a place where people are forced to become, be pregnant longer than they have to? Right? And then the question is not just around who has money, but what are the, what are the social, you know, identities, the systems of oppression along which that money is distributed. It's a long race class, age. So young people might, you know, people who are under 18 and, um, people living with disabilities, immigrants, people who are already living in a world where they're not being paid what they, what they're worth for their work, who find discrimination in the healthcare system on the day-to-day basis anyway, and may have fewer resources to be able to connect up to the types of transportation appointments that it takes to get that appointment, right? And so what we're gonna see is, and I, for, for anyone listening already, is working in abortion funding who's already working in reproductive health in these states, you're already seeing it, right? People for whom even before Roe abortion was difficult to obtain are gonna be even more delayed and more people are gonna be forced to continue their pregnancies. And for people for whom before Roe was overturned, they were barely able to get the abortion they needed, now it's gonna be outta reach, right? So there's more people for whom this is gonna be a problem. And you know, we, uh, this might be something that you might get at in your next question, but, you know, what does that mean for somebody for whom now abortion is simply outta reach? The resources aren't there, the money's not there. The social support is not there. The time off of work someone keeping your kids, what are their options? Their options are that they'll be forced to continue a pregnancy that they don't want, that they've made the decision is not the right choice for them at this time. Or they might think about self-managing their abortion. And in most states, technically self-managing an abortion is not illegal. It's very safe to self-manage an abortion with mifepristone and misoprostol. But as people who, if people who are choosing to self-manage their abortion are also people are doing so, cause they don't have the incredible amount of resources it takes to leave their state, they may be more likely to be targeted for involvement with law enforcement because they don't have as many resources to deal with law enforcement, right? So it's a perpetuating cycle where we really are having two worlds for abortion. I mean, it's always been that way in the United States, and now it's even worse.

Jennie: Yeah. It just feels like it's magnified by so many degrees where it's just so much starker that I think, you know, if you worked in repro or worked in abortion like it, they were inequities. You saw and knew and understood. And now it's just like on such a larger scale that it feels like, like the broader world is starting to pay more attention than they were before when it was just like a repro conversation. Now it feels like it's getting bigger. Or maybe that's my bubble of, I'm like in all the repro threads and streams and, and whatever, but it feels like it's getting talked about in a different way, which is just like a great kudos to like all the repro justice advocates who have been doing the work to make those stories better.

Liza: Oh, I, I completely agree. I mean, there's two sides to that. And the one side that you're, that you're talking about is for people who, for whom it, you know, Dobbs maybe sounded the alarm in a way that, you know, all the decades of, of attacks on abortion before didn't. It's really reproductive justice organizers and advocates who have been doing these decades of work, so that when those people, for whom June, 2022 was like the, you know, “oh crap “moment that when they went to go look for stories, resources for understanding of the issue, those materials and resources and, and narratives were there. That's invaluable and incredibly, um, important, right? And that's organizing, right? Meet people where they're at and then bring them in as you can and cause of the repro justice movement, we, we've been able to do that. I will say though, on the sort of, to try to understand how we got here a little bit, is that that sort of incremental worsening, I guess that you talked about, it's on purpose, right? We go back to the Hyde amendment, which is famously talked about really as the first, you know, post-Roe abortion restriction. The Hyde amendment is added every single year into the US budget. Um, and it's a bipartisan, it was a bipartisan effort up until Joe Biden ran for president, right? Everyone agreed that that was gonna be the status quo. That we were gonna have a national law saying that people who are entitled to Medicaid, whose health insurance is Medicaid, can't use their health insurance to cover abortion, right? So abortions are right under the constitution, but it doesn't have to be realized, right? Because we're taking away your health insurance from you. My colleague Heather wrote about this over a dozen years ago in an article where she highlights how we get to a place where all of a sudden people who didn't think that abortion was their issue are really alarmed because their rights are being threatened, right? Abortions now abandoned in their state. Well, Henry Hyde said when he proposed his amendment that he would like to stop anybody from having an abortion, but unfortunately, or fortunately, targeting poor women through what was the only vehicle that he had the moment, right? The very first abortion restriction post-Roe was targeting people who had the least amount of resources and the least amount of political capital to fight for their rights. And every single abortion restriction since then has followed that same path, right? Until the antis have built the political will among elected officials to make it seem reasonable to then just go for the whole thing. Right? Thinking about, you know, Indiana, the first state to pass an abortion ban after Dobbs, um, their, their Supreme Court heard arguments, uh, a few days ago about whether or not, you know, abortion was protected by the constitution. That didn't happen overnight. Abortion, uh, Indiana has been, um, drastically, severely advancing multiple abortion restrictions that are medically and necessary and completely for decades, right? And each one seems a little bit reasonable because it kinda is like, “oh, we don't want, we don't want taxpayer funding for abortion, we don't want abortion that's too far along in pregnancy. We don't want like young people to get an abortion.” All of these carve outs that make it palatable for people to accept. And the ultimate one that we're seeing now is these exceptions to abortion bans that in the United States. I wanna acknowledge that exceptions to abortions have two sides, right? In Latin America, we've seen these exceptions be used to advance abortion rights. So in countries where abortion was completely banned, introducing exceptions to bans like life and, um, health of the pregnant person have actually been tools to expand abortion rights. But in the United States, it's the opposite. Abortion exceptions to abortion bans like life, health of the mother, and all of those sorts of things, um, are used to make abortions politically palatable. And we have no evidence that they're used in real life, right? The New York Times wrote about this last week, but there's been, you know, articles about this, um, for a couple of decades that what it takes to actually get your abortion covered by your Medicaid if you've been raped, what it actually takes to get an abortion if your life is in danger in practice, is, um, nothing short of heroic and many times impossible. And so this idea that now people are becoming more aware that abortion is, like a bans on abortion, fundamentally put at risk the health and life of pregnant people and really place into question anybody's right in this country to be able to care for themselves in the way that they is best. Um, is, has been possible and predicated on the idea that for some people in some circumstances, it's not as important for them to be able to decide to get an abortion.

Jennie: I think the other tool they were really effective at for a really long time was introducing a what was a wild way to ban, which is now our reality, but like, whatever, like the quote unquote heartbeat bans, the, the like six week bans and like outrage would come in from all corners and they would not, they'd be like, “okay, we didn't pass that bill” and then quietly slip through a 20 week ban or a 72 hour waiting period. And then you wouldn't really hear much about that because they didn't do the like wild out there one, they, they did like the “reasonable” one.

Liza: That is absolutely the, the, the story. I mean for, you know, some of my colleagues worked on, you know, some of the, the early the heartbeat bills from like 10, 12 years ago, and at the time they were framed as sort of being completely absurd that even the, even the antis could agree on it cause they were right. No, they didn't, they didn't agree on it. That was sort of right, the right flank strategy. Then introducing a 20 week ban seemed pretty reasonable, right? And one thing I'll highlight is that a vision for what it means to be able as a person who could become pregnant to really decide, you know, if I wanna be pregnant, um, if I wanna continue my pregnancy, if I wanna parent, um, really centers my health and wellbeing, the health and wellbeing of people who could become pregnant. The only way to get there is through a reproductive justice practice and framework and understanding of the world, right? Because from a reproductive justice perspective, none of this is reasonable, right? Because two things. One, if we understand that power is central to what it means to restrict control coerce and decide whether or not to become pregnant, you know, how I wanna move through this world and my gender, that's about power at the social level, right? It's about maintaining supremacy in the patriarchy. If you fundamentally understand that reproductive coercion and restrictions are in service of that, then there is no reasonable ban, there is no reasonable carve out because they all serve the same purpose, right? Which is to advance oppression and take away the dignity and humanity of people who aren't white men, frankly. Right? If you wanna debate abortion on these intangible terms, you know, that frankly are, should not be legal issues, right? Whether, how comfortable people are with abortion, whether they think it's right or wrong, people have many diverse views on that. Uh, but when we're talking about what should be the law, like what are we gonna punish people for? What are we gonna allow people to be in community, build the families that they want? None of that really comes into play because the data are there and people's lived experiences speak for themselves. But the debate, I don't even know if it's a debate, I'm a scientist, but, you know, the justifications I will say upon which we got to Dobbs have fundamentally left out the human beings whose lives are at stake. And in fact, anyone wants to go back and look at the arguments and the Dobbs decision, the amount of time spent talking about, yeah, the desires, health, safety, humanity of pregnant people is minuscule, almost none, except for when Amy Coney Barrett talked about how safe haven laws take away the burden of parenting was really such an impoverished conversation when we think about what it means to be a pregnant person in this country, especially if you're Black, brown or an immigrant.

Jennie: Okay. That's all really, really heavy and it's all really heavy right now. So maybe let's talk a little bit about some of the things that have been happening to protect abortion access post Roe. Because there are, I mean, again, everything is terrible and it feels really terrible, but there are some like little bright, uh, bright might be a big word. There are a little spots of light of things being done.

Liza: Yeah. Things are heavy. Cause banning abortion is completely retrograde, but I’ll put into context is that was the plan all along, right? The movement to decimate abortion access has always planned to ban abortion and they plan to keep doing it. Even they wanna introduce a national abortion ban. So yeah, while grim, this is something that has been well documented and that's their goal. You know, something that will help us continue to organize, continue to move towards justice, continue to lead with love and human dignity, is knowing that that's actually their goal. And there is no common ground. There's no common ground, right? That the goal is to ban abortion completely. It to the extent of putting people in jail. So if you accept that that's the case and that they will not stop until we get there, then we can back out and say, you know, where are we really building the communities and the, um, the political will, the understanding that doesn't allow that to happen, right? That's how I feel about it. And we have so many great examples. First of all, many state governments and governors and legislatures have stepped up again because for the, in the decades before Dobbs came along, um, organizers at the state level have been talking about protecting abortion rights in their state constitution for a very long time, right? This wasn't just a brilliant idea that popped up cause of Dobbs, people have been doing this, people have been, have been writing these bills and trying to interest them for a very long time. And we've seen so many states now, um, really step up and protect abortion rights at the constitutional level. I don't even think I know what they all are. Certainly we're talking about, um, Connecticut, New York, Illinois, Oregon, and even in some of those states like New York, people are saying, “okay, that first go around was great. We can take it further, right? We can really, you know, revisit even the protections we have and make them even stronger for people at the state level who are organizing around these things.” Minnesota, they brought a, a case to their Supreme Court. Every single abortion restriction was overturned because the judge said, this is not, this is not protected in our constitution. And now they're trying to codify by introducing, um, an actual law. And this is incredible and super important. I also wanna highlight that like people are protecting reproductive health rights and justice at the community, even at the community level, right? We've seen states including, uh, we've seen cities and counties including in Texas, say, “okay, in, in this town we are going to carve out a, a budget for people to be able to access abortion, whether it be for transportation or an abortion fund.” And then something that I, you know, have been thinking about for a long time, and I wrote a paper with some colleagues from UCSF about this, is that abortion is healthcare. Yes. We, we, we know that abortion is central true act of justice, but abortion is also central to public health, right? I'm a trained public health scientist and professional, um, and the idea that abortion is not considered a central public health service is not based in evidence. And, you know, we advocated that departments of health should be providing abortion care just like they provide STI testing and treatment in many places. And some, you know, pregnancy testing, you know, in some cases prenatal care. And in fact, public health started out with helping pregnant women, you know, over a hundred years ago in this country. And now we see that New York City Department of Health and Mental Hygiene has started providing medication abortion for free as part of their services. And that's amazing. Um, I think they should be, that should be considered pioneering leader that other departments of health can look to, to be able to ensure that they're delivering the full spectrum of public health services, but they're a leader in the fact that they actually did it. The, the sort of the evidence and the framework for saying, you know, should public health departments be providing abortion has been there for a very long time. So all that is is really exciting. And I think, you know, for people who are feeling like, “geez, you know, I I can't influence the Supreme Court, right? Can you really even influence the Supreme Court in your state? “You know, except for potentially, you know, signing some things, but as an individual it can feel very overwhelming, but it's very likely that in your community, people are thinking of really creative ways that center the humanity of pregnant people to be able to ensure that abortion access is there to the extent possible.

Jennie: And then just as a Wisconsinite, I will throw in, there is a Supreme Court justice election in Wisconsin in April. So there is something you can do and you can still…

Liza: …that's amazing.

Jennie: So make sure to vote in April for, uh, Supreme Court Justice, which in Wisconsin is huge for abortion access right now. So make sure you are, there are still opportunities to make. That's incredible. I can't remember the exact date though, so sorry.

Liza: Well, you can put it, put it on the website. Yeah, I mean, yeah, I just read that. Um, not to, this is not me parroting, you know, a very, um, soulless talking point of the Biden administration, right? Like obviously, um, what politicians decide to do about abortion access is not my expertise. I'm a researcher. I evaluate the policies and people's experiences with abortion, but one thing I've noticed just as a citizen is that cause of where we're at, people are running on this platform, you know, in Indiana, a place like we just said, where the very right to an abortion is in play is, you know, people are jumping in their race or senator and they're talking about abortion as central to what their vision is for the state. And so for better or for worse, depending on how empowered people feel voting is actually gonna matter, um, in your communities. And that Wisconsin is an important example.

Jennie: Okay, well, I could absolutely talk to you forever, and this has been really fascinating. We should probably wrap it up so I can be cognizant of your time, but we always like to ask what can our audience do? We talked about one, you can vote in Wisconsin still, but what, what can our audience do right now?

Liza: I say this every single time cause it's so immediate and so tangible is you can donate to an abortion fund, abortion funds, uh, and practical support networks, which are organizations that help arrange people's transportation, are really making abortion access real in this country right now, really real and amazing things are happening because the reproductive justice movement in particular has never faltered from its vision. And then you have Guttmacher Institute, which can bring the data and the facts if you, you need them and you know, people do need them, but there's the sort of the bigger picture of like, what's the 10, 20, 30 or 100 year vision? It's abortion access for anyone who needs it, you know, and it's timely manner for free ideally. But we know that today, literally today, somebody is struggling to access abortion care because abortion is banned in their state. Um, or there's tremendous restrictions. And every single time you donate to an abortion fund, you're making abortion access real for somebody. So you can go to nnaf.org and you can actually just search your, you can donate to an abortion fund where you live. You can donate to an abortion fund, you know where your best friend lives, if they live in another state, you can donate in their name. It's really, um, a really important way for people to come together and help each other, right? It's mutual aid. It's not charity. It's really building power around, around abortion access.

Jennie: Yes. And a lot of abortion funds have a really amazing merch you can buy. Um, I'm actually wearing one right now from, I can't remember where it’s from, sorry, y'all, I think it's from maybe the Tea Fund in Texas. I feel like, don't quote me on that.

Liza: Merch is amazing, but it, you know, know if you have a t-shirt or a fanny pack or a mug, you're also taking part in shifting the culture around abortion and saying the word abortion, the idea that abortion is sort of should be rare or that it's an unfortunate thing that's necessary. Saying that you're pro-choice, you're celebrating Roe without talking about abortion. You know, I think that that the, um, analysis that a lot of reproductive justice advocates have brought around why that's problematic deserves to be really heard out, right? Certainly, you know, I'm not a comms professional. We can tailor our messages to people so we can meet them where they're at, try to understand what about this issue matters to them, but avoiding, um, the term for that reason when really what we can be doing is normalizing abortion, right? You know, at Guttmacher, my colleague Rachel Jones, who's the principal investigator of a lot of our abortion work, you know, she's, um, updated these, this for these data for a long time. One in four women in this country will have an abortion in their lifetime. And we say women because we use census data, but it's a proxy for anyone who could become pregnant. Abortion is super normal, right? 60% of people having abortions are already have already given birth. And for many people, um, their experience with abortion and their story is a super important part of, you know, how they come, how they came to become a parent, how they came to understand what their values are, how they relate to their partner and their families. And I just really think like when you buy abortion fund merch, you're drinking outta your abortion mug, you're wearing your abortion shirt, you're, deciding what you want the culture and values to be where you live among the people that you care about, um, and in the country that you live in, which is that abortion is a, is a really important and in many ways wonderful part of being able to take care of ourselves.

Jennie: Well, that is the perfect place to stop. Uh, Liza, thank you so much for being here today. I had so much fun talking to you about, really important but terrible topics,

Liza: That's a good way to put it. Well, thank you so much for having me, Jennie. And I know I talked a lot, but there's just so much really, there's so many important ways to relate and think about abortion beyond, you know, just the headlines. And I really appreciate you giving us a chance to, to go there.

Jennie: Okay, y'all, I hope you enjoyed my conversation with Liza. I had a wonderful time talking to her. I could have talked to her for hours. It was so wonderful.

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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