Sexual and Reproductive Health and Rights Hero Origin Stories: Round 4

It’s that time of year again—time to tune in for a reprisal of our most popular series! Longtime supporters of rePROs Fight Back have likely heard our past podcast episodes, SRHR Hero Origin Stories, SRHR Hero Origin Stories: Round 2, and SRHR Hero Origin Stories: Round 3, where we talked to a number of amazing heroes in the field of reproductive health, rights, and about how they began working in this space. This time, hear from abortion and sexual reproductive healthcare clinicians and providers themselves about their experiences and history working in this field.

Guests include:

Rae Pickett, Director of Communications - Virginia League for Planned Parenthood

Dr. Jennifer Chin - Fellow with Physicians for Reproductive Health

Dr. Christina Bourne – Trust Women Wichita

Dr. Toni Marengo – Planned Parenthood of the Pacific Southwest

Dr. Deyang Nyandak - Fellow with Physicians for Reproductive Health

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 yeah, I cannot believe that next week is Thanksgiving. I'm not really sure where honestly, where this whole year has gone, but like I was looking at my calendar and like looking through now to the end of the year. And like, it is just shocking how fast the end of the year is coming and all the things I need to get done before the end of the year. Oh my goodness. Okay. Deep breaths, deep breaths. So much happening. I am not traveling again this year for Thanksgiving and that's okay. I don't always, I don't often, go home for Thanksgiving-- every once in a while, since I've moved out here, I will, but more often than not, I don't. So that's a little bit of a bummer, but you know, hopefully, maybe for Christmas, we'll see. I think one of my favorite things that I miss out on not going home for Thanksgiving, I think I might've talked about this on here before, but I'm not a hundred percent positive, is so my mom's side of the family is ginormous. I don't know if I have talked about that. Um, my mom is one of 11 children and so my aunts and a number of my cousins all get together on the Saturday after Thanksgiving and we bake like a literal fuckton of cookies, like so many Christmas cookies. Y'all, there just so many. And I just, that's the one thing I miss about not going home. I mean, not seeing my family, but like not being able to do the big cookie day. So even though I'm not able to go, my mom always makes sure to grab, put together a box of my favorites for me. And that always makes me happy and I would always take them in to the office to share. Cause she always sends way too many, which is always delightful. And yeah, I'm going to miss that, but that's okay. I just, wasn't going to work out this year. I am hopefully going to be getting my booster. I have an appointment for, I think December 2nd to go get a Moderna booster, which is super exciting. I think I might've mentioned that I had gotten Johnson & Johnson when I got my original vaccination. So I'm very excited to get something that is going to definitely boost my immunity since the Johnson & Johnson seems a little, quite a bit less effective right now. So that will be very exciting to happen. Let's see. I don't think I have anything else major to talk about for me, but I do want to talk about something really important that's happening tomorrow, if you're listening to this on the day it comes out.

Jennei: So tomorrow, November 17th, is #ThxBirthControl day, and it is a day to go out on social media and say, thank you for your birth control and all the things you were able to do because of birth control. So I will make sure that we share the social media tool kit on our show notes page, and you'll be able to go and take action. So the hashtag is #ThxBirthControl and that's ‘THX’. So #ThxBirthControl. So make sure to tweet out why you are thankful for birth control tomorrow. And I know I will be sharing some fun pictures and talking about why birth control is healthcare and why birth control has been important to me. It's just, it's really important to show the world why birth control is so important. So take the time, join me in shouting out, #ThxBirthControl tomorrow. And with that, I think we're going to go to this week's episode and I am so excited for, for it. I think this is one of our favorite annual episodes we do, and that is our sexual and reproductive health hero origin stories. This year, I did something a little different. So in the past, I've usually talked to advocates, to get advocates, to tell their stories-- this year I have providers telling their stories and you know, there are some really great stories in here. I cannot wait for you all to hear it. And because it is a provider-based episode, I did not share my story this year. If you want to hear my story, I have told it every other year we have done it. So we will make sure to include links to previous versions of our sexual and reproductive health hero origin stories. So you can hear it and hear all of you, amazing advocates who have told their stories before. So I hope you enjoy it. So with that, listen to our heroes, tell their origin stories.

Jennie: Hi Rae, thank you for being here.

Rae: Hi Jennie, thanks so much for inviting me.

Jennie: So, we're doing an origin story episode. Do you want to tell us, one, introduce yourself and include your pronouns, and then maybe tell us how you got started in all of this?

Rae: Yeah, for sure. So my name is Rae Pickett and my pronouns are she/her. I am the Communications Director at Planned Parenthood Advocates of Virginia and the Virginia League for Planned Parenthood. But my more exciting life, I'm a doula. I'm a full spectrum doula. I typically work with birth and abortion patients and yeah, like that's such a weird job or like a weird hobby, I guess, right? People are like,” how can you do both?” Right? “Like how can you do birth and abortion?” And I'm like, “how can't you?”

Jennie: You know, like to me it makes perfect sense.

Rae: Right? It's just like the natural progression of things for me. And it wasn't until I trained as a birth doula that I realized that that was not a philosophy that was shared by everyone. And definitely something that I was really called into and called into being. Then, you know, when I was little, my dad, he was a labor attorney. We were very involved in progressive labor politics in Toledo in the nineties. And you know, I would get taken out of Catholic school in my little plaid jumper and go to like the Al Gore rallies. You know, my mom's like putting my baby sister, like up for Al Gore to kiss. And it was just like the vibe, right? The environment you go to Labor Day parades and you have six different t-shirts on and you just take one off depending on what union you're walking with. So that's kind of like the environment that I was raised in. And my mom was an actor. And so it just really, I think put me in a place where I was questioning a lot of things when maybe other kids were not, being a little strong-willed, mouthy, bossy, all those things, you know? And now I'm like, yeah, I am a mouthy, bossy full-spectrum doula!

[Both laugh]

Jennie: Exactly. Right. Like, it's so funny how you can like, trace like that has like actually nothing to do with like abortion or being a doula. But like we can trace it back to these like weird moments that you're like, yeah. But like, “this is when this spirit of it was like instilled in me.”

Rae: Right. And I also feel like as kids, we probably remember interactions with our parents with more detail than they do in specific ways. And so for me, I was in, you know, kindergarten through fifth grade at Catholic school. And you said the pledge of allegiance with “liberty and justice for all born and unborn.”

Jennie: And oh, we didn't do that.

Rae: I thought that was the pledge. Why wouldn't that be the pledge? Right? And my dad was a big Cleveland baseball fan and we would go to games and I don't remember why, but we said the pledge for some reason… it was either the pledge…it could have been the Star-Spangled banner. And I was like “born and unborn!” but my dad looked like he wanted to crawl in a hole. And he was like, “oh my God,” you could tell he was just mortified. And I was like, weird, you know, like what's dad being so weird about?

Jennie: Yeah, like why are you being weird! [Both laugh]

Rae: And I remember a few days later driving in the car with my mom and my mom said to me, “when you say, you know, the pledge of allegiance, why do you say that at the end?” And I was like, “that's the pledge of allegiance? Like, that's what we're, that's what we say every day.” And she's like, “actually the pledge of allegiance ends before that. And you know, that's something that other people have added. Why did you add it?” And I said, “well, because you know, killing babies is wrong.” You know, we talk about it all the time at school, totally normal thing to do with first and second graders. Right. Obviously. And she was like, “okay, I hear you. What if though, someone told you what you could and could not do with your body and told you that you had, or could not put a baby in your body.” And I was like, “well, that sounds terrible.” And that was pretty much it, you know! People sometimes take a really complicated journey to things, but for me, I was just like, “oh, well, cool.”

Jennie: I love that these two Catholic school girls basically have the exact same moment of like, “yeah, mom, I'm going to save babies. I'm going to go with my friend to save babies.” And she's like, “maybe we should talk about this. Like, what do you think about this?” And like talks about some situations. And there's like, “so do you still cool with that?” And being like, “no, no terrible!”

Rae: But you know, we, I would say maybe it's, you know, I'm from Ohio. I think maybe it's that Midwestern, you know, kind of nicety where I don't remember a lot of like vitriolic, you know, I don't remember that. That doesn't mean it wasn't there…

Jennie: I don't remember either.

Rae: I remember being very calmly, you know, supported in that, in that way that I came to that. And it wasn't until many, many, many years later that my mom told me that she had an abortion after I was born before she had my youngest sister. And I was in a place where I was, you know, very active in the reproductive justice movement. I had been to Texas in the Rio Grande Valley and really worked in the Colonias and saw the, the LatinX organizers who are really doing the work on the ground there. And that was just such a, such a life changing few days and moments. And so when my mom was able to tell me later that she had had her abortion, I felt very fortunate to be in a place where I knew I knew what it took for her to share that with me. Right? And I knew what it meant for our relationship for her to trust me with that after so many years. Yeah. And so I just, I was really like, “mom, you know, thank you. You know, thank you for sharing that with me.” And she told me about her experience, and she felt a lot of guilt and she felt, you know, a lot of confusion and she didn't know what to do and didn't know who to talk to. And for me to say to her, “you know, I am sorry that you had that experience. You did not deserve that you deserved to be loved and supported and respected in your decision.” And you know, she was like, “you're such a good doula.” [Laughs] I'm like, yeah, “I'm trying, I'm trying mom.” But being able to sort of like doula other people around you through their experiences, even if they're delayed, I think is a really important part of why I do the work also, selfishly.

Jennie: Yeah. And I think that's also makes me think of like that saying you often hear is like “everybody knows somebody who's had an abortion” it's whether those people feel comfortable telling you this story.

Rae: Yup. It's so true. You know, one in four people, you know, who can get pregnant will have an abortion in their lifetime. And that's a lot of people. So, it is hilarious to me when people say, oh, I didn't know anyone who had an abortion. I'm like, you do. They don't want you to know, righ? Like you, for some reason. But people, when I wear my, you know, my pink shirt to school pickup or my shirt that says “abortion is healthcare.” You know, I used to be very afraid that people would target me, that they would yell at me and they would come to my house. Right? I was scared. That is not the experience that I have. I have more people who I don't know, come up to me and say like, “I really liked your shirt” or “thank you. Thank you for what you do.” And I'm like, yes, yes!

Jennie: But also there have become some really amazing abortion t-shirts now.

Rae: So many good ones, so many good ones. And I love like the snarky ones, but I have this one that I'm wearing today that has sort of like a depiction from, it looks like maybe like the Roman era or something like that, maybe Greece… of someone supporting someone, who's either having a miscarriage or an abortion. And I like that one, cause people were like, “what’s on your shirt” and I'm like, “somebody is getting an abortion.” And they're like, “oh!”

Jennie: Um, my favorite one I just got, and then let me tell you, I've never bought a t-shirt so fast is when I saw this one, it's very eighties vibes and it says “Fund abortion, Meow.” And it has a cat on it. I bought two because honestly it was too good to only have one.

Rae: Is it is necessary. And people think I have a friend who says “you’re like the NASCAR of repro.” Like I just have swag and swag… people are probably like, what the hell is wrong with you guys? But abortion is such an issue is an issue that when you talk to people about it, you can connect, right? Like people you would never think are with you on the issue will connect with you when you are open and out loud about it. And unapologetic and people are drawn to that. I think. And I think people feel comforted, right? Cause they're like, oh, “I feel seen, I know that person's not going to judge me. I know they're, you know, they're fighting for me.” Right. I get people who are like, thank God, thank God you're doing the work that you're doing. Right. And “I'm like, thank you for existing, you know? And for, for getting the healthcare that you need.”

Jennie: Well, Rae, thank you so much for telling your story. I really appreciate it.

Rae: Thanks so much, Jennie. I was really excited to be here!

Dr. Nyandak: Hi everybody. My name is Deyang Nyandak, and I use she/her pronouns. I am a family medicine doctor practicing in Massachusetts. I care for patients of all ages and I also provide reproductive health care, which includes abortion care and contraceptive care. So I, uh, was born and grew up in India. I grew up in a devout Buddhist household and I was taught to be compassionate towards all living beings --that includes insects and mosquitoes. And I hate mosquitoes. They love me, but I hate them. And I became a doctor because I wanted to take care of people who needed my help. I went into family medicine because I learned that being a family medicine doctor really allows me to take care of everyone regardless of their age, gender, um, and their medical conditions. And I became an abortion provider out of love and compassion towards my patients. I, you know, I grew up in India and I was labeled as a Tibetan refugee because I did not hold any legal citizenship to any country. Um, I witnessed a lot of inequities when it came to healthcare. Um, particularly in, in, you know, reproductive healthcare. There was a time when my aunt and I were touring a hospital when she was about eight and a half months pregnant. We were walking through this labor and delivery, like a quote unquote “unit,” but it was more like a room with an empty bed in the middle of it. And my aunt was super disturbed to see a blood-soaked delivery bed. And she really wanted go to a different hospital. And I was eight years old at the time, and I knew even then that, you know, people deserve better care. And, and that is one of the reasons why I went into medicine. Yeah. Jennie, do you have any questions for me?

Jennie: No. I mean, that sounds very like a really striking moment that would stand out in your mind and really be formative and how you practice going forward.

Dr. Nyandak: Oh, absolutely. Absolutely. I mean, in my practice, so I work with a lot of patients who are recent immigrants, a lot of patients who speak languages that are not English. And I take care of them with the help of interpreters at our hospital system. And I really feel like the way I grew up really helped me shape into the doctor that I am today because I know, I recognize the struggles, right? Because I was an immigrant to this country, too. I also remember that my parents didn't have access to a car for many years. Uh, when we came into coming into this country, we didn't have a laundry system in our house and we, uh, we were in footsteps for, for a little bit and you know, we're both working full-time jobs. So when I take care of my patients in my clinic, like I am recognizing that they're taking time off from their work and they are facing so many barriers when they come to see me. And particularly when they're trying to seek abortion care at my clinic. And many of my patients are already parents. They're trying to coordinate childcare, they're again, trying to take time off from work. And when they come see me, I really do my best to take care of them and, you know, take care of them with compassion and care of them without any judgment from my part. And when I do procedures in the clinic, in the outpatient-based clinic run by family medicine doctors, these are all patients who are awake during the entire procedure. So that means that I have to be very thoughtful about my patient's experiences in the room. I talk to them about the procedure before we get started, I ask them permission and ask them if they want me to tell them what I'm doing with each step of the procedure. And I try to empower my patients by saying that we can take breaks during the procedure if they desire, if they need that. And, um, and they will give me the permission to continue if they feel ready. Um, so really, I feel like having that experience as some, as someone who had gone through and witnessed all of these inequities in healthcare, and now I am in this role as a physician with so much power in my hands that I really didn't recognize when I first became a doctor. And, and this is my way of giving back.

Jennie: Yeah. I mean, I just hear the compassion and care you treat your patients with just like bleeding through and it just, it warms my heart to hear, um, to hear that.

Dr. Nyandak: Thank you so much.

Jennie: Hey, Dr. Marengo, thank you so much for being here.

Dr. Marengo: Hi Jennie. Thank you so much for having me.

Jennie: So I'm really excited to have you here for our origin story episode. Do you maybe want to take a quick second and do an introduction and include your pronouns?

Dr. Marengo: Absolutely. Thank you again. So my name is Dr. Toni Marengo and I use she/her pronouns. I am the Chief Medical Officer at Planned Parenthood of the Pacific Southwest. I'm actually also a Fellow for the Physicians for Reproductive Health.

Jennie: Oh, great. So do you want to maybe just tell us your story, let us know, how did you get started in this?

Dr. Marengo: Yeah, so it's been kind of a circuitous path, maybe not the most straightforward… I'm, I'm a comprehensive OB/GYN by training. And I don't look it… you can't see me on screen, but, um, I trained like almost 20 years ago. And so when I was going through my OB/GYN residency, I really wanted to be a full scope OB/GYN. Um, and I also had a Navy commitment. So just, um, kind of figuring out who was going to help me pay for medical school all along the way. And also having a military background, uh, growing up near a military base, my father was a retired Sergeant Major in the Marine Corps. I decided that, uh, the Navy was going to be where I was going to go. And so after I finished my training, I, uh, served the United States Navy. And what's really interesting is I had wonderful, robust training in abortion care, as well as all reproductive health services at the University of Colorado. And this was before Ryan Programs and fellowships and complex family planning. This was my bread and butter OB/GYN training. Um, but as a pretty young, naive person in training, going into the military, I thought, “well, this isn't going to be a thing, right, because the military doesn't do abortions, so I don't have to think about whether I'm going to be a provider or not.” That was kind of one of those hot topic I remember amongst my class, like, are you going to continue to do abortion outside of our training, because we all chose to do abortions to learn and be part of the training. But I naively thought I wasn't going to have to think much about it when I was in the military. And that was a hundred percent like opposite of what I found when I put on the uniform and started taking care of our active-duty women. After I finished my residency, I ended up being stationed in a remote base on a Marine Corps base, actually. And I think that's really where my journey in reproductive health begins as a specialty niche because it was there that I realized that there were so many obstacles to obtaining just basic contraception, let alone abortion-- abortion was like further down the line, right? So just getting in to see a practitioner to talk about birth control and then go on to the next step, if a patient wanted an IUC or an implant for whatever reason, I mean, we're talking about not just contraception or family planning, we're talking about menstrual suppression for women or people with uteruses who are going to be deployed to faraway places who didn't want to deal with their period, but it was just difficult to get in the door. And so looking at these obstacles and then, layer on top of that, taking care of patients who were victims of sexual violence and assault in a very highly stigmatized environment where it was, you know, didn't want to report, maybe they ended up pregnant as a result. How do you seek abortion services? Who do you talk to? Who's an advocate for you? I just felt like because of the Hyde amendment, really, and the culture, that, you know, people who, you know, needed our services, people who needed reproductive health were just at such a disadvantage. And I just felt this need as a comprehensive gynecologist who had this training. And I was like, well, how do I connect my patients with what services could I legally perform in the Navy and then how could I get them into the hands that they need to be in if they needed abortion services, for example. So, um, I left the military as an active-duty person after my commitment was up, but then rejoined a few years later as a civilian working for one of the, we're actually the largest training program for OB/GYNs in the military. So that was Naval Medical Center, San Diego, and so proud to have worked there for nearly eight years as a civilian.

Dr. Marengo: So, I was helping my very good friend and colleague run the residency program. And again, seen many of my colleagues that were trained in the military, through no fault of their own, were really not introduced to a lot of the ongoing family planning, you know, advocacy, things that were going on. They didn't have necessarily all of the fund of knowledge because they just weren't taught it. Right? And there was still a lot of abortion stigma, things like “we can't even talk about abortion in the military. We can't do options counseling because we're paid by the federal government and that's against the Hyde amendment.” So, like really that kind of layering of stigma. So, I think fortunately as a civilian-trained prior active-duty OB/GYN who came back in as a civilian, I think I was able to say, “yeah, that's not really, that's not really true. That's not what the Hyde amendment says. And we are training, full scope practicing OB/GYNs who need this kind of knowledge and education to take care of our patients.” So I became the Director of Family Planning for Naval Medical Center San Diego, and was the only Director of Family Planning in the entire military system, uh, at that time. And then with the help of some amazing colleagues who were very supportive, we stood up the first walk-in contraception clinic and the entire military system, which became a best practice for the DOD. And now there are over, I want to say 25 walk-in contraception clinics in the United States and throughout the country based on the work that we did at Balboa. And then my journey continued. I mean, by about 2016, the politics in our country were changed quite a bit. I was already feeling that trickle-down effect at my own military institution with, you know, scrutiny with people not wanting to promote our walk-in contraception clinic, which is really it's birth control, right? It's just regular old healthcare. And I started to feel like I needed a larger platform for advocacy and to fight for all people, not just, not just our active duty and veterans, although that population is so near and dear to my heart, but in my own community here in Southern California, this is the community I grew up in and the opportunity to apply for and then become the Chief Medical Officer at Pacific Southwest was made available. And I am so fortunate to be able to come over and now be a hands-on abortion provider, myself, something I was trained to do, but didn't have the opportunity to do directly while I was with the military. So coming over, continuing to provide services now, advocating for all pregnant people who need our services are all, you know, people with uteruses. In addition to being somebody that our active-duty colleagues can reach out to if they have questions, I do ongoing training and education, and I facilitate services for patients who need our services here at Pacific Southwest.

Dr. Marengo: So that's been my journey in a large nutshell, but I continue to try to improve my own education, um, by doing things like the leadership training academy through a PRH Physicians for Reproductive Health, I'm trying to, to broaden my efforts in advocacy and outreach and as a lifelong educator for residents and students, I continue to do everything I can to give talks on, you know, the history of abortion in the United States. And I'll do that based on, uh, with a military focus or whoever invites me. We'll do kind of a deep dive into what's happening in state policy. So that's where I'm at right now. And our affiliate here at Pacific Southwest, I'm also so proud that we do so much training and education for folks who want to be abortion providers, whether they're already out in practice and they want to come learn how to be an abortion provider or training residents and students who come and work with us through, you know, from our area institutions.

Jennie: That was such a great story. And you touched on so many different parts that are fascinating. One, I think something you don't hear a lot about is access to reproductive health within the military. And so that's like a really important discussion to have. And then two, what also struck me was talking about how you were trained to do abortion, like as part of your medical school program. And like that's kind of started to change at a lot of schools because of politics. So like those were like two really big things that stood out to me as different about your story.

Dr. Marengo: Yeah. I mean, I, the, for training in O/ GYN, it is mandatory that you have some sort of training in abortion care. And I think unfortunately in highly restrictive states and then in military training programs, they, they get around that by saying, “well, we had a lecture on it, right? We had a lecture on abortion,” which is different than be provided the opportunity to make that part of your actual hands-on training. So, both in medical school and residency I went to medical school in Chicago and I was introduced early when I was doing OB/GYN rotations, I was introduced to abortion care there, but then very specifically in Colorado as a resident, I unfortunately, I would have had outstanding training in a military system, but I would have been missing that specific reproductive health care training that I was very proud to have kind of brought back when I was training at Balboa for my residents. So those residents, and they continue to have very robust training, but I do think at least during that time, it was pretty unique to be able to get hands-on abortion training. And that is what you need. I mean, I'm devastated to know the statistics that less than 20% of practicing OB/GYNs in our country will do an elective abortion, not necessarily because they don't support abortion… I think most OB/GYNs will say, this is an important part of health care for all people with uteruses, this is something that we should be doing as a group. But I think stigma, specific hospital policies, state policies, have kind of allowed people to say, “well, I support it, but I'm going to let somebody else do it.” And until we all kind of take that back and say, “no, this is my patient needs me and I'm trained to do this.” I, you know, I think we need to take a real stand as a community of OB/GYNs and push back on those stigmatizing policies and obstructionist policies that hospitals and politicians are putting up.

Jennie: Yeah. And then the, uh, one of the other things that you talked about is something we haven't really talked about a ton on the podcast but has been a really important issue that has continued to gain attention to that sexual assault in the military. So I was really glad to hear you raise that as something that, I mean, unfortunately you saw a lot of,

Dr. Marengo: You know, I, I think the military talks a lot about it and it comes up time and again, whether, you know, there's a new Surgeon General of the military, there's a new, you know, it's, it's well established that it's a thing, right? Uh, finally it's established that it's a thing. Um, it's starting to be hopefully, finally established that it's not her fault, right? It's not that active-duty service members fault anybody or, or his, because we do know that sexual assault happens to, you know, men in the military as well. So, it's not that the victim’s fault, but now what is the military going to do about it? So I think that's where we have the issue. It's like, okay, you're going to recognize that there's a problem, but we still haven't been able to solve this problem. So what is standing in the way of solving the problem and what is standing in the way of taking care of the patient once they have, you know, ongoing issues, whether that's counseling needs other mental health needs or actual physical needs, or let's say… here, a pregnancy as a result, you know, it wasn't until 2013 that the military said that an abortion was going to be a covered service for recipients of Tri-Care or military healthcare because of rape or incest. So it was 2013. So before that, if you were a victim of assault or incest and a pregnancy resulted, you, you were still on your own. So in 2013, uh, I was part of the group who wrote the view med policy that said, no, absolutely this should be a thing, but not only was it a, something that could be covered, we had to figure out a way for that person to be able to report it, the pregnancy, without necessarily having to report the violence, because they may not want to do both of those things. Right? And then we had to figure out a way for that person who reports a pregnancy. What if they're stationed in the middle of, you know, who knows where, how do you get them somewhere who will do it abortion? Right? So then you're having to deal with like, you know, physically moving somebody, but maintaining some privacy and then getting them into some, you know, skilled hands within a pretty short period of time. So it was a pretty detailed policy. I'm proud that it exists. I'm afraid it's still underutilized, again, because of stigma for assault and violence and double, triple, quadruple, that was stigma with abortion. So again, I'm very pro-military, love the military, and I'm a proud veteran. I think the military still has a lot of things to do to improve their healthcare for their active-duty service members who are seeking reproductive health services. And I'm proud to continue to advocate for that and fight for that.

Jennie: Dr. Marengo, thank you so much for your time today. I really appreciate you taking the time to tell your story.

Dr. Marengo: Thank you so much for having me on Jennie. I appreciate it.

Dr. Chin: My name is Jennifer Chin. I use she/her pronouns and I'm a current second year complex family planning fellow at the University of Washington. I grew up originally in the Seattle area and was surrounded by people who felt that abortion and family planning were important aspects of reproductive healthcare and grew up both in a church and in a family where abortion was not often talked about, but it was very much accepted as part of a personal decision for each patient and something that was between a patient and their doctor. I then went to University of California, Berkeley for my undergraduate degree in Public Health, with a minor in Global Poverty and Practice while taking pre-medical classes. And during that time, I decided that I wanted to become a doctor and wanted to go into the medical field but… I wasn't quite sure what field I wanted to go into quite yet. I knew that I really enjoyed working with kids, but I was also interested in women's health. And so I was both interested in pediatrics and OB/GYN and kept an open mind about that when looking at medical schools. Similarly in Berkeley and in the Bay area, I again was surrounded by people who felt that abortion and access to contraception were essential parts of healthcare and were not divisive issues. And I decided to go to medical school at Tulane in New Orleans in Louisiana, because I really liked Tulane's mission of being very involved in the community. And there are many student-led clinics and free clinics that were helping the surrounding communities. And when I went there, I started realizing that the idea that abortion and contraception should be accessible to everyone was not the general consensus among either my medical school classmates, my mentors and my attendings, or in the general public surrounding me. I remember a very specific incident during my OB/GYN clerkship, where I was working with my OB/GYN clerkship director, who was also in charge of our residency program. And we're seeing a patient in our resident clinic for a routine prenatal visit, and the patient was asking about genetic screening. And my attending said to her, “well, we don't need to do any type of screening because it's not going to change your decision about this pregnancy.” And I remember being very shocked by that statement because I knew that there are many options of genetic screening available to her. And potentially, if she found out some information that would have changed her decision about the pregnancy, she was still at a very early gestational age where she could have made a decision on whether to continue or terminate that particular pregnancy, or be able to plan for a pregnancy that had any type of anomaly or genetic abnormality. And I just remember thinking that this patient likely would not have anywhere else to turn for her prenatal care, because this was one of the few clinics that was accessible to her, both in terms of her insurance and location. And this was also an attending who was teaching all of us medical students and residents who would be future providers and teachers as well, this was the type of teaching that we were receiving in terms of genetic screening and options counseling. Additionally, throughout my curriculum at Tulane medical school, I received very, very little discussion or education about contraception. In fact, I only remember one lecture about birth control pills, and there was basically no information taught about abortion care. And so after that particular experience, I became very passionate about abortion access and contraception access and joined our Tulane Medical Students for Choice chapter, and eventually was the student leader for that chapter.

Dr. Chin: Through that experience, I also was connected with the very early members and the founders of the New Orleans Abortion Fund, which is now a very well-established fund within New Orleans. But at the time it was just getting off the ground. And it was an organization that was dedicated to fundraising and providing financial assistance for patients who need an abortion within the New Orleans and Louisiana area. Because as I found out in Louisiana, unlike in Washington and in California, abortions are not covered by Medicaid and not covered by insurance companies. And so all of those expenses need to be paid out of pocket, which can be very costly for many people. I also, while I was there, was part of a number of efforts to combat different TRAP laws. And we formed a coalition called the Louisiana Coalition for Reproductive Freedom, which was a group of about ten or more different local reproductive justice organizations who are all committed to making abortion and contraception access available to all people within Louisiana. And I was the medical student representative for that group. And through that experience actually was asked to testify against a sex selective abortion ban, which was being proposed, um, by someone who said that the point of this bill was to save Asian baby girls. And the idea was that many Asian parents were deciding to abort baby girls in favor of having sons. We looked through the research and found out that while potentially this is happening outside of the United States, that was not true within the United States. And really what this was doing was creating yet another barrier for patients to access care. And there are also strong implications for the provider of these abortions and anyone involved in an abortion that was done and decided because of the sex of the pregnancy. And so, as an Asian American medical student, I was asked to testify against this bill. And I was very nervous about this because I felt underqualified as a medical student and also felt that it was an extremely hostile environment, but with help from both my local advocates, as well as having a connection to the National Asian Pacific American Women's forum, who helped me craft my testimony and actually sent someone as well to testify alongside with me, I felt very supported throughout the whole process. And during the testimony, I felt very empowered to be able to use the knowledge that I did have and to speak my truth and tell everyone in the audience, what I knew to be true and we were actually able to defeat that bill, which was very exciting and very triumphant. And that experience made me extremely passionate about advocating for reproductive justice and for abortion and contraception access.

Dr. Chin: And in combination with finding out that I loved doing surgeries and loved delivering babies and loved being able to be part of my patient's entire life cycles, I decided for sure that I wanted to go into obstetrics and gynecology over pediatrics. It seems like the most direct path for me to be able to continue my work in reproductive justice and specifically in family planning. And so when I was looking at different residency programs, I specifically looked at programs that had excellent abortion training. And that's how I ended up at the University of Hawaii for my OB/GYN residency. And I had an amazing four years there. I received excellent training, excellent mentorship, was able to feel confident in my clinical skills, as well as conduct research and continue to be a strong physician advocate and feel supported in all of those efforts. And during that time, I also decided that I wanted to pursue further training through a Complex Family Planning fellowship, which is how I ended up here at the University of Washington. And I will say that throughout my fellowship and through my time providing abortion and contraception care, I always feel extremely lucky and grateful that I'm able to take care of patients who for many of them, they have interned away from many different providers, feel like they have nowhere else to go and are really feeling very desperate and vulnerable. And I feel privileged and lucky that I'm able to take care of them in an evidence-based manner and provide compassionate care to patients who really need that care and feel like no one else can provide that care for them. Dr. Chin: Thank you!

Dr. Bourne: Hi there. My name is Dr. Christina Bourne and my pronouns are she/her and I am actually, I'm a family doctor and a psychiatrist, so I'm dually trained, but I am also a very proud abortion provider. And I started becoming interested in abortion care because I myself had an abortion when I was 18 and had always kind of passively remained pro-choice, and fortunately was raised in a pro-choice environment and by pro-choice environment, I'm from, I'm from Arizona, but you know, my family's pro-choice. And so, I really never gave it much thought until moving to Wichita, Kansas, where I did medical school and really saw what the anti-choice movement is about. And so, it really kind of forced me to think about my own value system. Think about what kind of care I want to give to patients. And like where I fall in that really important spectrum of delivering health care and being pro-choice and kind of like challenging the notion of being pro-choice and actually doing abortion care, I think has been a journey for me.

Jennie: Yeah. You know, it's interesting. I've told my story before and I went to Catholic school for K-8. And so like my first exposure to like the anti- was somebody at school being inviting me to come “save babies” with her and her family over a weekend. And obviously my parents and I had, whatever, a long conversation decided not to go because again grew up in like a very pro-choice family, but like, I didn't have a ton of exposure to it until I went to college. And there were always these antis who would come and protest on campus that we would run into on library mall in Madison.

Dr. Bourne: Yeah. Yeah. I feel like, I felt like those antis, like, gosh, I feel like my experience with anti-choice folks, especially like anti-choice protesters is something that I think about a lot. And we have a pretty militant base of protestors, especially in our clinic in Wichita, Kansas. And I really feel like, unfortunately they get so much more publicity and so much more interest than what is deserved. I almost feel like really the best thing we can do with folks who are like picketing and in front of, you know, like on college campuses, like outside of our clinics and things like that is just like doing our best to ignore them because they're really looking to, gosh… like they're kind of like looking for a fight and they're looking to be hostile. They're looking to block people from coming into the clinic. They're looking to like show extremely like grotesque pictures and amplify stories that don't represent the fact that like abortion is just normal healthcare and part of just, you know, just our routine day today life and is really quite normal. And they have like really, really shifted the rhetoric to make it more of a hostile and scary rhetoric when really we it’s just part of our day to day experience.

Jennie: Yeah. You point out like, to me, the very obvious, like it's just healthcare, it's just basic health care and we need to quit treating it as something different.

Dr. Bourne: Absolutely. Yeah.

Jennie: And by “we,” like the broader “we” not people in the movement.

Dr. Bourne: No, absolutely. And I feel like even like, yes, the majority of like, and I, and I have talked a lot with my colleagues about this, I want to like to recognize that, of course my ideas are not formed in a vacuum and have really been influenced by my colleagues whom are all like thoughtful geniuses. So as I like go into some of my like rants and things like that, I want to acknowledge that like, acknowledge my community, who has trained me to be the provider that I am and has given me like a frame of reference for a lot of my thoughts, but where I'm going with that is just that the majority of abortions that I do are like very, you know, fairly unremarkable. And what I mean is like remembering that like abortions are normal and most people are coming in with like very like routine stories, very, you know, just normal everyday lives and just, you know, a pregnancy kind of, for them in that moment is something that they can't carry on. And that's, that's a hundred percent okay. A hundred percent normal. And I feel like we give a lot of, you know, even within the movement, which is what made me think about that. Even within the movement, we, we seem to have kind of these more like glorified abortion stories or, or more better abortion stories like, “oh, they were raped or there was a fetal anomaly or a fetal insufficiency” kind of this, that, and the other, and which moves it away from the point that like abortions are just normal healthcare and you don't need to have kind of a, a really big story to have an abortion. Like your story does not need to be quote unquote, “interesting” to have an abortion. And just having, you know, a routine day to day experience of like, oh, you're pregnant and like, this is not the right time for you. And that's like an A-OK reason. And there, we like moving away from like kind of our more moralistic good and bad, like this abortion is good versus this abortion is bad, it's something that even within our movement, we're kind of trying to move away from just to really emphasize that abortion is normal. Abortion is routine.

Jennie: Yeah. That makes me think of like the anti talking point, you see pop up and being like, “they want people to be able to get abortions on demand” and it's like, yes, you're you got it. You're right. We do. We want people to be able to access the abortion care they need.

Dr. Bourne: Absolute correct. It's like 1000000%. Like I, I practice in Wichita, Kansas, and in Oklahoma City. And I was actually talking with some, another news organization about this. I feel like our clinics are getting a lot more press kind of in this moment because of what's happening in Texas. I, of course, like have a lot of thoughts about that, that, you know, the press are now interested in kind of what we're doing and this, and this moment, because it's kind of a sensationalism type thing. But one of the questions that she asked me is she's like, kind of like, “what is like your dream in like abortion care, like what does dream abortion care look like in the United States?” And I feel like what, what my dream is, is really indicative of, of how sad we are. Like in this moment, I was like, just to have clinics in driving distance from folks is, is really all I want, like you're saying like abortion on demand, like where folks don't have to be driving 6, 8, 10 hours, and then we're considering round trip and, you know, all, all of these kinds of things to get care that they should just be getting down the road from them. Um, so I was like, my dream is pretty simple and just having abortion be more broadly accessible, but also pretty sad that like, that's like where my dream… I, I feel like that's like the ceiling of my dream, you know? And so like what, what does the floor look like? And I think that we're kind of looking at that the slow chipping away of Roe in these moments.

Jennie: Well, yeah, so that just makes me think, how are you doing, so like two and a half months in, how, how are you, and how's your clinic doing?

Dr. Bourne: Our clinic is very busy. We are busy, busy. So like, and so essentially, you know, as, as we all know, abortion is essentially outlawed in Texas. And then so the neighboring states are, are feeling that. And so of course our more major neighbor, neighboring states are going to be New Mexico…gosh, what I'm going to like prove my inability to do geography, but for sure, Oklahoma. So I would say New Mexico and Oklahoma, some, but then Texas is absolutely massive. Huge, huge, huge, huge, huge. So Oklahoma, our clinic right now in Oklahoma has essentially turned into a Texas clinic. And of course, Texas has one of the largest health systems in the country. And in Oklahoma, there are currently, I think, maybe at this point only three places that you can get an abortion. One of the clinics in Oklahoma actually recently closed, I think, due to just increasing stringency of legislation and things like that, which is sad. But so within Oklahoma, we've essentially turned into a Texas clinic and then our, our sister clinic in Kansas is now turning into a clinic for Oklahoma. So we're even displacing patients out of their state who live in those states to get that healthcare. And I would say like from like a worker's perspective and like an abortion provider’s perspective, like, I, I really do feel quite tired. I feel like physically tired just from the amount of time that we're working. But then I also feel like emotionally, like I'm really having to grapple with, like, we can't provide abortions for everybody. And we have to think about workers' rights, you know, capping the number of patients that we can see, you know, things like that. I, of course like as a doctor and like, I'm truly a pretty small piece of the picture of what we need to keep an abortion clinic running. But of course, like just thinking on a clinic day, I have folks who are autoclaving instruments, turning over rooms, cleaning rooms, of course, like nursing staff, like every single one of these people is like critical to access. Although like I could, I could perhaps do more abortions, like at some point, like we like have to really consider like the everyday life of people working in these abortion clinics as well, thinking about their access to healthcare, you know, living wages, things like that. Like, so it really like the, this legislation has really forced me to, to challenge my own view system of, of being this like quote unquote “savior” to having to, to think about more sustainability, kind of removing that savior complex that I think a lot of us are to some extent like entrenched in.

Jennie: Yeah, it's a lot. And I just, I mean, this again, is the heart going out to everybody who's having to deal with this for the people who are having to travel to access care, the providers who are getting to be exhausted, the clinic staff, like it, it's just so much on all of y'all right now.

Dr. Bourne: Yeah, no, it absolutely is a lot. And I think that the, the ripple effect of these really draconian laws is not like I would say, there'd be no way that we could have anticipated how we're gonna feel and like what this is going to look like for patients on their day-to-day life and experience, and like pregnant people in their day-to-day life and experience. And Texas has one of the highest maternal mortality rates in, in our country. And by that, I mean, like if you're a pregnant person, you have a, you have a much higher chance of dying in Texas due to your pregnancy and due to effects secondary to your pregnancy. So essentially what it feels like with these abortion legislations is that we're truly like sentencing folks to potential deaths. And I know that that sounds like very sensational and like, and dramatic, but it's truly not from a pure public health perspective that, you know, complications with pregnancy increase as gestational age increases. So if folks were able, if this was an unwanted or unintended pregnancy and actually the person desired abortion care, you know, being able to provide abortion at an earlier gestational age is safer for the person, but a lot of people are just now they're their most realistic kind of choice at this point is just carrying the pregnancy through because traveling out of state is just not feasible for all the reasons that we can think about.

Jennie: Yeah. And that's the thing… we have Dr. Foster who wrote the Turnaway study on our next episode. And she talks about, you know, there's a lot of conversation around the safety of abortion, but that's not really what the choice is, right? Like it's the choice between the safety of abortion and the safety of childbirth. So, you know, these are two very different risks.

Dr. Bourne: Absolutely. Absolutely. Oh gosh. That's so cool. I mean, the Turnaway study is of course, like such a, such a wonderfully done study. And then also like when taking a step back, like thinking, like, thinking about the individual people that had to experience being turned away from an abortion clinic, it's, it's, it's super, I think, I think we, as humans can hold two distinct simultaneously while this, while this from like kind of a medical clinical perspective is a super interesting study and simultaneously just so bleak and depressing thinking about the individual person's experience for sure.

Jennie: Well, Christina, thank you so much for being here. I really appreciate you sharing your story.

Dr. Bourne: Yeah, no, and I appreciate you giving me the platform too. Yeah. It's been really, really wonderful chatting with you.

Jennie: Okay. Y'all I hope you enjoyed this as sexual and reproductive health hero, origin story episode; this is one of my favorites each year. It's one we get requests for. So I hope everybody enjoyed it.

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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