The US Healthcare System is Already Failing People -- Abortion Bans Make it Worse

The Dobbs decision that overturned Roe v. Wade has, in many states, decimated access to abortion care and prevented abortion providers from treating patients. Dr. Leah Torres, Obstetrician/Gynecologist practicing in Tuscaloosa, Alabama, sits down to talk with us about the state of abortion access in Alabama and how the United States’ healthcare system layout is generally preventing access to quality care.

Currently, there is no abortion access in Alabama. Prior to the overturning of Roe v. Wade, the rate of people dying in pregnancy and childbirth in Alabama was twice the national average. Lack of abortion access will only make these extremely upsetting numbers worse. In addition, the United States’ current healthcare system is compounding these dangers for pregnant and birthing people in this country. From transgender healthcare to abortion to vaccination, the politicization of modern medicine comes from the select few embedded in our current healthcare system who have money and power to gain by exploiting the framework and those who seek care within it. Some states, such Alabama, continuously refuse to expand their Medicaid program blocking insurance coverage for those who need it most, while also limiting which providers and clinics can receive Title X funding. 

Medical students continue to face barriers to training in abortion care. Many residency programs state the miscarriage management training is the same as abortion care training, which is not true. Fellowships, which offer training in certain areas, are often years-long. This means after medical school and residency, many who want to learn about abortion care feel the need to take on another two-year long fellowship in family planning.

A lack of sex education across the United States and the gatekeeping of comprehensive information about healthcare intensifies the inability to realize sexual and reproductive health care. When powerful institutions control the narrative about our health and bodies, often informed by “religious freedom,” this can lead to interpersonal relationship problems and mis- and dis-information. While this may seem big-picture, it has a very pin-pointed impact, leading to providers like Dr. Torres to treat individual patients who are coming in for treatment because of lack of access to education and basic care elsewhere. Many who seek care at Catholic hospitals (entities that don’t often make their religious affiliation clear), may not receive the reproductive healthcare they want or need because of religious directives.

Links from this episode

Dr. Leah Torres on Twitter
Past podcast episode on Title X
Past podcast episode on Catholic hospitals
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, I'm still riding the high of last week's five-year anniversary for our podcast; I cannot believe five years and 158 episodes later we're still going strong. I'm still having so much fun getting to talk to so many amazing people and having so many of you tune in and hear what we all have to say. It's pretty amazing. I, I just am so grateful for each and every one of you, whether today is the first episode you're joining us for or you're 158th. Um, sorry about that y'all. That was my cats fighting in the background if you heard that. They're apparently feeling a little saucy today. But yeah, I'm just really grateful for all of you. So thank you. Um, if you follow us on social media, you might have seen, we have a giveaway going on right now, but if you don't, this is a great opportunity to do so. We have some fun new stickers that we had put together and we are going to send them to some lucky fans. So what you need to do is follow us on either Instagram, which is reprosfb or on Twitter at reprosfightback or both, and then let us know that you followed us on either platform and we will put you in the, um, in the drawing to get sent a bunch of fun new stickers from us. Uh, so you can wear your support for rePROs Fight Back. Uh, yeah. So make sure to do that. It's running through the end of the year, so you still have a couple days to do it. Um, I think I'm gonna stop there. I am just really looking forward to heading home for the holidays. This is, I'm recording this in advance. Um, actually when y'all hear this, I will be on my way back to DC and I hope you all have lovely holidays and a happy new year and I can't wait to see y'all in 2023 and hope that it brings much joy and happiness to everybody. And with that, let's turn to this week's episode. I am so excited for this week's episode. We are talking to the wonderful Dr. Leah Torres. She's an OBGYN in Tuscaloosa, Alabama. And we have a wonderful, wide-ranging conversation from being an abortion provider in a state that bans abortion all the way to how and why we need to fix this entire healthcare system from the ground up. It's a wonderful conversation and I hope you all enjoy it. So here's my interview with Dr. Torres.

Jennie: Hi Dr. Torres, thank you so much for being here today.

Dr. Torres: Thank you so much for having me, Jennie. I appreciate being here.

Jennie: Before we get started, do you wanna take a quick second and introduce yourself and include your pronouns?

Dr. Torres: Absolutely. Sure. Uh, my name is Dr. Leah Torres. My pronouns are she/her, I'm an obstetrician gynecologist practicing in Tuscaloosa, Alabama.

Jennie: So I am so excited to have you on; one, I've been following you on Twitter for forever and you always have such great wisdom around so many repro issues. Um, and I think right now you bring an interesting perspective since you're based in Alabama. Do you maybe wanna talk a little bit about the state of abortion access in Alabama and like what's going on right now?

Dr. Torres: Sure. Uh, that's gonna be a very quick conversation since there is no abortion access in Alabama. Um, that is troubling for so many reasons. But, uh, I think it's no surprise that one of the more troubling reasons is the maternal mortality rate is going to increase. And prior to Dobbs, Alabama had twice the national average of people dying in pregnancy and childbirth. And so that is only going to get worse now that the Supreme Court has decided that states get to determine the personhood of people who are pregnant. And Alabama has decided that people who are pregnant do not have personhood.

Jennie: It's just so infuriating. Um, just thinking of like all of the impacts, like it just seems like banning access to abortion is, I mean wrong for so many reasons, but also so shortsighted for all of the health implications it is going to have on people that they are supposedly saying they care about.

Dr. Torres: Exactly. And let's remember that when you talk about banning access to abortion, what you're really talking about is banning access to healthcare. And this is not a feeling, this is not a political stance. This is simply fact. The fact that pregnancy alters one's physiology and will continue to alter physiology through the duration of the pregnancy and even weeks after birth is fact. And so you can either accept that fact or deny it, but the fact remains that abortion is healthcare just as prenatal care is healthcare, just as gynecologic care is healthcare. You don't get to pick and choose what is healthcare when the facts exist to support that pregnancy alters physiology and no one should be forced to undergo the risks that are very real and very can be deadly, uh, to give birth. No one should be forced to do that. That should be something someone decides to do. And those risks should be undertaken willingly with continued and ongoing consent.

Jennie: I think you brought up some amazing points and one of the things I know that you wanted to talk about today is that this isn't just an abortion issue, it is a broader healthcare issue and it's the he current health system that is failing people.

Dr. Torres: Absolutely. Our healthcare system in general, since I've been practicing, it's been very clear to me that the system is designed to make a certain class of people rich at the expense of the lives of another certain class of people. That is the too long didn't read version of our healthcare system. That is manifesting in such ways as the attacks on trans healthcare, the attacks on Dr. Fauci during the covid pandemic, the attacks on vaccines, the attacks on abortion, I mean, name it, you, we have modern medicine that is being politicized and the reason it is being politicized is because people have money and power to gain by doing so in our current healthcare system as it is.

Jennie: Yeah, I it's so frustrating and it's such a huge system of people not being able to access care. I think, you know, one of the big areas that I think about a lot is the states that chose not to expand their Medicaid program and the people that are caught then unable to access care.

Dr. Torres: That is Alabama. Alabama has continued to not expand Medicaid. And in addition to that, Alabama has taken a number of stances or passed a number of legislative laws that limit access to healthcare even further. For example, the state of Alabama does not allow any healthcare clinic outside of a county health department to have Title X funding. So that limits access to healthcare because when you are uninsured or you can't afford private insurance but make too much money for Medicaid insurance, which is what the expansion is for, and what Alabama does not have, then you are stuck and you need that Title X funding. But you can only get it at a county health department. And if you think you might have a sexually transmitted infection like chlamydia now, obtaining an appointment in four months will give you nothing good for sure, and possibly pelvic inflammatory disease, becoming infertile, passing onto other partners. I mean, this is just one example of one area of many areas where the state of Alabama specifically is limiting access to care. And I am on the front lines seeing the repercussions.

Jennie: This is another area where we've definitely seen it be very politicized. I mean, Medicaid expansion was one of 'em, but you talked about Title X and you've definitely seen this become super politicized with states blocking abortion providers from getting Title X funding to states restructuring their program so that they can block certain providers. Um, and, and now there's was just a court ruling in Texas that that could have some broad implications for Title X. And again, it's just that basic healthcare access.

Dr. Torres: Exactly. And let's remember that people in Texas aren't some different species than people in Alabama. People are people and medicine applies the same everywhere. We have national guidelines, we have national organizations. Medical training itself is nationally accredited so that if someone trains to become a doctor in Illinois, they have the same education as someone training to be a doctor in Florida. And yet once you graduate, all of a sudden you need a different license for a different state. And there are different laws in different states that are regulating medicine even though medicine doesn't change state by state. And so this causes politicization of medicine because it can be, the laws can be used as a tool to ensure that the “right” people get the healthcare and other people just, you know, good luck.

Jennie: This is one of those issues… I recently had on Pamela Merritt with Medical Students for Choice and talking about the implications this is gonna have for medical students who are training right now and maybe not be able to get trained to provide abortion care in states where it's banned. And then what is that going to mean for them at practice going forward?

Dr. Torres: Well, they are going to be limited in their education and training. I in fact went to, uh, further my training after residency. Generally, you do medical school and then technically you're a doctor, but you don't know what you're doing. So you do residency and that's a doctor in training under other, you know, veteran doctors who say, “yes, that's correct, no, don't do that. Do it this way.” And you know, you get trained to do the medicine that you've earned the degree for. But after residency, I didn't feel that I was properly, or not properly, but rather adequately trained in abortion care. My residency program said, “well, we do miscarriage management. So that's the same.” And many residency programs say that and they quote unquote get away with it. I mean, it's technically a thing that they actually get away with. And I disagreed with that thought process and I said, well, I'm gonna do a fellowship in family planning. So that's two extra years of training. And so if I had to do two extra years of training in, after doing a residency program in a state, Pennsylvania, specifically, in a state that had no real like, you know, problems with abortion, at least not legislatively, what's gonna happen to those who are learning how to be OBGYNs and you know, healthcare practitioners in states where abortion has been turned into a class A felony like it has in Alabama? I mean, I essentially went through 10 years of training to be a felon in this specific state, and that just isn't right. People need all the tools that they can in their tool belt without legislators deciding what doctors should or shouldn't be trained in. That's not for them to decide.

Jennie: Yeah, I, this is all just so frustrating. Like it just seems like there's got to be so many easier ways to do this. Like people should just be able to get the access to the healthcare they need and, and access, I mean that in like the broadest sense of the term, right? Like it should be near them, they should be able to afford it. Like this all should be so much easier with you just get down to like the real simple, like healthcare is a human right, abortion is a human right, like all of this, we should just be able to access things so much easier and get the services we need.

Dr. Torres: And we can, it's not something that's mysterious, it's not as if other countries all over the world have never done anything like universal healthcare. And when I say that, what I mean is taxpayer based healthcare. We already have taxpayer-based healthcare. It's called Medicare and it's called Medicaid. And so it's nothing new to us, but what the powers that be are saying are “Yeah. But if we go into, you know, taxpayer-based healthcare where if you pay taxes here, you have access to healthcare, then think of all those poor hospital CEOs who aren't gonna be earning millions of dollars a year! Think of all those poor pharmaceutical company executives that won't be earning millions of dollars a year! Those poor insurance companies, oh my gosh, those guys will be, they might earn only million dollars a year, a year that that's like what, what's gonna happen to their billions of dollars?” That's just crazy. So we ignore places like Canada or several countries in Europe where, yeah, taxes are higher, but guess what? Our taxes already go to things like ambulance services, like the fire department, like the police department. In fact, our taxes are probably not optimized as it is. So I question if we would even have to raise taxes in order to pay for healthcare in our country and have a taxpayer based healthcare system. And that's where we need to start. People are not wanting to do that because the powers that be, the lobbyists, the pharmaceutical companies, the hospital administrations, um, you know, they have everything. And the insurance company absolutely has everything to lose as far as their wallets are concerned.

Jennie: You know, this makes me think of something unrelated, but not unrelated at all, is so they don't want us to have access, easy access to the healthcare, but in a lot of states they also don't want people to have access to the information. I'm just thinking of all of the states that don't have a comprehensive sex education. So people don't know about options or so many things. As somebody who had sex ed in a Catholic school from a nun, like it's very harmful and like is not helpful for your life later on. And I, I just see all of these as like symptoms of similar problems.

Dr. Torres: Oh absolutely. The broad brush there is an uneducated electorate is very easy to control, which is the opposite of an educated electorate makes informed decisions about their legislators, right? So if people are kept uneducated, then you can feed them the information that you want them to have and, and essentially you're now controlling them because you've made them think a certain way. And that is power. I practiced in Utah for six years. I know all about the power of keeping information from people. I saw it firsthand with the LDS church and people coming in saying, “There's something wrong with me, doc. You know, I don't enjoy sex with my husband and I know it's wrong to have sex” and like, I mean all of this abuse, I mean it's an abusive relationship in many ways when you have control over education and you're withholding facts and instead manipulating people in order to keep them in the line that you want them to be in. And so that's, and that's harmful. It causes harm. I've seen, I've seen it firsthand and I can't undo it in one visit, but that's what manifests. You have folks who are suffering because of the lies they were told. And that's just antithetical to what a government, or in that case a church should really want, right? You should want your people, you know, to be healthy, to be well, to be happy and have good brain health, but instead you cause damage. And that manifests in depression and anxiety and interpersonal relationship problems. I mean it's harmful. Keeping education and facts from people is damaging.

Jennie: This makes me think of, you know, talking about not being able to fix people in one visit. It also makes me think of the harm in not getting that visit or people who get turned away and, you know, kind of touching on a lot of the similar things you said, you know, when you look at the Turnaway Study, seeing what happens to people who are turned away from wanted abortions and the impacts that has on their lives. And now we're seeing this play out on such a grand scale in the country right now as to what those impacts are gonna be. We, you already talked about maternal mortality, but it's gonna have such huge impacts on so many people who are just trying to access basic healthcare and exercise their human rights. And it's so frustrating and so rage inducing. And one of those, like, I, I can't think small picture, like I have to think big picture cuz like, when I think of like the individual person, like, it just like breaks my heart and like kind of makes me freeze a little bit of thinking of like all the individual people that are being harmed right now.

Dr. Torres: And I saw one of those people today, I saw two of those people on Friday. I see at least five folks every week who are let down by the system if not harmed by the system. You know, everyone's super proud to say we don't allow abortion and we don't do abortions at our clinic. And the dirty secret in OBGYN care specifically, and I can say for certain in OBGYN care in Alabama specifically, the dirty secret is you don't wanna take care of pregnant people either. And that's another huge problem. And it is also contributing to that high maternal mortality rate because when you tell patients who call your clinic, “we're not gonna see you because you owe $300 from your other baby's circumcision, so pay that first and then we'll make an appointment,” or, “you're only eight weeks pregnant, we won't see you until you're at least 12 weeks pregnant.” And for those of you who don't get why that's bad, which I, you know, as non-doctors, I wouldn't expect you to understand, all of the organs and stuff that's important develops in those first 12 weeks. So that's your time to intervene, that's your time to make sure blood pressures are normal, there's no diabetes or there's no thyroid problems. They're not taking medications that are dangerous for a pregnancy. That's the time to intervene and save a pregnancy from detrimental harm to prevent a miscarriage and they say, “we don't wanna see you before 12 weeks in case you have a miscarriage.” Well, you've just missed the opportunity to prevent one. So there's that. There's also the, I don't, I've never heard of this before I came to Alabama and I've done, I've practiced in quite a few states and I've even experienced healthcare in other countries. Not until I came here have I ever heard of an OBGYN practice telling someone “we are not going to make an appointment for your prenatal care because you had one visit with another doctor before and we need those records first before we even make your appointment.: And these are all barriers to vital healthcare access to ensure that pregnant people and their newborns are as healthy as possible and have as little risk of dying as possible. And yet these are so common that I just start counseling patients like, “Hey, uh, our clinic doesn't accept your insurance, but I'm, you know, I'm gonna see you anyway. Here's the, here's the story for today, by the way, if and when you find a doctor with your insurance coverage, don't tell them you came here, get your appointment first, go to the appointment and then say, oh, I had a visit with Dr. Torres, she can send you records.” I can't believe that I have to do that. I cannot believe I have to tell people to hide certain truths about their care because otherwise they're gonna be denied care needlessly. There is no medical reason to say to a patient, I can't see you until I get records from your previous doctor. That never happens in my practice. It never happens. I've often had patients come in and say, “oh, I saw this other doctor.” And I'll say, “oh, okay, well good to see you today. Here's the plan. And also I'm gonna get records from that other doctor that what's supposed to happen.” The front desk person doesn't say, “we're not scheduling you.” So these are just a few examples of reasons why people are twice as likely to die in childbirth and pregnancy in Alabama than the rest of the nation. And these are things that can be fixed.

Jennie: I worked at a OBGYN office in the front area for like, I don't know, a couple months. That's not something we ever asked patients when we were scheduling appointments. Um, but I definitely relate to the, like so many, uh, providers are very like loud and proud about not providing abortion care. We definitely had providers at that, uh, that site that were very much like, “we don't do abortions.” And I just remember being like caught off guard that like, “wait, you're not providing basic healthcare to your patients.” I obviously didn't last there very long, but it, it was, um, shocking.

Dr. Torres: Abortion care is listed in the ACOG, the American College of Obstetricians and Gynecologists, the ACOG guidelines, it's part of ACOG guidelines. So basically, when you say that, you say, “I don't follow ACOG guidelines” and I'm sorry, but I'm not gonna go to any OBGYN who does not follow standard practices; that is inexcusable, especially in 2022, in the 21st century. This is not anything we should even be discussing. It shouldn't have been even discussed after the 20th century when we finally made abortion legal way too late. But anyway, better late than never. And here we are again. It, this is not it, it doesn't make any sense. It doesn't make any sense that one afternoon I am a fellowship trained OBGYN that provides comprehensive healthcare including abortion. And the next day I spent 10 years training to become what is considered a felon in the state of Alabama. And by the way, I do not have sovereignty over my own body.

Jennie: This also makes me think of… I'm sure you've had this conversation many a time, but where people start a story of, “oh, I had a friend who went, who was pregnant and was giving birth and wanted to have her tubes tied or something right then. And the the doctor said they couldn't do it right then…” And like they were starting to get on with like this whole saga. And I'm like, wait, I know where this is going already. Was it, was it a Catholic hospital? Um, and so many people being caught off guard be like, oh, how did you know? And I'm like, yeah, like it, I so many people are not aware of like services that they won't provide.

Dr. Torres: Religious freedom does not mean freedom to impose your religion on someone else. Religious freedom means you're allowed to practice on yourself, your own religion-- that does not go into the clinic, that does not go into the hospital, that does not pass go or collect $200. Your religion is your religion. Evidence-based medicine is evidence-based medicine and that is what you need to be providing for your patients, which includes informed consent. Informed consent, according to the American Medical Association, is complete factual data and evidence as supported by the current research and practices of all of the options, including the risks and alternatives-- saying “I'm Catholic” is not part of that. And so those people have been failed and bamboozled and their health put at risk, especially if they had health risks during that pregnancy and now they're risking another future pregnancy where likely those health risks, those health risks get worse. Pregnancy is notorious for being whatever it is the first time and then if something happens, it's likely to happen again and it probably will be worse the next time it happens.

Jennie: Well, and it also makes me so angry of like not telling people that's why they're being refused the care. So they don't know that like, “hey, if I just go see a different provider, like I can get the care I want,” like it's all terrible, but like the, the not being completely open and honest about it makes me so extra angry.

Dr. Torres: Well, and that's again, I mean that's unethical, right? So not only is it unethical to withhold that care and essentially what I would call hiding behind your religion, but it's also unethical not to disclose that and leave patients with fewer options that are not scientifically based, fewer options. They are personal belief-based and that is unethical and you should not be practicing medicine if that is how you're going to practice medicine because it is unethical.

Jennie: Dr. Torres, I could talk to you for forever, but I don't wanna take up a ton of your time. So maybe we'll end with, I always wrap up with what action, like what can our audience do? This seems like such a huge problem. What, what's things can our audience do that are helpful right now?

Dr. Torres: I would love people to walk away with this… well these, these points, I guess: abortion is healthcare and that's a fact. And if you have to defend that, you can say-- look up maternal physiology, end of discussion. So when there are bans on abortion, that's bans on healthcare. Abortion does not exist in a bubble. Abortion is part of the reproductive healthcare spectrum, as is prenatal care, as is fertility care, as is birthing care. And when you remove access to anything on the spectrum of healthcare, people are harmed. With abortion, some things that happen are more people die in pregnancy and childbirth. Our healthcare system is designed to make certain people rich at the expense of the lives of other people. Hospital administrations, pharmaceutical company executives and insurance company executives all win at the expense of lower socioeconomic class people. Marginalized people, trans people, LGBTQ+ people, people of color, uh, women, all of these marginalized groups suffer and are more likely to die because of our healthcare system. That's real, that's data, that's math. Our healthcare system needs to be burned to the ground and rebuilt, rebuilt so that patients are centered so that healthcare outcomes, real lives involved are centered. And we can do that. Other countries do that. It's not a question of how, it's a question of if, and as it is, people don't want it bad enough. And I think that's because the status quo works for those people. I am not happy with the status quo. I'm white, I benefit from it. I get that I'm a physician, I benefit from it, but I cannot sit back silent because I see firsthand the real people whose lives are really harmed by the way things are. It's not an easy fix, but it's fixable. And I think that people need to start thinking about what it would mean to have a taxpayer-based healthcare system. And that also includes taxpayer based higher education. I would gladly invest in someone's medical education who will then take care of me when I'm older. I'll gladly invest in someone's legal education to protect me legally or someone's engineering education so that the roads I drive on are safe. We should have taxpayer based higher education just like we should have taxpayer based healthcare, like many other countries already do have both of those things. And then you're not graduating medical school with a quarter million dollars of debt like I did and needing to have a job that pays an enormous salary like I did because you have an enormous debt to pay. But if you take those factors out and you have a reasonable salary, you probably have the right kind of people going into the medical field in the first place. And so those are the sort of take-home points of all of the issues that we have. And I think that people need to start, you know, making their voices more known to their legislators, making sure that you are seeking healthcare from someone who is going to respect your life and your medical decisions. Because if you don't give them business, and that's what our healthcare system is, it's a business, it's a capitalist system, then hopefully some things will change. But you need to use your voice.

Jennie: Yes, using your voice is so important. Like having one-on-one conversations with people, like I think changing hearts and minds is one of those things that it's a lot of work and I think people don't necessarily think of it as doing much, but you never know whose mind you're gonna change or who, if you change that person's mind, whose mind they'll change. It's important work that needs to be done. Um, I'm a big proponent of that. I would also add another really important thing that people can do right now is supporting clinics like the one Dr. Torres works at. And one way you can do that is donating to, Keep Our Clinics. That is, uh, that works to make sure that clinics that are providing abortion care are able to stay open. Um, because so many of them are open and still providing services, um, including post-abortion care. If you have to travel out of state to get the abortion, but you have a complication or something in that nature, you may be able to be able to go to the former abortion clinic to get care that you need instead of traveling back to where you had to travel.

Dr. Torres: Or fearing judgment or you know, poor healthcare provision from other places that might judge you for having had an abortion at West Alabama Women's Center. We are not reporting you to the police, we are not doing anything like that. We are a safe place free of judgment. We want people to get healthcare that they need and that's, that's our job and we are patient focused.

Jennie: Dr. Torres, thank you so much for being here today. I had a wonderful time talking to you.

Dr. Torres: Thank you so much for having me. I'm very, very honored to be here.

Jennie: Okay y'all, I hope you enjoyed my talk with Dr. Torres. I had a wonderful time talking to her.

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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