The Landscape of Abortion Care w/ Dr. Colleen McNicholas

Everyone always has a choice. Whenever somebody says no, you can't, or there's no rules for you, or you have to look like this, I go. I'll show you. I'll show you. Welcome to Go, ask Allie. I'm Alli Wentworth and today I'm discussing the landscape of abortion rights. I'm going to read a quote from the book Lady Justice by Dahlia Lithwick. In three the U. S. Supreme Court handed down is seven to two opinion in Roe v. Wade, and the American public has been in a heated civil war over

women's bodies ever since. This one issue. Abortion has been at the heart of every Supreme Court confirmation hearing for decades. Either explicitly or by way of secret signals and codes. Abortion providers have been gunned down, clinics have been closed, and state legislatures with the highest maternal death rates have passed laws that make it all but impossible to terminate at pregnancy. There As of June, Rob Wade is overturned and in half the states abortion is illegal or soon

will be. My guest today is Dr Colleen McNicholas. She is the chief medical officer of Planned Parenthood St. Louis Region, which also includes southern Illinois and southwest Missouri. She testified in front of the Senate Judiciary Committee this summer sounding the alarm for what medical professionals and their patients are

facing since Roe was overturned in June. Dr McNicholas has a unique insight guarding both sides of this issue, as Missouri is a banned state in Illinois is a protected state, and her work has been tireless. Welcome Dr Colleen McNicholas in St. Louis, Missouri, right now, that's right. I'm happy to be here. I'm so happy to have you. So we're going to just do a gentle dive into this world of women's reproductive health for my listeners to get

a real sense of what the landscape looks like right now. So, with the overturn of Roe versus Wade by the U. S. Supreme Court in June, abortion policies and reproductive rights are in the hands of each state. So half of the U. S. States are expected to ban abortion, taking away the constitutional right to a women's choice. Am I saying this correctly? Doctor?

I would add that the constitutional right, the federal protection to abortion has been eliminated, um, no matter where you live, and so you're right now, it's really left in the hands of the states. So I'm going to ask you, um, just to quickly define some terms for people so that when we use them, people will understand what we're talking about. The first term is trigger laws. If you could explain

trigger laws or we say trigger bands. So many states, my state included, had passed laws prior to this jobs decision that essentially said, if ever the Federal Protection the Road decision goes away, then in that state abortion would immediately become illegal. And in fact, that's exactly what happened in Missouri. Within minutes of the DABS decision being handed down. Our Attorney general invoked our trigger band um and Missourian's lost access to abortion, right, Okay, So that is a

trigger ban or trigger law. So what is a pre viability gestational ban? So after the Road decision, there had been a couple of other cases that came before the Supreme Court. Maybe the most notable following Row was the Casey decision, which really set up a framework for allowing states to restrict or regulate abortion based on points of pregnancy and viability was was the point that they chose.

And so there are states across the country, and I'll give Florida as an example who currently have implemented a pre viability ban. In Florida, you cannot get an abortion after fifteen weeks. And so what we know is that fifteen weeks is well before the point in which a pregnancy could survive outside of the person carrying that pregnancy, which makes it a pre viability ban. Um Okay. Method bands. Method bands means that states specifically target a type of procedure.

So it would be like saying, we are going to ban hysterectomyse for the purpose of um eliminate bleeding problems. Right, But in this case, there's specifically targeting a kind of abortion procedure. So if somebody needs an abortion, for example, in the second trimester, abortion a little bit later in pregnancy, there are only a handful of ways that we can do that, and by eliminating those possibilities, you then by de facto eliminate the access to that procedure or that

point of pregnancy altogether. And those are most commonly like dilation and extraction procedures. Correct, well, the most common way to do an abortion the second trimester is a dilation and evacuation UM a little bit different than a dilation and extraction, but what we know is that it's the

safest way to accomplish pregnancy termination later in pregnancy. And so there's lots of ironic things about the laws that states pass and anti abortion extremists past, but by and large, most of the restrictions and laws that they passed the band's targeting either justesational agor procedure type really make abortion less safe and and don't don't change anything about how

common it is. Okay, and s B A copycats. So Texas was, as everyone knows, allowed to enact and implement um essentially a type of law that is unique UM in the world of abortion regulation. They essentially allowed any comer, anybody in the whole state could target anyone that they thought was having an abortion or helping someone get an abortion, and an sp A was really focused on civil penalty, So you could be sued for helping your granddaughter get

to the abortion clinic. Your church could be sued if you were counseling folks or driving them to their to their appointment. But the penalty was really money. Right that there was a sort of a bounty hunter component to it, And since that has been allowed to go into effect, many states have tried to copy that and or build

on that. In Missouri, UM last year are one of our most extreme legislators introduced a piece of legislation that took the framework of that sort of all comers can attack anyone having or assisting an abortion, but extended it beyond our borders to say, it doesn't matter if a Missouri and is having a legal abortion outside of the outside of Missouri's borders, we're going to attack you too.

So we're gonna have to look out for some more of those kinds of bills UM in these coming legislative sessions. To okay so and and the High Amendment. The High Amendment UM is a longstanding federal regulation which really, um, it's quite honestly a racist way of targeting the most marginalized and most vulnerable. So what it says is that no federal dollars UM Medicaid dollars can go towards paying

for abortion services. And we know that abortion bands impact the most marginalized poor folks, black and brown community is the hardest, and so by eliminating that funding stream for folks to pay for this basic health care, we are putting that population at it even larger disadvantage. Okay, so those are these are kind of terms we're going to be discussing during this conversation. UM. Basically, Now, am I being extreme if I say only wealthy women in blue

states can terminated pregnancy? Well, I think that for folks who are not wealthy women in blue states, it is

incredibly difficult and has gotten exceedingly more difficult. There is an incredible network of abortion funds and practical support organizations and abortion providers who are doing their damnedest to make sure that UM, people of color, people in these communities where abortion has been banned still have access but it's pretty bleak, and I think to your point, the only people who have easy access are are folks who don't

live at those margins. And by the way, I've been reading over the past few months about how in Mexico UM they're even trying to get sort of morning after pills and you know, abortion care through their network into America Last Libres I think they're called. So even other countries are trying to help us. You know, if you look at the last fifty years, unmistakably the globe is

moving towards liberalization of abortion. There are only two countries that are moving backwards towards criminalization ours UM, and we're joined in that by Nicaragua. But truly across the globe there are probably since almost forty countries that have liberalized their abortion laws because they understand the public health crisis that results when you don't have access to safe and

legal abortion. I'm curious what you know when I said, I actually saw my internist this morning and I said I was doing this podcast and we were going to be talking about abortion rights, and she goes, I don't say abortion anymore. I say women's reproductive rights. Because even the word abortion is so triggering to people, and it's so much more than that, And I thought, you're right, it is women's reproductive health. I mean, that is the umbrella of all of it. So I'm curious you are

embedded there in Missouri fighting the fight. What are some of the biggest concerns you have right now? I know there are many, You're right, there are There are an endless number. But here here's the thing. You know, having practiced in Missouri for the ten years before the dab's decision, nothing about this moment was shocking to me. But you know, we've been preparing for this moment um. So there are

a couple of things that I worry about. Um, you know, there's short term problems, right, and the short term problem we we talked about a little bit already, right, which is the mass migration of people for basic health care. Right. We are staring down a reality where states will have abdicated it's basic responsibility for this very common health care.

And when you overlay that with other public health crisises that are happening at the same time, So maternity shortages, right, So there are huge swaths of the country where you can't get reliable o b g y N care. Right, So we're talking about forcing people to stay pregnant in places where there is no O B G y N in a country that has one of the highest, if

not the highest, maternal mortality rate for developed world. And so the overlay of those three things really causes I mean, we should be terrified about what the ultimate consequences of

those things will be. I mean, the the other thing is that we won't really know the full public health consequences of this decision for probably decades, but we do know every single day, and we are sitting with patients every single day who are traveling hundreds of miles from all across the south in the Midwest to our Illinois facility. And the infrastructure that is in place now is not going to be able to sustain moving that many people

who need so much resource for this care. And so I'm really worried that the existing network of abortion providers that are left are going to really struggle to be able to absorb the millions of people who are now going to be traveling for this care. You know, one of the things I keep thinking about with Missouri and Texas and so many of these states that have banned abortion is they see it in a, in my opinion,

in a very microscopic way. And I think about how we are trying to communicate the crisis that as women were in. And sometimes there's a part of me that wants to say, hey, by the way, if your son gets my daughter pregnant, he has to drop out of college and go work at the seven eleven because he now has to buy diapers, which are very expensive. Like I sometimes think that we need to pivot even the way we think about it. And you know, sometimes I want to say, of Texas, you know, the white women

in Houston, they're going to get abortions. It's the people that you demonize so much that aren't going to have the access. So there's to me, there's there's communication things that I feel aren't being penetrated through all the talk about like, oh, women abortions, Oh you're killing a baby,

like that seems to be the conversation over and over again. Yeah, I think what you're verbalizing is that you know their goal, their intent really has nothing to do with public health or the outcomes of families and how we build sustainable and healthy families. Right And and to your point, we also in the movement have not done a great job of helping folks understand that abortion truly is an intersectional issue. Right.

It's an economic justice issue, it is a racial justice issue. Um. You know, if we look, you know, carefully at why folks choose to have abortions, it's not because they don't want children. In fact, most of them are parents, most of them will have future children. It's really because despite being the country with some of the most consolidated wealth in the globe, we are also a country with the

highest levels of poverty. Right, And so if you want to impact the reason that people are having abortions, we really have to start looking outside of the actual act of abortion. We have to look at how much childcare costs, and how much of our population is still uninsured, Um, how many people are living in communities where the schools are not accredited. Right. We really have to think about an abortion as not just a reproductive health care issue, but also as as an issue that touches so many

different intersecting aspects of people's life. Yeah, it's just very hard to get that messaging out because you are met with you know, it's anti Christian. You're going to go to hell and you're a murderer. I mean, the terms that are thrown back are so severe and so strong long it dilutes any messaging you know about women's healthcare, I find, you know, I think one of the real ways to combat that is to to do some hard

work around stigma. We know that there are lots of religious folks who both have abortions and support abortion, So we have to do some work of taking back some of that language, right, Um, And that's hard because the stigma of abortion, having abortion, supporting abortion, providing abortion has been so ingrained in folks that sometimes it feels really risky and hard to take that step and say, actually, I'm a person of faith and I've had an abortion,

or I am a person of faith and I support abortion, or I was about to die in the hospital and I had to get an abortion. Absolutely. The other thing we have to do is help people realize that because abortion is healthcare. You know, I can't tell you how many people say, after I talk through what an abortion is or the many many scenarios in which people come to abortion care, they say, well, I did that, but that wasn't an abortion. Yes, yes, my friend, it was

an abortion. UM, and so abortion isn't just one thing. Even the basic reproductive health care they got was actually abortion care. Let's take a quick break and we're back. So walk us through a sixteen year old girl who's pregnant in Missouri and she needs and wants to get an abortion. What is she up against right now in Missouri? Well, she has to leave the state, um SO, she would have to one final place to to have that care.

And depending on where she went, because she's a minor, there may be some additional regulation and rule around accessing that care. I'm sorry, Well, she need parental concern. It depends on where she goes um SO, which now, obviously we are no longer providing abortion care in our St. Louis, Missouri facility, but we do provide abortion care across the river in UM in Illinois. And in Illinois is one

of the states. I would say that if Missouri had spent the last decade making sure that abortion was eliminated. On the flip side, there are places like Illinois who were doing some real work to make sure that abortion access was UM was solidified and so UM. Just this past year, the last remaining regulation in Illinois was overturned, and so no longer do folks who are seeking care in Illinois. Miners who are seeking care in Illinois need

any sort of parental consent. Having said that, most of our miners come with a trusted adult um that they've already disclosed, you know, their their need for care too. So this individual, depending on where they ended up, may or may not need parental involvement, which, as we all know, is sometimes okay and sometimes not safe. She would need to have money to pay for her procedure, so Missouri, like many states, has banned both public and private insurance

from covering the cost. So it doesn't matter if you are privately insured. If your insurance is through a company in Missouri, even if it wanted to, it couldn't cover the cost of your abortion care. And how much would that cost her, Well, it depends on how far along she is, but it's probably in the first timemester is

somewhere around five to seven dollars. Okay. Now, of course, if she's um, if she's coming to us, we help sort of pair her with things like abortion funds and those sorts of things to help reduce the cost in some of those barriers. Then she has to figure out how to get there? Right? Um. You know, one of the things that we are learning, lots of our work in this sort of post jobs time frame has been

around helping folks navigate those logistics. And so you know, we're finding that there is some real nuanced questions and surround navigation. Right, not just do you have a car to get to us? It's can your car drive nine miles here and nine miles back? Right? Does anybody else in your house rely on that car to get to work? Because although we know you're going to lose wages for today, we don't want to eliminate the possibility that your entire

family loses wages for this day, right. Um. So she's got to figure out how to find the place. Does she need any additional support from or is there requirements around parental involvement? How is she going to get here? How is she going to pay for it? Um? And you know, the constellation of those things makes it just impossible for some folks to to get there, even when we can provide them some support and managing those logistics. So what are what are you seeing right now this week?

Dr McNicholas, What are you finding to be the biggest obstacles, you know, besides the obvious ones, what what are you you know, frontline fighting right now? I would say hardest thing for us is really UM demand. UM. So before the decision, we were we could get folks in within two to three days, and now it's two to three weeks. And that's even on top of moving some operational things.

We've gone to six days a week and ten hour days UM and occasionally adding some Sundays into the mix to try and provide some more space for these folks UM utilizing every resource we can, telehealth and UM. But you know, the increase in demand, despite increasing hours and days, we haven't really been able to to move that needle at all. Folks are still waiting two in three weeks, which means they're also presenting for care later in pregnancy

when cost more, when they might need to stay overnight. Right, So it just compounds the barriers and the burdens that folks are navigating when trying to get this care. And how effective do you think it's going to be to have an abortion pill so that you can do the tell health element with the pill? Do you think that that's sort of going to come to be the way women terminate pregnancies. But we have definitely seen in the last couple of years that the utilization of medication abortion

has gone up dramatically. It is super safe, but it's not a method that everybody loves, right. It's a little bit unpredictable. Um. It takes a couple of days for

the whole process to sort of go on. Some folks have some privacy concerns around having to do something at home, so it's not a perfect solution for everybody, um, but it is an excellent option for many people, and absolutely we should be thinking innovatively about how to use technology and other things to keep the folks who can have care outside of the traditional brick and mortar health centers out of those centers, so that the folks who really

want to have procedural care or have to because either a medical co morbidity or because they're too far along for medication abortion, that they too have some highly access to care. By the way, I didn't know I was pregnant until got three or four months in, so you know, when you're pregnant, the days, the weeks go by pretty quickly. Um. What are the biggest fears you're hearing, are you hearing

I'm afraid of being imprisoned. You know, Yes, some folks are worried about criminalization when they go back to their their home states. Um. But the truth is that most folks come to this appointment understanding that it is a health care service that they need, and they need it now, and they're willing to take risks and do whatever they can um to be able to access that care. That's

been true for all of history, right, Um. I oftentimes say that the legality of abortion doesn't drive the necessity of it, right, and that folks are gonna do what they can because it is such an important decision for them and the health of their family, and and sometimes, as you said, even themselves, right that we s only know that pregnancy is not a health neutral event. Do you actually do you actually have any data about how many women who try who try to self abort, how

many women die in our country a year? Well, I would say that in our unlike in the pre road days when self managed abortion was unsafe, right, where folks were using um substances or chemicals or physical violence sometimes or trying to um sort of procedurally induce their own abortion. I think we're in a different space now, and I think in terms of sort of the safety of self manage abortion, there are sort of what I think are three things that people need to be able to do

that correctly and safely. The first is they need the right medication right. Um, If they can get the right medication, then we're you know, we're more than halfway there. They have to know how to use it, and they have to know when something might be abnormal. Now, medication abortion, whether you sit with me in a room or across the screen, or or where you just get the medication online and you have instructions you know, to read yourself. There's nothing unsafe about that, so long as you know

the parameters of when to seek extra care. So I think that self managed abortion will be a little bit different in this time frame than it was pre row. Having said that, just as we know that not everybody will be able to travel for abortion care, in this reality, not everybody will be able to get medication abortion, either via telehealth or some other way. And so there's still going to be a proportion of folks who we either

forced to stay pregnant. And then you know, as we know, will some of those at least will suffer significant pregnancy complications and maybe even die when really what they wanted was to not be pregnant um or perhaps they you know, some portion of folks will will turn to some other methods to terminate their pregnancy. And what are your thoughts

and what are you hearing about mobile abortion trucks. So we just announced last week that our affiliate is getting ready to roll out the first in the planned parent head system, certainly not the first across the country, but the first in the planned parent Head system mobile abortion clinic. And you know, for us, it is an important innovative strategy in how we're addressing this access problem. Right, So, there's only so much we can do to help get

people to us. The other component is moving our care closer to them, right And so we, as I said, we already know that particularly medication abortion is so safe and does not require in person care for most people, and so mobile abortion care is a real opportunity to

just get closer to them. If we can reduce their trip from four hundred miles to two miles, we might be able to get them back to work even that day, right, Or we might be able to get a childcare visit for them in a way that now makes this more accessible. So walk me through how these mobile abortion units work logistically. Yeah, well, I'm not sure how Just the Pill is. The other organization I know who runs a mobile abortion clinics, so I'm not entirely sure how the operations for for that

organization works. But for us, the process is going to be very similar to what happens when you call us for an abortion in either in our health care facility or via telehealth. So folks call, we will be able

to call and make an appointment. UM, will do the same screening that we do for folks now to make sure that medication abortion is a safe option for them, that they understand what the process is like UM, and then then we will work with them to figure out, you know, what is the closest place for them, are the most convenient place for them to be able to

either have that visit or pick up their medication. And for us, you know what we're in the process of doing right now is you know we are now three months post jobs and in a whole lot more months

post s B eight. Right, that really was the beginning of us seeing folks doing a lot of this traveling, So we actually have some data now to say where are folks coming from, what is the route in which they travel, Where is the most convenient place for those folks, right, And so we're looking at those travel patterns, were sort of drawing those geographic circles to say, Okay, it looks like we could have the most impact if we bring

the mobile unit to this area. And when you go in these units, is it just pillformed abortion for us? Right now? We're starting with medication abortion, but we have plans for and we have outfitted the unit to be able to give first trimester procedural abortion as well. Got it? And I'm assuming that these units are not huge right there, Like, well, I don't know. Ours is pretty big. It's a thirty seven ft r V. Oh that's big, okay, And it's pretty big. Yeah. It has two full exam rooms in

a lab in it. So, oh my god, that's wow. And we'll be right back and we're back with more. Go ask Galley. You must be worried about criminalization of the unit. Certainly there must be fears about sort of being out in the world unprotected, so to speak. How are you taking care of yourselves. Yeah, so it has always been true that antis are going to continue to try and attack regardless of what we do, and so I think that can't be a deterrent for us in

moving forward to expand access. So, as you said, UM, you know, although we are pushing boundaries and being innovative, we're going to do so in a legal framework. Um. If if we're in jail, we can't provide care, so that's not helpful, right, So the unit will will be operationalized throughout southern Illinois and we're going to get close to those borders so that we can help folks reduce the burden and the travel. But for us, it's going

to be you know, within the Illinois Illinois borders. But again, you know, as we look at the next legislative cycle on session, we fully expect that folks are gonna look at things like the mobile unit and try and find ways to attack that that kind of care too. You know,

I'm curious. I think it's important to ask you this question because of what we talked about before about not only the stigma of abortion, but what everybody, certainly in a lot of these states that have banned abortion believe, Um, that it's you know, the murder of a child. But would row versus way to protect besides abortion? Yeah, So, UM, the foundation of that decision was really rooted in privacy.

And there have been many other decisions since then, unrelated to abortion that use that same framework, UM, marriage equality being probably the most recent and most relevant. And so I think there lots of concern, and there should be lots of concern that other rights that are afforded to us based on protections of privacy are now up for grabs, UM, trans rights, UM, access to contraception right. So it wasn't all that long ago that folks could only access contraception

if they were married. Um. And so you know, we should be thinking about what is next because now so many things are up for debate. I mean, what happens if they do a federal ban on birth control? Well, is everybody going to get a vasectomy? I mean, how's that going to work? Well? I really, I have yet to see any mass movement in pregnancy prevention from male

body folks. Now. Having said that, UM, I will tell you that one of the services that we have seen the biggest increased demand for in the post jobs decision is for vast sectomy. Um. We have seen lots of folks coming forward for permanent sterilization, both both tubal sterilization for for female bodied folks and for vas sectomy, because folks know, right they abortion today and birth control next, and you know, this is a way that they, at

least at the moment, can have some reproductive autonomy. Those are expensive procedures a vassectomy or getting your tubes tied well, certainly for uninsured folks. You know, it's out of reach for them for sure, and it's permanent, right, So it does although I fully believe that people are capable of

making the decision to become permanently sterile. Um, we've now gone from uh, there are a whole host of reversible methods of contraception to I just want to skip all that because I'm that worried that I'm not going to be able to control my own fertility. So, you know, the past few months there, I mean, women have been

marching there on text threads with each other. A lot of women, not all women, A lot of women are upset by the overturn of Roe versus Wade, and I feel and I've talked to a lot of women that feel like they don't know what to do. So a lot of people feel, well, I'm gonna go. I'm gonna help people vote. That's the only thing we can do. We gotta we gotta help women vote. Um. Other women are giving a lot of money to abortion clinics. Um. And I think overall people are trying to do and

trying to help in any any way they can. But for the women listening to this podcast, what is the most productive thing that women can do to help scaffold this fight and help with women's reproductive rights? What can we do? I think there's actually two things, and the first is pretty simple but maybe the most scary, and that's talk about it. So I oftentimes say, in every single conversation, you have say the word abortion. Right. Um. Oh so say okay, sort of a running joke in

my family. My my wife is also a position and so uh not an O, B, G, I N. But so when we're in spaces for her work, she it's sort of like, can you wait like three minutes before you talk about abortion? Um? But but the truth is, you know, say it because saying it normalizes it, right. It allows people to feel like they have permission to also share their support. Um. We talked about earlier that so much of this is rooted in the stigma around abortion.

So I should say I started this podcast by saying that my intern has said call it women's reproductive rights, and you're saying, say abortion, So I should be saying abortion. I think saying abortion helps reduce the stigma around it. And you could say abortion is healthcare, um, but I do really think it's important to say the word because the word has become dirty somehow right and bad, and it's not bad, it's healthcare, right, and so I do feel strongly that we need to be talking about it.

And the other thing I would say, and this is sort of you know, bigger picture, is to take some steps back and when you are in other spaces, meaning when you are you know, marching against racial injustice, bring abortion to that table. And when you're thinking about democracy reform. You know, we didn't get to this place just because

of abortion. Right. The reason that we had a failed pandemic response was because you know, anti abortion extremists, the same ones who were anti vacts and anti PANDEMICUM, they had perfected the sort of silo wing of public health, creating this um situation where folks don't trust science, right, this is this is all part of the same picture. And so UM, I would say my second sort of ask is that you're involved in sort of the broader work of democracy and social justice issues because they really

are all intertwined. That's that's great. What about donating to abortion clinics and abortion care? Is that helpful? Have you found an influx of that? Absolutely? So. You know, I talked a little bit about our work to help manage logistics.

You know, when Texas Spate was first allowed to be implemented, we rolled out what's called our Regional Logistics Center, And our Regional Logistics Center really is a case management style operation where every person who's coming to southern Illinois for abortion care, either with ourselves set Planned Parenthood or with our independent clinic partner, Hope Clinic, UM, is offered a case manager who walks them through all of the logistics. How are you getting here? Who's watching your kids? Do

you need a hotel? Um? And it's sort of it's twenty four hours a day service. How help folks get to this? Right? That cost a lot of money, UM, And so we have done a lot of work to pair with abortion funds. Donating to abortion funds is it critically important? They're an important tool and being able to

help folks navigate this work. Um, But looking at places and organizations who are doing this work, the Regional Logistics Center, abortion funds, practical support organizations, that's really the short term. I think financial support that that the movement needs. Right now, what do you think the next generation of doctors is going to look like? I'm worried. Um, you know, I think as I think about sort of these long term consequences.

What we know is that about almost fifty of our O B, G, I N trainees are training and states where abortion is either already illegal or will soon be illegal. Which means a couple of things. Right. It means we're going to have a workforce that doesn't have the technical

skills to take care of some obstetric emergencies. Right. It means we're going to go back to a time where people are required to have hysterectomys or major abdominal surgery for ebstetric complications that could have been fixed with a D n E procedure. More importantly, I I will say I think that we are going to create a workforce of O B G I N s who did not have an opportunity to really understand the therapeutics and empathy.

You know, UM, I spent the first part of my career in academic family planning training residents to be competent O B G y ns. Not all of them went on to provide abortion care, but they all got to sit with hundreds of patients who are accessing abortion care to understand their stories, to understand how they come to this decision. And I fully believe that that opportunity to develop that empathy makes them better physicians no matter what they go on to do, whether they provide abortion care

or not. And that is going to be lost for you know, the next generation of providers. Oh my god, empathy is such an important word for this, um, You know, Empathy to me seems like the ingredient missing from every single horrific piece I read about this, from civil rights to abortion rights, all of it. Maybe we're losing empathy as a as human beings. I don't know, it feels

a little bit like that right now. Well, it's really easy to demonize things that you don't really have a personal connection to, right and so we're in your stand or understand that's right, and you know it's um. You know it is really a privilege and honor and and certainly fuels for those of us who provide abortion care. Fuels are continued work in this space to have the opportunity to sit with folks and to see the impact

that abortion has on their lives. Um. For so many people, you know, whether it's me handing them a pill or it's a procedural abortion that takes three minutes. Truly, you can see in just that short amount of time that folks feel like, Okay, now I have a chance. I can get my feet back under me. Right. I might be able to get my family out of poverty. I might be able to pay my bills next week. Right, I might be able to go to school. I might

be able to finish school. Right. Um. And when you don't have those stories or those experiences, and for many people, they just choose not to engage with it. Um. But really, when you fill in the picture with all of the grade that exists in the middle, it's really difficult to demonize folks who want to need abortion. Thank you so much for talking to me about this. It's always tricky and scary to talk about this because you want to talk about the right things, um, and there's so much

to it. I mean, this would be like a three day podcast if I got into the weeds of everything. But thank you for talking to me so honestly, and thank you for the work that you're doing. And I really appreciate it. Well, I appreciate the opportunity. As I said, it's so important that we elevate the conversation and so you're doing your part two and thanks for that. Absolutely, thank you calling, Thank you for listening to Go ask Ali.

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