The Loss of Abortion Rights Will Send Reverberations Through Many Spheres

I am back and I mostly refreshed and ready to face all of this stuff. I mean, mostly it was so delightful to take a week off and just do nothing. I did nothing y'all I did nothing. I did some fun reading. I read, you know, light fluffy books that are like beach read style books. I watched some trashy TV and movies. I did some baking and I didn't think about work or deal with work, or I didn't really think about repro too much.

It was just so delightful to take the time away and do nothing and do what I needed to do to recharge a little bit. I know June and July are going to be really , they're gonna be a lot. They're gonna be a lot, right. We're expecting row to come down and it's gonna be a lot and there's gonna be a lot to do. And I needed to take a break to prep myself for that.

But, you know, I think I , I talked about as maybe one of my new year's resolutions of just being better to take time off and to take a step away. Y'all we know that this fight for bodily autonomy is it is , uh , definitely a marathon, maybe an ultra-marathon, right? Like it's long and hard and it is not a sprint. So it is definitely something that you need to do, what is best for you to be able to do best for the fight.

So I know that means taking a step away every once in a while and taking a step back and then coming back when you are able, and that's fine and we all need to do it. And so I'm very glad that I took the week off. I , uh , I think I had mentioned I wanna be better about this, so I will definitely be taking more time off, even if it is just to do nothing and just to exhale and take a deep breath and relax, and be ready to come back in and keep fighting because gonna keep fighting, right?

Like there is a lot of fighting to be done and I am ready and I am more ready now that I took a week to recharge. So with that, let's turn to this week's interview. Y'all I had such a wonderful conversation with Pamela Merri , the executive director of medical students for a choice. It was so wonderful talking to her. We had a really great far ranging conversation, and we talked about everything from criminalization around abortion, to around to talking about more of the intersectional issues.

We need to think about when Roe comes down to thinking about what it is gonna need for medical schools and for people who need education around abortion or training, it was a really wonderful conversation and I hope you all enjoy it. Oh, and I just wanna flag one thing. I recommend a book while we were talking, but I think I forgot to mention the author. So I just wanna throw that in here so that if you look to find it, you can find it.

So I really recommended around criminalization that people read policing the womb by Michelle Goodwin. So I just wanted to throw that in here. Okay. With that. Let's go to my interview with Pamela . Hi Pamela. Thank you so much for being here today.

And one of the things that I think people are going to need to worry about is criminalization mm-hmm can you maybe talk about how that's, how that works?

There will likely be attempts to criminalize, aiding and abetting. And when we talk about self-managed abortion with pills, we're talking about a, you know, a phenomena that, that presents exactly like miscarriage. So because we're an international nonprofit , we are currently monitoring things on the ground in Poland, where they are creating a registry of pregnant people and they are doing it some with self-reporting and some of it with investigation.

And you know, we're not that far away from that. So when you have criminal penalties, when you have felony penalties for the person who administer or performs the abortion, and it's a medication abortion, then that is done outside of a medical environment, then you are criminalizing the pregnant person. And we have reached the point, as you said, with the imminent fall or fall of row , we're operating as if it's already gone.

And we've reached the point where we no longer are gonna be, you know, we , we no longer should allow for people to try to spin this. It is illogical to have a criminalization, to have a , you know, charges on the books for law enforcement, that doesn't also have a mechanism for evaluating crime scenes and evaluating situations. And then also has a mechanism for enforcement. And what we're seeing in Poland is that they're developing a mechanism for enforcement, for monitoring.

It's no different than a pseudo fed database that exists so that they can monitor a , you know, for methamphetamine use. So when, when I think of criminalization, I really think of it in, in an intersectional, broad scope. So the United States has the worst pregnancy outcomes in the developed world.

And every single state that is listed on the G mocker map for going dark on abortion access also has particularly bad pregnancy outcomes within comes within a country that is failing people who experience pregnancy. So they suck within a country.

That sucks when we talk about, and in terms of criminalization, many of those states in the Midwest and in the south are also in the midst of a movement for criminal justice reform for defunding, you know , the police and trying to establish some mechanism of accountability for state violence against and brown people. And the hyper surveillance of communities of color is already in place.

What we're really talking about from an intersectional lens is criminalizing abortion in an environment where black women and people who experience pregnancy are, are making very, very time sensitive , critical decisions that are best for their family and are now gonna be doing so under threat of first degree , murder charges, manslaughter, or aiding in abetting charges that are akin to manslaughter. So criminalization is real and how it happens is something we already have experience in.

Like, we don't need to speculate about whether or not they're gonna go through trash cans. We know that they go through trash cans. You know, I know people who have had social workers go through their drawers and do their personal items on home visits. So, you know, this is not a drill and I'm not catastrophizing. When I say that criminalization is a very real threat. Now the movement has set up some really awesome resources. The trick is making sure that people are aware of them.

So if, when, how has a hotline that has been in place for a while that people can call if they need legal help, but also can call if they just wanna understand their legal liability. And I know that that national advocates for pregnant women has been working on the criminalization of pregnancy outcomes and the eroding of, of civil rights for pregnant people for forever. And now, you know, they are a continued resource and a wonderful champion for people who get caught in this net.

But the reality is that my experience has shown that people get , who are incredibly vulnerable to criminalization are also, you know, incredibly vulnerable to playing out and trying to negotiate for the best possible outcome of a bad situation. So I'm deeply concerned.

I, I think that, you know, we've done a lot of work and we've put together a lot of resources, but the reality is that my community and communities throughout this country are, are living in a different reality than, than some folks think. And I'm not as optimistic about criminalization as some of my colleagues in the movement.

But the reality is that people, they tried very hard, I think, to not have this be a very public situation, because there's a lot of stigma and in, in communities, but what she's accused of versus what she might have actually done. And I, I think that, you know, people who are in marginalized communities are often boxed into corners where they, where they just try to keep it hush, hush, and tried to resolve the situation as best they can.

And that a lot of prosecutors and law enforcement are banking on that.

And then also trying to make sure that people are being accurate about your personal business, but amplify that across 30 states and the threat of being publicly humiliated, the threat of losing the respect of your peers and your community is a part of the oppression that exists when they take away your bodily autonomy.

It dates back to the days of the crack baby myth, and it shouldn't be on the books. It shouldn't be enforced, unfortunately it is .

And of course it is enforced in , uh , Milwaukee way more than in other surprise , surprise , surprise in that act is one where, you know, if you, if you go to the hospital or to your doctor to get a pregnancy test, to confirm a pregnancy, and you fill out your form intake form and admit on the form, as we're supposed to, that you either use drugs or have recently used drugs that you have a history of alcohol use or anything.

Then again, within discretion, they can, they can report you to the state. The state will have a rapid response, meaning that they call a hearing immediately. They could take you into custody, appoint a lawyer for your fetus, and they run this entire investigation and the court proceedings through the juvenile court system under this act. So you can't even publicly try to try to talk about it because of the privacy rules that are in effect.

And, you know, there's thousands of cases of people who have been faced with either treatment or incarceration and have lost their families. As you said, they're already parents, they lose custody of their children. They lose custody of the child if they carry the pregnancy to term. And all of this is built on outdated and thoroughly debunked, miss , because first of all, people should talk to their doctor about, you know, what medications they're on.

And second of all, we know that, you know, people can have very healthy pregnancy outcomes despite being, you know, heavy drug users, or they just need to make sure that they're being honest in getting medical information and in consultation. And a lot of people don't know about this law until they are sitting there in front of a judge and trying to figure out, you know, who's gonna pick their kids up from school while they're being accused of intentionally trying to harm the unborn.

And, you know, so it's just a broader example that there are communities in states across this country where people have been criminalized for their pregnancy outcomes and for their, their behavior. And as Lynn Paltro, who of N a P w national advocates for pregnant women often schooled me that, you know, it's about, it's about creating a different class of citizenship for people who are pregnant.

And so when we think about not having access to a , to abortion and, and potentially, I, I predict also having threats to access to hormonal birth control. What we're really talking about is the, what I like to call the bullet points under bodily autonomy.

So we talk about it and I often talk to people who don't do this work on a daily basis under that it's being able to go to the doctor and find out that you're at high risk for stroke and make a call that will save you from either a catastrophic health outcome or potential death. And that's not, you know, again, not me being dramatic. I personally know people who have had catastrophic pregnancy outcomes.

And I taught at a shelter where every single one of my students, 10 women knew somebody who died or lost an infant. And, you know, it's very real. So that's the first bullet, the second bullet being, you know, being able to space out your pregnancies and also being able to be, you know , the parent that you need to be, as you said, most people who have abortions , um , are already parents.

And then, you know, we're also talking about fertility and, you know, one of the things that I've learned just from the fact that we have chapters all over the world, our fastest growing chapters are in Africa, in south America and central America, nothing makes the case for access to abortion and reproductive healthcare , like a lack of access to abortion and reproductive healthcare .

So there's a reason why med students in Africa are forming chapter after chapter so that they can get resources and training to advocate for their patients. And it's because, you know, it, it impacts fertility. It impacts, you know, the ability to properly treat fibroids, endometriosis, polycystic issues, and so many issues that impact fertility that you know, are treatable, but require that you not be pregnant while you're getting treated.

We're also talking about, you know , uh , risk and the reality of medicine and in the United States, hospitals are like their own little city and they are incredibly risk averse. They have an entire legal team that determines whether or not they can do certain things and they can perform certain things. Most of us are lucky enough to have never had a medical procedure that we need done go before a hospital ethics and liability board.

But I can personally tell you that when it does, and I've had met people who it does the last place you want your healthcare and your life being determined is in that boardroom, but hospitals are risk averse.

So we are already seeing people who are miscarrying being turned away from hospitals and sent back home when they should be given a procedure that helps ensure that they complete the miscarriage and that they have that in ensures their future fertility because , uh , they don't want, they don't wanna risk the liability of getting sued or criminally charged or having their license pulled. We've seen cases already.

And this is just with Texas and Oklahoma going dark of people with ectopic pregnancies, having doctors and lawyers and medical ethicists sit around and debate when your life is in danger versus when your fertility's in danger. And I'll go ahead and answer the question they aren't worried about when the fertility is in danger, they don't want the liability.

So they're worried like will , will this patient Sue me because I created an , you know, a situation where they no longer will be able to get pregnant, or will I face, you know, losing my license in a series of lawsuits in criminal liability, which is very different than what we've ever seen in this country.

So the big issue that's been popping up in discussions in my world is about, you know, in vitro fertilization and the fact that it does , you know, it just doesn't make any logical sense that people would be able to continue in vitro fertilization the same way in a post real world. What that means. I don't know, but you know, the idea that you can just easily hop around when you're in the middle of, for many people in many years , long process, pretty daunting.

And the , the idea of the state appointing a lawyer for a series of fertilized eggs is also daunting. But as I said, you know, there's precedent for this. And, you know, there's, it's deeply disturbing, but we really could see people having access to certain treatments and in people having a certain status of healthcare based upon their geographic location.

And then the broader concern is that for people who are high risk pregnancies, and you know, those of us who are gen X , you know, know what it's like to have a friend say that they have a geriatric pregnancy , uh but for high risk pregnancy, the having felony penalties around , uh , healthcare decisions means that there's a long term threat of losing providers who are willing to take high risk pregnancies.

I don't know anybody who goes to med school and is comfortable with the idea that their patient might die or have a catastrophic outcome that is completely preventable. Um, so I have met these physicians or physicians in training that the Supreme court seems so confident are out there. Physicians go E even reluctantly where they can practice medicine and live up to their ethics and their oath.

And I can't imagine being a high risk obstetrician in a state that, that doesn't give you the option to do what's right for your patient.

So, yeah, I , it , the whole thing is really macab and and dark and twisted, but it, you know, I woke up this morning and I, I just couldn't believe this is where we're at, but I'm calling it the great regression. So that's my term for the time and space and era we're about to enter into

And you know, what we do know is that residency programs, which a lot of people conflate residency in med school, residency programs are the next step after med school and residency programs are accredited with the expectation. They have to either offer abortion training and family planning, training, and education, or connect their residents in an easy fluid way. If it's not fully integrated into the hospital, then they have to find a way to, to get them that training in education.

That's not the case for med schools. And one of the things that medical students for choice has really filled the gap over the years with is that, you know, it's really hit or miss.

It depends on what med school you're at, whether they're religiously affiliated, but for the most part MSFC chapters are the way that med make sure that they're getting the most accurate up to date , abortion training and family planning, training, and education, and also how they advocate for curriculum reform within their universities.

So that brings us to the imminent fall of , and if right now we have not received any guidance to my knowledge on what is going to happen with residency programs that are based in states that are about to ban in criminalize, will those residency programs lose accreditation or will the accrediting body change their accreditation, which is based upon the ACOG standard of care and best practices to meet a purely political and not medically guided ban. So that is on the table. We don't know.

And what we do know is that many of these hospitals are really anchors for their community and my board, which is 50% med students. The med students on my board have already in this last round were ranking residency programs based upon their geographic location and the likelihood that they would be able to easily receive training or access to opportunities for training in hours in a clinic. So it's already impacting what , you know, how people rank, where they wanna go.

The same is true for med schools. And our first ask is going to be our chapters all over the country. Every single med school are gonna be asking their deans to publicly declare their intention around abortion training and education. I think it it's a bare minimum that they owe to students who are currently enrolled and also to people who are considering them for application that, you know, do you intend to continue abortion training and education or not? Ms .

F C has received legal guidance that, you know, it is protected particularly because it's speech, we're not actually at the med school level. We don't actually walk people through performing on an actual person it's on an apparatus. They use the instruments of, but they don't. They have like an apparatus that allows for them to see what they would be doing.

So, you know, for us, we have the right to train and to educate people on this, particularly because if you're in med school in Georgia, that doesn't mean you're gonna go to residency in Georgia. And that certainly doesn't mean that you're gonna continue to your career in a state. So our members are deeply concerned about their ability to gain the skills they need to be competitive, but most importantly, to be good physicians. So we don't know.

And I know what I do know is that the last thing you wanna hear when you're about to spend eight years in a residency program, or when you're about to, you know, spend $250,000 and med school is we're not sure.

And so you, you wanna have the hours in , in the clinic, you wanna be able to do it as possible, but I can't stress enough that even with the wonderful gift that medication abortion is, even with that people are going to need in clinic abortion care either because medication abortion isn't right for them, or because that's the procedure that they need. And, you know, we need to be able to have physicians who have that experience and, and have that skill set .

And the other thing that I wanna point out is that , you know, most of our members, lots of our members don't plan to go into obstetrics in gynecology.

You know, they either wanna become family medicine practitioners, which is one of my favorite disciplines and, or, you know, I , I met somebody who, you know, plans to go into podiatry or something like that, but they know that there isn't a single area of medicine that doesn't have to factor in whether or not somebody's pregnant and offer that advice. And each one of my members wants to be able to give medically accurate information.

And a lot of them wants to be able to have the skill set , to provide if needed and definitely be able to walk their patients through what that's like, whether it's a patient who is, you know , seeking medical support for a pregnancy, or whether it's a patient who thinks they might be pregnant and is about to get their knee surgery done. They want to be able to answer these questions and provide them with, with access and care. And so it there's a great unknown.

The other thing that I see if, if we don't close this gap and we don't fix this manmade disaster quickly, then it won't take more than five to 10 years for us to start seeing really a geographic breakdown of access. And in seeing providers move to where they can go. And that breaks my heart. You know, I grew up in Missouri, what was a purple state and is now deeply read .

I spent 15 years of my life fighting for my fellow Missourians and for people who live in marginalized communities so that this would not happen. You know, I can't even fathom what could happen to a state that's already struggling and already has bad health outcomes. When you start thinking that, you know, high equality , obstetrics and gynecology is something you travel for. Yeah. It breaks my heart.

And, and obviously I , you know, I'm invested in, in making sure that the harm isn't too great and I'm invested in making sure that, you know, we support med students. However, we need to , uh , you know, medical students for choice is prepared to send med students to England. If we have to, to get access to training, you know, we're not , our mission is not going to change and our work is not gonna change, but it is a shame that, that this is where we're at.

And the best example, I was just talking to somebody earlier, the only examples that I can think of are like when, when we passed prohibition and, you know, it took 10 years to write that wrong. And the , it changed the landscape of our country radically and for the worse , and, you know, people were incarcerated, people died and, and all of that was avoidable, but, you know, a bunch of people were really happy for about, I think it was like 48 hours before the first illegal beer run was made.

And like I said earlier, nothing makes a case for abortion access, like an abortion ban. The second thing is that folks need to reprioritize where their energy support and money goes. I have been doing so for the last year. And my number one monthly donation is to the Missouri abortion fund. I highly highly recommend that people set up that monthly donation make it something that's a little bit of a stretch, but not too much.

But you know, if everybody who, you know, had a pro-choice button also had a recurring donation to an abortion fund or to the national network of abortion funds, that would make a huge difference. They are doing incredible logistics work. They are really mapped together. The kind of network they're working is inspiring, and we need to fund and support the heck out of it. Yep , yep . Support that fund support it. And you can actually find your local fund on the national network of abortion funds.

And yeah, I think it it's a must. Whenever I see somebody with, with pro-abortion paraphernalia, I'm always like you supporting a fund, do it. And then the other

We are about to see the kind of anti-abortion organizing that I grew up watching, but a lot of people who didn't grow up in the eighties might not necessarily be familiar with, but as Midwesterners, we were very familiar with clinic block aids and escalating menacing behavior, throngs of people in that you see outside of clinics in the south there , that's what we're gonna see after June.

So, you know, be a clinic escort, be a driver, be the person who helps drive somebody from the airport to where they're staying, help the helpers and, and be prepared to do so . Going forward, as we look at the rise in, in gas prices and inflation, that impacts our funds and our logistics people. So we can help that .

The other thing is to do the clinic escorting and do the training at the bare minimum. But one , if you've done a day of escorting, you have, you will talk about this movement in abortion access in a completely different way.

And with that, I will see y'all in two weeks, unless we need an emergency episode sooner for more information, including show notes. From this episode and previous episodes, please visit us at our website at re pros, fight back.com . You can also find us on Facebook and Twitter at repro fight back and on Instagram at re pros FB . If you like our show, please help others find it by sharing it with your friends and please rate and review us on apple podcast. Thanks for listening .