Brian Lehrer: It's the Brian Lehrer Show on WNYC. Good morning again, everyone. There's a remarkable and important article in the Atlantic now about how women will get abortions in a post-Roe world. It's so remarkable and important that a caller brought it up last hour without even knowing we had this segment scheduled. It's by Jessica Bruder, the author of Nomadland, her book that was the basis of the movie that won the best picture Oscar last year.

The article has history in it, like abortion in the United States was legal before it was illegal. At the time the Constitution was written, there were no state laws that banned it. Ironically perhaps, the article says it was doctors who pushed to have it banned in the mid-19th century. Ironically perhaps, it tells of an interfaith clergy group that helped get women abortions in the 1960s and '70s before Roe. It reminds us that just last year, the Supreme Court decriminalized abortion, the Supreme Court of Mexico that is. It reminds us that 99% of abortions are performed in the first 20 weeks of pregnancy, despite the political emphasis of the right on late-term procedures as a rationale for banning them all.

It reminds us that a Gallup poll last year found less than a third of Americans support overturning Roe. It's another example of Republican minority rule from gerrymandering and the minoritarian structure of the Electoral College and the US Senate. It refers to some terms we may soon be hearing more of, abortion refugees and the abortion diaspora, as well as the grassroots and underground networks of people beginning to enable it.

In fact, a separate news story this morning in the wake of the Alito draft is the New York State Legislature is already considering a bill that would establish an abortion fund, specifically for low-income women coming to New York as a safe haven state where abortions will still be available, but you have to be able to afford to get here.

A theme for Nomadland 2, The Abortion Land Diaspora. The article is about medications and devices that increasingly allow women to have abortions in the privacy of their homes, a privacy the Samuel Alitos of the world will have a harder time striking down, though some states are trying.

The article is called, "The Future of Abortion in a Post-Roe America." Jessica Bruder joins us now. It's so great to have you. Welcome to WNYC.

Jessica Bruder: Thanks for having me, Brian.

Brian Lehrer: Can we start with some of the history in your piece before we get to the present and the future? Abortion was legal in the US at the time the constitution was written based on British common law?

Jessica Bruder: Yes, absolutely. It all starts with history. In our nation's history it was not a big deal in the beginning. Part of that was related to science, which has advanced just a little bit since colonial America, in that basically the fetus was not considered as an entity even until what was referred to as the quickening. The quickening is that moment where a pregnant person first feels a fetal movement.

Prior to that, in the absence of cheap pee-on-a-stick pregnancy Dollar Store tests or any other scientific method for determining pregnancy, there was just no way to completely know. It was incredibly common for people to seek relief for what doctors referred to as a blocked menses or an obstructed menstrual cycle. Pregnant people who suspected they were pregnant, people could go to midwives. They could go to traditional healers. There were all sorts of home medical manuals that had recipes and different suggestions for how to bring back that blocked period.

Brian Lehrer: Maybe that's why it wasn't named as an enumerated right in the Constitution. Nobody was trying to take it away.

Jessica Bruder: Good point.

Brian Lehrer: You write, "The first abortion laws in this country were mostly poison control laws in an otherwise legal environment." Was that because of side effects, not the abortions themselves?

Jessica Bruder: That was mostly because people really jumped on this bandwagon. In all sorts of newspapers, the advertisement sections were just clogged with classifieds hawking all sorts of patent medicines and many of them somewhat dubious concoctions. They had very exoticized names like Madame Drunette's Lunar Pills. Usually, it was a doctor from Europe and something involving female renovation was a popular phrase.

Now, some of these pills were-- A lot of these pills were toxins to begin with and some of them were killing people. When we had the first abortion statutes come into a play, these were not ideologically motivated. These were essentially poison control measures aimed at protecting lives.

Brian Lehrer: You write that abortions were sought originally in this country mostly by women who got pregnant outside of marriage, but in the mid-1800s, it became more common among white, middle, and upper-class women. Why them? Why then?

Jessica Bruder: Well, the interesting thing is we don't know exactly who was having abortions because we don't have the records. What we do have is the media. The historian James Moore wrote a lot about this, how we can look back and look at public attitudes towards abortion, even if we don't have the numbers. In the beginning, there was this, what was considered conventional wisdom at the time. That people who were having abortions were these desperate wastrels who were going to face the shame and stigma of an out-of-wedlock pregnancy, and woe betide them. Aren't these people we could look the other way and perhaps pity.

That's a problematic attitude for lots of other reasons we won't get into, but over time, the incidence of abortion rose. People started realizing that it wasn't this tiny demographic and that people were saying, "I've had enough children," or people were using it to limit family size. There was a fair amount of racism and xenophobia in the culture. This should not be surprising. This actually led, in part, to campaigns against abortion.

There was a fellow named Dr. Horatio Storer who talked about will the future of our nation look like ourselves or essentially look like people he saw as outsiders, which again, was people of color, people who just weren't of this Anglo-Saxon Protestant group. He was one of the first people to lead what they ended up calling the physicians crusade against abortion. Part of that was racism and part of that was doctors getting organized to try to professionalize their ranks. They weren't as well respected as they are now, and to push out traditional healers and midwives who were the competition.

Brian Lehrer: You link the beginning of the real anti-abortion movement in that respect to the founding of the American Medical Association. Why would they have wanted to outlaw abortion, rather than try to lock the midwives and the traditional healers out of it and take it for themselves?

Jessica Bruder: Well, at the time abortion was primarily the province of these traditional healers and midwives. By casting aspersions on the practice of abortion, it was a way to also push them away. Doctors did end up leaving room for what they referred to as therapeutic abortion. If a panel of X doctors says that you need an abortion, then you can get an abortion. They were able to also just bring that more within their control.

We know that going forward, even when abortion began to get criminalized, there were plenty of doctors who were doing it, basically, you can say clandestinely, but some of them were doing it in a pretty wide open way as well. There was a bit of, doctors were speaking out of both sides of their mouths and also trying to gain control.

Brian Lehrer: Jumping ahead a century, you remind us in the article that illegal abortions were not safe abortions, even a high death rate in the years just before Roe.

Jessica Bruder: Yes. There was a high death rate. There were also people doing it safely. The midwives never went away. What I don't want to do is play into this dominant narrative we've had in the culture which I grew up on, which it's either the coat hanger or the clinic. While there were unsafe abortions, this was having definitely a bad impact on maternal mortality. We know the US continues to have pretty awful maternal mortality rates.

Brian Lehrer: By the way, so much for the simple argument that being anti-abortion rights is being pro-life, but go ahead.

Jessica Bruder: Oh, don't get me started. What about people who are in the world and maybe a social safety net to help them, but we don't need to go there. We can if you want. Gosh, I think my train just fell right off the track. Where were we, Brian?

Brian Lehrer: Oh, you were talking about people who were getting safe illegal abortions.

Jessica Bruder: It's incredible. You mentioned, for example, the clergy consultations service. We know that this was at least 1,400 priests along with a smattering of rabbis connecting people with safe procedures. We know about the Jane Collective, that group of people who started out as an abortion referral service and ended up learning how to do the procedures themselves.

We know about people handing out lists of vetted abortion providers overseas. Of course, that is only useful if one has the time and the means to travel. Then we know about a small group in Los Angeles, and I spoke with Carol Downer who's now 88. She and a group of feminists she was working with actually helped create and disseminate a DIY abortion device known as the Dell M. I actually have one on my desk right now, and I'm looking at it.

Brian Lehrer: That was such an interesting opening to the article, where you have the scene in which you meet a woman you call Ellie, name changed to protect the innocent from harassment, who shows you all the elements for one such device. You want to describe that interaction a little bit?

Jessica Bruder: Yes. First of all, it was pretty trippy because we were sitting on a beach in Southern California and this was not for recreation purposes. This was because Ellie was just getting over COVID and masked and we wanted to be out in the open air. Ellie also didn't want me coming to her home or didn't want to even disclose to me her address because of fears of harassment. We're sitting there with what I referred to as a very strange picnic in that, there's a towel out there and all these different parts, it looks like we're going to put together a seventh-grade science experiment and she started showing me how to build this thing.

I have it in front of me now. Basically, there's a small Mason jar with a rubber stopper at the top. Two aquarium tubes, they're coming out of the top. One of them goes to a syringe, but not something with a needle. Really just something with a barrel chamber that you can pull a stopper back on to create suction and the other plastic tube terminates in what's called a cannula.

In this case, it's a Carmen's cannula, it's a thin plastic straw that's used for suction and is actually the medical standard today for procedural early-stage abortions and was developed, I should say, in an underground illegal abortion clinic before Roe, which is why I'm always careful to emphasize that not all underground abortions are messing people up. This one clinic actually created something that is a standard internationally today.

This device is actually a suction device. It is a precursor or predecessor to what's known as a manual vacuum aspiration kit. These are used for first-trimester abortions. Basically, it is extracting the contents of the uterus. When people were trying to avoid unwanted attention from the legal authorities pre-Roe, they referred to this process with the device I have here as menstrual extraction. The idea being that you are extracting your period because, gosh, wouldn't it be great if you weren't bleeding for a few days or a week, and you could just get it over within a half an hour. If you happen to be pregnant, you had plausible deniability because it's very early along and who knew for sure.

Brian Lehrer: Listeners, I wonder if some of you have been reading Jessica Bruder's article in the Atlantic, The Future of Abortion in a Post-Roe America, which also includes such an interesting history of abortion before Roe versus Wade as we've been discussing in the early part of our conversation. We can take some phone calls from you with questions, stories, comments, whatever, 212433 WNYC 2124339692, or tweet at Brian Lehrer. Let's take a phone call right now, Wendy in Springfield, the New Jersey you're on WNY C. Hi, Wendy.

Wendy: Hi. This is always, well, not always, but often talked about in broad terms to abstract terms. We need to hear the stories of the women. There is a book called The Worst of Times by Patricia G. Miller and it was published in '93 when Roe V. Wade was threatened. It's about the women themselves or the survivors. Yes, there were legal or illegal abortions that were safe and illegal abortions that were not. In fact, we have a person who goes to someone who says "I can't do it. It's too late." She has to have the baby. My point is this. We need to hear the stories.

In October with the help of a women's group, I did a rally here in Springfield. 100 people showed up and we read stories from the book and people cried, so we need to hear the stories, we need to get off of the abstract. Every woman now does not want to tell her story, and every woman has a story of either herself or her friend or her sister or someone, but you need to read the stories of specific details so that's my point.

Brian Lehrer: Wendy, thank you very much.

Jessica Bruder: Let me amplify that, and make sure Wendy knows about a group called Shout Your Abortion, which is dedicated to abortion storytelling with the aim of busting stigma. I want to make sure she knows. I'll bet she already does that what was happening in that book and what she was seeking to amplify is something that's in very good hands now and that a lot of people are working with helping people who want to tell their stories, get it out there and just hoping that those stories can mean so much to other people who are still dealing with the stigma, which is unfortunately around these procedures.

Brian Lehrer: We'll continue with Jessica Bruder and your calls in a minute.

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Brian Lehrer on WNYC with Jessica Bruder probably best known as the author of Nomadland, the nonfiction book on which the movie with David Strathairn and Frances McDormand was based that won the best picture Oscar last year. This one may be up for the best magazine article of 2022, the Future of Abortion in a Post-Roe America in the Atlantic now. We'll get to more of your phone calls as we go. I want to go back to something that you mentioned before the break.

The Clergy Consultation Service, a group numbering 1400. You write mainly Protestant ministers, but also including rabbis and Catholic priests who in the 1960s and early '70s before Roe connected women with abortion providers. I guess their work is a reminder-- Oh, you wrote this, that their work is a reminder that the abortion debate often presented in stark terms of religious faith versus personal freedom has always been one where people weigh competing values in complex ways. Can you tell us more about the clergy consultation service and the religious basis for abortion rights?

Jessica Bruder: Sure. To talk about the clergy consultation service, I just think it's fascinating and it reminds us that whenever we look a little closer at something that it's more complicated than we might think from the outside. I remember reading a bit about the history of the group and learning that there were some people who ended up joining it, who were initially reticent, and squeamish around the topic.

One of the leaders said, "Look, I want you to come meet some of the pregnant people who are in these situations and who are dealing with it." When that happened, sometimes hearts and minds were changed and people joined the group because up close, they said, "Look, ministering to these people is part of what I feel called to do." These are people who are facing extreme challenges and people just really started coming around from a humanitarian perspective.

Brian Lehrer: You make a distinction in the article between a sprawling grassroots infrastructure. Oh, and, listeners, I want to say that we're going to do a separate call in on this later, the religious leaders being pro-choice existing in addition to religious leaders are against abortion rights. We're going to take some of your experiential phone calls on that. We're going to invite clergy and just other religious people to call in and talk back to people who think that the religious position is to be against abortion rights, plain and simple.

Really, the two main strands of your article looking to the future, I think it's right to say, are the grassroots and the underground networks trying to even out some of the disparities and access by income, which of course in this country's income hierarchy means disparities by race to fund out-of-state trips, and things like that, people you call the abortion diaspora and abortion refugees. Then also about medications, as well as the abortion devices that you were describing one of before that women can use on their own, two of the drugs that have the nicknames, mife and miso. Let's talk about abortion refugees first, can you?

Jessica Bruder: Now, this term to the best of my knowledge really started picking up after Texas passed SB 8, which was effectively that six-week ban. We all know Texas is a large state, which, what I didn't realize prior to researching this was that 1 out of 10 women of reproductive age live in Texas, which created just this huge diaspora, there was a wave of those who could afford to travel or who could find support for that, leaving the state to get abortions. There were bottlenecks in the neighboring states. There was an uptick in patients from Texas as far as Washington State and Maryland.

There were people who found that the appointment delays were suddenly so bad, and so backed up, that rather than getting a first-trimester procedure, or doing something like basically having a pregnancy that could be ended with abortion pills, they suddenly needed a more complicated procedure because they were further along in the pregnancy. It completely upended the abortion ecosystem, which was pretty fragile to begin with.

One thing it's worth mentioning here as we do talk about the grassroots is a lot of the hard work for years on this has been done by abortion funds. I know people always talk about Planned Parenthood, but we need to hear more about abortion funds because they're doing the work in the trenches of helping connect people with the resources that they need to get procedures, whether it's funding, the actual abortion or the medication, to helping people with travel, with child care, there are more than 90 abortion funds. There's the network of abortion funds connecting them throughout the country.

A lot of people when they say, "Well, where's the underground? Sign me up," they need to know about the grassroots because this is hidden in plain sight. This is something where when people are saying, "If I care about this and want to be involved, they are always starved for resources." I think their last data came out in 2019 and I believe they were able to feel maybe just a quarter of the calls they got for help. From their perspective, the house is already on fire and just this stuff that's going on now, it's just pouring gasoline on it.

Brian Lehrer: Is this a different kind of nomad land, you're documenting here? Does that have anything to do with your interest in this part of the topic?

Jessica Bruder: Well, I don't think I realized that until I was doing it, to be honest. One of the things that drew me to Nomadland is, there was a-- I was looking at a subculture of people who had essentially, in many ways been failed by the government, been failed by society, and rather than either just bemoaning things or fighting back or basically seceded in their own way, and said, "We're going to do this together, and we're going to carve out a place for ourselves." That was what was always interesting to me was that tension in part between the horrible situation that happened in many ways, but also just the resilience and the creativity that people mustered on the other side of it.

Heartache and inspiration all rolled up into one. I saw that here, and one of the biggest fronts I'm seeing it on, and probably more important to talk about even than devices is abortion pills. What people call abortion pills is really two medications, mifepristone, which some of your listeners might know is RU486, or the French abortion pill, and misoprostol, which is also known as, oh gosh. It starts with a C. I'm so sorry

Brian Lehrer: Miso? Sorry, I'll look it up.

Jessica Bruder: No, so it's a stomach ulcer medication, and I don't know why I'm blanking on it now. I just got over COVID, forgive me, so the fog is settling in.

Brian Lehrer: Well, you sound healthy.

Jessica Bruder: I'm trying. Basically, abortion pills were used in basically, about half of all legal abortions are more than half now. They are the primary tool, they're medically safer than Viagra or acetaminophen, and FDA approved for ending pregnancies up to 10 weeks. The World Health Organization has protocols for using them further along. The interesting thing about the pills is, they are a reason that our culture cannot in many ways go back to a pre-Roe era because now an abortion can be mailed, can be sent in the mail.

There's an overseas organization called Aid Access that sends abortion pills to people in all 50 states, regardless of the law. They can do this because they are outside of our judicial purview, so they are sending them from overseas and prescribing them. I actually have a packet of them on my desk because, well, I am not pregnant, they prescribe them for advanced provision. The idea is people can order them and have them as a break under glass scenario.

Brian Lehrer: Keep it on hand just in case. Is it Cytotec, am I getting that right?

Jessica Bruder: Cytotec, thank you, yes. The really interesting thing about Cytotec, so this is a drug that was created to treat stomach ulcers by Pfizer, Searle. When it first showed up in Brazil, in the 1980s, people there noticed that there was a warning label that said, "If you're pregnant, don't take this," that it could cause extreme contractions. People who were pregnant and didn't want to be said, "Hey, wait a minute, that might be what I need."

Essentially, the medical world ended up following the lead of this Brazilian women and endorsing misoprostol as an abortifacient. What it does is it creates contractions and when people are using it with mife, mifepristone, what mife does is it blocks progesterone, which is a hormone that's needed to continue the pregnancy. Then miso is used 24 to 48 hours later to induce contractions, and this is all done at home.

Brian Lehrer: This is the future that did not exist before Roe as alternatives. As you mentioned in the article, at least three states have outlawed self-administered abortions. There was just that horrible story that you probably saw last month of a 26-year-old woman in Texas named Lizelle Herrera who has been indicted on murder charges for what I've seen reported as the death of an individual by self-induced abortion. I think that was language from the indictment, as I've seen it reported. Is that the post-Roe future too?

Jessica Bruder: Well, let's hope not. I just want to update that to say that the charges were dropped. She was actually accused of murder, which is amazing. A good reminder that zealous prosecutors can get people tangled up for things whether the law endorses that or not because even in Texas, there wasn't a charge that stuck. I want to speak a little bit to speculation here because we don't know exactly what happened in this case, but somebody in a nonprofit involved with it spoke to the news and the idea was that what might have happened was that somebody went to the hospital, having used the pills, disclosed that to a doctor, and that a doctor went to the authorities.

We know that regardless of whether that happened in this situation, it's a huge concern among activists who are educating people about the pill, that that could happen again. That while the pills are discreet and easily mailed, that if people take them and aren't well educated on how to use them, and what resources to have set up, that they could end up getting in legal trouble. One does, while taking the abortion pills, want to be within two hours of a hospital in case of complications if the pills induce a miscarriage. The complications are the same that one could get with any miscarriage, spontaneous miscarriage, which could be there's a very small risk of excessive bleeding.

There's a small risk of retained tissue. The issue is, if somebody takes the pills and goes to the ER and says, "I took the pills, can they end up in jail?" Activists have been urging people to, if they go and see somebody in a state that is hostile to abortion, to say, "I'm having a miscarriage," and to leave the pills out, and I've spoken with activists and a doctor who's an expert in this stuff, and what they tell me is that the treatment is the same, whether it's a self-induced miscarriage via medication or a straight-up spontaneous miscarriage.

That was news to me, just the idea that people needed to navigate not only this crazy legal landscape but also just a semantic landscape when they are seeking medical care.

Brian Lehrer: Around miscarriage, there are some shades of grey, I guess, that can work to a woman's advantage legally or disadvantage in this frightening new world. Let's take one more phone call. Bonnie in Connecticut has a story from the past before Roe. Bonnie, you're on WNYC, hi there.

Bonnie: Yes. Hi, good morning. Thank you, Brian. Thank you for doing this. Early 1960s, we were teenagers, a friend of mine got pregnant. We had to go to the south side of Chicago where we had never been before to a very dingy old apartment building up the back stairs, up to the third floor, into a room where there was linoleum on the floor, where there was a bare table and where there was a bare light bulb over the table.

The abortion was performed. The doctor, I don't know, packed her with cotton and gauze and we were told to go home and remove it within 24 hours, which we did. Her contractions, her pain, and her hemorrhaging became so bad that we had to call my mother and my mother came and took us to St. Francis hospital. Luckily she survived. I was lucky enough to have my abortion after Roe v Wade and I had it at Columbia Presbyterian Hospital with a lovely doctor. I'm horrified and I'm terrified. I have a question, can they make this federal law? The states, of course, New York is talking about they would never ban abortion, but can it be a federal law?

Brian Lehrer: They can, but there isn't the support in Congress. I think that's the simple answer. Jessica, that and anything you want to say as we run out of time?

Jessica Bruder: No, I just wanted to thank her for sharing that story, because again, I think more information is the most important thing and we never want to go back to those dark days. Everybody can agree on that. I think part of it right now is getting the word out on what people can do and how they can stay safe. I think the pill is a big part of that future.

Brian Lehrer: Jessica Bruder's article in the Atlantic remarkable article is called The Future of Abortion in a Post-Roe America. Thank you for sharing it with us.

Jessica Bruder: Thanks, Brian.

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