Number of Abortions are Down in Texas, Up in Neighboring States
Melissa Harris-Perry: This is The Takeaway. I'm Melissa Harris-Perry. Let's talk about abortion. In this country, a majority of Americans believe that abortion should be legal in most or all cases. That's a fact that's been consistent for more than 30 years. Only 13% of Americans take the absolutist position that abortion should be illegal in all cases. That number has also been consistent for most of the past three decades, but that's the politics of abortion.
Earlier this month, we talked here on The Takeaway with Katie Woodruff, a public health social scientist at the University of California, San Francisco. She explained to us that when news media cover abortion primarily as a political issue, we obscure the reality that it is a personal medical decision.
Katie Woodruff: This is a fundamentally personal decision that a pregnant person makes to the best of her ability in her own unique circumstances. Everything about the way we cover this as a political issue just obscures that reality. In fact, we don't even see actual stories of pregnant people in news coverage. Very rarely do we hear about someone who's grappling with a pregnancy and trying to decide what to do, or about someone who's had an abortion, and how that went for them, and what it meant for their life to be able to do that.
Melissa Harris-Perry: Let's do that. Let's talk about abortion. Not an invitation to debate the politics. This is an invitation to discuss the realities of what's happening in our country right now as real people who need abortion care find they're unable to receive it.
In September, the Supreme Court allowed Texas' extreme abortion ban, SB 8, to go into effect. The law bans abortions after six weeks or at any time that an ultrasound can detect cardiac activity. The law allows private citizens to sue any person who aids and abets an abortion after this time. The effect has been immediate.
In a recent piece for The Washington Post, national reporter, Caroline Kitchener, writes about the exodus of clinic workers in Texas, many of whom left their jobs in fear of the legal repercussions of SB 8. This has left the remaining providers in Texas severely understaffed. The staffing shortage has increased wait times for an appointment, and because the law sets such a short clock for pregnant people to make a decision to terminate, these wait times, will they end up determining the outcome for many?
Kitchener tells the story of a single mother with two kids at home who's experiencing a rare pregnancy condition that's left her too nauseous to work. When she was finally able to get an appointment at Whole Woman's Health in Austin, Texas, the doctor informed her he was unable to perform the abortion because the pregnancy had progressed three days too long.
What happens next for her? We know that some people in Texas have been traveling to nearby states. Back in December, The Texas Tribune talked with providers in Kansas about the increased need that they'd experienced.
Healthcare Provider: We're scheduling 80 to 100 patients a week here in Wichita. A third to a half of the patients that we see every day are from another state, whether that be Texas or Oklahoma mainly.
Melissa Harris-Perry: Now, perhaps the woman in Caroline Kitchener's story was able to make her way to Oklahoma, or to Kansas, or to some other state, but maybe she wasn't. After all, how does she travel to another state for abortion care when she has two young children? If she is forced to carry this pregnancy, how does she work if she's too sick? How will all of her children fare? These are the questions we don't have the answer to, but asking them and trying to answer them, this is what it means to really talk about abortion.
Caroline Kitchener is a national political reporter covering abortion at The Washington Post, and Dr. Ghazaleh Moayedi is an OB-GYN and abortion provider in Texas. She's also a board member with Physicians for Reproductive Health and Texas Equal Access Fund.
Caroline, Dr. Moayedi, welcome to the show.
Dr. Ghazaleh Moayedi: Thank you so much.
Caroline Kitchener: Thank you so much for having me, Melissa.
Melissa Harris-Perry: Let's begin by talking about what is happening for people who need abortions in Texas. Where are they going, and are they able to access termination services at all?
Dr. Ghazaleh Moayedi: Where are they going is really everywhere. As we're speaking right now, I'm in Oklahoma, I've been here for the past four days providing care for people from Oklahoma, people from Texas, majority people from Texas, and even people from Arkansas, but my colleagues in Hawaii, my colleagues in Washington State, my colleagues in New York, my colleagues in Florida, all are reporting seeing patients from Texas. It has really been a nightmare, a health care crisis for our state for over five months for the folks trying to seek abortion care.
Melissa Harris-Perry: Caroline, you wrote for The Washington Post about people looking to terminate pregnancies before they're even completely certain that they're pregnant. Can you talk with us about that?
Caroline Kitchener: I started hearing about a month ago from providers in Texas who said they were really surprised with the amount of people that they started to see so early on in their pregnancies. People were coming in earlier and earlier and earlier before they even had a positive pregnancy test, sometimes before they even missed their period. They described this such intense anxiety that they were seeing among their patients.
Dr. Moayedi, I would love to hear whether you've seen the same thing, but they described people so anxious that they were coming in before they could even detect anything on the ultrasound screen, and before they could get an abortion. As a result of that, they were saying that their appointments had booked up, and it was really hard to see everybody before that six-week mark.
Dr. Ghazaleh Moayedi: Caroline, that's exactly right. This law has been traumatic really on the psyche of our communities and on everyone who's pregnant in our state. When people have experienced trauma, they have increased fear, increased anxiety and increased pain. That's exactly what I'm seeing in the folks I'm taking care of in Oklahoma.
For many people, it's taken maybe four to eight weeks to be able to get to a clinic in another state. That's because appointments are just booked. They're booked a month out or more. Sometimes we can't even take appointments because we're so overstretched for them. Then once they get to the clinic, they are just in a state of panic. They have waited two months to secure lifesaving and life-affirming healthcare. That translates to pain, anxiety, and fear when they're in our clinics as well.
Melissa Harris-Perry: Dr. Moayedi, I want you to say a bit more on the pain piece. Help us to understand why-- Because I want to be clear, surgical abortion is an incredibly safe and common procedure, but why would stress or distress cause more pain?
Dr. Ghazaleh Moayedi: Melissa, you're exactly right. Procedural abortion or medication abortion are incredibly safe. In a state like Texas, 10 to 14 times safer than childbirth, so incredibly safe. Pain, the way I explain it to patients, is that pain is about maybe 10% perceived, the actual physical pain, and the rest is the emotional everything that we bring to that experience as well. The best way for me to illustrate it is just to talk about my different practices.
I practiced in Hawaii for two years. Hawaii has very accessible abortion care. Many of our clinics don't even have protesters outside. You can use your health insurance or your Medicaid. Your health insurance will even fly you to another island to get care if abortion care isn't available on your island. You can get a same day appointment, you can go to a regular physician's office, you can be seen by a midwife or a nurse practitioner.
In Hawaii, our practice, generally, we used very little pain medication. Most people just received ibuprofen and lidocaine. That was by choice. Everyone had the option to be completely asleep, using their health insurance and be in a hospital, but people preferred to have an in-office procedure that was five minutes and they could drive themselves home. Most people did incredibly well.
When I provide care in places like Texas, and especially now in Oklahoma with Texans coming, people are having incredible amounts of pain. I'm the same physician, I'm doing the same procedure, everything is exactly the same. The only thing that has changed is the stigma around the procedure in the state that they're in, and the context of how they're trying to access the procedure. That is a very, very clear example of how just the policies and the stigma really impact our emotional state, and how we perceive pain.
Melissa Harris-Perry: Caroline, I'm struck by Dr. Moayedi's description there of the experience of pain for the patients. I'm wondering, I know you spoke with some other providers. Did you also sense from these providers that they are experiencing more trauma on a daily basis in their jobs?
Caroline Kitchener: Oh, absolutely. Some of these providers I've been talking to since May, and they're struggling. They talk about feeling personally guilty, and they know. They'll say to me, "Caroline, I know rationally this is not my fault. I couldn't do anything to stop this law, but at the end of the day they are the people in the room."
Dr. Moayedi, you are the person in the room who has to say, "I'm so sorry you're over." Sometimes that's the ultrasound position, but oftentimes that's the doctor, and it's really, really draining for these physicians to have to, again and again and again, turn people away.
Melissa Harris-Perry: Caroline, you actually opened your recent piece for the Washington Post. It opens with a pregnant person who's come in, who is seeking termination and is told, "Basically you're a few days past when the law allows us to terminate this pregnancy." Then what happens? There's the tears in the room, but when that woman stands up, where does she go? Is this when she then tries to book some travel to Oklahoma to see Dr. Moayedi? I'm just wondering, does this become a pregnancy she has no choice, but to carry?
Caroline Kitchener: In this particular case, I was told that she did not have the ability to get out of state, so she was looking at having to carry this pregnancy. Doctors tell me that they'll raise that option. They'll say you can go out of state. Especially there's a doctor that I speak with often in McAllen, Texas, right on the border, an extremely poor community, and when she raises the option of going out of state, people look at her like she has three heads. It is such a long journey, and people are just trying to get by day to day, and there's just no way. She knows when she says that, she sees a lot of people who are going over to the border of Mexico and getting pills, and some of them that works out okay. Some of them aren't really sure how to take them, they're not properly instructed, and she really doesn't know where they're going to go after they leave the clinic and they have that bad news.
Something that I was really struck by when I spent time in a Texas clinic back in September, was just how barely you can miss this deadline. You can come in, and you can be actually under six weeks, but if on the ultrasound there is some cardiac activity that is detected, then, and I want to be clear there, not a heartbeat, that is not a medically accurate term, but if you go in and there's some cardiac activity that is detected, even if you are 5/7 5/8, they're going to have to turn you away, and you can be that close.
Melissa Harris-Perry: We're going to take a break for just a moment. When we come back, we're going to continue this conversation and talk a little bit more about staffing shortages and the ability to provide these services.
Back with you now on The Takeaway. I'm Melissa Harris-Perry. We've been talking about the Texas abortion ban with Caroline Kitchener, national political reporter covering abortion at the Washington Post, and Dr. Ghazaleh Moayedi, who is an OB-GYN and abortion provider in Texas.
Dr. Moayedi, let me come back to you for a moment here. I'm wondering about opportunities for resistance here, and the ways in which physicians who are providers may be resisting these rules under different circumstances of providing abortion.
I want to be careful about this. When you talk about, for example, your experiences in Hawaii, and that a person could make a choice to be in a hospital anesthetize setting, or in a outpatient setting that most people chose that outpatient setting, I'm wondering, given these kinds of laws and rules, if people who have more resources and private physicians are able to make a choice to be in a private hospitalized anesthetize setting in which the choice to terminate, maybe at 8 weeks or at 10, is certainly not protected by law, but might be protected by the sheer privacy of it.
Dr. Ghazaleh Moayedi: It's certainly possible. I know that even before this law went into effect, there were certainly physicians around the state that provided very secret private care to their own patients that they cared for. It's not something that I know about, but I have heard from patients within the community. That has always been the case, that people with access and the means are able to get that care, and really everyone else is scrambling and struggling.
Melissa Harris-Perry: When you talk about providing care now for patients in Oklahoma, I have to say, it's not as though I perceive Oklahoma as a great progressive fashion for reproductive rights. I don't think Oklahoma's come out in the ways that New York has to say that it has plans to be a sanctuary state. For example, if Roe v. Wade falls under this Mississippi case. Is Oklahoma enough? Are there enough resources and providers in the state surrounding Texas to address the needs of these patients?
Dr. Ghazaleh Moayedi: No. I just have so unending respect for the clinic staff here in Oklahoma, how much they have been stretching themselves to care for people, but Oklahoma is not enough. New Mexico is not enough. Arkansas is not enough. Our surrounding states are not enough for the sheer number of people, and really thinking to June with the possibility of Roe V. Wade completely falling, the entire country is not enough to handle the capacity of the number of people that will need abortion care. We are already really stretched to the limit with just one state, and I am terrified about what's going to happen this summer.
Caroline Kitchener: I've been tracking really carefully all of the anti-abortion legislation that's been popping up all over the country and all of these surrounding states. Oklahoma is, they're trying to pass, I would say, among the most severe legislation in the entire country. They want to be an abortion at 30 days. They are tweaking they are already have a trigger law in place, so that means that as soon as Roe v. Wade is overturned, abortion will be illegal completely in Oklahoma. They are actually trying to tweak the language of their trigger ban. This is something that we haven't seen from any other state. They're trying to tweak their trigger ban to say, if Roe v. Wade is overturned in full or in part, they're adding the in-part. They are really anticipating whatever the Supreme Court says, they want to be able to come out and have that trigger ban and have that become law.
Melissa Harris-Perry: Caroline, this for me, I suppose is part of the challenge of trying to understand how to even address this going forward, that if we are in a circumstance where legislators can and are willing to move forward that aggressively, who is willing to continue being a provider?
The fact that the Texas law provides for ordinary citizens being able to file lawsuits, presumably also means that folks who are all different levels of provision, so these are the folks who are working in these clinics from administrators, to nurses, to PAs, to physicians, if I thought that going to work every day meant that I might be subjected to criminal prosecution, I'm not sure I'd keep doing my job. Is that legislative action enough to actually reduce the availability of abortion so low that even if there's not that trigger law, there's simply no one to even provide the abortions?
Abortion rights activists would say, this is all part of the strategy. The strategy is to instill fear in physicians, in staff members, and have them all quit. You saw that happen.
There's a provider that I spoke to who really, really deeply believes in this work, and had been flying in from California regularly to perform abortions in Texas, but when SB 8 hit, she stopped, and it was a really difficult decision. At the end of the day, she's young, she's in her 30s, she has her whole medical career ahead of her, and she was so afraid that she would get a lawsuit or a bunch of lawsuits hurled her way, and that might jeopardize her medical license, that might jeopardize her insurance. She just couldn't risk that. Watching her go through that, it was so hard. You could just see how torn she was.
You saw one of the leaders of one of the main abortion clinics, one of the biggest abortion--
Melissa Harris-Perry: Dr. Ghazaleh Moayedi, Caroline Kitchener, thank you both for taking the time.
Dr. Ghazaleh Moayedi: Thank you so much for having me again.
Caroline Kitchener: Thank you, Melissa.
Melissa Harris-Perry: Caroline Kitchener is a national political reporter covering abortion at the Washington Post, and Dr. Ghazaleh Moayedi is an OB-GYN and abortion provider in Texas, and a board member with Physicians for Reproductive Health and Texas Equal Access Fund.
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