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I’m Kai Wright, and these are The Stakes. In this episode: We’re in charge, get over it.
LASHONDA PINCHON: The next available day would be Tuesday, Thursday, or Friday of next week. However, if she can make it on Wednesday, she can have it done on Friday…
KAI: LaShonda Pinchon is the lead nurse at the Alabama Women’s Center in Huntsville.
LASHONDA: Yes. It’s at least a 48 hour waiting period, so if she can come in on Wednesday by 10, she can come back as early as this Friday. You’re welcome. Bye, bye.
KAI: This is an abortion clinic... Or, more precisely, THE abortion clinic, within at least 150 miles. And the only provider of second trimester abortions within hundreds of miles. So patients turn up here from way beyond Alabama.
LASHONDA: Tennessee, Louisiana, Florida, Mississippi -- lots from Mississippi and Louisiana.
KAI: I asked LaShonda to give me tour. I honestly meant it as a kind of pro-forma thing, you know? Like, hey, show me where you work... And at first, it was just standard stuff like the front desk, the exam rooms... But then, we ended up in this kinda strange spot.
LASHONDA: This room here is pretty important. It is our supply closet.
KAI: And it’s got regular medical supplies in it -- gloves, and gowns, and janitorial stuff
LASHONDA: It is also our safe room. There is a panic button in this room, right behind you there.
KAI: A little rectangular, silver plate on the wall, like a light switch. But there’s a bright, red button where the switch oughta be. LaShonda says they’ve never had to use it, it’s thankfully just been for storage.
But, that’s not even the strange thing. Here’s what really caught me off guard: The reason they made this space double as a safe room is they’d already spent a ton of money on it… in order to meet state requirements, for the supply closet.
LASHONDA: This room is fireproof. So this was one of the requirements that state mandated, that we had to have a fireproof room.
KAI: A fireproof room?...
LASHONDA: So this room was about twenty thousand dollars.
LASHONDA: You tell me and we'll both know.
KAI: It’s here because about six years ago the state changed the safety code for abortion clinics. But here’s thing, if you’re looking for a political frontline in America’s abortion wars, this 20 thousand dollar closet is a great place to start.
[CLIP OF ALABAMA SENATE]
BOBBY SINGLETON: [YELLING] Hold on, hold on, hold on...
CHAIRMAN: Motion passes. Committee Amendment is tabled.
SINGLETON: Mr Chairman, Mr. Chairman. There was no motion. There was no motion.
[CLIP FADES DOWN AND MUSIC FADES UP]
KAI: You have surely heard the news. In May, Alabama passed the nation’s most restrictive anti-abortion law. If the law takes effect, it will become a Class A felony to provide an abortion here in almost all cases, with no exemption for rape or incest, punishable by up to life in prison.
[CLIP OF PRESS CONFERENCE]
TERRI COLLINS: The bill is meant to address Roe versus Wade and the issue that that decision was made on which is: is the baby in the womb a person? I believe that the baby in the womb is a person.
KAI: It’s one of more than two dozen abortion bans that have passed in some form this year, across 12 state legislatures, many of them plainly in conflict with existing Supreme Court precedent.
[WATERFALL OF NEWS CLIPS]
NEWSCASTER: Missouri is about to join the growing list of states restricting abortion…
NEWSCASTER: The most restrictive abortion bill in the country just passed in Alabama...
NEWSCASTER: Well Georgia has passed one of the most restrictive abortion policies in the country...
KAI: And so now, we wait for these laws to make their way to the Supreme Court. But from LaShonda Pinchon’s vantage point, from here inside the Alabama Women’s Center, it’s not clear what we’re even waiting for.
I mean, this is where things get real -- move away from the political slogans and into actually trying to exercise this right. And it could take years for the Court to weigh in. So what’s happening in the meantime? And moreover, how did we even get to the point where you need a $20,000 closet, if you wanna provide a constitutionally protected medical service?... I figure the best people to answer these questions are the staff of the Alabama Women’s Center.
MAKEDA HARRIS: Okay so just come in...yeah. Just make sure you come in this week, okay?
KAI: Okay, in my life, I’ve had the routine benefit of…just a certain kind of black woman. And this is a fraught thing, because it can become a caricature. But there really is a type of black woman who’s just, got this.
MAKEDA: Pull the door open.
KAI: She loves hard, and she gets it done. And that really is the best way I can describe all the women I met working at this clinic. Certainly, LaShonda Pinchon.
LASHONDA: So my job is just to make sure that they're comfortable. It's gonna be a stressful day anyway, just because this is not something that anybody ever really wakes up and says, “Hey. Today's Friday, I think I’m gonna go over there and have me an abortion.” This is usually a very long, thought out process.
KAI: A busy day might see 40 patients come through this clinic. And LaShonda says her first order of business with each of them, is to lower their blood pressure, both literally and metaphorically.
LASHONDA: It's a de-escalation process a lot of times. I have to usually talk my patients down, you know. I'm usually the comical one. I always try to make my patients feel more comfortable, usually through jokes.
Kai: What's your best material? What's your best joke?
LASHONDA: Ha! I don't really have like a joke-joke. It's like whatever that patient is going through.
KAI: Uh huh.
LASHONDA: Oh, my biggest pet peeve, I can tell you that. It’s bonnets. On the head.
LASHONDA: Women that come in with their bonnets. I always tell ’em they're gonna look so much prettier when they take their bonnets off. So I have ’em go in the bathroom, fix their hair up, because you know, I want them coming to the abortion clinic looking just as presentable as they go to their regular doctor’s office. I don't accept anything less.
KAI: LaShonda started off as a cardiac nurse, but she didn’t wanna be an in emergency room all the time. So she answered a blind job ad for this clinic. And when she discovered this was an abortion provider, it suddenly felt like a calling.
LASHONDA: It was like God was saying, this is what I have for you. That prayer that you've been praying? This is my answer. And I try -- I'm not gonna say never -- I try not to question when I receive an answer.
KAI: That was 14 years ago. And in those years, she has witnessed the steady erosion of the right to an abortion in Alabama.
LASHONDA: I've gone through the 24 hour waiting period. The 48 hour waiting period. Having to change buildings because the hallways weren't wide enough at our other facility. You know I've been here through the duration of it.
KAI: The rest of the country sort of looks at this recent bill and says, “Oh my god.” You know? But are we in a different place, from your experience, sort of on a day to day level?
LASHONDA: I don't think we're in a different place. I think we that have been in this fight, weren't shocked. So The ones that haven't been paying attention are the ones that are shocked. Those of us that have seen law after law after law coming down the pipeline, we weren't shocked.
LASHONDA: Alright. This is our lab area. This is where our specimens are processed. We have to send every specimen to an independent lab. That's by state law.
KAI: That’s because the blood and tissue from each procedure has to be weighed. The existing law -- not the new one, that’s not in effect yet -- but the current law, bans abortion after 22 weeks. And the lab test is one way the state policies that rule... But really, there’s another point to the rule: It’s an expense.
LASHONDA: You know some of this is just tissue. It’s just blood. But we have to package that, we have to pay to get it packaged, we have to pay to get it sent to the lab.
KAI: This regulation’s an old one, but it’s an increasingly hard one to follow. They use a lab in Georgia, and it recently closed down for a while.
LASHONDA: And that was like, we were freaking out. Because nobody around here wants to do it. So we have--our other lab is in Texas.
LASHONDA: We send specimens all the way to Texas.
KAI: Of course, anti-abortion legislators are ratcheting up their demands for how clinics dispose of fetal tissue. Indiana now makes clinics provide for an actual burial or cremation.
And listen, if you think abortion is murder, I guess all this stuff makes sense. That is certainly where the Republican Party of Alabama is coming from.
[CLIP OF ALABAMA SENATE]
CLYDE CHAMBLISS: I mean you can see right here, this this little pin, that’s the size and shape of an unborn child’s feet at ten weeks.
KAI: But I asked at the start of this episode how we got here. And whatever ideas about morality may have fueled the anti-abortion movement, the story of this moment is ultimately one about power. It began with the 2010 midterm election...
BARACK OBAMA: Some election nights are more fun than others. Some are exhilarating, some are humbling… [END CLIP]
MICHAEL LI: 2010 was a really big wave election and it resulted in Republicans taking power not only in Congress but also in many states.
KAI: Michael Li is a lawyer for the Brennan Center for Justice at New York University. His work focuses on the design of our democracy.
MICHAEL: And in states like Alabama and Wisconsin and in North Carolina, Republicans ended up in charge for the first time in many, many years. And in fact in Alabama for the first time since Reconstruction.
KAI: He says, going into that election, Republicans understood something crucial: whoever controlled state governments in 2010 would draw the political map for the next decade... And the Supreme Court had just ruled on Citizens United, opening the door for unlimited, largely untrackable spending. So Republicans just, made it rain.
MICHAEL: Karl Rove actually wrote about it in the Wall Street Journal, so it wasn't as though it was some kind of secret project. and Democrats, it should be said, were asleep at the wheel. It was like a slow moving hurricane that you can totally foresee coming. But Democrats didn't do anything to prepare for it.
KAI: We are still living with the results. And importantly, the candidates who stormed into statehouses in 2010 weren’t just any old Republicans.
MICHAEL: 2010 was the year where the Republican Party took a sharp turn to the right.
KAI: It was the birth of the tea party. And since they were the ones who drew the political map, their dominance was baked in.
MICHAEL: When you draw these districts such that you have, you know, basically safe Republican seats, the election that really matters then is the primary. Americans overall actually have not become that much more polarized than we have been in the past, the one group that has become more polarized are the primary voters, that small fraction of the electorate that votes in primaries. And that is a much more conservative, if you're a Republican, electorate on issues like abortion and immigration and a whole host of issues.
KAI: And so, a whole lot of states were molded into this much more conservative view.
LAURA HALL: The culture was one of, “We are in charge and get over it.”
KAI: This is Rep. Laura Hall, and the Alabama Women’s Center is in her district. She’s a Democrat, and she says her new Republican colleagues used their power to its fullest extent—on a lot of issues, but certainly abortion.
LAURA: I mean, it just seems like every year or so, there is another bill. I'd say if you are concerned about power and the impact in a negative way they can have in your state or your district, look at Alabama. This is a good example of when you have a supermajority.
KAI: But it happened all over the country... The legal turning point in the abortion fight was 1992, with a pivotal Supreme Court ruling that essentially invited tighter state regulations. But the political turning point? That was 2010... Fully one third of all restrictions put on abortion since Roe v. Wade, have been put in place since 2010.
And now, in a deliberate effort to provoke a final battle in the Supreme Court, this legislature has decided the doctor at the Alabama Women’s Center ought to be prosecuted for a Class A felony.
YASHICA ROBINSON: My life's goal wasn't to be an abortion provider. It was just to be a good obstetrician-gynecologist.
KAI: Dr. Yashica Robinson is the last remaining abortion provider with hospital admitting privileges in the state of Alabama. She is also one of the busiest OBs in Huntsville.
YASHICA: I do about on average 20 to 25 deliveries a month.
KAI: To some, these may be incongruent facts. To Dr. Robinson, it’s just the full spectrum of reproductive health care. She had her first child as a teenager, and she got care during that pregnancy at a clinic for poor, young moms. She decided then her life’s work would paying that gift back.
YASHICA: I wanted to work with young ladies like myself.
KAI: And that’s a really sweet idea. But you gotta understand just how isolated Dr. Robinson has become in Huntsville. She is a pariah, even in the medical community.
She doesn’t like to talk about it, not on tape. She’s gotta live and work here and, it’s hard enough without making new enemies by griping to reporters like me. But...you can’t practice medicine in a vacuum.
YASHICA: Babies come 24 hours a day, 7 days a week. There is no schedule. And so it would be helpful to have a constant call group, somebody to give me call relief. But because I am an abortion provider, it’s difficult to find other physicians who are willing to share call with me. So I have missed graduations. I've missed funerals. I've missed weddings. I missed my class reunion just last year, and I really really wanted to go.
KAI: She’s also had nasty run-ins with colleagues, even in the middle of deliveries. She thinks she’s been blackballed by lenders. She had to fight a federal indictment for alleged fraud; she won the case.
And now, this new law… Which, despite all that Dr. Robinson has seen, actually caught her off guard. She thought the governor would veto it.
YASHICA: And for some reason I was very optimistic that she would not sign that bill. I mean, now, I know that many people may think that's foolish, but I was. [laughs] And I recall the day that she signed it, and it was heartbreaking for me.
KAI: You know...it's just a lot that you're describing, to continue to do this. And given the direction that things have gone politically, it can feel like, I imagine, a losing battle that you're doing all of this for, and that's -- I'm just trying to get an understanding of what would, why and how you continue to do that then.
YASHICA: You know it is...it's…[pause]...I know that I pay an overwhelming cost to be able to provide abortion care here. And I know that my family pays a price for providing the services. But if I think about it, on the other hand, if I just take what would quote unquote be the easy way out, and just quit because that's what anti-abortion activists want me to do then, I mean I have to think about the price that, you know, mentally how that's gonna affect me. And I'm not trying to sound like some hero or something. But really I -- I mean I feel like that would be a bigger cost for me.
KAI: To understand what she means here, you gotta hear at least one of the many stories she tells about her patients.
YASHICA: So I have had a patient when she was 12 years old. She was about 11 weeks, if I remember correctly, when I first met her. She was a victim of incest. She was not a citizen and she had been violated by her uncle. When her mother found out about her pregnancy and about what had taken place with her uncle, the mother did not report it for fear that the uncle would be deported.
KAI: I should say that we can’t independently confirm that part of the story. But the girl was certainly put in foster care -- and that made her choices about her pregnancy more complicated. Alabama requires parental consent for a minor to get an abortion. If she can’t or won’t get that consent, she can appeal to a judge for permission.
YASHICA: She made the decision herself that she wanted to have an abortion. However Alabama also recently passed legislation which allowed the fetus to be appointed a guardian ad litem, if I'm saying the word correctly, so it's basically like an attorney for the fetus.
KAI: And sure enough, a district attorney took up this case on behalf of the fetus. Which meant the 12 year old girl had to testify at a hearing.
YASHICA: My understanding is, she's placed on a witness stand and the district attorney was able to ask her questions, basically interrogate her like she's a criminal.
KAI: She made it through this ordeal. And she won... the judge said she could abort the fetus. But at this point, you can imagine the trauma this 12 year old child carried into Dr. Robinson’s clinic.
YASHICA: You know as a provider I feel like my responsibility is to be strong and be supportive for my patient. But I recall having to step out of the room and just take a moment to get myself together because I didn't want to cry in front of the patient, because I felt like if she didn't feel like she had people around her who could be supportive then I felt like we were letting her down.
KAI: They did not let her down. They gave her the care she needed. By that point, she was 17 weeks pregnant.
YASHICA: I remember all of us sitting in the parking lot on the hot asphalt under the tree and we just felt like we just felt like we had run a marathon.
KAI: And she was a few weeks away from it being illegal.
YASHICA: Yes, just a few weeks away.
KAI: Abortion remains legal in the state of Alabama. It is still legal in all 50 states. For the moment, this is still a constitutionally protected right.
But being legal, is not the same thing as being available… And so, up next, a group of doctors are trying to prove women can safely get abortion care through their phones. And is that the future for women in places like Alabama? That’s after the break
KAI: Ok, so let's talk about actual medical science. Our producer Jessica Miller has been reporting on the broader public health questions around abortion ever since the 2016 elections. Jess, you’ve been interested in how reproductive health providers are responding as access continues to narrow in many states, right?.
JESSICA MILLER: So when you think about an abortion you probably think of a surgical procedure, something invasive. But actually there are prescription pills that can do the same thing especially for a woman who is early in her pregnancy. So for a woman who is 10 weeks pregnant or under she's eligible for a medication abortion. And actually this is a pretty popular choice for women these days. The only problem is though is that it's really hard to get these pills. It can be depending on the state that you live in.
KAI: And I assume that's because the FDA has put limits on how they can be used, right?
JESS: Yeah, that’s right. So first of all you can't just go to the pharmacy and get these pills. You have to go to a licensed provider and pick them up in an office. And in some cases you have to take them in the presence of a doctor. But there's a research group called Gynuity that's doing a study to see if these pills could be administered remotely, but still safely.
So how it works now: I just told you that you have to pick up the pill from a licensed provider and you have to take it in the presence of a doctor.
JESS: But what this study is testing is whether or not you can do that over telemedicine. So a doctor would mail you the pills and you would take them at home. But when you do it you'd be like, Facetiming with your doctor. And the study is rolling out slowly in different states across America. One of them is Hawaii. And I actually was able to talk to a patient there who participated in the study.
PATIENT: There is no abortion services here on the island that I live on mostly just cost-wise to fly to Oahu is kind of inexpensive and people who are in poverty which is most of our island, that would not be an option for them. For me I could probably do it but it would be a struggle.
JESS: So this woman she had shown up to her normal OB Doctor pregnant not wanting to be pregnant. This doctor referred her to a doctor in Oahu who was doing this clinical trial. And this woman was able to receive her pills in the mail, she was able to pass the pregnancy at home and she told me she really appreciated being able to do this this way.
KAI: So that sounds like a great solution for a place like Alabama, frankly, one of these places where you have to drive so far to get care. Would it work there? Would it be available there?
JESS: Well it actually wouldn't work there right now because of state laws. So a lot of states whose legislatures are interested in restricting access to abortion have preempted this technology by passing laws that make it illegal.
But in the meantime, there’s still the issue of the FDA restrictions. So I asked someone involved in the study about that. I talked to Melissa Grant who is the COO of a group called Carafem, which is participating in the study, and she says that the FDA was really cautious about this medicine when it was invented 20 years ago. They hadn’t seen nonsurgical methods of abortion before. So if the current study works out, it would bring new data to the table. It could change those old FDA regulations and, who knows, maybe even make this technology available to women in the more restrictive states. Also, it’s worth noting that the anti-abortion movement has cited bad science in justifying some of these new restrictions. So Melissa says facts matter.
MELISSA GRANT: Having data is generally more positive than not having data. So being patient trying to collect information and continuing to move forward are crucial to make change. So, sure. Is it possible that that won't get looked at? Yes. But I think we have to be persistent and lead with the evidence.
KAI: Okay so this sounds like really it's the long game is what she's saying and I guess my question is even in the long game, right? Like is this going to help the women in Alabama and places like that? Is this the future for them.
JESS: I mean it's complicated. I think two things. Melissa Grant told me that a lot of the people she sees in Georgia are coming from across state lines. So we know that women are already driving for these services. So now a woman in Alabama doesn't have to drive all the way to Atlanta to her clinic. They can just get themselves over the border if they're 10 weeks pregnant or under…
KAI: Wow. right.
JESS: …and they can receive this treatment legally.
KAI: Through the telemedicine.
JESS: Yes because the clinical trial is going on in the state of Georgia.
JESS: For now. The other thing is that we know that women will want these drugs regardless of whether or not they're legal. And we know that already actually. A couple weeks ago The Guardian released an article about Aid Access which is Rebecca Gomperts' organization. It's operated overseas and they mail these pills illegally to women in the United States. And she said that from last March to this March in the span of one year about 21,000 American women wrote to her requesting these pills.
JESS: They didn't all receive the pills but that's how many requests they got. And she says that about three quarters of those women were from states like Alabama, like Georgia, that already have restricted access to abortion. So you know one thing's for sure: women are going to seek this treatment regardless…
KAI: That’s right.
JESS: ... of whether it's legal or not. And what we can do is try to make it as safe an environment as possible. To have the data, to have the research and hopefully one day it will make a difference.
KAI: It’s clear women are going to seek this treatment—it’s also clear that the staff of the Alabama Women’s Center are going to keep providing it.
LASHONDA: I'm licensed in several states.
KAI: Nurse LaShonda Pinchon again.
LASHONDA: I will provide this service where the service is needed and where it's legal, and if you make it illegal in Alabama, I will be a resource for women to get it done in a state where it's done legally.
KAI: Dr. Robinson told me the same thing. Actually, so did everybody. from the volunteers I met escorting women into the clinic, to the staff checking-in patients at the front desk. They all said they may well be chased out Alabama, but they won’t abandon this work.
LASHONDA: It's kind of like a beat down feeling, like we're doing everything we can everything you tell us we have to do, we meet those standards and we exceed those standards. So it's like when is enough enough? But we won't go away quietly.
The Stakes is production of WNYC Studios and the newsroom of WNYC.
This episode was reported and produced by me and Jessica Miller.
It was edited by Kaari Pitkin.
Karen Fillmann is our Executive Producer.
Cayce Means is our technical director.
Jim Schachter is vice president for news at WNYC.
And The Stakes team also includes…Amanda Aronczyk, Karen Frillmann, Christopher Johnson, Jonna McKone, Cayce Means, Jessica Miller, Kaari Pitkin, Christopher Werth, and Veralyn Williams…
With help from...Hannis Brown, Cheyann Harris, Michelle Harris, Rosie Misdray, and Jared Paul.
You can join the team, by signing up for our newsletter at TheStakesPodcast.org. In the next edition, I’m gonna share a photo essay of the staff of the Alabama Women’s Center, so don’t miss out. Sign up. And hit me up on twitter, @kai_wright.
Thanks for listening.