Immediately after the Dobbs v. Jackson Women’s Health Organization Supreme Court case that overturned Roe v. Wade,shock, sadness, and anger were predominant. But even still, abortion providers, abortion fund workers, and other advocates and leaders in the field provided, facilitated, and fought for access to care. Carole Joffe, professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco and professor emerita of sociology at UC Davis, and David Cohen, law professor at Drexel's Klein School of Law in Philadelphia and pro bono counsel to a number of Pennsylvania abortion clinics, sit down to talk with us about their book, After Dobbs: How the Supreme Court Ended Roe but not Abortion.
Since Dobbs, abortion numbers have gone up, likely related to impassioned grassroots advocacy, media coverage, fundraising, and the help of abortion funds and patient navigators. Some additional developments since Dobbs include providers moving their offices to different states and abortion pills becoming increasingly depended on. In addition, some similarities in both legal ruling and repeal of bodily autonomy can be drawn between Dobbs and the recent, devastating Supreme Court ruling, United States v. Skrmetti, which upheld Tennessee’s ban on gender-affirming care for transgender minors.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Jennie (00:03):
Welcome to rePROs Fight Back, a podcast on all things
related to sexual andreproductive health, rights, and
justice.
[music intro] Hi rePROs, how'severybody doing?
I'm your host, Jennie Wetter,and my pronouns are she/ her.
So y'all, I'm coming to youtoday with a bit of a heavy
heart.
I'm recording this on Friday,June 20th, and so it's still
(00:25):
very close on the heels of theSupreme Court decision in
Skrmetti.
We'll talk about that a littlebit in the interview today, and
we'll have a full episodetalking about it later, but just
still feeling just very, justheavy.
I just, I don't know.
I'm thinking of all of theyoung people who are going to be
impacted by the Supreme Court'sdecision to uphold Tennessee's
(00:48):
ban on gender-affirming care forminors.
It's going to have just hugeeffects on the lives of young
people.
We know that gender-affirmingcare is life-saving and
life-changing healthcare, and toprevent young people from
accessing it will just havedevastating impacts on their
lives.
You can't talk about thatdecision without talking about
(01:11):
an action the administrationtook the night before, where the
administration formallysuspended funding for the Trevor
Project, put a stop work orderout on the work that they were
doing for 988, the NationalSuicide Prevention Hotline.
Trevor Project was doing a lotof specialized support for LGBTQ
(01:33):
people, and the administrationhas ceased all specialized
support for LGBTQ people withthe 988 hotline.
So I just, my heart is breakingfor all of the young people who
are impacted by this decisionand now have lost this such an
important resource for supportwhen they may need it the most.
(01:55):
It's just senseless anddevastating and cruel and it's
just making, it's just reallyheavy right now and I just, my
heart goes out to all of thepeople who are impacted and know
that the fight doesn't stophere.
We see you.
We support you.
(02:16):
Trans rights are human rights.
That includes trans youngpeople.
That includes everybody whoneeds access to gender affirming
care.
We are in this fight until wehave bodily autonomy as a
reality for everyone.
And this week, it was a badsetback, but it is not the end.
And so, we'll keep fighting.
(02:38):
But I've just been sitting withthat a lot this week and just
thinking about all of the peoplewho are impacted.
And today, when this episodecomes out, it marks three years
since the Dobbs decision.
So, to have such a negativebodily autonomy ruling so close
to the anniversary of anotherterrible bodily autonomy ruling
(03:00):
is just it's hard and so I'mjust thinking of everybody right
now but I am feeling veryexcited for today's episode.
It's a little bit of a longerconversation, so I'm going to
keep the intro short.
I read this amazing book AfterDobbs: How the Supreme Court
Ended Roe But Not Abortion, andI could not think of a better
(03:24):
way to mark the three-yearanniversary of the Dobbs
decision than talking to theauthors of that book, David
Cohen and Carole Jaffe.
So, I'm so excited for you allto hear our conversation.
It was a great one, anddefinitely check out their book.
We'll have a bookshop link inthe show notes.
So with that, let's turn to myinterview with David and Carole.
Carole (03:44):
Nice to be here.
David (03:52):
Thanks for having
Jennie (03:53):
So before we get started, let's do a quick round
of introductions.
Carole, would you like to gofirst and introduce yourself?
Carole (04:00):
Sure.
I am a professor of obstetrics,gynecology, and reproductive
sciences at the University ofCalifornia, San Francisco.
I am a professor emerita ofsociology at UC Davis.
Jennie (04:16):
Great.
David?
David (04:17):
I'm a law professor at Drexel's Klein School of Law in
Philadelphia.
I also represent abortionclinics in Pennsylvania as pro
bono counsel on a wide varietyof matters, including litigation
and policy work.
Jennie (04:31):
So, I'm so excited to have the two of you on today.
I was telling you before, and Ireally loved your book.
Often when I talk about how Ican keep doing this work and the
parts that give me hope, youreally kind of dug into all the
parts that give me hope to keepgoing on.
So, I'm excited to get to that.
But I think we need to startwith kind of the elephant in the
room.
This is coming out on the Dobbsanniversary, but there was also
(04:54):
a big decision last week, thisweek as we're recording, that is
about bodily autonomy.
David, do you want to talkreally quick about the Skrmetti
decision?
David (05:03):
Yeah, so the Supreme Court on Wednesday issued a
ruling in a case calledSkrmetti, which is out of
Tennessee.
It involved the state banninggender-affirming care for
minors.
One of, I think it's almosthalf the states in the country
that do this.
And the claim in the case wasthat this violated the
Constitution prohibition on sexdiscrimination because cisgender
(05:27):
kids who need hormone therapy,for instance, are able to get
it, but trans kids are not.
And the Supreme Court rejectedthat claim.
It was a six to three decisionalong ideological lines.
And kind of, you know, echoingDobbs in a couple ways.
One, the court said that thisis not sex discrimination
(05:48):
because it's linked with medicalcare and it's linked with
medical care that not all girlsor boys get.
So it's not sex discrimination.
It's not like there's one sidethat can get it all and the
other side can't.
And then second, they said in afield where there's medical
uncertainty, we're going todefer to the legislature.
Kind of like Dobbs, where theysaid when there's dispute about
(06:12):
the morality of abortion andeven medical issues, too, we're
going to defer to legislatures.
So this is really just thecourt once again saying that
legislatures get to makedecisions about medical issues.
people's medical lives, justlike in Dobbs.
Jennie (06:27):
I found the especially tragic part of, I mean, all of
it was tragic and terrible, wasthat the announcement of the
ending of the LGBTQ supportsystems for 988 came down that
same morning or the night beforeand you were hearing about it
that morning.
And I was just thinking aboutall these young people who
needed that extra support thatday that was no longer federally
(06:48):
available.
David (06:49):
Yeah. I mean, it's tragic.
It's just tragic for kids inthese states.
And especially, you know,there's often discussion, "vote
with your feet," right?
If you don't like a state'spolicy, then move to another
state.
But kids, right?
Kids don't have the ability tojust move to another state.
So they're trapped in theseplaces, and they can't get the
care they need.
And it's just, it's going to betragic for them.
Jennie (07:11):
Okay, so let's turn to what we were here to talk about
today.
And that is three years sincethe Dobbs decision came down.
I really love that your booktalked about kind of you had the
three stages of interviews.
So before and then right afterand then was it like six months
later?
So, let's start with (07:28):
what was kind of the immediate reality
you were seeing after Dobbs?
And Carole, let's have you gofirst this time.
Carole (07:36):
Well, immediately after Dobbs, people were deeply
saddened, heartbroken, I don'tthink is too strong a term, but
frankly, for the most part, notsurprised.
What we found out was that theprovider community, their allies
and the abortion funds, I mean,they had begun strategizing
(07:58):
long before.
I mean, people knew this wascoming.
If there was any doubt, theleak that happened in the May
proceeding the June of thedecision, it was clear this was
going to happen.
So I remember vividly onedoctor who we asked how she felt
(08:19):
that day.
She said, it's like if an alienhad landed on this planet.
I mean, it was so shocking toher.
And she also said, and this hasstayed with me, "my life's work
has become a crime scene."
Jennie (08:36):
Yeah, I just remember even knowing it was coming and
for sure know it was comingbecause of the leak, there was
just this emotional differencebetween knowing it was coming
and then having it actuallyhappening.
There was still just your heartfell out, your stomach fell
out, and it was like, what do wedo now immediately?
Carole (08:55):
Speaking of stomachs, one person told us she was
driving with her family in thecar and heard it on the radio.
Told her husband to stop thecar and she had to vomit.
So, yes, stomachs wereliterally affected.
Jennie (09:12):
David?
David (09:13):
The emotions were raw.
The emotions were immediate andreally devastation.
But at the same time, thepeople that we were talking
with, they knew they had to getto work.
So, they had to process thisemotionally.
One person we talked to saidthat she had a period of time
with the people who were in heroffice with her, half hour,
(09:37):
maybe an hour.
But then they had to get towork dealing with what next.
We've got patients in thewaiting room.
We've got patients who arecalling about the weekend.
We've got a clinic that we, insome of the states, we have to
close.
Or we have a clinic we have tomove or change, or we're now
going to get flooded with calls.
So the people who we were inthe middle of talking with in
(09:58):
the year of 2022 when Dobbshappened, they, you know, like
us, processed all the emotions,but then they just had to deal
with, we still have to do thework that we're doing in this
radically changed environment.
And so, they had to figure thatall out.
Jennie (10:14):
Yeah, and it was...
hearing the stories of thethings everybody went through,
like, there were so manydifferent versions of ways that
people were going and makingthese adjustments to continue to
provide care, you know, as Imentioned like these were all
the reasons I had when peopleask [me to] talk about hope is:
all of these things theseamazing ways people fought to
(10:35):
ensure people were getting careis what is brings me hope.
That when people [say] like: don't you just want to give up? (10:38):
undefined
And it's like no, like, peopleare making sure that everyone as
many people as possible arestill able to access care.
And it was amazing to see themany ways that people did that.
David (10:52):
It's easy to when you're not in the middle of things and
you're not providing health careto try and to have the thought
that you said to say, you know,maybe this is time to just give
up.
Right.
It's devastating.
You look at the long termprospects of the Supreme Court
and you're just like, oh, mygosh, this is going to be
terrible for a long time.
But the people on the grounddon't have the luxury of even
(11:16):
entertaining that thought.
They've devoted their life tohealth care and a particular
kind of health care that theyare expert at.
And people are always going toneed abortions.
And so there are people whoneed this.
There are people who have theskills to provide it.
And so they're not sittingthere thinking, well, should I
(11:39):
just give up now?
They're saying, patients, I cando it.
I'm going to find a way.
Jennie (11:43):
Yeah.
The other thing I was thinkingof is: it's so easy to get
caught up in the fight andseeing like the new bad thing
that's coming or fightingagainst to ensure everybody is
able to access care.
This book was a great reminderon all the ways that Dobbs
didn't stop abortion, thatpeople were still able to access
the care that sometimes I canforget as I'm continuing to
(12:06):
fight to ensure that more peopleare able to get access.
So, that was really wonderfulto read.
So maybe you want to talk alittle bit about what we have
seen since then.
I know you had interviews up tosix months after, but kind of
where we are now and what hasbeen done to ensure that we are
increasing access.
(12:26):
David, why don't you go firstthis time?
David (12:28):
Yeah, so what we know has happened, you know, we started
finding this out six months alittle bit after Dobbs, that
abortion numbers have actuallygone up post-Dobbs, right?
This was the big surprise formost people.
When Carole and I started doingthese interviews in 2022, we,
(12:48):
like many people, thoughtabortion numbers were going to
go down and maybe go down quitesubstantially if up to half the
states in the country were goingto ban abortion or seriously
restrict it, the naturalconsequence, we thought, would
be that numbers would go downand a lot of people would no
longer be able to accessabortion who previously could.
But what we found out from thepeople who are the number
(13:09):
crunchers— that's not us, butthere are others, We Count,
which is a project of Societyfor Family Planning and the
Guttmacher Institute—[they] havesteadily released numbers that
have shown that abortion hasgone up in this country, about
10% in 2023, close to that,although a little less in 2024.
And so, that's been the bigsurprise, but that has
(13:35):
continued.
I think what we've seen, wedocument in our book a lot of
the different stories and we cantalk more about the different
methods, but providers havereally stepped up.
Supporters through funders,practical support groups have
done amazing things.
Funders have come through,whether it's individual funders
(13:58):
or foundations, but alsoindividuals.
And this we don't talk about inthe book as much because this
wasn't what we interviewed.
We interviewed providers.
But legislatures in pro-choicestates have done things that
we've been asking them to do fora long time, which is: get rid
of the restrictions that youactually do have on the books.
Even if you're a liberal state,look at your abortion laws and
(14:21):
get rid of the things that areunnecessary.
And they didn't do that beforeDobbs.
They were complacent.
But Dobbs really kicked themand said, we need to do that.
And so a bunch of states havesaid, okay, let's look at our
abortion laws and get rid of thethings that we don't need.
And they've opened up access,supported access with money as
well.
And so, I think that's beensignificant too.
(14:43):
And then just the last thing isthat popular opinion, right?
Abortion was everywhere for afew years and it's died down in
the past few months because ofsort of all of the, nonsense
from the Trump administrationhas really taken over the media
landscape for good reason.
But for a couple of years,abortion was everywhere in every
(15:05):
media outlet, covered multipleabortion stories.
And I think that helpednormalize abortion as a
political concept, as a talkingpoint, but also as medical care
that people you know, who mayhave thought abortion as
stigmatized or shameful before,maybe a little less so now that
everyone's talking about it.
So I think we've seen, youknow, in those big macro level,
(15:29):
big shifts post-Dobbs.
Jennie (15:31):
Carol?
Carole (15:32):
Yes, to add to that, for me, one of the real excitements
of doing this research was waslearning how at a very almost
granular level, if I can saythat, I mean, just to see in
real time how this washappening.
And what I'm thinking aboutparticularly is the role of
(15:52):
patient navigators.
Pre-Dobbs, there were abortionfunds, both at the national
organizations like the NationalAbortion Federation, like
Planned Parenthood, [and] almostevery state has a local
abortion fund.
So there were groups helpingpoor women and poor
(16:15):
pregnancy-capable people ofgetting procedures, of paying
for them.
But after Dobbs, thingschanged.
It wasn't just here, yeah,we'll help you pay for this.
We'll help you find a place.
We'll help you arrange aflight.
or a bus trip or pay for gas.
We'll help you find lodgingonce you get to the place.
(16:38):
I mean, this was incrediblylabor-intensive work from the
time a patient would contact afund till when she actually or
they actually got theirprocedure.
It was a matter often of weeks,everyday phone calls.
Okay, have you arrangedchildcare for people who were
(17:01):
driving?
Have you had your brake lightschecked out?
You don't want to get stoppedon the road for, you know, for
something like that.
The majority of abortionpatients are poor.
Many of them had never been inan airport, knew nothing about
TSA, didn't know they were notallowed to bring their shampoo,
(17:21):
for example.
So these patient navigatorswere on the phone with these
patients till the moment theygot on the plane, and then when
they get off the plane, how doyou get to the clinic or how do
you get to her hotel?
So it was really extraordinaryto see just the level of
dedication and hard work, laborintensive work to get people
(17:45):
where they needed to go.
And without this kind of work,we would not have seen this rise
in numbers.
Jennie (17:53):
So, a lot of clinics and people working in abortion
chose different paths and waysto get people to increase that
access.
So Carole, you just talkedabout patient navigators.
Are there any other of thepaths you want to talk about?
Carole (18:08):
Well, there was a lot of fundraising and it cannot be
stated strongly enough howimportant money has been to this
whole process.
to the past three years.
Right after Dobbs, there was aan explosion of funding.
(18:29):
Rage spending is how peoplehave, including us, have come to
refer to it.
And this money and the usefuldeployment of the strategic
deployment of this moneyexplains a lot.
A doctor located in the Midwesttold us of a story of a patient
who was coming from a bannedstate for an abortion.
(18:52):
There was a big, it was winter,big snowstorm in the Midwest.
Patient's flight is canceled.
Within hours, patient isrescheduled, a new flight to Las
Vegas, a new hotel, a newappointment, a new clinic to
pay.
And this is a combination ofthe incredible dedication of the
(19:14):
workers, but also the moneythat then they had at hand.
So even though, as you pointedout, Jenny, our book tells a
quite surprising, in its ownway, upbeat story story, yes,
people are still gettingabortions, but we end on a note
of caution.
We end on a note of cautionsaying, you know, if this level
(19:37):
of money, of donations is notsustained, much of what we saw
will not be able to continue.
Right after Dobbs, as I said,this explosion, since then we've
had an election.
Now we have huge range ofsocial problems, very worthy of
(19:59):
support.
For example, immigrationassistance.
There are many worthy causesasking people for donations.
But if people forget about theabortion funds, a lot of what
David and I documented may notbe able to continue.
Jennie (20:19):
As somebody who is very much a rage donator, I also have
my monthly donations.
So like, so like I do, I do doboth, but I, but I was very much
a rage donator and somebody whoworks on global repro as well.
So with the loss of foreignassistance, there are so many
places for your money to goright now.
It's really hard and it'sreally hard for the abortion
funds to keep up with that levelthat they're not seeing
(20:42):
anymore.
David, do you want to talkabout the other adjustments that
you saw?
David (20:46):
Yeah, so, you know, we saw a lot of abortion providers
move their practice from onestate to another.
And this happened in a lot ofdifferent places in the country.
You know, a provider in Texasmoved to New Mexico, a provider
in Tennessee moves to Virginia,or into Illinois from Tennessee
as well, the other side ofTennessee.
(21:07):
One of the providers we talkedto, and we tell her story in our
book, is Tammi Kromenaker,who's the director and owner of
Red River Women clinic that hadbeen in Fargo, North Dakota.
Fargo, North Dakota had beenthe only abortion clinic in the
state for a long time.
It's right on the river thatseparates North Dakota and
(21:31):
Minnesota, just across therivers, Moorhead, Minnesota.
Tammy and her clinic, they sawthe writing on the wall, just
like we all did.
And they were secretly planningif Dobbs came down the way they
expected to move across theriver into Minnesota.
And just patients would have todrive an extra few minutes
(21:52):
across the river, althoughactually all their Minnesota
patients, it would be closerbecause they were seeing people
from Minnesota before Dobbs.
And so they were planning for ayear before Dobbs.
And then once Dobbs hit, theydid this secretly so that the
anti-abortion movement wouldn'tfind out.
Word got out pretty quicklyafter Dobbs hit that this is
what they were planning to do.
(22:12):
And the escorts who worked atthe clinic started a GoFundMe
page to raise money to help withthe move.
And their initial ask was$25,000.
They hoped to raise $25,000 tohelp with the move across.
You have to move a wholemedical clinic across the river,
right?
$25,000 sounds like that wouldhelp.
(22:33):
Well, people were so pissed offafter Dobbs, this went viral in
a way no one expected.
And the expectation of the hopeof $25,000 turned into over a
million dollars raised in a veryshort period of time for this
clinic.
And it just shocked Tammy andeveryone she worked with.
She was able to do the move,buy the building, and move the
(22:55):
clinic across the river withoutany debt.
And really propel that clinicto success in Moorhead in a way
that no one expected.
And the irony of the situationis that as much as she was
devastated to leave North Dakotabecause that had been her home,
that had been her business'shome for decades and provide,
(23:17):
you know, she didn't want togive up.
She was a fighter.
She is a fighter.
She had fought the state ofNorth Dakota multiple times in
court and in legislature, andshe still was there.
Right.
And so it devastated her toleave North Dakota.
But what she found was thatmoving to Minnesota actually
made care so much easier for herpatients and for her workers
(23:39):
and for herself.
Because Minnesota didn't haveany of the regulations and the
restrictions that North Dakotadid that put barriers in the way
of people accessing abortion.
So she was able to providebetter medical care, more
efficient medical care, and withthe support of the politicians
and local communities.
In Minnesota, the governorcalled her, the senators,
(24:03):
attorney general, local FBI,they were all very supportive in
ways that she never had inFargo.
So, you know, it was one ofthose situations where she
didn't want to do it, butactually doing it now realized
it was a better situation.
And again, you know, the peoplein North Dakota, it's just an
extra five minute drive forthem.
Jennie (24:22):
I really appreciated that story.
I am originally from Wisconsin,born and raised.
So, uh, hearing about thatstory really touched me and
hearing about all of the workbeing done in Illinois for, to
get people to come there and anew clinic just opening in
Wisconsin, also very exciting.
So, but yeah, it was a nicehearing about something a
(24:43):
little local to where I grew up.
I want to say one more thing ofthe Tammy story.
She was not only visited of thesummer, you know, by local, I
mean, not just localpoliticians, both of Minnesota's
senators contacted her.
But I think in what has to be ahistoric first, Tammy and
(25:07):
several other abortion providersand some patients were invited
to the State of the Union byDemocratic senators.
And for someone like me, whohas studied abortion providers
for many years noting howstigmatized, how marginalized
they have been, often even bypeople who consider themselves
(25:31):
pro-choice, to have abortionproviders sitting at the State
of the Union— I mean, that tellsus something about the changing
status of abortion providers.
Okay, I guess the next big thing to talk about is
something that we're definitelybeen keeping an eye on is I'm
sure the fights in the courtsare going to continue to affect
(25:52):
it.
And that's medication abortion.
David, how about you go firstthis time?
David (25:56):
Yeah, so abortion pills have played just a massive role
post Dobbs.
And to be clear, they werebecoming much more common even
before Dobbs, right?
So abortion pills is twodifferent drugs, mifepristone
and misoprostol.
And mifepristone is the onethat's FDA approved for
abortion.
Misoprostol is FDA approved forulcer treatment but it's used
(26:18):
in conjunction with mifepristoneto accomplish a medication
abortion.
Mifepristone was approved in2000 and it was slowly becoming
right up until Dobbs it justcracked the majority of abortion
point right before Dobbs so 53%of abortions before Dobbs were
accomplished through medicationabortion.
(26:39):
Now the number is up into the60s and I would you know, the
most recent data is from acouple years ago, and it was
63%.
I would be surprised if it'snot up around 70% of abortions
or medication abortion rightnow, once we get the numbers for
this time period.
And that's because Dobbs haspropelled abortion pills into
(27:02):
the news in ways that, you know,people really wanted people to
learn about abortion pillsbeforehand.
But possibly because- a bigpart because of the
anti-abortion movement withtheir major lawsuit in Texas
that went to the Supreme Courtthat was about abortion pills.
The whole country learned aboutabortion pills in ways they
(27:22):
didn't know before.
So that's part of it.
But also providers have reallyexperimented with new delivery
models for abortion pills.
Sort of necessity being themother of invention, right?
And so there are now a lot ofnew ways to get abortion pills
post-Dobbs.
Some of that is not with amedical provider, right?
(27:44):
A pharmacy, informal supportgroups that just will distribute
pills, international mail toget abortion pills.
But within the United States,with licensed medical
professionals, we've had anexpansion of telehealth and
telemedicine clinics that areproviding abortion pills in
(28:05):
different places in the country.
And then the real novel legaldevelopment is telehealth shield
laws.
Shield laws have been passed.
They are laws that protectpeople in states where abortion
remains legal from other stateswhere abortion is illegal.
There are 18 states that haveshield laws generally, but eight
(28:27):
of those 18 states allow withintheir shield law license
medical professionals in thatstate to mail pills into a state
where they don't have alicense, including states where
abortion is banned.
So concretely, a New Yorkdoctor with a New York license
(28:47):
who is physically located in NewYork can mail pills into, say,
a state like Texas or Alabamaand do so protected by New York
law.
Now, they will be violatingTexas and Alabama law, but New
York will protect them.
And because of these shieldlaws, there are over 10,000
(29:11):
packs of pills mailed everymonth from these shield
providers, and the vast majorityare going to states with
abortion bans.
So people in states whereabortion is banned are getting
pills from licensed medicalprofessionals, and that is
increasing abortion access, eventhough clinics have closed in
(29:32):
those states.
Jennie (29:33):
Carole, do you have anything to add?
Carole (29:34):
Yeah.
Should the worst case happen,should FDA withdraw approval of
mifepristone.
Should the Comstock law startbeing enforced?
And I'll leave it to David toexplain to your listeners what
that will mean.
But spoiler alert, it's a scarystory, but we'll get to that.
(29:55):
Anyway, should we be in asituation where in the United
States, pills can no longer bemailed, or mifepristone is no
longer legal, should thathappen, an unknown number of
people are getting abortionpills from the internet,
(30:17):
bypassing the various groupsthat are now doing it.
They're just ordering pills.
Now, we could have a discussionof, is it better to get these
pills and not have anyinteraction with the doctor?
And for some people,unquestionably, it's much
better.
I just this morning read areport saying younger patients
(30:37):
in general really want thereassurance of talking to a
healthcare professional.
So, I'm not saying this isbetter.
I'm just saying if all elsefails, some people, those whose
pregnancies have not advancedtoo far, some people will always
be able to get pills from theinternet, often sent from a
(31:00):
foreign country.
There is some legal risk, butthe mail would have to be
examined very closely.
These pills will come in anunmarked envelope.
I'm sure it won't say abortionpills on the mailer.
And one thing that I find veryinteresting and reassuring is
(31:21):
that a couple of years ago, aresearch group in New York, a
group called Gynuity, it's areproductive health research
group, they actually orderedpills from these various places
offering them.
There was a lot of skepticism.
You know, are people justgetting taken for a ride?
Are these going to be sugarpills?
(31:41):
So they actually ordered thesepills, tested them, and it
turned out that these pills, forthe most part, these were the
real thing.
If all else fails, well, firstof all, big picture, there's
always going to be abortions.
Throughout history, therealways have been abortions, even
(32:06):
in places where it was illegal.
So, we could get into aninteresting discussion of what
else people might do, some ofthe options people might choose
would be more dangerous, butordering pills for the
foreseeable future will alwaysbe an option for some.
Jennie (32:27):
David, do you want to do Comstock real quick?
David (32:29):
Yeah, so Comstock is a federal law that was passed in
1873, so over 150 years ago.
And it's an obscenity law.
And the definition of obscenityincludes a lot of things about
immorality and indecency.
But basically, the way itaccomplishes its goal, it says
these things are unmailablematerial so that you cannot put
(32:52):
them in the mail.
A couple decades later, theyincluded private express mail
services.
So you can't mail things thatare considered obscene.
In the text of the law, it saysthat you can't mail anything
that can produce an abortion.
And so at the time, it wasreally understood that that
would mean abortion outside ofthe medical context, outside of
(33:15):
a medical professional context.
But the text of the law doesn'tsay that.
It just says producing anabortion.
And the anti-abortion movementtoday is saying this law that
you know, it was in the 1920s,1930s, the courts, not the
Supreme Court, but the courtsright under that, said this only
(33:36):
applies to unlawful abortionoutside of the medical context.
But the anti-abortion movementtoday is saying those rulings
were wrong, and what we have tolook at is the strict language
of the law, and it says anythingthat can produce an abortion,
and so that would mean you can'tmail pills, everything we were
just talking about, but you alsocan't mail that would be used
(33:59):
in a brick-and-mortar clinic fora procedural abortion because
that equipment and thoseinstruments are used to produce
an abortion.
So you can't mail those.
And so their extremeinterpretation of the Comstock
Act would basically shut downabortion because if you can't
mail things, whether expressmail or mail, or U.S.
(34:21):
postal mail, pills or equipmentor instruments, then how are
you going to practice abortion,right?
How are you going to do that?
And so they're pushing thatinterpretation.
Like I said, it's a federallaw.
So the Trump Department ofJustice gets to decide if they
want to put, you know, implementthat interpretation.
Now, to be clear, it would alsobe challenged in court.
(34:41):
There would be pushback.
And so, we don't know, youknow, I would hope it wouldn't
take even if they tried it.
But here we are five monthsinto his presidency and they
have not tried it.
I think that's notable becausethe anti-abortion movement has
written many letters urging themto do so.
They have been very vocal aboutthis and it hasn't happened
(35:05):
yet.
Now, it might not have happenedyet because they're busy doing
other terrible things andthey're going to implement
Comstock in this way later thisyear or next year.
But it might also not havehappened yet because they're not
going to do it because ofpolitical pressure or it's
unpopular or they want to spendall their political capital on
(35:26):
sending people to countries andprisons in other countries and
ICE raids.
So, we don't know what's goingto happen with the Comstock Act,
but it is a threat.
And as we said, if they reallydo strictly enforce it the way
they're trying to push, it couldbe devastating.
Jennie (35:46):
I guess that leads me to, if you're like me, which I'm
sure you have this as well,you're worried about any number
of things at this moment thatcould happen.
What is something that you wereeither keeping an eye on or
actively worried about right nowwhen it comes to abortion?
I think we have Carole firstthis time.
Carole (36:06):
I'm worried about RFK Jr., let's put it that way.
He has the capacity, heactually has announced he's
going to review the safety ofmifepristone, which is absurd.
You know, this drug has beenreviewed extensively.
It's been approved in thiscountry since year 2000, in
(36:30):
Europe since 1988.
When RFK Jr.
was before a congressionalcommittee and he was asked about
this, one of the Democraticsenators held up a stack of
papers.
Well, your listeners can't seewhat I'm doing, but held up a
big stack of papers and said,you do not need to review this.
(36:52):
It has been reviewedextensively.
So yes, I'm worried that intheory he could withdraw
approval.
But I think more realistically,what I'm also worried about is
an overturned of a Bidenadministration regulation that
said mifepristone does not haveto be picked up in person at an
(37:16):
office.
I mean, this was a response toCOVID.
When the regulation wasdropped, you don't have to be
there in person.
So as we've said earlier,telehealth has been incredibly
important to this.
If the FDA were to say, no, youcan no longer send this
medication through telehealth,that would be devastating.
(37:39):
I think it would cause lesspublic outcry than an outright
withdrawal of FDA approval.
I mean, people who do not thinkabout abortion 24-7, like the
three of us, would say, well,what's the big deal?
They didn't withdraw theapproval.
So yes, I'm worried about that.
Jennie (37:59):
David?
David (38:00):
So FDA, absolutely.
Comstock as well.
But I think I'm also reallyworried about sort of the
finances of abortion clinics andabortion providers.
We're seeing, you know, Caroletalked about sustainability with
rage donations, but that'scoupled with the attacks on
(38:22):
Medicaid providers, inparticular Planned Parenthood,
and the threats that taking awaysupport, financial support,
could really devastate abortion.
Abortion providers, theirpatients, and the people that
abortion providers see thataren't abortion patients, right,
that for other reproductivehealthcare and other kind of
(38:43):
healthcare.
And so at a time that we areseeing such attacks on abortion
and reproductive healthcare,just the financial
sustainability of these entitiesthat, you know, they need money
to survive.
They're not, you know, they'renot free clinics with, you know,
that just magically get theirsupplies and their workers and
(39:06):
their rent for free.
Right.
You know, a lot of peoplethink, oh, these this should be
mission driven and peopleshouldn't make money off this.
But people need to eat.
They need to put roofs overtheir heads.
They need to pay workers.
They need to get supplies.
So money is involved.
Right.
And if if the if there's allthese sets of with regard to
(39:27):
funding, that's really achallenge going forward with how
these essential medical carefacilities are going
to continue.
Jennie (39:36):
Yeah.
And along with Medicaid, TitleX as well, seeing attacks on
that.
Okay.
So I always like to end thepodcast, not just focusing on
all the things that are wrong orneed to be fixed, but the ways
the audience can get involvedand what they can do.
So any suggestions on how theaudience can get involved on
this?
David.
David (39:56):
Yeah, so look, there are things that we are very
concerned about in the future,but I do think that people need
to spread the word that as muchas the Supreme Court issued this
terrible opinion three yearsago, abortion advocates,
abortion providers, abortionsupporters are still doing this
(40:18):
incredible work of resistance onthe ground every day.
And so, I think part of whatpeople can do is: spread the
word.
Abortion remains legal in a lotof places.
Abortion pills remainaccessible everywhere.
Make sure people know that sothat people can get the care
that and not feel, oh, theSupreme Court overturned Roe v.
(40:39):
Wade, I guess we can't getabortions, right?
So it's important for people onthe ground to know that and
spread this word.
And then the second thing Ithink that people can do is, you
know, ultimately we want somekind of national right to
abortions that people all overthe country are protected.
And so we think, you know, Ithink of the environmental
(41:01):
movement from decades ago, thinkglobally, act locally, right?
I think this is a thinknationally act act locally thing
here, because you want to doeverything you can to get
Washington, D.C.
to change, but most peoplearen't going to be able to do
that.
But what you can do is you canescort at your local clinic.
You can be part of a practicalsupport group in your local
(41:22):
area, help drive people to andfrom clinics, and you can
support your local abortionfund.
All three of those things areintensely local.
They are not going to changethe general policy environment
in the entire country, but theyare going to help people getting
care today in your community,and you can be a part of that.
Jennie (41:42):
Great.
Carole (41:44):
Yeah, well, I obviously agree with all of that.
The only thing to add, and itmight sound a little lame, is
vote.
And when I say vote, not justfor president and for senators
and congresspeople, all of whichyou shouldn't vote for.
People in general havetypically not tended to vote
(42:07):
lower down on the ballot.
And these are incrediblyimportant.
Some of the most importantabortion action for years has
taken place in statelegislatures.
So state representatives, statesenators, city council people,
listeners might say (42:26):
well, what does that have to do with
abortion?
It could do plenty withabortion.
If you want to establish a newclinic, you have to establish
this clinic in a place wherethere's zoning.
And very often this becomesquite contentious.
So voting at every single levelon the ballot is essential.
Jennie (42:49):
Well, David, Carole, thank you both for being here
today.
I had so much fun talking toyou.
Carole (42:54):
Well, it's a pleasure to talk to you.
David (42:56):
Yeah, thank you very much.
Jennie (42:57):
Okay, y'all, I hope you enjoyed my conversation with
David and Carole.
Like I said, I really did lovetheir book, After Dobbs: How the
Supreme Court Ended Roe But NotAbortion.
You should absolutely check itout.
There is a link in our shownotes for a bookshop link so
that you can shop at your localbookstore.
Yeah, I hope you enjoyed thatconversation.
I thought it was reallyimportant and it was
(43:20):
great to see all of the ways that people are still being to access abortion care even as the Supreme Court tried to end access to it. Now, does this mean things are good? Obviously not. Obviously, we are continuing to fight to make access so much better for everybody. People should not be having to jump through all these hoops of traveling and all of these things to get it. But this book really gave a voice to what I was talking about—there are so many people on the ground doing so many amazing things to access care.
You can sometimes forget aboutin the day-to-day fight to
(43:55):
ensure that everybody is able toaccess care, which is so
important.
It is also important to take achance and celebrate the ways
that we have won, that we arestill able to get people access
to the care they need.
And this book gave me the timeto take a step back and
appreciate that bigger picturewhile still fighting to ensure
(44:17):
that more people are able toaccess care and that we don't
lose any more access.
So it was a great book for justkind of doing some reflection
and to read all of the storiesabout the amazing things that
people are doing to ensure thatpeople are able to get as much
care as they can.
Okay.
With that, I will see everybodynext week.
(44:39):
[music outro] If you have anyquestions, comments or topics
you would like us to cover,always feel free to shoot me an
email.
You can reach me at Jennie,J-E-N-N-I-E @reprosfightback.com
or you can find us on socialmedia.
We're at rePROs Fight Back onFacebook and Twitter
or @reprosfb on Instagram.
If you love our podcast andwant to make sure more people
(45:01):
find it, take the time to rateand review us on your favorite
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Or if you want to make sure tosupport the podcast, you can
also donate on our website atreprosfightback.com.
Thanks all!
Welcome to rePROs Fight Back, a podcast on all things
related to sexual andreproductive health, rights, and
justice.
[music intro] Hi rePROs, how'severybody doing?
I'm your host, Jennie Wetter,and my pronouns are she/ her.
So y'all, I'm coming to youtoday with a bit of a heavy
heart.
I'm recording this on Friday,June 20th, and so it's still
(00:25):
very close on the heels of theSupreme Court decision in
Skrmetti.
We'll talk about that a littlebit in the interview today, and
we'll have a full episodetalking about it later, but just
still feeling just very, justheavy.
I just, I don't know.
I'm thinking of all of theyoung people who are going to be
impacted by the Supreme Court'sdecision to uphold Tennessee's
(00:48):
ban on gender-affirming care forminors.
It's going to have just hugeeffects on the lives of young
people.
We know that gender-affirmingcare is life-saving and
life-changing healthcare, and toprevent young people from
accessing it will just havedevastating impacts on their
lives.
You can't talk about thatdecision without talking about
(01:11):
an action the administrationtook the night before, where the
administration formallysuspended funding for the Trevor
Project, put a stop work orderout on the work that they were
doing for 988, the NationalSuicide Prevention Hotline.
Trevor Project was doing a lotof specialized support for LGBTQ
(01:33):
people, and the administrationhas ceased all specialized
support for LGBTQ people withthe 988 hotline.
So I just, my heart is breakingfor all of the young people who
are impacted by this decisionand now have lost this such an
important resource for supportwhen they may need it the most.
(01:55):
It's just senseless anddevastating and cruel and it's
just making, it's just reallyheavy right now and I just, my
heart goes out to all of thepeople who are impacted and know
that the fight doesn't stophere.
We see you.
We support you.
(02:16):
Trans rights are human rights.
That includes trans youngpeople.
That includes everybody whoneeds access to gender affirming
care.
We are in this fight until wehave bodily autonomy as a
reality for everyone.
And this week, it was a badsetback, but it is not the end.
And so, we'll keep fighting.
(02:38):
But I've just been sitting withthat a lot this week and just
thinking about all of the peoplewho are impacted.
And today, when this episodecomes out, it marks three years
since the Dobbs decision.
So, to have such a negativebodily autonomy ruling so close
to the anniversary of anotherterrible bodily autonomy ruling
(03:00):
is just it's hard and so I'mjust thinking of everybody right
now but I am feeling veryexcited for today's episode.
It's a little bit of a longerconversation, so I'm going to
keep the intro short.
I read this amazing book AfterDobbs: How the Supreme Court
Ended Roe But Not Abortion, andI could not think of a better
(03:24):
way to mark the three-yearanniversary of the Dobbs
decision than talking to theauthors of that book, David
Cohen and Carole Jaffe.
So, I'm so excited for you allto hear our conversation.
It was a great one, anddefinitely check out their book.
We'll have a bookshop link inthe show notes.
So with that, let's turn to myinterview with David and Carole.
Carole (03:44):
Nice to be here.
David (03:52):
Thanks for having
Jennie (03:53):
So before we get started, let's do a quick round
of introductions.
Carole, would you like to gofirst and introduce yourself?
Carole (04:00):
Sure.
I am a professor of obstetrics,gynecology, and reproductive
sciences at the University ofCalifornia, San Francisco.
I am a professor emerita ofsociology at UC Davis.
Jennie (04:16):
Great.
David?
David (04:17):
I'm a law professor at Drexel's Klein School of Law in
Philadelphia.
I also represent abortionclinics in Pennsylvania as pro
bono counsel on a wide varietyof matters, including litigation
and policy work.
Jennie (04:31):
So, I'm so excited to have the two of you on today.
I was telling you before, and Ireally loved your book.
Often when I talk about how Ican keep doing this work and the
parts that give me hope, youreally kind of dug into all the
parts that give me hope to keepgoing on.
So, I'm excited to get to that.
But I think we need to startwith kind of the elephant in the
room.
This is coming out on the Dobbsanniversary, but there was also
(04:54):
a big decision last week, thisweek as we're recording, that is
about bodily autonomy.
David, do you want to talkreally quick about the Skrmetti
decision?
David (05:03):
Yeah, so the Supreme Court on Wednesday issued a
ruling in a case calledSkrmetti, which is out of
Tennessee.
It involved the state banninggender-affirming care for
minors.
One of, I think it's almosthalf the states in the country
that do this.
And the claim in the case wasthat this violated the
Constitution prohibition on sexdiscrimination because cisgender
(05:27):
kids who need hormone therapy,for instance, are able to get
it, but trans kids are not.
And the Supreme Court rejectedthat claim.
It was a six to three decisionalong ideological lines.
And kind of, you know, echoingDobbs in a couple ways.
One, the court said that thisis not sex discrimination
(05:48):
because it's linked with medicalcare and it's linked with
medical care that not all girlsor boys get.
So it's not sex discrimination.
It's not like there's one sidethat can get it all and the
other side can't.
And then second, they said in afield where there's medical
uncertainty, we're going todefer to the legislature.
Kind of like Dobbs, where theysaid when there's dispute about
(06:12):
the morality of abortion andeven medical issues, too, we're
going to defer to legislatures.
So this is really just thecourt once again saying that
legislatures get to makedecisions about medical issues.
people's medical lives, justlike in Dobbs.
Jennie (06:27):
I found the especially tragic part of, I mean, all of
it was tragic and terrible, wasthat the announcement of the
ending of the LGBTQ supportsystems for 988 came down that
same morning or the night beforeand you were hearing about it
that morning.
And I was just thinking aboutall these young people who
needed that extra support thatday that was no longer federally
(06:48):
available.
David (06:49):
Yeah. I mean, it's tragic.
It's just tragic for kids inthese states.
And especially, you know,there's often discussion, "vote
with your feet," right?
If you don't like a state'spolicy, then move to another
state.
But kids, right?
Kids don't have the ability tojust move to another state.
So they're trapped in theseplaces, and they can't get the
care they need.
And it's just, it's going to betragic for them.
Jennie (07:11):
Okay, so let's turn to what we were here to talk about
today.
And that is three years sincethe Dobbs decision came down.
I really love that your booktalked about kind of you had the
three stages of interviews.
So before and then right afterand then was it like six months
later?
So, let's start with (07:28):
what was kind of the immediate reality
you were seeing after Dobbs?
And Carole, let's have you gofirst this time.
Carole (07:36):
Well, immediately after Dobbs, people were deeply
saddened, heartbroken, I don'tthink is too strong a term, but
frankly, for the most part, notsurprised.
What we found out was that theprovider community, their allies
and the abortion funds, I mean,they had begun strategizing
(07:58):
long before.
I mean, people knew this wascoming.
If there was any doubt, theleak that happened in the May
proceeding the June of thedecision, it was clear this was
going to happen.
So I remember vividly onedoctor who we asked how she felt
(08:19):
that day.
She said, it's like if an alienhad landed on this planet.
I mean, it was so shocking toher.
And she also said, and this hasstayed with me, "my life's work
has become a crime scene."
Jennie (08:36):
Yeah, I just remember even knowing it was coming and
for sure know it was comingbecause of the leak, there was
just this emotional differencebetween knowing it was coming
and then having it actuallyhappening.
There was still just your heartfell out, your stomach fell
out, and it was like, what do wedo now immediately?
Carole (08:55):
Speaking of stomachs, one person told us she was
driving with her family in thecar and heard it on the radio.
Told her husband to stop thecar and she had to vomit.
So, yes, stomachs wereliterally affected.
Jennie (09:12):
David?
David (09:13):
The emotions were raw.
The emotions were immediate andreally devastation.
But at the same time, thepeople that we were talking
with, they knew they had to getto work.
So, they had to process thisemotionally.
One person we talked to saidthat she had a period of time
with the people who were in heroffice with her, half hour,
(09:37):
maybe an hour.
But then they had to get towork dealing with what next.
We've got patients in thewaiting room.
We've got patients who arecalling about the weekend.
We've got a clinic that we, insome of the states, we have to
close.
Or we have a clinic we have tomove or change, or we're now
going to get flooded with calls.
So the people who we were inthe middle of talking with in
(09:58):
the year of 2022 when Dobbshappened, they, you know, like
us, processed all the emotions,but then they just had to deal
with, we still have to do thework that we're doing in this
radically changed environment.
And so, they had to figure thatall out.
Jennie (10:14):
Yeah, and it was...
hearing the stories of thethings everybody went through,
like, there were so manydifferent versions of ways that
people were going and makingthese adjustments to continue to
provide care, you know, as Imentioned like these were all
the reasons I had when peopleask [me to] talk about hope is:
all of these things theseamazing ways people fought to
(10:35):
ensure people were getting careis what is brings me hope.
That when people [say] like: don't you just want to give up? (10:38):
undefined
And it's like no, like, peopleare making sure that everyone as
many people as possible arestill able to access care.
And it was amazing to see themany ways that people did that.
David (10:52):
It's easy to when you're not in the middle of things and
you're not providing health careto try and to have the thought
that you said to say, you know,maybe this is time to just give
up.
Right.
It's devastating.
You look at the long termprospects of the Supreme Court
and you're just like, oh, mygosh, this is going to be
terrible for a long time.
But the people on the grounddon't have the luxury of even
(11:16):
entertaining that thought.
They've devoted their life tohealth care and a particular
kind of health care that theyare expert at.
And people are always going toneed abortions.
And so there are people whoneed this.
There are people who have theskills to provide it.
And so they're not sittingthere thinking, well, should I
(11:39):
just give up now?
They're saying, patients, I cando it.
I'm going to find a way.
Jennie (11:43):
Yeah.
The other thing I was thinkingof is: it's so easy to get
caught up in the fight andseeing like the new bad thing
that's coming or fightingagainst to ensure everybody is
able to access care.
This book was a great reminderon all the ways that Dobbs
didn't stop abortion, thatpeople were still able to access
the care that sometimes I canforget as I'm continuing to
(12:06):
fight to ensure that more peopleare able to get access.
So, that was really wonderfulto read.
So maybe you want to talk alittle bit about what we have
seen since then.
I know you had interviews up tosix months after, but kind of
where we are now and what hasbeen done to ensure that we are
increasing access.
(12:26):
David, why don't you go firstthis time?
David (12:28):
Yeah, so what we know has happened, you know, we started
finding this out six months alittle bit after Dobbs, that
abortion numbers have actuallygone up post-Dobbs, right?
This was the big surprise formost people.
When Carole and I started doingthese interviews in 2022, we,
(12:48):
like many people, thoughtabortion numbers were going to
go down and maybe go down quitesubstantially if up to half the
states in the country were goingto ban abortion or seriously
restrict it, the naturalconsequence, we thought, would
be that numbers would go downand a lot of people would no
longer be able to accessabortion who previously could.
But what we found out from thepeople who are the number
(13:09):
crunchers— that's not us, butthere are others, We Count,
which is a project of Societyfor Family Planning and the
Guttmacher Institute—[they] havesteadily released numbers that
have shown that abortion hasgone up in this country, about
10% in 2023, close to that,although a little less in 2024.
And so, that's been the bigsurprise, but that has
(13:35):
continued.
I think what we've seen, wedocument in our book a lot of
the different stories and we cantalk more about the different
methods, but providers havereally stepped up.
Supporters through funders,practical support groups have
done amazing things.
Funders have come through,whether it's individual funders
(13:58):
or foundations, but alsoindividuals.
And this we don't talk about inthe book as much because this
wasn't what we interviewed.
We interviewed providers.
But legislatures in pro-choicestates have done things that
we've been asking them to do fora long time, which is: get rid
of the restrictions that youactually do have on the books.
Even if you're a liberal state,look at your abortion laws and
(14:21):
get rid of the things that areunnecessary.
And they didn't do that beforeDobbs.
They were complacent.
But Dobbs really kicked themand said, we need to do that.
And so a bunch of states havesaid, okay, let's look at our
abortion laws and get rid of thethings that we don't need.
And they've opened up access,supported access with money as
well.
And so, I think that's beensignificant too.
(14:43):
And then just the last thing isthat popular opinion, right?
Abortion was everywhere for afew years and it's died down in
the past few months because ofsort of all of the, nonsense
from the Trump administrationhas really taken over the media
landscape for good reason.
But for a couple of years,abortion was everywhere in every
(15:05):
media outlet, covered multipleabortion stories.
And I think that helpednormalize abortion as a
political concept, as a talkingpoint, but also as medical care
that people you know, who mayhave thought abortion as
stigmatized or shameful before,maybe a little less so now that
everyone's talking about it.
So I think we've seen, youknow, in those big macro level,
(15:29):
big shifts post-Dobbs.
Jennie (15:31):
Carol?
Carole (15:32):
Yes, to add to that, for me, one of the real excitements
of doing this research was waslearning how at a very almost
granular level, if I can saythat, I mean, just to see in
real time how this washappening.
And what I'm thinking aboutparticularly is the role of
(15:52):
patient navigators.
Pre-Dobbs, there were abortionfunds, both at the national
organizations like the NationalAbortion Federation, like
Planned Parenthood, [and] almostevery state has a local
abortion fund.
So there were groups helpingpoor women and poor
(16:15):
pregnancy-capable people ofgetting procedures, of paying
for them.
But after Dobbs, thingschanged.
It wasn't just here, yeah,we'll help you pay for this.
We'll help you find a place.
We'll help you arrange aflight.
or a bus trip or pay for gas.
We'll help you find lodgingonce you get to the place.
(16:38):
I mean, this was incrediblylabor-intensive work from the
time a patient would contact afund till when she actually or
they actually got theirprocedure.
It was a matter often of weeks,everyday phone calls.
Okay, have you arrangedchildcare for people who were
(17:01):
driving?
Have you had your brake lightschecked out?
You don't want to get stoppedon the road for, you know, for
something like that.
The majority of abortionpatients are poor.
Many of them had never been inan airport, knew nothing about
TSA, didn't know they were notallowed to bring their shampoo,
(17:21):
for example.
So these patient navigatorswere on the phone with these
patients till the moment theygot on the plane, and then when
they get off the plane, how doyou get to the clinic or how do
you get to her hotel?
So it was really extraordinaryto see just the level of
dedication and hard work, laborintensive work to get people
(17:45):
where they needed to go.
And without this kind of work,we would not have seen this rise
in numbers.
Jennie (17:53):
So, a lot of clinics and people working in abortion
chose different paths and waysto get people to increase that
access.
So Carole, you just talkedabout patient navigators.
Are there any other of thepaths you want to talk about?
Carole (18:08):
Well, there was a lot of fundraising and it cannot be
stated strongly enough howimportant money has been to this
whole process.
to the past three years.
Right after Dobbs, there was aan explosion of funding.
(18:29):
Rage spending is how peoplehave, including us, have come to
refer to it.
And this money and the usefuldeployment of the strategic
deployment of this moneyexplains a lot.
A doctor located in the Midwesttold us of a story of a patient
who was coming from a bannedstate for an abortion.
(18:52):
There was a big, it was winter,big snowstorm in the Midwest.
Patient's flight is canceled.
Within hours, patient isrescheduled, a new flight to Las
Vegas, a new hotel, a newappointment, a new clinic to
pay.
And this is a combination ofthe incredible dedication of the
(19:14):
workers, but also the moneythat then they had at hand.
So even though, as you pointedout, Jenny, our book tells a
quite surprising, in its ownway, upbeat story story, yes,
people are still gettingabortions, but we end on a note
of caution.
We end on a note of cautionsaying, you know, if this level
(19:37):
of money, of donations is notsustained, much of what we saw
will not be able to continue.
Right after Dobbs, as I said,this explosion, since then we've
had an election.
Now we have huge range ofsocial problems, very worthy of
(19:59):
support.
For example, immigrationassistance.
There are many worthy causesasking people for donations.
But if people forget about theabortion funds, a lot of what
David and I documented may notbe able to continue.
Jennie (20:19):
As somebody who is very much a rage donator, I also have
my monthly donations.
So like, so like I do, I do doboth, but I, but I was very much
a rage donator and somebody whoworks on global repro as well.
So with the loss of foreignassistance, there are so many
places for your money to goright now.
It's really hard and it'sreally hard for the abortion
funds to keep up with that levelthat they're not seeing
(20:42):
anymore.
David, do you want to talkabout the other adjustments that
you saw?
David (20:46):
Yeah, so, you know, we saw a lot of abortion providers
move their practice from onestate to another.
And this happened in a lot ofdifferent places in the country.
You know, a provider in Texasmoved to New Mexico, a provider
in Tennessee moves to Virginia,or into Illinois from Tennessee
as well, the other side ofTennessee.
(21:07):
One of the providers we talkedto, and we tell her story in our
book, is Tammi Kromenaker,who's the director and owner of
Red River Women clinic that hadbeen in Fargo, North Dakota.
Fargo, North Dakota had beenthe only abortion clinic in the
state for a long time.
It's right on the river thatseparates North Dakota and
(21:31):
Minnesota, just across therivers, Moorhead, Minnesota.
Tammy and her clinic, they sawthe writing on the wall, just
like we all did.
And they were secretly planningif Dobbs came down the way they
expected to move across theriver into Minnesota.
And just patients would have todrive an extra few minutes
(21:52):
across the river, althoughactually all their Minnesota
patients, it would be closerbecause they were seeing people
from Minnesota before Dobbs.
And so they were planning for ayear before Dobbs.
And then once Dobbs hit, theydid this secretly so that the
anti-abortion movement wouldn'tfind out.
Word got out pretty quicklyafter Dobbs hit that this is
what they were planning to do.
(22:12):
And the escorts who worked atthe clinic started a GoFundMe
page to raise money to help withthe move.
And their initial ask was$25,000.
They hoped to raise $25,000 tohelp with the move across.
You have to move a wholemedical clinic across the river,
right?
$25,000 sounds like that wouldhelp.
(22:33):
Well, people were so pissed offafter Dobbs, this went viral in
a way no one expected.
And the expectation of the hopeof $25,000 turned into over a
million dollars raised in a veryshort period of time for this
clinic.
And it just shocked Tammy andeveryone she worked with.
She was able to do the move,buy the building, and move the
(22:55):
clinic across the river withoutany debt.
And really propel that clinicto success in Moorhead in a way
that no one expected.
And the irony of the situationis that as much as she was
devastated to leave North Dakotabecause that had been her home,
that had been her business'shome for decades and provide,
(23:17):
you know, she didn't want togive up.
She was a fighter.
She is a fighter.
She had fought the state ofNorth Dakota multiple times in
court and in legislature, andshe still was there.
Right.
And so it devastated her toleave North Dakota.
But what she found was thatmoving to Minnesota actually
made care so much easier for herpatients and for her workers
(23:39):
and for herself.
Because Minnesota didn't haveany of the regulations and the
restrictions that North Dakotadid that put barriers in the way
of people accessing abortion.
So she was able to providebetter medical care, more
efficient medical care, and withthe support of the politicians
and local communities.
In Minnesota, the governorcalled her, the senators,
(24:03):
attorney general, local FBI,they were all very supportive in
ways that she never had inFargo.
So, you know, it was one ofthose situations where she
didn't want to do it, butactually doing it now realized
it was a better situation.
And again, you know, the peoplein North Dakota, it's just an
extra five minute drive forthem.
Jennie (24:22):
I really appreciated that story.
I am originally from Wisconsin,born and raised.
So, uh, hearing about thatstory really touched me and
hearing about all of the workbeing done in Illinois for, to
get people to come there and anew clinic just opening in
Wisconsin, also very exciting.
So, but yeah, it was a nicehearing about something a
(24:43):
little local to where I grew up.
I want to say one more thing ofthe Tammy story.
She was not only visited of thesummer, you know, by local, I
mean, not just localpoliticians, both of Minnesota's
senators contacted her.
But I think in what has to be ahistoric first, Tammy and
(25:07):
several other abortion providersand some patients were invited
to the State of the Union byDemocratic senators.
And for someone like me, whohas studied abortion providers
for many years noting howstigmatized, how marginalized
they have been, often even bypeople who consider themselves
(25:31):
pro-choice, to have abortionproviders sitting at the State
of the Union— I mean, that tellsus something about the changing
status of abortion providers.
Okay, I guess the next big thing to talk about is
something that we're definitelybeen keeping an eye on is I'm
sure the fights in the courtsare going to continue to affect
(25:52):
it.
And that's medication abortion.
David, how about you go firstthis time?
David (25:56):
Yeah, so abortion pills have played just a massive role
post Dobbs.
And to be clear, they werebecoming much more common even
before Dobbs, right?
So abortion pills is twodifferent drugs, mifepristone
and misoprostol.
And mifepristone is the onethat's FDA approved for
abortion.
Misoprostol is FDA approved forulcer treatment but it's used
(26:18):
in conjunction with mifepristoneto accomplish a medication
abortion.
Mifepristone was approved in2000 and it was slowly becoming
right up until Dobbs it justcracked the majority of abortion
point right before Dobbs so 53%of abortions before Dobbs were
accomplished through medicationabortion.
(26:39):
Now the number is up into the60s and I would you know, the
most recent data is from acouple years ago, and it was
63%.
I would be surprised if it'snot up around 70% of abortions
or medication abortion rightnow, once we get the numbers for
this time period.
And that's because Dobbs haspropelled abortion pills into
(27:02):
the news in ways that, you know,people really wanted people to
learn about abortion pillsbeforehand.
But possibly because- a bigpart because of the
anti-abortion movement withtheir major lawsuit in Texas
that went to the Supreme Courtthat was about abortion pills.
The whole country learned aboutabortion pills in ways they
(27:22):
didn't know before.
So that's part of it.
But also providers have reallyexperimented with new delivery
models for abortion pills.
Sort of necessity being themother of invention, right?
And so there are now a lot ofnew ways to get abortion pills
post-Dobbs.
Some of that is not with amedical provider, right?
(27:44):
A pharmacy, informal supportgroups that just will distribute
pills, international mail toget abortion pills.
But within the United States,with licensed medical
professionals, we've had anexpansion of telehealth and
telemedicine clinics that areproviding abortion pills in
(28:05):
different places in the country.
And then the real novel legaldevelopment is telehealth shield
laws.
Shield laws have been passed.
They are laws that protectpeople in states where abortion
remains legal from other stateswhere abortion is illegal.
There are 18 states that haveshield laws generally, but eight
(28:27):
of those 18 states allow withintheir shield law license
medical professionals in thatstate to mail pills into a state
where they don't have alicense, including states where
abortion is banned.
So concretely, a New Yorkdoctor with a New York license
(28:47):
who is physically located in NewYork can mail pills into, say,
a state like Texas or Alabamaand do so protected by New York
law.
Now, they will be violatingTexas and Alabama law, but New
York will protect them.
And because of these shieldlaws, there are over 10,000
(29:11):
packs of pills mailed everymonth from these shield
providers, and the vast majorityare going to states with
abortion bans.
So people in states whereabortion is banned are getting
pills from licensed medicalprofessionals, and that is
increasing abortion access, eventhough clinics have closed in
(29:32):
those states.
Jennie (29:33):
Carole, do you have anything to add?
Carole (29:34):
Yeah.
Should the worst case happen,should FDA withdraw approval of
mifepristone.
Should the Comstock law startbeing enforced?
And I'll leave it to David toexplain to your listeners what
that will mean.
But spoiler alert, it's a scarystory, but we'll get to that.
(29:55):
Anyway, should we be in asituation where in the United
States, pills can no longer bemailed, or mifepristone is no
longer legal, should thathappen, an unknown number of
people are getting abortionpills from the internet,
(30:17):
bypassing the various groupsthat are now doing it.
They're just ordering pills.
Now, we could have a discussionof, is it better to get these
pills and not have anyinteraction with the doctor?
And for some people,unquestionably, it's much
better.
I just this morning read areport saying younger patients
(30:37):
in general really want thereassurance of talking to a
healthcare professional.
So, I'm not saying this isbetter.
I'm just saying if all elsefails, some people, those whose
pregnancies have not advancedtoo far, some people will always
be able to get pills from theinternet, often sent from a
(31:00):
foreign country.
There is some legal risk, butthe mail would have to be
examined very closely.
These pills will come in anunmarked envelope.
I'm sure it won't say abortionpills on the mailer.
And one thing that I find veryinteresting and reassuring is
(31:21):
that a couple of years ago, aresearch group in New York, a
group called Gynuity, it's areproductive health research
group, they actually orderedpills from these various places
offering them.
There was a lot of skepticism.
You know, are people justgetting taken for a ride?
Are these going to be sugarpills?
(31:41):
So they actually ordered thesepills, tested them, and it
turned out that these pills, forthe most part, these were the
real thing.
If all else fails, well, firstof all, big picture, there's
always going to be abortions.
Throughout history, therealways have been abortions, even
(32:06):
in places where it was illegal.
So, we could get into aninteresting discussion of what
else people might do, some ofthe options people might choose
would be more dangerous, butordering pills for the
foreseeable future will alwaysbe an option for some.
Jennie (32:27):
David, do you want to do Comstock real quick?
David (32:29):
Yeah, so Comstock is a federal law that was passed in
1873, so over 150 years ago.
And it's an obscenity law.
And the definition of obscenityincludes a lot of things about
immorality and indecency.
But basically, the way itaccomplishes its goal, it says
these things are unmailablematerial so that you cannot put
(32:52):
them in the mail.
A couple decades later, theyincluded private express mail
services.
So you can't mail things thatare considered obscene.
In the text of the law, it saysthat you can't mail anything
that can produce an abortion.
And so at the time, it wasreally understood that that
would mean abortion outside ofthe medical context, outside of
(33:15):
a medical professional context.
But the text of the law doesn'tsay that.
It just says producing anabortion.
And the anti-abortion movementtoday is saying this law that
you know, it was in the 1920s,1930s, the courts, not the
Supreme Court, but the courtsright under that, said this only
(33:36):
applies to unlawful abortionoutside of the medical context.
But the anti-abortion movementtoday is saying those rulings
were wrong, and what we have tolook at is the strict language
of the law, and it says anythingthat can produce an abortion,
and so that would mean you can'tmail pills, everything we were
just talking about, but you alsocan't mail that would be used
(33:59):
in a brick-and-mortar clinic fora procedural abortion because
that equipment and thoseinstruments are used to produce
an abortion.
So you can't mail those.
And so their extremeinterpretation of the Comstock
Act would basically shut downabortion because if you can't
mail things, whether expressmail or mail, or U.S.
(34:21):
postal mail, pills or equipmentor instruments, then how are
you going to practice abortion,right?
How are you going to do that?
And so they're pushing thatinterpretation.
Like I said, it's a federallaw.
So the Trump Department ofJustice gets to decide if they
want to put, you know, implementthat interpretation.
Now, to be clear, it would alsobe challenged in court.
(34:41):
There would be pushback.
And so, we don't know, youknow, I would hope it wouldn't
take even if they tried it.
But here we are five monthsinto his presidency and they
have not tried it.
I think that's notable becausethe anti-abortion movement has
written many letters urging themto do so.
They have been very vocal aboutthis and it hasn't happened
(35:05):
yet.
Now, it might not have happenedyet because they're busy doing
other terrible things andthey're going to implement
Comstock in this way later thisyear or next year.
But it might also not havehappened yet because they're not
going to do it because ofpolitical pressure or it's
unpopular or they want to spendall their political capital on
(35:26):
sending people to countries andprisons in other countries and
ICE raids.
So, we don't know what's goingto happen with the Comstock Act,
but it is a threat.
And as we said, if they reallydo strictly enforce it the way
they're trying to push, it couldbe devastating.
Jennie (35:46):
I guess that leads me to, if you're like me, which I'm
sure you have this as well,you're worried about any number
of things at this moment thatcould happen.
What is something that you wereeither keeping an eye on or
actively worried about right nowwhen it comes to abortion?
I think we have Carole firstthis time.
Carole (36:06):
I'm worried about RFK Jr., let's put it that way.
He has the capacity, heactually has announced he's
going to review the safety ofmifepristone, which is absurd.
You know, this drug has beenreviewed extensively.
It's been approved in thiscountry since year 2000, in
(36:30):
Europe since 1988.
When RFK Jr.
was before a congressionalcommittee and he was asked about
this, one of the Democraticsenators held up a stack of
papers.
Well, your listeners can't seewhat I'm doing, but held up a
big stack of papers and said,you do not need to review this.
(36:52):
It has been reviewedextensively.
So yes, I'm worried that intheory he could withdraw
approval.
But I think more realistically,what I'm also worried about is
an overturned of a Bidenadministration regulation that
said mifepristone does not haveto be picked up in person at an
(37:16):
office.
I mean, this was a response toCOVID.
When the regulation wasdropped, you don't have to be
there in person.
So as we've said earlier,telehealth has been incredibly
important to this.
If the FDA were to say, no, youcan no longer send this
medication through telehealth,that would be devastating.
(37:39):
I think it would cause lesspublic outcry than an outright
withdrawal of FDA approval.
I mean, people who do not thinkabout abortion 24-7, like the
three of us, would say, well,what's the big deal?
They didn't withdraw theapproval.
So yes, I'm worried about that.
Jennie (37:59):
David?
David (38:00):
So FDA, absolutely.
Comstock as well.
But I think I'm also reallyworried about sort of the
finances of abortion clinics andabortion providers.
We're seeing, you know, Caroletalked about sustainability with
rage donations, but that'scoupled with the attacks on
(38:22):
Medicaid providers, inparticular Planned Parenthood,
and the threats that taking awaysupport, financial support,
could really devastate abortion.
Abortion providers, theirpatients, and the people that
abortion providers see thataren't abortion patients, right,
that for other reproductivehealthcare and other kind of
(38:43):
healthcare.
And so at a time that we areseeing such attacks on abortion
and reproductive healthcare,just the financial
sustainability of these entitiesthat, you know, they need money
to survive.
They're not, you know, they'renot free clinics with, you know,
that just magically get theirsupplies and their workers and
(39:06):
their rent for free.
Right.
You know, a lot of peoplethink, oh, these this should be
mission driven and peopleshouldn't make money off this.
But people need to eat.
They need to put roofs overtheir heads.
They need to pay workers.
They need to get supplies.
So money is involved.
Right.
And if if the if there's allthese sets of with regard to
(39:27):
funding, that's really achallenge going forward with how
these essential medical carefacilities are going
to continue.
Jennie (39:36):
Yeah.
And along with Medicaid, TitleX as well, seeing attacks on
that.
Okay.
So I always like to end thepodcast, not just focusing on
all the things that are wrong orneed to be fixed, but the ways
the audience can get involvedand what they can do.
So any suggestions on how theaudience can get involved on
this?
David.
David (39:56):
Yeah, so look, there are things that we are very
concerned about in the future,but I do think that people need
to spread the word that as muchas the Supreme Court issued this
terrible opinion three yearsago, abortion advocates,
abortion providers, abortionsupporters are still doing this
(40:18):
incredible work of resistance onthe ground every day.
And so, I think part of whatpeople can do is: spread the
word.
Abortion remains legal in a lotof places.
Abortion pills remainaccessible everywhere.
Make sure people know that sothat people can get the care
that and not feel, oh, theSupreme Court overturned Roe v.
(40:39):
Wade, I guess we can't getabortions, right?
So it's important for people onthe ground to know that and
spread this word.
And then the second thing Ithink that people can do is, you
know, ultimately we want somekind of national right to
abortions that people all overthe country are protected.
And so we think, you know, Ithink of the environmental
(41:01):
movement from decades ago, thinkglobally, act locally, right?
I think this is a thinknationally act act locally thing
here, because you want to doeverything you can to get
Washington, D.C.
to change, but most peoplearen't going to be able to do
that.
But what you can do is you canescort at your local clinic.
You can be part of a practicalsupport group in your local
(41:22):
area, help drive people to andfrom clinics, and you can
support your local abortionfund.
All three of those things areintensely local.
They are not going to changethe general policy environment
in the entire country, but theyare going to help people getting
care today in your community,and you can be a part of that.
Jennie (41:42):
Great.
Carole (41:44):
Yeah, well, I obviously agree with all of that.
The only thing to add, and itmight sound a little lame, is
vote.
And when I say vote, not justfor president and for senators
and congresspeople, all of whichyou shouldn't vote for.
People in general havetypically not tended to vote
(42:07):
lower down on the ballot.
And these are incrediblyimportant.
Some of the most importantabortion action for years has
taken place in statelegislatures.
So state representatives, statesenators, city council people,
listeners might say (42:26):
well, what does that have to do with
abortion?
It could do plenty withabortion.
If you want to establish a newclinic, you have to establish
this clinic in a place wherethere's zoning.
And very often this becomesquite contentious.
So voting at every single levelon the ballot is essential.
Jennie (42:49):
Well, David, Carole, thank you both for being here
today.
I had so much fun talking toyou.
Carole (42:54):
Well, it's a pleasure to talk to you.
David (42:56):
Yeah, thank you very much.
Jennie (42:57):
Okay, y'all, I hope you enjoyed my conversation with
David and Carole.
Like I said, I really did lovetheir book, After Dobbs: How the
Supreme Court Ended Roe But NotAbortion.
You should absolutely check itout.
There is a link in our shownotes for a bookshop link so
that you can shop at your localbookstore.
Yeah, I hope you enjoyed thatconversation.
I thought it was reallyimportant and it was
(43:20):
great to see all of the ways that people are still being to access abortion care even as the Supreme Court tried to end access to it. Now, does this mean things are good? Obviously not. Obviously, we are continuing to fight to make access so much better for everybody. People should not be having to jump through all these hoops of traveling and all of these things to get it. But this book really gave a voice to what I was talking about—there are so many people on the ground doing so many amazing things to access care.
You can sometimes forget aboutin the day-to-day fight to
(43:55):
ensure that everybody is able toaccess care, which is so
important.
It is also important to take achance and celebrate the ways
that we have won, that we arestill able to get people access
to the care they need.
And this book gave me the timeto take a step back and
appreciate that bigger picturewhile still fighting to ensure
(44:17):
that more people are able toaccess care and that we don't
lose any more access.
So it was a great book for justkind of doing some reflection
and to read all of the storiesabout the amazing things that
people are doing to ensure thatpeople are able to get as much
care as they can.
Okay.
With that, I will see everybodynext week.
(44:39):
[music outro] If you have anyquestions, comments or topics
you would like us to cover,always feel free to shoot me an
email.
You can reach me at Jennie,J-E-N-N-I-E @reprosfightback.com
or you can find us on socialmedia.
We're at rePROs Fight Back onFacebook and Twitter
or @reprosfb on Instagram.
If you love our podcast andwant to make sure more people
(45:01):
find it, take the time to rateand review us on your favorite
podcast platform.
Or if you want to make sure tosupport the podcast, you can
also donate on our website atreprosfightback.com.
Thanks all!
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