Roe Reversal: 1 Year Since Supreme Court Took Away Federal Right to Abortion

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Mark ( 00:06 ):
We're marking the one - year anniversary since the shockwaves of June 24, 2022. That's when the US
Supreme Court issued its landmark ruling, taking away the constitutional right to abortion, negating
nearly five decades of legal precedent. The controversial decision pushed the abortion decision to all 50
states.
Margaret ( 00:28 ):
The effect on women's reproductive health has been enormous. Here to share their perspectives are Dr.
Herminia Palacio, the President and CEO of the Guttmacher Institute and Robin Marty, the Director of
Operations for the West Alabama Women's Center, which had to stop performing abortions one year
ago because of the Supreme Court decision. And this is Conversations on Health Care.
Mark ( 00:50 ):
Well, welcome, Dr. Palacio, to Conversations on Health Care and welcome back to our program, robin.
Robin Marty ( 00:58 ):
Thank you for having me back.
Mark ( 01:00 ):
It's good to see you both.
Robin Marty ( 01:01 ):
Thank you. It's great to join you.
Mark ( 01:03 ):
Let's start with you Robin. We last talked about a year ago, and at that time the Dobbs decision, it
overturned a constitutional right to abortion and that led to the implementation of an Alabama law
banning abortions with no exceptions for rape or incense. I'm wondering if you could share with us what
this past year has been like.
Robin Marty ( 01:27 ):
Yes. Well, it hasn't been easy, by any means. Immediately afterward, we ended up losing both the
Montgomery Reproductive Health Services Clinic. That one closed. We lost one of our two planned
Parenthoods. The Planned Parenthood in Mobile, Alabama closed. So at this point, there is a
Birmingham Planned Parenthood that is seeing patients. We are seeing patients. And there's a
Huntsville Clinic that is seeing patients. And we are all basically doing SDI testing, reproductive health
care. We are now doing free prenatal care and pregnancy confirmation.
( 02:04 ):
We also know that there are a number of people who are going to hospitals with miscarriages and are
having difficulty being seen. That is happening repeatedly at our one hospital here in Tuscaloosa. We
know that we have just finished our first legislative session since this decision came down and there has
been no introduction of any efforts to expand contraception. There has been no effort to expand
prenatal care. And the only thing that the legislature has done to address this is they have now made it

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easier and faster for people to be able to adopt and for people to be able to relinquish rights to their
newborns.

Margaret ( 02:46 ):
Well, this is a hard question to ask, but Robin, we can assume women in your state are carrying to term
sometimes or previously they would have had and made use of other options. How are they coping?
What are you seeing on the ground? Is there support for women? Is there support for them after
delivery? What are you seeing?

Robin Marty ( 03:07 ):
There really isn't much. One thing that has surprised me somewhat by what we're seeing in Alabama is
that so far our hospitals are not reporting any sort of real increase in childbirth. What that tells us is
what we always kind of assumed, which is it does not matter if abortion is legal or illegal, people will find
a way to get an abortion. And I believe that a lot of people are probably seeking out medication online,
through the mail. We assume that because it was already difficult for people to be able to get to our
clinics in our state. And so the idea that now they have to travel as far as Georgia, Florida, North
Carolina in order to get care, we don't think that's really happening and we're not seeing a lot of it.
( 03:51 ):
One of the most frustrating things that is happening for us is the fact that there has been no expansion
of Medicaid, which means that for people who are unable to access birth control and then become
pregnant, they are able to get onto Medicaid once they've confirmed their pregnancy. However, the
state has not made it any easier for them to do that. In order to confirm a pregnancy, to get onto
Medicaid, a person has to see a doctor in person and get a confirmation of pregnancy, and that then
starts their four to six week wait in order to get approved for Medicaid. Only after that can they actually
start prenatal care with a Medicaid - approved doctor, which then is another period of time that they
have to wait in order to be able to find a doctor who will see them.
( 04:34 ):
So what we are doing is we are giving people free prenatal care from the point in which their pregnancy
has been confirmed, which we are also doing for them. And then we continue that care until the point in
which they find another doctor who will take over that care. Or at this point, we are now starting to
have our first few patients who are about to give birth.

Mark ( 04:53 ):
Wow. What an enormous amount of choreography that must go on to get coverage. And Robin, we've
been following your work since we last talked a year ago, and you wrote in Time Magazine in March the
following, "As bad as things have been since the Dobbs decision, without support for contraception,
prenatal care and other reproductive health services, the crisis will only grow worse and the next person
getting pregnant may not survive at all." You wrote that three months ago. What do you want us to
know today?

Robin Marty ( 05:26 ):
I want you to know that there still is nothing that the state is doing in order to address this crisis. We
have 25 hospitals that are now on the verge of closing because without Medicaid expansion, they
cannot afford to stay open. We have no doctors, and honestly, the state legislature has decided that the
best outcome is simply for people to become pregnant, to bring up the birth rate in our state. But they

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do not care if the person who carries that child survives. They believe that they have plenty of people
who would be willing to take in new babies, to be able to adopt, to be able to take care of these new
children that come in. But for the women, the women are the collateral damage.

Margaret ( 06:06 ):
Well, I just want to highlight because I think all of our listeners, as well of all of us here of course, are
very aware of the tragic death of the elite Olympic contender, Tori Bowie, recently late in pregnancy
probably due to preeclampsia, or that's what's supposed. We know we have these horrific health
disparities in maternity outcomes even regardless of socioeconomic status and all of the issues that
you're discussing with us just make the situation more fraught with worry and with the very real risk of
death for people.
( 06:42 ):
But maybe Robin, just one more question to you on that legal challenge to FDA's approval of
Mifepristone, the drug most commonly used in medication abortion regimens. I understand women in
Alabama who use these pills, even if they got them via mail order from out of state, can be prosecuted.
Is it your assumption that women are going ahead with this anyway and have there been any instances
of prosecution?

Robin Marty ( 07:09 ):
So we are not concerned as much about people who are taking the medication being prosecuted at this
moment, because the legal hurdles for them were always the same. It was always illegal for them to be
able to get medication from outside of the state. There are chemical endangerment laws that they could
be charged under. There are not following a prescription. If the state wants to be able to put somebody
in jail over managing their own abortion, they have many ways that they can do that. It doesn't matter
whether these medications are considered legal in our state or not legal in our state.
( 07:45 ):
And that's one thing that I want to make sure that a national audience understands, because with this
Mifepristone lawsuit, lots of people have gotten very upset about what it could do to access to abortion.
But the reality is there is still Misoprostol. There are still many ways that people can access abortion and
the worst case scenario for a blue state is something that we would kill for down in the South, to be able
to have Misoprostol, to be able to have a procedural abortion. We have nothing. And so we want to
make sure that people understand that in a lot of ways this lawsuit has distracted blue states into
huddling around and making sure that they can take care of themselves. And so all of the resources that
were being poured into states where abortion is illegal, they've all dried up because we've been divided
by it.

Mark ( 08:31 ):
Robin, let me get one last question in before we talk to Dr. Palacio. There have been discussions about
your clinic providing direct referrals to out - of - state abortion clinics, but that hasn't happened. Why not?
And what's the threat that you're worried about?

Robin Marty ( 08:48 ):
So we have been informed ever since the Dobbs decision came down that according to our attorney
general, there is a criminal conspiracy charge that exists in the state of Alabama. And according to the
lawmaker, it is that if you provide any sort of information or resources that leads somebody to do

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something outside of the state that is considered illegal in the state in which they come from, that in
itself is a crime. And so for us, it has shut down our abortion funds. It has shut down our practical
support networks. And it's even stopped clinics from being able to say, "Here is your closest abortion
clinic, or here is where you can go if you are six weeks along, here's where you could go if you are 14
weeks along. Here is where you could go if you are 20 weeks along."
( 09:34 ):
We are not allowed to provide that information, because according to our Attorney general, the
provision of that information would be a crime on us, even though it is not a crime for that person to
then go ahead and have the abortion in that state.

Margaret ( 09:49 ):
Thank you for that, Robin, and for sharing that with our audience. Very, very important to get out. Dr.
Palacio, you lead the Guttmacher Institute, which is focused on research and policy to advance sexual
and reproductive health and rights. Let's take what Robin has told us and broaden it out. What's the
state of reproductive rights in the United States a year after the Supreme Court's decision?

Herminia Palacio ( 10:14 ):
Thank you, and I'm really happy to be here with you. I have to say that so much of what Robin laid out
from her boots - on - the - ground perspective really, I think, belies many of the talking points behind these
egregious policies. So I'd just like to sort of build on what she said and sort of talk about the state of play
a little bit. So really, the Dobbs ruling, which happened June 24th, were coming up on its anniversary
very shortly, as you said in your introduction, sent the decisions back to the states, was not just about
sending things back to the states. And it wasn't just about people being able to make decisions on a
state - by - state basis.
( 11:02 ):
Right now, the rush to make abortion illegal has been fast and furious. There are 13 states where it is
banned completely. And in the state of Wisconsin, it's de facto on hold because there is legal
uncertainty. But what Robin really talked about in terms of that there've been no additional resources
for contraception, no additional resources to protect people in pregnancy, no expansion of Medicaid, I
think really sort of talks about what the historical contexts are of reproductive health rights and justice
in our United States and what the history is. This isn't just about abortion. This is about the dignity and
the humanity of people making their most intimate decisions possible.
( 11:51 ):
And there's good research that shows when you deny a person an abortion, that there are significant
consequences of being unable to attain a desired abortion. This is by the turn away study. There're
economic consequences. There're consequences for their children. There're sort of long - term
consequences. The data are clear and they really sort of substantiate what you heard from Robin in
terms of the day - to - day impact on people's lives. And her point about that making abortion illegal
doesn't diminish people's desire to obtain an abortion, we have really robust evidence from our global
work that says just that.
( 12:42 ):
If you look at 150 countries, and we've produced country - specific abortion incidents rates, and you look
at countries where abortion is highly restricted and countries where abortion is not restricted legally,
abortion rates themselves don't vary that much. What you do when you restrict legal access to abortion

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is you don't diminish the rate of abortion. You diminish the safety of abortion. You drive people
underground. You make it harder for people to get abortion.
( 13:13 ):
And frankly, most unfortunately, the methods that we've used as a research center to ascertain abortion
rates in highly - restricted environments, we are now having to brush off some of those methods to
obtain abortion rates here in restricted states where individuals, where doctors, where systems are at
legal risk if they perform abortions and if they admit to performing abortions and if they assist with the
performance of abortions.

Mark ( 13:49 ):
Well, Dr. Palacio, thanks for illuminating the implications and also talking about this rush to ban
abortions. But as I think about Georgia, which bans abortions at about six weeks of pregnancy, most
often before many women know they're pregnant, I'm wondering what the data tells you about how
women are responding to this. And I know South Carolina has a similar law. I think it's being held up
right now, but as you said, there's a larger rush across the board happening to limit women's access.

Herminia Palacio ( 14:31 ):
Well, it's a rush and it's a disingenuous rush, I would say to sort of couch these just gestational bans.
These gestational bans have one and only one aim, which is to render abortion unattainable for women.
When you have a band that's implement, a six - week gestational band before people are even aware
that their pregnancy, that is a de facto ban on abortion. It limits people's access. It means that people
have to travel. It means that people have to either, and we're talking about the burden falling
disproportionately on folks who have historically faced inequities, Brown and Black people. People who
live in rural communities where travel is hard. People who don't have incomes.
( 15:19 ):
So if you think about the on - the - ground effect of either a gestational ban or an outright ban, you may
have to give up a few days of work to go access an abortion someplace else. Well, that may lead to a loss
of job. You may have a loss of income. Most people who have abortions have other children already. So
you have to arrange for childcare. You may have to have a child that you don't want to have if you can't
get your abortion in time for these gestational bans. So the consequences are intentional. They are
deliberate. They are protean, and they fall hardest on the people who don't have access to other
services.

Robin Marty ( 16:08 ):
If I can just jump in with what Dr. Palacio said, one of the things that we are seeing that is the most
alarming about people who are seeking out abortions under these gestational bans is the fact that a
person who is intending to try to seek out an abortion is a person who is not getting prenatal care. And
so when we do have patients who come in and say, "Okay, I have tried to get to this state. To get to this
state, I wasn't able to do this. Obviously, it's too late, I'm going to be having this child," that is a person
who's missed prenatal care through the entirety of the first trimester, sometimes even the second
trimester.
( 16:43 ):
These are people who have not been able to take care of their health in the same way and also have the
added stress of an unwanted pregnancy on there. So these are going to lead two bad health outcomes,

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both for the person who is carrying the child, but also the baby when it's born. These are harms that are
interlapping over each other because the person was unable to get that abortion in the first place.
Herminia Palacio ( 17:07 ):
Absolutely. And the Mifepristone case is an example again, that belies the talking points where this is
supposed to be just a state's right issue. We have one judge selected in Amarillo, Texas shot for his
ruling, that says that the FDA erred 23 years ago when it made its decision to approve Mifepristone and
the two decades worth of safety and efficacy data are irrelevant to his opinion. He has substituted his
personal opinion for medical judgment. And the effects are not necessarily where people anticipate. So
Mifepristone is used in the United States, as Robin said. It's mostly a two - drug regimen, Mifepristone
and Misoprostol. Medication abortion is used in over 50% of abortions the United States.
( 18:08 ):
And in some of the blue states medication abortion comprises the overwhelming majority of abortions
performed, because the medication has been readily accessible. So in fact, if Mifepristone is taken off
the market, the ability to provide this highly - effective, two - drug regimen is going to plummet actually in
places where you might not expect, places that really support abortion rights, places that have really
permissive and supportive policies towards people so that, again, it belies the intention that this is really
about states' rights. This is in fact reducing the rights of states that have progressive policies to protect
their population's access.
Mark ( 19:02 ):
Margaret, we had the FDA -
Herminia Palacio ( 19:02 ):
And it's not... And what -
Mark ( 19:03 ):
Yeah, we had -
Herminia Palacio ( 19:05 ):
Oh, sorry. Go ahead.
Mark ( 19:06 ):
We had the FDA commissioner on, Califf, who stood by that report that they had done decades ago as
very solid and strong.
Herminia Palacio ( 19:21 ):
Absolutely.
Margaret ( 19:23 ):
Dr. Palacio and Robin, I think you might want to comment on this as well. Everything that has been said
so far is in this context of our political environment. And we have a presidential election in the future
and that season already well underway. How do you see the political debate taking shape in the political
environment around this issue? What are you expect to seeing as we move closer to the elections?

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Robin Marty ( 19:57 ):
I believe that as we move closer to the election, we are going to see the right do what they always do,
which is try to force abortion as a talking point, but try to force it as abortion that exists only in the third
trimester, that allegedly is happening on infants right before they're about to be born. Those are the
only ways, the only talking points they can bring out that bring people to their side. The reality is that
the right has now instituted a rule that essentially says that you can only run for them if you believe that
abortion must be completely illegal, that there may be no exceptions whatsoever. And that is something
that progressives need to use in order to make people understand.
( 20:38 ):
We just had a recent survey come out, I believe it was Gallup that said that 70% of people believe that
abortion should be a right. And that 70% of people believe that medication abortion should be available
at any time. We know that the majority of people, and then the majority of voters, believe that a person
should have the right, at least at some point, to decide whether or not they want to carry a pregnancy to
term. And those are the ways that we need to talk about it. We need to talk about it as, are you going to
force a person to carry a child to term regardless of what it does to that person's health? Are you going
to force every person to carry a child to term regardless of how that child was conceived? Are you going
to force every person to carry a child to term regardless of what it does to their economic health?
( 21:24 ):
That is where we need to be having this discussion. But we also need to recognize the fact that we can
have a progressive majority in the House, in the Senate, and in the White House. And we can still throw
abortion rights under the bus, because we saw that happen in 2009 with the Affordable Care Act. So it's
not just about getting people elected, it's about getting people to follow through on their promises and
understand that this is an issue that matters at the least to more than half of the nation. And we need to
be able to produce children when we are physically and mentally ready for it.

Mark ( 21:57 ):
So Dr. Palacio, let me just pull the thread a little on that because there have been some interesting
developments that sort of tie into the data that Robin was just sharing with us in states like Michigan
and Kansas and other advanced reproductive rights who are moving forward with that. What does that
tell us about the state of this conversation across the country?

Herminia Palacio ( 22:23 ):
I think what it tells us is that in some ways the efforts to render abortion inaccessible, once they
succeeded in that in so many places, that it really sort of something that for many folks, not for those of
us who've been tracking it, but for many folks seemed unthinkable. And the unthinkable now requires
protection. So yes, in states like Kansas, in states like Michigan, there have been referendum that now
protect abortion very specifically, restrict the ability for legislatures to take away abortion rights. I think
it's important as we think about politics, with a capital P, to also think about democracy with a small D,
because I think that these issues are interrelated.
( 23:14 ):
And this is one area where I think the media has a tremendous opportunity and I would submit
responsibility to sort of shed light and the resources to be able to do things like follow the money. Many
of the movements that we're talking about are not just isolated movements. When you think about the
movements for anti - immigration movements, when you think about the movements that are really
robustly anti - racial diversity and anti - racial equity, the movements that anti - voting that are restricting

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the rights of Brown and Black people if you look at where anti - voting is happening, these are
movements that are not happening without conversation. They're movements that are sharing funding,
and frankly, they're movements that are being exported out of the United States into other countries.
( 24:03 ):
And so again, my plea to the media in particular is to follow the money and shed light, because I think
our citizenry needs to know how all of these anti - reproductive rights, anti - immigration rights, anti -
voting rights, are really all anti - democracy.

Robin Marty ( 24:18 ):
I have to follow up and just say, one of the things that I have really noticed as a researcher on abortion
rights and abortion access is the fact that starting a few years ago, once these new laws were
introduced, they all became introduced with felony punishments, aiding and abetting, a felony
punishment, criminal conspiracy, felony punishment. And that in itself is an attempt to destroy
democracy, because they know that the people who are going to be assisting someone to get an
abortion, a family member, a good friend, those are all people who are probably going to support
abortion.
( 24:53 ):
And hence, that means if they can get them arrested on a felony in states like Alabama, they are never
going to be able to vote again. Alabama never returns voting rights to a felon. And so in a lot of ways it's
true that reproductive justice, reproductive rights, all of these things are voting rights. Voting rights are
a reproductive justice issue.

Margaret ( 25:14 ):
Well, maybe a question to both of you on the rights of people and the concerns for all people in
America, we certainly hear about the challenges of access to health care in rural areas, in particular,
health care writ large, as well as maternity deserts and difficulty with access to maternity care. But an
analysis from the Association of American Medical Colleges found that newly - graduated physicians who
were applying to their medical residency programs were likelier to avoid practicing in states with the
most stringent abortion restrictions. Is that an unintended consequence that the abortion movement
never considered? Do you think that this point is being made about the real impact, particularly on our
rural states?

Herminia Palacio ( 25:59 ):
So I would say that there is very little that I think is completely not, hasn't been considered. I think that
the expectation that there would be a diminishment of available OBGYNs who were willing to produce
abortion in these states was not something that was an unintended consequence. That said, I do think
that the consequences are going to be bigger and more significant than was intended, and that I think
that this is going to play out in the public sphere. Residents, medical students, are largely of
reproductive age. And I don't think these are just decisions about where are they going to be able to
practice as OBGYNs for the craft.
( 26:46 ):
I think that over the next couple of years, you may start to see a diminishment of cardiologists, and
internists, and pediatricians, not because they're making choices about their practice of reproductive
health services, but they're making choices about their decisions as people who are embarking at the
beginning of their reproductive lives, and where do they want to choose to live in order to be able to

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sort of, and what kinds of health care do they want to be able to access, as they set about making the
decisions about whether or not to have children and whether or not to terminate a pregnancy.
( 27:24 ):
So I think as people start to realize that they may not only have diminished access to getting an
abortion, but eventually, they may have diminished access to getting treatment for their heart attacks. I
think it's something that we haven't seen yet, and again, that we need to really, really track.

Robin Marty ( 27:41 ):
I agree. It's utterly deliberate. And I will say that I've only been in Alabama for three years now, and I
have been surprised every day by the things that I learn about this state. And one of them is the fact
that everything done here is very deliberate. It's done very deliberately to uphold white supremacy, to
uphold the power of the people who are already in power. And of course they want people who might
agree with abortion rights or who might provide abortions to not be practicing medicine down here in
any way, shape or form. They are happy to only be surrounded by people who are going to continue to
keep them in power, who are not going to fight the system, who have no ability to fight the system.
( 28:21 ):
And the reality is that as long as there are hospitals in Birmingham with some people, as long as there
are hospitals in Huntsville with some people, so that those who have resources are able to access their
care, they don't care about anyone else. They are just as happy to live in a dying state as long as this
state is white and white people are in power and white people are making the medical decisions for
everyone else. And that is shown everywhere in our medical system where almost everyone is white and
male.

Mark ( 28:51 ):
I'm wondering for both of you, sort of a final question, where do we go from here? You both have
interesting perspectives, one local, one national. What do you see the next 12 months looking like?

Herminia Palacio ( 29:03 ):
[inaudible 00:29:05].

Robin Marty ( 29:05 ):
Well -

Herminia Palacio ( 29:06 ):
Oh, go ahead.

Robin Marty ( 29:08 ):
... from a local standpoint, and honestly, local is all that we can do right now down here. That's all we
have the resources for. It's all we have the footprint to be able to handle. When Dobbs came down, we
had about three months to try to figure out how to keep our clinic open. And it is a year later and we are
still open, and we are still in a position where we have three months to keep our clinic open. But we
have made it a year. We have made it a year despite the state refusing to offer us any form of grants.
We have made it a year without the state being willing to work with us in any way with any of our

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prenatal care, our HIV care, any of the things that we are doing. We have continued to provide this care
to people for free.
( 29:52 ):
We do not turn people away when they cannot pay. And that is what we're going to continue to do for
the next year, because we know that the first year is an adjustment year. It's the second year where we
are going to see the people who truly cannot get out of state or be able to access abortion. It's when
we're going to start to see the people who gave birth the first time now get pregnant again and give
birth the second time way too soon without time for their bodies to recover. This is the point in which
we are going to see real health care outcomes happen, and so we are going to do everything we can to
continue to be here in order to address that. =

Herminia Palacio ( 30:26 ):
What Robin, I think, spoke to was the type of resiliency that it requires as we are moving forward. We
didn't get here overnight. These have been long, long laid plans, decades of planning, decades of
funding, decades of winning small local elections, state elections and national elections, and years of
packing the courts with judges who would make certain kinds of ruling. So we're not going to unwind
this in the next 12 months. But I do think what we can do is start to lay the groundwork. We already
have groundwork for some federal legislation that could be protective. We have the Women's Health
Protection Act. We have EACH, which would eliminate the Hyde Amendment. We have HEAL, which
would allow immigrant women access to Medicaid.
( 31:26 ):
So we have several pieces of federal legislation that are written, that are being carried by national
advocates, that have been introduced in Congress multiple times, and we need to get them across the
finish line. And that's where elections really do matter. But I'm reminded that, at least I personally am
reminded, that all of these fights for justice require sticktoitiveness. They are never linear. There are
setbacks along the way. And that is what I think keeps all of us in this fight, is understanding that the
backlash that we're seeing now is precisely a backlash against the progress that has been made. And
that progress is inevitably followed by backlash. And we have to keep metal to the metal to not allow
the backlash to become the history.

Margaret ( 32:25 ):
Along with that, Dr. Palacio and Robin, I want to just give a shout - out to our colleagues in the
community health center movement who are in these states that we've been discussing, including
Alabama, that I know are working so hard to make health care a right and not a privilege and equal
access to health care and to really promote and protect women's health as well. It's very difficult. We
can't even, I think, begin to imagine as health care providers up here in New England, just how difficult it
is for colleagues on the ground there that are really trying to make that health care access a right and
not a privilege. So thank you for all of this work.
( 33:07 ):
And thank you both for joining us for this very important anniversary discussion. Thank you to our
audience. There's more online about Conversations on Health Care, including a way to sign up for email
updates. Our address is chcradio.com. Dr. Palacio and Robin, thank you so much for your continued
work.

Robin Marty ( 33:25 ):

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Thank you for having us.
Herminia Palacio ( 33:26 ):
[inaudible 00:33:26] very much.
Mark ( 33:26 ):
Absolutely.

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