West Alabama Women’s Center Director Talks About the Impact of Roe

Post - Roe Decision Amanda Allen and Robin Marty

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Marianne O’Hare : Welcome to Conversations on Health Care. This week we welcome
t w o importing guests on the frontlines of the Roe v. Wade decision.
Amanda Allen with The Lawyering Project and Robin Marty,
Operations Director of the West Alabama Wome n's Health Center on
working around abortion bans in red states.

Robin Marty: In a hospital, they or someone they love might end up investigated
and in jail , so that's what keeps us going.

Marianne O’Hare: We hear from Fact C heck.org ’s Managing Editor Lori Robertson and we
end with a bright idea improving everyday lives. Now here are your
hosts, Mark Ma s selli and Margaret Flinter.

Mark Masselli: It's a monumental rev ersal of a constitutional right. The US Supreme
Court voted to overturn Roe v. Wade, a situat ion Surgeon General
Murthy calls a major step backward for public health. There are only
20 states in the District of Columbia right now where abortion is legal
and likely to be protected. The other states have so called trigger
bands and other restriction s that have been activated are in the
works.

Margaret Flinter: Joining us to discuss this situation is Amanda Allen. She's S enior
C ounsel and the D irector of The Lawyering Project, which is a
nonprofit that uses the law to improve abortion access and to up hold
the rights and dignity of people seeking and providing abortion care.
Robin Marty is also with us. She is the director of operations at the
West Alabama Women's Center Inc . , in Tuscaloosa. It has had to stop
performing all abortions as results of the Supreme Court decision.

Mark Masselli: Well, Robin and Amanda, thank you both for joining us and Robin,
let's start with questions for you. You're the author of the handbook
for a Post - Roe America. Tell us what service your clinic is still offering.
At thi s point, what options do Alabama women have? W e really hate
to ask this question , but is the so called back alley abortion what
some will need to turn to ?

Robin Marty: First of all, thank you for having me on. The clinic is actually still open .
We closed f or about a week and a half. We waited a few days after
the decision came down because we still had patients that had come
in for their first day appointment, which is an appointment in
Alabama that requires them to have counseling and ultrasound and
then t hey have to leave for at least 48 hours before they can return to
have an abortion. W e had more than 100 patients who had already
had this first day and now no longer were able to get an abortion in
our state. W e decided that it was still our responsibilit y to help them
figure out where to access an abortion, how to make sure that they
had the resources to get there . T hen we closed because we wanted to

Post - Roe Decision Amanda Allen and Robin Marty

make it very clear to the state that we were going to abide by all of
their new la ws.

W e reopened last Mon day a s a reproductive health care center, we
are expanding some services that we already did provide such as birth
control, HIV care, some prenatal care . Then we're adding in more
things as well. We've started an IUD program . We're working on Pay
What You Can Emergency Contraception . We're definitely working
more on making sure people have prenatal care and pregnancy
confirmation so they are able to access Medicaid in our state. W e'll
keep doing that essentially until we run out of money or we run out of
pa tients.

Margaret Flinter: Well, Robin are you concerned that it might become a crime to even
give this kind of advice to patients on how and where they can access
abortion? H ow is that affecting the family planning advice that you
provide or that of other health care providers in the state?

Robin Marty: Yeah, it's very difficult. We chose to continue providing the referrals
for the patients that we had already established relationships with
because we felt that because we'd already begun medical care in
tho se cases, that we had basically both a medical reason and a moral
reason to make sure that they were able to finish that care. T o not do
that would be some form of medical malpractice. We were informed
that that could be seen by our Attorney General as con spiracy. But we
went ahead with it.

I specifically actually told my staff, my staff is primarily black women,
single mothers, head of households for their family , and I specifically
told the staff that I would fire them if they would not make these
referra ls. I did that because I wanted to make sure that if something
did happen that all of the responsibility would be solely on me in case
the Attorney General did decide to do something. Once we reopened,
we are no longer providing referrals. We cannot tell p eople even as
much as what is the next legal stage right now. We are only allowed
to provide completely public information such as a website like
www.ineedana.org where a person can then put in their information
and get that for themselves.

Mark Masselli: Amanda, your organization says the decision is a national disgrace
that will leave indelible stain on our democracy. The Lawyering Project focuses on expanding access to abortion services through
t elehealth and medic ation assisted technology. Tell us what advice
you can share with Robin and her colleagues?

Amanda Allen: Well, there are a lot of legal uncertainties right now a nd that's why
you're seeing clinics close, clinics move operations from a state where abortion is banned to a state where abortion is now legal, and a lot of
fear around just the basic things like information sharing, providing

Post - Roe Decision Amanda Allen and Robin Marty

referrals, helping patients get out of states like Alabama to receive
abortion care where it's legal . A lot of those quest ions are lingering ,
a nd they're huge b ecause as Robin notes, these are real people whose
freedom might be on the line if a grove prosecutor or other sort of
enforcement official decides to go after someone for providing a
referral or provi ding transportati on assistance.

W e a re in a real legal gray area in some ways. But what is clear is that
the other side is not going to stop at returning this issue to the States.
We have already seen the playbook from the National Right to Life ,
they want to go after peop le who help people who need abortions
cross state lines . T hey want to go after people who just share
information or advertise for abortion services in states where it's
legal , and so this is not going to end just every state gets to decide for
itself. That was always a disingenuous line from Alito ’s opinion . It was
always going to lead to this state versus state , these battles about
what charges can be brought sort of for this cross state care that that
we're going to be seeing more and more of .

Margaret Fl inter: Well, Amanda, the governor of South Dakota has said that her state
will not only prosecute doctors and presumably others like nurse
midwives who perform abortions, but also work to restrict women's
access to abortion pills. We are based in Connectic ut, which recently
passed a law shielding physicians who prescribe the pills through
t elehealth to patients in other states including the states that restrict
abortion. What's your view on this? Does t elehealth medication
abortion preset one possible optio n for women in states like where
Robin lives ?

Amanda Allen: It could but it does pose a pretty big risk to the provider who's
prescribing the drugs , a nd that's because the way t elehealth laws
work , t he law of where the patient is located is what controls. I t
doesn't matter if the provider is based in a state like Connecticut or
New York or California because the state where the patient is located
is really the law that governs , a nd so South Dakota if it's has a total
ban on abortion, that would include medi cation abortion, and so they
could go after that provider.

Now, what states like Connecticut are do ing with the law you
mentioned, is trying to provide an extra layer of protection for that ,
s o saying we won't cooperate in investigations for abortions that
would have been legal if performed here in our state , s o we won't
commit any state resources to furthering any of those investigations
or we w on’t comply with an extradition request. But these are
untested bills right now. These are untested legal strateg ies , a nd I
think the bottom line is that there's really no zero risk strategy right
now.

Mark Masselli: Robin, the pro - life Mississippi Attorney General says as a result of the

Post - Roe Decision Amanda Allen and Robin Marty

decision the government should strive to pass and I quote, “ laws that
empower w omen, including an overhaul of child support child care . ”
The U.S. Conference of Catholic Bishops pledged to redouble efforts
to support women facing unexpected or difficult pregnancies and to
support young parents. Are these realistic options?

Robin Marty : They are, but they have always been realistic options . There have
always been issues and policies that could have passed and that these
very people have held up. The reality is that they have been holding
these things hostage, promising that they would s omehow release
them and back them and support them if they got their real goal,
which was to end legal abortion. T hey always could have done this ,
a nd they never did. E ven in Texas where we've seen for almost a year
now, what it looks like when there is al most no abortion access they
have had 10 months now in order to try and put any of these things in
place and still haven't. The idea that we would now suddenly believe
them is like Charlie Brown trying to kick the football. It's never going
to happ en.

Aman da Allen: Mark, if I might just add. There is no plan for this. The National Right
to Life could have put out a playbook that addressed all of these social
support systems that you referenced. It could have addressed health
insurance, making sure there's c hildcare available, making sure t hat
school lunches are paid for, making sure that paid leave is available.
Their playbook addressed how to triple down on these abortion bans
and how to basically make sure that abortion is difficult to get in any
state in this country and so that’s their playbook.

Robin Marty: I also need to add the fact that people don't completely understand
that these are states that are banning abortion. They're also the same
states that have yet to actually expand Medicaid. Alabama has not
expanded Medicaid, refuses to expand Medicaid . When our
lawmakers said, okay, so you are making abortion completely illegal,
can we at least expand Medicaid n ow ? The lawmakers came back and
said actually, we still think it's too expensive. It's too ex pensive to give
people health care , but you can still force them to give birth against
their will.

Amanda Allen: And the Venn diagram between states with the highest maternal
mortality rates and abortion bans is a complete circle .

Margaret Flinter: As the Biden A dministration seems to be casting about to take steps
that it can take in response to the ruling, I understand that they've
directed the Centers for Medicare and Medicaid CMS to take every
legally available step to protect family planning care . Whil e Medicaid
may not get the attention of leaders in the state, most hospitals live
or die by Medicare and Medicare rules. Do you think that there's
anything that CMS can do and it's known as the largest health care
policy setting group to help?

Post - Roe Decision Amanda Allen and Robin Marty

Robin Marty: I mean, I want to be helpful, but no . The reality is that we live in a
country right now where states get to opt out of anything that they
choose to opt out of. The point is that the states have all the power at
this moment. The one thing that Biden admin istration offered that
could actually help us down here is expansion of birth control access
and emergency contraception access. But that's not going to happen
down here, because our states have already put a stranglehold over
who gets Title X funding. Fo r instance, in Alabama, Title X funding only
goes to county health departments . It cannot go to any other clinic . It
goes specifically to county health departments . We have patients who
were waiting three, four months to try to get in to get an implant or
a n IUD, because those are the most expensive forms , a nd that's the
only place where they can get it. U nsurprisingly, they ended up with
our clinic pregnant instead .

Mark Masselli: You know, the decision has had such a profound impact all across the
country. Maybe the both of you could just talk to us about the people
who work in your organizations and how they're coping and how
you're dealing with it as leaders, what are you hearing?

Amanda Allen: Yeah, I mean, I think for my organization, everyone is really
devastated a nd it takes a toll, right . I mean, this work is not only long
hours, but it's emotionally difficult. You're working directly with
abortion providers or abortion funds, we're actually helping pay for
people to get the care they need, book their bus tickets, get them on
a plane , and it can be very overwhelming. Our focus has been on just
doubling down on our efforts to help providers , to help the patients
they serve and that's what keeps me going, and I think that's what
keeps everyone in this mo vement going is knowing that there are
people out there who need our help and that accessing an abort ion is
literally life changing.

Robin Marty: For us it’s almost like mourning a death. My career has been about
assuming that Roe would be overturned. My s taff --- and it was still a
shock when it happened. We know that we have three months,
essentially three months to get established to get grants to find
funding, to be able to stay open, not just for all of these projects but
because we know that no matter how much money and how many
resources you give pregnant people there are some who are not going
to be able to leave the state , and those people are going to try to
medication, hopefully, to terminate their own pregnancy. T hey are
going to be afraid that t hey're going to be arrested for it , a nd so we
have to be there because we will be a safe place for them to come to
in order to get that follow up care that in a hospital they or someone
they love might end up investigated and in jail. T hat's what keeps us
going is knowing we've got three months to figu re out how to make
that happen.

Post - Roe Decision Amanda Allen and Robin Marty

Mark Masselli: Thank you both for sharing .

Margaret Flinter: Well, we t hank you for the work that you're doing. But I'd like to ask
the two of you. It has been one after the oth er stories of what I would
call only by the nearest of misses d id women not die after
experiencing a spontaneous miscarriage in the states where abortion
is now illegal . I've been hearing about ectopic pregnancies that
ruptured , a pregnancy that was never viable from the moment and
implanted in that fallopian tube and where the only treatment is
surgical to prevent death by hemorrhage. We've been hearing about
people as spontaneous abortion who had to wait and wait until the
heartbeat was no longer heard. T h at is going to result in deaths.
Woman had absolutely nothing to do with experiencing a
spontaneous miscarriage and yet may die because somebody
withholds the necessary medical treat ment due to a la w now on the
books in the state. Who is legally responsib le for that death?

Amanda Allen: Well, it is terrifying what is happening and this was never just about
abortion because when you try to regulate these things, then you're
putting doctors and other health care providers, you're essentially
tying their hand s. I just read a story about a woman in Louisiana who
was 16 weeks pregnant and was forced to labor her dead fetus
because the hospital doctor ’ s lawyer said that it would be an abortion
under Louisiana law and they could be charged with a crime. That
shoul d never happen here. Y et, story after story is just painting this
picture of this really horrifying reality that we're in where ectopic
pregnancies is, as you said Margaret, which are never ever viable, a re
not being treated right away, where o bstetric eme rgencies are getting
drawn out to the point of near death . B ecause of the way these laws
are written d octors don't know how much does a patient has to bleed
out before I can provide her care. W hat I do kno w is that these are
devastating , devastating implic ations a nd literally probably at this
moment there is a doctor somewhere not sure whether they can
provide the best care for their patient, it's unconscionable .

Mark Masselli: Amanda, let's just stay with you for a moment . The Lawyering Project
has a numbe r o f active cases it's involved in. If you can give our
listeners a general sense of the issues at stake here.

Amanda Allen: I'll first note that we did have a huge victory in one of our cases in
Minnesota . A bout a week ago a judge struck down almost every single
abortion restriction on the books in Minnesota as unconstitutional
under the Minnesota Constitutions Protections of Privacy . That judge
struck down a 24 hour waiting period, a requirement that doctors give
patients a lec ture that the state has writ ten, a law that requires an
adolescent patient to notify both their parents before they can get an
abortion . That victory is really going to make a big difference because
Minnesota as you know is right there in the middle of the country

Post - Roe Decision Amanda Allen and Robin Marty

where its neighbori ng states are about to ban abortion if they haven't
already. I t's going to become a major access point for people not just
in the Midwest, but some clinics in Minnesota are seeing one - third of
their patients from Texas right now.

Part of our strategy movin g forward is to make sure that access is as
unencumbered in states like Minnesota as possible, because those are
going to be the hub stage. W e want to make sure that people can get
there and not have to deal with any of this state mandated waiting
period . We really want to clear the way for providers to be able to
really increase their services to meet the demand.

Margaret Flinter: I know the American Medical Association has advised medical
professionals not to report a patient for the loss of a pregnancy w hich
they say violates privacy laws and medical ethics. I wonder what
advice is there for patients around how they can protect their own
privacy . It does feel like there's a real risk to people being found out
how can women protect themselves?

Amanda Allen : Well, I think one thing to know is that there is no reason to present at
a hospital or an emergency room and say you've had an abortion and
you need medical attention , b ecause you never know if somebody
that works at that hospital is going to be hostile to abortion and
report you. That is likely what happened in the case a few months ago
in Texas where a woman was charged with murder for her pregnancy
outcome . It’s most likely going to be somebody reporting a person
who presents with a pregnancy loss of s ome sort .

There is no medical difference between an abortion and a
miscarriage . There is no blood tests that can be run to see if you have
taken medications that would cause an abortion. I think just in terms
of people knowing what they have to disclose an d what they don't
have to disclose is fairly important. T hen there's Google and other
websites that are tracking people's movements. There's a movement
for people to delete some of these period tracking apps from their
phones and limit the amount of data t hat these tech companies can
collect. I think that's probably worth exploring.

Robin Marty: Yeah, and one of the things that we do definitely recommend is that if
you are pregnant and ambivalent, it's often better just not to tell
more people than you beli eve you can trust. Most people who are in
some way shape or form prosecuted over their pregnancy outcomes
usually find that it's their texts or their emails that are looked at that
become sources of information to try and prosecute somebody.
L ooking at whe n they do Google searches, if they do Google searches ,
using private browsers for that only texting people over signal which
is encrypted and using disappearing messages is a useful tool. It feels
a lot of times like in the south we don't have a lot of pow er when it
comes to political things we can do.

Post - Roe Decision Amanda Allen and Robin Marty

One thing that I am excited about is that I believe that Alabama is
going to be looking at i ntroducing a piece of legislation that essentially
says that the state will not investigate people who have poor
pre gnancy outcomes. T his is extraordinarily important not just for
people who will end up trying to self - manage their care , b ut also
because as I said, we don't have Medicaid out here , we don't have
prenatal care . 50% of our pregnancies are unintended . That i s a lot of
unintended pregnancies that could potentially end up with unhealthy
pregnancies and unhealthy people carrying them and potential
miscarriages.

T his is a type of legislation that could actually have some sort of legs
in really red states like Ala bama and Mississippi . Even if it still fails, at
least then there are lawmakers who are on the record saying, y es I
know, when we pass these bans we said we would never actually
punish the person who was having the abortion. But look now we had
an opportun ity to put that in writing and we chose not to .

Mark Masselli: I want to pull the thread a little on the sort of politics of this in terms
of states. W hat are you seeing in Alabama in terms of people rallying
in support of the work that you're doing and ho w do you see all this
maybe playing out in the November elections? Robin also Amanda as
well, are we seeing any momentum ? There's traction in terms of the
types of candidates that are being put forward.

Robin Marty: I've been frankly astounded by how much reaction there has been in
Alabama . Everybody has a N ational M arch D ay, but Alabama kept
going a nd in more and more cities . E ven just last weekend there was
another Reproductive Rights Rally in Huntsville, where there were
some legislators who came and dem anded that the governor have a
special session to rescind the abortion ban . It obviously was not going
to happen. But the fact that there's still all of these actions happening,
there's rallies all the time . Our issue in Alabama isn't about
enthusiasm or a bout what people believe when it comes to
reproductive rights and civil rights in general. I mean, this is the
birthplace of the civil rights movement.

Our issue is the way that our government has put together, the way
that gerrymandering is done, not just on the state level . T here's local
gerrymandering in our city councils and in our counties, like
everything has been put together in order to assume that white
Republican men stay in power a nd so that is going to be a process
that is going to take so long to undo. But there is a zeal for it now, and
that this has actually pushed people to realize that they have become
unempowered that they have lost any sort of real representation in
their state and in their nation. And if we can start really moving how
our districts are decided and divided, then we might have a shot going
forward.

Post - Roe Decision Amanda Allen and Robin Marty

Margaret Flinter: Thank you Robin , t hank you Amanda . Thank you for taking the time
out of your very busy days as you work through this historic time to
talk with us . We will conti nue to follow your work . T o our listeners ,
you can learn more about C onversations on H ealth C are and sign up
for our updates at www.chcradio.com . Amanda and Robin, thank you
again so much for all that you're doing an d for joining us today on
Conversations on Health Care .

Robin Marty: Of course, any time.

Amanda Allen: Thanks for having me.

Mark Masselli: Thank you both.

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Mark Masselli: At Conversations on Health Care we want our audience to be truly in
the know when it comes to the facts about health care reform and
policy. Lori Robertson is an award winning journalist and Managing
Editor of FactCheck.org, a nonpartisan, nonprofit consumer advocate
for voters that aim to reduce the level of deception in US p olit ics. Lori,
what have you got for us this week?

Lori Robertson: The Food and Drug Administration and numerous peer reviewed
academic studies have concluded that medication abortions are safe
and effective, and that serious adverse events for medication
abor tions are relatively rare. Recent research was conducted on
women who received abortion pills through the mail after a video
conference with a clinician rather than in - person from a medical
clinic. That research didn't appear to show an increase in “ seriou s
safety concerns ”. But South Dakota Governor Kristi Noem who
opposes abortion, defended her state's ban on prescriptions via
telemedicine appointments by calling medication abortions “ very
dangerous medical procedures ”, and claiming a woman is five times
more likely to end up in an emergency room if they're utilizing this
kind of method for an abortion.

Noem’s press office said Noem meant to say four times more likely,
and it cited research on emergency room visits by women with
Medicaid coverage who got m edication abortions. The governor isn't
citing the study correctly however. It found that women who got
medication abortions were 53% m ore likely , not four times , to have a
subsequent emergency room visit for an abortion related reason than
a woman wh o rec eived a surgical abortion. But other researchers
warn that the study only tracked ER visits, not whether those visits
required medical intervention.

One researcher noted that many people may visit emergency rooms
because they don't have a primary care doct or , a nd this is particularly
the case with Medicaid enrollees. Other research published in 2015

Post - Roe Decision Amanda Allen and Robin Marty

on women in the California Medicaid program tracked ER visits as well
as diagnosis and treatment. It found that major complications were
relatively rare in both medication and surgical abortion. Medication
abortions are done early in pregnancies and now account for more
than half of abortions in the United States . In South Dakota Noem
signed into law the state’s ban on medical abo rtion by telemedicine in
March. T hat's my fact check for this week. I'm Lori Robertson,
M anaging Editor of FactCheck.org.

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Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Public Policy
Cen ter at the University of Pennsylvania. If you have a fact that you'd
like checked, e - mail us at www.chcradio.com , we'll have
FactCheck.org's Lori Robertson check it out for you here on Conversations on Health Care.

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Mark Masselli: Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. Of the 6.6
million births per year in this country over half are unintended , and
a mong teens those rates are ev en higher. Colorado has been
conducting an experiment for several years to examine what might
happen if sexually active teens and poor women were offered the
option of long term birth control such as IUDs or implants.

Dr. Larry Wolk: What was so striking w as the word of mouth amongst these young
women to each other and the network of support that was built to
access this program through these clinics to help the tens of
thousands of women over the course of the four to five years really
did result in these significant decreases in unintended pregnancies
and abortions.

Mark Masselli: Dr. Larry Wolk , Medical Director of the Colorado Department of
Health and Environment .

Dr. Larry Wolk: The result in decrease is 40% in both cat egories pregnancy and
abortion to more than 50 % even approaching 60% reduction in those
unintended pregnancies and abortions.

Mark Masselli: There was a significant economi c benefit to the state as well.

Dr, Larry Wolk: We've seen a significant decrease in the number of young moms and
kids applying for and needing public assistance. This will translate into
better social and ec onomic outcomes for these folks. Amongst young
women 15 to 24 w e've seen a decrease in sexually transmitted
infections, and the rates are now below the national avera ges.

Post - Roe Decision Amanda Allen and Robin Marty
Mark Masselli: A free long term contraception program offered to at - risk teens and
women trying to avoid the economic hardship of unplanned
pregnancies leading to a number of positive health and economic
outc omes. Now that's a bright idea.
[ Music ]
Mar k Masselli: I'm Mark Masselli.
Margaret Flinter: And I'm Margaret Flinter.
Mark Masselli: Peace and Health.
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Marianne O’Hare : Conversations on Health Care is recorded in the Knowledge and
Technology Center Studio in Middleto wn , Connecticut, and is b rought
to you by the Community Health Center , now celebrating 50 years of
providing quality care to the underserved where health care is a right
not a privilege, www.chc1.com and ww w.chcradio.com .
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