Today, Explained - Decisions after Dobbs

Episode Date: February 9, 2023

The Supreme Court’s decision overturning Roe v. Wade is reshaping the way a lot of Americans think about pregnancy and abortion. Vox’s Marin Cogan talks to patients and doctors about how reproductive health care has changed in the months since Dobbs. This episode was produced by Victoria Chamberlin and Jillian Weinberger, edited by Matt Collette, fact-checked by Laura Bullard, engineered by Paul Robert Mounsey with help from Patrick Boyd and Efim Shapiro, and hosted by Sean Rameswaram. Transcript at vox.com/todayexplained Support Today, Explained by making a financial contribution to Vox! bit.ly/givepodcasts Learn more about your ad choices. Visit podcastchoices.com/adchoices

You probably weren't counting if you watched at all, but President Biden's State of the Union address clocked in at something like 9,224 words. Of those, about 76 were about abortion in America. Congress must restore the right that was taken away in Roe v. Wade and protect Roe v. Wade. The Vice President and I are doing everything to protect access to reproductive health care and safeguard patient safety. But already more than a dozen states are enforcing extreme abortion bans.

It's been seven months since the Supreme Court overturned Roe v. Wade. Ahead on Today Explained, we're going to take the temperature of decision-making around reproductive care in America. The all-new FanDuel Sportsbook and Casino is bringing you more action than ever. Want more ways to follow your faves? Check out our new player prop tracking with real-time notifications. Or how about more ways to customize your casino page with our new favorite and recently played games tabs. And to top it all off, quick and secure withdrawals.

Get more everything with FanDuel Sportsbook and Casino. Gambling problem? Call 1-866-531-2600. Visit connectsontario.ca. Go mother. Today, explain other letters attack. My name is Tia Freeman. I am a sex educator and a reproductive justice activist here in Nashville, Tennessee. I've had two abortions personally, and then I also have a son. So that makes my experience a little different. I had an abortion prior to the birth of my son and one post the birth of my son.

My first abortion I had, I was in college. I believe I was like 20, I think, if the math is right. I never wanted kids. From a little girl, they were like, you'll change your mind when you get older. And I was like, no, I won't. I know what I want. I know what I want my life to look like. And that was very career focused. And then when I had my son, like now I was at a better financial position, but still emotionally and mentally being a mother's a lot. And so I know if I wanted to be the best mother possible for my son, that did not mean bringing more children into the home. That would be more taxing on my emotional bandwidth. When the opinion was first leaked, I was at my house and my grandmother and my son were actually about to go back to our family home of South Carolina.

And so I remember like packing them up to hit the road and then going and like taking a nap. Like, oof, mom's off duty. Like, I'm going to sleep. And then I remember waking up in the middle of the night because I was thirsty and my phone's blowing up. Like, I'm getting all these messages. The Supreme Court opinion leaked. Roe's getting overturned. And then for 24 hours, I was up. I remember the chaos and the like fury and all the emotions that come with losing your rights. choices? And what does that look like for my children, for my grandchildren, for my nieces,

my cousins, my nephews, and, you know, all these people who that choice is removed from them. The decision to have my tubes tied was always something that I wanted to have done, but it wasn't something that, like, I was adamant, right? I thought, like, okay, maybe not today, but it's okay. They'll get to it, right? Like, it's not something that I was likeant, right? I thought like, okay, maybe not today, but it's okay. They'll get to it, right? Like it's not something that I was like, no, I'm making demands. Someone's going to tie my tubes, right? That fire and passion behind it didn't come till after the reversal of Roe, because now I was limited in what my options are. And so it made having a permanent sterilization method that much more of a priority for me. Before, I had time to kind of play around with it.

Oh, okay, maybe next year they'll change their minds, right? Or maybe after this thing, they'll change their minds, right? But now there's no other thing. This is it. This is all we've got. January the 4th was when I had my procedure done. I had, you know, a litany of questions that were like, do you think you're going to regret it? You're that positive that you don't want to have any

more kids, right? You love Xavier. You don't think that your decisions on motherhood have changed? No, I love my son so much. I don't want to do anything to impede on his upbringing. And I know that mentally I could not sustain another one. I couldn't do it. Hello, teeny embryos. I'm Phoebe Buffay. Hi. I'm hoping to be your uterus for the next nine months. My first introduction to the idea of surrogacy was when Phoebe had her brother's triplets on Friends.

You know, they want you so much. So when you guys get in there, really grab on. That made me think. I had always known I wanted to be a mom. I always wanted to grow babies. I'm the middle child, the oldest daughter of three. And I always had this idea that my mom was really good at grow babies. I'm the middle child, the oldest daughter of three. And I always had this idea that my mom was really good at growing babies. And so I'm going to be really good at it

too. But I didn't really know that I wanted to raise as many kids as I was willing to grow. So being introduced to the idea of surrogacy was really enlightening for me and really, really interesting. The first surrogacy that I went through, I actually carried for a single gay dad. He had grown up in a very religious household with a lot of siblings and had always wanted to be a father since he was a little kid. He was present for the birth. He was in the delivery room. I would not have wanted it any other way.

He was able to catch his son when I delivered. And I have never been so overwhelmed in my entire life. The emotion in the room, the love in the room, everyone was so thrilled. Everyone was so excited. And of course, birth is hard, but I forgot about everything as soon as I saw him with his son in his arms. It was incredible. It was a really incredible process to build a relationship with someone and to be able to help him have this family that he wanted his entire life.

I know that the right to be able to terminate in medical necessity is no longer a guarantee. I can absolutely never consider another surrogacy in this kind of atmosphere. Not even a question. grow and deliver a baby to help someone else have the family they've always dreamed of, that it was such a personal decision for me. And the idea of losing that for absolutely strictly political reasons is just absolutely heartbreaking. It was a really big part of my life, something that I wanted since I was very young to be a mom, to be pregnant, to have babies, to have babies for other people. It's been so much of my life for such a long time. And to know in that moment when I heard the decision had come down that it's too risky. I'm Ellen. I live in the state of Illinois, 38 years old. I am pregnant with my first child, 30 weeks along. I live in Chicago. I've lived here for, I think, eight years.

It's getting harder and harder to keep track. We got pregnant in late October, early November, 2020. And I was initially diagnosed with a miscarriage, which later was found to be an ectopic pregnancy. So I had emergency surgery and they discovered the ectopic pregnancy was way up in my right fallopian tube. So they had to take the whole tube out. And luckily the surgery was successful, but you know, I did lose that tube, which was, you know, collateral, collateral damage, I guess. I didn't know this before the surgery, but the number I was quoted was that I have a 10% chance of having another ectopic. That's pretty high. and i think initially my worries were about whether i whether i would be able to get pregnant again or kind of like you know what what this would mean for fertility but

we did an iui an intrauterine insemination which was uh initially successful and then we lost that pregnancy. In that case, I think there was a genetic abnormality, but I had to have a DNC after that. We finally made the decision to do IVF, did a fresh embryo transfer, which was successful. And I have been very lucky to have an uneventful pregnancy leading up to this point, which after everything we've been through has been a real blessing. And we're very excited. I always imagined us having two children. And now that we are approaching the end of this pregnancy, we're trying to think about what the future might hold. And knowing that I could have an ectopic pregnancy again and watching what's happening in states like Texas and Oklahoma where people are going to the hospital with potential ectopics

and not being able to get treatment for that, even though it's a non-viable pregnancy, it's scary. It scares the hell out of me. It's like they're not even trying and it makes me feel like less of a citizen. This is not something that affects a few people. You know, there are millions of people in the U.S. who are of childbearing age who are making these decisions. If it's a question of between, you know, me and a non-viable embryo, which is what an ectopic pregnancy is, an embryo that will never be born, never become a person.

If it's between saving that embryo and saving me, like, save me. Like, I'm a person. I have dreams. Like, it's hard to believe that you would put a non-viable pregnancy ahead of my life. In a minute, on Today Explained, the Vox reporter who found us these voices, Maren Kogan, she's going to share her reporting on decision-making after Dobbs. Thank you. save time and put money back in your pocket. Ramp says they give finance teams unprecedented control and insight into company spend. With Ramp, you're able to issue cards to every employee with limits and restrictions

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to speak to an advisor free of charge. BetMGM operates pursuant to an operating agreement with iGaming Ontario. Today Explained, we are back with Maren Kogan, a senior correspondent in the Vox newsroom. Maren, we just heard from a bunch of women that you got in touch with in the wake of Dobbs. And I want to know what else you heard when looking into how life in America has changed around reproductive rights since the decision. I think the main thing I heard was so much fear and uncertainty. And this was true whether women were mothers or not mothers. The women I heard from who knew they didn't want children were just

rushing to make plans. One of them got her tubes tied. She called her doctor the day the Dobbs decision came out. All sorts of things from where women were choosing to start their careers, where they wanted to move, where their daughters would live. It was having these huge ripple effects that I think I didn't fully anticipate when I started looking into the story. That's interesting because we actually had the president of the American Medical Association on our show, I think back in August of 2022, and he did predict some of these issues. Ectopic pregnancies, not properly cared for, those can threaten the life of a pregnant person. And I also think once you take away access to full-spectrum reproductive health care,

which includes physicians taking care of patients with desired pregnancies all the way through to delivery, and also sometimes includes abortion, what's going to happen in these states, particularly to marginalized populations, as these laws go into effect? Well, we know some things that are going to happen. We're going to see some patients turning to self-managed abortions without engagement of a healthcare team, and we know that's less safe. So at least some people, at least the medical professionals, some of them, saw some of this coming. That's why both the American Medical Association and the American College of Obstetricians and Gynecologists have called the Dobbs decision basically an assault on reproductive health, you know, saying that it impinges on health and privacy and rights of patients.

And it impinges on the ability of doctors to provide the care they think their patients need. Both organizations have been very forceful on this. And so a lot of my reporting was finding out that some of the things they predicted are in fact coming to pass, but it was also backing up a little bit and looking at the effects of this decision before we even get to those points where women are in these desperate situations. It's them trying to game plan these different scenarios and how they can avoid finding themselves in these really dire situations. Yeah, we're talking about bigwigs here and their sort of forecasts in the wake of Dobbs, but you've reported on what actual doctors are seeing on the ground in their patient populations. What

have you found? I spoke to a few different doctors. One of them was Dr. Taniqua Miller. She's an OBGYN and a professor at Emory School of Medicine. She said that her patient population, it skews a little bit older. They've become much more empowered to talk about contraception options. And the DOPS decisions did make some of them wonder if the birth control they relied on would be under attack next and how they might plan for that. I also spoke to Dr. Linda Pryne at the Miscarriage and Abortion Hotline. She founded this hotline in 2019. We actually started it during the Trump years when we were just frustrated with all of the piling on of state restrictions.

Little did we know how bad it would get and how much it would be needed. So initially, there was only a group of 12 of us, and we staffed it for about 12 hours a day, and we each took a couple of shifts a month. And that was plenty in the beginning, and then it got busier. They're getting a ton of calls, especially now that the Dobbs decision has passed. Dr. Prine said that they're getting, she would say, about three times as many calls to the hotline than she did before the decision. To the point where now there's 60 volunteers, and we cover the hotline in three shifts a day, and it's really busy. Like, you can't do your day job when you're on call for the hotline.

Right after Dobbs, she said they were getting a lot more calls from people who just wanted the pills on hand. They were in states with restrictions and they said, I want to get the pills now. It's called advanced provision. And those of us who work for Aid Access get a lot of requests for advanced provision. You know, people aren't pregnant at all, but they want to have these pills in their medicine cabinet for just in case. And now, you know, now that we're a few months past this decision, she says they're getting a lot of calls from people in restricted states who are desperately seeking help finding medication abortion so that they can have self- directions. So they call us about that, but also they're further along in pregnancy and they're calling us scared because they've passed a tiny but recognizable fetus and they are freaked out and they weren't expecting that.

And it's frankly traumatizing for what people are going through because they haven't had any anticipatory guidance that this might be happening. And people who've had an abortion before with pills didn't pass anything that they could see. Pills like mifepristone and misoprostol are approved to end pregnancies up to 12 weeks. But usually they're taking them around under eight weeks, which is very early in a pregnancy. And I should say that second trimester medication abortions like this are common in places like Scandinavia. So this is not like a deeply unsafe procedure. But Dr. Prine says basically that these delays and these sort of enforced secrecy of having to do it at home are causing unnecessary trauma for women. So we get calls from people completely, you know, freaked out, crying, sobbing.

What do I do? And that's, I think, for us, the trauma and the horror of the Dobbs decision. People are having to go through something that they should not have to be experiencing. Early in the show, we heard from Ellen, who talked about her experience with ectopic pregnancy. And so I kind of wonder, just apart from the abortion question, in the show we heard from Ellen, who talked about her experience with ectopic pregnancy.

And so I kind of wonder, just apart from the abortion question, how has Dobbs affected just standard maternal health care? Do we know? Yeah, there are a lot of these fears women have, especially if they've had complications in pregnancies in the past, about not being able to get emergency care if they have a pregnancy complication. There are big problems with access to normal early maternity care. The bigger problems that I'm hearing from my OBGYN colleagues in these red states with just normal maternity care are terrible.

I just hear them trying to get their own patients to another state for care that they need. You know, people are literally on signal chats trying to find care for their patients. So, yeah, that's what I'm hearing. That's the devastating news out of so many of these states. Is someone like Dr. Prine going to be one day prescribing abortion pills to someone in a state that has outlawed them? I mean, she would certainly like to be.

Oh, yeah? Yeah, absolutely. I mean, she's working to help patients who are in these states where it's banned get the care that she thinks they need. Basically, she and other providers and advocates are working with state lawmakers to try to pass these shield laws, kind of an inversion of the normal order of how states cooperate on legal issues and extradition. So basically, these shield laws, kind of an inversion of the normal order of how states cooperate on legal issues and extradition. So basically, these shield laws say, okay, if our healthcare providers help a patient in a state where the procedure is banned, either by prescribing abortion medicine or offering care, and they get charged by legal authorities in that state, we are not going to

help that state with extradition or prosecution. So Massachusetts has passed a law like this, and lawmakers are working on them in New York and some other states as well. Did you ask her if she's at all afraid of ending up in jail, prison one day behind all this? She said that she wasn't super worried, despite the fact that those risks are real and they are there. But she said, despite that, she lives in New York. A lot of attorneys have offered to help her out pro bono if something did happen. And she also thinks that it would probably be like a bad move for state legal

authorities to start going after doctors. I don't think that's a really much of a realistic strategy on their part. If they do try it, I doubt they'll stick with it for long. So I'm willing to be out there and let them, you know, let them see how that goes over. I will say though, Sean, she did say like she's not planning a trip to Austin or New Orleans anytime soon. I'm not going to see her at South by Southwest, huh? No. No vacations in Texas for me. Do we yet have data on how this country has fundamentally changed since Dobbs? What doctors are seeing? How many patients are coming in with different questions?

How many more or fewer people are getting abortions? The whole big picture. Do we have that information yet? Keep in mind, the Dobbs decision was only seven months ago. This is such a major tectonic shift in the rights and freedoms of so many people in this country. And I do think that there will be reverberations for years to come, but we don't have a longitudinal study just yet because we're still living in the very, very immediate aftermath of all of this. I will say we do have some solid data about what happens to women who are denied abortions. I'm talking about the Turnaway study. We recruited just under a

thousand people from 30 abortion facilities across the country. We followed all these women for up to five years, calling them every six months to do interviews in English or Spanish. Researchers at UC San Francisco, they looked at two groups of women who came to abortion providers seeking to have abortions. Okay, so in one group were the women who were able to have those abortions, and in the other group were the women who were denied or turned away because they had come in past the gestational limit. Basically, what they found was that the women who had abortions saw almost no negative effects. Their mental health was better after, so was their physical health, and their children fared better. But the women who had brought unwanted pregn likely to have had high-risk births and more likely to rate their own health as poor in the intervening years. So we know that there

are very real consequences to denying women abortions. But I think what we're still trying to understand, and definitely what I was trying to figure out in my reporting, are the ways in which this is having an impact even before we get to this point. I think we'll know more in the years to come, but it's obvious based on my reporting that it is already having a major impact on women's lives and their decision making. Maren Kogan, she's a senior correspondent at Vox. Read her reporting on reproductive care in America at vox.com. Our show today was produced by Victoria Chamberlain and Jillian Weinberger. It was edited by Matthew Collette and fact-checked by Laura Bullard.

Paul Robert Mounsey mixed and mastered with help from Afim Shapiro and Patrick Boyd. I'm Sean Ramos-Furham. It's Today Explained. My co-host is Noelle King. Aminat Alsadi is our supervising producer. The rest of the team includes Halima Shah, Abishai Artsy, Hadi Mawagdi, Amanda Llewellyn, Miles Bryan, and Siona Petros. Extra help from Jolie Myers.

We use music by Breakmaster Cylinder and Noam Hassenfeld. Today Explained is distributed by WNYC. We are part of the Vox Media Podcast Network. Thank you.