--:-- Sean Rameswaram: Welcome to Today Explained. I'm Sean Rameswaram.
--:-- Noelle King: And I'm Noelle King.
--:-- Sean Rameswaram: Today, we're going to take the temperature of decision-making around reproductive care in America.
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--:-- Tia Freeman: My name is Tia Freeman.
--:-- Noelle King: I am a sex educator and a reproductive justice activist here in Nashville, Tennessee.
--:-- Tia Freeman: I've had two abortions personally, and then I also have a son.
--:-- Noelle King: So that makes my experience a little different.
--:-- Tia Freeman: I had an abortion prior to the birth of my son and one post the birth of my son.
--:-- Noelle King: My first abortion I had, I was in college.
--:-- Tia Freeman: I believe I was like 20, I think, if the math is right.
--:-- Noelle King: I never wanted kids.
--:-- Tia Freeman: From a little girl, they were like, you'll change your mind when you get older.
--:-- Noelle King: And I was like, no, I won't.
--:-- Tia Freeman: I know what I want.
--:-- Noelle King: I know what I want my life to look like.
--:-- Tia Freeman: And that was very career focused.
--:-- Noelle King: 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.
--:-- Tia Freeman: 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.
--:-- Noelle King: That would be more taxing on my emotional bandwidth.
--:-- Tia Freeman: 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.
--:-- Noelle King: And so I remember like packing them up to hit the road and then going and like taking a nap.
--:-- Tia Freeman: Like, oof, mom's off duty, like I'm going to sleep.
--:-- Noelle King: And then I remember waking up in the middle of the night because I was thirsty and my phone's blowing up.
--:-- Tia Freeman: Like I'm getting all these messages.
--:-- Noelle King: The Supreme Court opinion leaked, Roe getting overturned.
--:-- Tia Freeman: And then for 24 hours, I was up.
--:-- Noelle King: I remember the chaos and the like fury and all the emotions that come with losing your rights.
--:-- Tia Freeman: I just remember feeling a profound sense of loss because I had been able to have these choices.
--:-- Noelle King: 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.
--:-- Tia Freeman: The decision to have my two sides was always something that I wanted to have done, but it wasn't something that, like, I was adamant, right?
--:-- Noelle King: I thought like, okay, maybe not today, but it's okay.
--:-- Tia Freeman: They'll get to it, right?
--:-- Noelle King: Like, it's not something that I was like, no, I'm making demands.
--:-- Tia Freeman: Someone's going to tie my tubes, right?
--:-- Noelle King: 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.
--:-- Tia Freeman: And so it made having a permanent sterilization method that much more of a priority for me.
--:-- Noelle King: Before I had time to kind of play around with it, oh, okay, maybe next year they'll change their minds, right?
--:-- Tia Freeman: Or maybe after this thing, they'll change their minds, right?
--:-- Noelle King: But now there's no other thing.
--:-- Tia Freeman: This is it.
--:-- Noelle King: This is all we've got.
--:-- Tia Freeman: January the 4th was when I had my procedure done.
--:-- Noelle King: I had a litany of questions that were like, do you think you're going to regret it?
--:-- Tia Freeman: You're that positive that you don't want to have any more kids, right?
--:-- Noelle King: You love Xavier.
--:-- Tia Freeman: You don't think that like your decisions on motherhood have changed?
--:-- Noelle King: No, I love my son so much.
--:-- Tia Freeman: I don't want to do anything to impede on his upbringing.
--:-- Noelle King: And I know that mentally I could not sustain another one.
--:-- Tia Freeman: I couldn't do it.
--:-- Phoebe Buffay: Hello, teeny embryos.
--:-- Phoebe Buffay: I'm hoping to be your uterus for the next nine months.
--:-- Noelle King: My first introduction to the idea of surrogacy was when Phoebe had her brother's triplets on Friends.
--:-- Phoebe Buffay: You know, they want you so much.
--:-- Noelle King: So when you guys get in there, really grab on.
--:-- Phoebe Buffay: That made me think I had always known I wanted to be a mom.
--:-- Noelle King: I always wanted to grow babies.
--:-- Phoebe Buffay: I'm the middle child, the oldest daughter of three.
--:-- Noelle King: And I always had this idea that my mom was really good at growing babies and so I'm gonna be really good at it too.
--:-- Phoebe Buffay: But I didn't really know that I wanted to raise as many kids as I was willing to grow.
--:-- Noelle King: So being introduced to the idea of surrogacy was really enlightening for me and really really interesting
--:-- Phoebe Buffay: The first surrogacy that I went through I actually carried for a single gay dad.
--:-- Noelle King: 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.
--:-- Phoebe Buffay: He was present for the birth.
--:-- Noelle King: He was in the delivery room.
--:-- Phoebe Buffay: I would not have wanted it any other way.
--:-- Noelle King: He was able to catch his son when I delivered.
--:-- Phoebe Buffay: And I have never been so overwhelmed in my entire life.
--:-- Noelle King: The emotion in the room, the love in the room, everyone was so thrilled.
--:-- Phoebe Buffay: Everyone was so excited.
--:-- Noelle King: And of course, birth is hard, but I forgot about everything as soon as I saw him with his son in his arms.
--:-- Phoebe Buffay: It was incredible.
--:-- Noelle King: 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.
--:-- Phoebe Buffay: I know that the right to be able to terminate in medical necessity is no longer a guarantee.
--:-- Noelle King: I can absolutely never consider another surrogacy in this kind of atmosphere.
--:-- Phoebe Buffay: Not even a question.
--:-- Noelle King: To go through IVF, to grow and deliver a baby, to help someone else have the family they've always dreamed of.
--:-- Phoebe Buffay: That it was such a personal decision for me.
--:-- Noelle King: And the idea of losing that for what are absolutely strictly political reasons is just absolutely heartbreaking.
--:-- Phoebe Buffay: It was a really big part of my life, you know, 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.
--:-- Noelle King: It's been so much of my life for such a long time.
--:-- Phoebe Buffay: And to know in that moment when I heard the decision had come down that it's too risky.
--:-- Noelle King: I'm Ellen.
--:-- Ellen: I live in the state of Illinois, 38 years old.
--:-- Noelle King: I am pregnant with my first child, 30 weeks along.
--:-- Ellen: I live in Chicago.
--:-- Noelle King: I've lived here for, I think, eight years.
--:-- Ellen: It's getting harder and harder to keep track.
--:-- Noelle King: We got pregnant in late October, early November 2020.
--:-- Ellen: And I was initially diagnosed with a miscarriage, which later was found to be an ectopic pregnancy.
--:-- Noelle King: So I had emergency surgery and they discovered the ectopic pregnancy was way up in my right fallopian tube.
--:-- Ellen: So they had to take the whole tube out.
--:-- Noelle King: And luckily the surgery was successful.
--:-- Ellen: But, you know, I did lose that tube, which was, you know, collateral damage, I guess.
--:-- Noelle King: 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.
--:-- Ellen: That's pretty high.
--:-- Noelle King: And I think initially my worries were about whether I would be able to get pregnant again or kind of like, you know, what this would mean for fertility.
--:-- Ellen: But we did an IUI, an intrauterine insemination, which was initially successful.
--:-- Noelle King: And then we lost that pregnancy.
--:-- Ellen: In that case, I think there was a genetic abnormality, but I had to have a DNC after that.
--:-- Noelle King: We finally made the decision to do IVF, did a fresh embryo transfer, which was successful.
--:-- Ellen: And I have been very lucky to have an uneventful pregnancy leading up to this point.
--:-- Noelle King: Which after everything we've been through has been a real blessing.
--:-- Ellen: And we're very excited.
--:-- Noelle King: I always imagined us having two children.
--:-- Ellen: And now that we are approaching the end of this pregnancy, we're trying to think about what the future might hold.
--:-- Noelle King: 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.
--:-- Ellen: It scares the hell out of me.
--:-- Noelle King: It's like they're not even trying, and it makes me feel like less of a citizen.
--:-- Ellen: This is not something that affects a few people.
--:-- Noelle King: You know, there are millions of people in the U.S. who are of childbearing age who are making these decisions.
--:-- Ellen: If it's a question of between me and a non-viable embryo, which is what an ectopic pregnancy is, an embryo that will never be born, never become a person.
--:-- Noelle King: If it's between saving that embryo and saving me, save me.
--:-- Ellen: I'm a person.
--:-- Noelle King: I have dreams.
--:-- Ellen: It's hard to believe that you would put a non-viable pregnancy ahead of my life.
--:-- Sean Rameswaram: 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.
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--:-- Sean Rameswaram: Today Explained, we are back with Maren Kogan, a senior correspondent in the Vox Newsroom.
--:-- Maren Kogan: I think the main thing I heard was so much fear and uncertainty.
--:-- Sean Rameswaram: And this was true whether women were mothers or not mothers.
--:-- Maren Kogan: The women I heard from who knew they didn't want children were just rushing to make plans.
--:-- Sean Rameswaram: One of them got her tubes tied.
--:-- Maren Kogan: She called her doctor the day the Dobbs decision came out.
--:-- Sean Rameswaram: All sorts of things from where women were choosing to start their careers, where they wanted to move, where their daughters would live.
--:-- Maren Kogan: It was having these huge ripple effects that I think I didn't fully anticipate when I started looking into the story.
--:-- Sean Rameswaram: That's interesting because we actually had the president of the American Medical Association on our show, I think back in August of 2022.
--:-- Maren Kogan: And he did predict some of these issues.
--:-- Sean Rameswaram: Ectopic pregnancies not properly cared for, those can threaten the life of a pregnant person.
--:-- Maren Kogan: 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?
--:-- Sean Rameswaram: Well, we know some things that are going to happen.
--:-- Maren Kogan: We're going to see some patients turning to self-managed abortions without engagement of a health care team, and we know that's less safe.
--:-- Sean Rameswaram: So at least some people, at least the medical professionals, some of them saw some of this coming.
--:-- Maren Kogan: 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.
--:-- Sean Rameswaram: 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.
--:-- Maren Kogan: It's them trying to game plan these different scenarios and how they can avoid finding themselves in these really dire situations.
--:-- Sean Rameswaram: 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.
--:-- Maren Kogan: What have you found?
--:-- Sean Rameswaram: I spoke to a few different doctors.
--:-- Maren Kogan: One of them was Dr. Tanequa Miller.
--:-- Sean Rameswaram: She's an OBGYN and a professor at Emory School of Medicine.
--:-- Maren Kogan: She said that her patient population, it skews a little bit older.
--:-- Sean Rameswaram: They've become much more empowered to talk about contraception options.
--:-- Maren Kogan: And the Dobbs 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.
--:-- Sean Rameswaram: I also spoke to Dr. Linda Prine at the Miscarriage and Abortion Hotline.
--:-- Maren Kogan: She founded this hotline in 2019.
--:-- Sean Rameswaram: We actually started it during the Trump years when we were just frustrated with all of the piling on of state restrictions.
--:-- Maren Kogan: Little did we know how bad it would get and how much it would be needed.
--:-- Sean Rameswaram: 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.
--:-- Maren Kogan: And that was plenty in the beginning.
--:-- Sean Rameswaram: And then it got busier.
--:-- Maren Kogan: They're getting a ton of calls, especially now that the DOPS decision has passed.
--:-- Sean Rameswaram: 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.
--:-- Maren Kogan: To the point where now there's 60 volunteers and we cover the hotline in three shifts a day and it's really busy.
--:-- Sean Rameswaram: Like you can't do your day job when you're on call for the hotline.
--:-- Maren Kogan: Right after Dobbs, she said they were getting a lot more calls from people who just wanted the pills on hand.
--:-- Sean Rameswaram: They were in states with restrictions and they said, I want to get the pills now.
--:-- Maren Kogan: It's called advanced provision.
--:-- Sean Rameswaram: And those of us who work for Aid Access get a lot of requests for advanced provision.
--:-- Maren Kogan: You know, people aren't pregnant at all, but they want to have these pills in their medicine cabinet for just in case.
--:-- Sean Rameswaram: 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-managed abortions at home now that they're not able to go to a clinic.
--:-- Maren Kogan: They're ordering pills from online pharmacies, and they come sometimes with no directions, so they call us about that.
--:-- Sean Rameswaram: 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.
--:-- Maren Kogan: And it's frankly traumatizing for what people are going through because they haven't had any anticipatory guidance that this might be happening.
--:-- Sean Rameswaram: And people who've had an abortion before with pills didn't pass anything that they could see.
--:-- Maren Kogan: Pills like Mifepristone and Misoprostol are approved to end pregnancies up to 12 weeks.
--:-- Sean Rameswaram: But usually they're taking them around under eight weeks, which is very early in a pregnancy.
--:-- Maren Kogan: And I should say that second trimester medication abortions like this are common in places like Scandinavia.
--:-- Sean Rameswaram: So this is not like a deeply unsafe procedure.
--:-- Maren Kogan: But Dr. Pryant says basically that these delays and these sort of enforced secrecy of having to do it at home are causing unnecessary trauma for women.
--:-- Sean Rameswaram: So we get calls from people completely you know freaked out crying sobbing
--:-- Maren Kogan: What do I do
--:-- Sean Rameswaram: And that I think for us the trauma and the horror of the Dobbs decision
--:-- Maren Kogan: People are having to go through something that they should not have to be experiencing.
--:-- Sean Rameswaram: Early in the show, we heard from Ellen, who talked about her experience with ectopic pregnancy.
--:-- Maren Kogan: And so I kind of wonder, just apart from the abortion question, how has Dobbs affected just standard maternal health care?
--:-- Sean Rameswaram: Do we know?
--:-- Maren Kogan: 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.
--:-- Sean Rameswaram: There are big problems with access to normal early maternity care.
--:-- Maren Kogan: The bigger problems that I'm hearing from my OBGYN colleagues in these red states with just normal maternity care are terrible.
--:-- Sean Rameswaram: I just hear them trying to get their own patients to another state for care that they need.
--:-- Maren Kogan: You know, people are literally on signal chats trying to find care for their patients.
--:-- Sean Rameswaram: So, yeah, that's what I'm hearing.
--:-- Maren Kogan: That's the devastating news out of so many of these states.
--:-- Sean Rameswaram: Is someone like Dr. Prine going to be one day prescribing abortion pills to someone in a state that has outlawed them?
--:-- Maren Kogan: I mean, she would certainly like to be.
--:-- Sean Rameswaram: Oh, yeah?
--:-- Maren Kogan: Yeah, absolutely.
--:-- Sean Rameswaram: 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.
--:-- Maren Kogan: Basically, she and other providers and advocates are working with state lawmakers to try to pass these shield laws.
--:-- Sean Rameswaram: Kind of an inversion of the normal order of how states cooperate on legal issues and extradition.
--:-- Maren Kogan: So basically, the 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.
--:-- Sean Rameswaram: So Massachusetts has passed a law like this, and lawmakers are working on them in New York and some other states as well.
--:-- Maren Kogan: Did you ask her if she's at all afraid of ending up in jail, prison one day behind all this?
--:-- Sean Rameswaram: She said that she wasn't super worried, despite the fact that those risks are real and they are there.
--:-- Maren Kogan: But she said, despite that, she lives in New York.
--:-- Sean Rameswaram: A lot of attorneys have offered to help her out pro bono if something did happen.
--:-- Maren Kogan: And she also thinks that it would probably be like a bad move for state legal authorities to start going after doctors.
--:-- Sean Rameswaram: I don't think that's a really much of a realistic strategy on their part.
--:-- Maren Kogan: If they do try it, I doubt they'll stick with it for long.
--:-- Sean Rameswaram: So I'm willing to be out there and let them, you know, let them see how that goes over.
--:-- Maren Kogan: I will say, though, Sean, she did say, like, she's not planning a trip to Austin or New Orleans anytime soon.
--:-- Sean Rameswaram: I'm not going to see her at South by Southwest, huh?
--:-- Sean Rameswaram: No vacations in Texas for me.
--:-- Maren Kogan: Do we yet have data on how this country has fundamentally changed since Dobbs?
--:-- Sean Rameswaram: What doctors are seeing?
--:-- Maren Kogan: How many patients are coming in with different questions?
--:-- Sean Rameswaram: How many more or fewer people are getting abortions?
--:-- Maren Kogan: The whole big picture.
--:-- Sean Rameswaram: Do we have that information yet?
--:-- Maren Kogan: Keep in mind, the Dobbs decision was only seven months ago.
--:-- Sean Rameswaram: This is such a major tectonic shift in the rights and freedoms of so many people in this country.
--:-- Maren Kogan: And I do think that there will be reverberations for years to come.
--:-- Sean Rameswaram: 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.
--:-- Maren Kogan: I will say we do have some solid data about what happens to women who are denied abortions.
--:-- Sean Rameswaram: I'm talking about the turn away study.
--:-- Maren Kogan: We recruited just under 1,000 people from 30 abortion facilities across the country.
--:-- Sean Rameswaram: We followed all these women for up to five years, calling them every six months to do interviews in English or Spanish.
--:-- Maren Kogan: Researchers at UC San Francisco, they looked at two groups of women who came to abortion providers seeking to have abortions.
--:-- Sean Rameswaram: 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.
--:-- Maren Kogan: Basically, what they found was that the women who had abortion saw almost no negative effects.
--:-- Sean Rameswaram: Their mental health was better after, so was their physical health, and their children fared better.
--:-- Maren Kogan: But the women who had brought unwanted pregnancies to term had negative mental and physical health consequences.
--:-- Sean Rameswaram: So, for example, they were more likely to have had health complications like gestational hypertension.
--:-- Maren Kogan: They were more likely to have had high-risk births and more likely to rate their own health as poor in the intervening years.
--:-- Sean Rameswaram: So we know that there are very real consequences to denying women abortions.
--:-- Maren Kogan: 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.
--:-- Sean Rameswaram: 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: Maren Kogan, she's a senior correspondent at Vox.
--:-- Sean Rameswaram: Read her reporting on Reproductive Care in America at Vox.com.
--:-- Noelle King: Our show today was produced by Victoria Chamberlain and Jillian Weinberger.
--:-- Sean Rameswaram: It was edited by Matthew Collette and fact-checked by Laura Bullard.
--:-- Noelle King: Paul Robert Mounsey mixed and mastered with help from Afim Shapiro and Patrick Boyd.
--:-- Sean Rameswaram: I'm Sean Rameswaram for him.
--:-- Noelle King: It's Today Explained.
--:-- Sean Rameswaram: My co-host is Noelle King.
--:-- Noelle King: Amina Al-Assadi is our supervising producer.
--:-- Sean Rameswaram: The rest of the team includes Halima Shah, Abishai Artsy, Hadi Mawagdi, Amanda Llewellyn, Miles Bryan, and Siona Petros.
--:-- Noelle King: Extra help from Jolie Myers.
--:-- Sean Rameswaram: We use music by Breakmaster Cylinder and Noam Hassenfeld.
--:-- Noelle King: Today Explained is distributed by WNYC.
--:-- Sean Rameswaram: We are part of the Vox Media Podcast Network.
