E13: Woman and Abortion Access: Carole Joffe & David S. Cohen, Obstacle Course

[00:00:00] Section: Podcast introduction

[00:00:00] Overdub: Hello, welcome to The Story of Woman, the podcast exploring what a man-made world looks like when we see it through her eyes. Woman's perspective is missing from our understanding of the world. This podcast is on a mission to change that. I’m your host, Anna Stoecklein Lau and each episode I'll be speaking with an author about the implications of her absence - how we got here, what still needs to be changed, and how telling her story will improve everyone's next chapter.

[00:00:34] Section: Episode level introduction

[00:00:35] Anna: Hello friends. Welcome back. And thanks as always for being here. We've got a very pressing issue to discuss today: abortion and people's access to it or lack thereof. And whether you are listening on the day it's released or a year later, it's probably still a pressing issue.

I am recording this on May 17th, 2022. The U S Supreme court is due to rule on the Dobbs B Jackson women's health organization case in June of this year. This is of course the case that could overturn Roe V Wade, which was the landmark decision of the very same Supreme court back in 1973, that ruled that the constitution of the United States protects a pregnant woman's Liberty to choose to have an abortion without excess government restriction.

And about a week ago, the Supreme court draft decision for that june ruling was leaked to the world and it's not looking very good for RO. I spoke with my guests today, before this leak, which is why it wasn't mentioned. And with the speed at which things are changing, there was probably something else big in the news by now.

But everything we discuss in our conversation today is still relevant. No matter when you are listening to this and what has happened since. But I do also recommend the podcast called Access, which is all about abortion. And the host Garnett Henderson does a fantastic job bringing you the latest updates and news in the abortion space.

Today I spoke with Carol Joffey and David Cohen, coauthors of the book Obstacle Course, The Everyday Struggle to Get an Abortion in america. That title feels a bit ironic as it is about to get even more difficult, which is pretty unfathomable given as you will soon hear how hard it is already with Roe V. Wade in place.

But before we get into, I want to tell you a little bit about my story real quick, because as you probably know, by now, I, and many others, think stories are one of the most important tools for driving change and the stories surrounding abortion have been silenced for way too long. I was born and raised in Missouri and I attended Catholic school where I was taught about the horrors of abortion. The murderers, and the dead babies. And it was all pretty easy to get on board with. I mean, when positioned this way, who wouldn't want to save the lives of babies, I'm not a psychopath.

So that's a pretty hard stance to argue against. Except of course, though, it was presented as such, this was not the full story. This is not the full story. Nothing in life is that black and white. And certainly not something as complex as this.

You know, who I was never told about in my upbringing, the lives of the women that find themselves pregnant in the first place, the women and pregnant people that are food insecure and don't have enough money to feed the mouths of the children they already have. The women that were raped by a stranger, by a friend, by an uncle. The women that became pregnant by their abusive partners, because not so fun fact, domestic violence very often escalates when a woman is pregnant. There is a link between abuse during pregnancy and a woman's chance of being killed by her perpetrator.

Nor was I told about the women that wanted more than anything in the world to have a baby only to find out at 20 weeks that their wanted baby has a fatal fetal anomaly that means it wouldn't survive outside the womb. Or the women that wanted more than anything in the world to have a baby only to experience a placental abruption that would kill her and her baby if the pregnancy continued. Or the women that are on the brink of graduating high school and would be the first person in their family to go to college and are planning to become a lawyer.

These lives and all the rest of the women with their own different stories were mysteriously left out from my education. Nor was I ever told as we will soon hear that abortion has been around literally forever. No past or present society exists that we don't have a written record about abortion. Or that when the societies that will have women seeking abortions, because as I just mentioned, they literally all do, but when these societies ban abortions or restrict them, the number of abortions do not decrease. In fact, the number often increases. And I'll tell you why in a second, but what happens is the number of women and pregnant people that die increases. Why? Because those abortions aren't going anywhere. They have just changed from being incredibly safe, like twice as safe as getting your tonsils removed safe, because they were procedures carried out by trained medical professionals to underground back alley abortions, or even home remedies, such as poisons, hangers and stairs. And this is not hyperbole. This is reality in 1930, illegal abortion was listed as the official cause of death for 2,700 women in the U S or 18% of maternal deaths recorded in that year.

And in 1965, illegal abortion still accounted for 17% of all deaths due to pregnancy and childbirth that year. But then abortion related mortality decreased by 85% in the five years after Roe V. Wade was passed. Why? Because colonoscopies are 10 times more deadly than medically practiced legal abortion. Even pregnancy itself is 14 times more dangerous than getting an abortion.

And of course when these restrictions are in place as always, it is black women, women of color, indigenous women and poor women that suffer because everyone else will still be able to get their abortion by traveling out of state or out of the country if they must. But these women, women of color whose maternal mortality rate is three to four times higher than white women in the U S which already has the highest maternal mortality rate of any developed country, will be forced to literally risk their lives, carrying a pregnancy to term for whatever reason they don't want to.

And believe it or not, the number of abortions are actually declining in the U S but not because of restrictions. The seemingly paradoxical catch is that the states that have seen the greatest decline are those without any major restrictions like California, Hawaii, and Oregon. Whereas the states with the most restrictions like Arkansas, Mississippi, North Carolina, and Missouri, where I'm from, have actually seen an increase in the abortion rate.

And why is that? Because access to safe and legal abortion often goes hand in hand with greater access to an information about contraceptives. The only thing proven to decrease the number of abortions. I mean, that makes sense. Generally speaking, unintended pregnancies lead to abortion. So preventing unintended pregnancies seems like a pretty good method for decreasing abortion rates. But what do I know?

But that's not the goal anyway, the goal is to protect the lives and wellbeing of the women and pregnant. And of course, to leave medical decisions to medical professionals, not to male politicians who haven't the slightest about basic female anatomy, let alone providing medical care for a pregnant person.

Clearly I have come a long way in my thinking since my early years education. And the only thing that changed was learning the full story. I did not lose my heart or become a psychopath or lose my morals in any way. I simply pieced together the full story. The story that is spun by and to the anti-abortion movement is a narrow slice of a distorted reality. And I understand why people buy into it. Like I said, murdering babies is not something I would ever put my name to. Not to mention. This is a political strategy, 50 plus years in the making complete with a playbook on everything from how to get anti-abortion judges on the Supreme court, to how to evoke emotions from voters, with language, instructing politicians and advocates to say mother instead of pregnant person, or womb instead of uterus and committing abortions, rather than doing them.

Once again, this is not hyperbole. These examples are straight from a book published in 1971 called Handbook on Abortion, which was co-authored by a man called John C Wilke, otherwise known as the father of the anti-abortion movement. He also recommended using props and pictures of babies that are laughably disconnected from the actual gestational stage. And I'm sure we've all seen these pictures before.

So it's understandable that people buy into. This is one reason I want to tell my story, having been on the receiving end of these lies, having bought into them myself, but I would encourage everyone listening, no matter what your stance is, to find the full, true story, and only then decide for yourself what your beliefs are.

And remember, even if you say you yourself would never and could never have an abortion, the good news is that is exactly what you can continue to do and believe. That is literally the definition of pro-choice And stay tuned next week, or if this is the future check out episode 14, where I speak with Dr. Willie Parker, a devout Christian, and an OB GYN, specializing in abortions. I speak with him about the morality of abortion and his decision to be pro-choice as a person of faith and as a Christian.

Okay. That is probably enough for now. I have to cut myself off somewhere clearly I could just go on and on about this topic, but I want to get to our guests. I have two incredible guests today. Carol Joffey and David Cohen. They co-authored their book Obstacle Course. Carol Joffey is a sociologist and professor in the advancing new standards in reproductive health program in the department of Obstetrics, Gynecology and Reproductive Sciences at the University of California, San Francisco. She is also professor of sociology, uh, Marietta at the University of California Davis and is the author of Dispatches From the Abortion Wars and several other books on abortion provision.

David Cohen is it professor of law at Drexel University's Kline School of Law in Philadelphia and his co-author of Living in the Cross Hairs: The Untold Stories of Anti-abortion Terrorism.

Based on patient's stories, as well as interviews with abortion providers and allies from every state in the country, their book tells the story of abortion in America. Capturing a disturbing reality of insurmountable barriers people face when trying to exercise their legal rights to medical services.

We will get into these barriers today from forced ultrasounds and dishonest medical information to arbitrary waiting periods and harassing protest. We also talk about what happens to women and pregnant people that are not able to get the abortions that they want. And we talk about the future and what we can do as individual.

Thank you for coming along for this tangent of an introduction, but it's more important than ever that we all speak up and defend the most fundamental and basic right a person could have, the right to control their own bodies. Especially in a country that claims to be all about individual freedoms and liberties.

Oh, the irony. Anyway, please enjoy my conversation with Carol Jaffe and David Cohen.

[00:13:07] Section: Episode interview

[00:13:08] Anna: Hello, welcome Carol and David. Thank you both so much for being here. I'm very excited to talk to both of you today, about your book Obstacle Course: the everyday struggle to get an abortion in America.

And as this struggle is becoming greater and greater every day, I've got a lot I want to talk to you about, we'll just get right into it. To start, I wanted to have one of you, maybe Carol, you could start for us setting the scene and just tell us a bit about the story you were trying to tell in writing this book, and why is access to abortion so important?

[00:13:45] Carole: Well, the story we were trying to tell us what David and I have observed over many years, both of us being deeply involved in studying abortion in the United States. And it became so clear to us how extraordinary difficult it was in many states for people to literally get to an abortion clinic. We have for many years done a lot of work with abortion providers and we, it just became so clear to us that these people had to turn themselves into pretzels in order to make an abortion happen.

And this was so unlike every other aspect of healthcare in the United States, that one of our guiding principles in this book became quote, "abortion exceptionalism" the way abortion is unlike no other healthcare service in the United States, to the extent to which its legally regulated to the extent which is targeted by protestors and so on.

[00:14:46] Anna: Absolutely. And David, anything you want to add?

[00:14:48] David: I think because a lot of people up until this year, thought, well, abortion is legal in this country everywhere. And that may be changing later this year, we fear that it will, but that abortion is legal everywhere in this country. So what's the big deal.? And part of what we wanted to show is that just because something is legal, like abortion, doesn't mean everyone is able to get it to the extent that they need it.

Because the reality is there are so many to use the word from our title, there are so many obstacles that really abortion hostile states put in the face of someone who wants to get an abortion or needs to get an abortion, that it makes it almost impossible for people to get what is a legal right. And so we really wanted to lay out sort of that entire picture of all of the ways in which states burden someone's ability to get an abortion to show that just because something's legal doesn't mean everyone can access it.

[00:15:49] Anna: Absolutely. And you've laid it out beautifully. I mean, it was very disheartening and frustrating, uh, to just see you took us through, from the decision, to finding a clinic, to getting to the clinic, coming up with the money, waiting periods, counseling, the procedure, you took us through that whole journey and we'll get into some of that today, but it's just completely arduous.

And as you pointed out throughout the book, nothing is based in science or reason. Adding to the frustration of this situation. But I want to go over some just kind of basic facts about abortion real quick cause there's a lot of MIS and disinformation out there. So I want to ensure that we're all on the same page here.

So just kind of some rapid fire information I'd like to find out, how common abortion is, what are the demographics like for people who get them? Is it safe? And how long has abortion been around? And I can repeat those. But it's four little questions. I don't know, David, if you want to kick us off for this one.

[00:16:54] David: Sure. So, abortion is incredibly safe. It's one of the safest. Medical procedures that people can have. It is much safer than childbirth. It is safer than liposuction. It is safer than colonoscopy. Abortion is a very safe medical procedure that is regulated as if it's not it's regulated as if it is very dangerous, but it is not. You know, like I said, to start off. If you're talking about abortion and childbirth, childbirth is so much more dangerous for people...

[00:17:32] Carole: 14 times more likely to die in childbirth then having an abortion.

[00:17:37] David: Right. But we don't see the regulation of childbirth and the way, I mean, we, we don't want that. That's not what we're saying, but all the attention is paid on abortion, which is the safer of the two.

[00:17:48] Anna: Yeah, these restrictions are passed in the name of safety as well. That's always what they're citing when they're passing these laws. Aren't they? And what about, how common is it?

[00:18:00] Carole: The figure used to be one out of three women in the United States would have an abortion by the age of 45. More recently, the figure used is one out of four women.

[00:18:11] Anna: One out of four women. So quite common. And what about the demographics? What are the demographics like for people who get abortions?

[00:18:18] David: I think most important to the things that we're talking about is about half of the people who get abortions in the United States are at or below the poverty line. And the poverty line is set very low in the United States. And then another 25% are at the poverty line or up to 200% of the poverty line, which is still very low income.

So about 75% of the people who get abortions are poor or low income in the United States, which makes overcoming the obstacles that we talk about it incredibly difficult. Because for someone with means with someone, with resources, overcoming obstacles is just a matter of, well, not always, but often just a matter of throw more money at the problem. But when you don't have money to throw at a problem, that problem becomes really, almost impossible to hurdle.

[00:19:08] Carole: Another fact to say about the demographics is disproportionately people of color, black women, brown women, have abortions at much higher rates than their percentage in the us population.

[00:19:24] Anna: Yes. And when you consider that and the struggle for them to get an abortion, and then you look at, you know, you're just talking about the safety of pregnancy, us maternal mortality is the highest of any developed country. And the rate for Black women is three to four times higher than white women. So Black women are more likely to be denied abortion and more likely to die as a result of being forced to carry the pregnancy to term.

[00:19:50] Carole: That's exactly right.

[00:19:52] Anna: And another statistic of the demographics that I wanted to point out that I pulled from your book and elsewhere that I think a lot of people aren't aware of is that 60% of patients are already parents.

[00:20:06] Carole: If I could just say something about the parents. Um, I mean, it's significant in a variety of ways. I mean, one way that that fact really matters is often people say the reason they are having an abortion is because they fear they won't be able to adequately care for the children they have. Another way in which that fact is very relevant. It just makes getting to an abortion harder. David and I heard repeated stories of women, not able to arrange childcare, whole families driving to a clinic and the person getting the abortion, perhaps the adult who came with her or them, and the children in the backseat of the car sleeping in the clinic parking lot. So, I mean, the fact that so many abortion patients are already parents really has very significant implications

[00:21:00] Anna: Absolutely. And the last one with this set of questions is just how long has abortion been around?

[00:21:07] Carole: Since recorded, seriously, since we recorded history. One of the earliest medical textbooks we know that from approximately 2,500 BC, a Chinese medical textbook, has discussions of both contraception and abortion, and that tells you something. Literally there was no society for which we have any written record where abortion is not there.

[00:21:33] Anna: Yep. And that's another fact that I think is not well known in this conversation or definitely not brought up enough in this conversation. So, then what did the majority of Americans support in terms of access to abortion? Maybe

[00:21:47] David: The polls are very consistent that an overwhelming majority of Americans support some form of legal abortion and do not want Roe V Wade to be overturned. Now, when you start adding in specific issues around abortion and specific restrictions, the numbers change a little in terms of when and how, but the bottom line issue of legality, americans are consistently on board with abortion being legal. And that really hasn't changed in the decades that people have been studying it.

[00:22:22] Anna: All right, so, abortion is pretty common. It is very safe. It has been around forever. The people who get them are majority parents and, or living below the poverty line and not in a position to be able to afford to raise a child, and the majority of Americans support abortion. So where do all of the obstacles that we're about to get into come from?

[00:22:49] Carole: I mean, there's not one clear answer to that. However, for me the best answer, I mean, it really has two parts. The extraordinary affectiveness of a 50 year campaign by the anti-abortion movement to stigmatize abortion which means as David said, people support abortion. They don't necessarily talk about it or even necessarily vote on it. The fact, I mean, it's two different questions. Do you want Roe to remain. Yes. Is that one of the key issues that you vote on and for the anti-abortion movement, abortion is what they vote on. You cannot be a credible candidate really almost for any Republican office in the country, whether it's president, Senator, local state representative, local dog catcher, maybe going a bit too far, but, and people who support abortion don't necessarily see that as their key issue that helps explain the disparity. But the other thing to be said, which, you know, I've just indicated is abortion has been an extraordinarily important part of the Republican party, really ever since around 1980, when Ronald Reagan, became president and was supported by the anti-abortion movement.

So there's just huge resources from the Catholic church, from evangelical churches, from the Republican national committee. I mean, it is impossible to think about modern conservatism in the United States without the issue of abortion. Which leads to the interesting question, what's going to happen to the conservative once abortion is no longer there, you know? Well, bashing gays return, will critical race theory, will burning textbooks take the place. I'm not so sure. I mean, abortion has been uniquely uniquely effective for the conservative movement in the United States.

[00:24:52] David: And one other thing that I think is really important here is the role that gerrymandering plays in ensuring that the very conservative legislators who vote for these restrictions are not accountable to anyone but they're handpicked voters. And so the law in Texas, for instance, that has been making headlines for the past year, the civil bounty hunter law, is not popular in Texas, among the people of Texas.

But the legislators who vote for it know that that doesn't matter because they have carved out their legislative districts knowing that they are secure, despite the fact that most people in Texas don't like this law. And so when you have the power to decide who votes for you, you pick the people to vote for you who are anti-abortion and you draw those lines in a way that makes sure that it doesn't matter what the majority thinks.

[00:25:55] Anna: Hmm. Yeah, I think that's yet another thing that is not known in the mainstream is just how strategic this has been over more than four decades and still continues to be. And this was a longterm plan all along.

So let's get into some of these obstacles. There are way too many to go through in an hour, but do one of you want to walk us through, or whether it's hypothetical or even a real situation, that if we find ourselves wanting an abortion in say a Southern or Midwest, what might that look like?

[00:26:33] Carole: We can start with the decision. Somebody finds out they're pregnant and already you immediately see, you know, the abortion exceptionalism things kick in. Normally, uh, when you're making a decision, you consult people, you consult your friends, you consult your doctor, if it's a health issue, you of course consult your doctor. With the abortion everything is complicated now. Many doctors, not all but many doctors, well, first of all, the majority of doctors in this country, including obstetrician-gynecologist do not provide abortion. So you probably know you can't just go to your own doctor if you have one and not everybody does.

And you know, you could end up at a crisis pregnancy center, which we've written a lot about in the book. An institution that deliberately confuses people, purports to be an authentic abortion clinic, but you go in and it turns out they're anti-abortion and they're lying to how far along you are. Oh, you're too far along to get an abortion. Or they'll say, you know, you're not that pregnant yet, take a few weeks to think about, knowing full well you'll, you know, exceed the gestational limit and your stage. Some, I mean, there are cases of doctors, willfully withholding information refusing to give a referral.

To me one, even though I would have thought I would be beyond shock after so many years of studying this, truly one of the most shocking things I've ever confronted is a number of states, I believe Arizona was the first, passed a law saying if a doctor on an ultrasound see significant anomalies, but does not tell that to the patient because of the assumption that or suspicion that she might get an abortion, the doctor can't be sued. That's okay to do. In other words, laws are passed that basically say, you know what, it's okay to lie to you patient.

[00:28:35] Anna: Wow.

[00:28:36] Carole: So just deciding what to do, who you can talk to, what information you can get is already a problem.

[00:28:44] Anna: I definitely want to spend some time for a minute here on these crisis pregnancy centers, because I mean, honestly, what I kept thinking throughout your book is how all of it sounds completely made up. You know, if, if I didn't know better, I would think this was completely made up.

[00:28:59] Carole: we're actually not. We're actually novelist.

[00:29:02] Anna: Yeah. Yeah. And this is a, a horror book, I guess, but, um, yeah, these crisis pregnancy centers, which I just have some statistics here. So there are roughly 1,587 abortion clinics in the U S and over 3000 crisis pregnancy centers. So just about double the amount of these fake clinics. And I mean, legally wise, maybe David, you want to comment on this, but I've written from your book here that these clinics have more constitutional rights essentially than real clinics because states force real abortion clinics to tell their patients things that are medically false or unnecessary. And yet these fake clinics aren't required to give patients accurate information.

[00:29:49] David: Yeah, the Supreme court has it all backwards. They'd basically have said because real abortion clinics are providing medical care, the state is allowed to force them to say certain things as part of the informed consent process, because that's not about speech, that's about action. Whereas because these fake clinics are not providing medical care, they're just political arms of the anti-abortion movement, because they aren't providing medical care, the state cannot make them say anything, because that would be infringing on their free speech rights. So as I like to say, the real clinics have fake first amendment rights and the fake clinics have real first amendment rights and that's all backwards, but that's a sign of what this conservative Supreme court is doing, which is basically saying we are going to allow anti-abortion states to restrict abortion in all sorts of ways and maybe even ban abortion depending on what happens this summer, but we're going to tie the hands of the pro-choice states and not let them try to improve the lives of patients and provide them.

[00:31:02] Anna: So you have these crisis pregnancy centers that literally will come in, buy property sometimes right next to an existing abortion clinic, they name it something similar, you had an example in the book that was, you know, Denver's Women's Health might have a fake clinic, right next door that's Denver's Women's Help. And then inside they have nonmedical professionals wearing white coats and walking around acting like they're medical professionals and lying to their patient about their situations through misread ultrasounds, through their options is exactly as you're saying. And then in contrast to that, what are some things that legislators require real medical providers to say to their patients? And is any of it based in science?

[00:31:50] Carole: Number of states mandate that the provider tells the patient they are at higher risk of breast cancer. They won't be able to have children again if they want to, that they're higher risk of suicide. I mean, one of the most notorious is the so-called post-abortion syndrome that they'll be depressed and they'll regret it and they'll never recover.

I mean, all these things have been disproved. Oh, in some states, the provider or somebody who works at the clinic has to say you are about to terminate the life of a wholly unique living human being. Now for the most part, what providers have told us as, you know, patients just tune it out.

Sometimes the providers say, I am required to tell you this, this is not my belief. But sometimes understandably patients get very upset. I remember David and I were interviewing somebody in Texas and a provider and she said, you know, she was dutifully going through the list, you might get this, you might get that. And the patients start crying and saying, why you, if it's not true, why are you telling me this? I think that brings up an interesting point that, for scholars, for activists, there's a real line of demarcation, there's the abortion providing world. And then there's the world of the politicians who regulate. But for patients who come in, who perhaps are not, especially political who haven't thought much about abortion one way or another until they needed one, they don't make this distinction. So patients come to clinics angry at the providers inside, you know, why do you let those people protest here as, as if they're giving permission?

Why are you telling me I'm going to get breast cancer if you yourself say, you know, and that, that makes an already challenging job even harder. From my perspective, anybody who works in an abortion clinic should get a purple heart.

[00:33:54] Anna: Absolutely. I mean, they're literally risking their lives.

[00:33:58] Carole: That's right. You know, for your global visitors, a purple heart in the United States is a badge given to soldiers who've been particularly heroic under attack.

[00:34:10] Anna: I agree. And as you say it, it doesn't just undermine the doctor patient relationship, but creates a complete distrust in the government because they're saying this isn't true, but our state is requiring that I tell you this. So who do I believe my state or my doctor?

And then. And then when they've gone through all of this, making the decision, finding the clinic, getting to the clinic money, which, you know, we haven't even gotten into, but I know you said is, is the biggest barrier because as you laid out in the beginning, the majority of people who get them are in poverty. Then you get to the clinic and after they've gone through all of this, or maybe they have a waiting period as well, I have to wait three days, they come back, they get to the clinic and what the have to endure to simply walk from their car to the clinic door is unreal. And again, sounds completely made up. Someone in your book, described it as a circus, and I think that's kind of the best word for it.

And I've written out some things that I pulled that are real examples of what goes on and then feel free to add if you have any others, but there are stuffed animals and baby dolls hanging by their necks from trees. There are people dressed in biblically themed gowns and robes, there are people screaming into megaphones. There are children, there are people jumping in front of cars and refusing to move. And there are even people that take pictures and videos of these patients and post them online.

And of course, I mean, that's awful in all circumstances, but some of these patients are sexual assault survivors, as you point out in your book, rape results in over 32,000 pregnancies in the US every year. So these women are going through this circus, being yelled at, being threatened, just to simply get the healthcare that they need following their rape. So, yeah. Is there anything else that you would add to kind of paint the picture of what that's like, and then how can law enforcement not help?

[00:36:06] David: I mean, basically you have covered several things, but it's really just the imagination of the anti-abortion movement in front of a building where they don't want people going in. And so, you name it it's happened. In terms of just creating a visual and physical barrier and audible barrier to someone getting into a clinic.

You know, if it's one person sitting on the side of a sidewalk, praying the rosary quietly under their breath, patients might not notice it, even that that's a protest, there's someone who's out there who's angry about abortion. Right. But when you start talking about people starting to shout and yell and follow and larger numbers of people and signs and props like you're talking, like you described to start this off, it gets very intimidating and difficult for people to get into a clinic and that's the goal.

They aren't allowed to blockade. A federal law makes it illegal to blockade a clinic. So that's not allowed, although that still happens from time to time. But you know, the police are really hesitant to crack down on what anti-abortion protesters are doing in front of a clinic, because the police don't want to be charged with taking sides.

And so they give them a lot of leeway. And so what that does is create sometimes a circus like atmosphere in front of an abortion clinic, but not a fun circus, right. A really intimidating, physically difficult to move circus. So that patients look at the entrance and say, how am I going to get in there? Is it going to be too emotional for me to get in there? And so that's a really difficult moment for a patient. Now clinics have developed ways to try and make it easier. A lot of clinics use escorts that are volunteers who their job is to help people walk through the protestors. And these escorts, you know, they get up really early on Friday and Saturday mornings or whatever the clinics open.

And they are there with brightly colored vests and they basically say nice things to the patient. Don't listen to them. You're going to be fine. Isn't it a beautiful day otherwise, you know, those kinds of things, distract them so that as they're walking through this throng of protestors, the patient is focused on I'm going in to get medical care, safe, legal, medical care, and not all the horrible things the protesters are saying. And, you know, most patients get through not a problem. But for some patients it's really emotionally difficult. Other patients turn around, they come back some other time. And the anti-abortion movement has really made it so that they have this leeway in front of these clinics to all, but physically harass someone out of getting an abortion.

[00:38:55] Carole: In terms of patients being upset. I mean, David's right there range of reactions. Some people tune it out. Some people are upset until they get in, but sometimes people are really upset. And this came home to me actually, after David and I finished this book, I was visiting a clinic, one of the few clinics in the United States that actually does later abortions. Later abortions usually for when there's very serious fetal anomalies or the fetus can't survive. These are, as you might imagine, among the most tragic of all abortions and I mean, this patient very graciously allowed me to observe her abortion. She was, I think about maybe 28, 30 weeks pregnant, the fetus, you know, was not gonna survive. And so, they did the abortion. I mean, the people were very kind to her as you might imagine. And that, I mean, I think in general, abortion providers are kind, but there's special protocols in place for these very sad cases. Anyway, the abortion was done. And I remember the doctor saying, okay, you know, you can go now. And she said, I can't leave. She said, they're still there. I can't leave while they're there. I mean, it was just heartbreaking.

[00:40:14] Anna: Awful. I mean, awful on many levels. And one is even on a physical level, because you said in your book that people who experienced emotional stress immediately before medical procedure suffer from greater pain and risk of complications. So on top of the emotional and psychological toll this takes there's actual physical risk from this.

And you mentioned later abortions, and I do want to talk about that for a minute, because I know personally a good amount of people that say they support a woman's right to choose, but only up until a certain point. So I want to talk about, what is the reality of abortion later in pregnancy, who's getting these?

[00:40:57] Carole: Actually it's a variety. I mean, a lot of these as I've just suggested are pregnancies that just go horribly wrong. These are people who typically come to the clinic with a very supportive partner that these are people who've literally set up the crib already. I mean, and then digest get horrible news.

Either something is very wrong with the fetus or they themselves may have contracted a physical problem. For example, if you get cancer, and you need chemo, that's inconsistent with continuing a pregnancy. So, we have these very tragic cases. Sometimes, very young people who are typically victims of incest.

I mean, we, we have talked to providers, who've done abortions and 11 year olds, 12 year olds. You know, who didn't understand they were pregnant. I can remember a counselor telling me, asking the 12 year old girl, do you understand what happened to you? And, she said, no. I mean, she didn't even know why she was pregnant anyway.

So people like, I mean, very young patients like that. But also, I mean, it's not just incest victims. It's not just horribly wrong pregnancies. It's people who took a very long time to get the resources necessary for an abortion. So abortions that could have ideally, I mean, if abortion were in every community available, affordable, if Medicaid that's the program in the United States that pay us for poor women, they would have an abortion in the first trimester. By the time they find a place. By the time they get the money, by the time they go through all the waiting periods with some states, literally have 72 hour waiting period. By the time all this happens already much later. So some of these third trimester abortions, which is true, the American public as a whole does not support, some portion of these could happen much earlier. But having said that there's always going to be the need for these very late, very tragic abortions.

[00:43:10] David: But it is important to put the numbers in perspective. It's, you know, I think a lot of people think that later abortion happens all the time. And it's very common. I think it's 91% of abortions take place at 12 weeks or earlier, in the first trimester. And only 1% take place after 20 weeks, which we're not even talking about the end of the second trimester.

Later abortion, if you're thinking during the third trimester is just a sliver of 1%. We're talking a very small number in the United States every year. And you know, the reasons that Carol just offered are the reasons that people sometimes need abortion that late in pregnancy, but it's a small number of people, a really small number of people, but it's very important to those people. There is no doubt about it. I mean, for those people, that is their life, that is their health, that is their family and they need care. It's just that the numbers of them are.

[00:44:08] Carole: And I should say, I should add to that, that the anti-abortion movement has been extraordinarily effective and making people think that that's half of all abortions a few years ago, there was this so-called partial birth abortion phenomenon. Partial birth abortion as a made up term that exists nowhere in the literature.

It referred to a fairly rarely used technique, which was sort of a modification of the main second trimester procedure used. And I mean, just an excellent, effective, propaganda campaign. Republican senators would stand on the floor of Senate and they'd show posters of, of a baby with scissors at its neck. Ridiculous, untruthful propaganda, but tremendously effective led to some polls saying, you know, half of all abortions are in the third trimester, you know, which is of course nonsense. As David just said, we're talking 1%.

[00:45:10] Anna: in you see that still resonate in public opinion today that there's this exception of I support it, but not at the end. And it's because of all of this messaging and exactly as you say propaganda. So I think it's worth