BONUS. Dr. Meera Shah on Storytelling to Combat Stigma

Dr. Meera Shah, guest from episodes 1 and 2, speaks with Garnet about the process behind her book, You’re The Only One I’ve Told, how her work has changed the conversation about abortion within her family, and what’s ahead after the confirmation of Amy Coney Barrett to the Supreme Court.

This conversation was originally streamed as part of the EstroGenius Festival on October 24, 2020.

Music by Lily Sloane, logo by Kate Ryan.

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Garnet Henderson [00:00:01] Hey, everybody, before we get started today, I just want to remind you that ACCESS is an independent production. We rely on listener support. And it's really easy to make a one time or monthly contribution to help support the show. You can do that by visiting glow.fm/apodcastaboutabortion. And that'll be linked in the show notes as well. 

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Garnet Henderson [00:00:55] Welcome to ACCESS, a podcast about abortion. I'm your host, Garnet Henderson. And today I'm bringing you a bonus conversation with Dr. Meera Shah. You'll remember Dr. Shah from our first and second episodes. She's the chief medical officer of Planned Parenthood Hudson Peconic, and she's also the author of a book called You're the Only One I've Told: The Stories Behind Abortion. Dr. Shah and I had a conversation as part of the EstroGenius Festival, which normally happens here in New York, but this year happened online. We talked about the process behind her book, which consists entirely of first person abortion stories as told to Dr. Shah. And she had a lot of really interesting things to say about how storytelling can combat abortion stigma and how her work has really changed the conversations around abortion, even within her own family. So first, I want to thank the people who attended the event, and thank EstroGenius for having us. And I wanted to make the full conversation available to everyone who wasn't able to attend. Now, one note here, which is that the conversation was recorded last week. So Dr. Shah and I do speak briefly about the confirmation of Judge Amy Coney Barrett to the Supreme Court as a hypothetical. Of course, that is now a reality. I am recording this on Tuesday, and Judge Barrett was confirmed to the Supreme Court yesterday. So today has been a really somber day for people who work in abortion access and for people who've had abortions, which, as you know, if you've listened to previous episodes of this podcast, is a lot of people. But I think that Dr. Shah's points about abortion stigma and how important it is to shift the way we talk about abortion are more relevant now than ever. So I'm excited for you to hear what she had to say. 

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Garnet Henderson [00:03:24] Dr. Shah, thank you so much for joining us today. 

Dr. Meera Shah [00:03:27] Thank you so much for having me. I'm excited to be here. 

Garnet Henderson [00:03:30] Great. So I know that you're a family medicine physician. You provide abortion care as part of a large spectrum of care that you offer to your patients. So could you just start by telling us a little bit more about the kind of work that you do? 

Dr. Meera Shah [00:03:43] Yeah. So I am a board-certified family medicine physician, but I specialize in sexual and reproductive health care. So I provide prenatal care, abortion care, contraceptive care, I do cervical cancer screening, breast cancer screening. I also provide vasectomies, as well as hormone therapy for the transgender community, and HIV prevention services such as PREP and PEP. And we're about to launch the rapid initiation of ART, which means that on the same day that an individual is diagnosed with HIV with the rapid test, we will initiate antiretrovirals that very same day. So I provide the full gamut of services. And, you know, and we keep up with science. So as things evolve, as things change, we are very quick to adapt our protocols to make sure that we're providing the most evidence based, patient-centered care. 

Garnet Henderson [00:04:46] Great. And did you enter medical school knowing that this was the kind of doctor you wanted to become? 

Dr. Meera Shah [00:04:52] Absolutely not. I always knew that I was going to work in public health and work in social justice, but I didn't know what that would look like until I became a resident. And I had an incredible mentor who really introduced this idea that abortion is normal. I was just so intrigued by how she worked so hard in her career and in her practice and in her teaching to normalize abortion, just portray it as, you know, this is something that can be offered in an outpatient setting. And, as you know, just as good of an option as someone who chooses to continue a pregnancy and become a parent. She really set an example for me in my career. And I was just also so intrigued that politicians are constantly trying to prevent access to such an important and vital service. And so not only do I provide direct patient care, I also advocate for my patients at a state and national level in any way that I can, whether it be advocating for certain policy or speaking out and trying to decrease stigma around abortion and sexual health. 

Garnet Henderson [00:06:25] And what kind of attitudes around abortion were you exposed to growing up? 

Dr. Meera Shah [00:06:31] So great question. I grew up in South Carolina. I am the daughter of Indian immigrants. I, we didn't talk about sexual reproductive health. We didn't talk about sex. I come from a family of physicians. But because of my culture, that just is not something that we talked about. And it wasn't until I started doing this work and started becoming more open about it that I introduced the exact nature of the work that I do to my parents. And because I presented it with such confidence. And I have a really good relationship with my parents and they they trust me. And it was actually a really smooth introduction to my day-to-day. They were really accepting and open, and through storytelling, I've been able to really gain their support. So. I care for people from the Indian community. One of my health and one of my health centers is located in Long Island and there's a large Indian community in that area. And they come to see me because I speak their language. You know it started out as one or two patients, but then word got out. And, you know, any time I care for somebody who is of Indian descent or somebody who's Gujarati-speaking, I tell my mom and my mom just is like, oh, my gosh, Indian people have abortions. And I'm like, yes, mom, Indian people have abortions. And just this, you know, it it was something she could relate to. Something she could identify with. And now she's... I don't mean to suggest that she wasn't in support of abortion access before, but now more than ever, she is, you know, a little activist in her own right. And she talks about it. She talks about it with her girlfriends. She read my book. And so I truly believe that through storytelling, we can change the narrative around around abortion. 

Garnet Henderson [00:08:38] And so, speaking of storytelling, you have a new book out. So tell me a little bit about the book and what made you want to write a book about abortion. 

Dr. Meera Shah [00:08:48] So, you know, I've always loved reading and writing. And this is something that I've wanted to do for a really long time, is to is to just be a more consistent writer about things that I believe in, things that I know that the topics that I work on in my daily practice. So I really, just a few years ago started to put pen to paper and and started to write. And I also felt that my work was really misunderstood, even among, you know, my social networks. I surround myself by a lot of smart people who claim to be progressive and vote a certain way. But they also just didn't know much about abortion or would, you know, kind of unknowingly use stigmatizing language around abortion. Like, "Abortion shouldn't be used as birth control. But I believe in abortion." Or, you know, and a lot of that stems from from myths or, you know, stigmatizing headlines or just not really understanding, you know, some of the sexual reproductive health at a deeper level. And so I wanted to change this. And, you know, and I, and so I started to write stories. And I made a really deliberate effort to to highlight the stories of a diverse group of individuals. Because I hear often that, you know, that, you know, young people are the ones who get abortions or, you know, people just straight up ask me, what does your typical... Who gets abortions? What does it look like? And my answer is always the same—everyone. And so I try to make that clear in my book by highlighting just the diverse makeup of people who get abortions or who are impacted by, you know, a loved one having an abortion. 

Garnet Henderson [00:11:03] Yeah. I mean, that's exactly why I wanted to create the podcast, right? Because I found the same thing in reporting on reproductive health and abortion access specifically. Well, first of all, but those two things are often very separate. Like, there's the rest of reproductive health, and then there is abortion. And it's something that people just don't want to talk about, including people who consider themselves supportive of the right for someone to get an abortion. Because, you know, abortion is constantly in the news, it seems, except so often we're talking about it without really talking about it. And in particular, there's often just a big flurry of attention, especially when a really restrictive law is passed or enacted. But so often we're not connecting policy to people and talking about how those laws, those bans actually affect people's lives. And that is why I think personal stories are so powerful. But it can be really difficult for people to tell those personal stories because of abortion stigma, because they're worried about their family, other people they know finding out, they're worried about harassment and threats, because that is also a serious problem. So tell me a little bit about how you went about connecting with the people whose stories are featured in your book, because it is all personal stories. So tell me a little bit about how you found those people and what your conversations with them were like. 

Dr. Meera Shah [00:12:37] Yeah. So none of the storytellers were my patients. One individual was, but by the time I interviewed her, she'd actually become a colleague. And so I most of the people in the book are people who just kind of organically told me their story. And then I went back to them maybe a few years later to say, you know, I remember a few years ago you shared your story with me. Would it be OK if I did a more in-depth interview with you and included your story in the book? And everyone pretty much said yes. I also had colleagues connect me to people who they knew who were interested in sharing their stories, or friends who connected me. It just, I mean, I ended up having more stories than I was able to fit on the page, as I did have a word limit. But I really did get an overwhelming amount of interest in sharing stories. And I really wanted to address all the different sort of tangential stories and topics around abortion, too, like later abortion, self-managed abortion and and, you know, get at who are these people? And like, you know, let's let's stop talking about abortion as like this this thing that happened to them in isolation. Let's let's talk about all of the intersections of that human being and what makes them them. And then what I found those that and not surprisingly, that that each story was layered also by political interference. Right. So, like there is this each story was littered by like restrictions and laws and rules. And and so it can't just be, unfortunately, you know, at this point in time, your abortion story can't just be about like your individual experiences, the human being. It has to be about like the setting in which you're in. And so I wanted to highlight that, too, to make the point that there's so much interference. That the politicians are basically in my exam room, even though I practice in New York. There's certain things that I have to do that, you know, that don't make sense. But I have to in order to comply with the law. 

Garnet Henderson [00:15:01] Yeah. Can you give just one or two examples of things like that, that you would not necessarily choose to do as a physician, but that you have to do because it's required? 

Dr. Meera Shah [00:15:11] Yes. So, you know, for example, in the electronic medical record, there's a there's a federal law that requires that we have to write exactly the technique that we would use or not use for that abortion. So, like, you know, it's part of something that stems from the partial-birth abortion ban. Where I have to say, you know, that I use a certain technique or I didn't use this certain technique in order to do that abortion. OK. I mean there's really no point. There's there's no point to that, right. There is also I fly to Indiana once a month to provide abortion care. And I have to read a script to the patients that say that, you know, abortion can cause mental health issues. Well, that's not true. Yes, abortion is a life event. And so in that sense, you know, like buying a house, having a child, having an abortion. Things that are like big deals in people's lives that can trigger emotion, you know, experiencing a death in the family, like, yes, it's a life event that can, you know, have a downstream effect in terms of the way an individual processes it. But it doesn't consistently cause anxiety, depression, PTSD, as the anti-abortion folks say. Yet I have to say that to every single patient. Or in Texas, I have to say that abortion causes breast cancer, which is not true. There are a lot of things that I have to do that that don't make sense or not medically indicated aren't magnetically sound. But in order to comply with the law, you have to do it anyway. 

Garnet Henderson [00:17:03] Right. And to your point about partial-birth abortion, in case anybody doesn't know this, that is a federal law that George W. Bush signed into law. It was vetoed by Bill Clinton. And partial-birth abortion is not a medical term. And so that law caused problems because it was passed and then signed into law by the president. But it doesn't actually have a specific medical meaning. So it was not exactly clear what is being banned. So when you say that, you have to say, I did not do a partial-birth abortion, that's... a partial-birth abortion is not a thing that you would do. 

Dr. Meera Shah [00:17:46] Right. It's it's not a thing. Such as late-term abortion. That's also not a thing. That's something that the anti-abortion folks made up. It's not a medical term. You wouldn't find it in any sort of medical textbook at all. It's just stigmatizing language. It's actually really triggering. I mean, that phrase, partial-birth abortion. Yeah. That triggers emotion. And it gets people listening. So for other reasons, it you know, it brings about attention. But for medical purposes, it's it's just it's just a waste of time. 

Garnet Henderson [00:18:20] Right. And so the first episode of the podcast, which people are going to hear after our conversation, features you explaining what actually happens during the most common abortion procedures. And the reason I wanted that to be the first episode of the podcast is because a lot of people really have no idea unless they've actually had an abortion, how it really works. And so I wanted to include that. And I'm wondering if there are some really common misconceptions about abortion that you tend to hear from your patients when they're coming in. 

Dr. Meera Shah [00:18:56] Yeah, well, one of the biggest things right here is just. It's almost like I mean, they don't have to say it, but I know that what they're thinking is that, you know, they feel really bad or they feel alone in their experience. So the underlying message there is that it's not common. And so what I do immediately is let them know that what they're experiencing is very normal. It's very common. One out of four women in the United States have an abortion in her lifetime. And I literally see their shoulders drop and a sigh that like, oh, my gosh, really? Like that many? And the reason that they don't know is because people just aren't talking about it. That abortion is dangerous when in fact, it's the safest medical one of the safest medical procedures that we do. That abortion will affect future fertility. When, in fact, the truth is that it does not impact future fertility. So, yeah. These are the things that I that I hear and that I'm constantly, constantly correcting and telling people the truth about. 

Garnet Henderson [00:20:06] An abortion has been a topic in this presidential campaign, as it sort of always is. And it's also on a lot of people's minds because of the nomination of Amy Coney Barrett to the Supreme Court, a judge who is thought to be someone who will vote to overturn Roe v. Wade, or at least further limit abortion access. So I'm wondering if you ever hear anxieties about those political events from your patients. Do people ever come in worried that this is a right that they're going to lose? 

Dr. Meera Shah [00:20:42] Yes. I mean if not from patients, definitely from colleagues, from friends, just the communities that I that I'm you know, that I work in, that I specialize in. Yes. There's  a lot of anxiety around this because if she becomes the next judge, and she sits on the Supreme Court, that'll make the Supreme Court with a conservative majority, six to three. And yes, she would have a big hand in potentially reversing Roe v. Wade, which would then cause trigger laws to be put in place... to become activated. Which means that in many, many conservative states, abortion would automatically become a crime. Whereas in states like New York, which is progressive, abortion has been codified in the health law. So it's viewed as a as a health care service. So it would be protected in places like New York. And what we would probably see happen are two is twofold. One, we may we would probably see an increase in people having to travel further distances than they already are having to travel to places like New York to get abortion care. But then again, only rich, likely white people would be able to do this. So it would worsen health disparities that already exist. So low-income Black and brown people would be pushed further to the margins and would be, you know, unable to access abortion care. And then there would be an increase in people having to access their pills online and manage their abortions at home. So it's a really scary thought to see, you know, to think about what could what could happen and what's in our future. But we're gearing up for the fight. 

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Garnet Henderson [00:23:13] Once more, thanks to the EstroGenius Festival for having us. Thanks to Dr. Shah for speaking with me again. And thank you to you all of the listeners of ACCESS. I really appreciate you. Don't forget to subscribe wherever you get your podcasts, share the show with your friends. Visit our page. glow.fm/apodcastaboutabortion to give if you're able. Leave us a rating or review, those things do really make a big difference. And follow us on Instagram and Twitter @accesspod. We are going to be back in a few weeks with our next episode, which is about clinic harassment and protesters during the pandemic. So I hope you tune in for that. See you then.