2. COVID-19 and the Divided States of Abortion

Within the U.S., we have two countries — the states where lawmakers are neutral or supportive of abortion access, and the states where lawmakers have made it as difficult to get an abortion as possible. Today, we examine how the pandemic has widened this gap even further.

Guests:

• Dr. Meera Shah, Chief Medical Officer of Planned Parenthood Hudson Peconic and author of You’re the Only One I’ve Told

• Leah Coplon, certified nurse midwife and Program Director for Maine Family Planning

• Dr. Bhavik Kumar, Medical Director for Primary and Trans Care at Planned Parenthood Gulf Coast

Music by Lily Sloane, logo by Kate Ryan, episode photo by Robin Marty.

Do you have a story about abortion during the pandemic? I want to hear it! Email or send a voice memo to accesspodcast@protonmail.com. You can remain anonymous.

[Full transcript below photo]

Garnet Henderson [00:00:00] Welcome to ACCESS, a podcast about abortion. I'm your host, Garnet Henderson. 

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Garnet Henderson [00:00:38] Last week, you met Dr. Meera Shah, who guided us through what actually happens during an abortion. I heard from a lot of you that you were really surprised by some of the things you learned, and I think we have some more surprises in store today. I recorded that interview with Dr. Shah about a year ago. Remember, back when it was okay to shake hands and sit in a small room talking without masks on? So, it's safe to say that Dr. Shah's life as an abortion provider is very different than it was a year ago, just as all our lives look very different than they did last year. When the pandemic began, it became more challenging to access medical care, including abortion, everywhere. But in the United States, baseline access to abortion varies dramatically depending on where you live. In other words, it was already much harder to get an abortion in some states than in others. This is because certain states, mostly concentrated in the South and Midwest, have enacted dozens of anti-abortion laws over the past few decades, many of which, in isolation, don't seem like that big of a deal. Some abortion restrictions are obviously extreme. You might remember, for example, when several states passed laws last year that would ban abortion at six weeks. Not one of those laws is actually in effect, because they violate Supreme Court precedent. But because they would be the most restrictive abortion bans on the books if they were enforced, they got people's attention. Hollywood threatened to boycott the entire state of Georgia over it. There is no question that those laws would have catastrophic effects if they were enforced. But right now, today, there are other anti-abortion laws that have a much greater affect on people's lives. Laws you've probably never heard of. And that's because, honestly, they're boring. Like I said, a lot of abortion restrictions don't sound like much on their own, but they add up, and in total, they make it really hard to get an abortion, and really hard to be an abortion provider. We're left with two different countries, in a way: the states where lawmakers are supportive of abortion access, or at least pretty neutral, and the states where lawmakers have made it as difficult to get an abortion as they possibly can. Today, I want to show you how all these boring, under-the-radar abortion restrictions add up to be really consequential, and how the pandemic has widened this gulf between supportive and restrictive states even further. We're going to start in New York with Dr. Shah, who, as a reminder, is the chief medical officer of Planned Parenthood Hudson Peconic. New York is a state that is very supportive of abortion access, but it was also the state hardest hit by COVID-19 early on. 

Meera Shah [00:03:42] It all happened really quickly. Within the first few weeks March, we started to hear that cases were being diagnosed, people are being hospitalized. And in fact, New Rochelle, which is a town just north of New York City, became a hotspot for the virus. And that's actually where one of my health centers is. So we had to act fast. 

Garnet Henderson [00:04:04] The need for abortion doesn't just stop in a crisis. In fact, many experts predicted that COVID-19 would lead to an increase in demand for abortion services. Nearly 40 million people have lost their jobs. These people may have trouble accessing contraception, or might choose to end a pregnancy they would otherwise want because they can't afford to have a child right now. One report from the Guttmacher Institute found that one in three women say they've struggled to get birth control or have delayed reproductive health care during the pandemic. The survey found that Black, Latinx, queer and low income women have been disproportionately affected. 

Meera Shah [00:04:46] People of color, low income people were the first ones to lose their jobs, and their kids were at home, and people were losing their health insurance. So people were coming to the health centers because they were like, 'Well I don't know how long I'm going to have health insurance.' The disparities in health care were so great. They've always been great, unfortunately, but it became that much more apparent during the pandemic. 

Garnet Henderson [00:05:08] So Dr. Shah and her team raced to make as many services as possible available via telemedicine. 

Meera Shah [00:05:15] I think it was about 72 hours, 48, 72 hours. They rolled out an entire telehealth platform to deliver health care. It's probably the hardest I've ever worked, because not only did we have to make sure that the technology was up and running, but we had to make sure that our clinical protocols were adapted to be delivered in a remote fashion. 

Garnet Henderson [00:05:38] This included medication abortion. And if you haven't listened to our first episode, now would be a great time to go back and do that. We're gonna be talking a lot about medication abortion today, and that first episode has all the details about what it is and how it works. OK, so Dr. Shah was able to try something that was new for her health centers. They began offering some patients what's called a no-touch or no-test medication abortion. This is when a provider screens someone for medication abortion in a telehealth visit, with no in-person testing. All the major professional organizations in this area, like the American College of Obstetricians and Gynecologists and the National Abortion Federation, agree that this no-test protocol is a safe way to provide first trimester abortion care. But before the pandemic, it wasn't common in the U.S. Here's how it works. In order to be sure that medication abortion will be a safe and effective option, there are two most important pieces of information a provider needs. First, they need to know how pregnant their patient is. Second, they need to be confident that this person does not have an ectopic pregnancy. That's a pregnancy occurring outside the uterus. Traditionally, these two pieces of information are confirmed with an ultrasound. But the thing is, ultrasound isn't actually necessary in most cases. A provider can figure this stuff out via telehealth. Pregnancies are typically dated from the first day of a person's last menstrual period, which is a date that most menstruating people will either know or be able to look back at their calendar and figure out. Even if a provider were to do an ultrasound, they'd still be asking the patient the first day of their last menstrual period and usually dating the pregnancy based on that. So if someone can't recall that date within a reasonable margin of error, maybe because they have really irregular periods, or they were using a method of birth control that made their period go away, then they do need to come in for an ultrasound. Likewise, if a person is experiencing any symptoms like unusual abdominal pain or cramping, or they have other risk factors for ectopic pregnancy, they need an in-person exam. But as long as the provider is confident about these two things, after talking to the patient — number one, how pregnant they are and number two, no ectopic pregnancy — they ask some other screening questions, just like when prescribing any medication. And as long as everything checks out, they prescribe the pills, the patient comes to pick them up, takes them at home, and has a 24 hour number to call if they have any questions or concerns. 

Meera Shah [00:08:26] I mean, I had a patient who is an emergency responder working on the front lines, and she was sitting in her ambulance on her break and getting her care via telehealth. And we screened her for the medication abortion, and then the visit took about ten, fifteen minutes. And then she drove her ambulance to the health center to pick up the meds. And, you know, she was able to continue on her shift and continue helping answer emergency calls for a lot of sick COVID patients. So, you know, we've been able to see some literal heroes on the front linesw who also need healthcare. Which is really cool. 

Garnet Henderson [00:09:11] This no-test protocol is new in the U.S., but telemedicine abortion actually is not. Here's a little history. In 2008 in Iowa, Planned Parenthood debuted what's called a site-to-site telemedicine model. Researchers who reviewed this program found that medication abortion prescribed via telemedicine was just as safe as medication abortion prescribed in person. So now this model is used at Planned Parenthood affiliates in at least 10 states, as well as at independent clinics that are not affiliated with Planned Parenthood. To learn more about how site-to-site telemedicine works, I spoke with Leah Coplon. Leah is a certified nurse midwife and the program director at Maine Family Planning, which has really been a telemedicine pioneer. 

Leah Coplon [00:10:00] We actually, back in 2014, started a small pilot doing telehealth medication abortions, and there were just a handful of states doing them at that time. And we started in our most rural counties in the state and we did a model where patients would go to their local clinic, and we have 18 clinics around Maine, and they would go get everything they needed there in terms of ultrasound, any lab work, they would go through the informed consent and get all the instructions for a medication abortion, and then when it was time to actually swallow the pill, they would connect via telehealth with our physician who was at our main clinic in the Agusta site. And we did that for about one year as a pilot in these very rural counties. And then we expanded to all of our clinics statewide. So all 18 clinics in 2016. So in 2016, people in Maine could go to any of their local Maine Family Planning clinics, they could get everything they needed, and then connect via video conference with the physician, actually swallow the pill and then go home and do their medication abortion. 

Garnet Henderson [00:11:07] You might be thinking that this doesn't really sound like telemedicine, because it still involves going to a clinic in person. But here's the thing. 87% of U.S. counties have no abortion provider. And this shortage is particularly acute in rural areas. Most abortion providers actually travel between multiple locations, and in some cases across state lines to provide care to more people. A lot of clinics only have an abortion provider on site one or two days a week. So someone who needs an abortion not only has to get to a clinic, which could involve arranging travel, child care and time off work, they have to be able to get there on exactly the right day of the week. Site-to-site telemedicine alleviates some of these barriers by enabling providers to connect with patients across multiple locations all in one day. Since 2016, there has also been a study operated by an organization called Gynuity Health Projects, which mails abortion pills directly to patients. It's called the TelAbortion Study, and it started out in just five states, but is now operating in 13 states and in Washington, D.C.. Now, you'll remember from last time that the FDA-approved protocol for medication abortion involves two pills. Mifepristone, which blocks the hormone progesterone, and misoprostol, which causes the expulsion of the pregnancy. They're often called mife and miso for short. Mife is regulated under an FDA program called REMS, Risk Evaluation and Mitigation Strategies. Among other requirements, this means that mife normally has to be dispensed directly to the patient in a doctor's office or clinic. But Gynuity has a special waiver from the FDA, allowing them to mail pills. Maine Family Planning is a provider in the Gynuity study, so in addition to their own site-to-site telemedicine program, they can mail pills to patients who are eligible for the TelAbortion study. 

Leah Coplon [00:13:14] We joined the Genuity study in 2017 and started also providing medications by mail to Mainers at that time. And then the following year, in 2018, we added New York as a site. So we were able to mail medications to folks in New York. One thing that has changed dramatically, even before the pandemic, was Maine did have a law on the books that required only physicians to provide abortions. But last fall, in September, that law fell and it meant that nurse practitioners, nurse midwives, physician assistants could now provide abortions. 

Garnet Henderson [00:13:52] This is one of those state law barriers, and it's actually more common than almost any other. 32 states have laws like that one Maine used to have, which say only physicians can perform abortions, including medication abortion. Seven more states say that advanced practice clinicians, or APCs, like certified nurse midwives, nurse practitioners, and physician assistants, can offer medication abortion, but not procedural abortion, like aspiration abortion or D&E. This is despite plenty of evidence that APCs can safely perform abortions. Medication abortion, in particular, is just prescribing a pill, which APCs do all the time. Physician-only laws limit the pool of abortion providers even further, because particularly in underserved areas, a lot of the health care providers are APCs. Maine is one of a handful of states in which abortion law has become more progressive over the last few years, and the repeal of this one law alone had a huge impact. 

Leah Coplon [00:14:58] So actually, our telehealth program kind of dissolved a little bit at that time, because we didn't really need it anymore. We didn't need patients to connect with a physician, the nurse practitioner at their local clinic just provided the abortion. But lo and behold, then the pandemic came and we went back to telehealth abortions, which we're doing almost exclusively right now. That's mostly what people want. 

Garnet Henderson [00:15:22] We're mostly talking about state laws that are barriers to abortion access today. But I do want to say a little more about REMS, this FDA policy, because it's one of the biggest impediments to medication abortion access nationwide. And it's particularly relevant right now, during the pandemic. You might have seen recent headlines proclaiming that the abortion pill can now be delivered by mail. This is because in July, the ACLU won an injunction blocking that requirement that doctors dispense mife to patients in person. So, problem solved, right? Unfortunately, it's not so simple. First, the Trump administration is challenging this ruling. It could be overturned at any moment. Second, it's time limited. The injunction will expire when the pandemic is over. And finally, the other REMS requirements are still in place. So physicians still have to be registered with the drug manufacturer and stock mife in their office, which is expensive. You still can't get it in a pharmacy. There are also dozens of state laws that make mailing the abortion pill either illegal or questionable, regardless of federal policy. Outside of the TelAbortion study, many providers who weren't mailing pills before the pandemic are still trying to figure out what they can and can't do. I spoke with Leah before the REMS injunction, but when I followed up with her more recently, she did tell me that Maine Family Planning has begun mailing pills to patients in Maine through their own telemedicine program in addition to the TelAbortion study. Dr. Shah told me that her health centers in New York are still looking into it. Telemedicine, even when the pills can be delivered by mail, is not a magic wand. For one thing, some people will always need or want an in-clinic abortion. For another, access to telemedicine is a privilege. It requires an Internet connection, a computer or smartphone, and often the ability to read in English. It's just not accessible to everyone. But especially during the pandemic, what it has done is enable more people to stay at home, and this makes things safer for everyone. And Leah says it's given abortion providers an opportunity to provide care that is even more patient-centered. 

Leah Coplon [00:17:50] Patients certainly can choose to still have an aspiration abortion with us if they'd like. They absolutely can have an ultrasound if they prefer. But what we're finding is that most people are quite comfortable doing an abortion without an ultrasound. They know how far along they are, again, and, you know, they don't feel the need for an ultrasound for us to be able to tell them, yes, you're exactly as pregnant as you thought you were. So that that's been the thing that's been really interesting to me is to realize how much that ultrasound was our need and not necessarily patients' need. 

Garnet Henderson [00:18:22] So because they practice in supportive states, Leah and Dr. Shah have had the flexibility during the pandemic to innovate and do what they can to make it easier for their patients to get abortions. But what about providers in those other states where it was already much harder to get an abortion? We're diving into that next. 

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Bhavik Kumar [00:19:14] I never imagined or thought this would be the time when the government of Texas would make an effort to essentially ban access to abortion as the pandemic was starting, let alone the sort of rollercoaster of, you know, open, close that ended up happening over the few weeks after the executive order was issued. 

Garnet Henderson [00:19:36] That is Dr. Bhavik Kumar. He is the national medical spokesperson for the Planned Parenthood Federation of America, the medical director for primary and trans Care at Planned Parenthood Gulf Coast, and a staff physician at Planned Parenthood Center for Choice, both of which are in Houston, Texas. So back in March, things looked very different in Texas than they did in New York or Maine. On March 22nd, Texas Governor Greg Abbott issued an executive order banning non-essential medical procedures. This wasn't that unusual. It happened in a lot of states. But what was different in Texas was that the order included all abortions except those necessary to preserve the health or life of a pregnant person. Providers were warned that if they violated the order, they could face fines of up to $1,000 or 180 days in jail. A group of abortion providers, represented by the Center for Reproductive Rights, quickly sued to block the ban. They argued that abortion is time sensitive and essential. First, they succeeded. A federal district court judge granted a temporary restraining order blocking enforcement of the abortion ban. But then, the Fifth Circuit Court of Appeals stayed and eventually overturned that restraining order, siding with the state of Texas. No abortions. Next, the district court judge issued another, more narrow restraining order, allowing medication abortions and abortions for people who would be past the gestational age limit in Texas if they were forced to wait until the ban expired. The Fifth Circuit narrowed that order further, blocking medication abortion, but still allowing abortions for people who were close to the gestational limit. But then the Fifth Circuit reversed itself, allowing medication abortions to go ahead. And then the Fifth Circuit reversed itself again, allowing Texas to ban nearly all abortions. Finally, and somewhat anticlimactically, on April 21st, Governor Abbott's order expired and abortion providers were able to resume normal operations the next day. Are you confused? Because I certainly was. As a journalist, I've never seen anything quite like this. And Dr. Kumar says he hasn't either. 

Bhavik Kumar [00:21:58] No, it's never happened in my career. It's never happened to any of my colleagues that I've talked to. Those of us who provide abortions and are in this work in some capacity, we know a lot about the world of abortion access when things weren't legal. We talk about the pre-Roe days, and a lot of my mentors who provided medicine talked about it at that time when abortion wasn't legal and the things that they had to do. And I never thought I would see that in my lifetime, right? And so to be faced with the reality that, ok, now for some unknown amount of time, abortion is going to be unavailable for people in the state and they'll have to travel out of state. And so many of the things that I had heard happened before Roe were starting to happen in Texas. And so it was just very surprising, very traumatic is the word that I would use, for me and for other providers because we were facing, you know, if we decided to move forward and help our patients with the care that they needed, the consequences were, you know, a fine, six months in jail, and potentially losing our license. And so it's unfathomable to think that all of those things could happen because I'm providing health care for people that need it. And then, you know, on the other side,  there's people that are coming to us and saying that they need help, that they can't be pregnant, and are expecting us to help them. And that's what we do. And so, again, I think it was traumatic for patients as well because we didn't have answers for them, right? The options at the time were, we're not sure where we're going to open again, if we'll be able to open. And the other thing you can consider is traveling out of state at a time when we were in the early stages of the pandemic, advice was from health experts to not travel, especially not travel hundreds of miles to another state. And then folks that are accessing abortion are already facing so many barriers, like trying to find child care, time off work if they have a job, and navigating all of that on top of having to travel hundreds of miles just didn't make any sense. 

Garnet Henderson [00:24:05] Other states — Oklahoma, Alaska, Arkansas, Louisiana, Mississippi, Alabama, Tennessee, West Virginia, Ohio and Iowa — also attempted to temporarily ban abortion around the same time. Most of these bans were blocked pretty quickly, though arkansas did manage to enforce a rule requiring that patients have a negative COVID-19 test no more than 48 hours before having an in-clinic abortion, when virtually no facilities in the state were willing or able to do that testing. But nowhere did clinics open, and close, and open, and close as many times as they did in Texas. And this created a huge amount of confusion. 

Bhavik Kumar [00:24:49] At that time we opened and closed a total of eight times, so. 

Garnet Henderson [00:24:53] Eight times? 

Bhavik Kumar [00:24:53] Eight times, exactly. So a number of patients were really just strung back and forth and left with a lot of confusion. There's one patient in particular that I remember, and I saw this patient right before the executive order was issued. And unfortunately, this patient had to come into the health center a total of five times. And the first time I saw her, you know, I think we connected over... I don't remember if it was a mask or if it was a hat, but there was just something that they were wearing. We were just talking about it. You know, I knew that I was going to see her the next day, but that was the first time that we had to shut down the health center. And then the next time the patient was able to make it back, I think she was like in the process of signing consent forms. And again, we had to shut down, and I just felt so bad. And then again, there was another time she was in the health center, and she made a little bit further along. I think she was in triage and it was, you know, noon. I thought, OK, great. Like she's maybe like minutes away from getting to the procedure room where we can do the procedure. And unfortunately, they shut down, made us shut down again. And I just thought, oh, my gosh, there's no way like, she's she's right there. They're just minutes away. Can we just do this one procedure? I felt so bad for her. She was really understanding, but very distraught and upset. And of course, that stays in your mind. Like, I can help her. We have the staff. We have the know-how. And I just remember feeling so frustrated and apologetic about what was happening. And she knew it wasn't our fault, but she was also so frustrated. And when she was finally able to make it back, it was a great moment just because finally she got the care she needs. She felt relief. And I just kept thinking about what she had to go through, having to come into the health center five times during a pandemic. And, you know, some of those times she had a ride who was waiting for her. And so that person was also being brought on this unnecessary rollercoaster. And that story just sticks with me, because I want to make sure I remember that and how awful that was and and to what lengths the government of Texas went to in order to make it so difficult, but also reminds me of how resilient people are and how dedicated they are to getting the care that they know they need. 

Garnet Henderson [00:27:03] Dr. Kumar said that for up to two months after his clinic was able to reopen, he was still seeing patients who had been forced to wait for abortions. In fact, in the three weeks after the ban expired, providers across Texas reported a significant increase in the number of patients who needed abortions later in pregnancy. The Planned Parenthood Center for Choice, where Dr. Kumar works, saw a 28 percent increase in abortions after 10 weeks. At Southwestern Women's Surgery Center in Dallas, there was a 57 percent jump in second trimester abortions. Requiring people to delay abortions like this forced them to stay pregnant when they didn't want to be. And it took away some of their choices. Remember, medication abortion is only FDA-approved for up to 10 weeks pregnancy, and Texas law requires abortion providers to follow that protocol to the letter. So anyone who was forced to wait until after 10 weeks was forced into having an in-clinic procedure. During a pandemic. And once you get into the second trimester, abortions are more expensive, and there are fewer places you can go to get one. On top of all that, abortion clinics in Colorado, New Mexico, Nevada, and Alabama reported an influx of patients from Texas in March and April. So this ban cut off abortion access for some people. And it really did drive others to travel across state lines at a time when, for everyone's safety, they should have been able to stay close to home. But clinics in Texas are open again, and the pandemic isn't over. So can Dr. Kumar give his patients the opportunity to stay home and have a no-test medication abortion? Not so fast. 

Bhavik Kumar [00:28:52] Providing abortion care in Texas, I always see confusion among patients, right. Because there's so many things that we have to navigate. There's so many things that we have to say that the state makes us say, and then we follow it up with more up to date evidence. Sometimes patients will ask me something, is this an option? My friend who lives in perhaps another state was able to access their abortion in this way. Was that an option for me? And so then I have to explain what the laws are here and how medically, those things probably are an option for them, but because we live in Texas, we're not able to do those things. 

Garnet Henderson [00:29:25] For starters, Texas is one of 18 states that outlaws telemedicine abortion. You have no choice but to see a doctor face-to-face. It is also one of 26 states that requires an ultrasound. And not only that, Texas has a mandatory delay of 24 hours after the ultrasound. So visit number one, you have to go to a clinic in person, have your ultrasound, and listen to the provider recite a state-mandated script that includes medically inaccurate information. That's what Dr. Kumar is talking about when he says the state makes him say certain things. Then you have to wait at least 24 hours and come back for a second visit to actually have the abortion. And, the doctor who does your ultrasound and reads you the script has to be the same one to do the procedure or give you the medication. So you better hope you have time in your schedule to get to the clinic on two days when the same doctor is there. And there are extra rules for medication abortion. 

Bhavik Kumar [00:30:27] Texas is one of the most restrictive states in the country when it comes to medication abortion. There is a number of provisions, but the main one that we have to follow, in addition to a ban on telemedicine for abortion specifically, is that Texas law requires you have to follow an outdated FDA protocol. And that requires that the person who is receiving the medication abortion, is here in person and that the physician is dispensing the medication directly to the patient. It also requires that they come back for a follow up visit. And that has to be in person. It has to be between seven and 14 days. All of those things are medically unnecessary. 

Garnet Henderson [00:31:10] Requiring doctors to follow the FDA guidelines might sound reasonable. After all, the FDA is the agency we rely on to tell us that prescription drugs are safe. But this recommendation for an in-person follow up is yet another FDA protocol that experts consider to be outdated. As you heard in the last episode, it is totally acceptable and safe for patients to take a home pregnancy test to confirm that their abortion worked and have their follow up via telehealth. Doctors in most states are free to do this, because unlike the REMS requirements, this in-person follow up thing is just a guideline. Except, that is, in Texas, Ohio and North Dakota, where state law says the FDA guidelines must be followed exactly. All in all, it takes three visits to a clinic to get a medication abortion in Texas. One for the ultrasound and counseling, one to get the pills, and one for a follow up. All while people in other states are safely receiving no-test medication abortions, never stepping farther into a clinic than maybe the front desk. This is what I meant when I said that when it comes to abortion access, we have two different countries within the United States. 

Bhavik Kumar [00:32:28] When abortion is in the news, you know, if there's some law, if there's any sort of notion that clinics are closing, health centers are not open, what I find in conversations with patients is that it just adds to the stigma. It's really difficult for a lot of folks who are living their everyday lives to keep up with what's happening with abortion access until they find themselves in a situation where they need access. And they may remember they saw something on the news, and they're not quite sure what it means. But their main concern, and I hear this from my patients all the time, is, can I still get an abortion? 

Garnet Henderson [00:33:04] Everyone I spoke with for today's episode pointed out that people seeking abortions are more likely to be people of color and more likely to be poor or low income. These marginalized communities bear the brunt of all abortion restrictions. And they've also been the hardest hit by the pandemic. 

Bhavik Kumar [00:33:21] And I think, you know, for the folks that are listening, just thinking about how much longer this pandemic is going to last and not knowing what the future holds, I think it's certainly possible that things could get worse. And again, it's those communities and those people that will feel the consequences of that in a more profound way. And I think that's just important for folks that value access to abortion to keep in mind. 

Garnet Henderson [00:33:44] One of the reasons why anti-abortion lawmakers have thrown so many excessive regulations at medication abortion is because it has the potential to change everything. Imagine if any doctor could just write you a prescription for the abortion pill and you could go pick it up in a pharmacy. You could just get an abortion from your family doctor. No need to jump through any of the hoops you've heard about today. Weirdly enough, the pandemic has gotten us closer to that than ever before, but only in some states. The other thing about medication abortion? Just like everything else, you can find those pills on the internet. And that's what we're talking about next week. It's called self-managed abortion, when people get the pills and do their own abortions outside a medical setting. So, I hope you'll join us to learn more about that. One more thing before we go. Do you have a story about abortion during the pandemic? I want to hear it and I may use it in a future episode. So whether you had an abortion or maybe you work in a clinic or as a clinic escort, I want to hear about your experiences during the pandemic. You can email me or send a voice memo to accesspodcast@protonmail.com. I'll also drop that in the show notes. You can remain anonymous if you want, and if you're worried about security, you can make a proton mail account, which is free, and your message will be fully encrypted end to end. 

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Garnet Henderson [00:35:27] ACCESS is produced by me, Garnet Henderson. Our music is by Lily Sloane and our logo is by Kate Ryan. Many thanks to today's guests as well as to Dr. Daniel Grossman. You can subscribe to ACCESS wherever you get your podcasts and follow us on Instagram and Twitter @accesspod. A full transcript of this episode is available on our website, apodcastaboutabortion.com. This is a fully independent production, and if you're able to support the show, it would make a huge difference. You can contribute by visiting glow.fm/apodcastaboutabortion. That's also linked in the show notes. You can also really help out by leaving a rating or review, and please, share the show with your friends. Thanks and see you next time. 

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