Original subtitles

- [Sarah] Mr. Chief Justice, and may it please, the court,

we are not here to advocate abortion.

We do not ask this court to rule that abortion is good

or desirable in any particular situation.

We are here to advocate that the decision

as to whether or not a particular woman

will continue to carry or will terminate a pregnancy

is a decision that should be made by that individual.

- [Justice Burger] But any doctor,

I suppose, who may refuse her?

- [Sarah] Certainly, your honor, he may,

he may refuse any kind of medical procedure whatsoever.

Here, it's the question of whether or not

the state by the statute will force the woman to continue.

The woman should be given that freedom

just as the doctor has the freedom to decide

what procedures he will carry out

and what he will refuse to his patient.

(tense music)

- I'm sort of a typical doctor

who's just kind of out in the world.

But then I also go and do abortions in difficult places.

I think most people who go into healthcare

have the same goals.

Everyone wants to take care of patients.

Good morning!

But there's a lot that goes in between that goal

and the reality of what can be done.

(music slowly fades)

(distant traffic) (birds singing)

(traffic rushes past)

(pump creaks)

(phone rings)

- Hello, South Wind Women's Center.

This is Katie. How can I help you?

Okay. I can help you do that.

To start off with,

can I get your name first and last?

Okay. Can I get your date of birth?

We are always working our best

to be in compliance with the law because that is how

we remain open to provide care to patients.

Okay. So we've got all that figured out.

Now I'm gonna read you some information.

This is called 72 hour consent statement.

This has to be read to you at least 72 hours

before you wanna be seen per Oklahoma state law.

It's gonna take me a couple minutes to read to,

so just bear with me, okay?

"The state of Oklahoma requires we offer you a book called

'A Woman's Right to Know'.

You don't have to read this book.

We just have to offer it to you.

A link to this book can be found on our website.

And we also have copies available in our office.

We can send you a copy of this book by mail if you choose.

The state of Oklahoma requires we provide you

with the following information.

This is just extra things that the state makes us do

that adds five minutes onto their appointment,

and, you know,

distracts them from listening to the important things.

I want them to know, you know,

what to expect during the appointment.

And, you know, I want them to have the presence of mind

to be able to ask the questions

that they are wondering about.

And so, I don't want their mind dulled

by this political speech that I have to give to them.

At no cost, (indistinct) from me

that medical systems benefits (rapid speech) that may occur

and that the man involved in the pregnancy is liable,

so assists in the support of your child

even has to pay for your abortion.

They cloak all of these laws in language that implies

that they're medically necessary,

that they're about women's health,

when actually they interfere with our ability

to provide safe healthcare to people.

I mean, we particularly see that in this state

in that we have a 72 hour waiting period.

We cannot see anybody sooner than 72 hours

after that statement has been read.

And that means that since we only have a doctor in

a few days a week, that can push people out another week,

which if you're getting close to a gestation change

that can change the procedure you have done,

that can mean you have to go

to a different state to have it done right.

To inform you that may be an ultrasound images

of the heart in your fetus.

The booklet also needs you to know the facility

offers these services at no cost.

These materials from provided by state board,

medicalized insurance supervision,

and script details about pregnancy

and lists agencies that offer alternatives to abortion.

Okay. That part's done.

So now we'll just go over the rest of the details

for your appointment, okay?

(gentle music)

(indistinct speech)

Are you for an appointment?

- Yes. - Okay.

Can I get a photo ID?

- Sure. (gentle music)

- Dr. George Tiller, who was my former boss,

he became one of the very few providers of

late termination of pregnancy

and the anti-choice folks hounded him.

After he was assassinated,

it was either pack up and find a different line of work

or dig in and not let these extremists,

these terrorists, tell us what to do.

I did not want them to have the last word.

- You have a seat on the bed,

doctor will be with you shortly.

(door closes)

- In two days we can see sometimes 70 patients.

Primarily they're from the Oklahoma City area,

the Metro, that's about 50%.

Then from there, it's all over Oklahoma.

We do see patients from Texas.

(gentle music)

- Even though it's challenging here politically,

it doesn't mean we can't do the work

that we want to do or need to do.

It just might take a little more creativity,

a little more money, because you know,

like for example, having to fly physicians in.

(laughs)

- I talked my way past 40 people at the TSA pre-check line

so I could make it on my plane.

- I believe in you doctor. - Amazing.

I go to Oklahoma City in Wichita

because there aren't doctors that perform,

particularly second trimester abortions,

in those cities or states.

Hi, I'm Dr. Chiavarini. It's good to meet you.

Have you you've paid cash for the NuvaRing before?

- Mm-hmm. - Yeah,

it's pretty expensive, huh? - Yeah,

it's really expensive. - Yeah.

So do you, what county do you live in?

- Oklahoma City county.

- Oh, okay.

Did you wanna see the ultrasound or not?

- It's. - It's up to you.

Some people do and some people don't. So we just always ask.

It's not something that, you know, it's really your,

some people are really curious and some people are like,

"I don't wanna see anything," so.

- Yeah. - Okay.

I grew up in the south,

so saw a lot of the way that women were not

necessarily respected that I think informed me

to be invested in making sure that women were taken care of.

No surprises. - Okay.

The good news is you're super, super early.

So, that makes this procedure very straightforward.

It's very, very quick.

And the recovery should be really fast.

Basically, tomorrow should feel like you're on your period.

- Okay. - So,

I don't know if you have to work soon or?

- I do tomorrow.

- Okay. (chuckles)

Yeah, I mean,

you should be able to get up in the morning

and take some ibuprofen and it'll be like working

when you're on your period.

- Okay.

- [Molly] We have a doctor in two days a week.

- Yeah. - We have 60,

70 patients on the books that you have to see in two days.

So we know it's gonna be a long day.

I mean, the thing is just, you know,

there's not a lot of clinics in part of the country.

- Looking adorable. - Thank you.

Any last minute questions?

- Nn-nnh - Okay.

- All right. (indistinct chatter)

- Okay.

The first thing I'm going to do

is I'm just gonna feel your cervix, okay?

So you're just gonna feel me touch on the outside.

A little bit of cold goop here.

So you'll feel some pressure.

We talk to women a lot about owning their own decisions

and that they have nothing to feel sorry for.

And especially the women who have a lot of guilt

and they feel like they don't have

the support of their families or they're being

very judged by their families.

It's okay. - Are you nervous?

Oh, that's normal! - It's okay, sweetie.

- You know, if you weren't nervous,

you'd be crazy and weird.

- Right. - Everybody's nervous

before this.

Okay, the next thing I'm gonna do

is I'm gonna put a speculum in

just like when you have a pap smear, okay?

You're doing so great.

Think women come in feeling like

that if they're grieving or they're sad that that means

that they're doing something wrong.

We talk about that a lot.

I tell them,

"Look just 'cause you're sad about something

doesn't mean it's the wrong thing to do."

- Okay. - Okay sweetie.

The next thing I'm gonna do is stretch your cervix.

So you may feel cramps.

- Phase two. - Okay?

So the best thing that you can do is take

big old, deep breaths. - Deep breaths.

Okay? - In through your nose.

- [Dr. Chiavarini] You can't get out of a pregnancy

without pain and tears, regardless of how it ends up.

And sometimes it's tears of relief.

But more than often than not,

it's tears of sadness and grief.

- [Katie] Down like it's supposed to do.

So we're gonna breathe through in through your nose.

Out through your mouth. - You are a rock rockstar.

Good job. - Keep breathing.

- [Katie] You got this.

Deep breath in through your nose.

- [Dr. Chiavarini] We take a break for just a second,

and then we got about five more seconds and you'll be done.

Okay? - You doing okay?

- You doing okay? - But you're gonna be like,

"Oh, that one, shit!"

(laughing)

- [Katie] What would you be doing

if you weren't here with us today?

- [Patient] Probably sleeping.

- Asleep! - Sleeping!

Oh, that sounds awesome. - Cool!

- Okay. Five more seconds.

- (indistinct) Asleep.

- You got this girl? You got it?

- Absolutely! - Keep breathing.

In through your nose.

- [Katie] She's a rock star. She's got this.

- Big old breaths.

- [Katie] Deep breath in your through your nose.

- Big old breaths. - Out through your nose.

You're doing excellent, babe.

- Good job! - Almost there.

(instrument clacks)

- All right, you are done! - Congratulations.

- [Patient] That's it?

- That should feel much better.

- [Nurse] Just I've told everyone to massage their uterus.

- [Dr. Chiavarini] Oh yeah. It helps.

That's the worst it was gonna feel it.

It's gonna...

- Yeah. - You'll be fine from now on.

You'll probably just feel like you're on your period.

- Okay. - You just said

you said you have to work tomorrow, right?

- Mm-hmm. - Yeah.

You won't feel, you'll feel so much better tomorrow.

- Okay. - Just take some ibuprofen.

- Okay. - You doing all right?

- [Patient] Yeah. I'm good, thank you.

- Okay, all right.

I'm gonna get you cleaned up. Okay?

You okay?

- Uh-huh.

- Women and people come from all walks of life.

They all have their own stories and their backgrounds

when they walk in here.

(door clicks shut)

We do try to meet them where they're at.

So when someone is even downright hateful, sometimes we,

I don't take it personally.

I know you don't because

- Yeah. - There's something else

going on, I know that it's not us.

(gentle music) - Thank you so much.

You're so awesome.

- You're welcome.

So basically you're just gonna have

some cramping for the next few days,

but we're sending you home with the ibuprofen

and that will help tremendously as well as that

uterine massage that I showed you in the OR.

(gentle music) (indistinct chatter)

- The thing that is unique about abortion care

is that because it's not an easy thing to do

you have to be pretty dedicated to the work.

(distant chatter)

The people that came into abortion care

a generation or so ago came into it out of feminism

and watching so many women suffer under illegal abortion.

And I know that there was a fear among older providers

that there wouldn't be so much commitment

to providing abortion services because

my generation is the post Rowe generation

and we didn't see these kinds of things happening.

(distant chatter)

- This photograph is actually my mugshot

taken by the Chicago police on, as you see, May 4th, 1972.

(gentle guitar music)

The bust was actually on May 3rd.

Seven Janes were taken.

And abortion, when it is illegal, is felony homicide.

Those were the charges.

We, the women who worked in it, called it The Service.

In my own case,

I actually discovered The Service in the summer of 1970

through asking a medical student, who was a pal of mine,

"I may need. Do you know?"

And he said, "Everybody here," meaning

the University of Illinois Medical School at Chicago,

"everybody here says,

call this number and ask for Jane."

That was pretty striking to me.

I thought, "Oh really?"

The women who worked in it used that as sort of a code name,

"Call this number and ask for Jane," that was the line.

In the main,

the medical industry was not the least bit interested

in assisting women in those ways.

And of course, as we know,

the medical industry was not particularly interested

in assisting women in many ways. (chuckles)

(gentle piano music)

And it was in those years that we saw the rise of the book,

"Our Bodies, Ourselves,"

which began as a newsprint pamphlet of,

I don't know, maybe a dozen pages.

It was like contraband.

Everybody, we thought, "Oh my God, look at this!

Look what they're doing."

And that came out of those years

because the medical industry

was not serving the needs of women.

(gentle music)

- The values of "Our Bodies, Ourselves,"

and empowering women with information about their bodies.

It changes the role of the doctors away from paternalism

to partnering with women to achieve their health goals.

Women, when they present to the healthcare system,

they're now armed with more information.

They're now aware of what the possibilities are.

And so the very paternalistic approach to,

"I'm the doctor and I know what's best for you."

That's shifted greatly.

(gentle music)

- I certainly believe that it's good that Roe v Wade

made abortion legal in the United States.

However, if you read the text,

you see that it's the doctors who have the power of choice,

not the women.

- [Sarah] If the right of privacy is to mean anything,

it is the right of the individual,

whether married or single,

to make determinations for themself.

It seems to me that you cannot say,

this is a woman of this particular doctor

and this particular woman.

It is- - Well,

doesn't it follow from that then,

that a woman can come into a doctor's office and say,

"I want an abortion."

- [Sarah] And he can say, "I'm sorry, I don't perform them."

(gentle music)

- I do feel like the Roe decision was still

too much associated with

patriarchal and parochial notions that pervade healthcare,

placing a woman's reproductive capabilities under, again,

the receivership of men,

just in the capacity of being medical providers.

There's not an innate right to self-determination

and bodily autonomy.

It is a woman's entitled to access abortion care

if other people are complicit with her decision.

- Because we were illegal,

it was extremely important for every woman or girl

who came to us to understand when you make this decision,

you are accepting responsibility for breaking a law

and literally taking your life into your own hands.

And that was what we wanted.

We wanted ourselves and other women and girls

to take our lives into our own hands

and not give them over to either the medical industry,

or to the police or to organized religion.

But to be able to say, "This is who I am.

I have given this serious thought,

this is what I need to do.

I can outline the reasons for you, but I don't have to."

At the same time that we were doing

abortion work underground,

we were learning about many medical/political practices

that were unacceptable to us.

And certainly I think would be unacceptable

to many, many people now.

(gentle guitar music)

- [Willie] Our healthcare and medical system has been

no better than the country in which it resides.

For example,

there's no denying what happened

with the Tuskegee Syphilis Trial.

- [Narrator] This is not the story of syphilis, the disease.

It is the story of public health organization

who stamp out syphilis.

- A group of people in the public health service

decided that they want to figure out

what was the natural medical course of untreated syphilis.

So there were black veterans who contracted syphilis

and rather than being treated,

they were allowed to be studied which was

unethical and tragic given that penicillin

had already been identified

as an effective cure for syphilis.

(somber music)

It's that history that's undeniable that's there.

So people in the anti-abortion movement

have exploited the doubt and the suspicion

that communities of color have about the medical system.

♪ We shall overcome

(somber music) - The conspiracy theory

of black genocide, for example,

the latest iteration was around 2006 with billboards

in Atlanta and other major urban areas

that framed abortion as black genocide

exploiting the epidemiology that notes that

the highest rates of abortion

occur for African American women.

The majority of the healthcare providers in this country

are white people.

So to allege racism and genocide has a chilling effect,

even on people who are committed to providing the care.

(haunting tones)

(car whooshes along)

- Most physicians, you're honored, you are respected.

There's a lot of authority.

That is not afforded to abortion providers.

You don't talk about, I am an abortion doctor.

You're an abortionist.

You don't, there are words that are meant to be disparaging

used to describe people who do abortions.

So yeah, this is our friendly protestor, Sarah.

She's here every day and, actually Mona the clinic manager,

just a couple weeks ago went down and was talking to her

and was like, (reverse alarm beeps)

"Do you even know what happens in an abortion clinic?

Like have you any idea?"

And was like, "Why don't you just come in?

And like, if a patient agrees,

you can even listen to a counseling session.

We are not evil."

[Interviewer] Was she not interested in?

- [Sarah] No, not interested.

- [Receptionist] Go ahead and come through

the door on the right.

(chattering)

- [Woman] It's a two year fellowship

that is both researching.

- Thanks.

I'd grown up with parents who were very pro-choice and,

you know, had talked about planned parenthood and abortion,

and that was fine and you know,

wasn't something restricted in my family at all.

So that felt like a very natural thing for me to do.

Tomorrow, but I don't think that's gonna be able to happen.

And so I signed up to volunteer one day a week

at Planned Parenthood and then ended up getting hired

to be a medical assistant and that was when I met Deb.

- Right. - Sounds good.

- She's in two.

I'm Deb, hi, the doctor.

We are here to end your pregnancy today, correct?

- Yes. - Do you have any

questions about that?

- No. - Okay.

I'm gonna start by listening to your heart and lungs.

- I just loved how she interacted with me and with patients

and just had this really great presence.

That, coupled with the whole message and the culture

and everything about family planning just clicked.

It was really like, I found what I wanted to do.

- So you're gonna feel me touch you here

and then a cold speculum, a lot of pressure.

(monitor beeps)

So you may feel a little tugging.

If it's too much, you let me know.

- [Patient] Okay.

- So that cramping will ease up in the next few minutes.

Okay and little pressure as the speculum comes out.

And any cramping you're having

will ease up in the next five to 10 minutes.

So I am gonna go to the lab and make sure we're done. Okay?

And I'll be right back. - Okay.

- What we look for are different things

at different gestational ages.

So at seven weeks, we're looking for the pregnancy sac.

So everyone talks about their amniotic fluid,

but there's actually an amniotic sac

within the chorionic sac,

and the chorionic sac is the true pregnancy sac.

Everything else we see is uterine lining,

also called decidua, and we're also looking for the decidua,

the uterine lining that sits right over the pregnancy sac.

And so that also helps us know we have what we need,

but I know from ultrasound she's seven weeks pregnant.

My pregnancy sac is seven to seven and a half weeks,

which is exactly what her ultrasound showed.

(knocks on door)

How's the cramping?

- [Patient] It hurts. It's not like it'll go.

- Would you like an Naproxen?

- Yeah. - Okay.

I'll get you one of those.

So one of my favorite facts is the uterus

is the strongest involuntary muscle in your body.

- Yeah. - And you are feeling

it's full effects. - Yeah.

- So while it's not comfortable,

it actually means your uterus is doing

exactly what we want it to be doing,

okay. - Okay.

- So the way a uterus stops bleeding is by contracting.

- Okay. - And that's what

uterus is doing. - Okay.

- So that's great.

Everything looks great. - Okay.

- Okay. Do you have any questions?

- No. - Okay.

So we are at the other end of the phone

if you think of any.

Okay? - Okay.

- And you're gonna see your doctor and get that implant.

- Yes. - Okay.

So between now and then no sex or condom each time.

Okay? - Okay.

I don't even plan on it.

It's led me to this.

- Yes. But often we don't plan and there it goes.

- I know, all right. - Okay.

All right.

(indistinct speech) (gentle guitar music)

As an abortion provider, one can get very isolated.

And so one of my favorite things about coming here

is having colleagues.

- [Sarah] I'm gonna go in and see this one, and-

- She's the one you're also hoping to-

- Yeah, I only have six dilators in there, so.

- Yeah. - I'm thinking that's

not probably gonna happen.

- Sarah is truly, one of my favorite people in the world.

Friday, so.

Last week when she had a complication,

the first thing she did on the way home is call me.

I had a difficult patient on Tuesday,

the first thing I do is call her.

- Well, I mean, one thing about

the family planning community is that I think

it is really tight knit and we do

really rely on each other for support because

we can be isolated from the rest of, not just medicine,

but even obstetrics and gynecology sometimes,

we're considered other.

And so, yeah, we have a really strong sense of community

and we're incredibly supportive of one another.

And so, you know,

that's a benefit of being in a marginalized group.

(gentle music)

(distant chatter)

- So my name is Rachel Hoffman.

I'm a medical student and I am co-chair of

Medical Students For Choice at UDub.

We wanna welcome you all again, to introduce the panelists.

We have Dr. Sarah Prager, who is an OB-GYN

and Dr. Deb Oyer, who is in family medicine.

- Medical Students For Choice really does what it does

by establishing a strong community within which

we can all feel safe.

And that is so important for all of us to gain the courage

to overcome the stigma that we will face

on an almost daily basis in the medical community

and the community at large.

- There is a pretty big spectrum in terms of

how much, if at all,

medical schools have abortion on their curriculum.

I know there are many residents who start

OB-GYN residency programs

without having any exposure to abortion.

I will admit,

I don't know the particulars of each and every site

where you all can be sent to do your clerkship

and whether or not abortion care is a part of that.

I would say the minority of rotations in OB-GYN

are going to specifically offer exposure to abortion care.

- What you really wanna learn from your core clerkship

is how to talk to a woman about an unplanned pregnancy.

And then you will also see miscarriage management,

which quite frankly, surgically,

is really not considerably different than an abortion.

It's the emotion in the conversation beforehand.

You know, if every time someone comes in pregnant,

the office says to them,

"Oh, congratulations, isn't this great," that's not okay.

- How many of you are planning after your training

to be practicing in a rural area?

- I think if I were practicing in a more rural place,

seeing more news stories,

I don't know if I'd feel safe providing abortions.

- So I spent five years as a,

the leader of an abortion providing clinic

in rural central Pennsylvania.

We had some pickets at the clinic,

but they were generally respectful.

And remember,

picketing is a constitutionally protected activity,

not in and of itself scary.

And then I went to Portland, Oregon.

(chuckling) Oh my God.

I was threatened.

My house was picketed by those people

who said abortion providers should be murdered.

It is a more confusing picture than you might believe.

- Since you helped train students to provide abortions.

Have you found that some students

are really passionate about it,

but are too scared to actually do it afterwards?

'Cause we've all heard, you know, the horrific news stories.

- I in no way would ever negate the fact

that there has been violence

and probably will be violence again

in abortion clinics and towards abortion providers.

But I also want to put into perspective a little bit,

the safety issue when we talk about abortion care.

And who knows which what type or types of physicians

are at most risk from homicide?

It's actually emergency medicine physicians

and psychiatrists.

To put it in perspective.

There are a lot less safe things you could do as a physician

than be an abortion provider.

- Like cross the street.

(laughing)

(distant traffic)

(traffic hums past)

(cycle clatters)

(phone rings)

- Good afternoon, Downtown Women's Center. This is Tristan.

We've been here over 30 years.

We're a small clinic like you would go

to see just your regular doctor if you had a cough.

(gentle music)

We work very closely with Oregon Health Sciences University

and their fellows and residents.

- Here at OHSU,

We've developed a very close connection

with the clinics in town.

- So I'm the physician that's

gonna be doing your procedure today.

Do you like me to kind of tell you

what I'm doing with each step or do you prefer me not to?

- I think if you're talking, that's probably good.

- Okay.

- We have our medical students and residents,

and fellows and faculty working in those settings.

- I'm gonna have you lay all the way back.

It's super important to all of us and all of our doctors

that we train the next doctors.

(door squeaks, closes)

- I come here periodically

to train family practice residents.

We think it's really important to prepare our residents,

to be able to take care of women who need abortion care,

who need help with miscarriage management#

when they have early pregnancy losses,

and who can help women get

whatever kind of contraceptive choice they want.

Oh, let's go just through the instruments.

We talked a little bit about,

these are called manual vacuum aspirators or MBAs for short.

There's this really fun model where we use

a papaya as a pretend uterus.

And so you're gonna feel firm, firm, firm, firm, firm,

and then a give because then the relatively larger space,

potential space of inside the uterus.

And that has a really characteristic feel as well.

Not very many of my residents go out

and actually become abortion providers, but many,

if not most of them are able to manage early pregnancy loss.

And then you take your aspirator and you get this ready.

Whoa.

I'm gonna insert the flexible cannula in there.

You get the seeds coming through.

I love bringing residents here

so they get to see what a feminist clinic is like.

And it's a very patient centered place.

- Uh-huh.

Yeah, so there would be a couple of different options.

You could either do an in clinic procedure

here with a doctor where you come in for about

two and a half to three hours and just everything

would happen for you at that visit.

Not everybody's terrified or ashamed to have an abortion,

but everybody goes through something.

Okay, so you can come back, talk to somebody and kind of.

Some women just wanna come in and be like, "Are we done?

How long do I have to be here?"

Other women stay much longer

and really need our help a little bit more.

- So once you're in position,

the actual procedure takes about six to seven minutes.

- Okay.

- The doctor will start with a quick pelvic exam.

So just locating how your uterus is oriented in your body

and where your cervix is.

And then he'll place the speculum,

which you've probably seen before.

- It was a pelvic exam, right.

- So, yeah, - (indistinct) thing.

- After the pelvic exam,

then in order to see the cervix, you know,

you have to kind of open the walls

of the vagina a little bit, so, this.

- I have had the experience of people coming in here

really conflicted about caring versus terminating

and like really on the fence truly.

And I try and do the pro-con thing of each side.

Sometimes I've even told them, you know,

take 24 hours with each decision.

- All right. I think I'm gonna go.

Everything okay here?

- Yes.

The patients have left. Everybody did well.

- Great. - And we'll see you soon?

- [Amanda] Yeah. Next week.

- [Pamela] Thank you.

- Around the time when Roe versus Wade was decided,

abortion care was provided primarily

in big medical centers and hospitals,

they were simple and straightforward and the hospitals

were prepared to provide that care.

But, a number of political factors led to

a shift out of hospitals, into freestanding clinics.

- In the absence of the access to healthcare,

the freestanding clinic movement,

it was what put abortion within the reach of women

when they needed it.

(gentle music)

- Is this the one who had the miscarriage?

- Yeah.

- Health centers based on a feminist model

expressing the values of empowering women,

it changes the very paternalistic approach to

"I'm the doctor and I know what's best for you."

- My first time at a feminist women's health center,

when they were interviewing me,

they told me the feminist healthcare model at that point

was the doc was just a technician.

So the women came in-

- Hired hands. - Hired hands, exactly!

We were literally come in, wield the cannula and leave.

I can see why doctors were seen as not an ally.

(car horn sounds)

(distant siren wails)

- When the women's health movement was getting started

there was a lot of anger at physicians,

all of whom pretty much were men.

The husbands and the doctors

seemed to own our reproductive organs.

(gentle music)

So we were really pushing back against that.

We wanted to take control of that part of our lives.

(slide carriage clicks)

What we came up with was taking control of our own bodies

through cervical self-examination.

(slide carriage clicks)

And you need very little to do a cervical self-exam.

You just need one speculum, a flashlight, and a mirror.

(slide carriage clicks)

Always we'd do this in a group

so we could support each other.

(slide carriage clicks)

And one of the rules in the group was always that

the woman looks at her own cervix first,

and that's a profound change

from what happens in an exam room.

(slide carriage clicks)

Can you see the baby being delivered?

But there's one person missing.

You can't see the mother.

And so there was a lot of advocacy for women to

be allowed to be more active and present during childbirth.

(slide carriage clicks)

So the self-help ideas to find out from each other

what's right and what's not right about the medical care

that we're being given.

(paper crackles)

- The transition to freestanding clinics was, in many ways,

a big step forward in the way abortion care was provided.

The advantage is

they're completely dedicated to abortion care

and they're able to provide care much more cost effectively.

So simple first trimester surgical abortions

can be done very safely in clinics

and been where the majority of abortions have been

provided in this country for a long time.

However, it also had some downstream consequences.

Abortion providers began to be viewed

as outside the mainstream of medicine.

They're kind of viewed as rogue physicians.

In addition,

those clinics were just obvious targets for terrorism.

(somber music)

- In the early '90s, there was so much violence going on.

We were literally terrified to come to work some days.

- These activists, I prefer to refer them as terrorists,

but they had put my name on a hit list,

a deadly dozen list they called it.

This deadly dozen list was issued

on the heels of two assassinations of physicians.

And both of those people had had a very similar in format

wanted poster put out on them.

In the middle of all this,

a bunch of protesters came out to my home,

which frightened me.

And so I was worried for the welfare of my children.

We had to go through what to do in case of hostile fire.

What do they do? Where do you go?

Something you don't really wanna talk to your kids about.

We sued these people, and the jury in their wisdom,

decided that indeed, this constituted a true threat

and we were awarded at the time,

the largest civil judgment ever in the history of Oregon.

(solemn music) (crowd singing, talking)

(indistinct chatter)

This anti-abortion activism comes out from a weird coalition

of the Roman Catholic Church and the evangelical Christians,

which before historically, had been at each other's throats.

And now in this issue, they can get together.

And the Catholic Church has the money

and the evangelicals have the foot soldiers.

- That's shifted a little bit now.

So now we're still incredibly vigilant.

We have security,

patients have to push a doorbell and announce who they are

to get into the clinic.

We just need to be proactive to make sure that

people feel safe, but not so safe that they're wondering

why is all of this stuff here in the first place?

(solemn music) - None of us who work at

Downtown Women's are at Lovejoy Park in the parking lot.

(people chatting)

We don't want anything to happen to our car.

We don't want people to know what our license plate is.

You know, it's probably fine. It's probably safe.

But we take those small precautions because

we just don't wanna risk it.

Are you all ready?

- Yep. - All right.

I'm just gonna check and make sure we have

everything all set before we get started.

It was never a question of is the work worth doing?

It was more of an how is this going to impact

maybe my career choices in the future?

And also how is it gonna impact my family?

One there. And one here.

Are there gonna be protestors on my lawn?

Are people not going to want to come see me

for other OB-GYN issues because I'm an abortion provider?

Does that feel okay on your hips?

- Mm-hmm. - Okay.

- My medical school class was the first

to have more women than men.

That shift was happening, not just within OB-GYN,

but within medicine in general,

the older guys were men and the younger docs were women.

And most of us applying into OB-GYN were women.

And so it just seemed like

that was the direction things were headed.

- Okay, so a little bit of gel on the outside,

and you're gonna feel my touch.

Lots of pressure. And then a hand on your stomach as well.

- I think that having women providers

speaking out on behalf of their women patients,

potentially there's more weight to our words

and to our actions when it comes to

advocating for women's reproductive justice.

(indistinct chatter) - Can I have another waffle?

- You want another waffle?

(indistinct chatter)

- What time's your flight?

- 10:40.

(zipper sounds)

It used to be that if you were

training in residency in OB-GYN,

it was not a requirement that you had abortion training.

It's better now as a whole.

CREOG, which is the

Council for Residency Education and OB-GYN

has very clear guidelines for abortion training.

Now your program has to offer it

and you can opt out if you choose not to do it,

but it's supposed to be part of your regular schedule.

(door closes)

Medical Students for Choice played a role.

They were increasingly in positions of leadership

and had clout and increasing the numbers of women

who were in leadership roles.

(car door clunks)

But I think it just depends on where you are,

whether or not that's a reality, geographically.

(gentle music) (distant traffic sounds)

(indistinct chatter)

(phone rings)

- Hello, South Wind Woman's Center.

This is Katie. How can I help you?

(door clicks shut)

- Hey - Hi.

You wanna have a seat up here?

Great. I'm Dr. Chiavarini.

It's nice to meet you. - You too.

- It's required that OB-GYN residents

train in abortion care.

That requirement really comes into conflict

with what we find in state law.

The anti-choice folks in this part of the country,

they've been able to push through the legislatures

these laws that ban medical professionals

from gaining that adequate training at home.

For example, if you're part of a public institution,

and that's where our teaching hospitals are,

then you cannot be associated with abortion care.

And so it's a matter of sending residents out of state,

and that's a hardship to be expected to go to

another state, another city to do a training

is I think asking a lot of people.

- At the medical school in Oklahoma City,

when they have patients who have severe anomalies

and they request termination of the pregnancy,

increasingly they send them to us.

You know, it's not like round.

- Yeah.

- They want to always keep us at arms length.

It's like, you don't really want us until you need us.

- We're lucky, especially here in Portland,

because the community is fairly small and we know

most of the docs who work at the other hospitals.

And so you know that if you have an emergency

and need to send a patient to their emergency room,

that they're gonna be getting good care,

but it's not always like that

everywhere else in the country.

- [Katie] It will be soon.

I can go check for you in just a minute. Okay?

- We had a patient that was from about three hours away,

she had a failed medication abortion,

meaning that not everything

completely passed through her uterus

and she did not want to stay here for any intervention.

- I think she was maybe just worried and overwhelmed

or who knows what was going on, but she just suddenly,

when we were in the middle of our treatment plan,

decided that she just wanted to leave

and go to the emergency room.

- [Receptionist] It's up to her.

- But I want to write up something that

the interventions that we made today.

And then I'll get Andrea to sign it if that's okay?

- There's a lot of concern about,

if you have to send your patient to another doctor

who isn't supportive of that woman's choice,

then what kind of care is she gonna get

when she goes to the emergency room and you know,

how are they going to judge you as the provider?

- She's gonna show up at this ER

and they're gonna be like,

"Oh, of course she has no records.

Like they probably just like sent her out the door."

You have to be perfect because if you have a complication,

then suddenly you're horrible

even though everyone has complications.

And she would've literally been fine and been able to

walk out probably half an hour to an hour later.

- Yeah. - And with some prescriptions

and would've been fine.

But she decided that she would be in better hands

going to the emergency room.

And we were trying to write up

a summary of what happened today

so that she would get better care in the ER,

and be able to give them that information.

But she wasn't willing to wait for that information.

So she just left without any information

about what had been done for her today.

- Okay. Yeah.

Let me go get Aria. Okay?

- I mean, I don't know how she's gonna present.

I don't know. She's not from Oklahoma City.

We have a hospital

right down the street here that's Baptist.

We have a couple of Catholic hospitals

and then we have the state University of Oklahoma Hospital

that's not religiously affiliated yet,

but they just got merged with a Catholic University

so are a Catholic organization, so,

we'll see what happens with that, so.

(gentle music)

- [Andrea] Yeah?

- I was just curious about sort of residency,

but kind of going back to the whole Catholic hospital thing.

Like, should you just completely avoid any program

that's based in a religious organization entirely?

- Yes. - 0h, wow!

(laughing)

- Okay, there is this growing issue of

Catholic hospital systems merging with

secular hospital systems and then taking over

some of the directives in terms of what can and can't happen

in those previously secular hospitals.

And usually those mergers are happening,

not for philosophical reasons, but for financial reasons,

but there are huge changes that can actually happen

in terms of the care that women are able to receive.

(bells chime) (choral music)

- People do not realize how integrated

the Catholic healthcare system is becoming through mergers.

Oftentimes they're walking into a hospital

that may have a name that doesn't sound Catholic at all

and yet the doctors are not allowed

to offer a full range of options.

- If you come into the hospital, for example,

with a miscarriage,

the pregnancy is separating from the uterine wall,

but there is still a heartbeat,

in a Catholic hospital that pregnancy cannot be ended

until the heartbeat is gone.

In spite of the fact that that pregnancy is going to end,

it is no longer really a viable pregnancy

and the woman's life is in danger.

- Nobody even thinks if they are having a miscarriage,

"If I go to Saint whatever's Catholic hospital

and I'm having a miscarriage,

I'm bleeding to a dangerous amount,

but I still have an embryo with a heartbeat,

are they not gonna actually treat me

because that would be an abortion?"

Nobody is gonna be thinking about that in that moment.

The Catholic Church's point of view is,

well, if patients, they know what we are all about,

and if they wanted access to these services

like contraception, or postpartum tubals, or abortion care,

or end of life care or LGBTQ care,

they just go someplace else.

But that's not actually logistically possible in many places

unless a patient wanted to drive, sometimes out of state.

(soft music)

- I actually did my residency at a Catholic hospital.

I chose it because their mission

was to take care of the poor and the elderly

and that was very important to me.

There were crosses on every wall.

At eight o'clock, if you were in the hospital on call,

prayers came over the PA system,

but there were no rules about abortion

other than it could not happen in the hospital.

So we could go to another clinic to train

to become an abortion provider.

At the end of my first year our contract changed

and said we could not do abortions anywhere.

You know, I was a year into my residency.

I had two more years. Was I gonna fight this?

I also, at that point,

determined I was pregnant and thought,

what I'm gonna fight for is my maternity leave.

Since I left working for the Catholic hospital

and over the 25 ensuing years,

the ethical directives have really taken over.

- So this is a list of rules, basically,

that you're supposed to apply when taking care of patients

in a Catholic healthcare system

and the Bishop of whatever area can determine the degree

to which the ERDs should be enforced.

And then individual hospitals sometimes even vary

how they interpret the Bishop's interpretation.

The language is a little bit tricky

around ectopic pregnancy.

An ectopic pregnancy is a pregnancy that is located

outside of the uterus.

They are not viable and this can be

catastrophically dangerous.

But to the letter of the law within Catholic ERDs,

you are ending a fetal life, which is not allowed,

and that is held to the same value or higher value

than a woman's life.

(engine ticks over)

- [Deb] When I first came to Seattle,

there was Swedish and there was Providence

and they were totally separate.

- For financial reasons,

Swedish needed to merge with another hospital

and Providence was the hospital system

with which they merged.

There was a lot of outcry and concern

that these ethical and religious directives

would hold sway over all of the physicians

that work at Providence hospital.

And my understanding is that

there was a lot of language that, you know,

don't worry about it.

There isn't going to be any influence on that.

But there clearly is

because inpatient abortions with live fetuses

could no longer happen.

So the operating room at Swedish was no longer a place

where abortions for a live fetus

could happen at any gestational age.

- Now, most women do not need

their abortions in the hospital,

but when a woman needs an abortion in the hospital,

she needs one in the hospital.

We can have someone who has say severe heart disease

or severe asthma who just needs more monitoring

than we are capable of doing in an outpatient setting.

So when Swedish got rid of doing any inpatient procedures,

we lost that ability for patients.

- If there is no longer an ability to do those procedures

in a safe place, we are really actually harming women.

(traffic rushes past)

- Physicians who really wanted to provide

they get out into the real world and realize,

oh, they have a contract that happens to be signed

through an entity that abides by the Catholic rules.

And all of a sudden they have to sign a clause

that says they won't provide abortion care.

- Even doctors who have authority need to have a job.

And Washington's a great example

when 49% of the hospital beds (gentle music)

are affiliated with the Catholic church, it's kind of hard,

actually, it's impossible in fact, in many counties,

to have a job at a hospital

that is not affiliated with the Catholic church.

(indistinct chatter)

(machine beeps) - Everything, all right.

- Do you have any last minute questions for me at all?

- I don't think so. - No, okay.

- So this is the mask. It goes over your nose.

- Okay. - Okay?

- You're gonna hear the machine turn on

and it's gonna be about 30 seconds of suctioning, okay?

So just some cramping during this, all right?

- Let the nitrous help you and then blow it out. Good job.

- As much as abortion is a procedure

that should be considered normal and is safe

and shouldn't be stigmatized,

it is a procedure that occurs when something

undesired has happened and you're, you know,

and you're trying to reconcile it.

It's not like getting plastic surgery, it's,

this is an unwanted event that you're dealing with.

- Hang in there, sweetie, it's almost over.

You're doing great.

- I think you wanna acknowledge that, but,

at the same time, if you linger too much on that,

people will use that as a reason why abortion shouldn't be,

why abortion's a negative, you know?

It's because, just 'cause the circumstances are negatives

it doesn't mean the procedure itself is.

- Easing up for you now. - I'm gonna take

that speculum out, just relieve some of that pressure.

All right. And we're all done.

Everything went really well.

- Good job.

- Okay. How are you feeling right now?

A lot of cramps. Yeah.

This is kind of the worst of it right now. Yeah.

It'll get a lot better even in the next few minutes here.

Okay.

We'll just kinda have you hang out here for a little bit.

All right.

A lot of times people say, you know,

"Why do women get abortions or do you ever,

when you ask women why they get abortions,

like what do they say?"

And I say, you know, "Honestly,

for the majority procedures I do,

I have no idea why they get an abortion.

'Cause I don't ask."

- Feel like going next door. You can walk?

(indistinct) Not very far.

A more comfortable bed with a heating pad.

- That's right, if someone sees me and they're uncertain,

then obviously I wanna talk to them about it.

But as a provider, you know,

you have to ask yourself who in the room

knows what's best for that woman's situation?

You know, is it me? Or is it her?

Some people will appeal to the pro of abortion

by saying that these are women

who are in these horrible circumstances

or these are pregnancies are in these terrible circumstances

and you can make an argument that that's a really,

that that argument is ultimately

working against where you wanna go.

'Cause then you're making distinctions between

what's a meaningful abortion and what's not.

- There absolutely is this idea

that there's a good abortion or bad abortion.

Just like there's an idea that there's

a good patient or a bad patient in many other situations.

You know, this diabetic patient takes her insulin.

She's a good diabetic.

This diabetic patient doesn't take her insulin.

She's a bad diabetic.

But what are we actually talking about

when we're talking about that?

We're making it about ourselves.

If I'm talking about this patient is good or bad,

that's my judgment.

It's my job to come in and educate a patient

on risks and benefits and to facilitate

the healthcare that she needs.

- So what are your thoughts?

- I mean, I think it's probably

just her first period after her miscarriage.

(indistinct speech) - Okay.

For me, what's hard is when younger girls come in,

and their mothers bring them in

and either they agree or they don't agree

with what their parents think their decision should be.

And so that's always hard.

I've been a teenage mother and I'm a parent.

And so I can understand both aspects

of how the teenager may feel and how the parent may feel.

Either way, I still believe like,

that girl should be able to make the decision

that she wants to make even if inside

my gut feeling feels like

they should listen to their parent.

(traffic hums past)

- When I started here, staff were very cultured to,

we rip out pictures of babies

out of the magazines in the lobby.

We don't show baby wipes.

We tear those off.

And I watched this thinking,

"That's odd. The women that come in here are mothers.

Like what are we hiding from?"

So is it possible, like we get you a hotel,

we could put you there.

Sister could go home, get her baby.

And then come back to the hotel and stay with you tonight?

Being a woman who worked here through her two pregnancies,

nine months pregnant doing ultrasounds, having patients go,

"They let you work here?"

I'm like, "Yeah, they let me work here. Yes!"

And I'm getting you at about like 19 weeks.

- 19 weeks. - Yep.

That's pretty much right, you know,

from like your last ultrasound.

In the past 18 years that I've come here,

one of the things that I've watched change

for actually the better is that we're not shameful.

And so I am just about done with the ultrasound.

Did you want to be able to visualize it?

You absolutely don't have to look.

- I will. - You wanna look, okay.

This is your pregnancy right here.

And it kind of goes through right here.

- I see it. - Do you see it?

- Yeah. - Okay.

Do you have questions?

- Yeah. - Okay.

So I'm gonna take it off.

Last year's the first year we sent out Christmas cards,

we put our faces out there.

It was like, this is what we do!

Oh yeah, she could do that too.

It's just the idea that she needs

somebody tonight with her in that room.

So that's kind of where she's at.

- Okay.

So the reason that it needs to be a two day procedure

is because we need to be able to have time

to dilate your cervix in order to make this

procedure safe for you.

So what they'll do today is insert a few dilators.

You'll go back to your hotel,

which I'll take care of as soon as we're done in this room

and get you that information.

- [Patient] Okay.

- And then you'll come back tomorrow to our Renton office

and then that's when they'll remove those dilators

and then they'll remove your pregnancy at the same time.

Did you have any questions about that?

- [Patient] So that's not gonna be removed today?

- Not today. No.

We just need to be able to have time

to dilate your cervix so that we can

remove the pregnancy tomorrow. - Okay.

- And then you hit, Okay.

And now you hit Document.

There can be a lot of judgment that surrounds LGBTQ care.

So we do hormone therapy, transgender care.

We provide just a safe place for the entire community

to be able to come and have a free conversation regarding,

you know, any aspect of sex,

whether it's vaginal sex, whether it's anal sex.

We want all of our clients, patients,

to come through this door and be able to say,

"Hey, this is what's going on with me.

I've had this type of partner."

(crowd shouts)

(gentle music) - There's a strong bond

and relationship between LGBTQ people and women who are

seeking control of their fertility by abortion.

The more visceral aspects of anti-abortion sentiment

is related to the insistence on the

primary roles for men and women

and LGBT expressions of human sexuality challenge

patriarchal notions of what

the appropriate roles are in society.

And similarly women,

as they explore their fuller humanity

by actualizing all of their potential

and take control of their sexuality,

means it is now uncoupled from an aspect of sexuality

that has to relate to men or a particular man.

(gentle music)

Right around the time that I had my call

to add abortion care to my,

the scope of practice that I pursued.

It was also when I began to do a deeper dive in feminism.

I'm not just being a good guy when I pursue feminist goals.

I'm in pursuit of a fuller humanity,

because if I have to subordinate women

to have to feel like a man

then I'm losing an aspect of my humanity.

(gentle music) My consciousness raising

occurred with me affiliating with

the organization of Sister Song.

And as I was transitioning

more fully into my identity as a feminist,

I was introduced to the concept of reproductive justice.

(gentle music)

- Well, the beauty of the reproductive justice framework

is that it is the isolation of abortion

from other social justice issues.

And so it allows us to have the conversation about abortion,

at the same time, we're talking about white supremacy,

or economic injustice or welfare rights,

or HIV aids or housing or police brutality,

all the other things that go on in our community.

- Reproductive justice allows for a framework

that is inclusive of issues that would be

seemingly remote from one another.

It's not about are you for adoption?

Are you for abortion? Are you for birth justice?

Are you for LGBTQ rights?

A reproductive justice framework

allows for the intersectionality of these issues.

- And so I think that is our best ally right now

that we have an intersectional inclusive framework

that allows us to have conversations with people

who are uncomfortable, maybe,

only focusing on abortion 'cause you know,

reproductive justice is the right to have a child

and not have a child and to parent our kids.

(gentle music) (distant traffic sounds)

(indistinct chatter)

- I really wanna talk a little bit today about

what an abortion looks like and you know,

what it looks like in reality and how it's portrayed,

and how it ultimately sort of affects

being an abortion provider.

Have you guys both seen abortions?

- Yeah. - Okay.

And how far along did you, how far along,

what's the latest gestational age you saw a procedure till?

- Saw it around first to second trimester.

- First. - 14.

- It's 15 weeks. - 15 weeks, okay.

What you think of the 15 week procedure when you saw it?

- It was at the time I was supporting the procedure

and we were using ultrasound to assist.

So I think it was a little bit more

eye opening for me at the time.

I did feel some sadness for sure.

- Yeah. - And to experience that

for the first time was,

was an interesting growth moment I think for me.

- I actually remember the first time I did a,

like a pretty late, you know, a 20 week plus abortion.

I remember that in that procedure,

all of a sudden the head comes out and I remember, you know,

physically jumping back like "Ugh!" you know,

because it was a really disturbing thing to look at.

And since then I've done enough that I try to sort of

block that reaction, but I, I,

it's a reaction that if you've talked to people

that do abortion, almost everyone had

the first time they had that moment.

And yet that's a reality of the procedure. Right?

And we don't talk about it

and it's because we don't talk about it

here's this void of information, you know?

And, when that void exists,

people can fill it with whatever they want.

- A group called the Center for Medical Progress,

a pro-life concern, has been investigating

Planned Parenthood for three years.

- Do you guys remember the

fetal tissue controversy last year?

- Selling the body parts of aborted babies.

- Some of it was obviously fake.

When they cut the video, they made it,

they tried to make it seem like people were

selling tissue when really

they were just talking about the transport costs.

But some of it was actually

just putting out facts about abortion,

but because no one had heard about it before,

it was all of a sudden, "Oh my God!

Like you remove the. This is how you do an abortion?

And it, that's what it looks like?"

A year ago I had a patient, it was a late abortion,

and she understood how it was being done,

but she wanted to see the fetus at the end.

You know, I was kind of like,

"I don't know if you wanna see this."

And I was honestly, I didn't feel like,

I didn't want her to see it personally, you know?

But I also recognize that that was her choice,

and this was something that came from her body

and there's a process to her abortion, you know,

not the procedure, but her abortion,

her, the experience that she's undergoing

that she wants to find a closure in

and it might involve seeing the removed fetus.

- If we don't talk about it, the stigma continues.

- Right. - And I have felt

for a very long time when I lecture on abortion

or even talk about it to a non-medical audience,

I feel like I need to talk about what really happens,

because, if you're gonna be pro-choice,

you need to know what actually happens.

And I don't feel like everyone needs to know about

every medical procedure,

but there's so much negative about what happens.

- Hi. - Hi, I'm Deb Oyer,

the doctor, this is Seb Patel,

the other doctor. - Hi.

- Nice to meet you. - Nice to meet you.

- How was your night?

- Last night? - Mm-hmm.

- It was okay. - Okay.

- Yeah, I just threw up a lot

and then I had a lot of cramps.

- Okay. The medicine sometimes can make that happen.

All right, let's get this show on the road then.

- Okay, just a light press here

and we'll put the speculum in here, lots of pressure.

- Surgery can be disturbing. It can be messy.

It can be hard to watch.

Abortion becomes more psychologically messy

because of this other potential being.

Eight weeks and below we see just the gestational sac,

and that's easy for most people.

Beyond that, we do start seeing recognizable fetal parts,

and there are people who are

comfortable with that theoretically,

but still have some sort of aversion, a gut reaction,

to seeing a more developed fetus.

For other people it's just like,

"Oh my God, that is so cool."

For those of us who've studied embryology

to actually see it in different stages.

Perfect.

We'll take some pap.

We all have our different issues we bring

to everything in life.

And if somebody struggles with ending a potential life,

I'm gonna sit down and hear them out.

But you are ethically required to be able to

talk to your patient about abortion,

to be truthful about abortion with them

and use scientific facts,

not those that the other side would give.

And to also, if you're not going to do their abortion,

to refer in such a way that you're not putting them down.

So not, you know,

"I'm gonna send you to see Dr. Prager

because I don't believe in this."

- Right- - But I'm gonna send you

to see Dr. Prager, because this is her specialty,

just as I'm gonna send you to see Dr. So-and-so,

who's the cardiologist 'cause that's their specialty.

- All right, speculum's coming out.

There you go. You're all done.

(indistinct chatter)

- Everything went really well. And your IUD is in as well.

Okay? (indistinct)

So as soon as Seb gets you cleaned up,

we'll push you back up the table and let you rest for while.

- All right. - Okay?

- Thank you so much. - You are very, very welcome.

We go up to 26 weeks,

through 21 weeks as a two day procedure.

And then from 22 weeks to 26 as a three day procedure.

People end up being that far along for a few reasons,

figuring out you're pregnant, getting it together.

And often they'll spend some time

trying to get money together

before they even go in to see anybody.

(gentle music)

- Unfortunately,

oftentimes the women who are the most needy,

those that have the most profound social issues

or financial challenges are the least able

to get abortion services

because of the distance they have to travel

or the time they have to take,

or the health insurance loops

that they have to jump through.

And as a consequence,

they end up in the second trimester or even later,

and they have to then have an abortion

that's much more complicated and carries greater risk.

(gentle music)

I think it's ironic that the anti-choice movement

has in fact effectively pushed abortions into

later in pregnancy.

(indistinct chatter)

When I look at the patients that come to me

for pregnancy care and you know,

maybe I'm lucky enough to deliver their babies,

they're very thankful and appreciative.

- Yeah! - Good job!

- Welcome baby. - Congratulations.

- Congratulations. - Thank you.

(baby cries)

- Later, take a deep breath.

There you go. You're doing great.

But honestly I think the gratitude

of patients in abortion care is even more profound.

- I'm Dr. Sarah Prager.

How are you? - Good.

- Good. This is Dr. Seb Patel,

- Hi! - Hello.

- We're gonna be working together today, okay?

I can't fix all of the other stuff that potentially led to

that being a situation that she is having to now manage.

I can't fix the fact that, you know,

she no longer has her same insurance and so

she wasn't able to pick up her pack of birth control pills

and that's why she got pregnant.

or she's now in the second trimester because it took her

10 weeks to raise the money to be able to get here.

You know, any number of things.

So I can't fix that, but I can fix her immediate problem.

All right. So we're all done.

That's it.

I've heard many times from colleagues or other people,

"You know, nobody likes to do abortions,

but somebody's gotta do them.

It's a necessary evil."

And I actually completely disagree with that.

I enjoy incorporating abortion care into my life.

I think we make assumptions also about

how this has to be a really private thing.

And I'm gonna tell it a brief story

just to show that not everybody feels that way.

I was at SeaTac airport getting a muffin

(laughing)

and the woman behind the counter looks at me, she said,

"I know you!" in this volume voice, "You did my abortion!"

Lots of people in line,

other people she works with standing right there.

And I'm like, "Yes, I did." (laughing)

- More than anything else,

I hope that you walk out of here today,

knowing what a huge difference all of you make

in giving your patients access

to the family planning care they need,

no matter what specialty you choose.

(gentle music) - Most of those people

will not end up being abortion providers,

but they will be people who have learned

how to talk to patients about abortion,

and we need those people,

at least as much as we need abortion providers.

Because when there's a hospital that's becoming Catholic,

you need the cardiologist, you need the anesthesiologist.

You need everybody to stand up and say,

our ethical directives are to take care of our patients.

- You're just gonna feel some cold goop.

Sorry about that.

- My grandmother is an 86 year old Catholic woman

who goes to mass every day.

She doesn't know that I work here.

I don't think that she would be exactly pleased,

but at the same time,

I don't think that she would be entirely disappointed either

because I'm doing something that I think is

just so incredibly important.

- [Sarah] How you doing? You feeling okay?

Right now about one in every three women

has an abortion at some point in the United States.

As long as women are getting pregnant,

abortion is gonna need to be around.

(gentle music)

- Now we're at a juncture where

we have a government that's trying to outlaw abortion,

stigmatize it, defund it,

and to do so is not gonna mean

that abortion need is gonna go away.

(gentle music)

(indistinct chatter)

We should be maladjusted to the norms that undermine women.

And we should be nonconformist with laws and policies

that are not rooted in justice.

(music ends)