Patients Face “Intolerable” Risk & Uncertainty
HAVANA TIMES – Millions of pregnant people in the United States have now lost access to abortion in their state since the Supreme Court overturned Roe v. Wade. Anti-abortion “trigger laws” have gone into effect in numerous states across the country, including Texas, where it became a felony to perform an abortion starting Thursday, punishable by up to life in prison.
We speak to Dr. Bhavik Kumar, a Texas-based abortion provider, and Mini Timmaraju, president of NARAL Pro-Choice America, about how doctors are navigating the legal environment after the end of Roe v. Wade. “What I’ve seen over the last seven years of providing abortion care in Texas is that politics has found its way into my exam room, into my health center. It’s soaked its way into everything I do as a healthcare provider,” says Kumar, who adds that conservative politicians have attacked both abortion and trans healthcare in similar ways.
Meanwhile, Timmaraju says even anti-abortion laws that allow abortion under extreme circumstances undercut bodily autonomy by leaving life in the hands of a panel of judges or hospital staff. “It’s an absolutely intolerable way to manage reproductive healthcare in this country,” she says.
AMY GOODMAN: This is Democracy Now!, democracynow.org, The War and Peace Report. I’m Amy Goodman, with Juan González.
We spend the rest of the hour looking at how millions of pregnant people in the United States have now lost access to abortion in their state since the Supreme Court overturned Roe v. Wade. The Washington Post reports this includes at least one in three women.
Meanwhile, more restrictions are being implemented in state after state. This week alone, anti-abortion “trigger laws” went into effect in Texas, Tennessee and Idaho, and on Saturday, Oklahoma will increase penalties for doctors who perform illegal abortions for pregnant people to include a $100,000 fine and up to 10 years in prison. The Texas anti-abortion trigger law that went into effect Thursday makes it a felony to perform an abortion, also punishable by a $100,000 fine and up to life in prison. Tennessee’s similar trigger law has no exceptions for rape, incest or fatal fetal anomalies.
Meanwhile, a trigger law set to take effect today in North Dakota was blocked Thursday in state court when a judge granted a preliminary injunction against the measure that makes it a felony to perform an abortion with limited exceptions for rape, incest or medical emergency.
Abortion access is now a key issue in the 2022 midterm elections. Many states report a surge in women registering to vote. This is President Biden kicking off his midterm campaigning Thursday night in Maryland.
PRESIDENT JOE BIDEN: So, how extreme are these MAGA Republicans? Just take a look what happened since the Supreme Court overturned Roe v. Wade. In red state after red state, there’s a race to pass the most restrictive abortion limitations imaginable, even without exception for rape or incest. But these MAGA Republicans won’t stop there. They want a national ban. They want to pass a legislative national ban in the Congress. If the MAGA Republicans win control of the Congress, it won’t matter where you live: Women won’t have the right to choose anywhere. Anywhere. Let me tell you something: If they take it back and they try and pass it, I will veto it.
AMY GOODMAN: This comes as Arizona’s Republican Senate nominee, far-right venture capitalist Blake Masters, is now downplaying his support for a “fetal personhood” law as he seeks to challenge incumbent Democratic Senator Mark Kelly in November. This week, Masters’s campaign quietly overhauled his website, scrubbing it of many of his extreme anti-abortion views.
Last week, South Carolina Republican state Rep. Neal Collins said he’s reconsidering his support of his state’s so-called fetal heartbeat bill after hearing how it had led to one of his constituents being denied abortion care for her unviable fetus because it required her to wait until a heartbeat could no longer be detected. Collins spoke before the South Carolina House Judiciary Committee.
REP. NEAL COLLINS: A 19-year-old girl appeared at the ER. She was 15 weeks pregnant. Her water broke. And the fetus was unviable. … The attorneys told the doctors that because of the fetal heartbeat bill, because that 15-week-old had a heartbeat, the doctors could not extract. … There’s a 50% chance — greater than 50% chance that she’s going to lose her uterus. There’s a 10% chance that she will develop sepsis and herself die. That weighs on me. I voted for that bill.
AMY GOODMAN: State Representative Collins was one of three Republicans who abstained from a vote on the measure, which passed along party lines in the committee and is set for a floor debate on Wednesday.
For more, we’re joined by two guests. In Texas, Dr. Bhavik Kumar is with us, medical director of primary and trans care at Planned Parenthood Gulf Coast in Houston, co-chair of the Committee to Protect Health Care’s Reproductive Freedom Task Force. And in Philadelphia, Mini Timmaraju is with us. She is the president of NARAL Pro-Choice America.
We welcome you to Democracy Now! I should add, Mini Timmaraju, that today is also the 102nd anniversary of the 19th Amendment, which gave women the right to vote. When you look at what’s happening around this country, I mean, the fact that women — new women voters are surging all over this country now, it looks like it has changed the prospects for the midterm elections. Can you talk about what has taken place just this week with trigger ban after trigger ban?
MINI TIMMARAJU: Thank you so much for having me, Amy.
And, you know, the trigger bans are outrageous. They’re horrifying. It’s important to note, however, in many of these states, as these trigger bans are coming into place, these are states that already passed really horrific restrictions, including Texas, where my colleague Dr. Kumar is. I mean, look, we’ve already had a six-week ban that was left to stand by the Supreme Court with a vigilante enforcement mechanism and outrageous fines and penalties in Texas since last year. So, Texans have been living under a draconian nightmare for a very long time. Now, you add the other states you mentioned — you know, Idaho, Oklahoma, Tennessee — it’s small comfort that we have some limited restrictions now by the courts. It’s good news that the court struck the North Dakota trigger ban, or at least held an — put an injunction.
But I want to note something about North Dakota and the dystopian situation in this country. The one abortion clinic in North Dakota that existed has already crossed lines and moved over to Minnesota, because they understand they can’t functionally provide healthcare in the state of North Dakota with everything going on. So, even though the court put an injunction on that trigger ban, there is no abortion access in North Dakota.
And that is the landscape we’re talking about. We’re talking about women and pregnant people having to travel hundreds of thousands of miles to get access to care, working moms, people with kids already — most folks who seek abortion care already have children — having to figure out how to get child care, how to get gas, how to get transportation, how to take some days off work, just to have access to what should be a basic, fundamental human right that they’ve had guaranteed for almost 50 years in this country. So, it’s nothing short of horrific. And I know my colleague is going to be able to tell you a lot more about what’s happening on the ground.
JUAN GONZÁLEZ: Well, Mini Timmaraju, I wanted to ask you about some of the high-profile cases that have already come to public light. Some of them are really absolutely chilling.
MINI TIMMARAJU: Yeah.
JUAN GONZÁLEZ: There was a Baton Rouge, Louisiana, resident who was 10 weeks pregnant, was denied an abortion at a Louisiana hospital, even though an ultrasound showed her fetus was developing without a skull. The condition, known as acrania, does not appear on a list of accepted conditions for an abortion in Louisiana. In Florida, there was a 16-year-old orphan ordered to carry her pregnancy to term, after she petitioned the court for the right to have an abortion, testifying that she was, quote, “not ready to have a baby.” But a three-judge panel denied the request, ruling that the girl “had not established … she was sufficiently mature to decide whether to terminate her pregnancy.” These cases, as they become more and more apparent to the public, what do you expect to happen?
MINI TIMMARAJU: So, I think two major responses I have to this. And thank you for asking this question. One, advocates have been talking about these cases for decades to Republican extremists in these states. So, you played the clip of the South Carolina legislator acting completely shocked of the consequences of his actions supporting a really problematic bill and a ban. This is what happens with abortion bans. And we’ve seen decades of targeted restrictions against abortion providers throughout many, many states in this country that have already put abortion care out of reach for the majority of people in rural areas, people of color, people without means, because of federal bans on funding for abortion. So, it’s really important to understand, these horrific stories that are coming to public light have already been happening in many parts of the country.
The other point I want to make is this is why bans — total bans are problematic, but this is also why just passing bans and then adding exceptions doesn’t work. Right? You just talked about how a three-judge panel had to make a determination of a lifesaving procedure for a mother and her situation, right? Do you want three-judge panels and hospital administrators making decisions in life-and-death cases? It’s an absolutely intolerable way to manage reproductive healthcare in this country. And considering how devastating and dangerous pregnancy is — it’s the most dangerous time for most women in their life, is pregnancy — do we really need to be waiting weeks upon weeks and asking legislators, panels, administrators to make these lifesaving decisions?
So, these cases are increasingly horrific. What you saw a few weeks ago in Kansas is an indication of what the American public thinks of these bans. And when asked directly how they feel about it, they are unequivocally clear: They do not want government in their business, they do not want these bans and restrictions, and they’re ready to fight back.
AMY GOODMAN: Dr. Bhavik Kumar, you’re in Texas, and you’re a doctor. The trigger law that just went into effect makes it a crime for you to perform an abortion. You face a $100,000 fine and life in prison. Your response?
DR. BHAVIK KUMAR: Yeah, this is now the third abortion ban since the overturning of Dobbs. And as Mini said, Texas has been in a post-Roe world for almost a year now, with Senate Bill 8. So, practically, on the ground, this doesn’t change anything. Abortion has not been accessible in Texas for some time now, and it continues to be inaccessible, which means people that are trying to access care, whether it’s abortion, folks that are experiencing a miscarriage, folks with a wanted pregnancy that have had something go wrong, or even folks with an ectopic pregnancy, may not be able to get the care that they need. And we’re seeing the same thing play out in a number of other states.
What’s important to note here with this trigger law — like you said, it has penalties of life in prison, fines of $100,000 — is that it adds another boulder, another weight onto healthcare providers’ shoulders as they try to navigate what they can and can’t do, think about who they need to contact, whether it’s attorneys in a hospital or an emergency room, contacting an ethics committee. And as a healthcare provider, as a physician, when I’m thinking about taking care of a patient, the last thing I should be thinking about is which attorney I need to ask, which law I need to consider, what the penalties may be, as I go through options with a patient.
What I’ve seen over the last seven years of providing abortion care in Texas is that politics has found its way into my exam room, into my health center. It’s, you know, soaked its way into everything that I do as a healthcare provider. And it’s really unfair, because people are suffering. We’ve heard a couple of stories from South Carolina, from Ohio and other places, in Louisiana, about what’s happened to some folks. But these are stories that we hear every single day. There are hundreds, if not thousands, of people that are experiencing the same things. And I’m worried that things will only continue to get worse if we don’t do anything and vote these folks out.
JUAN GONZÁLEZ: And, Dr. Kumar, you mentioned having to consult lawyers. With these new restrictions, what is considered aiding and abetting an abortion? Is that legally clear yet?
DR. BHAVIK KUMAR: Absolutely not. Again, these laws are passed by politicians who are not healthcare providers. So, whether it’s aiding and abetting, whether it’s these vague exceptions for medical emergencies, these are not well defined. And we’re seeing that play out, where there’s chaos, and there’s confusion, and there’s also this chilling effect where folks, whether they’re providing information, like abortion funds, or physicians or nurses that are trying to take care of patients when it comes to medical emergencies, it is not well defined. So clinics and hospitals are instead left to figure out what they can and can’t do, and figure out how much risk they want to take. And again, that’s simply unfair. There are people trying to get care, trying to get information, and they’re sort of in this limbo of not sure what to do, what to ask, what they can and can’t say. And these things are starting to vary by clinic, by state. And again, it’s really unfair, because people are suffering in the meantime.
AMY GOODMAN: So, Dr. Bhavik Kumar, be very specific. I mean, you are with Planned Parenthood in Houston, in Texas. What does it look like? What does Texas look like now, when it comes to trying to access reproductive care? How many clinics have closed? I mean, what do you do? Did you perform abortions before, and you don’t now?
DR. BHAVIK KUMAR: Yeah, absolutely. When we were able to, we would provide abortion care. So, before Senate Bill 8 went into effect, which was about a year ago, we could provide abortion care up to the legal limit. So, the vast majority of folks that we would see qualified for an abortion here in the state, closer to where they live. Of course, there were a number of restrictions that were already on the books, and so the situation wasn’t ideal. Folks still had to wait at least 24 hours, go through a number other hurdles to get the care that they need. Folks weren’t allowed to use their insurance. But since Senate Bill 8 went into effect, and, of course, in the last two months with now three abortion bans, today I’m essentially not allowed to provide any abortion care to anybody if there’s a viable pregnancy. And the same is true for folks that present to an emergency room. Now, we are able to see folks before an abortion. So, if they need an ultrasound, if they need any kind of blood work, we can provide that. And then, for folks that have had an abortion in another state, we can still see them for follow-up care.
It’s important to note that folks are traveling out of state. And that’s what’s happening in Texas and in about 16 states where there’s some abortion ban in effect. And folks are traveling sometimes hundreds, if not thousands, of miles, which means time off of work, finding child care, navigating the multiple jobs that they may have. And, of course, there are some folks that aren’t able to travel. I’ve seen folks that are undocumented and say, “I can’t risk somebody finding out my documentation status or my family being deported.” I’ve seen folks that are tethered to an abusive partner, who tell me, “It’s been difficult for me to even get to the clinic here today, which is about five, 10 miles away. I can’t travel to another state.” And sometimes I don’t know what happens to these folks. They’re either able to make it to another state to get the care they need, or they’re forced to stay pregnant. And that’s simply unfair, unjust. They’re making sound decisions about what’s best for them. They know they can’t be pregnant. They know that it’s not the right time for them to parent. And instead, they’re left with no other option. And that’s been a reality for almost a year now in Texas.
JUAN GONZÁLEZ: And, Dr. Kumar, since the overturning of Roe v. Wade, and, in Texas, S.B. 8, what’s the climate been like in terms of harassment by anti-abortion activists and potential violence to healthcare providers?
DR. BHAVIK KUMAR: Yeah, the harassment and, quite frankly, the terrorism that we see among anti-abortion folks has been there for some time, and of course it’s remained there. Even though we’re not providing abortion care now in Texas, we still have protesters harassing staff, harassing patients that are trying to access other care, whether it’s family planning care, such as contraception, or STI testing, or just coming in for breast and cervical cancer screenings. They’re harassing everybody that comes into our clinic.
It’s also important to note that these terrorists that are outside of our clinic are very closely linked to the politicians that are passing these anti-abortion laws. It’s one movement, that is not rooted in the well-being of our patients, in the well-being of Texans and folks trying to access reproductive care. And it has to stop. We’ve been saying this for some time. We’ve been telling politicians about the harms that will happen if we pass these laws. You know, it’s exhausting, as a physician, to tell people that aren’t medical professionals about these harms, about what these violent acts are doing, whether it’s outright violence against people or it’s violence in the form of these racist and classist laws. But they haven’t listened, and, unfortunately, they’re seeing the consequences of these things play out now. So, again, I really, really want to call on people to take action. We’ve had some success in Kansas, and I’m hoping we’ll see the same success in November.
AMY GOODMAN: I also wanted to, very quickly, ask you, Dr. Bhavik Kumar, about the federal appeals court ruling against an Arkansas law banning gender-affirming medical care for transgender children, three-judge panel ruling temporary injunction against the law — that the law should remain in effect while legal challenges proceed. The whole issue of trans care and how it links to reproductive care?
DR. BHAVIK KUMAR: Yeah, thank you for asking that question. I think there are a lot of similarities between the two. I’m an abortion provider. I also provide trans care. And so it’s very clear to me that the playbook that we saw with abortion care, where it was one law, it was one group that was targeted — in this case, minors — it was one state, and slowly, slowly, we saw an overturning of everybody’s rights. And here we are with Roe overturned. Abortion is inaccessible in so many states. And I can see a similar pattern with trans care, where we have Alabama that’s passed a law, we have Arkansas now, we have courts deciding what can and can’t happen.
At the end of the day, we know that this care is safe. We know that — and I say this as a physician who provides this care, who’s trained in providing this care — this trans care is lifesaving. It reduces people’s ability — it reduces people’s suicidality. It saves people’s lives. It’s important to have people be able to access this care, especially minors.
And what we’re seeing with the opposition is that they’re targeting folks in Southern states and targeting the most vulnerable among us. In this case, it’s children. And so, again, this is another issue that’s very closely linked to anti-abortion movements, where folks that support anti-abortion laws also support these anti-trans laws.
At the end of the day, for me as a physician, these decisions should be left between me, my patients. We should use science and medicine and counsel our patients on what’s best for them and let them decide what they want to do with their lives and their bodies and uphold their dignity and humanity.
JUAN GONZÁLEZ: And I’d like to bring Mini Timmaraju back into the conversation. The recent decision — I think it was on Wednesday — by a federal judge in Idaho —
MINI TIMMARAJU: Yeah.
JUAN GONZÁLEZ: — blocking portions of a trigger ban on abortion, could you talk about that?
MINI TIMMARAJU: Sure. In Idaho, the Department of Justice brought suit on the provision on EMTALA, the emergency care provision piece. And, look, in Idaho, the court did say, “Look, you” — the ban is still in place, which is deeply problematic. But a good step is that now if a patient — again, has to prove it, and the doctor has to prove it, so it’s not ideal — but if a patient can prove that they have an emergency, they can have access in an emergency room to abortion care. For all the reasons Dr. Kumar just laid out, this is still very problematic, but it’s an important first step, because this is an example of how the Biden administration is taking a strong stance for reproductive freedom and reproductive rights and trying to use all the tools in their tool box, particularly the DOJ, to intervene in some of these most problematic cases.
AMY GOODMAN: Well, I want to thank you for being with us. There’s so much to talk about it, and we will continue to. Mini Timmaraju is president of NARAL Pro-Choice America. She’s speaking to us from Philadelphia. And Dr. Bhavik Kumar is the medical director of primary and trans care at Planned Parenthood Gulf Coast in Houston.