The fight for abortion rights
Alyssa Place (00:01):
Welcome to Perk Up, a podcast about workplace culture and benefits brought to you from the team at Employee Benefit News. I'm Alyssa Place, executive editor at EBN. With Perk Up!, my colleagues and I are sharing the stories of businesses who have implemented forward thinking, covetable workplace policies and benefits, keeping their employees happy and their company's bottom line thriving. This week, associate editor Deanna Cuadra explores a topic employers have been grappling with since last summer, abortion and reproductive care.
Deanna Cuadra (00:40):
Hi there. I'm Deanna Cuadra, and today I'm asking us to delve into a particularly sensitive subject: abortion care. It's rarely easy to discuss something as deeply personal as a decision to receive an abortion, but now that the U.S. has left abortion access to the discretion of state governments, the personal has become forcibly public. On Friday, June 24th, 2022, the U.S. Supreme Court agreed that the state of Mississippi has a constitutional right to ban abortions at 15 weeks in the case of Dobbs versus Jackson Women's Health Organization. This decision overturned Roe v. Wade, the landmark legislation had protected the federal right to abortion for nearly 50 years. Since then, 18 states have banned or severely restricted abortion care with only a few states making exceptions for rape. That's left 25 million women in a dangerous position: choose what happens to their body and risk being prosecuted by the law or sacrifice their autonomy, health and safety.
That number doesn't even account for the trans men and non-binary Americans who have been silently hurt by these bans. And while big companies like Apple, City Group and Yelp have announced their support for abortion access, promising to cover employees' travel expenses if they're forced to seek care in another state, this doesn't necessarily soften the blow. Because the overturning of Roe v. Wade has far-reaching consequences —ultimately, this decision punched another hole in U.S. healthcare, limiting care in an already notoriously inaccessible system. Healthcare providers like Dr. Mary Jacobson knows this amounts to a deadly cost. Dr. Jacobson is a board-certified obstetrician and gynecologist, as well as a clinical associate professor at Stanford University and chief medical officer at Alpha Medical, a digital women's health services platform. She's been practicing for over 25 years, witnessing firsthand why abortion care is lifesaving.
Dr. Mary Jacobson (02:25):
People stand to lose their lives. Maternal mortality is about 14 times higher in people who carry a pregnancy to term than people who have a medical abortion. So abortion, as lay people know, we believe, I believe is an essential component of comprehensive evidence-based healthcare. All people should have access to the full spectrum of comprehensive evidence-based healthcare. Just like an appendectomy is part of healthcare, an abortion is part of healthcare.
Deanna Cuadra (03:00):
The U.S. already boast the highest maternal mortality rate among developed countries with 24 deaths per 100,000 births. Research from the University of Colorado Boulder found that abortion bans throughout the U.S. would cause that number of maternal deaths to rise by 24%. Black women who have historically suffered from discriminatory healthcare practices are expected to see deaths rise by 39%. As Dr. Jacobson reminds us, pregnancy is no easy feat and comes with a host of health risks during and after, from anemia, diabetes, and hypertension to severe depression and anxiety. Those who become pregnant risk, their physical and mental well-being. They also risk death, most commonly from blood clots that affect the heart and brain, high blood pressure complications, otherwise known as eclampsia and heavy bleeding. And while states like Texas have a medical emergency exception for abortions, providers still have to ensure that they can prove their patient was dying before receiving proper care. There will be generational long consequences for patients and providers alike. Dr. Jacobson says.
Dr. Mary Jacobson (03:59):
Efforts to impede access to abortion care interfere with the relationship between a person and their healthcare professional. I feel very passionate about this because the patient-clinician relationship is a critical component of the highest quality of healthcare. Any efforts that interfere in this relationship harm people seeking essential healthcare and those providing it. It breeds distrust in the system, which erodes the relationship between the patient and the provider. Let's think about citizens of states where medical residents and medical students train where they're not allowed to train in abortion care. Well, these students, these medical residents could end up not wanting to learn in these states, right? We have OBGYNs that may be leaving states where abortion is no longer legal. How is that going to impact the healthcare of the patients in those states? Today, about 50% of the counties in the United States don't even have an obstetrician-gynecologist. What is that going to look like in the next few years? And again, how's it going to impact the quality and access to healthcare in these states? With overturning of Roe v. Wade in the Dobbs decision, clinicians may be subject to criminal penalties, lawsuits, fines or other punishments for providing the full spectrum of evidence-based care.
Deanna Cuadra (05:33):
Yet these consequences are often dismissed in favor of prevailing rhetoric used by those who consider themselves pro-life. Banning abortion equates to preserving families. It equates to saving lives. Monifa Bandele, chief strategy officer at MomsRising, finds this argument darkly ironic. MomsRising is a social welfare organization and advocacy group dedicated to families, and Bandele takes a specific focus on maternal justice and considers abortion care vital to the well-being of families.
Monifa Bandele (05:59):
It's a little known fact. People don't know that 60% of the people who seek abortion care are already mothers. They're already parents. They have children in their care and they're trying to figure out ways to care for them and center them and maintain a family. So you have on one side people saying they're trying to ban abortions to protect the nuclear family, but what they're actually doing is completely the opposite, right? It's totally disrupting and destabilizing the adults in these families and in these households from being able to make the decisions that they need to, to care for their existing children.
Deanna Cuadra (06:42):
Kaitlin Soule, a licensed marriage and family therapist, author and mom to three had an abortion after giving birth to her second daughter. Soule had her first two children 15 months apart when she discovered she was pregnant for a third time, just six months after giving birth. She hit her breaking point.
Kaitlin Soule (06:58):
I remember just most days kind of barely being head above water as far as postpartum goes. I had a lot of support around me, which I'm very lucky for, but like so many moms, I feel like I just had this notion that I had to be the one to do it all and take on everything. And so I have a really supportive partner who was able to help a lot, but I don't think I tapped into that as much as I should have or could have. I certainly didn't tell anybody I was struggling with postpartum anxiety or depression. Maybe I didn't even recognize it myself, but I was very much just, I don't know how to describe it other than if you know, you know. It's this sense of overwhelm and how am I going to keep doing this? And then I found out we were pregnant.
Deanna Cuadra (07:43):
Soule wasn't on birth control due to bad reactions she was having to it at the time. And while Soule doubted that she could become pregnant again so quickly, she took the morning-after pill for extra reassurance. But when Plan B failed her, she knew she wasn't physically or mentally ready to be pregnant again.
Kaitlin Soule (07:59):
And I didn't tell anybody besides my husband. The first thing I did was I emailed my OBGYN at the time, the same OBGYN who had provided prenatal care for me and I guess the babies when I was pregnant. And I had asked him, told him the situation, and told him how I was feeling, and that I was pretty sure I wanted to have an abortion and I wasn't ready to have another baby. I thought he would understand because he was actually the one who told me I should take a break in between if we wanted to have a third, because I had the first two so close together that I was having, my body just wasn't doing great, and I'd had some birth trauma, and he suggested waiting longer between the second and the third. Well, I email him and tell him that I'm considering having an abortion and why. And he just wrote back one sentence I'll never forget it said, 'Dear Caitlin, I don't do those procedures anymore. Please reach out to a different doctor.' Please reach out to somebody else, basically. And it was just cold and short.
Deanna Cuadra (09:03):
Soule fortunately found a provider who affirmed her decision. Since Soule realized she was pregnant early on, she only had to take two pills to terminate her pregnancy at six weeks. Soule's confident she made the right decision not only for herself but her family.
Kaitlin Soule (09:17):
Anti-abortion, right, is all about building the family and love. And what they forget is that sometimes the most loving thing to do is to not bring another child into the world. And so I think that that is how it affects families. I know for us it was a matter of capacity and resources and us feeling like if we brought another child into the world at that time, we wouldn't be able to care well for the two children that we had, for the two babies that we had at that time. So I think it's really everything. I think it's our well-being. I think it's our mental health, our emotional health, our physical health and all those things are critical. And so I don't think it just boils down to one thing. I think it's just saying, what if families lost the right to, or the access to just healthcare in general, which many families do right? That would be devastating to somebody who was sick and needed care. So I think if we underestimate what it means to be forced to bring a child into the world when you're not ready or don't have their resources, we're really not understanding the big picture and what family wellness is.
Deanna Cuadra (10:32):
The CDC tells us this much. A majority of women who seek abortions already are mothers A majority fall below the poverty line. Meanwhile, the U.S. is the only nation out of the OECD's membership of the world's strongest free market economies to not have a paid maternity or medical leave policy, let alone an infrastructure that supports the cost of childcare, which has increased by 41% since the start of the pandemic. Costs total at an estimated $14,000 per year per child, according to a Lending Tree report. This conflicts with anti-abortion arguments, according to Bandele.
Monifa Bandele (11:08):
It is not pro-life because we talked about how harmful and dangerous it is to your health and to your life, and also to the children that are already in the household. How is it pro-life to them to now maybe lose their housing because a parent cannot continue to work? They don't have paid leave. There's not childcare infrastructure. Bringing in another child, forcing the entire family into poverty, into homelessness — all of these things clearly are not pro-life. We don't have any form of universal healthcare in the United States. This hurts everyone.
Deanna Cuadra (11:51):
The U.S. is infamous for its lack of social safety nets, finding itself towards the bottom of every list ranking nations according to quality of life, despite being the largest economy in the world, according to Business Insider. In lieu of universal rights and healthcare, Dr. Jacobson, Bandele and Soule suspect that employers will make or break the quality of care workers can receive, especially in the next few years. Given that employers are already responsible for covering healthcare for half of the U.S. population, this is just one more piece left to their discretion. If employers choose to take a stand on abortion care, it will likely be through their benefits. This can come in the shape of travel stipends for those seeking care in other states and expanded reproductive care coverage. Companies like Amazon, Apple, Buzzfeed, CVS Health, Goldman Sachs, Indeed.com and Warner Brothers Entertainment are already offering financial assistance to employees who must travel to other states to receive an abortion.
Some companies are going even further. The small San Francisco-based PR firm Bospar announced that it will pay up to $10,000 in moving costs for any of its Texas-based employees who wish to permanently leave the state. New Jersey-based software company Alloy will cover 50% of legal expenses up to $5,000 if an employer or their partner finds themselves in trouble. But employers have to be wary of potentially being criminalized for aiding and abetting workers seeking abortions and invading their employees' privacy by forcing employees to share personal medical information. Soule's advice? Don't be afraid to ask for help.
Kaitlin Soule (13:17):
Bring in an agency or a consulting agency or somebody who could, if you don't have the skills or the know-how, who could take a look at your policies and what you're offering to your employees, what your mental health care is, what your family care and support is like, and tell you where you can shift and make some changes to improve.
Deanna Cuadra (13:39):
Dr. Jacobson underlines that it is in an employer's best legal interest to seek out a third party to provide these benefits. Employers could find themselves in hot water for directly helping an employee access abortion services.
Dr. Mary Jacobson (13:51):
Employers have to be careful how they communicate with their employees. If the company is in a state where abortion is illegal, if the employee is in a state where abortion is illegal. So that's number one, because employers are in a difficult position because they don't want to be viewed as aiding and abetting an employee to seek abortion care. I think an excellent option is to work for them to work with a third party company that offers abortion services and create an environment, a culture of safety with respect to communication between either between the employer and that third party, or enable their employees to go directly to that third party. This way, the employer doesn't have any access to the specific employee who's seeking their services.
Deanna Cuadra (14:48):
Employers can make a difference in their employees' lives, but to be a true advocate, they have to know what they and their workers are going up against. The loss of abortion care will disproportionately impact women of color and marginalized communities. Despite black women only representing 12.8% of the U.S. population, they make up 22.3% of women in poverty. American Indian or Alaska Native women make up 24.6%. Comparatively white women account for just 9%, according to the Center for American Progress. Why? According to Bandele, these realities are rooted in the ideologies of white supremacy.
Monifa Bandele (15:22):
Many countries that we see able to really put its families and its people first tend to be more homogenous. We really struggle here in the United States to put these safe social safety nets in place because we've yet to really attack some of the white supremacist thinking around this idea that people aren't working hard and that's why they're poor. And even if people are poor and working hard, they're sitting in that situation still. This kind of like American narrative that everyone else, particularly people who are black, brown, indigenous, just aren't working as hard as you are.
Deanna Cuadra (16:02):
This kind of thinking especially hurts black women who often face discrimination from healthcare providers. Nearly 20 years ago, the National Academy of Medicine released a report highlighting how providers are less likely to deliver effective treatments to people of color than white patients. For example, black patients are more likely to be discharged too early after surgery and less likely to receive coronary bypass operations and medical imaging. They're more likely to have their limbs amputated than white patients. As of 2020, black Americans' average lifespan is approximately six years shorter than their white counterparts. As for maternal mortality, black women are over three times more likely to die of childbirth, an issue Bandele and her team have been chipping away at for more than 10 years.
Monifa Bandele (16:45):
You know at MomsRising, we've been working on maternal healthcare now for over a decade, and particularly in the last six years, have highlighted the fact that the United States is the most dangerous place to give birth in the developed world. Like period, full stop, dead last. The maternal mortality rate still is increasing and increased even more under covid. So forcing people to give birth already in a climate and in a society where we don't have the proper infrastructure, where we haven't addressed the racial biases and the racial discriminations that happen that are prevalent in the healthcare system, that's really at the crust of a lot of these deaths. So the healthcare provision system is racist, and then you can't even get to it because there's, you have to have enough money, you have to have the right insurance, you have to be in the right program, as opposed to a universal healthcare system where everyone can just access the care that they need when they need it.
Deanna Cuadra (17:43):
Bandele and Dr. Jacobson argue that ultimately it's non-white and LGBTQ-identifying Americans without substantial economic resources that will take the brunt of the consequences as reproductive care becomes more restricted. Dr. Jacobson explains.
Dr. Mary Jacobson (17:57):
People who carry an unwanted pregnancy, who do not have the resources to travel, as an example, for their care, who can't take time off of work because they can't afford it, which include Black, indigenous, women of color, trans women and non-binary people who have historically faced and continue to face repercussions of oppression. Unfortunately, white supremacy as well as glorification of able white cis hetero women.
Deanna Cuadra (18:27):
What do you mean by the glorification of white hetero-cis women?
Dr. Mary Jacobson (18:32):
There's a segment in the right movement that want to go back to the 1950s, right? That want to go back to Stepford wives — a woman's place is in the home and a woman are all females assigned at birth, by the way. And that's the ideal state.
Deanna Cuadra (18:50):
In other words, an end to abortion care also puts an end to bodily autonomy and the agency to plan for the kind of family one will want and when they will want it. If women are unable to choose when to have children, their chances of financial security dwindle, and thus their independence. In fact, the National Women's Law Center knows that being denied an abortion increases the rate of negative public records such as bankruptcies and evictions by 81%. That all creates a power imbalance to serve some and not others. And that's by design, Bandele says.
Monifa Bandele (19:20):
Traditionally, right in this patriarchal society, women were viewed to produce laborers, right? It's like that is your number one function. That is your number one job to produce the bodies to carry forth and do the work that's needed for the larger corporations, the wealthy class, all of these folks. And so we're very much still in that mindset. People don't say that explicitly, but when you actually look at the policies, that's what they do. So that's really a lot of where it comes from. It's an economic advantage to many powers that be that women don't have this right to choose right and to control their own economics.
Deanna Cuadra (20:06):
In capitalism, of course, employers hold power and they influence how employees and communities of workers are treated. DEI goals have long been a corporate talking point, but employees are now demanding action. As employers respond to the overturning of Roe v. Wade, it's vital that they anticipate the trickle down impact Roe could have on additional rights and start thinking about how they can protect their workers. Because if abortion bans are rooted in power and greed, then Roe v. Wade is just the tip of the iceberg. Contraceptives and even fertility care may very well be on the chopping block. Even before the federal right to abortion was taken away, 17 states barred abortion clinics from receiving public funds for contraceptives. Nine states allowed doctors and nurses to refuse patients services related to contraception. Since last summer, the state of Louisiana had tried to pass a bill criminalizing the use of IUDs and plan B, calling both treatments abortion methods, and equating their use to homicide. That directly challenges people's ability to family plan, and ironically, family build, says Dr. Jacobson.
Dr. Mary Jacobson (21:06):
Pro-life or anti-abortion groups, their mantra: life begins at conception and it ends at birth. So laws banning abortion could potentially put fertility treatments such as in vitro fertilization in jeopardy. So think about if laws are enacted that deem a frozen embryo human life — doing things like genetic testing on it during the IVF process or discarding it could become illegal. I mean, we know that IVF is expensive, right? So it's for the privileged few, but now it's going to be the privileged few who live in privileged states potentially. Can you imagine having frozen embryos in a state where abortion is illegal, like in Texas as an example?
Deanna Cuadra (21:52):
This is not just conjecture. In Supreme Court Justice Samuel Alito's draft opinion on the overturning of Roe v. Wade, he states, 'Procuring an abortion is not a fundamental constitutional right because such a right has no basis in the constitution's text or in our nation's history.' Of course, let's not forget how limited rights were for most communities at the country's founding. It's an alarming point in time to want to emulate. Supreme Court Justice Clarence Thomas stated that the rulings surrounding contraception and gay rights should be reconsidered, citing protections granted by the decisions in Griswold versus Connecticut, Lawrence versus Texas and Obergefell versus Hodges, which gave married couples the right to contraceptives, the right to engage in private sexual acts and the right to same-sex marriage respectively. The threat to these rights felt so tangible that in December, Congress even mobilized and passed the Respect for Marriage Act in December, protecting same-sex marriages at the federal level. Dr. Jacobson predicts that abortion bans will ultimately lead to less federal protection for women and LGBTQ-identifying Americans. She fears what will happen to non-binary and trans patients who already struggle to access care. Nearly 240 anti-LGBTQ+ bills were introduced in 2022.
Dr. Mary Jacobson (23:03):
What do we know about the queer community in medicine? So first of all, we as a medical community stigmatize the queer community in quotations as a homogenous group of sexual and gender minorities. But unfortunately, they're subjects of relatively little health research, right? We think about health status of the queer community populations. It's limited mostly to mental health, HIV and other sexually transmitted infections. With respect to abortion, think about what you've read about abortion. Think about what you've heard on the news about abortion. We hear about women's reproductive rights. We hear about women having abortions. We hear about cis women. We assume it's cis heterosexual women. So already we're continuing compounding with stigmatization as well as marginalization and not being inclusive of these groups. So that's the first thing, is that the queer community is invisible in what's going on with abortion. So I think that this may unfortunately compound the lack of trust in the medical community and also reinforce stigma and implicit biases.
Deanna Cuadra (24:26):
Despite what many Americans are up against. Dr. Jacobson is confident that the fight for abortion care and healthcare as a whole does not stop here. In fact, the midterm election saw five states vote in favor of abortion access. Three months before midterms, Kansas voted no on a state amendment that would've completely taken away the right to abortion.
Dr. Mary Jacobson (24:44):
Look at outcomes of abortion rights in Kansas, Kentucky, Michigan, California, Vermont and Montana, and then look at Democratic governors who were elected in states like Michigan, Wisconsin, and Pennsylvania, where they focused on abortion access and made it through rallying cry for voters against the candidates that were against abortion. So I think that it has to come from the grassroots, protecting our rights, protecting our democracy, and I think that removing a person's right to abortion care is a microcosm of those larger issues. I'm wearing the tiara of optimism because I believe in this country. I believe in democracy.
Deanna Cuadra (25:34):
As for Soule, she finds hope in the people she meets every day who are vocal about their rights and the rights of their fellow Americans.
Kaitlin Soule (25:40):
I have the unique privilege of getting to meet with women of all different ages, but I'm thinking especially of my young millennial, young millennials. I'm an older, I'm a geriatric millennial. My young millennials and my Gen Zs who are just like so open-minded and so loving and so ready to make change and such activists. And then I look around at my own peers too, and the women that I've chosen to surround myself with these days, and they're out there fighting for women's rights, fighting for equality.
Deanna Cuadra (26:14):
Bandele who works on the front lines of civil rights advocacy, has seen firsthand how people have mobilized against abortion bans, from widespread donations to abortion funds, to massive civic engagement campaigns, creating new voters and human rights activists.
Monifa Bandele (26:29):
I think of myself as holding a baton from my late grandmother and what the work that she had to do as a black nurse in Pittsburgh. One, just even getting to be a nurse. Then she helped to create a pipeline to get black women access to the nursing school. Then in handing it to my mom, doing social work, building out an office of the WIC program here in Brooklyn. Then here I am working at Mom's Rising, working on public policy issues. And I have two daughters, and they will determine their own path. And so people have to think of this path as being this beautiful and powerful and glorious relay race where we lost some ground when Dobbs came down. But just think about all of the strong and fast runners behind us, and their energy is like this force multiplier. They cant, she can't lose. I'm like my grandmother. She can't lose. My mom. She can't lose. So I can't lose because we are going to keep it going.
Deanna Cuadra (27:39):
I appreciate everyone who joined me today. I'm Deanna Cuadra with Employee Benefit News.
Alyssa Place (27:44):
Thanks for joining us for this episode of Perk Up. We'll be back in two weeks with a brand new episode. This episode was produced by Employee Benefit News with audio production by Kellie Malone. Special thanks to Monifa Bandele from MomsRising, Dr. Mary Jacobson at Alpha Medical, and Kaitlin Soule who shared her story with us. Rate us and review us wherever you get your podcasts, and check out more content from the EBN team at www.benefitnews.com.