Access to Later Abortion Will Always be Needed

Abortion later in pregnancy is often misunderstood and heavily targeted through both policy and stigma. Erika Christensen, co-founder of Patient Forward and later abortion patient and advocate, Jenn Chalifoux, later abortion patient and advocate, and Dr. Diana Greene Foster, demographer and Professor at the University of California San Francisco and lead of the Turnaway Study, sits down to share their personal stories and talk with us about why access to later abortion will always be needed.

Some people—including young people, people with chronic health conditions, and people who have been recently pregnant—are late to discover they are pregnant. That means those who make this discovery later in pregnancy in states with six-week abortion bans do not have access to abortion. Further into pregnancy, costs rise, available providers decrease, and barriers to care mount. Since Dobbs, ten states have enshrined viability measures into their constitutions, and 41 states still ban abortion at some point in pregnancy. The good news? Culture is shifting—more Americans agree that legislators should not be involved in pregnancy decisions, including in the third trimester. There are also more clinics and providers for abortion later in pregnancy than there were previously, and states are continuing to repeal viability limits. 

For more information, check out Pantsuit Politics: https://www.pantsuitpoliticsshow.com/s/podcast

Transcript

Jennie: 0:44

Welcome to rePROs Fight Back, a podcast on all things related to sexual and reproductive health, rights, and justice. Hi, rePROs. How's everybody doing? I'm your host, Jennie Wetter, and my pronouns are she/her. So I feel like almost every week before I sit down to record the intro, I am like struggling about what to talk about. I just feel like I'm not that exciting and I don't have a ton of things happening that I feel like y'all want to hear about. So this week was no different than many other where I was like, I don't know what I'm going to talk about. And then I opened social media and saw something that brings me joy every year. And I am so excited, y'all. This week is a really, really important week. That's right. It is Fat Bear Week. I'm so excited. If you have not experienced the joy of Fat Bear Week, y'all, you have to dive in. It is just pure delight. It is done by the Katmai National Park in Alaska and it is about their brown bears. And so every year brown bears need to eat all this food so that they can hibernate, get fat for hibernation. So, Katmai started doing Fat Bear Week and created a tournament for education purposes and it is just so much fun. So you go on, it starts the 22nd, so you go vote for your favorite bear. There's a round robin every day where you go and pick I don't remember how many it is every day, like, three or four or , like, two or four of your favorite bears um as the tournament progresses and we'll have crown our Fat Bear Week champion at the end of the week. And it is just so much fun and it brings me joy every year to see cute bears, hear their stories; there's always like a delightful story of who this bear is. It's just so much fun. I don't know. It's one of those things that brings me joy every year. So I hope that you go and check out Fat Bear Week. It is a lot of fun. Okay. Let's see. The only other thing I really wanted to talk about is this is the last in our series that we've done six episodes on abortion later in pregnancy. And y'all, I am so, so grateful to everybody at Patient Forward, Bonyen and Garin and Erica. Thank you. Thank you so much for every for helping co-create this series for thinking up the topics and finding amazing guests. It has just been such a wonderful series and I am so grateful to all of you for all of that you did to make this a wonderful series, for being on the podcast multiple times, for helping find guests; like, this series would not have existed without all of you. So, thank you, Patient Forward. I am so grateful for your partnership and being such great collaborators so thank you so much. And y'all, I had so much fun doing this series. So if you have ideas for other things you would like us to see do in this format, to do a deep dive on different aspects of a particular issue, let me know and we'll see if we can make it happen. So yes, send me your ideas. With that, let's turn to my interview. I am so grateful this week for having three wonderful guests. We are talking about, again, abortion later in pregnancy, but we're Thank you to Patient Forward. Thank you to Erika, Jenn, and Diana for this episode, and let's turn to our conversation. Hi, Erika, Jenn, and Dr. Foster. Thank you so much for being here. It's a pleasure. Thanks.

Jenn: 5:26

Thank you so much for having us.

Jennie: 5:27

Okay, before we get started, let's do introductions so everybody can learn to recognize people's voices. And I'm going to go the order I see you on my screen, which definitely will help our audio people, right? Because they can't see you, but that's okay. So Jenn, would you like to go ahead and introduce yourself first?

Jenn: 5:44

Sure. My name is Jenn Chalifoux. I am an attorney in Colorado, and I am a later abortion patient as in 2010. So, I'll be speaking about that today.

Jennie: 5:59

Okay. Dr. Foster?

Diana: 6:00

My name is Diana Green Foster, and I'm a demographer and a professor at the University of California, San Francisco. And I led the Turnaway Study, which looks at what happened to people who were too too late to get an abortion, too far along in pregnancy compared to people who are just under the limit. And I have had the pleasure of speaking to Repros Fight Back about it. But here, this was such a great opportunity to focus specifically on later abortions with other experts on later abortion and talk about what we know about later abortion in this post-Dobbs era.

Jennie: 6:40

And then last, let's go to Erika, who has been very much a partner in in this series of six. I cannot believe this is our last one, but Erika, would you like to go ahead and introduce yourself?

Erika: 6:51

Yeah, thank you so much, Jennie, and thank you again for working with Patient Forward on this series. I think all of the episodes have been amazing, and we just thank you for being willing to platform later abortion care in this way. It's really important. I'm Erika. My pronouns are she/her. I'm co-founder of a strategy and advocacy organization called Patient Forward. We're the only national organization focused primarily on eliminating barriers to abortion care throughout pregnancy. And I'm also, like Jen, a later abortion patient advocate.

Jennie: 7:25

Okay. Like I said, this whole series has been focused on abortion later in pregnancy. And sadly, we were at the end, but I'm so grateful for Patient Forward for all of their help in making this series happen. It would not have happened without y'all. We wouldn't have had such amazing guests. But now that we're at the final episode, I thought it was a good time to sit back for a second and think: what is the thing that you think is missing from the general narrative around abortion later in pregnancy? And I don't know who wants to go first.

Erika: 7:57

Oh, I do! Well, I mean, what's interesting is that I think what is, to me, the reason that we wanted to do this episode is that the central sort of intersection of later abortion and later recognition of pregnancy is so important. It's so relevant that we thought that it deserved its own episode and its own dedicated time because it is so sort of systematically erased from the conversation in most instances. So to me, that's the one I'll pick. I could give you a bulleted list, but I know Diana and Jen will have good additions as well. But I'm going to start with just later recognition. I mean, I just think it's just so crucial and that's why I'm so excited to talk about it today. I

Diana: 8:44

I think that later abortion is really the target of the most hateful language around abortion and so misunderstood. And the misunderstandings seem to trivialize people's decision making in a way that's just ridiculous. And so, like Dr. Shelley Sella says, if you can understand third trimester abortion, you can understand all abortion, that there's something, if you could understand all abortion, understand why someone could be late in seeking an abortion, you will understand so much more about all of abortion and all of the massive barriers that have been imposed on people to getting an abortion, particularly affect later patients and make everybody later or nearly everybody later. It slows people down. So at the same time, we're making abortion, we're heaping on stigma. We're also making everybody be later. It's, it's a crazy world.

Jenn: 9:48

I really agree with everything that's been said. For me, I think there's a reticence to fully embrace later abortion seekers with the same rights protecting fervor that we hear about earlier abortion seekers, particularly among our own, you know, major repro rights organizations. And I think there's a lot of focus on the reasons why somebody is seeking an abortion when they're later, but there's not a lot of focus on what drove this later. Why is it later now? And what outside the person who's seeking the abortion could have driven the person this late? So, yeah, I think that that really needs to be talked about more. And I'm excited to talk about it today.

Jennie: 10:39

Me too. I'm so excited to have all of you on to talk about this. Let's maybe start with Diana. since you were the lead researcher on the Turnaway Study, and you found that there were two common pathways that people experienced when they were needing a later abortion. Can you explain them and why later abortion will always be needed?

Diana: 11:00

Sure. One thing that I think wasn't fully recognized before the Turnaway Study was that some people are late to discover they're pregnant, and there's an assumption that somehow that's because they're irresponsible and instead what we find is that people have a huge range of experiences with pregnancy and some people have the benefit of not being nauseated and not being tired and not having all the symptoms of pregnancy. For wanted pregnancies that's a wonderful blessing to not experience some of the negative side effects but if you weren't trying to become pregnant then it's very possible for to spot throughout your pregnancy and not realize you're pregnant until quite late. And so I think that this lack of sympathy for late recognition of pregnancy is a problem. We also find that people who are using contraceptives in the month they conceived are much more likely to be late, which makes sense because they were doing everything they could to avoid becoming pregnant. And so they thought they were covered. And many people, many contraceptives, contraceptive methods, you don't get periods. So there's nothing to miss. So you can be late in discovering that you're pregnant. So one major reason that people are late in seeking abortion is that they were late to discover they are pregnant. All these states with six-week bans just completely make abortion unavailable for these folks. So in fact, if we're talking, if you look at people who had abortions in the third trimester, a third of them only discovered they were pregnant at or beyond 20 weeks. This is in the Turnaway study where we've removed people who, not including people with fetal diagnoses, which also happen later in pregnancy, or maternal health problems, which also tend to emerge throughout pregnancy, specifically in the later half of pregnancy. So late discovery of pregnancy is a major thing. And the other is barriers to getting abortion slow people down. So trying to make abortion more difficult to get. There are laws that explicitly mandate waiting periods. So that exactly slows people down by law. And my colleagues here at UCSF Answer have found that a 72-hour waiting period doesn't slow people down by 72 hours. It slows people down by more than a week because getting all the logistics to get somewhere and having an opening at the clinic Our laws, the ones that raise costs, that increase the cost, those slow people down because people are waiting, trying to raise money to pay for an abortion. And anything that increases the distance slows people down. So all of these abortion bans that make abortion, clinic-based abortion illegal in certain states will dramatically slow people down. And we've found that the fraction of people getting second trimester abortions, pre-DOBs, from these states with bans was 8%, and it's 17% post-dubs. So, it's more than doubled. So, abortion bans slow people down by making people travel vast distances. So, money, distance, both of those dramatically are a major cause of people needing to have later abortions.

Jennie: 14:34

Yeah, I think that's one of those things that people think of a lot of those abortion bans, like waiting periods or anything else that can slow people down in a vacuum or think of them as like this one thing and not understanding how they all interact together to push care further out of reach because it's not just a waiting period it's clinics in your area have closed and you have to travel further and that makes the cost more expensive and now you can't get a medication abortion because you got pushed further out so then now you need a procedural abortion now that's more expensive and you need to raise more money so these all interrelate and push care later and make people have to wait longer to access the care they need. Exactly. And then I guess the only other bit is, you know, I think a lot of people try to talk about making abortion care easier to access, which is great, but then making it seem like, well, then we don't need to worry about abortion later in pregnancy. So, do you maybe want to talk a little bit about why that's important and why we always need to make sure that it's available?

Diana: 15:40

Yeah. So if it were just about policies that slow people down and that was the only reason then better access would help everybody but that isn't the only reason people have later abortions they have it because they didn't realize they were pregnant they have it because some they got some information about their life or their pregnancy that made them reconsider carrying to term and so there won't be a point where you can say okay everyone deserving of an abortion could get it if only we set the limit at some number of weeks It's just that life is too complicated. People's situations are too individual for policymakers to decide some limit that would work for everyone. Instead, you know, limits stigmatize the people who are beyond it and act like they're not important. And just backing up for any listeners who don't know about the Turnaway Study; the Turnaway Study looked at people who were too far in pregnancy to get an abortion compared to people who are just under a limit and did get it. And when we follow people over time, we see worse outcomes. In every way those two groups differ, it's to the detriment of people who couldn't get their abortion. So greater poverty, worse physical health, poor outcomes for their existing children, less likely to have an intended pregnancy later. I could go on and on and I won't, but it's important for everybody to be able to make this decision. And it's not like people who have later abortions, somehow we should just throw them away and not care. Their outcomes, their kids' outcomes, their lives matter too.

Jennie: 17:22

Yeah, I highly recommend if you have not read the book about the Turnaway Study to read that. We'll make sure to link to the episode that we had Diana on the podcast before to talk about the Turnaway Study so you can get a much more in-depth understanding of the entire study and not just the little bit we were able to talk about today. Jenn, you have personal experience with later recognition. Can you share a bit about that and how it related to your decision-making timeline?

Jenn: 17:51

Yeah, definitely. So a lot of what Diana just said is personally relatable for me and I'll touch on it. So I found out that I was pregnant when I was 18. And when I found out that I was pregnant, I found out that I was well into my second trimester already. And so to kind of set the seen, I was struggling with an eating disorder at the time. I had come home from college on a medical leave so that I could attend eating disorder treatment in my hometown, which was in New York State. And I was going through the treatment and I was getting better, but my period wasn't coming back. And it's a very common symptom, not always, but very common that people who have restrictive eating disorders might lose their period. Amenorrhea is the medical term for it. And so, you know, I had a team of doctors who were working with me at the eating disorder facility. And none of us were concerned about my period because it just made sense for my symptoms at the time. And it was probably a couple of months into my treatment. By the time I was just talking to my mom and mentioning that my period hadn't come back and she very casually kind of offhand said, well, there's no chance that you're pregnant, right? And I was like, oh my God, no, I'm on birth control. And I had been on birth control for over a year at that point. But what she said stuck with me. And maybe a week or so later, I took a pregnancy test and it was positive. And a little while after that, I got a blood test and that confirms that I was pregnant. And it was the blood test that tipped off how far along I was or an estimate, which wasn't even, it turns out, accurate. But what was accurate was that I was told that I was well into my second trimester at that point. When I look back, I had a lot of symptoms of pregnancy and those symptoms were masked by the eating disorder that I was dealing with. I had nausea, but we thought that that was part of the refeeding process. I was gaining weight, but I was supposed to gain weight because I was recovering from my eating disorder. And so for that reason, I missed it. And the doctors that I was working with missed it. None of them asked me if I was pregnant. It was my mom who asked me. So that was how I missed it and how I found out. Of course, it wasn't as easy as, okay, I'm pregnant. Now let me get an abortion tomorrow. So that's what I thought it was going to be. And I was all ready to make an appointment with Planned Parenthood. And then they told me that I couldn't do a medication abortion because of how far along I was. Because I found out that I was pregnant when I was already in my second trimester, that meant I had less time to do all of the things that anybody who finds out they're pregnant has to do in order to make a decision about what they want for themselves and for that pregnancy. And then in order to gather the resources necessary to make that decision. And so I thought I had enough money for my abortion on my own, but now I wasn't looking at a medication abortion. Now I was looking at an abortion in a clinic that would likely take at least two days. because I had to go in first to prep. And that was going to be a lot more expensive. We're talking tens of thousands of dollars without insurance. And I realized I didn't have enough money. So then I had to take a few days to think about how am I going to come up with the money? Am I going to tell my parents? I had to psych myself up to have that conversation with them. And they were immediately supportive. I did tell them. They were incredibly supportive. And I am beyond blessed that my mother had an insurance plan that I was on that covered most of my abortion. That is like almost unheard of. That's not the case for so many other people, right? So many other people have to take the time to actually gather tens of thousands of dollars out of nowhere in a country where most people don't have enough money in their bank account to get through next month. So I had to make those decisions. Then there were all kinds of appointments I had to go to. I went to see my OBGYN. I had to get an ultrasound. I had to get an appointment at a clinic that would do my abortion where I was living on Long Island. There weren't any. So I had to go into Manhattan. I'm lucky enough to live in close proximity at the time to a major city that had an abortion clinic that does later abortions. Most people do not. Then when I got to the abortion clinic for, it was actually a hospital, for my first day for PrEP, they did an ultrasound that day. And they said, wait a minute, you're even farther along than we thought. It's going to be a three-day procedure. You have to come in for two days of PrEP. And then we'll do, so we can't even do it this week. We have to schedule you for another week. And so I had to wait another week. And at that point, they told me if I had been even a week later than I already was, I would have had to go out of state to get the abortion because at the time, New York State had a cutoff of 24 weeks. I don't remember if I was 23 or 24 weeks. I don't remember how they interpreted that cutoff at the time, but I know that I got it as late as I possibly could in New York. And that was even though I tried to get it as soon as I possibly could. The moment I found out that I was pregnant, It was, and I don't have it written down, but to my recollection, it was over a month between finding out that I was pregnant and getting the abortion. And I found out that I was pregnant already in my second trimester. And so that's how my later discovery of pregnancy because of my eating disorder greatly affected my abortion timeline and pushed me later. And when I look back on that story, I think about all of the ways that I am deeply privileged to have had access to insurance, to have lived in close proximity to a clinic, to have lived in a state that allowed me to get an abortion up to 24 weeks when I could have been living in a state that had waiting periods or a state that didn't allow me to do that at all. I believe myself to be very grateful. I mean, I am very grateful and I believe myself to be very privileged. It took me a long time to get to that point because for a long time after my pregnancy and my abortion, all I felt was frustration and despair that I had gotten it so late.

Jennie: 24:10

Jenn, thank you so much for sharing your story I think it's so important that people hear a full range of experiences that people have because I think a story like yours is not one you hear as often right there is so much focus on the the fetal indication that you don't hear the other stories as loudly they don't break through as much I think some of them are shared but but they're not the ones that are being like heralded and that you hear in like big loud like crashing like This is why it's so important. And these are all important that people are able to access the care they need.

Jenn: 24:47

Yeah, I really agree. For a long time after I got my abortion, the only time I heard people mention later abortion was either to just flat out demonize it or to say, no, we need later abortion because people find out about fetal indications and we need a path for them to be able to make decisions about their pregnancy and their fetus. like, fully. And I was not hearing, we need later abortion because some people just need an abortion and it's late. And that was... And that just drives stigma, right? Yeah, I felt... You feel alone. I felt very, very stigmatized. You know, I, for a very long time, I was thinking, oh my God, what's wrong with me? Like, what is wrong with me that I needed an abortion for some completely different reason? Like, why did it take so long? I should have realized sooner. And also, like... a little emotional just thinking about it i always do also the i mean the most stigmatizing part is feeling like people people can understand later abortion when it's for fetal indication Even if this next part isn't spoken aloud, the implication is that if you're getting a later abortion for another reason, it's too late for you. Like you shouldn't get one. We're not okay with that. And that was the message that I was hearing and internalizing for like 10 years after my abortion until I got connected with Erica and Patient Forward and until I found out about Diana's research. And all of that just changed my life.

Jennie: 26:27

This whole idea that I feel like permeates like all of this anti-abortion Yeah.

Erika: 26:58

And I like, I just, sorry, this is Erika talking now. I guess I just want to really highlight and not try to cover that this is stigma that is perpetuated by people who get paid to advocate for abortion. Okay. This is anti-abortion stigma. And I just think that we are like past time. This is when we need to be having these conversations now that we're no longer sort of under the thumb of Roe. Now is the time to ask ourselves and to really take accountability, I think, to people like Jenn and so many thousands of other people who have been made to feel this shame and stigma by the people paid to protect abortion. It truly blows my mind. Whenever I'm privileged enough to hear Jenn or any later abortion patient tell their stories like this, it just really kills me. I just These are not the antis, but it is anti-abortion, anti-abortion stigma perpetuated by supposedly pro-abortion people. Because what our exceptions are saying is that we need exceptions to keep the, quote, wrong people from, quote, "misusing abortion services." Who is that? Who are those people? Not Jenn, right? I'm sorry. I'm so fired up. I'm so angry. Every time I hear Jenn's story, I just get so angry all over again. Jenn, thank you for sharing. It means you have changed the world. Here's the other thing. Before Jenn telling her story like this, I mean, it was so few. There are a couple other people in this whole country who would be willing to talk about their experiences like this, and I truly believe it has changed the world. I just am so grateful to you, Jenn, for for continuing to tell your story and to represent the majority of later abortion seekers. The majority.

Jenn: 29:02

Thank you, Erika, for your anger on my behalf and really on behalf of everyone else who needs a later abortion. Yeah, I mean, I would watch debates, political debates. I would watch politicians that I planned to vote for talk about why we should have, you know, viability restrictions. And depending on your definition of viability, like I might not have been able to get an abortion under a viability standard, given the timeline of my pregnancy or people talking about exceptions. And my pregnancy would not have fallen under any of the major exceptions that are so frequently talked about for such a long time. And still, to this day, today, still, even now that we no longer have Roe and we can make our own framework, even still to this day, I hear pro-choice organizations supporting restrictions on later abortion. And I take it personally because it feels like saying if you need an abortion for any of the reasons that our movement has accepted people need to need abortions if you just need an abortion because you don't want to be pregnant and you have bodily autonomy and we love and support your bodily autonomy that's great but if you need it after a certain date We don't care about your bodily autonomy anymore. And it was like, well, but why? Why doesn't my body and my decision and my future and what I want for myself, why doesn't it matter as much as people who didn't have an eating disorder so they found out earlier or people who weren't on birth control so they found out earlier or people who just found out earlier, period? It's deeply stigmatizing and that stigma can do serious damage. For a long time, I thought that my abortion had been traumatic. I've done some work since. And now I understand it was my pregnancy that was traumatic. It was the fact of realizing I was pregnant so late. And then all of the stigma that I internalized that I used to beat myself up. It's just unacceptable for our movement to put people in that position.

Erika: 31:10

No, that's important. And just in case like maybe a little bit of data is helpful to back you up. I think it's also would be surprising to a lot of people how common later recognition of pregnancy is. is. I think that there's this idea that, you know, people just immediately feel nauseous, peonistic, and you know that that happens at like five weeks or something. But we know that one in 13.5 pregnancies are discovered after 12 weeks of all pregnancies. That's a lot. And that's after the recommended window for medication abortion in the United States, which is how the vast majority of people are getting care right now. And so you understand that it actually affects so many people. I think we've been sort of victims of this small numbers theory where, you know, this doesn't affect that many people, therefore compromising on their backs isn't that big of a deal. But in fact, it is a big deal. The 1% of abortions happen after 20 weeks is a fake stat based on a deliberate misreading of CDC data. And we know that later recognition is incredibly common So this not only affects thousands and thousands of people a year, but we know that it tends to affect people that are already living at the margins through no fault of their own, who lack healthcare, housing, who are experiencing food insecurity. It's the same people, young people. I mean, Jen was young. Young people are overrepresented among later abortion seekers and those who discover pregnancies later for very obvious reasons. I think I think that it's very, I mean, if you think about it for just a moment, it becomes, I mean, honestly, sometimes I think, how does anyone discover a pregnancy early? Like when you look at the sort of systemic forces at play, you're like, wow, in these United States, people actually can figure out they're pregnant early and get to an abortion early. It seems miraculous that most people in fact can, because the structures that we've built make it very easy for someone to be in Jen's position. or, you know, I haven't talked about this much, but I discovered a pregnancy later. I had a third trimester abortion and soon after I was pregnant again a month later and my body was very out of whack. And a couple months after that, I had a miscarriage in a Whole Foods bathroom and it was very traumatic. I was in the Whole Foods bathroom for hours. My husband and partner at Patient Forward, Garin, had to like buy me a very expensive, you know, like yoga outfit from Whole Foods because I completely, I mean, I had a very dramatic miscarriage in a public bathroom. And, you know, after that, we decided to see a fertility specialist because by then I had had a lot of losses and we were actively trying to become parents. And, you know, months later, I was in a fertility clinic and, you know, they took our history, heard about all my complicated pregnancies. And then they said, okay, let's Quick do a physical exam and the doctor did an ultrasound and he said, there's a baby in there. And we said, what? The nurses all start crying because they've heard our history. And they're like, oh my God. And they're all saying, they're like, well, we don't normally get good news this quickly at the fertility clinic, but there's a baby in there and she appears to be around 14 weeks. So you really need to get into a OB immediately. And sure enough, and we were shocked. By the way, another commonality between my story and Jen's is that we were both actively seeing, like having very active medical care, like we were regularly being seen by doctors. After my miscarriage, I went to my OB to be checked. And they said, Oh, yeah, well, you just got to let it complete, you know, because, you know, they just did sort of an oral exam. And that was it, there was no follow up. So no one noticed that I was still pregnant and likely lost a twin. You know, again, pregnancy can be a hellscape. You know, it's just so squirrely. And it just can't possibly be contained by the law. I mean, it just is so, I mean, it's lunacy. But in our case, we were very lucky because, again, we were actively trying to be parents. So we got into prenatal care as quick as we could, you know, and that's now our kid. You know, that's our child. That's, you know, that's how she came into this world. And we were already doing abortion advocacy. And so to experience later recognition like that just really brought it home for us. You this really could happen to anyone. All of the sort of stigmatizing conventional wisdom that we all hear is complete bullshit and we have to stop perpetuating it. And I think a way to fight this disinformation and stigma is by hearing stories like Jen's and so many others who just really, anyone hears Jen's story or I can speak for myself. I heard that story and said, well, that could have been me at 18 very easily. And I think we can all identify with these stories when we hear them.

Jennie: 36:33

Okay. So that is, I feel like such a perfect place to end, but we also have to get to Erika's part, which is the policy and advocacy part. So Dr. Foster talked about the research Jenn walked through and Erika as well, personal real life experiences. Erika, do you want to talk about how all that leads to policy and the reality of doing advocacy around abortion later in pregnancy? And also what are you seeing right now for the legally landscape? Is it getting better? Is it getting worse? What are we seeing?

Erika: 37:06

Well, there's good news and bad news, which I'll share. And then, of course, I'm so eager to hear Jenn and Diana's thoughts on this question, too. But from my perspective, first, the good news, research shows a monumental shift in culture change. That's good news. A majority of people consistently say now that they do not want government interference in pregnancy decisions, including explicitly in the third trimester. So public opinion has undoubtedly moved, and it's moved towards supporting and not punishing people throughout their pregnancies. Now, before people come for me, does that mean people are not still uncomfortable about abortion later in pregnancy? Sure. But they're also realizing that they can both feel uncomfortable about something and not want to meet that discomfort with giving the government tremendous power to police pregnancies. So that's good. Morgan, Good news is that more all-trimester clinics are opening more than ever before, and they're led by young, diverse clinicians who are offering modern, trauma-informed care. This is great news. More good news, I want to highlight our colleagues in Massachusetts. For the first time in any state, Massachusetts advocates are loudly and boldly working to repeal the state's viability limit and recognizing that government has no place in pregnancy decisions. And that is the first time we've ever seen that. Other states have repealed viability limits, but they've done it quietly. This is the first time we've seen a whole campaign around doing it. And by the way, Massachusetts voters are supporting it by 66 percent, according to the polling. So that is great. Some less good news is that we're still overinvesting in later abortion bans. Since Dobbs, 10 states have enshrined viability limits into their constitutions and collectively ballot measures with viability limits have cost upwards of $200 million altogether, and we're expecting to see more of these bans on state ballots next year. Obviously, we do not think that it's a good idea to spend hundreds of millions of dollars on protecting the state's right to criminalize people later in pregnancy. It is a horrible trend since Roe. That's been kind of heartbreaking. More bad news, 41 states do still ban abortion at some point in pregnancy. Nearly half of those states are around viability, usually interpreted on the So there's still a long way to go, you know, before the field meets people where they are in later abortion, which is to say people want full reproductive freedom throughout pregnancy. They don't like pregnant people being criminalized. And we think it's time that our policies meet people where they are. That's sort of the long and the short of it. But I'm eager to hear what Jen and Diana think as well. Good news. Good, good, bad policy news, I guess, is the sort of broad, the broad prompt.

Diana: 39:58

It's this is such an honor for me. me to be on this podcast with Jenn and Erika. I have never met Jenn before and her story is such a perfect capture of so much scientific data. I know that's not how she wanted to live her life is to act out scientific data, but we have found that young people are much later to recognize they're pregnant because their periods are irregular anyway, because they may not be familiar with all the symptoms of pregnancy. People with chronic health conditions which she was experiencing also are later to discover they're pregnant because often chronic health conditions have the same symptoms of pregnancy. And Erika's story of having been recently pregnant and that explaining why she was late to discover pregnancy, that's also something we see because having been pregnant and your body's still recovering and feeling terrible, especially if you deliver the child or... Had a massive miscarriage in Whole Foods. People's bodies experience lots of symptoms for lots of reasons, and it's not always pregnancy. And so it's perfectly reasonable that you could not know you're pregnant. You can also just not have symptoms. So this is, yeah, really an honor to be with people who are willing to share their personal experiences. And the science has their backs completely.

Jennie: 41:27

I always like to end the podcast by not just talking about like what's bad or what we need to change, but how can the audience get involved? So what are some of the things the audience can do to get involved in this conversation or this fight?

Erika: 41:39

I'll start. I guess what we know, both because we're people who notice things, but also this is backed up by research, is that stories go a long way in helping change hearts and minds. And what we also know is that secondhand stories, like telling someone's story that you heard, that you read in the news, can can be as effective as hearing it from the person themselves. There are organizations that have spent a lot of money on doing a lot of deep canvassing and that's one of their big takeaways. And I think if you're listening to this podcast today, you now know Jen, now you know me. And so when your friend or family member or coworker says something wrong and stigmatizing about later abortion care, you can say, well, you know, actually my friend Jen experienced this when she was a teenager. And she was going through a hard medical event and blip, blop, bloop. You know that story now. You know us. We're friends. And so please use these stories to help fight disinformation. That's something you can do.

Jenn: 42:42

I just really agree. I think for me, the more I share my story, the more empowered I feel in my own experience and the less shame and stigma I feel. And the more I share my story, the more people come up to me and say, oh my gosh, that's so crazy. What happened to you? And I'm I'm like, yeah, and it happens to so many other people who don't have the resources that I had. So I just want to echo, I think, sharing if you have a later abortion story or a later recognition story and you feel safe sharing that, absolutely please do if that's a place where like if you're comfortable with that, but also just talking about it more in general, pushing back on misinformation in general when somebody says something that doesn't feel accurate or when someone one says something stigmatizing, even if it feels uncomfortable to push back, doing so as long as you feel safe is so important and can help make people think, oh, I didn't realize that the way I was phrasing this is exclusionary. I didn't realize the way I was framing this leaves out people who are having this experience. Maybe I need to rethink how I talk about later abortion. The more you share, the more minds you can change and hearts you can open.

Diana: 43:56

And I'll add, in addition to the share of stories and humanizing the experience rather than letting it be some ideological debate that this is actually a human experience that is so shared and that people deserve compassion and humanity is that there's so much to be outraged about right now and that's a problem for so many reasons but one is that our attention is constantly being pulled by other things and there I know that abortion funds have seen a drop off in their funding. So especially funds that help later abortions like the Bridget Alliance are worthy recipients of support so that if you can keep that cause in mind while we're faced with such an onslaught of important issues, that this is one that still deserves attention and increasingly deserves attention.

Jennie: 44:57

Okay. I want to be respectful of everyone's time, especially since since I know Diana has to run. So Diana, Jenn, Erika, thank you so much for being here today. It was so wonderful to get to talk to all of you.

Diana: 45:08

Yeah, thank you, Jennie and Jenn and Erika. Really great to spend time with you. Thanks so much.

Erika: 45:14

100%. Same, same.

Jenn: 45:16

Yes, thank you, everybody.

Jennie: 45:18

Okay, y'all. I hope you enjoyed my conversation with Jenn, Erika, and Diana. I had so much fun talking to them about abortion later in pregnancy and later discovery. It was just such a great series and I am so grateful to everybody at Patient Forward for helping make this happen. So thank you again, and I will see everybody next week. If you have any questions, comments, or topics you would like us to cover, always feel free to shoot me an email. You can reach me at jennie@ reprosfightback.com, or you can find us on social media. We're at Repros Fight Back on Facebook and Twitter, or @reprosfb on Instagram if you love our podcast and want to make sure more people find it. Thanks, all.