you fall. i am so excited to be with you here to discuss your book. let us start at the beginning. like me, your reporter covering the impending and then actual fall of roe v wade. what made you want to add to

your already overloaded work schedule and a book to it? it justt so important to me that we have something really comprehend that went beyond the day to day news and beyond the politics to really understand who are the people who are affected by this? xgwhat does it mean to live as someone who can become pregnant in an america without roe v wade? i don't know of any other format other than a book in which we can really get into those stories and it was obviously a lot of work to do while covering this, but it just felt so critical. and i'm so glad that we finally have the finished product. so obviously 2024 in 2020 for abortion is an enormous subject, one that encompasses politics, religion, health care, gender equality, among other things. yespecifically focus on providers and patientwhy wast was the most important place to focus? there's an obvious answer, which is i'm a health reporter and when i write stories, i think abou doctors nurses, medical

personnel, and i think about the people they treat. but in this particular story as well, i think that this can feel so abstract for so many people. they understand abortion as a political issue. they understand it as something they might hear about at church. they might think; about through all these other lenses. but to really understand what this means, you need to know what it feels like to, be in a clinic or to be at home, getting pills, to look at that pregnancy test and see, i am pregnant and i don't want to be. and to figure out what that means. i think that only by really spending time with these stories can we fully grasp what world we are living in now and how much it has changed from two years ago. and really the focus on providers to i think we sometimes do think about the patients, but we rarely think about the people who are providing abortions. they are caricatured by the anti-abortion movement as people who are out to make profit. they aom ignored by most of the medical community. i mean, you really found a mb of health care

professionals, abortion providers and providers care why torn by all of this and what's so striking to me is these are very, very well-trained physicians, nurses, technicians. they have gone to school, in some cases for a very, very long time to learn how to do the care that they are providing. and what they have seen is their expertise just complete dismissed. and there are political reasons for this. of course, we have abortion bands that are in effect that lawmakers did not intend to have an impact when they passed them. we have, as you mentioned, this long history, the anti-abortion movement vilifying doctors in part because it was a politically easier sell than vilify people. but what what i really found was these health care providers have been working tirelessly, not even for just the past two years, but especially now. and they feel a great sense of of moral urgency, of the duty that they to on when they

underwent medical training to provide care their patients. and they also are just so afraid of what comes next. they know that things can only get worse for them and for their patients unless there is political change. a lot of the coverage of sort of post roe and i am guilty of this as much as anybody has been of these what i call the wanted pregnancies that have gone wrong. they're mostly white, mostly upper middle class women who have the ability to speak out and get on tv and into newspapers, who have truly tragic stories. but that's not really the majority of abortions or even the it is a minuscule piece of the people who get abortions every year. of how that how it shakes out who who the people who most get a■bo in this country. i'm so glad you brought that up, because it was really important to me that this book capture that which is people who get abortions, they are usually in their twenties. they are usually people of color. they are usually already moms d they discover this pregnancy

and do not want to keep it cannot keep it because of economic reasons, because they know intimately what it means to already have a child and to know that they cannot go through that again while being a good parent to the family. they already have. there's a story in this book that i think about a lot of a young woman named angela, who is exactly that shexas. she is latina. she has only had her son when she learns she is pregnant again. and that is the kind of story that maybe is harder to talk about because it doesn't tug at your heartstrings in the obvious way of the the person who almost died wanting to have a kid. but it's so important. and these are stories that really deserve our attention because they reflect the reality of who is most affected. so i feel like you've chosen people, individual roles to be to represent sort of the populations that are most likely to find themselves in need of an abortion and having a difficult time getting one.

talk about how you sort of decided to to structure the book. the book is structured in four parts, and there are four main characters we follow. many other smaller stories come up along the way. but there is a young woman named tiff who is a teenager in texas. when she becomes pregnant before roe is overturned. but after senate bill eight, the six week abortion ban cut off access for most texans. she ultimately does have a child. and her story really illustrates for us the systemic barriers that make abortion impossible, even when you already have this little window that exists. the there is the story of angelo, who i just mentioned, and she captures exactly that. the normal person who is seeking an abortion, the parent and the what it means to be a working person, to struggle to find the six, $700 to pay for that. and that is just too much. and to find travel costs on top of that and the stigma that comes around abortion, she can't tell her family about she knows that they would judge her and look down on her and maybe even cut her out of their lives. there is a mother named darlene

whose story i spend a lot of time on. she is closest to the stories that we often hear about where she becomes pregnant and really wants to keep the pregnancy. but there are complications where she is not sure if it is safe. no doctor is sure if it is safe, but they can't even give her a sound medical advice because they are so afraid of breaking the state laws and ultimately she has the means to fly to california from texas to get medical care that is actually appropriate and comprehensive and allows her to make her decision for herself. and the last story i think about is a young man named jasper, and he lives in florida and he is trans and he finds out he is pregnant right before bobby. then 15 week ban is in effect. his story is so important to me for a few reasons. there is the fact that not all people who get abortions are women. and we need to talk about that. we often don't. there are trans people. for someone like jasper, he is living in a world that has put real restraints on his health

care on two fronts. the abortion that he ultimately pursues, and gender affirming care that is important for his medical, health and well-being. and on top of that, his story really underscores how even a 15 week ban on abortion can have really, really intense consequences. he doesn't find out he' becausee thinks to test him for pregnancy because he looks like a man and when he does learn. he has one week, even in he wans an abortion to find the money, to make the appointments, and to go to a clinic twice over 24 hours. he thinks a lot in the following. whether that was the right decision, and even though he knows he can't be a parent all he wishes is that he'd had more time to make that decision on his own terms. i've been covering abortion for a long time, since the late 1980s, and i'm kind of jealous because all of the years i was covering abortion, roe was in existence. abortion was technically legal.

every place in this country. and yet it was so difficult to find either providers or patients who were willing to talk to me and have their names used because there was so much stigma around abortion. people. you know, we would hear that one of every three or one of every four women had had an abortion. but most people don't know that their friends and or relatives because, as you say, even even now people are afraid to tell their close friends and their family members that they're doing this. how did you find these people? and i. i confess i'm jealous that people are now willing to talk about this more openly. i think it's come as a big surprise to a lot of people how common abortion is, how common pregnancy complications are. i mean, it's not just people who you know, are young and discover that they're pregnant. it's people who are getting pregnant on purpose and then having difficulties later on. i think what you're speaking to is there really has been this shift in the culture of how we talk about pregnancy and how we

talk about abortion. and part of that comes from every single story that is published. it makes it a little bit easier because people see there is someone else out there like me. and maybe if i share my story as well, the next there's a real sense of moral urgency that i felt like i heard from patients and providers, especially early in the post jobs landscape. they really, really hoped that by being public about their experiences that, they would lead to. at the very least, people understand just what it means to be someone who can become pregnant in this country and just what a burden has been placed upon them because of these new laws. i'm glad you mentioned that, because the name of the book is undue burden, which is kind of a double entendre for those of us who are deep into this issue. tell us why you named it undue burden and what that refers to undue burden as as you know, and as you referenced, is it's a phrase that comes from a supreme court case. the less famous roe v wade case.

in some ways, planned parenthood bkc in which that decision came in 1992, and it was seen at the time many expected it to overturn roe, and in fact, it upheld roe, but it weakened it. it said that states could not ban abortion, but they could regulate it as long as the laws they passed did not impose an undue burden. people seeking care. and this was a very confusing standard. people did not really know what it meant. and it had been interpreted in lots of different ways. it was used to uphold a lot of restrictns dobbs that made abortion, if not illegal, still quite difficult to come by. it was not easy to get an abortion, even under the roe casey framework. when i thought about undue burden as a title and i have to give some credit to my brilliant editor, kara reilly ater ideas. and i just fell in love with it because. we are living in that world now. people are, in fact faced with that undue burden. and this is what that looks like. talk about some of the barriers.

i mean, even before roe v wade felt that, because i think you illustrated so well in the book about the difficulties even where abortion legal in getting abortions, abortion has been so hard to come by for a long time. and part of that is, what it means to get health care in this country in general. abortions are expensive. they are an inherently unplanned expense. and even before the dobbs decision, most insurance plans, especially medicaid, did not cover abortion, which means you have to pay for something. you definitely really did not expect to. and it will, at a minimum, be hundreds of dollars. but it can be thousands if you are later in pregnancy. it can be tens of thousands of dollars. and where we are now is the stakes are even higher if you areng out of state for care, you need to find potentially child care. you need time off from work. you need someone potentially to come with you if you are having a later abortion and it is more advanced, you might need to rent a car, find planefind a hotel, figure out how to get

around in a place you've never been to before. these are in credible barriers, even for people with great means and what it speaks to is just abortion has never been easy to come by, but now, even with a right that is protected in some states, it will become more difficult, has become more difficult for all of us. as you point out, in book, a lot of what's happening is completely predictable. was there something that really surprised you in the reporting on this? i think what i have been struck by over and over again has been the power of medication, abortion. and this is something we read about in the news as well, that there are who have gotten these shield laws passed in their states that are meant to protect them as long as they stay in their home states and they are prescribing and maili pills to people in states with abortion ban. so if i lived texas and wanted to order abortion pills, i could have a doctor in new york prescribe them to me and they would mail them and in theory, at least a doctor wod be

protected. this would be medically very safe. i could terminate my pregnancy at home. this has become a much more common regimen. but even as i was so surprised then and really taken by how much this has achieved, i think it's important to note that it's not an option that works for everyone. it's not an option that would have worked for a lot of the patients we describe in this very book. and it d come even if patients are not breaking laws because abortion bans do not target the patients, it still brings legal risk that a lot of the people i spoke t very concerned about. yeah, i did. i noticed that people seemed that people you talked to seemed very worried, even though they, in theory, could not prosecuted themselves. there just seemed to be so much uncertainty in all of the states and states with bans and states with restrictions in states without. and there's some really great polling that's been done by kff that shows that largely don't know what the abortion laws are in their home states. and then you on this this fear, this sense that, well, my state did say it's illegal and here i

am trying to get one. what if i am breaking the law? we don't know what our health care like. we don't know all sorts of things. it is a lot to ask someone to be able to keep track of these drastically changing laws and what the punishments are and who is covered by and who is not. and they change frequently. they change constantly. i was in florida a couple of weeks ago and i remember hearing people calling the clinic on the phone to figure out what the abortion law was there because they just switched to a six week ban. they did not know florida had switched when they tried to understand the different laws in north carolina versus virginia. they were really confused. they didn't understand why i had to wait and go to visit separately in north carolina, but not in virginia. but the appointment is closer in north carolina. but in virginia, i could still get my abortion faster. it's just such a patchwork system. it is so hard to understand. even if you cover this full time. yeah, i know. one of the things that surprised me is that a lot of the states that are putting themselves out as haven's place in blue states

that have a lot of abortion clinics and you know, abortion rights supporting legislatures and governors actually haven't done all much to help a lot of these clinics, particularly those near the border where people are coming from. the states where it's now illegal. i had some phone writing those chapters. as we go back to. there's one chapter set in illinois, in new mexico, these two bordering states that have seen lot of people travel there for abortions, especially illinois. but if we go back to the summer that roe v wade was overturned, the illinois governor said he would call a special session and pass all these laws to make sure that illinois could be a sanctuary. he didn't do that. he waited until the legislature came back and then they passed laws. and then they added more support. and, you know, you work on your own schedule. but what that really underscored for me and many people i spoke is that there were differing levels of urgency based on how immediately and how you were affected. the other state that i think

about a lot is california which has seen also a lot of people traveled from out of sta. the state has put funding into trying to support abortion care in their state. and for people traveling there. but it's a tremendous burden to be pce was already underfunded because states have never put a lot of moy the federal government doesn't. and what we see is this the system that has been underfunded for a long time gets more resources but still has a tremendous new strain upon it. and at the same time, you have people being asked to do something really quite in incredible fly from texas or louisiana or somewhere far to jcalifornia for an abortion. on a short timeline, because of the time sensitivity of this procedure. it's just it's too much for single states to try and fix on their own. of course, this is exactly what the anti-abortion community wanted. right. they wanted to make abortion as difficult to obtain as possible in as many states possible. and that's exactly right. the goal was always to make

abortions not happen, to have people stay pregnant and give birth, have more children, and i think there are some things that we get it in this conversation even that have the anti-abortion movement. the fact that people have been able to travel, have been able those are sources of deep frustration to them. and they would love to find ways to limit that they are working actively to figure out how to get to that next stage, where if abortion is illegal in your state, are not going to get one. but i mean, it is certainly a success for them that even when people can circumvent these bans, it is incredibly difficult for them to do. so. i feel like dobbs is kind of rock that's been dropped into a pool and we have these ever widening ripples. i mean, sort of the first one is i think you've already are the the stress on the clinics sort of near the border. in the border states, two states with banned, but also it affects how women get other sorts of

medical care and othertright. exactly. i spoke to a lot of doctors who, you know, they used to provide colposcopy and they used to provide pap smears and contrast supportive care. and then they only had time to do abortions. there's a clinic that i think about that used to do gender affirming care and they couldn't because now they only can do abortions. and this really underscores the spillover consequences. you may live in a state where your health■yq/e not changed. where, if anything, you're right to an abortion has been strengthened. but that doesn't mean that you weren't losing access to reproductive health care because we are just putting a really intense burden upon a deeply frail system. and we we don't have the means to to address that, to make the system less frail, to bring it back to the size it once was, let ale be to adequately to what patients are looking for. yet one of the things i think that was unintended but has happened is that it's become

so much more difficult to get an abortion in many of these states. people are having abortions later in pregnancy, which of course, is the opposite. if you look at public opinion polling, people are much more favor of abortion. the earlier in pregnancy it is, but that's kind of the opposite of what's happening. absolutely it is. a loss for the anti-abortion movement. it is also loss for health care because abortion is safe no matter when you get it. but it is safer and easier. the you are in pregnancy when you are in your first trimester, you have more options. you can do you can do a procedure. but where we are as patients just don't have the ability to get from i don't south texas to new mexico, arizona or illinois within as quick a time as they would like to. they need to find the money, find the time off and the appointment, figure out all those barriers we talked about and then get to the next appointment in clinics that have been overwhelmed, that can take several. and the thing about pregnancy is it just keeps going and then

before you know it, you are 15 weeks pregnant and this is the abortion that you want when you were six weeks along. but you get it until this point. the other thing that that does, of course, is it puts strain on providers because medication, abortions, which are very common and effective and in the first trimester are easy. you give someone some pills. you talk to them about the consequences and you do follow up later and they take the pills on their own. no$cw you have to do these procedures. if someone is later, that takes longer, takes more resources. it limits what capacity you have when you already are seeing a much higher demand. ■so the way that this is sort of rippling out, you don't have to be po be seeking birth control to, have this affect you. right. it's affecting the actual supply of health professionals in some of these states. it absolutely is. and i know you've done really great work on this. this was really part of the book was what means for the training of medical moving forward. and if you go or become a

medical resident, the training after med school in a state with an abortion ban, there's a real problem, which is you can't learn to provide abortions as an aspiring ob gyn in a state that outlaws abortion. and this matters because abortion care, it alsoarriage ce miscarriages and.e we pe medically, medically, yes. of course. and you don't you don't enough miscarriages as a resident often to become really proficient to provide excellent care so abortions are really helpful in getting up to speed, being really excellent at doing this foréd i've spoken to so many doctors who are just deeply concerned about whathappen. are we going to have like half of doctors who just weren't able to become trained in providing this care because it wasn't legal for them and the only option they was to fly out of state once a month, get training and then come back to where they lived otherwise.

it's it's pretty untenable. and there are other concerns about long term deterring doctors from becoming obgyns at all and choosing other specialties. and this is already a difficult field and is one where we don't have enough providers, where there are, you know, greater higher malpractice insurance, lower reimbursement rates. we, from a public health standpoint, do not want to be deterring doctors from going but that is exactly these laws could do and it's not obstetrs and gynecology. we're seeing this sort of across the board that graduating students don't want to go to states with abortion bans, restrictions partly of who they are, not necessarily because of what kind of doctor they want to be. exactly. the majority of health care workers are women and you think about the timing of medical school very often by the time you are a resident, that might be when you're thinking about starting a family. and i have spoken to so many future physi who understand that if they live somewhere with an abortion ban, that could affect them professionally and it could affect them personally.

if they have a choice, they would much rather live somewhere where they know that if they become pregnant and something goes wrong, they will have access to the standard care and not have to worry about it being compromised by a state's laws. i was surprised to see smadocton is clearly legal who are concerned about providing abortions to people coming from states where it's illegal to talk about that and some of that is starting to shift because we have these shield laws in place. but what those do is they protect physicians only when eylaws exist. and i've spoken to doctors asking them, you know, would you want provide medication abortions to someone in texas while you're in california and they are they aren't sure because some of them are licensed in a state like kansas as well, and they don't want to jear license, not be able to provide care there. they also know that if theyto ad broken when they weren't in it. you know you have a layover in texas on your way somewhere

else. dallas fort worth is a huge airport like you could be in legal trouble. and that is a tremendous to ask of people who are doing this. yes. because they love it, but also because it's a career, it's how they support their lives and their families and to something re is just so much legal uncertainty right now that it's very difficult as a physician to know w what might even if not n, someday put you in legal jeopardy and going forward, i mean there are efforts to outlaw abortion nationwide and there are ways to do it right. exactly. there is the comstock act, which we have talked about a lot. it is this 19th century anti immorality law. it was used to ban ulysses, ban leaves of grass and it also used was used to restrict access to birth control and to abortion and the birth control provisions been repealed. but the anti-abortion provisions are still on the books have never been repealed, have not been enforced because in part of

roe, but an antiabortion administration could use those levers to ban medication, abortion nationwide or ban abortion across the country? and that is something that the former president trump has not weighed on explicitly, but many of his former advisors have. and they would love to do that if given the chance. there's also, you know, cases in front of the supreme court. i mean, this is not you're talking how uncertain the law is. the law hasn't finished developing where it's going to go has it? exactly. and i mean, there were doctors i spoke to in this bookm their ofs in new york watching cases play out in texas, play out in idaho, wondering what is this going to mean for me and how i provide care. in new york, the judges who are making these decisions, i did not vote for them. they are not accountable to me. and yet they could institute decisions that will make it very difficult for me to give my patients. the standard of care we've about the mifepristone case in front of the supreme court. that is a very obvious example.

it speaks in large part how concerned thecation, abortion and, their desire to restrict access to it because of its effectiveness in undercutting abortion bans. and that case, i mean, we'll see how the court rules, but it's really an opening salvo in a longer campaign to limit access to medication. abortion and to ultimately lay the legal for a jurisprudence that would allow for national abortion and we should talk about personhood, which is also a goal for for some people, which is the idea that as soon as an egg is fertilized, it becomes a person with full legal rights that could have implications well beyond abortion. absolutely. we have already started to see that play out temporarily in alabama and that all happened after this went to print. i mean, it's not something that we talked about, but it is something that the ideas are very clear, which is if you believe a fertilized egg, an embryo is a person you don't support ivf, you don't support some kinds of birth control because you you see this egg in

the -- and you say, we have to protect that, even though like a lot of those would never actually become a fetus, let alone become a live being. but that is a very natural point for a large sector of the anti-abortion movement. they are concerned about the politics right now and would ke to do their best to wait until some of the anti jobs backlash has abated. but it is absolutely something on their mind and something that we are going to start seeing play out in state courts across the country and eventually in state legislatures. what it mean beyond things like, you know making ivf illegal? i mean, miscarriage could be illegal. and that like that is really striking because we any one of us who becomes pregnant miscarry and that if view the law of a fertilized egg as murder, as manslaughter, what have you, then what does that mean for the person who was carrying that do do you blame them legally and we

we already do have anti-masker stigma that exists against a lot of people who lose their pregnancies like we can't control that. and that makes as a whole just so much more legally dangerous. it really builds upon the idea that i heard over and over from patients and providers in this book of this notion that if you can become pregnant, you are a second class citizen. we've already seen in some states prosecutors going after investigating pregnant women for things that they might do while they are pregnant or if they, you know, if they miscarry in what are considered suspicious circum i imagine that this is only going to sort of grow. yeah. and i mean, to your point, like that's not we had that before the dobbs decision as well. and what we do know about that prosecutorial, you know, going after usually after women of cr or low income white people like this is not something that happens equally. it is in many ways

discriminatory. and there is a real concern that as the anti-abortion movement becomes more emboldened and as they find more laws that are pa o laws can use, whether that is you something about chemical endangerment and or i don't know some kind of like murder or statute people will start trying to use those as well to to really pick and choose how they want to enforce anti abortion not just law but ideology. i was taken by how many women that or patients include jasper were so a so worried about what might happen to them but also had so much difficulty finding information i guess you know having reported on for so long, it seems that there's much information that's out there. you just, you know, google meit all comes up. it doesn't all come up. it really depends on who you are, where live, how your algorithm works. like i spent some time at an

abortion clinic that was just getting started in illinois and it couldn't get listed on google for a long because they were so new. it much easier now than it was a couple of years ago to find information about managing abortion. but you have to know what keywords to search, whether that's mifepristone or abortion pill or plan c or eight access. and these things that that we know about because write about these these are things people who are online in the right internet know about because it comes up in their community but it's not as widespread as as many of us would think. and the thing about any kind of health care is you don't think about it until you have to like i don't wake up thinking maybe in a few years i'll need a colonoscopy because why would i? and by the same measure, people think about abortion, what the law is, how to find it, what it means to get an abortion until absolutely must. so talk about abortion funds, which i think is■/ something tht people that that are out there, that people don't know about it.

so so striking to me how abortion funds are and how few people know about them. they are these small nonprofit, often very, very low staff organization ones. they take money in, they get it from donors and they give it to people for abortions. some of them focus on the cost of travel. some of them focus on the of their procedure. some of them partner with clinics. they basically help undercut this immense financial that has always existed, but especially now for people seeking abortions. and they play a critical they are also really, really struggling at the moment because. there is just so much more demand on them. travel is expensive. it is becoming more expensive as people have further to go. and after jobs we saw a really immense surge in donations to abortion clinics. a lot of people who are really angry gave all this money. it's what the the clinics that are that the funds staffers call rage giving and that's kind of ended up after the florida ban took effect. for instance, they did not see a

surge. donations in florida, abortion funds. and what that is going to show us is longer term, people continuing to have to travel further and further, more and more expensive distances, take on higher cost, get an abortion. maybe you're going from miami to virginia, which crazy. there y and help you just do not have the resources anymore to support think they'll able to cover the costs that of everyone who comes for them anymore. i want to talk about how we got here. you know, we think obviously abortion has been a huge issue for the last couple of years. it's been a brewing issue for many years, but it goes on it certainly longer than the history of the country right? absolutely. i mean, abortions is as old as america and the right to an abortion is also as old as america. and we've seen that, you know, from the 1800s, efforts to stigmatize to outlaw. we saw doctors opposing because

they hated the midwives who performed them. and it was part of a way to disempower women was too restrictive abortion but the anti-abortion movement as we know it didn't really come into full existence until the 20th century. and it didn't become as powerful as it is until it right after roe, when they saw themselves lose and they said, we have to overturn this. they began immediately working to get abortion bans legal again. and, you know, they were very focused they figured out how to work legislatures, how to work through public opinion, how to work through the federal govern. they won. there's also been this big flip flop when i first started covering abortion of all, it was not not at all partizan. you had, you know, sort of abortion rights, democrats and republicans and anti-abortion democrats and republicans. but by and large, in the early years, roe republicans wmodemoc. and yet that's turned around completely. and i mean, that's part of a much broader history, right, of the wholef political institutions.

there is a million reasons for that. civil rights. think about, you know, i just read a lot of lyndon johnson biographies that plays where he played a role. but you're absolutely right that there anti-abortion democrats and there are there are a couple of pro-abortion republicans republicans. they are so so so rare now compared to what used to be. it's really become just like if you support abortion rights, the only party for you is democrats. and if you oppose abortion rights, then you have to be in the republican. and this is actually something that we are starting to see kind unravel in elections because. we've seen so many elections. are abortion specific? you know, whether your state constitution protects the right to an abortion and a lot of republicans are crossing over to vote for abortion rights when they have the chance to do so even if they would probly vote for a republican otherwise and that is going to be something that i think is really interesting to consider longer term. is does fuel any kind of

realignment, maybe it doesn't, but maybe it at the very least complicates how we think about how people vote for whom and why. and going to vary by state, too, right? mean one one. you can at some of these very conservative states that have voted for abortion ballot measures. i things that no one expected like kansas kentucky and yet in those states there still it seems that the legislatures and the governors who are republican are still pretty anti-abortion even in the face of their voters have obviously some of their republican voters because they're republican having gone the other way. exactly. it's really speaks to these conflicting influences that they have to work with. right. because they obviously care about their voters, but they also care about the very influential, very wealthy anti-abortion movement that has paid his dues, has worked, to make sure that it is in a cake that the republican party cannot ignore. this is the story of what we saw in florida, because florida initially had they didn't pass

abortion bans, it was a very pro-abortion state. and then in the lead up to jobs, they pass a 15 week ban and the promise was, well, this is our compromise. this is our florida deal. we are sticking to our middle of the road solution. that, of course, isn't what happened right. the decision the there was a campaign to pass a six week ban. instead it was endorsed heavily by the anti-abortion movement and natial natnal abortion folks said florida is our priority and f passed a six week ban and this really underscored as i think that no matter where your voters are and florida strongly support abon rights. if you look at any polling that but what matters perhaps more is who are the institions and organizations that you have aligned yourself with and who support yo political success so that leads me to organized medicine, which has a very, i would say, checkered history on this issue,

where it's organized, where has organized medicine been and where is now in both of our lifetimes that organized medicine has support abortion restrictions? we were just talking yesterday about how they supported the partial birth abortion ban under george bush and. what we have now is the american medical association has come out largely against abortion bans. they have come out quite strongly in the idaho case looking at whether emergency medical protect, doctors rights to provide abortions. and that's which is, i think speaks to a lot of things. part of it is that the medical establishment is younger now is more diverse, has spent more time, you know, becoming more aware of what this means. they're they're not trying to move women out of profession, but it also is to the fact that doctors autonomy is being really, really constrained and affected by these laws. they cannot provide care that. they may not have considered abortion. they thought it was just, you know protecting a pregnant person, experiencing complications, and are now

realizing, wow, this is really, really important and it could make it unsafe for me to practice the career i devoted myself to doctors are really into in a difficult position and a lot of states because if they provide the what's the standard of care, they could be prosecuted in some of these states. and if they don't, they could be sued for malpractice. and that is a dynamic that has played out in texas to an extent, not in terms of a lawsuit. but there is this case before the state supreme court. this is all women who had pregnancy complications could not get an abortion. the case of a man who has become a spokesperson for president biden, i mean, she had to wait until. she was in texas before she could get an abortion and the state has said, well, that's not the fault of our laws. you really should be suing your doctors because they are the ones did not understand how to read the laws and. and the plaintiffs have argued, no, our doctors are doing the best they can, but there is so little clarity and, so little daylight. when we think about what this

narrow, confusingly written exception, actually covers that they could not legally in good faith, say that this abortion was was covered and protected. it's funny■a exceptions. bans have been an issue as long as there have been bans. yoknow, the hyde amendment, which prohibits federal abortion funding has been numerous times. at one point it was only funding was only allowed to save the life of the woman. then they they had rape and incision. they took it out and they put it back. what are we finding about these exceptions to bans now that that obviously are pretty widely supported and e■éven many republicans say they support exceptions are very politically popular and they largely don't work. there is a lot of data that shows even when states have abortion bans, exceptions like no one's getting an abortion, which would suggest that these are not working. and if we look at the text of what these exceptions stipulate, it is very, very onerous. you might need a police report or a restraining order or some other legal d

for a case of rape or incest. the vast majority of sexual assaults are never reported that is just not a feasible thing to ask of someoneespeally within a or 15 week timeline. it makes this an exception on paper. but in practice it is just not something that people can be or are using. i know doctors have been asking for more clarity for some of these exceptions. are they getting it anywhere? ey are doing their best, but the the largest thing i hear still is confusion. there are occasional laws that are passed in florida, just put out some guidance saying that actually someone experiences problem preterm, premature rupture of membrane. that is something that will be covered by the states exceptions and that i mean that's tremendous some states have gone back to trying to add exceptions around ectopic pregnancy specifically although others like texas they add this exception but they also say, well you can have an affirmative

defense, which means you you provide the abortion. you could still be sued, but can prove that you were doing it under the exception and then you'll be okay, which really does help a lot of positions. but what doctors keep saying is these these small things like might help us with some patients here and there. but pregnancy so complicated it is just not feasible for us to create a laundry of exceptions and say we have covered every possible situation that could come up. the only thing that basically really works is pressing them. yeah. and of course, i mean, we've seen with these exceptions, i mean, there was a case of, a woman who is who was bleed who was actively bleeding and was sent out to wait her car in the parking lot until she was sick enough that the doctors justify saying she was, you know, she was going to die if you didn't get the abortion. and the thing about that is, even if you save the patient's life, like when you almost die, there are long term health consequences and those may not be counted as like a direct death caused by a shortened life span or a harder time being

healthy. while you are alive is still patient. harm that we should be thinking about when we consider the impact these laws have had. where's the public on this. i mean obviouslypolls going bact do you do you feel like sort of the this has come much more into the forefront of reporting and? you know, people talking about it. it's something that's been been hidden. is it is it bringing along the public or is the public dividing itself even more the way it wa before? it is interesting, because republicans largely follow the republican party line. they largely oppose. but the majority of thecluding independents do not approve of the state of being, of how things are. they support the right to an abortion broadly. theyeft up to patient and a doctor they do not support the idea of leaving it up to the states as. former president trump has said he would do. they think there should be federal abortion protections. this is all in with where public opinion was before most supported roe. while it was law of theand.

but what what it does what has changed is that this is more of a priority for many voters. there are these maybe not single abortion voters, but top issue abortion voters. there are some who are much older and some who are much younger, perhaps we don't know why, but it is really striking that this be a presidential election where. abortion may not shape the election but will be much more influential than it ever has been. the us is one of the few countries in the world that's actually moving towards more restrictions. abortion, the rest of the country, the rest of the world is going the other way. do we have any feel why we we have a very successful and influential anti-abortion movement with ties to a very powerful religious right. and that is largely what is at play here and what i found to be so interesting while researching this book is the of roe has actually been cited by religious conservatives in other countries as a model. they are trying take steps and

strategies from done here and replicated countries likere they are very religious country but not now not doing it as well as we are. and so they they want to see what they can learnm. there are, you know, these march for our lives that are e we hav. they have these 30 days for life movements that are tied to texas, based organizations. and so we have this very effective movement that isn't as prevalent in other parts of the world, but it could be one of the things we didn't talk about isomimaginative ways the anti-abortion movement has gone about trying to accomplish goal and was sort of the that the texas bounty law, if you i mean, talk about texas before roe was overturned. i will never forget where i was when we found out that the texas six week ban was going into effect. it was we got that decision very late at night, had been waiting for it. the law was already in effect, but they were hoping that the supreme court would block and ly

phone and it was like, well, they didn't block it. it's taking effect. and the moment that that happened, i thought it was clear. my editor thought it was very clear. and every doctor i've spoken to since agreed that roe was going to be overturned because0i it wh the dobbs case, thead sign frome court that you can circumvent this protection. here is a clear strategy to do it if you would like to do the same, have at it. explain how they did that though they got it's really a really is quite ingenious and famously was described as craftedx by some geniuses by a supreme court. kaganyowere not targeted the law but anyone who aided or abetted the provision of the abortion, that could be your doctor. it could be your uber driver. it could be someone who gave you money, someone who i don't know about you. lunch afterward could be sued by. and i think it was $100,000.

it's been a while. so i think that was that 10,000 excuse me. so $10,000. 10,000 minimum, $10,000. you could be sued by any private r. it was not a state law. it was a civil law. and this did not criminalize abortion explicitly, but it made it functionally impossible to provide because if you provide it, you risk this suit. that would be untenable to to go through with. you have to defend yourself in court and probably would lose at least $10,000. and this■m was this was so it ws so smart because it a ban on abortion. but it was like if you could argue listen doctors can go out there and provide abortions as long as they're willing to pay $10,000 every time. but it means that you could be sued out of existence. and after that ban took effect, what we did see was even while states were preparing for the decision, figuring out what kind of bans they would want, there were a couple idaho and oklahoma, who also passed

copycats of this texas law just in case. so that no matter what, they would be able to ban abortion when the time came. and of course, it couldn't. i mean, at that point, the court didn't need to overrule it because it technically circumvented the way roe work because it didn't implicate any of the state official and yeah, they said that this is a really interesting novel. legal question. wow. should think about this so smart. what a great scholarly thing for us to consider. but that was ultimately what they found was that is didn't this didn't break roe because, it didn't ban abortion, and they didn't have to weigh in on that question. and i actually remember listening to as the case later progressed, an appeals judge in new orleans and the fif circuit saying, well, we don't need to weigh on this too much because who knows the laws on abortion could change soon enough. we're all wti decision. and she was right. so so how much has this of this new sort of creative way to to try to restrict impacted the

abortion rights forces? i they are trying their best to figure out ways to to overcome these bans. and something that we talked about right, this shield law provision, it's very clever is you pass laws that protect in your state. you rely on abortion and, something that can be mailed can be very safely, effectively, take it at home. you find other ways to help people get around these very, very punitive laws. but what i can add, i think we will see over time is maybe not a cold war, maybe a hot war. honestly but different trying trying to outsmart other figuring out what are the creative ways i can do it no matter what side i'm on to, even without banning what you are doing to find a way around it. and i think it's an open question where that takes us. and now we're talking about travel bans and the supreme court has been pretty clear that you can't ban travel, at least for now.

but we absolutely are seeing efforts to try and at the from m traveling, and that actually will. the other has to if laws because the care in that case in colorado was provided in colorado is protected under a shield law. the state is not going to comply with any texas based subpoenas. so we'll see how that goes and where that takes us. but in texas, we're seeing these local trump. how are they hoping to work? those are those are they rely again on this the civil litigation structure. they again do ta person. but they say if you drive through my town and are carrying a pregnant person to get an abortion out of state, then anyone could sue you. the driver who's driving this other person, though, they've been passed in like a fewts of texas. they haven't had much of an effect, yet only because like, how do you enforce that? how do you know why someone driving where they are going, whether they went through your town? i, i imagine we could someday see a case come out through that, but it does seem much more difficult to pull off than

something like sb eight, the six week abortion ban was and, you know, we we didn't we haven't talked about it explicitly. but there is the chilling effect we did see in texas after, the six week civil ban went into to effect that abortion providers stopped writinabortions. yes. even though didn't technically have to stop providing them. certainly not before six weeks. a lot of them did because they just didn't want to take the leback to what we were talking about earlier. right. people know what their rights are. are confused, are afraid. i have spoken to people who don't know if they're legally allowed to leave their state travel, who don't know if they're allowed to take the second medication of their abortion at home. and again, they should be able to because the laws don't target them. but there is a real culture of confusion, a real culture of fear that is amplified by all of these different laws and bans and municipal codes being passed may or may not have concrete effect, but that certainly to the confusion that exists.

we've talked a little bit about the abortion pill, i guess, what, 63% of abortions are now done using medication, rather, a procedure. but the future of the abortion pill is not assured either. it is absolutely not. the supreme is hearing a case and the case was filed in texas in originally the anti-abortion plaintiffs were trying to get mifepristone one of the two medication abortion pills take off the market completely. they wanted the court to say the fda made a mistake more than 20 years ago when they approved this pill. they didn't consider it carefully enough be taken off the market. they rushed the facts. they did not. they spent a lot of time looking at a lot of data of the pill that is very safe and very effective. the supreme court not weighing in specifically on whether to take the pill off the market, but are considering more recent efforts to expand access, including the ability to provide it through telemedicine and including which doctors are allowed to provide it, which health care professionals and at what point in pregnancy it can be used because it is iv i mean, it is approved up

through ten weeks. i've through 12 because the evidence is so strong. but the court if they found in favor of the anti-abortion plaintiffs would take that back to seven weeks, which is just so early that it would not be usable for a lot of people. and we'll see how the court rules there are a lot of questions about whether the plaintiffs have standing, whether they have proven that they have experienced actual harm from this pill being available as is and have right to challenge it. would have really significant implications for all of the people who use medication. abortion, whether that is through the mail or just simply at home because it is what they prefer and i have spoken to docts who some of them would switch to a different less effective, more painful, still effective, still safe mechanism where you use more of this other drug the second medication used. but i have spoken to some doctors who don't know what they would they do worry that the misoprostol regimen is not as

good, is not the appropriate care they should be given. they don't know if they should have dropped telemedicine in that situation and if they should just keep going with a price done by a male as long as they can. and what it really underscores is just how, even though it feels like it has been a lifetime of two years, we are in the early days of figuring out what all of this is going to look like and what it will mean. i mean, a trump administration just a point ahead of the food and drug administration who could just cancel the approval right. they absolutely could. and i mean, historically, there hasn't been there's always tried to be some level of independence of the fda specific only from the politics of the president but all things are off. when you have someone who has often talked about using different levers of the administration to, specifically further political aims■j and if depending on priorities of the people in a trump administration, how they want to on abortion and a lot of them do oppose abortion quite strongly. his advisers, it's not at all

out of the question about something better fda could do. so what are you looking at going foard? obviously, as you say, we're we're in the early days. this there's an awful lot of things that have yet to sort of play out. i am waiting to see what happens wibecomes even more expansive. i am also really curious, especially about what it means to live in the south because for for a lot of our our post roe history. florida still allowed abortion through 15 weeks. florida no longer. and what that means is, if you look at a map of the united states half of it doesn't allow and most of that is in the south and losing this state in particular florida the third biggest day in the country. in addition to texas the second biggest losing that many abortion clinics that many providers displacing that many patients i think will have really significant implications. and i want to keep seeing what happens to the people who need care and write another book. we'll see. thanks to shefali luthra.

thank you so much. thank you for having me. ■abakari sellers is anator

and he made in the 2006 south carolina state legislature as frican american official in the