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How to get ready for what reproductive care could look like if Roe is overturned


So what now? That's the question that's buzzing within reproductive health communities. In particular, how should those Americans of childbearing age prepare now if Roe is overturned by the Supreme Court? Well, joining us now are two people who have thought a lot about this - Robin Marty, who's the operations director for the West Alabama Women's Center and the author of "Handbook For A Post-Roe America," and we have with us Dr. Raegan McDonald-Mosley. She's a practicing OB-GYN and the CEO of Power to Decide, a sexual health and planning nonprofit group. Welcome to both of you.

RAEGAN MCDONALD-MOSLEY: Thank you for having us.

ROBIN MARTY: Thank you for having me.

CHANG: Robin, I mean, you are in this state, like half of all U.S. states, that would make abortion illegal immediately. You're in Alabama. Can you just walk us through specifically what that would entail?

MARTY: So I want to explain really quickly that although half of the states are likely to have no access to legal abortion, there are very few states, even those with triggers, that will immediately be impacted by the ruling - a time period before something will go immediately into effect. For us, that's not the case. And that means that we have to be sure that, if we have patients who are in for care, they will be in the waiting room. And we have to make sure that we have them in either beginning the dilation process or already taking their pills before a decision comes down, which for us would be at 9 a.m. We usually have our patients in at 8, but we're moving our patients in even earlier on any day that could potentially be a decision day just to make sure that we can care for as many as possible before we can't anymore.

CHANG: Well, I want to talk about what people should be thinking about and doing right now because these abortion restrictions mean that some people are going to be looking for ways to make sure that they don't have an unintended pregnancy now. And, Raegan, as a doctor, just tell us; what kind of contraception would you recommend?

MCDONALD-MOSLEY: Let me just sort of preface this, Ailsa, by saying I welcome any opportunity to talk about reproductive health and birth control. But I have to admit that the premise of this question - that abortion access will be so hard to obtain in over half the states in our country - that that just within and of itself feels very dystopian and troubling. There are definitely some methods that, you know, have lower failure rates in sort of, you know, the real-world use. So there is permanent birth control, both the tubal ligation as well as the vasectomy depending on someone's anatomy. So those are permanent methods that should only be used if someone knows that they don't want to have any more children. And those are more than 99% effective. There are also implants, contraceptive implants and IUDs, both hormonal and non-hormonal, that are also 99% effective.

But those methods might not be for everyone. So all of the other methods, you know, should be available to them, including the contraceptive pill, the patch, the ring, the injectable contraception, which are also still very effective, over 90% effective. But, again, you know, it's a really great opportunity to sort of learn about all of these methods, the side effects and then choose what method, you know, is right for you.

CHANG: And when it comes to emergency contraception, like Plan B or something like that, can we just remind people how long they have to take it for something like Plan B to still be effective?

MCDONALD-MOSLEY: Emergency contraception, whether or not it's a pill or an intrauterine device, should be taken within five days of unprotected intercourse. And, as you know, it can be hard to sort of get a provider visit and get the pills and fill the prescription within five days. And so one thing to consider is advance provision. Before you need it, before you have unprotected intercourse, just have it in your medicine cabinet.

CHANG: Yeah. OK. I have been hearing recommendations about stocking up on Plan B or other emergency contraception, but you do think that that's a good thing to do? Like, is there anything people need to know in terms of shelf life or expiration?

MCDONALD-MOSLEY: So there are two different types of the pill version of emergency contraception. One you just mentioned people sort of often refer to as Plan B. It's available over the counter. So folks can just go into the drugstore today and pick up a couple of packs if they want. And it generally has a very long shelf life in the order of three to four years...


MCDONALD-MOSLEY: ...Meaning someone could buy it now and may not have to use it for a year. And it's still active and good. But you should look at the expiration date on the specific box of the product that you're going to buy, meaning, you know, if a product's going to expire next month, you want to choose one that says on the box is going to expire in a year or two.

CHANG: Let's say someone takes a pregnancy test in a state that does ban abortion and that test comes out positive. Let's talk about this scenario now. So, Robin, what options do these people have if they want to end their pregnancy in that state?

MARTY: So there are a number of different options that a person can undergo. Some of them involve trying to decide to go to a clinic outside of their states. There are abortion funds and practical support groups that can help provide financial assistance, logistical support. But also, what we're seeing is that most people, especially in the South - they have an immense amount of difficulty to be able to afford all of the bus tickets, plane tickets...

CHANG: Right.

MARTY: ...Times off of work. That's simply not going to be doable for a lot of them.

CHANG: Yeah. Well, Raegan, from an OB-GYN's perspective, if I am looking for a clinic where I live or near where I live, maybe even in a neighboring state, what should I be looking for?

MCDONALD-MOSLEY: So the first thing is, you know, to identify where you can go. And so we have a resource at Power to Decide called There's another resource called I Need an A, and these have databases of reliable abortion clinics throughout the country.

MARTY: I agree with everything Raegan said. I would also like to say that reaching out to a local independent abortion clinic just to ask questions is definitely a thing that can be done. Abortion clinics are always going to be aware of what's going on in their region. And as much as online sources are amazing, they are so hard to keep to-the-minute up to date. And so, I mean, if you have a question, just ask. That's what we're here for.

CHANG: And, Robin, I mean, we are hearing that, in many states that would ban abortion, they are more interested in punishing providers rather than the patients seeking abortions. So how honest or direct should a patient be when talking to a doctor about the option of an abortion or treatment after they've tried an abortion?

MARTY: Right. I actually put together a checklist of questions that people can ask their doctors. So it's a checklist that a person can go through and say, how do you feel about abortion? If I asked for an abortion, would you make a referral? It's an entire list of things that, frankly, doctors have to be vetted for at this point because there are states where you cannot sue a doctor if they withhold information from you about your pregnancy. So we've already seen how abortion laws have completely undermined the doctor-patient relationship, and that's only going to get worse once it's doctors and patients who could potentially end up in jail.

MCDONALD-MOSLEY: Ailsa, this is Raegan. I just wanted to chime in from a medical perspective and point out, realizing that someone may not have the opportunity to fully vet a provider, it's important to realize that if someone is having, you know, prolonged bleeding or may need medical attention after having a medication abortion with medications that they obtained themselves or with the care of a provider - that that very much looks like a miscarriage, right? And so someone can potentially, you know, present to an emergency room or to their provider and say, I'm having cramping and bleeding, and I had a positive pregnancy test, and receive the care that they need without having to reveal that they have taken abortion medications.

CHANG: That was Doctor Raegan McDonald-Mosley. She is a practicing OB-GYN and the CEO of Power to Decide, a sexual health and planning nonprofit. We also had Robin Marty. She's the operations director of the West Alabama Women's Center, and she is the author of "Handbook For A Post-Roe America." Thank you both so much for spending all this time with us.

MARTY: Of course - any time.

MCDONALD-MOSLEY: Thank you so much.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.

Ailsa Chang is an award-winning journalist who hosts All Things Considered along with Ari Shapiro, Audie Cornish, and Mary Louise Kelly. She landed in public radio after practicing law for a few years.
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