Interview with Texas Abortion Provider on the Abortion Rights Emergency

"The time machine has been turned back about 40 years"

August 4, 2014 | Revolution Newspaper | revcom.us

Revolution Interview
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In 2011, Texas had 46 clinics; by September 1 this year, there are likely to be only six left. Nationwide, hundreds of laws restricting abortion have been passed in recent years. Six states have only one abortion clinic left. As the Abortion Rights Freedom Ride 2014: Ground Zero Texas entered Houston in the midst of the nationwide abortion rights emergency, Sunsara Taylor conducted the following interview for revcom.us with an abortion provider in Texas.

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Sunsara Taylor: Thanks for taking the time, in the midst of such a crisis, to talk. Before we get into the emergency developing today here in Texas, let me ask you: Why do you do abortions?

MD: What initiated my concern about abortion was I’ve seen deaths from illegal abortion and attempts at self-induced abortion and that is enough to make anyone think more about the situation, particularly safety. Also if you have loved ones, wives and daughters, I feel it is very important that every woman should have access to safe abortion services, and I felt I needed to help provide this needed service. In my opinion Roe v. Wade (the Supreme Court decision that legalized abortion) was the best ruling that has ever happened in the world for women’s reproductive rights but at this time of certain political ambitions, women are facing the possibility of losing these rights. I very strongly feel that women have to overcome the apathy that exists amongst the majority. They themselves have to regroup and unite NOW and realize there are concerted efforts at this time to deny women of this fundamental reproductive right that they have had for the past 40 years. It is happening, it is reality, and women need to realize that something they have taken for granted for many years could be history.

ST: When you say that you’ve seen the deaths in the past, a lot of young people don't know what you are referring to. Could you paint a bit more of a picture of what it was like before Roe?

MD: It was a horrible scenario. Women would try to abort themselves. Everybody thinks the cliché of coat hangers is just some made-up term. It’s not, it’s reality. Women would do anything possible to themselves if they thought it would cause them to abort. Women would beat themselves in the stomach. I had a patient who attempted to inject turpentine into her abdomen, thinking it would reach her uterus. The end result: sepsis and a sloughing of her abdomen wall. These patients experienced either uterine perforation, hemorrhage, acute infection or a combination of these complications. There are many people today that are not aware of what women endured during this time, nor the morbid consequences. It is a fact that any country that has illegalized abortion, the morbidity and mortality rate definitely increases. I hope that women never again will be faced with that dilemma.

ST: Can you tell us about some of the women you see in your offices, who they are, what their lives are like? I know that one in three women get an abortion but most keep it secret. Could you tell us about them?

MD: By the time of 45 years of age approximately 35% of women will have had an abortion, and this doesn’t spare any particular religious sect. It is inclusive of all religion. You see a potpourri of women. The youngest patient I ever saw was 9 years old, the oldest 53. I have seen everything from incest to rape, whatever the situation may be. There are no races, ethnicities, socio-economic class, or religions excluded from the women seeking abortion services. I don’t believe that abortion should be used as contraception but women have abortions the majority of the time because it is a personal issue. It is circumstances that many in the general public do not understand or have not been confronted with. Someone who has never been in that particular situation cannot be passing judgment on someone else because they don’t know what is going on in their life.

We have patients that are seen that are 11, 12, 13, 14 years of age, that is not unusual. We are talking about 12, 13, 14 years of age. These patients are usually clueless about what is going on with their body. Sometimes there is denial. You have mothers being seen with their young daughters (sometimes the father accompanies their daughter) that don’t know what to do. They are apologetic. Sometimes it is very obvious that the patient is pregnant when preparing her for an ultrasound. The mother states, "I just found out yesterday." They have stated before, "She always wears loose fitting clothing. I never noticed."

It goes back to the education of our society. Many religious faiths do not want to discuss or mention sex education or the bad word, sex. If we can start educating younger, we aren’t trying to tell these young girls to have sexually active lives; but when you know what to expect, what the consequences might be, you may rethink and avoid an unplanned pregnancy. Many of the patients already have children, sometimes three before turning 20 years old. Many of them are single mothers or they live with somebody. There are definitely a smaller number of patients that are married, but in this subgroup, there are more circumstances relating to fetal abnormalities. Again the need for abortion access is not exclusive.

Sometimes patients come in apologetic, like "I’m sorry I waited so long," or "I’m sorry I really don’t know what to do, I’m in a predicament," or "I lost my job." I had a patient one time who was in the middle of her second trimester, she came in and said, "I am so sorry, I don’t know what to tell you," and I said, "Well ma’am, what has happened?" She said, "I had this guy and he was going to marry me, we were going to get engaged and so forth, and all of a sudden we found out I was pregnant and this morning I woke up and he had packed up his belongings and he left." The sad thing in these situations... what people don’t understand is that women don’t have the convenience of packing their bags and leaving. This is a very simple thing for men to do.

So, this isn’t always something they want to do. But they have the ability to think rationally and to make a personal decision for themselves and for the present family that they have and for their future. A lot of women may think that women enjoy coming in, but those people don’t have a clue. We’ve seen a lot of people come in with genetic disorders and fetal abnormalities. We’ve seen women who have gone through many in vitro fertilizations and the result has been something devastating because the fetus has abnormalities. But then they have anti-abortion protesters yelling and screaming at them on their way in, telling them you’re a killer, you’re this, you’re that. They have no clue as far as what’s going on in these people’s lives.

A patient comes in and says, "I don’t know what to do, I don’t really have any choice, I already have two at home, I have a hard time putting clothes on them, being able to feed them." What people need to understand is this has to be a situation of quality not quantity. Not having more [children] but having the ability to have a family that you can take care of, love, care for, these are the things that are very, very important. To the general public they have on their mind one thing: you’re a killer, you’re a whatever, that is all they can relate to. They have to understand that they are very demeaning to women. This is really anti-woman bullying, this is sexist.

ST: Why do you say that?

MD: Because they are out here literally trying to belittle women and prevent them from being able to make decisions on their own and saying that they were created to be nothing more than a reproductive vessel. There is an old saying, maybe you’ve heard it before, "Women should be barefoot and pregnant." I think what is happening, we talk about the glass ceiling for women when it comes to business and jobs and pay, well we are hitting a big glass ceiling here, women are not equal, women are not being allowed to make a personal decisions on their own. My belief as far as the genders, women are the strongest. Maybe not to the weight room to see how much weight they can lift, I’m talking about the family unit, holding the family together. Like I said it is too easy sometimes to leave. You have women come in who basically say I don’t know what to do. I’ve got this relationship and the guy says I am going to marry you but we’re having problems, we’re fighting. So they have difficult decisions to make; one of the most difficult of their lives. They have major decisions to make and they need help but also they need the freedom of choice.

ST: You know one thing that is coming alive as you speak is that there is a war on women’s abortion rights, there are all these restrictions that have been passed, all this harassment, and I want to come back to that in a few minutes, but this is also not happening in a vacuum. It is happening in a society where women are systematically oppressed, brutalized, discriminated against. All this degradation of women is part of a fabric of society and it is coming through as you’re speaking how abortion intersects with and is all the more important because of all of that.

MD: Yes, it is all-inclusive. Women have to realize that they are equal and they are going to have to understand that they are going to have to take things in their own hands and be proactive. I am talking about non-violence for sure. But it goes back again to rallying the women because whether they realize it or not, their reproductive rights are definitely being taken away from them. We live in a society where people are apathetic; they see it one day and it's going to be there for many more years. Not necessarily. Alert. Wake-up call. Women’s reproductive rights 2014 a thing of the past. What happened?

ST: Can you describe what kind of restrictions there are in Texas today? What are the hurdles women have to jump through to get an abortion and what is looming?

MD: The hurdles of Texas are multiple and there have been a number of changes in the last several years. In Texas we have a large number of restrictions and many more every year. In Texas the process has changed from a woman being able to make an appointment and that same day have blood work, counseling, pre- and post-op instructions and then have the actual abortion procedure that same day to scheduling initially for an ultrasound only, extensive disclosures about the procedure, special requirements for the person performing the ultrasound, discussion with the physician to inform the patient of specific information required by the Texas law and then, if the patient wants to have an abortion procedure it must be performed on a return visit that is more than 24 hours after her ultrasound was performed.

ST: You mean face to face, in person?

MD: Yes. In 2004 for patients that were more than 15 weeks gestation in their pregnancy, their procedure had to be started and completed in a hospital or a licensed ambulatory surgery center. Now we have a new bill, HB2, which was legislated last year, which has also affected how the abortion bill is administered. The general consensus from many physicians who have done this for many years is that the new guidelines are not working near as well and are very patient-burdensome with more visits and more ultrasounds and less success. Therefore, availability of the abortion pill in Texas is minimal, and most patients cannot justify all the additional required visits. Again, more restrictions to abortion access.

As a footnote to that, what is happening as a result of all these new laws is that women, like men when they are employed, have a job, they need to make a living to support themselves and their children. As a consequence of the new legislation their access is impeded again by these restrictions because employees are not allowing the patient to be excused for half a day or sometimes a full day to have a doctor’s appointment without the risk of losing their job.

Therefore, there is a problem for patients being able to comply with the restrictions. Many times it is almost impossible to coordinate patients' appointments with their work schedule. They require about any and every possible scheduling option, even appointments, weekend appointments. There are numerous roadblocks in the path of women in Texas trying to have abortion access.

ST: And on HB2 there are also restrictions on the providers that go beyond what you describe.

MD: HB2 also has a section of law that was overturned by a district court judge, but then the 5th Circuit Court of Appeals overturned that as far as physicians having admitting privileges within 30 miles of wherever the procedure is being done. That is like telling every doctor out there you have to have admitting privileges or you cannot practice medicine. Have you been to an oral surgeon? Have you had wisdom teeth removed? They give you anesthetic; you may have an issue, you may have an anesthetic complication as far as breathing or whatever else, and you possibly may need to be admitted to the hospital. Do they have admitting privileges? No. Possibly they may have some kind of medical backup as far as a hospital, but they themselves personally do not have admitting privileges.

Also, you have patients that travel 40, 50, 80, 90 miles. The law also requires the provider to give each patient a list specifically of the hospital closest to them so if they have a problem they can go to the emergency room closest to them and the ER Department phone numbers. So that is a little bit hypocritical. If you’re going to tell the physician they have to have admitting privileges but most of these patients are going to go to the hospital which is closest to them anyhow. They are not going to travel an hour and a half to get to the hospital where their physician has privileges if there is a closer hospital to them. And if you have an emergency at a facility, an ambulance is called to transport a patient to the nearest hospital emergency room. If the physician has privileges 30 miles away and you are in a metropolitan area, that may mean an hour, maybe more, in traffic. If another hospital is five to seven minutes away, they are going to take the patient there. It is their policy and procedure. So I am trying to understand this conflict as far as requirements.

After that we have a situation where by September 1 of this year facilities are required to be "equivalent to" an ambulatory surgery center to be able to provide abortion services. So there are going to be a number of facilities that will not be able to retrofit their facilities to be able to do that.

ST: Can you just briefly describe what are the requirements of an ambulatory surgery center that are different than most of these clinics? My understanding is that all but six clinics that are left in Texas will close because of this.

MD: These requirements are numerous. You have to have certain widths as far as hallways, certain heights of doors, certain requirements as far as your air conditioning. Your surgical suites have to have their own independent air conditioning unit. You have to have special plumbing, special electrical, you have to have generators. You have to actually have medical gases pumped in, not a portable oxygen stand. You have to understand that most clinics are like a regular doctor’s office, seven by nine exam rooms. But starting September 1, the operatory room has to be a minimum of 240 square feet. That is quite a substantial difference. Clinics have been converted from maybe a residence located in commercial offices.

ST: It's very clear that the motivation behind the restrictions, they say that it is for the safety of women but in fact it is actually motivated by the desire to take away women’s rights.

MD: That’s very obvious. They are saying it is the safety of women but actually their goal is to drop abortion services in Texas. So they will find that anything and everything they can possibly do to try to achieve this goal with unsubstantiated legislation.

ST: What do you think it says about the society we live in that this right of women to decide something as fundamental as whether she is having a child or is forced to have a child against her will, that that right is being taken away from her?

MD: I don’t believe in one-liners but it is very simple. The time machine has been turned back about 40 years. We are taking a U-turn and we are going south. And we have to do what we can do to divert that southward bound traffic back the other way. It is going to take grassroots, we’ve heard that term, but it is going to take numbers. Women have to be on the same page to believe in the cause for their reproductive rights. You’re going to have some women that don’t believe in choice. But, let’s face it, probably 70 plus percent of the people that are against women's reproductive rights are men. They’re not women, they’re men. As far as the legislation, we have politicians now practicing medicine. I don’t know, I thought you had to go to medical school, and thought you had to have a license to practice, but they’re basically practicing medicine is what they’re doing. They do not use scientific fact. Medicine and providing health care is not based on superstition! But, when it comes to all these restrictions, there remain no facts to prove what these alleged "problems" are that need all these restrictions when it comes to women's reproductive rights.

ST: The level of harassment you indicated in terms of what women have to go through, and actually this is around the country, what impact does that have?

MD: It makes a very large impact on women. The point is, is that this is a democratic society, if you want to go ahead and protest, ok, that’s your right. But, it’s not your right to demean, belittle, accuse, shame, a woman when you don’t know what her situation is. All these horns, and all these megaphones, and all this screamin' and hollerin’ and cursing… There’s no grounds, there’s no excuse for that. That’s not acceptable. Not acceptable. Basically, it's just humiliation, and I don’t see any reason why. What have these women done to them? What have they done to them to cause this type of treatment? They’ve done nothing. This is a free country, supposedly, they should be able to have the freedom to do what they want, it’s a legal act, and it should definitely stay that way.

ST: Earlier you described what an enormous difference Roe v. Wade made in women’s lives and for the whole way that women are in society. And it wasn’t just the law, there was upsurge, there was a liberation struggle, there was a whole atmosphere where, not only did the law change, the people changed in the course of fighting and winning the change in that law. So, on the eve of the Abortion Rights Freedom Ride 2014 coming down here to Texas with the aim of making a real leap in the kind of resistance that can turn this whole assault around—not just stop this or that measure, but the kind of transformation with people in a mass way through rising up and defeating this war on women—what difference do you think that succeeding in this would make on women’s lives, on society, on doctors who do this service? And what would be your message to people considering whether they should step out and be part of this struggle?

MD: The message is if you don’t do it, you are not going to have reproductive rights. Everyone likes to be on the winning team. We always want to be able to celebrate. We like big crowds so we don’t have to stand out. That’s just human nature. One of the things that’s going to be very, very important in this process is if you can finally rally women to quit being apathetic, realize what’s really going on. If you were to survey my patients, probably over 90% are clueless about what has been going on as far as reproductive rights, particularly here at home in the state of Texas. They come and say, "Why can’t you do the procedure today? We used to be able to come in and do it the same day." "Well ma’am, do you realize, have you been up to date about what is going on with the law?" "I don’t know."

So, that’s the first step: you have to educate, then advocate. Education is the bedrock for the whole process. That’s the common denominator for all the principles that assimilate in this cause. In order to get women to come out and start being able to feel like they can do that, you have to get a cause going and they have to associate with the cause. They have to be unified, determined, and believe in the cause, their reproductive freedom.

The other barrier is the stigma of the word "abortion." If you say the word abortion, that is evil. It’s terrible. Like I alluded to before the interview, abortion is in the medical literature, it’s in the medical terminology, it’s in the medical dictionary. It’s all over the place. It’s a common way that doctors and medical people communicate. The word is abortion. No matter if it’s incomplete, habitual, spontaneous, whatever. That’s the nomenclature that we deal with as far as in the world of women and their health care too.

You need to also realize, you have to go back to sex education. It goes back to these young teenagers. They need to know simply what it’s all about, what’s in the future for them. Mothers need to be educating their daughters about the history of women’s reproductive rights…there was this movement and there was victory—Roe v Wade. But then we became very apathetic because, hey, it’s there, it’s not going to go away.

Well, I don’t think it works that way. A lot of things in life you have to perpetuate. If you don’t practice this, after a while, it may not be there, right? Be more of what is happening in this country, usually politically, that may have an effect on you and your family. Now it is a woman’s reproductive right. You’ve heard a lot of times politicians say, "We have to look out for our children and grandchildren." That’s correct. Women have to look out for their daughters and granddaughters.

ST: And men too.

MD: Yes, and men also. I agree wholeheartedly. And there are men who are for women’s rights. There are men who aren’t "male chauvinists." I think it needs to be across the board. We’ve seen men stand up for the women they’re with when they get harassed by these protesters. It’s almost got to the point of confrontations. But that’s what has to be done. You have to stand your ground. I don’t mean violence. Non-violent. But the point is there has to be that understanding because the ideology as far as the two sides is always going to be there. There’s not going to be debate because there’s not going to be any "common ground."

And particularly with the political landscape we have right now, politicians are using this to score points and to get votes. They will do whatever it takes to get people out to vote. And that’s a large part of the effort right now—voting. They’re going to go out there and bring people to vote while the other side has to realize they can’t be apathetic. Can’t say, "My vote doesn’t make any difference." And don’t do anything about it.

So it has to be literally a surge, full-scale surge, to get women to realize what is happening, what this means. This precious privilege that you fought for in the years before may not be there much longer. Years and years ago, you had to go to the east coast or the west coast [to get an abortion]. Well, if it keeps going like it is now, we’re going to go back in history and you'll have to go to the east coast or the west coast to be able to access services. We’re going back. So if and when women and men realize what the situation is, look at the big picture, become informed, hopefully they will realize what’s happening. And hopefully they will join the cause.

This is a very important and critical time for women, 2014, and I can’t believe we’re seeing this. Technology has advanced. Everyone can do everything with their little hand-held device, but the fact is, conversely, that a woman’s reproductive freedom is deteriorating expeditiously.

One other thing to mention which is usually forgotten in the discussion but actually is the most important component of the abortion access movement is we have to find some way, futuristically, to be able to train physicians to provide these services because there are few young physicians awaiting to continue the access to abortion services. There are very few or any hospital training programs available to obtain the training. Also many of the younger physicians, themselves, don’t want to provide these services, the fear factor. If you are in this world as a woman’s specialist, abortion is part of your specialty. Now it’s your personal choice if you choose to perform abortions or not to perform them but uncompromised abortion access needs to continue to be available to women and provided safely with sound medical regulation (oversight), not by unsubstantiated, biased, politically motivated legislation to eventually stop all access to abortion.

ST: Thank you for taking the time to talk. A lot of people are going to learn a lot from this and it’s going to make a difference, so I appreciate you taking the time.

MD: You’re very welcome. I hope it does something positive.

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