Ep. 39: Advance Provision of Abortion Pills Is Community Care + Immigrant Justice

2:44AM Feb 28, 2023

Speakers:

LaKia Williams

Keywords:

abortion

people

abortion pills

telehealth

pills

citizen

episode

reproductive justice

managed

health care

reproductive health

access

medication

medicaid

clinic

citizenship

welfare programs

provider

provision

health care provider

Welcome to Black Feminist rants where we center conversations on reproductive justice and activism. I'm your host Lakia Williams and let's begin welcome back to another episode of Black Feminist rant. I'm so excited to be talking to y'all. This is actually the first solo episode that I'm recording for 2023 It's not the first episode that y'all are gonna hear, but this is the first episode I'm recording. And today's episode is in partnership with Plansee pills. Plansee is an information resource for self managing at home abortion with pills. And that's basically what we're gonna be talking about today, specifically, telehealth abortion services, and advanced revision of medication abortion. But before we jump in, if you haven't subscribed to the newsletter yet, please do so. We send reminders for new episodes and work cited links so you can see all the citations for the articles. So let's jump right in and talk about telehealth abortion. So Erica Chang, the executive director of the reproductive health education and family medicine, states in her study published in the contraception journal that and I quote, telemedicine abortion is a broad term that describes the use of telecommunications, phone video conference texting email to provide one or more aspects of abortion care such as counseling, eligibility assessment, medication provision, guidance through the process and follow up assessment. Through telecommunication people can receive a prescription for abortion medication, collect the prescription from a facility or through post or the mail, take the medication within the comfort of their home and receive pre and post abortion information and care and quote, so as you just heard, there can be many components to telehealth abortion care, and sometimes telehealth abortion is confused with self managed abortion. So self manage abortions are abortions that someone has outside of the typical medical setting, so there is no involvement of a licensed healthcare provider. If you want more information on what a self managed abortion is, pause this episode and go listen to episode 34 titled self managed abortion with abortion pills. That episode was in partnership with urge as a part of the self managed abortion fest. And I'll link that episode below as well. Now, for most people who do use telehealth abortion services, they do have their abortion at home. But since they're using a health care provider to go through, go to their virtual appointment or to get their prescription. It's not technically a self managed abortion. But I do want to highlight something that I learned from Dr. Jamila parrot who is the CEO of physicians for reproductive health is that typically, abortion care and telehealth abortion or self managed abortion is a continuum. It's a spectrum. So there aren't, a lot of people will overlap. So someone could begin their abortion process as a self managed abortion so they could self source their abortion pills outside of the medical setting. But maybe they have a complication. And they contact a health care provider. So that kind of blurs the lines between telehealth abortion and self managed abortion. So it's not always cut and dry. And there's not a hierarchy people getting the care that they need is what's most important. The method by which they do that doesn't really matter as long as it is the ideal situation for them. But I did want to add that context because I know it can be confusing because when we're talking about abortion, there's so many different types that we're discussing. And so there can be some confusion with telehealth abortion and self managed abortion. So I'm just adding that for clarification, not to say that there's the super specific definitions that we have to adhere to when we're talking about them. Because a lot of times there is that overlap that Dr. Jamila period talks about, and because there can be some confusion I'm going to talk about what telehealth abortion and self managed abortion can typically look like. So typical self managed abortion with pills looks like someone's self sourcing their own abortion pills and having an abortion at home. But it can also include an herbal abortion, abortion massage or other forms of self managed abortion other than pills. However, for telehealth abortion, it's when a person has a medication abortion or abortion with pills with the support or supervision of a health care provider. So typically, people will attend a virtual appointment and receive a prescription from a licensed healthcare provider and take the pills in their own home. So again, the main difference between a self managed abortion with pills and a telehealth abortion is whether licensed medical provider is involved in the process. So if someone lives in a state where telehealth abortion services are readily available, and if they have access to income and health insurance and things to pay for these appointments, then telehealth abortion may be a great option for them. But there are 1000s of people who live in states where telehealth abortion services aren't accessible and they also may not have the funds to go to a clinic. So self managed abortion where you can self source your pills may be a more economical and practical option for them. Now as you probably heard in my description of a typical typical self managed abortion and typical tele abortion is that they use a similar methods so the reason there's often confusion between self managed abortion and telehealth abortion is because they typically use abortion pills or medication abortion. As a refresher the protocol for medication abortion, whether it's at home or in A clinic is swallowing one meal a person pill. And then 24 hours after that holding for my suppressive pills in the mouth and between the cheek and the gum, two on each side for 30 minutes. So you do not swallow the misoprostol pills, you hold them in your mouth and allow them to dissolve. And if they don't fully dissolve after 30 minutes, you just drink some water, switch it around a little bit and swallow. So this protocol is the same whether it is fully self managed at home, or if the first pill is taken under supervision of a medical provider. Again, that is one we pay per stone pills while out 24 hours before for miser process pills are held in between the cheeks and gum for 30 minutes. So I've already highlighted earlier that there is no hierarchy between telehealth abortion or self managed abortion. Obviously one form is no better than the other and they both have their pros and cons. A telehealth abortion can be ideal for someone who lives in a state where abortion is legal and providers are willing and able to prescribe me a pistol and misoprostol is also a great method if a person does not have access to an abortion doula or friend who can help explain the process to them. However, telehealth abortion would not be an option for someone in a state where abortion is not legal or where there are laws that restrict access to abortion care and pills. Telehealth abortion can also be inaccessible to people who do not have health insurance or access to a clinic or provider. This is why there has been such a large push by the reproductive justice movement to educate people on self managed abortion because it can allow people to circumvent the access issues of getting medical care. However, abortion in general will not be fully accessible until we have over the counter access to me paper stone and misoprostol so that people can walk into a Walgreens or CVS and purchase a two medications without needing to see a healthcare provider. This will also allow people to obtain an advanced provision of medication abortion. Now this is so funny because I was reading that as part of my script that was written December 24. And this was before the FDA updated their protocol or their guidelines to allow for me paper stone to be readily available in Walgreens or CVS. And so we're already seeing a really positive step in the right direction. However, in order to get maybe prestone, one of the abortion pills, no CVS or Walgreens, you still need a prescription. So you still need that provider. That interaction with the provider. So it's still not fully accessible. What we need is over the counter access, and Walgreens and CVS, so people can walk into the store, pick it up on the counter and have an advanced provision. So if they get pregnant in six months, they have those pills available or if someone in their community becomes pregnant, and they may not have the money for the pills, they have that on hand. That's what a future of accessible abortion looks like. So I've already mentioned the term advance provision. So I'm going to talk a little bit more about what that is. So advance provision simply means having medication on hand or in advance of anticipated need or condition. So having an advanced provision of abortion pills means having abortion pills before you become pregnant, or in anticipation of you or someone else one day becoming pregnant and wanting to end the pregnancy. Now this sounds like an amazing practice, especially considering the number of time limit abortion bans, such as the one in Texas that prohibits abortions after six weeks of pregnancy. If someone in Texas found out they were pregnant just a few days before the six week limit, they would likely not have enough time to get abortion care considering clinic wait times the need to travel and other things. So having abortion pills on hand can help in time sensitive cases. Advanced provision of abortion pills can also be really important if you or someone else or someone you're in community with may be uncomfortable interacting with the healthcare system in general. And there could be so many reasons that someone could be uncomfortable with the healthcare system such as traumatic experiences, their immigration status or their gender identity. I want to talk about each of these examples a little bit because it really highlights why we can't talk about abortion access in a silo. abortion access is a justice issue. People who have been historically discriminated against may not want to go to a health care clinic, especially when it has to do with their reproductive health. There is a long depressing history of this country in the medical system, particularly experimenting and tormenting black and brown women from the forced sterilization of black and Latino women to the birth control trials on Puerto Rican women, black and brown women have had their lives and reproductive health taken advantage of and we have been used as experiments not as autonomous people, the medical system has never been a safe space for black and brown women. So earlier I mentioned immigration status and how that could be a sign of concern for someone seeking health care and reproductive health care.

So especially in hostile states, people may fear receiving health care because of fear of deportation. A study by Jessica Hill, a scholar of international conflict management states that and I quote, laws and policies impact health outcomes for immigrants and their families across Immigration and Citizenship classifications, through regulating access to resources like health insurance and health care, and through influencing the overall environment in which immigrants make decisions about health seeking behaviors. So this really highlights how undocumented people and immigrants in general are not able to receive the health care that they deserve because they are weary of the potential for deportation. Even for documented immigrants who are not yet citizens, they could be fearful of accepting governments assistance such as Medicaid or other welfare programs, because it can impact their ability to be granted citizenship. This topic alone could be an entire episode. But I do want to speak about it briefly, because I think it's important that as a movement, we discuss immigrant rights more when we talk about reproductive injustice. So the SparkNotes version of this is that in order for a non citizen, and that is a term used by the DHS or the Department of Homeland Security, so in order for a non citizen to be eligible for citizenship, they cannot be deemed a quote unquote, public charge. So I'm going to read the direct quote from the Department of Homeland Security that was released on September eighth 2022. It says, and I quote, a non citizen who is deemed likely to be a public charge, meaning that they are likely to become primarily dependent on the government for substance can be denied admission or lawful permanent residence known colloquially as a green card, and quote, so in that statement, the DHS is saying that if someone who is not a citizen is deemed to be heavily reliant on the government to survive, they can be denied citizenship, even if they meet all the other criteria, just because the government doesn't want to have to invest in these people. And so historically, non cash welfare programs such as Medicaid and nutrition assistance, were not included in the quote unquote, public charge definition. But under the Trump administration, the use of Medicaid and other welfare programs were considered public charges, which would impact a person's ability to be granted citizenship or permanent residence. Now, this rule has been vacated, as stated in the September 8 issue, September 8 2022, issued by the Department of Homeland Security, but the legacy of that ruling under the Trump administration has caused a decrease in enrollment of non citizens and welfare programs, such as Medicaid. So the legacy of the Trump administration saying hey, if you use these public assistance programs, we're not going to allow you to be a citizen, people are still fearful of that, because they don't want that to be a reason that in the future, they can't get access to citizenship. So also, we can see how easily this ruling is changing through administrations. So I definitely could empathize with someone who's not a citizen saying, hey, this may not be the rule now. But in four years, when as a different president, me accepting this assistance could negatively impact me and prevent me from being a citizen. So am I going to get the health care that I need today? Or am I just going to go without in hopes of being a citizen in the future, and that is a terrible place to put people in, that is a violation of their human rights to have to decide between being a citizen and having your healthcare tech people shouldn't have to worry about, Okay, I'm getting into like no borders. And like I said, this could be a topic on its own. But I just want to highlight how important it is that when we talk about abortion access, we can't just talk about this wealthy white like lens like it's such a bigger picture like this is healthcare. This is people's lives. So it is good to know that as of December 23 2022, enrollment in Medicaid or nutrition programs will not make someone inadmissible to becoming a citizen. But again, this is so fickle, this could change with a new administration, but for the sake of accuracy and spreading, accurate, current relevant information. If someone uses Medicaid today that is not going to be used against them for getting citizenship. Again, that could change as we see. But as of now, that is not the case. Luckily. So again, tying this back to access to abortion pills, that's why it's so important for people to have things like over the counter meat they pressed on, because if someone can't get access to health care, if someone can't afford it, if someone doesn't have health insurance, they're going to need another way to access these pills. And that we see that there are so many other intersecting issues that prevent people from getting access to the health care that they need in general, especially when it comes to reproductive health care. And even more when it comes to abortion. And I'm sorry, I'm yelling, I'm not yelling at Shaw. I'm yelling at the system. But I'm trying to really back. So I also mentioned gender identity as a reason that some people may not feel comfortable going through the healthcare system. And this is because medical settings are very binary, they force people to disclose their gender and sex and unfortunately, not all healthcare providers are competent on queer identities. Because of this, the healthcare setting could be a very gender dysphoric experience for someone and it could also force them to disclose themselves to strangers. So many things can happen in a clinic, such as someone being referred to as a dead name or being misgendered. That can make it very uncomfortable for people to go into a healthcare setting and to prefer to self manage their abortion on their own. If they could circumvent going to a place that can be very triggering for them, they may prefer that option. So all of these reasons and issues highlight why it's so important that people have access to abortion care on their own terms. That can look like an in clinic procedure or a telehealth appointment, or a self managed abortion. But the most important thing is that people are aware of the different types of abortion care available to them. Also, we don't only need to make abortion more accessible because of vulnerable and marginalized populations need greater access to it. But we need to be actively working towards dismantling the systems that keep doing On populations of vulnerable and marginalized, yes, we need over the counter abortion pills. So undocumented people and people without access to health care can access abortion pills. But we also as a movement need to be supporting immigration justice efforts, because reproductive justice isn't only about improving people's reproductive lives, but ensuring that they can live full autonomous lives free of oppression, whether that is reproductive oppression or not, period. So if you are claiming to be a reproductive justice advocate, but you only show up when it's about abortion, you are failing, you are failing community and you're not doing what needs to be done to ensure that people have reproductive justice, and I'm gonna need you to do better. And if you want to do better hit me up and we're gonna figure it out. Because, listen, listen, I'm tired of people only coming out to the row anniversary rallies, like where are you when people are being detained? Where are you when people are being incarcerated? Where are you when people are being laid off and can't get jobs and being paid $7 an hour, you need to show for those issues as well. Not only when it has something to do with a uterus, okay, okay, y'all had to get a little sassy at the end of this episode. But thank y'all so much for tuning into this episode. And thank you to plan C for including BFR and your creative fellowship, we will have a couple more episodes coming out. If you learn something, please let me know. Oh, y'all please. If you enjoyed this episode, or if you enjoyed any BFR episode, please leave a review on iTunes. Also leave us a rating on Spotify. If you would like to donate that will be down below. Sign up for our newsletter. Follow us on social media also request new episode topics too, because I want to expand a little bit so let me know what things you want to talk about. If you have something you really want to talk about. You want to be a guest let me know. Oh, I just gotta take this time for me to stop recording. Okay, I'll talk to y'all later.