Good afternoon everyone and welcome to our event post row access and equity. My name is Eva Brandstetter and I'm a senior editor at ProPublica and I'll be your host today. We're going to wait for a few more minutes for more people to join us so thanks for your patience. In the meantime, just some housekeeping close captioning of this program is available and can be enabled by clicking on the close caption option on the bar towards the bottom of your screen. Today we're going to be discussing access and health equity post row. This is the second event in our three part series of events surrounding this issue to bring clarity to the the state of reproductive rights in America. And we're very excited for the panelists that we have today and for the range of topics they're going to discuss and we're so glad that you're joining us. It looks like we have enough folks now on now so again thanks for joining us and let's get started. If you're just joining us my name is Eva Brandstetter and I'm a senior editor from ProPublica and I will be your host today. Welcome to today's section session post row access and equity. As I said close captioning of the program is available it can be enabled by clicking on the close caption option on the on the bar in the bottom of your screen. And as an additional note the session is being recorded and a link to the video will be provided to everybody who signed up and registered before the session. For those new for those new to us for public as a nonprofit newsroom dedicated to investigative journalism. We would be thrilled for you to check out the other work that we do on the side after this. And today I'll be talking to two of our reporters and and experts what as well about abortion access and health equity post row and and all the issues that you've been reading so much about several so called Haven states are making headlines for taking steps to expand or guarantee access to abortion. And these expansions and guarantees are attracting residents from more restrictive states who are seeking out abortion care. So for individuals who are incarcerated for example who can't afford to travel or who come from historically disadvantaged communities access can still be difficult, as I'm sure some of you have been reading, even with added abortion protections pro choice states are not fully able to counteract the effects of rose demise. And so today our panel speakers will shed some light on the question of access for groups who are commonly overlooked by traditional media will also be answering your questions we've had many of them already submitted and please continue to submit those during our program. We'll get to as many as we can. To begin I'd like to invite two of our own reporters Jessica loosen hop and can be the Serana who have recently reported on the effects of row to help open up the conversation. So welcome to be the and Jessica. And then to just briefly summarize the stories that Jessica and can be that have done and then talk to them a little bit about the reporting so you can hear more about that. We also have a call out for people who can't want to let us know about how the bands on abortion across the US have impacted medical care for them or people they know situations they're aware of, and so we'll be dropping the link to that call in the chat to encourage you to submit any information relevant to that call out. So Jessica had wrote a story in August about Minnesota and really look very fascinating look at the data that she was able to find regarding who was who's seeking out and obtaining reproductive health care abortion in in Minnesota and it's a fairly diverse group, Minnesota of Minnesota residents, but what she found and she can talk more about that is those coming from out of state, people of color made up a much smaller percentage on average of the patient population. So the story looked at how there was an incident at the border in which a woman from Australia was said she had been questioned quite aggressively about her abortion history and possible abortion history, and by the CBP and immigration side, so that raised some questions and the larger story focuses on how immigrants say that immigrant advocates say that these questions actually aren't asked often enough about women's health status when they're coming into the US when they're in US custody, when they're being held in immigration facilities that there is not enough attention to the need for reproductive health care. So with that, I guess I wanted to ask you Jessica, you know, Minnesota is one of these so called haven states that we mentioned at the outset, where abortion access is protected by the state constitution. So you took a closer look at the statistics that the state is keeping on on who's receiving abortion care. Can you talk about what questions you were hoping to answer with that story. I think that as somebody you know I am based here in Minnesota I cover Minnesota and so as a resident of a so called again haven state. I really wanted to, you know, haven that word kind of makes it sound like, you know, it's a pretty bucolic sounding and I can't really interrogate that a little bit more. And I thought the data was a good way to do that. Particularly, you know, because I feel like I was reading a lot at the time about how abortion bands and other places are going to sort of disproportionately affect women of color, and that made me sort of want to turn that on its head a little bit and say okay well then who do what do we know about pregnant people who are traveling to a place like Minnesota for for this care. Each state keeps abortion data a little differently and it turns out Minnesota keeps it in a way that we could sort of single out data that has specifically to do with out of status. And, as you said, it turns out that that the demographics for pregnant people traveling into Minnesota for that care differ quite dramatically from in state residents who are seeking out the care and so while in state pregnant people seeking the care it's a pretty diverse group, people who are traveling into Minnesota historically are overwhelmingly white. And so that to me, again, this is data from before from its backwards looking, but I just thought that it was interesting to at least sort of point out here's what we know so far about who's going to be able to travel into a state like Minnesota for this care. Right. And we're going to get into later with our panelists that issue of travel, who can afford to travel and defer many reasons. It's very difficult for lots of folks so I think that reporting you did in Minnesota kind of foreshadows, possibly the trends that we're going to see across the country. Thank you for that. Kavita, you know, as part of your reporting you looked take a look at reproductive health care access in immigration facilities. And that's a context that hasn't been discussed very much in the news. So what did you learn about how this has been handled in the past and are we seeing any changes yet in that space since Roe was overturned or is it too early to say. Yeah, well, so immigration agencies are federal so even though abortion bans have gone into effect in border states like Texas and Arizona facilities located there are still supposed to operate under specific national detention standards and those standards do currently have access to abortion information and services, and the Biden administration has reaffirmed that, but advocates told me in discussion that they still see this as very tenuous. Now there's a couple of different kinds of facilities that hold immigrants and asylum seekers but I want to focus on one type as an example which is shelters for unaccompanied children. And these are supposed to be temporary places for minors who come without a guardian to stay until they're released into to a family member or a foster family in the United States, but sometimes they do stay for longer. And there's limited data but I was able to find in court records that between 2018 and 2019 53 girls in those facilities asked for an abortion. And as context, just remember that for people coming to the US Mexico border the way to get here the journey is through human smuggler networks and sexual assault is very common on that journey. And in general women coming to the United States they're often coming to seek asylum because they're trying to escape gender based violence intimate partner violence, even within their homes. So, I point out those facilities because there's a really instructive test case for thinking about what could happen in the future. President and appointee in his administration who all oversaw those shelters for unaccompanied minors tried to block girls from getting abortions, and he sent them to anti abortion counselors funded by anti abortion groups. And the American Civil Liberties Union heard about this, and they launched a lawsuit, and on the basis of row versus way they won, but now they couldn't use that argument, and these policies, they're not law, they're created by the executive branch. So, as one ACLU representative put it to me, you know if an anti abortion president gets elected, then these policies are up for grabs. What are the facilities records in general when it comes to reproductive health care issues I mean they're been concerns about the treatment of, you know, women are pregnant and are these these immigration detention facilities what are their records in general when it comes to reproductive health care. That's what came up in the story and it's interesting because talking with advocates it reminded me of how much this is all linked. You know I learned historically their concerns have focused on how pregnant individuals are treated in the detention facilities. And there are many documented cases that have to do with lack of care or inappropriate care under Obama pregnant and nursing people that was a group that got prioritized for release so you could be released while waiting for your immigration hearing. Trump did away with that. Biden has brought that back so ideally there shouldn't be pregnant people in detention for very long. But you know now and advocates maintain that that's because they can't receive appropriate health care there in those settings. But immigration authorities they can still detain pregnant people if they have some kind of past infraction and so it's a space that advocates are continuing to watch and monitor and that we as legislators keep trying to learn more about. Great. Thank you so much, both of you for sharing your reporting. I'd like to invite our panelists to join us on screen. Thank you so much for being here. I'm going to introduce them when they join us. Hi guys. So Amy Hadstrom Miller is the president and CEO of Whole Women's Health and Whole Women's Health Alliance. She's an independent abortion provider who manages clinics in nine states across the USA. Charles Myers is professor of economics and co director of the Middlebury initiative for data and digital methods at Middlebury College. Her current work focuses on primarily on access to abortion care and the effect of abortion restrictions and or burdensome processes, such as traveling to receive care or mandatory what mandatory waiting periods on the incidence of abortion. So both of these panelists have highly relevant expertise to share with us today, and then we will have a third, a third panelist joining us Dr Carolyn suffering she'll be joining us soon she's a professor of oncology and obstetrics and director and advocacy and research on reproductive wellness of incarcerated people at the Johns Hopkins University School of Medicine. She has worked extensively on reproductive health issues, affecting incarcerated women for from providing clinical care and jail to research policy and advocacy so when she joins us in progress I'll just ask you all to remember her, her bio there.  You all have pretty unique areas of expertise and interface with specific communities. So from where you sit. What are your initial perceptions of how the ban and resulting changes have had an impact. And I realize there have been many but sort of the, the biggest impacts that you see. Yeah, I'm happy to take that I'm Amy, like you introduced me. So, it's had a huge impact. And I think one of the biggest impacts is chaos, uncertainty, fear. A lot of abortion seekers are very confused about their rights. They're confused about where access could be a lot of abortion providers are afraid about criminalization and afraid about practicing the specialty that we're trained to practice because of people who are migrating from state to state, etc. And I want to just point out that's exactly the intention of these kinds of restrictions is to create this landscape of uncertainty and fear, and, you know, make it hard for people to get access to safe abortion care. More and more we're seeing two Americas emerge, which we saw even before row fell with disparities in healthcare access but also with so many hurdles to get access to safe abortion. And now that 13 states have criminalized abortion, and it's completely unavailable in those places, we're seeing those those chasms grow even further. And many of the people we serve in abortion clinics in my clinics at Whole Woman's Health and many clinics across the country. Most people are already parenting. Most people are working one or more jobs and they can't just pick up and travel hundreds of miles to get access to safe care in a different community. Kind of to Jessica's point that she was talking about from Minnesota. I'm a Minnesota native and Whole Woman's Health has a clinic in Minnesota. And I think one of the things we're seeing pre dobs is very different than like the area she studied studied in her report is very different with Minnesota reporting because prior to row falling. Most of the people who traveled into Minnesota were coming from the Dakotas of Wisconsin, where abortion restrictions were, you know, greater than in Minnesota but those populations are primarily white folks and you know, economic disparities are in play as well. Even with SBA enforced in Texas, we saw people traveling all the way from Texas into Minnesota. And as recently as August when I was in Minnesota working with my clinic staff, we had about 15 patients in the waiting room, and I think 12 of 15 people were not from Minnesota. I think we're seeing a big change post dobs than what we saw pre June in the country and you know kind of the number one thing our patients are saying and abortion seekers are saying to us. First, they don't always know abortion is not accessible or legal still when they're calling in the place they may be calling from. And two, they want the next available appointment. So if you want an abortion, your drive to seek an abortion and become unpregnant is even more great, I think, and so folks are not necessarily going to the closest place, or the most accessible or logical place you might say oh someone from Texas is just going to go to New Mexico if they're told there's a wait a few to four weeks they're going to figure out where to go next. And so we're seeing migration all over the country. Yeah, so I think in some ways Amy and I can really compliment each other and painting this picture because that's a picture. You know the Amy has of what it looks like to be a provider on the ground right now. And for me as a data person and as an economist, I'm looking at it through a quantitative and somewhat abstract lens. So thinking what I would do to try to illustrate these these two Americas that Amy describes is share a new tool that I launched just this week. I'm going to put it in the chat for folks if they want to check it out it's called abortion access dashboard.org. And I'm also going to share my screen so if you don't want to check it out right now you can sit tight and watch me walk you through it but it's going to I'm going to show you an image of those two Americas. So this dashboard relies on data that I collected maintain on the locations of all us abortion facilities and I update those data monthly right now. In addition to updating those data, I have a team of 25 undergraduate students at Middlebury College where I work, who have been conducting mystery calls to collect appointment availability information at all us abortion facilities they've been doing it monthly, we're switching to quarterly. And I'm going to come back to this landing page in just a second, but I want to actually go over to a different page that has a slider that shows you how the landscape of access has changed since stops. So, this image that you're looking at right now is a map of the United States of course, and every census tract in the US which is like a pretty small neighborhood like area is shaded according to how far you would have to travel to reach the nearest abortion facility. And where you see it where you see the darkest green it's less than an hour, where you see light green, it's one to two hours, and then where you see pink, we're starting to see higher travel types. All of the little blue dots that you can see here are the abortion facilities that were open on March 1 in this country. And what I'm going to do is to show you how the landscape has changed since stops. So this is the current landscape of abortion access in this country right now we're in a scenario in which 13 states are enforcing total bands on abortions that have closed all of the providers in those states. And that actually glosses over some complexity related to, for instance, Georgia's six week gestational age ban, or a flickering of bands in states like Arizona where they are they're in effect they're not in effect that have actually caused some providers to, to give up and shut down so there's other losses in access but you can see, just with the slider that we have this portion of the country in the deep south and the Great Plains that has experienced tremendous increases in travel times so that a large number of people are now more than seven hours from a provider. Now I'm going to go back to the main landing page which just shows you the current state of access because there's a few other things I want to say about how access is changing through this quantitative lens. So, we're back to the present with more information. So, right now we have 13 full bands being enforced, and even accounting for providers that have moved across state lines to continue providing services. We still have had a net loss of 62 abortion facilities since March, due to these mostly due to these bands. So, you can see the long travel distances, you can click on states to see summary statistics for instance in Texas since March the average distance to the nearest abortion provider has increased from 44 to 500 miles, and the average travel time from less than an hour to more than seven hours. And so, though, can begin to explore what access looks like if you can reach these providers because in what some people are calling haven states we have providers that are experiencing and huge influx of patients out of the band states who are seeking abortions. And it's likely to put a lot of pressure on them to meet that demand and so in the app if you click on any of these destinations you can explore both the travel routes showing you where people are coming from for whom for instance, Wichita is their nearest provider. And you can see that in Wichita, they've had there's two facilities there. They've had more than a 2000% increase in the population of women in the region that they would serve. Of course, not all of those women stay in Wichita in particular if they're seeking abortions there. One of the facilities didn't have any appointments available within two weeks when we called in September. So they're also struggling to meet demand. You can similarly see in other places for instance if I zoom in on oops that was the wrong one, if I zoom in on Kansas City. Similarly, they're only one of the three facilities was able to meet demand when we called. And that's true, not only in the cities that are kind of the most obvious direct destinations, but also in states for instance like Colorado that are just receiving a huge influx of people from places like Texas. And in Colorado for instance if we look at Denver, only half of their eight facilities had appointments available within two weeks when we called last month. I'll start my share there for people who would like to explore the landscape of access clearly you can look at the state of your choice, but what I would say from a quantitative perspective is that these state bands are opening up enormous inequities and access so that a large fraction of the US suddenly finds themselves hundreds of miles away from providers. But that's not the end of the story because even for people who live in the locations where facilities remain open those facilities are struggling to meet this new demand. Fascinating. Thank you so much for that. Thank you for sharing with us that tool and the data I think is really important. I'm just thrilled to say that we're joined by Dr Carolyn suffering, and she is a professor of gynecology and obstetrics, and as I said director of the advocacy and research on reproductive wellness of incarcerated people at Johns Hopkins University met School of Medicine. So she focuses a lot on on some of the issues we're talking about access issues affecting incarcerated women. I want to recap the question for you Dr suffering and that is just sort of an opening question to all of the experts what your initial perceptions are of the biggest impacts of, you know, the overturning of row, you know, biggest changes and impacts that you're seeing. Thank you so much for that question and thank you so much for for having me I'm honored to be here part of this conversation with wonder, wonderful co co panelists as well. And what we are seeing as to how this is affecting incarcerated people answer to that is, we don't know, because we know so little about what is happening behind bars in our country they are the least transparent institutions despite being publicly funded institutions. So what I'm about to say is what I anticipate we will see or what I anticipate is likely happening, based on research that my team has conducted and based on experience that I've had work previously working as a healthcare provider in a carceral community and also now working in the community as an abortion provider. So the first thought that I had when this was not when row was overturned because we all knew this was coming but as we saw this coming down the pike. And that was this impacting incarcerated individuals abilities to access abortion because for those people who are incarcerated in states where abortion is banned or severely restricted, they do not have the freedom of movement to travel to another state. Now of course so many individuals in abortion restrictive states cannot travel because they, as we've heard and as we know that they cannot. So getting together the logistics and the financial means to do so is challenging, but for people who are in prison or jail or other institutions of incarceration they categorically do not have the option to even try to arrange to travel to another state. This also is true for people on probation and potentially people on parole and also probation, right there are limits to where they can physically move because they are still they may not be behind bars but they are still under state control. So their ability to seek an abortion when they need it is by definition constrained by the state's control of of their lives. Now, this is certainly also going to have an impact on incarcerated pregnant folks needing abortions who are in abortion supportive states because of the influx from people from out of state and the strains that we're already seeing on people in states so even in those prisons and jails that are in states with with that have access to abortion providers that have supported laws. There's going to be incarcerated people who feel the effects because they don't have control over their scheduling. There's, there are already barriers in place in those states. And so, to understand what the impact on abortion access for incarcerated individuals might be like, really also under that requires understanding, what was it like before June 24. And it depends. It was highly variable, not simply on whether someone was in a state that was overall abortion supportive or overall abortion restrictive, but it depends what prison or jail, you are, you are in in that state. So from a legal perspective, pre dogs, the legal record was very clear that incarcerated individuals retained their constitutional right to abortion. This was established through, through several case laws, I wish I could say numerous, but, but several cases that established this precedent that removing a person's constitutional right to abortion did not serve any what was called a technological purpose. And so they maintained that right to abortion. And that was also consistent with the right that all incarcerated individuals have to act to health care based on a 1976 Supreme Court cases still versus gamble. So the courts have affirmed that abortion falls under the health care that that was required for prisons and those to provide. But in practice it did not look like that and our research team has studied this extensively, both through evaluating policies, abortion policies at prisons and jails and this has also been done by by researcher Rachel Roth who survey prison state prisons about their abortion policies. We have also done that, and also with jails. And what we found when it comes to policies that in our study of 22 state prison systems. While most of them did allow abortion in, in at least the first trimester, only half of them allowed it in both first and second trimester. And even at the ones that did allow abortion, most of them required the incarcerated individual to fund the abortion themselves. So this is even in a state where Medicaid might have otherwise funded abortion, you're incarcerated, Medicaid is suspended so you can't access that benefit, you can't really access any private health insurance while you're incarcerated either. So functionally there were a lot of barriers, even in abortion supportive states, even in a state where or abortion is legal to viability, a prison in one of those states only allowed abortion up to 14 weeks. In contrast to the state, the state law and prisons and jails could get away with this because no one really pays attention to those policies. Then when we also looked at how many abortions are occurring in prisons and jails, we, we collected prospective data for one month from these 22 state prison systems and from the five largest jails. Most of, most of which are in abortion supportive states, California, New York and Illinois, but two of which are in Texas. What we found in the jails is that 15% of the pregnancies that ended in jails ended in abortion so that was similar to, to national immigration ratios, but in the prisons, in the state prisons of the 800 or so pregnancies that ended in one year in prison, there were only nine abortions, nine, and two in the federal system so 1% of the pregnancies that ended, ended in abortion. And this is a quantitative study so we couldn't fully explore the reasons why we have followed that up with qualitative data. And although those haven't been published, one of the striking findings of that study was that most incarcerated pregnant people just assumed they didn't have a right to abortion. And it was a very casual assumption. It was just, oh, I just thought I didn't have any rights. The story, the situation with abortion access for incarcerated individuals before June 24 was already fairly abysmal and already fairly variable, and the variability is important because you know the jails like Cook County LA County Rikers Island in New York. The individuals there did have access to abortion. But I started this by saying, you know, that I was initially concerned with access to abortion. The situation was already grave, it's going to get worse. The marginal difference, it's unclear how much what I'm also concerned about is the ripple effect in unincarcerated people in terms of other pregnancy care in these systems that are already ill equipped to provide comprehensive pregnancy and postpartum care to this population. It's fascinating. Yeah, I just wanted Caitlin and then Amy to talk about the effects of, you know, these certainly for incarcerated people, as doctors everyone told us it's almost very bleak situation but the barriers to travel. Can you all talk about the effects of distance on people. Yeah, so I'll start because this has been the focus of a lot of my work in recent years is isolating and measuring the effect of travel distance on abortion attainment. And the way we do this in my very quantitative field is we rely on what are called natural experiments. If you're interested in how distance affects people, you can't really run like a randomized controlled trial, for instance, as you would for a drug test because I could not ethically or feasibly go out into the population and say oh if you wanted abortion you have to travel 25 miles. And if you want an abortion it's 300 and now I'm going to see what happens to you right so that is not an option for scholars. But what we can do is use situations where sudden changes in access have as good as randomly assigned distance for us and we've had several of them in the last decade coming from various state level supply side restrictions that have suddenly shuttered providers this happened in Texas in 2013 when a law closed half of their providers pretty much overnight on November 1. It happened with some laws in Wisconsin and we've had other contexts to examine it. And so what we've done in my field and it's my work and that of others is we use publicly available data on abortion and birth rates, and we measure as distance goes up. How many people still get to the providers, how many people don't. And if we see people not reaching abortion facilities, what happens to them next do we see them give birth. And what that literature shows is that distance has a tremendous effect on people seeking abortions, and that an increase from zero to 100 miles prevents about a fifth of people who want abortions from reaching providers. And that initially when when economists like me started disseminating that result there was a lot of surprise in our field but also for instance in federal courts where this was really important to measuring the burdens of abortion restrictions and kind of the pushback we would get is like oh, if abortion is so incredibly important to somebody's life, they're going to figure out a way. And it's, it's such a class lens through which somebody views healthcare access because as Amy's described, as Dr. Suffren's describing, people who are on the ground in this field talking to folks seeking abortions are not surprised that distance is such a barrier. So based on what we've seen quantitatively in the literature, my best estimate of what is likely to happen due to the unfolding bands is that about a quarter of the people in the affected areas are going to be trapped, primarily by distance and poverty. For those people who get trapped, some of them are likely to self manage their abortion to find another way. So what we've seen in the data at least in the last 10 years about three quarters of them carried a term and give birth as a result. And so, just in terms of numbers. I think that's generally the magnitudes that we should be expecting to be look at looking at barring other policy interventions, maybe huge success for abortion access funds or mail order distribution, which we can talk about but I'd like to hear Amy's perspective and and if she thinks that number sounds realistic I'm curious to know. Yeah, I appreciate this and I will just say that it's so important to study the data that you all are studying and and publish the data and impact. And listen to real people impact, like tell the stories of the impact and, and my staff do and I can't even begin to quantify the trauma and the difficulty of having people who are completely trained to perform abortions and dedicated their life to the service to now have to answer the phone and deny people that care and measuring that impact on the abortion workforce and on folks who have been trained and are ready to help. And now they're serving as sort of travel agents and trying to like tell people what flight to take and what car to use and how to get to someplace. When there's absolutely no reason but for these politics that they can't provide the care themselves. I also think there's no other medical procedure in this country where we tell people oh you just drive 700 miles, right, that is a procedure that a third of the population will have at some point in their life. Abortion is incredibly common it's incredibly important and it's time sensitive essential health care, which I know many of you understand, but I think we have to look at the ways in which the opposition is trying to deny people care outright delay people's ability to access care which drives up cost which drives up risk, which also makes the abortions they finally are able to obtain abortions that less people are comfortable with, including the patient. This is all part of a strategy I think we need to just always remember to tell the stories of the people that are impacted and listen to what's happening to people as they try to build their families, and they're forced to either continue a pregnancy they don't feel ready for financially emotionally in their family. Or they have to seek to self manage their own abortion or they're forced to travel those are really, I agree with you those are sort of the three paths that we're seeing people talk about we're also not seeing people to care to Dr suffering point like it's hard to measure people when you can't. They're missing right their data doesn't matter they're missing there's not a clinic anymore in Texas where you can talk to the patients right like there's no they're there right and so I think a lot of what's happening right now is disappearing. I want to point you to the turn away study from UCSF that that measures Diana green foster that measures what happens to people when they're denied the abortion that they seek and it it measures sort of the impact and people over decades are clinic in the calendar which has now been been shuttered by these laws was one of the participants in that study and I think it's a really timely, timely data to look at. Another thing I would just point to thinking about what Kavita was talking about before is that the Jane Doe that had the abortion in that the ACLU fought for in the Callan out of a detention center had her abortion at whole women's health in Callan and Dalia Lithwick tells the story through Brigida Mary's eyes at the ACLU and her new book, Lady Justice so I just recommend reading that it's pretty powerful story. We started a program at home itself called the wayfinder program, which literally, it's like a super literal name like we help people find their way to an abortion when they've been denied an abortion and that program started actually all the way back when Governor Abbott used the COVID pandemic as an excuse to ban abortion in April of 2021 and April 2020 and then it got sort of brushed off unfortunately and reignited when we had to deal with SBA. And so it's been a program that has grown exponentially now that abortion is banned in so many states and what we're doing is basically trying to help people from places where abortion has been criminalized, or where it's been restricted or banned. Find their way to a place where they can get safe access to abortion and with abortion funding, both for the traveling as well as for the actual procedure, but also just logistics of trying to find where's the next available appointment to what you were talking about Dr. Myers to like what clinics are open what clinics can see them. One of the things I will say as an independent abortion care provider which means that we're not affiliated with my parenthood is that independent providers don't have a national brand like my parenthood does in some ways and so when you lose the independent provider in your community, right, like, you know, emw in Kentucky you know Red River women's clinic in North Dakota you know whole women's health in the calendar. Those folks don't know what how to search for that kind of clinic in Kansas or Colorado or Illinois because they don't know the name, right and so I think there's some independent providers that may be available to meet surge demands. And we're just trying to figure out ways through either the abortion finder or I need an a, or some of these lists serves to get people access to places where they may not have to have as much of a wait time. Other thing that's fun to just because I have two researchers on here and probably way more people listening also other thing that's really been interesting is just that the migration isn't of people isn't necessarily following proximity like I touched on a minute ago and we're just seeing this with our wayfinder program. People are going to places where they have an uncle or they have an aunt I have a friend I can stay with I maybe I went to college there maybe I grew up there or you know people are picking where they go for their abortion and it's not necessarily just the closest. And I think it has a lot to do with travel it has a lot to do with economics, people feeling safe, knowing where they can go a familiarity. But also when we have so many people who are primarily black and brown driving cars with license plates from southern places. We need to think a lot about where those folks feel safe and welcomed and protected where they can blend in right you may be able to blend in a little more easily in St. Louis than you can if you drive to some little town in southern Illinois where you know somebody's open to clinic right, or you may feel more comfortable going to Albuquerque than you would to go to Hobbes right or you may feel more comfortable in Chicago and and I think we have to think about safety of our patients because our patients are being profile and surveilled and followed. We have to think about safety of providers, and we have to think about safety of the staff, because now the anti abortion forces have fewer places to focus on so we're seeing an increase in in some of those the vitriol. From people who are emboldened by this when and are now going to cross over the border from Texas into places like New Mexico or Illinois and try to sort of foment the sort of red voters in a blue state, some of the words that I've heard people use right so. I brought a lot of stuff into that but that's a little bit of what we're seeing and what we're trying to navigate as we try to support people to travel into places they may never have gone before they don't know anything about. A lot of our patients have never flown before they don't have an ID they've never been through airport security. So we've built this whole like guide for them that's like, isn't he doesn't even use words or language that has pictures like this is what the metal detector looks like this is what the thing looks like this is how you do this. Because so many of our patients. You know have it haven't done any of this kind of thing before and then the first time they do it's it's in the context of seeking abortion. It's fascinating perspective on the ground. Really appreciate you sharing that. I wanted just to have each of you talk for a few minutes. We are going to go to audience questions near the top of the hour. So I wanted to have each of you talk for a few minutes about the equity issues at play and we've talked some right about people who are incarcerated, you know people who wind up in immigration and we've talked about some various communities, a few communities we've talked about today but there are so many that should be overlooked in terms of access. So what communities have you all noticed have been overlooked by traditional media that should be part of this conversation who are who are you, I wouldn't say most concerned about but who do you think is really being missed and really being challenged and Dr suffering if you could go first. Well, I think I've somewhat already answered that question with incarcerated individuals. It's, they are forgotten, because it our society has created a system that makes us believe that prisons and jails are over there. But it's they're part of the community and in fact if anything proved that to a very strong point it was the coven 19 pandemic right where we saw rates skyrocketing behind bars and it was because of flow to and from the community from workers and people leaving and and coming. So I think incarcerated individuals is a population that we absolutely must pay attention to for somebody, excuse me for so many reasons. All of the disparities and inequities in abortion and other pregnancy care and reproductive health and supporting the well being of families, all of the disparities that we know exist in this country already that track along racial and ethnic lines. And those are also true incarceration right so black women are incarcerated at twice the rate of white women, indigenous women as well have significantly higher rates of incarceration than white women, same with Hispanic women as well. That's how the Bureau of Justice statistics reports their ethnicity. The disparities that already exist in abortion care and in other pregnancy and reproductive health care that tracks with who is incarcerated in our country. And when it comes to all of the, you know, inequities in pregnancy care and, and the broader ways that our society doesn't support certain individuals and certainly certain families from thriving. So I think we absolutely need to pay attention to what's happening to them. I think we're going to probably see more pregnant individuals behind bars in this country, just based on, you know, the number we're potentially going to see, likely going to see more pregnant people give and birthing people in this country. So I anticipate that more of them will be incarcerated as well and these systems as I mentioned earlier are ill equipped to deal with them. And then they're, if they're forced to give birth and give birth while in custody, they're then forced to be separated from their newborns so they're denied the right to have an abortion, and they're also denied the right to parent. So this is a huge issue of inequity and injustice, and one that we absolutely must pay closer attention to. Thank you for that. Caitlin. Economists aren't known for being emotional but I'm, I find this description. Really hard to hear. But I measure things. So I can tell you that in the literature that uses quantitative methods to isolate and measure the effects of abortion restrictions. We have seen the same story, the same, the same dominant story for 50 years, which is that abortion restrictions disproportionately impact people of color and young people. We saw it when abortion was legalized 50 years ago. Roe v way didn't make abortion accessible to everybody what it did was dramatically reduce the inequalities of access people with means primarily white women, middle class women upper middle class women, they had been finding ways to obtain safe abortions, even if they lived in places where it wasn't legal. There was people who black women, young women people were who were more marginalized and society who faced much more difficulties and what we saw with the legalization of abortion, it dramatically reduced burst particularly to teens it reduced teen motherhood 50 years ago by about a third. It reduced black maternal mortality by somewhere between 20 and 40%. We had huge effects on young women and women of color. And that's what we're going to see again right now we see it in all of the current literature on mandatory waiting periods on parental involvement laws and on distance. The biggest effects are for young women and women of color. And for me, I think, on the one hand, I think, you know, you kind of ask what the press is missing. I don't necessarily think that journalists are missing that fact. And that's a good thing I see it covered I see people talking about it. But it's also interesting in the economics literature in the economics world. I so often get questions about the economic impacts of these policies where people ask me, Okay, well, our business is going to leave the south. Are they going to have trouble recruiting workers in the south. What is the political kind of pushback going to be and one of the things that I find a little bit troubling about those questions is I feel like sometimes there's this failure to recognize that people who can choose where to live and where to have jobs and, you know, or like professors deciding where they want to professor. Those are not the people who get trapped by a lack of abortion access. They find a way to travel. And so I think sometimes we're missing just the extent to which this is an inequality of access story. Great. And Amy.  My favorite questions. I think reporters are missing talking about abortion as an economic issue, especially in the context of the election. I have seen reporters I just, you know, saw Steve Pernacchi like analyzing the the election. On Friday, and he separated economics with abortion and told the story like abortions followed to number five and the economy and inflation is number one. And anybody who understands, like why people need abortions why family needs access to safe abortion, how access to safe abortion has improved outcomes and mental health family health economic justice, etc, would not separate abortion from an economic issue. So I think it would be really cool to see some reporters dig into that, because I think understanding the reasons that we need abortion and what safe abortion does for family outcomes and women's health outcomes and all these things is really important. To I think there's a struggle, I think with some reporters that I have talked to to deal with that that there isn't sort of a heroic arc there's no narrative there's no narrative of us being able to say we're going to sue we're going to get an injunction we're going to we're going to get a TRO we're going to fight back we're going to bring this to Supreme Court and then we'll win. We've been able to tell that story for a long time whole and self students state of Texas know less than 11 times right and we won a few times and so I think that piece is tough when I talked to reporters, sometimes they're like but but but but they want to have the answer to the questions that they asked me be a different answer, because they're having trouble accepting that some people are going to be forced to carry pregnancy to term some people are denied abortion yes this is real. There is not this heroic arc, and I think we have to be careful, telling sort of like we raise thousands of dollars to help somebody travel hundreds of miles in order to get an abortion that took five days that's not, that's not heroic, that's a tragedy. Right. And so we have to talk about abortion in a different way than I think we've gotten used to right because we're used to this sort of fix, or the legal system is going to save us, and or the, you know executive branch is going to write a yo or you know I mean we're in a very different, you know we just got a president who said abortion for the first time like feels like two weeks ago right and so I think we're in a different place where you know the relief where we've gotten used to with providers suing and getting injunctions to block is not there anymore. And so I think it's a really new a new framework and I want. I want more complex stories to be told that aren't so black and white. And before we go to audience questions, I just want to follow up with you and me and talk about what it's like to have to both close down clinics like you have in Texas, and then ramp up clinics, you know, in places.  Yeah, it's been a really tough time, not only for our team at home itself, and, and, you know having to close down the clinics we had in Texas, which is where we started, and also try to get ready for a surge and or just keep stability in the clinics we have in Minnesota and Maryland and Virginia, and see these disparities, depending upon where people live, continue to emerge. And it's to, you know, two different sides of the same sort of skill set trying to figure out how can we prepare to help people travel and migrate and how can we deal with the trauma and the injustice of having to, to close those clinics. And that part's been really challenging, you know people saying things like well why did you close. Well, it's asking a lot. And I'll say, you know, we were forced to stop doing the work we love. Right, like, like people want you to own like oh somehow a failure in the provider right that we weren't able to figure out how to stay open or we're not able to figure out how to help people get the care they need and I think that piece is really important for us to to examine right this is a community, a societal challenge it's it's it's much broader than anyone sector of us can fix right now. So, you know, we're grateful that we're able to see patients in some places. But it's been very difficult to figure out how to help people get the care that they need, and just listen to the stories of the desperation of people who can't even begin to think of how they're going to travel across the country to get the care they need. Yeah. Thank you for sharing that and just for all of you for the wisdom that you brought to this discussion and wanting to stay around we're going to have obviously we're going to turn now to the q&a portion with our audience but before doing that I'd like to share a link to our event survey in the chat box and we really would appreciate your feedback for those of you who joined us today. Again, if you'd like to ask a question please click on the q&a icon at the bottom of your screen and submit it to us we'll get to as many as we can. Now for our first submitted question. I wanted to ask a question from Allison Herrera colleague of mine here in Oklahoma about access for native women and she knows that this tool Caitlin that you showed us is incredibly useful to map out access. She's wondering if you or if any of you all are aware how the law has impacted Indian health service and those who seek their care at those facilities. I have an answer that wasn't a fairly short no, but but that that that is the truth for me I can with the data I have I can or I can provide anybody who's interested because I'm very much about open science with the data to map and quantify changes to access at any spatial level but I have not specifically studied how it's impacting Indian health services and we do know as I said before that communities of color, rural communities. They are often disproportionately impacted by by closures. Okay. So our next question is that do you have any advice, any of you for health care social services providers serving young people. The IPOC people of color incorporated incarcerated people and how to, you know, keep complete and accurate charts that won't be used against them. Dr. suffering you probably have some advice for this and potential criminal actions. Yes, I'm also a healthcare provider and an abortion provider although I practice in an abortion supportive state in Maryland, but what what my colleagues and I, not only in Maryland but across the country are advocating doing is just recording the medical facts. You know, someone comes in to the emergency department, pregnant and bleeding. That is, you just need to evaluate that the bleed and document that that they're bleeding and what you're doing to stabilize them but not anything that led up to that. You know, whether they, because of potential for criminalization of self managed abortion in certain states but you take care of them as you take care of any other patient who comes in with those same symptoms and documenting the medical facts of the case. Yeah, I would add to that and that's, that's super important we've been doing that for years I would add to that that it's not a crime to help people get the abortion that they need in the state where abortion is legal. And I think people are really afraid and have been grown up, like I think the aiding and abetting part of SBA got everybody worried. Right. We're we're we're post SBA now, right and and and there's many states where abortion is legal and people from any place can go to those states and have abortions that are legal, if they can get there right and so I think there's a lot of fear about can I tell people that that abortion is still legal could I tell someone in Texas how to get to somewhere in New Mexico or Kansas could I tell someone from Ohio how to get to an abortion in Michigan. Yes. Right and I think the more we can just let people know that you can provide information that you can. You can give people that information I think that sort of pre compliance piece that we're seeing or the fear. I want it to not grow more than it needs to write because there's enough misinformation already. And so just hope that we can encourage people to give information that's not like the you know the international gag rule or something right like like abortion is still legal in many places and Texans and Mississippians and Louisiana's can be seen in those those places where abortion is legal just like people who live there can be. Great. Thank you. Another good question how effective or travel funds and getting people to doctors offices. Do you know I'm waiting to measure. They're changing like the entire the amount of funding they have their organization their scale is all changing right now and so I'm not. I think we're going to have to measure what the what the total effect is but I do have a few thoughts on it. I have no doubt that just just from the qualitative evidence alone at this point that they are assisting people in obtaining abortions who otherwise would not have been able to. To I also have no doubt that there are large numbers of people who remain trapped by distance and poverty for whom the travel funds aren't a viable way out. First of all is Dr. Suffrens discussing like the travel funds are not necessarily any help at all to an incarcerated person. But other people are trapped by other circumstances that aren't just about the lack of funds for travel it's about figuring out how to take time off of work figuring out how to get childcare. Sharing it doing so may involve sharing information with people who you know might pose a risk of violence to the person seeking an abortion. So what we've seen in the data so far there's been travel funds, by the way, for a very long time like so our analysis of the number of people get trapped has always been in the context of which travel funds existed, and we still saw large numbers of people trapped by distance. So, you know, I think we'll continue to analyze the effectiveness of those funds but they're not going to need all of this unmet demand and unmet need. I have some questions about security anonymity surveillance, and you guys may not have a lot of specifics on that on this issue but I wanted to ask it, regarding, you know, tools for people, how to how to maintain their anonymity, how to protect themselves from potential legal action. You know there's another question about tracking telemedicine and mail forwarding to restricted states. Is there anything. There's a lot there. As far as the travel funds go I think it is helping people travel, especially gas cards. More than sort of flights kind of stuff. But I think you're right that not everybody can travel right so it's like a little, it's a little bit of both but I think people are very much helped and, and if there aren't travel funds people continue pregnancies or self managed I mean it's a direct relationship like they can't come up with it, necessarily. And this question I think there is some surveillance what the surveillance I was referring to is people being profiled, like people who are traveling together like let's say you're driving from, you know through West Texas on to Albuquerque right. I think people are sort of, you know there's anti abortion people who are saying we're going to like, you know, if two women are traveling over the border, etc right I don't know if that's being encouraged but I've heard patients talking about that, and worried we've also seen, you know there was the person who you know was talking about abortion and Facebook Messenger and that that information was used against them we've seen that. Also that kind of electronic surveillance. I think you know, anti abortion people are involved and they're not going to stop right and so I think we can't assume that those kinds of things are going to be surveilled but we also have to realize that abortion is a moral good it's a social good that that it's essential medical care, and it's available and people still need to access to safe abortion right and so I think the fear about criminalization and the sort of pre compliance as that sort of you know one of the first signs of authoritarianism right I think we have to balance that right because the more we can talk about it and and almost stand in a place of pride if you're in a state where abortion access to safe abortion is protected as essential medical care to say welcome to Virginia welcome to Maryland we are proud to be here. We will to help you right instead of this sort of like we better be careful nobody finds out right. I think sometimes it's a matter of how bold we want to, we want to, we want to be in the places where it's supposedly safe for us to do so, and to me that's part of what it means when people say haven state it's not just. It's a haven state right like we have we have a responsibility as part of this country right to be of service to the people who need us from other parts of the country. Go ahead. Can I just add a thought that it is a huge question so I'll add a thought that's from a different perspective and something I've wrestled with professionally. So, one of the big questions that all the quantitative people in my field are just waiting to be able to answer is what the net effect of all of this will be on abortions and burst. And to answer that we're really waiting for several years for vital statistics to be released that we can analyze. In the meantime, everybody's trying to figure out if they can get a sneak peek at what's going on and they're adopting different strategies but one strategy that several teams of researchers are adopting is to buy data from location data brokers. So, everybody probably knows this but if you have apps on your phone, a lot of them are tracking where you are. And those apps sell that data to location data brokers, which collect it and then they sell it to other companies that use it for all sorts of things. In the academic, I've had undergraduate students last year, for free, obtain information that counts of the number of people showing up at US abortion facilities.  And so there's this huge, first of all, there's an ethical question for me about whether it is ethical to use such data. I've taken a public stance that I won't use it but I think it's a really difficult. I think it's a really difficult question and I've not necessarily condemning the people who are using it for academic research. But also for me it raises this huge question about the potential for surveillance via people's phones I mean this isn't actually hard to do. To my knowledge, none of the brokers are providing the data to government agencies that might want to surveil people seeking abortions and to my knowledge that's not like happening. That's certainly an area where I've watched the role of technology in in what's unfolding with a decent dose of anxiety. Interesting. We had another question about Indigenous communities and then the challenges that women face to, you know, get even just basic OBG way in care so I guess I wanted to ask Caitlin, and, and any of our panelists if you have advice about the best sources for people to help track for future research. You know, there's some journalists on our panel today there are people that are just very avidly interested in this issue. So do you have any recommendations sources of information to track inequities. I'm just chiming with a couple of organizations like indigenous women rising or sister song that have a commitment to do work with indigenous women because I think there may be people tracking things more than. And we realize right so just trying to like make make that encouragement. I know from the maps that that Caitlin shared and maps that I've been staring at for the last year and a half right over here on my wall. Um, that, you know, if you look at where a higher percent of population of indigenous folks live, those states have had abortion span. And so, I think, you know, it's probably an issue that some of the specifically dedicated to indigenous women and indigenous repro work, some of the words might be dedicating some thought to. And that's not represented here in our panel. Okay. Let's see, there was a question about birth control measures spiking up as a result of these restrictions. I don't know, Dr. Saffron, if you could answer that is that is that at least easily accessible in these regions. Not necessarily. It depends. Access to contraception is highly variable. It always was depending on, you know, general access to reproductive health care. But we're also seeing there are also concerns about regulation of contraceptive methods because of misinterpretation that they are abortion methods. I've already heard anecdotally of a jail in a in an abortion restrictive state that now does not provide emergency contraception. So and that's that's an example from a jail but I think they're they're also going to be challenges with contraception access even in community settings as well. Okay, and I'm going to go ahead and close our session today with the final question. And we've talked a lot about a lot of resources and we, you know, research you can direct people to but do you all have any additional research or resources that you would like to direct our attendees to after today's session groups. Anything like that. Where can people go for help. The Institute is always a good go to source of as much real time data as, as we can get, and they frequently update their website. So I would say the Gutenocker Institute. And Caitlin your, what your tool that you showed how can people access that. Yeah well first of all I just have to second Gutenocker who does an incredible job of disseminating timely public health data. I'll put the link to my tool again in the chat. So, I'm tracking and updating monthly right now changes in bands changes in travel distance changes and appointment availability and you can go to my tool to obtain those data also for scholars you can download county and month, or sorry county and state level measures and access and I've also got links to other open science data sets that I published that can be used for academic research or just describing. I think the other thing to just pay attention to is on in the academic community. We're all analyzing the effects of these changes in access right now right like so my dashboard describes how access is changing in a quantitative way. The next step for us is to analyze and then what what's happening to people and so I would simply say stay tuned we're waiting on the data to be released I'm working on some projects right now on on mental health, for instance. I would add a few things I would give people the abortion care network, which is the organization of independent clinics across the country and the abortion care network has a has a fund called the keep our clinics fund, which folks can donate to which is actually giving direct access to independent clinics across the country to keep our doors open or to transition our services if we have to shutter our doors, and to really just keep those logistics available to independent providers. Another web, another or a guy would point people to is a national network of abortion funds which is helping people with resources to pay for their abortion and also resources to travel. And then of course, our wayfinder program which is how's it whole women's health alliance which is doing similar work both in services and helping people get access to abortions in places where it is still available. Thank you so much. That's our time for today I did want to close with just a note for our listeners that her public a we are measuring issues that impact Americans and with data and with the approach that we bring to any journalistic enterprise and so we're not taking a position but we are looking at where issues are impacting people all over America and how we can measure that and so that this discussion has really been about providing this information for everybody out there and there's a wide variety of opinions and feelings about this. This issue, and I think we've captured today how how how this issue has really impacted some of the most vulnerable communities in America so I just can't thank you all enough for joining us to our panelists to the reporters, and to our audience for some really thoughtful questions. And just wanted to remind everyone again that this event has been recorded and you'll soon you'll receive an email with a full video of today's event. And we'll also post this recording on the ProPublica YouTube channel. We encourage you all to join our last session in this three part series, and be the first to know about program by visiting our events page which is ProPublica.org backslash events. And from all of us at ProPublica thank you so much for joining us have a great rest of your evening and see you next time.