Episode 16: Unpacking the Past, Present, and Future of Safe Abortions with Dr. Allison Berry
During episode 16 of Art of Citizenry Podcast, Manpreet Kaur Kalra is joined by Dr. Allison Berry, a family physician, mother, and trained abortion provider. Together, they discuss the nuances of the recent Supreme Court decision to overturn Roe v. Wade, explore the inequities that come from banning safe abortions, and unpack how religion + politics have dictated the physician-patient relationship. As a primary care physician and Public Health expert, Dr. Berry offers her personal experiences caring for patients and humanizes the fight for reproductive justice.
đź“Ś IMPORTANT NOTE: For medical providers like Dr. Berry, coming out as an abortion provider is very risky to their safety. I want to thank her for her time, compassion, bravery, and for sharing her expertise with us because it is important that we humanize abortions and give voice to our medical experts.
Topics Covered: Dr. Berry will be talking to us about reproductive justice, what getting an abortion actually means, the recent Supreme Court ruling, the way language shapes narratives around abortions, the nuances around abortion access irrespective of the state you reside in, and her own upbringing as a member of the Catholic church.
Meet Our Guest
Dr. Allison Berry, MD MPH — Health Officer for Clallam and Jefferson Counties
Dr. Allison Berry is a family physician, mother, and trained abortion provider. She graduated from Johns Hopkins University School of Medicine and received her masters from the Johns Hopkins Bloomberg School of Public Health. Most recently, her work has been focused on the COVID-19 pandemic as she has served as the health officer for Clallam and Jefferson Counties, in Washington State.
đź“Ś LISTENER NOTE FROM DR. BERRY: I work as the Health Officer for Clallam and Jefferson Counties and as a family physician for the Jamestown Tribe. My views expressed here are my own and have not been vetted by or approved by my organizations.
Roe v. Wade: A Brief History
In 1973, the US Supreme Court ruled that the Constitution of the United States protects a pregnant person’s liberty to choose to have an abortion. This landmark ruling challenged the individual abortion laws passed by various states and made abortion legal at the federal level above and beyond the state level.
The case of Roe v. Wade was initially brought forth in 1969 by Norma McCorvey, known in the case as “Jane Roe,” a woman who lived in Texas and wanted an abortion, but could not have one because abortions were illegal in Texas unless it was absolutely necessary to save the life of the pregnant person. The lawsuit was filed against her local district attorney, Henry Wade, hence Roe v Wade.
Considered one of the most controversial cases in constitutional law, the Supreme Court ruled that criminalizing abortion violated the constitutional right of privacy, balancing abortion rights with regulations. Roe v. Wade articulated that states do not have the right to regulate abortions until approximately the end of the first trimester of pregnancy. The court also identified a fetuses viability, or ability to live outside of the womb, at 24 weeks of pregnancy.
Since Roe v. Wade, anti-abortion groups have continually challenged the court, narrowing its scope with cases including Planned Parenthood of Southeastern Pennsylvania v. Casey in 1992 (more on this in the Glossary below).
Dobbs v. Jackson Women’s Health Organization
In May of 2021, the Supreme Court agreed to review a lower court’s decision to strike down a 2018 Mississippi state law that banned abortions after 15 weeks, which is well before the 24 week fetal viability measure set forth by Roe v Wade. Though the law was clearly unconstitutional, Mississippi lawmakers passed the measure fully expecting it to be challenged in hopes that the case would be taken on by the 6 to 3 majority conservative Supreme Court, an imbalance that only happened in the last presidential term. As expected, the state law was challenged by the Jackson Women’s Health Organization abortion clinic, the only abortion clinic in the state of Mississippi.
At the heart of the most recent case, Dobbs v. Jackson Women’s Health Organization, the single question being answered by the courts was if bans on all pre-viability abortions are unconstitutional. In other words, are states able to ban abortions before the 24 week precedent that Roe v. Wade had set? As you are well aware by now, the court ruled to overturn Roe v Wade and Planned Parenthood v. Casey, stating that pregnant people do not have the constitutional right to an abortion and that abortion laws were up to states to determine, effectively making abortions illegal in multiple states overnight.
Map by Guttmacher Institute. The map reflects state policies in effect as of July 8, 2022.
“The abortion landscape is fragmented and increasingly polarized. Many states have abortion restrictions or bans in place that make it difficult, if not impossible, for people to get care. Other states have taken steps to protect abortion rights and access. To help people understand this complex landscape, our interactive map groups states into one of seven categories based on abortion policies they currently have in effect. Users can select any state to see details about abortion policies in place, characteristics of state residents and key abortion statistics, including driving distance to the nearest abortion clinic.” Access the map here.
A Fight for Bodily Autonomy
Bodily autonomy is the right we hold as individuals to make decisions about our own bodies.
DR. ALLISON BERRY, MD, MPH —
“Pregnancy is complicated and carries significant risk. The decision of whether or not to continue a pregnancy is a complex and nuanced one that can only be made by the person who is pregnant.”
The conversations around abortion rights and United States law are complicated, not because they have to be, but because we live in a society rooted in patriarchal misogyny that has historically and continues to believe in maintaining control over people’s bodies.
Overturning Roe v. Wade is the direct result of a patriarchal worldview that recognizes Christian morality as the only moral compass that is allowed to define social norms. One that denies individuals, particularly pregnant people, autonomy over their own body and their own health.
The Supreme Court’s decision to overturn Roe v. Wade will only further exacerbate existing inequities, disproportionately impacting those already marginalized by systems of oppression - people of color, poor people, people residing in rural regions, among others.
It's important for us to realize that even within states where abortions are protected such as Washington, equitable access to care, including reproductive care and abortions, is still incredibly difficult.
Wealthy, upper middle-class individuals who have the resources and ability to travel to a state where abortion remains legal will remain the only ones who are able to access safe abortions. This is what it means to hold privilege and power within a classist society.
Access to Safe Abortions is a Human Right
Abortions will not stop. Only safe abortions will. And we will see an increase in complications and deaths when physicians are not a part of the process. When alcohol was banned during the Prohibition period, we saw a significant increase in the amount of unsafe alcohol production that poisoned and killed many individuals due to a lack of regulations and oversight. If something is supposedly not happening, you cannot address it. Without protections and regulations in place, we are creating unsafe environments for further harm and inequity to manifest.
To truly value life, there needs to be an increase in paid maternity leave, child care assistance, free preschool and everyone needs to have access to safe housing, healthy food, and a strong education.
Access to safe abortions is a conversation that requires us to unpack not just the importance of Roe v Wade, but all the other ways in which the United States of America has chosen to make access to health care more difficult for pregnant people, particularly those who navigate multiple intersections of systemic oppression. Understanding these nuances is important to understanding the reality we are fighting against and the future we are fighting for.
This decision is not about protecting lives, it is about control and denying agency for women, for pregnant people, for patients, and for trained medical professionals. Abortions, like any other medical treatment, are part of essential health care. Denying essential health care is unjust and denying safe abortions only puts those most vulnerable at further harm.
Reproductive Justice
The Reproductive Justice framework recognizes the need for intersectionality, looking at reproductive health through the lens of social justice and human rights.
The concept of “reproductive justice” was coined by a group of Black women in 1994 in recognition that the Women’s Rights Movement, led by and representing white women, lacked a lens that could more equitably fight for the needs of Black, Indigenous, and women of color, and other marginalized people.
“These women named themselves Women of African Descent for Reproductive Justice, and RJ was born. Rooted in the internationally-accepted human rights framework created by the United Nations, Reproductive Justice combines reproductive rights and social justice. The progenitors of RJ launched the movement by publishing a historic full-page statement with 800+ signatures in The Washington Post and Roll Call.” (Reference: SisterSong)
Read the statement placed by Women of African Descent for Reproductive Justice in Washington Post in August, 1994.
DR. ALLISON BERRY, MD, MPH —
“We have a long history of forced sterilization in this country, of limiting access to safe pregnancy for people of color who are carrying pregnancies. And so I think the important thing from my end is truly reproductive justice. And that as a pregnant person, you have the right to decide how that pregnancy goes. You have the right to decide to end it, you also have the right to decide to continue it, and to continue it in a society that supports and makes possible a healthy pregnancy and childbearing. And that's a place where we fall down a lot when we take care of pregnant people of color.
We need to fight equally for the ability of Black and Brown parents to safely deliver pregnancies. Know that for for many people, the thing that they want, and that they are unable to access is a healthy pregnancy. And so I think what really is important in these conversations is to center the autonomy of the pregnant person.”
The main goal of the reproductive justice movement is to move beyond the pro-choice movement’s singular focus on abortion. As stated by Kimala Price in their paper “What is Reproductive Justice?: How Women of Color Activists Are Redefining the ProChoice Paradigm” published by Duke University Press:
“Frustrated by the individualist approach of the pro-choice framework, a growing movement created and led by women of color has emerged to broaden the scope of reproductive rights. Calling itself the reproductive justice movement, this coalition of women of color activists and their allies are using a human rights and social justice framework to redefine choice.”
Asian Communities for Reproductive Justice (ACRJ) states:
“Reproductive justice exists when all people have the economic, social and political power and resources to make healthy decisions about our gender, bodies and sexuality for ourselves, our families and our communities.”
What does it mean to decolonize healthcare?
During this episode, I asked Dr. Berry what it means to decolonize healthcare and her response was so incredibly powerful. I do highly recommend listening to the words below in her own voice during the episode.
DR. ALLISON BERRY, MD, MPH —
“From a healthcare perspective, I think it is freeing our work, freeing our patients from the limitations and bounds that are placed on our patients from colonization onward. We've been built in a colonial system, which controls the bodies of pregnant people, particularly pregnant people of color, and that pervades everything that we do. It pervades the way that we approach pregnant people generally. It's why my pregnant patients of color are more likely to get a CPS referral than my white pregnant patients. It's why access to services in communities of color are often much, much less than other parts of the country. And so I think decolonizing healthcare involves looking at what the root of some of this legislation is, what some of our norms of operation are, and finding where those colonial roots are and uprooting them in our practice. And I think a key part of that is learning that history and also looking at our patients as the truly autonomous beings that they are. And if we can get past that idea of deciding for our patients what they do, deciding for other citizens in our community what they do with their bodies, that would be one of the most critical things we could do to decolonize our services.”
Episode Glossary: Legal Frameworks, Concepts + Terms
Fetal Viability —
The point at which a fetus can survive outside the womb.
Dobbs v. Jackson Women’s Health Organization —
In May of 2021, the Supreme Court agreed to review a lower court’s decision to strike down a 2018 Mississippi state law that banned abortions after 15 weeks, which is well before the 24 week fetal viability measure set forth by Roe v Wade. Though the law was clearly unconstitutional, Mississippi lawmakers passed the measure fully expecting it to be challenged in hopes that the case would be taken on by the 6 to 3 majority conservative Supreme Court. As expected, the state law was in fact challenged by Jackson Women’s Health Organization, the only abortion clinic in Mississippi. The clinic sued Thomas E. Dobbs, state health officer with the Mississippi State Department of Health. At the heart of the case, Dobbs v. Jackson Women’s Health Organization, the question being answered by the courts was if bans on all viability abortions are unconstitutional. On June 24, 2022 the Supreme Court overturned Roe v. Wade and Planned Parenthood v. Casey, stating that pregnant people do not have the constitutional right to an abortion and that abortion rights should be defined at the state level.
Roe v. Wade —
In 1973, the US Supreme Court ruled that the Constitution of the United States protects a pregnant person’s liberty to choose to have an abortion. This landmark ruling challenged the individual abortion laws passed by various states and made abortion legal at the federal level above and beyond the state level. In this case, the Supreme Court ruled that criminalizing abortion violated the constitutional right of privacy, articulating that states do not have the right to regulate abortions until approximately the end of the first trimester of pregnancy. The court also identified a fetuses viability at 24 weeks of pregnancy.
Planned Parenthood of Southeastern Pennsylvania v. Casey —
In 1992, the Supreme Court ruled on the case Planned Parenthood v. Casey, which upheld the central ruling of Roe v. Wade: that states could not prohibit abortions before fetal viability. However, disregarded the trimester framework:
“Roe had established a framework to govern abortion regulation based on the trimesters of pregnancy. In the first trimester, it allowed almost no regulations. In the second, it allowed regulations to protect women’s health. In the third, it allowed states to ban abortions so long as exceptions were made to protect the life and health of the mother.”*
This framework was replaced with an “undue burden” test which ultimately allowed for restrictions on abortions.
*Reference: NY Times - What did Planned Parenthood v. Casey say?
Undue Burden —
Undue burden is a standard established by Planned Parenthood v. Casey in 1992 that is used by courts to evaluate whether state laws on abortion are constitutional. “An undue burden arises if the purpose or effect of the state restriction on abortion has placed a substantial obstacle on someone seeking an abortion”* of a fetus pre viability.
*Reference: Cornell Legal Information Institute
Targeted Regulation of Abortion Providers (TRAP) Laws —
TRAP laws are designed to limit abortions by creating regulations that prevent clinics and medical facilities from being able to provide abortions. As defined by Planned Parenthood: TRAP laws are “targeted restrictions on abortion providers designed to close them down rather than to make them safer for women.”*
*Reference: Planned Parenthood
Hyde Amendment —
The Hyde Amendment was passed just a few years after Roe v. Wade and was brought forth by anti-abortion Congressional member Henry J Hyde. Since 1976, the Hyde Amendment has been reenacted every year. It prohibits federal funds from covering abortion services for people enrolled in Medicaid, Medicare and the Children’s Health Insurance Program (CHIP). In addition, it prohibits federally funded clinics, many of which offer care to underserved communities, from offering abortion care.
Conscious Clauses / Protections —
Referred to as “conscious provisions” in this episode.
Legal statutes that permit health care providers to “refuse to perform, accommodate, or assist with certain health care services on religious or moral grounds.”* In some cases, these statutes also permit health care providers from referring patients to alternative providers. These provisions are most commonly seen enacted in connection to abortion care, contraceptives, sex affirming therapy, etc.
- Reference: US Department of Health and Human Services
Trigger Laws —
Laws that are currently not enforceable, but are written to go into effect when an event or circumstantial change occurs. In this context, the term “trigger law” is used to refer to state laws specifically written to prohibit or significantly limit access to abortions in the event that Roe v. Wade is overturned. “In June 2022, the Supreme Court ruled in Dobbs v. Jackson Women’s Health Organization to overturn Roe v. Wade, causing trigger laws related to abortion restrictions to go into effect in a number of states.”*
*Reference: Definition of Trigger Laws
CPC (Crisis Pregnancy Centers) —
Crisis Pregnancy Centers, often also referred to as Pregnancy Resource Centers, are clinics or mobile vans that present themselves as women health clinics, but are designed to discourage people from getting abortions by spreading misinformation, emotional manipulation, and other harmful tactics. They are often run by conservative anti-abortion Christian organizations working to dissuade pregnant people from receiving abortion care. Although they are incredibly harmful and misleading, they have received millions of dollars of taxpayer funding as nonprofits.
Ectopic Pregnancy —
“In a normal pregnancy, the fertilized egg implants and develops in the uterus. In most ectopic pregnancies, the egg settles in the fallopian tubes. This is why ectopic pregnancies are commonly called "tubal pregnancies." The egg also can implant in the ovary, abdomen, or the cervix, so you also might hear these referred to as cervical or abdominal pregnancies. None of these areas has as much space or nurturing tissue as a uterus for a pregnancy to develop. As the fetus grows, it will eventually burst the organ that contains it. This can cause severe bleeding and endanger the mother's life.”*
*Reference: Johns Hopkins All Children’s Hospital
Embryology —
The study of embryos and their development.
Embryo —
The stage of development that starts at fertilization (joining of an egg and sperm) and lasts up to 8 weeks.
*Reference: ACOG - American College of Obstetricians and Gynecologists
Fetus —
The stage of human development beyond 8 completed weeks after fertilization.
*Reference: ACOG - American College of Obstetricians and Gynecologists
Spontaneous Abortion —
Another term used for miscarriage, or spontaneous loss of a pregnancy.
*Reference: ACOG - American College of Obstetricians and Gynecologists
Induced Abortion —
An intervention to end a pregnancy.
*Reference: ACOG - American College of Obstetricians and Gynecologists
Resources
What You Can Do —
Dr. Allison Berry, MD, MPH: “It's important for the people in power to see that the majority of Americans actually want access to safe and legal abortion. And so letting them see that with protests with calling representatives with writing letters, all of those things do make a difference.”
National Network of Abortion Funds —
The National Network of Abortion Funds - Offers financial and logistical support to those seeking abortions. “The National Network of Abortion Funds builds power with members to remove financial and logistical barriers to abortion access by centering people who have abortions and organizing at the intersections of racial, economic, and reproductive justice.”
If you are seeking abortion and need financial + logistical support: abortionfunds.org/need-abortion
If able, please donate to support abortion access funds: abortionfunds.org/funds
ineedana.com —
Helps individuals find verified abortion providers near them. Our goal is to provide a simple, up-to-date, and localized source of information for people seeking abortions.
Plan C —
Provides up-to-date information on how people in the U.S. are accessing at-home abortion pill options online. “We envision a world in which the ability to end an early pregnancy is in the hands of those who need it.”
National Women’s Health Network —
Connecting women with mail order abortion pills while we still can.
Repro Legal Helpline —
Offering free legal advice for individuals seeking abortions. The Repro Legal Helpline is a free, confidential helpline where you can get legal information or advice about self-managed abortion, young people's access to abortion or judicial bypass, and referrals to local resources.
The Miscarriage + Abortion Hotline‍ —
If you need support to self-manage your miscarriage or abortion call or text: 833-246-2632
All Options —
Judgement-free counseling on all options.
Data Privacy —
If you are seeking an abortion, online data privacy is incredibly important. Here are some articles to help you navigate your privacy online:
[For Context] NPR: Privacy advocates fear Google will be used to prosecute abortion seekers
[For Context] Time: Lawmakers Scramble to Reform Digital Privacy After Roe Reversal
[Actionable Tips] Washington Post: Seeking an abortion? Here’s how to avoid leaving a digital trail.
[Actionable Tips] Boston Globe: Post-Roe, here’s what you can do to protect your digital privacy
Calls to Action for Businesses —
This list is based on one compiled by Planned Parenthood. I made a few adjustments to broaden its scope.
Assess workforce health care coverage and benefits, including travel stipend, paid time off, child care, abortion funds, etc.
Advocate and use the company platform to champion sexual and reproductive health and rights (SRHR) access, and call out the economic and social harms of abortion bans.
Support and donate to abortion access funds (such as the National Network of Abortion Funds).
Implement employee donations/matching gift programs.
Encourage employees to donate relevant staff expertise and in-kind business support to abortion advocacy organizations and clinics.
Publish internally — and ideally, externally — a national company plan in support of reproductive rights and health care access.
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