SIO345: The Effects of Counseling and Protestors on People Who Get Abortions

Transcript

This transcript was generated automatically and may contain errors — the audio is the record.

0:00:12 Thomas: Hello and welcome to Serious and Queers Only. This is episode 345. I'm Thomas. That's Dr. Lindsey Lobsterman. How you doing?

0:00:20 Lindsey: I'm excited and overwhelmed, but probably not as much as Marsh is. Huh? Yeah?

0:00:24 Thomas: Yeah, I don't know when this is coming out, but whenever it's coming out QED either is happening or already happened and that's great. Either way.

0:00:31 Lindsey: Yeah. I've never been before. I'm very excited.

0:00:33 Thomas: Oh yeah, it's the best. Everybody within the sound of Manchester come to QED when you heard this. I don't know when when this is going out, but whatever, one way or the other, it was either very fun or definitely make sure you see us there, everybody.

0:00:48 Lindsey: I am going to try to get this out before QED.

0:00:50 Thomas: Oh, okay. Go. Well, Challenge for accept that challenge on your behalf.

0:00:56 Lindsey: Thank you. I accept it.

0:00:57 Thomas: Yeah. I'll be your second on that or whatever. Like if it's a duel, but doing the duel though.

0:01:00 Lindsey: Oh. Yeah. Okay. All right. And we get guns.

0:01:03 Thomas: Yes. You get to shoot this audio file until it's edited properly. That's how they used to do it back in the old West. Take the old record and shoot it until it was edited properly, we've come a long way. Anyway, what are we going to talk about today? Dr. Lobster.

0:01:06 Lindsey: Okay, makes sense.

0:01:21 Lindsey: Abortions. Yeah, because we started this series and then we had a bunch of other stuff that we had to do. So this is episode three of our series on the Turnaway Study. So today we're going to talk about a cluster of papers that explore the impacts of various federal and state abortion regulations on women's experiences.

0:01:21 Thomas: Oh, okay.

0:01:38 Thomas: Would Would you say it's a small cluster of papers that barely has Has any pain receptors or ability to, so this cluster of papers, yeah,

0:01:44 Lindsey: I would say that. It doesn't have a soul yet. Yeah, I confirmed.

0:01:48 Thomas: I like the idea that eventually clusters of papers do have souls. Just not at this level. Okay.

0:01:53 Lindsey: They do at some point. Yeah. Not at this level. No. Yeah, so really interesting set of papers, a little bit of a sort of grab bag of things we're going to be talking about. So, for instance, as part of their care, abortion facilities routinely provide abortion counseling for their patients, meaning that they provide patients with information about the procedure and the aftercare and they review risks and benefits and alternatives to abortion. Very standard part of practices that abortion providers engage in.

0:02:20 Thomas: Also a standard part for Christians to try to make people consume disinformation on that same thing.

0:02:27 Lindsey: Correct. And some states require that this abortion counseling include certain specific pieces of information, information, for example, that abortions carry a risk of death, which is technically true but is also somewhat misleading.

0:02:40 Thomas: Oh, you know what else carries a risk of death?

0:02:41 Lindsey: Uh, Pregnancy. Yeah.

0:02:43 Thomas: Yeah. Yeah, pretty, high risk of death, especially in America for black women, by the way.

0:02:45 Lindsey: Very true. Yep. It's pretty dangerous, as it turns out, yeah, mm,

0:02:51 Thomas: Maybe something we should fix.

0:02:53 Lindsey: -hmm. Also, some states require that the information be provided that some women who have abortions uh struggle with things like depression after they have an abortion.

0:03:02 Thomas: Oh, you know, it also can cause depression.

0:03:03 Lindsey: Yeah, Uh, hmm, I think they even gave it a specific name, didn't they? Yeah.

0:03:08 Thomas: Yeah, it's like after you do something, I can't remember what it is after. What is the thing? Yeah, like after something, you get depression. What is that? You know, It's funny, too. I know we always say this, but we I don't look at your notes. That's, this isn't some coordinated bit we're doing.

0:03:10 Lindsey: Something part of me yeah, no,

0:03:23 Thomas: It's just funny that that happens to be true, that everything they talk about, like, it's also, and I'm sure you're going to tell us the numbers, but it's like either at least a risk or a bigger risk to actually just go through a pregnancy.

0:03:23 Lindsey: Oh, No, it's a much, much bigger risk to go through a pregnancy than it is to have an abortion. It's not even close. I mean, especially we're talking about early abortions, like medication, like, there's all, there's like a just a vanishingly small risk associated with with having those, and that's just in absolute terms, but if you stack that up against carrying a pregnancy to term, like no, it's it's not Even close.

0:03:38 Thomas: Okay. Right. Right. Okay. Yeah. Oh, true. Yeah. True. Good point. I was just leaving room for like one of the things bullshit they talk talk about to be higher for, I don't know, but yeah, you're right. I shouldn't even, don't even need to leave that room. Should while I've already interrupted you, should we take just a second to kind of remind people what this is? You gosh, it's Been at least, I dunno, a month or two since we did the last one of these.

0:04:15 Lindsey: Yeah.

0:04:16 Thomas: Turnaway studies, I always forget when they were there more recently than I thought. Remind us that when, when, when this was done.

0:04:22 Lindsey: 2008 is when they started collecting. People should go. So the first two episodes that we did on this were episodes 339 and 340. And we go really deep into the methodology and how they recruited their sample and stuff. But yeah, this was a sample of like a thousand women that were seeking abortions. Some of them actually received abortions, some of them were turned away, hence the moniker, the turn away study. And I'll be bringing in some of of the methodology as we go through these results, but I'm not going to do like the deep dive on that that I did in those first two episodes. So I would recommend that people listen to those first.

0:04:52 Thomas: Right. Right, right. Well, and, um, to make sure I have it right too, this was like, there's the data set or whatever. And then the turn away papers or whatever is, is just like a bunch of people have done different kind of studies based on that same data. Is that how it works?

0:05:07 Lindsey: Yeah, these are all like different analyses that are coming out of the same data set.

0:05:11 Thomas: So it's like not the same, like, you person doing all this stuff. They, they got the initial data set and then other people kind of, you science stuff to it.

0:05:19 Lindsey: There are a lot of authors here, but I do notice that these papers tend to share a lot of authors. So there is a like sort of a core team of researchers that design the study and then have have done a lot the publishing on it. I haven't actually looked into what their procedures are in terms of sharing their data? That would be a really interesting question, because I feel like there are questions I could ask of this data. So I assume that they would share their data with interested parties, but I actually don't know how much of that they do. It's a good question.

0:05:46 Thomas: Right. Sorry. Just basic science stuff that I know that I, that you, not realize that non -science people don't know. So that's what we're dealing with here. It's been really interesting. There's probably countless of these we could do, but this is the third one that we've done, right? So, all right. What's in store for us in round three? And listen to those old episodes if you haven't.

0:05:59 Lindsey: Yes. Yep. Yeah, absolutely. Yeah. So again, we're talking about these papers that explore the effects of these federal and state abortion regulations. So, I brought up the required information as part of abortion counseling because they look at the effects of some of the regulations on the actual sort of operations of these abortion clinics. So some states require that you provide information like the risk of death and the risk of depression, whatever. And supposedly those regulations were passed in service of protecting patients, right?

Under the guise of like, this is informed consent. Everybody ought to be required to provide this kind of information. But the regulations that were passed really were part of fairly explicit attempts to decrease abortion rates. That's the case for this particular regulation about providing patient information. It's true for a lot of the ones that we're gonna be talking about. So some states require or have these regulations around what information has to be provided.

Some states require that patients be given the opportunity to view their ultrasounds if they're seeking an abortion. Talk about a study focused on that. And there are federal and state regulations regarding abortion funding and which dollars can be used to pay for abortions. So we're going to talk about a study on that. We're also going to talk about protesters at abortion clinics and how those affect the experiences of women that are seeking abortions, yeah.

0:07:21 Thomas: Yikes, yeah.

0:07:22 Lindsey: So all of these regulations have impacts on those seeking abortions, including emotional impacts and financial impacts and so on, and these studies were designed to look at what those impacts look like. And this is important because, again, regulations are passed under the thinnest possible veneer of being to ensure the well-being of people seeking abortions. But whether or not they actually help or harm is an empirical question, and we didn't have great data on it prior to the Turnaway Study. First two studies are about abortion counseling and education, including patients' perceptions of the helpfulness of the the services that they receive in this regard, facility standards, and federal and state regulations and how they interact with those things.

I'm going to try to sort of spend the least amount of time on these two, but there are a few key takeaways here that are important. So both papers are focused on the quality of abortion counseling. The first focuses on the reports of staff at the abortion facilities and their sample. So what level of care do the staff report that their facility is providing?

And the second paper focuses on the care that the women in their sample say they actually received and how satisfied they are with that care. So they're getting these reports from sort of both sides of it, which I think is good. So this first study is by Gould and colleagues. It was published in 2012. And this is a pilot study on how abortion facilities provide patient education and emotional support.

So most of their results in this data focus on data from interviews with staff at abortion facilities, not from the patients themselves. Their goal here is to fill an information gap about the typical practices that abortion facilities use to ensure informed consent in their patients, which is important, and to provide emotional support to abortion patients. The regulations, again, often pass with this justification that they're just trying to facilitate patient care, right?

Justification that if they don't impose those requirements regarding waiting periods and specific information provision and ultrasound protocols and so on, abortion providers would just be sort of like like passing out abortions willy-nilly and

0:07:39 Thomas: Yeah.

0:09:20 Lindsey: Not making adequate attempts to evaluate patient circumstances or ensure informed consent. The point of this study is to say, well, let's see.

0:09:28 Thomas: I Consent is a good thing. Makes sense that we want to have that, right?

0:09:29 Lindsey: Yeah, absolutely. Uh-huh. I would hope that there's a real focus on informed consent, regardless of whether there are specific state regulations about what abortion provides, you know?

0:09:40 Thomas: Yeah. That should be like just a doctored normal thing.

0:09:44 Lindsey: Uh -uh. I'm pretty sure it is a doctor -normal thing, right?

0:09:46 Thomas: Okay. Good. That.

0:09:47 Lindsey: We'll see what what these results bear out. So they interviewed 27 informants from abortion care facilities, and I know, right? And these informants included clinic directors and program managers, as well as clinicians and counselors that actually worked in these abortion facilities. And they asked these informants a mix of rating scale items and open -ended questions about their facility's practices related to patient education, emotional support of patients, and actual abortion procedures. These informants were recruited as part of the broader turn -away study, and so they were located at the recruitment sites that we've already described in past episodes. These are providers across the U.S. They're providers with the latest gestational limits of any facility within 150 miles. They provided a breakdown of what region in the U

0:09:54 Thomas: Sounds clandestine.

0:10:36 Thomas: Yeah.

0:10:36 Lindsey: -S each of their providers were at. So they had nine providers in the South, seven providers in the Midwest, six providers in the West, and five in the Northeast in this particular analysis. We got a representation across the U.S. It's good. The results are very descriptive. There's not a ton of like inferential stats, p-values, that kind of thing. We're just sort of getting a sense of what these staff members said typical practice looks like at their facilities. So here's what the informants said about provision of patient education and emotional support. The vast majority, 92 plus percent of informants, reported that the staff at their facility, quote, always, they selected the option always from a rating scale, do the following things as part of abortion counseling practices. So they provide information about the abortion procedure. Good, glad they're all doing that. They assess the certainty of patients' abortion decisions, and they provide contraceptive health education. It's all good things, yeah.

0:10:47 Thomas: Sure. Okay. Do They also talk about God's plan and eternal damnation for those who go against God's plan or no good.

0:11:35 Lindsey: These I don't think they sampled from any crisis pregnancy centers, so probably not, yeah.

0:11:40 Thomas: Although It would have been actually, it would have been good to get one in there and just be like, oh, here's just to see what they do, yeah.

0:11:41 Lindsey: Oh, My God, and I've heard heard anecdotes about what they do. I've had friends that have gone to those places thinking that they were abortion clinics, and it's horrifying.

0:11:55 Thomas: It Know, it's in a dark way it would have been funny if they did successfully fool the people doing the study that they were, because that's what they do, is they'd like trick vulnerable women into like thinking that they're an abortion care center. It would have been interesting if they did that to the people doing the study. Shit, this isn't even a real thing.

0:12:11 Thomas: It All right, well, we better study it while we're here, yeah.

0:12:03 Lindsey: Yep. Mm -hmm. Yeah, exactly. Honestly, I would love to see a parallel study done at Crisis. I don't think that they would cooperate, unfortunately, but it would be interesting. 74% of informants also said that their staff always assess patient feelings and provide emotional support as part of that counseling counseling process. So still a majority. It's not the 92 plus that we're getting with some of those basic informational things. But still, 74%, that's three quarters, are providing emotional support and assessing patients' feelings. It does look like there's more variability here, though, right, in terms of whether emotional support is part of this process for abortion providers at sort of a formal level, or that they can say they always do those things. All informants reported that their facilities always encourage patients to take more time to consider their decision if they expressed ambivalence about having an abortion.

0:12:18 Thomas: You're Right, yeah. Fair.

0:13:00 Thomas: Enough

0:13:01 Lindsey: This counters a common anti -abortion narrative, though, about providers pushing abortions as the only option.

0:13:01 Thomas: Oh Oh Yeah, I thought when you go in there they hand you your abortion, like at the door, they're just like, here it is.

0:13:11 Lindsey: Yeah, they require it. Yeah. As soon as you walk in. Yeah I mean this is an argument that comes up in a lot of spheres actually. We've talked about it.

0:13:11 Thomas: Yeah. Yeah. Like Trans care as well, yeah.

0:13:19 Lindsey: Exactly. Yeah, people like to throw that out about gender affirming care, that if you go to somebody who practices that, that they're going to push gender transition. It's just not true, right? Same thing here, not supported by the data they they collected here. Informants at the overwhelming majority of facilities described really extensive high quality procedures for training staff in terms of delivering abortion counseling. And they go into a lot of detail about this. I won't reiterate it all, but it really does sound like very extensive training. So what they generally saw these providers was tons of training materials, staff doing shadowing. They log hours of supervision with their supervisors. They have have regular discussions with supervisors and peers, attend meetings, do a review of training materials. A lot of training here. So it sounds like these facilities are generally, you know, what you expect to be happening at a place that's providing health care.

0:13:19 Thomas: Yeah. Yeah. Any Medical anything, yeah, you

0:14:15 Lindsey: It shouldn't be necessary to say this, right? But this is sort of the undercurrent of a lot of the discussion justifying having regulations like this.

0:14:16 Thomas: Would hope Right. Yeah.

0:14:24 Lindsey: Like if we weren't telling them to get patient informed consent, these places wouldn't be doing it, yeah.

0:14:24 Thomas: Yeah. Yeah. It's actually just like a couple feminists who don't shave their armpits who have no medical training, and they make you kill your baby the minute you walk in.

0:14:29 Lindsey: Uh -huh, yep. Exactly. Whether you want to or not. Informants reported that the majority of facilities regularly assess patients' mental health and psychosocial needs. So all but three reported that patients are routinely asked about prior mental health history, and usually through a standard medical intake form, suggesting that it really is part of like a sort of the formal intake process, right?

0:14:41 Thomas: Yeah.

0:15:01 Thomas: Fair Enough, but man, do I get tired of those, like, every appointment, and I'll be, it's a lot of stuff where it's like, don't you already have, I've been to you a hundred times, couldn't you tell me what I've already done here? You know, they should at least like pre -fill them out with stuff that's long -standing You know that I get if you want to ask if I'm being abused by my partner every time, that's I get it, that's fine, or like any new issues, sure, but like I have to start from scratch over and over, do you have any allergies? Yeah man, I've told you a thousand times, that's why I do this every, especially if you have a medical thing where you have to go in a bunch of times for like minor things, it really adds up. Anyway, this is griping aside, it's good that they, they do this.

0:15:01 Lindsey: Yeah.

0:15:16 Lindsey: It Is good, it is weird to me though that they haven't really streamlined that process Like these forms should talk to each other at this point, it's 2022, right?

0:15:42 Thomas: Yeah. Doesn't like, yeah, doesn't make you feel like oh, is this not my dot? Did I go to the wrong place or something? Like why do I? Yeah, like I've been here a bunch.

0:15:50 Lindsey: I feel unwelcome here when they, yeah, it's like when a friend totally forgets the conversation you've had with them, that's Yeah, about a quarter of facilities utilize a dedicated needs assessment form to help evaluate patients' emotional state and psychosocial needs related to the pregnancy or abortion. And about half, a little more than half, have questions that are designed to assess the same things, but they're integrated into another form. So they don't have a dedicated form. But what we're seeing here is that it's typical practice for providers to screen for potential risk factors regarding mental health and assess current emotional state.

0:15:56 Thomas: Yep, yep. Okay.

0:16:23 Lindsey: Facilities varied in terms of how much of the patient education was provided in various modalities. So like in -person versus delivering pre -recorded information or handouts. When I had My abortion, the way that they sort of divvied this up was that the state mandated Republican bullshit stuff about how, you know, abortion means you might die or, you know, have serious, all that stuff was pre recorded. And they noted at the beginning of the recording that the State of Virginia requires that we provide the following information.

0:16:23 Thomas: And

0:16:52 Lindsey: And I remember appreciating it that it was tagged that way, personally. But then all of the stuff that the facility actually cared about was provided in person, so I had like face-to-face conversations with nurses and stuff about the alternatives to abortion and my certainty and the procedure. So wow,

0:16:51 Thomas: Yeah yeah that's can't remember if they got rid of it, but I remember talking to, you my Australian friends about how they have to do in every marriage ceremony, they have to do the like marriages between one man and one woman. Remember they get rid of that? Australians? I can'T remember. Chime in. But if they Got rid of That or if they Didn't, that is a thing that there's asshole conservative government passed, I think.

0:17:27 Thomas: And so then you get creative ways of, you know, people trying, you they had to incorporate it to be legally married, so they you know, they do, they do a little different little things to signify, like, hey, this is the bullshit we have to do, and kind of reminds me of that, like the things that's the might be the state level bullshit that red states make you do, it's nice that that's kind of presented differently, and then the stuff that matters, maybe you get that more human touch.

0:17:27 Lindsey: Yeah yeah Exactly right, and probably because before this legislation went into effect, like they were already doing all of this stuff that actually matters for quality of patient care, so they're just gonna like, okay, so, so we'll keep doing the stuff we're doing. And then this extra stuff that we have to do, we can write.

0:18:02 Thomas: Right yeah, yeah yeah and good point, like it's not, not necessarily true that anything, anything the government would want to make sure that providers say or do is bad. It's just, I know in this context, it probably is, but I don't know.

0:18:20 Lindsey: No, it is. I think because, you know, a lot of these laws were passed with a particular motivation that they were pretty open about, which was reducing abortions. Good stuff.

0:18:30 Thomas: That's Dr. Lindsay Lobsterman language for not good stuff. Just so everybody, yeah, we need to get a drop, an audio drop that's just like not, you know, that you put in.

0:18:34 Lindsey: Yeah, not not cool. If I say that something's rad, it's really not. Yeah. Backslash

0:18:45 Thomas: Our humor is So edgy, cutting edge, or it's very cutting edge, yeah.

0:18:45 Lindsey: S. That's it is we're millennials. Nails. So when asked about their facility's philosophy about abortion care and counseling, and this was an open -ended question, by the way, so that they could get a sense of what was most salient to these informants without any kind of prompting. So, when asked what their facility philosophy about adoption care and counselling was, staff overwhelmingly emphasized that their values were the provision of patient -centered, supportive, non -judgmental care that incorporates incorporates emotional support, and that is compassionate and empowering. So that's good. That's actually the end of what I want to say about that particular study.

0:18:50 Thomas: Okay. Yeah.

0:19:23 Lindsey: Essentially, what they are establishing is like, hey, it looks like these healthcare providers are actually providing healthcare.

0:19:29 Thomas: Yeah, and they actually seem to know about something to provide health care, and in ways it's just very interesting.

0:19:34 Lindsey: The next paper pairs with this one, though. So this is looking at some of the same questions about patient care, but now we're getting reports from the patient perspective. So they asked the women seeking abortions in the Turnaway study, specific questions about what questions they were asked as part of their care, the information provided to them when they went to get their abortion, and their satisfaction with the care that they received. Here are the takeaways from this study. So 68 % of their participants said yes to the question of, quote, did you get counseling from your abortion facility about whether to have an abortion? This is the question they were using to assess like provision of abortion counseling. And if you If you remember, it was like 92 plus percent of the clinic informants said they were providing this. And actually, all of the clinics in this sample provide abortion counseling, right? They provide the information about the procedure. But only 68 % of the participants are actually saying yes to that question.

0:20:29 Thomas: That's interesting.

0:20:30 Lindsey: It is kind of interesting that you're getting a gap there.

0:20:30 Thomas: I I mean, I could very easily imagine, though, that like, especially when you're going in for something that's, you know, probably a little stressful, maybe a little weird, um, remembering perfectly everything that a doctor told you. I know, I wouldn't.

0:20:44 Lindsey: That's true. Very true. And like the question is sort of when you hear the word counseling, it might elicit something that's different from the experience you had. Like, it's possible that if you have a brief conversation with your provider, where your provider says, do you want to have an abortion? And you say, yes. And they say, are you sure? And he say, Yes.

0:21:03 Lindsey: And I say, yeah, and they're like, they're, like, you're positive, you don't want to carry this child to term, there's like, put it up for adoption or something.

0:21:02 Thomas: Like that's counseling. Yeah. Right. But it, it, but probably is the right amount of counseling, like, if somebody's absolutely sure, you know, you make sure, and then fine. That's

0:21:25 Lindsey: And you counseling, right? But from the provider's perspective, it's like abortion counseling is that conversation. It's also information given about like how the procedure is going to go and what you should do afterwards, all that kind of stuff. So I think that that's probably the gap here. People may be interpreting that word counseling differently. Of those who said they received counseling, virtually everyone, so 99% of the folks who said they received counseling indicated that the counselor communicated that they would support any decision that they wanted to make about whether to have an abortion. 3 % reported being encouraged to have an abortion, and less than 1 % reported being discouraged from having an abortion Ideally, we want those percentages to be as close to 0 % as possible.

0:21:56 Thomas: Good, right.

0:22:07 Thomas: But that's lower than I would have thought, I could maybe I'm more pessimistic about what's going on, huh.

0:22:09 Lindsey: It's quite low. No, it's quite low. 3%, encouraged, 1%, discouraged. And what they're trying to tap here, right, is pressure. Whether there's pressure to go in one direction or another. Other. And I don't even think that the responses here that you were encouraged or discouraged necessarily means that there was pressure from the counselor. It could just, so their interpretation, for instance, was that at least some of the women who said they were encouraged to have an abortion probably meant this more as like the counselor was supportive or something as opposed to pressuring them.

0:22:20 Thomas: Yeah. Yeah.

0:22:43 Thomas: Totally, especially with percentages that low, like I could see, you know, might interpret something a little differently than what was meant, or

0:22:46 Lindsey: Yeah. Yeah, exactly. But yeah, so these are low percentages. That's great. So are facilities abilities pressuring women to have abortions, the absolute max upper limit on how often that happened in this particular sample was 3%. So yeah, if your auntie Muriel or whatever tries to tell you that Planned Parenthood is pushing abortion so that they can sell baby parts, right? I think this is a relevant thing to bring up.

0:22:52 Thomas: Yeah. Yeah, wow, oh.

0:23:12 Thomas: God, that that reminds me, I'm low on baby parts, I gotta go to the store later.

0:23:16 Lindsey: I know you go through them so quickly, don't you? Yeah.

0:23:17 Thomas: Yeah. And it's like, I go through different ones, you know, so like, I'll have plenty of, like, oh, baby hearts, but, like, I don't have a lot of legs, or what you know, yeah.

0:23:24 Lindsey: I use a lot of legs too. Yeah. Constantly.

0:23:25 Thomas: You just go through them unevenly, it's been, it's really frustrating, oh.

0:23:28 Lindsey: Yeah, I mean, if they are doing this, if they aren't trying to pressure people so they get more baby parts, they're doing a really bad, bad job of it, because 97% of abortion patients aren't picking up on it in the sample.

0:23:37 Thomas: I thought you were gonna say, because I've had a a hell of a time getting my baby parts. Like, come on guys.

0:23:40 Lindsey: Exactly. There's been a real shortage. Supply chain issues.

0:23:43 Thomas: Yeah. Then they all got stuck in that canal once, you know, the birth canal. No, sorry.

0:23:45 Lindsey: It's the worst. Oh, wow. Wow. Okay. That was good.

0:23:52 Thomas: Up to you if you keep that or not.

0:23:54 Lindsey: I'm keeping it. I'm definitely keeping it, so

0:23:55 Thomas: Heard that it's Lindsay's fault, everybody. Bad jokes that stay in.

0:24:00 Lindsey: Generally, women who said they received abortion counseling said it was helpful, but women were less likely to say that it was helpful if they received care at a clinic that was subject to state-mandated aspects of counseling. Which is interesting, again, a number of states have laws that require the provision of specific information or state-approved written materials that they have to provide as part of abortion counseling. And as I alluded to, that was true in Virginia at the time that I had an abortion. They were repealed a few, a few years after I had my procedure, but at the same time, I had to, I was required to call up this phone number where they had this pre-recorded message, I had the state-mandated stuff in it. I had to do the transvaginal ultrasound, I don't know if I mentioned that actually. Yeah, that sucked. That was not cool.

0:24:43 Thomas: They, so you were forced to do a transvaginal ultrasound against your will.

0:24:47 Lindsey: Let's come back to that because we got the ultrasound thing. Maybe we can talk a little bit more about that. But yeah, so Virginia was subject to a lot of these regulations at the time, and those parts of it sucked. It largely sucked because I could feel the pro -life Republicans in the room as I was going through these things. I knew where all these things came from, and that really sucked. The part that was nice was that virtually all of the staff themselves were really compassionate and kind and focused on being supportive, but they were having to do that in a way that navigated around all of these state regulations. It really felt like in certain moments, especially, you could feel the tension between those two things. In my anecdotal experience, these regulations do more to interfere with high quality patient care than they do to ensure that that care is high quality. And I think that the take -home

0:24:50 Thomas: Okay. Because Absolutely Yeah

0:25:34 Lindsey: Results from this study track with that. It really calls into question the utility of of having these laws that regulate abortion counseling specifically. Yeah, I've

0:25:35 Thomas: Totally To Put it mildly The signature understated Dr. Lindsey Lobsterman Ostrom. I've forgotten your real name now actually, I think it's just, sorry, you're Dr. Linda Lobstermann. Yeah.

0:25:52 Lindsey: Forgotten to.

0:25:52 Thomas: Your understating style, yeah, it's not good to have assholes mandating who, the way, who don't have the expertise, who aren't doctors, mandating what doctors should be doing with you in a room.

0:26:02 Lindsey: Exactly. Good times.

0:26:04 Thomas: That's That's My new thing, I'm now going to just say, not every time you do that, that'll Be then So

0:26:06 Lindsey: Yeah. Backslash ass. Okay. That sounds really fun. That'll be a good game for us. Okay, so those, that's what I have to say about abortion counseling and those regulations. Next paper focuses on abortion patients' experience of protesters.

0:26:24 Thomas: This is the third paper we're doing already

0:26:26 Lindsey: Yep. At the time that this paper was published, so this was by Foster and colleagues published in 2013. And at at the time this paper was published, the evidence suggested that picketing at abortion facilities had increased in recent years. So they reported data from 2000 to 2008, and there were indications that picketting itself had gone up, as had reports of aggressive behaviors from picketers, like trying to make contact with or block abortion patients' entrance to the abortion facility. I found a report on prevalence of violent and disruptive incidents reported by abortion providers, and these numbers have apparently continued to increase since the time of this study's publication.

0:26:26 Thomas: Oh Oh 2008, that's interesting, what do you think about that year? Because I would have thought that, like, you know, Bush administration, this would have been, or is it, yeah, I don't know, or maybe do they get worse when, like, they're out of power? Maybe, don't know. What do you think about that time that it says that it indicates that things got worse?

0:27:20 Lindsey: Hmm. I didn't really think that much about it. I feel like as long as I have been sort of tuned into these issues, it's felt like these are becoming more and more salient issues. I mean,

0:27:24 Thomas: Oh, okay. Fine. Yeah. Yeah, just thought if you indicated that it like started to get worse specifically around there, or did I misunderstood what the study was saying?

0:27:38 Lindsey: Yeah, I don't think they were saying that it like specifically got worse in 2008. They were just showing that like there were these trends over time that protests were becoming more common and more disruptive and violent.

0:27:41 Thomas: Oh okay. Gotcha. Also be social media by the way, if it's like allowing allowing these people to organize better, you know?

0:27:51 Lindsey: Yeah, that could be.

0:27:53 Thomas: Yeah. Interesting. All

0:27:53 Lindsey: But yeah, so that was true when they published this, the most recent data they had access to was 2008. And they were like, look, it's increased over this eight -year span. And that has continued to happen. So the prevalence of these incidents has apparently continued to go up. Some studies have examined the impact of protesters on abortion care in general, and they've documented the ways in which protesters negatively impact the operations of clinics and interfere with care. However, prior to this study, we didn't have great information that could speak to the impact of protesters on the psychological experience of abortion patients. And our assumption might be that they would negatively affect the experience of abortion patients, but we don't know without data, do we? That's the focus of the study.

0:28:06 Thomas: Yeah. Yeah. Right. Yeah, Unless there's some other effect of like, I'm going to get an abortion even harder than if you guys are going to complain about it. I doubt that's that's probably not.

0:28:42 Lindsey: I don't Know. It's an open question, right?

0:28:43 Thomas: There might be some of them, but on average, I doubt it.

0:28:47 Lindsey: We'll see. So they're interested in the emotional reactions that these women in the Turnaway study had to protesters. They were interested in the prevalence of encountering protesters and their level of engagement with them. So we'll see what they found. They used data in this study from both interviews with staff at the abortion providers and interviews with abortion patients to shed light on this question. So they asked abortion provider staff questions like, "Does your facility regularly have anti-abortion protesters who are visible to patients?" Staff at 85% of the clinics in this sample said yes.

0:29:17 Thomas: Oh, really? This was was an all over the country sample. Wow. The

0:29:23 Lindsey: Country. If yes, they also asked, would you describe the tactics used by protesters at your clinic on an average day as passive, aggressive, or mixed? 35 % were passive -aggressive.

0:29:34 Thomas: Or passive aggressive. Oh, you're getting an abortion, huh? Hmm.

0:29:37 Lindsey: That's how nice for you. I love that for you, yeah,

0:29:38 Thomas: Wow, couldn't have. Yeah, I do. I do look, I respect people doing what they need to do. But But, yeah, I also like kind of seriously wondering, given the fact that in deep red states and in places where this is a problem and all that and protesters are a problem, there's are also just way fewer places to get abortions. And I'm So I'm almost wondering if this is even worse than it's being represented. Like, if if 85 percent of places are saying, yeah, this is a problem, and we know there's like, you know, one fucking abortion clinic in all of Texas, because, or whatever, you know, because like the Republicans have ruined it, it almost seems like that's even understating the problem, maybe.

Just mathematically, if you are surveying providers and you are saying 85 percent say there's an issue here, and we know that in the deepest red states, there's just not that many that, you You know, like so that that 85 percent has to come from somewhere. And if there there are way more abortion clinics in blue states, you know, you'd predict that if anything, that would understate the problem. It would be like even more. I guess I'm saying mathematically speaking, that would mean even more abortion clinics in blue states are having this problem than I would have thought.

0:30:02 Lindsey: That's a good point. Yeah, I mean, I don't know, Virginia is purple. There were always protesters outside the Planned Parenthood.

0:30:57 Thomas: Yeah. Yeah. Well, it's important, you know, maybe for someone like me who doesn't have experience with this to to kind of recognize that even in, as I always say, in California, we've got the most Trump voters of any state, like, assholes there's are everywhere. I kind of would think that they would only organize and do these aggressive things, or at least do them more, in deep red states. But maybe not, I don't know. Maybe they maybe, and there's enough pro -lifers everywhere to do this anywhere, I suppose.

0:31:24 Lindsey: Yeah, no, I think that's true.

0:31:27 Thomas: Wonder how many states have rules about it, though. Like, I know I'm pretty sure that there's at least some ability to restrict what they're able to do. But First Amendment means that, you know, I don't think you can totally get rid of it.

0:31:33 Lindsey: Yes. No. No, I don't, I don't think that you can. I am almost certain that this was due to state regulations, the protesters that went to Planned Parenthood had to stay a certain distance back. From the abortion clinic, pretty far back too, so that was kind of nice. Some of the women in the sample are going to report like actually having people try to physically not let them into the clinic, that wouldn't happen, and yeah.

0:31:47 Thomas: Yeah. Yeah.

0:31:58 Thomas: You know, is going to be, I'm genuinely asking you from a place of ignorance, because when we had to get an abortion, and you still call it, I guess you still called it that when, you kno, we just had a totally non -viable pregnancy. But But, had to take the pills and do the stuff that just done at our doctors, like it's because we have Kaiser, because of the health insurance we have. But there wasn't like abortion provider that anyone would have been able to protest, really. And I just wonder, like, I really know the details of like, why is that? Is it because with people who have less, either don't have health insurance or don't, maybe in those areas where you have to go to like a place that does abortions, right?

0:32:13 Lindsey: That's A really good question, because I know that in this sample, not all of the places that they are, uh, recruiting women from are like at Planned Parenthood, some of them are at hospitals, some of they are, you know

0:32:48 Thomas: Yeah, yeah, exactly. We did it at a hospital. Well, it is just a massive medical thing. I guess it's a hospital, but Kaiser is so weird. Every time we talk about it, nobody understands what it is. It's just like a massive healthcare factory.

0:32:49 Lindsey: Yeah.

0:33:00 Lindsey: So I will say, though, the reason that I went to a Planned Parenthold was because it didn't occur to me that I could go to a regular doctor.

0:33:10 Thomas: Interesting.

0:33:11 Lindsey: Like I'm feeling a little dumb now, um, but I thought if you wanted an abortion, you had to go to the abortion place.

0:33:13 Thomas: Huh. I mean, it's like a reasonable assumption to me. Yeah. I didn't even think about it till just now. I was like, Oh, wait a minute. We just, it just was our normal OBGYN or whatever. I imagine maybe we're the anomaly. Cause again, every time I talk about Kaiser and our coverage, it seems to be the anomaly everywhere. And maybe for other places you'd You'd have like your little OBGYN office that, you know, would get associated with like, oh, they provide abortion care or something, maybe.

0:33:16 Lindsey: Hmm. Yeah. Yeah.

0:33:41 Lindsey: And I think you're right about like servicing, saying like lower income populations and populations that don't have health insurance. I mean, you know, Planned Parenthood is kind of, they do actually direct like specific attention to those kinds of things. So that's probably part of it as well.

0:33:44 Thomas: Gotcha.

0:33:54 Thomas: I brought it up is maybe more people should have the kind of good healthcare that we have because Lydia works for the state. So the state union has bargained for like really good healthcare. Maybe everybody should have like really good healthcare. Care and then, yeah.

0:34:03 Lindsey: Hmm. You think everybody should have healthcare?

0:34:08 Thomas: Yeah, crazy, like what if everybody just had the ability to go get this done at their normal kind of doctor, didn't need a special facility, you know, wouldn't that be cool, that

0:34:10 Lindsey: Weird. That really would be rad. No, not after that. That would be actually rad.

0:34:20 Thomas: Yeah. That's it, yes, now what's the opposite of not, that doesn't work, yes. Huh, I don't know.

0:34:26 Lindsey: Yes. Good. I haven't heard yes, huh, in a while. That's good. So they asked the staff about the tactics used by protesters, whether they were aggressive, passive, or as you say, passive aggressive, mixed. 35 % of the informants characterized the typical protesters as aggressive. 22 % said the protesters were passive, and 44 % said that the behavior was mixed. More aggression than I would like to see, personally.

0:34:30 Thomas: Yeah. Yeah. Yeah. Yeah. Just, I want zero of it. There shouldn't be anybody protesting healthcare that you're getting.

0:34:59 Lindsey: No.

0:34:59 Thomas: That shouldn't, I don't care how like cordial they are about it.

0:35:03 Lindsey: Agreed. Yeah.

0:35:04 Thomas: I go in to get like my blood pressure checked, there shouldn't be a guy who's like, ah, down with blood pressure checking.

0:35:10 Lindsey: Right? It is bizarre. Yeah.

0:35:13 Thomas: It's weird. There's no other thing where that happens.

0:35:15 Lindsey: No, there's not. I have a lot of feels about this.

0:35:18 Thomas: Unless I go in to get like human cloned, maybe that would be like the one other thing.

0:35:22 Lindsey: Yeah, I would protest that. No.

0:35:24 Thomas: Yeah. If it was me, Thomas should not be cloned. Just anybody else, please. I'll never get through a podcast ever again. If Thomas is cloned once hard enough.

0:35:26 Lindsey: No. No, we need multiple clones I think. Yeah okay so they also asked how frequently the staff have to comfort the patients who are upset by protesters. Like this has happened regularly, occasionally, very rarely, never. Staff at 83 % of the clinics said that they regularly had to comfort patients who were upset by protesters, 83%. As one staff member put it, quote, before a couple of years ago, we didn't have protesters as much, but now that they're out there all the time, everything's changed. Many patients come in upset and their ride comes in wanting to run people over. We spend a lot of time on that now. So cool. Sounds like these protesters are having at least one of the effects that they want to have, right? Upsetting women who are in vulnerable situations and annoying the fuck out of medical professionals. So congratulations to them.

0:35:45 Thomas: Oof, that's dark.

0:36:07 Thomas: Oof.

0:36:20 Thomas: Know, if those red states are going to pass those bills where they can run over Black Lives Matter protesters, which is fucking horrible. At the very least, let's pass it so that we can run over abortion protesters. Like, fine. Fight fire with fire. I'm tired of this shit.

0:36:32 Lindsey: Yep. It's pretty bad. Yeah.

0:36:35 Thomas: I'm of the opinion that no protesters should ever be run over. But I'm saying, like, if the red states start it, then, you know, like... I'm sorry. We live in that world now.

0:36:41 Lindsey: Right. Yep. In terms of the information that they got from the actual abortion patients themselves, they were getting these answers in the context of an interview that they did one week following their appointment at the abortion provider. So women seeking abortions were asked the following questions relevant to their experience with protesters. So first they were asked, did you see any anti -abortion demonstrators outside of your provider when you entered? 46 % of women said yes. And again, keep in mind, this isn't just Planned Parenthoods. Some of these women are at non -specific clinics and hospitals and stuff. So 46% of women said, yes, there were protesters when I went to the facility. The second question was, did any of the anti - abortion demonstrators talk to you? And 31 % of women said yes.

0:37:11 Thomas: Yeah.

0:37:28 Lindsey: So then they were asked, did any of the anti -abortion demonstrators try to stop you from entering the clinic? And 16 % of women, yeah, right. So let's let's just emphasize this breakdown. 442 women said they saw protesters at all. That's the total number of women who encountered them. Of those 442, 148 saw them, but that was it. And so that's 33%. 139 of that 442 at least talked to them.

0:37:35 Thomas: Jeez. That's a crime.

0:37:58 Lindsey: So that's a third. And then 155 of them said that somebody tried to stop them from going into the clinic. So 155 out of 442.

0:38:07 Lindsey: That's 35 % of the women who encountered protesters at all.

0:38:07 Thomas: That Oh, oh, wow. What was the 16 % you said then?

0:38:11 Lindsey: 16 % of the entire sample, but it was, yeah, a third of, yeah.

0:38:15 Thomas: Basically, 16% of anyone who tries to get an abortion has a crime committed against them. Is that what we're like yeah

0:38:22 Lindsey: Yep. That's an accurate representation of this. So yeah, over a third had somebody try to stop them from entering the clinic. Two thirds of those who had encounters with protesters at All said that the protesters addressed them in some way, right? And I'm guessing it wasn't to wish them luck during their abortions. It's gross. It's very upsetting. And then finally, they were asked to what extent did the protesters upset you, if at all? And they could say not at all, a little bit moderately, quite a bit extremely. I've got a little Bit of information here about how these women's experiences varied by a couple of things. I'll come back to the upsetness in just a second. So women's experiences with protesters varied by US region. This is kind of interesting to me. So 72 % of women living in the Midwest experience protesters compared to 52 % in the Northeast, East, 58 % in the South, and less than 10 % in the West. I

0:38:37 Thomas: Interesting yeah

0:39:17 Lindsey: Thought so too. I would kind of, you know, stereotypically have assumed that the South would be the highest on that, but the Midwest is showing up as the highest in terms of, I don't know if there was any difference in terms of like how many providers they had in urban versus rural areas across these different regions, but it's possible there was some imbalance there that's creating some wonkiness in these numbers. I'm not sure. Among women who encountered protesters, 48% said that they were not upset by them at all. So that's good. I'm happy about that. But that means that 52% said that they were at least a little upset. So 37% of these women said that they were a little bit upset or moderately upset. 16% said they were quite a bit upset or extremely upset. And there were some things that predicted how upset they were. So women who reported that the decision to have an abortion was more difficult for them were more upset by the encountering protesters than women

0:39:32 Thomas: Good yeah yeah

0:40:06 Lindsey: Who reported less difficulty with that decision. That makes sense to me. Predictably, as well, women who were addressed by or actually stopped by protesters were significantly more upset than women who just saw them. Makes sense. However, there was no association between the emotions women experienced about the abortion itself and their level of exposure to protesters. So like their level of regret or relief or guilt or happiness, sadness, anger about the abortion itself, not predicted by encountering protesters.

0:40:09 Thomas: Huh

0:40:35 Lindsey: It is interesting. And I feel like this is in there as just like a useful bit of info for the protesters themselves, because if they think they're making a difference and changing women's attitudes toward abortions, it doesn't seem like this was very effective, at least in this sample.

0:40:35 Thomas: That's kind of interesting

0:40:50 Lindsey: Yeah, half of these patients were upset by the protesters, themselves, but this did not translate into a different emotional experience of the actual abortions. The only caveat I'll give around that is that we can't tell from these data whether any of the protesters successfully deterred someone from having abortion, because if they

0:40:48 Thomas: Yeah well, that's good, oh like they would have left and they wouldn't be in this data set, yeah that's

0:41:09 Lindsey: Wouldn't be in the study, yeah. But at least among the people that are still in there, it doesn't, there's no difference in terms of whether they encountered protesters or not, or the level of interaction they had, and the feelings they're reporting about the actual abortion.

0:41:21 Thomas: A pretty real caveat though, you know, just because we can't really be certain about the frequency of, you in these deep red areas, they do successfully convince a lot of people not to get it. You know, if that number is big enough, then I think it, I don't know how I would interpret this.

0:41:36 Lindsey: No, I think that's entirely possible. I'm not ruling out that there are some cases here in which they're actually making a difference, and that would not be a good thing either. So, yeah.

0:41:45 Thomas: Right. Definitely heard of that happening. At least, you Know, I've heard of it. I've read of that, that someone has gone, you Now, picture if you're really religious, maybe, and you're unsure and, You know you're conflicted if you go and some person yells at you that you're going to hell. Oh, I don't know. There's got to be at least some number of people who are like, oh man, maybe I shouldn't do this. Maybe this is a sign that I shouldn't be doing this or something.

0:41:56 Lindsey: Mm-hmm.

0:42:08 Lindsey: Yeah, entirely plausible to me. It's very possible that they're, you know, because of how they're getting this sample, that they're ending up with mostly the people who are mostly more certain about their decision already. So yeah, you wouldn't capture the segment you're talking about. Yeah, so I thought there was a lot that was really valuable in this report.

0:42:18 Thomas: Yeah. Yeah, exactly. Yeah.

0:42:25 Lindsey: A lot of the conclusions are not super surprising, right? Protesters are disruptive. The rates that they're reporting of trying to prevent someone from entering a clinic seem very high to me. I don't love any of that. I was trying to remember, I think there were protesters there on the day that I went. It's tough to remember because I kept going back to that Planned Parenthood for my birth control after I got the abortion. So I can't remember if it was that day in particular, but they were almost always there every time you go to the Planned Parenthood and I've been yelled at if

0:42:34 Thomas: Wow.

0:42:53 Thomas: Did you fuck with them at all? Be like, I'm going to get two now. I'm getting two now because you yelled at me. I'M

0:42:59 Lindsey: It was if I was getting an abortion today I probably would but like at the time it's no, it actually surprised me how upset I was by it. It was very, it was very upsetting to have somebody yell at you under those circumstances.

0:43:03 Thomas: Right. Yeah? No, I understand. That's yeah. No, totally. I get it. Yeah no, that's always upsetting. Even no no matter how much like they're wrong and you're right. Like, yeah, making a joke. I didn't mean to be flippant about that experience because

0:43:13 Lindsey: Yeah no, I didn't take it that way, but yeah, no, I actually was, I was surprised that it hit me as hard as it did. It, I anticipated that people were probably going to be there. You know, I wasn't thrilled about it, but like, like, yeah, I got like, I got very angry about it actually. Yeah. Anyway, not at all. No.

0:43:35 Thomas: Yeah. But it didn't change your feelings on whether or not you regretted that abortion, right? Yeah.

0:43:43 Lindsey: It just made me angry

0:43:44 Thomas: Just made you upset with these assholes. Yeah.

0:43:46 Lindsey: At those people. Yeah. Yeah. Like it just, okay. So go back to your blood pressure comparison. It did feel kind of like that. Like it was so intrusive. It was like, okay, I'm going to have this medical thing done and you feel entitled to this information for some reason. Like, fuck you, man.

0:43:55 Thomas: Yeah. Yeah. A very intrusive medical thing too. It's not, you know, it's not like someone's just listening to your heart on a stethoscope. Yeah, no, it's one of the more evil things in the world. I can't believe that this exists in our country. I know we have a First Amendment, but God, it is almost the Westboro Baptist where it is like, I can not believe this evil thing is allowed to exist. Where they would like go picket funerals and stuff and just the worst kind of behavior in the name of, you know, an all -loving God. So I know how that works, but yeah, no, that's horrible.

0:44:05 Lindsey: Yeah. Mm-hmm. Yeah. Mm -hmm yeah yep It's pretty cool there.

0:44:37 Thomas: Not.

0:44:39 Lindsey: You go. Yeah, so, uh, take-homes: not surprising, abortion protesters are apparently very effective at yeah

0:44:46 Thomas: Pieces of shit. Oh, yeah. We've run the numbers. We're done the science thingy. These people fucking suck.

0:44:48 Lindsey: Uh, -huh yeah Actually, that's probably a better summary than what I had planned. Yep. Let's stick with that. Yeah.

0:44:57 Thomas: No, but I love the takeaway. I mean, again, it's finding kind of a silver lining, but I am glad that at least the numbers they've captured, it is not affecting how they feel about the decision. Because I could imagine that going the other way. So that's a little silver lining. But it is affecting their fucking experience of it for sure.

0:45:09 Lindsey: Sure. For Sure, and that sucks.

0:45:18 Thomas: What, everybody? We've got even more Turnaway Studies. We've Got Another Part on this because it truly is just a treasure trove of valuable insight, these Turnaaway Papers. So I'm excited. Can What we expect in the sort of the part two of the Part Three that we're on?

0:45:33 Lindsey: Yeah, we're going to talk about two studies in the part two. One of them is about ultrasounds and the responses that women have to viewing their ultrasounds, in the course of abortion care. And then we're going to be talking about the cost of abortion and abortion health insurance coverage.

0:45:43 Thomas: Yeah. All right. Well, oh, reminder, by the way, please support the show, patreon.com/seriouspod. And if you are a patron, any questions you might have about this or any other episodes, You can pop in a question on the Q &A thread that we'll put up every month at the beginning of the month, collect all those up, and we'll answer some listener questions, patron questions more specifically, each and every month. So that's a fun thing. And it's a useful thing, too. If there's anything that you wanted clarity on that maybe we brushed over, it's a great place to do that. So check out the patreon.com/seriouspod. Help Lindsay be a full -time science thingy discusser, which is definitely the term for Yeah.

0:46:28 Lindsey: Correct?

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