SIO346: Even More Reasons To Never Let Republicans Have Power

Transcript

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

0:00:12 Thomas: Hello, and welcome to Serious Inquiries Only. This is episode 346. I'm Thomas. That's Dr. Lindsey Osterman. How are you doing? Good.

0:00:20 Lindsey: Fantastic. How are you?

0:00:22 Thomas: And there's no not attached to that, right?

0:00:24 Lindsey: No. No. Yeah, we need to trademark that.

0:00:25 Thomas: Yes, huh? Well, today, you may remember from last episode, we've got more on the Turnaway Papers. Interested to learn more about what data says on these efforts that, know, you people in red states have made to intrude into the doctor's office and, you know, be able to impose their will on people who are seeking basic medical care, learn more about how that affects people. So it's really valuable information. Why don't you remind us where we left off and what we're going to cover today?

0:00:50 Lindsey: Mm-hmm. Sort Yep, of broad umbrella is like, yeah, as you said, now these regulations and efforts to decrease abortion are impacting people. In the first episode, we talked about abortion counseling and how regulations interact with that in terms of the experience that abortion patients actually have. And then we talked encountering protesters on women's experience of getting abortions, so that was really fun, um.

0:01:22 Thomas: Not, oh, was that a not? I don't actually know. Was that a no?

0:01:25 Lindsey: Is probably the wrong word, I'll go with not for that one. Yeah, yeah, so today we're gonna, we're going to wrap up this series of papers by talking about um, study that looked at women's responses to viewing ultrasounds as part of their abortion care, and a second study on the out-of-pocket costs of abortion and insurance coverage for abortions in this sample.

0:01:48 Thomas: I'm sure you're goingto tell us, but are these medically necessary, medically unnecessary, Unnecessary or going to be a combination of both?

0:01:56 Lindsey: So talking about the ultrasounds?

0:01:57 Thomas: Yeah, I guess they're basically always medically unnecessary, right?

0:02:01 Lindsey: Apparently so.

0:02:02 Thomas: In an abortion. Like to say, I'm remembering that obviously we had a few, but that was because we didn't know what was going on. And so we had to have one or two to see what was happening. But I suppose once you're getting an abortion, there's really no reason to have to do that, right.

0:02:17 Lindsey: That is correct. They are medically unnecessary, which is something I did not realize.

0:02:21 Thomas: Wait, we didn'T?

0:02:23 Lindsey: Well, and I'll tell you why specifically. So I mentioned last time that I had a transvaginal ultrasound when I got my abortion. And I was aware of the reasons that people have to get transvaginal. And so I was like associating it with some of the Republican stuff. And I had a bad reaction to being told that I was going to have to have a transvaginol ultrasound.

0:02:29 Thomas: Yeah.

0:02:41 Thomas: No, no. Fucking kidding, wow.

0:02:44 Lindsey: Nurse that seemed kind of surprised by the reaction that I had and was like oh no, we, we have to do this because you're so early in your pregnancy, that we wouldn't be able to do a transdermal ultrasound and

0:02:48 Thomas: Yeah. But that's not answering the question, that's still under the assumption that you need an ultrasound, huh?

0:02:59 Lindsey: Yeah, right. Right? And so that's what didn't register for me. Was enough for me to go, oh, okay. So like, maybe this isn't one of the ones that is Because of the Republicans. Maybe this is just actually necessary. As I was doing, as I was looking into a few things for this, I found the thing about them being medically unnecessary. And I was like, well, what was she talking about then and I can come up with is that like, yes, they are medically unnecessary for an abortion, it's, they, they are the gold standard in terms of estimating gestational age, so I think like if we didn't have the kinds of restrictions around that that we do with abortion, that maybe they wouldn't have to be a routine part of care. I also, doesn't track in my situation because she's like, we have to do the transvaginal one because you're so early in your pregnancy. So is probably for the best, honestly, it had to happen.

0:03:10 Thomas: Yeah. God, sure. Yeah.

0:03:45 Thomas: That just struck me of as her kind of Jedi mind tricking you into not caring about it anymore, yeah. It Probably Was for

0:03:52 Lindsey: And I was upset. So, yeah.

0:03:53 Thomas: The best, but I I just, uh, apologies, um, so you were sexually assaulted. Like, honestly, forcing someone to undergo a transvaginal ultrasound that is medically unnecessary, I feel like we have a word for that, and I feel like it, that word is sexual assault. Like, what I mean, making someone do something that they, they don't have to do. I don't understand how that could be looked at any other way.

0:04:14 Lindsey: Yeah. It's, it's definitely not the way that I framed it, that I have framed it to myself since the thing, but it's, not to say that I agree with these policies. Like

0:04:26 Thomas: Sure. I'm sorry. Don't let me put words in your mouth. I didn't even I was just talking in general about like that, that experience. I mean, it just in general, I know it's a it's it's a little different because maybe the medical provider is not necessarily the perpetrator of this. It's more like, you know, people in Congress or some shit. So it's little bit weird and different. But like, honestly, I if if that happened just in your everyday life, Like if in someone's everyday life, someone forced them to do that, that's an assault.

0:04:41 Lindsey: Yeah, agreed.

0:04:55 Thomas: It's so disgusting. I believe that that at all permissible to make somebody undergo that medically unnecessary. It's it really shouldn't be. And I think it only is because because the court is so right wing that they're willing to let like that that requirement stand. It's just disgusting.

0:05:10 Lindsey: No, was funny. So, I mean, you know, when we did the first recording where I talked about, about experience in more detail, my friend that was was very supportive as I went through this process. Like, she, she had had an abortion herself and was just like, you, really good about being supportive and telling me what to expect and all this stuff. So...

0:05:26 Thomas: Wow.

0:05:26 Lindsey: She listened to our episode, and she was like, it's real cute that you painted this in the rosy terms you did, because you had to get a transvaginal ultrasound, you had to pay for the entire thing out of pocket, you had to do the the 24 hour waiting period with the two appointments, because, like, all the, they've been, again, they've since been repealed in Virginia since I had mine, but like all, all his trap laws were in place when I had it. So, like, all of those things. And I was like, oh, yeah, it did actually kind of suck more than I remembered when we were talking about it.

0:05:51 Thomas: Wow. Wow.

0:05:52 Lindsey: There was a lot of shit. And the protesters, I mean, like... Yeah, it kind of sucked, actually. Yeah.

0:05:56 Thomas: So I'm, sorry. Again, I don't want to like put words in your mouth that you wouldn't say, but in my opinion, people who are forced to undergo this are sexually assaulted and then made to pay for it. Mean, I that it's, it's so disgusting. I don'T even know how to deal with that.

0:06:08 Lindsey: Yeah. Yep. So, this is a good pair of studies to put together, right? We're going to talk about the ultrasounds. And then we're going talk about how people are being forced to pay for them.

0:06:17 Thomas: And look, wasn't unreasonable for you to be like, oh yeah, this is a normal part of it because I'm sure for, again, in our case, in any case where you're not sure what what you're going to do. Then an ultrasound is, yeah, I mean, that might be part of it. You might be still making the decision. You know, that Might be where you discover an anomaly that will lead to an abortion. So that might Be a normal, medically necessary part of it. But if you just go, if someone, if anyone just goes and says, I would like an abortion, no medical reason that that needs to happen.

0:06:29 Lindsey: Mm -hmm. Mm -huh.

0:06:49 Lindsey: No. There's... there's not. Yeah, it's it's great, yeah, it's uh, not yeah, with

0:06:56 Thomas: All Right. Well, with that said, we can move on to the science thingy. Yeah.

0:07:00 Lindsey: So uh, funny that you started there, because that is also where these authors start in the introduction of their paper. Um, they start with this sentence, they say, "Although pre-procedure ultrasound scanning is not medically necessary, it's used to confirm and gestationally date pregnancy, is increasingly routine in U.S. abortion care." And I was like, oh, shit. Okay. Right. So I've got to go revisit this memory and figure out, like, what happened there. But yes, all of that is true. Many states require abortion providers to offer women the opportunity to view their ultrasound when they are getting an abortion. And the motivation here is explicitly, explicitly to dissuade women from having abortions, based on research indicating that women who with With wanted pregnancies, among women with wanted pregnencies, ultrasound viewing can facilitate maternal -fetal bonding.

0:07:20 Thomas: Yeah. Yeah. Really?

0:07:48 Lindsey: On that research, like, that's why they're goddamn assholes. Seriously. Is no direct evidence that women with unwanted pregnancies are dissuaded from having abortions by seeing their ultrasound, by the way. And no, there is not. There some reports from crisis pregnancy set, I don't believe a goddamn word they say, But there are reports from crisis pregnancy centers that claim that this is the case. We don't have good data on this of whether that is

0:08:12 Thomas: I I Think I've heard at least somebody on some interview talk about that having an effect, um, so I, I, you know, like, I, I would be surprised if it didn't have some effect, but I guess it's good if it's not having the intended effect.

0:08:12 Lindsey: True. Well, It's this one of the things that we're going to look at in this sample, right? And, you know, we've talked about limitations in the sample. So it's possible that there are some segment of people that we are not capturing here, right. Right. But that's one of the things we're going to look at is, like, is there any evidence in the Turnaway study that viewing the abortion has an impact on how people are thinking about their their decision to have an abortion? Right. Before, before this, we just didn't have great data on it.

0:08:52 Thomas: Yeah.

0:08:52 Lindsey: So that just wasn't an evidence based claim. It wasn't necessarily like we had evidence that they didn't do that. Abortion rights activists, on the other hand, they they dispute the claim generally that ultrasounds reduce abortion rates. But they do make claims about the ultrasounds making the experience of abortion more difficult and negative for women, particularly those who are seeking abortions at later gestational ages, which seems like a reasonable prediction to me, right?

0:09:14 Thomas: Yeah, yeah.

0:09:17 Lindsey: That could very well be the case.

0:09:18 Thomas: The more it'll actually look like a baby in there.

0:09:21 Lindsey: Yeah, right. Are some competing claims in this conversation, but there's a dearth of evidence regarding a number of relevant questions here, including whether women seeking abortions want to see their ultrasounds and what their emotional responses are to actually viewing their ultrasound if they do decide to view them. And so this study is designed to help fill that information gap. We're talking about data that was gathered as part of the Turnaway study. Please listen to past episodes to know more about that methodology. But these are women who are seeking abortions across the U.S. Of the analyses that we're about to talk about only include people who actually had their abortions. So that's 721 of the total. It's like close to 1000 people in the total Turnaway study. So this is only 721 of them. And apparently, it only occurred to them to ask some of these questions about the ultrasounds after they had started data collection. So there's a small number of people, 19 participants, that we don't have answers to their questions. Um,

0:10:15 Thomas: But Also, I mean, it does sound like there could be that cherry-picking effect a little bit, right? If they didn't go through with it, as on the basis of the ultrasound, we wouldn't know, right? % of people in your sample got an abortion, I'm what if someone involved at any level of this went to get an abortion, was forced to look at an ultrasound, decided not to, so no idea if that's a large number, it could be a minuscule or zero number, but could be there, right?

0:10:40 Lindsey: It's a good question, and I'm, I'm that if we looked at some of the the broader documentation on the Turnaway study, we could get a sense of how, how much attrition they had due to reasons like that. Um, how many people you lost from the Turnday study overall, because like these people would have been like enrolled and then decided, decided against having an abortion after they enrolled in the study. I

0:10:51 Thomas: Um, Well, remind me, is it, every I thought we were already starting from the cherry pick sample, sample, let's refresh everybody on what the sample was, but

0:11:10 Lindsey: So close to a thousand women. It's like 956 women, I think, who sought abortions across the United States. So they're all coming in seeking abortions. And some of them are in their first trimester. And Some of them Are later than that, and get abortions, and some of them are later than That get turned away. So that's their their full sample.

0:11:31 Thomas: They did this by going to certain providers and just grabbing everybody who went there, right?

0:11:36 Lindsey: No, no, that's, that's a good question. So They went and sampled from certain facilities across the US. And every time so they would recruit one person who was turned away from having an abortion. And for every turn away that they recruited, they would also recruit somebody who got an abortion and was in their first trimester, and somebody who Got an abortion was past their first trimester.

0:11:59 Thomas: So the people I'm talking about, I don't think would even be in the steady, yeah. So We have no idea what Yeah, what that could be.

0:12:02 Lindsey: Correct. Right. So yeah, that's a selection bias in general. Yeah. And that recruitment thing just a tiny bit. So for every turnaway that they recruited at a particular site, the researchers actually recruited three other individuals, not just two. So they recruited two women who sought abortions just before the gestational cutoff and one woman who sought an abortion during the first trimester. So like close calls almost were turnaways and then one person who was in the first trimester. So there were not close calls.

0:12:06 Thomas: Sure.

0:12:35 Thomas: And those people, did all of them end up getting an abortion, or would they have like fallen out of the study if they didn't, or when they quote-unquote recruited them, was it after the fact, so they knew who got an abortion? Okay.

0:12:48 Lindsey: Like, I think that they were recruiting people on the day that they came in to have their abortion. So it's like, they're already getting people who have decided they're going to have the abortion, you know?

0:12:53 Thomas: Right. So, Okay, so just confirming that if anybody, everybody in at those same providers had like gone in, seen it, made, been made to watch an ultrasound and then they're like, I'm not so sure about this, I'm not doing it, they would be nowhere in these, the samples. Okay.

0:13:11 Lindsey: I, I mean, I don't know. I think, I feel like that's true.

0:13:13 Thomas: No, it sounds right, I just, so I, I really sounds to me like we can't really make any claims about what, who that is, you know, that could be a million people, could be zero people, right?

0:13:22 Lindsey: Yep, that's truth. Claims That's that they're able to make from this are, are little more limited than that. Yeah, that think

0:13:22 Thomas: Yeah. So I Just, I think it's important because I don't think we can universally say these ultrasounds don't affect people, you know, or don't cause them to change their minds.

0:13:35 Lindsey: I think that is extremely fair. Yeah. But we haven't even talked about the results yet. You don't know what's going to happen.

0:13:39 Thomas: But now time to talk about the result. We talked about what the results can't tell us. What do they tell us?

0:13:44 Lindsey: It's important to talk about what the results can't tell us. That's That's most of science, actually, is talking about what their adults don't tell Us. So during their initial interview, this was one week after their abortion, women were asked whether they were offered the opportunity to see their ultrasound. If they said yes, they also asked them whether they'd said yes to viewing the ultrasound. And if they had viewed the ultrasound, they asked them, how did you feel about the ultrasound either during the ultrasound itself or afterwards? And notice the lack of leading language in this question. Their phrasing is careful here to not imply that their experience was one way or another. Just

0:13:46 Thomas: Yeah, it really is. Yeah. Yeah, right, right. Right.

0:14:23 Lindsey: How did you feel about it? They also gathered information from the abortion providers themselves regarding whether they were subject to state laws requiring them to provide the opportunity to view the ultrasound, and their facility policy in general, regardless of state regulations, was to offer women to view the ultrasound, right? Some facilities just had this as a policy of their own accord, not because there were state laws regulating it.

0:14:48 Lindsey: They just always offered them an opportunity to see the ultrasound. Sound.

0:14:43 Thomas: Wow. That's interesting. Well, yeah, but that's specific wording. Offered them or like, do they make their patients go through that?

0:14:57 Lindsey: Offered them.

0:14:57 Thomas: Okay. Gotcha. There's nothing.

0:14:58 Lindsey: Yeah. But I think that that's all that the state regulations do, right?

0:15:00 Thomas: No, I thought there was some, well, maybe these were proposed and didn't pass or something, but there definitely was a proposed bill that would force people to undergo this.

0:15:09 Lindsey: Yuck.

0:15:10 Thomas: And I don't remember the status of that, but it's at least somewhere. Yeah. I mean, there's nothing wrong with, I guess, being offered and option, but I don't know how perfect information is in the mind of the person. Because it sounds like you, yeah, what the hell happened with you? You had to do it, right?

0:15:26 Lindsey: I had to have the ultrasound, but I didn't have to actually view it.

0:15:29 Thomas: Oh, I'm sorry. We're talking about the difference between viewing and not.

0:15:32 Lindsey: Viewing.

0:15:32 Thomas: Okay. Yeah. You're totally right. Two different things. Yeah, Yeah, that's like even more intrusive. So if possible. Gotcha.

0:15:33 Lindsey: Yeah, mm -hmm. Yep. Mm-hmm, yep. It's pretty cool.

0:15:41 Thomas: Not.

0:15:42 Lindsey: Not. So yeah, what they found. So 48 % of participants in their sample reported that they were offered a view of their ultrasound. And certain demographic characteristics predicted or not women were offered this opportunity. So women were particularly likely to be offered an ultrasound viewing if they didn't already have children. So 54 % of those who didn't have children versus 45 % of those Who already had kids were offered to view the image. Gestational age of the pregnancy was less than 21 weeks that predicted a higher likelihood of being offered to be the image So thankfully, women who were at 21 weeks or later had the lowest incidence of being offered to view the ultrasound. I think that that's, you know, probably related to the things that we're talking about.

0:16:03 Thomas: Hmm. Yeah.

0:16:26 Lindsey: Somebody's already decided they're going to have an abortion. It's, I think some people are making a judgment call here in terms of the clinicians. Conditions. Were more likely to be offered an ultrasound viewing if the facility they were at was subject to state laws requiring them to be offerred. So obviously, right. It wasn't 100%. So 91% of the women that were at those facilities where they were like state required to see the ultrasound, 91% said that they were actually offered to view it. Now, this could be a couple of things you mentioned that people might forget things. So if they were offered it and then they didn't get it, it might not have been a memorable moment to them.

0:16:40 Thomas: Yeah. Yeah. Right.

0:17:00 Lindsey: So memory bias, I think it's also possible that there's just a handful of clinicians out there that are sticking it to the man. And

0:17:06 Thomas: That's what I'm hoping. Because like, how are they enforcing this? Are there a lot of secret shoppers that the government does?

0:17:07 Lindsey: Yeah. No. Idea, I don't, yeah, so I, I hope that that's actually the majority of those nine percent, but um,

0:17:17 Thomas: Yeah, me too. It's also, you know, it's a hard decision because if you're in a shitty state and they catch you, then they shut you down and now people don't have access to you at all. So I don't blame providers for not doing that. Hmm.

0:17:23 Lindsey: That's not good. Yeah. Yeah, same. So 91 of the women at the facilities that were subject to state laws, 75 of the women who were at places where the facility had a policy to offer them, but they, they weren't in a state that was regulated by state laws, seventy five percent of those women, so that they were offered to be view their ultrasound. At the clinics that weren't regulated by state regulations and didn't have a provider policy to make that offer, only 33% of those women said that they were offered ultrasounds at those kinds of places. Those who were offered a view of their ultrasound, 65% said yes.

0:18:04 Lindsey: I it was higher than I expected it to be. It was. 65 % that said, yes, younger women were more likely to say yes. And women who didn't already have kids were more unlikely to say, yes.

0:18:03 Thomas: That's a lot, yeah. That makes sense, yeah.

0:18:15 Lindsey: Yeah. And the authors were kind of like, yeah, it's probably a curiosity thing or something, you know, don't have priorities. It might be kind of interesting to view it. Whose facilities were subject to state laws requiring them to offer an ultrasound were also more likely to say. Yes, that really did surprise me. I want to view the ultrasound and it was very much tied up with the fact that I knew why, why I was being offered a view of the ultrasound. Like I was hooked into that political conversation about why there were regulations around that. And I was pissed off about it. So I was like, no, I don't want to see the ultrasound curiosity.

0:18:45 Thomas: Well, But Even still, I don't know, you've set all that aside. I'm not sure why one would want to do this necessarily. I, yeah, I know, okay, I'll speak for myself, if it were me somehow I wouldn't want to do that, but who knows, yeah.

0:19:03 Lindsey: If never know. I it would have been really interesting to be able to make that decision independent of what all the Republican fuckheads are trying to do around this. I'm, I, a curious person. I might've been interested in seeing it. I don't know. T know, so yeah, actually, that's a good segue, because the next set of results that they talk about are the emotional experiences that women describe regarding viewing these ultrasound images. And these are kind of surprising and interesting. Results that I'm about to summarize are from qualitative responses that they coded into themed categories. So when I give like numbers and percentages, I'm talking about like how often something was coded into one of these themes, like what percentage of the responses were coded into these themes. They're not mutually exclusive. So somebody's response could be coded in multiple themes.

0:19:05 Thomas: That's true Hmm.

0:19:44 Thomas: So percentages won't add up to 100, basically is what you're saying, sure.

0:19:47 Lindsey: Exactly. Exactly. Yeah, most frequent feeling that was reported here was neutral. 77 of the 212 responses that they coded in this way, that's 36%, were coded into this category of feeling nothing or feeling fine, which I thought was interesting. So that was the most frequently response. The most frequent responses were all negative emotional experiences. So % of the responses suggested the women reported feeling sad or depressed and viewing the ultrasound. % said feeling guilty or second guessing their decision. There's your thing. I mean, they ultimately did it. But yeah, 14 % said that they felt bad or upset. And what women seem to mean by that varied significantly from the other detail in their response. So some women said they felt mad about the abortion itself.

0:19:56 Thomas: Hmm. Yeah. Makes sense, yeah. Yeah.

0:20:43 Lindsey: Sort of saying things indicating that viewing the ultrasound was just bringing up feelings about the situation in general, like about the solution. They're in with their partner that might have, you, the motivation to have the abortion, things like that, um, why they felt bad or upset sort of ranged here. A negative emotional response was not associated with later gestational age, which is interesting, so that counters a point that we talked about earlier, or it's inconsistent at least, um, next most frequent descriptions of emotional experiences were actually positive in nature, so 10 percent of the responses indicated that women said that viewing the ultrasound made them feel happy or excited.

0:21:04 Thomas: That is interesting. What what Huh.

0:21:20 Lindsey: I don't know. I guess that they're not going to be pregnant. I really don't know. Hard for me to get there. Happy or excited. % said they felt comforted by viewing the ultrasound. 5 % said They felt good. What they could mean by that is, you know, it's right?

0:21:25 Thomas: Yeah, just people who are like, boy, I'm really sure now that I don't want that baby, be Hmm, yeah.

0:21:41 Lindsey: I mean, yeah, there might be some sort of closure associated with actually seeing it. I really don't know. Said I No to the ultrasound. And yeah, I know. Final finding to note from this study. So women at facilities who had explicit policies to offer a view were more likely to report negative emotional experiences in response to viewing the ultrasound than women at faculties with no policy. This difference was significant when you made the comparison between facilities that had no internal policies to facilities that just had like, policies that were generated by the facility itself, that comparison was significant.

It was only marginal, marginally significant when you compared the places without policies to those that were subject to state policies. So difference was in the same direction, like people are having worse experiences, worse emotional experiences when there's regulations involved or policies involved. Involved. It seems to be a larger difference if it's just a policy that's kind of at the clinic itself as opposed to a state policy, which is interesting. Was surprising to me.

I felt like my negative reaction to it was actually tied up with my knowledge of the state regulations. But don't know, like, guess my reaction wouldn't have been captured

0:21:42 Thomas: All right. Yeah. Hmm.

0:22:47 Thomas: Right.

0:22:47 Lindsey: In these data because I declined the ultrasound, right? We don't have access to that. That's

0:22:49 Thomas: Yeah. That's a good point, so that is cherry picking it a little bit, yeah.

0:22:54 Lindsey: It is right, yeah, this is only reactions among women who were like, uh, yeah, I'll see the ultrasound.

0:22:58 Thomas: If anyone was like Lindsay and like double middle fingered, like, fuck off, I hate this policy, they're not in the bat, that data set.

0:23:07 Lindsey: Yep. Yep, am not, I am NOT in that data set, right, but it's, it's interesting, so I'm not sure why having the policy makes a difference here, except that like maybe staff feel more free to make a judgment call about whether offering someone a viewing is a good decision or not, like there's some circumstantial things that people are like, yeah, maybe I won't make that offer this time or something that track with the experience that people would, I really don't know, um, also possible that when it's part of policy that they're like, you know, if there are certain questions or things you have to say as part of your job and they're just sort of, they become rote.

0:23:07 Thomas: Hmm. Yeah. Yeah.

0:23:40 Lindsey: After a while, so it's possible that like the way they're handling asking about this is, there, like, might need to be more attention directed toward this, so one of the things that the authors suggest is that it's possible that people, that the patients were not hearing this as an offer as much as like a recommendation, like a medical recommendation to view it.

And so they were like, we need to direct attention toward how staff are asking people if they want to see their ultrasounds and make it clear that they're not being pressured into seeing them if they don't want to. So, I take homes here. So, one, offering the opportunity to view the ultrasound is not uncommon with or without the state regulations, that was happening at a lot of these providers.

Idea that women are only going to be given this opportunity if it's regulated, yeah, maybe not consistent with what we saw here. The ideathat viewing an ultrasound of an unwanted pregnancy is likely to suddenly transform the woman's experience of the pregnancy and dissuade them from having an abortion. It's not consistentwith these results, but for all the reasons you bring up, there's probably not a ton that we can infer from a sample that's limited

0:24:41 Thomas: Yeah.

0:24:41 Lindsey: In the ways that it is. I also three, the idea that viewing an ultrasound at a later gestational age is associated with more negative reactions, also not consistent with these results. However, we're only looking at people who actually said they wanted to see the ultrasound. So we don't have data here on how many women declined in gestacional group as opposed to. But we do have information about the reactions once people actually view them, right? Negativity there is not associated with gestational age.

Four, women had more negative reactions to their ultrasounds if they were at clinics that had policies offering viewings, maybe for the reasons we were just discussing. They need to make it clear that this is an offer and not a recommendation. There's no pressure. Finally, I think it's important to emphasize that the most frequent specific emotional reaction that women reported to viewing the ultrasound was meh, right?

The authors point out something that I think is rather poignant, which is that this is yet another way in which these debates often ignore the actual experience that abortion patients have. You know, in this case, there's an assumption, I think, on both sides of this issue, that viewing an ultrasound is going to prompt some sort of deep emotional reaction. At least in this sample, limited though it is, it seems like that's not maybe the typical response here. I don't know, I thought that was a very interesting point.

0:25:57 Thomas: Trying to think if that's also, so, still affected by the, by the sample. I don't know.

0:26:01 Lindsey: I'm sure it is. You we're looking at a huge chunk of people who are not having sort of like this deep emotional reaction. I think I'm not saying that we shouldn't worry about some of the specific cases that we've alluded to, but but I don't know.

0:26:16 Thomas: Yeah. Did you find this kind of encouraging?

0:26:19 Lindsey: Encouraging.

0:26:20 Thomas: That, I don'T know, maybe that for the most part, this sample, these people were like, meh.

0:26:26 Lindsey: Don't know about encouraging. I just found it interesting. Like I, because I didn't look at mine, I'm really not sure if that would have, if my reaction to it would have been surprising to me. So it was interesting to me that the most common theme that responses were categorized into was like, eh, it really didn't prompt a strong reaction, um, don't know, I just found that interesting. Okay, um, study that I want to talk about, this is by Roberts and colleagues, published in 2014, and this is about the cost of abortion. So 1976, Federal Medicaid has not covered abortions except in cases where the pregnancy resulted from rape, rape or incest, or the life of the pregnant person is threatened. In other words, elective abortions that result from consensual sex are not covered by Medicaid, by federal Medicaid dollars. The time that this article was written, again, 2014, the following things were also true at the state level. So 33 states prohibited any state funds from being used to pay for abortions, states prohibited private insurance companies from covering abortions, yeah. Yeah.

0:26:54 Thomas: Yeah.

0:27:27 Thomas: What? Does that work?

0:27:30 Lindsey: Mean, regulations still exist in a bunch of states, by the way. So I looked up some more recent stuff to see how much the regulations have shifted. And according to a summary from the Guttmacher Institute, which I will link, currently 25 states restrict abortion coverage in health insurance exchanges, and 22 restrict abortion coverage and health insurance plans for public employees. And these restrictions all invoke some combination of life endangerment to the pregnant person, rape, and or incest as reasons that abortion, but like as exceptions for, But otherwise, yeah, so 22 states restrict heavily what you can cover. States, Louisiana and Tennessee, prohibit any abortion coverage, rich, even in circumstances of life endangerment, rape, or incest. Is current.

0:27:33 Thomas: Yeah, yeah.

0:28:03 Thomas: As exceptions. Yeah, what?

0:28:18 Thomas: That, You know, I've never heard this discussed. I'm really surprised because that I mean, that's like effectively banning Roe. I'm assuming long before Roe was just overturned.

0:28:21 Lindsey: Yep.

0:28:30 Lindsey: For a lot of people, yeah.

0:28:31 Thomas: How ever heard that discussed. That's the way I did not. I assumed it was a problem of access to health care, not states restricting what health care could even do. Had you ever heard of that? You did of your state not allowing your insurance to cover your abortion, abortion. Yeah.

0:28:40 Lindsey: Oh, yeah, yeah I mean I had first -hand experience of it, of, yeah I don't know that I, Well, so, so, I, you know, fine health insurance, I think, through my school, but they didn't cover elective abortions. So I, I don't know that I connected that to state regulations, but it probably was, yeah.

0:28:59 Thomas: That's What? I mean, I've just, I've never connected to that, and I'm just surprised of all the, like, content I've consumed on this topic over the years. I, unless I'm forgetting, I've, I've ever heard that mentioned. And you're saying this, these policies, you, laws, these policies long, long predate, you know, Roe being overturned this year, right? Huh.

0:29:17 Lindsey: Yeah, yeah.

0:29:18 Thomas: Wow, okay. That's going in there and telling a private company what, what it can and can't cover for. Some of these, I mean, I get that you, I getthat they can do the, like, public employees in red states, you know, like that sucks, but I gethat they have the authority to do that, I suppose. But I, I, I didn't even know, I guess, that they could tell private insurance companies that they couldn't cover this in their state.

0:29:19 Lindsey: It's I Was surprised by that too, yeah. I mean, I, it was, um, surprising to find out about, like, states having policies about what Medicaid can pay for or whatever, um, yeah. I was impressed by that, but yeah.

0:29:42 Thomas: Huh. Wow. Mean, it may also answer kind of my point. Of like the last episode of why, you know, Planned Parenthood locations, specific locations that try to help provide abortion care, why they might be more necessary. I didn'T think about the insurance part of it. This is just blowing my mind. That's so anyway, even more important that we raise money to help people fund abortions.

0:30:13 Lindsey: Yeah, we're, we're going to talk about that, because they get information about the different money sources that people are using to cover their abortions. And abortion funds actually play a pretty big role in that, proportionally, in the sample. So, yeah, your dollars are going to a good place when you, when you donate to these funds for Sure. Yeah. So, so of all this, right. Depending on where you live, you may have to pay for your abortion out of pocket, even if you have health insurance, even if you might die if you don't get an abortion. Um, it's especially probable that you'll paying, be paying for all or most of it yourself if you are having an elective abortion that resulted from consensual sex, that is, that is a thing, um

0:30:27 Thomas: Yeah.

0:30:47 Thomas: Guess the lesson is just always lie about how you got pregnant, right?

0:30:50 Lindsey: Guess I, the person I talked to at my insurance company might have asked me that, um I can't remember now, but they probably would have had to, right.

0:30:54 Thomas: Mm hmm. Yeah. It's not like the insurance company is that incentivized to pay out more money. Yeah, they probably wouldn't do the like, hey, just lie about this.

0:30:57 Lindsey: Yeah.

0:31:06 Lindsey: Yeah, she, yeah. Anyway, so that's cool. So yeah, so this means that a lot of women, a lot of people that are seeking abortions, incur significant out of pocket costs for their abortions. Yeah, as we talked about a minute ago, and I've mentioned it in previous episodes, I did have to pay out of bucket for mine. Despite having health coverage, I was in a stable enough place that my partner and I were able to split that out of packet cost. Many people are not in in that position. And honestly, I would not have been in that position if I'd gotten pregnant just a year or more earlier. Like I literally would not Have had access to $550 to scrape together. At that point, I

0:31:19 Thomas: Yeah. Yeah. Yeah. Not to mention, countless people are in a situation where it's not even safe to tell their partner about the abortion, let alone fund it. It's a very tragic and desperate situation. Why I'm really glad we started the OA fund, because we've raised a shit ton of money and we plan to raise more for this exact thing.

0:31:48 Lindsey: Right. Mm-hmm. Yep.

0:32:02 Thomas: It's even more dire than I even knew. New.

0:32:05 Lindsey: It's bad. And talked in some length about the fact that these financial barriers actually drive up the number of abortions that happen after the first trimester, means, by the way, that the abortion ends up being even more expensive than it would have been in the first rimester. And importantly, we talked about the fact that these costs are disproportionately burdening low -income abortion seekers for pretty obvious reasons.

0:32:14 Thomas: Yeah, yep. Yep.

0:32:28 Lindsey: Yeah, so this article was written as additional federal and state-level restrictions were being enacted at the time that were likely going to further limit coverage of abortion care. And the purpose of this paper was to examine the current out-of-pocket costs of abortions in the U.S. as of 2014 and associated impacts on those seeking abortions. And so this is super useful information because it gives a sense of how existing restrictions personally impacting abortion seekers, and it allows us to extrapolate the significance of increasing those restrictions even further, um, fun stuff, not so

0:32:28 Thomas: There you go. I've got them in your head now.

0:33:04 Lindsey: Always, study included the full turn away sample, but the majority of the analyses that they did focused on the 725 women who actually received abortions, that's just the variables that they looked at, a lot of them, um, for people who actually had the procedure, right, and had the cost. Researchers obtained data on the cost of participants' abortions and how they paid for them, as well as demographic information. So whether the woman was living above or below the poverty threshold, for example, to predict certain things about.

So a third of the sample was below the federal poverty line. Of the participants were seeking abortions after the first trimester. And we talked in a in a previous episode about the fact that that's not representative of national stats. Most abortions nationally are first trimester abortions, but because of the way that they recruited, right, sort of oversampling people who are seeking abortions at later gestational ages. % of their participants received their abortion in a state in which Medicaid would cover their abortion. So Now let's talk about costs of these abortions. So the median cost of a first trimester abortion in this sample was $490, with a range of costs between $225 and $750. First trimester. The median cost increased to $750 for abortions sought between 14 and 19 weeks, gestational age, with range of $480 to $1 ,500.

0:33:53 Thomas: Right.

0:34:32 Thomas: What's being included in this cost? The whole package like travel, you know, all that. OK, just the abortion procedure.

0:34:33 Lindsey: Nope. Just the abortion procedure itself. That's talk about

0:34:40 Thomas: Gotcha.

0:34:40 Lindsey: Travel.

0:34:41 Thomas: Gotcha. Yeah that's important.

0:34:41 Lindsey: Yep. And for abortions sought 20 weeks and later, the median price was $1 ,750 with a range of costs between $946 and $6 ,008. Lest anyone forget, remember the circumstances of the women in this sample who sought later abortions, which we talked about in 340. They were poorer, younger, figured out they were pregnant later. And then once they did figure it out, they faced obstacle upon obstacle in obtaining an abortion. So imagine yourself being a young person without $500 or whatever it is to pay for a first trimester abortion. You're trying to get the money for that. And you're watching the price creep up to $6,000 as you try to obtain that money. If you have it, is unlikely to cover it if it's elective, which virtually all of the abortions represented in the sample are. And your choice is between figuring out how to come up with six thousand dollars and you know raising a fucking kid that you don't want, which as we all know is really cheap, right? Isn't it cheap being a parent? Yeah.

0:35:01 Thomas: Yeah yeah. Yeah Not. No, I guess you didn't know, it's not the same structure. Sure, I'm scombert on the way about to be paying, you know, a good full-time employee wage for my three kids to be in various schools and daycares, so no.

0:35:55 Lindsey: Nope.

0:35:55 Thomas: Not very cheap. Seven.

0:35:57 Lindsey: Yeah, it's, this is a nightmare. Like, funding sources, how are people paying for these abortions? So two-thirds of the women in the sample received at least some financial assistance in covering their abortion. This doesn't mean their abortion was covered totally, but they received at least some. So seven percent said that they got some coverage through private insurance. Seven percent, thirty Know, right.

0:36:18 Thomas: Percent. And this isn't, sorry, remind me, this sample hasn't been cherry-picked in terms of why they're getting the abortion, or has it? Okay.

0:36:20 Lindsey: Yeah. Not. The Turnaway Study in general excludes women who are having abortions for medical reasons, but yeah, otherwise no. It

0:36:31 Thomas: Uh, So that affects it a little bit, we're dealing with, with already people who apparently, like, insurance companies don't have to cover a lot.

0:36:35 Lindsey: Does a Yeah.

0:36:40 Thomas: Okay. Or aren't allowed to cover. Yeah. Okay, still, that's stark. Wow.

0:36:40 Lindsey: So these are these Um, Yeah, so seven percent received some financial assistance from private insurance, 34

0:36:49 Thomas: Is there any data on how, what percent actually had health,

0:36:53 Lindsey: In their total sample here, 725 people, um, % had no insurance, 42% had Medicaid, and 29% of the sample had, had private insurance.

0:37:04 Thomas: Wow. Wow. So only 29% with no insurance, and yet insurance only helps 7% of the people.

0:37:12 Lindsey: Private insurance only helped 7%. Yeah.

0:37:13 Thomas: Oh, sorry, private insurance. Well, was Medicaid allowed to help them though?

0:37:18 Lindsey: Yeah. So state Medicaid on some of the, some states do allow Medicaid to provide coverage. So yeah. So 7% got some help from private insurance, 34% of their sample got some assistance from Medicaid.

0:37:29 Thomas: Okay, gotcha. So that's important to know. So I guess I should just apples to apples look at the private coverage number. What percent had private healthcare? So 29% of the sample had private healthcare health but only 7% of the sample got any help from that insurance. Okay.

0:37:29 Lindsey: Um, yeah. Uh, 29%. Right.

0:37:45 Thomas: Okay. So there's a big gap there.

0:37:45 Lindsey: That's is, yes, there is a very big gap there.

0:37:49 Thomas: Just to reiterate, the thing that they probably pay money into, whose job is to help provide health coverage in terms of cost, did not help them with a healthcare thing that cost money. Okay. Very important healthcare thing. Probably or death healthcare thing, that the thing, the company they have to fork over money to each and every month probably did not help them with. Okay.

0:38:02 Lindsey: Correct. Yep, correct.

0:38:12 Lindsey: A lot of money. Is not cheap. So 7% private, 34% got assistance from Medicaid, 29% got some financial assistance from other organizations. So we're talking here about things like abortion funds. That's a big chunk of the sample that's getting help directly from these places. Another 29% just didn't get any financial assistance to pay for their abortion.

0:38:13 Thomas: Yeah. Yeah, yeah.

0:38:35 Thomas: And you So, and we're only talking about people who got the abortion because what the sample is. So, we don't know how many people face this barrier and then we're like, well, shit, I can't do it. I didn't even think of that. So that, wow. People who are able to get help from things like Medicare, Medicaid, from things like, you know, private insurance, they're going to be over -represented in this sample.

0:38:38 Lindsey: Yeah.

0:38:57 Lindsey: Yeah, Mean, and some of the results that we talked about with the abortions that take place at later gestational ages spoke spoke to some of this, right? It was like the financial barriers that were being encountered directly impacted not just the women who ended up actually getting abortions later, it was a big issue with the turnaways. Was a bigger issue in the later abortions than it was in the earlier abortions, but it was an even bigger issue with The Turnaways. Yes, a of why people ended up not being able to get abortions in this study, in this sample, was what were financial barriers.

0:38:58 Thomas: Wow. Yeah. Yeah? Yeah.

0:39:31 Lindsey: It's awful. So finally, out-of-pocket costs here. % of women who had Medicaid coverage paid $0 out of pocket. So it's good to live in a state with Medicaid coverage for abortions.

0:39:38 Thomas: All right. Yeah, okay.

0:39:42 Lindsey: Of those whose insurance included abortion coverage of some sort paid less than $20. But a quarter of these folks, a quarter of the folks whose private insurance actually included abortion coverage, paid $200 or more for their abortion.

0:39:57 Thomas: So, some sort of copay, probably.

0:39:58 Lindsey: Yeah, right. Of those who did not have coverage, either through Medicaid or through private insurance, and thus either received assistance from another organization, like an abortion fund, or received no assistance at all, paid a median amount of $575 out of pocket. So people without private health insurance or Medicaid, yeah. Yeah.

0:40:16 Thomas: And again, just to reiterate, this is still just for the cost of the procedure? Okay, so we haven't switched to total costs yet or anything. Okay, yeah.

0:40:20 Lindsey: Yes. That's right. Nope. About 20% of these no insurance coverage folks paid $1,000 or more out of pocket. 20%. That's a big chunk. Those costs, as you say, again, you don't have my notes, those costs are just for the procedure. If we look at the total out-of-pocket costs, including abortion and travel, the costs were equivalent to more than one-third of the women's monthly personal income for 56 percent of participants. 56, a lot.

0:40:48 Thomas: Oof, wow. Given that rent is about 140% of the average income, uh, there's not a lot left. Yeah.

0:40:57 Lindsey: Nope. Just don't eat that much that month. It's not that important, as it turns out. Food is optional. Yeah, it

0:41:00 Thomas: Yeah. Not not just gotta sneak it in there now, every time you do sarcastic things.

0:41:07 Lindsey: Okay. I like it. I'm going to leave every single one of them in. Also Have Some Results Speaking to Cost as as a barrier to receiving abortion, as you were mentioning a minute ago. So this echoes some of the results that we talked about at length in episode 340. 54 % of the sample reported that raising money for their abortion delayed them in having the procedure.

Was more true for those who were already at a later gestational age, those who were not white, it was Who were not residents of a Medicaid abortion coverage state, those WHO were living below the federal poverty line, and those who did not personally have Medicaid or private health insurance. So for those folks, they were more likely to report that raising money for the abortion delayed them in having the procedure.

And as we've said several times, we're still ending up with a sample here that actually got their abortions, but you can extrapolate that out to people who face those barriers and are not able to get their abortations because of that. But same thing holds. Summarize, out -of -pocket costs for the women that that seek sought abortions in this sample were substantial, even among those who were in fact receiving assistance from either private insurance or Medicaid or other organizations. And a third of the women in this example were not receiving assistance at all and therefore had even higher out-of-pocket costs.

0:41:55 Thomas: Yeah. Yeah. Yeah.

0:42:23 Lindsey: Abortions are not covered as consistently as they should be by health insurance. And the burden, yes, they should.

0:42:27 Thomas: Because they should be covered 100% of the time. Just yeah, it falls far short of of that. Not

0:42:31 Lindsey: Yeah, correct. The burden imposed by that lack of coverage is much heavier for already disadvantaged individuals and delays their access to abortion. That's cool. Yeah. Just one of the many reasons to roll back restrictions on abortion coverage. I mean, I think we've covered a lot more of them just here, but, um, so those are my science thingies. General take -homes restrictions and regulations on abortion care that often proposed in terms of, like, "No, this is actually for... it's benevolent, we want to make sure that women are receiving good care and we want to make they make good decisions, so we're gonna have all these regulations." This take home from these studies is not that. They're having those effects they weren't designed to.

0:42:42 Thomas: Yeah, yeah,

0:43:13 Lindsey: Go vote.

0:43:14 Thomas: I now If we don't, um, we don't keep the House and win the Senate and maybe add two seats to the Senate, if we do not do that, and odds are we are not. Um, make sure you are doing everything you can, the numbers, of they were looking okay in the summer and now they are bad again. Um, you do not keep the House and win. If we don't do that, we're not codifying Row, we're not doing any of that. But let's assume we codify, we had enough to codify. I wrote, I, I've seen that this is true, but I would also hope that if that bill could happen and we gain a couple senators and literally never have to say the names Kyrsten Sinema or Joe Manchin again in our lives, then maybe repealing a federal standard that abortion needs to be covered by health insurance. I wonder if that that would be on the table.

0:43:20 Lindsey: Mm -hmm. Yep. Mm, rad. That would be amazing. You because I was focusing on all the doom and gloom states, I did forget to include a few things. I think that there was something like seven states that actually require insurance companies to cover abortions.

0:43:54 Thomas: Um, yeah, it would be great.

0:44:06 Thomas: Yeah.

0:44:06 Lindsey: So that was cool.

0:44:07 Thomas: Good.

0:44:08 Lindsey: So making that federal would be awesome. I would love that.

0:44:10 Thomas: Again, we don't get to do any of that at all of any kind if we don't win the midterms, which it's looking like we' re not going to do. So, uh volunteer, donate, vote, everything, tell your friends.

0:44:12 Lindsey: Nope.

0:44:22 Thomas: It's immensely important. Yeah oh, is that what we figured out worked?

0:44:20 Lindsey: Mm-mm. Shame your friends, right? Yeah. Ostracize your friends and it'll make them want to identify with the in -group more and then go vote, I think.

0:44:31 Thomas: Right. Well, lots of takeaways there. You know, it gives us a bit of a plan of action, too, of what we need to do to help. For one, we'll continue to do everything we can through the OA fund to fund abortions because, geez, people need even more help than I thought. Was already something, a fire that I wanted to shovel money on forever because people should have the right to get abortion access. But you know, again, if we want to make progress on this, I'm sorry if it's not a message that people like to hear. But actually, we just have to elect Democrats because that's how it works. And there's that's the way that this happens. And there'S really no avoiding that that maybe do that. Thank you. Right, Lindsay. Thanks for a great couple of science thingies.

0:44:44 Lindsey: Yep correct go vote yep thank you yes

0:45:15 Thomas: It's been it's been quite a journey. There's a lot there support the show patreon.com/seriouspod and if you have any questions about this or any other episodes go to that Q&A thread on patreon.com/seriouspod that's a patron perk to be able to ask any questions and maybe Lindsay will even grade your paper for you alright

0:45:33 Lindsey: Huh

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