Ask The Expert: What’s going on with reproductive rights?

Dear Readers,

I get so many questions each week about everything from relationships, to finances, to family dynamics, and beyond. Over the past few weeks, I’ve gotten a flurry of questions from women across the country thinking about their future families or worrying for a friend or loved one whose choices about her future are getting harder to untangle. In the few years since the Supreme Court revoked the federal right to abortion, we went from one law of the land, to 50. 

The states have written their own laws and regulations, making it almost impossible to keep a clear understanding of what kind of healthcare you can access where and when. I’m no expert on the subject, so I called in Dr. Kristen Sramek, a physician with years of experience doing reproductive healthcare to help us understand what’s going on and what it means for real patients.  

Welcome, Dr. Sramek!

Dr. Sramek: Thanks, Grace. I’m always happy to weigh in and help answer folks’ questions.

Grace: Help us get to know you a little–what drove you into this line of work?

Dr. Sramek: I always knew that I wanted to take care of people across the lifespan, and I also loved women’s health and pediatrics. So that’s how I ended up in family medicine. And then, as I practiced, I saw that the times I felt most like I was able to to help people feel comfortable was in like that intimate gynecology setting around sexual health. The more I got involved in the field, the more I saw the gaps—that even among specialists like OBGYNs, so few providers were trained in offering care like abortions, that it’s really hard to find one you trust. I really believe that providers shouldn’t be there to make judgements, they should be there to support you and help you make healthy decisions. Pregnancies end for all kinds of reasons, and I knew there were plenty of women who couldn’t get the help they needed. So I made a decision to continue my training to include abortion care as part of my family medicine practice.

Grace: The reason I wanted to chat was to help us untangle what all of the court rulings and changing laws mean for real women, real patients who are seeking care. It’s been a very complex and confusing few years of new laws and legal battles. Can you tell us about your experience as a doctor in these last few years since Roe v. Wade was overturned? 

Dr. Sramek: It’s been a really tricky two years. Even though I get almost daily updates around this stuff myself, sometimes I still get overwhelmed by the legislation that keeps coming down to try and restrict access to abortion and even to birth control. Beyond being confusing, all the new laws, particularly in my home state of Montana, make it harder for patients to find a provider who can help them, which then puts them in a position to either travel or wait longer than they should to get care. Our providers here in Montana have seen a 200% increase in patients since Idaho’s abortion ban, and similar things are happening in states like Kansas. Thanks to telemedicine, patients who come in early in their pregnancy can often get a prescription without having to travel, but now that states are trying to ban medication abortion, even this option could disappear. 

Grace: This is something I keep hearing about and I’m really curious. I think a lot of people think of abortion as a procedure, but it sounds like that isn’t really the case any more. Can you help me understand that?

Dr. Sramek: You’re totally right. Over the past several years, medication abortion has become the most common method, since we are seeing patients come in early enough for a pill to be effective. Most patients seeking an abortion are in their first trimester and have either miscarried or decided that they cannot continue a pregnancy for whatever reason. Patients that come in later for an abortion are usually experiencing a medical issue or dealing with news that their pregnancy isn’t viable. Those patients’ stories are always some of the most heartbreaking for me to hear, especially as a mother myself. 

Grace: Just listening to you, I’m thinking about all of the other myths around reproductive care and abortions in general. What other common misconceptions do you run into as a doctor?

Dr. Sramek: There are so many wacky ideas that I wish I could clarify for folks. I often hear people worry that women are using abortions as birth control, which has always sounded strange to me. 1 in 4 people who can carry pregnancies in America will have an abortion in their lifetime–either by choice or as a result of a miscarriage–and most of those people are already parents. I’ve sat with so many patients going through this, and I’ve never understood where this idea comes from, that abortions are easy to access and women are getting them left and right. 

There is also a lot of misinformation out there about safety. Both medication abortion drugs and the abortion procedure are very safe—just as safe as any other routine medical care, and a lot safer than childbirth. Mifepristone, one of the drugs used to manage abortions and miscarriages, has been around for 40-some years, is available in over 100 countries, and is safe enough that you can pick it up at the pharmacy and take it at home like you would an antibiotic. As a physician, I wish I could make lawmakers understand that this is healthcare, just like anything else.  

Grace: I hear you talking about abortion to mean terminating a pregnancy but also having to do with miscarriage—does it refer to both of those things?

Dr. Sramek: Oh great question! Yes, it does. I sometimes forget as a physician who deals with these topics all the time, but abortion is a medical term that refers to both voluntarily ending a pregnancy and managing a natural miscarriage. 

Grace: I see, I didn’t realize they fell under one umbrella. I know you’re passionate about this line of work, since you’ve dedicated your life to serving patients. But can you try and sum up for me what fuels your passion after so many years in medicine? Why do you feel so strongly about making sure that patients can access the healthcare they need today?

Dr. Sramek: I’m obviously passionate about this as a doctor, but I’m really personally driven by the human side of all of this. Seeing the relief on someone’s face when they know things are going to be alright and just holding their hand, I can feel the gratitude and the peace that comes from getting good care and trusting that your doctor is on your team. It’s so crazy to me that, especially compared to other countries around the world, it seems we are just moving more and more backwards. As a doctor, a woman, and a mom, I won’t go silently into that kind of future. I have to keep advocating for my patients to have safe access to the care they need. 

Grace: Thank you for sharing all of that, Kristen. Just hearing you has me tearing up a bit! Okay, last question: If women in our community have more questions or need help finding reproductive care in their area, where would you recommend they look for information?

Dr. Sramek: I’m really glad you asked, because finding trustworthy info can be harder than you might think. I will share a few links for women who want to learn more or need to find a provider, but I also want to drop a quick public service announcement: The #1 source of misleading information for patients are so-called “pregnancy resource centers” or “crisis pregnancy centers.” Lots of these places masquerade as healthcare but are actually working to keep patients from accessing abortions, if that is what they need. 

Okay, PSA over! Here are some of my favorite go-to resources: 

• This talkline is a great way to walk through your options with a real human: https://www.all-options.org/find-support/talkline/ 
• Here you can get remote access to medication abortion: https://www.justthepill.com/ 
• This site is great for accessing info about birth control, abortions, the morning after pill, and gender-affirming healthcare: https://www.mayday.health/ 
• This resource library is where I send patients with questions about all things sexual health–from birth control methods, to breaking down your options by cost: https://www.reproductiveaccess.org/resources/ 

Grace: Thanks so much for sharing these resources, I will be sure to keep them in my back pocket for the future! It’s always such a pleasure chatting with you, I really appreciate you taking the time to walk through all of this together. 

Dr. Sramek: Of course, Grace. I’m always happy to lend a hand.