Women Deserve To Access Health Care Without Interference

By Ona Marshall. Originally published in the Courier Journal.

Extremist politicians are trying to close our clinic, but we won’t stop fighting for our patients.

Right now, anti-abortion politicians in Kentucky are pushing hard to enact a law with a sweeping set of abortion restrictions and medically-unnecessary red tape. Yes, abortion is still legal in Kentucky, but our rights are on the line. These measures contradict the recommendations of all major health expert associations and raise serious concerns about patient privacy as well as the importance of providing medically accurate health information to the public. It’s clear that extremists intend to push abortion care out of reach entirely and shut down our health clinic. 

As one of only two clinics remaining in the state, and the one that provides the majority of abortions, we know how devastating this would be for Kentuckians.

Fortunately, a federal judge just ruled that the law can’t be enforced for the next two weeks while they consider next steps. That means, yes, abortion is still legal and available in Kentucky. However, the court didn’t strike down the law entirely, and we must brace ourselves for another fight as anti-abortion extremists double down on their attempts to ban care.

Lawmakers have recently been emboldened by the possible weakening or overturning of Roe v. Wade—the landmark Supreme Court ruling that protects the legal right to abortion–but this law isn’t entirely new. It’s part of a long history of attacks on Kentuckians’ freedom and safety. For instance, when surveyed, two out of three patients report anti-abortion harassment at our clinic, and our abortion providers have experienced threats of violence. These threats extend beyond the clinic property–to our homes, other offices, friends and family members.

Incidents of violence, including hate emails, death threats, loud noise, obstruction, trespassing, and assault have and will continue to rise. This harassment prevents patients at our clinic from receiving the best possible care, and our friends, family, and Louisville community members will continue to be harmed until we address anti-abortion stigma at the root. 

All people, in Kentucky and beyond, deserve the right to access quality health care without fear or political interference. We’ll continue to fight hard to protect all Kentuckians’ access to abortion care. For instance, we work with the Louisville Police Department and the County Attorney’s office to enforce the buffer zone to ensure patients have safe, assault-free, unobstructed access to and from our health care facility. But we still need more support from our leaders and our neighbors.

We need all Kentuckians to join us and help counter extremism and misinformation that allow anti-abortion laws to flourish. Extremists don't represent the views of most of us in Kentucky, and our voices can drown out theirs. Most of us–including the many people of faith in our state–support the right to abortion. We’re proud to consider the Kentucky Religious Coalition for Reproductive Choice as one of our strongest allies. Our movement represents people from all backgrounds and all walks of life, unified by the shared understanding that access to reproductive health care is critical to building healthy, thriving communities. 

While our independent clinic continues to provide care to our patients, we urge you to join us in this moment of crisis. 

We must work together to fend off politicized attacks on our health care and support the abortion funds and independent clinics that play a critical role in our communities. We must call upon our representatives to protect and expand access to abortion care with legislation based on research and medical best practice, instead of misinformation. 

Most importantly, we must speak out in our communities to reject stigma and affirm that everyone deserves to be able to make decisions about if, when, and how to start a family–without political interference. 

How To Properly Counsel Patients Post-roe

Madeline Dyer, MSSW has been a fervent supporter of abortion access in Kentucky and the nation. She is a former counselor and Safety Zone Enforcement Coordinator for EMW Women's Surgical Center in Louisville, Kentucky, and a fellow with the Feminist Majority Foundation, National Clinic Access Project.

She has worked closely with the Kentucky Reproductive Freedom Fund since it’s founding. Recently, she penned an op-ed, “How to Properly Counsel Patients Post-Roe — Lessons from the social work field enable us to be part of the solution” for MedPage Today highlighting her experiences providing counsel at the clinic and the impact the loss of access to abortion has on patients. Click here to read the full article on MedPage Today or scroll down to read her thoughts.

“For 2 years I counseled patients seeking abortion care at a local independent clinic in Kentucky. It was an honor to help connect patients with the care they needed to achieve their goals for if, when, or how to grow their family. For some of our patients, they only ever told those of us who worked at the clinic about their abortion, so the counseling experience created a unique space to share their stories. For many, this was incredibly soothing.

It was gratifying to see the spark of recognition in patients' eyes when they realized I would care for them and support them, unlike the anti-abortion protestors they often had to pass by to enter our clinic, or the potentially unsupportive family or friends they may have encountered before. Patients' body language relaxed as they realized the stigma and harassment they faced outside the clinic was over, and that I was there to help them, without judgment.

Often, my work as a counselor started with unpacking the traumatizing experiences my patients faced when they sought abortion care. Anti-abortion protestors would frequently station themselves outside the clinic to try to intimidate and coerce visitors into continuing a pregnancy they didn't want or that wasn't healthy for them. Many of these protesters aren't peaceful demonstrators -- they scream at patients, insult them, follow them closely and aggressively, and invade their personal space, all while claiming to want to "counsel" patients and provide advice about pregnancy options. This couldn't be further from the truth.

These extreme protestors are co-opting the language of counseling to try to legitimize their efforts to politicize basic healthcare and impose their personal religious beliefs on all of us. Now, protestors are even more emboldened to harass clinic staff and patients after the Supreme Court overturned Roe v. Wade this summer. As state politicians and special interest groups seize the chance to push new abortion bans based on politics, instead of medical expertise and science, anti-abortion harassment in the form of so-called "sidewalk counseling" will continue to intensify and inflict serious harm on patients across the country.

We're facing a health crisis, and it's time that we, as social work professionals, set an example for what real counseling looks like: compassionate care, without judgment, that provides accurate information and helps all people thrive and empowers them to make decisions about their futures.

As counselors, we have a duty to our patients to affirm and validate their decisions about whether they carry or end a pregnancy, regardless of what we personally would decide in the same situation. Protecting our patients' right to privacy, self-determination, religious freedom, and their ability to make decisions in the best interest of their mental and physical health and well-being should be an ethical priority for every counselor. You don't need to be an advocate or an expert, but you can't be afraid or ashamed to discuss abortion and build trust with clients who make the decision to end a pregnancy.

For some people, abortion can be a challenging decision, but for many it's a simple one. In fact, research shows that the most common emotion associated with abortion is relief. Many patients are confident about their decision, and are only looking for compassion and validation. So, if your patient isn't struggling with their decision, there's no need to pathologize what is not there.

Let's not forget that when people are denied a wanted abortion, they experience increased stress, lower levels of life satisfaction, decreased work productivity, and decreased mental well-being. They are subjected to the potential dangers and costs of pregnancy and childbirth, and exposed to the threat of workplace discrimination and harassment. To combat this, we can talk to our clients (or patients for doctors, nurses, etc.) openly and compassionately about all of their pregnancy options, so they can arm themselves against misinformation. We can also help our clients or patients navigate the hostile political landscape by taking time to educate ourselves about the basic laws in our state and helping them understand this information. In states with steep barriers and near-total bans, we can stay informed and seek opportunities to resist political interference in the confidentiality of our counseling. When we stay true to our profession and serve as a resource for patients, rather than another obstacle, we can help shift the needle in people's ability to fully participate in their relationships, friendships, workplace, and life.

The ability to talk about their abortion, to normalize this healthcare for people who are unfamiliar or have only heard misinformation, is one of my favorite parts of counseling. I hope you'll join me and the growing movement of mental health care professionals working to build a world where all of our patients have the freedom to build the families they choose.”

NPR Interviews Kentucky doctors consider patient care following the Supreme Court's abortion ruling

NPR journalist, Leila Fadel, conducted an interview to discuss threats Kentucky doctors are forced to consider regarding patient care following the Supreme Court's abortion ruling overturning Roe v. Wade.

You can listen to or read the full conversation here. Below you will find a portion of the transcript detailing the portion of Fadel’s interview with Ona Marshall, co-founder of the Kentucky Reproductive Freedom Fund & co-owner of EMW Surgical Center, and Dr. Majorie Fitzgerald, EMW Surgical Center Physician.

FADEL: Good morning.

MARJORIE FITZGERALD: Hi. Come on in.

FADEL: Thank you.

FITZGERALD: Good morning.

FADEL: Good morning. I'm Leila.

FITZGERALD: Marj (ph).

FADEL: The next morning, we meet Ona Marshall, the co-owner of the clinic, and Dr. Marjorie Fitzgerald (ph). She goes by Marj. She's an anesthesiologist at EMW. They show us around the now closed clinic.

FITZGERALD: So we're going to go on in here.

FADEL: OK.

FITZGERALD: So this has been set up to be so comfortable, this donated by a former patient.

FADEL: That's Dr. Fitzgerald showing us a room of recliners where patients wait. On average, they performed 20 to 25 procedures a day. People would come from across Kentucky and the country. But today, she says, the clinic feels hollow. And Marshall says, there have been brief interruptions in care before, when the Kentucky legislature enacted laws restricting abortions or forcing doctors who perform them to jump through new hoops.

ONA MARSHALL: But usually, we had an injunction in less than 24 hours.

FADEL: This time, it's unclear if the clinic will ever resume care. That depends partially on what Gatnarek does in court this week. Marshall and Dr. Fitzgerald say it's always been hard for patients to get in the door because of anti-abortion rights protesters outside. It was so difficult for the patients that when Dr. Fitzgerald would check their vitals...

FITZGERALD: I would invariably see patients' heart rates when they've just come in - like, they would lose their shoe because someone stepped on their shoe, knocking it off. I mean, they were physically assaulted sometimes. And their heart rate would be 120, you know? They'd be hypertensive. They were - I mean, it was like a stress response.

FADEL: Ona Marshall jumps in here.

MARSHALL: Last Saturday before Father's Day, we had 160 protesters.

FADEL: One hundred and sixty. So if you're coming in for care, you have to get through 160 people?

MARSHALL: Yes.

FITZGERALD: They have bullhorns.

MARSHALL: So they're blocking the sidewalk.

FADEL: Bullhorns?

FITZGERALD: Oh, yeah.

MARSHALL: Yeah. Loudspeakers, sometimes loudspeakers in the front and the back.

FADEL: Saying?

MARSHALL: Oh, saying...

FITZGERALD: It's murder, just insulting them.

MARSHALL: Yeah, insulting them about the clothes they wear. If they have shorts on, that's why they got pregnant.

FADEL: The protesters aren't outside on the day we visit. The few signs of the patients that typically come through here are the pile of thank you cards on a bird feeder in the corner and the six empty stretchers prepared for patients who would be waiting for procedures. Dr. Fitzgerald doesn't know if she'll ever help prepare another patient here for surgery.

What happens now for you?

FITZGERALD: I will do what I can to help women get service elsewhere.

FADEL: She's 74, a self-described morning person. Her white hair is partially pulled back. A red pen graces her white blouse. Keep our clinics, it reads, a little heart next to the words. Dr. Fitzgerald says she was drawn to this work because she started in health care before Roe v. Wade was law in the United States.

FITZGERALD: I went to medical school to be an obstetrician and then decided to be an anesthesiologist. But I was a nurse before I went to medical school. I worked at what was the city hospital here called Louisville General Hospital. And I saw patients who had sepsis from having had illegal abortions. I think having seen those women that did not have the option for safe care has never gone away. I still remember those women. Now we go back to the days of illegal abortions, and women's lives will be lost because of this.

FADEL: She recounts some of the stories of her patients at this clinic.

FITZGERALD: I've taken care of patients who had gone through IVF only to find out that they have a congenital anomaly that is not compatible with life. They are grieving. I've taken care of, a couple of weeks ago, a 13-year-old and a 14-year-old next to a patient who's 44 years old. It's the gamut of women that are desperate. And it's the hardest day in their life to a person. As they're going to sleep, they look up and thank me and thank the staff for being here and providing care for them.

FADEL: As we prepare to leave, Dr. Fitzgerald shares another reason she does this work, why she says she knows what a country without Roe v. Wade means.

FITZGERALD: My story is not unique. Many grandmothers, faced with a birth control failure in their young adult years pre-Roe v. Wade, had to resort to an illegal abortion.

FADEL: Wow.

FITZGERALD: And that was my story. And that's been my - one of my motivating factors in providing care for other women.

FADEL: Wow. What was that like? Can you describe it?

FITZGERALD: It was through the assistance of women who got me to a facility in Chicago. And I had what was an illegal abortion.

FADEL: And the facility you went to - we're sitting in a facility that is bright. I mean, we were describing the colors downstairs, purple and pink and green. And there are recliners. Was the facility like that?

FITZGERALD: No, it was dangerous.

FADEL: What did it look like?

FITZGERALD: It was dangerous. And it was none of this.

FADEL: She said nothing more about that day.