0:01

All right, y'all ready to huddle? Yes.

0:05

That's Dr. Stephanie Arnold. She opened

0:07

Seven Hills Family Medicine in downtown

0:09

Richmond, Virginia two years ago. NPR's

0:12

Selena Seven-Steffen and Alyssa Nadwirney

0:14

visited the clinic. Dr.

0:16

Arnold works with a small team,

0:18

a registered nurse and several medical

0:20

assistants. I'm doing chronic

0:23

condition management via telehealth in

0:25

five minutes. At 10 a.m.,

0:27

I'm doing a follow-up on

0:29

diabetes, and then I'm seeing

0:32

a knee pain visit and

0:34

an ADHD follow-up, and

0:37

then we have three aspiration abortion

0:39

appointments. That's three

0:41

procedural abortion appointments alongside all the

0:43

other appointments. A little bit of

0:45

everything today, which is very typical

0:47

for family medicine. In the

0:49

doctor's office, there is a follow-up for

0:52

a patient with GI issues. So your

0:54

labs came back and honestly are looking

0:56

pretty good. There

0:58

was no evidence of celiac to

1:00

explain. Then another patient comes in

1:02

for gender-affirming care, gearing up to

1:05

start testosterone. But I think

1:07

I mentioned that there's like kind of two extremes

1:09

on the dosing approach. Yeah, we want to go in

1:11

the middle. Fast track or the scenic route. We're going in

1:13

the middle. Yeah. All right. Providing

1:16

all sorts of care, gender-affirming care,

1:18

and all aspects of reproductive health

1:20

care, including abortion, are part of

1:23

the philosophy of Dr. Arnold's clinic.

1:26

She started her practice a few months

1:28

after the Supreme Court overturned Roe v.

1:30

Wade. Many of the abortions

1:32

provided here are done with medication. The

1:35

first pill people take is Mifoprestone. So

1:37

this is the Mifoprestone. Look at

1:40

the box. It's six in a box. And

1:43

so they take this here. The

1:45

second medication is mesoprostol, which patients get

1:48

to take home with them. And

1:50

the staff follows up with all abortion patients

1:52

to find out how they're doing. Hey

1:54

there, this is Katie. I'm just calling from the doctor's

1:56

office. I want to try again to check in with

1:58

you about how you're feeling. Anti-abortion

2:00

rights activists oppose primary care

2:03

doctors like Dr. Arnold providing

2:05

abortion care. Dr.

2:08

Christina Francis in OBGYN in

2:10

Indiana, who runs the American

2:12

Association of Pro-Life OBGYNs, says

2:16

abortion is nothing like managing a

2:18

chronic condition like diabetes. Chemical

2:20

abortion drugs end the life of my fetal patients,

2:22

so that in and of itself makes it different

2:25

from a diabetes drug. But

2:27

also the complications related to a diabetes

2:29

drug are not going to require an

2:31

expertise that's outside of the skill set

2:33

of a family medicine physician to manage.

2:36

But Dr. Stephanie Arnold points

2:38

out the American College of

2:40

OBGYN says any clinician who

2:42

can screen patients and provide

2:44

or refer for follow-up care

2:46

can safely provide medication abortions.

2:50

As Arnold sees it, abortion has been

2:52

separated from other kinds of care for

2:54

political reasons, not for medical

2:56

reasons. It's just important to

2:58

me to fight back against that stigma. There's

3:01

no reason for this care to be siloed.

3:03

It's very much a part of all

3:06

the other care that I'm giving. I don't

3:08

feel like it's any different than my management

3:10

of chronic pain or

3:13

endometriosis. This is just a

3:15

routine part of my day. Consider

3:17

this. For decades, people seeking abortions

3:20

had to go to specialty clinics

3:22

like Planned Parenthood, sometimes with people

3:25

opposed to abortion protesting outside. But

3:28

since Roe v. Wade was overturned,

3:30

a movement to take abortion out

3:32

of its silo and integrate it

3:34

into everyday primary care has gained

3:36

momentum. From

3:43

NPR, I'm Wana Summers. This

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message comes from NPR sponsor PolicyGenius, where you

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Consider This from NPR. NPR's

5:00

Selena Simmons-Duffin dug into the trend

5:02

of more and more family doctors

5:04

beginning to provide abortions. And

5:07

she explored how abortion care got separated

5:09

from other care in the first place.

5:12

She takes it from here. Imagine

5:14

a young woman makes an appointment with

5:16

her family doctor. She has some abdominal

5:18

pain and some other symptoms she wants

5:20

to get checked. Her doctor says, why

5:22

don't we just run a pregnancy test

5:24

just to be sure and it's positive.

5:26

That's Dr. Sheila Atayi, a family doctor

5:28

in Sacramento, California. After a

5:30

pregnancy test comes back positive, then you

5:32

kind of like go through that like

5:34

options counseling with them. The options include

5:37

continue the pregnancy and schedule a prenatal

5:39

visit or end the pregnancy and get

5:41

an abortion. Both are available right there

5:43

in the same clinic. For some people

5:45

they know right away. For some people

5:48

I've seen them week after week to

5:50

support them through whichever route

5:52

they choose. Atayi fought hard to

5:54

fully integrate abortion into the clinic

5:56

where she works. She says for

5:58

a long time, clinic administrators weren't

6:00

convinced. Then, Roe v. Wade was

6:02

overturned in the Dobbs decision. I

6:04

was like, listen, we

6:06

need to do these things. And they were

6:09

like, yes, you're right. And like, everyone

6:11

was kind of like emboldened, right, like

6:13

after Dobbs in the blue states. In

6:15

Fort Collins, Colorado, family medicine doctor Ben

6:18

Smith can relate. There was an

6:20

all hands on deck mentality that

6:22

happened after Dobbs, where there

6:24

was, you know, an incredible kind of

6:27

surge of interest and willingness and a

6:29

sense of capacity. NPR heard similar

6:31

stories from doctors in Michigan, Minnesota,

6:33

and Pennsylvania. Some of these states

6:35

have also loosened regulations, like getting

6:37

rid of waiting periods. In

6:40

Smith's primary care clinic, they don't do

6:42

many abortions, about one or two a

6:44

month. But he says even that small

6:46

number can make a difference, since Colorado

6:48

has become a destination for people traveling

6:50

from states with abortion bans. Every

6:52

abortion that we do in primary care

6:54

becomes a space for a more

6:57

nationally facing organization that can

7:00

accommodate someone who is traveling

7:02

from Texas, from Florida. There

7:04

isn't a lot of data yet on

7:06

exactly how many internal medicine or family

7:08

medicine doctors are beginning to provide abortion

7:10

in primary care. But there is some

7:12

evidence that the trend is growing. A

7:14

recent study found a surge in applications

7:17

to programs that train primary care providers

7:19

on abortion. Some have online resources. This

7:21

training video shows a doctor talking with

7:23

a patient about what plans they have

7:25

for getting pregnant and using different kinds

7:27

of birth control. I'm here for you

7:29

to talk about any of the different

7:31

options. And also,

7:34

if you do get pregnant and you don't

7:36

want to continue the pregnancy, I have pills

7:38

for that too. Great. Thank

7:41

you. Problem. Okay. So let's go

7:43

back to talking about your diabetes.

7:45

There are barriers for clinics, including

7:47

stigma and administrative hurdles, like the

7:50

FDA's rules for prescribing abortion pills,

7:52

says Elizabeth Janiak. She's a professor

7:54

at Harvard Medical School who co-leads

7:57

expand one of the training programs.

8:00

She says those barriers help explain why

8:02

the portion of primary care doctors offering

8:04

abortion is quite small. But one thing

8:06

that I think is really important to

8:08

remember is that even if we were

8:10

to be really conservative and say 5%, there

8:12

are so many primary care doctors in this

8:14

country. So we're talking thousands and thousands of

8:16

providers. The federal government estimates there are

8:18

more than 250,000 primary care physicians in

8:23

the U.S. That's more than six

8:25

times the number of OBGYNs. And

8:27

Janiak points out nearly 40% of

8:29

U.S. counties have no OBGYNs, which

8:32

means there are reproductive health gaps

8:34

to fill. There have

8:36

long been family doctors who provided abortion

8:38

and advocated for access, but it hasn't

8:40

caught on like this before, says Mary

8:43

Ziegler, a law professor at UC Davis

8:45

who's written extensively on the history of

8:47

abortion. Back in the 50s

8:49

and 60s, she says, abortions generally

8:51

happened at hospitals, but not all

8:53

hospitals offered them, often for religious

8:55

reasons, and access across the country

8:57

was uneven. So in the 70s,

9:00

abortion rights groups began

9:03

focusing on the opening of

9:05

freestanding abortion clinics. On

9:08

one hand, she says the clinics did

9:11

expand access. On the other hand, they

9:13

physically and symbolically isolated abortion from other

9:15

health services and made them easier

9:17

to stigmatize, made it easier for

9:19

abortion clinics to be

9:22

protested and made it easier to argue that

9:24

abortion was very different from other forms of

9:26

health care. For years, a

9:28

key anti-abortion strategy was to target

9:30

those clinics with regulations, known as

9:32

TRAP laws, that mandated a certain

9:34

width of hallways or required doctors

9:36

to have admitting privileges at hospitals,

9:38

for instance. Here's Ziegler.

9:41

TRAP laws, combined with the

9:43

rise of clinic blockades and clinic

9:45

protesting and even violence against abortion

9:48

doctors, led to a

9:50

pretty precipitous decline in the number of

9:52

physicians who were either trained to perform

9:54

abortions or willing to perform abortions.