Dr. Ghazaleh Moayedi joins Rafa Kidvai to discuss the challenges faced by abortion providers in the wake of a post-Roe reality–and how her Texas-based practice has had to navigate barriers to care even before the Dobbs decision. Dr. Moayedi shares the impact of abortion bans she experiences first-hand on both providers and patients, and the strategies she employs to ensure continued compassionate abortion care.
Visit Repro Legal Defense Fund to learn more. Follow Dr. Moaydei on Twitter at @dr_moayedi.
If you have questions about your legal rights or access to abortion, go to the Repro Legal Helpline or call 844-868-2812. If you are being criminalized for something that happened during a pregnancy, go to reprolegaldefensefund.org.
Rafa Kidvai: This is Nobody Criminalized how the state controls our bodies, families, and communities. I'm Rafa Kidvai, director of the Repro Legal Defense Fund at If/When/How. On our podcast we talk with experts, activists, and advocates whose daily work intersects with reproductive justice and the state's targeting of marginalized communities. Sister Song, a Reproductive Justice collective led by women of color defines reproductive justice as the human rights to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities. You will hear us restate the shared commitment throughout our interviews because regardless of the issues guests focus on, that is ultimately the world we all intend to create.
Our guest today is Dr. Ghazaleh Moayedi. Dr. Moayedi is a board certified OBGYN, educator, writer and community activist. She's the founder of Pegasus Health Justice Center, a community resource championing holistic wellness through justice driven, patient-focused healthcare and advocacy. Since she's based in Texas, Dr. Moayedi faced substantial challenges in delivering abortion care. Even before a Roe V. Wade was overturned. We discuss her experiences as an abortion provider and the crucial role she plays in creating a future with accessible and compassionate abortion care.
Hi, Dr. Moayedi. We are so thrilled to have you join us today.
Dr. Ghazaleh Moayedi: Hi, Rafa. Thank you for having me.
Kidvai: As a physician, you have a really unique perspective on reproductive justice and abortion care, and I guess in your experience, what are some of the biggest challenges facing your patients today?
Dr. Moayedi: Quite literally being situated right here in Dallas, the people that I take care of, the biggest challenge is just being able to access healthcare and that includes abortion care that thousands of Texans every single week are having to leave the state and go 1, 2, 3, 4, many states over just to access basic healthcare, but also that our state really suffers from access to all aspects of reproductive healthcare. People struggle to find quality prenatal care or culturally relevant prenatal care that many members of my community suffer from obstetric racism and the consequences of it that people are routinely denied the methods of birth control that they want because population control is paramount in the minds of many healthcare providers in my community. Rather than giving people the methods that are best for them and that they choose.
And even past that, I provide telemedicine menopause care for people all over the country, and what I see is that this doesn't end for us once we are past reproductive age. That women specifically all over the country struggle to get basic healthcare to treat menopausal symptoms and are routinely denied basic healthcare for evidence-based healthcare to treat menopausal symptoms. So this is a huge issue across the reproductive lifespan and I think really speaks to one of the foundational tenets of reproductive justice that we are more than reproducing bodies and we deserve healthcare past our ability to be able to reproduce.
Kidvai: Let's talk about the Supreme Court decision and the decision to overturn Roe. Like many other states, the decision in Dobbs triggered a law in Texas that creates harsh criminal penalties for providers and doctors for performing or aiding abortions at all stages of pregnancy effectively abandoning nearly all abortions in medical settings. Prior to the Dobbs decision, Texas passed a six week abortion ban, can you talk about the impact these laws have had on you and your patients?
Dr. Moayedi: I mean, immediately after SBA took effect, I transitioned my practice from providing abortion care in a very limited scope within Texas to traveling outside of Texas to take care of people that were having to travel as well. So I had been traveling to Oklahoma for about a year prior to that really as a direct result of clinics closing because of COVID. We have been dealing with this threat of the overthrow of Roe in Texas for quite a while. At the very beginning of COVID, the governor shut down abortion clinics saying they were non-essential healthcare. That's when I really started increasing the number of state licenses that I had and really thinking of how do I change how I provide care.
Kidvai: I was just wondering if you've seen a lot of confusion as the laws have changed about what care can be provided amongst both patients and providers?
Dr. Moayedi: Out-of-state perspective, the patients that we are contacting with are really the ones that are able to make it out, but from a patient perspective, what I have definitely noticed over the past two years is that, for example, in the clinics that I worked at here in Dallas, a week of providing abortion care, I would take care of people from all sorts of racial and ethnic backgrounds that multiple times a week I would need translation services for multiple different languages. But what I am noticing anecdotally is that not all of those people are able to make it out of state. So there's definitely a disparity in who is able to get out of state for care and who isn't.
What I am seeing from the provider side in Texas specifically is a lot of confusion among colleagues among the physicians and other healthcare providers about what they're allowed to do, what they're allowed to say, what information they can give to patients and what they can write in medical record. It's very confusing for folks. They want to do right by their community. They want to take care of their patients well. If I tell them where to go, am I going to get arrested? What does this mean? And we don't know what it means until either someone is arrested or unless people bring forth lawsuits for clarity.
Kidvai: Speaking of laws that we don't understand, one of the most controversial parts of the Texas law is this provision allowing private citizens to sue anyone who helps a person obtain an abortion after six weeks. What are your thoughts on abortion providers specifically being targeted and what is the impact of these laws on those that practice?
Dr. Moayedi: I think among the general healthcare community, there's clearly a lot of confusion about what it means and what the implications might be. It creates a very toxic medical environment because everyone now becomes worried that their colleague is someone that could sue them or turn them in. The other piece of it is that it's important to recognize that even though abortion care is banned for other reasons in Texas outside of this bounty hunter law, having a bounty hunter law sets a very dangerous precedent in our state, and this is already being replicated in other states like Oklahoma as a means of social control for the care of trans people. The reality is that a law like this is not legal in Texas and it has nothing to do with abortion. It has everything to do with all sorts of other reasons around the Texas constitution. So even if challenging this law doesn't get abortion care back, it is incredibly important that we continue to push back against laws like this in order to protect all the other people in our community that we serve because we can't allow bounty hunter systems to dictate medical care.
Kidvai: Absolutely. How does this law actually fit into a larger picture of state surveillance of reproductive healthcare?
Dr. Moayedi: Certainly that abortion is often one of the testing grounds of extreme policies, and then it is rolled out in all sorts of other ways. So it's not a surprise to me at all, although it is deeply painful that so many anti-trans bills have been introduced in that almost all of them are being modeled after abortion bills. White supremacist bills are also being introduced and talked about really in the same manner, and I think that that's an important connection to make because it was never about abortion only that the anti-abortion movement is deeply tied to and a part of the White supremacist movement in the United States, that they're not different people but very much part of the same organizations and movements. So it is not a surprise that they're using the same tactics to further marginalize and discriminate against trans people and to explicitly say that we don't care about Black people and we don't care about protecting them, and we don't even want you to receive education about Black history because it endangers White supremacist systems.
Kidvai: Absolutely. Thank you for really laying that out really clearly. For us all. One of the arguments that is often made in support of state surveillance of abortion care is that it's necessary to protect the health and safety of patients. As a healthcare provider, I'm wondering what harm does the surveillance actually do for patients?
Dr. Moayedi: I think it's important to recognize that there's certainly a difference between vital statistics data and state surveillance. There are many things that we keep vital statistics data on so that we can understand nationally public health trends, and we do that for maternal morbidity. We do that for birth rates and death rates and what those reasons are, but also that those things are not colorblind and they're not objective. They're based on forms that are created by people, which means they inherently have bias and they inherently are subjective. Even though we try and pretend like vital statistics is just numbers, we are starting to talk about it more, but tracking maternal deaths hasn't changed the fact that we have more and more people dying in birth every single year, and so that state surveillance has never improved outcomes. It just is a different avenue for us to understand what's happening.
The reality is the way that state surveillance is employed in abortion care has never been about safety. It's always the antithesis of safety that starts at the very beginning of understanding the safety of abortion in comparison to birth, in comparison to continuing a pregnancy, but also that so many abortion laws force us to not practice the best evidence-based care. They force us to not do what is most safe for the patient. I'll give an example. Prior to everything happening in Texas, one of the laws that we dealt with around medication abortion was that we could only dispense medication abortion per the FDA label. So that includes how many weeks we could give it to, it was to seven weeks until the label was changed to 10 weeks, but it also includes the route of administration for the misoprostol. So misoprostol is the second set of drugs used in the medication abortion regimen, and the label says that it is placed in between the cheek and the gums, but we know that that route can increase the amount of diarrhea that someone has.
So there are people that are eligible that have different gastrointestinal conditions like Crohn's disease, ulcerative colitis, where you might not want to take a medication orally that increases diarrhea. So the state law actually prevented me from being able to counsel someone to take that medication vaginally, even though that would be the best medical advice and compelled me to tell someone to take it in a route that would not be best medical advice for them. Obviously, that isn't going to dramatically change the safety of the medication, but just a really small example of how these laws telling a physician or a healthcare provider, they have to use the FDA label. Well, that's not about safety at all. It's just about restricting access to care.
Kidvai: Absolutely. And also straight up to tell your patients total lies about the medical implications of abortions being forced to do something that is not why you got into your practice in the first place. You didn't get here to make people feel scared and unsafe. You wanted to dispense the best medical advice.
Dr. Moayedi: Exactly. And very much using pseudoscience ideologies to legislate medical practice, which is incredibly disturbing. But I think that everything that we saw with COVID, I think for most abortion providers was like, "Well, yeah, we could have told y'all that that was going to happen." We knew what was going to happen with the backlash to COVID, with the backlash to the backlash to science and public health policy because that extremist ideology has been used and employed in abortion care for decades.
Kidvai: Another place that I think safety is implicated or is used in the medical setting is mandatory reporting and providers are often misunderstanding what the expectations are of them. And I'm wondering how mandatory reporting laws have been used to criminalize people or mislead providers, and why is it important to talk with providers about mandatory reporting laws?
Dr. Moayedi: Yeah. I think this is such an important issue now especially, but I think there are definitely a bucket of providers that turn patients into the police because of malicious intent, and I don't want to overlook that there are providers that take their own ideology and really intend to punish patients for their actions, and I see that not just in miscarriage outcomes or seeking self-managed abortion, but also in drug use in pregnancy and people who are struggling with substance use as well. But I think a lot of times overwhelmingly, at least from the physician side, we don't really learn the ins and outs of mandatory reporting. It is very confusing. I see pediatricians that really think it is a liability issue if they don't call child protective services.
And of course there are some states where that is a law around drug use in pregnancy, but people are just very confused and they're worried about liability. They're worried about what the implications could be if they don't, and they truly believe that they will be helping someone by engaging them in state surveillance from child protective services. And in a state like Texas, the reality is that our foster care system is criminally negligent for children right now that children are quite literally sex trafficked and abused in our foster care system. So what happens when we turn children over to state surveillance is actually we expose them to quite a great amount of harm. There isn't an easy way for physicians specifically to be able to connect what the consequences of reporting might be and what their legal requirements around reporting more.
Kidvai: I mean, we say this with self-managed abortions all the time, is that because there's stigma around self-managed abortions, people think it's wrong and therefore further criminalized or illegal to self-manage your abortion. And I don't just mean medical providers, I mean prosecutors and right attorneys who really don't understand the law or much like what you described in the medical setting. Some people use it to hurt people, which I think is also a truth. This podcast is called Nobody Criminalized, and I guess I just wanted to know what that phrase means to you.
Dr. Moayedi: For me, coming from an immigrant community and serving multiple immigrant communities, that is one of the first things that really comes to my mind is about how our very bodies as immigrants or children of immigrants continue to be criminalized simply for where we exist in the world. The past few years, really what comes to mind for me around this and what that makes me think about is all of the ways in which immediately when you become pregnant, you are at the scrutiny of so many people in the community around what happens to your pregnancy, what you do with your own body. I remember vividly when I was pregnant and a resident prior to that, I would bike to work every day, and I continued to bike to work every day when I lived close to the hospital, and once I became pregnant, a supervisor became very concerned that I was continuing to bike to work and really wanted to tell me about how I needed to stop biking to work because I was pregnant.
And it was really very upsetting for me that what I was doing with my own body, how I was traveling to work, was somehow such a big concern for them now that I was pregnant. And that also that I couldn't make a decision for myself as a pregnant person, what I thought was a safe way to get to work or the right way to get to work, that somehow now it becomes the opinion and under the jurisdiction of other people to decide what was safe and how I should be safe for myself. And I see this in birth care so often that everyone is so concerned about what this pregnant person is doing, and really none of us should be more concerned than them. It's their body.
Kidvai: Absolutely. That feeling of being under extreme scrutiny when you're pregnant and the amount of judgment that comes around your decisions, the paternalism that you're faced with, I feel like we have learned so many lessons in the Repro movement over the years about how to be creative in our resistance, and not that this isn't an abhorrent terrible moment, but I also imagine that there's lots of promising strategies and approaches being used by providers, and I'm wondering if there are any that are giving you particular hope right now.
Dr. Moayedi: Let's preface with, I guess everything is terrible. Not much is getting better, but also very laser focused on my OBGYN community specifically. The result of this fallout has been that the accrediting body for OBGYN or all residency programs has really made a statement affirming that they believe that abortion care is important and that even if you live in a state where abortion has been banned, that getting training in abortion care is necessary as part of OBGYN education, where before it was much easier to be like, well, it's hard to do. We can't do it. Because of all of this fallout there is more of a directive that this has to be done and people have to figure it out. That's one little sliver in just the OBGYN world, but I think a lesson that we can all really learn at this time is we have nothing left to lose.
There isn't a point in being meek. There isn't a point in being afraid. There isn't a point in hiding or putting our head downs like let's be as bold as we can be. The anti-abortion movement didn't start with small requests. They have really always taken a very extreme position, and I'm not saying let's become extremists, but let's be extreme in our love of our community. Let's be extreme in our boldness to support the health and wellness of our communities. Let's stop compromising for crumbs and let's really demand everything that we deserve, and let's start from that place.
Kidvai: Thank you so much for those words. They were so beautiful. It reminds me of the Assata Shakur chant. "It is our duty to fight, our duty to win. We must love each other and protect each other. We have nothing to lose but our chains," and that goal to see the bigger picture, realize that this is life or death. Our humanity at stake means that we can't be fighting for the little crumbs we need to be fighting for actual liberation. Being bold in our vision. Thank you so much. You are a gift.
Dr. Moayedi: Thank you so much for having me.
Kidvai: Dr. Moayedi's frontline experiences in Texas reveal the hurdles faced by providers and patients amid rapidly growing restrictions and bans on abortion care. We've explored how abortion bans not only harm people's health and wellbeing, but also disrupt provider patient relationships. We also discussed mandatory reporting and the important role providers play in protecting people from or beginning the domino effect of criminalization.
Dr. Ghazaleh Moayedi is a board certified OBGYN, educator, writer, and community activist. She's also the founder of Pegasus Health Justice Center. Follow her on Twitter at Dr_Moayedi. I'm Rafa Kidvai, the host of the podcast and director of the Repro Legal Defense Fund at If/When/How. The Repro Legal Defense Fund funds bail and strong defenses for anyone criminalized for something that happens during pregnancy. Learn more at reprolegaldefensefund.org. If you have questions about your legal rights, go to repro legal helpline.org or call (844) 868-2812.
Nobody Criminalized as produced by LWC Studios for the Repro Legal Defense Fund at If/When/How. Sage Carson and Jen Kurdish are the media and marketing If/When/How, Pamela Kirkland is the show's producer. Paulina Velasco is the managing producer at LWC Studios. Cogen Tahiro is lead producer and mixed this episode. And remember, keep your community safe and don't talk to cops.
CITATION:
Kidvai, Rafa, host. “Abortion Providers Adapt to Post-Roe Realities.” No Body Criminalized, Repro Legal Defense Fund at If/When/How. May 8, 2023. Reprolegaldefensefund.org.