A Midwife’s Reaction to Buffer Zones, Hobby Lobby, and How We Can Fight Back

This past week has been a tough one for advocates of reproductive justice. We saw the Supreme Court strike down a buffer zone law in Massachusetts as well as determine that Hobby Lobby and other private employers can refuse to cover birth control in their employee health plans

As a health care provider that not only has to deal with protesters on the regular, as well as constantly battle with health insurance companies to cover birth control that they are supposed to be covering anyway, I can’t help but feeling frustrated and demoralized. 

I wrote a piece for Socialist Worker almost two months ago, leading up to the buffer zone law, and I don’t think I can summarize the way the protesters make me feel, or make my patients feel any better than I did then:

I STARTED my first job as a midwife a few months before 40 Days for Life began. But that didn’t mean that my clinic didn’t encounter protesters. Somehow, the anti-choicers know which days are in-clinic abortion days, and I was still in my training period when I encountered them for the first time. I had arrived at the clinic before they got there, but I didn’t need to look outside to know that they had arrived.

On in-clinic abortion days, my job is twofold, one medical and one emotional. My first task is generally straightforward: I see women to give them necessary medications before their procedure, talk to them about what to expect, and get them settled with a birth control method for afterward.

My second task, helping a woman through her emotions about the day, is anything but straightforward. The wide range of emotions I see is astounding, and I feel grateful for each woman who shares her story with me. We tell all women that any number of emotions, from sadness to relief, from grief to empowerment, are all normal and expected.

But there is one emotion that creeps into my exam room, which I know would not be there if the anti-choicers were not there.

“I’m scared,” a tearful young woman confides in me.

“Tell me more about what you’re scared of. Is it the procedure, or something else?” I try to coax out the crux of this woman’s feelings.

“I’m scared I’ll hate myself.”

I hear this often.

“What if those people out there are right?”

“Do you think I’m going to hell for this?”

“They said this will hurt for the baby, is that true? Will the baby feel pain?”

I spend the precious few moments I have to try and undo the damage–the self-doubt, self-loathing and slut-shaming that the anti-choicers have rolled into a science.

That first day was emotionally draining, and while I have gotten better at comforting women through these difficult emotions, I have not gotten used to it.

As I left the staff entrance that day, I had completely forgotten that the protesters might still be there. I looked up and saw their giant crosses and posters of “aborted” fetuses and an unexpected shock of fear and intimidation shot through my core.

I stopped dead in my tracks as I locked eyes with an old man who was praying and singing. He watched me walk to my car. I watched him take a photograph of my license plate. I immediately wished I had removed my nametag before exiting the clinic.

I seethed in rage as I drove home. In all my days as a clinic defender, I held a healthy anger in my heart that pushed me and my comrades to stand up to this type of harassment. But that day I felt different. This was personal.

This man, and all those like him were the reason many of my patients sat in puddles of tears in the chair next to mine throughout the day. He was protesting the individual choices of the women that I cared for that day. He was protesting my very existence as an abortion provider. He and those like him were not only there to harass and intimidate the patients and staff–one of his aims, I quickly realized, was to scare me.

After that day, I had a long talk with my partner about driving to the clinic in my easily recognizable car versus biking. My mother, to this day, tells me to leave the clinic with the rest of the staff.

 

While I, and many other radicals, have complicated feelings about the buffer zones, as proven time and time again, the police are not on our side.  If police were called out to a buffer zone, laws like these often are used against those advocating progressive politics. But I worry about how far right this argument has gone, and how the conversation about buffer zones can turn to one of free speech instead of focusing on the very real harassment and intimidation that anti-choice demonstrators engage in. 

I am scared that the next time I have protesters at work, or am on a clinic defense line, the anti-choicers, not just outside my clinic, or in my state, will feel so emboldened by this ruling that they escalate their harassment, tactics, and intimidation. 

A clinic escort in New Jersey shared her experience with the protesters, one that anyone who has worked in an abortion clinic or who has defended one knows all too well:

I have seen countless women reduced to tears and shaking, just for trying to access the health care to which they are constitutionally entitled. Prior to the implementation of our buffer zone, there would be two men positioned on either side of the door, filming the faces of every single patient and companion who walked inside. I’ve had patients ask me, with terror in their eyes, “Why are they doing this to me?” I have witnessed a man whose wife was terminating a wanted pregnancy due to a fetal anomaly be lectured by an anti-choice “sidewalk counselor” on why God has a plan for that “baby” and he should “be a man, Dad.” I have watched as patients and companions cover their face to avoid being filmed by the anti-choice protesters who put their images online. I have watched one of my fellow clinic escorts be violently shoved by an anti-choice protester. I have personally been sexually harassed by an anti-choice protester.

 

As if we all thought the news couldn’t get any worse, we all woke up Monday morning with the news that Hobby Lobby has won it’s suit and does not have to comply with ACA regulations that require insurance companies to cover birth control as preventative health care. 

I wish I could say I was surprised. I wish I could say I was shocked and not expecting the court to rule this way. But as this excellent Jacobin magazine piece explains, the Supreme Court as an entity was designed to undermine democracy, progressive politics, and uphold the status quo. 

I want to add a voice from the inside of what it looks like to provide birth control coverage in the so-called “era of free birth control,” and how this ruling will have an unbelievably harmful effect on women, families, and damn near everybody. 

I can speak to my experience of attempting to provide birth control, and the roadblocks that insurance companies still have, and the effect that it has on women. 

As far as birth control pills go, each insurance company has their own special “formulary” of pills that they will and will not cover. Are these formularies published anywhere for providers to find, so that we know the pill we are prescribing will be covered under that patient’s health plan? Excellent question, dear Watson. They answer is no. And even if they were published, none of us have time to go to each insurance company’s website, hunt around for their specific formulary, and determine which pill is the closest to the one we want to prescribe. What ends up happening is that I will call in a script, and then it will get bounced back for pre-authorization, or the insurance company will insist you change it to their preferred brand. 

All of this takes time and resources that we don’t have, and causes significant delays in many women being able to pick up their birth control pills. Furthermore, many insurance companies are still only allowing patients to pick up one pack of birth control at a time, meaning women have to take a monthly trip to the pharmacy, exactly on time, every single month, which decreases women’s ability to keep taking pills on time, thus increasing the rate of pill failure (read: insurance company policies are a significant factor in women facing hardship in continuing a birth control method.)

Now, let’s talk about the long-term methods like IUDs and the implants that we know work oh-so-well and are now being recommended as first line birth control methods for young women. Insurance companies, even though they are supposed to be paying in full for these devices are still trying to weasel out of it. Most private plans still require pre-authorization, which can take a few days up to a few weeks. 

In that time, a woman has to take time off work, come see us, her health care providers for a consultation visit, then must wait until her insurance authorizes the insertion, and then must schedule another appointment, take off more work, then, hopefully, come in for the device. 

I can’t tell you how many women I have seen who are using condoms, the pull out method, or have partners who refuse to wear condoms consistently get pregnant in that waiting period. It is heart breaking to have to turn away a woman who has already been told she has to wait, then has unprotected sex, or conceives in the waiting period that the pre-authorization period enforces. 

These hurdles are already in place for women WITH HEALTH INSURANCE that hypothetically covers their contraceptives. The hoops that women who work for any of the (at least) 19 other companies that have filed similar suits will have to jump through to get much needed health care is a devastating thought. 

This entire ruling sends a very clear message, one that shows just how far right we have come, and just how much work we have to do to turn the conversation around: That reproductive health care is not health care. That birth control is not health care. That abortion is not health care. 

We need to write, to read, to organize a fighting movement to push this conversation back to where it belongs. No, Cecile Richards, we do not just need to pay attention to who is running in November. Allowing the Democrats to handle this situation has helped us get into the mess we are in today. 

We need to picket the shit out of Hobby Lobby. We need to build connections with other groups that are fighting for justice. We need to get out into the streets, we need to declare from every city in this country that we will fight this until there is justice and health care for everyone. 

So go forth, get angry, speak up, speak out and organize. Join a clinic defense. Start a clinic defense. Fight for single payer health care,  fight for trans* civil liberties and justice, birthing rights and autonomy, and full reproductive justice for everyone, because we have a whole lot to win, and we won’t go back. 

 

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