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On this episode of Mic Dispatch, correspondent Kendall Ciesemier follows Dr. Colleen McNicholas, an abortion provider who travels over 400 miles nearly every week to work at four clinics in three states — Missouri, Kansas and Oklahoma, where access to care is limited.

Patient No. 1: I still respect life, but, like, now I’m gonna have an abortion. Like, that’s… What does that even mean for me? You know, like, who am I?

Patient No. 1 (pauses, crying): I’m sorry.

Kendall Ciesemier, correspondent: Oh, no. It’s OK.

Dr. Colleen McNicholas, associate professor, OB-GYN, Washington University of St. Louis: Hi, [I’m] Dr. McNicholas.

McNicholas (voiceover): Once you come to this clinic and you walk in these doors, those women are just like all the other women in the clinic and to them, it’s not an issue of what political party I am. To them, that doesn’t matter. Right? It’s just the reproductive health care that they need today.

Ciesemier (voiceover): In the U.S., nearly 1 in 4 women will have an abortion by the age of 45. But abortion is becoming harder to access in states in the Midwest and the South, where conservatives have put in place new anti-abortion laws. It’s often difficult and unsafe for abortion providers to operate in these states, requiring out-of-state doctors to fly in to provide care. And many worry it could soon get even harder to access an abortion.

Clip from EWTN: Democrats worry Roe v. Wade hangs in the balance with the nomination of Judge Brett Kavanaugh to the Supreme Court.

Clip from EWTN: State lawmakers are looking for ways to either gut or enshrine abortion into state law, and some Democrats on Capitol Hill say Brett Kavanaugh poses a big threat.

McNicholas (to Ciesemier): Exactly. Exactly.

Ciesemier: Where are we headed?

McNicholas: We’re headed for Oklahoma City, where the clinic is.

Ciesemier: So, why do you have to travel to provide care?

McNicholas: There are many places in the country, particularly conservative states, where providing abortion care can be really challenging because abortion has become so politicized and hostile in many places, there’s some concerns that people who provide abortion care have around safety for themselves or for their children.

Ciesemier (voiceover): Dr. Colleen McNicholas is an abortion provider who travels over 400 miles almost every week to provide care. She works at four different clinics in three different states: Missouri, Kansas and Oklahoma.

Ciesemier: Do you get tired of all the travel?

McNicholas: Sometimes physically tired, not tired of the mission of what I’m doing.

Ciesemier: Well, and you have a family.

McNicholas: And I have a family, right, that has jobs and school and baseball. Any, any slight fluctuation in the travel plan can certainly throw off an entire — an entire family.

McNicholas: All right, are you going honey? Yes.

McNicholas: So right now we’re headed to the airport. Sounds like we have a very busy day. There’s almost 60 patients on the schedule for Friday, so we’ll start early and probably work late. But you know, that’s true of abortion care, right? When there’s really limited access to abortion and it requires that people fly in from other places, it can make for a busy couple of days because there just isn’t providers on other days.

Ciesemier: People are just waiting for you?

McNicholas: It’s not always me, but yes, they are always waiting for somebody to fly in to be able to provide that care. So in the Columbia and Kansas City affiliate, I am the only provider at those. And look at the bumper sticker right here in front of us. It says “choose life” right there.

Ciesemier (voiceover): There are virtually no abortion providers living in these areas, so in order for the clinics to remain open, McNicholas has to fly in to fill the gap. The clinics can go weeks without a provider and remain closed until a doctor is back in town. Anti-abortion groups camp outside the clinics where Dr. McNicholas works, even when the clinic is closed. Some extreme activists have even turned to violence, including a bombing in 1986 and the assassination of one clinic doctor, George Tiller, in 2009.

CBS News: One of only a handful of doctors in the country performing late-term abortions.

ABC News: Dr. George Tiller was shot and killed in church yesterday. For years, Tiller was a lightning rod for abortion rights opponents, and his murder is sparking new fears for the safety of other abortion providers.

Julie Burkhart, founder and CEO, Trust Women: There was an assassin who came in and shot him point blank in his head, so, you know, and said that he had to assassinate Dr. Tiller because babies were in imminent danger.

Ciesemier: Do you personally worry about security for yourself?

Burkhart: I have. I’ve had death threats. I think doctors are afraid of being assassinated.

Ciesemier: Do you think that’s a real fear?

Burkhart: Oh, yes, yes. It took me two years to find one provider.

McNicholas: Dr. Tiller is the most recent example we have of the consequences of really extreme anti-abortion rhetoric and behavior. But for the same reason, it was maybe even more compelling for that to be a clinic that I go to. The fact that Julie has been able to reopen that clinic in this space that Dr. Tiller worked is really sort of a testament to our movement, saying, “We won’t be bullied by you.”

Burkhart: I have witnessed that the anti-choice folks since Trump was elected, it seems like they’re just more emboldened.

Ciesemier: Are you on higher alert?

Burkhart: Yes, I would say.

Ciesemier: OK.

Burkhart: Yeah, they regularly take down license plates, license plate numbers, and we’ve also had altercations between patients, their partners and the protesters.

Tarek Turkey, Mic camera operator: How you doing?

Lora Goetz, anti-abortion rights protester: Oh, I’m fine. I’m...

Ciesemier: Would you mind talking with us?

Goetz: I don’t mind a bit.

Ciesemier: OK, I’m Kendall. How often are you out here?

Goetz: I come every week as scheduled, but then if they need fill-ins, I do that sometimes, too.

Ciesemier: When patients come up here, what do you say?

Goetz: I just try to offer them information. I just say, “Here. What could it hurt to read this pamphlet?”

Ciesemier: Do you get people taking your information?

Goetz: Not a lot, once in a while, not a lot. And if we save one life every month or year, that’s worth it. That one person is still a beautiful creature of God that God wanted to be born.

Ciesemier: What do you think about the violence, though, that has been committed by anti-choice or pro-life people at this clinic?

Goetz: I think there’s...

Ciesemier: The doctor, Dr. Tiller who worked here, he was assassinated.

Goetz: He was later assassinated. Yeah, he was. And you know, I — that to me — no, but he was doing late-term abortions like crazy and he, you know, people coming from different states to have him do the late-term abortions, and I can see how somebody could just really feel like they were doing God’s will.

Ciesemier: By killing him.

Goetz: Right. I wouldn’t do it, no. And I don’t condone it.

Ciesemier: Yeah. OK.

Goetz: But you know, but I’m saying we do so little. That was one life compared to millions.

Ciesemier (voiceover): Not all people who are anti-abortion are picketing outside of clinics. Polls show that the country is split on the issue of abortion, with a majority of conservatives saying abortion should be illegal in all or most cases.

Clip of Paul Ryan from the New York Times: Now I believe that life begins at conception. That’s why — those are the reasons why I’m pro-life.

McNicholas: Good morning. Good morning! Oh, sorry.

McNicholas: There’s no clinic closing time. The clinic closes when all the patients have been seen. So depending how the day is going, that might be 8 o’clock, that might be 11 o’clock. It just sort of depends on what the day brings. But we don’t ever leave until everybody’s been seen.

McNicholas (to Patient No. 1): Do you want to see the ultrasound?

Patient No. 1: Yes.

McNicholas: OK. I’m going to do the measurements and then I’ll flip it around.

Ciesemier: So, how did you come to your decision?

Patient No. 1: I have kids already. I work a lot and I am the sole earner in my household and pregnancy is miserable for me. I mean, I’ve been sick this whole time and working 12-hour shifts and triple-digit heat, like, that’s not been easy and it’s not going to get any easier and I can’t afford to take time off work.

Ciesemier: Yeah.

Patient: And it’s just not — nothing about the situation fits.

Ciesemier: Right.

Patient No. 1: So it’s the best thing to do. If I lived in a country where this was not available, I don’t know what I would do at all.

Ciesemier: Yeah.

Patient No. 1: I would be in despair.

Ciesemier: Were you at all nervous coming here?

Patient No. 1: Oh yeah, yeah. Terrifying. I still respect life, but, like, now I’m gonna have an abortion. Like, that’s… What does that even mean for me? You know, like, who am I?

Patient No. 1 (pauses, crying): I’m sorry.

Ciesemier: Oh no, it’s OK.

Patient No. 1: When you do something difficult, it’s always scary, and I don’t make decisions based on fear ever. So these ladies just help me feel like a person. So...

Ciesemier: You are a person.

Patient No. 1: I am a person, I am a person deciding not to let another person live. And that’s hard to face.

Ciesemier: How many weeks did you have to wait to see the doctor when you were scheduling the appointment?

Patient No. 1: Because I had to reschedule, a month went by. I had to reschedule my appointment twice trying to get it together to afford it. This is the last day that I can do the medical. So if I would’ve waited, like, two more days, I would have had to have a surgical.

Ciesemier (voiceover): When a patient calls to make an appointment here, they have to wait until the traveling provider is in town. Sometimes patients wait up to a month for care. This impacts both the type of abortion a woman can have and how much it will cost.

McNicholas: All right. Let’s get you your medication.

Ciesemier (voiceover): A medical abortion, or the abortion pill, can be administered 10 weeks into the pregnancy. Beyond 10 weeks, a patient must have a surgical abortion, which is more invasive and potentially more costly.

McNicholas: OK. Your goody bag and your papers to check out. OK. So out the door, to the right and check out at the front window and we’ll see you at follow-up. OK?

Patient No. 1: Thank you so much.

McNicholas: Alright, have a good day.

Ciesemier: And no insurance?

Christy Krog, clinic director, Trust Women Oklahoma City: No, it’s not allowed.

Ciesemier: In the state of Oklahoma.

Krog: In the state of Oklahoma.

Ciesemier: So these patients are paying out of pocket?

Krog: Correct. If they don’t have insurance, it’s hard to get birth control. Birth control is not the easiest thing to get around here.

Ciesemier: Really? Why not?

Krog: Doctors just — I don’t —

Raven Funez, charge nurse, Trust Women Oklahoma City: If you don’t have any insurance, you’re kind of just out of luck when it comes to —

Krog: Yeah, you’re kind of stuck with something like a pill or something versus something that’s three or five years.

Ciesemier: Right.

Funez: Yeah, and all of it out of pocket is $1,000 at least for any kind of IUD or implant.

Krog: Uh-huh.

Ciesemier: Really?

Krog: Nexplanon…

Funez: And the pills, depending on what kind you get, they can even be costly.

Krog: Exactly.

Ciesemier: So it actually could be more than an abortion?

Krog: Yeah. Yeah, absolutely.

McNicholas: One of the most amazing things about interacting with patients is how little they actually know about the politics of abortion. But it’s not really until they’re here having an abortion that they even engage in the issue. Because most people aren’t living in those extremes.

Patient: Sounds good.

McNicholas: Alright.

Patient: Thank you.

McNicholas: They access the care when they need the care, and that’s when they think about the care. Globally speaking, the hardest aspect of my job is having to see patient after patient, navigating tremendous hurdles and shame and guilt in this sort of quest for normal reproductive health care.

McNicholas: So, the patient is 18 weeks. So we’re going to do a D&E.

Patient No. 2: I was going to ask, though. Can you just tell me if it’s a boy or a girl?

McNicholas: I can look. Sometimes I can tell and sometimes I can’t, but if I can, I’m happy to tell you. OK.

Ciesemier: How did you come to make your decision?

Patient No. 2: It’s just, like, the situation I’m in. I’m not financially ready for another child. Because I really at first didn’t believe in abortions, but everybody has their certain situations, and it’s just, you don’t know what someone is going through.

McNicholas: Alright, couple of cramps here. You’re doing awesome.

McNicholas: Our existence as a species really relies on women’s ability to be able to control their fertility. If women can’t control if, when, how many times to be pregnant, then they can’t control their education destiny and they can’t control their economic destiny and they can’t control their ability to really reach their full potential in society. And so, because of all of those things, I think abortion care is justice care.

McNicholas: Blow, blow, blow, blow, blow. Good job. Good job. You’re always stronger than you think you are.

Ciesemier: And what are you missing these past few days not being at home?

McNicholas: Well, there’s a baseball game about to start here in an hour that I won’t be at. But just sort of everyday life things, you know — homework and baseball and dinner at the table together. Certainly there are times when my family probably feels it more than I do, but I think we feel like it’s sort of an important part of the life that we live.

McNicholas: I’m going to give that to you. Thank you.

McNicholas: I think what’s missing is that reality of abortion. The prevalence of abortion. The fact that women of all types have abortions. Christian women and Catholic women and Muslim women and Jewish women, all these women, old women, young women, white women, black women, brown women, everybody accesses or at some point has some interaction with abortion. Once you come to this clinic and you walk in these doors, those women are just like all the other women in the clinic and to them, it’s not an issue of what political party I am. To them, that doesn’t matter. Right? It’s just the reproductive health care that they need today.

Natasha Del Toro, anchor, Mic Dispatch: Dr. McNicholas works in states that have been pushing for anti-abortion legislation. Currently, there are a number of state-level cases that would place even more restrictions on abortion care.

Take Oklahoma, where anti-abortion activists tried to get a law passed that would require a doctor with admitting privileges at a hospital within 30 miles be present for any abortion. The law would’ve ruled out Dr. McNicholas’ ability to provide care to the women we just saw. But the court found that the law violates both the U.S. and Oklahoma constitutions. Anti-abortion groups will continue elevating these cases to the Supreme Court in the hopes that these state-level laws will soon be deemed constitutional.

More than 40 years after Roe v. Wade, the landmark decision from 1973 that provided women the constitutional right to safe and legal abortion, a woman’s right to choose is still in jeopardy. Is this troubling to you?

Let us know what you think about the future of abortion access.

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