The Fight for Abortion Training full transcript

LINDSAY: I'll remember it for the rest of my life. It was like the six of us sitting together, so excited for the future. 

ALLISON BEHRINGER: It's a Friday in June of 2022 and it's Lindsay’s first day of her residency, which means she is officially a doctor – but has four more years of specialty training. 

Orientation is underway, in a big conference room filled with hundreds of other first year residents. She’s one of six who are doing their speciality in obstetrics and gynecology, or ob-gyn.

LINDSAY: We kind of all got the notifications on our phone at once and we looked at each other and we were like, “Is this real? Like, are you guys seeing this?” And there were tears and, and we were so panicked about what this meant.

ALLISON: The United States Supreme Court has just issued its decision on the case of Dobbs v Jackson Women's Health Organization, which concluded that there is no constitutional right to abortion. The Dobbs decision overturns Roe v. Wade, leaving the power to regulate abortion rights up to individual states. 

Lindsay’s residency program is in a conservative state in the south.

LINDSAY: It's just this fear of realizing people who can get pregnant have just lost their choices. And I was just like I'm gonna fail my patients. I'm gonna have to turn people away. 

ALLISON: Across the country thousands of ob-gyn residents are having the same realization. Effective immediately, abortion is banned in 12 states. 

Fast forward to today, almost exactly a year later, and nearly 60% of all US women live in a state that bans or severely restricts abortion. And about half of the country’s ob-gyn residents, like Lindsay, have lost the opportunity to learn how to perform one. 

There’s been so much important reporting and storytelling over the last year about how these bans are impacting patients in all kinds of ways. 

Today on the show, we want to focus on a different aspect of the story: The impact that abortion bans are having on the education and skills of healthcare providers. And the devastating ripple effect on current and future generations of patients – those seeking abortions, and those in need of other reproductive care like miscarriage management and life saving procedures. Plus, we uncover the centuries-long fight over who gets access to abortion training in the first place.

From KCRW, you’re listening to Bodies. I’m Allison Behringer.

ALLISON: Ask anyone who’s been through residency and they’ll likely describe some of the most grueling and challenging years of their life. You have very little control of your schedule and you consistently work 80 hours a week on a small salary. And every couple weeks, you’re on a different rotation, focusing on a new area of your specialty. 

And you’re simultaneously playing these two roles: both as a doctor treating patients at a hospital and as a trainee, learning new skills under the supervision of the attending physicians.

Lindsay’s first two rotations were on labor and delivery. Her next rotation was family planning, which includes abortion training. 

But right before that rotation, Lindsay’s state started to enforce a law that bans abortion at any stage of pregnancy, with just a few medical emergency exemptions. The abortion clinics closed the very day that she was supposed to start training.

LINDSAY: My entire goal in being an ob-gyn was to provide this full spectrum of care to people in these huge life events. And I feel like part of it just got closed off the minute I became a physician. If I can't do abortion, I'm not gonna have the skill set that I think is really important to being good at my job. 

ALLISON: The new law in Lindsay’s state also made it a criminal offense for a doctor to provide abortion, and by extension to train someone how to provide one. Lindsay isn’t her real name, by the way. Over the course of reporting, I’ve spoken to over a dozen residents in restricted states, very few of whom felt comfortable being recorded. For this reason, we're not using their real names, nor their states or institutions.

Throughout the fall of 2022, Lindsay dealt with the consequences of the ban nearly every day. Like, any time a person came in with an ectopic pregnancy, which is a potentially fatal condition in which the fertilized egg implants in the fallopian tubes, and has zero chance of viability, Lindsay was taught that she still needed to inform the patient about the option of adoption. 

LINDSAY: We train in medical school and residency to follow the evidence and do what the science shows to protect our patients and their health. And so it just goes against everything that we learn as physicians.

I think a common scenario is this concept of p-prom or preterm rupture of membranes. So people whose water is breaking well before they're due to deliver, and well before their fetus has developed what it needs to to survive. And it poses great risk to the pregnant person because once the water has broken, the chances of infection, and other complication goes up significantly. We find ourselves unable to act until things escalate to a point of risk that in the past we probably never would have seen.

Under her state’s law, if there is cardiac activity in the fetus, even if the fetus will not survive, Lindsay cannot provide the option of an abortion.

LINDSAY: I have seen several cases of people whose water broke well before their fetus was viable, and they were forced to wait until they became infected or acutely ill to receive care, or they had the choice to get in their car and drive to another state.

Residency is a bit like an apprenticeship. At first, you’re doing a lot of observing – then you begin assisting with hands-on guidance from your attending physician…and then, as you build confidence, you progress to treating patients yourself, under supervision. 

But Lindsay is learning with her hands tied. She says that instead of things getting easier and easier, in some ways, they’re getting harder. 

LINDSAY: There's this trauma that I think my co-residents and I carry with us. And it just feels like the antithesis of what residency is supposed to be. We're coming into these next cases and meeting these next patients with anxiety and with uncertainty and with fear for what's gonna happen to them.

I chose ob-gyn because I wanted to be able to take care of people from start to finish through incredibly difficult situations. And I wish I could stand by patients, but instead I'm forced to prolong their suffering or turn them away and ask them to go elsewhere. And it's just not the physician I ever wanted to be.

ALLISON: There are two main categories of abortions: medication and procedural. Medication abortion is the most common way that people end a pregnancy and it’s used in the first trimester.  Providers of medication abortions need to learn how to counsel patients and prescribe the medication. Pretty straightforward. 

As for Procedural abortion, there are a couple different options. Some are more complex for more advanced or complicated pregnancies, but the most common is the MVA (manual vacuum aspiration).

LINDSAY: That's using basically a small manual vacuum or aspirator,  to gently suction the pregnancy from the uterus. 

ALLISON: Then there is what’s called a D&C.

LINDSAY: It's a dilation and curettage where we use a small instrument to kind of scrape the insides of the uterus to make sure there's nothing retained. 

ALLISON: Both of these methods are also relatively straightforward to learn. They are extremely safe for patients. (Safer than a colonoscopy, actually!) And there are very few complications. 

And it’s not as if it takes 100s of procedures to get the hang of the skill. But the thing is, trainees learn how to handle complications by witnessing complications and so trainees need a SUPER high volume of cases to increase their chances of dealing with the complications.

And here’s a really important thing to note: providing an abortion to someone is the same exact procedure as providing miscarriage management or providing the care that could save the pregnant person’s life in an emergency situation. It’s the same skill. Just different context.

And this is why abortion is such a foundational skill for any ob-gyn or reproductive healthcare provider. For example, the residency director at University of Wisconsin told me that since the state banned abortion in 2022 she’s noticed that her first year residents who haven’t gotten any practice with abortion have lower competency in basic skills like miscarriage management than compared previous classes. And a research paper out of Penn State that surveyed 4th year residents found that those with the most abortion training felt the most prepared to handle early pregnancy loss.

After medical school, residency is where you decide on your speciality – like if you want to be a family medicine doctor, or an ob-gyn. And where you end up for your residency almost wholly determines the kind of training that you’ll get and your opportunities down the line. And so residency-hopefuls spend a lot of time making their ranked list of favorite programs -- hoping they’ll be selected in turn by a program that offers the best training for their desired specialty.

Lindsay grew up in the north, but after doing medical school in the south she felt drawn to a southern residency that she knew offered abortion training.

LINDSAY: I felt like a lot of my friends back home and my family back home, we had these progressive ideals, but no one was even in a place to practice those ideals and kind of be walking the walk on a day-to-day basis.

And I felt like my time in the South, I fell in love with grassroots organizations and how change happened and watching political change happen. And I feel like progressive people in the south are fighting a way harder battle

But when Lindsay ranked her residency program, she didn’t realize that battle was going to include fighting for the right to abortion training. 

LINDSAY: I think it's important to note that many of us in these training programs never thought we'd be in a place where abortion's illegal. 

ALLISON: Instead of training with patients, her program had to adapt: Lindsay and her fellow residents trained on plastic models of reproductive organs and on papayas – it turns out that the fruit is a pretty good replica of the uterus!

And the thing is Even before Dobbs, not all residencies provided the same level of abortion training. In fact, a 2018 study out of UC San Francisco found that only about two-thirds of ob-gyn residency programs routinely trained their residents in abortion care. 

So, the Accreditation Council of Graduate Medical  Education, or ACGME is the body that sets training standards for all branches of medicine. And After Roe v WAde granted the right to abortion in 1973, the ACGME was supposed to develop training standards for abortion.

But, it didn’t. 

By the early 1990s, only 12% of ob-gyn programs offered training in abortion care. In response, a group called Medical Students for Choice started advocating for this training. And in 1995 – nearly 20 years after the passage of Roe – the ACGME finally set standards for abortion training

But then, politicians got involved:

CAROLE JOFFE: What happened is Congress immediately passed a law, basically saying: you, residency programs, you don't have to conform with this.We will still send you money even if you don't live up to this standard

ALLISON: This is Carole Joffe, a sociologist who’s been studying abortion provisions for over 40 years. Her most recent work is about the gaps in abortion training post-Dobbs.

CAROLE JOFFE: That is just a very direct example of the incredible stigma of facing abortion or what I like to refer to as quote abortion exceptionalism, the idea that abortion is treated differently than any — really than any other branch of medicine.

A lot of my scholarship has been about this very point. What didn't happen after Rowe and why? And, here's my answer: Within medicine itself, there was a lot of discomfort and ambivalence around abortion.

ALLISON: See, before abortion was legalized, there were doctors who took the risk to provide abortions. There were also non-medical, everyday people providing abortions.

CAROLE JOFFE: So many women were coming into emergency rooms bleeding. Either they had tried to do their own abortions or they had gone to a so-called butcher.

ALLISON: And it was these so-called “butchers” who captured the popular imagination of the public and of the medical community. 

CAROLE JOFFE: Mainstream medicine, even though they wanted abortion to be legal, they didn't feel good about the abortion provider. They thought all of them were butchers, which was not true, but that's what they thought. So they didn't set up training, they didn't set up clinics in their hospitals. 

ALLISON: And as abortion became more and more politicized, the government passed an amendment that barred federal public funding for abortion. At the same time, some state legislatures in conservative states refused to give money to public hospitals and universities if they offered abortion training. 

So the training had to be moved to independent freestanding clinics, like Planned Parenthood.

To help connect residents with actual solid abortion training, various abortion rights organizations took it upon themselves to work with some residency programs to navigate all these barriers and actually meet the official standards. 

And that’s how the country’s abortion training became a mish mash of standards and availability. 

CAROLE JOFFE: These politicians don't — some of them do not give a damn whether women live or die.

ALLISON: There is a huge shortage of ob-gyns in the United States. The American College of Obstetricians and Gynecologists recently predicted that by 2050, there’d be a shortage of 22,000 of these doctors.

This shortage is especially felt in rural communities and has created so-called ob-gyn deserts.

NATALIE: In the rural communities, the majority of the obstetrical care is being provided by family medicine physicians.

ALLISON: This is Natalie. She’s in her third and final year of residency for the family medicine speciality. Again, we aren’t using her real name or any specifics about her location.

Natalie got inspired to become a rural family medicine doctor when she was working in public health, making sure that rural hospitals were meeting the needs of the patients.

NATALIE: In working with these communities and working with the physicians there who were almost exclusively family medicine physicians, something kind of clicked and I just kind of felt like I'd found my people.

And certainly as a BIPOC person, I feel very strongly how important it is to have a physician who looks like you. Data show that people get better care from people who look like them too. And so I feel really passionate about that piece of it.

ALLISON: Natalie also knew she wanted to incorporate abortion training into her practice: she’d witnessed the lack of access to abortion and reproductive healthcare in rural areas.

The thing is, getting abortion training is even harder for family medicine doctors than it is for ob-gyns. Roughly only 5% of family medicine residencies offer abortion training.

So when Natalie was coming up for her rank list for family medicine, ranking one of those few programs was a big priority.

She matched at her first choice, at a hospital in a small city that serves the surrounding rural population.

NATALIE: It felt like a world of possibilities were open to me as a first year resident. There's no other field that lets you deliver a baby and talk to a nice 80-year-old lady about her urinary symptoms and switch and talk to a kid about their asthma. I loved being able to take care of the entire family. There's just something really special about that.

ALLISON: During her first two years, Natalie learned how to provide medication and procedural abortion at the local Planned Parenthood. The method of doing a first trimester procedural abortion is relatively uniform, but every provider has their own unique style. Like Natalie…she is short and has small hands, so she learned a lot by observing providers with a similar stature, how they gripped the instruments and how they positioned their bodies.

Going into her third and final year, she was on the brink of competency. But after Roe fell, and the legislators in her state voted to ban abortion, the opportunity to further hone her skills vanished. 

NATALIE: I have worked really hard to make sure I am a safe and responsible provider. And to be told by someone with no medical background whatsoever of what I can and cannot do is hard to take.

ALLISON: For the first time, she found herself living with the fear that if she tried to help someone with their miscarriage, she could get…maybe get sued? Put in jail? The laws were confusing and unclear.  She also started having to turn away patients who wanted to end their pregnancies. 

NATALIE: There are so many emotions. And just feeling that sense of powerlessness and that sense of inadequacy of: this person is trusting me with her care and I can't provide what I should be able to. And it just makes me really sad for our patients.

ALLISON: Natalie has also seen first hand how severe the consequences of the lack of abortion training can be.There was one patient who lived hours away from Natalie’s hospital in a rural community. She had just given birth, but she had a complication and started to hemorrhage. She had to be life-flighted to Natalie’s hospital.

NATALIE: And she, she died because she essentially bled out in the plane. And that's a delay. Right. That was a delay in care. They couldn't stabilize her in her home, in her community and so she, she died. 

I don't think there were any ob-gyns in that community and so I don't think there were any providers who could do the surgery that she would've needed. 

And I think it only highlights the damage that these restrictive laws have, especially on specific populations, like our rural patients, our poor patients, and then our patients of color. 

ALLISON: The thing about these abortion laws is that states that are the MOST restrictive with abortion already and historically have had some of the worst reproductive health outcomes. Louisiana, for example, has the worst maternal mortality rate in the country. It also has some of the most restrictive abortion laws. In fact, 9 of the 10 worst states for maternal mortality are in abortion restricted states. 

And according to a report by the Gender Equality Policy Institute, published in January of this year, women living in a state that banned abortion after Dobbs were up to 3x more likely to die during pregnancy, childbirth, or soon after giving birth. Babies born in banned states were 30% more likely to die in their first month of life. That same report found that 70% of Black women, as compared to 60% of all women, live in restricted states…AND that Black women were 3x as likely to die in pregnancy, childbirth, or right after giving birth as compared to White women. 

Many of the people we spoke to predicted that all the new abortion bans are going to make these disparities worse.

When the Dobbs decision passed, residency directors in conservative states were scrambling. They were making phone calls to friends and colleagues across the country in abortion-protected states, asking them, please, would take on my residents? Like, even if THEY could no longer legally provide training for their residents, maybe their residents could do a short “away-rotation” in another state to get those skills.

Of course, program directors in abortion-protected states have to weigh whether their program actually has the capacity to take on out-of-state residents, on top of their own residents. 

And then there’s funding to consider.

Like if a program is state funded, it’s unlikely that it will cover the salary of a resident while they’re in another state. There’s also travel expenses and lodging.

AND they need to sort out malpractice insurance and a medical license in another state.

But against all odds, Lindsay’s program organized a series of month-long away rotations in the northeast for its first year residents. Lindsay is concerned that naming the host institution or host state could jeopardize this opportunity for others.

LINDSAY: As far as we know, our state legislators are not aware that we're traveling to this other state for training. I don't want our governor and our legislators to know any of the details of what we're doing and why because I would be really sad to see this training restricted.

ALLISON: After the break, Lindsay performs her first abortion.

And we’re back. Lindsay was the first in her cohort to go on an away rotation to the Northeast. And so in January of 2023, Lindsay got on a plane…and when she landed, it was a new world. She was excited, but nervous. 

LINDSAY: Whenever you do a procedure for the first time as a resident, there's this imposter syndrome and there’s this huge anxiety of like, what if I mess up ? 

ALLISON: For Lindsay's first abortion, for a patient with a  7-week pregnancy, her supervisor or attending physician was with her the whole time. Lindsay started by giving her patient options

LINDSAY: I offered medications, so the Mifepristone and Misoprostol. And then I offered the vacuum procedure and I told her that we could either do it in the office with local anesthesia or in the operating room under general anesthesia.

ALLISON: The patient decided that she wanted to stay in the office and get the vacuum procedure – which again is the most basic and common procedural abortion. 

LINDSAY: I explained to her that it would be me and my attending physician and I actually told her I had not yet done this procedure, but that my attending would be very hands-on helping me. And she was really happy to help me with my education, which patients are usually really gracious about that.

The first part is very similar to a pelvic exam, so obviously I'm confident in that at this point. So I placed the speculum. I placed the clamp on the cervix. I inject with local anesthesia.

ALLISON: Lindsay placed the vacuum so that it was at the top of the uterus. Her attending physician checked the placement. 

LINDSAY: And when you use a vacuum in a manual vacuum aspiration, you twist it and kind of spin it so that it covers all the surfaces of the uterus. And I think it's just one of those things where, someone explains that to you and you watch them do it, but then in real life you're like, do I spin this quickly?

My attending kind of had her hand on top of mind turning my hand how she would, how she would do it herself. And so it helped me develop my own habits and muscle memory. 

ALLISON: The procedure went well.  Lindsay and the attending cleaned up the instruments. And then made sure the patient was feeling OK. 

LINDSAY: I expected myself to feel like this wave of feelings afterwards. But I wouldn't say that there was like a moment where I was like, oh my gosh, I just did something so profound. It just, it just felt like going to work and providing medical care, which we do every day. It was a constant reminder that abortion is common and it's normal and it's safe.

And I left that day feeling so light and happy compared to what I normally feel in my home state where sometimes I carry home this burden of like, I spend a lot of time at home thinking about, like, I wonder if they're going to try to self-manage their abortion at home. I wonder what they're gonna do. Whereas in this other state, I knew the ends to those stories because they chose them in front of me with every piece of information available. 

ALLISON: But this away rotation wasn’t without sacrifice. In order to make sure that the hospital back home had coverage, Lindsay’s fellow 1st years were picking up extra shifts to cover for her. She’d do the same when she got back when others left for their away rotations. In fact, the night she got home, , she went directly from the airport to the hospital for a shift.

Meanwhile, Natalie, the family-doctor-in-training, wasn't any closer to completing her abortion training. Her residency director hadn't been able to organize an away rotation for all the residents... so Natalie arranged one herself.

She applied to a program called Midwest Access Project that connects residents in need of more thorough abortion training with away rotations. 

Natalie’s application was accepted – and a few grants came through as well: she would be spending two weeks at an abortion clinic in Minnesota, a state that protects the right to abortion.

I spoke to Natatlie in Minnesota when she was halfway through her away rotation. 

NATALIE: There's that ever-present fear that I don't think I really realized was there until I was in a place like this where I didn't have to worry about it and then realizing, oh, there was that weird tension that I was feeling.

I can tell you I am absorbing so much more here than I have before. There's just a different sense of not feeling afraid anymore…Which will come back as soon as I go back

ALLISON: In Minnesota, Natalie was getting to do multiple procedural abortions every day.

She was finally the doctor that she wanted to be to her patients.

NATALIE: Almost every single one you have that moment where they look up at you and you kind of just lock eyes for that moment and they just say, thank you so much for helping me with this. You can see the relief in their face and you can see and hear just how grateful they are that you were there and that you helped them through this.

Being in this clinic and seeing the impact you have on these patients and being able to offer this service only furthers my resolve to help with this and to fight for it.

ALLISON: Natalie and Lindsay…in a way…they’re the lucky ones. With all the barriers and the limited spaces available, the vast majority of residents in restricted states have not been able to leave their state to get trained. Like, Lindsay told me that she personally doesn’t know of anyone else in the south who is getting the opportunity she did.

I spoke with a number of residents who went into their programs expecting top notch abortion training and are finishing their year without any. I also talked to ob-gyn graduates who are in the midst of pursuing additional years of even more specialized training … These are the doctors who need to learn how to handle the most complex abortion and pregnancy loss situations. 

They all told me about the heartbreak of watching patients suffer. And the frustration of not being able to get the training that they wanted.

Doctors aren’t the only ones who have had their abortion training taken away. For decades, nurse practitioners, nurse midwives and physician assistants have also been pushing for this training AND for the right to put that training to use.

There’s a deep bench of thousands of these healthcare providers who have the potential to make abortion more accessible AND help with the influx of out-of-state patients traveling to abortion-protected states. And yet, as of 2019, only 5 states allowed nurse practitioners and nurse midwives to provide that most basic aspiration abortion procedure.

I spoke with many of these healthcare providers and I kept hearing how providing first trimester medication and procedural abortion is not any more complex than other procedures that they regularly do, like placing IUDs or providing miscarriage management or delivering babies. And numerous studies have demonstrated that they CAN be trained to safely provide medication and aspiration abortion. 

Midwives actually used to be the main providers of abortion. Long before the United States was even a country, long before abortion was criminalized, midwives delivered babies, provided abortions and did pretty much everything related to reproductive healthcare. 

MICHELE BRATCHER GOODWIN: The people who were performing abortions and providing reproductive health care were nearly exclusively women.

ALLISON: This is Michele Bratcher Goodwin. She’s a scholar and professor whose work spans health policy and law.

DR GOODWIN: And that knowledge was being passed on women to women. And it's important to understand that half of those midwives were black women — who had been enslaved black, who were free.

ALLISON: These Black women accounted for such a large portion of midwives in part because they had brought from Africa the plants and herbs that induce abortion and the knowledge of how to use them. Also, during this time, Black people in the United States held a huge amount of expertise in all kinds of fields and medicine was a big one. 

But around the time of the civil war, both the government and a quickly privatizing medical sector dismantled that authority. 

White men who wanted to enter the newly-founded field of ob-gyn found themselves in competition with these Skilled Black midwives. So these men launched a smear campaign.  

DR GOODWIN: So they begin writing about how the midwives are unsanitary, how they're engaged in evil practice. And the key thing that they use in order to push their agenda is to say that these midwives are doing something that is unholy and evil: they're practicing abortion. 

ALLISON: In the late 1800s, these white male doctors are successful in their campaign to ban midwifery’s reproductive care, and, for the first time in US history, criminalize abortion.

DR GOODWIN: We go from seeing about 100% of reproductive healthcare being governed by women, to at the beginning of the 20th century, it's about 1%. They are incredibly successful with pushing women out, with making sure that medical schools bar women from entry.

Then that also means that black women were completely erased. The people who had been most relied upon in medicine. Go get the midwife, make sure she's here because someone is dying, because someone is about to give birth and we need her right away. Go find her. Go to the next plantation. All of that is wiped away. What's wiped away is the millennia of knowledge and practice and cultivation and training of others to do the work of medicine.

And it's been for more than a century that midwives have been trying to regain the presence that they had and the respect that they had centuries ago.

ALLISON: In the last two decades, nurse midwives, along with nurse practitioners and physician assistants, have been making huge strides to regain that knowledge and the ability to train the next generation. As more states begin to allow these providers to practice… more training opportunities are needed to catch up to the demand — slowly but surely progress is being made: Like recently, when a new law in Maryland allowed these providers to do abortion, it also included funding for training. 

Whenever I ask reproductive healthcare providers about themselves, they’re always quick to center the conversations around patients: patient health, patient choice, patient suffering…

But healthcare providers are suffering too.

There’s this concept of moral injury – when a person feels like they’ve violated their morals or ethical compass, because of the situation that they were in. 

For healthcare providers deeply committed to reproductive healthcare, These moral injuries are becoming so great, so extreme that some are leaving their states. A few months ago in Idaho, a maternal health unit had to shut down because so many of its ob-gyns had left the state. 

According to a study by the Association of American Medical Colleges, ob-gyn Residencies programs  in restricted states have seen a 10% dropoff in applicants. 

State healthcare systems depend on residents staying after graduating and working in local hospitals and clinics. These already understaffed abortion-restricted states are at risk of losing these recent grads.

NATALIE: And the more restrictive the laws get, the harder it is for these populations to just get general care. And then you just lose all of that knowledge. 

ALLISON: Natalie is still trying to figure out if she wants to stay in her residency state after she finishes her program. 

NATALIE: I think at the beginning of residency there was the very real chance that I was gonna stay. I really like where I am. I like the people I work with. I love my patients and I'm in a state where there's such a need for family medicine physicians 

I have daily conversations about is this worth it? Why do you want to help this state that’s so hostile to you?

ALLISON: Natalie has testified at state legislature hearings about the need for abortion. And she can’t shake the fear that she might become a target a violence for her advocacy, especially because she stands out as a person of color. 

NATALIE: I went into this profession to help people. And having that fear of all of a sudden being criminalized for certain things that I do, it makes folks like us not wanna fight anymore. We're just tired of it. And I think before there was that, well, someone has to fight for it. And increasingly I'm starting to wonder if that's worth them the mental and the emotional toll.

ALLISON: As for Lindsay, when she got back from her away rotation, it was straight back to the new normal of post-Roe America.

LINDSAY: It's kind of this whiplash of being able to do everything for people and then being back and back here and kind of feeling stuck.

Like certainly people are suffering as we speak. But it's also a problem in a decade from now and beyond when these hundreds of residents training in the south didn't get the training that they should have. 

ALLISON: At the same time, Lindsay points out that the experience that she’s having at her home program is actually becoming a necessity. Because the reality is, She’s getting the training on how to handle situations and advocate for patients in a post-Roe South.

Like the time when an 8-week pregnant patient needed to terminate for health reasons…but didn’t qualify for the ban’s exemptions. Lindsay and her team spent hours navigating the legal minefield and coordinating with an abortion clinic in another state so the patient could drive there and get care.

LINDSAY: There are really difficult situations that arise when people don't have access to abortion. And we're unfortunately becoming experts at navigating those situations and supporting patients through them.

So it's something that I don't wish upon anyone else, but I do feel like we have become kind of more comprehensive in our care because we see these really unique and awful tragedies at our own institution and have had to learn to navigate those as well.

The reasons I did medicine are holding true more here and now, then I ever would've imagined. And it's been a massive privilege despite it not always being a happy experience. 

There's a huge need for pro-choice physicians in the South. I think some of us need to stay. And I feel strongly about being one of those people.

ALLISON: Just this past month North Carolina banned abortion after 12 weeks and South Carolina banned it after 6 weeks. That’s millions of people who lost access to abortion and  thirteen more ob-gyn residency programs that won’t be able to adequately train their residents.

Thank you to Lindsay and Natalie and to everyone we spoke with for this episode. When I asked residents how they dealt with all this fear, frustration and uncertainty, they told me about the support from their co-residents, and attendings and residency directors – a team of people supporting one another. 

And as we wrap up the final episode of season 4, I wanted to just take a moment to acknowledge all the communities of people that have been part of this season – you, our listeners included. 

At the beginning of production, I read this line by Thich Nhat Hanh and it’s stuck with me all year. It goes, “We are here to awaken from the illusion of our separateness.” I think for me, learning from the people we meet in our reporting is that awakening.

 I’m also so grateful for the talented and dedicated Bodies team for making this work possible. You’re all the best.

You can find a transcript of this episode as well as additional resources on our website, KCRW.com/Bodies. You can follow Bodies on Twitter and instagram at @bodiespodcast. And if you like Bodies, consider writing us a review on Apple podcasts

This episode was reported and produced by me, Allison Behringer and Lila Hassan. Our story editor is Mira Burt-Wintonick. Additional story editing and advising by Cassius Adair and Sharon Mashihi. Music by Hannis Brown and Dara Hirsch. Sound design by Mira Burt-Wintonick. Mixing by Nick Lampone. Transcription help from Nisha Venkat. Special thanks to Cathy Bachur, Camila Kerwin, KalaLea, Caitlin Pierce and Kristen Lepore. Episode art by Neka King. Cover art by Sarah Bachman. Bodies is supported and distributed by KCRW. Our executive producer at KCRW is Gina Delvac. Thank you to the whole KCRW team, including Mia Fernandez, Kerin  Smith, Nathalie Hill, Connie Alvarez, Scott Dallavo, Evan Solano, Adria Kloke, Arielle Torrez, Christopher Ho, Laura Kondourajian, and Alexandra Castle, with special thanks to Natalie Kyriakoudis and Jennifer Ferro. I’m Allison Behringer, host and executive producer of Bodies. Thanks for listening.