Some say Margaret Atwood wrote the dystopia that best describes America's bleakest future. We say it was Robin Marty.
Her “The New Handbook for a Post-Roe America” laid out almost exactly that sort of war Republicans would wage on reproductive freedom with their new 6-3 Supreme Court majority, and how to still get health care by any means necessary.
And she’s living the nightmare of the post-Dobbs South first-hand as the executive director of West Alabama Women’s Center. Please donate to support their life-saving work.
We talked about what her clinic can’t tell their patients. She told us why the blue states have let her down. And she leaves us with a vision of how abortion rights could help spark a movement that inspires a new day in the South.
Catch up on all the episodes of “How are you feeling about democracy?” here. Special thanks to members of this Patreon for sponsoring and sharing this podcast. If you want to back what we’re doing, please join the earlyworm society – free or paid, your support matters.
***********
TRANSCRIPT
Jason Sattler: Can you give us an idea what life has been like for your clinic and your patients since Roe was overturned?
Robin Marty: Yeah, it's been pretty terrible.
For most of the people who come into my clinic, the patient base that we have is actually a community base that was built off of patients who originally came to us for abortions back when that was legal. So in the period in which abortion became illegal and we reopened as a nonprofit free-and-sliding scale clinic, we only saw maybe three or four patients a week, but those patients were people that we had taken care of when they had abortions. And now they knew there was no abortion. They were either trying to make sure they didn't get pregnant or they were trying to get some former prenatal care because they were pregnant. And they knew that we were people who would take care of them, that we took care of them while they had abortions, that we were respectful. That we cared about what happened to them. And so that came into us because honestly, there weren't any other options for them.
That grew over time. And now we're almost two years down the road. We see close to a hundred patients, sometimes more than a hundred patients a month. And they are all literally just word of mouth. It's all people who have heard from other people that we care and that we are the place to go to, to be seen immediately, to be seen regardless of their insurance status and to be treated with respect. And for them, they are coming in and finding out that not only has abortion become completely illegal and inaccessible, we're not allowed to speak about it. We can't tell them where they can go to get an abortion. We cannot tell them that it's okay for them to take pills, and according to the state, they will not be prosecuted for it, according to our law. We don't know if we believe that anymore based on the Supreme Court ruling that came through our state that said that personhood matters more than anything else.
But according to our abortion bill, a person can manage their own abortion and not be arrested. They could technically come to us afterward and make sure everything was okay. And we're not gonna tell anybody that they tried to have an abortion. We wouldn't even know unless they said it to us. But we can't tell them that. We can't tell them that at this moment the closest abortion clinic for them would be in Tallahassee, Florida, and we can't tell them that's only until now, May 1st, and then that's not going to be an option for them anymore. So this has gotten worse and worse. But also our legislature has done absolutely nothing to try to bring in more contraception for people to be able to prevent pregnancies or do anything in order to expand health care so that people can actually be able to take care of themselves if they do become pregnant.
In Alabama, we are now the only state in the nation, I believe, where Title X funding can only go to the county health departments via the Alabama Department of Health. And that means that there is no ability to access free or sliding scale contraception except in the one county health department in each county in the state. And often that's a three, four month wait for people to get health care.
We are the only state I believe now, except for Mississippi, who I believe is changing it, where If a person becomes pregnant and is not already on Medicaid, and Alabama is one of 11 states that has not expanded Medicaid... If they're not already on Medicaid, depending on their income, they can get on to Medicaid, if they apply for it, but they have to have a letter from the from a doctor, and it has to be from a doctor, that says that they are pregnant, and you can't get that letter because doctors won't see somebody who doesn't already have insurance. So even once they get that letter, it's then a at least 60 day wait in order to get Medicaid approved, and only then can you start to go and see a doctor. So that's why we have 25 percent of our population that's not getting any care in the first trimester. And the state legislature is doing nothing.
Instead, they made it easier for people to be able to foster and adopt. They made it faster and with less oversight to have parental rights dissolved so that this can happen. And they created baby boxes so that people can abandon their newborns up to 30 days now and have no repercussions, which actually encourages people not to get prenatal care.
Jason Sattler: Is this a conspiracy? Is this a plan? It's just to get more babies. It's just more babies. That's all the plan is here?
Robin Marty: If it were just more babies, that would be one thing. But it's not just more babies. What we know is that right now, when you deny people contraception, obviously that means low income people are going to get pregnant. And that's purposeful.
But two things happen, and you can see this in our healthcare system right now. We have one of the worst maternal mortality rates in the nation, but we have the worst maternal mortality rate when it comes to Black women. One out of every 100 women that give birth are going to die in childbirth. That is a statistic from the Milken Institute who just did a big research project on this. So we know that. On the other hand, if you had read a report that came out of Pregnancy Justice a few months ago, they've been tracking people who are thrown in jail when they're pregnant. In Alabama, this happens a lot under the guise of chemical endangerment, which is often meth, sometimes pot and is predominantly white.
And so Alabama is responsible for half of the jailings for chemical endangerment. So here you have Black women that they're trying to get pregnant and they're most likely to die. And you have white women that they're trying to get pregnant and they're most likely to get jailed and also be able to have their babies taken away from them because now it's easier to adopt and get rid of parental rights.
And so you can see this in action when you look at our infant mortality rate. Because our infant mortality rate in the last year decreased, but our infant mortality rate only decreased for white babies. It increased for Black babies to a point in which it actually was larger, but just not large enough that it would take down the amount that they improved well being for white babies.
So this is about any baby can be adopted, but their prefer preference is obviously white babies, and if you just happen to kill the Black moms in the process, so be it.
Jason Sattler: Okay, you know... I didn't expect it to be even as bleak as that and I follow you pretty closely online and I get a sense of how bleak it is.
Robin Marty: I'm nothing if not bleak. Yes.
Jason Sattler: That's true. Yeah. So it sounds like it's so bad that Florida banning abortions at least through the year won't affect you that much.
Robin Marty: Oh, no, it's gonna be terribly. Okay. Yeah, let me get into that. We're all so busy about what is happening in Florida that it feels really ugly to me to say, "Yeah, but this is how this is gonna hurt Alabama, too." But this is how it's gonna hurt Alabama too. We know that right now there's probably about 2000 abortions that are happening in out in Florida that were people from Alabama. You take away Florida. Those Alabama people are traveling to North Carolina or Illinois. That's the next closest spot.
It's not going to happen. Because even if it was going to happen, you now have 80, 000 abortions that were happening in Florida that are going to have to go out of the state. So that overwhelming amount of number, there are not enough clinics to be able to deal with this. So that's the bad. We know that this is essentially going to end any ability for an Alabamian to be able to get an in clinic legal abortion.
That's bad. What is more bad? What is worse? Because I can get more bad. What is worse is the fact that now that we have had this IVF ruling from the state Supreme Court, we have, as I said, a law that says that abortion is completely illegal. However, if somebody is having an abortion, they cannot be punished for it.
That's our law, but as the Supreme Court has shown us because of the Sanctity of Life amendment, and in all the statements they made, when they put this amendment ruling out, this constitutional amendment overrules any legislation that is written. So that means that it doesn't matter that our state legislature says you can't be prosecuted for having an abortion. All it takes is a prosecutor a judge anybody, a sheriff to go in and say, okay, I think you had an abortion. I don't know if that was a miscarriage or not. We're going to go ahead and put you under arrest. And according to our state Supreme Court, any action that stops a growing viable pregnancy at any point after conception, that is essentially ending of a human life.
So we are going to see women in Alabama arrested. We are going to see pregnant people in Alabama arrested. That's what's happening next.
Jason Sattler: Was that the point of the ruling from the supreme court ? Was that an attempt to make it clear to prosecutors that they want to see prosecutions like this?
Robin Marty: I suspect. They're one of the things that the state supreme court was really adamant about making sure was written into their ruling was the fact that you can take a legislative approach to this and -- as you saw in Alabama, they then immediately wrote a bill -- but the court said, we don't have to follow your law because that's not the law. This is the constitution." And I think he specifically said the constitution must be followed over policy unless the policy is written into the constitution. So that was his way of saying, unless you are going to change something and put it in the constitution, this constitution is what we have to follow.
That's alarming because essentially it's saying that this new bill from the IVF, like it's a gentleman's agreement right now. It doesn't have any teeth. It doesn't have any standing. It is just there in place and everybody's honoring it until there's another case that goes up to the state supreme court, and then we'll do this again. And so that's what every piece of legislation out in Alabama is like right now, is if something comes up to the state supreme court, that's when we're going to find out whether personhood overrules everything.
Jason Sattler: Best case scenario, 60 percent of Floridians say they want abortion rights in November. This becomes null and void in 2025. But we have more than half a year until then. What will this look like on the ground in Florida?
Robin Marty: Yeah. I... I'm really terrified that we're going to lose a lot of clinics.
Like I said, there were more than 80, 000 abortions in the state, and that means that, I believe I checked and it was like 52 abortion clinics in the state. And that's a lot of abortion clinics. We have seen in states like Georgia that you can have a heartbeat ban and it is possible for clinics to stay operating during that time period because there are frankly a lot of people who can find out that early if they are pregnant.
But is there going to be the mass of them that are going to be able to keep 52 clinics open? Because if I'm being really candid, having run an abortion clinic and having seen how other abortion clinics run, they don't keep cash on hand. Most of them, they're businesses. You're not going to find a lot of places that are like ours that says, we know the, that the curtain's coming down. We know that our community still needs this. We're going to switch and do something else and save the money and try to do everything we can to stay open as long as possible."
Like you saw clinics that existed in Texas and everywhere else that said, "Oh, you know what? We're folding up. We're going to go into blue states where it's easier and where we can get more money."
So I hope that because this is a short term thing, that there will be an effort with the clinicians to stay open, knowing that once the clinic closes, it's really difficult to open again. But six months is a really long time. And also the the amendment can work and you could still get a Trump presidency. And so what happens there? So there's just so many what ifs that I don't know what's going to happen. I'm just really scared.
Jason Sattler: One thing that you pointed out that I'd never thought about before is how difficult it would be to reopen a clinic. Think about how Ron DeSantis has treated the state's biggest employer Disney, because he mistakenly thought that would give him some political advantage. I imagine Florida Republicans would stab each other with rakes to be the one who stopped an abortion clinic from opening.
Robin Marty: I mean they already are. We know that there was a clinic that's been trying to open in pensacola ever since Dobbs, and that clinic has been denied the ability to open because the state will not give it a license. This is an example of a clinic in an area that has no access because if there's a Pensacola clinic that would be amazing for our Florida patients. This place has no access and there is a politicized medical board that is keeping the person who wanted to open it from being able to get a license.
And want to make it clear, this isn't just a red state thing, and this isn't necessarily even just a Republican thing. We saw DuPont Clinic which is originally in DC trying to open a California clinic in, I think, it was Beverly Hills, for months and months. And they've been blocked by landlords and haven't been able to do it.
Jason Sattler: There's a lot of excitement about the political potential of Florida, abortion rights being on the ballot because it hasn't lost anywhere since it's been on the ballots since Dobbs. So there's a, almost a giddiness, when you don't look at the actual other ruling
Robin Marty: When you don't look at the people, it's really great.
Jason Sattler: I don't want you to say is this distasteful? But how do you feel?
Robin Marty: This is all going as was expected in all honesty. I read Controlling Women and that was Katherine... You I just went to go and look on my bookshelf. Take notes, stage direction: she looks on her bookshelf behind her, but it's not right there.
And she was a former litigator for Center for Reproductive Rights. And it's a book that is an agenda of what to do next, but also it talks a lot about the cases that they had tried. And she reminisces about how when Planned Parenthood v. Casey was going down that wasn't necessarily the bill they expected it to, the ruling to happen in, but it was the one they decided was the most likely to be a direct attack on Roe. And so they were expecting Roe to get overturned back then in the 80s or 90s with this case. And they loved it. They thought that this would be the greatest thing to happen. She says, because the timing would be so good because it would be right before a presidential election. And when I read it, it just broke my heart because there was literally a line that says, "Yeah, some women are going to be affected but think of what it's going to do for the outcome. And they'll probably get the White House and they'll get all of Congress. And then there's going to be national protection. So it won't even matter. It's just going to be a little inconvenient, for some period of time."
I'm like, these are women who are going to die giving birth. And we're saying, "Okay, is expendable for this great political emotion that happens later." And you saw 2009, we had the white house, we had Congress, we had everything. We were almost a veto-proof majority in the Senate. And we got Obamacare with abortion exceptions.
Jason Sattler: Just to spread out the misery a little bit. I know you don't know the rest every state as well as Alabama. But is this consistent throughout the South?
Robin Marty: Texas is seeing a surge in births. There was a report that just came out from Pro Publica in Louisiana that the doctors are so afraid of being accused of performing abortions that when they have patients who are 16-18 weeks pregnant and their water breaks and they're already going into sepsis, they'll give them c sections in order to prove that they were definitely not doing an abortion. So we're talking about abdominal surgery -- major surgery with actual repercussions, long term, including never being able to potentially give birth vaginally again -- all for a non-viable baby because the doctors are that worried about losing their license.
Mississippi was telling 12-year-old rape victim who didn't realize that it could have been an exception and she just gave birth. This is everywhere, and it's spreading. I used to say that we were going to be looking for the story of the first year to post-Dobbs and how bad things are and what it looks like and how terrible it is. But the reality is the first year, the second year, these are not the years that really are going to show the harm. It's when you get into the third and fourth and fifth. And so the person who became pregnant and then was forced to give birth and then becomes pregnant again. And it's forced to give birth again when her body didn't get a chance to recover when she still has underlying health conditions from the last one when there's still no prenatal care preventative care in the middle, that's when we're going to see the surge in deaths.
Jason Sattler: Some people say that Margaret Atwood wrote the dystopia of the best predicts, the darkest version of America's future. I say it was you Robin Marty. Your likely scenario number one from your book Handbook for a Post-Roe America predicted, almost exactly what has happened since. And I think you saw at the moment that Amy Coney Barrett was confirmed,
Has any of the surprise you on a federal level? And what do you see coming next?
Robin Marty: The thing that surprised me most was the way that blue state clinics abandoned the South. And I'm not even going to call them red state clinics anymore. When I was envisioning a post trauma America, I assumed that there would be at least one clinic in every state that would exist in order to make sure that people were still able to get care so that people wouldn't have to go into hospitals if they thought that there was something wrong. So that people could see, "Am I having an actual pregnancy or am I having a miscarriage that's going to happen?" I thought that because especially the places that had multiple clinics would be seeing such a surge from people coming into their blue clinics that they would keep these open as a form of community care, and they did not. That breaks my heart every day.
I think that now that we are two years into this, we are starting to see what that looks like and what kind of harm that is causing. And also how bringing back before-and-after care clinics is truly the way that we are going to get through this crisis. Because now Florida is showing us people are not going to be able to leave their states.
We have in so many ways this wonderful opportunity that we could create a abortion access in the South that is better than at any point in which abortion was legal, because we have shield laws in Massachusetts and New York and all these places that are now sending pills into our states, sending them to the like much more cheaply than they were when abortion was legal, without the need for travel, without the multiple waiting periods. But we can't do that without clinics that can provide care afterwards. Otherwise we're just abandoning people there.
We had so many opportunities. I'm hoping that we're coming to a point where we can bring those back into play, especially to hold us over until we can get a federal right, which I think we have to because this is a human right. This "Is a person going to die in childbirth? Should they be forced to?" And so if we can get these clinics back in here to be able to do that, or we can get the Planned Parenthoods to agree that really is their responsibility -- because they do still have at least a clinic in, I think, almost all states, maybe not South Dakota, that one might have finally closed... But point being, there needs to be this network, whatever it is. And if we can get that in place to hold the line for now, this could be seen as an opportunity instead of a catastrophe.
Jason Sattler: You're constantly talking about what the struggles your clinic's going through. You're describing this difficulty in organizing a concerted effort to respond to Dobbs in the way that you hoped and expected. Yet there's all this passion at the polls. Voters come out every time to protect abortion rights. They obviously believe in it.
How much of the difficulty you're experiencing do you think comes from a residue of the past? Or is there a larger structural issue that I just don't understand here?
Robin Marty: I would say it's an ageism issue for the most part. We still have so many old political leaders and so many old leaders of the movement, maybe not necessarily still in the key positions, but still having a lot of influence. So they came from a time where you would think that saying abortion in Alabama is going to get you in trouble. And right now, we're seeing polling in Alabama that says at least 75 percent of Alabamians don't want the Sanctity of Life Amendment. We're seeing polling that says a majority of people, even a majority of Republicans in Alabama, believe that abortion should be legal for the first 15 weeks. So abortion is not a scary thing to say, but even when I'm talking to, like, when I do interviews with people who are from New York and such, they still say abortion's probably not popular in the South. I'm like, "Have you talked to a Southerner? Are you getting data on this?" It's not true at all.
Abortion is popular. And we're still stuck in the same mindset of "pro-choice" instead of pro-bodily autonomy, pro-keeping people alive. Once we can move past that and get out of these really dated ideas of what abortion should look like, and then also figure out that we need to be able to support our red states and our rural areas -- because they are not toxic, they are pro-abortion -- and give them the resources.
I think that this Mifepristone case that happened, honestly, did so much to destroy any momentum that could have happened with the movement. Because the second that lawsuit happened, everybody who could have been starting to look at how do we improve our landscape suddenly circled up into, "Okay, how do we protect this thing for ourselves?"
Because Mifepristone was something that could have potentially disappeared in New York, in California, in all of the states that already felt safe. And so it was that threat that divided us again. And that's the thing the right is so good at doing, finding a thing to slam at us. And then all of a sudden we just, we all break apart. Our coalition is over. So what we need to do is get that coalition back.
Is the next election the coalition election for abortion, be it nationally and in every state? I hope so. In Alabama, we have a second district that is newly opened because of the Supreme Court undoing all of the gerrymandering that was in it. It is 50 percent Black, and there is a very strong possibility, based on the polling data that we've seen -- we know people like abortion there, we know people want the government to leave them alone, which at this point, the Republican Party is the party of big government -- we know that there is a really good chance that we could flip that. And if we flip that, that could flip the House. And yet we still can't seem to get anybody to come down here and pay attention to it.
Jason Sattler: Even after Marilyn Lands won a state Senate seat in a Trump district just a week or two ago?
Robin Marty: Exactly and she ran on a super abortion platform. And she ran on the idea that Republicans are the party of theocracy. And it resonated south of Huntsville. And I'm gonna be honest. I drove to Huntsville this weekend in order to pick up my little kittens, who are really adorable. And God, the number of Confederate flags I saw on the way out there.
There are things happening. I feel such a sea change going on in the South, in Alabama itself. This is the point where everybody pushed us to the wall and we're fighting back. We just need somebody to please give us some ammo.
And that kind of leads to the question I have about what gives you hope. You're very visible and I think it's very important that you are visible about the struggle of keeping a red state clinic open. I'm, sorry. You just said not to call it...
I say we are an abortion clinic. The movement doesn't think we're an abortion clinic. That's why they don't support us. The powers that give money to people does not think we're an abortion clinic. We're an abortion clinic, regardless of whether or not we're allowed to legally do it. Because an abortion clinic is a place that would provide abortion if they were allowed to, but also believes in centering a patient, that believes in bodily autonomy, that believes that birth is something that a person should be able to do on their own terms.
We're always going to be a red state abortion clinic and hopefully someday will be one that can provide abortion again But one of the things that gives me hope right now, like I'm not gonna lie. We have two months cash on hand I just laid off an employee yesterday. It broke my heart I barely have any left. So at least I can't do that too many more times.
But then I went to a meeting in rural Alabama, all the way over by Mississippi, with a woman who is opening a birth center. And it was a gathering of birth workers in western Alabama, and we sat and talked about how to change everything. We talked about what we need to do, how to form coalition, how to become a real force in making policy. This force is one that won't be political, that won't be partisan. Because our Democrats, the ones who are elected, hate abortion just as much as our Republicans do. We need to make people understand the life-or-death situation that we're in right now, and that Black women are dying. They are dying in droves.
And seeing these doulas, seeing these midwives, seeing the foundation that wants to help sponsor all of this and has provided many of us with grants in order to help us with our work, we knew that we weren't alone and that there was a chance to change everything. And that's all we kept talking about was this is a moment.
This is a moment we could feel viscerally, is this is a moment. where things turn. And now we're starting to have plans how to do that. Like always it requires resources and maybe more resources than exist in Alabama and trying to get people who are not Alabama to understand that and that we need help too, is always going to be a struggle, but it's a struggle with people who are strong and that I believe are going to change the world.
And for people who aren't in Alabama who do want to help, what would you advise. Let's start with the obvious...
You can always donate to us and our clinic has a donation page up at
https://alreprohealth.com/
Make sure that you are paying attention to the fight that's going to be happening in the second congressional district It has not gotten a lot of attention yet because we're still doing runoffs
In Alabama.
Sorry. Yeah. But you can help support races in other states. Definitely pay attention to what's going on in Alabama for the second congressional district. Make sure that when you are talking about what's happening in florida that we elevate the people who are going to be the most affected by it.
We are seeing people give money to abortion funds. That's good. We're seeing people give money to places that are going to be mailing in pills. That's also good. But again, we need to make sure that the clinics stay open and supported as much as possible too.
And then God, everybody vote, please vote. Oh, for the love of God, vote. I know. Oh, okay. Saying this as an author, not as a nonprofit, carefully. Yeah, Biden's probably terrible and I'm not happy either, but I think everything that's happening right now is because of Trump and his judicial picks. And I do not think, in all honesty, that we will come back from a second term of Trump. I think that what scraps of democracy exist, especially down here, will be gone. And please hold your nose and vote, because I can't guarantee we'll still be a state if that doesn't happen.
Jason Sattler: One last question, since we have you: privacy rights and abortion apps. This is something none of us had to think about growing up, but how should people who may have to get an abortion one day think about using their devices?
Robin Marty: I did a whole thing on security and how to stay secure in searching for abortion information. And then, everybody else, I read that thing about the incognito browser. And now my brain is just blown. How do you explain to people how to be secure on the internet when the tools that we are being told are supposed to be secure on the internet are actually tracking your data too?
What I can say is that you need to be secure. Obviously, you need to try to limit your footprint as much as possible, but in the end, what really matters the most is who you talk to about your abortion. So if you are going to choose to do any sort of work when it comes to this, whether it's getting an abortion outside of the legal channels, whether it's helping someone get an abortion outside of the legal channels, what you need to do is make sure that you are limiting who you talk to about it. Everything that has happened so far has been somebody talking to somebody who told someone who told the police. And so the two biggest places are a friend of a friend, Is going to be the person who gives it away, and, or it's going to be going into the hospital and stating that you did something, because the hospitals are going to report. If you go into a hospital, if you're having any sort of issue, "I think I'm pregnant, I appear to be bleeding, I'm scared." Those are all the information pieces that you need to give to a doctor. Nothing else needs to come out.
As long as doctors are not aware that you did something that could be construed as illegal, and as long as friends of friends do not know about it, then it doesn't matter what information is in your web browser or in your phone or in any of that because there will be no reason to search for it in the first place. That's the biggest security there is.
Jason Sattler: And that puts into context how important it is that a movement does start now. This is not a way that anyone should be asked to live. I think it's amazing what you do. And I know that you moved to Alabama just to do this.
And I want to thank you for doing that. It's an incredible thing to to put your values that forward in your life. And you're also really fun and fun to talk to. So thank you, Robin Marty.
Robin Marty: I will be back anytime you want me.
"Surviving the Post-Roe South" with Robin Marty