How To Fix America’s Maternal Health Crisis and Fight For Reproductive Freedom

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Welcome to Assembly Required with Stacey Abrams from Crooked Media.

I'm your host, Stacey Abrams.

The mission of this show is to tackle complicated, sometimes overwhelming issues with the goal of finding a way in so we can begin to work it out.

And today is no exception.

The U.S.

is one of the most expensive countries in the world in which to have a baby, and that's presuming you have insurance and no complications.

For everyone else, the cost can be astronomical or impossible to meet.

Although private insurance plans and Medicaid are required to cover care associated with childbirth, one in eight Americans who have medical debt say it was at least partially caused by the bills associated with pregnancy and childbirth.

But as much as money is a factor, in the 21st century, in one of the most medically advanced nations on earth, the act of giving birth can cost more than anyone should be expected to pay.

In America, for people of color, maternal mortality and morbidity rates are on the rise, despite advances in health care.

For black women, it's devastating.

Nationally, three and a half times more likely than their white counterparts to die during or shortly after pregnancy, but that's nationally.

When we go to certain counties and cities, then it can be five times, ten times, fifteen times more likely their deaths than their white counterparts.

That was law professor Michelle Goodwin just last year speaking at a United States Senate hearing.

The disparities in maternal health are stark.

Among Native Hawaiian or Pacific Islander women, black women, and American Indian and Alaska Native women, the risk of death rivals rates in less developed nations.

And the vast majority of maternal deaths are most likely preventable, over 80%, according to the CDC.

So what's going on here?

Well, like most of the health crises we face, access to health care is a major part of the puzzle.

In the U.S., 25 million people are uninsured.

That's almost the population of the entire state of Florida.

And the Congressional Budget Office projects that for the next decade, an additional 1.7 million people will become uninsured each year.

While federal and state programs may be available during pregnancy, issues like cardiac-related conditions, undiagnosed medical disorders, and mental health conditions, including substance abuse, often require pre-pregnancy support, support that is often unavailable in the states that have refused to expand Medicaid coverage, states that are disproportionately home to black and brown communities.

Even in states that grudgingly or gratefully expanded access to health care via Medicaid or the Affordable Care Act, the policies policies put in place during the pandemic are now being rolled back.

But insurance coverage is just one piece.

Then there's the availability of hospitals and doctors.

In states like Georgia that refuse Medicaid expansion, urban and suburban hospitals in predominantly Black or Hispanic communities are closing at alarming rates.

The situation is increasingly dire if you live in a rural area.

where the struggle to find a hospital near you with a labor and delivery room has reached nearly untenable levels.

Over 200 hospitals in rural areas have shuttered their maternity wards over the past 10 years.

That means more than half of all rural hospitals in the country don't offer birthing services.

Tennessee, Texas, and Georgia lead the country in hospital closures, a list no one wants to lead.

And unsurprisingly, these three states have refused to expand Medicaid.

But it's not just a lack of hospitals that's concerning.

In Georgia, 82 of our 159 counties do not have an OBGYN, and we also have a shortage of medical transportation.

Experts say rural hospitals in America are more prone to staffing and financial challenges because they serve a higher proportion of low-income families in areas with fewer births.

These vital resources are leaving communities that often need them most.

In addition to all of that, there's also the issue of reproductive health care in particular.

Since the Supreme Court overturned Roe v.

Wade, 20 states across the country have banned or significantly limited abortion access.

And this upcoming election, abortion is on the ballot, with voters deciding in multiple states on ballot measures to protect the right or not.

This issue doesn't just affect a woman's right to choose, it also affects a person's ability to get the care they need.

The Associated Press found that since 2022, the year that the Supreme Court made its decision, more than 100 pregnant women across the country who went to emergency rooms in medical distress were turned away or treated negligently.

Now, I've just walked us through a lot of troubling statistics.

But what's important to remember is that there are real people behind the data, and their stories are finally coming to light.

ProPublica found at least two women in Georgia who died after being unable to get either a legal abortion or timely medical care.

Official state committees examining pregnancy-related deaths concluded that both were preventable.

The women lost to these horrific laws are Amber Thurman and Candy Miller.

Their inability to access abortion care in Georgia directly led to their deaths.

They were both mothers, and we know their stories because of ProPublica reporter Kavitha Serrana, who has been focused on the impact of abortion bans on the already critical maternal health crisis in America.

We'll be talking to her later in the episode.

But first, we're going to check in with Congresswoman Jennifer McClellan of Virginia.

She's spent two decades working to improve health care in her state and then as a national legislator.

She has championed expanded access, reproductive freedom, and she's also tackled some of the less discussed obstacles to becoming a parent in this country, like access to child care.

As always, we'll dig into the issue and ask our experts what we can do about it.

So stay tuned.

Representative McClellan, welcome to Assembly Required.

Thank you for having me.

It is always my pleasure to hang out with you.

So you served in the state legislature for 17 years before running for Congress.

In fact, that's where you and I met.

I know that one of your key achievements during your tenure was helping to convince Virginia to finally adopt Medicaid expansion.

Another was re-enfranchising returning citizens, former convicted felons, and restoring their right to vote.

You and I got to know each other talking about tax policy because these are issues that people tend to ascribe to the federal government.

But you and I both know that for at least half of the country, the state makes the decision for everybody else.

So, can you talk about the nexus of these issues and why not just staying at the state level and working on the issues you care about, but telling people about this has become a passion project of yours?

You put your finger on it that the state, even though it doesn't get as much attention from voters or the media, you know, the state started out as the laboratories for public policy.

And in some cases, that's good, and in some cases, that's bad.

But

whether it's voting rights, whether it's education, whether it's access to health care, even when you have a large federal policy, it's the state that implements it.

So you take the Affordable Care Act, which said we're going to expand Medicaid to cover

more people that are above the poverty line, but still not making enough money to buy private insurance.

It that only worked if everybody had access to insurance, and a big part of it was if you don't, if you have a state that doesn't expand Medicaid, then you've got that key gap of hundreds of thousands of people who don't have health insurance, even if you have an exchange in place, even if you have private insurance in place.

And so, in Virginia, um, it took a while, it took almost almost 10 years,

maybe not quite 10, but a long time for us to expand Medicaid under the Affordable Care Act.

But it also took us a long time to create our own health care exchange.

We defaulted to the federal government.

And it's just better if you have a state government running that exchange because then they can easily see People change eligibility all the time, whether you lose a job, whether you're on Medicaid and then you gain a job, whether you begin earning more.

And so, if you have the state with oversight over all three buckets, then you can make sure people get the insurance that's best for them.

And that's much easier to do at the state level than at the federal level.

But again, the states have primary responsibility for access to voting and voting laws, running elections.

And so, you name the issue.

The state is really a critical link to whether what Congress does actually happens on the ground on some issues.

And then on other issues, they're the ones that are putting that issue in place and implementing on the ground.

The federal government barely has a role in.

Well, you have been one of those extraordinary leaders who has transitioned from the state house to Congress, but not forgotten where you came from.

Right.

And I want to return to that conversation, but I want to set the stage.

Today's conversation, although we've spent a bit of time talking about education and health care and voting rights, today's conversation is about the scourge of maternal mortality and what we need to do to improve maternal health care.

You and I served in this legislature, different states, but at the same time.

But one of the reasons I thought of you for today's episode is because of a personal experience that you have had twice.

Can you describe your experience navigating the maternal health care system?

I did it backwards from a lot of women, a lot of women who get into politics or run for office.

They get married, they have kids, they usually get involved through their kids, and then they run for office.

I ran for office, then got married, and then had children.

So I was able to see as a sitting policymaker how our maternal health care system works for better,

for good and for bad.

And so,

and and I was what, I had what was called geriatric pregnancy with my oldest child, who's 14 now, but I was 38 when I got pregnant with him.

And so when I got pregnant with him, Virginia was right in the middle of

attempts to further restrict access to abortion.

And my doctor, one of my doctors,

talked to me about how abortion laws impact doctor-patient relationship and told me about patients that he had

who had to make very difficult choices.

Like he had one woman who had a hole in her heart and she was on birth control, but she got pregnant anyway and knew that if she carried that pregnancy to terms, she would die.

People who suffered miscarriages that what's called an incomplete miscarriage, where there's fetal demise, but you need to have a DNC to remove the fetus.

Where you have patients who get a devastating diagnosis, where if

the

fetus,

the pregnancy is carried to term,

the baby won't live once born.

And so he helped me understand the connection between maternal mortality and abortion laws.

Now, fortunately for me, I had a textbook pregnancy with my son.

Fast forward to my daughter, I was 42 when I was pregnant with her and I had, so it was a much higher risk pregnancy.

And I had something called placenta previa,

which is where the placenta is between the baby and the birth canal.

And so I knew I was going to have to have a C-section.

I knew that I was at risk of bleeding.

I had access to high quality prenatal care.

So I knew exactly what could go right and what could go wrong.

But I still almost died giving birth to her because one morning my placenta ruptured.

I was rushed to the emergency room and I was wheeled into the hospital with the peace of mind that my doctor in that moment could make whatever decision she needed to based on what she felt was best for her patient.

But that moment of living through an at-risk pregnancy, living through almost dying,

really gave me an appreciation for how many patients don't have that peace of mind, either because they don't have access to quality prenatal care, they don't have, they live in a state with an abortion ban that has put pressure on their provider to make decisions based not on what's best for my patient, but what's going to cause me or my employer to face criminal liability.

And you know, in your own state, the tragedy that that has led to.

And it's no surprise that the states that have abortion bans or extreme restrictions to access to abortion are also the states with the highest maternal mortality rates.

It's directly related.

And so I think, and it's also given me an appreciation for

when you have a pregnant woman who works,

how oftentimes she's forced to choose between a healthy pregnancy and keeping her job.

And why things like the Pregnant Worker Fairness Act are so important to provide accommodations to pregnant workers or

workers in a postpartum period so they don't have to make that choice between a healthy pregnancy, their life, and their job.

Can you talk a little bit more about the act?

Yeah, so I was really excited in the state legislature.

And here's a really good example of how sometimes the states get ahead of the federal government.

Virginia became the 28th state to pass the Pregnant Worker Fairness Act, which requires employers to provide workplace accommodations for pregnant workers and postpartum workers.

And it's things like,

you know, if what, especially in the postpartum period, providing breaks for pumping and storing a place, a non-bathroom place to pump and a place to store breast milk to providing, you know, if you have some aspect of your job that could put your pregnancy in danger, they have to provide an accommodation to allow you to do something less strenuous or less dangerous.

And so there were 28 states that passed this law.

Virginia was the first one in the South to do it.

And then Fortunately, the federal government, Congress finally passed it and it just took effect, I believe, last year, so that now, no matter where you live, you have access to these accommodations.

It has been challenged in the courts,

but right now, women still have access to these really important protections when they're pregnant or in a postpartum period.

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One reason this is such an important issue is because you understand the longitudinal frame of this conversation.

In particular, you understand that black women, that Native American and Alaska Native women, that Native Hawaiian and Pacific Islander women have incredibly high high rates of maternal mortality.

And that maternal mortality, the count starts the day they give birth and basically goes out for a year.

But there's also the conversation about what happens before they get pregnant.

One of the issues of broader access is directly related to those women who are not yet pregnant, but need access to health care because of the concommittant issues that they face.

And we had for a brief moment because of COVID, an expansion of Medicaid, an expansion of the children's health insurance program, and both are unwinding right now.

As someone who understands this, as both a state legislator and a congresswoman, how do you talk to your fellow congressional members about the importance of health care access, particularly for the poor and the young among us?

Oh, great question.

You know,

and it's another example of how sometimes the states are leading,

because not only do we know that Black women are three times more likely to die

in or shortly after childbirth than white women,

we know the reasons in some states.

And so in Virginia, I sat on our

health care commission.

You know, we looked at the data to show the reasons why.

And while white women are more likely to die from suicide or

drug overdose postpartum related to mental health issues or postpartum depression, black women were more likely to die because of cardiovascular issues they had before they got pregnant.

And it's exactly your point that it was already a lack of access to preventative care, to

in some cases, access to medication to lower high blood pressure or cholesterol medication, or even access to the screenings to find out that you have these issues that could lead to heart disease.

Or they live in areas where they don't have access to preventative care and primary care.

And so that gives you the ability to look outside of your silo and say, this isn't just about

access to health care.

In some cases, it's about access to transportation.

In some cases, it's about

not having access to affordable health care.

In some cases, it's the stress

that being a black woman puts on you because racism itself and sexism are

public health crises.

In some cases, you live in an area where because of environmental injustice, because of

landsiding decisions, you happen to live in an area that has

two power plants and

a textile,

a chemical plant that is making you more likely to breathe air that is killing you or that is exacerbating issues you may already have like asthma.

So part of it is making sure my colleagues first see the big picture, first understand

what are the underlying causes of the maternal health crisis, and it's not one size fits all.

And in some cases, it's something that's interconnected to another issue.

And one of my biggest frustrations about government at any level is we govern in a silo, but people don't live in silos.

So, healthcare and environmental policy and education policy, transportation policy,

whether we're addressing inequities lingering from slavery and Jim Crow, all of that comes together to affect whether someone is healthy or not.

And you can't talk about maternal health without talking about environmental justice, without talking about

the legacy of slavery and Jim Crow, without talking about transportation policy.

They're all interconnected because all of these factors impact a woman when she becomes pregnant and is trying to

navigate multiple different systems to deliver a healthy baby.

I love the fact that you weave those pieces together.

And I want to pull on one thread because we know that while race is a determining factor in the disparities in maternal health, income isn't always the deciding factor.

So for example, Serena Williams famously shared her experience of having severe complications after birth.

But what really stood out for so many who read that Vogue article was how Williams had to insist on getting medical attention and the care that she needed because she was was doubted by her doctor.

I mean, she's one of the most famous athletes in the world, and they're still doubting her ability to describe her symptoms.

What does this tell you about how far we still have to go to get black women and women of color, in fact, all women, the medical attention we deserve?

So, part of what it tells me is we need to reevaluate how we are training our medical professionals.

And it's time we were having this conversation because not too long ago, I was at a maternal health summit that our local

Virginia Commonwealth University medical school and the healthcare system had where they talked about that.

And they talked about the fact that you need to train your providers to have cultural competency

and to understand

you may know

sort of medicine as it was taught to you, but that doesn't mean you know the whole picture about what is affecting someone or that they trust you enough to talk to you about what is happening with them.

And I think you put your finger on the fact that for so many women, it's this

view of the provider.

I know better than you.

I know your body better than you.

Well, you see me maybe once a year if I'm lucky.

Even when I'm pregnant, you know, when I was pregnant and

I went to see my doctor, most of my time was not spent with her.

It was spent with a nurse or a care partner checking my vitals and everything.

But you've got to learn how to develop this relationship of trust with your patient, but that trust is two-way.

And when your patient tells you, I feel this,

trust that they know their bodies better than you do.

And again, to your point, it's not just

going back to the interconnectedness between maternal health and

heart health and cardiovascular health.

I was at a different conference where we were talking about disparities in cardiovascular health.

And there was a woman there who had her first heart attack at 36,

right after she gave birth.

She knew she was having a heart attack.

She went to the emergency room.

She said, I think I'm having a heart attack.

And they looked at her and they said, you don't have the risk factors of someone having a heart attack.

You're 36, you're healthy.

never had high blood pressure or or you know

you're not having a a heart attack they sent her home she was having a heart attack and she ended up having to have a heart transplant and it's like if you had just listened to her and done the test

you'd have seen she was having a heart attack rather than just looking at her saying oh you're 36 year old healthy woman who's never had heart disease you're fine

I mean one of the issues I've been working on recently is expanding our understanding of diversity, equity, and inclusion, DEI.

And what you just described is a perfect example of what DEI attempts to correct for.

That if we don't explicitly call out the diversity in the nature of the patient, the inequity in how their medical needs are treated, and the inclusion of them in how we train doctors and train care providers to understand them.

people die.

People are in jeopardy.

And that medical equity is absolutely one of the ways that DEI is helping keep us alive.

Oh, yeah.

And what's frustrating is if you don't use the term,

then nine out of 10 people, when you explain what you're trying to do, they're like, oh, of course, why wouldn't we?

Why wouldn't we want to do that?

But

for some reason, and I think we both know why.

DEI and particularly equity has been weaponized to be

somehow,

I don't know.

I mean, it depends who you talk to and what the situation is as to what it is, but it's something

that harms people and divides people.

When really, it is something that helps people and brings them together and corrects the fact that

300 years of slavery and Jim Crow and the impact that it still has on society didn't go away with a magic wand when laws changed.

It requires intentional effort to undo the legacy, to undo the impact.

And that does not mean that we're taking from one group of people and giving to another.

It means we are creating a world where we understand

that people are different.

People,

even people of the same race are different and their bodies are different and how they present is different.

And you need to deal with the individual standing in front of you as a healthcare professional, not your stereotype of what you think an entire group of people should or should not present when they come to you saying they have a particular issue.

I couldn't have said it better myself.

So during pregnancy, childbirth, and postpartum, you just described the fact that there's a spectrum of behavior, there's a spectrum of need.

Well, we know that there's also this spectrum that goes into keeping parents healthy in addition to and beyond the medical side of things.

In fact, one of our listeners emailed us to ask about the connection between maternal care and getting women through the postpartum phase.

I know this is a key issue for you.

So, can you please tell us about the Child Care Assistance for Maternal Health Act, what it does to support families, and why affordable child care is a key part of this puzzle of maternal health?

Oh, absolutely.

I love that, Bill, too.

So, I mean,

it seems intuitive that

stress

is damaging to your health.

And

the stress of having, I mean, I don't think people really fully understand the stress of being pregnant, going through childbirth and recovering has on the human body.

So that's the first point is just understanding that the entire process of giving birth is stressful and you need time to recover.

But then as a new parent, especially if you're a first-time parent,

but even if you

already have children, the stress of how do I take care of myself

and take care of this infant that is dependent on me for everything

at the same time in a society where we don't have paid family medical leave, in a society where it is difficult.

for your partner in many cases to take the time to help you to recover or take care of a child.

And so, what this bill does is like, we're going to take part of that stress off

by

focusing on closing the gap, you know, fixing the child care crisis for this

most stressful period in the parent, a new parent's life of we're going to make sure you have access to child care in the prenatal, in the postpartum period when you are trying to recover and take care of yourself.

And that is especially important if you have children already.

I already told you, I almost died with my second child.

She had to be in the NICU for six weeks.

And I was there with her while her father was trying to work.

We were lucky that my four-year-old son at the time was in child care, was in preschool.

But not everybody is that lucky because the

waiting lists for childcare

from birth to five are incredibly long and it's incredibly expensive for a lot of people.

So, this bill is to make sure, at least in that

initial postpartum phase,

we're going to focus on investing in expanding child care for that period.

Now, there are other bills because we've got to fix the problem for everybody.

There are a lot of other bills that are designed to fix the child care problem broadly, but this one says, in the meantime, we are going to focus on that critically important window when the mother is trying to recover from the physical stress of giving birth while trying to take care of an infant at the same time and maybe one or more children.

Well, Jennifer, at Assembly Required, we like to go through all of our options for effecting change.

And we've talked a bit about the legislative branch, but the elections on the ballot will extend beyond federal races and certainly beyond state-led races.

But we know almost every vote can impact our health care system and our maternal health care challenges.

So, what other contests should we be thinking about that maybe we need to connect to this issue?

I know you referenced earlier the environmental question.

I often think about the role of judges and district attorneys.

Tell our audience, tell our listeners what other races they need to be paying attention to if they care about this issue.

Everything on your ballot.

So, I mean, judges interpret the law.

I mean,

Georgia is a really good example.

You had one judge who invalidated your abortion ban, and now you've just had your state Supreme Court that put it back in place.

So, judges are critically important.

Local governments, whether it's mayors, your city council members, board of supervisors, whatever it's called,

they affect everything from land use decisions are primarily theirs.

Land use decisions directly affect where the hospital is going to be.

Is it going to be, if you live near a hospital, do you have access to public transportation to get to a hospital or to a provider?

Your school board candidates are critically important.

I said earlier in the program, education is the foundation for thriving, healthy communities and a thriving, healthy democracy and a thriving, healthy economy.

If you're not paying attention to who's on the school board making decisions about what's taught in school and how, and how much teachers are getting paid, whether those teachers get access to paid family medical leave,

you're seeding your power in determining that result.

I mean, I think everything on the ballot is important.

Every single office in a government buy of and for the people,

government will only reflect the perspective of and therefore meet the needs of the people who participate.

That's every level of government.

That's every single office.

If you're not using your power to determine, am I putting people in place that are going to listen to my perspective, let alone reflect it, and then therefore meet my needs,

you're giving up your power.

So use it for everything on the ballot, even ballot questions, even constitutional amendments or referendum, even if it's not a person, your vote is your power to determine, is government going to meet your needs or not.

Congresswoman.

Jennifer McClellan, you have been a champion in the state house and in our congressional halls, and you are always a champion for change and for getting good done.

So thank you so much for joining us here today at Assembly Required.

Thank you.

After the break, our second guest will help us navigate more of what we know about reproductive rights, including abortion care and maternal health, and what's at stake around the country.

Stay with us.

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Kavita Serana is a reporter at ProPublica.

Kavita recently broke several important stories about abortion access in Georgia and elsewhere, and she joins me now.

Kavita, welcome to Assembly Required.

Thanks for having me.

Well, before we started recording, you mentioned that you are a writer, not a speaker, but your stories tell such important

narratives.

One of the reasons I wanted to talk to you for this episode is that in Georgia, Amber Thurman and Candy Miller both needed abortion care, and both of their deaths were determined to have been preventable.

Based on your reporting, can you explain what happened to them and why?

Yeah, I'll start with Amber.

Amber Thurman was a 28-year-old mother of a six-year-old son.

She was six weeks pregnant when Georgia's abortion ban went into effect.

There was no options for her within the state.

According to her friend, she was hoping that

a challenge to the law would pause the ban and she may be able to get care close to her home.

Instead, around

nine weeks, she realized that probably wasn't going to happen.

She went out of state to North North Carolina.

While she was on her way there, she had an appointment for what's called a DNC procedure to empty the uterus.

And while she was on her way, she ran into traffic and the clinic told her that instead they could give her abortion medication, which is a standard option at that stage.

It's important to say that abortion medication, you know, major medical studies and organizations who have been researching this for decades find that it is very safe and effective, but sometimes complications can develop.

So, later in the week,

Amber had complications, and she went to the hospital.

And

what we know from the records is that when she arrived at the hospital, she was already developing a grave infection called sepsis,

and she needed a DNC to empty the uterus of infected tissue.

But doctors didn't provide that for 20 hours.

They watched her get sicker, her blood pressure dip, and her organs start to fail.

They talked about providing a DNC twice, but by the time they operated, it was too late.

We know that the Maternal Mortality Review Committee, every state has a committee like this that looks at maternal deaths.

They looked at the timeline of what happened and they concluded that her death could have been prevented.

They specifically said that the delay in care had a large impact, and if doctors had provided a DNC earlier, there was a good chance of saving Amber's life.

Did the doctors explain why they failed to deliver care earlier?

We don't know what was going through the doctor's head, and the hospital didn't respond to requests to comment, so we can't speculate.

All that we know is that these laws are vague and confusing, and they have led to many delays in care that have been documented.

The second case is about a woman named Candy Miller.

She was a 41-year-old mother of three, and what I think is important to point out is from the outset is she had major health challenges.

She had lupus and diabetes and was often in and out of hospitals for treatment.

So

her sister said that doctors had told her that another pregnancy would be life-threatening.

Women with lupus have a 20-fold higher maternal mortality rate.

But when she got pregnant, it was a couple months after Georgia's ban had gone into effect and she didn't have any options in the state.

Even though she had these health risks, her condition at the moment was stable.

And what doctors are telling me is that the way these laws are interpreted, you know, they don't have any health exceptions.

They only have exceptions for,

you know, what's called to prevent death.

So

she didn't even go to a doctor.

She found abortion medication online.

We don't know how far along she was in her pregnancy,

but she experienced complications from her autopsy report.

It looked like she probably would have needed a DNC.

But her family later told the coroner that she wouldn't visit a hospital because she knew about the abortion bans.

And

she was later found unresponsive with a mixture of fentanyl and the kind of medication that's in Benadryl and Tylenol.

Her family doesn't know what was going through her head, but

they did say the understanding in their family was that if you were found to

have an abortion, you could go to jail for that.

I just want to make sure that listeners would hear that Georgia courts have ruled that women can't be prosecuted for their own abortions, but there's been a lot of confusion.

There's been a district attorney attorney who said that, you know, women should prepare to be prosecuted for their own abortions.

And there's not a specific, you know, some laws have included specific language that says women can't be prosecuted for their abortion.

And Georgia's law doesn't say that.

But regardless of all the legalese, you know, Candy Miller didn't know about that.

She just knew about the public conversation on this topic.

One of the things that the Associated Press has reported on since 2022, over 100 pregnant women in medical distress have tried to seek help from emergency rooms or were turned away or they received inadequate care.

A woman in Florida and a woman in Texas both had to miscarry in public restrooms.

A pregnant woman in California waited nine hours in an emergency waiting room and ended up needing a blood transfusion.

And to your point about the lack of clarity in the law, the U.S.

Supreme Court recently refused to clarify the issue of emergency abortion care in Texas.

You raised this issue with Georgia, the fact that, regardless of what the law says, what people understand

because of the vagueness of the law seems to be having an effect.

And

therefore, we have seen several states add ballot initiatives that are pending this November.

Can you talk about how states are responding to the reports of death in their jurisdictions?

Are they responding?

And what kind kind of information are we getting?

Well, and I would first point out what you were saying about this effort to clarify the law:

there's actually been

examples of attorneys general fighting against clarifying the law.

In Texas, the attorney general said that you know the state couldn't be held liable if doctors over-comply with the law for fear of violating it.

In Texas, actually, the attorney general

argued that

the state shouldn't have to follow federal guidelines offering emergency care for pregnancy complications.

This is a federal guideline that requires hospitals to provide that care.

And the Attorney General said that the state law should supersede that.

And that would mean that

in a particular case that was argued, a woman who

had a pregnancy that wasn't viable, and her doctor said she may suffer complications if she were to carry it to term.

He said he would prosecute that doctor if she provided an abortion in Texas.

Secondly, several states have ballot initiatives pending this November regarding reproductive care and abortion.

Can you give us your sense of what's happening either specifically or in general across the country when it comes to the issue of how citizens are asking their governments to respond.

One thing that I have found interesting is recently there's been a conversation among the Republican candidates saying that it's up to the states to decide about abortion.

And it is true that every time

a state has put this on the ballot,

people...

voters have been choosing to protect abortion rights in their state.

But there's also been a lot of efforts, which we've reported on ProPublica

from Republicans to

not allow those ballot initiatives or change the language to make them more confusing.

And in some states,

such as Tennessee,

there is no option to create a ballot initiative.

So there's a big question of, well, when will these voters get to vote on this issue if it's left up to the states?

Georgia is also one of those states without a ballot initiative.

So we wonder the same thing.

Well, I want to bring us to a close because you have been so thoughtful.

And here at Assembly Required, one of the things we try to do is encourage our listeners to do something somewhere soon, to start taking action or to just get a deeper understanding on topics that they care about.

And so, my last big question to you.

What other questions should we be asking?

One thing I've been thinking about is: what does it look like for

patients who are pregnant.

I was pregnant last year to ask our providers about how they're going to handle these kinds of situations.

So, I live in New Jersey where abortion is not restricted.

And so, but I still wanted to ask my providers, you know, how would they handle situations if I were to have a pregnancy

complication?

Did they have people on staff who knew how to provide DNC procedures, DNE procedures, and did they have any specific policies

that could affect me if I did have a pregnancy complication?

Another thing that we are doing at ProPublic is we're continuing to ask officials who have a say in these laws, attorneys general, governors, prosecutors, about how they will be applied.

And we're not just asking them how will they be applied generally.

We're trying to bring specific examples to say, if this is going to be decided by the government, how should the law be interpreted in these specific cases?

One of the things I've learned learned in this reporting is that we're talking about situations that are heartbreaking and that no one would want to have to face.

So that means that people are not prepared to think through what information they need to know.

And we're trying our best to keep asking questions and bring that information to the public.

Kavita Serana, thank you for your time today.

Thank you for your incredible reporting.

One thing I've learned about you in this conversation is the care you take to not only ask questions, but to get the answers right.

And that matters.

And that is a testament to your craft and to the work that you put out here.

So thank you for joining us.

Thank you so much, Stacey.

Thank you again to Representative Jennifer McClellan and to Gavita Serrana for expanding our understanding of the legal restrictions, the policy complications, and the underfunding of maternal health care in America.

As Congresswoman McClellan urged us, please make sure you are voting all the way down the ballot and in every election every year, because many of these choices implicate maternal care.

So it's not just about who wins at the top of the ticket, it's who's making any decisions about our health care.

And as Kavita reminded us, we all have the power to ask questions of our governors and legislators, of the attorneys general, of district attorneys, and of our hospitals.

So write letters, send texts, make phone calls, and ask how they intend to respond, not to the generic, but to specific cases.

Because regardless of whether it applies to you directly or right now, we all have the right to know how the rules work, especially when lives are on the line.

In addition to those two calls to action, each week we want to leave you with a new way to engage in a segment we like to call our toolkit.

At Assembly Required, we encourage the audience to be curious, solve problems, and do good.

So keep digging into the complicated intersections of all of these health issues by following the work of not only ProPublica, but also the journalist at The 19th, an independent nonprofit newsroom that reports on gender, politics, and policy.

At 19thnews.org, you can find the latest news on reproductive rights and the gender-related angles to major political stories.

Also, because maternal mortality has multiple dimensions, I encourage you to learn more about one of the risks in our healthcare deserts, like Clay County, Georgia, where the refusal to expand Medicaid has had devastating consequences.

Visit pbs.org and watch The Only Doctor to learn more.

Now, if you know anything about me, my next call to action won't be a surprise, and I hinted at it at the top.

If we want to save lives, we must vote.

From the top of the ticket with Kamala Harris, the candidate who actually believes in reproductive choice and expanded access to maternal health care, to congressional members, all the way down the ballot.

So find out what, if any, positions on health care access, Medicaid expansion, child care, and abortion that your local officials have.

Many times, local and state elected officials have the power to impact you and your neighbor's access to health care, whether you know it or not.

For example, Medicaid expansion is controlled primarily by your state's governors, so hold them accountable.

If you live in Arizona, Nevada, Colorado, Montana, Nebraska, South Dakota, Missouri, Florida, Maryland, or New York, read about the constitutional amendments that might be on your ballot about abortion to make an informed choice when you vote.

Lastly, learn more about how your legislators and those in Congress are making moves on maternal health by checking out the Black Maternal Health Caucus and specifically their progress on the momnibus.

Now, if you want to tell us what you've learned and saw, or tell us about what you want to know more about, send us an email at assemblyrequired at Crooket.com or leave us a voicemail, and you and your questions and comments might be featured on the pod.

Our number is 213-293-9509.

That wraps up this episode of Assembly Required with Stacey Abrams.

See you here next week.

Assembly Required with Stacey Abrams is a crooked media production.

Our lead show producer is Steven Roberts and our associate producer is Paulina Velasco.

Kirill Polaviev is our video producer.

Our theme song is by Vasilis Fotopoulos.

Thank you to Matt DeGroote, Kyle Seglund, Tyler Boozer, and Samantha Slossberg for production support.

Our executive producers are Katie Long, Madeline Haringer, and me, Stacey Abrams.

Every weekday, NPR's best political reporters come to you on the NPR Politics Podcast.

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