Jennifer Kerns on Women's Rights

Foreign.

I'm Guy Kawasaki and this is the Remarkable People podcast. Today's remarkable guest is Dr. Jennifer Kearns. Our topic is the implications of the overturning of Roe vs. Wade by the US Supreme Court. Suffice it to say that the sky is truly falling for women's reproductive rights. Jennifer is a practicing OBGYN and an associate professor at the University of California, San Francisco. She's also the director of the Complex Family Planning Fellowship. She has been traveling from the Bay Area to Oklahoma City to provide reproductive care. Thus, she has firsthand knowledge of the reality and needs for abortion services versus the dehumanizing picture that has been painted by many politicians. Jennifer attended the University of California, San Francisco for medical school and obtained her Ms. And MPH degrees from the School of Public Health at the University of California, Berkeley. In 2009, she received the Outstanding Resident Teaching Award and in 2010 she was named Outstanding Clinical Fellow. When a man does something courageous, the saying is that he has some balls. For years I pondered the female equivalent and the best I have come up with is she has some ovaries. Let me tell you something. Jennifer has some big ovaries because she is in the thick of the battle for women's reproductive rights. Before we get started, let's test your knowledge of pregnancy and abortion. True or false? With proper care, a six week old baby can survive outside a woman's body. True or false? Six weeks pregnant means it's been six weeks after a woman's usual time for her period. True or false? You can hear the opening and closing of heart valves of a six week old baby. In each case, the answer is false. If you do well on this quiz, you're probably more knowledgeable about pregnancy than six of the nine Supreme Court Justices. I'm Guy Kawasaki. This is remarkable people. And now here's the remarkable Dr. Jennifer Kearns.

Who is getting an abortion right now and what are the circumstances?

Everybody you can imagine is getting an abortion. Abortion is one of the most common procedures in the United States. About 1 in every 3 or 4 people of reproductive age between 15 and 44 will have had an abortion at some point in their lifetime. We're really talking about people of all ages, all races, all religious identities, all different races and ethnicities, including people who don't have families already and people who do have families. So it really is a cross cutting issue across the population.

What percentage do you think are third trimester abortions and what are the circumstances for these?

Those are incredibly rare. So when we talk about abortion, over 90% are done at either 13 weeks or less gestation, that's about three months. You know, when we talk about third trimester abortion, this is a real outlier. This doesn't happen very frequently. Sometimes this is really highlighted in the media. It's something that grabs people's attention because obviously it's a little bit more to confront when you think about somebody being that far along in pregnancy. So when it does occur, it occurs under really dire circumstances. So these are situations where somebody has had a very late diagnosis of a severe complication with the pregnancy, perhaps a fetal anomaly or a malformation that is lethal that will mean that the baby will never survive. We also sometimes see people develop some pretty serious medical problems in pregnancy. Pregnancy puts people at risk of different health problems. It raises the risk of stroke, of blood clots, of hypertension, blood pressure disorders, seizure. So there are some people who develop some pretty serious medical conditions and that might prompt a decision around termination if we're talking about saving the health or the life of the person who's pregnant. Also in some cases we see people who have presented very late in pregnancy. And one example of this is people at really extremes of youth and people who've been victims of sexual assault, of incest. I've taken care of people who are 11, 12 years old and don't discover they're pregnant until quite late. But again, these are incredibly rare circumstances. And when we talk about abortion in the US this is really not like a topic that is happening. What we're really talking about are people who for the most part are recognizing that they're pregnant early in pregnancy, seeking pregnancy termination, which is an incredibly safe procedure, which now, of course, is at risk and won't be an option for many people in the U.S.

So when you do a third trimester abortion, it is for a very good medical reason. It's not because you just decided, I don't want a baby.

Yeah, that's right. I think that one of the problems with talking about third trimester abortion is it conjures up some idea that people are being really thoughtless and careless about this decision. And for the purposes of highlighting this point, it's probably a good thing to talk about. And that's probably the only reason it's a good thing to talk about, which is that people are not making this decision lightly. So people are looking at their lives, they're looking at their circumstances, and they are making the decision to undergo abortion for reasons that are true and right and loving for themselves and for the people who they already care for. For their existing families. And that's no different for people who undergo third trimester abortion. Again, these are extremes of circumstances that people are presented with babies whose brains are not developing in any kind of normal way or have a genetic anomaly that means that they are not going to survive. And then at that point, continu a pregnancy when a baby is not going to survive makes no sense. All it does is pose greater risks to the person who's pregnant.

So not having third trimester abortions is going to cost lives?

Yeah, I think restricting abortion for any reason is going to cost lives. This is a story that we have learned over and over again. We've learned it in this country before Roe v. Wade. We've learned it from other countries. We've seen it just at the state level with extreme restrictions. Anytime you restrict abortion or make it illegal, women suffer, families suffer, existing kids suffer. So what we're about to see is we're about to see an uptick in maternal morbidity and mortality, which is pretty gruesome to think about since this country already has such a horrible maternal mortality and morbidity, especially for people of color.

Do you think that politicians and Supreme Court justices have an accurate view of who is getting an abortion and the circumstances?

No, they really don't. They have really missed the story on this one and continue to miss it. And we see this really highlighted in some of Justice Alito's writings in the leaked document. He uses language that is incredibly dehumanizing. He uses the term abortionists to describe people who perform abortions. He uses incredibly dehumanizing language for anybody who seeks abortion and for those who assist in abortion or do abortion work. And it's this kind of language that really is successful at separating the human story. The reason that people undergo abortion, sort of what you see in front of you is the personal story and making this sort of a political tool and an element of control. They really don't have their finger on the pulse of what's going on here in this country, which is that people are coming to this decision out of a desire to protect their own health, to further their own health and wellness, and to do that for their families, their loved ones and their communities.

How effective is restricting abortion in preventing abortion?

It is effective in that it creates some incredible barriers for people. So there are certainly some people who are going to be forced to continue a pregnancy that they wished to terminate because of these restrictions or because it's made illegal. What it also does is it forces people to turn to alternatives this is a big discussion that's going on right now. So one of the alternatives is self managed abortion or sourcing an abortion outside of the medical community. And we actually know that self managed abortion is very safe and very effective. The bigger issue is, number one, helping patients access safe self managed abortion. And that really means helping them access the medications that are used to affect an abortion. And probably more concerning is number two, which is the legal context in which it's happening. So people who are in states where it's going to become illegal, who self manage their abortion, are of course at risk of being prosecuted for doing something illegal. Big picture, what we know happens when we restrict abortion and when we make it illegal is that people continue to try to access abortion. This doesn't change the problem. There are estimates that about 300,000 women are in states where abortion will become illegal who will need to access abortion. And the projection is that only about 100,000 of those people will be able to travel across state lines and access abortion in a neighboring state where it's legal. 100,000 will be able to like obtain funds, take time off of work, find childcare, all of the things that are required to travel out of state to access abortion. So that leaves a couple hundred thousand people who won't be able to access abortion. And then those people are the people that we're talking about. Those people will either be able to successfully self manage an abortion in a safe manner, they may try other methods that are unsafe. We've seen this happen over and over again. Again, a lesson from this country, from other countries, and then people who will be forced to continue a pregnancy when they weren't a position to bring another baby into this world.

Do you see any ways to turn down the temperature on this battle between pro life and pro choice parties?

I think it really the way to really come together around this is to talk about people and to talk about individual stories. We have statistics like 1 in 3 and 1 in 4 people undergo abortion in their lifetime. And we also know that the majority of Americans support keeping abortion legal. And yet we're facing a political situation where about half of the states are projected to make abortion illegal. So there's a real disconnect happening. And I think when we talk to people who oppose abortion, the way to really talk about it is through individual stories and individual people. And that's where connection is made. And I think this is why the strategy of people who oppose abortion has been so successful is that they've managed to create and promote this agenda of dehumanization and so many people who are removed from this situation or think that they're removed, meaning they don't know that people in their lives possibly have had an abortion or may have an abortion. These people have managed to look at this whole issue from a perspective of judgment and not really understanding individual circumstances. One example of this is many of us, myself and my colleagues, have seen people come for abortions who say that they are against abortion. And it's a real piece of cognitive dissonance and a real conundrum to think about. You know, when we get down to the level of the person and talk about individual circumstances, I think that's when we make connections. And it's that human connection that will help people understand a situation that maybe they didn't understand previously.

And what does someone who says.

She'S.

Anti abortion say about getting an abortion? How does one rationalize that?

Yeah, you know, I think people really know in their fabric whether it's right for them to bring a child into this world or not. And that's just something that I've seen over and over again with patients who I've taken care of. And people also come with other emotions around it. Some of those are self judgment, some of those are shame. It's nearly impossible not to absorb some stigma in this country. And then certainly for certain groups of people who grow up in communities where this is really stigmatized, it's nearly impossible to not internalize some of that stigma as well. So I don't envy these people who really battle out some internalized shame around this pitted against this deep true knowing that they have, that this is not right for them. So I think that we see this not just in abortion care, but we see this sort of all over with people and how they grapple with certain decisions. But I think what it comes down to is that ultimately they know that for them it is not right in that moment. And it doesn't necessarily translate into then becoming a voice for advocating for other people who are in that situation. There's still so much internalized judgment and stigma at the individual and community level to battle.

The magic number seems to be six weeks. And what is the state of the embryo? Fetus, Whatever's the right term at that point, at six weeks.

So first I would say another word for magic might be strategic in terms of choosing six weeks as the number for this abortion restriction. So this is what's happening in Texas, this was just passed in Oklahoma, six week ban. So just to back up a little bit what we mean by Six weeks is the pregnancy has not been developing for six weeks. The pregnancy has been developing for four weeks at the most. So we count six weeks as the time from the last menstrual period. Pregnancy starts to happen about two weeks after that. So it's about four weeks that we're talking about. And that leaves very little time for somebody to detect pregnancy. So somebody has to miss a period. Usually then within that week, at some point a pregnancy test might be positive. And so that gets somebody closer to five weeks. So that's sort of best case scenario of detecting pregnancy. Then you have to call some clinics, find an appointment and actually get in before six weeks. And God forbid you're in a state where there's a 72 hour consent law which then tacks on three more days to when you can have that appointment. So what's happening at six weeks? These bands have been termed the fetal heartbeat ban. So the wording is that they've chosen six weeks because that's when there's a heartbeat. When we say the word heartbeat, we imagine a fully formed four chamber heart with valves that's beating. You know, that's what we hear when we put our head up against somebody's chest or when we use a stethoscope. We hear the valves opening and closing. And that's what we think of as a heartbeat. It's an incredibly evocative term. I think it evokes a lot of sort of fond feelings for many people, especially for people who have been pregnant or have been with somebody who's been pregnant and they go to some appointments and there's always the point when you are waiting for the heartbeat and you hear this and it's a really exciting thing. But at six weeks, what we're talking about with a heartbeat is we're talking about a grouping of cell, what will become like the driver of electrical activity in a fully formed heart. So these are cells that have electrical activity that are just forming. And what we hear is actually the translation of that electrical energy through an ultrasound probe. So we're not hearing a heartbeat as we think of it today, sort of as we think of it in a fully formed individual. What we're hearing is electrical activity whose sound is transmitted through a transducer and then comes through a machine in a particular kind of way. It's a pointed and strategic move by people who oppose abortion to really restrict abortion completely.

But could it not be an inadvertent loophole in the sense that one could legally argue that you didn't hear a heartbeat you heard this ultrasound created sound.

It wasn't the heartbeat.

So isn't that a loophole that defeats this law?

Yeah, it certainly could be. I think the other piece to this is that what we're seeing in some of these bills is that people who are assisting people in obtaining abortion are also at risk. So any old person can come around and say, hey, I think that this person over here was trying to help this patient obtain an abortion. And then you're suddenly in a system where it's very unclear what your arguments can be. We've already seen some elements of this happen in Texas and we know that that providers and other people who work in abortion care are really scared. They're scared of being charged with a felony for doing the work that they've been doing this whole time. So yeah, certainly it could be viewed as a loophole. I don't know that anybody is feeling very protected these days in terms of using it as a loophole.

So when do you actually hear a heartbeat? Valves opening and closing?

Yeah, that's a great question. There are stethoscopes that you can use later in pregnancy and the sound that you would hear from those would actually be the fully formed heart. I'm not a specialist in pediatric cardiology and I'd have to look up the actual age at which the valves develop and the four chambers of the heart. I certainly know that at six weeks, that's not what we're talking about.

And at six weeks, in just the state of the art medical facility, best doctors and nurses in the world, is a six week old fetus viable outside of the woman's body?

No, never. We're talking about a piece of tissue that is on the order of millimeters in size. We don't have technology to grow an embryo into a fetus into a baby outside of a person.

So flipping the question the other way, at what point would you say it is morally and should be legally wrong to provide an abortion?

Yeah, that's a great question. I think looking at it from the position of abortion as being part of reproductive health care, as being medical care, I don't know that there's any reason to place restrictions on abortion. So the reason to place restrictions on something is if there's a public health need, right? There's some problem happening where some people are going around and doing something that we consider dangerous or immoral. So this is not happening. You know, as we were talking about earlier, people are not going around and at eight months of pregnancy deciding that they want to end the pregnancy for whatever reason, this is not the reality that's happening. Anytime restrictions are placed on any kind of medical procedure, it starts to interfere with some very real scenarios where abortion might be the best answer for everybody. So this is a decision that belongs with patients and it belongs with patients in consultation with their healthcare providers. Restrictions on abortion are unnecessary and harmful. Wow.

So let's say that Roe vs Wade.

Is reversed and you live in one of those trigger states and you're an OB gyn. How is your practice going to change?

Yeah, that's a great question. We have some colleagues in Texas and in Oklahoma. I'm already hearing stories come out of Texas of some scenarios where patient care is really being affected in a negative way. So one example is with ectopic pregnancies. Ectopic pregnancies are pregnancies that implant outside of the uterus, typically in the fallopian tubes. And those are pregnancies that will never make it. So they will never progress, they will never grow into a normal pregnancy, into a baby. The fallopian tube cannot support an ongoing pregnancy. And in fact what it does if it keeps growing in the fallopian tube is it ruptures, it explodes, essentially. And pregnancies have an amazing ability to recruit blood supply. And when that happens, people are at grave risk of dying from hemorrhage. There are cases already in Texas where providers are afraid to care for people with ectopic pregnancy. So they now have this six week heartbeat ban. And there are some providers who are afraid of being caught up in this legislation, afraid of being prosecuted for doing an abortion if they're taking care of people with an ectopic pregnancy. So we have a situation now where some patients are being transferred out of Texas with a life threatening condition, which is not in the best interests of people at all, that's delaying medical care for really silly reasons. The other piece to this is that anybody who works in pregnancy care knows that there are so many other scenarios where people could be really caught up in this, both providers and patients. Now anybody who's pregnant and bleeding and comes into the emergency room could be suspected of trying to self manage an abortion. So people who have miscarriage, people who have a pregnancy and, and it's unclear sort of where that pregnancy is growing, all of these people could potentially have a spotlight on them and be accused of trying to self manage an abortion. And the way the law is right now really opens it up to kind of anybody who has an axe to grind about this, to point somebody out and refer to the authorities. You Know, we already saw this in Texas with the case of somebody who presented to an emergency room and was then arrested for suspicion of trying to self manage an abortion. And luckily there was a district attorney who decided not to press charges. But you could see that going a really different way depending on what area of the state or what state in the country that a patient is in.

So just to be clear, so you're saying that a woman with an ectopic pregnancy who is having this medical crisis goes to an error and may be refused treatment because terminating an ectopic pregnancy is considered an abortion and illegal? Did I get that right?

I think the concern is that the writing of this law is vague enough that it could be applied to a variety of circumstances. And the bigger point is you can't just write something and assume that it's just only going to apply to abortion. There are so many other scenarios in early pregnancy where there's overlap. And what that does is it opens the door for people to then be confused and worried about doing the right thing, about caring for patients in the right way. And that's already what's started to happen.

In Texas is the philosophy that once an egg is fertilized, anything that prevents that egg from developing, including preventing implantation, is an abortion.

I think you can talk to 100 people and have 100 different definitions of when it's relevant. And people have different lines about when it's okay to do something and not do something else. I think the bigger unifying idea behind all of this is it's control. It is making sure that people are not in control of their own fertility. If it were something else, if it were about love for children in this country, we would see really different policies in this country. If it were concern for the unborn and concern for babies, we would see people who were promoting legislation in a lot of different areas. We would also see people supporting contraception. And these have never been pieces of a political agenda that have gone along with people who oppose abortion. So what we're really talking about is control. And we can talk about what happens before fertilization and after fertilization with implantation. And we can talk about the different organ systems that develop at different times. And is there a heartbeat and is it electrical activity? And ultimately what this comes down to is that this is a very clear agenda for pregnant people to not have autonomy over their own fertility.

Wow. I just want to understand something about birth control. So is an iud, which can prevent pregnancy by affecting sperm or by affecting implantation, and is Plan B, which can affect implantation. Are those things at risk?

Yeah, I think a lot of us are worried. Contraception and emergency contraception, which is what you're referring to, are next on the chopping block. These are also methods to control fertility. And before this recent spate of abortion restrictions and before the leaked document, we've seen contraception regulated in a variety of different ways. So, yeah, the different forms of emergency contraception that you mentioned, Plan B and also IUDs, can be used as emergency contraception, meaning a form of contraception after an act of unprotected sex, Those are certainly at risk, as are every other contraceptive method that we know of. So birth control pills, patch ring injection, these all kind of fit in the same category of ways that people control their fertility. And that's really the issue at stake here.

And at an extreme, what about surplus embryos from IVF procedures?

Yeah, this is a great point. We talk about abortion, and these restrictions specifically target abortion, but this seeps out into lots of other different areas. So people who have undergone IVF or have some leftover frozen embryos, these are also things that are going to be caught up in all of this legislation. The fate of those is certainly uncertain. And I wouldn't be surprised if these also sort of get wrapped up in all of these restrictions and people aren't able to use them or access them.

So if you are a young woman.

And let's say you're in a trigger.

State, this is post Roe versus Wade. So you're in this worst case, and you're using a period tracking app, or obviously you're using Google searches to search for, I don't know, abortions near me or something like that? So now, should you be paranoid that some assistant district attorney is going to, you know, bring a murder charge up against you, and then they're gonna subpoena your phone and look where you searched and subpoena the period tracking app company and figure it out. Well, she was tracking fine, and then all of a sudden there were no periods. What happened here? Am I being paranoid or can that scenario happen?

It's terrifying. I think that you're right on to think about this, and people are definitely talking about this. I think most of us have had, or all of us have had the experience of showing up in a different city. And then all of a sudden we're getting advertised through social media or something about things happening in that city. And you start to realize pretty quickly, wow, just by virtue of having a smartphone or being on social media or Being on these websites and my location on. There's information about me that is being transmitted. And it brings up some very serious privacy concerns. We consider healthcare to be this bastion of privacy that there's this embedded right to privacy with our healthcare. And that may not be true. In fact, this person who presented for care in Texas, who was reported to authorities, she presented to a healthcare facility. So there was something about that situation where some people deemed it appropriate to share her medical information. So should we be concerned about all of the ways that we use our devices and ways that our information can be tracked? Absolutely. You know, paranoid to. To turn to like a paper and pen. I don't think it's. It's being paranoid at all. You know, if I lived in one of these states, I would absolutely want to minimize the risk that other people were accessing some of my private information, specifically around my periods and any information that I was trying to look up.

In this rare instance, you really could make the case that the sky is falling. This is not hysteria at this point, is it?

It's really not. I think a lot of us are feeling some degree of panic and sadness and horror just knowing what's ahead of us. I'm of a gener where all of my time in medical training and in my career have been at a time when abortion has been legal. But I was taught by some people of a generation that practiced before Roe v. Wade, and we used to routinely hear stories from them about what it looked like. There were entire hospital wards dedicated to taking care of people who were sick from unsafe abortions. And we heard these stories over and over again, and it was unbelievable. I think many people have thought for a very long time that this is sort of an unalienable right now in this country, and that this won't go away and that Roe v. Wade has enough press precedents that it won't be overturned. And certainly with the face of the Supreme Court right now, it's pretty clear that it won't be protected by the Supreme Court. So, yeah, it absolutely does feel like a pretty devastating moment just knowing the kind of suffering that will be exacted on the population of the US and specifically a population that's already suffering from poor access to health care, from being marginalized by the medical community and a host of other things in their lives. So, yeah, I. I think your description of the sky is falling is pretty apt.

I think one of the statements that people against abortion say is that people who have had abortion, they go into depression. There's a lot of Negative effects after having an abortion. And has that proven to be true?

Yes, we actually have a lot of research to speak to this topic. One of the most interesting studies that has produced quite a number of manuscripts and a bunch of analyses have happened from it. It's called the Turn Away Study and this is a study out of ucsf. There's actually a book that was published all about the study as well. And what they did was they compared people who presented for an abortion and were denied an abortion because they were just too far for whatever the clinic's gestational limit was. They compared those people to people who presented and just made the cutoff. A very similar group of people, some of whom were forced to continue the pregnancy because they couldn't access abortion at that place. And then some people who were able to obtain the abortion. And they've followed these people for quite a while afterwards too. And what we know now is that people who are denied an abortion have increased physical health problems. They're more likely to be stuck in poverty. Their families are more likely to be stuck in poverty. Existing children in those families do worse. People have a higher risk of being stuck in abusive or violent relationships when they're forced to continue the pregnancy. So we have a whole of literature demonstrating long term effects, not just for the person, but for the people in that person's family as well who are affected. And it's a real domino effect. So it's that person and then it's that person's family and the communities that person is in. We also know that abortion does not cause mental health problems. There were a number of research studies that were conducted very poorly with questionable research methods that came to this conclusion that said, oh, we analyzed these data and we found that people who undergo abortion are more likely to be depressed or anxious after the abortion and that it's because of the abortion. And we know from some very well designed studies right now that that is not true. This has been shown sort of very definitively in the literature. Abortion does not cause mental health problems. Getting back to your very first question of who has abortions? Everybody has abortions. People who already have depression have abortions. People who don't have depression have abortions. So the story really is that people's mental health before the abortion is pretty similar to people's mental health after abortion. Plus for the vast majority of people, a great deal of relief. So what we see is that greater than 90% of people report immediately after the abortion feeling a great amount of relief. In short, no, abortion does not lead to mental health problems. It doesn't lead to many other things that people who oppose abortion also state. There's a myth out there also that abortion increases your risk of breast cancer. In fact, there are certain states that require people in abortion clinics to tell patients this, even though it is untrue. And we know from again, many studies that abortion does not increase someone's risk of breast cancer.

Do you think that these people who are drafting these laws, do they talk to doctors or scientists at all or are they just making shit up as they go?

Yeah, if they're talking to doctors or scientists, they're not talking to the right ones, that's for sure. There are a lot of people like myself who do a lot of advocacy work and speaking with legislators. I think ultimately what happens is people have an idea about what they want to happen and then they gather data that supports that. They're not talking to people who would present some difference of opinion. I think it's people have come to their conclusion and then they gather some information that supports that conclusion.

Wow. If you put it in context, if you said, all right, we're going to go along with the second Amendment, you have the right to bear arms, but just like you can't have an abortion after six weeks, you can't have a gun until you're 60 years old. So, yeah, what's the problem? Wouldn't that be the liberal version of.

A law like this?

This is a semi facetious question, but what is going to happen when some Republican's daughter, or more accurately granddaughter, has an unwanted pregnancy or an ectopic pregnancy, or is trying to conceive and has extra fertilized embryos in those scenarios, those people are going to violate the law, right?

Yeah. And you know, the people, people with access to travel, access to money, people who have privilege in any of the ways that we think of privilege, are still going to be able to access abortion. They're going to be able to drive or fly to a place where abortion is still legal. We're talking about really putting the squeeze on a group of people who are already practically squeezed dry. So the people who are really going to suffer are the people who are already suffering. You know, it's not going to be the daughters and granddaughter of Republican senators and any kind of legislators. Those people are going to be just fine.

So it's going to be up to some assistant district attorney who wants to make a name for himself and is going to pick a black or brown or yellow woman to foster his political career. Am I being Too depressingly negative and pessimistic.

I think you're painting a picture of what we see happen in a whole lot of different scenarios. And, yeah, there's a lot of power that is going to be given to people like district attorneys to hospital administration to determine what the institutional policies are that they're going to follow to really set the tone around this. And some people may end up being lucky and being in a place where somebody doesn't have this agenda at the top of their mind. And there likely will be some people who really do want to make an example and take a lead in this direction on this. We've seen this play out a lot of times in other areas. It's scary to think about. And I don't think that you're. You're being hyperbolic. And in painting that picture, well, once.

I publish this episode, I'm gonna lose all my Republican followers to this podcast. So basically all three of them, but three of them think I'm Robert Kiyosaki of Rich Dad, Poor dad, not Guy Kawasaki. So I'm not too worried. I have to ask you one more hyperbolic potential question, which is, is going forward, is any vote for a Republican, whether it's a senator, board of education, I mean, even at the lowest state level, is a vote for a Republican a vote against women's reproductive rights?

Yeah, I think it really is. The Republican Party today is not the Republican Party of 20, 30 years ago or more. The Republican Party has gone through a transformation where they have made this issue, the issue of abortion, a single issue for their voters. Are there Republicans out there who support pro choice agendas? Sure. But does the Republican Party really strong arm its entire party to stand behind opposing abortion? Absolutely. We have seen this play out in millions of ways at the federal and the state level. If you are interested in protecting reproductive health for people in this country, you really have to look at what people's voting record is. And certainly I would be be suspicious of voting for anybody who's a Republican, since the party has been very clear that this is one of its number one agenda items.

So what can people do? How can they support women's reproductive rights going forward?

We, of course, want to tell everybody to vote. That continues to be probably the number one thing that people can do. At the same time as I say that you have to. I have to acknowledge that voting districts are chopped up in a way that feels pretty unfair as well. And so sometimes that can feel like it's not really a clear path to having your voice Heard speaking out, talking to people in your communities about what your views are, being somebody that other people can come to if they need help, advocating telling stories that have a human face and don't really come from a place of dehumanization. These are all ways. And then certainly if anybody is in a position to make donations, these are incredibly important right now. There are a number of organizations that are mostly working right now now to help patients get from states where it's heavily restricted or illegal to states where it is illegal. And I'm happy to provide some names of those.

Provide them. I'll put them in the show notes also. Okay, one last question. What if somebody's out there saying, you know, it's their fault they got pregnant. Why didn't they not have sex? Why didn't they have birth control? They blew it. It's their fault, not ours. It's not the legal system's fault. They blew it.

Absolutely. This is something we hear all the time. And this is a really judgmental frame that some have. And it's a way that people distinguish themselves from others and from saying, you know, oh, I wouldn't be in this situation. I think the reality is that people do have sex. We've seen that, like abstinence programs don't work. This is not really consistent with human behavior. This really comes from, like a Christian supremacy framework to just tell people, just don't do it. You know, Also the reality is that we have an epidemic of sexual assault and problems with consent in this country and outside of this country, of course, as well. We're not just talking about people and their individual actions. We're talking about a society that. Where it's not always possible to just move through without having sex. So that's kind of a non. Starter. And yeah, I would just say that the reality is that people do.

So I hope that this battle. Because your name is out there and you're in many NPR articles, that's how I found you. So I hope that this does not take too much of a personal toll on you. My money's on you, Jennifer. My money is on you. Yeah.

I really want to acknowledge all of my colleagues who work across the country, and specifically people who work in areas where it does feel less safe. I'm pretty privileged to work in the Bay Area. I have a community and a support network and work colleagues that afford me layers of protection. And I'm very aware of that. And I'm aware that many of my colleagues don't have that. They're working in states where they have to really stay underground. I also feel like this is part of job. I have these privileges here to be able to do this and to be able to be out there a little bit and have my name out there. And I'm happy to do it because I'm on the shoulders of all of these other people who are in the trenches and are really living life quite differently in different communities. So a huge respect for everybody who's doing this work and especially people who are doing it in communities where it feels less safe.

Let me just say that I am morally appalled at what's going on with women's reproductive rights. The oorTurn of Roe vs. Wade is an example where the sky is truly falling. Jennifer suggested some organizations that you can support in order to take action in this war on women's reproductive rights. I created a landing page with links to each organization. Organization go to tinyurl.com choicematters now again. T I n y u r l.com choice matters now. I'm Guy Kawasaki. This is remarkable people. Thank you to Jennifer Kearns and the women and men who are taking a stand stand and providing help right now in the war against women's reproductive rights. One more time. T I N Y U D R l dot com Choice Matters now. And maybe, just maybe, you're the granddaughter of a Supreme Court justice, Senator, Representative, Governor, just attorney. Forward them this episode. Ask them to take the test at the beginning. You never know. My thanks to Peg Fitzpatrick, Shannon Hernandez, Madison Nismer, Luis Magana and Alexis Nishimura. The Remarkable People team. Until next time, mahalo and aloha. This is Remarkable People.