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Settle In with Irin Carmon
01:02:30
Journalist Irin Carmon was eight months pregnant when the U.S. Supreme Court overturned Roe v. Wade, returning the right to an abortion back to state lawmakers. In this episode of Settle In, Carmon tells Amna Nawaz about how her own experience inform...
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- [00:00]
A
Hi, everyone, it's Amna Nawaz. Welcome to another episode of Settle In. Today's guest is author and really one of my favorite journalists, Irene Carmon. Even if you don't know her by name, I guarantee you you have come into contact with her work. She is one of the leading reporters when it comes to women's health and reproductive rights and all of the impacts in America to health care since the overturning of Roe v. Wade. You probably also heard of her because she's the force behind the notorious RBG book documenting the life and of Supreme Court Justice Ruth Bader Ginsburg. And she's written extensively on all of these topics. Her new book is called Unbearable, and it documents the stories of five women who are all pregnant or trying to get pregnant in modern America. And it all, of course, unfolds at a time when your health care and your rights really depend on where you live. It's a beautifully written book, very intimately told, and it written also talks to us about how her own pregnancies inform her work and how she approaches these interviews and these women. She shares the story of the very first time that she and I met, which I didn't know the backstory. We both just ended up crying talking to each other on the set of this very big fancy photo shoot, which she tells very in a funny way. But it's a great book, It's a great conversation. I hope you'll take a listen. So settle in and enjoy my chat with author Irene Carmon.
- [01:29]
Irene Carmon, it is such a pleasure to talk to you today. Welcome to the podcast.
- [01:33]
B
Thank you so much. I'm so thrilled to be here.
- [01:36]
A
So I have been a big fan of your reporting for a very long time. I feel like you are one of the not just person with great expertise in a lot of these issues around women's rights and reproductive rights and the legal landscape or policy meets people in their real lives. But you always tell these stories with such empathy and such heart and your voice is so unique in this space, which is why I was so excited to read your new book, which is called Unbarrel. And it is the subtitle that is the punch here, which is Five Women and the Perils of Pregnancy in America. So as someone who spent so much time in this space reporting on these stories, what made you want to bring all these stories and these five women in particular together in this book right now?
- [02:20]
B
Well, first of all, I'm so thrilled to be in conversation with you about this. Thank you so much for having me so the starting idea or premise, before it even began to tell the stories, was that pregnancy is a profound experience that can change you. Regardless of the course your pregnancy takes, regardless of how you feel about it. It's a physical change, it's a psychological change. It's something that brings up all of your deeply held values, your relationships, and it's also something that law and medicine have opinions about. And so, depending on where you live, the course of your pregnancy and the choices that you have about it will be profoundly different, depending on who you are, depending on how much money you make. So we tend to think of the pregnancy as, you know, a single thing, or we tend to think of abortion is over here, infertility is over here, birth is over here. Starting from that premise of the profound kind of differences, but also deep seated universality of how significant a pregnancy can be in somebody's life, I also wanted to break down the silos of these different experiences of pregnancy. They've been siloed by the law, they've been siloed by the practice of medicine, they've been siloed by history and practitioners who have been separated from each other. But in reality, as these five women's stories make really clear, over the course of somebody's life, they can experience pregnancy in so many different contexts, with so many different themes, feelings, and with so many different legal treatments. But when it comes to seeking care for those pregnancies, or to be able to have a say over what happens with your body and your life, the same animating principles limit us. So whether you. So you know, the women in my book, most of them, some of them are pregnant more than once throughout the course of the book, most of them actually are not looking to end their pregnancies, and they want to keep their pregnancies, they want to raise their children. But as I report on in the book and as I tell their stories, which unspool over the course of before, during and after pregnancy, the way that American medicine and law has been set up has.
- [04:41]
Has profoundly limited and harmed and cruelly treated too many people who find themselves in these situations. Whether that's needing miscarriage care, whether that's having respectful and safe birth care, or whether that's seeking to end a pregnancy.
- [04:58]
A
The fascinating thing about the stories as you share them is that even when you expect things to unfold in a certain way because of someone's socioeconomic status or because of where they live, some of these same things and same challenges and same treatments ring true even there. And I'm gonna Unpack all of that. I wanna talk to you about some of those silos you mentioned there too. But I have to put to you this one line when you were talk about why you wanted to write this book in the very first few pages. Cause this stuck with me. You said, what's clear to me from my years of reporting and my own experiences is how incomplete our story of American reproduction has been and how much has been unexpressed, hidden or taken for granted. The incomplete part stuck with me. What did you mean by that?
- [05:44]
B
Well, first of all, we can't have too many stories about what this profoundly life changing experience can do. I think for me, when I the real inspiration for writing this book, the actual moment, even though in some ways I was leading up to it in my entire career of reporting, was being pregnant. I was six months pregnant for the second time when Roe v. Wade was overturned with the Dobbs decision. And I was eight months pregnant when the decision was finalized. And for me, one of the stories that I wanted to tell, I was covering the decision as a reporter in New York magazine. I was writing about all the implications for policy and for law and the dynamics of the decision and the holding. But I was also feeling in my bones what it would mean for this profound change in American law and life, how it would actually affect people. And I did not need an abortion. I did not seek an abortion. I was really excited to be pregnant. But I also found myself thinking, why hasn't anybody talked about how what an enormous physical.
- [06:52]
And grave undertaking pregnancy can be in the context of even when you want to, and what it might mean to force this on someone. I'm not saying nobody talked about it, but for me it was something that I felt in my bones. I felt it in my blood. I could feel like in the extra heart that was beating inside of me that there was a profound erasure from that opinion in particular and from the way a leader wrote about it of the seriousness of pregnancy, regardless of the circumstances you find yourself in. So one of the parts that I thought was incomplete and inexpressed is that you might think of yourself unexpressed is that you might think of yourself as never needing this kind of care, right. And there are women in the book who I write about who never saw, thought they would be in this situation, right. And find themselves seeking a kind of care that is stigmatized, that is illegal, that is secret, or that they will be punished for one way or another.
- [07:43]
And so it felt like the best way to tell that story was to. I started a Little bit by weaving in my own personal story, even though in many ways it's not an extraordinary one. But I think the very fact that for me, as a married, white, upper middle class, privileged woman who literally reports on this for a living, the feelings that I had of being made to feel smaller or less than a fully adult human in control of my own decisions during my pregnancy were so instructive for me because I thought, like what, what chance does anybody who doesn't have all of this going for them have in this system that says that the moment you become pregnant, you have fewer constitutional rights, you have fewer rights of autonomy in medicine, you will be treated like, to quote one of the women in my book, a child animal. And that's not to diminish the fact that my pregnancies and many other people's pregnancies were deeply joyful and I was excited about them. But that's not a reason to diminish the individual pregnant person's humanity.
- [08:47]
A
I mean, clearly being pregnant, as you're record reporting these stories, it informs how you view the issue, right? It informs how you view these women's lives. It informs, I'm going to assume, the questions you ask and the kinds of places you're willing to go and probe or not. And I wonder if how. Because I remember being, I remember being a few months pregnant, being in a war zone, and I remember being there and looking at the lives of people around me and it really striking me in the moment, just the vast difference between the life that I was going to be able to provide my child and the lives that most of the children on the ground were going to have for the rest of their days. And it absolutely had an impact on the way that I looked at this. Right. Absolutely had an impact on what I chose to ask in the moment. Your own experience of being pregnant as you're reporting on other women's pregnancies. How hard was that for you? How do you figure out where the line is to separate yourself as journalists, but also sort of participate in what has to be a vulnerable conversation on both sides?
- [09:51]
B
It felt like a real honor and privilege to have that kind of intimate conversation with someone. And I don't think that I could have understood it or had the same level of empathy for it if I wasn't going through easier, more privileged version myself. And so, you know, yes, I think it's, obviously it's difficult to do things like read a book about stillbirth when you're eight months pregnant, but that's, I mean, it's a privilege to be able to tell these stories. And I think, you know, most of the stories in this book. I would not have been able to tell them or I would not have thought to tell them if I wasn't situated where I was in my own life. And I was reporting on this before I ever became a parent. But I will say that it changed my skin in the game and it changed how I felt about what an enormous upheaval on your hormones, on your sense of self, on your relationships with other people a pregnancy can be. And so I described what happened with Dobbs. I would say also one of the women whose stories I tell in the book Shelly Burns in Alabama, I discovered her story of being arrested six days postpartum. I was reading about it in the local press. It had gone somewhat viral. She was arrested six days postpartum for a single positive drug test. And rather than being offered treatment or support, she was dragged from the hospital with handcuffs and jailed for months. And she is still separated from her children.
- [11:21]
And so to experience that, while I was sitting, I was telling you that this chair I'm sitting on is the chair that used to be in my kids rooms where I fed both of them. And it was literally in the middle of the night on this chair that I was reading about this sobbing because I, like I said, I have so much support in my life, but I was sobbing constantly. I talk a little bit about the hormonal changes that happen in postpartum, how abrupt it is, how it's almost like going through menopause in 20.
- [11:52]
A
You write about it like falling off a hormonal cliff, which is, I was like, this is exactly the way. No one's described it that way to me before, but it's so right on.
- [11:59]
B
I mean, we go through all kinds of changes in our bodies over time, but for it to happen so quickly and after the physical trauma again, even if it's a beautiful, joyful experience, you have just passed a human out of your body one way or another. And so for her to be experiencing that, but now she's sleeping on the floor of a concrete floor of a jail, bleeding out, being denied sanitary supplies, being denied access to antidepressants, when she struggled with postpartum depression before, which was clearly related to her substance use issues, for her to have cellmates who are also pregnant, or postpartum women who have also tested positive for drugs and been charged with child abuse against their own fetuses. And for all this treatment to be justified as being pro life, as being for the babies. So I think if I, I think any person can connect to this story, but the way that it happened to me was I feel this in my body. And I must, when she's ready, I must go speak to her. I must spend time with her in Etowah County, Alabama. And I was so lucky that she agreed.
- [13:11]
A
So let's talk a little bit more about some of these women because Hallie is one, as you mentioned, she's in Alabama. Two other women are in Alabama and the other two are in New York City.
- [13:21]
B
Why?
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A
Why those two locations to you?
- [13:25]
B
So from the beginning I was thinking about the silos that we talked about. And in the course of reporting on this for near magazine and actually when I was a reporter at MSNBC, I had first met Dr. Yashika Robinson, who is an incredible doctor, who, a two time teen mom who raised her kids and also went to medical school at the same time, was one of the very few black women providing abortions in the South. In Alabama, she provided them for as long as she could, even while delivering babies, which the law and the medical structure makes extremely hard to do. So really there for her patients, no matter what kind of care that they needed in their pregnancy. And also gynecological care, really sacrificing her health, her finances in order to be there for her patients. And after Dobbs shuttered the abortion clinic, I found out that Dr. Robinson was fighting to open up a birth center which would provide options that weren't available in the area for women with low risk pregnancies who wanted a care setting that wasn't like the hospital. And so you think like fighting, why would she be fighting to open up a birth center when they're saying that they welcome, you know, again, pro life? The answer is because of the stranglehold that doctors have in Alabama over the regulatory process. Don't want the competition. Even though, as we know all over the country, maternity wards are closing, options are diminishing, even urban Alabama has very few pregnancy options. And so just to convert, you would think that this would be anti abortion politician's dream to convert. Or at least someplace where people could agree to convert an abortion clinic to a place where women can give birth on their own terms. But this required going to court and making similar arguments with the ACLU. I thought Dr. Robinson, her courage, her refusal to abandon her patients, advocating for them inside the hospital when that was the level of care that they needed, advocating for them when she could provide abortions, it just felt like she was kind of the living embodiment of the story I wanted to tell. So I kind of started with her. She was breaking down those silos and she was doing this work long before it was an idea in my head.
- [15:49]
A
And she also had both the personal experience, she had her own prejudices, her own stories, and then the professional experience of where she's trying to work towards that change and break down those silos that you talked about.
- [16:00]
B
Right, exactly. And you know what? And I think also at times, I'm very critical of the medical establishment, but I think that showing that there was a doctor who was willing to treat her patients with that kind of level of respect and autonomy and provide even when they needed a high level of medical intervention to be there for them, but also say, well, maybe you need something different with a midwife and to help use her authority as a doctor to back that up was really significant. I thought it was kind of a balanced and interesting way to introduce these ideas. And especially for her as a black woman, to be an heir to a medical tradition, but also breaking with a medical tradition that had experimented on people who look like her. On enslaved women.
- [16:47]
I read about how there's a statue in front of the Alabama State Capitol of J. Marion Sims, who's the so called father of gynecology, who, in order to cure or treat obstetric fistula, experimented for years on enslaved women without anesthesia. And I know this is something the show has reported on in the past. And so for her to stand before statues that are in tribute to those women and to say, we will provide better care that is culturally and historically competent, I knew, okay, this has got to be a part of this story. And the funny thing is, I found out by covering the birth center trial that her lawyer, one of her lawyers on the ACLU of Alabama team, Allison Moman, had her own story. And her story was that she was desperate to become pregnant, give birth and raise a child.
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And Alabama kept putting hurdles in the way of that as a queer couple, as somebody who was experiencing recurrent miscarriage. Now, again, we've been told that miscarriage would not be affected by abortion bans, but reporting over the past few years has shown that that is. Excuse me, has shown that that is not the case. You know, that there's such a chilling effect that even if technically something falls within the realm of the law that there is no fetal heartbeat, somebody could still be denied care even if they're in agony. Allison, I read in the book, had four miscarriages, Two of them, she ended up going to another shattered abortion clinic. For miscarriage care because they were not afraid to give her that kind of care. And I really wanted to include Allison's story because to show, again, there are intended and unintended consequences here, and you could argue that it is an intended consequence, that the law was not meant to enable people like Allison and her wife to start a family because they fall outside of the accepted norm of what a family should look like. Heterosexual, Christian, married. At the same time, who would say that somebody should have to travel for hours in agony from a miscarriage just because somebody somewhere might think that the care she needed looked like an abortion? Doctors cannot operate under this kind of fear and still do what's best for their patients. I mentioned how I learned about Haley's story, and it was incredibly important, important to me from the beginning to write about my own backyard, write about how.
- [19:18]
A
Even you being in New York City.
- [19:20]
B
Even in New York City. Yes, even in New York City, one of the bluest jurisdictions, the wealthiest city in the country. When I learned that we had a higher rate of racial disparity in maternal mortality, that is to say, black women were likelier to die than white women at a higher ratio here in New York City, that in Alabama, I needed to understand why.
- [19:47]
A
That is wild. That is wild. Pause there for just a moment. Because that statistic, I'm sure a lot of people have seen reports. We've covered it at NewsHour as well. We know the national rates. Right. We know that black maternal mortality is far outpacing their white counterparts in America. When you think about where that would be happening, you would assume it's in places where overall healthcare standards might not be as well funded, where there are greater racial disparities across other health lines as well. But in New York City, it's higher. The gap is bigger than in Alabama. What did you think when you learned that?
- [20:22]
B
Well, I spent a long time trying to investigate it. I think that the part of there's a couple of things happening, and one is that where there is great wealth, there is often great inequality. And so there is research that shows across the board that where in hospitals where black women that tend to serve black women in communities where black women live tend to be underfunded, tend to have higher maternal mortality and morbidity rates, meaning serious illness related to pregnancy and birth.
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In New York City, you can see this played out in both public and private hospitals that are in neighborhoods that are predominantly people of color, that simply do not have the human capital or the resources, next to some of the most resourced, richest.
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Win tons of awards for research. Great NICUs, great acute care specialists right across the river. We're just a few minutes away. We have already tolerated. Not everyone has tolerated. But New Yorkers have become used to living under a certain level of inequality in the city. I think that actually what I realized is that part of the reason that.
- [21:37]
Or that the number is starker here is because in places like Alabama, white women actually have less access to care. And here, if you are a privileged person, you have access to really good care, at least in the traditional sense of having access to the most qualified doctors in the world and the most high tech equipment. That said, I think one of the things I wanted to get across is that money is in everything when it comes to medical care. And that particularly in pregnancy care, which all the reasons that we discussed can be so intimate and so personal that more is not always better. And so the two women that I write about in the book have very different backgrounds, but both of them end up at one of these underfunded public hospitals. Woodhull. Because they are seeking something different, which is that they're seeking something more personal, more individual. And what's so interesting is I almost did too. So when I was pregnant in 2020, it was peak Covid. This was my first pregnancy. And I started reporting on what was happening in the hospitals. There were women giving birth alone because of lack of ppe. There were COVID positive women whose babies were being taken away from them at birth because there was so much fear around contagion. It was chaotic, it was messy, people were doing their best, but there was a lot of harm. And we know now also that pregnancy put you at a greater risk of COVID complications. So what you asked me about reporting on this stuff while I was pregnant, my coping mechanism was reporting on this.
- [23:09]
A
And that's, that's how you coped. You were like, I'm not going to.
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B
Create this anymore traumatic experience.
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A
I'm going to lean in, I'm going to lean all the way into.
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B
There's something very. I mean, you lean right into a war zone. I leaned right into the hospital room.
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A
I'll tell you, it's a support group we need for journalists.
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B
It's like a sick.
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A
But I get it, I understand it. So you lean in and you find all these stories, which, by the way, in the landscape of our Covid coverage, like barely got attention in terms of pregnancies during that time.
- [23:39]
B
So this was again, because had I not been experiencing it, I might not have noticed it the same way. And so you know, and my first attitude towards. Towards seeking my own care was like, I'm just going to find a great doctor and I'm going to trust them. During COVID I became obsessed with not being in the hospital or being in the hospital for the minimum amount of time that I could get away with. And I started reading all of these books that I honestly did not want to read before I got pregnant because I thought they were not my vibe. I started reading, like, Spiritual Midwifery and because I just thought, if I can stay at home long enough and labor at home long enough, then I won't go to the hospital and get sick and die. This was what I was thinking. Of course, when you're pregnant, you're also super anxious a lot of times.
- [24:17]
A
It all makes sense when you're pregnant, though.
- [24:20]
B
And I was lucky because I was actually. Well, I should just say that the other thing that was happening. My daughter was born in June 2020. Was that the. Wow. Well, I mean. And both of these experiences, my dob's pregnancy and my Covid pregnancy, helped me see inside out what this system was like, because everything was in crisis. When things are in crisis, you can kind of see what things are really made of.
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A
Yeah.
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B
And so.
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When I wrote a personal essay in the spring of 2020 about being pregnant and not really knowing what was going to happen with anything, a couple of people reached out to me and they said, you know, there's this great midwife at Woodhall who runs the show Woodhull. Being a Brooklyn public hospital that didn't have a great reputation among upper middle class people. And. And, you know, people would said to me, you wouldn't think so, but it's actually a great place to give birth. I thought, well, that's interesting. I've got my plan, though. It's okay. The week before, I think I was 38 weeks, which it turned out to be. The week before my daughter was born.
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The city. So Black Lives Matter protests are happening in the city, and there's fear of unrest. And Bill de Blasio calls a curfew, the mayor calls a curfew. And there are checkpoints at bridges and tunnels. And so I'm on one side of the checkpoint and my hospital's on the other. And so now I'm imagining giving birth at a checkpoint. And so I was like, well, I'm gonna get a copy of my medical records, and if I can't make it, I'm going to Woodhull now. They lifted the curfew like a couple of Days before I went into labor, I was able to get my plan. I was able. I actually blessed my daughter because she was born an hour after I got to the hospital, and we left 24 hours later because, like, that's out of hell. That was just a roll of the dice medically, that we got out and not get Covid, and everyone was okay. But while I was counting my blessings, two or three weeks after my daughter was born, a woman named Shaja Semple went to Woodhall the way I had contemplated going and did not leave alive. And so I thought I. You know, I don't know if I would have been treated the same way as she was. Maybe not. But I still felt like a sense of that could have been me. Why was it her.
- [26:45]
That it happens.
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A
Close to your experience?
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B
And why is the place that I said that I was told was a place that respected pregnant people and their autonomy? And the story was that she had been pressured to get an epidural that she didn't want and an induction that she didn't want, although it may have been medically indicated. But why was there. There was an anesthesiologist. It was later determined who killed her, who was disciplined by the state, who fled the country, and who actually had a pattern of poor behavior, a poor care that. Because, again, underfunded public hospital that doesn't have a lot of doctors, doctors are getting paid less. They feel like they can't afford to fire anyone. It's during COVID So it's exacerbating all these underlying things. And so I wanted to understand how a place that I had been told actually was a supportive place, especially for black women in the community, which was ultimately a community hospital, could have harmed her. And then I was. So the first thing I wanted to do was I wanted to embed at Woodhull and think about what it was like for people every day there to try to experience trying so hard to make the system better. And, you know, they were not interested in that idea. I tried. I had some conversations with them. They were not interested in that idea. And I was trying to figure out how I was going to tell this story. And my daughter started preschool. My baby was born that summer. About a month later, my daughter started preschool. By this point, my younger baby was one. I went to a picnic with a bunch of parents who our kids were going to start school together. And somebody asked me about the book, and I was trying to explain it, but I really didn't want to say too much. You know, it's like you don't really want to talk about work at a school picnic. And I just said, it's, it's about what, how you're treated when you're pregnant, you know, And I was like, like a child. And somebody else said, like an animal. And then somebody else said, like a child animal. And I thought, wow, okay, I. I didn't want to make any assumptions about how anybody here was feeling about their pregnancy, but here we are in the richest cities.
- [28:47]
A
These are other moms in the world. These are other moms similarly situated to you?
- [28:51]
B
Yeah, I mean, you know, there was a mix of backgrounds, but they were all in a pretty good position. And, and, and the husbands were like, immediately tense. Like they, like they were worried about their wives being triggered or their partners being triggered. I mean, there was like a lot of feelings and I just thought, wow, okay, there's something going on here. I need to find out more that even. Yeah. Women who are privileged have felt dehumanized in the course of their pregnancy care. What's there? On the day that school started, one of those moms, the one who said child animal, she and I ended up getting coffee. She was pretty emotional about drop off. I gave her a hug and she. I was talking about how hard it was, just I was one year postpartum and I still felt like it was yesterday. And she said, I totally get it. I almost died when I had my baby. And I said, what? Where did you go? And she said, have you heard of Woodhull? And I just like almost fell over. And so that is Maggie, one of the five women that I write about. And two months after we had that conversation, another woman died at Woodhull, Christine Fields. And in the course of reporting, I found out that Maggie and Christine had had the same doctor, the same injury, and very different outcomes.
- [30:11]
A
I mean, there is a sense of.
- [30:15]
There'S a risk behind every pregnancy, obviously, but there's sort of like a. You're gambling when you do this, depending on where you are, depending on your doctors, depending on your facility, depending on a lot of things in the moment. And you weave their stories together so beautifully. But what I found so interesting was how you ground all of this in the historical context. I mean, you mentioned J. Marion Sims and the horrific, brutal experimentation on black women and sort of how that line carries forward to the clear racial divisions that we see today. You also talked about, like, the co opting of pregnancy by men, in particular by men in the medical establishment. And I think we never really think about it that way or talk about it that way because today so many obgyns are women. Like most of my medical care through my pregnancies was from women. But the way you talk about it, in terms of how medical doctors and men in positions of power took control of this and how that influenced what the industry and the practice and the culture is today. Tell me a little bit about that.
- [31:23]
B
Well, I'm so glad you asked about that, because it was. It was fascinating for me to learn about the history. One of the. Some of it I knew. But what I didn't realize is how much it illustrated the reason why so many different kinds of pregnancy care had been separated from each other. And. And how. What do I mean? Traditionally, women were the caregivers of pregnancy. Some of these were trained attendants. They learned through apprenticeship midwives. Some of it was just women in the community who accompanied you. And this is true across cultures, right? Everywhere we have documents, everywhere we have oral storytelling. This was how people gave birth in community with other people and with a woman who was a trained attendant. Surgery did not really evolve until roughly the 19th century past just being, you know, like, when we think about, for example, a cesarean. A cesarean was considered something that until the 19th century, you did with the understanding that a mother would not survive. You were. Because there was no way to stop the bleeding. There was no way to stop an infection from an incision. And so surgery was considered a very low trade, basically like animal husbandry or butchering. Barbers also were part of the, you know, the same tools were being used. This was in Europe, and this was in early America that we have this. This tradition. But in the. Around the middle of the 19th century, medicine was looking to make itself more credentialed. And they were talking about white, educated men, but at a time where medicine itself, calling yourself a doctor was something that anybody could do. And formal medical schools were ad hoc. And really, across the board, they wanted to establish basic minimum standards, which is good, but they also wanted to corner the market, and they saw an opportunity in birth care. What's so interesting is that these same women that I described, that would be there for you over the course of your pregnancy and also when you were ready to give birth to. And I'm not saying that they were perfect, right? I'm not saying that they had deep, you know, forever wisdom that if you had acute care, if a baby was stuck, if you needed acute care, that they knew what to do, but the human race survived. And.
- [33:41]
And what they. What the other kind of care that these midwives were Performing was helping women space and end their pregnancies to the best of their technological capacity. So giving women herbs, helping them have abortions. Now the line between miscarriage and abortion historically is very blurred because first of all, people did not have pregnancy tests, which I think is really fascinating to think about. So it was really just before you're showing, it was really how you feel in your body, you may not have had a regular period because you don't have access to, I don't know, everything from a calendar to stable nutrition. So honestly, early pregnancy was this very gray area that people didn't even know if they were bleeding, did they have a late period or was it a miscarriage? And the same could happen if you didn't want to be pregnant. So what the medical establishment of the mid and late 19th century did was capitalize on fears of midwives who were, by that point midwifery traditions were being kept alive by black women from the south and immigrant women of all different backgrounds, capitalizing on stereotyping them and scapegoating them as superstitious, dirty, and also capitalizing on fears of a changing America that was becoming more diverse and saying that abortion providers, many of whom were midwives, some of whom were quack male doctors, were contributing to the erasure of the white race. Now if you're hearing some commonalities with great replacement theory now, you are not wrong to do so. And so medicine actually promised, traditional medicine, promised, mainstream medicine, promised that they could provide safer births and that they would also get rid of abortions. And it was the American Medical association, the same one we have now, although they take a very different position, that helped pass abortion bans that did not exist at the founding, throughout the 19th century, while also taking over birth. And there were a lot, there were, it wasn't all good or all bad, right. But at the time we didn't even know about, or they didn't know about, for example, hand washing. So it turns out that many, that many of the women who gave birth in hospitals or with medical students unintentionally were infected by doctors who were also.
- [36:02]
Experimenting on corpses, learning from corpses, whereas midwives only really saw pregnant women. So there was a lot of spread of infection. Antibiotics and hand washing are probably the most responsible for the dramatic decline in maternal mortality from the 19th century. But of course doctors took credit for it.
- [36:23]
A
I mean, the idea that it was sort of co opted, taken over by a male power establishment then, right? And as you say, good and bad, Right. There's some standards that need to be Set. Obviously, medicine has come a long way, thank goodness, from those days. But I wonder how that culturally feeds into how we look at pregnancy and labor and delivery and birthing today. When we think about pain management, when we think about how women are listened to, which of their concerns are taken seriously and which are not. Because this idea that this is a process in the human experience in which it's just gonna be painful and there may be complications, and we don't really know why some things happen. Like the amount of mystery that surrounds pregnancy to this day baffles me.
- [37:10]
B
Right.
- [37:10]
A
It baffles me when we know so much about so many other things in life that this remains just shrouded and we just don't know some things. How much of that is sort of like a cultural hangover to the way that the medical establishment took over the process?
- [37:27]
B
Well, and I realized that I didn't answer your question about the fact that right now the majority of obstetricians and gynecologists are women. And I think your next question answered it in a way which there is a cultural hangover. Not with every OB or gyn, but there is a cultural hangover of medical paternalism. One of the things that I write about in the book, and I'm going to sort of draw this out in a piece for New York Magazine, is how because abortion providers always had to operate after abortion was legalized, again, because they always had to operate outside of the medical establishment, because they were separated out and shunned, some of the women in my book experienced more respectful care at the hands of abortion providers than they did with traditional gynecologists and obstetricians. So I do think there is a cultural hangover of this paternalism that even women in the medical establishment can experience. And I think when we think about some of the things that are happening right now, like Maha and mistrust of traditional medicine.
- [38:29]
There'S a lot to critique there. I would critique almost all of it, but I think it is exploiting a real distrust of medicine, mainstream medicine. It's still the case that the number one reason that women are hospitalized is to give birth. And a woman at the end of her. Of women who are at the end of their reproductive age now, 80% of them have given birth, and even more of them have given pregnant. Have been pregnant. I couldn't find the number of pregnancy. But if you think about the fact that 80% of women by the age of, say, late 40s have given birth in America right now, we're talking about a Huge number of people who have experienced a very vulnerable moment or set of moments and trajectory where one in five of them in surveys have said that they were mistreated.
- [39:23]
A
One in five.
- [39:25]
B
And where you are much likelier to be mistreated if you are a person of color, if you are on public health insurance, if this is the part that blew my mind. Negatively associated with mistreatment in birth, regardless of maternal race. So regardless of the person giving birth race, having a black partner makes you more likely to be mistreated.
- [39:51]
And so, you know, our hospitals and our medical providers don't exist in a vacuum.
- [39:59]
And I think there's been a lot of work to confront this. But what I really worry about is that all of the progress that was made of this in the last few years is being systematically erased. And so even the measurement of maternal mortality and morbidity at the state level and at the cdc, the PRAMS studies, the research into maternal mortality federally are being dismantled right now.
- [40:27]
I talked to researchers who were hearing about their grants being revoked, and their research was about integrating midwifery into the hospitals so that women might not die giving birth. And so, yes, there's a mystery to it, but there's a lot that we know that we could prevent. Like, I think there is a fundamental mystery to pregnancy. For example, nobody knows why people go into labor spontaneously most times, right? Sometimes nobody can explain why somebody doesn't become or stay pregnant. There really is. I think there is. You know, there's an amazing author, Britta Bushnell, wrote a. She's a birth educator, actually. But I really was, I found, extremely thought provoking the way she talks about that. There's. There is always going to be an inherent mystery and lack of control at the heart of pregnancy, but that's not the same thing as surrendering your autonomy to a broader system that is treating you like a vessel or like a cognitive machine, or like an inconvenience or like a problem. There's also research showing that when black women, for example, question their treatment, they are more likely to be mistreated. So It's a catch 22.
- [41:34]
I think. The CDC says that 80% of maternal mortality is preventable. There are so many things that we do know. The inherent mystery of life and birth, it's not a fixed thing. There may be things at the core about our bodies that we are very far from understanding, but we do know that there are a lot of things we're doing right now that we don't need to be doing that are actively harming people. At these important intervals in their lives, starting with the denial of care all the way down.
- [42:04]
A
Doesn't need to be as dangerous an undertaking as it's become.
- [42:08]
B
This is a choice America has made. It's a choice it's making in so many different spheres of pregnancy. Whether it's birth, whether it's criminalizing people who have substance abuse problems when they're pregnant, where they wouldn't be, you wouldn't be jailed for a positive drug test somewhere if you aren't pregnant, to the denial of miscarriage care, to how someone is treated in birth and the access that they have based on who they are and where they live.
- [42:33]
A
Let me ask you a little bit about where we are today, because the post Dobbs landscape after Roe v. Wade was overturned, it's like a mosaic. It's a patchwork, right, Depending on where you are, your rights and access to reproductive care, to abortion care, they really vary widely. But take me back just for a second to 2022.
- [42:57]
Tell me about where you were when you learned that Roe v. Wade had been overturned. What was that moment like for you and what went through your mind?
- [43:05]
B
I was on live TV.
- [43:07]
A
You were on live TV when you found out?
- [43:09]
B
Well, 30 seconds later. So, funny thing, the day that the Dobbs opinion, I should say, I knew what was happening when uncovered oral argument, because you could hear it. I just did not know how far it would go. I think for those of us who have been covering this for a long time, we knew that when the composition of the Supreme Court changed, when Trump got three justices, that this was just a question of when they did not expect it to happen. So absolutely. As opposed to they were asked to hear a 15 week ban. They went all the way into abortion being banned at any stage of pregnancy, or at least allowing states to do so. But we were expecting the big decision, the way we get everyone big decisions in June. But it was, I think it was May 4, it was early May, and I was asked to be a guest on Chris Hayes's show on MSNBC to talk about the fact that the Senate was Senate Republicans were introducing a national abortion ban. And so I was sitting in my little home studio set up not so different from this one. And I was about to turn off my phone and I got a text from the producer saying, have you seen this? And it was a link to the Politico. And we were literally going live in 30 seconds. And I was like, okay, well, it's a good thing that I've been preparing for this my whole life as I mentioned I was at least six months pregnant at this point, too. And I'm like scrolling through my phone and then 30 seconds later, I'm live with Chris. And I remember saying to him, you know, the sky has fallen. People have been accused of being Chicken Little, predicting this day would come, and here it is. And it was the draft opinion. But within two months, we learned that that was precisely the opinion that would carry the day and be the law of the land. And I predicted in that moment that it was going to cause harm and devastation to pregnant people across the country. And I wish that I had been proven wrong, but I was not.
- [45:06]
A
You know, we still, it's worth pointing out we live in a country where the majority of people, I think it's over 60%, say that some kind of abortion should be legal in some way. Right. And that varies widely depending on where you are and all of that. But for us to be living in this landscape now, providing care across this patchwork with people traveling across state lines to get care in some cases, how sustainable is that? Where do you see this going?
- [45:38]
B
Well, you mentioned people traveling across state lines. I think that's what people envision would be the post Roe reality. And I think we envisioned that people would be physically harmed trying to take matters into their own hands.
- [45:53]
I also, before Roe was overturned, wrote about the idea that when there was no doctor to prosecute, women might be prosecuted if they ordered pills online, because it was already starting to happen. I did not anticipate the fact that blue states would pass shield laws that protected doctors within their borders from being prosecuted by or extradited to other states if they wrote prescriptions through telemedicine for abortion patients in banned states. Now, Aid Access, which is one of the biggest networks of doctors that are providing abortions by pill through telemedicine to people who live in states where abortion's illegal, has said that it is writing 14,000 prescriptions a month.
- [46:40]
A
14,000Amonth.
- [46:42]
B
And some of those people live in states where abortion is legal, but they either they can't access a clinic, but the majority of them are in banned states. And this, I mean, that's the most recent data. I have been told by people who know in the course of my reporting that the even more recent data, the numbers are going to be even higher because people are finding out about this as an option. For a few hundred dollars, they can have a consultation with a doctor and have pills, the same ones that you would get at an abortion clinic mailed to you. This is a game changer. Now, the anti abortion movement is aware that this is happening and they are trying to do everything that they can to try to go after the doctors. But many of their identities are secret and the blue states won't give them up. We are being set up for a huge conflict that I'm sure will end up at the Supreme Court about whether, for example, Louisiana indicted a doctor in New York for providing this kind of care because they were able to find out her identity. So Brett Kavanaugh had said in his concurrence in Dobbs that, you know, people have a right to travel and that states can pass different laws, but what happens when one state says, no, I will not help you prosecute a doctor who's the far ranked care that is legal here within our borders just because it's illegal in yours. And so the Trump administration is looking at ways, they're doing it very quietly to try to crack down on mailing the pills and cracking on access to the pills. And this could make a really big difference to the future of abortion care. But one of the quiet ways in which the effects of Dobbs is just kind of being muffled is that there must be about, I don't know, 10,000 people every month who are having abortions at home and they never need to get follow up care or they don't need to, you know, they don't come within the scope of the law. Like the law enforcement never finds out about them.
- [48:36]
And that is a complete sea change from what happened before Roe v. Wade, which was that when Roe v. Wade happened, what really precipitated it was women and septic distress from illegal abortions. How long this will continue. It's very unsettled from a legal perspective, but from a medical perspective, there has been a huge difference in what abortion provision looks like. And very few people, some people are, but very few people are having to travel across state lines.
- [49:11]
A
You mentioned the Supreme Court. And I have to bring up, you wrote the book on Ruth Bader Ginsburg.
- [49:19]
B
Yeah, right.
- [49:19]
A
Notorious rbg. And there have been folks recently, even people on the left, people who were big fans of her and who recognize the enormous contributions and groundbreaking work that she did, who now question whether she may have undone some part of her legacy by not stepping down and allowing another liberal justice, someone who's more aligned with her and her views, to be appointed in her place. That whether that could have avoided the majority, the conservative majority you reference that President Trump has been able to put in place on the court. How do you look at that? Do you Think there's some truth to that?
- [50:01]
B
I think it's a valid question. And I think with the hindsight of history, it is absolutely clear that Justice Ginsburg should have retired long before our book came out in 2015. 2014 was where Democrats lost the Senate and it was pretty foreseen that they were gonna lose the Senate. I always say that. I wrote this in my obituary of Justice Ginsburg, who I was so lucky to get to write about, and I was so lucky to get to know her. She officiated my wedding. Did she really? She wrote to me in the middle of the court's busiest part of the term in June 2020, when I had my daughter. The next day I heard from her. She was an extraordinary person, and it's been a privilege to tell her story to the world.
- [50:45]
A
Yeah.
- [50:45]
B
The same aspects of her outlook, her personality, her grit that made her who she was also.
- [50:55]
Made her make her worst decision. So had she listened to other people about, you know, whether she should challenge these laws or whether she should be a mother and an attorney, whether she should do all of these things that everybody told her not to do, had she not been kind of stubborn and pigheaded and believed in her own wisdom, she would not have been Ruth Bader Ginsburg, justice of the Supreme Court and pioneer women's rights. And at the end, she believed that history would not shift in the dramatic way that it had. She was not the only person who didn't think that Donald Trump could be president. She underestimated the fierceness of his support.
- [51:36]
And unfortunately, when it comes to the Supreme Court, timing is everything. We know she passed in September 2020. If she had left for three more months, Joe Biden could have appointed her successor. So I think it's important to recognize that. But I also want to point out, I think that there is this tendency to want to blame the person who honestly did more than anyone on the Supreme Court for the cause of reproductive freedom, for its undoing. And it's a very simple story, you know, oh, this feminist icon, it's her fault Roe was overturned. And I don't think I'm defensive about this, but the fact is that the votes to uphold Mississippi's 15 week ban, which fundamentally was what overturned Roe v. Wade, was a 6, 3 opinion that John Roberts wrote, a concurrence, not a dissent in Dobbs to say, I would have just gone more slowly. But the moment that the right to privacy is undermined as a doctrine, it was just a matter of time that all like, why is a 15 week ban. Okay, but not all bans. It would have just been a half step.
- [52:43]
A
I think you're saying it would have happened anyway. Is that what you're saying?
- [52:46]
B
It would have happened anyway? Jot the biggest difference in the composition of the Court was Anthony Kennedy retiring. Because Anthony Kennedy was a defender of abortion rights, if very reluctantly. And in 2020, he voted, excuse me, in the Court's last opinion before Dobbs June Medical Kennedy voted to strike down the abortion restriction. So even though he had a lot of reservations about abortion, he was the person keeping Roe v. Wade in place. And when he retired and was replaced by Brett Kavanaugh, that was the difference. What Arbitrary's death did was accelerate. Certainly gave a different story because now we had a quote unquote pro life woman on the court.
- [53:35]
It didn't make anything better, but it didn't cause it. And I think when we think about the level of politicization of the Supreme Court, the level of democratic decay and destruction that is happening right now, it's very tempting to blame a single person who became the Notorious RBG by warning us that this was going to happen. Right. That it was the voting rights dissent that led my co author, Shawna Knishnick to dub her the Notorious rbg. She was warning that the Court was going to undo significant precedent, undermine major civil rights law. And that was what led her to be so admired in the contemporary sense outside of the legal circles that had recognized her as a women's rights pioneer. And so I get it, people want to channel their anger at everything that happened at one person. And let me just reiterate, she should have retired. But it's too simple to tell a story that one person could have changed this outcome. That for 50 plus years a systematic movement was building all the architecture from the pipeline of conservative justices, the support of the Federalist Society, every state legislature passing dozens of anti abortion restrictions to try to tee them up for the Supreme Court, the movement courting the president, the movement electing Donald Trump president, all of these contributed to a situation where people are living under abortion bans that the majority of Americans do not support.
- [55:01]
A
So we need to have a little moment of full disclosure here in our conversation, which is that I count myself lucky to have been among one of your interviewees. I know what it is to be on the other side of Erin Carmon asking you questions and probing for details about your life and how you just feel. I mean, I just felt like I could trust you. I felt like I could open up about my life. You were Profiling me. You should say a number with a number of other women journalists for a piece you were writing a few years ago. And I think we both cried, right?
- [55:35]
B
I'm pretty sure we both cried.
- [55:37]
A
I think you asked me about my children, and if you ask me about my children, I will cry. There's like an 80 to 90% chance I cry.
- [55:43]
B
To be clear, I'm pro crying. I think we should all have feelings.
- [55:47]
A
But at the time you were asking me about being a working mom, right? About being away from my kids, about all of those things. And we talked about the guilt and the pressure and all of that. And you have two girls as well, and you are continuing to report on all of these necessary critical issues. And I just wonder how much of your motherhood now that it exists in a separate category, but the fact that you have two girls who are going to go out into the world and live in a very different world to the one that you grew up in, how much of that fuels or informs what you do and how you do it now?
- [56:23]
B
It intensifies and makes more urgent the mission of my career, which is to tell these stories and which is to draw attention to what is wrong. I dedicated this book to my daughters and they know that they cannot know what's inside the book until they're much older.
- [56:45]
And I think a lot about how I also tell them the story of how they were born because I want them to know that it was hard and it was a lot of work. And when my daughter was born in 2020, we were really. She wants to know, why is everybody wearing a mask? Why didn't my grandparents get to hold me for the first three months of my life? These are all complicated stories that, you know, a three year old and a five year old can only hear bits about.
- [57:13]
I want a future for my daughters and for everybody else's kids where becoming pregnant does not mean the loss of your dignity, your autonomy or your life. I also want my daughters to know that I was so lucky to have a joyful experience bringing them into the world. And every day that I spend with them, every minute that I spend with them, even when they're being really annoying and not, you know, getting dressed to go to school or something, but not like that is the best part of my day. I mean, I was telling you before we started talking about how.
- [57:53]
School drop off is one of the happiest moments of my day. Another happy moment of my day is like when the kids like come wake us up and climb into bed with us because they're still so little.
- [58:03]
A
Yeah.
- [58:04]
B
And so one of the things I write about in Unbearable is that something can be both euphoric and excruciating and that everybody deserves a chance at dignity and happiness. And that, for me, being their mother has been a beautiful privilege in my life. And, you know, there's a phrase on the Internet where people talk about, like, touch grass. You know, get off the Internet, go outside, you know, smell the flowers. I think having a child or being a caretaker to a child is the best way to touch grass, because you. And I'm not saying I'm never, like, on my phone when I'm with my kids or anything, or that they don't watch TV or anything like that, but more that the immediacy, the physicality, especially when they're little, the fact that you have to explain the world to them, even when you don't understand it that much yourself, even when you're still trying. And the gift that they have for finding your vulnerabilities and what you don't know and your weaknesses, the ability to discover joy through their eyes as you're introducing them to the world, these are all things that, for me, have been really generative and also helped me in all the ways we discussed and more, see the world better and differently as a journalist.
- [59:24]
A
Those girls are so lucky to have you.
- [59:25]
B
Erin, thank you so much. I'm lucky to be their mom. And I really did feel like that day that you and I talked. I don't know if I even told you, I told you today, but I don't think I told you when we were sitting across the table from each other, that it was my first week back from parental leave for my second daughter, and it was my first assignment. And they said, do you want to write about these incredible newswomen who are getting together to do a photo in tribute of Barbara Walters having passed away? And I told you that I had not experienced breastfeeding on the go because my first daughter was born during COVID and I was home all the time. And so I was lugging this pump and all the parts of it to pump breast milk for my daughter. And we were in this really fancy photo shoot with, like, catering, and Brigitte Lacan was the photographer and Connie Chung was there, and Christian Amanpour, and, you know, just the most amazing journalists of every generation were there. And. And I realized that I had forgotten the caps to the bottles. And so thus, any milk that I pumped would have. Could not. Like, I could not open, carry, you know, open container on the subway. And so I had to dump out.
- [60:33]
A
All that at you. We have all been there. It's so tragic.
- [60:36]
B
I was sobbing.
- [60:37]
A
You're like, what?
- [60:38]
B
I was sobbing in the bathroom of Chelsea Pierce right before. And I spoke. So. But that's. But that's the realness of it. I mean, you know, the setting of it was very extraordinary, but the realness of it is like, wow, I forgot one piece of something and now I can either explode or this milk is going down the drain.
- [60:56]
A
I will say in the moment, I had no idea until you told me about this today that that had been going on. So kudos to you because you were such a professional. But I will say because you and I immediately got into it. We, like, jumped right into the tough stuff and we were both crying all of a sudden. And I was like, there is something very real and very raw about this woman and I like it. And I had no idea you'd been sobbing in the bathroom.
- [61:19]
B
Hormones and breast milk about to explode.
- [61:22]
A
That's it. That was the key. That's the key. Erin, it's been such, such a pleasure to speak with you. I can't thank you enough for making the time. The book, I'll say again, is so. It's so powerful, it's so necessary and I think for so many people, they'll see so many parts of their own experiences in it, even if they don't feel like the women in the book are they themselves. It's just, it's so really well done and leans into all your expertise and I can't wait to see what you do next. The book is unbearable. The author is Irene Carmon. Thank you so much. It's been a real pleasure.
- [61:56]
B
Thank you for this huge honor and conversation.
- [62:32]
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