Inside an Oklahoma City Abortion Clinic
A recent scene at the Planned Parenthood in Oklahoma City was a glimpse into the future—an influx of patients to clinics in states that provide more reproductive rights than their neighbors. Photograph by Sue Ogrocki / AP
The staff is struggling to meet the needs of Texas patients, with no relief in sight.
by Katie Watson
The modern design of the waiting room at the Planned Parenthood clinic in Oklahoma City signals efficiency and high-quality care; it has a blond-colored reception desk and the smooth floors and white pillars of a tech startup. Patients from Texas have packed its modular couches and chairs since September 1st, when Texas banned abortions after approximately six weeks of pregnancy. I spent three days there talking to patients and watching health-care workers hustle, and, behind the scenes of that bright waiting room, two things were apparent. The clinic’s staff is running the brick-and-mortar version of a mash unit with passion, humor, skill, and aplomb. And this is not sustainable.
At 5:45 p.m. on a recent Thursday, Dr. Iman Alsaden, the thirty-four-year-old medical director of Planned Parenthood Great Plains (P.P.G.P.), was hunched over a laptop at a long white table in an area that staffers simply call “the back.” Eight reclining chairs separated by privacy curtains were filled with gowned patients; Alsaden was reviewing the ultrasounds and charts of those who had requested a medication abortion, to confirm that they were good candidates for it. The method, which accounted for more than a third of abortions in the U.S. in 2017, involves taking two medications, one that stops the pregnancy from growing and then a second, up to forty-eight hours after the first, that causes cramping and bleeding similar to a miscarriage. (Nineteen states, including Oklahoma, require the clinician to be physically present when a patient receives the first pill, prohibiting the use of telemedicine for medication-abortion prescriptions. On December 16th, the F.D.A. permanently lifted its requirement that patients receive the first pill in person, but states may regulate medication beyond what the F.D.A. requires.)
A physician’s assistant walked in with an ultrasound, which showed that a Texas patient who was scheduled for a medication abortion was past the clinic’s eleven-week deadline for it. Instead the patient needed Alsaden to perform a dilation-and-curettage (D. & C.) procedure in the clinic, which takes time: between one and three and a half hours for preparations, a few minutes for the procedure, and fifteen to thirty minutes of recovery. The clinic was closing in fifteen minutes.
“I can tell her you said no,” the physician’s assistant told Alsaden.
“I don’t feel like I can say no,” Alsaden replied.
Alsaden checked the patient’s chart for her home town, then checked her phone for the driving time—she was from the Dallas area, about three hours away.
“Can she come back next week? If she really can’t, I can do it,” Alsaden said.
This was the third patient that afternoon whose ultrasound showed that her pregnancy was too far along for a scheduled medication abortion, and she was not the last patient of the night—twelve more were waiting for medication abortions, and others still needed D. & C.s. The last staffer didn’t leave the clinic until ten o’clock that night.
The Texas ban has made this the new normal for Alsaden and her colleagues. On the days I visited the clinic, more than half the patients there were medical refugees from Texas, but crossing state borders for abortion care is not new. We’ve long lived in a Balkanized system of abortion access, in which Americans in some places can end unwanted pregnancies with varying degrees of effort, and those in others have to marshal tremendous determination, resources, and social support. In 2019, sixteen per cent of abortion patients in Illinois—more than seventy-five hundred people—came from neighboring states such as Indiana, where regulatory and institutional barriers have made abortions difficult to obtain after the first trimester of pregnancy without a medical reason.
On December 10th, the Supreme Court ruled that federal courts can review the Texas law, which violates Roe v. Wade but attempts to avoid legal challenges by putting enforcement in the hands of citizen bounty hunters. In the meantime, the Court left the ban in effect, which means that women in Texas who want abortions still have few options other than travel, and that clinic staffers in bordering states will continue to edge toward burnout. But the larger threat to abortion rights is Dobbs v. Jackson Women’s Health Organization, which concerns Mississippi’s ban on abortion after fifteen weeks of pregnancy and directly challenges Roe. The Justices heard oral arguments in the case on December 1st, and their questions suggested that a majority of them are open to a full reversal of Roe. If that happens, then the scene at the Oklahoma City Planned Parenthood clinic is a glimpse into the future—an influx of patients to clinics in states that provide more reproductive rights than their neighbors.
Since the nineteen-eighties, many clinics in states hostile to abortion care have been staffed by what could be described as a domestic version of Doctors Without Borders—“fly-in doctors” who spend some number of days each month caring for people caught in the political crossfire. The problem this system addresses is not a national shortage of physicians who perform abortions but the uneven distribution of those who do—caused in part by the fact that many medical schools and residency programs in anti-abortion states do not offer clinical abortion training. This creates one more “stigma tax” on abortion patients in hostile states, because the additional expense of a fly-in doctor’s travel, lodging, and licensing in a new state often must be passed on to them.
Alsaden was a fly-in doctor for two years. Based in Chicago, where she delivered babies and did gynecological surgery at a hospital, she spent a week and a half every month performing abortions at Planned Parenthood clinics in Kansas and Indiana. During the pandemic, that became two weeks per month in Kansas and Oklahoma, after the local medical director became sick. When that doctor stepped down, Alsaden stepped up, moving to Kansas City to become the medical director of P.P.G.P. in January. The job requires travel—to clinics in Kansas, Oklahoma, Arkansas, and western Missouri—and Alsaden found it hard to leave her home town of Chicago. But she likes Kansas City, she said—“it’s more calm, and less expensive.” She and her girlfriend are raising chickens there, and so far they have been happy.
On Friday, Alsaden was joined by a new fly-in doctor from Denver, whom I’ll call Heather Green. At a Mexican restaurant that night, Green, an earnest young white woman who did a health-equity fellowship after her obstetrics residency, shared that she was seven and a half weeks pregnant and terribly nauseated. Still, she said, “it didn’t feel different” to perform abortions. “It’s such a personal decision,” Green said, eating the soup that was the only thing that sounded good to her on the menu. “I’m excited, and those are my circumstances.”
American abortion providers are often hesitant to speak publicly about their work because doing so can make them a target for harassment. Alsaden, however, is not only willing to be interviewed and quoted by name but she has put her name and photo on the P.P.G.P. Web site. She attributes her insistence on being “out” as an abortion provider to the harassment she’s endured for her visible queer and Arab identities—she’s almost always worn her black hair cropped, and she has tawny skin. “I’m not going to be in the closet about anything,” she said. “I’m not going to participate in that system of shame and stigmatization.”