# abortion
EMILY KWONG, HOST:
You're listening to SHORT WAVE...
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KWONG: ...From NPR.
Hey, SHORT WAVErs, Emily Kwong here with a SHORT WAVE favorite - NPR science desk reporter Pien Huang, who's joined by NPR contributor Dr. Mara Gordon.
PIEN HUANG, BYLINE: Hey, Emily.
MARA GORDON, BYLINE: Hey, Emily.
KWONG: Hi. So, Pien, I hear you've got a story to start us off with.
HUANG: Yes. So a few weeks ago, the **Supreme Court's draft ruling on abortion rights** was leaked, and that set off **alarm bells** that nationwide abortion rights could soon be ending.
- Supreme Court's draft ruling on abortion rights 最高法院关于堕胎权的草案
- alarm bell 警钟
KWONG: I remember this day.
HUANG: Well, on that day, a woman named Nora (ph) was on the couch in her apartment getting through** a medical abortion**, which is done by taking pills.
- a medical abortion 药物流产
NORA: And I was bleeding through a pad about every 40 minutes. And I would take **panty liners** - I made, like, these caterpillar pads just to cover all the bases. They lasted maybe 40 minutes.
- panty liners 卫生护垫
HUANG: We're just using Nora's first name for her personal safety, and she's a **baker** in upstate New York.
- baker 面包师、糕点师
NORA: And I've always wanted kids, but I'm 22, and I am poor. And I just can't even** wrap my head around**, like, just going to the doctor, getting an ultrasound - all of these things are very expensive - over a baby that you could be forced to have.
- wrap my head around 比喻，搞不定自己
HUANG: While deciding to **end her pregnancy** was hard, getting the FDA-approved pills was not.
- end pregnancy 结束妊娠
KWONG: Where did Nora get the pills?
HUANG: She got them online through this medical provider called Aid Access, and it's one of **a handful of** online telehealth abortion providers that have been **springing up** in recent years.
- a handful of 少量的
- spring up 出现、萌芽
GORDON: So this is Mara. The companies - they're named things like Hey Jane and Abortion On Demand, and they benefited from some rule changes during the pandemic that have allowed abortion pills to be sent through the mail and taken at home. The FDA made these rule changes **permanent** last year. Now, as more abortion **restrictions loom over** parts of the country, Robin Tucker, a **nurse** **practitioner** and **midwife** who works with Aid Access, says these telehealth services are seeing a surge in demand.
- permanent 永久的
- restriction 限制、管束
- loom 隐约可见、笼罩
- nurse 护士、保姆
- midwife 助产士、接生婆
- telehealth 远程医疗
ROBIN TUCKER: The future of abortion access is going to be getting pills out there and getting pills in the hands of people. That's, like, one of the interventions that can provide the most **autonomy** in this kind of environment where people are going to lose reproductive rights.
- autonomy 自主性、自治权
- reproductive rights 生殖权力
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KWONG: Today on the show - how the boom in telehealth **startups** that mail abortion pills is clashing with the legal landscape and the culture of medicine. I'm your host, Emily Kwong.
- boom 繁荣
- clash 冲突
- landscape 风景、景色， legal landscape 法治环境
HUANG: I'm Pien Huang.
GORDON: And I'm Mara Gordon.
KWONG: And you're listening to SHORT WAVE, the daily science podcast from NPR.
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KWONG: All right, Mara, we're going to start with you. Can you talk about how abortion has **undergone** a change - from being **solely** a surgical **procedure** to one that can be done through the mail?
- undergo 经历、经受
- sole 唯一的、单一的，仅仅；鞋底、比目鱼
- procedure 程序、步骤
GORDON: Yeah. So for years, patients usually had to go to **freestanding clinics** that offer abortion. In a lot of places, you couldn't just go to your regular doctor's office or your regular **gynecologist's** office to get an abortion because there were just so many rules and regulations about abortions. They're called TRAP laws, or targeted regulation of abortion providers. So as a result, people often had to travel **pretty far** to get an abortion. There was one study published in The Lancet a few years ago that found that 1 in 5 women would have to go more than 40 miles to get to a clinic that provides abortions.
- freestanding clinic 独立诊所
- gynecologist 妇科医生
- pretty far 相当远的
- The Lancet 柳叶刀（医学顶尖期刊）
KWONG: Wow. Yeah, I can see that **taking a lot of work in and of itself**, right? Like, you're arranging childcare, taking time off work, securing gas money, **bus fare**, maybe even finding a place to stay.
- taking a lot of work in and of itself 本身好多工作要做
- taking time off work 休假
- bus fare 巴士票
GORDON: Yeah. And patients also faced **harassment** from anti-abortion **protesters** because they often targeted those clinics that specifically provided abortions. So now, with telehealth abortions, patients can access pill abortions privately from home with a credit card and just a few taps on a smartphone. That's what Jamie Phifer has been seeing. She's the founder of Abortion On Demand, a company that provides telehealth abortions in 21 states.
- harassment 骚扰, sexual harassment 性骚扰
- protester 抗议者、反对者
JAMIE PHIFER: Most of my patients are sitting in their parked cars. They're doing a 15-minute video on their lunch break at work. They are waiting to **head home after traffic clears**. Some of them are sitting on the couch **breastfeeding their infants**. They're waiting to pick up their kids from day care.
- head home 回家
- traffic clear 交通通畅
- breastfeeding infants 哺育新生儿
KWONG: That's interesting. So Pien, what has changed with regulations in the U.S. that allows these services to be available so widely now?
HUANG: Well, it's two main things, and they're both really recent - they happened during the pandemic. So first, there was a boom in telehealth across all kinds of medicine. You know, people started getting **routine** medical visits, physical **therapy**, their **rashes** checked out through telehealth. And also, insurance companies started paying up for it. And the second thing that happened was that there was a specific change to abortions. So during the pandemic, the FDA relaxed the rules for one of the pills, mifepristone. And pre-pandemic, it required an in-person provider visit. But then, the FDA started allowing it to be sent through the mail, so that actually made it possible for these **internet-based** services to start providing fully **remote** abortions. You do an online telehealth appointment, you get the pills in the mail, and you take them at home.
- routine 例行公事、日常工作
- therapy
- rash 轻率的；rashs 皮疹
KWONG: OK. But we've also been hearing a lot about states that restrict abortion or will soon, as Roe is **overturned**. What does that mean for people from these states getting these pills?
- overturn 推翻、颠覆
HUANG: Well, even now, when abortions are still legal in every state, telehealth abortions are not. So in states like Texas, Louisiana, Arkansas, telehealth abortions are **straight-up** banned, and other states have some **in-person** requirements.
- straight-up 直截了当
- in-person 亲自的、在场的
GORDON: And Alina Salganicoff, director of women's health policy at the Kaiser Family Foundation, says that this leaves many **grey areas**. For example, can you see a doctor in a different state? Can friends and family send you pills across state lines?
- grey area 灰色地带
ALINA SALGANICOFF: So we really are **moving into a new zone**. I think it's going to be challenging for providers, I think it's going to be challenging for patients, and I think we're going to see a lot of **litigation** as these cases move forward.
- moving into a new zone 进入新的地带
- litigation 诉讼、打官司
KWONG: Wow. So much gray area. And she's saying that the **tensions are already stewing**.
- stew 炖
- tensions are already stewing 局势正在升温
GORDON: Yeah, both in terms of what will people actually do and how will any of this get enforced.
KWONG: Yeah.
HUANG: Now, most telehealth abortion providers are only operating in states where it's fully legal.
KWONG: Uh huh.
HUANG: But in states where it's not, some of these providers have a **workaround**.
- workaround 变通方法 、替代方法
KWONG: Like what?
HUANG: Well, take Aid Access, for instance. They have a doctor based in Europe who sends abortion pills from India. But the FDA is, quote, "very concerned" about these drugs' safety, and one doctor with Aid Access told me it can delay an abortion by several weeks. She asked us not to identify her by name to protect her family, and she says providers would prefer to send FDA-approved pills to other states, but they would need legal protection.
UNIDENTIFIED PHYSICIAN: We're really trying to **lobby** the state to pass those **assurances** that my license will not be at **jeopardy**, my **malpractice** will not be at jeopardy, and that I will not be **extradited** to another state and prosecuted - because these are criminal and civil **penalties** that we're looking at.
- lobby 游说
- assurance 保证、担保
- at jeopardy 处于危险中
- malpractice 医生处置不当，医疗失职
- extradite 引渡
- prosecute 被起诉、检举
- penalty 处罚、罚金
KWONG: Wow. These providers have some pretty serious issues to **grapple with**.
- grapple with 克服难题、格斗
HUANG: Yeah. And some states, like Connecticut, Washington, California, have passed or are thinking of passing laws like this that would protect their **clinicians**.
- clinician 临床医生
KWONG: Got it.
Mara, going back to you - as a medical professional, can you just explain how these pills work?
GORDON: Generally, medication abortions in the U.S. are a combination of two drugs, mifepristone and misoprostol. Together, the pills block a **hormone** that is needed to continue an early **pregnancy**, and then they get the **uterus** to **expel** the pregnancy. The pills are safe. They're effective. They work for any pregnancies up to 10 to 12 weeks.
- hormone 激素、荷尔蒙
- uterus 子宫 uteri 复数形式
KWONG: And mifepristone's been around for a minute.
GORDON: Yeah, it's not new. The FDA approved it in 2000, and its use has been growing. So about 10 years ago, it was used in about a quarter of all U.S. abortions, and now it's used in about half.
KWONG: And you said these drugs are safe, they're effective. But in the past, patients have needed to see **practitioners**. How are doctors doing that now, through telehealth?
- practitioner 医师
GORDON: Yeah, this is a huge change. So in medical school, I learned that doctors always need to do an **ultrasound** and blood tests before an abortion. That's to figure out how far along someone is in their pregnancy. It's to make sure it's not an **ectopic** pregnancy, check for risk factors like **anemia** - things like that. But rather than doing these tests, telehealth providers have a checklist that they go through with their patients. They'll ask about when their last **period** was, medications that they're taking, any pain that they're feeling - that's to figure out how at risk the patients are for **complications**.
- ultrasound 超声波
- ectopic 异位的
- anemia 贫血
- period 月经
- complications 并发症
KWONG: But what happens when someone's not a good candidate for this?
GORDON: So if they're pretty far along in their pregnancy, or if they're at risk for a lot of bleeding, the providers will **refer them to in-person care**, or they'll ask them to get an ultrasound before mailing the pills.
- refer to 提交，送交，归于，介绍
HUANG: There's a paper from March 2022 that showed that major **adverse** events were very rare. Less than 1% of abortions performed without this kind of testing needed follow-up care, like **blood transfusions** or surgery, and patients were really satisfied with their care.
- adverse 不利的、相反的、敌对的
- rare 罕见的、稀薄的，牛排三分熟
- blood transfusion 输血
KWONG: So given how many people are using abortion pills - a lot sent through the mail - what does this change mean for doctors and how they view abortion?
GORDON: Yeah, medicine is a field that can be really slow to change. I remember, at the beginning of the pandemic, my colleagues and I - we were not ready to move to telehealth. There were so many logistical challenges. But I think, more importantly, telehealth challenges the power balance in the doctor-patient relationship. You know, instead of me making my patients wait in an exam room, when I do telehealth, my patients - they make me wait. You know, oh, Dr. Gordon, wait one second while I get the video chat set up.
KWONG: Yeah.
GORDON: And I think that this is really highlighted in telehealth abortion. The providers have to trust what their patients are telling them about their health rather than using tests to confirm it, and that is **a huge cultural shift** from the way that we're taught to practice medicine when we're in school.
- a huge cultural shift 巨大的文化转变
So abortion is an area of medicine that's also under a lot of legal **scrutiny**. I've talked to a lot of doctors who provide abortions, who are really **staunch** abortion rights **advocates**, and they're still pretty nervous about the idea of doing an abortion without an ultrasound, even with the research that shows that it's safe.
- scrutiny 详细的调查/检查 under scrutiny 接受详细检查
- staunch 忠实的、可靠的、坚固的
- advocate 拥护，拥护者
KWONG: I want to end with a broad question to both of you. So the possible **overturning** of Roe means there will be no federal protection to the right to an abortion in this country. States will come up with their own laws. As both of you continue your work reporting - and in your case, Dr. Gordon, providing care - what questions do you have?
- overturn 推翻
HUANG: Well, we're in a gray area right now with a lot of these issues, and we have a lot of big questions to answer about what will and won't be legal, what the medical regulations are going to be, and how all of these changes are going to play out in real time. One of the things that stayed with me is the idea that, even if Roe vs. Wade gets overturned, there are safer options now than there were before Roe, like these pills. So hopefully women won't have to revert to using dangerous methods like **coat hangers** to end abortions, which is a popular symbol for pro-abortion-rights advocates. But still, if Roe v. Wade is overturned, a lot of women and others that want to end their pregnancies will have super limited access to abortions. Even in **haven** states, it'll increase the wait times for abortions. And the longer you wait to get an abortion, the riskier it is.
GORDON: Yeah. One thing that really interested me in our reporting, Pien, was the **clinicians** who said that they'd be willing to provide telehealth abortions across state lines. I think there's going to be a lot of changes coming, you know, about how far anti-abortion states can go to prosecute a doctor in another state, and how far a state can go to protect their own doctors, too.
KWONG: Right, because** clinicians are licensed state by state**.
GORDON: Yeah. But we live in a world where people travel, and the internet is **breaking down all those geographic barriers**. You know, for example, I live in Pennsylvania. I **practice medicine** in New Jersey. If one of my patients is traveling, say, to Nebraska, they forget their blood pressure pills, I will electronically **prescribe** those pills to a pharmacy there. When it's for medical care other than abortion, nobody **bats an eye**. And another thing I'm really curious about is something that's called advanced **provision**. It's when people who aren't even pregnant get abortion medications to keep on hand just in case they need them or a friend needs them.
- prescribe 开处方药
- provision 供给
HUANG: Yeah, and that's a real gray area, too. It's an **off-label** use for the pills, and it really just opens up this whole new front on abortions that are self-managed, which is to say without the guidance of a medical professional at all.
- off-label 标签外的
GORDON: Yeah. But as a doctor, I really worry about a world where patients feel like they might have to lie to the people who are taking care of them. But if abortions get further restricted, it may be where things are headed.
KWONG: It's a world that we've never really known, and certainly not in my lifetime, so thank you for getting answers to some of these questions.
HUANG: Thanks, Emily.
GORDON: Thank you.
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KWONG: This episode was produced by Rebecca Ramirez and edited by Gisele Grayson, who is our senior supervising editor. Margaret Cirino checked the facts. Robert Rodriguez was our audio engineer. Andrea Kissack runs the science desk. Edith Chapin is vice president and executive editor-at-large. Terence Samuel is vice president and executive editor, and Nancy Barnes is our senior vice president of news. I'm Emily Kwong. Thank you so much for listening to SHORT WAVE, the daily science podcast from NPR.
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