By Gabriella Borter

BIRMINGHAM, Ala. (Reuters) – Inside Planned Parenthood’s Birmingham, Alabama, clinic, a quiet space with few windows and stock photos of the city lining the walls, a woman tapped her hand against her stomach as Dr. Shelly Tien performed a surgical abortion.

Tien, aged 40, was flying to Birmingham from her home in Jacksonville the previous day. She would then return to Jacksonville that night. She had performed an abortion in Oklahoma a week before. According to the National Abortion Federation (NAF), she is one of 50 doctors that travels across states to perform abortions in areas with restricted access.

“You’re doing great,” Tien told the woman on the exam table. “So strong. Breathe. Excellent job.”

Tien is a maternal-fetal medicine specialist and spends many hours driving in airports with rental cars, FaceTiming her boyfriend, and power walking through airports. This allows her to assist women who are not able or willing to have their pregnancies ended.

Tien permitted Reuters to travel with her from Florida, Alabama to deliver abortions in March. In December she visited Oklahoma to watch her work.

This could mean that the window to make such trips is closing. According to the conservative U.S. Supreme Court majority, they are open to reversing Roe v. Wade’s 1973 ruling which allowed abortion in America.

Conservative lawmakers passed new restrictions on abortion in anticipation of the decision in the Mississippi case. Nearly two dozen US states, including Alabama and Oklahoma have laws which limit access to abortions in the event that their constitutional rights are overturned.

Tien saw the decline in abortion access over recent years and decided that she would help to fill it.

Tien began flying to Oklahoma City from Illinois to provide high-risk abortions. In February, Tien moved with her dog from Illinois to Florida to begin a part-time position at Planned Parenthood Jacksonville. She also added Birmingham trips in December.

Her life in a post Roe world is not something she wants to speculate on. She is concerned that some women may resort to unsafe methods to terminate their pregnancies.

“My plan is to always do abortions,” she said in an interview. “I’ll do it legally, and I’ll follow whatever state restrictions and regulations are in place. What that actually will look like, I’m not entirely sure.”

STIGMA & SAFETY

Six states, including Alabama and Oklahoma where Tien is employed as an abortionist, have at least one state that relies entirely on outside doctors for their care.

Zack Gingrich Gard of Trust Women Oklahoma stated that abortion is not performed by many doctors due to safety and stigma.

The process of obtaining the required licenses and credentials for a traveling doctor can take several months. If the state requires abortion doctors to be admitted to local hospitals, it may take even longer.

Only Missouri and North Dakota have laws requiring hospital admitting privileges. Other laws have been stopped by courts including Louisiana’s similar law that was struck down in 2016 by the Supreme Court.

These rules are argued by abortion opponents to protect women who may have serious complications following an abortion or need additional care. According to the latest data from the Centers for Disease Control and Prevention, nearly 630,000 abortions took place in the United States during 2019. This is more than one abortion per minute.

The state’s doctor performing the procedure must leave the state within a short time. “Continuity of care” and the possibility for medical supervision that lasts more than an hour can become a problem, according to Sue Swayze Liebel (state policy director at the anti-abortion group Susan B. Anthony List).

Abortion rights advocates point to studies https://pubmed.ncbi.nlm.nih.gov/26241413 that show abortion complications https://pubmed.ncbi.nlm.nih.gov/22270271 are extremely rare, and abortion is much safer than childbirth. For emergency cases, the clinic has follow-up protocols. Two abortion-related deaths were identified by the CDC in 2018, according to its most recent annual reports.

Tien is able to see patients in Birmingham from all over Alabama. She also has clients from Mississippi, Louisiana and Georgia, which are states that restrict abortion. It is important that women schedule appointments in time to meet with one of the visiting doctors. Also, they must account for 48 hours waiting period required by Alabama between their first appointment and their scheduled abortion.

Tien had six surgical abortions in March and twelve by medication on his day of appointments.

Patients ranged from the ages of 19 to 36. One of the women had traveled several hours to Louisiana. A second woman tried to find enough money to purchase abortion pills. Spanish-speaking patient communicated via translation telephone line with nurses.

Tien sat in a private office across from AW 22 (a local mother with 2 young children, ages 4 and 8 years).

AW, who asked to go by her initials for privacy, said the father of her latest pregnancy wasn’t financially stable. She did not tell him about her plan to have an abortive birth.

She said, “I felt like he was trying to get me to change my mind.” “I don’t want to change my mind.”

Tien gave AW a mifepristone tablet to take. She advised AW that she take the misoprostol tablets at home to finish the abortion.

Tien assured her that women are strong. “Women do this every day.”

Tien stated that she believed women had to have full control of their bodies and pregnancies from an early age. She once read a saying she felt summed up her sense of calling: “Medicine = science + love.”

Tien recognizes that her work could make her vulnerable and she takes steps to ensure this. After she had been hired by Planned parenthood in Florida, Tien was reimbursed for an alarm system. In case of emergency, she keeps at least one quarter full tank in her car.

A full-time security officer checks all bags at the Oklahoma City clinic. Tien in Jacksonville enters through the back door of the clinic, away from protestors who frequently stand outside.

A March visit saw a woman standing outside of the clinic holding a sign saying, “Life, The First Inalienable Right.”

Travel WOES

The Birmingham clinic was deserted by evening. Tien had a bite of a bagel at her desk and looked on her cell phone.

She was delayed on her flight from Jacksonville to Atlanta, so she will likely miss her return to Jacksonville. The next morning she was to go there for abortions. She is approximately 400 miles (or 645km) from Jacksonville.

How do I get back to Jacksonville quickly from Atlanta? By driving or by early morning. flight?” In a text to her boyfriend, she inquired about flight.

She chose to fly.

“One thing I don’t have stamina for is driving,” she said.

Tien called Jacksonville’s clinic manager to tell her she would be late to the morning appointments.

The flight from Atlanta arrived on time. Tien raced through airport with her backpack in turquoise bouncing around her shoulders and connected to Jacksonville within minutes.