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 (40) had traveled to Birmingham just one day earlier and would be returning to Jacksonville that evening. One week prior, Tien performed abortions in an Oklahoma clinic. 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 let Reuters accompany her on her March trip from Florida to Alabama in order to perform abortions and observe her work in Oklahoma, December.

These trips are not possible anymore. According to Politico’s leaked draft, the conservative majority of the U.S. Supreme Court appears set to vote against Roe v. Wade which legalized abortion in all 50 states.

To prepare for the Mississippi decision, conservative lawmakers passed new restrictions regarding abortion. Liberal states have tried to protect and expand abortion rights.

Nearly two dozen US states, including Alabama and Oklahoma have laws which allow them to limit access to abortion if the constitution is overturned. Oklahoma’s governor may sign legislation this week banning abortions after six weeks. It will be effective immediately.

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

Tien quit her Illinois high-risk pregnancy practice in January 2021 and made the move to Florida, along with her dog, to start a new job at Planned Parenthood Jacksonville. She flew to Oklahoma City the following month to provide abortions at Trust Women’s clinic. She added Birmingham trips in December.

Although she is hesitant to speculate on what life will look like post-Roe, she calls that possibility “deeply tragic”. She is concerned that some women might resort to unsafe methods of ending 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–Gaylord is a spokesperson of Trust Women Oklahoma. He stated that safety concerns and stigma surrounding abortion prevent many conservative doctors from doing abortions in their localities.

Traveling doctors can be required to get the credentials and licenses they need to practice in the respective states. It may take longer for those who have laws that require abortion doctors to admit patients at the local hospital.

Only Missouri and North Dakota have laws requiring hospital admitting privileges. Some laws, such as similar ones in Texas or Louisiana, that were struck down by Supreme Courts in 2016 and 2020 respectively, have been blocked.

Opponents of abortion claim that such laws protect women from dangerous complications and require follow-up 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.

According to Sue Swayze Liebel of the anti-abortion group Susan B. Anthony List, “continuity in care and the ability for medical oversight that spans over one hour” can be a problem if the doctor involved leaves soon.

Proponents of abortion rights point to research that shows complications in abortion are very rare. Abortion is also safer than childbirth. In emergency situations, clinics have protocols that allow for follow-up. In its latest annual report, the CDC reported that there were two cases of abortion-related death in 2018.

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. Women must schedule their appointments so that they coincide with the visits of one the travelling doctors. They also need to account for the 48 hour waiting period Alabama has between the initial appointment and the abortion appointment.

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. One woman was driving from Louisiana to get money for her abortion pills. Another spoke on the telephone. 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.

“I felt that he wanted to force me to change my minds,” she stated. “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 claimed that from her earliest years, she felt strongly about the need for women to be in control of their bodies. 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.

One woman held a sign outside of the clinic that read, “Life is the first inalienable rights.”

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?” She asked her boyfriend in a text message.

She chose to fly.

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

Tien called Jacksonville Clinic Manager to inform her that she was going to be late for morning appointments.

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