Missouri OB-GYN talks public health in a ban state and drawing on identity to inform patient care

By: Elisha Brown – August 10, 2024 5:00 am

In Missouri, getting an abortion was difficult years before the U.S. Supreme Court overturned Roe v. Wade.

Lawmakers enacted restrictions that put up hurdles to abortion care: Doctors at clinics had to get admitting privileges to nearby hospitals, and patients listened to state-mandated counseling that discouraged abortion, then waited 72 hours to get one. There were only 150 abortions performed in the state in 2021, Missouri Independent reported.

Editor’s Note: This is part of a series of conversations about voter-initiated efforts to restore abortion access across the country.

After the Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision in June 2022, Missouri became the first state to outlaw abortion. The ban did include an exception for medical emergencies, which doctors say is unclear and ill-defined, jeopardizing their patients’ health. The law carries penalties of five to 15 years in prison for doctors, along with medical license suspension.

Last year, a political action committee called Missourians for Constitutional Freedom formed to restore the right to abortion. The group ended up in court with Attorney General Andrew Bailey and Secretary of State Jay Ashcroft, Republicans who oppose abortion rights, arguing over ballot titles and financial summaries for much of the last year.

Ashcroft’s office has yet to confirm whether the group’s measure will make the ballot this fall. If it does, voters will decide if they want to codify the right to abortion up to fetal viability, or later in pregnancy if the “good faith judgment” of providers deems it necessary to protect a patient’s health or life.

Missouri doctors have joined the campaign to expand abortion access and lessen government interference in their jobs. Dr. Iman Alsaden, the chief medical officer for Planned Parenthood Great Plains, has spoken at petition drives across the state explaining how the ban harms pregnancy care. Alsaden has a history of providing abortions in regions with restrictions — they worked in Oklahoma when Texas passed a six-week ban in September 2021. But they no longer provide abortions in Missouri due to the ban.

Alsaden is Iraqi American and comes from a medical family. They grew up with a physician father and a nurse mother who would always help friends in need. At first, Alsaden resisted following in their footsteps, they said, because of the pain their parents endured treating ailing patients.

During a conversation with States Newsroom in June, Alsaden discussed why they practice obstetrics, how identity shapes their work and the effect anti-abortion rhetoric has on doctors and patients.

The following interview has been edited and condensed.

States Newsroom: What made you decide to specifically become an OB-GYN who provides abortion care?

Iman Alsaden: As an OB-GYN, you will always be serving an underserved population. People that are pregnant-capable are so poorly treated in this country, and that is evidenced by the maternal-mortality rate.

I believe in bodily autonomy and basic human rights. It was amazing to me that I could meld that with a medical career and sort of be a physician activist in that way. I’m a queer person. Growing up, people always told me, “You’re not in the right bathroom. You’re not dressed the right way. You don’t look like a girl. You don’t do this. You don’t do that.” And instead of having the voice to say, “Because maybe I’m not a girl, or maybe I don’t like boys” or that kind of thing, I was sort of silenced. But there was this inherent thing in me where I always knew that I was doing the right thing, and it was my body, my right, my life, and I could not understand why so many other people cared about what I was doing with my life.

If I can spend every day of my career, little-by-little, making life more fair in that way and giving people the ability to exercise their basic human rights, control their own lives and live a life that they’ve imagined, that to me was just a very powerful idea.

SN: Many doctors in your position shy away from media and public political conversation, especially since the Dobbs ruling. Why did you decide to support Missourians for Constitutional Freedom and the group’s effort to restore the right to abortion up to fetal viability with exceptions later in pregnancy for the life or health of the patient?

IA: I recognize that there are issues with “viability” laws. However, I think restoring abortion access to thousands of people who have not had abortion access for the better part of a decade is a really powerful thing. And it gets us closer to getting people the care they need in the communities they live in. That to me is enough to support this initiative. I think people should be able to live the lives that they want, and part of that is having the ability to control their own lives and bodies. Supporting this measure will hopefully restore that right and restore access to many people that have had difficulty.

SN: Currently, Missouri only allows abortions in the case of medical emergencies. Have you been able to provide care in the state under that exception?

IA: No. I don’t practice abortion here in Missouri at all, and medical emergencies occur in hospitals. I don’t currently practice in any hospital in Missouri. Inconsistencies are written into these medical emergency laws. It’s absolutely a huge detriment to patient care because you have people sitting on septic pregnancies until way longer than they should. I’ve heard of people being hesitant to treat ectopic pregnancies. The law is inserting itself too much in medicine and making things unsafe for patients. It’s really dangerous. Politicians should be ashamed of themselves.

SN: Anti-abortion rights opponents in Missouri, including the secretary of state and the attorney general, have fought the petition. There was also a decline-to-sign counter-campaign before the group turned in nearly 400,000 signatures in May. How does the anti-abortion movement’s rhetoric spread misconceptions about your job?

IA: Innumerable instances. Let’s start with the fact that whenever I walk into work, I get called a murderer. It’s really dangerous to tie physicians’ hands and not have them be able to do the right thing for patients. When you become a doctor, your responsibility is your patient, and the fact that the government is interfering in the fair and good practice of medicine is embarrassing. Doctors should not be afraid to practice medicine, right? That fear that’s instilled in people is worsening patient outcomes. We’re in a sad state. We’re in a public health crisis.

SN: How does the intensity of the political debate impact patients seeking reproductive health care?

IA: The impact on patients cannot be quantified. It is enormous. Anti-abortion laws affect people that are of lower socio-economic status, non-white people, people that live in rural communities. The amount of resources it takes for someone to get in the car and be able to drive 10 hours … You need a car. You need gas. You need a driver’s license. You need to be able to find someone to take care of whatever family members you were taking care of, because we know that most people that have abortions are already parents. If you start making the laundry list of the things that are required to obtain an abortion, it’s an enormous list that very few people can actually do. Thank goodness for abortion funds. But at the same time, we should never lose sight of the fact that this care should be available to people where they live. People should not have to jump through hoops to get essential medical care.

SN: How does your identity inform the work you do, especially when treating marginalized patients?

IA: It’s easy to treat people with respect and care, because I’m part of a marginalized community — not economically but socially and racially. Keeping in mind your own identity when being a doctor is really important. We don’t want to be total robot doctors. But also we have to be aware of things like implicit bias. I try to say the same things to every single patient, because I know that everybody has implicit bias. And one way to reduce that is to treat people with the same high-level of respect and care, no matter who they are or where they’re coming from.

Correction: This story has been updated to note that Dr. Alsaden is Iraqi American.

This article was originally published by the Louisiana Illuminator.