Missouri OB-GYN talks public health in a state where there is a ban and how to use identity as a basis for patient care • Alabama Reflector
Editor’s note: This is part of a series of conversations about voter-initiated efforts to restore access to abortion across the country.
In Missouri, it was difficult to obtain an abortion years before the U.S. Supreme Court overturned Roe v. Wade.
Lawmakers enacted restrictions that made abortion care more difficult: Doctors at clinics had to obtain credentials from nearby hospitals, and patients listened to state-mandated counseling discouraging abortions and then waited 72 hours before they could get one. Only 150 abortions were performed in the state in 2021, the Missouri Independent reported.
Following the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization in June 2022, Missouri became the first state to ban abortion. However, the ban included an exception for medical emergencies, which doctors say are unclear and poorly defined and endanger the health of their patients. The law provides for prison sentences of 5 to 15 years for doctors and the revocation of their medical licenses.
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Last year, a political action committee called Missourians for Constitutional Freedom formed to restore abortion rights. The group ended up in court with Attorney General Andrew Bailey and Secretary of State Jay Ashcroft, two Republicans who oppose abortion rights, and spent the last year arguing over ballot titles and financial summaries.
Ashcroft’s office has not yet confirmed whether the group’s proposal will come to a vote in the fall. If it does, voters will decide whether to codify the right to abortion up until the fetus is viable or later in pregnancy when doctors “exercise good judgment” deem it necessary to protect the patient’s health or life.
Missouri doctors have joined the campaign to expand abortion access and reduce government interference in their work. Dr. Iman Alsaden, the chief medical officer of Planned Parenthood Great Plains, has spoken at petition drives across the state, explaining how the ban harms prenatal care. Alsaden has performed abortions in regions with restrictions in the past—they were working in Oklahoma when Texas passed a six-week ban in September 2021. However, because of the ban, they no longer perform abortions in Missouri.
Alsaden is Iraqi-American and comes from a family of doctors. Her father was a doctor and her mother was a nurse who always helped her friends in need. Alsaden was initially reluctant to follow in their footsteps because her parents endured pain while treating sick patients, he says.
During a conversation with States Newsroom in June, Alsaden discussed why she practices birth control, how identity shapes her work and the impact anti-abortion rhetoric has on doctors and patients.
The following interview has been edited and shortened.
State Newsroom: Why did you decide to become a gynecologist and to perform abortions?
Iman Alsaden: As a gynecologist, you will always be caring for an underserved population. Pregnant women are treated so poorly in this country, as the maternal mortality rate shows.
I believe in bodily autonomy and basic human rights. It was amazing to me that I could combine that with a medical career and be a kind of physician activist in that way. I’m a queer person. Growing up, people would always say to me, “You’re not in the right bathroom. You’re not dressed right. You don’t look like a girl. You’re not doing this. You’re not doing that.” And instead of having the voice to say, “Maybe I’m not a girl or maybe I don’t like boys” or something like that, I was kind of silenced. But there was this innate something inside me that always knew I was doing the right thing, and it was my body, my right, my life, and I couldn’t understand why so many other people cared about what I was doing with my life.
If I can spend every day of my career making life fairer in this way, bit by bit, and giving people the opportunity to exercise their basic human rights, to control their own lives and to live a life as they imagined, then that is a very powerful idea to me.
SN: Many doctors in your position shy away from media and public political debate, especially since the Dobbs ruling. Why have you chosen to support Missourians for Constitutional Freedom and the group’s efforts to restore the right to abortion up until fetal viability, with exceptions later in pregnancy when the patient’s life or health is at stake?
IA: I know there are problems with “viability” laws. However, I think it’s a really powerful thing to restore access to abortion for thousands of people who haven’t had access to abortion for nearly a decade. And it gets us closer to getting the care they need to people in the communities where they live. That’s reason enough for me to support this initiative. I think people should be able to live the lives they want, and that includes the ability to make decisions about their own lives and their own bodies. Supporting this measure will hopefully restore that right and give access back to many people who have struggled.
SN: Currently, Missouri allows abortion only in medical emergencies. Have you been able to obtain medical care in this state under this exemption?
IA: No. I don’t do abortions here in Missouri at all, and medical emergencies do happen in hospitals. I don’t work in any hospitals in Missouri right now. These medical emergency laws are inconsistent. It’s absolutely a huge detriment to patient care because people are letting a septic pregnancy sit out much longer than they should. I’ve heard of people being hesitant to treat an ectopic pregnancy. The law is too intrusive in medicine and making things unsafe for patients. It’s really dangerous. The politicians should be ashamed of themselves.
SN: Opponents of abortion rights in Missouri, including the Secretary of State and Attorney General, have fought the petition. There was also a counter campaign rejecting the signatures before the group submitted nearly 400,000 signatures in May. How does anti-abortion rhetoric spread misconceptions about your job?
IA: Countless cases. Let’s start with the fact that I get called a murderer every time I go to work. Tying the hands of doctors and preventing them from doing the right thing for patients is really dangerous. When you become a doctor, you are responsible for your patient, and the fact that the government is interfering in the fair and good practice of medicine is embarrassing. Doctors shouldn’t be afraid to practice medicine, right? This fear that is being instilled in people is worsening outcomes for patients. We are in a sad state. We are in a public health crisis.
SN: What impact does the intensity of the political debate have on patients seeking reproductive health care?
IA: The impact on patients is impossible to quantify. It’s enormous. Anti-abortion laws affect people of lower socioeconomic status, non-whites, people who live in rural communities. The amount of resources it takes to get in the car and drive 10 hours… You need a car. You need gas. You need a driver’s license. You have to find someone to take care of the family members that you’re caring for, because we know that most people who have abortions are already parents. When you start to create the long list of things that are required to have an abortion, it’s an enormous list that very few people can actually do. Thank God 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 shouldn’t have to jump through hoops to get basic health care.
SN: How does your identity influence your work, 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. As a doctor, it’s very important to keep your own identity in mind. We don’t want to be complete robot doctors. But we also have to be aware of things like implicit bias. I try to tell every single patient the same thing because I know everyone 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 come from.