It’s been two years since the U.S. Supreme Court overturned Roe v. Wade, and access to reproductive care is top of mind for many voters. Twenty-one states now ban or restrict the procedure to earlier in pregnancy than what was allowed under Roe.
And almost half of the United States now also restricts gender-affirming care.
But other states, including Vermont, have moved to protect access to reproductive care.
This interview was produced for the ear. We highly recommend listening to the audio. We’ve also provided a transcript, which has been edited for length and clarity.
Mitch Wertlieb: So, access to reproductive care, and especially abortions and gender-affirming care, differ starkly now from state to state, and I’m guessing they are also subjects of intense debate.
Is this the case based on national surveying, and is it playing a role in how Vermonters think about this issue?
Elodie Reed: Totally.
So, if you’re looking at recent polling, Pew Research Center says 63% of Americans think abortion should be legal in all or most cases.
And then according to Gallup, six in 10 adults oppose laws banning gender-affirming care for minors.
And then you have the American Medical Association and the American Academy of Pediatrics, which both oppose restrictions on both kinds of care.
And so the way we politicize these types of health care is definitely on the minds of Vermonters who responded to our Citizens Agenda project.
Like 35-year-old St. Albans resident Amanda Roselli. She says she comes at this from the perspective of someone who does not want to have children.
Amanda Roselli: I worry a lot about a future state in which birth control isn't readily available to me.
She says the overturning of Roe v. Wade a couple years ago feels like the top of a slippery slope.
Amanda Roselli: We're starting to see how it's not just about abortion, it's not just about overturning Roe v. Wade. It's now spreading into all of these other areas, even ones that we didn't even consider with things like IVF.
Mitch Wertlieb: So Elodie, what Amanda is referencing there is when IVF clinics in Alabama paused service earlier this year … and that happened after the state Supreme Court there said frozen embryos should be considered children?
Elodie Reed: Yeah, that's right.
I talked about Amanda's slippery slope idea with Felicia Kornbluh. She’s a University of Vermont history professor who studies reproductive politics.
Felicia Kornbluh: Both abortion and gender-affirming care are at this cross point between what I'll call an authoritarian impulse and, particularly, a hierarchy around sex and gender and sexuality. ... A kind of movement that doesn't care very much about popular democracy and doesn't care very much about individual liberty or people's will.
And Kornbluh says this viewpoint has largely taken over the Republican Party.
Mitch Wertlieb: OK, but Vermont passed a constitutional amendment protecting the right to an abortion in 2022. If rights were further restricted on the national level — like, say, a federal abortion ban — would that impact Vermont?
Elodie Reed: Yes. Anti-abortion advocates have promoted the enforcement of the Comstock Act, which is a 19th-century anti-obscenity law that prohibited the mailing of drugs or information for abortion or contraception purposes.
While the language about contraception has since been removed, it’s still a law on the books that’s applicable now that Roe v. Wade has been overturned.
And while the Biden administration has opted to not enforce the Comstock Act, a new — likely Republican — administration definitely could. And this could supersede state laws, including Vermont’s, that protect reproductive rights.
Essentially, it could become illegal to mail abortion medication, and even perhaps the instruments used to perform in-clinic abortions.
Mitch Wertlieb: As for gender-affirming care, I understand a case is making its way through the U.S. Supreme Court now, right?
Elodie Reed: Yes — it’s a case examining the constitutionality of states banning gender-affirming care for minors. And it’s worth noting that in a lower court, the overturning of Roe v. Wade is cited as precedent for the constitutionality of these bans.
Mitch Wertlieb: OK. So how do things currently look at the state level for reproductive care?
Elodie Reed: So Vermont’s politics and policies definitely lean towards protecting these medical services.
As mentioned, we have a constitutional amendment enshrining the right to abortion. And we now have so-called “shield” laws that protect Vermont providers and patients from criminal charges filed by out-of-state prosecutors over abortion and gender-affirming care.
Mitch Wertlieb: Elodie, beyond legal protections — are there ways to improve access to reproductive care in Vermont?
Elodie Reed: There are. For instance: Providers and facilities can be more inclusive of LGBTQ+ people.
That’s according to Kell Arbor, who is director of the health and wellness programs at the Pride Center of Vermont.
Arbor told me one of the biggest challenges is this widespread adherence to a gender binary.
Kell Arbor: I'm somebody who was assigned female at birth and I'm in a nonbinary genderqueer body. I still am sexually active, so I should still have access and good screening. That's swabbing of all genital, anal, oral areas, that's blood draws, that's urine screens, and that's good counseling from providers, which is really already difficult to get doctors to talk about sex, and then the layer of, maybe I'll write you a prescription for PrEP, for the HIV preventative med, but I don't want to talk about anal sex or other type of polyamorous, multi partner, casual sex, things that might be, how I'm living my life.
In addition to training providers to have these kinds of conversations, Arbor says inclusive intake paperwork and bathroom signage can make a difference, too.
Mitch Wertlieb: And what about the availability of providers?
Elodie Reed: Planned Parenthood of Northern New England is the largest provider of sexual and reproductive health care in Vermont as well as New Hampshire and Maine.
Jessica Barquist: There are, of course, hospitals and other doctors that provide that, but that is our, our sole purpose.
That’s Jessica Barquist, a spokesperson for the Planned Parenthood Vermont Action Fund.
She says Planned Parenthood has seven health centers across Vermont, and offers telehealth too. They served around 16,000 patients in Vermont last year.
But like a lot of the health care industry, Barquist says Planned Parenthood is facing workforce shortages and financial challenges.
Jessica Barquist: Planned Parenthood of Northern New England is projecting a deficit budget of $8.6 million over the next three years.
The last time they had a deficit budget, in 2022, Barquist says five Planned Parenthood centers closed in Vermont: In Bennington, Hyde Park, Middlebury, Newport and St. Albans.
And she says they hear from residents of those communities who are missing those clinics, and missing the care they provide.
Mitch Wertlieb: OK, obvious thing here, we’re a rural state. Is geographic distance from providers a barrier?
Elodie Reed: Definitely.
Caitlin Myers: One of the biggest barriers to accessing any type of health care is distance.
This is Middlebury College economics professor Caitlin Myers. For abortion care specifically, she’s kept close track of which facilities are publicly advertising this service over time, and how far people have to travel to reach the closest provider.
Caitlin Myers: I have long maintained a database of U.S. abortion facilities, and it goes back to 2009 and it has information on every publicly identifiable facility in the country, and in particular, notes about when they're providing abortions, when they might stop providing abortions or shut down.
And Myers updates this database every month.
Mitch Wertlieb: So how does abortion access look in Vermont based on the distance data?
Elodie Reed: Basically, the distance from the population center of the county to the nearest abortion provider, depending on where Vermonters live, can be anywhere between 4 and 53 miles.
Essex County has the worst access by this measure — Chittenden and Rutland Counties have the best.
Mitch Wertlieb: So, Elodie, I’m looking at this map we’ve made, and it looks like access has actually improved for Essex County, as well as Caledonia and Orleans Counties in recent years.
Elodie Reed: That’s right.
According to Caitlin Myers, that’s because Planned Parenthood began providing abortions in St. Johnsbury since the clinic closures in 2022.
Caitlin Myers: The other thing that’s really … impacting Vermont is telehealth provision of abortion. So now, if you live in Vermont and you want an abortion, you can order abortion pills through the mail from a licensed clinical provider, and this is safe and effective in the first trimester.
Myers points out data from the Guttmacher Institute showing a 20% rise in abortions in Vermont since the pandemic.
On the whole, she says telehealth is the biggest factor when it comes to expanding abortion access in states without bans.
But like we talked about earlier — the right to abortion, as well as gender-affirming care, are very much in flux on a national scale. And so we’ll have to see what happens, starting with next week’s election.
This story is part of Vermont Public’s Citizens Agenda approach to election coverage. We’re asking a simple question: What do you want the candidates to be discussing as they compete for your votes? Front Porch Forum is our lead outreach partner for this project.
Have questions, comments, or tips? Send us a message.
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