Entropy in a Post-Roe World: An Interview with Andi Friedman

Andrea (Andi) Friedman is a nationally recognized leader in reproductive rights. She manages a high-level team working to change the narrative on abortion and is a leading thinker and strategist in the field. She previously served as Director of Reproductive Health at the National Partnership for Women & Families. Prior to joining the National Partnership, she served as Foreign Policy Advisor to the late Senator Frank R. Lautenberg (D-NJ) where she covered foreign aid, military, and veterans affairs and trade. She has also worked internationally as a human rights lawyer, served as Vice President of the Global Justice Center, and began her career as one of the first staff members of the Women and Public Policy Program at Harvard’s Kennedy School of Government. She has a JD from Harvard Law School and a BA summa cum laude from Tufts University. She is currently on the Board of Directors of Personal PAC, Project 50, and the Midwest Access Project.

Avital Strauss: Now that Roe v. Wade has been overturned, what are the resources being funneled in to protect reproductive rights? What are the biggest priorities in terms of expanding abortion access going forward?

Andi Friedman: Increasing access to abortion and fighting for reproductive rights requires a multi-pronged approach. This starts with helping people from restrictive states get safe care. Those who want to travel to a state with access to care often need help overcoming barriers to travel. Abortion funds have been set up to assist with travel. These funds help pay for the travel expenses themselves and often pay for someone to accompany individuals seeking an abortion throughout their travels. With abortion now restricted in over half of the United States, the need for these funds is dire. These funds exist all over the country. You can find a list of funds through the National Network of Abortion Funds.

Another priority is sharing information about self-managed care. Many people do not realize that there are pills you can take to end your pregnancy. They are safe and effective. In fact, they have a better safety profile than Tylenol or Aspirin. They are heavily restricted not because there is any medical or health need but because abortion has been politicized. It is so important to spread the word that these pills exist, are easily accessible, and are safe. Now, doctors in a few states are mailing these pills across state lines under a new type of protection called shield laws. Shield laws allow clinicians to partake in any legally permissible healthcare activity in the state without risking litigation or losing their license. There are actually a number of doctors in states that have passed shield laws who will mail those pills to anyone in the country, regardless of the law in the recipient’s state. However, it is important to note that the person having the abortion still has to be aware of the laws in their own state and the risk they may be taking in having an abortion. The Repro Legal Helpline can help people who are self-managing an abortion navigate these questions.

Of course, shifting the political environment to win back our rights is hugely important. When Roe v. Wade was overturned, a lot of people did not see it coming. They thought our rights were safe, and now that our rights have been taken away, these same people are motivated to fight against restrictions on our bodily autonomy. Since Roe was overturned, we have seen massive shifts and voter turnout in favor of reproductive freedom. More threats to reproductive healthcare are coming, and we need people organizing and voting to prevent these laws from being enacted. At the same time, we are also seeing in states that were considered anti-abortion states, that in fact, there are a lot more people who support abortion rights than many people thought. These citizens are sending a resounding message that abortion access is extremely popular, people want it to be legal, they do not want the government involved, and they believe it is not a decision for the government to make. It is a personal decision, and people really believe that and are voting that way.

AS: What are the biggest dangers or traps in this fight? What rights are now put at risk by the overturning of Roe v. Wade?

AF: Underestimating what the anti-abortion movement is all about is a grave danger. They have seen what a political liability their position is, and they are trying to backtrack. We cannot be fooled. Roe was built on a long line of cases around what privacy means in the Constitution. Now, there is a whole series of rights that we have come to rely on and assume as fundamental and irrevocable that are at risk. The anti-choice movement is already coming for contraception and LGBTQ+ rights, having introduced bills attacking both of these principles. In overturning Roe, the Dobbs v. Jackson Women’s Health Center decision went much, much farther than restricting abortion access in the harm that it does. If you did not believe us before, believe us now. 

Additionally, these anti-abortion advocates are not satisfied with restricting abortion on a state-by-state basis; they want a national ban. If anti-choice politicians win the White House and Congress in the upcoming election, there will be a national ban. Even more, the anti-abortion movement wants to see personhood written in the Constitution. Overturning Roe was not their goal; overturning Roe was a step on the way to their goal. Their goal is for the Supreme Court to reinterpret the Constitution to find that the word “person” applies to fetuses so that the same rights we have as people living in the world are given to fetuses. This understanding equates having an abortion to committing murder, which is exactly what these advocates want to see upheld by the Constitution. There are already a few justices on the Supreme Court who would likely support this. 

With all of these traps, it is extremely important that we stay vigilant and do not take for granted this current moment where we are seeing this political shift happening. The reality is that abortion is still banned or heavily restricted in about half of the country and still very restricted in many other parts. It is going to be a long fight to even get those basic rights back. We are in a human rights crisis, and they are not done.

AS: What can we expect to see emerge in states that we may not have previously seen before Roe was overturned? 

AF: These newer bans are emerging in unprecedented ways. States are trying to ban travel to other states, which is clearly unconstitutional but has not been fully litigated yet. As I said, states are likewise trying to ban contraception, starting with Plan B, the morning-after pill. There is already legislation trying to label it as a type of abortion, even though it is not. Plan B only works if you’re not yet pregnant to prevent pregnancy, but they are filling social media with disinformation. States are also working to redefine the language surrounding abortion and reproductive freedom. Anti-choice states are trying to shift the conversation and get us to stop saying “bans.” In fact, many anti-abortion politicians and advocates are actually going after reporters, telling them that it is not a “ban” but rather a “compromise” because they know how unpopular these bans really are. As the conversation shifts, more and more extreme legislation is being promoted. In vitro fertilization (IVF) restrictions are coming. There is some leaked audio from anti-choice advocates advising legislators to be quiet about the impending IVF restrictions for now because people aren’t ready to hear it yet, but challenging IVF is the plan. 

AS: What can people do?

AF: These stories need to be told. Telling your own story about having an abortion or sharing your reproductive healthcare journey, if you are comfortable doing so, is incredibly powerful. There is nothing more impactful to shift the narrative and therefore shift the political environment than making people aware of how many people around them have stories about abortion or have family members who have had abortions, how normal it actually is, and how fundamental it is to people’s health, lives, and futures. 

AS: What groups are adversely affected by the reproductive health care restrictions, and how can we reduce disparities in accessing care? 

AF: The people who are most impacted by these bans are low-income individuals, disproportionately people of color, Black, Latina, and others. Because of the disparities in our healthcare system, those are communities that have been least likely to have access to comprehensive healthcare to begin with and have higher rates of needing abortion access. 

Luckily, there are many ways we can advocate for true, fair, and equal access for everyone, no matter a person’s zip code or how much money they have. This starts with getting rid of bans on coverage. In 1976, a law called the Hyde Amendment was put in place to block the use of federal funds to pay for an abortion. It has been extremely damaging and particularly harmful to low-income communities, which disproportionately tend to be people of color. What the Hyde Amendment effectively meant is that abortion was available for people who could afford it and not available for people who couldn’t. Trying to get the Hyde Amendment removed has been a long battle, and it is a battle we cannot give up on. Beyond this, even in those “safer” states, efforts need to be made to ensure that everyone can access reproductive healthcare, regardless of how much money they have, what they look like, and where they live. 

AS: How will laws restricting reproductive health care affect the training of OBGYNs? Are there concerns about the United States experiencing a shortage of providers? 

AF: Abortion is a fundamental part of reproductive health care. Abortion bans mean doctors cannot provide their patients with evidence-based care, and these bans are driving providers out of those states. We’re also seeing medical students, when they’re choosing their residency or their fellowship to work as OBGYN, only wanting to go to states where they can learn and practice abortion care. This is understandable, as it is a critical piece of their work. In fact, it is required to learn how to provide abortion care in order to be an OBGYN. In response to this, there are organizations helping people travel to different states to get that training. Beyond this, there is a huge problem with the number of Catholic hospitals that have to follow religious directives, including not providing abortion care and other forms of reproductive care such as sterilization. OBGYNs practicing or training in one of those hospitals cannot get the experience they need. With many states and hospitals struggling to attract OBGYNs to provide care, there are dangerous OBGYN deserts and maternity care deserts. Nobody wants to practice care when they can’t provide the best possible care to their patients. Those who are suffering acutely from these shortages are, once again, individuals who cannot afford to travel, are not able to find a doctor, and live in rural areas, especially people of color who have historically not had access to quality care. 

AS: What can we as students do, and what we should be advocating for on campuses and beyond? 

AF: Students can have a tremendous impact by talking about reproductive healthcare issues, spreading information, sharing stories, and supporting and uplifting others who do the same. A lot of campus activism centers around access. Students need to be asking: Does their campus healthcare center currently offer medication abortion? If not, why, and how can students advocate for that? We are also now seeing vending machines with emergency contraception in them. It is available over the counter, so there is no reason it cannot be in a vending machine. Students can start advocating for an emergency contraception vending machine in their campus center. It is also important to consider healthcare coverage policies. Do staff have abortions covered under their insurance plans? What about students under the school’s healthcare plan? Additionally, does the university support travel for students and staff to access reproductive healthcare? Students should also look at what the university has said or done in response to reproductive healthcare restrictions. Starting to ask those questions, even if the answers are hard to find, is so important to promote a campus environment that supports reproductive healthcare needs. Universities need to know that students are looking at these laws. Students can also spread information about things like abortion pills and contraception. So, students have a critical role in ensuring that their campuses are safe spaces for reproductive rights and, of course, students can also help mobilize the campus to vote and organize throughout the state to ensure that the laws to which their campus is bound uphold everyone’s basic healthcare needs. 

AS: Why do you think reproductive healthcare is a human rights issue? Why should people care about it? 

AF: Reproductive healthcare and abortion access are fundamental to being able to control our bodies and decide our own futures. Deciding if, when, or how to have a family is the most impactful decision you will ever make in your life. While it can be a wonderful thing, it will change your life forever, and if having a child is something you do not want or are not prepared for, this can be challenging. No one should be forced to carry a pregnancy to term or become a parent who is not ready to do so. Making our own reproductive decisions is essential for our human right to self-determination, dignity, and bodily autonomy. There is no question in my mind that abortion and reproductive healthcare are essential to our ability to be equal in our society.

*This interview has been edited for length and clarity.