Q & A Abortion

Dr. Cheryl Chastine of South Wind Women’s Center Talks Reproductive Justice and Not Backing Down

Renee Bracey Sherman

Dr. Chastine fights back against anti-choice threats and intimidation by providing the best possible care to her patients, who often travel long distances as additional political and economic hurdles are put in their way.

This piece is published in collaboration with Echoing Ida, a Forward Together project.

Abortion providers are the backbone of reproductive health care. They are there for patients in emergencies, and often experience stigma simply for providing a procedure that is essential to economic and reproductive freedom. My doctor was there for me ten years ago, and with the mounting challenges and restrictions providers face every day, I am ever grateful.

First recognized in 1996 to commemorate the assassination of Dr. David Gunn, National Abortion Provider Appreciation Day honors and celebrates those in our community who put their lives on the line to ensure we receive safe abortion care. In time for this year’s appreciation day, Rewire interviewed Dr. Cheryl Chastine, an abortion provider at the South Wind Women’s Center in Wichita, Kansas.

A young provider, Dr. Chastine represents the future of abortion care; she infuses reproductive justice values and transgender patient care into her practice. She has given up a lot, personally and professionally, to provide care to her patients throughout the Midwest and the Great Plains region, but she refuses to back down due to threats or intimidation. Instead she fights back by providing the best possible care to her patients, who often travel long distances as additional political and economic hurdles are put in their way.

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Rewire: What inspired you to become a reproductive health-care provider?

Dr. Cheryl Chastine: I knew I needed to provide abortions when I realized that there were people who would not be able to access abortion care if I didn’t. As providers, we are the links between the abstract right to abortion and the reality of being able to actually have one. I became a doctor to provide respectful, compassionate care to people who might be afraid or ashamed. Working in reproductive health lets me do that.

Rewire: What is the one thing you want everyone to know about why you do the work you do?

CC: No one ever expects to need to access abortion care themselves. It’s impossible to predict how you’ll feel about an unplanned pregnancy until you find yourself in that situation. I trust the person who is pregnant as a moral decision makerdecisions about whether to give birth are never made lightly. I provide abortions because my patients need them, as they have been needed in every time period and in every society. Every patient whom I’ve provided with abortion care, I’ve done so because they asked me to.

Rewire: You provide abortion care at the South Wind Women’s Center in Kansas, a clinic in the same location where the late Dr. George Tiller, who was murdered by an anti-abortion extremist, practiced. The stigma toward abortion providers remains strong, both in society and in the medical community. What would you say to medical students who want to get more involved in this work but are concerned about their personal safety?

CC: None of us go to medical school in order to do what is easy. You can’t decide not to do what’s right under the logic that “someone else will do it.” If you allow fear to stop you from doing something you know is right, then that’s a victory for terrorism. And if you choose not to provide out of fear, you deprive yourself of the incredible rewards of being a provider of abortion care. You can help someone enormously, at a desperate time in their life, in just a few minutes. It’s hard to match that feeling.

Rewire: What can medical students do to navigate the system if they want to become abortion providers?

CC: If you’re in medical school, or in residency, Medical Students for Choice is a great place to start. They’ll connect you with a whole community, including fellow students, residents, and wonderful mentors. They can help you to access clinical experience with abortion through their Reproductive Health Externship, which offers established connections with providers as well as funding. Even if you don’t have a chapter, the national organization will be more than happy to work with you.

Rewire: In the past few years, many laws have been passed intended to interfere with the doctor-patient relationship and force providers to disseminate inaccurate information about abortion and health care. How has that affected your ability to care for your patients? And how has it affected your clinic’s ability to adequately meet the needs of its community members?

CC: Kansas requires a patient who needs an abortion to receive certain state-mandated information in writing, and then wait 24 hours before they can proceed. We don’t find that that information or that wait changes anyone’s mind. What it does is adds additional logistical barriers, because it forces patients to return for another visit, and often necessitates delaying care for a week or more. Patients already think about this decision carefully for days and weeks before their appointment. It’s insulting to patients’ judgment and morality to treat them as incapable of making their own decisions without state interference.

Rewire: Why has South Wind been called “ground zero of the abortion wars”?

CC: Abortion has been particularly controversial in Wichita for decades. Kansas is a religious state as well as a state where individualism, privacy, and wariness of regulation run deep. Lots of people in Wichita who might otherwise have been neutral on abortion were forced to take sides due to threats of picketing and boycotts if they worked with Dr. Tiller as they would with any other business. Now, as a relatively new clinic, South Wind has attracted particularly vociferous anti-choice efforts to close it, as well as particularly strong national support.

Rewire: What do you believe is the role of abortion providers in the broader movement to protect their patients’ rights?

CC: This is a tough onemany abortion providers already feel like targets. And while cardiologists are seen as experts on cardiology and neurosurgeons are seen as experts on neurosurgery, abortion providers are often not seen as experts in abortion; they’re treated by anti-choicers, and many in the “muddled middle” as suspect, biased, and incompetent, which of course couldn’t be further from the truth. I think any physician who has the bravery to provide high-quality abortion care in this political context is already putting themselves on the line in defense of their patients’ rights and humanity. To be an activist beyond that has to be a choice. Physicians for Reproductive Health does sponsor a program called the Leadership Training Academy, where providers and other pro-choice physicians receive instruction and support on advocating for patients who need abortion care through the political process and the media.

Rewire: How do you infuse the teachings of reproductive justice into your medical practice?

CC: The reproductive justice framework is absolutely central to my approach to patient care. I work to situate my approach to counseling each patient within the context of their particular social and economic circumstances. I want to help my patients to be able to have the children they want to have, when they want to have them, meaning my approach to the topic of abortion is nondirective. It’s very important to our counseling process that we ascertain whether the patient is choosing freely to have the abortion; we inquire specifically about coercion with regard to abortion and pregnancy. We work with several abortion funds to help our patients overcome financial obstacles. I discuss each patient’s goals for childbearing and tailor their contraceptive counseling accordingly. I also provide patient-centered, informed-consent hormone replacement therapy, and general medical care for transgender patients, which I consider a central part of my practice.

Rewire: What can people do to raise awareness and support reproductive health-care providers across the country, and help ensure that you and other providers are able to continue providing women with access to critically needed health-care services?

CC: There are lots of ways we need support that you can help provide. You can write to your elected officials and your newspaper, expressing support for the idea of abortion care as a decision best made by the person who might need the abortion, and therefore supporting minimizing external obstacles to accessing that care. Contact your local clinic or clinics, especially if they’re independent, and ask if you can support themvia volunteering, escorting, fundraising, or even by working with them for business services like catering or construction. Find out what other health care you can receive there and consider going there for your care. You can talk to your friends and family about abortion as a common, normal experience; bringing it into personal context helps create nuance and support more than any abstract ideological discussion.

This interview was conducted via email. It has been lightly edited for length and clarity. 

News Politics

Clinton Campaign Announces Tim Kaine as Pick for Vice President

Ally Boguhn

The prospect of Kaine’s selection has been criticized by some progressives due to his stances on issues including abortion as well as bank and trade regulation.

The Clinton campaign announced Friday that Sen. Tim Kaine (R-VA) has been selected to join Hillary Clinton’s ticket as her vice presidential candidate.

“I’m thrilled to announce my running mate, @TimKaine, a man who’s devoted his life to fighting for others,” said Clinton in a tweet.

“.@TimKaine is a relentless optimist who believes no problem is unsolvable if you put in the work to solve it,” she added.

The prospect of Kaine’s selection has been criticized by some progressives due to his stances on issues including abortion as well as bank and trade regulation.

Kaine signed two letters this week calling for the regulations on banks to be eased, according to a Wednesday report published by the Huffington Post, thereby ”setting himself up as a figure willing to do battle with the progressive wing of the party.”

Charles Chamberlain, executive director of the progressive political action committee Democracy for America, told the New York Times that Kaine’s selection “could be disastrous for our efforts to defeat Donald Trump in the fall” given the senator’s apparent support of the Trans-Pacific Partnership (TPP). Just before Clinton’s campaign made the official announcement that Kaine had been selected, the senator praised the TPP during an interview with the Intercept, though he signaled he had ultimately not decided how he would vote on the matter.

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Kaine’s record on reproductive rights has also generated controversy as news began to circulate that he was being considered to join Clinton’s ticket. Though Kaine recently argued in favor of providing Planned Parenthood with access to funding to fight the Zika virus and signed on as a co-sponsor of the Women’s Health Protection Act—which would prohibit states and the federal government from enacting restrictions on abortion that aren’t applied to comparable medical services—he has also been vocal about his personal opposition to abortion.

In a June interview on NBC’s Meet the Press, Kaine told host Chuck Todd he was “personally” opposed to abortion. He went on, however, to affirm that he still believed “not just as a matter of politics, but even as a matter of morality, that matters about reproduction and intimacy and relationships and contraception are in the personal realm. They’re moral decisions for individuals to make for themselves. And the last thing we need is government intruding into those personal decisions.”

As Rewire has previously reported, though Kaine may have a 100 percent rating for his time in the Senate from Planned Parenthood Action Fund, the campaign website for his 2005 run for governor of Virginia promised he would “work in good faith to reduce abortions” by enforcing Virginia’s “restrictions on abortion and passing an enforceable ban on partial birth abortion that protects the life and health of the mother.”

As governor, Kaine did support some existing restrictions on abortion, including Virginia’s parental consent law and a so-called informed consent law. He also signed a 2009 measure that created “Choose Life” license plates in the state, and gave a percentage of the proceeds to a crisis pregnancy network.

Regardless of Clinton’s vice president pick, the “center of gravity in the Democratic Party has shifted in a bold, populist, progressive direction,” said Stephanie Taylor, co-founder of the Progressive Change Campaign Committee, in an emailed statement. “It’s now more important than ever that Hillary Clinton run an aggressive campaign on core economic ideas like expanding Social Security, debt-free college, Wall Street reform, and yes, stopping the TPP. It’s the best way to unite the Democratic Party, and stop Republicans from winning over swing voters on bread-and-butter issues.”

Roundups Sexual Health

This Week in Sex: The Sexually Transmitted Infections Edition

Martha Kempner

A new Zika case suggests the virus can be transmitted from an infected woman to a male partner. And, in other news, HPV-related cancers are on the rise, and an experimental chlamydia vaccine shows signs of promise.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Zika May Have Been Sexually Transmitted From a Woman to Her Male Partner

A new case suggests that males may be infected with the Zika virus through unprotected sex with female partners. Researchers have known for a while that men can infect their partners through penetrative sexual intercourse, but this is the first suspected case of sexual transmission from a woman.

The case involves a New York City woman who is in her early 20s and traveled to a country with high rates of the mosquito-borne virus (her name and the specific country where she traveled have not been released). The woman, who experienced stomach cramps and a headache while waiting for her flight back to New York, reported one act of sexual intercourse without a condom the day she returned from her trip. The following day, her symptoms became worse and included fever, fatigue, a rash, and tingling in her hands and feet. Two days later, she visited her primary-care provider and tests confirmed she had the Zika virus.

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A few days after that (seven days after intercourse), her male partner, also in his 20s, began feeling similar symptoms. He had a rash, a fever, and also conjunctivitis (pink eye). He, too, was diagnosed with Zika. After meeting with him, public health officials in the New York City confirmed that he had not traveled out of the country nor had he been recently bit by a mosquito. This leaves sexual transmission from his partner as the most likely cause of his infection, though further tests are being done.

The Centers for Disease Control and Prevention (CDC)’s recommendations for preventing Zika have been based on the assumption that virus was spread from a male to a receptive partner. Therefore the recommendations had been that pregnant women whose male partners had traveled or lived in a place where Zika virus is spreading use condoms or abstain from sex during the pregnancy. For those couples for whom pregnancy is not an issue, the CDC recommended that men who had traveled to countries with Zika outbreaks and had symptoms of the virus, use condoms or abstain from sex for six months after their trip. It also suggested that men who traveled but don’t have symptoms use condoms for at least eight weeks.

Based on this case—the first to suggest female-to-male transmission—the CDC may extend these recommendations to couples in which a female traveled to a country with an outbreak.

More Signs of Gonorrhea’s Growing Antibiotic Resistance

Last week, the CDC released new data on gonorrhea and warned once again that the bacteria that causes this common sexually transmitted infection (STI) is becoming resistant to the antibiotics used to treat it.

There are about 350,000 cases of gonorrhea reported each year, but it is estimated that 800,000 cases really occur with many going undiagnosed and untreated. Once easily treatable with antibiotics, the bacteria Neisseria gonorrhoeae has steadily gained resistance to whole classes of antibiotics over the decades. By the 1980s, penicillin no longer worked to treat it, and in 2007 the CDC stopped recommending the use of fluoroquinolones. Now, cephalosporins are the only class of drugs that work. The recommended treatment involves a combination of ceftriaxone (an injectable cephalosporin) and azithromycin (an oral antibiotic).

Unfortunately, the data released last week—which comes from analysis of more than 5,000 samples of gonorrhea (called isolates) collected from STI clinics across the country—shows that the bacteria is developing resistance to these drugs as well. In fact, the percentage of gonorrhea isolates with decreased susceptibility to azithromycin increased more than 300 percent between 2013 and 2014 (from 0.6 percent to 2.5 percent).

Though no cases of treatment failure has been reported in the United States, this is a troubling sign of what may be coming. Dr. Gail Bolan, director of CDC’s Division of STD Prevention, said in a press release: “It is unclear how long the combination therapy of azithromycin and ceftriaxone will be effective if the increases in resistance persists. We need to push forward on multiple fronts to ensure we can continue offering successful treatment to those who need it.”

HPV-Related Cancers Up Despite Vaccine 

The CDC also released new data this month showing an increase in HPV-associated cancers between 2008 and 2012 compared with the previous five-year period. HPV or human papillomavirus is an extremely common sexually transmitted infection. In fact, HPV is so common that the CDC believes most sexually active adults will get it at some point in their lives. Many cases of HPV clear spontaneously with no medical intervention, but certain types of the virus cause cancer of the cervix, vulva, penis, anus, mouth, and neck.

The CDC’s new data suggests that an average of 38,793 HPV-associated cancers were diagnosed each year between 2008 and 2012. This is a 17 percent increase from about 33,000 each year between 2004 and 2008. This is a particularly unfortunate trend given that the newest available vaccine—Gardasil 9—can prevent the types of HPV most often linked to cancer. In fact, researchers estimated that the majority of cancers found in the recent data (about 28,000 each year) were caused by types of the virus that could be prevented by the vaccine.

Unfortunately, as Rewire has reported, the vaccine is often mired in controversy and far fewer young people have received it than get most other recommended vaccines. In 2014, only 40 percent of girls and 22 percent of boys ages 13 to 17 had received all three recommended doses of the vaccine. In comparison, nearly 80 percent of young people in this age group had received the vaccine that protects against meningitis.

In response to the newest data, Dr. Electra Paskett, co-director of the Cancer Control Research Program at the Ohio State University Comprehensive Cancer Center, told HealthDay:

In order to increase HPV vaccination rates, we must change the perception of the HPV vaccine from something that prevents a sexually transmitted disease to a vaccine that prevents cancer. Every parent should ask the question: If there was a vaccine I could give my child that would prevent them from developing six different cancers, would I give it to them? The answer would be a resounding yes—and we would have a dramatic decrease in HPV-related cancers across the globe.

Making Inroads Toward a Chlamydia Vaccine

An article published in the journal Vaccine shows that researchers have made progress with a new vaccine to prevent chlamydia. According to lead researcher David Bulir of the M. G. DeGroote Institute for Infectious Disease Research at Canada’s McMaster University, efforts to create a vaccine have been underway for decades, but this is the first formulation to show success.

In 2014, there were 1.4 million reported cases of chlamydia in the United States. While this bacterial infection can be easily treated with antibiotics, it often goes undiagnosed because many people show no symptoms. Untreated chlamydia can lead to pelvic inflammatory disease, which can leave scar tissue in the fallopian tubes or uterus and ultimately result in infertility.

The experimental vaccine was created by Canadian researchers who used pieces of the bacteria that causes chlamydia to form an antigen they called BD584. The hope was that the antigen could prompt the body’s immune system to fight the chlamydia bacteria if exposed to it.

Researchers gave BD584 to mice using a nasal spray, and then exposed them to chlamydia. The results were very promising. The mice who received the spray cleared the infection faster than the mice who did not. Moreover, the mice given the nasal spray were less likely to show symptoms of infection, such as bacterial shedding from the vagina or fluid blockages of the fallopian tubes.

There are many steps to go before this vaccine could become available. The researchers need to test it on other strains of the bacteria and in other animals before testing it in humans. And, of course, experience with the HPV vaccine shows that there’s work to be done to make sure people get vaccines that prevent STIs even after they’re invented. Nonetheless, a vaccine to prevent chlamydia would be a great victory in our ongoing fight against STIs and their health consequences, and we here at This Week in Sex are happy to end on a bit of a positive note.