Q & A Abortion

Texas Abortion Provider Launches Program to ‘Shift’ Abortion Stigma: A Q&A With Amy Hagstrom Miller and Amanda Williams

Andrea Grimes

Amy Hagstrom Miller and Amanda Williams at ChoiceWorks speak about their vision for their new nonprofit Shift, why they’ve chosen to launch in Texas, and what the end of abortion stigma might look like in red states.

I drive by what used to be Whole Woman’s Health’s flagship abortion clinic here in Austin all the time. Every time I pass by, I think of how it never really felt like a doctor’s office inside. Warm, purple walls. Inspirational quotes painted inside counseling and exam rooms. A recovery room filled with cushy recliners. More like a retreat, or maybe a sanctuary.

But there’s been a “For Rent” sign outside for months, ever since HB 2, the 2013 omnibus anti-abortion law, forced it and dozens of other providers to shutter last year.

I hated seeing that “For Rent” sign. And now I’m pleased to report that it’s gone. Instead, Austin Whole Woman’s Health has been reincarnated as an organizing and co-working space called ChoiceWorks, the operational headquarters of a new nonprofit from Whole Woman’s Health CEO Amy Hagstrom Miller: Shift.

Shift, according to Hagstrom Miller, is a group “working to strategically shift the stigma around abortion in our culture,” and “committed to fostering open and honest conversations, lifting up all communities, and advocating for reproductive freedom.”

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I sat down with Hagstrom Miller and Shift Program Manager Amanda Williams at ChoiceWorks to talk more about their vision for Shift, why they’ve chosen to launch in Texas, and what the end of abortion stigma might look like in red states.

Rewire: Big question first: What is Shift? How’s it related to Whole Woman’s Health?

AHM: Whole Woman’s Health has always been involved in the advocacy and education realm, with a really strong commitment to having open and honest conversations about abortion in the context of the wider range of reproductive rights and justice issues and a human rights framework. People don’t just experience abortion as a medical procedure. And they don’t just experience it as a civil right, either. In the direct service realm, the conversation about abortion has some ambiguity around it. So how do we get that nuance into the public policy and culture change sphere?

I noticed years and years ago that the only people talking about abortion in public were the people who were against it. We would have people in our clinics who would say, “Not only did I have a great abortion experience, but this is the best health-care experience I’ve ever had. But it’s at an abortion clinic.” And they would articulate: “I feel so empowered, I made the right choice, I feel affirmed.” So they have this great, empowering experience and they walk out the door and there’s just silence on the issue. Nobody’s talking about abortion as though it’s a good in our society, or as though good women would have an abortion. I had this banner outside Whole Woman’s Health for years that said, “Good women have abortions.” People flipped out.

Inside our clinics, we talk to people and say, you know, there’s no one right way to have an abortion. People say, “Hey, can I see my fetus?” And we’re like, sure. They say, “I wanna baptize it.” Sure. Let’s do it. Let’s figure it out.

And so Shift is trying to take that sort of experience we have in the service out into the public sphere where it’s really needed.

Rewire: Why a nonprofit? Why now?

AHM: We’ve always had a 501(c)(3) ever since we opened—that was an abortion fund, before a lot of abortion funds existed. But then a couple of years ago, in the middle of the 2013 legislative session, we started to have people really interested in how to help my voice and Whole Woman’s voice remain on the scene.

The voice that we’re bringing is very unique: We’re speaking on behalf of providers, talking about how real people experience abortion as a medical service but also as a cultural experience. How can our voice remain in that conversation around reproductive rights? It’s very different than the researcher voice or the patient storytelling stuff that Advocates for Youth or Sea Change is doing, and it’s different from the family planning folks who sometimes avoid talking about abortion.

From that idea grew a much stronger foundation than our previous 501(c)(3) work. We had support from multiple donors saying, “We’d like to see you do crisis mitigation,” “We want your clinics to be able to be open,” and “We want to see providers be able to continue to be a voice and continue to influence policy stuff.” Like: If there’s an amendment about to be introduced by the Democrats, let’s make sure it actually helps. Or, let’s sit with [legislators] and say: This is what an ambulatory surgical center does, this is what the regulation already is.

We see ourselves in a place to be able to have a 501(c)(3) with much more funding and structure to be able to do longstanding culture change work and movement building. Informing some of the policies. Helping us figure out what proactive policy would look like.

Rewire: Do you have any hopes on that front, or work you’ve done so far in that direction?

AHM: I always fantasize: What would it look like if abortion care were treated as legitimate in women’s health care, just like miscarriage management or delivery? There would be no question that abortion is covered by insurance or Medicaid. We’d have standards of care that aren’t targeted in a negative way, but in positive ways. There wouldn’t be stigma, so that you could talk about it openly and honestly. We could reframe the notion that there’s only one kind of woman who has an abortion, or that abortion isn’t a normal part of a medical history. That’s our goal: To say everything is normal, everything is funded, everything is talked about.

If that’s our goal, how would we get there from here? Obviously being involved in abortion funding work, and the economic justice work of All Above All and other campaigns, but also really trying to figure out ways that we can be of service to progressives, to talk about abortion better.

Some of our programs are inviting people to come into the clinic—this, where we’re talking, is one of those clinics. We have a safe space where we kind of re-enact a day in the life of a clinic for not just the media, but our allies. We’ll walk through, literally from the phone call all the way through the paperwork, ultrasound, and counseling, so people can see how regulations actually affect the service, experientially. But then we could also have this interaction where people can, in a safe place, say, “But what is that you’re seeing in the ultrasound? What happens in the ultrasound? Can I see the instruments?” And they’ll say things like, “Oh my goodness, there aren’t any sharp instruments,” or “Can I see the fetal tissue?” or whatever. A safe place where we can do education about what actually happens.

Amanda Williams: Just earlier, I walked a visiting organization through the space and I showed them the equipment, and one of the women was like “Aaaaah!” The way we just have it there for them, I’m like, you can touch it! My vocabulary’s a little rusty on what everything is, but I walked them through as much as I could. She was quiet and I was like, “So what do y’all think?” And she was like, “This is awesome.” They loved it. She’d never had an abortion, but they talk about it all the time. They work on these issues. I’m like, y’all were doing abortion work, but you had no clue. There’s that disconnect.

AHM: One of the things I love to do, with staff, we do this thing I call “downriver.” Which teaches the staff how the jobs fit together and why they’re all important. Staff members get up on to the table. They play a patient. So when a guy gets on the table and puts his feet in the stirrups, it’s profound. I turn on the suction machine so people can hear what it sounds like. Even though they’re not having an abortion, there’s some stuff that people go through. Sometimes they get a little triggered, and that vulnerable, emotional place is where we want to teach people. This is what we’re doing here. That’s the fun part. I see us being able to do some education for people in the field who are providers who may not get the same kind of education about their jobs that Whole Woman’s provides to the people who work for us. But also have it be a place where literal destigmatization happens. Like, “Can I touch the machine?”

AW: And talking about that. Like, your ignorance about the procedure is a product of stigma. You can actually see that connection. That’s what’s powerful for me. Those shocked faces. This is stigma!

AHM: And this is my whole life’s work of turning lemons into lemonade. I have, as it turns out, a bunch of suction machines I don’t know what to do with. So if they can become used for show and tell? Awesome. I have all these nitrous oxide mixers. Are we going to throw them away? Or I can use them. So that’s part of this space. It’s part of a reclaiming.

Being able to do these “Abortion 101” workshops are, in my mind, the beginnings of what I would call kind of an “Abortion University,” which would train not only progressive people, but people in the field who aren’t doctors. So the counselors, the advocates, the administrators. Like, who teaches you, as a liberal arts grad, how to run a clinic and host a health department inspector? How are we training people in the field to handle the dynamics of working in red states and working with TRAP laws? Figuring out regulatory compliance, things like that.

We can also practice handling the things that people may have uncomfortable issues about. For example, how can I help somebody prepare for a question about 20-week bans they’re going to get as a progressive? How can I help them learn how to pivot, or help them learn to talk from a level of expertise, while also acknowledging that moral complexity?

We see ourselves as facilitating these open and honest conversations and not being afraid to talk about any of the difficult stuff, because we see it all the time around abortion as providers. Because the people we serve are pretty articulate about the hang-ups they have. They come from the broader culture and they go back into the culture. It’s not a mystery. We’re not messaging for people we don’t see. The people are right in front of us! So in some ways I feel there isn’t an affiliation really between Shift and Whole Woman’s Health, except for our clinics are kind of a lab for us. They’re where we learn what people want to talk about and how they want to have things framed. And then we can be able to talk about the issues with the kind of complexity that has people start to feel like their voices are being heard and their stories are being respected.

Rewire: What are some specific programs or policies that Shift is working on?

AHM: We’ve been funded for doing some hotline work where we can collaborate and bring advocates, patients, and providers together in a statewide way. So that we can coordinate. And do something about the fact that so many people think abortion is illegal. Doing like some billboards or some web campaigns that say, “Do you need an abortion? We can help you.” You’re triaging people, helping them get to the abortion fund, helping them get to a clinic that’s open. And knowing there’s going to be people who call us who’ve tried to self-induce. Or who have a question like, “Is there a place where I can go in my community where they won’t hurt me, or judge me?”

So we placed two billboards on Highway 83 (the main thoroughfare in the Rio Grande Valley), in McAllen, Texas. They say, “If you need an abortion, we can help you and you’re not alone” in Spanish. And they have the Shift logo and a link to SafeAbortion.org. We have to do billboards in lots of places. Our goal would be to do them in West Texas, right? And facilitate a hotline, but also radio, or on a bus, or different ways to reach a population of people who really have no idea.

We’ve been funded for bigger things, but we’ve also done some crisis mitigation stuff in the Rio Grande Valley, and a mural for the clinic there.

There’s a spirit of entrepreneurial innovation in our clinic services delivery, and we can kind of bring that to this nonprofit advocacy organization. In that spirit: We try stuff. Some of it works and some of it doesn’t, but we keep trying stuff.

Rewire: Are there existing organizations or groups that are doing work you find informative or inspirational?

AHM: There are a few of us, independent abortion providers, who’ve worked in the clinic and in the advocacy realm both. Primarily they’re women-led, women-owned sort of organizations that come from this framework of “I do direct service work and I have a clinic, but I do it because I’m trying to make the world a better place for women.”

I think of my friend Tammi Kromenaker in North Dakota. I think of my friend Renee Chelian in Detroit. I think of Preterm, a clinic in Ohio. Feminist Women’s Health Center in Atlanta. People who are doing this kind of praxis, where they’re speaking about life as a provider in the public realm and the advocacy realm. Part of what I’d like to do is I want to figure out a way to support and train providers to go out into the world and have a place where we work through “Why am I hiding in the shadows?” Or, “Am I participating in the stigma on some levels?” And can we facilitate some conversations about the “bad provider”?

AW: Because right now we kind of just ignore them.

AHM: The bad provider thing is rough. How can we talk about that? Whenever I see the word “access,” I don’t want access to abortion, I want access to quality abortion. I host little debates within the field: Is any abortion a good abortion? I don’t think so. I want us to have those ethical debates.

In my mind there are some clinics that haven’t kept up with holistic approaches, whose providers understand women don’t just experience abortion as a medical procedure, and they also may not have kept up with modern medicine. Is there a way we can go into the community and keep access but also raise the standard of care? It’s not that people are doing harm, but abortion in my mind is specialty medicine, and it involves an approach that’s holistic. You should have fundraising for women, counseling programs, and other reproductive health-care options for people as part of your service. So some folks who are just in the medical model, emptying the uterus safely, are kind of old-school. We can go in and help them retire gracefully and take what started in the 1970s forward into the next generation.

That’s a big part of what we do at Whole Women’s Health. But how do we talk about that?

That’s where Shift comes in. Because we need to. We don’t want the byproduct of these regulations to be that there’s only giant providers who can raise money to build ambulatory surgical clinics and that’s all we have. That’s what happens when you have high regulation on abortion care. You have people who, in order to comply with the law, have to be giant. You can look at other “industries” and you can totally see that. They’re doing away with the mom-and-pop businesses in the same way. Barnes and Noble. Walgreens.

I think we could do some storytelling about clinics like the Feminist Women’s Health Clinic in Atlanta, or of Emma Goldman in Iowa City or Tammi’s clinic in North Dakota. That could be part of what we try to do to talk about what good abortion [care] looks like, without talking about “bad providers.” [Ed. note: See Rewire reporting exposing unethical providers here.]

Rewire: Who are you telling those clinic stories to? Or telling them for?

AW: I often think that a big piece of our movement-building work is reaching people who don’t even talk about abortion at all. How do we incorporate them into the conversation? How do we reach them where they are? This everyday person who might have an idea of what abortion is but will be easily persuaded into believing abortion is wrong, because that’s the narrative that’s currently out there. So I see Shift being key in taking control of that narrative and taking back that storytelling power. Whether that’s in our community work or in the media: reaching everyday people and incorporating them into this movement in a way that no one in Texas is doing. That’s something I see us being very capable of doing. And when you talked about organizations that influence us, I love the work that the Sea Change Program has done, although I think we would be very different. The work they do with the book clubs and stuff—I love their research. I think we can use that.

AHM: They have the research, and they’re very much in line with the content, but the service provision is something they don’t have.

AW: We can bring that into the conversation in a way that no one else can. Reaching everyday people is something that campaigns or organizations have tried to do, in a way, but they always end up reaching the same kind of people. So I hope that we can shift that and finally make waves in that area. That’s going to take a lot of collaboration. That’s going to take a lot of community work and a lot of education, frankly. Because I think our audience is going to be different than what’s traditionally the audience in this movement. Especially when so many groups are so focused on policy. How can we participate in that, but break away from it?

AHM: And Shift, there’s a lot of things we can do with that. Shifting Texas. Shifting stigma. Shifting whatever kinds of things we need to work on. Because abortion encompasses a lot of it, but I think there’s other stigmatized reproductive health issues, and it’s all really intertwined. Because it’s about power, and it’s about putting us in our place. And we know that. But abortion becomes this lightning rod for a lot of it. And it’s by design. It’s good for the other side to keep the lightning rod on abortion, because then they don’t have to talk about the other stuff.

People have often said to me, especially the last two years, “You should work in the political sphere!” I’m just like, first of all, no way. Second of all, I see that disconnect so strongly. Even yesterday with our coalition partners, we got in this heated argument, we’re talking about policy about our strategies reaching Latinas in the Rio Grande Valley or whatever, and I’m like, you know the vast majority of my patients aren’t Democrats. Republicans have abortions every day inside my clinics. Let’s talk to them. What seed could we plant there? When 95 percent of Texans identify as Christian? And 70,000 of them every year have abortions. Woah! That’s something to work with. And they’re here! These clients have figured out how to reckon with “I’m a Christian Republican but I am the kind of person who had an abortion.” They may not talk about it after they walk out of our door, but all of those things are true. So what invitation can we make for them to see themselves differently? Or see pro-choice differently?

Rewire: Maybe those patients could tell you, or coalition partners, something really valuable about messaging that’s not currently working.

AHM: Oh, they do, all the time.

Rewire: Because as you say, there are 70,000 Texans getting abortions here every year. We know that.

AHM: They’re sitting right here! They’re sitting here, almost all of them, like literally almost all of them, with another person with them. People say, “People just need to tell their abortion stories,” and I’m like, no they fucking don’t. I mean, I love when they do. But we can’t make shifting the movement that person’s burden. That’s not her fucking job. She doesn’t owe that to us. So I get super animated about this, “Oh we just need to have more patients tell their stories,” you know? No we don’t! We have providers that don’t talk about what they do. For good reason, and there’s a risk there. So what if we start with the loved one who called and made the appointment? What if we start with the person who’s here, who says, “I’ve helped someone get an abortion. I’ve loved someone who got an abortion.” That’s not so scary to say. Because no one’s asking you to name who it is. No one’s asking you if you caused the abortion.

I envision pregnancy histories that are taken on men, that ask men their pregnancy history as part of their health history. Like, down the road, I would love that. “How many pregnancies have you had?” Because I want a frame where we can talk about how men benefit from abortion. We’re not there yet. It drives me nuts, but it drives me nuts for a reason I’m trying to shift. Nobody thinks they’re going to need an abortion until they do, so nobody pays attention to the law until they need an abortion. So some of that, changing who we’re talking to.

AW: And making space for difference. A lot of times when we talk about storytelling, we’re all waiting for the abortion moment in the story. But really people want to talk about their lives. We need to be listening for not the abortion itself, but their lives. Really, the highlight should be on the person’s life and their journey and not just the abortion. That’s where we strive to be this, sort of, platform of the difference.

AHM: Amanda hit the nail on the head. Journalists always ask me this all the time: “So how come your movement isn’t being successful and those gay people have had all the success?” And this is at the root of it right here: It’s that your abortion doesn’t define who you are. It’s not who you are as a person. It’s not your identity. Where, being gay is who you are. Abortion is like, something you did. That’s why I don’t like this whole coming-out thing about abortion. Because it’s not an identity.

Rewire: There are, though, people on the anti-choice side who wear their abortion, specifically their abortion regret, as their entire identity. Texas state Rep. Molly White comes to mind.

AHM: Right. But I think there’s something for us to work on there. This is a new thing I’m trying to develop. I want Shift to incubate this stuff. Should we have a campaign where white men talk about how they benefitted from abortion? It sort of makes you throw up in your mouth a little bit, but maybe actually people listen to them. Would that work? I don’t know. Like, “I got to go to law school because my girlfriend in college had an abortion.” Like, holy shit! Because it’s true. What would happen if that happened? These are the things I think about all the time in the Shift context. What if we told this story? Would it work? Would it not? What if we have a woman talking about her abortion who’s breastfeeding? Woah! Would that be good or would that backfire? We should try it. In a small pilot.

I’m guessing we’ll probably make some pro-choice people uncomfortable.

Rewire: So what is your role as the provider at the table?

AHM: For a while I was the only provider funded for this state advocacy work in any of the states. I believed, so strongly that I could barely keep my mouth shut, that if we work on culture change and movement building and policy work, and we leave clinics still doing bad abortions in the state, it’s never going to work! I feel really strongly about this. So if we as a movement can’t talk about that? Our goals on the culture change and policy? It’s never gonna work. It’s never gonna work because you’ll have those photographs, whether they’re of Gosnell or Steve Brigham, and anti-choicers [are] going to use those clinics as examples of every abortion. And the abortion provider doesn’t have any sympathy in the public.

So this is where I see: Oh, we’ve got to tell a more nuanced story about why we do this work. What is this work? It’s not just uterus-emptying. But we’ve got to be able to talk about the service. And our avoidance of it? People see it. They see it so clearly. I want to, behind the scenes at first, work on our stuff. So that we don’t leave what my friend Charlotte Taft calls the “crumbs at the picnic.” We have a picnic and we don’t clean up and anti-choicers grab every little crumb. Abortion, money! Ooh, “late-term” abortion! Fetal pain! Oh, sex-selection! I could make a list of all the things that all of us are terrified of being asked about. That’s totally by design.

And when we say “Oh, abortion is only part of what we do,” or “Oh, we believe in prevention first,” how can we as a movement say those things proudly, but not say them in a way that stigmatizes?

AW: Real talk. Real talk about abortion. That’s our tagline.

This interview has been edited for length and clarity. 

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