Oftentimes in the reproductive rights community we tend to focus on the stories of abortion providers and clinic escorts, both of whom are rightly considered heroic to the movement. But while these spotlights are justified, there are other stories that are then overlooked. Many people don’t think about administrative staff at a clinic, and how important they are to ensuring patients get comfortable, compassionate, and respectful care.
Clinic staff are the people who are on the front lines of patient care in many ways. They are the ones to answer the phones to take appointments, helping the patients through what can be a time of crisis. They confirm that patients know what to expect with the procedure and make sure they have the resources they need before coming to the appointment. They also offer counseling and information services, which can include discussing contraceptive options following the appointment, as well as looking for warning signs of abuse in relationships, either when the patient may be hiding this appointment from their partner, or when their partner might be coercing them into the procedure.
Thanks to Julie Burkhart, the founder and CEO of Trust Women and the South Wind Women’s Center (SWWC), I was able to interview several of the staff from the South Wind clinic here in Wichita, Kansas. What I found were incredibly passionate, caring, and determined individuals, who all make personal sacrifices just to be able to come to work every day. From giving up privacy, to worrying about safety, to combating the social stigma surrounding abortion care, they would not be doing what they are doing without a desire to help people when they need it the most. And despite all of the challenges, many of which have been imposed by our Kansas legislature, they still work as hard as they can to ensure that patients have the best care they can offer.
Although it can be complicated and emotionally taxing to be fully invested in each patient and their needs, the staff really take that responsibility to heart. They understand that for many of the patients they see, this is a difficult time in their life for any number of reasons, so they try to be as comforting and supportive as they can, to make the experience as positive as it can be. For all of this, they understand there are no trophies, no fans, and no press, just the satisfaction of knowing they are doing their part to help those who need it.
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Here are just a few of the many responsibilities and issues clinic staff must confront on an almost daily basis.
Administrative staff contribute to one of the most important functions at the clinic: taking appointments. When a person calls the facility, the staff that answer the phones are the first contact with a patient. As Burkhart explained, “In a clinic setting, administrative staff are on the front lines when it comes to patient care. When patients call, they first speak to one of our patient care coordinators. At our clinic here in Wichita, we want all patients to have a positive experience when seeking health care.”
According to Molly, one of the administrative staff at SWWC, being the first contact with a patient in a field as stigmatized as abortion can be a challenging responsibility. “Making a phone call to the ‘abortion clinic’ is oftentimes one of the most anxiety producing things a person will have to do,” she said. “Our administrative staff have to be multifaceted. We need to be caring, thoughtful, and empathetic while also having to make sure we comply with state regulations, preparing the patients for their day with us, and completing the call in a timely fashion so we can help the next person.”
Ashley, another administrative staff member, explained, “Many times they are scared, angry, upset, confused, and are experiencing many different emotions. Each patient is dealing with their pregnancy differently, and we have to be there for them. How we speak to them could be the difference between whether someone feels comfortable coming to our facility or not. And when the next closest clinic is almost three hours away, we may have just eliminated that patient’s ability to access care.”
When a patient arrives at the facility for their appointment, they once again are greeted by the administrative staff after going through security. Just as the first contact on the phone is important to providing a comforting environment, the first in-person contact is essential. This is complicated by the expectations many patients have when coming in. Ashley told me that “because of the stigma surrounding abortion, they have no idea what to expect when they walk into our facility. Oftentimes, we are met with surprise at how nice and clean our facility is and how kind everyone is to them. And sometimes it’s hard to deal with that, because that means they were expecting something terrible, maybe gross and dirty, but they still came to us.” Molly added, “We need to be the opposite of anything false they’ve read on what can be a really stressful day for them. We want to be as comforting as we can.”
In Kansas, insurance plans are prohibited from covering any costs related to an abortion unless the holder purchases a separate “abortion rider” on their plan. Because of this restriction, nearly all of the patients seeking abortion at SWWC have to pay the full cost out of pocket. A procedure in the first trimester can cost from $600 to $800, with the price increasing as the pregnancy progresses. This can be a challenge because many patients do not have the financial means to do this. So, securing outside funding for some patients, primarily from abortion funds or local organizations, is an important part of what the administrative staff does.
According to Sophie, who handles all funding requests at SWWC, “The National Abortion Federation (NAF) is the primary source of funding for many clinics. NAF has qualifications that have to be met in order for the patient to receive funding assistance and then the amount of funding received depends on the procedure price. If the patient needs other funding, after qualifying for NAF, then other organizations are approached by me, on the patient’s behalf.”
The funding process can also be a challenging time. Sophie explained, “Sometimes patients will get very upset if they don’t meet the qualifications for funding or if they aren’t getting as much funding as they need. Also the funding intake phone calls can be emotionally trying because patients will often cry and confess a lot about their lives concerning the abortion, such as unsupportive family or partners, missing work because of pregnancy symptoms, and finding child care for the appointments.” As with any other part of patient care, supporting patients through this time is an important task.
Addressing the Needs of Survivors
Some of the staff at SWWC are trained on how to meet the needs of patients experiencing intimate partner violence (IPV) and an unintended pregnancy. IPV can take different forms and can be difficult to recognize, but the interactions between patients and administrative staff, including the counseling sessions, are possible ways to address it.
According to Ashley, “If a patient discloses a history of assault, or there are warning signs based on things the patient says or does, we act accordingly. Sometimes the patients don’t want our help, and we have to be OK with that. But those who do, we take the proper steps to find resources, including connecting them with organizations that might be able to help them,” she said.
Ashley added, “We have several plans in place when a patient is experiencing domestic violence or is a survivor of sexual assault. But we can never fully prepare for every individual, unique case because each patient has different needs. Our job is simply to help the patient access the care they need as safely as possible and provide them with the resources available to get them any help they are needing.”
Wichita has a unique history surrounding clinic violence and the anti-choice movement. (For those who may not know, in 2009, Dr. George Tiller, an abortion provider in Wichita, was assassinated in his church.) This reality makes it important for staff to be aware of situations that can be threatening. Although clinic violence or the threat of violence is often targeting the provider or owner of the clinic, this does not mean that clinic staff are free of this risk. With protesters watching, video recording, and taking down license plate numbers of everyone who comes in and out of the facility, they get to know the staff very well. This subjects staff to the threats of harassment or violence because their identities become public. Also, in the case of direct violence, such as a shooter, clinic staff are often some of the first targets.
SWWC, operating out of Dr. Tiller’s former building, is fortunate to have a privacy fence around the perimeter to keep some distance between patients and protesters. But protesters still intimidate in any way they can. One way they do this is by tracking who goes in and out of the facility. Ashley said, “Because I am admin staff, I’m usually one of the first to arrive and last to leave the facility, so it’s intimidating knowing that they know who I am and track my movements.” According to Molly, dealing with these intimidation tactics has become a normal part of working there. She said that “a day without protesters outside writing down our tag numbers and taking pictures of us wouldn’t be a normal day.”
One way the staff has direct contact with anti-choice extremists is with disturbing phone calls. Ashley said, “As someone whose main job at the clinic is to answer phones, I am victim to harassing phone calls. And I have to know what to do in an emergency situation or with a threatening phone call.” There have been several instances of harassing phone calls, and the staff has to be prepared to take each situation seriously. They have a close relationship with the Wichita Police Department, as well as the FBI, to help them investigate threats they encounter and determine the best way to handle such situations. This is a less visible form of clinic violence, but can be just as serious in some cases.
Kansas also does not have a friendly political climate for supporters of reproductive rights. With a new ban on the safest method of performing second-trimester procedures enacted just this year, the state has the strictest regulations on abortion anywhere in the country. This can put a strain on the staff at a place like SWWC, as they work to offer the best care possible. Ensuring patients are aware of all of the regulations is important to providing care, but the waiting periods and excess paperwork make the process more complicated and time consuming. Also, keeping up to date with ever-changing regulations and fighting new bills takes valuable time away from the staff being able to offer the best care.
When I asked Julie Burkhart about the challenges of fighting anti-choice bills, she said, “Anti-choice bills are most certainly a distraction. Abortion care is medical care and we all know that medical care is itself a bureaucratic system. Now, couple that with anti-choice laws and anti-choice legislation and you have an intense, punitive system in which to navigate. It takes careful navigation and attention to detail due to the ideologues who are waiting for any opportunity to further restrict abortion care.”
With new restrictions on access to abortion introduced every year, it becomes more difficult to provide the care people need. It is important that advocates recognize these challenges when we are doing this work, and do what we can to support providers and staff as they work to overcome these restrictions while offering the best care. And in order to stop the progress of this anti-choice legislation, Burkhart put it best when she said that, “Ensuring that we have a voice, both locally and nationally, is important in our pursuit for equal rights.”
Editor’s note: Some of the names have been changed to protect the privacy of the individuals interviewed for this piece.