MICHEL MARTIN, HOST:
For decades, people seeking abortions have gone to specialty clinics like Planned Parenthood. But there's a growing movement to make abortion part of primary care. NPR's Selena Simmons-Duffin spent a day in a clinic to see that idea in action.
SELENA SIMMONS-DUFFIN, BYLINE: Seven Hills Family Medicine is in downtown Richmond, Va. It's an unassuming storefront kind of clinic.
STEPHANIE ARNOLD: Hello. Hi.
SIMMONS-DUFFIN: And inside, it's cozy - natural light, exposed brick, homey furniture. Down a long hallway at the back, the staff is filing in with coffees in hand, gearing up for the day.
ARNOLD: All right. You all ready to huddle? So looking at the schedule today, last time I checked...
SIMMONS-DUFFIN: This is Dr. Stephanie Arnold's private practice. She founded the clinic two years ago. She works with a small team - a registered nurse and several medical assistants. Dr. Arnold reads through the printed copies of the schedule for the day.
ARNOLD: I'm doing chronic condition management via telehealth in five minutes. At 10 a.m. I'm doing a follow-up on diabetes, and then I'm seeing a knee pain visit and an ADHD follow-up. And then we have three aspiration abortion appointments.
SIMMONS-DUFFIN: Three procedural abortion appointments alongside all the other appointments.
ARNOLD: A little bit of everything today, which is very typical for family medicine. And then there's...
SIMMONS-DUFFIN: Dr. A, as her staff calls her, is 37 years old. She's wearing a bright patterned jumpsuit, her self-imposed uniform. No white doctor's coat for her.
ARNOLD: I don't wear one for multiple reasons. I don't like it. It's gross. And a lot of people find them upsetting.
SIMMONS-DUFFIN: Basically, not the vibe she's going for. The day gets rolling, and it really is a little bit of everything. A patient walks in and scoots onto the exam table with a suspected yeast infection.
ARNOLD: All right. I'm going to do a quick little swab so I can look at it under the microscope.
SIMMONS-DUFFIN: In the doctor's office, there's a follow-up for a patient with GI issues.
ARNOLD: So your labs came back and honestly are, like, looking pretty good. There was no evidence of celiac.
SIMMONS-DUFFIN: Later in that same appointment.
ARNOLD: All right. Let's talk about your chronic back and hip pain.
SIMMONS-DUFFIN: Another patient comes in for gender-affirming care and sits at the edge of their chair with excitement to start on testosterone.
ARNOLD: I think I mentioned that there's, like, kind of two extremes on the dosing...
UNIDENTIFIED PATIENT: Yeah.
ARNOLD: ...Approach.
UNIDENTIFIED PATIENT: We want to go in the middle.
ARNOLD: Fast track or the scenic route. We're going in the middle.
UNIDENTIFIED PATIENT: Yeah.
ARNOLD: All right.
SIMMONS-DUFFIN: Providing gender-affirming care and reproductive healthcare, including abortion, are part of the philosophy of this clinic. Dr. Stephanie Arnold started this practice a few months after the Supreme Court overturned Roe v. Wade. After the decision leaked, she posted an online fundraiser describing her vision and raised $10,000 in 24 hours. She would ultimately raise $75,000, which she says allowed the practice to open much faster than she expected. Out in the waiting room, a patient who took the bus from Tennessee sits in wait for her abortion appointment. She gets an ultrasound and counseling while Dr. Arnold switches into scrubs for the aspiration abortion procedure.
ARNOLD: I'm going to go do an aspiration. Just in the mix.
SIMMONS-DUFFIN: Yeah.
In between patients, Nurse Caci Young gives a tour of the procedure room.
CACI YOUNG: This is the nitrous. This is Karen.
SIMMONS-DUFFIN: That's the machine with a cylinder of laughing gas - named Karen because it looks a bit like the robot from "Spongebob." There's an exam table, like you'd see in any doctor's office. They use it for all sorts of procedures.
YOUNG: Mole removal, skin tags, IUD placements, biopsies and abortions.
SIMMONS-DUFFIN: All on the same table. Dr. Arnold does abortion early in pregnancy, up to 12 weeks. Today's abortion patients are having procedural abortions using what's called a SofTouch device, a small handheld tool that creates a vacuum and allows a doctor to empty the uterus through suction. Many of the abortions provided here are done with medication. There's a pharmacy right in the doctor's office, says Nurse Young. The first pill people take is mifepristone.
YOUNG: So this is the mifepristone. You get a box. There's six in a box. And so they take this here.
SIMMONS-DUFFIN: The second medication is misoprostol, which patients take home with them. And the staff follows up with all abortion patients to find out how they're doing.
KATIE: Hey there. This is Katie. I'm just calling from the doctor's office. I wanted to try again to check in with you about how you're feeling.
SIMMONS-DUFFIN: Also on the schedule for an abortion later today is a member of the Navy. Dr. Arnold says they frequently do abortions for military service members who deploy again soon after.
ARNOLD: Recently, it's been a lot of sailors. And we've been, like, trying to get in touch with them while they're on a boat to make sure that they're doing OK. So far, so good, but it is...
SIMMONS-DUFFIN: Anti-abortion rights activists oppose exactly what Dr. Arnold is trying to do here, which is to normalize abortion care. Dr. Christina Francis, an OB-GYN in Indiana, who runs the American Association of Pro-Life OBGYNs, says abortion is nothing like managing a chronic condition like diabetes.
CHRISTINA FRANCIS: Chemical abortion drugs end the life of my fetal patient, so that in and of itself makes it different from a diabetes drug. But also, the complications related to a diabetes drug are not going to require an expertise that's outside of the skillset of a family medicine physician to manage.
SIMMONS-DUFFIN: But the American College of OB-GYNs says any clinician who can screen patients and provide or refer for follow-up care can safely provide medication abortions. As family Dr. Stephanie Arnold sees it, abortion has been separated from other kinds of care for political, not medical, reasons.
ARNOLD: It's just important to me to, like, fight back against that stigma. There's, you know, no reason for this care to be siloed. It's very much a part of all the other care that I'm giving. I don't feel like it's any different than my management of chronic pain or, you know, endometriosis. This is just, like, a routine part of my day.
SIMMONS-DUFFIN: Arnold is very public about the range of things she offers at Seven Hills Family Medicine. She lists abortion and gender-affirming care on her website and Google reviews. Being public is protective, she says. It shows how she's a mom and a family doctor, not an abortionist, the term Justice Samuel Alito used in the Supreme Court decision that overturned Roe v. Wade.
ARNOLD: This is, like, all part of their tactics to dehumanize and other the type of care that we are providing. But, yeah, I'm a real doctor, taking care of all kinds of real doctor things.
SIMMONS-DUFFIN: She knows what she's doing is risky. She says her husband and business partner sometimes says he wants to wrap her in bubble wrap. But she has made the practice she always wanted to work in, and she believes in it.
Selena Simmons-Duffin, NPR News, Richmond, Va.
MARTIN: Later on ALL THINGS CONSIDERED, a look at how this primary care trend is taking hold in states without abortion bans and a history of how abortion first came to be offered in standalone clinics. Listen wherever you happen to be on your phone, your laptop, your smart speaker or on the radio.
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