A quick warning this week: This episode mentions suicide and contains graphic descriptions of an abortion.

Dan Gorenstein: A personal and political fight to keep abortion legal in Michigan is in full swing.

Michigan is one of more than 20 states poised to ban abortion if Roe v. Wade falls — the state still has a ban on the books that predates Roe.

Activists and officials there are working to protect the right — in the courts, on the campaign trail, at the ballot box this November and through stories.

Today, our contributor Alice Miranda Ollstein speaks with one woman who got an illegal abortion in Michigan and the various political levers state leaders have to keep the right to the procedure legal.

From the Leonard Davis Institute of Health Economics at the University of Pennsylvania, I’m Dan Gorenstein. this is Tradeoffs.

***

Alice Miranda Ollstein: Renee Chelian remembers laying down, blindfolded, in the back seat of a stranger’s car.

She wore the blindfold so that if Renee was ever caught and questioned by police she would have no idea where she was going.

When she removed the face covering, she was in a warehouse somewhere in Detroit.

Renee Chelian: There were grease stains and oil stains on the floor. There were card tables chairs with so many other women. Once I realized how many people were there, I never looked up.

AMO: It was 1966, seven years before Roe v. Wade.

Renee was 15 years old and terrified.

RC: I was afraid if I looked up and made eye contact with someone that they wouldn’t do my abortion. So I just stared at everybody’s shoes until it was my turn.

AMO: Renee climbed onto the flimsy table, eyes averted so she would never recognize her doctor.

Just a few weeks before, she had been at her house, trying to figure out how to tell her parents she was pregnant, even contemplating ending her life.

RC: I remember laying in the bathtub and taking a razor blade and thinking, “I could cut my wrist and the bathtub is full, so I’ll just put my hand on the water and I’ll bleed to death.” And then I cut my finger and it hurt and I was like, “I don’t think I can do this.” But, I didn’t feel like I had anything else. I mean, it’s a feeling of desperation I can still summon.

AMO: Afraid of having the baby and giving up her future, afraid of committing suicide, Renee talked it over with her parents.

They laid out options she had no idea existed.

RC: My parents came to my bedroom and asked me if I wanted to have an abortion. And I didn’t know what it was. They explained to me that I wouldn’t be pregnant anymore, but that it could be dangerous because it was illegal, which meant we couldn’t tell anybody.

AMO: Renee’s parents set it all up over the phone. They had to use code words because they shared the line with neighboring houses and worried they’d get reported to the police.

And now here she was, on her back, about to get a procedure she had never heard of even four weeks before.

The doctor put her to sleep.

Then — using a crude but common method — he stuffed gauze into Renee’s uterus to trigger a miscarriage.

RC: When I woke up, they were explaining to my dad that I was farther along than they thought. My understanding was I would pass the pregnancy at home within a couple of days.

AMO: But this dangerous, illegal operation didn’t take.

The teenaged Renee would have go through several more risky steps to terminate her pregnancy.

First, the warehouse doctor recommended the anti-parasite drug quinine.

She picked it up under a fake name.

RC: I took that and it didn’t do anything. A week went by and nothing happened. So we had a second appointment.

AMO: So again, a blindfold, a stranger’s car, a warehouse — a different one this time.

Her second doctor used the same method as the first, but also ruptured the membranes surrounding her fetus. And her family doctor sent her antibiotics, just in case.

RC: I’m sure they were worried about a 15-year-old kid ending up in the emergency room, you know, dying or sick.

AMO: It worked.

Her dad took her brothers and sisters out when Renee’s contractions started, leaving her to deliver in the family’s one bathroom.

Her mother shut all of the windows to muffle her screams.

A nurse arrived with strong painkillers in hand.

RC: I don’t know how long I was in labor before I passed the pregnancy. And then I passed the pregnancy in the toilet. And then came: What the hell are we going to do with it?

AMO: Renee’s mom and the nurse huddled.

Renee heard the nurse say for $200, someone could remove the fetus from the toilet.

Renee’s mom — who was six months pregnant at the time — fished it out herself.

RC: She asked me if I wanted to see it, and I told her no. And somebody came and picked it up. And my dad came home with all of my siblings and came in to see how I was doing and said to me, “We will never speak of this again.”

AMO: For a long time, Renee obeyed her father.

But this most recent threat to Roe — which crystalized for her when Texas passed its controversial 6-week abortion ban last year — has pushed her to tell her story publicly.

RC: The idea that we’re gonna go back makes me sick to my stomach. You know, like to the point where, I mean, I spent days crying, weeks crying. I think that was probably as close as I’m gonna come to an emotional breakdown.

AMO: Instead, in March, 71-year old Renee joined tens of thousands of volunteers in Michigan working to gather 425,000 signatures to put an amendment on the ballot this November. If they succeed, it would guarantee a right to an abortion in the state’s constitution.

RC: While my heart does break for what’s going to happen everywhere else, I’m not letting myself go there right now. What I’m concentrating on is keeping Michigan safe.

AMO: For months, she’s worn an oversized button reading “Ask me how to protect abortion rights” wherever she goes.

RC: I wear one when I’m out, and I carry a petition in my purse. And people will stop me and ask when I’m in line at Target and they sign the petitions there.

AMO: If the Supreme Court overturns Roe, bans in more than 20 states are set to go back into effect.

Michigan is one of them.

The stakes for Renee are personal and professional.

With her two adult daughters, she runs the Northland Family Planning Centers, a group of abortion clinics in the Detroit and Ann Arbor suburbs.

If Michigan manages to preserve the right to an abortion, Renee may need to staff up.

But the future, of course, is uncertain, and Renee is already anticipating what the fallout could look like if the state’s ban takes effect.

RC: I don’t think political people have really thought about what kind of health care crisis there’s going to be in this country. We’re going to see women self-inducing. We are going to see people breaking the law and the criminalization of women. And we’re going to see children suffer. I mean, half of our patients already have kids, and they tell us the reason for their abortion is to take care of the children that they have now. What happens to those kids who are born to families who can’t take care of them?

AMO: That’s the question that sticks. It fuels her work to keep abortion legal in the state.

She wants people to know the trauma she went through — blindfolded in that car, the dirty warehouse, in her bathroom — came from abortion being illegal.

The abortion itself rescued Renee from having to drop out of school, marry her 16-year-old boyfriend and abandon her dreams.

RC: The feeling that I had when my parents asked me about an abortion was like God had reached out and given me a second chance in my life.

AMO: Renee is clear-eyed about the road ahead.

She knows abortion rights may crumble, but she’s committed to making sure people understand the fear, desperation and danger that comes with history repeating itself.

DG: Alice Miranda Ollstein reporting.

When we come back, we’ll speak with Alice about the steps elected officials and activists in Michigan are taking to try and keep abortion legal in the state.

MIDROLL

DG: Welcome back.

We’re speaking with Alice Miranda Ollstein, a health care reporter with Politico, on the various political levers available to political leaders and activists in Michigan who are attempting to keep the procedure legal.

Michigan is one of 20+ states that could see the right go away if the Supreme Court overturns Roe v. Wade.

Alice Miranda Ollstein, welcome.

AMO: Thank you, glad to be here.

DG: You’ve reported that Michigan Democratic officials and activists like Renee are trying a bunch of different strategies at once to protect abortion.

It’s the same menu of options a lot of states are looking at right now as they anticipate the fall of Roe v. Wade, and Michigan could be a blueprint of what’s to come more broadly.

I’d like you to walk us through the pros and cons of these strategies. Let’s start with lawsuits.

AMO: Sure, so the strategy that has had the biggest impact in Michigan so far is a lawsuit brought by Planned Parenthood that’s challenging the state’s 1931 abortion ban. So they recently won a preliminary injunction meaning the ban won’t immediately go back into effect if Roe falls. But it’s not a permanent fix, because that could get reversed on appeal.

Gov. Gretchen Whitmer also has her own lawsuit that’s still pending. She is asking the state Supreme Court to decide whether the state’s abortion ban violates the state’s constitution.

DG: Right, and she’s up for re-election this fall, yeah?

AMO: She is and you know, let’s remember Michigan is a swing state. And all of the Republicans that are running to replace her are vocally anti-abortion. And so when I talked to Gov. Whitmer, she really emphasized just how precarious this moment is,

Gov. Gretchen Whitmer: You know, we’ve pursued this kind of three-pronged strategy because we don’t know which one might be successful. We don’t know if any of them will. Maybe they all will. We don’t know. And I think that’s why this is such a stark, kind of scary, confusing moment

DG: OK Alice, so that’s lawsuits. What about this ballot initiative that Renee is a part of? What’s up with that?

AMO: So activists like Renee, really feel that the ballot initiative is their best bet — their strongest tool. When I talked to the ACLU folks in the state, they said, the lawsuit is the shield. But the ballot initiative is the sword. And so if Renee and others can hit that signature threshold in the next few weeks, get on the ballot this November, and convince a majority of voters to vote for it, it would put permanent protections in the state constitution. And that wouldn’t apply just for abortion, it would apply to a very broad array of reproductive health services like birth control, miscarriage, management, etc.

DG: What’s the likelihood this ballot measure will pass, Alice?

AMO: So they’re fairly confident they’re going to be able to get enough signatures and get enough votes. But it’s not clear. And it’s going to be a really tough and really expensive battle for the next few months. Anti-abortion groups that I talked to in Michigan are gearing up for a fight. They’re planning to spend big on advertisements, sending volunteers door to door to try to convince people to vote against this. The progressive side is also planning to have a very tough fight even though currently they’re ahead in the polls.

DG: It sounds like this fall is really shaping up to be a high-pitched battle in the state. Are there other levers officials are trying to pull?

AMO: So if all of these different things fail, and the 1931 ban goes back into effect, the state’s Attorney General Dana Nessel has said that she will not prosecute any doctors for violating it. But Nessel herself is up for reelection this fall running against, again, a vocally anti-abortion Republican opponent. So if she loses, it could really have a big impact. And she’s really making sure that voters know that when they go to the polls, and this is what she told me a couple of weeks ago when we chatted.

Dana Nessel: If I’m your attorney general, I will not enforce those laws. It’s prosecutorial discretion. I don’t have to enforce those laws. There’s all kinds of laws in the books. Adultery is a crime here in Michigan, you know, I haven’t enforced that.

AMO: So another con to the prosecutorial discretion strategy or tool is that even if Nessel wins reelection, she won’t bring any charges under this ban, but she can’t stop all of the local prosecutors in the state from doing the same.

DG: So Alice, I know you’ve spent a lot of time lately reporting on the ground in Michigan, and you’ve done some great stuff for Politico on this. And one of the areas of focus has been looking at providers and how providers are planning for a post-Roe reality. What did you hear from these people?

AMO: Michigan’s abortion ban is decades and decades old. It doesn’t take into account medical innovations that have happened since then. And so it has language around medical emergencies and threats to the life of the mother. But there’s a lot of questions about what does that exactly mean? Can someone provide an abortion when there’s just a small chance of the patient having a bad outcome? Or do they definitely have to be on the brink of death before the abortion can be performed? There’s just a lot of unanswered questions.

And there are providers like Renee who say they’ll have to shut down immediately if the ban goes into effect, but at the same time, having to make plans for a huge wave of patients coming from other states. And so they are trying to make sure they have the capacity to see everyone because they’re worried about having their resources be overwhelmed.

DG: Final question, Alice. What do you think other states can learn from what Michigan is going through — this state where it’s almost like a jump ball?

AMO: I think there are a lot of lessons that we can already glean from Michigan. So one is that lawsuits and courts in general just really can’t be depended on. I think the other lesson is that, these state level officials like Attorney General Nessel, like the governor, these are the people who will be deciding who gets punished under these laws, who can get an abortion under what circumstance, and they are just becoming more important than ever. I think the final lesson is that state constitutions are really going to be a huge focus going forward. And we’re already seeing a bunch of states try to organize a referendum to get the state constitution to say once and for all, is abortion protected or not. And so there’s going to be referendum votes later this year in Kansas and Vermont, and that will give voters a way to directly weigh in on this question.

DG: Alice Miranda Ollstein, thanks so much for taking the time to talk to us on Tradeoffs.

AMO: My pleasure.

DG: And one final thing, Alice, that story with you and Renee was spectacular. Thanks so much for that, too.

AMO: And a big thank you to Renee for sharing such a tough and personal story.

DG: I’m Dan Gorenstein. This is Tradeoffs.