Archive for the ‘Abortion & Reproductive Rights’ Category

April 3, 2014

Smoke and Mirrors and Women, Oh My

by Katherine L. Record

Last week, the Supreme Court attracted lots of attention when it heard arguments about whether a corporation can exclude mandatory preventive benefits from its employee health plan, based on a religious objection to certain types of healthcare.

This is a tale as old as time; religion has long been the basis for opposition to reproductive (i.e., women’s) health – including the preventive healthcare now in question, contraception.

Yet this argument has nothing to do with government infringement on the practice of religion.

In fact, the corporation, Hobby Lobby, covered two of the four contraceptive devices in dispute until its lawyers were actually arguing the issue in court, apparently to little detriment to the company’s faith in God. What’s more, Hobby Lobby’s 401(k) includes more than $73 million invested in the companies that produce these objectionable contraceptives (e.g., intrauterine devices, emergency contraception).

This has not stopped Hobby Lobby from arguing that the Affordable Care Act (ACA) is threatening its freedom, as a corporation, to practice religion.

This is a clever argument. We take religious freedom seriously, as we should. Masking coverage of FDA-approved contraceptives, as the ACA requires, as an infringement on faith is catchy. Nonetheless, it is nothing more than smoke and mirrors, which we, as attorneys, have a knack for creating.

Practicing law is often a matter of distilling a problem into sterile elements and stringing them together to form a line of reasoning that favors a given conclusion. Generally, this allows judges to apply the law with an even hand, no matter how complicated life gets.

Yet it also allows us to paint an issue as something it is not. This is particularly problematic when the issue is inequality, a concept lawyers have masqueraded for years (justifying slaves as property, segregation, limited voting rights, a narrow definition of marriage).

Last week we did it again.  Here’s the picture Hobby Lobby painted:

The ACA’s requirement that most health plans cover preventive services, including all FDA-approved contraception, violates the Religious Freedom Restoration Act of 1993 (RFRA). RFRA is a federal law that bars Congress from enacting a law that substantially burdens religious practice, even if it generally applies to all faiths, which passes muster under the First Amendment. In other words, RFRA creates more robust protection of religious freedom than the First Amendment.

Let’s break it down:

(1) RFRA protects the corporation’s right to practice religion just as it does a person’s right to practice (i.e., a corporation is a person, which is the case under the First Amendment, but has never been treated as such under this federal law);

(2) covering certain types of contraception substantially burdens this corporation’s religious practice; and

(3) the government does not have a compelling interest that justifies this insufficiently narrowly tailored intrusion into the company’s faith.

Sounds good, right?

It did to the Court. Last week, the attorney representing the United States and the Justices of the Court focused on this argument just as Hobby Lobby painted it, waxing poetic on statutory interpretation, principles of corporation law, the distinction between for-profit and non-profit tax status, and the intention of Congress as it existed in 1993 – when it enacted RFRA to protect a “person’s” right to religious practice.

All of this is irrelevant.

The legal profession is being dishonest by cloaking the real issue in legal doctrine. Hobby Lobby paints contraceptives as the Scarlett letter of the ACA, alleging that coverage of some types disrupts their Christian faith. Yet the ACA requires coverage of all FDA-approved contraception to protect women’s health – not to promote sex that does not produce offspring. In fact, 98% of sexually active Catholic women use contraception, yet the Catholic Church marches on.

As it turns out, healthcare is healthcare, even if you have a uterus.

Women who do not space out pregnancies are at higher risk for adverse outcomes – both for the mother and the child. Women who get pregnant accidentally – whether unintentionally or unwillingly, are more likely to give birth prematurely, to develop depression, to avoid prenatal care.

Moreover, some women require contraception for reasons entirely unrelated to conception (e.g., amenorrhea or menstrual irregularities, fibroids, endometriosis). And not all women can take the kind of contraception Hobby Lobby deems pious (e.g., an intrauterine device can be medically necessary if a woman cannot take the pill).

In short, women and children are healthier when medically indicated contraception is available – which is why contraception is a healthcare benefit. Requiring companies to offer the same level of healthcare to both female and male employees does not impede religious autonomy, it keeps the workforce healthy.

In June, the Supreme Court will issue a ruling couched in terms of religious autonomy. Yet it will not affect religious practice, Hobby Lobby’s or otherwise. Rather, the Court will determine whether an employer can charge women more than men for preventive services (i.e., provide comprehensive coverage for men and partial coverage for women). In other words, the Court is once again considering equality, masqueraded as a religious threat.

Are women sufficiently person-like to access the same degree of medical coverage as men? The Court very well might say no.

Fortunately, the law is not a foregone conclusion. Indeed, over time, the Court has reversed itself on matters once considered predetermined by our forefathers (e.g., the federal ban on gay marriage, criminalization of sodomy, and the status of black persons as, well, persons). Women might not be equal to men quite yet, but there is hope.

Katherine L. Record is the Senior Fellow at the Center for Health Law and Policy Innovation (CHLPI) at Harvard Law School and a member of the Our Bodies Ourselves board of directors. This post was previously published on Harvard Law School’s Petrie Flom Center Bill of Health blog.


March 18, 2014

Experts Discuss Women’s Health Movement and Healthcare Reform

“We are a very rich country, but we have rationed healthcare in a way that is unconscionable.”

Judy Norsigian, Our Bodies Ourselves co-founder and executive director, doesn’t hold back in this March 6 discussion on women’s health with Sonia Pressman Fuentes, National Organization for Women (NOW) co-founder.

Luz Corcuera, program director of Healthy Start Coalition of Manatee, Fla., hosts the dynamic conversation, which covers the history of the women’s health movement and the founding of Our Bodies Ourselves and NOW, as well as current healthcare issues, the effect of poverty on health, and more.

At about half-way in, Fuentes talks about joining the the Equal Employment Opportunity Commission in the late 1960s and being the first female lawyer in the general counsel’s office, where she encountered reluctance to enforce the sex discrimination aspect of the Civil Rights Act of 1964 prohibiting discrimination on the basis of race, color, religion, sex or national origin.

Fuentes wasn’t an activist at the time, but as one of the few women at the Commission, she found herself frequently in the position of representing women’s interests.

“Whenever an issue came up, I always said, ‘Well what about sex discrimination?’ So my boss, the general counsel, took to calling me a sex maniac because I always raised the issue of sex discrimination.”

The whole interview is well-worth watching. Thanks to Manatee Educational TV in Florida for hosting the conversation!


February 11, 2014

In Memoriam: Dr. Gary Romalis

Dr. Gary Romalis, a major proponent of women’s reproductive health and rights, died on Jan. 30 at age 76.

Dr. Romalis was dedicated to helping women by providing abortion. In a 2008 speech at University of Toronto, Romalis addressed some of the horrible consequences he had witnessed of unsafe abortions, and explained why he chose to provide abortions:

I can take an anxious woman, who is in the biggest trouble she has ever experienced in her life, and by performing a five-minute operation, in comfort and dignity, I can give her back her life.

Dr. Romalis life was threatened multiple times by anti-abortion extremists. In 1994, Romalis was shot by a sniper while eating breakfast in his home. In 2000, he was stabbed by a man as he was entering his Vancouver office. After recovering, Romalis kept working — in fact, after 2000, he limited his practice to only abortions.

Judy Norsigian, Our Bodies Ourselves executive director, remembered the effect this violence had on Romalis and his family:

Dr. Romalis was not only a brave physician who continued to provide abortion services after two frightening attempts to kill him, he was a constant role model for medical students and residents considering a career in the reproductive health field.

I will never forget the day my late husband, Irv Zola, chair of the sociology department of Brandeis, came home after comforting Dr. Romalis’s daughter, then a student in my husband’s class. She was so shaken and bewildered that anyone would want to attack her sensitive and caring father, and being 3,000 miles away from him made it even harder.

Renee Ghert-Zand, a family member of Dr. Romalis, writes in The Forward:

My cousins have lost an exceptionally warm, loving and involved father and grandfather. The Vancouver Jewish community has lost a compassionate and committed member. Canada has lost a courageous physician who let nothing stand in the way of his doing the right thing.

Toward the end of his 2008 speech, Gary said: “After an abortion operation, patients frequently say ‘Thank You Doctor.’ But abortion is the only operation I know of where they also sometimes say ‘Thank you for what you do.’”

Thank you for what you did, Gary.

Our condolences are with Dr. Romalis’s family, as is our gratitude for his lifetime of service.

Remembrances of Dr. Gary Romalis:
NAF Mourns the loss of Member Dr. Gary Romalis
Department of Obstetrics and Gynecology Mourns an Iconic Member
In Memoriam – Dr. Gary Romalis


February 7, 2014

U.S. Abortion Rate Drops, But What Do the Numbers Mean?

The U.S. abortion rate has declined to its lowest levels in four decades, according to a new report from the Guttmacher Institute.

As of 2011, the rate had declined to 16.9 abortions per 1,000 women aged 15–44, almost half of what it was in 1981 (29.3 per 1,000 women) and the lowest since 1973 (16.3 per 1,000).

While the record number of abortion restrictions passed in 2011 may come to mind as a possible cause, the data used largely predate those restrictions.

The Guttmacher report also notes that even states that did not implement new restrictions during the study period also saw declines:

It is crucial to note that abortion rates decreased by larger-than-average amounts in several states that did not implement any new restrictions between 2008 and 2010, such as Illinois (18%) and Oregon (15%). So, even in states like Louisiana and Missouri, we cannot assume that the new restrictions were responsible for the decline in abortion incidence.

More plausible explanations, according to the report, might be the increase in long-acting, highly effective methods of contraception such as IUDs; increasing use of birth control among young women in general; and overall declines in the pregnancy and birth rate.

This doesn’t mean, however, that the surge of restrictions enacted over the past several years will not have a negative impact on women’s access to abortions — it just doesn’t show yet in the data.

Judy Norsigian, Our Bodies Ourselves executive director, had this to say about the numbers:

At this point, it is misleading to suggest that restrictions don’t make a difference.  The restrictions that we are seeing now, after this study was done, are of an entirely different order, because they are causing a dramatic rise in the closing of clinics. Just look at the crisis in Texas now. We know that abortion providers in Texas and other impacted states will continue to do their best to meet the needs of the most vulnerable women who can’t afford to travel to places where abortion services are available, but these providers will face huge obstacles.

It is also important to recognize that although there may be a reduction in the abortion rate overall, the rate rose nearly 18 percent among the country’s poorest women — a trend that might reflect the growing economic challenges facing women now. Of the more than 1.2 million legal abortions reported in 2008, women whose family income fell below the national poverty level accounted for 42 percent of these abortions.

For further exploration of Guttmacher’s results and the reasons behind the numbers, see:


February 5, 2014

Does Viewing an Ultrasound Deter Women from Having an Abortion?

ultrasound viewing study

Source: Relationship Between Ultrasound Viewing and Proceeding to Abortion / Obstetrics & Gynecology January 2014

We all know what forcing women to undergo and view ultrasounds prior to an abortion is supposed to do — influence women to carry their pregnancies to term.

That’s why crisis pregnancy centers, which operate with an anti-abortion agenda, offer ultrasounds even though most are not equipped to provide medical services, and anti-abortion mobile buses park near schools and offer free ultrasounds to pregnant women.

But does viewing an ultrasound really deter women from choosing abortion?

According to research findings, bolstered by a new study, the answer is probably no.

Researchers from University of California, San Francisco and Planned Parenthood looked at data for more than 15,000 women seeking abortions at a Los Angeles Planned Parenthood clinic in 2011. All patients underwent a pre-procedure ultrasound, which can be standard in abortion care, and all were offered the opportunity to view the ultrasound screen. (Mandating that women undergo an ultrasound, view it, and listen to a description of the fetus is a whole other issue.)

Less than half, 6,346 women, chose to view it. Almost all of them, regardless of their viewing choice, went on to have abortions (98.8 percent).

Researchers also considered how certain the women felt about their decisions to have an abortion. Women who were highly certain about their decision did not waver, regardless of whether they viewed the ultrasound.

As might be expected, women who were were less certain of their decision to abort the pregnancy and who viewed the ultrasound were slightly less likely to have an abortion than like-minded women who did not view it (95.2 percent of those who viewed it continued with the abortion compared with 97.5 percent of those who did not).

Other factors, such as gestational age, weighed more heavily on the decision. Women who were 17 to 19 weeks pregnant, for example, were almost 20 times more likely to continue the pregnancy than women up to nine weeks pregnant, regardless of whether or not they viewed the ultrasound. The authors suggest that this may have to do with women’s feelings about terminating a pregnancy earlier vs. later.

The authors caution that their findings may be different from situations in which the ultrasound is forced, but they conclude that mandatory viewing should be avoided:

Finally, these results cannot be generalized to women’s experience of ultrasound viewing in settings where it is mandatory, although given the very high percentage of women proceeding with abortion after viewing the ultrasound image, it is unlikely that mandatory viewing would substantially affect the number of abortions performed. It may, however, affect patient satisfaction and health outcomes, which research shows are enhanced when patients feel control over decisions related to their care. Mandating that women view their ultrasound images may have negative psychological and physical effects even on women who wish to view.

The clinical implications of this study are twofold. First, women should be offered the opportunity to voluntarily view their ultrasound images before abortion. However, because fewer than half of women select this option, mandatory viewing should be avoided. Second, health care providers engaged in ultrasound viewing should be sensitive to how patients react to their images but avoid making assumptions about the effect of viewing on patient decision-making. Patients with low decisional certainty about the abortion decision may need more time and support in reaching a decision about whether abortion is the correct decision for them.

For more on the use of ultrasounds in the context of abortion, read this excellent commentary by Tracy Weitz, one of the study’s authors and director of the Advancing New Standards in Reproductive Health (ANSIRH) at UCSF (and a contributor to “Our Bodies, Ourselves”). Written last March, during the height of political battles around mandating transvaginal ultrasounds, Weitz takes a closer look at the weak rationale for anti-abortion activists thinking that ultrasound viewing would reduce the number of abortions.

To date, she notes, “no peer-reviewed empirical data has supported this proposition that viewing an ultrasound image discourages women from abortion. In fact, what limited information does exist suggests that women seeking abortions have a range of experiences associated with viewing their ultrasound and any mind-changing occurs in a complex context that may or may not include ultrasound viewing along with other factors.”

Conversations about mandatory ultrasound, Weitz argues, should be focused on how these laws drive up costs, make providing abortion care more difficult, do not improve health outcomes, and eliminate patient autonomy.

To learn more about situations and states in which ultrasounds are regulated in the context of abortion, view this fact sheet from Guttmacher Institute. Currently, three states mandate that an abortion provider perform an ultrasound and show and describe the image; eight states mandate the ultrasound and require the provider to offer the patient the opportunity to view the image.


January 22, 2014

On The Anniversary of Roe v. Wade, Get Informed and Get Active

Today marks the 41st anniversary of the Roe v. Wade decision making abortion legal throughout the United States.

As we have seen, however, legality does not equal access. Many states have chipped away at Roe v. Wade; in 2012 alone, 22 states enacted 70 new abortion restrictions, making abortion much more difficult to obtain

There have been numerous stories lately on state abortion battles and where the push will be in 2014 to further reduce abortion access, as (mostly male) politicians, seeking to boost their midterm election profiles, will try to enact more barriers.

Abortion rights activists are going on the offensive. So should you.

For this anniversary of Roe, make a plan to support reproductive choice in 2014. Connect with supporters in your area.

Contact your senators and representatives and let them know you support the Women’s Health Protection Act (S 1696/HR 3471), which would prohibit many restrictions that intrude on a woman’s decision and make it more difficult for physicians to provide abortion services.

Learn about abortion restrictions in your state, and check to see if bills proposing new restrictions have been introduced.

We need to talk more openly about abortion as a health issue for women, and we need to work together to ensure it remains a legal option in the years to come.


January 13, 2014

A Woman’s Life Has Ended, but Hospital Insists on Life Support for Fetus Against Family’s Wishes

Right now in Fort Worth, Texas, 33-year-old Marlise Munoz lies in a hospital bed, brain dead after experiencing a blood clot in her lungs. Munoz’s family has been prohibited from honoring her wishes to be removed from life support.

Why? Munoz is pregnant.

When her clot happened, Munoz was 14 weeks pregnant; she’s now 20 weeks pregnant. Texas is one of 12 states in which a pregnancy at any stage invalidates a woman’s advance directive for her end-of-life care. The other states are Alabama, Idaho, Indiana, Kansas, Kentucky, Michigan, Missouri, South Carolina, Utah, Washington, and Wisconsin.

According to the Center for Women Policy Studies, additional states can invalidate a pregnant woman’s wishes and force her to be kept on life support if it’s “probable” that the fetus will develop to the point of live birth. A few more states have similar rules but limit them to women whose fetuses are already viable.

The New York Times notes that some experts in medical ethics have said they believe the hospital is misinterpreting Texas state law prohibiting medical officials from cutting off life support to a pregnant patient. At this point, Munoz’s fetus is not viable outside of her uterus, and it’s unclear whether it was compromised by the amount of time she went without medical attention following her collapse or the subsequent deterioration of her body: 

Mrs. Munoz’s parents and her husband, Erick Munoz, 26, remain in limbo, even as they and other relatives help care for the Munozes’ 15-month-old son, Mateo. Mr. Munoz has returned to his job as a firefighter but continues to sit by his wife’s side at the hospital. She had been due to give birth in mid-May, but the hospital’s plans for the fetus — as well as its health and viability — remain unknown. Mr. Machado [Marlie Munoz's father] said he had been told by the hospital’s medical team that his daughter might have gone an hour or longer without breathing before her husband woke and discovered her, a situation he believes has seriously impaired the fetus. “We know there’s a heartbeat, but that’s all we know,” he said.

Mrs. Machado said the doctors had told her that they would make a decision about what to do with the fetus as it reached 22 to 24 weeks, and that they had discussed whether her daughter could carry the baby to full term to allow for a cesarean-section delivery. “That’s very frustrating for me, especially when we have no input in the decision-making process,” Mr. Machado added. “They’re prolonging our agony.”

Lynn Paltrow of the National Advocates for Pregnant Women has commented:

What is quite stunning about these statutes for women is that they don’t even take into account a woman’s pain. A woman could be in excruciating pain and near death’s door and they still would force her to suffer. These are extraordinary laws creating separate unequal status for pregnant women in which they lose control of medical decision making, the right to bodily integrity and right to be free of excruciating pain.

Not being allowed to die in peace, or watching a family member be denied their wishes, is the stuff of nightmares. This extreme situation, however, isn’t the only one in which pregnant women’s freedoms have been restricted.

In October, there was some media coverage of Alicia Beltran’s case. Beltran had beaten a drug addiction and was 14 weeks pregnant when her doctor and a social worker tried to force her to take an anti-addiction drug and took her to court when she refused.

The National Advocates for Pregnant Women has documented hundreds of U.S. cases of pregnant women who were subjected to or threatened with incarceration, detention, or forced medical or other interventions that the state decided were in the best interest of the fetus — not the woman.

A petition has been launched asking Texas Attorney General Greg Abbott to leave this decision to Marlise Munoz’s family. To learn more about “pregnancy exclusion laws,” read “Marlise Munoz Case Shines Light on Dehumanizing ‘Pregnancy Exclusion’ Laws,” by Lynn Paltrow and Katherine Taylor.


December 17, 2013

When Off-Label is Safer for Women: The Politics of Medication Abortion

Among the numerous tactics used to restrict abortion access, several states have proposed or implemented laws that impose unnecessary restrictions on medication abortion. These restrictions interfere with evidence-based practices that are considered safer for women’s health.

Some states are requiring that medication abortions follow the exact regimen approved by the FDA back in 2000, though research has since proven that lower doses are safer and just as effective. (The FDA has approved updated labeling since 2000, but these updates have not addressed the commonly used lower-dose regimen; it is not clear whether the drug company plans to submit new data and request these changes.)

The FDA protocol calls for a clinician to provide 600 mg of the first drug, mifepristone, for the patient to take orally, followed 48 hours later by 400 mcg of oral misoprostol. More modern, evidence-based regimens call for only 200 mg of mifepristone, followed later by 800 mcg of misoprostol that is held in the cheek until it dissolves instead of swallowed. The newer regimen also allows for the misoprostol dose to be taken at home.

Guttmacher Institute: State Policies on Medication AbortionBut states looking to make abortions more difficult for women to obtain are requiring physicians to administer the second dose in person. This mean women are forced to make an additional clinic visit — a significant hardship for many patients.

It’s common practice for doctors to prescribe drugs “off-label,” which means in a different way or for a different purpose than what the FDA has specifically approved. This allows doctors to use the most current evidence and their own judgment. Indeed, a new study accepted for publication in the journal Contraception illustrates how the practice of medicine can change to improve patient safety after a drug has been approved by the FDA.

The researchers reviewed Planned Parenthood data from the five years prior to 2006 — the year Planned Parenthood clinics changed their protocol for medication abortion from vaginal to oral administration of misoprostol, and added additional steps (such as STI testing and routine antibiotics) to reduce infection risk — and the five years after.

They found three deaths out of 218,928 abortions before the change, and no deaths among 711,556 abortions after the change. The Planned Parenthood study used the common reduced dose regimen of 200 mg mifepristone followed by 800 mcg of misoprostol. Other studies have also demonstrated the safety and effectiveness of the reduced mifepristone dose.

When politicians insist on the outdated FDA-approved regimen, they are prohibiting the use of the safer approaches.

The outdated FDA regimen, says Rachael Phelps, medical director for Planned Parenthood in Rochester and Syracuse, is “dramatically less effective, has more side effects, is harder for women to use, and increases the likelihood of an additional invasive procedure compared to the evidence based regimen. Mandating the FDA regimen forces doctors to provide substandard medical care and is just plain bad medicine.”

A case challenging such a law in Oklahoma had been set to go before the Supreme Court, but was dismissed following a state Supreme Court ruling that the law would effectively ban all medication abortion in the state. Texas’s controversial HB 2 law also requires adherence to the outdated FDA-approved regimen.

For a quick guide to additional states with restrictions requiring the old regimen or barring remote doctors from supervising medication abortion via telemedicine, view this fact sheet from Guttmacher Institute.

The federal Women’s Health Protection Act (S1696 / HR 3471) introduced this year would prohibit such restrictions. Among provisions addressing telemedicine abortion, hospital admitting privileges, and other targets of recent legislation, the bill would forbid any “limitation on an abortion provider’s ability to prescribe or dispense drugs based on her or his good-faith medical judgment, other than a limitation generally applicable to the medical profession.” Contact your senator or representative to support this Act.


December 3, 2013

Science Says: Emergency Contraception Does Not Block Implantation of a Fertilized Egg

Last week, in a post about how some types of emergency contraception are less effective or ineffective in women weighing more than 165 pounds, we mentioned that the European equivalent to Plan B One-Step was getting a new label that will note the problem.

Let’s take a look at the other reason for the label change: European health officials have determined — and want to make clear — that the drug “cannot stop a fertilized egg from attaching to the womb.”

This is a big issue, as abortion opponents have long opposed EC on the grounds that it might prevent a fertilized egg from implanting in the uterus. U.S. labels of levonorgestrel-containing emergency contraceptive pills, such as Plan B, don’t directly refute the possibility.

But as The New York Times noted last year, recent science suggests that this is not the case; the pills work only by preventing ovulation and fertilization.

Last week, NYT reporter Pam Belluck noted how the FDA and other health agencies responded to the scientific studies:

References to the possibility of blocking implantation were then removed from the websites of the National Institutes of Health and the Mayo Clinic. And an F.D.A. spokeswoman, Erica Jefferson, said that “the emerging data on Plan B suggest that it does not inhibit implantation.”

On Tuesday, Ms. Jefferson reiterated that view. The drug agency has not moved to change the label, saying manufacturers must request a change. Plan B One-Step’s manufacturer, Teva Pharmaceuticals, declined to comment. It had previously said scientific evidence suggested that the pill did not disrupt implantation.

Although pregnancy is not medically considered to have begun until a fertilized egg has successfully implanted in the lining of the uterus, media coverage around this topic has often obscured this distinction and promoted a false idea that emergency contraception is the same thing as the abortion pill (RU-486) or abortion in general. Medical professionals generally assert that “emergency contraception is not effective after implantation; therefore, it is not an abortifacient.”

Effect on Lawsuits
Hobby Lobby is one for-profit corporation that filed suit to avoid complying with Obamacare coverage for contraception, claiming that forms of contraception that could interfere with the implantation of a fertilized egg are tantamount to abortion. The Supreme Court will hear the case, focusing on whether for-profit companies can be required to provide coverage that may conflict with the private religious beliefs of the business owners.

As Linda Greenhouse wrote in an op-ed about challenges to the contraception mandate under the Affordable Care Act, a coalition of medical groups, led by Physicians for Reproductive Health, filed a brief in the case, noting in part that “the weight of the scientific evidence establishes that the FDA-approved contraceptives and emergency contraceptive are not abortifacients.”

Read Greenhouse’s column for an excellent look at how the religious-based challenges represent a culture war on “modernity.” For more on the lawsuits, SCOTUSblog is a smart resource.

And we highly recommend the Emergency Contraception website for easy-to-understand fact sheets, such as this one: “Does emergency contraception cause an abortion?


November 13, 2013

Researchers Explain How Anti-Abortion Legislation Threatens Women’s Health

Protest rally against Texas HB2 and SB1 on July 15

July 15 protest rally in Austin against anti-abortion legislation / Photo by Mirsasha

There have been a number of recent articles and campaigns detailing, often from a personal perspective, how legislation restricting access to abortion will harm women’s health.

A new article that will be published in the journal Contraception goes a step further — it draws on research to address the specific hardships women face and urges healthcare providers to push back against such restrictive measures.

The authors — researchers from university medical centers and health policy organizations such as Ibis Reproductive Health who have collaborated together before on matters of abortion and women’s health — open with a sharply worded question: “What happens when abortion access is severely restricted for 26 million Americans? Texas is about to find out.”

Texas, as you might recall, passed a law in July — the subject of State Sen. Wendy Davis’s epic filibuster – that mandates hospital admitting privileges for abortion providers; requires abortion facilities to meet the same standards as ambulatory surgical centers; bans most abortions after 20 weeks post-fertilization (22 weeks “pregnant”); and restricts use of medication for abortion to an outdated regimen. A lawsuit was filed to try to overturn some of these restrictions.

The admitting privileges requirement was temporarily blocked this month, then reinstated, causing up to a third of abortion clinics to suddenly close and forcing women to scramble for alternatives. The issue may end up in front of the Supreme Court. (More wrangling took place this week; view the latest coverage at RH Reality Check).

Despite claims that the new restrictions are for women’s “safety,” the authors report that the evidence suggests something different: “Evidence from other countries indicates that severely restricting abortion does not reduce its incidence — it simply makes unsafe abortion more common.”

Among the public health concerns raised in this article is the potential increase in the number women attempting to induce their own abortions:

In 2012, we conducted a survey with 318 women seeking abortion in six cities across the state to assess the impact of the 2011 restrictions. We found that 7% of women reported taking something on their own in order to try to end their current pregnancy before coming to the abortion clinic. This proportion was even higher — about 12% –among women at clinics near the Mexican border. Misoprostol and herbs were the methods women more commonly mentioned. By comparison, a nationally representative survey of abortion patients in 2008 found that 2.6% reported ever taking something to attempt to self-induce an abortion. The confluence of extremely limited access to abortion in the context of poverty, access to misoprostol from Mexico, as well as familiarity with the practice of self-induction in Latin America, makes it particularly likely that self-induction will become more commonplace in Texas.

Early medical abortion with misoprostol is a safe and effective regimen and is  recommended by the World Health Organization in settings without access to mifepristone. But if women do not have accurate information, they may use ineffective dosages and may not realize the abortion failed until much later in pregnancy, forcing them to seek a second-trimester abortion or continue the pregnancy and have a child they do not want or feel they cannot care for. Using misoprostol in the second trimester also increases the risk of hemorrhage that might require surgical intervention or transfusion, as well as the risk of uterine rupture if inappropriately high dosages are used, especially with a history of prior cesarean delivery. And while misoprostol is unquestionably a safe method to self-induce abortion, women may use a variety of less effective and more dangerous methods to end a pregnancy on their own, including taking herbs or self-inflicting abdominal trauma.

The authors also explain that a reduction in the number of clinics, due to the provision requiring clinics to meet the standards of ambulatory surgical centers (ASCs), is likely to cause delays for women seeking care, resulting in later, more costly abortions. They describe the following scenario involving delays and travel burdens:

In 2011, 2,634 women living in the Valley obtained an abortion. Neither of the two existing abortion clinics in the Valley is an ASC, and one of the clinics has already announced its planned closure. The nearest ASC is in San Antonio, about 250 miles away, adding about eight hours of travel time to the process of obtaining an abortion. If a woman chooses a medical abortion, state law requires her to make this long journey at least three times. These barriers are likely to be too great for many women.

The three visits rule is due to a provision in Texas law requiring doctors to follow an outdated regimen for medical abortion. Most U.S. providers, they note, use a newer protocol, which has been found safe and effective — and requires only two visits instead of three. They write:

Texas is only one of several states attempting to regulate abortion out of existence — a trend that should be deeply troubling to the medical community. First, it represents a stunning incursion into the physician’s exam room, allowing state representatives to dictate how doctors should practice medicine. Second, it is in blatant contradiction to evidence-based medicine.

And they call on physicians to be more involved in protesting this type of legislation:

As the fight for abortion rights in Texas moves from the legislature to the courts, it is critical that reproductive health specialists — both clinicians and researchers — add their voices to this outcry, highlighting the negative impact of these restrictions and demanding that all women have the right to comprehensive health care services.

The article, “The Public Health Threat of Anti-Abortion Legislation,” will appear in an upcoming issue of Contraception.


October 4, 2013

Wendy Davis is Running for Governor in Texas, and That’s a Big Deal

Democratic State Sens. Sylvia Garcia (obscured), Royce West, Wendy Davis and Kirk Watson after the Senate passed the abortion bill on July 13, 2013. Photo by Callie Richmond / Texas Tribune (Creative Commons)

Wendy Davis, the Texas state senator who held off a vote restricting abortion rights by staging an 11-hour filibuster in June, announced on Thursday that she will run for governor.

Davis’s filibuster was an attempt to block legislation intended to reduce abortion access, including a 20-week ban on the procedure, imposition of surgical center standards for abortion clinics, and a requirement for providers to have admitting privileges at a nearby hospital — which would force the majority of Texas’s 42 abortion clinics to close.

The legislation was later enacted; a lawsuit is underway to block the admitting privileges and medication abortion provisions of the law from taking effect.

The state senator’s actions inspired women’s health advocates around the country (and a whole bunch of memes). Her actions capped off a difficult six months, as states enacted 43 provisions aimed at restricting access to abortion — the second highest number on record at the mid-year point, and as many as were enacted in all of 2012, according to Guttmacher Institute. These states are, not surprisingly, mostly led by Republican male politicians.

If Davis is successful in her run (a very big “if” considering Texas hasn’t had a Democratic governor since 1995, when the formidable Ann Richards, mother of Planned Parenthood President Cecile Richards, was in charge), she would join a very small group of female governors throughout the country. At present, there are only five.

But as Danny Hayes, a political science professor at George Washington University, writes in the Washington Post, getting more women to run for office is a very big deal: “[B]ecause the main barrier to electing more women in the United States is getting them to run in the first place, Davis’s emergence — the result of her 11-hour filibuster against an abortion bill in the state Senate in June — may be critical for encouraging other female candidates to throw their hats into the ring.”

While Davis’s views on abortion are clear, female representation is, of course, no guarantee of more sensible approaches to women’s reproductive health. Arizona Gov. Jan Brewer (R) signed a 20-week ban in that state last year.


September 25, 2013

“After Tiller” Focuses on Real Life Stories of Abortion Doctors and Their Patients

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After Tiller” is an important new documentary that explores the controversies around third-trimester abortions in the wake of the assassination of Dr. George Tiller.

Only four doctors in the United States now offer the procedures; the filmmakers explore how these providers “risk their lives every day in the name of their unwavering commitment toward their patients.”

Reviewing it for The New York Times review, film critic A.O. Scott, referencing a scene in which a young, pro-life woman’s request for abortion is discussed, calls it “one of the most illuminating discussions I have seen about the complicated reality of abortion.”

He concludes:

Documentaries can rarely be judged as works of dispassionate, neutral reporting since few of them aspire to uphold those journalistic criteria. Rather, a documentary should be assessed as a representation of the world as it is, from a perspective that is itself part of that world. “After Tiller” is impressive because it honestly presents the views of supporters of legal abortion, and is thus a valuable contribution to a public argument that is unlikely to end anytime soon.

New York Times editorial page editor Dorothy Samuels praises the film for taking “a complicated subject beyond the familiar muck of abstract and often ill-informed talking points to deliver a frank portrayal of the real life situations of the physicians and their desperate patients.”

Similarly, Jason Bailey, writing in The Atlantic, calls it “a rare consideration of the abortion debate that moves past labels and abstracts and takes a long look at the people involved. It is a showcase for empathy, a quality lacking in many conversations on the subject.”

The film premiered at this year’s Sundance Film Festival and is starting to open around the country. Scheduled screenings are listed online. Not playing near you? You can request a screening to bring “After Tiller” to your town. You can also follow @AfterTiller on Twitter, and like the documentary’s page on Facebook.

Want to learn more? Head over to PBS, where Tom Roston talks with “After Tiller” filmmakers Martha Shane and Lana Wilson on the Doc Soup blog.


September 23, 2013

Take Action: Reproductive Rights Campaigns

1 in 3 Campaign

Draw The Line – #UniteTonight | Sept. 25
The Center for Reproductive Rights is holding #Unite Tonight events around the country on Wednesday, Sept. 25. Flagship events will be held in New York and Los Angeles.

If you’re interested in hosting an event in your home and rallying friends to support reproductive rights, sign up to be an Ambassador. The Center will host a live, interactive online presentation for participants.

And if you haven’t already signed the Bill of Reproductive Rights, what are you waiting for?

1 in 3 Campaign Week of Action | Oct. 22-29
The 1 in 3 Campaign, a project of Advocates for Youth, is sponsoring a Week of Action to encourage conversations about abortion access around the country. Community events include tabling, dinner parties, book clubs, and campus events.

Student groups, organizations and individuals can sign up online to register an event and to receive info from the Campaign to help get the conversations started.

Medical Students for Choice Conference on Family Planning | Nov. 9-10 
If you’re a medical student or a student of another health profession interested in reproductive healthcare, consider attending Medical Students for Choice’s annual conference in Denver. Topics will include contraception, abortion, advocacy, and other issues.

As the website notes, “From hands-on opportunities to learn techniques to thoughtful explorations of personal issues related to providing abortion, MSFC’s Conference on Family Planning provides a safe environment for learning and networking with fellow students and mentors.”


September 19, 2013

Association of Reproductive Health Professionals Honors Our Bodies Ourselves Founder Judy Norsigian

We are thrilled to announce that the Association of Reproductive Health Professionals selected Judy Norsigian, Our Bodies Ourselves co-founder and executive director, as the recipient of the 2013 Irvin M. Cushner Lectureship.

The lectureship honors a layperson, public figure, or health care professional who has raised public awareness of and inspired public policy debate about an important issue in health care. The honoree delivers a presentation at the ARHP’s 50th annual conference, which starts today in Denver.

Judy’s lecture is titled “Reproductive Health and Justice: How Our Advocacy Can Best Address Persistent Problems and New Challenges.” It addresses such issues as maternity care and abortion, medical technologies, and the use of legal strategies, public education, and outreach to policy makers and media to preserve and expand access to reproductive health and justice.

The lectureship’s namesake, Dr. Cushner, was a leader in reproductive health. Past Cushner honorees have included Dr. Jocelyn Elders, Patricia Schroeder, Carole Joffe, Henry Waxman, and Cecile Richards.


August 23, 2013

Studies Show How Abortion Restrictions Hurt Women; New Investigative Report Shows Why More Restrictions Are Medically Unnecessary

We recently wrote about the Turnaway Study, a research project that involved following women who were denied an abortion because they were past the provider’s gestational age limit and comparing their outcomes to women who received an abortion (either during the first trimester or at near-limit, when the women were almost out of time). Women were recruited for the study from “last stop” abortion clinics — those where there’s not a provider with a later gestational age limit within 150 miles.

A new paper released in the American Journal of Pubic Health begins to present results from that study, focusing on the reasons for delays in seeking abortion care. The research has been conducted by the Advancing New Standards in Reproductive Health group at UCSF’s Bixby Center for Global Reproductive Health.

One of the findings provides further evidence of important disparities in access to abortion care: the women who received abortions in the first trimester instead of near the limit were more likely to have a college degree and to have a higher income.

For women who were turned away or had near-limit abortions, “money” and “finances” were the most likely reasons for delay. The authors report that reasons for delay among women who were turned away for being over the gestational age limit included travel and procedure costs (58.3 percent of “turnaways” reported this issue), not recognizing the pregnancy (almost half of turnaways), insurance problems, not knowing where to find abortion care (reported by a third of turnaways), and not knowing how to get to a provider.

Interestingly, the near-limit women in this study reported less difficulty deciding to have abortions than the women who had the procedure during the first trimester. This finding runs counter the anti-abortion notion that women who have late-term abortions have simply been irresponsible in waiting so long to make a decision.

The authors also performed some calculations to try to estimate how many women are turned away each year due to gestational age limits. They concluded that 4,143 women in 2008 were forced to carry their unwanted pregnancies to term because of gestational age limits. This does not include additional women who would have been turned away for medical, financial or parental consent reasons. We can only assume this number will increase if the current anti-abortion push for 20-week limits gains ground.

In related news, the National Women’s Law Center has released a new report, “‘Shut That Whole Thing Down:’ A Survey of Abortion Restrictions Even in Cases of Rape.” A year after former Missouri Rep. Todd Akin’s remarks on abortion and rape (Happy Road Trip Anniversary!) NWLC has analyzed state and federal abortion restrictions proposed in the first six months of 2013 for how they would affect victims of rape.

Astonishingly, NWLC found that the vast majority of proposed legislation would create barriers to abortion for rape victims. For example, 27 provisions in the 38 state provisions restricting women’s access to abortion would apply to a woman whose pregnancy resulted from rape. These include provisions such as forced ultrasounds and requiring women to listen to a fetal heartbeat where there were no exceptions for rape victims.

“The GOP could have learned an important lesson: Picking on rape victims, even in the context of abortion, doesn’t play very well with the voting public,” writes Jill Filipovic at Salon. “Instead, the Republican party seems to have internalized the message that marginalizing rape victims is ok, as long as you don’t brag about it.”

And in case you missed it, RH Reality Check published an impressive series of investigative stories this week that proved abortion is already highly regulated and overwhelmingly safe. There’s a huge database of state documents available for review.