Women in the United States are often subject to numerous restrictions when seeking abortions, including burdensome waiting periods and gestational age cutoffs that vary depending on state. Some abortions are delayed due to a lack of funds or no insurance coverage, or a shortage of available providers. All of these factors contribute to women not being able to obtain legal abortions once they choose to do so.

Last week, The New York Times published a great article about research into what happens when women are denied abortions. The ongoing project is called the “Turnaway” study, and it involves a group of UCSF researchers, led by Dr. Diana Green Foster, a demographer and an associate professor of obstetrics and gynecology at the University of California, San Francisco.

The researchers are following three sets of women: those who had first trimester abortions; those who had abortions near the gestational age limit; and those who were denied an abortion because they were just over the gestational age limit.

This research is important for a couple of reasons. First, studies looking at mental health effects after abortion often make inappropriate comparisons between women who had abortions and women who never sought them. (Anti-abortion advocates often try to cite mental health effects as a reason to deny women abortion, even though reliable evidence does not support the notion of a “post-abortion syndrome.”) These studies ultimately end up ignoring the emotional effects on women who wanted but were denied abortions.

Second, other research has not typically followed women forward in time (instead of asking them to remember) to see how they fare in terms of physical and mental health, education, employment, relationship status, and other factors. Foster is tracking the study participants via interviews conducted every six months for five years.

As the researchers explain:

The Turnaway Study is an effort to capture women’s stories, understand the role of abortion and childbearing in their lives, and contribute to the ongoing public policy debate on the mental health and life-course consequences of abortion and unwanted childbearing for women and families.

Foster’s research is increasingly relevant as states attempt to pass more restrictions on abortion access that could lead to costly delays and denied procedures. Nationally, the House just passed a ban at 22 weeks of pregnancy (20 weeks post-fertilization). It stands little chance of being enacted (assuming it could pass the Senate — highly unlikely — the president would likely veto it), but it does reflect the GOP’s intent to shrink the amount of time women have to obtain an abortion — which would lead to more turnaways.

A few publications have already resulted from the Turnaway group, mostly focusing on issues such as patient education, the effect of anti-abortion protestors, and commentary on how to reduce turnaways. It looks like some articles about denials in general and women’s emotional responses have been written and accepted by journals, but are not yet available to the public. We’ll keep an eye on those and provide an update when results are available.

In the meantime, read the full New York Times article, which describes the research in-depth and covers one woman’s story of being denied an abortion. After being turned away by a Planned Parenthood clinic in one state and a detour through a crisis pregnancy center that further pushed her past the gestational age limit, she found herself out of time, gas money, food, and other resources.

Robin Marty and Jessica Mason Pieklo, co-authors of the new book “Crow After Roe: How ‘Separate But Equal’ Has Become the New Standard in Women’s Health and How We Can Change That,” joined Amy Goodman of Democracy Now last week to discuss states where laws have “practically regulated abortion out of existence.”

You can also follow their excellent reporting at RH Reality Check: Marty is the publication’s senior political reporter, and Pieklo is a senior legal analyst.
   

The Reproductive Justice: Activists, Advocates, Academics in Ann Arbor (“A3 in A2″) conference taking place this week aims to foster learning, dialogue and collaboration around reproductive justice issues. OBOS Executive Director Judy Norsigian, one of the conference advisory board members, is leading a session on informed consent and moderating Friday’s final panel.

Until recently, the term reproductive justice was used mainly by a relatively small number of people involved with abortion rights and women’s reproductive health (read about its history at SisterSong). The phrasing is more inclusive than abortion rights and takes into account all aspects of women’s ability to control their own reproduction, including social inequalities that affect the ability and right to have or not have children and to parent children in healthy environments.

The term has been discussed, and debated, quite a bit lately. Over at RH Reality Check, Jon O’Brien, president of Catholics for Choice, recently argued why reproductive justice cannot be a substitute for the terms “choice” or “pro-choice,” prompting this response from reproductive justice activists (who, it should be noted, consider Catholics for Choice an ally). Their response notes in part:

Women of color struggled within the pro-choice movement to bring their needs to the forefront, and they also created new organizations built on a broad, intersectional analysis and understanding of reproductive rights and health. The shift from choice to justice does not, as O’Brien says, devalue the autonomy of women who face obstacles. Instead, locating women’s autonomy and self-determination in human rights rather than in individual rights and privacy gives a more inclusive and realistic account of both autonomy and what is required to ensure that all women have it. Advocating for reproductive justice was not counter-posed against being “pro-choice” or supporting abortion rights. Rather, reproductive justice re-framed and included both.

The push toward a more comprehensive understanding of reproductive rights has also been adopted by the Unitarian Universalist Association (UUA) of Congregations. Delegates at last year’s General Assembly meeting selected “Reproductive Justice: Expanding Our Social Justice Calling” as the 2012-2016 Congregational Study/Action Issue — meaning congregations and districts are invited to engage and reflect on it, in any way they see fit — and the subject will be the focus of this summer’s GA meeting.

Earlier this year, Billy Moyers invited Jessica González-Rojas, executive director of the National Latina Institute for Reproductive Health, and Lynn Paltrow, founder and executive director of National Advocates for Pregnant Women, to discuss the topic.

“What’s happened is that women are beginning to recognize that what’s at stake is more than abortion,” said Paltrow. “It is their personhood — their ability to be full, equal, constitutional persons in the United States of America.”

For more information: Check out the Reproductive Justice Briefing Book. Produced by the Pro-Choice Public Education Project, it offers a comprehensive look at a variety of topics, including sex education, abortion, adoption, pregnancy, disability, incarceration, immigrants, LGBT issues, race, and class.

Every member of Congress has pages of accurate information on women’s health at their fingertips – more than 900 pages to be exact – now that they have the latest edition of “Our Bodies, Ourselves.”

Thanks to supporters of OBOS’s Educate Congress campaign – inspired by a road trip to deliver “Our Bodies, Ourselves” to then-Rep. Todd Akin – we hand-delivered or mailed the newest edition and a letter signed by prominent health policy experts to all members of the U.S. House and Senate.

Educate Congress launched with a simple premise: Everyone deserves access to accurate information concerning women’s reproductive and sexual health – especially those who write the laws.

Deliveries began Feb. 28, when I spent the day meeting with members on Capitol Hill. It was the day that the House finally passed the Violence Against Women Act, which made the trip particularly poignant.

Joining me were Christy Turlington Burns, founder of Every Mother Counts (EMC), and Erin Thornton, EMC executive director. We collaborated on scheduling and delivered EMC materials along with “Our Bodies, Ourselves,” including a special petition for women members of Congress congratulating them on their leadership role and asking them to affirm support of policies that protect the health and well-being of girls and women around the world, especially those that will reduce infant and maternal mortality rates.

Two National Women’s Health Network (NWHN) interns, Alysson Reddy and Grace Adofoli, provided invaluable logistics support and shoulder-bag transport of the rather hefty copies of “Our Bodies, Ourselves.” We received warm receptions not only from those who know the book and OBOS’s work, but also from members who want to be better prepared to address key reproductive health concerns.

Our first meeting was with Rep. Jim McGovern (MA), a consistent advocate of evidence-based policies. Christy and Erin presented a copy of EMC’s excellent documentary about maternal mortality, “No Woman, No Cry.”

Alysson and Grace helped me walk the corridors of three House office buildings in record time, with stops in the offices of Representatives Adam Kinzinger (IL), Steven Horsford (NV), Gary Peters (MI), Kay Granger (TX), Betty McCollum (MN), Chellie Pingree (ME), Michael Capuano (MA), Marsha Blackburn (TN), James Clyburn (SC), Jackie Speier (CA), Nita Lowey (NY), Anne Kirkpatrick (AZ), Joseph Kennedy (MA), and Cheri Bustos (IL).

The day ended on the Senate side, with visits to Senators Jeanne Shaheen (NH) and Elizabeth Warren (MA). Diana Zuckerman, president of the National Research Center for Women and Families (NRCWF), joined me in discussing women’s health with Sen. Warren and her chief of staff, Mindy Myers.

Time was running short, so Allyson and Grace returned later that week to deliver books and letters to Senators Mitch McConnell (KY), Rob Portman (OH), Carl Levin (MI), Mark Begich (AK) Charles Grassley (IA), Pat Toomey (PA), Jeff Flake (AZ), and Christopher Coons (DE).

OBOS has already received personal thank-you notes from several members of Congress who indicated that the book will be a useful resource. We’re confident it will be of value to staff members working on policy issues.

If you visit the D.C. office of your representative or senator in the coming months, let us know if you get a chance to ask about how “Our Bodies, Ourselves” might have been referenced. Establishing sound, science-based policy about reproductive health is no easy feat, but it will be all the more likely if each of us finds ways to promote this goal.

OBOS will continue to monitor where information interventions are needed. Please help fund our efforts to send books to state legislators, educational leaders, and other public officials.

* * *
Photo, clockwise: EMC’s Erin Thornton and Christy Turlington Burns, Rep. Gary Peters, OBOS’s Judy Norsigian, and NWNH interns Alysson Reddy and Grace Adofoli; Judy and Christy with Sen. Jeanne Shaheen; Judy, Sen. Elizabeth Warren and NRCWF’s Diana Zuckerman; Rep. Chellie Pingree; Judy and Christy with Rep. Jim McGovern (center). 

Last week, a judge ordered the FDA to make emergency contraception pills available over the counter, with no age restrictions, capping a long and frustrating legal battle to increase access.

Versions of levonorgestrel-based emergency contraceptive pills (such as Plan B and Next Choice) are expected to be made available without restriction within 30 days, but it’s not clear whether there will be some administrative interference. The FDA might decide on new labeling or to limit the forms of emergency contraception made available. There is also the possibility that the decision will be appealed.

OTC access for all ages is essential because most emergency contraception pills are most effective when used as soon as possible, and time, distance, money, and privacy can be serious barriers, especially for teenagers, to obtaining and filling a prescription in time to prevent pregnancy.

The push to make emergency contraception pills (also known as morning-after pills) available to all ages without a prescription suffered a major setback in 2011, when HHS Sec. Kathleen Sebelius blocked the FDA’s decision to remove the age barrier. Since 2009, emergency contraception has been available without a prescription for anyone age 17 and older.

Sebelius’s objections focused on the idea that young girls would use EC in unsafe ways. Susan Wood, A former director of the FDA’s Office of Women’s Health who in 2005 resigned over political delays around emergency contraception, rejected Sebelius’s claim that more data was needed on safety and label comprehension, noting that “this type of age restriction, and worries about the use of medicines by teenagers, have not been applied to other products.”

U.S. District Judge Edward R. Korman, in reversing the FDA’s decision to deny a citizen petition for all-ages access, seems to agree that the “What about 11-year-olds?” objection is merely a smokescreen. From the memorandum:

This case is not about the potential misuse of Plan B by 11-year-olds. These emergency contraceptives would be among the safest drugs sold over-the-counter, the number of 11-year-olds using these drugs is likely to be miniscule, the FDA permits drugs that it has found to be unsafe for the pediatric population to be sold over-the-counter subject only to labeling restrictions, and its point-of-sale restriction on this safe drug is likewise inconsistent with its policy and the Food, Drug, and Cosmetic Act as it has been construed.

Instead, the invocation of the adverse effect of Plan B on 11-year-olds is an excuse to deprive the overwhelming majority of women of their right to obtain contraceptives without unjustified and burdensome restrictions.

Korman characterized Sebelius’s actions as “obviously political” and “arbitrary, capricious, and unreasonable,” and wrote:

Nevertheless, even with eyes shut to the motivation for the Secretary’s decision, the reasons she provided are so unpersuasive as to call into question her good faith. While the Secretary has strung together three factual statements in her memorandum to Commissioner Hamburg, she has failed to offer a coherent justification for denying the over-the-counter sale of levonorgestrel-based emergency contraceptives to the overwhelming majority of women of all ages who may have need for those drugs and who are capable of understanding their correct use.

While we’re celebrating the judge’s ruling, we should also keep in mind the fact that President Obama is still praising Sebelius’s unprecedented, access-denying interference and overriding of the FDA’s scientific review process.

More coverage:

• The Top 11 Zingers From the Emergency Contraception Decision – Sharona Coutts at RH Reality Check
• Emergency Contraception and Moral Panic: Dissecting the Newest Misinformation Campaign – Sidra Zaidi at RH Reality Check
• Doctors Celebrate Plan B Ruling – Physicians for Reproductive Choice
• Federal EC Ruling will Benefit Immigrant and Young Latinas – Press release from the National Latina Institute for Reproductive Health
• Federal Judge Orders FDA to Broaden Access to Emergency Contraception – Center for Reproductive Rights; includes a great timeline showing milestones in the struggle for OTC access for more than a decade.

Background information from Our Bodies Ourselves:

• Emergency Contraception Still Not Easily Available to Young Women
• Newly Appointed Acting Surgeon General Played Role in Holding Up OTC Sale of Emergency Contraception
• Information on emergency contraception from “Our Bodies, Ourselves,” including both pills and IUDs

In the United States, 87 percent of counties have no abortion provider, forcing some women to travel potentially long distances for reproductive health services, while others delay making a decision until later in the pregnancy, when an abortion is more costly and restrictions are more severe.

One way to increase access is to increase the range of providers who are permitted to do abortions, such as nurse practitioners, nurse midwives, and physician assistants.

Currently, non-physician clinicians can perform surgical (aspiration) abortions legally only in Montana, Oregon, New Hampshire and Vermont. In some states, these providers can oversee medication abortions, though that, too, has become a contentious issue as more legislatures seek to restrict women’s access to abortion.

Are laws requiring physicians to perform surgical abortions necessary, from a patient-safety perspective? Not according to a recently published study.

Tracy Weitz, director of Advancing New Standards in Reproductive Health, a collaborative research group and think tank at University of California, San Francisco, and Diana Taylor, ANSIRH’s director of research and evaluation, primary care initiative, set out to answer the question of healthcare outcomes and applied for a waiver of California legal statutes that limit surgical abortion to physicians. They note:

In 2008, 1.21 million abortions took place in the United States, with more 200,000 (18%) in the State of California. Nationally, 92% of abortions take place in the first trimester, but Black, uninsured, and low-income women have less access to this care. In California, only 87% of women using state Medicaid insurance obtain abortions in the first trimester. Because the average cost of a second-trimester abortion is substantially higher than that of a first-trimester procedure, shifting the population distribution of abortions to earlier gestations would result in safer, less costly care. Increasing the types of health care professionals involved in abortion care is one way to reduce this health care disparity.

For the purpose of the study, 40 certified nurse midwives, nurse practitioners and physician assistants in ANSIRH’s Health Workforce Pilot Project, who already had experience with medication abortions, were trained to perform surgical abortions. (ANSIRH’s Early Abortion Training Workbook, which is used in medical schools around the world, is also available online.)

The authors compared the outcomes of abortions performed by those medical professionals to outcomes of abortions performed by 96 physicians. Patients were not randomized to a provider type; they were asked if they would agree to have the non-MD provider on duty perform their first trimester abortion.

Complications were rare in general, with only 1.3 percent of the 11,487 abortions resulting in any type of complication. While the newly trained CNM/NP/PA group had slightly more complications than the group with abortions performed by more clinically experienced MDs, the difference was not considered significant.

The authors conclude that “only 1 additional complication would occur for every 120 procedures as a consequence of having an NP, CNM, or PA as the abortion provider,” and these would largely be minor complications, such as a low-level infection or bleeding that could be treated at home or at an out-patient clinic.

The study was published in the American Journal of Public Health. Based on the findings, the authors argue in favor of expanding the types of providers who can perform abortions:

The benefits of expanding access to abortion for California’s women outweigh the small initial difference in risk, particularly because it would likely move many second-trimester abortions into the first trimester, significantly decreasing the overall risk of complications, which increases with gestational age. Expanded access is also likely to afford more women the opportunity to obtain care without the additional indirect costs associated with traveling to a geographically distant abortion provider.

We would hope, after reading this study, that more state legislatures would consider removing restrictions on non-physician clinicians, but we know such a move would require great amounts of political will, as the trend in recent years has been to restrict rather than increase access.

by Hanna Pennington 

No one ever really wants to take health class; it’s a required course, something people try to get out of the way so they aren’t that about-to-graduate senior who still has to take health. And that’s because at most high schools, health class doesn’t offer much — and everyone knows it.

I spent 80 minutes every other morning in health class during the second semester of my sophomore year, and when faced with an end-of-the-year survey about the class, I realized that the time had not been “spent,” but wasted.

We had not discussed birth control; condoms were the only form of contraception mentioned, and they came up only in the context of preventing STIs. A significant number of high school students are already taking hormonal birth control, like the pill, for a variety of reasons, whether to regulate hormone imbalances that can cause acne, reduce the pain of bad menstrual cramping, or because they are having sex, but the pros and cons of the pill were never addressed.

Through reading “Our Bodies, Ourselves” and other feminist websites and books, I have learned about many types of birth control. But this is because I care about this kind of thing. Most people don’t know what they should have been taught until it’s too late.

Another way in which my health class was insufficient, and also offensive, was that LGBTQ people were only mentioned in the context of HIV/AIDS, which we learned about by watching the film “And The Band Played On.” There was no other discussion.

As a bisexual person, I felt shortchanged. I sought out resources online, much the way I did with birth control, but again, this didn’t make up for the lack of class information. The majority of high school students are straight, but it is important to provide for those who aren’t, or who might be questioning. It is important to learn about how to have safe gay sex, not only safe straight sex; that information is a lot harder to find, unless you know where to look.

Related: A “Real” Sex Ed Story: A Teenager Recalls Lessons From “Our Whole Lives”

Another issue we did not discuss is consent. People need to learn not only that it’s OK to say no, but that enthusiastic consent is the key to happy, healthy sex (in fact, there’s a petition to make consent a mandatory part of sex-ed in public schools).

Abuse, both physical and sexual, should also be discussed. And resources should be provided for everything: where to get help if you’re being abused, where to purchase prescription contraception at a discount, where to get tested for STIs, and the number for the closest Planned Parenthood, for starters.

Finally, we never discussed masturbation. It is important for students to know that instead of it being something unholy or disgusting, masturbation is a perfectly healthy and important way to explore one’s own body and sexuality.

According to research by the Sexuality Information and Education Council of the United States (SIECUS), comprehensive sex education is more effective in preventing teen pregnancy than abstinence-only education. In her 2008 New Yorker article “Rex Sex, Blue Sex,” Margaret Talbot analyzed the differences in sexual patterns of teenagers living in different parts of the country, including the prevalence of teen pregnancies and STIs and use of contraception.

In conservative red states, where abstinence-only education is the norm and religion dictates much of the discourse, teenagers have sex earlier, usually without protection. In more liberal blue states, where there is often (but not always) more comprehensive sex education, teenagers wait longer to have sex and use protection more often when they do.

Although I live in blue-state New York, my health class was not all that. It is possible to acknowledge teenagers being sexual without encouraging it, but our teachers didn’t acknowledge any part of it. It is irresponsible to teach the class assuming that everyone is and will remain abstinent until marriage.

The 2009 documentary “Let’s Talk About Sex” examines young people’s attitudes toward and knowledge of sex and sexuality, comparing America’s largely insufficient programs to those of places like the Netherlands, where parents and children talk openly about sex (and which have lower rates of teen pregnancy and STIs).

Although I was briefly tempted to move overseas, there are comprehensive sex-ed curriculums in the United States, even if they can be hard to find.

One of my friends attends Rye Country Day School in Rye, N.Y. A program there encourages underclassmen to ask upperclassmen leaders whatever they want about sex, relationships, and so on. I was really impressed when I first heard about this, as it fosters an environment that removes shame from asking questions, which is how people get the answers they need.

At Manhattan Country School, there is a sex-ed curriculum, designed by Dr. Cydelle Berlin, that involves theater arts and peer education. Trained actors answer questions while in character. There is a box in every classroom in which students can leave anonymous questions.

The Unitarian Universalist Church, instead of strictly discouraging or not discussing sex as other churches often do, teaches a K-12 sex ed curriculum called “Our Whole Lives.” As stated on the website, the program “not only provides facts about anatomy and human development, but also helps participants clarify their values, build interpersonal skills, and understand the spiritual, emotional, and social aspects of sexuality.”

This curriculum is based on SIECUS’ “Guidelines for Comprehensive Sexuality Education,” which spans the same age range and includes such important topics as body image, gender identity, masturbation, abortion, and sexuality and society.

When reading this curriculum, I was pleasantly surprised how enlightened, inclusive, and accurate it was. But this should not be surprising; accurate language should be the norm.

It is bad enough that decisions about women’s health are made mostly by male politicians, but it is even more disheartening when you realize that some of them have no idea what they’re talking about. High school students aren’t the only ones who need basic education about reproduction, but it’s a good place to start.

Hanna Pennington is a high school senior in New York whose first foray into feminist activism was at age 7, when she wrote a letter to a children’s magazine protesting the omission of Sacagawea in an article about the Lewis and Clark Expedition. 

Erin Thornton, Judy Norsigian, Rep. Jim McGovern, and Christy Turlington Burns

Last fall, following a sex-ed road trip with The Ladydrawers to deliver “Our Bodies, Ourselves” to former Rep. Todd Akin (of “legitimate rape” fame), Our Bodies Ourselves launched Educate Congress, a campaign to deliver the book to all members of Congress and key administration officials.

The basic premise: Everyone deserves access to accurate information concerning women’s reproductive and sexual health — especially those who write the laws.

Today OBOS kicked off delivery of the book, as Judy Norsigian, OBOS executive director and one of the original authors of “Our Bodies, Ourselves,” hand-delivered copies of the newest edition to about 20 legislators and staff members.

The point was made that the problem isn’t just poorly chosen words; rather, a lot more needs to be done to advance evidence-based health policy.

Norsigian walked the halls of Capitol Hill with Christy Turlington Burns, founder of Every Mother Counts, and EMC’s executive director, Erin Thornton. They submitted EMC’s petition to female members of Congress, asking them to support policies that protect the health and well-being of girls and women around the world, especially those that will reduce infant and maternal mortality rates.

Doing this on the day that the House finally passed the Violence Against Women Act made it particularly poignant.

NWHN interns Allyson Reddy and Grace Adofoli with Judy Norsigian and Rep. Chellie Pingree

Thanks to Allyson Reddy and Grace Adofoli, interns at the National Women’s Health Project, the book launch was a success. More books will be delivered in the coming weeks, until every member of Congress has, in their office, up-to-date information they can rely on when drafting bills that have a real impact on girls and women.

A big thank you to the supporters of Educate Congress! And a special shout out to fellow road-trippers Anne Elizabeth Moore, Rachel N. Swanson, Nicole Boyett and Sara Drake; Congress scheduler Christina Knowles; everyone who participated in the making of the Educate Congress video, especially Paul Noble and Anthony Cupaiuolo (bro!); and Malcolm Woods, who helped organize the Educate Congress launch at the National Press Club and kept the word going on Twitter (with the aid of “The West Wing” staff). All of you made this happen!

Erin Thornton, Christy Turlington Burns (holding the film “No Woman, No Cry”) Rep. Gary Peters, Judy Norsigian, Allyson Reddy, and Grace Adofoli

Taleen K. Moughamian, a women’s health nurse practitioner in Philadelphia, traveled to Armenia in the fall of 2012. Working with the Children of Armenia Fund, she conducted  health exams, including breast and cervical cancer screenings, and provided contraceptive counseling. The following account is based on her work and conversations with Armenian women.

by Taleen K. Moughamian

The differences between Armenia’s capital, Yerevan, and the rest of the country are vast. While Yerevan has most of the modern-day conveniences you could ask for, the villages I visited in the Armavir region have populations between 300 and 1,000, mostly comprised of women.

Their husbands have gone –- off to neighboring countries, especially Russia, to find work. They usually stay away for 10 months out of the year. Some men have even started new families in their work countries.

It was not uncommon to meet women who needed to be treated for sexually transmitted infections (STIs) because their husbands are having extra marital affairs while abroad. They are upfront about this, though it surprised me how openly they talked about it.

I heard so many of them say, “They are men. They have needs. What can we do?”

This has created a huge problem and is one of the reasons why STIs, including HIV, are on the rise in Armenia.

There is limited access to effective contraception, so the rate of abortion, which is legal up to 12 weeks, is high. Most of the women who seek an abortion are married, already have two or three children, and do not feel they can provide for a larger family.

Sex-Selective Abortions
For some women, this means having three or four or even 15 abortions over the course of their lives as they struggle to create a family they can support. The median number of abortions for women over 40 is eight, according to a 1995 study conducted at a Yerevan abortion clinic.

Sex-selection has also become a huge issue. Since women leave their homes and join their husband’s family after marriage, a son provides a source of security for his parents. I met so many women who have had multiple abortions because the sex of the child was not what they had wished; for more data, see this UNFPA report on sex selection in Armenia and this story in The Armenian Weekly.

If you look at recent family planning data, it appears the number of abortions is going down, but from what I observed, that is not necessarily the case. Rather, more abortions are going unreported.

Rise in Unsupervised Abortions
Women are using an over-the-counter medication called Cytotec (the brand name for misoprostol) to induce abortions at home without the supervision of a trained medical professional. Cytotec’s indication is to treat ulcers, but it also acts as an abortifacient. Fifty cents worth of Cytotec can induce an abortion, whereas a surgical abortion usually costs about $35-$50.

When used properly, Cytotec is very safe, even without clinical supervision. But it is most effective when used in combination with a second drug, mifepristone (see more on this below).

Women in the villages I visited were not familiar with the World Health Organization guidelines now used by women all over the world. (Note: Women on Waves offers guidance, based on the WHO research, on how to do an abortion with pills.)

Many Armenian women are therefore in a dangerous situation, as they are using Cytotec without the relevant information about its efficacy or side effects, which can range from an incomplete abortion to bleeding to death.

Barriers to Contraception
As part of my work with the Children of Armenia Fund (COAF), I counseled women on birth control options. This has been quite a challenge, as there are so many myths surrounding birth control, and it’s expensive for rural women. One pack of birth control pills costs about $15-20 a month in Armenia. For a village family barely making $100 a month, it is completely unaffordable.

Besides the cost and access issues, social factors also influence a woman’s reproductive health. Although many husbands are supportive, others do not allow their wives to use birth control.

Sometimes the mother-in-law gets involved, too. When a woman in Armenia gets married, she moves in with her husband and his mother. The mother-in-law is usually the matriarch of the family, so she has a lot of pull in decision-making, even when it comes to her daughter-in-law’s reproductive health.

Changing Patterns, Changing Lives
During my last week in Armenia, I met a woman who had come to her village clinic for an abortion. She had two children and this was going to be her fourth abortion. She told me that her husband wants to have another child, but that he’s an alcoholic -– has been since the day they got married –- and he beats her.

She doesn’t think it’s right to bring a child into this world when her life at home is so unstable, and yet she is completely dependent on him for financial security. Living in the village, there are very few resources for either of them to get any help.

Stories like this are difficult to hear; you quickly realize how vital organizations like COAF are to these women. COAF provides free screenings for breast and cervical cancer and free treatment for STIs. With the help of the UNFPA, I inserted intrauterine devices (IUDs) for free to eligible women. This provides them with one of the most effective forms of birth control for up to 10 years.

On my final day working with COAF, one of the women was so thankful that as soon as the IUD procedure was complete, she jumped up and gave me a big kiss. She had had six surgical abortions, and she could not remember how many times she had taken Cytotec to end her other pregnancies.

It amazed me how much the women opened up to me. They are yearning for accurate information and resources, and they are deeply grateful not only for the health care that is provided but for the conversations about their bodies and their health.

Some women may not change their minds about birth control right away, but I know they at least have the information they need to consider it, and sometimes that is enough to start changing attitudes.

Despite all the economic and cultural barriers, I believe things are changing for women in Armenia -– slowly, of course, but moving in the right direction. There is no reason why Armenian women should have to keep relying on abortions for family planning, or why they should be misinformed about their reproductive health.

My hope is that educating women about their health and family planning options will empower them to take control of future. At the very least, they know where and when to seek care if they need it.

Related: Learn more about OBOS’s partner in Armenia, “For Family and Health” Pan Armenian Association (PAFHA), and efforts to adapt and distribute women’s health information based on “Our Bodies, Ourselves.” The preface to the Armenian edition is available in English.
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Ed. note about mifepristone and misoprostol:
Mifepristone and misoprostol are now frequently used together to produce what is called “medication abortion” for women who are less than eight weeks pregnant. The drugs are not identical and perform different actions. Mifepristone, often known by its manufacturing name RU-486, is almost always used for abortion or to end missed miscarriages. Misoprostol has wider applications and may be used in place of prostaglandins to create cervix softening prior to birth. It can also help prevent stomach ulcers that are caused when people take non-steroidal anti-inflammatory drugs (NSAIDS).

Under the supervision of a health care provider, women choosing a medication abortion typically use an oral dose of mifepristone first, followed by either an oral or vaginal suppository dose of misoprostol several hours later. In slightly more than 90 percent of women, this induces abortion within two days, provided it is used in early pregnancy. Misoprostol becomes increasingly less effective in more advanced pregnancies, and other, more effective drugs may be chosen for pregnancies that are more than eight weeks along.

The different actions of mifepristone and misoprostol explain their effectiveness in inducing abortion. Mifepristone works to separate the placenta from the uterine lining, and it causes uterine contractions. Additionally, the drug has some effect on the cervix and may cause it to soften.

Although we celebrated the 40th anniversary of Roe last week, access to abortion is not only difficult for many women, but legislators are working to make it even more difficult.

On Saturday, Melissa Harris-Perry opened a discussion on her show with these remarks:

Before 1973′s Roe v. Wade, complications from abortion was the leading cause of death among women of childbearing age. This was especially true for women of color. As access to abortion once again narrows, it puts women’s lives in danger. So while much of the debate about reproductive rights is focused on the legal interpretation and the Constitution and the bodily rights of women, we can’t forget the basic issue of access. [...] Access is the frontier on which we need to be fighting. 

It was a great conversation (watch above if you missed it!), and we were thrilled to see Steph Herold, a New York Abortion Access Fund board member and a contributor to the new edition of “Our Bodies, Ourselves” (which we’re aiming to send to all members of Congress; learn more here), and Feministing editor Chloe Angyal taking part in the round table, along with The Nation editor/publisher Katrina vanden Heuvel and Demos senior fellow Bob Herbert.

Herold talked about the implications of the Hyde Amendment, which since 1976 has banned Medicaid coverage of abortion, and how that limits access for low-income women.

“We really believe that however people feel about abortion, politicians shouldn’t be be able to deny women health care coverage just because they’re poor,” said Herold.

As legislatures reconvene for the new year, we’re keeping an eye on proposed bills that further restrict access to abortion.

In the states:
Proposed bills in Arkansas would prohibit all abortions after 20 weeks, ban the practice of remotely prescribing medication for abortions (otherwise known as telemedicine), and ban abortion coverage in health insurance exchanges.

A bill has been introduced in Florida to ban all abortions except in medical emergencies and to sentence abortion providers (or those who assist or own/run clinics) with up to life to prison. The bill has failed in previous years.

The previously defeated personhood bill is back in Oklahoma.

You may have seen news of a New Mexico bill from Republican state Rep. Cathrynn Brown, which would make it a felony for a woman to have an abortion if the pregnancy resulted from rape or incest. The bill frames such abortions as “evidence tampering.”

Brown claims the bill is being misunderstood; at the very least, it’s poorly written, as it very clearly prohibits not only “compelling or coercing another to obtain an abortion” but also “procuring or facilitating an abortion.” The bill is reportedly being re-written; advocates should keep an eye out for clarification of the language.

Here’s another summary on more abortion restrictions being proposed around the country.

At the federal level:
Multiple bills have been proposed by Tennessee lawmakers to prohibit Planned Parenthood from receiving Title X family planning funding (here’s my personal take as a Tennessean).

A bill has been introduced to define “life” as starting at fertilization.

Other bills would require hospital admitting privileges nationwide for abortion providers (a medically unnecessary move intended to restrict access), and would criminalize people who take a minor across state lines to access abortion, including a sister or aunt as well as other relatives and friends.

Lizz Winstead, Daily Show co-creator and producer, has a message for what’s at stake on the 40th anniversary of Roe v. Wade.

On the 40th anniversary of the Supreme Court’s Roe v. Wade decision, we celebrate four decades of legal abortion — which has undoubtedly changed and saved many women’s live. Yet we recognize there is still much work to be done.

To help change policy and to ensure that all legislators understand the basics about women’s bodies and reproduction, OBOS has re-opened the campaign to send copies of “Our Bodies, Ourselves” to every member of Congress.

Let your friends and colleagues know there’s still time to join the campaign — we’ll be delivering the books to D.C. starting in late February.

OBOS is also taking part in Trust Women Week to urge policy makers to support reproductive justice and access to contraception and abortion. You can add your name to a petition that will be sent to legislators. If you’re in San Francisco, there’s an event this Saturday starting at 10 a.m. at Justin Herman Plaza.

Many organizations and individuals are covering the anniversary today from a variety of personal and political perspectives. Below are some interesting commentaries and reminders of what has been accomplished and how we can work to ensure access for all women. Please leave your favorite links in the comments.

At reddit, two abortion clinic workers have answered a wide variety of questions from readers.

Kimberly Inez McGuire of the National Latina Institute for Reproductive Health spoke at a Center for American Progress panel on Roe 2.0: Strategies for the Next Generation of Reproductive Rights Activism. Also, check out the group’s new Yo Te Apoyo (I Support You) campaign and Roe v. Wade 40 years later: Latinas weigh in on abortion.

NARAL Pro-Choice America is holding their annual Blog for Choice day; expect links to many posts on the topic of personal stories and abortion.

Planned Parenthood has a 40th anniversary video.

The author at Deana’s blog, a professor of sociology, talks about the new study documenting attacks on pregnant women’s autonomy (see our recent post on this issue).

The National Women’s Law Center encourages us all to write our legislators to support abortion access and stand against restrictions.

Physicians for Reproductive Choice and Health have made available online the documentary “Voices of Choice: Physicians Who Provided Abortions Before Roe v. Wade.” The film includes interviews with Bylle Avery, founder of the National Black Women’s Health Project, and Dr. George Tiller, an abortion provider who was murdered.

The 1 in 3 campaign, a project of Advocates for Youth, provides stories from individuals who’ve had an abortion. The organization has also released a book of stories and resources for college campuses.

Shanelle Matthews has a powerful story and insightful commentary at The Crunk Feminist Collective: The story that’s taken ten years to tell: On abortion, race and the power of story. Here’s an excerpt:

The narrative that abortion gives women and transpeople an opportunity to live the rest of our lives, to become a doctor or a lawyer or whatever isn’t true for everyone. For some of us, abortion just provides one more day. One more day to live our lives exactly the way we want to. For some of us the decision isn’t political, it’s essential. It is essential to taking care of the children we already have, to circumventing difficult medical experiences or to just not be pregnant. There is nothing heroic about having an abortion. It is an essential part of reproductive health care.

Bridgette Dunlap at RH Reality Check describes an unusual argument for the legality of abortion, resting not in the right to privacy but in the 13th Amendment forbidding slavery and involuntary servitude. This argument suggests the government may not outlaw abortion, because “to do so would be to require physical service from a woman for the benefit of a fetus.”

Flyover Feminism is hosting a week-long series on reproductive rights.

In Mississippi, the state’s only abortion clinic may close. Coverage includes “Inside Mississippi’s Last Abortion Clinic,” from Mother Jones, and “In Jackson, Mississippi, Southern Hospitality and Food for Thought on Access to Abortion“ at RH Reality Check.

Monica Raye Simpson, Executive Director of SisterSong issued a statement celebrating Roe but highlighting the bigger picture: “We need to discuss how issues such as economics, immigration reform, interpersonal violence, rape and lack of comprehensive sexual education are all a part of the equation needed for reproductive justice to be achieved.”

Jill Filipovic in “Roe v Wade at 40: what American women owe to abortion rights” writes about the ongoing struggle to make reproductive rights accessible to all women:

The primary victims of the pro-life strategy are poor women. The pro-life movement has stepped up its legislative game in the past two years, introducing and passing record-breaking numbers of anti-choice laws in 2011 and keeping the victories coming in 2012. They’ve made it not only hard to get an abortion, but to get birth control, sex ed and health care generally.

The result is that Roe’s promise of abortion rights isn’t available to large swaths of the American population.

The National Women’s Law Center explains that the health care reform allows states to pass laws banning private insurance coverage of abortion in state exchange plans, meaning that “in twenty states, a woman will not be allowed to purchase an exchange-based health plan that covers abortion services, and also may not be able to purchase a plan that provides insurance coverage for abortion at all.”

As we were saying, there’s plenty of work left to do.

Although this January marks the 40th anniversary of the landmark Supreme Court decision legalizing abortion, we know that there is still much work to be done to ensure reproductive justice for all women.

The Guttmacher Institute reports that 2012 saw the second highest number of abortion restrictions enacted in a single year; the Center for Reproductive Justice addresses each state in this report.

Among the provisions ultimately defeated were “fetal personhood” bills in Mississippi and Oklahoma. But the notion that fetuses should be protected from the women carrying them has resulted in the restriction and punishment of women across America.

Lynn Paltrow, executive director of National Advocates for Pregnant Women, and Jeanne Flavin, a professor of sociology at Fordham University and chair of NAPW’s board, have put together an extremely interesting and important study: “Arrests of and Forced Interventions on Pregnant Women in the United States, 1973–2005: Implications for Women’s Legal Status and Public Health.”

Paltrow and Flavin (who is also the author of the 2008 book “Our Bodies, Our Crimes: The Policing of Women’s Reproduction in America“) tried to identify and examine U.S. cases from 1973, the year of Roe v. Wade, through 2005, in which a medical or government authority tried or succeeded in stripping a woman’s autonomy because of pregnancy. The study appears in the Journal of Health Politics, Policy and Law.

These cases could have involved threat of or actual arrest, incarceration, or increased prison/jail time; detention in a hospital, treatment program, or mental institution; or forced medical intervention. Descriptive detail of several cases is provided, along with summary statistics on the findings.

Looking at legal, medical and other sources, Paltrow and Flavin analyzed 413 cases, which they speculate are “a substantial undercount,” because cases were difficult to identify and some sources referred to additional cases.

The data reveals substantial racial, income and geographic disparities. While almost every state had multiple cases, the regions with the most were the south (56 percent) and midwest (22 percent). These cases disproportionately targeted black women (52 percent of cases overall, and 72 percent of cases in the south), and 71 percent involved low-income women (enough so that they qualified for indigent defense).

Most women who faced criminal charges were charged with felonies; a greater percentage of black women (85 percent) were charged with felonies than white women (71 percent).

The authors explore how these disparities are interlinked with disparities in drug laws, disproportionate application of criminal laws, and outdated stereotypes about cocaine use (such as the “crack baby” myth).

The vast majority of the cases — 84 percent — involved allegations of illegal drug use. In the remaining cases, “women were deprived of their liberty based on claims that they had not obtained prenatal care, had mental illness, or had gestational diabetes, or because they had suffered a pregnancy loss.”

Although concern for the health of the fetus/infant is typically offered as a reason for increased scrutiny or detainment of pregnant women, in 64 percent of the cases there was no reported health issue cited in the allegation.

Chillingly, most cases were reported by people in so-called “helping professions”: health care providers (41 percent), social workers (12 percent), and hospital, child protective services, or police personnel (17 percent). Health care providers reported black women at a higher rate (48 percent) than white women (27 percent).

As the authors point out:

Due in part, no doubt, to the strong public health opposition to such measures, no state legislature has ever passed a law making it a crime for a woman to go to term in spite of a drug problem, nor has any state passed a law that would make women liable for the outcome of their pregnancies. Similarly, no state legislature has amended its criminal laws to make its child abuse laws applicable to pregnant women in relationship to the eggs, embryos, or fetuses that women carry, nurture, and sustain. No state has rewritten its drug delivery or distribution laws to apply to the transfer of drugs through the umbilical cord. To date no state has adopted a personhood measure, and no law exists at the state or federal level that generally exempts pregnant women from the full protection afforded by federal and state constitutions.

In other words, nothing about existing law should make women subject to such persecution. They also note that public health groups have observed that targeting pregnant women may lead to women avoiding medical care or having unwanted abortions to avoid increased and punitive scrutiny.

Paltrow and Flavin also highlight these cases in the context of proposed personhood laws, which would give fetuses individual rights and potentially could lead to increased prosecutions of women. They authors note that they have identified “more than two hundred cases initiated against pregnant women since 2005 that also overwhelmingly rest on the claim of separate rights for fertilized eggs, embryos, and fetuses.”

Opponents to personhood laws have cautioned that such measures could lead to forced medical interventions on pregnant women along with possible punishment for miscarriages and stillbirths. While personhood proponents often dismiss these warnings as scare tactics, the research shows there is good reason to be concerned.

Paltrow and Flavin conclude with a call for change:

In light of these continued efforts and our findings, we challenge health care providers, law enforcement and child welfare officials, social workers, judges, and policy makers to examine the role they play in the arrests and detentions of and forced interventions on pregnant women. We call on these same people to develop and support only those policies that are grounded in empirical evidence, that in practice will actually advance the health, rights, and dignity of pregnant women and their children, and that will not perpetuate or exacerbate America’s long and continuing history of institutionalized racism.

Finally, our study provides compelling reasons for people who value pregnant women, whether they support or oppose abortion, to work together against personhood and related measures so women can be assured that on becoming pregnant they will retain their civil and human rights.

The whole article is well worth a read if you can get a copy. The abstract is freely available online.

This January 22 marks the 40th anniversary of Roe v. Wade, the landmark U.S. Supreme Court decision that made abortion legal.

Many local and national pro-choice and reproductive justice organizations will be holding events to mark this anniversary. Here are a couple we know about, including one we’re excited to co-sponsor with many great organizations in our home state. Know of others or want to share your own? Please tell us in the comments!

In Massachussetts, we’re co-sponsoring the Roe v. Wade 40th Anniversary Legislative Breakfast and Lobby Day at the State House on January 14. You can sign up to attend the breakfast, with keynote speaker Paula Johnson, MD, MPH, Executive Director of the Connors Center for Women’s Health and Gender Biology, and/or the lobby events, a chance for you to meet with elected officials after a brief advocacy training. Please sign up online to participate.

In Manhattan on Jan 14, Physicians for Reproductive Choice and Health is hosting “Roe Revealed: Doctors Tell Their Stories on the 40th Anniversary of Legalized Abortion,” with Dr. Willie Parker, Dr. Linda Prine, and a special guest. The event with these abortion providers is $20; additional tickets are required for the reception.

NARAL Pro-Choice America is holding its annual Blog for Choice Day on Jan 22. This year, they’re asking participants to share their own stories of why they’re pro-choice. As usual, you can sign up online to join in.

While there’s plenty of reason to celebrate 40 years of Roe, legislative attacks on reproductive and sexual health and choice continue around the country. In 2011 alone, U.S. lawmakers enacted 92 abortion-restricting provisions in bills designed to curtail women’s rights to health services. According to the Guttmacher Institute, that number shattered the previous single-year record of 34 such provisions enacted in 2005. Such laws make it more difficult, and painful, for women to exercise their legal right to terminate a pregnancy.

What will you do this year to ensure reproductive justice for all? For starters, check out Our Bodies, Our Votes, our resource for fighting back against attacks on women’s health and rights. While you’re there, order a sticker and submit your picture to our awesome Click It, Stick It, Share It tumblr.

Related:
History of Abortion in the U.S. – an “Our Bodies, Ourselves” excerpt
The 40th Anniversary of Roe v. Wade: A Teachable Moment, by Linda K. Kerber

“All that stuff I was taught about evolution and embryology and the Big Bang Theory … all that is lies straight from the pit of Hell.”

“If it’s a legitimate rape, the female body has ways to try to shut that whole thing down.”

Comments like these are what spurred us to create Educate Congress, a campaign to deliver “Our Bodies, Ourselves“ to every member of the U.S. House of Representatives and Senate. Because these comments really were spoken by members of Congress.

And that’s not the only problem. Misinformation is too often used as the basis for crafting bad policy, which is why we’re working to show how Congress can advance evidence-based reproductive health policy, based on science and fact. Reproductive health policy pertains to issues such as birth control, abortion, breast and ovarian cancers, the effects of environmental toxins on women’s health and fetal development, and more.

We’re into our final countdown, with just eight days left to reach our goal of raising $25,000 to deliver books to every member of Congress and key members of the administration and government agencies whose work involves health care policy.

You can select a specific representative or senator to receive the book or donate to the general fund. There are great perks to show our thanks, including stickers, tote bags, signed copies of “Our Bodies, Ourselves” by OBOS founders and Gloria Steinem, and a signed Legitimate Road Trip poster commemorating the drive from Chicago to St. Louis with The Ladydrawers to rush sex-ed materials to Rep. Todd Akin.

Please help us reach our goal — because, really, doesn’t everyone deserve access to comprehensive sex-ed?

Watch American Voices: Our Bodies Ourselves on PBS. See more from Need To Know.

The most recent episode of the PBS news show “Need to Know” featured an excellent yet disturbing segment about state legislatures slashing funding to women’s health clinics.

Mona Iskander looks at the effects this is having on women — particularly low-income women — and their ability to obtain birth control, STI screenings, and other reproductive health care services. Our own Judy Norsigian, OBOS’s founder and executive director, weighs in at the end about women’s health activism.

As part of the show’s online series “American Voices,”  Judy covers the beginnings of the women’s health movement in the United States and the launch of “Our Bodies, Ourselves.” She discusses the long history of denying women access to services as well as information about their bodies, and notes the effects of so many years of misinformation:

Over the years, we saw repeated attacks on good sex education. So much so that we then ended up with federally funded abstinence-only sex education in many of our schools. And the damage done there is still showing, well into the 21st century. I’ve met professors at medical schools who have said incoming medical students have said that using condoms promotes HIV/AIDS. And that comes straight from their abstinence only sex education in high school.

Watch the video above (just 3.5 minutes) for a look at how hard women have worked to ensure access to accurate, evidence-based information, and why it’s more important than ever  that politicians use this information when setting health care policy.

Want to help educate Congress? Send a copy of “Our Bodies, Ourselves” to your favorite representative or senator. It makes a great holiday gift!