Archive for the ‘Abortion & Reproductive Rights’ Category

August 14, 2013

How Many Abortion Complications Are Caused by Stigma, Secrecy and Silence?

Although close to one-third of all U.S. women will have an abortion by age 45, there is often little discussion of the topic because of the stigma involved.

In a commentary published in the journal Obstetrics & Gynecology, Dr. Lisa H. Harris describes the cases of two women who had access to safe, legal abortion but who completed their abortions in unsafe conditions because “each woman needed her abortion plan to remain a secret.”

In both cases, the women were undergoing cervical dilation prior to planned surgical abortions and failed to complete the procedures at the clinic. The first woman feared loss of housing and a child custody battle if her family found out about the abortion, so pretended to have miscarried. She later ended up in the ICU.

The second woman, after having a complication, could not tell anyone about her situation and had no transportation back to the clinic. She ended up going to the hospital by ambulance.

While abortion is generally very safe in the United States, Harris writes that if political wrangling leads to increased stigma (alongside more restricted access), complications may increase:

This leads me to ask, how many serious abortion complications are caused by stigma, and the secrecy and silence it generates? Because overall rates of serious complications or death from abortion in the United States are extremely low (the abortion mortality rate is 0.7 per 100,000 abortions), abortion stigma may not currently pose an important public health threat. However, abortion is becoming increasingly contested in U.S. politics and discourse, and social scientists note its increasing stigmatization. Insofar as abortion stigma leads to compulsory secrecy for many patients, which in turn may lead to disruptions of care and lapses in treatment, we might expect rates of some serious complications to increase.

The 1 in 3 Campaign is currently working to fight abortion stigma, encouraging people to share their stories of abortion and challenge shaming. The campaign website features activism resources, including a campus toolkit, and other information about abortion rights and policy.

Secular Women is also running the #ShameLESS campaign, and is posting stories on the AbortTheocracy website.

Related: Carol Joffe, a professor at the Bixby Center for Global Reproductive Health, explains how Kansas is taking the stigmatization of abortion providers to a whole new level.

August 8, 2013

Taking the Stigmatization of Abortion Providers to a New Level

by Carole Joffe

No school district, employee or agent thereof, or educational service provider contracting with such school district shall provide abortion services. No school district shall permit any person or entity to offer, sponsor or otherwise furnish in any manner any course materials or instruction relating to human sexuality or sexually transmitted diseases if such person or entity is an abortion services provider, or an employee, agent or volunteer of an abortion services provider.

Carole JoffeThe above provision is contained in a nearly 50-page bill (pdf) that recently went into effect earlier this year in Kansas. (A judge temporarily blocked two other provisions of the law, but allowed this one to remain.)

To be sure, the relentless assault on abortion that we are currently seeing in other state legislatures — Texas, Ohio, and North Carolina, among others — are far more consequential in the short run. Ambulatory surgical center (ASC) and hospital admitting privilege requirements really do have the capacity to shut down clinics; in Texas, the number of Texas abortion facilities could go from 47 to five in that huge state.

Already, due to a similar ASC requirement, earlier rammed through the Pennsylvania legislature as a cynical response to the Gosnell scandal, a number of clinics in Pennsylvania have closed. And the bans on abortions after 20 weeks, adopted by a number of states, will affect a relatively small number of women, but typically those in desperate medical and/or social condition.

But other provisions of abortion legislation, of which the Kansas one cited above is a prime example, do a different kind of damage. They further the stigmatization and marginalization of abortion providers by making clear that these individuals are not welcome in that most central of community institutions: the schools. It is not just participation in sex education from which Kansas providers are barred.

As Stephanie Toti, senior attorney at the Center for Reproductive Rights, which is challenging this law, told me, “This is unprecedented discrimination against abortion providers. … The prohibition on providers serving as ‘agents’ of a school district has the effect of barring them from serving as chaperones on field trips and engaging in most other volunteer activities.”

So abortion providers are at this moment banned from Kansas schools — and supposedly this will promote the safety of adult women getting abortions, as is the typical sanctimonious rationalization of the various laws we are seeing.

I asked several lawyer colleagues if they knew of other instances in which a whole occupational category was banned by law from volunteering in schools. They did not. Indeed, as far as I can tell, only sex offenders as a class are de facto banned from school grounds.

This shocking ban on abortion providers’ involvement in the schools leads me to recollect other instances I have encountered of attempts to isolate this group and keep them from community involvement. I think of a provider I’ve written about who I call Bill Swinton (not his real name), a family medicine doctor in a small town in the Pacific Northwest. He was deeply involved in both his church and his community, and served for three terms on the local school board. But he was defeated for a fourth term in the late 1980s, as the abortion wars intensified; needless to say, his status as a provider was the key factor in his defeat.

I think as well of another doctor I’ve written about named Susan Golden (also not her real name), in a town in the Midwest, who integrated abortion provision into her family medicine practice. When she and her partner planned to take part in a community health fair, presenting on the care of newborns, the entire event was abruptly cancelled by the anti-abortion owner of the facility where the fair had been scheduled to take place.

As disturbing as these incidents were, they did not have the force, or the legitimization, of law. The Kansas provision does — and as such, takes the stigmatization of abortion providers to a new level.

Assuming the Kansas law, including this provision, is not overturned, we can only speculate as to what effects it might have.

Speaking personally, I remember as a child the enormous pride I felt when my father, a cardiologist, came to my elementary school with his microscope and showed the class wondrous things. As a working mother, I recall how much I valued occasional volunteer stints in my daughters’ schools, getting to know both their classmates and other parents.

It is very disturbing to contemplate that providers and their children will be deprived of these experiences. And it is equally disturbing to contemplate the messages that others in the community will receive from such a ban.

This provision truly is stigma on steroids.

Carol Joffe is the author of “Dispatches from the Abortion Wars” and a professor at the Bixby Center for Global Reproductive Health. This article originally appeared at RH Reality Check and is reprinted with permission.

July 31, 2013

The Medical (and Political) Problem with 20-Week Abortion Bans

July 15 protest rally in Austin against anti-abortion legislation

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

The recent wave of anti-abortion legislation has caused much confusion and concern over what the future of reproductive healthcare might look like in a few years.

Texas recently enacted a 20-week abortion ban, and 13 states have passed similar bans. In Congress, Republican senators are pushing to bring a 20-week abortion ban up for a vote after the August recess, reports The New York Times.

Let’s first look at the language in these bills, which usually reference “20 weeks post-fertilization.” Aside from the restrictive issues, these post-fertilization bans present a major problem — that’s not how pregnancy is measured.

When a doctor or midwife indicates that someone is “20 weeks pregnant,” what they mean is that it has been 20 weeks since the first day of the last menstrual period (or LMP). This can be a bit confusing, because the first day of the last period is not when ovulation followed by fertilization actually occur.

This LMP method is used because it’s the easiest to measure. While ovulation is often estimated at about two weeks after the start of the last menstrual period, it can occur at different times for different people, making it impossible to know exactly when ovulation — or fertilization or implantation, for that matter — occurred.

LMP, however, is something we can point to on a calendar and is easily knowable. That’s why healthcare providers ask the question.

To recap the terms:

  • 20 weeks “pregnant” = 20 weeks after the first day of the last menstrual period (LMP); used by medical providers to date pregnancies.
  • 20 weeks “gestational age” = usually the same as above, measured since the first day of the last menstrual period; used by medical providers to date pregnancies.
  • 20 weeks “post-fertilization” = may be approximately 22 weeks “pregnant” by the normal method of measuring; used by politicians to promote 20-week abortion bans.

In other words, nobody but politicians uses fertilization as a way of dating a pregnancy. For the record, a pregnancy does not start at fertilization; implantation must occur for the pregnancy to progress.

So why are politicians using “post-fertilization”? For one, politicians may simply have very little understanding of pregnancy. This would not surprise us in the anti-science era of “legitimate rape.” (Though we really wish members of Congress would read their copies of “Our Bodies, Ourselves.”)

More cynically, politicians may be deliberately fostering confusion in order to make it more difficult for women to determine whether they are within their legal right to obtain an abortion.

For example, a woman told she is “22 weeks pregnant” by a healthcare provider may assume she’s past the cutoff and no longer able to obtain an abortion. In reality, she may be just 20 weeks post-fertilization and still eligible for a short period of time.

Anti-abortion advocates justify 20-week post-fertilization limits based on the widely disputed idea that fetuses may feel pain at that point. The so-called “Pain-Capable Unborn Child Protection Act” (HR 1797) that the House passed in June specifically referred to 20 weeks after fertilization as the cutoff for legal abortion, based on the widely disputed idea that fetuses can feel pain at this point.

However, a 2005 systematic review on the topic concluded that “pain perception probably does not function before the third trimester.” Similarly, a 2010 report by the Royal College of Obstetricians and Gynaecologists (UK) concluded: “Interpretation of existing data indicates that cortical processing of pain perception, and therefore the ability of the fetus to feel pain, cannot occur before 24 weeks of gestation.”

For all the supposed concern about pain, it’s almost unheard of for anti-abortion activists to discuss the counterbalancing notion of pain, illness, injury and potential death that a woman may face carrying a pregnancy to term — see Jessica Valenti’s most recent column in The Nation for more from this perspective.

It’s also important to remember, as Paul Waldman points out, that these bills contain provisions that aim to shut down abortion clinics, including onerous Targeted Regulation of Abortion Providers (TRAP) laws that are costly and do nothing to increase safety:

Abortion clinics often require doctors from out of state to travel to the clinic, because of the harassment, threats, and even assassinations that local doctors have been subject to? Then we’ll require that every doctor have admitting privileges at a hospital within a certain number of miles, which out-of-state doctors won’t have. And we’ll throw in some rules on how wide your hallways need to be (not kidding), meaning in order to stay open you’d have to do hundreds of thousands of dollars of remodeling. Failing that, we’ll make sure that women who need abortions will have to suffer as much inconvenience, expense, and humiliation as possible.

Ultimately, the GOP’s concern is not so much about minimizing human suffering, but about advancing strategies for keeping women from exercising their right to safe, legal abortion. Writing at RH Reality Check, Imani Gandy does a  good job explaining the anti-choice litigation strategy, noting in part:

The push for 20-week abortion bans is part of a national strategy implemented by anti-choice advocates to create exactly the sort of legal mess that will force the Supreme Court to reconsider Roe v. Wade and Planned Parenthood v. Casey, and to revisit the viability standard that has served as the constitutional foundation for abortion rights for 40 years.

An analysis by RH Reality Check suggests that the strategy deployed by anti-choicers is deeply subversive. It capitalizes on personal feelings and anti-abortion hostilities by enticing judges and legislatures to abandon empirical science in favor of biased, agenda-driven science or, as it is sometimes called, “junk science.” Proponents of junk science, which has become a cottage industry among anti-abortion advocates, confuse the issue of fetal viability, invent claims about fetuses feeling pain (or masturbating in utero), and call into question established medical standards.

The strategy is a smart one, to be sure. Anti-choicers understand that once junk science has been incorporated into legislation, courts are not inclined to question those scientific findings—no matter how agenda-driven they are—and will simply apply the law to those “facts.” In cases when junk science is presented to a court, a judge (or justice) hostile to abortion rights requires only the flimsiest reasoning to ground their legal opinion in fact, even if those “facts” are anything but factual.

As the American Congress of Obstetricians and Gynecologists wrote when addressing political attempts to limit abortion based on ideas about fetal, pain: “Facts are important.”

Let’s hope the courts think so, too.

July 26, 2013

Clear Channel Won’t Run Ads for Women’s Health Clinic, Cites “Decency Standards”

Following a successful campaign urging Facebook to apply its community standards toward pages and groups promoting rape and other violence against women, Women, Action & the Media (WAM!) has launched a new effort: calling on Clear Channel to lift a ban on radio ads promoting a Wichita, Kan., women’s health clinic that provides abortions.

“At a time when access to reproductive health services, including but not limited to abortion, is under ever increasing attack by politicians and antichoice extremist groups alike, it’s ever more critical that women learn about the services that are still available to them,” said Jaclyn Friedman, executive director of WAM!.

The South Wind Women’s Center recently opened to provide a full range of sexual and reproductive health services, including well-woman exams, cancer screenings, contraception and pregnancy-options counseling. It is one of just just three facilities in all of Kansas that provide abortion care — and one of only three clinics in Wichita (which has a metropolitan population of 650,000) that provide subsidized birth control for low-income individuals.

The clinic is run by Julie Burkhart, a colleague of Dr. George Tiller, the abortion provider who was murdered in his church by an anti-abortion advocate in 2009. Burkhart founded Trust Women, which supports South Wind, to continue Tiller’s vision of entrusting women to make their own decisions for their health and their families. It does not perform late-term abortions as Tiller did.

In defending pulling the ads, Clear Channel claimed the ads are “divisive” and violate “decency standards.”

How “divisive” are the ads?

They never use the terms “abortion,” “pro-choice,” or “reproductive rights.” The first ad is completely innocuous and mentions the expertise and experience of the clinic’s family medicine and ob/gyn providers.

The second ad might be considered more provocative — but only to those who refuse to trust women with their own health decisions. While it never explicitly mentions Tiller’s murder, it reminds listeners that the clinic was “founded to re-establish access to full spectrum reproductive health care.”

Sadly, the most controversial message in these ads may be that the Center is “entrusting women with their own medical decision-making.”

The WAM! campaign also points out the irony in Clear Channel’s advertising: “Wichita’s Clear Channel stations happily play ads for a local sex shop. How is blocking access to information about where to get maternity care and cancer screenings less ‘divisive’ than running sex ads in a conservative Christian town?”

On Thursday, Wichita’s Clear Channel General Manager Rob Burton told a reporter: “As members of the Wichita community, KZSN has a responsibility to use our best judgment to ensure that advertising topics and content are as non-divisive as possible for our local audience.”

Tell Clear Channel that you’ll #changethechannel (hashtag for the campaign) unless it starts running South Wind’s ads. Here’s how you can get involved:

  • Sign SWWC’s petition to Clear Channel calling on the company to run the ads and stop blocking women’s access to health care information.
  • Contact Clear Channel to tell them you’ll #changethechannel unless it agrees to run SWWC’s ads:
    • Call Wichita General Manager, Rob Burton, at 316-494-6601, and Wendy Goldberg, Clear Channel’s senior vice president for communications, at 212-549-0965. Tell them:
    • -Women deserve to know about and have access to legal, safe healthcare.
    • -Refusing to run these ads is what’s truly “divisive.”
    • -Clear Channel is restricting free enterprise, and hurting women by restricting their access to health care.
    • -Clear Channel is letting a tiny minority of anti-choice extremists dictate what women will and will not have access to.
    • -You’ll #changethechannel unless Clear Channel lets South Wind Women’s Center’s ads run.
  • Ask your friends to do the same!

July 22, 2013

Night Sweats: A Memoir on an Unplanned Pregnancy

Librarian Laura Crossett has just published a memoir of her unplanned pregnancy, “Night Sweats: An Unexpected Pregnancy.”

I’d recommend it on the merits alone, but here’s another reason: Laura is donating half of her proceeds from book sales to Our Bodies Ourselves.

Crossett describes her experience as a 35-year-old single woman — one month into a relationship and six months into a new job — facing a very unplanned pregnancy.

As the book description notes, her predicament is not uncommon, though her story is:

Almost half the pregnancies that occur in the United States each year are unplanned. Some of them happen to married women, some to unmarried; some occur due to failure to use contraception; some due to contraceptive failure. Some happen to women who hope one day to have children; some to women who never wanted children at all.

In a political climate that polarizes around issues of sexuality and choice and a popular culture that glamorizes pregnancy and fetishizes motherhood, we rarely hear the stories of women who did not seek to become pregnant. Night Sweats is one of them.

Despite the serious nature of her situation, there are some really funny bits in “Night Sweats” that made me chuckle. Discussing how pregnancy books assume certain kinds of family structures and access to resources, Crossett writes: “It’s like 1952 in pregnancy books, only with organic baby food and no BPA.”

The book is structured around the church year of the Episcopal Church, but if you are unfamiliar with its traditions (as I am), it’s not confusing (or preachy). Crossett is very straightforward about considering abortion when she learned of her pregnancy, and it’s interesting to explore her thought process.

We know that more than 70 percent of women seeking abortions are religious, but we don’t always get to hear these everyday stories amid the political rhetoric around the procedure.

You can purchase “Night Sweats” directly from Crossett if you happen to be in the Iowa City area, or you can buy it online:

In the acknowledgements, Crossett cites “Our Bodies, Ourselves: Pregnancy and Birth,” along with Ina May’s “Guide to Childbirth,”as “the best books” she has read on the subject.

During an email exchange, Crossett expanded on her appreciation for OBOS’s approach: “I picked up the ‘Our Bodies, Ourselves Pregnancy and Childbirth’ book (I’ve always been a fan of OBOS), and there, finally, was a book that never made an assumption. It talked about planned and unplanned pregnancies and people of color and GLBTQ people and people with mental illness and addiction and people who’d been raped and people with partners and people without — it was just so great.”

Learn more about and read excerpts from OBOS’s “Pregnancy and Birth,” or order it online for yourself or in bulk for health clinics or groups providing health-counseling services (there’s a steep discount!). Finally, if you’re interested in directly supporting our work, please make a donation online!

July 12, 2013

State by State: Laws Restricting Abortion and Family Planning as of Mid-2013

 abortion restrictions enacted at midyear for 2007 through 2013

If you’re having trouble keeping up with the assault on abortion rights across the states, you’re not alone.

While we’ve been hearing a lot out of Texas, and some from North Carolina and Ohio, many other states have enacted regulations restricting access to healthcare.

These include obstacles such as requirements for hospital admitting privileges for providers, bans on medication abortions by telemedicine and abortion after 20 weeks, and biased counseling laws — requiring, for instance, that women be provided with information falsely linking abortion to breast cancer.

Other new laws, such as restrictions on family planning funding, have further affected women’s access to reproductive health services.

How bad is it? According to updated information from the Guttmacher Institute, states enacted 106 provisions related to reproductive health and rights in the first six months of 2013 alone. This includes 43 restrictions on access to abortion — the second-highest number ever at the mid-year mark, and as many as were enacted in all of 2012.

Guttmacher points out a glimmer of sunshine as well: Among the numerous restrictions, some states saw new laws to expand comprehensive sex education, make STI treatment of partners easier, and increase access to emergency contraception for women who have been sexually assaulted.

Rachel Maddow this week looked at the overall impact of state-by-state anti-abortion laws, showing how states under Republican control since the 2011 elections are restricting access. Maddow also provides more information on some of the individual states.

Visit for breaking news, world news, and news about the economy

July 10, 2013

CIR Prison Investigation Opens Another Chapter on Sterilization of Women in U.S.

We learned this week of an appalling story involving coerced sterilization of women — an issue that never seems to disappear completely from view despite a long and painful history.

The Center for Investigative Reporting found that at least 148 female inmates in two California prisons were sterilized between 2006 to 2010 — and there may be 100 more incidents dating back to the late 1990s.

Due to supposedly strict limits on sterilization of inmates, state approval was supposed to be obtained prior to these procedures. CIR reports that not only were approvals not obtained, but former inmates report being coerced into agreeing to sterilization.

CIR reporter Corey G. Johnson writes:

The women were signed up for the surgery while they were pregnant and housed at either the California Institution for Women in Corona or Valley State Prison for Women in Chowchilla, which is now a men’s prison.

Former inmates and prisoner advocates maintain that prison medical staff coerced the women, targeting those deemed likely to return to prison in the future.

Crystal Nguyen, a former Valley State Prison inmate who worked in the prison’s infirmary during 2007, said she often overheard medical staff asking inmates who had served multiple prison terms to agree to be sterilized.

“I was like, ‘Oh my God, that’s not right,’ ” Nguyen, 28, said. “Do they think they’re animals, and they don’t want them to breed anymore?”

Pressure was applied particularly to women with multiple children, and doctors apparently tried to bypass the required approval process. CIR reports that when Daun Martin, the Valley State Prison medical manager between 2005 and 2008, became aware of the restrictions, she and the prison’s OB-GYN, Dr. James Heinrich, worked around them:

“I’m sure that on a couple of occasions, (Heinrich) brought an issue to me saying, ‘Mary Smith is having a medical emergency’ kind of thing, ‘and we ought to have a tubal ligation. She’s got six kids. Can we do it?’” Martin said. “And I said, “Well, if you document it as a medical emergency, perhaps.’”

The story prompted The Sacramento Bee to call for a full review into whether “anyone ought to have been disciplined,” and to “make sure all the necessary safeguards are now in place.”

Forced sterilization is unfortunately nothing new in the United States: 33 states at one time allowed it for “eugenic” purposes, often targeting people of color and people with mental illnesses.

The phrase “Mississippi appendectomy” has come to describe much of this abuse, referring to the sterilization of poor black women — especially in the South — who were sterilized without their consent and sometimes without their knowledge.

Back in 2002, Oregon’s governor issued an apology for forced sterilizations carried out on women who were in state care (including, according to one article, “wayward teenage girls”). North Carolina only formally repealed its last forced sterilization law in 2003. The Winston-Salem Journal did a detailed series on these abuses in 2002. West Virginia repealed a law allowing sterilization of those deemed “mentally incompetent” just a few months ago, and it just took effect.

While these states tend to claim that sterilization abuses stopped in the late 1970s, political fighting continues in many states about whether to compensate and how to recognize victims.

Where laws have ended forced sterilization practices, however, it appears that coercion has continued to thrive.

CIR asks that anyone with knowledge of the sterilization abuses in California prisons — whether as a victim, family member, or medical or prison employee — to share their experience via this form or to contact CIR’s Corey G. Johnson directly (916-504-4085, ext. 202 or cjohnson AT

July 1, 2013

Keeping Up With Anti-Abortion Attacks in the States

Following up on the amazing filibuster by Texas State Sen. Wendy Davis, Republican Gov. Rick Perry has called for a second special session, beginning today, in which he hopes to push through abortion restrictions.

Texas Tribune will once again provide livestreaming; here’s a seating chart for understanding who’s who in the state Senate.

For continued updates, follow the Twitter accounts of scATX and naraltx and the hashtag #standwithTXwomen. There’s also a virtual march event page on Facebook and a livestream of the rally outside the Statehouse.

For more good commentary from Texas that helps to put the Davis’s filibuster in context, read these columns from the Texas Tribune: “‘Ruly Mob’ Was Prompted by Civic Duty” and “Protest Caused by Unruly Bunch in Control.”

Texas is not the only state suffering from anti-abortion attacks. Mississippi is implementing a law that will make it much harder for women to have medical abortions. The law requires women to take the necessary pills in the presence of a doctor and schedule a mandatory follow-up a couple of weeks after the abortion.

In Ohio, Gov. John Kasich, flanked by a group of white male legislators, signed a state budget Sunday evening that included several abortion-related laws, including measures to strip funding from Planned Parenthood, divert money to right-wing crisis pregnancy centers, and defund rape crisis centers that provide women with information about abortion services. (You might recall that the Supreme Court last week decided the U.S. government could not refuse funding for global programs that do not take an anti-prostitution pledge; it will be interesting to see if Ohio can block funding for programs that share information about legally available options for rape survivors.)

Meanwhile, North Dakota’s extremely restrictive new laws will go into effect one month from today.

Today’s Women’s Health Policy Report has more news about other states, including North Carolina. And the Guttmacher Institute has an overview of the new wave of laws intended to shut down abortion providers and seriously restrict access. It’s going to be one long, hot summer.

June 19, 2013

Groundbreaking Study Follows Women Who Underwent Abortions and Those Who Were Turned Away

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.

June 10, 2013

“Crow After Roe” Looks at Inequities in Reproductive Healthcare

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.

May 31, 2013

Reproductive Justice: The Movement Whose Time Has Come

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.

May 20, 2013

“Educate Congress” Accomplished: Every Member Now Has a Copy of “Our Bodies, Ourselves”

Our Bodies, Ourselves Goes to Washington

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.

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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). 

April 12, 2013

The Long Political History of Increasing Access to Emergency Contraception

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:

Background information from Our Bodies Ourselves:

April 5, 2013

Study: Expand Abortion Access by Expanding the Types of Professionals Who Can Provide Care

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.

April 2, 2013

Lessons in Denial: A Student Perspective on High School Health Class

by Hanna Pennington 

Hanna PenningtonNo 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.