Americans have mixed perceptions about the Affordable Care Act (ACA), responding in significantly different ways to various questions about the federal health-care law, according to a new study by the Kaiser Family Foundation (KFF).
Most provisions of the ACA have gone into effect, but many people are still unsure of whether the reform is positive. Forty-one percent of people responding to the KFF poll said they view the law favorably, compared with 46 percent viewing it unfavorably.
People’s opinions of the ACA change drastically when responding to questions about specific provisions of the law, indicating that although Americans may not like the idea of Obamacare, they steadfastly support many of the specific reforms put in place by the law.
The survey also found that views of Obamacare aren’t fixed, and that, given more information, people seem to like the law more.
More than two years after the Supreme Court largely upheld the ACA, the only major provision of the law that hasn’t taken effect is the employer mandate, which will require businesses with more than 100 employees to offer those workers basic health insurance.
That provision will finally take effect in early 2015, and the public largely supports the measure; 60 percent of Americans favor the employer mandate and 38 percent do not, according to the KFF survey.
Opinion of the employer mandate is also not static, showing that the way in which the provision is portrayed greatly affects its popularity. When given the statement that “most employers with 100 or more workers already offer health insurance and won’t have to pay the fine” reserved for those who don’t satisfy the federal mandate, the number of respondents in favor of the provision increased by more than 15 percent.
When given the statement that “some employers are moving some workers from full time to part time to avoid paying the fine,” the number of people with an unfavorable opinion increased by 30 percent.
The individual mandate, which went into effect this year, is by far the most unpopular provision of the ACA, with 35 percent of the American public saying they have a positive opinion of it, according to the poll. In comparison, 75 percent of the public favors Medicaid expansion, 76 percent favors insurance subsidies, and 78 percent favors the creation of online health insurance exchanges—all central pieces to the ACA, which is being actively undermined in red states like Missouri.
But like the employer mandate, opinion of the individual mandate is malleable, and when given specific statements that qualify the mandate, people’s opinions change.
For example, when asked to consider, “Most Americans still get coverage through their employers or a public insurance program” and, “People would not be held to this requirement if the cost of coverage would consume too large a share of income,” many of the people who previously opposed the individual mandate said they felt positively about it.
When provided the statement, “Requiring all Americans to have health insurance could mean that some people would be required to buy health insurance that they find too expensive or did not want,” 15 percent of those with a previously favorable opinion said they felt negatively about the mandate.
Political scientist Jonathan Bernstein wrote last week that people’s view of President Obama largely determines the way they perceive the signature achievement of his presidency. It shouldn’t surprise policymakers that voters support most elements of the health-care reform law but oppose the ACA as a whole, Bernstein wrote.
Despite the evidence from the KFF poll that shows most people favor provisions like Medicaid expansion, many conservative legislatures across the country have done their best to halt implementation of the health-care reform law.
Almost half of the states still have not expanded Medicaid, a Republican policy decision that affects millions of people across the country. As RH Reality Check reported in September, seven of the 11 major metropolitan areas with uninsured rates higher than the national average are in states that have opted out of expanding health insurance for low-income residents.
The editorial board of the New York Times recently published an op-ed in praise of midwives, spurred by new guidelines out of the United Kingdom advising that low-risk pregnancies actually fare better out of hospital settings and under midwifery care. This editorial gives weight and visibility to an argument many in the birthing community have been making for some time: that midwives should be the standard of care for low-risk, healthy pregnancies, as well as key players in more complicated pregnancies. However, even as it championed midwives, the Times editorial board unwittingly slipped into language that suggests midwifery care is a second-tier option—language that reflects broader public attitudes throughout the United States.
The Times acknowledged that despite the difference in the British and U.S. health-care systems, “There is no good reason that midwives should not play a more important role in childbirth here.” Toward the end of the editorial, however, the board examined ways some organizations are trying to integrate midwives into their practices (emphasis ours):
Some medical centers are trying to have the best of both worlds by allowing midwives greater autonomy within the hospital. The Mayo Clinic, often a pacesetter, lets midwives handle low-risk pregnancies independently and hand off to doctors any cases that become complicated.
Words like “allowing” and “lets” imply a submissive relationship within the U.S. health-care system, in which permission may or may not be granted to midwives in order to practice what they have been trained, licensed, and certified to do. The above section also reinforces the idea that midwives drop care once a pregnancy gets complicated. In reality, however, midwives and doctors often work as a team for the benefit of a patient, rather than the midwife simply transferring care. While this was likely not intentional at all on the part of the New York Times, it’s clear that this way of thinking—that midwives are somehow seen as the lesser choice when it comes to birth providers—has become ingrained in how our society thinks and speaks about midwifery.
Instead of using this value-laden language, the Times could have worded its assessment in a more egalitarian manner, such as: “At the Mayo Clinic, often a pacesetter, midwives practice independently and collaborate with physician when needed.”
Reframing the topic in this way also avoids playing into the idea of a “longstanding turf war between obstetricians and midwives,” as the Times put it elsewhere in their editorial. The situation is much more complicated than simply a “turf war” between two professions. While some individual providers might find themselves at odds, the false “turf war” narrative is more of a manufactured concept than it is representative of reality. Instead of fueling the false binary of doctors versus midwives, a shift in language in this way would uphold midwives and physicians as colleagues working together toward a shared goal of providing care that meets the needs of each individual patient.
Unfortunately, when it comes to midwives actually practicing, this type of language has set the stage, so to speak. In the United States, midwives—who are overwhelmingly female, which is a factor that cannot be overlooked in this discussion—are “allowed” to do their jobs, and only then with many constraints that often restrict them from practicing to the fullest extent of their licensure. Regulatory restrictions vary from state to state and affect the type of care midwives can provide, including where they can practice, what types of patients they are “allowed” to care for, and, oftentimes, how much they will be reimbursed for their services.
For example, although the Affordable Care Act stipulates that midwives should be reimbursed under Medicare 100 percent of the amount that physicians bill for identical service, the same can’t be said for Medicaid. The federal health-care program for low-income individuals’ reimbursement rate varies from state to state: A midwife may be reimbursed only 75 or 85 percent of the set fee for prenatal and delivery services, while a physician will receive 100 percent for the same work. This is vital to note, as Medicaid is often states’ largest single payer of Certified Nurse Midwife services, indicating the importance of midwives in marginalized communities.
Indeed, while some midwives are like those profiled in trend pieces in the New York Times, who care for white, upper-middle-class women, many others offer crucial services in underserved communities, taking on patients in low-income rural or urban areas where there may be provider and resource shortages.
And despite all of this, midwives remain unnecessarily regulated, both in language and in practice: set at odds with doctors rather than treated by legislators, the media, and the public as commensurate to them.
At the end of the day, it’s not about who provides the care that needs to change; rather, it’s our model of care that needs fixing. There is plenty of space and a great need for a range of providers—including physicians and midwives—when it comes to maternity care. Instead, however, we currently face a system that divides providers at the cost of the patient.
Health care in this country thrives in a for-profit world. And if you follow the money, you’ll see that this goes beyond midwives and doctors, into the insurance industry and corporate offices. Woven within this profit-centric system is the fact that the current approach in place driving maternity care in the United States is a biomedical model. This model—which focuses on pathology, physiology, and biochemistry of a disease, but does not bother to look at social, environmental, or psychological factors—procures the most revenue and is less patient-centric.
In these instances, it pays to follow the money trail and ask what type of care makes the most profit and for whom? Does the fact that providers are being paid more for interventions and the use of certain products influence their care? Are obstetric providers rewarded for the number of patients they see or for the slower-paced individualized care they can provide? Do hospitals receive more revenue for filling, or emptying, NICU beds? These are all questions we—both providers and patients—should be asking of our health care system.
As a whole, both the larger for-profit system and the biomedical model promote quantity over quality. Providers are rewarded for seeing more patients, because that brings in more revenue. This combination is at odds with the midwifery model of care—a model that has been shown to benefit both mother and infant. The American College of Nurse-Midwives carefully breaks down this model of care on its website, emphasizing the strong patient-provider relationship, patient agency, and individuality in care. It’s about long-term outcome improvements and quality over immediate revenue and quantity. Because of this, the midwifery model of care is disruptive to the for-profit/biomedical model. And disruption is exactly what is needed to fix this broken system.
When it comes to maternity care in the United States, the model of care needs to change to one where both physicians and midwives can flourish equally, as has been the case in the United Kingdom and other European countries. At present, we also need to be aware of how we discuss and frame the work of those providing care. Our for-profit system is set up to reward those billing more hours, patients, and procedures—due to the model of care they provide, that isn’t usually midwives. That has since translated into society viewing midwives as “less than” providers, despite evidence that they should be leading the way in all aspects of maternity care.
So, yes. Kudos to the New York Times for recognizing the immense benefit of midwifery care, but let’s go even further in our championing of the profession by respecting midwives in our action and our language. Hopefully the guidelines coming out of the UK will push this much-needed conversation into the mainstream and promote midwifery care in the United States. And, in the meantime, let’s do our best to talk about these providers of care in a way that is commensurate with their skill and evidence-based accomplishments.
19.12.14 - El 2 de diciembre de 2014, en la Organización de los Estados Americanos (OEA) en Washington D.C, Paula Avila-Guillen, Asesora de Incidencia para Latino América y el Caribe, en representación del Centro de Derechos Reproductivos, participó en la Mesa Redonda: Violencia contra las mujeres y derechos sexuales y reproductivos en las Américas: Avances y desafíos persistentes. La intervención del Centro resaltó la relación entre violencia y derechos reproductivos en las Américas y visibilizó el contraste entre las altas cifras de violencia sexual y el reducido acceso para las mujeres a servicios esenciales de salud como el aborto debido a barreras legales y administrativas.
En la mesa se resaltó la importancia y el impacto de la reciente “Declaración sobre la Violencia contra las Mujeres, Niñas y Adolescentes y sus Derechos Sexuales y Reproductivos” aprobada por el Comité de Expertas del Mecanismo de Seguimiento de la Convención de Belém do Pará (MESECVI) (MESECVI/CEVI/DEC.4/14, septiembre de 2014). La mesa fue organizada por la Comisión Interamericana de Mujeres (CIM), la Misión Observadora Permanente de Francia ante la OEA y la Organización Panamericana de la Salud (OPS). Encuentre aquí el video.
A school board in Gilbert, Arizona made headlines last month for voting to physically cut pages out of a biology textbook in order to keep students from learning about abortion. Despite reassurances to the contrary from both the district’s superintendent and the state’s education department, the Gilbert Public Schools Governing Board feared that teaching the biology of abortion would violate a state law that says schools cannot promote elective abortions over childbirth and adoption.
Taking X-Acto knives to textbooks is extreme and rare, though it has certainly been done before. The battle for control over what these texts do and do not teach children, however, is not rare in the slightest—and it can manifest in ways that are far more insidious than ripping pages out of a book.
Censoring Abortion Information in Arizona
The Gilbert Public School System (GPSS), which has 38 schools and more than 39,000 students, offers an Advanced Placement Biology course for high school students. The course uses a textbook, Campbell Biology; Concepts and Connections, which is popular in schools around the country. Over the summer, GPSS was contacted by the Alliance Defending Freedom (ADF), a Scottsdale, Arizona-based legal advocacy group which describes itself on its website as a “servant ministry building an alliance to keep the door open for the spread of the Gospel by transforming the legal system and advocating for religious liberty, the sanctity of life, and marriage and family.” ADF warned that because the textbook explained how mifepristone—a drug used in medical abortion—works without discussing adoption, it was in violation of Arizona law.
The law in question, which was passed in 2012, orders that abortion not be privileged over carrying a fetus to term and putting it up for adoption as an option for unplanned pregnancies. However, explained the American Civil Liberties Union in a letter to superintendent Christina Kishimoto and the GPSS school board, it does not mandate that students be deprived of information about abortion or contraception. Nor, the Arizona ACLU said, is it meant to apply to individual learning resources. In other words, it does not mean that young people can’t learn about abortion at all; nor does it mean that adoption must be mentioned every time abortion is brought up. Interestingly, biology courses were not the intended target of the law: At the time of its introduction, its sponsor, state Sen. Nancy Barto, explained that she wanted to give guidance to schools when they were inviting outside speakers into health class or special sex education classes—as in, she didn’t want educators to only invite speakers that would advocate for abortion rather than adoption.
And superintendent Kishimoto was not concerned, either. For one thing, she pointed out to the East Valley Tribune, no one other than ADF, a single community member, and members of the board itself had ever complained about the book. Moreover, she added, both the district’s attorneys and the Arizona Department of Education had reviewed the textbook and its accompanying curriculum; they’d decided that the district would not be breaking the law if they continued to use them.
Chris Kotterman, deputy associate superintendent for policy development and government relations at the state education department, agreed. He told USA Today in an email that he had reviewed the book and it did not appear to be violating the statute. He added: “In general, the mere mention of a means of medically inducing abortion does not automatically signal a lack of preference for childbirth and adoption … the responsibility lies with the teacher to provide context for the student.”
Still, the school board voted to remove the pages and redact the information anyway. Alessandra Soler, the executive director of ACLU Arizona, told RH Reality Check after the decision that she was disappointed by the extent to which the board had bowed to pressure from the ADF. Moreover, she worries that this will encourage the conservative group to go after more school districts in the state.
“Our concern now is that this is going to open the door to future censorship. I think ADF is now going to target other school districts and send similar letters, allowing politics and bias to dictate what is being discussed in the classroom,” she said.
Decades of Debate
The extreme nature of Gilbert’s proposed action, and the controversy surrounding it, made headlines all over the country. But there are other, subtler ways for disapproving parents or politicians to exact influence over the information children can access in school, sometimes before that information ever makes it into a classroom.
And these efforts to restrict education based on personal beliefs go back decades. Every expert RH Reality Check spoke to for this article mentioned Norma and Mel Gabler, a Texas couple who began reviewing textbooks in 1961 when their son came home from school with a history book that they felt was inaccurate. Their tactic was to comb through stacks of textbooks, creating a list of errors that would be rolled out on a scroll at school board meetings throughout Texas and later around the country. Neither of the two attended college or had any background in education, but they were able to find numerous factual errors in textbooks, such as one history book that said Napoleon had won the battle of Waterloo.
Still, they are probably best known for pointing out what they considered ideological errors. According to a 1981 profile in the New York Times, which called the couple “an important voice in American education,” the Gablers’ goal was to rid schools of all material they considered “antifamily, anti-American, and anti-God.” The Gablers took on evolution and disapproved of any textbook that did not included an alternate explanation. They also objected to secular humanism. As the New York Times explained:
The trouble with most of the textbooks, the Gablers contend, is that they are written from the perspective of people who do not believe in God or an absolute value system. This perspective, they say, is a religion called secular humanism, which permeates every aspect of contemporary society and teaches youngsters to lie, cheat and steal.
In practice, the profile continued, this meant opposing a textbook that a line like “The law that allowed slavery in America was wrong, so people could break the law.” After all, the Gablers reasoned, a textbook should never sanction breaking the law.
And the couple was successful—Joan Bertin, the president of the National Coalition Against Censorship, told RH Reality Check the Gablers became so important that national publishers would go to Texas to meet with them. In addition, the Gablers began to hold workshops across the country to help others learn their tactics. Eventually, they founded an nonprofit organization called Education Research Analysts, which still works to change material in textbooks. The organization notes on its website: “We are a conservative Christian organization that reviews public school textbooks submitted for adoption in Texas. Our reviews have national relevance because Texas state-adopts textbooks and buys so many that publishers write them to Texas standards and sell them across the country.”
Over time, the Gablers’ initial strategy of cutting information from textbooks after classroom use morphed into a preemptive influence over material. “Publishers didn’t even need the Gablers anymore,” explained Bertin, “Because they just knew what was going to meet with objections.”
Many of these standards are still in place today. Ken Miller, a professor at Brown University and co-author of Biology: The Living Science, the most popular high school biology book in the country, told RH Reality Check that his publisher set some parameters based on what might raise conservative alarms. When he wrote the first draft of his book, for example, he considered putting information in it about contraception. But that never happened:
When we decided what was going in the book we looked we looked at state science standards in places like New York, California, and even Texas. We noticed that none of these standards said anything about contraception. I like to explain how the pill works, for example, because it helps students understand the endocrine system. I talked about weaving it in, but my editors said it wasn’t in the standards and talking about it will be a flashpoint. They said, “It’s probably a great lesson on biology but it ain’t going to be in the book.”
Textbooks and Texas
Part of why the Gablers were able to become so influential in the textbook industry—and why their legacy there endures—is because they started in Texas. The process of approving textbooks in Texas is very public and highly political. Every decade or so, publishers must present their wares to the State Board of Education (SBOE), an elected body whose members represent areas the size of three congressional districts, which means that it takes million of votes to get elected. Some of the experts RH Reality Check spoke to suggested that many Texans see serving on the SBOE as a stepping-stone to higher political office. In the case of textbook evaluation, the SBOE allows for public comment before voting on which will go on the approved list for public schools in the state. Sometimes, these approvals are contingent on mandated changes by the SBOE.
Though a new law, passed in 2011, allows schools to buy materials that are not on the list, most do not because they would have to prove their choice meets state standards. Going with something on the approved list is certainly easiest.
Because Texas is such a large state with huge buying power, national publishers have been willing to make changes in order to ensure that their books are used in classrooms there. In Norma Gabler’s 2007 obituary, the New York Times noted, “It is difficult and costly for publishers to put out multiple editions, so a book rejected by Texas might not be printed at all.” As a consequence, other, smaller states have historically had to use books that were changed for Texas. For example, in 2012, RH Reality Check wrote about a report by the New York Civil Liberties Union that found outdated, inaccurate, and sexist information in health textbooks used in the state. On textbook, Holt’s Lifetime Health, defined the vagina as an “organ that receives sperm during reproduction.” An expert we spoke to at the time noted that this edition of Lifetime Health was identical to the one that had been passed—after changes had been made—in Texas.
Dan Quinn, communication director at the Texas Freedom Network (TFN), which describes itself as “the state’s watchdog, monitoring far-right issues, organizations, money and leaders,” tells RH Reality Check that he has seen many changes to textbooks made to appeal to the Gablers and those conservative advocates who followed in their footsteps.
One of the most notable changes was made in 2002, when the publisher of a world geography textbook agreed after pressure from the SBOE to revise references to the formation of fossil fuels and glaciers. The authors had said these formed “millions of years ago” but this was changed to read “in the distant past” and “over time” so that it didn’t directly contradict the Bible’s account of when the world began.
Even after information makes it to the page, this system makes it easy for politicians to nix it from later editions before it gets into future classrooms. Quinn recounts how conservatives on the SBOE were able to get the oldest and most widely used civics book—Frank Abbott Magruder’s American Government, first published in 1917—to change its description of the U.S. Constitution from a “living document” to an “enduring document.” It’s just one word, but it transforms the meaning to suggest that the Constitution is static and unchanging, putting the text more in line with conservative legal thinking.
Miller’s book has also been subject to Gabler-esque reviews and pressure to change language for its Texas editions. Biology: The Living Science was one of the textbooks up for approval by the Texas SBOE in 2013. At issue was the explanation of evolution. SBOE members who believe in creationism felt that evolution should be presented as a theory next to other “theories,” such as intelligent design, rather than as proven science.
When the SBOE revised its standards for teaching science a few years prior, it had added what Quinn described as “traps” for publishers. For example, the standards now suggest that students learn about gaps in the fossil record that can’t be explained by evolution. The standards also want students to question how something as complicated as a human cell could have been created through an unguided natural process—another format that gives equal weight to creationism and evolution. As they acknowledged these theories, Miller took the opportunity to expand the explanation of evolution more thoroughly. As Miller told RH Reality Check:
Our reaction to that, when we adapted the book for Texas, was to include more of an explanation over and above the national edition so we could address these issues. So the coverage of evolution is actually a little more complete. But it meets both the letter and the spirit of the standards.
When Miller and his publisher, Pearson, submitted the book for review, a creationist on the review committee listed two dozen “errors” in the book; the SBOE leaned on Pearson to make changes. Both Miller and another professor reviewed all of the supposed errors and responded with journal articles and other sources backing up what the original draft had said. As a result, the publisher refused to change anything. Though the SBOE voted in November 2013 to approve all of the science textbooks, inclusion of Miller’s book was contingent on a final review of these purported inaccuracies. Three experts, chosen by board members, reviewed the book and voted unanimously to approve it. Quinn says the entire process of approving science books was a win for science and rational thinking.
Unfortunately, the same can’t be said of the vote on social studies textbooks that also took place in Texas last month. This time, books to be used in geography, U.S. history, U.S. government, and other classes beginning in fall 2015 were up for evaluation. The SBOE’s historical influence could be seen immediately in the books presented for approval—many included misleading information about climate change, religion, slavery, affirmative action, and Native Americans that seemed designed to please conservative members of the board.
For example, one of the books included a side-by-side discussion of climate change. On one side was an explanation by the Intergovernmental Panel on Climate Change, a scientific body under the auspices of the United Nations. On the other side—which denies climate change is happening and/or that it is a result of human behavior—was an explanation by the Heartland Institute, a think tank with ties to the Koch brothers that aims to “to discover, develop, and promote free-market solutions to social and economic problems.”
After asking experts to review the proposed books, TFN found numerous other actual errors and biases. For instance, it reported, among many other issues, that a number of the government and world history textbooks exaggerated Judeo-Christian influence on our nation’s founding; included biased statements and negative portrayals of Islam and Muslims; downplayed the role that conquest had in the spread of Christianity; and spread misleading information about the doctrine of separation of church and state.
This time under public pressure from groups like TFN and the National Center for Science Education, which advocates for accurate, unbiased, scientific information in classrooms, publishers agreed to make changes and focus more on the legitimate science of climate change. The side-by-side comparison and other information that gave legitimacy to climate change deniers were cut. The SBOE also opted to direct some changes to social studies texts.
Even so, Quinn says that wasn’t not nearly enough. The books, he said, still mention Moses’ influence on our democracy and other misleading pieces of information:
It came down to the publishers making a calculated decision about what they could get past the conservatives on the board. It’s a prime example of how in Texas, politics, rather than scholarship, is the driving force for what kids learn in the classroom, and our politics affect kids nationwide.
Such controversies are likely to continue in the future. For instance, Texas is set to choose which Health Education books—including information on sexual education—make it onto the approval lists in 2018.
Gilbert May Not Cut Pages after All
Meanwhile, back in Arizona, the effort to cut pages out of the textbook may be stalled. Superintendent Christina Kishimoto was asked by the board to come up with a plan for redacting the textbooks—a decision that seems as simple as deciding between Sharpies or X-Acto knives—but both she and some members of the board have put off the planning until at least the summer. And, she has reiterated her objection to making any changes.
There is the possibility that it won’t happen at all because the November elections changed the make-up of the board. The new board takes control in January and could decide to revisit the issue.
Of course, board member Julie Smith, who voted for censoring the textbook doesn’t understand why tearing pages out of books is so hard. She told the East Valley Tribune: “This is not rocket science, people. It’s very clear-cut.” Smith was one of the drivers behind the original decision; she told the New York Times that when she heard the book mentioned abortion she almost drove off the road because she felt it violated her religious rights. “I’m Catholic; we do not contracept,” Ms. Smith said. “It is a grave sin.”
Ken Miller, for his part, has a different take on the Gilbert controversy: “I can’t think of any better way to make sure that students are going to read a page in a book than trying to ban it or tear it out,” he sad.
Whether they end up cutting out pages or not, the board in Gilbert will likely be remembered for its willingness to take drastic measures to prevent young people from getting a complete, unbiased education. Unfortunately, attempts to do so take many different forms, some of which garner much less publicity. Hopefully, the ridiculousness of redacting an honors biology book—which caught the attention of mainstream media such as the Rachel Maddow Show—will also bring attention to the other ways states, school boards, and others who choose to carry on traditions like the Gablers’ control what young people read at school.
The post A Textbook Case: The Continuing Battle for Control Over What Students Read appeared first on RH Reality Check.
Looking over the battle for reproductive rights that took place in 2014, I wish I could say that I’m optimistic for the coming year. But that, frankly, would be a lie. The sad fact of the matter is those who oppose the basic right to control one’s own reproduction have had a banner year, as they watch their efforts to chip away at abortion and contraception access finally come together in such a way that the restrictions may become permanent. Things are looking bleak for American women, and there’s no way to get around that fact.
There are three big court cases that really show how dire things got in 2014: Planned Parenthood v. Abbott, Whole Woman’s Health v. Lakey, and Burwell v. Hobby Lobby. The first two deal with the same outrageous semi-ban on abortion in Texas; the third, as you probably know, gives employers the opportunity to inflict their judgments on their employees’ private lives.
The progress of the first two cases, in particular, shows that anti-choicers really are getting close to their desired goal of shutting down access to legal abortion for huge swaths of American women, especially those who don’t have the means to travel and pay for legal, safe abortion care. The first, Planned Parenthood, was a chilling display of how little the radical-right crop of judges pushed into power by conservatives over the last few decades cares for things like precedent or common sense when it comes to hammering through their agenda. The case addressed the part of the Texas bill, HB 2, that banned doctors from providing abortions unless they have admitting privileges at a nearby hospital, something that is nearly impossible for many rural doctors to obtain. In March, the Fifth Circuit ruled that those restrictions were constitutional.
Even though abortion laws must not impose an “undue burden” on abortion provision, Judge Edith Jones decided to define “undue” so loosely in her written opinion that it appears no burden can actually be undue. As detailed by Jessica Mason Pieklo at RH Reality Check, “As far as the Fifth Circuit is concerned, when states like Texas pass laws restricting abortion rights in the name of maternal health, they have no obligation to prove, with evidence, that those restrictions will actually advance maternal health.”
In other words, I guess you could theoretically pass a law requiring women to be ritually beaten and forcibly dehydrated before they get an abortion, but as long as you claim that you’re doing it for their health, hey, who are the experts to stop you? That logic shut down almost half the clinics in Texas.
Round two, Whole Women’s Health, has fared ever-so-slightly better. The part of HB 2 that would force clinics to meet ambulatory surgical center standards—even if all the facilities do is provide the abortion pill—was also upheld by the “all restrictions are good restrictions” Fifth Circuit court. But, at the last minute, the Supreme Court allowed an injunction against that decision. While that saves the hides of some of the clinics in Texas, however, the injunction isn’t necessarily a sign that things are turning around. It’s just as likely that it suggests the Supreme Court knows it will eventually have to deal with all these new state regulations, Texas’ among them, that amount to a near-ban on abortion, and it is preparing to do just that. Unfortunately, the last time the Supreme Court heard a case regarding an abortion ban, it was upheld. The balance of power in the Court between liberals and conservatives has not changed since then.
Perhaps it’s because those in favor of reproductive rights restrictions sense victory on the horizon when it comes to abortion, but 2014 also ended up being the year contraception ended up back in front of the Supreme Court. This was the first time the Court had ruled on the matter since 1971, when the Court decreed that women have a right to access contraception, even if they aren’t married. And this time, contraception lost, which goes to show how thorough the project of turning the courts over to rabid, radicalized right-wingers has really been. After all, more than 99 percent of sexually active women ages 15-to-44 have used birth control, and 90 percent of Americans say it’s morally acceptable. Still, that small minority of contraception-haters somehow wowed the highest court in the land.
Of course, the ostensible justification for the anti-contraception ruling in Burwell v. Hobby Lobby, in which the Court ruled that employers can be exempted from federal law requiring that the insurance plans you pay for for your employees cover contraception, is that this isn’t about contraception but rather “religious freedom.” This excuse is asinine: The only “religious freedom” the Court agreed to protect was the “freedom” to restrict someone else’s access to contraception. If you want to deny your employees, say, insurance coverage of blood transfusions or painkillers, too bad. “This decision concerns only the contraceptive mandate and should not be understood to hold that all insurance-coverage mandates, e.g., for vaccinations or blood transfusions, must necessarily fall if they conflict with an employer’s religious beliefs,” the decision read. So either religion only concerns contraception, and the hating thereof, or this is just an anti-contraception decision, with “religious freedom” being little more than window dressing to make the radicalism of it all easier to swallow.
What do we have to look forward to in 2015, then? Unfortunately, things do not look like they’re getting better. As Molly Redden at Mother Jones explains, anti-choicers now have even more seats in state legislatures than they did in 2014, and they apparently can barely wait to use their new power to pass more and more laws trying to take ownership over your uterus. And while much of their pre-filed legislation is about abortion, the increasing hostility toward contraception is peeking out already, as well, with a proposed bill to try to keep schools from hiring Planned Parenthood (as in, the experts) to teach sex ed and a bill to keep counties and towns from forcing deceptive crisis pregnancy centers to disclose the fact that they don’t offer abortion or contraception services.
If there is any silver lining to be found here, it’s that all these attacks on abortion and contraception aren’t coming out of nowhere. It’s clear that the escalation in anti-choice activism is a reaction to something, and it’s not hard to guess what it is: Women have, in recent years, really been gaining control over our reproductive capacities. Teen births are down, the average age of first birth is going up, and contraception use is clearly improving. Those against reproductive rights are losing culturally, so they’re going to try to regain control legally. Unfortunately, as this year’s events show, there’s a lot of power in going that route.
The Metro Council of Louisville voted Thursday to raise the city’s minimum wage, increasing it above the federally mandated $7.25 per hour to $9 per hour by 2017.
Louisville joins 11 cities that have raised the minimum wage in 2014. It is the first city in Kentucky and the first city in the South to increase the minimum wage.
The vote came after months of intense debate about the benefits that an increased minimum wage would have on low-income workers versus the impact that the increase may have on local business.
The debate over the increase was drawn along sharp partisan lines. All 16 Democrats on the council voted to support the increase, while all nine Republicans voted against it. The city’s Democratic Mayor Greg Fischer said he will sign the increase.
“It is a balanced compromise solution that gives hardworking families a raise while minimizing the risks of job losses in our city,” Fischer said during the Louisville Metro Council meeting, according to the Associated Press.
The minimum wage increase is not the only workers’ rights issue that has created a partisan divide in both state legislatures and city councils. The American Legislative Exchange Council (ALEC) is planning a number of attacks on workers’ rights in 2015, including opposing increases in the minimum wage, paid sick leave, and the collective bargaining rights of labor unions.
ALEC is the controversial right-wing lobbying group that has crafted wide-ranging legislation proposed and enacted by conservative legislatures across the country.
Opponents of the Louisville increase claim that businesses will move outside of the city limits to avoid paying the higher wage while still benefiting from city services.
“If we’re going to have Louisville compete, we have to compete on a level playing field,” Republican Councilman Kevin Kramer said, according to Reuters.
The U.S. Labor Department and economic think tanks have debunked many of the most common talking points used to fight boosting the minimum wage, showing that wage increases have long-term benefits for workers and a mostly positive impact on bottom lines.
Efforts to raise the minimum wage have gained traction on both city and state levels around the country, as Congress has balked at raising the federal minimum wage thanks in large part to GOP opposition.
The Chicago City Council this month voted to raise the city’s minimum wage from $8.25 per hour to $13 per hour by 2019. In November, Illinois voters approved a non-binding ballot measure that asks lawmakers in the state legislature to increase the state’s minimum wage.
While no cities in the South have increased the minimum wage, voters in Arkansas approved a ballot measure on Election Day that will increase the state’s minimum wage to $8.50 per hour by 2017.
Arkansas voters joined voters in other states who raised their minimum wage through ballot initiative on Election Day, including Alaska, Nebraska, and South Dakota.
The post Louisville Joins Recent Wave of Minimum Wage Increases appeared first on RH Reality Check.
The Ohio house passed a bill Wednesday meant to completely clear a backlog of untested rape kits in law enforcement offices across the state. After the unanimous passage of SB 316, the bill now heads to Gov. John Kasich’s desk for a signature.
After being collected following a sexual assault, many rape kits across the country never make it out of law enforcement offices, going untested and creating a backlog. In 2009, the Cleveland Police Department started documenting the rape kits backlogged; it has spent years cataloging the kits.
The department by 2011 had identified several thousand rape kits that had never been tested, at which point Ohio Attorney General Michael DeWine announced a sexual assault kit testing initiative requiring law enforcement agencies submit untested kits to the Ohio Bureau of Criminal Investigation for processing, at no cost to the department.
In an op-ed for the Washington Post, DeWine, along with Cuyahoga County prosecutor Timothy J. McGinty, called the program a great success.
The Ohio officials said that more than 4,100 rape kits had been tested since July, with 1,474 matching records in the national DNA database. More than 135 people had been indicted thanks to the rape kit initiative, including 37 John Does.
SB 316 expands on DeWine’s initiative by both tackling the remaining backlog and creating a plan for future kits. The law will require law enforcement agencies to forward the remaining untested rape kits to the state within one year.
The state’s Bureau of Criminal Investigation would then be required to put the test into a national database, according to Cleveland.com.
Ohio’s law enforcement agencies will have up to 30 days to submit new rape kits as they come in.
DeWin’e Democratic challenger, David Pepper, this year leveled criticisms of how the Republican attorney general had handled the rape kit backlog during his time in office, calling nine consecutive months of increases in the backlog a “glaring management failure.”
DeWine eventually defeated Pepper in November’s election.
“Next year we hope to see a bill introduced to eliminate the statute of limitations on rape, so that when 20-plus year old kits are tested and perpetrators are identified, that cases can be prosecuted after the current 20 year statute,” Katie Hanna, executive director of the Ohio Alliance to End Sexual Violence, told Cleveland.com. “We owe that to survivors and to our communities.”
The nationwide rape kit backlog has received legislative attention in recent years, though action toward ending the backlog has in large part been left up to states.
Though Congress passed the Debbie Smith Act, a bill meant to support state and local initiatives to reduce backlogs, the act has gaps that have proven significant in preventing efficient testing. And in September, a federal bill to fund rape kit testing fell victim to Congressional budget squabbles.
But states have picked up the slack. In mid-November, for example, the Manhattan District Attorney’s Office announced that it had committed up to $35 million to fund the clearance of rape kit backlogs across the country, a project done in partnership with the Joyful Heart Foundation’s End the Backlog program.
The post Rape Kit Testing Law Passes, Heads to Ohio Governor’s Desk appeared first on RH Reality Check.
It’s the end of the year, and thus the perfect time to reflect on the ways in which young people in 2014 led the charge for change in the human rights and justice movements.
1. Young people were at the forefront of racial justice activism in 2014. Throughout the history of this country, Black men have been killed at the hands of police officers, often while unarmed, in the name of “safety.” Safety for whom, we don’t know. But what made 2014 different was not the brutality of these murders. Nor was it the unwillingness of grand juries to indict in high-profile cases like the deaths of Michael Brown and Eric Garner at the hands of law enforcement. What made this year different was a grassroots movement, largely led by youth organizers, flooding the streets in Ferguson, conducting die-ins in New York City, shutting down intersections in Washington, D.C., blockading freeways in Oakland, and walking out of classrooms around the country. Young people of color continue to be active leaders and participants in this work to declare that Black lives matter and that police violence must end.
2. Malala Yousafzai became the youngest recipient of a Nobel Peace Prize. Yousafzai, a Pakistani advocate for women and girls and especially access to education, was at age 17 awarded a Nobel Peace Prize for her activism, making her the youngest recipient ever. She began campaigning for education for girls at age 11, and first drew international attention after Taliban fighters shot her in the head. This year Yousafzai traveled to Nigeria, issuing an appeal for increased funding for education after more than 200 girls were abducted from a school by Boko Haram terrorists. Yousafzai’s bravery and moral clarity serve as inspiration to young feminist activists around the world.
3. United We Dream and immigrant youth demanded that the president issue an executive order on immigration. After foot-dragging that extended past the November elections, President Obama made good on a promise to issue an executive order extending relief to undocumented immigrants. The order protects up to five million undocumented residents, and especially the parents of children who have citizenship, as well as the parents of DREAMers brought to the country as children. As with other controversial executive actions—notably one in which the president refused to extend religious discrimination into an executive order barring employment discrimination on the basis of sexual orientation by federal contractors—Obama was compelled to act because a left flank used direct action to inject clear moral analysis into the debate. Leading that flank was United We Dream, an immigrant youth-led organization that, among other direct actions, led activists to get arrested outside the office of Sen. Harry Reid (D-NV). In July, activists from the group were escorted out of the Netroots Nation conference while interrupting a speech by Vice President Joe Biden with the chant “stop deporting our families”; after a pause, the vice president encouraged the audience to applaud them.
4. With one mattress, Emma Sulkowicz turned campus sexual assault into a striking piece of performance art. Sulkowicz, a visual arts major at Columbia University, turned her rape on campus into an unavoidable activist conversation with a piece titled “Carry That Weight,” in which she carried a twin-size dorm mattress around campus to draw attention the fact that her rapist, a fellow student, had not been expelled. Her piece inspired a Carry That Weight Day of Action on more than 100 campuses, with thousands of students carrying mattresses to call for reforms to the way colleges address sexual assault.
5. Know Your IX kept leading a grassroots movement to demand accountability on campus sexual assault. There is no one better to organize against oppression and injustice than those most directly affected, and the growing organization Know Your IX—a reference to Title IX, under which educational institutions receiving federal funding must address sexual assault as a civil rights obligation—does just that. The survivor-led and student-driven group, founded last year, remained at the forefront of efforts to inform students who have been sexually assaulted of their rights and demand that the Department of Education improve its enforcement of the law. These efforts played a clear role in a new national dialogue about campus sexual assault and the unveiling of the It’s On Us campaign by the Obama administration in September.
6. Young people participated in and led abortion speak-outs. 2014 continued to be a challenging year for abortion rights in the legislatures; as of December 1, states had enacted 23 new restrictions on abortion access. However, advocates are actively working to create culture change around abortion and break stigma through storytelling. Young people were among the 100 individuals participating in the first-ever live-streamed abortion speak-out hosted by the 1 in 3 Campaign, which is run by Advocates for Youth. Abortion speak-outs also occurred during in-person events on college campuses, including the University of Michigan, the University of Central Michigan, and the University of Central Florida, where hundreds attended.
7. Emily Letts filmed and shared her abortion, demystifying the process. Letts, a counselor at Cherry Hill Women’s Center in New Jersey, filmed her abortion and shared the video online, an act that showed a common medical procedure as it truly is. “I could have taken the pill, but I wanted to do the one that women were most afraid of,” she told Cosmopolitan. “I wanted to show it wasn’t scary—and that there is such a thing as a positive abortion story.” The video has been watched more than a million times.
8. Alex, an 8-year-old-boy, rapped about coming out as transgender to his mom. The confluence of rampant discrimination and inadequate legal protections for transgender people hits youth particularly hard; more than half of transgender youth will attempt suicide by age 20. But in one short viral video released by Camp Aranu’tiq, a camp for transgender youth, an 8-year-old boy named Alex seized a difficult narrative and turned it into a source for hope. His rap details his positive story of coming out as transgender to his mom, and ends with a call that “We all deserve freedom, love, and respect!”
9. Pro-choice students at Catholic-affiliated universities fought back against restrictions on reproductive and sexual rights, and free speech. One of the primary faces of today’s pro-discrimination movement is the religiously affiliated university. Playing a prominent role among those are Catholic-affiliated colleges attempting to hold a line for the archconservative U.S. Conference of Catholic Bishops. In 2014, students and their allies at these institutions fought back. In Indiana, three Notre Dame students using the pseudonyms Jane Doe 1, Jane Doe 2, and Jane Doe 3 joined a brief opposing their university’s lawsuit against the birth control benefit. In the District of Columbia, students from the group H*yas for Choice were removed by campus police twice this year for tabling in peaceful protest of the Vatican’s stance on reproductive rights and LGBTQ rights; these efforts have led the group to grow in popularity and size.
10. A Florida youth council fought for access to comprehensive sexual education, and won. The Broward County Youth Council, a leadership group of ten high school, college, and graduate students, fought long and hard to have the Broward County school board adopt comprehensive sexual education standards, and that fight culminated in 2014 with a big win. Students in the county will now receive medically accurate, LGBTQ-inclusive sexual education. As local student Keyanna Suarez told CBS Miami after the vote, “There’s not gonna be a taboo about anything. Everyone’s gonna be able to open up, ask questions, and get the info they need to make these decisions because some parents aren’t giving them the education at home.” Broward County is the sixth largest public school system in the country.
11. Colorado high school students walked out of class to protest a proposal to downplay the role of protest in U.S. history. In September, hundreds of high school students in the Denver area walked out of their classrooms in protest of a proposal to focus history curricula on topics that promote respect for authority. “I don’t think my education should be censored,” Tori Leu, a student who protested at Ralston Valley High School told the Guardian. “We should be able to know what happened in our past.” One month later, the Jefferson County School Board passed a compromise proposal that essentially overruled the proposed change.
12. The Harry Potter Alliance tackled income inequality with creativity. The alliance, which engages Harry Potter fans, used the recent success of The Hunger Games to engage young people in income inequality activism. The Odds in Our Favor campaign uses the #MyHungerGames hashtag to encourage people to share their personal stories about class-based injustice. The organization has also compiled pictures of youth using the story’s three-finger salute to protest income inequality.
Baker’s dozen bonus: RH Reality Check continued to foster and share the voices of young people on the important issues of sexual and reproductive rights, health, and justice. As a proud servant leader of the RH Reality Check young writers program, I would be remiss not to mention the commitment of this publication to young people. It was on full display in 2014.
In July, Associate Editor Regina Mahone traveled to Detroit to attend the Youth Sexuality Media Forum; you can read her resulting report on how the media can better cover youth sexuality here. President and Editor in Chief Jodi Jacobson spoke to 19 young reproductive rights activists from around the world at a Youth Champions Initiative in Palo Alto, and Senior Legal Analyst Imani Gandy and Investigative Fellow Zoe Greenberg attended in-person as well; you can read Imani and Zoe’s fantastic conversation with four of the youth champions here.
The participants in our young writers program receive mentoring, intensive coaching, and editorial support beyond the bounds of what traditional freelance writers receive, and publish pieces on RH Reality Check at a competitive rate. What follows is just a small sample of what those participants published this year. Emily Spangler, a high school student in Illinois, wrote about how other young women can get involved in politics; Marcus Lee, a student at Morehouse College, discussed ways men can embrace a culture of consent; Erin McKelle, a student at Ohio University, took a look at the consequences of young people not voting; Lizzie Fierro, a high school student in Texas, spelled out how we can combat sexism in science, technology, engineering, and mathematics (STEM) subjects; and Briana Dixon, a student at Spelman College, took a nuanced look at the news of a couple who sued a sperm bank after mistakenly receiving a Black sperm donor. (Insert group hug!)
Contrary to a narrative that young people are apathetic or lazy or too busy texting to care about human rights, in fact young people are at the helm of the movement for justice for all people. I, for one, can’t wait to see what they pull off in 2015.
Image: Unity via Shutterstock
The post 12 Ways Young People Organized for Human Rights in 2014 appeared first on RH Reality Check.
Over the past decade or so, the public language in anti-abortion lobbying has shifted from “Save the children!” to “For the health of the mother!” Having apparently determined that over-the-top tactics of lying down in front of cars and chaining themselves to clinic doors were turning off the public at large, prominent groups like the National Right to Life now often push for laws they say benefit “everyone involved”—including the pregnant person.
While anti-choice groups still use inflammatory language like “infanticide” and “abortion mill” in their newsletters and blog posts, the emphasis has shifted to passing targeted regulation of abortion provider (TRAP) laws—all under the guise of protecting, as the National Right to Life puts it on its website, “mothers and their unborn children.”
As a reproductive justice advocate who has had a first-trimester abortion, anti-choicers’ language around these laws became even more clearly hypocritical to me following a different, in-office reproductive health procedure I recently underwent to save my life. Given the degree of anti-choice rhetoric about how much stress women undergo to get abortions, I hadn’t even considered the thought of being uncomfortable and emotionally exhausted by any other reproductive health service. After all, the public doesn’t hear much about the thousands of women like me who are at high risk for cervical cancer, and we certainly aren’t a priority of any anti-abortion group I’ve encountered. If anti-choicers truly cared about women to the degree they claim, surely they would treat abortion procedures just like any other reproductive health need—and leave decisions about safety and comfort up to women and their doctors.
An Arbitrary Standard
One TRAP law that has been particularly damaging in recent years requires abortion providers to adhere to ambulatory surgical center (ASC) standards. Conveniently omitting that first-trimester abortion only sends a tiny fraction of patients to the hospital in need of follow-up care, anti-choice groups and legislators have continuously maintained that the width of a facility’s hallways, number of parking spaces, and size of the janitorial closets guaranteed through certification as an ASC will be what safeguards the patient’s health during their five-minute procedure.
Dr. Leah Torres, a Salt Lake City, Utah-based OB-GYN specializing in reproductive health, says these laws do exactly the opposite.
“TRAP laws are passed under a false premise of patient safety,” Torres told RH Reality Check. “Patient safety is the top priority of any physician, yet the laws that are passed prohibit me from taking care of people in the safest way I know how. This does, in fact, hurt my patients. Harm is done when physicians’ hands are tied.”
The most famous ASC law was penned in Texas, where its parent omnibus anti-abortion law, HB 2, is winding its way through the appeals courts, due to be heard by the full Fifth Circuit on January 8. Texas is certainly not the only state with this requirement. Anti-abortion groups across the country have pushed laws, such as the model legislation from Americans United for Life, that have proven to close the doors of clinics. Accreditations and building specifications are a matter of public record, so it’s easy to determine whether or not local clinics meet the expensive building requirements to become ASC-certified. If they—like many of the Texas facilities—do not meet those requirements, anti-choicers conceivably know that having the construction done to meet the standards is often a multi-million dollar ordeal that results in closure rather than renovation.
Occasionally a right-to-lifer will slip and publicly admit that abortion is safer than pregnancy, or that all the talk about “women’s health” is just a façade to divert attention from their intention to close clinics. With those missteps on the record, let’s just be honest about the whole thing: Anti-choice groups and the legislators they back aren’t interested in the health of the patient. Their interest stops at the health of the embryo or fetus. If they cared about the whole health of the patient, that interest would have revealed itself at some point during their more than 40 years in existence as a movement.
Dr. Torres says she has yet to see someone calling themselves “pro-life” advocating for preventative and life-saving care.
“It is discriminating to profess concern for patient safety for one procedure, for one population—women of reproductive age—and not for all people across all specialties,” says Torres. “It is hypocritical and it feels false, as well as insulting.”
Indeed it does.
Abortion is, after all, the only reproductive health-care procedure that seems to matter to these groups. Having spent time volunteering and organizing as a clinic defense escort in Chicago, New York, New Jersey, and Los Angeles, I can attest to the very singular focus of the picketers and the groups they represent: With the exception of the occasional anti-contraception sign, all the misinformation-filled pamphlets, screaming, and photoshopped, gory placards are abortion-motivated. This seems curious, as any “life”-focused activist should be interested in the lifesaving services offered at most clinics and doctor’s offices. You never see them screaming on their capitol building’s steps demanding the expansion of preventive care like Pap tests, STI testing, prenatal support, and the like. They aren’t passing out condoms at AIDS walks, or even offering child-care assistance for the children a patient already has. If a National Right to Life, Pro-Life League, or Operation Rescue member is holding a sign somewhere, their only concern is forcing a pregnant person to carry to term.
This gap in empathy and what constitutes “saving a life” exhibited by millions of anti-choicers was particularly evident to me when I went in to my gynecologist this August for a loop electrosurgical excision procedure (LEEP), which removed abnormal tissue on my cervix both for further testing and to hopefully excise any pre-cancerous cells, thus preventing cervical cancer. I am on what I call the “HPV merry-go-round,” having contracted a strain of the human papillomavirus (HPV) in my 20s that my immune system has not yet successfully fought off ten years later. HPV is so common that, according to the Centers for Disease Control and Prevention, “nearly all sexually active men and women get it at some point in their lives,” so I’ve never felt particularly “damaged” by the diagnosis, just frustrated and extremely inconvenienced.
Most strains don’t cause health problems (especially in men, who often never discover they were or are a carrier). The handful of problematic strains, however, lead to annual HPV-associated cancer diagnoses in approximately 20,000 women and 12,000 men, with cervical cancer in women being the most common (12,109 cases and 4,902 deaths in 2011). As a consequence, preventive treatments such as colposcopies and LEEPs can be literally lifesaving.
Over the past decade, I’ve gone through occasional stretches with normal Pap test results and just the one doctor’s visit for that year. More often than not, though, I’m back for additional Paps, the now routine-for-me colposcopy to determine just how abnormal or pre-cancerous the cells of my cervix are, and, most recently, a LEEP.
So after three colposcopies and a LEEP—all performed in my doctors’ offices—I’ve had more than my share of “work” done in terms of reproductive health procedures. Personally, I am comfortable saying that my first-trimester abortion was a less stressful appointment and came with less discomfort than the four procedures performed to prevent any developing cervical cancer. My LEEP in August was particularly traumatic because my doctor and her staff had what I will politely describe as a lack of bedside manner. Picturing the cold procedure room where I was left for nearly 90 minutes in only a gown, with no information or counseling from my doctor, makes my pulse race even months later. (According to Torres, the pre-procedure counseling for LEEPs should take place in an office setting with the patient fully clothed.)
When I got home, after having used Twitter heavily during my lengthy wait for the doctor, I checked my feeds. Many people had responded with words of concern and love. Two of my best friends—knowing I have an anxiety disorder and that the lidocaine used to numb my cervix might still be causing heart palpitations in addition to the ones my body was producing on its own—had continued to check in on me while I was on the subway without cell phone service. Everyone, it seemed, was concerned with my health.
Everyone except the anti-choicers who routinely harass me online for my abortion advocacy, that is. Their silence on my experience—and on the everyday experiences of patients who visit their doctors’ offices for procedures carrying risks similar to abortion—is deafening. They seem to trust medical professionals to perform all manner of non-abortion-related care without bystander intervention; do they not understand that the abortion specialty operates just like the rest of medicine?
As with other medical fields, best practices for obstetrics and gynecology procedures are governed by associations of medical professionals like the American Congress of Obstetricians and Gynecologists and the National Abortion Federation. Torres says that she spent time developing skills for both LEEPs and first-trimester abortions early on in her career; she considers the “level of surgical skill,” as she put it, required for each to be comparable.
And the risks for both procedures are comparably negligible, too. The LEEP takes longer because of the time spent waiting for the lidocaine to fully numb the cervix (think the time you spend in the dentist’s chair waiting for the Novocain to kick in before a filling). According to Planned Parenthood, it’s rare to have issues requiring follow-up care after either procedure; the organization’s website counsels patients to watch for similar symptoms, including abnormally heavy bleeding or signs of infection such as fever or vomiting.
When compared to my LEEP this August, my abortion experience four years earlier at a Planned Parenthood in Chicago was warm, comforting, less painful, and over much more quickly. In fact, I can theoretically see a more understandable case for some of the ASC guidelines being pertinent to the LEEP than to the abortion, as the former felt more invasive—the doctor wears a mask to keep the smoke produced during cauterization out of their eyes, and I was in stirrups more than twice as long.
Still, no one is demanding legislation to regulate it. Nor, as Torres points out, are they rallying against colonoscopies, which are 40 times as risky as abortion, or dental procedures that require anesthesia.
“There are many riskier procedures done by other specialists in the office and no mention is made of their needing admitting privileges”—another common TRAP law—“or that their procedures require a surgical center,” said Torres. “No one demands [gastro-intestinal] specialists only perform [colonoscopies] in an ASC. Also, if you think about the sedation procedures dentists perform, those medications are also used in surgical procedures in ASCs yet dentists are not required to be in an ASC to use them.”
In fact, Torres has never seen a law proposed to regulate how she performs any other procedures, including LEEPs, in her office—or how dentists and proctologists and plastic surgeons perform procedures in theirs.
A LEEP, Torres said, “Saves the life of the patient. I don’t know why those who value life do not advocate for all surgical procedures be performed in ASCs if they are that convinced [ASCs] ‘safer’ and ‘saves lives’ over anything else.”
She’s not advocating in favor of more of these laws, of course, as they increase the financial and logistic burden on both patients and providers, along with occasionally decreasing safety. She is simply pointing out the reality of which procedures get held up for additional scrutiny.
“Medically, sometimes the office is safer for a procedure and sometimes the hospital is safer. That [decision] should be made by the medical professional—not the patient, not the lawyers, not the politicians,” said Torres.
“I’m prohibited from performing abortions in Utah hospitals, for example. You’d think that would be the ‘safest’ place, but state laws prohibit facilities receiving state funds from performing abortion—and all Utah hospitals receive state funds. Lots of contradiction,” she continued. “So, if I think I can’t safely perform the abortion in the office, even [one] with ASC standards, then I have to send the patient to another state. This happens all over the country.”
The Growing Restrictions
Torres couldn’t be more right. Legislators in nearly every part of the country are wasting time and money exhibiting a complete disregard for women’s basic humanity as autonomous persons. Hundreds of laws have been introduced restricting abortions across the country. In fact, since Roe, nearly every state in the union has enacted legislation inserting the state house into exam rooms.
Why do we not trust providers and patients when it comes to one of the safest procedures in medicine? Because, apparently, the patient seeking an abortion has a uterus and presumably was so bold as to have sex, and that means legislators—overwhelmingly rich, white men—have a centuries-old right to dictate what happens next. While no one, not even an anti-abortion “advocate” or legislator, would deny me access to the procedures that have hopefully prevented me from developing cervical cancer, they don’t recognize my right to control the contents of my uterus.
The abortion that I know saved my life? That, anti-choicers feel compelled to weigh in on.
If “pro-life” organizations and legislators truly cared about women’s health, they would be campaigning for wider access to HPV screenings and vaccines. Or, just perhaps, they would stop to consider leaving it up to the experts: the doctors and patients.
Certainly, the incoming wave of new Republican legislators following the 2014 midterms won’t lead to a lessening of the country-wide trend anytime soon. As RH Reality Check has reported, Americans United for Life is well-funded thanks to wealthy donors like the Koch brothers; its model legislation is ready and waiting for right-wing legislators to introduce this January. Meanwhile, likely Majority Leader Mitch McConnell has promised to introduce a federal 20-week ban in the Senate to match the one the now farther-to-the-right House passed last year. The president is opposed to the ban and would probably veto such legislation, but the national prominence of a bill pushed and passed “for women’s health and safety” gives undue validity to the state-level measures that will follow on its heels.
Providers like Torres are not opposed to the public discourse and legislator interest in their profession; Torres simply takes issue with the motivation revealed by the way they circumvent evidence and care guidelines from physicians.
“I have no problem with elected representatives involving themselves in public health issues. I think political involvement in health care is necessary,” said Torres. “However, political dictation of how medical care is provided should not occur without the proper medical training and knowledge to support it … Just as I do not walk into a courtroom and start practicing law, they should not interfere with the safe, evidence-based health care [being provided] to their constituents.”
The post My Latest Reproductive Health Procedure Makes Anti-Choicers Seem Even More Hypocritical appeared first on RH Reality Check.
The Washington, D.C., city council unanimously passed a bill Wednesday that would prohibit employers from discriminating against employees based on reproductive health decision-making—including the decision to terminate a pregnancy.
The Reproductive Health Non-Discrimination Amendment Act of 2014 amends the District’s Human Rights Act, which deals with employment discrimination, to add that an employer cannot discriminate in “compensation, terms, conditions, or privileges of employment” because of an employee’s or a dependent’s “reproductive health decision making, including a decision to use or access a particular drug, device or medical service.”
Some advocates say the bill could be interpreted to reverse the Hobby Lobby decision in D.C. by requiring all employers, including religious employers, to provide coverage for contraception and abortion in their health-care plans.
Anti-choice groups agree with this interpretation and are already up in arms over the D.C. bill, which has not yet been signed by outgoing Mayor Vincent Gray.
“We certainly did introduce this bill originally in response to the Hobby Lobby decision,” the bill’s sponsor, Councilman David Grosso, told RH Reality Check. “It motivated us to try to extend more protections to employees.”
Grosso said the bill doesn’t actually contradict Hobby Lobby. It doesn’t force employers to purchase a certain kind of insurance or be involved in conversations about contraception or abortion with employees.
The bill only says that a boss can’t fire or retaliate against an employee if, for instance, the boss finds out the employee is using birth control or once had an abortion.
There is no language in the bill that either singles out or grants exceptions to religious employers, and a committee report says that the bill “is not about insurance coverage, but rather about employment discrimination.”
Asked whether the bill was intended to reverse Hobby Lobby, Ben Shelton, legislative counsel for the city council’s judiciary committee, told RH Reality Check that “it was not written to that effect.”
It’s unclear whether, in practice, the bill could be interpreted to affect insurance plans or religious employers.
Gray expressed concerns about the legislation in early December. The council addressed one, that the bill did not apply equally to both genders, with a technical amendment.
Gray’s other concern, that the bill might run afoul of the Religious Freedom Restoration Act, was dismissed by the Council.
Grosso said it “didn’t make any sense” to include an explicit religious exemption clause, as Gray requested, in the new bill because it amends an act that already includes such an exception.
Moreover, Shelton said, the council didn’t like the idea of “handcuffing” the District into one particular legal interpretation when precedent might change.
If Gray doesn’t sign the bill, it will eventually be transmitted to Congress. If he vetoes it, the council presumably has enough votes to override, given that the vote was unanimous.
Congress could theoretically block the measure with a motion to disapprove, but that would have to pass both chambers and be signed by President Obama.
Court challenges are another matter, but the bill’s supporters are optimistic that it will hold up if challenged by anti-choice groups.
The act, Shelton said, is intended only to “protect everyday folks” from being wrongfully terminated, regardless of the religious leanings of their employer.
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