Nebraska legislators heard testimony Wednesday during a judiciary committee hearing on two pieces of legislation that would implement new regulations for the state’s abortion providers.
LB 114, sponsored by state Sen. Beau McCoy (R-Omaha), would require that any facility that provides five or more abortions in a month, or one or more second- or third- trimester abortions, be defined as an ambulatory surgical center.
Under current state law, ambulatory surgical centers are required to meet state and federal standards for surgical outpatient facilities, as well as have written agreements with a hospital that patients will be transferred to in case of an emergency beyond the capabilities of clinic staff.
During the hearing, McCoy said he sponsored the bill out of concern for the health and safety of women.
“I think we would agree we would want anyone who would enter the doors of an abortion clinic to hopefully have the same standard of care they would receive in any other clinical environment across Nebraska,” McCoy said, reported the Associated Press.
Rob Moore, regional organizer at Planned Parenthood of the Heartland, said the legislation is one of a growing number of laws around that country that are intended to limit access to reproductive health care.
“They’re trying to put in as many restrictions as they can to make them so cost-burdensome they can’t be open,” Moore said, according to the AP.
LB 114 is what’s known as a targeted regulations of abortion providers (TRAP) bill, a type of legislation designed to single out abortion clinics and providers and subject them to regulations that are more stringent than those applied to medical clinics generally.
Dozens of TRAP bills have been introduced in state legislatures in the past few years, as well-funded and politically powerful anti-choice groups push the regulations through legislative allies.
Members of the committee questioned witnesses about how much new licenses would cost facilities in equipment and renovations, but no one was able to provide specific numbers.
LB 187, sponsored by state Sen. Bill Kintner (R-Papillion), would require that clinics that provide abortion care post signs ostensibly intended to prevent women from being forced to terminate a pregnancy. Kitner introduced a similar bill during the 2014 legislative session, but it failed to be voted out of committee.
State law already prohibits coercing a woman into terminating a pregnancy.
The bill also requires the Nebraska Department of Health and Human Services (DHHS) to create a web page to publish information related to the state’s forced counseling law, and requires abortion providers to offer a link on their websites to the DHHS web page.
Because neither bill has been designated as a priority, it is unlikely they will be passed by the legislature.
The post Nebraska Bills Would Make Care More ‘Cost-Burdensome’ for Abortion Providers appeared first on RH Reality Check.
Democrats in the U.S. House and Senate on Wednesday reintroduced the Family and Medical Insurance Leave (FAMILY) Act, which would create a national insurance program guaranteeing paid family and medical leave for all workers.
The proposal, sponsored by Sen. Kirsten Gillibrand (D-NY) and Rep. Rosa DeLauro (D-CT), wouldn’t add to the federal budget. It would create a new independent trust funded by tiny paycheck contributions of 0.2 percent each from both workers and employers.
The United States is the only industrialized nation that doesn’t guarantee paid time off to care for a new child, a sick relative, or oneself during a serious illness.
The 1993 Family and Medical Leave Act (FMLA) provided up to 12 weeks of time off to care for a new child or a family member—but that time is unpaid, and it’s only guaranteed for companies with at least 50 employees.
The status quo is that women and their families have to cobble together time off to have a baby, and everything depends on the generosity of individual employers. Women frequently get fired or demoted due to pregnancy or childbirth, and many simply can’t afford to take unpaid time off.
“When a young parent needs time to care for a newborn child, it should never come down to an outdated policy that lets her boss decide how long it will take—and decide the fate of her career and her future along with it,” Gillibrand said in a statement. “When any one of us, man or woman, needs time to care for a dying parent, we should not have to sacrifice our job and risk our future to do the right thing for our family.”
The FAMILY Act would guarantee workers who take paid leave two-thirds of their typical wages during their time off. Crucially, it would also give benefits to the many Americans who want to work full-time but can’t, who work at small businesses, or who are self-employed or even unemployed, as long as they have sufficient work and earnings history.
It benefits all workers but would give a particular boost to women, low-income people, and people of color, who disproportionately lack workplace benefits like paid leave.
The program is modeled off of successful state-level efforts in California and New Jersey. A staggering 91 percent of businesses in California said the policy change had a positive effect or no noticeable effect on business profitability and performance, while 99 percent said it boosted or didn’t change employees’ morale.
Some business leaders have endorsed the measure, citing the benefits of worker retention.
“When we increased paid maternity leave at Google from 12 to 18 weeks, we discovered it wasn’t just good for mothers, it was good for business, doubling our retention rate amongst mothers,” Susan Wojcicki, CEO of YouTube, said in a statement. “I’ve personally benefited from Google’s policy, but all working families, regardless of their employer or state of residence, deserve the benefits of paid family leave.”
While President Obama has been a vocal advocate for women’s economic security in recent months, he has not publicly endorsed the FAMILY Act, focusing instead on leave for federal employees and encouraging states to create their own leave programs.
The post Paid Family Leave Proposal Wouldn’t Add to Federal Budget appeared first on RH Reality Check.
It costs less than a dollar to walk across the bridge to Nuevo Progreso, a small Mexican town just outside of McAllen, Texas, that caters to what locals call “snow birds”—mostly white Texan retirees, who drive their RVs and campers down south to warm up in the winter time and take advantage of the affordable prices in Mexican drugstores.
Driving across isn’t much more expensive; parking on the narrow streets is really the hard part. Huge, warehouse-style markets sell everything from shot glasses, to rocking chairs, to blue jeans, to life-size metal parrots that make for some fantastic patio decor. Many also include pharmacies in the rear of the store. They accept American dollars and most of the clerks speak English. If they don’t, it’s easy enough to communicate by writing a note or showing a prescription slip.
The day I walked over to Nuevo Progreso with my husband, it was pouring. The sidewalks of the town were soaked, and we dodged puddles and gutter-showers looking for a place to grab some chips and salsa and a couple micheladas. The streets were busy, despite the weather, but plenty of folks had settled into the cantina inside the main drag’s sprawling market.
Once we were inside too, I approached the man behind the counter of the pharmacy. “Cytoteca?” I asked, using the brand name for misoprostol.
The pharmacist didn’t blink an eye, telling me it was $128. I didn’t go there to haggle, but I couldn’t help myself—I’d heard reports that pharmacies sold miso for about a third of that.
“That’s too much!” I said.
He shrugged, pointing to a box on the shelf behind him. “The generic? Miso? Only $40.”
It would cost $40 for 28 200-milligram misoprostol pills—enough, according to the World Health Organization (WHO) protocols for its use, to induce two pregnancy terminations.
When most people think of self-induced abortions, at least here in the United States, they probably think of the decades-old, pre-Roe v. Wade horror stories, involving back alleys and coat hangers. But these pills, available from Mexican pharmacies for a tenth of the cost of a clinical abortion, are changing the way people talk and think about the procedure.
Miso’s History as an Abortifacient
Misoprostol—commonly referred to as miso—is in a class of medicines called prostaglandins. It’s an anti-ulcer medication with a variety of medical indications, and it’s often used to treat people who have arthritis. Obstetricians also use it in labor and delivery to soften the cervix and reduce hemorrhaging.
“The action of all the prostaglandins is to cause cervical maturation or softening or opening of the cervix as well as uterine contractions,” explained Dr. Dan Grossman, a gynecologist, abortion provider, and researcher with Ibis Reproductive Health in San Francisco. But, Grossman told me, it’s also “kind of unique among the prostaglandins because it’s orally active. It can be taken as a pill.” Other prostaglandins need to be given by injection.
Miso pills are, according to Dr. Grossman, also “very stable.” They aren’t especially sensitive to heat, and they don’t need to be refrigerated. They’re also affordable.
And, Grossman said, if it’s taken in the correct dosage by the right means, misoprostol is “among the most effective ways” to end early pregnancy “if a person doesn’t have access to a clinic-based abortion.”
Because of this, doctors and researchers have long advocated for the use of misoprostol for pregnancy termination as a harm reduction strategy—a term that public health experts use to describe efforts to reduce the negative consequences of certain human behaviors, in this case self-induced abortions—in countries where abortion is illegal and, as a result, severe complications and mortality rates from abortion attempts are very high.
But it wasn’t doctors and medical researchers who first began spreading the word that miso could be used to safely induce abortion when and where legal clinical options weren’t available; it was South American women.
Misoprostol became available over-the-counter in Brazil in 1986, and women there quickly realized it could be used as an abortifacient. According to the World Health Organization, “women’s use of misoprostol in Brazil decreased the severity of unsafe abortion complications, and to some extent also decreased the number of women admitted to hospital.”
The drug has advantages over more invasive means of self-induction. When not performed by a professional with sterilized instruments, inserting foreign bodies through the vagina into the cervix carries a significant risk of infection and perforation of the internal organs.
Miso use, according to the WHO protocols, carries an extremely low complication rate when it is taken by people who don’t have IUDs, who can confirm they are less than 12 weeks pregnant, and who know they do not have contra-indicating medical conditions that may cause them to bleed excessively. Still, the WHO cautions that people who use misoprostol to induce abortion should not do so alone, and should not do so if they cannot travel to a hospital within a couple of hours in case of complications.
The WHO guidelines advise that the medication can be taken in three doses of four pills, spaced three hours apart. The pills are dissolved under the tongue. A person who takes the medication this way may expect to have a low-grade fever, nausea and vomiting, or diarrhea in addition to cramps and, in 80 to 90 percent of cases, the termination of their pregnancy.
Misoprostol use according to WHO protocols is nearly undetectable, and its effects mirror that of spontaneous abortion, or miscarriage, which happens in an estimated 10 to 20 percent of known pregnancies. In countries where people can be prosecuted for attempting to self-induce abortions, those who can present at a doctor’s office or emergency room with the symptoms of a miscarriage can more easily escape detection by the authorities than those who may have remnants of objects left behind inside their bodies.
“While there’s a very small chance of excessive bleeding, similar to a miscarriage, usually the worst thing that can happen is it doesn’t work,” said Laura (not her real name), who has traveled around the world sharing the WHO’s protocols for misoprostol use for inducing abortion in places where clinical abortion care is illegal or inaccessible.
Laura has recently turned her attention to Texas, in part because of the state’s draconian laws that have severely reduced abortion care access in recent years. While the WHO protocols for miso-induced abortions are “not a panacea for the whole country,” Laura told me, the availability of reliably sourced medication in Mexico makes Texans uniquely positioned to be able to access a self-induction method that is more effective than herbal teas and supplements and far less risky than doing violence to their own bodies by inserting foreign objects into their vaginas, getting partners to punch them in their stomachs, or using bleach or turpentine douches. Laura told me she considers it an “ethical obligation” to share the WHO protocols with Texans.
Laura shared the WHO protocols with me last year. The work she does sharing this information is totally legal—as legal as sharing a recipe for cupcakes, or a pattern for a dress. The information itself is publicly available. She did not provide miso to me, or tell me that I—or anyone—should use the protocols to induce abortion. She is careful to impart all the information in a restrained, passive, third-person voice, and she advises others to do the same.
Today, self-induced abortion is “rare,” according to Dr. Grossman, who, along with his colleagues at Ibis and the University of Texas Policy Evaluation Project, has conducted some of the country’s leading research on self-induction and misoprostol use, particularly in Texas.
A 2008 nationally representative survey by Dr. Rachel Jones at the Guttmacher Institute estimated that about 2.6 percent of abortion patients seeking clinical abortion care had reported “ever taking something to self-induce abortion.” But in Texas, the frequency of self-induction attempts appears to be higher: In a 2012 study that Grossman and his colleagues conducted in the state, 7 percent of abortion patients reported trying to end their current pregnancies on their own before going to a clinic. In South Texas’ Rio Grande Valley, that number was 12 percent. Most of those women reported using herbal means to attempt to end their pregnancies; miso use was the second most common method reported.
According to the study:
The confluence of extremely limited access to abortion in the context of poverty, access to misoprostol from Mexico, as well as familiarity with the practice of self-induction in Latin America, makes it particularly likely that self-induction will become more commonplace in Texas.
Indeed, people living in the Rio Grande Valley, one of the most economically strained areas of the country, have long lacked access to a range of affordable health-care options, including abortion care. Today, just one reproductive health clinic remains there, open only because federal judges have allowed the Whole Woman’s Health facility in McAllen to temporarily provide abortion care.
Certainly, said Grossman, “some of these women are being forced to do this on their own because they can’t [access clinical abortion care].”
“If any women are [self-inducing abortion], that’s too many women,” Grossman told RH Reality Check. “Women should be able to access safe, high-quality affordable services in a clinical facility if they want to do that.”
Unfortunately, that is not the reality throughout the country. While Roe may have made abortion legal, it did not guarantee that it would be affordable or accessible. And with the passage of the Hyde Amendment just three years after Roe in 1976, lawmakers blocked Medicaid funding for abortion care and made it even harder to obtain for the poorest Americans.
This has become even more true in recent years, as lawmakers draw on model legislation—specifically targeted at abortion providers—written for them by anti-choice groups like Americans United for Life and designed to make abortion care very, very difficult to access.
Texas’ omnibus anti-abortion law, HB 2, is the granddaddy of all such laws. HB 2, which Gov. Rick Perry signed in the summer of 2013, bans abortion after 20 weeks, severely restricts the prescription of medication abortion, requires doctors who provide abortion care to have admitting privileges at local hospitals, and mandates that abortion facilities operate as hospital-like ambulatory surgical centers. Before the law passed, Texas had more than 40 abortion providers. Today, it has a little more than a dozen.
If Texas’ law goes into full effect—it’s currently partially tied up in federal court—the state will have just eight legal abortion providers, located in the four major metropolitan areas in the eastern half of the state. In fact, Texans have already had a glimpse at what that will look like. For a few days in October 2014, the state was able to fully enforce HB 2’s provisions. Overnight, all but a handful of clinics were forced to close their doors. Now, Texans await a federal ruling on the law in the Fifth Circuit Court of Appeals, and legal experts expect the case to ultimately be resolved at the Supreme Court.
In the meantime, Texans are going to incredible lengths to obtain legal abortion care and help others do the same. Texas has three abortion funds—the Lilith Fund, the Texas Equal Access (TEA) Fund, and the West Fund—whose activists work on the ground to help Texans pay for their abortions, in addition to Jane’s Due Process, which assists minors in acquiring a judicial bypass. Others help to fund the gas cards, bus tickets, and hotel rooms they often need in addition to their procedures. For example, Fund Texas Choice (FTC), a nonprofit that helps Texans pay for transportation and lodging costs to travel to legal abortion facilities, reported in February that it hears from 50 or so Texans per month who need help accessing legal abortion.
But FTC and its ilk can only do so much to help, and people seeking abortion care may be limited by their availability to get off work, find child care, or travel out of state. In December, FTC was only able to plan travel for four clients; in January, that number was 18.
When Texans cannot access clinical abortion care, some will have no choice but to carry their pregnancies to term. Others will seek out non-clinical methods of ending their pregnancies. Misoprostol could be a game-changer for those Texans, not only because of its affordability and availability, but because it takes a tremendously important family planning decision out of the domineering control of anti-choice lawmakers and puts it back in the hands of pregnant Texans themselves.
While he clearly advocates for legal, clinical abortion care and access to same, Grossman was frank about the fact that “maybe many women would prefer” to use misoprostol themselves. “The reality is that it may be empowering,” said Grossman, for some people to self-induce abortion, as long as they understand contra-indicators and other prerequisites for being able to take misoprostol safely.
But, said Grossman, in the pro-choice community, “it’s hard to talk about the whole range of views on this topic.”
That’s been my experience, as well—the specter of the back-alley abortion looms large, understandably so, when people speak out against abortion restrictions like the ones in Texas.
Legal abortion care, particularly first-trimester abortion care, is very safe—whether it’s a medication abortion prescribed by a health professional or a surgical abortion performed by one.
Contrast that with the number of people who died from complications resulting from illegal abortions before Roe: Though the actual numbers are impossible to know, the most reliable estimates calculate that anywhere between 5,000 and 10,000 people died per year before the landmark Supreme Court case. This is likely one of the major reasons that many people associate self-induced abortions with danger; they have often led to complications, even death.
The most frequently referenced method of such self-inductions is, of course, the coat hanger, a chilling reminder of the danger and desperation surrounding abortion care before 1973. But it was far from the only one: “Almost any implement you can imagine had been and was used to start an abortion—darning needles, crochet hooks, cut-glass salt shakers, soda bottles, sometimes intact, sometimes with the top broken off,” wrote retired gynecologist Waldo Fielding in the New York Times in 2008.
Pro-choice activists, doctors, and lawmakers often say that anti-choice legislation will merely drive abortion care into back alleys, and to the kinds of dangerous methods described above. That is, in the overwhelming majority of cases, true. But miso could be an exception.
It wasn’t until I learned the WHO protocols myself that I shifted my thinking on self-induced abortion and came to believe that, though it may be trite to say, knowledge is power when it comes to being able to safely end a pregnancy, despite intrusive laws that block access to abortion care.
And power—political power, particularly—is something Texans who believe in safe abortion care haven’t had in a long time.
“This Is About Bodily Autonomy”
Even the most radical folks I spoke with for this story didn’t tell me that they believe miso is automatically the answer to the growing problem of abortion inaccessibility in the United States. Most people said they believed access to clinical abortion is a fundamental human right; that clinical abortion care should be more, not less, accessible; and that it should be fully funded by the government for anyone who needs it. But that dream is a long way from being realized anywhere in the United States, and especially in Texas.
Miso isn’t available to folks who can’t cross the border—that includes unauthorized Texans who can no more travel to Mexico than they can San Antonio, beyond an interior border patrol checkpoint—or who don’t know someone who can.
And it’s difficult for someone to know whether they’re getting the right medication unless they’ve purchased it directly from a pharmacy, which means people who can’t easily cross the border—whether they live in North Texas or Cleveland or New Orleans—must gamble on ordering medication online. Beyond that, it’s simply illegal to possess miso in the United States without a prescription. And breaking the law is breaking the law. Particularly for people of color, and especially for unauthorized residents, falling afoul of law enforcement is a terrible risk.
So far, authorities have reported making just one arrest related to the sale or possession of misoprostol in Texas—of a woman in South Texas who sold abortion-inducing medication at a flea market, in addition to other illegally obtained medications.
No one—and I mean no one—I spoke to for this story told me they believe breaking the law to self-induce abortion is the first, best option for ending an unwanted pregnancy. Everyone I spoke to emphasized their desire to see increased availability and accessibility for legal abortion care. Many volunteer as clinic escorts, helping shield patients from anti-choice protestors who would harass and shame them. They believe, passionately, in clinical abortion care. They also know it simply isn’t an option for some Texans.
The people, particularly Latinas, who are working to spread information about the WHO protocols for misoprostol in Texas are also some of the Texans who are doing the most work, both in the capitol and on the ground, to combat Texas’ oppressive anti-abortion law and to help Texans access legal abortion.
Melissa Arjona, a reproductive justice activist who lives in the Rio Grande Valley, shares the WHO protocols with small groups in her community and, like me, learned the protocols from Laura last year.
“It’s a good thing, being next to Mexico, because you hear about people ordering pills in the mail and you don’t know if it’s real or not,” she said. “Here, it’s really easy access, it’s something that allows people to take it into their own hands.”
The complicated reality is that for some people, using misoprostol to induce abortion outside of a clinical setting is a safe, affordable, and accessible alternative to traveling what can sometimes be hundreds of miles to the nearest abortion provider, where even a medication abortion prescription can run into the several hundreds of dollars. This isn’t true everywhere; pills purchased online or on the black market from distributors who may not know (or care) whether they’re selling the real thing can be ineffective at best and dangerous, even potentially fatal, at worst.
But pharmacies on the Mexican side of the southern U.S. border sell the real thing—packaged by the manufacturers—for a fraction of the price of a clinical abortion.
Those Mexican pharmacies have often been demonized in the press when it comes to the subject of abortion—one report claimed that Texans would be “lured” across the border to purchase abortion pills, as if a nefarious, moustachioed villain lay in wait across the Rio Grande. (When I crossed, the only thing that really came close to “luring” me in was the cheap beer.)
In Texas, many abortion providers have stopped prescribing medication abortion—a combination of mifepristone and misoprostol—because the new law requires the drug combination be administered according to 13-year-old FDA guidelines that are limited by a smaller gestational-use window, and less effective than newer, evidence-based regimens.
This essentially leaves Texans seeking legal abortion with one option: surgical procedures. And looking at that $40 box of miso in Nuevo Progreso, I could easily see why someone who couldn’t pay for a $400 surgical procedure at the Valley’s last remaining abortion provider, or an overnight trip to San Antonio to the next-closest legal clinic—assuming they could pass through one of the interior border patrol checkpoints that dot South Texas highways—might opt for these pills, especially as more people in the region learn about them.
Before she learned the WHO protocols, Melissa Arjona told me that it was “kind of scary to think about pills being used that way,” but once she learned about the safety of miso—”backed up by the actual WHO”—she found the information gave her a kind of strength.
“You can give out the information without potentially harming people because the risks are the same as a miscarriage,” she said—excessive bleeding is a potential complication of any miscarriage, whether induced with misoprostol or spontaneous, and infection could potentially occur as a consequence. (For context: The risk of death from childbirth is about 14 times higher than from clinic-provided surgical abortion early in pregnancy.)
She may not have a medical background, and Arjona is careful to emphasize that she’s just “sharing information,” but in a state where tens of thousands of people may soon live hundreds of miles from the closest legal abortion provider, she may also be saving lives by giving Texans the knowledge that their options may not be as limited as anti-choice lawmakers would want to make them. Simply knowing it’s possible to self-induce with miso, said Arjona, is “a lot more empowering.”
So far, Arjona estimates that she’s shared the information with around 100 people, and has developed, along with her fellow Valley activists, a knowledge-sharing model tailored to the needs and culture of their community. She doesn’t use an instructive “training” model; instead, she invites friends and neighbors to join her in their homes for conversations about the WHO protocols.
They may be talking about abortion, said Arjona, but the bigger picture is much more important: “This is about bodily autonomy.”
Image: Aquistbe/ Flickr
The post Changing the Way People Think About Self-Induced Abortions appeared first on RH Reality Check.
Kansas Gov. Sam Brownback (R) made his constituents the subject of a “real live experiment” on the effects of implementing a right-wing economic policy agenda. The experiment by many measures seems to have failed spectacularly, but Brownback continues to claim it is a success.
The governor says his radical anti-choice stances have been—and will continue to be—an economic boon for the state.
Brownback, whose re-election to the governorship was opposed by a cadre of Kansas Republicans, was interviewed during a recent edition of the radio program Washington Watch, hosted by Family Research Council President Tony Perkins, a prominent anti-gay activist. During the program, Perkins praised the governor for pursuing a “pro-family agenda and at the same time a pro-economic growth agenda,” reports the website Right Wing Watch.
“Well, it’s working,” Brownback responded. “And we’re pretty straightforward here. What we want Kansas to be is the best place in America to do two things: Raise a family, grow a small business.”
Brownback cited the many anti-choice bills that he has signed as governor, and highlighted a bill that is part of a coordinated effort to ban a medical procedure used for second-trimester abortions and the management of miscarriage. Brownback argued that policies to restrict reproductive rights “tie closely together” with conservative economic policies.
“They really support each other,” Brownback said during the interview. “One of the problems we have in the country is we’re not forming enough families.”
Brownback, in his first few years as governor, instituted radical conservative economic reforms. In 2012 the governor signed into law one of the largest tax cuts in the state’s history, which critics said would cost the state more than $2 billion over five years.
Brownback’s tax cuts have resulted in an 8 percent revenue loss that has had a devastating effect on the state’s ability to meet basic funding levels for public education and has busted the state’s economy, according to an analysis by the Center for Budget and Policy Priorities.
The analysis also concluded that the tax cuts disproportionately benefited wealthy households.
The Kansas Supreme Court in 2014 ruled that funding of the state’s public school system was unconstitutional, thanks in large part to Brownback’s tax cuts for the state’s wealthiest residents. Brownback and Republican state lawmakers had argued that funding public education was a political matter, not a constitutional one. Brownback, in a statement released after the ruling, pledged to keep “our schools open.”
When the state’s credit rating was downgraded by Standard & Poor’s, the credit bureau specifically cited the effect of the tax cuts pushed by Brownback and his conservative allies in Kansas.
Brownback’s massive tax cuts have failed to generate the job growth that was promised. The state was outperformed by other states in the region in 2014, and was far behind the average job growth nationwide, according to a report released this week.
In response to the $648 million budget shortfall the state is projected to have in the 2016 fiscal year, Brownback has proposed huge tax increases on tobacco and liquor, diverting state funds for highway construction to general government programs and delaying a long-term funding gap fix for the state retirement system for teachers and government workers.
Brownback’s policy agenda has included several anti-choice bills, and state lawmakers have introduced several more that did not make it to his desk.
Brownback signed a bill banning abortion at 22 weeks’ gestation based on unsubstantiated findings that a fetus can feel pain at 20 weeks’ post-fertilization, as well as a bill that requires abortion clinics to be inspected at least twice a year, with at least one of those inspections to be made without prior notice to the facility.
Brownback in 2013 signed a massive anti-choice omnibus bill that stripped tax credits for abortion providers, mandated abortion providers give medically inaccurate information to women seeking abortions, banned sex-selection abortions, and included radical “personhood” language.
The anti-choice legislation that Brownback has signed into law has not only severely restricted access to abortion care in the state, but has come at a significant financial cost. During 2012 and 2013, the state spent nearly $1 million in litigation costs defending anti-choice laws, according to an analysis by RH Reality Check.
Brownback has defended anti-choice laws, despite the many legal challenges. “You can’t know for sure what all comes out of that afterwards, but it was the will of the legislature and the people of the state of Kansas,” said Brownback, according to reporting by the Lawrence Journal-World.
Brownback’s agenda has included other policies besides restricting reproductive rights.
Brownback signed into law a program to test welfare applicants for drug use that only administered 20 drug tests in the first four months of its existence, despite the $2.1 million cost of the program. Brownback also signed an executive order last month that rescinded discrimination protections for state employees based on sexual orientation and gender identity.
The post Brownback: Anti-Choice Laws Will Serve as Economic Boon appeared first on RH Reality Check.
The news out of Arkansas the last few weeks just keeps getting more horrifying. First it was revealed that state Rep. Justin Harris (R-West Fork) had once employed Eric Cameron Francis, a man accused of raping a 6-year-old girl last year, at Harris’ day care, Growing God’s Kingdom Preschool. Then it was discovered that Harris had actually given the little girl in question over to Francis, after having adopted and then “rehomed” her when Harris and his wife felt they couldn’t care for the girl or her little sister any longer. Then there were reports that Harris believed the girls, who had suffered abuse in their biological mother’s home, were possessed by demons and had subjected them to “exorcism.” Oh yeah, and while Harris loves bashing other people for getting government money, there are allegations that he continued to cash the checks he got for adopting the girls even after they were “rehomed.” And that’s on top of the dazzling stream of money he got—$4 million so far—from the government to run his day care, even though there are strong indications that the facility—which, again, is called Growing God’s Kingdom—was not following rules forbidding religious indoctrination.
Could this story get any worse? Of course! Now it’s been revealed that Harris is sponsoring a bill that could force underage rape victims to bear their rapist’s children. Despite his public statements expressing sadness over his adopted daughter being assaulted by the man he gave her over to, Harris appears not to have learned a single thing about compassion or empathy for rape survivors.
The bill in question, HB 1424, would change Arkansas’s current parental consent law to make it harder for underage rape victims to get abortions. Right now, the law requires minors who want abortions to either get parental consent to do so or subject themselves to the humiliating, arbitrary judicial bypass process. However, there is an exception for girls who have become pregnant through rape or incest. This new legislation would remove that exception. Apparently, Harris and his colleagues don’t think life is hard enough already for these individuals.
To make it worse, this kind of legislation might actually force teenagers to ask their own rapists for “permission” to abort, given, again, the parental consent clause. A lot of sexual abuse of minors happens in the home, often at the hands of people who are supposed to be the child’s guardians. Harris really should know this. After all, not only were the girls he adopted exposed to sexual abuse in their original home, but he handed them over to a man who raped one of them. If he had a lick of sense in him at all, he would know better than anyone how adolescents are sometimes abused at the hands of people who are supposed to be caring for them.
But instead of learning anything, he evidently wants to give men who rape their daughters more control over whether or not their victims will have their baby. He’s also working to make judicial bypass harder to get, so all girls, rape victims or not, will have to endure more obstacles—and take more time that may push them over the legal threshold—to get an abortion. Harris needs to worry a little less about alleged demons and pay a little more attention to the evil in the real world—the kind of evil he is perpetuating by trying to restrict abortion care for rape survivors.
This additional restriction isn’t just about girls who have endured assault at the hands of their family members, either. Not every rape survivor has a loving and supportive family. Take, for instance, this “men’s rights activist” that Jeff Sharlet interviewed for GQ:
A sore point for Factory, who has two daughters, who, like young women everywhere, he says, compete for the most exaggerated rape claim. It is, he says, a status thing. When one of his daughters came home one night and said she’d been raped, he said, “Are you fucking kidding me?” Sitting with us, he hikes his voice up to a falsetto in imitation: “‘Oh, I just got raped.'” He laughs. There’s a moment of silence. A bridge too far? “I told her if she pressed charges, I’d disown her.”
If the daughter of a man like that is pregnant from rape, what are the odds that she’s going to be able to talk through her options with her parents? Basically zero.
I am somewhat grateful to Justin Harris in one way: By sponsoring this bill, he has become the perfect distillation of the entire patriarchal conservative Christian mentality. Not just because he is alleged to have done exorcisms on both his adopted daughters and on the kids in his day care while ignoring or even perpetuating ordinary human evil. No, Harris perfectly embodies the Christian right because he’s all about mindless, unquestioning support of control over women’s bodies.
Emphasis on mindless. After all, all these restrictions on abortion are created under the assumption that women and girls cannot be trusted to make the best decisions for themselves about their own bodies and therefore need someone else—politicians, judges, or parents—to decide for them. Harris, with his strict anti-choice views, clearly believes he deserves more say over a woman’s body than she does.
There’s also a deeper irony in this story. Harris felt entitled to say “no thank you” to raising two little girls, after he had asked for them, overruled people’s reported objections to adopting them, and finalized the adoption—all because he and his wife realized after the fact that they were in over their heads. But while he reserved the ability to say “no” to parenthood after making all these commitments, he wants to begrudge women who are saying “no” responsibly, by doing it before they have a baby and before someone else has come to depend on them, of the same right. This isn’t even “abortion for me and not for thee.” Harris, as a mighty patriarch, wants to put his personal comfort before the needs of actual human beings who require care, all while demanding that women sacrifice their own wellbeing for people that don’t even exist yet.
The hypocrisy and cruelty on display here is truly astounding. Harris is a man who has amply demonstrated that he can’t handle taking responsibility for himself and his family, but he still mindlessly demands control over the bodies of teen girls, even those who have been raped. Looking over the landscape, it’s hard not to wonder if this country would be better off if we took all the conservative men out of government and replaced them with teenage girls. After all, teen girls seem to be better decision-makers.
Image: Arkansas House/Youtube
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The City of Madison Common Council on Tuesday passed a resolution asking federal and state governments to increase funding for full-spectrum reproductive health-care services, including abortion, for low-income people.
Because of the 1976 Hyde Amendment, which bans the use of federal funds for abortion care except in cases of life endangerment, rape, or incest, those who have public health insurance through Medicaid or another state or local program generally cannot use that insurance to cover an abortion.
Though some states, including California, Washington, and Maryland, use state funding to cover abortions, many others follow the federal standard, leaving abortion care largely inaccessible for millions of low-income pregnant people.
Meanwhile, city and municipal governments, like Madison, have taken it upon themselves to demand full spectrum reproductive care for all people, no matter their income, as anti-choice Congressional lawmakers ensure low-income women don’t have access to safe abortion care.
There are hundreds of thousands of people in Madison of reproductive age who rely on public health insurance and are unable to use that insurance to cover the cost of abortion care, should they need it, according to the resolution.
“[T]he Madison Common Council is taking a stand to say that the amount of money a woman has should not prohibit her from having an abortion,” Alder Lisa Subeck, a Madison council member and sponsor of the resolution, said in a statement. (Subeck was recently elected to the state legislature.) “This is not what Madison stands for. With this resolution we are saying it loud and clear: we will not look the other way.”
Though in a GOP-dominated state like Wisconsin, whose Republican governor recently pledged to sign a 20-week ban on abortion if it comes to his desk, resolutions like the one in Madison are largely symbolic. Still, state officials and advocates maintain the council’s pro-choice stance is important.
“It is true that unfortunately, given the way that politics are playing out in Wisconsin, with an incredibly anti-choice legislature and governor, we won’t be seeing increases in reproductive care access coming from the state level,” said Jenni Dye, research director at One Wisconsin Now and member of the Dane County Board of Supervisors, in which Madison is found. “It’s incredibly important in this period of time to have local officials step up and say they are committed to and will fight for broader access. It keeps the dialogue going.”
Seattle, Travis County, New York City, and Philadelphia, among others, have passed similar resolutions. And both Oregon and Washington this year introduced legislation seeking to expand abortion access for low-income people.
The post Wisconsin City Asks Gov. Walker to Remove Abortion Funding Bans appeared first on RH Reality Check.
After enrolling at a new public high school during my senior year, I quickly realized how difficult it would be to succeed as a pregnant 17-year-old student. I had assumed that my peers would be the ones isolating me or making me feel like an outsider, so I was shocked when my teachers became my bullies. I did not want to stay in school when the people who were meant to educate and guide me were often the same ones judging and shaming me. Thanks to the work of a single dedicated social worker for teen parents in my school and her ability to advocate for my Title IX rights, I was able to graduate with my class. But not everyone will have such resources. And with that in mind, I feel it is vital to remind expectant and parenting students of their federal right to an education.
A 2006 report by the Gates Foundation found that 26 percent of youth who drop out of school in the United States said that becoming a parent was a major factor in their decision. However, many pregnant and parenting teens also reported in that same Gates report that they felt more motivated to stay in school after becoming pregnant or parents, and would have stayed if their schools provided equitable access to the necessary support. For some students, that support looks like scheduling accommodations or access to in-home tutoring. For others, support simply looks like being able to learn in a discrimination- and harassment-free environment.
Such an environment certainly wasn’t accessible for me. Looking back at my first week of school, I remember a moment where I looked at my senior year schedule to see that I was pulled out of all my honors classes. When I asked my guidance counselor why, she told me that girls like me—in other words, pregnant girls—couldn’t handle the workload. When I walked into classrooms, teachers would pull their glasses to the tips of their noses and glare at me while I tried to maneuver my protruding belly behind a small desk. During my last trimester, my legs were swollen and my belly was heavy, so it would often take me more than the allotted four minutes to go from a first-floor classroom to my next class on the fourth floor, on the other side of the building. One teacher made it a point to give me detention every time I was late and to remind me, in front of my class, that my pregnancy was a choice.
A few weeks before my due date and maternity leave, I made the second trip of the year to my guidance counselor’s office to ask for help with picking and applying for colleges. Barely making eye contact, she regurgitated the common stereotype: “Girls who get pregnant in high school struggle to finish high school and rarely go to college.” She pointed me to a stack of brochures from local community colleges and went back to typing on her computer. Given that the odds were apparently stacked against me, I began to wonder if it was worth trying anymore or if I should just drop out and not deal with the stress. Every day, I would ask myself whether I would bother coming back the next day.
These factors exacerbated the effects of the trauma I had undergone earlier in life. Before my pregnancy, I had experienced abuse, witnessed violence, and coped with depression. School had always been my escape from the real world and a place where I could focus on my own growth. But my pregnancy changed that: It granted my instructors the opportunity to project their own judgment and unconscious biases upon me.
And I wasn’t unique. Many young parents across the country have experienced adversities and are in need of empathetic support systems in their educational experiences. A recent report by the Massachusetts Alliance on Teen Pregnancy revealed that 30 percent of expectant and parenting teens experienced homelessness over the course of the one-year survey; 46 percent of the teen parent population had been physically or emotionally abused or neglected by their caregivers; and 18 percent of teen parents had experienced sexual abuse. Yet we know that with empathy and equitable access to resources, teen parents are capable of overcoming these obstacles and succeeding in a variety of spheres, including academically.
One major way teens can help empower themselves is by asserting their federal rights. Many young parents may not know this, but many of the experiences and educational hardships they are facing are actually illegal. The National Women’s Law Center has compiled a clear list of expectant and parenting students’ rights as outlined in the federal law Title IX, which forbids gender discrimination in schools. Within Title IX, expectant and parenting students have the right to excused absences for pregnancy-related issues, reasonable time to make up work missed from excused absences, and maternity leave. If their schools provide temporarily disabled students with at-home tutoring, expectant and parenting students are also legally entitled to the same.
Students cannot be kicked out of school for being pregnant or parenting and do not need to bring in medical notes to continue their education or continue participating in extracurricular activities. Additionally, parenting students have the right to privacy, and no school official can share their pregnancy information with anyone without full consent. And regardless of parenting status, students have the right to continue their learning without being shamed. As Title IX clarifies, harassment because of pregnancy is a form of sex discrimination and a violation of the federal law.
With this in mind, young parents can and should demand transparency about their Title IX rights in school—and, in turn, to ask for a clear policy in their district that enforces those rights. In my case, a policy clarifying how teachers were allowed to engage with students and mandating training for all people working with young parents could have made my high school experience much more bearable. My social worker knew the complex issues around teen pregnancy and didn’t reduce my identity and life to my pregnancy; she was also well-informed on how to challenge or report instances of Title IX violations. But these weren’t guaranteed for other parenting students without a social worker. So ensuring a policy that includes language on why breastfeeding is a valid reason to be in the nurse’s office twice a day, or one that explicitly reinforced a young father’s involvement by excusing absences during the mother or baby’s medical appointments, maternity leave, or when babies are sick, could have helped students in the future.
Additionally, my educators, nurses, and guidance counselors would have benefited from learning how to be genuine support systems for young parents. Adults can sometimes unconsciously project judgment onto young parents or make stigmatizing comments that reduce them to statistics. Those little moments can have a deep and serious impact on a young person’s self-determination. Recently, a group of seven young moms formed a campaign, #NoTeenShame, to help push new frameworks that elevate strength-based language. Administrators should take cues from efforts like these, which amplify the voices of lived experiences.
Implementing policies that encompass these practices would ensure that the needs of young people are being met, allowing them to move toward their own dreams and goals. And district officials themselves have cause to cooperate; Title IX is mandatory, and violating these rights can cause a school to lose its federal funding.
We see a stark number of young people leaving school despite being motivated to stay because of the school’s lack of sensitivity. For young parents across the country, there are a few things we can do to protect our peers and ourselves:
As a former teen mom, I know the journey to implementing a district-wide policy seems overwhelming and that challenging an entire school system feels impossible. But young parents fighting for—and making—change could benefit the educational system.
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The GOP-dominated Montana house on Monday passed a ban on the use of telemedicine for abortion care.
HB 587, sponsored by Rep. Keith Regier (R-Kalispell), would prohibit a physician from providing abortion care, attempting to perform an abortion, or prescribing medication to induce an abortion without being in the physical presence of the patient.
The bill passed the house by a 53-46 margin, mostly along partisan lines, with four Republicans joining the Democrats in voting against the legislation.
Abortion providers use telemedicine to offer access to abortion care to women, many of them in rural areas, who do not live near a reproductive health-care provider. At a local health clinic, where the medication is dispensed, a patient will sit with a nurse while communicating with her doctor via video conferencing tools.
Regier said during the floor debate that the bill’s intent is to ensure that abortion providers are able to determine the exact number of weeks of the pregnancy and if there are any complications from an ectopic pregnancy.
Twenty out of every 1,000 pregnancies are ectopic, according to the Mayo Clinic.
Telemedicine abortion care “is not good for the woman,” Regier said, reported the Great Falls Tribune.
Research has shown that telemedicine abortion is safe and effective. Ibis Reproductive Health has concluded that “restricting telemedicine for medication abortion is not evidence based, and limits women’s access to high-quality abortion care, particularly in rural areas.”
Rep. Ellie Boldman Hill (D-Missoula) offered an amendment to “protect” men from vasectomy by telemedicine, which was voted down 55-45.
Hill said the intent of the bill is to make abortion care more difficult to access for women in rural areas. “We all know what this bill is about,” Hill said during the floor debate, reported USA Today. “Let’s take our ‘nanny state’ [and] make it an inability to get reproductive care equally.”
Telemedicine abortion care is only available in Iowa and Minnesota, and 17 states have passed laws banning the practice. Arkansas became this latest state to ban the practice when Gov. Asa Hutchinson (R) signed a telemed ban into law in February.
Anti-choice lawmakers around the country have introduced several bills over the past few years to end telemedicine abortion, many times at the urging of powerful national and state anti-choice groups.
Martha Stahl, president of Planned Parenthood of Montana, told the Flathead News that the bill would restrict abortion access in a state that has a large rural population.
“The reality is a woman is not in the same room with a doctor when an abortion takes place for over a decade now,” Stahl said. “Legislators should leave it to medical professionals to determine whether this is a good thing to do through telemedicine.”
HB 587 now moves to the state senate, where it will await a committee hearing before being brought to the floor for a vote. Republicans hold a 29-21 majority in the senate.
Corporate franchise owners opposed to Seattle’s new $15 an hour minimum wage law have failed at their first attempt to convince a federal court the measure was unconstitutional.
U.S. District Judge Richard Jones on Tuesday issued a 43-page opinion rejecting every argument put forth by attorneys for the International Franchise Association (IFA) and five Seattle-area franchisees to preliminarily block the law.
Attorneys for the IFA argued that the law discriminates against franchise businesses by classifying them as “large” employers under the ordinance regardless of the number of people employed by the particular franchise because of their connections to corporate franchise parents.
Seattle’s ordinance requires large businesses, defined as those with more than 500 employees, to raise the minimum wage to $15 an hour over three years, starting April 1. Businesses that employ fewer people have seven years to phase in the wage increase. Employers with 500 or fewer employees will be required to pay workers at least $10 an hour starting in April.
The plaintiffs argued that local franchises like McDonald’s and Holiday Inn should be covered only if they meet the ordinance’s employee threshold requirement.
Former Solicitor General Paul Clement represents the plaintiffs in this case. Clement represented Hobby Lobby in its challenge to the birth control benefit in the Affordable Care Act and frequently represents other conservative interests in high-profile cases before the U.S. Supreme Court.
During last week’s hearing requesting the blocking of the ordinance, Clement claimed that the record was littered with evidence of unlawful discriminatory bias against franchises.
“Discrimination is so overwhelming on businesses with interstate commerce—we prefer to have local business, they are better for neighborhoods,” Clement said at the hearing, referencing testimony from city council meetings where the issue of whether or not franchises would be subjected to the ordinance’s phase-in was debated. “That is a view someone can have, but it isn’t a view that the commerce clause allows a local government to have.”
Jones disagreed, finding there was no evidence the ordinance unlawfully discriminated against franchises.
“As an initial matter, comparing franchisees and independent small businesses is somewhat difficult; they are not ‘similarly situated’ in all relevant respects,” Jones wrote. “It is true they compete in the same markets and it is also true that a franchisee who owns only one outlet may share some similarities with an independent small business. That said, franchisees and independent small business have different business structures.”
The plaintiffs also charged that the ordinance violated the Equal Protection Clause of the 14th Amendment by arbitrarily and irrationally discriminating against small franchisees in classifying them as large employers.
Jones rejected this argument outright, holding that the “plaintiffs have neither shown a likelihood of success nor raised serious questions going to the merits of their equal protection claim.”
With the request for an injunction denied, Seattle’s wage hike is set to take effect April 1. A trial on the merits of IFA’s claims is expected to begin in late October.
African-American civil rights leaders and members of Congress are calling on the Senate to immediately confirm Loretta Lynch as the first Black female attorney general of the United States.
They’re harshly criticizing Republicans and Senate Majority Leader Mitch McConnell (R-KY) for making Lynch wait longer than any attorney general candidate in the past 30 years to get a vote—even though her qualifications are widely praised and she was already confirmed by the Senate twice as a U.S. attorney.
“The politics that Republicans have played with Ms. Lynch’s nomination are deplorable,” said Rep. G.K. Butterfield (D-NC), chair of the Congressional Black Caucus, on a press call with other Black leaders.
Butterfield also called it “unprecedented” that Sen. Thom Tillis (R-NC), from Lynch’s own home state, voted against Lynch in the judiciary committee.
It’s been four months since Lynch’s nomination was announced, and the 20 days since she finally cleared the Senate Judiciary Committee are longer than the past five attorney general nominees combined have had to wait for a vote.
“When women all over this country see the right person for the job at the right time flawlessly perform, and still be denied the opportunity for an up or down vote on being able to get the job, it sends a very toxic message,” said Sherrilyn Ifill, president and director-counsel of the NAACP Legal Defense and Educational Fund.
“All over this country, women are watching, African-American women are watching, the civil rights community is watching,” Ifill said.
McConnell is holding up Lynch’s confirmation vote until the Senate reaches some kind of agreement on a human trafficking bill. Democrats are blocking the bill, which they used to support, until Republicans agree to remove anti-choice language that would expand the reach of the Hyde Amendment. Some advocates argue that the bill shouldn’t pass even without the Hyde language.
“The actions of Mitch McConnell are petty and mean-spirited,” said Rep. Marcia Fudge (D-OH).
McConnell’s justification for holding up the nomination is “flimsy at best,” said Wade Henderson, president and CEO of the Leadership Conference on Civil and Human Rights.
“We all know senators can walk and chew gum at the same time,” Henderson said, pointing out that it’s easily possible for the Senate to vote on Lynch’s nomination while debate over the trafficking bill is still going on.
The issues of racial and gender bias also came up.
“The fact that she is a woman, the fact that she is Black, I think plays a major and a pivotal role in why it taken this long,” said Paulette Walker, national president of Delta Sigma Theta Sorority, of which Lynch is a member.
“I think race certainly can be considered as a major factor in the reason for this delay, but it’s also the irrationality of the new Republicans,” Butterfield said. He said the new Tea Party wing is more extreme than conservative Republicans used to be, and that the two parties used to at least be able to agree on getting nominations confirmed at the end of the day.
“Rather than focus solely on the motivation of the Senate—in other words, are they doing this because she is an African-America woman…I think it’s about, what are women writ large, and African-American women, perceiving when they watch this?” Ifill said. “It’s not just what the intentions are, it’s about how it’s being internalized by the broader American public.”
She added that the delay is also about opposition to President Obama, “which is not free from matters of race as well.”
Sen. Richard Durbin (D-IL) said Wednesday on the Senate floor that the GOP is forcing Lynch to “sit in the back of the bus” by using the trafficking bill as an excuse to hold up her nomination.
“Loretta Lynch will be fine,” said Sen. John McCain (R-AZ), who says he opposes Lynch’s confirmation. “The young women who are being sexually trafficked now and mistreated are not gonna be fine.”
Image: CBS News/ Youtube
The post African-American Leaders Condemn GOP for Holding Up Lynch Confirmation appeared first on RH Reality Check.
In a column for The Nation last Friday, writer Katha Pollitt questioned the push among reproductive justice activists to use gender-inclusive language when talking about abortion. Pollitt claimed that such rhetoric “render[s] invisible half of the population and 99.999 percent of those who get pregnant.”
I’m a physician who provides abortions. I’m a physician who provides medical therapy for transgender patients. Both areas of care, for me, are aspects of the same commitment: to provide necessary, lifesaving services that center my patients’ autonomy. Still, I’ll readily admit that I, too, was confused at first by calls to use language with regard to reproductive rights and justice that would be inclusive of transgender men and nonbinary individuals. It seemed like common sense to me that of course my pregnant patients were women and would be referred to as such. As a progressive, though, one of the important lessons I’ve learned is that what looks like “common sense” is often a reflection of unexamined biases. And I’ve realized that assuming every person seeking an abortion is a cisgender woman just further reproduces the prejudices that render transgender people invisible and vulnerable.
On the same day The Nation ran Pollitt’s piece, Reuters reported on a survey of trans men regarding health-care use; more than three-quarters of the individuals had transitioned medically, meaning they were using hormone replacement therapy and/or had obtained surgical treatment. Forty-two percent of the respondents reported experiencing health-care discrimination, including denial of equal treatment, verbal harassment, and/or physical assault. Furthermore, the survey respondents disproportionately reflected a privileged minority of transgender individuals: white, college-educated, employed, privately insured trans men. That figure is undoubtedly higher among less well-off demographic groups of trans men and nonbinary people.
Cisgender people, particularly white individuals, have the privilege when seeking health care of being able to present as their authentic selves without fear. Transgender people, especially people of color, do not. Dr. Kortney Ryan Ziegler, an Oakland, California-based filmmaker, writer, and scholar who is also a Black transgender man, told me that for himself and other trans men he knows, the experience of accessing medical services is fraught with bodily exposure and the risk of discrimination.
For instance, while traveling out of town once, he went to an urgent care clinic for a cold. “The nurse noticed I had a prescription for testosterone and asked me about it. So I ‘came out’ to some random [registered nurse] because I had a cold, [even though] it had nothing to do with anything else,” he said.
He also recalled clearly how, while still presenting as a Black “woman,” “there were many times I know my race played an important role in how I was (mis)treated.”
Explicitly inclusive language is meaningfully beneficial to people like Ziegler, he says, because it can help ameliorate the harms of the fear of being harassed or mistreated: When such rhetoric is used, it can signal that trans men and nonbinary trans people are more likely to be acknowledged and accepted as themselves.
As an abortion provider working in a conservative area of the country, I’ll readily state that nearly all of my patients present as cisgender women. Does that mean that they all are cisgender women, though? We live in a cisnormative society, meaning that the experiences of cisgender people are overwhelmingly centered. In addition to the aforementioned risk of health-care discrimination, visibly trans individuals are subject to employment and other economic discrimination, family and partner rejection, housing discrimination, and a very real danger of violence. When this is the known price of coming out as trans, it’s one many people feel unable to pay.
Feminists like Pollitt who argue against inclusive language assert that because “99.999 percent of the population” seeking abortions are cis women, it is inaccurate and inappropriate to use gender-inclusive language. So how many trans people are we really talking about? It’s more than 0.001 percent. Suppose you time-traveled back to the 1950s and asked the average physician how many of his or her patients were gay. They would probably respond, “None” or, “Maybe one or two.” It’d be easy to conclude, therefore, that 99.999 percent of all people were straight, so there’d be no need to include any forms of non-heterosexual orientation in language or activism. Assuming the proportion of non-heterosexual people has stayed roughly constant, though, our 1950s physician likely did have a number of gay, lesbian, or bisexual patients. The doctor simply took them to be heterosexual. They may have even presented themselves as such, out of a legitimate fear that the physician would behave prejudicially toward them.
Using the same logic, how can providers or activists dare to presume that every patient we can’t “read” as trans is cis? Numerous trans individuals “pass” as a cis member of their gender, or they present—in some or all settings—as a cis member of their assigned-at-birth gender.
So the truth is, we don’t know what proportion of the population is transgender. The blog FiveThirtyEight covered this last year: No national surveys ask the question, and “even if they did, the responses might not be reliable because some people are afraid to answer, while others disagree on what ‘transgender’ even means.” But we do know that trans and genderqueer people within the reproductive rights movement are calling, in significant numbers, to be included.
When those in the reproductive justice movement prioritize trans inclusivity, more trans individuals feel comfortable publicly identifying as such. Furthermore, that visibility can guide people who’d previously lacked the tools to articulate their feelings of difference. Anna Rubin, who was assigned female at birth, identifies as agender, and uses the pronoun “they,” says they were able to figure out they were trans while researching the best uses for inclusive language at their then-employer, a reproductive rights nonprofit.
When writing a blog post for the nonprofit, Rubin had used the term “trans*.” The use of the asterisk is controversial: Some cisgender people have advocated for the asterisk to include transvestites, who are cisgender, so many trans people feel that it represents an attempt by cis people to encroach on the trans identity. “Somebody called me out on using [the asterisk],” Rubin said. “Wanting to do the right thing pushed me toward resources that helped me figure me out.”
In turn, that self-realization equipped Rubin with a way to push back against gendered language.
“Even before I figured out that I was trans,” Rubin said, “I’d not identified strongly with the label ‘woman.’ [So] it was kind of an overload when I came onboard [the organization] and started getting hammered with it. I felt so alienated before I even figured out why.”
This, Rubin continued, reflected the implicit and explicit discrimination they saw in the wider movement. “I was also made uncomfortable by the lack of respect shown to trans people in the movement. … It was really hard to hear, ‘I think genderqueer people are just confused,’ when I was trying on the label ‘genderqueer’ for myself,” they said.
As a result, Rubin said, “I was miserable under the weight of the assumptions. … I feel like I rushed myself out of the closet in order to confront them with someone they needed to respect. Because when I tried to advocate for myself, and people like me, without being able to say, ‘Hey, this is important to me as a trans person,’ I got such disappointing pushback. [But] once it was pointed out that there was a real problem that affected a real person that they saw every day, they changed.”
Parker Molloy, a journalist who is a transgender woman, sees gendered pro-choice slogans of the past as entirely compatible with an increasing understanding of gender variation—and a corresponding update to our word choice. For example, with regard to the frequently invoked phrase “Trust Women,” Molloy said, “In its truest, most earnest form, it is a promotion of bodily autonomy. It’s trusting an individual to make their own choices, and eliminating gatekeepers. … Trans existence and identities push back against social expectations, push back on the idea that someone else should be given control of our bodies, and push back on the concept that biology is destiny.”
“Trust Women,” in other words, is a call to respect bodily autonomy, and that same respect can now compel us to update our language.
The category “women” doesn’t map neatly onto the category “people who can get pregnant,” and not just because people who aren’t women can and do get pregnant. Many women, conversely, are unable to get pregnant. Some of those women are trans, and others have reproductive tract anomalies that make pregnancy impossible.
In addition, reproductive justice advocates, including trans activists, have called for deemphasizing anatomical language as a rallying call. A trans-inclusive worldview is one that acknowledges that there are women (and nonbinary people) who have testes and penises, and men (and nonbinary people) who have vulvas and vaginas. A laser focus on genital anatomy is one of the major ways that cisgender gatekeepers exclude, ostracize, and disbelieve trans people. Cisgender solidarity around presumed shared genital anatomy, too, is a way trans people are excluded and erased. Given that, it makes sense that centering reproductive rights language around specific anatomy can strike trans people as both deliberately exclusionary and reinforcing of their dysphoria.
Furthermore, rejecting anatomy-centered language is also about centering lived experiences. Objections from trans people and supporters to the constant association of “abortion” with “vaginas” have often been met with ridicule from many, including left-liberals: “How could abortion not be about vaginas? It involves a vagina! That’s how you get pregnant and where you have the abortion!”
To that I would simply ask: Is parenting about vaginas? Or, if you prefer: Is motherhood about vaginas? Would we use vaginas as the symbol of parenthood? Should we title, say, a maternity-leave advocacy group “Lady-Parts Leave Equality”? Should a proposed affordable child-care bill be called the “Vagina Defense Alliance”?
We wouldn’t, because we see that parenthood is about lives and families, and incidentally involves vaginas in the physical logistics along the way. Abortion, too, is about lives and families. Historically, it’s been anti-abortion activists who wanted to make abortion about naughty, dirty sex and vaginas; pro-choice activists saw abortion as being about autonomy, the full realization of all of us as humans, whether or not we have the capacity to get pregnant. So it’s perplexing to me to see mainstream left-liberals insisting on titling their abortion events after genitals. I’m all for refusing shame, but that’s an emphasis that detracts from the actual significance of abortions for the people having them.
And, again, it is not as if gender-inclusive language hurts cisgender women. As an abortion provider, I now make a practice of using it—not only when speaking about the issue on traditional and social media, but also when talking to my patients. Never once have I felt that any of my cisgender patients was harmed, confused, or distressed by my talking about “pregnant people.”
When we frame abortion access around autonomy, we should also understand this parallel: Justice for transgender people, too, is a question of bodily and personal autonomy. As physicians and as reproductive justice activists, we are called to recognize each person’s right to inhabit their true gender, rather than participate in forcing them into the category they were assigned at birth. That means that we must give primacy to people’s understanding of themselves. We can’t advocate that each pregnant person be able to effect the best decision for themselves—while simultaneously insisting that people who aren’t cisgender should go along silently with language in which they don’t exist.
As Molloy put it, “Abortion is an issue of bodily autonomy. Being trans is an issue of bodily autonomy. Abortion is a trans issue.” And, I’ll add, transness is a reproductive justice issue. The movement can’t deny trans people a seat at the table in the abortion conversation; they were already there. It’s up to everyone else to acknowledge them.
An Idaho senate committee on Monday approved a proposal that would effectively ban telemedicine abortion in the state, sending the bill to the full senate for amendment.
Though it doesn’t outright ban the practice, HB 154, the “Physician Physical Presence and Women Protection Act,” would institute a number of requirements on physicians that would make providing telemedical abortion care effectively impossible.
Among other provisions, the bill would prohibit dispensing abortion-inducing drugs unless a physician has examined the patient in person, has determined that the patient is not experiencing an ectopic pregnancy, and has the ability to provide surgical intervention in the case of an emergency, either through admitting privileges with a local hospital or through written agreement with local physicians who can provide emergency care.
The state house approved HB 154 this month, moving the proposal to the state senate for consideration.
Telemedicine abortion allows people who live in rural areas or at a great distance from a reproductive health-care provider to access medication abortion. Physicians can use video conference tools to remotely prescribe and direct the patient while she takes mifepristone, a drug used to terminate pregnancy.
Only two states, Iowa and Minnesota, make telemedicine abortion care available, and 16 states have outright banned the practice. These bans have come despite recommendations from the World Health Organization and the National Abortion Federation that physicians assistance and other mid-level providers can safely offer medication abortion.
An identical bill, HB 88, was also introduced in Idaho this session, though it has not moved out of committee. A bill similar to both was introduced in Idaho in 2013, but failed to pass.
Both state legislative chambers are dominated by Republicans, with a 29-8 senate majority and a 56-14 house advantage.
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