Women Beware! Birth Control, Abortion, and Your Healthcare Are at Risk

 

You’re a middle-class mom with two kids, a mortgage, a fragile marriage, and an elderly parent to care for when you find yourself pregnant. You’re a sexually active college student and because of a condom failure you’re pregnant. You’re pregnant with a wanted child when you learn your fetus has a serious anomaly and probably can’t survive outside the womb. You are a rural woman with limited income who gets routine healthcare at a Planned Parenthood now threatened with closure.

Variations on stories like these abound. For all kinds of women, and their advocates, they are terrifying, as federal and state legislators continue gunning for Planned Parenthood and vehemently resisting female autonomy, privacy, and decision-making.    

As a recent New York Times piece by the editorial board stated, “In its continuing assault on reproductive rights, the Trump Administration has issued potentially devastating changes to the nation’s nearly 50-year-old family planning program, Title X, which allows millions of women each year to afford contraception, cancer screenings, and other critical health services.”

To be clear, health clinics like Planned Parenthood have been barred from using federal funds for abortions, but they have been able to to offer non-federally funded abortions and other family planning services under one roof. Now the Department of Health and Human Services wants to make clinics that provide abortions navigate ridiculous regulations if they want to receive Title X funds. I mean ridiculous regs, like having separate entrances for abortion patients, or establishing an electronic health records system separate from their regular system. Providers will also be prohibited from making abortion referrals, or providing information that adheres to standards for “informed consent.”

In addition to threats at the federal level, more and more states are attempting to pass ridiculous anti-abortion laws, like requiring wider hallways or revamping janitor’s closets.

More Draconian is the unethical “domestic gag rule” that allows so-called “pro-life” staffers in Title X facilities to say a particular procedure doesn’t exist or to lie to patients about false risks of abortion.

As Dr. Leana Wen, the new president of Planned Parenthood, told The New York Times, “There will be many providers that will face an impossible decision: to participate in Title X and be forced to compromise their medical ethics, or to stop participating in that program,” a step that would lead to overwhelming demand for reproductive health care but not much in the way of supply to respond.

Since Roe v. Wade was decided in 1973, states have been constructing a maze of abortion laws that codify, regulate and limit whether, when and under want circumstances a woman can have an abortion, as the Guttmacher Institute points out. Major provisions to states laws, some on the books, other in litigation or defeated, include requiring that abortions be performed in a hospital or set gestational limits on abortion.

One example is the attempt to ban abortions when a faint heartbeat is detected, which can occur as early as six weeks, before a woman may know she is pregnant. Another is state restrictions on coverage of abortion in private insurance plans, and states allowing individual health care providers to refuse to participate in abortions. Some states mandate that a woman have counseling, including information on purported links between abortion and breast cancer, the ability of a fetus to feel pain, or long-term mental health consequences for the woman.

The Trump administration clearly wants to evict Planned Parenthood from the federal family planning program. It also hopes to ban abortion referrals. At the state level, early abortion bans called “heartbeat bills” are being proposed in several states. So far, five of them have advanced this legislation but every “heartbeat bill” passed to date has been overturned in state or federal court. With Judges Gorsuch and Kavanaugh on the Supreme Court, who know what will happen?

Five states have already passed preemptive “trigger laws” which would immediately ban abortion outright if Roe v. Wade is overturned.

Several abortion cases are currently in federal appeals courts or pending litigation in various states. Lawsuits are challenging such issues as required waiting periods, required ultrasounds, 15-week bans, admitting privileges, abortions for minors, and Medicaid coverage.

The situation, not only for women seeking their constitutional right to abortion, but for women – and men - seeking appropriate, quality, accessible, affordable reproductive health care ranging from preventive screening and contraception to treatment of sexually transmitted diseases, grows ever more dire as the Trump administration, and state legislators attempt to control what should be women’s private, personal decisions.

The irony is that rules rooted in anti-abortion (and anti-sex education) feelings threaten access to contraception, which prevents unwanted or unintended pregnancy and consequently increases health care costs in a nation where the cost of care is already skyrocketing.  Can anyone explain why that makes sense? 

More importantly, perhaps, can anyone fathom what would happen without Planned Parenthood?

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Elayne Clift writes about women, health, and social issues from Saxtons River, Vt.

www.elayne-clift.com

 

 

Let's Be Clear About Third Trimester Abortion

As a longtime women’s health educator and advocate, I was apoplectic when I read a recent commentary in my local newspaper by a “chaplain serving an elderly population” who is also “treasurer of the Republican Party” in my state and a “county party chair.”

The op.ed. proffered so many spurious and false assertions, often stated by others with far-right political views, that my hair was nearly on fire. Given where we are in this country regarding abortion, I felt compelled to address one of the egregiously uninformed views of the author, which I did in a Letter to the Editor.  It seems to me now important to share what I wrote for a wider audience, in the hope of reaching others inclined to make uninformed claims about a vital issue that affects so many lives and the culture in which we live. 

This is the claim that blew me away. It relates to a bill in my state proposing a law like ones in some other states protecting a woman’s right to abortion moving forward. “The bill goes far beyond Roe [v. Wade], guaranteeing unrestricted abortion through all nine months of pregnancy…” the author wrote. It’s a misleading claim that calls for revisiting the facts regarding the inaccurate use of the term “late term abortion.”

The first thing to note here is that abortion after fetal viability is a rare occurrence and usually involves a medical crisis. According to the US Centers for Disease Control and Prevention, abortions after 21 weeks make up less than 1.3% of all abortions in the United States. Abortions that occur beyond 24 weeks make up less than 1% of all procedures. Exceptionally rare cases that happen after 24 weeks are often because a fetus has a condition that cannot be treated and and that renders the fetus unable to survive, regardless of gestational age or trimester.

Secondly, the 14th amendment of the Constitution, which guarantees due process and equal protection under the law, was vital to the 1973 Supreme Court decision in Roe v. Wade. The 14th amendment also protects the right to privacy and the Court held that a woman's right to an abortion fell within that statute. By a 7–2 majority the Court ruled that unduly restrictive state regulation of abortion is unconstitutional. Importantly, the Court also determined the point of fetal viability as the “capability of meaningful life outside the mother's womb,” hence the 24- week marker. The Court’s decision gave women a right to abortion during the entirety of the pregnancy, however, while defining different levels of state interest for regulating abortion in the second and third trimesters.

It’s important to know that, as the Guttmacher Institute points out, if a physician determines that the child is “non-viable” and/or the abortion is necessary for the physical or mental health of the mother, a woman can have an abortion from the moment of conception until the child’s birth. State laws restricting third trimester abortions are unconstitutional under the precedent of Doe v. Bolton, a case in which the Supreme Court overturned a Georgia law. (Numerous states have laws that ban or restrict abortions in the third trimester. Because these statutes remain in place or haven’t been contested in federal court, they may imply that they are allowed by federal law. But because federal law trumps state law, no restrictions can be enacted that do not also allow the doctor to determine if abortion is necessary for the health of the mother.)

Here’s another fact: Overturning Roe and Doe won’t end all third-trimester abortions. When the Supreme Court throws the abortion issue back to individual states, third-trimester abortions will still be protected in states that reiterate prior standards for “viability” or “health.”

But here’s the most important thing for everyone to know. No woman decides to have an abortion after 24 weeks recklessly or without a great deal of anguish. Perhaps she does it because of a serious illness she has, like decompensating heart disease. Maybe her baby has a delayed diagnosis of anencephaly, which means the fetus forms without a complete brain or skull. There are a multitude of medical crises that can precipitate a third trimester abortion. But the decision is never taken lightly. In most cases, there is deep grieving and a profound sense of loss, brought about because of medical necessity and the wish that a much loved and wanted baby not suffer.

That’s why people like the man who wrote the troubling commentary – claiming that he “doesn’t oppose or seek to diminish women’s rights” and that he “supports [women’s] right to their own body and right to choose” -- people who misunderstand not just the right to abortion but the reasons women choose it, at any stage of pregnancy, must move beyond facile arguments, misstatements of fact, and feeble justifications. They must somehow begin to recognize that for many women, the choices they face are devastating and immensely complicated.  

Most urgently, they must find it in themselves to be compassionate and to resist judging those whose experiences and viewpoints differ from theirs. 

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Elayne Clift writes about women, health, politics, and social issues from Saxtons River, Vt. www.elayne-clift.com

 

Back to Barefoot and Pregnant Politics

 

In the late 1970s as I was beginning my career in women’s health, one of the first feminist icons I met of was a flamboyant, passionate, and deeply committed woman named Perdita Huston.  She had made her mark internationally working as a journalist and a Peace Corp professional, but what put her on the feminist map was her 1979 book Third World Women Speak Out

 

Huston’s book was remarkable because she was the first person to give women in the developing world a chance to tell their own stories. She gave them voice, and with that voice what they proclaimed most loudly was that they wanted fewer children, and they wanted those children to be educated.

 

It was a radical moment with far-reaching ramifications because it coincided with the early days of family planning becoming a goal of international funding agencies like the U.S. Agency for International Development (USAID). With the help of the Women in Development movement, spawned in large part by the Women’s Movement at large, donor organizations had begun to realize that family planning was key to a country’s economic and social development and that women’s reproductive health was an issue that mattered.

Subsequent years revealed that family planning was, indeed, a wise investment. Countries like Egypt and Bangladesh showed that once women controlled their fertility, families, communities, and countries benefited, whether by increasing educational opportunities for girls, widening agricultural opportunities for women, or bringing women into decision-making at some levels of society.

None of this happened quickly or easily; there are always naysayers and development “specialists” willing to argue against innovation (and empowering women), no matter how simple and effective an intervention may be. But gradually the world saw how important family planning was to the healthy development of nations, let alone women and their families.

Now fast forward to Trumpian times, in which the president has reinstated Ronald Reagan’s Mexico City Policy of 1984 – revoked by Bill Clinton, restored by George W. Bush, and revoked by Barack Obama - in which nongovernmental organizations are forbidden to receive U.S. federal funding if they perform or promote abortion in other countries. 

Trump goes even further. His administration, including the Departments of Health and Human Services, Treasury and Labor, wants to make it easier for employers to deny contraceptive coverage to their employees if the employer has “a religious or moral objection” to doing so. The administration also wants to make it harder for women denied birth control coverage to get no-cost contraception directly from insurance companies, as they have been doing.

In an attempt to rush this through, the administration made the absurd claim that taking time to seek public comment would be “contrary to the public interest,” and went so far as to say that coverage of contraception could lead to “risky sexual behavior,” a nod to those who believe women’s sexuality is evil.  Not only is that one huge misogynistic insult to women; what is riskier than setting women up for unwanted pregnancies while trying to eliminate safe abortion and shut down Planned Parenthood?

 These actions are a setback of huge proportion. They affect not just American women, but women around the world.  In Madagascar, for example, the change in policy is forcing dramatic cutbacks by the largest provider of long term contraception in the country, Marie Stopes International (MSI), which receives millions of dollars from USAID for its work there. Ironically, abortion is illegal in that country, but MSI cannot receive American aid because it will not renounce abortion as part of reproductive health services in other parts of the world.

Hundreds of women and girls flock to remote MSI clinics where they receive everything from malaria prevention to HIV treatment to contraceptives. It’s a scene repeated all over the developing world no matter who is providing services. What is to become of all those women?

The policy, already making its way to the courts, is clearly aimed at mollifying organizations like March for Life and Real Alternatives, anti-abortion groups that don’t qualify for religious exemptions but claim to hold strong moral convictions unrelated to a particular religion.

In his long string of lies, Trump and his administration have claimed, absent of any evidence, that its new rules won’t have an effect on “over 99.9 percent of the 165 million women in the United States,” while simultaneously arguing that low-income women will still be able to get subsidized or free contraception through community and government health programs. All this while the administration plans to substantially cut government spending on such programs.

The President’s attack on birth control, safe and accessible abortion, and the Affordable Care Act is low on intelligence and high on lies. It is spiteful, vindictive, woman-hating, and downright mean. It will hurt millions of women and their families. There are only two ways to describe it: utterly inhumane and grossly misogynistic. Everyone should be resisting mightily.

Where Are Women's Organizations in the Fight for Reproductive Rights?

In 411 BC, a comedy by Aristophanes rocked Greece. Lysistrata was a play about one woman’s mission to end the Peloponnesian War by persuading other women to withhold sex from their husbands and lovers until they had negotiated a peaceful settlement.

More than two millennia later, on October 24, 1975, 90 percent of women in Iceland went on strike for a day in the name of economic and social justice. They refused to go to work, to cook or to take care of children. It called to a halt every sector of the country.

On April 25, 2004 the national Mall in Washington, DC witnessed the March for Women's Lives which drew over 800,000 people. Organized by the Feminist Majority, NARAL Pro-Choice America, NOW and Planned Parenthood Federation of America among others multi-generational attendees focused on reproductive rights alongside entertainers, politicians and icons of the feminist movement. The press had a field day.

Each of those events represents a strategy for social change that helped shape history. I’m wondering where such strategies are now among women’s organizations.

Following the recent Black Lives Matter marches that were so effective in garnering media attention and which helped push President Obama to call for renewed efforts to enact new gun-related regulations, I began to wonder why there isn’t a more visible, strategic presence among women’s organizations given the growing attacks on women’s reproductive rights at both national and state levels.

While I recall the power of the many marches I participated in during the 1980s in which issues such as abortion, women’s privacy and their human rights were captured through sheer numbers, compelling personal testimonies, and a responsive media, I’m not necessarily making a case for such mass protests as the best strategy. I understand that from police protection to publicity to Porta-potties, such events involve extraordinary organizational skills and plenty of personnel. They are also hugely expensive. I also know that many of the marches of my day had less than the desired impact on legislation.

I get as well that social media and the Internet have changed the way organizations do things in major ways. But beyond asking people to sign petitions and donate money what is their impact in the absence of human-face, big numbers activism? What exactly is the social media strategy? And what is being done to augment it? (I ask these questions while acknowledging Planned Parenthood’s impressive use of social media under the leadership of Cecile Richards.)

So I decided to put these questions to more than half a dozen key women’s organizations – including the very ones that had organized the 2004 March for Women’s Lives. It breaks my heart to report that with one exception none of them even bothered to answer my repeated calls and emails, even though I’m a bona fide journalist with a certain amount of name recognition among these groups. (Perhaps, like the National Organization for Women they’re too busy promoting “pink Viagra”). The one organization that responded after much prodding was Naral Pro-Choice America; they sent me a bit of canned PR stating that they were “committed to amplifying the voices of Americans who believe that women should be in charge of their own healthcare choices.” The piece mentioned “in-person rallies” and “online petitions” and “getting Google and Yahoo to remove their false advertising.” It said they had challenged TED Talks “to change their policy from one that excludes abortion talks to one that embraces them.” 

 Excuse me? That’s it?

One woman I did talk to was Donna Dees-Thomases, who organized the highly successful Million Mom March in 2000 calling for an end to gun violence. The march, which boasted 750,000 people in Washington, DC and 250,000 others marching in satellite rallies in over 70 American cities on Mothers Day that year, led to a highly successful grassroots movement in which chapters were established around the country. Now united with Handgun Control, Inc. and the Center to Prevent Handgun Violence and known as the Brady Center, their chapters continue to advocate for gun violence prevention legislation primarily at the local and state levels, resulting in many legislative successes. That’s strategy at work.

“Women are organizers,” Dees-Thomases told me, explaining the successes the Brady Center has had. “They’re out in front and they’re making an impact.” At the same time, she thinks too many women in leadership may have become “institutionalized thinkers.” They don’t realize, she explains, that, for example, simply organizing and assisting a few women to visit their state legislators, to testify, to write letters can have a big impact. In other words, it seems to me, they no longer think strategically, or put effort into that kind of activism.

They don’t even bother talking to feminist journalists anymore, it seems, and that gives me pause (especially when I pull out my checkbook.) It also leaves me wondering where the women’s movement goes from here. I guess I won’t be waiting for a callback on that.