Published: Sat, 29 Apr 2017 00:00:00 -0400
Last Build Date: Sat, 29 Apr 2017 01:54:47 -0400
Tue, 21 Mar 2017 15:30:00 -0400
(image) A provision in the Republican health care bill would bar Medicaid patients from choosing Planned Parenthood clinics for covered care. The idea, ostensibly, is to curtail abortion by driving Planned Parenthood out of business. Some folks also argue that the move is fiscally responsible. But contrary to conservative talking points, terminating Medicaid's relationship with Planned Parenthood would neither drive down costs for the publicly-funded health insurance program nor reduce dependence on abortion, as I note in today's Los Angeles Times.
If, as Republicans insist, patients can seek all the same services elsewhere, Medicaid costs will remain unchanged. The move won't necessarily affect Planned Parenthood's ability to provide abortions, since it doesn't rely on Medicaid reimbursements for this service. At the same time, less access to contraception and family-planning services could lead to greater demand to terminate pregnancies.
Presently, the U.S. health care scene is totally ill-equipped to handle the influx of low-income, reproductive- and sexual-health care patients we would see if we simply strip Planned Parenthood from patient options. America is already experiencing a shortage of obstetricians and gynecologists, many private providers won't see Medicaid patients, and community health centers are stretched thin as it is. Meanwhile, more than half of the approximately 2.8 million patients Planned Parenthood sees annually cover their visits via Medicaid. Like it or not, Planned Parenthood—which provides everything from cervical cancer screenings and urinary tract infection treatment to emergency contraception, prenatal care, and vasectomies—is currently a crucial part of the medical care and family-planning ecosystem.
Want to reduce dependence on Planned Parenthood? Look at why it's so popular among Medicaid patients in the first place, what alternatives currently exist (not a lot), and how we can remedy this dearth of alternatives. In many cases, government rules are to blame. But simple changes—allowing birth control pills to be sold over-the-counter; clearing the regulatory way for telemedicine; rethinking scope-of-practice rules that prevent nurse practitioners, pharmacists, and midwives from performing tasks they're perfectly capable of; and repealing regulations that prevent non-traditional providers (like mobile or retail health care clinics) from setting up shop in medically underserved areas, for starters—could go a long way toward making it so Planned Parenthood isn't the only OB-GYN option for many. And as I argue in the Times,
Helping bring more medical options to marginalized populations is a worthy goal for even the most ardent Planned Parenthood supporter.
Whether one's underlying goal is ensuring access to vital reproductive and sexual healthcare, reducing women's need for abortions, or reducing publicly funded healthcare expenditures, focusing on breaking down barriers to innovative, independent and cost-effective care in underserved areas will make a world more difference than micromanaging where poor women can get birth control pills.
Read the whole thing here.
Mon, 20 Mar 2017 12:30:00 -0400Conservative starlet Tomi Lahren is facing a heap of backlash from her usual supporters after an appearance on ABC's The View in which she defended the decriminalized status of abortion. Lahren, who hosts a popular show (Tomi) for Glenn Beck network The Blaze and is a frequent guest on Fox News programs, said that as someone who "loves the Constitution" and believes in limited government she can't support the government "decid[ing] what women do with their bodies." "I'm pro-choice," Lahren admitted, calling it hypocritical to profess support for small government yet want to ban abortion. "I'm for limited government, so stay out of my guns, and you can stay out of my body as well." Contra Lahren's critics, this is a perfectly coherent position, and one that was once perfectly respectable within the mainstream conservative movement. There's only tension between believing abortion should be legal—which is all being "pro-choice" means—and the Constitution's prescription of "life, liberty, and property" protection for all if you believe that personhood begins at conception. But one needn't believe this, nor even be a Christian at all, in order to champion conservative political philosophy. And even if one does believe that abortion is an immoral practice, it doesn't necessarily follow that one must wish it banned completely. There are plenty of pro-life Americans who believe a blanket ban on abortion is not the best way to end the practice, given how black markets work. They instead strive to end abortion through changing hearts and minds, advocating better pregnancy-prevention methods, working to expand adoption options, and things like that. Again, this might seem horrific to people who believe that aborting an eight-week old fetus is the exact same as murdering a 2- or 20- or 80-year-old, but that's a matter of moral or religious perspective. Many others who believe abortion is wrong are simultaneously able to hold that it's not the same degree of wrong as ending a life outside the womb, or that the competing rights of pregnant women make abortion morally justifiable in some circumstances. Listen, I am not glorifying abortion. I don't personally advocate for it. I just don't think it's the government's place to dictate. https://t.co/qRjbAtJdo7 — Tomi Lahren (@TomiLahren) March 19, 2017 These are all positions that can convey coherent internal logic and political/moral belief systems. You may think folks like Lahren—who says she is personally against abortion, even though simultaneously pro-choice—are wrong, and that abortion is always the gravest of transgressions or never so, but it's erroneous and unfair to brush aside their beliefs as simple stupidity, hypocrisy, opportunism, or cowardice. It's exactly this kind of reflexive dismissal of differing beliefs and moral gray areas that keeps us locked in the stupidest kind of culture war over abortion, one that manifests in it being the most important litmus test for acceptance into political movements on the right and left and results in a host of high-profile, symbolic battles that all lead back to the same status quo. Anyway, a lot of conservatives have been calling for Lahren's head since her View appearance, insisting it's an embarrassment and an outrage that such a pro-choice harpy could be a public face of Republicanism. As with Milo Yiannopoulos—who said all sorts of horrible things about women, Muslims, transgender people, etc., but was only ousted from polite conservatism after joking about pedophilic priests—it's telling (if predictable) that tepidly pro-choice views are the dealbreaker for the right with Lahren, while things like calling Black Lives Matter activists "the new KKK," referring to the Middle East as a "sandbox" that needs to be bombed, and defending the shooting of unarmed black men by cops never really rustled Republican jimmies.[...]
Mon, 23 Jan 2017 15:00:00 -0500On his first Monday in office, Donald Trump signed executive orders instituting a hiring freeze for all federal government positions outside the military and reinstating a ban on international aid going to nonprofits that provide abortions or promote information on them, regardless of what other services they offer. The contentious abortion rule represents a back and forth that's been taking place under Republican and Democratic administrations since the 1980s. Known as the "Mexico City Policy," it was instituted under President Ronald Reagan, reversed by Bill Clinton, restored by George W. Bush, and again reversed by Barack Obama. Not to be confused with the 1973 Helms Amendment, which bans groups from using U.S. government funds directly for abortion services abroad, the Mexico City Policy targets broader conduct, requiring that "as a condition of their receipt of federal funds," groups must agree to "neither perform nor actively promote abortion as a method of family planning in other nations." A diverse group of more than 100 public health, women's issues, and civil liberties organizations have already issued a statement opposing the return of the Mexico City Policy, which they refer to as "the global gag rule." "The global gag rule ... interferes with the doctor-patient relationship by restricting medical information healthcare providers may offer, limits free speech by prohibiting local citizens from participating in public policy debates, and impedes women's access to family planning by cutting off funding for many of the most experienced health care providers who chose to prioritize quality reproductive-health services and counseling over funding that restricts care and censors information," it says. Groups endorsing the statement include the American Civil Liberties Union, the American Congress of Obstetricians and Gynecologists, Amnesty International USA, the National Organization for Women, the Alliance to End Slavery & Trafficking, the Unitarian Universalist Women's Federation, the International Medical Corps, New York University's Global Justice Clinic,and Human Rights Campaign. The Mexico City Policy is one of several federal aid conditions that have been contingent on controversial social issues. Since 2003, the U.S. has banned groups that get grants to fight HIV/AIDs and/or human trafficking from supporting the decriminalization of prostitution. Referred to as the anti-prostitution pledge, the policy was proposed for anti-HIV groups as part of Bush's "Emergency Plan for AIDs Relief," passed by Congress in May 2003 as the "United States Leadership against HIV/AIDS, Tuberculosis, and Malaria Act." It stipulated that no grant money could be used "to promote or advocate the legalization or practice of prostitution or sex trafficking" nor to "provide assistance to any group or organization that does not have a policy explicitly opposing prostitution and sex trafficking." The anti-prostitution pledge was also part of the bipartisan 2003 reauthorization of the Trafficking Victims Protection Act (TVPA), which stated that no federal money "may be used to promote, support, or advocate the legalization or practice of prostitution" and no funds "may be used to implement any program" by an organization that "has not stated in either a grant application, a grant agreement, or both, that it does not promote, support, or advocate the legalization or practice of prostitution." Many public-health and human-rights groups opposed these policies on the grounds that decriminalizing prostitution is often supported as a means to stop the spread of sexually-transmitted infections and sex trafficking by force, fraud, or coercion. The pledge was initially applied only to foreign nonprofits, but in 2005 the Bush administration began applying it to U.S. groups, too. In 2013, the U.S. Supreme Court ruled that the part of the pledge requiring anti-HIV/AIDs groups to explicitly denounce prostitution was unconstitutional as it violated the First Amendment. "This case ... is about com[...]
Tue, 03 Jan 2017 09:30:00 -0500
(image) President-elect Donald Trump has promised to appoint Supreme Court justices who will overturn Roe v. Wade, the seminal 1973 case affirming a right to legal abortion across America. If it happens, it won't be a popular move. According to a new poll from the Pew Research Center, less than one-third of Americans think that Roe should be overturned.
In the Pew poll, conducted November 30 through December 5, 2016, just 28 percent of respondents said they hoped the historic ruling would be history, while 69 percent—including a majority of Republicans—said the Supreme Court should leave Roe alone. Among Democrats or Democratic-leaning respondents, 84 percent said they did not want to see Roe overturned, while 53 percent of Republican respondents agreed.
Among respondents who described themselves as "moderate" or "liberal" Republicans, only 27 percent supported overturning Roe, ccompared to 57 percent of those who described themselves as "conservative" Republicans.
"Public opinion about the 1973 case has held relatively steady in recent decades, though the share saying the decision should not be overturned is up slightly from four years ago," Pew notes. In January 2013, 63 percent said that Roe should not be overturned. In 2003, it was 62 percent and, in 1992, just 60 percent.
Republican opinion remains little-changed since 1992, when 52 percent of GOP respondents told Pew they support Roe v. Wade. At that time, just 66 percent of Democrats said the same.
Men were slightly more likely to support overturning Roe than were women (30 percent, versus 26 percent). And contra claims that America is getting less pro-choice, those age 50 or older were more likely than their younger counterparts to say Roe should go (33 percent, versus 24 percent).
Education was also associated with a divide on Roe, with 35 percent of respondents who had a high-school education or less saying it should be overturned but just 23 percent of those with a college degree and 12 percent of those with a post-graduate degree saying so. And while Catholic and Protestant support for overturning Roe was roughly equal—34 percent and 35 percent, respectively—nearly half of white, evangelical Protestants said they think Roe should be overturned.
Wed, 07 Dec 2016 11:08:00 -0500A measure that would ban abortion after a fetal heartbeat can be detected—that's around three- to four- weeks post-conception—has managed to pass both houses of the Ohio legislature, despite the fact that federal courts have struck down all similar bans as unconstitutional. The measure, which cleared the Senate Tuesday as a last-minute addition to a larger bill concerning state child-abuse laws, states that "except when there is a medical emergency or medical necessity," Ohio doctors shall not perform abortions "if it has been determined that the unborn human individual the pregnant woman is carrying has a detectable fetal heartbeat." Detection of a fetal heartbeat is "a milestone with no meaning to the federal laws governing abortion," as Molly Redden noted back in 2013, when Arkansas and North Dakota first passed heartbeat-based abortion bans. But "the people who support these laws dream that they will provide a legal basis for overturning Roe v. Wade," in which the U.S. Supreme Court said states cannot ban abortion before a fetus could live on its own outside of the womb. Generally, a fetal heartbeat can be detected at a "gestational age" of around six weeks. But gestational age is calculated from the first day of a pregnant woman's last menstrual period, and doesn't actually refer to the number of weeks a zygote or fetus has existed. A gestational age of six weeks means it's been some three to four weeks since an egg was fertilized. In effect, a measure like the one Ohio approved would ban abortion at a point in pregnancy when many women don't even realize they're pregnant yet, and long before common chromosomal and developmental abnormalities can be detected. And even if a pregnant woman takes a test exactly 28 days after the start of her last period, that leaves her with just about two weeks to come to a decision about the pregnancy and then obtain the money for, schedule, and obtain an abortion (all while circumventing Ohio's various waiting periods), in a state where many women live hours from the nearest abortion clinic. This could put the heartbeat bill at odds with not just Roe but the more recent Planned Parenthood v. Casey. That case upheld the idea "that the Constitution protects a woman's right to terminate her pregnancy in its early stages," but presented a new standard for analyzing whether restrictions on abortion were unconstitutional: did they pose an "undue burden" on women's access to abortion. Even if a fetus could somehow be declared viable at around a month old, presenting women with a mere one or two week window to terminate a pregnancy would seem to fail the undue burden test. Many prominent anti-abortion advocates have opposed measures like Ohio's heartbeat bill, recognizing that they "have no chance in the courts," as Paul Linton, author and former general counsel for Americans United for Life, has said. State and federal courts have struck down such measures from Arkansas and North Dakota, with North Dakota's bill going all the way to the U.S. Supreme Court. In January, the Court upheld a lower court's ruling striking down the measure. But that was before the death of Justice Antonin Scalia and the election of Donald Trump. A future Supreme Court could perhaps rule differently. Ohio Senate President Keith Faber (R-Celina) said repeatedly that previous versions of the heartbeat bill weren't worth passing because they would be struck down as unconstitutional, but "Trump's election changed the dynamic," he said. It's unclear whether Ohio Gov. John Kasich will sign the heartbeat bill into law. Just as the detection of a fetal heartbeat has no particular relevance to federal abortion guidelines, it's a similarly poor marker of moral or medical significance. Our ability to detect a fetal heartbeat means nothing in terms of a fetuses' consciousness or ability to feel pain or viability outside the womb (all of which won't come until later). But it comes after the point of "personhood" th[...]
Fri, 04 Nov 2016 13:15:00 -0400
(image) The percentage of Americans who believe abortion should be legal in all or most circumstances is at the highest it has been in more than two decades, according to the latest national poll from Pew Research Center. In the October 20-25 survey, 59 percent of respondents said abortion should be generally legal, while just 37 percent said it should be banned in all or most circumstances. "Support for legal abortion has fluctuated in recent years," Pew noted, "but is at its highest level since 1995."
Among Republicans only, beliefs about abortion in the latest poll were almost directly inverse that of the general U.S. population, with 62 percent of Republican respondents saying abortion should be illegal in all or most cases and just 34 percent saying the opposite. There was little difference among men and women, with 32 percent of Republican women and 36 percent of Republican men expressing pro-choice views.
Meanwhile, more than three-quarters of Democrats (79 percent) say abortion should be legal most of the time—up from 70 percent in Pew's March survey—and just 18 percent say it should generally be illegal.
"The partisan gap in support for legal abortion, 45 percentage points, is at its widest point in close to a decade," Pew points out.
On the Democrat side, it's women who have driven the increase in pro-abortion sentiment since the Pew's March poll. In that one, 68 percent of Democratic women and 75 percent of Democratic men said abortion should generally or always be allowed. In October's poll, the percentage of Democratic men saying the same was down slightly, at 71 percent, but the percentage of Democratic women who said abortion should mostly or always be legal shot up 18 percentage points, to 85 percent.
Mon, 31 Oct 2016 15:42:00 -0400While the overall U.S. abortion rate continues to decline, a growing percentage of legal abortions in America are being induced via drugs, not surgery, with 43 percent of abortions at Planned Parenthood clinics relying on this method in 2014. That's up from 35 percent in 2010, according to a Reuters analysis of clinic data. And in states without strong legal restrictions on abortion pills, the rates relative to surgical abortion were even higher. In Michigan, they comprised 55 percent of all abortions and in Iowa, 64 percent. The two medications used for drug-induced abortions in America—mifepristone and misoprostol—were approved by the U.S. Food and Drug Administration (FDA) 16 years ago. "The method was expected to quickly overtake the surgical option, as it has in much of Europe," Reuters notes. "But U.S. abortion opponents persuaded lawmakers in many states to put restrictions on their use." Most of these state restrictions have been rooted in religion, ideology, and politics rather than good-faith concern for women's safety. Taking mifepristone and misoprostol to terminate a pregnancy—aka medical abortion (in contrast with surgical abortion)—has been found just as safe if not safer than surgical abortion, and it doesn't require a woman to be put under anesthesia or undergo an invasive procedure. Even more revolutionary, this sort of abortion doesn't require—at least not for medical reasons—a visit to a hospital or any sort of specialized abortion clinic, nor the employ of a specialized doctor. After a basic health check-up and an ultrasound to determine gestational age (the pill regimen is only recommended and approved up to 10 weeks pregnancy), the whole process involves ingesting one pill and, within the next 72 hours, ingesting another pill. This isn't to say medical abortion is an easy process for women, who report extreme cramping, nausea, and other difficulties for a few hours to a few days after taking the pills. But it is, for many women, easier than obtaining a surgical abortion, with one of the biggest benefits being that it can cost significantly less. This, combined with its ability to take place outside a special health facility, makes it much more accessible to rural and low-income women. And increased accessibility may lead, in turn, to earlier pregnancy terminations. Since medical abortion has been legal in the U.S., the percentage of abortions performed in the first six weeks gestation has grown significantly. According to the U.S. Centers for Disease Control and Prevention (CDC), the percentage of U.S. abortions occurring within the first six weeks of pregnancy rose 24 percent between 2003 and 2012. Meanwhile, the percentage of abortions occurring at or after 13 weeks remained relatively unchanged. This means the biggest shift was from abortions occurring between weeks six and 13 toward those occurring between weeks one and six. This doesn't necessarily mean medical abortions drove the shift to earlier abortions, but it is one plausible (partial) explanation, given the simultaneous growth in medical abortions as a share of overall (and especially early-term) procedures. Between 2001 and 2011, medical abortions went from 6 percent of all abortions to 23 percent, according to the CDC's most recent report. Some have worried that the increased availability of abortion drugs has or will lead to an increase in the total number of abortions that occur in America. But so far, these fears seem to be unfounded: between 2002 and 2011, the total number of U.S. abortions decreased 13 percent, according to the CDC. The abortion rate—the number of abortions per every 1,000 women ages 15- to 44-years-old—was also down, by 14 percent, to 13.9 abortions per 1,000 women. And this rate is down from nearly 30 abortions per 1,000 women in 1980. The bottom line is that U.S. women are both getting fewer abortions and, when they do, having them e[...]
Fri, 21 Oct 2016 08:00:00 -0400In the U.S., most abortions are procured within the first 12 weeks of pregnancy. Yet our political discussions about reproductive freedom frequently center on late-term abortions. And so it went Wednesday during the final 2016 presidential debate, with a segment on Roe v. Wade quickly devolving into arguments about "partial birth abortion." In Hillary Clinton's ideal world, "you can take a baby and rip the baby out of the womb of the mother just prior to the birth of the baby," Donald Trump told debate viewers. "Based on what she is saying and based on where she's going and where she's been, you can take baby and rip the baby out of the womb. In the ninth month. On the final day." As many people have pointed out, this is not true, at least not in any meaninful way. While there are a few states where a woman could theoretically get an elective abortion at any point in pregnancy, it would not be done via "intact dilation and evacuation"—the medical term for the procedure people refer to as "partial birth abortion"—or anythng like "rip[ping] the baby out of the womb." And while intact dilation and evacuation (D&X) is legal when a woman's life is at stake if she doesn't terminate the pregnancy, there's little chance a woman who's been wanting her pregnancy up until that point, or the doctor treating her, will choose D&X when there are less controversial and legally ambiguous ways to accomplish the abortion. There's also little evidence that anyone actually chooses to terminate a pregnancy "at nine months." Just a little over 1 percent of U.S. abortions take place at any point after around five months pregnancy. Trump's understanding of how abortions work, and when they are and aren't allowed, is severely lacking. But he's not alone: a lot of people seem to believe that U.S. laws permit any pregnant woman to abort a fetus at any time for any reason. So let's take a closer look at later-term abortion laws in America... "Partial-birth abortion" is illegal in the U.S. Politicians who bring up "partial birth abortion" do so because they know it can spur strong and visceral reactions of disgust and moral indignation, not because it's especially relevant to U.S. health care, morals, or laws circa 2016. For 13 years, since 2003, federal law has prohibited physicians from performing D&X procedures, aka partial birth abortions, at any point in a pregnancy. Almost a decade ago, in 2007, the Supreme Court upheld the ban as constitutional. In addition, 19 states have their own laws against these sorts of abortions. While the federal ban does include an exception for situations where the mother's life is endangered, abortion doctors claim they avoid the procedure anyway, as there are other options with less liklihood of legal repercussions. Even before the federal ban, D&X procedures accounted for just 0.2 percent of all abortions, and most of these were performed before the point where a fetus can feel pain or survive on its own outside of the womb. Late-term abortion is illegal in most of the U.S. A typical human pregnancy lasts 38 weeks after an egg is fertilized. Only seven states and the District of Columbia allow abortion at any point during a pregnancy, according to reproductive-research org the Guttmacher Institute. In the other 43 states, abortion is banned—with limited exceptions, such as for the safety of the mother—after the second trimester, after the point of fetal viability (when a fetus could live on its own outside the womb), or after a specified number of weeks (generally 20-24). When exceptions are required, many states require two physicians to sign-off on the procedure before it's permissable. Very few U.S. women abort after 20 weeks pregnancy. Even with late-term abortion allowed in some parts of the country and under certain circumstances, nearly all abortions performed in the U.S. happen before the end of the second tr[...]
Wed, 19 Oct 2016 14:30:00 -0400Christian leader James Dobson, founder of Focus on the Family, is urging the owners of pro-life pregnancy centers in California to practice civil disobedience in the face of a new rule dubbed "The Reproductive FACT Act" by state legislators. "If California attempts to enforce this law," Dobson said in a Tuesday statement, "then do not comply. Make them put you in jail." The measure requires all licensed pregnancy clinics to post and distribute the following notice: "California has public programs that provide immediate free or low-cost access to comprehensive family planning services (including all FDA-approved methods of contraception), prenatal care, and abortion for eligible women. To determine whether you qualify, contact the county social services office at [phone number]." Pregnancy centers that do not offer medical services and are not licenced by the state must post signs announcing that the facility "is not licensed as a medical facility by the State of California and has no licensed medical provider who provides or directly supervises the provision of services." A lawsuit challenging the measure on First Amendment grounds was rebuffed by the U.S. Court of Appeals for the 9th Circuit last week, upholding a lower court decision not to halt enforcement of the law. "Christians across America must express their outrage at the Ninth Circuit Court's ruling to uphold California's so called 'Reproductive FACT Act,'" said Dobson. "Since Roe. V. Wade, privately funded crisis pregnancy centers across America have provided a refuge and an alternative to women who might have otherwise chosen abortion. ... This ruling now forces these clinics to violate their sincerely held religious beliefs, and it is an affront to our constitutionally mandated rights to life and to religious freedom." "This decision is further affirmation of the importance of this presidential election," said Dobson. "Hillary Clinton or Donald Trump will be responsible for appointing the replacement of Antonin Scalia, and–in all likelihood–two to three other Supreme Court Justices. That court will eventually decide whether or not this remains the law in California and becomes law across America." Lawyer Ken White, of Popehat, has more about the California law and the court's decision, which is worth reading if you care about why the 9th Circuit decided how it did. A lot of it turned on the level of scrutiny being applied. When a court applies scrutiny, it's holding the government's justification for a challenged law to a standard. How tough the standard is depends on the nature of the law and how the plaintiff says it's defective. In some situations, courts apply strict scrutiny — for instance, laws that punish speech based on its content generally trigger strict scrutiny. If a court applies strict scrutiny, the government must show that the law in question serves a compelling government interest and is narrowly tailored to achieve that interest. Practically speaking, applying strict scrutiny almost always means that the court will strike down the law. In the middle you've got intermediate scrutiny, which requires the government to show that the law promotes an important government interest and is substantially related to that interest. At the low end you've got the "rational basis" test, which almost any law can pass. In this case, the Ninth Circuit decided the compelled speech in question was "professional speech," which triggers intermediate scrutiny. White notes that "content-based speech regulation often—usually—triggers strict scrutiny." But in this case, "the court said that while the law is content-based, it's viewpoint-neutral—that is, it does not discriminate based on one particular opinion or view, and applies to all clinics regardless of how they feel about abortion." "The 'viewpoint neutral' argument seems odd here,[...]
Mon, 27 Jun 2016 17:36:00 -0400In its first significant abortion ruling since 1992, the U.S. Supreme Court Monday held that Texas abortion regulations were unconstitutional. As Damon Root noted here earlier, the 2013 Texas statute, known as H.B. 2, was "one of the strictest anti-abortion laws in the United States." With four liberal-leaning justices and three strict conservatives on the Court, Justice Anthony Kennedy was the swing voter in this case, and his siding against the state of Texas tipped the scales to Whole Women's Health clinic favor by a vote of 5-3. The decision means Texas can't require all abortion doctors to obtain admitting privileges at a nearby hospital nor force abortion clinics to meet surgical-center standards regardless of whether they perform surgical abortions. With similar regulations recently passed—and challenged in court—across the country, the Court's ruling could effect abortion access in all regions of the U.S. The Court found that the Texas restrictions (more background on them here) put an "undue burden" on women seeking abortions without serving a legitimate interest of the state—i.e., keeping patients safe or holding doctors and clinics accountable). "Neither of these provisions offers medical benefits sufficient to justify the burdens upon access that each imposes," wrote Justice Stephen Breyer for the majority. "Each places a substantial obstacle in the path of women seeking a previability abortion, each constitutes an undue burden on abortion access, and each violates the Federal Constitution." Backhanded regulation of abortion clinics sold under the guise of women's safety has been one of the most popular, and successful, tactics of the pro-life movement in recent years. More than 20 U.S. states require abortion clinics to meet ambulatory surgical-center standards, according to the Guttmacher Institute, and more than 14 states say abortion doctors must have some affiliation with a local hospital. These "TRAP laws" (targeted regulation of abortion providers) have forced shut abortion clinics in Texas, Virginia, Mississippi, and elsewhere. Against this backdrop, the Supreme Court's decision matters far beyond Texas—and not just geographically. It gets to a fundamental debate about legal abortion in America, one last opined upon federal in 1992's Planned Parenthood v. Casey: is abortion a limited right subject to strong state subjectivity or a fundamental constitutional right with which legislatures may not interfere? "Today, the Supreme Court reaffirmed that the Constitution protects not just the theoretical right to abortion, but the right of a woman to actually get one without unwarranted interference from politicians," said Jennifer Dalven, director of the Reproductive Freedom Project at the American Civil Liberties Union (ACLU), on Monday. "The decision should send a loud signal to politicians that they can no longer hide behind sham rationales to shut down clinics and prevent a woman who has decided to end a pregnancy from getting the care she needs." Its "effects are likely to be felt around the country," stated the ACLU. The Supreme Court's decision doesn't automatically invalidate state laws similar to Texas' H.B. 2, but should they be challenged in court (and many already have been), state judges now have the SCOTUS decision to serve as a precedent, making their revocation likely. Still, as Vox writer Sarah Kliff noted, "one thing that stands out about the Texas case is that it was very facts-based: Justices wrote extensively about the effect the law was having on clinic closures, the distance that women had to drive, and their overall access to abortion. So there is a possible world in which abortion opponents try to mount a defense with different facts — if they can make the argument that in their state, abort[...]
Tue, 24 May 2016 16:02:00 -0400Feticide laws were originally enacted to punish crimes against pregnant women that also result in the death of the fetus inside her. Indiana is now using its feticide law to punish a woman for possibly self-inducing an abortion. Last year, the state sentenced Purvi Patel to 20 years in prison for taking the abortion pill without a doctor's supervision—or at least that's how Patlel's supporters portray the situation. The complicated and controversial case came before the Indiana Court of Appeals on Monday. According to documents from Patel's trial, she became pregnant in 2013 and decided to have an abortion because she feared what her religious parents would think. But Patel was also worried that it was too late for her to be prescribed the abortion pill, which is only approved for use through the ninth week of pregnancy. Text messages she sent to a friend said she had ordered the drugs herself from a pharmacy in Hong Kong, although Patel's defense claimed at trial that she never took the drugs. Indeed, testing found no traces of the abortion drugs in Patel's system. But as Homicide Crime Scene Technician Tom Cameron testified at Patel's trial, there is no scientifically reliable way to test for those medications. The situation came to the attention of police when Patel showed up to the St. Joseph hospital emergency room with excessive bleeding. When pressed, she claimed that she had miscarried, giving birth to a stillborn. Patel said she deposited the stillborn fetus in a dumpster behind the restaurant (owned by Patel's family) where she worked. Hospital staff reported this information to local police, who then found the fetus and arrested Patel. She was charged with both feticide and child neglect. Prosecutors said the charges were not contradictory, as Patel could have illegally attempted to terminate her pregnancy, given birth to a live child anyway, and then let it die. A jury agreed, finding her guilty on both accounts. Appearing before the appeals court yesterday, Patel's lawyer, Lawrence Marshall, argued that "the evidence in this case [for a child neglect charge] was not there whatsoever. Not a single expert ever said—in any sort of declarative way—that yes, this infant would have survived had Ms. Patel done differently." As for the feticide charge, Marshall argued that Indiana's feticide statute was not intended to be applied to women for "unlawful abortion." The state, of course, claimed otherwise. It's not clear when the appeals court will issue its decision. "If this case were only about a woman who clearly gave birth to a live baby and then killed her child, it would be clear cut," noted The New York Times' Emily Bazelon last year. There is a line between pregnancy and birth, and once it is crossed, the state has just as much at stake in protecting the life of a newborn as it does in protecting the life of anyone else. But the evidence that Patel’s baby was born alive is sharply contested. The pathologist who testified for the defense, Shaku Teas, said the baby was stillborn. Teas told the court the fetus was at 23 or 24 weeks gestation and that its lungs weren’t developed enough to breathe. (Here’s more support for this position.) But the pathologist for the prosecution, Joseph Prahlow, testified that the fetus was further along than that — at 25 to 30 weeks gestation, which is past the point of viability — and was born alive. [...] Whatever happened to Patel and her baby at the point of delivery, it’s hard to imagine that either the prosecution or the judge at sentencing would have come down as hard on her if they weren’t sure she’d tried to induce her own illegal abortion. And this is where Patel’s case moves from a [...]
Wed, 11 May 2016 11:00:00 -0400
(image) Maryland Gov. Larry Hogan (R) did indeed sign the "Contraceptive Equity Act" into law yesterday, mandating that the state's health insurers cover emergency contraception and vasectomies at no out-of-pocket cost to consumers. The measure has been much-hyped by Maryland lawmakers and reproductive-health care groups as the first state expansion on Obamacare's contraception mandate. But that distinction will be short-lived, as Vermont has now passed a similar requirement for insurers to cover male sterilization without any co-payment permitted.
Vermont Gov. Peter Shumlin (D) is expected to sign the measure, which passed the state Senate and House earlier this month.
Specifically, the bill codifies the Affordable Care Act's (ACA) contraception mandate—the controversial requirement that health insurance plans offer a range of female birth control options at no out-of-pocket cost to enrollees—into Vermont law; allows women to obtain up to one-year's supply of birth control pills at once (previously three months' worth was the limit); and add the male sterilization surgeries known as a vasectomies to the list of birth control options that insurers must offer "free" of charge.
Obviously, the more "free" services that legislators require insurers to offer, the more insurance companies will raise premiums or otherwise adjust their business models to make up the difference. But shifting the cost of preventing unwanted pregnancies from reproductive-age women and men to all Americans seems to be a major new policy goal. The Maryland measure even managed to pass with strong bipartisan support.
Vermont's bill was sponsored by Rep. Chris Pearson, a member of the Progressive Party. Birth control "is a family decision in many cases, and we should not pretend that this burden only falls to women," he told Vermont public radio. "[It should] reflect the reality in that many, many cases, families make this decision together, and that’s appropriate."
Families can of course make decisions together without needing them subsidized, but hey. Maybe Pearson's rhetoric sounds legit if you don't listen too hard.
The new state contraception mandates are already drawing objections from religious groups that oppose all methods of birth control. Catholic Deacon Pete Gummere noted that the Catholic Church's opposition to "artificial" prevention of pregnancy does include vasectomies, and argued that Catholic employers shouldn't be required to offer health-insurance plans that they consider an affront to their religious principles. This was the argument at the center of the 2014 Supreme Court case Burwell v. Hobby Lobby, in which the Court granted a religious exemption from the ACA's contraception mandate. We may soon see the issue transferred to state courts if this new contraception mandate catches on.
Mon, 09 May 2016 12:05:00 -0400The New York City Human Rights Commission (NYCHRC) has issued a memo to local bartenders, servers, and food-business owners: refusing to serve alcohol or certain foods, such as raw fish, to pregnant women violates the city's human rights law. "Judgments and stereotypes about how pregnant individuals should behave, their physical capabilities and what is or is not healthy for a fetus are pervasive in our society and cannot be used as pretext for unlawful discriminatory decisions," the commission says. The guidance was part of a wide-ranging NYCHRC document explaining how the city's anti-discrimination statutes apply to pregnant women. "Pregnancy discrimination," it explains, is seen as a form of gender-based discrimination for purposes of public accommodations, housing, and employment in New York City. "Any policy that singles out pregnant individuals is unlawful disparate treatment under the [New York City Human Rights Law (NYCHRL)] unless the covered entity can demonstrate a legitimate non-discriminatory justification for the distinction," the guidance states. Illegal actions include "those that categorically exclude pregnant workers or workers who are capable of becoming pregnant from specific job categories or positions, deny entrance to pregnant individuals to certain public accommodations, or refuse to serve certain food or drinks to pregnant individuals or individuals perceived to be pregnant." Examples of violations include "a restaurant policy that prohibits staff from serving pregnant individuals raw fish or alcohol," "a blanket exclusion of pregnant individuals from hospital inpatient drug detoxification programs," or "an employer requir[ing] pregnant employees to take unpaid leave at a certain month in their pregnancy." The guidance also spells out illegal behavior "rooted in stereotypes or assumptions regarding pregnancy," which includes an employer choosing "not to assign a pregnant employee to a new project after learning they are pregnant because he is concerned that the worker will be distracted by the pregnancy" or "a bouncer [denying] a pregnant individual entrance to a bar based on the belief that pregnant individuals should not be going to bars and/or drinking alcohol." And those aren't even likely to be the most controversial bits. Other elements of the guidance include: Employers must allow "modest and/or temporary accommodations" to pregnant employees, including "minor changes in work schedules; adjustments to uniform requirements or dress codes; additional water or snack breaks; allowing an individual to eat at their work station; extra bathroom breaks or additional breaks to rest; and physical modifications to a work station, including the addition of a fan or a seat." Absent "undue hardship, an employer must provide a clean, sanitary, and private space, other than a bathroom, that is shielded from view and free from public intrusion from coworkers," for women who have recently been pregnant to "to express milk," in addition to "a refrigerator to store breast milk." If an employee would rather pump breast milk at their desk or usual work station, they "shall be permitted to do this so long as it does not create an undue hardship for the employer, regardless of whether a coworker, client, or customer expresses discomfort." Employees who have recently miscarried or aborted a pregnancy "are entitled to reasonable accommodations from their employers," including "a period of unpaid leave to recover or a more flexible schedule for a period of time to account for additional appointments related to the procedure or experience." The employer is permitted to request medical documentation. With all of t[...]
Mon, 02 May 2016 18:00:00 -0400The American Civil Liberties Union (ACLU) and is suing the state of Indiana over an abortion law that essentially creates a protected class of fetuses. The law, passed in March and set to take effect July 1, prohibits Indiana doctors from performing an abortion if they know a woman is seeking it based on the sex or race of the fetus, or because it has been diagnosed as potentially having Down Syndrome or "any other disability." The state contends that abortions of this sort amount to discrimination in violation of civil rights law. Any doctor who breaks this ban may be disciplined by the state medical board, held civilly liable for "wrongful death," or be charged with a felony. Fetal-tissue transportation, collection, and research will also become felony crimes. The measure— House Enrolled Act (HEA) 1337—includes a slew of other new regulations for abortion clinics and doctors, too, including a requirement that all aborted and miscarried fetuses must be cremated or buried and that "a person or facility having possession of a miscarried or aborted fetus [must ensure that it] is preserved until final disposition occurs." At present, fetal tissue and placenta resulting from abortions and miscarriages that happen before 20 weeks pregnancy "are treated like any other medical waste," according to Vox. Opponents of the law worry the fetal cremation/burial regulation will turn all women who miscarry—something which occurs in about 10 to 20 percent of pregnancies as a conservative estimate—into criminal suspects, as well as place an unnecessary burden on them in a time of mourning. Under the new law, any woman who miscarries at home could be committing a crime by not burying or cremating the fetus or making arrangements for its burial or cremation. Yet any woman who miscarries and then does take the fetal remains to be buried or cremated risks state suspicion and investigation. Remember, Indiana is the same state that recently put a woman in prison for 20 years over what she claims was a miscarriage but the state classified an illegal abortion. Additionally, HEA 1337 states that a) women seeking abortions must receive a mandatory ultrasound 18 hours before the procedure, and b) abortion doctors must not only have an agreement with a physician who has admitting privileges at a local hospital but renew this agreement annually, and submit proof of renewal to the state. Though billed as a step to ensure women's safety, such admitting agreements are wholly unnecessary, since a patient experiencing post-abortion complications can be treated at any hospital, regardless of whether that hospital has a preexisting relationship with their abortion doctor. Indiana Gov. Mike Pence called the measure "comprehensive pro-life legislation that expands the information that expectant mothers received" and "also provides additional protections for the unborn." But the ACLU, which is joined in its lawsuit by Planned Parenthood of Kentucky and Indiana, asserts that the new law is unconstitutional. "Repeatedly the U.S. Supreme Court has said that a woman may get an abortion within the first trimester for whatever reasons she deems best, based on her circumstances,” ACLU Executive Director Jane Henegar has explained. "The ACLU stands firmly against discrimination in all forms, but that isn’t what this law is about," said Henegar. [...]
Fri, 29 Apr 2016 16:00:00 -0400Contra the claims from Florida's state health agency, there's no evidence that a Gainesville women's clinic performed illegal second-trimester abortions, an administrative law judge has ruled. The Bread and Roses Women's Health Center, which is licensed to provide pregnancy testing, birth control, and first-trimester abortions, was accused by the Florida Agency for Health Care Administration (AHCA) of performing five abortions on women who were more than 14 weeks pregnant, which the clinic is not licensed to do. But according to Judge Lawrence P. Stevenson, the state "presented no testimony or documentary evidence refuting the credible evidence presented by Bread & Roses" that AHCA was wrong. Sonograms provided by the clinic "show on their face that the pregnancies for each of the five procedures at issue were first trimester pregnancies and within the scope of Bread & Roses' license," wrote Stevenson in a 25-page ruling. The monetary stakes here for Bread and Roses weren't huge—if found guilty, the clinic would have faced a $2,500 fine. But even if the issue didn't come back to bite them later, you can bet the case would be used to fodder Florida Republicans' narrative that abortion clinics often skirt regulatory rules. There's also little room for doubt here that Florida's health agency—which lobbed similar administrative complaints against three Planned Parenthood clinics recently—has an agenda as well. "Planned Parenthood representatives have maintained that abortions were performed during the first trimester," according to AP, "and that regulators tried to change the definition [of first trimester] to justify an investigation ordered by Gov. Rick Scott." In this instance, AHCA brought the complaint against Bread and Roses based on the flimsiest of pretenses: five abortion-patient files that did not include the start dates of the women's last periods. However, these files did contain ultrasound info indicating how far along the women were, a method of documentation that had suited AHCA just fine for the previous 10 years, according to clinic director Kristin Davy. "AHCA presented no evidence to counter Ms. Davy's credible testimony that Bread & Roses had been submitting its [monthly summary] reports in the same manner for the previous 10 years without incident," wrote Stevenson in his decision. Nor could the agency explain "why it suddenly believed that Bread & Roses' [monthly summary] reports showed that the clinic was performing second-trimester abortions." The judge recommended that the agency dismiss its complaint against Bread and Roses. AHCA already dismissed its complaints against the Planned Parenthood clinics, in March, saying they were unnecessary now that a new state law a) prohibited state money from going to Planned Parenthood, and b) changed the definitions of pregnancy trimesters. "It was not entirely clear why regulators considered the previous action to fine the clinics moot—the new law does not take effect until July 1 and would not have applied to last year’s complaints," reports AP.[...]