Reproductive Rights Prof Blog

Abortion Coverage and Health Care Reform

Time Magazine: Could Abortion Coverage Sink Health-Care Reform?, by Karen Tumulty:

Should government-subsidized health coverage pay for abortion procedures? For more than three decades, that question has seemed pretty much settled. The Hyde Amendment, passed by the House on September, 30, 1976, forbade Medicaid — a program for poor people, jointly administered by Washington and the states, which had up to then paid for about 300,000 abortions a year — from using any federal money to pay for the procedure. All but 17 states followed suit, banning use of their own funds as well; with a few modifications, the ban has stood up ever since.

The prospect of sweeping health reform, however, has reopened the issue. While current versions of the legislation do not address the abortion issue at all, late last month 19 anti-abortion Democrats in the House sent a letter to Speaker Nancy Pelosi, warning "we cannot support any health care reform proposal unless it explicitly excludes abortion from the scope of any government-defined or subsidized health insurance plan."

Uganda Moves to Ban Female Genital Mutilation

Salon.com (Broadsheet): Uganda to outlaw female genital mutilation, by Lynn Harris:

Let's make sure this one doesn't get lost in this week's Palin/Jackson shuffle: Uganda has moved to outlaw female genital mutilation. 

"God knew what he was doing when he created us. Do you think you are more intelligent than God?" President Yoweri Museveni asked the crowd at a recent event launching a campaign against the practice, Uganda's New Vision reported. "There is no part of the human body that is useless."

The president also dismissed any defense of FGM as a "cultural" practice, calling it dangerous not only to women but also to the babies they may later have trouble bearing. According to the Guardian, he also "pledged to help provide an alternative source of income for women who earn a living circumcising girls." 

A Lack of Medicaid Funded Abortions Forces Many to Carry Pregnancies to Term

Guttmacher Institute news release: Restricting Medicaid Funding For Abortion Forces One in Four Poor Women to Carry Unwanted Pregnancies to Term:

Approximately one-fourth of women who would obtain a Medicaid-funded abortion if given the option are instead forced to carry their pregnancy to term when state laws restrict Medicaid funding for abortion, because they lack the money to pay for the procedure themselves. According to a new report, “Restrictions on Medicaid Funding for Abortions: A Literature Review,” by the Guttmacher Institute and Ibis Reproductive Health, Medicaid funding restrictions also delay some women’s abortion by 2–3 weeks, primarily because of difficulties women encounter in raising funds to pay for the procedure.

Currently, 32 states and the District of Columbia allow Medicaid funds to be used for an abortion only in cases of rape and incest, or if the woman’s life is endangered, in accordance with the federal Hyde Amendment; only 17 states have policies to use their own funds to pay for all or most medically necessary abortions. Lacking insurance coverage, some poor women need a considerable amount of time to come up with the money to pay for an abortion, and may have to pull resources from other family necessities, like food or rent, if they are able to find the funds at all. As the cost of the procedure increases with gestation, many poor women become trapped in a vicious cycle of scrambling to raise enough money before the cost—and risk—increase further, while others are left with no recourse but to carry an unwanted pregnancy to term.

House Committee To Vote On Lifting DC Abortion Funding Ban

ACLU press release: House Committee To Vote On Lifting DC Abortion Funding Ban:

WASHINGTON – The House Appropriations Committee is expected to vote this evening on a financial services appropriations bill that includes a provision lifting a 20-year-old ban on the use of local funds for abortions in the District of Columbia. The American Civil Liberties Union urges Committee members to lift the DC abortion funding ban and opposes any attempts to reinstate this restriction.

 

“The federal government should not be in the business of telling the District of Columbia how to spend its own money,” said Vania Leveille, ACLU Legislative Counsel. “The District of Columbia, like our 50 states, should be free to determine local health policy based on the needs of people living within its jurisdiction. The decision whether or not to become a parent should not depend on where you live or how much money you make.”

 

Since 1980, Congress has prohibited the use of federal funds appropriated for the District of Columbia to pay for abortion services except in cases where the woman’s life is endangered and when she is a victim of rape.  Beginning in 1988, Congress went one step further by also preventing the District of Columbia from using its own locally raised revenues to provide abortion care for low-income women.  Congress lifted the ban in 1993 and 1994, but reinstated the measure one year later.

 

The Obama administration set the stage for today’s vote in its 2010 budget proposal by giving the District of Columbia the same privileges as the states to use local funds to support abortion care for low-income women.

 

“For far too long, this ban has allowed non-resident members of Congress to impose their own ideology, morality or religious belief on the District’s residents,” said Leveille. “Lawmakers who seek to negate the will of the District’s residents or leaders are not even accountable to the people of the District.  It is well past time for Congress to do the right thing and end this abortion restriction.”

 

For more information, go to: http://www.aclu.org/reproductiverights/abortion/40235leg20090707.html.

The Silence on Stillbirths

Wash. Post: Even Doctors Avoid Talking About Stillbirth, by Alan Goldenbach:

About a month after our son died, my wife and I made our first visit back to her obstetrician's office hoping to get answers to some of the questions that haunted us.

We had already learned why he died a day before he was supposed to be born; an autopsy showed his umbilical cord had become knotted. What we were left with was a helpless feeling, exacerbated by the fact that our son's death blindsided us. Over the previous year, we had absorbed countless pieces of pregnancy literature and fiercely adhered to our obstetrician's guidelines for a healthy pregnancy. While we knew that stillbirth is possible in every pregnancy, no book nor our doctor ever mentioned the term....

There are about 26,000 stillbirths annually in the United States -- one in about every 160 pregnancies, according to the Centers for Disease Control and Prevention. That is 10 times the number of deaths attributed to sudden infant death syndrome, which has been identified as a key public health issue, and four times the incidence rate of Down syndrome, for which prenatal testing has become almost ritual. Domestically, there are 2 1/2 times more stillbirths annually than deaths from AIDS.

Risks of Pregnancy and Diabetes

USA Today: Expectant mothers with diabetes face risky challenge, by Mary Brophy Marcus:

Before she became pregnant, Molly Duerr never understood why expectant moms would say they didn't care if it were a boy or a girl, only that the baby be healthy.

"I thought, 'Of course you'd want to know what the baby's going to be,' " says Duerr, 30, who has type 1 diabetes. But after becoming pregnant last year and realizing all the health risks associated with diabetes, she says, "I got it."

A growing number of women, like Duerr, are either heading into pregnancy with diabetes — type 1 and type 2 — or developing gestational diabetes while pregnant, says endocrinologist Sue Kirkman, vice president of clinical affairs for the American Diabetes Association. Kirkman says diabetes raises the risk of miscarriages, delivery complications, maternal health problems and birth defects, but she adds that the risks can be slashed with pre-conception counseling, tight control of blood sugar and maintaining a healthy weight before and during pregnancy.

Despite Court Order, Arizona Sheriff Continues to Block Prisoners' Access to Abortion

ACLU Press Release (7/2): "America's Toughest Sheriff" Agrees To Stop Requiring Court Orders For Abortions But Creates New Obstacle:

PHOENIX - The American Civil Liberties Union late yesterday asked an Arizona court to prevent Maricopa County Sheriff Joseph Arpaio from requiring inmates to prepay transportation costs before they can obtain an abortion.

As part of a partial settlement in an ACLU lawsuit involving the right of women prisoners to obtain timely, safe and legal abortions, Arpaio agreed to follow a 2005 court order prohibiting Maricopa County correctional facilities from requiring inmates to obtain a court order before an abortion. However, in the course of settlement negotiations, Arpaio decided inmates must prepay transportation and security costs associated with obtaining the procedure.

"After defying court rulings that prison officials cannot require women prisoners to obtain a court order before an abortion, Sherriff Arpaio finally agreed to abide by the courts; however, he put up yet another obstacle to care," said Brigitte Amiri, a senior staff attorney for the ACLU Reproductive Freedom Project. "Arpaio's new requirement that inmates must pay for transportation costs upfront amounts to a bait and switch. It's time for Sherriff Arpaio to stop playing games with women's health."

In May 2004, on behalf of a woman inmate seeking an abortion, the ACLU challenged an unwritten Maricopa County Jail policy that required inmates to obtain a court order before officials would transport for abortion care.  The Superior Court of Arizona, Maricopa County, struck down the unwritten policy in August 2005, holding that it violated women's reproductive rights and served "no legitimate penological purpose." The Arizona Court of Appeals upheld that decision; both the Arizona and the United States Supreme courts refused to hear the case.

Regardless of these rulings, Maricopa County Jail continued to require women to obtain a court order before an abortion, and in August 2008, the ACLU asked the court to hold Arpaio in contempt. In the course of settlement negotiations in that case, Arpaio shifted tactics and began insisting that inmates who seek abortions must pay upfront for transportation and security costs. Inmates requiring transportation for other medical care are not charged for transport either before or after receiving services.

"The courts have already confirmed our position that Arizona prison officials cannot put up roadblocks to abortion care simply because they do not agree with the decision to end a pregnancy," said Alessandra Soler Meetze, Executive Director of the ACLU of Arizona. "Sheriff Arpaio's latest move to require prepayment is just another way for him to take the law into his own hands."

In last week's partial settlement, Arpaio agreed to notify all employees and include information in the Rules and Regulations for Inmates that a court order is not required for a pregnant inmate to obtain abortion care.

The case is Doe v. Arpaio, CV2004-009286. Lawyers on the case include Amiri and Talcott Camp with the ACLU Reproductive Freedom Project, and Dan Pochoda of the ACLU of Arizona.

To read the brief: www.aclu.org/reproductiverights/abortion/40106lgl20090701.html

To read last week's partial settlement: www.aclu.org/reproductiverights/abortion/40091lgl20090619.html

Abrams & Brooks on Same-Sex Marriage and the "Accidental Procreation" Argument

Kerry Abrams (University of Virginia) & Peter Brooks have posted Marriage as a Message: Same-Sex Couples and the Rhetoric of Accidental Procreation on SSRN. Here is the abstract:

In his dissent in the 2003 case Goodridge v. Department of Health, Justice Robert Cordy of the Massachusetts Supreme Court introduced a novel argument in support of state bans on same-sex marriage: that marriage is an institution designed to create a safe social and legal space for accidental heterosexual reproduction, a space that is not necessary for same-sex couples who, by definition, cannot accidentally reproduce. Since 2003, every state appellate court considering a same-sex marriage case has adopted Justice Cordy's dissent until the recent California Supreme Court decision In Re Marriage Cases. In case after case, courts have held that marriage allows states to send a message to potentially irresponsible procreators that 'marriage is a (normatively) necessary part of their procreative endeavor' and that same-sex couples do not need marriage because they only procreate after considerable effort and forethought. This article examines the accidental procreation argument through the lenses of anthropological theory, history, literature, and constitutional law. We conclude that marriage has sometimes been used to channel male heterosexuality into reproduction, but to argue that this goal is the sine qua non of marriage is to vastly oversimplify its history in both law and culture. We then undertake a genealogy of the accidental procreation argument and speculate about its possible effects on the institution of marriage. We suggest that if courts continue to insist upon a definition of marriage that is so distinct from the actual practice of the institution, the law may actually be less and less influential in regulating intimate behavior.

Teens' Planned Parenthood Records Remain Private in Ohio

ACLU Reproductive Freedom Project (7/1): Ohio Supreme Court Protects The Privacy of Medical Records in Abortion Case:

The Ohio Supreme Court today moved to protect the privacy of minors’ medical records when the minor is not a party in a lawsuit.  The case involves a lawsuit against an Ohio Planned Parenthood and attempts by a teenager’s parents to obtain the medical records not only of their own daughter but of all teenagers seen at that clinic over a ten year period.

“We are pleased that the court blocked the disclosure of the private medical records of teenage patients who are not directly part of a given lawsuit,” said Louise Melling, Director of the ACLU Reproductive Freedom Project.  “Adults and teenagers alike need to know when they seek medical care that their private records will not be dragged into someone else’s legal dispute.  Confidentiality is at the core of the doctor-patient relationship and must be fiercely protected...”

In June 2008, the ACLU filed a friend-of-the-court brief in the case asking the court to protect the privacy of minors’ medical records, arguing that the confidentiality of medical records is essential to the doctor-patient relationship, minors’ access to reproductive health care and the right to privacy. The brief was filed on behalf of the Ohio Chapter of the American Academy of Pediatrics; Ohio Academy of Family Physicians; Society for Adolescent Medicine; National Association of Social Workers; National Center for Youth Law; Center for Adolescent Health & the Law; Ohio NOW Education and Legal Fund; Ohio Domestic Violence Network; ACTION OHIO Coalition for Battered Women; Break the Cycle; and Women Empowered Against Violence, Inc.; the ACLU filed a friend-of-the-court brief in the Ohio Supreme Court.

See also: ACLU Blog of Rights: Just How Private Are Your Private Medical Records? (post includes a link to the decision)

India: New Delhi High Court Decriminalizes Gay Sex

NY Times (7/2): Indian Court Overturns Gay Sex Ban, by Heather Timmons & Hari Kumar:

In a landmark ruling Thursday that could usher in an era of greater  freedom for gay men and lesbians in India, New Delhi’s highest court decriminalized homosexuality....

Homosexuality has been illegal in India since 1861, when British rulers codified a law prohibiting “carnal intercourse against the order of nature with any man, woman or animal.” The law, known as Section 377 of India’s penal code, has long been viewed as an archaic holdover from colonialism by its detractors...

Thursday’s decision applies only in the territory of India’s capital city, but it is likely to force India’s government either to appeal the decision to the Supreme Court, or change the law nationwide, lawyers and advocates said.

Consuming the Placenta

Time Magazine: Afterbirth for Dinner, by Joel Stein:

There is so much you can't know about your spouse when you get married, like that one day she will want to eat her placenta. But there are two things you don't argue about with a pregnant woman: what she eats and that being full of life indeed looks sexy. So when Cassandra told me that for $275, a woman would come to our house, cook Cassandra's placenta, freeze-dry it and turn it into capsules to help ward off postpartum depression and increase milk supply, I said, "$275 is a bargain compared with the $20,000 I'll have to spend to tear out our kitchen immediately afterward."

Most mammals, Cassandra explained, eat their placentas, to which I countered that most dogs eat their poop. I stopped arguing there, figuring that like many of Cassandra's hippie ideas — the compost bin, rubbing lemon on her underarms instead of deodorant — she'd give up on this in a few weeks. Even as the due date approached and she was still set on eating her placenta, I couldn't imagine that she'd remember to request it from the doctor after the most physically draining experience of her life.

Nineteen House Dems Vow to Oppose Health Care Reform that Includes Abortion Services

Daily Women's Health Policy Report: Nineteen House Dems Plan to Vote Against Health Reform if Abortion Funding is Included: 

Nineteen House Democrats recently sent a letter to House Speaker Nancy Pelosi (D-Calif.) stating that they will not vote for health care reform legislation "unless it explicitly excludes abortion funding from the scope of any government-defined or subsidized health insurance plan," CongressDaily reports. In the letter, the lawmakers wrote that they want to ensure that the Health Benefits Advisory Committee cannot recommend that abortion services be included as part of benefits packages. They wrote, "Without an explicit exclusion, abortion could be included in a government-subsidized health care plan under general health care."

Martha Davis on the Importance of a Transnational Perspective in Teaching Reproductive Rights

Martha F. Davis (Northeastern University) has posted Reproductive Rights in the Legal Academy: A New Role for Transnational Law on SSRN. Here is the abstract:

Most law school courses approach reproductive rights law from a purely domestic perspective, as an extensive survey of casebooks and course material reveals. The authors argue that a transnational perspective can enhance the teaching of sexual and reproductive health in all of the law school courses and doctrinal settings in which this topic in treated. While the topic of “Global Sexual and Reproductive Rights” can be presented in a free-standing course, transnational perspectives should also be integrated across the curriculum where sexual and reproductive rights are discussed. Expanding reproductive rights pedagogy to address transnational perspectives will aid in exposing a wide range of students to transnational material, will expand students’ preparedness to analyze such materials, and will better reflect the debates on sexual and reproductive health currently taking place outside of law school classrooms. Drawing on a range of foreign and international material, the authors provide specific suggestions for integrating such material into courses on Constitutional Law, Family Law and Bioethics.

Daily Kos: Obama and the Elusive Common Ground on Abortion

Daily Kos: The Fog is Lifting over Common Ground on Abortion, by Frederick Clarkson:

President Obama has made much about finding common ground on abortion, and Democratic oriented think tanks like Third Way and Faith in Public Life have ballyhooed the idea, while finding very limited agreements with a small group of white evangelicals. As some of us have pointed out, the abortion reduction agenda that is part of the conversation is not only slanted to the religious right, it is, in fact the agenda of the antiabortion movement and the religious right.

President Obama, in a meeting with Catholic reporters in advance of his meeting with the Pope, acknowledged very little attainable common ground on abortion.

Obama Reassures Catholic Health Care Workers in Advance of Meeting with Pope

Wash. Post: Obama Reaches Out Before Vatican Trip, by Jacqueline L. Salmon:

President Barack Obama said today that he still favors a "robust" federal policy protecting health-care workers who have moral objections to performing some procedures even though he plans to roll back a Bush administration rule that expanded such protection.

Speaking to eight religion reporters at the White House before his first meeting with Pope Benedict XVI next Friday, Obama sought to reassure Catholic health-care workers that they would not be forced to perform abortions and other procedures that violate the Church's teachings. Obama said he is a "believer in conscience clauses" and supports a new policy that would "certainly not be weaker" than the rules in place before the expansion late in President George W. Bush's administration.

Colorado Groups to Submit Another "Personhood" Initiative

The Gazette (Colorado Springs): Groups to make another try for 'personhood' measure, by Mark Barna:

Two anti-abortion groups, Colorado Right to Life and Personhood USA, will submit a new "personhood" initiative to the Colorado Legislative Council on Thursday in hopes of getting a measure on the 2010 state ballot.

Colorado voters soundly defeated a similar measure, Amendment 48, in the 2008 election.

But initiative sponsors say things will be different in 2010 because they will be better-funded and better able to articulate their message and will introduce a measure that's more accurately worded....

Last year, 73 percent of the vote went against Amendment 48, which was sponsored by Colorado for Equal Rights.

Study Suggests Daily Sex, Rather Than "Saving Up" Sperm, Improves Odds of Pregnancy

Science Fair (USA Today): Don't save that sperm -- daily sex may increase pregnancy chances:

Couples hoping to conceive a child likely improve their odds with daily sex before ovulation, rather than refraining before making an attempt, finds a study of sperm health.

Reported Tuesday at the European Society of Human Reproduction and Embryology (ESHRE) meeting in Amsterdam, the study involved 118 men suffering from "higher-than-normal" genetic damage to the sperm. The study led by Australia's David Greening of IVF Sydney in Wollongong found that after a week of daily sex, genetically damaged sperm dropped by an average of 26% among the men.

Catholic Hospital System Ends Joint Venture with Insurer that Covers Abortion Services

Boston Globe: Caritas ends joint venture, by Michael Paulson & Kay Lazar:

Caritas Christi Health Care, the financially challenged Catholic hospital system founded by the Archdiocese of Boston, is abruptly ending its joint venture with a Missouri-based health insurer at the insistence of Cardinal Sean P. O’Malley, who has decided that the relationship represented too much of an entanglement between Catholic hospitals and abortion providers.

The change will have no effect on patient care, because Caritas will continue to participate in the state-subsidized program, called Commonwealth Care, but now simply as one of many healthcare providers treating patients, and no longer as a co-owner of an insurance venture.

Caritas’s withdrawal from the insurance venture, just days before it will start providing care to low-income residents as part of the state’s efforts to establish near-universal health coverage here, is a vindication of sorts for a variety of conservative Catholic critics of the cardinal, who have been arguing angrily that it would be “evil’’ for Caritas to collaborate with a health insurer that covers abortion services.

Chlamydia, The "Silent STD"

Wall Street Journal: Chlamydia, the Silent STD That Can Cause Infertility, by Melinda Beck:

One of the biggest frustrations in public-health circles today involves a tiny bacterium called Chlamydia trachomatis.

Chlamydia infection is the most common sexually transmitted disease, responsible for a record 1.1 million cases reported to the Centers for Disease Control and Prevention in 2007, and experts there estimate that twice that many cases go undetected. Left untreated, chlamydia can cause infertility or potentially fatal ectopic pregnancies. But many women aren’t even aware that they were exposed to it—possibly years ago—until they try to have a baby and can’t.

Chlamydia can be detected with a simple urine test. It can be treated with a single dose of antibiotics, and the CDC has been urging all sexually active women under 26 years old to be tested for it annually, as well as older women who have had a change of sexual partner. Yet fewer than 40 % of women in those categories are being screened. “You’d think this would be a no-brainer,” says John Douglas, director of the CDC’s division of STD prevention. “That’s why we’re trying to get the message out.”

Ignoring the Octomom

Kimberly D. Krawiec (Duke University) has posted Why We Should Ignore the 'Octomom' on SSRN. Here is the abstract:

Thanks to the “Octomom” - a single, low-income, California mother of six, who recently gave birth to octuplets conceived through IVF - the American public this year turned its attention to assisted reproductive technology. In this essay, I take issue with one set of proposals to arise from the controversy: embryo-transfer limits, variations on which have been proposed in Georgia, Missouri, and, most recently, by Naomi Cahn and Jennifer Collins. Examining national and international multiple-birth rates, as well as similar limits in other countries, I argue that government-mandated embryo-transfer limits would produce fewer benefits and higher costs in the United States than proponents assume. First, the Octomom is a sad and disturbing, but aberrant, case. Second, questions of embryo transfer and multiple birth inevitably intersect with other politically contentious issues, including the moral and legal status of embryos and abortion. These political minefields render it highly unlikely that the United States will implement comprehensive embryo-transfer regulation effectively designed to reduce multiple births anytime soon.