Tuesday, July 9, 2019
Jun. 26, 2019 (Vice): Med Students Are Doing Vaginal Exams on Unconscious, Non-Consenting Patients, by Hannah Harris Green:
For decades, medical students around the country have been expected to perform pelvic exams on unconscious women--not for the patient's benefit but solely for the student's experience. Sometimes these exams are performed multiple times by different students on the same patient. The exams involve a student inserting "two gloved fingers into the patient’s vagina and [placing] one hand on her pelvis in order to feel the uterus and ovaries." This patient is never asked for consent prior to the procedure nor is she informed of the exam afterward.
One former student--now a pediatrician in Baltimore, Maryland--learned of these procedures during his OB/GYN rotation while studying at the University of Pennsylvania Medical School in the 1990s. He refused to participate, joining in a movement to ban the practice. Ari Silver-Isenstadt took a year out of his medical studies to study the ethical implications of this practice at Penn's School of Education. He subsequently published a study in 2003 in the American Journal of Obstetrics and Gynecology that found that over 90 percent of students at the five Pennsylvania medical schools he had focused on had performed vaginal exams on non-consenting, unconscious patients. He noted that students' initial discomfort with the procedure quickly dissipated as it became a regular part of their rotations.
California became the first state to ban these invasive exams in 2003, the same year of Silver-Isenstadt's study. Since then, Illinois, Virginia, Oregon, Hawaii, Iowa, Utah, and Maryland have followed suit. Additional states that have introduced similar legislation this year include Connecticut, Minnesota, Missouri, Nebraska, New Hampshire, New York, Oklahoma, Washington, and Texas. No federal legislation yet addresses the issue.
Some medical schools have also banned the practice institutionally as well--like Harvard--but others, including Duke University, consistently ask their medical students to perform pelvic exams sans consent throughout their education.
While the procedure invades the privacy of any patient, consequences can be particularly severe for patients with a history of sexual trauma who either find out a pelvic exam was performed on them while unconscious or else wake up during the produce, as did Ashely Weitz in 2007.
Weitz said testifying about her experience in support of Utah's law in February was nerve-racking, especially because she expected there to be other women at the hearing at the state house with similar experiences, but she was the only one. Given the nature of these exams, people don’t know if it's happened to them. She said it was “a very healing practice to say 'this shouldn't happen to me, it shouldn't be happening in the way that it is happening in an institution.'” But there are still parts of the incident that she hasn’t recovered from. “It changed the way that I sought and received medical care,” she said. “I was, you know, thereafter very certain that I was never going to be sedated or unconscious in a manner that would have allowed that situation to happen again. So it was in itself very traumatizing.”
Utah's ban on unconscious pelvic exams was signed into law in March of this year. It requires both medical students and doctors to get explicit consent to perform such exams on anesthetized women. A law professor at the University of Illinois, Robin Fretwell Wilson, credited Weitz's testimony as the primary driving force behind the state legislation.
Wilson herself advocates for requiring specific consent for any pelvic exams. While opponents to legislation requiring consent argue that general consent forms signed upon entering a teaching hospital already cover these exams, Wilson and other advocates for patient protections assert that it is ethically wrong to practice procedures that are of no benefit to the patient without direct consent.
Many advocates, including Weitz, connect the growing opposition to these vaginal exams to the rising tide of the #MeToo movement in recent years. "The #MeToo movement has helped people like Weitz better understand that the violations they endure are part of a wider cultural problem."
Wilson acknowledges that even 10 or 15 years ago, the attitude toward this practice was completely different. "At the time, medical school faculty 'were more than willing to stand their ground and say, "not only do we do it, but the patients in our hospitals have a duty to participate."' . . . 15 years ago, many schools 'did not see it as an issue.'"
Advocates of legal regulations requiring patient consent, though, still fear that enforcement of the new laws will be difficult. "In order for authorities to find out, students would need to both be aware of the law and willing to report wrongdoing by their supervisors, so [Silver-Isenstadt is] hoping the culture is what will ultimately change."
Wednesday, June 26, 2019
Jun. 24, 2019 (The Guardian): Appeal court overturns forced abortion ruling, by Harriet Sherwood:
An appeals court in the UK overturned a recent decision by the court of protection in London, which had ordered a young pregnant woman to have an abortion against her wishes.
The pregnant woman is in her twenties and suffers from learning and mood disorders, such that her mental capacity is akin to that of a "six to nine-year-old child."
There is no public information as to how the woman got pregnant and a police investigation is ongoing. In the meantime, the woman--now 22-weeks pregnant--and her mother both wish for the pregnancy to continue and her mother intends to care for the child once born. A social worker agrees that the pregnancy should be allowed to continue.
Three medical professionals, including one obstetrician and two psychiatrists, with England's National Health Service initiated the legal challenges when they sought permission from the court to terminate the pregnancy.
The court that ordered the termination originally stated that its decision was in the best interests of the woman. The woman's mother, a former midwife, appealed the decision. The appeals court is expected to provide their rationale at a later date.
Abortions may be performed up to 24 weeks in a pregnancy under Britain’s 1967 Abortion Act.
Tuesday, June 25, 2019
June 21, 2019 (Rewire News): Here's What You Need to Know abut the Hyde Amendment and Efforts to End It, by Ally Boguhn:
As the Hyde Amendment re-emerges as a political issue, Rewire News provides a helpful information about the rider that is attached to federal appropriations each year that prevents the use of federal Medicaid funds for abortion care. The article notes that similar restrictions have been applied to other forms of government health insurance including the Indian Health Services, Medicare, the Children's Health Insurance Program, and health care for people in the military, federal prisons, and the Peace Corp and federal government employees. Similar restrictions were also imposed on plans available on the Affordable Care Act's Health Exchanges.
Since the Amendment became law in the 1970s, some states have used their own funds to provide abortion coverage for individuals on Medicaid as a result of court decisions requiring coverage under their state constitutions or legislative action. In 2017, Illinois became the first state in decades to pass legislation authorizing the use of state Medicaid funds for abortion. And earlier this month, New York City allocated $250,000 to fund abortions for women who are not covered by Medicaid or insurance and cannot afford the procedure.
In recent years there has been new momentum at the federal level to eliminate the Hyde Amendment. In 2015, Rep. Barbara Lee (D-CA) introduced the Equal Access to Abortion Coverage in Health Insurance (EACH Woman) Act, which would ensure that individuals who received health insurance through the federal government were covered for abortion care. In 2016, the Democratic Party included repeal of Hyde on its platform. However, House Democrats have not pushed the issue.
Despite their stated opposition to the Hyde amendment, House Democrats included it in their 2019 budget. In early June, Reps. Ayanna Pressley (D-MA), Diana DeGette (D-CO), Barbara Lee (D-CA), Jane Schakowsky (D-IL), and [Pramila] Jayapal introduced an amendment to strike Hyde and instead expand access to abortion coverage. Their efforts were ultimately unsuccessful.
The Hyde Amendment is poised to be a critical topic in the 2020 presidential election. Many contenders for the Democratic nomination have come out against the policy, and former Vice President Joe Biden recently twice switched his position on the matter (ultimately being against it). Meanwhile, President Trump supports codifying Hyde into law.
Thursday, June 13, 2019
Jun. 10, 2019 (Politico): Judge says Missouri’s lone abortion clinic must remain open for now, by Rachana Pradhan:
On Monday, a judge blocked Missouri's attempts to close its last remaining abortion clinic. Planned Parenthood, which operates the clinic, has struggled against state officials' attempts to shutter the clinic based on claims of violations, which jeopardize its licensing.
Judge Michael Stelzer had previously granted the Planned Parenthood clinic reprieve from the states' attempts to deny license renewal upon the clinic's license lapse in May, and Stelzer has now directed Missouri health officials to make a decision as to whether to renew the clinic's license by June 21.
Planned Parenthood officials attest that the licensing conditions were essentially pretextual and "accused state officials of orchestrating a politically motivated probe to stamp out abortion." Last month, Missouri lawmakers banned almost all abortions beyond week eight of a pregnancy.
Missouri is just one of six U.S. states that have only one clinic providing abortions.
June 13, 2019 in Abortion, Abortion Bans, Anti-Choice Movement, Current Affairs, In the Courts, In the Media, Politics, Pro-Choice Movement, Reproductive Health & Safety, State and Local News, State Legislatures, Women, General | Permalink | Comments (0)
Wednesday, June 12, 2019
Jun. 11, 2019 (The New York Times): Botswana's High Court Decriminalizes Gay Sex, by Kimon de Greef:
A three-judge panel in the capital of Botswana voted unanimously to overturn a colonial-era law banning gay sex in the country.
"'Human dignity is harmed when minority groups are marginalized,' Judge Michael Leburu said as he delivered the judgment, adding that laws that banned gay sex were 'discriminatory.'"
"Homosexuality has been illegal in Botswana since the late 1800s, when the territory, then known as Bechuanaland, was under British rule." The penal code outlawed “unnatural offenses,” defined as “carnal knowledge against the order of nature.” Violations of this law could result in seven years in prison; a five-year sentence could be imposed just for attempting to have gay sex or engage in any other "homosexual acts."
The court had the opportunity to strike down the law, because an anonymous gay plaintiff challenged the law's constitutionality. The court had previously upheld Botswana's discriminatory laws in the face of a prior 2003 challenge.
Last year, India similarly struck down its anti-gay statutory vestiges of colonialsm.
Unfortunately, other African countries like Kenya have decided the opposite way, upholding laws that criminalize sexuality.
Homophobia is widely entrenched on the continent, with gay sex outlawed in more than 30 countries. In several northern African nations, including Somalia and Sudan, homosexuality is punishable by death; offenders in Sierra Leone, Tanzania and Uganda face life in prison.
Even in countries like South Africa with progressive gay rights legislation, the African continent continues to find "widespread rejection" of homosexuality.
Nonetheless, gay rights groups and LGBTQ activists in Botswana celebrate the historical moment this week that came with the High Court's decision.
Friday, June 7, 2019
Jun. 4, 2019 (Quartz): Canada will invest $1 billion globally in women's and girls' health every year, by Annabelle Timsit:
Prime Minister Justin Trudeau announced Canada's new commitment to invest over one billion dollars annually in women's and girls' health. The funding will in large part benefit sexual and reproductive health in the face of growing threats around the world to women's rights, including the right to abortion.
This funding is an increase from Canada's prior years' commitments and comes with increased focus on supporting "female entrepreneurs, indigenous women, and LGBTQ people."
Allocating funding, among other socio-political resources, to the protection of Indigenous women in particular is especially critical in light of the recent report of the Canadian national inquiry regarding mass killings and disappearances of Indigenous women and girls throughout Canada. (See The New York Times (Jun. 3, 2019), by Ian Austen and Dan Bilefsky).
The three-year inquiry's final report labeled the systemic violence suffered by the Indigenous populations in Canada "a race-based genocide." It also included over 200 recommendations to implement systemic changes, like reforming police practices and the criminal justice system overall, as well as expansion of Indigenous women's shelters and empowering Indigenous persons to serve on civilian boards overseeing civil services. In addition, the report's authors call for the elevation of Indigenous languages to official languages of Canada, alongside English and French.
The inquiry, long overdue in the face of pervasive, violent colonialism, was prompted in 2014 when Tina Fontaine, a 15-year-old girl from the Sagkeeng First Nation was found dead in the Manitoba Red River, wrapped in a plastic bag and weighed down with 25 pounds of rocks. The main suspect in her murder was acquitted.
Tuesday, June 4, 2019
Jun. 1, 2019 (Vox): Illinois affirms the "fundamental right" to abortion by passing a new bill, by Gabriela Resto-Montero:
Illinois, in a newly-passed bill called the Reproductive Health Act, states that a “fertilized egg, embryo, or fetus does not have independent rights." The passing of this law thus grants pregnant people in Illinois the protected right to terminate their pregnancies. The Act was passed on Friday, May 31, 2019 and is expected to be signed by the governor.
State Senator Melinda Bush sponsored the bill and declared Illinois "a beacon for women's rights, for human rights." The legislation "repeals a 1975 state law that required spousal consent, waiting periods, placed restrictions on abortion facilities, and outlined procedures for pursuing criminal charges against abortion providers." It also "rolls back some state restrictions on late-term abortions by repealing Illinois’ Partial Birth Abortion Ban Act," a law that had not yet been enforced due to court injunctions.
While legislative threats to reproductive rights grow in numbers and severity throughout the country, Illinois is one of the first states to take concrete steps toward cementing the right to abortion--among other reproductive rights--within its borders. Other states (i.e. Alabama, Georgia, Ohio, Missouri, Indiana, Kentucky, Mississippi) are vying for a slot on the SCOTUS docket and with it a chance at the overturning of Roe v. Wade and its Constitutional protections.
Recently, though, the Supreme Court signaled it is not quite ready to re-consider Roe. "In its decision regarding an abortion law passed by Illinois’ neighbor, Indiana, justices struck down one provision while affirming another part of the law, largely avoiding the question of whether abortion should be legal."
Planned Parenthood and the American Civil Liberties Union are leading the way with lawsuits aimed at preventing the so-called "heartbeat laws," and comparable legislation threatening reproductive rights and the safety and dignity of pregnant persons, from going into effect within anti-abortion state legislatures. "The Planned Parenthood Action Fund reports that so far in 2019, there have been 300 anti-abortion bills introduced in 36 states."
Illinois is not the only state working to protect abortion rights, though. "Some 13 states including New Mexico, Rhode Island, and Nevada have proposed bills to include a right to abortion in their Constitutions. While many of those efforts are still in their early stages, Vermont passed a bill to include the protection in its Constitution last week."
June 4, 2019 in Abortion, Abortion Bans, Anti-Choice Movement, Current Affairs, Fetal Rights, Politics, Pro-Choice Movement, Reproductive Health & Safety, State and Local News, State Legislatures | Permalink | Comments (0)
Friday, May 3, 2019
May 2, 2019 (New York Times): Trump Administration Strengthens 'Conscience Rule ' for Health Care Workers, by Margot Sanger-Katz:
On Thursday, the Department of Health and Human Services issued a new regulation to protect health care providers who refuse to provide services based on their religious or moral conviction. Under the regulations, health care institutions that fail to respect the the conscience rights of such workers would face the loss of federal funds.
After the 440-page rule was released, some groups said they feared the provisions were overly broad and could imperil care for patients seeking reproductive health care. They also said it could lead to discrimination against gay or transgender patients and their children, and weaken public health efforts to expand childhood vaccinations.
On a call with reporters, Roger Severino, Director of HHS's Office of Civil Rights maintained that the regulation is needed to protect health care workers who object to providing certain services. However, there are concerns that the rule is overly broad and will interfere with patients' ability to get care.
“The rule allows a very wide range of people — from the receptionist to the boards of hospitals and everyone in between — to deny a patient’s medical care if their personal beliefs get in the way,” said Fatima Goss Graves, the president of the National Women’s Law Center. Ms. Goss Graves described the rule as not only tightening enforcement of civil rights laws but also changing the balance of rights between patients and their clinicians.
Monday, April 29, 2019
April 25 (Washington Post): Trump abortion 'gag' rule blocked by federal judge, by Fred Barbash:
Last Thursday, a district court judge in Washington state issued a nationwide injunction preventing a new Health and Human Services Administration regulation from going into effect.
Groups receiving money under the Title X program, about $286 million annually, already were prohibited from performing abortions with those funds. But under the new rule, they could no longer refer a patient for an abortion and would also have to maintain a “clear physical and financial separation” between services funded by the government and abortion services or referrals.
In issuing the injunction, the judge found that the regulations violated Title X and the Affordable Care Act and were arbitrary and capricious under the Administrative Procedure Act. He also found that the change in the regulations “likely violates the central purpose of Title X, which is to equalize access to comprehensive, evidence-based, and voluntary family planning.”
In a particularly scathing passage [he] wrote that the rule probably "creates unreasonable barriers for patients to obtain appropriate medical care; impedes timely access to health care services; interferes with communications regarding a full range of treatment options between the patient and their health care provider, restricts the ability of health care providers to provide full disclosure of all relevant information to patients” and “violates the principles of informed consent and the ethical standards of health care professions."
Tuesday, April 9, 2019
The Cut (Apr. 3, 2019): Alabama Lawmakers Want to Make Abortion a Felony, by Amanda Arnold:
States' attempts to severely restrict access to abortion services show no signs of slowing down, and in one state, the race to prohibit the procedure has indeed turned down the path of total criminalization.
The bill, HB314, was proposed proudly by Alabama representative Terri Collins and would classify performing any abortion as a Class A Felony, which carries a sentence of 10-99 years in the state. The single exception included in the bill is if "foregoing the procedure would pose a 'a serious health risk to the unborn child’s mother.'"
Of course, as a blatant violation of precedent under Roe v. Wade and the established Constitutional right to an abortion, the bill, should it pass, would immediately be subject to legal challenges. In a showing of support for the extreme anti-abortion movement, though, 65 of Alabama's 105-member House co-sponsored HB314.
The ACLU of Alabama pointed out that, in addition to the "egregious infringement on women’s reproductive rights" that the bill represents, HB314 "will potentially cost taxpayers 'hundreds of thousands' of dollars to cover the bill’s legal fees."
Monday, April 8, 2019
YES! Magazine (Apr. 2, 2019): For Black Women, Reproductive Justice Is About More Than High-Risk Pregnancies, by A. Rochaun Meadows-Fernandez:
Recently, journalists, medical professionals, and advocates have been emphasizing the discrepancy in medical care between White women and women of color. The maternal mortality rate is already abysmally low in the United States; this rate is even worse for Black women. These reports have largely focused on the medical risks of pregnancy and childbirth for women of color, but there is another, lesser-reported area of reproduction that also disproportionately burdens women of color: infertility.
"While infertility affects roughly 12 percent of the population, Black women are twice as likely to experience challenges achieving or sustaining a pregnancy—and less likely to seek assistance." Infertility can also severely harm the mental health of someone wishing to get pregnant.
Options to prevail against infertility often include the use of assisted reproductive technologies, including surrogacy.
Surrogacy has been met with controversy from many angles over the years. Those against the practice express concerns of stigma, exacerbated classism, commodification of women's bodies, and exploitation. "Some countries, including Mexico, have banned commercial surrogacy under the guise of protecting low-income women and children from exploitation."
Advocates, however, argue that surrogacy is a viable option for many people to pursue their dreams of parenthood they otherwise have trouble achieving.
Black women in particular are less likely to pursue surrogacy, among other reproductive technology, and are less likely to be surrogates as well.
According to the Centers for Disease Control and Prevention, from 1999 to 2016, gestational carriers resulted in 13,380 deliveries and the birth of 18,400 infants. Although the current figures are unknown, surrogacy is helping to counter infertility struggles.
Still, the number of Black surrogates and Black intended parents remain low.
This could possibly be because of the stigma from slavery that historically frames enslaved Black women as surrogates for their White female owners. But is most likely because of the high costs normally associated with surrogacy (about $100,000, which includes medical and health care expenses for the carrier and agency or finder fees)—although some may turn to family or friends where there is no compensation—called altruistic surrogacy.
Surrogacy can occur in two ways: the traditional way in which the surrogate is impregnated by either the intended father's sperm or that of a donor, while using her own eggs; or, gestational surrogacy in which the surrogate is impregnated using the eggs of either the intended mother or an egg donor. In the former, the surrogate is genetically related to the child and the in the latter, she is not. Gestational surrogacy requires a few additional interventions, like IVF, and is generally more expensive.
Many intending parents prefer gestational surrogacy, though, in order to lessen the likelihood that the surrogate will develop an emotional connection and assert a biological claim of custody over the resulting child. "This is an intended parent’s worst fear."
"Juli Fraga, a psychologist who specializes in women’s health, including pregnancy-related depression...suggests that it is especially important for all members of the surrogacy contract to be open to seeking mental health services."
In re Baby M is one of more famous cases illustrating potential legal battles that may arise over surrogacy. In this case, intended parents William and Elizabeth Stern fought for custody after their surrogate, Mary Beth Whitehead, invalidated their contract and attempted to claim custody over "Baby M." The court ultimately held that the surrogacy contract was entirely unenforceable, likening it to the "sale of a child." The court also held that William Stern, the child's biological father, retain custody according to the best interests of the child, but that Whitehead, the surrogate and also the child's biological mother, also retain visitation rights with the child.
Similar cases have continued to arise between surrogates and intended parents. Baby M influenced a shift in the legal protections and parameters for surrogacy, though. "It’s now suggested that intended parents prioritize entering contracts in states that support protective surrogacy legislation. But only 17 states and the District of Columbia have laws governing the conditions of surrogacy."
It is important to ensure that Black women are receiving the same medical care and equitable access to reproductive services, including reproductive technology and protections in cases of surrogacy (either as the intending parent or the surrogate), as White women. Equally as important is removing the stigma around infertility and opening conversations to all women about their reproductive options.
In once recent case, GloZell Green, a Black woman and YouTube star, was told by a fertility specialist that she'd waited too long to have children at age 39. Green began searching for the best way to enter motherhood and ultimately had a baby girl through gestational surrogacy. Green shared her surrogacy journey with her millions of subscribers, hoping to break the stigma and open conversations. She highlights that "above all else, she doesn’t want Black women to be embarrassed about infertility."
Sunday, March 31, 2019
New York Times (Mar. 29, 2019): When Joe Biden Voted to Let States Overturn Roe v. Wade, by Lisa Lerer:
In 1981, with an anti-choice President newly elected and Republicans controlling the Senate, social conservatives pushed for a constitutional amendment to allow individual states to overturn Roe v. Wade.
The amendment cleared a key hurdle in the Senate Judiciary Committee in March 1982. Support came not only from Republicans but from a 39-year-old, second-term Democrat: Joseph R. Biden Jr.
“I’m probably a victim, or a product, however you want to phrase it, of my background,” Mr. Biden, a Roman Catholic, said at the time. The decision, he said, was “the single most difficult vote I’ve cast as a U.S. senator.”
The bill never made it to the full Senate, and when it came back up the following year, Mr. Biden voted against it. His back-and-forth over abortion would become a hallmark of his political career.
Mr. Biden entered the Senate in 1973 as a 30-year-old man who argued that the Supreme Court went “too far” on abortion rights in the Roe case. He told an interviewer the following year that a woman shouldn’t have the “sole right to say what should happen to her body.”
By the time Biden left the vice presidency in early 2017, he was a 74-year-old who argued a far different view: that government doesn’t have “a right to tell other people that women, they can’t control their body,” as he put it in 2012.
Even before announcing a 2020 presidential candidacy, Mr. Biden has started trying to rebut concerns about his past stances, telling party officials in Delaware this month that he has “the most progressive record" of anyone running for president.
Abortion poses a particularly challenging issue for Mr. Biden. The Trump Administration's efforts to restrict access to abortion and a new conservative majority on the Supreme Court have elevated concerns among many Democrats that federal protections of abortion rights could be chipped away or eventually overturned — and that the next president needs to be a dependable ally on abortion issues.
“Anxiety is super high among women across the country,” said Ilyse Hogue, president of NARAL Pro-Choice America. “Joe Biden is trying to carve out a space for himself as the middle, moderate candidate, and he’s going to have to really get with the times and understand that standing with abortion rights is the middle, moderate position.”
She added, “I can’t tell you if he’s there or not.”
Biden spokesman Bill Russo told the Times that the former vice president "is a supporter of the Roe decision who fought to protect abortion rights by mounting a fierce opposition to the nomination of a conservative judge, Robert H. Bork, to the Supreme Court in 1987."
But, the Times notes, "Mr. Russo declined to detail Mr. Biden’s current views on specific policies he once supported, including banning all federal funding for abortion services and research."
Saturday, March 30, 2019
New York Times (Mar. 28, 2019): Opinion: The Flood of Court Cases That Threaten Abortion, by Linda Greenhouse:
Within the next few weeks, Linda Greenhouse writes, a challenge to Louisiana’s abortion law will arrive at the Supreme Court as a formal appeal. Louisiana requires that doctors who perform abortions in the state "do the impossible by getting admitting privileges in local hospitals." The law, she writes, is “substantially similar” to the Texas law the Supreme Court declared unconstitutional in Whole Woman’s Health v. Hellerstedt in 2016, and yet the United States Court of Appeals for the Fifth Circuit "implausibly upheld the Louisiana law nonetheless."
A majority of the Fifth Circuit is at war with the Supreme Court’s abortion precedents, writes Greenhouse, and was even before the Trump administration filled five vacancies on the appeals court. The Trump-appointed judges "clearly understand their marching orders": one of those judges, James C. Ho, wrote in a published opinion on “the moral tragedy of abortion,” a gratuitous comment that Greenhouse says "served to make him stand out from the crowd."
Meanwhile, Chief Judge Ed Carnes of the United States Court of Appeals for the 11th Circuit began his opinion striking down an Alabama law that criminalizes the procedure most commonly used to terminate a pregnancy in the second trimester: “Some Supreme Court justices have been of the view that there is constitutional law and then there is the aberration of constitutional law relating to abortion. If so, what we must apply here is the aberration.” In a footnote to his 36-page opinion, Judge Carnes refused to call doctors who perform abortions either “doctors” or “physicians,” noting that “some people” regarded those designations “as inapposite, if not oxymoronic in the abortion context.” He called them “practitioners.” He also described the constitutional right to abortion as something the Supreme Court had decided to “bestow on women.”
Alabama has appealed the decision, Harris v. West Alabama Women’s Center, to the Supreme Court, noting in its brief that eight other states have enacted the same law. The justices will consider in mid-April whether to hear the case.
Greenhouse, in her decades of reporting on the federal judiciary, says that she cannot "remember seeing such expressions of outright contempt for the Supreme Court. In this age of norm-collapse, something has been unleashed here."
In another appeal pending before the Supreme Court, this one from Indiana, the Seventh Circuit struck down a law that makes it a felony for a doctor to perform an abortion if the patient wants to terminate her pregnancy because the fetus has been diagnosed with Down syndrome or “any other disability.”
In an opinion concurring with the majority decision, Judge Daniel Manion accused the Supreme Court of making abortion “a more untouchable right than even the freedom of speech.” While the outcome of this case was “compelled,” he said, “it is at least time to downgrade abortion to the same status as actual constitutional rights.”
Indiana’s appeal, Box v. Planned Parenthood of Indiana and Kentucky, arrived at the Supreme Court in October. The justices have taken it up at their private conference eight times and will consider it again at the conference scheduled this Friday.
Greenhouse is most concerned by the recent Sixth Circuit decision, where that court upheld an Ohio law that bars state public health money from going to any organization that performs abortions, namely Planned Parenthood. Planned Parenthood is the largest provider of H.I.V. testing in Cleveland, Akron and Canton. It performs abortions at three of its 27 clinics in the state.
Writing for the court, Judge Jeffrey Sutton found that Planned Parenthood had no right to invoke the doctrine of unconstitutional conditions because while women have a right to obtain abortions, neither Planned Parenthood nor any other abortion provider has the right to perform them.
Greenhouse concludes that she doesn’t "know whether Planned Parenthood will appeal the Ohio decision, Planned Parenthood v. Hodges."
"It’s received little attention — not surprisingly. As framed by the appeals court, it’s not the kind of issue that sends culture warriors to the barricades. But there’s no chance that the justices will miss its significance. Is it the small-target case they have been waiting for? Could be."
March 30, 2019 in Abortion, Abortion Bans, Anti-Choice Movement, In the Courts, Politics, President/Executive Branch, State and Local News, State Legislatures, Supreme Court | Permalink | Comments (0)
Tuesday, March 26, 2019
NPR News (Mar. 22, 2019): Controversial 'Abortion Reversal' Regimen Is Put To The Test, by Mara Gordon:
Dr. Mitchell Creinin, a medical researcher and professor at the University of California, Davis, will be spending the next year or so using a research grant from the Society of Family Planning to put to the test a treatment he sees as dubious — one that recently has gained traction, mostly via the Internet, among groups that oppose abortion. They call it "abortion pill reversal."
Creinin, an OB-GYN, has spent the bulk of his career in family planning research. He has studied topics ranging from different treatments for miscarriage to how women choose birth control methods.
Performing abortions, he says, has always been a part of his practice and philosophy. "I need to provide these services to help women," Creinin says.
Proponents of "abortion pill reversal" say it can stop a medication-based abortion in the first trimester, if the progesterone is administered in time. Dr. Creinin, though, says the progesterone treatments are ineffective at best in halting an abortion that has already begun. Promotion of the treatment, he says, can be potentially harmful by giving pregnant women misleading information that an abortion can be undone.
Legislators in Arkansas, Idaho, South Dakota and Utah have passed laws requiring that doctors who provide medical abortions must tell their patients that "reversal" is an option, although they are not prevented from also telling patients if they think the treatment doesn't work. Medical researchers such as Creinin and the American College of Obstetrics and Gynecology (ACOG) are concerned by that trend.
Proponents of the technique say they do have evidence. That evidence is anecdotal, Creinin says, or comes from studies that lack rigorous controls.
According to the American College of Obstetrics and Gynecology, "as many as half of women who take only mifepristone continue their pregnancies." (If the pregnancy does continue, mifepristone isn't known to cause birth defects, ACOG notes.)
While searching online, many find the website for the Abortion Pill Rescue Network, a nationwide group of clinicians who provide the supposed treatment. The network is backed by Heartbeat International, an anti-abortion rights group, and, according to spokesperson Andrea Trudden, includes more than 500 clinicians willing to prescribe progesterone to patients who have initiated the medication abortion process.
Dr. Daniel Grossman, an OB-GYN at the University of California, San Francisco, says all of the published studies supporting this use of progesterone have been marred by methodological flaws that inflate the "success rate" of the reversal treatment.
Dr. Creinin's study is slated to involve 40 women who are between 44 and 63 days of pregnancy and are seeking to have a surgical abortion. As a condition of the research, the women would have to be willing to take mifepristone, the initial pill that would normally trigger a medical abortion, and then a placebo or progesterone.
Two weeks later, researchers will see if there's any difference in the rates of continued pregnancy. If progesterone can prevent the effects of mifepristone, Creinin says, he'll find that more women in the group that got progesterone still have a pregnancy that's progressing.
Creinin hopes that his work will help medical researchers better understand if this kind of treatment can actually help women who change their minds after taking mifepristone for a medication abortion. If the results show the progesterone doesn't work, Creinin hopes that they will discourage state legislators from mandating that doctors tell their patients about an ineffective treatment.
Creinin started enrolling patients in the study in February. He isn't sure how long the study will take, but says he probably won't have preliminary results for at least a year.
Tuesday, March 12, 2019
Politico (Mar. 12, 2019): Appeals court rules Ohio can defund Planned Parenthood, by Alice Miranda Ollstein:
In an en banc opinion issued Tuesday, the Sixth Circuit Court of Appeals found that Ohio may cut state funding to Planned Parenthood because the organization performs abortions, overturning a lower court ruling that blocked the state from stripping about $1.5 million of annual support from the network of clinics.
The Sixth Circuit's ruling affects six state public health programs in Ohio, but doesn't touch Medicaid. The Supreme Court in December declined to review a case brought by other Republican-led states seeking to cut off Medicaid funding for Planned Parenthood and other reproductive health organizations that offer abortions.
Four of the eleven Sixth Circuit judges who sided with Ohio in Tuesday's decision were appointed by President Donald Trump. The judges said Ohio’s law barring state health department funding from going to any provider who offers “non-therapeutic abortions” or advocates for abortion rights, “does not violate the Constitution because the affiliates do not have a" substantive "due process right" under the Fourteenth Amendment "to perform abortions."
In her dissent, Judge Helene White and five of her colleagues argued that the state’s law “would result in an undue burden on a woman’s right to obtain non-therapeutic abortions if imposed directly.”
The opinion is available here.
The New Yorker (Mar. 6, 2019): The Challenges of Innovating Access to Abortion, by Sue Halpern:
As states across the country continue to enact burdensome and medically unnecessary restrictions on safe and legal abortion care, last week the New Yorker examined the landscpe for access to abortion care via telemedicine.
Hawaii has one of the least restrictive abortion policies in the country, and yet services are still hard to come by due to geographic challenges. In 2018, only two of the Hawaiian islands had abortion providers: Maui and Oahu. As a result, medication abortion via telemedicine is a vital service to Hawaiian women seeking care.
Telemedicine—obtaining medical services over the phone or through the Internet—is not a new phenomenon. In the U.S., it began to take off in the late nineteen-fifties, and a 2016 federal grant to increase access to health care in rural areas has made it more mainstream.
TelAbortion, a service provided by the reproductive-health initiative Gynuity, enables a woman to terminate a pregnancy in the privacy of her own home, but with medical oversight. The service is available in Hawaii, Maine, New York, Oregon, and Washington as a five-state trial launched by Gynuity in response to the ever-diminishing availability of abortion services in the United States.
Although the five states in the TelAbortion trial have some of the most accommodating abortion laws in the country, Gynuity is only able to run the trial with a waiver from the F.D.A., which has put onerous restrictions on the distribution of abortifacients. Mifepristone is one of only seventy-five F.D.A.-approved medications controlled through its Risk Evaluation and Mitigation Strategy (REMS), and only one of fifty with its most stringent restrictions. According to the F.D.A., REMS, which regulates such drugs as Thalidomide, which is known to cause birth defects, is a drug-safety program for “medications with serious safety concerns to help ensure the benefits of the medication outweigh its risks.” The REMS mandates that mifepristone only be dispensed to a patient in a clinic, medical office, or hospital. A doctor can’t send a patient to their local pharmacy with a prescription for the medication, because pharmacies are not allowed to carry the drug. This limits the ability of physicians to administer the medication and of patients to obtain it, despite nearly twenty years of evidence demonstrating its safety and efficacy. The American Congress of Obstetricians and Gynecologists has recommended eliminating the REMS altogether. An F.D.A. panel of experts recommended eliminating one aspect of the REMS in 2016 when the mifepristone REMS came up for review. It was overruled by the F.D.A. commissioner, an Obama appointee.
Medication abortion should make access to care easier, but some of the more recent restrictions passed by state legislatures also make getting medication abortion, which is already constrained by the REMS, more difficult. Seventeen states require that a clinician be physically present when mifepristone is taken. Thirty-four states require those clinicians to be licensed physicians. Women who obtain and self-administer medication abortion outside the traditional medical establishment, typically from an Internet pharmacy, may be subject to arrest and imprisonment. In 2013, a woman in Pennsylvania who had ordered them online for her daughter was sentenced to a nine-to-eighteen-month jail term for “providing abortion without a medical license, dispensing drugs without being a pharmacist, assault and endangering the welfare of a child.”
It is now possible to order these medications through AidAccess, a program overseen by a doctor in the Netherlands. While no one has been arrested, the promulgation of fetal-homicide laws—thirty-eight states now have them—and aggressive prosecutors puts women at risk of arrest if they obtain them in this manner.
According to the Guttmacher Institute, “these laws are even being used to pursue women who are merely suspected of having self-induced an abortion but in fact had suffered miscarriages.”
Monday, March 11, 2019
Rewire.News (Mar. 7, 2019): Here's How Democrats Want to Classify Reproductive Rights as Human Rights, by Katelyn Burns:
The Trump administration's State Department deleted reproductive rights from its human rights report last year. Now, Congressional Democrats have introduced a bill that would require the inclusion of reproductive rights--by way of an accounting of "access to reproductive health care"--in the report.
"The 'Reproductive Rights Are Human Rights Act' was introduced by Democratic caucus vice chair Rep. Katherine Clark (D-MA) and announced at a press conference Thursday [March 7, 2019] along with Rep. Barbara Lee (D-CA) and U.S. Senate co-sponsors Bob Menendez (D-NJ) and Richard Blumenthal (D-CT)."
Representative Clark said:
The way that we are able to protect human rights internationally is through shining a light on the violations. I think what this administration is saying is that we are no longer interested in finding out what is happening with women’s health and monitoring, assessing and protecting women across the globe.
The State Department's annual human rights report is of critical important to the our government, notes Amanda Klasing, acting co-director of the women’s rights division at Human Rights Watch. Congress uses this report in determining appropriations pertaining to foreign assistance, and immigration judges likewise rely on the report in making decisions about pending asylum claims.
If a woman crosses the border from El Salvador claiming asylum in the United State because she is threatened with jail time in her home country for having a miscarriage, for example, an immigration judge might look to the human rights report to determine whether this is a credible basis on which she may claim asylum.
The information that used to be included on the report was gathered by foreign service officers who had established relationships with health care providers and advocates around the world. These relationship no longer exist under the current administration. Not only is the information foreign service officers previously gathered lost, the contacts that enabled substantial, accurate reporting are gone.
"There will be a minimum of a year or two years for embassies to rebuild meaningful relationships where they can actually be substantially reporting on what’s happening," said Stephanie Schmid, U.S. foreign policy council at the Center for Reproductive Rights (CRR).
Since the deletion of reproductive rights from the report, the CRR has twice sued the State Department under the Freedom of Information Act in an effort to access documentation about the erasure. The newly-proposed bill "mandates that foreign service officers must consult with reproductive health and rights organizations in local communities to gather accurate information for the human rights report."
Advocates for reproductive rights hope this bill will solidify the importance of including reproductive rights among human rights generally.
'There is a sense that there are hard human rights issues and then there are soft human rights issues,' Klasing said. 'The State Department is still reporting on the hard human rights issues like torture, extrajudicial killings, but there’s some flexibility as to whether or not these [reproductive rights] actually qualify as human rights. As somebody who has interviewed both people who have been victims of state sponsored violence, torture, abuse, and people who have had their reproductive rights violated, the feeling of abuse, the feeling of violation is the same. It’s a visceral feeling.'
Saturday, March 9, 2019
The Irish Times (Mar. 4, 2019): Irish ban on funding abortion services in developing world to be lifted, by Pat Leahy:
As a result of the 2018 repeal of Ireland's constitutional ban on abortion, Irish foreign humanitarian and development policy is shifting, too. Previously, Irish foreign aid money was generally prohibited from being used to fund abortion services, because such medical and reproductive health programmes were contrary to Irish law.
Irish Aid, the development aid programme of Ireland's government, is now launching a new initiative on "sexual and reproductive health and rights." The Ministry of Foreign Affairs last week launched its new policy on development aid: "A Better World." The policy has four priorities, including prioritizing gender equality, reducing humanitarian need, climate action, and strengthening governance. The reconsiderations of reproductive health aid are expected to flow from this new policy.
The main focus of Irish Aid's programmes lies in sub-Saharan Africa, where Ireland has long-standing assistance programs in eight countries. Irish Aid also has established programming in Vietnam, South Africa, and Palestine, among other nations.
The prior Irish policy of withholding funding for abortion services echos the Trump administration's global gag rule pertaining to foreign aid. Programs and policies that police the reproductive health services offered in foreign nations have a significant, negative impact in countries aiming to slow population growth and provide comprehensive health care and education to women and girls.
Tuesday, March 5, 2019
Houston Chronicle (Feb. 25, 2019): Texas gave anti-abortion group millions for women's health, despite warnings, by Jeremy Blackman:
In May 2016, Carol Everett sent an email to fellow anti-abortion activists detailing “an extraordinary pro-life opportunity.” Her nonprofit, the Heidi Group, she said, had spent the past year pushing for nearly $40 million in funding to help Christian pregnancy centers “bless many poor women” across Texas. The opportunity she was discussing? An application to become one of the state’s leading family planning providers as part of the Healthy Texas Women program, which offers free women’s health and family planning services to eligible, low-income women.
Everett had never contracted with the state and had no clinical background. Many of the pregnancy centers she cited don’t provide contraception, a core family planning service. Still, state health officials gave her significant public funding anyway, ignoring warning signs and overruling staff that recommended millions less in funding, according to a review of the contracting by the Houston Chronicle. When Everett’s clinics began failing, Texas delayed for months in shifting money to higher performing clinics and chose to devote vast amounts of time to support Everett and her small, understaffed team.
The Heidi Group was not the only contractor that struggled in Healthy Texas Women. By the end of the first year, others had met just 46 percent of their combined patient targets. They had spent just over a third of their proposed fee-for-service expenditures, the state’s preferred source because every expense can be tracked. Those excelling early on were established providers versed in the state’s complex billing procedures. For them, the program has been a boon from the beginning, increasing funding for equipment and staff, and adding reimbursements for a larger swath of health services. Still, many of the smaller, less-experienced clinics could not scale up quickly enough and felt they had not received adequate training on billing and enrollment delays.
The state's separate Family Planning program within HHS had twice the success rate, both in spending and patient targets. Though the 39 Healthy Texas Women contractors had access to more money in the first year, those in the Family Planning program outspent them by several million dollars, which the state said it could not immediately verify. Because of its less stringent eligibility requirements, Family Planning program providers say they can more easily meet need where it exists. And for many of them, that is with immigrant and undocumented families.
Though it’s impossible to say how many more women could have been served had the resources been shifted sooner, several competing clinics involved in Healthy Texas Women burned through their funding early in the grant cycle, surpassing their targets for both spending and patients treated. Had they been sent some of the $6.75 million sitting in wait for the Heidi Group, the door could have opened for thousands more women to receive access to contraception, STD screenings and breast exams.
“We would definitely have been able to serve more,” said Marcie Mir, the chief executive officer of El Centro de Corazon, which serves immigrant communities in East Houston.
The Houston Chronicle’s review included emails, internal records, and interviews with two dozen people, and found that the Texas HHS made repeated concessions, and not just to the Heidi Group. State health officials lowered the standards for applicants in two new women’s health programs, including Healthy Texas Women, and revised past patient counts, making it easier to show growth. Quality control measures were stalled, and only the Heidi Group received on-site clinical assessments in the first year, despite similar problems with other contractors.
At least one top Republican, Governor Greg Abbott, laid the groundwork for Everett’s selection, controlling her appointment to an influential committee helping to develop the new programs, according to records. The health official who allocated Everett's award has close personal ties to the conservative Texas Public Policy Foundation, whose founder, Dr. James Leininger, has been a key donor to the Heidi Group, as well as to Abbott.
Everett’s funding was revoked last fall after two years of poor performance, and auditors are reviewing whether the Heidi Group mishandled funds.
Despite an uptick in number of people served in 2017 from the previous year, Texas still served 100,000 fewer patients than in 2010, despite spending about $35 million more in 2017, including federal dollars.
What has happened in Texas may be a preview for the country at large. The Trump administration on Friday announced it is cutting family planning funding to abortion affiliates, a decision that further undermines groups like Planned Parenthood, which provide the bulk of non-abortion services to low-income women nationally. The move, much like the one in Texas years ago, is expected to direct millions toward faith-based providers.
The New York Times (Mar. 1, 2019): An 11-Year-Old in Argentina Was Raped. A Hospital Denied Her an Abortion, by Daniel Politi:
Despite laws in Argentina saying that pregnant people may seek abortions in the case of rape (one of the only instances in which abortion is legal in the country), an 11-year-old rape survivor was denied the abortion she requested and instead forced into a C-section delivery.
The child was reportedly raped by her grandmother's boyfriend. She discovered her pregnancy at 19 weeks after going to the hospital complaining of severe stomachaches. Both the child and her mother pushed for her to receive the abortion, but doctors administered drugs without consent to hasten the development of the fetus so that she could deliver instead (the doctors told her that they were giving her "vitamins").
Fernanda Marchese is the executive director of Human Rights and Social Studies Lawyers of Northeastern Argentina, which is representing Lucía (a pseudonym) and her family. Marchese reports that the hospital permitted anti-abortion activists to enter Lucía’s hospital room, "where they urged her to have the baby, warning that she otherwise would never get to be a mother."
"Reproductive rights groups filed emergency lawsuits that led to a court order instructing the hospital to carry out an abortion at once." The doctors still refused, citing conscientious objections.
Private sector doctors Cecilia Ousset and José Gigena agreed to conduct the abortion, but because Lucía’s pregnancy was so far along, they decided they had no choice but perform a C-section. Dr. Ousset identified that Lucía’s life was at risk throughout the ordeal in a phone interview with the New York Times. Lucía is now healthy and should be discharged soon.
Genetic material from the umbilical cord will be studied and possibly used to prosecute the man who is alleged to have raped Lucía. He has already been arrested.
Although the case has gained notoriety, many say it reflects a reality in parts of Argentina. “In the north of Argentina,” Dr. Ousset said, “there are lots of Lucías and there are lots of professionals who turn their back on them.”
March 5, 2019 in Abortion, Abortion Bans, Anti-Choice Movement, In the Media, International, Medical News, Politics, Pregnancy & Childbirth, Reproductive Health & Safety, Sexual Assault, Women, General | Permalink | Comments (0)