Monday, January 20, 2020
Supreme Court Will Consider Trump Administration Rule Allowing Employers to Opt Out of Contraceptive Coverage
New York Times (Jan. 17, 2020): Supreme Court to Consider Limits on Contraceptive Coverage, by Adam Liptak:
Last Friday, the Supreme Court announced that it will hear two consolidated cases considering a Trump Administration rule that allows employer to opt out of the Affordable Care Act's contraceptive mandate based on religious or moral objections.
Last May, the Third Circuit blocked the regulations and issued a nationwide preliminary injunction.
The Trump Administration is arguing that the regulations are authorized by the ACA and required by the Religious Freedom Restoration Act. While the case presents interesting policy questions about whether and when employers can assert moral or religious objections in order to opt out of a statute of general application, the legal issues that the Court will consider are whether there was statutory authority under the ACA or RFRA to issue the regulations and whether the Administration complied with Administrative law requirements.
Friday, January 10, 2020
Amicus Brief filed by Members of Congress invites the Supreme Court to overrule Roe and Casey, what is really making the Court’s abortion precedent “unworkable”?
By Cynthia Soohoo (January 10, 2020)
Last week over 200 federal lawmakers filed an amicus brief inviting the Supreme Court to overrule its 1973 case Roe v. Wade, which recognized woman’s fundamental right to access abortion. The brief, signed by roughly 80% of Republicans in Congress and 2 Democratic House Members, takes the position that the “undue burden” standard that the Court applies to determine if abortion restrictions are constitutional is “unworkable” and so “vague and opaque” that the Court should not only reconsider the undue burden standard but the right to abortion itself.
The brief was filed in June Medical Services v. Gee which addresses the constitutionality of a Louisiana law requiring that doctors who perform abortions have admitting privileges at hospitals within 30 miles from where the procedure is performed and will be argued before the Court in early March. The brief’s extraordinary request is not surprising given that it was written by Americans United for Life, an anti-abortion public interest law firm that has led the fight to overturn Roe v. Wade since the 1970s. But the brief’s argument is ironic given strong evidence that to the degree that Roe and Casey can be deemed unworkable what has made it so is the staunch refusal of anti-choice activists to accept the decisions and the extreme politicization of abortion so that changes in the Supreme Court’s composition raise expectations that states and lower courts need not follow the law.
The refusal to accept Roe’s core holding, despite repeated reaffirmance by the Supreme Court, is illustrated by the claim made in the Legislators’ Brief that “Roe did not actually hold that abortion was a ‘fundamental’ constitutional right, but only implied it.” Not only have AUL and other anti-abortion groups refused to accept Roe, since the 1970s, they have consistently churned out model bills creating different types of abortion restrictions designed to undermine access to abortion and test the limits of Roe. After Casey allowed states to adopt pre-viability restrictions on abortion to protect women’s health as long as the restrictions do not impose an undue burden on abortion access, AUL encouraged states to pass new health regulations specifically targeting the provision of abortion. Known as TRAP laws, these laws do not prohibit abortions, but they impose regulatory requirements that make it difficult or impossible for the doctors who provide abortions to stay in business, raising the question of whether TRAP laws can create an unconstitutional undue burden.
This is the question that the 2016 case, Whole Woman’s Health v. Hellerstedt resolved. In doing so, the Supreme Court clarified that courts applying the undue burden standard should determine whether a challenged law advances the state’s purported interest and then balance the laws’ benefits with the burden it imposes on abortion access. After applying the standard, the Supreme Court held that an admitting privilege law that is virtually identical to the law challenged in June Medical Services was unconstitutional because the law provided no health benefit and imposed numerous obstacle in the path of a woman seeking an abortion.
Contrary to claims that the undue burden standard is “unworkable,” in 2016 and early 2017, courts had no problem applying the standard, especially in cases involving admitting privileges. After Whole Woman’s Health, the Supreme Court declined to hear cases challenging decisions striking down admitting privilege laws in Wisconsin and Mississippi. Alabama’s Attorney General dropped an appeal of an admitting privilege case, stating that “There is no good faith argument that Alabama’s law remains constitutional in light of the Supreme Court’s ruling.” Tennessee dropped a challenge to an admitting privileges law, and where states refused to drop cases, courts struck down admitting privilege laws.
But application of the undue burden standard and respect for Roe and Casey shifted when the Supreme Court’s composition changed. After Justice Kavanaugh joined the Court in late 2018, legislatures rushed to pass even more extreme laws that go to the heart of Roe’s core holding that a woman has a right to choose an abortion prior to fetal viability. These laws included a total abortion ban in Alabama and multiple state bans on abortion just a few weeks into pregnancy. Illustrating just how cavalier states became about complying with Supreme Court precedent, in 2019 Ohio passed a 6 week abortion ban despite the fact that an identical bill had been vetoed the year before by its former Governor John Kasich, an anti-choice Republican, because the law was unconstitutional.
Even though lower courts have struck down the extreme abortion bans laws, states have become more aggressive in continuing legal challenges, perhaps in hopes that the cases will work their way up to the reconstituted Supreme Court. This leads us back to June Medical Services and the argument in the Legislators’ Brief that the Supreme Court should reconsider its precedents because the undue burden standard has become unworkable. As recognized by dissenting Fifth Circuit Judge Patrick Higginbotham, who was part of the Fifth Circuit panel that heard June Medical Services below, the application of the undue burden standard after Whole Woman’s Health is “straightforward.” What is making it unworkable is the expectation that the newly constituted Roberts court will be open to the invitation to overturn Roe and Casey. Hopefully, the invitation will be declined.
Tuesday, December 3, 2019
(December 2, 2019):
Yesterday, 27 amicus briefs were filed with the Supreme Court in June Medical Services v. Gee . The case asks the Court to determine the constitutionality of a Louisiana law that requires doctors performing abortions to have admitting privileges in nearby hospitals. Although the Court found a similar provision unconstitutional in the 2016 case Whole Woman's Health v. Hellerstedt, the 5th Circuit upheld the Louisiana provision. June v. Gee will be the Court's first opportunity to decide an abortion case since Justice Gorsuch and Kavanaugh joined the Court.
The briefs were filed in support of June Medical's position that the law is unconstitutional and reflect a broad range of interests and perspectives. In addition to briefs filed by constitutional law experts, federal court scholars and the ABA, two briefs were filed on behalf of women who have had abortions. Other amici include: reproductive justice organizations and scholars, Civil Rights, Women's Rights and LGBTQ organizations, reproductive health organizations, medical professionals, social science organizations, members of Congress, former federal officials and 21 states and the District of Columbia. Catholics for Choice submitted a brief on behalf of religious organizations from a broad range of faiths. The case is scheduled for oral argument on March 4.
Saturday, November 23, 2019
Bustle (Nov. 13, 2019): SCOTUS Will Hear An Abortion Rights Case With Major Implications, by Jo Yurcaba:
The Supreme Court of the United States will hear the Louisiana abortion case June Medical Services v. Gee. The case was appealed from the 5th Circuit by June Medical and challenges a state law that will require abortion-providing clinics to have admitting privileges at a local hospital.
Louisiana, in the course of the appeal, also seeks the have the Court overturn "third-party standing" precedent. This long-standing rule allows clinics and providers to sue on behalf of their patients. Without such a rule, many pregnant persons would not choose to lose their anonymity by filing a case or else may not have the means to pursue comparable litigation in defense of their rights.
Anti-abortion activists and lawmakers hope to eliminate third-party standing as a way to keep challenges to abortion restrictions out of courts in the first place. Should the court strike down the validity of third-party standing, it may also call into question prior abortion precedent--including 1973's landmark Roe v. Wade--which was won without a direct patient-plaintiff.
Third-party standing was established just three years after Roe. Justice Blackmun at the time held that physicians have a unique ability to speak for their patients, stating that the physician is particularly qualified "to litigate the constitutionality of the State's interference with, or discrimination against" a person's abortion rights. Blackmun specifically acknowledged the gamut of challenges those facing abortions face. Experts cite, for example, that half of all women who get abortions are low-income and certainly cannot match the resources of their abortion providers in defending their rights.
Travis J. Tu, Senior Counsel for the Center for Reproductive Rights, is arguing the June Medical Services case before SCOTUS and says that overturning third-party standing could "take a wrecking ball to 40 years of abortion jurisprudence."
June Medical Services echoes a prior case SCOTUS decided in 2016: Whole Woman's Health v. Hellerstedt. Hellerstedt ruled that Texas' House Bill 2, which attempted to implement similar targeted regulations of abortion providers (TRAP), was unconstitutional and placed an undue burden on persons seeking abortion access.
Despite the 2016 decision in Hellerstedt, the 5th Circuit decided against precedent, upholding the Louisiana law.
Proponents of laws imposing admitting privileges generally justify them on the purported ground that they protect the health of pregnant persons seeking abortions. In reality, many hospitals will not grant admitting privileges, because they are not necessary.
TRAP regulations at their core are intended by anti-abortion activists to regulate abortions out of legal existence. Like the law at issue in June Medical, TRAP regulations generally require abortion providers to have admitting privileges at local hospitals, but they may also impose other requirements, including that abortions only be provided in certain, costly, far-more-complicated facilities than is reasonably necessary. The intended effect of TRAP laws is the same: severely limiting, if not outright abolishing, any clinics or providers who can legally offer abortions.
If the Louisiana law is upheld, June Medical Services will be the only remaining abortion-providing clinic in the state after two others are regulated out of existence. The eventual decision in June Medical will bring comparable consequences, whichever way it goes, for the many pending cases challenging similar abortion-restricting laws around the country.
November 23, 2019 in Abortion, Abortion Bans, Anti-Choice Movement, Current Affairs, In the Courts, Politics, State and Local News, State Legislatures, Supreme Court, Targeted Regulation of Abortion Providers (TRAP) | Permalink | Comments (0)
Friday, November 22, 2019
Reprohealthlaw Blog Commentaries (Oct. 31, 2019): The Mexican Supreme Court's latest abortion ruling: In between formalities, a path to decriminalization, by Estefanía Vela Barba:
In Mexico's Supreme Court's latest abortion ruling, issued earlier this year, the justices of the First Chamber found that denying a woman access to abortion when her health may be at risk is unlawful, violating her right to health codified in the San Salvador Protocol and the International Covenant on Economic, Social and Cultural Rights (ICESCR).
The San Salvador Protocol is an additional protocol to the American Convention on Human Rights that expands on the original protections of economic, social, and cultural rights referenced in the American Convention. In General Comment No. 14, the Committee on Economic, Social and Cultural Rights interpreted Article 12 of the ICESCR to affirm the right to individual autonomy regarding one's own health decisions and the right to attain the highest standard of health.
The Mexican Court relied on these international instruments in tandem with their constitution to emphasize that the right to health includes the right to access the "full range of facilities, goods, services, and conditions" necessary to execute one's health decisions and attain the highest possible level of health.
The Court held that Mexico's General Health Law, which does not "explicitly contemplate access to abortion," must be interpreted in a way that is compatible with the internationally-codified right to health. The Court further understood that health holistically encompasses physical, mental, and social well-being "as defined by each individual." The decision, furthermore, referred to abortion as a "therapeutic intervention." The denial of such an intervention is a denial of a woman's right to health, the Court said.
The case is also important in that it had to overcome the procedural challenges of an amparo proceeding. An amparo proceeding is meant as a guarantee of an individual's Constitutional rights and can generally only be brought under particular circumstances once all means of appeal have been exhausted. Essentially, the purpose of amparo suits is "to stop or reverse an unjust ruling."
In Mexican case law, the amparo suits tend to be interpreted quite narrowly, limiting its availability in denial-of-abortion cases, since the resolution of the lawsuit nearly always takes significantly longer than the duration of a full-term pregnancy.
Here, the plaintiff had already successfully sought her abortion in Mexico City, and the district court in Mexico held that the suit should not reach the merits, because "the subject matter of the government action being challenged ceased to exist" once the plaintiff obtained her abortion.
The Mexican Supreme Court, though, on appeal, applied the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) to find that it must adopt a more liberal interpretation of the bounds of this amparo suit in order to account for the disparate impact of the apparently "gender-neutral" provisions allowing for such lawsuits. The Court found that denying Jane Doe's case based on the procedural limitations of amparo alone would "hinder women's right to access justice in practically everything related to pregnancies, including their termination."
While the Court did not address the interplay with the Mexican Criminal Code and General Health Law as it related to abortion services and focused primarily on the implementation of the General Health Law, many abortion-rights activists consider this ruling a progressive step forward for the country.
Friday, November 15, 2019
New York Times (Nov. 15, 2019): Planned Parenthood Awarded More Than $2 Million in Lawsuit Over Secret Evidence, by Sabrina Tavernise:
On Friday, a jury in San Francisco found that the Center for Medical Progress (CMP) violated the federal Racketeer Influenced and Corrupt Organizations Act and awarded punitive and compensatory damages of $2.3 million. In 2015, the organization's leader David R. Daleiden and Sandra Merritt created a phony tissue procurement company and used false identities to meet with Planned Parenthood employees. Daleiden secretly taped the meetings and posted deceptively edited videos. The jury found CMP, Daleiden and Merritt committed fraud, trespass, and made illegal recordings and breached contractual confidentiality provisions. The jury found that Planned Parenthood was entitled to $469,361 in compensatory damages and $870,000 in punitive damages. Under RICO, compensatory damages are tripled.
Daleiden and Merritt argued that they were undercover journalists. However, the district judge in the case ruled that journalism is not a defense for the illegal acts of fraud, trespass and secret recording.
Thursday, November 14, 2019
Law.com (Nov. 8, 2019): Trump's DOJ Retreats From SCOTUS Fight Over Undocumented Teens, Abortion, by Marcia Coyle:
Earlier this week, the Trump Administration decided not to ask the Supreme Court to review an injunction blocking an Office of Refugee Resettlement (ORR) policy that prevented undocumented minors from having access to an abortion while in government custody. The Supreme Court had granted the Department of Justice two extensions of time to seek review, but in the end the DOJ did not file a petition by its Nov. 8 deadline.
The case, Azar v. Garza, gained attention during Justice Brett Kavanaugh's confirmation hearings because of a dissent he wrote from a D.C. Circuit decision upholding an order instructing the ORR to allow the named plaintiff in the case to obtain an abortion. If the Supreme Court had taken the case, Justice Kavanaugh would probably have recused himself.
In June, the D.C. Court of Appeals affirmed a lower court decision certifying a class of pregnant unaccompanied minors in government custody and issuing the preliminary injunction.
Wednesday, November 13, 2019
The New York Times (Nov. 6, 2019): Judge Voids Trump-Backed 'Conscience Rule' for Health Workers, by Benjamin Weiser and Margot Sanger-Katz:
The Trump administration's "conscience rule" aimed to provide a way for health care providers to refuse to assist with abortion or other medical procedures on the basis of their religious or moral beliefs. The rule furthermore would've empowered these providers to refuse to give patients seeking care any referral to a willing provider. The rule attempted to coalesce dozens of separate laws, including those related to abortion and end-of-life care, into a singular framework.
It was scheduled to go into effect later this month, but a federal judge on Wednesday, November 6 voided the rule in a 147-page opinion. In his decision, Judge Paul A. Engelmayer said that the Department of Health and Human Services (HHS) did not have the authority to implement much of the rule. He further found that the HHS's purported purpose behind the rule was "factually untrue."
The agency claimed that the rule was meant to address an alleged "significant increase" in conscience complaints received by HHS--that is, complaints by health care workers who wished not to perform or participate in certain procedures. Judge Engelmayer, though, found that of the 358 complaints HHS claimed to receive during the identified period, only about 20 were true, unique, and relevant to the law at issue.
Opponents of the rule, including Planned Parenthood, one of the plaintiffs in the case, lauded the decision, saying it prevented the Trump administration from "providing legal cover for discrimination."
In addition to Planned Parenthood, the other plaintiffs included 19 states, three cities, a county, and an additional reproductive health care provider. This was only one of several parallel cases filed throughout the country.
HHS and the Justice Department are reviewing the decision as they consider whether to appeal.
November 13, 2019 in Abortion, Anti-Choice Movement, Culture, Current Affairs, In the Courts, Medical News, Politics, President/Executive Branch, Reproductive Health & Safety, Women, General | Permalink | Comments (0)
Tuesday, November 12, 2019
Reproductive Rights Prof Blog (Nov. 12, 2019): UN Human Rights Expert Recognizes Obstetric Violence as a Human Rights Violation by Lara Russo:
On October 5th, 2019, the United Nations Special Rapporteur on violence against women, its causes and consequences presented a report to the UN General Assembly that looked at obstetric violence globally. The report entitled, “A Human Rights-Based Approach to Mistreatment and Violence Against Women in Reproductive Health Services with Focus on Childbirth and Obstetric Violence,” marks the first time an international human rights body has identified obstetric violence as a violation of human rights.
The term "obstetric violence" is widely used in South America, though is not commonly used in the international human rights community as of yet. The term broadly refers to mistreatment and violence experienced by pregnant people during facility-based childbirth. Internationally, violence against women is defined as “any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life.”
The report details the numerous ways that women’s human rights can be violated in the birth context including: forced or non-consensual procedures, torture or cruel and inhuman or degrading treatment from use of restraints or lack of anesthesia during painful procedures, use of medically unjustified procedures, and violations of privacy, confidentiality, humiliation and harassment by health care providers.
Informed consent is highlighted in the report as a fundamental human right that can act as a safeguard against obstetric violence. Pregnant people are frequently denied their right to make informed decisions about their care during childbirth, which the report identifies as a human rights violation. Examples of violation of informed consent include presentation of consent forms to a pregnant person while in labor when it is difficult or impossible to understand the forms or formulate questions about treatment and when a doctor makes decisions on behalf of a pregnant person because the doctor’s medical knowledge is deemed superior to a woman’s entitlement to information and autonomous decision-making.
The United States was explicitly criticized in the report for the common usage of non-consensual procedures and restraints of pregnant people during birth. In the U.S. it is legal in many states for doctors and medical students to perform pelvic exams on unconscious women who are under anesthesia for another procedure, who do not require a pelvic exam, and who have not explicitly consented to one. Despite recent reforms, pregnant people who are incarcerated in prison, jail, and immigration detention continue to be shackled and restrained during labor, delivery, and the post-delivery recovery period. The Committee Against Torture also has expressed concern about the shackling of incarcerated pregnant people in the U.S.
In addition to the obstetric mistreatment in the United States highlighted in the report, other forms of violence and mistreatment also occur. A recent study found that 1 in 6 pregnant, laboring, and postpartum women in the United States experienced mistreatment by medical providers. This number rose to 1 in 3 when narrowed to deliveries in hospitals rather than freestanding birth centers or at home and disparately impacts black women and people of color. This mistreatment includes being yelled at or scolded, ignored or refused assistance when asking for help, being coerced into interventions, such as induction or epidural, and threatened with having treatment withheld.
Among the recommended actions to address the issue of obstetric violence, the Special Rapporteur includes increased budgetary resources devoted to quality reproductive health care, ensuring professional accountability and sanctions by professional associations in cases of mistreatment. The report recommended addressing intersectional discrimination or compound stereotypes stating that
Some women experience intersecting forms of discrimination, which have an aggravating negative impact, and gender-based violence may affect some women to different degrees, or in different ways; appropriate legal and policy responses are needed in this regard.
One’s experience of intersectional discrimination or compound stereotypes can increase the likelihood of experiencing obstetric violence. The United States could do better in all of these realms.
The position of Special Rapporteur on violence against women, its causes and consequences was created in 1994 as a means of integrating the rights of women into the human rights mechanisms of the United Nations. The mandate of the special rapporteur is to seek and receive information on violence against women, recommend ways in which to eliminate such violence, and work collaboratively with the other United Nations humans rights mechanisms.
Thursday, October 31, 2019
The Washington Post (Oct. 29, 2019): Alabama abortion law temporarily blocked by federal judge by, Ariana Eunjung Cha and Emily Wax-Thibodeaux:
A federal district court in Alabama blocked the state's extremist abortion ban, passed in May, earlier this week. The law would almost entirely proscribe the termination of a pregnancy in Alabama, including in cases of pregnancy resulting from rape or incest. The single exception to to the ban would be in the case of serious risk to the life of the pregnant person.
Alabama state representative Terri Collins--the author of the bill--has framed the law as a direct challenge to Roe v. Wade, and stated in response to the preliminary injunction that this decision "'is merely the first of many steps'" in the anti-abortion movement's "effort to preserve unborn life." Rep. Collins aims for challenges to the law to make it to the Supreme Court and called this week's ruling "both expected and welcomed" on the journey to SCOTUS.
Judge Myron H. Thompson, who penned the decision out of the U.S. District Court for the Middle District of Alabama, "wrote that it violates Supreme Court precedent and 'defies' the Constitution."
The Alabama law joins eight other states' blocked attempts at restricting abortion access unconstitutionally.
Tuesday, October 29, 2019
California Governor Signs SB 464 into Law, Requiring Perinatal Health Providers To Receive Implicit Bias Training
Essence (Oct. 10, 2019): California Now Requires Perinatal Health Providers To Receive Implicit Bias Training, by Tanya A. Christian:
California Governor Gavin Newsom signed the "California Dignity in Pregnancy and Childbirth Act" (SB 464) earlier this month, which mandates implicit bias training for health care providers serving pregnant persons. State Senator Holly Mitchell authored the bill. Reproductive justice-oriented groups, including Black Women for Wellness, NARAL Pro-Choice America, Act for Women and Girls, as well as California Nurses Association all backed the law, which earned unanimous support in the state legislature.
The law is aimed at reducing maternal mortality among Black women--who face a disproportionately high rate--in the United States. It will require all care providers to both engage with bias training and improve their data collection processes in order to better understand the causes behind pregnancy-related deaths.
"As it stands, the U.S. leads the developed world in the number of pregnancy-related deaths. Black women compromise a large portion of those casualties, presenting a risk of mortality that is three to four times that of White women."
California currently has the lowest maternal mortality rate in the country and hopes to improve it further through SB 464.
Monday, October 7, 2019
U.S. joins 19 nations, including Saudi Arabia and Russia: ‘There is no international right to an abortion’
The Washington Post (Sept. 24, 2019): U.S. joins 19 nations, including Saudi Arabia and Russia: ‘There is no international right to an abortion’, by Ariana Eunjung Cha:
The United States, in a statement delivered to the United Nations General Assembly (UNGA) on September 23 this year, rejected the use of the term "sexual and reproductive health and rights" throughout U.N. documents and in particular within the international Sustainable Development Goals. Health and Human Services Secretary Alex Azar delivered the statement and emphasized that international instruments should not promote "abortion as a means of family planning." He disputed that there is an international right to an abortion.
The U.S., one among 19 nations who joined in the statement, further emphasized that "[they] only support sex education that appreciates the protective role of the family in this education and does not condone harmful sexual risks for young people."
The Netherlands delivered a responsive joint statement on behalf of 58 countries rejecting the U.S. position and stressing "the need to uphold the full range of sexual and reproductive rights." Country representatives also took to Twitter to object to the U.S. statement, using the hashtag #SRHR (sexual and reproductive health and rights), explicitly embracing the language the United States aims to erase.
Many country representatives, along with civil society advocacy groups, underscore that on this issue of abortion the U.S. "align[s] with countries like Saudi Arabia and Sudan with poor human rights records." They also emphasize the problematic nature of the United States' campaign to persuade other countries to form a new coalition in support of these regressive policies, calling attention to the fact that these efforts put "unfair pressure on poor countries" dependent on U.S. aid.
The Trump administration worked hard leading up the General Assembly to recruit conservative governments to support its efforts to roll back sexual and reproductive health and rights across the board. This campaign could have devastating effects on adults and children who rely on international programs for basic health care, particularly prenatal and postpartum health care.
The United States-led campaign at the UNGA last week follows a similar effort directed at the World Health Organization (WHO) in which the U.S., Brazil, Egypt, Saudi Arabia, and several other states campaigned to reject the term "sexual and reproductive rights" from WHO policy, as Colum Lynch for Foreign Policy reports.
Fortune (Sept. 19, 2019): "A Doctor Who Prescribes Abortion Pills to U.S. Women Online is Suing the FDA. Is She Breaking the Law?", by Erin Corbett:
Dr. Rebecca Gomperts, a physician licensed to practice medicine in Europe, launched the website Aid Access in 2018 in order to meet the growing need for accessible abortion care in the U.S.
Patients seeking to end a pregnancy in its early stages through the use of the medications misoprostol and mifepristone can complete an online consultation form on Aid Access about their pregnancy and general health. Dr. Gomperts prescribes the medication to patients so long as they are "healthy, less than 10 weeks pregnant, and live within an hour's distance of a hospital in case of emergency."
Medical abortion is an FDA-approved method to end a pregnancy, and studies have found that independently managing an abortion using misoprostol and mifepristone pills is both safe and effective.
"There is no evidence that home-based medical abortion is less effective, safe or acceptable than clinic-based medical abortion,” reads one study from the World Health Organization (WHO).
The two pills work in combination to terminate a pregnancy in the first 12 weeks. Together, they are over 96% effective, and using misoprostol on its own is more than 80% effective in the first trimester.
Dr. Gomperts emphasizes that the science supports the safety of medication abortions, including those done entirely by the women seeking the abortion themselves (in some cases, women may go to a clinic to physically receive the medication; in others, like here, women are prescribed the medications remotely, which are then mailed to them). "All medical abortions are self-managed," though, Dr. Gomperts says. "Women that go to a clinic and get the pill and have their miscarriage at home—it’s exactly the same procedure if they get the pills online.”
In the wake of the confirmation of right-wing, anti-choice Supreme Court Justice Brett Kavanaugh, along with the slew of extreme state-level restrictions on abortion access in recent years, Dr. Gomperts found that patients reaching out to her were seeking her help not only because they wanted an abortion but because they didn't know where else to get help or even information on any local health services available to them.
Dr. Gomperts received inquiries from over 40,000 women between March 2018 and August 2019. She prescribed the two abortion medications to just over 7,000 of those persons. The majority of the requests came from women living in abortion-hostile states with strict laws, like Alabama, Georgia, and Mississippi. Dr. Gomperts has consulted with women in all 50 states.
While several states have laws that criminalize any self-managed abortions, all of these statutes "pre-date Roe, likely making them unconstitutional," Erin Corbett, author of the Fortune article, says. They've been applied against pregnant persons nonetheless.
On September 9th, Dr. Gomperts and her attorneys filed a lawsuit in federal court in Idaho against the FDA and other federal officials, claiming that they illegally confiscated "between three and 10 'individual doses of misoprostol and mifepristone' that Dr. Gomperts had prescribed to patients since March."
The FDA claims that her practice "'poses an inherent risk to consumers who purchase'" these medications.
Dr. Gomperts asserts several claims for relief under both the Constitution and the Administrative Procedure Act. Prosecuting Dr. Gomperts or her patients would violate their rights to liberty, privacy, and equal protection under the Fifth Amendment, the lawsuit claims.
Friday, September 20, 2019
Sept. 11, 2019 (Rewire.News):‘We Are Headed Toward a Public Health Crisis’: Title X Clinics Grapple With Trump’s ‘Gag Rule’, by Erin Heger:
The Trump administration recently introduced a 'gag rule' on recipients of Title X funding, which provides federal money for family planning services to low income individuals hroughout the country. The new rule prohibits clinics receiving Title X funding from referring their patients for abortion care. Clinics that provide abortion services will also have to physically separate abortion and Title X-approved services.
HHS Office of Population Affairs operates Title X by funding “grantees” (health care organizations, state health departments, or non-profits) that oversee the distribution of Title X funds to safety-net clinics and other sites to provide family planning services to low-income, uninsured, and underserved clients.
Because of the recently introduced restrictions, health care organizations and some states are choosing to opt out of receiving Title X funding altogether rather than attempt to comply. The most notable of rejections may be from Planned Parenthood, which announced last month that it was rejecting funding under the new guidelines. The organization's clinics serve 40 percent of the country's Title X patients, and there are concerns that other providers will struggle to take on the resulting predicted increase in patients. According to Guttmacher Institute, there will need to be an estimated 70 percent expansion in clinics' caseloads in order to make up for Planned Parenthood's absence.
Seven states have also opted out, but other states and health care organizations have decided to stay, for fear that clinics they fund will not be able to afford to stay open without the Title X money. Providers in Missouri, for example, are in large part continuing to accept funding. With previous restrictions on abortions leaving the state with only one abortion clinic, access to reproductive health care is extremely limited as is. "For the majority of Title X patients, their Title X provider is their only source of health care, particularly in small and rural communities," Audrey Sandusky of the National Family Planning and Reproductive Health Association told Rewire.News.
The second part of the gag rule requires that clinics somehow separate out their abortion services from their other functions. This is set to go into effect this coming March, but it's yet to be determined what hoops clinics will have to jump through to remain safely in compliance under these new standards. Many of the providers' plans submitted to the U.S. Department of Health and Human Services have not been approved as of yet. The largest of the Title X administrators, Essential Access Health, has had their plan approved, but its details have not been released.
Sandusky pointed out how low-income individuals already face serious barriers in their lives, and this new restriction makes it even more likely that they will go without care if they cannot go to a Title X provider. "That means they go without cancer screenings, STD testing and treatment, and HIV services. Given the uncertainty that exists across the country, we are headed toward a public health crisis." This certainly seems to be the case.
Thursday, September 19, 2019
Sept. 16, 2019 (AP News): Many U.S. women say first sexual experience was forced in teens, by Lindsey Tanner:
A new study published in JAMA Internal Medicine reports that "the first sexual experience for 1 in 16 U.S. women was forced or coerced intercourse in their early teens"--and often perpetrated by persons nearly a decade senior to the survivors.
The national survey conducted for the study did not use the term rape when asking participants about forced sexual experiences but identified a first sexual intercourse experience as "involuntary." Almost half of the participants who reported involuntary intercourse were physically held down during the experience, while just over half of the same respondents described being "verbally pressured to have sex against their will."
The lead author of the study, Dr. Laura Hawks, affirms that “any sexual encounter (with penetration) that occurs against somebody’s will is rape. If somebody is verbally pressured into having sex, it’s just as much rape."
The study goes on to show that persons whose first sexual intercourse experiences amounted to rape reported "fair or poor health" twice as often as other women. The same women also "had more sex partners, unwanted pregnancies and abortions, and more reproductive health problems including pelvic pain and menstrual irregularities than women whose first sexual experience wasn’t forced."
The new study adds to the findings of prior research that identified a range of long-term effects of sexual assault, including "social isolation, feelings of powerlessness, stigmatization, poor self-image and risky behavior, which all may increase risks for depression and other mental health problems"
An editorial in this issue of the Journal "notes that the study lacks information on women’s health and any abuse before their first sexual encounter." It also doesn't include data on sexual violence after the women's first encounters, which, the editorial notes, may further "contribute to health problems."
The Journal calls for further research to fully understand and address the "range and consequences," particularly as related to long-term health outcomes, of sexual assault on survivors.
Sex education specialists have responded emphasizing the need for inclusive education in U.S. schools that teaches children about consent among other healthy sexual practices.
September 19, 2019 in Culture, Medical News, Reproductive Health & Safety, Scholarship and Research, Sexual Assault, Sexuality Education, Teenagers and Children, Women, General | Permalink | Comments (0)
Tuesday, September 17, 2019
September 10, 2019 (NBC News): It just got a Little Easier for Low-Income Women in Texas City to Access Abortion Care, by Adam Edelman:
Last week, City Counsel members in Austin, Texas voted to include funding for low-income women to access abortion. This creative measure supports abortion access through funding services like travel to and from abortion clinics, lodging, and child care for women who need abortion procedures.
A Texas state bill enacted earlier this year, SB22, bans any Texas municipality from allocating public funding to groups that provide abortion care. However, the City Counsel's funding does not actually fund the procedure, sidestepping the restrictive legislation.
'Advocates of the funding told NBC News it would not violate any of Texas’ restrictive abortion laws. Rather, they explained, the bill would merely help low-income women who need abortion care navigate a complicated landscape.'
Current Texas law imposes a number of barriers that make obtaining an abortion more time consuming and costly. Texas law bans abortion after 20 weeks post fertilization and requires pregnant women in Texas to visit an abortion clinic twice, first to undergo a sonogram and then, after a 24 hour wait, to actually have the procedure. Additionally, all such costs must be paid out of pocket, as Texas law also prohibits private insurance from covering abortion care. The Austin law helps women pay some of the additional costs imposed on them by Texas law.
New York City Council recently approved a similar funding measure that allocated $250,000 to fund abortions for poor women who live in, or have traveled to New York City from the procedure.
Advocates of the Austin measure hope that this action can provide an example for blue cities in red states to creatively advance abortion rights in their own cities.
Thursday, September 12, 2019
Sept. 10, 2019 (CBS News): Medication abortion reversal is "devoid of scientific support," judge rules in North Dakota, by Kate Smith:
Legislators in North Dakota recently mandated physicians tell patients who are receiving medication abortions that the procedure may be reversed. North Dakota House Bill 1336 bases its text "on a pair of studies that have been contested by The American Medical Association and the American College of Obstetrics and Gynecology."
Judge Daniel Hovland, on Tuesday, September 10, issued a 24-page decision granting an injunction against the bill, which he said is "devoid of scientific support, misleading, and untrue." Further elaborating that:
'State legislatures should not be mandating unproven medical treatments, or requiring physicians to provide patients with misleading and inaccurate information...The provisions of [Bill 1336] violate a physician's right not to speak and go far beyond any informed consent laws addressed by the United States Supreme Court, the Eighth Circuit Court of Appeals, or other courts to date.'
The lawsuit against the Bill was filed by the American Medical Association and Red River Women's Clinic. Red River is North Dakota's only legal abortion provider. According to research conducted by the Guttmacher Institute, people seeking abortions in the state must, in addition to very likely traveling long distances to reach the clinic, "undergo a state-mandated 24-hour waiting period." Minors may not receive an abortion in North Dakota without notifying their parents, and the state limits the ways a private insurance provider may cover the procedure.
A separate North Dakota state law "requires physicians to tell patients that abortion terminates 'the life of a whole, separate, unique, living human being.'" The AMA and Red River suit also challenges this law, but the court has not yet addressed this claim, thus far only issuing the preliminary injunction against House Bill 1336.
September 12, 2019 in Abortion, Abortion Bans, Anti-Choice Movement, Fetal Rights, In the Courts, Mandatory Delay/Biased Information Laws, Medical News, Politics, State and Local News, State Legislatures, Targeted Regulation of Abortion Providers (TRAP) | Permalink | Comments (0)
Thursday, September 5, 2019
Aug. 29, 2019 (The Washington Post): 'Nobody cared': A woman gave birth alone in a jail cell after her cries for help were ignored, lawsuit says, by Allyson Chiu:
Diana Sanchez was booked into Denver County Jail just three weeks ahead of her due date in July 2018. Early in the morning on July 31, Sanchez's contractions began. Her water broke and labor progressed without any help from prison or medical personnel. Sanchez gave birth to a baby boy alone in her jail cell, on top of a single absorbent pad--the only item provided to her despite her persistent cries for help. Immediately after the birth of Sanchez's son, a man wearing surgical gloves entered her cell to apparently examine the baby; however it wasn't until over 30 minutes post-birth that Sanchez and her new baby were transferred to the hospital.
Sanchez's birth experience was captured in full on surveillance footage of her cell. In the footage, Sanchez is seen unfolding the square pad deputies provided her and placing it on her bed. The video also shows her labor in full, including her water breaking, her shouts for help, her frantic efforts to remove her pants and underwear as the baby was coming. In August, Sanchez told KDVR: "They put my son's life at risk. When I got to the hospital, they said I could have bled to death."
The U.S. has the worst maternal mortality rates in the developed world across the board, but for women of color and incarcerated women, the rates rise significantly.
Sanchez has filed a lawsuit against the city and county of Denver, Denver Health Medical Center, and six individuals after the internal investigation found no wrongdoing. Mari Newman, Sanchez's attorney, says she hopes to "achieve some measure of accountability and to force wrongdoers to change their behavior.”
The suit mentions several past incidents in which inmates under the supervision of the city and county of Denver and Denver Health Medical Center personnel allegedly did not receive adequate care. One case, which was settled about 10 years ago, resulted in an agreement that jail staff are required to report medical emergencies up the chain of command and if no action is taken, to call 911 themselves, Newman said. Had that commitment been followed, Sanchez’s experience might have been avoided, she said.
A spokesperson with the Denver Sheriff Department asserted that deputies took appropriate action and "followed the relevant policies and procedures," adding that the Department has updated its policies to "ensure that pregnant inmates who are in any stage of labor are now transported immediately to the hospital."
Wednesday, September 4, 2019
August 24, 2019 (Axios): How many steps it takes to get an abortion in each state, Orion Rummler, Aida Amer:
Each year states devise and pass more and more restrictions on access to abortion -- from mandatory waiting periods to required viewing of an ultra sound. While legislatures consider each new restriction on its own, people who need abortion care experience the collective impacts of multiple restrictions. And, collectively these restrictions can create an undue burden to abortion access, as delay, travel time and cost, days off from work, childcare all add up.
To illustrate the barriers placed in the path of a person seeking abortion care, Axios has published piece showing how many steps it takes to get an abortion in each state.
Women and transgender men must take 5-8 steps to get an abortion in the most heavily regulated states. They often have to wait at least 24 hours after seeking an abortion, attend counseling against the decision and take at least 2 trips to a facility — and in 6 states, only 1 such facility is available.
Based on statistics from Guttmacher Institute, Axion charts restrictions in each state to conclude that
- Virginia is the most restrictive state in the U.S. for minors under 18, who must take 8 steps to have an abortion by obtaining parental notification and parental consent.
- Arizona, Indiana, Louisiana, Mississippi, Ohio, Wisconsin and Virginia are the most restrictive states for adults over 18.
- Utah, South Dakota, Oklahoma, North Carolina and Missouri have the longest wait times before one can undergo the procedure, clocking in at 72 hours.
Tuesday, September 3, 2019
HHS Threatens to Defund UVM Medical Center for Allegedly Failing to Protect Conscience Rights of Nurse Who Opposes Abortions
August 29, 2019 (Rewire News): HHS Launches Another Attach on Abortion Providers Under Guise of 'Conscience Rights," by Dennis Carter:
Rewire News reports that the Office of Civil Rights in the Department of Health and Human Services has accused the University of Vermont Medical Center of “intentionally, unnecessarily, and knowingly” scheduling nurses to assist with abortions “against their religious or moral objections." HHS Head Roger Severino claims that these alleged actions violate the Church Amendments, laws from the 1970s that protect the conscience rights of individuals to object to performing or assisting in abortion or sterilization procedures if it is contrary to their religious or moral beliefs. HHS has given the center 30 days to change its religious freedom policies or lose federal funding.