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)
Monday, March 4, 2019
"Wrongful Birth" Claims and the Paradox of Parenting a Child with a Disability- applying a therapeutic justice lens
Therapeutic justice in the Mainstream (Feb. 28, 2019): "Wrongful Birth" Claims and the Paradox of Parenting a Child with a Disability- applying a therapeutic justice lens, by Sophia Yakren:
Prof. Sophia Yakren discusses her new article in the Fordham Law Review on "Wrongful Birth" claims. She argues that the claim, which is typically raised by a mother with a child who was born with a disability against a medical professional who failed to disclose relevant prenatal information which denied her full information in deciding whether to abort the pregnancy, "likely has a significant anti-therapeutic impact on the individuals it is designed to compensate." She writes:
It is distressing enough for a parent to characterize her child’s existence as a harm in public; making matters worse, scholars, courts, and the media have also blamed and shamed mothers for following tort law’s lead in this way.
Although plaintiff-mothers often file suit because they lack the funds necessary to raise children with disabilities in an inadequate health care system, legal scholars have portrayed them as the messengers of discriminatory attitudes about disability and have even accused them of supporting eugenics. Further, scholars have condemned plaintiff-mothers for allegedly failing to embrace, accept, and love their own children unconditionally.
Noting that the current legal regime both stigmatizes disability and strains caretakers, Yakren's blog and article suggest needed legal reforms to acknowledge the complex reality and emotion strain of the situation.