Reproductive Rights Prof Blog

Biden's Symbolic Exclusion of the Hyde Amendment Won't Help Native American Women

By K.A. Dilday (June 1, 2021)

On Friday, President Joe Biden released a proposed budget for 2022. Reproductive rights advocates hailed it for the historic exclusion of the Hyde Amendment: It is the first White House budget in decades to exclude the 1976 Amendment prohibiting the use of federal funds for abortion.

The exclusion is largely symbolic: The Hyde Amendment can only be repealed by lawmakers, and Democrats who support repealing it don’t hold sufficient majority in the Senate to do so. But it is a turnaround for Biden who voted to pass the Amendment as a senator and continued to back it for many years. With this latest step, President Biden is signaling that his administration will support the right of reproductive freedom for all women.

Thus, some reproductive rights activists are cautiously optimistic despite the looming specter of the Supreme Court’s hearing next term of a case that could potentially eviscerate the protections of Roe v. Wade. But there is a group of women in the United States that has suffered disproportionately under the Hyde Amendment and therefore to whom symbolic gestures mean little.

Although all low-income women bear the weight of the Amendment’s restrictions as it affects recipients of the federal-state healthcare program Medicaid, non-elderly American Indian and American Native women use public health services at a higher rate than any other ethnicity according to the healthcare research foundation KFF.

While some states have a workaround for abortion services provided by Medicaid—using exclusively state funds rather than federal—many of the U.S. Indigenous population use the federally funded Indian Health Service (IHS) which operates hospitals and outpatient facilities in addition to providing other support services. Approximately 1.9 million American Indian and Alaska Native women living on or near reservations receive care at those facilities and through linked health service providers.

The Hyde Amendment did not technically apply to the Indian Health Services until 2008: As noted by Andie Netherland in the American Indian Law Review,  “...the Hyde Amendment provided that ‘[n]one of the funds contained in [the] Act’ could be used for abortions, [but] the Amendment did not apply, at that time, to the funds allocated to the Indian Health Service through a different act.” In 2008, the Senate expanded the Hyde Amendment’s application to the Indian Health Service.

Despite its not being legally bound by the Hyde Amendment, the Indian Health Service adhered to it in years preceding 2008. A 2002 report by the Native American Women's Health Education Resource Center (NAWHERC) found that between 1981 and 2001, only 25 abortions had been performed by IHS units. The report also cites a 1996 memo from the IHS director clarifying that the IHS would only provide abortions in the case of rape, incest, or limited circumstances when the mother’s life was in danger, the three exceptions permitted under the Hyde Amendment that were pushed through in 1993 under the Clinton Administration.

Reproductive rights activists say that the difficulty of obtaining an exception under the Hyde Amendment is particularly hard on Native American women based on findings that Indigenous women are 2.5 times more likely to report experiencing sexual assault than other races, and one in three Native American women reports having been raped. And, the American Addiction Centers compiled data from the 2018 National Survey on Drug Use and Health indicating that Indigenous Americans have the highest rates of alcohol, marijuana, cocaine, inhalant, and hallucinogen use disorders compared to other ethnic groups.

A recent federal case highlights the particular burden that these challenges and the Hyde Amendment’s restrictions to reproductive rights place on Indigenous women. In the precedent-setting United States v. Flute (2019), the Eighth Circuit reinstated an indictment dismissed by the District Court for South Dakota-Aberdeen against a young Native American woman for manslaughter, after prenatal drug use resulted in the death of her baby four hours after birth. As Eighth Circuit Judge Steven M. Colloton noted in his dissent: “According to the United States Attorney, the government has never before charged a mother with manslaughter based on prenatal neglect that causes the death of a child.”  

Flute gave birth on the Lake Traverse Reservation of the Sisseton Wahpeton Oyate Tribe, which is under federal jurisdiction. Her case was characterized by the Harvard Law Review as escalating “to the federal level the state judicial trend of using broad interpretations of statutes designed for other purposes to criminalize prenatal conduct.”  As Judge Colloton also wrote in his dissent: "No federal statute enacted after 1909 has expanded the manslaughter statute to encompass a mother’s prenatal neglect." In an article about the Flute case in the most recent edition of the American Indian Law Review, Andie Netherland noted that pregnant Indigenous women who face addiction may face criminal prosecution for involuntary manslaughter “more frequently than non-Indian women due to the unavailability of abortion services within the Indian Health Service.”

For these reasons, Native-American reproductive rights activists say that even post Roe v. Wade, the immediacy of their fight for reproductive justice and self-determination never changed. A 2019 article in Indian Country Today noted “the new abortion laws don’t ever have to be implemented and the Supreme Court doesn’t have to overturn Roe to make abortion inaccessible for Native women; restrictions are nothing new. For Native women, the lack of access to abortions has been real for years.”  

The looming loss of reproductive rights feared by many in the United States would not be a loss but a reiteration of the status quo for many Indigenous women. In the absence of real, tangible change, the symbolic exclusion of the Hyde Amendment does not give Indigenous women much cause for celebration. 

 

With Dobbs Will the Supreme Court Roll Back Nearly 50 Years of Abortion Rights?

By Kelly Folkers (May 25, 2021)

Last week, the Supreme Court agreed to hear a case that poses a direct challenge to the right to seek an abortion in the United States. It’s a test case that has been expected by reproductive rights advocates since the Supreme Court’s rightward lurch during Donald Trump’s four years in office: Trump appointed three conservative justices, all of whom have signaled willingness to roll back reproductive rights. If the Court significantly alters abortion jurisprudence or overturns Roe v. Wade (1973) entirely, reproductive rights will evaporate in many states, leaving millions of women and people who can get pregnant without a fundamental right to their bodily autonomy.

In Dobbs v. Jackson Women’s Health Organization, the Court has agreed to consider whether all bans on pre-viability abortions are unconstitutional. Although pre-viability bans on abortions are unconstitutional under Roe v. Wade and Planned Parenthood v. Casey, the rightward swing of the federal judiciary has emboldened state legislatures to pass pre-viability bans to test the courts. Just this past month, Texas Governor Greg Abbott (R) signed into law a bill banning abortion as early as six weeks—before many people know they are pregnant. South Carolina enacted a similar law in February. Texas and South Carolina join more than a dozen other states with similar laws, many of which have been held unconstitutional and enjoined by court order.

Dobbs involves a Mississippi law called the Gestational Age Act, which prohibits abortions if the “probable gestational age” of the fetus is more than 15 weeks. While there is dispute within the medical community regarding the exact age at which a fetus becomes viable and states vary in their definition of fetal viability (i.e., the fetus’s ability to survive outside the uterus), most experts agree that it is clinically improbable for a fetus to be viable under 22 to 24 weeks. Notably, the Act does not contain exceptions for rape or incest, allowing exceptions only for medical emergencies or severe fetal abnormalities. Mississippi’s sole abortion provider filed suit within hours of the law being enacted, and for now, the Fifth Circuit Court of Appeals has affirmed the U.S. District Court for the Southern District of Mississippi’s ruling to permanently enjoin the law.

Though the Supreme Court is more conservative than it has been in decades, abortion jurisprudence has long been settled in the United States: The state cannot place an undue burden on a pregnant person’s right to have an abortion pre-viability. In 1992, the Supreme Court reaffirmed Roe’s “central holding” that pregnant people have a protected right to seek an abortion in Planned Parenthood v. Casey. Casey adopted the “undue burden” test, which provides that state action violates the right to an abortion if it has the purpose or effect of imposing a substantial obstacle to a person seeking to abort a non-viable fetus. Although Casey permits regulation of abortion before viability, it does not question that bans on abortions before fetal viability are a violation of the Due Process Clause of the Fourteenth Amendment to the U.S Constitution. 

Since Casey, Supreme Court decisions have focused on how to apply the undue burden test to laws that regulate the provision of abortion. In the 2016 case Whole Woman’s Health v. Hellerstedt, the Court struck down a Texas law requiring that abortion providers have admitting privileges at nearby hospitals and that facilities where abortions are performed meet the requirements for ambulatory surgical centers. The Court found that the requirements placed a substantial obstacle in the path of people seeking abortions and there was no evidence showing that either requirement made abortions safer. Balancing the law’s benefits and burdens, the Court held that the law imposed an undue burden. Even more recently, in 2020, the Supreme Court struck down an almost identical Louisiana admitting privileges law in June Medical Services v. Russo. The outcome of the cases was similar, but a notable difference was the justices who voted with the majority and their reasoning. In 2016, Chief Justice John Roberts was a dissenting justice, but in 2020 he added the crucial fifth vote to strike down the law in a separate concurring opinion. Justice Roberts stated that his respect for precedent motivated his decision to vote with the Court’s liberal bloc in June Medical, but he stood firm in rejecting the balancing test the Court applied in Whole Woman’s Health.

After June Medical, it remains uncertain what test the Court will apply to determine if restrictions on the provision of abortion impose an undue burden. But Dobbs presents the court with a different issue that goes to the heart of Roe’s central holding: whether a law banning abortion before viability can ever be constitutional.

Some constitutional law experts predict that if the Court holds that bans on pre-viability abortions are permissible, it will effectively allow states to outlaw abortion. Indeed if Roe v. Wade is reversed, more than 20 states have laws banning abortion at various points in fetal viability that are designed to be triggered automatically, enacted swiftly, or dormant only because of Roe, according to Nancy Northup, the president of the Center for Reproductive Rights. These laws would make abortions difficult or impossible to obtain in many states.

A decision in Dobbs is not expected until the spring or summer of 2022, but some state legislatures are already taking action to codify protections for pre-viability abortions if Roe v. Wade is overturned. Some states are going even further: In Oregon, Governor Kate Brown (D) recently signed the Reproductive Health Equity Act, which requires private insurers to cover abortions with no out-of-pocket costs. Similar bills are pending in New Jersey and Virginia. These bills go beyond what the federal Constitution guarantees because they obligate public and private insurers within their states to pay for abortion; the Supreme Court has previously held in Maher v. Roe and Harris v. McRae that state and federal payers, respectively, are not constitutionally obligated to cover abortions.

Until the Supreme Court hands down what may be a landmark decision for reproductive rights, people seeking abortions retain their right to do so, but just barely.

Manuela v. El Salvador Could Affect Abortion Law Across the Americas

By Shelby Logan (April 6, 2021)

In 2008, Manuela, a 33-year-old Salvadoran, had a miscarriage at home. When she lost consciousness, concerned family and friends took her to a hospital in San Francisco Gotera, a small town in eastern El Salvador. When Manuela was discharged some days later, instead of returning home, she was taken to jail.

Manuela (the pseudonym used to protect her family’s identity) was accused of having an abortion and charged with aggravated homicide.

She had been reported to the police by hospital staff. Because her pregnancy occurred outside of marriage, they believed Manuela, a mother of two young children, must have tried to abort. Manuela, who could neither read nor write, was not provided legal counsel while being questioned. After a process in which she was represented by three different public defenders, Manuela was sentenced to 30 years in prison. While the doctors focused on criminalizing her obstetric emergency, they missed a large mass in Manuela’s neck and, while in prison, she was diagnosed with cancer. She died behind bars two years later.

On March 10, 2021, the Inter-American Court of Human Rights heard the first arguments in Manuela y Otros v. El Salvador, marking the first time a Latin American country's anti-abortion law and its effect on women's health and human rights, have been challenged in an international court.

Manuela’s story had motivated an international slate of activists who brought her case to the Inter-American Commission on Human Rights in 2012. Finding that Manuela’s fair-trial rights had been violated, the Commission referred the petition to its judicial affiliate, the Inter-American Court of Human Rights. Almost nine years to the day after they brought Manuela’s case to the Commission, last month, an international coalition of groups argued before the Court for reparations for Manuela’s family and asked that the Court compel the Salvadoran state to take public responsibility for not guaranteeing the human right of Manuela and others like her to life and health.

El Salvador has among the world’s most strict abortion law, outlawing the procedure entirely. This includes special instances where a child was conceived by rape or incest or where the health of mother or child is at risk. In the last 20 years, at least 181 women who experienced obstetric emergencies were prosecuted for abortion or aggravated homicide just like Manuela.

Activists continue to express that a total ban on abortion further develops a culture of systemic discrimination and gender-based violence, one that disproportionately affects women in vulnerable situations. They are arguing that El Salvador’s mandatory reporting of obstetric emergencies to the police is a violation of women’s right to privacy and health, a human rights violation.

The plaintiffs have asked the Court to hold El Salvador accountable for laws that deny and criminalize reproductive health, and cause violence against women who suffer obstetric emergencies.

The Court’s decision, due to be released this year, is expected to create jurisprudence within the Inter-American Human Rights system. Including El Salvador, 20 states in Latin America and the Caribbean have recognized the Court’s jurisdiction. The Court can require the payment of reparations to victims but, more significantly, it can order structural and normative changes to State practice.

It is activists’ hope that the Inter-American Court of Human Rights' decision becomes a path for justice and hope for all women in Latin America and the Caribbean who are criminalized for their obstetric and reproductive processes and needs.

The ICC's Ongwen Decision Is a Leap Forward in Accountability for Gender-Based Crimes

By Shelby Logan (March 9, 2021)

On International Women's Day this Monday, gender justice activists worldwide were able to celebrate a long-awaited victory. In February, for the first time in history, the International Criminal Court (ICC) convicted an individual for forced pregnancy as a war crime. The Court, in a landmark verdict, found Dominic Ongwen of Uganda, a former commander in the militaristic anti-government group Lord’s Resistance Army, guilty of 61 charges, including the widest range of sexual crimes ever brought before the ICC.  

Ongwen’s conviction on charges including sexual-based violence, forced pregnancy, and outrages upon personal dignity committed against women, is a necessary move forward for the ICC: After decades of advocacy, the international community is holding individuals accountable for sexual crimes against women during conflict.

Although sexual and gender-based crimes have always been part of conflict, international criminal proceedings during the 20th century omitted them from charges beginning with the Nuremberg Tribunal, which specifically excluded sexual crimes against women from its charter. It wasn't until 2002, the year the International Criminal Court was inaugurated, that sexual crimes against women as elements of genocide, crimes against humanity and war crimes were enumerated in international criminal proceedings. Yet, even if prosecutors initially charged a defendant with sexual crimes, the charges were usually dismissed later to prioritize charges for mass killings.

A major shift occurred in 2014, when the Office of the Prosecutor of the ICC released the “Policy Paper on Sexual and Gender-Based Crimes.” Prosecutors began to introduce more charges for gender-based crimes but still failed to convict. On behalf of victims, gender-justice advocates began writing shadow reports pushing the Office of the Prosecutor to commit to charges and follow through with prosecution. As Ongwen’s personal story is also tragic—he was one of many young children who have been forced to join the Lord’s Resistance Army—the ICC found him guilty only for crimes committed after it considered him a “fully responsible adult.“ His conviction marks a first crucial step in accountability for sexual and gender-based war crimes and a turning point.

Yet, as the gender-justice community celebrates the result in the Ongwen case, it is clear that more change is needed in world courts. Even in Ongwen’s case, only charges against women-identifying persons were included. Several charges of sexual violence committed against men were left off the docket. While sexual violence against transgender and male-identifying persons is often underreported, the Ongwen decision as well as events unfolding in China and Myanmar, may provide ground for more inclusivity in prosecuting sexual-based crimes.

Advocates have a crucial window of opportunity to advance jurisprudence on sexual and gender-based violence crimes. Combined with the latest Strategic Plan for the ICC Office of the Prosecutor, which seeks to address the underreporting of sexual and gender-based crimes, and the recent Ongwen ruling, the priority of gender justice at the ICC has been pushed to the forefront.  

SCOTUS Will Hear An Abortion Rights Case With Major Implications

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. 

Mexico's Supreme Court Affirms Abortion Access as Right

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. 

Judge Voids Trump-Backed 'Conscience Rule' for Health Workers

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.

Alabama abortion law temporarily blocked by federal judge

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. 

Dutch Doctor Provides Abortion Pills to U.S. Women, Sues FDA

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.

Medication abortion reversal is "devoid of scientific support," judge rules in North Dakota

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.

UK Appeal court overturns forced abortion ruling

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.

Missouri’s lone abortion clinic must remain open for now

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.

Botswana's High Court Decriminalizes Gay Sex

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.

The Flood of Court Cases That Threaten Abortion

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."

Sixth Circuit En Banc Majority Rules Ohio Can Defund Planned Parenthood

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.

Alaska Supreme Court upholds decision blocking restrictions on Medicaid funding for abortions

Jurist (Feb. 18, 2018): Alaska Supreme Court upholds decision blocking restrictions on Medicaid funding for abortions, by Jordan Ross:

The Alaska Supreme Court last week upheld a prior decision preventing the implementation of a 2013 regulation limiting Medicaid coverage of abortion in the state to circumstances either covered by the Hyde Act or deemed medically necessary by a physician.

The Hyde Amendment is a 1976 legislative provision that proscribes the use of federal funds to pay for an abortion except when necessary to save the life of the pregnant person or if the pregnancy is a result of rape or incest. 

The lawsuit was brought by Planned Parenthood of the Great Northwest and argued that the regulations violated the equal protection clause of Alaska’s constitution by discriminating against women choosing to have an abortion.

Planned Parenthood argued that the restrictive definition provided for the “medical necessity” of an abortion singled out the procedure from other Medicaid-funded services. By doing so, the regulations subjected women to discriminatory practices and violated their guarantee of equal protection. A superior court declared the laws unconstitutional and subsequently prevented the laws from taking effect. The state appealed, arguing the statute and regulation should be interpreted more leniently.

In the state's Supreme Court decision, the court reaffirmed the ruling of unconstitutionality. The court "stated the laws are under-inclusive, singling out abortion among other argued 'elective' procedures available to pregnant women." Furthermore, the regulation facially treated pregnant women differently based on their “exercise of reproductive choice,” the court said. As such, the state will not be permitted to enforce the Medicaid-limiting regulations. 

An Overview of State Abortion Laws

NPR (Feb. 9, 2019): An Overview of State Abortion Laws, by NPR Weekend Edition Saturday:

On Saturday, NPR's Scott Simon spoke with Julie Rovner, chief Washington correspondent for Kaiser Health News, about new abortion laws in state legislatures across the country.

On Thursday, the U.S. Supreme Court blocked Louisiana from enforcing a restrictive abortion law. The court will likely hear a challenge to the merits of that law this fall. Many states are moving to pass a number of new abortion laws to prepare for the possible overturn of Roe v. Wade.

Rovner discussed efforts by anti-choice legislators to pass legislation in order to bring the issue of abortion to the Supreme Court again and again, as well as efforts by pro-choice legislators to safeguard abortion access in the event that Roe v. Wade is overturned. Rovner also discussed the Trump Administration's impending plans to "evict Planned Parenthood" from Title X, the federal family planing program.

Listen to the interview below:

Supreme Court Blocks Louisiana Abortion Restrictions

The New York Times (Feb. 7, 2018): Supreme Court Blocks Louisiana Abortion Restrictions, by Adam Liptak:

The Supreme Court blocked the Louisiana admitting-privileges law that Justice Alito issued a stay for just last week in June Medical Services v. Gee. 

The law would have effectively limited the abortion providers in the state of Louisiana to one, by requiring such providers to have admitting privileges at nearby hospitals. Many hospitals either would not extend such privileges or were not in the required 30-mile radius of the abortion-providing clinics at risk under the law. While initially passed in 2014, the Louisiana law has been entangled in lawsuits ever since. SCOTUS struck down a similar statute in Texas in 2016 in Whole Woman's Health v. Hellerstedt. 

The Supreme Court stayed enforcement of the Louisiana law, but it may ultimately decide to take the case for full review.  This would allow the Court to reconsider the clarification provided by Hellerstedt on the "undue burden" standard, initially implemented in Planned Parenthood v. Casey (1992). This standard says that legislation that has either the purpose or effect of placing a substantial obstacle in the way of a pregnant person seeking to exercise their constitutional right to an abortion creates an undue burden on them, and is therefore unconstitutional. Medically unnecessary laws that offer minimal, if any, health benefits to pregnant persons while increasing their obstacles to seeking an abortion constitute "undue burdens."

The vote was 5 to 4, with Chief Justice John G. Roberts Jr. joining the court’s four-member liberal wing.

El Salvador court frees Imelda Cortez, jailed under anti-abortion laws

BBC News (Dec. 18, 2018): El Salvador court frees woman jailed under anti-abortion laws, by BBC News:

A woman who was jailed for attempted murder under El Salvador's strict anti-abortion laws has been freed.

Imelda Cortez, 20, says she became pregnant by her stepfather who sexually abused her for many years. Doctors suspected she had tried to perform an abortion after she gave birth to a baby girl in a latrine in April 2017. The child survived, but Imelda Cortez was arrested and spent more than 18 months in jail as she awaited trial. Prosecutors argued that her failure to tell anyone about the pregnancy and seek medical help after giving birth constituted attempted murder, which carries a possible 20-year sentence in El Salvador.

On Monday, however, a court ruled that Cortez, who was unaware that she was pregnant, had not sought an abortion. Cortez's lawyers said that to avoid a harsher sentence, she had admitted to neglecting her newborn baby, which carries a one-year jail term. The court ultimately decided to dismiss that offense and told Cortez she was free to go home.

"This sentence... represents hope for women who are still in prison and are also being tried for aggravated homicide," defense attorney Ana Martinez told reporters following the verdict.

El Salvador is one of several countries in the world where abortion is completely banned and carries heavy penalties. While the country is not alone in Latin America in having a total ban on abortions, it is particularly strict in the way it enforces the ban: doctors have to inform the authorities if they think a woman has tried to end her pregnancy. If they fail to report such cases, they too could face long sentences in jail.

Human rights groups are calling this enforcement of the ban a criminalization of miscarriages and medical emergencies, with more than 100 people convicted in El Salvador since 2000.

Woman who bore rapist’s baby faces 20 years in El Salvador jail

The Guardian (Nov. 12, 2018): Woman who bore rapist’s baby faces 20 years in El Salvador jail, by Nina Lakhani: 

In the wake of fetal personhood, or similar, ballot measures being proposed and passed throughout the U.S., it's important to look to other countries where abortion is criminalized to see the effects of living in a world where abortion and those who seek or perform them are punished.

A survivor of habitual sexual abuse by her grandfather has been imprisoned in El Salvador since April 2017 on charges of attempted murder. Last April, Imelda Cortez, then 20-years-old, gave birth to a child fathered by her rapist.  She experienced intense pain and bleeding before the birth, which caused her mother to bring her to the hospital. The doctors there suspected an attempted abortion and called the police. The baby was born alive and well, but Imelda has never been able to hold her, as she's been in custody since her time in the hospital last year. 

Authorities conducted a paternity test, which confirmed Imelda's claims of rape, yet her grandfather has not been charged with any crime. Imelda's criminal trial began this week and a decision from a three judge panel is expected next week. 

Abortion is illegal in all circumstances--no exceptions--in El Salvador. The strict ban has led to severe persecution of pregnant people throughout the country, often most heavily affecting impoverished, rural-living people. Most people accused of abortion simply experienced a pregnancy complication, including miscarriage and stillbirth.

This pattern of prosecutions targeting a particular demographic suggests a discriminatory state policy which violates multiple human rights, according to Paula Avila-Guillen, director of Latin America Initiatives at the New York based Women’s Equality Centre. Cortez’s case is a stark illustration of how the law criminalises victims.

Abortion has been criminalized in El Salvador for 21 years. While a bill was drafted nearly two years ago--with public and medical support--aiming to reform the system and relax the ban to allow the option of abortion at least in certain cases (for example, rape, human trafficking, an unviable fetus, or threat to a pregnant person's life), it remains stuck in committee and is not expected to make it to vote.