Reproductive Rights Prof Blog

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.

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.

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.

Nearly seven percent of U.S. women say first sexual experience was forced

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. 

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.

Telemedicine Abortion is Safe

July 23, 2019 (Rewire.News): Telemedicine Abortion is Safe, No Matter What Anti-Choice Lawmakers Claim, by Auditi Guha: 

A study released July 9 finds that outcomes for medication-driven abortion through telemedicine are comparable in-person medication abortion.

The results support the importance of telemedicine for reproductive health and safety particularly for those who cannot easily reach abortion clinics due to oppressively-restrictive anti-choice legislation. 

Medication abortion has been legal in the United States for nearly twenty years and is supported by the American College of Obstetrics and Gynecologists, National Abortion Federation, and Planned Parenthood. The procedure uses a combination of mifepristone and misoprostol pills and the telemedicine aspect helps clinicians have a wider reach in authorizing and supervising the process through remote video conferencing.

Telemedicine medication abortions have often been provided in clinics where the licensed clinicians video conference in while the patient is in clinic with nurses or other professionals, but direct-to-patient telemedicine abortion services are growing. Most patients requesting these services live in abortion-hostile states where they cannot easily reach a clinic at all.

The anti-choice movement has responded by working to restrict access to telemedicine abortion as well as in-clinic abortion services. Legal bans or restrictions currently exist in Arkansas, Idaho, Mississippi, and Utah. 

The recent study, though, "indicates that telemedicine abortion is 'a safe and effective way of ending an early pregnancy, with very rare complications' and can provide the same quality of health care patients receive at a health center," according to Dr. Julia Kohn, national director of research at Planned Parenthood Federation of America and the lead author of the study.

Kohn further says: "In many ways, this study does reaffirm what we already know: Medication abortion via telemedicine is safe and effective at ending an early pregnancy."

Vaginal exams on unconscious, non-consenting patients are legal in 42 states

Jun. 26, 2019 (Vice): Med Students Are Doing Vaginal Exams on Unconscious, Non-Consenting Patients, by Hannah Harris Green: 

For decades, medical students around the country have been expected to perform pelvic exams on unconscious women--not for the patient's benefit but solely for the student's experience. Sometimes these exams are performed multiple times by different students on the same patient. The exams involve a student inserting "two gloved fingers into the patient’s vagina and [placing] one hand on her pelvis in order to feel the uterus and ovaries." This patient is never asked for consent prior to the procedure nor is she informed of the exam afterward.

One former student--now a pediatrician in Baltimore, Maryland--learned of these procedures during his OB/GYN rotation while studying at the University of Pennsylvania Medical School in the 1990s. He refused to participate, joining in a movement to ban the practice. Ari Silver-Isenstadt took a year out of his medical studies to study the ethical implications of this practice at Penn's School of Education. He subsequently published a study in 2003 in the American Journal of Obstetrics and Gynecology that found that over 90 percent of students at the five Pennsylvania medical schools he had focused on had performed vaginal exams on non-consenting, unconscious patients. He noted that students' initial discomfort with the procedure quickly dissipated as it became a regular part of their rotations. 

California became the first state to ban these invasive exams in 2003, the same year of Silver-Isenstadt's study. Since then, Illinois, Virginia, Oregon, Hawaii, Iowa, Utah, and Maryland have followed suit. Additional states that have introduced similar legislation this year include Connecticut, Minnesota, Missouri, Nebraska, New Hampshire, New York, Oklahoma, Washington, and Texas. No federal legislation yet addresses the issue. 

Some medical schools have also banned the practice institutionally as well--like Harvard--but others, including Duke University, consistently ask their medical students to perform pelvic exams sans consent throughout their education. 

While the procedure invades the privacy of any patient, consequences can be particularly severe for patients with a history of sexual trauma who either find out a pelvic exam was performed on them while unconscious or else wake up during the produce, as did Ashely Weitz in 2007.

Weitz said testifying about her experience in support of Utah's law in February was nerve-racking, especially because she expected there to be other women at the hearing at the state house with similar experiences, but she was the only one. Given the nature of these exams, people don’t know if it's happened to them. She said it was “a very healing practice to say 'this shouldn't happen to me, it shouldn't be happening in the way that it is happening in an institution.'” But there are still parts of the incident that she hasn’t recovered from. “It changed the way that I sought and received medical care,” she said. “I was, you know, thereafter very certain that I was never going to be sedated or unconscious in a manner that would have allowed that situation to happen again. So it was in itself very traumatizing.”

Utah's ban on unconscious pelvic exams was signed into law in March of this year. It requires both medical students and doctors to get explicit consent to perform such exams on anesthetized women. A law professor at the University of Illinois, Robin Fretwell Wilson, credited Weitz's testimony as the primary driving force behind the state legislation. 

Wilson herself advocates for requiring specific consent for any pelvic exams. While opponents to legislation requiring consent argue that general consent forms signed upon entering a teaching hospital already cover these exams, Wilson and other advocates for patient protections assert that it is ethically wrong to practice procedures that are of no benefit to the patient without direct consent.

Many advocates, including Weitz, connect the growing opposition to these vaginal exams to the rising tide of the #MeToo movement in recent years. "The #MeToo movement has helped people like Weitz better understand that the violations they endure are part of a wider cultural problem."

Wilson acknowledges that even 10 or 15 years ago, the attitude toward this practice was completely different. "At the time, medical school faculty 'were more than willing to stand their ground and say, "not only do we do it, but the patients in our hospitals have a duty to participate."' . . .  15 years ago, many schools 'did not see it as an issue.'"

Advocates of legal regulations requiring patient consent, though, still fear that enforcement of the new laws will be difficult. "In order for authorities to find out, students would need to both be aware of the law and willing to report wrongdoing by their supervisors, so [Silver-Isenstadt is] hoping the culture is what will ultimately change."

An 11-Year-Old in Argentina Was Raped. A Hospital Denied Her an Abortion.

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.”

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. 

In Nigeria, Trump administration policies bite hard

Devex (Feb. 5, 2019): In Nigeria, Trump administration policies bite hard, by Paul Adepoju: 

Trump's policies limiting reproductive rights and funding for reproductive health and education services continue to wreak havoc on foreign initiatives aimed at promoting family planning, slowing population growth, and educating girls and women.

Nigerian hospitals and NGOs are facing severe shortages of reproductive health supplies since Trump both cut funding to the United Nations Population Fund (UNFPA) and implemented the "global gag rule," withdrawing funding from any agency that offers abortion-related education or services. 

Nigeria, a middle-income country facing a population boom, lost over 60% of its funding for family planning supplies and services in the year after Trump pulled UNFPA funding. "In 2016, when UNFPA got its last support from the U.S. government, it was able to spend $15,444,880 on family planning in Nigeria. In 2017, it spent just $6,132,632."

Trump justified these funding cuts by promulgating theories that the UNFPA cooperated with coercive abortions and involuntary sterilization, which the UNFPA categorically denies and is readily backed up by multiple human rights organizations.

The rate of contraceptive usage in Nigeria is already very low, and the African country also faces one of the highest maternal mortality rates in the world. 

Several organizations--including Generation Initiative for Women and Youth Network--are on-the-ground in Nigeria working to educate women and provide safe and reliable access to health care to shift these statistics. Their work, though, has been severely limited by the loss of funding as a result of U.S. policies under the Trump administration. 

Erin Williams, program officer for grantmaking and international partnerships at the International Women's Health Coalition, told Devex: 

As a result [of these policies], Nigerian health services will continue to fragment, deteriorate, and decrease, increasing the burden on vulnerable women and girls in search of comprehensive and quality health care. More women will look for contraceptive and pregnancy alternatives outside the medical and legal system.

While much of the justification for pulling U.S. funding relies on anti-abortion ideology, the implications of the policies are much farther-reaching than "just" abortion. Nigeria has slowed in its ability to address maternal health needs generally, including instances of gender-based violence, as well in its ability to address wide-reaching disease concerns like the spread of malaria and tuberculosis. Furthermore, the policy-shift has actually led to increased numbers of abortions throughout Sub-Saharan Africa in the countries hit hardest by the loss of funding. 

Congress this week is set to introduce the Global Health, Empowerment and Rights Act, which would repeal the global gag rule permanently and help to ensure consistent reproductive health care around the world. It is unlikely to be passed by the Republican-controlled Senate, however, or to be signed by Trump. 

More women in poor countries use contraception, says report

AP (Nov. 12, 2018): More women in poor countries use contraception, says report, by Ignatius Ssuuna and Rodney Muhumuza: 

A report released this week states that modern contraception is effectively expanding and becoming more commonplace in developing countries throughout the world.

The report--issued by Family Planning 2020, a U.N.-backed international advocacy group--cites that there are 46 million more users of contraception in the world's 69 poorest countries in 2018 than there were in 2012. 

Access to modern contraception helped prevent over 119 million unintended pregnancies and averted 20 million unsafe abortions between July 2017 and July 2018, although populations continue to soar across Africa and other low income countries, the report said.

'The best way to overcome this challenge of rapid population growth is by giving women and girls (the) opportunity to decide how many children they want to have,' Beth Schlachter, executive director of Family Planning 2020, told The Associated Press.

Many of the countries included in the report are in sub-Saharan Africa. The birth rate in this part of the world is about 5.1 births per woman, according to a recent U.N. global population report. "Over half of the global population growth between now and 2050 will take place in Africa, according to U.N. figures." Despite the growing fertility rates in Africa, contraceptive use is growing fastest in this region of the world as well. 

Options for various contraceptive methods--including short-term, long-lasting, emergency, and permanent--have significantly expanded in many of the countries analyzed in the report.

Many millions of people who wish to delay or prevent pregnancy, however, still do not have adequate access to birth control. Lack of information--including perceived side-effects of medications as well as societal disapproval--deter many from finding the right contraceptive method for them.

The goal of Family Planning 2020 is to bring contraception to "120 million more women and girls in developing countries by the year 2020." Donors have committed millions of dollars to meet this goal. 

 

Abortion Rights Got Two Important Legal Wins Last Week

Rewire.News (Oct. 1, 2018): Abortion Rights Got Two Important Legal Wins Last Week, by Jessica Mason Pieklo:

 A Federal court in Kentucky ruled a 1998 state law aimed at limiting abortion clinics unconstitutional. 

The law requires abortion clinics to have written transfer agreements with ambulance services and hospitals, often referred to as "transfer and transport" requirements.  Even though the state's last abortion clinic (and a plaintiff in the lawsuit) has been able to maintain the licensure required by the law--and so stay open--the court agreed with the clinic's argument that Kentucky Gov. Matt Bevin (R) has used the law as a tool to try to cut off abortion access. 

Judge Greg Stivers ruled:

The court has carefully reviewed the evidence presented in this case and concludes that the record is devoid of any credible proof that the challenged regulations have any tangible benefit to women’s health.  The regulations effectively eliminate women’s right to abortions in the state. Therefore, the challenged regulations are unconstitutional.

The judge affirmed that “the challenged regulations are not medically necessary and do absolutely nothing to further the health and safety of women seeking abortions in the Commonwealth of Kentucky." The decision is expected to be appealed in the 6th Circuit. 

A federal court in Virginia also ruled last week that that a similar lawsuit challenging the state's anti-choice licensing and oversight restrictions can move forward. 

 

Alaskan Survivors of Sexual Assault Urge Murkowski to Vote ‘No’ on Kavanaugh

Rewire.News (Sept. 25, 2018): Alaskan Survivors of Sexual Assault Urge Murkowski to Vote ‘No’ on Kavanaugh, by Katelyn Burns: 

Even before last week's hearing for Dr. Blasey Ford's allegations against SCOTUS nominee Brett Kavanaugh, indigenous groups in Alaska have been voicing their opposition to the Judge's confirmation. 

Alaskan sexual assault survivors--many of whom are Natives--are calling on Senator Lisa Murkowski (R-AK) to vote "no" on Brett Kavanaugh's nomination this week. Activists have also been protesting at Senator Dan Sullivan's office (R-AK), however, unlike Senator Murkowski, he announced his support for Kavanaugh shortly after the nomination in July. 

Sexual assault is a pervasive problem in Native American communities. Natives, including Alaskan women, suffer from rape and sexual assault in staggeringly disproportionate numbers with little access to justice. 

"According to the 2015 Alaska Victimization Survey, 50 percent of Alaskan women have been victims of sexual assault, intimate partner violence, or both." Furthermore, 97 percent of Native Alaskan sexual assault survivors suffered the violence at the hands of non-Native perpetrators. Notably, tribal justice systems cannot prosecute non-Natives for sexual assault.

Survivors are also speaking out in defense of Dr. Ford's delay in coming out publicly with her allegations. “Most of the time we would be blamed for being provocative in some way. So I can understand why someone would wait years to bring up a sexual assault," said one Alaskan Native survivor. 

Native communities also oppose Kavanaugh's nomination on his views of Native rights generally and his misunderstanding of tribal history and government systems. 

Massachusetts Passes Repeal of 173-Year-Old Abortion Ban Amid Fears for Future of Roe v. Wade

July 23, 2018 (TIME): Massachusetts Passes Repeal of 173-Year-Old Abortion Ban Amid Fears for Future of Roe v. Wade, by Samantha Cooney: 

Earlier this month, Massachusetts became the first state to formally respond to the possibility of Roe v. Wade being overturned in the world of a two-Trump-nominee Supreme Court. Although abortion is already legal in the state, Massachusetts still has a 173-year-old law on the books banning the procurement of a miscarriage. 

The bill is called the NASTY Women Act (Negating Archaic Statutes Targeting Young Women) and passed in a landslide. While abortion has technically been legal in the state since 1981, state legislators were driven to quick action to further protect these rights after Justice Kennedy announced his retirement.

A Masschusetts State Democrat said:

I think people are beginning to realize these are strange times we live in. Nothing is impossible, and we’ve got to have a ‘plan B.’ If these laws are enforced, what do we do? We’re not willing to sit back and say, ‘Well, it’s not going to happen here.’ The word for that is denial.

New Mexico and New York each have efforts underway to protect abortion rights as well.

While some critics accuse the NASTY Women Act and other similar bills of unnecessary political posturing, supporters cite that the rights we may take for granted are not always guaranteed. Rebecca Hart Holder, the president of NARAL Pro-Choice Massachusetts, says "the reality is any state can have a threat to abortion care.”

HHS Refuses to Release Documents on the New Office of Civil Rights (OCR)

The Department of Health and Human Services (HHS) announced the opening of a new division in January of this year: The Office of Civil Rights (OCR). The OCR's primary mandate is to enforce refusal of care laws. 

Refusal of care laws essentially empower medical providers to deny care to patients if they disagree with the ethics of a particular procedure based on their religious grounds. The purported goal of these laws is to protect a healthcare provider from being forced into providing care that "violates their conscience." 

This is an Executive-ordered decision that does not require legislative or judicial approval to go into effect or to implement its new rules and regulations.

Critics of refusal of care laws express concern that these requirements do not simply "protect" health care providers consciences, but can instead seriously harm patients. These laws may lead to a pharmacist refusing to fill a birth control prescription, a doctor refusing hormone therapy to a transgender patient, limitations placed on services to LGBTQ persons and partners, and of course abortion services may also become more limited.

HHS does not require providers who refuse treatment to refer patients to other providers or provide any information at all on other providers.

The OCR further has authority to initiate compliance reviews of any organization receiving federal funding to ensure conformity to the new rules. 

Earlier this month, the Center for Reproductive Rights (CRR) and the National Women's Law Center (NWLC) filed a lawsuit against HHS for refusing to release records pertaining to the creation of the OCR. The organizations initially requested these records via a FOIA request in January 2018. The CRR and NWLC seek knowledge of why the new division was needed, how the OCR operates, allocates funding, and may be influenced by outside groups.

"We’re filing this lawsuit to force the Trump-Pence administration to justify why it’s using resources to fund discrimination, rather than to protect patients," said Gretchen Borchelt, NWLC Vice President for Reproductive Rights and Health. 

HHS's new Office of Civil Rights follows additional moves by the Trump administration to limit equitable access to reproductive health care, including promoting the "Global Gag Rule," its domestic counterpart, and establishing regulations aimed at severely limiting funding to Title X programs. 

Call for Public Comments on Proposed Rule to Limit Title X Funding

Last month the Trump administration proposed a rule prohibiting the granting of federal Title X family planning funds to family planning providers that also perform abortions. The so-called “Domestic Gag Rule” would create new, unnecessary barriers for patients seeking access to birth control and other services from their trusted reproductive health care providers. In addition, the rule would prevent doctors and nurses across the country who receive federal funding from referring patients for safe, legal abortions. 

 

While the new rule is scheduled to go into effect immediately upon publishing of the final rule, the Department of Health and Human Services (HHS) is required to take public comments into consideration before making the rule permanent. 

 

The Center for Reproductive Rights has posted links to assist those interested in sending comments which provide draft language and templates.

1. Send a comment to HHS opposing the proposed rule through the Center for Reproductive Rights website using the draft language linked here. 
2. Submit a comment on behalf of your organization urging HHS to rescind the rule. A template is available here. If you need support coordinating the ask within your association or developing a comment, please do not hesitate to reach out to the Lawyers Network team at [email protected]. 

Who gets the embryos? Whoever wants to make them into babies, new law says.

The Washington Post (Jul. 17, 2018): Who gets the embryos? Whoever wants to make them into babies, new law says, by Ariana Eunjung Cha: 

New court cases cases are grappling with the decision of what to do with frozen embryos created during a marriage that later dissolves. In many cases that Cha reports on, the couples chose to create and freeze several embryos in the wake of a cancer diagnosis and treatment schedule that threatened later fertility.

When these same couples faced divorce, there were bitter divides over what should be done with the embryos: one party wanted to maintain "ownership" of the embryos for a future chance at children while the other wanted the embryos destroyed, fearing unwanted future financial or relationship obligations. 

With the number of frozen embryos in the United States soaring into the millions, disputes over who owns them are also on the rise. Judges have often — but not always — ruled in favor of the person who does not want the embryos used, sometimes ordering them destroyed, following the theory that no one should be forced to become a parent.

In Arizona, though, a "first-in-the-nation law" went into effect on July 1 that states "custody of disputed embryos must be given to the party who intends to help them 'develop to birth.'"

The legislation represents for some lawmakers the idea that frozen embryos have their own right to life, and many imagine that the implications could eventually include a delineation of when life begins and a claim to a separate set of embryonic rights of their own as human beings (rather than the discussion being centered on who "owns" the embryos). 

Some groups, like the anti-abortion Thomas More Society, advocate for that embryos to be considered "children" in the legal sense, asking judges to make decisions on disputes based on the best interest of the "child." 

Debates to extend personhood to unborn embryos and fetuses abound in anti-abortion work. Abortion rights advocates are concerned that these discussions could further disintegrate the right to abortion in the United States. "If a days-old embryo in a freezer has a right to life, why not a days-old embryo in utero?"

While judges have historically ordered disputed embryos destroyed based on the wishes of the party who does not want a child, an Arizona judge chose to balance one party's "probable inability to have a child without the embryos" against the other party's "desire to not be a father" a different way. 

Maricopa County Superior Court Judge Ronee Korbin Steiner held that Ruby Torres, who wanted the embryos in order to have biological children one day, had no right to them. The judge did not order them destroyed, though, and instead ordered that they go up for donation.

Torres appealed the decision and expects a new ruling any day. 

The new Arizona law that states embryos shall be given to the party who intends to develop them to birth was written in response to this case to "help" people in Torres' situation. It also attempts to recognize the rights of those who do not want the embryos used by providing that those parties would not be liable for child support in the future. 

Both the judicial decisions and the legislation continue to prove extremely controversial:

The Center for Arizona Policy, a conservative lobbying group that has successfully pushed antiabortion legislation in the state, supported the measure, saying the bill would “lead to more consistent rulings.”

The American Society for Reproductive Medicine, which represents doctors, nurses and other professionals who work on fertility issues, opposed the measure, arguing that it would have a profound impact on reproductive medicine.

Medical professionals foresee profound complications to stem-cell research in particular, which relies on embryos donated to science. Such research is believed essential in developing treatments for many diseases and conditions like Parkinson's and Alzheimer's. The treatment and storage of embryos as a result of the new legislation will likely make embryonic stem cells much more scarce.

In a friend-of-the-court brief in Torres' pending appellate case, the Academy of Adoption and Assisted Reproduction Attorneys urged judges in the Arizona Court of Appeals to balance the interest of each former spouse. They argue that the parties claims are not equal and that "the constitutional protection against compulsory parenthood is [generally] greater than any procreative interest in pre-embryos." 

Time will tell both if the appellate judges affirm Judge Steiner's controversial ruling (likely leading to further appeals) while we also wait for the inevitable challenges to Arizona's new embryo law.

A Larger Role for Midwives Could Improve Deficient U.S. Care for Mothers and Babies

ProPublica (Feb. 22, 2018): A Larger Role for Midwives Could Improve Deficient U.S. Care for Mothers and Babies, by Nina Martin:

The results of a five-year study, conducted by researchers in both the U.S. and Canada, on the effects of midwifery on maternal and infant health are in. The study was published in the peer-reviewed journal PLOS ONE; it analyzes hundreds of laws throughout the United States that dictate what a midwife can and cannot do when it comes to prenatal care and the birthing process. 

'We have been able to establish that midwifery care is strongly associated with lower interventions, cost-effectiveness and improved outcomes,' said lead researcher Saraswathi Vedam, an associate professor of midwifery who heads the Birth Place Lab at the University of British Columbia.

The midwife model emphasizes community-based maternal and infant care along with avoiding any unnecessary, and potentially dangerous, interventions. Midwives have long been widely embraced in Europe as a positive component of maternal care. In the U.S., though, midwives often represent a "culture war that encompasses gender, race, class, economic competition, professional and personal autonomy, risk versus safety, and philosophical differences." 

The title "midwife" can have multiple meanings, ranging from "certified nurse-midwives," to "direct-entry midwives," to "lay midwives." Depending on the title and the state in which the midwife works, the midwife will have a different level of training and may or may not be licensed or regulated by the state. 

This new study indicates, though, that midwives may be part of the answer to the U.S.'s problematic infant and maternal mortality rates. Severe maternal complications have sharply risen over the past 20 years, and maternal care is seriously sparse in certain areas of the country. "Nearly half of U.S. counties don't have a single practicing obstetrician-gynecologist." 

While midwife regulations vary widely among states, the study shows that states that have more fully integrated midwifery systems within their health care have significantly better outcomes for mothers and babies. States with restrictive midwife regulations--like Alabama, Ohio, and Mississippi--regularly score much lower on tests of maternal and neonatal well-being.

Alabama, which has the worst infant mortality rate in the country, has long had strict midwife regulations, "reflecting attitudes that wiped out the state's once-rich tradition of black birth attendants." Alabama lawmakers, though, recently passed a bill legalizing certified professional midwives, taking one small step toward the process of greater midwife integration, and, hopefully, improved maternal and infant health care across racial and economic lines. 

Access to midwifery is often split among racial lines, as many of the states with the worst outcomes (and higher levels of opposition to midwives), including Alabama, have large black populations. The study suggests a correlation between improved access to midwifery and reduced racial disparities in the maternal health care field.

Jennie Joseph, a British-trained midwife who runs the Florida birthing center and nonprofit Commonsense Childbirth affirms this:

“It’s a model that somewhat mitigates the impact of any systemic racial bias. You listen. You’re compassionate. There’s such a depth of racism that’s intermingled with [medical] systems. If you’re practicing in [the midwifery] model you’re mitigating this without even realizing it.”

The study, though, does not conclude that better midwife access will directly lead to better outcomes or vice versa. It acknowledges that many other factors also affect maternal and infant health among states, including access to preventative care, insurance, and rates of chronic disease.

Nonetheless, maternal health advocates have long recognized the benefits of midwifery and this is not the only study to highlight the positive effects of supporting midwives. A 2014 study found that integrating midwives into health care could prevent more than 80 percent of maternal and infant fatalities worldwide, in both low and high-resource communities. Even in the U.S., organizations such as the American Congress of Obstetricians and Gynecologists have begun embracing nurse-midwives despite lingering skepticism by many. 

Planned Parenthood Will Launch 10 New Video Chat Abortion Locations in 2018

Cosmopolitan (Feb. 6, 2018): Planned Parenthood Will Launch 10 New Video Chat Abortion Locations in 2018, by Jennifer Gerson Uffalussy: 

A safe, early-pregnancy abortion option has been making waves across the United States since Planned Parenthood began its telemedicine abortion pilot program in Iowa in 2008. 

Telemedicine abortions enable those seeking a pregnancy termination to meet with a nurse in a local clinic where both patient and nurse loop in an abortion-providing doctor via video chat. The doctor consults with the patient to determine that they are a good candidate for early pregnancy termination and then authorizes the nurse to dispense two small pills to the patient. The patient takes the first pill in the office in the presence of the nurse and doctor and then later takes the second pill at home. The pregnancy is terminated within a day or two. 

These medications have become known at "the abortion pill" and include both mifepristone and misoprostol, which work together first to block the hormones a woman's body needs to sustain a pregnancy and then to empty her uterus. The FDA-approved abortion pills are for ending pregnancies less than 10 weeks along. A study of Planned Parenthood's telemedicine pilot program found that access to telemedicine abortions decreased second-trimester abortions throughout the state. Second-term abortions require surgical procedures and can carry increased risks.

Although abortion is legal in all 50 states, many states have tightened their restrictions on abortion access, making it very difficult for a person facing an unwanted pregnancy to safely terminate it. Restrictions such as mandatory waiting periods and insurance limitations are compounded in states with very few clinics that can perform abortions. In fact, about 90% of counties in the U.S. do not have an abortion provider. 

Telemedicine allows a patient to meet with an abortion provider even if she doesn’t live near one. Instead of driving long distances, women can go to a closer clinic or Planned Parenthood and video-chat a live, somewhere-in-state abortion provider who prescribes and (virtually, via on-site clinic staff) hands over the meds. “There is no increased risk of complications with a telemedicine visit,” says Daniel Grossman, MD, director of Advancing New Standards in Reproductive Health at the UCSF Bixby Center for Global Reproductive Health. He led a groundbreaking study published last fall that found telemedicine abortions are just as safe as those in which a woman swallows mifepristone in the same room as a physician.

While mifepristone has so far demonstrated a highly-safe success rate (its rates of complications are fewer than most common pain relievers), it cannot be obtained over-the-counter; instead a clinic, hospital, or doctor's office must dispense it.

Some states will allow a pregnant person to video chat with a doctor from her home and then receive both pills in the mail. Since 2008, though, 19 states have challenged the expansion of telemedicine abortions by passing laws that specifically require mifepristone to be dispensed "in the physical presence of the prescribing clinician."

Planned Parenthood continues to expand its telemedicine program despite the challenges. It has now established 24 telemedicine locations in the nation and plans to add at least 10 additional locations--some in new states--throughout this year. 

To find out if telemedicine abortion is available in your area, call the national Planned Parenthood hotline at 800-230-PLAN.

For Nonbinary Parents, Giving Birth Can Be Especially Fraught

Rewire (Jan. 25, 2018): For Nonbinary Parents, Giving Birth Can Be Especially Fraught, by S.E. Smith

Pregnancy and childbirth are vulnerable times in any parent's life. Add to that the highly gendered-status of both pregnancy and birth, and trans and non-binary parents are finding it difficult to locate an inclusive community with educated medical staff as they, too, enter childrearing chapters.

With the trans community, conversations about birth and parenting are few and far between and often fraught with discomfort. Now, though, more parents-to-be identify as trans men or somewhere else on the non-binary spectrum of gender identity. And the medical community has not yet caught up. "And, as in any area of reproductive health-care services, this isn’t simply a matter of gender: Race, class, and geography can play a huge role in whether non-binary people are able to access inclusive, affirming birth care."

Gender-affirming care--including asking for a patient's pronouns with their name, using gender-affirming language, and regularly seeking consent before performing examinations, particularly those that require a medical professional to touch the patient's genitalia--is important.  When it is absent, patients report both physical and psychological trauma.

Many in the trans and non-binary communities are increasingly seeking home births with gender-affirming midwives in order to create the most comfortable environments for themselves. Midwifery can be prohibitively expensive though, and insurance rarely covers it. So for others, a hospital may be the safest or the only choice. Advocates say that hospitals and birth collectives would do well to invest in specialized training for medical providers "to ensure that everyone at a facility is trans-competent, or working on getting there."

This issue is likely to amplify in coming years with a more visible nonbinary community, as well as a more active movement to reframe the way we look at pregnancy and birthing. Trans people—binary and otherwise—are some of the biggest stakeholders in the conversation, and they’re contributing with inclusive birthing classes and provider training in addition to working as care providers themselves.

The trans and non-binary communities call on leaders within the medical community to initiate changes from the inside, including re-training initiatives and reframing core educational documents for inclusivity.