Reproductive Rights Prof Blog

HHS Threatens to Defund UVM Medical Center for Allegedly Failing to Protect Conscience Rights of Nurse Who Opposes Abortions

August 29, 2019 (Rewire News): HHS Launches Another Attach on Abortion Providers Under Guise of 'Conscience Rights," by Dennis Carter:

Rewire News reports that the Office of Civil Rights in the Department of Health and Human Services has accused the University of Vermont Medical Center of “intentionally, unnecessarily, and knowingly” scheduling nurses to assist with abortions “against their religious or moral objections." HHS Head Roger Severino claims that these alleged actions violate the Church Amendments, laws from the 1970s that protect the conscience rights of individuals to object to performing or assisting in abortion or sterilization procedures if it is contrary to their religious or moral beliefs.  HHS has given the center 30 days to change its religious freedom policies or lose federal funding. 

 

According to Severino, the nurse who filed the claim feared she would lose her job if she opted out of assisting with the abortion. A medical center spokesperson stated that UVM has “robust, formal protections that safeguard both our employees’ religious, ethical and cultural beliefs, and our patients’ right to access safe and legal abortion” and that “employees are protected from discrimination based on any decision they make to opt out of procedures for treatments.”  She also stated that UVM promptly investigated the allegations when they were first made and determined that they were unsupported. 

 

Despite UVM’s ongoing discussions with HHS, Severino opted to issue the public statement. This action appears reflective of the direction of the Civil Rights Office, which has prioritized discrimination and religious claims of health care providers rather than discrimination faced by people who seek to access health care services.  According to Rewire: 

 

Since Trump entered the White House, OCR officials have transformed the office into a powerful political entity centered on so-called religious freedom. In 2018 Severino launched a health-care discrimination wing of OCR, known as the Conscience and Religious Freedom Division, to defend health-care providers who oppose abortion and do not want to treat LGBTQ people. This case marks the third enforcement action the division has taken to protect “conscience rights,” and it’s first action in defense of an individual health-care worker who objects to participating in abortion care.

Texas gave anti-abortion group millions for women's health, despite warnings

Houston Chronicle (Feb. 25, 2019): Texas gave anti-abortion group millions for women's health, despite warnings, by Jeremy Blackman:

In May 2016, Carol Everett sent an email to fellow anti-abortion activists detailing “an extraordinary pro-life opportunity.” Her nonprofit, the Heidi Group, she said, had spent the past year pushing for nearly $40 million in funding to help Christian pregnancy centers “bless many poor women” across Texas. The opportunity she was discussing? An application to become one of the state’s leading family planning providers as part of the Healthy Texas Women program, which offers free women’s health and family planning services to eligible, low-income women.

Everett had never contracted with the state and had no clinical background. Many of the pregnancy centers she cited don’t provide contraception, a core family planning service. Still, state health officials gave her significant public funding anyway, ignoring warning signs and overruling staff that recommended millions less in funding, according to a review of the contracting by the Houston Chronicle. When Everett’s clinics began failing, Texas delayed for months in shifting money to higher performing clinics and chose to devote vast amounts of time to support Everett and her small, understaffed team.

The Heidi Group was not the only contractor that struggled in Healthy Texas Women. By the end of the first year, others had met just 46 percent of their combined patient targets. They had spent just over a third of their proposed fee-for-service expenditures, the state’s preferred source because every expense can be tracked. Those excelling early on were established providers versed in the state’s complex billing procedures. For them, the program has been a boon from the beginning, increasing funding for equipment and staff, and adding reimbursements for a larger swath of health services. Still, many of the smaller, less-experienced clinics could not scale up quickly enough and felt they had not received adequate training on billing and enrollment delays.

The state's separate Family Planning program within HHS had twice the success rate, both in spending and patient targets. Though the 39 Healthy Texas Women contractors had access to more money in the first year, those in the Family Planning program outspent them by several million dollars, which the state said it could not immediately verify. Because of its less stringent eligibility requirements, Family Planning program providers say they can more easily meet need where it exists. And for many of them, that is with immigrant and undocumented families.

Though it’s impossible to say how many more women could have been served had the resources been shifted sooner, several competing clinics involved in Healthy Texas Women burned through their funding early in the grant cycle, surpassing their targets for both spending and patients treated. Had they been sent some of the $6.75 million sitting in wait for the Heidi Group, the door could have opened for thousands more women to receive access to contraception, STD screenings and breast exams.

“We would definitely have been able to serve more,” said Marcie Mir, the chief executive officer of El Centro de Corazon, which serves immigrant communities in East Houston.

The Houston Chronicle’s review included emails, internal records, and interviews with two dozen people, and found that the Texas HHS made repeated concessions, and not just to the Heidi Group. State health officials lowered the standards for applicants in two new women’s health programs, including Healthy Texas Women, and revised past patient counts, making it easier to show growth. Quality control measures were stalled, and only the Heidi Group received on-site clinical assessments in the first year, despite similar problems with other contractors.

At least one top Republican, Governor Greg Abbott, laid the groundwork for Everett’s selection, controlling her appointment to an influential committee helping to develop the new programs, according to records. The health official who allocated Everett's award has close personal ties to the conservative Texas Public Policy Foundation, whose founder, Dr. James Leininger, has been a key donor to the Heidi Group, as well as to Abbott.

Everett’s funding was revoked last fall after two years of poor performance, and auditors are reviewing whether the Heidi Group mishandled funds.

Despite an uptick in number of people served in 2017 from the previous year, Texas still served 100,000 fewer patients than in 2010, despite spending about $35 million more in 2017, including federal dollars.

What has happened in Texas may be a preview for the country at large. The Trump administration on Friday announced it is cutting family planning funding to abortion affiliates, a decision that further undermines groups like Planned Parenthood, which provide the bulk of non-abortion services to low-income women nationally. The move, much like the one in Texas years ago, is expected to direct millions toward faith-based providers.

When Abortion Is Illegal, Women Suffer

The Atlantic (Oct. 11, 2018): When Abortion Is Illegal, Women Rarely Die. But They Still Suffer, by Olga Khazan:

On Thursday, The Atlantic published a piece surveying nations that maintain bans on abortion, in light of the belief that abortion is expected to become further restricted with Brett Kavanaugh on the Supreme Court.

Khazan writes that legal experts believe the majority-conservative court likely won’t overturn Roe v. Wade, but rather will chip away at abortion rights by narrowing the circumstances in which a woman can obtain the procedure. Still, abortion rights advocates fear that increasing restrictions will force low-income women into desperate situations and increase the rate of self-managed abortion, in which interest has spiked in recent years as access to safe and legal abortion erodes in many states.

If other countries provide guidance, Khazan writes, "abortion restrictions won’t reduce the number of abortions that take place." According to the Guttmacher Institute, abortion rates in countries where abortion is legal are similar to those in countries where it’s illegal, and in countries where abortion is illegal, botched abortions still cause about 8% to 11% of all maternal deaths, or about 30,000 deaths each year.

But, Khazan observes, doctors have gotten better at controlling bleeding in recent decades, and there has also been a major revolution in how clandestine abortions are performed thanks to medication abortion (mifepristone and misoprostol).

Mifepristone and misoprostol have made Brazil's rate of treatment for severe complications from abortion decline by 76 percent since 1992. In Latin America overall, the rate of complications from abortions declined by one-third since 2005.

Meanwhile, in El Salvador abortion is illegal, but one in three pregnancies still ends in abortion. Many women there who want to abort their pregnancies, Khazan finds, obtain misoprostol on the streets.

"Those who have internet access and reading skills can look up information about how to take it properly."

Federal prosecutors in El Salvador are known to visit hospitals and encourage doctors to report to authorities any women who are suspected of self-inducing their abortions. But because federal prosecutors are only visiting public hospitals and not private hospitals, poor women are much more likely to be reported for their illegal abortions than rich women.

In Brazil, where abortion is also illegal, about 250,000 women are hospitalized from complications from abortions, and about 200 women a year die from the complications. About 300 abortion-related criminal cases were registered against Brazilian women in 2017.

In Ireland prior to the repeal of its criminal abortion ban, women would travel to England to get the procedure—often using a fake English address so they could get the procedure for free under the United Kingdom’s National Health Service. Others, Khazan writes, "would order abortion pills from Women on Web, a Canada-based service that ships the pills to women in countries where abortion is illegal."

Whether a self-induced abortion is dangerous likely depends on where a woman gets her pills and what kind of information is available to assist her. Irish women’s outcomes were better than the Brazilian women’s possibly because they had access to regulated services like Women on Web. Brazilian customs officials, meanwhile, confiscate shipments of medication abortion into the country, forcing women to turn to the black market.

The American market for abortion drugs will boom under a Kavanaugh Supreme Court, says Michelle Oberman, a Santa Clara University law professor, but it will also become more difficult to penalize abortion providers for illegal abortions, since with medication abortion there is no doctor, only the woman. In that case, Oberman says, “everything I saw [in Ireland] will happen here”: the hospital reports, the prosecutions, the jail sentences.

Many states have already prosecuted women for doing drugs while pregnant or for otherwise allegedly harming their fetuses. Overwhelmingly, those punished tend to be poor women and women of color.

Irish Parliament Debates Bill to Legalize Abortion

BBC News (Oct. 4, 2018): Irish Parliament Debates Bill to Legalise Abortion, by Deirdre Finnerty:

The Irish parliament is debating legislation to legalize abortion services nationwide. It is the first time the Irish parliament has addressed the issue since the Eighth Amendment - a near total constitutional ban on abortion - was removed by referendum in May.

Irish Health Minister Simon Harris hopes abortion services will be available in Ireland starting in January.

Known as the Regulation of the Termination of Pregnancy Bill, the legislation allows for abortion services to be provided "on demand" up to the 12th week of a pregnancy, and in the case of a fatal fetal abnormality or where the physical or mental health of the mother is in danger.

Harris has said that abortion would be made available free of charge.

Introducing the bill in the Irish assembly, Harris said the referendum was a resounding affirmation of support for right of women to make choices about their lives.

"More on women's health, women's equality, more on continuing to shape an inclusive and equal society," said Harris.

Separate legislation will be introduced at a later date to allow for "safe access" zones - designated areas that prevent protests around abortion providers.

The Irish government must work with doctors to implement services and provide training and support. Dr. Mary Favier, founder of Doctors for Choice, told the Irish Times that planning for abortion by the Department of Health had been "a shambles."

"There's been no clinical lead appointments. There's been no technical round tables established. There's been effectively no meetings held," she said.

Mike Thompson, a general practitioner in east Cork, told the BBC that the government's proposed timeline of January 2019 was "ambitious" and "challenging."

"Unless there is a clear and robust guideline, no GP will provide the service. It has to be safe," Dr. Thompson said.

Earlier, anti-abortion doctors said they did not wish to be forced to refer a pregnant woman seeking a termination to another doctor. A bill allowing for doctors to opt out of providing a medical or surgical abortion if they do not wish to perform the procedure was introduced in the Irish parliament earlier this year. The legislation requires that doctors refer a woman seeking an abortion to another doctor who will perform the abortion.

The health minister said that conscientious objection was one thing, but refusing to refer women wishing to terminate their pregnancies to other doctors was quite another.

It is unclear how a small number of doctors objecting to providing abortion care will affect the rollout of abortion services in Ireland.

India Strikes Down Colonial-Era Ban on Gay Sex

The New York Times (Sept. 6, 2018): India Strikes Down Colonial-Era Ban on Gay Sex, by Jeffrey Gettleman, Kai Schultz, and Suhasini Raj:

India's Supreme Court unanimously struck down a ban on consensual gay sex, a remnant of the country's colonial past and one of the oldest bans of its kind. The Court called the law "irrational, indefensible and manifestly arbitrary." 

The Court's decision came after weeks of deliberation, years of legal arguments, and decades of activism. Human rights advocates in India and around the world celebrated as India joined the growing list of countries granting full rights to gay-identifying people. Similar laws have been overturned in the United States, Canada, England, and Nepal, among others. 

In 2009, a court in New Delhi had ruled that the law could not be applied to consensual sex, but religious resistance to this decision followed by an appeal led to the restoration of the full law in 2013. The court deferred at that point to the Parliament and claimed the law only applied to a "minuscule fraction of the country."

In 2016, activists rallied five brave plaintiffs identifying as gay and lesbian Indians who alleged their rights to equality and liberty were violated under the law (Section 377). Eventually, more than two dozen additional Indians joined the case while it was pending before the Supreme Court.

The September 2018 decision struck down the prohibition against gay sex, and the Court also made illegal all discrimination based on sexuality, extending "all constitutional protections under Indian law" to gay people.

The law was written in the mid-19th century and applied to "unnatural sexual acts." The law, which criminalized people who engaged in "intercourse against the order of nature," remains on the books to apply to cases of bestiality, for example, but now no longer can be used against consensual sex. “'History owes an apology to members of the community for the delay in ensuring their rights,' Justice Indu Malhotra said."

Menaka Guruswamy was one of the lead attorneys representing the petitioners. This decision is a "huge win" she said. The lawyers' arguments centered on the legal issues but also embraced pleas to the Justices to recognize the humanity of those who have been affected by Section 377 for decades.

The law is notably a vestige of British colonialism. Hinduism, the dominant religion in India, is generally permissive of same-sex relationships, but levels of tolerance were eviscerated under British rule. The British leaders implemented Section 377, which imposed a life sentence on those in violation. While the law has been greatly limited, India remains a conservative country in many ways, and fundamentalist groups across religions--Hindu, Muslim, and Christian--protested the decision.

In recent years, though, many more Indians have come out, identifying publicly as gay, lesbian, and transgender. Now that these lifestyles are no longer criminalized, Indian activists hope that many more Indians will come out and be embraced by their country. 

Argentina's Senate Narrowly Rejects Legalizing Abortion

Aug. 9, 2018 (New York Times): Argentina's Senate Narrowly Rejects Legalizing Abortion, by Daniel Politi and Ernesto Londoño:

After 16 hours of deliberation, Argentina’s Senate narrowly rejected a bill to legalize abortion on Thursday, dealing a painful defeat to a vocal grass-roots movement that pushed reproductive rights to the top of Argentina's legislative agenda and galvanized abortion rights activist groups throughout Latin America, including in Brazil and Chile.

As legislators debated the bill into the early hours of Thursday morning, thousands waited outside the Congress Building in Buenos Aires, weathering the winter cold.

Supporters of the legislation, which would have legalized abortion care during the first 14 weeks of pregnancy, had hoped Argentina would begin a sea change in reproductive rights in a largely Catholic region where 97 percent of women live in countries that ban abortion or allow it only in rare instances.

In the end, 38 legislators voted against legalization, 31 voted in favor, and 2 legislators abstained.

Opposition in Argentina hardened as Catholic Church leaders spoke out forcefully against abortion from the pulpit and senators from conservative provinces came under intense pressure to stand against legalization.

While the bill's failure is considered a major setback for the activists who backed it, analysts said the abortion rights movement has already brought change to Central and South America in ways that would have been impossible just years ago.

On Wednesday, demonstrators rallied in support of the Argentine bill in Uruguay, Mexico, Peru, and Chile, where they gathered in front of the Argentine Embassy in Santiago, chanting and wearing the green handkerchiefs that became the symbol of Argentina’s abortion rights movement.

Recently, activists in Argentina scored a victory with the passage of a law that seeks to have an equal number of male and female lawmakers.

"If we make a list of the things we’ve gained and the things we’ve lost, the list of things we’ve gained is much bigger,” said Edurne Cárdenas, a lawyer at the Center for Legal and Social Studies, a human rights group in Argentina that favors legalized abortion. “Sooner or later, this will be law.”

In the region, only Uruguay, Cuba, Guyana and Mexico City allow any woman to have an early-term abortion.

For Argentina, the debate over abortion has tugged at the country’s sense of self. It is the birthplace of Pope Francis, the leader of the world’s Catholics, who recently denounced abortion as the “white glove” equivalent of the Nazi-era eugenics program. Recently, though, the country has begun shifting away from its conservative Catholic roots. In 2010, Argentina became the first country in Latin America to allow gay couples to wed. Francis, then the archbishop of Buenos Aires, called that bill a “destructive attack on God’s plan.”

The organized movement that pushed the failed bill started in 2015 with the brutal murder of a pregnant 14-year-old girl by her teenage boyfriend. Her mother claimed the boyfriend’s family didn’t want her to have the baby. As debates about violence against women on social media grew into wider conversations about women’s rights, young female lawmakers gave a fresh push to an abortion bill that had been presented repeatedly in the past without going anywhere.

In June, the lower house of the Argentine Congress narrowly approved a bill allowing women to terminate pregnancy in the first 14 weeks. Current law allows abortions only in cases of rape or when a mother’s life is in danger. While the measure failed in the Senate this week, it made some inroads: among the senators who voted for it was Cristina Fernández de Kirchner, who as president had opposed legalizing abortion.

“Society as a whole has moved forward on this issue,” said Claudia Piñeiro, a writer and abortion-rights activist in Argentina. “Church and state are supposed to be separate, but we’re coming to realize that is far from the case,” Ms. Piñeiro said as it became clearer that the push for legalization would lose.

“That will be the next battle.”

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. 

Students sue University of Notre Dame for restricting access to some birth control

Washington Post (Jun. 27, 2018): Students sue University of Notre Dame for restricting access to some birth control, by Erin B. Logan: 

A Notre Dame alumna and three current student sued the university on Tuesday in the wake of Notre Dame's February 2018 announcement that it would deny access to "abortion-inducing" contraceptives. The lawsuit alleges violations of federal law and the First and Fifth Amendments. In addition to the university, the suit names the departments of Health and Human Services, Labor, and Treasury.

These health-care policy changes to Notre Dame's plan will affect undergraduate and graduate students as well as university employees and their dependents. The policy will go into effect on July 1 for employees and in August for students.

The roll-back of coverage by the university is a response to the U.S. Department of Health and Human Services' fall 2017 announcement that it would rescind the Obama-era rule mandating free contraceptive coverage in health plans. This requirement currently remains in effect, though, due to judicial injunctions. Notre Dame, however, carved out an exception for itself with the federal government after a 2013 suit against the mandate claimed a violation of its moral and religious convictions.

Supreme Court Backs Anti-Abortion Pregnancy Centers in Free Speech Case

New York Times (Jun. 26, 2018): Supreme Court Backs Anti-Abortion Pregnancy Centers in Free Speech Case, by Adam Liptak: 

Justice Thomas wrote for the five-justice, conservative majority who decided Tuesday that California's "crisis pregnancy centers" cannot be forced to provide information on abortion services in the state. 

The case, National Institute of Family and Life Advocates v. Becerra, No. 16-1140, centered on a California law that requires pregnancy centers whose aim is to dissuade pregnant people from abortions to provide information on the availability of abortions in California.

The state requires the centers to post notices that free or low-cost abortion, contraception and prenatal care are available to low-income women through public programs, and to provide the phone number for more information.

The centers argued that the law violated their right to free speech by forcing them to convey messages at odds with their beliefs. The law’s defenders said the notices combat incomplete or misleading information provided by the clinics.

The state legislature enacted the law after finding that hundreds of the pregnancy centers used "intentionally deceptive advertising and counseling" to confuse or intimidate women from making informed decisions about their health care. The law also required that unlicensed clinics disclose that they are unlicensed. 

Justice Thomas wrote that the requirements for the notices regarding abortion availability were too burdensome and infringed on the clinics' rights under the First Amendment. The ruling reverses a unanimous decision from a three-judge panel of the United States Court of Appeals for the Ninth Circuit, which had upheld the law.

Justice Breyer penned a dissent, joined by Ginsburg, Sotomayor, and Kagan, citing the contradiction between the majority's decision here and a Court decision in 1992 that upheld a Pennsylvania law that required abortion-performing doctors to inform their patients about other options, like adoption. 

Is Your Hospital Catholic? Many Women Don’t Know.

Rewire.News (June 6, 2018): Is Your Hospital Catholic? Many Women Don’t Know, by Amy Littlefield: 

About one in six women in the United States name a Catholic facility as their go-to hospital for reproductive health care.

However, more than a third of these women are unaware that their hospital is Catholic, according to a survey revealing an “information gap” about Catholic hospitals, where religious rules dictate access to contraception, sterilization, and abortion services.

Among women who listed a Catholic hospital as their primary facility for reproductive care, only 63 percent knew that the hospital was Catholic, researchers found. The study, published in the journal Contraception, did not address whether respondents knew how Catholic hospitals restrict care.

Women with annual incomes under $25,000 are less likely to realize their hospital is Catholic than women who make more than $100,000 a year, the researchers found, underscoring how these barriers disproportionately affect marginalized patients. A January report found women of color are more likely to give birth in Catholic hospitals and thus bear the brunt of these religious restrictions.

Patients seeking care in Catholic facilities have been turned away while bleeding and made to wait until they sicken to receive miscarriage treatment. Cesarean section patients in Catholic hospitals often can’t have their tubes tied at the same time they give birth, requiring a second surgery elsewhere. Transgender patients have had gender-affirming surgeries canceled on religious grounds.

The researchers called on hospitals to better advertise their Catholic affiliations. “Efforts are needed to increase hospital transparency and patient awareness of the implications that arise when health care is restricted by religion,” they wrote.

Women overwhelmingly want to be informed about religious restrictions: eighty-one percent say it’s important to know these barriers when they decide where to go for care.

Baltimore to join lawsuit against U.S. health agency over cuts to programs that help prevent teen pregnancy

The Baltimore Sun (Mar. 7, 2018): Baltimore to join lawsuit against U.S. health agency over cuts to programs that help prevent teen pregnancy, by Ian Duncan:

The city of Baltimore intends to join a lawsuit against President Trump filed last month by the nonprofit Healthy Teen Network. The suit was filed in U.S. District Court in Baltimore after Healthy Teen Network's federal grant--given to develop and fund the study of an app providing sex education--was significantly reduced.

Baltimore’s health department received an $8.5 million federal grant to help provide sex education for about 20,000 students over five years. Last year, the federal health agency told Baltimore that the program would be severed from its funding after three years instead, leading to a loss of $3.5 million.

The lawsuit alleges that Trump’s appointee to a senior position in the U.S. Department of Health and Human Services has reduced federal grants for programs that do not match the official’s belief that people should not have sex until they are married.

While the lawsuit by Healthy Teen Network states they did not receive a clear explanation for the funding cut, the lawyers claim that the cut in funding is directly related to the appointment of abstinence-only advocate Valerie Huber, who was appointed Chief of Staff for the Office of the Assistant Secretary of Health at the U. S. Department of Health and Human Services in June 2017.

"Dr. Leana Wen, the city’s health commissioner, said the reduction would greatly harm the department’s ability to provide services."

“We have made significant progress to reduce teen birth rates, and the last thing that should happen is to roll back the gains that have been made.”

Facebook is Ignoring Anti-Abortion Fake News

The New York Times (Nov. 10, 2017): Facebook is Ignoring Anti-Abortion Fake News, by Rossalyn Warren

As Facebook addresses the role of "fake news" on its platform, largely in relation to the 2016 election and Russian political propaganda, another potentially more difficult concern arises. The spread of false reproductive rights and health news is widespread and often harder for Facebook to spot (and manage).

Facebook’s current initiatives to crack down on fake news can, theoretically, be applicable to misinformation on other issues. However, there are several human and technical barriers that prevent misinformation about reproductive rights from being identified, checked and removed at the same — already slow — rate as other misleading stories.

Identifying a fake news sources is not always straightforward. The social media giant says it often targets "spoof" sites that mimic legitimate news sources. But misleading anti-abortion sites can be hazier to identify. They generally publish original pieces, but often alongside inaccurate facts or with poor sourcing, which "helps blur the line between what’s considered a news blog and 'fake news.'"

Facebook aims to limit fake news by making it more difficult for these sources to buy ads or generate spam. "Most false news is financially motivated," Facebook says. This is not often the case with anti-abortion advocates, though, who are overwhelmingly driven by strong religious or political beliefs. The goal isn't profit but persuasion. 

Many are concerned that misinformation regarding reproductive rights and abortion in particular may detrimentally affect current political movements. Ireland plans to hold a referendum next year regarding whether to lessen the country's strict abortion regulations. Pro-choice advocates are worried that the rapid spread of abortion-related misinformation on Facebook (like a purported causal link between abortion and breast cancer) may affect the vote. 

Facebook has yet, though, to directly address concerns over this type of scientific misinformation in the same way they have begun to address fake news about last year's election. 

Supreme court agrees to hear antiabortion challenge to California disclosure law for pregnancy centers

Los Angeles Times (Nov. 13, 2017): Supreme court agrees to hear antiabortion challenge to California disclosure law for pregnancy centers, by David G. Savage:

The Supreme Court has granted certiorari to hear NIFLA vs. Becerra, in which an anti-abortion group challenges a California law that requires crisis pregnancy centers to notify patients that the state offers contraception and abortion services. 

The case centers on the Reproductive FACT Act, which requires pregnancy centers to disclose whether they have a medical license and whether medical professionals are available. The law also requires centers to post a notice in the waiting room that reads: "California has public programs that provide immediate free or low-cost access to comprehensive family planning services, including all FDA-approved methods of contraception, pre-natal care and abortion."

California lawmakers passed the disclosure law two years ago after concluding as many as 200 pregnancy centers in the state sometimes used “intentionally deceptive advertising and counseling practices that often confuse, misinform and even intimidate women” about their options for medical care.

The National Institute of Family and Life Advocates (NIFLA) represents 110 pregnancy centers in California that all claim the disclosure provision violates their free speech as "compelled speech." Such a disclosure, they claim, conflicts with their faith-based goal of encouraging childbirth and preventing abortion. 

The Californian pregnancy centers initially lost their case under three federal district judges. On appeal, the 9th Circuit Court upheld the lower court's decision. Last month, however, a judge in Riverside County ruled that the law violated the free-speech provisions of California's own state Constitution. 

California's Attorney General Xavier Becerra stands by the disclosure provision and its intent to provide women accurate information about their health care options.

It takes five justices for a majority opinion, and many expect the Court's decision to turn on the vote of Justice Kennedy. 

Trump administration narrows Affordable Care Act’s contraception mandate

Washington Post (Oct. 6, 2017): Trump administration narrows Affordable Care Act’s contraception mandate, by Juliet Eilperin, Amy Goldstein and William Wan:

In the next move on Trump's path to dismantle as many Obama-administration initiatives as possible, the Trump administration issued a rule today that many predict will leave hundreds of thousand of women without free access to contraceptives. 

The Health and Human Services Department now allows a much wider group of employers and insurers to exempt themselves from covering birth control on religious or moral grounds. Although the administration estimates that "99.9%" of women will still receive free birth control through their insurance, the only basis of that estimate is the finite number of lawsuits that have been filed since Obama introduced the contraceptive mandate provision in 2012. Officials do not know, however, how many employers denied contraceptive coverage on "religious" or "moral" grounds before the ACA, and so an accurate number of women who may lose coverage cannot yet be estimated. 

In 2014, the Supreme Court heard the Hobby Lobby case in which the Christian owners of the Hobby Lobby chain craft store objected to providing certain forms of birth control. The court ruled it illegal to impose the provision on "closely held corporations," the definition of which is sure to widen under Trump's provision. 

Senior Justice Department officials said the guidance was merely meant to offer interpretation and clarification of existing law. But the interpretation seemed to be particularly favorable to religious entities, possibly at the expense of women, LGBT people and others.

The guidance, for example, said the ACA contraceptive mandate “substantially burdens” employers’ free practice of religion by requiring them to provide insurance coverage for contraceptive drugs in violation of their religious of beliefs or face significant fines.

 

This new rule will almost certainly prompt fresh litigation against the Trump administration, likely on the grounds of sex discrimination--as the mandate disproportionately affects women--and religious discrimination based on the argument that these exceptions enable employers to impose their religious beliefs on their employees. 

Abortion Foes Find a Friend in Donald Trump. But for How Long?

New York Times (May 6, 2017): Opponents of Abortion Warily Measure Progress, by Jeremy W. Peters:

President Trump has proven himself to be a friend of abortion opponents.  Left unclear, though, is whether he has any influence in the battle over the roughly $500 million Planned Parenthood receives each year.  Moderate Republicans are not lining up to end support of Planned Parenthood.  Even the bill passed in the House of Representatives last Thursday only reduces funding for Planned Parenthood for one year and leaves the organization eligible for money to support family planning.  The Senate will prove more of a hurdle in any attempt to defund Planned Parenthood.

Conservative Republican attempts to revive interest in completely defunding Planned Parenthood have now taken the form of vilifying the organization for focusing more on defeating Republicans than on supporting women.  The position is hopelessly out of step with American opinion.  The majority of Americans believe the group should receive public funding for its work.   

Christian conservatives, whom President Trump hopes to reward for supporting him in 2016, are becoming wary of his attempts to prove that he is a friend of their causes.  He has, for example, refused to end workplace protections for LGBTQ employees put in place by President Obama in 2014, although last March he did make the protections harder to enforce.  Christian conservatives are upset that the lives of those forced by Obama's executed order not the discriminate against LGBTQ employees are being "destroyed by the demands of the sexual identity activist class . . . ."  Trump may not be up to the task of coming to the aid of groups who hold such extreme and unyielding perspectives.    

Free Birth Control in Philippines Ignites Religious Skirmish

New York Times (Jan. 27, 2017): Duterte’s Free Birth-Control Order Is Latest Skirmish With Catholic Church, by Aurora Almendral:

The Philippines, where six million women have no access to contraceptives, delivers free birth control to indigent women through a program that also offers prenatal care and mandates that sex education be taught in schools and that companies provide reproductive health services to their employees.  The program has been billed as "pro-life, pro-women, pro-children and pro-economic development." 

But the Catholic Church has long fought the implementation of the program, going so far as to block key components of it via petitions filed in the Supreme Court.  Unable to implement the program, the Health Department's budget has been slashed.  Sex education in schools remains substandard, based in abstinence-only rhetoric.  The Philippines is the only country in Asia where rates of pregnancy among teenagers increased. 

President Duterte's administration is coming back strong against the court's decisions, vowing to uphold the law and eliminating some of the decisions' ambiguous wording.  Two archbishops have acknowledged defeat.      

One commentator, contrasting Duterte's clash with the church with President Donald Trump's reinstatement of the Reagan-era global "gag rule" forbidding foreign NGOs from receiving U.S. family planning funds if they perform, counsel or refer women for abortion services or advocate for the liberalization of abortion laws where they work, sees the policy of the United States, not the Philippines, as the real threat to women's health.

Dismantling the Abortion vs. Religion Debate Through an Inclusive Judaism

Bustle (Sept. 14, 2016): This Feminist Rabbi Is Dismantling the Abortion vs. Religion Debate, by Cate Carrejo:

Jewish values emphasize equality and dignity for all people above all.  For Rabbi Lori Koffman this means taking care of everyone's health, economic security and well being.  Reproductive justice is a major part of this value system.

Koffman is the chair of the National Council of Jewish Women's Reproductive Justice Initiative, which is aligned with a national coalition of access-to-abortion groups.  While many see a contradiction between reproductive justice and religious values, Koffman sees them as inextricably intertwined. 

"The decision whether and when to have a family is one of the holiest decisions anyone will ever make," Koffman says. "It really should be up to the woman and her partner if she has one or their partner if they have one and their own religious faith, any religious advisors if they have them, and really nobody else."

Koffman feels strongly that no one's religious values should be allowed to shut down someone else's opposing religious values.  The basis of her commitment to reproductive justice, then, lies in the freedom to choose: "I can exercise my religious belief, because I can then choose to have an abortion or not. Someone who sees the world differently from a religious standpoint, then they can make the choice not to have an abortion because their religious values don't support abortion."  

Koffman will continue speaking out for a reproductive justice that includes a multiplicity of reproductive health choices.  

Religious Faith and Abortion Liberty

Huffington Post (Jul. 18, 2016): Voices of Faith Speak for Abortion Rights, by Marie Alford-Harkey: 

Religious people who support abortion rights have largely been ignored in the debate over abortion.  There is a widely held misconception that people with religious convictions are anti-abortion.  This is a false dichotomy.  It is not true, as Dr. Willie Parker has noted, that "people with a faith identity and abortion care are mutually exclusive.  

For people of faith, making moral decisions is a sacred responsibility.  According to this belief system, it is up to the individual, not the polity, to make decisions about his or her own body, "which we believe are gifts from God."  It is thus unsurprising to find individuals of various belief systems advocating for dismantling barriers to abortion care.  This kind of oppression is not consistent with religious faith; it contradicts it. 

In support of allowing women on their own to make the personal decision to seek abortion care is the compassion that lies in ensuring that they have access to safe medical care.  Indeed, healthcare for women that includes abortion care is a moral imperative.  At the very least, ensuring safe access to abortion "avoids imposing one religious view on everyone."

     

FOIA Lawsuit seeks information about denial of reproductive health care in Catholic hospitals

Rewire (May 24, 2016): ACLU Sues for Complaints Filed Against Catholic Hospitals for Denying Reproductive Health Care, by Nicole Knight Shine:

The ACLU has brought an action under the Freedom of Information Act against the federal Centers for Medicaid & Medicare Services (CMS) seeking complaints against Catholic hospitals for denial of emergency medical treatment.  CMS receives and investigates complaints of violations of the Emergency Medical Treatment and Active Labor Act, which requires that hospitals receiving federal funds provide emergency care to stabilize a medical condition, including a miscarriage.  The ACLU complaint describes instances where women seeking treatment for miscarriages were turned away from emergency rooms at Catholic hospitals.  Religious Directives written by the U.S. Conference of Catholic Bishops forbid doctors in Catholic hospitals from performing abortions unless a woman is in grave danger.

Roughly one in six hospital beds are in a Catholic facility, with the top four U.S. Catholic health systems expected to take in more $90 billion from Medicare and Medicaid in 2016, according to the ACLU’s 10-page lawsuit filed in U.S. District Court for the Southern District of New York.

Supreme Court Requests Additional Briefing in Zubik

Think Progress (March 29, 2016): How to Make Sense of the Baffling Order the Supreme Court Just Handed Down on Birth Control, by Ian Millhiser:

On Tuesday, the Supreme Court handed down an unusual order seeking more briefing in Zubik v. Burwell, a challenge to Obama administration regulations intended to expand access to birth control. Under the regulations at issue in Zubik, most employees must include contraceptive coverage in their employer-provided health plan. Employers who object to birth control as religious groups, however, may either fill out a form or write a brief letter seeking an exemption from this requirement. Once they do so, they are permitted to offer insurance that does not cover birth control, and, in most cases, their insurance provider will offer a separate, contraception-only plan to the employer’s workers.

The Supreme Court's order instructs the parties to “file supplemental briefs that address whether and how contraceptive coverage may be obtained by petitioners’ employees through petitioners’ insurance companies, but in a way that does not require any involvement of petitioners beyond their own decision to provide health insurance without contraceptive coverage to their employees.”  The Court appears interested in whether the employer could notify the insurance company that it does not wish to provide birth control when they contract for insurance and the insurance company could then notify employees that it will separately provide contraceptive coverage cost-free separate from the employers' plan.  This solution would allow employees to receive coverage from the employer's insurer and avoid the need to purchase a separate policy.

The catch, however, is that it may not be possible for the federal government to put such a solution in place, at least without a change to federal law. Employer benefits are governed by complex federal statutes such as the Employee Retirement Income Security Act (ERISA). The Obama administration found authorization for its current rules in the existing ERISA statute, but it is not entirely clear that current law will enable them to move forward with the idiosyncratic solution described in the Supreme Court’s Tuesday order. Indeed, it is likely that one reason that the Court asked for additional briefing in this case was to determine whether the government has the authority to implement the justices’ preferred solution under ERISA.