Reproductive Rights Prof Blog

Will the FDA Permanently Remove In-Person Dispensing Requirements for Medication-Induced Abortions?

By Kelly Folkers (Aug. 10, 2021)

As the COVID-19 pandemic continues, increasing numbers of patients are seeking care through telemedicine, allowing them to communicate with their doctors and be prescribed medicines without leaving home. Access to abortion medication is a part of this trend, with more pregnant people seeking to terminate early pregnancies by requesting access to medication they can self-administer at home. Despite the FDA’s decision earlier this year not to enforce a previous requirement that abortion medications be administered in person, access to medication-induced abortion remains vastly inequitable as conservative state legislatures target the practice.

Current Food and Drug Administration (FDA) regulations on abortion medication officially require that the first dose be administered in a healthcare setting or under the supervision of a provider specifically certified to prescribe the medication. In 2020, the ACLU filed a lawsuit on behalf of the American College of Obstetricians and Gynecologists (ACOG) challenging the in-person dispensing requirement, which resulted in a nationwide injunction preventing the FDA from enforcing the rule. But the Supreme Court lifted the injunction in January 2021 and held, in a 6-3 decision, that the district court should have deferred to the FDA’s expertise, avoiding the question of whether the rule imposed an undue burden on the constitutional right to abortion. After President Biden took office, the FDA announced in April 2021 that it would not enforce the in-person dispensing requirement for the duration of the COVID-19 pandemic.

The agency is now considering permanently removing the in-person dispensing requirement. But as access to abortion hangs in a precarious balance as the Supreme Court prepares to hear a direct challenge to Roe v. Wade later this year, have passed laws in 2021 targeting medication-induced abortions.

There are two types of abortion: surgical and medication. While a surgical abortion is a medical procedure that must be performed in a clinic or medical office, the procedure for most medication-induced abortions requires that patients take two medicines, mifepristone and misoprostol, at least 24 hours apart, respectively. ACOG has stated in its most recent guidance on medication-induced abortions, that patients can safely and effectively take abortion medications at home. But the FDA issued a Risk Evaluation and Mitigation Strategy (REMS) for mifepristone when it was approved in 2000, requiring that the medication be ordered, prescribed, and dispensed under the supervision of a health care provider who is specifically certified to administer it. The agency issues REMS to “reinforce medication use behaviors and actions that support safe use of that medication.” While there have been some reported adverse events, including a handful of deaths, associated with use of mifepristone, the medication is widely considered to be safe and effective, with over 3.7 million patients having been prescribed the drug since its approval.

Though the FDA announced that it would not be enforcing the REMS on mifepristone during the pandemic, even before the pandemic, the restriction had long frustrated abortion rights advocates, who believe it is too restrictive and politically motivated. In 2019, former FDA Commissioner Dr. Jane Henney argued in the New England Journal of Medicine that the restrictions on distribution of mifepristone made at its approval in 2000, before the drug was widely used and in the United States and additional safety and efficacy data collected, may no longer be appropriate.

Despite ACOG’s assertion that the in-person dispensing requirement has no medical benefit for patients, conservative state legislatures have used the Supreme Court’s decision to target medication-induced abortions. Montana has effectively banned telehealth for abortion. Ohio has a similar law in effect, which is being challenged by Planned Parenthood and other advocacy groups in court. Indiana not only required that the first dose of medication be administered in the presence of a healthcare professional, patients must be advised that their abortions can be reversed with progesterone, which is not scientifically supported. The law has since been blocked by a federal judge. At least 20 states prevent telemedicine appointments for abortion pill prescriptions, and more than 30 require that physicians must write the prescriptions, rather than nurse practitioners or physician assistants who are otherwise able to prescribe medication.

Though laws limiting access to medication-induced abortion continue to threaten reproductive rights, there is hope that under the new Democratic Administration, the FDA will end the restrictive in-person dispensing requirement.

As the ADA Turns 31, Reproductive Rights Activists Note the Link Between the Two Battles

By Fallon Parker (Aug. 3, 2021)

Last week marked the 31^st anniversary of the Americans with Disabilities Act (ADA), which seeks to affirm and protect the rights of people with disabilities. Among other provisions, the act guarantees equal opportunity to person with disabilities in employment, transportation, services, accommodations, and other areas. While the ADA has resulted in significant changes for the disabled community, persons with disabilities who use reproductive healthcare still struggle to gain access to services.

Disability rights and reproductive justice have always been closely linked. Buck v. Bell, which has not been overturned, allowed for sterilization of institutionalized persons in order to benefit the “welfare of society.” Eugenics, which was espoused as a way to “improve society” and specifically targeted disabled persons, among other marginalized groups, motivated some early supporters of birth control.

Today, it is recognized that persons with disabilities have the same reproductive and sexual health needs as persons without disabilities, and yet studies show that persons with disabilities do not access reproductive care at the same rates as their peers. According to the National Council on Disability, disabled persons reported avoiding regular gynecological visits because they were difficult to obtain, and that healthcare workers often refrained from discussing contraceptives or STD screening with disabled persons and expressed surprise to learn disabled persons were sexually active. Persons with disabilities are also likely to have fewer pap tests and mammograms than persons without disabilities. Additionally, disabled persons are poorer on average than non-disabled persons, and income is directly related to ability to access reproductive services. And some disabled persons who rely on Medicaid do not have access to insurance coverage for abortion services.

Recently there has been an influx of attention to the intersection of disability rights and the reproductive justice movement. Britney Spears, the singer who has been under a conservatorship for 13 years, finally had her day in court and revealed, among other things, that her conservatorship forces her to wear an IUD. While the exact terms and genesis of the conservatorship are not public, it reportedly followed an involuntary temporary psychiatric hold filed on her 13 years ago based on an assessment that she was a possible danger to herself or others.

This year, Spears expressed to a court her desire to have more children and her frustration with not having any control over that decision. In response to Spears’s testimony, several websites have published accounts from disabled persons noting the similarities between Spears’s lack of bodily autonomy and the restrictions that disabled persons face daily. Sara Luterman, a journalist who is disabled, was interviewed for Slate and broke down how difficult it is for people to remove themselves from a conservatorship or guardianship. Luterman mentioned Ryan King, a man with an intellectual disability who could not remove his conservatorship, even though his conservators, who were his parents, asked the court to remove it. Like it is for King, Luterman fears it will be difficult for Spears to remove herself from her conservatorship.

Spears’s conservatorship and her fight for bodily autonomy highlight a common reality for many disabled persons, especially those with reproductive needs. While the ADA was a significant moment in the fight for disability rights, it has fallen short in providing reproductive justice for disabled persons. Within the mainstream reproductive justice movement, disabled persons are often left out of the conversation. The anniversary of this landmark legislation is an opportunity to reaffirm commitment to the importance of disability rights in the fight for reproductive justice and consider how the next 30 years can be used to ensure equitable access to reproductive healthcare for all.

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

By Shelby Logan (April 6, 2021)

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

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

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

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

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

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

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

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

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

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

A New Survey Indicates ACA Increased Birth-Control Options but COVID-19 Threatens Gains

By Kelly Folkers (March 16, 2021)

Since President Obama signed the Affordable Care Act (ACA) into law almost ten years ago, increasing numbers of patients have been able to use their desired form of contraception, according to the results of a recent national survey of OBGYNs. One of the law's most popular provisions requires insurers and employer-sponsored plans to cover most FDA-approved contraceptive methods without charging a co-pay or co-insurance. But with the COVID-19 pandemic continuing into its second year and the future of the ACA pending in the Supreme Court, these important gains furthering reproductive autonomy hang in a precarious balance. 

The Kaiser Family Foundation reports that 63 percent of providers have seen contraceptive use significantly or somewhat increase after the implementation of the ACA's birth-control coverage mandate in 2012. Importantly, 69 percent of OBGYNs surveyed reported that the number of their patients able to select their desired method of contraception significantly or somewhat increased subsequent to the provision's implementation. 

Historically, access to contraception has led to a number of beneficial outcomes for women and people with uteruses. Since oral birth control pills became legal in 1965, more women have enrolled in college and earned higher wages. But like any type of health care, birth control is not a one-size-fits-all approach. Patients need a menu of birth control options available as some may cause unwanted side effects. 

Despite the ACA's important gains, the survey also revealed that lower-income patients, particularly those on Medicaid, face significant difficulty in affording and accessing sexual and reproductive healthcare. Though 78 percent of the OBGYNs surveyed accepted Medicaid, many noted barriers to enabling contraceptive choice like the need to get prior authorization or being limited to prescribing an initial contraceptive supply for only 30 days. While the survey provides important context to suggest that the ACA has significantly improved access to contraception nationwide, the survey respondents included, primarily, providers who practice in states with Medicaid expansion, in urban settings, and in private clinics.

At the same time, the ongoing COVID-19 pandemic has created new barriers to accessing care. According to the Guttmacher Institute, one third of women reported delays or cancellations in contraceptive or other sexual and reproductive healthcare. While physician accessibility has increased with the use of telemedicine, at least five states require that providers prescribe birth control in person. 

Without guaranteed, affordable access to one's desired birth control method, many patients may need emergency contraception or abortion. But several states have essentially used the pandemic as a pretext for almost completely curtailing abortion access. For example, early in the pandemic Texas banned all abortions that were not "necessary to preserve the life and health of the mother," essentially requiring any person seeking an abortion in Texas to travel out of state. In many red states, patients have had to rely on the support of community organizations to provide transport for an abortion, risking their life and health to exercise their constitutionally protected right to reproductive autonomy. 

While the ACA laid the foundation for increased access to reproductive health care, the Kaiser Family Foundation survey signals that access to the full array of FDA-approved birth-control options remains inequitable. Further, the pandemic has revealed the need for states to ensure reproductive autonomy and justice by guaranteeing coverage for the full array of contraceptive options for all and removing unnecessary barriers to accessing reproductive health care. 

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.

U.S. joins 19 nations, including Saudi Arabia and Russia: ‘There is no international right to an abortion’

The Washington Post (Sept. 24, 2019): U.S. joins 19 nations, including Saudi Arabia and Russia: ‘There is no international right to an abortion’, by Ariana Eunjung Cha: 

The United States, in a statement delivered to the United Nations General Assembly (UNGA) on September 23 this year, rejected the use of the term "sexual and reproductive health and rights" throughout U.N. documents and in particular within the international Sustainable Development Goals. Health and Human Services Secretary Alex Azar delivered the statement and emphasized that international instruments should not promote "abortion as a means of family planning." He disputed that there is an international right to an abortion.

The U.S., one among 19 nations who joined in the statement, further emphasized that "[they] only support sex education that appreciates the protective role of the family in this education and does not condone harmful sexual risks for young people."

The Netherlands delivered a responsive joint statement on behalf of 58 countries rejecting the U.S. position and stressing "the need to uphold the full range of sexual and reproductive rights." Country representatives also took to Twitter to object to the U.S. statement, using the hashtag #SRHR (sexual and reproductive health and rights), explicitly embracing the language the United States aims to erase. 

Many country representatives, along with civil society advocacy groups, underscore that on this issue of abortion the U.S. "align[s] with countries like Saudi Arabia and Sudan with poor human rights records."  They also emphasize the problematic nature of the United States' campaign to persuade other countries to form a new coalition in support of these regressive policies, calling attention to the fact that these efforts put "unfair pressure on poor countries" dependent on U.S. aid.

The Trump administration worked hard leading up the General Assembly to recruit conservative governments to support its efforts to roll back sexual and reproductive health and rights across the board. This campaign could have devastating effects on adults and children who rely on international programs for basic health care, particularly prenatal and postpartum health care. 

The United States-led campaign at the UNGA last week follows a similar effort directed at the World Health Organization (WHO) in which the U.S., Brazil, Egypt, Saudi Arabia, and several other states campaigned to reject the term "sexual and reproductive rights" from WHO policy, as Colum Lynch for Foreign Policy reports. 

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. 

India's Transgender Bill Raises Rights Concerns

July 23, 2019 (Human Rights Watch): India's Transgender Bill Raises Rights Concerns:

India's parliament introduced a new bill meant to protect the rights of transgender people on July 19 this year. Human Rights Watch ("HRW"), though, says that the Transgender Persons (Protection of Rights) Bill does not protect certain important rights upheld by India's Supreme Court in 2014--namely, the right of transgender persons to self-identify. 

The human rights organization warns that "even though the bill says that a transgender person 'shall have a right to self-perceived gender identity,' its language could be interpreted to mean transgender people are required to have certain surgeries before legally changing their gender."

Meenakshi Ganguly, the South Asia director at HRW, emphasized that "it's crucial the the law be in line with the Supreme Court's historic ruling on transgender rights." The proposed law, instead, "appears to mandate a two-step process for legal gender recognition," requiring a trans person first to apply for an initial certificate and then to apply for a "change in gender certificate," which many perceive as requiring gender-affirmation surgery along with medical confirmation.

The bill also gives discretion to the district magistrate to determine the "correctness" of the person's application for the certificates yet is silent as to how the decision of "correctness" should be made. 

In 2014, the country's highest court ruled in NALSA v. India that transgender people are a recognized third gender, enjoy all fundamental rights, and are entitled to specific benefits in education and employment. The bill introduced this month does not address whether a trans person holding a male or female gender certificate, though, will have access to the government welfare meant for transgender persons. 

Human Rights Watch further calls out the bill for not only seemingly violating India's Supreme Court holding, but also for violating international standards for gender recognition, which require separation of legal and medical processes of gender reassignment. "Self-declared identity should form the basis for access to all social security measures, benefits, and entitlements."

Notably, the bill also includes intersex persons; HRW calls for the parliament to rename the  bill to make it clear that it includes intersex persons and establish additional explicit protections for intersex persons along with transgender persons.

Other changes parliament should make, HRW says, include: prohibiting medically unnecessary procedures on children, requiring the issuing of legal identity documents to interested persons that identify their preferred gender, and emphasizing training of teachers to "adopt inclusive methods" to ensure transgender or intersex children are not harassed, bullied, or discriminated against. 

Says Ganguly: “To enact a law that meets international standards, it’s critical that parliament fully bring transgender people into the conversation."

Another State Could Soon Insert Anti-Abortion Propaganda Into Public Schools

July 19, 2019 (Rewire.News): Another State Could Soon Insert Anti-Abortion Propaganda Into Public Schools, by Erin Heger: 

Ohio--the only U.S. state without standardized health education--may soon require public schools to focus on the “humanity of the unborn child” in health education curriculum. 

House Bill 90, introduced by the state's GOP legislature, infuses anti-abortion language into health and science materials for students and would restrict schools from providing any abortion-related information or referrals to students facing pregnancy. The legislature aims for school programs to thoroughly detail information about fetuses and gestation, promoting carrying any pregnancy to term.

In 2016, Oklahoma also introduced similar legislation (calling it the "Humanity of the Unborn Child Act"), however it has not yet been implemented in the state due to "budget constraints."

Both HB 90 in Ohio and Oklahoma’s Humanity of the Unborn Child Act state their intended purpose is an “abortion-free society.” However, not informing young people of all their options does little to prevent abortion and instead leaves people not knowing what to do or where to turn when they do face an unintended pregnancy, said Cameron Brewer, an educator with Planned Parenthood Great Plains.

“If we are restricting the information students have access, to then we are doing them a disservice as educators,” Brewer told Rewire.News. “My goal as an educator is to make sure my students have all the information they need to make the best decisions for them.” 

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."

Missouri’s lone abortion clinic must remain open for now

Jun. 10, 2019 (Politico): Judge says Missouri’s lone abortion clinic must remain open for now, by Rachana Pradhan: 

On Monday, a judge blocked Missouri's attempts to close its last remaining abortion clinic. Planned Parenthood, which operates the clinic, has struggled against state officials' attempts to shutter the clinic based on claims of violations, which jeopardize its licensing.

Judge Michael Stelzer had previously granted the Planned Parenthood clinic reprieve from the states' attempts to deny license renewal upon the clinic's license lapse in May, and Stelzer has now directed Missouri health officials to make a decision as to whether to renew the clinic's license by June 21.

Planned Parenthood officials attest that the licensing conditions were essentially pretextual and "accused state officials of orchestrating a politically motivated probe to stamp out abortion." Last month, Missouri lawmakers banned almost all abortions beyond week eight of a pregnancy.  

Missouri is just one of six U.S. states that have only one clinic providing abortions.

Canada to invest in women’s and girls’ health, also recognizes genocide of Indigenous women

Jun. 4, 2019 (Quartz): Canada will invest $1 billion globally in women's and girls' health every year, by Annabelle  Timsit:

Prime Minister Justin Trudeau announced Canada's new commitment to invest over one billion dollars annually in women's and girls' health. The funding will in large part benefit sexual and reproductive health in the face of growing threats around the world to women's rights, including the right to abortion. 

This funding is an increase from Canada's prior years' commitments and comes with increased focus on supporting "female entrepreneurs, indigenous women, and LGBTQ people."

Allocating funding, among other socio-political resources, to the protection of Indigenous women in particular is especially critical in light of the recent report of the Canadian national inquiry regarding mass killings and disappearances of Indigenous women and girls throughout Canada. (See The New York Times (Jun. 3, 2019), by Ian Austen and Dan Bilefsky).

The three-year inquiry's final report labeled the systemic violence suffered  by the Indigenous populations in Canada "a race-based genocide." It also included over 200 recommendations to implement systemic changes, like reforming police practices and the criminal justice system overall, as well as expansion of Indigenous women's shelters and empowering Indigenous persons to serve on civilian boards overseeing civil services. In addition, the report's authors call for the elevation of Indigenous languages to official languages of Canada, alongside English and French. 

The inquiry, long overdue in the face of pervasive, violent colonialism, was prompted in 2014 when Tina Fontaine, a 15-year-old girl from the Sagkeeng First Nation was found dead in the Manitoba Red River, wrapped in a plastic bag and weighed down with 25 pounds of rocks. The main suspect in her murder was acquitted. 

Illinois affirms the “fundamental right” to abortion by passing a new bill

Jun. 1, 2019 (Vox): Illinois affirms the "fundamental right" to abortion by passing a new bill, by Gabriela Resto-Montero: 

Illinois, in a newly-passed bill called the Reproductive Health Act, states that a “fertilized egg, embryo, or fetus does not have independent rights." The passing of this law thus grants pregnant people in Illinois the protected right to terminate their pregnancies. The Act was passed on Friday, May 31, 2019 and is expected to be signed by the governor.

State Senator Melinda Bush sponsored the bill and declared Illinois "a beacon for women's rights, for human rights." The legislation "repeals a 1975 state law that required spousal consent, waiting periods, placed restrictions on abortion facilities, and outlined procedures for pursuing criminal charges against abortion providers." It also "rolls back some state restrictions on late-term abortions by repealing Illinois’ Partial Birth Abortion Ban Act," a law that had not yet been enforced due to court injunctions.

While legislative threats to reproductive rights grow in numbers and severity throughout the country, Illinois is one of the first states to take concrete steps toward cementing the right to abortion--among other reproductive rights--within its borders. Other states (i.e. Alabama, Georgia, Ohio, Missouri, Indiana, Kentucky, Mississippi) are vying for a slot on the SCOTUS docket and with it a chance at the overturning of Roe v. Wade and its Constitutional protections. 

Recently, though, the Supreme Court signaled it is not quite ready to re-consider Roe. "In its decision regarding an abortion law passed by Illinois’ neighbor, Indiana, justices struck down one provision while affirming another part of the law, largely avoiding the question of whether abortion should be legal."

Planned Parenthood and the American Civil Liberties Union are leading the way with lawsuits aimed at preventing the so-called "heartbeat laws," and comparable legislation threatening reproductive rights and the safety and dignity of pregnant persons, from going into effect within anti-abortion state legislatures. "The Planned Parenthood Action Fund reports that so far in 2019, there have been 300 anti-abortion bills introduced in 36 states."

Illinois is not the only state working to protect abortion rights, though. "Some 13 states including New Mexico, Rhode Island, and Nevada have proposed bills to include a right to abortion in their Constitutions. While many of those efforts are still in their early stages, Vermont passed a bill to include the protection in its Constitution last week."

New Bill to Classify Reproductive Rights as Human Rights

Rewire.News (Mar. 7, 2019): Here's How Democrats Want to Classify Reproductive Rights as Human Rights, by Katelyn Burns:

The Trump administration's State Department deleted reproductive rights from its human rights report last year. Now, Congressional Democrats have introduced a bill that would require the inclusion of reproductive rights--by way of an accounting of "access to reproductive health care"--in the report.

"The 'Reproductive Rights Are Human Rights Act' was introduced by Democratic caucus vice chair Rep. Katherine Clark (D-MA) and announced at a press conference Thursday [March 7, 2019] along with Rep. Barbara Lee (D-CA) and U.S. Senate co-sponsors Bob Menendez (D-NJ) and Richard Blumenthal (D-CT)."

Representative Clark said:

The way that we are able to protect human rights internationally is through shining a light on the violations. I think what this administration is saying is that we are no longer interested in finding out what is happening with women’s health and monitoring, assessing and protecting women across the globe.

The State Department's annual human rights report is of critical important to the our government, notes Amanda Klasing, acting co-director of the women’s rights division at Human Rights Watch. Congress uses this report in determining appropriations pertaining to foreign assistance, and immigration judges likewise rely on the report in making decisions about pending asylum claims. 

If a woman crosses the border from El Salvador claiming asylum in the United State because she is threatened with jail time in her home country for having a miscarriage, for example, an immigration judge might look to the human rights report to determine whether this is a credible basis on which she may claim asylum.

The information that used to be included on the report was gathered by foreign service officers who had established relationships with health care providers and advocates around the world. These relationship no longer exist under the current administration. Not only is the information foreign service officers previously gathered lost, the contacts that enabled substantial, accurate reporting are gone.

"There will be a minimum of a year or two years for embassies to rebuild meaningful relationships where they can actually be substantially reporting on what’s happening," said Stephanie Schmid, U.S. foreign policy council at the Center for Reproductive Rights (CRR).

Since the deletion of reproductive rights from the report, the CRR has twice sued the State Department under the Freedom of Information Act in an effort to access documentation about the erasure. The newly-proposed bill "mandates that foreign service officers must consult with reproductive health and rights organizations in local communities to gather accurate information for the human rights report."

Advocates for reproductive rights hope this bill will solidify the importance of including reproductive rights among human rights generally.

'There is a sense that there are hard human rights issues and then there are soft human rights issues,' Klasing said. 'The State Department is still reporting on the hard human rights issues like torture, extrajudicial killings, but there’s some flexibility as to whether or not these [reproductive rights] actually qualify as human rights. As somebody who has interviewed both people who have been victims of state sponsored violence, torture, abuse, and people who have had their reproductive rights violated, the feeling of abuse, the feeling of violation is the same. It’s a visceral feeling.'

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. 

NY’s Reproductive Health Act is Not Radical; It Simply Recognizes that the Lives and Dignity of Pregnant People Count Too

NY’s Reproductive Health Act is Not Radical; It Simply Recognizes that the Lives and Dignity of Pregnant People Count Too (Feb. 7, 2019), by Cynthia Soohoo:

Not surprisingly, President Trump’s attack on New York’s Reproductive Health Act during Tuesday night’s State of the Union address blatantly mischaracterized the RHA. But it also underscores a glaring gap in anti-abortion advocates’ pro-life views -- the right to life and dignity of people who are pregnant.

The RHA continues to recognize a state interest in fetal life and prohibits abortions after 24 weeks in almost all circumstances. However, the law also recognizes that in some situations, denying a pregnant person the ability to end a pregnancy imposes serious and irreparable harm on her, including situations where the pregnancy endangers her life and health. And in those situations, the state cannot force the pregnant woman to continue the pregnancy against her will. This is consistent with current Supreme Court jurisprudence and international human rights law. The UN Human Rights Committee made this explicit in a recent General Comment clarifying that while states can regulate abortions, they should not do so in a manner that violates the right to life of the pregnant person or her fundamental human rights.

The RHA does no more than protect the human rights of pregnant people. The law only allows abortions post-24 weeks in two situations. First, abortions are allowed where the fetus will not survive outside of the womb. The RHA recognizes that a woman should not be forced to continue what was often a wanted pregnancy -- knowing that the fetus will not survive -- against her will. In such cases, the state’s interest in protecting a viable fetus is not at issue, and human rights experts have held that denying a woman access to an abortion in these circumstances is cruel, inhuman and degrading treatment.  

Second, the RHA allows a woman to have an abortion where continuing the pregnancy endangers her life or health. Some women may choose to continue pregnancies in these circumstances. But the RHA acknowledges that the pregnant person must be allowed to make her own choice taking into account the risk that she faces and the impact her death or disability would have on her family and community.

In both situations covered by the RHA, human rights experts have held that state denial of an abortion violates the human rights of the pregnant person. In fact, concern over state prohibition of abortions in those circumstances led UN human rights experts to write to the U.S. to encourage passage of laws like the Reproductive Health Act. This is not a radical position. It is merely the recognition of the value of the life and dignity of pregnant people. The failure of critics of the RHA to understand this is a glaring gap in their “pro-life” views.

Supreme Court Blocks Louisiana Abortion Restrictions

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

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

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

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

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