Reproductive Rights Prof Blog

Arkansas Continues Attack on Reproductive Rights With a New Anti-Transgender Law

By Kelly Folkers (April 13, 2021)

On April 6, the Arkansas state legislature overrode a gubernatorial veto and enacted a bill (H.B. 1570) that will ban access to gender-affirming care (GAC) for people under the age of 18, the first law of its kind in the United States.

H.B. 1570 is one of 80 bills regulating transgender and gender expansive (TGE) people’s access to societal resources that were introduced in state legislatures during the first three months of 2021. Considering the already hostile landscape for reproductive rights in Arkansas, the new law further threatens reproductive rights by legalizing discrimination in healthcare.

The Arkansas law creates a blanket ban on GAC for minors, carving out exceptions only for persons with disorders of sex development, people who are injured by or later regret GAC (an extremely rare occurrence), and people who require surgeries similar to gender-affirming operations for reasons unrelated to gender transition. Notably, the law states that medical care under these circumstances is not gender-affirming care, although patients meeting the criteria for the exceptions receive the same or similar prescription medications and surgeries. This disparate treatment among patients receiving the same or similar care raises an important question: Why is the Arkansas legislature so concerned with TGE youth specifically?

Across the board, professional medical associations consider GAC to be a safe, ethical, and a sometimes life-saving form of healthcare for minors and adults. GAC includes a wide array of psychosocial, medical, and surgical care options aimed at helping TGE people achieve a physical appearance consistent with their gender identity. (It is important to note that not all TGE people choose some or any of these options; having a TGE identity is not a medical or psychological condition that, in and of itself, requires treatment.)  

For minors who want treatment, they can start with the administration of puberty suppressing hormones, which prevent potentially distressing bodily changes like breast growth, voice deepening, or facial hair development. Medical experts say that puberty suppression is fully reversible although there is ongoing study of its long-term effects.

For those who want more treatment, gender-affirming hormone therapy involves the administration of estrogen or testosterone aimed at enabling the development of secondary sex characteristics that more closely align with an individual’s gender identity. As gender-affirming hormone treatment can affect adolescents’ fertility, professional medical guidelines state that clinicians should counsel youth on possible options for fertility preservation, which involves harvesting and storing gametes. Though fertility preservation is expensive and often not covered by insurance, the standard practice is to ensure that TGE youth and their families receive fertility counseling before starting any treatment that may affect future reproductive choices.

Even in states with liberal GAC policies for minors, gender-affirming surgical procedures are typically only accessible to individuals who have reached the age of majority, with some limited exceptions.

The Arkansas legislature claims it has a compelling government interest in “protecting the health and safety of its citizens, especially vulnerable children.” The bill’s title is the “Save Adolescents from Experimentation Act,” implying that GAC is a form of medical experimentation on unwilling youth. Bioethicists have long held that there is a distinction between clinical care and medical research, each of which requires different ethical standards and responsibilities toward patients and research participants. It is uncontroversial within the medical field that GAC is a valid form of healthcare.

Additionally, the bill perpetuates the “desistance” myth, or the erroneous notion that the majority of youth who begin puberty suppression or gender-affirming hormone therapy eventually stop treatment and identify with the gender they were assigned at birth. The conservative right wields these and other claims to justify policies that serve to exclude TGE people from accessing healthcare and other public accommodations, thinly veiling their transphobia as a “compelling government interest” to protect youth.

Combined with another recently passed Arkansas law (S.B. 289) that allows doctors to refuse to treat patients because of religious or moral objections (even though clinicians already have federal protections for conscientious objection to abortion and sterilization procedures), TGE people’s right to medical care is rapidly being eroded in the state. S.B. 289’s opponents, including the Human Rights Campaign and the American Civil Liberties Union, predict that it could allow doctors to refuse care to LGBTQ+ patients altogether in addition to further justifying limits on access to abortion, contraception, and other forms of reproductive healthcare.

This recent legislative action in Arkansas is part of an alarming nationwide policy trend of discrimination against TGE people. Anti-trans policies are continuing to diffuse throughout the United States, including state legislation restricting transgender girls from participating in sports and requiring TGE people to use bathrooms that correspond to their gender assigned at birth. This wave of new legislation is not random: the sheer volume of bills that have been introduced this year suggests a highly organized attack on the rights of transgender people that will require an equally coordinated response. 

Author’s note: The author of this article, a cisgender white woman, wishes to note that her perspective does not fully capture the variety and nuance of perspectives among TGE people.

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."

Human Gene Editing Receives Key Panel's Support

New York Times (Feb. 15, 2017): Human Gene Editing Receives Key Panel's Support, by Amy Harmon:

In a move that some fear heralds the era of designer babies for the very wealthy and that has led other countries to ban germ line genetic editing, a panel of influential American scientists has thrown its support behind inheritable modifications of human embryos.  Although touted as a way to cure disease, many see the potential for this science to be used for more nefarious motives--enhancing mental or physical endowments, for example--that smack of eugenics.

The research is explicitly aimed at allowing parents who both carry deadly recessive traits to have children who are not afflicted by such diseases as Tay-Sachs, beta thalassemia, and Huntington's.  The report calls for prohibitions on using the technology for enhancements, but it does not have any legal effect. Federal law, though, currently prohibits the use of "federal money to support research that results in genetically modified offspring."     

The issue arises on the heels of technology--Crispr-Cas9--that brings germ-line genetic editing out of the realm of science fiction.  The tool allows researchers to insert and delete genes more or less precisely, although the possibility remains that some DNA will be snipped off inadvertently.  They will experiment first on patients with cancer and blindness using genetic alterations that are not inheritable.  

What to Think about the Decrease in Sperm Quality

New York Times (March 12, 2017), Are Your Sperm in Trouble?, by Nicholas Kristof: 

Sperm is decreasing in quality and testicular cancer is on the rise.  Studies show a rapid decrease in sperm quality from 2001 to 2015.  Some suggest that endocrine disruptors--chemicals found in plastics are to blame.  In one study of the effect of endocrine disruptors on fish, the males became intersex and incapable of reproducing.  

Human reproduction might be threatened by these developments, but scientists disagree about the scale of the problem.  Some believe we are are crossing the line where the question "can we sustain ourselves?" becomes relevant.  After all, endocrine disruptors mimic hormones; as such they possess the power to interfere with the biological process of becoming male in the womb.

Some have taken to avoiding plastics, including the ubiquitous sales receipts produced by thermal printers.  But individual action is probably not enough.  The endocrine disruptor lobby in Congress mirrors the power of Big Tobacco before the regulation of smoking became a foregone conclusion.    

Study Suggests Absence of Link Between I.V.F. and Breast Cancer

New York Times (July 19, 2016): I.V.F. Does Not Raise Breast Cancer Risk, Study Shows, by Catherine Saint Louis: 

The use of estrogen and progesterone in in vitro fertilization has in the past stoked fears that the procedure could place patients at risk of developing breast cancer.  A retrospective analysis published in 2008 found found "a potential increase in breast cancer among I.V.F. patients older than 40."  But later studies, in Israel and Australia, suggested more of a danger for younger women.  Some believed that infertility itself might be linked to breast cancer.

Several studies conducted in recent years, however, suggest that the fear is unfounded.  The most comprehensive of these studies, published in July in the Journal of the American Medical Association, found "no increased risk among women who have undergone I.V.F."  The study likewise found no increased risk among women who had less invasive treatments for infertility.  Oddly, the study emphasized what appeared to be a reduced risk of breast cancer among women who have submitted to I.V.F. multiple times.  

The JAMA study is not conclusive.  More research needs to be conducted, including on the risk of breast cancer in postmenopausal women who have had I.V.F. 

 

 

Cloned Sheep Appear to Age Normally

New York Times (July 26, 2016): Dolly the Sheep's Fellow Clones, Enjoying Their Golden Years, by Joanna Klein: 

Dolly, the first cloned sheep, born in 1996, appeared to be older than her years and was put down at just age six after being diagnosed with osteoarthritis and tumors in her lungs.  Other cloned mammals have developed diabetes or been plagued with obesity.  Several jurisdictions have reacted to these development by passing restrictive legislation:

Not only did many countries, including Canada and Australia, ban reproductive cloning in animals, but the United Nations banned all kinds of cloning in humans in 2005.  Last year the European Union made importing food from cloned animals or their offspring illegal.

But four other sheep created from the same cell as Dolly was are now old and, in contrast to Dolly, are enjoying healthy lives.  About sixty in human years, they show a normal incidence of heart disease, type two diabetes, and osteoarthritis.  Their longevity appears to answer the lingering question whether cloned animals age prematurely.  The data are reflected in studies of cloned cattle and mice.  One conclusion that might be drawn is that "once cloned animals survive the first few years of life, they won’t die any sooner than other animals."

Scientists think that safe and efficient cloning procedures will emerge in five to ten years.  One hope is that improved cloning techniques will help us grow food for the ever-growing human population, protect endangered species, and perfect new medical therapies.

Sex-Testing Female Athletes: Humiliation Masquerades as Gender Fairness

New York Times (June 28, 2016): The Humiliating Practice of Sex-Testing Female Athletes, by Ruth Padawer:

By all accounts Dutee Chand is a running star likely to win a gold medal for India in the Rio Olympics.  But along the way, she was been subjected to a litany of questions aimed at ascertaining her "true gender." 

Like other female athletes before her who know nothing about testosterone levels or "abnormal" sexual development, Chand has been subjected to repeated doubts about her gender, to the extent that authorities in India demanded a "gender verification test" so that she would not be an embarrassment to Indian athletics.  The gender verification test proved highly invasive and even mortifying.  It was an evaluation of testosterone levels and included "measuring and palpating the clitoris, vagina and labia, as well as evaluating breast size and pubic hair scored on an illustrated five-grade scale."  The results showed levels that were too high, and Chand was barred from racing.  She was accused in the press of being a boy, a hermaphrodite and a transsexual.

Refusing to be cowed, Chand sued the International Olympic Committee for discrimination based on atypical sex development.  The IOC has a sordid past of questioning whether women who excelled in athletics were actually male.  Decades of suspicion that countries have been passing men off as women have led the IOC to develop protocols for verifying gender.  But the chromosome test it preferred and the "hyperandrogenism" test that replaced it were flawed: they could not identify the women whose elevated levels of testosterone were actually of benefit in athletic competition.  Still, the IOC claims it must protect female athletes from having “to compete against athletes with hormone-related performance advantages commonly associated with men.”  Nonetheless, there is absolutely no hand-wringing over elevated testosterone levels in men, and no attempt is made to argue that they would give anyone an athletic advantage.  Moreover, a number of physiological differences that offer specific competitive advantages--increased aerobic capacity, resistance to fatigue, exceptionally long limbs, flexible joints, large hands and feet and increased numbers of fast-twitch muscle fibers--remain completely unregulated, to say nothing of the socio-economic advantages that so many athletes bring to competition.            

Last July, the Court of Arbitration for Sport disapproved of the IOC's testing women athletes for testosterone.  In the court's estimation, the degree of advantage provided by naturally occurring testosterone is no more significant than is more significant "than the advantage derived from the numerous other variables which the parties acknowledge also affect female athletic performance: for example, nutrition, access to specialist training facilities and coaching and other genetic and biological variations.”   

 

 

Making IVF Safer with Nuclear Transfer

CTV News (June 9, 2016): New IVF Method Limits Transfer of Bad DNA to Babies: Study:

Nuclear transfer, a reproductive technique wherein the nucleus of an egg cell replaces the nucleus of an egg cell that has healthier cytoplasm, holds promise for older women whose eggs have undergone changes with age that make them unsuitable for reproduction.

Now United States scientists want to use the technique to avert birth defects that have their genesis in the cytoplasm of the mother's egg, affect the muscles, eye, brain or heart of the child, and have no effective treatment.  The idea is that by transferring the nucleus of an egg to an egg with healthy cytoplasm, disease-causing mutations of the mitochondria (the energy centers of the egg cells, will not be passed on to the child.  The technique has been legal in Britain since last year.     

So far, the study has shown that that "small tweaks to the existing procedure can reduce the risk of mutant mitochondrial DNA transferal."  Two examples are performing the procedure on the day of the egg's fertilization and freezing the egg of the patient rather than that of the donor. 

The technique does not remove the risk of the child's contracting a disease but does reduce it.  Ongoing research will focus on refining the technique. 

Chimeras: Medical Cure or Threat to Humanity?

National Public Radio (May 18, 2016): In Search for Cures, Scientists Create Embryos That Are Both Animal and Human, by Rob Stein:

Does creating animal-human hybrids--also known as chimeras--damage humanity?  Some bioethicists think so.  They are responding to developing technology that would perfect the manufacture of embryos that are part human and part animal.  The hope is that these embryos could be used to study human diseases and to grow human organs that could be used for transplants.  One technique is to remove genes from animal embryos that create certain organs and to fill the void with induced human pluripotent stem cells in the hope that they will fill it by creating the corresponding human organ.  If the patient needing the transplant donated the stem cells, her body would be less likely to reject the new organ.    

The National Institutes of Health has decided not to fund this research until the ethical issues are resolved.  These include the ethics of conducting experiments on animals and the uncertainty of what injecting human cells into animals might do.  One of the fears is that human intelligence might appear in animals or the embryo could develop into a creature that is half-human.   

Cuckoldry: Reality or Urban Legend?

New York Times (Apr. 8, 2016): Fathered by the Mailman? It's Mostly an Urban Legend, by Carl Zimmer:

Stories about adultery and uncertainty about paternity permeate mass media and popular culture.  At the dawn of the era of DNA testing, some data suggested that up to 30% of the children born to married couples were the product of adultery.  But those data involved requests by husbands who suspected their wives had extramarital paramours.  New research suggests that births of children from wives' adulterous liaisons actually occurs very seldom. 

The new study looks at inheritance of the Y chromosome.  The Y chromosome is passed down in almost identical form from fathers to sons.  By studying the chromosomes of living related men in various countries (Spain, Italy, Germany, Mali and Belgium), researchers came up with an adulterous paternity rate of less than one percent. 

One reflection of the low rate may lie in the inefficacy of human sperm to compete for fertilization as compared to other species'.  "The only way for men to have evolved comparatively ineffectual sperm," according to one researcher, "was for them to have experienced high rates of paternity over time."  She added that better assurances of paternity lead to higher investments of fathers in their children.  These investments have been critical to the survival of the species given that humans are completely helpless when they are born.  

Marco Rubio Responds to Criticism Over Ill-Advised Climate Change Comments by Dubiously Claiming Scientific High Ground on Abortion

ThinkProgress: Marco Rubio’s scientific blunder on abortion, by Tara Culp-Ressler:

Sen. Marco Rubio (R-FL), who has recently come under fire for failing to name a single source to justify his assertion that “there’s no scientific evidence” to prove humans are contributing to climate change, is defending his comments by claiming that at least he knows the science about abortion.

In an interview with Sean Hannity on Wednesday, the senator said that liberals who criticize him for ignoring climate science are revealing their “hypocrisy” because they ignore the science supporting the idea that life begins at conception. Rubio claimed this concept is a “proven fact” that people on the left are ignoring. . . .

If Rubio is trying to use abortion politics to prove that he and his Republican colleagues have a clear grasp of science, though, he waded into the wrong issue area. . . . 

___________________________________________

I've written about the anti-choice movement's deliberate exploitation of the ambiguity of the term "life" here.

-CEB

New Emergency Contraception Label Undermines Corporations' Objections To Health Plans Covering the Pills

As I was saying in my last post, the evidence shows that emergency contraceptive pills work before fertilization, not after (contrary to the claims of corporations like Hobby Lobby).  Now European health authorities are changing the labeling to reflect this information.  

-CEB

The New York Times:  New Birth Control Label Counters Lawsuit Claim, by Pam Belluck:

European health authorities have made two significant changes to the label of an emergency contraception pill that is equivalent to Plan B One-Step. One of the changes could be relevant to two cases that the Supreme Court added to its docket on Tuesday.

The new label of the drug, Norlevo, says it “cannot stop a fertilized egg from attaching to the womb,” contradicting a claim by some abortion opponents that has fueled their objections to the Affordable Care Act.

The new label also warns that Norlevo loses effectiveness in women weighing more than 165 pounds and does not work in women over 176 pounds.

Norlevo is not sold in the United States, but Plan B One-Step and two generic versions are identical to it. . . .

Promise of Post-Fertilization Contraceptive Methods Is Limited By Politics

LiveScience: Politics Is Main Hurdle to 'After Sex' Birth Control, Experts Say, by Bahar Gholipour:

Political opposition is the main hurdle to developing birth control methods that could be more suitable than current options for many women, health experts said today (Sept. 23) in an editorial. The authors called on researchers to embrace and study birth control methods that act after sex, and can be taken only occasionally.

Current contraception methods are designed to work primarily by keeping sperm and eggs apart, but it is also possible to prevent pregnancy after an egg is fertilized. . . .

The Dubious Scientific Claims Behind "Fetal Pain" Abortion Bans

The New York Times:  Complex Science at Issue in Politics of Fetal Pain, by Pam Belluck:

It is a new frontier of the anti-abortion movement: laws banning abortion at 20 weeks after conception, contending that fetuses can feel pain then.

Since 2010, a dozen states have enacted them, most recently Texas.Nationally, a bill passed the Republican-dominated House of Representatives in June.

The science of fetal pain is highly complex. Most scientists who have expressed views on the issue have said they believe that if fetuses can feel pain, the neurological wiring is not in place until later, after the time when nearly all abortions occur. . . .

See also: ThinkProgress: Scientists Studying ‘Fetal Pain’ Don’t Actually Want Their Research To Justify Abortion Bans, by Tara Culp-Ressler.

Safety Trials in Australia Test New Contraceptive for Women

The Age (Australia): Experts hope new contraceptive will cut abortion rates, by Natasha Wallace:

A radical female contraception that simultaneously paralyses sperm and protects from sexually transmitted diseases aims to stem abortion rates in Australia among the next generation of young women.

The compound, which may eventually take the form of a sponge or vaginal ring to be inserted two or three days before sexual intercourse, is unique in that it is activated only on contact with semen, said University of Newcastle professor John Aitken said. . . .

________________________________

Here's Professor Aitken attempting to explain how the contraceptive works: "Like the Sleeping Beauty, it [the contraceptive] only becomes woken at the moment of insemination."  And you thought she was awakened by a kiss.

-CEB

Research Shows Promise for Use of Embryonic Stem Cells to Restore Sight

The Guardian: Embryonic stem cells could help restore sight to blind, by Alok Jha:

Photoreceptors grown from embryonic stem cells have been successfully implanted in the retinas of blind mice

Scientists have shown that light-sensitive retinal cells, grown in the lab from stem cells, can successfully integrate into the eye when implanted into blind mice. The technique opens up the possibility that a similar treatment could help people who have become blind through damage to their retinas to regain some of their sight. . . .

A Look at the Science Behind Claims About Fetal Pain

The Daily Beast: The Uncertain Science of Fetal Pain, by Michelle Goldberg:

As the Republican-led House of Representatives passes a far-reaching bill that would ban most abortions after 20 weeks based on the science of ‘fetal pain,’ Michelle Goldberg reports on whether the unborn can feel hurt.

Despite being passed by the House of Representatives, the Pain-Capable Unborn Child Protection Act, which bans abortion after 20 weeks, has no chance of becoming law as long as Democrats control the Senate and the White House. It’s significant, though, as evidence of a broad new legislative assault on Roe v. Wade, one that aims to use the uncertain science of fetal pain to ban abortion before viability. . . .

Stem Cell Research Produces Small But Steady Gains

The Atlantic: 2013: Year of the Stem Cell, by Lindsay Abrams:

Researchers have already safely injected stem cells into patients with neurodegenerative diseases and spinal cord injuries -- and they've seen the potential to vastly improve lives.

. . . In 1998, when human embryonic stem cells were first isolated, we anticipated a "rush of medical advances," as The New York Times put it. That promise -- along with all of the ensuing controversy -- is still alive, has already become reality in select cases -- for example, with bone marrow transplantations -- and still has plans to live up to all of the expectations that have been set for it.

"The question now," the Times wrote then, "is what use can be made of the potentially awesome power to rejuvenate human cells." After 15 years, there are a lot of people waiting for a miracle, for the day cell-based therapy gives back what's been taken from them.

Opinion Piece Challenging Purported Appeals to Science in Support of "Fetal Pain" Abortion Bans

The New York Times - Opinionator:  Can Neuroscience Challenge Roe v. Wade?, by William Egginton:

When I was asked this summer to serve as an expert witness in an appellate case that some think could lead to the next Supreme Court test of Roe v. Wade, I was surprised.

Rick Hearn is the attorney representing Jennie McCormack, an Idaho woman who was arrested for allegedly inducing her own abortion using mifepristone and misoprostol — two F.D.A.-approved drugs, also known as RU-486 — and for obtaining the drugs from another state over the Internet. While the case against Ms. McCormack has been dropped for lack of evidence, Mr. Hearn, who is also a doctor, is pursuing a related suit against an Idaho statute, the “Pain-Capable Unborn Child Protection Act” (Idaho Code, Section 18-501 through 18-510), and others like it that cite neuroscientific findings of pain sentience on the part of fetuses as a basis for prohibiting abortions even prior to viability. . . . 

Two Scientists Receive Nobel for Cloning and Stem Cell Research

The New York Times: Cloning and Stem Cell Work Earns Nobel, by Nicholas Wade:

Two scientists who were awarded the Nobel Prize in Physiology or Medicine on Monday helped lay the foundation for regenerative medicine, the hotly pursued though still distant idea of rebuilding the body with tissues generated from its own cells. They are John B. Gurdon of the University of Cambridge in England and Shinya Yamanaka of Kyoto University in Japan. . . .