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The last month has been particularly brutal for abortion rights activists and women's health advocates, as state after state has proposed and/or passed various bills that restrict abortion access and undermine abortion care. In response, there has been a re-energized reproductive rights movement, with many across the nation stating that they "Stand With Texas Women" or "Stand With North Carolina Women." But in this response, abortion rights activists have overlooked and dismissed a very important reality: Not everyone who has an abortion is a woman.
Abortion is so often framed as a women's issue by both those who advocate for abortion rights and those who seek to dismiss abortion as frivolous. And for abortion rights, a movement that took root in the late 1960s and early 1970s, this makes sense. Prior to a deeper understanding and problematizing of gender and the way that it works, in our social construction, only women had abortions because only women could get pregnant. But in 2013, we should know better, and we need to do better.
At this crucial moment for reproductive freedom and abortion access, the abortion rights movement stands at yet another crossroads: How do we adequately address and include those who have abortions but are not women?
We must acknowledge and come to terms with the implicit cissexism in assuming that only women have abortions. Trans men have abortions. People who do not identify as women have abortions. They deserve to be represented in our advocacy and activist framework. Honestly, I am guilty of perpetuating that harmful myth, both in my rhetoric and framing. I often frame abortion restrictions as misogynistic attacks meant to control women's reproductive lives, and that is true. But abortion restrictions also affect the lives of people who aren't women, and they hinder trans men and gender-non-conforming people and others who were Designated Female at Birth (DFAB) from accessing abortion care, as well.
"Stand with Ohio Women" and the "War on Women" may be great rallying cries, but they also very clearly reiterate the notion that abortion is both solely a women's issue and that only women have abortions. This can make those in the trans community feel excluded, and it can deter them from both seeking the abortion care they may need or becoming actively involved in abortion rights advocacy.
Leading the way on becoming more gender inclusive around the issue of abortion is the New York Abortion Access Fund (NYAAF), which recently agreed to shift its mission statement and values to reflect more gender inclusive language. NYAAF also created a Gender Inclusive Task Force to reach out to the LGBTQ communities and inform them that NYAAF helps fund abortions for all people, not just women. They state:
We want to make sure that NYAAF isn't just working toward every woman's right to access affordable abortion care, but every person's right, regardless of their gender. We realized that embracing gender inclusivity is about more than not assuming the gender pronouns that our callers use or replacing 'woman' with 'people' everywhere on our website. Becoming gender inclusive is an important part of our values as an organization.
More abortion rights and abortion care organizations need to follow suit with NYAAF. But individual activists can take action on a smaller level, even without the official sanctioning of nonprofits and advocacy organizations. We can begin by listening.
Ellen, who identifies as transgenderqueer, notes that "the best thing [cisgender] allies can do is to be receptive to criticism and ask trans people for alternatives. When you do this, it shows that you're listening and aware that your choice of language makes an impact." As Ellen also highlighted, trans people often feel that they are a burden to cisgender (which means your gender identity is the same as the sex with which you were born) abortion rights activists when they call out the problematic and exclusionary language upon which we rely.
Beyond that, we should begin to accept and grapple with, on individual and community levels, what it means to frame abortion as a women's issue and why we continue to be so reluctant or unable to be more gender inclusive. This requires effort, yes, but it is essential to our work and to a deeper understanding that reproductive justice does not only apply to women, but to all people. All people who need an abortion should be able to access one, and that does not solely apply to women.
I agree that restricting abortion rights is a misogynistic attempt to control women's reproductive lives and undermine women's reproductive autonomy. I firmly believe that misogyny lies at the heart of restricting abortion rights. But I also acknowledge that the misogyny of restricting abortion rights applies to trans* people, too. It affects a trans man who needs an abortion in North Dakota just as much as it does a cisgender woman in Texas. As Ellen so poignantly said, "this abortion debate is about agency, about choice and about attacks on our bodies," and that includes those who are not women.
So yes, I stand with women. I also stand with trans men and gender-non-conforming people. Do you?
Here is a helpful glossary of trans, genderqueer, and queer terms.
'After Tiller,' a controversial award-winning documentary about the four doctors who openly perform third-trimester abortions despite death threats and the assassination of their mentor, is set to be released this fall.
In a bizarre tirade, a Republican state senator in Missouri lashed out at an Anglican priest over the issue of abortion and gun rights last week.
Missouri State Senator Brian Nieves (R-Washington) had posted a photo of a gun on his Facebook page last Friday, explaining that a constituent “brought some of his personal Arsenal [sic] for me to look at and Drewel [sic] upon.” The photo quickly generated comments, with one woman saying that Nieves was a “white racist redneck” and the priest saying he hoped Nieves would “realize that true patriotism is more than carrying a deadly weapon.”
In response, Nieves accused the two commenters of working for the Riverfront Times, a local publication, and called them stupid.
“There is NO Possible way ya’ll are real people who really believe what you’ve written on my page,” Nieves wrote. “I’m simply not falling for it. You two are obviously just people who are pretending to be that stupid in the hopes of drawing me in to some senseless argument and then try to snatch a quote for the RFT or some other lib-rag. Sorry, I’m on to you, you over played your cards and made your comments far too stupid.”
But Nieves quickly continued the “senseless argument” after the priest said he was “saddened that any elected official would reduce himself/herself to name calling.” Nieves accused liberals of being “bullies” and then questioned whether the priest supported a woman’s right to terminate her pregnancy. When the priest replied that he supported reproductive rights and opposed the death penalty, Nieves wondered whether liberals like the priest were suffering from a mental illness.
“A person commits a heinous crime, the kind we hear about in the news, and they are not allowed to be executed but an innocent baby who is wrapped in the comfort of his/her mother’s womb – Having been created by God – can be literally ripped apart, viciously murdered, and this ‘Man of God’ supports it?!?!?!” Nieves wrote.
Nieves continued to argue with the priest for another 30 minutes, writing that an abortion to save the life of the mother was “a matter of convenience” and that the priest made him sick.
“I am perhaps too old and tired for this debate this evening,” the priest wrote. “You don’t seem to understand, or wish to understand what I said about education or providing birth control so abortion is no longer necessary. But then again, you couldn’t scream your disgust at me if you did.”
Though Nieves said he was too smart to fall for the alleged plot to “snatch a quote for the RFT,” the Riverfront Times was the first to report his Facebook comments. The online rant was later picked up by The Huffington Post on Monday.
UPDATE: On Monday night, Nieves denied saying that an abortion to save the life of a mother was a matter of convenience.
“I never – NEVER said that an abortion to save a Mother’s life is a matter of convenience! In fact, I never even came close to saying such a thing!” he wrote on his Facebook page.
His full comment from Friday is posted below:
“Chris…. ‘Life of the Mother?’ Your own argument proves it is a matter of convenience! Tell me this – Do you even know what a partial birth abortion really is? No, seriously, do you actually know what it is?? If so, explain to me what a partial birth abortion is.”
A federal judge on Monday temporarily blocked North Dakota's new abortion law, which bans procedures to end pregnancy once a fetal heartbeat can be detected, as early as six weeks.
The law, the most restrictive in the country, was to go into effect August 1. U.S. District Court Judge Daniel Hovland granted a preliminary injunction blocking it in response to a lawsuit filed by Red River Women's Clinic, the only abortion clinic in the state.
The clinic said banning abortions that early, before many women even knew they were pregnant, would bar nearly 90 percent of the abortions it performs.
The clinic argued that the law violates the U.S. Constitution and places the health of women in danger.
"The court finds the plaintiffs have established that they and their patients will be subjected to the threat of irreparable injury in the absence of a preliminary injunction," the judge wrote in his ruling.
If the clinic closes or is forced to stop performing abortions, the closest alternatives are about 250 miles away in Minneapolis and St. Paul, Minnesota, and Sioux Falls, South Dakota.
Governor Jack Dalrymple, a Republican in a state with a Republican-controlled legislature, said in March that it was not clear if the law would be constitutional but that money should be provided by the state to defend it.
The law, approved in March, is among a host of restrictions on abortion passed by Republican-led state legislatures this year. A dozen states have approved bans on most abortions after 20 weeks of pregnancy, but none have approved restrictions as strong as the ones enacted by North Dakota and Arkansas.
In March, Arkansas banned most abortions after 12 weeks of pregnancy. A federal judge blocked the law in May, at least temporarily.
The GOP-controlled North Carolina legislature is currently attempting to push through stringent abortion restrictions by any means possible. First, they tried attaching them to a totally unrelated anti-Sharia measure. Next, they tacked them onto a bill otherwise related to motorcycle safety. But voters aren’t exactly pleased with those efforts.
According to a new poll from Public Policy Polling (PPP), just 34 percent of North Carolinians support the proposed abortion restrictions, which would impose unnecessary regulations on abortion providers and restrict access to medication abortion. Forty seven percent oppose them — and a full 80 percent think it’s “inappropriate” to combine abortion restrictions with unrelated measures on sharia law or motorcycle safety.
North Carolina Gov. Pat McCrory (R) made a campaign promise not to sign any additional abortion restrictions into law, in favor of focusing on economic issues. He threatened to veto the abortion restrictions attached to the anti-Sharia bill, which is what prompted lawmakers to add them to a transportation bill instead. Now, despite his initial promise to avoid reproductive restrictions, McCrory has suggested he might consider signing the motorcycle safety bill with the abortion-related amendments intact.
The governor might want to reconsider that stance after taking a look at his recent approval ratings, however. The PPP poll finds that McCrory’s popularity has taken a tumble. For the first time since taking office, he now has a negative approval rating — just 40 percent of voters approve of the job he’s doing, compared to 49 percent who disapprove. And only 68 percent of the people who voted to elect McCrory still think he’s doing a good job.
The dissatisfaction with North Carolina’s current legislative priorities is widespread. For the past several months, thousands of protesters have been rallying against the radically right-wing North Carolina legislature in a series of “Moral Monday” protests. Over 60 pro-choice activists, including the president of Planned Parenthood of Central North Carolina, were recently arrested during one of those protests. PPP finds that North Carolinians support the protesters over the legislature by a 47/41 margin.
While spouting a series of lies, Bill O’Reilly whined recently on Fox News that women in Texas are providing what he considers insufficient reasons for getting an abortion. The exchange between him and Fox’s official fake feminist Kirsten Powers went like this:
Powers shot back: “The current status quo in Texas that these people are fighting for, who are fighting the bill, is to be able to abort your baby up until the third trimester.”
“Yeah!” O’Reilly jabbed. “For any reason! Women’s health! ‘Hey! Look I sprained my hand!’”
“Yeah,” Powers said. “For any reason. For any reason. Yeah.”
To hear O’Reilly and Powers talk, one would think that in order to get a safe, legal abortion under the standards set out by Roe v Wade, one has to go in and provide a “reason” that you “deserve” this abortion, and some kind of authority figure determines if it’s good enough before you get an abortion—their only concern is that women are supposedly not giving good enough reasons. Obviously, these two pundits know better and are just being dishonest with the viewers, but that they are engaging in this rhetoric in the first place speaks to a serious problem in how abortion is discussed in this country.
Abortion is often framed as a mercy bestowed upon a woman who has committed the “crime” of having had sex. Mercy is something that someone else grants you, however, and not something you can simply decide for yourself that you deserve. That’s what people are stabbing at when they say they don’t want women to use abortion “as birth control.” The fear is that a woman might get an abortion without feeling remorseful or may, gasp, even feel like she’s entitled to it without having to apologize or grovel. Basically, people are uneasy with leaving the decision of whether or not an abortion is deserved to the woman seeking it herself. What a lot of people in the gray area between pro- and anti-choice want is for women to have to justify themselves in order to get abortions, even if it’s something as simple as making women feel ashamed of themselves for what they supposedly did wrong.
The problem with that, beyond the inherent sexism of it, is that there’s no real legal way to make women justify themselves, besides maybe making them sign a piece of paper that says, “I’m sorry I was a naughty girl who had sex. Can I please have my abortion now?” Roe v Wade sets things like time limits and Planned Parenthood v Casey says that there can be no “undue burden” to access, but the court decisions that shape abortion law don’t speak to “good” vs. “bad” reasons to have abortions, and for good reason. Abortion is medical treatment. It goes against basic medical ethics to require a patient to argue their moral worth before they are permitted access to health care they require.
The confusion between how ordinary people talk about abortion in terms of deserving-ness and how the law handles abortion, as a matter of rights, is why so much polling data on abortion is bunk. Gallup is notoriously bad on this front, showing that somehow half of Americans call themselves “pro-life” but a majority still want abortion to be legal. In other words, a lot of Americans call themselves “pro-life” but disagree with the “pro-life,” i.e. anti-choice movement about abortion access. I believe that speaks to a longing a lot of people have for women to be able to access abortion, but only if they provide a good reason for it. Of course, there’s no legal way to determine the difference between a good and a bad reason, to separate the “good girls” who just “made a mistake” from those deemed unrepentant sluts.
That is the legal reality, but the anti-choice movement knows that they gain ground when they can appeal to the mushy middle’s desire to make abortion available, but only if you somehow have proved yourself worthy of mercy for your supposed sins. Restrictions like waiting periods and mandatory ultrasound shaming rituals are sold to the public as ways to make the woman seeking abortion “earn” it by inducing shame—forcing her to feel bad about what she supposedly did, basically a time out in the corner for the naughty girls. In reality, they instead attack access, adding time and expense to the abortion. Instead of separating the good girls from the sluts, they are more likely to separate those who are privileged enough to be able to afford both the expense and the time off and those who can’t.
This is also why anti-choicers like to talk about women “regretting” abortion. The underlying narrative, aimed at the mushy middle: Abortion is clearly too easy to get. Women are impetuously rushing into it, only to realize later that they were bad girls who didn’t pay enough for their sins. We need to make it harder to get, so that only the truly deserving, those who feel remorse, can get it. The idea is to shift focus to reasons and to get people thinking about those who have “good” ones vs. those who supposedly do not.
Unfortunately, I fear that pro-choicers may be making this problem worse by our rhetoric. Every time anti-choicers try to restrict abortion, we trot out women who’ve had abortions to put a face on the situation. It’s a good idea, but as Jessica Grose of XX Factor writes, the women in these stories almost always feel the need to justify their abortions, to explain that they are deserving—which in turn implies that others are not.
First-person abortion stories in major publications are almost always about “appropriate” abortions. Shrouded in mournful tones, regretting the baby that couldn’t be, reflecting on that upsetting choice. But this is such a narrow way of looking at an experience that a third of women in America have. Most people who get abortions aren’t teenagers or terminating unviable babies. Six in 10 women who get abortions are already mothers, and 3 in 10 women have two or more children. The abortion rate is highest among women in their 20s. And there is a range of emotions that women feel when they’re getting what is essentially a medical procedure. Some feel relief, some feel nothing, others even feel joy.
Pro-choicers definitely don’t mean it this way! Most of us believe that women are entitled to abortions if they want them, and you don’t need to have to provide your reasons for the rest of us to judge. But it’s inescapable: If you trot out your sob story to convince people you deserved your abortion, you end up implying, even if accidentally, that some women don’t deserve theirs. When both pro- and anti-choice people are forever debating what is and isn’t an acceptable reason to have an abortion, it shouldn’t be surprising that the people in the middle think that’s what this debate is about.
Because of this, I have to sign off on Grose’s suggestion: Tell your abortion stories, but don’t try to justify yourself! We need to get the message out that, as with every other medical intervention out there, pre-viability abortions don’t need to be earned. You don’t need to be a “good girl” who is full of remorse. The woman who slept with 30 guys and accidentally got pregnant because she foolishly took her chances without a condom deserves her abortion just as much as the loving mother of two who has discovered a fetal defect incompatible with life. We believe this to be true, and we can only start convincing the public that it’s true if we start talking about this belief more straightforwardly.
As court fights have become increasingly critical in shaping the nation’s abortion laws, here’s a look at 10 of the most important cases pending right now in state and federal court.
1. Wisconsin. The American Civil Liberties Union and Planned Parenthood have challenged a law requiring every physician who performs an abortion at a clinic to have staff privileges at a local hospital, arguing that the measure would force two of the state’s four abortion clinics to close.In Wisconsin. A federal judge issued a temporary restraining order against the law, which Gov. Scott Walker (R) signed on July 5; the judge will hold a hearing on the case this week.
2. North Dakota. The state’s Gov. Jack Dalrymple (R) garnered national attention in late March when he signed into law a bill restricting abortions as soon as a heartbeat is detectable, which can be as early as six weeks. But he has also signed off on bills prohibiting abortion based on sex selection and genetic abnormalities, barring non-surgical abortions and requiring hospital admitting privileges for abortion doctors. The Center for Reproductive Rights is challenging all of these bills, some in state court and some in federal court. The fetal heartbeat bill takes effect on Aug. 1, so there is a chance the federal judge overseeing that challenge would issue a preliminary injunction that would prevent it from taking effect in the state.
3. Virginia. NOVA Women’s Healthcare, the state’s busiest abortion clinic, just closed because its operators said it could not afford to comply with new regulationsrequiring costly upgrades in order to meet strict, hospital-like standards. A separate clinic, the Falls Church Healthcare Center, filed an administrative appeal petition in the Arlington Circuit Court in June challenging the new rules imposed by the Virginia State Board of Health. The Commonwealth has responded, so the case is going forward.
4. Arkansas. The ACLU, the Arkansas ACLU and the Center for Reproductive Rights are challenging a law barring abortions starting 12 weeks after fertilization, which was adopted after the Arkansas legislature overrode Democratic Gov. Mike Beebe’s veto of the law. In May the judge overseeing the casetemporarily blocked the law, which was set to take effect in July.
5. Kansas. The Center for Reproductive Rights has challenged a sweeping anti-abortion bill. Last month the center got a preliminary injunction blocking two provisions of the measure, ones requiring providers to endorse specific literature on abortion provided to patients and redefining what constitutes a medical emergency for a woman seeking an abortion.
6. Arizona. The ACLU, the NAACP and the National Asian Pacific American Women’s Forum filed suit in May against an Arizona law that bans abortion on the basis of gender and race selection, arguing that it is based on stereotypes about Asian Americans and African Americans.
7. Alabama. The ACLU, the ACLU of Alabama, Planned Parenthood Federation of America and Planned Parenthood Southeast are challenging a law requiring abortion providers to obtain admitting privileges at nearby hospitals. The judge in that caseissued a temporary restraining order late last month against the measure, just as a federal judge had blocked a 2012 Mississippi law challenged by the Center for Reproductive Rights that requires any physician performing abortions in the state be a board certified or eligible obstetrician-gynecologist with admitting privileges at an area hospital.
8. Texas. Planned Parenthood President Cecile Richards said Saturday that her group was “evaluating litigation options” regarding the just-passed Texas abortion bill, which would not only bar abortions starting 20 weeks after fertilization but would impose an admitting privileges requirement and other operating requirements for abortion rules. Gov. Rick Perry (R) has pledged to sign the bill, but has not done so yet.
9. Oklahoma. The Center for Reproductive Rights has challenged both a law restricting non-surgical abortions and one requiring an ultrasound before a woman has an abortion. In both cases, the state supreme court has permanently blocked them. The U.S. Supreme Court agreed to consider both cases, though it sent back a few questions to the Oklahoma Supreme Court regarding the suit involving medication abortions.
10. North Carolina. The Center for Reproductive Rights, the ACLU and Planned Parenthood have challenged a 2011 measure requiring abortion providers to show an ultrasound image to a pregnant woman, describe the features of the fetus and offer her a chance to listen to its heartbeat. A federal judge issued a preliminary injunction in the case in October 2011, and the case is still pending. Both the House and Senate in North Carolina have both recently passed more sweeping anti-abortion bills, and the governor has said he would sign the House version of that legislation. If signed, that bill could spark its own legal challenge.
On August 13, 2010, an 18-year-old New Jersey resident arrived in a clinic in Elkton, Maryland, to undergo a surgical abortion. She was 21-and-a-half weeks pregnant, and had driven just over an hour from a clinic in Voorhees, New Jersey, where the day before, Dr. Steven C. Brigham had initiated the procedure.
Just 15 minutes into the surgery in Maryland, the patient suffered major injuries. Her uterus was ruptured, and her bowel had been perforated and was protruding into her vagina.
Instead of immediately calling 911 for emergency assistance, her doctors—Brigham and his associate, Nicola I. Riley—waited nearly two hours, according to findings from the Maryland State Board of Physicians. They then dressed the patient, who was still sedated and slumped over, and lifted her into a wheelchair. They rolled her outside, put her in a car, and with Brigham at the wheel, took her to a nearby hospital. Her injuries were so severe that hospital staff had her airlifted to Johns Hopkins Health Center for emergency treatment.
The patient survived, and as was reported Thursday morning in the New York Times, her story now forms a key part of the evidence that is being used in an administrative proceeding brought by New Jersey’s attorney general to have Brigham’s medical license permanently suspended or revoked.
However, what has not yet been reported is the extent to which legitimate providers in the states where Brigham practiced went to warn state officials of the threat Brigham posed to the health of the women he served.
In numerous complaints, emails and phone calls over a period of more than two decades, legitimate abortion providers from New Jersey and neighboring states alerted authorities to Brigham’s dangerous conduct, furnishing warnings they say went largely unheeded. Doctors provided copies of many of these complaints, as well as extensive logs of their calls, to RH Reality Check.
An investigation by RH Reality Check shows that New Jersey officials responsible for overseeing healthcare in that state could have prevented injuries to this and subsequent patients, had they acted on warnings about Brigham that predicted this exact scenario.
“If they had listened right in the beginning and taken appropriate action, I think these harms would have been prevented,” Jen Boulanger, a clinic administrator who has spent years amassing complaints about Brigham and his associates, told RH Reality Check. “I think state agencies were afraid of raising eyebrows about abortion, but they just should have handled it like they do any other field of medicine.”
A spokesman for the New Jersey attorney general’s office, which has ultimate oversight of the New Jersey Board of Medical Examiners, said the office could not comment on Brigham, because of the ongoing dispute over his medical license.
Attempts to reach Brigham, as well as attorneys listed as his representatives on official documents, were unsuccessful.
Brigham has now had his medical license suspended or revoked in up to six states, but public records show that he remains at the helm of an abortion chain called American Women’s Services, which is based in New Jersey, and owns or is affiliated with 15 clinics in four states. There is no requirement that the owner of a medical facility actually possess a medical license, state officials said.
The issue of abortion has once again leapt to the forefront of state and national politics. Already this year, dozens of anti-choice laws have been proposed or have passed at the state level, and a 20-week abortion ban recently passed in the U.S. House of Representatives.
Anti-choice advocates, including activists, and state and federal politicians, have capitalized on the case of another rogue provider—Kermit B. Gosnell—to falsely claim that he represented the norm in abortion care.
The documents provided to RH Reality Check, however, show that reputable providers tried for years to sound the alarm on a rogue provider. In Brigham’s case, they made sustained efforts to prompt officials in New Jersey, Pennsylvania, and Maryland to enforce the regulations that already existed to ensure safe abortion care. The documents provided show that authorities were often slow to respond to those warnings, if they acted at all.
For the providers who spent years trying to stop the problems they saw at Brigham’s clinic, the fact that he is still involved in women’s health—and being used as justification for restricting access to abortion—signals systemic problems with how the authorities and politicians treat reproductive health issues. They also said they believe many of these new legal restrictions—in addition to being medically unnecessary—could push more women into the hands of rogue providers, such as Brigham or Gosnell.
“It’s heart-breaking,” said Claire Keyes, who worked for more than 30 years as director of the Allegheny Reproductive Health Center in Pittsburgh, where she treated dozens of patients who had been to clinics owned by Brigham. “This isn’t throwing women under the bus. This is like backing up over and over and over them.”
A Long History of Problems
Brigham had already accrued a long history of harming patients by the time he botched the abortion in 2010.
Over a period of more than two decades, Brigham has left patients with severe bowel injuries, severed ureters and sweeping lacerations to the uterus, and requiring emergency hysterectomies for procedures that, when done by a properly trained provider, has avery low risk of complication, public records show.
In fact, Brigham first came to the attention of national abortion providers shortly after graduating from Columbia University College of Physicians and Surgeons in 1986. His prestigious education and natural charisma led many colleagues to give him a warm welcome into the professional community.
“We were very enthusiastic about this doctor when he first came,” said Suzanne Poppema, a former board chair of the National Abortion Federation (NAF) and Physicians for Reproductive Health. “He was young and socially adept and seemed to say all the right things, and asked good questions that you would expect someone just starting out to ask.”
But that impression changed quickly, Poppema said. Colleagues noticed that Brigham continued to ask the same questions at subsequent meetings, which struck them as odd. And then they began to hear troubling reports about the young physician’s medical practices.
“Right away we started hearing that he was moving into both early and later second-trimester abortions. And he had a complication,” she said, referring to a problem with an abortion procedure.
In the hands of a skilled provider, abortion carries avery low risk of complication, even after 20 weeks’ gestation, and certainly lower than the risks associated with giving birth. However, the risk of complication increases as the pregnancy progresses, and like any complex medical procedure, specialized training is required. NAF board members believed Brigham lacked those skills, and decided to confront him to express those concerns.
“I sat down with him and three other physicians, and we said to him, ‘You have to promise that you will not do any second-trimester abortions until you have spent two weeks with one of our senior physicians,’” Poppema recalled.
But Poppema said Brigham never completed that training. NAF rejected his application for membership, and lodged their concerns with Pennsylvania authorities, including the attorney general and the State Board of Medicine.
By 1992, however, Pennsylvania’s board of medicine had already become concerned about Brigham’s conduct. In April of that year, Brigham reached a deal with the board in which he agreed never again to practice medicine in Pennsylvania. In exchange, the board dropped an investigation against him, according to court documents later filed in Florida. RH Reality Checkwas unable to ascertain what prompted that investigation.
“We thought that just getting his license revoked would take care of it,” Poppema said. “But it turns out, it didn’t do any good to revoke his license. He just goes to another state, or better yet, he figured out he doesn’t need a license to open a clinic.”
Indeed, two weeks after he agreed to stop practicing in Pennsylvania, Brigham botched a 23.5-week abortion in New York, leaving his patient with a lacerated uterus, a severed ureter, and a colon so damaged that she required a colostomy—a form of bowel surgery that frequently leaves patients needing an external bag to drain their digestive systems.
And in November 1993, a 20-year-old patient who had gone to Brigham in New York for an abortion at 26-weeks’ gestation required an emergency hysterectomy after Brigham lacerated her cervix, uterus, and uterine artery.
In its ruling following these incidents, New York’s State Board for Professional Medical Conduct concluded that Brigham was an “imminent danger to the health of the people of New York,” found him guilty of gross negligence, and suspended his medical license. Relying partly on those conclusions, Florida also stripped Brigham’s license to practice in that state.
The New York board also drew damning conclusions about the doctor’s character.
“[Brigham] repeatedly exaggerated his medical training, experience and skill,” wrote the committee that heard Brigham’s case. He “has demonstrated he lacks appropriate judgment and insight as to his own limitations.”
The New York regulators also echoed Poppema’s concerns that Brigham lacked the skill and training required to perform later abortions. Brigham inflated his qualifications, but eventually “testified that what he referred to as special training in preparation for his activities in the abortion field consisted of limited interludes of observation of other physicians,” the board wrote.
New Jersey initially followed suit; the state restricted Brigham’s practice in February 1994, and banned him from performing second-trimester abortions, and required him to hire someone to supervise his practice, and to review patient records.
Brigham fought the decision to suspend his license, and eventually prevailed. The New Jersey medical board found in August 1996 that Brigham had not violated the required standard of care, and restored his medical privileges.
Brigham would soon expand his activities to multiple other states—including those where he could no longer legally practice medicine himself.
Brigham Finds Loophole, Continues Pattern of Harm
By the mid-2000s, Brigham’s abortion clinic network had grown bigger than ever. At its peak, American Women’s Services and its affiliates had at least 17 locations in New Jersey, Florida, Pennsylvania, Virginia, and Maryland, public records show.
Brigham also established multiple other companies with interlocking ownerships and linked addresses, which were associated with numerous nonprofit entities. He hired other physicians, technicians and administrative employees—some of whom have also faced disciplinary proceedings from multiple state medical boards.
Physicians in surrounding states were now receiving frequent complaints from patients who had been treated at a Brigham clinic, according to doctors interviewed by RH Reality Check.
“We had a standard complaint form, believe it or not,” said Claire Keyes, whose clinic in Pittsburgh often treated patients who had been seen at a Brigham clinic. She said they developed the form specifically for patients from those clinics. “We never got them from any other place, only from Brigham’s clinic, where patients were mistreated or they were so uncomfortable that they left, or they left but they discovered that they were still pregnant but they wouldn’t go back there.”
Keyes said that she and her staff regularly sent the complaint forms to the Pennsylvania Department of Health or occasionally to the state attorney general.
“I kept hoping that the evidence that we were giving the state would prompt them to want to do something,” Keyes said. “But as far as I know, that was not the case.”
Jen Boulanger, who was executive director of the Allentown Women’s Center at the time, also recalls dozens of patients reporting problems with Brigham’s clinics, ranging from confusing information, exorbitant fees, and allegations of improper sexual conduct by a doctor who worked for Brigham. (The doctor was stripped of his New York medical license after the Board of Medical Examiners found that he had sex with a patient at one of his clinics and was accused of sexually abusing three others.)
Boulanger maintained a log both of these complaints, and of her attempts to alert officials at the Pennsylvania health department, attorney general’s department, and medical board. The log, a copy of which she provided to RH Reality Check, includes names and contact information for officials who were later implicated in that state’s failure to perform basic inspections of abortion facilities, or to act on warnings about the criminal conduct of Kermit Gosnell.
“It was almost one complaint a month on average that we received from a patient,” Boulanger said. “It was so frustrating because I felt like we did everything we could do.”
A spokesman for the Pennsylvania Department of State said he could not comment on complaints of investigations into individual practitioners.
New Jersey doctors were also trying to alert authorities there of what they saw as the threat posed by Brigham and his associates.
In a complaint lodged online with the New Jersey Board of Medical Examiners in September 2005, a doctor alleged that Brigham had resumed performing second-trimester abortions at his clinic in Voorhees, despite the fact that his facility lacked the license required to do abortions past 14-weeks gestation. A copy of the electronic receipt confirmation was provided to RH Reality Check.
The doctor outlined the procedure that patients had described to her. They said Brigham would commence the abortion procedure at his private offices in Voorhees, by inserting laminaria, a type of seaweed commonly used in abortion procedures to soften the cervix in preparation for a later abortion. Because the cervix can require more than 24 hours to dilate, some providers ask their patients to return the following day to complete the procedure.
Reputable clinics usually require patients to stay for a short period of observation after laminaria are inserted, and ask them to remain under the supervision of a responsible adult until they return. In normal circumstances, a registered nurse and doctor are on call at all times in the event that a patient requires urgent treatment.
New Jersey law also requires all abortions at more than 14-weeks gestation to take place in a hospital or licensed surgical ambulatory facility—Brigham’s office did not fall within those definitions.
According to the doctor who filed the complaint, Brigham’s patients reported that he did not follow any of these best practices.
Instead, when patients returned the following day, he would inform them that they had to drive themselves to another clinic in a neighboring state to complete the operation. Brigham would often lead a group of patients, all traveling in separate vehicles, to an out-of-state clinic, in what was described in legal filings as an abortion “caravan.”
“These methods are not within the normal national standard of care for second trimester abortion services as put forth by the American College of Obstetrics and Gynecology (ACOG), the National Abortion Federation (NAF), and other nationally recognized experts in abortion care,” wrote the physician who lodged the complaint. The method posed “a serious threat to the health, safety and welfare of the public,” the doctor wrote.
But if New Jersey took any action on those warnings, the person who filed the complaint didn’t hear about it. In fact, over the following years, the parade of injured or distraught patients swelled as doctors continued to file complaints and write letters to New Jersey authorities.
On February 17, 2010, a group of New Jersey doctors, abortion clinic administrators, and counselors collected their complaints and sent a 24-page packet to Sandra Murray, an investigator in the enforcement bureau of the New Jersey Office of the Attorney General, as well as to William Roeder, executive director of the New Jersey State Board of Medical Examiners. Fax records indicate that the complaints were received at the number listed on Murray’s business card.
The complaints centered on a company called Grace Medical Care, one of Brigham’s many companies, as court filings would later show.
“Patients are being directed through Grace Medical to another state, likely after their initial laminaria insertion, and probably to Maryland, where there exist no guidelines for monitoring outpatient second trimester termination of pregnancy, and where the law is unclear at which point in the pregnancy termination becomes illegal—leaving murky waters for providers like Brigham to expand their reach unnoticed,” one doctor wrote.
“In my professional opinion, this practice is dangerous,” wrote another doctor who contributed to the complaint. “To ask a woman in the midst of second trimester abortion to cross state lines to an unfamiliar facility, which may be hours away, is potentially life-threatening.”
Neither Murray nor Roeder would comment for this story, but some seven months after Murray’s office received the packet, the precise scene predicted in these complaints played out when Brigham and his associate had the 18-year-old patient drive herself from Voorhees, NJ, to Elkton, MD, botched the abortion, and left her requiring emergency surgery at Johns Hopkins Health Center.
States Take Action
In the wake of that botched abortion, Maryland authorities raided the Elkton clinic, where they discovered at least five fetuses, though news reports said there were many more.
Based on the size of the fetuses, officials allege that Brigham—who had never held a license to practice medicine in Maryland—performed abortions up to 26-weeks gestation at the Elkton clinic. Additional patient records produced by the New Jersey attorney General in proceedings in that state indicate that Brigham performed up to 50 abortions between January and August 2010 at the Elkton clinic, including on fetuses up to 31-weeks gestation.
New Jersey’s Board of Medical Examiners temporarily suspended Brigham’s license in October 2010, and alleged almost identical facts to those contained in the multiple complaints lodged to its own office over a period of more than five years.
“Dr. Brigham has constructed an elaborate sham to allow him to do an end-run around New Jersey’s regulatory requirements,” the board wrote.
“Dr. Brigham’s deceptions extend even to his patients, who are kept uninformed of information as basic as where their procedure would be performed and even, in some instances, the identity of the physician who would be performing the procedure,” the board said. “His willingness to do so, and the lengths to which he has gone to further his scheme, manifestly support a conclusion that his continued practice would present clear and imminent danger.”
But Brigham’s clinics remained open. Doctors working nearby continued to receive complaints from patients who’d had a brush with his clinics, and they continued to write to the Board of Medical Examiners, pleading with them to take action.
On October 14, 2011, William Roeder, the board’s executive director, replied to yet another series of complaints from doctors who worked near Brigham’s New Jersey clinics. He informed the doctors that the board “appreciated” their “interest in this matter.”
“Please be advised that Dr. Brigham’s medical license has been temporarily suspended,” he wrote. “However, he can open another facility.”
A Patient Death
New Jersey’s administrative proceeding to permanently strip Brigham’s medical license is ongoing, but in February of this year, a patient died at the Baltimore office of Associates in OB/GYN Care, a group of four clinics listed on Brigham’s website as the Maryland facilities for his network, American Women’s Service.
Following the death, inspectors from Maryland’s Office of Health Care Quality found that all four OB/GYN Care facilities—located in Silver Spring, Cheverly, Frederick, and Baltimore—had an “unwritten protocol” that allowed unlicensed staff to perform and interpret ultrasounds and administer drugs, without any supervision.
“These deficiencies… could have resulted in serious or life-threatening harm or death to the patient,” the report found. On May 23, 2013, the state department of health decided to continue a temporary suspension because Associates in OB/GYN Care had not shown any compelling evidence as to why it should be allowed to reopen.
As recently as mid-June, callers to American Women’s Services were told that they could obtain abortions at their clinics in New Jersey or Virginia.
Staffers also told reporters that the Maryland clinics were temporarily closed “for renovations.” When asked directly by RH Reality, the person answering the company’s 1-888 number denied that the closures were related to regulatory problems. Maryland officials declined to comment when told about that answer.
A Florida clinic, American Family Planning, is controlled by one of Brigham’s companies and continues to operate from its premises in Pensacola, according to state officials.
However, American Women’s Services’ web site tells patients seeking treatment in Pennsylvania that they can attend Brigham’s New Jersey clinics. Since September 2009, Pennsylvania has banned Brigham from owning or running an abortion clinic, making it the only state to do so. Pennsylvania officials said they were prevented from commenting on complaints or investigations into medical practitioners.
For the doctors who had tried for decades to stop Brigham’s dangerous conduct, this reality comes as a blow.
“You feel completely powerless,” said Poppema, the former chair of NAF and Physicians for Reproductive Health. “We spend enough of our time trying to beat back harassment, threats, and anti-abortion legislation. The fact that we have to spend time policing someone in our own profession is just depressing.”
Correction: A version of this article incorrectly identified Jen Boulanger as a physician. She is in fact a clinic administrator. We regret the error.
Over the past week, Texas has captured national attention with a dramatic show-down between a Republican-controlled legislature and thousands of reproductive health advocates. As grassroots activists work to block a package of stringent abortion restrictions that failed to advance in the regular legislative session, but that lawmakers continue to bring up for extra consideration in multiple special sessions, the media is taking notice.
In its coverage of the ongoing fight, the media is obviously interested in putting Texas’ proposed legislation — which would criminalize abortions after 20 weeks and force the vast majority of the state’s abortion clinics to close — into a broader context. The New York Times mapped out the public opinion on 20-week abortion bans. Following the same logic, Politico referred to Texas’ abortion proposal as a “bill that polls well” since “support for legal abortions drops dramatically after the first trimester.” The Washington Post pointed out that multiple other states already have 20-week bans on the books. Fox News referred to protests over a “strict abortion bill banning the procedure after the 20th week of pregnancy,” and a Washington Post columnist characterized Sen. Wendy Davis (D) as fighting for late-term abortion rights. And it’s easy to draw comparisons between Texas’ proposed ban and the national 20-week ban introduced in the House and, potentially, the Senate.
The implications of banning abortions at 20 weeks, which is an effective method of chipping away at the legal protections under Roe v. Wade, is an important part of the conversation. But many of the narratives the media is crafting about Texas’ abortion fight aren’t actually getting at the full scope of the story.
In addition to criminalizing abortion services after 20 weeks, the other provisions in Texas’ abortion proposals would impose harsh restrictions on abortion providers. By subjecting abortion clinics to new regulations that would force them to make expensive updates to their facilities — unnecessary measures that major medical groups, like the American College of Obstetricians and Gynecologists, oppose — Texas’ bill would force 90 percent of the state’s clinics to close their doors. That would leave just five abortion clinics in the entire Lone Star State — the second most populous state in the country.
That type of indirect attack on abortion access is an extremely popular anti-choice tactic that is effectively advancing in many other states across the country — largely because it’s a complicated policy that may not spark as much initial outrage. Compared to abortion bans, which tend to capture the most media attention, it’s easier for abortion clinic restrictions to fly somewhat under the radar.
But women’s health advocates point out that legislation targeting abortion clinics is actually the most serious threat to women’s reproductive access, with far-reaching implications for women seeking abortion care. Planned Parenthood’s Cecile Richards has warned that closing so many clinics in the Lone Star State would ensure abortion is “virtually banned in the state of Texas.” That’s not in reference to abortions after 20 weeks; Richards is talking about the impact on every single women who lives in the state.
Texas is 773 miles wide and 790 miles long. The proposed restrictions would wipe out all of the abortion clinics in the western half of the state, leaving just a handful remaining in urban centers. If the measures currently being advanced in the legislature become law, many women living in rural areas will be forced to travel hundreds of miles to get to the nearest clinic — a trek that low-income women, who struggle to take time off work and pay for transportation,aren’t likely to be able to afford.
And the real catch? Outside of the debate about abortion access after 20 weeks — even outside of the fight for abortion rights altogether — the “abortion clinics” in question are often providing health services that encompass much more than helping women terminate a pregnancy. Many of them also provide preventative care, family planning counseling, STD testing, and cancer screenings. And they offer those health services to Texans of both genders who are typically uninsured.
Under Texas’ proposed legislation, many clinics that currently offer birth controls and condoms would have to cease those services for some of Texas’ neediest residents. “That is part of the concern that’s getting drowned out in the abortions versus pro-life soundbite,” Texas Rep. Trey Martinez Fischer (D) told ABC News in a recent phone interview.
Previous research conducted in Texas over the past three years has demonstrated that poorer women in the state already struggle to navigate the existing abortion restrictions that block their access to reproductive care. Imposing even more barriers to health clinics, which many low-income women also rely on as their primary care provider, could be disastrous.
That prospect is especially concerning because Texas Republicans have already taken drastic measures to reduce these types of preventative health resources for low-income women in the state. In 2011, they slashed family planning funding and forced many women’s health clinics to either contract their services or shut down altogether. Last year, they successfully defunded Planned Parenthood, a move that forced even more clinics — including dozens that weren’t even affiliated with the national women’s health organization — to close their doors. The result? Texas is now funding 176 fewer health clinics than it did in 2011, and over 50 have been forced to shut down because of it. 200,000 women have already lost access to preventative care like birth control and cancer screenings. The state’s health department has projected that there will be an additional 24,000 unintended births as a result of the cuts because so many women are struggling to access the contraceptive services they need.
The GOP-controlled legislature has taken a dive in public opinion polls thanks to those family planning cuts. Before the regular session ended this year, Republicans actually agreed to work to restore some of that funding largely because they started to get worried about the growing backlash from their constituents. But many stringently anti-abortion members of the legislature decided they didn’t want to give up the fight so easily. Now, in the special sessions, their anti-woman agenda — one that Texas Democrats kept at bay for most of this year — is back in full force.
That’s a little bit more about the story in Texas (although not as clear of a picture as the activists on the ground could paint). That’s what ignited a groundswell of grassroots activism. That’s why so many people are so angry. That’s why thousands of protesters are standing up against these serious attacks that are putting a stranglehold on Texas women’s reproductive health, and that continue to squeeze tighter and tighter. Most women’s health advocates would certainly argue that maintaining women’s legal abortion access after 20 weeks is critically important. But that’s only one battle currently raging in Texas, and much of the coverage is missing everything else that reproductive rights activists are fighting for in the larger war.
This is such a simple concept that I can’t believe we still have to say it, but we do: The legal right to an abortion means nothing to the person who can’t get to a clinic, the person who can’t speak the language spoken in a clinic, the person who doesn’t have enough money to pay for an abortion, and the person who doesn’t have the required documentation.
Texas state Sen. Wendy Davis (D-Fort Worth) knows this; it’s why she stood for 11 hours on the floor of the senate as part of a dramatic filibuster. State Sen. Leticia Van De Putte (D-San Antonio) knows it too; it’s why she left her father’s funeral and drove three hours so she would arrive at the senate floor in time to speak against SB 5. Also in the know are the hundreds of people, men and women alike, who protested their hearts out for hours—and days—on end and ultimately were the ones who pushed the Texas legislature’s special session to end before a vote could be reached on the regressive bill that would make abortion inaccessible to millions of Texans.
The proposed legislation, referred to as SB 5 in the state senate, includes, among other things, a 20-week abortion ban and costly, medically unnecessary regulations that would close all but five clinics, in four cities, in the state, which is the largest in the continental United States and has a population of some 26 million people. As Planned Parenthood Action Fund President Cecile Richards noted, SB 5 would result in a “virtual ban” on safe abortion in Texas.
We must remember that the fight against SB 5 is one that Texas—and states around the country—have been fighting for years. It is a fight that has been waged on many fronts, including legal challenges meant to provoke a challenge to Roe v. Wade and hundreds of bills introduced each year to make the legal right to an abortion effectively unavailable through the introduction of forced waiting periods, “fetal pain” bills, mandatory ultrasounds, attacks on Medicaid coverage, earlier bans, untenable physician and hospital requirements, parental involvement, and state mandated counseling. All of these restrictions amount to one thing: targeting the most vulnerable amongst us, including those who are poor, immigrants, women of color, LGBTQ individuals, undocumented people, young people, and people with disabilities.
In his recent article in the New York Times Magazine, “What Happens to Women Who Are Denied Abortions?”, Joshua Lang explores the findings of study from researchers at the University of California, San Francisco on the barriers women face in getting timely abortion care. Lang notes that there are indeed many reasons women are turned away from abortion clinics, notably a lack of funds or if they are deemed obese, but concedes that “most simply arrive too late.” Mr. Lang’s article stops short of naming the deeper implications of these findings—namely that devastating poverty and inequity are the real barriers, not being overweight or ignorant of your body. This kind of inequity is what makes abortion effectively illegal for so many women, and what the battle on the floor of the Texas state senate was all about.
As a longtime member and supporter of abortion funds, I know what it is like to work day and night to raise money, in the face of bans on coverage by politicians, to help women get the abortions they seek. I have seen poor women and families face the heartbreaking challenge of raising the money for an abortion, only to have the price go up week by week, keeping it just out of reach—an excruciating phenomenon known as “chasing the fee.” My colleagues and I see firsthand what Dr. Diana Greene Foster found in her study: Poverty is a women’s health issue, and policy changes are the solution.
So as the fight against SB 5 continues, with Republican Texas Gov. Rick Perry having just called a second special session to try and pass the bill, we know that Texans have their work cut out for them. As do we all—not just to fight for abortion access for all women, but on many fronts. In this moment, it’s crucial that we fight the narrow politics of the right with a big, broad-based politics of our own. It is crucial that we name the impact that these restrictions will have on vulnerable populations. It is crucial that we call for the repeal of the Hyde Amendment, which prevents federal monies from covering abortion care. It is imperative that we call for the elimination of unnecessary waiting periods, bans, and restrictions.
Once again: Poverty is a women’s health issue, and policy changes are the solution. We must call for an end to abortion bans that deny women the ability to make the decision that’s best for them, just because they are poor. As we work to fight another day, it is our duty to call for the recognition that those who live in poverty deserve the same health-care access as those who do not.
Conservatives Double Down on the War on Women
By Amanda Marcotte
With all the moaning and wailing at Fox News and other right-wing media outlets about the supposed unfairness about the phrase “war on women,” you’d think conservative politicians would try to avoid the charge by, you know, not waging it. Or at least laying off it a little. Instead, the opposite is happening. The American Civil Liberties Union (ACLU) fears this will be the worst year on record for reproductive rights, possibly worse than the previous two worst years, 2011 and 2012. The group has a map of the legislation offered and passed on the state level. Click here to see the interactive version.
This is not a matter of politicians cleaning up leftover business or trying to finish what they started before moving on to other issues that are much less likely to get them accused of waging a war on women. These pretty much all indicate new legislation that politicians are introducing, despite their strongly stated desire not to be accused of waging a war on women. Apparently, people are just supposed to look the other way and pretend the war on women isn’t happening.
Not only is the war intensifying in terms of number of bills, but the bills themselves are getting worse. Ohio and Texas are good examples of how ugly things are getting, and how rapidly. Ohio Republicans have introduced an omnibus anti-abortion bill that would require forced ultrasounds, a 48-hour waiting period, a mandatory script full of lies, detailed instructions for doctors on exactly how they’re supposed to deliver the mandated shaming, and, bizarrely, a requirement that doctors tell patients how much they’re getting paid per abortion, as if doctors are salesmen working on commission. The myth that abortions are the result of profiteering instead of patient demand remains one of the primary examples of how the anti-choice movement never lets logic or sense factor into things; your average childbirth costs about 17 times as much as your average abortion. Just on that stat alone, we can safely assume doctors provide abortion because it’s the right thing to do, not because it’s some kind of awesome money-maker beyond all others.
Texas has its own omnibus bill, and Rick Perry’s misogyny is so completely out of control that he called a special session to try to get it passed. The bill’s requirements of hospital admitting privileges and making every abortion clinic an ambulatory surgical center are designed to shut down all but five clinics in the entire state, which is over 800 miles wide. While Texas anti-choicers have it out for all women, they apparently especially want to punish women in rural or suburban areas by forcing them to make long, expensive journeys to get abortions. (Or to buy black market abortion pills, an increasingly popular, if iffy on the safety front, option.) This is after, as Andrea Grimes reports for RH Reality Check, Texas voters were promised that Republicans would hang up the religious extremism for a while. Their religion supposedly forbids abortion, but apparently not dishonesty.
Needless to say, this kind of politically unpopular woman-hating garbage can no longer be seen as an attempt by politicians to get votes. On the contrary, these politicians are doing this despite the fact that voters don’t like it. At the end of the day, we have to accept that the rash of anti-choice legislation is due mostly to the fact that state offices have been positively filled up with men (and a handful of women) whose intense dislike of female autonomy and desire to strip women of their basic human rights overrides other concerns, such as maintaining their popularity. In some cases, they are hoping the voters aren’t paying attention enough to throw them out over it. In other cases, like Texas, they know that voters will hold their noses and re-elect a Republican even if he eats a live puppy on TV. Either way, they are determined to get this business of ending women’s basic human rights done.
A new report from the Census showing that the number of white people who died exceeded the number of white people who were born for the first time last year will only make things worse. The only thing that freaks out the conservatives who are pushing anti-choice legislation more than female autonomy is the possibility that white people won’t have a death grip on power for the rest of time in this country. That’s why, along with all this anti-choice legislation, Republicans are pushing for stringent voter ID laws, the only purpose of which is to harass and deny the vote to eligible voters who tend to lean left, to target people of color to prevent them from voting.
The perception, rightly or wrongly, on the right is that the decline in the white birth rate is because white women are too busy getting educated and leaning in to bother with babies. Of course, most of the decline is due to contraception more than abortion, but that’s OK from the anti-choice perspective, because they’re opening up the war on women to attack contraception too. Not that this is simply about trying to get white women to breed more (an attempt that’s probably doomed anyway). Restricting contraception and abortion access makes it harder for women to lift themselves out of poverty, and women of color are disproportionately harmed by such policies. Forcing women in poverty to pay hundreds, sometimes thousands, of dollars they don’t have just to get an abortion is a nifty way to set these women back financially, sometimes so much so that they never really recover. For conservatives who are trying to preserve white privilege, then, attacking reproductive rights is a twofer.
That’s why this isn’t going away, and even though it’s incredibly exhausting, pro-choicers have to settle in and realize the war on women is going to be a long, protracted fight. Conservatives, probably correctly, believe that if they don’t stomp out women’s hopes and dreams for better, more just, more liberated lives now, then they will probably never have another chance. That’s what we’re up against, and at least by knowing it, we will have a better chance of defeating them.
The American College of Obstetricians and Gynecologists, a national organization representing thousands of women’s health experts, has publicly come out against the state-level abortion restrictions that impact the way doctors are allowed to treat their patients. The group’s Executive Board has issued an official statement opposing all laws that “unduly interfere with patient-physician relationships” and compromise patients’ health care for political gain.
“Given the relentless legislative assault on the patient-physician relationship that we’ve seen in the past few years — and unfortunately continue to see — we were compelled to issue a formal Statement of Policy,” the group’s president, Dr. Jeanne A. Conry, explained in a press release. “A disproportionate number of these types of laws are aimed at women’s reproductive rights and the physicians that provide women’s health care services.”
In its formal statement, the doctors’ group criticized specific pieces of anti-abortion legislation that comes between women and their doctors — including forced ultrasound laws that require women seeking abortions to look at an image of their fetus before continuing with the medical procedure, “disclosure” laws that require doctors to tell women about the scientifically disputed link between abortion and breast cancer, and laws that require doctors to use an outdated procedure for administering the abortion pill.
The OB-GYNs point out that these type of laws allow legislators, instead of doctors, to set medical protocol. When doctors aren’t allowed to follow the current accepted medical practice because of a politically-motivated law, they aren’t able to provide their patients with the best quality of care. That dynamic has contributed to a serious shortage of women’s health doctors in states with harsh abortion restrictions, since medical professionals would rather avoid situations in which they may have to choose between providing their patients with the best health care and following a complicated state law.
“We are speaking out not just on behalf of OB-GYNs, but for all physicians and patients,” Dr. Conry noted. “Many of these laws are dangerous to patients’ health and safety. As physicians, we are obligated to offer the best evidence-based care to our patients. Government should stay out of imposing its political agenda on medical practice.”
This isn’t the first time that the College has weighed in on an area of women’s health that has become overly politicized by elected officials. Last fall, the group came out in support of improving women’s access to birth control by allowing them to buy it over the counter. It has repeatedly encouraged doctors to help reduce unintended pregnancies by providing teens with long-lasting contraception like IUDs. And, as the Obama Administration has continued to advocate imposing age restrictions on over-the-counter emergency contraception, OB-GYNs have reiterated that they don’t support preventing young teens from buying Plan B without a prescription.
Iowa Gov. Terry Branstad announced Friday that he expects to sign the state’s budget into law, including a new rule that will allow him to decide on a case-by-case basis whether Medicaid funds will be used to reimburse for abortion services when pregnancies are the result of rape or incest, when there are fetal abnormalities, or to protect the life of the woman.
The rule will give the anti-choice Republican governor complete control over federal Medicaid funding for the roughly two dozen Medicaid-eligible abortions that are performed in the state each year. It could also make many providers unwilling to offer abortions in cases that should be covered, because they won’t know if Medicaid reimbursement will occur.
As RH Reality Check reported in May, restricting access to safe abortion care for Medicaid patients has been a multi-year debate in the Iowa legislature, with anti-choice legislators repeatedly proposing bills or amendments, and even a direct query to the governor, in an attempt to deny reimbursement for almost all abortions that are eligible for Medicaid funding. This new tactic of allowing the governor to approve each case allegedly came about as a compromise between warring factions anxious to get final budget approval. However, it offers the potential for abortion opponents to get the all-out ban they wanted—Gov. Branstad’s could refuse to allow Medicaid reimbursements, or the lack of clarity regarding what he will and will not approve could make doctors afraid to offer services to begin with.
Branstad appears to have no desire to address that lack of clarity. When asked during an appearance on Iowa Public Television how he would approach the new protocol, he touted his opposition to abortion in all instances, though he admitted he would need to consider whether the funding rules apply. “As I understand it, the decision is not whether there’s an abortion or not, the decision is whether the state is going to approve funding, which is a decision that is made after the fact,” said Branstad, according to the Sioux City Journal. “So I’m not really going to have any say in whether this procedure occurs or not—I would discourage it wherever possible—but then I’ll have to make a decision whether or not it’s appropriate under the circumstances and under the guidelines that we have.”
It remains unclear what those “guidelines” are. Under the federal Hyde Amendment, all abortions performed in cases of rape, incest, or health of the pregnant person should be covered—though how those rules play out in practice leaves much to be desired. Iowa has traditionally also included cases of fetal anomaly, and for this year at least, those have been the majority of the abortions in question. As the Journal reports, there have been nine Medicaid abortion payment requests this year, of which eight were for medical issues with the fetus. Under Iowa’s traditional rules, all such procedures should be reimbursed, and under Hyde only one of them should be. Without specifically saying which “guidelines” he would consider, Branstad leaves most of this fiscal year’s cases in legal limbo.
Even more problematic than those ambiguities, and putting so much power over people’s reproductive decisions into one person’s hands, is the reinforcement of the idea that there are “worthy” and “unworthy” abortions—putting a value judgement on when it is appropriate to allow a person access to have an abortion. If and when Branstad does make his guidelines clear (which he would likely do out of fear that a denial in payment for a sexual assault case could put the state’s full Medicaid funding in jeopardy, not because of concern for reproductive rights), those value statements would get passed on to the public.
“This law seems to harken back to those days [when] outsiders get to determine if a woman’s reason for an abortion fits their prescribed list of ‘good enough’ reasons,” reproductive justice activist Steph Herold told RH Reality Check. Herold, who has focused much of her work recently on helping to reduce stigma surrounding abortion, noted that the governor’s new role isn’t unlike that of the original “hospital approved” abortion panels women often had to endure prior to legal abortion, where the pregnant patient would be required to prove herself worthy of needing the procedure.
“Medicaid should cover abortion. Period,” said Herold. “No one should have to be subject to a politician’s review to determine if their abortion warrants coverage. Iowa falls under the Hyde Amendment, meaning that Medicaid can only cover abortion in the case of rape, incest, or life threat. This is already unjust. Now the governor wants to make Hyde even more cruel by asking survivors of rape, incest, and medical emergencies to let him decide if their circumstances merit insurance coverage? What a callous law. It perpetuates the idea that some abortions are more deserving of insurance coverage than others, when really, all types of insurance—Medicaid and private health insurance—should cover abortion no matter the circumstance. No one should have to forgo rent to be able to access the health care they need.”
New Infographic: Contraception Is Highly Effective
By preventing unintended pregnancies, contraception provides significant health, social and economic benefits for women. But as this infographic documents, correct and consistent contraceptive use is critical.
The two-thirds of U.S. women at risk of unintended pregnancy who use contraception consistently and correctly throughout the course of any given year account for only 5% of all unintended pregnancies. The 19% of women at risk who use contraception inconsistently account for 43% of unintended pregnancies, while the 16% of women at risk who use no contraceptive method at all for a month or more during the year account for 52%.
These simple statistics demonstrate how effective contraceptive use can be. They also categorically refute claims by anti-contraception activists that access to contraception somehow leads to more unintended pregnancies and subsequent abortions.
In fact, most women having abortions were either not using any contraception or were using a method inconsistently. In 2000, the most recent year for which data are available, almost one-half (46%) of abortion patients were not using a contraceptive method in the month they got pregnant. Among the 54% of abortion patients who were using some form of contraception, the overwhelming majority acknowledged that their use was inconsistent, for example, because they had missed a pill or had not used a condom every time. The population of women obtaining abortions does not include the large majority of consistent contraceptive users, since they did not experience an unintended pregnancy and therefore never had a need for abortion services.
The contraceptive method used is also a factor. Users of highly effective methods, such as the pill and the IUD, are underrepresented among women who have abortions, compared with the general population. Meanwhile, users of less-effective methods, such as condoms and withdrawal, are overrepresented among abortion patients. But use ofany method is far more effective than using no method at all: Couples who do not practice contraception have approximately an 85% chance of having an unintended pregnancy within a year.
All of this is why debates around contraception should focus on ways to empower the one-third of sexually active women who want to avoid an unintended pregnancy but are not using a contraceptive method consistently and correctly. Among other steps, this includes
protecting and expanding programs like Title X and Medicaid that make family planning services accessible for low-income and young women;
removing cost barriers that prevent women from obtaining the methods they think are best for them, especially long-acting IUDs or implants, which are the most effective methods on the market (the Affordable Care Act’s contraceptive coverage guarantee is a big step toward increasing women’s access to these methods);
making emergency contraception available to all women over the counter without age or point-of-sale restrictions; and
developing new methods for women whose needs are not met by currently available contraceptives.
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Additional resources:
Facts: Contraceptive Use in the United States
Video: The Benefits of Contraceptive Use
Analysis: Besieged Family Planning Network Plays Pivotal Role
Analysis: The Case for Insurance Coverage of Contraceptive Services and Supplies Without Cost-Sharing
Analysis: Renewing Support for Contraceptive Research and Development
Research: The Social and Economic Benefits of Contraception
Research: The Preventive Benefits of Contraceptive Services and Supplies
Research: Contraceptive Use Is the Norm Among Religious Women
Republicans in the House Judiciary subcommittee voted on Tuesday to expand Rep. Trent Franks' (R-Ariz.) proposed D.C. abortion bill to apply to the whole country and advanced the bill favorably to the full committee. The bill would ban abortions after 20 weeks of pregnancy in the United States in all cases except those in which the mother's life is in danger.
All four Democrats on the panel voted against advancing the Pain-Capable Unborn Child Protection Act, arguing that it is unconstitutional and allows no exceptions for rape victims, incest victims, women whose health is endangered by a pregnancy, and cases of severe fetal anomalies. The 1973 Supreme Court decision in Roe vs. Wade protects women's ability to have an abortion up until the fetus is viable outside the womb, which is usually believed to occur around the 24th week of pregnancy.
Reps. John Conyers (D-Mich.) and Ted Deutch (D-Fla.) said they objected to the fact that all of the lawmakers debating the abortion bill are men and that none are doctors. "It is totally out of order for us to determine a medical question like this under the guise of acting as members of the very vital House Judiciary Committee," Conyers said. "No good has ever come from an all-male committee deciding the law about a woman's body. This is not appropriate."
Deutch said that watching "a group of men" make medical decisions on behalf of women is "hard for people to take."
"To insert a role of politics in all this, in what for [some parents] has gone from the greatest exulation they may have felt as a married couple to the depths of despair at learning they have found themselves in a situation they have to make that painful decision, is just not what we should be doing," he said.
All six Republicans on the panel voted in favor of the amendment to expand the bill nationwide. They argued that fetuses can feel pain after 20 weeks of pregnancy, a claim that is medically disputed, and suggested that the Supreme Court might eventually come around to their side on the abortion issue. Franks challenged the notion that his bill is part of what the Democrats have called a Republican "war on women."
Late-term abortions "have been happening hundreds of times every single day for decades in America," he said. "Those who incomprehensibly call trying to change this a 'war on women' overlook the fact that roughly half of these babies that are so torturously killed each day are just little tiny women."
