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New Year, New Legislation Supporting Abortion Rights

17 Jan

It’s easy to feel disheartened by the number of anti-choice laws, ballot initiatives, and court cases sweeping the country.  In 2013, 22 states enacted 70 abortion restrictions and everyday it feels like there is another major news story on how our reproductive rights are being restricted. With the start of a new year, there have been a flurry of articles arguing that 2014 could be a make or break it year for reproductive rights. In a lot of ways, 2014 already feels reminiscent to the restrictions we saw in 2013. This week the Judiciary Committee in the House of Representatives passed HR 7,  to prohibit taxpayer funded abortions, and the Supreme Court is hearing cases on the contraception mandate and the buffer zone surrounding abortion clinics. But in exciting news, we are also seeing new state legislation that would actually protect abortion rights! Here are some important bills for you to keep an eye on:

Washington’s Reproductive Parity Act

Currently abortion coverage varies greatly by insurance carriers and by state, and since the ACA requires that no federal funds can be used to cover abortion services, coverage is even harder to come by in the health exchanges. In a direct response to this ACA requirement, the Washington state legislature introduced a bill that would require all insurance policies that cover maternity care to also cover abortion services. This bill would not only increase access to covered abortion services but also make sure that abortion coverage would not be affected even by the ACA abortion provisions.

New York’s Women’s Equality Act

This 10 point plan was first introduced last year but failed to pass during the legislative session. Governor Cuomo recently re-announced his support for The Women’s Equality Act which addresses a number of important equality issues including equal pay, sexual harassment, and trafficking. In terms of abortion policy, this bill would codify Roe v. Wade into state law and ensure abortion access up to 24 weeks or when necessary to protect the life or health of a pregnant person (currently it only includes exceptions when a pregnant persons’ life is in danger).

New Hampshire’s Abortion Clinic Buffer Zone Bill

Similar to the Massachusetts’s law currently being debated in the Supreme Court, SB319 would establish a buffer zone around abortion clinics. By establishing a 25 foot buffer zone, this bill hopes to help protect patients from harassment and intimidation from protestors.

Vermont’s Bill to Decriminalize Abortion

Bill S315 was introduced last week to decriminalize abortion in the state. While abortion is legal in Vermont, there are old laws that criminalize performing and advertising abortion services. As a result, this would law would officially recognize a persons’ right to have an abortion in the state of Vermont.

The Women’s Health Protection Act 

While this isn’t an example of state legislation, it is an exciting development in Congress. In 2013, the Senate introduced the Women’s Health Protection Act that would prohibit states from passing TRAP (Targeted Regulation of Abortion Providers) laws. This law would make it illegal for states to pass laws impeding access to abortion services including building standards for abortion clinics, and mandatory ultrasound laws.

All of this legislation is still in the beginning of stages, but it is nonetheless an exciting step in the right direction. But why does this matter when Vermont, New Hampshire, Washington and New York already protect a person’s right to choose and there are so many other states that are restricting abortion services? Because it’s about the message it’s sending. Of course, ideally we want to be seeing this type of legislation introduced in states where people face significant barriers to accessing abortion services. But seeing efforts to protect abortion access is a huge deal and what I believe is an important part of changing the conversation about abortion policy. Since 2010, we have been bombarded with abortion restrictions and examples of our reproductive rights being threatened. While there have been victories in defeating ballot initiatives and court cases, and important community organizing and activism, at the legislative level we have mostly been on the defensive. It’s shocking to think that the last time Congress passed proactive abortion legislation was in 1994 with the Freedom of Access to Clinic Entrances Act! Seeing legislation introduced that protects the right to choose allows us to be on the offensive, gives us time to talk about why these issues matter and engage with communities and lawmakers. But most importantly, this type of legislation shows that no matter the number of anti-choice laws introduced, we are not done fighting.

So thank you Vermont, Washington, New Hampshire, New York and to all those supporting the Women’s Health Protection Act for bringing us some much needed positive news. Here’s to hoping 2014 is a year filled with a lot more of it.


Abortion and the ACA: What You Need To Know

11 Dec

I believe that health care is a human right, which is why I have been a long time supporter of health care reform. When the Affordable Care Act (ACA) passed, while I realized it wasn’t going to be the answer to all of our healthcare problems, I also knew that it was a step in the right direction.  And now it’s game time! The roll out of the ACA has started and I feel very strongly about being an out and proud fan of the ACA and doing everything I can to help it be as successful as possible. But the problem is, the ACA actually really sucks when it comes to abortion coverage and it’s been making me think, as an abortion supporter, how do I negotiate fully supporting a law that may actually make access to abortion harder?

Before we dive into that, let’s take a look at abortion coverage in the ACA.

1) Abortion cannot be listed as an essential health benefit. The ACA outlines 10 essential benefit categories that must be covered in health insurance plans, and the specific requirements are determined by each state. The ACA prohibits states from including abortion as an essential health benefit.

2) The Hyde Amendment is still in place. The Hyde Amendment, which prohibits the use of federal funding to cover abortions except in the case of rape, incest or endangerment of the life of the pregnant person, still applies. A big part of the ACA is the optional state expansion of Medicaid to persons up to 133% of the federal poverty guideline. While the Medicaid expansion is great for increasing coverage to low income people, with the Hyde Amendment in place Medicaid will continue not to  cover elective abortions unless someone lives in one of the 17 states that only uses state money to pay for abortions.

3) No federal funds, including federal subsidies used to buy health insurance, can be used to pay for elective abortions. If a health insurance plan in the healthcare exchanges offers abortion services for cases other than incest, rape or endangerment of the pregnant person, plans have to follow segregation requirements to make sure that no federal money is used to pay for abortion services. This means that individuals have to make two separate premium payments: one for the payment of abortion coverage which they have to use their own money for, and another payment for the remainder of the coverage which can use federal subsidies.

4) All state health insurance exchanges must offer one plan that does not cover abortion. But there is nothing that requires that there is at least one plan that DOES cover abortion.

Put all together, we end up with a system that fails to recognize abortion as an essential health right, expands the Hyde Amendment restrictions to more people, and creates a really complicated system for abortion coverage. Now it’s important to remember that the rules regarding the separate premium payments only applies to insurance bought in the state healthcare exchanges. So for people with private employer based insurance that covers abortion these rules won’t affect them. But considering that the health care exchanges are set up for people who should benefit from federal subsidies and don’t have any other access to health insurance, it continues to make access to abortion harder for people who may need it most. Also, the separate health insurance premium for abortion coverage, could act like an abortion rider that people can choose to purchase. So instead of someone just buying one insurance policy to cover everything, they’d have to choose to buy a separate policy for abortion coverage, and make two separate payments. But that takes away the whole point of having insurance because it’s supposed to protect us from the unexpected and as we all know, no one plans to have an abortion. What’s even worse is that insurance companies may become less willing to provide abortion coverage because of the hassle and red tape they have to go through to collect separate payments. And on top of that, there is also a lot of state variation. Already, 18 states have prohibited abortion coverage in any plans in the state exchanges and nine states have prohibited abortion coverage in the entire private health insurance market.

Basically that’s a lot of bad news. Sure, it’s great that the ACA will cover preventative services and now we can access birth control with no copay, but the problem is that people need access to the full spectrum of sexual and reproductive health care. People will always need abortions and we have a fundamental right to access them just like any other healthcare service. If the purpose of the ACA is to increase access to health insurance and consequently access to healthcare, it feels disingenuous to be perpetuating a system where not all healthcare services are treated equally. Not only does it affect access, but it continues the stigma and shame surrounding abortion.

So where do we go from here? The most important thing is to keep working hard to increase abortion access to those who need it. The ACA will make abortion funds, and sexual and reproductive health clinics as important as ever and they need our support and commitment. On top of that, we need advocates on the ground to help people navigate an ever changing system, and understand what their options are for abortion coverage. It won’t be easy, and at times it will feel really frustrating, which is why we also have to remember to put the situation in perspective. We have a broken health care system that needs to be fixed and the ACA finally offers an opportunity to start fixing the system slowly but surely. Obviously this doesn’t mean that the way the ACA treats abortion is justified, but it’s important to remember that this is just the first step in a long process. I am cautiously optimistic that the goal of the ACA to improve access to insurance and healthcare, will lead to deeper conversations and ideas about what that means and looks like on the ground. That’s why we have to remember that this fight is far from over. We have to keep talking about why abortion is an essential part of healthcare, so that we can grab any opportunity there is in the future to improve access and coverage of abortion services.

Same As It Ever Was: The incremental denial of abortion access in Texas

11 Nov

A guest post from Sarah Tuttle, Lilith Fund Board Member. 

The recent HB2 decision by the 5th Circuit Court of Appeals has meant a busy week in abortion access circles in Texas.  Many of us on the ground were unprepared for such swift action.  We were just adjusting to the 20 week ban which had come into effect, and were working to prepare for whatever came next.

Both the summer of action at the Capitol, and the swift motion of the court case, has awoken many people to the cause. We made jokes over the summer about taking a ship to international waters off the Gulf of Mexico where we’d have a doctor available to perform abortions. Joking was one of the only ways to shake the feeling that we were traveling back in time in an unexpectedly cruel way. It has been fantastic to see so many people rally, realizing a right we thought was secured by the Supreme Court was in such a vulnerable position.  For many people it was the first time they stopped to think about the effects that could ripple through the lives of Texans.

I serve on the Lilith Fund board and run our hotline committee. I’ve been with Lilith for a year and a half. And I’m here to remind you of something that I feel is lost, even when we talk with our allies.  Our clients are people. This isn’t just a cause. These are people’s lives, people’s families. Our clients are not just patients, stories, plantiffs, witnesses or data.

Passionate, well-meaning people from all over the country are calling and emailing Lilith to help, to donate,  and we are beyond grateful.  But when we get suggestions that we should start an “Abortion Underground Railroad,” we cringe.  This is not slavery.  This is not the time to appropriate the pain and suffering of generations of African Americans to try and comprehend our own.  Many of our clients our Latina and African American. We refuse to add insult to injury.

People are calling the Lilith Fund to offer rooms and rides to support abortion access.  We’re not the right people to talk to. There are practical support networks slowly growing around Texas to pool these resources.  These networks will be critical in the next few months, especially with the danger of the “Ambulatory Surgical Center” requirements looming in September. We could be down to a handful of clinics, and travel will become an even larger problem.

But the scope of the issue, of people being denied abortion because of lack of resources, this is not new. It is exacerbated by HB2, not created.  In just the last three years, we have been able to raise over $100,000 per year. Last year we provided over $80,000 in direct assistance to people who needed abortions. We do not come even close to meeting the state-wide need for financial assistance.

Even before HB2, Lilith was unable to meet the need of all our callers. We serve a portion of Texas (the rest is served by the Texas Equal Access fund).  Our hotline is open 3 half days a week. Each shift we get between 15-30 calls. We can usually fund less than half of them.  Our funds only cover a fraction of their abortion. For those who are earlier in pregnancy, perhaps we can cover a third of their procedure. For those further along we might only be able to cover a fifth, or a tenth. Our clients mostly get referred to us by clinics. We never even see those unable to reach a clinic.

The Lilith Fund has operated for over a decade. We work with our data to try and best meet our clients needs. We recently saw a dip in our redemption rate (how many clients actually redeemed their financial aid vouchers).  Data analysis revealed what you might have guessed: higher voucher amounts lead to higher redemption rates. Giving higher vouchers means helping fewer people. But obviously an unredeemed voucher implies no help at all.  We raised our voucher amounts.

Even this year, which has been an incredibly good fundraising year (for deeply frustrating reasons), we have nowhere near enough resources to meet the growing need for abortion funding. We talk to our clients to assess what their situation is, what other pressing needs they have. They may have a long way to travel.  They may have children that need looking after.  They may be struggling to get enough hours at work. There is not enough money to cover all their needs. When they call us they are already borrowing from friends, already pawning prized possessions. They are postponing their procedure a few more days till they get that next check, or taking from grocery money for a few weeks running.

When I give clients financial assistance vouchers, I am also giving practical support. My voucher frees up money for other things – maybe it is gas, or childcare. Maybe it is to pay rent.  When I give a client funding for an abortion, I am trusting her to decide what she needs. I am respecting her. As a person.

I understand the urge to give things, to share resources. But I think it is crucial to examine our motivations, especially when we reach out to those in need. One of the biggest indignities of poverty is the loss of choice. Not being able to choose the food you feed your family, not being able to choose the gifts you give your children at Christmas.  When I fund abortion, I hope that one of the things I’m giving is agency.  I respect you to look at your available resources and do what is best.

Our clients are people. They are not just stories, or placeholders, or ways for us to channel our activism. They are people who deserve respect, kindness, agency, and support while they live their lives. This isn’t just a cause, or something they can walk away from or take a break from. This is their life. In this moment, I hope we can provide the support they need.

Texas: A love letter

4 Nov

Dear Texas:

Like many of us, I was appalled and devastated to hear that the Fifth Circuit Court of Appeals blocked a lower federal court’s injunction that will force many of your abortion providers to close their doors. As of Friday, the Texas Tribune reported that at least nine abortion providers have been forced to stop providing services.

In the midst of all of this, your activists, providers, legislators, reporters, and others have worked tirelessly to make change and bring your fight into the national spotlight. Texas: your courage, determination, and mobilization has changed the way that I think about restrictive legislation, and has given the rest of the country hope that we can turn the tide.

Yet, when the bad news about HB 2 came out this week, I was appalled by the responses on my Twitter feed that I should give up on you, that I should have expected this to happen. Some said that Texans who care about reproductive health access should just move somewhere else. These folks were quick to judge you, Texas, but I imagine that they were singing a different tune during Wendy Davis’s game-changing filibuster and when they watched the sea of thousands in orange shirts united and committed to the fight. Are these people who are urging me to just give up on you the same folks who have donated to Wendy Davis’s campaign for Governor?

Texas: Don’t let these people get you down. (Not that you would, because you don’t take any shit.) Let the haters hate, and know that you have changed and reinvigorated all of us. You are facing extreme difficulties in an increasingly oppressive climate, but each time someone tries to knock you down you come back stronger.

Reasons for my love include but are not limited to:

The reasons go on and on, and I wish I could write a love note to each one of you who are fighting day in and day out. What I want you to know is that I care about you, no matter how many people want me to abandon you. I might not be able to be there in person, and I will never understand the huge barriers that you face. But I believe in you.

With all my love,


International reproductive Rights, May 24 edition: China, El Salvador, and Contraceptive Progress

24 May

China’s “one child policy” in the spotlight

China enacted its so-called “one child policy” over 30 years ago.  Facing a population boom, the government decreed that no couple could have more than one child (with a few exceptions) and strictly enforced this policy with prohibitive fines and, for those who were pregnant and could not pay, forced abortions.  Although in some cases these forced abortions have been documented and received international attention, it seems likely that every year millions of women in China are forced to undergo abortions they do not want or need.

Just as in most of the world, however, the policy is unequally applied, and exposes deeper injustices.  A recent op-ed in the New York Times highlighted the case of Zhang Yimou, a well-known film director who has 7 children (with 4 women).  According to the article:

The truth is: for the rich, the law is a paper tiger, easily circumvented by paying a “social compensation fee” — a fine of 3 to 10 times a household’s annual income, set by each province’s family planning bureau, or by traveling to Hong Kong, Singapore or even America to give birth.  For the poor, however, the policy is a flesh-and-blood tiger with claws and fangs.

Just as the option to choose when, whether, and how to have children in the United States is increasingly dictated by a family’s ability to pay for contraceptive and abortion services, Chinese women’s opportunities to have the number of children they want is dictated by their ability to pay a fine or travel for the privilege to give birth.  Either way, the end result is the same: reproductive injustice.

Beatriz continues to suffer due to “absolute” abortion ban in El Salvador

Beatriz is the pseudonym of a young woman who has been in a hospital in El Salvador for weeks.  She needs an abortion.  Those of you who are fans of the “Gang” know we don’t believe in exceptionalism; we think when a person says they need an abortion, for whatever reason, they need an abortion.  Unfortunately, most of the world does not agree with us and insists on defining which reasons for abortion are legitimate as a means of restricting access.

Even by the standards of exceptionalism Beatriz seems a likely candidate for access to an altogether too difficult commodity: a safe, legal abortion.  Beatriz has lupus, a disease that can worsen during pregnancy and puts her at increased risk of potentially lethal pregnancy-related complications compared with women who do not have lupus.  She also is suffering from kidney failure, a complication of her lupus that may be aggravated by her pregnancy.  Finally, the fetus she is carrying is anencephalic; it is missing parts of its brain and if it survives birth is unlikely to live more than a few hours.

Unfortunately for Beatriz, she lives in one of the most restrictive countries in the world when it comes to abortion.  While in almost all countries in the world the threat to her life would guarantee her right to an abortion to save her, El Salvador has no exceptions to its abortion ban, and no explicit exception to the ban to save a woman’s life.  Beatriz’s doctors have appealed to the country’s supreme court on her behalf, but it has deliberated for weeks without issuing a ruling.  Meanwhile, Beatriz is suffering.  Click here to sign a petition to the Salvadoran government asking them to uphold their obligation to protect her human rights and her life.

Uneven progress on improving access to contraceptives

A recent study that compared contraceptive use in low- and middle-income countries between 2003 and 2012 found a sharp increase in the number of women wanting to use family planning methods, from 716 million to 867 million.  There was a modest increase in the percentage of women who did not want to be pregnant who were using modern contraceptive methods, but population growth overpowered this effect.  While some progress has been made in some regions, mid and western African countries saw no increase in contraceptive use over the decade.  Another article in the same journal called for sustained efforts to provide contraceptive services to all women and couples who wish to delay or limit future childbearing.

International news roundup: Updates on Brazil, Circumcision, and UN Commission on the Status of Women

25 Mar

Brazilian doctors’ group urges decriminalization of abortion

As in many countries in Latin America, abortion is extremely restricted in Brazil. Currently, women can only legally have an abortion if the pregnancy results from rape, if their lives are threatened by the pregnancy, or if the fetus has a brain anomaly. Despite these restrictions, abortion is widespread, with an estimated 1 million Brazilian women undergoing abortions yearly. As in many countries where abortion is restricted, women with money can still get safe abortion care, while poor women must resort to unsafe abortions. The end result is an estimated 200,000 women per year hospitalized due to complications of unsafe abortions, making unsafe abortion the third most common reason for obstetrical hospital admissions and one of the top causes of maternal mortality in the country.

A group representing Brazilian doctors, the Federal Council of Medicine, is now urging federal lawmakers to allow abortions on demand in the first 12 weeks of pregnancy. The group has noted the strong impact unsafe abortion has had on public health in Brazil and also pointed out that current abortion laws in the country “are inconsistent with humanitarian commitments” and act paradoxically against “social responsibility and international treaties signed by the Brazilian government.” The Council represents 400,000 physicians; let’s hope they get more attention than the National Conference of Brazilian Bishops, which has already registered its distaste for this development.

No surgeon needed with new circumcision device

What do circumcisions have to do with abortion? Not a whole lot. But you may or may not know that circumcision does have a lot to do with reproductive justice for men and women living in countries with high HIV prevalence. Male circumcision, when performed by a skilled provider, reduces a man’s risk of acquiring HIV from an HIV-positive woman by about 60%. Unfortunately, it doesn’t appear to work the other way; that is, circumcision of HIV-positive men does not protect their female partners. However, by protecting men from acquiring HIV, their partners are likewise protected. Because many women do not have control over condom use in their relationships, and because try as we might we are still nowhere near 100% condom use, offering voluntary circumcision to men is one of the most promising interventions available to decrease the spread of HIV.

Despite this, scale up of voluntary male circumcision has been slow. Although there are many reasons for this, the skilled health worker shortage in low-income countries is a major barrier to increased implementation of male circumcision. The New York Times reported this month on the PrePex device, an inexpensive tool that, after being left on for about one week, causes the foreskin to drop off. Best of all, applying it takes less time than surgery and no surgeon is needed; nurses and medical officers can learn to use the device quickly.

UN Commission on the Status of Women makes important strides

Although some activists feared that, as happened last year, no outcome document would be agreed upon after this year’s Commission due to attempts from conservative actors (such as the Holy See, Iran and Syria) to derail negotiations, in the end a document was produced (see a draft here).

In addition to reaffirming important previous international agreements made in Beijing and Cairo, the document condemns violence against women, calls upon states to protect women and girls from violence, promotes education for all as a human right, and recognizes the need for women to be fully integrated into economic and social life. It also states that women who have been raped have the right to emergency contraception and safe abortion where permitted by local laws.

I of course would have liked to see more about the right to contraception (which is a right for all women, not exclusively those who have been raped) and safe abortion regardless of context or local laws, but with conservative forces working for months behind the scenes to prevent any progress, I consider this a small step forward.

New Pope in Rome But Same Anti-Contraception, Anti-LGBT Policies Will Endure

14 Mar

There had been black smoke for days, a signal from the conclave of cardinals that they had yet to decide the new leader of the Catholic Church. Yesterday morning as those of us on the west coast were heading to work, reports came in that white smoke now billowed from the Sistine chapel, a new pope had been chosen.

Meet Jorge Bergogolio, the archbishop of Buenos Aires, now known as Pope Francis I . As the Bishop of Argentina, he opposed Argentina’s leadership on birth control access, he is anti-abortion, anti-condom, and anti-LGBT* rights. A new pope, but no new policies. As he enters the papacy, he has a host of scandals and abuse issues to address.

those problems included reforming the Roman Curia, handling the pedophilia crisis and cleaning up the Vatican bank, which has been working to meet international transparency standards.

Pope Francis is the first Pope from the Americas, and it is said that his election indicates the Catholic Church’s focus on the global south. He grew up in Argentina as the son of Italian immigrants and studied to be a chemist. He has been known for his love and constant study of philosophy. On first look, he may appear a fresh choice for the Church. Upon closer inspection it is clear that the new Pope is more of the same.

For women and families in the global south, new efforts from a conservative Pope Francis’ church could spell disaster. The Catholic Church has previously denounced spreading information about wearing condoms, and have resisted calls to widen access to contraception in poor countries. With the election of this new, more conservative, Pope, all hope that the Church may change their ideology is lost.

While he is known for modernizing an Argentinian church considered to be among the most conservative in Latin America, he is also known for his strict views on morality — having staunchly opposed same-sex marriage, contraception and abortion.

He has called adoption by gay parents a form of discrimination against children — a stance that was publicly criticized by Argentinian President Cristina Fernández de Kirchner.

There you have it, more of the same. And while the new Pope is renowned for his HIV /AIDS work and his outward showing of compassion for the poor, his policies are no less hateful.