Backlash Against the Misogynists

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abortion access, abortion laws, Citigroup, Lyft, Maryland, reproductive health, Texas, Uber, Yelp

According to the Guttmacher Institute, the year 2021 saw the passing of the largest quantity of anti-abortion legislation since 1973, when a woman’s Constitutional right to have an abortion was established in the U.S.  And the U.S. Supreme Court still seems on track to either drastically weaken or overturn Roe v. Wade this summer.  Amid all the depressing news, however, there are some bright spots.  Most of the positive developments are outside of the U.S.—the vocal and successful women’s reproductive rights campaigns in various countries of Latin America, for example.  But a few recent actions in the U.S., including several by companies in the state of Texas, have pushed back against the vicious misogyny of many state legislators and their supporters.

Citigroup, a major financial enterprise with over 8,000 employees in Texas, has announced that it will pay travel costs for any of them who are affected by SB-8.  This is the Texas law that not only bans abortion after six weeks, but also threatens lawsuits against anyone involved in assisting someone to circumvent the law (for example, by facilitating travel of a Texas resident to a more woman-friendly state). 

The transportation companies Lyft and Uber have also announced policies in defiance of SB-8.  They have offered to pay expenses for any of their Texas-based drivers who might get sued for taking a woman to an abortion clinic.

Yelp, the online search and review company, has said that their over 200 employees in Texas will be reimbursed for expenses if they need to travel out of state for abortion care.  Moreover, representatives of Yelp have stated that the reproductive health guarantees offered to their Texas workforce will be extended to their employees in any state who might face “current or future action that restricts access to covered reproductive health care.”  Employees will be able to submit their requests for reimbursement of abortion-related medical expenses directly to Yelp’s health insurance provider, so neither fellow Yelp workers nor officious misogynists trying to enforce SB-8 or similar legislation will be able to track the persons involved.  This latest action builds upon several years of Yelp’s efforts in support of abortion rights.  The company does not allow anti-abortion entities of the “crisis pregnancy center” type to portray themselves neutrally or masquerade as abortion clinics.  And in the months leading up to the passage of SB-8 Yelp offered to double-match employees’ donations to reproductive health rights organizations opposing the legislation.

Yelp and Citigroup will support the expenses of employees in Texas who need to travel out of the state for abortion or other reproductive health needs; Uber and Lyft will cover the expenses of any driver who is sued for transporting a woman to get an abortion.

Meanwhile, back in the state of Maryland legislators are the latest to take a stand in defense of reproductive health rights.  A bill scheduled to take effect July 1 of this year allows nurse practitioners, nurse midwives, and trained physicians’ assistants to perform abortions, requires insurance providers to cover abortion costs, and apportions $3.5 million per year for abortion training.  Maryland’s Republican governor Larry Hogan vetoed the bill, but under the leadership of the Speaker of Maryland’s House of Delegates, Democrat Adrienne A. Jones, the House overrode the veto by a vote of 90 to 46; and the state Senate concurred with a 29 to 15 override.  Maryland joins California, Colorado, Connecticut, Hawaii, Illinois, Maine, Massachusetts, Montana, New Hampshire, Oregon, Vermont, Virginia, Washington and West Virginia in permitting abortion to be performed by medical professionals other than physicians, and it is one of sixteen states that provide at least some state funds for abortions.

Sources for this piece include the Guttmacher Institute website and April 10 and April 12 articles in the New York Times.

Adrienne A. Jones, Speaker of the Maryland House of Delegates

With a Little Help from Their Friends

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abortion, abortion access, abortion laws, Colombia, Dr. Jorge Villareal, Latin America, Oriéntame, reproductive health, Roe v. Wade

Latin American reproductive health rights activists have logged another victory.  Last week the Constitutional Court of Colombia (the highest court in the country) voted five to four to decriminalize abortion in the first twenty-four weeks of pregnancy.  Colombia thus joins Mexico and Argentina in decriminalization, which means that three of the four most populous countries of the region have taken a major step toward making abortion legal and accessible.  (Brazil’s vocal feminist movement is pushing for legalization, but so far has had no success.)

Colombian reproductive health rights activists are quick to point out that their victory owes a lot to their relationships with activists in other parts of Latin America.  The Colombians consulted with movement lawyers from Mexico, adopted street theatre performances originating in Chile, and wear the distinctive green kerchiefs first used by women activists in Argentina.

Latin American feminists know that the constant sharing of strategies and tactics across the region has made all of their movements stronger and more vibrant.  They contrast their recent successes with the string of TRAP laws in many U.S. states and the ominous probability that the U.S. Supreme Court will reverse Roe v. Wade this summer.  Catalina Martínez Coral, a lawyer and member of Causa Justa, the coalition of abortion rights groups that brought the relevant case to the Colombian Constitutional Court, noted that the waves of feminist activism are “now an inspiration going south to north… We are going to inspire people in the United States to defend the rights set out in Roe v. Wade.”  Serra Sipel, the chief global advocacy officer at Fòs Feminista, an international alliance of reproductive rights groups, agrees, saying “We in the U.S. can really learn a lot” from Latin American feminist organizations.

Some of the roots of Colombia’s reproductive rights movement can be traced back to a visit to the U.S. by the eminent Colombian obstetrician/gynecologist Dr. Jorge Villareal Mejía.  Dr. Villareal toured some of the first legal abortion clinics that opened after the Roe v. Wade decision and decided to find a way to offer similar services in his homeland.  In 1977, he opened the first of his Oriéntame clinics in Bogotá.  The clinics offered a full range of reproductive health services, including abortion.  They charged on a sliding scale, and their promotional materials delicately urged their more affluent clients to contribute to the costs of procedures for poorer women.

Dr. Jorge Villareal Mejía (1927-2001)

I have known about Oriéntame since the early 1990s. Before full legalization of abortion in Colombia I referred to it by a pseudonym in my writing, in particular in my book Sex and Herbs and Birth Control.

Under Dr. Villareal’s direction the clinics pursued a remarkable two-pronged strategy.  On the one hand, Oriéntame skirted the question of illegality of abortion by labeling its services as “walk-in patient treatment of incomplete abortion.”  As a medical director of the organization once explained to me, a sympathetic Jesuit priest reconciled his support for Oriéntame with the Catholic view of abortion as a sin by reasoning that once a woman decided in her mind to have an abortion, she had begun the process.  Oriéntame personnel were merely aiding her to complete her abortion safely.  And indeed, in the forty-five years of their existence the clinics have performed close to a million abortions with a vanishingly small number of serious complications.

The second aspect of Dr. Villareal’s vision involved a brilliant outreach program.  To quote from Sex and Herbs and Birth Control (in which I referred to Oriéntame as CRH, or Centers for Reproductive Health): “CRH offers scholarships to midwives and doctors from other areas of Central and South America who might want to set up similar clinics.  They have trained over 600 physicians, nurses, physicians’ assistants, and traditional as well as licensed midwives in vacuum aspiration abortion techniques; their students perform abortions in clinics in Bolivia, Colombia, Ecuador, Guatemala, Mexico, Paraguay, Peru, Uruguay, Venezuela, and elsewhere…. In Peru I met a director of the country’s society of women obstetricians who had attended the program and was an enthusiastic advocate of the idea; I’ve run into CRH graduates in Nicaragua and Chile as well.”

Oriéntame personnel have not only trained numerous reproductive health specialists from all over the region in the latest abortion techniques.  They have also shared their expertise in how to make use of the legal exceptions in various law codes to increase women’s options.  As Giselle Carino, an Argentinian activist in Fòs Feminista, noted: “Without a doubt, we learned from the Colombians.”

Although for large portions of its history Oriéntame managed to steer clear of police harassment, a spate of incidents in 1994 encouraged Dr. Villareal’s daughter Cristina, who was taking over directorship of the organization from her father, to reach out to feminist groups in order to unite with medical practitioners to try to change Colombia’s laws.  Cristina Villareal joined with others to form the coalition La Mesa por la Vida y la Salud de las Mujeres.  In 2006 the group’s efforts caused a broadening of legal exceptions in which abortion was permitted in Colombia, and full decriminalization through twenty-four weeks was achieved in late February of this year.

Oriéntame and its international training program continue to offer reproductive health services in Colombia, train physicians, midwives, and healers, and advise affiliates on the best ways to navigate legal pitfalls.  But, as feminist activists in Latin America know and their counterparts in the U.S. are finding out, it does not pay to be too complacent.  As Cristina Villareal warns, “This is a battle that is never completely won… You can’t let your guard down.”

Sources for direct quotes are February 21 and 23, 2022 New York Times articles by Julie Turkewitz.  Additional information can be found at https://orientame.org.co (Spanish) and https://orientame.org.co/en (English).

“Fetus-Centered” yet High Infant Mortality

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abortion, abortion access, abortion laws, Caesarian sections, infant mortality, maternal mortality, prenatal care, reproductive health, U.S. Supreme Court

January 23, 2022 marked the forty-ninth anniversary of the landmark U.S. Supreme Court decision Roe v. Wade. Unfortunately, given the current right-wing composition of the Court, Roe v. Wade is unlikely to make it to the fiftieth anniversary.  The Court is expected to uphold a Mississippi law prohibiting abortion after fifteen weeks from a woman’s last menstrual period, which is at approximately thirteen weeks of fetal gestation.  Mississippi’s governor has repeatedly boasted that the state will continue its efforts to make Mississippi “abortion-free,” and he and his supporters have drafted a number of anti-abortion laws that will go into effect as soon as Roe v. Wade is overturned.  Conspicuously absent from any of this bluster is any attempt to improve the lot of pregnant women, including those who wish to bring their pregnancies to term.  Mississippi does a horrendous job of protecting pregnant women, mothers, and newborns.

Mississippi is not the only state whose legislators are eagerly awaiting the demise of Roe v. Wade.  It is also not the only state whose politicians style themselves as “protectors” of pregnant women and their fetuses.  As in other states in this category, the sanctimonious pronouncements hide a sordid reality of neglect and unconcern for those the grandstanders claim to value.  Mississippi is woefully inadequate in providing prenatal care to its large population of uninsured pregnant women, ranks worst in the nation in health care access and quality, and has the second-highest rate of teen pregnancies in the U.S. (after Arkansas).  It also has high rates of infant mortality, premature births, and low-birth-weight infants. 

As it turns out, the same coercive circumstances that make abortion access difficult or impossible in many parts of the U.S. also contribute to bad outcomes for pregnant women and newborns.  It’s well known that the U.S. has the highest rates of maternal and infant mortality in the industrialized world.  The rates vary widely by region of the country and economic circumstances, with anti-women states like Mississippi leading the way and with the greatest negative impacts on women of color and the poor.  Despite pious platitudes about protecting women and “the unborn,” these states stand out for their callous treatment of women seeking to carry their pregnancies to term.

Recently, I reviewed a book by Louise Marie Roth titled The Business of Birth: Malpractice and Maternity Care in the United States (New York University Press, 2021).  I confess, I wasn’t super-enthused at first.  The subtitle seemed to suggest a rather narrow focus on the intricacies of U.S. tort law and the details of malpractice suits stemming from unfortunate outcomes for pregnant women and newborns.  However, in reality the book has a much broader scope.  The author paints a fascinating, albeit often distressing, picture of the complex interactions of medical practitioners, hospital administrators, insurance providers, malpractice attorneys, and state legislators.  Often the result is a toxic mix of circumstances leading to huge numbers of unnecessary Caesarian sections and chemically induced deliveries, coercion of pregnant women (especially poor, rural, and minority women), outrageously expensive pregnancy care, and, as noted above, the highest rates of maternal and infant mortality in the developed world.  Roth supplements her analyses of changes in law codes and standards of care with interviews with obstetricians, nurse-midwives, lawyers, and insurance adjusters.  The upshot is that less affluent and less educated women can be pressured into episiotomies and repeated Caesarian sections, rendered virtually immobile during labor by the exigencies of constant electronic fetal monitoring, and have their deliveries artificially induced on a Friday so obstetrical staff don’t need to come in on the weekend (resulting in the weekend birth decline notable in many U.S. hospitals).

Roth describes the misleading and often false information medical personnel cite to compel women to consent to procedures that in many cases are unnecessary, expensive, and possibly harmful.  Repeated Caesarian sections, for example, present increasing risks of future pregnancies ending in miscarriage or stillbirth, yet hospital administrators urge or even force them on women ostensibly because of overblown fears of malpractice suits.  But nervousness about legal liability is only part of the story.  In the period 1995 to 2015 the odds of a Black woman with low risk of delivery complications being given a first-birth C-section were 35% higher than for non-Hispanic white women.  The odds of being coerced into repeated C-sections were also higher for Black women. 

There are obvious parallels to the plethora of misinformation pushed on women seeking abortion in many states.  In fact, Roth makes it abundantly clear that the same forces that constrain women’s access to abortion work to prevent many pregnant women’s access to the best care for themselves and their newborns.  

Reproductive health regime	Fetus-centered	Woman-centered
	Mississippi	Oregon
Infant mortality (per 1000 live births)	11.46	5.99
Maternal mortality (per 100,000 live births)	20.8	12.8

Roth distinguishes between fetus-centered and woman-centered reproductive health regimes and persuasively argues that pregnant women and their offspring are better served in states that protect abortion rights “and prioritize women’s rights over fetal life” (p. 10).   She gives numerous examples of both types of reproductive health regimes.  Particularly striking is her comparison of Oregon and Mississippi.  Oregon has no TRAP laws, requires comprehensive health insurance to cover prescription contraceptives and abortion, permits nurse practitioners to provide both medical and surgical abortions, and covers abortion services for the poor with state funds.  The state, emphatically a woman-centered reproductive health regime, has below-average rates of teen pregnancy and infant mortality, good state-supported prenatal care, and above-average maternity care outcomes.  By contrast Mississippi, the epitome of a fetus-centered reproductive health regime, has a large number of TRAP laws, long mandatory waiting periods, and extreme anti-abortion measures that are set to become law as soon as Roe v. Wade is overturned (which will probably happen this summer).  And, Roth would argue, not coincidentally, Mississippi has some of the worst maternal and infant mortality statistics in the country.

Women of Texas: South of the Border for Reproductive Rights

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abortion, abortion access, abortion laws, Mexico, reproductive health, Supreme Court of Mexico, Texas, U.S. Supreme Court

The U.S. border with Mexico

As anyone knows who follows the status of women’s reproductive rights in the U.S., access to safe, legal abortion is becoming more and more difficult.  Onerous laws are increasingly widespread, especially in Republican-dominated states.  The worst of them is the recently passed Texas SB-8, which prohibits all abortion after fetal heartbeat can be detected (approximately six weeks gestation)—a time at which most women are not even aware that they are pregnant.  Moreover, SB-8 deputizes private citizens to sue not only anyone who performs an abortion, but also anyone who “aids and abets” the procedure, be they clinic staff, counselors, nonprofit employees who arrange financing, even Uber drivers taking women to appointments.  The law has been described as a “bounty hunter system.”  Plaintiffs, who do not have to show any connection to the abortion recipient nor do they even have to live in Texas, are awarded $10,000 plus legal fees if they win their case; successful defendants get nothing.

Abortion rights protest in Washington DC

Health rights activists fear that the Supreme Court, whose three Trump appointees are extremely reactionary, will overturn the landmark 1973 Roe v. Wade decision affirming women’s constitutional right to abortion. In response to appeals to block the Texas law pending judicial review, the Supreme Court ruled 5-to-4 to let the law go into effect. The dissenting justices included the normally quite conservative Chief Justice John Roberts, who called SB-8 “not only unusual, but unprecedented,” and said that the law should have been blocked while appeals were underway.  Justice Sonia Sotomayor labeled SB-8 “a flagrantly unconstitutional law engineered to prohibit women from exercising their constitutional rights.”  Justice Elena Kagan called her five colleagues’ refusal to block the Texas law “unreasoned, inconsistent and impossible to defend.”

Justices Sonia Sotomayor (above) and Elena Kagan (below) of the U.S. Supreme Court

On September 9 Attorney General Merrick Garland announced that the U.S. Department of Justice was filing a challenge to SB-8, which he called “clearly unconstitutional” in part because it allows individuals to infringe upon the constitutional rights of others.  Meanwhile, however, abortion services in Texas are in complete disarray.  Dr. Bhavik Kumar (a Planned Parenthood physician who is one of the plaintiffs in a lawsuit against SB-8) has had to turn away numerous panicked women whose pregnancies are past the SB-8 cut-off, and he worries that they will have to resort to unsafe means to end their pregnancies.  Dr. Kumar stresses that it’s plain to all who know anything about women’s reproductive decision making that “banning abortion does not change the need for abortion.”  The women Dr. Kumar’s clinic usually helps will have to go elsewhere.

A Great Step Forward in Mexico

Ironically, for many Texas women, the closest accessible, safe, and reasonable abortion possibility might be across the border in Mexico.  At the same time that five U.S. Supreme Court justices are callously displaying their disregard for the safety and constitutional rights of women, on September 7 the Mexican Supreme Court, in a unanimous decision, ruled that making abortion a crime is against the constitution.  Mexican Chief Justice Arturo Zaldivar noted that the decision “is a watershed in the history of the rights of all women, especially the most vulnerable.”  The decision opens the way for challenges to the laws in most Mexican states that criminalize abortion, and also allows activists to petition for the release of women jailed for the procedure.  Mexican feminist organizations are hopeful that the twenty-eight states that ban abortion under most circumstances will soon be compelled to join Oaxaca, Hidalgo, Veracruz and Mexico City in allowing first trimester abortion.  Mexico will become the fifth Latin American country (joining Argentina, Cuba, Guyana and Uruguay) to decriminalize the procedure.

Chief Justice Arturo Zaldivar of the Supreme Court of Mexico

Some feminists are fully aware that the unanimous decision of Mexico’s Supreme Court stands in stark contrast to what Justice Sotomayor called the “stunning” irresponsibility of her Supreme Court colleagues in the U.S.  Paula Avila-Guillen, executive director of the Women’s Equality Center, said that the Mexican decision is a bright spot in the fight to protect women’s reproductive rights worldwide.  Avila-Guillen saw reason for optimism in Latin America “even as we see the U.S. Supreme Court and Texas walk women back into darkness.”  She also pointed out that the Mexican court’s decision specifically struck down the state of Coahuila’s anti-abortion law.  Coahuila borders Texas, so it could very well be that Texas women will be among those to benefit from Mexico’s ruling favoring women’s reproductive rights.  Avila-Guillen mused: “Could the safest way for Texan women to have access to a safe, legal abortion soon be to make their way to Mexico?”

(Sources consulted include pieces in The New York Times, Axios, CNN and NPR.)

Abortion Access During the Pandemic

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abortion access, Colombia, COVID-19, Germany, U.S., unwanted pregnancy

Last time, I commented on the efforts of anti-abortion politicians in Alabama, Oklahoma, Texas, and other U.S. states to restrict women’s reproductive rights by declaring abortion a “nonessential” procedure. An article that appeared on 14 June 2020 in The New York Times (“Coronavirus Created an Obstacle Course for Safe Abortion”) discusses the obstacles that exist in some other countries as well. That article, along with websites of UNFPA, WHO, and NPR, are the sources for this post.

Julie Burkhart, a former associate of the murdered abortion doctor George Tiller, founded “Trust Women,” a group that operates clinics in Oklahoma and Kansas. She has commented on the ways that anti-abortion forces are using the COVID-19 pandemic as an excuse to further corrode women’s abortion access. Desperate women have no choice but to travel hundreds of miles in search of abortion. Burkhart’s Kansas clinic has been registering huge increases in patients, many of whom are fleeing from the lockdowns in other jurisdictions. In a recent week, she noted, her clinic saw 250 women, compared to forty per week in more normal times.

The U.S. situation is particularly bleak for a so-called “developed” country, both because of the pandemic’s economic consequences falling disproportionately on poor women and women of color, and because of the highly politicized nature of abortion access here. But even in countries such as Germany and Austria, where women’s reproductive rights are less restricted, public health officials apparently forgot about abortion when they made lists of time-sensitive procedures that should be available immediately rather than postponed. Feminist activists had to remind regional governments and individual hospitals to consider women’s reproductive health and include abortion as an essential, time-sensitive medical need. Another problem in Germany is that some abortion providers themselves are in at-risk categories. In one rural district of Bavaria, for example, the only abortion doctor is over seventy and so had to stop to guard his own health.

There have been some bright spots. France, Ireland, England, Scotland, Wales and Colombia have loosened their restrictions on telemedicine. They now permit at-home use of pills for early abortions after a phone or online consultation with a doctor. Health activists are hopeful that this relaxation will continue after the dangers of the pandemic have passed.

In Colombia, professionals in the Orientame reproductive health clinics note that contraceptive access in rural and underserved areas can be erratic under the best of circumstances, so telephone and online consultations for early medical abortions are an important aspect of women’s reproductive health services in the country.

Dr. Natalia Kanem, Executive Director of UNFPA

As always, the worst effects of the coronavirus and the accompanying economic dislocations have hit and will continue to hit women of scarce resources all over the world. Women’s health rights activists and officials of the United Nations sexual and reproductive rights agency UNFPA have been sounding the alarm for months. In April UNFPA’s executive director Dr. Natalia Kanem warned that the travel restrictions and disruptions to regular clinic services caused by the pandemic could result in an added seven million unintended pregnancies worldwide. “As a corollary,” Kanem noted, “unsafe abortions will increase.” Earlier this month the World Health Organization went further, predicting dire consequences if poor countries either cannot or will not support continuing reproductive health services at pre-pandemic levels. “Even a 10 percent reduction in these services could result in an estimated 15 million unintended pregnancies, 3.3 million unsafe abortions and 29,000 additional maternal deaths during the next 12 months,” the WHO warned.

Cautious Optimism after a U.S. Supreme Court Decision

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abortion, abortion access, abortion restrictions, anti-abortion movement, reproductive health, Texas, TRAP laws, U.S. Supreme Court, Uruguay

Over the past few days, the news media as well as social media platforms such as Facebook and Twitter have been abuzz with news of the U.S. Supreme Court’s 5-to-3 decision in the Whole Women’s Health v. Hellerstedt case. The court struck down the Texas state legislature’s 2013 restrictions on abortion clinics; these restrictions had already caused half the abortion clinics in Texas to close, and threatened many more. A June 27 article in The New York Times called the decision “the court’s most sweeping statement on abortion since Planned Parenthood v. Casey in 1992, which reaffirmed the constitutional right to abortion established in 1973 in Roe v. Wade.”

Justices Sotomayor, Ginsburg, and Kagan. There was a gender gap in the 5-to-3 decision. The women justices voted 3-to-0 to throw out the Texas TRAP law; the men voted 3-to-2 in favor of the Texas restrictions.

People interested in women’s reproductive health have heralded the decision as signaling the likely end of most of the so-called TRAP laws (targeted restrictions on abortion providers) so beloved by right-wing state legislators all over the country. Indeed, anti-abortion forces view Whole Women’s Health v. Hellerstedt as a shocking defeat. (The Washington Superior Court ruling against the Skagit County hospital district for failing to provide abortions that I was so pleased about last week seems like very small potatoes in comparison.)

I have to admit that when I first heard of the Court’s decision, I was as ecstatic as anyone else, and did not particularly cavil at the descriptions of Whole Women’s Health v. Hellerstedt as being a death-blow to the U.S. anti-abortion movement. Upon reflection, however, my enthusiasm has become more measured. Such court decisions are welcome, of course. But history has shown us that one cannot rely upon the courts to ensure fair treatment. After all, the Miranda v. Arizona court decision of 1966 (which limited police powers and required that arrested persons be informed of their right to a court-appointed lawyer) has not notably resulted in equal justice for the poor. And anyone who knows anything about the recent history of abortion in the U.S. is well aware that neither Roe v. Wade nor Planned Parenthood v. Casey ensured access to abortion for women of scarce resources outside of certain major metropolitan centers.

Anti-abortion zealots are already regrouping, and strategizing about what their next moves will be. Their onslaught against the health rights of women over the past few decades has been unceasing, and there is no reason to assume that they will view Whole Women’s Health v. Hellerstedt as anything other than a temporary setback. The TRAP laws have certainly been an effective tactic. But women are also denied access to abortion through intimidation of health care professionals and patients at the doors of clinics, cuts in funding to clinics that provide reproductive health services to the poor, and the failure of more than a handful of medical schools to require their students to learn procedures to terminate pregnancy.

It is, of course, far better for abortion to be legal than illegal. But that is not the end of the story. Sometimes a place where abortion is illegal can have better access than certain other places (such as many rural regions in the U.S.) where it is legal. Take, for example, the South American country Uruguay, which in 2012 became the second country in Latin America and the Caribbean (after Cuba) to legalize abortion under a broad range of circumstances. Interestingly, already for a decade or so before legalization, Uruguay had succeeded in drastically reducing maternal mortality from unsafe abortions by means of “before” and “after” appointments for poor women at the public hospital. Physicians would see women contemplating illegal abortions to instruct them in the correct administration of misoprostol/Cytotec, though they would not provide information on how to acquire the drug (which in any case was freely available over the internet). After the women self-aborted chemically, Uruguayan physicians would confirm completeness of the procedure and if necessary perform a uterine aspiration if there were any complications. This subtle skirting of Uruguay’s abortion prohibitions has come to be known as the “Uruguay Model,” and has been informally adopted by doctors in other countries with restrictive abortion laws, such as Uganda, Tanzania, and elsewhere. See the article by Patrick Adams in The New York Times.

News from Washington State: Hope on the Abortion Front

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abortion access, abortion laws, in vitro fertilization, religious fundamentalism, Senator Patty Murray, veterans, Washington State

Anyone who is concerned about reproductive health issues has had plenty of bad news in the past few years. In Latin America and the Caribbean the menace of the Zika virus has caused governments to warn women against becoming pregnant, in most cases without loosening restrictive anti-abortion laws or providing increased contraceptive options. Despite problems of access, Guttmacher Institute scientists estimate that women of the region have about 6.5 million abortions per year (https://www.guttmacher.org). Most are illegal, many are performed under unsafe circumstances, and at least 750,000 women per year experience post-abortion complications.

In the U.S. more and more state legislatures have enacted so-called “TRAP” laws (targeted regulation of abortion providers) (http://www.reproductiverights.org/project/targeted-regulation-of-abortion-providers-trap) making it difficult if not impossible for many abortion providers to continue to offer the procedure. And Planned Parenthood clinics are under constant threat of losing state and federal funding despite the fact that most offer a full range of women’s health services (including cancer screening, in vitro fertilization, and sex education) that would not otherwise be accessible to women of scarce resources.

The U.S. is not a monolith, however. TRAP laws and other threats to women’s reproductive health do not affect all parts of the country equally. Take, for example, the Pacific Northwest. In 1991 voters in the state of Washington sent a clear message when they acted to limit Christian fundamentalists’ ability to curtail women’s abortion rights. By means of a direct popular vote, Washington residents enacted the Reproductive Privacy Act (RPA), which bars the state legislature from passing abortion restrictions, requires the state to finance abortions for poor women, and mandates that any public hospital that offers maternity services must also provide abortion services.

In 2015 the American Civil Liberties Union of Washington sued the Skagit County public hospital district on the grounds that Skagit County was referring women desiring abortions to Planned Parenthood clinics rather than offering the service themselves. The county claimed that their hospitals had no physicians willing to provide abortions and cited the RPA provision allowing individual doctors to opt out of doing abortions. But Skagit County Superior Court Judge Raquel Montoya-Lewis has ruled that the hospital district is required to find someone willing to provide abortions since they provide maternity services, and that the individual opt-out provision of the RPA cannot be employed at the county-wide level. The victory is a small one, of course, and it remains to be seen whether Skagit County will appeal the court decision. But at least the case has served to remind people in Washington State of the RPA and its provisions.

U.S Senator Patty Murray of Washington State

Another intriguing battle being waged right now concerns Washington Senator Patty Murray’s efforts to get the federal government to pay for reproductive assistance for injured U.S. veterans. For example, it would pay for in vitro fertilization for a couple who could not conceive in the normal way because of battle wounds (such as shrapnel in the uterus or testes). Her measure has passed the Senate, but is being obstructed in the House of Representatives. According to a June 22, 2016 editorial in The Seattle Times, opposition is being spearheaded by the conservative Family Research Council on the grounds that in vitro fertilization could result in the destruction of fertilized eggs (which is tantamount, in the eyes of Catholic and Protestant religious fundamentalists, to abortion). Senator Murray has noted the outrageous ironies of the situation: the U.S. claims that it is sending young people to the Mideast with the purpose of fighting Islamic religious fanatics who seek to impose their will on the population at large. But after U.S. soldiers are wounded in the course of that struggle they come home to fall victim to Christian zealots who impose their extremist views on the majority of Americans who do not share their fanaticism.

Reproductive Justice a Theme of Conference in Puerto Rico

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abortion access, Caesarian delivery, Catholic Church, Cuba, doulas, low-income women, natural birthing, Puerto Rico, reproductive justice, women of color

Recently I attended the National Women’s Studies Association meeting in San Juan, Puerto Rico. Among the dizzying array of panel presentations were two of particular interest to me. One focused on women of color creating organizations to support non-medicalized birthing options for poor women. The organizations, Birth Justice Project and Black Women Birthing Justice, sponsor classes for pregnant women in the California state prison system with the goal not only of obtaining better outcomes for their pregnancies but also training them to become doulas (informal birth assistants) after their release. The same panel featured a well-known Puerto Rican midwife, Rita Santiago, who was largely responsible for the resurgence of midwifery on the island. Historically midwives had handled virtually all births and most of the health needs of women and children in Puerto Rico. But when the U.S. assumed the colonial mantle of the Spanish at the beginning of the 20th century, the government and medical profession initiated a concerted campaign against midwives and in favor of hospital births attended by (largely male) physicians. These interventions had disastrous results for women’s health. Even now, Puerto Rican women have high Caesarian rates—approximately half of all babies on the island are delivered by Caesarian. These rates are well above the levels deemed acceptable by the World Health Organization. By comparison, Santiago noted that Cuba’s rates are low; about 8% of Cuban births are surgically managed, yet their maternal and infant mortality statistics are far better than those of Puerto Rico.

Another fascinating panel was organized by the Chicago Abortion Fund (CAF). CAF began thirty years ago with the goal of providing money for low-income women to obtain abortions after the Hyde Amendment cut off federal funds for the procedure. But they have branched out and adopted a reproductive justice (RJ) framework for their activism, which situates abortion access in the context of general health equity for low-income women and women of color. According to a CAF brochure, the broader orientation is necessary because “The mainstream reproductive rights movement has, in some instances, …been elitist and has ignored the needs of women of color and low-income women.” CAF has developed an abortion access toolkit that is widely used by other RJ-oriented activists around the country.

A poignant aspect of the abortion issue was brought to light in the discussion that followed the presentations. A young Latina woman in the audience asked how one deals with feelings of guilt about having an abortion. She is a high school student in a state that mandates so-called abstinence-only sex education, and she said that this, combined with the religious proscriptions drilled into them by Catholic and fundamentalist Christian parents, renders her and her peers unable to easily access birth control, terrified and uncertain where to turn when pregnancy results, and obsessed with the notion that they are betraying their culture or committing an unforgivable sin if they attempt to get an abortion.

The panelists were sympathetic, and CAF’s Latina intern said that she had suffered the same guilt when she terminated her own pregnancy. The advice offered by her and other panelists went along the lines of: remember that it’s your body and your life; you’re the best judge of what is right for you at this time. Certainly these statements are reasonable and can go some way toward assuaging guilt. However, I suggested an additional line of reasoning that might have some effect, especially on the young woman’s Catholic peers and (possibly) on their families. Namely, I pointed out that restrictions on abortion are relatively recent. Until 1869, when the Catholic Church banned the procedure, the Church had a flexible attitude toward abortion. I noted that Catholic saints and theologians (for example, St. Bridget, Hildegarde of Bingen, and Thomas Sanchez) and even a Pope (Peter of Spain, who became Pope John XXI) tolerated abortion, and some developed abortifacients themselves. I don’t know how much this information helped the young woman. But I am convinced that a significant component of making women of similar backgrounds more comfortable with their reproductive decisions is the disseminating of information on the wide acceptance of abortion in many cultures and circumstances both now and in the past.