Arkansas and Hawaii Lawsuits Present Challenges and Opportunities For Medication Abortion

Originally published in The American Prospect on November 3, 2017.
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The U.S. abortion rate recently hit its lowest level since Roe v. Wade, but medication abortion—non-surgical abortions induced through drugs—has increased in popularity since the Food and Drug Administration first approved Mifeprex in 2000. (Medication abortions typically involve using both Mifeprex—colloquially known as “the abortion pill”—and another drug, misoprostol.)

Yet despite the proven efficacy of medication abortion for safely terminating early-stage pregnancies, a series of regulatory and statutory restrictions have prevented many women from being able to use this abortion option. Two different legal battles taking place right now—in Arkansas and Hawaii—illustrate why.

In 2015, Arkansas passed a law requiring physicians who prescribe drugs for non-surgical abortions to secure contracts with a second doctor who has hospital-admitting privileges. The American College of Obstetricians and Gynecologists and the American Medical Association have both said that there is “no medical basis” for such mandates.

It can be difficult for abortion providers—especially ones in conservative states like Arkansas—to obtain admitting privileges, because hospitals tend to avoid partnerships that could produce a backlash from anti-choice groups. When Texas passed a law in 2013 requiring all abortion clinics to obtain hospital-admitting privileges and to meet ambulatory surgical center building standards, nearly half of the state’s clinics shut down soon afterward. The U.S. Supreme Court overturned the package of restrictions in 2016, concluding they posed an unconstitutional burden on Texan women seeking to end their pregnancies.

In March 2016, U.S. District Judge Kristine Baker issued a preliminary injunctionblocking the Arkansas admitting-privileges law from taking effect while Planned Parenthood Great Plains sued the state. But this past July, an Eighth Circuit Court of Appeals panel lifted Baker’s injunction, concluding that she would need to show more specifically how Arkansas women would be harmed by the law. Planned Parenthood maintains that its two abortion facilities in Little Rock and Fayetteville would no longer be able to provide medication abortion if this law were to take effect, and that neither of those centers provide surgical abortions.

Following the July decision, Planned Parenthood requested that the Eighth Circuit’s full bench of judges review the panel’s ruling. But in late September, the Eighth Circuit declined to do so. “The extremists who put this law into place will now be responsible for the lives they’ve put in harm’s way,” said Aaron Samuleck, the interim president and CEO of Planned Parenthood Great Plains, after the September decision.

The Eighth Circuit is one of the most conservative appellate courts in the country. In 2015, its judges recommended that the U.S. Supreme Court “reevaluate its jurisprudence” on abortion, urging the high court to return greater reproductive decision-making power to the states.

Now Planned Parenthood Great Plains has notified the U.S Supreme Court that it intends to file what’s known as a petition for a writ of certiorari, which essentially means that the organization plans to ask the high court to review their case. When they do file their petition, Planned Parenthood also plans to also ask the Supreme Court to issue a preliminary injunction to block the admitting-privileges law from taking effect. Planned Parenthood has also gone back to the Eighth Circuit to ask that the appellate court refrain from enforcing the law while they petition the Supreme Court—a request the Eighth Circuit granted in mid-October. So for now, the law remains on hold.

Meanwhile, a very different sort of medication abortion challenge is under way in Hawaii. The FDA has Mifeprex (mifepristone) on its Risk Evaluation and Mitigation Strategies list (REMS), a designation the government uses when it determines that increased restrictions are necessary for a drug’s benefit to outweigh its risks. Because the abortion pill is on the REMS list, the FDA can require that only certified medical professionals in hospitals, medical offices, or clinics administer it. In other words, women can’t fill a prescription for Mifeprex at their local pharmacy. But just as it can be difficult for abortion clinics to obtain hospital-admitting privileges because of political objections, many medical centers also encounter political resistance to stocking and distributing Mifeprex.

In early October, the American Civil Liberties Union filed a lawsuit against the FDA, charging that the agency was both violating its own statutory authority, as well as the Constitution’s due process protections, by preventing commercial pharmacies from filling Mifeprex prescriptions. The lawsuit was filed on behalf of a Hawaiian doctor on Kauai, who cannot stock Mifeprex in his office or direct women to nearby abortion clinics since there are none on the island. If patients come to him seeking early-stage abortions, he has to tell them to fly to another island for the procedure—something that can both increase a patient’s costs, as well as delay it for weeks, if not entirely.

Reproductive rights advocates say there’s no reason for the FDA to put Mifeprex on the agency’s list of particularly risky drugs. In 2016, the American Congress of Obstetricians and Gynecologists stated that putting the abortion pill on the REMS list “is inconsistent with requirements for other drugs with similar or greater risks, especially in light of the significant benefit that mifepristone provides to patients.” In their new lawsuit, the ACLU argues that the restrictions are unscientific and onerous. They note that blood thinners, Viagra, and other drugs carry greater risks than Mifeprex, yet local pharmacies can fill prescriptions for these medications.

In an interview with The American Prospect, Julia Kaye, a staff attorney with the ACLU’s Reproductive Freedom Project, says the Arkansas and Hawaii cases target different issues, but ultimately revolve around the same core problems: “unconstitutional and unjustified” restrictions on reproductive health care.

Moreover, despite the FDA’s stated concern about possible risks, the agency does not even require patients to take Mifeprex at a designated health-care setting; they only must obtain it there. “There is simply no safety benefit to requiring that a patient be handed a pill at a clinic to then swallow it home, rather than [receiving it] at a pharmacy,” says Kaye. (Some health-care facilities prefer patients to take the medication on site, but the FDA doesn’t require it.) The FDA’s own research also concludes that medication abortion “has been increasingly used as its efficacy and safety have become well-established by both research and experience, and serious complications have proven to be extremely rare.”

“Often health-care providers are unable to stock the abortion pill because of bureaucratic hurdles, or because of opposition to abortion by co-workers,” explains Kaye, who adds that health-care providers must navigate multiple layers of institutional approval before they can administer the drug. “The process is not only complicated and time-consuming, but because there are so many individuals who need to sign off on procurement, even a single individual who objects to abortion can significantly delay or even derail stocking this medication,” she says.

While research suggests that women generally prefer surgical abortions (which tend to be faster procedures that involve less bleeding) over medication ones, many women are unable to access surgical abortions, due to the diminishing number of abortion clinics, as well as restrictions such as mandatory waiting periods. Medication abortion provides women with much-needed reproductive health-care alternatives—especially low-income women, and women living in conservative, rural, and medically underserved parts of the country.

An ACLU win in the Hawaii case would affect FDA restrictions on Mifeprex nationwide.

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Late-Stage Abortion Provider Won’t Succumb To Protestors Who Forced Him Out of His Last Maryland Clinic

Originally published in The Intercept on October 30, 2017.
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For seven years, protesters had targeted LeRoy Carhart and his abortion clinic in Maryland, one of just three places in the country women could go for late-stage abortion care. Two months ago, the protests finally worked, as Carhart’s landlord abruptly bowed to pressure and shuttered the clinic, selling the space to anti-abortion protesters instead.

But Carhart is back, with a new Maryland clinic.

Since 2010, he has commuted weekly to Maryland from his home in Bellevue, Nebraska. Carhart is a 76-year-old retired Air Force surgeon who has also owned and operated a Bellevue-based clinic with his wife Mary Lou since 1992. He began traveling to Maryland regularly when Nebraska passed the nation’s first 20-week abortion ban in 2010. Carhart’s mentor, George Tiller, used to provide later-stage abortions at his clinic in Wichita, Kansas, but was murdered in 2009 while attending church.

Maryland is one of the most supportive states in the nation when it comes to access to abortion at all stages of a pregnancy, according to Diana Phillip, the executive director of NARAL Pro-Choice Maryland. Nebraska, on the other hand, is one of the more restrictive.

Earlier this month, the U.S. House of Representatives voted along party lines in favor of a 20-week abortion ban based on the dubious scientific claim that fetuses can feel pain at that stage of gestation. A similar bill passed the House in 2015 but was blocked by Senate Democrats. Senate Majority Leader Mitch McConnell has promised to bring this new bill to a vote, and President Donald Trump has also said he strongly supports it. Though reproductive rights advocates say any 20-week federal ban would face immediate constitutional challenge, the measure nonetheless targets abortion providers like Carhart, who could face up to five years in prison for their services.

Carhart is undeniably committed to his work. In addition to the four days he spends working in Maryland, the physician works out of his Nebraska clinic two or three days per week, meaning he spends 26 out of every 28 days on the job.

“I just know it needs to be done, and it doesn’t bother me,” Carhart told me, as we sat together in his new clinic, located at the Wildwood Medical Center in the Washington, D.C., suburb of Bethesda. The walls are adorned with art and posters championing female resilience. “Feminism is the radical notion that women are people,” reads one framed poster hanging on a wall. “Females are strong as hell,” says another.

Carhart’s former Maryland clinic – Germantown Reproductive Health Services, located about 11 miles away – had been owned by Todd Stave and his sister, Nancy Stave Samuels. The two inherited it and another Prince George’s County abortion clinic from their parents; their father had been a gynecologist and obstetrician who long provided health services including abortions in the D.C.-area. While the Staves and their abortion facilities have always faced harassment, including a clinic firebomb in 1982, the pressure ramped up in 2010 when Carhart started working in Maryland. The Maryland Coalition for Life, an anti-abortion advocacy group, formed that year in response to Carhart’s arrival.

In addition to regular protests outside the clinic, calls to the landlords’ homes dramatically escalated over the last few years. A group of protesters even picketed Todd Stave’s daughter’s middle school in 2011, holding up gruesome signs along with her father’s picture and contact information.

The Maryland Coalition of Life helped raise money to close both the Germantown and the Prince George’s County clinics in one fell swoop. About half of the $1.2 million offered to Stave and his sister came from an anonymous Christian businessman, who now owns the property, and the other $600,000 from roughly 400 donors, according to Rewire.

In interviews, Stave said he felt conflicted about the move to close the two clinics, but that at the end of the day it was a dollars-and-cents decision. “There’s a lot of sadness, yeah, a feeling that we’re letting the public down,” Stave told the Washington Post“It’s a tough thing to do, there’s no question about it.” He said the rising costs of security and the declining demand for abortion ultimately drove his decision. The Guttmacher Institute reported this year that the abortion rate has fallen to its lowest level since Roe v. Wade, though the exact reasons are unclear.

It wasn’t easy for Carhart to find a new location for his clinic. “We looked at other spaces and unfortunately it’s really hard to find contractors, vendors, and landlords for abortion clinics because of the harassment,” said Chelsea Souder, a spokesperson for Carhart’s Bethesda and Bellevue clinics.  “We had two other possible places and they both fell through when the [anti-abortion activists] got wind of where and started making threats. We were really lucky to find this place.”

“I’ve got a really, really supportive landlord,” Carhart added. “I can say he’s definitely pro-choice. I have no idea if he’s pro or anti-abortion for himself, but he’s pro-choice, and that’s my ideal. That is the middle ground.”

In some ways, the new facility is more secure than the previous Germantown one. According to Souder, local police officers canvas the building and parking lot on a regular basis, and they also also coordinate with local and federal law enforcement. While anti-choice activists still plan on staging regular protests – and have already started – they can’t stand on the medical center property or outside the adjacent SunTrust bank, which has the same owners. The closest anti-choice activists can stand is on the main road, which is far enough away that they can’t be seen or heard from inside the medical facility. “And our patients have to park in the back so they don’t have to walk by protesters,” Souder said.

“We will definitely maintain a prayerful presence on the sidewalk there,” Maryland Coalition for Life Regional Director Andrew Glenn told The Intercept.

Before protests successfully bought out Carhart’s Germantown clinic, they tried other tactics to shut his facility down. In 2013, a 29-year-old teacher from White Plains, New York, died from complications resulting from a late-stage abortion Carhart performed. The activists blamed Carhart and urged the state to close his clinic, but the autopsy report produced by the state’s Office of the Chief Medical Examiner found that the woman’s death resulted from natural causes, not medical malpractice.

The Maryland Coalition for Life also bought a building across the street from Carhart’s Germantown clinic in 2012, launching Germantown Pregnancy Choices, a so-called crisis pregnancy center. CPCs are facilities that work to persuade women against having abortions, providing them with resources and support, but also often disseminating misleading or patently inaccurate medical information. With an estimated 3,500 nationwide, crisis pregnancy centers outnumber abortion clinics 3-to-1.

Shortly after Carhart’s clinic was bought out, Germantown Pregnancy Choices closed too. Janet Kotowski, the crisis pregnancy center’s former manager, told The Intercept that their focus had been on connecting women who came in from outside Maryland with supporters back where they came from. (More than two-thirds of Carhat’s Germantown patients were from out-of-state.) “Because we have multiple other pregnancy centers in Maryland that offer ultrasounds, counseling, and post-abortive services for women, we felt ours was no longer needed,” she said.

When asked if she expects a new crisis pregnancy to open near Carhart’s Bethesda clinic, Kotowski said she doesn’t know. “I know that people are motivated to help these women, and we have seen women who change their minds when we offer help, so we would like to have that opportunity again,” she said.

Glenn of the Maryland Coalition for Life also said the group is currently exploring all its options with regards to opening a new crisis pregnancy in Bethesda.

According to data from the Centers for Disease Control and Prevention, a little more than 1 percent of abortions in the United States occur after the twentieth week of pregnancy, which is halfway through a woman’s second trimester. Carhart’s website states that the clinic’s most common reasons for providing later-stage abortions include “the very late diagnosis of a pregnancy in a woman with a severely compromising medical condition, very young maternal age, rape and incest.”

Anti-abortion advocates insist that Carhart and the services he provides are dangerous.

“I’ve been tracking Mr. Carhart since the mid-1990s and he’s one of the most ghoulish individuals you’ll ever meet,” Troy Newman, president of the anti-choice Operation Rescue, told The Intercept. When asked if he worries the procedure will become even less safe for women if it’s forced underground, Newman shot back that it’s already unsafe. “There’s nothing safe about abortion, certainly not for the baby,” he said. “Carhart is a butcher.”

Kotowski agreed, pointing to a lawsuit filed in 2016 by a former patient alleging negligence and misconduct, but the suit settled out-of-court, with no admission of liability. And Carhart’s new clinic is licensed by the Maryland Department of Health and certified by the National Abortion Federation.

Newman of Operation Rescue spoke excitedly about the progress his allies have made in restricting access to abortion across the country. “We got Trump elected – we put a lot of effort into that, we’re putting Supreme Court justices in place, and now stacking legislation that is going to end abortion as we know it,” he said. “I think these guys should be very worried they’ll soon end up in jail.”

Despite years of threats and harassment, and the escalating anti-choice political climate, Carhart remains undeterred in his commitment to providing abortion care. One goal he has set for his new clinic is to train new abortion providers, both to increase the number of doctors who can perform the procedure across the country, and also to help him balance his substantial workload. There are fewer and fewer places that offer abortion provider training opportunities to medical residents, especially later-stage abortion care, according to Phillip of NARAL Pro-Choice Maryland.

“I’m looking to train two or three other doctors to work with me here [in Bethesda] and then start a training program for residents and fellows to work wherever they want to work,” Carhart said.

“Morale is good, it’s really good,” Souder added. “Everyone feels really excited to get back to work.”

A Legal War in Arkansas Threatens Abortion Rights Everywhere

Originally published in VICE on September 7, 2017.
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When Donald Trump ran for president, despite his long history of pro-choice positions, he essentially offered evangelical Christians a dealHelp elect me, and I will appoint pro-life, conservative justices to the Supreme Court. Sure enough, less than three months into his presidency, Trump’s first SCOTUS appointee—Neil Gorsuch—was confirmed, and anti-choice advocates seemed to be one step closer to their ultimate goal of overturning Roe v. Wade.

It may take another appointee to truly tilt the scales of justice against reproductive rights in America’s highest court. But in the meantime, conservatives have been eyeing the Eighth Circuit Court of Appeals, based in St. Louis, Missouri, as a vehicle to bring such a challenge. That’s where, in 2015, appellate judges urged the nation’s highest court to revisit existing abortion jurisprudence, and turn matters over to the states, as conservatives have long dreamed.

Now that same federal appeals court, which may be more hostile than any other to abortion rights, is getting a bunch of new opportunities to go after a woman’s right to choose in Arkansas—and maybe even set the stage for the end of Roenationally.

Over the past several years, legislators in Arkansas—one of seven states under the Eighth Circuit’s purview—have passed some of America’s most restrictive abortion laws. Already in 2017, Arkansas passed a statute that would criminalize doctors who perform dilation and evacuation (the most common second-trimester procedure), and also permit husbands to sue to doctors to prevent their wives from obtaining abortions—with no exceptions even for rape or incest.

Set to go into effect on July 30, the law was blocked after the American Civil Liberties Union, the ACLU of Arkansas, and the Center for Reproductive Rights sued over it and three other recently-passed abortion restrictions. Lawyers brought the suit on behalf of a physician working at one of the last two abortion clinics in the state, and argued the laws posed unconstitutional burdens on a woman’s right to choose.

On July 28, federal judge Kristine Baker blocked the laws’ enforcement, and Arkansas Attorney General Leslie Rutledge filed for an appeal two weeks ago. A spokesman for the AG did not return multiple requests for comment.

What should worry abortion-rights advocates is that there’s plenty of reason to suspect the Eighth Circuit will be sympathetic to Rutledge’s challenge. In March 2016, Judge Baker issued another injunction against a 2015 Arkansas lawrequiring physicians who prescribe abortion-inducing drugs to secure contracts with doctors with hospital admitting privileges—a high bar to meet in the increasingly conservative state, and one the American College of Obstetricians and Gynecologists and the American Medical Association said had no medical basis. This past July, the Eighth Circuit lifted Baker’s injunction, ruling she would need to more concretely prove that a sizable number of women will face harm under that law.

In an interview with VICE, Steve Aden, chief legal officer and general counsel for Americans United for Life, said he felt the Eighth Circuit’s request for “some real math” was reasonable. He also defended the admitting privileges requirement as a common-sense measure to protect women’s health, noting that other outpatient surgical procedures generally require it. “If you or I go to a clinic and get Lasik or a colonoscopy, chances are really good that the doctors will have admitting privileges,” he said.

Meanwhile, the US Supreme Court last year heard arguments for Whole Woman’s Health v. Hellerstedt, widely considered to be the most significant reproductive rights case in nearly 25 years. In a 5-3 decision, the justices ruled that a package of Texas abortion restrictions imposed an unconstitutional burden on women seeking to end their pregnancies.

Fatima Goss Graves, the president and CEO of the National Women’s Law Center, told VICE anti-abortion opponents haven’t been much deterred by that outcome. On the contrary, she said, they are eagerly working to put more abortion cases before the Supreme Court as soon as possible. “They are still purposely trying to pass extreme laws that conflict with Whole Women’s Health, with Roe, so they’ll [then] be challenged in court,” she said. “That is the strategy.”

Another Arkansas case that could reach the Supreme Court concerns conservative boogeyman Planned Parenthood. In 2015, following the release of doctored videos purporting to show Planned Parenthood illegally profiting from the sale of fetal tissue, Arkansas Republican Governor Asa Hutchinson announced he would be terminating Medicaid contracts with the women’s health organization. Judge Baker blocked the move that September, but last month, a three-person panel on the Eighth Circuit decided Arkansas could cancel its Medicaid contract with Planned Parenthood—a notable departure from rulings in the Fifth, Seventh and Ninth Circuits. On August 30, the plaintiffs appealed to make their case again before the entire Eighth Circuit.

Aden, of Americans United for Life, thinks this case stands a shot of reaching the Supreme Court given the Eighth Circuit’s first decision diverged so sharply from other Appeals Courts nationwide.

I asked Bonyen Lee-Gilmore, a spokesperson for Planned Parenthood Great Plains (an affiliate overseeing Arkansas, Kansas, Missouri, and Oklahoma), if they would appeal to the Supreme Court, should the full Eighth Circuit uphold the Medicaid ruling. “When it comes to next steps in the legal world, we really play it one step at a time,” she said. “Every time a decision comes down, we’re evaluating all our legal options, and the reality is we could end up in the Supreme Court, but we’re not there yet. Right now we’re just seeing if we can successfully secure an en banc appeal.” (To hear a case ‘en banc’ means before the entire bench of judges, rather than a three-person panel.)

It’s worth noting that even though Arkansas’s governor cancelled state Medicaid contracts with Planned Parenthood over the 2015 fetal tissue videos, three Republican-led congressional investigations and 13 state-level probes—including one by a Texas grand jury—found no evidence of wrongdoing.

Gillian Metzger, the Stanley H. Fuld Professor of Law and vice-dean at Columbia Law School, thinks the Eighth Circuit “has really pushed the envelope” on constitutional retraction of reproductive rights in America. But whether these specific cases make it to the Supreme Court, she said, comes down—as always—to how willing justices are to engage with the abortion issue again. “The bigger question is does the Court have an appetite for this after 2016? And my guess it might wait a little bit to see how the Whole Women’s Health decision plays out,” she said.

In the meantime, President Trump will have the opportunity to fill three vacancies on the Eighth Circuit. If all are confirmed, according to longtime legal writer Rox Laird, only one of the Eighth Circuit’s eleven judges will have been appointed by a Democratic president, making it “the most ideologically lopsided of all the US Court of Appeals.”

Even if pro-choice advocates secure Medicaid funding for Planned Parenthood and defeat this round of abortion restrictions in the Eighth Circuit—by no means a safe bet —advocates aren’t expecting legislators to slow down their anti-abortion efforts any time soon. In mid-August, Planned Parenthood Great Plains and the ACLU argued yet another case in Arkansas federal court, protesting a law mandating the suspension of an abortion provider’s license for any minor error found during an inspection. That rule doesn’t apply to any other licensed health center in the state.

“We’ll be on high alert when the legislature returns in 2019 and continue to fight these extreme attacks on women and their rights,” said Rita Sklar, the executive director of the ACLU of Arkansas. “Often, the only way to get Arkansas politicians out of the exam room is to take them to court.”

Indiana Court Overturns Purvi Patel’s Feticide Conviction

Originally published in The American Prospect on July 25, 2016.
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The Indiana Court of Appeals last week overturned the 20-year prison sentence for Purvi Patel, the first woman in the United States to be convicted under a feticide law for having an abortion. The 3-0 decision marks a victory for reproductive rights advocates, who argued that using feticide laws to convict women who end their pregnancies sets a dangerous precedent for abortion rights and criminalizing the procedure.

Legal experts warned that if the conviction were upheld pregnant women would be prosecuted for all sorts of things—from self-inducing an abortion to smoking cigarettes, or even slipping down the stairs. Feticide laws are on the books in 38 states, and were originally passed to protect pregnant women who were victims of domestic violence.

Indiana strengthened its feticide law in 2009, after a pregnant Indianapolis bank teller was shot during a bank robbery, and lost the twin girls she was carrying. In the appeals decision, the judges wrote, “We hold that the legislature did not intend for the feticide statute to apply to illegal abortions or to be used to prosecute women for their own abortions.” They called Patel’s conviction under a feticide statute “an abrupt departure” from earlier cases.

However, while Patel’s Class A felony charge was vacated, the judges did not drop the second charge in the case. She is still left with a neglect conviction—a felony offense—though the court said it should be reduced from a Class A neglect charge to a Class D one. The minimum sentence for a Class D neglect felony is six months, and the maximum is three years. Patel has already been sitting in jail for more than a year.

Attorneys for both sides continue to review the decision; neither has indicated whether they planned to appeal to the state’s Supreme Court.

Kate Jack, an Indiana-based attorney who has provided legal advice to the National Advocates for Pregnant Women, told The Indianapolis Star that while the issue is not entirely closed, she does think the decision “will really give pause” to anyone considering bringing future feticide charges against pregnant women.

The decision comes on the heels of the Republican National Convention, where Donald Trump picked Indiana Governor Mike Pence as his running mate. Reproductive rights groups have already been organizing against Trump’s incendiary rhetoric around women and abortion rights, and the selection of Pence as his vice president has only angered advocates further.

Aside from being the chief executive of the only state to convict a woman who ended a pregnancy under a feticide statute, Pence has also achieved notoriety for supporting other reproductive health-care limitations. While serving in the U.S. House of Representatives he backed an unsuccessful 2011 federal effort to defund Planned Parenthood. When Pence became governor of Indiana in 2013, he continued to attack the organization. By 2014, state funding for Planned Parenthood had been reduced by nearly half of its 2005 funding levels: Nearly a decade of cuts forced the closure of five clinics.

In March, Pence went even further, signing an omnibus bill that included some of the strictest abortion measures in the country, including a ban on women who wish to end their pregnancy if their fetus has genetic abnormalities, such as Down syndrome. The law also called for prosecuting doctors who provided abortion services to women suspected of wanting to terminate a pregnancy based on genetic problems. A federal judge blocked this law from taking effect last month, saying it was likely unconstitutional.

While reproductive rights groups say they are heartened that the court reversed Patel’s feticide conviction, they disagree with the judges’ decision not to drop the neglect conviction. Yamani Hernandez, the executive director of the National Network of Abortion Funds, issued a statement saying that the court’s new decision does not go far enough to restore full justice. By allowing the prosecutors’ argument that Patel could have prevented the death of her child to stand, Hernandez says, the judges have rejected “both medical science and compassion for a woman who needed medical care, not to be sent to prison.” She argued that ultimately people of color will “bear the brunt of unscientific laws and misplaced moral outrage.”

Patel remains in prison for now, and advocates are continuing to call for her release. Reproaction, a group focused on abortion access and reproductive justice, released a statement calling upon Mike Pence “to be pro-life for real and release her immediately.” They add that the state of Indiana “owes Purvi Patel a profound apology.”

Q&A: The Abortion Battle’s Next Phase

Originally published in The American Prospect on July 12, 2016.
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In a landmark ruling last month, the Supreme Court struck down a package of Texas abortion restrictions known as Targeted Regulation of Abortion Providers (TRAP) laws. Such laws, which have proliferated around the country, typically restrict abortion access by imposing rigid and expensive hospital-style mandates on clinics. The Court’s ruling in the case, known as Whole Woman’s Health v. Hellerstedt, found that the restrictive Texas TRAP laws were unconstitutional because they placed an “undue burden” on women, and marked a major victory for the reproductive rights movement. The American Prospect’s Rachel Cohen spoke with Ilyse Hogue, the president of NARAL Pro-Choice America, which helped lead the challenge to the Texas TRAP laws, to ask about the ruling’s implications for abortion access and for the upcoming election. This is an edited transcript of that conversation.

Rachel Cohen: Now that the Supreme Court has struck down TRAP laws, what’s next on the agenda for anti-choice opponents?

Ilyse Hogue: Over the years, [abortion opponents] have realized that honesty can only get them so far in terms of achieving their goal of ending legal abortion. TRAP laws were really a way to deceive the public, cloaking their efforts around the idea of protecting women’s health. The Supreme Court just eviscerated the anti-choice posturing that TRAP laws are in any way about women’s health.

So one of their favorite tools just got taken away from them. They are reeling, but they are not the type to take their ball and go home. We’re anticipating them pushing forward on a number of different fronts. I think they will step up their harassment at clinics—harassing patients and doctors. And we’ve seen some really insidious things from state legislatures, like recently an effort in Missouri to force clinics to turn over their private medical records to the state. I think we’re going to see anti-choice opponents continue to pour resources into crisis pregnancy centers, which are just another way to deceive women.

How will the reproductive rights movement respond?

We are pushing back on their crisis pregnancy center efforts. In California last year, legislators passed the Reproductive FACT Act, which sets a national model for requiring all crisis pregnancy centers to be really clear with their patients about what they do and don’t do. Other states are looking at California’s law, and I think it’s very much at the top of legislators’ minds for the beginning of 2017.

We’ve also seen states where pro-choice legislators are filing to appeal TRAP laws that are already on the books, like Daylin Leach, a Democratic state senator, in Pennsylvania. And we’re working as a movement to step up litigation and public education to repeal the rest of those laws around the country. Importantly, we’re really moving to a position where we will not just fight anti-choice lies and deception, but where we can actively push for legislation that expands access to abortion. For example, a number of states are looking at medical abortion, and allowing nurse practitioners to provide abortion services. California already has that and other states are looking at it.

On top of this, we’ve got two pieces of federal legislation that are picking up momentum. The Women’s Health Protection Act, which would enforce and protect the right of a woman to decide for herself whether to continue or end a pregnancy, and the Equal Access to Abortion Coverage in Health Insurance Woman Act, which would repeal the Hyde Amendment and ensure that abortion services could be covered under federal health insurance.

NARAL recently released a statement calling the Democratic Party platform “the strongest platform for reproductive freedom we have ever seen.” What’s so significant about it?

The platform is a symbolic statement of values, as well as a navigation tool for what kinds of legislative and public policy remedies there are for the issues that we face. So the fact that it explicitly calls for the repeal of the Hyde Amendment, as well as the Helms Amendment, [which restricts U.S. foreign aid from paying for abortion services] is huge. It acknowledges that there have been discriminatory practices both here and abroad against women who want to control our own reproductive destiny.

The reproductive justice movement deserves an enormous amount of credit for getting us here. Reproductive freedom in the 21st century is acknowledging that we are whole beings. There is not one group of women who gets abortions, and others who go on to be parents. We are just the same women at different times in our lives, making the decisions that are best for us and our families. That the platform takes a step towards acknowledging that is a real testament to the economic and reproductive movements that have come together.

How long will it take Texas and the other states with TRAP-style restrictions to restore abortion access to women?

I’m really glad you asked that question. The answer is too long and it varies state by state. Texas is five times the size of other states, so it will take longer there. But what’s important in answering that question is acknowledging that in the minds of the extreme anti-choice minority, this was a scorched-earth strategy. They always knew they could lose at the Supreme Court, but the amount of damage they were able to do in the meantime, in terms of clinics on the ground, in terms of women who could not access services—that’s significant damage that can never be fully undone.

While it’s important to win, we can’t actually let them gain such ground in the future. We can’t just depend on Supreme Court strategies when it comes to ensuring women access to our basic rights.

That brings us to the election. What role do you expect abortion and reproductive health to play in state and federal races?

We have to be very focused, not only on getting our champion into the White House, but on the down-ballot races, because the harm is coming disproportionately from state legislatures.

We’ve been doing a lot to hold incumbents accountable for the unbelievable amount of times they’ve tried to restrict access to abortion. Their constituents did not elect them to do that, especially at the expense of all the important business that has not gotten done. In both the federal election and for local and state races, we’re making sure voters have the information to hold their officials accountable.

This is a long-term project. We’ve got to make gains in 2016, and come 2020 and 2022, I think we’re going to start seeing some of these state legislatures really shifting on these issues.

In the 2012 election, Todd Akin, a Republican candidate from Missouri lost his race, in large part because of his outrageous comments about “legitimate rape.” Are we seeing similar types of remarks from Republicans this year?

I think people have been trained to be more careful, because when they speak their truth they find themselves at odds with the majority of their constituents. These anti-choice candidates don’t want to talk about their position once they get to a general election because they know they’re on the wrong side, and they don’t win elections if they do. We saw that so clearly in 2014 when Scott Walker, three weeks before his Wisconsin election, ran an ad saying he supports legislation to provide women with more information and to leave the final decision to a woman and her doctor. This is coming from a man who had done more to legislate abortion out of existence than every previous governor before him.

But I think what’s changed between 2012 and 2016 is that back then, the pro-choice movement was able to leverage those off-the-cuff Republican statements. But we’re not going to wait for them now. We’re going straight to the voters to remind them about their officials’ records. We did that really recently in New Hampshire with an  ad campaign targeting Republican Senator Kelly Ayotte, reminding her constituents about all the anti-choice work she spent her time working on, when they didn’t want her to.

What about Donald Trump? He went so far as to say that women should be punished for getting abortions, but then quickly walked it back.

Donald Trump is not playing by the anti-choice or the GOP rulebook in any way, and we know that. One thing that’s super important to me from where I sit at NARAL, but also as an American, and as a mom, is just the way he’s giving voice and credibility to deeply-held misogynistic ideas. I think he will do tremendous damage whether he wins or not, because he has given permission to this very dark underbelly that does not represent what we need to be or what we can be. This is especially true when it comes to his misogyny, and his willingness to dehumanize women. I think particularly because he is facing a woman opponent we’re going to see a new wave of misogynistic activists who feel like they have the high ground.

How has Obama been on reproductive rights? NARAL endorsed Hillary Clinton in January. Might Hillary be different from him?

Obama has been a great backstop against the endless assault by the anti-choice majority in Congress. He has vetoed every bill we’ve needed him to veto in no uncertain terms. But what we need now is a leader in the White House who centralizes these ideas about reproductive freedom as human rights, integral to the health and security of women and families in America. That’s not really been the center of his presidency, and I think it will be the center of Hillary Clinton’s.

Future of Abortion Access Remains Unclear After Supreme Court Oral Arguments

Originally published in The American Prospect on March 2nd, 2016.

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A deeply and now evenly divided Supreme Court heard oral arguments on Wednesday in the most consequential reproductive rights lawsuit to come before the high court in nearly 25 years.

The touchstone for the justices, who now number only eight since the death last month of Antonin Scalia, was the standard established by the high court in its 1992 ruling Planned Parenthood v. Casey, which found that abortion restrictions may not place an “undue burden” on women seeking to terminate a pregnancy.

At issue in the current case, known as Whole Woman’s Health v. Hellerstedt, is a package of abortion restrictions passed by the GOP-controlled Texas legislature in 2013. During oral arguments Wednesday, the eight justices seemed divided along predictable ideological lines. The Court’s four conservatives challenged whether the Texas restrictions impose an “undue burden” on women, and its four liberals questioned the medical necessity of the restrictions.

In Casey, the court ruled 5-4 that states may legally pass restrictions on abortion access so long as those restrictions do not create unreasonable obstacles for women who seek to exercise their constitutional right to safely terminate a pregnancy. InHellerstedt, reproductive rights supporters have set out to prove that Texas’s new restrictions indeed violate the standard established under Casey.

The Texas law, known as HB2, requires that all abortion providers in the state obtain admitting privileges at a local hospital, and that clinics meet ambulatory surgical center (ASC) building standards. A key argument from the plaintiffs challenging HB2 is that these requirements have led to the closure of roughly half the state’s abortion clinics.

Chief Justice John Roberts and Justices Samuel Alito and Anthony Kennedy all questioned whether there was sufficient evidence to make that claim. Stephanie Toti, the attorney representing Texas abortion providers, noted that in the five years prior to HB2’s passage, the number of abortion clinics in Texas stayed relatively constant. Once HB2 became law, however, eight clinics closed in anticipation of the restrictions, and 11 closed the day they went into effect.Toti argued that the timing of the closures, as well as testimony from the plaintiffs, provided ample evidence to show that the clinics closed as a result of HB2’s mandates. But the conservative justices seemed unconvinced.

The four liberal justices all pressed Texas Solicitor General Scott Keller on why the admitting privileges and the ASC requirements were medically justified. They pointed out repeatedly that Texas has not required other providers of such outpatient procedures as colonoscopies and liposuction to meet ASC standards, despite the fact that those procedures carry far greater medical risk. (The American College of Obstetricians and Gynecologists and the American Medical Association have also said there is “simply no medical basis to impose a local admitting privilege on abortion providers.”) Moreover, Justice Stephen Breyer noted that even if the Texas legislature thought it was improving women’s health care by putting these standards in place, there’s evidence that women now face more barriers to abortion access, which increases the likelihood for riskier late-stage or self-induced abortions.

Another disagreement centered on whether the few abortion clinics left in Texas are capable of providing service to everyone who needs reproductive care in the state. More than 70,000 women in Texas seek abortions each year, but Alito argued that it’s impossible to know for certain whether there are too few clinics because “we really don’t know” what the capacity is of the existing providers. Donald B. Verrilli Jr., the U.S. solicitor general, disagreed, arguing that it’s “common sense” that just eight, nine, or ten clinics in all of Texas would not be enough to meet the demand.

The case’s outcome rests largely with Kennedy, the justice who originally helped craft the vague “undue burden” standard in 1992’s Casey decision. If Kennedy sides with the state of Texas, that will presumably leave the high court deadlocked 4-4. That would leave in place the Fifth Circuit Court’s decision to uphold HB2. But it would also mean that the Hellerstedt ruling sets no new national precedent. Kennedy also signaled the possibility of sending the case back to the lower court for remand—or further fact-finding—to better determine whether the number of clinics left in Texas can meet the state’s demand for abortion. It’s possible that another version of Hellerstedt will return to the Supreme Court when a successor to Scalia is appointed. The Hellerstedt ruling is expected this summer.

Hundreds of reproductive rights supporters, dressed in purple, and anti-abortion activists, wearing blue, rallied energetically outside the Supreme Court this morning in the cold; holding up signs, chanting songs, and making speeches—at times drowning one another out. Some supporters camped outside the high court Tuesday night, while others arrived early in the morning by bus, from states like North Carolina and Georgia, and cities like Philadelphia and Cleveland.

Cecile Richards: Grace Under Fire at Planned Parenthood

This story originally appeared in the The American Prospect’2016 Winter issue.

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On a warm Tuesday morning in late September, Cecile Richards, the 58-year-old president and CEO of Planned Parenthood, went before Congress to defend her organization. A few months earlier, the Center for Medical Progress, an undercover anti-abortion group, had released a series of doctored videos that purported to show Planned Parenthood illegally profiting from the sale of fetal tissue. Planned Parenthood denied the accusations, but outrage spiraled furiously among conservatives. Republican officials launched state and federal investigations, while presidential candidates and members of Congress called for defunding Planned Parenthood entirely, threatening to shut down the government if their demands were not met.

Riding this whirlwind of righteous anger, Republicans eagerly anticipated their confrontation with Richards. Yet when she came before the House Oversight and Government Reform Committee, Republicans suddenly found Richards grilling them, not the other way around. “Mr. Chairman, you and I do disagree about whether women should have access to safe and legal abortion,” she said, staring into the eyes of Jason Chaffetz, the Republican from Utah who chaired the hearing. “At Planned Parenthood, we believe that women should be able to make their own decision about their pregnancies and their futures—and the majority of Americans agree. We trust women to make these decisions in consultation with their families, their doctors, and their faith, and not by Congress.”

A week later, Chaffetz admitted that after formally investigating Planned Parenthood, he and his colleagues had been unable to find any evidence of financial wrongdoing. Eight states that launched their own investigations have also failed to produce any smoking guns. The absence of evidence, however, hasn’t deterred GOP-controlled state governments from attempting to cut funds for Planned Parenthood, or moderated Republicans’ demonization of the organization.

These attacks, though, have only inspired Planned Parenthood’s supporters to rally to its defense. Three days before Richards testified, a progressive coalition delivered a petition in support of Planned Parenthood to Senate Democratic Leader Harry Reid and Senator Elizabeth Warren; it had more than 1.2 million signatures. On the day of Richards’s testimony, hundreds of thousands of advocates across the country organized rallies and Internet campaigns to demonstrate solidarity, in what would be Planned Parenthood’s first ever “National Pink Out Day.”

In 2016, the battle over reproductive rights will almost surely grow more intense. The Supreme Court is set to rule on two major cases: one concerning contraception coverage, and the other on abortion access. The latter, both sides agree, may be the most consequential case for abortion rights since 1992, when the high court ruled that states could not impose an “undue burden” on women who wish to end a pregnancy. State legislatures, which enacted 288 abortion restrictions between 2011 and 2015, will no doubt continue to test the limits of what such “undue burdens” really mean.

2016 also marks the centennial anniversary of Planned Parenthood, an organization that has become the target of an anti-abortion movement that steadily grows more aggressive and violent. The FBI reported an increase in the number of arson attacks and vandalism incidents at abortion clinics in the wake of the Center for Medical Progress videos, and the president of the National Abortion Federation said abortion providers have seen “an unprecedented increase in hate speech and threats” since the videos were released. In late November, a man opened fire in a Planned Parenthood clinic in Colorado Springs, injuring nine people, and killing three. After the shooting, the suspected gunman invoked the doctored videos, telling local authorities, “no more baby parts.”

Richards, who has spent a decade at Planned Parenthood’s helm, toils at ground zero of the culture wars being fought across the country. Every day she is flooded with hundreds of hateful messages on social media, calling her evil, a Nazi, a monster, a murderer. In 2006, Jim Sedlak, the vice president of American Life League and one of the nation’s most ardent Planned Parenthood critics, predicted she would never last more than a year or so as Planned Parenthood’s leader. (A mere “place holder” president, he dubbed her.)

Yet ten years later, Richards remains self-assured in her post, guiding the nation’s largest reproductive-rights organization through the most politically fraught period it’s ever faced. She comes well-suited for the challenge. Richards brings to her role decades of experience in political organizing, and a career as a premier coalition builder across liberal America. She brings as well a strategic and moral vision that has impelled her to push Planned Parenthood beyond where it’s been, to lead more forcefully in the broader cultural and economic battles for women’s autonomy and equality.

IN 2006, JUST THREE WEEKS after Richards started her new job as Planned Parenthood’s president, South Dakota’s governor signed a bill outlawing abortion, the nation’s first state-legislated ban. (It was soon struck down in federal court.) “Listen, the reason I took this job is, I feel like we need to go into the 21st century,” she told The Washington Post that year. “Clearly, with some folks in the country, we’re going to get there kicking and screaming.”

Hiring Richards, in many ways, signified a new moment for Planned Parenthood. The abortion issue had been growing increasingly more politicized and polarized since the mid-1980s. (In the 1970s, the share of pro-life Democrats actually exceeded that of Republicans.) The partisan polarization of recent decades first became evident in 1984, and by the 1990s, political scientists were noticing a new and statistically significant relationship between voters’ abortion attitudes and whom they cast their ballot for in elections.

The three presidents who preceded Richards came in with backgrounds in health care, nursing, and Planned Parenthood itself. Richards’s resume, on the other hand, listed years of experience in organizing, campaigning, and electoral politics. While Planned Parenthood had been inching toward political advocacy in the 15 years before Richards arrived, she came in prepared to steer Planned Parenthood to the front lines.

In practice, this meant investing more in strategic communications and developing a new generation of youth leadership; it also meant engaging more forcefully in political campaigns. In 2008, Planned Parenthood endorsed Barack Obama for president—its second presidential endorsement ever—and Richards spoke at the 2008 Democratic National Convention. That same year, the organization launched the One Million Strong Campaign—a massive effort to mobilize pro-choice voters. Partnering with Catalist, a progressive voting database, Planned Parenthood worked to build the first national voter model designed to specifically target pro-choice women.

Planned Parenthood’s political spending has also increased throughout Richards’s tenure. While the organization’s overall election spending has grown, its direct campaign expenditures have also come to represent a larger piece of the pie. Today, with Richards shaping its political programs, the organization not only spends more money in elections, but it also takes greater control over how its money is spent.

For its critics, these efforts serve as incriminatory proof that Planned Parenthood falsely bills itself a woman’s health-care network. Richards does not buy these accusations, but she can’t readily ignore them either. As both the CEO of one of the biggest national health-care organizations, which relies substantially on government reimbursements, and as the leader of a massive nonpartisan political outfit, engaged in one of the most polarized fights in the United States, Richards must always remain extra careful to keep the organization’s two halves legally separated, particularly when Republicans control both Congress and a majority of state governments. Forty percent of Planned Parenthood’s $1.3 billion in annual revenue comes from Medicaid and Title X, a federal family-planning program.

“Cecile had to grow into her [role] as CEO of a major health-care provider, that was something she had to learn,” says her husband, Kirk Adams, who served as vice president of the Service Employees International Union and is now executive director of the Healthcare Education Project in New York. “But on the other hand, she has always been first and foremost an organizer, and she continues to do that at Planned Parenthood at a very high level. It’s just fundamentally how she approaches a problem.”

As an organizer, Richards looks at the numbers—one in five women in the U.S. have relied on Planned Parenthood at some point in their life for health care. Learning how to motivate those patients to become advocates, volunteers, and pro-choice voters is what makes Planned Parenthood a “movement” in a way that your local hospital is not.

This strategy carries certain risks, but if you ask Richards how the politics and the direct health services fit together, her eyes light up. “We’re a better health-care provider because we’re a movement that advocates and pushes forward, and we’re a better movement because we have real experience every day with folks coming in and asking for care,” she says, grinning. This symbiosis, she’s convinced, only makes the organization stronger.

THE REALPOLITIK INHERENT in Richards’s vision of Planned Parenthood has at times created tensions with other parts of the reproductive-rights movement. This was evident during the 2009 health-care reform debates, when the entire law seemed to hinge on whether Congress could find a political compromise around abortion. Richards and Planned Parenthood were at the center of the debate, fighting fiercely for the law’s passage. Richards took great pains to emphasize that covering contraception and women’s general health services—or 97 percent of what Planned Parenthood does—were the organization’s primary priorities. In effect, she accepted that abortion would not be treated like all other health-care services during those very heated, public fights.

In the end, to the frustration of many reproductive-rights advocates, legislators passed the historic health care law with a provision that permitted states to ban abortion coverage in private plans in their state insurance markets. Today, 25 states have done just that.

Pro-choice members of Congress shared Richards’s sense of what was politically possible. “It appeared questionable that the Affordable Care Act would pass, up until literally the last hours, because of the issue of abortion,” recalls Democratic Representative Jan Schakowsky, a member of the House Pro-Choice Caucus. “I think the ACA is as good as it can be; I think we did what we had to do if we had any hopes of passing the bill. I do not think we compromised too greatly or too soon: This was down to the wire on the day that the legislation passed.”

Erin Matson, the co-founder of Reproaction, a reproductive-rights activist group, disagrees. The health-care reform debate, she says, is a perfect case study in why reproductive-rights advocates lose. “The whole strategy from pro-choice leaders [during the ACA debates] was ‘Let’s just be reasonable.’ Give me a break! When has that ever stopped the right?” Matson believes the women’s movement has been too co-opted by the Democratic Party, and that Planned Parenthood’s strategy of stressing that “just 3 percent” of their services were abortion-related “was a classic example of accepting that abortion is shameful.”

Nonetheless, the Affordable Care Act has brought about tremendous advances for women’s health. Insurance companies can no longer consider pregnancies “pre-existing conditions,” and more preventative services are now covered under health insurance. In 2011, the White House issued a new regulation adding birth control to the list of mandatory services an employer’s group health plan must offer, providing a major economic lifeline to millions of women.

AT A TIME WHEN the reproductive wars have become a key driver of the country’s political divisions, Richards’s background and experience leave her supremely well-positioned to lead Planned Parenthood. Born in Waco, Texas, in 1957, Richards lived most of her early childhood in Dallas until her parents relocated their family—Cecile, then 11, and her three younger siblings—to Austin. While her mother, Ann Richards, Texas’s one-term governor in the early 1990s, was a heroic figure to liberals across America, her father, David, was also somewhat of a state icon. An unapologetic labor and civil-rights lawyer, David litigated many social justice cases, including a voting-rights case before the U.S. Supreme Court.

Richards likes to say her house was just like any other, except the dining table was used for stuffing envelopes and sorting precinct lists, rather than eating. (This isn’t quite true: The Richards family often threw big dinner parties, perhaps one reason why Cecile loves to cook and bake.) But it is true that she was politicized at a young age. Her first dance, at age 12, was a fundraiser for the United Farm Workers. By the time she was in middle school, administrators were reprimanding her for wearing a black armband in protest against the Vietnam War.

In 1972, Sarah Weddington, a young feminist lawyer based in Austin, decided to run for state legislature. Weddington asked Ann Richards, who worked as a housewife, to help manage her campaign. Cecile, then 14, worked with her siblings and mom to help get Weddington into office. (Not long after her victory, Weddington would go on to present the oral argument in Roe v. Wadebefore the Supreme Court, the momentous suit that legalized abortion in the United States.)

As an undergrad at Brown University, Richards continued to direct her energies toward activism. On campus, she protested apartheid in South Africa, and nuclear power plants in New Hampshire. “It’s not like college got in the way of her organizing,” her brother Dan once quipped.

After graduation, Richards went to work in the labor movement. She spent the next decade organizing janitors, garment workers, hotel housekeepers, and nursing home staffers in Louisiana, California, and Texas. That experience, she says, provided her with “really the biggest education I ever had.” Those low-wage workers, she notes, are very much the same women who rely on Planned Parenthood for health care.

The values Richards learned in the labor movement are the same ones that inform her vision of Planned Parenthood. “It’s not only about direct services, which is incredibly important, but it’s also about empowering the folks who are turning to [us] for health care,” she says. “When you think of how many people have been to Planned Parenthood in this country, from every walk of life, if those patients were empowered to participate in our democracy, a lot of the conversations that are happening in Congress right now would not be happening.” Richards wants to provide women not only with STD screenings, abortions, and pap smears—she also wants to help those patients find their political voice.

In 1982, she met Kirk Adams, a fellow union organizer. She became his boss, and three years later, his wife. In 1990, Richards and Adams worked on Ann Richards’s gubernatorial campaign, and stayed in Austin throughout Ann’s time in office. After one term in the statehouse, George W. Bush beat her in a landslide in 1994.

Her mother’s loss was painful, but Richards didn’t rest for long. She founded a new grassroots organization in 1995, the Texas Freedom Network, which aimed to curb the growing influence of the Texas religious right, particularly those activists seeking control of the school boards. “She always put herself in the line of fire, fighting for the most progressive values, in tough places, and in tough times,” says Steve Rosenthal, a former AFL-CIO political director. It was no easy fight, and Richards received heaps of vitriol from well-funded conservative opponents, foreshadowing her time at Planned Parenthood. Undeterred, she traveled all over Texas, rallying like-minded supporters who opposed teaching Bible stories in science class, expanding abstinence education in schools, and using public vouchers to send children to private schools. The Texas Freedom Network “started as a file box of names in Cecile’s kitchen and grew to many thousands of people,” her successor told the Texas Monthly in 2004.

Later on, Richards, Adams, and their three kids moved to Washington, D.C., so Adams could take a national position with the AFL-CIO. In 2002, Richards took a job working as deputy chief of staff for Nancy Pelosi, who was named Democratic whip in the House. Richards held that position for 18 months, though she says the experience helped her realize she was better suited to effect change from outside Congress, rather than within.

WHEN RICHARDS LEFT Capitol Hill in 2003, she took a job leading a new organization, America Votes—a coalition of progressive organizations that would work together to turn out voters for the 2004 presidential election. There had always been big, active progressive organizations, but their leaders mostly operated in silos, and did not talk to, or even know, one another. I asked Steve Rosenthal, one of America Votes’s founders, why they picked Richards to head this unprecedented $250 million effort.

“We thought we needed someone who was politically astute, who had the ability to work with people at a very basic level, who could get the trust of the organizations and mobilize them all into a new organization,” he says, explaining there was “really nobody else” they could have imagined fitting the bill.

At America Votes, Richards continued to do what she did best: organize. Specifically, she coordinated an electoral strategy among the nation’s largest and most influential unions and progressive groups—ranging from the American Federation of Teachers and the NAACP, to the Sierra Club and NARAL. She sought to help leaders understand how their efforts were, and really always have been, interconnected. She helped delineate which demographic and geographic groups each organization would target, and which would be most effective in delivering a message to a particular set of voters and getting them to the polls. It was a level of coordination hitherto unknown among the nation’s progressive organizations, and putting it together required diplomatic skills of the highest order.

Another innovation progressives introduced in the 2004 campaign was an effort to specifically target single women. The organization Women’s Voices Women Vote had recently formed, and aimed to draw attention to unmarried women, a growing political constituency largely ignored by progressives in previous cycles. Page Gardner, the group’s founder, pointed to the 22 million single women eligible to vote in 2000 who did not cast ballots. Single women, Gardner found, more strongly identify as “pro-choice” than married women. This mattered, as reproductive rights were already a major issue in the 2004 campaign, with critical judicial appointments on the line.

Despite these novel efforts, however, George W. Bush was re-elected, and the future of America Votes hung in the balance. Some of the biggest funders and backers wanted to scrap the project, and start with something fresh for 2008. Richards, who recognized how important this type of initiative was for the progressive movement, began appealing to all the major donors and partners, to convince them that this was not a project to abandon. “Just to be totally blunt, Cecile is the reason the organization still exists,” says Rosenthal. Greg Speed, the current president of America Votes, agrees. “I thought it was going to end after 2004,” he admits. “Cecile didn’t let that happen.”

I asked Richards why she felt it was so important to keep the organization alive after John Kerry lost. “How could we go back to a day where everybody goes, ‘Oh we’ll just do our own thing and see how it works out?’” she answers. “[2004] was really the first time that a lot of these big progressive groups had ever sat at the table together, and thought, ‘OK, how can we do our work in a smarter way, use our resources better, learn from each other?’ It was fascinating because not only did people build relationships that they perhaps did not have before, but there were even heads of progressive groups that had never door-knocked before that election!” Richards thinks one of the most important legacies of that campaign was building a common understanding of what grassroots advocacy and mobilization is really about.

When America Votes first formed, Planned Parenthood was only just beginning to dip its toe into politics. Though its founder, Margaret Sanger, was a radical birth-control activist in the early 20th century, Planned Parenthood itself eventually grew to be seen as a responsible, noncontroversial organization; family planning was considered bipartisan, sensible policy after World War II. Indeed, for many years Planned Parenthood garnered strong support from elite members of the Republican Party: Barry Goldwater’s wife was a founding member of the Planned Parenthood affiliate in Arizona.

These political dynamics began to change after the Supreme Court legalized abortion in 1973, and the religious right, a strongly anti-abortion faction within the Republican Party, increased its power over the course of the 1980s. In response, Planned Parenthood established a political arm in 1989, and a political action committee in the late 1990s. In 2000, Planned Parenthood started to experiment with ads in battleground states, and by 2004, it made its first-ever presidential endorsement.

In deepening the organization’s political activities and solidifying its place in the progressive universe, Richards has drawn on her experience at America Votes. “To see how much [Planned Parenthood] has changed, even in the past ten years … I’m not saying that’s all a result of America Votes, but it certainly opened my eyes to what the opportunities were, partnering with a lot of these organizations,” she says. “In some ways, that was probably part of the reason I came to Planned Parenthood.”

IN 2010, THE TEA PARTY soared to power, running on promises to dismantle the new health-care law, cut taxes, and ban abortions. In 2011, as the new crop of conservatives took power in statehouse after statehouse, those lawmakers introduced more than 1,100 reproductive health and rights-related provisions, according to the Guttmacher Institute, of which 135 were enacted in 36 states by the year’s end. Ninety-two of the new provisions restricted access to abortion, shattering the previous record of 34 abortion restrictions adopted in 2005. In Congress, the House voted to defund Planned Parenthood, and threatened to shut down the government entirely if a rider to defund the organization was not included in the federal budget deal. Congressional Republicans have been trying to defund Planned Parenthood ever since.

Republicans also started pushing for “religious freedom” exemptions for businesses and insurance companies, so that they would not have to offer birth control under their plans. As Katha Pollitt notes in her 2014 book, Pro: Reclaiming Abortion Rights, despite the fact that reliable contraception remains the most effective way to prevent abortion, “not one major anti-abortion organization supports making birth control more available, much less educating young people in its use.” In 2014, after a series of legal challenges, the Supreme Court ruled that closely held corporations could be exempt from providing employees with contraceptive coverage. This summer, the Supreme Court will decide if the government can even require nonprofits simply to fill out a form if they object to the birth-control mandate on religious grounds. “We’ve always known that the right wing has been anti-abortion but some people thought, well, that doesn’t extend to contraception,” says Schakowsky. “We know better now. … That was made clear for the world after the Affordable Care Act.”

In early 2012, the Susan G. Komen Foundation, under pressure from conservative activists and with a new anti-abortion senior vice president, announced that it would no longer fund breast cancer screenings at Planned Parenthood. The backlash was swift and unprecedented—Planned Parenthood raised $3 million in three days, and a deeply embarrassed Komen reversed its decision within the week. A whole new generation of supporters moved to social media to defend Planned Parenthood and express their outrage.

While Planned Parenthood and its allies pushed back against attacks on women’s health, other activists were growing worried about the tone and direction of the public conversation. They recognized that the reproductive-rights movement needed a new and bolder strategy—one that aimed to change cultural attitudes around abortion, not just laws and regulations.

Debra Hauser, the president of Advocates for Youth, an organization that focuses on young people’s sexual and reproductive health, says that in late 2010 and early 2011, as the Tea Party swept into power, her group heard from frustrated youth leaders who wanted to respond in some way to the incessant political attacks on abortion. They noticed that while many were worried about the future of reproductive health care, very few people were actually talking about abortions as such. The escalation of the right’s anti-choice rhetoric, says Hauser, was making any such discussion more difficult. “Honestly, the fear-based strategies and the vehemence makes it very, very difficult for people,” she says. “I think all of us have internalized some fear and shame [about abortion] that can be so immobilizing.” She and her team understood that this stigma, which limits the societal conversation, ultimately impacts how legislators think about abortion, too. New laws requiring women to undergo transvaginal ultrasounds and mandatory waiting periods, so they could “think more carefully” about their decisions, were little more than efforts to shame those who didn’t want to carry to term.

Advocates for Youth began to lay the groundwork for a public storytelling campaign, in which people could share their abortion experiences if they felt it was safe to do so. The effort was named the “1-in-3 Campaign”, because the Guttmacher Institute found that a third of all U.S. women will have had an abortion during the course of their lives. “If you tell one abortion story, people tend to shut it down. They say, ‘Oh well she could have done this, or she should have done that,’” says Hauser, who researched how storytelling has impacted other social movements. “But when you start to hear multiple stories at once, it becomes much harder to dismiss.”

Hauser admits that, initially, some mainstream reproductive-rights groups quietly pushed back on this de-stigmatizing campaign. But by 2013 and 2014, the groups started to embrace the strategy, and even more diverse efforts began to take shape. A new anti-stigma organization, Sea Change, formed in 2014 to conduct social science research on reproductive stigmas, with the goal of ultimately reducing them. Another organization, SHIFT, formed in 2015 to amplify the voice of abortion providers—those who understand the complicated ways in which women relate to abortion as both a medical and a cultural experience. These efforts began to effect a real change in the zeitgeist—new film narratives and TV plots started to emerge, featuring women who ended their pregnancies in relatively nontraumatic ways.

And all of this activism has created the space for more women to come forward with their own stories. In 2014, in an essay entitled, “Ending the Silence That Fuels Abortion Stigma,” Richards described her own abortion experience in Elle magazine. She was already raising three kids at the time—Lily, and twins Hannah and Daniel—and felt an abortion “was the right decision” for her and her husband. She said it “wasn’t a difficult decision.”

“Rarely do you see a leader of an organization putting her own skin in the game like that,” says Steph Herold, the managing director of Sea Change.

I asked Richards why, after leading Planned Parenthood for eight years, she had felt the time was right to share her own story. Though she had never hidden the fact that she had an abortion, she said she never really thought to share it so publicly, in a major women’s magazine, in part because her abortion was never a defining part of her life. And it still isn’t.

But she’s glad she spoke out. “Women now come up and tell me their stories about having an abortion—and boy, if this makes them more comfortable about sharing that story with me, or with anyone else, and helps them lift whatever burden is on them, hallelujah!”

Richards’s decision to tell her own story is part of a new effort within Planned Parenthood to take on abortion stigma. “I think the biggest change that I’ve seen in Planned Parenthood is that instead of emphasizing that abortion is only a small percentage of their services, they’re saying that they’re proud to provide abortion care,” says Herold. “They’re moving to a point where they say, ‘Yes we provide all kinds of health care, and abortion is just one service in the spectrum of all health-care services we provide.’” Indeed, this past October, Richards published a piece in Cosmopolitan, articulating that message in a way Planned Parenthood has generally avoided in the past. “If we want women to have fulfilling careers and economic stability, we have to give them full access to the full range of reproductive health care, including abortion,” she wrote. “Of course abortion services are health care.”

Several weeks after the Cosmopolitan piece came out, I asked Richards for her thoughts on the “only 3 percent” talking point, and if she worried it unwittingly contributed to abortion stigma. Planned Parenthood is an unabashed, unashamed provider of safe and legal abortion, she says, and she’s “incredibly proud” of that fact. “It’s just super-important to me that people understand that women have a whole range of health-care services that they need and being able to make decisions about reproduction is pretty fundamental,” she adds.

THE EFFORT TO FIGHT stigma coincides with another development in the reproductive-rights movement: a shift away from rhetoric about “choice” and “rights” to broader themes of justice, access, and security.

After the 2012 election, the Democratic Party started to really grasp what Page Gardner had been trying to communicate for the past decade. Single women, a growing portion of the electorate, proved to be game-changers in Obama’s re-election campaign; he won their vote by a margin of 36 points, despite losing married women to Mitt Romney. In 2013, Democrat Terry McAuliffe was elected governor of Virginia, in large part because he won single women by 42 points. (He lost married women to the Republican candidate.) Campaign research conducted the following year revealed that women’s health and economic security were issues that strongly motivated both the progressive base and swing voters. Researchers also found that drop-off voters (those less likely to vote in midterms) were more motivated to cast a ballot if they felt they were going to be voting against a candidate who would endanger women’s health.

The New York Times ran a story in 2014 detailing how mainstream reproductive-rights groups were in the midst of reframing their advocacy to connect with more voters. The article—“Advocates Shun ‘Pro-Choice’ to Expand Message”—explored how Planned Parenthood had taken the lead in conducting public opinion polling after 2011, in order to find talking points, like “women’s health” and “economic security,” that resonated with more people. In 2013, Planned Parenthood released a video, “Moving Beyond Pro-Life vs. Pro-Choice Labels.”

Gretchen Borchelt, the vice president for health and reproductive rights at the National Women’s Law Center, says that policy-makers have long separated economic issues from reproductive rights, which has meant that reproductive-rights groups generally worked apart from other progressive organizations. “But separating these issues doesn’t make sense; it doesn’t speak to the reality of people’s lives,” she says. “There has been growing recognition of this in the last few years, making it a pivotal moment to push forward policy solutions that place reproductive rights alongside the other policies that help women and their families thrive.”

Still, the struggle to push the reproductive-rights movement in new directions has not been without challenges. Even as the Democratic Party and mainstream groups like Planned Parenthood have been linking their advocacy more with other progressive issues—either because they recognize its inherent value, its strategic worth, or both—some smaller organizations that have been making these arguments for years have, at times, felt sidelined. After the Times story ran in 2014, Monica Raye Simpson, the executive director of SisterSong, a reproductive justice group led by and focused on women of color, published an open letter calling out mainstream groups for failing to acknowledge their decades-long work making connections between reproductive choice and women’s health and economic prospects.

“We appreciate that you push us to do this more, and to do it better,” Richards wrote back in response. “And we hear you when you say that we are not doing enough.” A few months later Richards and Simpson met in person, and published a joint statement pledging to build a stronger partnership.

I asked Simpson how things have played out in the year and a half since that meeting. “We’ve really seen mainstream organizations reaching into the women-of-color-led organizations to get our expertise, and actually have us at the table and shape the conversation,” she says. While Simpson acknowledges there’s still a long way to go in terms of truly making the reproductive-rights movement “intersectional” (a social justice concept that means reckoning with different forms of oppression and how they impact, and compound, one another), she does feel Planned Parenthood “is starting to show up more” for them.

One way that Planned Parenthood is “showing up” for a broader range of constituencies is through its membership in the All Above All coalition, a growing political effort to overturn the Hyde Amendment—the 40-year-old law that prohibits federal spending on abortions. Women of color and low-income communities most affected by Hyde have been leading the campaign.

During Cecile Richards’s testimony this past September, she told the House Oversight and Government Reform Committee that in her opinion, the Hyde Amendment “discriminates against low-income women.” Erin Matson, who has been frustrated by some of the rhetorical timidity of the reproductive-rights community, was surprised and encouraged by Richards’s comments. “That’s not how Planned Parenthood talked about Hyde in the past,” she says.

A WEEK BEFORE THANKSGIVING, Planned Parenthood’s political arm launched its 2016 election effort, pledging to spend at least $20 million defending reproductive rights. “We will organize and mobilize to elect lawmakers who are in our corner,” Richards announced in a video ad.

Most public opinion analysts suspect that the conservative strategy of targeting anti-choice voters in Republican primaries may backfire in the general election. An NBC-Wall Street Journal poll conducted in August found that Planned Parenthood has a significantly higher favorability rating than any other group or individual tested—including the Supreme Court, President Obama, both political parties, and key Republicans running for president. Handfuls of other recent polls and surveys have reported nationwide majorities opposed to defunding the organization.

Even on abortion, despite the high-profile attacks, public opinion hasn’t substantially changed. The percentage of Americans who believe abortion should be legal in all circumstances, in some circumstances, or under no circumstances has stayed relatively constant since Gallup first started asking the question in 1975. In 2015, Gallup found that 29 percent of Americans believe abortion should be legal under all circumstances, 51 percent believe it should be legal under some circumstances, and 19 percent believe it should be legal under no circumstances. While Republican candidates are staking out positions to appeal to those who oppose abortion under all circumstances, it turns out that not even all those voters are on board with the GOP attacks. A recent YouGov poll found that more than a third of Americans who support strict abortion restrictions nonetheless hold a favorable opinion of Planned Parenthood.

Republican presidential candidate Ben Carson, who compared supporting a woman’s right to choose to supporting slavery, has made clear that he’d like to see Roe v. Wade overturned, along with laws that permit women to terminate pregnancies in cases of rape or incest. Marco Rubio, a candidate favored among GOP elites, also wants abortion to be made illegal with no exceptions for rape or incest. But in a CNN/ORC national poll taken just before the 2012 presidential election, 83 percent of all voters—and 76 percent of Republicans—said they favored allowing abortions in cases of rape or incest. “The RNC is not happy about this Republican primary,” says Anna Greenberg, one of the nation’s top Democratic pollsters. “This is not a strategy [for them], it’s a disaster.”

The anti-abortion rhetoric stands not only to motivate the progressive base, but also to agitate independent voters. Independent women in particular tend to be more socially liberal and economically conservative, and Greenberg notes that a lot of the misogynistic and anti–reproductive rights rhetoric has actually helped Democrats more effectively communicate with this swath of the electorate.

“While backing Republicans into a corner might gin up some primary votes, [these positions are] wildly, wildly unpopular with the general public,” says Erica Sackin, Planned Parenthood’s director of political communications. “When Romney said the first thing he’d do as president is defund Planned Parenthood, he lost the 2012 election by the largest gender gap in history.”

Planned Parenthood wants to help elected officials understand that being forthright in their support for abortion and reproductive rights is both better policy and smart politics. In effect, the organization, along with other women’s groups, is now engaged in its own anti-stigma work on the electoral level, pushing leaders away from the “safe, legal, and rare” abortion mantra that pro-choice Democrats used, starting with Bill Clinton’s 1992 presidential campaign. The Democratic Party officially removed the phrase from its platform in 2012, and advocates are now urging politicians to think of abortion more along the lines of “safe, legal, and where we live.”

Richards believes the country has arrived at a real inflection point. “It’s just abundantly clear,” she says, that the assaults on Planned Parenthood are not about the organization as a health-care provider, but about “folks who resent that women actually have the legal right to make their own decisions about their pregnancies. That’s what they’re mad about, and they’re really mad.”

The stakes are high, but Richards is looking forward to the challenge. “I’m just grateful we’re getting to what is actually the real fight,” she says. “I believe this country is not going to go backwards. It has been incredibly inspiring to see young people, who I do think live their lives in a more public way, who really do want to throw off judgment and shame about so many things, including abortion. To me, that is a bright new day, and I hope, I think, it’s all going to come together in one place.”

California’s New Crisis Pregnancy Center Law Creates a Roadblock for Anti-Abortion Activists

Originally published in In These Times on October 30, 2015.
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Earlier this month, California Governor Jerry Brown signed the nation’s first statewide law to regulate crisis pregnancy centers (CPCs). CPCs are facilities that work to counsel women out of having abortions, offering them resources like diapers, baby formula and maternity clothes, but also often disseminating misleading or outright false medical information. Boosted by government funding under George W. Bush, they have proliferated over the past 15 years, with an estimated 3,500 nationwide—outnumbering real abortion clinics 3-to-1.

California’s Reproductive Freedom, Accountability, Comprehensive Care and Transparency (FACT) Act, which overwhelmingly passed the state assembly in May, is being hailed as a landmark victory in a nationwide effort to push back against the rise of CPCs.

The new law, set to take effect January 1, will govern California’s nearly 170 CPCs, about 60 percent of which operate with no medical license. The law requires unlicensed facilities to post a notice—in “no less than 48-point type”—stating that they have neither a state medical license nor licensed medical staff. Licensed CPCs, for their part, will be required to inform women about available public assistance for contraception, abortion and prenatal care.

Whether or not the law can withstand a court challenge, however, remains to be seen. The decades-old movement to regulate CPCs has been repeatedly thwarted by First Amendment challenges.

Although CPCs began cropping up in the late 1960s as individual states lifted their bans on abortion, the clinics flew under the radar until the 1980s and 1990s, when they became a subject of a heated debate that went all the way to halls of Congress. Detractors argued that CPCs’ strategies to lure in women—such as offering free non-diagnostic ultrasounds and staffing their non-medical volunteers in white lab coats—amounted to false advertising. Defenders said their actions were protected speech.

The passage of the Personal Responsibility and Work Opportunity Reconciliation Act in 1996—or “welfare reform”—increased federal funding for abstinence education and helped to fuel the expansion of CPCs, as In These Times reported in 2002. The law enabled the Bush administration to funnel $60 million in federal abstinence-only funds to crisis pregnancy centers between 2001 and 2005, often doubling or tripling the centers’ annual budgets.

In response, a number of investigations into CPC practices were launched. A 2006 congressional investigation, initiated by Rep. Henry Waxman (D-Calif.), looked specifically at CPCs that received federal funding, and found that most provided women with false or misleading medical information, which “often grossly exaggerate[ed] the risks.” (Federal funding for CPCs continues today, despite the Obama administration’s efforts to end it.) NARAL, a national pro-choice organization, has also been investigating CPCs for more than a decade, and has discovered that staffers routinely overstated the risks of abortion or simply lied—telling women that ending a pregnancy would lead to infertility, breast cancer or even suicide. A 2008 NARAL investigation into 11 crisis pregnancy centers across the state of Maryland found that “every CPC visited provided misleading or, in some cases completely false, information.”

Drawing on the Waxman report and NARAL’s investigations, in 2009, Baltimore passed the first-ever legislation designed to curb CPCs’ misleading advertising practices. Challenging CPCs from a false advertising perspective was, in part, a strategic decision. As Slate’s Emily Bazelon reported in 2009, “There’s a whole branch of law, commercial speech, to explain why false advertising gets less First Amendment protection.” The law required Baltimore CPCs to display signs—in both English and in Spanish—clarifying that they do not provide abortion or birth control referrals. Similar laws were soon passed in New York City, Austin, and San Francisco.

These ordinances were all challenged in court on First Amendment grounds. CPC backers argue that the regulations violate their religious freedom and their right to free speech. Baltimore’s law was struck down in 2011 and is still tied up in court appeals. Austin’s was overturned, as were key aspects of New York’s law. Given their free services and nonprofit statuses, judges have tended to see CPCs’ speech as “noncommercial”—a designation that generally receives greater constitutional protection than commercial speech. But San Francisco’s law, which passed in 2011, has thus far withstood legal challenge.

Pro-choice advocates in California treaded very carefully in drafting the FACT Act. “We paid a lot of attention to the bills crafted in other cities,” says Amy Everitt, the state director of NARAL Pro-Choice California. NARAL also enlisted the help of Attorney General Kamala Harris, a Democrat, to identify language that might be deemed unconstitutional.

Everitt explains that laws which require centers to post signs describing what they do not provide (such as abortion referrals) have tended to be more legally vulnerable than those that require facilities to distribute “neutral” information about available government services. So the FACT Act only requires licensed clinics to inform women of the many services available to pregnant women. In California, state Medicaid funds can cover the cost of an abortion, and millions of Californian women became eligible for Medicaid with the passage of the Affordable Care Act.

“In California, we have some of the best pro-choice policies in the whole country, but if women aren’t aware of what’s available to them, then they can’t use them,” says Everitt. “They need to find out about their options, and they need to find them out when they are actually out seeking care and information.”

Crisis pregnancy centers have already filed two suits against the Reproductive FACT Act. The law “is an outrageous and unconstitutional violation of both the right of free speech and the right of freedom of religion for our members in California,” said Thomas Glessner, the president of the National Institute of Family and Life Advocates, in an email quoted in Life News.“The Act unconstitutionally forces pro-life pregnancy centers, on pain of government penalty, to engage in government disclaimers that they would not otherwise provide.”

In response, Everitt notes that the state has a “public health interest” in ensuring that women can access high-quality reproductive care. “Women are seeking their options,” she says. “They are going online and they are looking for information to make their decisions about unintended pregnancy or pregnancy scares, and they were not getting the information they wanted in certain places like CPCs.”

Crisis pregnancy center advocates usually deny that CPCs mislead women, arguing that those who come to visit are well aware of the clinics’ anti-abortion slant. But investigations by reproductive-rights groups and Congress have found that CPCs often set up shop in close proximity to real reproductive health facilities and hide their anti-abortion agenda when women call seeking information. CPCs have also spent significant sums of money to advertise their services misleadingly in newspapers, on billboards, on social media and through Internet search engines.

While the fate of California’s new law remains uncertain, energized advocates are determined to build on their newfound political momentum. Everitt says she hopes their new law will serve as a model “for every state to pursue.”The new measures are “what it looks like to respect women,” adds Ilyse Hogue, the president of NARAL Pro-Choice America.“Empower us and trust us to make the best decisions for ourselves and our families.”

We know College Feminists Care About Sexual Assault. What About Abortion?

Originally published in The American Prospect on October 24, 2014.
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In the past three years, more abortion restrictions have been enacted in the United States than in the entire previous decade. At the same time,85 colleges and universities are now under federal investigation for their handling of sexual violence. While these two issues are not divergent, campus feminists have devoted much of their energy to challenging their universities’ failure to adequately handle sexual assault cases—often at the expense of abortion rights advocacy.

But the growing threats to reproductive justice—like the Texas law that could shut down most of the state’s abortion clinics, and looming ballot measures in Colorado, Tennessee, and North Dakota that could result in women losing their legal right to terminate a pregnancy—have catalyzed the ongoing efforts of national pro-choice organizations to invest in student leaders. Campus activist priorities and national women’s rights goals might finally be aligning—sort of.

For many students attending schools in East and West Coast states, the legislative efforts to restrict abortion access commonly found in red states can seem quite distant from their own daily gender struggles. Changing local culture around rape and sexual assault, on the other hand, seems far more urgent.

“Campus activism tends to be reactionary, and women are generally kept on the defense,” says Sarah Beth Alcabes, a recent graduate of the University of California, Berkeley. “It’s hard to organize for coherent proactive action beyond the immediate threats we face. Maybe if campuses were safe for women, there would be energy for them to focus on places not in their immediate vicinity. But that’s not the case.”

At Johns Hopkins University in Baltimore, students have filed an anoymous Title IX complaint alleging that the school failed its responsibility to ensure the safety of students when it allowed a fraternity to continue throwing parties even after police began an investigation into an alleged gang rape that took place at the frat house. One of the complainants says that the focus of leaders on her campus has been the enforcement of federal sexual assault laws for a simple reason: “There’s no equivalent to those sorts of laws for abortion,” she explains, “so the pro-choice movement doesn’t occupy the same place as gender-based violence on the college campus.”

But geographic distance from the most pressing abortion battles and political momentum around sexual assault prevention are only part of the story. Even in those states where access is regularly threatened, many college feminists have avoided tackling the issue of abortion directly—in part because the abortion debate is so polarizing, and in part because many campuses are unwilling to institutionally support such activism.

At Texas Tech University in Lubbock, Sophia Dominguez, the president of the Texas Tech Feminist Majority Leadership Alliance (FMLA), says she believes that reproductive rights are an important feminist issue, but her group must “recognize the political culture of Texas and adapt [its] advocacy accordingly.” She says her peers feel “repressed in the ways in which to openly discuss and address reproductive freedom.” As such, Tech FMLA has been fighting Texas Tech’s rape culture, which students believe is a more immediate problem to tackle, even in light of the Texas legislature’s anti-abortion efforts.

Kierra Johnson, executive director of URGE, a national campus organization committed to reproductive and gender equity, says that the leaders of many URGE chapters tend to focus on sexual assault because there is less official support for abortion work, even when a group is affiliated with a campus women’s center. “We might be able to push for more access to contraception,” Johnson says. “But the more the conversation centers around abortion, the more uncomfortable the administration is with getting behind it. Regardless of how people feel about abortion, when you talk about it, it charges an environment, and that’s the last thing campus administrators want.”

Several national organizations—the Feminist Majority Foundation, Planned Parenthood for America, NARAL Pro-Choice America, and URGE—are trying to change these campus dynamics by building networks of college students who will advocate for reproductive justice and gender equality. While coordinated inter-campus solidarity is currently pretty minimal, efforts to build a larger college pro-choice infrastructure are growing.

But even with support from outside organizations, building a student pro-choice movement is tough. Molly Waters, a senior at Webster University in Webster Groves, Missouri, works as one of NARAL’s campus representatives for the Choice Out Loud campaign, an effort to help millennials engage in conversations about reproductive rights.

“I don’t think abortion is the first thing feminist students would organize around, just because it’s so polarizing and has such a stigma,” Waters says. “I understand it. I myself am a Christian. I think a lot of people are more tempted to discuss birth control or general reproductive rights and not so much abortion rights.”

NARAL donates supplies to campus chapters, organizes conference calls between campus representatives in different states, and facilitates national communication through Facebook groups. Yet Waters observes that many students just seem to have a general lack of interest in political activity. “One thing that can be really frustrating is just how many people don’t want to protest or be active as much,” Waters says. “And that’s understandable; we’re in college, we have a lot on our plates. But there does seem to be a lack of energy for action.”

Kaori Sueyoshi, a senior at the University of North Carolina at Chapel Hill, feels more optimistic. “The student movement here in North Carolina has been growing quickly with the Republican takeover of our state,” she explains.

In 2010, Republicans won the majority in the state legislature, and won the governor’s mansion in 2012. Since then, North Carolina has enacted a controversial set of abortion restrictions, as well as a stringent voter ID law. In turn, over the past two years, college students across North Carolina have gathered together to network, strategize, and advocate for reproductive rights in their communities. Sueyoshi has been involved with Planned Parenthood’s network of campus activists, known as Generation Action, and attended the Youth Organizing & Policy Institute, a national student conference that Planned Parenthood hosts in Washington, D.C. “I think the national college advocacy movement is growing much stronger,” she says.

She may be right. At Vanderbilt University in Nashville, Tennessee, Marlies Biesinger, co-president of the Vanderbilt Feminists, says that advocacy around abortion politics has never been a real priority for them. But for the first time, in light of the political buzz around Tennessee’s Amendment 1—which could give the state legislature, not the state Supreme Court, full authority to decide the legality of abortion—the Vanderbilt Feminists have started to hold educational events to raise awareness about the ballot measure’s implications and push students to vote this November. And at Rice University in Houston, Rice for Reproductive Justice formed just last year to campaign for gubernatorial candidate Wendy Davis and organize around a broad set of issues that inhibit reproductive freedom.

If threats to safe and legal abortion access continue to drive both college advocacy and the formation of relationships between student leaders, the questions then become: What can these activists actually do together? How, when anti-choice measures are primarily passed through state legislatures, can national advocacy play an effective role?

“The movement has shifted,” Johnson says, because anti-choice activity has moved from the federal to the state level. “For a long time there were lots of opportunities to engage on a national level. But we’re not going to mobilize people in Alabama to work on Texas. No matter how much noise you make, at the end of the day the elected officials only care how people are voting in their state and districts.” While broad-based online petitions exist, like those organized by Change.Org and Moveon.org, right now there just are not a lot of opportunities for pro-choice activists, in or out of college, to campaign on the federal level.

Despite the relatively limited array of federal policy opportunities, the need to mobilize and educate students about reproductive rights remains pressing. The All* Above All campaign, which is focused on lifting health insurance bans on abortions, is one possible avenue for students to pursue. “There’s just a real lack of awareness about what these abortion restrictions are, so we need to educate constituents and our elected officials,” Johnson says.

For Waters, the more progressive culture of her Missouri liberal arts college feels worlds away from the conservative southern Illinois town she grew up in, where mentioning abortion rights would “automatically make you a Satanist.” Coming to college and finding a new environment to educate herself, and later educate and agitate others, has been transformative. “You know, it’s taken a while for me to get there,” Waters says. “It takes a lot of education that many people just don’t usually have.”

Common sense on Plan B.

Originally published in the Baltimore Sun on April 9, 2013.

Last week, a federal district judge in New York ruled that girls younger than 17 should be allowed to purchase the Plan B contraceptive pill over the counter. Unlike the Obama administration, Judge Edward Korman got this one right. The 2011 decision by Health and Human Services Secretary Kathleen Sebelius to restrict access for younger girls not only denied them a safe and legal means to prevent unwanted pregnancy but ignored all scientific evidence that supported its access.

Emergency contraceptive pills, commonly known as “Plan B,” are drugs that work to prevent pregnancy if taken shortly after sexual intercourse. Plan B, which has been available by prescription since 1999, contains levonorgestrel, a synthetic version of the hormone progestin. Levonorgestrel has been used in birth control pills for more than 35 years; Plan B contains a higher dose and is taken as two separate doses 12 hours apart.

Given that teen pregnancy rates in the United States, while declining, are still high for an industrialized nation, the need for easier access to all forms of safe and effective contraception is great. And there is no question that Plan B is safe; aspirin is more dangerous and susceptible to misuse. For that reason, the Food and Drug Administration recommended in 2011 that Plan B be made available over the counter without a prescription.

Nonetheless, President Barack Obama defended Ms. Sebelius’ decision to reject the FDA recommendation, saying at the time that he believed the nation should exercise “common sense” when deciding what medicines to allow over the counter. White House spokesman Jay Carney reiterated that line on Friday, again calling it a “common-sense approach.”

Common sense would be to make decisions based on reputable scientific research, as Mr. Obama had pledged to do during his first inaugural address, when he said he would “restore science to its rightful place” in policymaking. Instead, “common-sense” effectively means “compromise” with those whose real agenda is to erode access to contraception and those who mistakenly think Plan B has something to do with abortion.

Plan B is not an abortion pill, like RU-486, which must be administered in a doctor’s office. Instead, it prevents the fertilization of an egg, which is why it must be used within about 120 hours of intercourse. Nonetheless, Plan B has become a target of abortion-rights foes and those who think that increasing access to contraception somehow leads to promiscuity.

The Obama administration’s decision to reject the Food and Drug Administration’s advice on Plan B was a surprising one for a president who has otherwise done much good for the cause of women’s health care. Under the Affordable Care Act, women can now receive free birth control; they can get preventive services like mammograms, new baby care and well-child visits without co-pays; and there are greater crackdowns on discriminatory insurance premiums based on gender.

The only conceivable explanation for the president’s decision was that it was an attempt, amid a re-election campaign, to avoid fueling the trumped-up narrative that his efforts to extend contraception access amounted to a “war on religion.” Judge Korman called the ban “politically motivated, scientifically unjustified and contrary to agency precedent.” His decision was supported by scientists, experts, women’s reproductive health groups and the American Academy of Pediatrics, which had advised its members to issue blanket Plan B prescriptions to teen girls as a means to get around the Obama administration policy.

This ruling comes at a time when women’s reproductive rights are being put at risk in state houses across the country. North Dakota recently passed legislation to ban any abortion after six weeks, the strictest such measure in the nation. It trumped legislation passed in Arkansas earlier this year to ban abortions in the 12th week of pregnancy, and it is about to be leapfrogged by a Kansas bill that defines life as beginning at fertilization.

It is unclear yet whether the Obama administration will try to fight the Plan B ruling. Mr. Carney said in a news conference that the president’s opinion “has not changed.” But now, the president doesn’t even have the excuse of political expediency to justify his position. The science is clear, and so are the public health benefits of making Plan B widely available. The president should let this decision stand.