Written by Sarah Seltzer for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

The Child Catchers chronicles the hypocrisy of anti-abortion & right-wing Christian activists.

Kathryn Joyce’s new look at the adoption industry, The Child Catchers: Rescue, Trafficking, and the New Gospel of Adoption, contains within its pages true horror stories. Perhaps most shockingly, the book details what appears to be the long-term abuse of a group of Liberian orphans “adopted” into a life of virtual slavery in Tennessee — starved, hit, manipulated, and isolated by “parents” practicing an extreme brand of back-to-the-land Christianity.

But Joyce, through intensive reporting around the world, also tells the stories of “orphans” who have actual families, even mothers, back home and who were adopted under false auspices, as well women in the United States who are manipulated into relinquishing children for adoption by crisis pregnancy centers (CPCs).

Throughout the book, these dynamics of exploitation are recreated on a macro scale as the increasing drive for Westerners, often people of faith, to adopt orphans keeps feeding into, and off of, a global system of poverty, corruption, and mistreatment of women and children. Joyce’s work touches on bigger social issues, like the intersection of capitalism with reproduction, the role of religion in shaping policy, and the way conventional — and even inspirational — narratives of care and charity intersect with old paradigms of oppression and power.

Joyce recently spoke to RH Reality Check about how the movement she chronicles relates to abortion politics and the treatment of biological families of adoptees at home and abroad.

RH Reality Check: Ideologically speaking, how did the concept of adoption as a positive alternative to abortion end up morphing from “Don’t have an abortion, adopt!” rhetoric into this massive movement to actually facilitate adoption on a broad scale?

Kathryn Joyce: Adoption and abortion have long been linked. For years, it’s been presented as a neat, common-ground solution to the abortion debate — something that politicians on the right and left can agree on. For liberal politicians, it offered a way to moderate support for abortion. For conservatives, it was presented as a solution for women who didn’t want to parent, or who couldn’t. It was also framed as an answer to the pro-choice challenge: Who is going to care for all these babies you want women to have?

RHRC: You also address how the post-Roe landscape demographically affected the practice of adoption.

KJ: The real push to increase adoptions came in the last few decades, after the rate of domestic infant relinquishment for adoption dropped, going from around 20 percent of never-married white women in 1972 to closer to 1 percent today. The rates were historically lower for women of color, who were less likely to be pressured to relinquish in pre-Roe days because there was more adoption “demand” for white infants. Today, I think domestic relinquishment rates for Black women are statistically zero. So as demand outstripped “supply,” a lot of organizations became invested in increasing the number of women relinquishing.

RHRC: The capitalist angle strikes me, almost like the “market” for adoption mimics 19th century European imperialism, going to new territories to find “supply” through exploitation.

KJ: Yes, I think you see that overseas as well as here in the United States — the sort of “country-hopping” that happens in inter-country adoption, as adoption booms and busts move from nation to nation, but also in the experiences of U.S. mothers, about whom some organizations wrote multiple reports, trying to figure out how they could encourage more adoptions.

RHRC: Given your contact with people on both sides of the equation, do you think the choice to carry to term and then relinquish is never going to be as common as adoptive parents want it to be, which tips the power relationship?

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Written by Kathy Bougher for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

See all our coverage of Beatriz here.

Petition the El Salvadoran President and Supreme Court for Beatriz’s life here.

On Wednesday, May 15 the Supreme Court of El Salvador will hear testimony from Beatriz, the 22-year-old woman who has petitioned the court to allow her to have a life-saving abortion, a procedure prohibited under all circumstances in El Salvador and punishable by lengthy prison terms. She is pregnant with an anencephalic fetus; it is missing most of its brain and will not survive outside the womb. In addition, Beatriz, the mother of a toddler, suffers from lupus, hypertension, and renal insufficiency. Her doctors at the Maternity Hospital, where she has been for almost a month, advised her that an abortion was necessary to save her life.

“I want to live,” has been Beatriz’s consistent response to her doctors as well as to those who oppose her request.

The court has summoned Beatriz, her lawyers, and her doctors to testify, according to Morena Herrera, president of the Agrupación Ciudadana por la Despenalización del Aborto Terapeutico, Etico and Eugenico (Citizen Group for the Decriminalization of Therapeutic, Ethical and Eugenic Abortion) in a phone call with RH Reality Check. The state prosecutor and the Institute for Legal Medicine will also provide testimony. Both oppose her petition for an abortion. Sí a la Vida, a right-to-life group, requested permission to participate, but was denied. Herrera reports that her group learned recently that the director of the Institute for Legal Medicine is married to a member of the board of directors of Sí a la Vida. Although the Supreme Court has the demonstrated capacity to respond to petitions from Salvadoran citizens on other matters within as little as 24 hours, it has stalled for weeks in this matter. At this point it is unknown whether the court will issue a final decision on May 15.

Beatriz’s mother, Delmy, spoke Tuesday at a press conference organized by Herrera and the Citizen Group, saying, “It is now that my daughter needs support and help, not when her health gets even worse…. My daughter wants to live. I don’t want my daughter to die…. Her life is in your hands.” She has written a letter to the court that will be presented on Wednesday.

Beatriz’s petition has ignited controversy and debate on many fronts within El Salvador and around the world. Amnesty International, the United Nations, governments of several countries, and the Interamerican Human Rights Commission strongly support Beatriz. The Catholic Church and so-called right-to-life groups oppose her request.

Salvadoran President Mauricio Funes spoke publicly on the issue for the first time on Monday when, as Herrera explained in her phone call to this writer, feminists confronted him as he inaugurated a new bridge in the town of Suchitoto with banners asking “Mauricio Funes, if Beatriz were your daughter, what would you do?” Funes, the first president from the leftist FMLN party, finally said, “Beatriz has the right to make decisions about her life.” On behalf of the government, he entrusted the case to Dr. María Isabel Rodriguez, minister of health, who has supported Beatriz’s position from the beginning.

At the end of last week the minister reiterated her position that a therapeutic abortion was the “viable, just solution, without a doubt.” The Institute of Legal Medicine conducted its own studies and declared that Beatriz was not in imminent danger and could continue her pregnancy. The Minister called those comments, “uneducated and vulgar.”

Rodriguez reiterated that Beatriz’s life is in danger. She also discredited the report from the Institute for Legal Medicine that was presented to the court: “It is not true that she is not in danger. The lupus that this young woman has is not curable and can’t be changed overnight. We know this disease is systemic, which means that it attacks all the organs, and we can’t know at what moment we’re going to have complications with her.”

As Herrera explained, in a country where until recently even abortion rights supporters were cautious about using the word abortion out loud, student groups at the University of El Salvador have petitioned the school administration to suspend classes tomorrow so that they can attend the massive demonstration planned in support of Beatriz outside the Supreme Court building. Youth groups have participated in the frequent rallies supporting Beatriz.

The Citizen Group and other feminist organizations have maintained a constant presence with rallies, press conferences, and news releases. On Sunday they demonstrated in front of the cathedral with a banner that read “Letting Beatriz Die Offends God.” Sí a la Vida has also been active in Catholic churches, voicing its opposition to Beatriz’s petition and claiming that feminists are using Beatriz to further their agenda. At the same time, Funes states that the government is taking care not to exploit the case for political ends.

Radio de Todas, a feminist radio station in El Salvador, will broadcast the proceedings on Wednesday morning online in Spanish beginning at 8:30 a.m. Central Standard Time.

Written by Adele Stan for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Whosoever desires constant success must change his conduct with the times. — Niccolo Machiavelli

Cardinal Timothy M. Dolan is part of a dangerous reframing of "religious liberty."

At a gathering of Catholics in his archdiocese last year, Cardinal Timothy M. Dolan, the archbishop of New York, uttered a strategic point that would have done Machiavelli proud. The bishops, he said, are perhaps not the church’s best messengers.

“In the public square, I hate to tell you, the days of fat, balding Irish bishops are over,” he told his flock, according to the New York Times, at a diocesan convocation on public policy. Reporting for the Times, Tim Stelloh and Andy Newman wrote of an example he gave the crowd, an apparent reference to the hiring of Helen Alvaré by the National Conference of Catholic Bishops in 1990:

[Dolan] told a story about bishops hiring an “attractive, articulate, intelligent” laywoman to speak against abortion and said it was “the best thing we ever did…”

Dolan, as president of the United States Conference of Catholic Bishops (USCCB), decided this week to operationalize his assessment by hiring Kim Daniels, a former operative for Sarah Palin’s political action committee, as his spokesperson — a new position with a much broader mission than that covered by Alvaré in the 1990s.

An attorney and youthful mother of six who echoes the bishops’ disdain for contraception and abortion, Daniels is a smart cookie with an appealing personality. In other words, an “attractive, articulate, intelligent” laywoman.

When the USCCB announced Daniels’s appointment, the thing that grabbed reporters’ attention was her work in 2010 as an operative for Sarah Palin’s political action committee, SarahPAC — a résumé entry conveniently omitted from the bishops’ announcement about their new hire. If there was any doubt remaining of the bishops’ total alignment with the most right-wing part of the Republican Party, that data point should lay it to rest. But the rest of Daniels’ career is far more interesting — and troubling.

The Reframing of Religious Freedom

Over the course of the last several decades, as reasonable people, including most lay Catholics, increasingly rejected the church’s medieval worldview on women’s rights, human sexuality, and LGBTQ rights, the political power of U.S. bishops has been on the wane. During the debate over health-care reform, President Barack Obama went around the prelates in order to confer some Catholic buy-in on the deal, ultimately winning the approval of a number of highly placed nuns, who signed a letter to that effect, as well as the head of the Catholic Health Association, who also happens to be a Catholic sister.

The bishops were incensed. At that moment, their lack of sway over their own people was revealed for all to see. They needed a new angle, one that could also speak to the hearts of those ordinary Americans who, in the wake of the church’s massive child-sex-abuse scandal, now judged them to be mere mortals, and deeply flawed mortals at that. Enter the Red, White, and Blue.

The success of the Tea Party movement, with its bigoted and misogynist underpinnings dressed in the regalia of patriotism, was apparently not lost on the bishops. On the heels of their humiliating defeat with the Affordable Care Act, the bishops found a new, patriotic-sounding cause to wrap around their attempts to codify prejudice and discrimination as secular law: religious freedom, which is guaranteed by the First Amendment to the Constitution. Summon the fife and drum!

Trouble is, the bishops’ notion of religious freedom differs a bit from that of the founders, who sought to avoid the establishment of a state religion by promising Americans freedom of worship. What the bishops seek, on the other hand, is the right to impose their religious views on those who do not subscribe to their theology. Any impediment to their totalitarian view is now framed as a breach of their religious freedom. And Kim Daniels has been deeply involved in the advancement of this strategy.

Media-Friendly and Studio Ready Church Ladies

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Written by Editor-in-Chief Jodi Jacobson for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

The Gosnell case shouldn't inspire legislators to crack down on reproductive freedom.

There are two roles anti-choicers like to play for which they are ill-equipped. First, they like to play doctor. And second, they like to play God. In doing so, they spread outright lies about both abortion and contraception to mislead and whip the public into a frenzy about sex, pregnancy, and childbirth. And then, believing themselves to be the righteous ones, they seek to capitalize on their self-created panics to make public health and medical policy for the country based solely on emotion, facts be damned. Their end goal, as they make clear, is to outlaw abortion and contraception no matter the costs to public health, women’s lives, or society writ large.

The trial of Kermit Gosnell provides anti-choicers and their allies with a perfect platform for their efforts. In Gosnell, they have an unethical, unscrupulous criminal acting as a doctor. He preyed on women too poor to seek early, safe abortion care, ran a filthy “clinic,” and conducted illegal abortions during which, it is alleged, some infants were born alive and killed. In their quest to make safe, legal abortion care as inaccessible as possible, anti-choicers are now seeking to sway public policy by conflating safe abortion care with Gosnell’s atrocities, to tar all legitimate providers of safe abortion care as Gosnell clones, and to use a criminal case as a justification to drive legitimate providers out of business.

One recent example of this effort comes courtesy of Washington Post columnist Jennifer Rubin, who, in a column Wednesday, suggested several ways to further diminish access to safe, legal abortion care in the United States through what she calls a “Gosnell amendment.” If you read the piece, it is clear she has no idea what she is talking about.

Rubin, for example, calls for changes in Medicaid but appears not to understand how Medicaid works in the first place. She also calls for changes in federal funding of abortions, but appears not to understand that current law already severely restricts public funding of abortion.

She writes:

First, all Medicaid and other federal support for abortion services should come with caveats—health standards (of the type Pennsylvania refused to issue and enforce) and appropriate training for all personnel. Second, federal taxpayer dollars should not go for late-term abortions.

Let’s start out by making clear that this is the kind of grasping for irrelevant straws I described above (using the existence of a criminal to tar and feather an entire field of professionals who have no relationship to the criminal activity). For one thing, as confirmed in a phone call today to the Pennsylvania Department of Public Welfare, and notwithstanding the fact that what he did was illegal in the first place so the case illustrates nothing about safe abortion care, Gosnell was not receiving Medicaid payments for women seeking abortion. In fact, in 2010, there were only seven abortions in the entire state of Pennsylvania paid for by state tax funds, and no federally funded abortions anywhere in the state that year. As in zero. Zip.

But no mind: Rubin claims that Gosnell proves there are problems with federal Medicaid funding of abortion care, because eliminating Medicaid funding of abortions for any low-income woman under any circumstance is high on the anti-choice agenda and Gosnell gives them a platform for their arguments.

As for regulations and “health standards,” both the Centers for Medicaid and Medicare Services and state Medicaid agencies already work together both to certify and regulate Medicaid providers of all kinds, and both medical societies and advisory boards at the state and federal level set standards for care. Does this mean there is never any fraud? Of course not: Republican Rick Scott, the current governor of Florida, was implicated in one of the biggest Medicare frauds in the country in the late ’90s, showing that laws on the books are in fact broken until evidence is accumulated to bring a case. It was not lack of law or regulation, but rather lack of enforcement that allowed Gosnell to carry on for so long. Changes to Medicaid would therefore not have prevented and will not prevent past, current, or future quacks or criminals from operating in such a capacity until they are caught, just as homicide laws will never prevent all homicides and laws against arson won’t eliminate arsonists. Laws and regulations are meant both to define and to hopefully reduce criminal activity but will never eliminate it.

Rubin’s suggestion that federal taxpayer dollars should not go for abortions also is a head-scratcher, since the Hyde Amendment already forbids the use of federal funds for abortions except in cases of life endangerment, rape, or incest. This law has guided public funding for abortions for low-income women under joint federal and state programs since 1977. At a minimum, states must cover those abortions that meet the federal exceptions. States also are free to expand coverage of Medicaid funding of abortion for other reasons, using their own funds. Pennsylvania does not offer expanded Medicaid coverage for abortion.

Moreover, the system in Pennsylvania (as in many states) is such that even in cases of rape and incest it is virtually impossible to get reimbursed for a Medicaid-eligible abortion. As Claire Keyes, former director of a clinic in Pennsylvania, told RH Reality Check via email:

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Editor’s Note: The Justice Department filed suit to block Judge Korman’s ruling.

The Obama administration said Wednesday that girls under 15 should not have access to the most common morning-after contraceptive pill as the Justice Department filed a notice to appeal a judge’s order that would make the drug available without a prescription for girls and women of all ages.

Written by Editor-in-Chief Jodi Jacobson for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

This article was amended at 10:16 am, Wednesday, May 1, to correct the date of the amended application by TEVA to the FDA. It was resubmitted in 2012, not 2011.

See all our coverage of EC Over-the-Counter here.

New FDA emergency contraception regulations still do not go far enough.

Today, in a proposal that can best be described as adding insult to injury, the Food and Drug Administration (FDA) approved making emergency contraception (EC) available over-the-counter for teens and women ages 15 and up. This convoluted proposal from the Obama administration comes despite a court order in early April by U.S. District Court Judge Edward R. Korman to make EC available over-the-counter to all ages within 30 days of his decision. It comes from an administration which pledged to make science the cornerstone of public policy and instead has consistently flouted a wealth of accumulated evidence on emergency contraception. It also comes after several studies showing that current policy requiring prescriptions for some groups and not others has confused so many pharmacists that access to EC has been denied to many who were in fact legally eligible to obtain it quickly. In practice, the new policy will almost certainly perpetuate, not resolve, that confusion.

The battle to make EC available over-the-counter has gone on for over a decade and spanned both the Bush and Obama administrations. Judge Korman’s ruling was issued in response to the Center for Reproductive Rights’ (CRR) renewed lawsuit against the FDA seeking to expand over-the-counter access for all women to all brands of the morning-after pill, including Plan B One-Step and Next Choice. The most recent CRR lawsuit was filed after Kathleen Sebelius, secretary of the Department of Health and Human Services, overruled a 2011 FDA decision to make emergency contraception available over-the-counter to all ages, underscoring that the Obama administration, like its predecessor, has difficulties dealing with the realities of sex and pregnancy prevention.

The administration’s newest plan is to make EC available over-the-counter to individuals ages 15 and up, but still require prescriptions for those under age 15. While pharmacies can stock it in the family planning section of main store shelves, people seeking to buy EC will have to show identification with a birth date to a cashier. The plan comes after approval this week by the FDA of an amended application submitted by Teva, the manufacturer of Plan B One-Step, to allow OTC sale to those ages 15 and over, after an earlier request to do so had been denied by FDA in December 2011. The amended application was in any case superceded by the scientific evidence that led the FDA to rule in 2011 on making emergency contraception available OTC to all ages, the decision that was, as noted above, subsequently overturned by Sebelius. So in using the approved Teva application as the reason for this newest decision, the FDA is essentially reversing itself and ignoring the science on which its 2011 decision was based. Confused yet? Me too. It’s a complete circus, and I have no doubt that leadership at the FDA, which tried to make evidence-based policy in 2011, came under pressure from the White House to find the “fix” it announced today.

According to the FDA press release:

The product will now be labeled “not for sale to those under 15 years of age *proof of age required* not for sale where age cannot be verified.” Plan B One-Step will be packaged with a product code prompting a cashier to request and verify the customer’s age. A customer who cannot provide age verification will not be able to purchase the product. In addition, Teva has arranged to have a security tag placed on all product cartons to prevent theft.

In addition, Teva will make the product available in retail outlets with an onsite pharmacy, where it generally, will be available in the family planning or female health aisles. The product will be available for sale during the retailer’s normal operating hours whether the pharmacy is open or not.

NPR reported that “the FDA said … Plan B One-Step will be packaged with a product code that prompts the cashier to verify a customer’s age. Anyone who can’t provide such proof as a driver’s license, birth certificate or passport wouldn’t be allowed to complete the purchase. In most states, driver’s licenses, the most common form of identification, are issued at age 16.”

There are several serious problems with this approach, apart from the fact that it ignores scientific and medical findings that call unequivocally for over-the-counter access for all.

First, the policy is not in compliance with the court ruling and therefore may in fact be thrown out. The Department of Justice will have to bring it before Judge Korman for approval and potentially seek a stay of his ruling altogether, throwing EC once again back to the courts.

Second, it still requires a prescription for a subset of the population potentially in need of EC, and therefore creates a significant barrier, especially for low-income teens under 15 years of age or those without ID who “look” younger and are denied access. Emergency contraception is for emergencies. It prevents unintended pregnancy by preventing ovulation, and is therefore most effective when taken within 72 hours of unprotected intercourse (including in cases when another contraceptive method may have failed). The need to see a physician to obtain a prescription that the public health and medical communities have deemed unnecessary is both time-consuming and expensive, and will entail additional indirect costs in terms of loss of time at school and work, likely on the part of both teens and their parents. This requirement serves the interests of no one except anti-choice opponents of birth control, and those in the Obama administration who still seem unable or unwilling to think beyond their own fears of teens and sex, or to go beyond personalizing policy to accommodate their own paternalistic fears of their daughters as sexual beings.

Third, language, lack of identification, and other potential barriers will remain an obstacle for many communities. Many 15- and 16-year-olds do not have IDs that display birth dates, and those who are well above the age limit but “look younger” to a clerk will be required to produce identification, documentation that many people in this country still do not have readily available or that, in a hurry, some might not remember to bring with them to the store.

Latinas, for example, face many of these barriers to access. In reaction to the decision, Jessica González-Rojas, executive director of the National Latina Institute for Reproductive Health, stated:

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Written by Martha Kempner for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Poverty is a leading factor in teen motherhood.

Like many RH Reality Check readers, I have been closely following New York City’s fear- and shame-based campaign against teen pregnancy. The print ads include pictures of crying babies with captions like “Honestly Mom, chances are he won’t stay with you. What happens to me?” The ads also tell teens that if they have a kid, they will grow up to be poor. But the ads get it all wrong. Teen parenting doesn’t cause poverty; poverty causes teen parenting.

Developed by the New York Human Resources Administration (HRA), the campaign has seen a significant backlash since it was introduced last month. A group of activists in the city created a counter-campaign and demanded the city take the ads down. As Miriam Pérez noted in an article for RH Reality Check, the backlash may have resulted in a few tweaks and improvements, but the ads are still up, and the HRA hasn’t changed the campaign’s underlying tone at all.

I finally saw the ads for myself last week. My subway car was plastered with crying babies telling their potential teen parents not to get pregnant. The ads I saw were focused on money. In one, a curly haired toddler in a bunny rabbit shirt said, “Dad, you’ll be paying to support me for the next 20 years.” Another featured a one-and-a-half-year-old African-American girl with a bow on top of her head and tears streaming down her cheeks, saying, “Got a good job? I cost thousands of dollars a year.”

But the one that got me, the poster that I happened to be standing in front of for my ride on the C train, was one that might almost be seen as encouraging had it not been so completely meaningless. It read, “If you finish high school, get a job, and get married before having children, you have a 98 percent chance of not being in poverty.”

I don’t know whether this statistic is accurate, though it very well might be. Let’s face it: If you graduate from high school and get a job, you are two steps ahead when it comes to not living in poverty, whether or not you get married and have kids.

But these are big “ifs” that are affected by things way out of teenagers’ control, like where they’re born, the quality of the schools in their area, whether their parents are highly educated, whether their parents are employed, the employment rate in their neighborhood, and what the economy is like when they turn 18. And none of that has to do with whether or not they become parents before they get married.

Pérez points out that supporters of the campaign are missing the point — stigmatizing teen parents won’t prevent future teen parents, because that stigma already exists. I would add that the campaign misses another very important point: Teen parenting does not cause poverty. Poverty causes teen parenting.

Cause and Effect

The ads point out that economic outcomes for teen parents and their children tend to be poor. We know that teen mothers are less likely to graduate from high school, that the children of teen mothers are also less likely to graduate from high school (one ad in the campaign points to this statistics), that teen mothers are less likely to marry, and that they are more likely to live in poverty.  It would be easy to assume that these are natural consequences of teen parenting.

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Written by Bridgette Dunlap for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Government lawyers filed an emergency motion to dismiss lawsuit over contraceptive coverage mandate citing exorbitant costs in responding to document requests.

This week, the government filed an emergency motion in the New York Archdiocese’s lawsuit against the contraceptive coverage mandate, requesting that the court halt proceedings and dismiss the case. The emergency is that the government is hemorrhaging money defending a regulation it will never enforce against the Archdiocese.

Roman Catholic Archdiocese of NY v. Sebelius is the only lawsuit out of the 23 brought by religiously affiliated organizations not to be dismissed at the district court level for lack of standing or ripeness. The cases have been dismissed because religiously affiliated non-profits are currently completely exempt from the contraceptive coverage requirement. They enjoy a one-year safe harbor period provided for the religious accommodation to be finalized. If you haven’t been injured, you can’t sue.

The government swore up and down from the day the case was filed that the rule in its current form would never be enforced against the Archdiocese and its co-plaintiffs and that a new rule with a new religious accommodation was on the way. As promised, the Obama administration released a new proposed rule, is now reviewing comments from the public on it, and will release the final rule by August. However, in the New York Archdiocese case, Judge Brian M. Cogan found that the administration’s assurances were not enough and that the impending threat of the rule was injury enough for the plaintiffs to proceed.

The Archdiocese et al. proceeded to serve the government with requests for every document under the sun. “Discovery” is the process in which litigating parties get evidence by requesting relevant documents from each other. To respond to a document request, a party has to review documents to determine whether they are responsive to the request and make a log of documents that are responsive but won’t be turned over because they are protected by attorney-client or another privilege. Computer searches only get you so far; a human attorney or paralegal has to determine if a document is responsive or privileged.

Plaintiffs in these cases being 1 for 23, the Archdiocese may have sought to make the most of its unique situation. It made discovery requests the government calls “enormously burdensome and irrelevant.” The Archdiocese also noticed a deposition of Health and Human Services (HHS) Secretary Kathleen Sebelius. Lawsuits are brought over regulations all the time — it is pretty audacious to demand a cabinet member show up in person for yours. That was indeed too far, and Judge Cogan granted Sebelius a protective order.

The plaintiffs didn’t stop there. The Archdiocese subpoenaed the Executive Office of the President (EOP), even though it isn’t a party to the lawsuit, many of the requested documents are protected by various privileges, and you must have an extra good reason to get documents from the president. Also, the EOP being in D.C., the subpoena was issued in a district that has thrown out three of these 23 lawsuits for lack of jurisdiction.

The Archdiocese later withdrew the subpoena. We don’t know why. Perhaps it realized it was an unreasonable request. This did not happen, alas, until after our tax dollars were put to work on a very lengthy motion to quash the subpoena. But whatever that cost, it pales in comparison to the expenditures of various agencies on the New York document requests; in the emergency motion, the government estimates completing the requested document production would take eight years and cost over $10 million.

We should take that estimate with a grain of salt, of course, but the government has sought to back it up. Attached to the emergency motion are declarations from officials of various offices and agencies as to what they have spent so far on this one case and what they estimate it will cost to finish. Two-hundred HHS employees have spent have spent over 2,000 hours and located over 7.6 million pages of potentially responsive documents so far. That has cost over $177,000. Those documents haven’t been reviewed by HHS or their Department of Justice counsel yet. The Internal Revenue Service has spent over a quarter of a million dollars.

The lawyers, paralegals, and IT professionals needed to complete discovery are expensive — even those of the lower-paid government variety. Offices that don’t have enough staff for this have hired contract lawyers, but they can’t afford to do that anymore because of the sequester. Lest you think it’s not a big deal to have government lawyers tied up or that the effect is minimal in the scope of things, consider one example contained in the declaration from the Department of Labor (DOL). The DOL’s Plan Benefits Security Division investigates and litigates cases of fraud or mismanagement in employee benefits. The division, which recovered $1.38 billion for U.S. workers in 2011, argues that the impact on the public interest of putting its attorneys on document review will be far greater than the financial loss.

The Archdiocese, which employs 10,000 people in programs receiving many millions of dollars in government grants each year, will never have to provide health plans with contraceptive coverage under the rule as proposed. Despite this, it is waging a legal battle that is imposing significant costs on the taxpayers who fund its work. And this is only one lawsuit. With the additional cases brought by secular for-profit corporations, over 60 lawsuits have been filed in this scorched earth litigation campaign — which we have to pay to defend.

On the same day the emergency motion was filed, Judge Cogan granted it in part, staying all discovery and proceedings until the contraceptive coverage rule is final. So the government lawyers can get back to other business for the moment. But once the rule is final, I expect we will see that some if not all of those 22 dismissed cases (the ones that haven’t already been appealed) will be refiled.

Back in February, with the sequester looming, the U.S. Conference of Catholic Bishops, which, like the Archdiocese of New York, is led by Cardinal Timothy Dolan, signed a statement by religious leaders urging legislators to protect the interests of the poor. The Bishops’ litigiousness does not reflect the same awareness of our limited resources nor concern for those who will be hurt most by the sequester. Instead, the Archdiocese seeks to deprive its employees of affordable contraception — provided by an outside company — that will enable employees to limit their families to the size they want and can support, using up resources that are needed elsewhere in a time of economic distress.

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Written by Jon O’Brien for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

At a time when state legislatures continue to break new records for the number of restrictions on reproductive health-care access introduced, passed into law, and placed on ballots, when lawsuits against birth control coverage continue to trickle into the courts, when political candidates can’t even get it right on rape and the White House has repeatedly used abortion and birth control as bargaining chips, those of us who support reproductive autonomy face critical questions. One question should not be, as some have recently posited, whether or not a group adheres to a pro-choice or a reproductive justice frame when doing its work. It should be how each of us, individually and as organizations, can best use our knowledge, strengths, resources, and values to bring about change that makes women’s reproductive autonomy a reality.

Pro-Choice Action

Right now, we need every voice and perspective we can get to speak out loudly, strongly, wherever, and to whomever they can, in whatever language they speak best, to protect rights that many thought were guaranteed. A movement that is monolithic does not use the best everyone has to offer. One that allows all organizations and individuals to identify as they see fit and truly put their passions to work on shared or complementary goals will thrive. We win when we have a definite, common goal that requires real action, and we win when we allow a variety of groups to speak to their own communities with their own voices. We recently saw this in Florida, where women’s organizations such as the National Organization for Women (NOW) and the League of Women Voters; religious organizations such as Catholics for Choice, the National Council of Jewish Women, and the Religious Coalition for Reproductive Choice; and reproductive justice organizations such as the Miami International-Latinas Organizing for Leadership and Advocacy (MI-LOLA) all worked to soundly defeat two ballot measures aimed at curtailing abortion access and real religious liberty.

Unfortunately, some advocates for reproductive health, rights, and justice insist we wordsmith the movement rather than take action. Some folks are paralyzed by semantics, stuck in a vain search for a magic word or phrase that will convince everybody to agree with us. In doing so, the focus is taken off what we believe and what we need to do, and we are reduced to creating word clouds of marketing frames outlining why we must replace the concept of “choice.” “Reproductive justice” has been suggested as this magic phrase.

Both choice and reproductive justice have a place in our battle for women’s autonomy. But one cannot take the place of the other.

At Catholics for Choice, we approach the word “choice” from an ideological standpoint, one that includes justice at its very core — social justice. We are called by our faith to advocate most strongly for policies that protect and lift up all people, particularly the most marginalized and the poorest of the poor. Our religious beliefs compel us to recognize the dignity and rights of all people, who deserve respect and equal access to reproductive health care, no matter their race, color, class, or creed. We cannot settle for any less. Why some people have failed to recognize that justice is an inherent part of what we do is a mystery to us.

We believe, however, that the reproductive justice model is an important piece of the reproductive rights movement. It works for some groups to reach the constituencies that they must reach. It reminds the rest of the movement that we are not, nor should we be, a homogenous steamroller.

As our colleague Loretta Ross, the co-founder and national coordinator of SisterSong, has noted, it was American women of color who first coined the term “reproductive justice” almost 20 years ago, in 1994. They did this to embrace a broader range of concerns that many women of color in the United Sates shared and that were not being addressed by some in the pro-choice movement. They found a phrase to express their unmet needs and through which they could develop solutions. SisterSong continues to highlight these concerns, and we are a stronger movement because of their efforts.

Unfortunately, as others have adopted this framework, some people have chosen to denigrate the language and framework of choice, even sighing a “huge sigh of relief” when others choose to stop identifying as pro-choice. We do not need to tear down each other in order to build ourselves up, and it is misguided to assume that there is a single way to approach a common goal or a single way of viewing the work that we do and why we do it. Those who have dismissed choice have most often misrepresented it. They have pointed to polling data claiming that the number of people calling themselves “pro-choice” is in decline, when most of us already believed that putting “choice” vs. “life” in head-to-head polling is a mindless approach. We’ve long known that Americans have felt that pitting the two terms against each other creates a false dichotomy, and that even those who consider themselves staunchly “pro-life” don’t want to see Roe v. Wade overturned and do support abortion access at least some of the time.

Some have also claimed that Millennials don’t “get” choice, that choice does not reflect what Millennials need to hear in order to support access to reproductive rights. As Jennie Bristow noted in her perceptive essay on the alleged generation war over abortion rights in the United States, “Winning the argument for choice might be difficult today — though it is hard to see why it is more difficult now than in previous decades. What is certain is that younger generations of women, and their daughters, will lose a great deal if we turn our back on the ‘pro-choice label.’” It is, on the one hand, patronizing to assume that young people do not understand what being pro-choice means or must be told something different in order to gain their support for reproductive rights. It is equally troubling that many of those claiming that we need to use something other than choice to speak to Millennials view young people as a problem to be solved rather than a source of energy and people power for our movement.

Young people are the ones most often out canvassing, working phone banks, staffing, and leading our organizations, and they are more supportive of reproductive rights than other generations. They are the ones who are of reproductive age. The supposed “intensity gap” between pro-choice young people and anti-choice young people today largely tracks the so-called “intensity gap” between people of different generations. That perceived lack of involvement does not mean that young people cannot or will not prioritize choice. It does mean that those of us charged with sustaining the movement need to do less talking at young people about how they are the problem. We need to instead offer them real action that all people — young and old — can rally around.

It is not as if reproductive justice itself is not without its challenges. While it is absolutely right for some organizations, we cannot afford to be Pollyannaish in assuming it is right for everybody. In particular, we cannot be dictatorial in charging every group to use the term or pretend that it is inherently superior to choice in its ideology.

Some of the challenges of the reproductive justice framework illustrate why it cannot be a substitute for choice, as a concept or as a practical strategy. They include the following.

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Written by Dr. Linda Prine and Dr. Ruth Lesnewski for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

In one of the clinics where we work, a 16-year-old girl came in with a sprained ankle.  She left with a prescription for birth control.

This turn of events is not as surprising as it seems:  As family physicians, we treat the whole person.  A quick update revealed that our 16-year-old patient had recently begun to have unprotected sex — and had no plan to get birth control. One of the reasons we love practicing family medicine is that we get to know our patients over time and provide the preventive care they need at every possible opportunity.

That is why we are dismayed that the Accreditation Council of Graduate Medical Education (ACGME) has proposed changes to the guidelines for family medicine residency programs removing the requirement that residents learn to provide contraception. These changes will go into effect in 2014 unless the ACGME is convinced otherwise, during an open comment period taking place this week.

A majority of U.S. women get their basic health care from a family physician or other primary care provider, and often that includes reproductive health care. Especially in rural and low-income areas, family physicians do it all! They not only provide birth control but also provide prenatal care, deliver babies, manage miscarriages, counsel patients about unintended pregnancies, and, increasingly, offer pregnancy termination so that their patients do not have to travel long distances and see unfamiliar doctors for these services.

ACGME’s motivations are legitimate:  It seeks to simplify the rules for the nation’s family medicine residency programs — numbering over 450 — and to allow for more creativity and flexibility. In some areas of practice, this makes sense. Many programs will continue to teach contraception; it will depend on the culture of the institution. However, residency programs based in religiously-affiliated hospitals (which operate nearly 20 percent of inpatient community-hospital beds in the U.S.), will most likely drop birth control training immediately.

Because the ACGME currently requires birth control training, religiously-affiliated institutions must figure out a way to comply. Many rotate their residents through external clinics to learn these skills — which are essential since 99 percent of women in the United States who have ever had sexual intercourse have used a method of contraception other than natural family planning at some point in their lives. Without this requirement, residents in religiously-affiliated programs may get no training at all in contraception.

Just last week, we attended a meeting where an assistant residency director expressed satisfaction at the prospect of no longer needing to teach residents how to counsel patients with unintended pregnancies of all of their options. This is our concern: Limiting the training of family medicine residents in birth control will have a disproportionate impact on the millions of low-income and rural women and teens who rely on their family doctors to provide the full-spectrum of reproductive health care. The Affordable Care Act greatly expands access to contraception for millions of women in the United States. But, if clinicians aren’t trained in providing contraception, then that access is meaningless, even if it is covered. We need to make sure all clinicians who provide primary health care for women are trained to provide high-quality contraceptive care.

Our next generation of family physicians must learn and practice more contraception, not less. Otherwise our shamefully high rate of unintended pregnancy (the highest in the developed world) will rise further.

There is time to make a difference. The ACGME is accepting comments on the proposed guidelines until April 25, 2013. Click here to download our suggested version of the official comment form.  Fill in your information and email it to familymedicine@acgme.org.  The Reproductive Health Access Project has an online campaign for all of us to tell the ACGME that their changes affect our health care.

Written by Kathy Bougher for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

The women of El Salvador are denied life-saving access to abortion.

Beatriz wants to live. A 22-year-old Salvadoran from a poor, rural community, Beatriz (a pseudonym to protect privacy) suffers from chronic and severe medical conditions. She is the mother of an infant. And she is roughly 18 weeks pregnant with an anencephalic fetus, a fetus without a brain. Doctors at the Maternity Hospital determined that the pregnancy is life-threatening, and Beatriz requested that Salvadoran medical personnel perform an abortion, but a 1998 law in El Salvador prohibits all abortions, without exception.

The Salvadoran feminist organization Agrupación Ciudadana por la Despenalización del Aborto Terapéutico, Ético y Eugénesico (Citizen Group for the Decriminalization of Therapeutic, Ethical and Eugenic Abortion), which has been working to decriminalize abortion in the country since 2009, petitioned the Salvadoran Supreme Court on April 15 to intervene and to direct medical personnel to provide without fear of criminal prosecution the procedures Beatriz needs to save her life. Under current law, both Beatriz and any medical personnel involved in an abortion would face criminal charges and prison time. The court responded with a temporary directive that medical personnel provide the care necessary to guarantee her life and health while they make a decision regarding the petition for an abortion. Medical personnel were also directed to present to the court within five days a report on the condition of the mother and the fetus to inform their deliberations.

Within the past few days Amnesty International has initiated a petition asking for life-saving medical care, including an abortion; the United Nations has spoken; and the Salvadoran Minister of Health, Dr. Maria Isabel Rodriguez, has requested that the Supreme Court approve the request. Dr. Rodriguez emphasized that Beatriz’s kidney function continues to deteriorate as the pregnancy advances, and that the public health system is ready to perform an abortion. The Salvadoran Attorney General for Human Rights also supports the request.

At a press conference the Agrupación convened in San Salvador on April 18, Esther Major, an Amnesty International representative in El Salvador, characterized the way Beatriz is being treated as “nothing less than cruel and inhuman.”

“While we are talking, while the Court is thinking and the government is delaying, Beatriz is suffering. … The Salvadoran government has clear obligations, international as well as domestic, to protect Beatriz’s life, and to assure that Beatriz can access vital treatment as soon as possible.”

Legal reforms in 1998 in El Salvador, promulgated by conservative religious forces, outlawed  abortion without exception. Previously it was permitted if the pregnancy resulted from rape or incest, the mother’s life was in danger, or the fetus was not viable. In addition, a constitutional amendment was added declaring that life begins at conception, which means that prosecutors can charge women who seek abortions with aggravated homicide, punishable by 30 to 50 years in prison, rather than the lesser crime of abortion, which carries a term of two to eight years.

Threats of prosecution and prison terms are not to be taken lightly under the 1998 law. The Agrupación has mounted legal and educational campaigns to secure the release of six women from prison. Since no comprehensive data exist in the country, the Agrupación is conducting its own research, which reveals that currently at least 24 women are serving prison terms of up to 40 years for abortion or aggravated homicide related to abortion charges.

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