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.

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.

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

A court ruled communications with Tiller's killer to be covered by ministerial protections.

On Friday U.S. District Judge J. Thomas Marten handed anti-choice terrorist Angel Dillard a win, ruling Dillard doesn’t have to disclose “ministerial discussions” she had with Scott Roeder, the man convicted of murdering abortion provider Dr. George Tiller.

As reported in the Topeka Capital-Journal, Marten’s ruling reversed an earlier decision that Dillard’s communications with Roeder were not protected by the ministerial exception because Dillard is not an ordained minister. But Marten held that Dillard was acting as a lay minister and was therefore entitled to the protection. It’s an incredible expansion of the privilege and one which the radical anti-choice community is no doubt taking notice.

Dillard is accused of sending a threatening letter to Dr. Mila Means who was training to provide abortion services after Tiller’s murder. According to the Department of Justice complaint against Dillard, the letter to Means mentioned Tiller’s assassination and warned Means against providing abortion services in Wichita.

In the same ruling Marten said Dillard must disclose communications she had with another inmate, Robert Campbell. Campbell claims Dillard hired him to stalk Means, while Dillard denies this and claims Campbell is trying to blackmail her.

But just because those communications must be disclosed does not guarantee they will make it into evidence in the trial, currently slated for October. At the time of trial they can be excluded from evidence if a judge decides the statements are too unreliable, a fact judge Marten made clear in his ruling. At issue in the case is whether the letter Dillard wrote to Means was a “true threat” in violation of the federal law designed to protect access to abortion clinics. In the letter, Dillard allegedly wrote that thousands of people from across the nation were scrutinizing Means’ background and would know “your habits and routines.”

The letter is chilling. In it Dillard writes, “They know where you shop, who your friends are, what you drive, where you live,” the letter said. “You will be checking under your car every day — because maybe today is the day someone places an explosive under it.”

The Dillard trial has shed light on the violent underworld of radical anti-abortion activists and the last thing this community needs is any additional enabling by the federal courts. But that’s exactly what this ruling does. If someone like Dillard can claim to be a minister so as to shield communications with convicted assassins like Scott Roeder who have admitted to wanting to instigate more deadly violence against clinic workers, then we can expect to see a lot more ministers among the most violent actors in the anti-abortion movement.

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.

Ohio wants to define "gateway sexual behavior" and then ban teachers from educating about it.

Though most of us are still not quite sure what it is, the concept of “gateway sexual activity” is back, or at least a ban on teaching about it is back.This time it is Republicans on the Ohio House Finance Committee who are worried about our young people heading down the wrong sexual path. So worried, in fact, that they are willing to impose fines on anyone who teaches about such sexual activity. That’s right, an amendment to the budget passed by the committee yesterday would prohibit providing or distributing condoms or other contraceptives on school grounds and ban any instruction that promotes “gateway sexual activity.” Teachers or organizations that violate this ban could be subject to lawsuits by parents as well as a $5,000 fine.

Some of us remember the first time we heard this phrase; it was last year when Tennessee Republicans passed a similar law that became the butt of national jokes because no one knew what a “gateway” behavior would be — a kiss, a foot rub, an expensive dinner? The law didn’t define it but lawmakers in Tennessee promised that we would know it when we saw it. As I reported for RH Reality Check at the time, one legislator explained in testimony on the floor:

“Everybody in this room knows what gateway sexual activity is. Everybody knows there are certain buttons when you push them, certain switches when you turn them on, there’s no stopping, especially for undisciplined, untrained, untaught, and unraised children who just want to feel affection from somebody or anybody.”

I can’t say that this explanation helped enlighten me though it did infuriate me with all of its judgment and blame.  Like many others, I preferred comedian Steven Colbert’s snarky take on it:

“Kissing and hugging are just the last stop before the train pulls into Groin Central Station. We desperately need to intervene earlier to keep kids from engaging in… all the things that lead to the things that lead to sex.”

In an effort to avoid any similar confusion (and perhaps prevent being made fun of on Comedy Central), Ohio legislators provided a definition of “gateway sexual activity.”  And, because teenage sexual behavior is so bad as to be felonious, they took the language straight from the state’s criminal code. So schools cannot promote:

“…any touching of an erogenous zone of another, including without limitation the thigh, genitals, buttock, pubic region, or, if the person is a female, a breast, for the purpose of sexually arousing or gratifying either person.”

Despite this very clear definition of behaviors that Ohio lawmakers think will inevitably lead to teens boffing like bunnies, I imagine that teachers in the state are still confused as to what they can and can’t say. After all, sexuality education is not about promoting specific behaviors, it is (among many, many other things) about helping young people think critically about those behaviors they will and will not choose for themselves. I suppose, though, that such confusion, combined with a hefty fine, will have the exact effect that lawmakers want; teachers will play it safe and say nothing.

As Damon Asbury, a lobbyist for the Ohio School Boards Association told the Dayton Daily News:

“I don’t think we should have teachers put on trial for teaching a prescribed curriculum. It takes you back to the Scopes Trial.”

Kellie Copeland of NARAL Pro-Choice Ohio told the Dayton Daily News that she also opposed the ban noting the amendment appears to be an attempt to ban comprehensive sex education programs in schools. She added:

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

A journalist looks at the barriers to reporting on women's reproductive freedom.

In recent days, amidst cries of a media “blackout,” a number of journalists have admitted to either missing or dismissing the story of Dr. Kermit Gosnell over the past two years. As one of the many journalists who has been covering the Gosnell story since it broke in early 2011, all I can say is: We tried to get the story out there. But more importantly, this politics-of-media framework distracts from the circuitous politics that enabled, and resulted from, Gosnell’s actual crimes and the women who were affected.

What Media Blackout?

After spending much of 2010 interviewing 58 witnesses, in January 2011 the Philadelphia district attorney’s office published a 281-page report accusing Kermit Gosnell of grotesque, depraved crimes.

There was blood on the floor. A stench of urine filled the air. A flea-infested cat was wandering through the facility, and there were cat feces on the stairs. Semi-conscious women scheduled for abortions were moaning in the waiting room or the recovery room, where they sat on dirty recliners covered with bloodstained blankets. All the women had been sedated by unlicensed staff — long before Gosnell arrived at the clinic — and staff members could not accurately state what medications or dosages they had administered to the waiting patients. Many of the medications in inventory were past their expiration dates.

Fetal remains were stored in milk jugs and cat food containers. A janitor admitted he routinely pulled fetal parts out of pipes. Unlicensed, untrained staff, including a high school student, pumped cheap, powerful drugs into the veins of women who were chemically coaxed into zombie-like stupors that sometimes lasted days.

Last week, Kristen Powers published an op-ed in USA Today that sparked a Twitter shame campaign, directly asking prominent national journalists why they hadn’t covered the case. And it worked. Now, more than three years after the raid and more than two years after the grand jury report, some national journalists who ignored the case entirely are suddenly wildly interested.

After years of coverage from outlets in Philadelphia and Harrisburg, outlets focused on women’s health issues, and yes, mainstream media outlets, apparently all it took to catch the attention of writers such as Slate‘s Dave Weigel, The Atlantic‘s Conor Friedersdorf, and Jeffrey Goldberg of Bloomberg was to target their collective egos — specifically, their insecurity about being perceived as having a liberal bias.

Weigel, one of the first writers to develop a sudden interest in Gosnell after Powers’ piece, wrote that when he read about Gosnell back in 2011, he didn’t “see a political story to chase.”

At 3801 Lancaster, the site of Gosnell’s clinic, patients chose their medicine and painkillers a la carte. In other words, the more cash a patient could give Gosnell, the more painkiller she could get. The poorer the patient, the more she would suffer. With all the talk about the Affordable Care Act, you’d think that such starkly stratified access to quality health care would be an interesting political story. The story touches on poverty, abortion, civil rights, state rights, healthcare, increasing inequality and race, to name a few topics of political interest that, if nothing else, came up quite a bit during the presidential election.

What Weigel really meant, of course, is that he didn’t see a story worth chasing. “Bored media,” indeed.

Written by Erin Grant 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 the Kermit Gosnell case here.

The Gosnell case highlights issues of class, race and access to reproductive healthcare.

Some reporters and media critics have claimed that not enough is being written about the trial of Dr. Kermit Gosnell, an illegal abortion provider who operated far outside the bounds of legitimate medical practice. In a recent column for USA Today, for example, Kirsten Powers claimed that the case is not receiving the attention that it deserves.

As a resident of Philadelphia and an abortion provider, I beg to differ. Gosnell’s atrocities have been covered widely. But what haven’t been covered as much as they should be are the reasons why the women who turned to Gosnell for abortion care were disproportionately low-income women of color who felt they had no other place to turn.

Whether you are a supporter or opponent of women’s health rights, or just interested in things related to reproductive justice, you should know that the Gosnell case has been written about steadily since February 2010, when Gosnell’s clinic was raided by the Drug Enforcement Administration and his license was suspended. The story was widely covered in the national mainstream media and by women’s health advocates in 2011 when the case’s Grand Jury report came out. So while the trial is news, there is little to no information that has not already been reported about Gosnell up to this point.

Indeed, when Google renders about 9,000 hits in 0.15 sec using the search term “Kermit Gosnell,” it’s hard to say this story lacks attention.

But this case is about more than just a practitioner who did bad things. His case embodies the “off-the-grid” abortions we can expect to see in states like Mississippi and North Dakota, where anti-choice harassment and regulations purposefully pass to close all clinics providing legal, safe abortion care mean only one clinic is left in each state, and even those are under threat of being shut down.

Gosnell’s “Women’s Medical Society” was not an unknown entity. In fact, it was surrounded by well-known and respected hospitals and clinics. But because they adhere to safe abortion care practices and because health care is expensive generally, the cost of care at these clinics was often out of reach to women who, without public assistance, don’t have and cannot afford regular health care of any kind.

Gosnell’s operation bears no resemblance to safe abortion care. His entire “practice” was illegal: There were untrained medical “assistants” and abortions performed at viability without medical cause. His “clinic” was unsanitary and unsafe and what Carole Joffe has referred to as a “chamber of horrors.”

Moreover, in a gruesome quid pro quo, Gosnell charged on a “sliding scale” for anesthesia; you got more anesthesia the more money you paid, so the poorer you were, the more pain you suffered. Women who went to Gosnell may have known of other places to receive abortion care, but they were either beyond the legal time limit when they could get an abortion in the state, or they could not afford safe abortion care.

What this case reveals is that the cost of dignity in health care has risen, and the attack on poor women intensified.

These realities underscore the real missing headline. In 2011, the Grand Jury report stated, “We think the reason no one acted is because the women in question were poor and of color.” Almost all of Gosnell’s patients are identified as poor women of color. Still, the mainstream media is largely not paying attention to the issues of race and class inherent in this story, which contribute to the reasons why Gosnell could thrive. Poor, under-insured women are not getting acceptable health care of any kind, but because this story is about abortion, these usually invisible women are suddenly the subject of public pity by anti-choice activists. They were made to suffer until many lives were taken.

In an age of rising stigma, discrimination, widespread misinformation, and violence against providers, facts get trampled. What Gosnell underscores is a point that women’s health and rights advocates have long asserted: Women who need to terminate a pregnancy will go to desperate lengths to do so, and by isolating abortion care, we drive women to back-alley providers.

Anti-choice conservatives know this but seem not to care. Mississippi state Rep. Lester “Bubba” Carpenter (R-Burnsville) put it bluntly at an Alcorn County GOP meeting: