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

Evidence-Based Advocacy is a monthly column seeking to bridge the gap between the research and activist communities by profiling provocative new abortion research that activists may not otherwise be able to access.

In today's culture, abortion providers face considerable stigma. Researchers at the University of Michigan study ways to mitigate its effects.

Ask anyone to tell you who’s doing the most innovative research on abortion provider stigma and they’€™ll tell you it’€™s Dr. Lisa Harris and her interdisciplinary team at the University of Michigan. Together they pioneered the Provider Share Workshop, a pilot project testing the possibility that a support group for abortion providers could help reduce the negative impact of stigma. She writes about topics that others in even the most pro-choice communities shy away from €”the need to have open and honest conversations about second trimester abortion provision, how stigma affects abortion complications, and, recently, the need to recognize conscience as a motivating factor in abortion provision. Now, Dr. Harris and her team, which includes social worker Jane Hassinger, and public health PhDs Michelle Debbink and Lisa Martin, have gone a step further and actually mapped out how abortion providers experience abortion stigma, coining a new term: the legitimacy paradox.

Based on their interviews with abortion clinic staff who participated in the Provider Share Workshop, Dr. Harris and her team theorize that the combination of stigma and silence perpetuate a vicious cycle:

When abortion providers do not disclose their work in everyday encounters, their silence perpetuates a stereotype that abortion work is unusual or deviant, or that legitimate, mainstream doctors do not perform abortions. This contributes to marginalization of abortion providers within medicine and the ongoing targeting of providers for harassment and violence. This reinforces the reluctance to disclose abortion work, and the cycle continues.

The marginalization of abortion providers within medicine and society at large is not a new issue. In fact, as Dr. Harris and others have written, negative portrayals of abortion providers go back at least two centuries in the United States. In the nineteenth century, the American Medical Association opposed abortion in part because non-physicians (such as midwives, osteopathic doctors, and others) were the majority of abortion providers at that time and took away valuable business from physicians. The AMA sought to criminalize abortion to push these competing practitioners out of business, and thus began the association of abortion provision with “deviance” from mainstream medicine.

As the women’€™s liberation movement made the case for safe and legal abortion in the mid-twentieth century, abortion providers were depicted as “back alley butchers.” This portrayal and the grotesque images associated with it communicated the very real dangers of illegal and unsafe abortion, but neglected that many thousands of safe illegal abortions that were provided by both clinicians and lay-people during this time. While the use of the “back alley butcher” imagery certainly helped to legalize abortion in the United States, Dr. Harris argues that it did so while further stigmatizing abortion providers.

To track how abortion providers experience stigma today, Dr. Harris’ team conducted a focus group with abortion clinic staff in a Midwestern abortion clinic. She documented that all abortion clinic staff, including clinicians, counselors, front desk workers, and others, feel the negative impacts of doing stigmatized work. Providers commented on encountering stigma in public discourse, such as in political rhetoric, from institutions, such as hospitals and churches, as well as in their every day relationships with family, friends, and even their patients. As a result of this stigma, providers often have to choose if and how to disclose their involvement in abortion provision, weighing the possibilities of relationship conflict and threats to their safety if they decide to disclose, or isolation and disconnection if they keep their work a secret.

What are the consequences of this stigma? One possibility is that it may contribute to violence and harassment of abortion providers. Dr. Harris and her team explain:

Read the rest of this entry →

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

Why do we shame women for abortions? (Photo: gogoloopie / Flickr)

Last week, I attended the annual International Federation of Gynecology and Obstetrics conference in Italy. During the five days I was there, nearly 500,000 women had abortions. Many of these women faced stigma, a mechanism of social control used to dehumanize and devalue women who need, or decide, to terminate pregnancies.

When we began to examine the social construct of abortion stigma several years ago, we found that very little had been published. And yet, it’s really the root of all barriers that women — and even providers — face to obtain or perform abortions.  Why do we legally deprive women of a health care service that could safe their lives? Why are women forced to undergo a waiting period in order to get an abortion? Why are abortion clinics often separate from other reproductive health care clinics? Why do women trade safety for secrecy and turn to “back-alley” providers? And the questions go on…

Stigma contributes to the idea that women who have abortions are not the norm, although they are. The social construct of abortion stigma creates an “us-versus-them” mentality — in spite of the fact that in the United States one in three women have abortions and a much higher share of all women globally terminate a pregnancy sometime during their reproductive lives, abortion is still constructed as something that is wrong, inappropriate, or deviant. Discriminating against women is therefore considered normal; 26 percent of women live in countries where abortion is legally restricted and many more live in places where they have to justify their abortion. If this isn’t discrimination, I don’t know what is.

“How can this decision be wrong?” asks Dr. Nozer Sheriar, a gynecologist in India. “How can any decision, choice or action taken by 43 million women each year around the world be wrong?” If all the women in the world who have had an abortion live together in one country, he points out, it would be the third most populous country in the world. Think about the level of discrimination against a group so large.

My colleague and fellow presenter at FIGO 2012, Tracy Weitz, has also spoken out about abortion stigma in the United States, arguing that even in the pro-choice community, we further the stigma by creating hierarchies of women — some who deserve an abortion, some who do not. And who gets to decide who can have an abortion? Doctors, institutions and policymakers do. We insist on talking about abortion with language such as “safe, legal and rare,” which reinforces the notion that abortion is wrong and abnormal. And even abortion providers and clinics — sometimes unknowingly — create an atmosphere that stigmatizes women. Some American women have shared that paying for their abortion felt “like a drug deal” and others say the security, while justified, made it “seem all the more like a shameful, secretive thing.”

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

Image: Aimee Ardell / Flickr

Like most people, the sum of who I am is much more than my individual traits. However, there is one fact about me that puts me way outside the mainstream. It’s that I’m a tran-sgender woman.

Last week, The Wall Street Journal reported that Massachusetts judge ordered prison officials to provide sex-reassignment surgery for a murder convict.

The piece started by talking about a transgender woman who used to meet in dark parking lots with other transgender people for support. “How things have changed since then for transgender men and women in America, who have made great strides in recent years toward reaching their ultimate goal: to be treated like ordinary people,” the piece noted.

I agree, strides have been made. But “great” grossly overstates the reality. Discrimination and misunderstanding is still rampant. I frequently feel that I’m assigned to a class of sub-humans. Even the judge who ordered the surgery said it was to treat “gender-identity disorder.” As a society, we still view transgender people as being against the natural order and place the blame on our minds, rather than where the real problem is: our incorrect bodies.

A recent article in the New York Times Magazine would indeed lead sympathetic readers to believe things are not so bad for transgender people and that there’s really just left over misunderstandings to clear up. The piece told honest, compelling, sometimes gut wrenching stories of good people trying to navigate the world for and with their gender non-specific children.

Consider that it was only in April of this year that the U.S. Equal Employment Opportunities Commission ruled that that discriminating against an employee or potential employee based on their gender identity is in violation of the Civil Rights Act. Forty-eight years after that Act passed Congress!

Twenty states now have laws prohibiting gender discrimination against LGBT people. However, that still means that 30 states do not.

I work with transgender people every day. Many of them have trouble finding housing or jobs, no matter what the laws say. Many of them are drug users driven to it, in part, because by living with the constant, unrelenting stigma we feel. It’s almost palpable.

I went to the street alone at 14 because I thought it was the only place for someone like me. I became a commercial sex worker because I believed it was the only occupation available to me. I looked around and saw that no one was going to give me a job.

Though I lived as a woman and looked like one, when I was arrested for solicitation, I was sent to the men’s prison. After one arrest for prostitution, I was thrown in the wing with the felons. When I inevitably contracted HIV, the doctors I sought continually called me by my birth name. When you have HIV, you want medical personnel who understand that your entire life changes the instant you get that diagnosis. Not someone who doesn’t bother to look in your eyes and see the very basics of who you are.

To be fair, these events happened to me 20 years ago. Back then, we didn’t have the word “transgender” and I was considered an effeminate gay boy. Things are different now but believing that there is significantly less discrimination because some people allow their sons to wear dresses is like thinking that because we have a black President, racism in America is gone.

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

Earlier this month, news spread of a Louisiana charter school’s policy that would have allowed faculty to force any student suspected of being pregnant to take a pregnancy test — and, if the test came back positive, to force her to go on home study.

Forced pregnancy testing in schools is a gross violation of young women’s fundamental human rights. Through legal advocacy, I have been working to get it recognized as such and outlawed — in Tanzania, Kenya, Uganda, in my home country of Nigeria, and in other countries in the African region where it occurs. It is a shock to see a practice I’ve come to associate with schools in the developing world being replicated in the United States.

I have seen the consequences firsthand, and they are devastating. In secondary school, the older sister of a classmate, who was a year ahead of us, was found to be pregnant and expelled by school administrators. We eventually learned that she was the victim of a rape which occurred in her home, but she was too terrified to tell anyone what had happened. As is the case with many victims of this injustice, no other schools would accept her. Her hopes for a better future were doomed.

In Tanzania, where nearly 44 percent of girls have either given birth or are pregnant by the age of 19, school administrators across the country force schoolgirls to undergo demeaning pregnancy tests often just before completing primary school — around the age of 11 — and with increasing, and random, frequency throughout secondary school. Some girls must strip to their underwear to reveal physical signs of pregnancy. Others are coerced into taking urine-based pregnancy tests. No one can refuse to be examined or tested.

The impact is staggering, long-lasting, and far-reaching. About 8,000 girls are expelled or drop out because of pregnancy in Tanzania every year. Too often families abandon their pregnant teen daughters, forcing them to live on the streets with their babies. Faced with the possibility of homelessness, some young women succumb to pressure from their families to seek financial support through early or arranged marriages. The impact of these violations to their rights to health, education, privacy, and freedom from discrimination ripples throughout young women’s lives. Many female leaders of human rights advocacy groups still remember, over twenty years later, how humiliating and disempowering it was to experience forced testing even though they did not turn out to be pregnant.

Government officials do next to nothing to improve the situation despite its epidemic proportions; nearly 60 percent of the country’s adolescents have sex before 18. And in a double standard that’s all too common in many places throughout the world, while young women are stigmatized and penalized for pregnancy, the men and boys involved are rarely identified and face few consequences for their role.

In the United States, the reaction to the news about the Louisiana charter school was swift. Under threat of a lawsuit by the ACLU, the school reversed course and amended its student pregnancy policy, which no longer includes the invasive forced pregnancy testing it initially announced. The revised policy now assures female students the opportunity to continue schooling on campus throughout pregnancy and the option for homeschooling. This is a just and appropriate result.

Nevertheless, the emergence of this idea in an American school should trouble anyone concerned with the protection of our fundamental constitutional and human rights. And it should serve as a reminder of the importance of guarding vigilantly against violations of these rights not just in the developing world, but also — sadly, it seems — in the U.S.

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

Yesterday morning, I learned about Delhi Charter School’s unethical and illegal school policy. The school has required teen girls to take pregnancy tests at the discretion of school officials. If a girl refused, she would be sent home from school. If her test came back positive, she would be sent home from school. Sound fair to you?

Sign a petition demanding that the school eliminate mandatory pregnancy tests and commit to giving pregnant students the same education, in the same place and at the same time, as all other students.

Not only is this policy unfair, it is illegal! Forcing a girl to take a pregnancy test is illegal. Sending a girl home from school for refusing is illegal. Sending a girl home for being pregnant is illegal. Women should never feel like they can lose their right to an education just for being a woman. This policy is discriminatory and unconstitutional.

Being in high school is tough as it is. Imagine being accused of being pregnant and forced to take a pregnancy test. As a former teen parent, I know this is unethical and just so wrong in so many ways. It has been 40 years since Title IX became a law and promised equal opportunities for boys and girls, but Delhi Charter School has demonstrated their lack of respect for our progression.

A school is intended to educate youth and provide them with a safe place to learn. What the Delhi school is teaching is to pass judgment, discriminate, and violate laws that don’t coincide with your personal beliefs. While boys are rightfully acquiring an education at Delhi, girls are pushed out and forced to face devastating consequences. Are the boys at Delhi Charter School having their rights stripped away for potentially being fathers? Are the boys at Delhi Charter School being pushed out for fathering children? Sadly, Delhi has exhibited disturbingly obvious sexism against women.

As a young parent, I can assure you that this ridiculous policy is no solution to any possible problem. When I was just 17 years old, school staff made it almost impossible for me to be in school and enjoy it. They made my life much harder than it had to be. Being an honor roll student with future goals, I knew I could not succeed in such a negative environment. If I didn’t have another option, I would have dropped out of school. Fortunately, I transferred myself to a public school that offered more support and even designated a person to be my coach and advocate. Not only did I graduate, I did it on time and maintained great grades in my honors classes throughout the year. But believe me when I say I had to stand up to staff on a daily basis to ensure I would graduate.

I am ashamed to see our educators making such poor decisions. Teen parents are capable of being wonderful students and amazing parents. Our lives are tough as it is. We don’t need others making it even harder for us to acquire our basic rights. Yesterday, I started my first petition against school officials. Please sign my petition and help me convince the Delhi Charter School to immediately drop their policy AND acknowledge that their policy is a violation of a woman’s rights.

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

Image by Timothy Takemoto

Earlier this month, a 31-year-old woman in Sweden was sentenced to one and a half years in prison for having unprotected sex without disclosing to her partner beforehand that she is living with HIV.

Even a perfunctory news search reveals that this is not the first time the Swedish justice system has applied criminal sanctions to potential HIV-transmission. In January, a 20-year-old man was sentenced to eight months in prison for having unprotected sex without disclosing his status. In December 2006, a 34-year-old woman got two months, and in January 2003, a 32-year-old woman one year. All of these sentences also required the person living with HIV to pay monetary damages to their former sex-partners.

For anyone who cares about human rights from a health and discrimination angle, these cases raise multiple red flags.

For starters, consensual sex between consenting adults should, in principle, never be subject to government control or regulation. Moreover, the criminalization of HIV transmission has multiple negative outcomes. It leads to distrust in the health and justice systems; it can discourage people from seeking to know their HIV status; it adds to the stigmatization of those living with HIV; and it is ineffective in bringing down HIV transmission.

In fact, UNAIDS recommends that governments limit criminal sanctions for HIV transmission to cases where all of three conditions are met: the person charged 1) knows he or she is living with HIV; 2) acts with the intention of transmitting the virus; and 3) actually transmits it. UNAIDS also recommends that cases of such intentional HIV-transmission should be tried under generic criminal provisions for bodily harm or assault, and not under HIV-specific provisions.

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Written by Jessica Mack 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 the Masterpiece series “Downton Abbey,“ Lady Mary Crawley, the eldest daughter of an Earl, cannot inherit the eponymous estate because she is a woman. She finds this demeaning and frustrating, but her future will be well taken care of regardless. This isn’t the case for millions of women around the world, who struggle to access, own, and inherit the tiny plots of land on which they live and work.

In China, women actually have equal rights to inherit and own land, yet rarely ever do. A recent survey in 17 Chinese provinces, undertaken by the global land rights group Landesa, found that only 17.1 percent of existing land contracts and 38.2 percent of existing land certificates include women’s names.

A gap-filled land registration system has meant that the country’s 700 million mostly poor and rural farmers often lack the legal documents for the land on which they toil. Rapid urbanization has set in motion a pattern of “land grabs,“ depriving an estimated three to four million farmers of their land every year.  While land rights in China remain a broad-scale class issue, of the few that do have legal protection for their land, hardly any are women.

“Women in rural China are still in a vulnerable position,” says Xiaobei Wang, a Gender and Land Tenure Specialist for Landesa. “Most of them are not fully aware of their legal rights on land or the importance of including their names in legal documents so they seldom assert their rights in land registration by requesting that their names be included.”

These are timely findings given that a nascent land rights revolution in the country has begun. In late-2011, the continued struggles of dispossessed farmers came to a head with an historic village rebellion, signaling to the Chinese government and to the world that something finally had to change. Now, government officials are rolling out a massive initiative to register each plot of land with certificates of ownership in the hopes of protecting poor farmers. Read the rest of this entry →

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

December 17th is International Day to End Violence Against Sex Workers.

When we think of violence against sex workers, we conjure up images of dangerous clients and serial killers who target prostitutes.  Indeed, the origins of the International Day to End Violence against Sex Workers, observed on December 17, lay in the decades-long serial murder of sex workers by the Green River Killer.  While these are heartbreakingly real forms of violence against sex workers, one area that receives scant public attention despite its entrenched global reality is police abuse of sex workers.

The illegal status of sex work in most countries has not eradicated prostitution.  Instead, criminalization has increased sex workers’ vulnerability to human rights abuses and created fertile ground for police exploitation, especially of street-based sex workers.

For example, in South Africa, where sex work has been illegal since the former apartheid regime criminalized it in 1957, police officers often fine sex workers inordinate sums of money and pocket the cash, resulting in a pattern of economic extortion of sex workers by state agents.  For some sex workers, the cost of a police bribe to evade arrest can equal an entire night’s worth of work.  In other instances, police have exhibited shameless levels of exploitation: In one reported example, a police officer in Cape Town demanded a sex worker give him money in lieu of arrest; when the sex worker told him she possessed only a meager 10 South African rand, or the equivalent of $1.25, the police officer even pocketed that pittance. Read the rest of this entry →

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

Earlier this fall, a committee of the Parliamentary Assembly for the Council of Europe held a hearing entitled “Putting an end to coercive sterilizations and castrations.” This debate continues today, November 21, 2011. What is remarkable about this is not the outcome or the discussion, but rather that it was necessary at all. After all, most parliamentary debates about contraception and childbearing these days seem to be about how to make women have more children than they want, not less.

However, if we scratch the surface a bit, it becomes clear that two seemingly contradictory political discourses happily coexist. On the one hand, policy-makers push for limits to contraceptive access for women, generally speaking. And on the other, they enforce policies that criminalize, condemn, or render impossible the reproduction of specific subgroups of women (and men), who for various reasons are seen as undesirable parents: Roma women, lesbians and gay men, transgender people, indigenous women, injection drug users, women living with HIV—the list goes on.

In this connection, coercive sterilizations and castration are at the extreme end of a spectrum that also includes criminal sanctions for drug use during pregnancy and barring LBGT individuals from in-vitro fertilization services and adoption, as well as a host of other policies geared at making pregnancy and parenting difficult for those deemed unworthy. In fact, the more “unworthy” the individual or group is considered by the general public, the more explicitly coercive the measure to limit their possibility for parenting. So much so that by considering the lengths to which a government will go to prevent certain individuals from procreating, we can gauge the extent of the stigma they face.

For example, it would probably no longer be politically viable to implement quotas for the sterilization of indigenous women, as the Peruvian government did in the 1990s, yet Roma women and even just poor women are still routinely sterilized without their consent in several countries. Lesbian women are rarely forcefully sterilized, yet they are often excluded from becoming adoptive parents or from benefiting from in-vitro fertilization processes. Many countries require transgender individuals to be sterilized before they can legally change their names or papers to reflect their preferred gender, and intersex individuals are often assigned a sex—and in the process rendered infertile—as infants and certainly before they can give meaningful consent. The most restrictive and invasive intervention, forced castration, is reserved for convicted sex offenders who, in turn, arguably are seen as the most unworthy and reviled of all.

As a human rights issue, coerced sterilization and castration are in many ways no different from other limitations on individual reproductive choice: they violate a number of fundamental rights, including the rights to health, privacy, and physical integrity. Additionally, they make discrimination and public contempt visible and as such can help target policy interventions to alleviate abuse.

But a more interesting aspect of the practice of coerced sterilization is that it crystallizes the hypocrisy of the limitations to reproductive rights. When I did research on access to abortion in Mexico in 2005, for example, I found that rape victims routinely were denied services they, by law, were entitled to, whereas sex workers and women living with HIV who were applying to the same hospitals for the same services were offered abortions they did not need and that would technically have been illegal.

When Parliamentary Assembly for the Council of Europe continues its debate on forced sterilizations on Monday, it would do well to think through in what other ways it can support individual choices on when, if, and with whom to become a parent. Only just a year ago, the Assembly refused to recommend adequate regulation of conscientious objection in the medical profession, a move that probably already has contributed to the denial of care to many women across the continent.

These are not separate issues. The Roma woman who is forcefully sterilized suffers as much as the one who is denied an abortion or other needed care. Everyone must be allowed to make individual and responsible decisions about parenting and procreation.

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

Rep. Henry Hyde

This article is cross-posted from the National Network of Abortion Funds.

The Hyde Amendment turns 35 this month. This provision, prohibiting federal Medicaid coverage of abortion in almost all circumstances, was the beginning of the anti-abortion movement’s post-Roe, all-out effort to ban abortion. It was a gateway bill, opening the door to the flood of restrictions that today constrict a woman’s ability to obtain an abortion, forcing women to “choose” between paying for other basic necessities and having an abortion, and, in too many cases, making abortion impossible. It became the precedent for all other denials of abortion funding, and reinforces our discriminatory, two-tier health care system in which people without financial resources cannot get the care they need.

The persistence of the Hyde Amendment also created a series of disastrous roadblocks to inclusive reproductive health coverage in other legislation. For example, Congress banned abortion coverage in “The Affordable Care Act” in 2010. Compounding this specific policy loss was the profound ideological loss of normalizing the exclusion of abortion from health insurance. During the battle over health care reform, President Obama reassured those who feared that there might be an end run around Hyde by saying, “I’m pro-choice, but I think we also have the tradition in this town, historically, of not financing abortions as part of government-funded health care.”

As we mark this anniversary with our continued activism, I draw several political lessons to inform our advocacy going forward.

Understand the fight we are in:  The agenda is anti-woman, especially poor women

Paradoxically, the debate over abortion is not primarily about abortion itself. Rather, as Dr. George Tiller so eloquently put it, “This battle is about the self-determination of women over the direction and course of their lives. Abortion is about women’s hopes and dreams. Abortion is a matter of survival.”

Over time the anti-abortion movement has gotten more sophisticated in its approach, arguing in recent years it opposes abortion because of the harm it does to women’s health. False claims that abortion is linked to breast cancer and causes women to suffer from post-abortion syndrome are intended to show that the anti-abortion movement cares as much about women as it does about fetuses. However, the theme of contempt and distrust for women, so clearly articulated during the original debate on the Hyde Amendment, recurs.  A recent attempt by Republicans to restrict government funding of abortion to cases of “forced” rape echoes the earlier debate where opponents claimed that “any woman who wants an abortion under Medicaid could go in and say” she has been raped, in order to get Medicaid to pay for her abortion.

Fight for what you really want

At the time the Hyde Amendment was passed, just three years after Roe v. Wade, its sponsors never thought they would succeed. The original Hyde Amendment proposal was unabashedly extreme, with no exceptions whatsoever, not even to save a woman’s life. Its sponsors were completely transparent about their goals. In 1976, Rep. Henry Hyde (R-IL) said:

“I certainly would like to prevent, if I could legally, anybody from having an abortion, a rich woman, a middle-class woman, or a poor woman. Unfortunately, the only vehicle available is the [Medicaid] bill.”

In 1977, Rep. Hyde and other House members held out for six months, orchestrating 25 roll call votes and delaying passage of a $60 million appropriations bill, before finally accepting a few exceptions in order to get the Amendment passed. But they kept pushing for what they really wanted until they successfully eliminated all but the exception for life endangerment in 1981. Up until 1993, Congress refused Medicaid funding to women who had been raped; only women whose lives were endangered by their pregnancy had any hope of receiving financial support for an abortion through Medicaid.

This tenacity became a signature characteristic of the anti-abortion movement: the ban on so-called “partial birth abortion,” the many state-level challenges to Roe itself, and egg-as-person amendments are just a few examples of this approach. The anti-abortion movement never takes no for an answer. By drawing lines in the sand and refusing to compromise, they have successfully restricted access to abortion, mobilized their base and made significant inroads into mainstream attitudes about abortion.

Do not allow the opposition to exploit divisions

By attacking abortion access, rather than legality, the Hyde Amendment divided the abortion rights movement along lines of race and class. It provided the possibility of being “pro-choice” without supporting real access, thereby trading away the needs of low-income women and women of color. When asked why women of color were not more visible in the pro-choice movement, longtime activist and former clinic director Brenda Joyner reframed the question to ask:

“[W]here is the primarily white middle-class movement in our struggles for freedom? Where was a white middle-class movement when the Hyde Amendment took away Medicaid funding of abortions for poor women?”

These divisions have continually arisen. Sometimes, as with the Hyde Amendment, women of different economic classes are pitted against each other. And sometimes, as in the argument over whether to support a health reform bill without abortion coverage, women are in the position of having their basic needs pitted against each other – trading reproductive health care for other health coverage. Here, too, President Obama actively contributed to this conflict, saying, “My main focus is making sure that people have options of high quality care at the lowest possible price” – as if abortion isn’t part of “high-quality care” for women.

As we look towards the future, it is my hope that we will resist the fragmentation that has weakened all of our struggles for social justice. The work of the abortion Funds reminds us daily that, as Audre Lorde told us, “There is no such thing as a single issue struggle, because we do not live single issue lives.” Overturning the Hyde Amendment is just one part of our goal of achieving reproductive justice for all women. It is important that we pursue a bold vision, especially in challenging times. We need this vision to mobilize our movement because, as we have seen, the arc of history does not bend towards justice all by itself – it takes all of our hands.