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State Policy Trends 2013: Abortion Bans Move to the Forefront

1:05 pm in Uncategorized by RH Reality Check

Keep Abortion Safe, Legal & Accessible

Keep Abortion Safe, Legal & Accessible

Written by Elizabeth Nash and Rachel Benson Gold 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 2013, as in recent years, state legislatures are devoting significant attention to issues related to reproductive health and rights. During the first three months of the year, legislators have introduced 694 provisions on these issues, and 93 have been approved by at least one legislative body.

Also in line with recent experience, abortion restrictions are at the center of state legislative activity. About half (47 percent) of all reproductive health measures introduced in the first quarter of the year seek to restrict access to abortion. But unlike in recent years, when the thrust of legislative activity was on regulating abortion (for example, requirements that women undergo an ultrasound, clinic regulations, or insurance coverage restrictions), this year legislators seem to be focusing on banning abortion outright — either by declaring that “personhood” begins at the moment of conception or by prohibiting abortion even during the first trimester of pregnancy.

In a positive development, at the end of March two states were poised to enact legislation expanding access to comprehensive sex education; if enacted, this would be the first time since 2010 that any state has done so. (See here for a more detailed version of this analysis.)

Abortion Bans

During the first three months of 2013, legislators in 14 states introduced provisions seeking to ban abortion prior to viability. These bans fall into three categories: measures that would prohibit all abortions, those that would ban abortions after a specified point during the first trimester of pregnancy, and those that would block abortions at 20 weeks after fertilization (the equivalent of 22 weeks after the woman’s last menstrual period, the conventional method physicians use to measure pregnancy). All of these proposals are in direct violation of U.S. Supreme Court decisions.

Legislators in 10 states have introduced proposals that would ban all, or nearly all, abortions. In eight of those states (Alabama, Iowa, Mississippi, North Dakota, Oklahoma, South Carolina, Virginia, and Washington), legislators have proposed defining “personhood” as beginning at conception; if adopted, these measures would ban most, if not all, abortions. Meanwhile, in four states (Colorado, Florida, Iowa, and North Dakota) legislators introduced measures that would ban abortion except in very limited circumstances, such as when the woman’s life is endangered or in cases of rape or incest; none have passed a legislative chamber.

Already in 2013, Arkansas and North Dakota have enacted legislation banning nearly all abortions beginning at some point in the first trimester of pregnancy. Similar measures have been introduced in four other states (Kansas, Kentucky, Mississippi, and Wyoming). The Arkansas and North Dakota laws are clearly intended as direct challenges to U.S. Supreme Court decisions that states may not impose an undue burden on women seeking an abortion prior to viability, a point that is generally reached just after the end of the second trimester of pregnancy. Supporters of abortion rights are widely expected to take up the gauntlet and contest the prohibitions.

Finally, legislation to ban abortions at 20 weeks post-fertilization was enacted in Arkansas and are pending in nine other states (Iowa, Illinois, Kentucky, Maryland, North Dakota, Oregon, Texas, Virginia, and West Virginia). These bans are patterned after a 2010 Nebraska law that has already served as the model for such laws in eight other states, two of which are enjoined pending legal challenges because they prohibit abortion prior to viability.

Medication Abortion Limitations

Legislators in eight states (Alabama, Arkansas, Iowa, Indiana, Missouri, Mississippi, North Carolina, and Texas) have introduced provisions to restrict medication abortion. If adopted, these restrictions would have a profound impact on access to medication abortion (see our related analysis here). State-adopted restrictions on medication abortion generally take two approaches.

First, some restrictions prohibit use of telemedicine by requiring the physician prescribing the medication to be in the same room as the patient. During the first quarter of 2013, both houses of the Mississippi legislature approved a telemedicine ban; the measure is awaiting debate by a conference committee. As of the end of March, similar provisions have passed a legislative chamber in Alabama and Indiana and are pending in the second body. Seven states already ban telemedicine for prescribing medication abortion. (In early April, the governor signed the Alabama measure into law and the state house passed the Indiana measure, which is now pending in a conference committee.)

Other restrictions require medication abortion to be provided in strict accordance with long-standing Food and Drug Administration (FDA) protocol, prohibiting use of a widely used, simpler protocol that has been demonstrated to be safe and effective. Legislation requiring the FDA protocol is pending in Iowa and Texas. Arizona and Ohio already have such a requirement in effect, and a similar law in North Dakota is enjoined because of a legal challenge.

Sex Education

For the first time since 2010, there is movement toward expanding comprehensive sexuality education. The Colorado legislature approved a measure to require all sex education in the state to be scientifically proven to delay sexual debut, reduce adolescents’ number of sexual partners and sexual frequency, or increase their contraceptive use. The measure, which is awaiting approval by Gov. John Hickenlooper (D), effectively would prohibit abstinence-only instruction. Meanwhile, the Hawaii house adopted a measure that would include instruction on skills for building healthy relationships, making decisions, and talking to family members about sex.

For more information:

Guttmacher State Center

State policies in brief

Major state policy developments in 2013

Chart of enacted bills

Policy analysis on medication abortion restrictions

2012 state policy trends

Read the rest of this entry →

Losing Ground on Women’s Rights: In 2011, Sex Ed, Contraception, Abortion Rights All Under Seige

12:25 pm in Uncategorized by RH Reality Check


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

By almost any measure, issues related to reproductive health and rights at the state level received unprecedented attention in 2011. In the 50 states combined, legislators introduced more than 1,100 reproductive health and rights-related provisions, a sharp increase from the 950 introduced in 2010. By year’s end, 135 of these provisions had been enacted in 36 states, an increase from the 89 enacted in 2010 and the 77 enacted in 2009. (Note: This analysis refers to reproductive health and rights-related “provisions,” rather than bills or laws, since bills introduced and eventually enacted in the states contain multiple relevant provisions.)

Fully 68 percent of these new provisions—92 in 24 states—-restrict access to abortion services, a striking increase from last year, when 26 percent of new provisions restricted abortion. The 92 new abortion restrictions enacted in 2011 shattered the previous record of 34 adopted in 2005.

• For summaries of major state-level actions in 2011, click here.
• For a table showing reproductive health and rights-related provisions enacted in 2011,     click here.
• For the status of state law and policy on key reproductive health and rights issues, click here.

Abortion Restrictions Took Many Forms

Bans. The most high-profile state-level abortion debate of 2011 took place in Mississippi, where voters rejected the ballot initiative that would have legally defined a human embryo as a person “from the moment of fertilization,” setting the stage to ban all abortions and, potentially, most hormonal contraceptive methods in the state. Meanwhile, five states (AL, ID, IN, KS and OK) enacted provisions to ban abortion at or beyond 20 weeks’ gestation, based on the spurious assertion that a fetus can feel pain at that point. These five states join Nebraska, which adopted a ban on abortions after 20 weeks in 2010 (see State Policies on Later Abortions). A similar limitation was vetoed by Minnesota Gov. Mark Dayton (D). Read the rest of this entry →

Study Debunks Theory of “Post-Abortion Syndrome”

8:52 am in Uncategorized by RH Reality Check

Written by Jodi Jacobson for – News, commentary and community for reproductive health and justice.

A study published this fall in the leading journal Social Science and Medicine found little support for the “abortion-as-trauma” framework pushed by anti-choice advocates who claim that a woman who chooses to terminate an unintended and untenable pregnancy is at higher risk for mental health problems because of the procedure, including everything from depression to suicide.

In fact, authors of the new study, conducted by Julia R. Steinberg (Department of Obstetrics, Gynecology, and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California) and Lawrence Finer (Guttmacher Institute) attempted–and were unable–to replicate results from an earlier study by Priscilla Coleman and colleagues (2009).

Using the US National Co-morbidity Survey (NCS), write Steinberg and Finer:

Coleman, Coyle, Shuping, and Rue (2009) published an analysis indicating that compared to women who had never had an abortion, women who had reported an abortion were at an increased risk of several anxiety, mood, and substance use disorders.

But, Steinberg and Finer continue, “[Coleman's] results are not replicable.”

That is, using the same data, sample, and codes as indicated by those authors, it is not possible to replicate the simple bivariate statistics testing the relationship of ever having had an abortion to each mental health disorder when no factors were controlled for in analyses.

Replication involves the process of testing research results and is a critical factor in developing evidence because it helps assure results are valid and reliable, helps identify the variables that may play a role in research findings, can be used to test the application of results to the real world, and may suggest new avenues of research to further refine scientific findings.

“We were unable to reproduce the most basic tabulations of Coleman and colleagues,” says Steinberg, postdoctoral fellow at UCSF, in a statement.

“Moreover, their findings were logically inconsistent with other published research—for example, they found higher rates of depression in the last month than other studies found during respondents’ entire lifetimes. This suggests that their results are substantially inflated.”

(See another article debunking anti-choice mental health claims on which we reported in November.)

The authors carefully examined the question of whether abortion is a causal factor in mental health outcomes or whether pre-existing mental health conditions may be co-factors in unintended pregnancies leading to abortion. Read more

Reproductive and Sexual Health in the States: Two Steps Forward, Several Steps Back

6:51 am in Uncategorized by RH Reality Check

Written by Rachel Gold and Elizabeth Nash for – News, commentary and community for reproductive health and justice.

By the end of March, 825 measures had been introduced in the 44 legislatures that have convened so far in 2010. Five legislatures (Mont., Nev., N.D., Ore. and Texas) do not meet this year, and North Carolina does not convene until May.

To date, seven new laws impacting reproductive health and rights have been enacted. Among the most noteworthy are measures:

  • mandating comprehensive and medically accurate sex education in Wisconsin;


  • allowing medical providers in Maine to prescribe or dispense a drug for treatment of STIs for a partner of a patient without first seeing the partner;


  • criminalizing self-induced abortion or miscarriages caused “intentionally or knowingly” in Utah;

  • requiring an abortion provider in Utah who performs an ultrasound before an abortion to show the woman the image and offer her the option of receiving a description of it;


  • requiring an abortion counselor in Utah to inform a woman seeking an abortion that the state’s counseling video is available online; allowing for an additional penalty for the murder of a pregnant woman in Wyoming; and


  • permitting a health care professional in Idaho to refuse to provide services related to abortion or family planning.


In addition to these laws, 49 other bills have been approved by at least one chamber of the legislature, and some interesting trends are beginning to emerge.

Treating Partners for STIs

In 2009, six states moved to expand access to STI testing, treatment and prevention by enacting legislation allowing a health care provider to prescribe STI treatment for a patient’s partner without having examined the partner. So far this year, legislators have introduced similar measures in seven states (Conn., Maine, Mo., Neb., Okla., R.I. and Wis.) to permit so-called “expedited partner treatment.” The enactment of legislation in Maine at the end of March brings to 15 the number of states with such provisions. 

The new law in Maine allows partner treatment for all STIs, as would the bills pending in three states (Neb., Okla. and R.I.). The bills in the remaining three states would be more limited. The Connecticut and Missouri measures would permit treatment only for Chlamydia and gonorrhea. The Wisconsin bill, which has been approved by the Senate and is awaiting action in the Assembly, would permit treatment only for Chlamydia, gonorrhea and trichomoniasis.

Insurance Coverage of Abortion

Given the visibility of abortion in the national debate over health care reform, it is not surprising that the issue is also garnering widespread attention at the state level. Action at the state level is clustering into two distinct categories—coverage under insurance policies currently being written in the state and coverage in policies that will be offered through the insurance exchanges created under health care reform. 

Measures have been introduced in three states (Kansas, N.H. and Okla.) that would restrict or prohibit insurance coverage of abortion under plans currently being written in the state. Bills pending in Kansas and Oklahoma would restrict coverage offered under all such plans. The measures in Kansas would permit abortion coverage only in cases of life endangerment, rape and incest; they would allow broader coverage only under riders purchased by individuals. Oklahoma currently permits abortion coverage beyond cases of life endangerment, rape or incest only through purchase of a rider. The pending legislation would ban coverage of all “elective” abortions without defining the term, potentially limiting coverage to cases of life endangerment; the rider option would be eliminated. Five states currently restrict insurance policies (see Restricting Insurance Coverage of Abortion).

Measures specifically targeting abortion coverage in plans offered to public employees are pending in five states (Ariz., Kansas, N.H., S.C. and W.Va.). The bill in Kansas would permit coverage only in cases of life endangerment, rape and incest; the Arizona measure would permit coverage in cases of life endangerment or possible “substantial and irreversible impairment of a major bodily function.” The bills in South Carolina (a state that currently restricts coverage to cases of life endangerment, rape and incest) and West Virginia would prohibit coverage of abortion with no exceptions. The South Carolina bill has been approved by the House and is pending in the Senate. Twelve states restrict abortion coverage for public employees (see Restricting Insurance Coverage of Abortion).

Measures introduced in four states (Iowa, Miss., Mo. and Tenn.) address the question of insurance coverage in the health exchanges that will eventually be established under the national health care reform legislation. Bills introduced in Missouri, Mississippi and Tennessee would block coverage in exchanges created by either the federal or state government. The Mississippi measure failed to receive committee approval by the deadline for action. The Missouri bill would allow coverage for abortion only if the woman’s life is at risk. The Tennessee measure would completely prohibit coverage of abortion. The Iowa measure would only allow abortion coverage when necessary to protect the woman’s life, if the coverage is purchased by the state via a “trust fund” that would be created as part of health reform.

Ultrasound Requirements for Women Obtaining an Abortion

So far this year, legislators have introduced 32 measures in 17 states seeking to involve or further incorporate ultrasound into abortion services. They range from bills that would require providers to offer information about ultrasound to those that would mandate not only that an ultrasound be performed, but also that the woman be shown the image. 

Measures pending in 13 states would require abortion providers to offer some information or services related to ultrasound. Bills pending in nine states (Ala, Iowa, Ind., Kansas, Mass., Neb., N.J., N.Y. and S.C.) would require abortion providers to offer information related to ultrasound, and/or to provide the woman with information about where she can obtain the procedure. Bills in four of these states (Iowa, N.J., N.Y. and S.C.) as well as four others (Ill., Md., Mo. and W.Va.) would require an abortion provider to offer a woman seeking an abortion an ultrasound. Currently, eight states require verbal counseling or written materials to include information on accessing ultrasound services. Three states require that a woman be provided with the option to obtain an ultrasound (see Requirements for Ultrasound).

In March, a measure to add requirements for providers performing an ultrasound in preparation for an abortion was signed into law in Utah; a similar measure is awaiting action by the governor in West Virginia. The Utah measure requires providers to display the ultrasound image and to offer the woman the option of a verbal description. The West Virginia bill would require providers to offer the woman the option to view the image. With the addition of Utah, nine states currently regulate the performance of ultrasound when performed as part of preparation for an abortion (see Requirements for Ultrasound).

To date, legislators in 10 states (Alaska, Ala., Kansas, Ky., La., Okla., R.I., S.C., Va. and W.Va.) have introduced measures to mandate the performance of an ultrasound prior to any abortion procedure; two of these bills have seen significant action. In Virginia, a measure passed the House but was defeated in the Senate. And in Oklahoma, a bill is pending in the House after having been approved by the Senate. The Oklahoma bill would require that the provider display and describe the image to the woman, although she would be entitled to “avert” her eyes; it is virtually identical to legislation enacted in the state in 2008 that was struck down by the court on procedural grounds. Three states require the performance of an ultrasound on any woman seeking an abortion, and require the provider to offer the woman the opportunity to view the image (see Requirements for Ultrasound).

Click here for:

Summaries of major state legislative actions so far in 2010

A table showing legislation enacted in 2010

The status of state law and policy on key reproductive health and rights issues

The Battle Over BPA

6:36 am in Uncategorized by RH Reality Check

Written by Amie Newman for – News, commentary and community for reproductive health and justice.

April 22nd is Earth Day.

It feels like an uphill battle at times. Protecting against those invisible toxins in the air, in our water, in the food we eat, in the containers that store the food and beverages we consume. We develop breast cancer, or polycystic ovarian syndrome or prostate cancer. And we wonder what the cause of these conditions might be. Heredity? Bad luck? How can we possibly place the blame on something we may come into contact with daily, products we assume are safe? We rely, of course, on government agencies like the Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) to help us identify what may or may not be safe. Unfortunately, the way the current system is set up may not be good for our health, according to a feature article by Jennifer Rogers published earlier this month on RH Reality Check and confirmed up by a new report, BPA Free and Beyond: Protecting Reproductive Health from Environmental Toxins by the Guttmacher Institute:

Some 2,000 new chemicals are introduced into the U.S. marketplace every year, according to the federal interagency National Toxicology Program (NTP). Yet, the NTP and others widely acknowledge that in many cases, neither corporations nor the government have adequately researched the ways in which exposure to these chemicals can affect people’s health and how much exposure is sufficient to constitute an unsafe risk.

This is what’s happened with BPA or bisphenol A. BPA is a chemical used in food and beverage containers (including baby bottles, water bottles and canned fruit) which has now been called out by the FDA because of its potentially dangerous effect on human health including on the health of some particularly vulnerable populations like babies, young children, and pregnant and breastfeeding women.

And the reproductive health effects can be immense, found in both men and women. From the Guttmacher Institute’s report:

Effects particular to reproduction in males include abnormal development of the prostate and urethra, decreased sperm count and quality, sexual dysfunction and increased risk of prostate cancer. In females, reproductive health consequences include recurrent miscarriages, early puberty, abnormal uterus development, polycystic ovarian syndrome, uterine fibroids, increased risk of breast cancer and oocyte (egg) chromosome abnormalities.

Back in January of this year, the FDA “acknowledged concern” about BPA echoing concerns cited by the National Toxicology Program but, writes Sneha Barot for the Guttmacher Institute:

“…it is also true that it is notoriously difficult to establish a definitive, cause-and-effect relationship between exposure to a specific chemical and health problems that may not develop until many years later.”

Still, advocates have worked hard to raise awareness and push for more oversight. Nalgene, which produces water bottles, voluntarily decided to stop using BPA in their products because of pressure from advocates and consumers. With the federal government slow to act on BPA, states have taken to passing their own legislation to ban or limit the use of BPA in the production of consumer items.

Washington state banned BPA in baby bottles and sippy cups during the 2010 legislative session. The new law goes into effect in July 2011. Minnesota, Connecticut, New York and Illinois have all implemented various bans on BPA use in baby bottles as well.

These are positive steps towards protecting our children from harmful toxic chemicals. However, the Guttmacher Institute is quick to note that the FDA’s statement of concern,

“…focused only on infant exposure, ignoring precautions for other vulnerable populations, such as pregnant women, breast-feeding mothers and women undergoing chemotherapy for breast cancer, not to mention all other children and adults who are exposed daily to the chemical.”

What is the Environmental Protection Agency’s (EPA) role in all of this?

According to Lisa Stiffler of The Sightline Institute,

“Back in December [2009], EPA Chief Lisa Jackson was talking tough when it came to toxics. "Chemical safety is an issue of utmost importance, especially for children, and this will remain a top priority for me and our agency going forward," she stated in a release.

So how do you explain her agency’s decision to postpone for at least two years an action plan on bisphenol A — a chemical that’s particularly threatening to infants and children and linked to obesity, cancer, diabetes, and behavior problems?”

The Guttmacher Institute notes that in fact the EPA is limited in its ability to “protect the public from toxic chemicals” because of current law, specifically the Toxic Safety Chemicals Act (TSCA), which essentially allows companies to utilize chemicals in their products unless or until they are proven dangerous, instead of placing the responsibility on companies to first prove safety before disseminating for public use.

It’s why the EPA is now pushing for legislative reform that would change the system. In addition, there is a move on the federal level, slow as it may be, to address BPA specifically. Sen. Dianne Feinstein  (D-CA) introduced legislation to ban BPA from food and drink containers. According to an April 20, 2010 article on POLITICO, Feinsten told them:

“I introduced my bill to ban BPA from being used in food containers because I feel very strongly that the government should protect people from harmful chemicals. I continue to believe that BPA should be addressed as a part of the food-safety overhaul and plan to offer an amendment to do so.”

Groups like The Breast Cancer Action Fund that, according to POLITICO, “works to eliminate breast cancer’s environmental causes,” support the ban 100 percent. In addition to Feinstein’s bill (sponsored in the House by Rep. Edward Markey (D-MA)), says the Guttmacher Institute,

“…several bills are currently pending that would directly affect BPA…Markey was able to include limited provisions on BPA in a food safety bill that passed out of the Energy and Commerce Committee last June. Companion bills introduced by Rep. Anthony Weiner (D-NY) and Sen. Charles Schumer (D-NY) would ban BPA in children’s food and beverage containers. Rep. Tim Ryan (D-OH) has introduced legislation to require a warning label for any food container that contains BPA or that could release BPA into food. And, Rep. Jim Moran (D-VA) and Sen. John Kerry (D-MA) have sponsored the Endocrine Disruption Prevention Act, which would establish a research program to help identify endocrine disrupting chemicals and determine their safety.”

However, notes Guttmacher, it is not feasible or efficient to simply rely on enacting new legislation every time a commonly used chemical is discovered to have potentially harmful health effects. Because of the TSCA, the EPA does not have sufficient power to truly protect Americans’ health from environmental toxins under current law. So, legislators like Sen. Frank Lautenberg have introduced bills that would reform TSCA -  instead of the EPA needing to prove harm, the chemical industry would need to prove safety. [Rogers' article offers an action step to take on this bill.]  And lest you think, “Isn’t this just common sense consumer safety?!” this is not the de facto position in the U.S.

Scientists and advocates have been arguing, in the United States, for adoption of the “precautionary principle” to bolster reform of current legislation. This principle, says the Guttmacher report,  “enshrines the belief that when there is sufficient evidence of a risk of severe or irreversible harm, public policy should fall on the side of protecting the public, despite the lack of scientific consensus on direct proof of causation. This approach, they argue, may be especially important in a society in which consumers cannot buy their way out of using harmful substances because chemical exposure is so omnipresent.”

While the European Union and Canada are both using this “precautionary principle” to oversee chemical use in consumer products, the U.S., says Guttmacher, will likely not adopt the principle any time soon.

So, what are we as consumers and, well, humans living on this planet to do? Well, says Rogers of the Reproductive Health Technology Project, if you’re a reproductive health and rights supporter, you can play an important role by understanding just how much toxins in our consumer products may be affecting our reproductive and sexual health:

I believe the reproductive health movement must be a key player in achieving chemical policy reform.  Our movement has a legitimate, unique, and necessary role to play in educating the American public about the dangers of toxic chemicals and in mobilizing for policy change. Not only do we have considerable resources and infrastructure to contribute to these efforts, but according to recent opinion research, three of the four most effective messages in support of chemical policy reform involve reproductive health concerns.

And as far as BPA goes, it may be a precautionary tale about chemical use in consumer products. Just because a product is being sold on store shelves in the U.S., notes the Guttmacher report, doesn’t mean its safety is ensured by the government. It’s not only important to advocate for bans on harmful chemicals, it’s critical to support broader reform efforts. With “thousands of other, yet-undeveloped” chemicals “expected to enter the market, and inevitably our bodies” says the report; we cannot rely on the companies that produce the products to police themselves. We must shore up the regulatory laws and systems that oversee toxins in our products, so they can also advocate for Americans’ health and lives.