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Why Admitting Privileges Laws Have No Medical Benefit

12:55 pm in Uncategorized by RH Reality Check

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

Hospital surgery with team

Forced hospital admitting privileges don’t protect women seeking abortions.

Last week, a federal judge in Wisconsin extended a temporary restraining order that prevented Wisconsin’s latest legislative attempt to reduce women’s access to safe abortion care—by requiring abortion providers to obtain admitting privileges from a local hospital—from going into effect.

Section 1 of Wisconsin Act 37 (SB 206), which was proposed by the Wisconsin legislature on June 4 and hastily signed by Republican Gov. Scott Walker on July 5, requires that physicians who provide abortion services have admitting privileges at a hospital within 30 miles of the location where the abortion is performed. The law was enacted ostensibly to reduce the risk to patients who suffer serious complications during an abortion, and to prevent abortion providers from abdicating their duty of care and leaving such women to fend for themselves. In reality, however, these laws place a substantial obstacle in the path of a woman seeking an abortion and contravene the constitutional principles set forth in Planned Parenthood v. Casey.

At first blush, these laws may seem sensible enough, especially if you believe that abortion is a dangerous procedure and providers should have hospital admitting privileges in case something goes horribly awry. Such is the concern of anti-choicers pushing for the Wisconsin law, as Susan Armacost, legislative director of Wisconsin Right to Life, noted in a July 5 statement. “Apparently, Wisconsin’s abortion clinics don’t believe their abortionists need to have hospital privileges at a hospital located within 30 miles of their clinic … or anywhere at all,” she said. “Currently, when a woman experiences hemorrhaging or other life-threatening complications after an abortion in Wisconsin, the clinic puts her in an ambulance and sends her to a hospital ALONE where she is left to her own devices to explain her medical issues to the emergency room staff. The abortionist who performed the abortion is nowhere to be seen. This deplorable situation must change.”

But documents submitted to the federal court in Wisconsin overseeing the case paint a very different picture of the admitting privileges law. According to Dr. Douglas Laube, a board-certified OB-GYN since 1976, the admitting privileges requirement is “medically unjustified and will have serious consequences for women’s health in Wisconsin.”

As Dr. Laube explained to the court, abortion is one of the safest medical procedures in the United States, alarmist claims to the contrary notwithstanding:

The risk of death associated with childbirth is 14 times higher than that associated with abortion. The risk of death related to abortion overall is less than 0.7 deaths per 100,000 procedures. (As a point of comparison, Dr. Laube states that the risk of death from fatal anaphylactic shock following use of penicillin in the United States is 2.0 deaths per 100,000 uses.) Less than 0.3% of women experiencing a complication from an abortion require hospitalization.

Abortion is an extremely safe procedure that rarely results in serious complications, and despite anti-choicers’ vehement efforts to cloak such laws in feigned concern for maternal health, current medical practices are such that risk to patients won’t be reduced by restrictive rules requiring admitting privileges.

When something goes wrong during a surgical abortion and hospitalization is required, the practical reality is that if a patient is transported by ambulance to a hospital, the EMT will make the decision about which hospital the patient should be taken to. Similarly, in cases of medical abortion, if a pregnant person experiences medical complications at home, she will likely be transported by ambulance to the nearest hospital, and not necessarily to the hospital nearest to the abortion clinic, or to the hospital for which, under the new act, the abortion provider will be required to have admitting privileges.

Moreover, such requirements do not account for modern practices for inpatient hospital care. Currently, typical hospital practices seek dedicated staff physicians to provide inpatient care, and whether an abortion provider has admitting privileges at a particular hospital plays little or no role in determining which hospital may be best suited to care for the patient.

Ultimately, as U.S. District Judge William Conley noted in his ruling,

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The Politics of Abortion in Latin America

12:29 pm in Uncategorized by RH Reality Check

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

 photo repudiamos_zps15653e22.jpg

In light of the recent case of Beatriz, a 22-year-old Salvadoran woman and mother of a toddler, who, while suffering from lupus and kidney failure and carrying an anencephalic fetus, was denied the right to an abortion, it is relevant to discuss the restrictive abortion laws in Latin America and some of the reasons behind them.

Latin America is home to five of the seven countries in the world in which abortion is banned in all instances, even when the life of the woman is at risk: Chile, Nicaragua, El Salvador, Honduras, and the Dominican Republic, with the Vatican City and Malta outside the region. Legal abortion upon request during the first trimester is only available in Cuba (as of 1965), Mexico City (as of 2007), and Uruguay (as of 2012). In the rest of the continent, abortion is criminalized in most circumstances, with few exceptions, the most common of which are when the life or health of the woman is at risk, rape, incest and/or fetus malformations. However, even in these cases the legal and practical hurdles a woman has to face to have an abortion are such that many times these exceptions are not available, or by the time they are authorized it is too late. The consequences of such criminalization are well known: high maternal mortality and morbidity rates due to unsafe back alley abortions that affect poor and young women disproportionately.

The current laws ruling abortion in the region have been inherited from colonial powers. They are a legacy of the Spanish and Portuguese empires. While European women have already gotten rid of these laws many decades ago, Latin American women still have to deal with them. Why is this so?

As both scholars and activists know by now, women’s rights, like other human rights, are only respected if a movement organizes around them and puts pressure on the state to change unfair laws and policies. While feminist movements swept Europe and North America during the 1960s and 70s, Latin American countries were busy fighting dictatorships and civil wars. It is not that women did not organize, but rather they did so to oppose the brutal regimes and to address the needs of poor populations hit by the recurrent economic crises. Reproductive rights just had to wait. When democracy finally arrived in the region—in the 1980s in South American and the 1990s in Central America—feminist movements gradually began to push for reproductive rights. For example, the September 28th Day of Action for Access to Safe and Legal Abortion was launched in 1990 in the context of the Fifth Latin American and Caribbean Feminist meeting held in San Bernardo, Argentina. Since then, most countries in the region have seen mobilizations and protests around this date. However, by the time the movements began to focus on reproductive rights, the global context had changed and the conservative right had also set up a strong opposition to any change to the status quo.

The strongholds of the opposition to decriminalization lie in two places: first, the Catholic Church, and second, the ascendance of the religious right in the United States. The Catholic Church has historically been a strong political actor in Latin America, ever since its large role in the conquest and colonization of the continent by the Spanish and Portuguese crowns in the 16th and 17th centuries. The church’s influence among both political and economic elites is still a reality in the whole region with only a variation of degree among the different countries. However, the church’s strong opposition to abortion has not been constant. While the church has always condemned abortion, it used to be considered a misdemeanor and not a murder of an innocent human life, as in the current discourse. In addition, it was not until the late 1800s that the church considered that life started at conception. Until 1869, a fetus was thought to receive its soul from 40 to 80 days after conception, abortion being a sin only after the ensoulment had taken place.

Even in the beginning of the 20th century, when many Latin American countries passed their current legislation that allowed legal abortion under certain circumstances, the Catholic Church did not pose a strong opposition to these reforms. As Mala Htun explains in her research on South American abortion laws, at the time abortion reforms were passed by a nucleus of male politicians, doctors, and jurists. In addition, these reforms legalized abortion only in very limited circumstances and required the authorization of a doctor and/or a judge, and therefore represented no real threat to the dominant discourse of abortion being morally wrong. The church only began organizing against abortion decriminalization when feminist movements came together to claim the autonomy of women’s bodies threatening this consensus.

When John Paul II became Pope in 1978, moral issues such as abortion were given a priority in the church’s mission as never before. Having lived through the Soviet conquest of his home country, Poland, and experienced the repression of Catholicism and the legalization of abortion there, the Pope felt very strongly about these issues. Once many of the European Catholic countries achieved the legalization of abortion in the 1970s and 80s, Latin America, being the largest Catholic region in the world, became the battleground in which abortion policy would be fought and decided.
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Talking to Men Who Are Clinic Escorts

11:08 am in Uncategorized by RH Reality Check

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

Button: Will You Stand with Planned Parenthood?

The stories of male allies at abortion clinics.

Recently, I was having a conversation with some other reproductive justice-inclined folks about cisgender men who are clinic escorts. Escorting, regardless of your gender, can be taxing. (It can also be powerful, rewarding, and beautiful.) You wake up early and stand outside an abortion clinic for hours. You may have to answer questions from people who are just walking by and want to know what’s happening, without knowing whether or not they’re going to be sympathetic. Anti-choice protestors will try to make your job harder via verbal or physical harassment.

For the most part, it is women who take on the job of escorting at clinics, but on occasion there are men. Generally speaking, in the abortion conversation, men are either providers, the partners of those getting abortions, or protestors. “I am constantly having to stop myself,” said MB, a female clinic escort, “from asking both the dude protestors and the dude escorts, what does this mean to you? Why are you here?”

I decided to track down some men who are clinic escorts to get answers to these questions. And I read their answers with this quote from Natalie, a clinic escort in Los Angeles, in mind: “Some cis male clinic escorts are great, and it’s an honor to volunteer with them. I think cis men who choose to get involved with clinic escorting have a responsibility to be conscious of what they bring to the dynamic. They have the power to present a male-inclusive feminism to patients, protesters, and passers-by, or to perpetuate the status quo.”

P is a 25-year-old data scientist who lives in Boston. He has escorted at a private clinic in Philadelphia and at a Planned Parenthood office in Boston.

RH Reality Check: Why did you decide to start escorting?

P: My girlfriend and I met in college. She had been a clinic escort with her mom before college and was continuing that before we started dating. She told stories about these crazy people who would protest, so after we started dating I was feeling like there was this remote possibility that something bad would happen to her while she was escorting, and if it did then I would feel terrible. So I started going along with her. It’s worth noting that she had been escorting by herself for a long time, so it wasn’t like I thought anything would happen. But I was appalled at the thought of not being there if something did happen. I also am pro-choice, but as in this paragraph, that was a bit of an afterthought.

RHRC: How do you think your identity as a cis man has affected your experience as an escort?

P: I think there was some extra special vitriol from anti-abortion protestors in some cases. One time I was volunteering in Philadelphia and there was this old white dude who was protesting, and he came up to me and started telling me how unmanly I was in various ways. The most memorable part was that he called me a “sissy bitch.” The clinic has a non-engagement policy for the volunteers, so I didn’t respond to him.

RHRC: What’s been the best part of escorting for you?

P: Like any kind of volunteering, it always feels good to have people express their gratitude. This wasn’t usually from patients so much, because they were usually pretty stressed out, but passers-by would sometimes say “Thanks for being here” or give thumbs up or whatever. That’s always nice.

Eric is 39 and works in high tech marketing. He escorted at the Summit Women’s Center in Bridgeport, Connecticut.

RHRC: What was your motivation to start escorting?

Eric: Some good friends of mine were organizing these escorts at a clinic in Bridgeport, about 40 minutes from where we were at college. I came from a family of activists, and I myself had participated in political and issue activism going back to middle school. I was eager for the opportunity to make a difference in individuals’ lives and experience life in the middle of the abortion conflict.

RHRC: How do you think your identity as a cis man has affected your experience as an escort?

Eric: We had some strict rules about how men could escort. Two escorts would walk with every woman, and at least one of them had to be a woman. But we also occasionally had other groups join us for escorting, and they didn’t abide by these rules, which annoyed me. I understood that these women were going through hard times, such as being told by a male-dominated society that they were murderers for making their own decisions about their bodies. So I respected our rules.

Harry Waksberg is a 25-year-old writer who volunteers at a clinic in Los Angeles.

RHRC: What was your motivation to start escorting?

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Stigma on Steroids: On Kansas Banning Abortion Providers From Schools

11:09 am in Uncategorized by RH Reality Check

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

No school district, employee or agent thereof, or educational service provider contracting with such school district shall provide abortion services. No school district shall permit any person or entity to offer, sponsor or otherwise furnish in any manner any course materials or instruction relating to human sexuality or sexually transmitted diseases if such person or entity is an abortion services provider, or an employee, agent or volunteer of an abortion services provider.

Kansas High School

Kansas schools now forbid anyone with ties to abortion clinics.

The above provision is contained in a nearly 50-page bill that recently went into effect in Kansas. (A judge temporarily blocked two other provisions of the law, but allowed this one to remain.)

To be sure, the relentless assault on abortion that we are currently seeing in other state legislatures—Texas, Ohio, and North Carolina, among others—are far more consequential in the short run. Ambulatory surgical center (ASC) and hospital admitting privilege requirements really do have the capacity to shut down clinics. Should the Texas bill currently being considered become law—as is likely, despite the heroic efforts of the thousands of orange-shirters gathered at the capitol—the number of Texas abortion facilities would go from 47 to five in that huge state. Already, due to a similar ASC requirement, earlier rammed through the Pennsylvania legislature as a cynical response to the Gosnell scandal, a number of clinics in Pennsylvania have closed. And the bans on abortions after 20 weeks, adopted by a number of states, will affect a relatively small number of women, but typically those in desperate medical and/or social condition.

But other provisions of abortion legislation, of which the Kansas one cited above is a prime example, do a different kind of damage. They further the stigmatization and marginalization of abortion providers by making clear that these individuals are not welcome in that most central of community institutions: the schools. It is not just participation in sex education from which Kansas providers are barred. As Stephanie Toti, senior attorney at the Center for Reproductive Rights, which is challenging this law, told me, “This is unprecedented discrimination against abortion providers. … The prohibition on providers serving as ‘agents’ of a school district has the effect of barring them from serving as chaperones on field trips and engaging in most other volunteer activities.”

So abortion providers are at this moment banned from Kansas schools—and supposedly this will promote the safety of adult women getting abortions, as is the typical sanctimonious rationalization of the various laws we are seeing.

I asked several lawyer colleagues if they knew of other instances in which a whole occupational category was banned by law from volunteering in schools. They did not. Indeed, as far as I can tell, only sex offenders as a class are de facto banned from school grounds.

This shocking ban on abortion providers’ involvement in the schools leads me to recollect other instances I have encountered of attempts to isolate this group and keep them from community involvement. I think of a provider I’ve written about who I call Bill Swinton (not his real name), a family medicine doctor in a small town in the Pacific Northwest. He was deeply involved in both his church and his community, and served for three terms on the local school board. But he was defeated for a fourth term in the late 1980s, as the abortion wars intensified; needless to say, his status as a provider was the key factor in his defeat. I think as well of another doctor I’ve written about named Susan Golden (also not her real name), in a town in the Midwest, who integrated abortion provision into her family medicine practice. When she and her partner planned to take part in a community health fair, presenting on the care of newborns, the entire event was abruptly cancelled by the anti-abortion owner of the facility where the fair had been scheduled to take place.

As disturbing as these incidents were, they did not have the force, or the legitimization, of law. The Kansas provision does—and as such, takes the stigmatization of abortion providers to a new level.

Assuming the Kansas law, including this provision, is not overturned, we can only speculate as to what effects it might have. Speaking personally, I remember as a child the enormous pride I felt when my father, a cardiologist, came to my elementary school with his microscope and showed the class wondrous things. As a working mother, I recall how much I valued occasional volunteer stints in my daughters’ schools, getting to know both their classmates and other parents. It is very disturbing to contemplate that providers and their children will be deprived of these experiences. And it is equally disturbing to contemplate the messages that others in the community will receive from such a ban.

This provision truly is stigma on steroids.

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For Decades, Authorities Let Rogue Abortion Provider Harm Women, Despite Pleas From Legitimate Doctors

1:01 pm in Uncategorized by RH Reality Check

Written by Sharona Coutts for RH Reality Check.

Hospital bed

An illegal abortionist was tolerated by the state for years despite many injured women.

On August 13, 2010, an 18-year-old New Jersey resident arrived in a clinic in Elkton, Maryland, to undergo a surgical abortion. She was 21-and-a-half weeks pregnant, and had driven just over an hour from a clinic in Voorhees, New Jersey, where the day before, Dr. Steven C. Brigham had initiated the procedure.

Just 15 minutes into the surgery in Maryland, the patient suffered major injuries. Her uterus was ruptured, and her bowel had been perforated and was protruding into her vagina.

Instead of immediately calling 911 for emergency assistance, her doctors—Brigham and his associate, Nicola I. Riley—waited nearly two hours, according to findings from the Maryland State Board of Physicians. They then dressed the patient, who was still sedated and slumped over, and lifted her into a wheelchair. They rolled her outside, put her in a car, and with Brigham at the wheel, took her to a nearby hospital. Her injuries were so severe that hospital staff had her airlifted to Johns Hopkins Health Center for emergency treatment.

The patient survived, and as was reported Thursday morning in the New York Times, her story now forms a key part of the evidence that is being used in an administrative proceeding brought by New Jersey’s attorney general to have Brigham’s medical license permanently suspended or revoked.

However, what has not yet been reported is the extent to which legitimate providers in the states where Brigham practiced went to warn state officials of the threat Brigham posed to the health of the women he served.

In numerous complaints, emails and phone calls over a period of more than two decades, legitimate abortion providers from New Jersey and neighboring states alerted authorities to Brigham’s dangerous conduct, furnishing warnings they say went largely unheeded. Doctors provided copies of many of these complaints, as well as extensive logs of their calls, to RH Reality Check.

An investigation by RH Reality Check shows that New Jersey officials responsible for overseeing healthcare in that state could have prevented injuries to this and subsequent patients, had they acted on warnings about Brigham that predicted this exact scenario.

“If they had listened right in the beginning and taken appropriate action, I think these harms would have been prevented,” Jen Boulanger, a clinic administrator who has spent years amassing complaints about Brigham and his associates, told RH Reality Check. “I think state agencies were afraid of raising eyebrows about abortion, but they just should have handled it like they do any other field of medicine.”

A spokesman for the New Jersey attorney general’s office, which has ultimate oversight of the New Jersey Board of Medical Examiners, said the office could not comment on Brigham, because of the ongoing dispute over his medical license.

Attempts to reach Brigham, as well as attorneys listed as his representatives on official documents, were unsuccessful.

Brigham has now had his medical license suspended or revoked in up to six states, but public records show that he remains at the helm of an abortion chain called American Women’s Services, which is based in New Jersey, and owns or is affiliated with 15 clinics in four states. There is no requirement that the owner of a medical facility actually possess a medical license, state officials said.

The issue of abortion has once again leapt to the forefront of state and national politics. Already this year, dozens of anti-choice laws have been proposed or have passed at the state level, and a 20-week abortion ban recently passed in the U.S. House of Representatives.

Anti-choice advocates, including activists, and state and federal politicians, have capitalized on the case of another rogue provider—Kermit B. Gosnell—to falsely claim that he represented the norm in abortion care.

TIMELINE OF EVENTS

1986: Brigham graduates from Columbia University College of Physicians and Surgeons. In the coming years, National Abortion Federation leaders grow concerned about his skill level. Brigham fails to complete his NAF training, and his application for membership is denied.

APRIL 1992: Brigham agrees to voluntarily retire from practicing medicine in Pennsylvania in exchange for the state dropping a pending investigation regarding him. His license is placed on permanent inactive status, and he is ordered not to ever apply for renewal or reinstatement.

NOVEMBER 1993: The New Jersey attorney general’s office files its first complaint about Brigham with the board of examiners. Two more complaints are filed in July and December of 1994.

JANUARY 1994: New York suspends Brigham’s license, calling him an “imminent danger to the health of the people of New York.”

FEBRUARY 1994: New Jersey restricts Brigham’s license, determining that his unrestricted practice presents a clear and imminent danger to the people of New Jersey.

NOVEMBER 1994: New York revokes Brigham’s license, finding him guilty of gross negligence and negligence on more than one occasion in practicing medicine.

FEBRUARY 1995: Florida suspends Brigham’s license.

JUNE 1996: Florida revokes Brigham’s license.

AUGUST 1996: Upon a favorable ruling by the Office of Administrative Law on the three complaints filed by the New Jersey attorney general, New Jersey reinstates Brigham’s medical license subject to conditions that Brigham only perform abortions during the first trimester of pregnancy in the state.

SEPTEMBER 2005: A complaint lodged online by a doctor with the New Jersey Board of Medical Examiners warns that Brigham was performing second-trimester abortions in New Jersey.

SEPTEMBER 2009: Pennsylvania bans Brigham from owning or running abortion clinics in Pennsylvania.

FEBRUARY 2010: A group of New Jersey doctors, abortion clinic administrators, and counselors send a collection of complaints to the enforcement bureau of the New Jersey attorney general’s office and to William Roeder, executive director of the New Jersey State Board of Medical Examiners.

AUGUST 2010: An 18-year-old patient is injured at Brigham’s Elkton, Maryland, abortion clinic and is airlifted to Johns Hopkins Health Center for emergency treatment. Maryland issues a cease and desist order to Brigham, demanding that he stop practicing medicine in Maryland without a license.

OCTOBER 2010: New Jersey suspends, but does not revoke, Brigham’s license.

FEBRUARY 2013: A patient dies at Brigham’s Baltimore abortion clinic.

The documents provided to RH Reality Check, however, show that reputable providers tried for years to sound the alarm on a rogue provider. In Brigham’s case, they made sustained efforts to prompt officials in New Jersey, Pennsylvania, and Maryland to enforce the regulations that already existed to ensure safe abortion care. The documents provided show that authorities were often slow to respond to those warnings, if they acted at all.

For the providers who spent years trying to stop the problems they saw at Brigham’s clinic, the fact that he is still involved in women’s health—and being used as justification for restricting access to abortion—signals systemic problems with how the authorities and politicians treat reproductive health issues. They also said they believe many of these new legal restrictions—in addition to being medically unnecessary—could push more women into the hands of rogue providers, such as Brigham or Gosnell.

“It’s heart-breaking,” said Claire Keyes, who worked for more than 30 years as director of the Allegheny Reproductive Health Center in Pittsburgh, where she treated dozens of patients who had been to clinics owned by Brigham. “This isn’t throwing women under the bus. This is like backing up over and over and over them.”

A Long History of Problems

Brigham had already accrued a long history of harming patients by the time he botched the abortion in 2010.

Over a period of more than two decades, Brigham has left patients with severe bowel injuries, severed ureters and sweeping lacerations to the uterus, and requiring emergency hysterectomies for procedures that, when done by a properly trained provider, has a very low risk of complication, public records show.

In fact, Brigham first came to the attention of national abortion providers shortly after graduating from Columbia University College of Physicians and Surgeons in 1986. His prestigious education and natural charisma led many colleagues to give him a warm welcome into the professional community.

“We were very enthusiastic about this doctor when he first came,” said Suzanne Poppema, a former board chair of the National Abortion Federation (NAF) and Physicians for Reproductive Health. “He was young and socially adept and seemed to say all the right things, and asked good questions that you would expect someone just starting out to ask.”

But that impression changed quickly, Poppema said. Colleagues noticed that Brigham continued to ask the same questions at subsequent meetings, which struck them as odd. And then they began to hear troubling reports about the young physician’s medical practices.

“Right away we started hearing that he was moving into both early and later second-trimester abortions. And he had a complication,” she said, referring to a problem with an abortion procedure.

In the hands of a skilled provider, abortion carries a very low risk of complication, even after 20 weeks’ gestation, and certainly lower than the risks associated with giving birth. However, the risk of complication increases as the pregnancy progresses, and like any complex medical procedure, specialized training is required. NAF board members believed Brigham lacked those skills, and decided to confront him to express those concerns.

“I sat down with him and three other physicians, and we said to him, ‘You have to promise that you will not do any second-trimester abortions until you have spent two weeks with one of our senior physicians,’” Poppema recalled.

But Poppema said Brigham never completed that training. NAF rejected his application for membership, and lodged their concerns with Pennsylvania authorities, including the attorney general and the State Board of Medicine.

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Trent Franks, Abortion Bans, and the Fetal Pain Lie

7:53 am in Uncategorized by RH Reality Check

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

Trent Franks

Trent Franks & other men, gunning for abortion again.

Wednesday, an all-male panel of House Judiciary Committee members, led by Rep. Trent Franks (R-AZ), passed a 20-week abortion ban. The bill, HR 1797, passed out of the Judiciary Committee by a vote of 20 to 12. The vote count fell along party lines, with the exception of Congressman Pedro Pierluisi (D-PR), the only Democrat who voted in favor.

House Speaker John Boehner (R-OH) has promised a floor vote on the bill next week.

This is a dangerous piece of legislation. It is based on false and completely disproven assertions about “evidence” of fetal pain; it makes legislators, rather than doctors, the arbiters of gestational age; and it would result in the trial and imprisonment of medical professionals who provide safe abortion care. Yet in what can only be called an irresponsible quest for what they call “balance,” many media outlets are assisting in the perpetuation of lies about a critical aspect of reproductive health care in support of policies that will deeply harm women and criminalize providers.

As currently written, Franks’ bill would create an absolute ban on abortions in the United States after 20 weeks post-fertilization, for any reason, under any circumstance, except the imminent risk of death of the pregnant person, which as the cases of Beatriz and Savita Halappanavar have shown is not exactly reassuring. Contrary to misreporting by the Washington Post and the Associated Press, it is not a “reaction” to the trial of Kermit Gosnell, but simply the newest iteration of a bill Franks has been pushing for years — and he is using the Gosnell case as an excuse to expand the bill from a focus “only” on the District of Columbia to a nationwide ban.

It is no secret that the GOP is out to ban all abortions in the United States, no matter the costs to women’s lives and health, nor the costs to families and society writ large. When they are not acting to ban abortions outright, legislatures controlled by the GOP and Tea Party are passing unnecessary and costly regulations intended to close clinics run by legitimate providers of safe abortion care, and creating hoops through which patients must jump to get safe abortion care intended to raise the costs of early abortion and to humiliate and shame women, plain and simple.

The GOP and anti-choice movement’s claims about “caring for women” are belied by the fact that passage of a bill that would create blanket restrictions on safe abortion care, would remove health-care decisions from the hands of doctors and the women who are their patients — and would guarantee that criminal actors such as Kermit Gosnell get plenty of business.

The ostensible premise of HR 1797 — and others like it at the state level — is that a fetus at or past 20 weeks post-fertilization “feels pain.” This is an assertion that has been rejected by every relevant major medical body in the United States and abroad.

In the findings section of the bill, for example, the text asserts the following (condensed here):

After 20 weeks, the unborn child reacts to stimuli that would be recognized as painful if applied to an adult human, for example, by recoiling…. In the unborn child, application of such painful stimuli is associated with significant increases in stress hormones known as the stress response…. Subjection to such painful stimuli is associated with long-term harmful neurodevelopmental effects, such as altered pain sensitivity and, possibly, emotional, behavioral, and learning disabilities later in life.

It further states (emphasis added):

The position, asserted by some medical experts, that the unborn child is incapable of experiencing pain until a point later in pregnancy than 20 weeks after fertilization predominately rests on the assumption that the ability to experience pain depends on the cerebral cortex and requires nerve connections between the thalamus and the cortex. However, recent medical research and analysis, especially since 2007, provides strong evidence for the conclusion that a functioning cortex is not necessary to experience pain.

The intention here is clearly to deceive.

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The Pillars and Possibilities of a Global Plan to Address HIV in Women and Their Children

12:54 pm in Uncategorized by RH Reality Check

Written by Alice Welbourn 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 following article based on a presentation by Alice Welbourn at the Women Deliver Conference, which took place earlier this month in Kuala Lumpur, Malaysia.

African Mother and Child

Is there a better way to we protect African women and their children from HIV?

I was recently invited to take part in a panel discussion at the Women Deliver Conference in Kuala Lumpur, Malaysia, the theme of which was “More than mothers: upholding the sexual and reproductive health and rights of women in the Global Plan.”

The plan in question is the “Global Plan Towards the Elimination of New HIV Infections in Children and Keeping their Mothers Alive,” about which I have co-written before. Since maternal mortality among women living with HIV is still so very high, especially in sub-Saharan Africa, it is critical that we have a Global Plan which works for women as well as for their children.

According to UNAIDS, over 40 percent of maternal deaths in some hyper-endemic countries are attributable to AIDS-related illnesses. Despite these extraordinary figures, sessions on HIV and AIDS still play a rather minor role in this conferences, and this was reflected by a rather sparsely populated hall for this session, despite the presence of such great advocates for women’s rights as politician and lawyer, Dame Carol Kidu of Papua New Guinea, UNAIDS Ambassador Crown Princess Mette-Marit of Norway, Sia Nyama Koroma, the First Lady of Sierra Leone (who is also an organic chemist and psychiatric nurse), and Helena Nangombe a dynamic young AIDS activist from Namibia, one of the Women Deliver 100 Young Leaders.

During the panel, Jan Beagle put this question to me: “Alice, we have seen significant progress through the Global Plan but we know we need to do more. Can you tell us what you consider has worked and what needs to be improved, to ensure that the HIV and sexual and reproductive health and rights of women and girls are adequately addressed?

This is what I replied:

What has worked is a scientific revolution. It is fantastic that the science is there now for anti-retroviral medication (ARVs) to support women with HIV to fulfill our sexual and reproductive rights, including the right to motherhood, if we wish. When I was diagnosed with HIV in 1992, when I was expecting a baby, it was feared that I might die, because ARVs didn’t exist in those days and it was also feared that the baby would die. So I was advised to have an abortion. Many women of my generation with HIV had no children at all. So it is wonderful now to see younger women with HIV able to fulfill their dreams of motherhood, since with ARVs it is now possible to have 99 percent HIV-free births, even with a normal vaginal delivery. So this is a brilliant breakthrough and huge cause for celebration for us all.

In terms of what could be improved, I would like to focus on three areas today, namely language, care and support and safety.

Firstly, language matters. Just reflect – please read out the following words to yourself aloud: “blame, stigma, fear, prevention, violence, discrimination, sickness, death.” How did that feel? We are learning from neuroscientists now that very negative language increases cortisol levels in our bodies, which in turn make us feel stressed. We are also learning from neuroscientists that if we use positive language this increases levels of oxytocin and serotonin in our bodies, which both make us feel happier and more positive in outlook. From this springs feelings and thoughts of hope, opportunities and possibilities, which we can harness to “think outside the box” and create new ways of addressing old challenges.

So what has this got to do with the Global Plan? Well the Global Plan is made up of four “prongs”, about more of which below. I am afraid the very word “prongs” rather makes me squirm. It feels invasive, sharp, attacking, threatening, and reminds me of pitchforks and damnation, abortions gone wrong or impalement.

Presumably because they also preferred more positive language, Anandi Yuvaraj and Aditi Sharma, the authors of an inspiring report from India last year, presented the Global Plan using the idea of four pillars instead of four prongs. To me the word pillars immediately invites an image of something strong, uplifting, bigger than us all, building up the best in us all, in all our societies worldwide.

So how does this shift of language play out in practice? Well the Indian report authors shifted the whole language of the Global Plan as follows. Instead of Prong 1 (which covers “preventing HIV among women of reproductive age”) the proposed “Pillar One: My Health.” Rather than Prong 2 (“Meeting unmet Family Planning needs of women with HIV”) they proposed “Pillar Two: My Choice.” They replaced Prong 3 (“Preventing HIV transmission to Infants”) with “Pillar Three: My Child.” And instead of Prong 4 (“Treatment, care and support for women and families”) they proposed Pillar Four: “My Life.”

Can you hear the difference? If not, just read that last paragraph out loud to yourself. If you were a woman living with HIV, which would you rather hear?

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House 20-Week Abortion Ban Hearing a ‘Farce,’ Says Leading Democrat

10:29 am in Uncategorized by RH Reality Check

Written by Sarah Posner 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 subcommittee of the House Judiciary Committee held a hearing Thursday on a bill that would impose an unconstitutional nationwide ban on abortions after 20 weeks post-fertilization. Four witnesses sat at the table during that hearing, but there was really only one person who mattered for the Republican lawmakers—whose aim, ultimately, is to outlaw all abortions. That person was Dr. Kermit Gosnell, the Pennsylvania physician now serving a life sentence for murder and manslaughter.

US Capitol Building

US Capitol Building

According to Rep. Trent Franks (R-AZ), chairman of the Subcommittee on the Constitution and Civil Justice, under whose jurisdiction the hearing was called, Gosnell is “not an anomaly in this gruesome Fortune 500 enterprise of killing unborn children.” The rogue doctor, who was roundly denounced by pro-choice activists as soon as the horrific conditions of his clinic came to light, is, for Franks, “the true face of abortion on demand in America.”

Using Gosnell as justification, Franks has retooled his proposed “Pain-Capable Unborn Child Protection Act”—previously introduced as a measure specific to Washington, D.C.—to apply to all 50 states. A D.C. 20-week ban has also been introduced in the Senate, although it is highly unlikely to come up for a vote.

If all abortion providers were like Gosnell, of course, they could be prosecuted under existing criminal laws, as Gosnell was. But they’re not—and that’s why House Republicans want to create a way to prosecute them. The Pain-Capable Act would subject doctors who perform abortions after 20 weeks to criminal prosecution, jail time, and monetary penalties. It would provide a cause of action for a woman who has an abortion after 20 weeks of pregnancy—or her husband, boyfriend, or one-night stand, as well as her family—to sue the doctor, including for punitive damages.

By pegging the gestational time-limit to disproven claims about fetal pain (which medical experts agree is not possible before the third trimester), the bill would lay the basis for limiting abortions even earlier in pregnancy, based on even more questionable science, as demonstrated at Franks’ hearing.

Maureen Condic, a University of Utah scientist who also opposes embryonic stem-cell research, testified that it is “uncontested that a fetus experiences pain as early as eight weeks.” By continually arguing that fetal pain is experienced far earlier than the established medical evidence, Condic did provide proof of something else: that Republicans’ ultimate goal is to outlaw abortion far earlier than 20 weeks.

The bill proposed by Franks contains no exceptions for the health of a woman who needs an abortion after 20 weeks, raising the specter of a woman (or the parents of a minor) suing a doctor who, in an emergency, saved her from horrific health consequences. It also provides no exceptions for rape or incest. The woman, the man by whom she is pregnant, or the woman’s family members could even seek a court order barring the doctor from performing abortions in the future.

Another of the Republicans’ three witnesses, anti-choice activist Jill Stanek, claimed that the Gosnell case is “evidence that the lines between illegal infanticide and legal feticide, both via abortion, have become blurred.”

By equating Gosnell’s criminal activity with all abortion, Franks and his supporters attempt to elide the fact that their bill is patently unconstitutional, as Rep. John Conyers (D-MI), noted. Just this week the Court of Appeals for the Ninth Circuit struck down a similar law out of Franks’ home state of Arizona.

Franks’ obvious aim is to test that conclusion, by forcing yet another legal challenge to Roe v. Wade. But he also seeks to enhance his position—at least in the court of public opinion—by attempting to persuade the public that if Gosnell, who performed illegal abortions and killed infants born alive, was found guilty of murder, all providers of abortion services must be similarly guilty.

Rep. Jerrold Nadler (D-NY), the subcommittee’s ranking member, strongly voiced his opposition to Franks’ claims. “[W]hat Dr. Gosnell did had nothing to do with abortion; it was murder,” Nadler said.

Calling the hearings a “farce,” Nadler noted that the Democrats, as the minority in the House, were not permitted by Franks to call more than one witness, while the three witnesses called by Republicans presented what Nadler called “false and misleading” medical evidence.

The one witness Democrats were permitted was Christy Zink, who recounted the heart-rending story of how she and her husband were informed during her 21st week of pregnancy that the fetus she was carrying had a lethal abnormality, agenesis of the corpus callosum. Zink said that if brought to term, her baby would have been born missing a part of its brain.

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Plan B Vending Machine Survives Anti-choice Misinformation Campaign

2:09 pm in Uncategorized by RH Reality Check

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

Plan B contraceptive wrapper

Plan B emergency contraception is available 24 hours a day via public vending machine at one college, much to consternation of anti-choice advocates.

A little more than a year ago, during the same week that the Susan G. Komen Foundation  announced that it would no longer provide funds to Planned Parenthood, Shippensburg University, a previously little-known state college in Pennsylvania’s Cumberland Valley, captured media attention throughout the United States. The sudden spotlight on Shippensburg came as a result of a decision administrators had made five semesters earlier — at the end of the fall 2009 term — to sell Plan B Emergency Contraception (EC) from a vending machine located in a remote corner of the campus.

According to Dr. Peter M. Gigliotti, Executive Director for University Communications and Marketing at Shippensburg, roughly 300 students a year had swiped their college IDs to obtain access to the machine in the two-and-a-half years it had been operating. Each was given an opportunity to confer with a counselor in person or by phone before inserting $25 to obtain Levonorgestrel, AKA Plan B, a medication that prevents fertilization, preventing pregnancy if taken with 72 hours of unprotected intercourse.

Gigliotti believes that someone on campus — he does not know if it was a disgruntled student, faculty member, or staff person — tipped off the press that Shippensburg had a Plan B vending machine and within hours the story was garnering headlines and energizing anti-choice and abstinence-only advocates across the country. “What we did by making Plan B available in a vending machine is very emotional for a lot of people,” he begins. “When the story broke we immediately received more than 1000 calls and emails. Right away it became clear to us that people were confused about what Plan B is and how it works. The largest number of contacts came from people who oppose Plan B on a moral or religious basis and they did not want to listen to facts. In their minds Plan B is an abortion and no amount of scientific information will change their minds. They told us that we were killing babies and were all going to go to Hell.”

In addition, impassioned callers berated college administrators, arguing that they were kowtowing to the demands of a misinformed student body, 85 percent of whom had previously indicated — through a 2008 student survey — that they wanted on-campus access to the drug. “My ‘favorite’ email asked us if we would give dynamite to our students if 85 percent of them wanted it,” he laughs. “It was absurd. What they failed to recognize is that Plan B is legal and available in most pharmacies, without a prescription, to anyone who is over the age of 17.”

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What’s Up With Women and HIV-Prevention Method PrEP?

2:52 pm in Uncategorized by RH Reality Check

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

"You are either affected or infected with HIV."

Why did a study show women had difficulty using a new HIV prevention drug?

At the 20th Conference on Retroviruses and Opportunistic Infections (CROI) in Atlanta this week, researchers reported that, in a large scale trial among African women, neither oral Pre-Exposure Prophylaxis (PrEP) nor the daily use of vaginal gel containing an anti-retroviral (ARV) drug had shown effectiveness in reducing HIV risk.

The clinical trial, Vaginal and Oral Interventions to Control the Epidemic (VOICE), enrolled 5,029 HIV-negative women and randomized them into five study arms. In one group, women were asked to take an oral tenofovir (an ARV tablet) daily. In a second arm, women tested the daily use of oral TDF/FTC (a two-ARV combination called Truvada), and in the third, women were asked to insert a vaginal gel containing 1 percent tenofovir gel that had been shown in a previous study to provide moderate protection against HIV.

The fourth and fifth arms were placebo controlled; women received either a pill or a gel that looked identical to the study products but contained no active ingredients. Comparing the rate of new HIV infections occurring among women in the control arms with those of women in the various intervention arms allowed the researchers to see if the use of the interventions reduced women’s rate of HIV acquisition. Participants in all arms were also regularly provided with free condoms, counseling about the need to use condoms consistently, and testing and treatment for sexually-transmitted infections (STIs) to reduce their HIV risk to the greatest extent possible.

Despite the fact that other trials of oral PrEP have shown some effectiveness in women, none of the VOICE interventions resulted in decreased HIV acquisition rates. Dr. Jeanne Marrazzo, co-principle investigator for the VOICE study, reported in her presentation at CROI that it appears relatively few participants in intervention arms of the trial actually used the products daily as instructed. By testing blood samples for the presence of the ARVs in the body, the researchers saw that only 25 to 30 percent of the women were using the products as instructed. A similar lack of adherence to daily product use also led to discontinuation of the FEM-PrEP trial in 2011.

The VOICE results are particularly frustrating and sad because of the high rates of new HIV infection that occurred among women in the trial. Even with the benefits of medical care, free condoms, condom counseling, and more, the rates were high — 6.3 percent among women in the oral tenofovir arm, 4.2 percent in the placebo oral arm, 4.7 percent in the Truvada arm, 5.9 percent in the tenofovir gel arm, and 6.8 percent in the placebo gel arm. The researchers reported that the greatest number of new infections occurred among women who were under the age of 25 and unmarried. The rate of women becoming HIV positive was less (although still high) among women who were over the age of 25, married, and/or who had partners over the age of 28. This pattern is prevalent globally. Even in the United States, younger women are at greater risk of HIV than their older cohorts.

This is also frustrating because we know that PrEP works when people use it. Data demonstrating this led to the Food and Drug Administration’s approval of Truvada for HIV prevention in the United States last year. In a 2010 study called iPrEx, Truvada reduced HIV risk among men and transgender women who have sex with men by 44 percent. Data from this study suggested that participants who took the drug strictly according to schedule and did not miss doses were up to 73 percent less likely to become infected. Adherence is a challenge across the board, however. About 50 percent of iPrEx participants were estimated to be adherent to the study protocol.

Other studies enrolling both women and men have also produced encouraging effectiveness data. In Partners PrEP, a study enrolling couples in which one partners was HIV-positive and the other was HIV-negative, effectiveness was shown to be 75 percent and adherence was estimated at 80 percent. The Centers for Disease Control and Prevention’s (CDC) TDF trial also showed adherence of about 80 percent, and the HIV risk of participants using the product was lowered by 63 percent.

So why is it that the two studies conducted exclusively among women did not yield evidence of effectiveness, when other studies enrolling both women and men did? What are the barriers to adherence that result in women finding themselves unwilling or unable to use this intervention daily? No answers to these questions are immediately apparent, although both the VOICE and the FEM-PrEP data are being further analyzed to look for clues.

If PrEP works for women (and men) when they use it, then why don’t women use it? Finding these answers will likely require additional research into the structural and cultural factors that shape behavior, perceptions of risk, and decision-making about sexual and health issues.

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