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Improving Abortion Access, Bringing Health Care Home

12:11 pm in Uncategorized by RH Reality Check

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

This piece is part of the Echoing Ida project, cross-posted with permission from Strong Families.

Toni Atkins

Toni Atkins of San Diego is part of a movement to increase abortion access.

Each time I take a road trip down California’s magnificent highways, I can’t help but think of the dozens of people who have stayed in my home while in the Bay Area for an abortion. I pass the road signs indicating the off-ramps for Modesto, Los Banos, and Humboldt thinking fondly of the friends I made, but sad about how far they had to travel for their abortions.

For over a year, I have served as a Practical Support Volunteer for ACCESS Women’s Health Justice; I house, prepare dinners for, and give rides to people staying in the Bay Area for an abortion procedure. They come by bus, train, and sometimes car, traveling for four-to-five hours at a time, because access to abortion procedures near their hometown is lacking. They come because they didn’t realize they were pregnant until it was past the gestational limit and the clinic nearest to them couldn’t perform the abortion. They come because the time they took to thoughtfully consider all their pregnancy options meant their procedure would cost more.

They come because the clinic closest to them shares an abortion provider with several other clinics and it could be a while before they can get an appointment. They come because while they were working and saving money to pay for an abortion, they crossed a gestational threshold and now must find more money for a more expensive procedure. They scrimp and save to take off more time from work to travel for what was a one-day, but is now a two-day procedure; get someone to cover a work shift; ask someone to watch their children; and, if they’re able to, find a supportive friend or partner to join them as they travel across the state to a city they’ve never been to … all for health care.

When my friends stay in my home, we sit on the couch and talk over dinner. We talk about how far they’ve traveled, their lives back home, their beautiful children, and what the next couple of days might look like. They often ask me why they couldn’t have an abortion in their own towns, where their support people could accompany them and hold their hands, where they would be able to go home the same day and tuck their children in at night after the procedure. Until now, I didn’t have an answer for them. But now that answer is waiting for a vote and a signature. The answer is California’s Early Access to Abortion Bill.

Earlier this year, assembly member Toni Atkins (D-San Diego) introduced AB 154, a bill that would increase the number of abortion providers, by allowing trained certified nurse midwives (CNM), nurse practitioners (NP), and physician assistants (PA) to provide early abortion care. This means that more people, especially in rural areas, will be able to have access to comprehensive abortion care earlier in their pregnancies, which would help reduce the rate of complications, bring down the cost for the procedure, and allow a patient to get the care they need closer to home. Many people don’t know that almost half of the counties in California don’t have an accessible abortion provider, and 22 percent of counties don’t have a provider at all. This creates an additional hardship on those in rural areas who have to travel further for their procedures.

Recently, the University of California, San Francisco’s Bixby Center for Global Reproductive Health conducted a multi-yearlong study in which they trained and evaluated CNMs, NPs, and PAs as they performed first trimester abortions alongside the doctors performing the same procedure—the outcomes were the same. With 92 percent of abortions in the United States occurring within the first trimester, the bill would reduce barriers and increase access for the majority of people seeking abortion care. AB 154 is legislation that supports the needs of our communities.

In the United States, 6 in 10 people having an abortion are already parenting a child, while 3 in 10 have two or more children. In the evening, I often hear clients making phone calls, putting their children to bed, telling them how much they love them. “Don’t worry,” they say, “I’ll be home to put you to bed tomorrow.” Wouldn’t it be nice if they could get the care that they need and be home in time to kiss their children goodnight? Instead of having to leave their families and travel five hours for a simple medical procedure, imagine if care were provided in their own hometown. I was fortunate—my abortion provider was a 15-minute ride from my house. I felt safe knowing that I wasn’t far from my home and I would be able to rest in my bed with my family nearby soon after the procedure.

The Early Access to Abortion bill is model legislation that will put patients and families first and contribute to healthy communities.

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How Having an Abortion in Texas Strengthened My Fight for Reproductive Rights

12:32 pm in Uncategorized by RH Reality Check

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

Texas Capitol Protest

Getting an abortion in Texas was an eye-opening experience for this pro-choice writer.

When I decided to come to Austin for a summer internship with NARAL Pro-Choice Texas, I knew I was signing up for an interesting few months. Although I had been working in the field of reproductive rights throughout high school and college, I was raised in Oregon—the only state in our nation that has yet to pass abortion restrictions in the 40 years since Roe v. Wade. And I attend college in New York, a state where there are no abortion restrictions prior to the 24th week of pregnancy. Before June, I had never been to Texas, let alone to the South.

I had read about the shaky state of reproductive rights in Texas, but I did not anticipate that I would be fighting tooth and nail with anti-choice legislators attempting to hastily and unfairly pass some of the most extreme and draconian abortion bills in the country during a special session, with the two-thirds rule conveniently suspended. I did not anticipate having to beg privileged legislators through my public testimony not to violate my privacy in their attempts to “help” me by doing what they think is best for me. (These legislators ultimately cut off my microphone and walked out on my testimony mid-sentence.)

And at 20 years old, entirely alone in a new city, I certainly did not anticipate having an abortion myself.

I found out I was pregnant on the first day of my internship. Contrary to common rhetoric, my choice to terminate my pregnancy was not the most difficult decision I have ever made, although don’t mistake this for carelessness. I had thought through this scenario before and was sure of my choice before I ever needed to be. Nevertheless, the process of having an abortion was, indeed, quite difficult—Texas law made sure of that. I knew Texas’ abortion restrictions: a 24-hour waiting period, a medically unnecessary sonogram, and a slew of propagandized literature lacking medical evidence. With the follow-up exam, that’s three visits to the clinic. These were all things I would have avoided in Oregon or New York, but doable for me, only because I had some money and my family’s support.

As I entered the clinic parking lot, I was greeted by a few protesters—all white, male, with Bibles in hand—attempting to shame and scare me in a moment when I most valued my privacy. I recall sitting in the NARAL office on the day before my procedure—the day after I’d sat through hours of heated public testimony on SB 5—when our office received a call from the very clinic where I had my appointment, alerting us to the aggressive presence of anti-choice protesters and the desperate need for clinic escorts. I had to excuse myself and went into the parking lot, where I sat behind a car and cried. I was terrified. I had previously thought about what it would be like to have an abortion, and I knew that, for me, it would be difficult. But, naturally, I had expected it would happen in Oregon or New York and, thus, be difficult because of whatever personal reasons, not because I would have to run the gauntlet of aggressive protesters.

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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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New Texas Law Unfair, Increases Inequality

1:21 pm in Uncategorized by RH Reality Check

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

Read all of RH Reality Check‘s coverage of the recent fight for reproductive rights in Texas here.

El Paso downtown

Women in communities like El Paso will find it much harder to receive reproductive health services under #HB2.

There will be many, many pixels spent on the ramifications of the new law in Texas, signed by Gov. Rick Perry on Thursday, a law set to close most of the abortion clinics in the state. I’ll spill some myself, and already have. What I want to address is the larger theme of the anti-choice movement that the Texas decision really brings to the forefront: The profound commitment to unfairness and inequality that holds the anti-choice movement together. Not just between men and women, though it’s certainly true that subjecting those with a uterus to state control over their reproductive organs contributes to that inequality. The anti-choice movement and their goals are unfair on every level, and the Texas decision shows that.

1) Inequality by geography. The anti-choice movement’s strategy of attacking abortion rights on a state-by-state basis may have been the expedient choice—it’s much easier to get largely unpopular abortion restrictions passed through state than national politics—but it’s also one that creates massive gulfs in access based on nothing more than geography. Even though all Americans are supposed to be equal in the eyes of the law, laws like this mean some Americans can’t easily get to an abortion clinic while some have all the access they need. This was already true for a lot of Texans compared to, say, New Yorkers—the anti-choice climate plus the huge swaths of rural land without much in the way of abortion access made sure of that—but this law will dramatically deepen the disparity between who and who does not have realistic access to their abortion rights.

In other words, Texas politicians just targeted their own people for the removal of rights, or at least realistic access to those rights. It’s not New Yorkers or Californians that will have to scrape together hundreds or even thousands of dollars to get access to a safe, legal abortion. It’s Texans, and for no other reason than the accident of geography. To make it worse, this disparity will happen within the state, too, as people who live in the urban areas around Austin, Houston, San Antonio, and Dallas will have clinics relatively close, but those who live in West Texas will have nothing.

2) Inequality by wealth. What that means, of course, is that the already-existing gaps of access between women of means and those without will get much worse. It’s a struggle for working class and low-income women to get any kind of health care; it’s a struggle for them to get an abortion even if there’s a clinic right down the street, because you still have to come up with $300-$600 to pay for the procedure. Now it’s just going to get worse, as many women will have to drive—or fly, because it’s really that far away now—hundreds of miles to get to clinic. Or worse than that, because the five remaining clinics won’t be able to handle the abortion demand, so women will have to look outside of the state, or even halfway around the country.

For women with means, being able to take an “abortion vacation,” perhaps flying to New York City for an abortion and staying in a hotel—maybe go see some sights while you’re there!—will be totally doable. For those who can’t just afford to drop a couple of thousands of dollars and take the time off work, that will be an impossibility. No wonder there’s an already existing black market in abortion pills, one that’s expected to grow after this law goes into action.

3) Unfairness to taxpayers/inequality in movement funding. One of the most under-discussed issues here is that the anti-choice movement is basically redirecting necessary tax revenues needed for things like education and infrastructure to fund their movement. Texas passed a law that is in direct violation of the “undue burden” clause of Planned Parenthood v. Casey. That means that the legislators opened up the state to a lawsuit, but it’s going to be an extremely expensive one, almost surely running into the millions of dollars. All the lawyers working to defend this law? Paid for by the taxpayers of the state of Texas.

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‘What Kind of Abortions Are We Willing to Let Texas Women Have?’: An Expert’s Testimony Against SB 1

12:15 pm in Uncategorized by RH Reality Check

The following is invited testimony on Texas’ SB 1, as given by Whole Women’s Health CEO Amy Hagstrom Miller to the state Health and Human Services Committee at the special senate hearing Monday.

Amy Hagstrom Miller

Madam Chairwoman and honorable committee members,

Thank you for inviting me as an expert witness for the hearing today. I appreciate the opportunity to lend my expertise to the committee, and I invite your questions. My name is Amy Hagstrom Miller, and I oppose these bills. I am the president and CEO of Whole Woman’s Health. We operate five licensed abortion facilities and one ASC [ambulatory surgical center] in the state of Texas.

In my testimony I will address four main issues:

  1. There is no safety problem related to abortion care in the state of Texas that this bill is addressing.

  2. The existing abortion facility regulations are rigorously enforced and are sufficient to ensure the health and safety of women in Texas.

  3. Medication abortion is safely offered in clinic settings and falls completely outside the scope of practice for an ASC.

  4. Requiring MDs to have admitting privileges is not equally enforced over other medical specialties, nor is it necessary to ensure the health and safely of Texas women seeking abortion care.

We have over 40 years of safe abortion on record in Texas, and the current regulatory system is more than adequate to ensure women’s health and safety. The ASC requirements put forth in this bill are unnecessary and completely unrelated to patient safety.

Abortion facilities in Texas are licensed, inspected, and highly regulated. We operate safe and professional facilities all over this state, and the ASC requirements will not improve care, but rather reduce access for women in Texas and put more women at risk for later term abortions or for illicit abortions outside the medical community. ASC regulations are primarily related to the physical plant and they do not make abortion any safer. While abortion is ethically, emotionally, and spiritually complex for many people, the fact is that it is medically simple. Abortion is provided by one MD and one nurse, it takes five to ten minutes, it is done under local anesthesia and optional mild sedation. Women get dressed and can walk on their own to the recovery room. There is no incision and an extremely low risk of infection. There is no need medically for the larger OR, the wide hallways, the additional airflow system, the regulated humidity, the locker rooms/showers, and janitor closets. ASCs are simply not needed for safe abortion care.

This bill also puts forward a radical restriction for the abortion pill—a simple set of medications women take to induce miscarriage, usually before there is even a fetus. This bill would require that medication abortion be offered only at a surgical center and that women be required to come in for no less than four face-to-face visits with the physician in order to take the pill. This is totally uncalled for medically. Why would it be in the best interest of Texas women to place any additional restrictions on their access to safe, early abortions? Restrictions on medication abortion should be removed from this bill completely.

Finally, I wish to address the requirement for all MDs providing abortion care to have admitting privileges at a hospital within 30 miles of the ASC. Abortion is one of the safest procedures in medicine—it is [14 times] safer than full-term childbirth and with a complication rate of .05 percent. Abortion providers rarely have transfers to or admissions into hospitals for their patients. The current system we have for abortion facilities in Texas works very well and ensures safety for the women we serve. No other MD providing day surgery at an ASC is required to have admitting privileges—the ophthalmologist, the orthopedist, the gynecologist. The current ASC regulations in force statewide and across specialties requires MD to have privileges or have a transfer agreement with a local hospital. This system is perfectly adequate to care for women seen in ASCs of a variety of surgeries across specialties.

In conclusion, let me remind you that abortion didn’t start with Roe v. Wade; safe abortion started with Roe v. Wade. Women have always had abortions, and Texas women will still need access to abortion if you pass this bill. The issue at hand here is what kind of abortions are we willing to let Texas women have? This bill is specifically crafted to reduce women’s access to abortion in Texas, plain and simple. It does nothing to prevent abortions or prevent unplanned pregnancy. It does nothing to change the need for abortion among Texas women. If these restrictions pass, thousands of women will be without proper care. I strongly oppose the passing of these bills and thank you again for hearing my testimony.

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Widely-Supported California Bill to End Shackling of Pregnant Women in Prison Faces Possible Veto

8:56 am in Uncategorized by RH Reality Check

Shackles photo: publik15 on flickr

Shackles photo: publik15 on flickr

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

This article is cross-posted with permission from Asian Communities for Reproductive Justice.

Over the past two years, I have worked alongside an amazing group of women to pass a common-sense bill for California moms. Assembly Bill 568 (Skinner) would limit the use of shackles on incarcerated pregnant women to the least restrictive restraints possible.

Translation: It would end the use of belly chains, leg irons, ankle restraints and other barbaric shackling devices that are used on pregnant women in jails and prisons across our state. Yes, shackles reminiscent of slavery are still being used on pregnant women as far long as 8 ½ months.

Medical professionals agree that it’s time for a change. The American Congress of Obstetricians and Gynecologists (ACOG) was so moved by this issue that they became co-sponsors of the bill. ACOG opposes the use of any restraints on pregnant women because it increases the risk of falling and leaving the pregnant woman, whose balance is already compromised, unable to break those falls. Read the rest of this entry →

Brownback Strips At-Risk Infants of Access to Health Care While Spending Millions on “Faith-based” Initiatives

12:07 pm in Uncategorized by RH Reality Check

Written by Kari Ann Rinker 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 State of Kansas has a health care crisis that it should be addressing, but instead the Brownback administration is tied up restricting women’s access to low cost birth control and abortion care. The crisis that I refer to is this fact according to the latest data from the Annie E. Casey Foundation:

Kansas dropped to 40th in the country in infant mortality, and to worst in the nation for African-American infant mortality, said Christie Appelhanz, vice president of public affairs of Kansas Action for Children in Topeka.

Ms. Appelhanz explains:

We have to invest in our kids. We need to be protecting the crucial supports — nutrition, early education, college savings — anything we can do to be sure kids are growing up healthy.  I think it’s important that children have access to food stamps, quality education such as Head Start and Early Head Start and workforce development.

Governor Brownback’s budget, which he unveiled in January 2011, drew much criticism due to drastic cuts proposed for Head Start in Kansas.  Their funding remained uncertain through the entire legislative session, until, after much public criticism it was finally restored.  But the problem doesn’t begin and end with Head Start funding.

This administration is also upending the Kansas Department of Social and Rehabilitation Services (SRS).  This agency is responsible for child protective services, child support enforcement, and child, adult and family well being services within the state of Kansas.  The state was on track to close 9 service centers, citing agency cost savings.  Public outcry has prevented one of those closures.  The City Council of Lawrence, Kansas has agreed to pick up the state’s tab and fund their own office to serve the most needy within their community. Yet, somehow the administration believes this agency can afford new and expensive “faith based initiatives” programs. For example, chief of staff Jeff Kahrs is making $100,000 a year in a new position. A deputy secretary leading a new faith-based initiative, Anna Pilato, is making $97,500.

They can also afford $13,000 closed door meetings to discuss their new push for faith programs within the state, where it was decided that polygamy is more in line with traditional values than same sex marriage.  Our Governor also is comfortable with applying for a $6.6 million dollar grant to promote marriage, while rejecting federal money for health care reform within our state and proceeding with the SRS office closures.   

Governor Brownback is promoting a “culture of life” from his mansion in Topeka and thinking of new ways to pimp out poverty stricken single mothers within the state while what we really need are healthy, empowered mothers, because healthy mothers lead to healthy children.  Health care, childcare assistance and educational opportunities should be the Governor’s focus.  Instead, the hypocrisy runs rampant and we wait for God and a big strong man to come along and save us from feminine handicap, meanwhile an increasing number of children are dying in the state of Kansas.

New Jersey’s Governor is Taking His Time on a Rape Kit Bill

9:12 am in Uncategorized by RH Reality Check

"Chris Christie"

"Chris Christie" Governor of NJ, by Marissa Babin on flickr

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

In March, the New Jersey State Senate overwhelmingly passed a bill to prevent sexual assault survivors from being charged for the rape kits used to collect forensic evidence.  The Assembly passed the measure in June. Months later, however, the bill remains “under review” on Governor Chris Christie’s desk prompting many advocates to ask what is taking him so long and some to start a petition demanding he take action.

Under federal law, health care providers must be reimbursed for the cost of these exams and the collection of evidence. They are supposed to look to government agencies for that coverage but bills are often sent to the assault survivor “due to administrative errors or attempts to get payment from a victim’s insurance company.”

The legislation that passed in New Jersey would prevent direct billing for any “routine medical screening, medications to prevent sexually transmitted infections, pregnancy tests and emergency contraception, as well as supplies, equipment, and use of space.”

Though it’s clear from his record (which includes “using a line-item veto to block funding in the state budget for clinics that provide family-planning services”) that woman’s rights and reproductive health are not a high priority for the Governor, it really is hard to understand why he’s dragging his feet on this bill.

April — An Abortion Bill A Day Keeps Voters In Play

6:39 am in Uncategorized by RH Reality Check

Written by Robin Marty for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

When you write daily about abortion laws and restrictions, a funny thing starts to happen.  It becomes so common place, you actually start to lose track of what really is happening.  Oh, don’t get me wrong, I can probably rattle off per state which ones are where in the process of passing each restriction, from “no taxpayer funding of abortions” to “fetal pain” to the ones that are actually trying to ban the whole thing.  I can give you a list of which states have constitutional challenges and which states are about to sue.

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