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“There is no medical justification for the FDA’s restrictions.”

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If you want to get Viagra in the United States, the process is pretty straightforward. You go to your regular doctor, she calls in a prescription to your local pharmacy, and you pick it up when it’s ready. With a few exceptions, this is how it works for most prescription medications.

But if you want the abortion pill, it’s a completely different story. For starters, you can’t get it at any pharmacy. Your regular doctor might be able to prescribe and dispense it to you, but you probably won’t be that lucky. You might be so unlucky that the nearest doctor who can actually prescribe you the medication is 150 miles away, which means you’ll spend hours on the road and possibly stay overnight. And if you’re really unlucky you might live in Hawaii, where those 150 miles include an ocean.

This last scenario is all too familiar for Graham Chelius, a family medicine doctor in Kauai, Hawaii. Kauai has no abortion clinics, and Chelius says he wants to be able to prescribe medication abortion so his patients don’t have to waste precious time and money booking a flight to the next island with a clinic.

But his hands are tied due to restrictions the Food and Drug Administration has placed on mifepristone, also known as RU-486, a drug that induces miscarriage in pregnancies up to 10 weeks along when taken with the drug misoprostol. Patients can’t get the medication from a retail pharmacy; they can only get it from a clinic, medical office, or hospital. Not only that, but the medical facility dispensing mifepristone has to register with the drug manufacturer in advance, and agree to order and stock the medication on-site.

These are major administrative burdens that many medical facilities just don’t want to bother with—and being added to a list of abortion providers can cause political headaches and fears of anti-abortion harassment. In Chelius’s case, he is unable to stock the medication because of his colleagues’s opposition to abortion.

So Chelius is suing the FDA, with the help of the American Civil Liberties Union, to try to force the agency to lift the restrictions and allow mifepristone to be distributed at pharmacies. If the lawsuit succeeds, it could dramatically transform early abortion access in the United States.


“This case isn’t the only one—nationally, the federal government is obstructing young immigrant women’s access to abortion. It’s blatantly unconstitutional, not to mention unconscionable.”

On Friday, the American Civil Liberties Union (ACLU) filed a second emergency action on behalf of Jane Doe, an unaccompanied immigrant minor being “held hostage” by the Office of Refugee Resettlement (ORR), after a district court on Wednesday denied a request for a temporary restraining order that would have allowed the teen to access an abortion.

As Rewire reported, ORR, the federal agency overseeing migrant youth in the United States after crossing the U.S.-Mexico border alone, has repeatedly stripped the teen of her right to access abortion care by preventing her from going to the clinic.

A Texas judge granted the teen a judicial bypass, allowing her to obtain an abortion without receiving consent from her parents. However, the 17-year-old had to cancel two appointments because ORR officials refused her transportation to the medical facility and refused to allow her to leave the shelter with her guardian for the purpose of obtaining an abortion. Under the law, ORR must provide transportation to minors when they need to go to court or see a doctor.

The ACLU’s Reproductive Freedom Project, which sought the temporary restraining order on Jane Doe’s behalf, called the Wednesday ruling a “serious disappointment.”

“The denial of abortion care and basic human rights by this Administration will not go unanswered: the ACLU will continue to pursue all avenues to get justice for Jane Doe and young women like her,” a statement from the organization read.

The teenager’s case highlights the difficulties of accessing abortion care in Texas—where few clinics remain, mandatory counseling is required by the doctor who will perform the abortion, and minors must either obtain parental consent or a court waiver—and, importantly, what advocates refer to as a “sea change” under the Trump administration.

“The Trump administration’s action is shocking—a young woman is essentially being held hostage and forced by federal officials to continue a pregnancy against her will,” said Brigitte Amiri, senior staff attorney with the ACLU Reproductive Freedom Project. “And this case isn’t the only one—nationally, the federal government is obstructing young immigrant women’s access to abortion. It’s blatantly unconstitutional, not to mention unconscionable.”

Historical Context

While pregnant people in the immigration system have long-encountered barriers to accessing health care, advocates say Jane Doe’s case is a harbinger of the “anti-choice fanaticism” working its way into the immigration system since Trump’s presidential inauguration.

In response to the September 11, 2001 attacks on the United States, then-President George W. Bush signed into law a sweeping Homeland Security Act, which restructured the U.S. immigration system, reconfiguring the Immigration and Naturalization Service and creating the Department of Homeland Security (DHS). As part of the law, ORR began caring for immigrant and refugee minors under the Department of Health and Human Services.

Susan Hays, legal director for Jane’s Due Process, an organization that provides legal representation to pregnant minors in Texas, including 17-year-old Jane Doe, told Rewire that the reshuffling of immigration agencies under Bush is part of the reason Jane Doe can’t access abortion. Under his administration, the rights and reproductive autonomy of minors held in shelters were handed off to different parties.

“Under Bush, social workers working with minors [in ORR shelters] could make legal decisions because the shelters had legal custody of the minors. But after two social workers helped an unaccompanied immigrant minor obtain an abortion, it really upset the Catholic-run shelter where they were employed and where the child was housed,” Hays said. “In response, Bush changed who has custody of minors.”

Now, Hays added, “ORR has legal custody and the shelter has physical custody, so shelter workers can’t consent to things like abortion. It’s made everything much harder. [So] we have to go to court.”

The legal director told Rewire it has been her experience that shelter workers where Jane Doe is housed “are horrified” by what is happening to her. But not all shelter workers may feel empathy toward Doe. The federal government grants millions of dollars each year to religiously affiliated organizations that refuse to allow young women access to abortion.

An “added layer,” Hays says, is that a bulk of these young women are pregnant as a result of rape that occurred in their country of origin or on their journey to the United States. Brigitte Amiri, who is working on Jane Doe’s case on behalf of the ACLU, told Rewire that she’s seen estimates as high as 60 percent for the number of minors raped en route.

In June 2016, the ACLU filed a lawsuit against the federal government for funding organizations that provide care, including access to medical care, to unaccompanied immigrant minors because the government allows these organizations “to refuse on religious grounds to follow the law that requires them to provide these young people with access to contraception and abortion, even if the minor has been raped,” the ACLU reported. Last week, the ACLU attempted to add Jane Doe to the existing lawsuit, but “a judge ruled that although the government had no justification for blocking the abortion, Doe’s case needed to be filed in a separate suit in a different court,” according to the ACLU.

Who is being granted millions of dollars to deny minors access to health care? These are organizations like the United States Conference of Catholic Bishops, which has been awarded upwards of $10 million to care for immigrant minors, despite the religious institution’s refusal to allow young people to access abortion services.

The government is failing unaccompanied immigrant minors, explained Amiri.

“The federal government has a legal obligation to provide day-to-day care for these minors, including shelter, clothes, food, and medical care. The federal government has been allowing religiously affiliated entities to impose their religious opposition to reproductive health care on unaccompanied immigrant minors in their care. There have been multiple stories of young women getting kicked out of these religiously affiliated shelters just for requesting an abortion after having been raped,” Amiri said.

“Part Handmaid’s Tale, Part Nazi Doctor”

Under President Donald Trump, conditions for pregnant people in ORR custody have only worsened.

In March 2017, the Trump administration implemented a revised policy “that allows [shelters] to wield an unconstitutional veto power over unaccompanied immigrant minors’ access to abortion,” according to court documents. This directive explicitly prevents unaccompanied immigrant minors in their care from obtaining abortions by prohibiting all federally funded shelters from taking “‘any action that facilitates’ abortion access to unaccompanied minors in their care without ‘direction and approval’” from ORR director, Scott Lloyd.

In an email from then-ORR director Kenneth Tota, obtained by the ACLU and included in court documents, Tota wrote that “grantees should not conduct [abortion] procedures, or take any steps that facilitate future [abortion] procedures such as scheduling appointments, transportation, or other arrangements without signed written authorization from the ORR Director.” Similar sentiments have been made by Trump appointee Lloyd, who wrote that “[g]rantees should not be supporting abortion services pre- or post-release; only pregnancy services and life-affirming options counseling.”
Tota’s memo was spurred by news that another minor at a contracted shelter had begun a medically induced abortion the day before. In his letter, Tota directed office officials to attempt to save the pregnancy.
Hays told Rewire this involved blocking the teen from taking the second pill associated with the abortion, transferring her to an emergency room, and forcing her to undergo a gynecological exam to see if the pregnancy was still viable.

The girl eventually received the second pill, but after her ordeal, an email from the ORR director said that “effective immediately,” shelter operators must send word whenever a girl expresses interest in ending her pregnancy. On March 14, the new Trump-appointed ORR director, Lloyd, wrote his staff, “Often these girls start to regret abortion, and if this comes up, we need to connect her with resources for psychological and/or religious counseling.”

The notion that the majority of patients will regret their abortion is a common refrain among the anti-choice movement, and one that is not based on scientific research.

Hays sees Lloyd as “an incredibly troubling figure,” ushering in “anti-choice fanaticism” that is “part Handmaid’s Tale, part Nazi doctor.”

“They’re treating immigrant girls as their breeding stock. Can you imagine fleeing violence in your country, walking across the entirety of Mexico, getting raped, and then having this white man in a suit show up and try to tell you he knows what’s best for you?” Hays said. “Did I mention that we have multiple instances in which Scott Lloyd is using taxpayer money, using the power granted to him by the federal government, to personally fly to Texas and ‘counsel’ minors about their pregnancies? He is trying to impose his religious beliefs on pregnant immigrants, a bulk of whom are pregnant as a result of rape. In all of my years doing this work, I have never heard of such disgusting overreach. This is beyond the pale of anything the government has ever tried to do as it relates to abortion and immigrants.”

In another email, Lloyd told his staff “the unborn child is a child in our care,” implying they were to make medical decisions accordingly. The following month, in April, Lloyd instructed ORR deputy director, Jonathan White, to ensure that another minor in custody, this time in Arizona, get an ultrasound and counseling at Choices Pregnancy Centers, a crisis pregnancy center, which comprise almost all of the approved counseling centers listed by the ORR when minors are requesting abortion care.

None of this is a surprise if you take a look at Lloyd’s resume. Before becoming ORR director, Lloyd was an attorney for the Catholic charity Knights of Columbus and served on the board of the Front Royal Pregnancy Center, itself a crisis pregnancy center. Crisis pregnancy centers are known to mislead or outright lie to patients about abortion. In a 2011 piece for the Center for Morality in Public Life, Lloyd wrote that “the defining event in an abortion, as we use the term in our common parlance and in medical settings, is the death of a human being who has not yet been born.” Under George W. Bush, Lloyd also advocated for a rule protecting health-care providers who oppose abortion on religious grounds during his time as a health and human services official.

Hays told Rewire that there was some understanding of what was coming down the pike when Jane’s Due Process began to hear “rumors” from various agencies about the shift occurring in ORR. Hays traced it up the line of command, where the Trump appointees began, and independently found that many of the troubling cases they began to hear about from unaccompanied immigrant minors in shelters could be tied to former HHS Secretary Tom Price before he resigned. Federal anti-choice officials working under an anti-immigrant administration have found a friend in Texas, a state that has led the way on anti-choice laws in the form of the omnibus anti-abortion bill HB 2 and anti-immigrant laws like SB 4.

Texas Attorney General Ken Paxton said in a statement regarding Jane Doe’s case that the state has a “legitimate and substantial interest in preserving and promoting fetal life.”

“No federal court has ever declared that unlawfully present aliens with no substantial ties to this country have a constitutional right to abortion on demand,” Paxton said. “If ‘Doe’ prevails in this case, the ruling will create a right to abortion for anyone on earth who enters the U.S. illegally. And with that right, countless others undoubtedly would follow. Texas must not become a sanctuary state for abortions.”

“This Is What They’re Up Against”

Jane Doe, nearing the 20-week mark of her pregnancy, may soon be unable to access an abortion at all. Part of the problem may be where Jane Doe is sheltered: in Brownsville, Texas.

Because Texas law also requires parental consent or a judicial waiver before a minor may obtain an abortion, Jane Doe had to go to court with the assistance of an attorney and an appointed guardian and to obtain the necessary judicial waiver, further delaying her care. While the young woman has legal authority to obtain an abortion, the federal government now has stepped in to block her from being transported to a clinic. They instead required her to visit a crisis pregnancy center to undergo counseling to continue the pregnancy, and she was required to have a sonogram conducted by non-medical personnel against her will.

Hays said that historically, the reasoning stated for abortion restrictions was health and safety, but Texas’ HB 2 “blew that apart.”

“Medical data shows us that abortion is incredibly safe. In Texas, it’s safer to get an abortion than it is to give birth,” Hays said, referring to the state’s recent designation as having the highest maternal mortality rate in the developed world. “HB 2 made it so that there’s no need to pretend there’s this pretense concerning safety; now the government can simply express its preference for what women should do, and the state can say it has an interest in the unborn child. Running with that logic, there’s no end to the number of burdens and hurdles you can put up for women seeking abortion, especially minors and women in custody of immigration authorities.”

Unaccompanied immigrant minors leave their home countries, often fleeing abuse, torture, and violence, and come to the United States without their parents. Once the minor reaches the United States, the federal government provides day-to-day care for them until they are reunited with family here, are given some type of status, or are deported. The government—and government-funded shelters—are required by law to provide minors with access to the full range of medical care.

It seems that outright denying reproductive health care to immigrants in custody is becoming a trend under the Trump administration. In September, Rewire reported on another shift in policy, this time related to pregnant people in the custody of Immigration and Customs Enforcement (ICE).

Until very recently, ICE had a clear policy on how it treated women in the detention system: Girls and women between the ages of 10 and 56 were given pregnancy tests upon arrival at a facility. If they had a positive pregnancy test result, they were released from detention within 24 hours. While no new, formal policy has been made public, ICE now appears to be detaining pregnant people at the rate of one per day, according to advocates. Many of the detained immigrant women listed in a recent complaint were pregnant as a result of rape during their journey north. Since they have received inadequate medical care, they were not presented with abortion as an option, and in some cases have experienced complications in their pregnancy, including miscarriage.

Amy Fischer, the policy director at the Refugee and Immigrant Center for Education and Legal Services (RAICES), an organization that works with immigrant women who have been detained, told Rewire that access to abortion and access to reproductive health services need to be viewed as a right for migrants who have been detained, the same way that access to an attorney is viewed as a right. While not being aware of the specifics of Jane Doe’s case, Fischer explained that minors held in shelters do generally receive better treatment than women in detention centers, but the fact remains that girls and women in these facilities are a particularly vulnerable population “whose trauma is not being considered.”

“You have girls and women who are fleeing gender-based violence, sometimes from countries where abortion has been criminalized. They come from a place where you can’t trust government officials, and then they are often raped on their way here,” Fischer said. “This idea that this population of girls and women will then be able to comfortably ask for an abortion in a detention environment, where there are men with guns, is simply a joke. When they do find the courage to voice that they want an abortion, this is what they’re up against. What is happening to Jane Doe is not just horrifying and traumatizing for her, but it’s unlawful.”

RAICES has supported a number of women released from ICE detention who have wanted to move forward with terminating their pregnancy. Now, with ICE detaining pregnant people, Fischer said it is the agency’s responsibility to provide access to abortion, as outlined in the Performance-Based National Detention Standards’ section addressing medical care for women. The problem is that advocates are not at all confident that ICE, a federal agency known for human rights violations, is equipped to properly facilitate abortions.

“We don’t trust them as an agency to support women because they attempt to dehumanize and criminalize immigrants at every turn,” Fischer said. “There’s a difference between supporting a person and their right to terminate their pregnancy, and essentially criminalizing it and making it as hard as humanly possible for her to access abortion. The latter seems to be how ICE approaches it, and it looks like that’s ORR’s approach as well.”

Unaccompanied immigrant minors are typically not held in shelters for very long, but Jane Doe has been at the Brownsville, Texas, shelter for six weeks.

“I have to believe this is because she is pregnant and seeking an abortion,” Hays said. “She has relatives in the country and she could have been released by now. I’m fearful they are waiting until she surpasses 20 weeks. I’m fearful they are going to transfer her to another shelter so that we can’t find her. I’m fearful that should she be released after 20 weeks, she’ll walk across the bridge to a border town for an unsafe procedure that she had the right to access here [in the United States]. Our government is endangering the lives of immigrant women. We cannot allow this.”


Rhona Mahony of NMH says Eighth Amendment creates ‘unacceptable clinical risk’

The master of the Rotunda Hospital Dublin, Prof Fergal Malone has said one woman had died in recent years while travelling home from the United Kingdom due to complications following a pregnancy termination. *

Speaking to the Oireachtas Committee on the Eighth Amendment he said: “We are aware of at least one of our patients from Ireland who died following a complication from a surgical termination of pregnancy while travelling between Ireland and a centre abroad.”

“Forcing patients to travel between two jurisdictions, particularly when dealing with travel between islands, will inevitably increase the risks to mothers’ physical health and wellbeing” he said.

Dr Rhona Mahony, master of the National Maternity Hospital, has said the Eighth Amendment “makes no clinical sense” before the foetus is viable.

Dr Mahony said the Constitutional provision “creates unacceptable clinical risk and should be removed”.

“Prior to foetal viability, we do not have the option of delivering a foetus because the foetus cannot survive and if a pregnant mother dies her baby dies too.

“Therefore, prior to foetal viability this constitutional provision makes no clinical sense. However, its presence facilitates a real possibility that clinical decision-making may be delayed and distorted as clinicians ponder the law rather than medicine.”

On the issue of foetal anomalies during pregnancy, Dr Mahony said 60 women who attended the maternity hospital service in 2016 travelled to the UK for a termination of pregnancy. Her statement also outlined that 43 women who attended the maternity hospital service had travelled for a termination of pregnancy so far this year.

In her statement, she noted “the diagnosis of a major foetal anomaly and particular a foetal anomaly in which survival is unlikely after birth is a really difficult part of my job”.

The Eighth Amendment of the Constitution of Ireland recognises the equal right to life of the mother and the unborn child. A referendum on the matter is expected to take place next summer.

* Speaking to the committee earlier on Wednesday, Dr Abigail Aiken, assistant Professor from the LBJ school of public affairs, University of Texas, said through in-depth interviews, Irish women had described the methods they would have had to resort to or which others sometimes would have made them resort to through coercion, had online telemedicine or travel not been accessible.

Research and interviews she conducted with women who had used the Women on Web website service to order abortion pills online outlined several ways Irish women would attempt to induce miscarriages.

“Very unfortunately, these include coat hangers, starvation, high doses of vitamin C, strenuous exercise, large quantities of alcohol, scalding water, drinking bleach, throwing themselves downstairs or running into traffic.”

A case study was read out to the committee about one of the women interviewed in this process, Rebecca (39) a mother of two.

In it Rebecca said she was “walking up to 20 km every day. I was doing sit ups, I was doing squats. I was doing anything I could possibly do to make this happen…”
“I was actually reading pregnancy sites that warn you not to do things and everything they were warning you not to do was exactly what I was doing”

Fine Gael TD Kate O’Connell questioned Dr Aiken on whether she identified the presence of “abortion regret” among women who undergo a pregnancy termination, and Dr Aiken said she had not, but there was a lack of research into the issue.

Senator Ronan Mullen was critical of the “imbalance in those invited to address the committee” on the topic of healthcare and the Eighth Amendment.

Representatives from the World Health Organisation (WHO) also addressed the committee on Wednesday.

They recommeneded the Government ensure that abortion services were available all over the country and should be integrated into the national health system if the Dáil and the electorate decided to overturn the current general prohibition.

Dr Bela Ganatra of the WHO said the restriction on abortion led to women ordering abortion pills online, which “does not meet the criteria as what WHO would regard as safe”.

Abortion services,” the WHO recommends, “should be integrated into the health system to acknowledge their status as legitimate health services and to protect against stigmatization and discrimination of women and health-care providers.”

The WHO also says that if there are to be charges for the procedure, women who cannot pay should be able to access abortion services without charge.”

Values-clarification exercises

In the event of abortion being legalised in all or most circumstances, the health authorities will have to train health care providers in order to ensure provision of the procedure, and should also provide “values-clarification exercises”, the body says.

“In addition to skills training, participating in values-clarification exercises can help all health-care personnel differentiate their personal beliefs and attitudes from the needs of women seeking abortion services.

“Values clarification is an exercise in articulating how personal values influence the way in which health-care personnel interact with women seeking abortion. Despite health workers’ attempts at objectivity, negative and predefined beliefs about abortion and the women who have them often influence professional judgement and quality of care,” the WHO says.

Potential barriers

The WHO officials also warned that even where abortion is legal, there are potential barriers to accessing safe services. They can include:

–“Restrictive interpretation of legal grounds, including the conditions that fall under health;

–Failure to provide public information on the legal status and availability of abortion;

–Excluding coverage for abortion services under health insurance, or failing to eliminate or reduce service fees for poor women and adolescents;

–Requirements for third-party authorisations from one or more health-care providers, or from a hospital committee, from a court or police, from a parent or guardian, or from a woman’s partner or spouse;

–Restricting the range of health-care providers and facilities, which may result in poor availability of services, especially in rural areas;

–Conscientious objection, by health-care facilities and by health-care personnel;

–Requiring mandatory waiting periods;

–Censoring, withholding or intentionally misrepresenting health-related information, in the context of abortion;

–Failure to guarantee confidentiality and privacy; and

–Requirements for medically unnecessary screening tests (such as requirements for women to view ultrasound images or listen to the fetal heartbeat).”


Irish women could be blocked from travelling to Britain for an abortion if Brexit takes place, a leading doctor has warned, writes Fiachra Ó Cionnaith, Political Correspondent

Master of the Rotunda Hospital, Prof Fergal Malone, made the claim as he separately said “at least one” Irish woman died from complications after an abortion in Britain because after-care was not readily available due to the need to travel.

Speaking at the latest meeting of the cross-party Oireachtas eighth amendment committee, Prof Malone said if Britain leaves the EU its common travel area with Ireland will end.

This, he said, will mean “the most vulnerable” women could see their access to the British-based care significantly curtailed.

“I am concerned by the impact of Brexit,” he said, adding teenagers and Irish-based refugees could be among those directly affected.

Prof Malone said if abortion is not legalised in Ireland, it is vital to access to the British system – which has given terminations to as many as 184,000 Irish women since 1970 – continues.

However, he insisted the current situation where vulnerable women travel abroad for an abortion and as such do not always receive the necessary follow-up care is still falls far below what is required.

Citing a previously reported case of an Irish woman who died in January 2012 due to complications after receiving an abortion at the Marie Stopes clinic in west London, he said:

“We are aware of at least one of our patients from Ireland who died following a complication from a surgical termination of pregnancy while travelling between Ireland and a centre abroad.

“Forcing patients to travel between two jurisdictions, particularly when dealing with travel between islands, will inevitably increase the risks to mothers’ physical health and well-being.”

At the time the case was first reported on four years ago, then children’s minister Frances Fitzgerald said it was a “traumatic and dreadful outcome” that would be discussed under the 2013 Protection of Life bill debate.

Meanwhile, the eighth amendment committee meeting also heard master of Holles Street Dr Rhona Mahony join Prof Malone in calling for abortion to be legalised and WHO calls for Ireland to come out of “the dark ages”.

Dr Mahony said the eighth amendment “makes no clinical sense” and that the law “creates unacceptable clinical risks and should be removed”.

Both Prof Malone and Dr Mahony also raised concerns over the “chilling effect” the eighth amendment has on doctors but that there are ways of referring someone to Britain for an abortion without breaking the law.

They said last year 98 women from their hospitals travelled abroad for abortions after life-limiting conditions in their foetus were confirmed.

However, they stressed it would be inappropriate to give a specific list of allowable conditions or limit at what point in a pregnancy a woman can have an abortion as each case is different.

At an earlier hearing of the six-hour committee, WHO department of reproductive health and research officials Dr Ronald Johnson and Dr Bela Ganatra while they did not want to suggest Ireland is living in “the dark ages” it needs to consider abortion reform.

Separate research from University of Texas assistant professor Abigail Aiken said up to 184,000 Irish women have travelled to Britain for an abortion since 1970, and that the sale of online abortion pills has trebled since 2010.

Ms Aiken said 63% of women who contacted online abortion group Women on Web were already mothers and half were over the age of 34.


I’m a pediatrician. My patients need access to birth control.

A woman holds birth control pills in Washington in 2001. Tim Matsui/Getty Images

In 2012, the United Nations declaredaccess to contraception a “basic human right.” Last Friday, the Trump administration made moves to decimate women’s access to birth control — thereby continuing his administration’s war against women.

Last week, the Trump administration announced the rollback of an Obama-era requirement that employers to provide women with insurance that covers birth control. Under the new rule, employers can exempt themselves from this requirement for “religious or moral” reasons. Any employer, regardless of the business, can now opt out of covering contraception. If you are a woman, whether you have to pay for birth control out of your own pocket will soon be dictated by the religious and moral opinions of your employer.

As a pediatrician, I see how access to contraception improves patients’ lives. I have many patients who rely on it to prevent pregnancy so that they can finish their education. Parents of my younger patients also rely on contraception to ensure their pregnancies are planned. Some patients need birth control to regulate heavy or irregular periods. Access to birth control has been proven over and over again to be good not only for women’s health but also for the health of their families. Planned pregnancies result in healthier pregnancies and higher educational and economic attainment for both parents. But I am now worried that some of them won’t be able to afford birth control without health insurance coverage.

I remember taking care of a patient who wanted to try to use the contraceptive patch because she was worried she couldn’t remember to take the Pill every day. When she went to the pharmacy, she learned it was not covered by her insurance without prior authorization proving she had failed another method. Even with coverage under the ACA, the requirement was only to provide coverage for a method in each category, often leaving it up to physicians to determine which was covered for which insurance company. There was no way my patient would be able to pay for it out of pocket — the patch costs up to $55 a month without insurance coverage.

It took my office weeks of back and forth with the insurance company to provide sufficient documentation for her — and this all happened in the post-ACA world of health care, an overall improvement in birth control coverage. These bureaucratic and financial barriers will multiply and, for some women, become insurmountable under the new rules.

Of the 61 million women ages 15 to 44, 62 percent of them are using a contraceptive method. The importance of the ACA contraceptive coverage mandate is highlighted in data showing how many women benefit from this coverage. In just two years between 2012 and 2014, the percentage of women accessing the birth control pill — the most common form of contraception — without any cost rose from 15 percent to 67 percent.

Similar gains were found in other forms of contraception as well. And the results of this contraceptive coverage have spoken for themselves. There have been declines in both unplanned pregnancy rates and teen pregnancy rates nationally. The unplanned pregnancy rate declined 18 percent between 2008 and 2011. Research shows that these declines can be completely attributed to use of contraception, not people having less sex.

The Trump administration has asserted that Obamacare’s birth control mandate encouraged “risky sexual behavior” in young women. But no study has shown that access to contraception causes significant change in sexual behaviors. In fact, the largest studyexamining same-day access to all forms of contraception showed that while there were no changes in sexual behavior, rates of unplanned pregnancy and abortion dropped substantially. These are outcomes that our government should be seeking. Instead, the Trump administration has signaled that the religious and moral views of employers are more important than women’s human rights.

This change has the potential to affect all women of childbearing ages. Nine out of 10 women use contraception at some point. In fact, more married women use contraception than unmarried women. And plenty of religious women use birth control: 89 percent of women who identify as Catholic and 90 percent of Protestants report using some form of contraception.

Although four states have taken action to safeguard against continued efforts at the federal level, this leaves a patchwork of access throughout the rest of the country. Your contraceptive method will be covered while you live in one state, but take a job or go to another state that doesn’t have these protections and you may have to change contraceptive methods or start paying out of pocket for the method you’re using. Women require access regardless of where they live or work.

As a doctor, the health of my patients matters most to me — and this is a perfect case where the interests of my patients, especially women, are getting sidelined by political forces. And people will suffer as a result.

This isn’t just about women’s health. We have a right to have sex.

The average age of onset of sexual activity for both men and women is 17 years old in the United States, and that age has not changed substantially since the 1940s. What has changed is the average age that women have their first child and marriage — meaning there are more years to protect against an unplanned pregnancy. It seems clear that regulations around contraception do not affect whether people choose to have sex. It only makes it more unsafe and, in particular, forces women to navigate unnecessary obstacles to engage in normal human activity.

Women use birth control primarily to plan their pregnancies, but birth control is also used as a medical treatment for irregular or heavy periods, and as a preventive therapy for women with medical conditions that make pregnancy unsafe. In fact, 14 percent of women report using contraceptives for reasons unrelated to pregnancy planning.

The administration reasons that the Obamacare mandate places undue religious and moral burden on employers. But the religious objections of a boss do not supersede the importance of basic rights for women. The new religious exemptions allow employers to treat their workers differently simply based on their gender. It’s worth noting that during the Hobby Lobby controversy, the same Catholic groups that supported pulling coverage for birth control often covered the costs of drugs for men suffering from erectile dysfunction. (The ACA, however, does not require coverage of drugs for ED.)

In our health care system, financial access is everything

Studies show that fewer women will use contraception — and rely on less effective options — when it costs more out of pocket. A national survey done before Obamacare found that a third of women using a less effective contraceptive method, such as the Pill, would switch to another more effective method if they didn’t have to worry about the cost. Women who don’t use contraception or don’t use it reliably account for 95 percent of the unplanned pregnancies in the US. And the costs of unplanned pregnancy add up — studies have also shown that spending money on contraception is ultimately more cost-effective. In fact, for every dollar spent on family planning through Medicaid, $6 is saved in ultimate taxpayer costs.

But without coverage, birth control quickly becomes expensive. The most effective forms of birth control, long-acting forms of reversible contraception such as intrauterine devices, can easily cost over $1,000 out of pocket and are used for between three to 12 years. Even the birth control pill’s monthly cost of $20 to $50 per month will be a burden for most women. With the rollback in coverage, many women will rely on methods that are cheaper or less effective, or choose to use nothing at all.

Under Obamacare’s rules, many young adults are covered under their parents’ insurance plans long into their 20s. But after the rollback, it’s possible that their access will be determined by choices made by their parents’ employers. This is out of my patients’ control. When a patient’s parent was employed as a janitor at a small religious institution, her access to contraception was jeopardized. Although neither my patient nor her family had a religious objection to using birth control, the employer insurance plan did not cover it. Employers’ religious beliefs have no place in these private decisions.

The administration asserts that the government “already engages in dozens of programs that subsidize contraception for the low-income women” who are most at risk for unintended pregnancy. But the problem of unplanned pregnancies is not limited to the poor.

Currently 45 percent of all pregnancies in the US are unplanned, and that number is closer to 85 percent when you look at teen pregnancies. All women need access to contraception regardless of their socioeconomic status or place of employment. Moreover, in a remarkable act of cynicism, many of the programs for low-income women that the administration cites are facing funding cuts under Trump, including Planned Parenthood, Medicaid, and the teen pregnancy prevention program.

This new rule reflects a disturbing trend in both the Trump administration and the current Congress to dismantle women’s rights. The contraception coverage rollback does nothing to advance health, and the claims put forward to defend it are not supported by evidence. It’s a cruel, purely ideological gesture that will hurt real women — and the men and children in their lives.


In a victory for women’s rights, a demonstrator has been found guilty of breaching safe access zones in Victoria

International women's day march
 ‘The court’s decision is a victory for women’s rights, upholding the right to access health services free of intimidation or harassment and with due respect for women’s privacy, dignity and reproductive autonomy.’ Photograph: Joe Raedle/Getty Images

A14-year-old girl, scared and vulnerable, realises that she is pregnant. A 43-year-old unemployed mother of five whose husband is recently deceased discovers she is pregnant and does not know how she will cope with another child. A 36-year-old woman with a planned pregnancy is processing a diagnosis of severe foetal abnormality.

Each year many Australian women deal with problem pregnancies. Some decide to continue with the pregnancy and some decide to terminate the pregnancy. Whatever the decision, they have a right to seek unbiased professional counselling and appropriate medical care; and they have a right to do so without being harassed, intimidated or interfered with as they are entering a clinic that provides the full range of reproductive health services. This is why Victoria’s safe access zone legislation, which prohibits certain conduct within 150m of a clinic at which abortions are provided, is so important.

In the Melbourne magistrates court this week, anti-abortion protester Kathleen Clubb became the first person to be convicted of breaching Victoria’s safe access zone legislation when she approached a couple entering a clinic and attempted to hand them anti-abortion pamphlets. The 51-year-old mother of 13 and active member of the anti-choice group known as Helpers of God’s Precious Infants was found guilty of “prohibited behaviour” within a safe access zone outside the Fertility Control Clinic in East Melbourne and was fined $5,000. The court’s decision is a victory for women’s rights, upholding the right to access health services free of intimidation or harassment and with due respect for women’s privacy, dignity and reproductive autonomy.

A not-guilty verdict would have inevitably led to further testing of the parameters of the legislation, which would have seen patients and staff outside abortion clinics once again become the subjects of targeted harassment. We are all too aware of what that testing would entail, and the devastating effect it would have on patients and staff.

In recent months, we have been interviewing staff at Victorian clinics to gauge the effectiveness of the safe access zones. We have heard that before the zones were established, protesters would intrude into the personal space of patients and staff, block patients from exiting cars and bar entry to clinics or access along footpaths outside clinics.

They would display graphic imagery of dismembered foetuses, thrust brochures and foetal dolls into people’s hands and provide frightening misinformation about the consequences of abortion. Their unwelcome intrusions were described as a form gender-based vilification (comparable to racial vilification) and violence against women. The protesters created an atmosphere of stress and stigmatisation and made staff and patients feel unsafe. Their actions were particularly damaging for women with a history of sexual or physical violence or other vulnerabilities.

Anti-abortion protest action has created barriers to access, particularly in rural and regional areas. Some patients have delayed treatment or failed to attend follow-up appointments in order to avoid the protesters and some have continued with problem pregnancies because they have not been able to access the health care that they require. We have been told about doctors who stopped terminating pregnancies and health services that ceased operating because of the activities of anti-abortion protesters.

Safe access zones in Victoria have been operating to prevent protesters from targeting individuals. Protesters remain free to express their views about abortion, but at a distance from clinic patients and staff. Staff working in clinics have described safe access zones as an acknowledgement of women’s equality and autonomy and the need to address gender-based vilification and violence against women.

Victoria’s safe access zones legislation protects rights which have been undermined by anti-abortion protesters with impunity for decades. It is clear that Clubb and the Helpers of God’s Precious Infants oppose the legislation and its operation. For others contemplating anti-abortion protest within a safe access zone, Magistrate Luisa Bazzani’s decision has sent an important message of deterrence. It is to be hoped that the four Australian states who have yet to introduce such protective measures will act to prioritise women’s right to health, privacy and dignity and will introduce safe access zones in the near future.


This bill is a moral and scientific atrocity. Call your senators and tell them to vote No.

“Congressperson, I am your constituent. May I have an abortion?”

Said no one ever.

Our state representatives are practicing medicine without a license. They do not even have the smallest amount of training, and I am certain they have never attended a medical school class.

Yet, in supporting a national 20-week abortion ban, they are telling doctors what may or may not be done regarding evidence-based medicine. Imagine your congressperson telling your surgeon which approach to use when taking out your gallbladder—laparoscopic or open. As a surgeon myself, I have asked other ob/gyns for advice regarding surgical approaches, but never have I sought an opinion from any of my state legislators.

The Senate will be voting on the Pain-Capable Unborn Child Protection Act, a misnomer in and of itself, after the bill passed the House on Tuesday. No scientific evidence exists to support the idea that a fetus of 5 months gestation can “feel pain.” The scientific community agrees that the neurons responsible for conducting and interpreting pain responses are not even present (meaning they haven’t formed yet) until the 3rd trimester (28 weeks).

But let’s pretend Senator Graham and the 45 co-sponsoring senators of the bill are correct—a fetus at 20 weeks gestation can feel pain (but even as we’re pretending, let’s remember: they cannot). Sounds ethical and moral to ban abortion at or after this gestational age then, right? Here is a list of what else they deem ethical and moral by supporting this bill:

  • Women who are sexual assault survivors must relive their trauma and risk further harm by reporting their assault to authorities if they want an abortion.
  • A 20-week fetus without kidneys that will be unable to survive at birth must be carried for five more months and then suffer and die while its parents watch.
  • If a doctor performs the evidence-based medicine that they are trained for, they will face prison time.
  • Fetuses after 20 weeks, though feeling pain, will not be required to be given pain medicine at the time they are pushed out of their mother’s birth canal, despite this process taking hours in many instances. Also, preterm babies in the ICU will not be required to receive pain medicine for all the poking and prodding (IVs, blood draws, spinal taps) they undergo. Circumcisions will continue to be performed with little to no anesthesia.
  • It is perfectly acceptable for a pregnant person to suffer, but by god no fetus will suffer if our government has anything to say about it.

I implored my state representative Mia Love to vote no on this bill, yet she perpetuated the misinformation and rhetoric that has harmed so many Americans to this day. I urge you to call your state’s senators and tell them to vote No on this inhumane and reprehensible bill. Regardless of your opinion on abortion, I think we can all agree that when politics interfere with evidence-based medical practice, horrible things happen.