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There is no reaction except horror whenever my friend Rebecca shares her birth story. At 33 weeks pregnant with twins, she was diagnosed with intrauterine growth restriction and preeclampsia, a serious blood pressure condition, and had an emergency caesarean section in the hospital where she worked.

“After giving birth, I got very sick. I was really dizzy, started vomiting and my blood pressure dropped somewhere around the 50s over 30s,” recalls Blake, who is now the director of nutrition at a pediatric center in New York. She describes an “impending sense of doom” when no one could figure out what was going on, and the catastrophes that followed were straight out of a nightmare. After multiple blood transfusions and forced expulsion of blood clots—”I felt like the OB was punching the shit out of my belly after a C-section”—the last thing she remembers is signing a waiver for an emergency hysterectomy to remove her uterus.

She woke up several days later in the ICU terrified. In that time, she had received as many as 35 blood transfusions and developed a lethal blood clotting disorder. While her uterus was fine, a radiologist finally discovered why her health deteriorated so quickly: She had three bleeding arteries. Multiple emergency procedures also resulted in a temporarily paralyzed bowel and several infections that kept her in the hospital for three weeks after giving birth.

How those arteries were injured remains a mystery, and six years later her frustration and fury is still palpable when she tells her story. Ultimately, malpractice attorneys told her that despite the near-death trauma, she had no case against the OB-GYN or the hospital. Why? Because she came out of the experience alive with no permanent physical damage.

You may have heard the story of Lauren Bloomstein that ended in tragedy: The 33-year-old neonatal nurse died 20 hours after giving birth due to undetected preeclampsia in 2011. Her story made nationalheadlines this summer as part of a ProPublica and NPR investigation. Like Blake, she suffered a devastating series of problems after her delivery, which ultimately led to bleeding in the brain and a drop in her blood platelet count. With a platelet supply shortage in the hospital, she died within hours.

When women who are medical professionals—who have access to quality prenatal care and who deliver in the hospitals where they work—have life-threatening births, it suggests there is a much bigger, more systemic problem with childbirth in the United States. Every year, about 1,200 women in the US have fatal complications from pregnancy and childbirth, and another 60,000 have near-fatal complications, according to the World Health Organization. And for every headline-grabbing story, there are countless other women whose suffering is overlooked. Often, they are women of color.

Although women dying during and after childbirth is a relatively rare occurrence among the 4 million births in the US each year, the numbers tell a dark story. Our country ranks a dismal 50th among 59 developed countries for maternal mortality, according to Amnesty International. (We were 60th out of 180 countries in a 2014 study.) Bucking global trends, the rate of deaths in the US is rising, not falling, jumping dramatically from 16.9 deaths per 100,000 live births in 1990 to 26.4 per 100,000 live births in 2015. Though changes in how maternal mortality is tracked may account for some of that growth, the figures are still staggering. And about half of those deaths were preventable, according to the WHO.

Overall, the WHO reports that “the poorest and most marginalized women” continue to face the highest death risk from pregnancy- and childbirth-related causes. Domestically, that fact is all too clear: Black women are almost 3.5 times as likely as white women to die as a result of pregnancy (43.5 deaths per 100,000 live births for black women versus 12.7 deaths per 100,000 live births in white women). Texas—which has the highest maternal mortality rate in the country and in the developed world, at 35.8 deaths per 100,000 live births—has particularly shocking outcomes among black women. Though black women make up 11 percent of live births in the state, they account for 29 percent of the maternal deaths.

How could this be the case? “In pregnancy, the body makes significant physiological adjustments, and that can put a woman at risk,” says Haywood Brown, a maternal-fetal medicine specialist in North Carolina and president of the American Congress of Obstetrics and Gynecology (ACOG). “These days, we’re also seeing increasingly more risk factors—giving birth later in life, chronic diseases, poverty, limited access to care—so when you have a cascade of events of things going wrong, they can go really wrong.”

Surprisingly, those health factors are less linked to “direct” causes of death including hemorrhage, infection, and blood pressure disorders like preeclampsia which can develop quickly. Instead, cardiovascular disease is the number-one cause of maternal death within a year of giving birth, followed closely by other chronic diseases such as high blood pressure and diabetes.

“For women with known or unknown cardiac conditions, the [physiological] stress might tip the balance and she may well decompensate,” says William Callaghan, chief of the Maternal and Infant Health Branch at the Centers for Disease Control and Prevention. “This could take many forms such as a heart attack, heart muscle failure, or the rupture of a blood vessel.”

In 2014, the Center for Reproductive Rights, the National Latina Institute for Reproductive Health, and SisterSong released a joint reporttitled, “Reproductive Injustice: Racial and Gender Injustice in US Health Care.” The report notes that cities and states with high African American populations have the highest rates of maternal mortality in the country, and the takeaway isn’t just the enormous racial disparity, but intersectional factors that can stack the deck against marginalized women.

For one, many black women are at a health disadvantage to begin with. The CDC reports that nearly 57 percent of black women over 20 years old are obese and nearly 45 percent have high blood pressure. Other disenfranchising factors include dismal sex education and contraception access, higher rates of unintended pregnancies, restricted abortion access, subpar prenatal care—particularly for women covered by Medicaid—and poor communication and trust between doctors and patients.

Callaghan points out that when underlying health risks aren’t recognized and properly managed, they can drastically impact pregnancy and childbirth. In a perfect world, those risk assessments would take place during a preconception or prenatal appointment, but that often isn’t the scenario for disadvantaged women who may not have health insurance.

A 2010 report from Amnesty International, “Deadly Delivery: The Maternal Health Care Crisis in the USA,” reports that women of color are 2.5 times more likely than white women to delay prenatal care. Bureaucratic hurdles within insurance coverage and Medicaid (which covers nearly half of all births in the US) can make it difficult to find a doctor, while women in rural areas are faced with a dwindling numberof healthcare providers. Factor in logistical issues like transportation, taking time off work and arranging childcare, and the roadblocks to seeing a doctor in a timely fashion can be insurmountable.

Meanwhile, women with unintended pregnancies are also more likely to delay care; in the US, 45 percent of pregnancies are unintended, with rates highest among poor women, women of color, according to the Guttmacher Institute. And poor women are more likely to carry an unintended pregnancy to term: This group has an unplanned birth rate nearly seven times that of higher-income women. While 75 percent of abortion patients were poor or low-income, white women are still more likely than black or Hispanic women to have an abortion.

Then, when women with underlying health conditions make it to the delivery room, they may not have the birth that’s best for them. Almost a third of babies in the US are delivered via C-section, up 50 percentsince 1996, and experts believe that women of color and low-income women are less likely than other groups to have medically necessary C-sections and more likely to have medically unnecessary C-sections. Both of these situations are bad for women’s health, and the decision to do a C-section is often made by a doctor on their behalf. C-sections are inherently more dangerous than vaginal deliveries, putting women at risk for infection, hemorrhage, injury, and scar tissue adhesion, and reaching a death rate of 11 out of 100,00 pregnancies. But if a woman needs a C-section and doesn’t get one, that’s also dangerous.

Since the passing of the Affordable Care Act in 2010, experts hoped maternal health outcomes would improve. After all, prenatal and maternal care and annual well-woman visits were established as essential health benefits covered without co-pays or deductibles and the eligibility for Medicaid was expanded. The goal was to take measured steps toward providing holistic care—including free prescription birth control, quality prenatal care, and in-hospital labor and delivery care—that could help prevent fatal complications among expecting mothers. (By the way, the Trump administration is expected to undo the free contraception rule any day now.)

But only 32 states chose to expand Medicaid and the ACA has been under attack ever since it was signed into law. And Obamacare still doesn’t cover everyone: There were 28 million Americans without health insurance in 2016. With the repeal of the ACA under threat once again by Republican lawmakers, counteracted by a swelling, Bernie Sanders-sponsored movement toward universal health coverage, the future of women’s healthcare access remains unclear. Sanders introduced a single-payer bill today, the same day two Republican Senators unveiled their last-ditch repeal bill.

In the meantime, experts are addressing the glaring need for collecting and analyzing data to get clearer understanding of what is going wrong in delivery rooms and to tackle those problems. Currently, maternal mortality tracking is done at a national level and essentially categorized by checking a box on a death certificate—a practice that means we could be vastly underreporting the number of maternal deaths. After all, if a woman dies of heart failure within a year of giving birth, it may not necessarily be categorized as pregnancy-related.

The CDC Foundation has determined that between 20 and 50 percent of maternal deaths in the US are preventable through the work of maternal mortality review committees (MMRCs). By relying on a cross-section of experts who represent areas such as obstetrics and gynecology, maternal-fetal medicine, forensic pathology, mental health, and social work, states can take a deeper dive into the causes of death and share that data more effectively. Bringing this type of analysis down to the state level is the goal of HR 1318, the Preventing Maternal Deaths Act of 2017, introduced by Representative Jaime Herrera Beutler of Washington state.

Many experts are looking to California, which has gone against the national trend and has seen a decrease, not increase, in maternal mortality. California Maternal Quality Care Collaborative is an initiative to make births safer for mothers through real-time data and toolkits that began in 2006. In the program’s first seven years, California has seen maternal mortality decline by 55 percent, and first-birth C-section rates have gone down more than 20 percent in participating hospitals. North Carolina has also reduced the gap in racial disparities through a Medicaid-based program called Pregnancy Medical Home in which doctors identify high-risk pregnancies sooner than before, have a toolkit of medical procedures to help prevent problems at birth, and have a comprehensive postpartum follow-up appointment.

In fact, redefining postpartum care is a core goal of ACOG. In busy OB-GYN offices, a six-week postpartum checkup may be limited to a brief exam and a birth control prescription to help women space their pregnancies. “The postpartum period is critical for counseling for postpartum depression, breastfeeding continuation, pregnancy spacing, and contraception without ever considering a pelvic exam,” Brown says.

However, longer-term postpartum care is a luxury that many new mothers can’t afford in any capacity. “As many as 40 percent of women on Medicaid or who are uninsured don’t make it to their six-week postpartum appointment,” says Brown of ACOG. In addition to healthcare access issues, lack of paid maternity leave and work-family support often force mothers back to work before their babies can even hold own their heads up—much less make OB appointments—just so they can keep their jobs. In states that didn’t adopt the Medicaid expansion, women above the federal poverty line who don’t have insurance through work lose their pregnancy-related coverage at 60 days postpartum, while infants are covered for up to one year.

The fact is, our nation’s medical and political systems have invested a lot of resources keeping fetuses and infants alive, and with demonstrable results: Although the number of babies that die each year still outpaces the number of women who die, infant mortality has dropped to its lowest point in 50 years, the CDC says, while maternal mortality is rising. The ProPublica/NPR report found stark differencesin the level of care between infants and their mothers: hospitals that have state-of-the-art neonatal intensive care units may not have the same level of care for high-risk pregnant women, and some doctors training to specialize in maternal-fetal medicine may have never spent time in a labor and delivery unit.

As the healthcare debate rages on, mothers-to-be are at a huge risk of slipping through the cracks. “We fought the ACA repeal because it would have a great impact on women being able to have affordable health care, have access to contraception and prenatal care,” Brown says. “If states that expanded Medicaid eliminate it, and those who make too much to qualify for Medicaid can’t get insured, women would lose those essential health benefits and that will only increase the risk for maternal mortality.”

It’s darkly ironic with our “pro-life” administration at the helm.

https://tonic.vice.com/en_us/article/mb7j4p/black-women-are-3-times-more-likely-to-die-from-being-pregnant

“While Trump and his cronies seek to grant broad licenses to discriminate, California is showing that we stand for reproductive freedom and economic justice for all.”

For some California workers, abiding by a religious code of conduct can spell the difference between gainful employment and a pink slip. Many California churches, religious groups, and anti-choice organizations require workers to sign statements of faith or codes of conduct as a condition of employment, as the California Family Council, a policy arm of the Family Research Council, noted.

But legislation heading to Gov. Jerry Brown’s (D) desk would render these types of agreements invalid, and bar employers from retaliating against a worker for reproductive health decisions. The bill cleared the Democratic-led state senate and assembly last week in floor votes.

Assemblywoman Lorena Gonzalez Fletcher (D-San Diego), the bill’s sponsor, said the legislation stops religious employers from infringing on a worker’s right to make personal decisions about birth control and pregnancy.

“Women in this country have been fired for getting pregnant while unmarried, for using in-vitro fertilization and for other personal reasons related to their own reproductive health,” Gonzalez Fletcher said in a statement. “No woman should ever lose a job for exercising her right to decide when, how, or whether to have a family.”

AB 569 protects workers from discrimination or retaliation for using any medication, medical service, or device related to reproductive health. Sponsored by NARAL Pro-Choice California and California Latinas for Reproductive Justice, the bill comes a few months after President Trump moved to expand religious imposition by signing an executive order, flanked by the Little Sisters of the Poor, who sued over the Affordable Care Act’s birth control benefit.

“While Trump and his cronies seek to grant broad licenses to discriminate, California is showing that we stand for reproductive freedom and economic justice for all,” Amy Everitt, state director of NARAL Pro-Choice California, said in a statement.

Gonzalez Fletcher said religious employers have discriminated against some workers’ health-care decisions in California. In one case, San Diego Christian College required a financial aid specialist to sign paperwork saying she wouldn’t have premarital sex. The college then fired her when she became pregnant, taking that as evidence that she had violated the code of conduct, as KTLA reported. In another case, the Archbishop of San Francisco tried unsuccessfully to require teachers to sign a code of conduct saying they wouldn’t use birth control or attempt artificial insemination.

Sixteen faith-based groups signed a letter supporting AB 569, but opponents argue the bill’s employment protections infringe on so-called religious freedom.

“Every organization that promotes a pro-life message must be able to require its employees to practice what they preach,” said California Family Council President Jonathan Keller. “It is unconscionable for any politician to attempt to abridge this sacrosanct religious liberty by inserting themselves into the employee-employer relationship.”

A similar measure passed in St. Louis, Missouri, is now facing a court challenge from religious groups, as the St. Louis Post-Dispatch reported.

An analysis by the state Senate Judiciary Committee indicates the California legislation is constitutional under the U.S. Supreme Court interpretation of the Free Exercise Clause in a key 1990 decision. In that case, Employment Division v. Smith, the high court held that a neutral law is constitutional as long as it doesn’t single out a religious behavior and is not motivated by the desire to interfere with a religion.

https://rewire.news/article/2017/09/18/california-bill-says-church-employer-cant-fire-workers-use-birth-control/

My questions about my grandmother’s death, of a self-induced abortion, haven’t changed since I was twelve years old. What feels new, in the Trump era, is the urgency of her story.

PHOTOGRAPH COURTESY KATE DALOZ

As a child, I knew only that my grandmother had died when my mom was still a baby. The one time I asked what had happened to her, a bolt of panic flashed across my mother’s face. “A household accident,” was all she said.

I was twelve years old when she finally told me the truth. Some friends and I had got into a long after-school discussion about abortion, prompted by the gruesome posters that a protester had staked in front of the Planned Parenthood in our Vermont town. I had already begun reading my mother’s Ms.magazines cover to cover, but this was the first time I’d encountered a pro-life position. When I hopped into my mom’s car after school, I was buzzing with new ideas. I had almost finished repeating one friend’s pro-life argument when I saw the look on Mom’s face. That’s when she told me: the “household accident” that had killed her mother had, in fact, been a self-induced abortion.

Her hands were tight on the steering wheel as she spoke. I realized later that it wasn’t the topic of abortion itself that made her so uneasy—she was a nurse and a Roe-era feminist who usually responded straightforwardly to even the most embarrassing health questions. Rather, her anguish arose from sharing a truth that she’d been brought up believing was too terrible to speak.

Sitting beside her in the passenger seat, I struggled to absorb the meaning of what she’d told me. I had only just grasped what abortion was a few hours earlier, and was still trying on this new pro-life idea. “O.K.,” I said, “but what about the uncle or aunt I never had?” Mom whipped toward me, face taut with a rage and fear that I somehow understood had nothing to do with me. “What about the mother I never had?” she said.

Until recently, everything my mom knew about her mother fit into one three-ring binder. Inside were letters, documents, and photos that my mother had collected over the years. After the election last fall, as an Administration hostile to women’s reproductive rights settled into the White House, I asked her to send the binder to me, and did some sleuthing of my own. I got in touch with aging relatives and family friends, who offered crumbling bundles of my grandmother’s letters, carefully preserved for decades. My questions about her life and death hadn’t changed since I was twelve years old. What felt new, in the Trump era, was the urgency of her story.

My grandmother, Winifred Haynes Mayer, was born in New York City, in 1912, to an upper-middle-class family. Her father, a doctor, spent time in France during the First World War, helping set up orphanages, and returned to the U.S. in love with a Frenchwoman and seeking a divorce. Win and her brother were raised in the Bronx by their mother, Nyesie, a nurse.

Nyesie was determined that her daughter receive a college education, and in 1929 Win enrolled at the University of Wisconsin, Madison. There she majored in English, helped found a literary magazine, and, in her senior year, met my grandfather, Eddie. Win was lean and athletic, with high cheekbones and windblown hair. In photographs, she always looks as though she’s just returned from a brisk stroll.

Win and Eddie married in 1939. She got pregnant immediately but miscarried after her doctor prescribed some medication, possibly for morning sickness. In a short letter to her mother, dated “Thursday, I guess,” she wrote, “I lost the little kangaroo early Wednesday morning and am now lying in an empty and ethery tearful state of mind.” Nyesie wrote back, with some words crossed out, “I wish so much that I were near enough to be useful to you.”

My uncle Peter was born in 1941. (“He is a very funny looking little squirt but we like him,” Win wrote Nyesie. “Are there any chipmunks in our family?”) Soon after the United States entered the Second World War, Eddie was recruited by the newly formed Office of Strategic Services, and the family moved to Alexandria, Virginia. They rented a small apartment from some friends, Katrina and Chandler Morse, whose rambling house was a gathering place for a community of O.S.S. families.

Sooner or later, they knew, Eddie would leave for London. But the dates and duration of his deployment kept changing, and the uncertainty began to wear on Win. With Eddie away on a three-day business trip, she noted, “I am getting a foretaste for which I do not particularly care.” When he finally departed in April, Win was seven months pregnant with my mother, Judy. Eddie would not meet his daughter until she was six months old.

Katrina, their friend and landlady, needed the apartment for her sister-in-law and infant niece, so Win moved away, to a nondescript block of Army housing. She spent the summer of 1943 caring for her two children alone in the thick Virginia heat. Her letters to Nyesie convey a parent’s mix of joy and fatigue. “Judy is a sweet, juicy little girl as ever,” she wrote. “She howls from 7 till 8:30 which is very dull because by then I am fed up with children and want only to sit on the front porch in the cool of the evening.”

Eddie’s letters indicated that he’d likely be returning in November, but that month came and went with no sign of him. Then, just before Christmas, Win’s neighbor ran over to relay an urgent message from Katrina—she’d heard, through the O.S.S. grapevine, that Eddie was on a flight home. Win quickly cleaned the house, and then rushed with the children to the grocery store. When she called Eddie’s office from the A. & P., they told her he was waiting at the train station. “So we all dashed in to meet him!” she wrote to her mother. “T’is wonderful to have our family whole again.”

It wasn’t to last. Eddie’s commanders had decided that his project would require him in Europe indefinitely; once deployed, under the best scenario he’d have short leaves every six to eight months. “I really don’t think the Lord would have had to try boils to find the limit of my endurance after that,” Win wrote. That winter, a preoccupied tone crept into her letters to Nyesie: “I . . . heard from Beth that Winston had been killed over Munster . . . and that his widow has had twins, a boy and a girl,” she wrote. “Birth and death follow each other so swiftly these days that one has no time for the appropriate feelings about either of them.” A few weeks later, Win learned that she was pregnant again.

This pregnancy, unlike the others, is never mentioned in her surviving letters. Nyesie came to visit the first weekend in April, and it’s likely that Win asked her in person for help in obtaining an abortion. This would not have come as a shocking request. Nyesie was part of a large social circle of progressive doctors and nurses, and she would have known which of her colleagues might be willing to perform a “D. and C.” in violation of the law. In the nineteen-thirties, she had arranged an abortion for her son’s wife, an actress. The couple had gone on to have two daughters.

Nyesie agreed to help Win. The next weekend, Win left her children in Virginia and travelled to New York. But, at the last moment, for reasons that have been lost, the arrangements Nyesie had made fell through. Win then turned to another New York physician she hoped might be able to help—her father. He refused. Eddie later told my mom that Win’s French stepmother had offered her this advice: “Frenchwomen take care of these things themselves.”

Back in Virginia the next Sunday, Win went with Eddie and the children over to Katrina’s house. The weather was cool and gray but the peach trees were in full bloom. Katrina wrote to her husband, who was stationed in London, “The maples are covered with their funny yellow-green flowers and the grass is that beautiful soft lush spring green.” Win left no record of what she was thinking or feeling that weekend as the others tilled the garden while the children napped in a hammock. But when I imagine her these are the things I think about: of how provisional and precarious early pregnancy feels, even when welcomed with more joy than fear; of how everything during that time narrows in toward the dark knot at your center, the turning point of your whole future; and of desperation, the kind that manifests not in panic but in a calm practicality. Of how plain the way forward can feel in those moments when other options have evaporated.

That Tuesday, April 18, 1944, Eddie went to work as usual. At noon, Win gave the children lunch and put them down for their naps. Then, as though it were any other task that needed to be completed during her few hours of solitude, she went into the bathroom. The sharp object she took with her—a knitting needle?—is another detail that has been lost. That evening, Katrina was coming home from the Washington Nationals’ opening day. “As I walked across the porch into the house from the game . . . the phone was ringing,” she wrote to her husband. “It was about 6:45. I let the phone ring while I went and let the dogs out who had been shut in our bedroom all afternoon. As I picked up the phone Eddie Mayer’s voice came to me saying, ‘Katrina—can you come right over. I think Winnie is dead.’ ” Eddie had arrived home from work to find his wife crumpled in the bathroom. Nine-month-old Judy was still in her crib, crying, but two-year-old Peter had been out of bed and wandering around the apartment for hours.

“The true cause as stated by the autopsy is ‘death due to shock as a result of an attempt to force a miscarriage by mechanical methods,’ ” Katrina wrote to her husband. “But the party line which we are following and telling every one is death caused by an embolism.” My mother would not learn what really happened for more than two decades. In lieu of an explanation, adults offered confusing half-truths that conveyed no clear message apart from their own guilt and shame. Once, Nyesie sat her grandchildren down in the living room to tell them the story, mixing the truth of the abortion with the lie of the embolism in a way she apparently thought that they could handle. My mom was five years old at the time. Almost seventy years later, she recalled the scene to me in detail: how she was sitting on the floor, looking up at her grandmother on the couch, backlit against the living room’s bay windows. “What I understood was that there was a baby and a bubble,” my mom told me. Her grandmother offered no follow-up, and the children had long since learned not to ask questions. Peter, who was seven years old, decided that his mother had died of cancer. But my mother heard something different: she knew that she had been a baby when Win died. It took her decades to shake the conviction that she’d been the cause of her mother’s death.

“It took all my courage and energy just to bring up the subject the few times I did,” my mom recalled. As a junior at the University of Hawaii—the farthest-from-home college she could find—she wrote her father a letter, demanding at last to know the truth. It arrived the same day Eddie found out that his own mother had died. “I’m so grateful for your having written,” he wrote. “It’s as tho I’ve been pulled back from a terrible brink of loneliness & lack of communication & hopelessly tumbling over the edge into the void.” But it wasn’t until he visited her a year later that she dared to bring it up again. She was the exact age that Win had been when Eddie first met her, and they bore a startling resemblance. As my mom remembers it, “I was driving my car from the Waikiki side to the Kailua side of Oahu when I told him that I wanted to know how Win had died.” In clipped sentences, he told her the truth. She reached over to grab his hand, but he shoved it back at her. Eddie lived for another forty years, but they never spoke about Win’s death again.

It was in the feminist movement of the nineteen-seventies that Mom found, for the first time, other women who were determined to talk about abortion—not in hushed tones but as a matter of health care and family planning. Three years after the Supreme Court decided Roe v. Wade, when I was a few months old, she finally sent away for her mother’s death record. Under “cause of death,” the coroner had written in a sloped hand: “Attempt at criminal abortion, self-inflicted.” The word “criminal” refused to sink in. “That night, for the first time in many years, I vomited several times,” she told me. “Somehow I knew I wasn’t sick, but was having a life purge.”

Winifred Haynes Mayer’s death certificate.

 PHOTOGRAPH COURTESY KATE DALOZ

Several months before the election, my own seven-year-old daughter asked me how her great-grandmother had died. Already, there’d been reports of a rise in self-induced abortions in states where access had been restricted. Despite years of thinking about Win’s death and how to talk about it, I was caught off guard by her question. We were on the street. I was wrestling car keys out of my purse with one hand while trying to keep a grip on my toddler son with the other. Like my own mother before me, I hesitated.

To understand Win’s story—what had happened to her, what she had done, and why—my daughter would need a number of moral and biological concepts that were not yet in place in her young mind. Still, I wanted to offer her a simplified version of the truth that could remain stable for her as she got older. I wanted to assure her that, even though this was a story she needed to grow into, she should always feel free to ask questions, and that I would answer as honestly as I could. And I wanted to break my family’s long-standing silence surrounding Win’s death, because silence only helps to perpetuate the fallacy that outlawing abortion has ever stopped women from attempting it.

If I couldn’t immediately explain to my daughter how Win died, I decided, I could at least explain why. “She needed help really badly and no one would help her so she died,” I told her. Then I added a reassurance that I’m not sure I’d feel confident offering today. “It’s not a thing that would happen to us now,” I said. “If we ever needed that kind of help, we would get it and we would be safe.”

https://www.newyorker.com/culture/personal-history/my-grandmothers-desperate-choice?mbid=social_facebook

Abortion funds and youth nonprofits help young people navigate the legal system to get judicial approval for abortion, push repeal of parental notification laws, and support youth advocacy.

Since January, hundreds of anti-abortion bills have moved through state legislatures across the country, but historically, some of the most longstanding restrictions have targeted young people seeking abortion care. Minors face many barriers not always related to age, such as medically inaccurate sex education (or none at all), lack of birth control, and limited resources. But with a new round of parental notification laws, minors’ abortion access may be narrowing to the point of near-impossibility.

In the state of Indiana, a bill that would require minors to get parental consent prior to having an abortion was signed into law until a federal judge blocked it from taking effect this June. In West Virginia, a provision allowing doctors to grant waivers to minors seeking abortions due to health risks was repealed in April, leaving minors to either obtain a parent or guardian’s consent or a judge’s approval. And Alabama Attorney General Steve Marshall filed paperwork last month to appeal a July decision that blocked the state’s requirement that minors undergo a trial-like hearing to obtain a judge’s approval for an abortion.

“Young people, minors, are definitely the demographic facing some of the most serious restrictions on their bodily autonomy, and these laws regard their bodies as their parents’ property,” said Amanda Bennett, the client services manager at Jane’s Due Process in Texas. “Here in Texas, where there’s so few abortion clinics, the problem is really exacerbated.”

Jane’s Due Process is a nonprofit that supports reproductive justice for minors by offering help with navigating the process to obtain judicial bypass, the legal waiver that allows them to have abortions without parental consent. As of 2017, 37 out of 50 states have parental consent laws for minors seeking abortion. The 1979 U.S. Supreme Court decision of Bellotti v. Baird ruled that minors do not need parental consent to obtain the procedure, but granted that as long as they have the option of obtaining judicial bypass for the procedure, such parental requirements are feasible.

Jane’s Due Process also refers minors to Fund Texas Choice for financial assistance for other services they may need, such as transportation or lodging. In 2016, Jane’s Due Process completed intake with 307 minors, although only 200 went on to work toward obtaining bypass; some minors with unintended pregnancies will have miscarriages, travel out of state, or even end up telling their parents or trusted adults further down the line.

The judicial bypass process starts with minors seeking abortions calling Jane’s Due Process’ hotline or completing its online intake form. Next, the organization arranges for an ultrasound and an attorney paid for by the state. Within five business days, a hearing is scheduled with a judge. A recent law requires hearings to take place in the minor’s county of residence rather than where they will have their abortion, and this has sometimes complicated the judicial bypass process, according to Bennett.

“Judges in counties [without abortion clinics] tend to be less equipped to deal with these situations, and the hearings can get messy,” she said.

Young people receive judicial bypass if the judge deems that the minor is mature and informed enough to make the decision, or if the judge finds that the minor’s family situation merits the procedure. In many cases, minors are able to obtain the waiver. But in July, a 12-year-old victim of rape and child abuse in Alabama was denied an abortion by a district attorney and only granted judicial bypass when a circuit court intervened.

Still, according to Bennett, even though most hearings with judges do result in minors being granted judicial bypass, this doesn’t change the inherent problems with the hearings, which are not dependably confidential. In examples from Minnesota and Massachusetts, according to StopPNA.org, “one young woman was sitting in a court corridor when her sister’s civics class came through; another saw a neighbor in the courthouse; a third encountered her godmother, who was employed as a court officer; another had to hide in the bathroom to avoid being seen by a family member who worked in the courthouse; and a young woman ran into her father right outside of the courthouse.”

Young people can also face hostile gatekeepers. Quita Tinsley of the Access Reproductive Care-Southeast abortion fund in Georgia recalled when “a young person called us after she had been to her local courthouse in Georgia to ask about judicial bypass. They lied and told her they didn’t know what she was talking about. They tried to act like it didn’t exist. We knew it existed, and we were the ones who had to help her navigate that process and get her a lawyer to be able to get her judicial bypass.”

Abortion funds know firsthand that the circumstances surrounding young people accessing abortion are already incredibly difficult. From 2010 to 2015, the National Network of Abortion Funds’ George Tiller Memorial Fund served a total of 481 young people under the age of 18. The majority of adolescents were geographically located in the South (50 percent) and Midwest (20 percent), and had to travel an average of 185 miles. The young people who called for funding were predominantly Black (59 percent) and ages 14-to-15 (36 percent) or 16-to-17 (56 percent). Of the 204 adolescents who reported information on the reason for obtaining an abortion, the primary driver (61 percent) was not having access to birth control. And for many young people, there were extenuating life circumstances, such as some form of government assistance, having multiple children, seeking an abortion due to being raped, and having partial or unstable living situations.

The average cost of young people’s abortions funded by the Tiller Fund was $2,800, three times what the patients could afford. The cost was magnified because more than two-thirds of the adolescents sought abortion care in the second trimester of pregnancy.

Bennett noted that while minors are matched with attorneys at no cost, there is no public funding for abortion in Texas. A recent study associated the defunding of women’s health and family planning clinics in Texas with higher rates of abortion in teens. It’s worth noting that there’s also a statewide crisis of poor sexual health education in public schools and households that contributes to unplanned pregnancies among people of all ages.

West Virginia FREE is another abortion funding organization that helps minors access abortion care. Working with the Women’s Health Center of West Virginia, the last abortion clinic in the state, West Virginia FREE offers financial support for the abortion procedure, as well as transportation and lodging expenses for people who must travel out of state due to the state’s ban on 20-week abortions. The group also connects patients with an attorney from its judicial bypass network.

According to Julie Warden, West Virginia FREE’s communications director, only two waivers were used in 2015, and none in 2016. “It’s rare, but no less burdensome for the people who have to go through that process,” Warden said.

Yamani Hernandez, the executive director of the National Network of Abortion Funds, saw how difficult accessing abortion could be for youth when she was executive director of the Illinois Caucus for Adolescent Health (ICAH).

Hernandez noted: “Young people of color, undocumented youth, transgender youth, and others are already too often criminalized because of their very identities. Young people who have been neglected by the systems that are charged with supporting them are often hesitant to enter the court system. Too many youth experience stigma around their decisions at home, school, and in health-care environments. Legislators interested in targeting youth with these laws need to take a giant step back and reconsider the consequences of the obstacles they are setting up.”

Hernandez, current ICAH Executive Director Tiffany Pryor, and groups such as the ACLU of Illinois support youth and center their voices in the ongoing effort to end forced parental notification in that state. “Every young person is in a different situation when they seek abortion care,” Pryor said. “For reasons of safety, fear of homelessness or violence, abuse, and neglect, it’s not ethical to require parental notification.”

As anti-abortion lawmakers ramp up efforts to limit abortion access in the months to come, young people aren’t silent. They’re fighting back.

In Illinois, Pryor described local efforts led by youth. “Recently, young people at ICAH have organized and demanded Gov. [Bruce] Rauner sign HB 40, legislation that would allow every person, whether covered by private or government-funded health insurance, to have affordable and comprehensive health care, including abortion care.”

Paula Mejia, a young activist with ICAH, says of the HB 40 action in Illinois: “It’s been so incredibly rewarding to work with other young people who are passionate about issues of social justice. … We urge Governor Bruce Rauner to #SignHB40 and keep his promise to not interfere with reproductive rights. It’s already been passed by the House and the Senate of Illinois, and that’s why we say #MajorityforHB40.”

Another young person, Brie Garrett, says: “Health care is our human right, and everyone deserves to have access to opportunities and systems that help their lives. HB 40 helps lower-income people, people of color, women, and people who can get pregnant.”

In the abortion access movement, we often tout unapologetic abortion access for anyone who needs it. But until young people are heard loud and clear and supported in their reproductive decisions, abortion access for all will not be a reality.

https://rewire.news/article/2017/09/13/laws-minors-abortion-groups-help/

Photo by Donald Kravitz via Getty Images. Altered by Broadly Staff

Even though the Miss America pageant has tried to adapt to modern sensibilities, emphasizing “female empowerment,” it remains committed to an antiquated ideal of femininity.

In September of 1999, the Associated Press reported on a shocking national development: The Miss America Pageant would lift its long-standing ban that disqualified contestants who’d been divorced or gotten an abortion.

Since 1950, the Miss America Organization (MAO) had required entrants to sign a contract stating that they had never been married or pregnant. Forty-nine years later, the organization’s newly appointed CEO Robert Beck sought to overturn that ban, instead requiring contestants to assure that they weren’t currently married, pregnant, or the “natural or adoptive parent of any child.”

The change reportedly came at the recommendation of an attorney, who advised that the policy could be in violation of New Jersey’s anti-discrimination laws. (The pageant is held annually in Atlantic City.) But despite this seemingly logical rationale, the proposed changes were met with swift and decisive backlash: “Miss America has a long history of high moral standards and traditions, and I’m opposed to anything that changes that,” Libby Taylor, the president of the National Association of Miss America State Pageants, told the AP. Several current and former contestants publicly lamented that lifting the ban would change the pageant for the worse, and somehow deprive Americans of good role models.

The individual state chapters of MAO sued their parent organization in an effort to maintain the ban, and the national organization acquiesced, delaying the policy change for a year. Then, two weeks later, Robert Beck was fired.

Although the Miss America Pageant wouldn’t confirm that Beck’s firing had anything to do with the abortion-and-divorce policy, speculation was rampant. “Beck was fired after one year on the job because he had the audacity to ask the board to get rid of the archaic ban,” read an op-ed published in The Central New Jersey Home News one day after his termination was announced . (Four years later, the AP reported that Beck was awarded $80,000 in severance after suing MAO over his firing. The Miss America Organization told Broadly that they have no comment regarding Beck’s termination.)

The pageant board later “shelved” the policy changes, according to the AP, and it’s not exactly clear where they stand now. A spokesperson for Miss America told Broadly that married and divorced women are still prohibited from competing in the pageant. “Miss America must be childless,” she said. When asked directly about women who have had abortions, however, she responded, “We do not ask.”

The Miss America pageant, which has been criticized as a “modern relic,” was originally founded in 1921. At the time, contestants were judged based on “their general appeal in appearance, personality, conversations with the judges, and interactions with the crowds,” as the official Miss America website puts it, somewhat sheepishly. (“The pageant was a product of its times,” they later add.)

“Miss America must be childless.”

Since then, Miss America has tried to rebrand as the “nation’s leading advocate for women’s education and the largest provider of scholarship assistance to young women in the United States,” championing its role in empowering women. But critics remain skeptical, arguing that the Miss America Organization has spent nearly a century projecting an antiquated image of the ideal woman—one that’s necessarily coded as virginal and traditional.

Dr. Kimberly Hamlin, a professor of history and global intercultural studies at Miami University, has argued persuasively that the Miss America Pageant gained popularity starting in 1921 precisely because it challenged American women’s newfound political power. “In the 1920s, when the Miss America pageant as we know it began, women’s place in American life was rapidly changing,” Hamlin tells Broadly. ” Women were voting and running for office, serving on juries, working in an expanded number of professions, and enjoying new freedoms in many aspects of life.”

The first-ever winner of the Miss America pageant was Margaret Gorman, who was just 16 at the time. The Miss America website calls her “girlish and wholesome-looking;” Dr. Hamlin notes that she was “barely five feet tall when she was crowned.” A contemporary New York Times article praised her for looking “strong, red-blooded, able to shoulder the responsibilities of home-making and motherhood.”

“From the outset, the Miss America pageant has celebrated and popularized a more retrograde image of American womanhood,” says Hamlin, “even as it bills itself as a scholarship program for women and even though many contestants today go on to notable careers.”

It’s true that the pageant has changed with the times, and there have been several progressive contestants throughout the contest’s existence. Rebecca King, the pageant winner in 1974, was outspoken in favor of abortion rights during her reign, and in 1989—a full decade before the controversy over abortion and divorce—32 of 51 contestants identified as pro-choice. Still, the uproar over the proposed policy changes in 1999 underscores the fact that the pageant remains contingent on a very narrow view of idealized femininity.

Hamlin emphasizes that the pageant’s abortion rule was probably less of a political statement about the right to choose and more of a reflection of the organization’s preference “that contestants be virgins, at least plausibly”—which is, of course, troubling in its own right.

“Contestants are not supposed to be too sexy, or to be people who have obviously had sex before,” she adds. “Being a mother, being married, or having had an abortion is a pretty good indication that one is no longer a virgin.”

https://broadly.vice.com/en_us/article/qvjdxm/miss-america-used-to-ban-abortionand-still-bans-moms-wives-and-divorcees?utm_source=broadlytwitterus

They were participating in a “red rose rescue” demonstration.

On Friday morning, at least two abortion clinics in the U.S. were targeted by anti-abortion protesters who stormed the clinics’ waiting rooms, refusing to leave. The protesters were eventually arrested by local police for trespassing.

HuffPost confirmed the arrests with Northland Family Planning in Sterling Heights, Mich. and Alexandria Women’s Health Clinic in Alexandria, Va. Two other clinics, one in Columbus, Oh. and another in Albuquerque, New Mexico were also reportedly targeted, but HuffPost has yet to receive confirmation.

According to Lara Chelian, the Director of Advocacy at the Sterling Heights clinic, there were four arrests made at her clinic.

Chelian said that about 20 anti-abortion protesters showed up outside the clinic on Friday morning ― something that is far from unusual. However, she told HuffPost that five of those protesters “stormed the [Northland Family Planning clinic’s] waiting room and refused to leave.”

One protester reportedly left when staff threatened to call police. The other four remained, and were later arrested.

“They must have posted bail immediately because the ones who are arrested are back [protesting] already,” Chelian told HuffPost on Friday afternoon.

Created Equal, an anti-abortion group whose members participated in the demonstration on Friday posted video footage on Facebook.

Participants of the demonstrations appear to have been performing “red rose rescues,” a concept that originated with Canadian anti-abortion activist Mary Wagner. The 43-year-old was released from a Toronto jail on Tuesday after serving six months while awaiting trial for previous arrests on abortion clinic grounds. Rather than being sentenced with jail time, she was given 30 months of probation.

Wagner was photographed and filmed participating in the Sterling Heights demonstration on Friday

Chelian confirmed to HuffPost that anti-abortion protesters were indeed trying to hand out red roses to patients driving into the clinic, and one protestor outside the Sterling Heights clinic uploaded a Facebook selfie with another protester in which she appears to be holding a bouquet of roses.

 Monica Migliorino Miller, an anti-abortion rights activist and writer who also participated in the Sterling Heights demonstration, said in a video she published on YouTube, “the red rose rescue is an act of charity on behalf of the mom scheduled for abortions and, of course, for the innocent unborn who are about to be put to death. Those who took part were willing to embrace the risks for these women and their babies.”
Jana Birchum/Getty Images

A new slew of state laws are aimed at making sure abortion coverage is banned from private health insurance plans—putting the procedure still further out of reach.

In September 1977, a 27-year-old woman named Rosie Jimenez died from an illegal abortion in McAllen, Texas. Her insurance, Medicaid, no longer reimbursed abortions and she didn’t have the money to pay for a legal the procedure out of pocket. Bereft of options, the student and single mother visited a local midwife who performed a “back alley” abortion at a fraction of the price. A few days later, Jimenez began hemorrhaging and vomiting due to a bacterial infection in her uterus. After seven days in intensive care at McAllen General Hospital, she died from organ failure and became known as “first victim of the Hyde Amendment.”

Two months before Jimenez’s death, a law that barred federal money from paying for abortion services through Medicaid went into effect. “I certainly would like to prevent, if I could legally, anybody having an abortion, a rich woman, a middle-class woman, or a poor woman,” said the bill’s author, Henry Hyde of Illinois. “Unfortunately, the only vehicle available is the … Medicaid bill.”

Jimenez’s story illustrates the impact of laws that restrict insurance coverage of abortion. Forty-one years after the passage of the Hyde Amendment, insurance coverage, public and private, remains a key battleground in the fight over abortion rights. Last month, Texas and Oregon passed laws that banned private insurance coverage for abortion and required it, respectively. The diametric opposition of these laws, signed on the same day, threw into sharp relief the role that insurance coverage plays in ensuring affordability and accessibility of abortion care for all women, not just the privileged.


On August 15, Texas Governor Greg Abbott signed HB 214 into law, banning most insurance plans in the state from covering abortion, unless a woman’s life is in danger. Dubbed “Pro-Life Insurance Reform,” the measure means that private insurance plans, whether purchased through the Affordable Care Act exchange or provided through an employer, cannot cover abortion services. Regardless of insurance, Texan women have to cover the costs of abortion care out-of-pocket.

Two thousand miles away in Oregon, Governor Kate Brown signed the Reproductive Health Equity Act, which advocates are calling “the nation’s most progressive reproductive health policy.” Among other provisions, RHEA requires insurance companies to cover abortion care, as well as birth control, without charging a copay.

“For anyone who even dips their toe into this work, you soon realize that insurance coverage, or lack of coverage, is one of the biggest determining factors in whether or not someone can get an abortion,” said Katherine McGuiness, the Board President of the Network for Reproductive Options, or NRO, an abortion fund that serves Oregon and Idaho.

Abortions are expensive, which is why insurance coverage for abortion care is critical to making it accessible. The average out-of-pocket cost for abortionsbefore ten weeks ranges from $300-$800, while second trimester procedures can cost thousands of dollars. And those costs don’t include related expenses that a woman will accumulate while getting an abortion, such as travel, accommodation, lost work time, and child-care.

While the Hyde Amendment targets low-income women through the Medicaid program, coverage bans on private insurance impact anyone with limited resources. A middle income person who lives paycheck-to-paycheck, is saddled with student loan debt, has family members to support, or recently faced an unforeseen expense may also find $500 unattainable. Given that more than half of Americans have less than $1,000 in their savings accounts (including thirty-four percent with no savings at all), these restrictions affect a large swath of women and can force them to make untenable choices. In a study conducted by Advancing New Standards in Reproductive Health (ANSIRH) at the University of California, San Francisco, half of abortion patients said they spent more than one-third of their monthly income to cover the costs associated with their abortion, potentially foregoing rent, utilities, or even food.


Elizabeth Nash, Senior State Issues Manager at The Guttmacher Institute, said that in the 1990s, “nobody” covered contraception or abortion, but after a series of advocacy campaigns, private insurers began covering these services without much pomp. “Up until the early 2000s, abortion coverage was typical,” she said. “It was a normal part of the package of services that were covered.”

Then came the furious debate around the Affordable Care Act, which devolved into a furious debate about abortion. One of the concessions made to get the ACA through was that states had the option to limit abortion coverage in plans offered through the exchanges, and 25 states have taken advantage of that offer. This laid the groundwork for more types of insurance restrictions. With Texas, 11 states now have private insurance coverage bans on the books. Many insurers in Texas already fail to cover abortion, so while the ban has a whiff of political theater, it’s also a deliberate attempt to choke off access to care.

One of the arguments used to justify the ban on federal funding for abortion is that taxpayers should not be “forced” to pay for something they are religiously or morally opposed to. Similarly, Governor Abbot’s argument for the Texas ban on private insurance coverage is that “no Texan is ever required to pay for a procedure that ends the life of an unborn child.” Except that’s not how taxes—or insurance—work. People don’t pick and choose where their money goes. Someone who opposes war still pays taxes that fund the military. A Jehovah’s Witness who believes it’s a sin to receive a blood transfusion still pays insurance premiums into a pool that pays for someone else’s transfusion.“I find puzzling the conversation about taxpayers paying for people’s abortions, as if people who have abortions aren’t taxpayers and shouldn’t also be able to have the taxes they pay go to supporting their healthcare like everybody else,” said Yamani Hernandez, the Executive Director of the National Network for Abortion Funds.


An aspect of the Texas law that attracted particular attention was that it necessitated the purchase of what was called “rape insurance.” In theory, the law allows women to buy supplemental insurance for abortion care, also known as “riders.” Since the insurance ban does not include exceptions for rape or incest, that means a woman who was raped and got pregnant would not have insurance coverage for an abortion unless, in advance of getting raped, she had bought a rider. Hence “rape insurance.”

But the rider system also means that anyone who wanted their insurance to cover abortion would have to anticipate that need in advance, which again, makes no sense. Unplanned pregnancies are, by definition, unplanned. There are countless reasons why unplanned pregnancies occur and why women choose to have abortions, but a healthcare system in which quality coverage depends on omniscience seems unreasonable. The whole point of insurance is to protect against unforeseen risk.

Furthermore, just because states permit insurance companies to offer riders does not mean they actually do. According to a National Women’s Law Center (NWLC) survey, there is no evidence that supplemental coverage is available in the seven states where lawmakers have allowed it as an option. As a patchwork of regulations across states makes abortion coverage more costly and complicated, disincentives to offer this coverage are mounting for insurers nationwide.

The Reproductive Health Equity Act in Oregon aims to prevent this from happening. By requiring insurers to cover abortion, the state set the standard that abortion is healthcare and insurers have to cover it accordingly. In addition, creating a standard for coverage means Oregon women will definitively know they can use their insurance for abortion. Fifty-three percent of women pay out-of-pocket for abortion, even if they have insurance coverage, and this is often due to uncertainty.

“Many women with private insurance plans fail to use their coverage for reasons including because they assume abortion is not a covered service and because they were given incorrect information regarding their plan’s policies on covering abortions,” wrote Katrina Kimport and Brenly Rowland, two researchers from the University of California, San Francisco, in a study released in late August.

The opacity, complexity, and volatility of policies surrounding insurance coverage and abortion care don’t just cause financial problems for patients, but also for clinics. Independent abortion care providers perform sixty percent of abortions in the U.S., but they are rapidly disappearing. According to the Abortion Care Network (ACN), which tracks clinic closures, the number of independent providers has plummeted by nearly thirty percent in the past five years. Many such clinics have subsidy programs to keep costs low for their patients, and coverage bans will take an additional toll on their solvency. If the trend continues, more clinic doors will close. The fewer clinics there are, the farther women have to travel to get care and the more the costs stack up.  If abortion is unaffordable for the vast majority of American women, it’s a right in theory, not in practice.

https://newrepublic.com/article/144793/insurance-cover-abortion