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Dude said it was a joke after I shared my abortion advocacy job while online dating. I wasn’t amused.

Last week, online dating giant OKCupid announced a partnership with Planned Parenthood. Site users can choose to answer a question about the health-care organization and earn an #IStandwithPP badge for their dating profiles. OKCupid says that about 200,000 people have now identified themselves as Planned Parenthood supporters.

This move, which allows me to see if someone disagrees with efforts to defund Planned Parenthood, couldn’t come at a better time for me. Last week, I had a run-in with the shadiest of online dating characters: the secretly anti-choice guy. We met on OKCupid and matched on a number of variables. We both have young kids; we both like travel and the outdoors.

I thought he was cute, so I suggested moving off the site to text, adding a humorous pre-admonishment not to send dick pics. I didn’t realize this would be nearly prophetic.

He texted, “What type of work do you do?” I replied, “abortion rights.”

I work in abortion rights advocacy in North Carolina. No lie, it’s a sweet gig and I’m super proud of it. I’ve worked for more than a decade for feminist causes, and it’s such a personal victory to say my career is specifically in abortion access.

But sure enough, my would-be-dreamboat showed me his—metaphorical—dick.

“Ugh your [sic] a baby killer.”

In that moment, I was the physical manifestation of the “typing” ellipses that tell you when someone begins typing but hasn’t hit send. I sat agog, staring at the hateful words.

Working in abortion advocacy means knowing some people find your work controversial. When I go to a clinic or step into the halls of my state’s legislature, I steel myself for the attacks. I harden myself against those who would take away the rights of others who choose abortion.

But when I’m online dating, I’m a bit softer. I have an expectation that the guys trying to hook up with me—the guys who had to see a picture of me holding a pro-abortion sign to reach my profile—will treat me with a modicum of respect.

While I sat in shock, another text followed.

“Hahah jkjk I believe it’s choice”

And another.

“I was looking for a fire up on your end.”

Oh, buddy. You have no idea what kind of fire you just set.

There is a rich tradition of men being offensive and then gaslighting those who don’t laugh, accusing them of not being able to take a joke. It felt like I was being set up to fail, no matter how I replied. Since the forum was online dating—in theory, a lighthearted space—I could feel my own internalized pressure to laugh it off and reassure this man that he was still in my good graces.

It was frightening to respond with my own truth.

“I mean, it’s not a great joke,” I wrote back after some consideration. “It’s my life’s work, you know?”

Long pause from my suitorduring which I experienced the self-doubt and adrenaline dump that confrontation brings.

Clearly, this should have been it. I should have written off the guy and moved on to other prospects. But because I am a communicator, a consensus seeker, and a glutton for punishment (and maybe because I just wanted to win, dang it), the conversation continued. If I were in any other career, I argued, it’d be offensive for him to make a joke at my expense.

“I’m not sure when it was made clear to me you were passionate about … oh well as I said I didn’t mean to offend you,” he wrote.

I wished him best of luck in his endeavors and closed the chat window.

As a woman, my body is a target. As a public-facing abortion rights activist, my work can be in the crosshairs. I receive hateful, even threatening Facebook messages almost weekly. Some even question my parenting abilities. I’ve been called a “baby killer” more times than I could ever count. I have no expectation that abortion rights is a 40-hour-a-week endeavor. But when it creeps into my dating life, I’m knocked off kilter.

A few years ago, newly divorced and fresh to the world of dating, I went out with a guy who didn’t know about my work before we sat down for drinks. When talk turned to careers, he asked me, “Don’t you think some people use abortion as birth control?” To my shame, I quickly changed the subject; I was more afraid of losing his attention than I was passionate about standing up for my values.

This time was different. Although I didn’t respond with anger and outrage, at least I pushed back. I had to wonder: How would have this been different if I were in a professional context?

Had I been on a street with a protest sign, I would have spoken with authority, telling him how his words were incorrect, and how they hurt women. If I were on the record with a TV station or a newspaper I would have quoted statistics or given a powerful quote.

But since I was in the odd interstitial space of online dating, where we are all concurrently strangers and also potential intimate partners, I didn’t have a snappy clapback waiting in the wings.

Two years ago when I built my first-ever online dating profile, I listed my profession as “nonprofit communications” and left my profile pictures apolitical. Since that time, I’ve had some good dates—great dates even—where I revealed my work, and I’m lucky that I seldom encountered negative responses.

That luck is probably more a statement about my liberal bubble. Stigma against abortion—and against those working in abortion advocacy—is very real and documented. Many of us don’t tell our potential dates what we do—at least not at first—because you don’t know what response we’ll get. People who work in abortion, like me, often cluster together to avoid the violence, harassment, and pain involved in dealing with people who accuse you of murder.

Unfortunately in online dating, there is no true safe space and no way to really cluster with like-minded individuals. An online badge like #IStandWithPP could even be a method creepy anti-choicers use to gain access to abortion advocates like me.

If I sound paranoid, I’m not. A local abortion provider recently revealed that she’d been raped by an online dating match, who talked about her work while assaulting her.

I’ve realized that I concealed the true nature of my work not out of personal privacy, but because I was afraid of rejection based on it. Realizing the absurdity of working specifically in abortion communications while being shadowy on OKCupid, I switched to a more “out loud” dating profile. My number of responses immediately went down, but the quality went up.

“I love the work you do! Get it!” wrote one anonymous dude a few weeks ago.

I just checked, and my gaslighting chat companion doesn’t have the #IStandWithPP flare on his profile. Then again, neither did I until a few days ago when I read about the promotion. It might be a helpful sign in the uncertain universe of online romance, but like any bumper sticker, yard sign, or T-shirt, it can’t be the only sign of a paramour’s convictions.

I join OKCupid in standing with Planned Parenthood, but I also stand with every woman who has been gaslighted in an interaction with a man—especially by a stranger on a dating site.

OKCupid, could you make a badge for that? It might save us all some hassle.


The Graham-Cassidy bill has all the problems of its predecessors — and some new ones.

Supporters of Planned Parenthood at a rally in Los Angeles on June 21, 2017.
 MARK RALSTON / Getty Images

Republicans’ latest effort to repeal Obamacare may look a little different from previous attempts — sponsors argue, for instance, that the plan lets states keep Obamacare if they want to. But when it comes to reproductive health care, the bill sponsored by Sens. Bill Cassidy (R-LA) and Lindsey Graham (R-SC) is a lot like previous repeal bills, except in areas where it’s much harsher.

Like previous bills, Graham-Cassidy imposes new restrictions that would make it harder for people to get insurance coverage for abortion, and for low-income patients to visit Planned Parenthood. Also like the other bills, it threatens Medicaid coverage and makes it easier for states to get rid of maternity care requirements.

A new element in this bill is that its program of block grants would create new ways for the federal government to restrict abortion coverage. Republican-led state legislatures have been working to curtail abortion access and pull funds away from Planned Parenthood for years now; Graham-Cassidy would accomplish both goals on a national scale.

Graham-Cassidy includes a lot of familiar abortion restrictions

The bill includes a provision, similar to those in previous repeal bills, that would effectively bar the use of federal Medicaid funds to pay for care at Planned Parenthood clinics. This would mean low-income patients who rely on Medicaid wouldn’t be able to get care at Planned Parenthood. Backers of such provisions have often claimed that community health centers would be able to fill in the gaps left by Planned Parenthood, but many reproductive health experts say this is unrealistic, since those centers would have to double or even triple the number of patients they saw for certain services. In order to replace Planned Parenthood’s contraceptive services, one of the many services they offer, health centers would have to see 2 million extra patients nationwide, according to the Guttmacher Institute.

What’s more, Planned Parenthood is a trusted and familiar provider for many patients, who may not necessarily know anything about their local community health center. As Dan Ramos, a state representative from Ohio, told the New York Times last year, “If someone doesn’t know where to turn, they know that Planned Parenthood provides a service that they might need.”

Like its forebears, Graham-Cassidy also includes restrictions on abortion coverage. Patients who got a tax credit to buy insurance on the individual market wouldn’t be able to use it to purchase insurance with abortion coverage, and small businesses that received a tax credit for providing insurance to their employees wouldn’t be able to offer plans covering abortion. Over time, this would mean fewer people would be able to buy individual plans that covered abortion, and so fewer insurers would offer them. Patients who can’t get insurance coverage for abortion are sometimes forced to forgo food or other necessities to pay for the procedure and may try to self-induce an abortion, which can be dangerous.

Graham-Cassidy would let states cut requirements that insurers cover essential health benefits, meaning insurance companies could stop offering maternal care or prescription drug benefits. Thirteen million women could lose access to maternal care.

Finally, the bill would end the Medicaid expansion, potentially depriving millions of low-income Americans of coverage. (The Congressional Budget Office announced on Monday that it would release a “preliminary” analysis of the bill early next week, but that won’t include an estimate of how many would lose coverage.) One in five women of reproductive age get their health insurance through Medicaid, and cuts to the program would put essential reproductive health services out of reach of many low-income Americans, especially black and Latino patients. More than half of all births and three-quarters of publicly funded family planning services are currently covered by Medicaid.

The bill also adds a new way for the federal government to restrict abortion at the state level

The new concerns for reproductive rights in Graham-Cassidy largely stem from its block grant program. As Vox’s Sarah Kliff explains, the bill would repeal Obamacare’s individual tax credits and the Medicaid expansion in 2020, and replace them with grants to the states. Those grants could then be spent in a variety of ways — on high-risk pools, for instance, or on programs “to help individuals purchase health benefits coverage.” But, crucially, none of the money from the grants could be spent on insurance coverage for abortion.

Many states already have restrictions on insurance coverage for abortion. But Graham-Cassidy would require all states to ban abortion coverage in any program that gets federal block grant money. If it took money to offer subsidies for individual coverage or otherwise bolster the individual market, then it would have to restrict abortion coverage on that market. If it used federal funds to offer subsidies to employers, the ban on abortion coverage would affect the employer market too.

Essentially, the federal government would have the states over a barrel — if they wanted money to help keep their residents covered, they’d have to sacrifice abortion coverage to get it.

Because there’s no telling yet exactly what states would do with the block grants, or how the law would be interpreted, it’s not clear what the impact of the abortion restrictions would be. But the block grant program would certainly offer the federal government a new and powerful tool to restrict abortion coverage, including in states that have few restrictions in place now.

It’s also worth noting that spending for the bill would expire in 2026, meaning that unless Congress acted to replace the block grant money somehow, anybody who relied on that money for any reproductive health care — or, indeed, any health care at all — would be out of luck.

Moderates in the Senate have expressed reservations over past repeal bills that would have left millions of low-income Americans uninsured. Sens. Lisa Murkowski (R-AK) and Susan Collins (R-ME) have opposed stripping funding from Planned Parenthood — and have votedagainst every repeal bill so far. As Vox’s Dylan Scott reports, the bill still needs a CBO score and the approval of the Senate parliamentarian before it can come to a vote, and in order to pass it, the bill’s sponsors can only afford to lose two Republican votes.

Graham-Cassidy would leave millions without coverage and severely curtail reproductive health coverage nationwide. It remains to be seen if that’s enough to kill it.

Correction: This article originally stated that the Graham-Cassidy bill would require states that got federal block grant money for their Medicaid programs to stop using state Medicaid funds to cover abortion. The bill would not do this.


As the founder and CEO of Whole Woman’s Health, it’s the right thing to do.

As soon as I heard Hurricane Harvey was coming to wreak havoc on Texas, I decided to offer free abortion care at Texas Whole Woman’s Health clinics to women affected by the storm. As independent abortion care providers rooted in the communities we serve, we stand up for the people who need us most. We did it after Hurricane Katrina in August 2005, we did it for Hurricane Rita in September 2005, and we did it for Hurricane Ike in September 2008. Until the end of September, we’ll be doing it again for those affected by Harvey. This is who we are, and this is what we do.

In trying times like these, I remember something one of my fellow reproductive rights warriors told me years ago. We were tangled in a Supreme Court case to fight Texas’ TRAP law House Bill 2, which passed in 2013. HB2 required that any clinic offering abortion services be classified as an “ambulatory surgical center” and any doctor performing an abortion have admitting privileges at a hospital within 30 minutes of the clinic. As founder and CEO of Whole Woman’s Health, those years were a difficult blur (although our eventual triumph made every second worth it). HB2 was unnecessary—abortion, being 14 times safer than childbirth, is very safe—and its devastating passage forced us to close our clinics in Austin and Beaumont. (Our Austin clinic has since reopened).

As we fought that exhausting battle, a colleague said to me, “It is always the right time to do the next right thing.” I carry that with me always, especially in these times. Right now, as abortion rights are threatened throughout the country, offering no-cost abortion care to women affected by Hurricane Harvey is the right thing to do.

Natural disasters like hurricanes can compromise abortion access in many ways.

At Whole Woman’s Health, our values are based in the moral and ethical human rights work of supporting and caring for people. To us, quality abortion care is health care. But it is also an integral part of economic justice, racial justice, and true reproductive justice for all. Our care model is rooted in the belief that access to quality abortion care is not only vital to women’s autonomy and self-determination, it is essential to our ability to function in society with true equality.

After devastation from a storm like Harvey, everything changes. People often lose their homes, their cars, and their jobs. People may have to evacuate to an area without accessible abortion care. Work schedules are cut, school is canceled, and people worry about lost pets. Daycares are closed. Local health care clinics are, too. There are countless ways a natural disaster can make it difficult to find a health center that offers abortions or make it impossible to pay for one. That’s why we’re here to help.

Whole Woman’s Health can’t fix everything after storms like Harvey, but we sure can offer our expertise and compassion to ease the financial, logistical, and emotional burden of getting an abortion after a natural disaster. Our highly-trained team is ready to offer cost-free abortions throughout the month of September at our San Antonio, Austin, McAllen, and Fort Worth clinics. This is who we are. We take care of each other.

Responses to our providing free abortions to those affected by Harvey have, unsurprisingly, been mixed.

Our efforts have drawn the attention of right-wing zealots. They have responded to our no-cost abortion care relief efforts with great vitriol. They’ve trolled us by asking whether anyone has been raped by the hurricane. They’ve targeted me personally in memes with my photo, saying simply awful things like, “There is a place in hell for you, Amy.” It appears our kindness to people in need makes them hostile. Go figure.

Delightfully, we have also had a great outpouring of support online, as well as generous donations to our Stigma Relief Fund, which is how we’re able to provide these services for free. We currently have 74 patients who have had care or are booked for care using this program. To date we have raised $15,000 for this effort, but the total cost of care for these patients will come to $40,000. If you’d like to donate, you can do so here. These contributions will serve the women who need them the most.

Let me tell you about a woman who is coming to one of our clinics this week after her life was devastated by the hurricane. She will have to take three overnight buses to access the Whole Woman’s Health closest to her, which will get her to town at 6:00 in the morning. Then she needs to take an Uber or a Lyft to a coffee shop or restaurant that is open early to wait for our clinic to open. And this is just for her “consult visit,” where she has to have a state-mandated sonogram and a script meant to intimidate her read to her by the physician. After that, she’ll have to spend the night away from home, unable to get her abortion until 24 hours after her sonogram, because of Texas’ cruel 24-hour delay law.

After she finally has her abortion with us, she’ll repeat the ride-sharing and bus routine back to her home. Through generous donations to our Stigma Relief Fund, we’ll be able to pay for all of this. Even when it seemed we had everything in place, she called late yesterday and said she still needed to find child care for those two days away from her children. We hope to help her with that, too. This is all to get a five-minute, much-needed, first-trimester abortion she simply cannot afford. This is her right. It should be, no matter where she lives or her ability to pay.

It is for her and for the many people like her that we at Whole Woman’s Health do the work that we do. In these times in our country, in light of the devastation on so many levels, doing this one small thing is our honor. Along with all my staff and physicians at Whole Woman’s Health, I’m grateful to help Texans rebuild their lives with dignity.


Dan Fisher insists that government officials should simply disregard any abortion-related court ruling with which they disagree.

If Republican candidate Dan Fisher wins Oklahoma’s 2018 gubernatorial election, he plans to ignore court rulings protecting abortion access.

“If elected, I will do everything in my power to bring this evil to an end and take executive action to ensure that all Oklahomans are equally protected, including the preborn,” the former Oklahoma state representative said in a video posted to his campaign’s YouTube page last week. “I will disregard any unjust rulings or perversions of the U.S. Constitution that claim that there is a right to murder preborn human beings in the womb.”

Fisher said in the video that anti-choice laws passed by Republican lawmakers “really only spell out the requirements for killing a preborn baby,” suggesting that they don’t go far enough. “Every one of these pro-life laws affirm abortion as legal, treat it as an acceptable choice, and seek to regulate the practice. If you think about it, these laws are basically pro-choice.”

“I am not running for governor of Oklahoma as a pro-lifer,” he said. “I am not running to regulate abortion. I am running to abolish it.

He called for the U.S. Supreme Court’s rulings on the matter to be disregarded. “When the courts are wrong they should be ignored,” he said, pointing to the Court’s 1857 decision in Dred Scott to uphold slavery.

Fisher struck a nearly identical tone in late August when he kicked off his bid for the GOP nomination for governor of Oklahoma. At a rally of supporters in Oklahoma City, he called the common medical procedure “murder” and said that “if you accept that abortion is murder, you’ll treat it like murder.” He did not say what the penalties would be for having or providing an abortion, but Rick Carpenter, a spokesperson for Fisher’s campaign, told Rewire that it would be treated “much like your homicide laws.”

Despite no longer holding office, Fisher was present when Oklahomans United for Life visited the state legislature to support the Oklahoma House’s passage of a resolution instructing state officials “to exercise their authority to stop murder of unborn children by abortion.” The text of the measure includes a line recognizing that “procuring or administering a non-life-saving abortion in Oklahoma is a criminal offense,” pointing to two statutes on the books criminalizing abortion in the state.

Those statutes state that receiving abortion care in Oklahoma is punishable by up to one year in prison and up to $1,000 in fines.

“In 2018, we’re going to have a new governor, and the governor better enforce the will of the people as expressed in this Resolution today,” Fisher said, according to an email newsletter from Oklahomans United for Life.

The anti-choice group sent a letter to Gov. Mary Fallin (R) after the resolution passed, demanding that the state’s chiefs of police and county sheriffs “station guards at the doors of” abortion clinics to block anyone trying to obtain care. “If these officials refuse to cooperate, you have authority under the Oklahoma Constitution to declare an emergency and direct National Guard personnel or state police officers to carry out your orders,” the letter stated.

Oklahomans United for Life confirmed in an email to Rewire that it has endorsed Fisher’s gubernatorial bid.

During his two terms as a state representative for District 60, Fisher introduced several anti-choice measures including attempts to prohibit certain types of research on human embryos. Eliminating legal abortion in Oklahoma is the first issue listed on Fisher’s campaign website, which includes a call to “turn Oklahoma into the first Abortion-Free-State.”

In a video posted online in July that depicts an appearance at an Oklahoma Conservative Political Action Committee (OCPAC) event, Fisher named abolishing abortion as one of the “four main planks” of his platform. In that same speech, he compared being a “pro-life Republican” in office without acting to end legal abortion to “liv[ing] in a community next to one of the concentration camps in 1944 Germany” and passing laws regulating the camps instead of ending them.

His platform calls for renewed focus on “state sovereignty,” protecting the “rights of gun owners,” and removing regulations on the energy industry.

Fisher received money in previous campaigns from energy companies, including small donations from Koch Industries, American Electric Power/AEP, and Spectra Energy, according to campaign finance records obtained through the National Institute on Money in State Politics’ database.

Fisher will compete against an increasingly crowded field of Republicans for the party’s nomination to replace Oklahoma’s term-limited governor.

Fallin won re-election in 2014 with nearly 56 percent of votes compared to Democrat Joe Dorman’s 41 percent. The seat is rated “likely Republican” by Inside Elections with Nathan Gonzales and Roll Call, meaning Republicans have “a substantial advantage, but an upset is still possible.”


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.


“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.


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.


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.


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.”