Last year, over 1,000 women travelled to England from NI to access abortion services. Why are people still forced to take a flight in order

As of a week ago, abortion is legal in Northern Ireland. Sort of. Abortion regulations came in to law on March 31 – making them technically legal, though still impossible to obtain as the government wrangled over how to actually roll them out. But last Wednesday, this was ratified in the House of Commons and the House of Lords; two votes confirming that the service must be made available to women in Northern Ireland from here on out.

Over 60,000 women have travelled to England since 1970 in order to terminate a pregnancy – including in the months since the regulations passed the first hurdle in March; overwhelming evidence that abortion is needed in Northern Ireland. Julian Smith understood this when he was Secretary of State for Northern Ireland, drafting the consultation on the regulations, but our devolved government has meant this issue is regularly stymied by politicians who cannot reach a consensus. Arlene Foster, the first minister, has previously blocked attempts at legalisation. “I don’t think it’s any secret that I don’t believe that abortion on demand should be available in Northern Ireland,” she said in April. “I think it’s a very retrograde step for our society.”

The House of Lords has stood firm in support of the Convention on the Elimination of all forms of Discrimination Against Women (CEDAW) and their inquiry findings on abortion in Northern Ireland in 2018, which found that the UK was guilty of grave and systemic human rights abuses by forcing people to have to travel from NI to England for abortions. It also stated unequivocally that devolution agreements do not preclude regions from obligations to human rights treaties, which subsequently means Westminster will always be ultimately responsible for human rights in NI. Similar findings were reflected again in the Women and Equalities Committee Inquiry on Abortion in 2019 which acknowledged the rise of the illegal use of telemedicine abortion pills from online sources; Westminster has since then been tasked with acting where the Assembly had failed.

Just two weeks ago, the Stormont Assembly held a vote to try and demonstrate to Westminster that NI opposed the new legislation. The vote did show a majority opposition, but this was hinged on one point; abortion legislation being extended to all non-fatal disabilities, such as Down’s syndrome.

Westminster has rightly stepped in after years of Stormont prevarication. Now all the Department of Health in NI has to do is properly commission services and provide information for doctors and abortion seekers. Yet, when pressed, they have said that they will not do so until there is full agreement from the Stormont Executive – a move that is legally unnecessary and what appears to be a ploy to allow the DUP and others to block and delay these long-awaited provisions coming into effect.

The DUP voted in April against a proposal to allow doctors to prescribe the abortion pill via telephone consultations – a measure that has been introduced across the rest of the United Kingdom in the wake of coronavirus lockdown. The Ulster Unionist Party abstained, a source close to the Northern Ireland executive said.

Westminster has made clear that any changes they make to the regulations must remain CEDAW compliant. CEDAW recommends a diagnosis of severe foetal abnormality should be treated without having to travel to England. That means that people like Sarah Ewart, who was denied an abortion in Northern Ireland in 2013 despite doctors saying her baby would not survive outside the womb, would be spared having to seek medical help in another country. It would treat those like Ashleigh Topley, who had to carry her pregnancy to term knowing that it had a fatal abnormality and would not survive. Seven years on, she still receives mental health support for this tragedy.

In October 2019, a judge at Belfast’s High Court ruled that Northern Ireland’s abortion law breaches the UK’s human rights commitments.

Previously, NI’s 1939 Bourne judgement allowed for abortion in cases where the mother’s mental health is at risk. In a more liberal society this would have meant abortion was legal, but in NI that was not enough. These regulations are now much clearer for outlining unequivocally that travel is not a human rights compliant solution, despite the proclamations of the Northern Ireland Office, who continued to advertise travel to England for NI women at the height of Covid-19.

The regulations also make clear it is the Department of Health who have to implement this. This means commissioning services, training staff, allowing trusts to get on with their work and publishing clear pathways. The NI Direct website has no information about what is currently available, should a woman be looking to seek an abortion; a Google search only brings news articles about campaigns.

We have seen rogue pregnancy centres in Belfast pretend to be abortion clinics, but use this ruse to misinform women that abortions will give them breast cancer, and purposefully delay women so that they are beyond the 10 week limit that would mean they can easily access and Early Medical Abortion. We need clear signposting from government bodies that mean women in crisis do not end up in places where seeking help may result in the opposite, without their knowing.

Alliance for Choice have been campaigning for abortion rights in NI for decades, and have been involved in a number of court cases, including one at the Supreme Court. We have helped people access pills from reputable sites, guaranteed access to abortions for those who cannot travel, gathered and shared people’s stories of abortions to try and undermine the mytth of the ‘typical abortion seeker’, and have heard the horrific experiences so many have been put through because of archaic laws that prevented access to legal abortions in our own country. We helped our siblings in Ireland campaign for the abortion referendum, and have continually fought for free, safe, legal and local abortion access because we understand the toll on people that secrecy and travel takes. Last year over 1000 women and girls travelled to England in order to access abortion services, we will continue to lobby Stormont, Westminster and the Dáil to make sure this becomes zero. Healthcare should not involve an airport.

These regulations being ratified should have meant we have achieved our goals and can take a well-earned break, yet health trusts are now finding themselves put in the very difficult position of trying to provide with no resources, training, staff allocation, or public health campaign as the Department of Health drags its feet.

Until abortion is free, safe, legal and local and until we have access to abortion, we will continue to call those in power to account.


It took President Donald Trump less than four years to take over the federal courts. It will take us a lifetime to undo the damage.

President Donald Trump may end up losing the presidential election in November, but the 200 judges he already got confirmed to lifetime appointments will outlast the next several elections.
U.S. Senator Chris Coons/YouTube

This afternoon, President Donald Trump got his 200th federal judge confirmed to a lifetime appointment.

It’s been an unbelievable run.

During a typical presidency—one where there isn’t someone like U.S. Senate Majority Leader Mitch McConnell (R-KY) ramming unqualified judge after unqualified judge through the nomination process—you could expect around 30 fewer confirmations. But one in four circuit court judges is now a Trump judge. The circuit courts are the federal appellate courts—the second-highest courts in the land. Those judgeships have always been pretty blindingly white, but Trump has nominated not a single Black person for those seats.

That whiteness isn’t limited to the appellate courts. All of Trump’s federal judge picks are substantially whiter than Obama’s appointees, and overwhelmingly male. And what’s perhaps most distressing is Trump’s picks are much younger: Cory Wilson, who was confirmed Wednesday afternoon to the U.S. Court of Appeals for the Fifth Circuit by a 52-48 vote, is 49. In fact, the Trump administration has bragged about the young judges that have been confirmed—the average age for Trump appointees is ten years younger than that of Obama’s.

A judge like Wilson now has decades to affect the federal appellate courts, so the impact of all these Trump nominations cannot be overstated. There’s legal immunity for killer cops. There’s the state of legal abortion. There’s full LGBTQ equality. There’s immigration.

These are just a handful of critical issues the federal courts will weigh in on in the coming months and years. Thanks to Trump’s success in stacking the courts, the circuit courts will consist of a bunch of Brett Kavanaughs and his fraternity brothers (and very few sorority sisters) deciding if social service agencies can discriminate against queer families or if states can ban abortion before patients even know they’re pregnant.

How does Trump find such dewy-eyed, youthful judicial candidates? In part, it’s because he’s letting the Federalist Society basically pick judges for him, regardless of their experience. Of the 53 judges Trump has put on the appellate courts, all but eight are tied to the Federalist Society, which is basically a breeding ground for lawyers who hate reproductive health freedoms.

It’s also because the administration is willing to give woefully unqualified people lifetime appointments to these seats, so the nominees don’t have to have spent years doing things like “practicing law.”

In fact, the American Bar Association (ABA) has rated nine of Trump’s judicial picks as “not qualified.” By contrast, during Obama’s two terms, the ABA gave exactly zero of his judicial picks that rating.

Consider Jonathan Kobes, now on the bench for the Eighth Circuit. Kobes, who is 45, was only 43 when Trump tapped him for the seat. Kobes was such a weak candidate that the ABA functionally couldn’t evaluate him. They had “difficulty analyzing Mr. Kobes’ professional competence” because he couldn’t even provide the sort of writing samples the ABA would typically review. Kobes gave the ABA some examples, but they said those were “either from Mr. Kobes’ early days as a lawyer, relating to relatively simple criminal law matters, or from his recent legislative work for Senator [Mike] Rounds. None of the writing that we reviewed is reflective of complex legal analysis.”


Of course, Kobes got confirmed anyway, and he’s recently showed us he’s just fine with cops shooting unarmed people in the back.

For a more recent example, there’s Justin Walker, Trump’s 199th confirmed judge; the U.S. Senate confirmed him last week. Walker is the newest member of the D.C. Circuit and he’s only 38 years old, getting the seat after less than nine months on the Western District of Kentucky bench. When he was up for the Kentucky seat, the ABA rated Walker as “not qualified” for several reasons, chief among which was that he basically had no experience as a lawyer. What Walker did have, though, was a ton of experience boosting U.S. Supreme Court Justice Brett Kavanaugh during his confirmation hearings—and that’s what counts these days.

In a typical presidential administration, a crusade so strong it appeared to make someone unable to “exercise dispassionate and unbiased judgment”—which is kind of the whole point of being a judge—would be disqualifying. In Trump’s world, this is a feature, not a bug.

Together, these Trump judges are shifting federal courts rightward at a fast clip. They have no real incentive to behave impartially, as they were chosen precisely for their ability to be partial to a conservative agenda.

Right now, here’s the figure and number you should be most worried about: The former head of the Federalist Society is revving up a dark money group that’s poised to throw at least $10 million at a campaign focusing on judges in the 2020 election.

Liberals need to put the issue of judges front and center for Election Day as well. The effects of the Trump agenda are going to be felt for decades, long after this administration is consigned to the ash heap of history. Clawing back the federal courts, nomination by nomination, is going to be key to pulling us back from the brink of a world where only white straight Christian men have rights.

Trump may end up losing the presidential election in November, but the 200 (and counting) judges he got confirmed to lifetime appointments will outlast the next several elections. Remaking the federal courts must be a top policy priority for progressives and Democrats moving forward. Otherwise, Trump may as well just be in office forever.


Ban beginning at six weeks, which is before most women know they are pregnant, is blatantly unconstitutional

The state capitol in Nashville. Photograph: Mark Humphrey/AP

Republicans in Tennessee have voted to ban abortion as early as six weeks after conception, in a surprise midnight vote held in the middle of a pandemic, without members of the public present.

The ban beginning at six weeks, which is before most women know they are pregnant, is blatantly unconstitutional and will almost certainly be blocked in the courts before it goes into force. Reproductive rights advocates were swift to promise a challenge.

The bill was not listed on the state legislature’s calendar and the vote took place in Nashville in a state capitol closed to the public because of the coronavirus pandemic.

The rate of new coronavirus cases in some Tennessee counties has risen, although the state’s weekly trend has plateaued.

Alexis McGill Johnson, acting president and chief executive of the Planned Parenthood Federation of America, said: “It is a disgrace that in the face of a true public health crisis, Tennessee politicians wasted their time with this last-minute move to attack abortion access before closing up shop this session.”

According to a local reporter, the only protesters present during debate were three women in masks who “snuck” into the public gallery. Placed in handcuffs by all-male capitol police, they yelled “Banning abortion in Tennessee does not save lives!” and “Pro-life is a lie, we don’t care if women die!”

The bill is almost certain to pass into law, as it was proposed by the state’s governor. It comes just days before the US supreme court is expected to issue an opinion in the most highly anticipated abortion rights case in decades.

Abortion is legal in all 50 US states, despite a recent spate of bans. The procedure was legalized to the point a fetus can survive outside the womb by the US supreme court in 1973, in the landmark case Roe v Wade.

The upcoming ruling is expected to indicate the nine-member court’s appetite for restricting abortion. The panel has a 5-4 conservative majority, thanks to the confirmation of two justices nominated by Donald Trump. Notably, all the conservatives are men.

During debate in Tennessee, Gloria Johnson, a Democrat from Knoxville, said: “I feel like there was a bargain made on my reproductive health rights in order to get the budget passed.”

The headline restriction of the new bill is a “heartbeat” provision, which bans abortion after fetal cardiac activity can be detected, which is typically between six and eight weeks after conception. At that stage, a pregnancy is still classed as an embryo. The chambers of the heart and the circulatory system are not yet formed.

The bill also requires abortion clinics to post a sign and provide information telling patients medication abortions may be reversible – although there is no medical evidence to support the claim – under penalty of a $10,000 fine.

It bans abortion outright for juvenile women in state foster care and bans abortion if sought because of a Down’s syndrome diagnosis, or because of gender or race. There are no exceptions for cases of rape or incest.

The bill also requires doctors to perform an ultrasound and forces women to view images of the fetus and to listen to cardiac activity and a description of its limbs and organs. Those requirements are likely to drive up the cost of abortions, which are primarily obtained by young and poor women.

The ban is also sequential, according to the Tennessean. If a court strikes down a provision banning abortion at six weeks, a ban will automatically be instituted at 10 weeks, then 12, 15, 18, 20, 21, 22, 23 and 24 weeks. A full-term pregnancy is 39 weeks after a woman’s last period. A fetus can live outside the woman at 24 weeks, although it is more likely to suffer severe disabilities. Abortions late in pregnancy are extremely rare.

“Hopefully we can protect more lives, we can save more babies,” said the Republican state representative Susan Lynn, according to local news station WJHL.

Despite the pandemic, Tennessee Republicans have refused to pass a bill to expand health insurance to 280,000 low-income residents who have no access to the healthcare system. According to the Kaiser Family Foundation, more than 666,000 Tennesseans lack insurance, including more than 77,000 children.


Pro-choice Christians exist! With Roe v. Wade in mortal danger, they’re mobilizing around “reproductive justice”

Donald Trump holding the Bible (Getty Images/Salon)

onald Trump’s upside-down Bible photo-op at St. John’s Church has led to unprecedented blowback from retired military generals, culminating in a mea culpa from Gen. Mark Milley, chairman of the Joint Chiefs of Staff. But the religious pushback was similarly sharp, starting with the Rev. Gini Gerbasi, an Episcopal priest who was among those “literally DRIVEN OFF of the St. John’s, Lafayette Square patio with tear gas and concussion grenades,” as she described on Facebook — an extraordinary use of state power to crush religious liberty. A bevy of leaders from the Episcopal Church spoke out forcefully, soon joined by CatholicsLutherans and others, including some evangelicals.

But as McKay Coppins writes at The Atlantic, “most white conservative Christians don’t want piety from this president; they want power.” In particular, they want the power of his judicial appointments, with the goal of overturning Roe v. Wade, writing their minority views into law for generations to come, even as their share of the population (though not the electorate) plummets. As noted in a forthcoming report from Political Research Associates, support for legal abortion is at a 25-year high:

At the same time, the main voting bloc opposed to legal abortion — white evangelical Protestants — is shrinking as a share of the population, even as it holds steady as a share of the electorate:

There could not be a more clear-cut example of anti-democratic minority rule than the multi-decade process of eroding abortion access, with ultimate goal of overturning Roe v. Wade.

But it’s not just a majority of Americans whose views are being overridden. It’s a majority of America’s religious believers, too. Hence the title of the report: “The Prochoice Religious Community May Be the Future of Reproductive Rights, Access, and Justice,” by PRA senior research analyst Frederick Clarkson, who wrote an essay and led a online colloquium based on his findings in mid-May. As the title of one section argues, “The Power is Not in the Polls; It’s in the Organizing.”

In the essay, Clarkson writes, “There is a vast prochoice religious community in the United States that could provide the moral, cultural, and political clout to reverse current antiabortion policy trends in the United States…. Taken together, they have vast resources, institutional capacity, historic and central roles in many towns and cities, and cadres of well-educated leaders at every level.”

This is not brand new, in historical terms. In his report, Clarkson cites the story of the Clergy Consultation Service on Abortion, the largest abortion referral service in pre-Roe America, with nearly 2,000 religious leaders involved.

His findings were not what he had initially expected, Clarkson told Salon.

“For many years, my colleagues and I have argued that there is much to be learned from the successes of the Christian Right (and much that we shouldn’t emulate),” Clarkson said via email. “But when I was tasked with a project to look over the horizon to a time when Roe v. Wade will have been overturned, I didn’t expect I find myself trying to live up to my own advice.”

He discovered that “part of the secret of the success of the Christian Right was what are called ‘parachurch’ organizations, and that the time had also come for the pro-choice religious community to have some of their own, if there was going to be any hope of turning things around someday.”

The power of “parachurch” organizations

Parachurches are nonprofit organizations outside denominational control, and Clarkson describes three different sorts of roles they could play. The first is issue-oriented groups, rooted in basic shared values. “A menu of possibilities would include the creation of state, local or regional groups — at least as pilot projects — to figure out what works and what doesn’t,” he said.  They could also vary in focus from within a single denomination, such as Catholicism, to being ecumenical or multi-faith. “They might also be multi-issue in the manner of what Religious Left organizations might be like if reproductive choice, access and justice were part of the agenda.”

The second sort of organization is electorally-oriented: both creating a voter base and building a cadre of political workers — up to and including candidates and office-holders. But they would not go away after Election Day. Their whole purpose is to be ongoing, to build capacity over time and not to require reinvention every two or four years.

The third kind of organization is needed to support the first two: clearinghouses, or strategy and training centers.

The overall result is more than the sum of the parts. “The genius of the Christian right was, first, to adjust theologies and connect specific religious values to the activities of politics and government and to the ongoing project of building for power via electoral politics,” Clarkson said:

Pat Robertson’s Christian Coalition was the first large-scale such organization, its leaders having moved past the apolitical theologies of evangelicalism to ones that not just accommodated, but required political action and governmental control. What historian Gary Wills recognized was, it was all about dominion. The coalition not only sought voters to expand its base, but turned voters into activists, activists into politicians and political professionals, and politicians into candidates and government officials.

All of that is what goes into keeping the Christian right’s political power constant, even as its share of population continues to plummet.

“Groups on the liberal left of the religious community might say they already do some of this,” Clarkson observed. “But exactly none, to my knowledge, do such things with the comprehensiveness and on the scale that the organizations of the Christian right have done — especially in organizing across the electoral cycle with a vision for the future.”

There are lobbying groups connected with major religious institutions that “focus on regulations, legislation and making public statements,” Clarkson said. “All good, but not the same thing as developing a broad and deep vision, and building capacity for electoral engagement.”

Another way of understanding parachurch organizations came from researcher Rachel Tabachnick in a response paper. She introduced a simplified organizational structure tree describing how they function: “First, the branches of the tree represent the deliverable products and services…. policy guidelines, education, media, get-out-the-vote efforts, etc.” Second, “The trunk of the tree represents the tangible resources,” which she describes in shorthand as “Fixers, Funders and Fellows.” The fixers are the architects who create the organizations. Third are the roots, the intangible resources: “These are often the least visible assets, but they are the foundations on which the rest of the organization depends. These include knowledge, vision, values and ideas.”

The religious right has had a relatively easy time building its infrastructure, in part because it was a social minority with relatively homogeneous views and strong deference to authority. In his essay, Clarkson writes:

The Christian Right has had the benefit of being more religiously and racially homogeneous while the prochoice religious community will necessarily be religiously and racially more diverse. Navigating our differences while building greater unity may be challenging, but the call to do so is at the core of the values of most religious communities — and this usually includes the commitment to the values of religious freedom, religious equality, and separation of church and state.

These core values alone could form the foundation for a broadly shared framework for advancing a pro-choice religious agenda. Separation of church and state is historically important for many people of faith — particularly Roman Catholics, as John F. Kennedy made clear in a famous speech to Protestant ministers two months before the 1960 election. A long line of Catholic politicians, in the spirit of Kennedy’s speech, drawn a sharp line between their own personal following of Catholic dogma (which is contested) and their actions as public officials.

The reproductive justice framework

But Clarkson also discussed another framework: that of reproductive justice, defined by the group SisterSong as “the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.”

This definition resonates with the comments of a CCS client who had chosen to have an abortion, interviewed by Gillian Frank and quoted in Frederickson’s report:

Later I had two healthy beautiful children and a marriage that’s been excellent, and I always felt that this fetus was a potential life, but I had, every month, the potential for life. And if I had gone forward with that pregnancy, the children I have now would not have come to be. And so this was a choice that I needed and deserved.

One of the colloquium respondents, Presbyterian theologian Rebecca Todd Peters, author of “Trust Women: A Progressive Christian Argument for Reproductive Justice,” elaborated on the reproductive justice perspective in comments she provided to Salon:

I would propose that the primary goal of this organizing should be to change the national conversation about abortion from a conversation focused on justification to a conversation focused on justice. Everything about how we think and talk about the issue of abortion is shaped by the justification framework and the belief that women need to justify their abortion decisions.

That framework needs to be rejected, she said:

The idea of focusing on reproductive justice [RJ] began with a group of 12 black women in 1994 and the RJ movement has been developed and led by women of color from the beginning. I have learned an enormous amount from the leaders and activists in the reproductive justice movement and I believe that RJ offers a clear and focused agenda for movement building that also has a solid prophetic connection to the social justice traditions of Christianity and Judaism that will make RJ organizing both challenging and meaningful in religious spaces and with religious communities.

Progressive religious traditions have repeatedly drawn on a justice perspective. Today, Clarkson noted, “a variety of issue coalitions that arguably fall under the definition of parachurch exist on the social justice spectrum, but they avoid any focus on reproductive health, rights and justice.” The reasons for this are varied. “Most originated in another time, when such matters were treated as marginal, if they were considered at all. Or they have no position and do not discuss such things because of the role of Catholics in the group. No such group has evolved in this regard, to my knowledge.”

Which is why the need should be obvious right now, as Peters, the Presbyterian theologian, notes:

Organizing outside of traditional church spaces is not the natural orientation of the progressive Christian community. There is a certain irony that the people who hold the most narrow and rigid dogmatic religious beliefs are also those who are simultaneously most interested, involved with and influenced by parachurch organizations like Focus on the Family and the Moral Majority. On the Christian right there is a unity of thought and dogma that is possible that I do not think is possible on the left.

At times, that unity can verge on sheer fantasy. As can be seen in one example that Tabachnick cited, the product of a 40-year relationship “between the ‘free market’ think tanks and the Family Policy Councils in many states” that “merges laissez-faire capitalism with social conservative policy”:

Evangelical activist David Barton, a Christian nationalist who has been described as one of the most influential leaders in the Christian Right today, exemplifies this blending of far-right social values and economic policy. He says he uses abortion as a litmus test to determine if a politician will “protect your money.” Barton says, “If you don’t respect the right to life, you won’t respect property, you won’t respect protecting income, you’ll think you ought to tax people more rather than protect their income, you’ll take it from them, you won’t protect their property, you won’t protect their religious liberties, you won’t protect their right of self-defense, you’ll try to take their self-defense away from them.”

Barton’s fantastical blending of right-wing grievances and bogeyman-paranoia is obviously not something progressives should seek to emulate. But if the content is inherently odious, the idea of developing new practices to build political power surely shouldn’t be.

Along these lines, Peters notes, “There are some very obvious spaces and places where the religious pro-choice community has ceded ground to the anti-choice folk. These are places where we can start our organizing,” based on a reproductive justice orientation.

First, she says, is “ministering to and with women who have had abortions,” explaining that “in refusing to recognize that abortion can be a reproductive loss (even if wanted and chosen), we have lost the opportunity to think about what women, particularly religious women, need and want in terms of spiritual and material resources as they navigate abortion care — including the weeks and months after their abortions.”

Second is working with local churches on reproductive justice, following the model of LGBTQ-welcoming churches that were critical to changing attitudes and understanding around LGBTQIA issues. “In my work across the country,” Peters said, “I continue to meet amazing and inspiring lay people and religious leaders who are eager for new and different language and ideas about how to think, talk and act differently on this issue in their congregations and in their communities.”

Third is “public religious voices in communities,” a ground-level approach to the misconceptions cited above. “The vast majority of the American public believes that the Christian position on abortion is anti-choice,” Peters observed. “While there are many of us who are speaking out with progressive Christian pro-choice arguments and perspectives, these voices are not being heard. A widespread public pro-choice campaign is needed and necessary in changing the public conversation about abortion in this country.”

In fact, parachurch groups could potentially develop programs that can synergize all three of the above.

In his conclusion, Clarkson writes: “This enormous sector of American society — the prochoice religious community — is currently under-recognized, under-reported on, under-resourced, and under-organized. But because this is so, it is also a virtually untapped source of hope for the future of reproductive freedom, access and justice — and that a better future is possible.”

When he wrote those words in mid-May, they might have sounded pollyanna-ish, even with all the evidence he had found. But consider how all our assumptions around police reform have been turned upside down in the last few weeks. Why can’t the same thing happen with reproductive rights?


In its first major test on abortion since President Trump appointed conservative Justices Neil Gorsuch and Brett Kavanaugh, the Supreme Court is expected to render a decision soon that will signal to state lawmakers how far they can go in restricting abortion access. How the Court comes down on the case could also serve as an indicator of its willingness to dial back reproductive rights going forward.

The case, June Medical Services v. Russo, comes out of Louisiana, but is strikingly similar to a Texas law the Court struck down four years ago in Whole Woman’s Health v. Hellerstedt. Both are considered to be the targeted regulation of abortion providers: Known as TRAP laws, they are medically unnecessary abortion restrictions that lawmakers pass under the guise of protecting women’s health.

This means the biggest change at play isn’t the Louisiana law itself or how it impacts women. It is who is sitting on the bench.

But first, what is the case?

In 2014, then Louisiana governor Bobby Jindal signed a law requiring that doctors performing abortions have admitting privileges at a nearby hospital. The law was challenged by Hope Clinic (whose corporate name is June Medical Services) and two abortion providers, and has been circulating through the court system ever since.

There are two key issues at the center of June Medical. The first is the restriction itself. The Louisiana law requires that abortion providers have admitting privileges to a nearby hospital, citing women’s safety. But complications from abortion are incredibly rare, and admitting privileges are hard to obtain by design. Roughly 70,000 abortions have been performed at Hope Clinic and only four patients have been sent to the hospital as a result of the procedure — equating to less than a .01 percent hospitalization rate. In conservative states where many hospitals are religiously affiliated or simply don’t want to be associated with abortion, the admitting-privileges requirement can greatly limit the number of providers able to perform the procedure, reducing options for women and therefore placing an undue burden on access. For this very reason, the Court struck down Whole Woman’s Health v. Hellerstedt in a 5-3 decision.

The other issue raised in June Medical is who can bring forward abortion cases. The state is arguing that Hope Clinic and its providers are not appropriate plaintiffs because they are not personally close with their patients, women can protect their own interests, and there is a conflict of interest when providers challenge regulations intended to make patients safer. But the admitting-privileges requirement has not been proven to protect women from harm; if anything, it limits access to safe, legal abortion, increasing risk.

Julie Rikelman, senior litigation director for the Center for Reproductive Rights, which is representing Hope Clinic, also points to the fact that the admitting-privileges law applies directly to doctors. Since they are subject to the law, and could lose their medical licenses or face criminal penalties if they violate it, she asserts that they are the right plaintiffs in this case.

Here’s another way upholding the law could have a huge impact going forward: Future cases would need to be brought by female patients or women seeking an abortion — not clinics or providers. Rikelman said this could be devastating for abortion access and many laws would go unchallenged. Women often do not have the resources to sue, and have concerns about their privacy.

How has SCOTUS changed since its last major abortion case?

In short: a little, then a lot. Gorsuch is reliably conservative, despite his surprising lead earlier this week on the Court’s ruling to protect LGBTQ people from workplace discrimination. But his presence on the bench didn’t change the liberal-conservative balance; he replaced fellow conservative Justice Antonin Scalia, who died a few months before the Whole Woman’s Health ruling (which left eight justices to decide the case).

It is Kavanaugh’s replacement of Justice Anthony Kennedy that marks the most significant change. Kennedy was a moderate conservative who became a key swing vote in Whole Woman’s Health when he sided with the Court’s more liberal justices, agreeing that the Texas law imposed an undue burden on women’s constitutional right to an abortion (a decision that saved most of the state’s abortion clinics from closing). But Kavanaugh is a hard-line conservative whose appointment has had abortion-rights advocates sounding alarms. Now, it is Chief Justice John Roberts — who was part of the dissenting opinion in Whole Woman’s Health, but has recently sided with liberal justices in multiple cases — who is expected to be the critical vote.

What are the political implications?

The decision comes in the middle of an election year, and will no doubt be viewed as either a victory or failure for President Trump, who pledged to put anti-abortion justices on the Court during his 2016 campaign — which he said would “automatically” overturn Roe. It didn’t, of course, but Gorsuch and Kavanaugh haven’t been up to bat yet. Now, in the middle of a national reckoning over racial injustice, these two white men chosen by a white, male president and confirmed by a mostly white, male Senate wield significant power over American women’s bodies.

The optics are glaring: Not only will the Court’s decision disproportionately impact low-income women, who may lack the means to travel out of state for care, but Black women. Due to an intersection of factors, including discrimination within the health-care system and lack of access to affordable, quality care, Black women terminate pregnancies at higher rates than white and Hispanic women. They also represent a higher percentage of state populations in parts of the country with severe restrictions.

How did we get here?

State battles over abortion laws largely stem back to the early ’90s, when in Planned Parenthood v. Casey, the Supreme Court upheld Roe but changed the legal standard by which restrictions are evaluated. The Court threw power back to the states, allowing restrictions that don’t place an “undue burden” on women seeking an abortion. The decision weakened Roe but did not, of course, overturn it. “What we’ve been faced with is really a tug of war over this … undue burden standard,” said Andrea Miller, president of the National Institute for Reproductive Health. “Ever since, it’s been, What is the purpose? What is the effect? What is the substantial obstacle?

What’s likely to happen?

How the Court will ultimately come down on June Medical is unclear, but the Court is expected to render its decision shortly. In March, abortion-rights advocates said they were encouraged by the questioning of Justice Roberts, who initially seemed likely to uphold the Louisiana law. During the hearing, he appeared frustrated when Louisiana solicitor general Elizabeth Murrill and U.S. principal deputy solicitor general Jeffrey Wall — who defended the law on behalf of the state and the Trump administration, respectively — struggled to adequately argue why the Louisiana law and the burden it placed on women was different from the Texas law previously struck down by the Court.

Alexis McGill Johnson, the acting president and CEO of the Planned Parenthood Federation of America and the Planned Parenthood Action Fund, said that she was heartened by the questioning “particularly of the female justices.”

Justices Ruth Bader Ginsburg, Sonia Sotomayor, and Elena Kagan predictably poked holes in Murrill’s arguments. Ginsburg called attention to the fact that women who have medication abortions take the pills at home and therefore a patient would likely go to the hospital closest to her, not her provider, making the doctor’s admitting privileges irrelevant. Kagan raised the issue that hospitals can refuse such privileges for a multitude of reasons that have nothing to do with the quality of the doctors and the care they provide. “They were talking about the practical implications of why this law makes no sense,” said McGill Johnson.


An amendment to a bill would require women to wait 24 hours after initial screening to receive an abortion. Pro-life groups see this as a step in the right direction, but Democrats say it was pushed through at the last minute without the public’s input.


Planned Parenthood in seen on Friday, May 8, 2020.

Early in the morning on Sunday, Republicans in the Iowa Legislature passed an amendment to House File 594 requiring a 24-hour waiting period between a woman’s initial screening with her doctor and an abortion procedure.

The amendment was tacked on to a bill that limits withdrawal of life-sustaining procedure from a minor. The bill was passed by the Iowa Senate along party lines, 31-16, around 5:30 a.m on Sunday. The bill is yet to be signed by Iowa Gov. Kim Reynolds.

The last-minute timing of the amendment frustrated Democrats like Sen. Zach Wahls, D-Coralville. The bill had been passed 53-42 and amended in the House earlier on June 13.

“The deep irony is that Republicans introduced a 24-hour waiting period for women to access abortion, but they didn’t even give the public 24-hours notice that they were going to do this,” Wahls said.

Pro-life organizations in Iowa see the bill as a step in the right direction.

“Any time a piece of pro-life legislation can pass through both chambers is a win for unborn babies, a win for women, and a win for science,” Caitlyn Dixson, executive director of Iowa Right to Life, said in an email to The Daily Iowan. “Iowa Right to Life is thrilled that even with the obstacles of the 2020 Session, a powerful piece of legislation was passed through.”

Drew Zahn, director of communications for The Family Leader — an Iowa-based religious group that advocates for conservative policy — said he hopes that 24-hour window and information about options besides abortion will result in women keeping the pregnancy.

“In Iowa, we already have consideration periods in place for major life decisions, such as marriage or divorce … It’s important women be given the time and information to know there are other options and ways to receive help,” Zahn said in an email to the DI.

Wahls said that for services like divorce, marriage, and adoption, requiring a wait period in the is different because it’s not a medical procedure, like abortion.

Francine Thompson, executive director at the Emma Goldman Clinic, which among other services provides abortions, said the logic surrounding the wait period is flawed.

“The reality is that women have given their decision thought. Women have given thought and consideration to whether or not they want to be parents,” Thompson said. “Many women have talked to those that are important in their lives and who they consult whenever they make decisions, and so it’s based on a faulty premise that somehow women don’t take time to consider what they might want to do when they find themselves faced with an unplanned pregnancy.”

Thompson said the majority of the clinic’s clients come from outside of the Iowa City area. The 24-hour waiting period will create a greater challenge for women who live far from abortion providers.

“Most clients travel, need to secure childcare, and possibly take time off from work and so that increases their expenses and of course it is most detrimental to those that have access issues anyway, so folks who maybe don’t have paid leave, who don’t have routine childcare, maybe who don’t even have transportation,” Thompson said.

Wahl had similar concerns about the ways the bill will affect women differently based on their financial situation and location.

“It’s just putting more obstacles, more roadblocks in the way and it’s not right,” he said.


“Those who were most marginalized before this are being hit the hardest now.”

In the face of COVID-19, barriers to accessing birth control have increased significantly, further denying people the reproductive health care they need.
Cindy Ord/Getty Images

Courtney Jones, a recent graduate of the University of Nevada, Las Vegas, has a story that rings all too familiar for people across the country who have been unable to access vital contraception before and during the COVID-19 pandemic.

Balancing demanding college coursework with a part-time job, Jones, 21, found herself struggling to visit her doctor and cover the costs that came with using a NuvaRing, a monthly birth control device. Eventually, she had to make the difficult decision to stop using it altogether.

“The last thing I want is another story like mine,” she said.

In the face of COVID-19, barriers to accessing birth control have increased significantly, further denying people like Jones the reproductive health care they need.

recent poll from the National Family Planning and Reproductive Health Association (NFPRHA) revealed that nearly half of women between 18 and 34 years old are concerned about accessing reproductive health care during the pandemic, in comparison to 13 percent of older women. About half of Black women share those concerns, compared to just 28 percent of white women.

According to Rebecca Thimmesch, campaign manager for Advocates For Youth’s #FreeThePill project, the cost of care during a period of financial unease, along with the safety concerns with physically visiting doctors, have “amplified” the struggles typically faced by people trying to access contraceptives. “COVID has been framed as a great equalizer, but what we’re actually seeing is that those who were most marginalized before this are being hit the hardest now because they often have fewer resources to fall back on,” she said.

For those who are able to use online birth control delivery services, apps have been an important way of getting access to care without visiting clinics or pharmacies. One such service, Nurx, said it experienced a 50 percent increase in requests for mail-order birth control since the public health crisis worsened in March.

Although telemedicine services and sexual health apps have become more popular, gaps in coverage remain, Thimmesch explained. “They’re not an across-the-board solution.” Some apps only serve a limited number of states, while others impose fees or may have age restrictions for confidential care. And patients who lack smartphones, access to reliable internet, or permanent addresses are locked out of these services with few safe alternatives.

“I think the last few months have been very challenging, but very crystallizing for us in the field,” Thimmesch said. “We’re seeing unprecedented attacks on sexual and reproductive healthcare; we’re facing a daunting slate of potential Supreme Court decisions; and we’re hearing from the young people we serve that they can’t access the care they need.”

Youth advocates working with the #FreeThePill campaign are still mobilizing during the pandemic—by distributing information on birth control access and organizing online resources for young people who want to participate in activism from home.

Jones is one of these youth advocates. Reproductive control and autonomy are at the heart of her work with the program. “We should have the freedom to make decisions for our own bodies and our own families. It makes you feel like you’re not in control when you don’t have the income, when you don’t have the transportation, or even the time to go to a doctor, get a prescription, go to a pharmacy, and pick it up,” Jones said. “We’re working to allow people to have reasonable, accessible, and affordable alternatives to medical visits and prescriptions.”

As a youth activist, it’s important to Jones that young people have a voice and are able to advocate for their reproductive health needs. “During this time, a lot of people don’t have the access and especially the money,” Jones said. “We want to make sure that people know we’re still fighting for their rights and what they deserve during this time.”

“It’s always been wrong to ask young people to jump through so many hoops to get the birth control they need. But now, it’s not just unnecessary, it’s risking health and safety,” Thimmesch said. “People are worried about their health and the health of their families, their livelihoods, and their ability to stay housed and fed. They shouldn’t have to worry about an unplanned pregnancy, too.”


In The Turnaway Study, Diana Greene Foster shares research conducted over 10 years with about 1,000 women who had or were denied abortions, tracking impacts on mental, physical and economic health.


This is FRESH AIR. I’m Terry Gross. When Mike Pence was running for vice president, he said, if we appoint strict constructionists to the Supreme Court, as Donald Trump intends to do, I believe we will see Roe v. Wade consigned to the ash heap of history where it belongs. Since then, Trump has appointed two conservative justices. The arguments used against abortion often refer to the medical risks of the procedure and the guilt and loss of self-esteem suffered by women who have abortions.

In order to explore what the impact of abortion is on women’s health and women’s lives, my guest, Diana Greene Foster, became the principal investigator of a 10-year study comparing women who had abortions at the end of the deadline allowed by the clinic and those who just missed the deadline and were turned away. The study focuses on the emotional health and socioeconomic outcomes for women who received a wanted abortion and those who were denied one.

Her goal is for judges and policymakers to understand what banning abortion would mean for women and children. The results of the study are published in Foster’s new book “The Turnaway Study: Ten Years, A Thousand Women, And The Consequences Of Having – Or Being Denied – An Abortion.” Turnaway refers to the women who were turned away from having an abortion. Foster is a professor at the University of California, San Francisco in the department of obstetrics, gynecology and reproductive sciences.

Diana Greene Foster, welcome to FRESH AIR. Before we get to the results of the study, what impact do you think the pandemic is having on access to abortion?

DIANA GREENE FOSTER: Thank you for having me. The pandemic has definitely made abortion a lot harder for women to access in certain states. There were a handful of states that tried to declare that abortion wasn’t an essential service. And that shut down clinics. And then a judge would put a hold on that. And they would open. But then they would have too many people waiting. And they couldn’t see everyone. It was, I think, particularly a nightmare in Texas, with a lot of people unable to be seen and people traveling hundreds of miles at a time when they should’ve been able to shelter in place.

GROSS: So why did you want to do this study comparing women who had abortions at the end of the deadline allowed by the clinic and women who just missed the deadline and were turned away?

FOSTER: The idea that abortion hurts women has been put forth by people who are opposed to abortion. And it really has resonated. So state governments have imposed restrictions in response to the idea that abortion hurts women, so telling clinics that they have to counsel women on the harms of abortion. And that idea made it all the way up to the Supreme Court so that Justice Kennedy, in 2007, used the idea that abortion hurts women as an excuse – or as a reason – for banning one procedure.

And what he said in 2007 was that while we find no reliable data to measure the phenomenon, it seems unexceptionable to conclude that some women come to regret their choice to abort the infant life they once created and sustained. Severe depression and loss of esteem can follow. And critics of this statement have said this is patronizing that women would need to be protected from their own decisions.

But the one thing I like about this quote is that he admits that there aren’t reliable data. And so my goal with the Turnaway Study was to create reliable data, so have a scientific study where the two groups of women are similar. But their outcomes are different because one group received an abortion and one was denied.

GROSS: You write that anti-abortion activists have shifted the debate from the rights of women versus the rights of fetuses to abortion being a woman’s health issue. How are people who are using women’s health to frame the issue, how are they using it? What is the argument they’re making?

FOSTER: I think, from both sides, there’s an emphasis on the danger of abortion. So if you ask most people, they would say abortion is dangerous. And anti-abortion people think that the complications are much greater than they are. And even pro-abortion rights people talk about how dangerous it was before it was legal. And so there, I think, people have an idea that it’s extremely dangerous.

But the truth is, in terms of complication rates, that abortion is safer than very common procedures like tonsillectomy and wisdom tooth removal. And it’s certainly much safer than having childbirth. So – and the National Academy of Sciences, Engineering and Medicine has just come out with a report summarizing the complication data for abortion that concludes with this, that abortion is not a dangerous procedure.

GROSS: Give us a sense of how you conducted this 10-year study, how you chose the women, how you got information from them about the consequences of having or not having an abortion.

FOSTER: So what we did to do this study was we went to 30 abortion facilities across the country who had the latest gestational age within 150 miles. So if you are too late – if you showed up at a clinic too late for that clinic, there was no one – no other facility within 150 miles who would do an abortion for you. And from each of these clinics we recruited, for every one woman they turned away, two women who were just under the gestational limit.

And because most of these sites had limits in the second trimester but 90% of American women who have abortions have them in the first trimester, we also recruited one woman from the first trimester. And another point is that these facilities had varying limits, all the way from 10 weeks up through the end of the second trimester. And so you could be denied an abortion in Fargo and receive an abortion at that very same gestation if you went to Dallas or New York.

GROSS: And then you – someone from your team interviewed each of the women how often over the course of the 10 years?

FOSTER: So we interviewed them one week after they either received or were denied an abortion, and then every six months for five years. And these interviews were not mostly about the abortion or even unwanted pregnancy. We were interested in their mental health, their physical health, their family’s economic well-being, how they were caring for the children they already have and whether they were having more children over the course of the five years.

GROSS: Your study found that women denied abortion had worse mental health problems – for instance, high levels of anxiety, lower self-esteem – than women who received abortions. Judging from what the women told you in this study, what accounts for that?

FOSTER: So we did find that there – an association between abortion and mental health. But it was exactly opposite to what has been said in the popular media. It’s not that receiving an abortion was associated with worse mental health, but in the short run, being denied the abortion was – so higher anxiety, lower self-esteem, lower life satisfaction. For up until the first six months, the women who were denied fared worse.

And, in part, it’s because they were still looking for another facility that could do their abortion. Or they were coming to terms with the fact that they were about to have a baby that they had previously felt that they weren’t able to take care of. So the anxiety and depression actually are, surprisingly, the same between women who receive and who are denied abortions after six months. The big differences that we find in this study over time are not about mental health.

GROSS: What are they about, the big differences?

FOSTER: So when you ask women, why do you want to have an abortion? – they give reasons. The most common is that they can’t afford to have a child, or they can’t afford to have another child. And we see very large differences in economic well-being over time. Another surprising fact is that most women who have abortions – 60% of women who have abortions in the United States are already mothers. And so a common reason is that they want to take care of the children they already have.

And we find that, in fact, there are differences in women’s ability to take care of their existing kids based on whether they received or were denied an abortion. Another reason is that they feel like their relationship with the man involved in the pregnancy isn’t strong enough to support having a child together.

GROSS: So let me ask you about the financial question because a lot of people would say, well, if you can’t afford to have a baby, that’s not a good reason not to have the baby. You know, people have babies all the time. You’ll find a way to make it work. So when you say that there are financial consequences about being denied an abortion, what are some of those financial consequences, short term and long term?

FOSTER: There are immediate differences in women’s ability to hold a full time job. And they’re reporting that they have enough money to meet basic living needs, like food, housing and transportation. And I completely understand people who who would like there not to be economic costs to having kids. And we could have a society with much more generous policies towards low-income moms. And that would be a good thing regardless of whether women have abortions or not.

I think one important point to note about financial reasons for abortion is that they were rarely the only reason. So 40% said they had financial reasons for having an abortion. But for only 6% was it their only reason. So people are just are weighing a whole host of life considerations when they’re deciding whether to have a baby or not. What’s important, I think, about the financial issues is that that it has long-term effects on people’s well-being.

And when we compare women who are denied an abortion and have a baby – their economic well-being to women who receive an abortion but have another child later within the study period, those later children, the subsequent to an abortion – they are raised in better economic circumstances. So when a woman says that she can’t afford to have a child, she actually does better if she’s able to wait to have a child. Even just a few years. Her child is less likely to be raised in poverty and less likely to be raised in a house without enough money.

GROSS: Are you looking at women in the study of a social – of a certain financial status?

FOSTER: Yeah, so women who seek abortions nationally are disproportionately low-income And that’s – particularly they’re low-income if they are seeking abortion later in pregnancy. And why is because it’s all of the costs associated with getting an abortion are much harder to overcome quickly or to gather the money quickly if you’re already trying to raise a family of four on $11,000 a year. So there are already – women who seek abortions are disproportionately poor. And when they’re denied an abortion, there’s a large economic cost.

GROSS: And talk a little bit about the economic cost. Why is there an economic cost to being denied an abortion if you’re already financially challenged?

FOSTER: So women who are denied an abortion are less likely to be able to continue working at the same rate. And in addition to not being able to work, they do often get some kind of public assistance, but it’s not enough to meet the massive costs of having a baby. So it’s diapers and child care if you are able to work and a place to live. It’s not a surprise to anyone that having a child is expensive.

But when you’re wanting to have a child, it’s often because you feel like you have the resources to do that and that you have the social support to help you support that child. And when women are turned away from abortion we don’t find the same kind of family support that women would need in order to feel economically secure. So when we look at women who receive abortions and women who are denied, over five years, the women who are denied are much more likely to be living alone, raising kids without other adult family members and without a partner, compared to women who receive an abortion.

GROSS: One of the reasons you found many women want to have an abortion is that they don’t want to remain tied to the man they got pregnant with. This might be because the man is abusive. It might be that the woman just doesn’t want to stay with him. It might be the marriage is already dissolving. Can you talk about that a little bit and why that’s such an important issue for the women?

FOSTER: Yeah. The – about a third of women seeking abortions have a reason that’s associated with the man involved in the pregnancy. And when we have a woman who tells her story and she’s in a violent relationship and she explains how it’s very difficult to find a job when you’re pregnant, to keep a job when you’re pregnant or find and maintain a job with a baby – and she attributes – says that the incidents of domestic violence skyrockets ’cause you’re financially dependent on your partner because you have to be home with the kid. And we actually find that women who receive abortions – their exposure to domestic violence goes down dramatically after receiving an abortion and that there is no decrease for years among women who are turned away. So being denied an abortion increases the chance that you’re tethered to a violent partner.

GROSS: Let me reintroduce you here. If you’re just joining us, my guest is Diana Foster. Her new book is called “The Turnaway Study: Ten Years, A Thousand Women, And The Consequences Of Having – Or Being Denied – An Abortion.” We’ll talk more after we take a short break. This is FRESH AIR.


GROSS: This is FRESH AIR. Let’s get back to my interview with Diana Foster. Her new book, “The Turnaway Study,” is about her 10-year study comparing women who had an abortion just before the clinic’s deadline and women who arrived just a few days too late and were denied an abortion. The study compares the physical health, mental health, financial circumstances and family life of these two sets of women.

I think it’s fair to say your biggest finding in your study is – correct me if I’m wrong here – that there’s no major consequences that you could find that most women have as a result of an abortion.

FOSTER: No negative consequences. We find that 95% of women who receive an abortion later report that it was the right decision for them. So I think it’s a surprising fact people assume that women feel regret. And I think it’s not that they don’t realize that there are moral questions involved, but they’re weighing their whole life responsibilities and plans and decide this is the right decision for them. And interestingly, I think people have been told so many times that abortion is wrong. But they know that they’ve been responsible in their own decision-making and that they haven’t done something wrong.

And so they assume it’s other women. But, you know, everyone is doing that. Everyone is assuming, well, if abortion is wrong but my abortion isn’t wrong, I’m just an exception. But, I think, if we talked more to people who had abortions, we would hear that everyone is doing the best they can and trying to make responsible choices that take care of themselves and their children.

GROSS: Well, a lot of people ask, well, if you didn’t want to have a baby, why didn’t you use contraception and prevent yourself from getting pregnant? So for people who ask that question, what are the answers you found in your study?

FOSTER: Yeah. Many women who have abortions are using contraception. Two-thirds of the women in our study were using a contraceptive method in the month that they became pregnant. And note that not using a contraceptive method is not guaranteed to result in a pregnancy. Lots of people take risks. And not everyone becomes pregnant. So you know, there are very few people who’ve never had sex at a time that they weren’t seeking to have a baby. And contraceptives are expensive. They – many have side effects. We make them as difficult to access as possible. And then we’re horrified when people don’t use them consistently.

So there was a woman named Chiara (ph) who was from Kentucky. And she had lapsed in her birth control by just a few days because the resupply hadn’t come in time. And her hope was everything would be OK, and then it wasn’t. You know, it’s surprisingly difficult to constantly be vigilant on contraception, especially if you’re the kind of person who doesn’t like the available methods.

GROSS: So what about women who were turned away from having an abortion and carried the child to term and kept the child? Did they end up, in the long run, being glad they had the child? And was there a difference between the short-term and long-term reaction to having that child?

FOSTER: Women who were denied an abortion – at the first interview, just one week later, two-thirds of them were still wishing that they could have an abortion. It goes down to about 12% at six months, down to 4% after they’ve had the child. And who is particularly at risk for wishing they had not had the child are people who place the child for adoption because I think there’s something about having a kid on your knee. You’re much less likely to say that you wish you hadn’t had that child. So people do report that they are glad that they had the child.

But we have another way of measuring how people feel about their child and it’s through a maternal bonding scale. So we asked women a series of questions about how they feel about their infant. And we asked women who were denied the abortion about the child they had because they were denied. And we asked women who had a subsequent pregnancy later that they carried to term. So it’s a series of questions like, I feel happy when my child laughs, or, I feel trapped as a mother.

And women who were denied the abortion are less likely to say, I feel happy when my child laughs and more likely to say, I feel trapped as a mother compared to women who were able to get their abortion and had another child later. And when you use this kind of objective measure of maternal bonding, you see that women who are denied an abortion are more likely to have poor bonding with that child than women who get an abortion and have another child later. It doesn’t say that these children are all unwanted at all. People are very resilient. And people do the absolute best they can with their children.

GROSS: Let’s take another break here and then talk some more. If you’re just joining us, my guest is Diana Greene Foster. Her new book is called “The Turnaway Study: Ten years, A Thousand Women, And The Consequences Of Having – Or Being Denied – An Abortion.” We’ll talk more after a break. I’m Terry Gross. And this is FRESH AIR.


GROSS: This is FRESH AIR. I’m Terry Gross. Let’s get back to my interview with Diana Greene Foster. Her new book, “The Turnaway Study,” is about her 10-year study comparing women who had an abortion just before the clinic’s deadline and women who arrived just a few days too late and were denied an abortion. The study compares the physical health, mental health, financial circumstances and family life of these two sets of women. Foster is a professor at the University of California, San Francisco in the department of obstetrics, gynecology and reproductive sciences.

How would you like to see your research used for policy relating to abortion?

FOSTER: I would love, first, to have its policy more broadly, which is much more generous assistance and less punitive assistance for low-income women who have kids regardless of whether their pregnancy was planned or not. We have welfare caps, where if you have an additional child, you don’t get any more assistance, which is draconian and cruel. So we need much more generous policies and child care so that nobody is making the decision just for economic reasons.

In terms of abortion, if we want abortions to happen earlier in pregnancy, then many restrictions should be taken off the books because they don’t improve women’s health. And they cause abortions to happen later. For example, the one that would have the biggest effect in making abortions happen sooner would be to drop the Hyde Amendment, which is a ban on the federal government paying for any abortions.

The people who rely on the federal government for their health insurance – that’s people on Medicaid, people in the military and people who are in the Peace Corps – all of those people are subject to this Hyde Amendment. And it means their public insurance program won’t cover their abortion. And so they have to raise the whole cost of it themselves. We even have some states that ban private insurance from covering abortion. So it’s not just a matter of not wanting your tax money paying for the abortion, it’s really, those laws seem to make it clear that it’s about making women pay the price themselves.

GROSS: A lot of people who oppose abortion oppose it because they equate abortion with murder. And in that respect, no amount of research that you can offer about the consequences of being denied an abortion on a woman’s life and even on her child’s life or the rest of her family’s lives, no amount of that research is going to convince somebody that abortion isn’t murder.

And in that sense, no amount of research is going to sway those people. Do you feel, in that respect, that your research is kind of futile because a lot of opponents of abortion oppose it because they think of it as murder?

FOSTER: Yeah. I’m under no illusions that this study will change somebody’s mind if they think that the embryo or fetus is a person. This study can’t resolve the question of when, in pregnancy, the embryo or fetus becomes a person or when the rights of the fetus would outweigh the person who carries it. That’s not what this study is about. What this study is is about what the consequences of either receiving or being denied an abortion are on women’s lives.

And Roe v. Wade talked about the tension between women’s bodily autonomy and the state’s interest in a developing fetus. And the law tried to strike a balance there. And what this study adds to that difficult set of issues is that there is more at stake than just women’s bodily autonomy and the well-being of a fetus who will become a baby.

It’s not just her body, but her whole life trajectory, her chance of having a wanted baby later, her chance of having a good, positive romantic relationship and her chance of supporting herself and her family. It affects their existing children and the well-being of her future children. It can’t resolve personhood. But it points out that if we make laws that make assumptions or make decisions about when personhood begins, it has huge ramifications for many other people.

GROSS: Let’s get to the Supreme Court. There are now two conservative Trump appointees on the bench. The Supreme Court is expected to hand down a pretty major abortion decision this month. And it pertains to Louisiana and whether doctors performing abortions need to have admitting rights in a nearby hospital. There was a similar case in Texas a few years ago. So tell us about this case and what kind of precedent it would set and what it might tell us about the new Supreme Court and abortion.

FOSTER: So June Medical Services v. Russo is the case that is about Louisiana’s admitting privileges law. It’s the same type of restriction that was ruled unconstitutional in Whole Woman’s Health v. Hellerstedt by the Supreme Court in 2016. But since then, we’ve gained two conservative justices. And what they decide here will send very large signals to abortion rights advocates and abortion rights opponents.

At issue is the same law about admitting privileges. But what the Supreme Court said in the earlier case, Whole Woman’s Health v. Hellerstedt, is that states need to weigh the scientific evidence about the burdens and benefits of restrictions. And they can’t pass laws that will have no benefit, but only burden. And so if the Supreme Court decides differently here, it’s another nod of our current government to saying that science will not be taken seriously and that it’s political ideology that gets to decide laws.

GROSS: What do you think are the odds that the Supreme Court will just overturn Roe v. Wade at some point?

FOSTER: Right now, the Supreme Court doesn’t have to overturn Roe v. Wade to make it nearly impossible for women to access abortions. Simply by allowing more and more restrictions to be implemented, they can make abortion nearly impossible to access. I think it’s a kind of a political question whether they would want to take such a stand on a law that actually is politically popular. So I don’t know, politically, whether they would do that. Apparently, Gorsuch and Kavanaugh were selected from a list of potential justices that had at least voiced that they were opposed to abortion rights. So they may have the desire. But I don’t know if they would take that political risk.

GROSS: What are the most significant findings for you from your study that we haven’t already discussed?

FOSTER: I think the most important idea that I would like to convey is to correct the idea that abortion is always a hard decision and that women need more time to think about it and that they can’t be trusted to make a decision that’s best for themselves. So in this study, about half the women say that the decision to have an abortion was easy or straightforward. And half say it was somewhat or very difficult. But having a decision be easy doesn’t mean that they weren’t thoughtful about it, that they were weighing all of the considerations, all of their responsibilities and deciding what was best for them. And I think it’s safe to say they were making good decisions in that when they say why they want to have an abortion, all of their concerns are borne out in the experiences of women who are denied abortions. So they’re worried they’re not financially prepared. And there are economic costs if you’re denied. They say it’s not the right time for a baby. And if they’re able to delay having a child, that child does better.

So I would love to impart first how common it is to have an abortion. About between 1 in 3 and 1 in 4 American women will have an abortion in her lifetime. You know, it’s people like the people you know. And they’re making decisions based on their life and what they think the consequences would be of having a baby when they weren’t ready.

GROSS: Let’s take a short break here. And then we’ll talk some more. If you’re just joining us, my guest is Diana Foster. Her new book is called “The Turnaway Study: Ten Years, A Thousand Women, And The Consequences Of Having – Or Being Denied – An Abortion.” After we take a break, we’ll talk about abortions in her family. We’ll be right back. This is FRESH AIR.


GROSS: This is FRESH AIR. Let’s get back to my interview with Diana Greene Foster. Her new book, “The Turnaway Study,” is about her 10-year study comparing women who had an abortion just before the clinic’s deadline and women who arrived just a few days too late and were therefore denied an abortion. The study compares the physical health, mental health, financial circumstances and family life of these two sets of women.

Diana, you had grandmothers on each side of your family that had unwanted pregnancies. One grandmother carried to term. That baby became your mother. The other grandmother had an abortion. So let’s talk about that. Let’s start with the grandmother on your father’s side of the family. Let’s start with how she became pregnant and why she didn’t want to carry to term.

FOSTER: The sad thing is that she died while I was in high school, so I never got to ask her these questions. I know that she became pregnant while she was living with my grandfather early in their marriage in New York City during the Depression. And she felt that they couldn’t afford to have a baby. And she – at the time, abortion was illegal. And she had to go to Puerto Rico to get an abortion. And I never got to ask her about her experiences.

I do know that when she died, you know – no mention was made of abortion over my childhood that I can remember. But when she died, my grandfather asked that all donations be made to Planned Parenthood. So I think that though it wasn’t talked about, it had a large impact on her life. And she went on to have three kids and was a loving, happy mother.

GROSS: Did anyone in your family actually come out and tell you that she had an abortion?

FOSTER: I heard it both from my mother and my father. So she must have had a quiet conversation with my mother at some point – is my guess. I doubt – I would be surprised if she directly told my father. It’s the kind of thing women might talk about with each other. And it’s really too bad that we don’t talk about our unwanted pregnancies because it gives the impression that it rarely happens when, in fact, many people have unwanted pregnancies. And we could have a little more empathy if we understood how common it was.

GROSS: Well, let’s look at your mother’s side. Your maternal grandmother, Dorothy (ph), got pregnant at the age of 19 from her golf instructor. The implication in the way you tell the story is that she did not want to have sex with him.

FOSTER: It was her funny way of talking. I don’t – what she says is that he taught her more than she needed to know. So I don’t know how coerced that was. He was married at the time and supposedly in the process of separating – is what he had told her. But when she told him she was pregnant, he said that he would get all his friends to say it could be theirs if she told anyone that it was his. So he was clearly a total jerk.

And she told her parents, who were very conservative Christians. And they were appalled, you know, horrified at the unwanted, out-of-wedlock pregnancy. And they begged her to get an abortion. And she – for reasons that she never fully explained to me, she refused. So she went to the Salvation Army home for unwed moms – mothers. And she gave birth to my mom and placed my mom for adoption.

And the kind of saddest part of her story comes next, which is her parents hadn’t visited her while she was at the Salvation Army home for unwed moms. And so she didn’t know if she had a home to go home to. And so after delivery, which was, like the women in my study, very complicated with a period of – a long period of disability after, she went home with another woman she’d met there.

And that brother, the brother of the one she went home with raped Dorothy. What he told her was she was already no good. So the idea that she was spoiled or tainted and so had lost all claims over her body – and that, I think, was even worse than the rejection by her parents and the placing a child for adoption, which can be very difficult. This idea that she was forever tainted was deeply harmful. And it’s an idea you hear still that somehow, if you become pregnant when you aren’t intending to, you lose say over what happens to your body.

GROSS: And your mother was able to track down her birth mother when your mother was in her mid-40s, and her birth mother, your grandmother, was in her mid-60s. Did you get to meet her?

FOSTER: I sure did. A friend of my mom’s did the geneology investigation, found Dorothy’s birth certificate, which had a note from Dorothy’s mom changing the spelling of Dorothy’s father’s name. And that note had a date, which put Dorothy in high school. And the friend of my mom called the high school alumni association and said she was looking for Dorothy. And the man said – oh, Dorothy, I had a drink with her last week.

GROSS: Oh (laughter).

FOSTER: So it was the first news we had that she was alive and well. And you know, tentatively – oh, well, could we have that phone number, please? (Laughter). And we called.

I grew up in Maryland. And when I went to college, I went to UC Berkeley in California. And Dorothy, who was living in Santa Cruz, was my closest relative. So she picked me up from the airport with all my stuff and dropped me at my dorms and was, you know, a close – just the greatest relationship through my college years of getting to visit her in Santa Cruz.

GROSS: Oh, what a great story.

FOSTER: Yeah, she never actually went on to have other children after my mom, and that’s something we also find in “The Turnaway Study” is that if you carry an unwanted pregnancy to term, it creates a detour in your life. And you’re actually less likely to have wanted children later. So she tried to have other children, and it just didn’t work out.

GROSS: Well, in your grandmother’s case, the pregnancy and the birth were so traumatic, especially being raped afterwards, while she was having a very difficult recovery from childbirth. That’s horrible to think about. But she had a decent life. Her life worked out for her, right?

FOSTER: Yeah, she was adventurous and ahead of her time in many ways of, you know, owning businesses and traveling. And she, you know, wasn’t a feminist in the way that we would say now. She really viewed that success was finding a man who would take care of you. And I think it’s ’cause that was the road she got off of, and she never got on it again. So she had – you know, she never had someone to just take care of her. So I might have gotten a Ph.D. from Princeton, but she was most happy that I was married and that the – my two children were my husband’s children. Those were, from her perspective, my biggest accomplishments.

GROSS: I suspect a lot of our listeners are thinking that if your maternal grandmother had aborted her unwanted pregnancy that your mother wouldn’t have been born and, therefore, you wouldn’t have been born. So why do you support the right to abortion?

FOSTER: Dorothy refused an abortion and gave birth to my mother. If she’d had an abortion, I clearly wouldn’t exist. And my dad’s mother overcame great obstacles to get a wanted abortion and later gave birth to my father. So if she hadn’t – if she had not had an abortion, I wouldn’t exist.

Given how – the long history of abortion in our country, many of us are alive today ’cause our mothers and grandmothers were able to avoid carrying an unwanted pregnancy to term. And this study shows that abortion may end the possibility of one life, but it enables women to take care of the children she already has and, if she chooses, makes it possible for her to have a baby under more favorable circumstances later.

GROSS: Well, Diana Foster, thank you so much for talking with us.

FOSTER: Thank you so much for having me and discussing “The Turnaway Study.”

GROSS: Diana Greene Foster is the author of the new book “The Turnaway Study: Ten Years, A Thousand Women, And The Consequences Of Having – Or Being Denied – An Abortion.” She’s a professor at the University of California, San Francisco in the department of obstetrics, gynecology and reproductive sciences.

This month, Turner Classic Movies is presenting a jazz and film series. Our jazz critic Kevin Whitehead has written a new book about jazz and film. After a break, he’ll defend the much maligned genre of jazz biopics. This is FRESH AIR.


It wasn’t  much past 8 a.m. on a Saturday morning in late April, and anti-choice protesters outside the Jackson Women’s Health Organization, the only abortion clinic in Mississippi, were already cantankerous: There were three men with bullhorns, including one on top of a ladder; a 1,200-watt speaker pointing toward the clinic’s front door; and another protester blowing a shofar. “Welcome to the circus,” said Kim Gibson, a clinic escort who works to keep the mayhem away from patients.

Even as the coronavirus pandemic has gripped the nation (new cases are still on the rise in Mississippi), protesters disregarded Jackson’s stay-at-home order and have consistently failed to wear masks or keep appropriate social distance — not only from one another, but also from patients, whose cars they readily approach in an effort to “counsel” them and hand out anti-abortion propaganda.

In the best of times, the scene outside the Jackson clinic is chaotic. Protesters regularly crowd the fence line of the Pink House, as it is known because of its vibrant pink façade. During the Covid-19 crisis, the activity has amped up. On a single day in late March, nearly 100 protesters descended on the clinic. A majority of the protesters don’t live in Jackson, and some have even traveled from out of state, including a family with eight kids who drove from North Carolina. “Abortion tourism,” Gibson calls it.

On May 1, two weeks before Jackson’s stay-at-home order expired and just before Gov. Tate Reeves officially announced the state would reopen restaurants and parks, armed protesters — including many who regularly protest at the Pink House — rallied at the Capitol in support of their right to assemble without face masks or social distancing. They’ve brought that same stridency, albeit without the firearms, to the Pink House.

Protesters have deliberately tried to bump into people outside the clinic and have refused to move from the sidewalk to allow escorts and patients to pass by. The cops have been called, but even when the city’s lockdown was in full effect, they did nothing to abate the madness. That’s not unusual in Jackson, where the police routinely fail to enforce city ordinances that should constrain the protesters’ activities. In April, while responding to Gibson’s call about a protester chasing the escorts and shoving his Bible in their faces, one officer told her that at the clinic, “we’re an island on our own,” she said. “I mean, literally, he said it.”

Gibson and Derenda Hancock, both veteran clinic escorts with a group known as the Pinkhouse Defenders, say the protesters have been buoyed by hope that the outbreak would close the clinic. “Since this has started, they are more aggressive because they think they have their teeth in something that will get it closed down,” Gibson said. “They’re just railing on the fact that it’s still open.”

Anti-abortion politicians across a large swath of the country seized on the public health crisis in order to push for clinic closures, while simultaneously backing less stringent restrictions on things like religious gatherings and gun shop operations. And both politicians and activists have cheered the protesters, decrying the rare instances in which they’ve been arrested for defying crisis-related health orders. After one such incident in Charlotte, North Carolina, Sen. Ted Cruz took to Twitter, writing, “NC Dem Gov has wrongly deemed elective abortion ‘essential,’ allowing abortion drs & staff to gather in larger groups. IF providing abortions is essential, then peacefully giving pregnant women counseling on alternatives to abortion is ALSO ‘essential.’”

The ongoing politicization of abortion amid the outbreak has emboldened protesters, created whiplash for patients and providers, and again highlighted the sensitive nature of a reproductive health care system operating under burdensome, and unnecessary, regulations.

It has also drawn into stark relief the hypocrisy of protesters who would defy health and safety measures in an effort to chastise women seeking health care. As the writer Danielle Campoamor posted on social media in mid-April, “The Venn diagram of people protesting shelter in place orders because they don’t like ‘the government telling them what to do’ and people who think the government should tell pregnant people who want abortions what to do with their bodies is one giant fucking circle.”

A pro-life activist and a volunteer who escorts patients into the Jackson Women's Health Organization, the last abortion clinic in Mississippi, waits for patients to arrive April 5, 2018 in Jackson, Mississippi. - Women have been able to legally seek an abortion throughout the United States since 1973's landmark Supreme Court decision Roe v. Wade. But the right to reproductive choice remain tenuous as debate over the issue continues to rage, especially in conservative states like Mississippi which have introduced myriad measures restricting access to services -- creating for many women an effective ban. Mississippi is among seven US states with just one place where women can seek an abortion. (Photo by Brendan Smialowski / AFP) / With AFP Story by Eleonore SENS: Facing legal threats, Mississippi's last abortion clinic stands defiant        (Photo credit should read BRENDAN SMIALOWSKI/AFP via Getty Images)

A anti-abortion activist and a clinic escort wait for patients to arrive at the Jackson Women’s Health Organization, the only abortion clinic in Mississippi, on April 5, 2018. Photo: Brendan Smialowski/AFP via Getty Images

Thrown Into Chaos

In addition to dealing with protesters, Gibson and Hancock have also helped the clinic manage strict new protocols designed to keep staff and patients safe. They’ve devised a whiteboard and number-card system to control the flow of traffic in and out of the parking lot and the clinic. People wait in their cars for their number to be called, and only patients are allowed inside. “We’re the ones who are really having to balance how many people are in the clinic at a time,” said Hancock. “We’re spacing everything.”

This is the way abortion services have been managed in clinics across the country, which adopted Centers for Disease Control and Prevention guidance in the earliest days of the pandemic. Routine gynecological exams were postponed while other appointments were pushed to telemedicine. Scheduling for abortion patients was retooled to maximize social distancing. “It is essential health care,” Julie Burkhart, president and CEO of Trust Women, which operates clinics in Kansas and Oklahoma, told me back in late March. “They need it immediately; they need it as soon as they can get in for an appointment. Pregnancy does not stop in the time of a disaster or this pandemic that we’re moving through.”

“The governor and attorney general’s ban put Texas patients in heart-breaking situations — it was politics at its worst.”

That view has not been accepted by elected officials in a number of states, some of whom were urged early on by anti-choice advocates to deem abortion nonessential. Nowhere was that message more warmly received than in Texas, where Attorney General Ken Paxton threatened providers with jail time if they did not heed an executive order to curtail nonessential medical procedures. While the order made clear that whether a procedure was essential should be determined by medical professionals, Paxton mounted an aggressive legal crusade to close clinics, arguing to the federal courts that the state’s police powers were vast amid a pandemic and that everyone had to make sacrifices and fall in line.

But that was a ruse. Gov. Greg Abbott said his pandemic order meant clinics must close, but he encouraged religious congregations to gather and labeled gun shops “essential” businesses. And Paxton, while chest-thumping about the state’s broad police powers, wrote a letter to officials in Gunnison County, Colorado, saying that their order barring nonresidents during the pandemic would deprive Texans of access to their vacation homes. “The banishment of nonresident Texas homeowners is entirely unconstitutional and unacceptable,” he said. As it turns out, Paxton’s protestation would benefit a contingent of nine political supporters who own property in Colorado and together have contributed nearly $2 million in campaign donations to Paxton and his wife, Angela, who is a state senator.

Still, Paxton’s pronouncement in late March sent Texas’s reproductive health care system into chaos. Hundreds of appointments had to be canceled as thousands of calls flooded the state’s clinics. Over a three-day period, Planned Parenthood of Greater Texas, which has clinics in Austin, Dallas, and Fort Worth, had to cancel 261 appointments and fielded nearly 600 calls from patients looking for services. “Patients were scared and frantic for options,” Sarah Wheat, the organization’s chief external affairs officer, wrote in an email. “Some patients traveled out of state, which put them in jeopardy during the ‘shelter in place’ orders. Others didn’t have this option due to financial, child care, transportation, time off work, documentation status, and other barriers. The governor and attorney general’s ban put Texas patients in heart-breaking situations — it was politics at its worst.”

A similar scene played out in states across a large section of the country: Ohio, Oklahoma, Iowa, Arkansas, Alabama, Tennessee, Louisiana, West Virginia, and Mississippi all took a shot at shutting down abortion clinics amid the pandemic. In nine states, including Texas, those efforts ended in legal action, with providers suing in state or federal court to stop the closures. (Although Mississippi Gov. Tate Reeves said the Pink House should close, state officials ultimately did not force the issue.)

“All the plans I had to get back to work, my hopes for my kids’ lives, I felt like it was all about to go down the drain.”

In all but two states, those legal challenges ultimately kept clinics open, though not without a significant amount of whiplash, which has resonated across the country’s beleaguered reproductive health care system. In Texas, each time Paxton lost his case in district court, he ran to the notoriously conservative 5th U.S. Circuit Court of Appeals for immediate (and unprecedented) intervention. As a result, the ban was repeatedly lifted and then enforced until the governor’s executive order on nonessential medical care was eased. Arkansas was also successful in shutting down all procedural abortion care — even for those women who would be past the state’s 20-week gestational limit by the time the order was lifted — thanks to a favorable ruling by the 8th Circuit.

Shuttering operations in a number of states, even if only briefly, sent women scrambling in search of care. Although Paxton and other public officials claimed that shutting down clinics was an effort to contain the spread of the virus, their actions forced many women to travel long distances, often across state lines. “I completely panicked,” one woman from Tennessee told the American Civil Liberties Union after finding out that she was 14 weeks pregnant and Gov. Bill Lee was shuttering abortion services. She’s a single mother of three kids under two. She’d had her tubes tied last year precisely because she didn’t want to have another child, but she got pregnant anyway. The woman was faced with having to drive to Atlanta for care — which would be nearly impossible with three kids in tow. What if they were exposed to the virus? Who would watch them during the procedure? “All the plans I had to get back to work, my hopes for my kids’ lives, I felt like it was all about to go down the drain,” she said. “I am a strong woman who has overcome a lot of adversity in my life, but this was too much.”

Kathaleen Pittman, the administrator of the Hope Medical Group for Women in Shreveport, La., poses for a portrait in the clinic’s recovery room on Feb. 20, 2020. The clinic is one of three in the state that provides abortions to women, and it is challenging a state law that requires doctors who perform abortions to have admitting privileges at a nearby hospital. The Supreme Court is hearing the case on March 4. (CREDIT: Rebecca Santana)

Julie Burkhart, president and CEO of Trust Women, is pictured during an interview at the Oklahoma state Capitol on April 10, 2017. Photo: Sue Ogrocki/AP

“It Just Feels Unrelenting”

In late March, Hancock and Gibson started seeing more out-of-state tags at the Pink House in Mississippi; in Oklahoma, Burkhart, who operates the Trust Women clinic, was struggling to accommodate as many people as possible amid the new protocols. Then, on March 27, Oklahoma Gov. Kevin Stitt announced that abortion services there would be banned. Burkhart said the state didn’t bother to tell her; she found out from the media. Women were waiting at the clinic, and Burkhart had to break the news that they would not be seen. Outside, a protester was using a microphone to yell at them. In all, 164 appointments were canceled.

In the days that followed, Burkhart’s staff came in to work the phones in an attempt to reschedule patients elsewhere: to Arkansas (which hadn’t yet banned care) and Wichita, Kansas, where Burkhart’s other clinic is located. “We were already seeing like a threefold or so increase of our patient load” in Oklahoma City, Burkhart told me on April 1, because of the “fiasco” in Texas. “So now everybody has been pushed up to Kansas.”

As multiple states tried to ban abortion, the Wichita clinic became something of a beacon. In 2019 the Kansas Supreme Court concluded that the state’s constitution guaranteed the right to abortion, and Gov. Laura Kelly signaled early on in the crisis that she would not tolerate any attempts to ban reproductive care.

Pressure on the clinic increased exponentially; in a single week, Burkhart said, the clinic saw more than 250 patients. That pressure continued even after the original restrictions on “nonessential” medical procedures eased, because officials in Arkansas and Oklahoma began requiring every woman seeking a procedural abortion to first test negative for Covid-19, which created a new logistical wrinkle for providers like Burkhart.

“We’re being lumped in with, like, plastic surgery.”

First, there was the matter of actually procuring testing kits — no small feat, considering widespread testing for asymptomatic individuals has remained largely unavailable. And then there was the matter of getting test results turned around quickly.

Testing was required before all “elective” procedures in both Oklahoma and Arkansas, so in a way, the mandate was just another attempt to deem abortion nonessential. “We’re being lumped in with, like, plastic surgery,” Burkhart said. But the advantage many other providers had was their affiliation with hospitals and other facilities with lab access. “So, they have access to the type of testing that we don’t have access to as a standalone clinic.”

In addition to a 20-week gestational ban, both Arkansas and Oklahoma have waiting times connected to abortion access; Oklahoma requires a 72-hour “reflection” period between a woman’s first appointment and the second, when she can actually receive care. Burkhart was already testing her employees amid the crisis, so she knew it would take roughly three to five days to get the results. Working with that lag time made scheduling abortion appointments even trickier.

“This mandate places another obstacle in front of women trying to access abortion care” and punishes patients, Burkhart wrote in a May email. After the testing requirement took effect, she had to reschedule patients whose test results didn’t come back in time; some who were earlier along in their pregnancies opted for medication abortion, which is available up through 10 weeks of pregnancy; others had to make the journey over state lines — including to Burkhart’s Kansas clinic — to avoid additional obstacles to service.

Burkhart and her staff were exhausted, she told me. “It just feels unrelenting.”

On June 12, the testing requirement for Oklahoma was lifted. How quickly things will level out, Burkhart said, remains to be seen.

Rhetoric and Threats

As the public health crisis dominated headlines, lawmakers in some states nonetheless continued apace in their broader efforts to erode reproductive rights. In Kansas, conservative lawmakers dismayed by their high court’s 2019 abortion ruling held hostage a bipartisan proposal to expand Medicaid coverage to roughly 130,000 uninsured residents unless their colleagues would agree to a constitutional amendment denying women abortion rights. In Oklahoma, lawmakers pushed through a bill that allows “parents or grandparents” to sue an abortion provider for “wrongful death.”

And in Kentucky, Gov. Andy Beshear vetoed a bill that would have extended to the state’s attorney general the ability to enforce health and safety codes, including the power to inspect abortion clinics — a brazen attempt to give law enforcement officials the power to directly oversee and meddle in clinic operations, which have long been monitored solely by public health authorities.

Kathaleen Pittman, the administrator of the Hope Medical Group for Women in Shreveport, La., poses for a portrait in the clinic’s recovery room on Feb. 20, 2020. The clinic is one of three in the state that provides abortions to women, and it is challenging a state law that requires doctors who perform abortions to have admitting privileges at a nearby hospital. The Supreme Court is hearing the case on March 4. (CREDIT: Rebecca Santana)

Kathaleen Pittman, administrator of the Hope Medical Group for Women in Shreveport, La., poses for a portrait in the clinic’s recovery room on Feb. 20, 2020. Photo: Rebecca Santana/AP

Indeed, in early April, it was two members of the Louisiana attorney general’s office — and not the Louisiana Department of Health — who descended on the Hope Medical Group for Women in Shreveport for an unannounced inspection, Kathaleen Pittman, the clinic’s longtime administrator, told reporters during a press call. They wanted to see how the clinic was managing social distancing, check its stock of PPE, and review various other Covid-19 protocols. They also demanded to see confidential patient records. “It was very disconcerting. We’re accustomed to unannounced visits from LDH, but never the attorney general’s office,” Pittman said, which “normally has no bearing as far as the inspection and the running of the clinics.”

“We are constantly, constantly bombarded with calls from women who are trying desperately to get in.”

The visit came amid the clinic’s struggle to accommodate patients from a growing list of states where public officials were using the pandemic as a pretext to close clinics. The AG’s office in Louisiana was unsuccessful in its bid to do the same. “We are constantly, constantly bombarded with calls from women who are trying desperately to get in,” Pittman said.

And then there was the harassment from anti-abortion activists. They were calling the clinic too. “One moment we’re trying to comfort a woman over the phone. The next moment we’re trying to get away from a phone call or to record the phone number of a harasser,” she said. “It has really begun to take its toll.”

Those in the reproductive rights movement know that threats are an unfortunate part of the landscape that at times, often related to the amplification of anti-abortion rhetoric by politicians, have ended in waves of deadly violence. “Anybody who has been in this field for very long knows someone who has been killed,” the Very Rev. Katherine Ragsdale, president and CEO of the National Abortion Federation, told me. Indeed, Burkhart’s Wichita clinic is in the same building that housed a clinic run by her friend and mentor Dr. George Tiller, who was assassinated in 2009 by an anti-abortion zealot. Burkhart has been the subject of sustained harassment, including by protesters who have picketed outside her home and put her face on “Wanted”-style flyers.

The NAF tracks violence and threats against abortion providers, which have ticked alarmingly upward since the 2016 election of Donald Trump. Amid the pandemic, Ragsdale says, the “deceptive, demonizing, dehumanizing rhetoric is on steroids,” with people like Texas AG Paxton twisting the purpose of public health orders into political rallying cries. By claiming abortion is nonessential — a medical determination he is unqualified to make — Paxton has essentially dog-whistled anti-abortion activists into action. “They’re emboldened,” Ragsdale says. “Saying that abortion isn’t essential health care, and at the same time, saying that these folks are exempt from social distancing and stay-at-home orders that everyone else is subject to because they’re expressing religious opinion.”

“He watched them gather 50 strong, no masks, no nothing. He watched them put up a ladder to look through the front door.”

With abortion rights advocates on the defensive at the federal and state levels over the last four years, Planned Parenthood’s advocacy arm is endorsing former Vice President Joe Biden in his race to defeat President Trump.

Activists are putting their hope in Biden, whom some see as having a mixed record on abortionas they watch a U.S. Supreme Court reshaped by Trump appointees for key decisions that could scale back access to abortion and birth control. They’re also reeling from a series of policy reversals related to reproductive health during the Trump administration.

“This is literally a life and death election,” Alexis McGill Johnson, acting president of Planned Parenthood, told NPR ahead of the announcement. We felt like we can’t endure another four years of Trump; we have to do everything we can to get him out of office.”

In a video statement announcing the endorsement, Biden pledges his support for reproductive rights and highlights his work on the Affordable Care Act during his time as President Barack Obama’s vice president. The law required participating insurers to cover reproductive health screenings and contraception without a co-pay.

“We will protect women’s constitutional right to choose, and I am proud to stand with you in this fight,” the presumptive Democratic nominee says in the video released Monday by the group’s advocacy and political arm, Planned Parenthood Action Fund.

Planned Parenthood is contrasting Biden’s record with that of Trump, who has won praise from abortion rights opponents for appointing conservative judges, and for blocking domestic and international organizations that provide abortions from receiving federal funds to cover other reproductive health care such as birth control and sexually transmitted infection screenings.

McGill Johnson told NPR that it’s urgent to reverse Trump’s policies.

“I think that’s where most Americans are,” she said. “We need to be able to kind of move past this very challenging, divisive, polarized era and move into a place where we can actually rebuild our lives after this disaster.”

In response, Jeanne Mancini, president of the anti-abortion rights group March For Life, said in a statement, “It is offensive to hear our nation’s largest abortion provider, Planned Parenthood, an organization that claims the lives of 345,672 American babies annually (a third of all of the abortions in this country each year), call the 2020 cycle a ‘life and death’ election. Those who really care about protecting life realize that the election of Planned Parenthood-endorsed candidate, Joe Biden, will result in a major increase of tax dollars going to the billion-dollar organization, including direct payment for abortions, among other deadly consequences.”

Planned Parenthood has endorsed the Democratic presidential candidate in every election cycle since 2004 when former U.S. Sen. John Kerry was the nominee. After endorsing Hillary Clinton in the Democratic primary four years ago, Planned Parenthood did not make a primary endorsement this year.

While Biden has long supported abortion rights, he’s been seen as less progressive on the issue than many other Democrats, including his former rivals for the nomination. For decades he supported the Hyde Amendment, which bans federal funds for most abortions, before reversing that position last year as he was starting his presidential campaign.

At a presidential primary forum hosted by Planned Parenthood Action Fund last year in South Carolina – which did not result in an endorsement for any candidate – Planned Parenthood Action Fund Executive Director Kelley Robinson noted that Biden had “evolved” on some issues, including the Hyde Amendment, and asked him how he’d ensure access to abortion for low-income women.

Biden responded by suggesting that he’d supported the policy in the past in an effort to compromise and achieve larger goals. He said he wants to expand access to health care for low-income people, including abortion.

“It became really clear to me that, although the Hyde Amendment was designed to try to split the difference here to make sure women still had access, you can’t have access if, in fact, everyone’s covered by a federal policy,” Biden said during the forum in June 2019.

Asked by NPR if Biden’s record on the issue could dampen enthusiasm for him this fall among the Democratic base, a broader concern for many in the party, McGill Johnson said he’s shown a willingness to “listen” and adjust his views.

“What we know is that he’s somebody that folks can work with. We know that he will deliver on basic — I mean birth control, access to abortion — these are actually bread-and-butter issues, and I think that’s what we really need right now,” McGill Johnson said.

In the midst of a coronavirus pandemic, nationwide protests for racial justice and what abortion rights advocates see as relentless incursions from the Trump administration, McGill Johnson said now seemed like the right moment to announce the endorsement.

In a sign of the urgency advocates are feeling around the issue, groups on both sides of the abortion debate said they’re spending tens of millions of dollars this year; the anti-abortion rights group Susan B. Anthony List, which supports Trump, has announced plans to spend more than $50 million during the 2020 campaign cycle. Planned Parenthood officials said they’re spending $45 million this election cycle, 50% more than four years ago.