“These are the positions we find ourselves in as women. We might advocate for access to reproductive health care, but when we need it we find ourselves alone.”

When labor rights activist Gina needed abortion care, she felt she had to hide it from her employer. Blindsided with an unplanned pregnancy despite having an IUD inserted a few months earlier, Gina kept her circumstance a secret.

“I’ve never wanted children,” said Gina, a 35-year-old woman from Lebanon, Missouri whose name has been changed to protect her identity. “That’s why I had an IUD, because it was one of the most effective forms of birth control.”

Gina had recently been approved to take vacation time for a trip abroad and didn’t feel like she could ask for more time off from work. Not only was she dealing with the dilemma of needing to miss work to receive the procedure, but she had to travel several hours to a Planned Parenthood in St. Louis, the only clinic performing abortions in Missouri at the time. She was able to adjust her schedule and take a day off, but she didn’t discuss her situation with anyone at the labor union for which she works.

“Even though I work for a progressive organization that supports reproductive rights, there is still a culture of shame,” Gina said. “It’s a personal decision with very intense personal feelings and I don’t want that to affect my career. Abortion is stigmatized so heavily. It’s difficult to have these open conversations.”

People face many barriers when accessing abortion, including taking time off work, getting to a clinic that offers abortion services, paying for the procedure, and, in some cases, arranging child care. Many like Gina also fear retaliation at work.

“We know women are being discriminated against in the workplace and in housing when it comes to their reproductive health care choices, and they need to be protected,” said Alison Dreith, executive director of NARAL Pro-Choice Missouri.

The St. Louis City Board in February passed a reproductive health anti-discrimination ordinanceprotecting people in employment and housing. The ordinance offers protection against discrimination for any reproductive health choice including abortion care, fertility treatments, birth control, and pregnancy.

Despite the ordinance, the work of protecting women in St. Louis isn’t over. The St. Louis Archdiocese is challenging this ordinance in court on the basis that the policy is an infringement on religious liberty, despite the law offering exemptions for religious organizations.

Municipalities nationwide have been slow to act in protecting people from this type of discrimination. Along with St. Louis, only Boston, Washington, D.C., and Delaware have ordinances on the books to protect people from discrimination based on their reproductive health choices. The Democratic-held California General Assembly recently passed a similar ordinance, but it was vetoed by Gov. Jerry Brown (D) on Sunday.

Gina is protected at her job by a collective bargaining agreement requiring her employer to give her time off for illness or medical procedures, but she thought she may experience repercussions other than termination if she were open about her abortion.

“There are other ways bosses can make your life difficult other than just being fired,” she said, citing examples such as receiving a bad assignment or being moved to a different department.

Not only can stigma cause workers to fear workplace repercussions, but missing work to receive reproductive health procedures can also affect employment.

One 22-year-old mother of four living in Blue Springs, Missouri lost her job after taking three days off work to receive and recover from an abortion. Amanda, whose name has been changed to protect her identity, was working full time as a night closing manager for Dollar Tree when she unexpectedly became pregnant. With four children under the age of five, she knew she couldn’t support a fifth.

She gave her employer two weeks’ notice that she would need time off, made sure her shifts were covered and provided a doctor’s note that mentioned she needed the time off without giving details about the medical procedure. When she showed up for her next shift, she was greeted with the news that she had been fired because she had missed too much work. Despite working at Dollar Tree for six months as an hourly worker, she had not earned enough time to be absent for three days.

“I was infuriated,” Amanda said. “Sometimes women have to take off work for unexpected medical reasons and employers need to be considerate of that.”

Out of work for about five months and reeling financially, Amanda returned to a serving job she had years ago, where she makes $3.75 an hour. Amanda’s situation was not surprising to Dreith of NARAL. “A majority of workers in this country don’t have paid sick leave or paid leave in general,” Dreith said. “It’s the low-wage workers who suffer the most when they have to take time off work. They can get fired even though they should be protected.”

Access to paid sick leave varies widely among employers, said Alex Granovsky, an employment lawyer in New York City who focuses on discrimination cases. Only 13 percent of private industry workers are able to access paid leave through work, according to the Bureau of Labor Statistics. One of the only protections available to many workers is the Family Medical Leave Act (FMLA), which protects a person’s job without pay for up to 12 weeks. Even then the benefits are limited, as FMLA applies to companies with 50 or more employees, and an employee must be working for the same employer for at least a year to qualify.

“Some states have sick leave protections, but in general there aren’t many protections for employees missing work,” Granovsky said.

It can be hard to distinguish discrimination based on reproductive health choices from employers enforcing a sick leave policy. Granovsky said inconsistent treatment can expose a bigger issue.  “If one employee misses two days due to an illness or medical procedure and it isn’t a big deal, but then someone else misses the same amount of work for a D&C [abortion procedure], and then loses her job, that might be something worth looking into,” he said.

There are some federal protections for pregnant workers, such as the Pregnancy Nondiscrimination Actand the Americans with Disabilities Act, which require employers to make accommodations for pregnant workers. No such protections exist for people seeking abortion care, leaving many struggling to balance their personal reproductive health choices with their jobs.

“These are the positions we find ourselves in as women,” Gina said. “We might advocate for access to reproductive health care, but when we need it we find ourselves alone.”


Recordings of California nursing courses reveal the extent to which students were taught about dubious anti-choice myths pushed by organizations opposed to abortion rights.

Nurses and other attendees had just settled in for the lecture, The Latest Research on PTSD and Abortion, when the instructor raised the specter of death.

“There are some women who almost die on the table,” Dr. Martha Shuping, a licensed psychiatrist from North Carolina, told the class. “I know one woman whose daughter did die on the table.”

Shuping taught the course this April at the annual conference of Heartbeat International, a multi-million-dollar anti-choice organization based in Columbus, Ohio. Heartbeat International is known for its worldwide network of 2,200 anti-abortion crisis pregnancy centers, or fake clinics. Less well known is the organization’s role as a nursing educator.

“How many of you are here for nursing [continuing education units]?” said Shuping, asking for a show of hands in the room at a Chicago-area Hyatt Regency hotel. “Okay, quite a few.”

Heartbeat International in 2012 won the approval of the California Board of Registered Nursing, the state’s chief nursing oversight body, to teach continuing education (CE) courses. Because other states accept CE units from California-approved providers, Heartbeat International can educate nurses from around the country.

Shuping read a passage in which a woman described her distress after her abortion procedure: “I started having nightmares in which I saw myself in a baby parts cemetery and holding a dead baby in my arms and crying for the ones I lost.’”

‘I Want to Be With My Babies’

California nurses must take 30 hours of CE courses every two years to maintain licensurenearly 3,000 California-approved CE providers offer this training. Heartbeat International markets its CE-provider status at conferences and online.

Rewire purchased an audio recording of Shuping’s course via the Heartbeat International conference website.

In it, Shuping introduced herself as a medical doctor, adding, “I’ve been helping people recover from abortions since 1985.” Shuping, who is known for making unsubstantiated claims about abortion’s links to mental illness, co-authored a flawed study suggesting abortion caused anxiety, mood, and substance-abuse disorders.

While Shuping spent much of the 70-minute lecture describing research on trauma related to pregnancy loss and abortion, she devoted about 20 percent of the time to anti-abortion anecdotes:

Here’s British artist Emma Beck, [she] committed suicide after an abortion in 2007. And she wrote, “I told everyone I didn’t want to do it. Even at the hospital. Now it is too late. I want to be with my babies.” So that was in a newspaper article. Again, sometimes people would like to say it’s not the abortion. It’s something else. And it’s not always something else. It might be the abortion, and there it is.

Shuping told attendees how Sheila Harper, founder of the abortion recovery ministry Save One, weighed whether to end her life after an abortion.

She went home from work early one day for the purpose of killing herself because of distress related to abortion. She got out her roommate’s gun. She was sitting with a gun in her hand kind of thinking how she was going to do this and kind of get psyched to pull the trigger. And the roommate came home early, providentially, and so she decided not to kill herself because that would be a mess for the roommate to find, and it kind of just made her stop. So again going back, that’s self-destructiveness, obviously.

Shuping then read excerpts from the book Forbidden Grief, written by Theresa Burke, who co-runs the “post abortion healing” ministry known as Rachel’s Vineyard.

That Shuping’s class didn’t hew to science is no surprise.

In January 2016, Rewire reported that Heartbeat International taught the course “Abortion Pill Reversal and Your Clinic” to nurses for CE credit. So-called abortion pill reversal is an experimental treatment advanced by the the anti-choice movement without rigorous peer-reviewed research to back it up. The American Congress of Obstetricians and Gynecologists in 2015 condemned abortion pill “reversal,” saying it is “not supported by the body of scientific evidence.” A month after Rewire‘s reporting on the abortion “reversal” class, state Sen. Jerry Hill (D-San Mateo) introduced legislation to require CE courses to be based on science and the nursing board to routinely audit CE providers—something it said it hadn’t done due to a shortage of resources and staff. Gov. Jerry Brown (D) signed the bill last fall.

The nursing board began an audit of Heartbeat International on January 29, 2016.

The board seemed galvanized to crack down on Heartbeat International’s unscientific curriculum. But what emerged over more than 18 months was akin to regulatory Whack-A-Mole.

‘Insufficient Scientific Evidence’

Rewire obtained a copy of the audit last month through a public records request. The trove of documents revealed Heartbeat International offered not one course—as previously reported—but three courses related to abortion pill “reversal.”

Included in the documents were descriptions of courses titled “Women’s Mental Health and Abortion” and “Breast Cancer Risks of Induced Abortion and Hormonal Contraception.” When Rewire showed the curriculum for the two courses, which included research citations, to Dr. Daniel Grossman, a leading reproductive health researcher and director of the University of California, San Francisco, research group Advancing New Standards in Reproductive Health, he said Heartbeat International “cherry-picked the references and ignored the most recent and rigorous data on these topics.” 

The weight of evidence has long disputed a link between abortion care and breast cancer or mental illness. In 2003, more than 100 experts convened by the National Cancer Institute rejected claims that abortion causes breast cancer, while an extensive review in 2008 of the “best scientific evidence” by the Task Force on Mental Health and Abortion of the American Psychological Association found abortion was not a threat to women’s mental health.

For much of 2016, Susan Engle, a registered nurse and auditor, probed the extent to which Heartbeat International’s courses were based on science, according to documents reviewed by Rewire.

In a letter dated October 11, 2016, Engle asked Susan Dammann, a registered nurse with Heartbeat International, to provide scientific evidence to back up its courses. Two months later, on December 27, Engle again wrote to Dammann, ordering Heartbeat International to suspend the three “abortion reversal” courses for “insufficient scientific evidence.”

Then, on January 17, 2017, Engle cracked down on the abortion pill “reversal” courses, writing:

…content related to medications used to reverse abortion, including but not limited to, Update on Abortion Reversal Abortion, Abortion Reversal and Your Clinic, and Reversing RU-486 does not meet the scientific knowledge required for the practice of nursing in accordance with CCR section 1456.

Engle warned Dammann not to offer the courses as a California-approved provider.

But three months later, at its April conference, Heartbeat International unveiled a slightly different course: “What Can Go Wrong with RU-486.” RU-486, or mifepristone, is one of the two drugs used in medication abortion, a regimen that abortion rights foes believe is reversible with a dosages of the hormone progesterone.

Had Heartbeat International tweaked the name to comply with Engle’s demand? The organization did not respond to a question about the course, but Heartbeat International’s president, Jor-El Godsey, offered a blanket statement in support of so-called abortion pill reversal:

As Yale School of Medicine’s Dr. Harvey Kliman told the New York Times this summer, the Abortion Pill Reversal is a proven medical intervention that, “makes perfect sense” and “is actually totally feasible.” Not only so, but Dr. Kliman—a pro-choice researcher and physician—said in the same interview that he would prescribe the Abortion Pill Reversal treatment to his own daughters.
Abortion Pill Reversal is the application of a safe, FDA-approved medical treatment that doctors and nurses have used for over 50 years in order to maintain safe pregnancies up until childbirth. No woman should be forced to complete an abortion she doesn’t want. It is the very essence of nursing and medical care to give a woman all the information she needs to make the healthiest choice for everyone involved in an unexpected pregnancy.

What Can Go Wrong with RU-486

Rewire purchased a recording of “What Can Go Wrong with RU-486.” Like the course on abortion and PTSD, the RU-486 course was taught by Shuping. An attendee can be heard asking Shuping about abortion pill “reversal.”

“Ok, ok, here’s a question about the reversal,” Shuping responded. “And the thing I have to say is that it’s not actually an accepted procedure.”

When Rewire asked Engle, the nursing auditor, a series of questions though an agency spokesperson, including whether she was aware of the course on PTSD and abortion and “What Can Go Wrong with RU-486,” Engle said she was not. She declined to speculate about whether the courses meet state regulations. The audit, Engle noted, covered the time period up to December 31, 2015—meaning recent courses, including those offered in April, were left out of the audit.

This summer, the nursing board flip-flopped on whether Heartbeat International can teach abortion pill “reversal.” In late July, the board initially said abortion pill “reversal” met scientific standards for nursing education. Less than two months later, the chief of the nursing board, Dr. Joseph Morris, sent Dammann a cease-and-desist letter to force Heartbeat International to stop abortion “reversal” instruction.

Heartbeat International is appealing the decision. Godsey, the organization’s president, in an op-ed last month in Newsweek called the decision a “naked political assault.”

Asked what it would take to revoke Heartbeat International’s status as a nursing educator, Engle cited state regulations. Among the reasons a provider can be removed: a felony conviction or material misrepresentation of fact.

Shuping told the class a story of a woman in England who wanted to reverse her medication abortion. “For instance I know a woman who was in England who had an RU-486 abortion and when she got partway through—she had taken her first tablet—but then she didn’t want to finish it up and take her additional medicine. And she really wanted her child and she was told, ‘No, no, you must continue.’”

A few minutes later, Shuping handed the class over to Heartbeat International’s Dammann, who told the nurses about abortion pill “reversal.”


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

Bill Grenblatt/Getty Images

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

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

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

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

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

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


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

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

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

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

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

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

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

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

Historical Context

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

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

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

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

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

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

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

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

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

The government is failing unaccompanied immigrant minors, explained Amiri.

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

“Part Handmaid’s Tale, Part Nazi Doctor”

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

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

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

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

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

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

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

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

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

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

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

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

“This Is What They’re Up Against”

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Values-clarification exercises

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

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

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

Potential barriers

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

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

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

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

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

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

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

–Requiring mandatory waiting periods;

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

–Failure to guarantee confidentiality and privacy; and

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In our health care system, financial access is everything

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

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

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

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

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

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