Abortion Information


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For the first time, women in Massachusetts are now eligible to get abortion services via telemedicine without having to leave their homes.

Massachusetts joined a federal study in late January that allows anyone living in a participating state to access telabortion services if they are under 10 weeks pregnant. All they need is an ultrasound from a primary care doctor and a telehealth visit with a provider that participates in the study. Then, the abortion medication is mailed to their home.

The telabortion study began in 2016 with just a handful of states to review the validity of FDA regulations that require the abortion medication, Mifepristone, be given in person by a clinician.

“We really see telabortion as just an expansion of options for people. We don’t really see it as replacing anything,” said Leah Coplon, who oversees the federal telabortion study for Massachusetts patients. “It’s just one more way to make abortions accessible to folks.”

Coplon is the program director at Maine Family Planning, one of the providers under the federal study. She’s been offering telabortions to Maine residents since 2017 and helped open up the service to Massachusetts residents earlier this year. Joining the study did not require any action by the legislature or the governor, merely a trained provider in the study and a licensed physician in the state.

There are several reasons why patients decide to choose this option, Coplon said, and privacy is a big one.

“As much as we work to de-stigmatize abortions, we recognize that for some folks there is a lot of stigma around it. If they can get what they need at home without having to interface with a healthcare facility and walk past protestors or drive by protesters, then that feels like the most safe and secure way for them to do it,” Coplon said.

Dr. Jennifer Childs-Roshak, who heads Planned Parenthood in Massachusetts, said telabortions also help address disparities that too often impact minority and low-income women.

“By providing ways for folks to receive abortion care in a way that doesn’t require taking time off from work, traveling long distances, having to find child care, putting their livelihood in jeopardy, it improves health equity,” Childs-Roshak said.

Telabortions are also cheaper. A medication abortion in a Massachusettts clinic can cost $500 to $700 — two or three times the cost of a telabortion.

This type of service, Childs-Roshak said, is also more critical for Bay State women than one might think.

“One might be surprised that even here in Massachusetts people must travel up to or more than 100 miles to access abortion,” she said. “This is a tremendous barrier for people on the western part of the state and the Cape and Islands.”

Recent interest in this national study has also expanded well beyond Massachusetts. Since the pandemic began, the number of states that participate has jumped from 10 to 17, plus Washington, D.C. Patient numbers also tripled in the first few months of the pandemic. But there are limits on which states can participate: It is currently illegal to mail Mifepristone in 19 states.

Tara Shochet, of Gynuity Health Projects, which runs the federal study, said a major factor in this increased demand is that pregnant women have been nervous about getting COVID-19 or spreading it.

“Folks didn’t want to go into places anymore,” Shochet said. “All sorts of medical establishments were cutting back on the number of people who could be inside at any time. Mandatory stay-at-home orders [were] in place. You add all these things to it, and this really turns into a very important way to access abortion care.”

But some doctors urge caution. Dr. Kerry Pound, an ER pediatrician and vice president of Massachusetts Citizens for Life — a group that opposes abortion — argues that FDA regulations requiring in-person distribution of Mifepristone exist for a reason. She believes the drug can be dangerous, possibly leading to hemorrhaging, vomiting and sharp pains.

“We are deserting women at this very vulnerable time when they should have care and supervision,” Pound said. “We don’t want to be by ourselves suffering, possibly bleeding severely — we are leaving them alone.”

Over 1,700 patients have participated in the telabortion study since 2016. Exit interviews have shown little if any difference in safety or effectiveness between dispensing the drug in-person and mailing it.

Source: https://www.wgbh.org/news/local-news/2021/03/25/massachusetts-women-can-now-access-abortion-medication-through-the-mail?fbclid=IwAR3BUYGpCztvHxYQkBusf4hF3SmV0fSA8vmUNOU9n9pEyAvCm9_6bcyShR0

NEW GUIDELINES ALLOW GREATER FREEDOM FOR WOMEN SEEKING ABORTIONS. FOR ILLUSTRATIVE PURPOSES ONLY. PHOTO: ANTHONY WALLACE / AFP

In Japan, a woman used to need her husband’s permission to have an abortion even if he had raped her.

Japan has announced new guidelines that allow women to get an abortion without their husband’s consent if they can prove their marriage has effectively collapsed due to domestic violence or other reasons.

Previously, women had to obtain written consent from the man who impregnated them to terminate their pregnancy. Exceptions are granted only if the women could prove the father of their future child was dead, missing, or had raped her. Additionally, if the husband was the rapist, a woman still needed his consent to carry out an abortion.

The new guidelines, announced on Sunday by the Japan Medical Association, came after growing calls from medical and rights groups for women to have more say over abortions.

The Crime Victim Support Lawyer Forum, or VS Forum, a group of lawyers defending the rights of abuse victims, was among several organizations that demanded a reform of Japan’s Maternal Health Act.

In June 2020, VS Forum requested the Japan Medical Association, Japan’s largest professional association of licensed physicians, to review how they grant abortions. 

“Though the law states that when a woman is a victim of rape she doesn’t need spousal consent for an abortion, in reality, that was often not the case,” Masato Takashi, the executive director of VS Forum, told VICE World News. “Female victims were turned away at many medical institutions.

Doctors were afraid of getting sued by the female’s partners, if they performed abortions without spousal consent.”

Japan’s health ministry adopted the recommendations put forward by the physician association, the Mainichi Shimbun newspaper reported on Sunday.

Though domestic violence support groups have cheered the new guidelines, they’re unclear how it will work in practice.

“The government hasn’t sent us any guidelines about how to better implement these revisions. Do victims need to speak to police to be considered victims of domestic violence? Or can it merely be victims who came to us for help? Nothing is made clear,” said a spokesperson from Saitama Victim Consultation Center, who declined to provide her name out of privacy concerns. 

Takashi, of VS Forum, said victims of domestic abuse could still be denied access to abortions because of the taboo around such violence.

“It’s common for a woman to keep her experiences of domestic violence a secret. She may feel shame, or embarrassment. So when she’s asked, ‘Did you report this to the police?’ Obviously, most women haven’t. This law helps, but it’s not enough,” he said.

In the past 25 years, laws concerning abortions have generally become more liberal globally, with 29 countries relaxing abortion laws since 2000. 

Yet millions of women still live under restrictive laws. 41 percent of the world’s female population cannot terminate their pregnancies freely, according to the Center for Reproductive Rights, a global legal advocacy organization. 

Japan is one of at least 12 countries that still require spousal consent for abortions. Some other nations include Turkey, Saudi Arabia, Kuwait, Morocco, Yemen, and Syria. 26 countries outright ban abortions.

Conversely, the Netherlands have some of the most lax laws around abortions. The United Nations has noted that “abortion is permitted virtually on request at any time between implantation and viability if performed by a physician in a (licensed) hospital or clinic.” For those living in the Netherlands, abortions are free of charge.

Source: https://www.vice.com/en/article/m7az34/japanese-women-no-longer-need-spousal-consent-for-abortions-if-they-were-abused

Center applauds introduction of federal legislation to reverse harmful Hyde Amendment and expand insurance coverage for abortion care

Members of the U.S. House of Representatives and Senate will introduce the Equal Access to Abortion Coverage in Health Insurance (EACH) Act, a federal bill to ensure that every person who receives health care or insurance through the federal government would have coverage for abortion care.  

The EACH Act would reverse the Hyde Amendment and related abortion coverage bans that push abortion care out of reach for people enrolled in federal health insurance programs like Medicaid and TRICARE or who receive health care through a government provider like the Indian Health Service and the Veterans Administration.

These bans deny abortion coverage for federal employees and their dependents, military service members, veterans, Native Americans and Indigenous people, Peace Corps volunteers, immigrants, people in federal prisons, and residents of Washington, D.C.

The Center for Reproductive Rights is part of a broad coalition, led by All* Above All, of more than 100 state, national, and regional organizations supporting the EACH Act. Through its U.S. congressional advocacy work, the Center advocates for federal laws that advance reproductive health, rights, and access, including the EACH Act.

“By denying insurance coverage for abortion, the Hyde Amendment and other coverage bans put abortion care out of reach for those working to make ends meet,” said Freya Riedlin, Federal Policy Counsel for the Center for Reproductive Rights. “We fully support the EACH Act, which will ensure that every person can make their own decisions about pregnancy, no matter how they get their insurance, where they live, or how much money they earn.”

Abortion coverage bans have long-lasting, harmful impacts

Studies show that restricting Medicaid coverage of abortion care forces one in four women with low incomes to carry an unwanted pregnancy to term—an outcome that can have long-lasting impacts for women’s health, well-being, and financial security. Studies also show that women who are unable to access wanted abortion care are at increased risk of experiencing intimate partner violence and health problems and are more likely to fall into poverty and to experience ongoing financial distress, including rising debt and eviction proceedings.

Abortion coverage bans compound the barriers to care many people already face due to systemic discrimination and economic insecurity. Black, Indigenous and people of color (BIPOC) are among those most harmed by abortion restrictions while also bearing the brunt of the pandemic and systemic racism. Because of the systemic barriers they face, BIPOC, people working to make ends meet, members of the LGBTQ+ community, and young people are more likely to qualify for Medicaid and other government insurance programs and are therefore also more likely to experience the financial hardships caused by the Hyde Amendment. 

In addition to reversing the Hyde amendment, the EACH Act would also prevent the federal government from prohibiting or restricting coverage of abortion care by private health insurance companies, including those participating in the insurance marketplaces under the Affordable Care Act.

The EACH Act of 2021 is being introduced in the House of Representatives by Congresswomen Barbara Lee (D-CA), Ayanna Pressley (D-MA), Diana DeGette (D-CO), and Jan Schakowsky (D-IL), and by Senators Tammy Duckworth (D-IL), Patty Murray (D-WA), and Mazie Hirono (D-HI) in the Senate. In the previous Congress, the EACH Act was introduced as the EACH Woman Act with now Vice President Kamala Harris as an original Senate sponsor. 

Lifting abortion coverage bans is an essential step toward equity in abortion access.

Congress first passed the Hyde Amendment in 1976 as a rider on the annual Department of Health and Human Services funding bill with the aim of prohibiting abortion care coverage under Medicaid. Lawmakers have renewed it every year since, and expanded its reach to ban abortion coverage for nearly all people who receive health insurance through the federal government. This has made abortion care inaccessible for people struggling financially for nearly 45 years. 

In addition to the Hyde Amendment, many people seeking abortion care are also subject to state-based restrictions that prohibit coverage of abortion care: 26 states prohibit coverage in health insurance marketplaces and 12 prohibit coverage in private health insurance plans. More than half (55%) of women of reproductive age enrolled in Medicaid live in states that block insurance coverage for abortion except in limited circumstances.

In the majority of states, the out-of-pocket cost for abortion care is considered financially catastrophic for households earning the state’s median monthly income. Without insurance coverage, people seeking care must often forgo basic expenses, such as rent, to access care; borrow money from friends and family; delay care; or forego care entirely and carry the pregnancy to term.  

Medicaid plays an essential role in providing health care coverage for people who experience elevated rates of poverty, under- and unemployment, and gaps in private insurance coverage. By dismantling economic barriers to accessing abortion care, passage of the EACH Act would be a critical step toward equity in health care access—and making sure every person can make health care decisions about pregnancy that are best for themselves and their families.

Source: https://reproductiverights.org/story/each-act-would-remove-major-economic-barriers-abortion-access-us?fbclid=IwAR3lS7F3pQikQjbtaS-zXMEdDATEgzvj01eU3bVfYayLOWZFY0oj0JRi7xE

Abortion rights demonstrators rally outside the Supreme Court in Washington on March 4, 2020. | Jacquelyn Martin/AP Photo

Pressure mounts on Biden to approve telemedicine for the use of abortion pills.

The battle over abortion rights has a dramatic new front: the fight over whether the Biden administration will make pills available online.

Even as they keep a sharp eye on the increasingly conservative Supreme Court, activists, lawmakers and medical groups are pushing Biden’s FDA to lift restrictions on a 20-year-old drug for terminating early pregnancies. Such a decision would dramatically remake the abortion landscape by making the pills available online and by mail even if the Supreme Court overturns or cuts back Roe vs. Wade.Advertisement

Pressure that had already been building for years over access to telemedicine abortions is reaching a peak, as patients fearful of Covid-19 are seeking to avoid in-person medical procedures whenever possible and demand for the drug has skyrocketed.

As the Biden administration deliberates on the federal rules on where, when and from whom patients can get the pills, with a federal court deadline looming in early April, conservatives are already erecting barriers. In court, in Congress and in statehouses across the country, they’re working to preemptively ban the pills or make them more difficult to obtain — with bills now pending in Indiana, Montana, Arizona, Arkansas, Alabama, Iowa this year alone.

“They’re trying as hard as they can to restrict access to the pills now because they know they won’t be able, later, to unring the bell,” said Mary Ziegler, a professor at the Florida State University College of Law who studies abortion. “This is just as important as what happens with Roe.”

Biden’s pledge to “follow the science” when it comes to public health is under scrutiny as medical experts argue — citing new data gained during the pandemic — that administering the abortion drugs remotely is safe and effective.

Should the federal rules get rewritten, someone in, say, Arkansas, could have a video consultation with a doctor in Massachusetts or even the UK and then receive the pills by mail. Even if red states moved to ban their importation, enforcement would be nearly impossible.

“It takes the fight out of the clinic setting into individual people’s homes,” explained Alina Salganicoff, the Director of Women’s Health Policy at the Kaiser Family Foundation. “That becomes much more difficult to regulate and could potentially broaden access.”

Women’s health and advocacy groups stress, however, that the pills are not a panacea. For one, they can only be used safely in the first 10 weeks of pregnancy — a narrow time window during which many people are not yet aware that they are pregnant. Additionally, taking the pills in a state that has banned them could be legally perilous, discouraging people from seeking medical help if they have a complication. This fear is not theoretical — already, even with Roe still in place, women have faced prosecution for self-induced abortions.

Biden may soon be forced to make a decision.Afederal appeals court is hearing a challenge to the Trump administration’s decision to keep the FDA’s in-person dispensing requirement for the pills in place during the pandemic, and Biden’s DOJ must tell themby April 7whether or not it plans to keep enforcing those rules.

Even if the Biden administration were to choose to defend the Trump rule, there’s a burgeoning online underground market for the pills which, like its counterparts in the formal health care system, has seen surging popularity during the pandemic.

Abortion opponents are already sounding the alarm about this potential wild west.

Congressional Republicans have for years raised concerns about the safety of the pills, sending letters pushing the FDA to take action against the drug and the online sellers who offer it. The most recent letters came last year, as nearly a hundred Republicans from each chamber of Congress urged the agency to take the drug off the market entirely.

Now that the administration is considering lifting the federal restrictions on the pill, conservatives are worried the state-level bans they’re rushing to enact won’t be enough.

“Chemical abortion really puts Roe vs. Wade on steroids,” said Kristi Hamrick with the anti-abortion group Students for Life of America. “Roe made abortion possible anywhere in the country during all nine months of pregnancy, but this is really a new frontier — doing it virtually and chemically.”

But for advocates like Silvia Henriquez, the co-president of the abortion rights group All* Above All, looser federal rules for the pills is part of a long-held goal.

“We are working towards a future where abortion care is there when we need it, where it’s affordable, accessible and on our own terms, without barriers,” she said. “Medication abortion gets us closer to that world — where it doesn’t matter who we are, how much we earn, or where we live.”

As conservative states have moved aggressively in recent years to restrict access to surgical abortions, passing hundreds of laws that have set limits on when, where and how people can have the procedure, demand for the cheaper and more convenient abortion pills has soared — including online, where patients have obtained the drug from underground marketplaces as well as approved vendors. In 2001, the drugs were used in just 5 percent of abortions in the U.S. By 2017, that jumped to 39 percent, according to the Guttmacher Institute. The increase came even as the total number of abortions dropped significantly.

Scientists and doctors are increasingly supportive of medication abortions and have long called for scrapping the rules dictating that patients pick them up in person even if they don’t swallow them until they get home. They say it’s a particularly pressing concern during the pandemic, when the government has moved to limit in-person dispensing — and promote telemedicine — for nearly every other drug.

Jen Villavicencio, an abortion provider and health policy fellow with the American College of Obstetricians and Gynecologists, told POLITICO that she started going from car to car seeing patients in her clinic’s parking lot and dispensing the pills after the Supreme Court intervened in January to restore the Trump administration rules that for several months had been blocked by lower courts.

“We were trying to avoid interactions with other people to try to quell the rising numbers of Covid-19 cases,” she said. “Many medications that have much higher risk profiles were allowed to remove the in-person requirement because of the pandemic. But that courtesy and safety measure was not offered to people who were seeking abortion care or miscarriage management.”

Medication abortion relies on two pills — misoprostol, which is lightly regulated, and mifepristone, which has been more tightly regulated by FDA since its introduction in the market decades ago.

Yetmifepristone “has very few risks at all,” argues Villavicencio. “It is more safe than over-the-counter medications like ibuprofen and Tylenol. We know this medication can be safely administered via telemedicine because we’ve studied it.”

ACOG, along with the American Medical Association and other leading medical groups, has been lobbying the Biden administration and arguing in court that the federal rules for dispensing the pills should be loosened. Their push has been echoed on Capitol Hill, where Democratic lawmakers have urged Biden to allow telemedicine abortions both during the pandemic and beyond.

But the decision still presents a political quandary for Biden, who until recently was relatively conservative on abortion for a Democratic politician.

The president has yet to take a position on the pills. When pressed by the New York Times in 2019 as part of a Democratic primary questionnaire on whether the medications should be over-the-counter, Biden gave a noncommittal answer, unlike several of his then-competitors, like Sen. Elizabeth Warren, who urged easier access to the pills.Advertisement

Asked where it stands on the dispensing requirements on the drugs, the Department of Health and Human Services declined to comment, citing the ongoing litigation. But Xavier Becerra, California’s attorney general who was just confirmed as Biden’s HHS secretary, last year led a coalition of 21 Democratic AGs in petitioning the FDA to allow telemedicine abortions at least for the duration of the pandemic.

“Forcing women to unnecessarily seek in-person reproductive healthcare during this public health crisis is foolish and irresponsible,” he wrote at the time.

As they await a decision, abortion rights opponents are fighting on two fronts: pushing Congress, state lawmakers and the FDA to enact restrictions on the pills or ban them entirely while also seeking to convince the public that the pills are dangerous.

For the last three years, groups including Students for Life of America have bought ads online and on TV, created mini documentaries, sponsored events on college campuses, and trained members to testify before their state legislatures about possible complications and side effects of the pills and the danger that women could be pressured or tricked into taking them without consent.

With easier telemedicine access to the pills, conservatives warn, even the fall of Roe vs. Wade wouldn’t curb their use in states that choose to ban abortion.

“There’s always been an issue of people crossing state lines, in order to do things that might be illegal,” said Roger Severino, a former top official in Trump’s HHS now working for a think tank.“It all depends on how the Biden administration reacts: if it fulfills its responsibility it’ll clamp down on the black market for it.”

Conservative fears around mifepristone are nothing new. When the drug was firstintroduced in the 1990s, politicians including George W. Bush worried the medication would popularize the practice.

Evidence since then — and especially during the pandemic — has borne those fears out. The popularity of so-called teleabortions has increased in the U.S. for years — long before the pandemic — both through the established health care system as well as more informal, underground groups. A January 2020 study in the American Journal of Public Health, for example, found increasing demand for one domestic teleabortion service operating underground in states where state restrictions on in-person abortion clinics increased. The federal government has also been seizing more pills shipped in from abroad, according to a POLITICO analysis of data on the FDA’s seizures of misoprostol and mifepristone obtained through the Freedom of Information Act.

In 2008, FDA intercepted nine shipments of abortion drugs, according to the FDA data obtained by POLITICO; in 2018, just a decade later, there were 26. The agency’s annual totals have varied widely from year to year: a low of 5 in 2015, followed by rises during the Trump administration of 19 in 2017 and 26 in 2018. The number fell to 10 in 2019, the last year for which information is available.

The shifting landscape overseas for access to mifepristone is a potential indicator of how widespread the practice of teleabortion could become in the U.S., whether it gains new footing legally under the Biden administration or is kept underground.

In the United Kingdom, the not-for-profit group MSI Reproductive Choices performed some 16,750 abortions through telemedicine alone in 2020 after the government loosened restrictions on the practice. (The country typically has around 200,000 abortions per year.) A new study of the pandemic year in the British Journal of Obstetrics and Gynecology says the practice has been successful: patients wait on average 4 days fewer to get an abortion, with little difference from in-person abortions in safety or effectiveness.

Jonathan Lord, the chief medical officer of the group, says the increased ease in obtaining the medications has had the effect of expanding access to abortion generally. When women had to go in-person to pick up the pills, many vulnerable women — such as those being abused at home — were too fearful to make the trip, worrying that their partners would discover what they were doing.

Now, the health care system can coordinate with social workers and police for people in the group. “They’re also the group we would really, really, really like to engage with,” Lord said. “That’s where telemedicine has really helped.”

The change has also diminished the importance of some of the underground groups.

Women on Web, the most prominent international group providing abortion pills through the mail outside of formal health care channels, got contacts from 0 patients in the the U.K. during the first few months of the pandemic — down from 35 or 40 a month. In a study of eight European countries, the group generally found surging demand for its services during the pandemic year — unless the country allowed for more teleabortion.

No matter what decision Biden and other policymakers make in the coming months, these trends are likely to continue long after the threat of Covid-19 has passed. The medication is likely to be the future of the abortion wars, if only because it’s the future of abortion.Advertisement

“There are so many direct and indirect ways that states have moved to limit access to surgical abortion — from waiting periods to parental notification and requirements for special licenses — and I anticipate they would be equally creative with medication abortions,” Salganicoff said. “Whether they can stop every pill from coming across the border is another story.”

Source: https://www.politico.com/amp/news/2021/03/20/abortion-pills-telemedicine-477234?__twitter_impression=true&fbclid=IwAR2A7HNHEiN66zSetM2FlzLL0YKWhLeJDI_hZar4qin0aZzCcAM3pSWhjdc

Anti-abortion demonstrators protest in front of the Supreme Court in Washington on June 29.Caroline Brehman / CQ-Roll Call via Getty Images file

“This legislative season is shaping up to be one of the most hostile in recent history for reproductive health and rights,” said Planned Parenthood’s president and CEO.

State legislators across the country are accelerating their efforts to limit access to abortions by fast-tracking a new round of anti-abortion laws this year, according to a report exclusively shared with NBC News.

Over 500 abortion restrictions have been introduced in 44 states this year, compared to around 300 at this time in 2019, according to the report, which Planned Parenthood produced with data compiled by the Guttmacher Institute, an abortion-rights research organization.

“This legislative season is shaping up to be one of the most hostile in recent history for reproductive health and rights,” said Alexis McGill Johnson, president and CEO of Planned Parenthood. “These abortion restrictions are about power and control over our bodies.”

Ralph Reed, founder and chairman of the Faith & Freedom Coalition, said the flurry of measures is part of a decadeslong strategy of states’ chipping away at abortion rights.

Like many of those who support such legislative efforts, Reed’s organization has worked to elect anti-abortion legislators who champion what he called “incremental” limits.

“We’re very bold and unapologetic in our aspirations that we want to see a day in America where the most vulnerable among us are protected,” Reed said. “The ultimate goal of the pro-life movement is to see Roe v. Wade overturned.”

Motivated by Justice Amy Coney Barrett’s appointment as the sixth conservative vote on the Supreme Court and President Joe Biden’s sweeping rollback of Trump-era anti-abortion efforts, state legislators have already passed a wave of laws this year aimed at giving the Supreme Court the opportunity to upend its landmark decision.

Enacting abortion restrictions at a rapid pace

South Carolina’s governor recently signed a law banning most abortions, making it the first state to have passed an anti-abortion measure this year. The bill, SB 1, requires doctors to perform ultrasound tests to check for cardiac activity, and if it is detected, an abortion can be performed only if a person’s life is in danger or in cases of rape or incest. Abortion-rights groups immediately sued, preventing the law from taking effect.

“We believe the Heartbeat Law is constitutional and deserves a vigorous defense to the U.S. Supreme Court if necessary,” South Carolina Attorney General Alan Wilson said in a statement.

So far this year, 12 abortion restrictions have been enacted in six states, compared with only one that had been passed by this time in 2019, the report said.

Nancy Northup, president and CEO of the Center for Reproductive Rights, the nonprofit organization that filed the lawsuit against South Carolina’s ban, said anti-abortion bills have become “more extreme.”

“We used to see more backhanded laws that forced clinics to shut down through impossible regulations. … But now politicians have dropped the smokescreen and are very open about their goal of banning abortion,” she said.

Conservative-leaning states shift focus

For years, state legislators have passed bills to limit access to surgical abortions; meanwhile, medication abortion — a more convenient and private way to end pregnancies — have grown in popularity and now make up over a third of abortions in the U.S.

The Food and Drug Administration requires the drug mifepristone, one of two pills used to perform a medication abortion, to be dispensed in clinics or doctor’s offices, rather than prescribed and picked up at pharmacies or by mail.

During the coronavirus pandemic, a group of doctors and advocates, led by the American College of Obstetricians and Gynecologists, challenged the rule. In mid-July, a federal judge suspended the restriction; the Supreme Court reinstated it in January.

The push to expand access to medication abortions during the pandemic and beyond fueled state legislators to propose limits on the method. As of now, 33 medication abortion restrictions and bans have been introduced. At this time in 2019, only 11 had cropped up in statehouses, according to the report.

In Montana, HB 171 would ban telemedicine abortions, prohibit medication abortions from being provided on school property and require informed consent from patients and state-mandated counseling before obtaining abortions.

“The abortion industry is changing, and chemical abortion is the new frontier, and states are motivated to upgrade their regulations,” said Sue Liebel, state policy director for Susan B. Anthony List, an abortion-rights advocacy group.

The American College of Obstetricians and Gynecologists is urging the FDA to lift its rules on mifepristone, saying medication abortions can be provided safely by telehealth. When medication abortions are obtained by telemedicine or in person, the likelihood of complications is less than 1 percent.

A rise in anti-abortion constitutional amendments

Even in liberal states that have taken steps to safeguard access, conservative lawmakers are seeking to add anti-abortion language to state constitutions.

Fourteen anti-abortion constitutional amendments have been introduced this year, more than three times the number at this time in 2019, according to the report.

Kansas legislators have already passed a constitutional amendment, HCR 5003, and next year, residents will decide whether the state constitution allows a right to the procedure.

“We want the people of Kansas to weigh in directly on the ballot so that we can pass laws, because right now their state Supreme Court makes that incredibly difficult,” said Katie Glenn, government affairs counsel at Americans United for Life, an anti-abortion-rights advocacy group.

If voters approve it, the proposal would amend the state constitution to say that nothing in the constitution protects the right to an abortion or the funding of an abortion. It would reverse a 2019 state Supreme Court decision that affirmed the right.

Elizabeth Nash, the policy analyst for state issues at the Guttmacher Institute, said such amendments give states more leeway to regulate abortion procedures.

“If the U.S. Supreme Court overturns federal abortion rights and neither the federal nor state constitution protects abortion, it would make it very easy for states to pass bans and restrictions and push care even further out of reach,” Nash said.

Source: https://www.nbcnews.com/politics/politics-news/report-details-wave-state-legislative-attempts-restrict-abortion-2021-n1262070?utm_source=instagram&utm_medium=post&utm_campaign=amjinstagram&utm_content=nbcnews-march2021

A 2010 women’s day celebration in Takaungu, Kenya, where women dicussed abortion, child marriage and women’s equality. (BBC World Service / Flickr)

“Women’s [and pregnant people’s] needs do not suddenly stop or diminish during an emergency—in fact, they become greater.”

A new resource created by Ipas and the Center for Reproductive Rights aims to help abortion care providers understand and manage their legal risks in areas hostile to abortion rights. The toolkit—”Improving Access to Abortion in Crisis Settings: A legal risk management tool for organizations and providers“—focuses on abortion care providers working in crisis settings, like caring for people displaced by natural disasters or conflict.

It emphasizes the importance of approaching abortion care with a human rights perspective, arguing governments have an obligation to “respect, protect and fulfill sexual and reproductive health and rights during conflict and humanitarian emergencies.” To help ensure states can effectively fulfill those responsibilities, the resource makes recommendations for how governments, organizations and medical professionals can provide accessible, confidential and dignified care for displaced people.

According to a Guttmacher Institute report on refugee reproductive rights, one-fourth of the 129 million people around the world in need of humanitarian assistance are women and adolescent girls of reproductive age. And as they point out, “Women’s needs do not suddenly stop or diminish during an emergency—in fact, they become greater.”

Providing reproductive health services during crisis situations requires unique strategies, resources and knowledge.

According to Carrie N. Baker, a women and gender professor at Smith College and an expert on reproductive rights and sexual harassment laws:

“Natural disasters and political conflict often result in unsafe environments with increased sexual and gender-based violence. In crisis settings, health care systems may disintegrate or be destroyed so that women and girls may not be able to access reproductive health care, which can lead to higher rates of maternal mortality and morbidity. Their lack of information about their rights or available services, as well as inability to afford services and fear of violence for seeking care, puts the health of women and girls at risk.”

The resource also provides guidelines to help abortion care providers assess their legal risks. It encourages them to understand the law in their specific location and situation, and provides suggestions for how providers can research the local legal context.

“Abortion law can be complex and confusing,” said Baker. “Even if abortion is allowed, police, lawyers and judges sometimes don’t know the law on abortion or have biased views against abortion. If local laws are unfavorable to legal abortion, government officials sometimes use the law to intimidate and harass pregnant people and abortion providers.

The resource lays out a series of questions designed to help providers catalog their legal risks, and the probability that those risks will impact their program. Then, they can make informed decisions and create a plan to ensure that patients can access abortion care, while not putting their providers in unnecessarily risky situations.

Providing abortion care can be a risky—or even dangerous—job. But it is a critical one, particularly in crisis settings and when dealing with marginalized or otherwise at-risk patients. This toolkit provides an essential resource to help medical professionals and their patients understand and reduce their legal risks, and reinforce that abortion care needs to be accessible and safe for people dealing with humanitarian crises.

Source: https://msmagazine.com/2021/03/16/abortion-ipas-center-reproductive-rights-improving-access-abortion-crisis-settings-a-legal-risk-management-toolkit/?fbclid=IwAR0zSOhOfhkbfyD3mIm5tjUe7Vr1sg1vvCPsy0vBfxwXQvin-O-2a3hZuvI

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image captionWomen will no longer have to wait seven days for an abortion

Women seeking an abortion in Jersey will no longer need to wait a week for an appointment after requesting a termination.

The island’s government has agreed to update the 1997 abortion law following calls from Deputy Louise Doublet.

She described the mandatory seven-day waiting period as an “unnecessary barrier to accessing safe and legal abortion care”.

Abortions are not offered in Jersey after 12 weeks.

Deputy Doublet said the seven-day waiting period can push women across the 12-week threshold, forcing them to leave the island to seek treatment, increasing the risk of complications.

She said medical abortions are usually only available up to nine weeks of pregnancy, so waiting seven days could also mean an unnecessary surgical procedure.

Her report also said there is only one clinic on the island.

“Dependent on how busy the clinic is or if bank holidays occur, there might be a wait for the second medical appointment,” said Deputy Doublet.

“A mandatory waiting period could result in women undergoing surgical procedures or having to travel off-Island unnecessarily.

“Approving this amendment would remove this requirement, in line with international medical best practice,” she added.

Source: https://www.bbc.com/news/world-europe-jersey-56515407

Indiana is again using abortion access for minors as a way to try and undo the last big abortion rights win at the Supreme Court.

The Seventh Circuit Court of Appeals issued a ruling about a week ago in Planned Parenthood v. Box that tees up a fight at the Supreme Court about what constitutes an undue burden on the right to an abortion and what standard courts should use to determine whether abortion restrictions are constitutional.

The question should be an easy one. In 1992’s Planned Parenthood v. Casey, the Supreme Court ruled that an abortion restriction imposes an undue burden if it places a substantial obstacle in the path of a person seeking a lawful abortion. The Court clarified the undue burden test in Whole Woman’s Health v. Hellerstedt in 2016, ruling that courts must weigh the burdens a law imposes on abortion access against the medical benefits those laws confer. If the burdens outweigh the benefits, then the law is unconstitutional.

Last year, in June Medical Services v. Russo, the Court reiterated that balancing burdens and medical benefits is required when analyzing whether an abortion restriction is constitutional. But Chief Justice John Roberts disagreed. In his view, Casey doesn’t require the balancing test—the one that the majority in Whole Woman’s Health already said was necessary. In Roberts’ view, Casey asks one question: “Is this law a substantial obstacle?”

And that’s what the appeals court had to consider in Planned Parenthood v. Box. At issue in that case is a change to Indiana’s forced parental involvement law. Indiana law states that a young person has to obtain consent from a parent before having an abortion; if they choose not to seek a parent’s consent, they have to go to court to seek a judicial bypass—that means asking a judge to determine if they are mature enough to have the abortion, and if not, if it’s in their best interest. In 2017, Indiana enacted a law that would require notifying the parent of any young person seeking a judicial bypass for an abortion, unless the judge decided that was against the minor’s best interests.

This change is obviously absurd. The whole point of the judicial bypass process is to allow young people to access abortion without involving a parent; if a young person has decided not to notify their parents that they plan to get an abortion, it makes no sense to force them to tell their parents that they are using the judicial bypass procedure. The change in the law makes an oppressive parental involvement mandate worse and is designed to further limit abortion access for young people.

The district court found that this new parental notice requirement imposed a substantial obstacle on some minors’ right to obtain an abortion, and the judge issued a preliminary injunction blocking it. On March 12, the Seventh Circuit affirmed the lower court’s decision, citing the balancing test in Whole Woman’s Health v. Hellerstedt and ruling that the new notice requirement imposed a burden without any appreciable benefit. In doing so, the circuit court deepened a circuit split (in other words, a disagreement among the federal courts of appeal) about whether or not a balancing of burdens and benefits is necessary.

On its face, Box is about expanding forced parental involvement laws. But there is a more insidious motivation at play here: Anti-choice advocates want to use cases like Planned Parenthood v. Box to reframe the undue burden test. They want to decimate abortion access by undercutting the undue burden standard. And parental involvement laws, like the one at stake in Box, make the perfect Trojan horse.

That’s because they are among the most common abortion restrictions, existing in over 35 states—and enjoying support from both Democrats and Republicans. They don’t evoke the same visceral reaction as more widely opposed restrictions, like forced ultrasound laws—meaning courts might be more sympathetic to upholding them, despite what that might mean for abortion precedent at large.

And anti-abortion advocates might get their way, thanks to Roberts’ concurrence last year in June Medical Services, in which he said that Casey doesn’t require a balancing test. The fate of abortion access hangs in the balance.

It’s important to stress that parental involvement laws like the one at stake in Box—like all abortion restrictions—are in and of themselves an undue burden.

Typically, parental involvement laws require that a young person either notify or obtain consent from a parent before having an abortion. In 1979, however, the Supreme Court ruled in Bellotti v. Baird that in order for parental involvement laws to be constitutional, they needed to include some kind of loophole: a way for young people to obtain an abortion without going to a parent in order to avoid giving veto power over someone else’s abortion decision to any single person.

Thus the judicial bypass process was born: a court hearing where a minor argues they are mature enough to make an abortion decision without involving a parent. The judge also has the option, if they find the minor is not mature enough, to allow the abortion to proceed on the grounds that it’s in the minors’ best interest.

Parental involvement laws already put young people at risk; they force minors to unecessarily engage with their parents or the courts to obtain an abortion. And the proposed expansion of Indiana’s parental involvement law would create another hurdle that will force young people to disclose their abortion decision to their parents—or more likely, to forgo abortions entirely for fear of having to involve a parent. The Seventh Circuit was right to block it.

But courts remain split over whether Whole Woman’s Health and June Medical Services require a balancing test. According to the Seventh Circuit, a balancing of burdens and benefits is required, but the sixth and eighth circuits have both ruled that it’s not required. And while a Fifth Circuit panel has ruled that the balancing test remains valid, we await a ruling from the full Fifth Circuit.

So what does this all mean? In short: The legal standard abortion advocates have long relied on to protect patients and providers from frivolous and harmful restrictions is in jeopardy, thanks to what is essentially a procedural schism—a circuit split regarding what the balancing test means and whether it is even required. Anti-choice lawmakers are relying on widespread support for seemingly harmless parental involvement laws to sneak through their agenda without appearing too extremist, even though these laws are just as extreme as any abortion restriction. And it’s a stark look into how abortion opponents plan to use abortion restrictions that appear less polarizing, but are nonetheless harmful and unecessary, to gain ground in their fight to restrict access.

A few years ago, this would not be the daunting prospect that it is today. But with a conservative supermajority on the bench—with justices like Amy Coney Barrett, who have been obvious in their disdain for abortion access—cases like these could have devastating effects, opening the doors for a flurry of restrictive abortion laws that would no longer be required to pass a critical and commonsense test.

Source: https://rewirenewsgroup.com/article/2021/03/22/this-abortion-rights-fight-is-calling-amy-coney-barretts-name/

Photo by Alex Bruski on Unsplash

Frantic attempts to schedule appointments. Driving across state lines. Every American is learning what it’s like to have to fight for health care access.

If your life is anything like mine, someone you know was vaccinated last week because someone else sat up all night, hitting refresh on an obscure website until they found an open appointment. Someone else you know probably just got their shot because their son or daughter sat on hold for hours on a phone line, until someone picked up and slotted them into a complex health system. Someone else you may know hopped in a car to drive across state lines, for several hours, to get a shot in some other jurisdiction. And someone else maybe received a phone call from someone they knew abruptly telling them to bundle their elderly parents or immunocompromised self into the car and just drive, because there were vaccines available someplace.

Kindly remember this experience—because what you are witnessing is precisely what happens whenever a woman’s reproductive health care facility shuts down. Access to vital, lifesaving health care becomes purely a function of whom you know, how fluent in English and how mobile you may be, and, of course, how much money you have. This may be a first for you, but for millions of women, especially in states that have closed virtually all of their abortion clinics in recent years, this is how reproductive health care currently works in America.

It’s hardly a controversial statement that while vaccine delivery is finally happening, the rollout has been chaotic and hyperlocalized. Every state and county and city may have different systems. The incomprehensible matrix of hospital and pharmacy websites, phone apps, and telephone hotlines assumes that everyone in America has ready access to technology, vast computer literacy, an email address, and hours of time to burn scaling the vaccine learning curve. (Here is an instructive example from the Washington Post’s Geoffrey Fowler guiding elderly Americans on navigating the systems.) You may be subject to fraudsters and grifters who prey on vulnerable people seeking health care in a crisis. Wealthy enclaves with big donors appear to have access that allows them to jump the queue, ahead of local seniors and the seriously ill. Learning to navigate these fragmented systems can take days. And if you aren’t fluent in English, computer-savvy, free to take time off work, and well connected, you will probably get vaccinated after those who are.

Nobody expected anything less, particularly given that high-end clients have received preferential treatment and resources throughout the pandemic. But at minimum we can learn from this natural experiment in scarce medical resources what will happen as several states continue their crusades to limit low-cost, accessible birth control and pregnancy care.

The state-level assault on abortion clinics, and particularly on independent clinics, long predated the COVID crisis. As Time magazine reported in December, “the number of independent abortion clinics in the U.S. has fallen 34 percent in recent years, from 510 in 2012 to 337 as of November. A total of 41 clinics have closed in the past two years alone.” Since 58 percent of people seeking abortions get them at independent clinics, the results have of course been catastrophic for women’s health. COVID itself has exacerbated the problemSix states were down to a single clinic before the pandemic hit, but 11 states attempted to suspend abortion services this past spring, opportunistically citing the pandemic as justification. While these efforts were blocked in the courts, some clinics closed, and the attendant legal fees and the burden of COVID regulations have all been devastating for others. For the women who require their services, the cost of declining abortion access is immeasurable.ADVERTISEMENT

Since Brett Kavanaugh’s confirmation to the Supreme Court, state legislatures itching to end the protections of Roe v. Wade have passed regulations that are defiantly unconstitutional, in an effort to force the issue nationwide. TRAP laws designed to shutter clinics under the pretext of advancing maternal health have been sidelined in some states as they now try to ban abortion outright. Last week, Mark Joseph Stern interviewed professor Mary Ziegler about Arkansas’ new, near-total abortion ban. The state joins at least 11 others in passing complete or near-total bans in the hopes of becoming the case that will overturn Roe. Also last week, Republican Texas state Rep. Bryan Slaton introduced a bill to abolish abortion, allowing for the death penalty for women and physicians who carry out the procedure.

We already know exactly what happens in a state that closes virtually all of its clinics. And we already know that states with the worst maternal and infant health outcomes are leading that charge. Missouri Gov. Mike Parson’s yearslong harassment crusade to shutter the last remaining clinic in his state, admittedly undertaken to end all abortion there, was stymied in the courts but proved devastating to both the clinic and to women forced to travel out of state to obtain their abortions in Illinois. What we do know about states that impose onerous TRAP laws is that the public health impacts have always fallen disproportionately on people of color and the poor. As Jasmine Wang, Peter Jacobs, and Hannah Pugh recently detailed here, “clinic closures across the country have resulted in longer wait periods and travel times, which place additional strain on patients in rural areas. Logistical requirements that do not improve patient safety—such as 24-hour waiting periodsmandatory ultrasounds and counseling, and informed consent laws—require patients to make multiple, sometimes costly trips to clinics.” We also know how quickly each of those burdens and extra inconveniences is dismissed by those who want to blame people for failing to access health care that is nearly inaccessible to them.

Yet again we are witnessing the stark division between the medical haves and have-nots, and yet again it’s got nothing whatever to do with moral virtue or medical need.

When Texas passed its controversial omnibus clinic regulation, House Bill 2, in 2013, the number of clinics that could operate in the state briefly dropped from 42 to 7. Had the Supreme Court upheld the new restrictions, Texas would have been left with 10 clinics—all in major cities—to serve 5.4 million women of childbearing age. Even after the Supreme Court struck down that law in 2016, many clinics never reopened. The number of clinics operating in the state now is about half what it was in 2013. While the litigation was wending its way through the courts, Texas experienced a natural experiment in what happened to women who lost access to reproductive care. Overnight, women seeking to secure abortions were forced to endure longer wait times, unnecessary repeat visits, burdensome travel, costly hotel stays, and missed work. The longer the wait time, the pricier the procedure became. In some cases, longer waits eventually precluded an abortion altogether. In Lubbock, for instance, a woman would have had to travel nearly 300 miles to reach her closest provider. Studies showed that the “number of Texan women of reproductive age living in a county over 100 miles from the nearest abortion provider in Texas more than doubled to just over one million when the admitting privilege requirement of HB2 went into effect.” Wait times at the remaining open clinics quickly soared to 20 days and longer. Women began to cross state lines to obtain abortions, turned to dangerous self-managed abortionsblack-market scammers, and drugs they could purchase in Mexico.

sample CNN account at the time was representative of how this affected poor women in particular: Women traveling hundreds of miles needed gas money. Poor and rural and non-English-speaking women didn’t always have access to bus tickets, taxis, hotels. Some slept in their cars while awaiting procedures. Women missed procedures because their babysitters didn’t show up, their paychecks didn’t clear, time off work was denied, protesters blocked clinics. And yet, at oral argument over HB 2 before a federal appeals court in 2014, Judge Edith Jones suggested that the 300 miles round-trip between the Rio Grande Valley and Corpus Christi was a breeze: “Do you know how long that takes in Texas at 75 miles an hour? This is a peculiarly flat and not congested highway.” Spoken like someone who has never slept in her car.

Vaccine access as it’s rolled out across the country highlights the same problems that were laid bare when Texas shuttered clinics. It has been an example of what can happen when capitalism and scarce medical resources collide. Yet again we are witnessing the stark division between the medical haves and have-nots, and yet again it’s got nothing whatever to do with moral virtue or medical need. Vaccines will go—as reproductive care has always gone—to the wealthy and well-connected, to those with resources and networks, to those with work flexibility, ample child care, and the ability to travel. Eventually, everyone will “have access,” but the same burdens and worries, limitations and encumbrances, that make it all but impossible for poor or non-English-speaking women in Mississippi and Missouri to access lifesaving reproductive care will present again when it comes to lifesaving COVID protection care. For Americans who haven’t thought carefully about why that happens, this present moment affords us that clarity.

We are doubtless a few short months away from the time at which we will begin to hear that there is simply something “wrong” with those who haven’t been vaccinated yet, that they were too lazy or unmotivated or distracted. (Indeed, narratives about measles vaccination rates tend to focus on anti-vaxxers, but as my former colleague Dan Engber wrote in 2019, lack of access to vaccination seems to be just as significant a problem in the U.S.) That’s what was said about poor women seeking to terminate their pregnancies, too—they weren’t trying hard enough. So long as access to lifesaving health services demands what this rollout is demanding—access that privileges the well-connected and the internet-connected—unevenness will be the rule. Blaming individual behavior for a systemic problem has long been the way to avoid solving systemic problems. But long after the crisis of this particular pandemic has passed, we would do well to question exceptionalist claims that basic health care required by all Americans is available to all Americans. As abortion clinics continue to close around the country, the pandemic should remind us that the pattern is long-standing, and that basic health care is still largely for the wealthy and the lucky.

Source: https://slate.com/news-and-politics/2021/03/vaccine-access-abortion-health-care-connection.html?fbclid=IwAR1OrfDIH89Wo1wOcxbSOPvdmhVMcHsC9LviJWA7Mt3_O37yqrE_bdErFqA

Women demonstrate at a screening of the hearing of the Inter-American Court of Human Rights over the case of Manuela, who was charged with aggravated homicide. Photograph: Marvin Recinos/AFP/Getty

Demands for justice for Manuela, who died of cancer during 30-year sentence, taken to international court in country first

When Manuela, a 33-year-old mother of two from rural El Salvador, had a miscarriage in 2008, she did what most women would do: she went to hospital.

There she was handcuffed to her hospital bed, accused of having an abortion, and charged with aggravated homicide.

The authorities said Manuela – whose full name has never been made public in El Salvador – must have been guilty of killing her baby as the child was conceived outside marriage. They did not allow her to speak with a lawyer while she was being interrogated.

Manuela was sentenced to 30 years in prison. Around the same time she was diagnosed with lymphatic cancer. Two years later, she died of her illness in prison.

On Wednesday, the Inter-American Court of Human Rights heard arguments in Manuela v El Salvadora landmark case that could shape policy and debate on abortion across Latin America.

As well as seeking reparations for Manuela’s family, the plaintiffs – a group of reproductive rights groups including the Center for Reproductive Rights and the Feminist Collective for Local Development – are also asking the court to mandate that the state take responsibility for failing to guarantee Manuela’s rights to health and life.

It is the first time that an international court has had the opportunity to challenge the staunchly religious Central American country’s aggressive prosecutorial approach to abortion.

“I remember my mum, she gave us advice and never left us alone. It is painful to grow up without a mother because that love is incomparable,” said Santos de Jesús, Manuela’s eldest son, in a statement to the media before the hearing. “I ask the state not to do these things because they left us abandoned without a mother.”Advertisement

Manuela’s treatment is not unique. El Salvador has some of the world’s most draconian abortion laws, with the procedure outlawed. Unlike in many other Latin American countries, El Salvador does not permit abortion in cases where the child is conceived by rape or incest, or where the health of the mother or child is at risk.

The penalties for women are often enforced. Over the past two decades, about 181 women who experienced obstetric emergencies were prosecuted for abortion or aggravated homicide, according to rights groups.

“We know that Manuela’s case is not isolated and that many other women are in the same situation,” said Catalina Martínez Coral, regional director for Latin America and the Caribbean at the Center for Reproductive Rights. “When Manuela went to hospital the doctors and the authorities immediately presumed guilt, going against all the guarantees of due process.”

The court’s decision, expected later this year, could have a sweeping effect throughout the region, as most Latin American countries respect the tribunal’s jurisprudence.

“This case will establish a standard not only in El Salvador but across the whole region on how we protect the reproductive rights a woman has when she arrives at a hospital,” Martínez Coral said. “A good decision will be a win for reproductive rights.”

Rights groups say Manuela’s ordeal was typical in El Salvador not only for its cruelty, but due to her status as a poor rural woman.

“What we are also seeing in El Salvador is the criminalisation of women who live in poverty,” said Paula Avila-Guillen, executive director of the Women’s Equality Center in New York, in reference to at least 25 other women who are in Salvadoran jails after obstetric emergencies.

“I am certain that if these women had had proper attorneys at the hospital, if they had had the agency to tell their story, if they had had the guidance of what to do in their situation, then none of them would be in prison,” she said.

Avila-Guillen added that this week’s hearing could apply pressure on Salvadoran courts to treat another woman who is in Manuela’s situation more leniently. The woman, called Sara, also had a miscarriage and will be sentenced in El Salvador on Monday.

“We don’t need more women dying in prison,” Avila-Guillen said. “And that’s what we’re hoping will come out of today [the court case].”

Source: https://www.theguardian.com/global-development/2021/mar/12/el-salvador-abortion-laws-on-trial-in-case-of-woman-jailed-after-miscarriage?fbclid=IwAR2VGAHvr6mDaRcHBBnalXpqOC56PVvWX6NW58Zk3MJ_K1VRxI_908UjdNI

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