Abortion – Abortion Clinics, Abortion Pill, Abortion Information

One woman reveals the lengths she went to in order to receive an abortion when Texas clinics closed due to the pandemic.

Shortly after Esmarie* learned she was pregnant in mid-March, the city in South Central Texas where she lives started to shut down in response to the coronavirus. Her college classes went online and she lost shifts at the two restaurants where she works, leaving her barely able to afford groceries. She knew right away that she did not want to continue the pregnancy but feared abortion clinics would soon be shut down too. It would be another six weeks before she was able to resolve her pregnancy with a self-managed abortion using abortion pills, which, when used as directed, have a success rate of 95 percent and are an increasingly popular option during the pandemic (one study showed a 27 percent rise in requests across the U.S. and a 94 percent increase in demand in Texas). Esmarie, 19, told us about her experience obtaining an abortion during the pandemic.

The day I found out I was pregnant, I saw all over Facebook that Texas was going to be shutting down the clinics. I thought, I’m not going to be able to have this abortion. I thought that I didn’t have a choice—I was going to have to just live with it. It was very scary because I couldn’t tell anybody. I was trying to get as many hours of work as I could.

It was also scary because of everything going on. Everything was closed. I wasn’t making enough money. The restaurants were giving me only 10 hours a week, so I couldn’t make enough to support myself. I was scared I would get COVID-19 because I was pregnant. I didn’t have a car, so I had to walk in the heat. No transportation, no work—I couldn’t meet my basic needs.

The abortion clinics were closed at that time, but the CPCs, the crisis pregnancy centers, those were open. When I was making phone calls, trying to see which clinics were open for abortion, they were the only ones who answered. They said, “We don’t do abortions, but you can get an ultrasound and we can talk to you about your choices.” But they really only give you two choices—adoption or parenting. I was definitely not going to do adoption because I was adopted and it just didn’t go well. But I knew I couldn’t raise my child at this time.

They try to tell you, “We’re going to help you do this, we’re going to help you do that.” I’ve had friends say they told them that too. But once the baby was there, there was no help. So I was just scared, just thinking, I’m really going to have to give birth. I just felt stuck. They just kept saying, “When you do have the baby.” I was wondering, Who am I going to tell? How am I going to get money? How am I going to get to my prenatal appointments? I was barely even able to make the two-hour bus ride to that CPC.

I started reaching out to anyone who could try to get me to a different state. A few years ago, I had an abortion in a clinic. I took the first pill in the clinic, then the second one at home. I reached out to someone who was out of state who had helped me the first time. I thought they weren’t going to be able to do anything. But they said they could fly me out to a different Texas city or to a different state if the one in Texas closes too.

Like I said, I’ve had an abortion before, so I know how it is. If I had to go out of state, who knows what state it was going to be? I only have family in Texas. I wouldn’t have had anywhere to stay. I didn’t have money for a hotel. I could barely even get food for myself. They found me an appointment at a clinic, but then they asked, “Do you want to go to that clinic or do you want to do it at home?” I said I would do it at home.

It took two weeks for the pills to arrive. I’m pretty sure the mail was backed up because of COVID-19, so after a week, I asked them to send another package. While I was waiting for it, I was just thinking, I’m only getting further and further along. It was so stressful. The people who sent them buy them outside of the U.S. and send them to women who need them.

The first time I had an abortion, I was eight weeks along. Eight weeks and 10 weeks is actually a very big difference. The first time, it was not that bad—I was able to handle the pain, I guess. But the second time, it was so bad. I couldn’t move, I had chills, and my stomach was hurting. It was so bad I brought my blanket into the restroom just so I could be next to the tub, be next to the toilet. I feel like this wouldn’t have happened if I would have just gotten the help earlier.

I was staying with a friend and I didn’t tell him anything about the pill. I remember my hair was all wet like I had been in the bathtub. It was around 3 in the morning. I was crying and I was bleeding; I bled through three maxi pads. You’re not supposed to bleed through more than two during a medical abortion. I was trying to take as much pain as I could, and I actually dealt with the pain for a good two hours. But then I just couldn’t do it anymore. I couldn’t lie down. I couldn’t sit down. I couldn’t do anything, so that’s when I decided to go to the emergency room even though there were COVID-19 patients there. My friend took me. The hospital was not that far off, maybe five minutes, but it felt like the longest drive ever. My phone was dead so I couldn’t tell anybody I was there. I was just on my own during that time.

I had forgotten my mask—that was not on my mind at all. I was nervous. I didn’t want to touch anything. I think I was having a panic attack because I couldn’t tell them I was having a miscarriage. They were asking me what was wrong and what I needed, but I couldn’t breathe because I was in shock. I just remember holding my stomach because it was hurting and I was crying because I was scared. I told them, “I’m bleeding and I was pregnant.”

Then I lost so much iron from bleeding that I passed out on the floor. I’m 4’11” and I weigh about 98 pounds. I remember a receptionist told me to go put hand sanitizer on. I walked to go get hand sanitizer and I woke up on the floor. They put me in a wheelchair. It was kind of embarrassing—I was bleeding all over the wheelchair, all over the floor and the restroom.

They gave me morphine for pain through an IV. I was on anesthesia because I guess they had to finish taking out whatever was left, so I was asleep. When I woke up, I used the hospital phone. I was trying to get ahold of my mom or my brothers or sisters. I wasn’t going to tell them what happened, but I did want to tell them I was in the hospital and I needed a change of clothes. I had bled through my pants and didn’t have extra clothes. I got ahold of my brother at 6:30 in the morning. He came to give me some clothes and stuff but I couldn’t have visitors, so he gave it to the front-desk person and they brought it to me.

The baby’s father gave me a ride home from the hospital, but I didn’t tell him why I was there. No one knew about the abortion, which I was sad about, but still, everyone was calling me, asking, “Are you okay?” My mom told other family members that I was in the hospital, so they started blowing up my phone: my sisters and my tías, my tíos. They started asking questions, so I told them, I don’t know, I was asleep, they had me on all kinds of medicines. I didn’t want to tell them anything because they’re going to judge me. They wouldn’t be supportive. I haven’t told my friends either.

To the politicians who closed down the clinics, abortion is a basic human right. Young ladies have the right to this. If they know what they want, they shouldn’t have to wait longer, because it can just make things worse.

*Esmarie’s name has been changed to protect her privacy. This article was supported by the Economic Hardship Reporting Project.

Source: https://www.cosmopolitan.com/politics/a33393312/abortion-covid-19-pandemic/?fbclid=IwAR1aFxTtn8ghCs21GNCBa5yeYoKBuGR0e60NDOOwT0ReoJxasSTcK5PKMYI

Harris is the first Black woman at the top of a major party ticket. The first Asian American. The first graduate of a historically black college or university.

According to FiveThirtyEight’s tracking, in the 116th Congress Kamala Harris ranks 99th out of 100 for voting in line with President Trump—a “bad” record all of us should be proud of.
Chris Carlson/Getty Images

It was a snowy Martin Luther King Jr. Day in 2019—I was in Park City, Utah, for work during the Sundance Film Festival. My friend Symone Sanders tagged along for this trip.

We took a break from our busy schedules as two Black women political strategists to head back to our hotel to watch Sen. Kamala Harris (D-CA) kick off her presidential campaign. As we watched her, we were in tears full of inspiration for what Black women could achieve. And even though we chose to work for different candidates within the primary—former Vice President Joe Biden in Sanders’ case, and Sen. Elizabeth Warren (D-MA) in mine—that feeling of history and inspiration remains.

Throughout history, Black women have fought against all odds to demand our seat at the table, to fight for our communities as a whole, to imagine a world where every person’s experiences are validated and justified. We have led both women and Black men to the freedom line, only to be told to wait our turn because the intersection of our identity was too burdensome.

Our time is now.

Harris is the first Black woman at the top of a major party ticket. The first Asian American. The first member of a Black Greek letter organization. The first graduate of a historically black college or university.

ProgressivePunch rates her record as a senator as one of the most progressive. And according to FiveThirtyEight‘s tracking, in the 116th Congress she ranks 99th out of 100 for voting in line with Donald Trump—a “bad” record all of us should be proud of.

When it comes to reproductive freedom, Harris has an impeccable record. She’s protected funding for Planned Parenthood health centers, opposed the domestic “gag rule,” supported the protection of the Title X family planning program, and introduced Black maternal health legislation alongside reproductive justice leaders. During her presidential campaign, she proposed a plan that would require states with a history of violating Roe v. Wade to get approval from the Justice Department before enacting new abortion laws.

Black women are excited. Even us members of Delta Sigma Theta sorority share joy with our sister Greeks of Alpha Kappa Alpha, who are making history with one of their own. Regardless of the numerous well-qualified women any of us thought would have been the ideal running mate, the mutual consensus is this is a historic moment, and we will absolutely not tear down a Black woman with the misogynoir we face daily.

There is room for disagreement in the big tent of the Democratic Party. Harris challenged Biden during the primary, and he still chose her as the most qualified running mate; I hope this campaign continues to build upon the same sentiment. It will take a broad coalition in November, especially in the midst of unprecedented voter suppression efforts along with the COVID-19 pandemic. And with racial justice at the forefront of our nation’s politics, our nominees must work with those who have been catalysts for this movement—including organizations like the Working Families Party, the Movement for Black Lives, and Black Womxn For.

Because that’s the beautiful thing about democracy when it works—our elected officials work for us. The people. The people who demand universal child care. Medicare for All. Eradication of poverty. A Green New Deal. Criminal justice reform. Canceled student debt. And we hold them accountable.

And they are shook. Trump, Pence, Barr. All of ‘em. Shooketh.

As Warren, my former boss, said, Harris is an inspiration to the many women who see ourselves within her, and most importantly, she is unafraid. Like Warren, and everyone else who remembers Harris during the Barr hearings, we’ve got our popcorn ready for the vice presidential debate in October.

But, “Black women, please brace yourselves. It is about to get so ugly. We are so hated, and anytime we are centered, we get vitriol from all sides. Remember what dude said about Tubman just a couple of weeks ago? Get ready,” my sister friend Jamilah Lemieux noted on Twitter.

The misogynoir that will be unleashed is only just beginning. It is on us to push back against these attacks and ensure the protection every Black woman and girl deserves—especially one fighting to represent us at the highest ranks of our government.

For the political media covering this election—which is overwhelmingly white and male—it’s time to hand the pen and microphone over to the Black people and women in the newsroom. And if you have a Black woman on your team, you may want to put her on this beat because no one will be able to capture the dynamics or nuance of this historic campaign like her. No matter how much you try to learn about the Mecca that is Howard University, Alpha Kappa Alpha (or the Ks), and Beyoncé, your experience won’t rise to the moment within our culture that is required for this coverage. This is literally like a dream where Ida B. Wells could have covered Barbara Lee and Shirley Chisholm.

This Delta is looking forward to saying Madam Vice President.

Source: https://rewire.news/article/2020/08/12/with-kamala-harris-as-bidens-vice-presidential-pick-our-time-is-now/

The good news is that most people will still have birth control after this decision because most employers want to cover it.

Over 61 million women have birth control coverage thanks to the birth control benefit—but we anticipate several hundred thousand people will lose coverage as a result of the Trump birth control rules. Shutterstock

The birth control benefit in the Affordable Care Act (ACA) is one of the most important nondiscrimination provisions of the health-care law. The benefit requires that employer-provided health plans treat contraception like all other preventive medicine and cover it with no additional costs or co-pays to employees.

When the U.S. Supreme Court ruled the Trump administration could allow employers to opt out of providing that birth control coverage in their employee health plans if the employer had a religious or moral objection, it threatened the birth control coverage of millions of employees and students across the country. It left many with the same question: Now what?

Mara Gandal-Powers, director of birth control access at the National Women’s Law Center (NWLC), walked us through some basic birth control benefit facts you may be wondering about.

Rewire.News: How can an employee find out if their health insurance plan covers contraception?

NWLC: Your HR or benefits staff at work should have answers to this question. But we understand that it may not be comfortable to ask that question of your employer, or if your insurance is through a spouse or parent’s employer it may not be possible.

You can also look at your health insurance documents—you have a right to access the full coverage documents at any time. You can search the documents to see if there are coverage exceptions—I recommend using the search terms “contracept” “family planning” and “birth control” because different documents might use different terms.

If an employer health plan covers contraception, how worried should employees be? Is there anything employees can do to make sure employers that cover contraception continue to do so?

NWLC: The good news is that most people will still have birth control after this decision because most employers want to cover it. Over 61 million women have birth control coverage thanks to the birth control benefit—but we anticipate several hundred thousand people will lose coverage as a result of the Trump birth control rules. If you currently have birth control coverage in an employer health plan, most plans will be required to provide you with a notice if they drop coverage, so pay close attention to letters or other communications from the insurance company.

Employees can talk to the benefits team and share that they are encouraged to see the continued birth control coverage. These comments can both help the benefits team know what employees want and motivate them should management consider a coverage change.

If an employer plan doesn’t cover contraception, what if anything can the employees do about it?

NWLC: Because there is no list of all employers that exclude contraception, it is important for employees to share this information with others so they can know as well. The NWLC operates a hotline called CoverHer, and we can talk with employees about their situation. Employees can also let people know through employer-review websites like Glassdoor, so that people job searching will know about this problem before they decide about a job there.

What’s next in the fight over the birth control benefit in the Affordable Care Act?

NWLC: This fight is definitely not over. The Supreme Court remanded Pennsylvania’s case back to the lower courts because there are claims that are still to be decided. And there are also cases brought by California and Massachusetts, as well as one in which we, Americans United for Separation of Church and State, and the Center for Reproductive Rights represent a student group, Irish 4 Reproductive Health, that had been stayed pending the Supreme Court decision. Each of these cases is now moving forward, and a lower court could stop the Trump birth control rules in any of them.

Source: https://rewire.news/article/2020/08/10/whats-next-for-your-birth-control-coverage-after-little-sisters-of-the-poor/

Inadequate Measures Heighten Existing Risks for Health, Lives

Banners and posters from a sit-in by pro-choice activists at the Ministry of Health in Rome on July 2, 2020. Organized by the Italian Abortion Contraception Network, activists and organizations called for free and accessible contraception and guaranteed access to abortion. © 2020 Matteo Nardone/Pacific Press/LightRocket via Getty Images

Government inaction has left women and girls facing avoidable obstacles to accessing legal abortion in Italy during the Covid-19 pandemic, putting their health and lives at risk, Human Rights Watch said today.

The government’s failure to ensure clear pathways to essential, time-sensitive medical care during the pandemic caused interruptions to abortion services and prevented some women from accessing abortion within the legal time limit, exacerbating longstanding barriers to safe and legal abortion in Italy.

“Women and girls in Italy have been left facing sometimes insurmountable hurdles to the sexual and reproductive health care they needed during a time of crisis,” said Hillary Margolis, senior women’s rights researcher at Human Rights Watch. “The Covid-19 pandemic only highlights Italy’s labyrinthine system to access abortion and demonstrates how the country’s outdated restrictions cause harm instead of providing protection.”

Between May and July 2020, Human Rights Watch interviewed 17 physicians, academics, and women’s rights activists, as well as 5 women who sought abortion or abortion-related care after the onset of the Covid-19 outbreak in Italy in February. In a letter to the Health Ministry, Human Rights Watch presented research findings and requested comment, but has not received a response.

Abortion is legal in Italy during the first 90 days of pregnancy for health, economic, social, or personal reasons. However, burdensome requirements and extensive use of “conscientious objection” by medical personnel to deny care leave women and girls scrambling to find services within the legal time frame, often requiring visits to multiple facilities within Italy or abroad – movement hindered by local and international travel bans to help prevent the spread of Covid-19. Some facilities suspended abortion services during the pandemic or reassigned gynecological staff to Covid-19 care.

Italy’s government did not immediately deem abortion essential health care during the pandemic. The Health Ministry clarified on March 30 that abortion services were non-deferrable, but hospitals and clinics did not always adhere to this guidance. Experts told Human Rights Watch that a lack of information about available services during the Covid-19 crisis further hindered access.

“I started panicking because I didn’t know where to go,” said a woman in her 40s who searched for a doctor to authorize and perform her abortion in mid-March in the Lombardy region, among the areas worst affected at the outset of the Italian outbreak. She said she was sent from one healthcare facility to another, as each denied her services because of the Covid-19 crisis. “The Italian state closed the door in my face,” she said. She finally got an abortion in a hospital in another town.

Unlike other European governments, Italian authorities did not take steps during the pandemic to facilitate access to medical abortion. Medical abortion is a safe and effective way to end a pregnancy using medication rather than more invasive surgical methods. The World Health Organization (WHO) recommends administration of mifeprostone followed by misoprostol for medical abortion, which it says can be safely self-managed by women up to the twelfth week of pregnancy where accurate information and support from a healthcare provider are available.

But medical abortion is only legal in Italy until the seventh week of pregnancy – when some people may not even know they are pregnant – and national guidance calls for the medications to be administered during a three-day hospitalization. While surgical abortion can be performed in an outpatient, or day, hospital, only 5 of 20 regions in Italy permit medical abortion on an outpatient basis.

Italy’s guidance on medical abortion runs counter to public health advice to minimize hospital visits during the Covid-19 crisis. People interviewed said that some facilities suspended abortion services, especially medical abortion, during the pandemic because they deemed the need for multiple clinical visits or hospitalization too high-risk or too burdensome on overstretched health facilities. They said women also feared going to hospitals because of the risk of contagion.

Restrictions on movement also inhibited access to abortion. In areas declared “red zones” during the Covid-19 outbreak, people could travel outside the home for health emergencies, but had to provide justification to authorities if stopped and could face fines for violations. Some women said the prospect of telling authorities they were seeking an abortion was itself a deterrent.

Experts, activists, and professional organizations, including the Italian Society of Gynecology and Obstetrics (SIGO), called on the government to expand access to medical abortion in response to Covid-19. In a positive move on July 2, the Health Ministry confirmed that it asked the High Council of Health (Consiglio Superiore di Sanità), a technical advisory body, to review national guidance on medical abortion.

Italy’s government should ensure that its response to the Covid-19 pandemic and other emergencies does not unduly impede abortion access, Human Rights Watch said. To ensure safe and accessible care, it should follow medical advice, such as that in WHO guidelines, by extending the legal time frame for medical abortion to 12 weeks and eliminating requirements for hospitalization, instead providing guidance on self-management of medical abortion with in-person or telemedicine consultations.

The government should also remove burdensome requirements and address other longstanding obstacles to abortion that undermine reproductive rights. This includes eliminating a mandatory waiting period and ensuring that regions comply with obligations so that conscientious objection does not prevent abortion access. The government should ensure that conscientious objection is only invoked by individuals rather than entire facilities and that it is accompanied by appropriate referrals to alternative services.

“The Covid-19 pandemic threw a spotlight on what women and girls in Italy have known for a long time – the law says they can have safe and legal abortion, but in reality, they face obstacles at every turn,” Margolis said. “This should serve as a wake-up call that, crisis or not, protecting reproductive rights isn’t optional.”

For more information on access to abortion in Italy, see below.

Names of women who sought abortions have been changed to protect their privacy. Interviews were conducted remotely by video or telephone in English, Italian, or in Italian with an interpreter. Participants provided full informed consent at the outset of each interview.

National Legislation and Policy

Italy’s Law 194 of 1978 permits abortion for any reason during the first 90 days of pregnancy. Only three countries in Europe have a shorter legal limit for abortion on request. Many women may not realize or confirm that they are pregnant until late in the first trimester.

Law 194 contains burdensome requirements, including a 7-day waiting period and mandatory counseling “to help [a woman] overcome the factors which would lead her to have her pregnancy terminated.” The Health Ministry website notes that “the primary objective of the law [194] is the social protection of maternity and the prevention of abortion.”

Abortion can be performed at public hospitals and, in some cases, at private clinics receiving public funds. It is among guaranteed free reproductive health services for citizens, permanent residents, and irregular migrants with a special health card.

Burdensome Requirements

Accessing abortion in Italy is a protracted process that entails multiple physician visits, including for a certificate verifying the pregnancy, duration of pregnancy, and desire to terminate. Unless the doctor states an abortion is needed urgently, this is followed by a seven-day waiting period, the longest in Europe. There are also often lengthy waits for appointments for abortions. People interviewed said that such delays prohibit access to medical or surgical abortion within the legal time frames and undermine women’s reproductive choice.

After searching for a physician providing abortion care to issue her a certificate in Lombardy in March during the Covid-19 outbreak, Valentina said she went to a city hospital for an abortion:

After three weeks of feeling sick, vomiting, going to different hospitals, I went to [a] hospital and they said, ‘We will call you after [the] seven days [waiting period].’ I said, ‘I don’t need seven days to think about it. I am a mother, I work, I already have difficulty raising my two children…. But they said, ‘It’s the law.’

Valentina said she was about five or six weeks pregnant and worried about exceeding the legal time limit for medical abortion. She eventually accessed an abortion in a nearby town.

Conscientious Objection

Under Law 194, personnel at health facilities can refuse to provide abortion on grounds of “conscientious objection” unless the life of the woman is “in imminent danger.” Official statistics for 2018 show that 69 percent of gynecologists and 46 percent of anesthesiologists nationally are self-declared conscientious objectors. The same government statistics reveal that in one-quarter of the areas listed, over 80 percent of gynecologists and at least 60 percent of anesthesiologists are registered as conscientious objectors. Government data shows that general anesthesia was used in over 52 percent of abortions in Italy in 2018, making the high rate of objecting anesthesiologists a notable obstacle.

Law 194 obliges authorities to ensure that conscientious objection does not prevent fulfilment of legal requests for abortion, even if it necessitates relocating personnel. It also specifies that medical personnel cannot deny pre- or post-abortion care. However, people interviewed said that these measures are not upheld or enforced.

In mid-March “Chiara,” 24, experienced pain and symptoms of infection following an abortion several months prior. Personnel at the first family planning clinic she visited in Calabria told her their only non-objecting doctor was on vacation for an unknown period. “Then I went to a center in a nearby city and they said, ‘We don’t do visits related to abortion, not before and not after, because the head of the center is a conscientious objector,’” Chiara said. According to the March 30 Health Ministry circular, non-deferrable care during the Covid-19 pandemic includes gynecological examinations for vaginal infections.

Obstacles During the Pandemic

People interviewed said that movement restrictions, lack of information, and closure of services during the Covid-19 pandemic exacerbated delays in accessing abortion within the legal time frame.

Movement Restrictions

On February 23, the Italian government declared parts of the Lombardy and Veneto regions “red zones,” prohibiting movement into or out of designated municipalities. On March 9, the government extended these measures to all of Italy. Movement outside the home was only permitted for needed work, buying necessities, or health reasons. The regulations required people to “self-certify” the rationale for movement which, according to a government web site, could “be subject to subsequent checks” and constitute a crime if found to be false.

Women in Italy often venture outside their city or region to access abortion, but the emergency measures restricted those options. Silvana Agatone, president of Free Italian Gynecologists’ Association for the Application of Law 194 (LAIGA), said women from northern Italy began contacting her in February for help finding local services that were still operating because travel was impossible. “In nearby cities, the women were not accepted even if they came from areas that were not yet ‘red,’ because the crisis units of the hospitals did not accept people from outside the city, so they were blocked and they couldn’t move [elsewhere],” she said.

“Elisabetta,” 28, said movement restrictions compounded her difficulties in finding an abortion provider in Lombardy: “I started to feel anxiety because I was in a red zone. I didn’t know how to move around or [where to go to] get a certificate.”

Lack of Guidance and Information

People interviewed said that even after the Health Ministry confirmed that abortion services were non-deferrable, a lack of guidance on providing these services during the pandemic hindered compliance. On March 31, the ministry issued guidance for care of pregnant women, women who have recently given birth, and newborns, as well as breastfeeding, but no such guidance for abortion-related care.

“During lockdown, the gynecological societies had to interpret the government guidance, and it took time to do that,” said Dr. Suzanne Mbiye Diku, a gynecologist in Rome. “We lost weeks…. I myself had at least three or four cases where women arrived too late. They could no longer have [a legal] abortion.”

Lack of centralized information about available services led to confusion and delays. Sara Martelli, coordinator of the Safe Abortion Campaign for Italy and member of the Pro-Choice Italian Network for Contraception and Abortion (Pro-Choice/RICA), said that activists and women had to determine themselves where services were still operating. “All of this information was gathered by phone calls, word of mouth, and people who worked there,” Martelli said in June. “It is not acceptable that there is no access to this information…. [H]ere we are talking about two months [into the pandemic] and nobody knows [anything] yet.”

Lack of Available Services

Some reproductive health services were suspended or relocated to provide space for Covid-19 patients. Reassignment of medical staff to Covid-19 wards and absence of personnel due to illness or self-isolation also led to reduced services. Services in northern Italy, where the pandemic hit first and particularly hard, were especially affected.

Valentina searched for a doctor to authorize and perform her abortion in mid-March in Lombardy, among the areas worst affected at the outset of the Italian outbreak. She said:

I went to my gynecologist – he said I can’t see you because of Covid. I went to the hospital, they said we can’t see you because of Covid. I went to another hospital – they didn’t even let me in the door because they said they were only taking urgent cases. They told me to go to the consultorio [family planning clinic]. So I called the consultorio. They said they were closed because of the pandemic.

Valentina said she felt desperate: “The Italian state closed the door in my face.” She finally accessed an abortion in a hospital in another town.

In some cases, delays in getting the necessary certificate because facilities closed or stopped providing services during the pandemic meant that women missed the legal time limit for medical or surgical abortion. People interviewed said it is impossible to know how many women turned to unsafe methods to have abortions.

Elisabetta tried to get a medical abortion in Milan when she discovered she was pregnant in early April. “I called all the hospitals of Milano province,” she said. “Some said they had suspended the service, some said they don’t do it at all…. Some said you can come and wait in line all day, but we’ll have to see if we can take you because we will only be able to see about three girls a day.” By the time Elisabetta found a hospital in a town about 60 kilometers away, the doctor said she was past the legal limit for medical abortion. Her surgical abortion was scheduled for mid-May: “I counted in my mind – it would only be about two days before the final legal date to end my pregnancy.”

A doctor at a public hospital in Rome that serves as a reference center for the Lazio region said they experienced around a 20 percent increase in women seeking abortion during the Covid-19 pandemic, which she attributed to the fact that some local facilities had closed or stopped providing certificates or performing abortions. Nongovernmental organizations facilitating access to abortion said that demand for assistance increased significantly, in part due to reduced services and movement restrictions.

“Our 24-hour emergency phone line went from 2 to 3 requests for help per month to 5 to 6 requests a day,” said Eleonora Mizzoni of Obiezione Respinta, a group that maps and provides information about abortion services. She said searches and requests via social media also increased.

Dr. Abigail Aiken of the University of Texas at Austin is researching access to abortion in Europe during Covid-19 with data from Women on Web, which provides medication for abortion by mail in areas with limited access. Dr. Aiken said that based on historical data analysis, research shows a 40 percent increase in contacts from Italy to Women on Web in the period beginning March 10, compared to what would have been expected prior to the pandemic.

Access to Medical Abortion During Covid-19

Italy’s Law 194 is among the European Union’s most restrictive for medical abortion, with a legal limit of seven weeks. At least 16 countries allow medical abortion at 9 weeks or beyond.

Government guidance calling for a three-day hospitalization for medical abortion cites concern about death from bleeding, though the WHO has found no increased risk for at-home management of medical abortion and found it can help combat the risks associated with unsafe abortion. People interviewed said there is no scientific basis for the three-day guideline and point to other EU countries and even areas of Italy that have successfully implemented less restrictive measures. Regional authorities have discretion in local implementation of protocols, but only 5 of 20 regions allow medical abortion in outpatient hospitals rather than requiring the 3-day hospitalization.

“The three days is absolutely crazy,” said a doctor in a public hospital in Rome, noting that medical abortion takes place in outpatient hospitals in the Lazio region. “We know there is a different reality in some regions.”

Even if done in outpatient hospitals, medical abortion in Italy requires three visits for consultation and echography, administration of medications, and follow-up. People interviewed said that the multiple medical visits and three-day hospitalization contributed to suspension of medical abortion during the Covid-19 crisis. “[Doctors] were saying this is too much, three visits [during the pandemic] – so they just cut the service,” said Dr. Marina Toschi, a gynecologist and member of Pro-Choice/RICA.

National guidance also ran counter to public health measures during the crisis. “Many structures have reacted by stopping the medical abortion as – absurdly – the [national] guidelines call for a three-day hospitalization for medical abortion, while the Covid-19 [public health] guidelines call for a reduction in hospital admissions,” Martelli said.

Dr. Toschi, who works in Umbria and Marche regions, said that even prior to the Covid-19 pandemic, only around 20 percent of hospitals in Italy provided medical abortions. She said that all medical abortion services ceased in Marche region during the pandemic, and many did not reopen until after July 7. Similarly in Catania, family planning centers reportedly remained closed in mid-June with no indication of when they might reopen, although ophthalmology and other medical services were operating.

In Umbria, medical abortion services continued during the pandemic, but only 3 of 11 hospitals provide them, Dr. Toschi said. Official statistics show that medical abortion using the combination of mifepristone and prostaglandins comprised less than 21 percent of abortions in Italy in 2018. In many European countries, over half of abortions are medical, and in some cases, over 80 or even 90 percent.

Efforts to Change Requirements

European governments, including in France, England, Wales, Scotland, Ireland, Spain, and Germany, took measures to facilitate access to medical abortion during the Covid-19 pandemic, including by extending legal time limits, permitting self-management of medical abortion at home, and conducting consultations via telemedicine.

In early April, nongovernmental groups, including LAIGA, Pro-Choice/RICA, the Italian Doctors’ Contraception and Abortion Association (AMICA), and Associazione Luca Coscioni, wrote to the Italian authorities calling for extension of the legal time limit for medical abortion and elimination of the three-day hospitalization, as well as use of telemedicine to allow remote access to medical abortion during the pandemic. They reiterated their request on June 8, noting “the difficulties and risks to access to abortion that persist.”

In June, Tuscany became the first region to permit medical abortion outside of hospitals, in designated clinics. On May 14, Tuscan authorities adopted a resolution extending the time limit for medical abortion up to nine weeks, noting that the Covid-19 crisis had brought to light concerns about abortion access.

By contrast, in mid-June the newly elected Umbrian government, led by the right-wing Northern League party, reversed a policy permitting medical abortion in outpatient hospitals, reverting to the three-day hospitalization.

On July 2, pro-choice activists protested outside the Health Ministry calling for expanded access to medical abortion and free contraception. At a meeting that day, Ministry representatives confirmed that they had asked the High Council of Health to review national guidance on medical abortion.

Access to Later Abortion During Covid-19

Beyond 90 days, abortion is legal in Italy if there is a serious threat to a woman’s life. It may be legal if there is a serious threat to her physical or mental health, including due to diagnosis of severe fetal anomalies, but the law requires doctors to “take any appropriate action to save the life of the fetus.” People interviewed said delays in testing and diagnosis during pregnancy mean women are not always aware of fetal anomalies during the first trimester, and some anomalies cannot be identified until later in pregnancy.

People also said that few doctors in Italy are willing to perform abortions after the 90-day limit. “Most doctors say, ‘It is not my problem, go somewhere else,’” said Dr. Toschi. Most people travel outside the country for later abortion, made more difficult by travel bans during the pandemic.

“Martina,” 30, a physician, said doctors first alerted her to a potential problem with her pregnancy in January. “I asked a lot of times to get the genetic testing, but they said the problem wasn’t serious enough,” Martina said. “When you are in such a situation, you are dependent on the doctors. You have no choice.”

When testing confirmed an anomaly causing serious bone problems, Martina was 28 weeks pregnant. Hospital staff told her she could seek an abortion outside of Italy but gave no further information: “They are afraid of even telling you where you can go because they worry about legal problems.”

Martina said she searched frantically online for information and contacted hospitals abroad, but several said they would not accept patients from Italy due to the Covid-19 crisis. Worried about border closures, Martina left for France in late February and eventually found a hospital where she had the abortion. She said she felt lucky to have made it out before the borders closed and to have had the necessary financial resources – around €2,000 for the procedure and travel expenses.

There is no available information on how many women were unable to access later abortion, despite a serious risk to their health or lives, due to Covid-19-related travel restrictions.

While Law 194 requires annual reports on its implementation, no data is available regarding denial of abortion service, so it is impossible to know how many people were unable to get a medical or surgical abortion within the legal time limits or were denied services multiple times before finding an abortion provider.

Access to Contraception

People interviewed said that obstacles to abortion access should be considered in conjunction with lack of access to birth control in Italy. Free contraception through the national health service stopped in 2016, and only six regions now provide free hormonal birth control. Experts noted the cost of contraception in Italy can be prohibitive for poor women and adolescents. Birth control pills cost around €150 to €200 a year, and an intra-uterine device (IUD) around €250 to €300. Eleonora Mizzoni of Obezione Respinta said this creates “discrimination in access” to contraception.

In their June 8 letter to the health minister, nongovernmental organizations called for urgent measures during the Covid-19 pandemic to include free contraception in family planning centers, noting that the economic fallout of the pandemic may affect people’s capacity to purchase contraception.

Human Rights Obligations

Italy has obligations to uphold the right to the highest standard of health, including sexual and reproductive health, under international treaties to which it is a party, including the International Covenant on Economic, Social, and Cultural Rights (ICESCR), the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), and the European Social Charter.

United Nations treaty bodies have found denial of access to abortion can amount to violations of the rights to health, privacy, and freedom from cruel and inhumane treatment. The UN committee that monitors compliance with the ICESCR has noted that women’s access to comprehensive sexual and reproductive health is “essential to the realization of the full range of their human rights,” and said that countries should remove all barriers. In 2017, the UN Human Rights Committee and the committee that oversees implementation of CEDAW (CEDAW Committee) both raised concerns about persistent barriers to abortion in Italy and said that the government should ensure access to abortion services nationwide. The CEDAW Committee specifically said that Italy should ensure that conscientious objection “does not pose an obstacle for women who wish to terminate a pregnancy.” UN treaty bodies have noted that mandatory waiting periods constitute barriers to abortion access and called for their removal.

The European Committee on Social Rights ruled in 2013 and 2015 that Italy’s failure to ensure consistent access to abortion, including the overly broad practice of invoking conscientious objection, constitutes a failure to uphold the right to protection of health and nondiscrimination in violation of the European Social Charter.

The Council of Europe has said that all member states must ensure full access to reproductive health care, including abortion, in their responses to the Covid-19 pandemic and called on member states to “urgently remove all residual barriers preventing access to safe abortion.”

Source: https://www.hrw.org/news/2020/07/30/italy-covid-19-exacerbates-obstacles-legal-abortion?fbclid=IwAR2aLv0v-9D4PJIS7lbp37CESi0yvuw-JRX5NWBEjk0BC_NumTTw7e8FAZ0#

Restrictions on training are not unusual, and it can prevent medical professionals from providing good care.

A majority of directors at 169 OB-GYN programs indicated in a survey that their institution’s restrictions on abortion went beyond what state law requires. Shutterstock

Brienna Milleson was a medical student working at the free clinic at Saint Louis University two years ago when a woman came in seeking a pregnancy test. It was positive, and the woman wasn’t sure whether she wanted to keep the pregnancy—a position many pregnant people are in each year. She wanted her doctor to explain her options.

Milleson didn’t know what to say to her, as her two years of medical school had never covered abortion, a procedure so common that 1 in 4 women have it by the time they’re 45. The more experienced student on duty didn’t know how to handle the situation either.

“I was just totally unprepared for this poor woman,” Milleson said. “I had no idea what to tell her.”

Milleson said her classes gave little detail about abortion. Abortion was mentioned in an ethics class, but the OB-GYN module did not go over common procedures. Saint Louis University is a Jesuit institution in Missouri, a state with a single abortion clinic also in St. Louis. It nearly became the first state with no abortion clinics until the health department relented in June and granted the remaining clinic a license, ending over a year of limbo.

This lack of training on abortion at medical schools is not unusual. In a recent study for Obstetrics & Gynecology, researchers spoke to directors at 169 OB-GYN programs about their institutions’ abortion policies. A majority, 57 percent, indicated their institution’s restrictions on abortion went beyond what state law requires.

In many cases, providers in the study reported that policies were unclear, as Milleson experienced, although it didn’t attempt to quantify how often that occurred. The study also found that a significant number of policies are unwritten: About one-third of teaching hospitals had tacit restrictions; another third of institutions had written policies.

These implied policies were a double-edged sword. “Vague or unwritten abortion policies, although difficult to navigate, gave health care providers some agency and flexibility over their practices,” the researchers wrote.

Lori Freedman, associate professor at University of California, San Francisco and one of the authors of the study, said the survey results reflect the stigmatization and politicization of abortion.

“When [abortion] became legally initially, hospitals and practices did do abortions. … Many doctors stopped providing, and the people filling that gap were the family planning clinics,” she said.

This politicization meant that, while more than half of abortions took place in hospitals right after Roe v. Wade made abortion a constitutional right, less than 14 percent did by 1989, according to Eyal Press’ 2006 book Absolute Convictions. According to the Guttmacher Institute, 95 percent of abortions took place in clinics in 2017. Although the lack of availability of hospital abortions can harm patients who need inpatient care, Freedman said that many times, having an abortion in a hospital isn’t necessary.

Inadequate training in abortion can also affect students’ training in miscarriage management, as many patients who miscarry need to be treated with the same procedures used in abortion, said Amy Caldwell, a clinical instructor of obstetrics and gynecology at the University of Chicago.

“Personally, I think it is incredibly important for medical students to have experience with abortion care as it is one of the most common procedures women in the U.S. experience (second perhaps to cesarean section),” Caldwell said. “Regardless of what type of medicine a medical student goes into, it is almost certain they will end up caring for patients with a history of abortion.”

While Catholic institutions have received a lot of attention over their strict restrictions on abortion, contraception, and gender-affirming care, they are not alone. Only 5 percent of the teaching hospitals surveyed were Catholic, meaning the vast majority of those with additional restrictions were non-Catholic.

The study didn’t ask about any religious affiliations other than with the Catholic church, but it did ask respondents what they believed to be the motivation for their hospital’s restrictions. About half said it was “personal beliefs or comfort.”

Stories like Milleson’s illustrate how restrictions can prevent medical professionals, including those who strongly believe in reproductive rights, from providing good care. Restrictions can also affect the readiness of more senior providers. Lee Hasselbacher, senior policy researcher at the University of Chicago’s Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, said she’s spoken to providers who want to provide abortions but don’t, even in situations when it’s allowed, because they don’t have experience in the procedure. Instead, they refer patients to a hospital or clinic that doesn’t have anti-choice restrictions.

Beyond the limits in training, Milleson noted some of her professors seem to not only object to abortion but also judge patients who’ve had one. A medical history for a patient seeking gynecological or obstetric care routinely includes their history of pregnancy and abortion. She worries how much of that attitude influences her classmates.

“Are they going to treat someone differently [if] they’ve had several abortions before?” she said. “It’s a legitimate concern of mine and several of my classmates.”

Milleson is currently undecided about her specialty, and doesn’t think the lack of instruction in abortion will necessarily limit her future options. Still, she worries that the anti-choice atmosphere will affect her OB-GYN rotation.

“A good or bad rotation can make or break your aspirations for a particular specialty,” she said.

Meanwhile, as a member of Medical Students for Choice, Milleson and other pro-choice medical students at Saint Louis University are working on getting official recognition for their chapter, which would let them do basic things like announce meetings via official mailing lists. The stigma against abortion means they have to take care to not ask the wrong professor to be their adviser.

The stigma affects faculty members as well. Hasselbacher spoke to a provider at a Protestant medical system who said the institution’s policies and attitudes interfered with the instruction they offer.

“When they give lectures on pregnancy loss and termination, they were very careful about how they talked about it and felt like they always had to be walking on eggshells a little bit so they weren’t going too far and [saying something] they might get reprimanded for,” she said.

Source: https://rewire.news/article/2020/08/06/medical-students-cant-provide-abortions-if-they-never-learn-how/

A call for Georgia Cities to stand up for reproductive justice

Photography: Richard Martin

he past month has brought two important wins for abortion rights in Georgia. On July 13, the Georgia District Court struck down HB 481, Georgia’s six-week ban on abortions. On June 29, the Supreme Court issued its decision in June Medical Services v. Russo, striking down Louisiana’s admitting privileges law. This decision correctly followed the precedent of Whole Woman’s Health, where the court found a nearly identical law in Texas unconstitutional.

In the 2016 Whole Woman’s Health decision, the Supreme Court determined that requiring abortion providers to have admitting privileges at a local hospital and forcing unnecessary, if not impossible, targeted regulations on clinics was unconstitutional, because of the undue burden they placed on people seeking care. These medically unjustified requirements had already forced over half of Texas abortion clinics to close and, if allowed to continue, would close even more, creating steep obstacles for people seeking abortion care — such as traveling up to 500 miles to the nearest clinic.

Additionally, in the June Medical Services decision, following decades of precedent, the Supreme Court allowed the third-party standing to remain in place, which permits providers and clinics to litigate cases on behalf of their patients. Since the vast majority of cases are brought by clinics and providers, to rule otherwise would have made it incredibly hard to bring future cases against abortion restrictions.

It may be surprising to some that June Medical Services even made it to the Supreme Court. If the decision in Roe stands, then why do states feel emboldened to pass laws restricting, and even banning, abortion access?

This is because the right to abortion care — and the ability to access care — has never been absolute, starting with Roe which stipulated that states can regulate abortion care for “safeguarding health, maintaining medical standards, and in protecting potential life” (Roe, 410 U.S. at 154). Roe made abortions early in pregnancy legal, but left the door open for restrictions that make access to abortion care increasingly difficult, if not obsolete. Various decisions since Roe have expanded states’ rights to overregulate access, including Planned Parenthood v. Casey, which put forth “undue burden” to accessing abortion care as the new standard for assessing abortion restrictions, an assessment largely left to the discretion of judges and lawyers. We have seen a marked increase in burdensome, costly and medically unnecessary regulations of abortion care across the U.S. In 2019 alone, states enacted 58 new abortion restrictions, over half of which would completely ban all, most or some abortions. There are now 18 different types of abortion restrictions across the U.S., the majority of which are in effect in Southern states. This is because of a wide-scale, coordinated effort by conservative state legislatures to reverse Roe, a battle they are waging with ever-increasing ferocity.

The truth of the matter is that although the Supreme Court’s decisions garner news coverage, the battle over abortion access is largely fought at the state level, and Georgia is no different. For us, this Supreme Court victory means sustaining the status quo, with patients in Georgia paying on average $500 out of pocket because public insurance does not cover abortion care, traveling long distances to the nearest clinic and out of state if the abortion is after 20 weeks since conception, waiting 24 hours between consent and the procedure, having your parents notified of your procedure, if you are under 18 years old, and overcoming countless other hurdles. Even if we succeeded in preventing all future abortion restrictions, unless we address these existing barriers to care, this will continue to be our reality.

Make no mistake: these medically unjustified restrictions are designed to make abortion harder to access, especially for Black people and other people of color, the LGBTQ community, poor folks, youth, and those who live in rural areas. The same racist systems perpetuating police brutality and white supremacy are also behind these restrictions, working together to oppress and control Black and other marginalized communities.

And Georgia’s lawmakers are doubling down on these racist policies. Just last year, Gov. Brian Kemp signed the now-stricken HB 481 into law, which would have banned abortion after six-weeks and bestowed “personhood” status on a fetus. In doing so, Georgia joined eight other states passing gestational age bans on abortion in 2019. The American Civil Liberties Union (ACLU), CRRs, and Planned Parenthood filed a legal challenge against HB481, on behalf of SisterSong Women of Color Reproductive Justice Collective and various healthcare providers, and over a year later, Georgia District Court finally struck down HB 481. Gov. Kemp, having already spent an estimated $300,000 on litigation, has vowed to appeal this decision and continue the fight, despite being in the middle of a pandemic with large budget shortfalls, and in a state with one of the highest maternal mortality rates in the nation, a burden disproportionately borne by the Black community.

If individual states can continue to pass such harmful laws, what does that mean for abortion access in Republican-led states like Georgia? It means we must demand change from the ground up; we must go local.

As COVID-19 has shown, city leaders have an important role to play in keeping their citizens safe and healthy. This includes ensuring they have access to holistic reproductive healthcare, including abortion care; especially in the face of a hostile, anti-abortion state legislature and governor.

So, what can cities do to improve access to abortion care and reproductive healthcare more broadly? Cities can expand access to abortion clinics by examining zoning laws to ensure clinics can open new locations near other medical facilities, conduct public awareness and education campaigns around comprehensive reproductive healthcare, protect clinics and clinic employees and patients from harassment and violence, create a fund that low income folks can access to cover the cost of reproductive healthcare, protect individuals from discrimination based on their reproductive health decisions, and so much more. All of these tools are within the tool box of municipal-level government and can directly combat harmful policies at the state level.

This is especially important in metro Atlanta, which is home to 11 out of the 15 abortion clinics in the state and a hub for healthcare in the South.

After HB481 was signed into effect, the Atlanta City Council issued a resolution condemning the new law. This public stance in support of abortion access created an opportunity for the AMPLIFY Georgia campaign, a partnership of local reproductive justice organizations, to approach the city council to back its stance against HB 481 with action.

From these conversations came about the creation of a first-of-its-kind commission. In Nov. 2019, the City Council passed a resolution establishing a Reproductive Justice Commission, which will consist of local experts, activists, and community members whose role is to advise the city council on how to advance reproductive health, rights, and justice in their city.

Due to COVID-19, appointments to this committee have stalled, but the need for this work has only grown. As city officials are taking a hard look at how they can better address the many competing health and safety needs of their citizens, the commission can provide expert, real-time advice to city leaders around how their policies could potentially help or harm reproductive health in Atlanta.

In addition to addressing the inequities in accessing abortion care, this commission would advise on a broad range of reproductive justice issues, including gender-based violence, menstruation, contraception, birth, and child care. If we want to meet these needs, city leaders must rethink whose voices and perspectives are heard and prioritized. The Reproductive Justice Commission is one tool for doing this.

We are living in a time when folks are taking to the streets to demand change, demanding local leaders move money out of policing and into Black and Brown communities. This shift allows for a reimagining of reproductive justice and abortion access in our cities, too.

It is time for cities across Georgia to take action to better meet the reproductive health needs of their citizens, during COVID-19 and beyond. As we celebrate the Supreme Court’s decision and the striking down of HB481, let’s remember that the fight for abortion access is far from over. We need strong leadership from cities to build on these wins by establishing a new status quo in Georgia, where all residents, not just the lucky few — can access safe, dignified, and affordable reproductive health services, including abortion care.

Source: https://www.mainlinezine.com/feature-georgias-hb-481-struck-down-but-the-fight-to-protect-legalized-abortion-continues/?fbclid=IwAR3h-Y8P3WGmNIVCzpz2cZNupW2KSxBgRqEj8Ydi37N1wt9OmRrHL6zZH2M

The standards could have a strong influence on textbook content across the United States.

Advocates hope the Texas State Board of Education will not only pass medically accurate sex ed for the state’s public school students but also incorporate sexual orientation, gender identity, and abortion care in the curriculum.
Robert Daemmrich Photography Inc/Getty Images

For the first time in more than two decades, the controversial Texas State Board of Education (SBOE) is slated to revise its sexual education standards in the fall, a historic opportunity to rewrite a problematic abstinence-only curriculum in a state that continually holds one of the highest teen birth rates and now rising STI rates in the nation.

Advocates hope the Republican-dominated board—which historically overrode facts with right-wing ideology—will not only pass medically accurate sex ed for the state’s public school students but also incorporate sexual orientation, gender identity, and abortion care in the curriculum.

The implications of the SBOE’s faulty curriculum decisions reach far beyond the state’s 5.4 million public school students: Because of the size of the Texas market, the standards could have a strong influence on textbook content in other states across the country.

“This is really the first time in a generation Texas can correct the really bad information—or the lack of information—in its health textbooks,” Dan Quinn of the Texas Freedom Network (TFN), a progressive nonprofit that monitors the board of education, told Rewire.News. “It’s an important chance for the SBOE to recognize the failures of abstinence-only policies over the past decades and take a big step forward.”

The “political” circus of drafting sex ed standards in Texas

The 15-member board’s history with creating health curricula is mired in conservative censorship and religious-right dogma.

Texas schools must offer health education from kindergarten through eighth grade, but the state does not require health class for high school. Today, more than 80 percent of Texas school districts either teach abstinence-only or nothing at all when it comes to sex education.

In 1994, a “political circus” erupted, Quinn said, when social conservatives demanded publishers make hundreds of changes to proposed new health textbooks, including removing information on condoms and other methods of birth control; STI and HIV prevention; an AIDS helpline; and even illustrations of testicular and breast self-exams for cancer, finding them too suggestive.

By 1997 the board decided to completely overhaul the standards, overwhelmingly emphasizing abstinence with only a single standard at the high school level calling for students to analyze the “effectiveness and ineffectiveness” of contraception. In 2004, publishers—wary of pushback from right-wing board members—submitted abstinence-only textbooks, largely omitting contraception as well as information on STDs and sexual orientation.

A 1995 Texas law, signed by former Gov. George W. Bush—which forces districts that choose to offer sexual education as part of health class to emphasize abstinence until marriage—has only emboldened the SBOE throughout the years. Texas is among 29 states in which abstinence must be stressed, according to the Guttmacher Institute.

After 22 years, the board’s current draft revisions—while still stressing abstinence—now include information about “sexual intercourse” as early as sixth grade; ways to “analyze the effectiveness and ineffectiveness” of contraception, including “prevention of STDs” in seventh and eighth grades; and “contraceptive methods, how they work, side effects, and the risks and failure rates” for high school students. In a further sign of progress, consent is also included, as well as standards on sexual abuse and setting boundaries.

The board held a 16-hour marathon virtual hearing on the health standards in late June, with the majority of the nearly 300 speakers testifying in favor of moving beyond abstinence-only education. The SBOE is expected to hold another public hearing on the updated draft—which can still undergo changes—and take an initial vote in September with a final vote in November. The standards will guide textbook publishers as they create books that schools will likely use for the next decade, at least. Under the current schedule, the state could adopt those books as early as fall 2021.

Can’t afford to get this wrong

The need to provide fact-based, medically accurate sex education is even more urgent when considering Texas’ track record on teen contraception use and pregnancy: More than 60 percent of high school seniors say they have had sex, and the majority report that they didn’t use a condom the last time they did so, according to TFN.

Texas has the ninth highest teen birth rate—nearly 45 percent higher than the national average—and the highest rate of repeat teen births in the United States. A baby is born to a teen parent in Texas every 21 minutes, according to the Texas Campaign to Prevent Teen Pregnancy. While researchers are hesitant to draw a direct causation, studies have shown a positive correlation between states that prioritize abstinence education and teenage pregnancy and birth rates. Additionally, the rates of sexually transmitted infections, including chlamydia and gonorrhea, are rising as much as 25 percent among Texas youth.

Despite some “loud voices on the fringe,” sexual education should not be a partisan issue, Jennifer Biundo, policy director at the Texas Campaign to Prevent Teen Pregnancy, told Rewire.News. She points to a recent poll, commissioned by her organization and conducted by a noted Republican polling firm, Baselice and Associates, which found 79 percent of Texas adult respondents, including 72 percent of Republicans, support teaching contraception, and similar percentages support teaching consent and inclusivity for LGBTQ students.

“We see that the large majority of parents support evidence-based, common-sense education for their kids that is medically accurate,” Biundo said. “The board has a tremendous opportunity here to ensure youth have access to information that is critically important for them to be in charge of their futures and build healthy relationships.”

While many are cautiously optimistic about the updated draft revisions, abortion as part of the full range of reproductive health care still is not addressed, which advocates say will only increase stigma and misinformation in a state deeply hostile to abortion rights. Due to a maze of onerous anti-choice laws, Texas is among the most difficult states to access abortion care in.

As a queer woman of color, Jessica Pires-Jancose said the lack of accurate rhetoric around sex and abortion negatively impacted her early sexual experiences and caused confusion, as she resorted to Google searches and her peers for information.

“When we omit abortion as a way to deal with an unintended pregnancy from our curriculum and conversations, we send the message that abortion and those who access this care are stigmatized, resulting in an environment where young people may not feel comfortable with opening up to the adults in their lives who should support and respect their decisions,” Pires-Jancose, a community organizer with NARAL Pro-Choice Texas, told the board in late June.

In addition to abortion, sexual orientation and gender identity are also omitted from the overhaul, troubling the LGBTQ community who understand that teaching about sexual orientation is vital to creating a safe environment for queer youth.

“We are deeply concerned that these standards don’t even acknowledge the existence of LGBTQ students in the classroom,” Jules Mandel, TFN’s outreach and advocacy coordinator, told the board. “Teaching about sexual orientation and gender identity and expression promotes respect for others, helps all students understand themselves and the people around them, and helps to reduce bullying, discrimination, and harassment.”

Christopher Hamilton, CEO of Texas Health Action, a sexual health-care provider that operates Kind Clinics, echoed the concern to the board, recalling bigoted misinformation he received as a child in Texas. “As a fifth-grader in Houston, I was taught gay men got AIDS when they had sex, and that was it. Even at that age, we knew that wasn’t right,” Hamilton said.

LGBTQ and pro-choice advocates face opposition from right-wing board members and influential conservative groups like Texas Values, which are aggressively campaigning against the revised curriculum with homophobic and anti-choice attacks, calling the proposals “radical indoctrination” and “highly sexualized propaganda.”

There are also vocal abstinence-only champions to contend with, like It Takes a Family’s Monica Cline, a former Planned Parenthood sex health educator who now ardently advocates for abstinence-only education. Cline told the board comprehensive sex education sets up the “expectation” that kids need to be sexually active and urged them to support “sexual risk avoidance”—a recent rebrand of abstinence-only programs that co-opts public health and rights-based language.

“I really believe that parents should be educated about sex and have these conversations with their children at home […] and not forced on them by a mandate in their public schools,” Cline said.

The logic of placing the onus on parents baffles District 3 State Board of Education member Marisa Pérez-Díaz, who points out that there are more than 100,000 Texas public school students who are homeless, and many are in foster care who don’t have families to provide them sexual education. Pérez-Díaz told Rewire.News that lack of information has led to a growing public health crisis in her district, which encompasses San Antonio and the southern Rio Grande Valley, as pregnant young girls cross the U.S.-Mexico border to undergo unsafe abortion procedures and come back ill.

“In Latino culture we’re very strict Catholic—no one talks about sex before marriage at home,” she said. “These young ladies aren’t being educated about their bodies and don’t have adults they can go to, and so they are making very drastic and dangerous decisions out of desperation.”

As one of five Democrats on the board, Pérez-Díaz is heartened to see some progress on sex ed but says the inclusion of sexual orientation and abortion will face an uphill battle.

“We’ve made small gains, but I feel like the old ideology is still alive and well in this conversation,” Pérez-Díaz said. “I am fearful we’re going to still see exclusionary-type language in the standards, and it’s really unfortunate.”

As a longtime watchdog of the SBOE’s culture wars, TFN’s Quinn acknowledged the progress and remains relatively optimistic, saying the board—whose political makeup has become less zealously right-wing over the years—has recently “steered away some of the worst controversies that made Texas a laughingstock to the country a decade ago.” However, he cautiously recalls that just a couple of years ago the board insisted in its social studies curriculum that Moses was somehow a major influence on the Constitution and founding documents.

“There’s been some improvement,” Quinn said. “But they haven’t moved completely away from the political circus.”

Source: https://rewire.news/article/2020/08/04/once-in-a-generation-chance-for-texas-to-move-beyond-abstinence-only-sex-education/

Payouts of forgivable federal loans to crisis pregnancy centers may total up to $10m while Planned Parenthood had to return $60m

Inside a crisis pregnancy center in Georgia, which offers free baby clothes and supplies in exchange for watching anti-abortion videos and pregnancy tutorials. Photograph: Khushbu Shah/The Guardian

Anti-abortion crisis pregnancy centers across the United States received at least $4m and possibly more than $10m in forgivable federal loans as part of the government’s first coronavirus bailout package, called the paycheck protection program (PPP).

Formally part of the Cares Act, the program was meant to give employers a cash infusion to retain employees just as coronavirus lockdowns caused revenue to nosedive. It allowed religiously affiliated and faith-based non-profits to apply.

Crisis pregnancy centers often operate out of storefronts with the look and feel of full-service reproductive health clinics. However, the organizations often provide “sham” medical treatments such as abortion “reversal” pills, oppose modern birth control methods and exaggerate medical risks of abortion to persuade women not to have them.

Doctors have described the centers as “legal but unethical”.

“Although crisis pregnancy centers enjoy first amendment rights protections [part of the US constitution], their propagation of misinformation should be regarded as an ethical violation that undermines women’s health,” wrote gynecologist Dr Amy G Bryant and co-authors in the American Medical Association’s Journal of Ethics.

The $4m-$10m range was calculated by examining data on PPP loans released by the US Small Business Administration. The SBA did not release exact amounts of loans, but published ranges for loans, for example $150,000 to $350,000. The total calculated is probably an undercount of the amount given to crisis pregnancy centers, since the SBA did not release data on loans under $150,000 and crisis pregnancy centers applied under a variety of industry categories.

The money given out to the centers, much of it in early April, paints a picture of a rush for cash among such organizations that the largest anti-abortion organizations promoted.

“Experts believe this program will be more popular than toilet paper, so act fast!” wrote Tony Gruber, the chief financial officer of the anti-abortion group Heartbeat International, as he announced a webinar on 7 April for members.

Heartbeat International claims to have 2,700 crisis pregnancy center affiliates worldwide, and was itself approved for a PPP loan of between $350,000 and $1m, according to data released by the SBA. Heartbeat International said it would save 42 jobs.

Crisis pregnancy centers seek “to prevent people from having and considering abortions”, said Andrea Swartzendruber, an assistant professor of epidemiology and biostatistics at the University of Georgia College of Public Health. Swartzendruber also spearheads the Crisis Pregnancy Center Map, which charts the location of more than 2,500 such groups.

“They also have secondary objectives too, which include Christian evangelism and promoting sexual abstinence before marriage,” said Swartzendruber.

The clinics are frequently more accessible than abortion clinics in the US, and have also spread internationally with American support. Their growth has also come at a time when abortion rights across the US have faced numerous efforts, especially from conservative state legislators, to restrict their ability to function.

The emergency funding given to crisis pregnancy centers represents an expansion of government support to anti-abortion organizations, at the same time as evidence-based family planning organizations have been systematically excluded from federal grant programs.

The PPP funding is in addition to up to $4m received by independent, anti-gay and anti-abortion lobbying groups. Meanwhile, the SBA has sought to claw back $80m Planned Parenthood received from the PPP. Planned Parenthood is the nation’s largest network of reproductive rights clinics, which provide a full spectrum of sexual health services, including abortion.

In at least one instance, PPP funding went to a crisis pregnancy center which had already received millions in federal family planning grants, and whose director had espoused theories promoted by white supremacists.

The SBA approved the Obria clinic in San Jose, California, for up to $350,000 in PPP loans, and the group said it would save 31 jobs. The Obria network of clinics already receives federal funding from the Trump administration, including a Title X federal family planning grant worth up to $5.1m over three years.

In a 2015 interview with the Catholic World Report, Bravo said abortion “threatens our culture’s survival”. She continued: “Take the example of Europe. When its nations accepted contraception and abortion, they stopped replacing their population. Christianity began to die out. And, with Europeans having no children, immigrant Muslims came in to replace them.”

The “white replacement theory” Bravo espoused is a common argument among white supremacists.

The Trump administration has also systematically excluded reproductive rights groups from the Title X program. In 2019, the administration instituted a “gag rule”, which barred family planning clinics from referring patients for abortion services. Existing federal law already barred these groups from using any federal money to pay for abortions.

The rule forced Planned Parenthood to abandon the program and $60m, even as Obria got a $5.1m grant. Obria was the first crisis pregnancy center to oppose birth control and abortion and and receive federal family planning dollars.

Source: https://www.theguardian.com/world/2020/aug/03/anti-abortion-centers-paycheck-protection-program?fbclid=IwAR1VUiiAj5cW-LMGKH9KK3zMtf2xLJ1ENOHoShFtunJnKDkwfDRdXJmdXpg

A worker socially distancing amid the COVID-19 pandemic in Dhaka, Bangladesh. Photo: Fahad Abdullah Kaizer / UN Women / CC BY-NC-ND

The coronavirus pandemic is causing tremendous upheaval to health systems around the world, disrupting access to family planning information and services, as well as to sexual and reproductive health more broadly. It is crucial that sexual and reproductive health and rights remain a priority despite these challenges, and they must be part of the ongoing discussion about how to best achieve universal health coverage.

Access to safe, voluntary family planning is a human right and a centerpiece for sustainable development. Investing in family planning addresses gender equality and women’s empowerment, reduces poverty, protects maternal and child health, drives economic development, and lowers the cost of health care.

Lack of access, conversely, has broad and devastating consequences for individuals, families, and even societies as a whole, disrupting health systems and economies and increasing inequality.

The pandemic is exacerbating already existing disparities, and women are bearing the brunt of its impact. Many are on the front lines supporting patients, putting their own health at risk. Many more are stuck at home, facing increased risk of domestic violence. Add to that the hurdles women face in accessing health care and contraceptives, and the compound impact is devastating.

Before COVID-19, there were already over 230 million women in low- and middle-income countries who wanted to use modern contraceptives but were not able to access them. In a recently published study on the impacts of COVID-19, the United Nations Population Fund, the United Nations’ sexual and reproductive health agency, estimated that 47 million women in 114 LMICs are at risk of losing access to modern contraceptives in the first six months of lockdown.

This could, in turn, lead to an additional 7 million unintended pregnancies, an increase in unsafe abortions and associated complications, and a rise in sexually transmitted infections such as HIV. These estimates show how urgent it is to act immediately to strengthen supply chains, improve preparedness and prepositioning, and ensure people can continue to access contraceptives.

Strategic partnerships, like the one between UNFPA and Bayer, are critical to ensuring continued access to contraceptives. The pandemic has shown that all sectors can come together to make a real difference, and we hope that this innovative thinking and speedy implementation continues long after the pandemic has passed.

Through this partnership, Bayer aims to keep working toward its commitment of providing access to contraceptives to 100 million women in LMICs by 2030, which it announced last November at the Nairobi Summit on the International Conference on Population and Development.

This partnership has identified concrete ways to reach those left furthest behind in some of the most challenging, crisis-ridden parts of the world by leveraging UNFPA’s strong local presence and deep humanitarian experience, along with Bayer’s technical and logistical expertise. Bayer will support UNFPA by helping to strengthen supply chains and overcome bottlenecks for medical supplies in humanitarian settings.

We live in a world where humanitarian emergencies are a reality, and it is critical that we learn from them. One of the lessons is the power of cooperation and the value of bringing new partners on board to innovate and address unmet needs.

As we work to overcome COVID-19, we must not lose sight of the deadline for achieving the Sustainable Development Goals by 2030. It is evident that COVID-19 is having an adverse impact on our ability to achieve them, which is why it is more urgent than ever that sexual and reproductive health and rights are an essential part of this agenda.

UHC and access to family planning need to be at the center of these efforts, especially for women in LMICs. The lessons from COVID-19 have shown the need for systems-based approaches, collaboration across borders, and decisive action delivered at speed.

The measures required to contain the current crisis must not hamper our ongoing efforts to improve women’s health and rights. And cross-sectoral collaboration is essential to keep both goals in sight. We must build upon these learnings, together, to ensure women have the power of choice.

Source: https://www.devex.com/news/opinion-the-power-of-choice-ensuring-access-to-family-planning-in-the-covid-19-era-97774