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Structural Racism in Medicine Worsens the Health of Black Women and Infants

The United States has one of the most abysmal maternal health records among industrialized nations, and Black women bear a disproportionate share of the burden.

U.S. women are two to three times more likely to die than women in Canada from the start of pregnancy to one year after delivery. The infant mortality rate for Black women’s babies was more than twice that of all races, according to 2017 data from the Centers for Disease Control and Prevention (CDC), and Black women are two to three times more likely to die from pregnancy-related causes compared with their white counterparts. In some places, it’s worse: In New York City, from 2006 to 2010, Black women were 12 times more likely than white women to die from pregnancy-related complications.

The reasons U.S. Black women have a higher risk of adverse maternal and infant health outcomes vary. Black women have the highest maternal mortality rate among women of all races in the United States, and their position doesn’t change with increased education level or income. Black women experience high levels of chronic stress produced by systematic racial bias and institutionalized racism structures, which have physiological consequences that can lead to higher health risks. Black women also encounter discrimination and bias in clinical and health-care settings from providers, contributing to the disparity in maternal care and fatality rates.

Even in states making gains in maternal health, Black women are suffering. The maternal mortality rate in California declined by 55 percent from 2006 to 2013, but the maternal mortality rates for Black women still remain far above average.

Thirty years ago, California created the Black Infant Health (BIH) program, a public health program to help pregnant Black women have healthier babies through a group-based and case-management approach. Recently, the program received a funding boost through California’s Perinatal Equity Initiative (PEI), which California Gov. Gavin Newsom signed last June.

The initiative is a result of the Dignity in Childbirth and Pregnancy Act (SB 464), introduced by California state Sen. Holly J. Mitchell (D-Los Angeles) to “actively fight the Black maternal mortality disparity in California.” The act includes the establishment of an implicit bias training program for perinatal care providers, reducing personal, interpersonal, institutional, structural and cultural barriers to health-care access, and requiring the California Department of Public Health to resume tracking of maternal mortality and morbidity. According to Mitchell’s press release announcing the act, although Black women make up only five percent of women in California, they account for 21 percent of pregnancy-related deaths.

The initiative is just one of more than 80 legislative efforts to address racial disparities in U.S. infant and maternal mortality rates. As Rewire.News reported last year, lawmakers in Illinois and Texas introduced bills that address implicit bias in their medical health-care systems (although the proposals appear stalled in the legislature) and ten states are proposing bills to expand doula care.

On a national level, federal lawmakers are hoping to reduce maternal mortality rates through improving provider training in bias, coverage and access to doulas, coordination and reporting among hospitals, and the adoption of best practices for improving maternity care with bills, including the Modernizing Obstetric Medicine Standards (MOMS) Act of 2019, introduced by Sen. Kristen Gillibrand (D-N.Y.), Mothers and Offspring Mortality and Morbidity Awareness (MOMMA) Act, Excellence in Maternal Health Act of 2019, and Preventing Maternal Deaths Act.

The new legislative and fiscal support for BIH will support the program’s participants, women who must be at least 18 years old and up to 30 weeks pregnant at the time of enrollment. For 30 years, in counties with the highest birth rates of Black infants, including Los Angeles, Alameda, Fresno, and Contra Costa counties, the Black Infant Health program has shown to be an effective contributor in reducing rates of low birth weight and preterm births, as well as infant mortality, among participants.

In the program, health advocates, nursing support, and social and outreach workers support women throughout pregnancy and the first year of their infant’s life through home visits. BIH’s process to determine interventions include community-based focus groups, environmental scans, and needs assessments conducted by the organization’s community boards, which are composed of physicians, Black mothers and fathers, social workers, health professionals, early childhood experts, community members, and researchers.

With additional funding from the PEI, each county’s office will expand and bolster its process.

Natalie Berbick, coordinator of infant health programs for Contra Costa Health Services, tells Rewire.News that the reasons Black women experience these maternal outcomes are “multifactorial and dynamic.”

“What the Black Infant Health model is very clear about is that the drivers of these disparities, the responsibility or onus to change them, do not [lie] on the Black woman,” Berbick said. “You have to think bigger and broader as to why we are seeing these persistent disparities.”

As a result of such thinking, the BIH program now includes group support services, case management methods, and other evidence-based strategies, Berbick said. “We’re providing social support, stress reduction activities, and empowering women with information so they could feel they have some agency in their lives,” Berbick said.

In Contra Costa County, the Black Infant Health program will now increase coverage of and access to doula services, as well as create a program to increase fathers’ involvement in alleviating maternal stress. The fatherhood program is based on that of the Alameda County Public Health Department, which houses the state’s only family health services department to offer direct services that serve male partners, according to Christopher Gibson, family advocate for the Alameda County Family Health Services’ Fatherhood Initiative.

Gibson works as an advocate for fathers in the area of maternal and infant health; he is also lead facilitator for Cafe Dad, the county’s fatherhood support group that provides safe spaces for fathers to share their parenting experiences, challenges, and successes. Gibson said fathers play a critical role in promoting healthy Black mothers and infants.

“I really think that men do not have the information or the knowledge of the benefit[s] of other types of care when it comes to pregnancy and giving birth,” he tells Rewire.News.

He hopes the Perinatal Equity Initiative in more of California’s public health departments will result in greater male partner involvement, such as participation in prenatal visits, and push service providers to treat fathers “like they are part of the family.”

Sharon Goldfarb is dean of nursing at the College of Marin and sits on the community board of the Contra Costa Perinatal Equity Initiative. She says her decades of experience as a health educator and family nurse practitioner who has worked with homeless, undocumented, and other underserved populations, have shown it is important that nurses know to recognize and speak up about the racism embedded in the medical system. She cites the lack of training in conducting Apgar tests to or diagnosing measles in Black patients as examples of the sort of structural racism she urges her students to recognize and speak up about in order to improve maternal and infant outcomes.

“We have to have [nursing] students who say there are problems. There’s inequality, and this is the field you’re going into. So go [into] the field with eyes wide open and be prepared to do something about it,” she said.

The PEI-funded Black Infant Health programs are expected to launch in the spring and seem promising, Berbick said. Community-based organizations will be able to apply for funding to implement the models.

State-level initiatives such as California’s recent advancements are just one of many steps needed to improve maternal and infant health among Black women. Eradicating the systems that inherently undervalue Black people and expose Black women to structural barriers to resources and coverage, environmental risks, and chronic stress is critical to improving maternal health care in the United States. We can do this by amplifying Black-women-led solutions in the fight for social, economic, and political equity.

At Iowa Debate, Reproductive Rights Nowhere to Be Found: Campaign Week in Review

Join Rewire.News for a weekly look at how reproductive health, rights, and justice issues are popping up on the 2020 campaign trail.

Advocates Slam ‘Indefensible’ Omission of Abortion Rights at Iowa Debate

The systematic rollback of reproductive rights on the state and federal level wasn’t mentioned during Tuesday’s Democratic presidential debate in Iowa, even as 8 in 10 likely Iowa caucusgoers call abortion rights “a must-have regardless of how they plan to participate,” according to CNN polling.

The 2020 presidential election comes a decade after Republicans swept to power in state legislatures, swiftly passing a raft of laws undercutting access to abortion care. Last year, Republican-held legislatures across the South and Midwest passed near-total abortion bans designed to challenge the precedent set in Roe v. Wade. Legislators in 32 states enacted 394 anti-choice laws from 2011 to 2017, according to the Guttmacher Institute.

The Trump administration, meanwhile, has stocked the U.S. Department of Health and Human Services with anti-choice activists who have dedicated their careers to ending legal abortion.

Still, abortion access didn’t make the cut during Tuesday’s debate among candidates who have pledged to take radical steps to fight back against Republican attacks on reproductive health care.

Jenny Lawson, executive director of Planned Parenthood Votes, said it was “indefensible” that abortion rights didn’t come up once during two hours of debate in a state that has seen Republicans pass a near-total ban on abortion.

“Iowans know better than anyone what it looks like for politicians to push their extreme agenda on people and their doctors,” she said in a statement, adding that Iowa lawmakers “have failed” their constituents. “At this critical juncture, the stakes for reproductive rights could not be higher. … We—and voters all across the country—demand better.”

The Democratic presidential debate in December only passingly addressed reproductive health care, drawing criticism from advocates. Candidates had a lengthy exchange about abortion access during the debate in June, answering questions with anti-choice framing and defending their reproductive health platforms.

“It’s not just about abortion—our lives, our bodies, our families, and our communities are literally on the line.”

Destiny Lopez, co-director of the All* Above All Action Fund

Destiny Lopez, co-director of the All* Above All Action Fund, a reproductive rights organization, said as the Democratic presidential field narrows, “it’s critical that voters know where candidates stand on issues of reproductive justice, which goes far beyond a promise to protect Roe v. Wade.”

“The stakes of this presidential election could not be higher for women of color,” Lopez told Rewire.News. “It’s not just about abortion—our lives, our bodies, our families, and our communities are literally on the line. It’s deeply disappointing that even as we face this stark reality, debate moderators failed to bring up any issues of reproductive health, rights, or justice at all.”

“Now more than ever, we need to hear from candidates on how they plan to overturn the Hyde Amendment and ensure fair wages, decent working conditions, and access to reproductive health care, including abortion, so that families can be healthy and live with dignity,” Lopez continued.

Networks that host presidential debates and moderators who ask the questions should treat abortion access as a top-line issue, said Mallory Schwarz, executive director of NARAL Pro-Choice Missouri, which last year almost became the first state post-Roe without a standalone abortion provider

“Amidst ongoing attacks on access to abortion from Republican lawmakers across Missouri, Georgia, and Ohio, Democratic presidential candidates must use every opportunity to speak directly and boldly on their plans to protect the right to choose,” Schwarz said in a statement to Rewire.News.

“The reality is: Abortion is not a niche issue, but a top priority for voters in 2020. … Voters deserve to hear each candidate’s response on how they will defend this fundamental freedom, including the steps they’ll take to stop coordinated attacks on clinics that provide abortion, repeal the Hyde Amendment, and expand abortion access, particularly for those individuals disproportionately impacted by state restrictions, including communities of color.”

What Else We’re Reading 

The New York Times reported on the potential impact of impeachment hearings in the U.S. Senate that will force three Democratic candidates—Sens. Amy Klobuchar (D-MN), Bernie Sanders (I-VT), and Elizabeth Warren (D-MA)—off the campaign trail just weeks ahead of the February 3 Iowa caucuses. Recent FiveThirtyEight polling shows Sanders in second place in Iowa, Warren in fourth, and Klobuchar a distant fifth place.

Forty-two percent of Black voters between the ages of 18 and 34 are backing Sanders in the 2020 primary election, according to the Washington Post, making him the most popular candidate in that demographic. Former Vice President Joe Biden, meanwhile, leads among Black voters between 35 and 49 years old and maintains a commanding lead among older Black voters.

Democratic presidential candidate Michael Bloomberg, the eighth richest person on Earth, will ask Silicon Valley billionaires for their support in the 2020 election, Recode reported. Bloomberg has drawn support from tech billionaire and Washington Post owner Jeff Bezos.

The Former Democrat Who Pledged Loyalty to Trump Gets a Pro-Choice Challenger

When U.S. House Rep. Jeff Van Drew (R-NJ) of my southern New Jersey congressional district switched to the Republican Party in December, he surprised many—but not local progressives like myself who already saw him as a Democrat in name only.

Van Drew pledged his “undying support” to President Donald Trump on December 19 in an announcement at the White House, despite the fact that, according to FiveThirtyEight, he had voted with the president just 10.3 percent of the time.

Van Drew established himself as a highly conservative Democrat by voting against the House impeachment inquiry into Trump and being one of two Democrats to vote against impeachment. As a state senator, Van Drew accepted a $1,000 donation from the National Rifle Association in 2008 (and received a 100 percent rating from the organization), the Intercept reported. Van Drew sponsored a state senate bill that would require parental notification for abortion for those under 18 (though he later withdrew his name).

Vote Smart quotes Van Drew’s 2018 campaign website as declaring himself “strongly and unequivocally pro-choice” and supporting Roe v. Wade, a statement that no longer appears on his site. Van Drew received a zero percent rating from National Right to Life and a 100 percent rating from Planned Parenthood Action Fund in 2019, as well as a 100 percent rating in 2016-2017 from Planned Parenthood Action Fund of New Jersey.

Since Van Drew’s party switch, he’s seemingly turned course on reproductive rights, supporting a discharge petition to force a vote on the so-called Born-Alive Abortion Survivors Protection Act, one of a wave of deeply problematic bills based on the lie that abortions regularly occur just before or after birth. Van Drew will appear alongside Trump at a rally January 28 in Wildwood, New Jersey.

Candidates on both sides of the aisle have made this 2020 primary what NJ.com calls “America’s hottest congressional race.” On the Democratic side, seven candidates are reportedly running in the primary to replace Van Drew, including Atlantic County Freeholder Ashley Bennett.

Bennett, 34, a psychiatric emergency screener, made national headlines and the cover of Time magazine in 2017 after defeating the Republican Atlantic County Freeholder incumbent, John Carman, who had “joked” earlier that year about whether women would make it back from the Women’s March in time to cook dinner. Fittingly, Bennett spoke at the 2018 New York City Women’s March and organized last year’s Atlantic City Women’s March honoring civil rights activist Fannie Lou Hamer as well as this year’s upcoming march.

After announcing her candidacy the day after Van Drew’s White House announcement, Bennett sat down with me to discuss what inspired her to run for Congress, her views on reproductive rights and access to health care, and what sets her apart from the many Democrats running to replace Van Drew. Bennett said she’d considered declaring her candidacy before Van Drew’s party defection, but began researching her campaign strategy in earnest after his vote against the impeachment inquiry. Bennett is from Egg Harbor Township, New Jersey, where I serve as treasurer of the local Democratic club.

Van Drew’s vote against the impeachment inquiry was “the straw that broke the camel’s back,” Bennett said.

“I haven’t been on the sidelines. I’ve been in the trenches and understand what it’s like to win a campaign and what it’s like to transition to serving in office and the demand of that,” she told me. “I understand what it’s like to serve in a partisan environment where you have to determine whether this vote is the best vote for your constituents even if it may be an uphill battle with the opposition”

When asked about her position on reproductive rights and abortion, Bennett responded quickly. “I’m pro-choice, and I’m pro-access to any type of services that women need,” she said. “I believe that women have a right to their own bodies. I think that as far as education about bodies, public health-wise, absolutely women should be educated and informed, and they should have access to resources.”

She’s planning to meet with Planned Parenthood, the League of Women Voters, and women’s groups and domestic violence shelters in the district to learn about “what we can be doing more of in terms of advocating for reproductive rights and for women in general.”

As for whether she believes there should be limits placed on that choice, Bennett elaborated: “Pro-choice means for me that every woman has to make that decision for herself. Every case is different, and that’s between her and her doctor. I don’t have a parameter as to what would be a limit to that because I don’t know everybody’s individual story or case.”

Bennett is against laws that require parental notification before a minor seeks abortion care.

“I think a physician and counselor should sit down with a minor to discuss not just their options as it relates to a decision regarding abortion services, but also helping them [with] identifying a support system while going through this process and determining what the minor’s home life may be like,” Bennett said. “We as the public cannot assume that every minor’s home environment is safe and supportive and nurturing. Having a physician and counselor speak with a minor is of vital importance to identify if a home environment is dangerous, what their safety net really looks like and supporting them in having autonomy over their own bodies. In the best case scenario, I think that when health-care providers can support a minor in their decision to tell their parental figure, those instances can be the most impactful for both the minor and their parent.”

Bennett opposes the “born-alive” legislation, calling it redundant in light of 2002’s Born Alive Infants Protection Act, which was also based on anti-choice myths. Bennett said the current bill “hinders the physician-patient relationship and puts medical decisions in the hands of politicians rather than doctors, and that is dangerous. The language is inflammatory towards those who provide those services.”

Bennett is concerned that bills like this one could take us “backward to a time where women were getting abortions by untrained professionals in unsanitary conditions and dying as a result of health complications.”

Closer to home, Bennett cited the disparity of maternal health care for Black mothers in Atlantic City, where Black babies are dying at a rate five times higher than the state average, as an issue she would like to tackle. Nationally, according to the NAACP, Black mothers “are 3-4 times more likely to die from pregnancy and birth-related complications than their white counterparts.”

Bennett is in favor of federal funding for Planned Parenthood, which withdrew from the Title X family planning program after the Trump administration enacted anti-choice restrictions.

“I believe that they do more than just provide abortion services; they provide health-care services for women who are in need of them in communities that don’t necessarily have access to doctors or other services. They provide those resources. That’s important; it helps to create the social safety net of community.”

She praised New Jersey’s recent move to provide $9.5 million in family-planning clinic funding to counteract the Trump administration’s 2019 Title X “gag rule” that blocks federal funding for health-care providers who perform abortions or give referrals for abortion services. Planned Parenthood, which pulled out of Title X funding in August 2019 rather than comply with the restrictions, noted that the “majority of patients in the Title X program identify as people of color, Hispanic, or Latino.”

Bennett emphasized the importance of bodily autonomy. “Having access to prenatal health care and services in regards to reproduction, and having the right to your own body, goes hand in hand with justice.”

As for the attempts to roll back the protections of Roe v. Wade at the Supreme Court and state levels, Bennett said that concerns her because “it’s a slippery slope backwards for women and for the advancements that women have made. It’s sad to see but I think that if we can get the right people elected we can turn the tide on that.”

Rachel Kramer Bussel serves as treasurer of the Egg Harbor Township, New Jersey Democratic Club, which issued a statement against Van Drew’s impeachment inquiry vote. 

A New Study Destroys the Central Argument Behind ‘Abortion Reversal’

Ninety-nine percent of women don’t regret their abortions five years after getting the procedure, according to a new study that undercuts the myth of abortion regret perpetuated by state lawmakers in support of “abortion reversal” laws.

So-called “abortion reversal” laws require clinicians to provide patients with inaccurate information about the possibility of reversing a medication abortion. “Abortion reversal” is a medically unproven, experimental protocol pushed by anti-choice activists who claim medication abortions can be reversed in the middle of the process: after a patient has taken the initial dose of mifepristone but before they take the misoprostol pill.

These “abortion reversal” laws rely on dubious science and are largely based on the myth that people who have abortions often come to regret the decision.

“Never have these claims held any water or been based on any evidence,” said Corinne Rocca, associate professor at University of California, San Francisco and lead author of the recent study on emotional responses post-abortion. “In looking at this research question, it was really important to lend some evidence to this. Is it true that women experience persistent or emerging negative emotions and decision regret?”

The researchers found that relief was the most commonly felt emotion by the participants throughout the five-year study, which was published in the journal Social Science & Medicine this week. Their previous study, published in 2015, found that 95 percent of women felt abortion was the right choice for them three years post-procedure.

“No studies in present day United States in this particular socio-political climate have looked [at this] over time, so that was the gap in the empirical evidence we were trying to fill,” Rocca told Rewire.News.

Despite the lack of data, anti-choice lawmakers have used the specter of regret to justify restricting abortion access—and, in recent years, attempting to force providers to share reckless information with patients. The controversial practice has proven dangerous: Researchers had to halt an “abortion reversal” trial last month after three women participating in the study experienced severe hemorrhaging.

In 2019, lawmakers in five states (North Dakota, Nebraska, Oklahoma, Kentucky, and Arkansas) passed “abortion reversal” laws, and Ohio Republicans passed a bill through the state senate.

“A number of women have regret after the abortion. They may have a regret during the process but, if they don’t know there may be a way to reverse the process, then they just don’t know,” state Rep. Mark Lepak (R-Claremore), who co-authored the Oklahoma reversal bill, told News 4 in October. “There are a lot of things in this world that, once you make a decision, you can’t undo. This is perhaps one that you can change your mind and you still have some hope that you could deliver a happy, healthy baby.”

Such arguments, Rocca said, are framed as “pro-women” by anti-choice lawmakers who say they are concerned about patients’ emotional and mental well-being and want to protect them from negative outcomes.

The myth of regret is the basis for “reversal” bills, but lawmakers use it to justify all types of abortion restrictions. Last year, Missouri state Rep. Nick Schroer (R-O’Fallon) argued that a near-total abortion ban would “curb the mental anguish many women suffer as a result of abortions.”

This justification has made its way up to the U.S. Supreme Court. In the 2007 Gonzales v. Carhart decision, which upheld the federal “partial-birth abortion” ban, Justice Anthony Kennedy wrote: “While we find no reliable data to measure the phenomenon, it seems unexceptionable to conclude some women come to regret their choice to abort the infant life they once created and sustained.”

Research shows no evidence that abortion is responsible for mental health problems, according to Guttmacher Institute.

One percent of the 667 women who participated in Rocca’s study regretted their decision after five years, though participants reported stronger emotions—both positive and negative—in the first week following their abortions.

These “findings challenge the rationale for policies regulating access to abortion that are premised on emotional harm claims,” the study concludes.

“We know that women do regret their abortion,” Christa Brown, director of medical impact for the anti-choice Heartbeat International and manager of the Abortion Pill Rescue Network, said in a statement to Rewire.News. Brown cited the number of women who have visited anti-choice pregnancy centers after their abortions, based on surveys of the anti-choice centers.

Rocca said she doesn’t want to “reduce the struggles of the people who come to a place where they don’t feel like they made the right decision,” but “it’s misguided to deprive the other overwhelming majority of people the option of making that decision.”

Correction: This story has been updated to clarify that Heartbeat International provided Rewire.News with a report that included data from anti-choice pregnancy centers.

The ‘Queer Candidate’ Is Out of Touch With LGBTQ Needs

Living an identity is not analogous to a political platform. Identity politics can be a tool candidates use to garner votes—“I’m a woman, so women: Vote for me”—or deflect against criticisms that their policy may fall short—“I can’t be racist because I experienced the marginalized identity of being a woman.”

Navigating the many social, political, and economic systems of the United States, both formal and otherwise, requires us to lean on different identities in different contexts. For instance, as a mixed-race Jewish queer woman, I understand the fear of coming out, but with tolerant Bay Area parents, I will never understand being ostracized or alienated because of my sexuality. Identity is a tricky thing because it allows us to relate to others in our community, but it doesn’t mean we connect on the same level or have the same experiences.

When former South Bend, Indiana Mayor Pete Buttigieg first announced his candidacy for Democratic nominee for president in April 2019, I was elated. Buttigieg is an LGBTQ trailblazer: He grew up in a state that allows discrimination of queer people on the basis of religion and came out as a married gay man while mayor of South Bend. He’s an important presidential candidate for a number of reasons, especially because somewhere in the United States, a young person is watching a man love a man in public.

But there are complicating factors in my relationship to this candidate as a queer person. I’m wary of how he’s using his sexuality to communicate his lived experience, policy positions, and ability to relate to other marginalized folks. Upon inspection, Buttigieg’s proposed policies aren’t about assisting and transforming the lives of the LGBTQ community—the beneficiaries of his platform are people most like Buttigieg himself: cisgender, masculine, white, wealthy, educated, and married.

Though Buttigieg would be the youngest and first openly queer president, I’m not convinced that his administration would address the existing conditions that economically, politically, and socially depress queer and trans people.

LGBTQ people have the highest uninsured rates of any demographic groups, and by ethnicity and gender, the rates are higher for nonwhite and non-cisgender people. The shifting belief among Democrats that insurers should not be able to make money off our health represents a new wave of queer politics that wrestles with the very foundation of private insurers, pharmaceutical companies, and medical debt collectors. But the Pete for America health-care platform, Medicare-for-All-Who-Want-It, maintains a role for private insurers, which refuse to cover patients with “pre-existing conditions” (a phrase meant to describe things like sexual assault recovery and pregnancy), charge exorbitant out-of-pocket costs, and deny coverage for mental health care and transition services.

Alternatively, Buttigieg’s opponents are presenting varied versions of Medicare for All plans like the one carved out by Sen. Bernie Sanders (I-VT), which would cover transition services and treatments, lower the cost of prescription drugs, make mental health care affordable and accessible. These plans abide by the thinking that no one should struggle to find, afford, or rely on employment for health care. The latter is especially inaccessible for queer and trans people, who are most likely to experience employment discrimination but remain unprotected from public and private workplace discrimination on the basis of gender and sexuality in more than two dozen states.

I’m also wary because Buttigieg’s LGBTQ- and other issue-specific policies lack an intersectional lens, failing to account for the diversity of experiences among queer and trans people. For instance, in Buttigieg’s “Becoming Whole” plan outlining the campaign’s LGBTQ policies, he addresses the murder of Black trans women by suggesting a plan to increase police training and sensitivity. Most Black trans women are not murdered by police, but by private citizens, and that overpoliced minority communities are actually put at greater risk of harm and violence.

Citing the disproportionate number of queer and trans people who are incarcerated, Buttigieg is in favor of “diversion” strategies and expanding rehabilitation programs. But Buttigieg believes that incarcerated people do not deserve the right, that withholding suffrage is “part of the punishment.” And while he is in favor of abolishing private federal prisons, a vast majority of prisons are publicly run. Any of the estimated 238,000 queer or trans people who are incarcerated will not be able to exercise their right to vote under his presidency, which is at odds with Buttigieg’s fundamental message of freedom: that one can live a life of their choosing.

In this section of the plan, Buttigieg redirects readers to his Douglass Plan: A Comprehensive Investment in the Empowerment of Black America, a nod to Black queer people that is the only race- and ethnicity-specific position in the platform. Black adults in America are five times more likely to be incarcerated than their white counterparts—and queer people of any race are more likely to be incarcerated than their straight peers—but it’s troubling that the only time brown and Black people are mentioned in Buttigieg’s LGBTQ policy proposal is with mention of incarceration. The Black vote doesn’t hinge on a candidate’s stance on a singular issue.

The plan also fails to address Indigenous members of the LGBTQ and two-spirit communities, nor are they mentioned in his Indian Country plan, though they are subject to some of the highest rates of gun and sexual violence, employment discrimination, and poverty.

In order to shift the foundation of heteronormativity that has guided everything from sex education to hospital visitation, a candidate needs to address white supremacy, patriarchy, and colonization. Buttigieg just doesn’t do that. Perhaps what makes his run so lackluster to me is because it centers whiteness.

Buttigieg’s stance on gun violence also betrays queer and trans interests. He believes Americans should be able to retain handgun ownership to “defend themselves,” and his broader plan includes a study of extremism and funding for police and other law enforcement. Research shows that most gun deaths are actually a result of privately owned handguns. Suicides account for two-thirds of gun-related deaths, and queer and bisexual youth are almost five times more likely to attempt suicide than their heterosexual peers. While the candidate’s LGBTQ+ Suicide Prevention Act proposes establishing a task force and identifying risk factors, gun violence prevention starts with addressing access to handguns, which Buttigieg does not acknowledge.

Buttigieg’s policies fail us in health care, incarceration, gun violence, and debt cancellation, to name a few. Debt cancellation would go a long way to ensure that queer and trans people can afford our lives and our health care, but Buttigieg’s approach of funding college for students coming from families that make over $100,000 a year demonstrates a lack of belief in education as a public good and ignores the high rates of poverty trans people face, thus creating additional hurdles to college affordability. Queer and trans people of color, and especially if they’re poor, will be the first to feel the impact of climate change, which Buttigieg is approaching with a level of caution that confounds me.

Buttigieg is exactly the kind of queer candidate that straight moderates can feel good about because he’s not too threatening. Being a white cisgender man is as much a part of Buttigieg’s identity as is his sexuality, and that has afforded him the ability to move through the world free of gendered and racialized oppression. This identity has dictated his experience in the classroom, his earning potential, and how a crowd reacts to the tenor of his voice. His identity allows him to run confidently as the Democratic candidate with the least experience, avoiding the question of “electability.”

It’s telling that the queerest generation has the least favorable opinion of the youngest and only LGBTQ candidate. Buttigieg’s lackluster approach to institutionalized racism, policing, health care, and climate change and justice could potentially work against us. The queer candidate should support the most vulnerable among us—people of color, homeless youth, the uninsured, the poor—and not cower to those who see this as radical.

But Buttigieg’s LGBTQ and general policy positions are as radical as the legacies of his skin color and gender, creeping along the edges of the status quo in an attempt to carve out room within the systems that were built to exclude, oppress, and kill LGBTQ people. I hope his candidacy brings more queer politicians into the fold—but for now, I’d rather have a straight progressive president who addresses these issues than a moderate gay man who doesn’t try to know us.

Florida Won’t Cover Transgender Health Care. Two Trans Women Are Suing.

Two transgender women are suing Florida government agencies for being denied gender-affirming health care under the state employee health plan’s exclusion for “gender reassignment or modification services or supplies.”

It’s the latest legal challenge to state health plans that deny coverage for gender-affirming procedures.

The Florida lawsuit, filed Monday, argues that the state’s exclusion of gender-affirming care violates Title VII of the Civil Rights Act and the U.S. Constitution’s equal protection clause. The plaintiffs, Jami Claire and Kathryn Lane, are state workers who were denied treatment for gender dysphoria. Claire is a scientist who has worked at the University of Florida for over three decades, and Lane is an attorney in the public defender’s office in Tallahassee.

“This was an intentional decision made by the [Florida] Department of Management Services to exclude this type of care, and we know that because there is already an exclusion for non-medically necessary care,” Simone Chriss, attorney at Southern Legal Counsel, told Rewire.News. “If what our plaintiffs were seeking was not medically necessary, it would just be denied for that reason, but it wasn’t. It was denied under the exclusion for gender-affirming care, which means that they recognize it is medically necessary but they choose not to cover it.”

The ACLU of Florida, Southern Legal Counsel, and pro bono attorney Eric Lindstrom filed the lawsuit against the Florida Department of Management Services, the Public Defender of the Second Judicial Circuit of Florida, and the University of Florida.

Claire said Florida’s exclusion of gender-affirming care has affected her financially and emotionally. She has had to pay out of pocket for many of the procedures she needs.

“When I had tried to access the medical care, the exclusion was there and I couldn’t access it and I had three suicide attempts,” she said. “Life wasn’t worth living at that point.”

Claire added, “I’ve spent thousands of dollars already and if this exclusion is not overturned and I get to the point where I retire, I will have to use approximately a third of my retirement money to pay for bottom surgery.”

Hormone replacement therapy, electrolysis, augmentation mammoplasty, orchiectomy, and facial feminization surgery were some of the procedures denied by the plaintiffs’ state plans due to the exclusion of gender-affirming care.

Transgender people face numerous barriers to health care access, including discrimination by health-care providers and economic barriers to accessing affordable care. According to the 2015 U.S. Trans Survey from the National Center for Transgender Equality, one-third of respondents who had seen a health-care provider in the past year had at least one negative experience related to being transgender. One in four respondents said they had a problem with their insurance in the past year related to being transgender, such as being denied gender-affirming care. Black, Native American, Latinx, and multiracial trans people were more likely to be uninsured than white trans people, according to the survey.

Twenty-two states and the District of Columbia have policies that prohibit health-care discrimination based on gender identity, according to the Pew Charitable Trusts’ Stateline. Twenty-one states have no policy for health-care coverage for trans people.

Billy Huff, a transgender man who worked at the University of Florida as the director of LGBTQ Affairs, said he was surprised when he found out about the state’s exclusion. He had only researched Aetna to find out if he had coverage.

“I was heartbroken,” he said. “I was at that point literally marking days off on my calendar until my surgery date and already had my consultation and paid for my down payment on the surgery out-of-pocket.”

There have been other lawsuits against exceptions for gender-affirming care in state plans. In 2018, Lambda Legal filed a lawsuit against the state of Alaska on behalf of Jennifer Fletcher, a state legislative librarian, because the state prohibited coverage for her transition-related care. The LGBTQ rights-focused organization, which does litigation and public policy work, said the denial of care violated Title VII of the Civil Rights Act. The case is still open.

Lambda Legal and the Transgender Legal Defense & Education Fund (TLDEF) filed a lawsuit in 2019 on behalf of current and former employees of the state of North Carolina who were denied transition-related care under the state employee health plan. In the complaint, Lambda Legal and TLDEF argue this violates the equal protection clause, the nondiscrimination clause of Affordable Care Act, and Title IX, since the defendants include state colleges and universities.

Lambda Legal attorney Taylor Brown told Rewire.News that defense of state plan exclusions vary from arguing that the procedures aren’t medically necessary and qualify as “cosmetic” to claiming that refusing to cover gender dysphoria is not discriminatory.

“We’re doing the research about these exclusions and looking into state plans and looking into public record requests on when these decisions were made and debated, and they often rely on outdated science or just pure speculation and misinformation,” Brown said.

“Every major medical association in the United States recognizes the medical necessity of transition-related care for improving the physical and mental health of transgender people and has called for health insurance coverage for treatment of gender dysphoria,” according to the American Medical Association. The American Medical Association also cites studies showing that health coverage that includes gender-affirming care is cost-effective compared to the costs associated with untreated gender dysphoria.

Brown said the claim that refusing treatment for gender dysphoria isn’t sex discrimination doesn’t hold legal water.

“We argue that it’s sex discrimination because these procedures we call transition-related health care—they’re often procedures available to cisgender people. So they’ll say that this is not sex discrimination. It’s condition discrimination. We’re not treating gender dysphoria. But we understand that the only people who have gender dysphoria are transgender people,” she said.

Some With Disabilities Don’t See Themselves in Amy Klobuchar’s Disability Plan

Democratic caucuses and primaries begin in three weeks, and presidential hopefuls are working in overdrive to gain voters’ support. Increasingly, such efforts include vying for the support of a traditionally overlooked voting bloc: people with disabilities.

At an event in Iowa last Friday, Sen. Amy Klobuchar (D-MN) unveiled a set of policy proposals related to disabled people. The plan, titled “Plan to Protect Equal Rights and Provide Opportunity for People with Disabilities,” proposes tax credits for caregivers, paid family leave, improvements to the Affordable Care Act (ACA), and more.

Klobuchar is one of several Democratic candidates who have released disability policy proposals, including Sen. Elizabeth Warren (D-MA), former South Bend, Indiana, Mayor Pete Buttigieg, entrepreneur Andrew Yang, former U.S. Secretary of Housing and Urban Development Julián Castro (who dropped out of the race earlier this month), and Sen. Kamala Harris (D-CA) (who dropped out of the race in December).

Other candidates, such as Sens. Bernie Sanders (I-VT) and Cory Booker (D-NJ), and former Vice President Joe Biden, include disability rights sections on their websites and have mentioned people with disabilities to varying degrees in their other proposed policy. No GOP candidate has similar proposals listed on their websites.

In 2016, 62.7 million eligible voters (or more than a quarter of the electorate) either were living with a disability or had a household member with one, according to researchers at Rutgers University.

Although people with disabilities are happy to see the unprecedented attention by politicians, some have significant concerns about Klobuchar’s approach. The plan fails to note if people with disabilities were involved in its creation, while other candidates were explicit in their engagement. Both Castro and Warren held Twitter Town Halls, where people with disabilities could directly ask the candidates about their proposed disability policies. They, along with Buttigieg, have received praise for crafting their ideas in consultation with people with disabilities.

Warren’s plan, for example, begins by recognizing the disability rights movement, explicitly naming activists, and Buttigieg described the experiences of Emily Voorde, a campaign staffer with a disability, as informing his commitment to issues that impact those with disabilities.

Klobuchar’s plan struck a different tone, absent of narratives from people with disabilities. As Julia Bascom, executive director of the Autistic Self Advocacy Network, tweeted, “I’m not sure who the campaign consulted with on this plan, but it sure as hell wasn’t self-advocates.”

Klobuchar’s approach to substantive issues also raised concerns. In her proposal, Klobuchar affirms her support of controversial legislation that allows for the surveillance of people with a variety of cognitive and developmental disabilities, including autism. She also mentions “treatment beds” as part of her discussion about mental health, suggesting she believes more people with psychiatric disabilities should receive support in inpatient settings. Disability advocates have pushed for decades for increased community-based supports and worry that the candidate’s plan would lead to people with psychiatric disabilities being unnecessarily institutionalized.

In her policy, Klobuchar does express her support for the Disability Integration Act, which would make long-term services and supports in the community a civil right. But some feel that is not enough, considering the plans’ glaring omissions of critical disability rights issues, such as repealing government rules that prohibit people who receive Supplemental Security Income (SSI) from marrying or ensuring disabled people have the right to raise families free of discrimination. (Both Warren and Buttigieg’s proposals address these problems.)

“So, the candidate plans that included people with disabilities supported an INCREASE in civil rights for our communities, except for Kloubuchar [sic]. The ADA’s 30, shouldn’t we be about moving forward, not rolling back?” Rebecca Cokley, director of the Disability Justice Initiative at the Center for American Progress Action Fund, tweeted, referencing the Americans with Disabilities Act, anti-discrimination legislation that became federal law in 1990.

People with disabilities are happy they are finally being acknowledged, especially by candidates who’ve consulted with the community in creating their proposals. But they’re still pushing politicians to do more.

As Andrew Pulrang, co-founder of the #CripTheVote movement, tweeted, “We’ve been celebrating the increased attention candidates are paying to disability issues. And @amyklobuchar is part of that increased attention. And that’s good. But attention is only one goal, and there is such a thing as good, bad, and mediocre disability policy.”

Republicans Are Trying to Ban Abortion Even in States Where They Have Little Chance

Republican state lawmakers aren’t only pushing near-total abortion bans in states with dominant GOP majorities. Even in New Hampshire, a state where pro-choice Democrats hold a majority in the state legislature, a near-total ban was introduced last week

The near-total abortion ban is one of four abortion restrictions New Hampshire Republicans introduced in the state house on January 8, the first day of the 2020 legislative session, even as other New England legislatures have moved to protect abortion rights from a potential undoing of Roe v. Wade by conservative justices on the U.S. Supreme Court.

Anti-choice politicians in state legislatures across the United States enacted a record number of abortion restrictions in 2019As states begin their 2020 legislative sessions, pro-choice legislators and advocates expect more of the same. 

“New Hampshire has a long bipartisan history of supporting a person’s right to make their own private health-care decisions, and as a result our state has one of the strongest reproductive health-care landscapes in the country,” said Derek Edry, communications manager for Planned Parenthood of New England. “These bills are really unprecedented in terms of how extreme they are.”

HB 1475, sponsored by New Hampshire state Reps. Dave Testerman (R-Merrimack) and Walter Stapleton (R- Claremont), is a “heartbeat” bill. Similar to the near-total abortion bans passed in other states, HB 1475 would prohibit abortion after a “fetal heartbeat” is detected. This can occur as early as six weeks’ gestation, before most people even know they are pregnant and when there is not yet a fetus or a heart. What can be measured at that time is electrical activity in an area of the embryo called the fetal pole.

“We have never seen the heartbeat bill before, this is the first time it has ever been introduced,” said Kayla Montgomery, director of advocacy and organizing for the Planned Parenthood New Hampshire Action Fund. “I assume a lot of that is due to what has been happening across the country.”

New Hampshire has one abortion restriction on the books: a forced parental notification law passed in 2011 that requires a minor under 18 years of age to notify a parent or get a judicial bypass before receiving an abortion. The state also prohibits public funding for abortion except in case of rape, incest, or life endangerment. 

New Hampshire Republicans introduced three other bills last week that mirror extreme measures introduced elsewhere in the country. They include HB 1675, declaring “the right of any infant born alive to medically appropriate and reasonable care and treatment.” Similar to a bill introduced in the U.S. Senate, this is based on the myth that babies routinely “survive” attempted abortion procedures and are harmed by abortion providers. 

New Hampshire Republicans have also introduced a bill banning abortion based on sex or or potential genetic abnormalities, and a bill that would remove the judicial bypass provision of New Hampshire’s current parental notification law, forcing all minors to notify their parents before receiving an abortion, even if that notification would be harmful or dangerous to them.

“A few extreme anti-abortion legislators are essentially trying to bring the Trump administration’s abortion agenda to the Granite State, and it’s really not representative of our state’s values as a whole,” Edry told Rewire.News.

Extreme anti-choice rhetoric came to the forefront last week as Patch reported that William O’Brien, a former Republican house speaker in New Hampshire who is running for U.S. Senate this year, compared abortion to the 9/11 terrorist attacks and slavery.

Democrats hold a four-seat lead in the state senate in New Hampshire. They have a 71seat advantage in the state house.

Republican Gov. Chris Sununu has a mixed record on abortion rights. He says he is pro-choice, but has supported defunding Planned Parenthood. In 2017, he signed into law a fetal homicide bill defining a fetus as a person at 20 weeks’ gestation for the purpose of criminal prosecution of murder, manslaughter, or negligent homicide. 

“There are over 1,000 bills the legislature is considering this year and many will not reach the governor’s desk,” Sununu’s communications director Ben Vihstadt said in an email to Rewire.News. “Governor Sununu is pro-choice, but will review the final language of any bill should it reach his desk.”

Montgomery said she expects bipartisan opposition to these anti-choice bills. If any of the anti-choice measures passed and were signed into law, Planned Parenthood would challenge them in court. 

“We are not going to let these bills pass. We are going to fight tooth and nail to make sure Granite Staters have access to safe, legal abortion,” Montgomery said. “As we’ve seen in a lot of other states where these bills have come up, they’re not constitutional. If something happens and something like this were to pass, we would certainly fight it in the courts.”

Having the Abortion Talk With Children Is Easier Than You Think. Just Ask These Parents.

In order to destigmatize abortion in our communities, we need to talk about it, and I believe many of these conversations must start at home—between parents and children. 

The foundations we lay when our children are young pave the way for the development of their ideologies, both good and harmful. Young people deserve factual information on abortion from people who’ve had them. Sometimes that means parents opening up and being honest with their children about their own experiences with family planning

Actress Michelle Williams—who is currently pregnant and the parent to a teenager—told her abortion story to an audience of millions during her recent Golden Globes speech. She credited her success in life to the fact that she had the right to choose. Williams’ speech resonated with other parents who have had abortions and feel like their right to choose positively impacted their lives in a number of ways.

But how do parents broach this conversation with their children? After having their own abortion talks, these parents want you to know the experience doesn’t have to be difficult, but transformative and strengthening for your relationship. Last names have been withheld for privacy.

Amiya 

When Amiya found out she was pregnant six months ago, she immediately knew she would get an abortion. At that point, Amiya’s daughter was 12 years old. The abortion “wasn’t something I really wanted to do, but as a parent, I knew it was something I needed to do,” Amiya told Rewire.News.

In the days leading up to her abortion, she was emotional, which her daughter noticed. “I didn’t want to tell her at first, but I decided I would use it as an opportunity to talk about options,” Amiya said. “I told her I was pregnant, but that I’d be having an abortion, and she looked a bit concerned at first.”  

When Amiya asked her daughter if she knew what an abortion was, her daughter said yes and “started crying and hugging me for several minutes.” Amiya apologized, thinking she was upset with her. But her daughter said she understood the reasons behind the choice, and that she wasn’t—and would never be—mad at her for something like that.

“During our conversation, I made it clear that she could always count on me to be in her corner during whatever life throws at her, and that she can always come to me for anything. I think that whole conversation really strengthened our bond as mother and daughter,” Amiya said.

Melissa

Melissa was in an abusive relationship when she discovered she was pregnant in October and chose to get an abortion. She talked about the decision with her 15-year-old daughter. 

“When I told my daughter, she started crying and told me how grateful she was that I trusted her with that,” Melissa told Rewire.News. “She feels like she can come to me with anything difficult because of it.”

Her daughter witnessed the abuse Melissa survived, and she completely understood the decision she made. For Melissa, having an abortion gave her back the control of her life that she needed to leave a harmful situation. 

Kathi

Kathi hadn’t planned on telling her 10-year-old daughter about her abortions, but the subject came up one day. Kathi’s husband lived with a debilitating health condition that her daughter was concerned may affect any future siblings she might have.

“I hadn’t planned on telling her that young, but she asked and I told her the truth,” Kathi told Rewire.News. The condition wasn’t hereditary, but Kathi wasn’t prepared to have any more children. She had her first abortion while finishing nursing school, and she had her second abortion at a time when she was busy caring for her husband and her daughter, who was a toddler at the time.

“I was honest with her, and I told her that realistically it wasn’t an option for me to have another child,” Kathi said. “After I told her, I immediately reinforced that she was a wanted pregnancy and a wanted child.”

Her daughter immediately understood her reasons behind each decision, telling her mother she loved her and didn’t want to see her struggle more. 

As a nurse, it was also important to Kathi that her daughter received accurate information, so she referred to her abortion as a dilation and curettage (D and C) and explained how it’s performed. “I also told her it was a nine-week fetus, and that it had no functioning brain, heart, or ability to sense pain like her and I have,” Kathi said.

Now an adult, Kathi’s daughter is staunchly pro-choice and advocates for others to have the same choice her mother did.

“I’ve never been ashamed or regretful of either abortion. I had my reasons, my future, and my body to consider,” Kathi said.

Parents know what’s right for their own lives: They understand what pregnancy looks like, birth, and the responsibilities of parenthood more than anyone. And when they decide they want to share their abortion stories, parents are more than capable of having meaningful conversations with their children about it.