An Overdue Conversation: Meeting the Sexual and Reproductive Health Needs of Orphans, Vulnerable Children and Youth

Serra Sippel

Serra Sippel is the Deputy Director at the Center for Health and Gender Equity (CHANGE).

Attention to the lives of orphans and vulnerable children has increased with celebrity adoptions of African children by Madonna and Angelina Jolie and Brad Pitt, and the opening of an elite school for girls in South Africa by Oprah Whinfrey. For decades children (defined as children under the age of 18) have been targets for acts of charity by celebrities, focusing on their special needs: food, education, vaccinations, and health care. But rarely addressed, if at all, are the very real sexual and reproductive health needs of orphans and vulnerable children (OVCs).

Serra Sippel is the Deputy Director at the Center for Health and Gender Equity (CHANGE).

Attention to the lives of orphans and vulnerable children has increased with celebrity adoptions of African children by Madonna and Angelina Jolie and Brad Pitt, and the opening of an elite school for girls in South Africa by Oprah Whinfrey. For decades children (defined as children under the age of 18) have been targets for acts of charity by celebrities, focusing on their special needs: food, education, vaccinations, and health care. But rarely addressed, if at all, are the very real sexual and reproductive health needs of orphans and vulnerable children (OVCs).

Throughout the world, children and youth are living without the support, protection and care of parents. They are also often abandoned by the state, making them susceptible to violence, exploitation and disease. Many of these youngsters are condemned to live on city streets, in conflict and war zones, and in refugee camps where there is no protection from violence, coercion and exploitation. Many are caring for siblings and dying parents—often selling sex to support them—and are at risk of exploitation and HIV infection. Some are already infected with HIV and often lack the skills and knowledge to prevent sexual transmission of the virus to others and re-infection for themselves.

Studies confirm this. One recent study in Zimbabwe found a greater number of HIV infections among female OVCs ages 15-18 than among their non-OVC peers. In addition, the female OVCs experienced higher rates of STI symptoms and teenage pregnancy. A study in Rwanda and Zambia examining sexual behaviors of 10-19 year-olds found that those who were orphaned experienced earlier sexual debuts than non-orphans.

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These young people live as best they can without protection from HIV infection, other sexually transmitted infections (STIs) and unintended pregnancies, and they suffer—young women and girls in particular—when their sexual and reproductive rights are not upheld.

Sexuality is basic and fundamental to our humanity. Yet many today have difficulty—some actually experience discomfort—addressing issues of sex and sexuality. This is especially true of young people's sexuality. In fact, one could rightly assert that the global community has been remiss in addressing sexual and reproductive health and rights of children and youth.

This negligence is found at both the national and international levels and much of it is driven by ideological and extreme religious perspectives on both sexual and reproductive health and rights and the rights of children. At the 2002 United Nations Children's Summit, the United States (one of only two countries—the other Somalia—that has not ratified the Convention on the Rights of the Child) joined the Holy See and a block of conservative Islamic states to obstruct consensus on issues related to the sexual and reproductive health and rights of youth, objecting to comprehensive sexuality education for youth and insisting upon abstinence-only education. They sought to uphold the rights of parents to control information communicated to their children, which meant they also opposed confidential counseling for youth.

Although "children" has been defined as individuals below the age of 18 (Convention on the Rights of the Child), most people hear "children" and envision a five-year-old rather than an adolescent or teenager. I propose that we change our language so that instead of OVCs we say OVCYs (orphans, vulnerable children and youth); this will enable policy makers and advocates to better understand the diverse needs (including, but not limited to, sexual and reproductive health) of this population.

Some fear that giving children and youth too much information about sexuality, reproduction and methods to avoid unintended pregnancies and STIs will encourage sexual promiscuity. But evidence shows that access to comprehensive sexuality information delays debut of sexual intercourse and protects those youth who are or will be sexually active from STIs and unintended pregnancies. And in light of the HIV and AIDS epidemic, information and services about safer sex—including condom use—as well as confidentiality and informed consent are critical to meeting the health needs of children and youth, especially those who are orphaned and vulnerable.

We cannot ignore reality. And the reality is that ignoring the sexual and reproductive health and rights of orphans and vulnerable children leaves them vulnerable.

If we are serious about providing real support to them, programs for OVCYs must integrate age appropriate, gender sensitive, comprehensive sexual and reproductive health services and education in order to meet the basic needs of this growing and vulnerable population.

Analysis Sexual Health

Centering Disabled People in Conversations About Menstruation

s.e. smith

It is not a surprise that disabled people have a spectrum of feelings about menstruation, as do nondisabled people. Too often, however, disabled people tend to be among the last of those consulted about policy and best practice recommendations when it comes to their reproductive health and rights—starting as early as their adolescent years.

For Dee, who works with a disability nonprofit in New York state, menstruation is a frustrating balancing act, especially after an injury that limited her mobility. Dee, who asked that Rewire not use her last name, must coordinate with her personal care attendant to put on underwear and a pad before transferring to her wheelchair and adjusting them. The perennial struggle with keeping pads in place can come at a high cost to undergarments, clothes, and wheelchair cushions.

“I hate it. If I could make it stop, I would gladly do so. I have told my family and health-care providers that if I ever need to be anesthetized again, I would prefer they perform a hysterectomy while I’m knocked out,” Dee told Rewire.

Meanwhile, Alice Wong, a disability rights activist and organizer who lives in San Francisco, says that “menstruation is a nice reminder that something is ‘working normally’ in my body when there are so many other aspects to my body that are not.” She has limited hand strength and dexterity, paired with elbow contractures that make it impossible for her to use the toilet independently. Her parents, who act as her caregivers, assist her with her bathroom needs as well as use of menstruation supplies. For her, menstruation can present some personal care challenges, and she noted that pads in particular can pose problems because they tend to dislodge while she’s transferring in and out of her chair or moving around during the course of the day.

Wong came up with an innovative solution that would allow her to menstruate in comfort: “As I got older and stopped caring what other people thought, I went with disposable briefs instead of pads. That’s right—disposable briefs that are used for incontinence! There’s better coverage and absorption. And they’re a lot easier to pull on.”

These experiences serve to reinforce the fact that in discussions about menstruation and disability, disabled people themselves need to be centered. It is not a surprise that they have a spectrum of feelings about menstruation, as do nondisabled people. Too often, however, disabled people tend to be among the last of those consulted about policy and best practice recommendations when it comes to their reproductive health and rights—starting as early as their adolescent years.

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So when the American Academy of Pediatrics came out with updated guidelines on the subject of menstrual management among disabled teens in June, some disability activists worried that the document could be yet another iteration of policy about disability that didn’t consult disabled people themselves.

The document turned out to be a pleasant surprise, though, and an indication that the AAP is continuing to lead a progressive turnaround on thinking about both adolescent health and disability. When it comes to disability and medical practice, conversations often center the convenience and desires of caregivers, parents, and guardians. Instead, this document focused on issues of relevance to the disability community, particularly with regard to the abuse of menstrual suppression, which doctors sometimes recommend to disabled patients and their caregivers.

Advocates for menstrual suppression in disabled people, by both hormonal and surgical means, argue that it’s necessary in cases of “severe” disability where people might experience hardship with their periods. This can include the challenges of managing menstruation when people have limited mobility and rely on caregivers for assistance with activities of daily living, including toileting. They also assert that menstruation can be “traumatic” for people with intellectual, cognitive, or developmental disabilities. Furthermore, they claim, people who menstruate can get pregnant—often seen by nondisabled people as undesirable, though it can disturbingly be the first and only sign of sexual abuse.

These arguments primarily focus on the convenience and preference of caregivers who don’t want to deal with menstruation, and they strip disabled people of autonomy. Many people have very complex, intimate, and personal relationships with their period. Letting disabled people speak in their own words about their experiences with menstruation should be central to any conversation about menstrual suppression, especially extreme measures like the so-called Ashley Treatment, in which the uterus and breast buds are removed and children are medicated to attenuate their growth, ensuring that they remain small and light. Though it is overwhelmingly rare, parents say the treatment makes their children easier to handle, reducing the risk that they have to surrender their children to care facilities.

The AAP guidelines, hearteningly, center the patient from the very first line, stressing that they must be involved in discussions about such a sensitive issue. The organization states clearly that menstrual suppression shouldn’t be done for the wrong reasons: “When the stated reasons for suppression are an inability of caregivers to deal with menses or fear of abuse or pregnancy, further investigation into the patient’s circumstances and safety is warranted. If the issue is mainly to get assistance at school, then health care providers can help families to address the student’s needs with the school.”

The document stresses that physicians should fully evaluate the medical and social needs of their disabled patients—including interest in sexual activity—before making a menstrual management recommendation that suits their circumstances. The authors discuss a variety of hormonal and nonhormonal birth control options and some of their implications for disabled people, but do not make specific recommendations.

This focus on choice, again, reflects disabled people’s wide variety of experience with menstruation. Wong, for example, said while she has “options to suppress menstruation whether via an IUD or oral contraceptives” and “considered it in an effort to simplify my life and personal care needs,” she ultimately decided against it.

For her, the challenges are worth it: Taking control of her period by using pads and disposable briefs is an assertion of her independence.

Sam de Leve, an athlete from Southern California who also spoke to Rewire about their relationship with menstruation, experiences relatively light periods thanks to an IUD and finds that this provides some conveniences—but they aren’t using the IUD for menstrual suppression and aren’t sure they’d actively seek it out for that purpose.

When it comes to the loaded politics of the Ashley Treatment, de Leve commented, “It seems a little convenient that they target the most gendered parts of the body (breasts, uterus) when deciding what to remove. They’d make transfers easier if they removed arms or legs, but Lord knows they don’t do that! So I don’t believe that these are solely practical considerations or even primarily motivated by practical considerations. I think some of these families have this innocent ‘pillow angel’ mental image of their child, and this aspect of these procedures is about maintaining that image, not just the functional argument many of these care providers make to justify the Ashley Treatment. This is consistent with the desexualization of people with intellectual disabilities, or thought to have intellectual disabilities.”

Their comments echo concerns of those in the larger disability community who worry that practices like menstrual suppression serve to desexualize disabled people, but don’t actually offer concrete benefits. This is something the AAP itself also discusses, commenting that disabled youth are sexually active, but also experience higher rates of sexual abuse, adding, “It is important to discuss that any menstrual suppression does not change the risk of abuse or sexually transmitted infections.”

In their discussion of the Ashley Treatment, which was sharply condemned by a working group after its development, the authors also include stern warnings about the history of coerced sterilization in disabled people, and they caution that such procedures have “clear ethical and legal implications.”

Disabled youth are often given inadequate sexual health education, including education about menstruation, and they’re ill-prepared for the onset of menarche. Guardians, parents, and caregivers are sometimes under the impression that they’re doing their charges a favor by suppressing menstruation without consulting them, but they’re not turning to adults who menstruate to ask them about their own experiences. If they did, they might find that disabled individuals would like to be able to make that choice for themselves. In a culture where disabled people are both figuratively and literally desexualized, hiding menstruation doesn’t resolve issues like the abuse and dehumanization of disabled people—it just sweeps these problems under the carpet.

These guidelines may serve as a wakeup call to pediatricians that it’s wise to discuss concerns about menstruation before its onset with patients and their parents. A conversation about what to expect and the options available can encourage people to think about their needs and wants ahead of time. Disabled youth tend to be very isolated from the rest of the disability community, and encouraging parents to connect their children with adult disabled mentors who can help them navigate menstruation and other matters can be rewarding for all parties, including parents who may feel at sea when it comes to caring for their children.

In recent years, the AAP has distinguished itself with common-sense, but still radical, policy proposals, like its recent recommendation to use long-acting reversible contraceptives to prevent teen pregnancy, and explicit discussion of disabled patients using contraceptives, reminding pediatricians and the public that disabled youth have sex. The organization is presenting factual, evidence-based information to its members when it comes to youth sexual health, and raising the prospect that teens will be empowered to take charge of their own fertility and choices, regardless of disability status and sexual history.

Analysis Abortion

‘Pro-Life’ Pence Transfers Money Intended for Vulnerable Households to Anti-Choice Crisis Pregnancy Centers

Jenn Stanley

Donald Trump's running mate has said that "life is winning in Indiana"—and the biggest winner is probably a chain of crisis pregnancy centers that landed a $3.5 million contract in funds originally intended for poor Hoosiers.

Much has been made of Republican Gov. Mike Pence’s record on LGBTQ issues. In 2000, when he was running for U.S. representative, Pence wrote that “Congress should oppose any effort to recognize homosexual’s [sic] as a ‘discreet and insular minority’ [sic] entitled to the protection of anti-discrimination laws similar to those extended to women and ethnic minorities.” He also said that funds meant to help people living with HIV or AIDS should no longer be given to organizations that provide HIV prevention services because they “celebrate and encourage” homosexual activity. Instead, he proposed redirecting those funds to anti-LGBTQ “conversion therapy” programs, which have been widely discredited by the medical community as being ineffective and dangerous.

Under Pence, ideology has replaced evidence in many areas of public life. In fact, Republican presidential nominee Donald Trump has just hired a running mate who, in the past year, has reallocated millions of dollars in public funds intended to provide food and health care for needy families to anti-choice crisis pregnancy centers.

Gov. Pence, who declined multiple requests for an interview with Rewire, has been outspoken about his anti-choice agenda. Currently, Indiana law requires people seeking abortions to receive in-person “counseling” and written information from a physician or other health-care provider 18 hours before the abortion begins. And thanks, in part, to other restrictive laws making it more difficult for clinics to operate, there are currently six abortion providers in Indiana, and none in the northern part of the state. Only four of Indiana’s 92 counties have an abortion provider. All this means that many people in need of abortion care are forced to take significant time off work, arrange child care, and possibly pay for a place to stay overnight in order to obtain it.

This environment is why a contract quietly signed by Pence last fall with the crisis pregnancy center umbrella organization Real Alternatives is so potentially dangerous for Indiana residents seeking abortion: State-subsidized crisis pregnancy centers not only don’t provide abortion but seek to persuade people out of seeking abortion, thus limiting their options.

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“Indiana is committed to the health, safety, and wellbeing [sic] of Hoosier families, women, and children,” reads the first line of the contract between the Indiana State Department of Health and Real Alternatives. The contract, which began on October 1, 2015, allocates $3.5 million over the course of a year for Real Alternatives to use to fund crisis pregnancy centers throughout the state.

Where Funding Comes From

The money for the Real Alternatives contract comes from Indiana’s Temporary Assistance for Needy Families (TANF) block grant, a federally funded, state-run program meant to support the most vulnerable households with children. The program was created by the 1996 Personal Responsibility and Work Opportunity Reconciliation Act signed by former President Bill Clinton. It changed welfare from a federal program that gave money directly to needy families to one that gave money, and a lot of flexibility with how to use it, to the states.

This TANF block grant is supposed to provide low-income families a monthly cash stipend that can be used for rent, child care, and food. But states have wide discretion over these funds: In general, they must use the money to serve families with children, but they can also fund programs meant, for example, to promote marriage. They can also make changes to the requirements for fund eligibility.

As of 2012, to be eligible for cash assistance in Indiana, a household’s maximum monthly earnings could not exceed $377, the fourth-lowest level of qualification of all 50 states, according to a report by the Congressional Research Service. Indiana’s program also has some of the lowest maximum payouts to recipients in the country.

Part of this is due to a 2011 work requirement that stripped eligibility from many families. Under the new work requirement, a parent or caretaker receiving assistance needs to be “engaged in work once the State determines the parent or caretaker is ready to engage in work,” or after 24 months of receiving benefits. The maximum time allowed federally for a family to receive assistance is 60 months.

“There was a TANF policy change effective November 2011 that required an up-front job search to be completed at the point of application before we would proceed in authorizing TANF benefits,” Jim Gavin, a spokesman for the state’s Family and Social Services Administration (FSSA), told Rewire. “Most [applicants] did not complete the required job search and thus applications were denied.”

Unspent money from the block grant can be carried over to following years. Indiana receives an annual block grant of $206,799,109, but the state hasn’t been using all of it thanks to those low payouts and strict eligibility requirements. The budget for the Real Alternatives contract comes from these carry-over funds.

According to the U.S. Department of Health and Human Services, TANF is explicitly meant to clothe and feed children, or to create programs that help prevent “non-marital childbearing,” and Indiana’s contract with Real Alternatives does neither. The contract stipulates that Real Alternatives and its subcontractors must “actively promote childbirth instead of abortion.” The funds, the contract says, cannot be used for organizations that will refer clients to abortion providers or promote contraceptives as a way to avoid unplanned pregnancies and sexually transmitted infections.

Parties involved in the contract defended it to Rewire by saying they provide material goods to expecting and new parents, but Rewire obtained documents that showed a much different reality.

Real Alternatives is an anti-choice organization run by Kevin Bagatta, a Pennsylvania lawyer who has no known professional experience with medical or mental health services. It helps open, finance, and refer clients to crisis pregnancy centers. The program started in Pennsylvania, where it received a $30 million, five-year grant to support a network of 40 subcontracting crisis pregnancy centers. Auditor General Eugene DePasquale called for an audit of the organization between June 2012 and June 2015 after hearing reports of mismanaged funds, and found $485,000 in inappropriate billing. According to the audit, Real Alternatives would not permit DHS to review how the organization used those funds. However, the Pittsburgh Post-Gazette reported in April that at least some of the money appears to have been designated for programs outside the state.

Real Alternatives also received an $800,000 contract in Michigan, which inspired Gov. Pence to fund a $1 million yearlong pilot program in northern Indiana in the fall of 2014.

“The widespread success [of the pilot program] and large demand for these services led to the statewide expansion of the program,” reads the current $3.5 million contract. It is unclear what measures the state used to define “success.”


“Every Other Baby … Starts With Women’s Care Center”

Real Alternatives has 18 subcontracting centers in Indiana; 15 of them are owned by Women’s Care Center, a chain of crisis pregnancy centers. According to its website, Women’s Care Center serves 25,000 women annually in 23 centers throughout Florida, Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin.

Women’s Care Centers in Indiana received 18 percent of their operating budget from state’s Real Alternatives program during the pilot year, October 1, 2014 through September 30, 2015, which were mostly reimbursements for counseling and classes throughout pregnancy, rather than goods and services for new parents.

In fact, instead of the dispensation of diapers and food, “the primary purpose of the [Real Alternatives] program is to provide core services consisting of information, sharing education, and counseling that promotes childbirth and assists pregnant women in their decision regarding adoption or parenting,” the most recent contract reads.

The program’s reimbursement system prioritizes these anti-choice classes and counseling sessions: The more they bill for, the more likely they are to get more funding and thus open more clinics.

“This performance driven [sic] reimbursement system rewards vendor service providers who take their program reimbursement and reinvest in their services by opening more centers and hiring more counselors to serve more women in need,” reads the contract.

Classes, which are billed as chastity classes, parenting classes, pregnancy classes, and childbirth classes, are reimbursed at $21.80 per client. Meanwhile, as per the most recent contract, counseling sessions, which are separate from the classes, are reimbursed by the state at minimum rates of $1.09 per minute.

Jenny Hunsberger, vice president of Women’s Care Center, told Rewire that half of all pregnant women in Elkhart, LaPorte, Marshall, and St. Joseph Counties, and one in four pregnant women in Allen County, are clients of their centers. To receive any material goods, such as diapers, food, and clothing, she said, all clients must receive this counseling, at no cost to them. Such counseling is billed by the minute for reimbursement.

“When every other baby born [in those counties] starts with Women’s Care Center, that’s a lot of minutes,” Hunsberger told Rewire.

Rewire was unable to verify exactly what is said in those counseling sessions, except that they are meant to encourage clients to carry their pregnancies to term and to help them decide between adoption or child rearing, according to Hunsberger. As mandated by the contract, both counseling and classes must “provide abstinence education as the best and only method of avoiding unplanned pregnancies and sexually transmitted infections.”

In the first quarter of the new contract alone, Women’s Care Center billed Real Alternatives and, in turn, the state, $239,290.97; about $150,000 of that was for counseling, according to documents obtained by Rewire. In contrast, goods like food, diapers, and other essentials for new parents made up only about 18.5 percent of Women’s Care Center’s first-quarter reimbursements.

Despite the fact that the state is paying for counseling at Women’s Care Center, Rewire was unable to find any licensing for counselors affiliated with the centers. Hunsberger told Rewire that counseling assistants and counselors complete a minimum training of 200 hours overseen by a master’s level counselor, but the counselors and assistants do not all have social work or psychology degrees. Hunsberger wrote in an email to Rewire that “a typical Women’s Care Center is staffed with one or more highly skilled counselors, MSW or equivalent.”

Rewire followed up for more information regarding what “typical” or “equivalent” meant, but Hunsberger declined to answer. A search for licenses for the known counselors at Women’s Care Center’s Indiana locations turned up nothing. The Indiana State Department of Health told Rewire that it does not monitor or regulate the staff at Real Alternatives’ subcontractors, and both Women’s Care Center and Real Alternatives were uncooperative when asked for more information regarding their counseling staff and training.

Bethany Christian Services and Heartline Pregnancy Center, Real Alternatives’ other Indiana subcontractors, billed the program $380.41 and $404.39 respectively in the first quarter. They billed only for counseling sessions, and not goods or classes.

In a 2011 interview with Philadelphia City Paper, Kevin Bagatta said that Real Alternatives counselors were not required to have a degree.

“We don’t provide medical services. We provide human services,” Bagatta told the City Paper.

There are pregnancy centers in Indiana that provide a full range of referrals for reproductive health care, including for STI testing and abortion. However, they are not eligible for reimbursement under the Real Alternatives contract because they do not maintain an anti-choice mission.

Parker Dockray is the executive director of Backline, an all-options pregnancy resource center. She told Rewire that Backline serves hundreds of Indiana residents each month, and is overwhelmed by demand for diapers and other goods, but it is ineligible for the funding because it will refer women to abortion providers if they choose not to carry a pregnancy to term.

“At a time when so many Hoosier families are struggling to make ends meet, it is irresponsible for the state to divert funds intended to support low-income women and children and give it to organizations that provide biased pregnancy counseling,” Dockray told Rewire. “We wish that Indiana would use this funding to truly support families by providing job training, child care, and other safety net services, rather than using it to promote an anti-abortion agenda.”

“Life Is Winning in Indiana”

Time and again, Bagatta and Hunsberger stressed to Rewire that their organizations do not employ deceitful tactics to get women in the door and to convince them not to have abortions. However, multiple studies have proven that crisis pregnancy centers often lie to women from the moment they search online for an abortion provider through the end of their appointments inside the center.

These studies have also shown that publicly funded crisis pregnancy centers dispense medically inaccurate information to clients. In addition to spreading lies like abortion causing infertility or breast cancer, they are known to give false hopes of miscarriages to people who are pregnant and don’t want to be. A 2015 report by NARAL Pro-Choice America found this practice to be ubiquitous in centers throughout the United States, and Rewire found that Women’s Care Center is no exception. The organization’s website says that as many as 40 percent of pregnancies end in natural miscarriage. While early pregnancy loss is common, it occurs in about 10 percent of known pregnancies, according to the American Congress of Obstetricians and Gynecologists.

Crisis pregnancy centers also tend to crop up next to abortion clinics with flashy, deceitful signs that lead many to mistakenly walk into the wrong building. Once inside, clients are encouraged not to have an abortion.

A Google search for “abortion” and “Indianapolis” turns up an ad for the Women’s Care Center as the first result. It reads: “Abortion – Indianapolis – Free Ultrasound before Abortion. Located on 86th and Georgetown. We’re Here to Help – Call Us Today: Abortion, Ultrasound, Locations, Pregnancy.”

Hunsberger denies any deceit on the part of Women’s Care Center.

“Clients who walk in the wrong door are informed that we are not the abortion clinic and that we do not provide abortions,” Hunsberger told Rewire. “Often a woman will choose to stay or return because we provide services that she feels will help her make the best decision for her, including free medical-grade pregnancy tests and ultrasounds which help determine viability and gestational age.”

Planned Parenthood of Indiana and Kentucky told Rewire that since Women’s Care Center opened on 86th and Georgetown in Indianapolis, many patients looking for its Georgetown Health Center have walked through the “wrong door.”

“We have had patients miss appointments because they went into their building and were kept there so long they missed their scheduled time,” Judi Morrison, vice president of marketing and education, told Rewire.

Sarah Bardol, director of Women’s Care Center’s Indianapolis clinic, told the Criterion Online Edition, a publication of the Archdiocese of Indianapolis, that the first day the center was open, a woman and her boyfriend did walk into the “wrong door” hoping to have an abortion.

“The staff of the new Women’s Care Center in Indianapolis, located just yards from the largest abortion provider in the state, hopes for many such ‘wrong-door’ incidents as they seek to help women choose life for their unborn babies,” reported the Criterion Online Edition.

If they submit to counseling, Hoosiers who walk into the “wrong door” and “choose life” can receive up to about $40 in goods over the course their pregnancy and the first year of that child’s life. Perhaps several years ago they may have been eligible for Temporary Assistance for Needy Families, but now with the work requirement, they may not qualify.

In a February 2016 interview with National Right to Life, one of the nation’s most prominent anti-choice groups, Gov. Pence said, “Life is winning in Indiana.” Though Pence was referring to the Real Alternatives contract, and the wave of anti-choice legislation sweeping through the state, it’s not clear what “life is winning” actually means. The state’s opioid epidemic claimed 1,172 lives in 2014, a statistically significant increase from the previous year, according to the Centers for Disease Control and Prevention. HIV infections have spread dramatically throughout the state, in part because of Pence’s unwillingness to support medically sound prevention practices. Indiana’s infant mortality rate is above the national average, and infant mortality among Black babies is even higher. And Pence has reduced access to prevention services such as those offered by Planned Parenthood through budget cuts and unnecessary regulations—while increasing spending on anti-choice crisis pregnancy centers.

Gov. Pence’s track record shows that these policies are no mistake. The medical and financial needs of his most vulnerable constituents have taken a backseat to religious ideology throughout his time in office. He has literally reallocated money for poor Hoosiers to fund anti-choice organizations. In his tenure as both a congressman and a governor, he’s proven that whether on a national or state level, he’s willing to put “pro-life” over quality-of-life for his constituents.


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