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 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.

Culture & Conversation Media

TRAP Laws and the Abortion ‘Crisis’: A Conversation With Award-Winning Filmmaker Dawn Porter

Tina Vasquez

Recently, Porter spoke with Rewire about the inaccurate framing of abortion as a “moral” issue and the conditions that have created the current crisis facing providers and patients alike. Her film will air nationally on PBS’ Independent Lens Monday.

Dawn Porter’s documentary TRAPPED focuses on the targeted regulation of abortion providers (TRAP) laws designed to close clinics. But, as Porter told Rewire in a phone interview, TRAPPED is also about “normal people,” the providers and clinic staff who have been demonized due to their insistence that women should have access to abortion and their willingness to offer that basic health-care service.

Between 2010 and 2015, state legislators adopted some 288 laws regulating abortion care, subjecting providers and patients to restrictions not imposed on their counterparts in other medical specialties.

In Alabama, where most of the film takes place, abortion providers are fighting to keep their clinics open in the face of countlessand often arbitrary—regulations, including a requirement that the grass outside the facilities be a certain length and one mandating abortions be performed in far more “institutional” and expensive facilities than are medically necessary.

The U.S. Supreme Court is expected to issue a ruling this month on a Texas case regarding the constitutionality of some TRAP laws: Whole Woman’s Health v. Hellerstedt. The lawsuit challenges two provisions in HB 2: the admitting privileges requirement applied to Whole Woman’s Health in McAllen, Texas, and Reproductive Services in El Paso, Texas, as well as the requirement that every abortion clinic in the state meet the same building requirements as ambulatory surgical centers. It is within this context that Porter’s film will air nationally on PBS’ Independent Lens Monday.

Recently, the award-winning filmmaker spoke with Rewire about the Supreme Court case, the inaccurate framing of abortion as a “moral” issue, and the conditions that have created the current crisis facing providers and patients alike.

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Rewire: What has changed for the clinicians featured in TRAPPED since the documentary premiered at the Sundance Film Festival in January?

Dawn Porter: Now, in Alabama, the legislature has passed a law banning clinics within 2,000 feet of a school. There’s a lot of frustration because the clinicians abide by the laws, and then more are put in place that makes it almost impossible to operate.

Everyone has been really focused on Dalton Johnson’s clinic [the Alabama Women’s Center for Reproductive Alternatives] because the clinic he moved to was across the street from a school, but the law has also affected Gloria [Gray, the director of the West Alabama Women’s Center in Tuscaloosa, Alabama]and that’s not something a lot of us initially realized. She’s afraid this will shut her down for good. I would say this has been a very hard blow for her. I think Dalton was perhaps more prepared for it. He will fight the law.

The good news is that it’s not like either of these clinics will close tomorrow; this gets decided when they go back for relicensing at the end of the year. Right now, they’re in the middle of legal proceedings.

Of course, we’re all also awaiting the Supreme Court decision on Whole Woman’s Health. There’s a lot of uncertainty and anxiety right now, for these clinic owners in particular, but for all clinic owners [nationwide] really.

Rewire: Let’s talk about that. Later this month, the Supreme Court is expected to issue its ruling on that caseEven if the Supreme Court rules that these laws are unconstitutional, do you think the case will change the environment around reproductive rights?

DP: It really depends on how the Court writes the decision. There may be no case in which it’s more important for the Court to have a comprehensive decision. It’s a multiheaded hydra. There’s always something that can close a clinic, so it’s crucially important that this Court rules that nothing can hinder a woman’s right to choose. It’s important that this Court makes it clear that all sham laws are unconstitutional.

Rewire: We know abortion providers have been killed and clinics have been bombed. When filming, did you have safety concerns for those involved?

DP: Definitely. The people who resort to violence in their anti-choice activities areI guess the most charitable way to describe itunpredictable. I think the difficult thing is you can’t anticipate what an irrational person will do. We took the safety of everyone very seriously. With Dr. Willie Parker [one of two doctors in the entire state of Mississippi providing abortions], for example, we wouldn’t publicize if he’d be present at a screening of the film. We never discussed who would appear at a screening. It’s always in the back of your mind that there are people who feel so strongly about this they would resort to violence. Dr. Parker said he’s aware of the risks, but he can’t let them control his life.

We filmed over the course of a few years, and honestly it took me a while to even ask about safety. In one of our last interviews, I asked Dr. Parker about safety and it was a very emotional interview for both of us. Later during editing, there was the shooting at the Colorado clinic and I called him in a panic and asked if he wanted me to take our interview out of the film. He said no, adding, “I can’t let irrational terrorists control my life.” I think everybody who does this work understands what’s at risk.

Rewire: It seems Texas has become ground zero for the fight for abortion access and because of that, the struggles in states like Alabama can get lost in the shuffle. Why did you choose to focus on Alabama?

DP: I met Dr. Parker when he was working in Mississippi. The first meeting I did with him was in December 2012 and he told me that Alabama had three clinics and that no one was talking about it. He introduced me to the clinic owners and it was clear that through them, the entire story of abortion access—or the denial of itcould be told. The clinic owners were all working together; they were all trying to figure out what to do legally so they could continue operating. I thought Alabama was unexplored, but also the clinic owners were so amazing.

To tell you the truth, I tried to avoid Texas for a long time. If you follow these issues around reproductive rights closely, and I do, you can sort of feel like, “Uh, everyone knows about Texas.” But, actually, a lot of people don’t know about Texas. I had this view that everyone knew what was going on, but I realized I was very insulated in this world. I started with Texas relatively late, but decided to explore it because we were following the lawyers with the Center for Reproductive Rights and they were saying one of their cases would likely go to the Supreme Court, and Whole Woman’s Health was most likely. They, of course, were right.

When you’re making a film, you’re emerged in a world and you have to take a step back and think about what people really know, not what you think they know or assume they know.

Rewire: In TRAPPED, you spliced in footage of protests from the 1970s, which made me think about how far we’ve come since Roe v. Wade. Sometimes it feels like we’ve come very far, other times it feels like nothing has changed. Why do you think abortion is such a contentious topic?

DP: I don’t think it’s actually that contentious, to tell you the truth. I think there is a very vocal minority who are extreme. If you poll them, most Americans are pro-choice and believe in the right to abortion in at least some circumstances. Most people are not “100 percent, no abortion” all the time. People who are, are very vocal. I think this is really a matter of having people who aren’t anti-choice be vocal about their beliefs.

Abortion is not the number one social issue. It was pretty quiet for years, but we’ve seen the rise of the Tea Party and conservative Republicans heavily influencing policy. The conservative agenda has been elevated and given a larger platform.

We need to change public thinking about this. Part of that conversation is destigmatizing abortion and not couching it in a shameful way or qualifying it. Abortion is very common; many, many women have them. Three in ten U.S. women have had an abortion before the age of 45. I think that part of the work that needs to be done is around stigma and asking why are we stigmatizing this. What is the agenda around this?

Evangelicals have done a great job of making it seem like this is an issue of morality, and it’s just not. To me, honestly, it doesn’t matter if you’re pro-choice or anti-choice. Everyone is entitled to their own opinions and beliefs. I can respect different opinions, but I can’t respect someone who tries to subvert the political process. People with power and influence who tamper with the political process to impose their beliefs on other people—I really can’t respect that.

Rewire: There are a lot of entry points for conversations about abortion access. What brought you to focus on TRAP laws?

DP: People often discuss abortion in terms of morality, but that’s not what we should be talking about. The reason why these laws have been so effective is because they successfully harm the least powerful of the group they’re targeting. Who’s getting picked on, who’s suffering the most? Women of color, people who are low-income, people who don’t have health insurance. There’s something so unjust about how these laws are disproportionately affecting these populations, and that really bothered me. I’m certainly interested in abortion as a topic, but I’m also interested in politics and power and how those things take shape to hurt the most vulnerable.

Rewire: In TRAPPED, we get to see a very personal side of all the clinicians and providers. One clinician discusses having to be away from her six children all of the time because she’s always at the clinic. We get to see Dr. Willie Parker at church with his family. And it was amazing to learn that the remaining providers in Alabama are friends who regularly eat dinner together. Was it intentional to humanize providers in a way we don’t usually get to see?

DP: Absolutely. The anti-choice side has successfully painted the picture of an abortion provider as this really shady, sinister person. I spent three years embedded in these clinics, and that couldn’t be further from what I saw. These are passionate, brave people, but they’re also very normal people. They’re not superheroes or super villains. They’re just normal people. It’s not that they don’t think about what they’re doing; they’re just very resilient and courageous in a way that makes me very proud. I wanted people to see that.

Rewire: Honestly before watching TRAPPED, I never thought about the personal toll that pressure takes on providers. Dalton Johnson used his retirement funds in order to continue providing abortion care. In several scenes, we see an emotional Gloria Gray struggling with whether or not to keep fighting these laws. Do you think people generally understand what it’s costing providers—financially and emotionally—to continue operating?

DP: I don’t think a lot of us think about that. People like Dalton are saying, “I would rather cash out my retirement than give in to you people.” We should not be asking people to make that kind of sacrifice. That should not be happening.

We also don’t spend enough time thinking about or talking about all of the things that have happened to create the conditions we’re now dealing with. It’s like a perfect storm. Medical schools are not training abortion providers, and the abortion providers that are around are getting older and retiring. Of course laws keep getting passed that make it more and more difficult to run a clinic. In this kind of environment, can you really blame people for not wanting to be providers? Especially when there’s the added pressure of having to take not just your own safety into account, but the safety of your family.

Anti-choice people target the children of abortion providers. They target them at home. This is a hard job if you want to have a life. I mean that literally too—if you literally want to have your life.

This is why so few go into this field. As the number of providers in some states continues to get eliminated, the burden left on those standing is exponentially greater.

The reason why we have a crisis around abortion care is not just laws, but because we have so few physicians. There are all of these factors that have come together, and we didn’t even get to cover all of it in the documentary, including the fact that Medicaid doesn’t cover abortion [under federal law. Seventeen states, however, use state funds to cover abortion care for Medicaid recipients.] A lot of this is the result of conservative lobbying. People have to be aware of all the pressures providers are under and understand that we didn’t get to this point of crisis accidentally.

Rewire: It can feel hopeless, at least to me. What gives you hope when it comes to this unrelenting battle for reproductive rights in this country?

DP: I don’t feel hopeless at all. I feel like it’s really important to be aware and vigilant and connect these dots. I wanted to help people understand the complications and the challenges providers are up against.

These providers have done their part, and now it’s time for the rest of us to do ours. People can vote. Vote for people who prioritize providing education and medical care, rather than people who spend all of their time legislating an abortion clinic. Alabama is in a huge fiscal crisis. The education system is a mess. The Medicaid system is a mess, and the whole Alabama state legislature worked on a bill that would affect a couple of abortion clinics. Voters need to decide if that’s OK. I think this is all very hard, but it’s not at all hopeless.