Lynn Paltrow is the Founder and Executive Director of National Advocates for Pregnant Women (NAPW).

Many people in the U.S. work to protect the rights of pregnant women and to ensure that they are treated with dignity and respect. But as a result of the divisive abortion debate, many of those advocates typically do not work together—or even speak to one another.

The anti-abortion movement has successfully used the abortion issue to divide the electorate, and a key part of their strategy has been creating the illusion that there are two kinds of women: those who have abortions and those who have babies. The truth is that 61 percent of women who have abortions are already mothers, and another 24 percent will go on to become mothers. Over the course of their lives, 85 percent of all women bring life into this world and provide the vast majority of care for the lives of those around them—without compensation.

This means that whether someone is an abortion provider or pro-choice advocate defending the right to choose abortion—or a midwife, doula, or birthing rights advocate seeking to ensure that women have access to health care providers that listen to and support them—they are advocating for the same women, regardless of their position on abortion.

Members of both groups struggle with U.S. policies that run counter to women's health and well being. Both know that many pregnant women are not receiving the information or support they need. Both represent pregnant women who lack protection from workplace discrimination—and lack supports available to women in virtually every other western industrialized country, like a national health care system and paid maternity leave.

Both groups are hurt by state legislative agendas that focus on restricting abortion to the exclusion of virtually every other health issue concerning pregnant women and mothers. (In the 2005 legislative session, over 650 bills were introduced that would directly or indirectly restrict access to abortion and contraception or advance the legal status of the fetus as if it were separate from the pregnant woman.)

Despite these shared challenges and their shared commitment to the health and rights of pregnant women—whether or not there is agreement on abortion—pro-choice and birthing rights advocates have only recently begun to talk, organize, or advocate based on their shared interests.

Finding common ground among these two groups, and beginning to build a broad-based coalition of activists were two of the primary goals of the National Advocates for Pregnant Women when we sponsored the 2007 Summit to Ensure the Health and Humanity of Pregnant and Birthing Women earlier this year in Atlanta.

The summit brought together over 300 maternal, birthing and reproductive rights/justice activists along with social justice activists, legal and policy experts and healthcare providers from 37 states, the District of Columbia, Mexico and Canada. It was co-sponsored by more than 60 organizations ranging from advocates for mother-friendly childbirth to those that advocate for the right to choose an abortion.

Participants moved beyond the divisive abortion debate to find common ground in the experiences of pregnancy and the increasing limitations to care and support that all pregnant and birthing women face.

For pro-choice advocates these barriers include laws that mislead or misinform women about abortion. Twenty-eight states currently mandate that women seeking abortion receive an approved set of materials that often contain misleading information (for example, raising expectations for benefits or child support if she continues to term that she may very well be unable to collect). Millions of government dollars are being spent on medically inaccurate abstinence-only education. Millions more in state and federal funding goes to pregnancy crisis centers whose staff have been caught red-handed providing false information to pregnant women about abortion.

But not only women seeking to end a pregnancy are being deprived of information. Today, caesarian sections account for nearly one in three births in the U.S., a statistic that far exceeds international recommendations. Even though c-sections constitute significant invasive surgery with a considerable recovery period, only two states, New York and Massachusetts, mandate that their hospitals provide women who are going to term with specific information regarding their birth-related practices.

Both pro-choice advocates and birthing rights advocates are challenged by decreasing access to services: the former struggles with the fact that 87 percent of all U.S. counties have no abortion providers; the latter struggles against policies at over 300 hospitals around the country that deny women who have previously had c-sections the right to even try delivering vaginally.

And both have been negatively affected by growing claims of "fetal rights." While these are advanced as part of the campaign to outlaw abortion, they have begun to effect the lives of women who personally identify as "pro-life." Christian fundamentalists have been told that they must have unnecessary c-sections to protect the rights of the fetus; pregnant women opposed to abortions have been arrested as child abusers in the name of fetal rights for things they did or did not do during pregnancy.

We saw at the summit that pro-choice advocates and birthing rights advocates can work together, whether they are identifying civil and human rights violations or formulating an agenda that genuinely values pregnant women, maternal health and motherhood.

The time has come to move away from divisive (and inaccurate) "pro-life" and "pro-choice" categorizations and stand together. We need broad based support for laws and policies that genuinely promote a culture of life—one that includes and values the women who give that life.

Republished with permission from TomPaine.com.

Editor's note: For more on the connections between the reproductive rights and maternal health communities, check out Jessica Aron's "The Pro-Choice Continuum."

The need for reform of the mental health-care system is well documented; those of us who have spent time trying to access often costly, out-of-reach treatment will attest to how time-consuming and expensive care can be—if you can get the necessary time off work to pursue that care. Advocates say, however, that U.S. Rep. Tim Murphy’s (R-PA) “Helping Families in Mental Health Crisis Act” (HR 2646), purported to help address gaps in care, is not the answer. Instead, they say, it is regressive and strips rights away from those diagnosed with mental illness. This leaves those in the LGBTQ community—who already often have an adversarial relationship with the mental health sector—at particular risk.

“We believe that this legislation will result in outdated, biased, and inappropriate treatment of people with a mental health diagnosis,” wrote the political action committee Leadership Conference on Civil and Human Rights in a March letter to House Committee on Energy and Commerce Chairman Rep. Fred Upton (R-MI) and ranking member Rep. Frank Pallone (D-NJ) on behalf of more than 100 social justice organizations. “The current formulation of H.R. 2646 will function to eliminate basic civil and human rights protections for those with mental illness.”

Despite the pushback, Murphy continues to draw on the bill’s mental health industry support; groups like the American Psychiatric Association (APA) and the National Alliance on Mental Illness (NAMI) back the bill.

Murphy and Rep. Eddie Bernice Johnson (D-TX) reintroduced HR 2646 earlier this month, continuing to call it “groundbreaking” legislation that “breaks down federal barriers to care, clarifies privacy standards for families and caregivers; reforms outdated programs; expands parity accountability; and invests in services for the most difficult to treat cases while driving evidence-based care.”

Some of the stated goals of HR 2646 are important: Yes, more inpatient care beds are needed; yes, smoother transitions from inpatient to outpatient care would help many; yes, prisons house too many people with mental illness. However, many of its objectives, such as “alternatives to institutionalization” potentially allow outpatient care to be mandated by judges with no medical training and pushed for by “concerned” family members. Even the “focus on suicide prevention” can lead to forced hospitalization and disempowerment of the person the system or family member is supposedly trying to help.

All in all, advocates say, HR 2646—which passed out of committee earlier this month—marks a danger to the autonomy of those with mental illness.

Victoria M. Rodríguez-Roldán, JD, director of the Trans/GNC Justice Project at the National LGBTQ Task Force, explained that the bill would usurp the Health Insurance Portability and Accountability Act (HIPAA), “making it easier for a mental health provider to give information about diagnosis and treatment … to any ‘caregiver’-family members, partners or spouses, children that may be caring for the person, and so forth.”

For the communities she serves, this is more than just a privacy violation: It could put clients at risk if family members use their diagnosis or treatment against them.

“When we consider the stigma around mental illness from an LGBT perspective, an intersectional perspective, 57 percent of trans people have experienced significant family rejection [and] 19 percent have experienced domestic violence as a result of their being trans,” said Rodríguez-Roldán, citing the National Transgender Discrimination Survey. “We can see here how the idea of ‘Let’s give access to the poor loved ones who want to help!’ is not that great an idea.”

“It’s really about taking away voice and choice and agency from people, which is a trend that’s very disturbing to me,” said Leah Harris, an organizer with the Campaign For Real Change in Mental Health Policy, also known as Real MH Change. “Mostly [H.R. 2646] is driven by families of these people, not the people themselves. It’s pitting families against people who are living this. There are a fair number of these family members that are well-meaning, but they’re pushing this very authoritarian [policy].”

Rodríguez-Roldán also pointed out that if a patient’s gender identity or sexual orientation is a contributing factor to their depression or suicide risk—because of discrimination, direct targeting, or fear of bigoted family, friends, or coworkers—then that identity or orientation would be pertinent to their diagnosis and possible need for treatment. Though Murphy’s office claims that psychotherapy notes are excluded from the increased access caregivers would be given under HR 2646, Rodríguez-Roldán isn’t buying it; she fears individuals could be inadvertently outed to their caregivers.

Rodríguez-Roldán echoed concern that while disability advocacy organizations largely oppose the bill, groups that represent either medical institutions or families of those with mental illnesses, or medical institutions—such as NAMI, Mental Health America, and the APA—seem to be driving this legislation.

“In disability rights, if the doc starts about talking about the plight and families of the people of the disabilities, it’s not going to go over well,” she said. “That’s basically what [HR 2646] does.”

Rodríguez-Roldán’s concerns extend beyond the potential harm of allowing families and caregivers easier access to individuals’ sensitive medical information; she also points out that the act itself is rooted in stigma. Rep. Murphy created the Helping Families in Mental Health Crisis Act in response to the Sandy Hook school shooting in 2012. Despite being a clinical psychologist for 30 years before joining Congress and being co-chair of the Mental Health Caucus, he continues to perpetuate the well-debunked myth that people with mental illness are violent. In fact, according to the Department of Health and Human Services, “only 3%-5% of violent acts can be attributed to individuals living with a serious mental illness” and “people with severe mental illnesses are over 10 times more likely to be victims of violent crime than the general population.”

The act “is trying to prevent gun violence by ignoring gun control and going after the the rights of mentally ill people,” Rodríguez-Roldán noted.

In addition, advocates note, HR 2646 would make it easier to access assisted outpatient treatment, but would also give courts around the country the authority to mandate specific medications and treatments. In states where the courts already have that authority, Rodríguez-Roldán says, people of color are disproportionately mandated into treatment. When she has tried to point out these statistics to Murphy and his staff, she says, she has been shut down, being told that the disparity is due to a disproportionate number of people of color living in poverty.

Harris also expressed frustration at the hostility she and others have received attempting to take the lived experiences of those who would be affected by the bill to Murphy and his staff.

“I’ve talked to thousands of families … he’s actively opposed to talking to us,” she said. “Everyone has tried to engage with [Murphy and his staff]. I had one of the staffers in the room say, ‘You must have been misdiagnosed.’ I couldn’t have been that way,” meaning mentally ill. “It’s an ongoing struggle to maintain our mental and physical health, but they think we can’t get well.”

Multiple attempts to reach Murphy’s office by Rewire were unsuccessful.

LGBTQ people—transgender, nonbinary, and genderqueer people especially—are particularly susceptible to mistreatment in an institutional setting, where even the thoughts and experiences of patients with significant privilege are typically viewed with skepticism and disbelief. They’re also more likely to experience circumstances that already come with required hospitalization. This, as Rodríguez-Roldán explained, makes it even more vital that individuals not be made more susceptible to unnecessary treatment programs at the hands of judges or relatives with limited or no medical backgrounds.
“Forty-one percent of all trans people have attempted suicide at some point in their lives,” said Rodríguez-Roldán. “Once you have attempted suicide—assuming you’re caught—standard procedure is you’ll end up in the hospital for five days [or] a week [on] average.”

In turn, that leaves people open to potential abuse. Rodríguez-Roldán said there isn’t much data yet on exactly how mistreated transgender people are specific to psychiatry, but considering the discrimination and mistreatment in health care in general, it’s safe to assume mental health care would be additionally hostile. A full 50 percent of transgender people report having to teach their physicians about transgender care and 19 percent were refused care—a statistic that spikes even higher for transgender people of color.

“What happens to the people who are already being mistreated, who are already being misgendered, harassed, retraumatized? After you’ve had a suicide attempt, let’s treat you like garbage even more than we treat most people,” said Rodríguez-Roldán, pointing out that with HR 2646, “there would be even less legal recourse” for those who wanted to shape their own treatment. “Those who face abusive families, who don’t have support and so on—more likely when you’re queer—are going to face a heightened risk of losing their privacy.”

Or, for example, individuals may face the conflation of transgender or gender-nonconforming status with mental illness. Rodríguez-Roldán has experienced the conflation herself.

“I had one psychiatrist in Arlington insist, ‘You’re not bipolar; it’s just that you have unresolved issues from your transition,'” she said.

While her abusive household and other life factors certainly added to her depression—the first symptom people with Bipolar II typically suffer from—Rodríguez-Roldán knew she was transgender at age 15 and began the process of transitioning at age 17. Bipolar disorder, meanwhile, is most often diagnosed in a person’s early 20s, making the conflation rather obvious. She acknowledges the privilege of having good insurance and not being low-income, which meant she could choose a different doctor.

“It was also in an outpatient setting, so I was able to nod along, pay the copay, get out of there and never come back,” she said. “It was not inside a hospital where they can use that as an excuse to keep me.”

The fear of having freedom and other rights stripped away came up repeatedly in a Twitter chat last week lead by the Task Force to spread the word about HR 2646. More than 350 people participated, sharing their experiences and asking people to oppose Murphy’s bill.

In the meantime, Sen. Lamar Alexander (R-TN) has introduced the “Mental Health Reform Act of 2016” (SB 2680) which some supporters of HR 2646 are calling a companion bill. It has yet to be voted on.

Alexander’s bill has more real reform embedded in its language, shifting the focus from empowering families and medical personnel to funding prevention and community-based support services and programs. The U.S. Secretary of Health and Human Services would be tasked with evaluating existing programs for their effectiveness in handling co-current disorders (e.g., substance abuse and mental illness); reducing homelessness and incarceration of people with substance abuse and/or mental disorders; and providing recommendations on improving current community-based care.

Harris, with Real MH Change, considers Alexander’s bill an imperfect improvement over the Murphy legislation.

“Both of [the bills] have far too much emphasis on rolling back the clock, promoting institutionalization, and not enough of a preventive approach or a trauma-informed approach,” Harris said. “What they share in common is this trope of ‘comprehensive mental health reform.’ Of course the system is completely messed up. Comprehensive reform is needed, but for those of us who have lived through it, it’s not just ‘any change is good.'”

Harris and Rodríguez-Roldán both acknowledged that many of the HR 2646 co-sponsors and supporters in Congress have good intentions; those legislators are trusting Murphy’s professional background and are eager to make some kind of change. In doing so, the voices of those who are affected by the laws—those asking for more funding toward community-based and patient-centric care—are being sidelined.

“What is driving the change is going to influence what the change looks like. Right now, change is driven by fear and paternalism,” said Harris. “It’s not change at any cost.”

The Texas Department of State Health Services (DSHS) quietly published a draft version of a pamphlet the state mandates physicians provide to pregnant people seeking abortion care.  

The draft version of “A Woman’s Right to Know” was published online Tuesday, just a day after the U.S. Supreme Court ruled two provisions of the state’s omnibus anti-choice law, HB 2, are unconstitutional.

There appear to be only minor changes to the previous version of the pamphlet.

The most significant change is an update stating that medication abortion can be prescribed “up to 70 days” from the pregnant person’s last menstrual period, in accordance with revised federal regulations.

The proposed revisions are available for public comment until Friday, July 29.

Lawmakers in several states have passed laws mandating that states provide written materials to pregnant people seeking abortion services. These so-called informed consent laws often require that the material include inaccurate or misleading information.

The previous version of the state’s “A Woman’s Right to Know” pamphlet contained 34.45 percent medically inaccurate statements, according to a study by a research team from Rutgers University.

The draft pamphlet notes that there is a “greater risk of dying from the abortion procedure and having serious complications the further along you are in your pregnancy.” The pamphlet cites a study, published in 2004 in Obstetrics & Gynecology, which examined abortion statistics from 1972 to 1997. Not apparent in the pamphlet is the researchers’ conclusion, which stated that “increased access to surgical and nonsurgical abortion services may increase the proportion of abortions performed at lower-risk, early gestational ages and help further decrease deaths.”

Moreover, a 2012 study found that abortion is “markedly safer than childbirth.” The study found that the risk of death from carrying a pregnancy to term “is approximately 14 times higher than that with abortion.”

There has been only one death related to abortion complications in Texas since 2008, according to the most recently available DSHS statistics.

The draft pamphlet does not explicitly make the claim that having an abortion causes breast cancer, a claim that is often made by anti-choice activists. However, the pamphlet states that “doctors and scientists are actively studying the complex biology of breast cancer to understand whether abortion may affect the risk of breast cancer.”

The link between abortion and cancer has been repeatedly debunked by scientific research.

“Scientific research studies have not found a cause-and-effect relationship between abortion and breast cancer,” according to the American Cancer Society.

A report by the National Cancer Institute also explains, “having an abortion or miscarriage does not increase a woman’s subsequent risk of developing breast cancer.”