A New Agenda for Girls’ and Women’s Health and Rights

Amie Newman

Saturday, March 8th was International Women's Day - a day celebrated every year that focuses on the unique issues affecting women and girls globally and to embolden ourselves to act on these challenges. In honor of International Women's Day and in order to foster a lively discussion and debate on what the best way to address these global issues may be, Rewire is thrilled to introduce our first co-produced and co-hosted online salon with our partner, UN Dispatch.

This post is part of our online salon: A New Agenda for Girls' and Women's Health and Rights, co-hosted with UN Dispatch.

Saturday, March 8th was International Women's Day – a day celebrated every year that focuses on the unique issues affecting women and girls globally and emboldening ourselves to act on these challenges. In honor of International Women's Day and in order to foster a lively discussion and debate on what the best way to address these global issues may be, Rewire is thrilled to introduce our first co-produced and co-hosted online salon with our partner, UN Dispatch.

Our participants (from around the world) include:

Adrienne Germain, President of the International Women's Health Coalition, will kick off our online salon. In a report commissioned by the Better World Campaign, Germain addresses what an agenda for addressing the global health of women and girls must look like and the opportunities the next President of the U.S. has to create an agenda that includes these crucial issues. The report is also summarized in this video:

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Over the next 10 days, our panel of women and one man will discuss Adrienne's ideas, as well as their own. These experts in women's health and rights from around the world will engage in an online conversation bringing to the salon their own areas of expertise, passion about these issues and unique ideas on how we can save the health and lives of women and girls around the world. We hope you will join this discussion too!

And when you're done reading head over to OnDayOne.org and submit your own ideas on what reproductive and sexual health issues our next President must address!

Analysis Law and Policy

State-Level Attacks on Sexual and Reproductive Health and Rights Continue, But There’s Also Some Good News

Rachel Benson Gold & Elizabeth Nash

Despite the ongoing attention to restricting abortion, legislators in several states are looking to expand access to sexual and reproductive health services and education.

State legislatures came into session in January and quickly focused on a range of sexual and reproductive health and rights issues. By the end of the first quarter, legislators in 45 states had introduced 1,021 provisions. Of the 411 abortion restrictions that have been introduced so far this year, 17 have passed at least one chamber, and 21 have been enacted in five states (Florida, Indiana, Kentucky, South Dakota, and Utah).

This year’s legislative sessions are playing out on a crowded stage. The U.S. Supreme Court is considering a case involving a package of abortion restrictions in Texas; that decision, when handed down in June, could reshape the legal landscape for abortion at the state level. Moreover, just as state legislatures were hitting their stride in late March, the U.S. Food and Drug Administration revised the labeling for mifepristone, one of the two drugs used for medication abortion. That decision immediately put the issue back on the front burner by effectively counteracting policies restricting access to medication abortion in a handful of states. (Notably, the Arizona legislature moved within days to enact a measure limiting the impact of the FDA decision in the state.)

Progress on Several Fronts 

Despite the ongoing attention to restricting abortion, legislators in several states are looking to expand access to sexual and reproductive health services and education. By the end of the first quarter, legislators in 32 states had introduced 214 proactive measures; of these, 16 passed at least one legislative body, and two have been enacted. (This is nearly the same amount introduced in the year 2015, when 233 provisions were introduced.)

Although the proactive measures introduced this year span a wide range of sexual and reproductive health and rights issues, three approaches have received particular legislative attention:

  • Allowing a 12-month contraceptive supply. Legislators in 16 states have introduced measures to allow pharmacists to dispense a year’s supply of contraceptives at one time; these bills would also require health plans to reimburse for a year’s supply provided at once. (In addition, a bill pending in Maryland would cover a six-month supply.) Legislative chambers in three states (Hawaii, New York, and Washington) have approved measures. Similar measures are in effect in Oregon and the District of Columbia.
  • Easing contraceptive access through pharmacies. Legislators in 12 states have introduced measures to allow pharmacists to prescribe and dispense hormonal contraceptives. As of March 31, bills have been approved by at least one legislative chamber in Hawaii and Iowa and enacted in Washington. The measures in Hawaii and Iowa would require pharmacist training, patient counseling, and coverage by insurance; the Hawaii measure would apply only to adults, while the Iowa measure would apply to both minors and adults. The new Washington law directs the state’s Pharmacy Quality Assurance Commission to develop a notice that will be displayed at a pharmacy that prescribes and dispenses self-administered hormonal contraception. Under current state law, a pharmacy may prescribe and dispense these contraceptives under a collaborative practice agreement with an authorized prescriber. Oregon has a similar measure in effect. (California, the only other state with such a law, issued regulations in early April.)
  • Expanding education on sexual coercion. Measures are pending in 17 states to incorporate education on dating violence or sexual assault into the sex or health education provided in the state. A bill has been approved by one legislative chamber in both New Hampshire and New York. The measure approved by the New Hampshire Senate would require age-appropriate education on child sexual abuse and healthy relationships for students from kindergarten through grade 12. The measure approved by the New York Senate would mandate education on child sexual abuse for students from kindergarten through grade 8. And finally, in March, Virginia enacted a comprehensive new law requiring medically accurate and age-appropriate education on dating violence, sexual assault, healthy relationships, and the importance of consensual sexual activity for students from kindergarten through grade 12. Virginia will join 21 other states that require instruction on healthy relationships.

Ongoing Assault on Access to Sexual and Reproductive Health Services

Even as many legislators are working to expand access to services, others are continuing their now years-long assault on sexual and reproductive health services and rights. Restricting access to abortion continues to garner significant attention. However, last year’s release of a series of deceptively edited sting videos targeting Planned Parenthood has swept both the family planning safety net and biomedical research involving fetal tissue into the fray.

  • Abortion bans. Legislative attempts to ban abortion fall along a broad continuum, from measures that seek to ban all or most abortions to those aimed at abortions performed after the first trimester of pregnancy or those performed for specific reasons.
    • Banning all or most abortions. Legislators in nine states have introduced measures to ban all or most abortions in the state, generally by either granting legal “personhood” to a fetus at the moment of conception or prohibiting abortions at or after six weeks of pregnancy. Only one of these measures, a bill in Oklahoma that would put performing an abortion outside the bounds of professional conduct by a physician, has been approved by a legislative chamber.
    • Banning D&E abortions. Legislators in 13 states have introduced measures to ban the most common technique used in second-trimester abortions. Of these, a bill in West Virginia was enacted in March over the veto of Gov. Earl Ray Tomblin (D). A similar measure was approved by both houses of the Mississippi legislature and is being considered by a conference committee. (Kansas and Oklahoma enacted similar laws last year, but enforcement of both has been blocked by court action.)
    • Banning abortion at 20 weeks post-fertilization. South Dakota and Utah both enacted measures seeking to block abortions at 20 weeks during the first quarter of the year. The new South Dakota law explicitly bans abortions at 20 weeks post-fertilization (which is equivalent to 22 weeks after the woman’s last menstrual period). The Utah measure requires the use of anesthesia for the fetus when an abortion is performed at or after that point, something that providers would be extremely unlikely to do because of the increased risk to the woman’s health. In addition to these new measures, 12 other states ban abortion at 20 weeks post-fertilization.
  • Banning abortion for specific reasons. In March, Indiana enacted a sweeping measure banning abortions performed because of gender, race, national origin, ancestry, or fetal anomaly; no other state has adopted such a broad measure. The Oklahoma House approved a measure to ban abortion in the case of a fetal genetic anomaly; the state already bans abortion for purposes of sex selection. Currently, seven states ban abortion for the purpose of gender selection, including one state that also bans abortion based on race selection and one that also bans abortion due to fetal genetic anomaly.
  • Family planning funding restrictions. In the wake of the Planned Parenthood videos, several states have sought to limit funding to family planning health centers that provide or refer for abortion or that are affiliated with abortion providers. These efforts are taking different forms across states.
    • Medicaid. Measures to exclude abortion providers (e.g., Planned Parenthood affiliates) from participating in Medicaid have been introduced in five states, despite the clear position of the federal Centers for Medicare and Medicaid Services that such exclusions are not permitted under federal law. In March, Florida Gov. Rick Scott (R) signed a Medicaid restriction into law. By the end of the first quarter, measures had passed one chamber of the legislature in Arizona, Mississippi, and Missouri; a measure introduced in Washington has not been considered. (A related measure enacted in Wisconsin in February limits reimbursement for contraceptive drugs for Medicaid recipients.)

Similar attempts by six other states have been blocked by court action since 2010. These measures include laws adopted by Indiana and Arizona as well as administrative actions taken in Alabama, Arkansas, Louisiana, and Texas.

  • Other family planning funds. Legislators in 13 states have introduced measures to prevent state or federal funds that flow through state agencies from being distributed to organizations that provide, counsel, or refer for abortions; the measures would also deny funds to any organization affiliated with an entity engaging in these activities. Measures in three of these states have received significant legislative attention. In February, Wisconsin enacted a measure directing the state to apply for Title X funds (the state is not currently a grantee under the program); if the state’s application were approved, the measure would ban this funding from going to organizations that engage in abortion care-related activity. A measure that would deny funds to organizations engaged in abortion care-related activity passed the Kentucky Senate in February. A similar measure in Virginia, which would both prohibit an abortion provider from receiving funding and give priority to public entities (such as health centers operated by health departments) in the allocation of state family planning funds was vetoed by Gov. Terry McAuliffe (D) in March.
  • Related funds. In February, Ohio Gov. John Kasich (R) signed a measure barring abortion providers or their affiliates from receiving federal funds passing through the state treasury to support breast and cervical cancer screening; sex education; and efforts to prevent infertility, HIV in minority communities, violence against women, and infant mortality.
  • Fetal tissue research. The Planned Parenthood videos have also led to legislation in 28 states aimed at research involving fetal tissue. Measures have passed one legislative chamber in four states (Alabama, Iowa, Idaho, and Kentucky), and new laws have been enacted in four states (Arizona, Florida, Indiana, and South Dakota) in the first quarter alone. All four laws ban the donation of fetal tissue for purposes of research. These new laws are the first to ever ban the donation of fetal tissue. The Arizona law also bans research using fetal tissue, and the new South Dakota law strengthens the state’s existing ban by now considering fetal tissue research as a felony; four other states (Indiana, North Dakota, Ohio and Oklahoma) have similar provisions in effect.

Zohra Ansari-Thomas, Olivia Cappello, and Lizamarie Mohammed all contributed to this analysis.

Commentary Law and Policy

The New McCarthyites: Lists, Lies, and the GOP’s Attacks on Women’s Health Care

Jodi Jacobson

McCarthyism is defined in the dictionary as the practice of making accusations unsupported by proof or based on slight, doubtful, or irrelevant evidence, and the practice of making unfair allegations or using unfair investigative techniques especially in order to restrict dissent or political criticism. I'd say today's radicalized GOP has them both down pat.

Watching last Tuesday’s congressional hearing on Planned Parenthood by the House of Representatives Oversight and Government Reform Committee felt less like viewing a bona fide hearing in the sense of fact-finding or rational questioning by capable public servants on issues of public import than it did, variously, like witnessing an inquisition, a series of performances in theater of the absurd, and raising Joe McCarthy from the dead.

Ostensibly, these hearings were called to investigate claims by an anti-choice group known as the Center for Medical Progress (CMP) that Planned Parenthood was profiting from the sale of fetal tissue. This in turn gave House Republicans a reason to call for “defunding” Planned Parenthood. But there has never been any actual evidence offered by CMP or anyone else to support the charges of profits from the sale of fetal tissue, which is widely used in critical health research and has long been regulated under federal law. No evidence was offered at the hearing either. None of the congresspeople had seen the full, unedited versions of these videos, which have yet to be publicly released by CMP, though they’d had months to ask for them. In fact, that same day, Missouri became the sixth in a list of states that have wasted taxpayer money on investigations that found the claims to be baseless. (Never mind that the Missouri Planned Parenthood clinic does not even offer fetal tissue donation, but you know, let’s investigate anyway.)

The sale of fetal tissue isn’t and never really was the point of this hearing nor in fact of the videos themselves. Rather this attack is yet another salvo in a very long, large, and well-organized campaign to destroy the single largest provider of reproductive and sexual health care in the United States. As noted by CMP founder David Daleiden in an interview with Politicohis agenda is to bring down Planned Parenthood by any means possible. Because after all, why worry about the lives and health of the three million people a year who get services at Planned Parenthood clinics when you have political points to score and a reputation to make.

But hearings were of course held anyway, because if there is anything the GOP hates more than gun regulations and immigrants, it’s the ability of women to get access to health care whether it be contraception, abortion, testing and treatment for sexually transmitted infections, or breast exams.

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Cecile Richards, president of the Planned Parenthood Federation of America (PPFA), appeared at the hearing voluntarily, but that did not prevent her from having to take five hours of abuse. Watching in real time, I quickly understood there were three reasons for this hearing. One was to try as much as possible to humiliate Richards, who, apart from being a political force in her own right, is also the daughter of former Texas Democratic Gov. Ann Richards, a Democrat herself, a former chief of staff for Nancy Pelosi, and the head of both a powerful health-care provider and a powerful political action committee. Attacking Richards covers a lot of bases for right-wing hate-mongers. Several House members appeared committed to doing anything possible to trip Richards up such that she said something, anything, they could perhaps later use as fodder for campaign ads and another round of attacks.

A second reason appeared to be to further obfuscate the issue of funding for reproductive health care such that the GOP could find “better” uses for that money.

Finally, and most insidiously, taking a page right out of the playbook of Sen. Joseph McCarthy, this hearing was about taking names and getting lists of providers, of clinics, of staff people and even of organizations providing family planning services abroad for the purposes of harassing and stigmatizing them, if not more.

The most aggressive tactics apparently meant to humiliate or trap Richards were used by Congressmen Trey Gowdy (R-SC) and Jim Jordan (R-OH). As the following videos show, they each asked leading questions of Richards, and, before she could even begin to reply they interrupted, answered for her, and then twisted what she had managed to say in reply. In fact, throughout the hearing, GOP congresspersons asked convoluted questions only to cut Richards off any time she tried to respond.

Gowdy didn’t bother with questions about fetal tissue, body parts, or funding. Instead he ran off the rails with irrelevant questions about whether or not Richards understood “how some of us may at a base level disagree with you on the origin of life?” He then went on to badger her about her opinions on abortion and on so-called partial birth abortion, neither of which were relevant to the stated purposes of the hearing and the latter of which does not exist.

Jordan focused on a Planned Parenthood video featuring Richards and made in response to the first release by CMP. He badgered Richards about this video, without allowing her to reply.

The effort to confuse the public around funding for Planned Parenthood was at first raised obliquely by House committee chairman Jason Chaffetz. He opened the hearing with a tearful though disconnected story about his personal family losses from cancer. Chaffetz said:

This is an important topic. The risk of getting a little—a little personal. My wife, Julie and I have been married some 24 years. Have our 25th wedding anniversary coming up in February.  I’m proud of my wife. She… she got her degree in psychology later in life after helping to raise three kids, some are still at home. She has just started to work [with] a plastic surgeon [who is] involved in helping women who are having to have their breast removed. And my wife (inaudible) helping these women. And I’m proud of her for doing that.

My mother—she passed away when I was 28 years old. She fought cancer for more than 10 years. She had breast cancer. And I miss her.  I lost my—I lost my father to cancer as well. Cancer, in this country, kills about 1,500 people a day. A day. And yet, our federal government only spends about $5 billion to fight it. If they were shooting 1,500 people a day, if there were rockets coming—we would be fighting this with everything we have got.

Then, Chaffetz continued:

And as I said before I came to Congress and I’m saying here today, as fiscally conservative as I can possibly be, we don’t spend enough on cancer. We don’t spend enough. We need to spend more. I would quadruple the amount of money if I had my chance to fight cancer and win. And the reason I’m passionate about the hearing today is we got a lot of health care providers, who, I think, in their hearts know that they’re trying to provide good.

The question before us is, does this organization—does Planned Parenthood really need federal subsidy? Does it need federal dollars? Every time we spend a federal dollar, what we’re doing is pulling money out of somebody’s pocket and we’re giving it to somebody else. What I don’t like, what I don’t want to tolerate, what I don’t want to become numb to is wasting those taxpayer dollars.

It is not at all unusual for congresspeople to use personal stories in hearings. Normally, however, such stories are relevant to the subject of the hearing itself. Cancer research was not relevant. It is funded through the National Institutes of Health, the budget of which was cut by Republicans in March of this year.

This hearing was about the federal funds that support services delivered by Planned Parenthood, which come through two avenues, either reimbursement of services for patients who qualify for Medicaid, or through funding to support Title X family planning services. To suggest funds for cancer research have anything to do with funding for these services reveals either that Chaffetz did not know his facts, or he was playing on sympathy as a guise for suggesting there was a choice to be made between the two. In the same way that the GOP either truly does not get it or purposefully misunderstands the actual process women go through to get mammograms (first a primary caregiver provides a referral, then you go to a radiologist), they seem bent on pretending that switching funds from Planned Parenthood to other purposes is a better use of money. We’ll have to watch for these comparisons to be made later.

But what was perhaps the most insidious aspect of the hearing were the “lists.” As the hours wore on, there were repeated requests for Richards to send the committee lists of everything from the organizations to which Planned Parenthood provides funding overseas to the names and contact info for clinics and providers. In the 1950s, former Sen. Joe McCarthy touted lists he claimed proved communists had infiltrated the U.S. government. He used those purported lists (which did not actually exist) to create fear and intimidate people throughout the country, and to haul them in front of Congressional committees. He ruined many lives. And it appears his spirit lives on in the contemporary GOP now in power.

Reproductive health providers know about lists. A number of organizations in the anti-choice movement have been known to make and publish lists online, including the names of doctors and service providers of abortion care, the names and addresses of clinics, and the home addresses of those who work at clinics. These lists are used to intimidate, target, follow, and sometimes harm or murder abortion providers and staff. Some state attorneys general have tried to use their power to obtain the records of women who have had abortions, and in at least one case, that of former Kansas State Attorney General Phill Kline, information gathered by his office was shared publicly and with anti-choice groups. And now, since CMP released its videos, there have been a number of attacks on clinics throughout the country.

Chaffetz started taking names and making lists almost immediately. He began with a question about the Democratic Republic of Congo (yes, you read that right, straight from fetal tissue to the DRC):

CHAFFETZ: Ms. Richards, Planned Parenthood has sent 32-plus million dollars in grants overseas. Does any of the funds go to the Democratic Republican of the Congo?

RICHARDS: Congressman, let me…

CHAFFETZ: No, no, no. We don’t have time for a narrative. I just want to know…

(CROSSTALK)

CHAFFETZ: Yes or no.

RICHARDS: You asked me a question. Any of the money that is — Planned Parenthood raises and is given by foundations and individuals to support family planning services is in Africa and Latin America, and they go to individual organizations.

I’m happy to provide you a list of those organizations, but I did not bring them with me.

CHAFFETZ: If you could give us a list of those organizations.

Chaffetz then asked for a list of Planned Parenthood’s “ownership in foreign companies,” a somewhat strange request to a nonprofit, but…

CHAFFETZ: Does Planned Parenthood have any ownership in foreign companies?

RICHARDS: I don’t believe so. I don’t know what you mean by ownership.

CHAFFETZ: Well, in your 2013 tax return, it lists $3.3 million marked as, quote, “investment,” unquote in Central America and the Caribbean. I’m just asking if that investment was an actual investment?

RICHARDS: We don’t own anything in those countries. What…

CHAFFETZ: OK. Let me keep going. I have to keep going. I need to — I would appreciate a list. You have been very cooperative so far.

Congresswoman Cynthia Lummis (R-WY) picked up this thread by asking for a list of affiliates that “receive the majority of their revenue from abortion.” Lummis insinuated that there must be something wrong with Planned Parenthood’s data on the share of services for abortion, given revenues from abortion appear higher than those from other services. Her line of questioning was wholly misleading. Surgical abortion is more costly than other services, and those services are not reimbursable by Medicaid or other government funds, so the revenue stream is not relevant to the share of services provided. It’s like asking a dentist why she brings in more money for root canals than teeth cleanings.

Chaffetz, however, did not want to let that point go by, and so he reiterated the request when Lummis was done. “[A]s a point of clarification, Ms. Richards, I want to make sure there’s no ambiguity here. The gentlewoman from Wyoming asked for a listing of affiliates where the majority of revenue comes from abortion services. You said you’d talk to your team. Will you actually provide us that list?”

Like Joseph McCarthy, GOP members of the hearing panel then went on to suggest some sort of guilt by association with President Obama and the Department of Justice.

JORDAN: Since the videos have surfaced have you had any conversations with the President of the United States?

RICHARDS: No I have not.

JORDAN: Since the videos have surfaced have you been to the White House?

RICHARDS: No I have not.

JORDAN: How many times have you been to the White House?

RICHARDS: During what period of time?

JORDAN: Since Mr. Obama’s been president.

RICHARDS: I don’t know that’s been I think seven years, so I would have to get back to you on that.

JORDAN: Our count shows that you, your board members and senior staff have been to the White House 151 times in six and a half years. I’m just curious, that’s why I ask the question if you’ve been to the White House or you talked to the President since these videos have surfaced?

RICHARDS: And I said I have not.

JORDAN: And you’ll get back with me on if the Justice Department has contacted you since these videos have surfaced?

RICHARDS: Well I think you listed several folks, so I’m happy to work with the committee and find out what all you need to know.

JORDAN: CMS, HHS, Inspector General, Justice Department; Justice Department’s the most important.

Was President Obama featured in the CMP videos? I don’t think so either.

Chaffetz then once again stepped in and reiterated the list of lists being requested, and added a couple more.

CHAFFETZ: We are looking for the amount of revenue by affiliate for abortion services. So you have the — that should be pretty straightforward. We would like to know which affiliate provides which services.

RICHARDS: I believe you have that, but we’re happy to provide that.

CHAFFETZ: We’re still—we want to make sure we’ve it crystal. I think we have portions of it, but we don’t have all of it.

RICHARDS: OK.

CHAFFETZ: The names of organizations and the countries that Planned Parenthood gives funds to overseas. So based on the tax returns and reports, you’re sending money to overseas. Some of them have been listed as investments, so as other things, we’d like to get some details and specificity as to how much is going to which country and what those are for. Is that fair?

RICHARDS: I really have to talk to my team about that but I will.

And:

CHAFFETZ: We obviously, have some concerns about the Planned Parenthood Action Fund. So we’re trying to get to the duties performed and compensation received for all Planned Parenthood or affiliate employees. This could either by for the Planned Parenthood Action Fund or for either of the — I believe there are two, 5207 organizations. One of our concerns, is that the shared services and the sharing of employees between political actives and non-political activities and we would like to understand how broad based that is.

CHAFFETZ: [And] the cost of reimbursement for both contraception, and abortion, and abortion obviously breaks down into in clinic as well as the pill.

RICHARDS: Actually, there’s a lot of kinds of contraception too.

CHAFFETZ: Yes, contraception, I left it as broad as I could. But for the abortion services…

RICHARDS: I’m just saying, I think it’s important, I’m not sure we got into much of that conversation about how birth control—how many different kinds of birth control there are now because that’s one of our specialties.

CHAFFETZ: Help us understand and what services and money you’re allocated and what the costs of that are. There were some points that should be helping to drive down those costs and we’re just not understanding the ratio…

RICHARDS: That’s why…

CHAFFETZ: It needs clarification. I’m not asking…

RICHARDS: It was clear that folks weren’t aware of the various costs of different kind of contraceptions..

CHAFFETZ: Exactly, and that’s where we need help. Not right now, just as a follow up.

And:

CHAFFETZ: A list of political organizations, Planned Parenthood collarbones, including the names in compensation of received of shared employees.

I think I covered that in general, but I’ll keep going.

Yes, it seems they will keep going, as one means of spreading fear and intimidation.

There are two definitions of McCarthyism in the dictionary:

  • the practice of making accusations unsupported by proof or based on slight, doubtful, or irrelevant evidence.
  • the practice of making unfair allegations or using unfair investigative techniques especially in order to restrict dissent or political criticism.

I’d say today’s radicalized GOP has them both down pat.