What Will the Future (of Reproductive Health and Rights) Look Like?

Brady Swenson

Five leaders from the reproductive health and justice community and many loyal readers gathered for a live discussion about the future of sexual and reproductive health policy. Read the full transcript here.

On Wednesday, December 17, reproductive health experts Marilyn Keefe of the National Partnership for Women & Families, William Smith of SIECUS, Heather Boonstra of Guttmacher Institute, Cristina Page of BirthControlWatch.org, and Rewire’s own Kay Steiger came together with many loyal Rewire readers for a live discussion about the future of sexual and reproductive health policy.

Click the “Replay” button below to read a full transcript of the discussion.


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Commentary Abortion

The Institutionalization of Abortion Stigma: What Care at an Ambulatory Surgical Center Can Look Like

Annika Mukherjee

Under HB 2, Texas' omnibus anti-abortion law, doctors must fulfill medically unnecessary requirements just to stay open, forgoing a patient’s comfort.

It only takes a visit to one community clinic and one ambulatory surgical center to see how HB 2, Texas’ omnibus anti-abortion law, is taking its toll on patient care. Doctors must now fulfill medically unnecessary requirements just to stay open, forgoing a patient’s comfort.

This situation will only get worse if the Supreme Court lets HB 2 stand. The Court, when its term begins October 5, could take up a challenge from reproductive rights advocates to “determine whether Texas can force more than 75 percent of the State’s abortion clinics to close.” While we wait to hear from the Court, I’d like to share my experience of touring two clinics—one that was constructed before HB 2 and one that was built to comply with the restrictive law.

Whole Woman’s Health (WWH) is a feminist organization that offers comprehensive gynecology services for people, including abortion care. During my internship at NARAL Pro-Choice Texas, Marva Sadler, WWH’s director of Clinical Services, gave us a tour of the organization’s San Antonio clinic. Sadler led us around the facilities, as if we were patients, so we could get a sense of the experience, from sitting in the waiting room to recovering in the Aftercare room. WWH San Antonio creates a unique and individualized experience for people obtaining abortions, actively fighting shame and honoring their individual experiences through soothing purple walls and lighting, empowering artwork, rooms named after powerful women, and a comforting atmosphere.

The clinic visit starts with counseling and then a one-on-one consultation with the doctor who would be performing the abortion, to answer any questions and to provide total awareness of the patient’s various options. Family members and escorts are welcome to accompany the patient throughout the process, although the patient is also given confidential time alone with the clinic staff, who are well-trained to identify issues like coercion, domestic abuse, and human trafficking. The patient also watches the Whole Woman’s Health video, which leads the patient through the entire process of getting an abortion “from the moment a patient walks through the door to when she leaves from recovery.” The patient has many opportunities to ask questions, discuss their options, and think through what is best for them.

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Whole Woman’s Health Director of Clinical Services Marva Sadler stands in the operating room at Whole Woman’s Health of San Antonio. If House Bill 2 were to go into effect, this type of room wouldn’t be able to be used for abortion procedures

Whole Woman’s Health Director of Clinical Services Marva Sadler stands in the operating room at Whole Woman’s Health of San Antonio. If HB 2 were to go into effect, this type of room wouldn’t be able to be used for abortion procedures

The operating room at the regular, non-ambulatory clinic is a small, intimate space with a lamp and two medical devices, an ultrasound system and a suction machine. The room is comforting and supportive, especially because an escort can act as a hand-holder throughout the process. The doctor’s patient-centered practice contributes to the warm atmosphere, as the patient and doctor have already been acquainted through counseling, and the doctor talks the patient through the procedure, explaining what is happening along the way. At WWH, they call this “verbicaine.” As Sadler described it: “Nine times out of ten, without any sedation, we talk patients through their procedures. We start a totally different conversation about something totally different, and then when they realize that the conversation is over, the procedure is over.”

The procedure is usually over within eight to ten minutes.

At the end, patients enter the Aftercare room: a space lit by lamps with purple blankets and lush reclining chairs. They can have “tranquili-tea”—a WWH-exclusive, specially brewed tea to help with cramping—use heating pads, and talk to staff and their escort(s).

“This is where the emotion happens,” says Sadler. Aftercare is where Whole Woman’s Health staff “really [get] to put their special touch in with patients, and this is where the difference happens. This is where they’re individualizing, and they get to make a difference in a life.”

Whole Woman’s Health erases stigma from the abortion process and transforms it into a wholesome experience centered on the patient’s needs. WWH’s staff are trained to break down the walls of abortion stigma in a safe, comforting and nonjudgmental environment, making sure they’re caring for the patient holistically from the time they walk into the clinic until after the procedure and follow-up appointment.

Unfortunately, restrictions like those in HB 2 have completely compromised WWH’s methods.

HB 2, among other things, requires that all abortion clinics meet the building standards of an ambulatory surgical center (ASC). Should this provision of HB 2 go into effect, only nine clinics would be able to serve all of Texas (see a comparison of the requirements here). After the Fifth Circuit Court of Appeals ruled to uphold HB 2’s provisions, Whole Woman’s Health, along with other Texas abortion providers and led by the Center for Reproductive Rights, took the law to the Supreme Court. The Supreme Court then granted a stay, blocking that provision of the law from going into effect while the Court decides whether or not to hear the case.

To comply with the state’s new restrictive abortion legislation, WWH constructed an ambulatory surgical center in 2010 that provides a vastly different patient experience. We toured that clinic, which is located across the parking lot from WWH’s regularly licensed abortion clinic, as well.

First entering the ASC clinic’s waiting room, we saw the same purple walls, but throughout the rest of the facility, it was stark white, an official ASC regulation. The atmosphere immediately transitioned into that of a shameful “asylum,” as Sadler put it. Notices and warnings were posted everywhere, where artwork might be if it were allowed. Alarm systems (or, as staff call it, “money hanging on the walls”) are plastered throughout the facility, rarely, if ever, used. There are internal alarm systems, hospital-grade fire alarm systems with sprinklers, a guest monitor, a generator monitor, and an emergency generatorall of which need to be tested and documented every day. These are extra obligations and extra money that are only a requirement of an ASC, adding nothing beneficial to the abortion procedure or to patient health and safety.

A gas line pipes through the wall in Whole Woman’s Health’s ambulatory surgical center. This is among the many pieces of medical equipment required for an ambulatory surgical center, but is never used during an abortion procedure.

A gas line pipes through the wall in Whole Woman’s Health’s ambulatory surgical center. This is among the many pieces of medical equipment required for an ambulatory surgical center, but is never used during an abortion procedure.

The preoperative room has bright, blinding overhead lighting that makes you feel like you’re being interrogated. Many different contraptions and systems are wired across and through the walls, including different gases, chemicals, and canisters.

In the five years that WWH has had this ASC, Sadler says, they haven’t needed to use this equipment once.

In spite of this, the canisters have to be replaced when they get old, the cords to the equipment have to be checked everyday, and IV access has to be maintained, whether the patient wants sedation or not.

Another requirement that jeopardizes the patient’s comfort is that they have to get completely undressed and put on a hospital gown, surgical booties, and a surgical bonnet. Patients aren’t allowed to walk around like they would in a regular clinic, but have to lay on a gurney, wheeled to and from the operating room. When abortion is treated like a dangerous surgery, it takes away the independence and strength of the decision to have one. Obviously, these provisions are necessary for facilities that provide intensive, invasive procedures, but for abortion care, this is absolute overkill and a waste of money, not to mention an uncomfortable experience for the patient. It serves to do nothing but further stigmatize one of the safest procedures available in health care.

The halls of the ASC clinic at Whole Woman’s Health of San Antonio consisted of other specific requirements that don’t seem to have any real use: a pharmacy with required medication that doctors there have never used and do not need to provide abortions (“When these meds expire, we just throw them away and order more,” says Sadler), crash carts stocked with medication that can be $200 a bottle, male and female locker rooms, two color-coded janitor’s closets, and a blanket warmer. ASC requirements even took away WWH’s special touch of providing purple blankets; the blankets have to be white.

The operating room at Whole Woman’s Health of San Antonio’s ambulatory surgical center, which meets all of the requirements of House Bill 2, even if they aren’t needed for an abortion procedure.

The operating room at Whole Woman’s Health of San Antonio’s ambulatory surgical center, which meets all of the requirements of HB 2, even if they aren’t needed for an abortion procedure.

In the ASC clinic, the process is much more intimidating. It was massive, with bright “alien eyes” staring down at us, filled with complex machines, even though abortion care only requires the ultrasound and suction machines. According to Sadler, the patient is strapped down onto the table—nude in a 60-degree facility—arms restricted with straps on both sides of the table that keep her from moving. The only people allowed in the room are the doctor, registered nurses, and surgical techs. Because the patient is not allowed to have an escort in the room, no one is there to hold her hand. As the doctors are maintaining all of the different equipment, that verbal connection and emotional touch found across the street at the non-ASC clinic is lost here.

“[The patient] is absolutely alone because there is no one there to hold her hand throughout the whole thing. It’s horrible,” says Sadler, staring down at the ASC clinic’s emotionless surgical table. “It’s really hard to watch. It’s night and day between this and the [other] clinic.”

Because the doctor can’t reasonably talk the patient through the procedure because of the masks on her face and the loud air pressure system, Sadler says, “there’s no conversation at all. It’s just surgery.” Doctors at Whole Woman’s Health still attempt to stop at the table before performing the surgery to let the patient know that “it’s not some stranger coming in with a mask on her face, taking over,” says Sadler. “Just to remind the patient of who [the doctor] is, and that everything will be OK.”

The recovery room requires patients to lie on cage-like beds, to be hooked up to three-lead monitors, with disturbing beeping and clashing noises, behind a curtain that closes them off from the rest of the room. They are still undressed and not allowed any sort of company. They can’t even drink tea because of ASC requirements mandating such clinics serve only pre-packaged food, so patients are given only Capri Sun and Goldfish, as if they’re children.

Sterile gurneys like these are required to be in an ambulatory surgical center’s recovery room, as opposed to the comfortable recliners and purple blankets of Whole Woman’s Health’s other locations

Sterile gurneys like these are required to be in an ambulatory surgical center’s recovery room, as opposed to the comfortable recliners and purple blankets of Whole Woman’s Health’s other locations.

“A lot of times a woman has put on their strong face, until it’s over, and this is where the emotion happens. There’s no room for emotions in this room,” says Sadler. “Because of the limited staff and lack of escort, there are times when she is left alone, and that’s really hard for us because that’s not who we are.”

In the recovery area, there are still mechanisms like suction machines, oxygen piping, or positive pressure systems that never get used but need to be tested every day. WWH is forced to pay about $5,000 to $7,000 a month for outside companies to test all of its equipment, even though the equipment will never actually be used.

Maintaining extra financial obligations while attempting to maintain WWH’s philosophy of quality care results in professional sacrifices from the staff. Sadler explained, “The money that we were using for staff development and staff wellness, we’re now pushing that in other places. So now we’re having to pick and grab and figure out how to keep up who and what we are, without losing that, but still staying compliant with all of the rest of this ridiculousness. We’ve managed, but I’m telling you we’ve been tired at the end of the day, and it would definitely be great to take a breath.”

The entrance to a men’s locker room at Whole Woman’s Health of San Antonio’s ambulatory surgical center. ASCs require both women’s and men’s locker rooms on site, another requirement of House Bill 2 that is absolutely not needed in abortion care.

The entrance to a men’s locker room at Whole Woman’s Health of San Antonio’s ambulatory surgical center. ASC requirements mandate both women’s and men’s locker rooms on site.

Sadler says that patients often ask why their families can’t accompany them into surgery or recovery or why the clinic has to comply with the ridiculous restrictions that the state requires.

“It didn’t used to be this way. Unfortunately for staff, it’s hard to explain something that makes no sense.”

If the Supreme Court rules in favor of HB 2, the state will force all abortionsboth the surgical procedure and medical abortions (with pills)—to be performed only in a clinic that meets ASC standards. This clearly represents the institutionalization of stigma.

When it comes to Whole Woman’s Health, in the non-ASC clinic, the patient is allowed to take ownership of their own body; they’re allowed to be comforted and allowed to walk away with a comfortable experience. In the ASC clinic, the process is intimidating and terrifying. HB 2 makes the abortion process more about compliance with a law intended to shut down abortion clinics than the care and safety of patients. Texans are hoping that the Supreme Court will agree.

News Abortion

What the ‘Abortion Drone’ Will (And Won’t) Mean for Reproductive Rights (Updated)

Emily Crockett

The Poland "abortion drone" is causing a splash in the media and excited buzz in the reproductive rights community, but it has also become a source of misinformation and anxiety.

UPDATE, June 29, 2:59 p.m.: The first-ever abortion drone flight was a success Saturday, Women on Waves founder Rebecca Gomperts told Rewire. Two women in Poland received and took abortion pills that were delivered to them via drone from Germany. While German police failed to stop the flight, Gomperts said, they threatened criminal charges, and also confiscated the drone controller and some personal iPads belonging to activists. It is “totally unclear on what grounds” criminal charges could be brought, Gomperts said, and official charges could take months. The group’s lawyer is looking into the case.

The first-ever “abortion drone” is scheduled to launch Saturday and deliver abortion pills to women in Poland, getting around that country’s restrictive abortion laws.

The action is causing a splash in the media and excited buzz among reproductive rights advocates, some of whom envision a future in which reactionary state legislatures are no match for nimble robots armed with mifepristone and misoprostol. But the drone has also become a source of misinformation and anxiety, with some media reports garbling the facts and some activists questioning the project’s methods.

The innovative and unusual use of technology has the media’s attention, with Gizmodo raving that “Abortion Drone is the Best Drone” and comparisons being made to Amazon and Google’s proposed drone delivery services. Meanwhile, anti-choice groups in Poland have reportedly vowed to shoot the drone down if they can find it.

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The headline-grabbing campaign is the brainchild of Women on Waves, a Dutch group known for keeping ships in international waters to give safe medication abortions to women living in countries that have outlawed abortion care.

Many media reports have been confused and inaccurate about how the drone’s pill distribution will work, Rebecca Gomperts, founder and director of Women on Waves, told Rewire in an interview.

Some reports have said that the pills will go to women’s groups who will then distribute the pills to women in need, or that the drones will drop packages over the Polish town.

“It’s not going to drop boxes full of abortion pills over Poland,” Gomperts said, laughing. “That’s ridiculous. It’s not how we work.”

Another report said Gomperts refused to say who the pills would go to and how.

But Gomperts set the record straight to Rewire in no uncertain terms: The pills will go directly from the drone to the women who are seeking an early abortion, with no intermediaries, she said. That means the local women’s groups openly participating in the action won’t be putting themselves at risk by illegally distributing the medication.

The women seeking abortion care are involved with those local groups, Gomperts explained, but only the women who are taking the pills will handle them. Women on Waves will confirm the women’s identities both in person and with a camera on the drone.

The drone will be small, less than five kilograms, and it won’t travel far—just a quick jump across a river and an international border, from Frankfurt an der Oder in Germany (where abortion is legal) to the town of Słubice, Poland (where it isn’t), staying within eyesight the whole way to comply with drone regulations.

The drone will carry mifepristone and misoprostol, a combination of drugs approved by the World Health Organization for safe termination of a pregnancy of up to nine weeks. Only two or three women are expected to take the pills—as long as they are still ready and willing to take the drugs on the day of the launch.

“We want to give space to them to decide to do it or not to do it,” Gomperts said.

The drone’s mission, Gomperts said, is twofold: providing a few women access to needed services, and raising awareness about the social injustices of illegal abortion.

That awareness serves both to inform women that they have the power to safely terminate their own pregnancies, Gomperts said, and to put pressure on governments to change their draconian anti-choice policies. Poland prohibits abortion except in very limited circumstances, and even then allows doctors to opt out of performing the procedure.

The drone operation is legal, or at least not technically illegal. The scale is small enough that no authorization is needed from either the German or Polish governments. And since Poland only criminalizes doctors who perform illegal abortions, not women who abort their own pregnancies, the women who will take the pills on the other side of the river shouldn’t be in any legal danger.

Gomperts said the local women’s health activists in Poland, who she has been in contact with since an earlier ship campaign in 2003, jumped at the chance to participate in the drone campaign.

“The Polish groups are very excited, and they are very happy to do this,” Gomperts said.

Some reproductive rights activists in other countries, however, are less enthused about the idea of an abortion drone coming to their borders.

The Global Post reported that Gomperts plans to try the drone program in other countries where abortion is illegal or restricted, such as Ireland, Brazil, and Mexico, if Saturday’s delivery is a success.

Sonia Correa, co-chair of the global research forum Sexuality Policy Watch and a longtime reproductive rights activist in Brazil, told Rewire that she and several other activists in her network were “horrified” at the prospect of abortion drones coming to Brazil.

“It’s just going to be an additional problem to cope with,” Correa said. “We need people to understand the conditions in which we are operating, and whatever type of support they provide needs to be in tandem with an understanding of the context and in negotiation with us. It cannot be parachuted.”

Correa said the electoral victories of conservative political segments in Brazil have become so regressive and sexually repressive that the risk of backlash from such a splashy media event would be too great.

Women are already being prosecuted as smugglers for taking misoprostol, which is illegal in Brazil, Correa said. She envisions police staking out a previously advertised abortion drone site to make arrests, or anti-choice groups capitalizing on the event to demonize feminists as using “weapons of mass destruction,” drones, against unborn children.

“For those of us who have been for so many years struggling for abortion rights within a solid human rights frame, a health rights frame—to see the right to abortion be so intimately associated with an instrument that in the popular imagination is correctly seen as an instrument of war … that imagery is very troubling and negative,” Correa said.

Gomperts clarified to Rewire that Women on Waves doesn’t have plans right now to go to Brazil or the other countries mentioned by the Global Post, and that the organization always consults closely with local groups before taking action. She mentioned those places as potential candidates for future actions, she said, but she recognizes that a country like Brazil with more restrictive policies would require a different approach.

“I really want to focus on what’s going to happen here [in Poland],” Gomperts said. “We don’t know what’s going to happen, so we have to really learn from this moment and then make decisions on where and how and what we can do in the future.”

She added that drones are also increasingly used for humanitarian and commercial purposes, and she urged activists not to restrict their strategies based on fears of backlash.

“The anti-abortion groups will say whatever they want. They will use anything,” Gompert said. “I think it’s more important to stay positive and creative and try to find indeterminate legal spaces where you can actually move ahead and create change … than to be afraid of backlashes.”

Other reproductive rights advocates are cheering the campaign as an innovative action that could help expand access to safe abortion.

“I think it’s a really excellent way of calling attention to the fact that women want access to safe abortion, and they are willing to do whatever it takes to get it,” Alice Mark, senior clinical advisor to the international reproductive rights group Ipas, told Rewire. “This is one possible way of getting the safest medications into their hands.”

Writing for Dame Magazine, reproductive rights journalist Robin Marty fantasizes about a “drone-led abortion revolution” that wouldn’t just work within the increasingly restrictive anti-choice regime in the United States, but instead “break it wide open.”

Gomperts said the United States is unlikely to see a Women on Waves drone, even though she decries the “desperate” and “unbelievable” situation where women in states like Texas are running out of options for safe abortion access. Her organization prefers to focus on countries in which abortion is illegal and women have even fewer options, she said.

Still, she hopes abortion rights groups in the United States might follow her lead someday. She’s excited about the possibilities for the technology, and she hopes it might give a boost of positive energy to activists who are burned out by relentless attacks on women’s human rights.

“It also has something fun about it,” Gomperts said. “Of course you’re not allowed to say ‘fun’ when you’re talking about abortion, but it’s not just negativity and heaviness and suffering. I mean, abortion is also a positive experience for a lot of people.”


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