In Arkansas, Bill Banning Abortion Procedures Is No Fantasy

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Arkansas bans "partial birth" abortion, and pregnant women and their physicians are left to guess which safe surgical abortion techniques HB 1113 bans.

In order to enact the "Partial-Birth Abortion Ban Act" (HB 1113),
a bill banning "something to do with abortion," the Arkansas General Assembly declared an emergency and proclaimed the
passage of the bill immediately necessary for the preservation of the public peace, health, and safety.

On Tuesday, February 10th, 2009, HB 1113 cleared a state House of Representatives committee after a dazzling display of third world potentate tactics from the bill’s sponsors, including the invocation of a "state of emergency" that required the Governor to take action on it or the bill would become law by default.  On February 19, 2009, the state Senate passed HB 1113 by a vote of 30-3 vote. And last Friday, February 20th, Gov. Mike Beebe signed the bill into law.  The bill provides no definition for the procedures it is banning and contains penalties as high as 6 years in jail for physicians performing the unidentified procedure.

Any and all Arkansas politicians who voted for HB 1113 are in dereliction of duty and
should be prosecuted for criminal incompetence. Here are but three
reasons why.

One: The Emergency Which Dare Not Speak Its Name

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There’s
a bit of difference between a scary ghost story told around the
campfire and a medical procedure that’s just been declared a scary
public threat by politicians.  One of these two requires a basis in reality.

To
figure out what exactly Arkansas politicians deem an imminent threat to public
peace, health, and safety you have to divine the medical meaning, if
any, behind the propaganda term "partial-birth abortion" and its
whimsical description found in HB 1113.

Deconstructing
propaganda might be a fun intellectual exercise for politicians but
it’s an incompetent way to set the medical standard of care or decide
if physicians are guilty of a felony and get to spend up to 6 years in
jail.

Unfortunately, Arkansas politicians can’t be bothered to
take their job seriously. So we, together with the pregnant women whose
health will be adversely affected by this bill, their families, and their physicians are left to guess exactly which surgical abortion technique HB 1113 bans.

Briefly, we have three possibilities:

Dilatation and Curettage (D&C): In this procedure, usually performed before 14 weeks estimated gestational age (an early term abortion),
first the cervix is dilated, then the pregnancy is evacuated by mechanically
either by scraping out the contents (sharp curettage), vacuum aspiration (suction
curettage), or both. 

Dilatation and Evacuation (D&E):
Usually performed after 16 weeks gestational age, a D&E involves dilation of the cervix, then mechanical destruction and evacuation of
fetal parts, followed by large-bore vacuum curettage.

Intact D&E or Dilatation and Extraction (D&X):
This
technique is usually indicated after 20 weeks and is similar to a D&E, except, and this is the key difference, an intact
extraction of part of the fetus takes place over the cervix. These procedures  are conducted in the case of either a maternal or fetal indication, including for women with uterine scarring or preeclampsia, or for fetal anomalies such as hydrocephaly.

Q: So, which one of these three distinct techniques is banned under HB 1113? 

A: Who knows?

The legislation itself does not provide definitive guidance.  For example, in its definition of "partial-birth" abortion, the legislation says, "in the case of breech presentation, any part of the fetal trunk past the navel is outside the body of the female." This scenario can happen in an induced abortion, a D&E, or a D&X.  So, a "partial-birth" abortion is, what?

Or its fantasy description of an abortion procedure – "the
physician blindly forcing a sharp instrument into the base of the
unborn child’s skull while he or she is lodged in the birth canal."

To
understand the problems with the above paragraph you need to know that
with termination, as opposed to term labor, you don’t achieve a fully
dilated and effaced (thinned out) cervix.  A partially dilated and
effaced cervix will not accommodate the fetal skull, and this is why
you have to reduce it. A trapped head is a true emergency. The cervix
has large blood vessels and could tear leading to catastrophic bleeding.

Now,
three problems. One, you collapse the skull in order to effect
delivery, not to kill the fetus (or, for that matter, because you like
poking sharp instruments into fetal skulls). The state of the fetus —
intact or dismembered — is not the deciding factor. If it were,
there’d be no need to reduce the skull of a dismembered fetus. Two, the
maneuver is not blind, it’s guided. And
three, you reduce the size of the skull in utero, in order to facilitate passage through the cervix, not in the vaginal canal.

Note
to Arkansas politicians: Just because you are not required to be
responsible or competent when enacting legislation doesn’t mean the
same applies to physicians taking care of patients.

Bottom
line, it’s impossible to tell from reading HB 1113 what exactly it
bans. The most you can say is that it’s something to do with the
medical procedure of abortion.  This level of ignorance and sloppiness
is irresponsible when dealing with medical matters.

Two: The Phantom Emergency

If
you’re going to yell fire in a crowded theater you better make sure
there’s actually a fire. And if you’re going to declare something to do
with a medical procedure an imminent threat to the citizens of your
state you better make sure you have evidence that the threat actually
exists.

State Rep. Dawn Creekmore (D) who sponsored HB 1113 said she is worried that Congress might overturn a 2003 federal law
that also bans something to do with abortion. Fretting over future
fantasy Congressional actions is not evidence that there’s a public
threat.

Neither is a lack of information. According to Martha
Adcock, an attorney for the Family Council, which assisted Creekmore in
writing the bill, "no information is available on whether any of the
4,844 abortions performed in the state in 2007 would have been covered
under the bill."

Note to Arkansas politicians: The proper
response to not having any information on whether a made-up medical
procedure is performed in your state is the exact opposite of declaring
a public peace, health, and safety emergency and enacting a bill
banning the procedure.

And since Ms. Adcock mentioned the 2007 Arkansas abortion data, let’s clarify something.  Her power to awe with propaganda is restricted to Arkansas politicians, and doesn’t extend to anyone who values reality. 

If
we look at the available data, excluding the one case with an unknown estimated gestational age, there were 4,698 surgical abortions in Arkansas in 2007.  Of these, 4,239, roughly ninety percent, were performed between 7 and 14 weeks estimated gestational age and involved a D&C.  Another
459, or about 10 percent, were performed between 15 weeks to 20 weeks estimated gestational age and involved a D&E.

No procedures were performed for 21+ weeks. More importantly, no
D&Xs.

Unlike Ms. Adcock and her Family Council outfit, we
might not have the power to draft legislation, but we are blessed with
the "look at data and interpret" special power. We can observe that federal law already bans the procedure that supposedly puts Arkansas into a state of emergency.  And we realize that if your bill bans a procedure done for an estimated gestational age of 20 weeks or more and your statistics show that there were no abortions done more than 20 weeks, that tells you
that your legislation bans a procedure not done in your state.

Bottom line,
based on their actions, it’s clear that Arkansas politicians don’t take
their jobs, not to mention their constituents, seriously.

Should any of the bill’s sponsors wish to prove otherwise, all they have to do is to:

1) Have Rep. Dawn Creekmore define the banned procedure and explain why
it, unlike its "delicate" alternatives — a D&E (dismemberment), a
torn cervix, the major abdominal surgery of a Cesarean section — is a brutal procedure.

2) Show that any D&Xs were performed in Arkansas in 2007 to begin with. [Hint: D&Xs are illegal under federal law.]

And for extra credit:

3) Justify why, when it comes to pregnant patients, being on the brink of
death is a prerequisite for being permitted access to proper medical
care.

4) Explain why [a] female upon whom a partial-birth abortion is performed is exempt from prosecution but a pregnant Ob/Gyn who performs the abortion is not.

On
that last point. According to HB 1113, all involved with something to
do with the medical procedure of abortion — physicians and lay people
alike — are considered criminals, except for the pregnant women
undergoing the procedure, by virtue of the state of their uterine
lining.

So, when a pregnant Ob/Gyn performs whatever it is
that HB1113 bans, based on the state of her uterine lining that Ob/Gyn
should not be held responsible for her actions. Yet HB 1113 contains no
such exemption. Why not?

Three: The Lying Liars and the Lies They Tell

In
medicine, unlike politics, lies have consequences. As a physician, if
you lie to your patients you are endangering their health and you are
guilty of malpractice, and deservedly so. You should be allowed
nowhere near those who entrust their health to you.

Unfortunately
for the people of Arkansas, as a politician you get to lie to people
unencumbered by a concern for the patients’ health or, for that
matter, by professionalism or the truth.

Here’s what Arkansas
politicians say, on the official legislative record mind you, are the
risks associated with something to do with the medical procedure of
abortion:

SECTION 3. EMERGENCY CLAUSE. It is
found and determined by the General Assembly of the State of Arkansas
that partial-birth abortion poses serious risks to the health of a
female undergoing the procedure; that those risks include, among other
things: an increase in a female’s risk of suffering from cervical
incompetence, a result of cervical dilation making it difficult or
impossible for a female to successfully carry a subsequent pregnancy to
term; an increased risk of uterine rupture, abruption, amniotic fluid
embolus, and trauma to the uterus as a result of converting the child
to a footling breech position and a risk of lacerations and secondary
hemorrhaging due to the physician blindly forcing a sharp instrument
into the base of the unborn child’s skull while he or she is lodged in
the birth canal, an act which could result in severe bleeding, brings
with it the threat of shock, and could ultimately result in maternal
death.


Since the medical literature is silent
on the risks of fantasy procedures, let’s assume for the sake of the
discussion that "partial-birth" abortion refers to D&X (intact
D&E). Here’s the actual information about D&X from the literature, medical experts, and medical professionals under oath:

The
court concluded, for example, that "[e]xperts for both sides labeled .
. . inaccurate" Congress’s finding that intact removal increases the
risk of uterine rupture, abruption, amniotic fluid embolus, and trauma
to the uterus. Similarly, the trial court found that experts for both
sides agreed that intact D&E "does not involve the capricious and
erratic use of instruments," thus undercutting Congress’s finding that
the procedure poses an increased risk of maternal laceration and
bleeding….

Evidence presented at the New York trial
also contradicted Congress’s finding that removing the fetus intact in
a D&E increases a woman’s risk of cervical incompetence, which can
lead to pre-term birth in subsequent pregnancies…


But wait, there’s more.

Not
only does the medical evidence refute politicians’ "finding" that
D&X (D&E with intact removal) presents serious increased risks
to women, it actually points to the safety advantages of the procedure:

The
New York trial record supports the safety advantages of intact D&E
based on three demonstrated facts: (1) D&Es of all variations have
safety advantages over induction abortions, (2) D&Es with intact
removal have safety advantages over D&Es with dismemberment, and
(3) these safety advantages are especially important for women who are
particularly vulnerable to catastrophic complications by virtue of
their already compromised medical states.


Bottom
line: If you’re an Arkansas politician, you should know that coming up
with a fantasy medical risk profile won’t mask the fact that you’re so
incompetent you have to rely on the kindness of strangers to divine the
exact nature of the threat you’re alleging. 

So there you have it, three reasons why the Arkansas politicians who enacted HB 1113 are in dereliction of duty: 1) they don’t know what medical procedure they’re banning, 2) they have no data to back up their claims, and, 3) they try to pass off lies as legitimate medical information.

Don’t
get me wrong, there are a lot more problems with HB 1113 than the ones
I just mentioned. For example, as a patient your confidentiality is not
guaranteed. The bill says it’s irrelevant if you do not consent to the
disclosure of your medical information. It’s the grown-ups (by
definition, everybody but you and your physician) who get to make these
decisions.

My point is that there needs to be a basic
competence requirement for any politician with totalitarian
inclinations who wants to play doctor and ban safe and effective
medical procedures.

Otherwise we keep ending up with
legislation like HB 1113 — where the politicians’ personal belief that
everything to do with the female reproductive system is scary and quite
off-putting, and pregnant patients are enough to declare a state of emergency.

As a
politician you have a duty to your employers, the taxpayers, to conduct
yourself and their business in a professional manner. Even when
legislating matters as trivial as medical care for pregnant patients.

News Politics

Anti-Choice Democrats: ‘Open The Big Tent’ for Us

Christine Grimaldi & Ally Boguhn

“Make room for pro-life Democrats and invite pro-life, progressive independents back to the party to focus on the right to parent and ways to help women in crisis or unplanned pregnancies have more choices than abortion,” the group said in a report unveiled to allies at the event, including Democratic National Convention (DNC) delegates and the press.

Democrats for Life of America gathered Wednesday in Philadelphia during the party’s convention to honor Louisiana Gov. John Bel Edwards (D) for his anti-choice viewpoints, and to strategize ways to incorporate their policies into the party.

The group attributed Democratic losses at the state and federal level to the party’s increasing embrace of pro-choice politics. The best way for Democrats to reclaim seats in state houses, governors’ offices, and the U.S. Congress, they charged, is to “open the big tent” to candidates who oppose legal abortion care.

“Make room for pro-life Democrats and invite pro-life, progressive independents back to the party to focus on the right to parent and ways to help women in crisis or unplanned pregnancies have more choices than abortion,” the group said in a report unveiled to allies at the event, including Democratic National Convention (DNC) delegates and the press.

Democrats for Life of America members repeatedly attempted to distance themselves from Republicans, reiterating their support for policies such as Medicaid expansion and paid maternity leave, which they believe could convince people to carry their pregnancies to term.

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Their strategy, however, could have been lifted directly from conservatives’ anti-choice playbook.

The group relies, in part, on data from Marist, a group associated with anti-choice polling, to suggest that many in the party side with them on abortion rights. Executive Director Kristen Day could not explain to Rewire why the group supports a 20-week abortion ban, while Janet Robert, president of the group’s board of directors, trotted out scientifically false claims about fetal pain

Day told Rewire that she is working with pro-choice Democrats, including Sen. Kirsten Gillibrand and Rep. Rosa DeLauro, both from New York, on paid maternity leave. Day said she met with DeLauro the day before the group’s event.

Day identifies with Democrats despite a platform that for the first time embraces the repeal of restrictions for federal funding of abortion care. 

“Those are my people,” she said.

Day claimed to have been “kicked out of the pro-life movement” for supporting the Affordable Care Act. She said Democrats for Life of America is “not opposed to contraception,” though the group filed an amicus brief in U.S. Supreme Court cases on contraception. 

Democrats for Life of America says it has important allies in the U.S. House of Representatives and the U.S. Senate. Sens. Joe Donnelly (IN), Joe Manchin (WV), and Rep. Dan Lipinski (IL), along with former Rep. Bart Stupak (MI), serve on the group’s board of advisors, according to literature distributed at the convention.

Another alleged ally, Sen. Bob Casey (D-PA), came up during Edwards’ speech. Edwards said he had discussed the award, named for Casey’s father, former Pennsylvania Gov. Robert P. Casey, the defendant in the landmark Supreme Court decision, Planned Parenthood v. Casey, which opened up a flood of state-level abortions restrictions as long as those anti-choice policies did not represent an “undue burden.”

“Last night I happened to have the opportunity to speak to Sen. Bob Casey, and I told him … I was in Philadelphia, receiving this award today named after his father,” Edwards said.

The Louisiana governor added that though it may not seem it, there are many more anti-choice Democrats like the two of them who aren’t comfortable coming forward about their views.

“I’m telling you there are many more people out there like us than you might imagine,” Edwards said. “But sometimes it’s easier for those folks who feel like we do on these issues to remain silent because they’re not going to  be questioned, and they’re not going to be receiving any criticism.”

During his speech, Edwards touted the way he has put his views as an anti-choice Democrat into practice in his home state. “I am a proud Democrat, and I am also very proudly pro-life,” Edwards told the small gathering.

Citing his support for Medicaid expansion in Louisiana—which went into effect July 1—Edwards claimed he had run on an otherwise “progressive” platform except for when it came to abortion rights, adding that his policies demonstrate that “there is a difference between being anti-abortion and being pro-life.”

Edwards later made clear that he was disappointed with news that Emily’s List President Stephanie Schriock, whose organization works to elect pro-choice women to office, was being considered to fill the position of party chair in light of Rep. Debbie Wasserman Schultz’s resignation.

“It wouldn’t” help elect anti-choice politicians to office, said Edwards when asked about it by a reporter. “I don’t want to be overly critical, I don’t know the person, I just know that the signal that would send to the country—and to Democrats such as myself—would just be another step in the opposite direction of being a big tent party [on abortion].” 

Edwards made no secret of his anti-choice viewpoints during his run for governor in 2015. While on the campaign trail, he released a 30-second ad highlighting his wife’s decision not to terminate her pregnancy after a doctor told the couple their daughter would have spina bifida.

He received a 100 percent rating from anti-choice organization Louisiana Right to Life while running for governor, based off a scorecard asking him questions such as, “Do you support the reversal of Roe v. Wade?”

Though the Democratic Party platform and nominee have voiced the party’s support for abortion rights, Edwards has forged ahead with signing numerous pieces of anti-choice legislation into law, including a ban on the commonly used dilation and evacuation (D and E) procedure, and an extension of the state’s abortion care waiting period from 24 hours to 72 hours.

Analysis Economic Justice

New Pennsylvania Bill Is Just One Step Toward Helping Survivors of Economic Abuse

Annamarya Scaccia

The legislation would allow victims of domestic violence, sexual assault, and stalking to terminate their lease early or request locks be changed if they have "a reasonable fear" that they will continue to be harmed while living in their unit.

Domestic violence survivors often face a number of barriers that prevent them from leaving abusive situations. But a new bill awaiting action in the Pennsylvania legislature would let survivors in the state break their rental lease without financial repercussions—potentially allowing them to avoid penalties to their credit and rental history that could make getting back on their feet more challenging. Still, the bill is just one of several policy improvements necessary to help survivors escape abusive situations.

Right now in Pennsylvania, landlords can take action against survivors who break their lease as a means of escape. That could mean a lien against the survivor or an eviction on their credit report. The legislation, HB 1051, introduced by Rep. Madeleine Dean (D-Montgomery County), would allow victims of domestic violence, sexual assault, and stalking to terminate their lease early or request locks be changed if they have “a reasonable fear” that they will continue to be harmed while living in their unit. The bipartisan bill, which would amend the state’s Landlord and Tenant Act, requires survivors to give at least 30 days’ notice of their intent to be released from the lease.

Research shows survivors often return to or delay leaving abusive relationships because they either can’t afford to live independently or have little to no access to financial resources. In fact, a significant portion of homeless women have cited domestic violence as the leading cause of homelessness.

“As a society, we get mad at survivors when they don’t leave,” Kim Pentico, economic justice program director of the National Network to End Domestic Violence (NNEDV), told Rewire. “You know what, her name’s on this lease … That’s going to impact her ability to get and stay safe elsewhere.”

“This is one less thing that’s going to follow her in a negative way,” she added.

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Pennsylvania landlords have raised concerns about the law over liability and rights of other tenants, said Ellen Kramer, deputy director of program services at the Pennsylvania Coalition Against Domestic Violence, which submitted a letter in support of the bill to the state House of Representatives. Lawmakers have considered amendments to the bill—like requiring “proof of abuse” from the courts or a victim’s advocate—that would heed landlord demands while still attempting to protect survivors.

But when you ask a survivor to go to the police or hospital to obtain proof of abuse, “it may put her in a more dangerous position,” Kramer told Rewire, noting that concessions that benefit landlords shift the bill from being victim-centered.

“It’s a delicate balancing act,” she said.

The Urban Affairs Committee voted HB 1051 out of committee on May 17. The legislation was laid on the table on June 23, but has yet to come up for a floor vote. Whether the bill will move forward is uncertain, but proponents say that they have support at the highest levels of government in Pennsylvania.

“We have a strong advocate in Governor Wolf,” Kramer told Rewire.

Financial Abuse in Its Many Forms

Economic violence is a significant characteristic of domestic violence, advocates say. An abuser will often control finances in the home, forcing their victim to hand over their paycheck and not allow them access to bank accounts, credit cards, and other pecuniary resources. Many abusers will also forbid their partner from going to school or having a job. If the victim does work or is a student, the abuser may then harass them on campus or at their place of employment until they withdraw or quit—if they’re not fired.

Abusers may also rack up debt, ruin their partner’s credit score, and cancel lines of credit and insurance policies in order to exact power and control over their victim. Most offenders will also take money or property away from their partner without permission.

“Financial abuse is so multifaceted,” Pentico told Rewire.

Pentico relayed the story of one survivor whose abuser smashed her cell phone because it would put her in financial dire straits. As Pentico told it, the abuser stole her mobile phone, which was under a two-year contract, and broke it knowing that the victim could not afford a new handset. The survivor was then left with a choice of paying for a bill on a phone she could no longer use or not paying the bill at all and being turned into collections, which would jeopardize her ability to rent her own apartment or switch to a new carrier. “Things she can’t do because he smashed her smartphone,” Pentico said.

“Now the general public [could] see that as, ‘It’s a phone, get over it,'” she told Rewire. “Smashing that phone in a two-year contract has such ripple effects on her financial world and on her ability to get and stay safe.”

In fact, members of the public who have not experienced domestic abuse may overlook financial abuse or minimize it. A 2009 national poll from the Allstate Foundation—the philanthropic arm of the Illinois-based insurance company—revealed that nearly 70 percent of Americans do not associate financial abuse with domestic violence, even though it’s an all-too-common tactic among abusers: Economic violence happens in 98 percent of abusive relationships, according to the NNEDV.

Why people fail to make this connection can be attributed, in part, to the lack of legal remedy for financial abuse, said Carol Tracy, executive director of the Women’s Law Project, a public interest law center in Pennsylvania. A survivor can press criminal charges or seek a civil protection order when there’s physical abuse, but the country’s legal justice system has no equivalent for economic or emotional violence, whether the victim is married to their abuser or not, she said.

Some advocates, in lieu of recourse through the courts, have teamed up with foundations to give survivors individual tools to use in economically abusive situations. In 2005, the NNEDV partnered with the Allstate Foundation to develop a curriculum that would teach survivors about financial abuse and financial safety. Through the program, survivors are taught about financial safety planning including individual development accounts, IRA, microlending credit repair, and credit building services.

State coalitions can receive grant funding to develop or improve economic justice programs for survivors, as well as conduct economic empowerment and curriculum trainings with local domestic violence groups. In 2013—the most recent year for which data is available—the foundation awarded $1 million to state domestic violence coalitions in grants that ranged from $50,000 to $100,000 to help support their economic justice work.

So far, according to Pentico, the curriculum has performed “really great” among domestic violence coalitions and its clients. Survivors say they are better informed about economic justice and feel more empowered about their own skills and abilities, which has allowed them to make sounder financial decisions.

This, in turn, has allowed them to escape abuse and stay safe, she said.

“We for a long time chose to see money and finances as sort of this frivolous piece of the safety puzzle,” Pentico told Rewire. “It really is, for many, the piece of the puzzle.”

Public Policy as a Means of Economic Justice

Still, advocates say that public policy, particularly disparate workplace conditions, plays an enormous role in furthering financial abuse. The populations who are more likely to be victims of domestic violence—women, especially trans women and those of color—are also the groups more likely to be underemployed or unemployed. A 2015 LGBT Health & Human Services Network survey, for example, found that 28 percent of working-age transgender women were unemployed and out of school.

“That’s where [economic abuse] gets complicated,” Tracy told Rewire. “Some of it is the fault of the abuser, and some of it is the public policy failures that just don’t value women’s participation in the workforce.”

Victims working low-wage jobs often cannot save enough to leave an abusive situation, advocates say. What they do make goes toward paying bills, basic living needs, and their share of housing expenses—plus child-care costs if they have kids. In the end, they’re not left with much to live on—that is, if their abuser hasn’t taken away access to their own earnings.

“The ability to plan your future, the ability to get away from [abuse], that takes financial resources,” Tracy told Rewire. “It’s just so much harder when you don’t have them and when you’re frightened, and you’re frightened for yourself and your kids.”

Public labor policy can also inhibit a survivor’s ability to escape. This year, five states, Washington, D.C., and 24 jurisdictions will have passed or enacted paid sick leave legislation, according to A Better Balance, a family and work legal center in New York City. As of April, only one of those states—California—also passed a state paid family leave insurance law, which guarantees employees receive pay while on leave due to pregnancy, disability, or serious health issues. (New Jersey, Rhode Island, Washington, and New York have passed similar laws.) Without access to paid leave, Tracy said, survivors often cannot “exercise one’s rights” to file a civil protection order, attend court hearings, or access housing services or any other resource needed to escape violence.

Furthermore, only a handful of state laws protect workers from discrimination based on sex, sexual orientation, gender identity, and pregnancy or familial status (North Carolina, on the other hand, recently passed a draconian state law that permits wide-sweeping bias in public and the workplace). There is no specific federal law that protects LGBTQ workers, but the U.S. Employment Opportunity Commission has clarified that the Civil Rights Act of 1964 does prohibit discrimination based on gender identity and sexual orientation.

Still, that doesn’t necessarily translate into practice. For example, the National Center for Transgender Equality found that 26 percent of transgender people were let go or fired because of anti-trans bias, while 50 percent of transgender workers reported on-the-job harassment. Research shows transgender people are at a higher risk of being fired because of their trans identity, which would make it harder for them to leave an abusive relationship.

“When issues like that intersect with domestic violence, it’s devastating,” Tracy told Rewire. “Frequently it makes it harder, if not impossible, for [victims] to leave battering situations.”

For many survivors, their freedom from abuse also depends on access to public benefits. Programs like Temporary Assistance for Needy Families (TANF), Supplemental Nutrition Assistance Program (SNAP), the child and dependent care credit, and earned income tax credit give low-income survivors access to the money and resources needed to be on stable economic ground. One example: According to the Center on Budget and Policy Priorities, where a family of three has one full-time nonsalary worker earning $10 an hour, SNAP can increase their take-home income by up to 20 percent.

These programs are “hugely important” in helping lift survivors and their families out of poverty and offset the financial inequality they face, Pentico said.

“When we can put cash in their pocket, then they may have the ability to then put a deposit someplace or to buy a bus ticket to get to family,” she told Rewire.

But these programs are under constant attack by conservative lawmakers. In March, the House Republicans approved a 2017 budget plan that would all but gut SNAP by more than $150 million over the next ten years. (Steep cuts already imposed on the food assistance program have led to as many as one million unemployed adults losing their benefits over the course of this year.) The House GOP budget would also strip nearly $500 billion from other social safety net programs including TANF, child-care assistance, and the earned income tax credit.

By slashing spending and imposing severe restrictions on public benefits, politicians are guaranteeing domestic violence survivors will remain stuck in a cycle of poverty, advocates say. They will stay tethered to their abuser because they will be unable to have enough money to live independently.

“When women leave in the middle of the night with the clothes on their back, kids tucked under their arms, come into shelter, and have no access to finances or resources, I can almost guarantee you she’s going to return,” Pentico told Rewire. “She has to return because she can’t afford not to.”

By contrast, advocates say that improving a survivor’s economic security largely depends on a state’s willingness to remedy what they see as public policy failures. Raising the minimum wage, mandating equal pay, enacting paid leave laws, and prohibiting employment discrimination—laws that benefit the entire working class—will make it much less likely that a survivor will have to choose between homelessness and abuse.

States can also pass proactive policies like the bill proposed in Pennsylvania, to make it easier for survivors to leave abusive situations in the first place. Last year, California enacted a law that similarly allows abuse survivors to terminate their lease without getting a restraining order or filing a police report permanent. Virginia also put in place an early lease-termination law for domestic violence survivors in 2013.

A “more equitable distribution of wealth is what we need, what we’re talking about,” Tracy told Rewire.

As Pentico put it, “When we can give [a survivor] access to finances that help her get and stay safe for longer, her ability to protect herself and her children significantly increases.”