Refusing to Provide Contraception to Women: Whose ‘Right’ Is it Anyway?

Amie Newman

The American College of Nurse-Midwives blog, Midwife Connection, poses the question, "Should a pharmacist be able to refuse to fill a prescription?" in response to "pharmacy refusal" policies currently making their way through Washington state courts.

The excellent blog, Midwife Connection, of the American College for Nurse Midwives (ACNM) published a thoughtful post the other day, “Should a pharmacist be able to refuse to fill a prescription?” on “pharmacist refusal” (ie, pharmacists refusing to fill prescriptions for emergency contraception because of a personal belief that contraception = murder). It was written by a certified nurse midwife in my home state of Washington. Midwives, of course, have a stake in this issue as CNMs can provide counseling about, information on, and prescriptions for contraception; a significantly important part of postpartum discussions with the women they serve. 

The post discusses a Washington state multi-year effort to ensure that pharmacists and pharmacies cannot discriminate against women who need a prescription for emergency contraception (EC) filled from their pharmacists. According to Midwife Connection:

Here in WA State, a prescription refusal issue is working its way
through the legal system. Many people are calling it “Refuse and Refer”
claiming that it is appropriate for a pharmacy or a pharmacist to
refuse to fill prescriptions to which they object on religious or moral
grounds, and refer clients elsewhere. A few claim they should be able
to refuse with no responsibility to refer at all.

In late October of this year, the Ninth Circuit Court of Appeals ruled in favor of "patients rights" in a case that,  according to Legal Voice, a legal advocacy organization in Seattle working on this issue, "involves a challenge brought by two pharmacists and a pharmacy to Washington State Board of Pharmacy rules requiring all licensed pharmacies to fill patients’ prescriptions, regardless of an individual pharmacist’s personal beliefs about a particular medication."

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In other words, the Ninth Circuit reaffirmed an earlier decision that rules created by the Washington state Pharmacy Board "do not aim to suppress, target, or single out in any way the practice of religion, but, rather, their objective was to increase access to all lawfully prescribed medications."

Legal Voice Executive Director Lisa Stone, at the time, said, "This decision helps clear the way for the state to enforce its rules, ensuring that all pharmacies comply with the requirement that all patients get their medication needs met in a timely manner, without delay, and without harassment."

And hopefully that’s true.

But not everyone feels that way, of course. 

Someone posted a comment on Midwife Connection soon after the post was published:

But to the pharmacists in question, it is forcing them to participate in the murder of another human. Which should not be forced on anybody.


I responded to clarify that, in fact, Emergency Contraception (EC or, its brand name, Plan B) is not an abortifacient but a method of birth control. If one believes abortion is murder, that’s a separate issue (which I, of course, vehemently disagree with). This is about denying a woman her right to fill a prescription for a legal, FDA approved medication because you personally don’t “believe” in it.

I responded to the commenter:

 

I think you are mistakenly referring to RU-486 or the medication used for a medication abortion. The post above is about Plan B or emergency contraception. It is not the medication used for an abortion but, rather, it is a contraceptive method. You cannot get any sort of medication, from a pharmacist, that causes an abortion. This discussion is about whether or not pharmacists have the right to opt out of providing legal, safe, FDA approved birth control to the women of their community. There is no major, mainstream medical organization in this country that considers the results of using emergency contraception “the murder of another human.”

Do pharmacists, ultimately, have the right to discriminate against women by refusing to provide EC? Personally, I would say that if a pharmacist has an issue with the provision of birth control to women, they should probably find another line of work as 98% of American women use birth control at some point in their lives – 98%! That means that women who consider themselves pro-life, pro-choice, religious or not – we’re all using it. To deny services to women is unethical and, I believe, discriminatory.


The commenter then responded to me:

Actually, you can get Cytotec from a pharmacy, which does cause abortions.

But,
it depends on how you define the various terms. In the mid-60s,
obstetricians successfully redefined pregnancy as starting not with
conception (which was the time it historically was considered to have
started), but after the fertilized egg implanted, which meant that
anything that interferes with implantation is technically not
abortifacient — even though it stops a new developing human from being
able to live and develop further. But if life begins at conception,
then preventing that new life from implanting in the uterus, the sole
way this new life can continue to live, then, yes, it is interfering
with that, and causing the death of the genetically unique human.

I
agree that there is a double-standard in a pharmacy dispensing and
stocking standard birth control pills but not plan B, because BCPs can
also interfere with implantation. It’s not the primary method of
pregnancy prevention (supposedly), but it is one of the secondary or
tertiary methods — and the same with Plan B.
The only difference might be the percentage of the time that BCPs
prevent implantation as opposed to that of Plan B. For instance, if
Plan B worked to delay or prevent ovulation 10% of the time and prevent
implantation 90% of the time, that might make a difference in people’s
minds, as opposed to BCPs preventing ovulation 90% of the time and only
preventing implantation 10% of the time. [Hypothetical numbers.]

What
if euthanasia or "assisted suicide" were legal — would you suggest
that doctors be required to assist in ending the person’s life, though
s/he were morally or ethically opposed to it? After all, it’s a medical
condition — they are there to do what the patient wants, not play God.
What if any doctor in the state could be required to come and execute a
criminal by lethal injection, although s/he was opposed to the death
penalty, or thought the person to be convicted was not guilty? After
all, it’s a legal decision; what does ethics, morality or religion have
to do with it? What if a doctor felt that abortion was murder, but a
woman wanted to abort her 20-week fetus after finding out that the baby
was a girl, and not the boy she wanted? That’s a medical decision —
who cares if it’s discriminatory against infant women — they’re there
to perform a medical function for a paying customer — that’s all. It’s
a business — no room for morals or ethics in business, eh? Especially
in the business of medicine? (Which leaves me wondering why you find
ethicists in hospitals, helping to make decisions in hospital policy.)
Frankly, I think we need a heapin’ helpin’ of ethics particularly in
medicine!

I’ve met numerous people who never knew that chemical
birth control (not just pills, but all forms) could allow ovulation but
prevent implantation; many were upset that they were never told of that
possibility. Most stopped taking it after finding it out, because they
could not in good conscience use it. So, just because 98% of women use
it, it doesn’t mean that they were fully informed of the consequences
of it — especially if doctors and pharmacists don’t know (because of
the above definition of pregnancy and abortifacients).

To require people to assist in what they consider to be murder is unethical and most certainly discriminatory.

While I wanted to post the following comment on the ACNM blog, it was ridiculously long and have decided to post here instead. What follows is my response to the above commenter:

To your point about Cytotec: First off, while Cytotec (misoprostol) is used in medication abortion, it is not FDA approved for a physician to prescribe it as an abortifacient on its own. An abortion is a medical procedure that can only be offered by a qualifed medical provider. Cytotec is approved for ulcers, via a pharmacist. It is true that some women in this country are using it to induce an abortion, by themselves. But they are getting it from other women or the black market

If birth control results in the murder of a human being (which you have every right to believe, of course, and don’t need my permission for that!), and most women don’t know that, why aren’t anti-choice organizations and anti-choice politicians focusing on outlawing birth control as much as they are focused on criminalizing abortion? I would think that birth control would be considered a murder weapon. I assume, then, that women who do knowingly, with informed consent, use birth control or emergency contraception would be prosecuted under this scenario? 

I am not refuting your right to believe that contraception kills but the truth is I (and, again, all major mainstream medical organizations, most physicians, and most women who take birth control) do not agree with this assessment.

In addition, the World Health Organization and many of the world’s governments have agreed, via the Millennium Development Goals, that contraception is critical to saving women’s lives, raising the status of girls around the world, improving newborn health, improving the health and well-being of entire nations, actually!

I do agree, absolutely, that all women deserve to be fully informed about what birth control does and exactly how it works, so that they may make the best decisions for themselves, their lives, and their families.  I have worked in women’s health for over ten years now and I have not once heard anyone, except those who consider themselves religious fundamentalists, refute how important contraception is for women’s health, autonomy and equality – from the World Health Organization to UNFPA to the International Federation of Gynecology and Obstetrics, American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the American Public Health Association. Even ACNM supports expanding access to EC. Are all of these experts wrong? Misguided? Misinformed?

As for morals and ethics in businesses, no one is saying one shouldn’t have morals and ethics. But what about the morals and ethics of the woman? A pharmacist has every right to abide by his or her own belief system, as long as a woman has a legal right to access the birth control she’s been prescribed by her doctor or that she requests on her own. And, yes, a legal right supersedes ones’ personal belief system, often, in this society. We do not allow those who may hold a personal/moral belief system, however repugnant, that African-Americans are inferior to Caucasians, to discriminate. We legislate discrimination against those who are differently abled and against those of a certain age. Why would we allow pharmacists to discriminate based on a personal belief system? For a pharmacy to refuse to fill a prescription to all women because a pharmacist on duty doesn’t "believe in it" is discrimination. If birth control is outlawed, then we can have this discussion again. We’re talking about safe, FDA approved, physician prescribed contraception, however.

What about women and adolescents who take contraception for other reasons? To regulate ones’ cycle, for example? Is that morally offensive to some pharmacists? Do women need to stand up at the counter and justify their reasons for needing a certain medication so that it jibes with the pharmacists belief system?

Do you, then, also agree that it is okay for a pharmacist who is homophobic or whose religious beliefs compel her/him to believe that homosexuality is wrong, to refuse to fill physician prescribed medication to a gay person? How about a pharmacist who hates Jews? Can they refuse to prescribe medication to Jewish people because they believe it is immoral to live as anything but a Christian? Is it based on the action one would take with the medication? What about Viagra, then? What if your religious or personal belief system is such that you believe sex outside of marriage is immoral? Do you then get to refuse to prescribe Viagra to a man unless you know he would be using it with his wife?

If a pharmacist believes that legal birth control is immoral and cannot perform part of his or her duties because of this belief system, the pharmacy should then either always have another pharmacist on duty who believes otherwise or the pharmacist in question should open his or her own business, and state clearly that they refuse to service the women of their community who need or want birth control. The community may still protest and try and shut them down because that’s our right in a democracy. But at least the pharmacist can try and peddle his/her morality with a certain amount of freedom.

One has the right, in a free society, to wholeheartedly believe with faith, that birth control is a murder weapon, preaching their belief system in order to convince others of their stance. But, again, in a democratic society, others with different religious, moral and ethical belief systems have the right to believe that birth control and family planning are ethical, loving, moral tools whose usage is supported by solid evidence via organizations like the World Health Organization, our best scientific and medical minds, and, well women themselves.

Finally, as I mentioned above, I am committed to making sure all women know exactly how birth control works. I have made it my life’s mission to ensure that women have the access to information and tools, around the world, to live as healthily and happily as possible. I challenge all of us to commit to this ideal.

If women themselves decide that contraception is murder,  and have as many babies as they will, over the course of a lifetime, because it’s their choice, then I support that. But we see that when women are given options, choice and information – full information – about birth control, women chose control, autonomy, safety and equality. 

Pharmacies, as private businesses, should not allow the pharmacists they employ to engage in discriminatory behavior because of a personal belief system. If a pharmacist belives that certain drugs are murderous, he or she should likely become a full time agent of change, rather than a pharmacist whose job it is to fill prescriptions for legal medication.

Analysis Politics

The 2016 Republican Platform Is Riddled With Conservative Abortion Myths

Ally Boguhn

Anti-choice activists and leaders have embraced the Republican platform, which relies on a series of falsehoods about reproductive health care.

Republicans voted to ratify their 2016 platform this week, codifying what many deem one of the most extreme platforms ever accepted by the party.

“Platforms are traditionally written by and for the party faithful and largely ignored by everyone else,” wrote the New York Times‘ editorial board Monday. “But this year, the Republicans are putting out an agenda that demands notice.”

“It is as though, rather than trying to reconcile Mr. Trump’s heretical views with conservative orthodoxy, the writers of the platform simply opted to go with the most extreme version of every position,” it continued. “Tailored to Mr. Trump’s impulsive bluster, this document lays bare just how much the G.O.P. is driven by a regressive, extremist inner core.”

Tucked away in the 66-page document accepted by Republicans as their official guide to “the Party’s principles and policies” are countless resolutions that seem to back up the Times‘ assertion that the platform is “the most extreme” ever put forth by the party, including: rolling back marriage equalitydeclaring pornography a “public health crisis”; and codifying the Hyde Amendment to permanently block federal funding for abortion.

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Anti-choice activists and leaders have embraced the platform, which the Susan B. Anthony List deemed the “Most Pro-life Platform Ever” in a press release upon the GOP’s Monday vote at the convention. “The Republican platform has always been strong when it comes to protecting unborn children, their mothers, and the conscience rights of pro-life Americans,” said the organization’s president, Marjorie Dannenfelser, in a statement. “The platform ratified today takes that stand from good to great.”  

Operation Rescue, an organization known for its radical tactics and links to violence, similarly declared the platform a “victory,” noting its inclusion of so-called personhood language, which could ban abortion and many forms of contraception. “We are celebrating today on the streets of Cleveland. We got everything we have asked for in the party platform,” said Troy Newman, president of Operation Rescue, in a statement posted to the group’s website.

But what stands out most in the Republicans’ document is the series of falsehoods and myths relied upon to push their conservative agenda. Here are just a few of the most egregious pieces of misinformation about abortion to be found within the pages of the 2016 platform:

Myth #1: Planned Parenthood Profits From Fetal Tissue Donations

Featured in multiple sections of the Republican platform is the tired and repeatedly debunked claim that Planned Parenthood profits from fetal tissue donations. In the subsection on “protecting human life,” the platform says:

We oppose the use of public funds to perform or promote abortion or to fund organizations, like Planned Parenthood, so long as they provide or refer for elective abortions or sell fetal body parts rather than provide healthcare. We urge all states and Congress to make it a crime to acquire, transfer, or sell fetal tissues from elective abortions for research, and we call on Congress to enact a ban on any sale of fetal body parts. In the meantime, we call on Congress to ban the practice of misleading women on so-called fetal harvesting consent forms, a fact revealed by a 2015 investigation. We will not fund or subsidize healthcare that includes abortion coverage.

Later in the document, under a section titled “Preserving Medicare and Medicaid,” the platform again asserts that abortion providers are selling “the body parts of aborted children”—presumably again referring to the controversy surrounding Planned Parenthood:

We respect the states’ authority and flexibility to exclude abortion providers from federal programs such as Medicaid and other healthcare and family planning programs so long as they continue to perform or refer for elective abortions or sell the body parts of aborted children.

The platform appears to reference the widely discredited videos produced by anti-choice organization Center for Medical Progress (CMP) as part of its smear campaign against Planned Parenthood. The videos were deceptively edited, as Rewire has extensively reported. CMP’s leader David Daleiden is currently under federal indictment for tampering with government documents in connection with obtaining the footage. Republicans have nonetheless steadfastly clung to the group’s claims in an effort to block access to reproductive health care.

Since CMP began releasing its videos last year, 13 state and three congressional inquiries into allegations based on the videos have turned up no evidence of wrongdoing on behalf of Planned Parenthood.

Dawn Laguens, executive vice president of Planned Parenthood Action Fund—which has endorsed Hillary Clinton—called the Republicans’ inclusion of CMP’s allegation in their platform “despicable” in a statement to the Huffington Post. “This isn’t just an attack on Planned Parenthood health centers,” said Laguens. “It’s an attack on the millions of patients who rely on Planned Parenthood each year for basic health care. It’s an attack on the brave doctors and nurses who have been facing down violent rhetoric and threats just to provide people with cancer screenings, birth control, and well-woman exams.”

Myth #2: The Supreme Court Struck Down “Commonsense” Laws About “Basic Health and Safety” in Whole Woman’s Health v. Hellerstedt

In the section focusing on the party’s opposition to abortion, the GOP’s platform also reaffirms their commitment to targeted regulation of abortion providers (TRAP) laws. According to the platform:

We salute the many states that now protect women and girls through laws requiring informed consent, parental consent, waiting periods, and clinic regulation. We condemn the Supreme Court’s activist decision in Whole Woman’s Health v. Hellerstedt striking down commonsense Texas laws providing for basic health and safety standards in abortion clinics.

The idea that TRAP laws, such as those struck down by the recent Supreme Court decision in Whole Woman’s Health, are solely for protecting women and keeping them safe is just as common among conservatives as it is false. However, as Rewire explained when Paul Ryan agreed with a nearly identical claim last week about Texas’ clinic regulations, “the provisions of the law in question were not about keeping anybody safe”:

As Justice Stephen Breyer noted in the opinion declaring them unconstitutional, “When directly asked at oral argument whether Texas knew of a single instance in which the new requirement would have helped even one woman obtain better treatment, Texas admitted that there was no evidence in the record of such a case.”

All the provisions actually did, according to Breyer on behalf of the Court majority, was put “a substantial obstacle in the path of women seeking a previability abortion,” and “constitute an undue burden on abortion access.”

Myth #3: 20-Week Abortion Bans Are Justified By “Current Medical Research” Suggesting That Is When a Fetus Can Feel Pain

The platform went on to point to Republicans’ Pain-Capable Unborn Child Protection Act, a piece of anti-choice legislation already passed in several states that, if approved in Congress, would create a federal ban on abortion after 20 weeks based on junk science claiming fetuses can feel pain at that point in pregnancy:

Over a dozen states have passed Pain-Capable Unborn Child Protection Acts prohibiting abortion after twenty weeks, the point at which current medical research shows that unborn babies can feel excruciating pain during abortions, and we call on Congress to enact the federal version.

Major medical groups and experts, however, agree that a fetus has not developed to the point where it can feel pain until the third trimester. According to a 2013 letter from the American Congress of Obstetricians and Gynecologists, “A rigorous 2005 scientific review of evidence published in the Journal of the American Medical Association (JAMA) concluded that fetal perception of pain is unlikely before the third trimester,” which begins around the 28th week of pregnancy. A 2010 review of the scientific evidence on the issue conducted by the British Royal College of Obstetricians and Gynaecologists similarly found “that the fetus cannot experience pain in any sense prior” to 24 weeks’ gestation.

Doctors who testify otherwise often have a history of anti-choice activism. For example, a letter read aloud during a debate over West Virginia’s ultimately failed 20-week abortion ban was drafted by Dr. Byron Calhoun, who was caught lying about the number of abortion-related complications he saw in Charleston.

Myth #4: Abortion “Endangers the Health and Well-being of Women”

In an apparent effort to criticize the Affordable Care Act for promoting “the notion of abortion as healthcare,” the platform baselessly claimed that abortion “endangers the health and well-being” of those who receive care:

Through Obamacare, the current Administration has promoted the notion of abortion as healthcare. We, however, affirm the dignity of women by protecting the sanctity of human life. Numerous studies have shown that abortion endangers the health and well-being of women, and we stand firmly against it.

Scientific evidence overwhelmingly supports the conclusion that abortion is safe. Research shows that a first-trimester abortion carries less than 0.05 percent risk of major complications, according to the Guttmacher Institute, and “pose[s] virtually no long-term risk of problems such as infertility, ectopic pregnancy, spontaneous abortion (miscarriage) or birth defect, and little or no risk of preterm or low-birth-weight deliveries.”

There is similarly no evidence to back up the GOP’s claim that abortion endangers the well-being of women. A 2008 study from the American Psychological Association’s Task Force on Mental Health and Abortion, an expansive analysis on current research regarding the issue, found that while those who have an abortion may experience a variety of feelings, “no evidence sufficient to support the claim that an observed association between abortion history and mental health was caused by the abortion per se, as opposed to other factors.”

As is the case for many of the anti-abortion myths perpetuated within the platform, many of the so-called experts who claim there is a link between abortion and mental illness are discredited anti-choice activists.

Myth #5: Mifepristone, a Drug Used for Medical Abortions, Is “Dangerous”

Both anti-choice activists and conservative Republicans have been vocal opponents of the Food and Drug Administration (FDA’s) March update to the regulations for mifepristone, a drug also known as Mifeprex and RU-486 that is used in medication abortions. However, in this year’s platform, the GOP goes a step further to claim that both the drug and its general approval by the FDA are “dangerous”:

We believe the FDA’s approval of Mifeprex, a dangerous abortifacient formerly known as RU-486, threatens women’s health, as does the agency’s endorsement of over-the-counter sales of powerful contraceptives without a physician’s recommendation. We support cutting federal and state funding for entities that endanger women’s health by performing abortions in a manner inconsistent with federal or state law.

Studies, however, have overwhelmingly found mifepristone to be safe. In fact, the Association of Reproductive Health Professionals says mifepristone “is safer than acetaminophen,” aspirin, and Viagra. When the FDA conducted a 2011 post-market study of those who have used the drug since it was approved by the agency, they found that more than 1.5 million women in the U.S. had used it to end a pregnancy, only 2,200 of whom had experienced an “adverse event” after.

The platform also appears to reference the FDA’s approval of making emergency contraception such as Plan B available over the counter, claiming that it too is a threat to women’s health. However, studies show that emergency contraception is safe and effective at preventing pregnancy. According to the World Health Organization, side effects are “uncommon and generally mild.”

Analysis Abortion

‘Pro-Life’ Pence Transfers Money Intended for Vulnerable Households to Anti-Choice Crisis Pregnancy Centers

Jenn Stanley

Donald Trump's running mate has said that "life is winning in Indiana"—and the biggest winner is probably a chain of crisis pregnancy centers that landed a $3.5 million contract in funds originally intended for poor Hoosiers.

Much has been made of Republican Gov. Mike Pence’s record on LGBTQ issues. In 2000, when he was running for U.S. representative, Pence wrote that “Congress should oppose any effort to recognize homosexual’s [sic] as a ‘discreet and insular minority’ [sic] entitled to the protection of anti-discrimination laws similar to those extended to women and ethnic minorities.” He also said that funds meant to help people living with HIV or AIDS should no longer be given to organizations that provide HIV prevention services because they “celebrate and encourage” homosexual activity. Instead, he proposed redirecting those funds to anti-LGBTQ “conversion therapy” programs, which have been widely discredited by the medical community as being ineffective and dangerous.

Under Pence, ideology has replaced evidence in many areas of public life. In fact, Republican presidential nominee Donald Trump has just hired a running mate who, in the past year, has reallocated millions of dollars in public funds intended to provide food and health care for needy families to anti-choice crisis pregnancy centers.

Gov. Pence, who declined multiple requests for an interview with Rewire, has been outspoken about his anti-choice agenda. Currently, Indiana law requires people seeking abortions to receive in-person “counseling” and written information from a physician or other health-care provider 18 hours before the abortion begins. And thanks, in part, to other restrictive laws making it more difficult for clinics to operate, there are currently six abortion providers in Indiana, and none in the northern part of the state. Only four of Indiana’s 92 counties have an abortion provider. All this means that many people in need of abortion care are forced to take significant time off work, arrange child care, and possibly pay for a place to stay overnight in order to obtain it.

This environment is why a contract quietly signed by Pence last fall with the crisis pregnancy center umbrella organization Real Alternatives is so potentially dangerous for Indiana residents seeking abortion: State-subsidized crisis pregnancy centers not only don’t provide abortion but seek to persuade people out of seeking abortion, thus limiting their options.

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“Indiana is committed to the health, safety, and wellbeing [sic] of Hoosier families, women, and children,” reads the first line of the contract between the Indiana State Department of Health and Real Alternatives. The contract, which began on October 1, 2015, allocates $3.5 million over the course of a year for Real Alternatives to use to fund crisis pregnancy centers throughout the state.

Where Funding Comes From

The money for the Real Alternatives contract comes from Indiana’s Temporary Assistance for Needy Families (TANF) block grant, a federally funded, state-run program meant to support the most vulnerable households with children. The program was created by the 1996 Personal Responsibility and Work Opportunity Reconciliation Act signed by former President Bill Clinton. It changed welfare from a federal program that gave money directly to needy families to one that gave money, and a lot of flexibility with how to use it, to the states.

This TANF block grant is supposed to provide low-income families a monthly cash stipend that can be used for rent, child care, and food. But states have wide discretion over these funds: In general, they must use the money to serve families with children, but they can also fund programs meant, for example, to promote marriage. They can also make changes to the requirements for fund eligibility.

As of 2012, to be eligible for cash assistance in Indiana, a household’s maximum monthly earnings could not exceed $377, the fourth-lowest level of qualification of all 50 states, according to a report by the Congressional Research Service. Indiana’s program also has some of the lowest maximum payouts to recipients in the country.

Part of this is due to a 2011 work requirement that stripped eligibility from many families. Under the new work requirement, a parent or caretaker receiving assistance needs to be “engaged in work once the State determines the parent or caretaker is ready to engage in work,” or after 24 months of receiving benefits. The maximum time allowed federally for a family to receive assistance is 60 months.

“There was a TANF policy change effective November 2011 that required an up-front job search to be completed at the point of application before we would proceed in authorizing TANF benefits,” Jim Gavin, a spokesman for the state’s Family and Social Services Administration (FSSA), told Rewire. “Most [applicants] did not complete the required job search and thus applications were denied.”

Unspent money from the block grant can be carried over to following years. Indiana receives an annual block grant of $206,799,109, but the state hasn’t been using all of it thanks to those low payouts and strict eligibility requirements. The budget for the Real Alternatives contract comes from these carry-over funds.

According to the U.S. Department of Health and Human Services, TANF is explicitly meant to clothe and feed children, or to create programs that help prevent “non-marital childbearing,” and Indiana’s contract with Real Alternatives does neither. The contract stipulates that Real Alternatives and its subcontractors must “actively promote childbirth instead of abortion.” The funds, the contract says, cannot be used for organizations that will refer clients to abortion providers or promote contraceptives as a way to avoid unplanned pregnancies and sexually transmitted infections.

Parties involved in the contract defended it to Rewire by saying they provide material goods to expecting and new parents, but Rewire obtained documents that showed a much different reality.

Real Alternatives is an anti-choice organization run by Kevin Bagatta, a Pennsylvania lawyer who has no known professional experience with medical or mental health services. It helps open, finance, and refer clients to crisis pregnancy centers. The program started in Pennsylvania, where it received a $30 million, five-year grant to support a network of 40 subcontracting crisis pregnancy centers. Auditor General Eugene DePasquale called for an audit of the organization between June 2012 and June 2015 after hearing reports of mismanaged funds, and found $485,000 in inappropriate billing. According to the audit, Real Alternatives would not permit DHS to review how the organization used those funds. However, the Pittsburgh Post-Gazette reported in April that at least some of the money appears to have been designated for programs outside the state.

Real Alternatives also received an $800,000 contract in Michigan, which inspired Gov. Pence to fund a $1 million yearlong pilot program in northern Indiana in the fall of 2014.

“The widespread success [of the pilot program] and large demand for these services led to the statewide expansion of the program,” reads the current $3.5 million contract. It is unclear what measures the state used to define “success.”

 

“Every Other Baby … Starts With Women’s Care Center”

Real Alternatives has 18 subcontracting centers in Indiana; 15 of them are owned by Women’s Care Center, a chain of crisis pregnancy centers. According to its website, Women’s Care Center serves 25,000 women annually in 23 centers throughout Florida, Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin.

Women’s Care Centers in Indiana received 18 percent of their operating budget from state’s Real Alternatives program during the pilot year, October 1, 2014 through September 30, 2015, which were mostly reimbursements for counseling and classes throughout pregnancy, rather than goods and services for new parents.

In fact, instead of the dispensation of diapers and food, “the primary purpose of the [Real Alternatives] program is to provide core services consisting of information, sharing education, and counseling that promotes childbirth and assists pregnant women in their decision regarding adoption or parenting,” the most recent contract reads.

The program’s reimbursement system prioritizes these anti-choice classes and counseling sessions: The more they bill for, the more likely they are to get more funding and thus open more clinics.

“This performance driven [sic] reimbursement system rewards vendor service providers who take their program reimbursement and reinvest in their services by opening more centers and hiring more counselors to serve more women in need,” reads the contract.

Classes, which are billed as chastity classes, parenting classes, pregnancy classes, and childbirth classes, are reimbursed at $21.80 per client. Meanwhile, as per the most recent contract, counseling sessions, which are separate from the classes, are reimbursed by the state at minimum rates of $1.09 per minute.

Jenny Hunsberger, vice president of Women’s Care Center, told Rewire that half of all pregnant women in Elkhart, LaPorte, Marshall, and St. Joseph Counties, and one in four pregnant women in Allen County, are clients of their centers. To receive any material goods, such as diapers, food, and clothing, she said, all clients must receive this counseling, at no cost to them. Such counseling is billed by the minute for reimbursement.

“When every other baby born [in those counties] starts with Women’s Care Center, that’s a lot of minutes,” Hunsberger told Rewire.

Rewire was unable to verify exactly what is said in those counseling sessions, except that they are meant to encourage clients to carry their pregnancies to term and to help them decide between adoption or child rearing, according to Hunsberger. As mandated by the contract, both counseling and classes must “provide abstinence education as the best and only method of avoiding unplanned pregnancies and sexually transmitted infections.”

In the first quarter of the new contract alone, Women’s Care Center billed Real Alternatives and, in turn, the state, $239,290.97; about $150,000 of that was for counseling, according to documents obtained by Rewire. In contrast, goods like food, diapers, and other essentials for new parents made up only about 18.5 percent of Women’s Care Center’s first-quarter reimbursements.

Despite the fact that the state is paying for counseling at Women’s Care Center, Rewire was unable to find any licensing for counselors affiliated with the centers. Hunsberger told Rewire that counseling assistants and counselors complete a minimum training of 200 hours overseen by a master’s level counselor, but the counselors and assistants do not all have social work or psychology degrees. Hunsberger wrote in an email to Rewire that “a typical Women’s Care Center is staffed with one or more highly skilled counselors, MSW or equivalent.”

Rewire followed up for more information regarding what “typical” or “equivalent” meant, but Hunsberger declined to answer. A search for licenses for the known counselors at Women’s Care Center’s Indiana locations turned up nothing. The Indiana State Department of Health told Rewire that it does not monitor or regulate the staff at Real Alternatives’ subcontractors, and both Women’s Care Center and Real Alternatives were uncooperative when asked for more information regarding their counseling staff and training.

Bethany Christian Services and Heartline Pregnancy Center, Real Alternatives’ other Indiana subcontractors, billed the program $380.41 and $404.39 respectively in the first quarter. They billed only for counseling sessions, and not goods or classes.

In a 2011 interview with Philadelphia City Paper, Kevin Bagatta said that Real Alternatives counselors were not required to have a degree.

“We don’t provide medical services. We provide human services,” Bagatta told the City Paper.

There are pregnancy centers in Indiana that provide a full range of referrals for reproductive health care, including for STI testing and abortion. However, they are not eligible for reimbursement under the Real Alternatives contract because they do not maintain an anti-choice mission.

Parker Dockray is the executive director of Backline, an all-options pregnancy resource center. She told Rewire that Backline serves hundreds of Indiana residents each month, and is overwhelmed by demand for diapers and other goods, but it is ineligible for the funding because it will refer women to abortion providers if they choose not to carry a pregnancy to term.

“At a time when so many Hoosier families are struggling to make ends meet, it is irresponsible for the state to divert funds intended to support low-income women and children and give it to organizations that provide biased pregnancy counseling,” Dockray told Rewire. “We wish that Indiana would use this funding to truly support families by providing job training, child care, and other safety net services, rather than using it to promote an anti-abortion agenda.”

“Life Is Winning in Indiana”

Time and again, Bagatta and Hunsberger stressed to Rewire that their organizations do not employ deceitful tactics to get women in the door and to convince them not to have abortions. However, multiple studies have proven that crisis pregnancy centers often lie to women from the moment they search online for an abortion provider through the end of their appointments inside the center.

These studies have also shown that publicly funded crisis pregnancy centers dispense medically inaccurate information to clients. In addition to spreading lies like abortion causing infertility or breast cancer, they are known to give false hopes of miscarriages to people who are pregnant and don’t want to be. A 2015 report by NARAL Pro-Choice America found this practice to be ubiquitous in centers throughout the United States, and Rewire found that Women’s Care Center is no exception. The organization’s website says that as many as 40 percent of pregnancies end in natural miscarriage. While early pregnancy loss is common, it occurs in about 10 percent of known pregnancies, according to the American Congress of Obstetricians and Gynecologists.

Crisis pregnancy centers also tend to crop up next to abortion clinics with flashy, deceitful signs that lead many to mistakenly walk into the wrong building. Once inside, clients are encouraged not to have an abortion.

A Google search for “abortion” and “Indianapolis” turns up an ad for the Women’s Care Center as the first result. It reads: “Abortion – Indianapolis – Free Ultrasound before Abortion. Located on 86th and Georgetown. We’re Here to Help – Call Us Today: Abortion, Ultrasound, Locations, Pregnancy.”

Hunsberger denies any deceit on the part of Women’s Care Center.

“Clients who walk in the wrong door are informed that we are not the abortion clinic and that we do not provide abortions,” Hunsberger told Rewire. “Often a woman will choose to stay or return because we provide services that she feels will help her make the best decision for her, including free medical-grade pregnancy tests and ultrasounds which help determine viability and gestational age.”

Planned Parenthood of Indiana and Kentucky told Rewire that since Women’s Care Center opened on 86th and Georgetown in Indianapolis, many patients looking for its Georgetown Health Center have walked through the “wrong door.”

“We have had patients miss appointments because they went into their building and were kept there so long they missed their scheduled time,” Judi Morrison, vice president of marketing and education, told Rewire.

Sarah Bardol, director of Women’s Care Center’s Indianapolis clinic, told the Criterion Online Edition, a publication of the Archdiocese of Indianapolis, that the first day the center was open, a woman and her boyfriend did walk into the “wrong door” hoping to have an abortion.

“The staff of the new Women’s Care Center in Indianapolis, located just yards from the largest abortion provider in the state, hopes for many such ‘wrong-door’ incidents as they seek to help women choose life for their unborn babies,” reported the Criterion Online Edition.

If they submit to counseling, Hoosiers who walk into the “wrong door” and “choose life” can receive up to about $40 in goods over the course their pregnancy and the first year of that child’s life. Perhaps several years ago they may have been eligible for Temporary Assistance for Needy Families, but now with the work requirement, they may not qualify.

In a February 2016 interview with National Right to Life, one of the nation’s most prominent anti-choice groups, Gov. Pence said, “Life is winning in Indiana.” Though Pence was referring to the Real Alternatives contract, and the wave of anti-choice legislation sweeping through the state, it’s not clear what “life is winning” actually means. The state’s opioid epidemic claimed 1,172 lives in 2014, a statistically significant increase from the previous year, according to the Centers for Disease Control and Prevention. HIV infections have spread dramatically throughout the state, in part because of Pence’s unwillingness to support medically sound prevention practices. Indiana’s infant mortality rate is above the national average, and infant mortality among Black babies is even higher. And Pence has reduced access to prevention services such as those offered by Planned Parenthood through budget cuts and unnecessary regulations—while increasing spending on anti-choice crisis pregnancy centers.

Gov. Pence’s track record shows that these policies are no mistake. The medical and financial needs of his most vulnerable constituents have taken a backseat to religious ideology throughout his time in office. He has literally reallocated money for poor Hoosiers to fund anti-choice organizations. In his tenure as both a congressman and a governor, he’s proven that whether on a national or state level, he’s willing to put “pro-life” over quality-of-life for his constituents.