Illinois — Less Preventing Unwanted Pregnancies, More Mandatory Ultrasounds

Robin Marty

There will be less opportunities to purchase Plan B in Illinois, and more requirements before you get an abortion if the right has its way.

A recent judge’s ruling in Illinois will make it more difficult for women to obtain Plan B, an emergency contraception that works to prevent pregnancy if taken within 72 hours of unprotected sex. 

Via CBN.com:

On Tuesday, Sangamon County Circuit Court Judge John Belz struck down a 6-year-old state law that required Illinois pharmacies to dispense emergency contraception.

“We’re thrilled,” Mark Rienzi, a Catholic University law professor and one of the pharmacy owners lawyers, said after the ruling.  

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“The law of Illinois and the law of the United States make it clear that people can enter the health care profession without having to check their conscience or religion at the door,” he said.

Glen Kosirog and Luke Vander Bleek, the pharmacists in the case, told CBN News they believe “Plan B” is an abortion pill. They pointed out that while the drug is designed to prevent fertilization, it can also kill a fertilized egg.

The circuit court judge appeared to sympathize with the pharmacists, ruling that forcing them to sell the pill would violate their right-of-conscience under Illinois law, and their religious rights under the U.S. Constitution.

Plan B is actually not an “abortion pill” but works to prevent fertilization.  It has no effect on women who are already pregnant.

The ruling is expected to be appealed.

Meanwhile, Catholic groups in the state are also pushing to force women seeking abortions to have to have mandatory ultrasounds and provide them to pregnant women prior to the procedure as a “courtesy.”  According to the Chicago Tribune:

[Catholic Conference of Illinois] would like to require women to view ultrasounds when considering abortion, but it says that wouldn’t pass in Illinois.

Opponents say the legislation would create an unnecessary hour of waiting time that is meant to be used to change a woman’s mind about the abortion.

Less prevention, more restrictions.  Sounds right.

News Abortion

Study: Catholic Hospitals ‘Dump’ Abortion Patients, Often Refuse Referrals

Nicole Knight

"What doctors told us is sometimes for abortion ... there was a sense of, 'You're on your own,'" said Dr. Debra B. Stulberg, assistant professor of family medicine at the University of Chicago.

The patient learned she had brain cancer in her first trimester of pregnancy. She needed chemotherapy and abortion care.

“I’ve got a woman whose life is threatened by brain cancer,” her doctor, an OB-GYN at a Catholic hospital, told authorities there. “I need to do a termination.”

Catholic hospitals follow religious directives that generally bar certain types of health care, including abortions, except when the patient is in imminent danger.

The hospital refused the treatment, telling the OB-GYN to refer his patient elsewhere.

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“They said, ‘Go take her to another hospital. Take her to another place. Those places are available to you. We don’t have to do it here…’,” the OB-GYN explained.

The case is among many contained in a new paper, “Referrals for Services Prohibited in Catholic Health Care Facilities,” which will be published in the September issue of Perspectives on Sexual and Reproductive Health. The study explores whether Catholic hospitals make timely referrals, provide complete and accurate health-care information, and supply emergency treatment when needed.

And it comes as Catholic facilities exert more and more control over U.S. health care, now accounting for one in six hospital beds nationwide, according to recent figures from the advocacy group MergerWatch.

“Until now, there hasn’t been a study asking about referral patterns in Catholic hospitals,” lead author, Dr. Debra B. Stulberg, assistant professor of family medicine at the University of Chicago, said in a phone interview with Rewire. “We set out to ask OB-GYNs how the institution where they worked affected the care they provide.”

In 2011 and 2012, Stulberg and her co-authors conducted in-depth interviews with 27 OB-GYNs who were working or had worked in Catholic hospitals.

The OB-GYNs came from a diversity of faiths and hailed from all parts of the country; 17 were female, ten were male. And while the qualitative nature of the survey means the responses cannot be generalized across Catholic hospitals nationwide, the survey reveals a referral process plagued by reports of inconsistencies and treatment delays.

Survey respondents described cases where they felt that referring a patient to an outside provider put the patient’s health at risk.

One OB-GYN found it “nearly impossible” to treat heavy vaginal bleeding because of the hospital’s ban on hormonal contraceptives.

“Say you have…a 45-year-old who comes in [at three in the morning] with heavy bleeding and irregular periods. The most common approach to stopping her bleeding is to give her high-dose birth control pills for a short period of time. So, that became very difficult…’cause they didn’t have them in stock. I won’t say it’s impossible to get them, because like the head pharmacist knows where there’s three secret packs, and if you happen to manage to find the head pharmacist at [that hour], you can. But it’s nearly impossible to get birth control pills to treat heavy bleeding.”

OB-GYNs described broad inconsistencies in how hospitals handled referrals, with some hospital administrators and ethicists encouraging or tolerating referrals, and others actively discouraging referrals. Sometimes doctors kept referrals hidden. Respondents reported that patients needing abortion care were given less assistance with a referral than those requesting other prohibited services.

In one instance, a secretary tried to block an abortion care referral.

“What doctors told us is sometimes for abortion … there was a sense of, ‘You’re on your own,'” Stulberg told Rewire. She said the disparities in referrals can delay medical treatment and reinforce abortion stigma.

By referring patients for abortions rather than allowing the doctors to administer the prohibited care, some respondents felt the hospital “dumped” or “punted” the patients.

“It tells women that this care is not standard. It’s something we do on the side, under the table,” Stulberg said. “Imagining myself in those patient’s shoes, I might feel really abandoned by my doctor.”

Respondents reported that they received mixed messages from hospital authorities when the facility’s moral teachings were pitted against its financial interests.

For example, Catholic doctrine prohibits handling eggs and sperm for in-vitro fertilization procedures, but a respondent said a Catholic hospital system skirted the ban by opening an off-site fertility clinic.

As the OB-GYN explained, “Now, they’re getting a little crafty with how they get around it, and they go off-campus [to provide such services]. So we actually do now have…an infertility specialist, who is starting up an in vitro fertilization clinic off-campus…. We had somewhere to send them anyway before—it was just out of the system—but now the system wants the business.”

The authors call on policymakers to require Catholic hospitals that refuse to offer care to refer patients to providers and to inform patients beforehand about the limits on treatment at religiously run facilities.

“Having consistent procedures and help to access abortion will reduce the chance that the patient will be given the run around and have her care delayed,” study co-author Lori R. Freedman, assistant professor in the departments of Obstetrics, Gynecology, and Reproductive Sciences at University of California-San Francisco, told Rewire in a phone interview.

The recommendations are in keeping with ethical guidelines from the American Congress of Obstetricians and Gynecologists, which advises health-care providers with religious objections to abortion care to notify patients beforehand and to refer them to abortion care providers.

The study builds on research published in Contraception by a team that included Freedman and Stulberg. They found that Catholic hospitals’ ban on tubal ligations caused unnecessary second surgeries and erected barriers to care for patients with low incomes.

“You really want women to find safe and compassionate providers as soon as possible,” Freedman told Rewire. “Delays…are not good for women.”

Analysis Abortion

Legislators Have Introduced 445 Provisions to Restrict Abortion So Far This Year

Elizabeth Nash & Rachel Benson Gold

So far this year, legislators have introduced 1,256 provisions relating to sexual and reproductive health and rights. However, states have also enacted 22 measures this year designed to expand access to reproductive health services or protect reproductive rights.

So far this year, legislators have introduced 1,256 provisions relating to sexual and reproductive health and rights. Of these, 35 percent (445 provisions) sought to restrict access to abortion services. By midyear, 17 states had passed 46 new abortion restrictions.

Including these new restrictions, states have adopted 334 abortion restrictions since 2010, constituting 30 percent of all abortion restrictions enacted by states since the U.S. Supreme Court decision in Roe v. Wade in 1973. However, states have also enacted 22 measures this year designed to expand access to reproductive health services or protect reproductive rights.

Mid year state restrictions

 

Signs of Progress

The first half of the year ended on a high note, with the U.S. Supreme Court handing down the most significant abortion decision in a generation. The Court’s ruling in Whole Woman’s Health v. Hellerstedt struck down abortion restrictions in Texas requiring abortion facilities in the state to convert to the equivalent of ambulatory surgical centers and mandating that abortion providers have admitting privileges at a local hospital; these two restrictions had greatly diminished access to services throughout the state (see Lessons from Texas: Widespread Consequences of Assaults on Abortion Access). Five other states (Michigan, Missouri, Pennsylvania, Tennessee, and Virginia) have similar facility requirements, and the Texas decision makes it less likely that these laws would be able to withstand judicial scrutiny (see Targeted Regulation of Abortion Providers). Nineteen other states have abortion facility requirements that are less onerous than the ones in Texas; the fate of these laws in the wake of the Court’s decision remains unclear. 

Ten states in addition to Texas had adopted hospital admitting privileges requirements. The day after handing down the Texas decision, the Court declined to review lower court decisions that have kept such requirements in Mississippi and Wisconsin from going into effect, and Alabama Gov. Robert Bentley (R) announced that he would not enforce the state’s law. As a result of separate litigation, enforcement of admitting privileges requirements in Kansas, Louisiana, and Oklahoma is currently blocked. That leaves admitting privileges in effect in Missouri, North Dakota, Tennessee and Utah; as with facility requirements, the Texas decision will clearly make it harder for these laws to survive if challenged.

More broadly, the Court’s decision clarified the legal standard for evaluating abortion restrictions. In its 1992 decision in Planned Parenthood of Southeastern Pennsylvania v. Casey, the Court had said that abortion restrictions could not impose an undue burden on a woman seeking to terminate her pregnancy. In Whole Woman’s Health, the Court stressed the importance of using evidence to evaluate the extent to which an abortion restriction imposes a burden on women, and made clear that a restriction’s burdens cannot outweigh its benefits, an analysis that will give the Texas decision a reach well beyond the specific restrictions at issue in the case.

As important as the Whole Woman’s Health decision is and will be going forward, it is far from the only good news so far this year. Legislators in 19 states introduced a bevy of measures aimed at expanding insurance coverage for contraceptive services. In 13 of these states, the proposed measures seek to bolster the existing federal contraceptive coverage requirement by, for example, requiring coverage of all U.S. Food and Drug Administration approved methods and banning the use of techniques such as medical management and prior authorization, through which insurers may limit coverage. But some proposals go further and plow new ground by mandating coverage of sterilization (generally for both men and women), allowing a woman to obtain an extended supply of her contraceptive method (generally up to 12 months), and/or requiring that insurance cover over-the-counter contraceptive methods. By July 1, both Maryland and Vermont had enacted comprehensive measures, and similar legislation was pending before Illinois Gov. Bruce Rauner (R). And, in early July, Hawaii Gov. David Ige (D) signed a measure into law allowing women to obtain a year’s supply of their contraceptive method.

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But the Assault Continues

Even as these positive developments unfolded, the long-standing assault on sexual and reproductive health and rights continued apace. Much of this attention focused on the release a year ago of a string of deceptively edited videos designed to discredit Planned Parenthood. The campaign these videos spawned initially focused on defunding Planned Parenthood and has grown into an effort to defund family planning providers more broadly, especially those who have any connection to abortion services. Since last July, 24 states have moved to restrict eligibility for funding in several ways:

  • Seventeen states have moved to limit family planning providers’ eligibility for reimbursement under Medicaid, the program that accounts for about three-fourths of all public dollars spent on family planning. In some cases, states have tried to exclude Planned Parenthood entirely from such funding. These attacks have come via both administrative and legislative means. For instance, the Florida legislature included a defunding provision in an omnibus abortion bill passed in March. As the controversy grew, the Centers for Medicare and Medicaid Services, the federal agency that administers Medicaid, sent a letter to state officials reiterating that federal law prohibits them from discriminating against family planning providers because they either offer abortion services or are affiliated with an abortion provider (see CMS Provides New Clarity For Family Planning Under Medicaid). Most of these state attempts have been blocked through legal challenges. However, a funding ban went into effect in Mississippi on July 1, and similar measures are awaiting implementation in three other states.
  • Fourteen states have moved to restrict family planning funds controlled by the state, with laws enacted in four states. The law in Kansas limits funding to publicly run programs, while the law in Louisiana bars funding to providers who are associated with abortion services. A law enacted in Wisconsin directs the state to apply for federal Title X funding and specifies that if this funding is obtained, it may not be distributed to family planning providers affiliated with abortion services. (In 2015, New Hampshire moved to deny Title X funds to Planned Parenthood affiliates; the state reversed the decision in 2016.) Finally, the budget adopted in Michigan reenacts a provision that bars the allocation of family planning funds to organizations associated with abortion. Notably, however, Virginia Gov. Terry McAuliffe (D) vetoed a similar measure.
  • Ten states have attempted to bar family planning providers’ eligibility for related funding, including monies for sexually transmitted infection testing and treatment, prevention of interpersonal violence, and prevention of breast and cervical cancer. In three of these states, the bans are the result of legislative action; in Utah, the ban resulted from action by the governor. Such a ban is in effect in North Carolina; the Louisiana measure is set to go into effect in August. Implementation of bans in Ohio and Utah has been blocked as a result of legal action.

071midyearstateeligibilitytable

The first half of 2016 was also noteworthy for a raft of attempts to ban some or all abortions. These measures fell into four distinct categories:

  • By the end of June, four states enacted legislation to ban the most common method used to perform abortions during the second trimester. The Mississippi and West Virginia laws are in effect; the other two have been challenged in court. (Similar provisions enacted last year in Kansas and Oklahoma are also blocked pending legal action.)
  • South Carolina and North Dakota both enacted measures banning abortion at or beyond 20 weeks post-fertilization, which is equivalent to 22 weeks after the woman’s last menstrual period. This brings to 16 the number of states with these laws in effect (see State Policies on Later Abortions).
  • Indiana and Louisiana adopted provisions banning abortions under specific circumstances. The Louisiana law banned abortions at or after 20 weeks post-fertilization in cases of diagnosed genetic anomaly; the law is slated to go into effect on August 1. Indiana adopted a groundbreaking measure to ban abortion for purposes of race or sex selection, in cases of a genetic anomaly, or because of the fetus’ “color, national origin, or ancestry”; enforcement of the measure is blocked pending the outcome of a legal challenge.
  • Oklahoma Gov. Mary Fallin (R) vetoed a sweeping measure that would have banned all abortions except those necessary to protect the woman’s life.

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In addition, 14 states (Alaska, Arizona, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Maryland, South Carolina, South Dakota, Tennessee and Utah) enacted other types of abortion restrictions during the first half of the year, including measures to impose or extend waiting periods, restrict access to medication abortion, and establish regulations on abortion clinics.

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

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