Commentary

International Reproductive Health Still Worth the Investment

Wayne Shields & Suzanne Petroni

United States investments in maternal, reproductive and sexual health programs have been a tremendous success but challenges remain, which the sexual and reproductive health community must help overcome.

Editor’s Note:  This editorial is reprinted from the June 2011 issue of the Association of Reproductive Health Professionals’ Contraception: An International Reproductive Health Journal.

The United States has been a global leader in the international population arena for nearly 50 years. United States investments in maternal, reproductive and sexual health programs have been a tremendous success, saving and improving many millions of lives. But many challenges remain, and the collective education and advocacy efforts of the sexual and reproductive health community can help overcome them.

The world’s population continues to grow at a rate of nearly 80 million people a year.1 An estimated 215 million women throughout the developing world want, but do not have access to, modern methods of contraception, which contributes to some 76 million unintended pregnancies and 20 million unsafe abortions each year.2 The number of women who die during childbirth remains unacceptably high, with hundreds of thousands still succumbing to mostly preventable maternal deaths each year.3 Hundreds of thousands more women are injured during pregnancy, with tens of thousands facing the tragedies of obstetric fistulae or unsafe abortions.3 AIDS is now the leading cause of death among women of reproductive age, and maternal mortality is the leading killer of women aged 15–19 years throughout the world.4 Because of gender discrimination and sociocultural beliefs, young women are particularly ill-equipped to negotiate safer sex practices with their typically much older partners.

Access to comprehensive sexual and reproductive health services can solve many of these grave challenges, and for many decades, the United States has supported the provision of such services for women and men in the developing world. At the International Conference on Population and Development (ICPD), held in Cairo, Egypt in 1994, the United States led the world — and joined leaders in health, science, medicine, women’s rights and the environment — in committing to provide the funding and support needed to meet the world’s reproductive health needs.5

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In recent years, however, US policies around these issues have become increasingly divisive and politicized, contributing to insufficient funding and constrained programs. Indeed, while not all programs supported by the US government are as efficient as they might otherwise be — operating as they do in silos, with ideologically driven restrictions, and sometimes in competition with each other — the assistance that the US provides to address the sexual and reproductive health needs of the world’s poorest people is absolutely critical and lifesaving. These investments must be protected from a new Congress, which seeks to curtail funding for development assistance, and they must be supported by an Administration that has made promising initial steps toward breaking down barriers and meeting the commitments made by the United States.

The significant progress that has been made in the past half century will be lost unless the United States and other nations reinforce their commitment to the ICPD agenda and to the notion that women’s health is worth protecting.

What Did the World Agree to in Cairo?
The ICPD Programme of Action, arduously negotiated over many months, was a comprehensive document that reached across a broad range of issues associated with population and development, including, but not limited to, education; infant, child and maternal mortality; population dynamics; the environment and consumption; migration; HIV/AIDS; and technology, research and development.5

While far-reaching in scope, the core of the ICPD was recognition that a sustainable world was not about numbers, but about people, and that all people, particularly women, must have access to reproductive health. This worldwide consensus recognized that achieving universal access to reproductive health is critical for individual health, family well-being, economic development and a healthy planet.

Reproductive health was defined at Cairo in more comprehensive terms than ever before, namely, as “a state of complete physical, mental and social well-being … in all matters relating to the reproductive system.” This meant expanding the definition beyond family planning — long the mainstay of population programs — to include maternal and neonatal health; prevention and treatment of sexually transmitted infections, including HIV/AIDS; and prevention and response to gender-based violence — all-critical elements of achieving universal access. Women’s empowerment, including their right to determine the number, timing and spacing of childbearing, was given paramount importance at Cairo.

The ICPD also encouraged breaking down the silos in which sexual and reproductive health programs had traditionally been divided, an innovative way to advance a more holistic— and realistic — view of health.

The ICPD Agenda Is as Needed as Ever
The United States was one of 179 nations that made a commitment in Cairo to help advance the health and welfare of women, men and young people around the world. This commitment was made out of a moral obligation to ensure that individuals can rise out of desperate poverty, a conviction that women and children should not suffer and die needlessly, and as a practical investment in our shared future. Some 17 years later, the principles and goals of Cairo are as relevant and needed as ever.

As health care researchers and providers know, sexual and reproductive health care is a critical component of the overall health and welfare of women, men and young people. Individuals’ welfare contribute to the welfare of communities, nations and ultimately the world. Their sexual and reproductive health status impinges greatly on the decisions of women, men and young people, and impacts their access to needed information, care and services.

Even as we face a global population that will soon number an historic seven billion, we can continue to advance toward a healthier, more equitable and sustainable world.6 Working in partnership with other nations around the world, we have a responsibility to do so.

We Know What Works
Despite the many challenges, we know from successful investments in global health that solutions are within reach.

Supporting the comprehensive package of simultaneous interventions recommended by the ICPD will ensure that voluntary contraception is affordable and safe; that women are empowered to decide whether and when they want to have a baby; that evidence-based sexuality education programs reach all those in need, so that unintended pregnancies and sexually transmitted diseases are prevented. These interventions will ensure that pregnant women have access to lifesaving information for themselves and their children, and that they give birth with skilled assistance. They will ensure that young women are not subject to sexual violence, including culturally driven practices, like female genital circumcision, that impair their rights and their sexual health.

What has been proven NOT to work are siloed programs and ideologically driven policy restrictions — such as the Mexico City Policy or “Global Gag Rule” that restricts family planning funding from organizations that provide — with their own funds — abortion counseling, lobbying or services.7

Comprehensive solutions are effective. Maternal mortality rates in Egypt have dropped by more than 50%, as contraceptive usage increased from 23% in 1980 to 57% in 2005. In Mexico, the infant mortality rate fell by 70% between 1970 and 2005, as the use of modern contraceptives and access to prenatal care increased.8 In the past 3 years alone, more than 6000 communities in eight sub-Saharan African nations have abandoned female genital mutilation.9 The number of people infected with HIV/AIDS in Zimbabwe nearly halved in a 10-year period: from 29% of the population in 1997 to 16% in 2007, as awareness about prevention methods increased.10 Similar successes appear in every corner of the world.

Fortunately, What Works Is Supported by the American Public
These are cost-effective elements of US foreign policy, and they are supported by an overwhelming majority of Americans across the political spectrum. According to American Public Opinion and Global Health (May, 2009), 68 percent of Americans said they support “helping poor countries provide family planning and reproductive health services to its citizens.” Some 78 percent support “improving the health of mothers and children in poor countries”.11 And according to the Kaiser Family Foundation, 85 percent of Americans think “promoting the rights of women” should be a top priority for the US government.12

The Obama Administration Is on Board…Mostly
The Obama Administration has recognized that we must not roll back the significant progress that has been achieved thus far, and has taken specific, concrete steps to advance more comprehensive, integrated, evidence-based approaches to sexual and reproductive health and women’s rights. The Global Health Initiative (GHI), a hallmark of the Administration’s international development policy, would institutionalize a cross-disciplinary and cross-agency approach to the challenges laid out in Cairo, breaking down the silos that have long hampered effective development assistance.13 Based on years of successes and understanding that women’s health and rights are absolutely essential to ensuring the health of communities and the world, the GHI is powerfully focused on interventions to prevent unintended pregnancy, promote women’s health and save women’s lives.

The GHI also recognizes the importance of innovation in achieving global health solutions. We hope that this recognition will lead to increased support by the Administration of new innovations to advance sexual and reproductive health, such as multipurpose prevention technologies that would allow women to simultaneously prevent unintended pregnancy and a range of sexually transmitted infections.14 Multipurpose prevention technologies represent the ideal illustration of working across issue silos to address the holistic health needs of women.

The creation of an Office of Global Women’s Issues, led by an ambassadorial-level appointment and reporting directly to the Secretary of State, and whose staff has been intimately engaged in advancing the GHI, is yet another indication of the prioritization of women and women’s health in US foreign policy and assistance.

And while we would argue that it does not go nearly far enough, President Obama’s budget request for Fiscal Year 2012 included necessary increases in funding for international reproductive and maternal health programs.

Call to Action
In more cases than not, the smartest long-term strategies build on what is proven to work with an infusion of fresh data and a dash of creativity. The Cairo principles have proven to work and serve to inform specific strategies to raise the standards of health and quality of life for women and their families in all nations.

It is important for all nations to show global leadership by continuing to break down barriers between disciplines, specialties, agencies and interest groups to address common public health goals. A sustained, long-term US commitment to advancing reproductive health is the way to make progress. Some countries are meeting their commitments to advance reproductive health, but the United States is not. In order to meet its fair share of the Cairo agenda and keep its promise to the world’s women, the US government should provide $3.2 billion for maternal, newborn, child and reproductive health programs and advance policies that ensure these funds are used effectively to meet the health needs of individuals. With adequate funding and appropriate policies, the United States can help to prevent the deaths of hundreds of thousands of women and children, reduce the spread of HIV/AIDS, grow economies, make poverty history and preserve natural resources the world over.

Cairo represented a watershed moment for the development and implementation of global health strategies, and we are on the right path — but the huge potential of these basic principles to create monumental changes in reproductive health globally has yet to be realized.

What You Can Do
To be most effective, policies should be evidence based and meet real-life needs. As reproductive health professionals, you rely on this approach to ensure the greatest likelihood of public health success. Your professional voice holds more sway than you might think.

Here is what you can do:

  1. Include information about the Cairo principles and our global progress when developing any relevant curriculum, continuing medical education program, speech, interview or other outreach platform.
  2. Initiate conversations with professional colleagues, policymakers, educators, religious leaders, members of the media and others to advocate for basing policy decisions on evidence — not ideology — and to support necessary national funding to reach the Cairo goals.
  3. Show your support for evidence-based policies and the Cairo principles by encouraging policymakers to provide support to the world’s women and increase funding levels to meet the commitments of support.
  4. Sign up for professional updates and helpful links to vetted information resources (government agencies, nongovernmental organizations, global health advocacy groups and donors, and others): www.arhp.org/supportglobalhealth. We encourage your support, advocacy and constructive comments.

References

  1. Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat . World population prospects: the 2008 revision. United Nations. http://esa.un.org/unpp Last accessed February 17, 2011.
  2. Susheela S, Darroch JE, Ashford LS, Vlassoff M. Adding it up: the benefits of investing in family planning and newborn and maternal health. Guttmacher Institute and United Nations Population Fund, 2009. http://www.guttmacher.org/pubs/AddingItUp2009.pdf Last accessed February 22, 2011..
  3. In: WHO , UNICEF , UNFPA , World Bank  editor. Maternal mortality in 2005. Geneva: World Health Organization; 2007;p. xiv, 10;http://www.who.int/making_pregnancy_safer/topics/maternal_mortality/en/index.html Last accessed February 17, 2011.
  4. World Health Organization . Women and health: today’s evidence tomorrow’s agenda. Geneva: WHO Press; 2009;http://www.who.int/gender/women_health_report/en/index.html Last accessed February 22, 2011.
  5. International Conference on Population and Development: summary of the programme of action . United Nations Department of Public Information. http://www.un.org/ecosocdev/geninfo/populatin/icpd.htm Last accessed February 17, 2011.
  6. Development Data Group, World Bank. In: 2009 World development indicators. Washington, DC: International Bank for Reconstruction and Development/The World Bank; 2009;p. 43.
  7. Cincotta RP, Crane BB. Public Health. The Mexico City policy and U.S. family planning assistance. Science. 2001;294(5542):525–526.
  8. Mortality country fact sheet, 2006. World Health Organization. 2006. Available at: http://www.who.int/whosis/mort/profiles/mort_emro_egy_egypt.pdf. Last accessed February 17, 2011.
  9. UNFPA, UNICEF. The end is in sight: annual report 2009 for the UNFPA/UNICEF Joint Programme on Female Genital Mutilation/cutting. 2010;http://www.unfpa.org/public/home/publications/pid/6435 Last accessed February 17, 2011.
  10. Halperin DT, Mugurungi O, Hallett TB, et al. A surprising prevention success: why did the HIV epidemic decline in Zimbabwe?. PLoS Med. 2011;8:e1000414.
  11. Ramsey C, Weber S, Kull S, Lewis E. Americans support US working to improve health in developing countries. World Public Opinion, Inc. (May 20, 2009). http://www.worldpublicopinion.org/pipa/articles/brunitedstatescanadara/610.php Last accessed February 17, 2011.
  12. Survey about U.S. role in global health reports that Americans want to take care of problems at home first in a recession, but say don’t cut funding for global health and development. Public Opinion and Research Program, Henry J. Kaiser Family Foundation (May 6, 2009). http://www.kff.org/kaiserpolls/posr05609pkg.cfm Last accessed February 17, 2011.
  13. The US Government’s Global Health Initiative. PEPFAR, United States Department of State. Available at: http://www.pepfar.gov/ghi/index.htm. Last accessed February 17, 2011.
  14. Initiative for Multipurpose Prevention Technologies (MPT) . Coalition advancing multipurpose innovations. http://www.cami-health.org/Initiatives.html Last accessed February 17, 2011.

Analysis Law and Policy

Indiana Court of Appeals Tosses Patel Feticide Conviction, Still Defers to Junk Science

Jessica Mason Pieklo

The Indiana Court of Appeals ruled patients cannot be prosecuted for self-inducing an abortion under the feticide statute, but left open the possibility other criminal charges could apply.

The Indiana Court of Appeals on Friday vacated the feticide conviction of Purvi Patel, an Indiana woman who faced 20 years in prison for what state attorneys argued was a self-induced abortion. The good news is the court decided Patel and others in the state could not be charged and convicted for feticide after experiencing failed pregnancies. The bad news is that the court still deferred to junk science at trial that claimed Patel’s fetus was on the cusp of viability and had taken a breath outside the womb, and largely upheld Patel’s conviction of felony neglect of a dependent. This leaves the door open for similar prosecutions in the state in the future.

As Rewire previously reported, “In July 2013 … Purvi Patel sought treatment at a hospital emergency room for heavy vaginal bleeding, telling doctors she’d had a miscarriage. That set off a chain of events, which eventually led to a jury convicting Patel of one count of feticide and one count of felony neglect of a dependent in February 2015.”

To charge Patel with feticide under Indiana’s law, the state at trial was required to prove she “knowingly or intentionally” terminated her pregnancy “with an intention other than to produce a live birth or to remove a dead fetus.”

According to the Indiana Court of Appeals, attorneys for the State of Indiana failed to show the legislature had originally passed the feticide statute with the intention of criminally charging patients like Patel for terminating their own pregnancies. Patel’s case, the court said, marked an “abrupt departure” from the normal course of prosecutions under the statute.

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“This is the first case that we are aware of in which the State has used the feticide statute to prosecute a pregnant woman (or anyone else) for performing an illegal abortion, as that term is commonly understood,” the decision reads. “[T]he wording of the statute as a whole indicate[s] that the legislature intended for any criminal liability to be imposed on medical personnel, not on women who perform their own abortions,” the court continued.

“[W]e conclude that the legislature never intended the feticide statute to apply to pregnant women in the first place,” it said.

This is an important holding, because Patel was not actually the first woman Indiana prosecutors tried to jail for a failed pregnancy outcome. In 2011, state prosecutors brought an attempted feticide charge against Bei Bei Shuai, a pregnant Chinese woman suffering from depression who tried to commit suicide. She survived, but the fetus did not.

Shuai was held in prison for a year until a plea agreement was reached in her case.

The Indiana Court of Appeals did not throw out Patel’s conviction entirely, though. Instead, it vacated Patel’s second charge of Class A felony conviction of neglect of a dependent, ruling Patel should have been charged and convicted of a lower Class D felony. The court remanded the case back to the trial court with instructions to enter judgment against Patel for conviction of a Class D felony neglect of a dependent, and to re-sentence Patel accordingly to that drop in classification.

A Class D felony conviction in Indiana carries with it a sentence of six months to three years.

To support Patel’s second charge of felony neglect at trial, prosecutors needed to show that Patel took abortifacients; that she delivered a viable fetus; that said viable fetus was, in fact, born alive; and that Patel abandoned the fetus. According to the Indiana Court of Appeals, the state got close, but not all the way, to meeting this burden.

According to the Indiana Court of Appeals, the state had presented enough evidence to establish “that the baby took at least one breath and that its heart was beating after delivery and continued to beat until all of its blood had drained out of its body.”

Therefore, the Court of Appeals concluded, it was reasonable for the jury to infer that Patel knowingly neglected the fetus after delivery by failing to provide medical care after its birth. The remaining question, according to the court, was what degree of a felony Patel should have been charged with and convicted of.

That is where the State of Indiana fell short on its neglect of a dependent conviction, the court said. Attorneys had failed to sufficiently show that any medical care Patel could have provided would have resulted in the fetus surviving after birth. Without that evidence, the Indiana Court of Appeals concluded, state attorneys could not support a Class A conviction. The evidence they presented, though, could support a Class D felony conviction, the court said.

In other words, the Indiana Court of Appeals told prosecutors in the state, make sure your medical experts offer more specific testimony next time you bring a charge like the one at issue in Patel’s case.

The decision is a mixed win for reproductive rights and justice advocates. The ruling from the court that the feticide statute cannot be used to prosecute patients for terminating their own pregnancy is an important victory, especially in a state that has sought not just to curb access to abortion, but to eradicate family planning and reproductive health services almost entirely. Friday’s decision made it clear to prosecutors that they cannot rely on the state’s feticide statute to punish patients who turn to desperate measures to end their pregnancies. This is a critical pushback against the full-scale erosion of reproductive rights and autonomy in the state.

But the fact remains that at both trial and appeal, the court and jury largely accepted the conclusions of the state’s medical experts that Patel delivered a live baby that, at least for a moment, was capable of survival outside the womb. And that is troubling. The state’s experts offered these conclusions, despite existing contradictions on key points of evidence such as the gestational age of the fetus—and thus if it was viable—and whether or not the fetus displayed evidence of life when it was born.

Patel’s attorneys tried, unsuccessfully, to rebut those conclusions. For example, the state’s medical expert used the “lung float test,” also known as the hydrostatic test, to conclude Patel’s fetus had taken a breath outside the womb. The test, developed in the 17th century, posits that if a fetus’ lungs are removed and placed in a container of liquid and the lungs float, it means the fetus drew at least one breath of air before dying. If the lungs sink, the theory holds, the fetus did not take a breath.

Not surprisingly, medical forensics has advanced since the 17th century, and medical researchers widely question the hydrostatic test’s reliability. Yet this is the only medical evidence the state presented of live birth.

Ultimately, the fact that the jury decided to accept the conclusions of the state’s experts over Patel’s is itself not shocking. Weighing the evidence and coming to a conclusion of guilt or innocence based on that evidence is what juries do. But it does suggest that when women of color are dragged before a court for a failed pregnancy, they will rarely, if ever, get the benefit of the doubt.

The jurors could have just as easily believed the evidence put forward by Patel’s attorneys that gestational age, and thus viability, was in doubt, but they didn’t. The jurors could have just as easily concluded the state’s medical testimony that the fetus took “at least one breath” was not sufficient to support convicting Patel of a felony and sending her to prison for 20 years. But they didn’t.

Why was the State of Indiana so intent on criminally prosecuting Patel, despite the many glaring weaknesses in the case against her? Why were the jurors so willing to take the State of Indiana’s word over Patel’s when presented with those weaknesses? And why did it take them less than five hours to convict her?

Patel was ordered in March to serve 20 years in prison for her conviction. Friday’s decision upends that; Patel now faces a sentence of six months to three years. She’s been in jail serving her 20 year sentence since February 2015 while her appeal moved forward. If there’s real justice in this case, Patel will be released immediately.

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.”