Analysis Abortion

The Opening of a Russian Front in the Abortion Wars

Merle Hoffman

Russia has embraced their very own anti-choice movement, and it looks strikingly like ours here in the U.S.

On Thursday, the New York Times’ Sophia Kishkovsky published a piece about alarming news that’s been buzzing in reproductive rights circles for the last couple of weeks – Russia has embraced  their very own anti-choice movement, and it looks strikingly like ours here in the U.S.

This is not news to me as I encountered the nascent Russian anti-choice movement 20 years ago when I attempted to open the first feminist medical center in Moscow, Choices East. My desire to create a Russian version of Choices in New York was sparked when I was confronted with a 35-year-old Russian woman who came to me for her 36th abortion.  At that time, abortion was the major form of birth control in the former Soviet Union, and many immigrants had ten or twenty before coming to Choices.  I listened in mute rage to one story after another of lives blighted by sexually transmitted diseases, domestic violence and hopelessness. For these women, the issue of abortion posed no questions of morality, ethics, or women’s rights versus fetal life.  My patient regarded her multiple abortions pragmatically, as a way of “just getting cleaned out.”

Like so many of her compatriots, she was violently opposed to using birth control. Most Russian gynecologists promoted the idea that the pill caused cancer, and preached the virtues of repeat abortions. Of course, the fact that many of them subsidized their three-dollar-a-month salaries by doing abortions on kitchen tables might well have had an influence on their thinking.

The only contraceptive devices locally produced were condoms, but these were so poorly made that they were called “galoshes,” and few men consented to using them.The two most popular forms of birth control for women were douching with lemon juice and jumping on cardboard boxes when their periods were late.

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The slogan of many pro-choice activists in the US—“Abortion on demand and without apology”—was a reality in Russia, but it had little to do with freedom and privacy, and a lot to do with state oppression and coercion.

I visited obstetric wards empty of patients, and was told that one out of three women who sought second trimester abortions in hospitals died from infections stemming from illegal abortions. One woman confided that the brutality of the state maternity wards was Russia’s most effective means of family planning.

When I attempted to bring birth control pills, condoms and insert the first Norplant, I was violently attacked in the press. Calling my plans to set up a women’s clinic in Moscow  with state of the art abortion care an “anti-Russian ploy,” Alexander Sterligov, former KGB general and leader of the Russian National Assembly, was quoted as saying, “We will not put up with Russians having more coffins than cradles.”

By the early 1990s, mirroring the growth of the American anti-choice movement, tapes of Jerry Falwell and Jimmy Swaggart had already  aired on Russian television, while a right-to-life conference in Moscow boasted five hundred attendees.

Twenty years later, these sentiments have metastasized into new attempts at legal restrictions, American-style pickets at clinics and appropriation of the English word, “pro-life”. It’s evident that Russia has caught onto Americans’ anti-choice tactics in its continuing assault on women.

The current Russian anti-choice campaign touting the protection of “life” is a smoke screen for the same old State/Church philosophies insuring power and control over women’s bodies. When Stalin criminalized abortion in 1936, a fetus’s right to life was not the agenda; the agenda was to populate Russia with soldiers to counteract Hitler’s rising militarism. In all of these calculations, women are the losers. True reproductive freedom is never under consideration. And so women make the choices they have to make.

Unfortunately, I never got to build my medical center. There were some brave Russian feminists who worked with me on presenting an open statement to Boris Yeltsin decrying the state of women’s health — but the real work of saving women’s lives and bringing choice and dignity to Russian women had to be put on hold, to be documented in my forthcoming memoir, Intimate Wars.

I hope Russian feminists will take heed and stand up against the anti-choice movement before it destroys the health and lives of current and future generations of women.

Analysis Law and Policy

What Monday’s Supreme Court Decision Means in the Fight for Abortion Rights

Jessica Mason Pieklo

Monday's decision striking two provisions of Texas' HB 2 doesn't just threaten similar laws nationwide; it could be the basis for finally stemming the onslaught of anti-science abortion restrictions in the states.

Read more of our coverage of Whole Woman’s Health v. Hellerstedt here.

Abortion rights advocates have insisted, since the beginning of the fight over targeted regulation of abortion providers (TRAP) laws, that despite anti-choice lawmakers’ claims to the contrary, the evidence proved these restrictions harmed rather than advanced patient safety. On Monday, the U.S. Supreme Court finally listened.

Monday’s decision in Whole Woman’s Health v. Hellerstedtwhich struck as unconstitutional Texas’ requirements in HB 2 that all doctors performing abortions in the state have admitting privileges at a nearby hospital and that all clinics meet the same requirements as stand-alone surgical centers—is not just a win for advocates and patients in Texas. It produced an opinion that has the potential to turn back the seemingly endless wave of restrictions from the states and to reinforce abortion as a fundamental right.

First things first. Whole Woman’s Health is a data-heavy opinion, and there is probably no better justice to pen one than Justice Stephen Breyer. The man seems to live for statistical analysis. He may offer up rambling hypotheticals during oral arguments, but his written opinions are more often than not grounded in data.

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The reason this matters is that both the conservatives on the Roberts Court and their supporters in the Fifth Circuit have tried their damnedest for years to sidestep piles and piles of facts. Such as the fact that in 2013, the year Gov. Rick Perry (R) signed HB 2 into law, the number of Texans who traveled out of state to have an abortion increased to 681, a jump Rewire reported as amounting to more than the previous four years combined. Conservatives also tried to explain away the fact that prior to the implementation of HB 2, there were 41 facilities providing abortion services in the state; by the end of 2013, 16 of those facilities had either stopped providing abortion services or closed altogether. And they tried to manipulate the legal standard governing how courts review abortion restrictions to do so. Justice Breyer, his liberal colleagues, and even noted abortion rights skeptic Justice Anthony Kennedy finally put a stop to all that nonsense. Here’s how.

When upholding the Texas abortion restrictions, the Fifth Circuit relied heavily on a line of reasoning in Gonzales v. Carhartthe 2007 Supreme Court case that upheld the so-called federal partial-birth abortion act. As part of that decision, the Court ruled that when there is a question of scientific or medical uncertainty, legislators could essentially pick a side they agree with and draft laws accordingly. We’ve all witnessed what happened next. Anti-choice lawmakers in the states went bananas concocting abortion restrictions with not much more than a hand-wave that those restrictions were grounded in science and designed to advance patient safety. The Fifth Circuit Court of Appeals took that ruling one step further in the fight over HB 2 and ruled that once legislators announce their justification for an abortion restriction, there was little, if anything, the federal courts could do to second-guess that reasoning.

Not so, the Court ruled Monday. “The statement [by the Fifth Circuit] that legislatures, and not courts, must resolve questions of medical uncertainty is also inconsistent with this Court’s case law,” Breyer wrote. “Instead, the Court, when determining the constitutionality of laws regulating abortion procedures, has placed considerable weight upon evidence and argument presented in judicial proceedings” holding that the “Court retains an independent constitutional duty to review factual findings where constitutional rights are at stake.”

Justice Breyer put that last part in italics just to drive home that yes, when it comes to the fundamental right to abortion, the federal courts are not simply rubber stamps for state lawmakers.

With that point made clear, Breyer then laid out—basically in a listicle—the number of places the Fifth Circuit got its review of the data wrong as to the effect of admitting privileges on the availability of reproductive care. It’s an impressive list that goes on for pages and includes “[a] collection of at least five peer-reviewed studies on abortion complications in the first trimester, showing that the highest rate of major complications including those complications requiring hospital admission—was less than one-quarter of 1%” as “[e]xpert testimony to the effect that complications rarely require hospital admission, much less immediate transfer to a hospital from an outpatient clinic.”

There’s more, but Breyer summed it up nicely: “In our view, the record contains sufficient evidence that the admitting-privileges requirement led to the closure of half of Texas’ clinics, or thereabouts. Those closures meant fewer doctors, longer waiting times, and increased crowding.”

Moving on to those claims made by attorneys for the State of Texas that the ACS provisions in particular advanced patient safety, Justice Breyer dropped some more data bombs. “Nationwide, childbirth is 14 times more likely than abortion to result in death, but Texas law allows a midwife to oversee childbirth in the patient’s own home,” Breyer wrote.

Colonoscopy, a procedure that typically takes place outside a hospital (or surgical center) setting, has a mortality rate 10 times higher than an abortion. The mortality rate for liposuction, another outpatient procedure, is 28 times higher than the mortality rate for abortion. Medical treatment after an incomplete miscarriage often involves a procedure identical to that involved in a nonmedical abortion, but it often takes place outside a hospital or surgical center. And Texas partly or wholly grandfathers (or waives in whole or in part the surgical-center requirement for) about two-thirds of the facilities to which the surgical-center standards apply. But it neither grandfathers nor provides waivers for any of the facilities that perform abortions.

How good does it feel to hear the Supreme Court call shenanigans on lawmakers who insist the best way to protect the health and safety of patients is by making comprehensive reproductive health care impossible to access? Probably as good as it feels to hear the Supreme Court shut down in the same opinion all the nonsense from abortion rights opponents claiming rogue provider Dr. Kermit Gosnell is proof positive that all abortion providers are dangerous predators that require the kind of regulation advanced in HB 2. “Gosnell’s behavior was terribly wrong. But there is no reason to believe that an extra layer of regulation would have affected that behavior,” Breyer wrote. “Determined wrongdoers, already ignoring existing statutes and safety measures, are unlikely to be convinced to adopt safe practices by a new overlay of regulations. Regardless, Gosnell’s deplorable crimes could escape detection only because his facility went uninspected for more than 15 years.”

Breyer went on: “Pre-existing Texas law already contained numerous detailed regulations covering abortion facilities, including a requirement that facilities be inspected at least annually. The record contains nothing to suggest that H. B. 2 would be more effective than pre-existing Texas law at deterring wrongdoers like Gosnell from criminal behavior.”

And: scene.

Immediately, Monday’s decision means that similar TRAP restrictions in other Fifth Circuit states like Louisiana are likely to be found unconstitutional. In states like Missouri or Kansas, it’s too soon to tell how the decision will affect those kinds of laws, but advocates are no doubt looking into that issue right now given the opening Monday’s decision creates.

And importantly, it makes it much more difficult for anti-abortion lawmakers to advance additional restrictions like “dismemberment bans” without being able to scientifically prove those laws actually advance patient care. These are laws that would effectively criminalize surgical abortions pre-viabilty, and are anti-abortion lawmakers’ latest attempts to cut off access to abortion while claiming to advance patient safety.

This is why Whole Woman’s Health v. Hellerstedt has the potential to reach far beyond TRAP laws in the fight for comprehensive reproductive health care. Finally, we’ve got a Supreme Court decision that demands facts over rhetoric and data over belief, and doesn’t fall into the “difficult decision that people disagree on” false equivalence. Monday’s decision is a clear, data-driven defense of the importance of access to comprehensive reproductive health care and an affirmation of abortion as a fundamental right. And that kind of defense has been a long time coming.

Analysis Abortion

Data Shows Surge in Texans Traveling Out of State to Get an Abortion

Teddy Wilson

A Rewire analysis has found that while Texas data shows there has been a decline in the number of abortions in the state, data from other neighboring states suggests there has been a dramatic increase in the number of Texans traveling out of state to access abortion care since the passage of HB 2 in 2013.

Last week, the Texas Department of State Health Services (DSHS) was accused by the American Civil Liberties Union (ACLU) of Texas of deliberately attempting to conceal abortion statistics from 2014, the first full year provisions of the state’s omnibus abortion law were in effect.

DSHS has yet to respond to a letter from the ACLU of Texas demanding that the agency make those statistics available to the public.

The news comes as the Supreme Court is set to issue a ruling on Whole Woman’s Health v. Hellerstedt, which challenges provisions of the abortion law, HB 2, which lawyers of the abortion clinics argue place an undue burden on patients and providers in the state, impeding their ability to provide or access constitutionally protected health care.

DSHS officials finalized the statistics in March, according to the ACLU in a statement, but they have yet to release the full statistics to the public.

“The details are being reviewed for accuracy,” Carrie Williams, director of media relations for DSHS, told Rewire. “We did release the provisional total several months ago but can’t release the underlying details until they are final.”

Even without those details, a Rewire analysis has found that while DSHS data shows there has been a decline in the number of abortions in the state, data from other neighboring states suggests there has been a dramatic increase in the number of Texans traveling out of state to access abortion care since the passage of HB 2 in 2013.

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The number of abortions in Texas has been steadily decreasing since 2008, according to data from DSHS: Over the six-year period, the number has declined by nearly 22 percent. There were 81,591 abortions in 2008, 77,850 in 2009, 77,592 in 2010, 72,470 in 2011, 68,298 in 2012, and 63,849 in 2013.

Around that time, the number of Texans who traveled out of state to have abortions also steadily decreased, by nearly 57 percent from 2008 to 2012. There were 225 patients who had abortions out of state in 2008, 220 in 2009, 129 in 2010, 138 in 2011, and 97 in 2012, according to DSHS.

In 2013, the year Gov. Rick Perry (R) signed HB 2 into law, the number of Texans who traveled out of state to have an abortion increased to 681more than the previous four years combined. Prior to the implementation of HB 2, there were 41 facilities providing abortion services in the state, and 16 of those facilities had either closed or stopped providing abortion services by the end of 2013.

Trisha Trigilio, staff attorney at the ACLU of Texas, told Rewire that the statistics for out-of-state abortions for Texans are concerning. “This is more evidence of what was already proven in court: Texas’ onerous regulations unnecessarily block access to safe, legal abortion in our state,” Trigilio said in an email to Rewire.

Specifically, a study from the Texas Policy Evaluation Project showed the implementation of HB 2 has increased travel distances to clinics, out-of-pocket costs, and overnight stays.

At least 400 more patients traveled outside of Texas to have an abortion in 2014 than did in 2013, according to Rewire‘s analysis. Data collected by the state health departments of Arkansas, Kansas, Oklahoma, and Louisiana shows that at least 1,086 patients traveled to those states from Texas to obtain an abortion after portions of HB 2 took effect.

“Based on this [analysis from Rewire], it’s clear that this law doesn’t make women safer, it forces them to travel across the Texas border to get the care they need—and for women who can’t afford to leave the state, Texas law may prevent them from seeing a doctor at all,” Trigilio continued.

Texas Patients Seeking Out-of-State Abortions

In the wake of HB 2, more than half of the clinics that provide abortion services in Texas have been forced to close, leaving large swaths of the state without access to legal abortion care. The majority of the clinics that have remained open are located in major metropolitan areas: Austin, Dallas/Fort Worth, Houston, and San Antonio.

As clinics that once served rural areas have closed, patients have been forced to drive hundreds of miles away from their homes to one of the state’s major cities or cross the border into neighboring states. 

Arkansas has seen a slight increase since the passage of HB 2 in the number of patients from Texas seeking abortion care.

Arkansas’ Health Statistics Branch of the state health department tracks the number of patients from out of state who have abortions. There were 21 from Texas in 2012, 25 in 2013, 41 in 2014, and 33 in 2015.

Kansas has also seen a slight increase in the number of Texas patients seeking abortion care, according to statistics published by the Kansas Department of Health and Environment. There were two patients from Texas who traveled to Kansas to obtain an abortion during 2012, 13 in 2013,  23 in 2014, and 24 in 2015.

Oklahoma saw a noticeable increase in the number of patients from Texas seeking abortion care there after the passage of HB 2, according to data from the Oklahoma State Department of Health annual abortion surveillance report.

There were 21 patients from Texas who had an abortion during 2012 in Oklahoma, 59 in 2013, 136 in 2014, and 131 in 2015.

Based on Rewire‘s analysis, it seems as if no other state has seen a larger increase in patients from Texas seeking abortion care than Louisiana.

The Louisiana Department of Health and Hospitals (DHH) publishes data on abortions performed there collected by the State Center for Health Statistics (SCHS), but has typically not published data on the number of patients who live outside the state who have an abortion in Louisiana.

Preliminary SCHS figures for 2015 provided to Louisiana Right to Life, a state affiliate of the anti-choice organization National Right to Life Committee, included data on patients from out of state who obtained abortions in Louisiana.

There were 9,311 abortions performed in Louisiana during 2015, and patients from out of state accounted for 1,362 of all abortions performed in the state, according to DHH data published by Louisiana Right to Life.

The data did not include the states of residency for the patients from out of state, which the organization noted is “not available at this time.”

However, preliminary SCHS figures for 2014 provided to the Louisiana Right to Life did include details on the states of residency for patients who had an abortion in Louisiana. There were 10,211 abortions performed in Louisiana during 2014, and patients from out of state accounted for 1,432 of all abortions performed in the state.

Out of the 1,432 abortions had by residents from out of state, 886 were from Texas.

More and more pregnant people are traveling to New Mexico to access abortion care. About 20 percent of the roughly 4,500 abortions performed there in 2014 involved out-of-state patients, according to state health department data reported by the Albuquerque Journal.

Brittany Defeo, program manager with the aid group New Mexico Religious Coalition for Reproductive Choice, previously told Rewire that the people she assists represent a wide range of ages and backgrounds. “They’re ages 18 to 40. It’s all walks of life,” Defeo said.

Defeo estimates that approximately one third of those seeking abortion services in New Mexico from out of state are from Texas. If estimates are correct, that would suggest that approximately 300 patients traveled from Texas to New Mexico to obtain abortion care in 2014. 

Natalie St. Clair, who assists patients seeking abortion care with nonprofit Fund Texas Choice, told the Texas Observer that she helps about ten clients per month travel to New Mexico to access abortion care. St. Clair explained to the Observer that clients often express shock over the barriers in Texas to accessing  abortion care.

“I hear a lot of ‘I had no idea that the laws were this way. I have to go out of state?’ There’s a lot of shame and guilt because people think it’s their fault, or they weren’t prepared enough,” St. Clair said. “I explain that [Texas laws] are set up this way on purpose … [They’re] making abortion inaccessible on purpose.”

Trigilio told Rewire that this data shows that HB 2 was never about protecting patients’s health and safety as proponents have claimed. “When a woman makes the deeply personal decision to have an abortion, she needs access to safe medical care and respect for the decision she has made. HB 2 impedes that,” the ACLU of Texas staff attorney said.