A Pennsylvania woman is being charged with violating the Freedom of Access to Clinic Entrances Act (FACE) after allegedly shoving two clinic escorts who were assisting a patient outside a Planned Parenthood.
Meredith Parente, 55, violated the Freedom of Access to Clinic Entrances Act of 1994, according to the complaint filed in U.S. District Court, when on Jan. 15 she shoved two people who were escorting a potential patient to the facility. The Planned Parenthood location is the scene of frequent anti-abortion protests.
If guilty, she can be assessed a civil penalty of $15,000 and damages of $5,000 to the two victims, the complaint said.
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Anti-choice legislators in Pennsylvania recently pulled out all the stops when debating a bill that would be one of the nation's harshest abortion laws if passed. But in the wake of a recent Supreme Court ruling, other state lawmakers are trying to stop that bill and change existing policy.
With the new U.S. Supreme Court abortion ruling, some Pennsylvania lawmakers want to roll back provisions similar to those struck down in Texas—and to head off any new restrictions in a bill debated on the house floor in late June.
Several legislators have called for repeal of Act 122, which was enacted in 2012 and mandates that Pennsylvania abortion clinics meet the standards of ambulatory surgical centers.
The U.S. Supreme Court struck down Texas’ ambulatory surgical center provision in the 5-3 Whole Woman’s Health v. Hellerstedt decision. Justice Stephen Breyer concluded in the opinion that the provision represented a “substantial obstacle in the path of women seeking a previability abortion” and was unconstitutional.
Soon after the decision, Sen. Daylin Leach (D-Montgomery/Delaware), a member of the bipartisan Women’s Health Caucus of the Pennsylvania legislature, wrote a memo recommending repeal of Act 122. And at a June 30 press conference organized by the caucus, Rep. Steven Santarsiero (D-Bucks) introduced legislation to do just that. He weighed in on another bill, HB 1948, discussed in the house on June 21.
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During that debate, “[anti-choice lawmakers] were exposed, they were unmasked,” Rep. Santarsiero said. “They stood one person after another after another in support of [HB 1948], and they came right out and said this is all about the anti-choice movement. They were exposed. They tried 20 years ago to claim it was not about that, but they’re not making any pretense at this point.”
Like Act 122, HB 1948 is an urgent matter. Anti-choice lawmaker Rep. Kathy Rapp (R-Warren) introduced the latter legislation in April, which would be one of the most severe laws in the country if enacted. HB 1948 would ban abortion beginning at 20 weeks. It also includes a “method ban” provision, which would criminalize dilation and evacuation (D and E), often used after miscarriages and for abortions earlier than 20 weeks.
Currently, HB 1948 is still on the schedule of the Pennsylvania Senate Judiciary committee. Though the senate may reconvene this summer, it’s unclear when or whether HB 1948 will move forward.
But advocates must not lose sight of this bill.
A ‘Dangerous Precedent’
HB 1948 inserts the legislature into the doctor-patient relationship, forcing medical professionals, ordinary Pennsylvanians, and even some legislators out of the process. In April, lawmakers twice rejected requests for input on HB 1948 from both medical professionals and the public. When Rep. Dan Frankel (D-Allegheny) spoke out against the bill, his microphone was reportedly cut off.
Struggling to be heard, doctors and relevant medical associations sent open letters and wrote op-eds against the bill. “We are highly concerned that the bill sets a dangerous precedent by legislating specific treatment protocols,” wrote Scott E. Shapiro, president of the Pennsylvania Medical Society, in an April letter sent to legislators.
They are right to be concerned. Around the country, lawmakers with no medical training frequently propose method bans to criminalize the safest, medically proven procedures. They then threaten to imprison doctors if they don’t provide less-than-optimal care for their patients. This kind of legislative coercion brings to mind Donald Trump’s March statement that women who seek abortion should suffer “some form of punishment” for having an abortion.
Punishment, indeed. Under HB 1948, the punishment can go one of two ways: Either women receive less-than-optimal care, or doctors must be incarcerated. While considering the potential fiscal impact of HB 1948, lawmakers discussed how much it would cost to imprison doctors: $35,000 a year, the annual expense to care for an inmate in Pennsylvania.
My colleagues here at the Women’s Law Project, who co-authored a brief cited by Justice Ruth Bader Ginsburg in her Whole Woman’s Health v. Hellerstedt concurrence, have sent an open letter to senate leadership asking them to remove HB 1948 from further consideration.
The letter said:
If enacted, HB 1948 would inflict even greater harm on the health of Pennsylvania women than House Bill 2 would have inflicted on Texas women. Relevant medical experts such as the Pennsylvania section of the American Congress of Obstetricians and Gynecologists (ACOG) and the Pennsylvania Medical Society strongly oppose this bill.
Under well-established constitutional standards, HB 1948 is quite clearly unconstitutional.
The Strange Debate About HB 1948
For a while, HB 1948 seemed to have stalled—like much business in the legislature. It took more than 270 days to finalize the 2015 budget—an impasse that forced dozens of nonprofit organizations serving rape survivors, domestic violence victims, hungry children, and the elderly to lay off workers and turn away clients.
But in April, Pennsylvania lawmakers whisked HB 1948 to the floor within 24 hours.Then, on June 21, the bill suddenly sailed through the appropriations committee and was rushed to the house floor for third consideration.
HB 1948 passed the house after the kind of bizarre, cringe-worthy debate that makes “Pennsylvania House of Representatives” feel like an insult to the good people of the state. Surely, Pennsylvanians can represent themselves better than elected officials who want to punish abortion providers, liken abortions to leeches, ignore science, and compare abortion regulations to laws restricting pigeon shooting. Surely, they can do better than the legislators who hosted the June 21 farce of a debate about a bill designed to force women to carry unviable pregnancies to term.
At that debate, primary sponsor Rep. Rapp stood for questions about HB 1948. But when Rep. Leanne Krueger-Braneky (D-Delaware County) began the debate by asking Rapp about what doctors, if any, were consulted during the drafting of the bill, Speaker of the House Mike Turzai (R-Allegheny) halted proceedings to consider if such a question is permissible. Also a co-sponsor of the bill, he concluded it was not, offering the explanation that legislators can inquire about the content of the bill, but not its source or development.
Rapp eventually stated she had many meetings while drafting the bill, but refused to answer with whom. She invoked “legislator’s privilege” and insisted the meetings were “private.” Legislator’s privilege is an esoteric provision in the state constitution intended to protect the process from undue influence of lobbyists, not shield lobbyists from public inquiry.
The bill’s language—referring to D and E by the nonmedical term “dismemberment abortion”—echoes legislation promoted by the National Right to Life Committee (NRLC). The NRLC has also drafted boilerplate 20-week bans, along with Americans United for Life, an anti-choice organization and a leading architect of the incremental strategy for building barriers to access safe and legal reproductive health care.
Next, Rep. Madeleine Dean (D-Montgomery) asked Rapp if similar bills have been deemed unconstitutional in other states.
Indeed, they have. According to Elizabeth Nash, senior state issues advocate at the Guttmacher Institute, similar D and E bans have been blocked in Oklahoma and Kansas, and 20-week bans have been struck down in Arizona and Idaho. HB 1948 is one of the first pieces of legislation to combine both provisions into one bill; at the Women’s Law Project, we call it a “double abortion ban.”
But no one in the chambers would know that these anti-abortion restrictions have been obstructed because, once again, Speaker Turzai halted the proceedings over these questions. This time, he stopped the debate citing the house rule that lawmakers cannot ask a question if they already know, or the speaker suspects they know, the answer.
In any case, so it went. Pro-choice lawmakers of the Women’s Health Caucus of the Pennsylvania Legislature spoke out against the bill, reading letters from physicians and sharing tragic stories of family members who died after being denied abortion care during severe pregnancy complications.
When Rep. Rapp was asked if she knew that many severe fetal abnormalities were not diagnosed until or after the 20th week of pregnancy, she responded that many were not diagnosed until birth, which misses the point: HB 1948 is designed to deprive women who receive a diagnosis of a severe fetal anomaly, even unviable pregnancy, at 20 weeks or later of safe and legal abortion.
That’s alright with Rapp and others pushing HB 1948; the bill contains no exemptions for fetal anomalies or pregnancies that were a result of rape.
The bill’s supporters didn’t refute allegations that if passed into law, it would negatively affect health care. They argued their case by invoking metaphors instead. They compared abortion regulations to laws about pigeon shoots. They compared fetuses to bald eagles and abortion to leeches. A white male legislator, a description unfortunately almost synonymous with “Pennsylvania legislator,” compared abortion to slavery, drawing the ire of Rep. Jordan Harris (D-Philadelphia).
“We use slavery references when it benefits, but won’t do anything about the systems that negatively affect their descendants,” tweeted Rep. Harris.
The house voted 132-65 in favor of the bill, mostly among party lines, though 25 Democrats voted for it and nine Republicans voted against it. Gov. Wolf has promised he will veto it if passes, while HB 1948 proponents are working to gather enough votes for an override if necessary.
While attending UC San Diego (UCSD), Ireri Lora used her school ID at the university’s medical school to access birth control and other services.
Lora, who was undocumented then, told Rewire, “Sometimes you would see border patrol agents walking around or parked in their trucks, but they were always parked directly in front of the main hospital entrance. They would take people straight from the hospital [to a border patrol station], and they wanted us to see them do that.”
This behavior wasn’t unique to the UCSD hospital, Lora said. An acquaintance whose family members worked for border patrol in San Diego had told her that federal agents would drive around the perimeter of hospitals and park outside of them, presumably to intimidate non-citizens.
Every time Lora had to get her birth control prescription filled, she would make sure multiple people in her life knew where she was going so that if trouble arose, they would answer her call immediately.
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There are, however, California residents for whom none of this matters.
The reasons vary, but what is true across the board is that the more your identity is layered by race, gender, sexuality, and immigration status and the further your income falls below the federal poverty line, the less access you will have to sexual and reproductive health-care services—even in California. There are community-based groups working to fill this gap, but resources are in short supply for those fighting to expand access to undocumented people.
Stifled by Fear of Deportation
In August 2015, when Blanca Borrego, an undocumented mother of three, was arrested by sheriff’s deputies at her gynecologist appointment in Atascocita, Texas, some in the media rightly expressed outrage. But undocumented communities knew it wasn’t an isolated incident and that immigrants are detained and deported for seeking care all the time. Borrego was yet another example confirming some of their biggest fears.
“The fear that accessing [health] services will get you deported is very real in undocumented communities and what happened to Blanca [Borrego] isn’t at all unusual, so it’s not an unfounded fear,” said Alma Leyva, a research coordinator at the UCLA Labor Center’s Dream Resource Center, a national source for research, education, and policy on immigration issues. “She was insured and had been in the country for a long time. A lot of people think, ‘If that could happen to her, why couldn’t it happen to me?'” Leyva told Rewire.
Nearly three years ago, the Dream Resource Center sought to document the experiences of immigrant youth and their families in navigating California’s health-care system as part of its 2013 Healthy California Survey Project. From June 2013 to August 2013, a research team comprised of 37 immigrant youth surveyed 550 undocumented and “DACA-mented” young people. What resulted was Undocumented and Uninsured, the first statewide research project by and about immigrant youth on health access.
As the report explains, while Deferred Action for Childhood Arrivals (DACA) recipients under the age of 21 are eligible for Medi-Cal—the state’s free or low-cost health coverage for children and adults with limited income and resources—that doesn’t resolve a primary reason undocumented people and DACA recipients do not seek care: fear.
National policies contribute to high numbers of deportations and increase immigrant communities’ mistrust, such as the Priority Enforcement Program (PEP), which requires that all fingerprints of arrested persons taken by local law enforcement be sent to ICE to check against immigration databases, and Section 287(g) of the Immigration and Nationality Act, which allows DHS to “deputize selected state and local law enforcement officers to perform the functions of federal immigration agents.”
According to the Undocumented and Uninsured:
The police and Immigration and Customs Enforcement (ICE) are not only in immigrant neighborhoods but also in the minds of undocumented people, triggering constant anticipation of harm and hypervigilant behavior. Emerging research indicates that immigrant youth experience feelings of shame, anger, despair, marginalization, and uncertainty stemming from discrimination, anti-immigrant sentiment, xenophobia, fear of deportation, and institutional barriers. Daily economic uncertainties elevate the risk of anxiety, depression, and vulnerability to mental illness for immigrant youth. Emotional traumas manifest in poor physical and mental health, which often goes untreated.
Leyva told Rewire that she has heard stories “where an undocumented youth was asked by a doctor to relay really complicated medical jargon to their mom as she was giving birth. They were so afraid they wouldn’t translate the information properly that it would be dangerous to their mom,” she said.
“There is anxiety around simple check-ups and fear around obtaining resources to get healthier. We’ve come to believe that this is just the price of being undocumented in this country, and that’s not OK. We too deserve the right to not just survive, but to live full, healthy lives. Health care is a right, not a luxury,” Leyva said.
Dire Circumstances in Rural California
Lora became a legal permanent resident in 2015, but while living in San Diego as an undocumented college student she said her “biggest fear” was a scenario like what happened to Borrego in Texas. In 2009, while working on college campuses and connecting with undocumented families, Lora learned that it was a universal fear among undocumented women.
“When I asked the moms [I worked with] if any of them, about 20 in all, had visited any particular clinics, they all shared that they were scared to because they heard border patrol patrolled the area or that vans waited outside to get people who were leaving the clinic, especially if the clinic was one that primarily served the Latino community. Fortunately, none of the mothers I ever worked with had been stopped by border patrol for seeking services, but that environment made them too scared to go to a clinic,” Lora said.
By that time, she and a friend had started a program where they brought different workshops onto campus based on the expressed needs of the community. Overwhelmingly, Lora said, undocumented mothers requested workshops about sexual education and birth control.
Lora worked with local community clinics from the Barrio Logan area of San Diego to do biweekly workshops in Spanish about sexual health. That experience led her to ACCESS, an Oakland-based organization “founded in 1993 by clinic escorts who were moved to action after witnessing the many barriers women were facing—especially young or poor women—to actually obtain an abortion.” ACCESS further explains on its website that the organization combines direct services, community education, and policy advocacy to promote reproductive options and access to quality health care for California women. It is one of the only organizations in California that helps to provide abortion access to undocumented women while also using a reproductive justice framework created by women of color for women of color.
Lora, who is now on ACCESS’ board of directors, began working with the organization as a healthline intern. The healthline, as Lora explained, empowers callers by giving them all of the information they need to advocate for themselves. It was at this time Lora learned of the very specific barriers undocumented women living in rural areas face.
“They always voiced fears about visiting any government agency to get Medi-Cal or a clinic like Planned Parenthood because they thought they’d be deported or profiled for showing a foreign ID,” Lora said.
Vanessa Gonzalez-Plumhoff, Planned Parenthood’s director of Latino outreach and engagement, made it clear that the health-care provider would not put a patient in harm’s way. She told Rewire that Planned Parenthood is serious about addressing the needs of the undocumented community, asserting that Planned Parenthood will provide health care no matter what, regardless of immigration, citizenship, or income status.
The reason why the services provided to undocumented women may differ by location, Gonzalez-Plumhoff said, is because of the legislative, political, and financial climate of a particular area. As reproductive health care continues to be attacked, it limits what services are made available from clinic to clinic.
Unlike most states, California allows low-income women to obtain public funds for abortion and also provides them with co-pay-free family planning services. Abortions are legal up to viability and California’s AB 154, which took effect in January 2014, increased the number of abortion providers in the state. The law authorized nurse practitioners, certified nurse midwives, and physician assistants to perform vacuum aspiration abortion, which previously only doctors were allowed to do.
But, like in most states, there are districts in California where abortion providers are nonexistent. According to the LA Times, UC San Francisco’s Bixby Center for Global Reproductive Health is largely responsible for the passage of AB 154, but just a handful of the clinicians trained under the six-year study are practicing in remote corners of California. Schools like the UC San Francisco School of Nursing are developing new training programs, but at this point, half of California’s 58 counties currently have no readily available provider. And even when new programs roll out in rural communities, they will only benefit women seeking abortions during the first trimester, leaving out a segment of the population at risk of fetal anomalies or later pregnancy complications.
The process of obtaining an abortion as an undocumented woman living in a rural area is complicated. Lora said these women often work in the fields and live in migrant camps, which makes obtaining the passport that some clinics require as a valid form of ID challenging—and that’s mostly because of the lack of transportation, which Lora said is a “huge barrier” for undocumented women seeking such identification.
In addition, these women often have to travel to reach one of the few clinics providing later abortion care in the state.
“A lot of clinics near women in rural areas only offer abortion until the first trimester,” Lora said. “By the time they’re referred to us, they’re often beyond that point, so they have to get transferred to a clinic that’s even farther away. Transportation comes up again and again.”
This is where ACCESS’ “practical support program” comes in. The organization helps callers navigate paying for care, leveraging over $200,000 of coverage per year for medical procedures. Also, with support from its network of volunteers around the state and the organization’s pool of funds, ACCESS provides around $25,000 annually to help with transportation, housing, meals, child care, medical costs, and doula support.
One of the toughest cases Lora ever handled on the Spanish healthline was an undocumented rape survivor who lived in a rural area. Her family didn’t know of the rape or the resulting pregnancy. By the time ACCESS could walk her through all of the steps, she was in her 20th week. Following the multi-week process, which included acquiring an appointment and bus tickets, she then had to come up with a lie to tell her family as to where she was going for two days.
“The information is not accessible and the barriers can seem endless. That’s why it’s especially upsetting to me when ACCESS constantly hears this misconception that people in California—and women of color in particular—purposefully wait until the last minute to get abortions. It’s simply not true. Most of the women I’ve spoken to were very clear that they wanted to terminate their pregnancies early on, but they were forced to wait weeks because of limited access to information, limited access to clinics, and because of transportation barriers and language barriers,” Lora said. “If abortion was as accessible in California as they paint it to be, all women who wanted to terminate their pregnancies would be able to do it in a week.”
Community Groups Are Working to Replace Fear With Trust
There is no telling how many women ACCESS has helped, but what is clear is the ripple effect of the progress the group is making. ACCESS alumna La Loba Loca, who identifies herself as a queer, machona, brown South American migrant, formed Autonomous Communities for Reproductive and Abortion Support (ACRAS) three years ago. La Loba Loca’s collective, comprised of mostly queer people of color, provides free and low-cost abortion support to Angelenos. Her personal project, Serpiente Birth & Spectrum Services, supports individuals and families during life transitions through bilingual full-spectrum companionship and doula work.
La Loba Loca takes a multifaceted approach to her companion work, coupling an academic framework with traditional knowledge gained through personal research and non-Western education, which she calls “abuelita knowledge.”
“I got into birth work because of abortion. To me, there’s no place people can go that will holistically support them getting an abortion,” La Loba Loca said. “I want to normalize abortion as just another aspect of reproductive health and remind people of the ways our grandmothers took care of their health and well-being outside of the medical industrial complex. It’s medicine and knowledge that is generational and that shouldn’t be lost.”
Above all else, ACRAS works to share knowledge and resources within communities. La Loba Loca has tirelessly compiled documents about abortion and reproductive health for the purpose of being used by undocumented people who don’t have easy access to clinics and hospitals. “The idea was also to include people in the collective who have historically been left out of these conversations or who have been denied the same kind of access to reproductive justice as other people,” she said.
La Loba Loca has been a major proponent of queer and trans people of color receiving the proper training to be both birth and abortion companions. The language used around reproductive justice isn’t inclusive, she said, and it can make queer and trans people of color afraid to discuss their bodies and their needs and afraid to access services.
“I’m hearing a lot of queer and trans people try to figure that out, just because accessing abortion as a queer or trans person can be difficult or when you do obtain one, it can be dehumanizing,” she said. “Right now, there are queer and trans people doing reproductive justice work, but it’s very isolating and frustrating to never receive the funding that’s needed to provide education for and about different bodies.”
To La Loba Loca, the answer to the lack of access and the poor treatment that undocumented people and other low-income communities of color often receive at clinics and hospitals is not working to change these systems, but rather using community-based resources to find ways around the structural hurdles. Roxana, an ACRAS member who requested that Rewire not use her last name, said that the road to sexual and reproductive justice has been built on the backs of women of color and the long history of institutions being harmful to communities of color who are already vulnerable is not something that can easily be overcome.
“I think of the Latinas in L.A. who were coerced into sterilization in the 1970s and how that distrust lingers in the community,” Roxana said. “The trauma stays, and it continues to be a barrier that scares people from going to an institution that historically been violent to people who look like them. It’s only harder when you’re undocumented.”
Like Lora, Roxana realized through her work that immigrant communities, Latino communities, and undocumented communities are all in need of sexual and reproductive health information that is in their language and that comes from people they trust.
At an ACRAS workshop around reproductive justice, according to Roxana, the age of attendees ranged from 15 to 65. A woman specifically asked if it was OK that her teenage daughter was there because she wanted her to have the information that she never did. ACRAS workshops bring a LGBTQ lens and the mother and her daughter were eager to learn about reproductive health for different communities and learn about gender and sexual identities that go beyond the binary. Roxana said the interest is there; it’s just a matter of providing it in a way that’s accessible.
“We’re having real conversations about real experiences and for me, as a person who does this work, it’s very political and very personally meaningful. It’s heart work; it comes from the heart,” Roxana said, growing emotional. “I want to go beyond ‘your body, your choice.’ I’m not really into that, especially because for a lot of us, what happens to our bodies isn’t a choice. For me, it’s more like ‘I got your back.’ ACCESS and collectives like ACRAS serve a very important purpose in our communities. We’re creating alternatives to a system that wasn’t meant for us and we’re providing access to people whose existence was never even considered. We have each other’s backs.”
CORRECTION: This piece has been updated to clarify ACCESS’ funding for “practical support.”