Analysis Politics

The Mammogram Diversion: Is Komen Laying the Groundwork to Reject Planned Parenthood Proposals?

Jodi Jacobson

Komen's ostensible new strategy, to focus its prevention grants "only on mammograms," would not only exclude Planned Parenthood clinics from eligibility, but would also deny tens of thousands of low-income and uninsured women medically-indicated primary preventive breast health services and, potentially, leave many with undiagnosed breast cancers.

See all our coverage of the Susan G. Komen Foundation’s break with Planned Parenthood here.

Is the Susan G. Komen Foundation using a “mammogram diversion” as a precursor to denying Planned Parenthood state affiliates access to future grants for breast cancer education and screening? 

Komen’s ostensible new strategy, to focus its prevention grants “only on mammograms,” would not only exclude Planned Parenthood clinics from eligibility, but would also deny tens of thousands of low-income and uninsured women medically-indicated primary preventive breast health services and, potentially, leave many with undiagnosed breast cancers.  This at a time when there is an urgent need among low-income and underserved women–those served by Planned Parenthood–for greater access to primary preventive care. Yet even despite the lack of medical evidence for the strategy, the far right anti-choice publicity machine went into high gear over the weekend in what seemed like a pre-emptive strike in support of it.

Last week, Komen created a firestorm when it said that Planned Parenthood affiliates would be prohibited from applying for the breast cancer education and screening funds they had been getting for five years. The first of what turned out to be a changing list of reasons was “a new policy” denying funding to any organization “under investigation” and specifically pointing to Planned Parenthood, which is the target of any number of witch hunts but no actual investigations. (Curiously, the new policy did not, apparently, apply to Penn State University, which is under actual criminal investigation, nor to a long list of universities and corporations in which researchers and others are under investigation and to which Komen money continues to flow.) Komen executives and board members at first vociferously denied the move was political, but they’ve now been caught out by emails provided to Laura Bassett of the Huffington Post which make clear that Karen Handel, Komen’s anti-choice Senior Vice President of Policy, was the architect of the new policy, and by reports that former Bush spokesman Ari Fleischer also was involved. Moreover, Jane Abraham, General Chair of the virulently anti-choice Susan B. Anthony List continues to sit on Komen’s advocacy board right there alongside Komen Chief Executive Officer Ambassador Nancy Brinker.

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Then came Part Two. As the backlash against the “investigation exception” grew out of control, Brinker came out with another reason that their grant criteria were changing: They want to focus directly on mammograms.

During Komen’s damage-control press conference, for example, Brinker told reporters:

“We have decided not to fund, wherever possible, pass-through grants. We were giving them [Planned Parenthood] money, they were sending women out for mammograms. What we would like to have are clinics where we can directly fund mammograms.”

She further stated:  

“We look at the quality of the grants,” Brinker said. “We don’t like to do pass-through grants anymore.”

Pass-through? Is an OB/GYN or a primary care provider such as an internist a “pass-through?” Or are they part of the continuum of care? Because except in highly unusual circumstances, women don’t generally walk into a radiology clinic for a mammogram without having first seen and obtained an order for a mammogram from a primary care provider. In some states, such as Maryland, low-income women cannot get a state-subsidized mammogram without first going to, being examined by, and getting an order for a mammogram from a licensed primary care provider.

Mammograms are only one part of comprehensive breast health strategies that begin with breast health education and self-awareness, collection of personal medical histories and risk factors, and conducting clinical breast exams. So is Komen trying to prevent and catch the greatest number of breast cancers at the earliest possible stages, or is it using mammograms as a foil for de-funding Planned Parenthood?

Until a few years ago, women were constantly told to conduct monthly self-examinations and, unless we discovered something in between appointments, to have our breasts checked annually by our primary care doctors. We were also told to get annual mammograms starting at age 40.

Now, however, that has changed. Public health bodies such as the United States Preventive Services Task Force (USPSTF) and the American College of Obstetricians and Gynecologists (ACOG) have reviewed the evidence on breast cancer prevention strategies, and have arrived at different conclusions. As a result, recommendations for breast cancer prevention are now in flux, and in fact are somewhat controversial.

Nonetheless, none of the new recommendations support Komen’s new strategy.

Guidelines released in 2009 by the USPSTF, for example, suggest that evidence does not support the efficacy of breast self-exams. They also state that only women ages 50 and older should be getting mammograms, and then only every other year until they are between the ages of 70 and 75 years. By contrast, ACOG, the American Cancer Society (ACA), the National Cancer Institute (NCI), and the National Comprehensive Cancer Network (NCCN) all still recommend mammograms for women ages 40 and over either every year or every other year.

The differences in mammography recommendations lie in part in the emphasis put on  risk-benefit calculations. Mammograms involve radiation and therefore carry risk. The USPSTF based its recommendations in part on the fact that the majority of breast cancers occur in women age 50 and older and the fact that repeated mammograms expose women to additional radiation which itself is a risk factor for cancer.  The others maintain that the risk is worth it for finding cancers in younger women which, though fewer in overall numbers, according to ACOG, have a lesser “sojourn time,” or the time in which it takes the cancer to grow and spread.

But again, mammograms are only part of the equation. All of these groups recommend clinical breast exams conducted by primary care givers at varying intervals.  But none except NCCN still recommend monthly breast self-exams as a primary preventive practice, suggesting instead that primary providers work with patients to increase “breast self-awareness.”

An ACOG breast health bulletin, for example, states:

Breast self-examination is the performance of an examination of the breasts in a consistent, systematic way by the individual on a regular basis, typically monthly. Historically, physicians have been encouraged to educate their patients on how to perform these examinations, and public awareness campaigns have focused on this intervention. It still may be appropriate for certain high-risk populations and for other women who choose to follow this approach

Currently, there is an evolution away from teaching breast self-examination toward the concept of breast self-awareness. The College, the American Cancer Society, and the National Comprehensive Cancer Network endorse breast self-awareness, which is defined as women’s aware-ness of the normal appearance and feel of their breasts. This concept has arisen because approximately one half of all cases of breast cancer in women 50 years and older and more than 70 percent of cases of cancer in women younger than 50 years are detected by women themselves, frequently as an incidental finding (29, 30). In addition, the effectiveness of self-examination was at odds with what was anticipated based on the aforementioned statistics.

Breast self-awareness should be encouraged and can include breast self-examination. Women who desire to perform self-examination as a part of this breast self-screen awareness strategy may be instructed in the appropriate technique, although emphasis is not on examination techniques. Women should report any changes in their breasts to their health care providers. Although this patient education strategy has not been studied to date, breast awareness may be of particular importance as part of a screening strategy because some women may falsely assume that negative mammography or clinical breast examination results definitively exclude the presence of breast cancer. New cases of cancer can arise during screening intervals, and breast self-awareness may prompt women not to delay in reporting breast changes based on false reassurance of recent negative screening result. Breast self-awareness aims to capture the importance of self-detection and prompt evaluation of symptoms because it relates to overall breast cancer morbidity and mortality. However, the effect of breast self-awareness education has not been studied.

The bottom line in all of this is that recommended breast cancer prevention practices now are based on increased not reduced connection and communication with a primary care provider of the kind Planned Parenthood represents to its clients.

Even the radiologists on Komen’s board agree: Dr. Kathy Plesser, a New York City radiologist and member of Komen’s scientific advisory board, said she would resign if Komen did not reverse its decision, according to the New York Times.

“I strongly believe women need access to care, particularly underserved women,” Dr. Plesser said. “My understanding is that by eliminating this funding, it will jeopardize the women served by Planned Parenthood in terms of breast care.”

And if the focus is on “outcomes,” Planned Parenthood clinics have proven they use their funds effectively. From a report by John Tomasic:

According to numbers made public by Komen this week, Komen gave Planned Parenthood of the Rocky Mountains $125,000 last year, or 4.3 percent of the nearly $3 million Komen spent fighting breast cancer. Yet Planned Parenthood clinics here detected nearly 20 percent of all of the cases of breast cancer discovered through Denver Komen spending, which supports roughly 40 organizations operating clinics, shelters, hospices, research facilities and so on mostly across the northern Front Range but also in Summit, Park and Douglas Counties.

In fact, just last year, Brinker herself strongly lauded Planned Parenthood and underscored the importance of Komen’s relationship with them for all of the reasons above.

Nonetheless, Komen’s new mammogram theme suggests that “Plan B” for the Foundation and the anti-choice community for denying future funds to Planned Parenthood’s clinical breast health education and clinical care programs may be “the mammogram diversion.”

The indication that something more than a foundation reconsidering its guidelines was going on came this past weekend, when the anti-choice community, which never lets medical and public health evidence get in the way of a good ideological crusade, began chanting “they don’t do mammograms” with the precision of a well-crafted and coordinated far-right talking-point campaign.  

For example, almost immediately as Komen’s press conference was over, the good soldiers of the anti-choice army such as the Washington Post’s Kathleen Parker immediately began deploying the mammogram diversion. Parker wrote:

To recap: Komen created a firestorm with its recent decision to stop donating about $680,000 a year to Planned Parenthood. (On Friday, Komen released a statement noting that Planned Parenthood will be eligible for future grants, although they won’t be guaranteed.) The bulk of that money was supposed to be used for breast cancer screening. Most Planned Parenthood affiliates don’t do mammograms but refer women elsewhere, sometimes reimbursing them using Komen funds.

George Will and Dana Loesch joined the fray on ABC’s “This Week” with George Stephanopoulos, where both complained that Planned Parenthood does not do mammograms.  Loesch said:

Now, you would think at some point in the past — it’s been a year to the date since Live Action called Planned Parenthood clinics in 27 different states to ask whether or not they had mammography machines. You would think that at that point — they’d had a year — Planned Parenthood would invest in obtaining licenses to operate and own mammography machines and give mammograms so they could have avoided this whole thing.

And Will stated:

This is not about women’s health. This is about providing 300,000 abortions a year. They — Planned Parenthood cleverly cast this to say we are in the mammogram business. They’re not in the mammogram business. They’re in the referral of mammograms.

Planned Parenthood Federation of America has never said it does mammograms. Planned Parenthood clinics do, however, serve as a gateway to mammograms when they are needed, just as your OB/GYN or internist would do. But first it also does what any good medical provider does: a family history, an exam, breast health education, clinical examination and the like, all the while offering other primary care, ranging from diabetes and blood pressure screening to Pap smears and contraceptive delivery. In short, Planned Parenthood clinics provide the same services to women as does a private OB/GYN, the difference being that for the low-income, uninsured or under-insured women Planned Parenthood is their OB/GYN and primary care provider. 

We can perhaps expect the staunchly anti-choice George Will–who is obviously not a woman though he likes to speak for them–to mislead people with this deliberately mis-informed Lila-Rose nonsense. But surely Dana Loesch has at some point in her life turned to an OB/GYN (and Dana, if you haven’t, go get a check up!). And surely having done so must have undergone a breast exam and discussion with her primary care provider at some point, or at least is aware these happen? Or is she so far out in right field she knowingly lies for the sake of being part of the anti-choice old-boys club?

There are good reasons Planned Parenthood does not do mammograms and good reasons why Komen should continue funding them nonetheless. Planned Parenthood refers and has always referred for mammograms because that is what primary care providers do. Mammograms are a specialized intervention done and evaluated by radiologists trained to conduct and read them. Planned Parenthood doesn’t do them for the same reason your OB/GYN doesn’t do them. They are part of a continuum of care in which different actors play different roles.

Yet it is a theme the right has been beating so forcefully the past several days it can’t be called anything but a coordinated campaign. The low-income, uninsured and under-insured women who come to Planned Parenthood for basic reproductive health care and gynecological exams do so because Planned Parenthood doctors and nurses are their OB/GYNs and primary care providers.

If Komen suddenly decides it is no longer about comprehensive breast cancer prevention services, it will be deciding as well to abandon those low-income and uninsured women whose primary care its grants were helping to support. And it will underscore that the anti-choice community–and now Komen with it–are less concerned about the health and rights of real women in need than they are about ideology and politics.  It will also be acting in the interest of reducing rather than increasing access to the low-income, uninsured and under-insured women of color who die at higher rates from breast cancer in large part because they lack access to such routine primary preventive care. As a breast cancer foundation, one would think Komen would be pouring more, not less, money into groups like Planned Parenthood.

From what I’ve seen, the vast majority of those millions of women and men whose own money make up the resources of the Susan G. Komen Foundation–the racers, walkers, neighborhood fund-raisers, and buyers of “pink” products–are more interested in saving people’s lives.

Analysis Politics

The 2016 Republican Platform Is Riddled With Conservative Abortion Myths

Ally Boguhn

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

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

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

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

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

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

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

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

Myth #1: Planned Parenthood Profits From Fetal Tissue Donations

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Analysis Abortion

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.

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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.

071midyearstateabortionstable

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.