Commentary Abortion

Winning the Race for Choice? We Need Missy “the Missile” Franklin’s Gold-medal Strategy

Rebecca Sive

"There is no silver in politics," as Carol Bellamy, girl politico and former director of UNICEF, said to me recently. While we're still swimming, we're not winning the race to keep abortion safe and legal.

Last week, our sisters at the Center for Reproductive Rights wrote about the “stunning decision by a district court judge upholding …an unconstitutional Arizona law… set to go into effect on August 2nd.” I read it and I was heart-sick. What next in this never-ending war on women?

Later in the day, The Center for Reproductive Rights and the American Civil Liberties Union … filed an emergency motion

Got that? “…per se unconstitutional.” That’s because the Arizona law is contrary to Roe v. Wade and Planned Parenthood v. Casey, America’s law of the land guaranteeing women’s right to safe and legal abortion.

Happily, later in the week, the Ninth Circuit “…blocked enforcement of Arizona’s 20-week abortion ban, signed into law earlier this year by Governor Jan Brewer….The bill is considered by many to be the most restrictive ban in the nation, and may present a direct challenge to Roe.”

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While we depend (and ever so gratefully so) on our sisters at the Center for Reproductive Rights and the American Civil Liberties Union (ACLU) to fight unceasingly in the courts to preserve whatever portions of this right they can, the sad truth is that the legal history of the battle to preserve the constitutional right to abortion has been death by a thousand cuts–for decades. And there is no end to the cutting in sight.

“There is no silver in politics,” as Carol Bellamy, girl politico and former director of UNICEF, said to me recently. Well, that about sums-up where we’re at this Olympics week. While we’re staying afloat and still swimming, we’re not winning.

So, what is our “gold medal strategy” to preserve American women’s constitutional right to safe and legal abortion?

According to People magazine, American swimmer Missy Franklin, my favorite Olympic gold medal winner, is nicknamed “the Missile.” Describing her wins last Monday (that same day of the miserable Arizona court decision), the Guardian wrote: “…resting her hands on her hips, [Franklin] looked straight down her empty lane. This was Franklin in missile-launching mode – and the explosive burst of her finish would not be denied.”

Girl-politico girlfriends: I say to you we need to take a page from the Franklin playbook: We need to get into “missile-launching mode.” (Enough with the metaphors you say? Bear with me: I’ve got just one more.)

As I see it, the failure of our current advocacy strategy to maintain federally, constitutionally-protected safe and legal abortion has been the steady unwillingness, not to say fear, to even be willing to get in the pool and clear the lane, much less launch down it to victory. Instead, we have joined and stayed in the crowd around the pool, milling around (the halls of Congress, say) while talking reasonably about fairness and choice, never launching towards a finish that “wouldn’t be denied.”

Well, girlfriends, that’s not a gold medal strategy, as the recent missile attacks in Arizona and Mississippi attest.

What is a gold-medal strategy is electing tens of thousands more pro-choice women to office and advocating for the appointments of thousands more as judges and other decision-making government officials. We can do this. We are the majority of American voters. We are overwhelmingly in favor of birth control. (And when birth control doesn’t work, abortion is an option a majority of women consider.) Further: When women run women win. And even further: When women take and hold office, they look out for other women in ways that men don’t and have never done (Just look at the history of laws protecting rape and domestic violence victims in case you doubt me).

Just like American women have singularly focused on winning in sports competitions, so much so that they are the majority of the 2012 American Olympics team, pro-women’s rights American women can singularly focus on becoming the majority of America’s public officials. We need only focus like American-girl missile Missy Franklin. Let’s launch towards this goal in time for the next Olympics.

Roundups Politics

Campaign Week in Review: Cruz Likens His Supreme Court Pick to ‘Lord of the Rings’ Character

Ally Boguhn

This week on the campaign trail, Donald Trump and Ted Cruz spoke about whom they would nominate for the vacant Supreme Court seat, and Trump saw his favorability plummet among women.

This week on the campaign trail, Donald Trump and Ted Cruz spoke about whom they would nominate for the vacant Supreme Court seat, and Trump saw his favorability plummet among women.

Cruz, Trump Discuss Their Supreme Court Nominations

Republican presidential candidates Sen. Ted Cruz (R-TX) and Donald Trump were hard at work dreaming up possibilities for a Supreme Court nominee should the Senate obstruct Obama’s pick for the vacancy.

Appearing at a rally over the weekend for Sen. Mike Lee’s (R-UT) bid for re-election, Cruz commented that Lee “would look good” on the Supreme Court. Cruz compared Lee to Gollum, a character from Lord of the Rings, claiming that “For Mike, the Constitution is ‘my precious,'” according to the Salt Lake Tribune. 

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Lee’s work opposing abortion during his time in Congress earned him a 100 percent rating from the anti-choice National Right to Life Committee. The Republican senator has supported several measures attempting to limit access to or outright ban abortion, including a 2013 bill to investigate all abortion clinics and extend “personhood” rights beginning at the moment of fertilization, which could outlaw many forms of birth control in addition to abortion.

Lee’s 2010 campaign website included a section noting his opposition to legal abortion and Roe v. Wade:

The Constitution says nothing that can plausibly be read to suggest—as the Supreme Court concluded in Roe v. Wade—that States are essentially powerless to protect unborn human life. This power to protect the most vulnerable members of society needs to be returned to the States.

Donald Trump also signaled he was mulling over potential picks for the Court’s vacancy, promising during a Monday press conference in Washington, D.C., to release a list of seven to ten potential picks. If elected, Trump vowed to choose nominees exclusively from the list, which he said will be created by the “Heritage Foundation and others.”

But as ThinkProgress reported, the Heritage Foundation “is an odd place for a presidential candidate to seek advice on any topic” given its history of discriminatory politics:

Heritage is a think tank known for its stridently conservative views and its unorthodox approach to mathematics. They oppose marriage equality, defend discrimination against LGBT Americans, and they have a surprisingly long history of reversing their own stances on health policy when doing so is useful to opponents of Obamacare. Their former chief “economist” is an ex-newspaper columnist and anti-tax activist with no doctorate in economics.

In 2013, Heritage released a widely criticized report claiming that immigration reform would cost an eye-popping $6.3 trillion. One of the co-authors of that report resigned four days later after news broke that “his graduate dissertation on immigration was premised on the idea that Latinos were less intelligent than whites.”

The Heritage Foundation is vehemently anti-choice, a position that could inform its picks for the Court. The organization’s “Solutions 2016” policy recommendations include calls to expand bans on using federal funding for abortion, redirect funding for reproductive health away from Planned Parenthood to community health centers, and codify protections for “medical personnel who decline to provide, pay for, provide coverage of, or refer for abortions.” Its website also details the organization’s opposition to Roe v. Wade, dismissing the decision as “judicial activism.”

Poll: 74 Percent of Women Registered to Vote Hold Unfavorable Views of Trump

A CNN/ORC International poll released Thursday found that Donald Trump is viewed unfavorably by 74 percent of registered women voters and 81 percent of people of color.

The poll, which asked registered voters whether they “have a favorable or unfavorable opinion” of presidential candidates, shows potentially major hurdles for the Republican front-runner moving into the general election. Comparably, 50 percent of women and 36 percent of “non-white” people polled said they had an “unfavorable” view of Hillary Clinton.

Polling from the Washington Post similarly found that Trump’s favorability among women has been steadily decliningjeopardizing the Republican Party’s already tumultuous relationship with women. “Trump’s favorability numbers have decreased 10 points among women nationwide since November, to 23 percent, while his unfavorable number among women has jumped to 75 percent from 64 percent, according to a Washington Post-ABC News poll taken this month,” reported the Post.

What Else We’re Reading

Franklin Foer explained for Slate that “there’s one ideology that [Trump] does hold with sincerity and practices with unwavering fervor: misogyny.”

The Washington Post’s Karen Attiah wrote about the sexism she experienced from Donald Trump after asking him a policy question during his sit-down with the paper’s editorial board.

ThinkProgress’ Aaron Rupar explains how the Republican presidential race has turned into a “sexist competition over whose wife is hotter.”

Voters in Arizona had to wait in line as long as five hours to cast a ballot in their state’s Tuesday primary thanks to a Supreme Court decision that “gutted” the Voting Rights Act (VRA) and “an ill-conceived decision” to cut polling locations in order to save money. As the Nation reported, “Phoenix’s Maricopa County, the largest in the state, reduced the number of polling places by 70 percent from 2012 to 2016, from 200 to just 60—one polling place per every 21,000 voters”a change that “would very likely have been blocked” had the VRA’s protections remained intact.

Bernie Sanders applauded Phoenix Mayor Greg Stanton’s request for a Department of Justice investigation into voting delays in Maricopa County.

Dark money groups in Wisconsin are outspending candidates on ads for the Wisconsin Supreme Court race. When voters head to the polls for the April 5 judicial elections, “they won’t know who funded most of the ad spending around this race,” said the Sunlight Foundation’s Libby Watson.  

Analysis Science

The Miseducation of California Nurses: Legal Loophole Enables Spread of Anti-Choice Medical Myths

Nicole Knight Shine

Heartbeat International and other anti-choice groups treat abortion pill reversal as if it’s a medical fact, but the science behind it is scanty, at best.

In a St. Louis high-rise hotel last April, health-care workers filed into a conference room to learn about the myth of undoing a pill-induced abortion, also called abortion pill reversal. The workshop, hosted by the anti-choice giant Heartbeat International, promised nurses in attendance that they could earn continuing education credits from a state some 1,700 miles away: California.

Missing from the conference materials was any disclosure saying that the medical establishment, including the American Congress of Obstetricians and Gynecologists (ACOG), rejects the so-called science behind abortion pill reversal. Instead, Heartbeat International displayed the medical imprimatur of the Golden State: “Provider approved by the California Board of Registered Nursing, Provider Number CEP 16061 for 1.25 contact hours for each workshop.”

How has Heartbeat International, along with other anti-choice organizations, co-opted a narrow area of health-care law in one of the country’s most progressive states? The answer exposes regulatory holes in the post-graduate education of California nurses.

Continuing education credits are required of nurses and doctors to maintain licensure in California and other states. The rationale is to ensure that health-care professionals, after the completion of their formal education, remain abreast of medical developments in order to safeguard patients and to, when appropriate, shape their care.

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Heartbeat International and other anti-choice groups have treated abortion pill reversal, both in courses offering these education credits and elsewhere, as if it’s a medical fact—but the science behind it is scanty, at best.

A single 2012 paper in Annals of Pharmacotherapy claimed to have reversed the medication abortions of four of six women included in the study.

A medication abortion, typically performed early in a pregnancy, involves the administration of two pills: mifepristone and misoprostol. Mifepristone blocks receptors for the hormone progesterone, causing the embryo to detach from the uterine wall, while misoprostol causes the uterus to contract and expel the pregnancy. The FDA-approved treatment, according to the Guttmacher Institute, accounts for more than one-quarter of abortions before nine weeks.

But by administering dosages of the hormone progesterone after mifepristone, anti-choice doctors claim they can “reverse” an abortion.

Experts say the six cases cited in the Annals of Pharmacotherapy paper are insufficient to draw conclusions. ACOG, a professional organization of 58,000 OB-GYNs and women’s health-care professionals, is dismissive of the purported treatment.

“There is really no clear evidence that this works,” said Dr. Daniel Grossman, ACOG fellow and director of Advancing New Standards in Reproductive Health, a research group at the University of California, San Francisco, in an interview with MedPage Today about the “science” behind abortion pill reversal.

Four years ago, when Heartbeat International applied to the California Board of Registered Nursing to teach continuing education courses, it listed Debbie Bradel, RN, as an instructor. Bradel is one of the foremost advocates of abortion reversal and has been for years. She is on the staff of the “abortion pill reversal program” at a San Diego area clinic, which claims to have a network of hundreds of doctors nationwide who advocate for the medically questionable procedure.

Bradel was not made available for an interview with Rewire, but her supervisor, medical director Dr. George Delgado, described the course, “Abortion Pill Reversal and Your Clinic,” which Bradel taught last year at the April St. Louis Heartbeat International conference. The class, Delgado said in a phone interview, was “given to licensed pregnancy centers for women who might be interested in changing their minds after taking the first pill.”

Delgado offered his own statistics to back the treatment, saying abortion pill reversal has resulted in about 145 births, with a success rate of 55 percent. He said between 75 and 80 women nationwide are pregnant right now, having undone their abortions with dosages of progesterone.

The class that Bradel taught, Delgado said, “describes the process for the reversal in great detail.”

When Rewire showed the course description to Diana Taylor, professor emerita with the UCSF School of Nursing, she said it was difficult to know the true nature of the class without a syllabus or course objectives, but she noted that the overall tone seemed skewed toward persuading, rather than informing.

“It made me think they’re re-framing their purpose, which is to keep women from having abortions,” Taylor said. “I think that we would really need to see those courses. If I were in that classroom, I guess I would be listening very carefully to how they talk about implementing these skills … because it’s counter to [the] nursing code of conduct to not give full information.”

Delgado did not respond to Rewire’s request for class materials, such as a syllabus or learning objectives, by deadline.

Screenshot 2016-01-15 10.34.35

Bradel’s “Abortion Pill Reversal and Your Clinic” course was among those available for health-care workers at the Heartbeat International conference in St. Louis.

A Loophole Welcomed by the Anti-Choice Movement

California is something of a standard-bearer for reproductive rights. The state in recent years passed a law allowing women to obtain birth control from pharmacists and has forced crisis pregnancy centers (CPCs), faith-based facilities that often masquerade as abortion clinics, to make disclosures about the availability of abortion care and birth control services. And in what may serve as a model for municipalities nationwide, San Francisco demands truth in advertising for CPCs, which frequently use misinformation to dissuade women from ending their pregnancies.

Heartbeat International, in contrast, is known for its nationwide billboards—“Pregnant? Scared? Need Help? Call us…”—designed to ensnare women seeking abortions. The Ohio-based organization is the umbrella group for 1,800 CPCs on six continents with the singular goal of “saving babies.”

That Heartbeat International is teaching nurses about abortion pill reversal capitalizes on something of a loophole in California law.

The California Board of Registered Nursing is part of the state Department of Consumer Affairs, which encompasses 40 boards, bureaus, committees, and a commission that each year, according to a state audit, process more than 350,000 applications for professional licensure and an estimated 1.2 million license renewals.

The law requires the state Board of Registered Nursing to vet nursing continuing-education providers, which range from private companies to universities. But it leaves it to approved providers to ensure the class material is lawful.

To become a state-approved provider, applicants complete a six-page application, including instructors’ qualifications and class descriptions, such as content and objectives. By law, the class content, according to the state Board of Registered Nursing website, “must be related to the scientific knowledge and/or technical skills required for the practice of nursing, or be related to direct and/or indirect patient/client care.”

Heartbeat International on its application, which Rewire received a copy of through a public records request, listed a single, benign-sounding course: “Knobology Applications: Or How to Get Better Pictures.”

Applications are then reviewed by licensed registered nurses, explained Christina Sprigg, chief of licensing and administrative services with the state board.

“We do not approve courses, we only approve the providers,” Sprigg said in a phone interview with Rewire.

Gaining approval appears to be almost a slam dunk. Figures provided by the California Board of Registered Nursing indicate that from 2012 to 2014, it received 764 applications and approved 82 percent. The board doesn’t outright deny applications, an agency spokeswoman explained in an email, but instead rates applicants as deficient, giving them up to two years to remedy any shortcomings needed to gain approval.

Once approved, providers essentially police themselves. Audits are rare and officials said they have never audited Heartbeat International, or two other major anti-choice providers, Care Net and the National Institute of Family and Life Advocates, whose applications were approved years ago when Arnold Schwarzenegger was governor.

In response to Rewire’s request for the number of total audits performed between 2012 and 2014, the agency said it “does not have any data on the number of provider audits completed for these periods of time.”

The board’s Sprigg put it simply: “It’s very few, only because we don’t have the staff to conduct the audits.”

It’s difficult to say whether California’s lax practices are standard across the country, or an outlier. The absence of a national governing body over continuing education means that regulation is left up to individual states, explained a spokeswoman with the National Council of State Boards of Nursing, an advisory body.

Problems with the California Board of Registered Nursing are not new. Investigations by ProPublica and the Los Angeles Times found widespread failures to discipline nurses for misconduct. The board took more than three years, on average, to investigate and discipline errant nurses, according to its own statistics, a process that in other states typically takes a year or less.

Dr. Pratima Gupta, a reproductive health advocacy fellow with New York City-based Physicians for Reproductive Health, worries that the system leaves California open to political exploitation.

“I think the concern is there isn’t enough bandwidth to do quality control, so there’s incorrect information out there,” Gupta said in a phone interview.

Allowing state-approved providers like Heartbeat International to dispense biased medical information, Gupta contends, is a public health problem.

“These courses are giving continuing-education nursing credits and they are disseminating incorrect information,” Gupta said.

Rewire has provided the state Board of Registered Nursing with the descriptions of the abortion pill reversal class and others offered by anti-choice groups that the state has approved as continuing education providers. The board, in written responses, repeatedly cited state law that said the agency is not required to approve courses.

The agency passed the buck to the continuing education providers, writing “California Code of Regulations section 1454 requires the approved provider to accept full responsibility for each course taught.”

Amy Everitt, vice president of NARAL Pro Choice California, believes anti-choice providers are using the state to “create that veneer of legitimacy.”

“What we really need is tighter standards so no one is getting credit for medically inaccurate training,” Everitt said in a phone interview. “I think it presents a health-care problem for women in California when they think they are getting medically accurate information, and they are not.”

“It’s Obviously Going to Impact Women’s Health”

Care Net is a massive anti-choice umbrella organization based in Virginia. Like Heartbeat International, its stock in trade is convincing women to remain pregnant, which it does through thousands of affiliated CPCs spread across the country. California approved its application to teach continuing education nursing classes nine years ago.

Once a provider gains state approval, maintaining that status is simple. The provider pays a $300 renewal fee every two years and must confirm that information contained in the initial application remains the same, Sprigg from the Board of Registered Nursing explained.

Care Net, like Heartbeat International, touts its status as a California-approved continuing education provider. Its annual conference brochure last year included this note: “Care Net is approved by the California Board of Registered Nursing to provide continuing education contact hours for nurses. Provider Number: CEP14950.”

Appearing in the same brochure was a listing for a continuing education course: “Fetal Pain: What’s the Evidence?”

A class available for continuing education credit at a Care Net conference.

A class available for continuing education credit at a Care Net conference.

Anti-choice lawmakers in Arizona and elsewhere have latched onto the notion of fetal pain in failed attempts to ban abortion after the first trimester. The medical establishment agrees that the fetal nervous system lacks the development necessary to feel pain until the third trimester. ACOG has said that fetal pain is unlikely before the third trimester and “no studies since 2005 demonstrate fetal recognition of pain.”

The instructor for “Fetal Pain: What’s the Evidence?” was Dr. Sandra Christiansen; her name also appeared on Care Net’s nine-year-old state application. But the application neglects to mention the fetal pain class, and so it’s difficult to say precisely what Christiansen may have taught nurses at the Care Net conference in San Diego last year.

What is clear is that Christiansen gave testimony two years earlier in support of Maryland’s Pain-Capable Unborn Child Protection Act, an attempt to ban abortion care after 20 weeks.

Christiansen didn’t respond to requests for comment.

Pinning down the number of nurses who have taken classes taught by advocates like Christiansen is impossible. The state doesn’t keep a tally of the courses that nurses submit for continuing education credit. It is clear, however, that the classes, worth only 1.25 “contact” hours, account for only a fraction of the 30 hours that California registered nurses must complete every two years to maintain licensure.

Even so, Gupta, a physician, worries that these classes are introducing bias, or worse, at a time when evidence-based reproductive health care is under attack by legislators and powerful and well-funded anti-choice organizations. California, until now, had been seen as a bulwark against this tide of medical misinformation.

“It’s obviously going to impact women’s health in that a nurse is receiving information that he or she is then disseminating to their patients,” Gupta said. “I think that’s the concern.”