Analysis Sexual Health

American Academy of Pediatrics Releases New Guidelines Supporting Male Circumcision

Martha Kempner

As European nations debate banning male circumcision entirely and states continue to cut Medicaid coverage for the procedure, the American Academy of Pediatrics releases a new opinion which says the health benefits outweigh the risks.  Still, the organization stopped short of recommending routine circumcision for newborn males. 

A few weeks after my first daughter was born, I talked to my childhood best friend who was pregnant with her second child and had just found out that she was having a boy.  I passed on a tidbit I had learned when I was pregnant; you should have your obstetrician circumcise your baby instead of your pediatrician because the OB is trained a surgeon.

She surprised me by telling me that she was not planning on circumcising her son at all.  I wasn’t opposed to that decision, it had just never occurred to me as an option. As a Jewish mother-to-be residing in New York City, everyone, including me, had assumed that if my child were male he would be circumcised and I guess I carried that assumption to my friend even though she was not Jewish and was living in California at the time. 

When I was born in the 1970s my assumption would have been a safe one but today there is a major debate raging across the globe over the practice of male circumcision. While public health professionals argue that it has important health benefits and certain religions still require it, a vocal anti-circumcision movement calls the practice cosmetic at best, barbaric at worst, and seeks to outlaw it.

The majority of male infants (80 percent) born in the United States were circumcised as recently as the 1980s, these numbers, however, have been steadily declining in the past couple of decades to just 55 percent in 2010. In Europe, the practice has fallen almost completely out of favor with just 10 percent of male infants circumcised at birth.   

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This week, the American Academy of Pediatrics (AAP) weighed in on the debate with an opinion that shows strong support for the procedure but stops short of calling for routine circumcision.

How the Guidelines Changed
When the AAP last took on this issue in 1999, it concluded that there were “potential health benefits” but that the scientific research was not sufficient to recommend routine circumcision. It went on to take what could best be called a standoffish stance when it said:

“As in any circumstance in which there are potential benefits and risks, yet the procedure is not essential to the child’s current well-being, parents should determine what is in the best interest of the child.”

The tone of the new opinion suggests more support for the procedure and it has been called a step toward endorsement by some experts. The new statement says

“Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure’s benefits justify access to this procedure for families who choose it.”

This increase in support appears to come from a review of recent research; a 23-page technical report was released along with the policy. The report looked at a number of studies conducted between 1995 and 2010 which found that potential health benefits of circumcision include preventing urinary tract infections, HIV, and penile cancer. Some studies found that circumcision can also prevent the transmission of certain sexually transmitted infections, including the human papillomavirus and genital herpes.

There has been a great deal of research in Africa suggesting that circumcision of adult men can reduce the risk of heterosexually transmitted HIV in men by approximately 60 percent. As a result of this research, the World Health Association (WHO) recommends:

“efficacious intervention for HIV prevention in countries and regions with heterosexual epidemics, high HIV, and low male circumcision prevalence.”

A CDC spokesman points out, however, that it’s difficult to predict the impact of male circumcision on the HIV rates in the United States because the current circumcision rates are higher than in the areas studied, the epidemic is different, and there is still a lot we don’t know about the effect of circumcision on male-to-male transmission of HIV. 

While the relationship of circumcision and HIV has gotten a lot of attention worldwide, a number of additional studies have suggested other potential health benefits. A 2011 study presented at the American Urological Association meeting, for example, found that the foreskin of uncircumcised males can be a reservoir for HPV.  This year, researchers released another study that found that men who are circumcised before they first have sex have lower rates of prostate cancer than those who are uncircumcised or have the procedure after they’ve already been sexually active.   

The technical report released along with the opinion also says that the risks are quite low.  In fact, major complications from circumcision, including death were “so infrequent” that the academy excluded them from the review. Two hospital-based studies found that the most common risks from circumcision were “bleeding, infection and penile injury.” The report concluded that when done by trained professionals in a sterile environment the procedure is generally well-tolerated by infants (though the opinion does suggests that even infants need more pain management that the sugar-coated pacifier that is standard in some places). The report also noted that the procedure has more risk when done on older men.  

Unlikely to Sway Parents

Whether or not a baby is circumcised in this country varies widely across religions, ethnic groups, and geographic regions. Jewish and Muslim children are usually circumcised, Hispanic parents are far less likely to circumcise their children than white or black parents, circumcision is more common in rural and suburban areas than in metropolitan cities, and 75 percent of boys born in the Midwest in 2009 were circumcised compared to just 25 percent in the West. Differences between states are striking–-89 percent of boys born in Michigan in 2009 were circumcised compared to just 15 percent in Washington state–-yet state health officials are unable to completely explain the differences. The most telling determinant may actually be whether the father is circumcised; a Denver study found that 90 percent of males who were circumcised chose to circumcise their sons compared to just 23 percent who were uncircumcised.

Like the previous opinion, this new version says the decision should ultimately be up to the parents. Dr. Marvin Wang, director of newborn nurseries at Mass General Hospital for Children, explains it this way:

“This new policy still puts the decision-making in parents’ hands. But what the AAP says now is, ‘We have enough to say that you can make the decision based on religion, cultural and family issues. But guess what? You can now throw health in as a reason for doing it if you want to.’”

Wang, however, does not expect that the committee will sway many parents’ decision.  In 2010, he released the results of a study he conducted in which parents of newborn males were shown both the AAP’s 1999 opinion and summaries of new research on HIV/HPV and circumcision. Neither made much of an impact on what parents chose to do. As Wang put it:

“Nothing was going to change their mind. What they come into it with is what they go out of it with.”

Paying for the Procedure

Where this new opinion may make a big difference, however, is with insurers.  As Douglas Diekema, a member of the AAP’s circumcision task force, explains:

“… it recognizes that there are clear medical benefits that outweigh the risks of the procedure, and that those benefits are sufficient to justify coverage by insurance.”

According to the CDC, the procedure costs between $200 and 600 dollars and coverage varies widely among private insurers. Moreover, at least 18 state Medicaid programs have recently stopped covering it. 

Arizona, for example, stopped paying for the procedure in 2002 apparently as part of an effort to trim one billion dollars from the budget. (Cutting circumcision saved the state 400,000 dollars a year.) The year before this change was made, 41 percent of male infants in the state were circumcised, two years later that number was down to 21 percent. Indeed, coverage for the procedure seems to be a strong predictor of whether or not parents choose it; according to a report by the Health & Human Services Department’s Healthcare Cost & Utilization Project, circumcision rates are 24 percent higher in states where Medicaid covers the procedure. 

A new study, published in this month’s Archives of Pediatric and Adolescent Medicine, suggests changes to coverage like the one Arizona made may be short-sighted when it comes to saving money. The study was conducted by public health experts and economists at Johns Hopkins University School of Medicine and found that if circumcision rates in the United States were to fall to the same levels as in Europe, we could face more than four billion dollars in increased health care costs over a decade to pay for treatment of urinary tract infections, syphilis, herpes, penile cancer, and HIV.

Probably Not the Last Word

As always when I write about this topic, I feel it necessary to say that my great-grandfather, Abraham Ravich, wrote about many of the same health benefits noted in the technical report in his book Preventing V.D. and Cancer through Circumcision. The book, which was published in 1974, was based on his experiences as a urologist in primarily Jewish neighborhoods in Brooklyn from the 1930s, 40s, and 50s. Having mentioned him before, though, I know that Poppy Abe was considered by many to be a zealot and that there is a very vocal community who still do not believe these health benefits. 

In advance of the statement’s release, Georganne Chapin, founding executive director of the anti-circumcision advocacy group Intact America accused the AAP committee of “scientific blindness.” She said of the committee:

“They also appear to be totally ignoring the fact that their European colleagues are not only unimpressed by the supposed ‘benefits’ of cutting up baby boys’ penises but are actually considering whether child circumcision should be banned on the basis that it violates children’s rights.” 

Ronald Goldman, the head of another opposition group, expands on these complaints saying that studies show circumcision causes loss of sexual satisfaction and can be psychologically harmful but the AAP says the research does not support these claims. Both Goldman and Chapin call the new statement “out of step” with what is going on in the rest of the world where many are calling for a complete ban on the procedure.

In Germany, for example, a regional court ruled in June that circumcision amounts to “irreversible interference in the integrity of the human body” because the procedure is performed on non-consenting minors who cannot object. (Jewish and Muslim leaders are protesting this verdict.) This decision was spurred by the case of a four-year-old Muslim boy who suffered a great loss of blood as a result of a botched circumcision. According to the Jewish Daily Forward, this case has led to debates about the ethics of what many see as an unnecessary procedure not just in Germany but in Switzerland, Austria, Denmark, and Norway. In fact, the move to ban circumcision entirely recently came to the United States when both San Francisco and Santa Monica entertained the possibility of ballot initiatives to prevent the practice within city limits. 

Such bans, however, instantly raise questions of religious freedom, and some have gone as far as to call them anti-Semitic and liken them to bans on circumcision that existed in Soviet-era Russia and Eastern Europe and in ancient Roman and Greek times. Moreover, bans seem to fly in the face of mounting public health evidence about the potential value of circumcision. California’s governor, Jerry Brown, agreed signing legislation in October 2011 that makes such bans illegal in his state and effectively killed the two that had been proposed.

The AAP’s new opinion is not quite that decisive.  Even its co-author says the opinion should not be considered the “verdict from on high” and that everyone needs to decide for themselves.  Still he adds, “but from a medical standpoint, circumcision’s benefits in reducing risk of disease outweigh its small risks.” 

In the 30 years since Poppy Abe died, public opinion and professional opinions on this topic have swung back and forth many times.  While I doubt this newest statement from the AAP will cement it in either direction, I do believe my great-grandfather would consider it a step in the right direction.    

Culture & Conversation Law and Policy

The Modern Struggle Over Anti-Trans Bathroom Laws Has Its Roots in Decades of Title VII Fights

Jessica Mason Pieklo

Because of Sex: One Law, Ten Cases, and Fifty Years That Changed American Women’s Lives at Work, written by Gillian Thomas, senior staff attorney with the American Civil Liberties Union Women’s Rights Project, goes beyond cases that helped shape workplace anti-discrimination policies. Rather, it focuses on ten key women whose own lives changed the law.

In 1966, Ida Phillips, a single mother working as a waitress, sat down at her kitchen table and wrote a letter to then-President Lyndon B. Johnson. She told him her story: Despite her qualifications, Phillips had been told by a Martin Marietta employee not to apply for an assembly-line position at one of the construction-material company’s manufacturing plant. The job would have paid more than double what she was making as a waitress. It included a pension plan and insurance, benefits unavailable in most female-dominated industries at the time (and which since have only marginally improved.) The reason Phillips was turned away? She was a woman with a preschool child.

That letter, Phillips’ subsequent lawsuit, and her Supreme Court win would help spark a civil rights revolution in the workplace—one with consequences that reverberate today.

So opens Because of Sex: One Law, Ten Cases, and Fifty Years That Changed American Women’s Lives at Workwritten by Gillian Thomas, senior staff attorney with the American Civil Liberties Union (ACLU) Women’s Rights Project. Despite its full title, though, Because of Sex goes beyond cases that helped shape workplace anti-discrimination policies, focusing on ten key women whose own lives changed the law.

Title VII of the Civil Rights Act of 1964 prohibits employment discrimination based on race, color, religion, sex, and national origin. And it was Phillips’ case, and the nine others profiled in the book, that would ultimately shape that law into one that, decades later, is an important tool in advancing gender and sex equality. As Thomas explained to Rewire in an interview, Title VII it is not just a foundational piece of civil rights legislation important for its historical effect on workplace equality. In the face of anti-transgender bathroom bills and statewide “religious liberties” legislation sweeping the country, it is a crucial tool for pushing equality forward.

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Thomas’ book is organized along three key themes in employment discrimination law: pregnancy-related workplace policies, gender stereotypes in the workplace, and sexual harassment. Those themes act as an inroad toward thinking more broadly about how, in Thomas’ words, we achieve “substantive equality” in the workplace. They illustrate how early fights over promotions and workplace policies that kept women out of certain jobs due to concerns of harming their potential fertility foreshadowed the legal showdowns over contraception coverage in employee health-care plans in cases like Burwell v. Hobby Lobby and Zubik v. Burwell.

“The subject matter areas that I saw [as a researcher and employment discrimination litigator] were, number one, women’s capacity for pregnancy, and then their subsequent roles as mothers, which, historically, has played a huge role in their second-class status legally,” Thomas told Rewire. “Women of color have always been seen as workers, irrespective of whether they had children, so that’s not an entirely universal stereotype. But I think it’s pretty safe to say that generally pregnancy and motherhood have proven to be enormous conflicts in terms of what equality looks like when you have these distinct differences” in how race and gender are perceived.

Take, for instance, the case of Peggy Young and the question whether an employer can refuse to make on-the-job accommodations for pregnant employees when it does so for nonpregnant employees. Young, another one of the women featured in Thomas’ book, was a United Parcel Service (UPS) “air driver” who became pregnant. When Young told her employer she was pregnant, UPS told her they couldn’t accommodate the light-lifting recommendation made by Young’s medical providers. Instead, UPS told Young, she would have to take unpaid medical leave for the remainder of her pregnancy.

In March 2015, the U.S. Supreme Court ruled against UPS, vacating the Fourth Circuit Court of Appeals ruling that had supported UPS’ policy. The decision produced a new test for assessing pregnancy discrimination claims and sent Young’s case back to the lower courts for another look. Not long after the Roberts Court’s decision, UPS and Young settled the lawsuit, bringing an end to Young’s case.

The decision was a qualified win for advocates. The Roberts Court had accepted Young’s argument that UPS had no legitimate business reason for failing to accommodate her particular request, but the decision went short of ruling businesses must accommodate any pregnancy request.

But Because of Sex doesn’t stop at unpacking overt discrimination like the kind detailed in Young’s 2015 case or Phillips’ one in 1966. The book also takes a look at what the law has described as more “benevolent” kinds of discrimination. These include employment policies designed to “protect” women from endangering possible future pregnancies, such as prohibiting women employees from working jobs where they may be exposed to hazardous chemicals.

“It really all boils down to two issues that we are talking about in all these things,” Thomas explained, when discussing workplace policies that, employers have argued, were put in place to protect their female employees from potentially endangering a pregnancy. “One is [employers] ignoring hazards that apply to men and making women into baby-making machines. And number two is [employers] treating health effects or health hazards on the job as reasons for diminishing women’s opportunities, instead of arming women with information and assuming that they will make the right choice for themselves.”

This disconnect is most apparent in the case of United Automobile Workers vJohnson Controls, Inc., another case Thomas highlights in her book. In 1982, the car battery manufacturer Johnson Controls sent a memorandum to all its employees that said “[w]omen who are pregnant or who are capable of bearing children will not be placed into jobs involving lead exposure or which would expose them to lead through the exercise of job bidding, bumping, transfer or promotion rights.”

The policy amounted to a demotion for many female employees and a closed door for others.

Title VII actually permits employers, in a limited context, to have employment policies that discriminate on their face, such as policies that permit churches to only hire members of the same faith. Johnson Controls argued its policy of keeping women out of certain positions due to employer concerns of health risks to future pregnancies fit within Title VII’s narrow window for permitting explicit discrimination.

The Supreme Court would eventually rule in 1991 that Johnson Controls’ policy violated Title VII because it forced female employees to have to choose “between having a child and having a job,” thereby rejecting the argument made by Johnson Control’s that a woman’s fertility—or infertility—can in most situations be considered a bona fide occupational qualification.

As Thomas noted in her book, “It was no coincidence that fetal protection politics were most prevalent in well-paid, unionized industries from which women historically had been excluded. Indeed they had been excluded precisely because they had been deemed physically unsuited for the dirty, sometimes strenuous work.”

But “in female-dominated fields, though, fetal protection policies made no business sense; they effectively would gut the workforce. That reality apparently trumped any hypothetical harm to employees’ future pregnancies,” Thomas wrote.

In other words, these policies didn’t exist in female-dominated fields.

Johnson Controls may have helped grant women the agency to determine how and when they earned a paycheck with regard to policies targeting their potential fertility, but it hardly ended the debate around when and how employers attempt to diminish women’s opportunities related to their roles as potential mothers. This has played out in the hundreds of lawsuits over the contraception benefit, for example.

In other words, if Johnson Controls had settled the question of whether a woman’s fertility was an appropriate grounds for discrimination, we would not have Hobby Lobby.

Because of Sex draws another connection between the historical fight over Title VII and the contemporary one: How do employers adjust workplace policies around shifting gender norms, and when is it discriminatory if they don’t?

The law asks, “What are women supposed to want to do?” said Thomas in her interview with Rewire. “What work are they able to do? What work do they want to do? [Given] assumptions and stereotypes that are about their abilities, their preferences, their interests and how [they are] conforming to [those] in terms of stereotypes about what femininity is—what [are] women … supposed to look and act like?”

Gender nonconforming behavior, and the manner in which employees experience discrimination as a result of that behavior, is a key component over the debate around transgender rights. But it would take a “shrill” woman and the birth of the notion of “workplace harassment” to get us and the law there first.

By every measure, Ann Hopkins should have been made a partner in the global accounting firm Price Waterhouse. She was smart. Ambitious. Worked hard and constantly outperformed her peers. But it was those very attributes that her male partners deemed “too aggressive” or as evidence that she needed “charm school,” and ultimately used to deny her a partnership that by every objective measure she had earned.

The Supreme Court would ultimately disagree. In 1989, it ruled Hopkins should have been made a partner and that the comments relating to her demeanor amounted to improper gender stereotyping, a violation of Title VII’s sex discrimination provisions.

If Hopkins was initially shut out of workplace advancement due to her defiance of feminine stereotypes, so too are women subjected to on-the-job harassment, as Thomas draws out in Because of Sex. “Sexual harassment didn’t even have a name in 1974, but was such a prevalent force driving women out of the work force, driving them into different jobs [and] subjugating them just generally in terms of the identity as sexual objects on the job,” Thomas further explained in her interview.

1974 was the year Mechelle Vinson first hired a lawyer to represent her in a case against her boss, who was chronically sexually abusing her on the job. But at the time, courts largely wrote off those kinds of complaints as a kind of chasing-around-the-office, and not sexual harassment, or in Vinson’s case, on-the-job rape. As described by Thomas in her book, “throughout the 1970s, many courts responded to complaints about abusive bosses with a collective shrug that conveyed, ‘You can’t blame a guy for trying.'”

“Sexual harassment was such a prevalent force driving women out of the workforce, driving them into different jobs, and subjugating them just generally in terms of the identity as sexual objects on the job,” Thomas told Rewire.

That “you can’t blame a guy for trying” attitude hasn’t completely gone away as far as the federal courts are concerned. After all, in 2013 the Roberts Court in Vance v. Ball State made it even harder for employees to bring workplace harassment suits, and employees still face losing jobs for “being too cute” or having their sexuality be a perceived threat to their employer’s ability to remain professional in the workplace.

Which is why, in the fight over transgender bathroom access in 2016, Title VII should be a powerful force in defeating these latest attempts to stymie social progress. The idea that “you can’t blame a guy for trying” has morphed into “how the hell can we police gender roles if we don’t know where you pee.” That’s thanks almost entirely to the manner in which the law has wrestled with gender stereotypes under Title VII, Thomas explained.

In 2012, the Equal Employment Opportunity Commission (EEOC), the federal agency charged with enforcing workplace anti-discrimination laws, issued the landmark decision Macy v. Holder, which held that employment discrimination based on transgender status was a form of unlawful sex discrimination under Title VII. Then in 2015, it issued a ruling stating that denying employees access to restrooms consistent with their gender identity is also a violation of Title VII. Meanwhile several federal courts of appeals have ruled that Title VII protects against gender identity discrimination.

But the Roberts Court has yet to weigh in.

“I think sexual orientation in a way is the sort of a final frontier” in Title VII litigation, said Thomas. “The court seems really fixated on this idea of analogizing very precisely from Hopkins. In other words, if you look or act in a way that doesn’t conform to gender stereotypes then, OK, [the courts] can understand that’s sex discrimination,” said Thomas. “But if your identity is not conforming to stereotypes in that you, you know, are romantically attracted to someone of your sex, that is harder for [the courts] to get, even though it’s obviously the most obvious manifestation of stereotype.”

This is, in many ways, a fight that started in the workplace—one that eventually got the backing of the Obama administration before becoming a flashpoint of conservative election-cycle politics. Thomas’ book doesn’t close on a prediction of what the next big Title VII fight will be per se, but it is impossible to finish it and not see the narrative threads of the historical fight for workplace equality woven throughout the the contemporary one. Sex. Gender. How the law understands and navigates the two. All this is what makes Thomas’ Because of Sex the closest thing to an assigned reading I can make.

News Abortion

This Democratic-Dominated Legislature Won’t Stop Attacking Abortion Access

Teddy Wilson

NARAL Pro-Choice America this year gave Rhode Island a failing grade on its annual scorecard of states’ reproductive freedom, along with Republican-dominated legislatures in Alabama, Nebraska, South Carolina, and Texas, among others.

You might not expect anti-choice measures to churn through a legislature in which Republicans hold 15 percent of the seats.

But it’s in Rhode Island that Democrats, not GOP lawmakers, have introduced every anti-choice measure in 2016.

Reproductive rights are under threat in states dominated by GOP legislators as well as states with Democratic legislative majorities, and laws attacking abortion access that have been passed in recent years have received at least some Democratic support.

While there are a variety of factors that contribute to the prevalence of anti-choice Democrats in Rhode Island, the lawmakers who are proponents of these bills look very much like the proponents of these bills in red states.

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Rewire analysis of legislation introduced in state legislatures during the first three months of 2016 found that 60 percent of the 311 anti-choice bills introduced were sponsored by white male Republicans. Male lawmakers introduced about seven out of every ten anti-choice bills during that time. 

White male Democrats sponsored nine of the 14 anti-choice bills this year in the Rhode Island state legislature. 

Rhode Island’s Democratic legislators hold a 63-11 majority in the house and a 32-6 state senate majority. But that doesn’t translate to a legislative body supportive of maintaining and expanding abortion access and reproductive health services. 

NARAL Pro-Choice America this year gave Rhode Island a failing grade on its annual scorecard of states’ reproductive freedom, along with Republican-dominated legislatures in Alabama, Nebraska, South Carolina, and Texas, among others. 

Susan Yolen, vice president of public policy and advocacy of Planned Parenthood of Southern New England, told the Providence Journal that there is a “big information gap” between the perception and reality of abortion politics in Rhode Island.

“People assume Rhode Island is going in the right direction when it comes to rights—it’s a blue state,” Yolen said.

Amy Retsinas Romero, president of Women’s Health and Education Fund, spoke during a March conference on reproductive rights at Rhode Island College about the challenges people face when seeking reproductive health care in the state.

“In Rhode Island we are an F. We are not that far from Texas,” Romero said, reported the Brown Daily Herald. “We should all be ashamed of ourselves.”

Rep. Edith Ajello (D-Providence) told Rewire that Rhode Island is in “pretty good shape” in ensuring access to abortion care and reproductive health care. She said there remain legislative issues that need to be addressed.

“We have laws on the books that have been declared unconstitutional. For instance, the spousal notice regarding abortion,” Ajello said, referring to the state’s requirement of notice to an abortion patient’s husband before the procedure. “It would be good to get rid of those and we have legislation in place to do that, but it has yet to pass.”

Rep. Arthur Handy (D-Cranston) sponsored legislation this year that would repeal the so-called spousal notice law. HB 7612 was held for further study by the house judiciary committee.

Ajello sponsored HB 7444, which would prohibit the state from interfering with a person’s decision to prevent, commence, continue, or terminate a pregnancy prior to fetal viability. Ajello said that the bill would codify into law protections for reproductive rights.

There have, however, been far more bills introduced to restrict reproductive rights, all of which have been introduced by Ajello’s fellow Democrats.

There have been 14 anti-choice bills introduced this year in the Rhode Island legislation. This collection of bills would restrict reproductive rights in a number of ways, including restricting funding for abortion care for low-income people in the state. It’s an issue that has been debated in the state for the last few years.

It’s not only Rhode Island Democrats in the house and state senate that back measures designed to chip away at abortion access.

Gov. Gina Raimondo (D) last year signed a budget that left nearly 9,000 residents without comprehensive abortion coverage through their insurance plans. The budget included a requirement that health insurers who offer plans on Rhode Island’s health insurance exchange to also offer plans that exclude coverage for elective abortion care.

The contingent of anti-choice Democrats and the few Republicans lawmakers does not appear to have enough political power to move most anti-choice bills through the legislature. Since the legislature is and has been dominated by one party for so long, policy disagreements have developed along ideological rather than partisan lines, political observers told Rewire

Ajello said in an interview with Rewire that there are members of the legislature who are anti-choice but are also “quite progressive” on other issues, such as marriage equality. 

“In the way that I see social conservatives in Texas, I don’t see those differences [in Rhode Island lawmakers],” Ajello. “We work together, cooperating on issues that we agree about and being respectful on issues that we don’t.”

H 7760, sponsored by Rep. Samuel Azzinaro (D-Westerly), would prohibit health plan coverage purchased in whole or in part with any state or federal funds through the Rhode Island health benefits exchange from providing coverage for induced abortions, unless it was to save the life of the pregnant person or if the pregnancy was a result of rape or incest.

Azzinaro has long advocated prohibiting health-care coverage of abortion care. Azzinaro said during a debate in 2013 about the state’s health-care exchange that tax dollars should not be used to fund abortion care.

“You want choice?” Azzinaro said, reported the Providence Journal. “We talk about choice, what choice do you have if you only have a plan that says we’re going to fund abortions.”

The house judiciary committee recommended in March that H 7760 be held for further study. State Sen. Marc Cote (D-Woonsocket) sponsored a companion bill pending in the senate judiciary committee.

A number of other bills designed to restrict abortion and reproductive health care have been introduced in the Rhode Island legislature. Many of the proposed measures create the same rhetoric surrounding anti-choice bills in state legislatures held by GOP majorities. 

H 7764, sponsored by Rep. Deborah Fellela (D-Johnston), would prohibit a person from performing or attempting to perform an abortion with the knowledge that the pregnant person is seeking the abortion solely on account of the sex of the fetus. 

The bill charges that any physician who intentionally violates this provision would be considered to have engaged in unprofessional conduct, and their license would be subject to suspension or revocation by the State Board of Medical Licensure and Discipline.

There is no documentation that so-called sex-selective abortions are widespread in the United States. Proponents of the bans often justify the anti-choice measure by using cultural stereotypes that target immigrant people of color.

Bills to ban sex-selection abortion care have been introduced in several states this year. Fellela sponsored a similar bill in 2014.

H 7764 was held for further study by the house judiciary committee; the companion bill S 2612, sponsored by Sen. Elizabeth Crowley (D-Central Falls), is pending in the senate judiciary committee.

H 7282 and S 2216, sponsored by Rep. Arthur Corvese (D-North Providence) and Sen. Louis DiPalma (D-Middletown), would prohibit a person from performing, or attempting to perform a “dismemberment abortion” on a fetus unless it is necessary to save the life of the patient or if the continued pregnancy would cause irreversible physical impairment of a major bodily function of the pregnant patient.

State courts have blocked such measures passed by Republican lawmakers in Oklahoma and Kansas. West Virginia’s GOP-held legislature in March voted to override the veto of a similar bill.

H 7282 was held for further study by the house judiciary committee, and S 2216 is pending in the senate judiciary committee.