News Abortion

Indiana Right to Life Seeks to Eliminate Access to Safe, Early Medication Abortion

Robin Marty

The group is claiming that a Lafayette clinic is violating law by providing medication abortions without licensing their clinic as a surgical abortion center.

Anti-choicers have been honing in over the past few years on early medication abortions—which take place by or before 8 weeks of pregnancy—seeing the protocol as a threat to their plan to make abortion physically and financially inaccessible. RU-486, a medication that safely induces abortion up to the ninth week of pregnancy, enables a woman to access abortion in privacy and without the immediate presence of a doctor. The availablity of RU-486 has expanded access to early safe abortion across the country at the same time that legislatures have become increasingly hostile to reproductive rights.

Efforts by right-wing controlled legislatures to limit the use of the drug run the gamut from forcing doctors to use outdated FDA protocols that add increased expense, mandating onerous and unnecessary counseling procedures, or forcing doctors to be physically present at the time of the abortion and for all additional follow up visits, in order to ensure that options like telemed abortions cannot be arranged for those who live too far from a clinic with a doctor on staff. Now, Indiana Right to Life, the state’s largest anti-choice organization, has a new attack.

It is accusing the Lafayette Planned Parenthood of conducting abortions without a license.

Lafayette Planned Parenthood has has a setup unlike any other clinic in the state. It is the only reproductive health care center that offers RU 486 but does not perform surgical abortions. As such, it doesn’t qualify as an abortion center according to the official definition in state law, which refers specifically to “a freestanding entity that performs surgical abortion procedures.”

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Because it does not meet the qualifications of a surgical abortion center, Lafayette Planned Parenthood isn’t required to have the same kind of license required by other clinics. It’s this fact that has Indiana Right to Life so upset.

“Women who visit this Planned Parenthood office deserve to find a facility that meets the state requirements for health and safety required of all other Indiana abortion clinics,” Indiana Right to Life Legislative Director Sue Swayze told the Indy Star

The group has filed complaint with the state board of health, hoping to instigate an investigation into the clinic. If the Lafayette clinic is not found to be breaking any laws, then IRTL says their next step would be to change the laws themselves.

“We filed a request with the Attorney General’s Office to find out what’s really happening here and what’s lawful and what’s not,” Swayze told WLFI News, adding that if they don’t need a license then that would be “something she and others want to work on getting changed,” according to the news report.

Are the licensing requirements for admitting privileges to a local hospital even necessary? Not at all, Planned Parenthood Indiana President and CEO Betty Cockrum told Rewire. Passing laws requiring admitting privileges where they are not necessary is a favorite tactic of anti-choice groups seeking to limit access to safe, legal abortion, all wrapped up in the guise of “patient safety.” And a requirement for admitting privileges has absolutely no relationship to the safety of abortion procedures.

“You’re in Southern Indiana, the Old National Highway, US 40, south of US 40 there is one clinic, it’s in Bloomington and it’s one of ours,” Cockrum explained. “Let’s just assume there is an unfortunate outcome. You live in Evansville. You drive to Bloomington, you have your procedure, you drive back home and you have a concern. How much good does it do that the doctor that performs the procedure in Bloomington has admitting privileges in Bloomington when you are three hours away in Evansville?”

With a medication abortion, admitting privileges make even less sense as a means of keeping patients safe, as the abortion isn’t even performed in the clinic. But according to another offshoot anti-choice group in Indiana, not only will they demand that the Lafayette clinic obtain admitting privileges and licensing, but they also seek to require that all medication abortion procedures follow and outdated FDA protocol.

“There are serious adverse reactions to RU-486,” Connie Basham, of Tippecanoe County Right to Life claimed in an interview with JC Online.  “FDA regulations require patients to return to the doctor three days after receiving the first pill, then 14 days later to evaluate their condition. The FDA requires the drug to be administered under the supervision of a physician in a licensed facility, and the dispensing physician must have admitting privileges at a local hospital. Is there a qualified physician on-site at the facility?”

Anti-choice tactics have all but eliminated medication abortion in Ohio. And a ban on off-label use in Oklahoma has been blocked in the courts.

Cockrum believes efforts by anti-choice Indiana groups are just another attempt to use bogus claims of “patient safety” to reduce access to safe abortion care. “At this point, if there is a restriction that has passed somewhere else that hasn’t come up in our legislature yet, I just assume someone is about to propose it.”

The question then is what sort of law they hope to propose. An FDA-only law such as Ohio’s, which would mandate providing women with three times as much of the drug as scientific evidence deems medically necessary, tripling the cost of a medication abortion? An “evaluation first” law such as was passed in Wisconsin, which also creates a potential felony if a woman didn’t meet with her original provider after the abortion was completed for a follow up appointment, a law which forced all entities to stop offering medication abortions out of fear of criminal prosecution? Or a Super-TRAP bill like one that actually failed in Missouri, requiring that doctors who prescribe for medication abortions have admitting privileges, meet patients 24 hours in advance, and have at least $1 million in malpractice insurance to boot?

Whichever approach is taken, it won’t be about patient safety. That would be a lie says Sue Ellen Braunlin of Indiana Religious Coalition in Support of Reproductive Justice.

“We have watched what [Indiana Right to Life] has done in the last two legislative sessions, and it has just been horrifying. They bring out people to testify and they are all emotional-based testimony. There was not one single medical or expert testimony in support of a single thing that they have brought up in the last two years.”

“Medical abortion is safer than aspirin, Tylenol and Viagra,” said Braunlin, an anesthesiologist, said in an interview last week. “They are setting it up for a TRAP law that they have tried to put through in previous sessions. Last year they tried to require that the dose used was exactly the dose required. In this case some physicians did get involved and say ‘This is three times more than what is required,’ and that did get dropped. But we knew they were going to try again.”

There has been no response so far from the Indiana Department of Health regarding whether or not it deems there is any merit to Indiana Right to Life’s complaint that the Lafayette clinic is “practicing medicine without a license.”  But whether or not IRTL gets an answer, you can expect them to ask more questions—and offer more “solutions”—once the state legislature meets again.

News Sexual Health

State with Nation’s Highest Chlamydia Rate Enacts New Restrictions on Sex Ed

Nicole Knight Shine

By requiring sexual education instructors to be certified teachers, the Alaska legislature is targeting Planned Parenthood, which is the largest nonprofit provider of such educational services in the state.

Alaska is imposing a new hurdle on comprehensive sexual health education with a law restricting schools to only hiring certificated school teachers to teach or supervise sex ed classes.

The broad and controversial education bill, HB 156, became law Thursday night without the signature of Gov. Bill Walker, a former Republican who switched his party affiliation to Independent in 2014. HB 156 requires school boards to vet and approve sex ed materials and instructors, making sex ed the “most scrutinized subject in the state,” according to reproductive health advocates.

Republicans hold large majorities in both chambers of Alaska’s legislature.

Championing the restrictions was state Sen. Mike Dunleavy (R-Wasilla), who called sexuality a “new concept” during a Senate Education Committee meeting in April. Dunleavy added the restrictions to HB 156 after the failure of an earlier measure that barred abortion providers—meaning Planned Parenthood—from teaching sex ed.

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Dunleavy has long targeted Planned Parenthood, the state’s largest nonprofit provider of sexual health education, calling its instruction “indoctrination.”

Meanwhile, advocates argue that evidence-based health education is sorely needed in a state that reported 787.5 cases of chlamydia per 100,000 people in 2014—the nation’s highest rate, according to the Centers for Disease Control and Prevention’s Surveillance Survey for that year.

Alaska’s teen pregnancy rate is higher than the national average.

The governor in a statement described his decision as a “very close call.”

“Given that this bill will have a broad and wide-ranging effect on education statewide, I have decided to allow HB 156 to become law without my signature,” Walker said.

Teachers, parents, and advocates had urged Walker to veto HB 156. Alaska’s 2016 Teacher of the Year, Amy Jo Meiners, took to Twitter following Walker’s announcement, writing, as reported by Juneau Empire, “This will cause such a burden on teachers [and] our partners in health education, including parents [and] health [professionals].”

An Anchorage parent and grandparent described her opposition to the bill in an op-ed, writing, “There is no doubt that HB 156 is designed to make it harder to access real sexual health education …. Although our state faces its largest budget crisis in history, certain members of the Legislature spent a lot of time worrying that teenagers are receiving information about their own bodies.”

Jessica Cler, Alaska public affairs manager with Planned Parenthood Votes Northwest and Hawaii, called Walker’s decision a “crushing blow for comprehensive and medically accurate sexual health education” in a statement.

She added that Walker’s “lack of action today has put the education of thousands of teens in Alaska at risk. This is designed to do one thing: Block students from accessing the sex education they need on safe sex and healthy relationships.”

The law follows the 2016 Legislative Round-up released this week by advocacy group Sexuality Information and Education Council of the United States. The report found that 63 percent of bills this year sought to improve sex ed, but more than a quarter undermined student rights or the quality of instruction by various means, including “promoting misinformation and an anti-abortion agenda.”

Analysis Law and Policy

After ‘Whole Woman’s Health’ Decision, Advocates Should Fight Ultrasound Laws With Science

Imani Gandy

A return to data should aid in dismantling other laws ungrounded in any real facts, such as Texas’s onerous "informed consent” law—HB 15—which forces women to get an ultrasound that they may neither need nor afford, and which imposes a 24-hour waiting period.

Whole Woman’s Health v. Hellerstedt, the landmark U.S. Supreme Court ruling striking down two provisions of Texas’ omnibus anti-abortion law, has changed the reproductive rights landscape in ways that will reverberate in courts around the country for years to come. It is no longer acceptable—at least in theory—for a state to announce that a particular restriction advances an interest in women’s health and to expect courts and the public to take them at their word.

In an opinion driven by science and data, Justice Stephen Breyer, writing for the majority in Whole Woman’s Health, weighed the costs and benefits of the two provisions of HB 2 at issue—the admitting privileges and ambulatory surgical center (ASC) requirements—and found them wanting. Texas had breezed through the Fifth Circuit without facing any real pushback on its manufactured claims that the two provisions advanced women’s health. Finally, Justice Breyer whipped out his figurative calculator and determined that those claims didn’t add up. For starters, Texas admitted that it didn’t know of a single instance where the admitting privileges requirement would have helped a woman get better treatment. And as for Texas’ claim that abortion should be performed in an ASC, Breyer pointed out that the state did not require the same of its midwifery clinics, and that childbirth is 14 times more likely to result in death.

So now, as Justice Ruth Bader Ginsburg pointed out in the case’s concurring opinion, laws that “‘do little or nothing for health, but rather strew impediments to abortion’ cannot survive judicial inspection.” In other words, if a state says a restriction promotes women’s health and safety, that state will now have to prove it to the courts.

With this success under our belts, a similar return to science and data should aid in dismantling other laws ungrounded in any real facts, such as Texas’s onerous “informed consent” law—HB 15—which forces women to get an ultrasound that they may neither need nor afford, and which imposes a 24-hour waiting period.

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In Planned Parenthood v. Casey, the U.S. Supreme Court upheld parts of Pennsylvania’s “informed consent” law requiring abortion patients to receive a pamphlet developed by the state department of health, finding that it did not constitute an “undue burden” on the constitutional right to abortion. The basis? Protecting women’s mental health: “[I]n an attempt to ensure that a woman apprehends the full consequences of her decision, the State furthers the legitimate purpose of reducing the risk that a woman may elect an abortion, only to discover later, with devastating psychological consequences, that her decision was not fully informed.”

Texas took up Casey’s informed consent mantle and ran with it. In 2011, the legislature passed a law that forces patients to undergo a medical exam, whether or not their doctor thinks they need it, and that forces them to listen to information that the state wants them to hear, whether or not their doctor thinks that they need to hear it. The purpose of this law—at least in theory—is, again, to protect patients’ “mental health” by dissuading those who may be unsure about procedure.

The ultra-conservative Fifth Circuit Court of Appeals upheld the law in 2012, in Texas Medical Providers v. Lakey.

And make no mistake: The exam the law requires is invasive, and in some cases, cruelly so. As Beverly McPhail pointed out in the Houston Chronicle in 2011, transvaginal probes will often be necessary to comply with the law up to 10 to 12 weeks of pregnancy—which is when, according to the Guttmacher Institute, 91 percent of abortions take place. “Because the fetus is so small at this stage, traditional ultrasounds performed through the abdominal wall, ‘jelly on the belly,’ often cannot produce a clear image,” McPhail noted.

Instead, a “probe is inserted into the vagina, sending sound waves to reflect off body structures to produce an image of the fetus. Under this new law, a woman’s vagina will be penetrated without an opportunity for her to refuse due to coercion from the so-called ‘public servants’ who passed and signed this bill into law,” McPhail concluded.

There’s a reason why abortion advocates began decrying these laws as “rape by the state.”

If Texas legislators are concerned about the mental health of their citizens, particularly those who may have been the victims of sexual assault—or any woman who does not want a wand forcibly shoved into her body for no medical reason—they have a funny way of showing it.

They don’t seem terribly concerned about the well-being of the woman who wants desperately to be a mother but who decides to terminate a pregnancy that doctors tell her is not viable. Certainly, forcing that woman to undergo the painful experience of having an ultrasound image described to her—which the law mandates for the vast majority of patients—could be psychologically devastating.

But maybe Texas legislators don’t care that forcing a foreign object into a person’s body is the ultimate undue burden.

After all, if foisting ultrasounds onto women who have decided to terminate a pregnancy saves even one woman from a lifetime of “devastating psychologically damaging consequences,” then it will all have been worth it, right? Liberty and bodily autonomy be damned.

But what if there’s very little risk that a woman who gets an abortion experiences those “devastating psychological consequences”?

What if the information often provided by states in connection with their “informed consent” protocol does not actually lead to consent that is more informed, either because the information offered is outdated, biased, false, or flatly unnecessary given a particular pregnant person’s circumstance? Texas’ latest edition of its “Woman’s Right to Know” pamphlet, for example, contains even more false information than prior versions, including the medically disproven claim that fetuses can feel pain at 20 weeks gestation.

What if studies show—as they have since the American Psychological Association first conducted one to that effect in 1989—that abortion doesn’t increase the risk of mental health issues?

If the purpose of informed consent laws is to weed out women who have been coerced or who haven’t thought it through, then that purpose collapses if women who get abortions are, by and large, perfectly happy with their decision.

And that’s exactly what research has shown.

Scientific studies indicate that the vast majority of women don’t regret their abortions, and therefore are not devastated psychologically. They don’t fall into drug and alcohol addiction or attempt to kill themselves. But that hasn’t kept anti-choice activists from claiming otherwise.

It’s simply not true that abortion sends mentally healthy patients over the edge. In a study report released in 2008, the APA found that the strongest predictor of post-abortion mental health was prior mental health. In other words, if you’re already suffering from mental health issues before getting an abortion, you’re likely to suffer mental health issues afterward. But the studies most frequently cited in courts around the country prove, at best, an association between mental illness and abortion. When the studies controlled for “prior mental health and violence experience,” “no significant relation was found between abortion history and anxiety disorders.”

But what about forced ultrasound laws, specifically?

Science has its part to play in dismantling those, too.

If Whole Woman’s Health requires the weighing of costs and benefits to ensure that there’s a connection between the claimed purpose of an abortion restriction and the law’s effect, then laws that require a woman to get an ultrasound and to hear a description of it certainly fail that cost-benefit analysis. Science tells us forcing patients to view ultrasound images (as opposed to simply offering the opportunity for a woman to view ultrasound images) in order to give them “information” doesn’t dissuade them from having abortions.

Dr. Jen Gunter made this point in a blog post years ago: One 2009 study found that when given the option to view an ultrasound, nearly 73 percent of women chose to view the ultrasound image, and of those who chose to view it, 85 percent of women felt that it was a positive experience. And here’s the kicker: Not a single woman changed her mind about having an abortion.

Again, if women who choose to see ultrasounds don’t change their minds about getting an abortion, a law mandating that ultrasound in order to dissuade at least some women is, at best, useless. At worst, it’s yet another hurdle patients must leap to get care.

And what of the mandatory waiting period? Texas law requires a 24-hour waiting period—and the Court in Casey upheld a 24-hour waiting period—but states like Louisiana and Florida are increasing the waiting period to 72 hours.

There’s no evidence that forcing women into longer waiting periods has a measurable effect on a woman’s decision to get an abortion. One study conducted in Utah found that 86 percent of women had chosen to get the abortion after the waiting period was over. Eight percent of women chose not to get the abortion, but the most common reason given was that they were already conflicted about abortion in the first place. The author of that study recommended that clinics explore options with women seeking abortion and offer additional counseling to the small percentage of women who are conflicted about it, rather than states imposing a burdensome waiting period.

The bottom line is that the majority of women who choose abortion make up their minds and go through with it, irrespective of the many roadblocks placed in their way by overzealous state governments. And we know that those who cannot overcome those roadblocks—for financial or other reasons—are the ones who experience actual negative effects. As we saw in Whole Woman’s Health, those kinds of studies, when admitted as evidence in the court record, can be critical in striking restrictions down.

Of course, the Supreme Court has not always expressed an affinity for scientific data, as Justice Anthony Kennedy demonstrated in Gonzales v. Carhart, when he announced that “some women come to regret their choice to abort the infant life they once created and sustained,” even though he admitted there was “no reliable data to measure the phenomenon.” It was under Gonzales that so many legislators felt equipped to pass laws backed up by no legitimate scientific evidence in the first place.

Whole Woman’s Health offers reproductive rights advocates an opportunity to revisit a host of anti-choice restrictions that states claim are intended to advance one interest or another—whether it’s the state’s interest in fetal life or the state’s purported interest in the psychological well-being of its citizens. But if the laws don’t have their intended effects, and if they simply throw up obstacles in front of people seeking abortion, then perhaps, Whole Woman’s Health and its focus on scientific data will be the death knell of these laws too.