Analysis Abortion

Uruguay’s House of Representatives Allows First Trimester Abortions, But Imposes Other Barriers

IWHC

Uruguay’s House of Representatives voted 50-49 to allow abortion up to the 12th week of pregnancy but the bill is far from what Uruguayans had hoped for.

Last night, as midnight approached, Uruguay’s House of Representatives voted 50 to 49 to allow abortion up to the 12th week of pregnancy. The bill is expected to be approved by the Senate and signed into law by President José Mujica before the end of the year.

The bill is far from what Uruguayans had hoped for. For one, it does not take first-trimester abortions out of the criminal code. Instead, it allows a woman to terminate her pregnancy only after she has appeared before an interdisciplinary panel of professionals to outline her reasons for requesting an abortion. The panel is required by law to tell her about alternatives to abortion, such as adoption. Moreover, it must “create an environment of psycho-social support to the woman, to contribute to overcome the factors which may be driving her towards pregnancy termination, and ensure that she has the information to make a decision that is conscious and responsible.”

In addition, the woman must wait five days to “reflect on her decision.” These requirements will most certainly discourage many women, and in particular young and poor women, from accessing safe services for fear of stigma and humiliation. They also mean that a woman who self-induces an abortion—with, for example, misoprostol— without going through these procedures would still face penalties.

Finally, the bill contains for conscience objections by individual providers and by hospitals, without spelling out what obligations providers and hospitals have to ensure that these objections do not deny women the safe abortions to which they would now be entitled.

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The debate in the House was fierce.  For those in favor of making first-term abortion available without restrictions, this bill fell far short of what women need. Álvaro Vega, a member of the majority governmental coalition, the Broad Front, lamented: “Is this an advance? No, this is not advancing anything.  We should…fully eliminate the articles (of the Criminal Code) that criminalize abortion. Abortions are not going to end in 2012.” It is estimated that in Uruguay every year there are 30,000 abortions, most of them unsafe.

Representatives on both sides of the debate were forced to leave the Chamber so that their alternates could take their places and vote the party line. A member of the opposition Colorado Party, who vacated his seat so that his alternate could cast a vote against the bill, criticized his party’s position: “This is totally wrong and fails our historic responsibility to allow free conscience.”

Those opposed to decriminalizing abortion were just as passionate. One Representative left the room in tears, saying that his wife had suffered two miscarriages. Another swore he would bring this matter to a national referendum. Given that some 60 percent of the population in Uruguay supports the decriminalization of abortion, such a referendum would face an uphill battle.

Meanwhile, outside Parliament, demonstrators marched. Young women, naked from the waist down and covered in bright body paint, stood and chanted: “They put in their restrictions, but our bodies are on the line.”

The text approved by the House is quite different from the version Uruguay’s Senate had passed at the end of 2011. That bill had removed penalties for abortion up to the 12th week of pregnancy, without making women jump through any hoops. That was also the case for a bill passed by Congress in 2007, but later vetoed by then President Tabaré Vazquez. A Presidential veto is not expected this time.

Implementation of the new law will need to be closely followed to ensure that safe abortion is in fact accessible. Health regulations spelling out how and where abortion services will be provided are yet to be developed, and health providers will have to be trained to respect women’s decisions and provide them with quality care. Measures will have to be taken to ensure that conscience provisions do not prevent women from accessing services altogether, and to address cases where delays push a woman’s pregnancy past 12 weeks.

At this pivotal moment, IWHC stands in solidarity with the feminist activists who have tirelessly advocated for the decriminalization of abortion in Uruguay. For more than 12 years, IWHC has proudly stood by MYSU (Mujer y Salud en Uruguay) a team of committed and effective advocates for women’s rights and health who have been central to recent advances in women’s rights in Uruguay. MYSU has played an instrumental role in educating and mobilizing Uruguayan society, building political will, and influencing political negotiations in the Congress. They did not give up after the 2007 veto and will continue fighting for increased access to safe abortion services. In the words of MYSU’s Director Lilián Abracinskas, “We will continue to fight for women to be respected as citizens who have the right and the autonomy to decide.”

News Abortion

Anti-Choice Legislator Confirms Vote on House Conscience Protections (Updated)

Christine Grimaldi

The Conscience Protection Act would give health-care providers a private right of action to seek civil damages in court, should they face supposed coercion to provide abortion care or discrimination stemming from their refusal to assist in abortion care. The Act allows providers to sue not only for threats, but also for perceived threats.

UPDATE: July 14, 10 a.m.: The House passed the Conscience Protection Act Wednesday night in a largely party line 245-182 vote. Prior to floor consideration, House Republicans stripped the text of an unrelated Senate-passed bill (S. 304) and replaced it with the Conscience Protection Act. They likely did so to skip the Senate committee referral process, House Democratic aides told Rewire, expediting consideration across the capitol and, in theory, ushering a final bill to the president’s desk. President Barack Obama, however, would veto the Conscience Protection Act, according to a statement of administration policy.

The U.S. House of Representatives will vote next Wednesday on legislation that would allow a broadened swath of health-care providers to sue if they’re supposedly coerced into providing abortion care, or if they face discrimination for refusing to provide such care, according to a prominent anti-choice lawmaker.

Rep. Joe Pitts (R-PA) told Rewire in a Friday morning interview that House leadership confirmed a vote on the Conscience Protection Act (H.R. 4828) for July 13, days before the chamber adjourns for the presidential nominating conventions and the August recess. Pitts said he expects the bill to be brought up as a standalone measure, rather than as an amendment to any of the spending bills that have seen Republican amendments attacking a range of reproductive health care and LGBTQ protections.

The office of U.S. House Speaker Paul Ryan (R-WI) had no immediate comment.

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Pitts’ remarks came during and after he hosted a “Forum on Conscience Protections” in the House Energy and Commerce Committee room to garner support for the bill.

Energy and Commerce Democrats boycotted the forum, a House Democratic aide told Rewire in a subsequent interview.

Legislation Builds on Precedent

Conscience protections are nothing new, the aide said. The latest iteration is a successor to the Health Care Conscience Rights Act (S. 1919/H.R. 940), which remains pending in the House and U.S. Senate. There’s also the Abortion Non-Discrimination Act (S. 50) and similarly named bills in both chambers. The fiscal year 2017 Labor, Health, and Human Services funding bill, which guts Title X and Teen Pregnancy Prevention grants, includes the Health Care Conscience Rights Act.

At the leadership level, Ryan’s recently released health-care plan mimics key provisions in the Conscience Protection Act. Both would give health-care providers a private right of action to seek civil damages in court, should they face alleged coercion or discrimination stemming from their refusal to assist in abortion care. The Conscience Protection Act goes a step further, allowing providers to sue not only for threats, but also for perceived threats.

The proposals would also codify and expand the Weldon Amendment, named for former Rep. Dave Weldon (R-FL), who participated in Pitts’ conscience forum. The Weldon Amendment prohibits states that receive federal family planning funding from discriminating against health-care plans based on whether they cover abortion care. Currently, Congress must pass Weldon every year as an amendment to annual appropriations bills.

Administration Action Provides Impetus

There hadn’t been much public dialogue around conscience protections with the exception of some anti-choice groups that “have really been all over it,” the aide said. The National Right to Life issued an action alert, as did the Susan B. Anthony List, to galvanize support for the Conscience Protection Act.

The relative silence on the issue began to break after the Obama administration took a stand on abortion care in June.

The U.S. Department of Health and Human Services’ Office for Civil Rights rejected anti-choice groups’ “right of conscience” complaint against California’s requirement that insurance plans must cover elective abortions under the definition of “basic health-care services.” Anti-choice groups had argued the California law violates the Weldon Amendment, but the administration found otherwise.

The California decision reinvigorated support for the Conscience Protection Act, the aide said. Ryan’s earlier health-care plan also specifically references the decision.

“We think this is going to be a big issue for us throughout the rest of this Congress,” the aide said.

Aide Outlines Additional Consequences

Beyond creating a private right of action and codifying Weldon, the Conscience Protection Act contains additional consequences for abortion care, the aide said.

The legislation would expand the definition of health-care providers to employers, social service organizations, and any other entity that offers insurance coverage, allowing them to raise objections under Weldon, the aide said. The aide characterized the change as a direct response to the California decision.

The legislation also broadens the list of objectionable services to include facilitating or making arrangements for abortion care, according to the aide.

The Republican-dominated House is likely to pass the Conscience Protection Act. But the aide did not expect it to advance in the Senate, which would all but certainly require a 60-vote threshold for such a controversial measure. More than anything, the aide said, the bill seems to be catering to anti-choice groups and long-time proponents of conscience clauses.

“The House oftentimes will pass these kinds of anti-choice proposals, and then they just go nowhere in the Senate,” the aide said.

Analysis Law and Policy

State-Level Attacks on Sexual and Reproductive Health and Rights Continue, But There’s Also Some Good News

Rachel Benson Gold & Elizabeth Nash

Despite the ongoing attention to restricting abortion, legislators in several states are looking to expand access to sexual and reproductive health services and education.

State legislatures came into session in January and quickly focused on a range of sexual and reproductive health and rights issues. By the end of the first quarter, legislators in 45 states had introduced 1,021 provisions. Of the 411 abortion restrictions that have been introduced so far this year, 17 have passed at least one chamber, and 21 have been enacted in five states (Florida, Indiana, Kentucky, South Dakota, and Utah).

This year’s legislative sessions are playing out on a crowded stage. The U.S. Supreme Court is considering a case involving a package of abortion restrictions in Texas; that decision, when handed down in June, could reshape the legal landscape for abortion at the state level. Moreover, just as state legislatures were hitting their stride in late March, the U.S. Food and Drug Administration revised the labeling for mifepristone, one of the two drugs used for medication abortion. That decision immediately put the issue back on the front burner by effectively counteracting policies restricting access to medication abortion in a handful of states. (Notably, the Arizona legislature moved within days to enact a measure limiting the impact of the FDA decision in the state.)

Progress on Several Fronts 

Despite the ongoing attention to restricting abortion, legislators in several states are looking to expand access to sexual and reproductive health services and education. By the end of the first quarter, legislators in 32 states had introduced 214 proactive measures; of these, 16 passed at least one legislative body, and two have been enacted. (This is nearly the same amount introduced in the year 2015, when 233 provisions were introduced.)

Although the proactive measures introduced this year span a wide range of sexual and reproductive health and rights issues, three approaches have received particular legislative attention:

  • Allowing a 12-month contraceptive supply. Legislators in 16 states have introduced measures to allow pharmacists to dispense a year’s supply of contraceptives at one time; these bills would also require health plans to reimburse for a year’s supply provided at once. (In addition, a bill pending in Maryland would cover a six-month supply.) Legislative chambers in three states (Hawaii, New York, and Washington) have approved measures. Similar measures are in effect in Oregon and the District of Columbia.
  • Easing contraceptive access through pharmacies. Legislators in 12 states have introduced measures to allow pharmacists to prescribe and dispense hormonal contraceptives. As of March 31, bills have been approved by at least one legislative chamber in Hawaii and Iowa and enacted in Washington. The measures in Hawaii and Iowa would require pharmacist training, patient counseling, and coverage by insurance; the Hawaii measure would apply only to adults, while the Iowa measure would apply to both minors and adults. The new Washington law directs the state’s Pharmacy Quality Assurance Commission to develop a notice that will be displayed at a pharmacy that prescribes and dispenses self-administered hormonal contraception. Under current state law, a pharmacy may prescribe and dispense these contraceptives under a collaborative practice agreement with an authorized prescriber. Oregon has a similar measure in effect. (California, the only other state with such a law, issued regulations in early April.)
  • Expanding education on sexual coercion. Measures are pending in 17 states to incorporate education on dating violence or sexual assault into the sex or health education provided in the state. A bill has been approved by one legislative chamber in both New Hampshire and New York. The measure approved by the New Hampshire Senate would require age-appropriate education on child sexual abuse and healthy relationships for students from kindergarten through grade 12. The measure approved by the New York Senate would mandate education on child sexual abuse for students from kindergarten through grade 8. And finally, in March, Virginia enacted a comprehensive new law requiring medically accurate and age-appropriate education on dating violence, sexual assault, healthy relationships, and the importance of consensual sexual activity for students from kindergarten through grade 12. Virginia will join 21 other states that require instruction on healthy relationships.

Ongoing Assault on Access to Sexual and Reproductive Health Services

Even as many legislators are working to expand access to services, others are continuing their now years-long assault on sexual and reproductive health services and rights. Restricting access to abortion continues to garner significant attention. However, last year’s release of a series of deceptively edited sting videos targeting Planned Parenthood has swept both the family planning safety net and biomedical research involving fetal tissue into the fray.

  • Abortion bans. Legislative attempts to ban abortion fall along a broad continuum, from measures that seek to ban all or most abortions to those aimed at abortions performed after the first trimester of pregnancy or those performed for specific reasons.
    • Banning all or most abortions. Legislators in nine states have introduced measures to ban all or most abortions in the state, generally by either granting legal “personhood” to a fetus at the moment of conception or prohibiting abortions at or after six weeks of pregnancy. Only one of these measures, a bill in Oklahoma that would put performing an abortion outside the bounds of professional conduct by a physician, has been approved by a legislative chamber.
    • Banning D&E abortions. Legislators in 13 states have introduced measures to ban the most common technique used in second-trimester abortions. Of these, a bill in West Virginia was enacted in March over the veto of Gov. Earl Ray Tomblin (D). A similar measure was approved by both houses of the Mississippi legislature and is being considered by a conference committee. (Kansas and Oklahoma enacted similar laws last year, but enforcement of both has been blocked by court action.)
    • Banning abortion at 20 weeks post-fertilization. South Dakota and Utah both enacted measures seeking to block abortions at 20 weeks during the first quarter of the year. The new South Dakota law explicitly bans abortions at 20 weeks post-fertilization (which is equivalent to 22 weeks after the woman’s last menstrual period). The Utah measure requires the use of anesthesia for the fetus when an abortion is performed at or after that point, something that providers would be extremely unlikely to do because of the increased risk to the woman’s health. In addition to these new measures, 12 other states ban abortion at 20 weeks post-fertilization.
  • Banning abortion for specific reasons. In March, Indiana enacted a sweeping measure banning abortions performed because of gender, race, national origin, ancestry, or fetal anomaly; no other state has adopted such a broad measure. The Oklahoma House approved a measure to ban abortion in the case of a fetal genetic anomaly; the state already bans abortion for purposes of sex selection. Currently, seven states ban abortion for the purpose of gender selection, including one state that also bans abortion based on race selection and one that also bans abortion due to fetal genetic anomaly.
  • Family planning funding restrictions. In the wake of the Planned Parenthood videos, several states have sought to limit funding to family planning health centers that provide or refer for abortion or that are affiliated with abortion providers. These efforts are taking different forms across states.
    • Medicaid. Measures to exclude abortion providers (e.g., Planned Parenthood affiliates) from participating in Medicaid have been introduced in five states, despite the clear position of the federal Centers for Medicare and Medicaid Services that such exclusions are not permitted under federal law. In March, Florida Gov. Rick Scott (R) signed a Medicaid restriction into law. By the end of the first quarter, measures had passed one chamber of the legislature in Arizona, Mississippi, and Missouri; a measure introduced in Washington has not been considered. (A related measure enacted in Wisconsin in February limits reimbursement for contraceptive drugs for Medicaid recipients.)

Similar attempts by six other states have been blocked by court action since 2010. These measures include laws adopted by Indiana and Arizona as well as administrative actions taken in Alabama, Arkansas, Louisiana, and Texas.

  • Other family planning funds. Legislators in 13 states have introduced measures to prevent state or federal funds that flow through state agencies from being distributed to organizations that provide, counsel, or refer for abortions; the measures would also deny funds to any organization affiliated with an entity engaging in these activities. Measures in three of these states have received significant legislative attention. In February, Wisconsin enacted a measure directing the state to apply for Title X funds (the state is not currently a grantee under the program); if the state’s application were approved, the measure would ban this funding from going to organizations that engage in abortion care-related activity. A measure that would deny funds to organizations engaged in abortion care-related activity passed the Kentucky Senate in February. A similar measure in Virginia, which would both prohibit an abortion provider from receiving funding and give priority to public entities (such as health centers operated by health departments) in the allocation of state family planning funds was vetoed by Gov. Terry McAuliffe (D) in March.
  • Related funds. In February, Ohio Gov. John Kasich (R) signed a measure barring abortion providers or their affiliates from receiving federal funds passing through the state treasury to support breast and cervical cancer screening; sex education; and efforts to prevent infertility, HIV in minority communities, violence against women, and infant mortality.
  • Fetal tissue research. The Planned Parenthood videos have also led to legislation in 28 states aimed at research involving fetal tissue. Measures have passed one legislative chamber in four states (Alabama, Iowa, Idaho, and Kentucky), and new laws have been enacted in four states (Arizona, Florida, Indiana, and South Dakota) in the first quarter alone. All four laws ban the donation of fetal tissue for purposes of research. These new laws are the first to ever ban the donation of fetal tissue. The Arizona law also bans research using fetal tissue, and the new South Dakota law strengthens the state’s existing ban by now considering fetal tissue research as a felony; four other states (Indiana, North Dakota, Ohio and Oklahoma) have similar provisions in effect.

Zohra Ansari-Thomas, Olivia Cappello, and Lizamarie Mohammed all contributed to this analysis.