Evidence-Based Advocacy is a monthly column seeking to bridge the gap between the research and activist communities by profiling provocative new research that activists may not otherwise be able to access.

There is no shortage of panic about teen pregnancy. Despite reports that teen pregnancy is on the decline, the mainstream media is still filled hand-wringing clips about babies having babies and causing the downfall of American society as we know it. But statistics tell a different story: it’s not teens that have the highest unintended pregnancy rates, but young adults, those of us ages 18 to 29. A new study by Jenny Higgins, Ronna Popkin, and John Santelli investigates this statistic by going beyond linking unintended pregnancy to demographic factors like poverty and education, and instead asks: what are young men and women’s levels of pregnancy ambivalence?

The researchers define pregnancy ambivalence as “unresolved or contradictory feelings about whether one wants to have a child at a particular moment.” Pregnancy ambivalence is a term that blurs the lines between intended, unintended, and mis-timed pregnancies. Measuring pregnancy ambivalence allows us to capture complex or not fully formed ideas and feelings about pregnancy. Some of our most-often cited statistics in the pro-choice movement use the binary language of “intended” and “unintended” pregnancy. This simply does not fit the complex reality of experiences with and feelings about pregnancy, especially for young women and young men.

Over the last decade, studies have picked up on the need to address and explore pregnancy ambivalence, but these studies have almost exclusively focused on women. Higgins et al. used data from the National Survey of Reproductive and Contraceptive Knowledge, a survey commissioned by the National Campaign to Prevent Teen Pregnancy and carried out by the Guttmacher Institute. The research team looked at questions relating to pregnancy ambivalence and contraceptive use, and their findings are quite startling. About 45 percent of respondents exhibited ambivalence towards pregnancy, and men were significantly more likely than women to be ambivalent (53 percent of men compared with 36 percent of women). People who expressed ambivalence about pregnancy were more likely to have used no birth control method in the past month.

Why is this significant? Because current pregnancy prevention models put the emphasis on addressing women’s experiences and feelings about pregnancy, while ignoring their partner’s needs. Men in this study had nearly three times the odds of women of being ambivalent about pregnancy, and this ambivalence was associated with reduced contraceptive use for men. 

The researchers suggest that different types of contraception may be related to how couples express pregnancy ambivalence. For example, couples using condoms may have a different relationship with pregnancy ambivalence than couple using an IUD—one method is “user-dependent,” and could be impacted by the heat of the moment, while another method is “user-independent,” and takes away a couple’s ability to decide if they want to use contraception every time they have sex. The research team also implores others to investigate the context in which pregnancy ambivalence occurs—are socially disadvantaged young women and men more or less likely to experience pregnancy ambivalence than privileged young women and men? Why? How does this impact their contraceptive use? Knowing the answers to these questions can help us have a more robust understanding of pregnancy ambivalence, and move beyond only “intended” or “unintended” pregnancy.

In addition to advocating for researchers to consider tough questions that go beyond binary thinking about pregnancy and contraception, the researchers propose that women alone cannot remain the only focus of pregnancy prevention efforts. Women do not engage in pregnancy decision-making alone, and their partners’ emotions must be addressed, perhaps not in the context of “pregnancy prevention,” but in interventions that help couples explore their intentions, attitudes, and feelings regarding pregnancy.

Instead of only emphasizing that couples should use contraception consistently and correctly, we have to figure out how to help them clarify their feelings about pregnancy, even if those feelings are messy and complicated. Encouraging couples to process their complex feelings about pregnancy may even improve contraceptive use, but that can’t be our only goal. In moving beyond a “pregnancy prevention” frame and encouraging open dialogue about the many emotions that pregnancy brings up for both women and men, we can engage and empower both partners to be active participants in reproductive decision-making.  

This piece was published in collaboration with Generation Progress.

North Carolina Gov. Pat McCrory (R) seems to think it’s a governor’s duty to classify which men and women are the “real” ones and which aren’t. Because of this, he has put the lives of all of North Carolina’s trans residents at risk by signing HB 2 into law.

Last week state legislators proposed changes to HB 2, but those changes do nothing to mitigate an unabashed blastoma of transphobia that is now lawfully spreading at a vicious pace.

In response to HB 2, droves of businesses and musicians have boycotted the state in hopes of stopping this unmitigated discrimination toward trans people from moving any further.

People have banded together to show their support for the trans community, and businesses across the state and country have declared themselves safe havens for trans-identifying individuals by submitting to the Safe Bathrooms map.

The map’s creators—River William Luck, a trans community activist, and his partner (and as of recently, fiancée), web design specialist Emily Rae Waggoner—both live in Boston, but the fight to protect trans rights affects them on a deeply personal level: They’re both from North Carolina.

When HB 2 was signed into law, Luck says, “I was on guard, because I’ve been told I’m in the wrong bathroom my entire life as a masculine-presenting female for more than 30 years.”

Now his home state has become one big ”Do Not Enter” sign for him and his friends still there. Luck’s reaction, however, was not one of helplessness. His instinct, which he learned to follow after years of experiencing and bearing witness to bigotry, was to bind the community and help strengthen it through tangible acts of love and support.

One Reddit commenter likened the map to the Negro Motorist Green Book of the 1930s to 1960s, which was published to help Black travelers in the United States find safe passage in times when racial persecution was legal. Like the Negro Motorist Green Book, the bathrooms’ map is not so much a novelty but a vital resource to protect the safety of its users at a time when history is repeating itself in a way that is marginalizing an already vulnerable population.

Before the Safe Bathrooms map, Luck started mailing hundreds of buttons from the #IllGoWithYou campaign to friends and family back home. The #IllGoWithYou campaign was developed as a means for allies to offer solidarity and protection to transgender and non-binary individuals. By wearing a button, participants pledge to stand up and speak up during instances of harassment and physical endangerment.

“This is my way of paying it forward,” Luck says. “What I’ve done is buy a shit ton of buttons and if someone wants one, I send them one. If they can’t afford it, I send them one. If they want to know more about it, I write them a note and ask people to pick up more.”

His reasoning is simple: “I would have given anything to have seen one of these when I was in North Carolina.”

Luck’s meaningful gestures extends to the clothes he wears, as he frequently can be found sporting a t-shirt that says “No Hate in Our State” or a tank top with the words “Proud Transman” printed in bold. River models several lines of what he refers to as “activism wear,” as a product ambassador a variety of labels including a Greensboro, North Carolina-based company called Deconstructing Gender, and another called Proud Animals.

It’s actually the former that planted the seed for the Safe Bathrooms map, as Luck and Waggoner were inspired by the photos of gender-neutral bathrooms posted on the company’s Instagram account. While the two were talking to Deconstructing Gender’s founder and CEO Avery Dickerson, who was transitioning at the time, Dickerson said to Luck and Waggoner, “Wouldn’t it be nice if there was a map of safe bathrooms where trans people could go without hassle?”

And so with Waggoner’s web design expertise and Luck’s social media skills, the Safe Bathrooms map came to life as a child of both necessity and wishful thinking. As they built it, the people came in droves: businesses, affected community members, and media alike.

With over 200 businesses included to date, the two have put together a functioning survival guide for trans residents and travelers who also possess bladders.

Waggoner shared one email with Rewire that she received from a man who owns an architecture firm in Maine, who requested to have his business be included on the map:

I, therefore this business, stand for equality, acceptance, and kindness to all. As a gay man, and one living with HIV for 30 years now, I know too well that indifference to discrimination, condoned cruelty, and legalized oppression are terminal illnesses. These behaviors killed the dreams, and injured the very souls of our young, and further darkened the roads the rest of us continue to travel. It must stop.

To be included on the Safe Bathrooms map, businesses need simply fill out this form and verify their trans-friendliness with a photo of a gender-neutral bathroom placard or other clear form of expression. Upon approval, businesses are represented on the map as a roll of toilet paper. For those lacking, the Safe Bathrooms website goes one step further and shows businesses where they can obtain gender-neutral bathroom signs for their private spaces.

Waggoner and Luck know personally how useful such a map can be. Waggoner says she’s had to stake out bathrooms to make sure the coast is clear, like a Secret Service member. One time, she says, “We were in a restaurant waiting to use the bathroom. We could feel the tension in the air and feel the stares. And it became very uncomfortable because people at the bar were openly just watching which bathroom River was going to go into. And we feared for his safety and our safety.”

Luck continues, “We ended up having to leave and go to a friend’s house so I could use the bathroom and detoured the whole evening plans so I could pee safe.”

Clearly the problem won’t end once HB 2 and other anti-trans laws like it are repealed. The attitudes that brought these policies into being still exist and must be dealt with. But, as Luck attests, there is a definite support system of love and acceptance in North Carolina. He found it in Greensboro as a music teacher at New Garden Friends School, a Quaker school. “They were so open and embraced diversity that I could be an out lesbian,” says Luck.

Greensboro has very distinct pockets of support, which is where a lot of the safe bathrooms appear on the map. But even in places less supportive deeper south, Waggoner notes there are still good friends to be found: “It’s been cool to see some of the small-business owners in some of the more rural towns popping up. Like in Salisbury, North Carolina. It’s really brave of them to do that—to be the first in their town to speak up and say something, and be the first on the map.”

The outpouring of support may be having an effect: University of North Carolina President Margaret Spellings recently gave a statement saying that she would not enforce HB 2 or change any of the school’s current provisions. Spellings did originally plan to enforce HB 2. It wasn’t until U.S. Attorney General Loretta Lynch declared the state in violation of civil rights and threatened to cut up to $4.8 billion in federal funding to the school that Spellings changed her position (and McCrory sued the federal government).

Before Spellings changed her decision, students from various on-campus alliance groups held loud protests outside of buildings in which she was attending meetings, in efforts to sway her judgment. Students at schools across the state affected by the law are making their opposition known.

On a K-12 level, there are organizational efforts through nonprofit Gay-Straight Alliance groups such as Time Out Youth, which offers resources and aid to LGBTQ minors living in inclusive North Carolina and South Carolina school districts. Its website lists student rights, including the rights to gender expression, confidentiality, and respective pronoun usage, as well the right to attend school functions and report on instances of bullying (which state public schools are required by law to deal with).

Luck has spent most of his life traveling against the grain of society’s intolerance–from a misunderstood kid living with his grandparents, to a determined and proud trans man working hard to end the ritual persecution of his fellow person.

Growing up in North Carolina in a conservative Baptist household, Luck remembers being called a “tomboy” and being told “not to act like a boy” as young as 3 years old. Luck attended and was eventually kicked out of a Christian high school for identifying as a “lesbian” (this was before he identified as trans). Luck says he’s been working steadily since he was 13, when his first job was at a Chick-fil-A.

In college, Luck had a psychology professor who taught that homosexuality was a disorder.

“I remember sitting in the class waiting for someone to say something, because I didn’t want to say anything,” Luck says.

After going to the head of the psych department, and then the head of the school, Luck managed to get the homophobic lesson pulled from the syllabus.

“That was a time in my life where I realized if I didn’t say something, no one would. And so I had to. That’s when my activism really started,” Luck says.

Coming to Boston for grad school, Luck found his new home to be much less critical of his outward gender appearance, and found true love in his partner. Luck says Waggoner accepted and supported his transition every step of the way—from coming out (a second time) as transgender, to life-affirming surgeries and ongoing treatments, to his sweeping romantic proposal involving a trip to New York City, a rare Harry Potter book, and a cleverly inserted engagement ring.

Luck and Waggoner hope to expand upon all the ground they’ve covered in North Carolina and take their Safe Bathrooms map to national and international levels.

Luck says he wants to ultimately see the whole state of North Carolina become “a giant roll of toilet paper.”

“We’d [also] love for it to grow to be an international thing, especially given all the anti-LGBT sentiments in other countries. Because we’re everywhere. And everybody needs to have that access,” he says.

The two do have an app in the works to accompany their Safe Bathrooms map, which they hope to give a Yelp-like interface to allow community members to find safe bathrooms on the go, and review and share their own individual bathroom experiences.

All of this work points to a very simple goal: to make it so trans people don’t have to endure daily humiliation exercises to find a toilet that comes with no strings attached.

“The bottom line is … I’m a human being who happens to be trans. But before I would label myself trans, I would say I’m an activist, an actor, a student, an artist, a musician, a good partner, a good relative … All these other qualities that define me that have so much more weight,” says Luck.

To show support for the trans community and be included on the Safe Bathrooms map, visit SafeBathrooms.club.

With the new U.S. Supreme Court abortion ruling, some Pennsylvania lawmakers want to roll back provisions similar to those struck down in Texas—and to head off any new restrictions in a bill debated on the house floor in late June.

Several legislators have called for repeal of Act 122, which was enacted in 2012 and mandates that Pennsylvania abortion clinics meet the standards of ambulatory surgical centers.

The U.S. Supreme Court struck down Texas’ ambulatory surgical center provision in the 5-3 Whole Woman’s Health v. Hellerstedt decision. Justice Stephen Breyer concluded in the opinion that the provision represented a “substantial obstacle in the path of women seeking a previability abortion” and was unconstitutional.

Soon after the decision, Sen. Daylin Leach (D-Montgomery/Delaware), a member of the bipartisan Women’s Health Caucus of the Pennsylvania legislature, wrote a memo recommending repeal of Act 122. And at a June 30 press conference organized by the caucus, Rep. Steven Santarsiero (D-Bucks) introduced legislation to do just that. He weighed in on another bill, HB 1948, discussed in the house on June 21.

During that debate, “[anti-choice lawmakers] were exposed, they were unmasked,” Rep. Santarsiero said. “They stood one person after another after another in support of [HB 1948], and they came right out and said this is all about the anti-choice movement. They were exposed. They tried 20 years ago to claim it was not about that, but they’re not making any pretense at this point.”

Like Act 122, HB 1948 is an urgent matter. Anti-choice lawmaker Rep. Kathy Rapp (R-Warren) introduced the latter legislation in April, which would be one of the most severe laws in the country if enacted. HB 1948 would ban abortion beginning at 20 weeks. It also includes a “method ban” provision, which would criminalize dilation and evacuation (D and E), often used after miscarriages and for abortions earlier than 20 weeks.

Currently, HB 1948 is still on the schedule of the Pennsylvania Senate Judiciary committee. Though the senate may reconvene this summer, it’s unclear when or whether HB 1948 will move forward.

But advocates must not lose sight of this bill. 

A ‘Dangerous Precedent’

HB 1948 inserts the legislature into the doctor-patient relationship, forcing medical professionals, ordinary Pennsylvanians, and even some legislators out of the process. In April, lawmakers twice rejected requests for input on HB 1948 from both medical professionals and the public. When Rep. Dan Frankel (D-Allegheny) spoke out against the bill, his microphone was reportedly cut off.

Struggling to be heard, doctors and relevant medical associations sent open letters and wrote op-eds against the bill. “We are highly concerned that the bill sets a dangerous precedent by legislating specific treatment protocols,” wrote Scott E. Shapiro, president of the Pennsylvania Medical Society, in an April letter sent to legislators.

They are right to be concerned. Around the country, lawmakers with no medical training frequently propose method bans to criminalize the safest, medically proven procedures. They then threaten to imprison doctors if they don’t provide less-than-optimal care for their patients. This kind of legislative coercion brings to mind Donald Trump’s March statement that women who seek abortion should suffer “some form of punishment” for having an abortion.

Punishment, indeed. Under HB 1948, the punishment can go one of two ways: Either women receive less-than-optimal care, or doctors must be incarcerated. While considering the potential fiscal impact of HB 1948, lawmakers discussed how much it would cost to imprison doctors: $35,000 a year, the annual expense to care for an inmate in Pennsylvania.

My colleagues here at the Women’s Law Project, who co-authored a brief cited by Justice Ruth Bader Ginsburg in her Whole Woman’s Health v. Hellerstedt concurrence, have sent an open letter to senate leadership asking them to remove HB 1948 from further consideration.

The letter said:

If enacted, HB 1948 would inflict even greater harm on the health of Pennsylvania women than House Bill 2 would have inflicted on Texas women. Relevant medical experts such as the Pennsylvania section of the American Congress of Obstetricians and Gynecologists (ACOG) and the Pennsylvania Medical Society strongly oppose this bill.

Under well-established constitutional standards, HB 1948 is quite clearly unconstitutional.

The Strange Debate About HB 1948

For a while, HB 1948 seemed to have stalled—like much business in the legislature. It took more than 270 days to finalize the 2015 budget—an impasse that forced dozens of nonprofit organizations serving rape survivors, domestic violence victims, hungry children, and the elderly to lay off workers and turn away clients.

But in April, Pennsylvania lawmakers whisked HB 1948 to the floor within 24 hours. Then, on June 21, the bill suddenly sailed through the appropriations committee and was rushed to the house floor for third consideration.

HB 1948 passed the house after the kind of bizarre, cringe-worthy debate that makes “Pennsylvania House of Representatives” feel like an insult to the good people of the state. Surely, Pennsylvanians can represent themselves better than elected officials who want to punish abortion providers, liken abortions to leeches, ignore science, and compare abortion regulations to laws restricting pigeon shooting. Surely, they can do better than the legislators who hosted the June 21 farce of a debate about a bill designed to force women to carry unviable pregnancies to term.

At that debate, primary sponsor Rep. Rapp stood for questions about HB 1948. But when Rep. Leanne Krueger-Braneky (D-Delaware County) began the debate by asking Rapp about what doctors, if any, were consulted during the drafting of the bill, Speaker of the House Mike Turzai (R-Allegheny) halted proceedings to consider if such a question is permissible. Also a co-sponsor of the bill, he concluded it was not, offering the explanation that legislators can inquire about the content of the bill, but not its source or development.

Rapp eventually stated she had many meetings while drafting the bill, but refused to answer with whom. She invoked “legislator’s privilege” and insisted the meetings were “private.” Legislator’s privilege is an esoteric provision in the state constitution intended to protect the process from undue influence of lobbyists, not shield lobbyists from public inquiry.

The bill’s language—referring to D and E by the nonmedical term “dismemberment abortion”—echoes legislation promoted by the National Right to Life Committee (NRLC). The NRLC has also drafted boilerplate 20-week bans, along with Americans United for Life, an anti-choice organization and a leading architect of the incremental strategy for building barriers to access safe and legal reproductive health care.

Next, Rep. Madeleine Dean (D-Montgomery) asked Rapp if similar bills have been deemed unconstitutional in other states.

Indeed, they have. According to Elizabeth Nash, senior state issues advocate at the Guttmacher Institute, similar D and E bans have been blocked in Oklahoma and Kansas, and 20-week bans have been struck down in Arizona and Idaho. HB 1948 is one of the first pieces of legislation to combine both provisions into one bill; at the Women’s Law Project, we call it a “double abortion ban.”

But no one in the chambers would know that these anti-abortion restrictions have been obstructed because, once again, Speaker Turzai halted the proceedings over these questions. This time, he stopped the debate citing the house rule that lawmakers cannot ask a question if they already know, or the speaker suspects they know, the answer.

In any case, so it went. Pro-choice lawmakers of the Women’s Health Caucus of the Pennsylvania Legislature spoke out against the bill, reading letters from physicians and sharing tragic stories of family members who died after being denied abortion care during severe pregnancy complications.

When Rep. Rapp was asked if she knew that many severe fetal abnormalities were not diagnosed until or after the 20th week of pregnancy, she responded that many were not diagnosed until birth, which misses the point: HB 1948 is designed to deprive women who receive a diagnosis of a severe fetal anomaly, even unviable pregnancy, at 20 weeks or later of safe and legal abortion.

That’s alright with Rapp and others pushing HB 1948; the bill contains no exemptions for fetal anomalies or pregnancies that were a result of rape.

The bill’s supporters didn’t refute allegations that if passed into law, it would negatively affect health care. They argued their case by invoking metaphors instead. They compared abortion regulations to laws about pigeon shoots. They compared fetuses to bald eagles and abortion to leeches. A white male legislator, a description unfortunately almost synonymous with “Pennsylvania legislator,” compared abortion to slavery, drawing the ire of Rep. Jordan Harris (D-Philadelphia).

“We use slavery references when it benefits, but won’t do anything about the systems that negatively affect their descendants,” tweeted Rep. Harris.

Democratic Rep. Dan Frankel, co-chair of the Women’s Health Caucus, attempted to put the bill into context by noting the barrage of abortion restrictions passed in Pennsylvania already. In addition to the ambulatory surgical facility requirement, the state already has a ban prohibiting women from purchasing affordable health insurance that covers abortion through the exchange; an arbitrary 24-hour mandated waiting period; and a Medicaid ban that allows federal funding of abortions only in cases of rape, incest, or life endangerment.

The house voted 132-65 in favor of the bill, mostly among party lines, though 25 Democrats voted for it and nine Republicans voted against it. Gov. Wolf has promised he will veto it if passes, while HB 1948 proponents are working to gather enough votes for an override if necessary.