Analysis Contraception

New Multipurpose Prevention Technologies Could Provide Many Benefits for Women

Martha Brady

Now is the time to embrace the development of new health technologies that could provide simultaneous protection for the multiple health risks many women face.

We stand at a unique moment in the evolution of women’s reproductive health programs and in the development of new health technologies for women. The global health community has recognized the need for an integrated approach to women’s sexual and reproductive health (SRH) to meet women’s multiple and diverse needs. And 21st-century health programs have embraced the integration of family planning, reproductive health, and HIV services. Now is the time to embrace the development of new health technologies that could provide simultaneous protection for the multiple health risks many women face.

Globally:

New technologies that could provide simultaneous protection against pregnancy and STIs, including HIV, could contribute substantially to the health of women and girls around the globe.

Thankfully, these products may not be too far off. Referred to as multipurpose prevention technologies, or MPTs, they are the result of collaboration among reproductive health, contraceptive, and HIV researchers. Donors and product developers are working together to create new technologies that offer simultaneous protection from these key SRH risks.

While the existing MPTs (male and female condoms) are effective when used correctly and consistently, many women simply are not able to negotiate condom use with their partners. New MPTs in development include vaginal gels, long-acting intravaginal rings, new and improved barrier devices, vaginal tablets, and films. Once developed and approved, MPTs will be a major advance for global public health and will provide millions of women with new means to protect them. But to get the products from the lab into the hands of the women who need them, key challenges must be addressed:

Understanding women’s preferences, choices, and needs. We know that many women want and need technologies that prevent pregnancy and STIs, including HIV. But finding the right delivery system is crucial. Data from several studies indicate that women don’t use products consistently for a variety of reasons. A recent example of this is the VOICE (Vaginal and Oral Interventions to Control the Epidemic) study. VOICE was a large-scale trial conducted in South Africa, Uganda, and Zimbabwe from 2009 to 2012 to test whether the daily use of a product containing the antiviral tenofovir (oral tablet or vaginal gel) could prevent the sexual transmission of HIV in women. The results showed that many women did not use the study products as directed. While low adherence prevented the study from being able to get an answer about the effectiveness of tenofovir to prevent sexual transmission of HIV among women, it did confirm that women have different needs, preferences, motivations, and barriers to use.

To design effective products that women can use, product developers must understand the challenges women face in accessing and using new technologies. The role that gender norms and power asymmetry play in women’s ability to access and use technologies cannot be underestimated. In, addition, preferences for specific MPT product characteristics (such as formulation, duration of action, and presence and magnitude of side effects) must be taken into account early on in the product-development process. For example, a long-acting product may be easier for some women to use than one that must be taken or used on a daily basis (like those in VOICE) or around the time of sex.

Overcoming technical challenges. Developing MPTs is complicated. Researchers work with active ingredients that have vastly different properties and are designing technologies that will be effective for anywhere from one hour to 90 days. For example, the active ingredients in the MPTs being developed by the Population Council include MIV-150 to prevent HIV; zinc acetate to protect against HIV and herpes; carrageenan to block human papillomavirus (HPV) and strengthen the effectiveness of zinc acetate (which may have protective effects against HIV and herpes); and levonorgestrel to prevent pregnancy. Council researchers are developing delivery mechanisms that release these drugs in a controlled manner for the lifetime of the product—for instance in a slow-release vaginal ring. Too much or too little of one compound can prevent the product from providing maximum protective benefit. Researchers have successfully tested a gel and a vaginal ring that contain three of these drugs and are beginning to design technologies that incorporate all four. More information about the Population Council’s microbicides pipeline is available here.

Bolstering and sustaining funding for R&D. Candidate products must go through a series of preliminary tests before ever reaching the large-scale effectiveness studies needed for product approval. It is the nature of research that many of these candidate products will never make it out of the lab and into effectiveness studies. And by their nature, first-generation products can usually be improved upon with additional study and refinement. That is why investment in MPT R&D is vital. Maintaining an active and robust product pipeline increases the chances that a handful of products will prove promising enough to move on to large-scale studies. Donors and others must recognize the importance of this research and consider MPT R&D a priority. And, when the first generation of new MPTs becomes available we must ensure that health systems are ready to deliver them and that financing mechanisms are in place to support their procurement and introduction.

Navigating complex regulatory issues. Because MPTs combine different components, they do not fit neatly into the discrete categories of “drug, device, or biologic” typically used by the U.S. Food and Drug Administration—the body charged with approving medical drugs and devices for use in the United States. The unique nature of MPTs poses challenges for regulatory bodies in other parts of the world, making their entry to the market complex. The good news is that efforts are underway to identify regulatory pathways for MPTs, and to clarify the regulatory requirements at different stages of product development. We are working now to engage regulators in the emerging MPT field so that the regulatory process is efficient, timely, cost-effective, and ultimately successful.

With continued effort, MPTs could address the major reproductive and sexual health challenges that women worldwide face. While momentum is growing, the public health, medical, and scientific communities must continue to move forward with a sense of urgency and clarity to accelerate the development of these potentially lifesaving technologies for girls and women around the globe.

Investigations Abortion

Anti-Choice Groups Use Smartphone Surveillance to Target ‘Abortion-Minded Women’ During Clinic Visits

Sharona Coutts

Women who have visited almost any abortion clinic in the United States have seen anti-choice protesters outside, wielding placards and chanting abuse. A Boston advertiser's technology, when deployed by anti-choice groups, allows those groups to send propaganda directly to a woman’s phone while she is in a clinic waiting room.

Last year, an enterprising advertising executive based in Boston, Massachusetts, had an idea: Instead of using his sophisticated mobile surveillance techniques to figure out which consumers might be interested in buying shoes, cars, or any of the other products typically advertised online, what if he used the same technology to figure out which women were potentially contemplating abortion, and send them ads on behalf of anti-choice organizations?

The executive—John Flynn, CEO of Copley Advertising—set to work. He put together PowerPoint presentations touting his capabilities, and sent them to groups he thought would be interested in reaching “abortion-minded women,” to use anti-choice parlance.

Before long, he’d been hired by RealOptions, a network of crisis pregnancy centers (CPCs) in Northern California, as well as by the evangelical adoption agency Bethany Christian Services.

Flynn’s endeavors quickly won him attention in the anti-choice world. He was invited to speak at the Family Research Council’s ProLifeCon Digital Action Summit in January this year, and he got a few write-ups in anti-choice press.

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In an interview with Live Action News—the website for Live Action, the group run by anti-choice activist Lila Rose that is responsible for bogus attack videos against Planned Parenthood—Flynn gave some details about his strategy. He sends advertisements for his clients to women’s smartphones while they are sitting in Planned Parenthood clinics, using a technology known as “mobile geo-fencing.” He also planned to ping women at methadone clinics and other abortion facilities. His program for Bethany covered five cities: Columbus, Ohio; Pittsburgh, Pennsylvania; Richmond, Virginia; St. Louis, Missouri; and New York City.

“We are very excited to bring our mobile marketing capabilities to the pro-life community,” Flynn told Live Action News.

Anti-choice groups were tantalized by the ability to home in on the women they think will be most susceptible to their message.

“Marketing for pregnancy help centers has always been a needle in a haystack approach—cast a wide net and hope for the best,” said Bethany Regional Marketing Manager Jennie VanHorn, according to the report. “With geo fencing, we can reach women who we know are looking for or in need of someone to talk to.”

Flynn’s targeting of women seeking abortion presents a serious threat to the privacy and safety of women exercising their right to choose, as well as to abortion providers and their staff, a Rewire investigation has found. But due to weak and patchwork laws governing privacy and data collection in the United States, the conduct appears to be perfectly legal.

Women who have visited almost any abortion clinic in the United States have seen anti-choice protesters outside, wielding placards and chanting abuse. This technology, when deployed by anti-choice groups, allows them to send propaganda directly to a woman’s phone while she is in a clinic waiting room. It also has the capability to hand the names and addresses of women seeking abortion care, and those who provide it, over to anti-choice groups.

“It is incredibly unethical and creepy,” Brian Solis, a digital marketing expert, told Rewire, expressing a view that was unanimous among a dozen experts in digital security, privacy law, and online marketing we interviewed for this story.

Solis said this example was the inevitable application of a technology meant for one purpose—mass advertising campaigns that, while considered by many people to be unseemly and intrusive, do not generally amount to a threat—to a very different, and troubling, objective.

“You can grab an uncomfortable amount of information from someone’s device and the apps they use,” said Solis. “It’s unfortunate, but any woman who plans to visit an affected Planned Parenthood, or anyone who works for Planned Parenthood, should be afraid.”

When Ads Follow You Around

By now, most Americans have experienced the following phenomenon: You look at something online—a hotel, a flower delivery service, a course at a local college—and the next thing you know, ads for that thing follow you around the internet for the next week.

A watch you looked at now pops up next to your Facebook feed; an ad for a coffee machine you researched on Amazon now lurks on your favorite news sites. And maybe, after researching cars online, it seems that Toyota knows whenever you visit a lot, and sends ads to your phone as you walk through the dealership’s doors.

This is all part of the new landscape of digital advertising, where marketers can tailor their ads to very specific groups of consumers by compiling “personas” based on the thousands of shards of data we all create as we go about our activities online.

While theoretically anonymous, these marketing personas are surprisingly accurate. Marketers likely know your age, gender, occupation, education level, marital status, and—if you have GPS enabled on your phone and are logged into apps that track you—where you live, work, and travel.

What Flynn realized is that he could use the same technologies to infer that a woman might be seeking an abortion, and to target her for ads from anti-choice groups.

“We can reach every Planned Parenthood in the U.S.,” he wrote in a PowerPoint display sent to potential clients in February. The Powerpoint included a slide titled “Targets for Pro-Life,” in which Flynn said he could also reach abortion clinics, hospitals, doctors’ offices, colleges, and high schools in the United States and Canada, and then “[d]rill down to age and sex.”

“We can gather a tremendous amount of information from the [smartphone] ID,” he wrote. “Some of the break outs include: Gender, age, race, pet owners, Honda owners, online purchases and much more.”

Flynn explained that he would then use that data to send anti-choice ads to women “while they’re at the clinic.”

In his sales PowerPoint, Flynn said that he had already attempted to ping cellphones for RealOptions and Bethany nearly three million times, and had been able to steer thousands of women to their websites. The price tag for one of Copley’s campaigns, he said, was $8,000.

Flynn initially agreed to speak with Rewire for this story, but did not respond to multiple follow-up emails and phone calls. Much of this report is based on materials that he sent to people he believed to be potential clients. Numerous messages seeking comment from management for RealOptions went unanswered; Jennifer Gradnigo, a spokesperson for Bethany Christian Services, confirmed that they have used Copley’s services and “appreciate their ideas,” but declined to discuss specific campaigns.

Not everyone who received Flynn’s pitch emails was impressed. One recipient contacted Rewire after speaking with Flynn, and expressed horror at what Flynn told her he was able to do on behalf of anti-choice clients.

“I felt disgust, and I felt protective of these women who are going to seek sensitive medical services at a time when they’re vulnerable,” said the recipient, who is a social worker at a Northern California adoption agency. Rewire agreed to withhold her identity due to her fears of retaliation from anti-choice activists.

“They’re being spied on by this capitalist vulture who is literally trying to sell their fetuses,” she said. “To do this to women without consent is predatory and it’s an invasion of her privacy, and unethical.”

In emails and PowerPoint presentations sent in early March, Flynn claimed to have reached more than 800,000 18-to-24-year-old women on behalf of RealOptions, and to have sent more than 2,000 of those women to RealOption’s website.

Rewire obtained three examples of the ads that Flynn said he had sent to young women’s phones on RealOptions’ behalf.

The ads are typical of CPCs.

They ask, “Pregnant?” or “Abortion?” and then include statements like “It’s your choice. You have time… Be informed” and “Get the facts first.”

GeoFencing Pregnant Ad

Like most CPCs, the claim that RealOptions provides “facts” about abortion is deceptive. While that language may lead women to believe they could obtain abortion care at RealOptions, in federal tax filings, the organization explains its mission as: “empowering and equipping women and men to choose life for their unborn children through the love of Jesus Christ in accordance with his word regarding the sanctity of human life.”

According to its website, RealOptions has received funding from the radical Christian group Focus on the Family. The organization was founded in 1981 by Marion and Tom Recine, fervent Christians who in a video posted to their website refer to the “many, many, many women who’ve come to Jesus because of the [RealOptions] centers.”

Flynn also says that he has targeted 140 abortion clinics on behalf of Bethany Christian Services over the past few months, and that 10,000 people clicked on the ads for Bethany that he sent to smartphones in those clinics, directing them to a “dedicated resource centers landing page.”

Bethany is the nation’s largest adoption agency, with assets of more than $45 million in 2014, according to the most recent available figures. The chain has faced accusations of pressuring birth moms to continue pregnancies against their will, of abandoning mothers who change their minds and decide not to go through with adoptions, and other abuses.

The social worker who received Flynn’s pitch deck told Rewire she was alarmed that Flynn had succeeded in reaching so many women on behalf of his anti-choice clients.

“He’s doing it and it’s working and it’s probably really impacting human trajectories,” she said. “It changes human lives to be funneled into a system like this.”

Advertising Is Now a System of Surveillance

Although it is now ubiquitous, mobile digital advertising is a relatively new phenomenon, only as old as the sophisticated smartphones on which it relies. As a result, laws and the regulators who enforce them are lagging behind when it comes to the many possible ways that bad actors can abuse smartphone advertising.

In terms of federal laws, many either don’t apply to Flynn’s conduct, or would allow it, according to Chris Hoofnagle, a professor at the University of California, Berkeley’s School of Law, and School of Information.

“Privacy law in the U.S. is technology- and context-dependent,” Hoofnagle said. “As an example, the medical information you relay to your physician is very highly protected, but if you go to a medical website and search for ‘HIV’ or ‘abortion,’ that information is not protected at all.”

In other words, it’s almost certain that the Health Insurance Portability and Accountability Act, known as HIPAA, would not apply.

The other limitations, such as they are, come from two sets of laws. The Federal Trade Commission (FTC) and state attorneys general can prevent advertisers from sending false and misleading ads; they can also stop advertisers from lying about what information they are tracking and what they plan to do with it once collected.

The FTC did not reply to Rewire’s questions in time for the publication of this story. However, the commission does not have jurisdiction over nonprofits, so it is highly unlikely that it could take action in this case.

The second set of laws concern user consent. Companies like Verizon and AT&T, known as carriers, are required to get affirmative consent before using “Customer Proprietary Network Information” gleaned through cellphone towers—including call records and location—for marketing. Apps don’t use network information, but rely instead on the GPS built into phones. They also need to obtain affirmative consent to collect and use information for marketing.

Obtaining that consent is easier than many consumers may think.

“The reality of this stuff is that no one’s asking what marketers will do with their information when they click, ‘I Agree,’ when an app asks if it can use their location,” Hoofnagle said. “If one consents to that tracking, and consents for it to be used for advertising purposes, that’s pretty much the end of the story.”

Certainly, most people wouldn’t imagine that by agreeing that, say, Yelp, Snapchat, Tinder, or the New York Times could use their location, that marketers could then use the same information for the very different purpose of figuring out whether they are seeking sensitive medical services.

Hoofnagle says that such use is perfectly legal, as long as companies don’t lie about what information they’re collecting—even if those disclosures are buried in fine print.

For his part, John Flynn is confident that his campaign is within legal bounds.

“I have worked with pharma, medical recruitment and many others where we mobile geo-fenced medical centers without a problem,” he wrote in an email to a potential client. “Bethany’s campaign targeted just medical centers and there was [sic] no issues. RealOptions in the San Jose area is presently targeting colleges and medical centers without issue.”

In the absence of robust legal limitations in the United States, advertisers have organized into self-regulatory bodies to police themselves, acutely conscious that examples of egregious privacy violations could spark a public backlash, and lead consumers to block ads and to opt out of targeted marketing.

Lindsay Hutter, a spokesperson from the Direct Marketing Association (DMA)—a New York-based group that represents direct marketers—said in an email statement to Rewire:

A key pillar of DMA’s work is to ensure that data-driven marketers conduct their work on an ethical basis, respecting the private information of consumers. This is particularly true for sensitive medical information about particular individuals, the use of which for marketing purposes without permission is against DMA’s Ethical Guidelines. Any location-based marketing should be opt-in, with the consumer notified that marketing offers are being presented due to their location.

Hutter did not provide a direct reply to our questions as to whether targeting women who might be seeking abortion care on behalf of anti-choice groups would be in violation of DMA’s guidelines.

It would, however, violate Facebook’s standards, according to Tom Channick, a company spokesperson.

“Our policies prohibit ads that make implications, directly or indirectly, about a user’s personal characteristics, including medical condition or pregnancy,” Channick said. “Deceptive or misleading advertisements are also prohibited.”

Flynn claims that he has a “relationship” with Facebook that allows him to “place mobile and digital ads in Facebook pages,” but Channick said the company could find no record of Flynn or his company ever using their platform.

Calling Flynn’s campaigns “really objectionable,” Hoofnagle said that these kinds of practices are toxic to the digital advertising industry, as well as the platforms—like Google and Facebook—that depend on advertising dollars.

He said this example drives home the fact that the nature of advertising has fundamentally transformed with the rise of the internet, and as smartphones have become ubiquitous.

“Advertising is a system of surveillance now,” Hoofnagle said. “It used to be billboards and television. Now it’s surveillance.”

Extremists Could Use Women’s Phones to Learn Their Names and Addresses

Surveillance has long played a central—and deadly—role in the efforts of anti-choice activists to intimidate women out of accessing abortion care, and to stop providers from making it available.

In the late 1990s, an anti-choice extremist created a website called the Nuremberg Files—in reference to Nazi Germany—which was a list of the names and addresses of doctors who provided abortions. Operation Rescue maintained a site called “Tiller Watch” that monitored the doctor’s whereabouts until he was murdered in the spring of 2009. Extremists have published “Wanted” signs with photographs of abortion providers. Activists in Texas stalk people entering local clinics, noting their physical appearance and license plates, hoping to determine which women went through with their abortion and whether anyone changed their mind, as well as to identify clinic workers. Many providers around the country report having been followed on their way to and from work.

Sasha Bruce, senior vice president of campaigns and strategy at NARAL Pro-Choice America, says that tagging the cellphones of women who go to abortion clinics falls within the pattern of intimidation.

“Intimidation frankly is the lowest threshold—that quickly turns to violence,” Bruce said. “That’s part of what’s troubling about this. There’s a real incitement that this information can contribute to.”

Bruce said she was alarmed in particular because Flynn was not just collecting information about what women looked at online, but also about their physical locations.

“If you have the smartphone ID, and then you can tie that to a location outside of the clinic, let’s say a home, that’s a real security threat,” Bruce told Rewire. “I worry about the extension of that—the desire of anti-choice activists to know who these staffers are, and who the women are.”

To be clear, there is no evidence to suggest that Flynn or his clients have or want to use geo-fencing to learn the real identities of women seeking abortion. But experts told Rewire that the potential for others to abuse the technology is a cause for alarm. In keeping with the view that transparency fosters security, Rewire has chosen to outline the ways this tracking could be misused.

In theory, when marketers gather information about individual smartphone users through methods like geo-location, that data is anonymized, meaning that it is not attached to a person’s name, but rather to a unique number known as an “advertising ID.” That is the number associated with the particular copy of the operating system that each of us has downloaded onto our smartphone. If you use a Google phone, your operating system is Android; for iPhone users, it’s your copy of iOS. Much of what you do on your phone can be associated with that advertising ID.

In most cases, marketers want to collect data from millions of potential customers, said John Deighton, a professor of marketing at Harvard Business School, in an interview with Rewire. The more data they have, the more ads they can send, which enhances their database.

“What your story is drawing to my attention is that these same surveillance technologies can be used at a much more micro scale,” he said. “You could imagine outright illegal use of geo-targeting: for example, geo-targeting a rich person’s house and getting an alert when they leave home.” That could, say, lead to high-tech burglary.

“Once you start realizing you can target desirable individuals, instead of being a big data function it becomes about tiny data,” Deighton said.

But if all of the data that marketers collect is supposed to be anonymized, how could bad actors—including anti-choice extremists—figure out the actual identities of the people they track?

The dirty secret of digital marketing is that it is in fact relatively easy to find out the real identities that are attached to our online IDs, according to experts who spoke with Rewire.

The most obvious way is simply to ask people for that information.

Both RealOptions and Bethany Christian Services require a person’s name and contact information in order to receive information online. Once a woman enters her name, email, home address, phone number, or ZIP code, that information is tied to her advertising ID, and Flynn could potentially marry that ID to all data associated with it and store it in what he calls his databank.

There are, however, plenty of less aboveboard methods to learn the name attached to an anonymous ID.

Any site or app that uses a profile with your name and any other information—Facebook, dating services, banking apps—can link your device, and your advertising ID, to the real you.

Legitimate services would not hand over personally identifying information willingly, but there are many instances of such information being made widely available. The cyber attack on Ashley Madison, the dating site for married people seeking extramarital partners, resulted in the release by hackers of the personal information of 32 million of the site’s users, revealing the potential for profile-based sites to be targeted.

Even without sophisticated hacks on established sites, bad actors can use techniques known as “social engineering” to learn the personal identities associated with advertising IDs.

For instance, if an anti-choice group wanted to learn the identity of women seeking abortions, instead of sending them ads for CPCs, they could send ads that seemed unrelated to abortion—for a competition to win $500, or for help with student loans—that tricked women into entering their names, email addresses, and any other information required by the form. Any woman who filled out the form would have unwittingly handed her name to anti-choice activists.

That would allow anti-choice groups to literally see women’s whereabouts in real time, said digital marketing experts who spoke with Rewire anonymously because they were not authorized to speak with the press. They described marketing software that allows them to see targeted individuals’ locations, the same way you can see yourself as a blue dot on a smartphone map. If certain people were seen at an abortion clinic regularly—say, during work hours—Flynn or his clients might even be able to infer that they work there.

“That’s what scares me about your story,” said Deighton. “Now we have an incentive to track people that isn’t the usual big data incentive.”

The question naturally arises: What can abortion providers and the women they serve do to fend off these digital affronts?

The simplest measure Planned Parenthood, or any other abortion provider, could take is to tell patients to leave their smartphones at home or in the car. If that isn’t possible or practical, the best advice is to turn off their GPS and log out of all apps before they come to a clinic.

It’s a simple step, but one that many people either won’t or don’t take, said Cooper Quintin, a technologist at the Electronic Frontier Foundation (EFF), a San Francisco-based organization dedicated to preserving fundamental rights in the age of technology.

“The way we need to fight back against this is by blocking these things that are tracking who we are and where we are and what things we’re looking at,” Quintin told Rewire. EFF considers location-based tracking to be a serious threat to privacy.

“Right now, there’s this big ideological debate about ad-blocking. What’s missing from that debate is the idea of blocking things that are tracking you. Tracking people and building up these databases of what they read online, where they go in the real world, linking their online behaviors to their offline purchases and real world behavior—these things can have real-world effects, and this is a horrific example of how this can affect people in a way that’s much more important than seeing some annoying or creepy ads that follow you around.”

Editor’s Note: Watch our video for info on how to avoid location-based tracking.

Analysis Human Rights

Living in the Shadow of Counterterrorism: A Daily Struggle for Muslim Women

Kanya D’Almeida

In the second part of Rewire’s “Living in the Shadow of Counterterrorism” series, we look at how Muslim families, particularly women, are forced to confront state violence on a daily basis­­—from living with the stigma of terrorism, to repairing their broken homes, to navigating what they say is a brutal and biased prison system.

This is the second article in Rewire’s “Living in the Shadow of Counterterrorism” series. You can read the other pieces in the series here.

When Virginia native Mariam Abu-Ali was 14 years old, her life abruptly turned upside down. It was 2003, two years after the September 11 attacks and well into an era of counterterrorism tactics that were systematically hollowing out Muslim residents’ civil liberties and constitutional protections in the United States. But the Abu-Ali family never imagined they would be caught up in the dragnet.

Mariam’s then-22-year-old brother, Ahmed Omar, had been studying in Medina, Saudi Arabia, when he was arrested in connection with a series of May 2003 terrorist attacks in Riyadh.

In an interview with Rewire, Mariam says her brother, who was born in Texas, was held in solitary confinement in a Saudi jail for nearly two years without ever being charged with a crime. During that time, Mariam tells Rewire over the phone, there is strong evidence that he was tortured. Although defense expert Dr. Allen Keller, director of the Program for Survivors of Torture at the Bellevue/NYU Hospital, examined Ahmed and testified at his U.S. trial to the evidence of torture, an appeals court eventually ruled that Ahmed’s statements to Saudi interrogators were “voluntary.”

When, after months of legal pressure from his family, he was finally returned to the United States, a court for the Eastern District of Virginia charged him with multiple counts, including conspiring with an Al-Qaeda cell in Medina to carry out terrorist attacks on U.S. soil. Following a trial that permitted the admission of what Mariam called “a coerced confession,” he was eventually sentenced to 30 years in prison, and later re-sentenced to life.

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Yet as legal experts like Elaine Cassel, author of The War on Civil Liberties: How Bush and Ashcroft Dismantled the Bill of Rights, have pointed out, “Nowhere in the indictment [was] Abu-Ali tied to any terrorist event or action”—either in the United States or in Saudi Arabia.

Instead, his case fell under the shadowy material support statutes that have governed much of the United States’ counterterrorism operation in the years since 9/11, under the USA Patriot Act of 2001. This set of laws allows the U.S. government to preemptively prosecute individuals for engaging in terrorism based on their perceived predisposition toward violence, rather than their actions.

Over the past 15 years, hundreds of Muslims have disappeared in a warren of these convoluted laws; they are currently locked up in high-security prisons around the country.

A constellation of families, scholars, activists, and civil rights organizations have long challenged the effects of material support charges, as well as the unfair trials and the lengthy and harsh prison sentences that tend to follow them. Over the past few years, they have come together in a campaign called No Separate Justice, an attempt to unite far-flung groups and individuals who are working to dismantle what they say is a parallel and unjust legal system for Muslim residents in post-9/11 America.

Women like Mariam Abu-Ali have been at the forefront of the movement—along with Zurata Duka and Shahina Parveen, whose stories Rewire has previously reported on—advocating on behalf of their loved ones.

In the second part of Rewire’s “Living in the Shadow of Counterterrorism” series, we look at how families, particularly women, are forced to confront state violence on a daily basis­­—from living with the stigma of terrorism, to repairing their broken homes, to navigating what they say is a brutal and biased prison system.

“Dangerous” Minds, Draconian Measures

Mariam Abu-Ali says her brother’s case represents many of the civil rights violations that have marred the decade and a half since 9/11, a sentiment that is echoed in the final opinion on Ahmed Omar’s case penned by the U.S. Court of Appeals for the Fourth Circuit.

In its unanimous decision to uphold the guilty verdict on nine terrorism-related counts against Ahmed in 2008, the three-judge bench wrote:

Persons of good will may disagree over the precise extent to which the formal criminal justice process must be utilized when those suspected of participation in terrorist cells and networks are involved … the criminal justice system is not without those attributes of adaptation that will permit it to function in the post-9/11 world.

While the opinion does not explicitly state what these “attributes of adaptation” are, studies on counterterrorism indicate they could refer to any number of legal practices that have become normalized since September 11. In particular, they could refer to the use of material support statutes, which have played a significant role in the prosecution of Muslim Americans like Ahmed Omar.

As FBI Assistant Director Gary Bald testified to the Senate Committee on the Judiciary in 2004:

It would be difficult to overstate the importance of the material support statutes to our ongoing counterterrorism efforts. The statutes are sufficiently broad to include terrorist financers and supporters who provide a variety of resources to terrorist networks. The statutes provide the investigative predicate which allows intervention at the earliest possible stage of terrorist planning to identify and arrest terrorists and supporters before a terrorist attack occurs. [Emphasis added.]

In short, material support statutes have enabled federal authorities to prosecute people based on suspicion of what they might do in the future rather than any overt criminal act. The statutes primarily refer to “support” for terrorist networks as weapons, arms training, or direct funding. Prosecutors, courts, and juries, however, have interpreted the laws much more broadly to encompass the sharing of religious or political texts online, casual conversations between friends, or charitable donations to organizations in areas controlled by terrorist groups.

In many instances, material support charges have amounted to nothing more than thought crimes, in which law-abiding Muslim residents have been penalized simply for expressing their religious and political views.

According to a 2014 report by Human Rights Watch, material support cases rose sharply in the decade following the September 11 attacks. Prior to 9/11, just six individuals had been charged under these laws in the United States. In the decade following, 168 of 917 domestic terrorism convictions analyzed by HRW fell under such statutes, accounting for 18 percent of all terrorism-related convictions in that time period.

Even a cursory look at some of these cases is sufficient to grasp the breadth of these laws, which have pushed deep into Muslim communities, tearing through many layers of social fabric along the way.

In 2012, the New York Times published an op-ed by Yale professor Andrew March on the case of Tarek Mehanna, a Pittsburgh-born doctor and community leader who was sentenced to 17 and a half years in prison because his opinions about Islam, expressed online, were deemed a form of material support for terrorist causes.

March wrote in the Times:

As a political scientist specializing in Islamic law and war, I frequently read, store, share and translate texts and videos by jihadi groups. As a political philosopher, I debate the ethics of killing. As a citizen, I express views, thoughts and emotions about killing to other citizens. As a human being, I sometimes feel joy (I am ashamed to admit) at the suffering of some humans and anger at the suffering of others. At Mr. Mehanna’s trial, I saw how those same actions can constitute federal crimes.

March’s op-ed illustrates a frightening truth about material support statutes: They allow for the preemptive prosecution of individuals who have not yet committed a crime but whom the government deems capable of possibly committing a crime in the future.

Other cases, such as the Holy Land Five, demonstrate a pattern in which material support laws have essentially criminalized charitable giving. The case involved the founders of the Holy Land Foundation, a Muslim charity that provided humanitarian aid to the needy, including women and children in Palestine. Though the government concluded that the Holy Land Foundation never directly aided a terrorist organization, it nonetheless prosecuted five of its members for funneling aid through charitable committees into areas controlled by Hamas, a designated Palestinian terrorist group, thereby violating material support statutes. Journalists called the verdict an attack on Islam itself, particularly the practice of zakat, which mandates that Muslims allocate a portion of their wealth or earnings for charitable causes.

Because cases based on material support statutes tend to paint the accused as extremely dangerous persons, they are often accompanied by harsh conditions of confinement, both pretrial and following a conviction.

From its very inception, the No Separate Justice (NSJ) campaign has fought this flawed notion, with mothers and sisters of the accused becoming the movement’s most prominent spokespeople. NSJ initially coalesced around the case of a Muslim American named Fahad Hashmi.

Hashmi had been working toward a master’s degree in international relations at London Metropolitan University when he was arrested at Heathrow Airport in 2006. In 2007 he became the first U.S. citizen to be extradited following the loosening of restrictions around the process after 9/11, according to an article by Jeanne Theoharis, a political science professor at Brooklyn College and co-founder of the NSJ campaign, who taught Hashmi as an undergraduate.

He was initially held in pretrial solitary confinement at the Metropolitan Correction Center (MCC) in downtown Manhattan. MCC’s notoriety was cemented in a 2010 New York Times article that quoted a former Guantanamo detainee, who was also held at the MCC, as saying the Cuban military prison was “more pleasant” and “more relaxed” than the federal detention facility in New York City.

Hashmi was also subjected to special administrative measures, government restrictions on a terror suspect’s communications that amount to a gag order on the case and their conditions of confinement. Advocates say these were drastic measures relative to the charges against him: Hashmi’s only crime, according to Theoharis’ article, was allowing an acquaintance to spend a night in his apartment, an acquaintance who would later deliver a suitcase of raincoats and waterproof socks to Al Qaeda members. This same acquaintance would later become a cooperating witness for the government in exchange for a more lenient sentence, and testify against Hashmi in a trial that ended with a guilty verdict and a 15-year sentence.

Stunned by Hashmi’s conditions of confinement, a group called Theaters Against War linked arms with Educators for Civil Liberties and the Muslim Justice Initiative to host weekly vigils outside the MCC in 2009. These gatherings, which continue to this day, form the nucleus of the NSJ movement.

“We wanted to build a coalition so people from different backgrounds could bring their institutional expertise and moral conscience into the same arena as family members, and create a space where people could express outrage at what was happening,” Sally Eberhardt, one of NSJ’s earliest organizers, tells Rewire.

At first, larger civil liberties groups kept their distance, possibly because “this isn’t exactly the most funder-friendly issue in the world,” Eberhardt suggests. But advocates persisted, holding candlelight protests even on the bitterest winter nights, singing songs and chanting poems in the shadow of the detention center. Those intimate gatherings formed the basis of what is now a national movement, encompassing multiple organizations and dozens of families.

Two outspoken leaders are the Sadequee sisters, Bangladeshi Americans who have been among the strongest advocates of prisoners’ rights and the most public critics of the government’s targeting of Muslim men—including their brother, Shifa.

From the Streets to the Prayer Rug: Pushing Back Against State Violence

Ehsanul “Shifa” Sadequee was born in Virginia and grew up in Atlanta, Georgia, the youngest of four siblings in a Bangladeshi-American family. According to his sisters, he was a curious and exceptionally kind child, who by his early teens had grown into a devout and diligent religious scholar.

In 2005, when he was just 18 years old, Shifa traveled to Bangladesh. In April 2006 he got married, but 12 days after his wedding, Bangladeshi authorities took and detained him, apparently at the behest of the U.S. government, for allegedly making false statements to the FBI at John F. Kennedy Airport on his way to Bangladesh the previous year.

Shifa’s sister Sonali, who is based in Atlanta, tells Rewire that this initial charge and arrest, which the High Court Division of the Supreme Court of Bangladesh later deemed a violation of international laws, was a terrifying process for the entire family. For days after Shifa was taken they had no news of his whereabouts. Fears that he would somehow wind up in Guantanamo, ensnared in the web of the “war on terror,” gnawed at the edges of their minds but the family pushed these aside, telling themselves that because Shifa had done nothing wrong, they had nothing to fear. With the phone ringing off the hook and the television on 24/7, they gleaned what scraps of information they could from CNN news reports.

It transpired that upon his arrest in Bangladesh, Shifa was stripped naked, wrapped in plastic, and flown via Alaska to New York, Sonali says, where he spent over three months at the Metropolitan Detention Center (MDC) in Brooklyn before being transferred to the federal penitentiary in Atlanta, Georgia. Shifa spent more than three years in pretrial solitary confinement before ever being formally charged with a crime, his sister said.

Once Shifa was inside the criminal justice system, Sonali explains, federal authorities quickly dropped the initial charges against him and began to build a case around allegations of material support.

At the heart of the case was Shifa’s renown as an Islamic scholar with a larger-than-life online persona—he had studied classical Arabic and the history of religion as a student in Canada and was a gifted translator, often sharing interpretations of Islamic or political texts on the internet. The Sadequee family says Shifa’s trial was riddled with shortcomings, including the use of previously classified evidence and the selection of jurors who admitted to having anti-Muslim bias—which Human Rights Watch says is a common problem. In addition, the prosecution used Shifa’s ideology as a brush with which to paint him as a fearsome radical, on the verge of carrying out a violent attack on U.S. soil.

Although Shifa, according to Sonali, never engaged in any actions beyond practicing free speech, he was found guilty on four terrorism counts in 2009 and, at the age of 23, sentenced to 17 years in federal prison. He represented himself at the trial, making him one of the first Muslim youth to do so in a national security case, according to his sisters.

Both Sonali and Sharmin Sadequee, who is based in New York, have been mobilizing on his behalf for over a decade. After years of shielding themselves from the backlash of isolation and Islamophobia that invariably accompanies charges of terrorism, the young women have turned their advocacy into an art form.

In an interview with Rewire, Sonali explains that when her brother was arrested, the women in her family developed an organic division of labor that allowed them to form a united front against the horror and uncertainty that had descended on their lives.

“I was already plugged into the social justice community in Atlanta, so I saw my role as tapping into that support network, bringing resources to my family to make sure we all understood the human rights issues involved, ensuring we had the skills to confront the media, which was bombarding us at the time,” she says. Her sister, meanwhile, dealt with the prisons, navigating bureaucratic visitation rules and ensuring Shifa had what he needed on the inside.

“Sharmin and my mother also reached out to the Muslim community, to mosques and other groups,” Sonali continues. “And the rest of the time, my mother was on the prayer rug. I don’t know how many hours she spent kneeling and praying.”

They built a website that is always fresh with the latest news about Shifa’s case and serves as a hub for their activism—they recently announced a letter-writing campaign to mark Ramadan, inviting more than 1,000 followers of a Justice for Shifa Facebook group to send greeting cards to Muslim prisoners. Countless hours are eaten up attending rallies, speaking on panels, or sitting with reporters, patiently unpacking the messy details of Shifa’s case.

The irony is that while the Sadequee sisters make a powerful team, they are constantly called upon to do what they say is the hardest thing of all: relive a time in their lives they would rather forget.

“I don’t like to do these interviews,” Sonali says bluntly. “I don’t enjoy them at all—but I recognize they have to be done. Only by sharing what happened to us, by talking about it, will others learn from it.”

They say they have been trying to create collective responses to state violence resulting from the “war on terror,” and hope to combat the government’s tactics of fear and isolation by building community power and resiliency. But this is easier said than done: Not only must the Sadequees contend with the lingering stigma of Shifa’s trial, but they also, until very recently, had to deal with the trauma of visiting their brother in a prison unit that has been described by former detainees as “Little Gitmo.”

CMUs: “A Religious and Political Quarantine”

Between 2009 and 2015, Shifa was imprisoned in the Communications Management Unit (CMU) at the federal detention center in Terre Haute, Indiana, a segregated portion of the prison comprised almost exclusively of Muslim men that has been the subject of a legal battle since 2010.

This past March, the Center for Constitutional Rights (CCR) urged the Court of Appeals for the District of Columbia to reinstate a lawsuit the group first filed six years ago challenging CMUs, which the Bureau of Prisons (BOP) quietly ushered into existence under the Bush administration—the first in 2006 in Indiana, and the second in 2008 in Marion, Illinois.

Conditions in these units, which house 60 to 70 prisoners combined, are harsh, according to the CCR: Although inmates are not held in isolation, they are banned from having any physical contact with family members during visits, and their calls are restricted to two per week, each for 15 minutes. By contrast, other BOP inmates are allowed 300 minutes worth of calls every month.

CCR claims the CMUs violate prisoners’ procedural due process rights, and argue that placement in these units is both arbitrary and retaliatory, with Muslim prisoners vastly overrepresented.

“Between 2006 and 2014, about 170 individuals filtered through these units and 101 of them—about 60 percent—were Muslims, even though Muslims only constitute 6 percent of the general federal prison population,” CCR Senior Staff Attorney Rachel Meeropol tells Rewire in a phone interview.

CCR reported in 2010 that in Marion, 72 percent of current CMU prisoners were Muslim, a 1,200 percent overrepresentation, while two-thirds of the CMU population in Terra Haute was Muslim, 1,000 percent higher than the national average of Muslim prisoners in federal facilities.

“We are challenging the lack of procedural protections before prisoners are placed in the CMU and also alleging that placement is in retaliation for protected political and religious speech,” Meeropol says, pointing out that inmates in the CMU are seldom given reasons for why they were moved into the units, and are routinely denied opportunities to earn their release into general population.

“CMUs are essentially a religious and political quarantine, the same kind of segregation that has supposedly been outlawed in this country,” she added.

In response to multiple requests for comment about these allegations, Justin Long with the Office of Public Affairs at the Information, Policy and Public Affairs Division for the BOP said in an email to Rewire, “The Bureau of Prisons cannot comment on matters currently in litigation,” and directed Rewire to the Bureau’s web page on CMUs.

In addition to being hard on inmates, Meeropol says CMUs are also “debilitating” for families, especially those with young children who cannot communicate with their fathers through letters, and often cannot understand why they are forced to speak to them through glass, using phones that are monitored by prison staff.

“Several mothers have told me that they’ve stopped bringing their children on visits because it was just too devastating,” Meeropol says.

The Collective Trauma of “Supermax” Prisons and Solitary Confinement

The alternative, some might say, is even worse. All over the country, Muslim prisoners are serving decades-long sentences in solitary confinement, which the United Nations has recognized as a form of torture. Advocates and relatives of terror suspects, or those incarcerated on terrorism charges, have long cried foul over these conditions of confinement, which they say is a form of collective punishment on entire families.

Zurata Duka, whose three sons, Dritan, Shain, and Eljvir were arrested in a manufactured terror plot by the government in 2007, is well aware of the toll of solitary confinement. Her sons have spent dozens of years between them in complete isolation, including long stints at the maximum-security facility in Florence, Colorado.

“My sons are strong—they never let us see them cry, even when their daughters are crying on the other side of the glass,” she says to Rewire. “But once my son Dritan told me he nearly lost his mind in isolation.”

Before his arrest, Zurata tells Rewire, Dritan had been very close with his youngest daughter. Every night he would put her to sleep, stroking her hair and singing lullabies. In those early days after he was taken away, the little girl would lie awake at night, calling out for her father. Unbeknownst to the family, thousands of miles away, Dritan was experiencing something similar.

“He told me, ‘Mom, I don’t know what happened. For three days I just lay there, stroking my pillow, thinking it was [his daughter]. I didn’t know who I was and I don’t know how I came back,’” Zurata recalls him saying.

His daughter was so desperate to see him that one day she penned a note to the president. It read: “Dear Mr. Obama. Today is my birthday. I am five years old. Please, if you can, bring my father back just for one day, so I can hug and kiss him, and then, if you want, you can take him back again.” Zurata says she mailed the letter to the White House. She never heard back.

Almost every family has a similar story. According to Mariam Abu-Ali, conditions of confinement often come up at annual gatherings of affected families, which she organizes in her role as director of the Prisoners and Families Committee at the National Coalition to Protect Civil Freedoms.

“About 90 percent of the attendees are women,” she says in a phone interview with Rewire, “and they bring a lot of pain and anxiety into the room. But I’d say the meetings are cathartic,” she adds. “It’s the place where we build bonds with the only people who know what we’re going through.”

Several women who’ve attended the conference in the past tell Rewire they are powerful spaces, offering families a rare chance to speak openly about their lives without fear of being misunderstood, judged, or pitied. It is also a moment for families, particularly women, to share in the collective nature of their trauma, especially the pain of incarceration.

In the 13 years that her brother has served, Mariam says she has come to the painful realization that prisons don’t just lock up individuals—they are a form of bondage on the entire family.

Because Ahmed Omar is imprisoned 1,600 miles from the family’s home in Virginia, in one of the BOP’s maximum-security facilities in Colorado, they only see him once or twice a year. Visits are limited to three family members at a time, meaning Mariam has not seen Ahmed in two years. He reserves his two monthly phone calls for his parents, so she can only hope to talk to him when she visits them. Even these calls are a source of enormous frustration. As she wrote in a recent op-ed:

My mom has spent every Tuesday and Thursday of the last decade, at home, sitting by the phone, patiently waiting for a call that sometimes did not come. And when the call does come, what can one even discuss in 15 minutes? Do you ask him how he’s doing? How can you even ask him how he’s feeling? Do you discuss his prison conditions? His legal case? How do you break the news to him when his aunt or grandfather has passed away?

“What you have to understand is that my brother’s case wasn’t just one devastating ‘moment’ in our lives—it’s a lifelong struggle,” Mariam tells Rewire. “This is not something you ever get used to, or accept. It’s about learning new ways of coping every single day, like living with a chronic illness.”

Each day brings fresh challenges, and tough decisions. For instance, Mariam used to maintain a website, manage a Facebook page, and post daily updates on a Twitter account all relating to her brother’s case. One day she felt she just couldn’t do it anymore.

“At a point you have to ask yourself—do I work full time and provide for my family or do I advocate full time on behalf of my loved one?” she asks. “This work, it’s emotionally draining, it’s a daily struggle and it doesn’t necessarily get easier with time.”

CORRECTION: An earlier version of this article misidentified the officials whom Shifa Sadequee had been accused of making false statements to. It was FBI officers, not immigration officials.