Roundups Abortion

Repro Wrap: Expanding Access to Reproductive Health Care

Robin Marty

In California, nurse practitioners, certified nurse-midwives, and physician assistants will now be able to perform some abortions; a Montana pro-choice leader speaks out; and Kansas sees a win for the South Wind Women's Center.

Too often the news is full of stories about the various ways states are limiting access to reproductive health care. Clinic closures, restrictive legislation, and insurance bans all force those seeking care to put more effort into obtaining what should be a basic human right. But there have been some recent wins in some parts of the country.

California is one step closer to allowing early abortions to be provided by skilled and trained medical professionals who are not doctors. AB 154 has passed the California senate, and will now return to the assembly for a final vote on additional senate amendments before heading to Democratic Gov. Jerry Brown for a signature. The bill, which passed 25 to 11, would allow “nurse practitioners, certified nurse-midwives and physician assistants to perform the procedure during the first trimester of pregnancy,” according to the Sacramento Bee.

Montana may not have the progressive political base of California, but it does have pro-choice advocates working to make access to all forms of reproductive health care a reality. The state’s NARAL affiliate has brought on a new executive director who is eager to explain that reproductive rights is more than just the right to access an abortion. NARAL Pro-Choice Montana Executive Director Maggie Moran writes in the Independent Record:

[B]eing pro-choice … means advocating for preventative techniques that reduce the need for abortion. This means believing in access to affordable birth control and family planning resources, as well as honest and accurate sex education for young people. It is through these techniques, as well as advocating healthy relationships and reducing sexual violence against women, that we will reduce the number of unintended pregnancies, making abortion rare. When faced with an unintended pregnancy, the decision to parent, adopt, or terminate the pregnancy is an incredibly private and personal one—one that should be made only by a woman with council from her family, loved ones and physician—not politicians. This is what being pro-choice truly means.

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In April, the South Wind Women’s Center in Wichita, Kansas, expanded abortion access in the state beyond the Kansas City metropolitan area. But the clinic has had a difficult time letting potential patients know about its services due to a refusal by Clear Channel to run its radio ads. The media company originally called the clinic’s ads “divisive” but has since reversed its position.

“[A]s a responsible broadcaster we should use our best judgment to accept and run ads that do not violate the law or FCC standards and which are not intentionally hateful or incendiary,” Tony Matteo, Clear Channel operations manager in Wichita, told the Washington Post.

Trust Women, an abortion rights group associated with South Wind, and Women, Action & the Media both organized to raise public awareness of Clear Channel’s refusal to air the ads prior to the company’s change of heart.

Culture & Conversation Media

It Shouldn’t Take a Superhero to Access Abortion Care in Prison, But in ‘Jessica Jones’ It Does

Renee Bracey Sherman

Critics have hailed the show for its realistic feminist-leaning plot lines and discussions of sexual consent, rape, and addiction. But while the show offers a depiction of a confident abortion decision, the reality of the situation is pure fiction.

This piece is published in collaboration with Echoing Ida, a Forward Together project.

The protagonist of Netflix’s Jessica Jones series is a former superhero with extreme strength who is trying to make it as a freelance private investigator in New York City. Played by Krysten Ritter, Jones is a cynical and whip-smart character who self-medicates with alcohol as she attempts to destroy her mind-controlling arch nemesis, Kilgrave (David Tennant).

Critics have hailed the show for its realistic feminist-leaning plot lines and discussions of sexual consent, rape, and addiction. But while the show depicts a confident abortion decision, the reality of the situation is pure fiction.

In the sixth episode, titled “AKA You’re A Winner!” Jones is called to a local jail after hearing that a young woman she rescued from Kilgrave, Hope Schlottman, was beaten by another incarcerated woman. Jones learns Schlottman paid the woman “$50 and a pack of smokes” in hopes of forcing a miscarriage because she was pregnant by Kilgrave. (Viewers learned in earlier episodes Kilgrave had taken Schlottman under his control—along with other women, including Jones—forcing her into sexual acts and to murder her parents, for which she was in jail.)

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“I’m pregnant … still,” she tells Jones. “I can feel it growing in me, like a tumor.” Schlottman says she wants an abortion but a provider cannot see her for at least two months. She tells Jones that she will pay for additional beatings until she terminates the pregnancy.

“Every second it’s there, I get raped again and again,” Schlottman says, adding, “I wanna live. I wanna have children, but I won’t give life to this thing. I won’t do it.”

Jones works with Schlottman’s lawyer to obtain an abortion pill. When presenting Schlottman with the pill, Jones tells her, “Once you take this there’s no do-overs. You’ll be sick as shit for about eight hours so I need you to be 1,000 percent sure.” Schlottman grabs and swallows the pill before Jones can finish her statement to show how sure she is, muttering, “Please work fast. Please work fast.” The show later depicts Schlottman cramping in her hospital bed as the abortion completes.

While the show does depict a young woman who is confident and determined to end her pregnancy, and who is able to access a medication abortion with the assistance of a superhero, for incarcerated people, this is not nearly the case.

One in 25 women at state prisons and one in 33 women in federal prisons are pregnant at the time they are admitted, according to the Sentencing Project. Like Schlottman, some will seek an abortion. While a set of court cases show how the constitutional right to abortion in the United States applies to people incarcerated, that hasn’t ended the barriers to accessing care. Many barriers are similar to the ones people outside prison face when seeking care, such as mandatory delays, financial hurdles, and transportation challenges, especially when multiple trips to a clinic are mandated under state law, Dr. Carolyn Sufrin, an OB-GYN who works with incarcerated women, told Rewire in an email.

But other barriers, she continued, are manufactured by local sheriffs and administrators, including requiring the cost of transportation and security to be paid up front, demanding additional administrative bureaucracy and court orders, and having incarcerated women cover the cost of the procedure due to the Hyde Amendment and the burden of Medicaid health-care costs shifting to the correctional facility. Women in prison also are more likely to experience unexpected delays and costs, as well as an overall loss of privacy during their decision.

Because courts and prison administrators view abortion as an elective medical care, it is subject to stigmatizing rules, which delay access and increase costs. Some incarcerated people call the American Civil Liberties Union to help expedite the legal process, or the National Network of Abortion Funds, where I work, for funding assistance, but only if they know that’s an option.

But back to Jessica Jones: At the end of the first season, the writers elevate one of the many false tropes about women seeking abortions in media when Schlottman dies by suicide.

More than 15 percent of women depicted in abortion story lines die after choosing to terminate, and 11 percent of those die by suicide, according to a study by the University of California, which looked at film and television from 1916 to 2013. Even when the deaths are not explicitly tied to the characters’ abortion decisions, this pattern reinforces the false narrative that people choosing the procedure experience negative mental health outcomes related to those decisions—rather than, for example, negative outcomes because of their circumstances created by unjust systems and anti-choice legislation—and deserve violence.

All of these circumstances make the depiction of abortion on Jessica Jones implausible. In reality, incarcerated people have a very difficult time accessing abortion care, particularly medication abortions.

Dr. Sufrin explained that the experience of a medication abortion in prison wouldn’t be as pleasant in real life as it is depicted in Jessica Jones.

“[I]t is highly unlikely that a prison or jail will have a provider who is certified to dispense mifepristone, which requires a special dispensing agreement with the manufacturer, and even more unlikely that the facility would stock the medications for medical abortion on site,” said Dr. Sufrin. “What’s more, medical abortion requires at least two visits to a clinic, the first to take the medications and the second for follow-up to confirm the pregnancy has passed. Each trip off-site to a clinic involves extra logistics and staff to transport the woman.”

Dr. Sufrin added that many prisons ration pads, tampons, and pain medication an incarcerated person can have, thus the pregnant person might not receive enough for the bleeding and cramping they’d experience during an abortion. Additionally, incarcerated people seeking a medication abortion are often afforded less privacy because there is no space for them to complete the abortion within the prison, unlike in a clinic for a surgical abortion, Dr. Monica McLemore, assistant professor at the University of California San Francisco School of Nursing, told Rewire.

“[M]edication abortion isn’t really offered as an option because of logistical space issues and ability for pain management, comfort care, and sanitary supplies in the jail,” she said.

“Medical abortion is practically just not a great option for incarcerated women,” said Dr. Sufrin.

The type of correctional facility in which an incarcerated person is held also makes a difference in the care they are able to receive, said Dr. McLemore. She explained that in California, access to an abortion while incarcerated is dependent on whether someone is housed in a public facility where the health services are run by the state health department, or a private facility where the services are privately contracted out.

“In our experience, getting women second-trimester abortions is very difficult at Santa Rita [a private prison] because of delays related to dealing with Corizon [the company with whom the health-care services are contracted],” said Dr. McLemore.

She recently supported a patient who wanted to terminate her pregnancy when she was around 18 weeks, Dr. McLemore said, but was forced to wait until her release over a month later to actually have her abortion.

Being forced to carry an unwanted pregnancy longer than one wants, or to term, can have negative impacts on mental health for anyone, especially an incarcerated person without adequate access to health care and mental health services. Unsurprisingly, a recently released report, called Who Pays? The True Cost of Incarceration on Families, found a majority of the incarcerated people surveyed experienced negative health impacts associated with being in prison. This can be compounded by the experience of not receiving urgent medical care there. Even in cases where the incarcerated person wants to carry the pregnancy to term, they are often denied basic prenatal care to ensure a healthy pregnancy and child.

Serious changes are needed to ensure all incarcerated people receive comprehensive and compassionate health care while in prison, including abortion care. Dr. McLemore said she’d like to see more sheriffs trained on reproductive and gynecological care and the role staff plays in patients receiving it while in custody. Health care should not be dependent on whether a correctional facility’s health system is privately contracted or not, she added.

Similarly, Dr. Sufrin would like to challenge the notion of “elective” and “medically indicated” abortions within the prison system. “An elective procedure is one that can be delayed indefinitely without a significant impact on someone’s life or healthwhich is clearly not the case for pregnancy,” she said. “And when you have women who are not able to access abortions by virtue of being incarcerated, then they are forced to carry unwanted pregnancies as part of their punishment.”

Simply put: It shouldn’t take a superhero to get an abortion in prison.

CORRECTION: A previous version of this article incorrectly stated the U.S. Supreme Court has taken up this issue. In fact, a set of lower court cases show the constitutional right to abortion in the United States applies to people incarcerated. We regret the error.

News Politics

Hillary Clinton’s Health-Care Plan Guarantees Veterans Access to Reproductive Services

Ally Boguhn

The Democratic presidential candidate released her platform on veterans' services and health care on Tuesday, highlighting the importance of addressing reproductive care and expanding LGBTQ care.

Expanded reproductive and LGBTQ health services are among the key components of Hillary Clinton’s newly released platform on veterans’ services in the United States.

Democratic presidential candidate Hillary Clinton released her platform on veterans’ services and health care on Tuesday, highlighting the importance of addressing care for women through the Veterans Health Administration (VHA), as well as expanding LGBTQ care and support, as prominent components of her plan.

“Women veterans are the fastest growing population served by the [Department of Veterans Affairs], highlighting the importance of proactively addressing the VHA’s ability to meet their needs,” Clinton’s proposal said.

To address those needs, Clinton proposed “requiring the provision of reproductive services across the VHA to ensure women have access to the full spectrum of medical services they need.”

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Along with expanding access to reproductive health services, Clinton outlined her plan to go “beyond simply modifying facilities and increasing the number of OB-GYNs employed by the VHA” by finding funding to allow for “expanding provider training” in order to “ensure women equal and respectful” care at the facilities.

The Democratic candidate highlighted the importance of providing child care at Veterans Affairs (VA) facilities, so that parents would be able to take advantage of the health services provided there.

As the Washington Post noted, “Clinton’s plan does not mention abortion specifically, and federal funds are currently barred for abortions in the VA system.”

Addressing shortfalls in the system around LGBTQ care would be another priority for Clinton. Her platform includes a promise to “recognize the honorable service of LGBT veterans by proactively reviewing and upgrading discharge records for veterans who were discharged because of their sexual orientation; and honoring their service by continuing efforts to improve the support and care they receive at the VHA to ensure respectful and responsive health care.” 

To date, there is one VA clinic specifically dedicated to the needs of transgender veterans; it opened this week in Cleveland, Ohio.

A 2011 report released by the VA found that number of women veterans in the U.S. has steadily climbed. Women are projected to comprise 15 percent of all veterans in the country by 2035. More than 635,000 women in the U.S. are enrolled in the VHA system and more than 400,000 actively seek care through the VAmore than double the amount who used the system in 2000.  

A 2014 report released by Disabled American Veterans, a veterans’ advocacy organization, found that gaps in health care for women veterans are a pressing issue and that the VA and Department of Defense “are still not fully prepared to provide equitable access to the gender-specific care and services that women need, even as the demand for such care increases.”