Commentary Abortion

The Social Status of Abortion Providers: ‘Doctors of Conscience’ Revisited

Carole Joffe

During her speech accepting the 2013 Lifetime Achievement Award from the Society of Family Planning in Seattle, Carole Joffe explained that although in many ways reproductive rights are under assault from state legislatures, "some things in the world of abortion provision are different—even arguably better" than they were in years past.

The following is a lightly edited version of remarks Carole Joffe gave while accepting the 2013 Lifetime Achievement Award from the Society of Family Planning in Seattle on October 7.

My journey as a researcher of abortion provision started in the late 1970s. I had just moved to the Philadelphia area for my first academic job, and I began an ethnography of a Planned Parenthood clinic in that city that was in the midst of incorporating abortion services. My interests at that time were in observing how a social movement issue becomes translated into a health-care “service.” But after immersing myself in that clinic for over a year, I became deeply interested in all categories of abortion providers, broadly speaking—counselors, nurses, physicians, clinic directors—and I have been studying providers ever since.

What I would like to do today is revisit some of the main points of my book, Doctors of Conscience: The Struggle to Provide Abortion Before and After Roe v. Wade. What I attempted in that book was to apply a sociological lens to the work of providers, including an investigation of the “social status” of providers, which is sociological jargon for asking, more simply, how did involvement in abortion work affect both the personal and professional relationships of that first generation of providers whose work spanned the years immediately before and after legalization?

I argued, based on the interviews I conducted with those physicians, that abortion provision early on suffered from a marginality from the rest of medicine. As I put it, “mainstream medicine supported legal abortion but not the abortion provider.” Very briefly, I claimed that within medical circles the legacy of the “back alley butcher” of the pre-Roe era carried over and stigmatized all those who had performed abortions before Roe and went on to do so afterwards—even the “doctors of conscience” I interviewed who had provided, at great personal risk, safe and ethical care before legalization. I also wrote of the personal isolation many felt as a result of engaging in this work.

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Today I would like to revisit and somewhat modify those arguments, because, as I will argue, some things in the field of abortion care have changed for the better. But before I proceed, let me be very clear! I am deeply aware that our field is in very serious trouble! This talk is not intended as a “don’t worry, be happy” motivational speech. Of course, as you all know, we are facing an unprecedented assault from state legislatures. Numerous clinics have closed in the last three years, and abortion provision in red states—and even in some not so red—has gotten extraordinarily difficult. And let me give a special shout out to those of you here who work in Texas, North Carolina, Ohio, Wisconsin, Pennsylvania, Virginia, Mississippi, and a list of other states that goes on too depressingly long.

Nevertheless, some things in the world of abortion provision are different—even arguably better as I have said—and I think these things will be very consequential in the years ahead as our field pushes back against this assault.

Let me start this story with the late Dr. Jane Hodgson, an obstetrician/gynecologist in Minnesota. Dr. Hodgson was one of the first physicians I interviewed for the study that became Doctors of Conscience, and someone from whom I learned so much. I interviewed her several times, and she is the subject of the first chapter of that book. Her historical importance is that she was the first and only U.S. doctor ever convicted of performing an abortion in a hospital. She did this openly in 1970, on a patient with rubella, hoping to become the test case that would come before the Supreme Court. As a result of this act, Dr. Hodgson was tried and convicted, and lost her Minnesota medical license; her license was not returned until the Roe decision in 1973. She went on to open several clinics in her state, wrote widely about abortion, including one of the first textbooks on the subject, and in the following decades was involved in several other key legal abortion cases.

But I will not talk today about the historical role Jane Hodgson played in abortion provision in the United States. Rather, I will reflect on what my interviews with her revealed about the impact of involvement with abortion on one’s social and professional identity.

To be sure, Jane Hodgson was not a complainer! On the contrary, as she said to me, reflecting on her decades-long involvement with abortion (in a statement which was repeated in her New York Times obituary), “I think in many ways I’ve been lucky to have been part of this. If I hadn’t gotten involved, I would have gone through life probably being perfectly satisfied to go to the medical society parties and it would have been very, very dull. I would have been bored silly.”

Upbeat as this statement is, nevertheless Jane Hodgson’s involvement with abortion was costly in numerous ways, both personally and professionally. In personal terms, one of the most painful costs of abortion involvement came when Hodgson attended her fiftieth reunion at Carleton College. As she told me, “They were giving me an alumni award at that reunion. I learned later from the committee that it was a very hot discussion whether they should give it to me or not but they finally did. But it was very painful. … I hadn’t been to one [reunion] and some of these people I hadn’t seen since college, and I’d rush forward to greet them and they’d turn away. It was kind of a low blow and I think that bothered me maybe as much as anything.”

Professionally, there were costs as well. As news of her arrest and trial spread, her favorite nurse, who had worked for years in Hodgson’s private practice, abruptly left; the strongly anti-abortion chair of the OB-GYN department at the University of Minnesota, where Hodgson had an appointment, was a key witness for the state and brought his residents to observe her trial—“I guess he wanted them to see what happens if you take the wrong path;” she was shunned at a meeting of the Minnesota Obstetrical Society, an organization of which she had formerly served as president.

In spite of the strong support Hodgson received from many influential individuals within medicine, she was particularly disappointed by the lack of any support from organized medicine, especially the American College of Obstetricians and Gynecologists. In one of the few moments of bitterness that Hodgson allowed herself in the course of many hours of interviews, she said, in response to my question of what the ACOG had done to help her case. “Nothing, not a thing. They never did anything.” (By coincidence, ACOG was holding a regional meeting in Minneapolis at the time of Dr. Hodgson’s trial, and she asked that someone come to testify on behalf of the need for safe abortion, and the public health consequences of unsafe abortion, but her request was refused).

I wish to argue to you today that since I interviewed Dr. Hodgson in 1987 and 1988, two significant changes have occurred, changes that would have greatly heartened her. Today, much of the medical community—beyond ACOG itself—is speaking up on behalf of abortion providers, and a quite extraordinary support community is in place within the abortion providing world itself.

One of most forceful of these recent statements on behalf of abortion providers, in response to the current wave of restrictions in state legislatures, has come from two professors at Harvard Medical School: Dr. Marcia Angell (former editor of the New England Journal of Medicine) and Dr. Michael Greene. In an op-ed published in USA Today, the authors decried the silence of organized medicine in the face of these legislative assaults, stating:

The profession as a whole, as represented by its professional organizations, needs to become involved, so that physicians are not left to fend for themselves. It is time for the American Medical Association and, particularly, the American College of Obstetricians and Gynecologists, to take a public position on behalf of the patients they are pledged to serve, and to support their members in doing so.

And ACOG, at both the national level and in state chapters, has been speaking out—to an unprecedented degree in that organization’s history. In the campaign season of 2012, for example, the national office of ACOG issued strong rejoinders to the notorious misstatements of extremist Republican candidates: for example, in response to Missouri senate candidate Todd Akin’s ludicrous claim about “legitimate rape,” the college declared that “Recent remarks by a member of the US House of Representatives suggesting that women who are victims of ‘legitimate rape’ rarely get pregnant’ are medically inaccurate, offensive, and dangerous,” and the statement went on to cite the “10-15,000 abortions that occur each year in the U.S. due to pregnancies resulting from rape or incest.”

Similarly, ACOG chapters at the state level have been very vocal about their opposition to the wave of restrictions passed by state legislatures. Texas OB-GYNs, for example, published a statement in the Austin American-Statesman decrying the “insidious legislation” passed by politicians in that state, and pointing to the fact “that these bills will not help protect the health of any woman in Texas. Instead, these bills will harm women’s health in very clear ways.” Physician groups in North Carolina, Wisconsin, Arizona, Georgia, and elsewhere have similarly spoken out against legislative interference with medical practice.

When Philip Darney and Uta Landy, both in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of California, San Francisco, recently attempted to replicate (and update) a 1972 campaign that had obtained the signatures of 100 leading academic OB-GYNs on a “statement on abortion” urging their colleagues to accept and prepare for the imminent legalization of abortion, the 2012 effort also collected 100 signatures, a striking number of them from department chairs and professors in “red” states. The 2012 statement, which called on their fellow OB-GYNs to take action in light of the legislative assaults on abortion, was published in the leading journal in the field.

It is not only obstetricians who have been protesting the attacks on abortion. The American College of Medical Genetics and Genomics, for example, issued a statement expressing its concern about the recent wave of restrictions saying “The ACMG believes strongly that a balanced discussion of options, including termination of pregnancy, should be available to pregnant couples where their fetus has been diagnosed with a genetic disorder or congenital anomaly.” But perhaps the most encouraging expression of support for abortion providers came in a recent article in the New England Journal of Medicine, in which the executive director of ACOG was joined by leaders of four other medical organizations, including those in pediatrics and family medicine. The statement of these leaders is especially noteworthy to me precisely because it is not just about abortion providers, but medical practitioners more generally. I take this group effort as one indication that leaders in other fields in medicine are finally willing to move beyond the historic marginality of abortion provision. As the authors state in this article, “Some recent laws and proposed legislation inappropriately infringe on clinical practice and patient–physician relationships, crossing traditional boundaries and intruding into the realm of medical professionalism. … We believe that legislators should abide by principles that put patients’ best interests first.”

To be sure, when evaluating the impact of these various examples of support for abortion providers (and correspondingly, criticism of legislators), some might say that these efforts are “too little, too late.” With the exception of the 1972 statement mentioned above, one can ask where were OB-GYNs and others in medicine earlier—for example, when providers like Jane Hodgson very much needed their support? Certainly, the relative silence, up ’til now, of colleagues not engaged in abortion provision, has contributed to the marginal status of the latter. Moreover, one might question how significant are these statements of support, given the arguable decline of medical authority generally at the present moment. These are fair questions, and I regret that in this talk, I don’t have the time to engage with them. I will say, however, as one who has closely observed the abortion providing community for many years, that this level of solidarity with providers that is coming from elsewhere in medicine is truly unprecedented, and has to be seen as a positive development.

But in my view, unquestionably the most important change that has occurred in the world of abortion providers since the time I interviewed Dr. Hodgson is the emergence of a very strong and multi-faceted community within this world. Until the early 1990s, though there were a few national pro-choice political groups, such as NARAL and the National Organization for Women (NOW), the only group that was specifically concerned with meeting the logistical—and collegial—needs of providers was the National Abortion Federation (NAF), which was founded in 1977. NAF, then (as now) provided an important source of affirmation for providers, particularly at its annual meetings. But for many years, NAF was nearly the only game in town for most providers and its membership was largely confined to clinicians.

Starting in the early 1990s, a quite astonishing number of groups sprang up, all of which, in different ways, spoke directly to issues of abortion provision. To cite just some of these, a Fellowship in Family Planning (1991) and the Ryan Residency Training Program (1999) were established to expand training and clinical research in this field among mainly young OB-GYNs while the Reproductive Health Access Program and the RHEDI program (Reproductive Health Education In Family Medicine), both of which originated in the mid-1990s, served the same function in family medicine and primary care; the Center for Reproductive Rights (1992) became, along with the previously existing Reproductive Freedom Project of the American Civil Liberties Union (ACLU), a leader in the legal defense of abortion; Medical Students for Choice (1993), along with Clinicians for Choice (1996), Law Students for Reproductive Justice (2003), and Nursing Students for Choice (2007), brought people at early stages of their professional careers into this world; the founding of the Bixby Center for Global Reproductive Health at UCSF (1999) as well as Advancing New Standards in Reproductive Health (2003), a program within the Bixby Center, and Ibis Reproductive Health (2003) dramatically expanded the opportunities for social science research about abortion, and the formation of the Society of Family Planning (2004-2005) established a forum where clinical and social science researchers could meet; Physicians for Reproductive Health (1992) is of particular interest because it is an organization of both abortion providers and non-providers, with the latter committed to promoting the interests of the former.

It is not surprising to me that there was this explosion of new organizations starting in the early 1990s. The late 1980s and early 1990s saw the dramatic escalation of anti-abortion activity: the first large-scale blockades by Operation Rescue and other aggressive actions at the site of abortion providing facilities, and of course, in 1993, the tragic murder of David Gunn in Florida by an anti-abortion fanatic, the first of what was to eventually become eight murders of individuals within the provider world. Moreover, the early 1990s also marked a growing awareness of those in the field of an abortion provider shortage—a shortage caused not only by the rising aggression of protestors, but of the failure of mainstream medicine to normalize abortion training and services in reproductive health care.

Some groups, particularly Medical Students for Choice (MSFC) very deliberately pointed to the activities of their opponents as the core rationale for their founding: the group was founded in the aftermath of the murder of Dr. Gunn, and also shortly after an anti-abortion group sent a deeply offensive mailing to numerous medical students across the country, which demonized abortion providers. Others of the groups mentioned above focused on the need to have more providers in the pipeline as the first generation of legal abortion providers were nearing retirement age.

But the unquestionable fact is that the emergence of these various new organizations—many of which have overlapping memberships—has helped create a new sense of community within the abortion providing world. It is a broad multi-faceted community not only of providers, but of lawyers, advocates, artists, clergy, film makers, social scientists, and others—and what I have seen in my many years of observing this world, is that this is a community, most of all, that has each other’s back. To give just a few examples, busy academic doctors fly across country to testify on behalf of colleagues in malpractice trials that can only be described as political witch hunts; clinic directors who are part of the Abortion Care Network, an organization of independent clinics, rush from various parts of the country on short notice to Texas to support their colleague, Amy Hagstrom Miller, and meet with her patients and staff, as the legislature was in the midst of attempting to destroy abortion care in that state; when medical students involved with MSFC are threatened with reprisals by anti-abortion faculty, this community steps in to help with finding appropriate residencies; when beleaguered clinic directors in states with only one clinic remaining find it difficult to remain open, Willie Parker and other providers go through contortions to manage their schedules so they can travel regularly to Mississippi and elsewhere; our community’s lawyers, from the ACLU, the CRR, and several firms doing pro bono service, work literally around the clock to fight restrictions; the numerous listservs that have sprung up not only provide a forum to discuss interesting and challenging cases but also serve as an online community, especially to those providers in isolated areas such as the deep South; last, but hardly least to me and to many of us here, this is also a community that includes enlightened funders that makes possible research on abortion—research that, given the extreme politicization of abortion, would not otherwise be possible.

And we have persuasive evidence that this community matters. For example, the evaluation forms of those who have completed the two-year Fellowship in Family Planning frequently make reference to what is gained beyond technical skills. As one participant said, “I got so much out of the past 2 years. I feel like I blossomed in my skills, not just clinically but also in research, policy, advocacy, and teaching. So great to be part of this community.” Another said, “Great opportunity to network with a great group of people who share similar goals and missions. FFP community so much greater than expected.”

Researchers have also noted the importance of a sense of community in enabling people to remain in this often challenging work. As Dr. Lisa Harris and her colleagues found, in evaluating the “Provider Workshops” that Harris initiated, “[M]ost participants … referred to deeper emotional bonds forged through sharing experiences and feelings (including potentially dangerous ones), laughing together, and a stronger sense of collective team identity…’I could do what I do for the next thirty years as long as I had the chance to have this kind of sustaining group.’”

Similarly, the social scientists Jenny O’Donnell, Tracy Weitz, and Lori Freedman, in their study of providers, report this from one of their interviewees: “I think the most sustaining thing is probably the other people I work with. Because working in abortion, it draws really good people” and go on to conclude that “having a professional community that normalizes abortion care seems to make work more attractive and sustainable for those engaged in abortion care provision.”

It is a sociological truism that social movements lead to the creation of other “counter-movements.” The modern anti-abortion movement emerged as a result of Roe; the excess and extremism of that movement in turn led to many of the organizations I mentioned earlier. And let me point you to this paradox: our opposition, which has taken such an unacceptable toll on us, in so many ways, at the same time has contributed to the creation of not just a counter-movement that is fighting back politically, but also a community with deep emotional bonds among its members—bonds of a kind that one rarely, if ever, finds elsewhere in medicine.

So I will conclude by pointing to the dual nature of the field of abortion provision, as I have come to understand it. Thanks in large part to the Ryan Program and the Fellowship in Family Planning, and of course the Society of Family Planning, abortion provision has made a huge leap forward in taking its place as a legitimate and reputable part of U.S. medicine. Look around this room and think of the numerous medical schools represented here—and those of you who, like me, were around 25 years ago, think about what the situation was like then, and how much has changed. But the unique history of abortion in the United States also makes abortion provision a mission-driven enterprise, and I will argue to you that this is why we will ultimately triumph over those attempting to shut us down.

In conclusion, it has been a privilege to devote my career to studying this field and I thank you all for the trust you have shown in me. And I, of course, am deeply grateful to the Society of Family Planning for this award.

News Politics

Missouri ‘Witch Hunt Hearings’ Modeled on Anti-Choice Congressional Crusade

Christine Grimaldi

Missouri state Rep. Stacey Newman (D) said the Missouri General Assembly's "witch hunt hearings" were "closely modeled" on those in the U.S. Congress. Specifically, she drew parallels between Republicans' special investigative bodies—the U.S. House of Representatives’ Select Investigative Panel on Infant Lives and the Missouri Senate’s Committee on the Sanctity of Life.

Congressional Republicans are responsible for perpetuating widely discredited and often inflammatory allegations about fetal tissue and abortion care practices for a year and counting. Their actions may have charted the course for at least one Republican-controlled state legislature to advance an anti-choice agenda based on a fabricated market in aborted “baby body parts.”

“They say that a lot in Missouri,” state Rep. Stacey Newman (D) told Rewire in an interview at the Democratic National Convention last month.

Newman is a longtime abortion rights advocate who proposed legislation that would subject firearms purchases to the same types of restrictions, including mandatory waiting periods, as abortion care.

Newman said the Missouri General Assembly’s “witch hunt hearings” were “closely modeled” on those in the U.S. Congress. Specifically, she drew parallels between Republicans’ special investigative bodies—the U.S. House of Representatives’ Select Investigative Panel on Infant Lives and the Missouri Senate’s Committee on the Sanctity of Life. Both formed last year in response to videos from the anti-choice front group the Center for Medical Progress (CMP) accusing Planned Parenthood of profiting from fetal tissue donations. Both released reports last month condemning the reproductive health-care provider even though Missouri’s attorney general, among officials in 13 states to date, and three congressional investigations all previously found no evidence of wrongdoing.

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Missouri state Sen. Kurt Schaefer (R), the chair of the committee, and his colleagues alleged that the report potentially contradicted the attorney general’s findings. Schaefer’s district includes the University of Missouri, which ended a 26-year relationship with Planned Parenthood as anti-choice state lawmakers ramped up their inquiries in the legislature. Schaefer’s refusal to confront evidence to the contrary aligned with how Newman described his leadership of the committee.

“It was based on what was going on in Congress, but then Kurt Schaefer took it a step further,” Newman said.

As Schaefer waged an ultimately unsuccessful campaign in the Missouri Republican attorney general primary, the once moderate Republican “felt he needed to jump on the extreme [anti-choice] bandwagon,” she said.

Schaefer in April sought to punish the head of Planned Parenthood’s St. Louis affiliate with fines and jail time for protecting patient documents he had subpoenaed. The state senate suspended contempt proceedings against Mary Kogut, the CEO of Planned Parenthood of St. Louis Region and Southwest Missouri, reaching an agreement before the end of the month, according to news reports.

Newman speculated that Schaefer’s threats thwarted an omnibus abortion bill (HB 1953, SB 644) from proceeding before the end of the 2016 legislative session in May, despite Republican majorities in the Missouri house and senate.

“I think it was part of the compromise that they came up with Planned Parenthood, when they realized their backs [were] against the wall, because she was not, obviously, going to illegally turn over medical records.” Newman said of her Republican colleagues.

Republicans on the select panel in Washington have frequently made similar complaints, and threats, in their pursuit of subpoenas.

Rep. Marsha Blackburn (R-TN), the chair of the select panel, in May pledged “to pursue all means necessary” to obtain documents from the tissue procurement company targeted in the CMP videos. In June, she told a conservative crowd at the faith-based Road to Majority conference that she planned to start contempt of Congress proceedings after little cooperation from “middle men” and their suppliers—“big abortion.” By July, Blackburn seemingly walked back that pledge in front of reporters at a press conference where she unveiled the select panel’s interim report.

The investigations share another common denominator: a lack of transparency about how much money they have cost taxpayers.

“The excuse that’s come back from leadership, both [in the] House and the Senate, is that not everybody has turned in their expense reports,” Newman said. Republicans have used “every stalling tactic” to rebuff inquiries from her and reporters in the state, she said.

Congressional Republicans with varying degrees of oversight over the select panel—Blackburn, House Speaker Paul Ryan (WI), and House Energy and Commerce Committee Chair Fred Upton (MI)—all declined to answer Rewire’s funding questions. Rewire confirmed with a high-ranking GOP aide that Republicans budgeted $1.2 million for the investigation through the end of the year.

Blackburn is expected to resume the panel’s activities after Congress returns from recess in early September. Schaeffer and his fellow Republicans on the committee indicated in their report that an investigation could continue in the 2017 legislative session, which begins in January.

Analysis Human Rights

From Protected Class to High-Priority Target: How the ‘System Is Rigged’ Against Unaccompanied Migrant Children

Tina Vasquez

Vulnerable, undocumented youth who pose no real threat are being stripped of their right to an education and instead sit in detention awaiting deportation.

This is the first article in Rewire’s two-part series about the U.S. immigration system’s effects on unaccompanied children.

Earlier this month, three North Carolina high school students were released from a Lumpkin, Georgia, detention center after spending more than six months awaiting what seemed like their inevitable fate: deportation back to conditions in Central America that threatened their lives.

Wildin David Guillen Acosta, Josue Alexander Soriano Cortez, and Yefri Sorto-Hernandez were released on bail in the span of one week, thanks to an overwhelming community effort involving pro bono attorneys and bond money. However, not everyone targeted under the same government operation has been reprieved. For example, by the time reports emerged that Immigration and Customs Enforcement (ICE) had detained Acosta on his way to school in Durham, North Carolina, the government agency had already quietly deported four other young people from the state, including a teenage girl from Guatemala who attended the same school.

Activated in January, that program—Operation Border Guardian—continues to affect the lives of hundreds of Central American migrants over the age of 18 who came to the United States as unaccompanied children after January 2014. Advocates believe many of those arrested under the operation are still in ICE custody.

Department of Homeland Security (DHS) Secretary Jeh Johnson has said that the goal of Operation Border Guardian is to send a message to those in Central America considering seeking asylum in the United States. But it’s not working, as Border Patrol statistics have shown. Furthermore, vulnerable, undocumented youth who pose no real threat are being stripped of their right to an education and instead sit in detention awaiting deportation. These youth arrived at the border in hopes of qualifying for asylum, but were unable to succeed in an immigration system that seems rigged against them.

“The laws are really complicated and [young people] don’t have the community support to navigate this really hostile, complex system. That infrastructure isn’t there and unless we support asylum seekers and other immigrants in this part of the country, we’ll continue to see asylum seekers and former unaccompanied minors receive their deportation orders,” said Julie Mao, the enforcement fellow at the National Immigration Project of the National Lawyers Guild.

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“A Grossly Misnamed” Operation

In January, ICE conducted a series of raids that spanned three southern states—Georgia, North Carolina, and Texas—targeting Central American asylum seekers. The raids occurred under the orders of Johnson, who has taken a hardline stance against the more than 100,000 families who have sought asylum in the United States. These families fled deadly gang violence in El Salvador, Honduras, and Guatemala in recent years. In El Salvador, in particular, over 400 children were murdered by gang members and police officers during the first three months of 2016, doubling the country’s homicide rate, which was already among the highest in the world.

ICE picked up some 121 people in the early January raids, primarily women and their young children. Advocates argue many of those arrested were detained unlawfully, because as people who experienced severe trauma and exhibited symptoms of post-traumatic stress disorder, generalized anxiety, and depression, they were disabled as defined under the Rehabilitation Act of 1973, and ICE did not provide reasonable accommodations to ensure disabled people were not denied meaningful access to benefits or services.

Just a few weeks later, on January 23, ICE expanded the raids’ focus to include teenagers under Operation Border Guardian, which advocates said represented a “new low.”

The media, too, has also criticized DHS for its seemingly senseless targeting of a population that normally would be considered refugees. The New York Times called Operation Border Guardian “a grossly misnamed immigration-enforcement surge that went after people this country did not need to guard against.”

In response to questions about its prioritization of former unaccompanied minors, an ICE spokesperson told Rewire in an emailed statement: “As the secretary has stated repeatedly, our borders are not open to illegal migration. If someone was apprehended at the border, has been ordered removed by an immigration court, has no pending appeal, and does not qualify for asylum or other relief from removal under our laws, he or she must be sent home. We must and we will enforce the law in accordance with our enforcement priorities.”

DHS reports that 336 undocumented Central American youth have been detained in the operation. It’s not clear how many of these youth have already been deported or remain in ICE custody, as the spokesperson did not respond to that question by press time.

Acosta, Cortez, Sorto-Hernandez, and three other North Carolina teenagersSantos Geovany Padilla-Guzman, Bilmer Araeli Pujoy Juarez, Pedro Arturo Salmeron—have become known as the NC6 and the face of Operation Border Guardian, a designation they likely would have not signed up for.

Advocates estimate that thousands of deportations of low-priority migrants—those without a criminal history—occur each week. What newly arrived Central American asylum seekers like Acosta could not have known was that the federal government had been laying the groundwork for their deportations for years.

Asylum Seekers Become “High-Priority Cases”

In August 2011, the Obama administration announced it would begin reviewing immigration cases individually, allowing ICE to focus its resources on “high-priority cases.” The assumption was that those who pose a threat to public safety, for example, would constitute the administration’s highest priority, not asylum-seeking high school students.

But there was an indication from DHS that asylum-seeking students would eventually be targeted and considered high-priority. After Obama’s announcement, ICE released a statement outlining who would constitute its “highest priorities,” saying, “Specifically individuals who pose a threat to public safety such as criminal aliens and national security threats, as well as repeat immigration law violators and recent border entrants.”

In the years since, President Obama has repeatedly said “recent border crossers” are among the nation’s “highest priorities” for removal—on par with national security threats. Those targeted would be migrants with final orders of removal who, according to the administration, had received their day in court and had no more legal avenues left to seek protection. But, as the American Civil Liberties Union (ACLU) reported, “recent border entrant” is a murky topic, and it doesn’t appear as if all cases are being reviewed individually as President Obama said they would.

“Recent border entrant” can apply to someone who has been living in the United States for three years, and a border removal applies “whenever ICE deports an individual within three years of entry—regardless of whether the initial entry was authorized—or whenever an individual is apprehended by Customs and Border Protection (CBP),” explained Thomas Homan, the head of ICE’s removal operations in a 2013 hearing with Congress, the ACLU reported.

Chris Rickerd, policy counsel at the American Civil Liberties Union’s Washington Legislative Office, added that “[b]ecause CBP refuses to screen the individuals it apprehends for their ties to the U.S., and DHS overuses procedures that bypass deportation hearings before a judge, many ‘border removals’ are never fully assessed to determine whether they have a legal right to stay.”

Over the years, DHS has only ramped up the department’s efforts to deport newly arrived immigrants, mostly from Central America. As the Los Angeles Times reported, these deportations are “an attempt by U.S. immigration officials to send a message of deterrence to Central America and avoid a repeat of the 2014 crisis when tens of thousands of children from Honduras, El Salvador and Guatemala arrived at the U.S. border.”

This is something Mao takes great issue with.

“These raids that we keep seeing are being done in order to deter another wave of children from seeking asylum—and that is not a permissible reason,” Mao said. “You deport people based on legality, not as a way of scaring others. Our country, in this political moment, is terrorizing young asylum seekers as a way of deterring others from presenting themselves at the border, and it’s pretty egregious.”

There is a direct correlation between surges of violence in the Northern Triangle—El Salvador, Guatemala, and Honduras—and an uptick in the number of asylum seekers arriving in the United States. El Salvador, known as the murder capital of the word, recently saw an explosion of gang violence. Combine that with the possible re-emergence of so-called death squads and it’s clear why the number of Salvadoran family units apprehended on the southern border increased by 96 percent from 2015 to 2016, as Fusion reported.

Much like Mao, Elisa Benitez, co-founder of the immigrants rights’ organization Alerta Migratoria NC, believes undocumented youth are being targeted needlessly.

“They should be [considered] low-priority just because they’re kids, but immigration is classifying them at a very high level, meaning ICE is operating like this is a population that needs to be arrested ASAP,” Benitez said.

The Plight of Unaccompanied Children

Each member of the NC6 arrived in the United States as an unaccompanied child fleeing violence in their countries of origin. Acosta, for example, was threatened by gangs in his native Honduras and feared for his life. These young people should qualify as refugees based on those circumstances under international law. In the United States, after they present themselves at the border, they have to prove to an immigration judge they have a valid asylum claim—something advocates say is nearly impossible for a child to do with no understanding of the immigration system and, often, with no access to legal counsel—or they face deportation.

Unaccompanied children, if not immediately deported, have certain protections once in the United States. For example, they cannot be placed into expedited removal proceedings. According to the American Immigration Council, “they are placed into standard removal proceedings in immigration court. CBP must transfer custody of these children to Health and Human Services (HHS), Office of Refugee Resettlement (ORR), within 72 hours.”

While their court proceedings move forward, HHS’s Office of Refugee Resettlement manages the care of the children until they can ideally be released to their parents already based in the country. Sometimes, however, they are placed with distant relatives or U.S. sponsors. Because HHS has lowered its safety standards regarding placement, children have been subjected to sexual abuse, labor trafficking, and severe physical abuse and neglect, ThinkProgress has reported.

If while in the care of their family or a sponsor they miss a court date, detainment or deportation can be triggered once they turn 18 and no longer qualify for protections afforded to unaccompanied children. 

This is what happened to Acosta, who was placed with his mother in Durham when he arrived in the United States. ICE contends that Acosta was not targeted unfairly; rather, his missed court appearance triggered his order for removal.

Acosta’s mother told local media that after attending his first court date, Acosta “skipped subsequent ones on the advice of an attorney who told him he didn’t stand a chance.”

“That’s not true, but it’s what they were told,” Benitez said. “So, this idea that all of these kids were given their day in court is false. One kid [we work with] was even told not to sign up for school because ‘there was no point,’ it would just get him deported.”

Benitez told Rewire the reasons why these young people are being targeted and given their final orders of removal need to be re-examined.

Sixty percent of youth from Central America do not ever have access to legal representation throughout the course of their case—from the time they arrive in the United States and are designated as unaccompanied children to the time they turn 18 and are classified as asylum seekers. According to the ACLU, 44 percent of the 23,000 unaccompanied children who were required to attend immigration court this year had no lawyer, and 86 percent of those children were deported.

Immigration attorneys and advocates say that having a lawyer is absolutely necessary if a migrant is to have any chance of winning an asylum claim.

Mao told Rewire that in the Southeast where Acosta and the other members of the NC6 are from, there is a pipeline of youth who arrived in the United States as unaccompanied children who are simply “giving up” on their valid asylum claims because navigating the immigration system is simply too hard.

“They feel the system is rigged, and it is rigged,” Mao said.

Mao has been providing “technical assistance” for Acosta and other members of the NC6. Her organization doesn’t represent individuals in court, she said, but the services it provides are necessary because immigration is such a unique area of law and there are very few attorneys who know how to represent individuals who are detained and who have been designated unaccompanied minors. Those services include providing support, referrals, and technical assistance to advocates, community organizations, and families on deportation defense and custody issues.

Fighting for Asylum From Detention

Once arrested by ICE, there is no telling if someone will linger in detention for months or swiftly be deported. What is known is that if a migrant is taken by ICE in North Carolina, somewhere along the way, they will be transferred to Lumpkin, Georgia’s Stewart Detention Center. As a local paper reported, Stewart is “the last stop before they send you back to whatever country you came from.”

Stewart is the largest detention center in the country, capable of holding 2,000 migrants at any time—it’s also been the subject of numerous investigations because of reports of abuse and inadequate medical care. The detention center is run by Corrections Corporation of America, the country’s largest private prison provider and one that has become synonymous with maintaining inhumane conditions inside of its detention centers. According to a report from the National Immigrant Justice Center, Stewart’s remote location—over two hours away from Atlanta—hinders the facility from attracting and retaining adequate medical staff, while also creating barriers to visitation from attorneys and family members.

There’s also the matter of Georgia being notoriously tough on asylum seekers, even being called the “worst” place to be an undocumented immigrant. The Huffington Post reported that “Atlanta immigration judges have been accused of bullying children, badgering domestic violence victims and setting standards for relief and asylum that lawyers say are next to impossible to meet.” Even more disconcerting, according to a project by Migrahack, which pairs immigration reporters and hackers together, having an attorney in Georgia had almost no effect on whether or not a person won their asylum case, with state courts denying up to 98 percent of asylum requests. 

Acosta, Cortez, and Sorto-Hernandez spent over six months in Stewart Detention Center before they were released on baila “miracle” according to some accounts, given the fact that only about 5 percent of those detained in Stewart are released on bond.

In the weeks after ICE transferred Acosta to Stewart, there were multiple times Acosta was on the verge of deportation. ICE repeatedly denied Acosta was in danger, but advocates say they had little reason to believe the agency. Previous cases have made them wary of such claims.

Advocates believe that three of the North Carolina teens who were deported earlier this year before Acosta’s case made headlines were kept in detention for months with the goal of wearing them down so that they would sign their own deportation orders despite having valid asylum claims.

“They were tired. They couldn’t handle being in detention. They broke down and as much as they feared being returned to their home countries, they just couldn’t handle being there [in detention] anymore. They’d already been there for weeks,” Benitez said.

While ICE claims the average stay of a migrant in Stewart Detention Center is 30 days, the detention center is notorious for excessively long detainments. Acosta’s own bunkmate had been there over a year, according to Indy Week reporter David Hudnall.

As Hudnall reported, there is a massive backlog of immigration cases in the system—474,000 nationally and over 5,000 in North Carolina.

Mao told Rewire that the amount of time the remaining members of the NC6 will spend in detention varies because of different legal processes, but that it’s not unusual for young people with very strong asylum cases to sign their rights away because they can’t sustain the conditions inside detention.

Pedro Arturo Salmeron, another NC6 member, is still in detention. He was almost deported, but Mao told Rewire her organization was able to support a pro bono attorney in appealing to the Board of Immigration Appeals (BIA) to stop proceedings.

Japeth Matemu, an immigration attorney, recently told Indy Week’s David Hudnall that “the BIA will tell you that it can’t modify the immigration judge’s ruling unless it’s an egregious or obvious miscarriage of justice. You basically have to prove the judge is off his rocker.”

It could take another four months in detention to appeal Salmeron’s case because ICE continues to refuse to release him, according to the legal fellow.

“That’s a low estimate. It could be another year in detention before there is any movement in his case. We as an organization feel that is egregious to detain someone while their case is pending,” Mao said. “We have to keep in mind that these are kids, and some of these kids can’t survive the conditions of adult prison.”

Detention centers operate as prisons do, with those detained being placed in handcuffs and shackles, being stripped of their personal belongings, with no ability to move around freely. One of Acosta’s teachers told Rewire he wasn’t even able to receive his homework in detention.

Many of those in detention centers have experienced trauma. Multiple studies confirm that “detention has a profoundly negative impact on young people’s mental and physical well-being” and in the particular case of asylum seekers, detention may exacerbate their trauma and symptoms of post-traumatic stress disorder. 

“People are so traumatized by the raids, and then you add detention on top of that. Some of these kids cannot psychologically and physically deal with the conditions in detention, so they waive their rights,” Mao said.

In March, Salmeron and fellow NC6 member Yefri Sorto-Hernandez received stays of deportation, meaning they would not face immediate deportation. ICE says a stay is like a “legal pause.” During the pause, immigration officials decide if evidence in the case will be reconsidered for asylum. Sorto-Hernandez was released five months later.

Benitez said that previously when she organized around detention, a stay of deportation meant the person would get released from detention, but ICE’s decision to detain some of the NC6 indefinitely until their cases are heard illustrates how “weirdly severe” the agency is being toward this particular population. Mao fears this is a tactic being used by ICE to break down young people in detention.

“ICE knows it will take months, and frankly up to a year, for some of these motions to go through the court system, but the agency is still refusing to release individuals. I can’t help but think it’s with the intention that these kids will give up their claims while suffering in detention,” Mao said.

“I think we really have to question that, why keep these young people locked up when they can be with their communities, with their families, going to school? ICE can release these kids now, but for showmanship, ICE is refusing to let them go. Is this who we want to be, is this the message we want to send the world?” she asked.

In the seven months since the announcement of Operation Border Guardian, DHS has remained quiet about whether or not there will be more raids on young Central American asylum seekers. As a new school year approaches, advocates fear that even more students will be receiving their orders for removal, and unlike the NC6, they may not have a community to rally around them, putting them at risk of quietly being deported and not heard from again.

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