Analysis Law and Policy

How Virginia’s ‘Conscience Clause’ for Genetic Counselors Could Set a National Precedent

Erin Matson

Genetic counselors in Virginia who object to abortion may now prevent women from learning the results of their genetic tests before their pregnancies progress to a point when legal abortion is impossible to obtain—and the practice could become legal in other states as well.

In August 2011, Liz Read-Katz was living in Texas, nearly 20 weeks pregnant, and was, in the words of the testimony she supplied to Planned Parenthood Advocates in Missouri, “ecstatic but scared as most soon-to-be parents are.” Then her doctor told her that her blood work revealed she had a one-in-ten chance of having a child with trisomy 18. Also known as Edwards syndrome, trisomy 18 is a chromosomal condition that, according to the National Institutes of Health, causes “many individuals … [to] die before birth or within the first month.” This began the cascade of events that led Read-Katz to consult with a genetic counselor for additional information to support her during her very much wanted pregnancy.

After receiving information from a perinatologist, a specialist in high-risk pregnancies, who suggested the chance of trisomy 18 was greater than one in ten, Read-Katz conferred with a genetic counselor while considering whether to have an amniocentesis. “[The genetic counselor] said several times that it wasn’t her position to tell me whether to have an amniocentesis or not,” Read-Katz told Rewire. The counselor provided her with knowledge of not just what the tests would entail and reveal, but also that her perinatologist had a rate of complications from amniocentesis that is lower than the national average. She explained that this information provided some measure of comfort. “It was very reassuring [to know that] no matter what choice we made, we wouldn’t be doing any additional harm.”

In the context of prenatal care, a genetic counselor moves genetic tests between doctors, labs, and sometimes more labs, eventually receiving results, interpreting them, and discussing them with patients. More than 2,000 individuals work as genetic counselors in the United States, according to the National Society of Genetic Counselors.

“Her role was to tell me … here are your test results, this is what they mean, and then she was the one who actually called me and told me that the amniocentesis came back as trisomy 18,” Read-Katz said. “I can almost do it verbatim. I could tell by the tone of her voice that she was sad for me and that she wanted to make sure that I was at home, that I wasn’t driving around. ‘I’m very sorry, but it does look like your child has trisomy 18,’ she said. I said, ‘I figured as much.’ ‘Well,’ she said, ‘I didn’t.’ She was very compassionate and asked if I had any questions. … I already knew. She said, ‘Yes, trisomy 18 is incompatible with life.’ She was able to provide me with a couple of other options in case my doctor wasn’t going to be able to help.”

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Read-Katz made the heartbreaking decision she and her husband found best. Within a few days, she was induced to deliver. “I know I had an abortion,” she said. “I know that.” No one wants to be confronted with the type of parenting decision Read-Katz had to face, and yet reality is cruel and unrelenting. At some point, some pregnancies will appear to diverge from healthy development. Genetic testing performed and interpreted with the help of a genetic counselor is a way to get the facts.

The integrity of counseling received by pregnant women could, however, change under what could become a national effort to include “conscience clauses” in state-level legislation licensing genetic counselors. Just such legislation, with a clause written by ardent opponents of abortion rights, was signed into law by Virginia Gov. Terry McAuliffe, who months before had pledged to be a “brick wall” against incursions on reproductive rights.

In short, genetic counselors in Virginia who object to abortion may now prevent women from learning the results of their genetic tests before their pregnancies progress to a point when legal abortion is impossible to obtain. “I’m beyond words,” Liz Read-Katz told Rewire. “What is the purpose of a genetic counselor if they’re not going to give you any information?”

Virginia’s Genetic Counseling Licensure Law

On March 20, Gov. McAuliffe approved a new law to license genetic counselors over the pleas of advocates for reproductive rights. Effective July 1, Virginia will offer licenses to genetic counselors. Much of the language is similar to model legislative provisions published by the National Society of Genetic Counselors, with the notable exception of a broad “conscience clause”:

Nothing in this chapter shall be construed to require any genetic counselor to participate in counseling that conflicts with their deeply-held moral or religious beliefs, nor shall licensing of any genetic counselor be contingent upon participation in such counseling. Refusal to participate in counseling that conflicts with the counselor’s deeply-held moral or religious beliefs shall not form the basis for any claim of damages or for any disciplinary or recriminatory action against the genetic counselor, provided the genetic counselor informs the patient that he will not participate in such counseling and offers to direct the patient to the online directory of licensed genetic counselors maintained by the Board.

As reported previously by Rewire, the bill and conscience clause was championed by Sen. Janet Howell (D-Reston), who was heralded in 2012 as a national reproductive rights leader for attempting to amend an anti-choice ultrasound bill, now law, with a requirement that would subject men to rectal examinations. A member of Sen. Howell’s staff told the president of NARAL Pro-Choice Virginia, the anti-choice Family Foundation drafted the clause.

Based in Virginia, the Family Foundation is recognized as a “State Family Policy Council” by the Family Research Council to “accomplish at the state level what the Family Research Council does at the national level.” (The Southern Poverty Law Center classifies the Family Research Council as a hate group.)

According to the Family Foundation’s website, lobbyists for the genetic counselors approached them prior to introducing a bill, which led to the conscience clause:

The story behind this amendment goes back a few months. This past summer, the lobbyists for the genetic counselors approached The Family Foundation with a draft bill to license genetic counselors in Virginia. We appreciated them coming to us prior to session to discern our impression of the bill and to see if we had any concerns. We decided to remain neutral on the topic of licensing genetic counselors, but we strongly encouraged the addition of a conscience clause to protect them from being forced to participate in counseling against their deeply held moral or religious beliefs.

The genetic counselors agreed to the conscience language and a bill was drafted that all parties agreed upon.

Gov. McAuliffe signed this conscience clause into law twice. First, the governor signed HB 612 into law and then shortly after issued a recommendation to amend the conscience clause in its companion bill, SB 330, that would have in part required genetic counselors to offer timely notice of refusals to provide care and make referrals to another qualified counselor. That recommendation failed to pass.

With HB 612 already law, Gov. McAuliffe was then urged by groups including the American Civil Liberties Union (ACLU) of Virginia and NARAL Pro-Choice Virginia to veto SB 330 for symbolic purposes. The governor neither vetoed the bill nor left it unsigned; he signed a genetic counseling licensure bill with a sweeping conscience clause into law for a second time on March 20.

Gov. McAuliffe’s office did not return a call asking why he signed a bill containing a conscience clause he wished to change; the National Society of Genetic Counselors did not respond to an email asking for comment on whether it has been talking about conscience clauses and if it might include model language for use in future state-level bills; and lobbyist Aimee Perron Seibert of the Hillbridge Group in Virginia did not respond to an email asking why a conscience clause was added to the Virginia law and how the specific language evolved. 

The Role of the Genetic Counselor

Genetic counselors can play a pivotal role in the provision of prenatal care. According to the National Society of Genetic Counselors website:

Genetic counselors work with other members of the health care team providing information and support to individuals and families concerned with genetic disorders or birth defects. …  [They] review available testing options and discuss management. … They also serve as patient advocates and refer individuals and families to community or state support services as appropriate.

A genetic counselor must obtain a master’s degree from an accredited program and then apply and sit for an examination in order to be eligible for certification by the American Board of Genetic Counseling.

“They have a difficult job, no doubt,” Anthony Gregg, vice president of clinical genetics for the American College of Medical Genetics and Genomics, told Rewire. He said that in the course of his practice as an MD clinical geneticist, genetic counselors help his medical teams track specimens through a process that is similar to a maze, including shepherding them through specialty tests at different labs, managing logistics and results as they come back into the office, and then helping with the delivery of results to patients and providers.

“Genetic counselors have been fighting for licensure state by state because it gives them greater professional standing and helps them with billing,” Alexandra Minna Stern, author of Telling Genes: The Story of Genetic Counseling in America, told Rewire.

That fight is less than half over. Virginia joins 18 other states listed on the National Society of Genetic Counselors website with laws licensing genetic counselors. Only two other states, Nebraska and Oklahoma, have a conscience clause incorporated into genetic counseling laws, and unlike Virginia’s new law, both are specific to abortion and therefore narrower in impact—these laws could protect a genetic counselor who did not provide accurate information that might lead to an abortion, for example, but can not be used to discriminate against a lesbian seeking fertility services.

A state law like Virginia’s should be watched, however: Virginia’s law sets a stricter precedent because it affects more than just abortion cases, while also, like Nebraska’s and Oklahoma’s, protecting counselors from lawsuits for refusal to provide services and imposing no requirement of timely notification of a refusal to provide services. And this issue should be viewed beyond the state level, as conscience clauses could become the new normal for the roughly two-thirds of remaining states that we can expect to be targeted for licensure bills.

“This is unprecedented,” said Minna Stern, referring to the insertion of conscience clauses into genetic counseling licensure laws. “This smacks against the very ethos of genetic counseling and what genetic counselors do, which is that they provide non-directive genetic counseling that is thoughtful and responsive to whoever the client is who comes in their door. Their job is definitely not to have a preconceived notion of whether or not they would respond to someone or to advise them to or not to terminate a pregnancy.” 

The Impact of Conscience Clauses for Genetic Counselors

A key part of a genetic counselor’s role in the provision of prenatal care is to impart information about what clues genetic tests performed on potential parents and/or a developing fetus may provide about expected health status in pregnancy and beyond. In this way, a conscience clause for genetic counselors differs from some other conscience clauses that permit doctors to refuse to provide services. It is not akin to a discussion with a doctor who tells patients he or she refuses to perform abortions in any or certain circumstances; it could instead involve entirely omitting discussions, and therefore awareness, of negative medical information based on the genetic information of parents or pertaining to a pregnancy, with the goal of preventing a patient from considering abortion. In other cases, genetic counselors brought in to assist with a patient who is already considering abortion in reaction to conditions made visible by ultrasound could refuse to discuss new information otherwise available via genetic tests.

“When patients are not provided a timely, balanced discussion of their legal options after the return of prenatal test results, fundamental medical principles are violated,” Dr. Gregg of the American College of Medical Genetics and Genomics told Rewire. “The ethical principle of autonomy requires that patients are provided complete and balanced information. … Informed consent is the hub of patient decision-making in medicine.”

“We don’t ask patients to choose without providing all options to them,” he added.

A 2013 statement from Gregg’s organization said the group “strongly opposes legislation that places limits on this access.”

What’s more, genetic counselors shepherd tests and results between various offices before sharing information with doctors and patients. The conscience clauses in both Nebraska and Virginia fail to require that genetic counselors provide timely notification of their refusal to provide services. This means that one individual could effectively block a patient’s access to legal abortion by dragging their feet. For example, routine chromosome analysis can take ten to 14 days for results to be returned, which means that a patient having an amniocentesis around 22 weeks of pregnancy could receive results as late as 23 to 24 weeks.

It is more difficult to obtain an abortion as pregnancy progresses. First, bans on abortion based on gestational age or length of pregnancy are the subject of a concerted push by the right. “There is great interest in limiting abortion at five months of pregnancy,” a spokeswoman for Americans United for Life told Politico in a piece covering the push for 20-week abortion bans. Such a ban was recently rejected by West Virginia Gov. Earl Ray Tomblin, who is anti-choice but called the bill “unconstitutional.” Second, many doctors, nurses, and institutions that provide earlier abortions may have conditions or an outright blanket policy against providing abortions later in a pregnancy. Third, cost increases as time goes on, both for the procedure as well as for travel to providers who may be accessible only by plane.

Liz Read-Katz had her abortion after 19 weeks and five days of pregnancy. She says the emotional consequences of waiting longer would have been devastating. “I was starting to show, people were asking me when I was due, and I would just cry,” she said. “I was petrified that I would start to feel the baby kicking. I was petrified that would happen.”

A conscience clause for genetic counseling also undermines the status of the medical profession as a whole, argues Susan Berke Fogel, director of reproductive health with the National Health Law Program. Conscience clauses are “not only bad for health-care delivery generally but really disrupt health care,” she said. “Obviously, the health quality implications are devastating. … Most health-care providers are very committed to providing quality care.”

This point of view seems to be shared or at least hinted at in both expected and unexpected quarters. In a position paper called “The Limits of Conscientious Refusal in Reproductive Medicine,” the American Congress of Obstetricians and Gynecologists states, “Conscientious refusals that conflict with patient well-being should be accommodated only if the primary duty to the patient can be fulfilled. … Health care providers have the duty to refer patients in a timely matter to other providers if they do not feel that they can in conscience provide the standard reproductive services that patients request.”

Citizen Link, an affiliate of the anti-choice group Focus on the Family, had this to say in an online post about genetic counseling:

The purpose of a genetic counselor is to help you understand your options and choose the best course of action for you and your family – not to impose certain treatments contrary to your views.

A “Strategy of Silence”

As previously noted, the National Society of Genetic Counselors did not respond to an inquiry for comment. While it may appear surprising that a group at the center of the push for licensure laws would not want to weigh in on this story, a deeper look at the past shows there’s nothing new about the group’s strategy of silence.

In 2009, Amy Goodman of Democracy Now! interviewed Dr. Warren Hern, who identified himself as a member of the society, about the group and the issue of abortion rights. During their chat, Hern discussed a meeting where Dr. Kenneth Edelin was invited to speak. Dr. Edelin was a noted physician who ultimately saw his manslaughter conviction overturned by the Massachusetts Supreme Court for performing a legal abortion shortly after the Roe decision; he died in 2013. “He was an incredibly eloquent speaker at this meeting,” Hern told Goodman. “And there were many people who were very angry that Dr. Edelin was invited to speak. So, you know, it’s very controversial within that organization.”

During the same show, a genetic counselor who declined to be identified said she had suggested the group issue a statement condemning the murder of Dr. George Tiller by anti-choice terrorist Scott Roeder. The counselor said she was told that some members of the group had suggested remaining silent. Speaking to Goodman, the counselor said, “There’s this climate of fear now, and it’s because of these extreme extremists, these anti-choice people, that everybody’s even more afraid. And it’s not only just the actual providers, but people who are indirectly related to sort of referring people to these clinics aren’t even willing to admit their involvement. And I think it’s really a shame, because the entire basis of the field of genetic counseling is to help facilitate choice and for people to make decisions that are best for them.”

Where Will The Conscience Clause Go Next?

In a letter to Gov. McAuliffe urging him to veto the senate’s version of the genetic counseling licensure law, the ACLU of Virginia noted that the Family Foundation, which said it wrote the clause, had stated their intention to make this language the default for other professions in the commonwealth. “If genetic counselors can be protected from being forced to violate their conscience, it follows that all other professions should receive equal protection,” the Family Foundation said on its website.

In an email to Rewire, ACLU of Virginia Executive Director Claire Guthrie Gastanaga expressed concern about the conscience clause traveling to other states. “The Family Foundation is part of a strong national network under the umbrella of the Family [Research] Council that does a very good job of touting their successes and seeking to have similar legislation enacted in other states,” she wrote. “Virginia will be held up as a ‘model’ for other states to follow as they consider such licensing bills.”

“We are deeply disappointed that Governor McAuliffe decided to approve this dangerous law which so clearly grants genetic counselors a license to discriminate against their patients,” Tarina Keene, executive director of NARAL Pro-Choice Virginia, said in a statement after McAuliffe signed the senate bill into law.

It wasn’t the first time the governor had upset reproductive rights advocates. While he had pledged to protect reproductive rights throughout his campaign, he sent shock waves through the pro-choice community prior to taking office by choosing to retain former Gov. Bob McDonnell’s secretary of health, Bill Hazel, who had a hand in the implementation of some of the most notable anti-choice policies of the previous administration, including a forced ultrasound law.

As far as genetic counseling goes, patients in Virginia and advocates in other states will be left to pick up the pieces. “I would suggest to you that this is a clear example of a legislative body and in this case a state governor who signed something without getting all the information before signing it,” Dr. Gregg of the American College of Medical Genetics and Genomics said.

“This is a fundamental problem when legislators step into water that they’re unfamiliar with,” he continued. “They are obligated to become informed. You only become informed by engaging the parties. … They could have called us just as you did, and in 30 minutes they would have gotten more information and changed this from a purely emotional discussion into one that [included] some of the facts and downstream effects.”

CORRECTION: A previous version of this article incorrectly noted that there was only one state with a conscience clause within its law licensing genetic counselors that is specific to abortion. In fact, there are two (Nebraska and Oklahoma). We regret the error.

Roundups Politics

Campaign Week in Review: Republican National Convention Edition

Ally Boguhn

The Trump family's RNC claims about crime and the presidential candidate's record on gender equality have kept fact-checkers busy.

Republicans came together in Cleveland this week to nominate Donald Trump at the Republican National Convention (RNC), generating days of cringe-inducing falsehoods and misleading statements on crime, the nominee’s positions on gender equality, and LGBTQ people.

Trump’s Acceptance Speech Blasted for Making False Claims on Crime

Trump accepted the Republican nomination in a Thursday night speech at the RNC that drew harsh criticism for many of its misleading and outright false talking points.

Numerous fact-checkers took Trump to task, calling out many of his claims for being “wrong,” and “inflated or misleading.”

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 Among the most hotly contested of Trump’s claims was the assertion that crime has exploded across the country.

“Decades of progress made in bringing down crime are now being reversed by this administration’s rollback of criminal enforcement,” Trump claimed, according to his prepared remarks, which were leaked ahead of his address. “Homicides last year increased by 17 percent in America’s 50 largest cities. That’s the largest increase in 25 years. In our nation’s capital, killings have risen by 50 percent. They are up nearly 60 percent in nearby Baltimore.”

Crime rates overall have been steadily declining for years.

“In 2015, there was an uptick in homicides in 36 of the 50 largest cities compared to the previous years. The rate did, indeed, increase nearly 17 percent, and it was the worst annual change since 1990. The homicide rate was up 54.3 percent in Washington, and 58.5 percent in Baltimore,” explained Washington Post fact checkers Glenn Kessler and Michelle Ye Hee Lee. “But in the first months of 2016, homicide trends were about evenly split in the major cities. Out of 63 agencies reporting to the Major Cities Chiefs Association, 32 cities saw a decrease in homicides in first quarter 2016 and 31 saw an increase.”

Ames Grawert, a counsel in the Brennan Center’s Justice Program, said in a statement posted to the organization’s website that 2016 statistics aren’t sufficient in declaring crime rate trends. 

“Overall, crime rates remain at historic lows. Fear-inducing soundbites are counterproductive, and distract from nuanced, data-driven, and solution-oriented conversations on how to build a smarter criminal justice system in America,” Grawert said. “It’s true that some cities saw an increase in murder rates last year, and that can’t be ignored, but it’s too early to say if that’s part of a national trend.” 

When Paul Manafort, Trump’s campaign chairman, was confronted with the common Republican falsehoods on crime during a Thursday interview with CNN’s Jake Tapper, he claimed that the FBI’s statistics were not to be trusted given that the organization recently advised against charges in connection with Hillary Clinton’s use of a private email server during her tenure as secretary of state.

“According to FBI statistics, crime rates have been going down for decades,” Tapper told Manafort. “How can Republicans make the argument that it’s somehow more dangerous today when the facts don’t back that up?”

“People don’t feel safe in their neighborhoods,” said Manafort, going on to claim that “the FBI is certainly suspect these days after what they did with Hillary Clinton.”

There was at least one notable figure who wholeheartedly embraced Trump’s fearmongering: former KKK Grand Wizard David Duke. “Great Trump Speech,” tweeted Duke on Thursday evening. “Couldn’t have said it better!”

Ben Carson Claims Transgender People Are Proof of “How Absurd We Have Become”

Former Republican presidential candidate Ben Carson criticized the existence of transgender people while speaking at the Florida delegation breakfast on Tuesday in Cleveland.  

“You know, we look at this whole transgender thing, I’ve got to tell you: For thousands of years, mankind has known what a man is and what a woman is. And now, all of a sudden we don’t know anymore,” said Carson, a retired neurosurgeon. “Now, is that the height of absurdity? Because today you feel like a woman, even though everything about you genetically says that you’re a man or vice versa?”

“Wouldn’t that be the same as if you woke up tomorrow morning after seeing a movie about Afghanistan or reading some books and said, ‘You know what? I’m Afghanistan. Look, I know I don’t look that way. My ancestors came from Sweden, or something, I don’t know. But I really am. And if you say I’m not, you’re a racist,’” Carson said. “This is how absurd we have become.”

When confronted with his comments during an interview with Yahoo News’ Katie Couric, Carson doubled down on his claims.“There are biological markers that tell us whether we are a male or a female,” said Carson. “And just because you wake up one day and you say, ‘I think I’m the other one,’ that doesn’t change it. Just, a leopard can’t change its spots.”

“It’s not as if they woke up one day and decided, ‘I’m going to be a male or I’m going to be a female,’” Couric countered, pointing out that transgender people do not suddenly choose to change their gender identities on a whim.

Carson made several similar comments last year while on the campaign trail.

In December, Carson criticized the suggested that allowing transgender people into the military amounted to using the armed services “as a laboratory for social experimentation.”

Carson once suggested that allowing transgender people to use the restroom that aligned with their gender identity amounted to granting them “extra rights.”

Ivanka Trump Claims Her Father Supports Equal Pay, Access to Child Care

Ivanka Trump, the nominee’s daughter, made a pitch during her speech Thursday night at the RNC for why women voters should support her father.

“There have always been men of all background and ethnicities on my father’s job sites. And long before it was commonplace, you also saw women,” Ivanka Trump said. “At my father’s company, there are more female than male executives. Women are paid equally for the work that we do and when a woman becomes a mother, she is supported, not shut out.” 

“As president, my father will change the labor laws that were put into place at a time when women were not a significant portion of the workforce. And he will focus on making quality child care affordable and accessible for all,” she continued before pivoting to address the gender wage gap. 

“Policies that allow women with children to thrive should not be novelties; they should be the norm. Politicians talk about wage equality, but my father has made it a practice at his company throughout his entire career.”

However, Trump’s stated positions on the gender wage gap, pregnancy and mothers in the workplace, and child care don’t quite add up to the picture the Trumps tried to paint at the RNC.

In 2004, Trump called pregnancy an “inconvenience” for employers. When a lawyer asked for a break during a deposition in 2011 to pump breast milk, Trump reportedly called her “disgusting.”

According to a June analysis conducted by the Boston Globe, the Trump campaign found that men who worked on Trump’s campaign “made nearly $6,100, or about 35 percent more [than women during the April payroll]. The disparity is slightly greater than the gender pay gap nationally.”

A former organizer for Trump also filed a discrimination complaint in January, alleging that she was paid less than her male counterparts.

When Trump was questioned about equal pay during a campaign stop last October, he did not outline his support for policies to address the issue. Instead, Trump suggested that, “You’re gonna make the same if you do as good a job.” Though he had previously stated that men and women who do the same job should be paid the same during an August 2015 interview on MSNBC, he also cautioned that determining whether people were doing the same jobs was “tricky.”

Trump has been all but completely silent on child care so far on the campaign trail. In contrast, Clinton released an agenda in May to address the soaring costs of child care in the United States.

Ivanka’s claims were not the only attempt that night by Trump’s inner circle to explain why women voters should turn to the Republican ticket. During an interview with MSNBC’s Chris Matthews, Manafort said that women would vote for the Republican nominee because they “can’t afford their lives anymore.”

“Many women in this country feel they can’t afford their lives, their husbands can’t afford to be paying for the family bills,” claimed Manafort. “Hillary Clinton is guilty of being part of the establishment that created that problem. They’re going to hear the message. And as they hear the message, that’s how we are going to appeal to them.”

What Else We’re Reading

Vox’s Dara Lind explained how “Trump’s RNC speech turned his white supporters’ fear into a weapon.”

Now that Mike Pence is the Republican nominee for vice president, Indiana Republicans have faced “an intense, chaotic, awkward week of brazen lobbying at the breakfast buffet, in the hallways and on the elevators” at the convention as they grapple with who will run to replace the state’s governor, according to the New York Times.

“This is a party and a power structure that feels threatened with extinction, willing to do anything for survival,” wrote Rebecca Traister on Trump and the RNC for New York Magazine. “They may not love Trump, but he is leading them precisely because he embodies their grotesque dreams of the restoration of white, patriarchal power.”

Though Trump spent much of the primary season denouncing big money in politics, while at the RNC, he courted billionaires in hopes of having them donate to supporting super PACs.

Michael Kranish reported for the Washington Post that of the 2,472 delegates at the RNC, it is estimated that only 18 were Black.

Cosmopolitan highlighted nine of the most sexist things that could be found at the convention.

Rep. Steve King (R-IA) asked, “Where are these contributions that have been made” by people of color to civilization?

Analysis Politics

The 2016 Republican Platform Is Riddled With Conservative Abortion Myths

Ally Boguhn

Anti-choice activists and leaders have embraced the Republican platform, which relies on a series of falsehoods about reproductive health care.

Republicans voted to ratify their 2016 platform this week, codifying what many deem one of the most extreme platforms ever accepted by the party.

“Platforms are traditionally written by and for the party faithful and largely ignored by everyone else,” wrote the New York Times‘ editorial board Monday. “But this year, the Republicans are putting out an agenda that demands notice.”

“It is as though, rather than trying to reconcile Mr. Trump’s heretical views with conservative orthodoxy, the writers of the platform simply opted to go with the most extreme version of every position,” it continued. “Tailored to Mr. Trump’s impulsive bluster, this document lays bare just how much the G.O.P. is driven by a regressive, extremist inner core.”

Tucked away in the 66-page document accepted by Republicans as their official guide to “the Party’s principles and policies” are countless resolutions that seem to back up the Times‘ assertion that the platform is “the most extreme” ever put forth by the party, including: rolling back marriage equalitydeclaring pornography a “public health crisis”; and codifying the Hyde Amendment to permanently block federal funding for abortion.

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Anti-choice activists and leaders have embraced the platform, which the Susan B. Anthony List deemed the “Most Pro-life Platform Ever” in a press release upon the GOP’s Monday vote at the convention. “The Republican platform has always been strong when it comes to protecting unborn children, their mothers, and the conscience rights of pro-life Americans,” said the organization’s president, Marjorie Dannenfelser, in a statement. “The platform ratified today takes that stand from good to great.”  

Operation Rescue, an organization known for its radical tactics and links to violence, similarly declared the platform a “victory,” noting its inclusion of so-called personhood language, which could ban abortion and many forms of contraception. “We are celebrating today on the streets of Cleveland. We got everything we have asked for in the party platform,” said Troy Newman, president of Operation Rescue, in a statement posted to the group’s website.

But what stands out most in the Republicans’ document is the series of falsehoods and myths relied upon to push their conservative agenda. Here are just a few of the most egregious pieces of misinformation about abortion to be found within the pages of the 2016 platform:

Myth #1: Planned Parenthood Profits From Fetal Tissue Donations

Featured in multiple sections of the Republican platform is the tired and repeatedly debunked claim that Planned Parenthood profits from fetal tissue donations. In the subsection on “protecting human life,” the platform says:

We oppose the use of public funds to perform or promote abortion or to fund organizations, like Planned Parenthood, so long as they provide or refer for elective abortions or sell fetal body parts rather than provide healthcare. We urge all states and Congress to make it a crime to acquire, transfer, or sell fetal tissues from elective abortions for research, and we call on Congress to enact a ban on any sale of fetal body parts. In the meantime, we call on Congress to ban the practice of misleading women on so-called fetal harvesting consent forms, a fact revealed by a 2015 investigation. We will not fund or subsidize healthcare that includes abortion coverage.

Later in the document, under a section titled “Preserving Medicare and Medicaid,” the platform again asserts that abortion providers are selling “the body parts of aborted children”—presumably again referring to the controversy surrounding Planned Parenthood:

We respect the states’ authority and flexibility to exclude abortion providers from federal programs such as Medicaid and other healthcare and family planning programs so long as they continue to perform or refer for elective abortions or sell the body parts of aborted children.

The platform appears to reference the widely discredited videos produced by anti-choice organization Center for Medical Progress (CMP) as part of its smear campaign against Planned Parenthood. The videos were deceptively edited, as Rewire has extensively reported. CMP’s leader David Daleiden is currently under federal indictment for tampering with government documents in connection with obtaining the footage. Republicans have nonetheless steadfastly clung to the group’s claims in an effort to block access to reproductive health care.

Since CMP began releasing its videos last year, 13 state and three congressional inquiries into allegations based on the videos have turned up no evidence of wrongdoing on behalf of Planned Parenthood.

Dawn Laguens, executive vice president of Planned Parenthood Action Fund—which has endorsed Hillary Clinton—called the Republicans’ inclusion of CMP’s allegation in their platform “despicable” in a statement to the Huffington Post. “This isn’t just an attack on Planned Parenthood health centers,” said Laguens. “It’s an attack on the millions of patients who rely on Planned Parenthood each year for basic health care. It’s an attack on the brave doctors and nurses who have been facing down violent rhetoric and threats just to provide people with cancer screenings, birth control, and well-woman exams.”

Myth #2: The Supreme Court Struck Down “Commonsense” Laws About “Basic Health and Safety” in Whole Woman’s Health v. Hellerstedt

In the section focusing on the party’s opposition to abortion, the GOP’s platform also reaffirms their commitment to targeted regulation of abortion providers (TRAP) laws. According to the platform:

We salute the many states that now protect women and girls through laws requiring informed consent, parental consent, waiting periods, and clinic regulation. We condemn the Supreme Court’s activist decision in Whole Woman’s Health v. Hellerstedt striking down commonsense Texas laws providing for basic health and safety standards in abortion clinics.

The idea that TRAP laws, such as those struck down by the recent Supreme Court decision in Whole Woman’s Health, are solely for protecting women and keeping them safe is just as common among conservatives as it is false. However, as Rewire explained when Paul Ryan agreed with a nearly identical claim last week about Texas’ clinic regulations, “the provisions of the law in question were not about keeping anybody safe”:

As Justice Stephen Breyer noted in the opinion declaring them unconstitutional, “When directly asked at oral argument whether Texas knew of a single instance in which the new requirement would have helped even one woman obtain better treatment, Texas admitted that there was no evidence in the record of such a case.”

All the provisions actually did, according to Breyer on behalf of the Court majority, was put “a substantial obstacle in the path of women seeking a previability abortion,” and “constitute an undue burden on abortion access.”

Myth #3: 20-Week Abortion Bans Are Justified By “Current Medical Research” Suggesting That Is When a Fetus Can Feel Pain

The platform went on to point to Republicans’ Pain-Capable Unborn Child Protection Act, a piece of anti-choice legislation already passed in several states that, if approved in Congress, would create a federal ban on abortion after 20 weeks based on junk science claiming fetuses can feel pain at that point in pregnancy:

Over a dozen states have passed Pain-Capable Unborn Child Protection Acts prohibiting abortion after twenty weeks, the point at which current medical research shows that unborn babies can feel excruciating pain during abortions, and we call on Congress to enact the federal version.

Major medical groups and experts, however, agree that a fetus has not developed to the point where it can feel pain until the third trimester. According to a 2013 letter from the American Congress of Obstetricians and Gynecologists, “A rigorous 2005 scientific review of evidence published in the Journal of the American Medical Association (JAMA) concluded that fetal perception of pain is unlikely before the third trimester,” which begins around the 28th week of pregnancy. A 2010 review of the scientific evidence on the issue conducted by the British Royal College of Obstetricians and Gynaecologists similarly found “that the fetus cannot experience pain in any sense prior” to 24 weeks’ gestation.

Doctors who testify otherwise often have a history of anti-choice activism. For example, a letter read aloud during a debate over West Virginia’s ultimately failed 20-week abortion ban was drafted by Dr. Byron Calhoun, who was caught lying about the number of abortion-related complications he saw in Charleston.

Myth #4: Abortion “Endangers the Health and Well-being of Women”

In an apparent effort to criticize the Affordable Care Act for promoting “the notion of abortion as healthcare,” the platform baselessly claimed that abortion “endangers the health and well-being” of those who receive care:

Through Obamacare, the current Administration has promoted the notion of abortion as healthcare. We, however, affirm the dignity of women by protecting the sanctity of human life. Numerous studies have shown that abortion endangers the health and well-being of women, and we stand firmly against it.

Scientific evidence overwhelmingly supports the conclusion that abortion is safe. Research shows that a first-trimester abortion carries less than 0.05 percent risk of major complications, according to the Guttmacher Institute, and “pose[s] virtually no long-term risk of problems such as infertility, ectopic pregnancy, spontaneous abortion (miscarriage) or birth defect, and little or no risk of preterm or low-birth-weight deliveries.”

There is similarly no evidence to back up the GOP’s claim that abortion endangers the well-being of women. A 2008 study from the American Psychological Association’s Task Force on Mental Health and Abortion, an expansive analysis on current research regarding the issue, found that while those who have an abortion may experience a variety of feelings, “no evidence sufficient to support the claim that an observed association between abortion history and mental health was caused by the abortion per se, as opposed to other factors.”

As is the case for many of the anti-abortion myths perpetuated within the platform, many of the so-called experts who claim there is a link between abortion and mental illness are discredited anti-choice activists.

Myth #5: Mifepristone, a Drug Used for Medical Abortions, Is “Dangerous”

Both anti-choice activists and conservative Republicans have been vocal opponents of the Food and Drug Administration (FDA’s) March update to the regulations for mifepristone, a drug also known as Mifeprex and RU-486 that is used in medication abortions. However, in this year’s platform, the GOP goes a step further to claim that both the drug and its general approval by the FDA are “dangerous”:

We believe the FDA’s approval of Mifeprex, a dangerous abortifacient formerly known as RU-486, threatens women’s health, as does the agency’s endorsement of over-the-counter sales of powerful contraceptives without a physician’s recommendation. We support cutting federal and state funding for entities that endanger women’s health by performing abortions in a manner inconsistent with federal or state law.

Studies, however, have overwhelmingly found mifepristone to be safe. In fact, the Association of Reproductive Health Professionals says mifepristone “is safer than acetaminophen,” aspirin, and Viagra. When the FDA conducted a 2011 post-market study of those who have used the drug since it was approved by the agency, they found that more than 1.5 million women in the U.S. had used it to end a pregnancy, only 2,200 of whom had experienced an “adverse event” after.

The platform also appears to reference the FDA’s approval of making emergency contraception such as Plan B available over the counter, claiming that it too is a threat to women’s health. However, studies show that emergency contraception is safe and effective at preventing pregnancy. According to the World Health Organization, side effects are “uncommon and generally mild.”