News Law and Policy

First Woman Arrested Under Tennessee Pregnancy Criminalization Law, for a Drug Not Covered Under the Law

Nina Liss-Schultz

The law specifically criminalizes “the illegal use of a narcotic drug while pregnant, if [a woman's] child is born addicted to or harmed by the narcotic drug.” But Mallory Loyola was arrested Tuesday for exposing her child to amphetamine, which is not a narcotic.

Read more of our coverage on the Tennessee Pregnancy Criminalization Law here.

A woman in Tennessee was arrested on Tuesday under a new law that criminalizes mothers whose babies are exposed to certain illegal drugs in utero. The law went into effect only a week prior to the arrest, which was made after her newborn tested positive for amphetamine.

Though the law specifically criminalizes “the illegal use of a narcotic drug while pregnant, if [a woman’s] child is born addicted to or harmed by the narcotic drug,” local reporting suggests that the woman, Mallory Loyola, was arrested for exposing her child to amphetamine, which is not a narcotic. Initial reports also make no mention of the presence of symptoms of withdrawal nor that the child was harmed by the exposure.

Loyola, who is the first person to be prosecuted under the law, was charged with assault, according to local TV station WBIR, a misdemeanor offense that carries a penalty of up to one year in jail and a fine of $2,500.

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Politicians in the state emphasize that the so-called Pregnancy Criminalization Law is intended to protect children. “The focus of this legislation is to protect babies being born addicted to drugs,” said Shelby County Attorney General Amy Weirich in a statement. “We are not talking about going after women who show up at their OB/GYN with a positive drug screen.”

But Farah Diaz-Tello, a staff attorney at National Advocates for Pregnant Women, notes that the use of the word “addiction” to describe infants exposed to drugs in utero is a vestige from the “crack babymyth, and is incorrect and misleading. “Babies cannot be born addicted to any substance,” Diaz-Tello told Rewire. “Addiction means a specific thing, it is a behavioral condition, and is distinct from dependency and simply experiencing withdrawal. You can’t say that they are addicted because they are not showing drug-seeking behavior.”

Diaz-Tello also says that laws like the one in Tennessee are actually a threat to public health, because they deter women who struggle with drug addiction from entering rehabilitation programs for fear of being held criminally liable. “If pregnant women are afraid they’ll be prosecuted if they’re honest with their doctors and seek medical help, they won’t seek the help,” she said.

Children like the one born to Loyola will be referred to the state’s child services and could potentially be removed from their parents.

In addition, the law mistakenly focuses only on the illegal use of drugs during pregnancy. Yet, according to the Centers for Disease Control and Prevention, prescription painkillers alone were the cause of “14,800 overdose deaths in 2008, more than cocaine and heroin combined.” Almost 20 percent of those painkillers were obtained legally, through a doctor’s prescription.

Tennessee is the first state to pass such a law through its legislative process. South Carolina and Alabama also permit women to be prosecuted for pregnancy outcomes, though the practice was legalized through the court system, not by the legislature.

Investigations Violence

As Threats Spike, Advocates Urge Feds to Strengthen Law Protecting Abortion Clinic Access

Sofia Resnick

Just two days after NARAL Pro-Choice America submitted a letter asking the U.S. Department of Justice to investigate anti-choice activities as domestic terrorism, an extremist opened fire on a Planned Parenthood clinic in Colorado, murdering three people and injuring nine others.

On a frigid January afternoon this year, a day before the 43rd anniversary of Roe v. Wade, about a dozen fresh-out-of-college feminist campus organizers marched the halls of Congress after divvying up a list of representatives to visit.

Smartly dressed under bulky winter coats, organizers Kelli Musick and Chelsea Yarborough, who work for the national nonprofit the Feminist Majority Foundation (FMF), dropped by the office of Rep. Marsha Blackburn (R-TN).

Blackburn chairs the House of Representatives’ Energy and Commerce Committee’s Select Investigative Panel, created last October principally to investigate Planned Parenthood. The panel formed after the anti-choice front group the Center for Medical Progress (CMP) released a series of heavily edited videos in which it claimed—though never proved—that Planned Parenthood was illegally selling fetal tissue.

As part of their mission that day, Musick and Yarborough left written materials with a staffer asking Blackburn to either redirect her panel’s focus to violent attacks on abortion clinics, or to dissolve it. Specifically, the FMF wanted the congressional panel to investigate the leaders behind CMP, whose rhetoric has fueled a recent spate of threats and attacks against abortion providers, the foundation’s president, Eleanor Smeal, told Rewire in an interview. Though the investigative scope of the panel is actually quite broad, it does not specifically include abortion clinic violence as an area to probe.

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But in the four months since Musick and Yarborough submitted their request to Blackburn’s staff, the panel has forged ahead with its investigation, not just into Planned Parenthood’s fetal tissue donation practices, but into abortion practices generally. This week, House Democrats requested that Speaker Paul Ryan (R-WI) disband this panel, arguing that it amounts to little more than a biased, expensive witch hunt on fetal tissue researchers and abortion providers.

Really, though, the FMF’s mostly symbolic ask is part of a recent, ongoing push by abortion rights groups to demand that the federal government start taking violence and threats aimed at abortion providers more seriously. National organizations last year began identifying a spike in violent acts, such as arson, vandalism, and death threats, directed at reproductive health clinics and staffers.

NARAL Pro-Choice America started a campaign last November asking the U.S. Department of Justice (DOJ) to investigate these types of activities as domestic terrorism. Just two days after NARAL submitted its letter to the federal agency, an anti-choice extremist opened fire on a Planned Parenthood clinic in Colorado murdering three people and injuring nine others.

This rise in threats and attacks—further documented in a report published last month by the National Abortion Federation (NAF)—has also prompted abortion rights groups to demand that the government strengthen and fully enforce the Freedom of Access to Clinic Entrances (FACE) Act, a 22-year-old federal law intended to ensure access to abortion clinics and to protect the lives of abortion providers and patients.

“The time for us being quiet is over,” Smeal said at a news conference held in January. “We are determined that we are going to bring the anti-abortion violence issue to the forefront of decision making.”

A Call for More FACE Investigations

The FACE Act, which allows for criminal and civil remedies, makes it a federal crime to use force or the threat of force to prevent people from accessing or providing reproductive health care. For example, the law bans the destruction of clinic property and the practice of blocking someone’s entrance into a clinic.

Before President Bill Clinton signed the FACE Act in 1994, some abortion foes would travel the country and barricade themselves in front of clinic doors. Such blockades came to be known as “operation rescue,” pioneered by the national group of the same name whose current president, Troy Newman, was involved in the aforementioned video campaign targeting Planned Parenthood.

“It’s called ‘interposition,'” Rev. Rusty Lee Thomas told Rewire in a phone interview. He said that this blockading practice is based on a biblical and historical concept, where “someone stands in the gap between the sort of tyrant and its victim.” Thomas said in this case, the doctors providing abortions were the tyrants and the aborted fetuses the victims.

Thomas now runs a group called Operation Save America. Back in the 1990s, he joined anti-choice activists in these ventures. But Thomas said he gave up this particular brand of protest after the DOJ sued him and others under the FACE Act in 1998, after he had attempted to block the entrances of reproductive health clinics in multiple cities in Ohio. Though the federal government ultimately dropped the charges, the threat of prison time and hundreds of dollars in fines ended his blockading days, Thomas said.

“Like anything else, when the price tag goes up, people really do have to weigh that,” he said. “By that time, the government was successful at scaring people and shutting it down. The tactic of ‘operation rescue’ was put to an end.”

Many abortion rights supporters agree with Thomas that the FACE Act curbed clinic blockades. They say this federal policy and similar state laws helped decrease violent attacks, such as clinic bombings and murders of clinic workers and doctors. Smeal said that, according to the FMF’s frequent clinic surveys, the year the FACE Act went into effect, more than 50 percent of abortion clinics reported experiencing violence; today that number has dropped to 20 percent.

Since 1994, the DOJ has filed a total of 27 civil FACE cases in 17 states, a Justice Department spokesperson told Rewire in an email. The spokesperson said the DOJ receives “a great deal of information” from national abortion provider groups, as well as from victims, local law enforcement, and media reports.

As Rewire has reported previously, both criminal and civil prosecutions under FACE tend to fluctuate based on which political party controls the White House: During President George W. Bush’s administration, for example, criminal prosecutions under the FACE Act declined by more than 75 percent to about two a year, compared to an average of ten prosecutions a year under the Clinton administration. During President Obama’s first term, the DOJ reported prosecuting 11 criminal cases under the FACE Act, charging 12 defendants.

During a Senate Judiciary Committee hearing in March on the oversight of the Justice Department, Attorney General Loretta Lynch testified that her agency increased criminal prosecutions and civil cases filed under the FACE Act within the “past five or six years.” But she did not give the total number of cases prosecuted under the act. She estimated that under the Obama administration, the DOJ has charged a total of 12 criminal cases criminally and nine civil ones.

Advocates and providers say these figures pale in comparison to the number of acts of violence and harassment annually committed against clinics and providers nationwide.

Since the NAF began tracking abortion clinic violence in 1977, the organization reports that as of 2015, there have been 185 arsons, 42 bombings, 26 attempted murders, and 11 murders, three of which occurred last year.

Advocates are currently waiting to see whether the government will bring a FACE complaint against Robert Lewis Dear Jr., who invoked anti-abortion animus upon arrest and during his first media interview after he admitted to shooting up the Colorado Springs Planned Parenthood clinic last November. During her testimony in March, Lynch said the DOJ is reviewing “a possible FACE Act violation” against Dear while his murder case proceeds in state court.

It appears, however, that this case will be in limbo for a while. Earlier this month, a judge ruled that Dear lacks the mental competency to stand trial, after forensic psychologists diagnosed him with a delusion disorder they claim is based on the accused shooter’s fringe political beliefs, among them that federal agents are spying on him. Dear, meanwhile, has been very clear that he does not want to plead insanity; rather, he wants to argue that the attack on Planned Parenthood was legally justified because he was fighting against the greater evil of abortion. For the time being, Dear will be treated at a state psychiatric hospital until, if ever, he is deemed competent to stand trial.

In any case, it might seem unnecessary to charge Dear with a federal felony crime of obstructing access to abortion when he’s already on trial for multiple murders. But some advocates say that charging these crimes under FACE is important symbolically because, as with hate crimes, the FACE Act helps draw the link between crimes like vandalism, arson, and murder, and a specific bias against a group of people. Being able to illustrate a pattern of anti-abortion crimes is necessary in order to bring awareness to law enforcement and the public and to potentially deter anti-choice extremists from threatening or committing acts of violence, they say.

It’s for this reason that physician assistant Susan Cahill wanted to bring a FACE claim against Zachary Klundt, who destroyed her All Families Healthcare clinic in Kalispell, Montana, in March 2014, forcing her to forever shutter her clinic.

According to testimony that surfaced during the sentencing hearing, Klundt had texted his mother hours before the break-in, asking her for information about the “abortionist,” and had told a psychiatrist evaluating him after the break-in that Cahill was a “murderer.” Notably, Klundt’s mother sat on the board of the anti-choice pregnancy center that purchased Cahill’s old building and evicted Cahill.

Yet despite this circumstantial evidence, Klundt testified that he smashed all of Cahill’s medical equipment and personal photos and poured iodine on her patients’ medical records because of serious drug addiction, not anti-abortion animus.

“Even though everybody knows why he did it, legally it wasn’t tried that way,” Cahill told Rewire.

Though third parties can bring civil suits under the FACE Act, Cahill said she likely would be unsuccessful trying to use the statute in this case, because Klundt was only found guilty of vandalism and the court did not make a specific finding about his motivations in committing this crime.

Instead, she is suing Klundt, his family, and the crisis pregnancy center that forced her from her old building, for negligence, nuisance, and “intentional infliction of emotional distress.” She said she hopes that if the case moves forward, discovery proceedings will surface what she suspects were Klundt’s anti-abortion motivations.

To be sure, not all anti-choice activists and abortion clinic protesters escalate to violence. And abortion opponents like Susan B. Anthony List national campaign chair Jill Stanek say the FACE Act goes too far in regulating the actions of protesters. Stanek told ​Rewire​ that most of these activists peacefully exercise their free speech rights to protest what they believe is a form of murder.

As an example, Stanek pointed Rewire to a FACE claim in 2010 in which the DOJ sued an activist in West Palm Beach, Florida, accusing her of blocking the flow of traffic at an abortion clinic while she tried to give pamphlets to a couple in a car. A federal judge dismissed the claim as baseless.

Stanek argued that it is a political strategy among abortion rights supporters to “play up” acts of anti-choice violence and threats. She added that abortion opponents also receive their share of attacks and threats, including herself. Upon returning from vacation in late January, Stanek said she found a brick thrown through her window with a note reading: “Quit the pro-life bullshit.” Her local newspaper in Mokena, Illinois, reported the alleged incident. Stanek posted photos she says depict the brick and busted window to Facebook.

While Stanek maintained that most abortion protesters organize peacefully and called people like Dear part of the “lunatic fringe,” she did concede that protesting in front of abortion clinics is, in part, an attempt by her movement “to stigmatize abortion doctors.” The goal is also, she said, to convince patients to turn away from clinics and for clinic staff to quit their jobs.

It’s this stigma and endless, sometimes hostile, presence in front of reproductive health clinics that, abortion providers told Rewire, can help breed eventual violence. But Stanek said the movement is not about to abandon this crucial aspect of their multi-pronged strategy to end legal abortion.

“As far as we’re concerned, the last front, the last place that we have a chance to save a baby is at the abortion clinic,” Stanek said. “Laws haven’t worked, pregnancy care centers haven’t worked, educating hasn’t worked. Now we have the mom going into the abortion clinic. And so that is what compels certain people to go to abortion clinics and try to get women to change their minds.”

Abortion Rights Advocates Say FACE Is Weak on Threats, Harassment

It was lunchtime during the summer of 2012 when Dr. Willie Parker walked outside of Jackson Women’s Health Organization in Jackson, Mississippi. It was his first day at the clinic, which happens to be bright pink and the last standing abortion clinic in the whole state. As such, it’s a regular fixture for protests.

As he walked to and from a nearby sandwich shop, Parker said he was accompanied by a protester who “berated” him the entire way. He felt intimidated and threatened.

Parker, who currently divides his time among six clinics in five states, told Rewire in a phone interview that the FACE Act is a “mixed bag,” arguing it does not fully protect providers, especially when they are not on clinic property. He added that abortion foes have learned all of the federal and local statutes to know how close they can physically reach patients and providers while staying inside the law.

“At what point am I out of the safety created by [the FACE] Act simply because I chose to walk across the street from an abortion clinic to get a sandwich?” he said.

Many abortion providers think FACE is a relatively weak law, particularly when it comes to harassment and threats made against them, an element of clinic violence many advocates say is often ignored at the federal level. Though it forbids “the threat of force,” such a provision is open to interpretation by the courts.

Drexel University law professor David Cohen, who co-authored a recent book about anti-abortion terrorism, told Rewire last year that the FACE Act should be amended to specifically include stalking and harassing abortion providers within the law’s current definition of “intimidate.” Additionally, Cohen recommends directing the courts to assess threats from the perspective of an abortion provider, and increasing penalties.

Threats to providers have drastically increased in the last year, say advocacy groups. They attribute this increase, in part, to the incendiary rhetoric that Planned Parenthood “sells baby parts,” a recurring mantra from the Center for Medical Progress’ smear campaign against the reproductive health-care network.

The NAF tracked 94 threats of direct harm in 2015, compared to just one threat in 2014. According to its latest report, NAF hired an outside security firm in mid-November last year to track online threats, which helped to identify more than 25,000 incidents of hate speech and threats within six weeks.

Meanwhile, researchers at FMF also witnessed a sharp rise in threats against abortion providers last summer. Smeal said researchers were so concerned that they postponed a clinic violence survey that they were prepping to come out earlier this year and instead tried to help clinics prevent threats from escalating into actual attacks.

“We were very, very concerned about the increasing level of threats,” Smeal told Rewire in an interview. “Most of us who have been involved in this for a long time thought it was one of the highest threat levels we’ve ever seen. We were waiting for the violent acts to occur.”

They didn’t have to wait long.

Dr. Savita Ginde, the medical director at the Planned Parenthood clinic in Colorado Springs, was one of the doctors featured in one of CMP’s videos. After the video streamed online, Ginde allegedly received online death threats, as well as picketers outside of her home. In November, Dear was arrested for shooting up her clinic, declaring afterward, “no more baby parts.” Ginde was not harmed.

The connection of threats to violence worries advocates like Smeal. Extremists do not always act on their threats, but they sometimes do, she said. Or they create a climate that motivates someone to act out what the crowd is cheering for.

It’s for this reason that the reproductive rights community eagerly anticipated the recent trial in the Justice Department’s civil lawsuit against abortion foe Angel Dillard in the hopes that the result might strengthen future enforcement against threats under FACE.

In fact, the opposite might have happened.

The DOJ sued Dillard in 2011 after she mailed a letter to family practitioner Dr. Mila Means. Means was, at the time, training to perform abortions in Wichita to fill the gap left by Dr. George Tiller, whom Scott Roeder murdered two years earlier, admitting it was because Tiller performed abortions. In the letter, Dillard, who has ties to Roeder, told Means that thousands of abortion opponents across the country were monitoring her movements and that should she begin offering abortions, she should take care to check beneath her car for explosives every day “because maybe today is the day someone places an explosive under it.” In the letter, Dillard also referenced Tiller speaking to Means from hell.

The agency interpreted this letter as a threat of violence that violated the FACE Act. Means ended up not opening an abortion practice in Wichita. She told Rewire after the trial that she backed out, in part, because of the cultural and political climate against abortion in Kansas. “The threats work,” she said.

This climate was evidenced in the Wichita jury’s decision reached earlier this month. While the eight jurors did conclude that Dillard’s letter constituted a “true threat” not automatically protected by free speech, they also accepted Dillard’s attorneys’ arguments that her threats were religious in nature rather than violent.

“The letter was intimidating, but it was a more spiritual threat, a more emotional threat,” Adam Cox, the presiding juror, told Rewire in an interview following the verdict.

Thus, they found the letter did not violate the law and did not warrant civil damages or a protective order to keep Dillard away from Means.

Smeal said she was disappointed by the verdict in the Dillard case.

“It just shows you how hard it is to enforce this law,” she told Rewire in a phone interview.

Smeal said she is working behind the scenes with other advocates and lawmakers on efforts to eventually expand and strengthen the FACE Act. In the meantime, she said, law enforcement at all levels should be employing other existing laws to prosecute but also try to prevent violent attacks against abortion providers.

Some advocates, for example, have called on the federal government to treat demonstrated acts of anti-abortion violence, bomb threats, or murder as domestic terrorism.

Since NARAL launched its campaign last fall demanding that the DOJ begin investigating anti-abortion violence as domestic terrorism, NARAL Vice President of Policy Donna Crane said her group has seen more congressional members speaking out about abortion clinic violence as domestic terrorism.

“We think [the campaign] has raised important questions about why all too often anti-choice violence at women’s health centers is seen somehow as different, maybe even somehow a little bit more acceptable,” Crane told Rewire in a phone interview. “We believe that it’s just another flavor of domestic terrorism, and it should be talked about as such and treated as such.”

Smeal said her organization is similarly not backing down from its campaign asking the House committee investigating Planned Parenthood to take to task the activist groups that have, she believes, contributed to a dangerous climate for abortion providers and their patients.

Already, Smeal said, supporters have sent the committee thousands of emails as part of this campaign. And though she said it is difficult to know what effect the FMF’s campaign has had so far, she said she knows congressional members are listening.

Earlier in May, House Minority Leader Nancy Pelosi and the committee’s ranking Democratic member Rep. Janice Schakowsky held a press conference asking Speaker Paul Ryan to disband the House select committee, arguing that its investigation is putting access to reproductive health care as well as the lives of doctors and fetal-tissue researchers in danger, a point Smeal’s group has been making for months now.

“We’re going to keep it up, because we’re worried [the committee is] endangering health-care providers,” Smeal said of her group’s campaign. “We want to continue to shed light on this anti-abortion violence and basically are doing that in every way we can.”

Analysis Law and Policy

Patel Oral Arguments Suggest a Dangerous Precedent for Prosecuting Pregnant People

Jessica Mason Pieklo

Attorneys for the State of Indiana argued it is entirely reasonable for the state to bring felony charges against women who try and terminate their own pregnancies.

Read our other articles on the Purvi Patel case here.

Almost three years ago, the State of Indiana first charged Purvi Patel with both feticide and neglect of a dependent following Patel’s home delivery of what state doctors testified was a 25-week-old fetus. Today, there is still no clear picture of the events leading up to those charges. Based on the conflicting evidence presented at Patel’s seven-day trial, it’s not clear what Patel knew about her pregnancy, including how far along she was. It’s not clear what exactly happened that day in Patel’s bathroom. And, most importantly, there is no clear picture of whether the delivery resulted in a live birth.

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But on Monday, lawyers from the state Attorney General’s Office argued to the Indiana Court of Appeals that none of those unknowns matter. Patel’s charges of feticide for unlawfully terminating her pregnancy and neglecting a live dependent were not contradictory. Quite simply, argued Indiana Deputy Attorney General Ellen Meilaender, if there’s evidence that a person’s conduct contributed to the death of a fetus or a severely prematurely infant born alive that then dies, that person faces possible felony prosecution both for feticide and criminal neglect of a dependent—setting a disturbing potential precedent for pregnant people throughout the state.

The Indiana feticide statute makes it a felony for a person to “knowingly or intentionally terminate a human pregnancy with an intention other than to produce a live birth or to remove a dead fetus.” The statute is silent on whether a self-induced abortion falls under this category. Indiana prosecutors argue that it does and told the appeals court Monday that the jury verdict against Patel proved them right.

The state made a similar argument with Patel’s conviction for felony neglect of a dependent. According to the state, by taking abortion-inducing drugs, Patel created a situation that put her “dependent”—in other words, her fetus—in harm’s way. Once delivered alive, the state argued, Patel had a legal duty to immediately seek medical attention on its behalf, including clamping her umbilical cord immediately after delivery to prevent neonatal blood loss and calling 9-1-1 for emergency care. It made no difference, prosecutors said, that the medical evidence was contradictory as to whether there was a live birth at all, or what, if anything, Patel understood was happening at the time of the delivery.

Patel’s attorneys may disagree with the inferences made by the jury, state attorneys argued, but that doesn’t mean the law grants the court grounds to overturn the jury verdict.

It wasn’t clear to me at the end of oral arguments that the three-judge panel was buying the State’s argument. The judges pushed Meilaender hard on where the law should draw the line between taking nonprescribed abortion medications that produce a live birth where the baby then dies—as the state argued happened here—to drinking whiskey, smoking cigarettes, or taking any other host of actions that may help contribute to a miscarriage. The judges seemed to agree that it would be excessive to prosecute pregnant people for smoking, for example. The judges also appeared skeptical about the argument that the feticide statute doesn’t require the fetus to die in utero, and that even a live birth can and should be prosecuted under this statute if the accused person’s original intent was to terminate a pregnancy outside Indiana’s stringent legal abortion requirements.

But it also wasn’t clear they bought the argument of Patel’s attorney, Lawrence Marshall, that the state hadn’t met its burden of proof when it convicted her. Marshall stammered to keep the judges on point, refusing to answer whether federal constitutional precedent, from Roe v. Wade to Planned Parenthood v. Casey, would protect many other people from unchecked pregnancy policing under feticide laws. (Spoiler: The simple answer is no—as Tennessee, Mississippi, Alabama, and Arkansas, to name a few, show).

The heart of the state’s negligence case against Patel rests on her alleged failure to seek care for a live birth. Yet Marshall could not specifically and directly answer the judges’ concerns that Patel, after allegedly cutting the umbilical cord during delivery, should have also immediately clamped or kinked it to prevent any blood loss to the fetus she just delivered. He did not note that it is unreasonable to expect any woman immediately following an extremely premature delivery to have the presence of mind to do such things, lest she face felony prosecution. He tried to point out that there was medical testimony at trial that at 25 weeks, severely prematurely born infants have only modest survival rates even when born at hospitals and immediately transferred to neonatal intensive care units, and tried to argue the state couldn’t prove that Patel had any idea a live birth had even happened. But all those counters appeared to fall flat on a panel of judges clearly willing to consider, and perhaps even accept, that Patel’s failure to kink her umbilical cord and call 9-1-1 immediately post-delivery was sufficient to convict her for felony neglect of a dependent.

Throughout the trial and the appeal, the state compensated for its lack of direct evidence about the situation by trying to redirect the jury’s focus to Patel’s “character,” which, prosecutors argued, helped inform the decision to convict her. Patel was in a relationship with a married man. Evidence at trial showed she had been texting back and forth with a friend concerning the pregnancy and her desire to terminate it, in part because of fears her conservative Hindu family would not support her. That’s both sexually provocative and naive, argued the state in its appellate brief—provocative because she was acting outside religious and social norms, and naive because “family would have loved her regardless and would have welcomed the baby, as it is their religious belief to love a child even if born out of wedlock and their religion is opposed to killing anyone or anything.”

Meanwhile, the state argued, the evidence that should be weighed in Patel’s favor did not matter. That included evidence at trial that showed Patel believed she was only about 12 weeks pregnant—not about 25 weeks—when she took the unprescribed abortifacient. Not important, argued the state. All that matters is her fetus was old enough to fall outside Indiana’s limit on 20-week abortions. Evidence at trial showed that Patel tried, ultimately unsuccessfully, to navigate Indiana’s web of anti-choice restrictions before ordering abortion-inducing medications online; but that just demonstrates Patel had the right criminal intent to support the jury’s conviction, said Meilaender, not that those regulations are difficult for non-lawyers to navigate on their own.

In other words, argued Meilaender, the details that should normally be necessary to support a criminal conviction—details such as what Patel knew, and when—just don’t matter in this case.

Those details do matter. That’s why the U.S. Court of Appeals for the Ninth Circuit rejected nearly identical arguments in the prosecution of Jenni Linn McCormack, an Idaho woman who also terminated a pregnancy and was criminally prosecuted for it. Expecting patients to understand the intricacies of abortion restrictions or face criminal prosecution at its very core unduly burdens abortion rights, that court ruled.

It will likely be months before the Indiana Court of Appeals issues its opinion. And I’m not going to make any guesses about how this case turns out. But I will say that, despite all the unknowns in the Patel case, there are plenty of knowns that ultimately affect Patel and pregnant people in Indiana as a whole.

We know that Indiana law does not mandate sex education be taught in its schools. The Indiana Department of Education recommends its inclusion as part of a school’s comprehensive health education program. But that’s it. And for those schools that decide to offer some form of sex ed, there’s no requirement that the information provided be unbiased and medically accurate, let alone do anything other than stress abstinence-only sex ed. And of course, parents in Indiana have the option of opting out of sex ed entirely for their children should they so choose.

We also know that legal abortion in Indiana is extensively and severely restricted. First, any person seeking an abortion must receive state-mandated counseling that includes information designed to discourage the patient from having an abortion. That counseling must be done in person. Indiana law then requires a patient to wait an additional 18 hours after that counseling session before an abortion can be performed. That means, effectively, patients must make two separate trips to an abortion clinic to have the procedure. A patient must also undergo an ultrasound before obtaining an abortion and during that ultrasound the provider must offer her the option to view the ultrasound image.

Indiana law also prohibits the use of telemedicine for medication abortion. Also, Indiana bans abortions after 20 weeks, with only a very narrow exception of when the patient’s life or physical health is at risk.

And if that patient can navigate the consent and waiting period requirements, how will they pay for the procedure? In Indiana, abortion is covered in private insurance policies only in cases of life endangerment, rape, incest, or the severely compromised health of the pregnant person. Individuals have the option of buying a separate abortion policy, but that, of course, is at additional cost.

What do Indiana’s sex ed requirements and abortion restrictions have to do with Patel’s conviction and appeal? Everything. Just like the fact that Patel, like Bei Bei Shuai before her, is not white and is not wealthy. A lack of comprehensive sex education means it’s increasingly likely other patients will, like Patel, have very little apparent understanding of the pregnancy process, particularly early on in pregnancy when indicators such as a missed period can be mixed. An increasingly draconian set of abortion restrictions means more and more patients like Patel will find themselves unable to access a legal provider or afford an abortion at all, which means that more and more patients like Patel will be forced into either attempting to self-terminate an unwanted pregnancy or carrying it to term.

Attorneys for the State of Indiana tried to tone down the “canary in a coal mine” aspect to Patel’s conviction. But there really is no denying it. During Monday’s arguments, they were pressing for the right to bring felony charges against women who terminate their own pregnancies. They insisted those prosecutions are exactly what the Indiana legislature intended when passing its feticide statute and further, such prosecutions advanced the state’s “significant” interest in protecting “unborn human life.”

Combine those arguments with the unavailability of comprehensive sex ed and the anti-choice restrictions in Indiana, and it’s clear that Patel’s case is absolutely a test case in the limits, if any, of state power to regulate pregnancies and their outcomes. Should Patel’s conviction be upheld, then the courts will have sent a very strong message to the the people of Indiana: The state expects and demands a healthy, live birth with each pregnancy, and failure to produce one could result in felony charges.