Mental health care practitioners in Oregon can no longer try to “convert” LGBTQ youth to heterosexuality, under a law passed last week by the state legislature.
HB 2307, passed by the Democrat-controlled state senate on Friday, will make Oregon the fourth jurisdiction, following California, New Jersey, and Washington, D.C., to ban so-called conversion therapy for minors.
The practice, in which mental health professionals seek to change a person’s sexual identity or orientation, relies on both the outdated belief that non-straight sexual orientation is a mental health disorder and the discriminatory belief that same-sex orientation is of less value than heterosexuality. The American Psychiatric Association (APA) removed “homosexuality” from the Diagnostic and Statistical Manual of Mental Mental Disorders (DSM) in 1973.
Conversion therapy, also called reparative therapy, has been lambasted by the medical and mental health professional communities, including the American Academy of Pediatrics, the American Psychological Association and the American Psychiatric Association.
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There’s no evidence to suggest that conversion therapy works, according to a 2009 report by the American Psychological Association, which surveyed literature on the subject.
Banning conversion therapy has gained widespread support around the United States. Backed by the National Center for Lesbian Rights (NCLR), bills like HB 2307 have been introduced in 17 states across the country, most of them this year.
Both the California and New Jersey laws have recently held up in court. And in April, the Obama administration threw its support behind the bans, and in particular a push to enact Leelah’s Law, which honors Leelah Alcorn, a 17-year-old transgender woman who committed suicide last year, and which would ban all forms of conversion therapy.
Though bills like the one passed in Oregon are significant, they are also limited. As Christen McCurdy wrote for Rewire in March, these laws don’t “address all the ways in which conversion therapy is actually practiced—which can include ‘treatment’ for dependent patients over the age of 18, or from members of the clergy or other non-licensed individuals.”
Still, the Oregon bill is a significant step towards stopping the practice of conversion therapy.
“This lifesaving law will protect the health and well-being of LGBT youth in Oregon and ensure that licensed mental health professionals cannot abuse their position of trust to do lifelong harm to children and tear families apart,” NCLR campaign coordination and staff attorney Samantha Ames said in a statement.
Donald Trump's running mate has said that "life is winning in Indiana"—and the biggest winner is probably a chain of crisis pregnancy centers that landed a $3.5 million contract in funds originally intended for poor Hoosiers.
Much has been made of Republican Gov. Mike Pence’s record on LGBTQ issues. In 2000, when he was running for U.S. representative, Pence wrote that “Congress should oppose any effort to recognize homosexual’s [sic] as a ‘discreet and insular minority’ [sic] entitled to the protection of anti-discrimination laws similar to those extended to women and ethnic minorities.” He also said that funds meant to help people living with HIV or AIDS should no longer be given to organizations that provide HIV prevention services because they “celebrate and encourage” homosexual activity. Instead, he proposed redirecting those funds to anti-LGBTQ “conversion therapy” programs, which have been widely discredited by the medical community as being ineffective and dangerous.
Under Pence, ideology has replaced evidence in many areas of public life. In fact, Republican presidential nominee Donald Trump has just hired a running mate who, in the past year, has reallocated millions of dollars in public funds intended to provide food and health care for needy families to anti-choice crisis pregnancy centers.
Gov. Pence, who declined multiple requests for an interview with Rewire, has been outspoken about his anti-choice agenda. Currently, Indiana law requires people seeking abortions to receive in-person “counseling” and written information from a physician or other health-care provider 18 hours before the abortion begins. And thanks, in part, to other restrictive laws making it more difficult for clinics to operate, there are currently six abortion providers in Indiana, and none in the northern part of the state. Only four of Indiana’s 92 counties have an abortion provider. All this means that many people in need of abortion care are forced to take significant time off work, arrange child care, and possibly pay for a place to stay overnight in order to obtain it.
This environment is why a contract quietly signed by Pence last fall with the crisis pregnancy center umbrella organization Real Alternatives is so potentially dangerous for Indiana residents seeking abortion: State-subsidized crisis pregnancy centers not only don’t provide abortion but seek to persuade people out of seeking abortion, thus limiting their options.
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“Indiana is committed to the health, safety, and wellbeing [sic] of Hoosier families, women, and children,” reads the first line of the contract between the Indiana State Department of Health and Real Alternatives. The contract, which began on October 1, 2015, allocates $3.5 million over the course of a year for Real Alternatives to use to fund crisis pregnancy centers throughout the state.
Where Funding Comes From
The money for the Real Alternatives contract comes from Indiana’s Temporary Assistance for Needy Families (TANF) block grant, a federally funded, state-run program meant to support the most vulnerable households with children. The program was created by the 1996 Personal Responsibility and Work Opportunity Reconciliation Act signed by former President Bill Clinton. It changed welfare from a federal program that gave money directly to needy families to one that gave money, and a lot of flexibility with how to use it, to the states.
This TANF block grant is supposed to provide low-income families a monthly cash stipend that can be used for rent, child care, and food. But states have wide discretion over these funds: In general, they must use the money to serve families with children, but they can also fund programs meant, for example, to promote marriage. They can also make changes to the requirements for fund eligibility.
As of 2012, to be eligible for cash assistance in Indiana, a household’s maximum monthly earnings could not exceed $377, the fourth-lowest level of qualification of all 50 states, according to a report by the Congressional Research Service. Indiana’s program also has some of the lowest maximum payouts to recipients in the country.
Part of this is due to a 2011 work requirement that stripped eligibility from many families. Under the new work requirement, a parent or caretaker receiving assistance needs to be “engaged in work once the State determines the parent or caretaker is ready to engage in work,” or after 24 months of receiving benefits. The maximum time allowed federally for a family to receive assistance is 60 months.
“There was a TANF policy change effective November 2011 that required an up-front job search to be completed at the point of application before we would proceed in authorizing TANF benefits,” Jim Gavin, a spokesman for the state’s Family and Social Services Administration (FSSA), told Rewire. “Most [applicants] did not complete the required job search and thus applications were denied.”
Unspent money from the block grant can be carried over to following years. Indiana receives an annual block grant of $206,799,109, but the state hasn’t been using all of it thanks to those low payouts and strict eligibility requirements. The budget for the Real Alternatives contract comes from these carry-over funds.
According to the U.S. Department of Health and Human Services, TANF is explicitly meant to clothe and feed children, or to create programs that help prevent “non-marital childbearing,” and Indiana’s contract with Real Alternatives does neither. The contract stipulates that Real Alternatives and its subcontractors must “actively promote childbirth instead of abortion.” The funds, the contract says, cannot be used for organizations that will refer clients to abortion providers or promote contraceptives as a way to avoid unplanned pregnancies and sexually transmitted infections.
Parties involved in the contract defended it to Rewire by saying they provide material goods to expecting and new parents, but Rewire obtained documents that showed a much different reality.
Real Alternatives is an anti-choice organization run by Kevin Bagatta, a Pennsylvania lawyer who has no known professional experience with medical or mental health services. It helps open, finance, and refer clients to crisis pregnancy centers. The program started in Pennsylvania, where it received a $30 million, five-year grant to support a network of 40 subcontracting crisis pregnancy centers. Auditor General Eugene DePasquale called for an audit of the organization between June 2012 and June 2015 after hearing reports of mismanaged funds, and found $485,000 in inappropriate billing. According to the audit, Real Alternatives would not permit DHS to review how the organization used those funds. However, the Pittsburgh Post-Gazettereported in April that at least some of the money appears to have been designated for programs outside the state.
Real Alternatives also received an $800,000 contract in Michigan, which inspired Gov. Pence to fund a $1 million yearlong pilot program in northern Indiana in the fall of 2014.
“The widespread success [of the pilot program] and large demand for these services led to the statewide expansion of the program,” reads the current $3.5 million contract. It is unclear what measures the state used to define “success.”
“Every Other Baby … Starts With Women’s Care Center”
Real Alternatives has 18 subcontracting centers in Indiana; 15 of them are owned by Women’s Care Center, a chain of crisis pregnancy centers. According to its website, Women’s Care Center serves 25,000 women annually in 23 centers throughout Florida, Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin.
Women’s Care Centers in Indiana received 18 percent of their operating budget from state’s Real Alternatives program during the pilot year, October 1, 2014 through September 30, 2015, which were mostly reimbursements for counseling and classes throughout pregnancy, rather than goods and services for new parents.
In fact, instead of the dispensation of diapers and food, “the primary purpose of the [Real Alternatives] program is to provide core services consisting of information, sharing education, and counseling that promotes childbirth and assists pregnant women in their decision regarding adoption or parenting,” the most recent contract reads.
The program’s reimbursement system prioritizes these anti-choice classes and counseling sessions: The more they bill for, the more likely they are to get more funding and thus open more clinics.
“This performance driven [sic] reimbursement system rewards vendor service providers who take their program reimbursement and reinvest in their services by opening more centers and hiring more counselors to serve more women in need,” reads the contract.
Classes, which are billed as chastity classes, parenting classes, pregnancy classes, and childbirth classes, are reimbursed at $21.80 per client. Meanwhile, as per the most recent contract, counseling sessions, which are separate from the classes, are reimbursed by the state at minimum rates of $1.09 per minute.
Jenny Hunsberger, vice president of Women’s Care Center, told Rewire that half of all pregnant women in Elkhart, LaPorte, Marshall, and St. Joseph Counties, and one in four pregnant women in Allen County, are clients of their centers. To receive any material goods, such as diapers, food, and clothing, she said, all clients must receive this counseling, at no cost to them. Such counseling is billed by the minute for reimbursement.
“When every other baby born [in those counties] starts with Women’s Care Center, that’s a lot of minutes,” Hunsberger told Rewire.
Rewire was unable to verify exactly what is said in those counseling sessions, except that they are meant to encourage clients to carry their pregnancies to term and to help them decide between adoption or child rearing, according to Hunsberger. As mandated by the contract, both counseling and classes must “provide abstinence education as the best and only method of avoiding unplanned pregnancies and sexually transmitted infections.”
In the first quarter of the new contract alone, Women’s Care Center billed Real Alternatives and, in turn, the state, $239,290.97; about $150,000 of that was for counseling, according to documents obtained by Rewire. In contrast, goods like food, diapers, and other essentials for new parents made up only about 18.5 percent of Women’s Care Center’s first-quarter reimbursements.
Despite the fact that the state is paying for counseling at Women’s Care Center, Rewire was unable to find any licensing for counselors affiliated with the centers. Hunsberger told Rewire that counseling assistants and counselors complete a minimum training of 200 hours overseen by a master’s level counselor, but the counselors and assistants do not all have social work or psychology degrees. Hunsberger wrote in an email to Rewire that “a typical Women’s Care Center is staffed with one or more highly skilled counselors, MSW or equivalent.”
Rewire followed up for more information regarding what “typical” or “equivalent” meant, but Hunsberger declined to answer. A search for licenses for the known counselors at Women’s Care Center’s Indiana locations turned up nothing. The Indiana State Department of Health told Rewire that it does not monitor or regulate the staff at Real Alternatives’ subcontractors, and both Women’s Care Center and Real Alternatives were uncooperative when asked for more information regarding their counseling staff and training.
Bethany Christian Services and Heartline Pregnancy Center, Real Alternatives’ other Indiana subcontractors, billed the program $380.41 and $404.39 respectively in the first quarter. They billed only for counseling sessions, and not goods or classes.
“We don’t provide medical services. We provide human services,” Bagatta told the City Paper.
There are pregnancy centers in Indiana that provide a full range of referrals for reproductive health care, including for STI testing and abortion. However, they are not eligible for reimbursement under the Real Alternatives contract because they do not maintain an anti-choice mission.
Parker Dockray is the executive director of Backline, an all-options pregnancy resource center. She told Rewire that Backline serves hundreds of Indiana residents each month, and is overwhelmed by demand for diapers and other goods, but it is ineligible for the funding because it will refer women to abortion providers if they choose not to carry a pregnancy to term.
“At a time when so many Hoosier families are struggling to make ends meet, it is irresponsible for the state to divert funds intended to support low-income women and children and give it to organizations that provide biased pregnancy counseling,” Dockray told Rewire. “We wish that Indiana would use this funding to truly support families by providing job training, child care, and other safety net services, rather than using it to promote an anti-abortion agenda.”
“Life Is Winning in Indiana”
Time and again, Bagatta and Hunsberger stressed to Rewire that their organizations do not employ deceitful tactics to get women in the door and to convince them not to have abortions. However, multiple studies have proven that crisis pregnancy centers often lie to women from the moment they search online for an abortion provider through the end of their appointments inside the center.
These studies have also shown that publicly funded crisis pregnancy centers dispense medically inaccurate information to clients. In addition to spreading lies like abortion causing infertility or breast cancer, they are known to give false hopes of miscarriages to people who are pregnant and don’t want to be. A 2015 report by NARAL Pro-Choice America found this practice to be ubiquitous in centers throughout the United States, and Rewire found that Women’s Care Center is no exception. The organization’s website says that as many as 40 percent of pregnancies end in natural miscarriage. While early pregnancy loss is common, it occurs in about 10 percent of known pregnancies, according to the American Congress of Obstetricians and Gynecologists.
Crisis pregnancy centers also tend to crop up next to abortion clinics with flashy, deceitful signs that lead many to mistakenly walk into the wrong building. Once inside, clients are encouraged not to have an abortion.
A Google search for “abortion” and “Indianapolis” turns up an ad for the Women’s Care Center as the first result. It reads: “Abortion – Indianapolis – Free Ultrasound before Abortion. Located on 86th and Georgetown. We’re Here to Help – Call Us Today: Abortion, Ultrasound, Locations, Pregnancy.”
Hunsberger denies any deceit on the part of Women’s Care Center.
“Clients who walk in the wrong door are informed that we are not the abortion clinic and that we do not provide abortions,” Hunsberger told Rewire. “Often a woman will choose to stay or return because we provide services that she feels will help her make the best decision for her, including free medical-grade pregnancy tests and ultrasounds which help determine viability and gestational age.”
Planned Parenthood of Indiana and Kentucky told Rewire that since Women’s Care Center opened on 86th and Georgetown in Indianapolis, many patients looking for its Georgetown Health Center have walked through the “wrong door.”
“We have had patients miss appointments because they went into their building and were kept there so long they missed their scheduled time,” Judi Morrison, vice president of marketing and education, told Rewire.
Sarah Bardol, director of Women’s Care Center’s Indianapolis clinic, told the Criterion Online Edition, a publication of the Archdiocese of Indianapolis, that the first day the center was open, a woman and her boyfriend did walk into the “wrong door” hoping to have an abortion.
“The staff of the new Women’s Care Center in Indianapolis, located just yards from the largest abortion provider in the state, hopes for many such ‘wrong-door’ incidents as they seek to help women choose life for their unborn babies,” reported the Criterion Online Edition.
If they submit to counseling, Hoosiers who walk into the “wrong door” and “choose life” can receive up to about $40 in goods over the course their pregnancy and the first year of that child’s life. Perhaps several years ago they may have been eligible for Temporary Assistance for Needy Families, but now with the work requirement, they may not qualify.
In a February 2016 interview with National Right to Life, one of the nation’s most prominent anti-choice groups, Gov. Pence said, “Life is winning in Indiana.” Though Pence was referring to the Real Alternatives contract, and the wave of anti-choice legislation sweeping through the state, it’s not clear what “life is winning” actually means. The state’s opioid epidemic claimed 1,172 lives in 2014, a statistically significant increase from the previous year, according to the Centers for Disease Control and Prevention. HIV infections have spread dramatically throughout the state, in part because of Pence’s unwillingness to support medically sound prevention practices. Indiana’s infant mortality rate is above the national average, and infant mortality among Black babies is even higher. And Pence has reduced access to prevention services such as those offered by Planned Parenthood through budget cuts and unnecessary regulations—while increasing spending on anti-choice crisis pregnancy centers.
Gov. Pence’s track record shows that these policies are no mistake. The medical and financial needs of his most vulnerable constituents have taken a backseat to religious ideology throughout his time in office. He has literally reallocated money for poor Hoosiers to fund anti-choice organizations. In his tenure as both a congressman and a governor, he’s proven that whether on a national or state level, he’s willing to put “pro-life” over quality-of-life for his constituents.
Words can and do hurt, especially when they cast people who seek or provide abortion care as immoral or murderers. But pro-choice activists can embrace unapologetic language that represents hope, self-determination, and bodily autonomy.
Recently, an anti-choice website profiled me, repeatedly describing me as “pro-abortion.” I understood immediately that this was meant to be an insult and a negative character judgment. But instead of taking offense or feeling bullied, I smiled—even as the vitriol poured into my Twitter mentions.
I haven’t always been able to smile at anti-choice trolls. They attack your ideology, personality, and even your family. It’s threatening and can feel very unsafe, and with good reason; just ask any clinic escort, pro-choice journalist, or abortion provider who has been targeted by anti-choice zealots or organizations. Online harassment and bullying is deliberate and meant to incite fear; it’s also a stepping stone to physical violence and intimidation.
The first time I was on the receiving end of such hatred, it made me sick to my stomach and I was tempted to abandon social media altogether. But removing my pro-choice voice from the conversation felt like handing trolls a victory. So with a few tweaks to my public profiles (like erasing my location and no longer posting photos of my children), I’ve decidedly moved beyond that fear and refuse to shrink in the face of online harassment (Twitter’s mute function certainly helps too).
These experiences taught me two very important lessons: first, about cowardice (it’s so easy to spew hatred from the anonymity of the internet) and second, about the importance of language. Most of us here in the United States have heardthe saying, “Sticks and stones may break my bones, but words will never hurt me.” While this is certainly true in the most literal of interpretations, we know words can hurt when they come in the form of threats against abortion providers or calling women who have abortions “murderers.”
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Indeed, the way we talk about abortion is critical, from how we describe our adversaries to legislative bill titles and abortion procedures themselves. When anti-choice lawmakers and activists wield language that is inflammatory, misleading, or demonizing, the public’s perceptions of abortion are compromised. The ensuing negativity, in turn, helps transform commonplace medical procedures into “morally repugnant offenses”—to use the language of ethics, which the anti-choice movement so often co-opts—that abortion opponents want to heavily restrict (at best) or outlaw (at worst).
The so-called pro-life constituency understands this all too well and has done a brilliant job of manipulating language to guide the national discourse on abortion. Even the “pro-life” moniker is a calculated—not to mention hypocritical—move. After all, if a person is not “pro-life,” they’re implicitly anti-family and anti-child. This automatically puts pro-choice activists and allies in a needlessly defensive position and posits anti-choice ideology as favorable.
Let’s be honest: These bills are not about protecting women’s health or safety. Their sole purpose is to demean women by prioritizing unviable fetuses over women’s very real health-care needs. And they’re successful in part due to their phrasing: The words “child,” “survivor,” and “protection” all evoke positive imagery, while simultaneously (and not so subtly) vilifying the person who no longer wishes to be pregnant.
To be fair, anti-choicers aren’t the only ones with a working knowledge of the power of language. The pro-choice community has made serious efforts in recent years to reclaim the word “abortion” and paint it as a positive (or at the very least, common) experience. Just look at 1 in 3 Campaign’s Abortion Speakout, the #ShoutYourAbortion social media campaign, and websites that curate positive abortion stories, and you’ll see a plethora of women embracing this shared reality. And it’s not just grassroots activists who have thrown down the proverbial gauntlet: Developers recently created a Google extension to change all “pro-life” mentions to “anti-choice.” Take that, anti-choice interwebs!
There have been efforts to move away from the terms “pro-choice” and “pro-life” altogether, because those simple labels don’t reflect a truly intersectional approach that goes beyond the traditional narrative around reproductive rights. I continue to identify as pro-choice because the term works for me. I believe it accurately expresses my support of the full spectrum of choice—parenting, pregnancy, adoption, and abortion—though I also understand and support activists’ rejection of the label.
As a pro-choice activist, I am heartened by these efforts and the ground gained. For so long, we’ve been on the defensive, from fighting stereotypes that pro-choicers can’t be parents to furiously trying to keep clinics open nationwide (and it doesn’t help that the mainstream media often fails to responsibly or fairly report on abortion). It’s been like trying to climb a steep hill covered in oil slicks.
But no longer. Thanks to the campaigns I’ve mentioned and others like them, pro-choicers everywhere—myself included—can more easily reclaim the power of language to shatter stigma surrounding abortion.
While I don’t pretend to have a new dictionary for those of us who work to support abortion rights, there are simple ways to leverage the words already in our lexicon to achieve success on this front. For starters, we can refuse to use the term “pro-life” in exchange for a more accurate description of the movement fighting to end access to a basic health service: “anti-choice.” We can also explicitly describe abortion as mainstream health care more consistently; doing so helps dispel the myth that abortion is rare, immoral, and a marginalized component of women’s health. And finally, we shouldn’t be afraid to embrace being called “pro-abortion.”
Why? Because “abortion” is by no means a dirty word—or thing, for that matter. I will happily embrace being called “pro-abortion.” Admittedly, the term is problematic when it’s used to suggest that all pregnancies should end in abortion or used to simplify reproductive justice and human rights issues. For me, pro-abortion means hope, self-determination, and bodily autonomy. And I’m most definitely in favor of all of those things.
I’d like to think the tables will turn in the very near future: that our courts nationwide will follow the Supreme Court’s lead and affirm the right to abortion without political interference, and that people will no longer be shamed for seeking abortion care. Until then, it’s paramount that each and every individual of the pro-choice community continues to demand progress. And what better way than with powerfully pro-choice and pro-abortion words? They’re the building blocks of our movement, after all.