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

Across the United States, billboards are visible evidence of the contentious abortion debate. Enlarged images of fetuses, cherubic babies, distressed women, and Bible verses tower over highways and byways like anti-abortion sentinels overseeing America’s culture wars.

Notice I didn’t mention images that show happy, pro-choice women, for it’s a lopsided roadside debate.

Rarely do we see billboards promoting abortion rights or the broader ideals of reproductive justice; there are few examples like New Voices Cleveland’s recent sponsorship of these billboards that affirmed, in the wake of the police killing of 12-year-old Tamir Rice in the city, that reproductive justice includes the right to parent and protect children. Abortion opponents have effectively cornered the market on this advertising medium and, to paraphrase a hackneyed phrase from “American Idol” judges, have made the billboard their own.

But the good news: The billboard is just a tool (like video is a tool)—and tools can be harnessed for any movement. In fact, past abortion-rights advocates used billboards to good effect—even before Roe v. Wade. Ideological warfare about abortion via advertising has a long track record, though it’s a past largely forgotten in history’s fog and the present’s relentless attacks on abortion rights. Today’s reproductive rights and justice advocates can’t afford to forget that past. They may need to “go back to the future” to resurrect this tool in an era where women face increasing restrictions on abortion, and providers face proposed laws that would curtail their ability to offer reproductive health care to women most in need.

So what is it that advocates need to remember or learn? For starters, many early billboards functioned as straightforward advertising for abortion—even when it wasn’t widely legal. This roadside sign popped up in McGrann, Pennsylvania, in 1971 and pointed people to neighboring New York state, which had legalized abortion in 1970.

Similar billboards featuring phone numbers began sprouting like giant flowers on the American landscape. As this picture demonstrates, referral services—some nonprofit and some that operated as for-profit entities—also took to streetsides before Roe to tell women that they could find health care in the form of abortion and sterilization.

Distributing information about abortion through billboards or other advertisements was not without risk; those who did so could face arrest. In 1972, Charlottesville, Virginia, newspaper editor Jeffrey Bigelow was charged with running advertisements for a New-York based abortion referral service and convicted under a state law banning any public promotion of abortion services. The case eventually made its way to the U.S. Supreme Court, but took a back seat to the bigger challenges to abortion bans: the cases that would become Roe and Georgia’s Doe v. Bolton. Bigelow v. Virginia was eventually decided in 1975; Bigelow’s conviction was overturned because there could be no limits on the advertising of a service that had become legal.

At the same time, the young anti-abortion movement was also rolling out its own billboards, said historian Jennifer Donnally, a Hollins University visiting professor who researches abortion politics and the new right. From the early days when anti-abortion advocates were organizing against state-level abortion law reform, they have made billboards a key part of their messaging.

“Anti-abortion billboards began to appear on highways in New York, Massachusetts, Michigan, and Washington [state] prior to the 1973 Roe v. Wade decision as part of statewide campaigns against abortion repeal efforts,” Donnally told Rewire.

Many of those billboards were tied to specific ballot measures or potential law changes. In 1970, when Washington state planned a referendum where voters could decide to allow abortion in some circumstances, opponents (and their billboards) came out in full force. “Kill Referendum 20, not me,” implored a billboard picturing a fake fetus cradled in an adult hand. Accused of using tasteless scare tactics, Voice of the Unborn (the group behind the billboards) replied through a representative, reported the New York Times in October of that year: “They show an exact medical school replica of a 4-month-old baby. If the billboards seem to be shocking, perhaps it’s the idea of abortion that’s shocking.” (The referendum passed with 56 percent of the vote, and allowed women and girls to have abortions if they requested them, with the consent of their husbands or guardians, and if the procedure was performed by a licensed physician.)

Donnally noted that anti-abortion billboards have taken different forms and served many purposes over time. They moved from makeshift messages in cornfields to slick public-relations creations, and they mobilized supporters in different ways according to the movement’s age and successes.

“The publicity billboards educated the public and recruited potential activists. Behind the scenes, efforts to place billboards trained anti-abortion activists in fundraising and media relations while also [making] activists feel effective when the movement was in its early stages, following setbacks or celebrating victories. Sometimes, billboard campaigns were sophisticated. Other times, a farmer in a rural area who had a hard time connecting to anti-abortion chapters concentrated in cities and towns took action into his or her own hands,” added Donnally. “They made a plywood anti-abortion sign and posted it on their land next to a heavily traveled highway.”

After the Bigelow ruling, anti-abortion advertising gained steam in the mid-1970s. A February 1976 Village Voice article called John C. Willke, then a practicing obstetrician and a future president of the National Right to Life Committee, the “visual aids guru of the pro-life movement.” Willke’s first visual aids were often slideshows that Willke and his wife presented in talks to high schoolers.

But, according to the article, Willke’s “newest project [was] the creation of the three billboard posters. The least offensive reads ‘Abortion: A woman’s right to choose.’” “Choose” was crossed out and replaced with “kill.” A second billboard depicted tiny feet and this text: “This baby won’t keep his mother awake at night … at least not yet.” Willke planned to erect a fetus billboard atop a building across from a Minnesota hospital that provided abortions, the article added.

Willke’s focus on the fetus and abortion’s supposedly negative and life-changing effects on the woman—now cornerstones of anti-abortion rhetoric—was an experimental and emergent strategy then. Emphasizing abortion as an emotional harm and women as its simultaneous victims and perpetrators, right-to-life groups were often explicit when telling their members how to best deploy billboards. An undated newsletter from the Jackson, Mississippi-based Christian Action Group provided hand-drawn illustrations of possible billboards, one showing “baby’s first visit to the doctor,” a menacing-looking physician holding a black sack and a frazzled woman hovering in the background. Also included was a sample billboard that showed a hand wielding a scalpel, labeled “a pro-choice pacifier.”

The illustrations came with this advice on using billboards to the best advantage: “One form of ‘advocacy advertising,’ such as political advertising, is to convince people of the justification of your point of view. Another is to make people ashamed to be with your [opponents]. These billboards are the latter.” Cultivating and multiplying shame was a tactic. As abortion opponents’ philosophy went, Americans—even the most well-intentioned or those ignorant of the “real” story about abortion—needed to be confronted visually with their silent complicity.

When Roe came under significant legal challenge in the 1980s, billboards became even more overtly political. In 1988, the year before the U.S. Supreme Court decision Webster v. Reproductive Health Services that allowed states to restrict abortion, a Planned Parenthood billboard showed six male (and mostly anti-abortion) Supreme Court justices holding their own sign saying “Freedom of Choice,” but with Chief Justice William Rehnquist slamming his gavel on the word “of” and Justices Harry Blackmun and Clarence Thomas holding a replacement sign with the word “from.” Also in 1988, anti-abortion activists experimented with a new form of advertising by placing anti-abortion placards in Atlanta taxis during the Democratic National Convention there.

A year later, in 1989, Prolife Across America was up and running. It works as an anti-abortion billboard mill, cranking out design after design (as well as radio spots and other advertising).

Therein lies the difference: Billboards have been institutionalized in anti-abortion media strategy and organizations, but they seemed to fade from the strategic agendas of reproductive rights organizations. In 2014, the Prolife Across America/Prolife Minnesota tax return reported that its designs were emblazoned on more than 6,000 billboards, reaching Americans stuck in traffic or driving to work every day with its larger-than-life messages. The group often says those messages are hotlines for pregnant women, educational, and roadside ministry all wrapped into one. Other organizations provide templates or the actual printed vinyl panels that bear the messages and drape over the standard billboard frames for prices as cheap as $200 (not including the cost of billboard rental, which varies widely according to geography, company, and the estimated number of motorists and views at given locations).

As the billboard has become a consistent anti-abortion platform, the messages billboards have carried read like a conversation between abortion opponents and other social movements. Billboard makers have blatantly adapted the slogans of feminism and civil rights and even the images of Black political leaders such as Frederick Douglass or Barack Obama—and with varying degrees of deftness or tone-deafness.

By the 1990s, billboards in the Midwest had reworked a common feminist bumper sticker to read “Pro-life: The radical idea that fetuses are people.” Later, billboards took an explicitly racial turn. In 2011, billboards proclaiming “Black & Beautiful” alongside pictures of Black infants appeared in Oakland, California. Sponsored by the anti-abortion group Issues4Life, the billboards appropriated the language of the Black Panther movement, which had its most well-known and vocal chapter in the Bay Area city.

Images and messages on billboards that explicitly targeted Black communities—and paved the way for others aimed at Latinos and Asians—were not entirely new. As scholar Gillian Frank has pointed out, a 1972 Michigan referendum about changing that state’s abortion law pushed anti-abortion groups to begin developing brochures that pictured Black babies and compared abortion to slavery, now old-hat anti-abortion fare.

More than 20 years later, diverse groups protested the encroachment of racist billboards in their home communities. In Oakland in 2011, Strong Families and a coalition of multiracial groups joined forces to persuade CBS Outdoor to take down controversial signage—a campaign similar to one used a year before by the Atlanta-based SisterSong Women of Color Reproductive Justice Collective when billboards also owned by CBS and claiming that “black children are an endangered species” appeared in the Georgia capital. Earlier this year, the reproductive justice group SisterReach successfully pushed for the removal of anti-abortion billboards in Tennessee.

Yet the hand that giveth does taketh away. Contemporary groups fighting for abortion access find that many billboard and other advertising companies reserve the right to deny or take down controversial content. And those contractual stipulations mean that some companies will reject outright advertising that specifically references abortion or simply points women to services—for fear that the other side will cause a ruckus and demand its removal. Fears of the “A-word” have made it into the online world, with Google determining that abortion ads were “non-family-safe” content and categorizing them with adult advertising and entertainment.

Whatever the advertising format, it’s clear that this type of commercial and political speech isn’t going away. And few people know that better than Jasmine Burnett, New Voices Cleveland’s field organizer in the Midwest. In 2010, she led the campaign to take down a SoHo, New York, billboard that proclaimed the most dangerous place for a Black person was the womb, and this year, Burnett was a driving force behind the Cleveland billboard.

Burnett said that it’s not enough to mount defensive campaigns that respond to the propagandistic billboards that increasingly dot urban and mostly Black neighborhoods. What’s necessary is billboard activism that moves beyond reproductive rights’ preoccupation with abortion and, in keeping with a reproductive justice lens, addresses the racism that’s an American bedrock.

“Anti-abortion billboards are an affront and an attack. [In doing the billboards, New Voices Cleveland] wanted to provide other spaces for creative thought, affirmation, and liberation,” said Burnett. “We work for the full health and well-being of Black women and people. For us, full health means having a different image of ourselves, being able to control and discuss our reproduction, and thinking about how we navigate self-determination in the midst of white supremacy.

“There are not many [billboards or other advertising] that talk about Black people’s lives,” Burnett added. “And we wanted our billboards to say, ‘We support your decision and right to parent or not parent. And we care about your life.’”

Employees and scientists with ties to the University of Washington’s Birth Defects Research Laboratory have won a temporary reprieve in federal court barring the release of their personal information to anti-choice activist David Daleiden and his cohorts.

Federal judge James L. Robart granted the restraining order on Wednesday, after the plaintiffs filed a class action lawsuit to block the release of a trove of documents requested by Daleiden and a representative from a Washington state anti-choice group. The unredacted records reveal the individuals’ identifying information, such as names, addresses, and phone numbers, according to court documents.

A hearing on a permanent order is expected later this month in U.S. District Court for the Western District of Washington.

Using the Washington state Public Records Act, Daleiden and Zach Freeman, communications director with the anti-choice Family Policy Institute of Washington, had sought records dating back to 2010 related to work at the Birth Defects Research Laboratory. The research laboratory collects, processes, and distributes fetal tissue for research at academic and nonprofit institutions nationwide, according to court documents. Also ensnared in the sweeping document request were various medical and bioscience institutions, including Seattle Children’s Hospital and Planned Parenthood affiliates.

Daleiden had requested purchase orders, invoices, emails, grant applications, contracts, materials transfer agreements, rent/lease agreements, and other documents, according to an exhibit in court documents.

Janet Chung, counsel with Seattle-based Legal Voice, who is representing the plaintiffs, said her clients wanted to stop the release of the unredacted records.

Daleiden, a self-proclaimed investigative journalist and head of the California-based anti-choice group Center for Medical Progress, was formerly indicted for his role in a string of discredited “sting” videos falsely accusing Planned Parenthood of profiting from fetal tissue donations.

Reached by phone on Friday, Chung explained that the plaintiffs, who remain anonymous in the complaint, “are very fearful that they may be subjected to the same type of harassment and violence” that abortion clinic employees have faced, particularly after the publication of the CMP videos. Releasing the unredacted records would violate the plaintiffs’ constitutional right to privacy and free association, according to the complaint.

Chung called Daleiden and Freeman’s records request a “fishing expedition” intended to “harass and intimidate.”

In an emailed statement, Daleiden said he is seeking the “truth” about a “cover-up” at the University of Washington.

When Rewire asked Daleiden whether he objected to redacting identifying information, such as names and addresses, he said in an email that his records request in February did not ask for the “personal contact information of any individuals whatsoever.”

As he explained to Rewire, however, he is seeking the communications of eight individuals whom he considers public figures:

My request only seeks those of 8 public figures…who are very publicly identified with their work at [Birth Defects Research Laboratory] with fetal body parts or with Planned Parenthood’s abortion program in Washington state.

The eight “public figures” that Daleiden names include a retired birth defects researcher, a research director at Seattle Children’s Hospital, and a top executive at Planned Parenthood.

Chung, however, told Rewire that Daleiden’s request was so broad that releasing the records would disclose the personal information of more than 150 individuals.

Chung said the plaintiffs resorted to court action because the state public records law doesn’t necessarily require the redaction of personal information, and the University of Washington had warned that it would release the records on August 5.

About two weeks before filing the complaint, Chung said they’d discussed redacting the documents with Daleiden, but he declined. She said they’re continuing to try to resolve the matter with Daleiden’s legal counsel.

In affidavits included with the complaint, plaintiffs claim they’ve been threatened, harassed, and exposed to violence —even murder—due to their ties to fetal tissue research.

As an employee at Seattle Children’s Hospital, identified only as John Doe 1 to protect his privacy and safety, writes:

In one case, Seattle Children’s diagnosed a fetus with a lethal disorder, and because of number of weeks of gestation, the patient had to travel out of state to obtain an abortion. I had interactions with the physician who performed the abortion relating to the autopsy that Children’s Labs performed on the fetus. That physician was later killed by someone with anti-abortion views.

Protecting the privacy and safety of researchers and employees with ties to fetal tissue science has emerged as an issue of growing concern among scientists as anti-choice groups and Republican lawmakers march on with what some have called a Planned Parenthood “witch hunt.”

In June, the head of the U.S. House Select Investigative Panel on Infant Lives revealed fetal tissue scientists’ identities in letters sent to U.S. Department of Health and Human Services—prompting fears in the medical research community the individuals will be subject to harassment and violence by anti-abortion activists.

As Chung told Rewire, “This is all very much rooted in the concern that the same types of harassment and violence that clinics experience are now being targeted on a wider range of people—all with the goal of chilling important research and medical care.”

The lawsuit is the fourth filed against Daleiden and his anti-choice group following the release of the first wave of CMP’s sting videos last summer. Planned Parenthood Federation of America, the National Abortion Federation (NAF), and StemExpress, a fetal tissue processing firm that once worked with Planned Parenthood, have all sued in federal court in California.

Daleiden often frames his work as citizen journalism, but in a brief filed with the NAF lawsuit, 18 of the country’s leading journalists and journalism scholars noted that “calling himself an ‘investigative journalist’ … does not make it so.”

In April, California Attorney General Kamala Harris’ office searched Daleiden’s California apartment as part of an ongoing investigation into the CMP’s secret recording methods.

Officials in a dozen states, including Washington state, have cleared Planned Parenthood of any wrongdoing in its tissue donation programs, and eight additional states have declined to investigate the health-care provider.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Sex Is Not Just for the Young

The New York Times recently profiled a nursing home with a sex-positive attitude for its residents. The Hebrew Home at Riverdale adopted its “sexual expression policy” in 1995 after a nurse walked in on two residents having sex. She asked her boss, Daniel Reingold, what she should do. He said, “Tiptoe out and close the door.”

Reingold, the president of RiverSpring Health (which runs the nursing home), said that aging includes a lot of loss—from the loss of spouses and friends to the loss of independence and mobility. But he believes the loss of physical touch and intimacy does not have to be part of getting older.

The policy acknowledges that residents have the right to seek out and engage in consensual acts of sexual expression with other residents or with visitors. The policy ensures that staff understand that their role is not to prevent sexual contact. In fact, some of the staff like to play cupid for residents. Audrey Davison, an 85-year-old resident, said that the staff let her sleep in her boyfriend’s room, and one aide even made them a “Do Not Disturb” sign for his door. She added: “I enjoyed it and he was a very good lover.”

Still, there are complicating factors to dating in nursing homes or assisted-living facilities. Some residents may be married to people who don’t live in the facility, and others may be suffering from memory loss, dementia, or Alzheimer’s, which can raise issues of consent. Hebrew Home’s policy states that Alzheimer’s patients can give consent under certain circumstances.

Though not all nursing homes have formal policies about sex, many acknowledge that their residents are or want to be sexually active and are working to help residents have a safe and consensual experience. Dr. Cheryl Phillips, a senior vice president at LeadingAge, an organization which represents nursing homes and others who provide elder care, also told the New York Times that this generation of older adults is different: “They’ve been having sex—that’s part of who they are—and just because they’re moving into a nursing home doesn’t mean they’re going to stop having sex.”

Of course, not all residents are lucky in love when they move in. Hebrew Home says that about 40 of its 870 residents are in relationships. Staff are trying to help the others. They set up happy hours, a prom, and have started a dating service called G-Date (for “Grandparent Date”). So far it hasn’t been too successful in making matches, but the staff is convinced that someday their efforts will pay off with a wedding.

Can Emojis Connect Youth to Sexual Health Services?

New York City’s public hospital system, known as Health & Hospitals, provides confidential sexual health services—including pregnancy tests, contraception, and tests for sexually transmitted diseases (STDs)—for young people 12 and older regardless of their ability to pay, immigration status, or sexual orientation. Health & Hospitals served 152,000 patients last year, but its leaders think it could do even more if more young people were aware of the services offered.

As a way to speak the language of young people, Health & Hospitals launched a campaign starring emojis in July.

The emojis are expected to reach 2.4 million young people in New York City through social media including Facebook and Instagram. The emojis include an eggplant, a monkey covering his eyes, and, of course, some birds and bees. The online ads read, “Need someone to talk to about ‘it’?”

When young people click on the emojis, they will be taken to the Health & Hospitals youth website, which explains available services and how to find accessible providers.

Dr. Ram Raju, president and CEO of NYC Health & Hospitals, said in a press release that the organization provides nonjudgmental services to youth: “Whether it’s birth control, pregnancy testing, emergency contraception or depression screening, the public health system has affordable services in local community health centers, where we speak your language, understand your culture and respect your privacy.”

But some worry that these emojis are confusing. Elizabeth Schroeder, a sex educator and trainer, told the New York Times that while she applauded the effort, she questioned if the images chosen were the best to convey the message.

We here at This Week in Sex have to agree and admit the images confuse us as well. The monkey is cute, but what does it have to do with STDs?

Choosing Between Appetites, Many Pick Food

Good food or good sex? These two sources of pleasure are rarely at odds with each other, but if they ever are, which would you choose?

A new survey, by advertising agency Havas Worldwide, posed this very question to almost 12,000 adults in 37 countries across the globe. The results show that about half of adults (46 percent of men and 51 percent of women) believe that food can be as pleasurable as sex. And one-third would choose a great dinner at a restaurant rather than sex; women were more likely to make this choice (42 percent compared with 26 percent of men).

Millennials were also more likely to make this choice than those slightly older Gen-Xers (35 percent to 30 percent). Of course, it’s hard to tell whether this says more about their sex lives or their eating habits.