California’s anti-abortion pregnancy centers want the Supreme Court to overturn state notice law

http://www.latimes.com/local/lanow/la-me-ln-pregnancy-court-20180318-story.html

California's anti-abortion pregnancy centers want the Supreme Court to overturn state notice law

At a faith-based pregnancy center here, rooms are crammed with baby supplies, both new and used, for expectant mothers, and a medical office contains equipment to allow pregnant women to view their fetuses.

“Life is not about waiting for the storm to pass,” reads a saying on a wall, “but learning to dance in the rain.”

The Alpha Pregnancy Center, located in a storefront on a busy street in the Mission District, is one of about 200 centers in California and thousands across the country pushing the U.S. Supreme Court to spare them from government regulation.

The California centers are challenging a state law that requires them to inform clients that contraception, prenatal care and abortion may be obtained free or at low cost from the state, along with a state phone number for information about Medi-Cal. The law also requires clinics to disclose if they are not licensed.

The case, which will be argued on Tuesday, pits the free speech rights of the anti-abortion centers against government consumer regulations. The decision is likely to affect abortion laws in other states.

The U.S. 9th Circuit Court of Appeals upheld California’s law, but similar requirements passed by cities and counties elsewhere in the nation have fared poorly in the courts.

Mark L. Rienzi, a religious liberties lawyer who represents pregnancy clinics, frames the debate as a question of whether the government can force anti-abortion activists to give clients phone numbers of abortion providers.

“Can the government make you say something you don’t want to say?” Rienzi asked. “They are pro-lifers. They exist to tell people you shouldn’t get an abortion.”

Rienzi said 11 states and local governments have passed laws to regulate what the pregnancy centers must tell clients — rules he argues amount to discrimination against abortion opponents.

Other analysts view California’s law as mere consumer protection. It was passed in response to reports that the centers were luring pregnant women without clearly identifying themselves as anti-abortion.

“The law is so clearly constitutional,” said UC Berkeley Law School Dean Erwin Chemerinsky. “It is one thing to compel somebody to speak. It is another thing to say you have to post on your wall information that is completely accurate.”

Rienzi, though, said California has plenty of resources to let low-income women know that they may be eligible for government-assisted contraception and abortion.

“I don’t think the government gets to turn private speakers into government billboards,” he said.

At the Alpha Pregnancy Center, nothing on the outside of the storefront indicates the group opposes abortion, but it states on its website that it does not provide abortion referrals.

The government-required notice is posted not on a wall, but is included near the end of three pages of a handout that deals primarily with privacy rights. Clients are required to sign that they have been given the form.

During a recent visit, only the executive director and a receptionist were working. A woman walked out pushing a baby carriage.

Most of the center’s clients are unmarried and about 80% decide to give birth, said the executive director, who declined to give her name. The center tries to help the women financially with donated goods and offers classes in money management, life skills, time management, child behavior and potty training, she said.

Brochures in the center are designed to steer women away from abortion.

One contains information on fetal development. At eight weeks, “the elbows and fingers can be seen,” it reads. There are photographs of fetuses at various stages.

Another pamphlet describes all that could go wrong with an abortion and links the procedure to breast cancer, mental illness and relationship problems, claims that those on the other side of the debate say are either false or misleading.

Elizabeth Nash, a policy analyst for the Guttmacher Institute, a research organization that favors abortions rights, said some pregnancy centers use deception to lure pregnant women who may be seeking abortions, while others are straightforward and even help women obtain government-funded healthcare.

The Supreme Court’s decision to review California’s 2015 law delighted crisis pregnancy centers, but it doesn’t mean they will win the case. Votes of only four of the nine justices are needed to take a case, and the court does not disclose those votes.

Justice Anthony M. Kennedy, often a swing vote, is likely to be the decisive vote in the case, National Institute of Family and Life Advocates v. Becerra, analysts said.

“It’s really hard to know what the Supreme Court is going to do here, ” said Stanford University Law School professor Pamela S. Karlan. “They have two competing impulses.

“On one hand the Supreme Court is extraordinarily receptive to a wide variety of 1st Amendment claims. On the other hand, this is a consumer protection statute, and the Supreme Court has at least so far not shown much interest in telling government they can’t regulate the information” that must be given to medical patients, Karlan said.

Some legal analysts said a ruling against California could hurt the anti-abortion movement by imperiling dozens of state laws that require providers to counsel patients that abortion may harm them.

The Supreme Court’s 1992 decision in Planned Parenthood v. Casey said that “counseling requirements are OK in the sense that the state is allowed to prefer childbirth over abortion,” Nash said.

Of 29 states with abortion counseling requirements, 20 require providers to give patients “misleading or inaccurate information” on such topics as fetal pain, fetal personhood, and links between abortion and breast cancer, future fertility and mental illness, she said.

The National Academy of Sciences released a major study Friday that found abortion was safe and debunked claims it increased the risk of infertility, breast cancer and mental illness.

Many of the state laws that require providers to make such claims have not been challenged because of the high costs of litigation, Nash said. But if the Supreme Court rules that California’s law violates free speech, these laws might become stronger targets, she and other analysts said.

“If the state can’t require that pregnant women be able to read a sign that gives them accurate information,” Chemerinsky said, “it seems an even stronger argument that healthcare professionals cannot be forced to utter falsehoods.”

 

Undocumented 17-Year-Old Must Delay Abortion, Court Rules

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An undocumented 17-year-old caught in a legal standoff with the federal government must further delay plans for an abortion after an appeals court ruled on Friday that the Department of Health and Human Services had 11 days to find a sponsor to take custody of the teenager.

The decision by the United States Court of Appeals for the District of Columbia Circuit could put her health at risk, doctors say, especially now that she is about 15 weeks pregnant.

“While first-trimester abortion is over 10 times safer than childbirth, the risks gradually increase in the second trimester to those of childbirth,” Dr. Nancy L. Stanwood, the chief of family planning at the Yale School of Medicine, said in an email. Forcing her to wait, she added, “harms her physical health, period.”

Further complicating matters, the teenager only has about a month to get an abortion in Texas, where she is being held. The state has banned abortion after 20 weeks of pregnancy unless there is a medical emergency.

The teenager, referred to as Jane Doe in court documents, found out she was pregnant last month after she was apprehended while entering the United States without her parents.

She decided to end her pregnancy, but Texas law requires a minor to get parental consent or a judicial waiver to do so. She obtained a waiver, but the government prevented her from going to any abortion-related appointments, the American Civil Liberties Union said in court documents, and forced her to visit a religiously affiliated crisis pregnancy center where she was asked to view a sonogram.

An undocumented 17-year-old being held by the federal government is seeking an abortion.

President Trump has worked to restrict abortions since his first days in office by expanding the so-called global gag rule, which withholds American funding from international organizations that discuss or perform abortions; taking aim at Planned Parenthood funding; and appointing several leaders who are anti-abortion, including E. Scott Lloyd, the director of the Office of Refugee Resettlement at the health department, and one of the defendants in the Jane Doe case.

The federal government said that it was not its role to facilitate abortion, and that the teenager still had the option of returning to her home country.

“Ms. Doe has options for leaving federal custody — either by requesting a voluntary departure to her home country (which the federal government is willing to expedite if requested) or by being placed in the custody of a sponsor,” the defendants stated in a memorandum on Tuesday. “Given these options, the government is not causing Ms. Doe to carry a pregnancy to term against her will.”

On Wednesday, a federal judge ordered the government to allow the teenager to get an abortion.

Tanya S. Chutkan, the United States District Court judge who initiated the temporary restraining order, said she was “astounded” by the government’s position.

“She can leave the country or she cannot get her abortion, those are her options?”

The government next argued for the right to appoint the teenager with a sponsor, which would release her from government custody, and said in court documents that the process of securing a sponsor would not unduly burden the teenager’s right to an abortion.

On Friday, the appeals court agreed.

The health department has until Oct. 31 to find a suitable sponsor; if it does, Jane Doe would be able to have an abortion. If she is not released to a sponsor by then, the government has the option of appealing once more.

The 11-day timeline to find a sponsor “seems far-fetched,” said Brigitte Amiri, one of the A.C.L.U. lawyers representing the teenager.

Sponsors are typically family members, according to the health department’s website, who help care for a child who has entered the United States illegally without their parents — often because the child is fleeing an abusive or violent situation.

The vetting process, which includes a background check, can take months, Ms. Amiri said, and earlier attempts to find a sponsor for Jane Doe were unsuccessful.

“They kicked the can down the road, and in this case they kicked the woman down the road,” Dr. Stanwood said. “They are just delaying her care to no end but their own ideology.”

A spokesman for the Administration of Children and Families, which is part of the health department, said in a statement that the care of minors like Jane Doe was important.

“For however much time we are given, the Office of Refugee Resettlement and H.H.S. will protect the well-being of this minor and all children and their babies in our facilities, and we will defend human dignity for all in our care,” the statement said.

The teenager will be 16 weeks and five days pregnant at the end of October, according to the nonprofit legal organization Jane’s Due Process, which has been working with the A.C.L.U. If the appeals process continues into November, the teenager will reach the 20-week mark, which would prevent her from having an elective abortion in Texas.

The sooner the teenager can have the abortion, “the safer it will be for her,” said Dr. Hal C. Lawrence, the executive vice president of the American Congress of Obstetricians and Gynecologists, who practiced obstetrics for nearly three decades.

As the uterus gets bigger, he added, the walls of the uterus get thinner, which increases the possibility of perforation and puts women at risk of additional blood loss during an abortion.

Health risks aside, delaying an abortion can cause emotional trauma.

“Women don’t just wake up one morning and decide they’re going to have an abortion,” Dr. Lawrence said. “And so to make her continue to struggle and be denied access to something which is legal — all that does is increase the psychological stress for her, and that’s not healthy.”

The United States has one of the highest rates of maternal mortality in the developed world, and abortion has been shown to be safer for women than childbirth.

The A.C.L.U. is considering several options, including further appeals.

For the teenager, the process has been exhausting, Ms. Amiri said.

“She talks about feeling very tired.”

 

Often Missing From The Current Health Care Debate: Women’s Voices

http://www.npr.org/sections/health-shots/2017/08/16/543723927/often-missing-from-the-current-health-care-debate-womens-voices?utm_campaign=KFF%3A%20The%20Latest&utm_source=hs_email&utm_medium=email&utm_content=55441015&_hsenc=p2ANqtz-9nhXUhC_zqpJNwIaw0vOuF3PfAn3PBrmE3HVyeYM_l7-5vAx-FPWjwuS3F0Ac1H67HXbfu9Hfyvmuf37WeEGpqXqf-Sw&_hsmi=55441015

Women have a lot at stake in the fight over the future of health care.

Not only do many depend on insurance coverage for maternity care and contraception, they are struck more often by autoimmune conditions, osteoporosis, breast cancer and depression. They are more likely to be poor and depend on Medicaid, and to live longer and depend on Medicare. And it commonly falls to them to plan health care and coverage for the whole family.

Yet in recent months, as leaders in Washington discussed the future of American health care, women were not always invited. To hammer out the Senate’s initial version of a bill to replace Obamacare, Majority Leader Mitch McConnell appointed 12 colleagues, all male, to closed-door sessions – a fact that was not lost on female Senators. Some members of Congress say they don’t see issues like childbirth as a male concern. Why, two GOP representatives wondered aloud during the House debate this spring, should men pay for maternity or prenatal coverage?

As the debate over health care continues, one of the challenges in addressing women’s health concerns is that they have different priorities, depending on their stage in life. A 20-year-old may care more about how to get free contraception, while a 30-year-old may be more concerned about maternity coverage. Women in their 50s might be worried about access to mammograms, and those in their 60s may fear not being able to afford insurance before Medicare kicks in at 65.

To get a richer sense of women’s varied viewpoints on health care, we asked several women around the country of different ages, backgrounds, and political views to share their thoughts and personal experiences.

Patricia Loftman, 68, New York City

Loftman spent 30 years as a certified nurse-midwife at Harlem Hospital Center and remembers treating women coming in after having botched abortions.

Some didn’t survive.

“It was a really bad time,” Loftman says. “Women should not have to die just because they don’t want to have a child.”

When the Supreme Court ruled that women had a constitutional right to an abortion in 1973, Loftman remembers feeling relieved. Now she’s angry and scared about the prospect of stricter controls. “Those of us who lived through it just cannot imagine going back,” she says.

A mother and grandmother, Loftman also recalls clearly when the birth control pill became legal in the 1960s. She was in nursing school in upstate New York and glad to have another, more convenient option for contraception. Already, women were gaining more independence, and the Pill “just added to that sense of increased freedom and choice.”

To her, conservatives’ attack on Planned Parenthood, which has already closed many clinics in several states, is frustrating because the organization also provides primary and reproductive health care to many poor women who wouldn’t be able to get it otherwise.

Now retired, Loftman sits on the board of the American College of Nurse-Midwivesand advocates for better care for minority women. “There continues to be a dramatic racial and ethnic disparity in the outcome of pregnancy and health for African-American women and women of color,” she says.

Terrisa Bukovinac, 36, San Francisco

Bukovinac calls herself a passionate pro-lifer. As president of Pro-Life Future of San Francisco, she participates in marches and protests to demonstrate her opposition to abortion.

“Our preliminary goal is defunding Planned Parenthood,” she says. “That is crucial to our mission.”

As much as the organization touts itself as being a place where people get primary care and contraception, “abortion is their primary business model,” Bukovinac says.

She said the vast majority of abortions are not justifiable and that she supports a woman’s right to an abortion only in cases that threaten her life. “We are opposed to what we consider elective abortions,” she says.

Bukovinac says she also tries to help women in crisis get financial assistance so they don’t end their pregnancies just because they can’t afford to have a baby. She supports women’s access to health insurance and health care, both of which are costly for many. “Certainly, the more people who are covered, the better it is” for both the mother and baby.

Bukovinac herself is uninsured because she says the premiums cost more than she would typically pay for care. Self-employed, Bukovinac has a disorder that causes vertigo and ringing in the ear and spends about $300 per month on medication for that and for anxiety.

She doesn’t know if the Affordable Care Act is to blame, but she said that before the law “I was able to afford health insurance and now I’m not.”

Irma Castaneda, 49, Huntington Beach, Calif.

Castaneda is a breast cancer survivor. She’s been in remission for several years but still sees her oncologist annually and undergoes mammograms, ultrasounds, and blood tests.

The married mom of three, a teacher’s aide to special education students, is worried that Republicans may make insurance more expensive for people like her with pre-existing conditions. “They could make our premiums go sky high,” she says.

Her family previously purchased a plan on Covered California, the state’s Obamacare exchange. But there was a high deductible, so she had to come up with a lot out-of-pocket money before insurance kicked in. “I was paying medical bills up the yin yang,” she says. “I felt like I was paying so much for this crappy plan.”

Then, about a year ago, Castaneda’s husband got injured at work and the family’s income dropped by half. Now they rely on Medicaid. At least now they have fewer out-of-pocket expenses for health care.

Whatever the coverage, Castaneda says, she needs high-quality health care. “God forbid I get sick again,” she says. And she worries about her daughter, who is transgender and receives specialized physical and mental health care.

“Right now she is pretty lucky because there is coverage for her,” Castaneda says. “With the Trump stuff, what’s going to happen then?”

Celene Wong, 39, Boston

The choice was agonizing for Wong. A few months into her pregnancy, she and her husband learned that her fetus had chromosomal abnormalities. The baby would have had severe special needs, she said.

“We always said we couldn’t handle that,” Wong recalls. “We had to make a tough decision, and it is not a decision that most people ever have to face.”

The couple terminated the pregnancy in January 2016, when she was about 18 weeks pregnant. “At the end of the day, everybody is going to go away except for your husband and you and this little baby,” she says. “We did our research. We knew what we would’ve been getting into.”

Wong, who works to improve the experience for patients at a local hospital, says she is fortunate to have been able to make the choice that was right for her family.

“If the [abortion] law changes, what is going to happen with that next generation?” she wonders.

Lorin Ditzler, 33, Des Moines, Iowa

Ditzler is frustrated that her insurance coverage may be a deciding factor in her family planning. She quit her job last year to take care of her 2-year-old son and was able to get on her husband’s plan, which doesn’t cover maternity care.

“To me it seems very obvious that our system isn’t set up in a way to support giving birth and raising very small children,” she says.

While maternity benefits are required under the Affordable Care Act, her husband’s plan is grandfathered under the old rules, which is not uncommon among employers that offer coverage. Skirting maternity coverage might become more common if Republicans in Congress pass legislation allowing states to drop maternity coverage an “essential benefit.”

Ditzler looked into switching to an Obamacare plan that they could buy through the exchange, but the rates were much higher than what she pays now.

If she goes back to work, she could get on a better insurance plan that covers maternity care. But that makes little sense to her. “I would go back to a full-time job so I could have a second child, but if I do that, it will be less appealing and less feasible to have a second child because I’d be working full time.”

Ashley Bennett, 34, Spartanburg, S.C.

Bennett describes herself as devoutly Christian. She is grateful that she was able to plan her family the way she wanted, with the help of birth control. She had her daughter at 22 and her son two years later.

“I felt free to make that choice, which I think is an awesome thing,” she says. She’s advised her 12-year-old daughter to wait for sex until marriage but has also been open with her about birth control within the context of marriage.

But she draws the line at abortion. “I just feel like we’re playing God. If that conception happens, then I feel like it was meant to be.”

Bennett had apprehensions about Trump but voted for him because he was the anti-abortion candidate. “That was the deciding factor for me, [more than] him yelling about how he’s going to build a wall.”

For her, opposition to abortion must be coupled with support for babies once they are born. She supports adoption and is planning to become a foster parent.

She also is concerned about the mental and physical well-being of young women. Bennett teaches seventh-grade math and coaches the school’s cheerleading and dance teams.

She watches the girls take dozens of photos of themselves to get the perfect shot, then add filters to add makeup or slim them down.

“There’s going to be an aftermath that we haven’t even thought about,” she says. “I worry we’re going to have more and more kids suffering from depression, eating disorders and even suicide because of the effects of the social media.”

Maya Guillén, 24, El Paso, Texas

When Guillén was growing up, her family spent years without health insurance. They crossed the border into Juárez, Mexico, for dental care, doctor appointments, and optometry visits.

Guillén is now on her parents’ insurance plan under a provision of the Affordable Care Act that allows children to stay on until they turn 26. She’s been disheartened by Republicans’ proposed changes to contraception and abortion coverage, she says.

In high school, Guillén received abstinence-only sex education. She watched her friends get pregnant before they graduated.

When it came time to consider sex, she thought she’d be able to count on Planned Parenthood, but the clinic in El Paso closed, as have 20 other women’s health clinics in Texas. She worries that if Republicans defund Planned Parenthood, more young girls, especially those in predominantly Hispanic communities like hers, will not be able to get contraceptives.

Jaimie Kelton, 39, New York City

When Jaimie Kelton’s wife gave birth to their baby 3½ years ago, she thought the country was finally becoming more open-minded toward gays and lesbians.

“Now I am coming to realize that we are the bubble and they are the majority and that’s really scary,” says Kelton, now pregnant with her second child.

Kelton says it seems as though Republicans have launched a war against women in general, with reproductive rights and maternity care at risk.

“It is crazy to think that most of the people making these laws are men,” she said. “Why do they feel the need to take away health care rights from women?”

Five things to watch in Senate GOP’s ACA repeal bill

http://thehill.com/policy/healthcare/338886-five-things-to-watch-in-senate-gops-obamacare-repeal-bill

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A draft of the long-awaited Senate healthcare bill, crafted behind closed doors, will be publicly unveiled on Thursday.

Just a day before the bill’s scheduled release, some senators said they still didn’t know the details of some key provisions, creating uncertainty as Senate Majority Leader Mitch McConnell (R-Ky.) pushes toward a vote next week.

Here’s what to watch for.

Trump revives policy eliminating funding for foreign groups that provide abortion services

https://www.statnews.com/2017/01/23/trump-abortions-mexico-city-policy/

President Trump on Monday reinstated a US policy preventing foreign nonprofit groups that receive federal funds from administering abortions or providing abortion counseling or referrals.

Originally enacted by President Ronald Reagan in 1984, the “Mexico City Policy” was rescinded by Bill Clinton and Barack Obama — and reinstated by George W. Bush and now Donald Trump — in the first days of each new administration.

Known as the “global gag rule” by pro-abortion rights groups, the Mexico City Policy goes a step further than existing legislation, which prevents federal dollars from being used for abortions. Instead, it prevents organizations that receive any federal funds from paying for their own abortion programs.

Existing legislation known as the Helms Amendment already prevents federal funding of foreign abortions “as a method of family planning,” a restriction abortion rights advocates say has led to excessive interpretation. George W. Bush’s administration clarified that the amendment exempted abortions performed in cases of rape, incest, or when the mother’s life would be endangered by the pregnancy.

Trump’s move forces nonprofit groups to choose between cutting abortion services altogether or looking to fill a major budget gap left by the withholding of federal dollars.

The executive order comes as part of a broader salvo on federally funded abortion and contraceptive coverage.

Separately, a bill under consideration by the House rules committee aims to change the Hyde Amendment, a provision in annual appropriations bills that prohibits federally funded abortions, into permanent law. The proposal would also make employers with insurance plans that cover abortion ineligible for tax credits under the Affordable Care Act.

Trump also issued an executive order on Friday that, depending on how the Department of Health and Human Services interprets it, could eliminate the ACA requirement that private insurers include contraception in their coverage.

Gov. John Kasich vetoes Heartbeat Bill, signs 20-week abortion ban

http://www.dispatch.com/content/stories/local/2016/12/13/John-Kasich-acts-on-abortion-bills.html#

While describing himself as a champion for the sanctity of life, Gov. John Kasich vetoed a bill Tuesday that would have forbidden abortions once a fetal heartbeat could be detected.

The second-term Republican, however, did sign into law a second bill, a GOP-backed lame-duck measure banning abortions after 20 weeks of pregnancy — providing an exception for saving the mother’s life but none for rape or incest.

The Heartbeat Bill’s foremost champion, Janet Porter of Faith2Action, immediately denounced Kasich’s “betrayal of life” and promised a campaign to find the necessary votes in the House to override the governor’s veto. The Senate’s vote was veto-proof on what would have been the nation’s most stringent abortion law.

In his veto message, Kasich said the Heartbeat Bill, which would have forbid abortions at about six weeks into pregnancy, was clearly unconstitutional under U.S. Supreme Court rulings and would have resulted in an expensive — and losing — court battle.

Supreme Court strikes down Texas abortion clinic restrictions

https://www.washingtonpost.com/politics/supreme-court-strikes-down-texas-abortion-clinic-restrictions/2016/06/27/ba55d526-3c70-11e6-a66f-aa6c1883b6b1_story.html

The Supreme Court on Monday struck down Texas abortion restrictions that have been widely duplicated in other states, a resounding win for abortion rights advocates in the court’s most important consideration of the controversial issue in 25 years.

Abortion down 14 percent in Texas since new restrictions closed clinics

http://www.latimes.com/nation/sns-tns-bc-texas-abortion-20160317-story.html?utm_campaign=KHN%3A+First+Edition&utm_source=hs_email&utm_medium=email&utm_content=27439261&_hsenc=p2ANqtz–P_B2qtpKG332eZBqQ6kw0MBMfELH2QtqQszxn9NirjAW0L745tm2JeQTCmTJnn-ONl_TvdQ87ZncGJbwWSaGrSTgKnQ&_hsmi=27439261

Texas

How Common are Abortion Complications? A Crucial Question hits the Supreme Court

How common are abortion complications? A crucial question hits the Supreme Court