Protesters take to the streets outside the U.S. Supreme Court on Tuesday, March 26, 2024, where justices questioned attorneys about broad changes in access to mifepristone. (Sofia Resnick/States Newsroom)

Policy, politics and progressive commentary

WASHINGTON—As the enormous yellow banner unfurled in front of the steps of the U.S. Supreme Court Tuesday morning, Laura Clime-Coates turned to her 9-year-old daughter and said, “Those are the names of people who agree with us.”

On the sign, titled “We the People Support Medication Abortion,” were what activists estimated to be half-a-million signatures from people across the U.S. asking the Supreme Court not to restrict mifepristone, a commonly used drug for abortions and miscarriage management. And for Clime-Coates, who said she signed several petitions in support of medication abortion, mifepristone is the reason her oldest child was standing beside her, and the reason she has a little sister at home in Baltimore.

Back in 2009, Clime-Coates said she experienced what she referred to as a missed miscarriage.

“There was no heartbeat, and it was risking my future ability to have children, and I really wanted children,” she told States Newsroom. “The tissue was not developing and threatening my uterus. My choice was to wait around and damage my body or take mifepristone.”

Clime-Coates and her daughter were among hundreds of abortion rights supporters holding signs and chanting, while inside, the justices heard oral arguments in U.S. Food and Drug Administration v. Alliance for Hippocratic Medicine, their first major reproductive rights case since overturning Roe v. Wade almost two years ago.

In the absence of a legal precedent protecting the right to terminate a pregnancy, the implications for abortion access in this case are as high as they have ever been. More than a dozen states have banned or heavily restricted abortion since 2022’s Dobbs v. Jackson Women’s Health Organization decision, but abortion rates have risen rather than fallen. The Guttmacher Institute recently published data estimating more than 1 million abortions in 2023, of which about 63% were via medication, and that only includes abortions in the formal medical system. Many reproductive rights researchers and providers credit the rise in part to the FDA lifting certain restrictions on abortion medication after more than two decades of consistent safety and efficacy data. Beginning in 2016, the FDA increased the gestational window women could terminate pregnancies using medication, adjusted the dosages, removed in-clinic requirements, and made medication abortion available via telemedicine and directly at pharmacies.

Initially filed in 2022 by anti-abortion doctors and medical groups a few months after Roe was overturned, the case has incurred criticism from throughout the medical and scientific community because of its flawed scientific claims that mifepristone is dangerous and should not have been approved by the FDA. At issue now in the FDA’s appeal to the Supreme Court is whether to uphold the 5th U.S. Circuit Court of Appeals’ opinion that the FDA must reapply older restrictions against the agency’s own scientific determination. The coalition of anti-abortion medical groups have largely relied on anecdotes from longtime anti-abortion activists, as well as a handful of studies produced by some of the main medical groups connected to the lawsuits, two of which were recently retracted by academic publisher Sage for methodological flaws and undisclosed conflicts of interest.

In anticipation of the oral arguments in this case, those in the pharmaceutical industry have expressed anxiety that a ruling against the FDA could stifle future drug development, by allowing anyone with an ideological opposition to a medication to try to force a drug-policy change.

“This case isn’t about mifepristone,” said Elizabeth Jeffords, the CEO of a small biotech company called Iolyx Therapeutics, on a webinar organized by reproductive health researchers last week. “This is about whether or not the FDA is allowed to be the scientific arbiter of what is good and safe for patients. …. It’s critical for our ecosystem that we continue to have investors, and investors will only come to our ecosystem if they have some certainty. If I had to believe that I would have to stand up to multiple litigations from parties without standing over the course of any drug that we’re working on developing, I wouldn’t have enough money to exist, and all of the little biotech companies would be out of existence as well.”

Pharmaceutical sciences professor Chris Adkins – who sparked the investigation into those studies and has co-authored a new academic paper in the journal Contraception breaking down what he says are significant methodological flaws – said it has been difficult to watch this case advance all the way to the Supreme Court.

“I just hope moving forward that we’ve got more public awareness that our federal courts have not always been the best evaluators of scientific evidence,” Adkins told States Newsroom. “I really hope that the public can really put some pressure on the courts to do a better job at evaluating the scientific and the medical literature, because I think this all impacts each one of us, our families, our futures. … This type of case could threaten regulatory approval or the processes they’re involved with, not just for mifepristone, but for others.”

But for both abortion opponents and supporters outside the Supreme Court Tuesday, the issue is personal.

“I was really glad I had that choice,” Clime-Coates said. “It’s health care! And I would hate for any of my children or any woman or anyone who’s capable of reproduction to not have that choice in the future.”

Alethea Shapiro, a protester from Florida, told States Newsroom she needed mifepristone years ago to terminate a pregnancy for medical reasons. “Hands off our mifepristone!” she yelled in a small circle of activists organized by the Women’s March and the Center for Popular Democracy. Some of the activists had prepared for arrests, but they eventually dispersed while law enforcement officers surveilled the crowd.

Robin Ross, an anti-abortion activist from Amarillo, Texas – home of the conservative federal district court where the case was originally filed, told States Newsroom she had secretly attended abortion rights demonstrators’ planning session the night before but said she learned little beyond logistics. The 57-year-old Navy veteran said she recently became an activist after learning that her teenage mother had attempted to abort her in the 1960s, before abortion was legal throughout the country. Ross said that she has had many health problems, including the inability to have children, because of the abortion attempt (she did not give specifics, but she said it was not the medication abortion method authorized by the FDA, at issue in this lawsuit). She is currently working to make Amarillo a so-called sanctuary city for the unborn.

“As soon as I heard about the ability to put my faith into action and me as an abortion survivor, I instantly wanted to start [anti-abortion activism].

Some anti-abortion activists proudly displayed their pregnant bellies in protest of medication abortion.

“I’m here because I’m 34 weeks’ pregnant. I’m advocating for the rights of my child, my baby in the womb,” said Savannah Evans from Tampa, Florida, who does marketing for the national anti-abortion group Live Action. “ I don’t want her to grow up in a world that sees an abortion as an acceptable option for women.”

At 22, Evans said her pregnancy was unplanned and that she was initially “terrified,” but she and her now-husband chose to parent.

Among the speakers in the largely outnumbered anti-abortion crowd, messages focused heavily on alleged high risks of medication abortion and called on the Supreme Court to order the FDA to reapply the since-lifted restrictions that have made it possible for women to have medication abortions via telemedicine and in their homes.

“FDA, do your job!” shouted Marjorie Dannefelser, the president of Susan B. Anthony Pro Life America. “We certainly do not have complete agreement upon the fact that there are two patients in every pregnancy, but we can at least pledge ourselves to one patient: the woman receiving abortion drugs in the mail in her home alone. … She has become her own abortionist in an unsafe home abortion.”

Recent research on telemedicine abortions, co-authored by University of California San Francisco epidemiologist Ushma Upadhyay, finds a low rate of serious adverse risks. And reproductive rights activists working to expand medication access around the nation said in interviews that abortion drugs are here to stay, even if the Supreme Court sides with the anti-abortion activists, which as States Newsroom reported Tuesday, is far from a sure thing.

“We know that people, no matter what happens with this case, are going to continue to access pills outside of the formal health care system,” said Bethany Van Kampen Saravia, senior legal and policy advisor at Ipas, which for decades has worked in countries with restrictive laws to train providers and help expand access to abortion care. Since the overturning of Roe, she said Ipas has refocused their efforts throughout the U.S., where at least half the states have near-total bans or heavy restrictions. As States Newsroom recently reported, new data shows a rise in self-managed abortions since the Dobbs decision.

“People will continue to get medication abortion through online access, through telehealth service, through online pharmacies, through your community network,” Van Kampen Saravia said. “Self-managed abortion is a WHO-recommended method of care. What Ipas knows from decades of working outside of the U.S. is that abortion with medication is safe and effective. And that’s not going to stop no matter what happens.”

Abortion providers who work in and outside of the formal medical system told States Newsroom they should be able to prescribe the current medication abortion regimen off label, if the FDA is ordered to change its protocol.

“We’re continuing to work because the pills are still on the market, they’re still registered, so they will be available and the doctors have the freedom to prescribe them off label,” said Dutch physician Dr. Rebecca Gomperts, founder of the online clinic Aid Access, which she said has been working with states with shield laws to ship abortion drugs to women in states with abortion bans. She was in front of the court handing out, for free, a small amount of boxes of the abortion-medication regimen. She said Aid Access will continue helping women self-manage their abortions.

“No matter what the Supreme Court is going to do, we’ll be there,” Gomperts said.

The post Hundreds protest outside the U.S. Supreme Court to keep abortion medication accessible appeared first on Nevada Current.

U.S. Speaker of the House Mike Johnson, R-Louisiana, was senior legal counsel for the Christian right law firm Alliance Defending Freedom from 2002 to 2010. (Getty Images)

Policy, politics and progressive commentary

When Mississippi Solicitor General Scott G. Stewart presented Dobbs v. Jackson Women’s Health Organization to the U.S. Supreme Court in December 2021, he argued that state lawmakers should be able to ban abortion at any time in pregnancy, not just after so-called “viability,” the point where a fetus could survive outside of a uterus. The U.S. Constitution, he said, does not specifically protect the “purposeful termination of a human life.”

“The viability line discounts and disregards state interests,” Stewart said, according to the transcript of the oral arguments, contending that state lawmakers should be able to draw an earlier line on when they believe human life officially begins.

“How is your interest anything but a religious view?” asked U.S. Supreme Court Justice Sonia Sotomayor, one of the three liberals on the majority-conservative court. “The issue of when life begins has been hotly debated by philosophers since the beginning of time. It’s still debated in religions. So, when you say this is the only right that takes away from the state the ability to protect a life, that’s a religious view, isn’t it?”

Without directly answering, Stewart reiterated that this question about the beginning of life should be returned to the states. Justice Samuel Alito, who would go on to author Dobbs’ majority opinion overturning Roe v. Wade, helpfully asked the solicitor general whether any secular philosophers and bioethicists might also share the view that personhood begins at conception. Stewart finally responded that his plaintiffs’ interest was “not tied to a religious view.”

Despite that assurance, the nonprofit law firm that helped Stewart argue and win the Dobbs case — the Alliance Defending Freedom — has worked for three decades to change laws to fit an explicitly conservative Christian worldview when it comes to reproductive and family issues, with a focus on ending legal abortion and limiting trans rights. ADF’s systematic strategy to effect generational changes, according to its website, includes targeted litigation and legal training. Constitutional legal experts who study the religious right say the anti-abortion movement’s best chance of keeping unpopular abortion bans on the books is through its growing network of conservative attorneys and judges cultivated by ADF and allied Christian law firms and law schools.

ADF has employed and trained thousands of like-minded conservative Christian attorneys, some of whom have climbed the highest rungs of power, including new U.S. Speaker of the House Mike Johnson (R-Louisiana) and several federal appellate judges, state house representatives, a former attorney general, and a conservative New York Times opinion columnist. Some of ADF’s trainees have gone on to clerk for Alito and fellow conservative Justice Amy Coney Barrett, according to a recent New Yorker report.

“They know that their ideology is unpopular, and in many cases, anti-equality or even downright unconstitutional,” constitutional attorney Andrew L. Seidel told States Newsroom, about ADF. He is the vice president of strategic communications for the progressive group Americans United for the Separation of Church and State and has written books about the religious right movement. “They are trying to build up these networks to capture the courts, to capture the legal professions. Because they can’t win otherwise.”

ADF did not respond to a request for comment. On its website, the group says its “ultimate mission” is “to keep the doors open for the Gospel — not just for you, but for your children, grandchildren, and the generations to come.” In that pursuit, ADF has successfully argued 15 critical cases before the Supreme Court, including overturning Roe v. Wade last year and establishing precedent for corporations to use their executives’ religious beliefs as legal justification to deny employees birth control or to refuse services to LGBTQ customers and students.

And despite its success, Dobbs is far from ADF’s last abortion-related case.

The Supreme Court will soon announce whether it will take up either of the group’s three lawsuits this term. Their lawsuit against the U.S. Food and Drug Administration could upend access to the abortion drug mifepristone. That case has been roundly criticized, not just by abortion-access advocates, but by legal, medical, and pharmaceutical groups for its flawed legal and medical claims and for judge-shopping. ADF, which is headquartered in Scottsdale, Arizona, is representing the Alliance for Hippocratic Medicine. This coalition of national anti-abortion medical groups officially registered in Amarillo, Texas, in August 2022, just three months before filing the lawsuit in a district with allied federal judges on the benches. A ruling from U.S. District Judge Matthew J. Kacsmaryk — who cut his teeth at the Christian right law firm First Liberty Institute — advanced the case up to the conservative 5th Circuit Court of Appeals.

On behalf of the state of Idaho, ADF has asked the Supreme Court to intervene in one of multiple cases challenging the federal Emergency Medical Treatment and Labor Act, which the Biden administration says requires emergency health providers to provide stabilizing care to pregnant people even if that care could lead to the termination of a pregnancy. ADF attorneys are arguing that some physicians could be forced to participate in abortions that go against their religious beliefs, despite no Idaho doctors publicly expressing this concern.

ADF’s other case before the nation’s highest court seeks to overturn a Washington state law that prohibits licensed therapists from using so-called conversion therapy on minors. This practice — which has been banned or restricted in more than half the country, according to the Movement Advancement Project — seeks to change a gay or transgender person’s sexual orientation or gender identity.

The legal group is working on nearly a dozen ongoing lawsuits involving abortion and contraceptive access in lower courts throughout the U.S.

Religious influence on reproductive health care

Within the span of 30 years, the Alliance Defending Freedom has grown into a nearly $100 million nonprofit with about 100 attorneys on staff and nearly 5,000 in its network, whose former CEO Michael Farris in 2021 earned more than half a million dollars, according to federal tax records. The group belongs to a broader religious right legal ecosystem that encompasses allied nonprofit law firms like the Becket Fund for Religious Liberty, First Liberty Institute, and the Thomas More Law Center, as well as religious conservative law schools like Ave Maria School of Law, Liberty University, and Regent University School of Law.

Boston University law professor Robert L. Tsai and University of California Davis law professor Mary Ziegler recently wrote in Politico that groups like ADF have given rise to what they call “movement judges,” who differ from merely partisan judges in that their legal decisions consistently align with specific ideological movements. Tsai and Ziegler credit the Dobbs ruling with the movement judges who pushed it along the way, and some of whom now sit on the nation’s highest court. They refer to Kacsmaryk, who presided over ADF’s lawsuit against mifepristone, as a movement judge.

“A movement judge is less likely to defer to experts than a technocratic one and more likely to think of issues in terms of values,” Tsai and Ziegler wrote. “A preservationist tries to work with existing precedent as much as possible and cares about how the institution is perceived. By contrast, a movement judge is focused on what a mobilized subset of people want and is willing to overturn precedent to get there.”

Seidel told States Newsroom that many of the Alliance Defending Freedom’s cases limiting access to abortion and contraception likely would not have advanced far were it not for the allied attorneys and judges that have risen to power in recent years. Influencers like Leonard Leo have aided this effort, as have religious right groups like the American Family Association.

Heading into a high stakes presidential election where the winner will potentially get to replace aging anti-abortion Supreme Court Justices Alito and Clarence Thomas, AFA has been researching and publishing the biblical worldviews of potential judicial nominees and is recommending those that align most with the religious right on issues like abortion and LGBTQ rights to future presidential administrations. At the top of their current wish list is ADF CEO Kristen Waggoner.

“Researching worldview is massive,” said Phillip Jauregui, head of the Center for Judicial Renewal, a division of the American Family Association Action political arm, speaking at the Family Research Council’s Pray Vote Stand event in Washington, D.C., in September. “We look at, what do they believe, where do they go to church? What do they say about these basic issues? Because when everything else is stripped away, what’s left is your faith or your worldview.”

To Seidel, the increasing convergence with one particular religious view into law is scary, and unconstitutional.

“What AFA is saying is that they want judges who are going to decide cases based on biblical principles, not based on Constitution or legal principles,” Seidel told States Newsroom. “The real question is, are they going to honor their constitutional oath when it comes into conflict with their personal religious beliefs? Or are they going to abuse their power and the power of their office to impose their personal religious beliefs on everybody? And what AFA is looking for is judges that are going to abuse their power.”

Jauregui did not respond to a request for comment.

The training programs 

According to ADF’s website, intern and job applicants must vow to adhere to a specific set of doctrines, including the beliefs that God created “each person with an immutable biological sex — male or female — that reflects the image and likeness of God,’’ and that marriage is a lifelong union between a man and woman. It also states that “We believe God endows all human life with inherent dignity, and it must be respected and protected from conception to natural death.”

ADF, according to its website, established its Legal Academy in 1997 to train “Christian attorneys in constitutional law so they can provide pro bono, dedicated service to the Body of Christ.” That same year, it established the Allied Attorney program, which ADF says currently has more than 4,000 members. Upon completion, participants are connected to a network of like-minded attorneys throughout the country who sometimes team up with ADF staffers and are eligible for resources and grants from the national nonprofit.

Another  program, Young Lawyers Academy, solicits recent law school graduates and early career lawyers working in government or large and mid-size firms to receive “specific resources and opportunities to engage in ADF-related issues at the outset of your career. … Daily worship and devotions will reinforce the importance of your core beliefs to your practice of law.”

And through its Blackstone Legal Fellowship, launched in 2000, ADF has trained more than 2,600 Christian law students and placed them in internships with powerful judges and state attorneys general, including with District Judge Kacsmaryk and Supreme Court Justices Alito and Barrett. The summer program recruits students from Christian and Ivy League universities, where they hear from some of the most influential Christian right attorneys and law professors, Barrett among them. Past faculty include former Attorney General Edwin Meese III and Princeton University law professor Robert P. George. George founded Princeton’s James Madison Program in American Ideals and Institutions, which Mississippi Solicitor General Scott Stewart attended, according to his LinkedIn profile.

Former ADF senior counsel Jeffery J. Ventrella, who helped design the Blackstone Legal Fellowship curriculum, most recently served as an associate attorney for Idaho’s office of the attorney general, which since Dobbs has tried to block out-of-state travel for people seeking legal abortions in other states. Ventrella is no longer in that role, according to state online records.

Ventrella edited “Natural Law for Lawyers,” written by J. Budziszewski, professor of government and philosophy at the University of Texas, Austin, which discusses “natural law,” a theory that “governments depend on a ‘higher’ law for their authority — a law which human beings discover rather than enact.”

In the book, Budziszewski reasons that abortion goes against natural law. He criticizes previous Supreme Court decisions that upheld the federal right to an abortion for suggesting that the beginning of human life is an open question. Denying the constitutional personhood of a developing embryo or fetus, to Budziszewski, is comparable to justifying murder and genocide.

“Consider the possibilities,” the law professor writes. “A teen with a gun idly fires a shot into your bedroom window — because for him you don’t exist. A sadist tortures your wife to death — because for him the meaning of her pain and fear is pleasure. A business rival wires your car to explode — because for him the universe is dog eat dog. An admirer of Adolf Hitler burns down the houses of your Jewish friends — because for him Jews aren’t human life. There is no way in law or logic to distinguish the Court’s argument for abortion from the other four arguments.”

The people ADF has trained

ADF encourages its fellows and trainees to get into government.

In an email newsletter promoting the fellowship, ADF highlighted former Blackstone Legal Fellow Rachel N. Morrison, who worked for the U.S. Equal Employment Opportunity Commission, which is charged with protecting employees’ from discrimination. “The connections and exposure to thinking holistically about faith and the law at Blackstone was essential,” said Morrison in the newsletter. She currently works for the Ethics and Public Policy Center, a religious right think tank in Washington, D.C.

“We’re working on so many issues coming out of the Biden administration; abortion, religious freedom, the redefinition of sex,” Morrison said in the newsletter. “It’s really been cool to see how God has used shut doors to guide my life — and then how he has opened other doors.”

But not all former fellows felt comfortable with the principles taught during the Blackstone Legal Fellowship. Attorney Paul Southwick recently told Rolling Stone that he was struggling with being gay and in the closet while also learning how to argue in court that gay people shouldn’t be allowed to adopt or have domestic partnerships. Southwick says he left the program early and now litigates on behalf of queer students who have experienced discrimination at religious colleges, often on the opposing side of ADF.

“The whole point is to have a Christian takeover of the government,” Southwick told Rolling Stone. “In ADF’s eyes, God has dominion over the church, but he also has dominion over the state.”

Neither Morrison nor Southwick responded to requests for comment.

Seidel’s group, Americans United for the Separation of Church and State, is currently representing progressive clergy in Missouri who allege their state’s anti-abortion law is a violation of the separation of church and state, given the bill’s explicit religious framing and references to God.

“They captured the Supreme Court and there have been no consequences other than everything they want, from overturning Roe versus Wade to this weaponization of religious freedom, tearing down the wall of separation between church and state,” Seidel said of the Christian right legal movement. “The pace of change is just so rapid and dramatic, I don’t think people realize where we are. They’re going to wake up tomorrow, and we are going to be the Christian nation that these groups have been fighting for for so long. We’re gonna look around and wonder what the hell happened?”

The post Anti-abortion attorneys ascend federal government ranks with Christian right legal training appeared first on Nevada Current.

Ohioans for Reproductive Freedom hold a Bans OFF rally in Columbus on October 8, 2023. (Graham Stokes for Ohio Capital Journal)

Policy, politics and progressive commentary

Anti-abortion leaders woke up Wednesday to the sobering reality that abortion rights remain the nation’s predominant political issue. Decisive wins in swing and red states in two national election cycles since Roe v. Wade was overturned last year have given momentum to reproductive rights groups, who aggressively campaigned and fundraised in key states across the country, and intend to triple down for 2024.

Meanwhile, the anti-abortion movement is scrambling for an effective 2024 strategy after crushing losses. Longtime anti-abortion activist the Rev. Pat Mahoney said in large part Republicans have been ineffective communicators on the issue and were wildly outspent.

“I think for the pro-life movement, we have to now truly recognize, when it comes to abortion bans, this is something that Americans do not want right now,” Mahoney told States Newsroom as he hustled to catch a connecting flight from Ohio – whose voters enshrined the right to abortion – home to Virginia, where Democratic candidates overtook the legislature after campaigns focused on abortion rights.

Mahoney is currently chief strategy officer for Stanton Public Policy Center, the political arm of Stanton Healthcare, a network of anti-abortion clinics headquartered in Idaho that offer limited reproductive health services. He said the anti-abortion movement needs to better coordinate a national messaging and fundraising strategy to be able to compete with the reproductive rights movement.

“Right now the pro-choice movement is more committed to funding in elections the protection and promotion of abortion than the pro-life movement is committed to ending abortion violence and making abortion unthinkable,” Mahoney said. “I live in Virginia. The state is doing well, the economy’s doing well, by all accounts. [Glenn] Youngkin is a relatively popular governor. Every ad I saw on television for every Democrat – I mean, a barrage of them – was how MAGA Republicans or pro-life anti-choice activists want to take women’s rights away. They were all about abortion.”

He said he’s expecting Republican candidates to continue “fumbling” the issue on the presidential debate stage in Miami tonight.

“Hardly any Republican has handled this well,” he said. “They’ve been all over the map.

Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, also urged the GOP – many of whose candidates tried to ignore the abortion issue or soften their stances – to “wake up.”

“The true lesson from last night’s loss is that Democrats are going to make abortion front and center throughout 2024 campaigns,” Dannenfelser said in a statement. “The GOP consultant class needs to wake up. Candidates must put money and messaging toward countering the Democrats’ attacks or they will lose every time.”

But anti-abortion leaders say they will not give up their mission and will continue pushing controversial policies like granting “personhood” to embryos.

“Voters overwhelmingly cast their ballot to enshrine abortion into the state constitution. This is a bitter pill, and there’s no sugarcoating it,” Americans United for Life interim president Kevin Tordoff said in an email to supporters. “You and I know that constitutional justice, always and everywhere, means equal protection for all. We will continue, as we have since our founding in 1971, to strive for the day when all are welcomed throughout life and protected in law. Let us continue to stand together in this mission.”

Anti-abortion movement leader Terrisa Bukovinac, meanwhile, is calling for the anti-abortion movement to get more radical. She comes from the direct-action wing of the movement that believes voters need to see graphic images of aborted fetuses in order to be moved on the issue. The self-described atheist and leftist used to work in animal rights activism in San Francisco before moving to Washington, D.C., to found Progressive Anti-Abortion Uprising, one of the few anti-abortion groups that supports LGBTQ rights. Bukovinac is running for president as a Democrat with a targeted goal of airing campaign ads in key markets that show graphic images of fetuses she and another activist obtained outside of an abortion clinic in 2022.

“The reason that we oppose [abortion-rights amendments] is because they are widening the scope of abortion into the third trimester for elective reasons,” Bukovinac told States Newsroom. “And if we’re not showing the victims, like non stop, of abortion in these later trimesters, then we’re not really communicating with people why we oppose these measures and why they should also.”

Bukovinac told States Newsroom she is working to air her first ad in New Hampshire by the beginning of next year, but fundraising for her tiny campaign has been slow-going. She said stations typically charge more for campaign ads that feature controversial content.

Following Tuesday’s losses, Bukovinac said Maryland Right to Life reached out to her to conference on strategies ahead of the state’s upcoming abortion referendum.

“I think that they have to show the victims of abortion in an aggressive way,” Bukovinac said, of anti-abortion groups. “They need to say that abortion is murder. They need to be doing direct actions. I think those are the three most important things that we’re going to be doing in the next however many years it takes to reach left on this issue.”

Tuesday’s results were equally instructive for abortion-rights organizers in showing how effective abortion rights is as a voting issue. Ohio organizers in particular faced many obstacles, led by state Republican leaders, in trying to even get their initiative on the ballot. Despite what activists said was misleading text on the ballot, the measure carried 57%, including 18% of Republican voters.

“Looking at the results in Ohio, Virginia, Kentucky and Pennsylvania, it is pretty clear that abortion matters to voters because it matters to people in their everyday lives,” said Angela Vasquez-Giroux, vice president of communications and research of Reproductive Freedom for All, an abortion rights lobbying group formerly called NARAL Pro-Choice America. “And I think when you look down the road to 2024, and you see places like Florida, that gives you a sense of what’s possible. Even where you have hostile legislatures and gerrymandering and all of the structural inequalities stacked against you, you can still make big change when you get the power back to voters.”

Since the U.S. Supreme Court overturned Roe v. Wade in June 2022, 21 states have eliminated or restricted access because of abortion bans. And as States Newsroom has reported, even with health exceptions and especially without them, women have been denied medical care during pregnancy-related emergencies.

“[Voters] understand that life is not these one-size-fits all bans,” Vasquez-Giroux said. “They don’t account for how complex pregnancy and life are. People understand that you can’t legislate a belief system onto a medical procedure and expect that nothing bad is going to happen.”

A sample of reproductive rights wins from Tuesday night:

Kentucky: Democratic Gov. Andy Beshear won re-election; challenger Republican Attorney General Daniel Cameron had also made abortion a huge focus of his campaign and gave voters varying answers on whether he would support exceptions to Kentucky’s near-total abortion ban in cases of incest and rape.

New Jersey: With every legislative seat up for grabs Tuesday, Democrats retained control of both houses, after Republicans had dismissed their strategy to focus on reproductive rights over issues like state spending and crime rates.

Ohio: A win for Issue 1 means the state’s constitution will now guarantee the right to abortion through viability (and beyond for medical emergencies), as well as the right to birth control, childbirth, fertility treatment and miscarriage management. The win means a blocked six-week abortion ban currently under review by the courts will likely be struck down. And it marks the seventh state to affirm reproductive rights on the ballot since Roe v. Wade was overturned.

Pennsylvania: Democrat Daniel McCaffery won his seat on the liberal-leaning Pennsylvania Supreme Court, and marked the second time that Reproductive Freedom for All endorsed in a judicial race.

Virginia: Democrats winning both state houses means Republican Gov. Glenn Youngkin is unlikely to push through the abortion ban he championed this election cycle. For now the state remains one of the few abortion access points in the South.

Vasquez-Giroux said Reproductive Freedom for All will continue to support local reproductive-rights groups with their ballot measures and state and local elections, and will help to coordinate strategy at the national level.

“No matter how you apply abortion as an issue, in elections, it’s successful because people understand exactly what’s at stake – your ability to live in a place where it’s safe to become pregnant. It’s a pretty big deal,” Vasquez-Giroux said. “Folks understand that it means that you have to protect it at every opportunity. … I think we can expect to see repeats of last night and 2022 in 2024.”

The post Abortion-rights victories cement 2024 playbook while opponents scramble for new strategy appeared first on Nevada Current.

Cancer is one of several conditions for which mifepristone is a potentially effective treatment. (Getty Images)

Policy, politics and progressive commentary

One of the anti-abortion doctors suing the U.S. Food and Drug Administration to rescind its 2000 approval of a medication abortion regimen on the basis that one of the drugs is dangerous is now consulting on the development of a breast cancer treatment that involves the same drug: mifepristone. It is the family doctor’s latest foray into medical consulting outside his medical certifications.

Dr. George Delgado is joining the scientific advisory board of Res Nova Biologics, Inc., which is developing a breast cancer treatment using mifepristone, despite plaintiffs’ arguments in the lawsuit that federal approval was illegally rushed (it was a four-year process) and that the drug’s approved use for first-trimester abortion should be reversed.

But in the press release announcing his role with Res Nova, he said: “In my opinion the concept of leveraging the effects of the abortion pill in life-saving as opposed to a life-taking scenario is extremely exciting. I am proud to join such a specialized team of therapeutic developers in advancing this novel approach to tumor immunotherapy.”

Delgado is among the four anti-abortion doctors and four conservative Christian medical groups whose claims are largely based on anecdotes and research that has raised red flags. And they contradict overwhelming evidence that mifepristone is safe after 5.6 million uses and effective for first-trimester abortions, miscarriage management and other medical conditions. The American Medical Association has accused the conservative courts that have advanced the case of  “elevat[ing] speculative pseudoscience over data and evidence, arbitrarily rolling back access to a safe and effective drug and leaving millions of women without a critical medication for reproductive health care.”

Nevertheless, the fate of U.S. abortion access once again rests on a forthcoming decision from the U.S. Supreme Court, to either take up this case, or effectively reinstate old restrictions to the drug. Conservative judges in lower courts have relied on plaintiffs’ claims along with testimony from Delgado and the other doctors alleging personal harm because mifepristone is FDA-approved for abortion.

In a legal declaration submitted in November 2022, Delgado wrote that he has treated women who “suffer complications from chemical abortions,” but he gave only examples of women whom he says felt regret and emotional distress. As an argument for standing, Delgado also said he loses money when patients have a medication abortion instead of seeking prenatal care services at his family practice in Escondido, California, which also offers anti-abortion counseling and a controversial protocol claiming to reverse the effects of mifepristone. The American College of Obstetrician Gynecologists says this protocol is “not supported by science.”

“[T]here is a tangible financial loss to my practice in losing the opportunity to render professional prenatal care for the mother or to care for babies who are never born,” he wrote.

Delgado is an outspoken anti-abortion activist best known for so-called “abortion pill reversal,” which is unregulated by the FDA and whose unverified claims led the AMA to sue North Dakota in 2019 over a state law promoting the procedure. Delgado serves on the American Association of Pro-Life Obstetricians and Gynecologists’ board of directors, despite not being an OB-GYN. At the height of the Covid-19 pandemic, Delgado also testified as a medical expert to keep mega churches open, though he is not a public health expert or epidemiologist. In legal filings he claimed expertise from having “treated many people with infectious diseases, including viral illnesses such as influenza, which tend to occur in epidemics.”

Now the family doctor has been recruited to the scientific advisory board of the biotech company based in Chula Vista, California, that is developing a breast cancer treatment using mifepristone.

Res Nova, a breast-cancer-focused spinoff of Therapeutic Solutions International, Inc., is developing FloraStilbene, a “proprietary formulation of RU-486 and pterostilbene which has been shown to overcome tumor associated immune suppression and increases responsiveness to chemotherapy and immunotherapy.” According to the press release (which refers to mifepristone as RU-486, the name the drug had during laboratory testing), the company “seeks to enter clinical trials of ‘repurposed’ abortion pill for breast cancer” and has signed with a compounding pharmacy.

“The similarities between pregnancy and oncology, including angiogenesis, immune modulation, and rapid growth are striking,” Delgado said.

Delgado is certified in family medicine and hospice and palliative medicine by the American Board of Family Medicine, and is not specialized in oncology or immunology. The Res Nova advisory board members currently listed on the website (Delgado has not yet been added) includes members with diverse specialties, including a board-certified neurologist and neuro-oncologist, a pharmacist, an attorney, a technology executive, and an IT consultant.

Res Nova president and CEO Famela Ramos—who is a nurse, an unsuccessful congressional and school board candidate, and on the board of an anti-abortion pregnancy center in Chula Vista—said she recruited Delgado partly because of the so-called abortion reversal technique he’s spent more than a decade developing and promoting.

“Having known the work of Dr. Delgado for many years and his great success in defending both the mother and the baby, it is exciting to have the opportunity to utilize his scientific and medical expertise in this unique intersection of reproductive medicine, immunology, and oncology,” Ramos said in the announcement, which refers to Delgado as an “expert in the biology of pregnancy and the abortion pill” and does not mention his lawsuit against mifepristone.

Delgado has also suggested that abortion is linked to breast cancer, a common anti-abortion claim. But according to the American Cancer Society, “scientific research studies have not found a cause-and-effect relationship between abortion and breast cancer.”

Ramos and Delgado declined to respond to States Newsroom’s questions.

Major U.S. medical groups have argued that Delagado’s lawsuit could have long-term consequences unrelated to pregnancy termination—and could upend drug research and development. Mifepristone is currently being investigated in clinic trials for a variety of cancers and mental health disorders. This lawsuit targets mifepristone for the specific use of abortion, and the drug’s manufacturers have said restrictions on the medication abortion regimen would not apply to clinical trials investigating mifepristone for non-abortion use. However, researchers have reported that even before Roe v. Wade was overturned anti-abortion policies made it difficult to study mifepristone.

Already mifepristone can be difficult to access for people who want abortions, but now the drug is also hard to access for the off-label use of miscarriage management because of high demand and confusion around medication abortion laws, according to States Newsroom affiliate Stateline.

“Dr. Delgado’s research interest in mifepristone as a potential preventive for cancer demonstrates the significant medical value that mifepristone provides,” said Molly Meegan, chief legal officer and general counsel for the American College of Obstetrician Gynecologists, which has filed friend-of-the-court briefs defending mifepristone’s approval and safety record in the FDA lawsuit.

Delgado helped create a network of anti-abortion health care providers willing to perform the so-called abortion pill reversal treatment without much data behind it and based on the doctor’s training at an institute that teaches a Catholic-friendly approach to reproductive health. The anti-abortion pregnancy center network Heartbeat International now manages the Abortion Pill Rescue Network.

The FDA’s medication abortion regimen, which is currently recommended for up to 10 weeks’ gestation, involves mifepristone to block the hormone progesterone, followed by the medication misoprostol which causes contractions. The “reversal” protocol has patients forgo the second drug in the regimen and receive doses of progesterone. States Newsroom has interviewed a patient who remained pregnant and gave birth to a healthy baby after going through this treatment at an anti-abortion pregnancy center in Idaho. But medical groups like ACOG and the AMA say there’s not enough evidence to show that it’s the progesterone that continues the pregnancy versus not completing the abortion regimen. The one attempt at a controlled study of this protocol ended prematurely because the OB-GYN and mifepristone expert leading the study determined it was unsafe after three patients hemorrhaged.

Though several states have passed laws requiring abortion clinics to tell patients they could potentially reverse their abortions if they change their minds, some states are now pushing back on the promotion and marketing of this treatment.

The California attorney general is suing Heartbeat International and another California-based crisis pregnancy network that have widely marketed “abortion pill reversal” despite its unproven claims, under the state’s False Advertising and Unfair Competition laws.

Earlier this year Colorado became the first state to ban the procedure, which was followed by a lawsuit from a Catholic clinic. State regulators have ruled that so-called “abortion reversal treatments” are not an accepted medical practice. But over the weekend, a federal judge appointed by former President Donald Trump blocked the new state law, citing the plaintiffs’ religious freedom.

The post Doctor suing FDA recruited to scientific advisory board to ‘repurpose’ abortion pill appeared first on Nevada Current.

The U.S. Supreme Court could decide the future of a key abortion pill, mifepristone, more than a year after the nation’s highest court overturned Roe v. Wade allowing states to decide their own abortion laws and bans. (Photo by Chip Somodevilla/Getty Images)

Policy, politics and progressive commentary

More than a year after the U.S. Supreme Court decided states could set their own abortion laws, including bans, the nation’s highest court now could cut off abortion access in states where abortion is still legal.

The Supreme Court began its new term this week and has yet to announce whether it will hear Alliance for Hippocratic Medicine v. U.S. Food and Drug Administration, before the term ends in June 2024. This case was designed by the religious right to overturn the approval of the commonly used abortion drug mifepristone. But whatever the court does — even if it declines to hear the case — will further alter healthcare access in the U.S., reproductive health advocates said on a call to reporters Thursday.

“The restrictions that the Supreme Court could reimpose would drastically reduce access to mifepristone and create barriers that are impossible to overcome for many patients who are seeking abortion care,” said Leah Koenig, data analyst and medication abortion researcher, at the University of California San Francisco’s Advancing New Standards in Reproductive Health.

Alliance Defending Freedom, the Christian right legal powerhouse representing the plaintiffs, has asked the court to fully reverse the approval of mifepristone and/or to remove restrictions that were lifted over the course of two decades, as the drug regimen maintained a high safety and efficacy record. The FDA’s most recent and not fully implemented change was to allow pharmacies to directly dispense the drug to patients. The U.S. Fifth Circuit Court of Appeals in its August ruling granted part of plaintiffs’ requests: Instead of removing approval altogether, the three-judge panel ruled instead to undo changes the FDA had made to the protocol since 2000.

Post-Roe, medication abortion and especially telehealth medication abortion have improved abortion access, especially for people living in states where it is banned or widely unavailable, said Dr. Julie Amaon, a family medicine physician and the medical director for the nonprofit Just the Pill, which launched in 2020 and connects patients with abortion pills via mail or mobile clinic in Colorado, Minnesota, Montana, and Wyoming.

Amaon said demand from patients exploded by 400% after Roe v. Wade was reversed. She said they’ve seen more than 6,000 patients who have traveled from more than 34 different states. But if the Supreme Court upholds the appellate decision, it will effectively re-apply old restrictions and increase mifepristone’s dosage against FDA’s current data-based protocol. The out-dated policy also shortens the gestational age from 10 to 7 weeks, before many know they are pregnant, and requires patients to make three in-clinic appointments. These new barriers would be difficult to overcome, Amaon said.

“This decision will also have far reaching implications on not only those who need access to safe abortion, but also on countless other established medical treatments as politics override science,” Amaon said. “The fear and urgency is palpable in our patients’ voices. They are frustrated with the confusing laws that vary from state to state and sometimes day to day.”

Science and legal experts have said plaintiffs’ arguments that the FDA illegally approved mifepristone and that the drug is dangerous are meritless. One of the primary sources Texas federal Judge Matthew Kacsmaryk cited to decide that a handful of anti-abortion doctors who don’t provide abortions have standing was a study now being investigated by health journal publisher Sage Publishing for allegations that the anti-abortion research team misrepresented its findings. Kacsmaryk has been involved deeply in the religious right legal movement.

Another federal judge favored by the far right, U.S. Judge James Ho, was one of the three judges on the Fifth Circuit appellate panel, who in a separate dissent voted to fully overturn the drug’s approval. He made the roundly criticized argument, based on environmental case law, that plaintiffs might suffer “aesthetic injury from the destruction of unborn life.”

The Fifth Circuit has a growing reputation of having extreme conservative opinions reversed by the Supreme Court. And former FDA attorney Eva Temkin told reporters she is confident that will be the case for Alliance for Hippocratic Medicine v. FDA. Otherwise, she said, the Supreme Court would likely upend current regulatory law.

“The Supreme Court can and should take this case and can and should reverse,” Temkin said. “I do think it is quite clearly a matter of national importance, not only because of the abortion impacts and the patient care impact, which of course can’t really be understated, but also because of the impacts on the drug regulatory environment and the industry and the investment and the way that patients access medicine more broadly. So I do have a lot of confidence.’’

In the event, this case changes the legality of mifepristone, abortion providers have been preparing to switch to a different medication abortion regimen that is still safe but less effective and has more side effects.

Whatever the Supreme Court ultimately does in this case will not be the last word in medication abortion access. But advocates are ready for the continued struggle.

“I think what happens then is a real all out fight about, again, an approved medication that’s been on the market for 20 plus years,”  said Kirsten Moore, director of the Expanding Medication Abortion Access Project. “And they’re just going to take it away from us? That will probably show up in the ballot boxes, in legislative fights.”

The post Abortion rights advocates say consequences dire if SCOTUS declines to hear pill case appeared first on Nevada Current.

The men of Operation Save America close out the group’s weeklong anti-abortion protest in front of the Nathan Deal Judicial Center in Atlanta, Georgia, on July 22, 2023. (John McCosh/Georgia Recorder)

Policy, politics and progressive commentary

Wendell Shrock doesn’t believe in condoms. “We should leave the uterus to God,” the street preacher from Tennessee tells States Newsroom, in front of an abortion clinic outside of Atlanta, mid-morning in late July. Sweat drips from his cowboy hat into his salt-and-pepper beard that stretches halfway down his red-plaid shirt. The retired police officer is running security for the conservative Christian group Operation Save America’s annual national event. Their followers interpret the Bible literally. Some believe constant procreation is God’s will.

Shrock surveils the crowd while his wife, Dawn, cares for six of their 11 children on the opposite end of a sidewalk crowded with warring abortion messages. One of their daughters walks over, and Shrock explains she will wed soon. He’s been praying God will give her 20 children. (For privacy reasons, he doesn’t share her age.) One of his sons got married about six years ago at 18 and has had a child every year since. Shrock says with pride that Dawn, who wears a hair covering and a long dress, has never held a public job.

“God created a woman, not only to have a baby and a baby to grow inside of her, but to nurture a baby,” says Shrock, who is not a spokesperson or leader for the group. “I could never have the closeness to my children that my wife has. That’s because God created her that way. He created her different from me. And I know that goes against some of today’s norms. ‘We’re all the same’— that’s not what my Bible says.”

Overwhelmingly, men are driving the quest to restrict and remove women’s reproductive rights in as many states as possible. Women leaders are and have always been involved in this decades-long fight. But in the post-Roe era, when more mainstream anti-abortion groups are trying to navigate increased bipartisan support for reproductive rights, a more extremist male-dominated faction has risen up. Groups like Operation Save America want to put women on trial for abortion. They want to eliminate all abortion exceptions and certain forms of birth control and fertility treatments. And they are finding support for these messages across the U.S. — in conservative churches and among conservative Christian lawmakers.

But even beyond the militant corner of the anti-abortion movement lies a male-dominated network of academics, attorneys, judges, lawmakers and lobbyists working on legal arguments that position fertilized eggs as constitutionally protected persons. And now that federal abortion rights no longer exist, these men are able to say the quiet part out loud: that somewhere between conception and the first few weeks of pregnancy, the rights of the zygote, embryo, or fetus trump those of the pregnant person.

South Carolina Supreme Court Justice John Kittredge recently argued as much in his opinion upholding the state’s so-called “heartbeat” ban, which was approved by the majority on what recently became the only all-male state supreme court in the nation.

“To be sure, the 2023 Act infringes on a woman’s right of privacy and bodily autonomy,” Kittredge wrote. “The legislature has made a policy determination that, at a certain point in the pregnancy, a woman’s interest in autonomy and privacy does not outweigh the interest of the unborn child to live.”

For South Carolina right now, that point is approximately four weeks of pregnancy.

Protecting and punishing women

Shrock recently texted States Newsroom about the gender roles he’s laid out for his daughters.

“As my daughters were growing up, I would from time to time ask them what they wanted to be when they grow up. Regardless of their answers, I would take them to this scripture and tell them that this is what God has said they should do when they grow up,” Shrock wrote, then quoted from the second chapter in the New Testament’s book of Titus, his version varying slightly from other translations:

Older women likewise are to be reverent in their behavior, not malicious gossips nor enslaved to much wine, teaching what is good, so that they may instruct the young women in sensibility: to love their husbands, to love their children, to be sensible, pure, workers at home, kind, being subject to their own husbands, SO THAT THE WORD OF GOD WILL NOT BE BLASPHEMED.

Asked to explain the verse on the phone, Shrock warned, “You won’t like it.”

“God in the Bible, in Genesis, God created a man to provide, protect,” he said. “And he gave the man a mission. And he created the woman; he said he needs a helper. God gave me a mission, and it’s my wife’s job to come alongside me and help me with that mission. And I know that goes against the world’s grain. They’ll say, ‘Wait a minute, what if she wants a career and what if she wants recognition? What if she wants to climb the corporate ladder?’ Well, God created my wife to have babies, to — literally what it says in Titus.”

Operation Save America’s pervading message is about empowering men and boys to adopt an old, punitive Christian worldview, one more widely embraced when women had few rights and power. But they also take their roles as provider and protector seriously.

For its national director Jason Storms and his father-in-law, longtime anti-abortion radical Matthew Trewhella, that partly means buying lots of guns and building militias. Trewhella has shared his 2013 manifesto calling for government defiance with many interested state lawmakers.

“We live in a culture of so many weak and pathetic Christian men who couldn’t fight their way out of a paper bag if their life depended on it,” Storms said in August 2022, from the pulpit at Mercy Seat Christian Church in Brookfield, Wisconsin, where he is the minister of evangelism and Trewhella is the lead pastor. “It’s not being a protector to your family that God has called you to be. Get yourself in shape. Cultivate some physical strength. Buy guns. If you need to, buy a lot of guns. It’s no limit on gun purchases; you have my blessing. … And if you buy a gun and you buy ammunition, train with it, and get around a group of men that you can train with. Get around a group of courageous men who will fight, bleed, and die with you, for you, and for your families and for your liberties.”

Storms, in an interview with States Newsroom following the original publication of this article, said his organization doesn’t advocate for violence against abortion providers and believes in advancing its causes through peaceful persuasion.

This year Operation Save America hosted its first Manhood Restored Bootcamp for boys and young men in Frankfort, Indiana, which involved hand-to-hand combat training and an event referred to in the schedule as “shooting range.” “Aborting your own child is a betrayal of every godly masculine virtue,” reads an OSA Facebook post leading up to the bootcamp. “Making alllowance [sic] for others to abort their own children emasculates society, decimating its soul and conscience. Abortion will end in America when Men become Men again.”

Storms said this bootcamp is also about teaching men to be responsible and good to women, including when it comes to sex and reproduction. He said he’s against “toxic masculinity” and noted that women participate in his organization.

“We do have a lot of very active women, and women that have jobs outside the home, like, all my kids.”

In addition to claiming to protect women, OSA is a fierce advocate of punishing women to the harshest letter of the law when it comes to their reproductive decisions. They call what they support “abolitionism,” and use language from anti-slavery and civil rights movements.

“Thirteen states have banned abortion,” Storms said during the last protest of OSA’s summer event in front of the Nathan Deal Judicial Center in Atlanta, on July 22 (at the time it was actually 14 states that banned abortion at all stages; now it’s 15). “In all those states they’ve given immunity to mothers, and mothers are still killing their children with immunity. That is a problem. We must pursue equal protection, equal justice, equal weights and measures.”

In a follow-up interview post-publication, Storms said the purpose of including criminal penalties for women is as a deterrent.

“I don’t want any woman to go to jail,” Storms said. “The bigger debate is more about the humanity of the preborn child than it is about the punishment for the moms. The whole reason why pro-life organizations exempt the mothers from punishment is because they think that that’s going to help them politically, with public opinion, to make it more palatable. But that’s actually not true. Now 15 states have banned abortion, right? Every single one of those exempt the mothers from punishment, so moms can still legally do self-managed abortion in every one of those states.”

OSA sees Georgia as a key battleground state, because, like South Carolina, it still allows abortion for the first few weeks of pregnancy, when electrical activity can be detected on an ultrasound. This law, whose constitutionality the state Supreme Court will determine this fall, does something legally strategic. It defines personhood with potentially future-history-making clauses:

“‘Natural person’ means any human being including an unborn child.” 

‘“Unborn child’ means a member of the species Homo sapiens at any stage of development who is carried in the womb.” 

But this near-total ban doesn’t go far enough for OSA and its partner groups like End Abortion Now, who’ve been lobbying for a much more extreme bill that was introduced earlier this year but has not advanced out of the state House. Under the “Georgia Prenatal Equal Protection Act,” doctors could be convicted under homicide charges unless they could prove the abortion was necessary to prevent “imminent death or great bodily injury.” Pregnant people suspected of having abortions could also be convicted under homicide charges, unless they could prove they were coerced into having the abortion. The bill says nothing about pregnant teenagers and children accused of this crime. Georgia is among 27 states where capital punishment is a possible sentence for homicide.

“In keeping with our oaths of office, the God-given right to life shall be secured and the impartial and equal protection of the laws shall be provided to all unborn persons from the moment of fertilization and at every stage of development, and abortion shall be abolished in this state, so help us God,” reads the bill.

OSA and its partners have lobbied for similar bills, many of them crafted by the Foundation to Abolish Abortion and advanced by sympathetic lawmakers, in more than a dozen states, including Alabama, Arizona, Kentucky, Missouri, and Oklahoma.

Men’s laws

The largest uterus in Washington, D.C., is made of reflective stainless steel. It’s embedded within a nearly 4,000 pound, 10-foot-tall bronze statue of a serenely pregnant Virgin Mary that now sits on the lawn in front of the Catholic University of America’s Theological College. Curled up inside what looks like a giant bowl is a bronze unborn Jesus.

Canadian sculptor Timothy Paul Schmalz says he believes it’s the first representation of Jesus as a fetus. Schmalz, whose work has been commissioned by the Vatican, opposes abortion. He toured the globe with this“Advent” statue before bringing it to its permanent home in May, in D.C., where it is now known as the National Life Monument. Schmalz’s goal is to get one in every U.S. state Capitol building. There’s a bill to erect “Advent” in Texas. One could end up in Arkansas, whose secretary of state is actively seeking design submissions for an anti-abortion monument.

It’s an appropriate representation in a statue of what many state legislatures are trying to do in statute: separate a woman from her womb.

This past spring, Washington Archbishop Wilton Cardinal Gregory blessed D.C.’s new giant uterus while surrounded by other male Catholic leaders. After the ceremony Schmalz told Catholic News Agency that he sculpted Mary’s uterus like a halo, one made of “mystical material.”

But in real life, the uterus is shaped more like a pear than a halo, located between a woman’s bladder and her rectum. Pregnancy begins when a fertilized egg implants in the uterus, which will nourish the egg until it develops into an embryo, then a fetus, and then a full-term baby. As the uterus expands, the woman’s other organs start to work exponentially harder to sustain this new life. Nearly every part of the human body changes during pregnancy and impacts the pregnant person’s comfort and mobility. Pregnancy for some causes temporary or permanent health conditions of varying severity. In the U.S., many people die during or soon after pregnancy or birth, especially pregnant people who are Black and Indigenous.

In 1973’s Roe v. Wade decision, the U.S. Supreme Court prioritized the rights of the pregnant person over the fetus until it reached a later stage of development. Even then, the court allowed states to give discretion to medical providers to weigh the physical and mental health risks women face against those of the fetus. A half-century later, in 2022’s Dobbs v. Jackson Women’s Health Organization, Justice Samuel Alito described each stage of the unborn’s development, but wrote not a word about the bodily developments of the person gestating that life.

The Court did not expressly address personhood in this ruling, but it’s expected to in a future case. That’s why anti-abortion legal architects are now toiling away at the legal definitions that they hope will crack the federal personhood code.

Some states are testing the constitutionality of so-called “heartbeat” bills that ban abortion around six weeks’ gestation, about two to four weeks after a missed period. According to the American College of Obstetricians and Gynecologists, an actual heart is not detectable by ultrasound until roughly 17 to 20 weeks’ gestation. What exists now is electrical pulses. At this gestational point, pregnant people often begin to feel extremely tired or dizzy or short of breath as their hearts begin pumping what will eventually be a 40 to 45% percent increase in blood volume.

South Carolina recently became the second state, after Georgia, with a six-week ban, and Florida could be next, which would make abortion virtually inaccessible in the South. The South Carolina Supreme Court made national headlines after its lone female justice retired, and the country’s only all-male high court promptly reversed her majority-approved opinion that a nearly identical six-week ban was unconstitutional.

Helping Republican lawmakers advance increasingly restrictive anti-abortion laws are longtime legal strategists like Robert P. George and Harold Cassidy, who live-streamed their recent strategy chat at Our Lady of Perpetual Help-St. Agnes Parish in Atlantic Highlands, New Jersey. George says he became an anti-abortion activist as a young teenager in West Virginia, shortly before the Supreme Court made abortion a federal right. The Princeton University law professor has spent his entire academic career trying to overturn Roe and block LGBTQ rights. He has advised several Republican presidents and founded many influential political groups.

For decades, the professor and co-author of the 2008 book “Embryo: A Defense of Human Life,” has been refining his legal personhood argument, which he submitted in a co-authored “friend of the court” brief in Dobbs, that the U.S. Constitution’s 14th Amendment already guarantees the right to life for unborn human beings. During his conversation with Cassidy, George said that abortion should not be allowed at any stage, because embryos’ unique DNA make them fully separate humans from the moment the sperm fertilizes the egg.

“Harold is the same guy who was the embryonic Harold, the fetal Harold, the infant Harold, the adolescent Harold,” George said, gesturing to Cassidy. “All of our lives begin from the earliest embryonic stage. And at all stages, and in all conditions, human life is valuable. So the first thing we’re up against is that people have been mis-instructed by the law itself.”

Universities across the country have begun to reproduce the conservative legal training ground George created at Princeton University’s James Madison Program in American Ideals and Institutions. He and his peers have been influencing young anti-abortion legal scholars with their brand of intellectual rather than overtly religious-based anti-abortion reasoning,

Cassidy’s legal career has centered around the so-called woman-protective argument, which the mainstream anti-abortion movement pivoted to during the Roe years in order to pass onerous legislative restrictions. Cassidy has represented women who claim to be victims of abortion, including Norma McCorvey and Sandra Cano, the anonymous plaintiffs in Roe v. Wade and its companion case, who would eventually oppose abortion. Cassidy asserts all women suffer mental traumas after having abortions. In a major legal victory, he drafted a provision in South Dakota’s law (which was upheld by an appellate court in 2008) stating that abortion terminates “the life of a whole, separate, unique, living human being.” Abortion is currently banned in South Dakota, but Cassidy is trying to advance this language in future federal abortion challenges. He twists up the rights argument, saying allowing abortion violates a woman’s right to parent.

“We have to protect the real rights of pregnant mothers: their right to give birth to their child, their right to keep and maintain the relationship with their children, their right to enjoin the equal protection of the laws that say it’s a homicide to kill their child, and their right to an interest in their child’s welfare and life,” Cassidy said.

Cassidy and George and many of their legal peers have long claimed to oppose abortion laws that would penalize women. But their arguments have helped spawn bills that do create criminal penalties for the pregnant person. And mainly men are advancing them.

Personhood laws will diminish the rights of pregnant people, says Khiara M. Bridges, a law professor at the University of California, Berkeley.

“It’s kind of like a zero sum type of game in the sense that the more rights you give to fetuses, the fewer rights you give to the people that actually gestate them,” Bridges told States Newsroom in a phone interview. “We have to acknowledge the conflict as opposed to obscuring it, which I think George and Cassidy participate in that. They need to say with a straight face, like looking people dead in the eye, that the fetus’ well-being is much more important to them than the well being of the person who gestates it. Otherwise they’re just lying and trying to win by obscuring this truth.”

Pregnant people are already facing the legal and medical consequences of abortion bans and onerous restrictions, including bans on information-sharing and attempts from anti-abortion activists and lawmakers to prevent minors and women from traveling out of state for legal abortions in Alabama, Idaho, and Texas.

Determining personhood from conception has terrifying implications for pregnant people, legal experts say. But it would affect more than abortion. If applied broadly, it could affect population counts and tax benefits. Many lawmakers advocating for personhood are unable to fully articulate the full implications or even how to enforce these laws. But even aggressively anti-abortion state governments like Texas’s have indicated personhood laws might only be used to prevent abortion rather than in ways that could benefit the pregnant person or fetus. The Texas attorney general’s office recently rejected a personhood argument in a lawsuit brought by a former prison guard who partially blames the state for her stillbirth.

That Texas’s government was suddenly uninterested in calling fetal life a person when it was unrelated to an abortion law wouldn’t surprise writer Gabrielle Blair, who believes most anti-abortion politicians are disingenuous. The Mormon mom of six behind the popular DesignMom blog has injected a new framework in the reproductive rights debate: Men are disproportionately responsible for unwanted pregnancies, and they should not leave pregnancy prevention exclusively to women, or criminalize women’s pregnancy decisions.

“We’ve put the burden of pregnancy prevention on the person who is fertile for 24 hours a month, instead of the person who is fertile 24 hours a day, every day of their life,” Blair wrote in the 2022 book adaptation of her viral 2018 X (formerly Twitter) thread, titled “Ejaculate Responsibly: A Whole New Way to Think About Abortion.”

Blair’s manifesto, like Matthew Trewhella’s, is also finding an audience among lawmakers, many of them women. She told States Newsroom that she’s heard from lawmakers receiving the book in Ohio, South Carolina, and Utah. South Carolina Republican Sen. Katrina Shealy read it into the legislative record. Blair said she’s also had encouraging conversations with men about making reproductive rights their issue too — working with rather than against women.

“For almost fifty years, a lot of men were focused on what it would take to overturn Roe v. Wade, claiming they wanted to reduce abortions,” Blair wrote in her book. “At any point, men could have eliminated elective abortions … without ever touching an abortion law, without legislating about women’s bodies, without even mentioning women. All men had to do was ejaculate responsibly. They chose not to. Today, they continue to choose not to.”

Some male-run groups pushing for stringent anti-abortion restrictions and penalties

• Defy Tyrants – Run by Matthew Trewhella, who has endorsed murdering abortion providers and promotes the idea of government defiance in the pursuit of ending abortion and LGBTQ rights, sometimes to violent ends.

• End Abortion Now – Headed by Arizona-based Jeff Durbin and dedicated to passing personhood bills around the country that create homicide charges for women and health care providers.

• Foundation to Abolish Abortion – Run by Texas-based Bradley Pierce; crafts so-called “abolitionist” anti-abortion bills that include criminal penalties for the pregnant person.

• Free the States – Run by T. Russell Hunter, a self-described “abortion abolitionist” who opposes “pro-life” groups that do not seek criminal penalties for the pregnant person.

• National Men’s March to Abolish Abortion and Rally for Personhood – Jim Havens and “Protest Priest” Fr. Stephen Imbarrato organize all-male marches through various cities, calling on men to fight against the “daily mass murder of preborn children.”

• Operation Save America – Outgrowth of the 1980s-era militant anti-abortion movement, whose mostly white male pastors lobby extremist lawmakers to introduce punitive anti-abortion laws; they train their home-schooled children to advance this movement.

• Sanctuary Cities for the Unborn – Founded by Texas pastor Mark Lee Dickson, who along with former Texas solicitor general Jonathan Mitchell have been using city ordinances to ban abortion and are lobbying state officials to pass ordinances that ban abortion-related travel on local roads.

The post A men’s movement takes reins in a nationwide quest to end abortion appeared first on Nevada Current.

Pharmaceutical sciences professor Chris Adkins, who has questioned the accuracy and data used in a 2021 study authored by anti-abortion doctors about the key abortion drug mifepristone, says U.S.-based academic publisher Sage Publishing is reviewing the paper. (Courtesy Chris Adkins)

Policy, politics and progressive commentary

The post Study cited by Texas judge in abortion-pill case under investigation appeared first on Nevada Current.

Opill, a progestin-only contraceptive pill, will be available without a prescription in the first quarter of 2024, according to its manufacturer. (Photo courtesy of Perrigo Company.)

Policy, politics and progressive commentary

The U.S. Food and Drug Administration announced Thursday it has approved the country’s first daily birth control pill that can be used without a prescription, a move that reproductive health advocates celebrated after more than 20 years of advocating for an over-the-counter option.

The contraceptive, called Opill, is a progestin-only oral pill that could soon become available in drug stores, convenience stores and grocery stores, as well as online, without requiring a visit to a health care provider.

Frédérique Welgryn, an executive at Opill’s manufacturer, Perrigo, said during a press conference Thursday that the company will work with its regional partners to build distribution plans nationwide, and said Perrigo is committed to making Opill affordable, but the retail price is not yet available. The company anticipates the pill will be on sale in major retail stores across the country and online by early 2024 and also plans to work to list Opill as an option with private insurance and Medicaid.

Other reproductive-focused organizations, including the American College of Obstetricians and Gynecologists, celebrated the announcement, as did the American Medical Association. But Dr. Jesse M. Ehrenfeld, president of the American Medical Association, said in a statement that it should be the first step of approval for a variety of oral contraceptive options for over-the-counter use.

“It is important that patients have options when choosing which type of birth control works best for them. We hope this is just the first of several to be approved,” Ehrenfeld said. “We must continue to remove barriers to affordable care for those in underserved, high-poverty and rural communities. We know barriers to oral contraceptives can lead to inconsistent or discontinued use.”

The FDA said Opill should not be used by those who currently have or have ever had breast cancer, and those who have had any other form of cancer should ask a doctor before use. It should not be used with any other hormonal birth control product, including other oral pills, patches or injections, vaginal rings or intrauterine devices. The most common side effects of Opill are irregular bleeding, headaches, dizziness, nausea, increased appetite, abdominal pain, cramps or bloating, according to the approval announcement.

Unintended pregnancy associated with poor outcomes

Welgryn said it took more than eight years to conduct the research for approval and complete the lengthy application process with the FDA.

“This has been a journey fueled by the passion of our team, researchers, health providers, advocates and women themselves, along with the unwavering belief that the women and people of this country should have greater access and fewer barriers when it comes to their reproductive health,” Welgryn said. “Today’s decision follows nearly 50 years of data and research showing that progestin-only pills such as Opill are safe and effective. It follows the joint FDA advisory committee’s unanimous votes recommending Opill … because the benefits of having access to Opill over the counter overwhelmingly outweigh the potential risks.”

Welgryn said an estimated 40 million women in America need contraception, and approximately 15 million of those are using a less effective method or no method at all, while 10 million are already using an oral contraceptive pill with a prescription.

According to research from the Guttmacher Institute, nearly half of the 6.1 million pregnancies in the U.S. in 2011 were unintended, and 18% of those pregnancies were considered unwanted. Further research has determined unintended pregnancy is significantly associated with higher incidences of depression during pregnancy and postpartum, along with higher rates of preterm birth and low infant birth weights.

Dr. Stephanie Sober, global lead of medical affairs for Perrigo, said during the press conference that the country’s current reproductive health landscape makes the pill’s approval all the more important. Fourteen states have near-total bans on abortion, and Iowa could soon join Georgia with a gestational ban at six weeks, before many people realize they are pregnant. Indiana’s abortion ban, which applies to all stages of pregnancy with exceptions for rape, incest, fetal anomalies and the life of the pregnant person, is expected to take effect Aug. 1.

“Opill over-the-counter paves the way for improved access by removing barriers for the people who struggle to access contraception most, particularly people working to make ends meet, people of color, young people, and those who live in rural areas,” Sober said.

“For some, the ability to secure insurance, find a provider, make an appointment, and then obtain child care and access reliable transportation, all can create an insurmountable obstacle to obtaining contraception. Being able to pick it up at a pharmacy knocks down those obstacles, and it’s truly game changing.”

The post FDA approves first over-the-counter oral contraceptive appeared first on Nevada Current.

The Society of Family Planning found in the nine months after the Dobbs decision, the rate of medication abortion jumped, but overall, providers reported more than 25,000 fewer abortions nationwide. (Getty Images)

Policy, politics and progressive commentary

Editors’ note: This report is part of a special States Newsroom series on abortion access one year after the U.S. Supreme Court decision struck down the federal right to abortion.

In April, a Reddit user in Alabama posted a breathless message to the abortion subreddit the morning after learning she was pregnant. She guessed she was early, two or three weeks maybe.

“There’s a clinic in GA about 3 hours away. They said they will do it as long as no heartbeat is found on the ultrasound. If they find a heartbeat what do I do then??”

Alabama, where abortion is a crime, is surrounded by states with abortion bans. But nearby Georgia currently allows a tiny window, which shuts once the embryo’s cardiac activity registers on an ultrasound. This happens generally by six weeks’ gestation, and the user was running out of time. In reality, she had to have been farther along, as pregnancy is counted from the first day of one’s last period. And now she was sick to her stomach and passing gelatinous blood clots.

This very active subreddit is moderated around the clock by the Online Abortion Resource Squad, a group of mostly volunteers that debunk abortion misinformation and help users navigate a labyrinth of abortion bans and restrictions. The end of federal abortion rights changed access nationwide. Even ending a wanted pregnancy is now more difficult based on your income, how far along you are, and your state’s ever-changing abortion laws.

In a plot twist for the user in Alabama, it turned out she had likely miscarried. “UPDATE!!!!! My uterus is empty,” she wrote. “Basically alabama politicians made me drive across state lines and pay $250 because I was too scared to go to my regular doctor .”

But then there’s the Reddit user who described weeping in a Planned Parenthood clinic because her pregnancy measured just a few days beyond its 19.6-week cutoff. Staff helped her make an appointment at another clinic. “I really want this to be over with,” she wrote. “Now to just figure out transportation for next Saturday. Easy enough. *fingers crossed*”

It’s been a year since the U.S. Supreme Court ruled in Dobbs v. Jackson Women’s Health Organization that states could criminalize all or most abortions, and now 15 states fully or mostly ban the procedure, while others have begun enacting gestational limits and other restrictions. That’s left the hundreds of thousands of U.S. women and minors who annually seek abortions forced to travel if they can, overwhelming the abortion clinics in states where it’s legal. This has led to astronomical patient costs and major care delays.

As a result, abortions in the second and third trimester of pregnancy appear to be on the rise, abortion providers, public health researchers, and patient advocates told States Newsroom. Many patients, they say, are experiencing the higher risks of complication, anxiety, and trauma that sometimes come with abortion later in pregnancy. And advocates say this situation is likely to get worse, with an abortion-provider shortage and states continuing to throw up new legislative barriers.

“Right now, in any state, there’s just no scenario where people aren’t getting delayed because of wait times for appointments,” said Ariella Messing, who founded OARS.

Messing told States Newsroom she spends about 80 hours a week managing the abortion subreddit and helping connect people to abortion providers and financial and practical support. OARS has been monitoring the subreddit since 2019, but activity spiked after Texas outlawed most abortions in 2021. Since Dobbs, it’s exploded. Messing said OARS decided to keep r/abortion open during the Reddit blackout protest.

Some of the abortion cases are so complicated and medically necessary that Messing, who previously worked as a case manager for the Baltimore Abortion Fund, personally gets involved, sometimes spending a whole day trying to help someone desperate to terminate a pregnancy under a ticking clock.

The woman for whom it took eight weeks to terminate a pregnancy that had become dangerous  kept Messing up at night, until that person terminated, finally, at 27 weeks.

“This wasn’t how they should be getting care – by a random stranger on Reddit,” Messing said.

Overwhelmed abortion providers and assistance groups

While the true extent to which Dobbs has prevented people from getting abortions remains to be seen, emerging research suggests that women and minors are increasingly unable to end a pregnancy, especially people of color and people living in poverty.

The Society of Family Planning has been measuring the number of abortions reported by abortion clinics and hospitals. In the nine months after the Dobbs decision, the rate of medication abortion jumped, but overall, providers reported more than 25,000 fewer abortions nationwide.

The Society’s latest #WeCount report did not capture how many people self-managed outside the formal health care system, or how far along patients were. But University of California San Francisco professor Ushma Upadhyay, who co-chairs the #WeCount project, said it would be logical for gestational ages to be rising, given the increased obstacles in accessing care quickly.

Additionally, brand-new research from the university’s Advancing New Standards in Reproductive Health program finds a nationwide increase in providers offering abortion later in gestation than they were previously due to rising demand, as well as more clinics offering telehealth medication abortion. But the demand is still overshadowing the need, especially later in pregnancy.

“The states where there are bans now, there were very few clinics in those states, because there were so many restrictions,” Upadhyay said. “But those clinics that were open did offer abortion care till later, usually midway of the second trimester. … So, right now there’s huge swaths of the country where later abortion is simply unavailable.”

Part of the problem is that so few clinics in the U.S., especially post Dobbs, go beyond 20 weeks’ gestation. The vast majority are independent clinics not part of the Planned Parenthood network, which has more resources and political clout than the independents.

There is a tiny cluster of clinics that provide abortions in the third trimester, on a case-by-case basis. One is in Boulder, Colorado, and the others are concentrated in and around Washington D.C., which has become a major national abortion destination.

Abortion providers say they are scheduling visits weeks out.

“Anecdotally, we are seeing in some places, people are being pushed, or people are having to delay their care, and it has resulted in people having procedures one to two weeks later than they then we saw the previous year,” said Melissa Fowler, chief program officer of the National Abortion Federation, which provides resources for abortion clinics and funds some patient costs. “And of course, we’re also seeing a delay with people who need later care as well.”

Dr. Sarah Traxler, the chief medical officer for Planned Parenthood North Central States, testified before the Minnesota lawmakers back in March about a 40% rise in second-trimester cases since Dobbs. The region encompasses Iowa, Minnesota, Nebraska, North Dakota, and South Dakota, with the bulk of patients going to Minnesota.

“Since June, I have cared for patients from everywhere,” Traxler testified. “I’ve seen patients who’ve flown from Louisiana, only to find that their complex pregnancy condition kept them from being seen in a freestanding clinic like mine, forcing them to continue a dangerous pregnancy because hospital-based care was not available to them.”

Astronomical costs

A first-trimester abortion can range from $500-$1,000 to tens of thousands in the second trimester, and up to $25,000 in the third, said Jade Hurley, communications manager for the DC Abortion Fund, one of more than 100 mutual aid organizations to crop up during the past two decades to help cover these steep costs, which are compounded by travel, transportation, and child care costs.

Financial and logistical barriers to abortion are not new, but Dobbs has exacerbated them. Shortly after the Supreme Court originally enshrined federal abortion rights in 1973, anti-abortion lawmakers began passing public-insurance bans on abortion, as a way to at least prevent part of the population from accessing this medical procedure.

“I would certainly like to prevent, if I could legally, anybody having an abortion – a rich woman, a middle class woman, or a poor woman,” said the late U.S. Rep. Henry Hyde (R-Ill.) during a floor debate in 1976 to defend a ban on the use of Medicaid insurance for abortion. “Unfortunately, the only vehicle available is the [Medicaid appropriations] bill.”

Just over a dozen states allow Medicaid to cover abortion using state-only funding. And as costs rise, abortion and practical-support funds around the country report receiving more higher dollar requests. These days funds typically have to work together, pooling grants from multiple funds just to serve one patient. Representatives from multiple abortion funds told States Newsroom they are also receiving more donations than at any other time, but they say the need is still overwhelming demand.

Hurley told States Newsroom in an email that since Dobbs, the fund has pledged nearly $2.3 million to more than 3,000 callers seeking abortions in the D.C. area. Their average pledge has jumped from $260 to $710, a 173% increase. Last month, the highest gap they filled was $4,500, Hurley said.

“We’re seeing a huge amount of people coming from all over the country,” Hurley said during a recent webinar hosted by the abortion-rights activist group Reproaction. “We had a person come from California very recently, which is honestly, you know, it’s shocking, because that’s so far away. … We’re dealing with funding gaps that we didn’t even know existed. And I think overall we don’t even know the true need that’s out there, from D.C. to across the country.”

Medication abortions are getting later, too

Two months ago, a 40-year-old woman in Arizona delivered a lifeless 13-week-old fetus into a plastic food storage container. The woman, who asked not to be named out of fear of criminal prosecution, told States Newsroom that the fetus had obvious deformities. She was a much wanted rainbow baby, the term given to a baby born after a pregnancy loss.

Until recently this mother of seven was “1,000% against abortion.” One stillbirth separates two sets of three kids. Her eighth pregnancy, last year, resulted in a twinless twin. But this pregnancy was even grimmer: What started out as triplets became one surviving embryo. At 13 weeks, the remaining living fetus was diagnosed with trisomy 18, a fatal genetic condition.

She voraciously read the literature on trisomy 18 and learned that the vast majority of babies born with this disease die before their first birthday, within months, days, or hours. For her the decision to terminate was simple. “Imagine bringing this baby home and all my kids love her and get attached, and then she died at 3 months or something?” she said.

But getting timely, legal care was a different story.

Her state currently allows abortion up to 15 weeks’ gestation, while an 1864 total abortion ban works its way through the courts. However, Arizona criminalizes something only a handful states do: Terminating a pregnancy because of fetal genetic abnormalities. Her doctor said she couldn’t terminate the pregnancy but suggested she go to an abortion clinic and not disclose she’d had genetic testing done. But the nearest clinics were booked out until May and June. A clinic in Nevada could see her, but she didn’t have the money or ability to travel.

Because she’s had so many kids and two stillbirths, the Arizona woman decided to go outside the medical system. She had her stepdad get her misoprostol over the border in Mexico. This medication is typically used to treat ulcers but is also an abortifacient, and it’s available over the counter for around $30 in Mexico. The typical two-drug regimen approved by the U.S. Food and Drug Administration two decades ago comprises the hormone-blocker mifepristone followed by misoprostol, which causes the uterus to contract and expel the embryonic or fetal remains.

Medication abortion – whether obtained at a clinic or via legal telemedicine, or by ordering pills from abroad – has helped fill an access gap since Dobbs. Most often women are terminating with the same two-drug regimen approved by the FDA. However, that protocol is approved only for up to 10 weeks’ gestation, while the World Health Organization okays the protocol for 12 weeks.

But many women are taking the medication as soon as they get them, even if that means well into the second trimester, because of travel and shipping delays, which fundamentally changes the experience. Rather than experiencing what may describe as moderate to heavy bleeding and moderate to excruciating cramps, second-trimester medication abortions involve delivering a more developed fetus, with its umbilical cord and placenta.

It took the Arizona woman about seven hours to deliver the fetus and placenta using the misoprostol-only regime, followed by weeks of bleeding. This method is considered safe and effective, but is associated with higher rates of incomplete abortion, and pain. Days later, the woman’s doctor found retained placenta inside her. She says she couldn’t imagine having done this without her birthing experience or guidance from her regular medical providers.

“Being like my basically ninth delivery, I knew what to do,” she said, “I would never just give the pills to somebody that has never had a baby. … I understood delivering the baby and then delivering the placenta, and my water breaking. But if you’re like a first-time mom, and you had to go through the pills at the gestation I did, they would freak out.”

And that’s exactly what’s happening, says family physician Linda Prine, who co-founded the Miscarriage and Abortion Hotline to help guide pregnant people seeking information on where to get abortion drugs and how to self-manage their abortions safely. She said at least once a day now the hotline is hearing from women who took the medication in the second trimester and were unprepared to deliver an intact fetus.

“Prior to the fall of Roe, we probably only had two calls per year of anyone using pills past 13 weeks. Now we have several every week and sometimes daily,” Prine told States Newsroom a few months ago, for a previous story. “The issues we see are the psychological trauma if they are not prepared for the experience, and the potential legal risks.”

Abortion access advocates note that all of this will be compounded if the U.S. Supreme Court ultimately orders a recall or severely restricts the abortion drug mifepristone in a high stakes lawsuit currently making its way to the high court.

‘End of the line’

For the many years that Roe v. Wade protected abortion rights, the vast majority of abortions happened in the earliest stages of embryonic and fetal development. In 2020, the Centers for Disease Control and Prevention reported that 93% of abortions took place before 13 weeks, less than 6% performed between 14 and 20 weeks, and less than 1% after 21 weeks’ gestation.

That 1% represents the most expensive, complex, and controversial abortion cases. They are multi-day procedures that involve on-call care and are performed by a vanishingly small number of providers. A physician well known for this work, Dr. George Tiller, was villainized by Fox News years before an anti-abortion advocate assassinated him in 2009.

At 84, Dr. Warren Hern, a former colleague of Tiller’s, is the oldest doctor doing this work, in Colorado. Another Tiller colleague, Dr. LeRoy Carhart, who provided later abortions in Maryland, died this past April at 81.

Shortly after Dobbs, Hern said his Boulder Abortion Clinic was seeing an uptick of 50% more patients but has been unable to sustain the demand. Hern told States Newsroom that his small clinic sees a weekly average of six to 12 cases from around the country, which is still more than before Dobbs. Whereas before his clinic would coordinate aftercare with patients’ regular doctors, now Hern said he rarely communicates with OB-GYNs in banned states and sends patients with generic letters hoping they will receive necessary aftercare.

“This is a national catastrophe,” Hern said. “The details are in our face every single day, every week. It has unfolding complications and consequences across the country for women, many of whom are not wanting an abortion, but they can’t get medical care for the pregnancy because the doctors are afraid.”

Slowly a younger crop of third-trimester abortion providers is emerging. Morgan Nuzzo, an advanced practice clinician nurse-midwife, started an all-trimester abortion clinic Partners in Abortion Care in College Park, Maryland, seven months ago with her partner Dr. Diane Horvath, an OB-GYN who specializes in complex family planning and has provided abortion for almost two decades.

Nuzzo says colleagues refer to clinics like hers as the “end of the line,” one of the last places in the country they can go for a safe and legal abortion. They see people on the spectrum of disability, from the very rich to the very poor. The oldest patient Nuzzo has seen is 53; the youngest is 10. Children over-represent Partners in Abortion Care’s patient population, Nuzzo said. As research shows, many people seek abortions into the later stages of pregnancy because they found out new information about the pregnancy (such as a fatal fetal anomaly or a new health risk) or their life circumstances, or because they didn’t know they were pregnant.

What her patients and their parents do share in common these days is confusion and anger, Nuzzo said.

“Even people who are dismayed by grief, by this horrible fetal diagnosis they might have received later in pregnancy, are still angry and frustrated at the chaos that they have to navigate in their times of greatest need,” Nuzzo told States Newsroom. “It is confusing, it is constantly changing, and it is chaotic. And sometimes you start to believe that that’s on purpose.”

Partners in Abortion Care treats an average of 10 to 12 patients weekly, Nuzzo said, prioritizing abortions after 20 weeks, with growing wait lists. They have to turn away at least one patient a week, she said, often because the patient is too far along, or has complicating health factors. Then it’s time to talk to patients about other options: carrying to term, or adoption. Partners requires patients to secure an ultrasound in advance to confirm how far along they are, but she said patients in states with bans are often too scared or unable to obtain an ultrasound outside of religious anti-abortion pregnancy centers, which are typically unregulated and offer non-diagnostic ultrasounds.

“The number of fetal genital pictures that people are given with no accurate dating associated with it has been astronomical since we opened,” Nuzzo said. “So, ‘I’m a girl,’ ‘I’m a boy,’ and a picture of a penis or a vagina. And a lot of times, that’s the only picture they’ll give to a patient. And I’m like, What am I supposed to do with this? This gives me no information.”

Consequential compromises on later abortion

In 2015, North Carolina Rep. Tricia Cotham made national headlines when she told her colleagues on the House floor about the painful and heartbreaking “induced miscarriage” she once had for a wanted but doomed and dangerous pregnancy. “This decision was up to me, my husband, my doctor, and my God,” she testified. “It was not up to any of you in this chamber.”

Then a Democrat, Cotham was testifying against a 72-hour abortion waiting period, which opponents argued would exacerbate abortion delays and which ultimately became law. Cotham told Time magazineshe’d wanted to quell later-abortion stigma.

But in April, Cotham, who campaigned on abortion rights, switched parties. Soon after, she helped state Republicans override the governor’s veto of a new 12-week abortion ban, which has limited exceptions for fetal anomalies. She also switched her own abortion narrative, now calling it a spontaneous miscarriage, contradicting her own words.

More GOP-led states (and presidential candidates) are leaning away from radioactive total abortion bans, and into these so-called gestational compromises. Like North Carolina, Nebraska recently prohibited abortions after 12 weeks. Florida’s new 6-week ban is on hold while courts litigate the state’s 15-week abortion ban.

A few Democratic-led states, meanwhile, are working on efforts to lift or relax their third-trimester gestational limits, like in Maine and Minnesota. But many others still ban abortion by or before 24 weeks’ gestation, with some exceptions. And many of the state abortion-rights amendment initiatives underway also maintain this Roe-era standard.

Like Cotham, Erika Christensen is a white woman with enough privilege to have accessed a later abortion because of fetal anomalies. Because even in 2016, the abortion-access landscape and policies already made it incredibly difficult to access and, for her, emotionally harrowing. But Christensen’s pregnancy experience took her in a different professional direction than Cotham.

“We were radicalized by the plane,” said Christensen, who was turned away in New York City and flew to Colorado for a multi-day procedure that cost thousands of dollars out of pocket. She and her husband soon after started Patient Forward, a later abortion advocacy group that successfully lobbied New York to relax its abortion law. Christensen said Roe-era gestational limits are too restrictive for this current landscape, and she criticizes Democratic-led initiatives that attempt to compromise on later abortion.

“There used to be a path where you could care for your patients up to a point, and then you sent them out of state,” Christensen said. “And you wouldn’t really have to put yourself out on the limb because there was somebody else who would take care of your patient. That path is gone. It’s dead, and it’s never coming back, not while we have what we have. So when we compromise on this population, we are really condemning them to forced pregnancy and birth.”

The post After Dobbs, abortion access is harder, comes later and with a higher risk appeared first on Nevada Current.

The U.S. Food and Drug Administration approved mifepristone, a key abortion drug, 23 years ago, and experts say it has been found to be safe, a claim a group of anti-abortion groups and four doctors challenge in seeking revocation of its federal approval. (Photo illustration by Anna Moneymaker/Getty Images)

Policy, politics and progressive commentary

America’s major medical institutions and drug policy scholars have roundly denounced as “pseudoscience” many of the claims brought by anti-abortion groups in a high-profile federal lawsuit asking the Food and Drug Administration to revoke its 23-year-old approval of mifepristone, one half of a two-drug regimen that has become the most common form of pregnancy termination post-Roe v. Wade.

But the appeals court’s three-judge panel that heard oral arguments Wednesday appeared to be persuaded not by the medical consensus in this case, but by some of the evidence brought forward by plaintiffs that consists largely of anecdotes, speculation, and cherry-picked studies brought by a handful of anti-abortion medical groups and doctors.  

Medical and public health societies led by the American Medical Association submitted a “friend of the court” brief before the 5th U.S. Circuit Court of Appeals, stating that the lower court’s ruling “relies on pseudoscience and on speculation, and adopts wholesale and without appropriate judicial inquiry the assertions of a small group of declarants who are ideologically opposed to abortion care and at odds with the overwhelming majority of the medical community and the FDA.”

While asking a question of U.S. Deputy Assistant Attorney General Sarah Harrington, Judge Jennifer Walker Elrod referred to mifepristone cutting off “nutrition” to the fetus, which is a false claim cited in the initial ruling written by Texas federal Judge Matthew Kacsmaryk in April. Kacsmaryk referred to mifepristone as a “synthetic steroid that blocks the hormone progesterone, halts nutrition, and ultimately starves the unborn human until death.”

According to Johns Hopkins Medicine, the progesterone hormone is produced in early pregnancy to help thicken the lining of the uterus to support implantation of a fertilized egg. Without that hormone stimulation, which mifepristone blocks, the lining breaks down and the pregnancy cannot continue. It is then followed by doses of misoprostol to induce contractions and expel the pregnancy.  

Former President George W. Bush appointee Elrod – like her fellow Donald Trump appointee Judges James C. Ho and Cory T. Wilson – shares ideological views on abortion with the plaintiffs’ anti-abortion coalition, which is represented by the Alliance Defending Freedom. So does Kacsmaryk, whose since-blocked decision to suspend FDA approval of mifepristone cites anecdotal evidence from plaintiffs. 

Mifepristone remains legal and on the market as the case winds its way through the legal system, and data from the FDA since the drug’s initial approval in 2000 shows it is overwhelmingly safe to use. Out of an estimated 5.6 million people in 23 years, 28 deaths have been associated with the FDA’s abortion medication regimen, which is a markedly lower rate than many common FDA-approved drugs, like Tylenol and Viagra. And as the FDA has noted, that number includes fatal cases “regardless of causal attribution to mifepristone,” such as people who died from homicide, suicide, and pulmonary emphysema. 

If the plaintiffs prevail, health care providers, medical institutions and pharmaceutical industry organizations have warned of its potentially catastrophic consequences. In addition to radically reducing access to abortion nationwide, removing mifepristone from the market would reduce access for miscarriage treatment, public health experts say, and have far-reaching consequences beyond abortion.

“The implications of this case are extraordinary, and they include the potential termination of access to mifepristone, a precedent for court interference in the FDA’s rigorous and science-based testing and approval process not just for mifepristone, but for any drug,” said Joanne Rosen, a senior lecturer in the departments of Health Policy and Management and Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health, during a media briefing hosted by the university Thursday. “This would be the first time in history that a court has abrogated the FDA’s approval of a drug over the objections of the FDA.”

Sympathetic, cynical and combative exchanges

The appeals court judges seemed sympathetic to the narrative brought by the plaintiffs that mifepristone is a dangerous drug, as they were in their previous opinion blocked by the Supreme Court, which would have restricted the use of mifepristone. A big question in this case has been whether the coalition of anti-abortion medical groups and four doctors, including Indiana state Sen. Dr. Tyler Johnson, have standing to sue. Plaintiffs have argued their doctors would suffer direct harm if mifepristone remains on the market.

Like medical and legal scholars following this case, Rosen said plaintiffs’ arguments for standing are weak, and if accepted would open the door to any group that wants to challenge the FDA’s approval of a drug for any reason.  

Plaintiff groups argue that their member doctors could be overwhelmed with a potential future influx of emergency room visits from mifepristone patients, or forced to treat an abortion patient against their will. These claims are based not on robust data but largely on the testimony of handful of plaintiff doctors, three of whom give mostly non-specific anecdotes about treatment they performed for women who allegedly had taken some form of medication abortion, but it’s not clear when the procedures took place and whether it was the FDA’s regimen. 

Harrington argued on behalf of the federal government that plaintiffs had not made claims of being forced to treat abortion patients against their will. 

“They claim injury from speculative downstream effects of choices made by a chain of other people who are not parties to this lawsuit,” Harrington said.

But Wilson pushed back.

“The declarants here said they’ve seen these patients, they’ve cared for them,” he said. “I take that to mean that they treated them and that they expect to see more in the future. How’s that not enough for standing if the doctor also has a conscience objection to doing so?”

The judges made a series of sometimes snarky and combative comments and questions aimed at the attorneys for the U.S. Department of Justice, representing the FDA, and the mifepristone manufacturer Danco Laboratories, and called into question trust in the FDA’s expertise and judgment. 

Echoing plaintiffs’ criticism of the FDA approving mifepristone as part of a particular category of drugs for serious illnesses, Ho said pregnancy is not a serious illness, quipping, “When we celebrated Mother’s Day, were we celebrating illness?”

A question of evidence

And they misstated non-scientific assertions by plaintiffs, such as claiming that non-fatal adverse reporting is no longer required by the FDA. Mifepristone manufacturers (but no longer medical providers) are still required to report non-fatal adverse reactions.

Much of the anti-abortion evidence submitted in this case was authored by researchers who work for the anti-abortion Charlotte Lozier Institute, whose role is to defend abortion bans and restrictions with research. Regarding mifepristone, Charlotte Lozier’s researchers have published articles that mostly speculate large amounts of under-reporting when it comes to abortion complications, and argue the true risk of mifepristone is unknown. 

Another anti-abortion organization, the Family Research Council, also submitted a 125-page amicus brief with false claims that the drug approval was expedited by former President Bill Clinton. It also cites research from the Charlotte Lozier Institute to back claims that the drug is unsafe. 

Judges echoed this sentiment and speculated on the safety of telemedicine abortion and questioned the FDA’s process of loosening restrictions over time. Elrod asked Harrington if a medical provider could examine someone via email rather than video, and if people could use telemedicine as an “intermediary” to send the medication to a state with an abortion ban. Elrod referenced amicus briefs that alleged individuals were engaging in those tactics to skirt state laws. 

Harrington said the statements referenced by Elrod in the briefs are unsupported and irrelevant to the central issue.

“None of that is dictated by the FDA, and none of that is relevant to whether the FDA’s determination that this drug is safe and effective with these conditions in place,” Harrington said.

Elrod pushed back, asking if it was a relevant factor to consider in issuing an injunction that would limit access to the drug. 

“If it’s violating other law, which we have to determine, perhaps, then we have to decide whether or not it’s appropriate to enter an injunction or not and that’s one of the factors we would consider,” Elrod said.

Public health experts say the appeals court’s attitudes toward the science in this case are deeply concerning. 

“Judges and lawmakers should not be substituting their own opinion for the experience, expertise, and authority of the U.S. Food and Drug Administration. Nor should they ignore the substantial weight of scientific evidence from hundreds of studies and millions of patients confirming the safety and effectiveness of mifepristone, which has been used for decades in both medication abortion and miscarriage management,” said AMA President Dr. Jack Resneck Jr. in a recent statement. 

Even if the appeals court rules to restrict or revoke approval of mifepristone, the federal government will most likely appeal the case to the U.S. Supreme Court. Regardless, the 5th Circuit Court judges’ reasoning could prove influential to the Supreme Court’s eventual decision. 

The post Appeals court judges embrace anti-abortion speculation appeared first on Nevada Current.