The Truth About Abortion

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by Sophia Yen MD MPH, pediatrician, adolescent medicine specialist.

Given that there are banners up on Market Street (San Francisco’s main thoroughfare) telling lies about abortion, saying “Abortion Hurts Women” and that the anti-abortion, anti-birthcontrol, anti-reprojustice marchers/rallies/leaders have been known to say a few myths about abortion, I thought it was important to write a piece about the Truth about Abortion.

The Truth is: Abortion doesn’t hurt women, but lies about abortion and lack of access to abortion hurt women.

Most of this comes from:

1. Abortion is safer than carrying a pregnancy to term (because of the many complications of pregnancy). First trimester abortion is one of the safest medical procedures, with minimal risk of major complications.

2. Abortion does not increase your risk of breast cancer.

3. Women who get abortions do not have a higher rate of depression and drug use, than women who do not get abortions.

4. >70% of women getting an abortion report a religious affiliation. 37% protestant, 28% Catholic and 7% other. 25% attend religious services at least once a month.

5. Abortions performed in the first trimester pose virtually no long-term risk of problems such as infertility, ectopic pregnancy, spontaneous abortion (miscarriage) or birth defect, and little or no risk of preterm or low-birth-weight deliveries.

6. 90% of abortions occur in the 1st 12 weeks of pregnancy. 33% occur at 6 weeks of pregnancy or earlier. 60% occur in the 1st 8 weeks (when a woman has missed just 2 periods).

7. Why do women have abortions? “The reasons women give for having an abortion underscore their understanding of the responsibilities of parenthood and family life.”
75% state they have concerns for or responsibility to other individuals, including children. 75% say they cannot afford a child. 75% say that having a baby would interfere with work, school or ability to care of dependents. 50% say they do not want to be a single parent or are having problems with their husband or partner.

8. Roe v. Wade in 1973 established that women in consultation with their physicians have a constitutionally protected right to have an abortion before viability free from government interference.

9. A super-majority (78%) of Americans feel that abortion should be legal in some circumstances. 50% “legal only under certain circumstances” and 28% “legal under any circumstances.”

10. Research shows that women who choose abortion and get an abortion are less likely to be under the poverty line than those who want an abortion and “turned away.”

11. Most women getting abortions are already mothers. About 60% of the women that get abortions have already given birth to 1 child and 30% have 2 or more children.

12. No racial nor ethnic group makes up the majority of women choosing abortions. 36% are white, 30% are black, 25% are Hispanic, and 9% are of other race.

13. 50% of the women getting abortion are 25 years of age or OLDER.

14. Abortion is a common procedure. At 2008 abortions rates, 1 in 10 women will have an abortion by age 20, 1 in 4 women by age 30 and 3 in 10 by age 45. (Abortion rates have gone down by ~ 17% since 2008)

15. Access to birth control results in use of birth control, which results in fewer unplanned pregnancies, which results in fewer abortions. Birth control = fewer abortions. (I thought this was common ground with the anti-abortion people. Unfortunately, it is NOT common ground. The Family Research Council in its “truth about abortion” pamphlet says birth control leads to more sex, leads to more abortion.)

If you agree that lies about abortion are a public health hazard and that the City of SF should use the funds from the banners to launch a public health campaign about the Truth About Abortion, please join other concerned citizens, health professionals, parents of impressionable young adults, young adults and more in signing this petition. Please also share on FB/twitter/email lists.

Thank you for TrustingWomen with their personal health decisions.

Petition: San Francisco: Protect Women and Girls from Lies About Abortion!

Sign here:

Lies About Abortion SF Jan. 2014The Issues

Banners falsely claiming that “Abortion hurts women” are hanging from publicly managed lamp posts on Market Street in San Francisco. The banners are displayed in the City’s lowest-income communities, which experience the highest rates of low-weight births, and emergency room visits for pregnancy. (1)

The prominent display of this false anti-abortion statement on public property misinforms the public about our health. It undermines women’s personal and private medical decisions, and thereby undermines public health. It also misrepresents the City’s previous support for reproductive health, rights, and justice, particularly for our most vulnerable communities.

1. Abortion is safe.  Access to legal abortion services is essential.

Abortion is one of the safest medical procedures in the United States. The risk of death is 12 times higher for carrying a pregnancy to term, compared with abortion. (2).

Many women routinely lost their lives from illegal abortions before the landmark Supreme Court Case, Roe v. Wade, legalized abortion in 1973.  Today, deaths from abortion have all but disappeared.

Women and girls have the right to decide whether and when to have children. Public policies and services must support that right.

Access to legal and affordable family planning health care services, including abortion care, has been integral to expanding opportunities for success and satisfaction by women and girls in the emotional, economic, educational and professional spheres, as well as for the men and children in their lives and for communities as a whole.

One in three American women will have an abortion by age 45, and 95% of heterosexually active couples have used birth control.

Denied abortion care perpetuates poverty, and women with incomes below 200% of the federal poverty level are already five times more likely to have unintended pregnancies.

2. State and federal legislation increasingly aim to defund reproductive health care services and limit the rights of women and girls.

Campaigns to stigmatize and defund abortion impose repressive views about sexuality, disempower women and girls, and prevent them from choosing and using the vital reproductive health care services they think best. Tactics include legislation, violence against abortion providers, and harassment of patients at health centers. These actions hurt women and girls.

3. San Francisco must protect and advance the public’s health.

We are proud that San Francisco and California have strong policies to assure women’s reproductive health rights.  In January 2013, the City and County of San Francisco commemorated the 40th anniversary of Roe v. Wade and commended the work of pro-choice advocates and service providers in the City.

But the public must be able to trust and rely on the City to provide accurate, credible information in order to safeguard our health.

(1) San Francisco Department of Public Health, Health Care Services Master Plan

(2) Women’s Health STATS & FACTS 2011. American Congress of Obstetricians and Gynecologists. p. 2.

Sign here to oppose abortion stigma with public health facts:

We are shocked to see banners falsely claiming that “Abortion hurts women” hanging from the City’s publicly managed lamp posts on Market St. in San Francisco. This statement is false, and harmful to women and girls. The display contradicts City policies and practices.

The City should:

1. Publicly oppose the deliberately false anti-abortion messages on the banners hanging on Market Street, oppose the views of the rally to be held by anti-abortion groups in San Francisco on January 24, 2015, and advocate proactively for public health policies, services and messages that encourage the right of women and girls to choose the best course for their own reproductive health.

2. Review the permitting process for banners to require that public health statements are scientifically accurate or limit banners to the name, date and location of the event being advertised.

3. Devote all proceeds from the anti-abortion banners to a Department of Public Health campaign to educate vulnerable populations regarding accurate and scientifically verifiable information about reproductive health and rights, including accurate information about the safety of abortions.

The Public Health Facts: Abortion Stigma Hurts Women and Girls

Lies About Abortion SF Jan. 2014 The Public Health Facts for Choice, Voice, and Safe Legal Abortion : Shutting Down Abortion Stigma in San Francisco

Banners stating that “Abortion Hurts Women” are now displayed on public sites on Market Street, in San Francisco’s lowest-income communities, which experience the highest rates of low-weight births, and emergency room visits for pregnancy. (1) Sign here to demand public health messages that tell the truth:


Access to abortion is an issue that is relevant to young people.

Almost 615,000 U.S. women aged 15–19 (or 6%) become pregnant each year, according to the Guttmacher Institute.

  • In 2010, 60% of pregnancies among 15-19 year olds ended in birth, 26% in abortion, and the rest in miscarriage.
  • Black and Hispanic women have the highest teen pregnancy rates (100 and 84 per 1,000 women aged 15–19, respectively); whites have the lowest rate (38 per 1,000).

Women aged 15-19 had 157,490 abortions in 2010. About 5% of all abortions are obtained by minors. The reasons that teens most frequently give for having an abortion include concerns about changes in their lives due to having a baby, ability to afford a baby now, and not feeling mature enough to raise a child (2).

The pregnancy rate among young women has declined steadily, from 117 pregnancies per 1,000 women aged 15-19 in 1990 to 57 per 1,000 in 2010. The decline between 1995 and 2002 was mostly due to dramatic improvements in contraceptive use, with only 14% of the decline attributable to decreased sexual activity. The pregnancy rate among black teens decreased 56% between 1990 and 2010, more than the overall teen pregnancy rate (51%). Teenage women have increased their use of a single method of contraception or multiple methods simultaneously, and decreased nonuse of contraception (3). This suggests that avoiding having children during teenage years is important to young women.

Abortion is safe.  Access to legal abortion services is essential.

Abortion is one of the safest medical procedures in the United States. The risk of death is 12 times higher for carrying a pregnancy to term, compared with abortion. (4)

Many women routinely lost their lives from illegal abortions before the landmark Supreme Court Case, Roe v. Wade, legalized abortion in 1973.  Today, deaths from abortion have all but disappeared.

Women and girls have the right to decide whether and when to have children. Public policies and services must support that right. Access to legal and affordable family planning health care services has been integral to expanding opportunities for success and satisfaction by women and girls in the emotional, economic, educational and professional spheres, as well as for the men and children in their lives and for communities as a whole.

Denied abortion care perpetuates poverty, and women with incomes below 200% of the federal poverty level are already five times more likely to have unintended pregnancies.

Barriers to Access to Abortions: Funding Cuts, Legal Restrictions. Stigma

Low Income Women Are Unfairly Impacted By Funding Restrictions (5)

Shortly after the Supreme Court’s Roe v. Wade decision in 1973 legalizing abortion in every state, Congress enacted the Hyde Amendment to an appropriations bill. It bars the use of federal funds to pay for abortions except in cases of rape, incest, and a threat to the mother’s life. The Hyde Amendment has been renewed each year since 1976. Young women are disproportionately impacted by funding bans because they are less likely to have a steady source of income and more likely to be uninsured than women of all ages. The cost of an abortion ranges from $350 to $1000. (California exercises its state authority to pay for abortions through MediCal.)

Funding restrictions force one in four women to carry unwanted pregnancies to term, with the proportion higher among younger women. (6)

Teens Face Additional Barriers To Access, Including Lack of Accurate Information

The majority of states – thirty-nine as of January 2014 – currently enforce laws that require a young woman to notify or obtain consent from one or both parents before she can receive abortion care. These laws endanger young women’s health and safety, while having no clear impact on birth rates or abortion rates.

Most young women do consult their parents before seeking abortion care, but those who do not may face dangerous circumstances at home. 50% of pregnant teens have experienced violence; 30% of teens who do not tell their parents about their abortions feared violence or being forced to leave home.

Parental involvement laws often delay young women’s abortion care, leading to riskier, later-term abortion procedures.

Websites that teens turn to for sexual health information often have inaccurate information. For example, of 177 sexual health Web sites examined in a recent study, 46% of those addressing contraception and 35% of those addressing abortion contained inaccurate information. (6)

Anti-Abortion Forces Have Found Stigma is a Powerful Tool

Cultural factors impact women’s ability to access abortion and lead to an atmosphere of silence and stigma around abortion. The anti-abortion movement increasingly seeks both to erect overt barriers to abortion and to change cultural values, beliefs, and norms about abortion so that women will seek abortion less frequently regardless of its legal status. From photographing women entering clinics to distributing flyers to the neighbors of providers, the anti-abortion movement foments abortion stigma as a deliberate tactic, not just as a byproduct of its legislative initiatives. Many clinics are regularly visited by protestors; politicians and other public figures routinely condemn abortion as murder. Some religions forbid abortion. Set off from other medical practices and beset by picketers, the institutional arrangements of abortion provision may validate abortion stigma. Women may internalize abortion stigma so deeply that they feel judged even by those who support their decisions. Abortion stigma may cause women to feel less empowered to ask questions about the procedure and its health consequences. Eroding public support for the idea of abortion is seen as an underpinning of future institutional limits. (Joffe, 2009)

The result is fear of being judged and secrecy around abortion. (7) One study found that women ages 19-24 experienced more stigma and had more worries about being judged than women in other age groups

Opponents of abortion in the U.S. have championed a new argument, that ‘abortion hurts women.’ This argument positions women as victims of a profiteering abortion industry and objects of pity, reduces providers to cruel and callous manipulators and women to ‘damaged goods.’

Although definitively refuted by substantial scientific studies, alleged links between abortion, breast cancer, and impaired fertility have been used to frame a “women-centered” anti-abortion strategy. In contrast with other examples, in which abortion reveals or symbolizes flaws in women’s character, here women become flawed because of the experience of having an abortion, and the abortion provider is further tainted, now harming both fetus and woman.

Seven states have integrated groundless claims about the psychological effects of abortion (such as so-called post-abortion syndrome) into regulations. These institutional practices deny the normalcy of abortion as a technique and as medical care and reinforce stigmatizing ideas that abortion is unhealthy.

(1) San Francisco Department of Public Health, Health Care Services Master Plan. 2012.

(2) “American Teens’ Sexual and Reproductive Health.” Guttmacher Institute. May 2014. New York, NY.

(3) “Facts on American Teens’ Sources of Information About Sex.” Guttmacher Institute. Feb 2012. New York, NY.

(4) Women’s Health STATS & FACTS 2011. American Congress of Obstetricians and Gynecologists. p. 2.

(5) NARAL Pro-Choice America: Discriminatory Bans on Abortion Funding Threaten Women’s Health

(6)  “Abortion and Young People in the United States.” Advocates for Youth. Accessed at:

(7) Norris, Alison, et. al. “Abortion Stigma: A Reconceptualization of Constituents, Causes, and Consequences.” Women’s Health Issues. May-June 2011.  Volume 21, Issue 3, Supplement, pp. S49–S54. Accessed at

TWSR Compels CA Universities, Regulators, to Enforce Right to Abortion Coverage

It is the leadership and spirit of women and men who know when to speak up and stand up for our rights that create social change.  When the presidents at two  Jesuit-affiliated universities in California tried to bluster their way into canceling abortion benefits for faculty, staff, and their dependents, the Trust Women/Silver Ribbon Campaign, a project of the Center for Policy Analysis, geared up a challenge.  We researched key rules and regulations, linked a powerful coalition of activist faculty with key organizations to shine a bright public light on the problem, and strategized and targeted the state regulatory authority that had the power to reverse the universities’ action.  On August 22, 2014, the California Department of Managed Health Care (DMHC) issued formal letters to California’s 7 major insurance companies to clarify that California law “prohibits health plans from discriminating against women who choose to terminate a pregnancy. Exclusions and limitations are incompatible with both the law and multiple California judicial decisions that have unambiguously established that every pregnant woman has the fundamental right to choose to either bear a child or to have a legal abortion.”

Turning It Around!   How did this happen?  In the Fall of 2013, faculty at Loyola Marymount University (LMU) in Los Angeles and at Santa Clara University (SCU) were distressed when their presidents announced that their university health insurance plans were dropping long-standing coverage for abortions.  The universities justified their actions based on unspecified changes in state and federal laws, including the Affordable Care Act.

Here’s the catch: The faculty did not agree.

Anna Muraco, a sociology professor at LMU, was shocked.  With no idea whether the change was legal, she began writing about it online.

In Santa Clara, law professor Stephen Diamond resigned an appointment at the SCU Ethics Center, telling the local media that the administration was violating its obligation to consult with the faculty on a change in working conditions of this magnitude. History professor Nancy Unger was similarly distressed and outraged.  Her long and successful career at SCU had thrived in an atmosphere of commitment to social justice and diversity, with respect for Catholic doctrine. In this case, “Father Doesn’t Know Best,” she wrote in the San Jose Mercury News.

In fact, both Universities were violating longstanding California laws that require employer health plans to cover abortions.  But campus and health plan administrators asserted that the change was legal, and would proceed.

Then, we called Prof. Nancy Unger.

“When Ellen Shaffer, Director of the Trust Women/Silver Ribbon Campaign (TWSR) reached out to me about the situation at Santa Clara, I felt as if someone had thrown us a lifeline.”   Professor Nancy Unger, University of Santa Clara

“Within a week, we were on the phone with a coalition of advocacy and legal organizations. With TWSR’s guidance, our campuses gathered the information we needed to mount a challenge, and combined the skills and expertise of the coalition partners to develop a strategy that worked. We turned our situations around.”  Ana Muraco, Associate Professor of Sociology, Loyola Marymount University

The faculty didn’t leave it at that.  At Santa Clara, they voted by secret electronic ballot. Two-to-one, they told the University president and the trustees:  Take it back.  Reinstate our benefits.  And consult us if you’d like to know what we believe.

Meanwhile advocates pieced together what had happened through meetings with DMHC.  After Initial assurance that there had been an error, the fact-finding continued as campuses were about to reopen in Aug. 2014.  The California state legislature’s Women’s Caucus weighed in.

Legal and media staff based in Sacramento got the word from the Governor’s office that DMHC had concluded their investigation.  They identified the errors that had set events in motion, and would release a correction the following day.

On August 22, 2014, the California Department of Managed Health Care issued formal letters to California’s 7 major insurance companies to clarify that California law “prohibits health plans from discriminating against women who choose to terminate a pregnancy. Exclusions and limitations are incompatible with both the law and multiple California judicial decisions that have unambiguously established that every pregnant woman has the fundamental right to choose to either bear a child or to have a legal abortion.”

Stigma and intimidation can compound confusion about the hodge-podge of laws and court decisions that determine our rights to decide whether and when to have a child, free of coercion, discrimination or violence.   But coverage for safe, legal abortion care has been restored at SCU and LMU.  And the spirit of advocacy must continue to animate the law.


On Tuesday, November 18, 2014, the Trust Women/Silver Ribbon Campaign helped to organize two sessions on abortion rights at the annual meeting of the American Public Health Association in New Orleans.

The topics, and links to the presentations where available, follow:

Session 4169: Abortion and Reproductive Rights: History and Current Politics Tuesday, November 18, 2014: 10:30 AM-12:00 PM  

Moderator: Cynthia A. Pearson , National Women’s Health Network

10:30 AM: Poverty and politics- their impact on women’s reproductive health outcomes over time Richard Kimball, MSN/MPH, PHCNS-BC, PhD, RN

10:45 AM: Dr. celestino lajonchere and the provision of abortion services in early revolutionary Cuba Ross Danielson,  PhD

11:00 AM: Access to Abortion and Contraception as Measures of Inequality Ellen R. Shaffer, PhD MPH , Renee Carter, MD MPH, James Wohlleb, PhD

11:15 AM: Sex Education, Abortion and Pregnancy Criminalization – Shaming Legislation & Its Impact on Poor Women and Girls in the Conservative Evangelical South Cherisse Scott, Founder/CEO, SisterReach, Tennessee

Organized by: Socialist Caucus Endorsed by: Women’s Caucus, APHA-Committee on Women’s Right

Session 4345: P. Ellen Parsons Memorial Session: Stirring the pot to defend women’s rights in New Orleans and nationally Tuesday, November 18, 2014: 2:30 PM-4:00 PM

Organizer: Ellen R. Shaffer, PhD MPH

Moderator: Jenna Jerman PhD, Guttmacher Institute

2:30 PM: New Orleans: Advocating for reproductive justice and public health in an epicenter of disparities Lisa Richardson, PhD.

2:50 PM: Documenting the impact of the Hyde Amendment on women’s abortion access Amanda Dennis, DrPH, MBE, Ibis Reproductive Health

3:10 PM: Saying the “A” Word: Abortion Advocacy and Assistance in Louisiana Jessie Nieblas, MPH, New Orleans Abortion Fund

3:30 PM: We can’t go back: Advancing women’s rights is key to public health Ellen Shaffer, PhD, MPH, Renee Carter, MD MPH, James Wohlleb, PhD

Ellen Shaffer/TWSR in SF Chron: Sex-Selection Laws Fuel Discrimination

Letters to the editor, Sept. 21          Published 5:03 pm, Friday, September 19, 2014

Women are entirely capable of deciding whether and when to have children. Criminalizing abortion for any reason directly undermines the status, value and autonomy of women. “San Francisco feminism: Go ahead and abort girls” (Insight, Sept. 14) mistakenly suggests that bans on abortions based on the sex of the fetus are both acceptable and necessary to avoid wholesale femicide.

While choosing abortion based on sex is virtually unknown in the U.S., the best way to eliminate any vestige of the practice here and internationally is to demonstrate that our societies value women, from paying us equally to trusting our personal reasons for seeking an abortion.

The San Francisco Board of Supervisors, led by board President David Chiu, deserves support for its leadership in prohibiting abortion bans that promote racial stereotypes about Asian Americans and restrict women’s access to health care.

Ellen R. Shaffer, PhD, Director, Trust Women/Silver Ribbon Campaign, San Francisco

NAPAWF, TWSR: Sex-Selection Abortion Bans Hurt AAPI Women

SF Supv. David Chiu, Dr. Ellen Shaffer, Trust Women/Silver Ribbon Campaign; Shivana Jorawar, National Asian Pacific American Women's Forum; Jenny Lam, Chinese for Affirmative Action; Preeti Shekar, Alliance of South Asians Taking Action; Dr. Pratima Gupta, Physicians for Reproductive Health; Chelsea Gelbart, NARAL CA

SF Supv. David Chiu, Dr. Ellen Shaffer, Trust Women/Silver Ribbon Campaign; Shivana Jorawar, National Asian Pacific American Women’s Forum; Jenny Lam, Chinese for Affirmative Action; Preeti Shekar, Alliance of South Asians Taking Action; Dr. Pratima Gupta, Physicians for Reproductive Health; Chelsea Gelbart, NARAL CA

Since 2011, far-right politicians have been deceptively and stealthily passing abortion bans on the backs of Asian American women. Such laws were the second most-proposed abortion ban in 2013. They have been proposed in 21 states and are the law in 8 states, and the ban was recently introduced in California.These politicians are saying that Asians Americans do not value girl children and that, because of us, the country needs to pass “sex-selective abortion bans.” This is a strategic ruse; they do not care about women’s equality. In fact, these are the same politicians who vote time and time again against things like equal pay and anti-domestic violence laws. The bans are wolves in sheep’s clothing.

In addition to attacking women’s health, these bans promote negative racial stereotypes. Worse, Asian American women may be turned away at their doctor’s office because doctors are afraid to provide abortion care to us, lest they be sent to jail.

On September 9, President of the Board of Supervisors David Chiu introduced a resolution condemning these abortion bans. At a press conference on Sept. 9, 2014, Board President Chiu announced that Supervisors Breed, Cohen, Kim and Tang are co-sponsoring the measure. It states:

Opposing “Sex-Selective Abortion Bans”

Resolution affirming San Francisco’s opposition to “Sex-Selective Abortion Bans” that perpetuate racial stereotypes.

WHEREAS, In 2014, sex-selective abortion bans have become the second-most proposed abortion ban in the United States, introduced in 21 states and passed in 8 states, including Illinois, Pennsylvania, Oklahoma, Kansas, North Carolina, North Dakota, Arizona, and South Dakota.

WHEREAS, A sex-selective abortion ban prohibits abortions performed on the basis of sex; doctors who perform such a procedure could face jail time, fines or lawsuits from a patient or her spouse, parent, sibling or guardian; a doctor or nurse who suspects a patient is seeking a sex-selective abortion is required to report her to authorities;

WHEREAS, Lawmakers across the country have successfully advocated for sex-selective abortion bans by perpetuating false and harmful racial stereotypes that such laws are necessary to stop an influx of Asian immigrants from spreading this practice and that Asian American communities do not value the lives of women;

WHEREAS, Sex-selective abortion bans encourage racial profiling of women by some medical providers, can lead to the denial of reproductive health care services to women by some medical providers, and lead to further stigmatization of women, particularly Asian American women;

WHEREAS, In 2012, a sex-selective abortion ban was proposed in the U.S. Congress, benignly named the Prenatal Nondiscrimination Act, and in February 2014, a similar measure was proposed by California State Assembly, AB 2336 by Assemblywoman Shannon Grove;

           WHEREAS, Some versions of sex-selective abortion bans have also included a race-selective ban, that would ban abortions performed on the basis of race and are based on suggestions that African American women are not capable of responsible reproductive health decisions and that abortion providers have a racist agenda;

WHEREAS, The State of Arizona is currently facing a lawsuit brought against its race-and sex-selective ban by the American Civil Liberties Union, National Association for the Advancement of Colored People and National Asian Pacific American Women’s Forum, for being unconstitutionally discriminatory against African American and Asian American women;

WHEREAS, A coalition of Asian American and reproductive rights, health and justice organizations has formed to educate the public about the stereotyping inherent in sex-selective abortion bans, to condemn the rhetoric of ban advocates as deeply offensive, and to organize to defeat such discriminatory policies;

WHEREAS, No city or state in the country has yet taken a position to publicly oppose sex-selective abortion bans; now, therefore, be it

RESOLVED, That the San Francisco Board of Supervisors urges the California State Legislature to reject any future attempts to pass a state sex-selective abortion ban; and, be it

FURTHER RESOLVED, The San Francisco Board of Supervisors calls upon other cities, states and the federal government to likewise reject these discriminatory measures.



Hobby Lobby: Science Fiction Trumps Women’s Health

The Supreme Court’s majority decision in the case of Hobby Lobby et al. presents serious threats to women’s rights, to the public’s health and the public order. Efforts to override the decision at the state and federal levels require energetic support.


As the dissent by Supreme Court Justice Ruth Bader Ginsburg, supported by dissenting Justices Breyer, Kagan, and Sotomayor, notes, “In a decision of startling breadth, the Court holds that commercial enterprises, including corporations…can opt out of any law (saving only tax laws) they judge incompatible with their sincerely held religious beliefs.”

The troubling ruling specifically grants a wide range of for-profit corporations the right to opt out of the federally mandated requirement to provide all FDA-approved contraceptives to employees through their health insurance plans, without co-payments and deductibles. If tolerated and uncontested, the ruling will:

  • Re-instate financial barriers to the most expensive forms of contraception, which are also the most effective;
  • Stigmatize contraception, which will depress effective use;
  • Eliminate discussion of the negative impact on the health and interests of the people most affected, employees and women, by assigning human characteristics and religious beliefs and rights to corporations, which are by design a legal fiction.

Cost and stigma are barriers to health


Contraception is widely used and recognized as “a fundamental health care service and a basic public health measure.  The ability to plan, start, space, and discontinue bearing children has transformed everyday life for women, families, and communities. Along with other improvements in medical care and public health, it has vastly enhanced women’s autonomy, professional and educational achievement, and emotional satisfaction and helped extend their life span… Mandates requiring wider insurance coverage for birth control are associated with more consistent use of contraception.”[1]


The major U.S. medical and health care professional associations recommend access to all FDA-approved contraceptive drugs and devices to safeguard the health of women, to reduce unintended pregnancy, as well as to protect the health of women for whom pregnancy may be hazardous, even life threatening.[2]

From 2008-2011, the rates of pregnancy, births and abortions all declined steeply in the U.S.  “Contraceptive use improved during this period, as more women and couples were using highly effective long-acting reversible contraceptive methods, such as the IUD.” [3]

However, many women report that cost is a barrier to obtaining and using birth control consistently. Insertion of an IUD, the most reliable reversible form of birth control for women who tolerate it physically, and who choose it, can cost $1,000.

Sharp inequalities in the rate of unintended pregnancy persist, remaining 5 times higher for low-income women and women of color compared with higher-income and white women. Almost half of all pregnancies in the United States are unintended – an exceptionally high rate.[4]  The ACA requirement waiving cost-sharing is essential.

In its 2011 final report of recommendations for women’s preventive health services to be included under the Affordable Care Act, ‘Clinical Preventive Services for Women: Closing the Gaps‘, the Institute of Medicine (IOM), found that stigmatizing access and coverage would increase even further the high rate of unintended pregnancies, and discriminate against women.

The Hobby Lobby owners believe that 4 selected methods of contraception are abortifacients.  This is scientifically wrong in 3 cases, and questionable in a fourth.   Nevertheless, Justice Alito says for the Court, on pp. 37-8:  “it is not for us to say that their religious beliefs are mistaken or insubstantial,” as long as they reflect “an honest conviction.”

Granting for-profit corporations protection as religious minorities

The Hobby Lobby decision is startling in the absence of analysis of its likely negative impact on the health of the women employees for whom four effective and expensive contraceptives will no longer be available through their employer’s health insurance plans.  Worse, the argument that won the day for the corporation would apply even if the corporation were opposed to providing any and all contraceptives to employees.

The Supreme Court decision fundamentally redefines corporations in a manner that privileges the views of business owners over those of other citizens.

A corporation is in essence a legal fiction, created to facilitate the business activities and purposes of groups of people by shielding them as individuals from the risk of liability that is the inevitable consequence of a business enterprise.  The majority decision in Hobby Lobby, however, confounds this definition.  It claims that a for-profit corporation can in fact have religious beliefs, because it is no more than an “association of a group of people.”

The legal standard developed by an earlier Supreme Court to protect “discrete and insular” religious minorities requires that the “least restrictive” course of action be taken to comply with a law.

The current decision analyzes the potential harm to Hobby Lobby from complying with the ACA’s contraception mandate strictly in terms of whether or not its religious objection to that law is sufficiently accommodated.  The equation essentially asks, is the mandate to move corporate funds from one corporate bank account to an insurance company’s bank account more or less burdensome to the corporation’s preferred religious belief about contraception, compared with, for example, moving some of the corporation’s funds into its payment of taxes, and having the government cover some of the cost of the mandate?

Remember this?

The Court’s decision does not factor in the impact of the employer’s benefits choices on the vast majority of individuals who are not a corporation, but use contraceptives.

For these reasons and for the public health’s sake, efforts must be initiated and supported to override the decision by enforcing the mandate at the state and federal levels that health insurance plans must cover the full range of FDA-approved contraceptives at no additional cost to the individual.



[1] Shaffer ER, Sarfaty M, Ash AS. Contraceptive insurance mandates. Med Care. 2012 Jul;50(7):559-61.

[2] Jones R and Jerman J. Abortion Incidence and Service Availability in the United States, 2011. Guttmacher Institute. Feb, 1, 2014.

[3] Jones R and Jerman J. Abortion Incidence and Service Availability in the United States, 2011. Guttmacher Institute. Feb, 1, 2014.

[4] National Survey of Family Growth (Finer and Henshaw, 2006); cited in IOM (Institute of Medicine). 2011. Clinical Preventive Services for Women: Closing the Gaps. Washington, DC: The National Academies Press, p. 102.

Buffer Zones, Hobby Lobby, and Prof. Tribe

Sticks and stones can break our bones, and too many women know that sometimes words are just the opening act.

Last week the Supreme Court invalidated a Massachusetts law that creates a 35-foot buffer zone of safety to shield women entering abortion clinics from the vituperative abuse hurled by anti-rights protesters.  According to the National Abortion Fund, these protesters too frequently have turned violent.

The buffer zone decision is not our friend.  But the decision does not require us to concede, as  Laurence Tribe pompously proclaimed in Friday’s NY Times, that “neither empathy for [abortion partients’] anguish, nor the need to protect the safety of women seeking such services, nor the clear need to guard against the rising tide of state laws designed to restrict access to abortions, can justify far-reaching measures that restrict peaceful conversation in public spaces.”

According to USA Today, “The court ruled unanimously that Massachusetts went too far — literally — when it created 35-foot buffer zones around abortion clinics to keep demonstrators away from patients.

“The decision united Chief Justice John Roberts and the court’s four liberals, who said the distance improperly removed demonstrators from public sidewalks and spaces. The other conservative justices would have issued a more sweeping verdict, striking down the ban on grounds that it targets abortion opponents’  specific point of view.”

There will be much more to say about all this starting on Monday, when we learn whether and how the Court refrains from sacrificing its legitimacy in the Hobby Lobby case, which asks to assign religious beliefs to corporations, and on that basis grant corporations the right to reject scientific evidence and to deny its employees legally mandated coverage for contraception.

These cases challenge us to confront the complex web of factors that the law and advocates invoke to defend reproductive rights.  The ruling and other U.S. laws confuse money, ownership and privacy with women’s basic rights to safety, health, autonomy, self-determination and equal, non-discriminatory treatment; and the  government’s obligation to protect those rights.

We have to assert the strategies that have achieved progress to date: creating wide consensus in the court of public opinion that isolates and stigmatizes the beliefs, language and acts that undermine us, as well as winning legal remedies where possible, and .

We accept that verbal or physical sexual harassment is illegal at work, in part because it creates a hostile environment that discriminates against women.

But we’ve taken additional routes to isolate, stigmatize and suppress harmful speech and actions that are not necessarily illegal.  We’ve severely curbed the need for women to mentally teleport to a distant planet when walking past a construction site, in part by integrating the workforce, and in part by confronting men on the Neanderthal catcalling that too often ensued.  Real threats persist.  But, for example, Donald Sterling’s repugnant racial views and comments, undoubtedly long tolerated in private, met with swift justice in the court of public opinion once aired and confronted publicly.

Threats and acts of violence against patients are not tolerated inside any medical institution, and we cannot tolerate it en route.

Massachusetts should immediately replace and strengthen the buffer zone law, and Governor Deval Patrick and AG Martha Coakley have pledged to do so.

Laurence, honey, go soak your head.

The rest of us, let’s analyze the complex conditions we face, speak up, and mobilize in the interest of safety, health, and justice.

What’s Next?

#EveryWoman, The Hobby Lobby Case, and The Supreme Court

#EveryWoman at the Supreme Court


As the Supreme Court Justices deliberate, #EveryWoman aims to make sure that they know the mainstream views and practices of Americans regarding birth control. Women’s access to affordable contraception, that is responsive to each woman’s health and life conditions, is a fundamental right with widely accepted health benefits.

Public discussions around the Hobby Lobby and Conestoga Wood cases have sometimes been shrouded in technical debates over interpretations of the Religious Freedom Restoration Act.

In the words of Justice Kagan, regarding the Affordable Care Act:  Congress has given a statutory entitlement and that entitlement is to women and includes contraceptive coverage.

Whatever the Court decides, the Trust Women/Silver Ribbon Campaign and our supporters aim to assure that this access continues.

The Hobby Lobby Case

The Affordable Care Act as adopted in 2010 required all health insurance plans to cover contraception as a preventive health benefit for women, without any additional copayments or deductibles. But some religious groups opposed this provision, primarily the U.S. Conference of Catholic Bishops and some evangelical Christian groups.  The final regulations issued in 2013 provided exemptions from the contraception coverage mandate to a wide assortment of employers, including those that admittedly hire employees of other faiths.   Numerous private employers followed suit by seeking an exemption from the law, based on the religious beliefs of the owners.  Lower courts issued a variety of conflicting rulings.  The Supreme Court agreed to hear the case presented by two such corporations, Hobby Lobby and Conestoga Wood. The case was presented on March 25, 2014, and a decision is expected towards the end of June.

The owners of these 2 for-profit corporations assert that their personal religious beliefs are also held by their corporations. Those beliefs compel them to want to offer health insurance to their employees, and they agree to include coverage of contraceptives. However, their beliefs also include opposition to abortion.  They mistakenly believe that certain contraceptives cause abortions, in preventing a fertilized egg from implanting in the uterus wall.  Science has shown that, instead, these methods prevent fertilization.  If Hobby Lobby and Conestoga  Wood can legitimately avoid following the law due to these claims, it could destabilize a range of other laws.

Selected excerpts from the transcript of the hearing in March demonstrate the Justices’ range of views.

JUSTICE KAGAN: Justice Sotomayor is quite right that there are quite a number of medical treatments that different religious groups object to. So one religious group could opt out of this and another religious group could opt out of that and everything would be piecemeal and nothing would be uniform. (p.6)

JUSTICE KAGAN: But, again, Mr. Clement, as Justice Ginsburg said, this was a very uncontroversial law. Your understanding of this law, your interpretation of it, would essentially subject the entire U.S. Code to the highest test in constitutional law, to a compelling interest standard. So another employer comes in and that employer says, I have a religious objection to sex discrimination laws; and then another employer comes in, I have a religious objection to minimum wage laws; and then another, family leave; and then another, child labor laws. And all of that is subject to the exact same test which you say is this unbelievably high test, the compelling interest standard with the least restrictive alternative. (p.14)

JUSTICE KAGAN: Well, with respect, Mr. Clement, I think that … the Court has had a different understanding of what the Religious Freedom Restoration Act does and the kind of analysis that it requires courts to perform than you’re arguing for in this case. …if your argument were adopted and there was a strict scrutiny standard of the kind that usually applies and a least restrictive alternative requirement, then you would see religious objectors come out of the woodwork  with respect to all of these laws. And because you say — and I think this is absolutely right when you say it — that you cannot test the centrality of a belief to a religion, you cannot test the sincerity of religion. I think a court’s hands would be bound when faced with all these challenges if your standard applies. (p.16)

JUSTICE KAGAN: But Mr. Clement, it’s not saying you must do something that violates your religion. It’s giving you a choice. You can do this thing or if this thing violates your religion you can do another thing. And that other thing is approximately the same price as the thing that you don’t want to do. (p.25)

JUSTICE KAGAN: I mean, Mr. Clement, isn’t that just a way of saying that you think that this isn’t a good statute, because it asks one person to subsidize another person. But Congress has made a judgment and Congress has given a statutory entitlement and that entitlement is to women and includes contraceptive coverage. And when the employer says, no, I don’t want to give that, that woman is quite directly, quite tangibly harmed. (p.37)

JUSTICE GINSBURG: It would make no difference if it were — there are 20 FDA-approved contraceptives, all of them covered by the Healthcare Act. (p. 38)

JUSTICE GINSBURG: You picked out, in one case, three, and the other case four? Suppose the employer says contraceptives all together are against my religion, so I’m not going to give any contraceptive coverage. (p. 38)

JUSTICE GINSBURG: But your argument, it seems to me, would apply just as well if the employer said no contraceptives.

JUSTICE SOTOMAYOR: Is your claim limited to sensitive materials like contraceptives or does it include items like blood transfusion, vaccines? For some religions, products made of pork? Is any claim under your theory that has a religious basis, could an employer preclude the use of those items as well? (p.4)

JUSTICE SOTOMAYOR: How does a corporation exercise religion? I mean, I know how it speaks and we have, according to our jurisprudence, 200 years of corporations speaking in its own interests. But where are the cases that show that a corporation exercises religion? (p.18)

JUSTICE SOTOMAYOR: So the dissent in this case, in the Tenth Circuit case, said how do we determine when a corporation has that belief? Who says it? The majority of shareholders? The corporate officers? The — is it 51 percent? What happens to the minority? And how much of the business has to be dedicated to religion? 5 percent? 10 percent? 90 percent? Just assume not a business like yours – you picked great plaintiffs, but let’s assume — Let’s assume just a business that sells 5 percent of religious books, doesn’t play Christmas music, doesn’t give off – works on Sunday, you know, does nothing else religiously. (p.18)

JUSTICE SOTOMAYOR: Is there — a different way of looking at it, the leeway? In U.S. v. Lee, we said, “When followers of a particular sect enter into a commercial activity as a matter of choice, the limits they accept on their own conduct as a matter of conscience and faith are not to be superimposed on the  statutory schemes which are binding on others in that activity.” So isn’t that really the answer, that we’ve never considered a for-profit corporation as exercising religion? (p.20-21)

CHIEF JUSTICE ROBERTS: I thought that part of the religious commitment of the owners was to provide health care for its employees.

JUSTICE SOTOMAYOR: Well, if they want to do that, they can just pay a greater salary and let the employees go in on the exchange. (p.23)

JUSTICE SOTOMAYOR: May I just put a footnote on this. I thought the average price of providing insurance for a single person is $4,000, and it’s $12,000 for a family — for a family. So the $2,000 tax — that’s what it’s called — is to help the government provide subsidies to people on the exchange that don’t have employer insurance. So it’s a tax because it is to do exactly what your client wants, to get the government to supply the contraceptives, not the insurance companies. (p. 26)

JUSTICE SOTOMAYOR: Counsel, one of the attorneys below on behalf of your clients admitted that the grandfathered policies weren’t going to be around very long because any change to an existing policy [terminates such plans] — and he said these changes happen on a yearly basis. And we already know from the government’s statistics that up to 40 percent now have grandfathered out. Your own client changed its policy, and that’s why it’s not grandfathered. And he changed it to drop contraceptives it was covering. (p.31)

JUSTICE SOTOMAYOR: I’m not sure that squares with Lee. The statute created the right to Social Security, and there the Court said you can’t deprive employees of a statutory right because of your religious beliefs. So Lee is contrary to the point you’re making. (p.35)

JUSTICE SOTOMAYOR: So we go back to the start of my question, that would be essentially the same for vaccines, blood transfusions, non-pork products, the government has to pay for all of the medical needs that an employer thinks or claims it has a religious exemption to? (p.84)

CHIEF JUSTICE ROBERTS: Isn’t that what we are talking about in terms of their religious beliefs? One of the religious beliefs is that they have to pay for these four methods of contraception that they believe provide abortions. (p.76)

JUSTICE SCALIA: There is not a single case which says that a for-profit enterprise cannot make a freedom of religion claim, is there? (p.50)

JUSTICE SCALIA: You’re talking about, what, three or four birth controls, not all of them, just those that are abortifacient. That’s not terribly expensive stuff, is it? (p.66)

JUSTICE ALITO: What about the implications of saying that no for-profit corporation can raise any sort of free exercise claim at all and nobody associated with the for-profit corporation can raise any sort of free exercise claim at all?

Let me give you this example. According to the media, Denmark recently prohibited kosher and halal slaughter methods because they believe that they are inhumane. Now, suppose Congress enacted something like that here. What would a corporation that is a kosher or halal slaughterhouse do? They would simply — they would have no recourse whatsoever. They couldn’t even get a day in court. They couldn’t raise a RFRA claim. They couldn’t raise a First Amendment claim. (p.78)

The Supreme Court


Supreme Court  Basics

The Supreme Court includes 9 justices, appointed for life. Each Justice is nominated by the president who is in office at the time a vacancy occurs, usually due to the resignation or death of another justice, and must be approved by a vote of the Senate.

The Court is part of the judiciary, one of the three branches of the U.S. government.  The other two branches are the Executive (president, who appoints the heads of U.S. agencies, such as the Dept. of Health and Human Services); and the legislature, including Congress.

The role of the Supreme Court is to decide whether particular laws or regulations adopted by local, state or federal legislatures or regulatory authorities are consistent with the U.S. Constitution.

Supreme Court decisions have played a key role in expanding access to contraception and abortion.  In Griswold v. Connecticut in 1965, the court found that the Constitution protected a right to privacy, striking down a state law that restricted unmarried people from obtaining contraceptives, followed by the Roe v. Wade decision in 1973, that legalized abortion.

The Justices are supposed to be nonpartisan.  They are generally considered to be divided on reproductive rights.

All of the Justices who are married appear to have used contraception regularly, as each has 3 or fewer children, except for Scalia, who has 9. (details below.)

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