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:

http://bit.ly/sftrustswomen

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. http://www.guttmacher.org/pubs/FB-ATSRH.pdf

(3) “Facts on American Teens’ Sources of Information About Sex.” Guttmacher Institute. Feb 2012. New York, NY. http://www.guttmacher.org/pubs/FB-Teen-Sex-Ed.pdf

(4) Women’s Health STATS & FACTS 2011. American Congress of Obstetricians and Gynecologists. p. 2. https://www.acog.org/~/media/NewsRoom/MediaKit.pdf

(5) NARAL Pro-Choice America: Discriminatory Bans on Abortion Funding Threaten Women’s Health   http://www.prochoiceamerica.org/media/fact-sheets/abortion-funding-restrictions.pdf

(6)  “Abortion and Young People in the United States.” Advocates for Youth. Accessed at: http://www.advocatesforyouth.org/publications/publications-a-z/2296-abortion-and-young-people-in-the-united-states.

(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 http://www.guttmacher.org/pubs/journals/Abortion-Stigma.pdf.

#EveryWoman at the Supreme Court

#EveryWoman 

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.) http://www.supremecourt.gov/about/biographies.aspx

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* Tweet about why access to affordable contraception is important, and share it with all of your followers.  Use #EveryWoman, and tell @SCOTUS and @oursilverribbon!

* Advocate Action: Sign and comment on our PETITION

House of Reps All-Male Hearing on Contraception, 2012

Hobby Lobby today announced that although it is a corporation, it does indeed have a religion: Boko Haram.  When its Christian owners argued before the Supreme Court to assert their right to deny insurance coverage for 4 types of birth control on the basis of the corporation’s religious beliefs, Justice Sotomayor questioned “How does a corporation exercise religion?”  The Corporation itself has so far been silent on its actual religious affiliation.

“With so many of our successful practices under attack around the globe this month, we felt it was time to speak publicly in defense of our faith,” the Corporation said.  “On May 6, a Boko Haram leader claimed responsibility for abducting hundreds of Nigerian school girls, planning to sell them.  In the U.S., with legislation in Missouri and Louisiana aiming to strip abortion providers of their right to practice, and in Congress to ban abortions after 20 weeks, when low-income women and women with medical abnormalities are most likely to need them, our staunch doctrine of assuring the long-term, structural subservience of women has been making enormous strides.

“The firing of Jill Abramson for her ‘brusque’ management style as NY Times editor, to be replaced by the man who had responded entirely appropriately to her by punching a hole in the wall at the Times, was simply more than we could have hoped for.

“This cascade of previously unimaginable successes has of course inflamed uncontrollably whiny, emotional, and humorless feminist apparatchiks around the globe, from groups like a Billion Rising, and the Trust Women/Silver Ribbon Campaign.   These modern women and their supporters would convince the US Supreme Court that it’s time to set the record straight and dismiss Hobby Lobby’s arguments, simply because they reflect the last gasp of the backwards, fringe mentality we represent. And frankly, the recent denunciation of Boko Haram by Al Qaeda contributed to prompting our declaration. By coming out publicly to claim our corporation’s religious affiliation with Boko Haram, we intend to put all such diversions to rest.”

(The corporation went  on to explain how this unique circumstance entitled it to claim its independent right to assert that Plan B should not be covered by Hobby Lobby because it is an abortifacient, which is otherwise labeled by mainstream scientific evidence as “absolutely without any foundation whatsoever.”)

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Women won historic numbers of seats in Congress in the November election. Voters across the political spectrum supported women’s reproductive  health, rights, and justice, and defeated candidates who trivialized  women’s safety. Florida rejected a ballot measure that would outlaw  public funding for abortions.

But many state legislatures and members of Congress continue to attack  access to birth control and abortion care, and cut funds for health care providers like Planned Parenthood. In Mississippi, state regulators plan to force  the last clinic that provides abortions to close. These  restrictions most severely affect low-income women and women of color,  and women in certain geographic areas.

Threats continue to women’s long-term economic and social security and safety.

Trust Women Week partner organizations are joining together to express the  powerful voices of the majority of women, men, children, families and  communities who uphold traditional American values of democracy, independence, fairness, progress, innovation and pragmatism.

See www.oursilverribbon.org to find an event near you – or create one and post it!

Messages to Congress

1.      I Trust Women and I Vote
Women can make our own decisions about our reproductive health, and we did and will vote to enforce that right.

2.      Her decision, her health
We extend respect and compassion to individual women facing decisions about a pregnancy.

3.      Keep abortion safe and legal, and make it accessible and affordable

4.      Stand up and be counted for the human right to reproductive health and justice.
Reproductive justice and rights call on us to create the  conditions necessary for health, recognizing that we must take action to overcome disparities based on social factors including race, gender,  and income. 

5.      Contraception is Prevention
Contraception must be included in preventive health care benefits in all public and private health insurance programs

6.      Fix the economy and stop the attacks on women’s health.
We call on the government and our elected officials to help improve our lives and create the conditions to be healthy.
7.      U.S. Out of My Uterus
Politicians should stop interfering in women’s personal health decisions, especially related to reproductive biology and sex.