The first time I needed emergency contraception, I was home from college and spending the summer with my family in rural Texas.

I had just gotten off birth control a few weeks earlier and was not expecting to have sex. After an unplanned fling, I knew I would have to come up with some excuse to sneak away and drive an hour and a half to the closest Planned Parenthood in order to get Plan B. It was a holiday weekend, I felt like I was up against a clock, and the logistics gave me a headache.

When I needed emergency contraception again a few years later, Plan B was easier to come by, as it was available over the counter. It was still expensive, and my insurance didn’t cover it.

While I was grateful that I didn’t have to drive as far to get it, I felt the pharmacist’s judgement burning a hole in my head. I remember thinking, “I wish there was a better option.”

This experience is one of the reasons I am grateful to do research that aims to increase access to methods of birth control. A recent study published in the New England Journal of Medicine, which my colleagues and I authored, found that Liletta—a hormonal intrauterine device—can also be a very effective form of emergency contraception. A person can have the hormonal IUD placed within five days of unprotected sex for the purpose of emergency contraception, and they can continue to use it as an ongoing method of contraception for up to seven years.

Research and practice guidelines have supported using the copper IUD for emergency contraception for decades, but prior to this study, the hormonal IUD hadn’t been adequately tested for this special indication. This research was important because each IUD has unique attributes that are more (or less) attractive to different users. While the copper IUD is the only reversible, long-acting method that is hormone free, the hormonal IUD can reduce or eliminate menstrual bleeding and cramping.

Our research found that the hormonal IUD had similar emergency contraception efficacy to the copper IUD. While our study did not directly compare IUDs to either oral emergency contraception pill, we found that the pregnancy risk in the first month after hormonal IUD placement following unprotected sex was less than 1 in 300 users—significantly more effective than oral emergency contraception options, which range from 1 to 3 pregnancies per 100 users.

These novel findings provide people with another option for emergency contraception—one that could potentially better meet their needs in the long term. Not only does the hormonal IUD work at preventing pregnancy for one (or two or more) episodes of unprotected sex in the previous five days, but people who use this option can also use it to prevent pregnancy for up to seven years.

It’s been over a decade since I’ve needed to navigate the economic, logistical, and stigmatizing barriers to access emergency contraception. Today, a better option is finally available—one that I wished for when I was in my 20s. It is my hope that this new information will reach the people who might need it and empower them to ask about the hormonal IUD for emergency contraception.

Additionally, states need to support coverage of the full range of emergency contraception, through contraceptive equity acts. These laws can affirm the federal contraceptive mandate in individual states and ensure that insurance covers all contraceptive options, including the hormonal IUD for emergency contraception, without cost-sharing and without preauthorization. This is crucial so that people who want to use IUDs for emergency contraception are able to access it where they want it, when they want it.

In 1977, Rosie Jimenez died after having an illegal abortion. But it wasn’t just the procedure that killed her—it was the Hyde Amendment.

A year prior, Rep. Henry Hyde, a Republican from Illinois, introduced the piece of legislation that still bears his name. The Hyde Amendment, which prohibits the use of federal money to pay for abortion, is a legislative provision that has been in place for decades—one that President Joe Biden promised during his campaign to finally overturn.

When Jimenez found out she was pregnant in 1977, she knew she didn’t want to be a parent. She wanted to finish college, and so she sought an abortion. Just a few months earlier, she would have been able to use Medicaid to pay for her abortion, but thanks to the Hyde Amendment, this wasn’t an option anymore.

Unable to afford the procedure out of pocket, she turned to an illegal abortion. Soon she was hemorrhaging and vomiting; she had a fever and her friends and family rushed her to the emergency room. There, she was given a tracheotomy, and soon after, a hysterectomy. But the infection in her uterus had become too widespread. After a painful seven days in intensive care, she died at the age of 27.

According to the Texas Observer, in just the short two months after the Hyde Amendment went into effect, complications from unsafe abortions were already on the rise in Jimenez’s Texas hometown.

“Between August and October of 1977, five women, including Jimenez, turned up at the emergency room with infections and related complications, probably from cheap illegal abortions, according to a report from the Centers for Disease Control and Prevention,” the Observer reported.

It has been over 40 years since the Hyde Amendment was first enacted, and the concept of federal funding for abortion remains contentious, despite overwhelming evidence that the ban endangers the lives of the most marginalized and vulnerable pregnant people, particularly those in rural areas and in communities of color.

In 2016, at the urging of abortion advocates, Hillary Clinton became the first presidential candidate to include repealing the Hyde Amendment in her campaign platform, making it the most progessive abortion platform in history. And while the final iteration of Biden’s campaign platform included a repeal, that move only came after pressure from abortion advocates in response to Biden’s initial support for the Hyde Amendment.

Some states, like Massachusetts, get around Hyde by using state money to cover abortion care for residents on Medicaid. Other states, like Texas, have additional bans that prohibit even private insurers from covering abortion care.

Abortion-related funding has already made headlines since Biden was inaugurated. This week he announced he would be rescinding the Mexico City policy, otherwise known as the global “gag rule.” The global gag rule prohibits government money from going to nongovernmental organizations that promote—or even talk about—abortion as a method of family planning. The global gag rule works in concert with a legislative provision that also restricts abortion access overseas: the Helms Amendment. Think of Helms as the international counterpart to Hyde; it bars U.S. foreign aid money from paying for any kind of abortion care in other countries. And, to be clear, Biden should throw this one into the incinerator too.

Biden’s decision to rescind the Mexico City policy came after criticism—mine, to be exact—that the Biden administration seems just a tad uncomfortable with actually saying the word abortion. First there was White House press secretary Jen Psaki dancing around it at a briefing; then there were President Biden and Vice President Kamala Harris’ statements commemorating the anniversary of Roe v. Wade, with the word “abortion” nowhere to be found. Even on Thursday as Biden signed the executive order, he evaded the term, opting instead for vaguer language like “reproductive rights” and “women’s health.”

But good news is good news, and the repeal of the global gag rule is pretty damn good news. What’s more, at least two states—Virginia and New Jersey—are looking to expand coverage for abortion care. If passed, the Reproductive Freedom Act in New Jersey would require private insurers to cover birth control and abortion care with no out-of-pocket costs. And on January 26, the Virginia House of Representatives voted to repeal a ban on abortion coverage for insurance plans in the state’s health-care exchange.

Repealing the Hyde Amendment is the least we can expect of liberal lawmakers. It’s a draconian and harmful law that puts the lives of pregnant people at risk. And it’s a grim reminder of how stigmatized and backwards United States abortion policy is. Insurance should cover abortion just like it covers any other procedure. That this is up for debate shows how far we still have to go to win this fight. Put simply, federal funding for abortion should be the floor—not the ceiling.

Repealing the Hyde Amendment is long overdue in the fight to ensure that comprehensive abortion access is a reality for all. It would be a recognition that abortion—like any other procedure, from an appendectomy to knee surgery—is just good medicine.

I don’t remember much about my first menstruation, beyond the fact that I wasn’t sure if I was menstruating or dying.

I was 13 by that point, so I already knew that periods were a thing. School had prepared us for that much, at least. But I suspected that vaginas could bleed for other reasons, too. Terrifying reasons. How was I to know whether the blood staining my underpants was the right kind of blood? The blood that was meant to induct me into that community of people who menstruate?

Now, I’m the mother of a 6-year-old, and I know that I cannot rely on the school system to prepare my daughter for everything it means to be a human in this world. To live in a body. I know that, whatever school districts are doing, parents need to take an active role in their child’s sexuality education, from birth on.

And yes, this can be difficult. Many of us didn’t grow up with the most awesome sex ed experiences, and there are large gaps in our knowledge—not to mention fact that tampons and other period products aren’t available to all. Some of us have grown up having internalized the idea that our sexuality is a taboo topic, perhaps because of our cultural or our faith background. But I assure you: You can still prepare your child for this time in their life in a way that is hopefully painless for the both of you.

So, how do we handle periods?

Don’t wait too long to introduce the topic

I experienced my first menses at 13, but some kids have their first period by age 8. So be warned that these conversations may have to start sooner than you think.

“Ideally, you want to talk to your kids about [menstruation] before they or their friends are bleeding,” said Melissa Pintor Carnagey, a sexuality educator and the founder of Sex Positive Families, a resource for families to help raise children through a shame-free approach. “You want them to have a heads up.”

No one wants to be blindsided by blood in their panties. With children, especially, the mind can go to all sorts of wild places.

Know that you’re always sending messages, even if you’re not saying a word

You may not talk to your kids about periods for any number of reasons. You may worry it will be uncomfortable or awkward.

You may feel they don’t have enough knowledge to speak about it with any level of confidence. you may assume that the schools will handle it.

But even when we don’t speak directly about menstruation, we are still inadvertently sending some pretty clear messages.

Carnagey pointed out that the silence that often exists around this natural bodily process speaks volumes. If there are menstruating people in the house and they’re hiding period products—or whispering about cramps and heavy bleeding, or furtively tossing out their underwear, or smuggling their bedsheets into the laundry room when they leak through their pads—kids will come to believe that menstruation is something of which they should be ashamed.

Meanwhile, open conversations about menstruation, and about how it’s affecting us and how it can manifest in other bodies, can have a positive impact on things like our children’s future intimate relationships and their levels of body confidence.

Look for teachable moments

How do you initiate these conversations? Carnagey says that while open discussions are good, actively normalizing periods is even better. A large part of their job involves locating those opportunities for normalization.

Like those moments when your child follows you into the bathroom and asks about your pad or your tampon. Or when commercials pop up on TV for period products. Or when you travel down the convenience store aisle devoted to “feminine hygiene products.”

“When they grab and play with menstrual products, do you stop them?” Carnagey said. “Are you talking about it, or are you hoping it just disappears? Are you imposing shame and avoidance and silence around these things, or do you recognize them as teachable moments?”

Resist falling back on fear-based language

Puberty is often spoken of as that time in life when changes happen—changes kids can find scary or strange. And for a long time, I didn’t know of any other way to speak about periods. Then I saw sexuality educator Al Vernacchio present a different educational framework, one in which he likens these bodily changes to superpowers. I was inspired.

When I mentioned this to Carnagey, she got excited. “I love talking about cervical mucus and vaginal discharge and how the body can do super powerful things,” they said. “I love just framing bodies in general as these amazing groups of organs and systems that are operating all day and night to keep us alive. It’s all about framing it from a strengths-based, empowering place.”

Of course, periods aren’t always pleasant for those involved. For me, I always experienced bloating, heavy bleeding, and debilitating cramps (among other things). Carnagey acknowledges that, yes, periods can suck, but using a positive framework doesn’t mean ignoring that.

“There are elements of predictability and unpredictability,” Carnagey said. They explained that the key is in making sure your child has all of the information and support they need so, as they begin to experience the various symptoms of menstruation, they know they’re not alone and they have the language to talk about it.

Carnagey recommends talking about the various things one might experience while menstruating, laying out what they can expect and what to do next. “It’s all about normalizing the diversity of experiences of the body,” they said.

Don’t stop with your daughters

Carnagey emphasizes that menstruation is not about gender—it’s about body parts.

“If we have a society where everyone is educated about this process that some bodies can experience,” they said, “it opens people’s minds and they then have the ability and the capacity to support others and to make decisions and rules and laws that make sense for people who menstruate.”

But even more than that, Carnagey insists that “we have to recognize that we are humans who have these experiences with our bodies, and we are also in community with other humans having these experiences, and it is to our benefit to know about what those experiences are and to foster empathy and understanding and support and self-awareness.”

You don’t have to know everything

“You’re not a bad parent if you feel like this is hard,” Carnagey said. “It’s not your fault. Our society has created so many barriers to the education we deserved. It’s not your job to have all the answers. It’s just your job to create that space.”

If you’re looking for additional resources you can use to facilitate these conversations, check these out:

• Vaginas and Periods 101, by Christian Hoeger and Kristen Lilla, is a pop-up book meant to normalize vaginas and menstruation.
• The Period Game, a board game with a spinning ovary (!), teaches kids about menstruation in a fun and engaging way.
  Six Minute Sex Ed is a podcast hosted by sex educator Kim Cavill, and episode 18, “Let’s Talk About Periods,” is focused on menstruation.
• Amaze is a website featuring animated videos on sex, relationships, and the body.
• Sex Positive Talks to Have With Kids is a book by Melissa Pintor Carnagey, sex educator and founder of Sex Positive Families.
• Go With the Flow, by Lily Williams and Karen Schneemann, is a fun graphic novel about a group of friends who go up against a high school administration that’s squeamish about the fact that half of their student population menstruates.

Good luck out there. Your kids need this.

I started working on menstruation over a decade ago. At the time, I often encountered raised eyebrows, puzzled faces, and attempts to tell me that we don’t really need to talk about “it.”

Since then, we have come a long way. Menstruation is gaining increasing attention at all levels. Some states have eliminated taxes on tampons and other menstrual products (which should never have been taxed to begin with). Others have begun providing menstrual products in schools, shelters, and prisons. Most recently, the Scottish government passed a bill to provide period products to everyone who needs them. Meanwhile, charitable organizations continue to address period poverty by supplying menstrual products, and states are adopting standards to ensure the products’ quality.

In short, efforts focus on product availability, product affordability, and product quality.

To be sure, most people who menstruate want something to bleed on. And I don’t mean to dismiss that. But a piece of cotton or even the medical-grade silicone used in menstrual cups will not address menstrual stigma—to the contrary, it covers up menstrual stigma. Implicitly, we’re told that we need to get our leaky, messy bodies under control. In other words, we still have much work to do to achieve menstrual justice.

With a new administration in place, we have an opportunity to work toward menstrual justice. As senator, Vice President Kamala Harris introduced legislation to fund research and education on uterine fibroids, which can cause heavy bleeding and health complications and which disproportionately affect Black women. To achieve menstrual justice, we need to advance this legislation and a lot more.

We need to address the disadvantages that menstruators face at all levels of society. We need to address the intangible and structural disadvantages alongside the tangible ones. We need to consider menstrual justice as part of gender justice because menstrual stigma has profound effects on the realization of human rights across all spheres of life.

Consider that people who menstruate are often unfamiliar with bodily processes, before reaching menarche. They have misconceptions and negative or ambivalent feelings about menstruation, which may cause anxiety and stress and impact their ability to learn. We need to combat myths and misinformation with nonjudgmental, age-appropriate, accurate, and accessible information. Comprehensive and continuous menstrual education is essential to increase body literacy and strengthen bodily autonomy, confidence, and self-esteem.

Consider that many menstruators hesitate to seek medical advice, and health-care providers are not necessarily trained on conditions related to the menstrual cycle. It takes up to seven years or more to be diagnosed with endometriosis, a painful condition where tissue similar to uterine tissue grows outside of the uterus. Testimonials of gaslighting, dismissal of menstrual pain, and odysseys through the medical system abound. Policymakers need to address the well-being of menstruators, their quality of life, and their access to menstrual health-related diagnosis, care, and treatment. Bringing about such change requires revisions in medical curricula to ensure adequate training, as well as increased funding for research on menstrual health conditions.

Consider that menstruators are often labeled as hysterical, not trustworthy, and unfit for decision-making. Menstrual pain and cramps are dismissed and we are told to just power through. These stereotypes and lack of accommodation contribute to the barriers women experience at work and in public life, resulting in lower earnings, less responsibility, and fewer promotions.

In 1978, Gloria Steinem’s piece in Ms. challenges us to consider what would happen “If Men Could Menstruate.” She argues that “menstruation would become an enviable, boast-worthy, masculine event: Men would brag about how long and how much.” Clearly, it didn’t occur to her back then that some men do menstruate. Still, she demonstrates—as powerfully today as 40 years ago—that our ideas of menstruation are socially constructed and shaped by patriarchal assumptions. Menstruating individuals are not “too emotional,” and taking time off is not a sign of weakness—unless we perceive it as such. We need to factor menstrual justice into efforts to address the gender pay gap and other injustices at the workplace.

Menstruation matters because it unites the personal and the political, the intimate and the public, the physiological and the sociocultural. Menstruation is a prime example of the politicization of women’s bodies, and of bodies generally perceived as Other. Menstrual justice is about power relations—the power of teachers to withhold or impart information, the power of health-care providers to gaslight patients or to engage with them and take them seriously, the power of employers to label people who menstruate as unfit or to support them.

Achieving menstrual justice requires us to transform these power relations. Policymakers working on education, health care, and employment have the power to adopt more comprehensive menstrual education curricula, to improve medical training for menstrual health conditions, and to allocate resources for research. Recent initiatives—such as a bill in New York state on more comprehensive menstrual education, including endometriosis and other health conditions, as well as increased funding for endometriosis research—show that such progress is possible.

Because menstrual justice is gender justice, we must make it a priority in 2021.

Today, President Biden signed a presidential memorandum to rescind the global “gag rule,” also called the Mexico City policy. The gag rule prevents U.S. aid to nongovernmental organizations overseas if they conduct abortion-related counseling, referrals, or advocacy.

From its first implementation in 1984, the global gag rule has slashed NGO’s ability to provide informed health care without risking the loss of much-needed U.S. aid. Now more than ever, having both popular support and political power, the Biden administration must go above and beyond repealing the global gag rule to protect, ensure, and expand abortion access and reproductive health care.

The global gag rule has been enforced by all Republican administrations since Reagan and rescinded by all Democratic administrations, but the version Trump signed in 2017 came with a particularly draconian set of restrictions. Trump expanded the gag rule’s scope to all U.S. global health assistance, not just family-planning organizations. This meant that initiatives addressing HIV and AIDS, child and maternal health care, water sanitation, nutrition, or infectious diseases would lose funding if they couldn’t certify that they did not participate in any abortion-related activity. Furthermore, if an NGO receiving any global health funding from the United States were to award a grant to another organization, that organization had to also prove to the U.S. government that it doesn’t support abortion-related activities—even if no U.S. dollars trickled down to them at all.

The repercussions of the gag rule reached far and wide, creating lasting effects on the lives of people who were unable to access the full spectrum of care during its enforcement. In 2017, $8.8 billion of global health aid flowing to more than 70 countries was subject to the gag rule. With the United States being the largest funder of international health initiatives, organizations working on the ground within their communities were vulnerable to losing their biggest pot of resources at the expense of providing accurate medical services and care.

For example, providers whose work was funded under U.S. global health programs would need to violate the patient-provider relationship due to the gag on discussing abortion as a possible avenue of reproductive health care. Advocates working with organizations to legalize or decriminalize abortion in their countries are censored from enacting change, and in places where abortion is already legal, people are unable to make use of their legal right to pursue the termination of a pregnancy.

Most frighteningly, the most recent iteration of the global gag rule has shown that the presidency is able to wield its power to affect other critical areas of care, like HIV and malaria, if doing so can act as an added deterrent to abortion-related activities.

The United States’ barriers to abortion care are not only reserved for its international partners.

Even with the repeal of the global gag rule, the narrower Helms Amendment of the Foreign Assistance Act will continue to restrict U.S. foreign aid funding from being used directly for abortion procedures. You can look at the Helms Amendment as the international counterpart to the domestic Hyde Amendment, a 1976 rider to the annual congressional budget crafted in response to the Roe v. Wade decision, which legalized abortion. Just like the global gag rule and the Helms Amendment, the Hyde Amendment blocks federal funding from going toward abortions, which means anyone insured under a federal program—like Medicaid, Medicare, Indian Health Services, or the military’s TRICARE—is unable to use their health insurance to cover their abortion.

There is simply no other medical procedure that experiences such restrictions, and while rescinding the global gag rule reaffirms the care and autonomy that communities and people considering and seeking abortions internationally deserve, President Joe Biden’s campaign promise to ensure informed and supportive access to abortion will not be fulfilled by a single presidential memo.

President Biden must prove his dedication to supporting all pregnant people choosing between all pregnancy outcomes, including abortion, by urging Congress to repeal the Helms and Hyde amendments and signing new, clean foreign aid and federal budget bills into law.

Access to reproductive health care should have never been subject to the political pendulum, but as decadeslong advocacy from domestic and international partners alike comes to a boil, the unignorable reality is that expanding access to abortion on the federal level is now undeniably within reach, full stop. In addition to rescinding the global gag rule, President Biden can do what no other president has done and establish himself and his administration as true bringers of progress and change by working to end the Helms and Hyde amendments.

Jennifer Carroll Foy, a gubernatorial candidate in Virginia, isn’t ready to breathe a sigh of relief now that Donald Trump is no longer president of the United States. The mom of two, who was one of the first Black women to graduate from the Virginia Military Institute before she became a magistrate judge, public defender, and delegate in the Virginia General Assembly, knows that attacks on abortion rights persist, regardless of who’s in the Oval Office.

“I have heard this sentiment that now that we have a Democratic White House and Congress—there’s not much to worry about,” Carroll Foy told Rewire News Group. “But we cannot be complacent. With the stacking of the federal judiciary with judges hostile to our fundamental rights, Roe v. Wade and the legal right to abortion is in jeopardy. With the Supreme Court—including Amy Coney Barrett, Brett Kavanaugh, and Clarence Thomas—salivating at the opportunity to repeal Roe v. Wade, now is the time to do everything we can to shore up these rights.”

Carroll Foy, who grew up in Petersburg, Virginia, a majority-minority community of low socioeconomic status, also knows that protecting Roe simply isn’t enough. Over 1,200 anti-abortion laws have passed since the landmark 1973 Supreme Court ruling—all disproportionately impacting Black people and people of color.

“I have seen firsthand the ramifications of what happens when people take advantage of communities, especially communities of color and of low socioeconomic status,” Carroll Foy said. “Right now, there is a fake abortion clinic in my hometown spewing out falsehoods about abortion and reproductive health to people just trying to get help and information. When that happens, it says that we aren’t capable of making our own decisions: that we aren’t entitled to the right to control our own bodies or are able to make our own decisions. And those types of attacks are attacks on all of us.”

There are as many as 4,000 so-called crisis pregnancy centers across the country—fake clinics that misrepresent themselves and lie to pregnant people about the gestational age of their pregnancy, about their options, and about abortion care, including how safe abortions are and how abortions are performed. The majority of them are strategically placed in primarily Black and brown communities.

“Most of my family still lives in Petersburg,” Carroll Foy said. “I want my kids to grow up in a community where they are not on the receiving end of this misinformation—that they’re not targeted or seen as being more susceptible to those types of tactics. That they’ll be entrusted to make decisions about when and if they want to start a family, and what that looks like.”

Many of these deceptive anti-choice centers have received federal loans and other grants that keep them staffed and afloat, while actual health-care clinics that provide abortion are shut down due to TRAP laws, or targeted regulations of abortion providers. In just five years, from 2011 to 2016, 162 clinics that provided abortion services closed. Only 22 opened. In 27 major U.S. cities, people have to travel at least 100 miles to reach the nearest abortion clinic.

For a large majority of this country—especially Black, brown, and poor people—Roe v. Wade exists in name only, a protection afforded only to the white and affluent. Meanwhile, Black and brown people are offered faux science by anti-abortion activists masquerading as morally sound, informative medical professionals.

Carroll Foy is ready for that to change. And she’s starting at home.

“When there’s an attack on access to abortion and reproductive health care, it’s actually an attack on people of color more than anyone else,” she said. “As governor, I will ensure that our state is that brick wall protecting people in Virginia, as much as we can, so that they have access to abortion.”

When she represented the 2nd District in Virginia’s House of Delegates, Carroll Foy fought to expand Medicaid coverage for 400,000 Virginians, helped Virginia become the final state needed to ratify the Equal Rights Amendment, and worked to pass the Reproductive Health Protection Act, which removed politically motivated and medically unnecessary barriers between people seeking abortion care and their doctors.

But the work is not done. As governor, Carroll Foy has vowed to appoint an all pro-choice cabinet. She’s the first gubernatorial candidate in the country to make such a promise.

“Reproductive freedom and justice impacts all parts of a person’s life,” Carroll Foy said. “When we think about reproductive freedom we have to think about it holistically. To have an all pro-choice cabinet would mean that we are all on the same page as far as understanding the intersectionality of access to reproductive health care and abortion rights and how it crosses over into so many other sectors of our lives.”

“It’s not just a statement—it’s a mission,” she continued. “We see ourselves, and I see myself, as that firewall, that barrier, protecting people. I want to make sure that I have a cabinet that is in full support of that mission. We will do everything we can to ensure abortion rights and access to reproductive health care in the commonwealth.”

Carroll Foy is also dedicated to expanding abortion access and other reproductive health-care services for LGBTQ people, who are also disproportionately impacted by anti-abortion laws. She lobbied and helped pass the Virginia Values Act, a law that bans discrimination against LGBTQ people when it comes to housing, employment, public places, and credit applications.

“What goes hand-in-hand with [reproductive justice] that a lot of people don’t talk about is working to strengthen and protect trans rights,” she said. “We have to go a step further and say that trans people also need equitable access to health care, including reproductive health care. The Jennifer Carroll Foy administration will make trans rights a top priority because until all of our rights are secure, none of our rights are secure.”

Virginia and New Jersey are the only two states electing a governor this year. The Democratic gubernatorial candidates in Virginia—reported by the Associated Press as “more diverse than anytime in modern history”—also include Lt. Gov. Justin Fairfax, state Sen. Jennifer McClellan (both of whom are also Black), state Del. Lee Carter, and former Virginia Gov. Terry McAuliffe.

Carroll Foy hopes that after the nation watched Georgia turn blue, and cheered as Black women—once again—handed Democrats not only the presidency but also the Senate, that sentiments about lifting up, protecting, and listening to Black women will manifest in real, tangible action to not only protect Roe, but expand access to abortion care for everyone, especially the Black and brown people who are disproportionately impacted by anti-abortion laws.

“There are sentiments—well-deserved, well-earned sentiments—of standing with Black women and trusting Black women,” she said. “But we need people’s bills and budgets to reflect those same values. We need not just advocacy, but action. And until that happens, there’s still that lack of respect and of us being treated fairly and equally. And that’s what this is all about. It’s about elevating all voices. It’s about ensuring all people have access to abortion care, no matter how much is in their checking account, what their ZIP code is, or who they love.”

“It’s about equity. It’s about respect. It’s about social justice. It’s about racial justice. It’s about civil rights,” she continued. “I just want to make sure people understand that that’s why this is so urgent and so needed and so necessary. That’s why I’m going to fight so vehemently to ensure people are protected in every way possible, especially when it comes to abortion care and reproductive health care.”

As a domestic violence survivor, Lisa felt scared and hopeless when, in an act of financial abuse, her abuser cut off her private health insurance plan. As a mother in survival mode, she had made her children’s health the first priority, but she also knew she needed to address the “unbearable” physical pain from when her abuser raped her following childbirth.

Without private insurance, Lisa enrolled in Medicaid and visited Planned Parenthood in Houston. There, they discovered her vaginal injury was a tear that needed immediate surgery, which she received at no cost through the government-run program. She later visited the clinic for Pap smears and yearly health exams.

“To say being able to use Medicaid at Planned Parenthood is vital is an understatement,” Lisa, whose last name has been withheld for privacy reasons, told Rewire News Group. “It saved me. There has to be somewhere women without financial resources can go in the middle of a pandemic for health care that is supportive and safe.”

Now, that critical lifeline for Lisa and some 8,000 low-income Texans—it also includes access to breast and cervical cancer screenings, a full range of birth control, STI testing and treatment, and annual exams—has been ripped from them by the state of Texas amid an unprecedented global health crisis. Following a five-year legal battle, this past November the largely conservative Fifth Circuit Court of Appeals sided with state officials in keeping Medicaid patients away from Planned Parenthood—an ideologically motivated attack rooted in patently false claims.

Barring an unforeseen legal maneuver, the reproductive health-care network will be excluded from the public health insurance program as of the beginning of February.

In 2015, the Texas Health and Human Services Commission sought to terminate Planned Parenthood’s Medicaid enrollment based on highly edited and widely discredited videos released by the anti-choice Center for Medical Progress that accused Planned Parenthood providers of profiting off the sale of fetal tissue. Those activists faced multiple felony charges in California for invasion of medical privacy and were forced to pay Planned Parenthood $13.6 million in damages for the illicit sting operation. The health network was cleared in all 13 state investigations into the alleged misdoing.

Texas providers then sued the state for breaking federal Medicaid law under the Social Security Act, which ensures patients have a right to choose their own provider as long as that provider is qualified. In 2017, U.S. District Judge Sam Sparks ruled against the state, repeatedly noting the dearth of evidence produced by state attorneys. (Sparks, appointed by Republican President George H.W. Bush, went so far as to sharply admonish the state’s arguments, writing it was more akin to “the building blocks of a best-selling novel rather than a case concerning the interplay of federal and state authority through the Medicaid program.”)

Texas appealed the ruling, and the notoriously conservative Fifth Circuit, some three years later, sided with it, arguing beneficiaries have “no right under the statute to challenge a state’s determination that a provider is unqualified.” Arkansas is the only other state that has implemented a similar Medicaid ban, and that case remains in litigation. While the goal of Texas officials is to punish Planned Parenthood for providing abortion services, abortion care itself is barred from being covered by Medicaid as a result of the federal Hyde Amendment.

Anti-choice zealot Ken Paxton, the Texas attorney general facing long-running fraud indictments as well as an FBI investigation for abuse of office, continued to use the debunked videos as a reason to stop Planned Parenthood patients from using their chosen provider. “Undercover video plainly showed Planned Parenthood admitting to morally bankrupt and unlawful conduct, including violations of federal law by manipulating the timing and methods of abortions to obtain fetal tissue for their own research,” he said in November.

Paxton is also under fire for helping incite the white supremacist siege at the Capitol with a speech prior to the riot in which he asked Trump supporters to “not quit fighting” to overturn the 2020 election results. He stands as the sole attorney general in the country to not sign on to either of two letters condemning the violent insurrection. Instead, he falsely claimed the mob was infiltrated by antifa.

After the Fifth Circuit’s ruling, Planned Parenthood requested the state give patients at least six months to find a new provider, but Texas only offered until February 3, just a 30-day extension. Thousands of low-income patients are now scrambling to quickly find new health care while navigating a deadly pandemic. These patients, among the most vulnerable and disadvantaged, already face steep economic and logistical barriers, exacerbated by the effect of COVID-19. Medicaid recipients in Texas face stringent financial qualifications: A single mother with a dependent child must have a monthly income of under $196, well below the federal poverty guideline. The exclusion will hit women of color the hardest as Medicaid recipients are largely Latinx and Black, groups disproportionately affected by the pandemic.

“Blocking patients from their trusted providers at this extraordinary time is unthinkably cruel,” Dr. Bhavik Kumar, medical director for primary and trans care at Planned Parenthood Gulf Coast, told Rewire News Group. “We are forced to tell our patients, many of whom are low-income people of color, we can no longer see them and send them off to find a new provider in the middle of a global pandemic. I get the sense they feel abandoned; it’s unethical in my opinion.”

“When they ask, ‘Why?’ we don’t have a logical answer for them because it doesn’t make any sense,” he continued.

While the state contends patients will be able to easily find a new health provider, the reality on the ground shows otherwise. Due to low reimbursement rates and other factors, Texas has a shortage of Medicaid providers. Just 30 percent of OB-GYNs in the state accept new Medicaid patients, a 2016 Texas Medical Association survey found.

Unfortunately, Texas doesn’t need to look too far into the past to predict the adverse outcome of the state’s politically driven decision: After lawmakers in 2013 excluded 50,000 patients enrolled in the Medicaid-based Women’s Health Program from receiving care at Planned Parenthood, researchers saw a 35 percent drop in women accessing the most effective methods of birth control and a 27 percent increase in births among women who had previously been able to access injectable contraception through the program, according to a study in the New England Journal of Medicine. With little capacity to take on the displaced patients—despite the state’s assurance—the program served nearly 40 percent fewer patients.

Compounded with Planned Parenthood funding cuts in 2011, the reproductive health safety net was left in tatters. The clinics that remained open had more limited services, and patients who depended on Planned Parenthood had trouble finding another provider, said Kari White, University of Texas associate professor of social work and principal investigator with the Texas Policy Evaluation Project, a multiyear study that tracks the impact of the state’s reproductive health policies.

The state confused patients further by directing them to a faulty online database listing several providers that didn’t enroll Medicaid patients. Those who did find new care were often forced to make multiple medically unnecessary visits before getting birth control.

“The promise that there were enough—and enough qualified—providers to serve all these new patients didn’t come to fruition,” White said. “We heard from patients that never ended up getting the care they needed. And today, the idea that there are all these providers just waiting to take on this patient population does not align with the evidence.”

Juggling motherhood and legal proceedings to fully detach from her abuser, Lisa has yet to find a new health-care option. The providers she called said she’d have to wait up to six months for her next appointment—a stark difference from the immediate care she used to receive at Planned Parenthood. Her abuser transmitted a high-risk, potentially cancerous form of HPV to her, which she must monitor with regular checkups.

“I’m worried that I won’t be seen, that I’ll wait too long to find out if the HPV has decided to take over,” she said. “What happens to women when they have to wait six months for care during a pandemic and don’t even know they have cancer?”

Since I joined NARAL Pro-Choice Texas as executive director nearly three years ago, I’ve thought every day about how we can boldly show up for the people in our state who need abortions.

I’ve thought often of the young woman who testified at the People’s Filibuster that her abortion enabled her to address her mental illness. Despite being raised by an abortion provider, despite being one of the 1 in 4 women who will have an abortion in her lifetime, despite being an advocate in the abortion rights movement, I had succumbed to the stigma that has been perpetuated since abortion became legal. That abortion was not health care, but something to be ashamed of. I used euphemisms like pro-choice, or reproductive health care, when I meant abortion care. I never told my story, but told the story of my dad’s work as an abortion provider and his heroism.

That woman’s story was my story and hearing her bravely tell her truth, despite the stigma, despite anti-abortion zealots, despite anti-abortion legislators trying to take that right away from Texans, changed my life and led me on a different trajectory.

The reality is that the majority of Texans and Americans believe that abortion should be safe and legal, and we need to start doing the work like we truly believe this sentiment. As abortion care becomes more restricted, and we face an anti-abortion majority on the Supreme Court, our current political reality demands that we be bold and abortion-forward in our fight to protect access.

To avow means to declare openly, bluntly, and without shame. Now more than ever, our state needs bold and unapologetic advocacy for abortion rights, and with that we are excited to announce that NARAL Pro-Choice Texas is now Avow.

At Avow, we’re working for a better Texas, where every person is trusted, thriving, and free to pursue the life they want. That’s why it’s our mission to secure unrestricted abortion care and reproductive rights for all Texans. We are changing the culture in Texas so that we can start developing and passing policies from a place of freedom and compassion, instead of fear and stigma. The existing restrictions on abortion care rely on and reinforce white supremacy, oppression, and misogyny. Anti-abortion extremism is about telling people how they can and can’t live their lives, and limiting Texans’ futures. When we fight for unrestricted abortion access, we are fighting for our families, our communities, our futures, and our freedom.

We are proud to avow that everybody has a place in this movement, especially those who’ve been historically marginalized: transgender and nonbinary folks, people of color, young people, and people who have abortions.

We believe that in order to win the longterm fight for abortion rights, we have to be bold, to not compromise on our values for political convenience, and to center the voices of Texans impacted by abortion restrictions, who are more likely to be people of color and people working to make ends meet. We believe that “culture change” work is just as important as political and electoral work and that we can’t successfully win a fight for abortion rights in the long term without pushing the boundaries of both. In Austin we, along with our allies, helped pass a city budget initiative that funds practical support for abortion care, and recently we increased that initiative to $250,000. This was possible because when it was suggested that we substitute the word “abortion” with “reproductive health care,” we stood our ground.

At Avow, we’ve made a commitment to educating legislators and having bold, unapologetic conversations about abortion. We do this so that candidates and elected officials can use medically accurate and bold abortion rights language and policy, instead of the vague and stigmatizing language that is far too common in our current political movements. We’ve made clear that this is what we need from the folks vying for our votes and representing us in the legislature. By building on this work and building our collective power, we’re working toward a future of bold, unapologetic abortion access in the halls of the Capitol and beyond.

For years, we’ve been on the ground fighting to make abortion accessible because we know that legality alone is not enough. Southern and red states like Texas have been the most resilient and creative in fighting back against restrictions, and we will tap into that resiliency as we embark on this new journey as Avow. Georgia showed us what’s possible when we lead with our values and our faith—I know we can do the same in Texas.

Everyone, say it with me: abortion. Trust me: It feels good to say. Abortion.

On Wednesday evening, President Joe Biden’s press secretary, Jen Psaki, stood in the briefing room for the first time, fielding questions from reporters and actually answering them. What a concept. Her answers were direct, unapologetic, and factual—that is until she was asked a question about abortion.

Eternal Word Television Network reporter Owen Jensen asked Psaki about the Hyde Amendment—which bars federal funds from being used for abortion except in cases of rape, incest, or life endangerment—and Trump’s expansion of the global “gag rule”—a policy that blocks foreign aid for nongovernmental organizations that provide or even talk about abortions. (The global gag rule is also known as the Mexico City policy; it was first announced in Mexico City in 1984 during the Reagan administration.) Jensen called them “two big concerns for pro-life America.”

“Well, I think we’ll have more to say on the Mexico City policy in the coming days,” Psaki replied. “But I will just take the opportunity to remind all of you that he is a devout Catholic and somebody who attends church regularly. … He started his day attending church with his family this morning. But I don’t have anything more for you on that.”

Not exactly the full-throated defense of abortion access we would hope for. Reproductive rights advocates were quick to pounce on the flaccid response, arguing that it appeared as if Psaki was kowtowing to the Catholic right wing, instead of standing firm on abortion access. After all, Biden’s faith is irrelevant to the abortion conversation in the first place. And more importantly, Psaki should have pointed out that the vast majority of Catholics, like Joe Biden, are pro-choice. Many have even had abortions!

What’s more, Psaki’s answer illustrated a longstanding problem among liberals and progressives: saying the word abortion. We saw it at the presidential debates; we’ve seen it in electoral politics for years. Politicians use words like “choice” and “reproductive health”—anything to avoid saying the word a-bor-tion. Abortion is too often treated as the third rail of politics: scandalized, stigmatized, and made taboo. Psaki took question after question without missing a beat, holding her ground on the administration’s policies. And her answer to Jensen’s question should have been no exception.

Psaki should have answered it like she would a question about student loans, or the economy, or climate change—by saying those words, and speaking about the policy and the people impacted. Instead she acted like the matter at hand was something to be sidestepped or treated with kid gloves.

It’s possible that Psaki was trying to avoid lending legitimacy to the question or EWTN itself, which was credentialed under Trump, and which has a longstanding reputation of right-wing zealotry. But without that context, her answer looked and sounded like a cop-out.

But here’s what’s odd: We have Biden’s answer on the question about the global gag rule. Ahead of the inauguration, the Biden-Harris administration released a list of planned executive orders, including one repealing the global gag rule. That is what Psaki was alluding to when she said there was more to come on that issue. But she should have just said that then.

And this ambiguity is likely why Dr. Fauci, everyone’s favorite pocket-size Italian, came out on Thursday morning and reaffirmed the administration’s commitment to reproductive health. “President Biden will be revoking the Mexico City policy in the coming days, as part of his broader commitment to protect women’s health and advance gender equality at home and around the world,” Fauci said in a speech to the World Health Organization.

Psaki could’ve said something like: “Biden announced this morning that he would be rescinding the Mexico City policy; like the majority of Catholics in the United States, President Biden is pro-choice.”

I wish I could chalk this up to a first-day fluke, but Psaki made a similar blunder on Friday when she was asked about Vice President Harris’ abortion platform during her campaign. She dodged the question by saying that those were Harris’ policies, and adding that she had nothing more to say on the issue.

Certainly, Psaki may not have wanted to get into a messaging war with Republicans about abortionduring the first week of Biden’s presidency, especially given the Biden-Harris administration’s stated commitment to reproductive rights.

In its first week, the administration dropped nearly a dozen executive orders addressing a range of issues central to reproductive justice.

Still, saying that abortion is good medicine is no more controversial than saying climate change is real, or wearing a mask saves lives. And the administration has spent a lot of time on sending a message about truth, facts, and science—about listening to the experts and prioritizing the health of people in the United States. By capitulating to gotcha questions about abortion, Psaki failed to live up to that promise.