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What the Sterilization of a Wealthy White Woman Reveals About Eugenics

Throughout history, white women have thrown the rights of other women under the bus in order to retain social status.

In her first book, The Unfit Heiress: The Tragic Life and Scandalous Sterilization of Ann Cooper Hewitt (out today from Grand Central Publishing), Audrey Clare Farley writes about the life of one such woman: Ann Cooper Hewitt, a wealthy white socialite and the daughter of inventor Peter Cooper Hewitt and his wife, Maryon.

When Peter died young and it looked like Ann would soon inherit his fortune, Maryon convinced doctors to sterilize her daughter without consent, due to Ann’s supposed promiscuity. The sterilization put Ann’s claim to Peter’s fortune at risk, allowing Maryon to inherit the estate. In 1936, Ann took her mother to trial, in a case that captivated the media.

“Ann’s social status certainly intrigued Americans, as did the sheer sensationalism of her feud with her mother,” Farley told Rewire News Group. “In fact, her case garnered far more press than Buck v. Bell, a sterilization case involving a poor rural Virginia woman that went all the way to the Supreme Court in 1927.” Ann lost her case but she—unlike many sterilized women in the early 20th century—later married and did not face social ramifications.

Rewire News Group talked to Farley, who received a Ph.D. in English from the University of Maryland, College Park, about how Ann’s defense against her sterilization was rooted in her white, wealthy privilege; how the eugenicists vilified female promiscuity; and how racism informed the way different disabilities were viewed in the eugenics movement before and during World War II.

In your book, you wrote about how Ann Cooper Hewitt was punished for her promiscuity. Were promiscuity and female sexuality perceived as almost a disability within the eugenics movement?

Audrey Clare Farley: In the early stages of the eugenics movement, promiscuity and oversexuality were thought to be a mark of feeble-mindedness—a catch-all term applied to sexually deviant, poor, substance-dependent, epileptic, intellectually disabled, or otherwise socially undesirable persons. Being feeble-minded meant someone was genetically and morally defective. So disability and immorality essentially went hand-in-hand, with eugenicists eager to prevent the proliferation of such traits.

But not all disabilities were equal, as not all were perceived to pose a threat to white supremacy, which was the ultimate goal of eugenics. Some disabled people, such as diabetics, were exempted from sterilization on the basis that their disease was one of the noble classes. Diabetes afflicted people of all classes and races, but only middle- to upper-class whites had the means to seek care, leading to a skewed sense of its incidence. While eugenicists didn’t love the idea of diabetics passing down their “defects” to their children, they were more worried about the lower classes breeding more prolifically than the upper ones. Also, diabetes wasn’t thought to incline someone to cross the color line, thereby diluting the purity of the gene pool.

Intellectually disabled and promiscuous persons were thought likely to mix with other races—a fact that Ann’s mother exploited. To prove Ann’s idiocy, Maryon Cooper Hewitt made a point of repeating how her daughter flirted with “Negro” servants. Following the eugenicists’ lead, she conflated interracial mixing and intellectual disability to justify medical intervention.

Ann’s mother, Maryon Cooper Hewitt, ordered her daughter to be sterilized without her consent. How do you think this action demonstrates how women can cause harm to other women, especially when they are acting in their own selfish best interest?

ACF: I think women, and particularly white women, often exhibit what Heather McGhee calls zero-sum thinking—a sense that there are only so many rights and resources to go around, so one person’s thriving depends upon another’s marginalization. Ann actually thought along these lines more demonstrably than Maryon. Rather than challenging the ethics of forced sterilization, she simply endeavored to prove that she was not deserving of surgery by virtue of her high-class education and such.

Not long before this, white women had advocated for the vote by promising that legal rights for them would not lead to rights for African Americans. And not long after, second-wave feminists strove for greater reproductive freedoms by strategically ignoring the needs of women of color. While some people do materially benefit from the exclusion of others, scapegoating is never going to lead to anyone’s true liberation. Nevertheless, many of us keep falling for the trap.

Eugenics operates under the assumption that people with bad genes should not reproduce. How did the hatred of otherness—as non-disabled straight white people viewed people of color, disabled people, queer people, and Jewish people—lead to the normalization of eugenics in World War II a few years after Ann’s trial?

ACF: Ann’s case, which focused a great deal on her mother’s failings, helped to modernize eugenics by shifting focus from hereditary to environmental defects and by enabling private practitioners to supplant asylum personnel as the persons responsible for diagnosing feeble-mindedness. As a result of these two changes, poor people of color became the primary targets of sterilization. There was no longer any need to prove imbecility or bad genes; the simple facts of poverty and large family size often sufficed to convince a doctor that a person was unfit for parenthood.

In California, Mexican Americans became disproportionately targeted for sterilization, as they were perceived to be hyper-breeders who drained public resources. In the South, it was so common for Black women to seek treatment for an abdominal procedure and come home without a uterus that the term “Mississippi appendectomy” emerged. The Civil Rights Act of 1964, which enabled African Americans to access public programs, didn’t help. It stirred fears that Black women were going to usurp welfare monies intended for whites. It’s impossible to tell exactly how many individuals were operated upon without their consent, as doctors often recorded procedures as voluntary and there was no centralized record-keeping. But experts have put the figure in the tens of thousands.

What is at stake for reproductive rights when we start to question whether or not someone is fit to be a mother?

ACF: If we allow the state—or medical persons acting on behalf of the state—to decide who should and shouldn’t reproduce, then individuals lose their autonomy to those acting upon arbitrary moral judgments. This doesn’t only mean doctors have the authority to deny “unfit” women the chance to reproduce. It means doctors can coerce “fit” women to reproduce. That is precisely what happened after World War II, when middle-class white women came to desire sterilization for birth control purposes. Many hospitals enacted the “120 rule,” whereby a woman’s age multiplied by her number of children had to equal or exceed 120 in order for her to qualify for surgery. Today many doctors continue to refuse white women surgery, saying such things as “you’ll change your mind.”

Meanwhile, as the World Health Organization reports, doctors target poor, disabled, incarcerated, undocumented, trans, and other marginalized persons for birth control implants and even forced sterilization.

The relationship between faith and eugenics is complicated. How has Christianity played a role in eugenics? And at the same time, how has it influenced the fight against eugenics?

ACF: Christians were split on forced sterilization. The Catholic Church declared it intrinsically evil, leading many Mexican Americans to fight forced sterilization, such as by challenging the constitutionality of sterilization statutes. Evangelical Protestants also tended to oppose sterilization, if only because it grew out of bogeyman Charles Darwin’s evolutionary theory.

Liberal Protestants, however, enthusiastically supported it. Methodist, Presbyterian, and Episcopal leaders preached about the importance of selective breeding, helping to give eugenics a theological dimension. Part of their support was due to a blithe embrace of science, and part was due to their belief that Jesus would only return to earth once humanity reached a state of near-perfection.

Today conservative evangelicals pat themselves on the back for opposing sterilization, but it is important to remember that sterilization was only one tool in the eugenics toolbox. After World War II, secular eugenicists began to promote marriage counseling and “family values” for able-bodied, middle-class white couples. They wanted to be sure that these couples didn’t slack in their duties to proliferate the race. Evangelicals like Dr. James Dobson cut their teeth working under such eugenicists. Much of the initial evangelical resistance to Roe was also driven by positive eugenics. Conservatives opposed abortion because white women, who were the most visible in the abortion rights movement, were exactly the type of people whom they wished to see reproduce. The religious right’s full-throated embrace of white nationalism today is another sign that eugenics very much continues to reverberate within certain faith communities.

To Prepare for Motherhood, I Looked to the Past

I was in my freshman year of college when I heard, for the first time, a recording of Billie Holiday singing “Strange Fruit.” I repeatedly listened to her sing both “Don’t Explain” and “Strange Fruit”—the former about a wayward lover, and the latter about the black victims of a murderous South. The images and moods in these two songs, the hushing and howling, Billie’s voice ringing with a huskiness my fingers could almost touch—all of it would merge in my mind until I saw lipstick smeared over twisted mouths and dead eyes bulging with hopes of greener pastures. I listened, again and again, until lovers’ bodies and bloody roots entwined, and a sweet rot emanated from my own mouth.

It seemed as though Billie were singing directly to our family. It seemed as though she were seeing us—the whole line of us, at least as far back as the age of Jim Crow.

Psychologists call it “trauma ghosting”—the body’s ability to “remember” a trauma that happened earlier in life or in an ancestor’s life. It can manifest as an extreme and inappropriate reaction to anything that “reminds” the body of that early trauma. I think about my aversion to the stage, how my body shakes from its innermost core at the prospect of a crowd in front of me. Perhaps my body sees an audience, senses it, and remembers a mob staring at my great-grandfather Burt as he is about to be lynched, or as another ancestor is being whipped in front of a crowd, or as another is standing on top of a platform being sold.

Let the dead bury the dead, Jesus said, but here I am: guilty of pining after my dead. Not knowing one’s story is like being buried alive. The living pretend they don’t know you’re under the soil, but there you are, plain as dirt, providing a foundation over which they trample and build and move on with their lives.


A few weeks into my pregnancy, I dashed into my go-to import store, an open warehouse of a place filled with home interior fashions and art we so loosely exoticize, materials we cloak and surround ourselves with to feel worldly and cultured. It is a chain version of an export store, bringing “the world” to those of us who can’t regularly afford to travel to faraway places or frequent exclusive import/export boutiques. I was stopping by the store to pick up some small percussion instruments for a volunteer workshop I was teaching at an elementary school.

Inspired by Afro-Caribbean music, I named the workshop Drumming Up Words and intended to marry song, syllable counting, storytelling, and poetry with the beating and shaking of percussion instruments. To add to the collection of instruments that I was bringing from home—djembe drums, a wooden xylophone, rain sticks, a triangle, bells—I wanted to see if the store had a few small last-minute items, such as a tambourine or maracas.

In the small toy section, I spotted some tiny plastic-rimmed tambourines. Determined to find something better, I bent down and combed my eyes over the bottom shelf. Something jumped out at me: bright colors on shiny metallic. I picked up the toy and my heart skipped. My hand flew to my mouth. The word hangman was blazoned across the toy’s packaging.

I raised it closer to my face. No, my eyes were not playing tricks on me. The metal box contained a magnetic version of the game that so many of us played in grade school. Except the letters were painted on magnetic pieces waiting to be spelled correctly or else the child (five and older) would be hanged. Unlike the stick bodies of our long-ago drawings, the “man” in this game was a realistic depiction of a human: a half-smiling white cowboy, chin full of stubble, a wide hat on his head, a rope around his neck, and an incomplete body. The rest of his body parts were just waiting to meet him, courtesy of the loser.

“This is not okay,” I said aloud, straining to get up. “This is not okay.” I wanted to buy the game as proof but didn’t want to be caught buying it. A few people, at ease on that quiet afternoon, passed by me and glanced at my stricken face as I stood in the middle of the toy section with my mouth agape.

I pulled out my cell and took a picture of the hangman game.

I was grateful that I was not yet a mother. What if I had been with my child, innocently looking for toys, when we discovered the hangman game? What if my child begged and begged me for it, and I, still in shock, had to explain why we could never buy such a game? At least now I knew to watch out for it. At least now I knew that I could be in the middle of Los Angeles shopping at a store that promotes a “global” take on living and run smack dab into a reminder of lynchings, wrapped in shiny, cartoonish packaging.

At home, I opened my computer and searched for the hangman game on Amazon, and there it was, bright as day. Parents love it, starred reviews revealed. And the product description made no bones about the objective and consequences of the game: “Guess an incorrect letter, and a body part is added. Solve the word before you get hung!”

A take ’n’ play anywhere game. All for the price of $9.99.


A memory (what feels like a memory) comes to me:

A white boy is writing his name—Lloyd—and mine on a blackboard, drawing a line between us. The chalk squeaks and strains against the board as the boy creates another long vertical line—his hangman’s pole—and a series of short blank lines beneath it. He turns to me with a sneer and the most difficult phrase he can fathom locked in his head, which is covered with silvery blond hair and filled with tricks.

We are in second grade, and every year, we stand next to each other when it’s time to line up in alphabetical order. A veil of camaraderie has emerged from this mash-up, but we are not really friends.

I sit in the middle row surrounded by vacant desks, praying that my brain will fill in all the blanks of Lloyd’s person, place, or thing.

I glance out the window where the rest of our classmates are running and squealing with delight, their faces glowing with sweat. Why have I chosen to spend my recess in a cold, quiet classroom filled with the grin stretching across Lloyd’s face and the anxiety over losing pinching at my chest?

“R!”

I call out the letter first because it seems to be a staple ingredient of most words, but there is no r, and there is not even a t—none of the usual standbys apply. Letter by letter, the boy hangs my errors, drawing in the body parts of the little stick person: head first, then neck, then right arm. If this boy were just a teeny bit nice, he’d give me facial features and fingers; he’d bless me with a triangle skirt, endowing me with more time.

I am stuck. I run out of the safe consonants and vowels. I feel caged and can sense my stomach sinking. Half of my stick body dangles on the edge of the pole as my opponent greedily waits to shout out my defeat.

I sit frozen in my bone-hard seat, feeling myself diminishing, centimeter by centimeter. The line extending from the expressionless, carved-out head on the blackboard is a vein in my neck.

But how was I losing? How was I losing to this boy—a C student?

I was the spelling bee champion. Our teacher, Mrs. Crain, had called me “smart,” and her praise had been like gold.

“Where’s Miss Spelling Bee now?” Lloyd teases as, time after time, he fills my stick body in on the chalked gurney.

“Hung!” he rings. I picture a little silver bell dangling at the back of his throat.

Hung!

The word echoes through the room. Fear and saliva rise in my throat.

The school bell rings. The other kids trickle back into the classroom, moist and happy. Lloyd does not offer the answer to his puzzle, and I do not ask.

Better to not know what hanged me.


These ghosts of memories are scattered across the landscape of my childhood recollections, much of them inseparable from my imagination and interpretations. Unbeknownst to Lloyd and me, we were players in a game much bigger than us. Unlike our parents, our only school option was the integrated school. Our teacher was black. My mother’s high school had not integrated until the year after she left, in 1970.

I do not know if Lloyd’s parents had taught him about segregation, but already I knew my place. I was fighting against this unspoken yet pervasive contract. I was fighting, as stealthily and stubbornly as it was. Through the sheer power of my supposed brilliance in those early grade-school years, I was attempting to break out of the mold that had been set for me. I was smart, they said, my family and Mrs. Crain, but they were all black, and Lloyd had proven them wrong. If I couldn’t hold my brain up as a prize to say, Look, I am more than you say, what good was I?

Marcus and I spoke often about our childhood moments of feeling devalued, and we swore to shower our child with love and affirmations, impenetrable shields from the mental arrows that would one day come, long before we had to fear the path of bullets.

This muscle of building up a child was already formed in Marcus. I had witnessed him pumping up his older sons and trying to infuse them with the power of who they could be, even when they were slipping and drawn to the streets that had once swallowed him. Marcus had not had a father to guide him, so he was teaching himself how to gift fatherhood to his flesh and blood.

I was rushing against time to locate and pick up all my missing parts, the fragments of which I had not felt the need to really salvage because I had not had the responsibility of young black life under my hands.

I was woefully unprepared.

From We Are Bridges by Cassandra Lane. Used with the permission of the Feminist Press. Copyright © 2021 by Cassandra Lane.

How Politicians Exploit Fears About Death to Attack Abortion Care

Americans are afraid of death. Like, really afraid of it.

It’s this reticence to embrace the inevitable, with healthy open discussions and accessible care, that makes the funeral industrial complex a thriving, moneymaking machine. The U.S. funeral industry is currently estimated at about $16 billion market size, with the median U.S. funeral costing around $7,640. It’s an industry fraught with cost barriers, old-school and outdated practices, and an aversion to progress.

So what happens when you cross that with the anti-abortion movement? Well, as you might imagine, it’s not great.

You’ve probably heard of fetal burial laws, which require the disposition of fetal tissue in a manner similar to that of well … a dead person. Most recently, an Ohio judge temporarily blocked the enforcement of a fetal burial law, which requires the burial or cremation of fetal remains. It was signed into law by Republican Gov. Mike DeWine last December; the judge’s decision earlier this month was handed down a day before the law was set to go into effect.

But the Ohio fetal burial law is far from unique. Arkansas, Indiana, Louisiana, and Texas all have enacted laws regulating the disposition of fetal tissue (though all but Indiana’s have been blocked by the courts), and lawmakers in numerous other states have introduced similar legislation.

Fetal burial laws are harmful for a number of reasons. For starters, they’re an abortion restriction, which means they’re de facto unecessary and dangerous. But you might be asking: If they’re legislating the disposal of fetal remains, doesn’t that mean the abortion has already happened? So how is it a restriction?

By invoking images of death through the requirement of burying or cremating fetal tissue, lawmakers are forcing patients to confront their abortion decision as a death.

And honestly, that’s a solid question. Fetal burial laws are insidious the same way laws that require abortion providers to have admitting privileges at local hospitals are insidious: They force providers into agreements with outside organizations that may not be amenable, and in many circumstances are openly hostile, to what abortion providers do. What ends up happening is that a clinic can’t find a hospital—or in this case, a funeral home—to help it comply with these laws, forcing it to close.

But fetal burial laws invoke an even more nuanced obstruction to care by playing into the country’s largely death-phobic nature. Death-phobia is more than just the fear of death and dying: It’s a culture of shame and stigma surrounding death and end of life that breeds anxiety and misunderstanding.

Progressive death-care workers, like those at the Order of the Good Death (where I work as a social media contributor), are pioneering a movement, deemed death positive, to combat the toxic culture around death in the United States, and instead encourage open communication about death and a shift toward understanding that shrouding death in silence does more harm than good.

By invoking images of death through the requirement of burying or cremating fetal tissue, lawmakers are forcing patients to confront their abortion decision as a death. But many don’t see abortion as a death or loss of life at all. And while we know that some people do grieve their abortions as they would a pregnancy loss, we also know that for many people abortion brings on feelings of relief and everything in between.

This forced association could cause patients to forgo or second guess an abortion because of the guilt or ill feelings it evokes, just like laws requiring fetal ultrasounds. These laws are, by design, a cruelty; subjecting pregnant people who choose abortion to emotional torment in the hopes that it will delay or exhaust them into changing their mind. And if they fail to change their mind, laws like those mandating fetal burial make sure that no matter how you feel about your abortion, it’s going to be a heavy and traumatic experience.

Invoking death-phobia to restrict abortion is not unique to fetal burial laws—other laws like those mandating perinatal hospice, which would require a person to carry an unviable pregnancy to term instead of having an abortion, also play to our fears and inability to talk about death openly.

Lawmakers who support fetal burial laws are counting on this country’s death-phobia. They need constituents to hear words like “cremation” or “remains” and recoil. If we’re so afraid of death—and we are—then equating it with abortion will only impede access.

What You Need to Know About COVID-19 Vaccines, Birth Control, and Blood Clots

On Tuesday, the Centers for Disease Control and Prevention (CDC) suggested temporarily pausing use of the Johnson & Johnson’s COVID-19 vaccine while researchers investigate a handful of reports of potentially dangerous blood clots.

This news, which came on the heels of similar incidents possibly related to the AstraZeneca vaccine, makes the already difficult job of encouraging vaccination among a somewhat reluctant public even harder.

Unfortunately, too many media outlets have taken it upon themselves to ease the public’s concerns by making quick comparisons to other medications, like the birth control pill, that carry a higher risk of blood clots. This is not helpful, nor is it entirely scientifically accurate. And it may end up encouraging young people using birth control to skip the vaccine and ditch their pills.

Around 7 million people in the United States have already gotten the J&J vaccine, and there have been six reported cases of blood clots. In Britain and the European Economic Area (which includes the countries of the European Union plus Iceland, Norway, and Lichtenstein), over 34 million people had gotten the AstraZeneca shot as of April 4, and health officials had received 222 reports of blood clots. By the numbers, this is a very rare condition and seems to happen more often in younger women.

Perhaps that’s why so many news outlets thought to compare the risk of blood clots from the vaccine to the risks young women might face from hormonal birth control.

A recent Business Insider article, with the headline “Panic Over AstraZeneca’s Shot Is Overblown,” noted birth control’s clot numbers are scarier: “After a year of taking birth-control pills, about one in 1,000 women will develop blood clots. (The risk is about 1 in 10,000 for all young women, so it’s elevated nearly tenfold in birth-control takers.)” This is a bit of an overstatement; most experts agree that hormonal birth control increases the risk of blood clots by three- to four-fold among pill takers without underlying health issues.

Such comparisons may seem like an easy way to explain risk, but even when accurate they don’t tell the whole story and so risk stirring up unnecessary fears about hormonal contraception.

A more familiar kind of blood clot

The blood clots that might be linked to the new vaccines are part of a condition known as cerebral venous sinus thrombosis (CVST), and they have not been well studied. CVST occurs when a clot (a mass of coagulated blood) forms in the brain’s venous sinuses, preventing blood from draining out of the brain and potentially leading to hemorrhage or stroke. Symptoms of CVST in these cases seemed to appear within two weeks of receiving the vaccine and were accompanied by low platelet levels, making treatment more complicated. The pause on vaccine distribution is designed, in part, to give experts time to determine the best treatment options.

By contrast, we know a lot about deep vein thrombosis (DVT), the blood clot condition related to the pill. This type of clot usually forms in the lower legs, thigh, or pelvis. The biggest risk with DVT is that a portion of the clot breaks off and travels through the veins to the lung, causing a pulmonary embolism. Risk for DVT is increased when someone is on hormonal birth control that contains estrogen (most hormonal birth control contains both estrogen and progestin) but also after surgery, during pregnancy or right after childbirth, and after extended periods of air travel.

While researchers are racing to figure out whether any underlying conditions make one person more at risk of CVST after a vaccine than another, we already know what increases the risk of DVT: smoking, high blood pressure, family history of clots, and obesity, among other things. Providers often caution women in these categories against going on hormonal birth control in the first place. The other important distinction between the new complications and those associated with birth control pills is that we know how to treat both DVT and pulmonary embolism.

The danger of comparing the risks by the numbers is that pill users will conflate the two medical issues and draw inaccurate conclusions about their own risk.

We don’t need another “pill scare”

In 1995, the U.K. Committee on Safety of Medicines warned that certain newer formulations of birth control pills presented higher risk of blood clots. The news was widely reported in the media, even as family planning officials expressed fears that this would lead to people dropping birth control altogether, which would, in turn, lead to more unplanned pregnancies. Research proved them right—over the course of the following year, conception rates in the U.K. were 4 to 7 percent higher than expected, and abortion rates were between 3 and 13 percent higher than expected.

The women who were taking the pill in 1995 had likely already been told by their health-care provider that hormonal birth control carried some risk of blood clots, but the information had been delivered in a more personalized and less alarming way. Reading it in a headline must have been shocking if it led to many women to simply stop using contraception. Many of the women who made this decision were likely not even on the brands of the pill included in the announcement.

This came to be known as “the pill scare,” and it could easily happen again.

Risk comparisons won’t work

We are a society of headline readers who often skip the details in favor of fear. Comparisons may seem like an easy way to make abstract risk concepts relatable, but they aren’t particularly useful. Anyone who has ever expressed a fear of flying has undoubtedly been told that they are more likely to die in a car accident. But all it takes is one headline about a plane crash killing everybody on board, and statistical probability becomes meaningless.

The job of those promoting the vaccine has become exponentially harder this week, but those of us who have spent careers promoting correct and consistent contraception use must ask the media to stop trying to help by using the pill as a comparison measure. This can only cause confusion, and possibly unintended pregnancy.

Abortion Patients Get Big Win From the FDA

For more on the future of abortion, check out our special edition.

As vaccinations roll out and some parts of the world start to reopen, we need to envision what the new normal will be. This means addressing existing inequalities illuminated during the pandemic, by looking at how we’ve adapted and bringing innovations into the future instead of reverting to how things were before. Making medication abortion readily available via telemedicine does both.

On Monday, the Biden administration took an important step in envisioning that new reality by announcing it was continuing to suspend a requirement that patients pick up abortion medications in-person during the pandemic.

Over the last year, the COVID-19 pandemic has created significant barriers to accessing basic health-care services, with women in the United States more likely to report experiencing major gaps in routine medical care, according to a survey.

But there is a silver lining: Research suggests telemedicine may improve access to health care and dismantle barriers to health-care services. While access to telehealth services has, to this point, been relatively limited in scope and unevenly available, the number of survey respondents who reported having a telehealth visit in the last year roughly tripled from pre-pandemic use. People who used telehealth reported high levels of satisfaction, meaning expansion of telemedicine could be a more permanent solution to gaps in access to in-person medical care—including reproductive health care.

Multiple countries have set up telemedicine services as a means of accessing abortion during the pandemic, with some temporarily allowing medication abortion pills to be distributed via mail. Still, the United Nations Population Fund estimated that 12 million women across 115 low-and middle-income countries lost access to contraception in 2020 due to the pandemic, leading to an estimated 1.4 million unintended pregnancies.

In August, a World Health Organization survey revealed family planning is one of the health services most frequently disrupted during the pandemic. Estimates last spring from the Guttmacher Institute painted a bleak picture: If 10 percent of safe abortions become unsafe because women cannot access services amid lockdowns and clinic closures, there would be an increase of 3 million unsafe abortions and 1,000 more maternal deaths. With major disruptions to national health systems caused by the need to respond to people affected by the virus, high-quality self-care interventions can provide an important alternative.

Abortion is essential health care, and access to abortion plays a key role in reducing health inequities across socioeconomic groups.

Scientific evidence shows it’s safe to prescribe medication abortion via telemedicine during early stages of pregnancy and to distribute medication abortion pills by mail. A recent Scottish study concluded “telemedicine abortion without routine ultrasound is safe and has high efficacy and high acceptability among women.” An English study similarly concluded that a “telemedicine‐hybrid model for medical abortion that includes no‐test telemedicine and treatment without an ultrasound is effective, safe, acceptable and improves access to care.”

There’s a window of opportunity to make access to medication abortion more easily available, including through telemedicine. In the United Kingdom, where temporary rules installed during the pandemic allowed medication abortion to be prescribed via telemedicine, the English and Welsh governments are consulting the public about whether or not to make those rules permanent.

In the United States, more than 150 members of Congress filed an amicus brief in February, challenging the Food and Drug Administration’s in-person requirement for dispensing mifepristone during the COVID-19 pandemic. Democrats from the House Oversight Committee also sent a letter to acting FDA Commissioner Dr. Janet Woodcock urging the agency to lift the Risk Evaluation and Mitigation Strategy (REMS) requirement that medication abortion pills be obtained in-person from a health-care provider. The FDA listened: This week, Woodcock said the agency would stop enforcing the requirement and would allow patients to receive medication abortion pills by mail—for the duration of the COVID-19 pandemic.

Women should always be in control of their health and reproductive lives—not just during global pandemics. Abortion is essential health care, and access to abortion plays a key role in reducing health inequities across socioeconomic groups. While telemedicine doesn’t address all access issues—problems and inequities with telecommunications infrastructure mean we will always need in-person access to abortion care—measures taken during the pandemic to increase abortion access should remain in place post-pandemic.

Let’s stand up to political opposition and follow the scientific facts: Make medication abortion available via telemedicine to women around the world.

Why Managing Endometriosis Is Harder for Young People

I’m Heather Corinna, a longtime sexual and reproductive life and health writer and educator, the founder of Scarleteen, and the author of three books, including the upcoming perimenopausal guide and tirade, What Fresh Hell Is This?

As someone long involved in the reproductive health of young people, and deeply invested in their well-being and visibility, I want to talk a little about endometriosis and young people.

As underdiagnosed and under-visible as endo and those with it are generally, that’s often even more the case for young folks with it.

Beyond the challenges and barriers endometriosis itself can cause for young people, and living with it causes for nearly everyone, there are a few extra issues specific to many young people with endo.

 

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Young AFAB (assigned female at birth) people often think pain is their birthright, especially menstrual pain, sexual pain, uterine, vaginal, and other kinds of pelvic pain. Pain is normalized for them: They expect it. They—and others they may report pain to—often think it’s right.

For young people with endo whose family members also have gone undiagnosed—which is common, given endo and genetics, the difficulty of diagnosis, and common lack of the level of health-care access necessary to even have a chance at getting a diagnosis—endo symptoms can also be considered normal.

If what’s happening with you is what happens with your mom and your aunt and is what happened with your grandma, and everyone just bore the pain because that’s apparently your lot, who’s going to even know to consider having that pain investigated?

Even if your relatives didn’t specifically have endo, if pain with menses, sex, or childbirth, or any other pain “of womanhood,” has been dismissed, considered normal, or justified in your family or community, well … good luck getting yours taken seriously.

Avoiding reproductive health care because of previous or ongoing consensual sexual activity or sexual abuse and fear of discovery of any or all of these is another common barrier. Pain and other symptoms can also be assumed to be because of these things, and, again, normal.

For those reasons and more, it often takes a long time to even consider something might be wrong, and more time still to get past the emotional, social, and other barriers to even seek out health care to evaluate that pain.

Small wonder young people are even more underdiagnosed than their older counterparts!

And if the source of pain is endometriosis, nearly everyone with endo knows that getting to the initial visit isn’t even half the battle—because that visit is usually a long way from a diagnosis, let alone accessible, effective treatment and other care.

When and if a diagnosis is made and treatment advised, a dependent young person is dependent on adults—and not just the adults’ ability to pay for that care, but their understanding of the gravity of the pain and disruption endo causes—for care and daily accommodations.

Suffice it to say, especially in the current climate, young adults who are outside parents’ care or other support systems may find affording and managing ongoing care, including surgeries, anywhere from tremendously difficult to impossible.

Young people with endometriosis need our belief in their realities, our understanding, and most of all, our support.

This post was adapted from a Twitter thread originally posted March 10.

What Endometriosis Might Mean for Your Fertility

I’m a health journalist and the co-founder of Endo Warriors, which provides education and support to people with endo. I’m also writing a book about family planning. And I’m writing a book that will delve into everything you need to know about if, when, and how to become a parent, called So When Are You Having Kids?

I was diagnosed with endometriosis when I was 12. Growing up, I knew infertility was a possibility, but I thought in vitro fertilization (IVF) was foolproof, so I didn’t worry too much. When I was 24, I was diagnosed with premature ovarian failure, which doctors suspect came from having seven endo surgeries.

I’ve been trying, on and off and with various levels of intensity, to get pregnant for almost five years with no success. Infertility has been the most trying and soul-sucking thing I’ve ever gone through, which is why I think it’s important to talk candidly about infertility.

Endometriosis is one of the leading causes of infertility, but not everyone with endometriosis is infertile. Estimates suggest around 30 percent to 50 percent of people with endo will face difficulties getting or staying pregnant.

 

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Endo can impair fertility in many ways: inflammation, distorting your pelvic anatomy, fallopian tube scarring and adhesions, altering immune system functioning, impairing implantation of a pregnancy, changing the hormonal environment of the eggs, and altering egg quality.

Repeat surgeries, as well as operating on endometriomas (a type of ovarian cyst), can also damage your ovarian reserve. Essentially, there are a lot of ways endo can damage your fertility, and it can be tough to figure out which endo-related issue is causing problems.

If you have endometriosis and are concerned about your fertility, it’s important to be proactive. One easy thing you can do is ask your gynecologist to check the hormones related to ovarian health (namely FSH, AMH, and estradiol).

If those tests come back abnormal for your age, your doctor will likely recommend you see a fertility specialist known as a reproductive endocrinologist. There are other tests that can check the health of your uterus and tubes, and look at the number of follicles your ovaries produce.

Sometimes people with endo assume they will be infertile and so they don’t use contraceptives or start trying to conceive before they are ready, and then they get pregnant without any issues. It’s hard to say who will and won’t get pregnant.

Screening for hormone issues, uterine abnormalities, endometriomas, and problems with the fallopian tubes can help you identify problems early on. If having kids is something you want, now or in the future, make a game plan with your gynecologist that fits your timeline.

This piece was adapted from a Twitter thread originally posted March 15.

What It’s Like for Black Women With Endometriosis

Do you know how endometriosis affects Black women?

If you’re not fully aware of endometriosis, here’s the gist: Endometriosis is a chronic inflammatory condition that predominantly affects the reproductive system but can also attack the thoracic and digestive systems.

Then there are the symptoms like excruciating periods, brain fog, painful sex, mood swings out the wazoo, random body pains … and the most disheartening of them all for many: infertility.

Eleven percent of American people between the ages of 15 to 44 have endo, and 1 out of 10 people assigned female at birth worldwide—and though it’s rare, cis men, too. It can take up to six to ten years to be diagnosed.

Even worse? For African American women and other women of color, it sometimes takes 11 to 15 years!

Why, you may be wondering? Because African American women are 50 percent less likely to be diagnosed with endometriosis than any other race.

Surprised? Not us. We’re also 50 percent less likely to receive pain medication than white women. Here’s another 50 percent stat for you: that’s the percentage of white medical trainees who believe African Americans have less sensitive nerve endings or a similar myth about Black bodies.

 

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Don’t believe us? Here’s proof, courtesy of the journal of the Royal College of Obstetricians and Gynaecologists, the Association of American Medical Colleges, and the Harvard Global Health Institute—just to get you started.

We are Endo Black, and as Black women with endo, we already deal with the anxiety that stems from oncoming periods and flare-ups regularly. But even taking a trip to the doctor’s office can lead to emotional anguish. Medical professionals have laughed at our pain.

Did you know that the “father of modern-day gynecology,” J. Marion Sims, operated on several enslaved African women in the mid-1800s without anesthesia? He wrote about his studies, and though we’ll never know every woman he mutilated, we know of three women.

And so we do this for them, “the mothers of gynecology”: Lucy, Anarcha, and Betsey.

This post was adapted from a Twitter thread originally posted March 23.

It’s Black Maternal Health Week. Let’s Talk About Abortion Access.

This week, a community of organizations across the country are speaking out about the importance of supporting, trusting, and listening to Black women, as we mark the fourth annual Black Maternal Health Week.

As a Black woman and physician who has provided the full range of pregnancy-related care—including prenatal, delivery, postpartum, and abortion care—for thousands of patients, I have seen firsthand how our maternal health system is failing and how Black women* are bearing the brunt of this failure.

I have also seen how this failure is intimately tied to Black women’s lack of access to comprehensive reproductive health care, including access to abortion care. The same systems and structures that result in Black women experiencing higher rates of mortality, morbidity, and mistreatment when accessing pregnancy care are directly correlated to the experiences Black women face when seeking abortion care.

The commonality here is not race, but racism.

The racial uprisings over the last year have clearly shown us that the legacies of white supremacy, and its resulting violence and harm, are not behind us. And the convergence of these uprisings with a global public health pandemic proves that the medical system is not somehow unaffected. When health-care providers don’t listen to the lived experience and personal expertise of Black women, they are perpetuating harm. When Black women aren’t able to make decisions about building their families due to medically unnecessary restrictions on abortion care, the result is harm. Understanding the connection between these two is critical.

Abortion restrictions are part of a long legacy of attempts to exercise power and control over the bodies of Black women. Restrictions on access to abortion care, such as targeted regulations of abortion providers (TRAP laws), insurance coverage limitations, and gestational age bans, disproportionately impact Black women for many reasons. Black women are more likely to live in states where these restrictive laws have been passed and less likely to have access to insurance that provides coverage for abortion care.

Black-led and Black-centered organizations like Black Mamas Matter Alliance advocate to shift culture in support of Black maternal health, rights, and justice.

Black women are also less likely to have quality, culturally responsive community-centered care during their pregnancy and the postpartum period and are three to four times more likely to die during pregnancy and the postpartum period than white women—meaning the decision to carry a pregnancy to term is a life-or-death decision for Black women. When abortion care is inaccessible, Black maternal health as a whole suffers because agency, autonomy, and self-determination are compromised.

While we continue to do the work as health-care providers to center and ground our care in trust and respect for individual agency and autonomy, we must also follow the lead of organizers across the country making meaningful impact on all aspects of maternal health, including abortion access. Black-led and Black-centered organizations like Black Mamas Matter Alliance advocate to shift culture in support of Black maternal health, rights, and justice. This includes advocating for policies that center Black pregnant people and supporting the work of the congressional Black Maternal Health Caucus, including the Momnibus bill, a comprehensive set of regulations and investments to address the crisis in maternal mortality and its disproportionate impact on Black women.

Our nation is in a moment of reckoning. We have an opportunity to actively lean into a liberatory framework that centers the health and rights of all people. In order to do that we must trust and follow the expertise of those who have been most impacted by these inequities in access and outcomes. The same is true for maternal health and abortion care. Our dreams for a future where Black pregnant and birthing people are thriving must include a world where all people, including Black people, can access the full range of pregnancy-related care—including abortion when and where they need it.

*More than cisgender women access reproductive health care, including trans people and gender nonbinary people. This piece uses “women,” while acknowledging the fact that people of all genders need and deserve access to comprehensive reproductive health care including prenatal, pregnancy, and abortion care.