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Simone Biles, Naomi Osaka, and the Justice in Prioritizing Black Women’s Mental Health

Olympians Simone Biles and Naomi Osaka sparked a national conversation about mental health and self-care after they spoke out and took action to protect their mental health. But missing from many of the stories about Biles and Osaka is an analysis of the impact of racism and sexism on mental health. That’s an especially important conversation to have as we continue to reel from the stresses of the pandemic.

The COVID-19 pandemic has negatively impacted the mental health of many, but Black and Hispanic people, young adults, essential workers, caregivers, and those with preexisting psychiatric conditions are suffering the mental health impacts at disproportionately high rates, according to the Centers for Disease Control and Prevention. This is particularly true among Black women. At the beginning of the pandemic, in April and May 2020, 27.7 percent of Black adults reported symptoms of depression, up from 19.3 percent in 2019. Black individuals also report higher rates of increased substance use and having seriously considered suicide in the past month, compared to white and Asian individuals.

Reproductive justice can only be achieved when Black women, femmes, girls, and gender-expansive individuals  get the help we need for emotional distress, including distress caused by anxiety, depression, or trauma. Black women and people need mental health services, now more than ever, given the racial reckoning in the country—largely led by Black women—as well as a global pandemic that is disproportionately impacting Black and brown communities.

While Black people in the United States experience traditional mental health challenges (like depression or anxiety) at the same rate as other racial/ethnic groups, we also experience profound mental and emotional distress that is uniquely and directly linked to racial oppression.

For Black women, this distress is doubly felt—experienced at the intersection of racial and gender oppression. The stereotype of the “strong Black woman” was born of Black women’s sheer need to persevere and be resilient in the face of staggering misogyny, racism, and the widespread economic and health disparities that result.

However, this label carries an undue burden for those it’s placed upon—often at significant cost to our mental and emotional well-being. A recent survey of Black women asked what would make it a better time to be a Black woman in the United States, who is free to raise healthy children if she chooses. The survey found 89 percent of respondents said decreasing the risk of drug and alcohol abuse in Black communities was either “extremely important” or “very important,” and 87 percent said improving access to affordable mental health care was either extremely or very important.

In its current state, the mental health workforce remains profoundly inadequate to meet these specific needs of Black and brown communities. Mental health professionals of color are shown to provide more appropriate and effective care to Black help-seekers, yet fewer than 4 percent of psychologists are Black.

In addition, the mental health field has failed to broadly implement clinical training that would improve awareness and understanding of the unique mental health needs of Black women, girls, and gender-expansive individuals. These and other factors such as stigma, prior negative experiences with health-care providers, lack of access to services, and inadequate health coverage compound into significant barriers to culturally competent and responsive mental health services. As a result, only about 30 percent of Black people in the United States who need mental health care receive it, compared to almost half of white people.

The recently released Black Reproductive Justice Policy Agenda lays out a blueprint of proactive policies to address Black mental health disparities. It calls on lawmakers to expand medical professionals’ diversity and their access to diversity and cultural competency training. Our legislators must also adopt new policies to expand access to mental health services and medications via telemedicine and provide rehabilitative funding and support for drug-dependent pregnant people. Congress should support programs that help individuals who are experiencing substance use disorder to create addiction recovery plans centered on meeting their individual and family goals. To begin to address these unmet urgent needs, we must pass the Tele-Mental Health Improvement Act, the Resilience Investment, Support, and Expansion (RISE) from Trauma Act, the Mental Health Services for Students Act, and the LGBTQ Essential Data Act.

Two brave women Olympians of color have sparked national awareness of mental health challenges. Now it’s time for policymakers to listen and take action to fix our broken mental health system. The nation and the world will benefit if they do.

Biden Says the US Will No Longer Detain Pregnant Migrants. Don’t Be Fooled.

Friends and family members have been sending me links to news stories about the Biden administration’s recent announcement that it will no longer detain most migrants who are pregnant, recently postpartum, or nursing. They know that I study the experience of pregnancy in immigration detention, and want to share what seems like good news.

My reaction might surprise them.

Of course it is a good thing for fewer pregnant, postpartum, or nursing people to be detained. It is always a good thing for fewer people to be detained, and it is especially important to protect the health of pregnant people and the unique bond that newborns have with their parents.

On its face, the administration’s announcement seems like a positive step in the right direction. But without meaningful action to fundamentally transform our immigration enforcement system, this change mostly serves as a cover for ongoing family separation and other forms of reproductive injustice.

My understanding of immigration policy as reproductive injustice is deeply informed by the work of the Black feminist SisterSong Collective and other reproductive justice advocates of color, as well as my own experience as a midwife in a border community. SisterSong defines reproductive justice as “the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.” This holistic vision of reproductive well-being provides a necessary counterpoint to a white feminist pro-choice movement that has historically left out the voices of Black women and other women of color. U.S. history is rife with examples of reproductive injustice perpetrated against women of color.

There is a direct link from the forced sterilizations and punitive welfare laws of the past to the devastating consequences that harsh immigration laws have on migrant and mixed-status families today.

I saw those consequences firsthand as a midwife working in community health in southern Arizona. I have had several patients miss prenatal appointments because their partner was detained, often during a traffic stop. In one case that I remember vividly, my patient’s partner was facing potential jail time and the possibility of deportation for the crime of having undocumented family members in his car. In these cases, pregnant people were left scrambling for income, child care, and transportation help, fearful for their partners’ well-being and struggling to care for other children while preparing to give birth. Their children did not know when their dad would be home, if ever. This is reproductive injustice.

Since Biden took office, his administration has deported or expelled almost 600,000 people, each one of these deportations or expulsions a potential family separation. Even if a pregnant migrant apprehended at the border is not detained, if they are separated from their partner and sent to detention, that is reproductive injustice. (Last year, I spoke to someone in those exact circumstances who didn’t know where her partner was or whether he was alright. She had no way to contact him.)

When a teenage girl is warehoused in a crowded, unsanitary detention camp staffed by untrained contractors who ignore her when she tells them she is having profuse vaginal bleeding—that is reproductive injustice. The nonconsensual gynecological procedures performed on pregnant people detained at Irwin Detention Center in Georgia, which in some cases ended their fertility, were a form of reproductive injustice. None of these circumstances would be prevented by the Biden administration’s recently announced policy change, which barely scratches the surface of the deep disregard our immigration system has for the well-being of families, parents, and children.

As Adam Serwer wrote, for the Trump administration, the cruelty was the point. Trump used inhumane policies like the family separations of summer 2018 to communicate to his base that he was tough on migrants and would make no exceptions. Trump explicitly engaged in racist rhetoric that cast pregnant migrant women as the carriers of “anchor babies” whose birth in the United States was a threat to a white-majority ethnostate. In late 2017, the Trump administration rescinded the Obama administration’s “presumption of release” policy and began detaining significantly more pregnant migrants. Pregnant people were sacrificed to make his point.

The Obama and Biden administrations, on the other hand, engage in a different kind of rhetorical game. They express public concern about migrants’ well-being and cultivate good press about “humanitarian exceptions” to immigration policy in a bid to put their supporters’ consciences at ease. They put a benevolent veneer on an inhumane system. I am certainly not arguing that the Biden and Trump administrations are equal in their cruelty toward migrants. Trump was worse. But both administrations, each in their own way, have used pregnant people as a convenient political prop.

Reproductive justice is a human right. Those of us who believe this must not be lulled into complacency by the announcement of cosmetic adjustments to immigration policy. We must continue to pressure the Biden administration and Congress to protect migrant families by making meaningful, lasting change.

Abortion Is Legal—but Texas Cities Keep Trying to Outlaw It

Another day, another Texas government trying to outlaw abortion.

The latest is Edinburg, a Rio Grande Valley city that tried last week to pass an ordinance that would have made it “unlawful” to provide an abortion or help someone access an abortion within the city.

At an Edinburg city council meeting last Tuesday, abortion advocates dominated more than three hours of public testimony against the proposal—and at the end of the night, not a single council member made a motion to vote on the anti-abortion ordinance, and the measure effectively died.

Elsewhere in Texas, abortion advocates have been less successful at preventing similar ordinances. In Lubbock, for example, after the city council rejected a “sanctuary city for the unborn” ordinance, voters ended up passing the measure in May. (Last month, a federal district judge dismissed a lawsuit that attempted to block the Lubbock ordinance from going into effect.)

Around two dozen cities have declared themselves “sanctuary cities for the unborn” in the last two years. Last year, the Lilith Fund for Reproductive Equity (which I’m on the board of) and Texas Equal Access Fund sued seven east Texas cities that passed anti-abortion ordinances that called abortion rights groups “criminal organizations” and prohibited them from operating with city limits. The lawsuit was dropped after the cities agreed to revise the ordinances’ language.

Zaena Zamora, executive director of Frontera Fund, and Nancy Cárdenas Peña, Texas director of policy and advocacy at the National Latina Institute for Reproductive Justice, are two of the advocates who spoke at the Edinburg council meeting. I talked with them last week about the harm inflicted by these anti-choice ordinances and what you can do to help fight against them.

When it comes to these local ordinances, it’s important to know that they don’t outweigh federal law. The right to an abortion is protected under Roe v. Wade, even in cities that have declared abortion unlawful. But the ordinances still cause mass confusion, spread misinformation, instill fear and stigma, and criminalize the important and necessary work of reproductive justice groups across the state.

This interview has been lightly edited for context and clarity.

Rewire News Group: How are you feeling knowing that the Edinburg ordinance has effectively died?

Zaena Zamora: It was an amazing experience being at the city council meeting and witnessing our community turn out to support abortion access. It was affirming and powerful to hear the testimonies of community members and to see the group of supporters who were outside the meeting room cheering them on. Being an abortion fund and advocating for abortion rights in Texas is often an uphill and emotional battle, and this past year’s legislation was particularly brutal.

This was such an important win for us because this is our community. Community members showed up, they were passionate and fought for our rights, and we won. It’s exactly the inspiration we needed.

Nancy Cárdenas Peña: I can’t quite put it into words, but I’ll try my best. It was an energizing moment that felt amazing and powerful. On one hand, you had the direct response of our collective efforts to bring out residents who played such an important role in the process. But it was also a reminder for anyone who lives outside of the valley: Religion is not synonymous with anti-choice. The Rio Grande Valley is not anti-choice. It was a purely grassroots local movement created from the strength of local leaders.

How would the ordinance have affected Texans seeking abortions—particularly Black and brown Texans, low-income families, Spanish-speaking folks, and undocumented individuals who are already disproportionately impacted by abortion restrictions and stigma—in an area where abortion access is already limited?

ZZ: Technically, the ordinance would not have affected people’s access to abortion in Edinburg because there is no abortion provider in the city. However, it would have created a dangerous narrative and spread false information to those seeking abortion. Anti-abortion ordinances are racist policies because those who are most affected are BIPOC individuals and, particularly in the Rio Grande Valley, undocumented individuals and those with English language barriers. Part of the goal of these anti-abortion ordinances is to create confusion around the legality of abortion. The language used in this ordinance also further stigmatizes and shames those who want to have an abortion and stokes fear in those who would help them.

NCP: It’s important to acknowledge the patterns of anti-choice policy across Texas and how that plays out in our own cities. The ordinance that the city of Edinburg attempted to pass was one of many attempts by anti-choice organizations to incorporate municipalities into their own political agenda. It strained the ability for medical professionals to exercise their expertise when it comes to the health of their patients and even adopted language around $10,000 bounties for people doing abortion advocacy work within the Edinburg city limits.

This was the first time we’ve seen local policy incorporate the newly adopted Senate Bill 8, signed into law by Gov. Greg Abbott and set to take effect in September, with specific language about the criminalization of a safe medical procedure in a community that is criminalized enough with the presence of border patrol, ICE, DEA, and police. Black and brown communities are often the recipients of criminalization efforts, and it’s important to note that although the restrictions of anti-choice bills are terrible for Texas, it’s incredibly more severe for Black and brown folks who deserve access to the full spectrum of reproductive health-care services.

Border communities like the Rio Grande Valley are restricted by internal immigration checkpoints that prevent people without papers from leaving. It’s imperative that our work continue to preserve the only remaining abortion clinic in the Rio Grande Valley from anti-choice efforts like the one we saw in Edinburg.

If these ordinances don’t actually outlaw abortion, why is it important they be rejected? What is the impact of even one person believing abortion is illegal because of them?

ZZ: I think it’s important to let our elected officials know that community members are not going to let them dictate their morals on their citizens. For those who seek abortion, it’s powerful to see their community stand up for their rights and to know that there is a network of support available to them. Particularly in the Rio Grande Valley, I feel like had the ordinance passed it would have created a domino effect of other neighboring municipalities adopting similar anti-abortion laws.

Abortion is lifesaving health care. Having even one person believe it is illegal can fan the flames of misinformation, which can have a devastating impact on a community. Look at COVID!

NCP: The fight should not be just at the state legislature. There is incredible power in organizing locally. When you observe a pattern of cities adopting anti-choice language, especially in areas with clinics, it’s not a matter of “if” this comes to our city, it’s “when.” One of the biggest obstacles we face is education of the community when it comes to determining if abortion is legal or not.

It’s important to note the options Texans have in spite of the anti-choice rhetoric. Call your local clinic. Call your local abortion fund. Texans still have options when it comes to accessing abortion care regardless of the narrative spun by people who would deny Texans the freedom to make their own reproductive health-care decisions.

What would it mean for the work of abortion funds and practical support organizations to be considered “unlawful” under these types of anti-choice ordinances?

ZZ: Abortion funds and practical support organizations provide a vital service to the communities they serve. As I said in my public comment, Frontera Fund pledged help to over 400 people in our community. These types of anti-choice ordinances directly name abortion funds (not specific, but in general) as organizations that “aid and abet” and put us in danger of frivolous civil litigation and harassment that impedes us from doing our work.

What can you tell people who want to get involved and speak against harmful legislation?

ZZ: One way to help is to just say the word “abortion.” It is not a dirty word. It is health care! Talk to your friends, family, and community members about why access to safe and legal abortion is important to you and your community. Check out and support Frontera Fund and sign up to volunteer, donate, and/or learn more about the work we do. Or check out your local abortion fund by going to abortionfunds.org. And for readers in Texas, go to needabortion.org.

NCP: There are plenty of ways to get involved and fight back against restrictive abortion bills. Please follow the organizations that are working on the ground. Follow us on social media. Donate to keep our work alive. There is always a space for folks who hold a passion to fight for their communities. Invest resources with the leadership and power that already exists in the Rio Grande Valley.

The activism in the Rio Grande Valley needs to be led by the amazing talent, especially the new generation of people who are ready to fight for their communities, that live in the Rio Grande Valley. We’ve consistently heard stereotypes from entities, individuals, organizations about a “lack of organizing power” in the Rio Grande Valley, but since the defeat of the anti-choice ordinance in Edinburg, it’s been a little quiet on their end and the silence is appreciated.

If Mississippi Were Truly Pro-Life It Would Stop Banning Abortion

Mississippi’s justification for unconstitutional abortion restrictions has long revolved around the assertion that the laws, like the 15-week ban recently taken up by the Supreme Court, protect women and children.

But the reality is now, and has long been, that Mississippi women and children’s health and economic security is not prioritized.

“There are just so many different intersections that we meet at here in Mississippi as Black women when it comes to all of those things that ultimately affect our reproductive rights and our reproductive justice,” said Jackson-based community organizer Amanda Furdge. “The lens is like a kaleidoscope—you’re just turning the dial and seeing what you’re going to land on.”

Furdge points to inequities in health care, child care, and education access that disproportionately impact women of color in Mississippi. “We’re talking about the things that we need all the way into 2021 that we’ve been asking for since our mothers and grandmothers have been asking for them,” she said.

When it comes to the most basic health, education, and poverty outcomes, Mississippi consistently ranks at the bottom.

More infants die here before their first birthday than anywhere else in the United States and most developed countries. The state’s infant mortality rate, while improved recently, is still nearly 9 deaths for every 1,000 births—comparable to Turkey and Brazil. Black infants die at nearly double the rate of white infants.

The racial disparity mostly tracks back to premature births, which can largely be thwarted by wraparound care before, during, and after pregnancy—something out of reach for many due to health insurance barriers. Nearly 1 in 5 women of reproductive age in Mississippi lack health insurance, compared to 13 percent nationwide.

“For us as Black women who are born and raised here in Mississippi and knowing Mississippi’s history as it pertains to Black people in general—but particularly Black women and how we are valued or not valued—we come from the lens of still trying to get equal pay, still trying to get adequate, fully funded child care and adequate, fully funded public education,” Furdge said.

Mississippi is the last state without an equal pay statute. It has restrictive barriers around accessing low-income child care and support programs, and it hasn’t fully funded its public education system since 2007.

“There’s nothing about the moves that [the state legislature] has made that backs up this idea that they’re trying to act in the interest of protecting women and/or children.”
-Izzy Pellegrine, sociologist and researcher at Mississippi State University

And a higher rate of people die during pregnancy, labor, or postpartum than in most other states. The state’s Maternal Mortality Review Committee points to Medicaid expansion—or at least extension during the postpartum period—as one part of the solution. The state has refused both, despite new incentives from the Biden administration and evidence that comprehensive health insurance saves lives, particularly during pregnancy and postpartum.

Pregnant people can access Medicaid insurance, but it cuts off two months after they give birth, just as many postpartum complications start to arise. In Mississippi, 86 percent of maternal deaths happen after labor, including more than a third after six weeks—a period in which health insurance is critical to accessing life-saving care.

Mississippi is one of 12 states that hasn’t adopted Medicaid expansion under the Affordable Care Act, which could have provided health insurance to about 166,000 Mississippians and cut uninsurance rates in half.

Even for folks here with insurance, barriers pop up along the way. Half the state sits in maternity care deserts, which means big pockets of areas don’t have obstetric hospitals, birth centers, OB-GYNs, or certified nurse midwives.

No evidence of protecting women and kids

Aside from expanding Medicaid, researchers here point to evidence-based policies that would help Mississippians plan pregnancies: comprehensive sex ed and improved access to birth control. These policies not only save lives but have a side effect of reducing abortion.

There’s a long list of interventions to decrease infant mortality and unintended pregnancies, and increase access to prenatal care, Izzy Pellegrine, sociologist and researcher at Mississippi State University, said. “But that’s not what we’re doing.”

Mississippi public schools have two options for sex ed curriculum: abstinence-only or abstinence-plus, both of which revolve around preventing sex before marriage. Classes are separated by gender, instructors cannot physically demonstrate birth control methods, and parents must opt-in.

“It’s just a little bit difficult to square the idea that our priorities are protecting women and children when the outcomes we are trying to protect people from are ones we know how to prevent, and we’re not taking the steps to prevent those,” Pellegrine said. “There’s nothing about the moves that [the state legislature] has made that backs up this idea that they’re trying to act in the interest of protecting women and/or children.”

Mississippi’s teen pregnancy and teen STI rates are among the highest in the nation. According to the Centers for Disease Control and Prevention, 41 percent of Mississippi high school students have had sex. Of those, 52 percent did not use a condom and 69 percent forwent contraceptives like birth control pills or an IUD the last time they had sex.

“If what we really want to do is improve outcomes, sex ed we know for sure is the place to start,” Pellegrine said. “It would be a lot cheaper for us to do a better job at sex ed than for us to continue these embattled abortion restrictions.”

From 2012 to 2018, the state spent nearly $1 million defending abortion restrictions that were almost all overturned by federal courts. And that was before the current 15-week ban or the subsequent six-week ban moved through the appeals stage.

Further, Pellegrine points out that most of the state is already under a de facto abortion ban because of years of TRAP laws—targeted regulation of abortion providers—that chipped away at access, forcing more Mississippians seeking abortion care to leave the state—at a higher rate than everywhere except Missouri and South Carolina.

“If we think about how abortion access is structured, for most women in Mississippi, we’re already living in an effectively post-Roe situation,” Pellegrine said.

‘A problem of class resources’

Most national coverage points out that abortion bans disproportionately impact women of color in Mississippi, where 72 percent of abortion patients are Black, painting the picture that only Black women seek abortions here. Not only does the state have the highest proportion of Black residents—nearly 40 percent of the population—in the country, the barriers to abortion care and health care in general disproportionately impact those living in poverty, of which a third of Black Mississippians are.

White pregnant people tend to leave the state for abortion care, “but that’s really a problem of class resources,” Pellegrine said.

“And the relationship between race and class is obviously deeply interwoven and especially in a place that has a history like Mississippi. But it’s not a function of racial differences in acts, it’s the relationship between race and class and how that shapes access to health care.”

Furdge, the community organizer, adds that abortion restrictions come down to race and gender power dynamics that have always been at play here.

“You know human beings, you know women and children intimately who directly benefit or not from the way that laws are being made and carried out,” she said. “If [lawmakers] really cared, they would put themselves in our shoes. You don’t even have to walk, you can just try them on and see how they fit.”

But Furdge also points to the legacy of grassroots organizers in Mississippi, particularly Black women like Fannie Lou Hamer and Myrlie Evers-Williams, and hopes national groups will help build off Mississippi momentum. She invoked a quote from Hamer: “Mississippi is not actually Mississippi’s problem, Mississippi is America’s problem”—and not just because the current 15-week case, Dobbs v. Jackson Women’s Health Organization, has the power to threaten abortion access for much of the country.

“We’re doing pretty OK, other than the bogus laws, and we’re working on that,” Furdge said. “As far as community, we got each other’s back. I believe we have one of the strongest and most grassroots, most loving, family-oriented, organizing structures in Mississippi than anywhere else.”

People Don’t Know If Abortion Is Legal in Texas. That’s a Problem.

Abortion is, and remains, legal in Texas. But an extreme new law is creating fear among clinic staff and sowing confusion among patients who don’t know whether abortion is still allowed in the state.

That’s exactly what restrictive laws like Texas’ SB 8, which Republican Gov. Greg Abbott signed into law two months ago, are intended to do.

“It has caused immense confusion for people needing abortion care in Texas, as many are worried that abortion is no longer legal and that clinics are closed,” said Amy Hagstrom Miller, founder, president, and CEO of Whole Woman’s Health and Whole Woman’s Health Alliance. She added that it’s been difficult to secure new staff during these uncertain times.

Whole Woman’s Health and Whole Woman’s Health Alliance are part of the coalition of more than 20 clinics, abortion funds, and support services that are suing state officials to keep SB 8 from going into effect on September 1. The group filed the legal challenge last Tuesday, with the help of the Center for Reproductive Rights, Planned Parenthood, and the American Civil Liberties Union.

SB 8 not only bans abortion as early as six weeks but also grants citizens the power to literally sue anyone who helps someone access an abortion—and rewards them $10,000 for doing so. It means anyone—from a rideshare driver who drives a patient to an abortion clinic, a spiritual leader who guides someone in their abortion decision, or a family member who helps a pregnant person pay for it—could face a lawsuit. The bill allows anti-choice activists, family members, and abusers who don’t agree with a patient’s decision to sue the abortion provider if they find out.

Hagstrom Miller said around 85 percent to 90 percent of her clinics’ patients access an abortion after six weeks’ gestation, and that’s because many people don’t know they’re pregnant before that point.

“This law creates an impossible timeline for people to learn they may be pregnant and quickly decide if having an abortion is what is best for them and their futures,” Hagstrom Miller said.

“Frankly, our current staff are terrified. If this law comes to pass and private citizens are emboldened to sue, they may be sued for providing a moral good to their community. That is why we are taking the lead in fighting this law. Because to us, access to quality, compassionate abortion care matters and we know that is what Texans deserve.”

The passage of SB 8 comes during a record-breaking year for abortion restrictions. In the first half of 2021 alone, states enacted more than 90 restrictions, the most anti-choice legislation since Roe v. Wade made abortion a constitutional right in 1973. In Texas, SB 8 comes on the heels of a total abortion ban that was voted into place by residents of Lubbock—now the biggest city in the country to try to ban abortion in its city limits (a lawsuit to block the ordinance was dismissed last month)—and, similar to SB 8, would allow anyone to sue a provider.

These laws have led to the same confusion and misinformation as other extreme anti-choice legislation, like 2013’s HB 2, which closed over half of Texas’ abortion clinics, and 2019’s HB 896, which would have banned abortion upon conception and made it a crime punishable by imprisonment or death. (HB 896 never made it out of legislative committee, but people seeking abortions still feared its consequences).

The outlook in Texas

For many abortion providers in Texas, the situation feels eerily similar to last year, after Abbott issued an executive order that banned most procedural abortions from late March to April 2020, early on during the COVID-19 pandemic.

Texans seeking abortions experienced similar barriers back then when it came to scheduling appointments; clinic availability was often limited, clinics weren’t able to serve all patients, and many had to travel out of state. One study found the number of procedural abortions at or after 12 weeks’ gestation increased by 82.6 percent in May 2020 once the order lifted, when compared to the previous May. Whole Woman’s Health had to cancel appointments for hundreds of patients while the executive order was in effect, not knowing when they’d be able to reschedule them.

Now, just a year later, and with COVID-19 cases rising once more, Texas lawmakers want to force pregnant people through it again.

Maria, whose last name is being withheld to protect her privacy, said the abortion clinic where she works has been “getting calls for weeks” from people seeking abortions in central and northern Texas whose local clinics do not have availability until the next month.

“People express shock at the fact that their local clinics are booked so far out, which is completely understandable,” she said. “Abortion is time-sensitive health care, and crisis pregnancies are urgent in nature. It makes little sense to hear that you can’t get your abortion for another month when you need your abortion right now.”

Jeana Nam, a counselor at a Houston abortion clinic, understands the fears patients must feel when it comes to the increased financial and logistical barriers extreme legislation like SB 8 will impose—because she could easily have been in their position.

“The stakes are high,” Nam said. “What’s more, I had irregular periods and didn’t realize I was pregnant until I was at seven weeks. If SB 8 had been in effect, I would have had to find a way to get care out of state, or (more likely) I would have become a mother before I was ready.”

Nam added that many of her patients are working parents. This means they will need to coordinate child care, travel, and other expenses in order to access abortion out of state.

“How are [patients] supposed to find the time, money, child care, sick days, [or other things] they need to leave the state for an abortion they could otherwise safely have right where they live?” Nam said. “Bans like SB 8 are punitive and absurd attempts to legislate away our right to bodily autonomy and self-determination.”

The grim consequences

The lawsuit describes the “absolute chaos” that will occur in Texas and the irreparable harms created if SB 8 is allowed to go into effect:

In particular, the burdens of this cruel law will fall most heavily on Black, Latinx, and indigenous patients who, because of systemic racism, already encounter substantial barriers to obtaining health care, and will face particular challenges and injuries if forced to attempt to seek care out of state or else carry an unwanted pregnancy to term. S.B. 8 will also cause irreparable harm to Plaintiffs, who are Texas abortion providers and individuals and organizations who help patients obtain abortions.

Cristina Parker, communications director at the Lilith Fund, one of the plaintiffs in the suit, said the consequences of SB 8 will affect the fund’s clients—and clients of all Texas abortion funds—the worst. Most of the clients Lilith Fund serves are people of color and low income folks. (Disclosure: I joined Lilith Fund’s board of directors this spring.) In 2020, the nonprofit organization was only able to fund 27 percent of the 4,557 calls it received.

“It’s already incredibly difficult to access abortion in Texas, but this ban would force Texans to travel out of the state for their care,” Parker said. “We’ll do everything in our power to ensure all Texans can determine what’s best for themselves and their families.”

Louisiana’s Democratic Governor Gave the Anti-Abortion Movement What It Wants

Louisiana Gov. John Bel Edwards—a Democrat—signed three new abortion restrictions into place in the last month, proving that Democrats love unnecessarily restricting access to a common and safe medical procedure just as much as Republicans do.

The first law requires physicians to tell medication abortion patients that “abortion reversal” is possible. Medication abortion typically involves a dose of mifepristone, followed by a dose of misoprostol. The law will force doctors to tell patients they can “reverse” the abortion after the first dose if they take the hormone progesterone.

This is a dangerous lie. Health experts and leading medical organizations oppose laws like this for that very reason. Even Edwards’ own health department opposed the law, with the state’s top health officer pointing out the safety concerns.

The second law amends Louisiana’s parental involvement statute and forces minors seeking an abortion to go through the judicial bypass process in a court in their hometown. This is bad, particularly for young people who live in small towns.

The judicial bypass process is a way minors can avoid getting parental consent for an abortion. (Louisiana, like a majority of states, forces a minor who’s seeking an abortion to get a parent’s consent.) Instead, they can go to court and convince a judge they’re “mature enough” for an abortion.

Before this new law, young people seeking a judicial bypass in Louisiana had options: they could either go to the court where they live or the court where the abortion would be performed—since there are so few clinics providing abortions, that can be hundreds of miles away from the minor’s hometown. Now they can only go to court in their home jurisdiction.

This restriction increases the danger that the young person will run into someone they know in court—a common risk for judicial bypass hearings.

As if that didn’t do enough to compromise young people’s right to privacy, the new law forces clinics to submit extra details to the Department of Health about minors getting an abortion with a judicial bypass—including information about whether the minor is a victim of abuse or receives services from the state.

Finally, the third law makes the state’s health department collect even more details on patients who receive abortions—down to their zip code!

Under the new law, information on abortions provided to patients under 13 will be automatically shared with the state’s attorney general and the Department of Children and Family Services. The law also requires hospitals to report information on patients seeking care for complications related to abortion. Anti-choice lawmakers are likely going to use that information to peddle the lie that abortion is unsafe.

The laws are set to go into effect August 1.

This post was adapted from a Twitter thread.

As Doctors, We Must Do Better to Provide Health Care for Trans and Nonbinary Patients

Regardless of gender identity or sexual orientation, everybody needs preventive care to stay healthy and acute care when they become sick or injured.

For the estimated 1.4 million transgender adults living in the United States, whose health-care needs are both widely stigmatized and misunderstood, there are hurdles to accessing that care. Discrimination in health-care settings too often leads to traumatic experiences and inequities in health outcomes for transgender and gender expansive people.

Discrimination and mistreatment by health-care providers can cause transgender and gender expansive people to miss preventive health screenings. At the clinic I operate in Phoenix, Desert Star Family Planning, we offer comprehensive reproductive and sexual health care that includes abortion, all reversible methods of birth control, gender-affirming care, miscarriage management, and sexually transmitted infection prevention and treatment. Physical exams and laboratory testing and screening for common chronic diseases and familial illnesses generally occurs annually. Young adults and older adults with risk factors should be offered testing and treatment for STIs. Cancer screenings should occur based on age, along with personal and familial risk factors.

Many trans people also need medical care to treat gender dysphoria. This transition-related care is medically necessary and saves lives. Just as major insurance carriers cover preventive health services, they are also required to cover transition-related care for transgender people.

Though it is illegal discrimination for insurance companies to exclude medically necessary transition-related care, some insurance plans still contain discriminatory exclusions. Providers may need to show the insurance company why the treatment is medically necessary, and an insurer might reject coverage for treatment they deem “cosmetic” or not necessary. Patients are often forced to navigate bureaucratic and legal hurdles to access the care to which they’re entitled; for patients with Medicaid, there are often additional barriers, depending on the state.

Finding a safe health-care space can be difficult. Gender diverse individuals regularly face discrimination from health-care professionals and staff. The 2015 National Transgender Discrimination Survey reported that one-third of respondents who had seen a health-care provider in the past year had at least one negative experience in a health-care office related to being transgender, and 23 percent avoided seeing a doctor when they needed to for fear of being mistreated.

People skipping care due to concerns of how they will be treated by a health-care professional is alarming. Providing accessible, gender-affirming health care is essential to reduce the inequities experienced by the transgender community.

If you’re seeking out safe spaces for gender-affirming care, here’s how you can spot one; for providers, this is only a starting point.

  1. Find a provider who explicitly states on their website that they provide gender-affirming care and/or that the facility is a safe space for LGBTQ+ people. This may not be very common, but when it is found, you know that the provider has intentionally taken steps to make their LGBTQ+ patients feel welcomed and empowered.
  2. The clinic staff asks for and honors your pronouns and preferred name. They also share their pronouns with you.
  3. You should see representations of yourself in the facility. A visible nondiscrimination statement that includes sexual orientation, gender identity, and gender expression shows a commitment to equitable care.
  4. Look for and connect with local LGBTQ+ organizations near you to learn what other transgender and gender expansive people are saying about the health-care provider and their staff.

The social and economic marginalization of transgender folks is widespread—and only exacerbated by the anti-trans legislation that some lawmakers are currently trying to pass around the country. A more holistic approach to the care of transgender and gender expansive people is needed.

My clinic is committed to meeting the need. We provide trauma-informed, patient-centered, and highly personalized gender-affirming care for adults with informed consent. That looks like wellness exams, vaccinations, hormone therapy (with dispensing of medications on-site), gender-affirming surgical referrals, and connections to behavioral health services.

With profound gratitude we are partnering with our transgender and gender expansive communities, offering a safe space to thrive. The time is now to provide health-care spaces that are more open and inclusive for all people.

Colorado Makes Abortion and Birth Control More Accessible

Colorado Gov. Jared Polis signed a bill last Tuesday to expand contraceptive coverage to undocumented immigrants. It was the state’s latest move to protect reproductive health access, after a legislative session that made abortion more accessible for survivors of sexual violence.

The bill, SB 9, ensures undocumented Coloradans can access affordable and free birth control and other family planning services. Medicaid recipients in the state will now be allowed to get a year’s worth of birth control at once, regardless of their immigration status.

This makes Colorado one of only a few states to offer reproductive health benefits to undocumented residents.

And in May, Polis signed SB 142 into law, ensuring that rape survivors who become pregnant can access abortion care anywhere in the state. The law undoes a decades-old restriction that required survivors to travel to a facility that Medicaid approves in order to access abortion covered by public health insurance.

Madeleine Schmidt wrote about the restriction for Rewire News Group in March:

The few patients who do qualify for a Medicaid-covered abortion can only get care at a hospital. Because most hospitals only offer abortion during medical emergencies, the only option available for low-income Coloradans who use Medicaid and become pregnant after surviving sexual violence is in Denver … For those living in rural parts of the state, the restriction forces them to make a long and costly journey rather than getting care at a more convenient local abortion provider.

“A patient’s income or ZIP code should never determine their access to quality health care,” Dr. Kristina Tocce, vice president of Planned Parenthood of the Rocky Mountains, said in a statement. “This new law eliminates additional stress, expense, and inequality.”

2021 has been the most volatile year for abortion restrictions in decades. Lawmakers across the country have enacted a whopping 90 restrictions since January. Only a few states have, like Colorado, taken legislative steps to protect abortion access.

Reproductive health providers and advocates hope more state lawmakers will look to Colorado as an example when it comes to protecting access—a charge more critical than ever, as a Supreme Court stacked with conservative judges prepares to hear a case that could upend abortion rights.

This post was adapted from a Twitter thread.

Indiana Abortion Providers Spared From Having to Tell Dangerous Lies to Patients

Here’s a sentence we don’t get to say often: Last week we got some good news out of Indiana. A federal judge blocked a new Indiana law that would have required providers to share outright false information with their patients about abortion.

Indiana lawmakers wanted to make providers talk about “abortion reversal”—specifically, to tell patients that they could reverse a medication abortion after they had taken the first of two doses.

This is an entirely bogus claim. There is no scientific evidence that indicates a medication abortion can be reversed, and leading medical organizations oppose laws that require providers to discuss abortion reversal for that very reason.

Abortion “reversal” doesn’t work—and worse, it’s actually dangerous. The only randomized clinical trial on the unproven treatment was shut down early in 2019 after several women ended up in the emergency room with severe bleeding.

The law, which Gov. Eric Holcomb signed in April, was set to go into effect on July 1. The district court judge’s temporary injunction blocks it while the legal challenge is underway.

In a statement about its win in court, the American Civil Liberties Union said: “Forcing providers to give their patients this misinformation is both unethical and unconstitutional,” the American Civil Liberties Union said in a statement about its win in court.

“Providers should not be forced to give patients inaccurate and dangerous misinformation,” said Parker Dockray, executive director of All Options, a plaintiff in the case. “Pregnant people deserve better—they need accurate information about all their options, and support to make the decisions that are right for them.”

The fight isn’t quite over yet, as a separate Indiana lawsuit, Whole Woman’s Health Alliance v. Rokita, continues to make its way through federal district court. That suit challenges another law requiring abortion providers to give their patients false information, along with a host of other abortion restrictions in the state.

If you want to learn more about the bogus science behind abortion reversal, listen to an episode of Boom! Lawyered below.

This post was adapted from a Twitter thread.