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“Fractions Of Women In Texas”: When Does Nine Hundred Thousand Seem Like An Insignificant Number Of Women?

How do you count women in Texas, and when do the numbers get big? There is a good deal of bad math in a decision made last week, by the Fifth Circuit Court of Appeals, that had the effect of closing all but eight abortion clinics in the state; until recently, there were about forty. Five million four hundred thousand Texans are women of childbearing age. Almost one and a half million of them will live more than a hundred miles from any clinic; nine hundred thousand will live more than a hundred and fifty miles away, seven hundred and fifty thousand more than two hundred and fifty miles. For a good many, there will be more than five hundred miles to go, unless they want to cross the border and take their chances in Mexico. For a two-to-one majority on the Fifth Circuit panel, that just wasn’t enough women for them to worry about.

The Texas clinics will close because of a law, passed by the state legislature last year, that placed new regulations on clinics that provide abortions. The Supreme Court has found that women cannot be cheated of their right to end a pregnancy before viability by way of laws that place an “undue burden” on them, as standard laid out in Planned Parenthood v. Casey, in 1992. But, as Jeffrey Toobin recently wrote, courts in recent years have become increasingly merciless in what they consider undue for a woman at what is often a moment of profound crisis, to the point where almost no burden seems too heavy.

Several aspects of the new law, like one requiring doctors to have admitting privileges at hospitals within a certain distance, survived challenges. But, in August, the District Court Judge Lee Yeakel struck down a rule that clinics have to be outfitted and operated as ambulatory surgical centers, even if they only provided medication-induced abortions early in pregnancies. Yeakel’s decision came after a trial at the District Court level that included testimony that requirement was not practical for most clinics, would leave no clinics open south or west of San Antonio, and was not based on any sound medical rationale. The state wanted the provisions to go into effect regardless, pending its appeal; Yeakel said no. The appeals court has lifted that stay, saying that it thought the law would ultimately survive the challenge. (It did leave room for a partial reprieve for a clinic in El Paso, though not for one in McAllen.) And so, on Friday, thirteen clinics in Texas began turning patients away.

The Fifth Circuit judges picked up on another phrase in Casey: “a large fraction.” A way to tell if a burden is undue is if it presents obstacles for a large fraction of the women for whom it is relevant. The fraction the Fifth Circuit calculated was one-sixth: nine hundred thousand women who would have to travel more than a hundred and fifty miles out of five million four hundred thousand who could possibly get pregnant—“not a large enough fraction to impress the appeals court,” as Ruth Marcus put it, no matter the absolute number. There are, if one is counting, at least three reasons this logic is wrong.

First, a sixth can be pretty large, depending on what the numerator (one, in this case) and the denominator (the six) represent. (One-sixth of New York City’s population lives in the Bronx.) That is why one uses a word like large rather than something more definite, like majority. When it comes to a decision that can shape a woman’s life, this Texas sixth is a large fraction—and that alone should have been enough for the judges.

Second, it’s not clear at all that the majority chose the right numerator or denominator—that the fraction really is a sixth. First, the numerator: Is it only the women who have to drive these distances who are affected when a state that, until recently, had sixty-to-seventy-two thousand abortions each year, suddenly has only eight clinics—all in a few cities? Or does it also mean that the women in the next clinic over will soon find it hard or impossible to get an appointment? Speed matters a great deal for abortion; Texas’s law also included a twenty-week limit. (In another sign of fractional bad faith, the majority suggested that a woman who had been a hundred and fifty miles from a clinic and was now two hundred and fifty miles away might only be facing an “incremental increase of 100 miles.”)

One can also reconsider the denominator, the bottom number. In Casey, the Supreme Court upheld some restrictions in Pennsylvania but overturned a requirement that married women notify their husbands. The state of Pennsylvania had argued that only twenty per cent of women seeking abortions were married and that ninety-five per cent would tell their husbands anyway, and so the fraction affected was tiny—maybe one per cent, and therefore too few to count. The Court rejected that math, saying,

The analysis does not end with the one percent of women upon whom the statute operates; it begins there. . . . The proper focus of constitutional inquiry is the group for whom the law is a restriction, not the group for whom the law is irrelevant.

The denominator that the Court chose in that case was “married women seeking abortions who do not wish to notify their husbands of their intentions and who do not qualify for one of the statutory exceptions to the notice requirement.” The fraction affected was suddenly very large.

The Texas decision briefly looks at the argument for a different denominator—women whose options will get worse because of the law—but then rejects it, bizarrely enough, because the resulting fraction is too large: it “would make the large fraction test a tautology, always resulting in a large fraction.” But that is only true if the burden on women for whom the law is relevant is, indeed, undue. One can imagine a law that presented X women with obstacles that Y of them could, nonetheless, easily navigate. What the judges see as a “tautology” is a sign that something is seriously wrong with the Texas law.

Third, as the dissenting judge in the Texas case noted, Casey doesn’t just talk about fractions: it talks about a “significant number” of women who, under the spousal-notification requirement, would not have meaningful access to abortion. After reviewing statistics on domestic violence, the Casey decision notes,

We must not blind ourselves to the fact that the significant number of women who fear for their safety and the safety of their children are likely to be deterred from procuring an abortion as surely as if the Commonwealth had outlawed abortion in all cases.

When does nine hundred thousand seem like an insignificant number of women?

There is another factor, involving other numbers: poverty. The Fifth Circuit judges acknowledged that women without much money would be more affected by the law than others: they might not have a car, or a way to take a day off from work to drive six hours. But that didn’t, somehow, change the judges’ calculation.

 

By: Amy Davidson, The New Yorker, October 5, 2014

October 11, 2014 Posted by | Reproductive Choice, Texas, Women's Health | , , , , , , | Leave a comment

“In Case Anyone Is Confused”: Don’t Fall For The GOP’s Over-The-Counter Contraception Racket

It’s time to call bullshit on the GOP’s embrace of over-the-counter birth control. Several Republican candidates, under fire for radical positions on women’s health, have recently adopted the idea in a naked attempt to woo female voters. These politicians say they’re all in favor of access to contraception. But sudden calls for the pill to be available without a prescription do not signal a real shift in conservative attitudes toward reproductive rights. They simply mask tired opposition to the Affordable Care Act’s mandate that insurers cover birth control.

The list of Republicans that have endorsed the idea includes Senate nominees Cory Gardner (Colorado), Tom Tillis (North Carolina), Ed Gillespie (Virginia) and Mike McFadden (Minnesota). Republicans running for the House have also spoken up for over-the-counter access.

None of these people were championing the proposal before their campaigns. Instead, they were working to limit women’s access to abortion and other healthcare. Gardner, who started the over-the-counter trend in June with an op-ed in The Denver Post, has campaigned for “personhood” measures that would outlaw abortion and possibly some forms of birth control since at least 2006. Early in his campaign Gardner denounced the state-level personhood legislation he’d supported—yet he’s still a co-sponsor on a federal bill that would have the same impact. Gardner has resorted to claiming that bill doesn’t exist.

Then there’s Tom Tillis, who endorsed over-the-counter birth control during a debate with Democratic incumbent Kay Hagan in September. As the top Republican in the state House, Tillis shepherded extreme anti-choice legislation in a decisively dishonest manner, inserting restrictions into unrelated bills like one ostensibly about motorcycle safety. Tillis, like other Republicans trumpeting their support for over-the-counter contraception, opposes not only the ACA’s birth control mandate but the healthcare law in general, which has a range of other benefits for women.

The latest candidate to pivot to contraception when confronted about her record is Joni Ernst, a Senate hopeful in Iowa who supports a personhood amendment as well as criminal prosecution of doctors who provide abortions. “When it does come to a woman’s access to contraception, I will always stand with our women on affordable access to contraception,” she said. Her campaign did not respond to a request to clarify which specific policies she supports that would increase affordability and accessibility.

In case anyone is confused: while affordable contraception does dramatically reduce rates of unintended pregnancy, it does not solve the problems created by cutting off women’s access to abortion services. In fact, attempts to block abortion access—for example, by cutting funds for clinics like Planned Parenthood that provide a range of services besides abortion—can have the perverse effect of making it more difficult for women to get other healthcare, birth control included.

Nor is making contraception available without a prescription an alternative to the birth control mandate (or, needless to say, the entire healthcare law). Over-the-counter birth control has support from the American College of Obstetricians and Gynecologists, a point that several Republican candidates have pointed out when their motives were questioned. Yet the same medical association is quite clear that women still need insurance coverage for contraception. Not all women can or want to take the pill, and other forms of birth control like the IUD are expensive and require a doctor’s appointment. In June, ACOG warned politicians against using calls for over-the-counter contraception “as a political tool.”

That Republicans need such a tool to alter their reputation among women is obvious. Young women are the key demographic in many midterm battlegrounds, and according to a Wall Street Journal/NBC News poll conducted in July and August, they prefer a Democrat-controlled Congress by a fourteen-point margin. (Men, on the other hand, favor Republicans by seventeen points.)

But why over-the-counter birth control, specifically? It’s a win-win-win for Republicans trying to appeal to female voters, while bashing Obamacare and boosting their free-market street cred. Candidates can say they support access to contraption while celebrating a “market-based approach to medicine,” as the editorial board of National Review described it recently. The editors commended Republicans for “running…to get government out of the birth-control business as much as possible, and to free up access to it for the women who want it.”

To understand why this sudden embrace of “access” is a racket, and a dangerous one, consider Kevin Williamson, National Review’s self-described “roving correspondent.” In a recent post titled “Five Reasons Why You’re Too Dumb to Vote,” Williamson characterizes women who care about preserving access to abortion or the birth control mandate as “women who cannot figure out how to walk into Walgreens, lay down the price of a latte, and walk out with her own birth-control pills, no federal intervention necessary.” He goes on to applaud the editorial board’s endorsement of the over-the-counter birth control fad.

A few days later, Williamson declared that women who have abortions should be hanged. “I’m torn on capital punishment generally; but treating abortion as homicide means what it means,” he said on Twitter. To be clear: what “pro-life” Williamson is arguing for is putting one in every three women in the United States to death.

“Democrats are not resisting the GOP’s suggestion because of any quibbles with its policy substance,” National Review said in response to suggestions that the GOP’s embrace of over-the-counter birth control smacks of opportunism. “They hem and haw because they want to continue to depict Republicans as intent on keeping contraceptives away from women.”

It doesn’t matter what Republicans are or aren’t intent on. The bottom line is that a variety of conservative positions, from opposition to the ACA to federal funding for women’s clinics, have had or would have the very real effect of making it more difficult for women to access healthcare in general and contraceptives specifically.

Furthermore, contraception is hardly the sum of women’s medical needs. When conservatives fight to empower women to make decisions about their own bodies in all cases, regardless of income, then maybe we’ll take them seriously. In the meantime, there’s little of substance in an ideology that promotes birth control without a prescription for some women and hanging for others.

 

By: Zoe Carpenter, The Nation, October 3, 2014

October 5, 2014 Posted by | Birth Control, Contraception, Women's Health | , , , , , , , , , | Leave a comment

“Fighting Bad Science In The Senate”: The Days Of Making A Sport Of Trampling On Women’s Health And Rights Are Numbered

The Senate hearing for the Women’s Health Protection Act shows just how important it is for women’s health advocates to push for the facts.

The propensity of anti-choice advocates to eulogize false science was on full display on Tuesday’s Senate hearing on the Women’s Health Protection Act (WHPA). That bill is a bold measure that would counter the relentless barrage of anti-choice legislation that has made abortion — a constitutionally protected medical procedure — altogether inaccessible for many U.S. women.

The bill was introduced last year by Senators Richard Blumenthal and Tammy Baldwin and Representatives Judy Chu, Lois Frankel and Marcia Fudge. It prohibits states from applying regulations to reproductive health care centers and providers that do not also apply to other low-risk medical procedures. It would, essentially, remove politicians from decisions that — for every other medical issue — remain between individuals and their providers.

The WHPA is long overdue. For the past three years, conservative lawmakers have used the guise of protecting women’s health to pass more than 200 state laws that have closed clinics, eliminated abortion services, and left women across the country without access to critical reproductive health care. The WHPA would reverse many of those policies and prevent others from being passed.

Tuesday’s hearing was representative of the broader debate over abortion rights. Those in favor of the bill argued that securing unfettered access to reproductive health care, including abortion, is critical to the health and lives of U.S. women and their families.

Those in opposition used familiar canards about abortion to argue that the law would be calamitous for U.S. women. Representative Diane Black of Tennessee had the gall to make the abortion-leads-to-breast cancer claim, one that has been disproven many times over. Others repeatedly cited the horrific cases of Kermit Gosnell, insinuating that all abortion providers (abortionists, in their lingo) are predatory and that late-term abortions are a common occurrence. In fact, if women had access to safe, comprehensive and intimidation-free care, Kermit Gosnell would have never been in business. Given the opposition’s testimony, you’d never know that late-term abortion is actually a rarity. According to the Centers for Disease Control, more than 90 percent of all abortions occur before 13 weeks gestation, with just over 1 percent taking place past 21 weeks.

At one point Representative Black argued that abortion is actually not health care. The one in three U.S. women who have undergone the procedure would surely argue otherwise.

Perhaps the most ironic testimony against the WHPA — and in favor of abortion restrictions – came from Senator Ted Cruz, who hails from Texas, a state with so many abortion restrictions that women are now risking their health and lives by self-inducing abortions or crossing the border to get care in Mexico. Senator Cruz attempted to validate U.S. abortion restrictions by referencing a handful of European countries with gestational restrictions on abortions. This was a popular argument during the hearing for Texas’ HB2 — the bill responsible for shuttering the majority of clinics in that state.

Cruz wins the prize for cherry picking facts to best support his argument. When citing our European counterparts, he conveniently ignored that such abortion restrictions are entrenched in progressive public health systems that enable all individuals to access quality, affordable (often free) health care, including comprehensive reproductive healthcare. Senator Cruz and his colleagues have adamantly opposed similar policies in the U.S., particularly the Affordable Care Act’s provisions for contraceptive coverage and Medicaid expansion. On the one hand conservatives lean on European policies to argue for stricter abortion restrictions at home, and on the other they claim those policies are antithetical to the moral fabric of the United States.

Would Cruz support France’s policies that enable women to be fully reimbursed for the cost of their abortion and that guarantees girls ages 15 to 18 free birth control? Or Belgium’s policy that enables young people to be reimbursed for the cost of emergency contraception? Or the broad exceptions that both countries make for cases of rape, incest, and fetal impairment, to preserve woman’s physical or mental health, and for social or economic reasons? He absolutely would not.

As the House of Representatives seems to be more motivated by suing the president than by voting on – let alone passing — laws that will actually improve the health and lives of their constituents, it’s highly unlikely that the WHPA will become law. But Tuesday’s debate – and the bill itself — is significant and shows a willingness among pro-choice advocates to go on offense after too many years of playing defense.

Bills such as the WHPA — even if they face a slim chance of being passed by a gridlocked Congress — provide an opportunity to call out conservatives’ use of bad science in their attempts to convince women that lawmakers know best when it comes to their personal medical decisions. And they allow us to remind lawmakers and citizens that despite all of the rhetoric to the contrary, abortion is a common, safe and constitutionally protected medical procedure, and that regulating it into extinction will only force women into back-alley practices like those run by Gosnell, costing them their health and their lives.

Those in support of the WHPA showed anti-choice lawmakers that the days of making a sport of trampling on women’s health and rights are numbered.

 

By: Andrea Flynn, Fellow at the Roosevelt Institute; The National Memo, July 18, 2014

July 21, 2014 Posted by | Senate, Ted Cruz, Women's Health, Womens Rights | , , , , , , | Leave a comment

“An Emboldened Anti-Choice Movement”: Republican Family Values Put Women’s Lives In Danger Worldwide

Last week, a committee in the US House of Representatives approved a spending bill that would slash funding for international family planning and reimpose a harmful policy that reduces contraceptive access and tramples on the rights of healthcare providers.

On Monday, the supreme court ruled that some US employers could deny employees access to birth control coverage if they claim a religious objection to contraception.

Is it just me, or do we seem to be in retreat? This latest disregard for women – in the US and overseas – is not unexpected, but it is certainly disappointing. In many ways, we have been fighting the same battle for the past 30 years. But the battle lines have shifted and, frequently, we have to struggle to retain hard-won ground.

When I started working on this issue in the early 80s, there was true, bipartisan support for family planning. Some of the most sincere anti-abortion Republicans realised that the consistent, commonsense public policy position for them to take would be to support overseas family planning funding. Better access to contraception would reduce unintended pregnancies and abortions, especially unsafe abortions.

The global gag rule, also known as the Mexico City Policy, was one of the first instances of the domestic anti-choice agenda interfering with the health and lives of women in developing countries. Introduced 30 years ago, during the Reagan administration, the policy bars foreign organisations that receive US family planning assistance from using their own private, non-US government funds to provide information, referrals, or services for legal abortion, or to advocate for the legalisation of abortion in their own countries.

Since it was introduced, the gag rule has been subject to the vagaries of US politics – imposed or kept in place by Republican presidents, and repealed by Democrat leaders. Though it was rescinded by President Obama on taking office in 2009, Republicans in the House have tried every year since to reinstate it.

Their efforts are testament to a rightward shift in US politics, including an emboldened anti-choice movement that has continued to gain political power. The middle has shrunk, the partisan divide has grown, and the Republicans being elected to Congress now are more extreme and bent on undermining women’s health and rights. Under the guise of “protecting the unborn”, the misguided policies they espouse threaten the health and lives of millions of women and families.

The US’s $610m contribution to international family planning and reproductive health in fiscal year 2014 helped 31 million women and couples receive contraceptive services and supplies. It prevented 7 million unintended pregnancies and 3 million abortions (2 million of them unsafe), and saved the lives of 13,000 women. In addition, 60,000 fewer children lost their mothers.

The fact is that family planning saves women’s lives. But in Washington these days, the facts do not matter. Last week Republicans on the House spending committee imposed a completely unnecessary cap on international family planning funding.

The House committee bill proposes cutting international family planning funding by $149m, almost 25% from current levels. Using analysis from the Guttmacher Institute, this would result in more than 7.7 million fewer couples using contraception, more than 1.6 million additional unintended pregnancies, and 745,000 more abortions. Almost 3,000 more women would die in pregnancy or childbirth, and 13,400 more children would lose their mothers. So much for family values.

We have been fortunate in that during the past few years, Republican attacks in the House have been blocked by Senate family planning champions, where, for now at least, Democrats retain control. This has essentially resulted in maintenance of the status quo on family planning policy and on funding. The Senate version of this year’s spending bill counters the House by including $644m for international family planning, and a permanent, legislative repeal of the global gag rule.

But this uneasy stalemate could change, depending on the outcomes in key races in November. If Republicans take control of the Senate, the truce will be broken and battle lines redrawn. The drastic cuts the House committee approved last week could be seriously considered in an omnibus spending bill, and an offensive could be mounted by opponents to attempt to force the gag rule on a pro-choice president.

The health of women around the world is far too important to continue to be thrust on to the frontline of US domestic culture wars.

 

By: Craig Lasher, Director of US Government Relations at Population Action International; The Guardian, July 17, 2014

July 19, 2014 Posted by | Family Values, Republicans, Women's Health | , , , , , , | Leave a comment

“Todd Akin Is Ready For Another Close-Up”: His Problem Was That He Was Too … ‘Conciliatory’?

In 2012, Sen. Claire McCaskill (D) was facing a tough re-election fight in Missouri, so she helped boost the Republican she assumed would be the easiest to beat: then-Rep. Todd Akin (R). The plan worked extraordinarily well.

Akin was an extremist by any measure, but the far-right lawmaker secured a spot in the Awful Candidates Hall of Fame when he famously said women impregnated during a “legitimate rape” have a magical ability to “shut that whole thing down.”

Akin soon after lost by 15 points.

All of this unpleasantness, however, was two years ago. Now the far-right Missourian is back and he wants the spotlight again.

Todd Akin takes it back. He’s not sorry.

Two years after the Missouri Republican’s comments on rape, pregnancy and abortion doomed his campaign and fueled a “war on women” message that carried Democrats to victory in the Senate, one of the few regrets he mentions in a new book is the decision to air a campaign ad apologizing for his remarks. “By asking the public at large for forgiveness,” Akin writes, “I was validating the willful misinterpretation of what I had said.”

Hmm. Todd Akin’s problem was that he was too … conciliatory?

Making matters worse, as Joan Walsh noted, Akin is not only retracting his 2012 apology, he’s also back to defending the comments that caused him so much trouble in the first place. “My comment about a woman’s body shutting the pregnancy down was directed to the impact of stress of fertilization,” Akin argues in his new book, adding that “this is something fertility doctors debate and discuss.”

Republican officials are clearly aware of Akin’s willingness to re-litigate whether women can “shut that whole thing down,” and they have a message for the former congressman: for the love of God, please stop talking.

No, really.

Todd Akin is back talking about rape in his new book and Republicans have a message for him: Shut up. […]

“Todd Akin is an embarrassment to the Republican Party and the sole reason Claire McCaskill is still part of Harry Reid’s majority,” said Brian Walsh, who served as communications director for the National Republican Senatorial Committee during the 2012 cycle.

“It’s frankly pathetic that just like Sharron Angle and Christine O’Donnell in 2010, he refuses to take any responsibility for sticking his foot in his mouth, alienating voters and costing Republicans a critical Senate seat. Worse, he’s now trying to make money off his defeat. The sooner he leaves the stage again the better.”

The GOP has vowed to prevent the stumbles on social issues that plagued Republican candidates on the trail last cycle. So its overwhelming reaction to Akin: his five minutes of fame need to be over.

That may be little more than wishful thinking. Yesterday afternoon, Planned Parenthood Votes issued a report that not only detailed Akin’s disturbing record, but connecting Akin to 2014 candidates. From the materials:

“Todd Akin and his dangerous agenda for women were soundly rejected by voters in 2012, yet candidates like Thom Tillis, Cory Gardner and Greg Abbott continue to follow in his footsteps,” said Dawn Laguens, Executive Vice President of Planned Parenthood Votes. “Todd Akin’s appalling beliefs about women and rape were too extreme for America’s women, and they represent policy positions shared by politicians like Cory Gardner, Thom Tillis and Greg Abbott – among others. Just as Todd Akin was held accountable for his beliefs, these candidates will have to answer for their opposition to basic access to medical care for America’s women, and especially their cold indifference to women who are survivors of rape and incest.”

While Todd Akin was best known for his comments about legitimate rape, he also supported a wide range of measures – such as redefining rape, wanting to ban emergency contraception for survivors of rape and incest, and supporting measures that could interfere with personal, private, medical decisions relating to decisions about birth control, access to fertility treatment, management of a miscarriage, and access to safe and legal abortion – that were far too extreme for the vast majority Americans.

Similarly, Abbott, Tillis and Gardner have used their positions to do things such as prevent rape survivors from suing those who negligently hire their attackers, trying to deny rape survivors from accessing emergency contraception, and forcing survivors of rape and incest to undergo an invasive trans-vaginal ultrasound before accessing an abortion.

Under the circumstances, the more Akin talks, the happier many on the left will be.

Disclosure: my wife works for Planned Parenthood but played no role in this piece.

 

By: Steve Benen, The Maddow Blog, July 11, 2014

 

July 13, 2014 Posted by | Todd Akin, War On Women, Women's Health | , , , , , , , | Leave a comment

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