Three years later, the elusive Connie Criminal is still coming to me for legal advice. Patti Plaintiff and Don Defendant are up to their old tricks. Bob’s still buying. Sam’s still selling. The Land of Law School Make-Believe is getting old.

Unsurprisingly, then, my summer internship—a Law Students for Reproductive Justice-sponsored placement at the National Network of Abortion Funds in Boston—is a welcome dose of reality, a chance to put some of what I’ve learned in the classroom to work in the field.  Where it matters. To real people.

The Network, which raises money to help women finance abortions, is comprised of over 100 individual member funds in over 40 states and four different countries. Through its “Hyde: 30 Years is Enough!” campaign, it works to reduce the economic barriers that impede women’s access to safe, legal abortions.

What this means for me, practically-speaking, is that in a whirlwind 10 weeks at the Network, I’ll have conducted legal research for two separate member funds. I’ll have investigated constructive steps to ensure public funding for abortion in the event the Hyde Amendment (a provision which restricts federal Medicaid funding for abortion in all but a very limited number of circumstances) is repealed. I’ll have analyzed states’ definitions of “medically necessary” in Medicaid statutes and administrative codes. I’ll have tracked health reform legislation. I’ll have attended the Network’s annual summit in Chicago—and a Network-organized vigil for the slain Dr. George Tiller. I’ll have defended and touted the importance of repro justice work in lengthy dialogs with family and friends (at least a handful of whom are vehemently conservative and anti-choice and who, probably without intending to, managed to help me better define and articulate my values). I’ll have piqued my husband’s interest in the cause. I’ll have done most of this to a steady backdrop of phone calls from women whose lives and futures depend on private funding for abortion and referrals from my Network co-workers to a local fund which might be able to subsidize their expenses and affect their reality dramatically for the better.

Because the reality is this: sans private funding, many of the women who turn to the Network for support would be forced to either give birth to unwanted children, incurring expenses incident to prenatal care, labor and delivery (to say nothing for the costs of childcare), and often risking their health in the process.  They might have to rely on unlicensed, “underground” providers if they can find one—or themselves, self-terminating pregnancies. The implications on women’s health—indeed, women’s lives!— are huge. Absent this private funding, some women’s only real “choice” is between bad and worse. 

Reality bites—and yet I think it’s tremendously dangerous to lose sight of it. My internship’s been invaluable in helping me stay focused: focused on what brought me to law school, focused on what keeps me there, and focused on affecting real change for real people post-graduation.

-Jonelle Kusminsky

Massachusetts School of Law ‘10

These days it seems like all I hear about are the twin crises of budget and healthcare, so I wasn’t surprised when one of my very first assignments this summer at LSRJ was to research religious hospitals and their funding. What did surprise me, however, was what I learned about the disparate standards of care between secular and religious healthcare facilities.

One out of every six patients in the U.S. is cared for in a Catholic hospital. In fact, the Catholic healthcare system is the largest private non-profit provider of healthcare in the nation – 70% of religiously affiliated hospitals identify as Catholic.  Because the Catholic healthcare system has significant medical responsibility for millions of Americans, the services they choose to provide or withhold can have a profound impact on the overall quality of care in the U.S. Additionally, religiously affiliated hospitals receive 50% of their funding from Medicare and Medicaid and also enjoy certain benefits like tax exempt status, low-cost financing through government bond programs, and in some areas, use of municipal buildings.

Because Catholic hospitals receive so much public funding and see so many patients, one might assume that the standard of care in a Catholic hospital is comparable to the standard of care in a secular hospital. Unfortunately, this assumption may not be true.

Some patients treated in Catholic hospitals – women in particular – may not be receiving reproductive healthcare considered basic and essential by secular medical facilities. That is because Catholic healthcare providers are governed by the Ethical and Religious Directives for Catholic Health Care Services, with which all Catholic health care providers are obligated to comply (Directive 5).

Under the Directives, Catholic hospitals are prohibited from providing contraception (Directive 52), sterilization (Directive 53), most infertility treatments (Directives 40, 41, 42), condom distribution for AIDS prevention (Directive 52 prohibits all contraception, regardless of the reason), or abortion services (Directive 45).  Directive 48 goes so far as to say no medical care that could be construed as abortion can be provided, even to a woman with an extra-uterine (ectopic) pregnancy.

It is also difficult to obtain emergency contraception in Catholic hospitals—even as treatment for rape or sexual assault. Despite the fact that it is expressly addressed in the Directives, the language of Directive 36 is unclear on when and under what circumstances EC can be provided:

Compassionate and understanding care should be given to a person who is the victim of sexual assault. Health care providers should cooperate with law enforcement officials and offer the person psychological and spiritual support as well as accurate medical information. A female who has been raped should be able to defend herself against a potential conception from the sexual assault. If, after appropriate testing, there is no evidence that conception has occurred already, she may be treated with medications that would prevent ovulation, sperm capacitation, or fertilization. It is not permissible, however, to initiate or to recommend treatments that have as their purpose or direct effect the removal, destruction, or interference with the implantation of a fertilized ovum.

Since emergency contraception is most effective in the first 72 hours, a healthcare provider’s refusal to provide comprehensive treatment can further traumatize survivors of rape and sexual assault by forcing them to leave the hospital and attempt to obtain EC elsewhere.

Catholic hospitals do provide a tremendous amount of care in rural and impoverished communities – indeed, they are often the only hospital in such communities. The question remains, however, whether funding institutions that refuse to provide the full spectrum of reproductive healthcare is really the best use of our scarce federal Medicaid and Medicare dollars.

-Megan Mullett

 “I’m working for Law Students for Reproductive Justice… It’s a pro-choice group.”  By the fifth time someone asked me what I was doing for the summer, I had become used to the follow-up question.  For the last year, since I became a member, I thought that reproductive justice was simply a nice way of saying “pro-choice.”  To paraphrase Bruce Lee in Enter the Dragon (and Buddhist philosophy), I quickly learned that I was pointing at the moon… focusing on the finger, and missing all of the heavenly glory.

At the Oakland intern training, we were basically put through a boot camp of reproductive rights issues, getting quick overviews of all of the different issues that we are fighting for.  We learned about the status of reproductive health care access in Africa, what the Obama administration is doing for reproductive rights issues, and what the Northern California ACLU is doing to ensure that students here are getting accurate sex education in schools.  The most important realization that I came to, however, involves the definition of reproductive justice.

The RJ movement is more than ensuring that people have access to abortions.  Reproductive justice ensures that everyone has the right to make an informed decision regarding the time and manner that they reproduce.  This definition encompasses immigrants’ rights, environmental justice, social justice, LGBTQIQ issues, abortion rights, and numerous other issues.  We don’t have reproductive justice if women don’t have the right to an abortion, but we also don’t have reproductive justice when women can’t access prenatal care.  We are fighting for both the ability to procure birth control, and the ability to access assisted reproductive technology.

As part of my internship this summer, I am working with the California Healthy Nail Salon Collaborative to ensure that chemicals used in nail salons are not harmful to either workers or patrons.  As I learn more about the toxins that are part of every day items, I think about how the term “reproductive justice” enables me to talk about this issue more coherently.  It represents a philosophy that I have always held dear, but have never really been able to express: the hope that everyone will be able to choose when, and if, they want to have children, without any other factors standing in the way of them exercising that right. 

-Jacob Johnson