Trans Sex Workers and Reproductive Justice

Candace Gibson, Resident Blogger (’12, University of Utah S.J. Quinney College of Law)

The reproductive justice and LGBTQ liberation movements share the values of bodily autonomy and sexual liberation and believe that all persons should have the resources they need to form the families they want.  However, many of these desires, including bodily autonomy, are often denied to trans persons, especially trans sex workers, many of whom are trans women of color. At a recent conference that I attended, Cyndee Clay, Executive Director of HIPS, painfully articulated the experiences of trans sex workers and their attempts to survive in our economy.  She had mentioned how trans sex workers not only faced violence from their clients but also from the police as they were arrested, how police officers often sexually harassed these individuals. In 2013, a D.C. police officer shot three transgender women in a car after one of the transwomen refused to provide sex for money.  Clay also discussed how often young trans persons were forced onto the streets because their families rejected who they were and that trans persons are excluded and erased from larger conversations on anti-trafficking efforts, unfortunately nothing new to many of us in different movements.

Clay’s comments remind me that we still live in a society hung up with gender, body parts, and the selling of sex.  Unfortunately, through our regulation and, in this case, criminalization of sexual desire for sale, we often harm and kill the most vulnerable without providing critical solutions and resources for those who are merely trying to survive.  Survival should not be the standard for some-we should all have the resources we need to thrive as persons and as members of our community.

Maybe, it’s time for the broader reproductive justice community to center the voices of sex workers, especially trans sex workers, in our conversations.  It may be hard at first but we have never shied away from a challenge.  

Support the HEAL Immigrant Women and Families Act!

This article was originally published by the National Center for Lesbian Rights.

Lauren Paulk is the Law Students for Reproductive Justice Fellow at the National Center for Lesbian Rights.

Though the Affordable Care Act (ACA) will go a long way toward ensuring access to quality healthcare for most LGBT individuals, many LGBT immigrants are still prohibited from obtaining the affordable health care they need. Despite being authorized to live and work in the United States, many immigrants—including LGBT immigrants—are ineligible for affordable health coverage and care through vital programs like Medicaid and the Children’s Health Insurance Program (CHIP).

Many immigrants are subject to a ban that makes them ineligible for federal Medicaid and CHIP for at least the first five years they are authorized to live and work in the United States, and other lawfully present immigrants who do not fall into an outdated and restrictive list of “qualified” immigrants are barred altogether. Since immigrants—particularly LGBT immigrants—are disproportionately low-income, it can be difficult or impossible to obtain the health care they need. That means five years without insurance coverage for critical and life-saving services, including pap smears, mammograms, HIV treatment, mental health care, or pediatric care for children.

Young people granted status through “Deferred Action for Childhood Arrivals” (DACA) are forced to wait even longer. DACA refers to a program enacted in 2012 that allows undocumented people ages 15-30 who arrived in the US as children (and who are currently in school or working) to remain here for renewable two-year periods. While they are considered lawfully present and are eligible to work and pay into public health benefits systems, they are prevented from accessing affordable care. Currently, people with DACA status are ineligible for federal Medicaid or CHIP coverage and the years they live in the United States with DACA status will not count toward the five years of lawful presence required before they become eligible. To add insult to injury, these young people are even ineligible to purchase private health insurance on the ACA exchange—with or without federal subsidies.

Many LGBT immigrants come to the US after fleeing interpersonal and state abuse based on their sexual orientation or gender identity. However, once they arrive, LGBT immigrants face a number of challenges to obtaining affordable and culturally competent health care. While the ACA will continue to combat the discrimination LGBT people face in the health care system due to lack of cultural competency, all of its positive effects are out of reach for LGBT immigrants because of gaps in coverage. The existing barriers to affordable health care disenfranchise hard-working LGBT immigrants who come to the United States to have a better life, only to encounter difficulty getting the care they need. Moreover, because LGBT immigrants are much less likely than non-immigrants to be able to access health care through their jobs, they are putting work into a system that does not support them.

However, new legislation introduced by Congresswoman Michelle Lujan Grisham would change these realities for good. The Health Equity and Access under the Law for Immigrant Women and Families Act of 2014 (“HEAL Immigrant Women and Families Act” for short) restores access to Medicaid and CHIP for immigrants authorized to live and work in the United States who are otherwise eligible. The bill also extends full participation in the ACA to young people granted status under DACA.

The HEAL Immigrant Women and Families Act is especially important for families. LGBT families are more likely to live in poverty than non-LGBT families, meaning health care on the private market is often out of reach. We know that LGBT people deserve the same access to health care as non-LGBT people, and this should include LGBT immigrants. The HEAL Immigrant Women and Families Act would bridge the gaps in the ACA, Medicaid, and CHIP by extending needed care options to immigrants, and in so doing, strengthen our workplace, our economy, and our communities. NCLR applauds Congresswoman Lujan Grisham for introducing the HEAL Immigrant Women and Families Act, and we encourage other members of Congress who support the LGBT community to stand beside her in expanding the health care options for many LGBT immigrants. Please show your support for the HEAL Immigrant Women and Families Act by signing this pledge, put together by the National Latina Institute for Reproductive Health. Please check out @NLIRH’s twitter timeline for more information on how this important bill will impact our communities!

#KeepItConfidential

Ruth Dawson, Resident Blogger (’12, Emory University School of Law)

Under a landmark California bill passed last year, individuals covered under another person’s insurance policy will soon be able to seek sensitive services such as birth control, STD tests, and mental health services, without worrying about the disclosure of these services to the policyholder. This person is usually a parent or spouse, a fact which often prevents people from using their insurance to get the medical care they need. Going into effect January 1, 2014, the Confidential Health Information Act (SB 138) closes a loophole in California law, where insurance plans unintentionally violate patients’ confidentiality by sending information about the services received home to the policyholder.

April is Sexual Assault Awareness Month, and is thus a particularly important time to be focusing on confidentiality of medical and mental health services. In addition to the common problem of young people heading to a free clinic for routine reproductive care and claiming no insurance (as many of my friends did instead of admitting to their parents that they needed care), this law will have a profound effect on survivors of sexual assault, domestic violence, and gender-based violence. Maintaining confidentiality is crucial for survivors of assault to feel comfortable and empowered to access the physical and psychological services they need, without fear of stigma, forced disclosure, or cruel yet common reactions, such as victim-blaming.

For this new law to have the wide-reaching impact advocates desire, we must create a smooth system for patients to request confidentiality, educate patients across the state that they have the option to request confidentiality, and train providers in how to effectively implement this system in service provision. The smoother the implementation of this bill, the more likely the new law will be used as a model for patient confidentiality of sensitive services around the nation.  I’m proud that California is making real strides to #keepitconfidential for all patients.

I’m a fan of birth control and religious freedom

Melissa Torres-Montoya, Resident Blogger (’11, University of California, Berkeley School of Law)

Admittedly, I’m a huge fan of March Madness. I jumped on board with the madness; making the effort to watch my favorite team (go Bruins!) specifically at the bar that serves as DC’s “official” UCLA bar, hanging out with friends who had brackets so we could enthusiastically and nonstop talk/compare our brackets, and basically addictively watching the games.  While this March Madness is at the end of the day all fun and games, the real madness that is going on this March is the Supreme Court hearing of Sebelius v. Hobby Lobby.
The precise legal question has to do with religious freedom.  As this National Public Radio piece points out, the legal standard for whether a law infringes upon the constitutionally granted right from laws “prohibiting the free exercise” of religion has changed over the years.  And this summer the Supreme Court will issue its decision as to whether  the new law requiring employers to provide health insurance that includes coverage for contraception poses a substantial burden on the corporate owner’s of Hobby Lobby’s right to free exercise of religion and whether as corporate owners they even have such a legal right.  The madness in this all, for me, is the non legal question here is that, for some, the question exists as to whether contraception is even considered a preventive health measure.  
Former Bush administration Solicitor General Paul Clement bemoans that “The federal government for the first time has decided that they are going to force one person to pay for another person’s not just … hip replacement, but something as religiously sensitive as contraception and abortifacients.”  Hobby Lobby, of course, would never challenge coverage of a hip replacement for a 75 year old employee who fell down the stairs.  Nor should they challenge the use of a medication by a 34 year old fertile woman to prevent pregnancy, a medical condition that changes a woman’s body so that she’ll grow a whole new human within her.  According to the world health organization family planning, ”allows spacing of pregnancies and can delay pregnancies in young women at increased risk of health problems and death from early childbearing, and can prevent pregnancies among older women who also face increased risks.“  Spacing of pregnancies, as experts at the Mayo Clinic describe, has medical implications.  So yes, contraception is just another medical treatment that should be included in health insurance coverage as routinely as say, a hip replacement or high cholesterol medication. Hopefully, a majority of the justices see it the same way and publicly identify contraception as a critical, routine and medically accepted preventive health measure.
Today, the Supreme Court is listening to oral arguments on this case and like most women in the U.S., I oppose Hobby Lobby’s attempt to carve out some contraception from the health insurance plan it provides its employees. I’m publicly acknowledging today that I’m a fan of birth control and religious freedom.  You should too.  Make your new cover page this or pledge your support here.

Sterilization Abuse Isn’t a Relic of the Past

Candace Gibson, Resident Blogger (’12, University of Utah S.J. Quinney College of Law)

As many scholars have noted, laws that were passed to involuntarily sterilize those who were poor, those with disabilities, those institutionalized, and those deemed “sexually promiscuous” and others during the beginning of the century also impacted women of color.

In 1903, President Theodore Roosevelt began to fear “race suicide” or that “Yankee ‘stock’ …. would be overwhelmed, numerically and hence politically, by immigrants, nonwhites, and the poor.”

Latinas were impacted on the continental United States as well as in Puerto Rico during the first half of the twentieth century. U.S. policy promoted permanent sterilization in Puerto Rico through door to door visits by health workers, financial subsidies, and employers favoring sterilized women in the hiring process.

Things hadn’t changed much by the seventies.  In Madrigal v. Quilligan, it came to light that medical practitioners at Los Angeles County Medical Center coerced low-income, immigrant women into sterilization within hours of giving birth.  One plaintiff, Maria Hurtado, described her situation: “I was told through a Spanish-speaking nurse, that the state of California did not permit a woman to undergo more than three caesarean section operations, and since this was my third, the doctor would have to do something to prevent me from having another caesarean operation.  They did not explain or describe the tubal ligation, and it was later performed on me without my knowledge or consent.” When the case was decided in 1978, the judge ruled that the practitioners had acted in good faith and without intent to harm.

Latinas in California’s mental health facilities were also subjected to sterilization abuse because they were labeled feeble-minded or because their parents could not support them or for other arbitrary reasons.  However, these women shared similar characteristics: they were of Mexican origin, they had little access to education, and their families migrated back and forth to the United States. This story of abuse started in 1909 and lasted until 1979.

To this day, advocates are hearing stories of abuse and coercion when women are in the hands of the state for their care.

During this past summer, it was reported that 132 women incarcerated in the California prison system were forcibly sterilized between 2006 to 2010.  As you can imagine, many of the women were women of color.  In 2010, Latinas and African-American women made up 59% of the California prison system and these numbers are indicative of the national trend of low income women and women of color serving time in prison for non-violent offenses.  The providers who sterilized these women assumed that these women were repeat offenders or believed these women should no longer parent because they had multiple children.  Many of the women went in for various reproductive health care needs and were misled to believe that sterilization was their only option for treatment.  It is disappointing that these women were deemed to have no dignity or autonomy by their providers. It is more distressing that the mainstream reproductive rights movement has forgotten about these women even though correctional institutions are the second largest provider of reproductive health services in this country.

The situation of these women and their families reminds us that we are a long way off from the right to parent and the social supports needed to actualize this right for many persons in this country.

Lady Parts

Mangala Kanayson, Resident Blogger (’15, Emory University School of Law)

Dear LSRJ Blog Reader,

Lady Parts (LP) is a student-run production that highlights the issues surrounding gender, sexuality, and identity, as pertaining to women. Through a series of monologues, LP aims to educate, enlighten, and empower both women and the surrounding community in order to accept, advocate, and celebrate.

In 2013,  Emory Law Students for Reproductive Justice, in partnership with the corresponding student organizations at the Public Health and Medical Schools, brought Eve Ensler’s play “The Vagina Monologues” to the Emory Graduate community for the first time. This year the show has progressed toward new goals. In the interest of creating a more diverse and inclusive show this year’s production will be featuring monologues written by Emory students about the modern day triumphs and hardships of being a woman. We are particularly interested in exploring the intersectionality of other aspects of identity (age, race, orientation, class) with womanhood and how our experiences are both shared and different.

If you’re in the Atlanta area and interested in acting or would like to learn more about the production, please click here and get involved. The show is on March 20, 2014 at 7pm in Tull Auditorium. We look forward to seeing you in March! If you’d like to support us but are unable to do so in person, please consider donating to our beneficiary SPARK on behalf of LadyParts here.

XOXO, Emory LSRJ

We must improve access to all reproductive health care

Melissa Torres-Montoya, Resident Blogger (’11, University of California, Berkeley School of Law)

Last year, as a LSRJ fellow, I had the incredible experience of working on federal policy work in Washington, DC, but as you can imagine, it was also an incredibly busy experience because, essential aspects of women’s health care and more broadly reproductive justice were under constant attack.  During my time as a fellow, I became particularly familiar with policies like the Hyde Amendment, a provision that has been passed every year since 1976 and unjustly restricts access to abortion services to women who get their health coverage through Medicaid.  This disproportionately affects  women of color and women with lower incomes.  Yes, Roe v. Wade says abortion is legal, but federal and state policies continue to narrow abortion access and the first to feel these continued attacks are the most vulnerable – communities of color and low income women.

This year, I started a new job where I’m working to end the HIV epidemic and help create an AIDS free generation.  As with many health justice issues, communities of color experience huge disparities in HIV infection rates.   Black women experienced 64% of the new HIV infections in 2010.  Latinas experience higher rates of human papilloma virus (HPV) and the death rate among Latins from cervical cancer is double that of white women.  Moreover, since Latinas experience disproportionate rates of HIV infection and HIV positive women are 4-5 times more susceptible to cervical cancer, the rates of HIV infection among Latinas likely contributes to the much higher death rate among Latinas from cervical cancer.

As I delve into HIV/AIDS advocacy work and reflect on my experience as an LSRJ Fellow and the anniversary of Roe v. Wade this week, I am re-remembering that attaining reproductive justice for women of color not only relies on increasing access to abortion care but also improving access to all reproductive health care.

Reflections on Roe: Out of Clinic Violence and Ash Rises a Reproductive Justice Advocate.

Deodonne Bhattarai, Resident Blogger (’12, Northeastern University School of Law)

McCullen v. Coakley, the case that could decide the constitutionality of all abortion clinic buffer zones, was heard by the Supreme Court less than two weeks before the forty-first anniversary of Roe v. Wade. The plaintiff was well chosen, a “grandmother” figure not immediately fitting the image of intimidation and violence that the zone around the Boston clinic was set up to protect entrants from.  Last year the Massachusetts buffer zone was upheld by the First Circuit Court as a way to mitigate “the persistence of a disorderly and threatening climate at facility entrances.”

Perhaps the plaintiff herself believes that she poses no risk to the women she encounters, but within the larger anti-choice/pro-choice movement she is allied with those who do. Boston knows well the devastation of clinic violence where, in 1994, two health workers were brutally murdered while serving their clients.

My own experience as a health worker was born out of the ashes of a local clinic – I was inspired to join the health center’s staff shortly after its offices were firebombed.  The subsequent arson investigation remains open. Clinic violence is a daily reality for those of us trying to ensure that the rights granted by Roe remain accessible to women of all ages and incomes.

Thirty-five feet is all that stands between a peaceful protest and a clinic blockade.  Even with the buffer zone, insults, photographing, and threats of religious retribution create a culture of intimidation whether the conservatives on the Court recognize it as such or not.  So on this anniversary of Roe, remember those who work behind bullet-proof glass, and their clients: women and men brave enough to make a decision for themselves and their families despite anti-choice protesters subjecting them to religious rhetoric, hateful name calling and other forms of aggression.

I’m in the 78%. Taking Back the Narrative: Asian American and Pacific Islanders DO Support Abortion.

Christine Poquiz, Resident Blogger (’12, University of California, Davis School of Law)

Working as a reproductive justice fellow at the National Asian Pacific American Women’s Forum (NAPAWF), we’re often combating myths (model minority anyone?) and misconceptions around the Asian American and Pacific Islander community.  AAPI women, activists, and organizers are speaking up, fighting back, and recreating the narrative around our community. A few months ago the hashtag #notyourasiansidekick took off on twitter to talk about the struggles that Asian American women face and AAPI feminism. The response to this hashtag was overwhelming and showed how many young AAPI women wanted a forum to talk about these issues. [click here to see the follow-up Google Hangout with NAPAWF’s executive director, Miriam Yeung]

On this 41st anniversary of the landmark decision Roe v. Wade, there are misconceptions that AAPI women aren’t affected by attacks on abortion rights. However, bans against public insurance coverage of abortion, like the Hyde Amendment, cause great harm for subpopulations of the AAPI community who depend on public insurance like Medicaid. Furthermore there is evidence that AAPI women use birth control at lower rates than the general public, have high rates of unintended pregnancies and utilize abortion services at higher rates. On top of all that, some legislators are using stereotypes about Asian American women to pass sex selective abortion bans that encourage racial stereotyping of AAPI women in the doctor’s office and could possibly even cause doctors to deny care to women in our community. AAPI women are significantly affected by attacks on abortion access.

The AAPI community needs to shape the conversation about us, or other people will do it instead. One traditional perception about the AAPI community is that we’re conservative in our values. However, from the National Asian American Survey (NAAS), which conducted opinion polling on over 6,000 AAPIs, showed that the AAPI community is progressive in our values. During this celebration of Roe, it’s crucial to highlight that 78% of AAPIs support some form of legal abortion. Furthermore, 69% of AAPIs believe that the government should stay out women’s personal decision-making.

Here at NAPAWF, we’re big proponents for data disaggregation, and the 78% is not reflective of each AAPI subpopulation. For example, the traditionally Catholic Filipino community is less supportive of legal abortion than the rest of the AAPI community. But even among the Filipino community, over 50% support some form of legal abortion. Moreover, there are higher rates of “I don’t know” within the Vietnamese and Hmong community, which shows advocates like us that there needs to be more culturally competent education around this issue for these communities.

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Most importantly, these top line numbers break the notion that AAPIs don’t support abortion. This year, NAPAWF is uplifting these numbers to show that AAPIs are supportive of abortion and a woman’s personal decision making. Our members, community leaders, and elected officials are taking part in a photo campaign saying that they’re part of the 78% and that they support Roe.

We’re working on changing the narrative. Send in your photo saying you’re part of the 78% today.

Comprehensive sex ed is essential, not “too racy” for youth

Melissa Torres-Montoya, Resident Blogger (’11, University of California, Berkeley School of Law)

2014 brought many fresh starts for me, most predominately the start of a new job in HIV/AIDs policy.  I spent much of my first week at my job better familiarizing myself with HIV/AIDs policy by plowing through many research studies and reports.

I happened upon a report by the Center for American Progress and my alma mater UC Berkeley School of Law exploring barriers to prevention and treatment of HIV among communities of color; making the case for a holistic approach to eliminate racial disparities in HIV/AIDs.  The report includes a recommendation for free comprehensive sex education. While comprehensive sex ed seems like a given for combating the epidemic of HIV, the report notes that despite the effectiveness of sex education, “conservatives have often opposed programs such as condom education and distribution.”  Such opposition to comprehensive sex education has led to “abstinence-only” education, most notably in the South, where the report also noted that the prevalence of abstinence-only education likely contributes in part to why residents of the South are  ”significantly less likely to obtain treatment to [HIV] once infected” than people in all other parts of the U.S.

It did not take long for the reality of this to come to light for me, as the same day I read this report one of the top stories in my google alerts was about how some parents in Charlotte, North Carolina find a sex education curriculum “too racy”to be taught at large to their ninth grade students because it includes a chapter entitled “How to Make Condoms Fun and Pleasurable.”  Teaching about how condoms can be fun and pleasurable is an effort to increase use of condoms among teens engaging in sexual activity to prevent unplanned pregnancy and transmission of HIV and other STIs.  Including a section in sex education curriculum that presents condoms in a way that tried to increase their use is a valuable and essential because it promotes safer sex practices among teens and the adults they will grow up to become.

As a former Law Students for Reproductive Justice fellow, it is obvious to me how reproductive justice intersects with health equity and justice issues, I only wish all policy makers and parents alike did too.