Sandra Fluke, Georgetown University Law Students for Reproductive Justice

This blog is part of the #HERvotes blog carnival.

As you may have recently read in the New York Times, although Georgetown’s student health insurance doesn’t cover contraception, it does cover birth control pills when they’re prescribed for medical reasons other than preventing pregnancy (e.g. severe acne, mood disorders, etc.).  This is called the “over-ride” process because it over-rides the usual ban on contraceptive coverage.  Unfortunately, this over-ride process is terribly flawed and fails many women at Georgetown.  The problems with this process illustrate the consequences for women’s health when university administrators dictate which reasons for a birth control prescription are the “right” reasons.

Because of an obsession with preventing students from fraudulently using the over-ride to get contraception coverage for the “wrong” reason (preventing pregnancy), students who attempt to use the over-ride process are sometimes subjected to questioning and accusations that they are lying about their qualifying medical needs.  This is followed with long delays and bureaucratic barriers that don’t exist for any other prescription covered by Georgetown’s insurance.  The Times profiled how Georgetown’s policy resulted in a medical tragedy for one woman.  In response a Georgetown spokeswoman said that:

problems like this were rare and that doctors at the health service knew how to help students get coverage for contraceptives needed for medical reasons.

If only that were true!  Georgetown Law Students for Reproductive Justice actually surveyed students at the law school about this.  For some students, the over-ride process works adequately, but 65% of students attempting to utilize the over-ride process reported being subjected to extensive questioning, inordinate clerical issues, extensive delays, or other complications because of disbelief from doctors and insurance administrators.  20% either never received their medication or were never reimbursed by the insurance company.  Here are the experiences of just a few students:

I was without birth control for many months because of problems with the over-ride.  I spoke with people at [the student health] clinic, the Georgetown main insurance office, the insurance company, the drug insurance company, and a pharmacy.  I was put on hold multiple times and had to call some of these people multiple times.  After investing at least ten hours in the process, I gave up. . . .

Simply because I am sexually active, the doctor assumed I was lying even though I have medical needs.  I struggled with getting an over-ride because the doctor was hesitant even though I reported severe pain and mood changes that affect my functioning as a student. . . .

[M]y OB/GYN suspects that I have endometriosis and I took a specific pill to help control it.  Endometriosis cannot be definitively diagnosed without surgery, and obtaining a waiver was stressful and time consuming.  It unnecessarily distracted me from my classes. . . .

I have found the health care coverage ban on birth control embarrassing and potentially harmful.  When scheduling a yearly gynecological exam, I was subject to a line of hostile questioning twice: once by the person scheduling the exam and once by the doctor performing the exam.  The questions included queries about my sexual history, which seems appropriate for the doctor to ask about, but not the scheduler.  A yearly gynecological exam is a recommended procedure and may not even be tied to a birth control prescription.  Georgetown’s refusal to cover birth control creates a potential burden on a woman getting this exam at all. . . .

Tragically, Georgetown’s policy has also created rampant misinformation regarding student insurance coverage of women’s reproductive healthcare generally, leading to some students foregoing essential medical care:

[I] was intimidated by the [‘override’] process and thus I did forego OBGYN care for over a year.  More importantly, the reputation that Georgetown has as being . . . unsupportive of women’s reproductive health prevented me from seeking out STD testing after I was sexually assaulted.  (I assumed [Georgetown] would not cover my HIV/STD testing because when I was tested last year at my provider’s office . . . as part of a regular/routine exam, I paid $500 due to lack of coverage.  It was not until several months after I was assaulted that I found out . . . that [Georgetown] would cover such tests.  In general, there is a problematic lack of info about women’s health coverage on campus.  I did not even know I could get an OBGYN exam at the law center until a friend told me my 2L year.  While I support Georgetown’s Jesuit identity and am a person of faith myself, I find our school’s policy to be . . . harmful to students. . . .

I’d say “harmful to students” is putting it lightly.  That’s why we’re so thankful that the new Affordable Care Act regulations will protect vulnerable students and end these types of dangerous insurance policies!

Emily T. Wolf, Vice-President, Fordham Law Students for Reproductive Justice

This blog is part of the #HERvotes blog carnival and is cross-posted from Fordham LSRJ’s blog.

After spending the past three semesters trying to understand Fordham University’s birth control prescription policy, we recently had a small victory when the University updated the health center’s website to clarify that birth control will not be prescribed at Fordham unless the student has a medical exception.  This victory came at the same time as a larger victory announced by the Department of Health and Human Services that a religious exemption to contraceptive coverage in health insurance will not be extended.

This is great news for students.  While insured students at Fordham and in New York are already covered by a New York state law that mandates insurance coverage for contraceptives (as well as students in 27 other states), this will ensure that all students who attend religious universities will be able to receive contraceptive at a more reasonable cost without a copay.  As we know, students are a vulnerable population (almost one in five young women ages 18-24 have experienced forced sexual intercourse) and low-cost contraception is an important part of being able to foster our own sexual health decisions.  Contraception can also ensure that students are able to decide when and how to parent children, which will certainly have an effect on students’ future careers.

Students of many different faiths and experiences attend religious universities.  While those in favor of a more broad religious exemption may have a problem with contraception as an imposition to their consciences, similar exemptions are already in place in over half of the states.  The Obama administration must continue to stand up for all of us to ensure that we receive the health care we need to survive and thrive.

Joanne Caceres, Harvard Law School

Things are busy as ever as the members of HLSRJ finally dive into our long planned Speak Out Week, which aims to engage the HLS student body in honest exchanges about reproductive health, listen to and share personal stories about reproductive choices, and explore the ways in which access to abortion and other reproductive services intersect with larger social movements. Kicking off our week, our first event was “Bro-Choice,” an event geared towards men and their role in the movement. I am happy to report that we had exceptional attendance and that several men signed up for our weekly email list. We are excited for further exploration into engaging men on campus!

Other events this week include two intersectional panels, one featuring women of color and the pro-choice movement, with Gretchen Sisson, Reverend Penny Willis, Jasmine Burnett and Kaitlyn Soligan; and one featuring different religious perspectives on reproductive justice, with Reverend Marvin Ellison, Rabbi Peter Stein, Reverend Matthew Westfox, and Prof. Daniel Dombrowski. As with all of our events, cross promotion and co-sponsorships greatly contribute to our success. Thanks to our partnership with students from the Harvard Kennedy School, we will be screening of 12th and Delaware followed by a conversation with NARAL Pro-Choice MA.

We are also speaking out using Facebook, our LSRJ website, posters, and word of mouth. We have asked HLS and other greater Boston students share their own reproductive health stories, in the hope that doing so will open up a more honest and nuanced conversation regarding the choices women make throughout their lives. To contextualize these stories more effectively, Julia Reticker-Flynn from Advocates for Youth will join us for a strategy discussion regarding how and why to share abortion stories. We encourage all students reading this to also contribute to our survey or tell us what pro-choice means to them in our new tumblr! We hope our events will inspire other groups on other campuses to Speak Out as well!

Early Sunday morning, Nancy begins to have excruciating abdominal pain. Immediately, she begins to worry about the health of her fetus. She wakes her husband and he rushes her to the town hospital thirty minutes away. Upon her arrival, it is determined that Nancy is miscarrying and there is no chance her fetus will survive. However, the town hospital (the only hospital within 180 miles), is a Catholic hospital governed by the Ethical and Religious Directives for Catholic Healthcare Services (Directives), a document developed and enforced by the U.S. Conference of Catholic Bishops. The Directives provide guidance on reproductive health services including surgical sterilization, family planning, emergency contraception, infertility treatment, and abortion. Though the doctors are certain Nancy’s fetus will not survive, they would not treat Nancy. They withhold this information from Nancy and continue to run painful and expensive test on her until hours later they determine there is no longer a fetal heartbeat. Under the Directives, abortions are not allowed even in cases of emergencies or when the mother’s life is at risk. In Nancy’s case, because there was still a fetal heartbeat, even though the doctors knew the fetus would not survive, termination of her pregnancy would be considered an abortion.

Though this story is fictitious, it is the reality of millions of Americans today.  One in six patients in the United States is cared for in a Catholic hospital.  Catholic institutions control 622 hospitals nationwide, the largest single group of nonprofit hospitals in the United States. Five of the ten largest healthcare systems, which operate hospitals and medical centers throughout the United States, are Catholic. A large number of these hospitals are in rural communities where these hospitals are the only health care options for the sick. The Catholic Bishops promote “natural family planning,” which means that no drugs, devices, or surgical procedures can be used to avoid pregnancy. Instead, families monitor the woman’s menstrual cycle and abstain from sex during her fertile phase.  The Directives prohibit almost all reproductive health services: contraceptives that do not promote “natural family planning” are prohibited, most treatments for infertility are not allowed, sterilizations for men and women are banned, and abortion, even in cases of rape, incest, or to save a pregnant woman’s life, is impossible to obtain. Special government exemptions, known as “refusal clauses,” permit hospitals to use religious doctrines as patient care guides while remaining eligible to receive public funding. Almost every state has some sort of refusal clause allowing individual health providers to refuse to provide abortion services. However, some states have religious-based refusal clauses for reproductive services such as birth control and sterilization.

Like Nancy, many women have no idea their local hospitals will not provide certain services to them even if their life is on the line. Further, many women do not know that these hospitals are not being held liable for the consequences of refusing to provide these services or for not making women aware of other alternatives at non religious hospitals. This is an issue that affects women all over the country and needs the attention of women universally. The more people who are aware of these lack of services, the larger an impact we can have on our country to stop merging public and religious hospitals. Reproductive justice will be achieved when women have access to the resources to have children, not have children, or parent the children they have with dignity. This is not achievable when women are being denied specific services because of practitioner’s moral beliefs. This cannot be achieved when women are not being given the information to make responsible decisions over their reproductive health with dignity and good faith in their doctors. Make yourself aware of your local hospital’s policies and your state refusal clauses.

Click here for a state directory of laws regarding reproductive health.

Erika Willis

I worked in an abortion clinic for years.  Many people, therefore, are surprised to learn that I completely respect the view that abortion is wrong.  When I began counseling patients, one of the first things my supervisors drummed into me is that a woman’s religious and cultural beliefs are always valid.  My job was not to convince women to have an abortion, or to tell them that abortion was morally right or wrong.  I was only there to provide support, guidance, and detailed knowledge about the abortion procedure itself.

My point of view diverges from the antis, however, when they try to force their personal convictions on everyone else.  The violence, deceit, and hatred that many in the movement embrace shocks and saddens me, and leaves me wondering how true Christians, Jews, or Muslims could act so counter to the tenets of their religion.

One particularly insidious, and increasingly popular, tactic is the antis’ operation of misleading abortion hotlines and “pregnancy help centers.”  These hotlines and “clinics” purport to be neutral, but what they really do is lie to and intimidate women.

I have been reading more news lately about this strategy, so I decided to investigate for myself.  Armed with my own detailed knowledge about the abortion procedure, I started calling different hotlines.  When I began, I was nervous that somehow, the woman on the other end of the line would be able to tell that I was a faker.  It quickly became apparent, however, that this would not be a problem—the lack of respect I received could only be based on the belief that callers are ignorant and easily manipulated.

“Please tell me about different types of abortions,” I asked the women, but she was not going to be easily led into that discussion.  “Well first,” she said, “could you tell me a little about your situation?”  I told her I was eighteen, pregnant, and anxious to have an abortion.  “Well, let’s slow down here,” she responded.  “Who is this guy?”  I replied, “Oh, just someone I barely know.  He’s going off to college, and I know he won’t be interested in helping me.  Plus, I want to go to college in the fall too.”

This is when our discussion got (actually, kind of hilariously) disturbing.  Here are some of the things the woman said: (more…)

“Reproductive rights” is a legal term. When a woman is making a decision about abortion, she’s not making a legal decision – she’s making a personal, moral decision that involves matters close to her heart – her religious beliefs, moral values, and life circumstances. Yet this is rarely recognized in legal and policy work, and that is having an adverse effect on efforts to preserve support for legal abortion. To claim or reclaim the language of values and morality in a positive way, we have to recognize that reproductive and sexual issues are primarily personal and begin to use moral – as opposed to rights – language when appropriate and sincere.

A decision about abortion is a moral decision in another sense: it can be more ethical – or more moral – to terminate an unwanted pregnancy than to continue it, for a host of reasons, including severe family conflict, the needs of other children, and a woman’s or family’s ability to care for another child.   (more…)

On Sunday, Americans will unite in front of television screens across the county, but two things will divide them: team affiliation and abortion. Yes, abortion will be part of this year’s Super Bowl festivities because Focus on the Family, the uber-conservative “family values” group, has purchased an advertising slot allegedly featuring quarterback Tim Tebow’s mom discussing her decision not to terminate her pregnancy despite her doctor’s recommendation. The message being: “If I’d had an abortion, my son never would have won the Heisman.”

Although Americans are used to taking sides on Super Bowl Sunday, how will they react when they’re asked to take sides on one of our nation’s deepest cultural divides during the Big Game? Some national women’s and reproductive rights organizations, including LSRJ, have already reacted–they’re petitioning CBS to pull the ad. This seems like a reflexive, even if justified, reaction. Though I haven’t seen the ad, I’m relatively certain that if it crossed my screen on Sunday, my TV and I would have it out–as we often do when I’m blindsided by bigotry and intolerance wrapped up in American flags, bald eagles, and yes, football uniforms. However, reproductive justice organizations aren’t being blindsided by the ad, so we have the time to formulate a well-reasoned, articulate response. (more…)

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

One of my favorite female musicians, Amanda Palmer of the Dresden Dolls, wrote in her blog this week about the BBC’s censorship of her song Oasis, “a tongue-in-cheek, ironic up-tempo pop song…about a girl who got drunk, was date raped, and had an abortion.” The BBC thinks that her lyrics “make light of abortion, rape, and religion.” Amanda, who is herself a survivor of date rape, writes,

our COLLECTIVE freedom to approach situations with humor, with irony, with anger, with sadness, with darkness, with an edge, from a different perspective, from within the situation…it’s ESSENTIAL.
we have to agree about this or we ALL get in trouble….

in the united states in 1996, about 1.3 MILLION women had an abortion. about half those women were under 25.
and i can assure you, there were approximately 1.3 million different reactions, experiences and stories behind those abortions.
countless girls have been raped or date-raped. are we allowed to talk about it, joke about it, turn it over from every side and try figure it our own confused reaction to it?
or is that just too icky, uncomfortable … and shameful?

should we just cry about it demurely and hope that the proper reaction, the one that society deems appropriate, will make it go away?

Her answer is profanely emphatic. As it should be. No one has the right to tell us what is an appropriate, acceptable reaction to what happens to us, to our bodies–to tell us what to feel, what to say, what to hide.

(more…)

Here’s a guest blog by Madison Burnett, rising 3L at Georgia State University and recently elected LSRJ national board president.

Atlanta, Georgia

Georgia is not an easy place to be a reproductive justice advocate. Abortion rights are constantly threatened at the state level, and every legislative session in Georgia provides new laws that undermine a woman’s decision to have an abortion or bills that serve as an attempt to challenge to the constitutional right to abortion. Anti-choice groups continue to disproportionately target the South and rural areas where they think- with some reason- that they will be more successful.

The week of July 14-20 served as a harsh reminder to the South’s reproductive justice community that our rights continue to be threatened. The anti-choice group “Operation Save America” came to Atlanta last week. The group, formerly known as Operation Rescue, has a history of blocking access to abortion and family planning clinics and some members have advocated violence against abortion providers. Their threatening activities of the week included throwing a brick through an abortion provider’s window, but luckily no one was injured.

Apparently even anti-choice conservative Christian churches aren’t acceptable enough for OSA. The group even protested at a church in the Sugar Hill suburb because the pastor had the audacity to indicate that women who have abortions shouldn’t be demonized. They also targeted moderate churches who support abortion rights and welcome gay parishioners.

OSA targeted Atlanta in an attempt to pervert our city’s history in the civil rights movement, twisting civil rights language with the goal of restricting women’s power to control their bodies and lives. This majority white, majority male group have gone so far as to accuse Black women and their families as “perpetrators of black genocide.”

The RJ community in Atlanta responded with strength and intelligence. SisterSong Women of Color Reproductive Health Collective, SPARK Reproductive Justice Now , and Planned Parenthood of Georgia led the way, organizing a press conference, counter-protests, and informative workshops. I have never been prouder to be a part of the RJ movement then when I read Spark and SisterSong’s joint statement. Spark also beautifully co-opted the group’s “sidewalk counseling” practice outside a OSA rally.

OSA’s presence is a reminder to all of us of the importance of standing up for reproductive justice, both as citizens and as future lawyers.