Carl Djerassi: A Legacy that Lives On

SJ Chapman, Resident Blogger (’12, Northwestern University Law School)

Carl Djerassi, who created the key ingredient in oral contraception, died on January 30.  The legacy he left behind was invaluable: a safe way for women take control of their reproductive lives.  Djerassi’s death spurred Megan Gibson to write a stunning article for Time on the history of birth control.  Gibson writes about epochs I can’t fathom – before birth control was available… before people even knew what it was.

Gibson writes, “For as long as men and women have been making babies, they’ve been trying not to,” quoting The Birth of the Pill: How Four Crusaders Reinvented Sex and Launched a Revolution.  Experimenting with contraception goes back to at least 3000 BC, where condoms appear in legends of King Minos of Crete.

Women began using methods for birth control that ranged from silly to lethal.  Women held their breath during sex, tied weasel testicles around their thighs, inserted crocodile dung into their vaginas, drank lead, drank mercury, or douched with Lysol.  Women used IUD precursors made of precious metals or glass, risking serious injury or infection.

Nearly 5000 years passed between 3000 BC and 1838, when vulcanized rubber led to the invention of rubber condoms, cervical caps and diaphragms.
Then, in the 1950s, Carl Djerassi led a team of scientists to develop a progesterone pill to block ovulation.  His synthesis led to the invention of the birth control pill, released in 1960.  By 1965, more than 6 million American women were on the pill.

During the 1960s, the battle against laws and stigma raged as women fought to gain access to the pill.  Finally in 1972 the Supreme Court ruled that the pill was legal for all women to use.  Today, more than 100 million women use the pill around the world, and it’s free to Americans under the Affordable Care Act.

Because of the pill, we live in an age when women can confidently and safely take control over their reproductive lives.  Not that there aren’t better methods waiting for us in the future. (Oh how I welcome the day when an LSRJ blogger writes “women used to resort to inane methods of birth control, like taking pills at regular 24 hour intervals to hormonally alter their bodies”).  But until that future arrives, I’ll be eternally grateful for Carl Djerassi’s contribution to reproductive justice.  And I’ll always be saddened by his passing.

Introducing the Denver Principles… to a New Generation

Jamille Fields, Resident Blogger (Law Students for Reproductive Justice Fellow at the National Health Law Program)

Preventing HIV and increasing access to care for people living with HIV/AIDS have long been interests of mine and is currently a part of my work portfolio. But, it was not until recently that I was introduced to the Denver Principles, which were outlined by a group of people living with AIDS in 1983–two years after the first instance of AIDS was reported. These principles changed the health care landscape for people living with HIV. I imagine other RJ advocates have not been introduced so I decided to pay it forward here.

 

I do not know if those who developed the Principles had the RJ framework in mind, but the principles are so RJ (or “Hella RJ” as LSRJ swag reads). Fear and discrimination of and against people living with HIV is still present, and it was even more blatant over thirty years ago. It was at this time that a group of fearless advocates stood at a gay and lesbian health conference to declare: “We condemn attempts to label us as ‘victims,’ a term which implies defeat and we are only occasionally ‘patients,’ a term which implies passivity, helplessness, and dependence upon the care of others. We are ‘People with AIDS.’” I imagine here the speaker dropped the mic and the crowd cheered. But, this powerful opening statement is only beginning of the Denver Principles.

 

The Principles are outlined into three different categories: (1) Recommendations for all People (aka the recommendations to be a decent human being), such as being a good ally for people living with HIV/AIDS when others attempt to separate them from their communities. (2) Recommendations for People with AIDS includes guidance for them to plan their own policy agenda. (3) The Rights of People with AIDS is where we, as lawyers, have a role to play, so I have outlined them here:

 

Principle 1: “To [have] as full and satisfying sexual and emotional lives as anyone else.”

This overarching guiding principle should govern the work we do as reproductive justice lawyers, whether or not we are specifically working on HIV/AIDS related care.

 

Principle 2: “To quality medical treatment and quality social service provision without discrimination of any form including sexual orientation, gender, diagnosis, economic status or race.”

The Affordable Care Act § 1557(enacted 27 years after the Principles) explicitly prohibits discrimination based on race, color, national origin, sex, age, or disability in health care delivery. This is an important tool that legal advocates can use to combat discrimination against people living with HIV. Here, at the National Health Law Program, we have filed a complaint against insurance companies for charging the highest level of cost-sharing for HIV/AIDS related drugs. We believe this is discrimination against people living with HIV/AIDS.

 

Principle 3: “To full explanations of all medical procedures and risks, to choose or refuse their treatment modalities, to refuse to participate in research without jeopardizing their treatment and to make informed decisions about their lives.”

This speaks to informed consent. Every person, including people living with HIV/AIDS, has a right to be fully informed of and to affirmatively consent to any health care procedures or research performed. This means ensuring the individual is made aware of all risks and consequences in a language and manner that ensures the person can make a voluntary choice whether to engage in the research or procedure. In general, it is important for lawyers to monitor language access and cultural competency in health care delivery.

Principle 4: “To privacy, to confidentiality of medical records, to human respect and to choose who their significant others are.”

The Health Insurance Portability and Accountability Act (HIPAA) is a federal law designed to protect the confidentiality and security of health information. In addition, states have varying laws related to confidentiality, particularly as it relates to youth. Issues of confidentiality are particularly important for people living with HIV/AIDS given the discrimination this community often encounters once their HIV status is learned. Legal advocates have a role to play in ensuring the enforcement and improving of these laws.

Principle 5: “To die – and to LIVE – in dignity.”

Enough Said.

Vessel: Providing Safe Abortion Services at Sea (and Beyond)

Anne Keyworth, Resident Blogger (’16, North Carolina Central University)

For the 42nd Anniversary of Roe v. Wade, our chapter was fortunate and honored to work alongside Carolina Abortion Fund and several other local reproductive justice agencies to do a screening of the film Vessel, an award-winning documentary about a doctor and sea captain who provides safe abortion services in international waters for women who have no legal abortion options in their country. Dr. Rebecca Gomperts is a physician from the Netherlands who uses her creativity and fearless advocacy to facilitate an underground route to safe abortion services.

This film encapsulates a woman who had a vision of what she wanted abortion access to look like: safe, legal, and affordable for all women, everywhere. She took it as her mission to provide safe abortion services to women who lived in places where they would otherwise not be able to access such services and that were accessible by boat. In doing so, she navigated unchartered territory in international law and on the abortion frontlines.

Her mission was not without challenges. At times her and her crew would be forbidden from entering into the harbors of some country’s waters and for days would have to engage in international legal disputes as to their rights to dock and provide abortion services to women outside of their waters. Many crowds greeted her and her crew with anger and hostility, and she was urged by leaders of many countries to leave their territory. While this certainly didn’t stop her from pursuing her mission, it did force her to think more creatively about less visible means of accomplishing her goals.

This led to her and her team’s efforts in training and empowering women around the world on how to give themselves safe medical abortions using the drugs Mifepristone and Misoprostol. This has since substantially expanded their outreach and the amount of women they are able to connect with and help in obtaining an abortion. They have been able to reach many women they otherwise would not have through their Women on Web internet site.

Our screening was packed and we were very fortunate to have the film’s director, Diana Whitten, join us for a discussion afterward who gave a great insight as to what it was like to observe the politics of this journey and the energy and enthusiasm of the crew on board the vessel. Our chapter decided to host a screening at our own university in March, and we can’t wait to share the film with more people! If your chapter is looking for events to plan in the future about abortion rights and access, I highly recommend considering hosting a screening. It’s a whole new spin on the abortion conversation and one that has a lot of room for growth, even here in the United States where in many communities, abortion is becoming more and more difficult to access.

vesselvessel2

Where Pro-Choice Lawyers Can Make a Big Difference: Clinic Violence and Intimidation

Emily Gillingham, Resident Blogger (’15, Michigan State University College of Law)

Anti-choice activists are like a slow-motion temper tantrum. They stand outside abortion clinics with graphic signs. If they don’t get their way, they may try to rent the space out from under the clinic and “counsel” women who unwittingly come to the space seeking an abortion without disclosing that they aren’t, in fact, the abortion clinic the women had expected to find there. Sometimes, they intimidate pro-choice activists by showing up at their homes holding graphic and threatening signs. Sometimes they intimidate clinic workers and women seeking reproductive healthcare by taking down their license plate numbers, a practice that is sometimes followed with stalking that can only be described as “creepy as f***.” Eric Scheidler of the Pro-Life Action League sent plastic handcuffs to abortion providers on the anniversary of Roe v. Wade; the message with one read, “Could you be next? If you want to get out of the abortion business, give me a call.” The suggestion, of course, was “quit your job or you’ll end up in these handcuffs,” which was particularly absurd, considering it was sent on the anniversary of the SCOTUS decision that legalized abortion. The Feminist Majority Foundation recently released their 2014 National Clinic Violence Survey, which shows that “targeted intimidation and threats” are way up (see Chart 4). Some anti-choice activists do whatever they can think of to keep people from exercising their constitutional right to an abortion, even when that means placing people in fear for their lives.

Sometimes, anti-choice activists are so “pro-life” that they kill people. A meticulous NARAL report on clinic violence notes that “since 1993, eight clinic workers – including four doctors, two clinic employees, a clinic escort, and a security guard – have been murdered in the United States.” And since 1991, there have been 17 attempted murders at clinics.

As lawyers and future lawyers, we are uniquely equipped to help keep abortion providers and their patients safe. Think about how you can flex your legal muscle to help your local clinic, be it pro-bono work obtaining protective orders against anti-choice activists who’ve crossed the line into harassment or intimidation; training clinic staff on how to document intimidation; advocating for legislation to protect clinic workers from targeted intimidation and threats; or anything else your unique skillset enables you to do to help. We owe it to the clinic staff and their patients to use our privilege in these high-impact ways, and hopefully we will keep people safe and clinics open by doing so.

Federal District Court holds Anti-Prostitution Loyalty Oath Unconstitutional as Applied to Foreign-Based Organizations

Rhiannon DiClemente, Resident Blogger (’16, Temple University Beasley School of Law)

I’ve written before on the ways in which the U.S. government exports its own repressive ideologies regarding sexuality and reproduction through foreign aid conditions. The Anti-Prostitution Loyalty Oath (APLO) is yet another example of this tired tradition. While academics and advocates continue to debate the social and moral legitimacy of commercial sex work, the U.S. government has taken a direct stance in opposition to prostitution and related activities. Through the APLO, it has required non-governmental organizations (NGOs) to adopt this position in order to receive funding.

The APLO amended the President’s Emergency Plan for Aids Relief (PEPFAR). Initiated in 2003, PEPFAR committed forty-eight billion dollars over a five year period to combat the spread of HIV/AIDS. The APLO inhibits freedom of speech by requiring that recipients of PEPFAR funds pledge their opposition to prostitution and sex trafficking. It also prohibits activities that “promote or support the legalization or practice of prostitution.” The provision governs not only the recipient’s use of U.S. government funds, but also private funds as well.

Not surprisingly, many organizations have refused to comply with the APLO, despite the need for HIV/AIDS prevention and treatment services (UNAIDS estimates that less than one percent of global resources are dedicated to HIV/AIDS programs for people involved in sex work). In 2005, the Brazilian government declined forty million dollars in U.S. funding by refusing to accept the APLO. Later, during the 2010 International AIDS Conference, activists interrupted the U.S. Global AIDS ambassador’s speech to chant “PEPFAR kills sex workers.” Many governments and community-based organizations, such as SANGRAM, see people involved in sex work “not as carriers of HIV but rather as individuals who can be empowered to become agent[s] of change” in the fight against HIV/AIDS.

After a lengthy legal battle, in 2013 the Supreme Court declared the APLO to be a violation of the right to free speech when applied to U.S.-based organizations. However, the U.S. government has attempted to narrow the scope of the decision by insisting that the ruling does not prohibit the imposition of the APLO on foreign affiliates. This is problematic because U.S.-based implementers often rely on foreign organizations to carry out their health projects on the ground. Thus, even after the decision, the APLO has continued to stifle debate and put the lives of people in sex work at risk.

However, on January 30, 2015, a federal district court decision denied this narrow interpretation. Judge Victor Marrero confirmed that the First Amendment prohibits the U.S. government from imposing the APLO on U.S. organizations and their affiliates, regardless of where the affiliates are located. This is a breakthrough ruling in support of a free and open civil society. Rather than silencing the voices of individuals on the ground—U.S. policy should work to amplify such voices. Purnima Mane, President and CEO of Pathfinder International affirms that “it is critical to retain the ability of individual organizations to provide a range of life-saving health services to whomever needs them without sacrificing the right to free speech.”

Access to Contraception an Issue for Female Servicemembers

Elise Foreman, Resident Blogger (’16, Emory University School of Law)

In the wake of the Hobby Lobby decision last term, it seems like the Internet is blowing up with stories about access to contraception and women’s health across the United States. However, one employer in particular seems to be neglecting the needs of its staff, with little backlash from pundits: the American military. (For the full story, see the Center for American Progress’ story, Access to Contraception for Female Servicemembers).

Fortunately, a bill was introduced yesterday in the House of Representatives that, if passed, would increase coverage for American service women. (Check out RH Reality Check here for coverage on the bill). Specifically, the bill would ensure that options available through the Affordable Care Act would be available through the military’s healthcare plan, TRICARE. As it stands now, certain methods are left off the list of covered birth control methods – even though service women are at higher risk for unplanned pregnancies and sexually transmitted diseases. The bill seems to face a difficult battle, despite slow progress for all federal employees.

Impeding access to contraception for American service women denies not only their reproductive rights but similarly places additional barriers on their ability to perform their duties effectively. As members of the armed forces, these women should be at the forefront of the contraception conversation and provided comprehensive care. Not only should this care be provided in times of crisis, but in times of relative peace as well. Denying these important methods threatens to hold these service members back, while allowing their male counterparts to surge ahead. And in terms of the military, this deficient care can be debilitating.

As reproductive rights advocates look forward to the legislative battles ahead, let’s ensure the women serving in the military are supported in this crucial aspect.

The Economics of Affordable Care

SJ Chapman, Resident Blogger (’12, Northwestern University Law School)

November 15 kicked off open enrollment season for health care, so I’ve had insurance on the brain.  I already took advantage of my “free” preventive/screening doctor’s appointment and obtained “free” FDA-approved contraception months after they became available to me under the Affordable Care Act, fearing the courts would whittle these mandates down before you can say reproductive freedom.

I’ve become especially interested the economics of the matter.  There’s no question that the Affordable Care Act has caused a lot of spending at every level.  The public at large funded legislators to draft and debate the legislation.  For-profits and not-for-profits have funded litigation either fighting or defending the law.  Folks who didn’t have insurance prior to the law must now buy it or pay a penalty.

While I like to think that the insurance companies are taking some responsibility for the reproductive health of the insured because they must now cover things like copays for well-women visits and contraception, my economic sense tells me that’s too good to be true.  It might seem like insurance companies would happily pay for preventive reproductive health services because it would save insurance companies money in the long run.  Under this reasoning, the cost of being on birth control long term and getting a pap every 3 years would be less than paying for unintended pregnancies or late-stage detected cervical cancer.  Unfortunately a recent New York Times article suggests that this isn’t the case.

So I suspect my insurance company figured out how to spread out what would have been my office visit and pharmacy copays so that they are still being paid out of our pockets instead of the insurers.  Maybe just adding a dollar to every monthly payment by (1) a man and (2) a woman who doesn’t get contraception by choice and (3) a woman who doesn’t get contraception because it is not age-appropriate would cover these costs.  Or perhaps increasing all deductibles by $50 would make up for the difference.

Ultimately is all this spending worth it?  Well, my answer is emphatically yes, because one of the ends of the Affordable Care Act is to expand reproductive health access to many people for whom it was previously cost-prohibitive.  This is a cause I earnestly support.  Even if it means we are all paying higher taxes, deductibles or premiums, I’m happy to support reproductive justice by spending a little more to increase access to reproductive health services.

Dwindling Opportunities for Abortion Provider Appreciation

Amy Krupinski, Resident Blogger (’14, William Mitchell College of Law)

A surreal experience is delivering abortion provider appreciation gifts to doctors’ offices.  First of all, a list of abortion providers has to be assembled, which is a difficult task for safety reasons.  That list is a closely guarded secret.  Then, you go to a doctor’s office, talk to the receptionist and say something along the lines of “because of the decision in Roe v. Wade, abortions are legal in this country and we appreciate the work you do every day to keep them safe and accessible,” and they look at you like they don’t know what you’re talking about because they weren’t even aware the doctor will perform abortions.  That is what it’s like in a state like Colorado, where there were a lot of private doctors’ offices where a doctor would perform an abortion.  Women didn’t have to be seen going into a Planned Parenthood if they didn’t want to.  However, due to the 205 restrictions passed across the country between 2011 and 2013, abortion procedures are limited and eliminated from certain practitioner settings.  It is a lot easier to stop providing them than to watch and wait for the day they’ll come after you for unnecessary doctor and clinic regulations, insurance coverage bans, and pre-viability bans on abortion.  These days around the country, there are significantly fewer stops on abortion provider appreciation day.  There will be no stops in my current community.  So on this Roe Day I spent time reflecting on these different environments and contemplating a remark I read, that it seems that women don’t even realize that abortions are still legal and I wonder where we’ll be in another forty-two years.

Roe Anniversary: A Look at History to Understand Our Present

Jamille Fields, Resident Blogger (Law Students for Reproductive Justice Fellow at the National Health Law Program)

I have always found studying history fascinating. I subscribe to the philosophy that “you can not understand where you are going until you understand where you have been.” That statement definitely applies to the Roe v. Wade victory for abortion rights and the subsequent battles to achieve abortion access. As history teaches us, it is often low-income women and women of color who are most likely to have access to their rights denied—and this holds true today.

To explore how much has changed and remained the same, I explored the organization where I work to understand their abortion rights advocacy throughout the years. The National Health Law Program (NHeLP) is a public interest law firm dedicated to health care access for low-income people. It was founded four years before the Roe v. Wade decision in 1969.

NHeLP, filed an amicus brief in Doe v. Bolton, the other decision issued on January 22, 1973. Here, Georgia law prohibited abortions, except in the cases of rape, severe fetal deformity, or the possibility of severe or fatal injury to the mother. Even in such cases, the law imposed burdensome restrictions, such as requiring three physicians to approve the procedure, and denied access completely to non-residents. NHeLP’s brief called out these restrictions: “It is an undeniable fact that abortion in Georgia and in virtually every other state in the United States is far more readily available to the white, paying patient than to the poor and the non-white.” This line could be pasted into related briefs today as abortion restrictions still disproportionately impact women who don’t have the money and ability to travel to a state with improved abortion access.

In Roe v. Wade, NHeLP’s amicus brief, written in conjunction with the American Public Health Association (APHA), noted the public health concerns raised from the Texas law that prohibited abortions, except to save the mother’s life. The brief notes illegal abortions, at the time, were the greatest contributor to maternal mortality. APHA and NHeLP recognized that women who were denied access to an abortion would often use unsafe means to terminate a pregnancy. Following Roe, the number of women treated for complications related to illegal abortion steeply declined.

Post-Roe but pre-Hyde, Medicaid and other public funding programs treated abortion as an ordinary medical service. (Imagine that!). The percentage of women of color obtaining legal abortions nearly doubled and the percentage of unmarried women also significantly increased.

But, Henry Hyde recognized that while he couldn’t win the victory of taking away abortion rights, the low-hanging fruit was to restrict abortion access for low-income women. (After all, what is a right without access?) The Hyde Amendment took us back to the problem that existed pre-Roe—low-income women, who often are women of color, often cannot access abortion.

At this writing, those who are opposed to abortion (Again!) recognize they may not be able to take away the right to an abortion, but they can trample on abortion access for the most vulnerable. It was surprising recently to see Republican women temporarily thwart the introduction of a proposed twenty-week ban bill. (I thought I was in the Twilight zone). But, I was then hurried me back to reality when the House (Again!) passed H.R. 7 to remove access to abortion for women receiving health benefits through public programs.

So, the fight continues. Today, RJ advocates benefit from the advancements many who came before us achieved. The victory of Roe is to be celebrated. However, if we are to truly apply the RJ framework, then we understand the victory is not yet won until it is won for all.

Rallying for More than Reproductive Health Equity

Rhiannon DiClemente, Resident Blogger (’16, Temple University Beasley School of Law)

This past September, I joined Philadelphia activists in iconic Love Park to share personal stories, educate community members, and call on our politicians to repeal the Hyde Amendment. The Hyde Amendment goes against our nation’s values of liberty and fair and equal treatment under the law by banning federal insurance or health plans, including Medicaid, from covering abortion.

I won’t lie, I was nervous to speak in front of the growing crowd. Despite the fact that I have been piling up student debt for six years now, I am a very privileged person. I know that the cost of an abortion would never prohibit me from exercising my right to one. I thought to myself, “What is my place in all of this?”

As a member of Law Students for Reproductive Justice, I know that 42 years after Roe v. Wade this right which I could exercise so freely still does not exist for many women. Hyde ensures that abortion is a privilege, only accessible if one can afford to pay for it. But repealing Hyde isn’t just a matter of equality, it’s also a matter of justice—justice for women who have long been punished for being victims of the systemic social, political, and economic flaws in our country. As a beneficiary of this system of oppression, it’s my duty to stand up and speak in solidarity with those who never really had the right to choose in the first place.

Here in Philadelphia, we know first-hand how the Hyde Amendment explicitly targets low-income women, women of color, and young women, ensuring that existing cycles of privilege and poverty remain firmly in place. Rally organizer Jasmine Burnett points out that despite being called the “City of Brotherly Love and Sisterly Affection,” “the motto certainly isn’t a reflection of the city’s stewardship to communities in need.”

In the city alone, more than 79,800 women of reproductive age currently utilize public insurance, but Pennsylvania prohibits state Medicaid coverage for abortion care. Local organizations, such as Women’s Medical Fund, provide financial assistance to women who cannot afford to pay for a safe abortion; however, many women still lack the financial means to ensure a safe procedure.

Just in 2011, scandal broke out after Kermit Gosnell was exposed for running a murderous abortion clinic that preyed on economically and socially vulnerable women. While many politicians called for tighter restrictions on clinics and providers, they failed to realize what led so many women to Gosnell’s clinic in the first place—desperation. A woman’s right to choose is the first line of defense. Such unnecessary deaths among the most vulnerable women in our society will continue until affordable, accessible abortion is made part of mainstream medicine.

Looking back, we weren’t just rallying for reproductive health equity that day, we were rallying for racial equality and economic justice. We stood together to demand that all women—regardless of race, age, or income level—be able to realize their constitutional rights. The rally gave me hope that the fight against restrictive abortion policies like the Hyde Amendment is far from over, and we are not backing down.