Holding the Line: Challenges to Reproductive Rights in 2016

Taken from the January/February 2016 issue of the Women's Health Activist Newsletter.

Looking back on 2015, we achieved some undeniably major accomplishments to advance reproductive health and reproductive justice for women in this country. From the introduction of the Equal Access to Abortion Coverage in Health Insurance (EACH Woman) Act in July, to the 6-3 Supreme Court ruling upholding the Affordable Care Act’s (ACA) health insurance subsidies for more than 7.5 million people in June, we have moved toward a more inclusive, and progressive, health system. The National Women’s Health Network (NWHN) celebrates these victories and their positive impact on women and families.

As the women’s health community reflects on the past year’s successes, though, we also look to the coming year with cautious optimism; optimism because we are fearless in our pursuit for improving health care for women and families in this country, and caution because we know our opponents will stop at nothing to roll back the progress we have made.

Abortion rights as a controversial issue is (sadly) not new. Republican Members of Congress and conservative elected officials in local and state governments have dramatically increased their attacks on women’s reproductive health care services in recent years. In the first week of its 2015 term, 6 anti-choice bills were introduced in Congress. Racial tensions continue to rise; almost 15 percent of American families are considered to be “food insecure;” and we face both domestic and international threats of terrorism. But, rather than try to address these pressing problems, Congressional Republicans have been focused on trying to dismantle the health care system that provides women with vital reproductive health care services.

The states are no better. From 2011 to 2014, state legislatures enacted a staggering 231 new abortion restrictions. And, in 2015, almost 60 percent (57%) of women live in states considered to be “hostile” or “extremely hostile” to reproductive rights (in 2000, only 13 states were considered “hostile”).1

We know that one in three women will have an abortion, and the majority of women will seek contraceptive and/or reproductive health care in their lifetime. Yet, too many elected officials are trying to take away these critical services, and to perpetuate shame and stigma regarding women’s reproductive health needs and choices.

Given this context, the introduction of the EACH Woman Act was nothing short of groundbreaking. For decades, reproductive rights advocates have been forced to play defense, reacting to the onslaught of attacks on women’s health care rather than being proactive. The EACH Woman Act — which ensures coverage for abortion, regardless of how much a woman earns, where she lives, or how she gets her insurance — changes that paradigm. With a pro-coverage abortion bill, we now have a chance to play offense, forcing anti-choice zealots to engage on our terms, not theirs.

Continuing this momentum, in October, more than 200 advocates from around the country descended on Capitol Hill to show their support for the EACH Woman Act, and for lifting the bans that deny abortion coverage to low-income women and other vulnerable communities. The 2015 Capitol Hill Day was a huge success; advocates attended over 140 meetings with Members of Congress and their staff, and urged them to be bold and end the discriminatory Hyde Amendment. Currently, the House version of the bill has more than 100 cosponsors, which is no small feat given the Hill’s hostile climate for reproductive rights.

As advocates, we celebrate our Congressional champions for their bold actions, while remembering that too many communities — especially low-income women, women of color, and immigrant women (to name a few) — are still disproportionately left out of important discussions about their health care. To address this challenge, in 2007 the NWHN, in collaboration with Black Women’s Health Imperative, and the MergerWatch Project of Community Catalyst, founded Raising Women’s Voices for the Health Care We Need (RWV). RWV is a national initiative that highlights women’s voices and needs as the Affordable Care Act is implemented. Through RWV, the NWHN is working to preserve abortion care coverage in the ACA Marketplaces, to persuade insurers to include abortion coverage in states that allow it and to expand Medicaid. We are working hard on abortion as part of ACA implementation because it is important to expand coverage for abortion care any way we can.

This year is expected to bring a major Supreme Court ruling on abortion access. In late 2015, the Supreme Court announced that it would consider Whole Woman’s Health v. Cole. This case challenges HB2, the 2013 Texas law that requires abortion care facilities to comply with the same building specifications as ambulatory surgical centers, and abortion providers to have admitting privileges at local hospitals. This law was passed under the guise of protecting women’s health, but the requirements are medically unnecessary. Several prominent medical associations, including the American Medical Association (AMA), the American Public Health Association (APHA), and the American College of Obstetricians and Gynecologists (ACOG), have publicly declared their opposition to HB2, stating that it “jeopardizes the health of women in Texas,” despite the law’s ostensible intent to protect women’s health.

The reality is that HB2 was designed to shut down abortion care facilities and would result in closing 75 percent of Texas’ abortion clinics — thereby severely restricting women’s access to safe abortion care. Before the law passed, Texas had more than 40 abortion care facilities; now there are just 19. If this restrictive law is upheld, only 10 clinics will remain to serve the more than 13 million women who live in Texas. A series of studies by the Texas Policy Evaluation Project (TxPEP) found that 100,000 to 240,000 Texas women age 18-49 have attempted to self-induce abortion at some point in their lives. In interviews with women who attempted self-induction, many highlighted barriers to clinic-based care as the primary reason why they attempted this. While many women reported using misoprostol to self-induce an abortion, which we know can be done safely, other women reported using “herbs or homeopathic remedies, getting hit or punched in the abdomen, using alcohol or illicit drugs, or taking hormonal pills.”2

Whole Woman’s Health v. Hellerstedt (formally Whole Women's Health v. Cole) is the most important abortion rights case in almost 25 years. Its significance cannot be overstated: millions of women’s lives and reproductive autonomy are at stake. But, it’s not the only reproductive health care case being contested this term. The Supreme Court will also hear yet more challenges to the ACA’s contraceptive coverage mandate, which was brought by several religiously affiliated nonprofits.

These challenges (there are seven in total) mark the second time in two years that the Supreme Court will hear arguments related to the ACA’s contraceptive coverage. Currently, religiously affiliated organizations (like schools and hospitals) must complete a form stating their moral objection to providing contraceptive coverage for employees. The groups are challenging this accommodation, claiming that they have a moral objection to filling out a form and stating their moral objection to contraception. This is absurd. Women need and deserve health insurance coverage for the comprehensive range of health care services, including reproductive services — not just for the services their employer deems to be appropriate.

It’s going to be a busy year. Both the legislative and judicial branches of our government are expected to be battlegrounds this year. These are the key challenges as 2016 begins — there probably will be more as the year continues. As women’s health advocates, we are prepared to fight, and to win. The coming months also offer opportunities to learn about the positions of various candidates at the local, state, and federal levels. While the presidential election is still months away, it is imperative that discussions about what this election means for women’s health begin now. When you head to the polling booths in November, remember to vote as if your life depends on it — because for women, it does.

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1. Nash E, Benson Gold R, Rathbun G, et al., Laws Affecting Reproductive Health and Rights:
2014 State Policy Review, Washington, DC: Guttmacher Institute, 2015. Available online at: http://www.guttmacher.org/media/inthenews/2015/01/05.

2. Grossman D, White K, L. Fuentes L, et al., “Knowledge, opinion and experience related to abortion self-induction in Texas,” Texas Policy Evaluation Project (TxPEP) Research Brief, Presented at the North American Forum on Family Planning, Chicago, November 14, 2015. Available online at: https://utexas.app.box.com/KOESelfInductionResearchBrief