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      Conservative attacks on abortion and trans healthcare come from the same place | Moira Donegan

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      On Monday, Jim Pillen, the Republican governor of Nebraska, signed a law that bans abortion after 12 weeks of pregnancy and restricts gender-affirming care for anyone under 19. The ban on trans medical care takes effect in October and the abortion ban goes into effect immediately. And so Nebraska has become the latest state to determine through law what might have once been determined by the more pliable tools of custom or imagination: the way that the sexed body a person is born with shapes the kind of life they can live.Be it through forced pregnancy or prohibited transition, the state of Nebraska now claims the right to determine what its citizens will do with their sexed bodies – what those bodies will look like, how they will function and what they will mean. It is a part of the right’s ongoing project to roll back the victories of the feminist and gay rights movements, to re-establish the dominance of men in public life, to narrow possibilities for difference and expression and to inscribe in law a firm definition and hierarchy of gender: that people are either men or women and that men are better.They’re not alone. Abortion bans have been proliferating wildly in the year since the US supreme court eliminated the right in their Dobbs decision, declaring that any state can compel women to remain pregnant, and creating different, lesser entitlements to bodily freedom and self-determination based on sex. But as the abortion bans have spread like an infection across the American south, midwest, and mountain west, they have been accompanied by a related political disease: laws seeking to prohibit minors and sometimes adults, from accessing medical treatments that facilitate gender transitions.Twenty-five states have enacted pre-viability abortion bans since Roe was overturned last summer, although in some states, like Iowa and Montana, abortion has remained legal pending judicial stays. Meanwhile, 20 states now ban gender-affirming care for minors, with a rush of bills being introduced over the past months. In addition to Nebraska, a slew of states have passed transition-care bans in 2023, including Utah, Mississippi, South Dakota, Iowa, Tennessee and Florida. Texas is soon to join them.It is not a coincidence that the states which have the most punitive and draconian bans on abortion have also adopted the most aggressive targeting of transgender people and medical care. The bills are part of the same project by conservatives, who have been emboldened in their campaign of gender revanchism in the wake of Dobbs. Both abortion bans and transition care bans further the same goal: to transform the social category of gender into an enforceable legal status, linked to the sexed body at birth and to prescribe a narrow and claustrophobic view of what that gender status must mean.It is no accident that the states that would forbid a teenager from transitioning are the same that would compel that teenager to give birth; it is no accident that the states with the greatest control over what women do with their reproductive organs are the ones where women’s restrooms have become sites of surveillance and control, with patrons, cis and trans alike, subjected to invasive and degrading inquisitions as to whether they are conforming sufficiently to the demands of femininity. That Nebraska combined these two projects into one bill, then, is less inventive than it is a dropping of pretense: the anti-feminist movement is anti-trans, and the anti-trans panic is at its core anti-feminist.The attacks on gender freedom from the right are not only united in their ideology, but increasingly in their rhetoric. Abortion and trans rights activists have long insisted that both abortion and transition are healthcare. It’s an apt and worthy argument, considering that both involve the interventions of medical professionals, both facilitate the wellbeing and happiness of those who receive them, and both result in horrific health complications when denied, from the high rates of mental distress and horrific, needless pregnancy complications that have been ushered in by Dobbs, to the dramatic rates of suicidal ideation and mental health problems in trans people who are denied the ability to transition. But increasingly, the right has begun to attack the notion of abortion and trans rights as healthcare, arguing that neither pregnancy nor non-transition constitute “illness”.At a recent oral argument over the fate of the abortion drug mifepristone, Judge James Ho, a Trump appointee on the fifth circuit court of appeals whose rabidly conservative opinions and trollish affect suggest supreme court ambitions, argued that the drug should be removed from the market in part because “pregnancy is not a serious illness”. “When we celebrate Mother’s Day,” Ho asked, his voice dripping with contempt, “are we celebrating a serious illness?” In that moment, Ho sounded uncannily like anti-trans activists seeking to ban care for young people, who argue, ad nauseam, that “puberty is not a disorder”.The rhetoric suggests a narrow and myopic view of “health”, the notion that bodies have destinies and should be made to fulfill them regardless of the desires of the people involved. A healthy body, we’re told, is one that conforms to socially imposed gender hierarchies, regardless of how miserable that conformity and imposition makes the people who inhabit those bodies.But while these practices of abortion and transition care constitute medicine and while their outcomes encourage health, it would be a mistake to fight the political battle for these services only on the ground of what counts as “healthcare”. Because the truth is that conservatives do not care about health – they don’t care about the integrity of the medical profession, or about patient outcomes, or about bodies, not really. They care about people, and about making sure that those people stay in line. In the grand tradition of feminists and queers alike, we should refuse to.
      Moira Donegan is a Guardian US columnist More

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      It’s time to guarantee healthcare to all Americans as a human right | Bernie Sanders

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      Let’s be clear. The current healthcare system in the United States is totally broken, dysfunctional and cruel. It is a system which spends twice as much per capita as any other major country, while 85 million Americans are uninsured or underinsured, one out of four Americans cannot afford the cost of the prescription drugs their doctors prescribe, and where over 60,000 die each year because they don’t get to a doctor on time.It is a system in which our life expectancy is lower than almost all other major countries and is actually declining, a system in which working class and low-income Americans die at least ten years younger than wealthier Americans.It is a system in which some 500,000 people go bankrupt because of medically related debt.It is a system in which large parts of our country are medically underserved, where rural hospitals are being shut down, and where people, even with decent insurance, have to travel hours in order to find a doctor.It is a system in which, in the midst of a major mental health crisis, Americans are unable to find the affordable mental health treatment they need.It is a system where, despite our huge expenditures, we don’t have enough doctors, nurses, dentists, mental health professionals, pharmacists and other healthcare professionals – and where we spend less than half as much of our healthcare dollars on primary care as do most other countries.It is a system in which, while we are desperately in need of more health professionals, young people are graduating medical school, dental school or nursing school, hundreds of thousands of dollars in debt; a system in which Black, Latino and Native American doctors and nurses are grossly under-represented as medical professionals.It is a system in which health care for most Americans remains attached to employment. Incredibly, during the pandemic when millions lost their jobs, they also lost their healthcare. It is a system in which the quality of care you receive in this country is dependent on the generosity of your employer or whether you have a union. Not surprisingly, workers at McDonald’s do not receive the same quality care as executives on Wall Street.All of that has got to change. The function of a rational and humane healthcare system is to provide quality care for all as a human right. It is not to make tens of billions of dollars every year for the insurance companies and the drug companies.Yes. It is long overdue for us to end the international embarrassment of the United States being the only major country on earth that does not guarantee healthcare to all of our people. Now is the time to finally pass a Medicare for All single-payer program. And that is the legislation that I am introducing in the Senate this week with 14 co-sponsors. In the House there will be over 100 co-sponsors.Let’s be honest. The debate over Medicare for All really has nothing to do with healthcare. It has everything to do with the extraordinary greed of the healthcare industry and their desire to maintain a system which makes them huge profits.While ordinary Americans struggle to pay for healthcare, the seven largest health insurance companies in our country made over $69bn in profits last year and the top ten pharmaceutical companies made over $112bn.The corporate opposition to the desperately needed reforms of our disastrous healthcare system is extraordinary.Since 1998, the private health care industry has spent more than $11.4bn on lobbying and, over the last 30 years, has spent more than $1.8bn on campaign contributions to get Congress to do its bidding.The pharmaceutical industry alone has over 1,800 lobbyists on Capitol Hill – including the former leadership of both political parties.That’s how business is done in Washington. Well, we intend to change that dynamic. We intend to fight for legislation which ordinary Americans want, not what powerful special interests want.Our Medicare For All legislation would provide comprehensive healthcare coverage to all without out-of-pocket expenses and, unlike the current system, it would provide full freedom of choice regarding healthcare providers.No more insurance premiums, no more deductibles, no more co-payments, no more filling out endless forms and fighting with insurance companies.And comprehensive means the coverage of dental care, vision, hearing aids, prescription drugs and home and community-based care.Would a Medicare-for-all healthcare system be expensive? Yes. But, while providing comprehensive healthcare for all, it would be significantly LESS expensive than our current dysfunctional system because it would eliminate an enormous amount of the bureaucracy, profiteering, administrative costs and misplaced priorities inherent in our current for-profit system.Under Medicare for All there would no longer be armies of people billing us, telling us what is covered and what is not covered and hounding us to pay our hospital bills. This simplicity not only substantially reduces administrative costs, but it would make life a lot easier for the American people who would never again have to fight their way through the nightmare of insurance company bureaucracy.In fact, the congressional budget office has estimated that Medicare for All would save Americans $650bn a year.Guaranteeing healthcare to all Americans as a human right would be a transformative moment for our country. It would not only keep people healthier, happier and increase life expectancy, it would be a major step forward in creating a more vibrant democracy. Imagine what it would mean if our government worked for ordinary people and not just powerful corporate interests.
      Bernie Sanders is a US Senator and the ranking member of the Senate budget committee. He represents the state of Vermont More

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      It’s not just trans kids: Republicans are coming after trans adults like me, too | Alex Myers

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      On Thursday 13 April, Missouri’s attorney general issued an emergency ruling that restricts access to gender-affirming care for both minors and adults, under the guise that hormone therapy is an “experimental use” rather than an FDA-approved treatment. For the past year, transgender youth have been a football for conservative politicians, with their access to gender-affirming care restricted or outlawed in 14 states. But this move by Missouri’s attorney general is the first attack on gender-affirming care for transgender adults; assuredly, it won’t be the last.The first time I tried to get access to gender-affirming care was in 2003. I was 24 years old and lived in Rhode Island. I’d been out as transgender for eight years by then, eight years spent looking (on a good day) like a 14-year-old boy, until finally the me I saw in the mirror and the me I saw in my head didn’t match any more. Only testosterone would make me feel like myself.I told my doctor, who was kind and sympathetic and said she had no idea about the protocols for administration of testosterone to a transgender person. She did find me a list of all the practitioners in Rhode Island who offered such care. There were three names on the list. True, Rhode Island is not a large state, but still: three names. I called them all. Only one would see me, and only after I had gone to therapy and had a psychologist certify that I was ready to transition.That was the standard back then – and that’s what the Missouri attorney general wants to require of adult transgender individuals now, only more extensive. In 2003 in Rhode Island, I needed to see a therapist for at least three visits. The Missouri AG wants documentation of least three years of “medically documented, long-lasting, persistent and intense pattern of gender dysphoria” before an adult can be approved to get hormones. Three years of therapy is lengthy, time-consuming and expensive; three years is a very long time to suffer before being allowed to get medical attention.Moreover, back in 2003, “gender identity disorder” was in the Diagnostics and Statistics Manual (DSM) as a mental disorder. Doctors required transgender individuals to visit a psychologist so that there was a “legitimate” diagnosis to accompany the prescription of hormones – even though, back then and still today, the use of hormones for gender reassignment is an “off-label” use. But that diagnosis was removed from the DSM in 2013, replaced with “gender dysphoria”.That’s the term Missouri’s AG uses in his emergency ruling and, in doing so, trying to return to the idea that being transgender is synonymous with being mentally ill, a narrative that the right has used at several historical moments to marginalize LGBTQ+ individuals. The narrative here isn’t really about a diagnosis or medical legitimacy – it certainly isn’t about the health of the transgender person. The subtext clearly is that transgender people are mentally ill and delusional, and they need a medical authority to help them figure out who they are.The therapist that I saw in 2003 was a gay man who had a lot of compassion for the situation I was in. He knew it was a hoop I had to jump through, and he also knew he had to do his job. He asked me questions, took notes, and eventually wrote a letter certifying that I fit the diagnosis of “gender identity disorder” and that hormone therapy would help treat this disorder.I felt uncomfortable with the process; it seemed to me then and it seems to me now that there isn’t anything wrong with my gender identity. I know very well who I am; it’s how I feel about my body that needed to be addressed in a medical way. That’s the shift that was made in the DSM – away from “gender identity” and towards “dysphoria”. That’s the shift that the Missouri AG is trying to undo and rewrite.But that diagnosis and that therapist’s letter got me a prescription for testosterone in Rhode Island, a medical intervention that was absolutely transformative and life-saving for me.And then I moved to south-west Florida. I called endocrinologist after endocrinologist, asking if they would see me, look at the paperwork from my Rhode Island doctor, look at the letter from the therapist. A dozen said no – one receptionist told me curtly that the doctor didn’t see “transgendereds”. Another hung up on me. A third said, “Are you kidding me?” Eventually, I found a doctor in the Miami area, a three-hour drive away, who agreed to see me.This was typical for transgender care back then and, sadly, now. Unless you live in or near a major metropolitan area, getting a doctor who is trained, comfortable and willing to provide gender-affirming care is not easy. I was a person with a lot of privilege: health insurance from my employer, a good income, the language and education and time to persist in finding a therapist and a doctor who would treat me. For many transgender individuals, this would be too much, especially to maintain for three years. Missouri is trying to pile more work on to an already significant burden.But more than the details of this particular attack, I hope people will see the mounting pattern here. The first wave of legislation came for transgender youth. This next wave is coming for transgender adults. Put these restrictions next to the rulings against abortion and you can see a larger picture of bodily control. Who gets to make medical decisions about their bodies? Not pregnant women. Not transgender people.Back in 2003, I was so frustrated by my own experience that I vowed to work for improvements. I’ve fought for transgender civil rights and worked in particular for transgender students. There were years when we were making headway, when a conversation between a transgender individual and their doctor was sufficient basis to prescribe hormones. Now, it seems like we are at an inflection point. It’s time to strip away the rhetoric and recognize what’s at stake: our rights to control our bodies, our rights to control our identities. And I’m not just talking about transgender people.
      Alex Myers is a novelist and teacher who lives in Vermont More

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      US supreme court blocks ruling limiting access to abortion pill

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      The supreme court decided on Friday to temporarily block a lower court ruling that had placed significant restrictions on the abortion drug mifepristone.The justices granted emergency requests by the justice department and the pill’s manufacturer, Danco Laboratories, to halt a preliminary injunction issued by a federal judge in Texas. The judge’s order would significantly limit the availability of the medication as litigation proceeds in a challenge by anti-abortion groups.The decision offered a victory to the Biden administration as it defends access to the drug in the latest fierce legal battle over reproductive rights in the US. The president praised the decision and said he continues to stand by the FDA’s approval of the pill.“As a result of the supreme court’s stay, mifepristone remains available and approved for safe and effective use while we continue this fight in the courts,” Biden said in a statement. “The stakes could not be higher for women across America. I will continue to fight politically driven attacks on women’s health.”The court’s ruling means that access to mifepristone will remain unchanged at least into next year as appeals play out and patients can still get medication abortions with the drug in states where it was previously available.Reproductive rights groups celebrated the ruling, while cautioning it does not necessarily herald the final outcome of the case. “This is very welcome news, but it’s frightening to think that Americans came within hours of losing access to a medication that is used in most abortions in this country and has been used for decades by millions of people to safely end a pregnancy or treat a miscarriage,” said Jennifer Dalven, director of the Reproductive Freedom Project at the American Civil Liberties Union. “Make no mistake, we aren’t out of the woods by any means. This case, which should have been laughed out of court from the very start, will continue on.”The decision came in the most pivotal abortion rights case to make its way through the courts since Roe v Wade was overturned last year. More than half of abortions in the US are completed using pills.The case was brought by a conservative Christian legal group arguing the Food and Drug Administration improperly approved mifepristone more than 23 years ago.The Biden administration vigorously defended the FDA against the charge, emphasizing its rigorous safety reviews of the drug and the potential for regulatory chaos if plaintiffs and judges not versed in scientific and medical arguments begin to undermine the agency’s decision-making.Conservative justices Clarence Thomas and Samuel Alito dissented, with Alito writing that the Biden administration and Danco “are not entitled to a stay because they have not shown that they are likely to suffer irreparable harm in the interim”.The order granting the stay was unsigned, so it is not known how each of the other seven justices voted.The case has moved quickly through the courts in recent weeks, as contradicting rulings have thrown the future of the drug into question.In early April, a federal judge in Texas, Matthew Kacsmaryk, first ruled in the lawsuit brought by a coalition of anti-abortion groups to suspend the FDA’s 23-year-old authorization of mifepristone entirely, writing that the agency wrongly approved the drug. After a challenge by the Biden administration in the fifth circuit court of appeals, a divided three-judge panel said the drug’s approval could stand, but imposed restrictions on it, limiting its use to seven weeks of pregnancy instead of the current 10-week limit, and banning delivery of the pill by mail.The Biden administration then asked the supreme court to intervene before the restrictions went into effect. Alito twice stayed the lower court ruling, keeping access to mifepristone unaltered while the court deliberated.Complicating matters, another federal judge issued a ruling directly contradicting Kacsmaryk’s, ordering the FDA to refrain from making any changes to the availability of mifepristone in 18 jurisdictions.That judge – Judge Thomas O Rice, in Washington – reaffirmed that order after the fifth circuit’s ruling.Both the Biden administration and pharmaceutical companies have warned of regulatory chaos around drug approvals, should the supreme court allow the restrictions on mifepristone to go into effect.“If this ruling were to stand, then there will be virtually no prescription, approved by the FDA, that would be safe from these kinds of political, ideological attacks,” president Biden said in a written statement after the Kacsmaryk’s decision in early April.The US vice-president, Kamala Harris, echoed the point in a statement responding to the appellate decision: “If this decision stands, no medication – from chemotherapy drugs, to asthma medicine, to blood pressure pills, to insulin – would be safe from attacks.” More

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      ‘A gamechanger’: this simple device could help fight the war on abortion rights in the US

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      Joan Fleischman has always had people flying in from across the world to her private abortion practice in Manhattan. In the two decades her clinic has been open, she has seen clients from far-flung places, such as Ireland, the Bahamas and Mexico, who couldn’t get abortions in their home countries. In the last year, that changed. Since the US federal right to abortion was overturned in June 2022, she is now more likely to see patients flying in from her own country.Often they are from Texas, sometimes Ohio, or Florida. Some with links to the city, others with none.After years of providing abortion care, Fleischman, 60, still finds these trips shocking. “Usually if somebody needs unusual medical care, they are willing to fly around the world for it – like for advanced neurosurgery or something. It’s always struck me as incredible that people are flying to me for the most simple procedure.”There’s a reason people fly to see Fleischman. She provides abortions through manual uterine aspiration – using a small, hand-held device to remove pregnancy tissue. The device is gentle enough that the tissue often comes out almost completely intact. It is also a quick and discreet procedure where a patient might be in and out of the door in less than an hour.Fleischman is co-founder of the MYA Network, a network of primary care clinics and clinicians in 16 states. They believe the tool could be radical in the hands of more primary care clinicians – clinicians they are amping up to train.The time to do that, they say, is now. The future of mifepristone, a major abortion pill used in more than half the abortions in the US, is in question due to a lawsuit brought by anti-abortion groups seeking to overturn the FDA’s approval of the drug. It could be determined by the same supreme court that ruled last year to overturn Roe v Wade. Manual aspiration is not new: it is used by many big abortion clinics across the US. But those are are notoriously over-stretched. In 2020, before Roe v Wade was overturned, 38% of reproductive-aged women lived in counties with no abortion provider at all.Especially given the threat to mifepristone, the MYA Network believes that primary care clinicians, who are vastly more common than abortion providers, are well-placed to help.But while more than 73% of primary care doctors believe abortion care to be within their scope of practice, a tiny fraction – less than 10% – of primary care doctors actually provide it.The network is planning to unveil an online curriculum and in-person trainings for the procedure, which many of the clinicians and institutions in the network have already been doing in their own states.“The number of clinicians who could be trained would be limitless,” says Michele Gomez, one of the doctors in the MYA network of clinicians.“There are so many clinicians out there who want to do something to help but just don’t know how, and this information and support could be a gamechanger.”As a young woman, Joan Fleischman often felt compromised. She frequently traveled overseas as a teenager to do basic aid work with a volunteer group, and would feel fear and humiliation from the unwanted sexual attention she would receive. That was the beginning of her understanding, as she describes it, of the constant vulnerability women walk around with.By the age of 18, Fleischman had her first abortion – an experience she describes as routine, mundane even. The pregnancy came as she started her first year at the University of Chicago, and was the least of her concerns. “It was a no brainer. I was like, ‘Pregnant? Nope, I’m going to be a doctor.’ So I went to Planned Parenthood and took care of it,” says Fleischman.It wasn’t until she started providing abortions that she even thought about the experience again.Fleischman was in her 30s, living in New York and already trained as a family practice doctor, when she saw an advertisement offering to teach doctors how to do surgical abortions.“I realized that after all these years in training, I’d never got to even see an abortion. I had saved lives, helped people at the height of the Aids crisis. I had delivered babies. These are things a family doctor does,” she says. “I was like, ‘why? That’s ridiculous.’ That’s where the passion started.”Fleischman took up more training, learning to perform abortions at a Planned Parenthood, in 1995.Planned Parenthood – as Fleischman pointed out herself – is the place where people “go to get it done”. It is a vital lifeline for many people, providing hundreds of thousands of abortions every year, many to low-income and uninsured clients.But the efficiency of their service contrasted with Fleischman’s training as a family doctor – which emphasizes the importance of the doctor-patient relationship. She was used to that relationship entailing a level of intimacy – her work involved home visits with patients, and entering lifelong relationships with them and their families.Fleischman recalls her Planned Parenthood training:“Women went station to station. They got their blood drawn, and then they sat in a little waiting room with other people. They got their ultrasound; they sat in another little waiting room, always with paper gowns on. They had been fasting for the whole night before. They saw a counsellor. Then they were in a bigger waiting room. And then they got called by name, to come in for their procedure. The surgeon went from room to room to room, doing 50-60 abortions a day.”She wanted to personalize the experience. For patients to be able to come in with their partners, to be talked through their options and their concerns, fully. “I just felt so disconnected. It seemed to me that the doctor was really a technician emptying uteruses,” she continues.“I was like, ‘I want to create a different model. I want people to have a different experience going through this’.”As the US is learning, ethical quandaries always arise when abortion is banned: what to do for the woman who turns up septic after a failed, self managed abortion? How to deal with life-threatening pregnancies that require intervention but also require an abortion? What about cases of rape, incest or pregnant children?Essentially: how much pain is the state willing to impose on people when it restricts reproductive freedom?In Bangladesh, a sort of answer to some of these questions came following the 1971 civil war, during which soldiers abducted Hindu and Bihari Muslim women and set up rape camps. Pregnancy as a result of rape skyrocketed; in the following years, suicide and maternal mortality also shot up. Abortions, of course, did not stop happening. In 1978, while abortion remained illegal, an estimated 800,000 abortions took place in the country, resulting in around 8,000 deaths.“Menstrual regulation”, as it came to be known – using the same manual aspiration technique that Fleischman now uses – became a sort of legal loophole, allowing safe abortions for early pregnancies.By 1974, menstrual regulation was legal and by 1979, Bangladesh started providing the procedure through its national family planning program.Now, one might walk through a busy street in Bangladesh and find a sign advertising menstrual regulation in a country where, at least officially, abortion is only allowed in life-threatening situations. A woman simply comes in and explains she has missed her period. She doesn’t take a pregnancy test before the procedure, and nobody asks her to. As long as she sees the clinician before 12 weeks, they will “restore her period” for her.“It’s just a clever policy, a wink and a nod – everybody knows what’s going on. It’s kind of a recognition that women need this care,” says Bill Powell, a senior medical scientist at IPAS, an international organization that trains medical professionals across the world to use manual aspiration.It also gives doctors discretion without explicitly violating the law. “They say: ‘I know if I don’t provide this care, this woman is going to go off and do something that is unsafe, and she’ll be back to my facility ill, needing emergency care, so therefore, I am saving her life by providing this procedure’,” Powell explains.Fleischman, who worked in Bangladesh in her youth, and her colleagues in the MYA network are adamant they are only proposing manual aspiration be used legally in the US – for abortion care where it is legal, and miscarriage management where it is not. But its use in ordinary medical settings could still provide a radical opportunity in the US, she says, by expanding the number of clinicians who can easily perform the procedure up until 12 weeks.Others have touted this idea, in a slightly different way: anyone can learn to use a manual aspiration device, and manage their own abortions, some activists argue. All they need to learn to do is to insert a cannula, which is like a large straw, through the natural opening of the cervix, and then attach the aspiration device. The device is like a syringe, which creates a vacuum. Once the pressure is released, the contents of the uterus are gently removed. The self-management option has other advantages – like cutting out the middle man in a climate where doctors are increasingly scared to provide abortion care, and equipping people with self knowledge when the future of access to abortion is unclear.Fleischman understands the necessity of self-managed abortion, especially in places where the procedure is illegal. But she believes that after receiving care, people should always be able to follow up with a clinician who knows their case if anything goes wrong, or even if it doesn’t. It dismays her that people are living in a climate in the US where they might not have that option; where people might be too scared to look for help; and where they may suffer with complications alone in the rare instances when something does go wrong.In states where abortion is legal, manual aspiration provides the opportunity to treat abortion like mainstream medicine, rather than something that’s siloed into abortion clinics, which are visible, small in number and under constant threat.The case brought by anti-abortion groups against the FDA’s approval of mifepristone – which is one of two abortion drugs used in more than half of all abortions in the US – will almost certainly be decided by the supreme court. The uncertainly over its future, Fleischman argues, could make the expanded use of manual aspiration critical to preserving abortion and miscarriage care.Some providers may switch to abortions using only the second drug, misoprostol. But misoprostol-only abortions are slightly less effective, and more often require care for incomplete abortions. That could result in straining already stretched abortion clinics, which will likely have more people knocking at their doors for both surgical abortions and follow-up care.With manual aspiration on the other hand, doctors can be mostly certain that the procedure is complete before the patient leaves the state.And in states with bans, clinicians could be trained to use the device to treat miscarriages. “It’s useful even where you are not allowed to provide induced abortion care … [to treat] miscarriage, or spontaneous abortion,” explains Ian Bennett, a family planning doctor who is part of the MYA network and a professor at the University of Washington.Bennett trains several dozen students a year in manual aspiration, teaching them the procedure as part of their regular medical training, and says students are actively seeking out this instruction in the new, post-Roe environment.Students “are selecting programmes where abortion care is integrated into their training, even over some that might be more prestigious,” he says.Clinicians in areas that border states with bans, which have seen big increases in demand for abortion services as a result, are also a target for training, as are “red parts of blue states”, explains Gomez. Clinicians in states where abortion is legal, who want to do something to fight the war on abortion could easily do so by integrating abortion into their practices, Fleischman and her colleagues say.“It’s done in a couple of minutes,” explains Fleischman.“When it’s done, you know that it’s done. There’s very few bleeding issues. You walk into an office, and an hour later, it’s resolved. I have people flying in and out of Dubai for this procedure. They schedule the appointment, they come in, and they depart that afternoon,” she continues.“There’s absolutely no reason this shouldn’t just be part of regular medicine.” More