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      Democrats won Virginia on abortion. Can it also win them the White House?

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      Days before Josh Cole won his toss-up race, the Democratic candidate for Virginia’s house of delegates predicted that his party would perform well on election day, largely because the issue of abortion had motivated many voters to turn out at the polls.“There are people who are absolutely passionate about reproductive freedom and making sure that an abortion ban doesn’t come to Virginia,” Cole said.Four days later, Cole was proven right, defeating the Republican candidate Lee Peters to represent house district 65 in Richmond, the capital of Virginia. Cole’s victory reflected Virginia Democrats’ broader success on election day, as the party flipped control of the house of delegates and maintained their majority in the state senate.Democrats’ wins in Virginia may now offer some helpful lessons for the party heading into a crucial presidential election. A year and a half after the supreme court overturned Roe v Wade, abortion continues to weigh heavily on voters’ minds, helping to lift Democrats’ prospects at the polls. Even as Biden remains unpopular and voters express pessimism about the state of the economy, Republicans have struggled to translate that dissatisfaction into electoral success.House district 65 in particular represents a fascinating example of how Republicans failed to win the support of swing voters who helped elect Glenn Youngkin, the Virginia governor, two years earlier. The district, which was newly redrawn following the 2020 census, lies roughly halfway between Washington and Richmond and encompasses the small city of Fredericksburg, as well as parts of Stafford and Spotsylvania counties.The battleground district supported Biden by 11.7 points in 2020, according to the University of Virginia’s Center for Politics. Just one year later, the district went for Youngkin by 2.8 points. Both parties had targeted the seat, with Youngkin himself appearing alongside Peters at a get out the vote rally in Fredericksburg the day before polls closed.Republicans had hoped Peters’ biography as a sheriff’s captain and a former marine would help him defeat Cole, a local pastor and former delegate who narrowly lost his re-election race in 2021. But Cole ultimately won the seat by 6 points.“This was in no way a predetermined result. It’s not a solid blue district at all. It was a winnable one [for Republicans],” said Mark Rozell, dean of the Schar School of Policy and Government at George Mason University. “And probably among the house of delegates districts, it best represents what went wrong for the Republicans when it should have been a better year for them in the legislative races.”Democrats credit their success in the district and elsewhere to one issue: abortion. Democrats consistently reminded voters of Virginia’s status as the last remaining state in the US south without severe restrictions on the procedure, warning that Republicans would enact an abortion ban if they took full control of the legislature.Those warnings appeared to resonate with Virginians; according to a Washington Post-Schar School poll conducted in October, 60% of voters in the state said abortion was a “very important” factor in their election decisions. More than half of Virginia voters, 51%, said they trusted Democrats more when it came to handling abortion policies, while 34% said the same of Republicans.In this year’s race, Cole kept relentless attention on the issue, citing his support for abortion rights in nearly all of his ads and mailers while attacking Peters over his “anti-choice extremism”.“It was very interesting because it seemed as if people were showing up on one issue,” Cole said after election day. “Of course, we did talk about kitchen-table issues when we’re on the doors and different things like that, but our message was simple. We need to trust women and we need to protect a woman’s right to choose and we need to make sure that the government doesn’t interfere with that.”Virginia Republicans were clearly aware that their stance on abortion could become a liability in the legislative races, particularly after the party’s disappointing performance in the 2022 midterms. To address voters’ potential concerns over abortion, Youngkin chose to deploy a new and untested messaging tactic. He proposed a “reasonable 15-week limit” on the procedure, rejecting the label of an abortion “ban” and instead accusing Democrats of being out of step with voters on the issue.“Most people believe that abortion at the moment of birth is wrong, far beyond any reasonable limit. Not Virginia Democrats,” the narrator said in one Republican ad. “They fought to make late-term abortions the rule, not the exception.”Republicans also attempted to downplay the significance of abortion in the legislative races, insisting Virginia voters were more focused on other issues. Peters himself made this argument at a September debate, saying, “Everybody is not concerned or worried about women’s rights, even though there are many, many women who are. Some people worry about public safety. Some people worry about their schools.”skip past newsletter promotionafter newsletter promotionBut in the end, Virginia Republicans’ efforts to redefine and minimize the abortion debate were unsuccessful. Democrats maintained a majority of 21-19 in the Virginia senate while flipping control of the house of delegates with a majority of 51-49.“They tested some new messages around this issue – with the intention of getting to the same result, which was an abortion ban. And voters just outright rejected them,” said Heather Williams, president of the Democratic Legislative Campaign Committee. “Republicans are still scratching their head on how to talk about an issue that voters don’t want.”Even fellow Republicans have acknowledged that abortion has become a persistent problem for the party’s electoral prospects. Bill Bolling, a Republican and the former lieutenant governor of Virginia, attributed the party’s losses to three factors: abortion, Donald Trump and a lack of a clear policy vision.“It really doesn’t take a rocket scientist to quickly analyze why Republicans did not perform better at the polls,” Bolling wrote last month. “Democrats successfully argued that Republicans wanted to ‘ban abortion’ in Virginia. While this argument was certainly not truthful, it was effective, especially with suburban women who have grown increasingly Democratic in their voting patterns in recent years.”In Cole’s view, his message to voters spread beyond abortion access to encompass other rights, allowing his campaign to embrace a central theme of safeguarding fundamental freedoms.“This election was about protecting rights, whether it’s the right to education, women’s rights, the right to live safely in the streets, or whatever have you. This race was about rights,” Cole said. “[Voters] understood that we definitely have to have people fighting for us on every level, who are looking out for us and our rights.”That theme was similarly present in the messaging of other Democratic candidates in Virginia, Williams said. She suggested that their success could offer a framework for candidates running next year, when Democrats will be fighting to hold the White House and the Senate and flip control of the House of Representatives.“The way that that [message] shows up in an individual community or state may look different. One community may gravitate much more towards having good safe schools and a planet to live on,” Williams said. “But that arc is still true – that fundamental freedoms matter and voters want to see their freedoms protected and not rolled back.”For Republicans, the results in Virginia present the latest in a series of warning signs about how the party is suffering because of its stance on abortion. Youngkin’s failure to take control of the legislature may signal that Republicans must find a way to shift the conversation away from abortion, although that strategy risks angering their rightwing base.“It seems to me that Republicans have just constantly squandered whatever advantage that they have by focusing on divisive social issues where the voters are not aligning with their position,” Rozell said. “So they need to find a way out of that trap that they’ve made for themselves. Otherwise, they’re going to keep losing winnable districts.” More

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      An ‘abortion abolitionist’ became an Oklahoma senator. The fringe is celebrating its big victory

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      When Dusty Deevers won his race to become an Oklahoma state senator on Tuesday night, he wasted no time in making sure his new constituents knew what he stood for.“Here in Oklahoma, it’s time to abolish abortion, abolish pornography, abolish the state income tax and give power and equal representation back to the people!” the Republican posted on X, the platform formerly known as Twitter.Deevers’ use of the term “abolish abortion” is no mere rhetorical flourish. On his campaign website, Deevers has identified himself as an “abortion abolitionist” – an adherent of a hardline, fringe segment of the anti-abortion movement that, in Oklahoma and elsewhere, is growing in the wake of the fall of Roe v Wade.Opposition to abortion is rooted in the belief that fetuses are people, worthy of rights and protections. But the mainstream “pro-life” movement posits that abortion patients should not be punished, since they are seen as the bamboozled victims of nefarious doctors and the “abortion industry”. Typically, abortion bans target abortion providers, not patients.Abortion “abolitionists,” on the other hand, hold what they believe to be a more ideologically consistent stance: if a fetus is a person, then abortion is tantamount to murder. And patients should be punished accordingly.Roe’s overturning has made a broader range of anti-abortion ideas look acceptable, as well as cast a spotlight on the contradictions and limits in current anti-abortion law, said Mary Ziegler, a University of California, Davis School of Law professor who studies the legal history of reproduction. In turn, that’s emboldened the abolitionists.“It’s not an easy question about how you can be consistent and exempt women from punishment,” Ziegler said. The abolitionists, she says, are essentially saying: “‘We’re the pragmatists, because if a lot of abortions are self-managed, or involve medical practitioners from out of state or even out of the US altogether, how do you propose meaningfully enforcing [bans] if you’re not going to punish women or other pregnant folks?“They’ve also been hated because people who are not opposed to abortion didn’t know that they existed,” Ziegler added. “And people who are opposed to abortion are not happy that people discovered that they existed.”Over the last several years, “abortion abolitionists” and their ideology have quietly amassed popularity in churches, state legislatures and online. Several abolitionist organizations filed an amicus brief in the decision that overturned Roe. Abolitionists Rising – which features a video of Deevers on its website – has almost 200,000 subscribers on YouTube, with at least one video with more than half a million views. (Deevers did not immediately reply to an interview request.) The YouTube account of Apologia Studios, which is run by prominent abortion “abolitionist” and pastor Jeff Durbin, has more than 500,000 subscribers.In 2023, legislators in at least nine states introduced bills that would advance the abortion abolition cause, such as by erasing provisions in laws that explicitly protect pregnant people from being prosecuted for having abortions. At least two of those bills explicitly cite the 14th amendment, which was originally passed to ensure that formerly enslaved people had equal rights, to extend rights and protections to fetuses.skip past newsletter promotionafter newsletter promotionThe anti-abortion movement has a long history of drawing comparisons between their cause and that of pre-civil war abolitionists trying to end US slavery, as well as civil rights crusaders. For decades, they have tried to use the 14th amendment to establish fetuses’ right to personhood, a push that is seeing renewed interest post-Roe.However, anti-abortion “abolitionists” often draw a line between their work and that of the mainstream pro-life movement. Not only do they frequently disdain the pro-life label, but while the pro-life movement has increasingly sought to portray its mission as secular, anti-abortion “abolitionists” are staunchly and openly Christian.“I think that the abolitionist movement is a litmus test for how much the anti-abortion movement needs to win or wants to win in democratic politics versus other means,” Ziegler said. “If you need to win with voters, abolitionists are not going to get anywhere, ever.”There is little support for severe punishments for people who get illegal abortions. Although 47% of US adults believe that women who have illegal abortions should face some form of penalty, just 14% think they should serve jail time, according to a 2022 poll by the Pew Research Center. “Abolitionists” don’t necessarily believe that people should face the death penalty for abortions. “I do believe that the unjustified taking of human life, if provable, ultimately, justly, ought to be capital punishment,” Durbin told the New York Times last year. “However, I don’t trust our system today to deal that out.”None of the “abolitionist”-style bills ultimately advanced very far in state legislatures this year. Still, they can be something of a PR nightmare for Republicans and the mainstream pro-life movement. After a host of news articles about South Carolina’s Prenatal Equal Protection Act, which would allow people who have abortions to face the death penalty, 10 Republican state legislators asked to remove their names as sponsors of the bill.That bill died in committee.While these bills technically focus on abortion seekers, in reality they would probably also be used to penalize people of color or poor people who have unintended pregnancy losses, according to Farah Diaz-Tello, senior counsel and legal director of If/When/How, a legal advocacy group for reproductive justice.“We know who the targets of these laws would be, because they’re the people who are already criminalized for pregnancy outcomes. So we would see an escalation of that status quo,” Diaz-Tello said. “Things that for people of wealth and privilege would be considered a tragedy end up being charged as a crime against people of color, in particular Black women, and people who are in poverty.”Deevers won his seat in the Oklahoma state legislature after its former occupant resigned for another job. On his campaign website, Deevers says that he supports Oklahoma’s version of the Prenatal Equal Protection Act, which was introduced in 2023. That bill eliminates language that would block Oklahoma prosecutors from targeting pregnant people for “causing the death of the unborn child”. Its sponsor, whose 2020 election was supported by the abolitionist group Free the States, did not immediately reply to a request for comment.“This bill would abolish abortion by making preborn children equal under law and closing the loopholes which allow for self-managed abortion,” Deevers’ campaign website reads, adding, “I am 100% against abortion and for its abolition.” More

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      US supreme court agrees to consider abortion pill access

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      The US supreme court on Wednesday agreed to hear oral arguments in a case that could determine the future of a pill used in most abortions in the US, in the first major abortion rights case to land at the country’s highest court since the justices overturned Roe v Wade and abolished the national right to the procedure in 2022.A decision in the case will probably arrive in summer 2024, just months before the presidential election. The outcome of the case could affect not just access to the pill, which has been repeatedly deemed safe and effective, but the Federal Drug Administration’s authority to regulate all manner of medications.The drug at the heart of the case is mifepristone, one of the two drugs typically used in medication abortions, which make up the majority of US abortions. Last year, an association of anti-abortion organizations and doctors, the Alliance for Hippocratic Medicine, filed a federal lawsuit arguing that the FDA had overstepped its authority when it approved mifepristone in 2000.In April, a Texas federal judge appointed by former president Donald Trump issued a preliminary ruling to suspend the FDA’s approval of mifepristone and pull the medication off the market. The US court of appeals for the fifth circuit – one of the most conservative federal appeals courts in the US – ruled in August that, while it was too late to suspend the FDA’s approval, the agency should significantly restrict access to mifepristone. The Biden administration and Danco Laboratories, which manufactures mifepristone, then asked the supreme court to weigh in on the case.The supreme court paused lower-court rulings while the case plays out, so mifepristone remains widely available in states that permit abortion. If the court allows the fifth circuit ruling to stand, it would roll back recent FDA efforts that refined the drug’s dosage and expanded access by allowing it to be prescribed later on in pregnancy and through telehealth.On Wednesday, the supreme court agreed to hear the consolidated petitions from the Biden administration and Danco Laboratories, which asked the justices to focus on the legal attempts to roll back those later FDA efforts. Those petitions also asked the justices to consider whether the challengers have the legal right, or standing, to bring the case in the first place.“You can’t just bring random lawsuits in court. You actually have to have been harmed by something,” said Greer Donley, an associate law professor at the University of Pittsburgh Law School. “That’s really what standing analysis is all about, to try to figure out if if the people who bring the lawsuit actually have a stake in the case.” Numerous legal experts have questioned whether the challengers in this case have properly demonstrated that they have been harmed by mifepristone’s continued legality.The supreme court also denied a petition from the Alliance for Hippocratic Medicine that asked the justices to explicitly consider the FDA’s 2000 approval of mifepristone. That move suggests that the supreme court is unlikely to pull mifepristone off the market entirely.In Donley’s view, the outcome of this case will probably signal whether the supreme court, which is controlled 6-3 by conservatives, wants to be involved in the post-Roe war over abortion rights. If the justices decide to focus on the standing issues in the case, they could sidestep having to rule on the substance of the case entirely.“I could see the more moderates on the supreme court thinking: ‘we don’t want to touch this,’” Donley said. “It might make the supreme court look like less of an activist court if it were to dismiss this case on the basis of really legitimate standing problems.”Any ruling by the court would affect all 50 states, including those that have protected abortion rights. (In recent months, officials in states such as Washington and California have announced that they have begun to stockpile mifepristone.)A ruling could also imperil the FDA’s regulatory power writ large and pose an existential threat to pharmaceutical companies. If courts can rewrite the FDA’s approval of abortion pills, any kind of drug – including, for example, drugs used to protect against HIV or to provide gender-affirming care – could end up in conservative jurists’ crosshairs.The ruling from the federal appeals court, Danco Laboratories warned in its briefs to the supreme court, “destabilizes the pharmaceutical and biotechnology industries by questioning when scientific studies – accepted by FDA – are sufficient”. More than 100 studies, conducted across 26 countries, have concluded that mifepristone is safe, a New York Times review found.If deprived of access to mifepristone, several abortion clinics have said that they would keep providing medication abortions using only misoprostol, the other drug typically used in medication abortions. Although misoprostol-only abortions are still overwhelmingly safe, they can have more side-effects and are slightly less effective than the two-drug protocol.Ultimately, regardless of how the supreme court rules, its decision will not curtail the thriving underground networks that routinely supply mifepristone to women looking to end their pregnancies, including in the 16 states with near-total abortion bans. In fact, a move to ban mifepristone is likely to cause a sharp rise in demand for the drug through those networks.In the wake of Roe’s fall, a vast web of abortion rights supporters and opportunistic merchants have sprung up to ship abortion pills to Americans. Inducing your own abortion is not illegal in most US states, even in states that have banned in-clinic abortions, and medical experts widely agree that it can be safe to use pills to “self-manage” an abortion early in pregnancy. More

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      We need to talk about America’s mental health crisis – and its larger causes | Robert Reich

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      I want to talk about an uncomfortable topic that needs much more open discussion than it’s receiving: the United States’ extraordinarily high level of anxiety.A panel of medical experts has recommended that doctors screen all patients under 65, including children and teenagers, for what the panel calls anxiety disorders.Lori Pbert, a clinical psychologist and professor at the University of Massachusetts Chan medical school, who serves on the panel, calls mental health disorders “a crisis in this country”.A recent New York Times article discussed what’s called “persistent depressive disorder”, or PDD, which an estimated 2% of adults in the United States have experienced in the past year.Nearly 50,000 people in the US lost their lives to suicide last year, according to a new provisional tally from the National Center for Health Statistics. (The agency said the final count would likely be higher.)The suicide rate, now 14.3 deaths per 100,000 Americans, has reached its highest level since 1941, when the US entered the second world war.Men aged 75 and older had the highest suicide rate last year, at nearly 44 per 100,000 people, double the rate of people aged 15-24. While women have been found to have suicidal thoughts more commonly, men are four times as likely to die by suicide.Suicide rates for Native Americans are almost double the rates for other Americans.(Some good news: suicide rates for children aged 10 to 14 have declined by 18%, and for those between 15 and 24 by 9%, bringing suicide rates in those groups back to pre-pandemic levels.)What’s going on?Maybe the widespread anxiety and depression, along with the near record rate of suicide, should not be seen as personal disorders.Maybe they should be seen – in many cases – as rational responses to a society that’s becoming ever more disordered.After all, who’s not concerned by the rising costs of housing and the growing insecurity of jobs and incomes?Who (apart from Trump supporters) isn’t terrified by Trump’s attacks on democracy, and the possibility of another Trump presidency?Who doesn’t worry about mass shootings at their children’s or grandchildren’s schools?Who isn’t affected by the climate crisis?Add increasingly brutal racism. Mounting misogyny. Anti-abortion laws. Homophobia and transphobia. Attacks on Asian Americans, Hispanic Americans, Jews, Arab Americans and other minority groups. And the growing coarseness and ugliness of what we see and read in social media.Consider all this and it would almost be stranger if you weren’t anxious, stressed and often depressed.Studies show that women have nearly double the risk of depression as men. Black people also have higher stress levels – from 2014 to 2019, the suicide rate among Black Americans increased by 30%.Are women and Black people suffering from a “disorder”? Or are they responding to reality? Or both?White men without college degrees are particularly vulnerable to deaths from suicide, overdoses and alcoholic liver diseases, with contributions from the cardiovascular effects of rising obesity.Are they suffering from a “disorder”, or are they responding to a fundamental change in American society? Or both?In their book Deaths of Despair and the Future of Capitalism, economists Anne Case and Angus Deaton argue that “the deaths of despair among whites would not have happened, or would not have been so severe, without the destruction of the white working class … .”Part of the problem, they say, is that the less educated are often underpaid and disrespected, and feel that the system is rigged against them.skip past newsletter promotionafter newsletter promotionEven if we had far more mental health professionals, what would they do against these formidable foes? Prescribe more pills? If anything, Americans are probably already overmedicated.Don’t get me wrong. I’m not arguing against better access to mental health care. In fact, quite the opposite. Increased staffing and improved access to mental health care are very much needed.Mental health care is harder to find now than before the pandemic. About half of people in the US live in an area without a mental health professional, federal data shows, and some 8,500 more such professionals would be needed to fill the gap. Most people rely on family doctors for mental health care.Officials are trying to widen familiarity with a national suicide and crisis lifeline that last year received a nationwide number, 988.But in addition to providing more and better access to mental health care, and a suicide and crisis hotline, shouldn’t we try to make our society healthier?Americans experience the least economic security of the inhabitants of any advanced nation. A healthy society needs more job security and stronger safety nets.The distribution of income and wealth in the United States is the most unequal of any other advanced nation. A healthy society ensures that no one working full-time is poor, and levies high taxes on the wealthy to help pay for what society needs.Guns and assault weapons are easier to buy in the United States than in any other advanced nation. A healthy society bans assault weapons and makes it difficult to buy guns.A lower percentage of Americans has access to affordable medical care than in any other advanced nation. A healthy society keeps its people healthy.The United States puts more carbon dioxide into the air per capita than almost any other advanced nation. A healthy society better protects the environment.Big money plays a larger role in American politics than it does in almost any other advanced nation. A healthy society does not allow big money to buy politicians.Some American politicians – like Donald Trump – gain power by stirring up racism, xenophobia and homophobia. A healthy society does not elect these sorts of people.The list could be much longer, but you get the point. The anxiety disorders suffered by Americans are real, and they apparently are growing. But instead of regarding them solely as personal disorders, maybe we need to understand them at least partly as social disorders – and get to work remedying them as a society.Granted, it would be difficult to achieve any of these criteria for a healthy society.But without seeking to achieve them, no number of mental health professionals, and no amount of medications or hotlines, will be enough to substantially reduce the stress, anxiety, depression and suicidal thoughts that so many Americans are now experiencing.In the US, you can call or text the National Suicide Prevention Lifeline on 988, chat on 988lifeline.org or text HOME to 741741 to connect with a crisis counselor. In the UK and Ireland, Samaritans can be contacted on freephone 116 123, or email jo@samaritans.org or jo@samaritans.ie. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org
      Robert Reich, a former US secretary of labor, is a professor of public policy at the University of California, Berkeley, and the author of Saving Capitalism: For the Many, Not the Few and The Common Good. His newest book, The System: Who Rigged It, How We Fix It, is out now. He is a Guardian US columnist. His newsletter is at robertreich.substack.com More

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      Dozens of independent abortion clinics closed in 2023 post-Roe, study finds

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      Dozens of independently owned reproductive health clinics shuttered in 2023, the year after the US supreme court overturned Roe v Wade, according to a new report from the Abortion Care Network.The group found that 23 independently owned clinics closed this year, on top of the 42 that shuttered in 2022, leaving over a dozen states, mainly in the American south and midwest, without a single brick-and-mortar clinic that provides abortion.“Even before Roe fell, we were the only abortion clinic in a very rural, very underserved state with limited access to health care, and now that’s all been exacerbated,” said Katie Quinonez-Alonzo, executive director of Women’s Health Center of West Virginia.Like most independent clinics in the United States, the Women’s Health Center of West Virginia struggled to keep its doors open after the supreme court decision paved the way for the state to ban abortion last year. The clinic still provides other reproductive and sexual health services, like gender-affirming care for transgender patients.“We want to stay here in our community and help the patients that are still counting on us, but it’s been one uphill battle after another,” Quinonez-Alonzo told the Guardian.The Women’s Health Center of West Virginia is an especially crucial lifeline for low-income, uninsured people in the state, who rely on the clinic for routine gynecological check-ups. Those services became harder to offer after West Virginia banned abortion, slashing the clinic’s revenue by roughly half a million dollars.This year, Quinonez-Alonzo anticipates a roughly $350,000 budget deficit.Independently owned clinics – in contrast with bigger players like Planned Parenthood – provide the majority of abortions in the United States. According to the ACN report, “indie” clinics make up the majority of clinics operating in states that are most hostile to abortion, and offer the broadest range of options for patients seeking the procedure. ACN researchers found that 73% of indie brick-and-mortar clinics offer both medical and surgical abortions, compared with just 42% of Planned Parenthood affiliates – so as they dwindle in number, so do options for women seeking care.Before the supreme court overturned Roe, the West Alabama Women’s Center provided over half of the abortions in the state.“In the deep south, it was always indie providers that were the ones providing abortions. Very few Planned Parenthoods existed in our region,” said Robin Marty, executive director of West Alabama Women’s Center.“Alabama used to have three Planned Parenthoods, we have just one now, the others have closed,” Marty said. “We’re still here, though.”After Alabama enacted a sweeping ban on abortion, the Tuscaloosa clinic refocused on protecting newly pregnant people’s access to affordable prenatal healthcare.But Alabama is one of 10 states that has not expanded Medicaid, leaving roughly one in seven women of childbearing age without any form of health insurance. The state allows newly pregnant women to apply for Medicaid, but that requires a doctor’s letter confirming the pregnancy.“But of course, as these people do not have insurance, they can’t get into a doctor in order to get this letter for Medicaid,” Marty said. “This is why we’re seeing so many people in Alabama who don’t have prenatal care in the first trimester.”Even after a patient receives a doctor’s letter confirming their pregnancy, it can take four to six weeks for the state to approve coverage. To help care for uninsured and pregnant people in Alabama, Marty said her clinic provides free prenatal care until a patient’s Medicaid coverage is approved. If financial trouble forces the clinic to close, a bad maternal health landscape will get worse.“The people in our community need prenatal care and birth control and STI testing just as much as they need abortion,” Marty said. “For these patients, there isn’t another healthcare provider here for them.” More

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      The women who made painful choices challenge Texas’s severe abortion ban

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      After Danielle Mathisen and her husband realized they would be having a baby girl, they started calling her “Mini”. “We figured she would be a mini-me,” Mathisen said.For months, Mathisen’s pregnancy appeared normal. Genetic testing went well. Her parents were thrilled – this would be the first grandchild in the family.But in September 2021, two weeks after Texas banned abortion past six weeks of pregnancy, Mathisen went in for her 18-week anatomy scan. And Mathisen, then a 25-year-old fourth-year medical student, quickly realized that something was terribly wrong.Doctors soon confirmed Mathisen’s fears: the fetus had only one kidney, severe scoliosis, a partially formed umbilical cord and improperly positioned hands and feet. The fetus also had an underdeveloped brain.Mathisen’s pregnancy was at risk of ending before she ever gave birth. If Mathisen did give birth, her baby would probably die from respiratory failure shortly afterward. “She doesn’t have enough brain to tell her lungs how to breathe,” Mathisen said.If she continued the pregnancy, Mathisen’s health could be at risk, too.Soon after her diagnosis, Mathisen started calling abortion clinics in Colorado. They were booked solid. Her mother ultimately found her an appointment at a clinic in New Mexico, which Mathisen said was holding appointments open for Texas women. The appointment was for the very next day.Afterward, when she returned to Texas, Mathisen and her husband told everybody that she had had a miscarriage. “Continuing a pregnancy that was not going to end up with a baby in the crib, but a baby in the casket – it did not make sense for me, personally,” she said.Now, though, Mathisen has gone public with her story. She is one of 20 Texas women who have sued their home state, arguing that they were denied medically necessary abortions. While Texas bans almost all abortions, the procedure, according to state law, should be allowed in medical emergencies. But abortion rights advocates and doctors in the state say that the exceptions in the law are so vague that doctors can’t decipher them. Instead, they are forced to watch until patients get sick enough to intervene.The Texas supreme court will hear arguments in the case on Tuesday. Rather than demolishing Texas’s abortion ban outright, the women – as well as two doctors who have also joined the case – are hoping that the court will agree to clarify the state’s abortion exceptions.A judge in Austin, Texas, heard arguments in the case in July, in a hearing believed to mark the first time that women testified in court about their experiences with abortion since the US supreme court overturned Roe v Wade last year.Amanda Zurawski, the lead plaintiff in the case, talked about learning that her cervix had dilated too early in her pregnancy. She had no chance of giving birth to a healthy baby – but she was also unable to get an abortion in Texas because doctors could still detect a fetal heartbeat, she said. Zurawski ultimately developed sepsis and spent three days in the ICU.Samantha Casiano testified about discovering that her fetus had been diagnosed with anencephaly, a condition where parts of a fetus’s skull and brain do not develop properly. But she did not have the money to travel out of state for an abortion, so she gave birth to a baby daughter who struggled for air and died just four hours after birth. Casiano was so overcome on the stand that, in the middle of testifying, she threw up.A few weeks after the women’s testimony, in August, the judge issued a preliminary injunction, ordering that doctors be allowed to perform abortions in cases where patients have an “emergent medical condition” that threatens their life or health.But Texas immediately appealed that ruling, which froze the preliminary injunction. In court filings, attorneys for Texas argued that doctors, not the state, are responsible for what happened to the women in the lawsuit.“These independent decisions by third-party medical providers, right or wrong, break any purported chain of causation” between the abortion ban and any medical emergency, they alleged.In any case, the attorneys argued, these women don’t have the legal right to sue, because the pregnancies at issue in the lawsuit are in the past and they are no longer at risk of imminent damage from Texas’s abortion laws. Multiple women involved in the lawsuit, including Mathisen, became pregnant again.Nick Kabat, a staff attorney with the Center for Reproductive Rights, which is representing the women in the Texas case, said that the Texas state supreme court –made up exclusively of Republicans – could buy that argument. Kabat is preparing for the possibility that the justices rule that, in order to sue, advocates need a plaintiff who is actively in the midst of a medical emergency.“They could say that what you need is a woman who is in an emergency in desperate need of an abortion,” Kabat said. “So basically, someone who has amniotic fluid dripping down their leg or they’re actively bleeding, where they have an IV connected to them that’s really keeping them alive. And you know what, if they say that, then we’ll find that patient, because the patient exists in Texas, unfortunately.”At the end of August, the Texas government enacted new legislation to, in theory, allow doctors to perform abortions in cases of ectopic pregnancies – a life-threatening condition – or when a pregnant person’s water breaks too early for the pregnancy to be viable.But critics say that those exceptions don’t cover the vast array of nuanced issues that can arise in pregnancy. In addition, rather than completely shielding a doctor from prosecution, the new exceptions offer doctors a defense in court only after they have been charged – a legal mechanism known as an “affirmative defense”.“Whatever fix the Texas government thinks it has adopted, it hasn’t solved this issue,” Kabat said. “That law has not changed the way doctors are practicing.”Mathisen ended up moving to Hawaii for her OB-GYN residency, rather than remain in Texas, where she had once hoped to work.“I’m currently pregnant with another baby girl, and I would love for her to live across the street from her grandma,” Mathisen said. “Right now, I can’t do that, because I don’t think I could go back to Texas and practice medicine if I cannot do abortions.”Since the Texas lawsuit was first filed in March, the Center for Reproductive Rights has filed similar lawsuits in Idaho and Tennessee. The Center is also representing a woman who has filed a federal complaint against a hospital in Oklahoma that, she says, refused to give her an abortion for a dangerous and nonviable pregnancy. Instead, staffers at the hospital allegedly told the woman to wait in the hospital parking lot until she was “crashing”.If the Texas state supreme court rules in favor of women like Mathisen, it will not set a legal precedent for the lawsuits in other states. But Kabat believes it would help.“These abortion medical exemptions are worded in very similar ways,” Kabat said. “A ruling in Texas in our favor would be powerfully persuasive to justices deciding similar cases in other states.”Throughout her ordeal, Mathisen clung to one small source of comfort: in the ultrasound, Mathisen could see that Mini’s hands were curved into the shape of a heart.“Like the heart that Taylor Swift makes,” Mathisen said. “The heart that she made with her hands, through all of my tears and sobbing – I was like, ‘She’s OK.’ It was just a sign that everything was going to be OK, even if we ended the pregnancy.” More

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      in UK Politics

      Covid inquiry: Jonathan Van-Tam says family was threatened with having throats cut during pandemic

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      Sign up for our free Health Check email to receive exclusive analysis on the week in health Get our free Health Check email The government’s former deputy chief medical adviser has revealed he thought about quitting after his family was threatened with having their throats cut during the pandemic. Testifying at the Covid inquiry on […] More

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      in US Politics

      Poor people in the developing world have a right to medicine | Bernie Sanders

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      Here is a simple moral proposition. No one in America, or anywhere in the world, should die or suffer unnecessarily because they cannot afford a prescription drug which, in many cases, costs a few cents or a few dollars to manufacture.As Chairman of the US Senate Health, Education, Labor and Pensions Committee (Help) I’m going to do everything I can to develop a new approach to the development and manufacturing of prescription drugs that responds to medical need, rather than short-term shareholder profit. Given the power and greed of the pharmaceutical industry this is not an easy task, but it’s one that must be pursued.The tragic reality is that, today, millions of people around the world are suffering, and dying, from preventable diseases because they can’t afford the outrageous prices charged by pharmaceutical companies. According to the World Health Organization (WHO), one third of humanity lacks access to essential medicines. For a staggering number of people around the world, this leads to what the WHO calls “a cascade of preventable misery and suffering.”There are a number of reasons why this tragic reality continues to happen.First, too often drug companies abuse patent monopolies to charge outrageous prices or otherwise keep lifesaving drugs out of reach for people around the world. For example, the Boston-based drug company Vertex is neither selling a transformative new treatment for cystic fibrosis in the developing world, nor allowing other local companies to produce it. Put simply, the company is not only refusing to bring a life-raft to people drowning with cystic fibrosis in poor countries, it is also blocking others from deploying their own life-rafts to people who need them to stay alive.Second, far too often, the medicines that are desperately needed by millions of people in poor countries are not being produced by the pharmaceutical industry because the drug companies cannot make sufficient profits by doing so. In the US and other developed countries people often pay exorbitant prices for life-saving medicines. Poor people in developing countries can’t. They don’t have the money. The result: they die. Because the business model of the pharmaceutical industry values dollars gained over lives saved, there are not enough companies looking for transformative treatments, especially for diseases that afflict poor people.Consider the case of tuberculosis (TB) – a disease that killed more than 1.3 million people in 2022, and is on the rise as a result of the Covid-19 pandemic. The TB vaccine still used today is more than a hundred years old, and only protects young children, even though adolescents and adults account for the majority of TB transmission. The testing of a promising new publicly-funded TB vaccine that could potentially save millions of lives was delayed after its corporate owner, GSK, decided to focus on more profitable vaccines.The scientist who brought GSK the idea of the TB vaccine decades ago now acknowledges that Big Pharma cannot deliver for developing countries. “You get a big company to take it forward? Bullshit,” he told ProPublica. “That model is gone. It’s failed. It’s dead. We have to create a new one.”Clearly, we must do better. The life of a millionaire in New York City is not worth more than the life of a person living in extreme poverty in South Sudan.Fundamentally, we need to transform how we pay for the development of new prescription drugs. This starts with funding open-source research, so lifesaving information is shared, and scientists around the world can work together to research and manufacture their own breakthroughs. Patents should not stand in the way of public health.If we can provide $886bn to the Pentagon for military spending, we can provide scientists with the money they need to develop cutting-edge cures that are accessible to everyone.People should not die because of their income or where they were born. We know what it will take to save lives. Now we must have the courage to stand up to the pharmaceutical industry. Let’s do it.
      Bernie Sanders is a US Senator, and chairman of the health education labor and pensions committee. He represents the state of Vermont, and is the longest-serving independent in the history of Congress More