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      Arizona proposal to protect abortion rights in state constitution advances

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      A proposal to enshrine abortion rights into the state constitution of Arizona, a key battleground state in the upcoming US elections, has inched closer to becoming an official ballot measure.On Wednesday, Arizona for Abortion Access, the coalition behind the measure, announced that it had turned in more than 800,000 signatures – more than double the needed amount to get the measure on the ballot come November.That’s more signatures than have ever been submitted for a citizen-led ballot measure in Arizona, according to Chris Love, a spokesperson for Arizona for Abortion Access.“It represents one in five Arizona voters,” Love said. “It’s an amazing feat for us. I think it’s a demonstration of the strength of our campaign and the excitement of Arizona voters to really settle the issue of abortion rights on the ballot in November.”Arizona currently bans most abortions past 15 weeks of pregnancy, but the state came close to outlawing almost all abortions earlier this spring. In April, the Arizona supreme court ruled to uphold a law that paved the way for a 1864 near-total abortion ban – passed before Arizona even became a state – to take effect. That controversial decision kicked off a weeks-long battle in the Arizona state legislature, where Republicans hold a one-seat majority in both the state house and senate, as Democratic lawmakers tried to pass a repeal of the 1864 ban. They ultimately succeeded after a handful of Republican legislators broke ranks and voted for the repeal.“Our message has always been the same: pregnant patients deserve the freedom to make their individual and personal health care decisions, and especially decisions about abortions, with their families and their health care providers,” Love said. “The back and forth that just happened with respect to the 1864 ban is a clear demonstration of why we need politicians out of the calculus.”If voters pass the ballot measure, which is officially titled the Arizona Abortion Access Act, it would eliminate the state’s 15-week ban and instead protect the right to an abortion until fetal viability, a benchmark that typically occurs around 24 weeks of pregnancy. It would also allow abortions to take place after fetal viability if a health care professional believes the procedure is necessary to protect a pregnant person’s life or physical or mental health.Roughly a dozen states, including Arizona and fellow swing state Nevada, are expected to hold ballot measures over abortion rights in the November elections. Activists in Nebraska and Arkansas are also set to turn in signatures supporting abortion rights ballot measures this week.Since the US supreme court overturned Roe v Wade two years ago, several states – including traditional Republican strongholds like Kansas, Kentucky and Ohio – have successfully passed ballot measures to preserve or strengthen abortion rights. Democrats are now hoping that enthusiasm for abortion rights will boost voter turnout and translate to support for their own candidates, particularly as Joe Biden continues to trail Donald Trump in the polls and has faced calls to step down in the wake of a devastating debate performance last week.Arizona county election officials now have until 22 August to officially verify the signatures. Part of the reason for turning in so many signatures, Love said, was to counter any efforts to legally challenge the signatures’ legitimacy. More

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      The abortion ruling hides conservative justices’ partisan agenda | Moira Donegan

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      The supreme court is a messy institution. It’s six conservative justices are mired in infighting over both the pace of their shared ideological project of remaking American law and life according to rightwing preferences, and over their preferred methodological course for doing so. Their squabbling is not helped by the fact that two of them, Clarence Thomas and Samuel Alito, keep embarrassing the court with gauche public scandals, which draw attention to the court’s legitimacy crises like a vulgar flag waving above One First Street. For their part, the liberals are exhausted, impotent, and at times apparently publicly despairing. Their dissents have sometimes taken on tones of exasperation and peeved sarcasm, as if they’re turning to the country and asking: “Can you believe this?” Their most senior member, Sonia Sotomayor, recently told an interviewer that over the past several terms, since the court’s conservative supermajority was sealed under the Trump administration, she has sometimes gone into her chambers after the announcement of major decisions and wept. She says she anticipates having to do so again: in one recent dissent, she warned ominously about the future of gay marriage rights.The court’s partisans like to point out that it controls neither the military nor the federal budget; the court’s legitimacy, they say, comes merely from the fact that people believe it to be legitimate. But increasingly, many of them don’t. The court’s approval rating remains at record lows, and the justices’ conduct over the past several years has punctured the mystique of scholarly seriousness that the institution once pretended to. They don’t seem like wise legal scholars, carefully and dispassionately deliberating the merits of competing interests and claims. Instead, they seem more like a bunch of bumbling partisan hacks – perhaps just more cynical and less clever than the average Republican operatives stuffed into suits throughout DC.The court did not appear particularly competent, for instance, when on Wednesday, a draft opinion in Moyle v United States, was briefly uploaded to the court’s web page. The case concerns Idaho, which has one of the most extreme and sadistic anti-choice legal regimes in the nation, and asks whether states’ attempts to ban abortions even in cases of medical emergencies can be preempted by Emtala, a federal law regulating emergency rooms. After it was uploaded, the opinion was quickly taken down; in a statement, a supreme court spokesperson said that the opinion had been uploaded briefly by mistake. By then, Bloomberg news had already obtained the full text of the draft, and it was published soon thereafter.This makes the third time in recent memory that an opinion in a high-profile supreme court case was leaked before its official release. The first was when Justice Alito reportedly told a conservative movement activist friend of his upcoming decision in 2014’s Burwell v Hobby Lobby, a case that struck down the Affordable Care Act’s contraception coverage mandate for religious employers; the second was when the draft of Alito’s majority opinion in Dobbs was leaked to Politico almost two full months before it was ultimately issued by the court. All three of these leaks have been in cases pertaining to women’s reproductive rights.But if the court is bumbling in their functioning, embarrassing in their public personas, and obviously fractious in their internal relations, then the leaked order in Moyle also shows that the conservative majority can be quite calculating in their political strategy. In the draft decision, issued per curium (that is, unsigned), the court dismisses the case as improvidently granted, and sends it back down to the lower courts. They include the restoration of a lower court order that had allowed emergency abortions to continue in Idaho hospitals while the case proceeds. For now, that means that women experiencing failing pregnancies in Idaho will still be able to get the care they need to preserve their health, their fertility and their lives; hopefully, emergency room doctors there will feel safe enough to actually perform the procedures, and patients will no longer have to be air lifted out of state to receive the routine care that will stabilize them. That’s what’s most important for the American public: that for the time being, lives will not be needlessly lost in service to the anti-choice agenda.But to the court’s conservative majority, what seems to be most important is pushing the abortion issue – and an inevitable ruling that eventually will allow states to ban emergency abortions – past the November election. The decision in Moyle was transparently a compromise between the court’s three liberals, who wanted to preserve women’s lives, and the three more pragmatic conservatives – John Roberts, Brett Kavanaugh and Amy Coney Barrett – who wanted to preserve Donald Trump’s electoral chances. These conservatives know that a ruling saying that states can allow women to bleed out, suffer septic infections, have seizures from eclampsia, lose the function of their uterus, and ultimately die – out of deference to preserving what by then are already doomed, futile pregnancies – would hurt Republican candidates in this November’s elections. That doesn’t mean they don’t want to issue such a murderous ruling; it means that they want to do so at a more politically convenient moment.So three of the court’s conservatives are acting like Republican political strategists, working to conceal their own legal agenda in order to minimize harm to their preferred party in an election year. That would be bad enough. But not all of the court’s conservatives can exercise even this degree of cynical, self-interested restraint. Although the order was issued per curium, Alito dissented, arguing that the state ban on emergency abortions should be enforceable under federal law; he was joined by Thomas and Neil Gorsuch. Some of his reasoning was echoed by Barrett, whose concurrence, studded with handwringing concerns as to whether Emtala sufficiently protected the conscience rights of anti-abortion doctors and whether it could preempt a state criminal law, read like a road map for anti-choice lawyers seeking to re-argue the issue at a later, more politically amenable time. (Another sign of the court’s dysfunction – how often opinions are now accompanied by a flurry of dissents and concurrences, with each of the justices seemingly very eager to publicly distinguish their own thinking from that of their colleagues.)Together, their writings made it clear that though the court’s conservatives are split – sometimes fiercely and peevishly so – over how fast to proceed, they agree over their ultimate goal: one day, probably sooner than we think, this case will come back, and the supreme court will allow states to ban emergency abortions. What follows will be blood on their hands. More

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      ‘A healthcare crisis’: Harris takes aim at Trump on anniversary of Roe’s fall

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      Joe Biden and Kamala Harris marked the second anniversary of the US supreme court ruling that overturned Roe v Wade with forceful campaign statements that laid the blame squarely on Donald Trump for ending the national right to abortion.In a video released on Monday, Biden pledged to restore the right to an abortion and “protect American freedom” if he is re-elected.The video, along with a campaign event headlined by the vice-president, came two years to the day since the court’s decision in Dobbs v Jackson Women’s Health Organization reversed nearly half a century of guaranteed federal abortion rights, and reflect the centrality of abortion in Biden’s presidential campaign.In College Park, Maryland, Harris took the stage to chants of “four more years”. In her remarks, Harris laid out what she said were the stakes for abortion access if Trump is re-elected.“Understand as much harm as he has already caused, a second Trump term would be even worse,” she said. “His friends in the United States Congress are trying to pass a national ban that would outlaw abortion in every single state – in states like New York and California, and even right here in Maryland.”Nodding to her background as a prosecutor, Harris called Trump’s attack on women’s reproductive rights “premeditated” and said he has “not denied, much less shown remorse, for his actions”.“In the case of the stealing of reproductive freedom from the women of America, Donald Trump is guilty,” she said.Harris called Republicans who have passed state-level bans Trump’s “accomplices” and warned that he would go even further by curtailing access to contraception and IVF.Pointing to the statistic that one in three American women live in a state with abortion restrictions, she said: “Today our daughters know fewer rights than their grandmothers. This is a healthcare crisis, and we all know who to blame: Donald Trump.”Kate Cox, the Texas woman who was denied an abortion under the state’s near-total ban last year despite a fatal fetal anomaly, introduced Harris in Maryland.“My state chose to drive me out of my home, my community, away from my children and my doctors, rather than to let me access care,” she said. “I will never again miss an opportunity to vote. I will cast my ballot in every election like my life depends on it.”Cox ultimately left Texas to receive care. Growing emotional from the stage on Monday, she shared that she is pregnant again, expecting a child in January. The crowd erupted in applause. “I hope that by then, when we welcome our baby into the world, we will have a world led by Joe Biden and Kamala Harris,” she said.“You are a hero of this movement,” Harris told Cox.In Biden’s video, the president, too, placed the responsibility for reversing abortion rights on Trump, quoting him boasting about the decision and taking credit for putting three conservative justices on the court.“Here’s what Donald Trump says about your freedom: ‘After 50 years of failure, with nobody coming even close, I was able to kill Roe v Wade,’” Biden says, quoting a Trump statement last year.“Two years ago, the supreme court justices that Trump handpicked helped overturn Roe v Wade,” Biden continues. “Decades of progress shattered just because the last guy got four years in the White House.”“We’re up against extremism. Send me back to the White House and I’ll fight like hell to restore Roe v Wade and protect American freedom.”The offensive comes amid polling evidence that with consistently weak approval ratings for Biden, concerns over reproductive rights represent Democrats’ best hope of retaining the White House in November.Since Roe v Wade was overthrown in 2022, ballot measures in several states – including ones that tend to vote Republican – have upheld or enshrined abortion rights locally, signalling that the issue has popular resonance particularly among female voters.On Friday, a group of Montana abortion rights supporters became the latest to announce that they had secured enough signatures to hold a November ballot measure asking voters to enshrine the right to abortion in the state constitution. Although that measure has not yet been confirmed by state officials, voters in roughly a dozen states are expected to weigh in directly on abortion rights this year, including in battleground states such as Nevada and Arizona.Democrats are hoping that these measures will boost turnout in their favor.Several groups – including the American Civil Liberties Union, the Center for Reproductive Rights and Reproductive Freedom for All – announced on Monday a $100m Abortion Access Now campaign across several states.Since Roe fell, Biden has frequently promised to “codify” Roe’s protections into law. Although his administration has issued executive orders aimed at boosting access to reproductive healthcare, including contraception, as well as defended abortion access in two supreme court cases this year, Biden cannot re-establish a federal right to abortion without congressional support. Congress has repeatedly failed to pass the Women’s Health Protection Act, a bill that blocks states from totally banning abortion before fetal viability, or the point at which a fetus can survive outside the womb.In a call with reporters on Monday, White House officials declined to reveal any plans for future abortion-related executive actions. Jennifer Klein, assistant to the president and director of the Gender Policy Council, also acknowledged that, if the supreme court rules against the Biden administration in a highly anticipated case over emergency abortions, “our options on emergency medical care are likely to be limited”.Trump has sought to backpedal on his stance in recent months, telling congressional Republicans in a meeting on Capitol Hill this month that the matter should be left to the states and warning them against pursuing a national ban. More

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      in US Politics

      Anger, fear and desperation: people reflect on two years since fall of Roe

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      After Roe v Wade was overturned in June 2022, Daphne did not want to leave anything to chance.Abortion is currently legal until 18 weeks in Utah, where the 38-year-old lives – but the state has a 2020 trigger law banning almost all abortion care that is currently under appeal.Daphne knew she didn’t want children so she decided to undergo surgical sterilization in October 2022, to have “peace of mind that [she] physically cannot become pregnant”.“My husband could have gotten a vasectomy for less money and an easier recovery time. However, that doesn’t change the outcome if I were to be assaulted. Living in Utah, I could not and would not risk having to seek an abortion, likely having to leave the state to do so, after an already traumatic event,” Daphne said.The procedure, which was not fully covered by her health insurance, left her around $1,000 out of pocket.“I’m lucky I was able to take these measures, and most cannot,” she added.Almost two years after the supreme court decided there is no constitutional right to abortion in the Dobbs v Jackson Women’s Health Organization case, patients have increasingly been forced to travel out of their state in order to access abortion care, while others have carried unwanted pregnancies to term. A study earlier published in January estimated there have been nearly 65,000 pregnancies from rape in states with abortion bans.Interstate travel for abortion care in the US doubled between 2020 and 2023, from one in 10 to almost one in five people leaving their state to access treatment, data from the Guttmacher Institute shows.In states where it is possible, many go to neighboring states. Hanz, a 30-year-old who works as a clinical social worker in an abortion clinic in Illinois, but lives in Missouri, found out they were pregnant in late July 2022, they recalled: “As soon as I saw the two lines on the test, I knew I had more rights standing in Illinois than I would when I got home that night. Abortion rights had already got so much worse in recent years – and then Roe was overturned.” (Missouri passed a trigger law in 2019 that banned abortions except in medical emergencies.)Hanz wanted a child, but felt it wasn’t the right time. “I was really weighing what I wanted and what felt like the right decision. It was very hard for me to terminate the pregnancy, but I had a difficult time growing up and didn’t feel I could bring a child into the world and not be able to give them the quality of life I wanted to,” they said.After spending a month carefully weighing their options, they crossed into Illinois to terminate the pregnancy at the beginning of September at nine weeks.“Making the decision was much harder than having the actual abortion,” Hanz said, adding that fears remain about crossing the border to receive care.“I’ve talked to people who thought they may be arrested when they returned to their home state – you’re not breaking the law by crossing the state,” Hanz said.For others, the introduction of abortion restrictions has meant they are not having children they may have had. Over the last few years, Brie, 41, had been considering having another child – but after Dobbs, she felt she could not undergo the risk of a pregnancy at her age in the state of Texas.“My husband and I had dreamt of a third child. Now, I know it’s definitely not going to happen,” Brie said, adding that she felt she could not risk a pregnancy in Texas, which has a near-total abortion ban.Her medical history adds to her fears: she had a complicated first pregnancy, including experiencing pre-eclampsia, and needed an emergency C-section.“It was scary and dangerous,” she said. “With my history, there’s no way I’d trust having this pregnancy in Texas or the south. I’d have to move.”The loss of the constitutional right to abortion has taken the choice out of her hands, she feels. “Our seven-year-old son is asking for a younger sibling,” Brie said. “I know I’m in a privileged position – we have two wonderful, healthy kids – but I don’t appreciate the state making my family planning decisions.”Abortion is an issue that divides her family. “The last two years have been a very volatile time, even having these discussions within my extended family,” she said. The issue is at odds with other values prized in Texas, she believes: “People here are very concerned with freedom. But there’s this huge conflict here between concern with personal freedom, and the approach to women and fertility. The only acceptable carveout is women that are pregnant.”Every month, she feels anxious about the chance of pregnancy. “It’s constantly on my mind and has been since Dobbs: am I going to be thrown under the bus by my state this month?“You play scenarios out, what if, where would I go, who would I tell. It’s a big wall of separation between who could you trust. I think that’s the goal: to isolate and put women in a position of insecurity.”For some, the fall of Roe was a call to action. Paul, in his mid-50s and living in North Carolina, knew little about abortion rights when he heard the news two years ago.“Up until then, it was not something I cared about – it was obvious that women should have the right to choose,” he said. He had thought abortion was a “settled issue”.When he heard the news, he remembers that he and his wife “stared at each other in silence, and thought, what the hell happens next? It doesn’t affect us personally, but it does affect millions of women. I went in completely blind.”Compelled by a need to take action, by November 2022, Paul had begun volunteering with a group that offered logistical assistance to people requiring abortions, often picking up patients who had travelled from states with more restrictive laws and driving them to clinics.“I’ve driven young teens with their parents who are absolutely petrified; women in their 20s who accept it’s something they have to do, and others to whom it’s no big deal. Everyone has a different set of circumstances – you don’t have to explain your reason to me,” he said.After North Carolina reduced the limit from 20 to 12 weeks in May 2023, the number of patients traveling to the state dwindled until the service disbanded. Now, Paul volunteers most weeks as a clinic escort.“More Saturdays than not, I can be found wearing a rainbow-striped vest, shielding women behind umbrellas as I walk them into the clinic. I have been called a murderer, a baby killer … And I’ll happily do it again next weekend as well,” he said. “A lot of men don’t want to acknowledge that men have a role to play in fixing this – it’s not up to just women.”For Jane*, a woman from Texas in her 60s, the writing was on the wall before Dobbs as she watched restrictions chip away at abortion rights year after year. ​Between 1973 and May 2022, 1,380 abortion restrictions were enacted in states, according to the Guttmacher Institute, with more than 630 of these enacted since 2011.Jane became involved in direct action in 2018, driving people in need of abortion to appointments: “I became involved because I realised pro-choice is just that – it doesn’t address access. It’s a limited way at looking at reproductive justice. Seeing the impact of restrictions on abortion, I felt that to do nothing is to be complicit.”After Texas passed a bill outlawing abortion following the detection of cardiac activity – usually around six weeks – in 2021, Jane was galvanized to take further action. Toward the end of that year, she reached out to Las Libres, a Mexican network that mails pills for self-managed medical abortion.“The inhumanity of restrictions just raised my temperature and made me increasingly angry and willing to stick my neck out and do something to help,” she said. “Dobbs was the logical next step after increasing regulations permitted under Roe. [Access] was very effectively overturned before Dobbs.”Jane has been packaging and posting pills to states with abortion bans for the last two years.“It is empowering and effective to fight back,” Jane said. “Perhaps I am in denial about my own risk, but I have had a good life, I enjoy relative financial stability in my retirement, and who better than me to be in a position to fight back? Small actions matter, and allow me to maintain hope.”
      *Name has been changed More

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      in US Politics

      The Guardian view on the US and vaccine disinformation: a stupid, shocking and deadly game | Editorial

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      In July 2021, Joe Biden rightly inveighed against social media companies failing to tackle vaccine disinformation: “They’re killing people,” the US president said. Despite their pledges to take action, lies and sensationalised accounts were still spreading on platforms. Most of those dying in the US were unvaccinated. An additional source of frustration for the US was the fact that Russia and China were encouraging mistrust of western vaccines, questioning their efficacy, exaggerating side-effects and sensationalising the deaths of people who had been inoculated.How, then, would the US describe the effects of its own disinformation at the height of the Covid-19 pandemic? A shocking new report has revealed that its military ran a secret campaign to discredit China’s Sinovac vaccine with Filipinos – when nothing else was available to the Philippines. The Reuters investigation found that this spread to audiences in central Asia and the Middle East, with fake social media accounts not only questioning Sinovac’s efficacy and safety but also claiming it used pork gelatine, to discourage Muslims from receiving it. In the case of the Philippines, the poor take-up of vaccines contributed to one of the highest death rates in the region. Undermining confidence in a specific vaccine can also contribute to broader vaccine hesitancy.The campaign, conducted via Facebook, Instagram, Twitter (now X) and other platforms, was launched under the Trump administration despite the objections of multiple state department officials. The Biden administration ended it after the national security council was alerted to the issue in spring 2021. The drive seems to have been retaliation for Chinese claims – without any evidence – that Covid had been brought to Wuhan by a US soldier. It was also driven by military concerns that the Philippines was growing closer to Beijing.It is all the more disturbing because the US has seen what happens when it plays strategic games with vaccination. In 2011, in preparation for the assassination of Osama bin Laden in Abbottabad, Pakistan, the CIA tried to confirm that it had located him by gathering the DNA of relatives through a staged hepatitis B vaccination campaign. The backlash was entirely predictable, especially in an area that had already seen claims that the west was using polio vaccines to sterilise Pakistani Muslim girls. NGOs were vilified and polio vaccinators were murdered. Polio resurged in Pakistan; Islamist militants in Nigeria killed vaccinators subsequently.The report said that the Pentagon has now rescinded parts of the 2019 order that allowed the military to sidestep the state department when running psychological operations. But while the prospect of a second Trump administration resuming such tactics is alarming, the attitude that bred them goes deeper. Reuters pointed to a strategy document from last year in which generals noted that the US could weaponise information, adding: “Disinformation spread across social media, false narratives disguised as news, and similar subversive activities weaken societal trust by undermining the foundations of government.”The US is right to challenge the Kremlin’s troll farms, Beijing’s propaganda and the irresponsibility of social media companies. But it’s hard to take the moral high ground when you’ve been pumping out lies. The repercussions in this case were particularly predictable, clear and horrifying. It was indefensible to pursue a project with such obvious potential to cause unnecessary deaths. It must not be repeated. More

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      in US Politics

      Louisiana’s move to criminalize abortion pills is cruel and medically senseless | Moira Donegan

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      This week, Louisiana moved to expand the criminalization of abortion further than any state has since before Roe v Wade was decided. On Thursday, the state legislature passed a bill that would reclassify mifepristone and misoprostol – the two drugs used in a majority of American abortions – as dangerous controlled substances.Under both state and federal classifications, the category of controlled substances includes those medications known to cause mind-altering effects and create the potential for addictions, such as sedatives and opioids; abortion medications carry none of this potential for physical dependence, habit-forming or abuse. The move from Louisiana lawmakers runs counter to both established medical opinion and federal law. Jeff Landry, the anti-choice Republican governor, is expected to sign the bill. When he does, possession of mifepristone or misoprostol in Louisiana will come to carry large fines and up to 10 years in prison.Louisiana already has a total abortion ban, with no rape or incest exceptions. But the Louisiana lawmakers are pursuing this new additional criminalization measure because while abortion bans are very good at generating suffering for women, they are not very good at actually preventing abortions. Data from the Guttmacher Institute suggests that the United States saw an 11% increase in abortions between 2020 and 2023 – a possible indication that pregnant people are still managing to obtain abortions in spite of post-Dobbs bans. As was the case in the pre-Roe era, women have continued to seek out ways to end their pregnancies, even in defiance of abortion ban laws.In the pre-Roe era, illegal abortions were often unsafe, and abortion bans caused a public health crisis: many hospitals had to open septic abortion wards, where women who had had incompetent or careless illegal abortions were treated for frequently life-threatening conditions. But the post-Dobbs reality is that advances in communications technology and medicine mean that illegal abortions need no longer be unsafe ones. Now, women living in states with abortion bans can access safe, effective abortion care in the comfort of their own homes, and often law enforcement and anti-choice zealots are none the wiser. Women can perform their own abortions, safely and effectively, without regard to the law’s opinion on whether they should be free to. They can do this because they can access the pills.The criminalization measure, then, is part of an expanding horizon of invasive, sadistic and burdensome state interventions meant to do the impossible: to stop women from trying to control their own lives. The Louisiana bill nominally will not apply to pregnant women – they’re exempted from criminal punishments for possession of the medications. But it will take square aims at the vital, heroic efforts of feminists, medical practitioners and mutual aid networks that have been distributing the pills in Louisiana: the people who have adhered to the principles of bodily autonomy and women’s self-determination even amid a hostile climate. These people’s courage and integrity is the greatest threat to the anti-choice regime, and so it is these people whom Louisiana’s new medical criminalization law will be used against first.But pro-abortion rights and women’s rights activists are not the only ones who will be hurt by the new law. For one thing, the criminalization of possession is likely to scare many Louisiana abortion seekers out of ordering the pills online, even if the bill itself technically excludes them from prosecution. These abortion seekers, dissuaded and threatened out of seeking the most reliable and safe method of self-managed abortion, may then turn to less safe options.But the new drug classification also has implications for a wide array of healthcare treatments. Mifepristone and misoprostol are not only used in elective abortions. They are also the standard of care for spontaneous miscarriages – the management of which has already become legally fraught for doctors in Louisiana, causing women to suffer needlessly and endanger their health. Misoprostol is used in labor, too, and in the treatment of some ulcers. The drugs’ needless, cruel and medically senseless reclassification as “controlled” substances will make these medical practices more difficult in a state that already has one of the worst rates of maternal mortality in the country. That’s part of why more than 200 Louisiana physicians signed a letter opposing the bill.The Republican legislators who have pushed the new criminalization do not pretend to actually believe that abortion drugs are habit-forming. Thomas Pressly, the state senator who introduced the bill, frankly said that his aim was to “control the rampant illegal distribution of abortion-inducing drugs”.But there is something to the notion that abortion access might be “habit-forming”. In the Roe era, after all, women began to conceive of themselves as full persons, able to exercise control over their own destinies – as adults, that is, with all the privileges and entitlements of citizenship. They formed a habit of independence, a habit of imagining themselves as people entitled to freedom, equality, self-determination and respect. It is these habits that the Republican party is trying to break them of.
      Moira Donegan is a Guardian US columnist More

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      in UK Politics

      Voices: Invest money and lose the bureaucracy: Independent readers have their say on a reformed NHS

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      Sign up for our free Health Check email to receive exclusive analysis on the week in healthGet our free Health Check emailThe NHS has come under additional scrutiny this week, following comments from shadow health secretary Wes Streeting.On Monday, Streeting warned the NHS will get no extra funding from Labour without “major surgery” or reform, including more use of the private sector.Public satisfaction with the NHS at lowest level on recordWe asked Independent readers how they felt the NHS could be improved, and whether a total reform of the service was necessary. Some argued against significant reforms, emphasizing the importance of proper funding and reducing bureaucracy within the NHS. Many cautioned against privatisation, while others stressed the need for better working conditions for healthcare staff and improved infrastructure, such as more modern hospitals. Concerns were also raised about the balance between managerial roles and frontline healthcare providers, as well as the consequences of whistleblowing and the potential loss of NHS principles. Here’s what you had to say:‘What kind of healthcare does society want?’Deep breath. The first thing to do is to try and identify what kind of healthcare society wants and what it is willing to give up to achieve that. Part, but only part, of that is who pays? Is it to be paid for out of current income or future income (debt) to be paid for by future generations? The second thing is how do you impose discipline on the provision of a service that is either wholly funded or partially funded by the state. What stops it being self-indulgent, complacent and lazy, and what drives it to strive every minute of every day to do its best to make its patients satisfied? The third thing is how do you encourage healthy practices that reduce demand for health services? Which models do the most for promoting self-care and reduce a kind of state healthcare provision dependency whereby responsibility for health is farmed out to a third party? Finally, none of these questions can be answered without thinking about what the alternatives are, how their efficiency and effectiveness compares, and what the barriers to change are.Bruxellois‘Less managers’The NHS doesn’t need reforming, what it does need is doctors, nurses and assorted clinicians and far less managers; the last time I checked there was a manager of some sort for every four staff.TomSnout‘The NHS does not need root and branch reform’The NHS does not need root and branch reform. Apart from anything else, reform takes time and money, the NHS has neither of these things.Let us face facts, when the (soft, firm and hard) right say ‘reform’ they mean scrapped. Perhaps more accurately they mean the founding principles of ‘free at the point of delivery’ needs to be scrapped.You can hide behind all the rhetoric you want, you can string all the usual platitudes about ‘illegal immigrants’, ‘freeloaders’, ‘self-inflicted’, blah, blah, blah at the end of the day, at some point removing the ‘free at the point of use’ principle will mean that normal decent, people will be denied healthcare at some level because it is unaffordable to them.What Streeting’s ‘middle class, lefties’ need to confront is what those ‘socially liberal, decent Tories’ at the dinner party mean by modernise’ is that they want a tax cut and if poor people suffer so much the better.It is rather strange that those ‘paitriots’ who find hot tick buns and purplish St George flags so objectionable are willing to abandon a uniquely British institution designed during the Second World War on British culture?Anyone who thinks our NHS needs a whole raft of health insurance bureaucracy welded onto the side, and then expect a better outcome are deluding themselves.Jim987‘Healthcare shouldn’t be about personal profit’The NHS needs to be properly funded. The current government provide 1.5% funding per year when 3.5% funding at least is needed. Protect whistleblowers. Doctors, nurses and care assistants have raised concerns about patient care but have then been sacked. Rather than cover-ups, support for whistleblowers would protect patients and enhance NHS care. Stop entrepreneurs like Branson and Mone bidding for NHS contracts: healthcare shouldn’t be about personal profit/gain. As for the suggestion by the shadow health secretary, Wes Streeting about using the private health sector, as private hospitals stand, it’s unsafe and unworkable; private hospitals don’t have A&E nor critical care facilities as backup unlike NHS hospitals. Furthermore, there is only a skeleton staff at night, no doctors to oversee patient care; if anything goes wrong, the patient has to be ferried to an NHS hospital for care. Better to keep patients within a well-funded and well-structured NHS. Keep the private sector completely separate.Benitas‘The people’s health should be a cooperative venture’If the UK experience of NHS reform is the template Solzhenitsyn is bang on the money. Health is not a “good” to be traded in the marketplace. The creation of an internal market has not led to improved outcomes for patients but increased profits for players. The most obvious example being PFI which is not unlike borrowing from loan sharks. More and more loans become necessary to service earlier loans.The people’s health should be a cooperative venture not a competitive venture.PinkoRadical‘Big is not always better’The problem with using private hospitals is that it makes NHS waiting lists longer. The consultants in the private sector are the same consultants practicing in the NHS, consequently more “private” patients equals consultants spending more time in private practice and less in NHS. Consultants need to be made to provide a minimum number of hours in NHS medicine or leave it altogether and promote the registrars to consultant posts. It also may be better to split up the regional services into more smaller units. Big is not always better. The regions have continued to centralise services making it more difficult for people in outlying areas. The old model of a matron also worked very well and should be considered again.Stardust‘Kicking the can down the road’“Using the private sector” usually boils down to getting the private sector to provide the upfront cash required, which they do in exchange for profits over the longer term. The most famous example is the PFI hospital building which has cost us a considerable amount more in the long term. It’s not a fix, it just kicks the can down the road, causing long-term budget issues and is poor value for money.The Mark in remarkable‘Cut the bureaucracy’Just cut the bureaucracy. Internal market dogma has almost brought the NHS to its knees. All levels of staff spend more time on paperwork than on delivering care.Paul‘Invest’Instead of reducing N.I. contributions the money should have been invested in NHS. Unless the intention from the government is to sell it off to the US and other foreign companies.Worker‘Look elsewhere before taking a saw to the NHS’The NHS provides a core functionality and should not be changed. I disagree strongly with Labour that the NHS is suffering from 1948 organization syndrome. Other countries do it differently, and this is shown in the performance tables where the UK languishes at the bottom of most of them. Germany has a strong network of independent medical specialists that take patients under the government’s legally required insurance scheme, as well as private schemes. Later in life people often suffer being in the private schemes as they can no longer afford them, in early life the private schemes cost less than the legally required schemes. Laws are changing in Germany, but patients can go directly to specialists. For example, if I developed a cataract I would just go direct to the eye doctor. This relieves both the GPs and hospitals of unnecessary load. It could be argued the small specialist clinics are more efficient than the hospitals. For something standard like a cataract operation in Germany, this is now a “conveyor belt” operation outside of the hospitals. Anything difficult with such an operation still ends up with the hospitals. The same applies to many frequent ageing illnesses, and specialists outside of the hospitals handle them. The UK should check other systems before taking any saw to the NHS, as the finest of surgical changes will be more successful, and that requires careful analysis and consultation.MP‘Postcode lottery’The NHS cannot be run like a business which is what the Tories tried to do. Too much money spent on bureaucracy towards that end. There needs to be a review to retain what is necessary and discard what isn’t. Healthcare has become a postcode lottery and this should not be the case. Failing hospitals need to be given detailed plans to resolve their identified issues within a timeframe and to be reviewed without notice within that time. Not all healthcare staff are angels and some are incompetent and a threat to their patients. The competent ones are leaving and the reasons are heartbreaking; their concerns for patient care are being ignored or they are being forced out. Whistleblowing can have dire consequences in hospitals with a toxic management culture. Standardized treatment protocols may be useful as some hospitals do not appear to have them or are ignoring them if they do. Cutting waiting lists would have to involve triaging patients in terms of urgency and perhaps identifying hospitals with shorter waiting lists and available beds to send them to. The other major issue is bed blockers, and that means sorting out social services also so suitable accommodation can be found in order to free beds. The Tories destroyed a vital functioning national resource and a somnolent populace couldn’t see it.Galileo666‘Hospitals are overloaded’Should the NHS be reformed to improve service?’Many have tried and failed.Until it’s recognised that the NHS is dealing with people and unpredictable events, nothing will change. You can plan as much as you like but no-one can forecast a major incident that fills all the hospitals in a region on a Saturday night when fewer doctors are working or the outbreak of a disease, virus etc. that closes a hospital down and so on. Until the planners see this and it’s calculated in nothing can change.It isn’t only about money. It’s about working conditions. The only way to improve things is to include those working in the NHS in discussions about change.The hospitals are simply overloaded. There has to be a better system for dealing with those who don’t need to go to hospital but do because they simply can’t get help anywhere else. There should be more day clinics for routine surgery where people arrive in the morning and depart later after treatment instead of having to go to hospital in the first place. It operates well in other countries.How any of it can be achieved without the new, modern, well-equipped hospitals the Tories promised but didn’t deliver, is hard to see!AmibigirlsSome of the comments have been edited for this article. You can read the full discussion in the comments section of the original article.All you have to do is sign up, submit your question and register your details – then you can then take part in the discussion. You can also sign up by clicking ‘log in’ on the top right-hand corner of the screen.Make sure you adhere to our community guidelines, which can be found here. For a full guide on how to comment click here. More