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    More Americans are stockpiling abortion pills without pregnancy – study

    More Americans are now stockpiling abortion pills in case they get pregnant, according to new research published Tuesday.Before Roe v Wade was overturned in June 2022, Aid Access, an organization that mails abortion pills to people across the US, received an average of 25 requests a day from people seeking the pills despite not being pregnant. After the leak of the supreme court decision to overturn Roe, that average shot up to 247 requests each day, the research published on Tuesday found.That number fell after the actual decision, but rose again to 172 a day in April 2023, as US courts signaled a willingness to restrict the availability of a major abortion pill.People have been turning to Aid Access for “advance provision” pills since September 2021, after Texas enacted a six-week abortion ban but long before the US supreme court overturned Roe and abolished the national right to abortion. Now, with wide swathes of the US south and midwest under abortion bans, an online market to request and obtain abortion pills is thriving.The study tracks requests between the beginning of September 2021 and the end of April 2023. In December 2023, the US supreme court announced that it would hear arguments in a case regarding the future of mifepristone, a major abortion pill. That case is expected to be decided by this summer.In total, over the study’s time frame, Aid Access tracked roughly 48,400 advance provision requests. It received more requests for advance provision pills from states that were anticipated to enact bans – even more than the requests from states that did enact bans.“It seems to suggest that what people are reacting to is the threat of reduced access, the threat of curtailment of reproductive rights,” said Dr Abigail Aiken, an associate professor at the University of Texas at Austin and a co-author of the study. “When you think about what advanced provision is, that makes sense, right? Advanced provision is getting out ahead of things. Advanced provision is advanced planning. Advanced provision is a way to protect a potential need you might have in the future if you think access to the service that would fulfill that need is going away.”Over the study period, Aid Access also received more than 147,00 requests from people seeking to end their existing pregnancies. Medical experts widely agree that it is safe to “self-manage” your own abortion, or perform an abortion outside of the formal US healthcare system, using pills within the first trimester of pregnancy.Compared with the people who wanted to terminate their existing pregnancies, people who sought advance provision pills were more likely to be white, child-free and living in urban areas. Choosing from a list of reasons, they most frequently told Aid Access that they wanted the pills to “ensure personal health and choice” and to “prepare for possible abortion restrictions”.Aid Access was launched in 2018 by Dr Rebecca Gomperts, a Dutch physician and one of the most visible abortion providers in the world. Gomperts, who co-authored the study published Tuesday, previously founded Women on Web, an organization that, like Aid Access, shipped abortion pills. However, Women on Web didn’t provide pills to the United States. Ultimately, Gomperts decided that the state of abortion access in the country was too dire to ignore.Advance provision pills cost $150 and should arrive within a few days of ordering, according to Aid Access’s website. During the time frame of the study, most of the pills were being shipped by overseas pharmacies, Aiken said.Now, to send abortion pills, US-based physicians associated with Aid Access have begun to rely on what are known as “shield laws”: protections in Democratic states for abortion providers who prescribe pills for patients in abortion-hostile states. This transition to focusing on using US providers was part of the reason for the study’s conclusion in April, Aiken said.skip past newsletter promotionafter newsletter promotion“It made sense to look at a time period where the service was entirely outside of the formal US healthcare setting,” Aiken said. “Now, I think a lot of people would argue that it’s happening within the formal healthcare setting, because it’s US provider-led and -based.”But while the US providers in blue states may be operating with the formal healthcare system, their patients in red states are not necessarily afforded the system’s protections and guidance. Someone who wants to get a check-up after an abortion, or even just talk to their doctor about their experience, may not feel able to.“In terms of the experience of the person actually using the pills, it may still look a lot more like a self-managed abortion,” Aiken said. “What that means for the nature of the service is an ongoing, interesting question that we’re thinking about now in the research field.”There was not much data available on what people ended up doing with the advance provision pills, Aiken said, since only a fraction followed up with Aid Access. However, of that fraction, most people still had the pills on standby months later.Last year, Gompertstold the Guardian that she wanted people to stock up on pills to protect themselves.“Don’t wait for the decision. Just get the medication now, get it in your house, get it in your hands,” she said. “If you’re in a war zone and the war is coming, you also make sure you have enough food in your house. This is how it feels. It really is a war. It’s a war on women.” More

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    The fight for abortion rights: what to know going into 2024

    More than a year after the US supreme court overturned Roe v Wade, the dust from the landmark decision’s collapse has yet to settle.It has been a dramatic year of fallout, with abortion rights supporters and foes now waging a state-by-state skirmish for abortion rights. They are sparring in state legislatures, courtrooms, voting booths and hospitals, with each side racking up victories and losses.With a presidential election and another major supreme court case on the horizon, the coming year promises to be at least as eventful. Here’s what you need to know about the fight over abortion in 2023 – and what it means for 2024.Abortion rights supporters keep winning at the ballot boxIn 2022, Republicans underperformed in the midterms and abortion rights activists won a string of ballot measures to preserve abortion rights, even in conservative states. This year, activists extended their winning streak – and they hope to replicate their successes in 2024.In November, Ohio became the first reliably red state since Roe fell to vote in favor of proactively enshrining abortion rights in the state constitution, while Virginia Democrats successfully fended off Republicans’ attempt to retake the state legislature by campaigning on a 15-week abortion ban.For activists and Democrats, these victories were proof that abortion is an election-winning issue – and, potentially, an issue that can draw in voters from across both sides of the ideological spectrum. Activists are already at work on 2024 abortion-related ballot measures in roughly a dozen states, including swing states like Arizona and Nevada.Abortions are on the riseAfter abortion clinics across the south and midwest were forced to shutter, patients overwhelmed the country’s remaining clinics. In the first year after Roe’s demise, the average number of US abortions performed each month rose rather than fell. Clinics and their advocates are now struggling to keep up. “What actually is happening is a complete disruption,” one expert told the Guardian.There is also a gaping hole in the data, which was released in October by the Society of Family Planning: it does not include abortions performed at home, a practice known as “self-managed abortion”. Medical experts widely agree that it is safe to self-manage an abortion using pills early on in pregnancy, and a number of services shipping abortion pills have increased in visibility since Roe’s overturning. But while evidence suggests that self-managed abortion is on the rise, the lack of concrete data about the practice reflects a growing problem in the post-Roe United States: as abortion moves further into the shadows of US life, we will know less about it.Legal battles over abortion bans are ongoingAbortion bans continued to cascade across the country in 2023, with near-total bans taking effect in Indiana, North Dakota and South Carolina. South Carolina and Nebraska, meanwhile, enacted laws to ban abortion after 12 weeks of pregnancy. In total, 24 states or territories have now banned abortion before viability, or roughly 24 weeks of pregnancy, which would have been illegal under Roe.Litigation over abortion restrictions is still unfurling in many of these states, and court cases have frozen bans in states like Wyoming and Iowa. Wisconsin abortion providers, meanwhile, found themselves in a unique position this year: after a judge ruled that an 1849 law that had been interpreted to ban abortions instead only banned feticide and did not apply to what she called “consensual abortions”, providers resumed performing the procedure – even though the ban is still technically on the books.Lawsuits may force other hardcore anti-abortion states to soften their bans in 2024 to clarify exceptions when abortions are permitted in medical emergencies. While Tennessee and Texas carved out narrow exceptions in their abortion laws, abortion rights supporters have still filed lawsuits in those two states, as well as in Idaho, that challenge the language. One Texan mother of two filed a lawsuit seeking an emergency abortion while she was still pregnant. (She ultimately fled the state for the procedure.)Theoretically, people in medical emergencies should be able to access the procedure even in states with bans – but doctors say that, in reality, these bans are so vaguely worded that they block doctors from helping sick patients. This summer, one of these lawsuits led women to testify in a Texas court about their experiences of being denied abortions. It was the first time since Roe fell, if not the first time since Roe itself was decided, that women did so.Abortion pills are in perilThe most common method of abortion, abortion pills, is at the mercy of deeply conservative courts in 2024.In April, a conservative judge in Texas ruled to suspend the FDA’s approval of a key abortion pill, mifepristone, in response to a lawsuit brought by a coalition of rightwing groups determined to make the pill the next target in their post-Roe campaign against abortion. A federal appeals court soon scaled back that decision, ruling to keep the pill, mifepristone, available but impose significant restrictions on its use. The supreme court then stepped in and decreed that the FDA’s rules around mifepristone should stay the same while litigation plays out.The Biden administration and a manufacturer of mifepristone in September have asked the supreme court to formally hear arguments in the case. In December, the justices agreed.Although the justices indicated that they will only rule on the restrictions imposed by the appeals court, rather than on the overall legality of mifepristone, the case could still have enormous consequences. Rolling back the FDA’s rules could allow future lawsuits against other politicized medications, like gender-affirming care, HIV drugs or vaccines. Plus, the supreme court will probably rule by summer 2024 – just months before the presidential election.Mifepristone is used in more than half the abortions in the country. If access to the drug is curtailed, many abortion clinics have said they will pivot to using doses of a different drug, misoprostol, to perform abortions, but misoprostol-only abortions are less effective and associated with more complications.Doctors are fleeing states with abortion bansWith abortion bans endangering their patients and threatening to send doctors to prison, doctors are fleeing states where the procedure is banned. After Idaho banned abortion, at least 13 reproductive health physicians left the state and at least two rural labor and delivery wards have closed. Doctors in Tennessee, Texas, North Carolina, Ohio and Florida have also told reporters that they are leaving states with abortion bans or planning to do so.OB-GYNs are already in short supply in the United States. About half of US counties do not have a practicing OB-GYN, according to the American College of Obstetricians and Gynecologists. The US maternal mortality rates are also worsening, particularly for Black and Native people, at a time when the United States already has the worst maternal mortality rate among industrialized countries.Doctors are now even afraid to get trained in states with abortion bans. Applications to OB-GYN residencies in states with near-total bans fell by more than 10% the year after Roe’s demise, according to data from Association of American Medical Colleges. Applications to US OB-GYN residencies overall dropped by about 5% – indicating that fewer doctors are planning to become OB-GYNs at all. More

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

    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

    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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    Kate Cox begged Texas to let her end a dangerous pregnancy. She won’t be the last | Moira Donegan

    In most cases, we would never have learned her name. Kate Cox, a Texas woman, is in a sadly common set of circumstances: a 31-year-old mother of two, Cox was pregnant with her third child when doctors informed her that something was wrong. Pregnancy complications are common, but in a state like Texas, they have become newly dangerous, threatening women with potentially disfiguring health complications, along with unimaginable heartbreak, as the state’s multiple bans have mandated grotesque and inhumane treatment of doomed pregnancies.Cox’s fetus had trisomy 18, a chromosomal disorder. Trisomy 18 is a devastating diagnosis. Most pregnancies end in stillbirths; those infants born alive with the disorder live anguished, short and painful lives. Cox was informed that her fetus, in the sterile medical parlance, “could not sustain life”. The fetus had malformations of the spine, heart, brain and limbs. The pregnancy also posed dire threats to Cox’s health; most significantly, she was at risk of losing her future fertility if she remained pregnant.If Cox made it to delivery – a big if – the child would live for perhaps an hour, perhaps a week. It would have to be treated with pain medications for the entirety of its brief life. None of these were cognizable concerns under Texas’s abortion ban. The law said that she would have to remain pregnant – would have to get sicker, have to endure greater and greater pain and grief, and then would have to labor and give birth to a daughter, who she would watch suffer and die.There are hundreds of women like Cox living in Republican-controlled states, women carrying pregnancies in which there is no hope that a living baby will result at the end of nine months. These are pregnancies that – because of abortion bans that provide no actionable exemptions for medically futile pregnancies or maternal health – women are forced to keep carrying anyway.Most people in this situation suffer in private; they endure the cooing at their bellies from oblivious strangers while they remain pregnant, and they purchase tiny urns in the brutal days after. Cox is different only because she made the decision to share her situation publicly. As her health deteriorated and she made multiple visits to the emergency room, she published an op-ed in the Dallas Morning News, and petitioned Texas courts for an abortion. It is the first recorded instance of an adult woman having to ask for government permission to end her pregnancy since Roe. On Friday night, the Texas supreme court refused. On Monday, Cox left the state, seeking an abortion elsewhere.There is a tendency, in coverage of abortion law, for writers to try and discipline their language. The issue is fraught and passionate enough, the thinking goes, surrounded as it is by stigma, ignorance and misinformation. There is one line of journalistic thought that holds that the best way to serve one’s readers, and to maintain their trust, is to write with as strict neutrality as the facts will allow. If I were to follow that line, I would tell you that the case raises vexed and unresolved legal questions about the extent of medical exemptions to abortion bans, and that the actions of Ken Paxton, the Texas attorney general, whose office intervened to prevent Cox from receiving an abortion, is signaling a maximalist view. I might not mention, in the interest of neutrality, that among the Texas supreme court justices who denied Cox her abortion was John Devine, an extremist Christian conservative with a long history of anti-choice activism, including, according to his boast at a campaign event, being arrested 37 times in harassment actions outside abortion clinics.But there is another line of thought that holds that euphemism is dishonesty, and that the effort to maintain journalistic neutrality in situations of grave injustice winds up obscuring more than it reveals. If I were to follow this latter method, I would tell you plainly that, by refusing to let her end this pregnancy, Paxton and the state of Texas in effect allowed Kate Cox to be tortured, and that she was forced to flee to escape that torture.Cox will not be the last woman in this position. She will not be the last woman to make a public plea to be permitted an abortion for a dangerous and non-viable pregnancy; she will not be the last one who is denied. She is part of a growing cast of abortion rights plaintiffs, a product of Dobbs’s cruelties and of the shifting strategic posture of the reproductive rights movement. These new claimants are not the traditional pro-choice litigators – clinics or doctors – but prospective patients themselves. In particular, the new plaintiffs are women who are seeking medical exemptions to terminate wanted but dangerous pregnancies. (In her op-ed, Cox referenced Zurwaski v Texas, a lawsuit in which 20 such women are suing to clarify and expand medical exemptions to Texas’s abortion ban.)Think of it as a crusade of the medically endangered: women who are faced with tragic, dangerous and heartbreaking circumstances in their pregnancies are emerging as a new face of the pro-choice legal movement. Like the anti-choice movement spent decades chipping away at the abortion rights and expanding restrictions, these women’s lawsuits seek to expand access in the most sympathetic of cases – those of medical emergencies – to carve out slightly larger loopholes for more women to access abortion through.It’s an incrementalistic strategy, one that assumes that legal abortion bans like those in Texas are here to stay for the foreseeable future. And it is also a strategy that makes some concessions to the bigotries and biases of the Texas court, to say nothing of American public opinion. Like many of the medically endangered plaintiffs, Cox is white and married. She is already a mother, and wants to be pregnant – she speaks extensively, and movingly, of desiring more children, and of wishing that she could have this one. Unlike many in her shoes, when faced with a horrible consequence of a sadistic law, she was able to seek both publicity and legal help. Unlike many in her shoes, when she was denied an abortion, she was able to flee.None of these things about Cox – neither her privilege not her palatability – make her a bad person, or make her suffering any less horrific. But they do make her an appealing face for a movement that is seeking to reason with a rabid and revanchist cadre of judges. There is nothing the right can object to in her, the thinking goes, and there is nothing they can get from making her suffer: her child will die. And yet her plea was rejected by the Texas courts, which suggests that the anti-choice movement does feel that they can get something out of Kate Cox. They get the ability to make her beg. Then, they get the satisfaction of saying no.The way we talk about abortion has warped in the wake of Dobbs. We use bloodless language of gestational limits; we may even be tempted to describe once-unheard of 15 week bans as comparatively “moderate”. We look on the bright side, like to the fact that Cox, denied the care that will keep her healthy and alive in Texas, was able to go elsewhere. Amid these adjusted expectations it is easy to lose track of how far we’ve fallen in our standards for women’s dignity and freedom. Two years ago, a woman in Cox’s shoes was able to control her own body and life on her own terms; now, she has to go before a court, all her virtues on display, and beg not to be maimed. “I am a Texan,” Cox said in her op-ed. “Why should I or any other woman have to drive or fly hundreds of miles to do what we feel is best for ourselves and our families, to determine our own futures?” It was an appeal to her dignity as a citizen. But Texas only saw her as a woman.
    Moira Donegan is a Guardian US columnist More

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

    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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    High stakes for abortion rights as Pennsylvania votes on key judge pick

    Pennsylvania voters will select a new member of the state’s supreme court on Tuesday in a judicial election that has become the unlikely focus of Republican billionaire donors, political action committees and abortion rights advocates.Democrat Daniel McCaffery is facing off against Carolyn Carluccio, a conservative judge whose apparent opposition to abortion access has drawn the ire of Planned Parenthood and other reproductive justice groups.As McCaffery and Carluccio compete for a seat on the Pennsylvania supreme court, total spending in the race surpassed $17m, according to the Associated Press – an unusually high price tag for an election that typically sees low voter turnout. But Democrats and abortion rights advocates hope Pennsylvania voters view Tuesday’s ballot as a proxy for reproductive freedom in Pennsylvania.“This election, Pennsylvania voters have a choice between Carolyn Carluccio, who has tried to hide her anti-abortion positions and dodge questions about the judiciary’s role in protecting abortion rights, and Daniel McCaffery, a proven champion of reproductive freedom,” said Breana Ross, campaigns director of Planned Parenthood Votes Pennsylvania.Abortion rights advocates hope to energize Pennsylvania voters by casting Carluccio as an existential threat to abortion access. This strategy delivered liberals a resounding victory in the Wisconsin supreme court race earlier this year, when record numbers of voters turned out to elect Janet Protasiewicz, a Democrat who pledged to defend abortion rights. Protasiewicz’s conservative opponent, Dan Kelly, refrained from voicing his opinion on voting rights.Carluccio’s campaign, taking its cues from Kelly’s unsuccessful playbook, has avoided sharing her views on abortion. After winning the primary election in May, Carluccio removed information about her opposition to abortion from her campaign website, according to a May report from the Keystone.Carluccio’s campaign site previously vowed to defend “all life under the law”.“When we redesigned our website, we chose to no longer include a résumé link. Judge Carluccio listed on her résumé that she would ‘defend all life under the law’, and she meant just that: under the law,” Rob Brooks, a spokesman for Carluccio’s campaign, told the Guardian.Carluccio has frequently branded herself as a non-political actor who operates outside the bounds of traditional partisanship.“I reject calls to rule based on partisan or ideological grounds and instead rule according to our laws,” Carluccio wrote in an August op-ed about her candidacy.Despite Carluccio’s insistence on her own ideological neutrality, her campaign has invited the support of distinctly rightwing groups. In a February letter to the Pennsylvania Coalition for Civil Justice Reform, Carluccio disclosed that her candidacy was endorsed by the Pennsylvania Pro-Life Federation, a leading anti-abortion group in the state.According to campaign finance reports, her campaign received over $4m from Commonwealth Leaders Fund, a political organization funded by the billionaire GOP donor Jeffrey Yass.Pennsylvania Democrats said Carluccio is hiding her ties to the anti-abortion movement in a disingenuous bid for primary voters. The general electorate is supportive of abortion access – 64% of all Pennsylvania voters in the 2022 midterms said abortion should be legal in most or all cases, according to polling from the Associated Press.“Her campaign is clearly trying to portray her as acceptable to a primary audience,” said JJ Abbott, executive director of Commonwealth Communications, a progressive political consulting firm. “They know abortion is a motivator for voters, since the Dobbs decision, voters are more likely to engage in elections because of what is at stake for abortion.”But the stakes of Tuesday’s election are not straightforward. Unlike Wisconsin, where the threat of the 1849 near-total abortion ban loomed overhead, the outcome of Pennsylvania’s supreme court race will not directly affect abortion access in the state. Tuesday’s race will not change the composition of Pennsylvania’s high court – four of the seven seats on the current bench are held by Democrat-affiliated justices. Carluccio is operating in what appears to be a much less dire political environment than Kelly, whose campaign struggled to avoid the topic of abortion while Wisconsin was feeling the effects of the 1849 ban.Still, Planned Parenthood and other reproductive justice advocates said the abortion rights movement needs to look ahead to the 2025 election, when three of Pennsylvania’s Democratic justices will appear on the ballot.The long-term maintenance of Pennsylvania’s liberal supreme court majority is a priority for abortion rights advocates. In September, Planned Parenthood Votes launched a seven-figure advertisement campaign against Carluccio, the largest ad buy in the group’s history.As anxieties mount, abortion rights supporters are hopeful that Pennsylvania voters, as in Wisconsin, will heed the warnings offered by Planned Parenthood on the long-term consequences of Carluccio’s candidacy.Dr Benjamin Abella, a medical professor and emergency physician in Philadelphia, said voters like him are “paying attention” to Carluccio’s efforts to hide her campaign’s ties to rightwing anti-abortion groups.“The public understands that we should not be lulled into a false sense of security on abortion rights, especially if a judge is keeping quiet on their intentions and positions,” he said. “There’s no such thing as a safe state any more and that any and every election poses a risk.” More

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    She was censored over trans rights. But lawmaker Zooey Zephyr won’t be silenced

    Zooey Zephyr had just arrived on the outskirts of far-flung Libby, Montana, this summer when a text message came through with a warning. There were anti-LGBTQ+ protesters at the Pride celebration that was already under way on the banks of the Kootenai River.Calm and steady, she pulled her white rental sedan into the lot and brought it to a stop. Instead of protesters, the car was immediately thronged by a cluster of fans. One, a middle-aged woman with long, wavy brown hair cascading from under a bedazzled baseball cap, asked Zephyr with urgency: “Do you remember me?”Later that afternoon, the woman who approached Zephyr took to the Pride stage to tell her story.She had feared coming out as transgender for years in this small, conservative town, but finally got the courage to do so when she witnessed Zephyr, 35, a Democratic state representative from Missoula, stand up to a legislative body controlled by Republicans hellbent on silencing her and driving her out of the state capitol where she was elected to serve. Seeing another trans woman refuse to be silenced gave her the power to live her own truth.This is what it’s like traveling with Zephyr – even to a remote, Republican-controlled corner of the massive state where she was born and raised. Montanans from all walks of life – many of whom have been cast aside and told their lives and politics don’t matter and won’t be heard – show up to tell her their stories and look for some hope in return.There is the fantasy of Montana that gets too much national attention, fawning stories of pristine public lands, macho cowboys and sprawling ranches. Amid rapid gentrification, those relics are all becoming figments of the collective American imagination.And then there is truly remote, rural Montana, the barely mentioned places like Libby. This community of fewer than 3,000 sits on the lush curves of a river beneath the Cabinet mountains in the north-west corner of the state, closer in place and conservative politics to north Idaho and eastern Washington than any major city in Montana.It’s a former asbestos mining town, one that voted Democratic for decades. It weathered a huge industrial poisoning scandal linked to the mine in the 1990s and early 2000s, which killed nearly 700 residents over the years. It’s a place beaten up by extractive corporate interests and nearly forgotten. But this year’s Pride celebration, one of the first organizers have ever pulled off, was vibrant, joyous and filled with dozens of supporters. (It was smaller than last year’s event, the organizers say, and they fear that was due to the wave of anti-queer and anti-trans rhetoric that has flooded Montana and other parts of rural America.)The protesters Zephyr was warned about, a cluster of angry-looking white men, were there, walking menacingly through the crowd. One carried a placard that read: “If you’re looking for a sign to kill yourself, this is it.” No one paid them much attention.I ask Zephyr what she would have done if confronted by the protesters. She smiled and said without missing a beat: “What do you think I’d do? I’d talk with them.”We’ve spent enough hours together now that I know she’s serious.Zephyr has become a symbol of graceful defiance in a state recently flooded with hate-riddled speech and politics. But how did she – a gamer, an elite wrestler as a child and later a dance instructor – become one of Time magazine’s “100 Next”, leaders the publication anointed as people who could change the world?Her rise to international fame began in 2022, when she became the first openly transgender woman elected to the Montana legislature, after a grassroots campaign prompted by the Republican majority’s mounting attack on trans rights and the independent judiciary system.The 2023 legislature, which convened in January, included a spate of legislation that undercut medical care and other essential rights for trans people. To be clear, these were not issues rising from a groundswell of popular support. Montana has only recently flipped to being deep red politically, and the most talked-about topic across the state these days is the unaffordability of housing.Making life difficult for trans people is not something most voters were demanding. But Republicans insisted that trans rights were a threat and pursued legislation, ignoring hours of testimony against the bills.The severity of the attack on trans rights in Montana was new; far-right conservatives targeting the marginalized as a tactic is not. Ken Toole, who was director of the Montana Human Rights Network through battles over gay rights and marriage equality in the 1990s and 2000s, recalls a similar landscape. “The conservative movement in the state used these kinds of issues to characterize the political debate [then and now],” he said. “Essentially, it’s scapegoating.”This spring, during a debate over a bill to limit gender-affirming care for youth, Zephyr spoke passionately against the legislation: “I hope the next time there’s an invocation, when you bow your heads in prayer, you see the blood on your hands,” she told the house.It was then that the Republican leadership decided her words went too far.Leadership demanded she apologize; she refused. Multiple studies have shown that trans youth have higher suicide rates, she argued, and this kind of legislation would have a detrimental impact on kids.In retaliation, the legislative leadership, run largely by one family, cut her microphone for three days, a move unprecedented in a citizen legislature with a long history of spicy rhetoric and fiery debates.On the third day of her silencing, a group of protesters filled the house gallery, a collection of seats above the grand chamber, to challenge what was happening. They chanted “Let her speak” as Zephyr held up her microphone and put a hand over her heart.Police in riot gear swept the protesters from the capitol and, in another historic move, the Republican leadership closed off public access to the gallery for the remainder of the legislative session. Republicans later voted to banish Zephyr from the house chambers, leaving her to set up a makeshift office on a bench outside the door of the body where she had been elected to serve. The next day, several women related to Republican legislators showed up and took over her bench, seemingly hoping to drive her out of sight.It was this anti-democratic wave against Zephyr and her own calm, deliberate opposition to fading away quietly that shot her into media stratosphere. The story spread fast and far in a country watching democratic norms fall away in Republican-controlled states.She appeared on ABC’s The View, was featured across national and international media, and was invited to national events. For months, her message seemed to be everywhere. Montana Republicans, in trying to silence one opposing voice, had accidentally turned her into a national star. For Zephyr, though, the moment was about much more than fleeting celebrity. She’s planning to build a lasting movement out of it.In each conversation I’ve had with Zephyr, her fiancee figures prominently. She proposed to Erin Reed, the trans journalist and activist, shortly after the legislative session ended this spring; they traveled to France to celebrate. Reed lives on the east coast, and for now Zephyr is committed to her work in Montana, making this state a more inclusive and safe place for families like her own.Zephyr was born in 1988 in Billings, Montana, still the state’s largest city. It’s long been the heart of conservative Montana politics, a place where ranchers and Chamber of Commerce types ran the show. Her own family was conservative and religious.She describes her childhood there as fairly unremarkable, like that of any other Montana kid. In 2000, her father’s work prompted the family to move to Seattle. There, Zephyr found her passion in sports, winning five state wrestling titles and finishing high school with an offer of a wrestling scholarship. She opted to stay closer to family and go to the University of Washington instead, but it’s clear that competitive sports shaped her. She still recites by memory the words of a banner that hung over the practice room: “Every day I leave this room a better wrestler and a better person than when I entered,” she says, adding how the coach made them slap the sign as they left the room.It’s become a personal motto.After graduation, Zephyr was called back to Montana. This time, as an adult, she went to Missoula to study creative writing at the University of Montana. She found a job at the university and worked part-time teaching the Lindy Hop at a local dance studio. In 2018, she reached the point in her life when it was time to come out to her community and transition. Her family’s response caused her to cut ties, but as she tells the story, Missoula, one of Montana’s more progressive cities, surrounded her with love and warmth.It was then that she chose her name: Zooey Simone Zephyr. Zooey, meaning life, Simone, a tribute to her paternal grandmother, and Zephyr, “a gentle breeze blowing from the west”.“I thought, ‘I want to be that, a gentle breeze,’” she says.Her community rallied around her. Her boss immediately had the restroom signs changed to remove gender markers, getting ahead of any questions. Her dance students didn’t bat an eye when she told them her name and identity as a woman. And her friends gathered at a brewery to celebrate the transition. The response from Missoula made her certain she was in the right place.In the years since, she has at times debated leaving Montana as the attacks on trans people mounted. But now, she says, “I’m not going anywhere. This is my state. I was born here. You can’t kick me out.”She toyed with the idea of running for a different office, but her heart is in organizing.We talked at length about the changing face of Montana and what it means to have grown up here, particularly when it seems the politics have been hijacked by a national agenda that has very little to do with ordinary people’s lives. She felt no one in elected office was listening to her, and so once she decided to run, she was dead set on winning.“I remember thinking to myself: if you really want to move the needle, you need representation,” she said.In Missoula, representation is spreading. Gwen Nicholson, a young Indigenous transgender woman who was born and raised there, is running for city council on a progressive platform centered on affordable housing.Nicholson worked in the capitol during the anti-trans onslaught this winter. She remembers thinking: “Why am I not welcome? Why does it feel like this place, which is my home and has been home to my family for generations, is trying to push me out?”Nicholson said she had confessed to a friend: “‘All this shit makes me want to run,’ and they were like, ‘Run away, or run for office?’ There has to be some material way to fight back.”This is the kind of movement Zephyr wants to see catch fire all across Montana. The state has been defined for generations by complex, sometimes surprising politics – but contemporary rhetoric has flattened its identity in recent years to that of just another deep red state. In traveling throughout her home state, she has found opinions that go far beyond the standard talking points that overwhelm political debate.“Every conversation you have with someone, you go to a community where Democrats haven’t run a candidate in a long time, and you talk to folks there, and they want to fight back,” Zephyr says.Zephyr will kick off a different kind of political effort in Montana beginning this fall. She’s creating a political action committee to raise money that will help her travel the state and recruit and train candidates for state office. In the last election, Democrats didn’t even appear on the ballot in one-third of legislative races, and the resulting landslide gave Republicans a supermajority and nearly unlimited power over Montanans’ lives. Dissenting voices were ignored and written off. Zephyr intends to build a movement that will empower progressives to run and win in places like Libby where Democrats haven’t won in years.“We can make that difference on the ground, we can move the needle on the ground here in a way that the national Democratic party wouldn’t know how to do,” she says. “It starts from the bottom.” More