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Abortion Looms Over 2022 State Ballots

Axios, September 22, 2022

Five forthcoming state ballot initiatives on abortion rights could add fissures to the fractured post-Roe landscape and the evolving patchwork of reproductive health policies. The big picture: The U.S. Supreme Court decision overturning the constitutional right to an abortion has hardened sentiments in red and blue states and put critical access questions in front of voters this fall. Kansas showed how potent the issue is in driving turnout last month, when voters during state primary elections overwhelmingly rejected an amendment that would have struck abortion protections in the state’s constitution. The turnout of more than 900,000 was nearly half of all registered voters in the state, and almost double the amount of voters that Kansas normally sees in a primary election. State of play: Voters in California, Michigan and Vermont have proposed constitutional amendments on the ballot next month that aim to protect abortion access. Kentucky and Montana voters will face questions on further restricting abortion rights and conferring legal rights on fetuses. The Kansas vote could be viewed as a positive for Democrats, who have made abortion rights a pillar of their midterm strategy. But things may not be as clear cut for those at the polls. Advocates on both sides are campaigning hard, aware that success or failure could boil down to their ground games. Michigan: The ballot has a proposed amendment that would create a right to “reproductive freedom,” including the option to choose an abortion. It also would allow the state to regulate abortion after the point of “fetal viability” but not prohibit it if medically necessary. California: Voters will decide whether to enact an amendment that adds a “fundamental right to choose to have an abortion” to their state constitution. Vermont: A ballot initiative proposes a state constitutional amendment declaring “an individual’s right to personal reproductive autonomy,” which includes the option to choose an abortion. Montana: The issue on the ballot focuses on giving infants who survive later abortions status as “legal persons” and would impose criminal penalties on health providers who do not act to preserve the life of what amendment opponents term “nonviable infants.” Kentucky: While the state is already one of those that ban abortion, residents will vote on a measure that would ensure the state constitution does not “secure or protect a right to abortion, or require the funding of abortion.”

The End of Roe Could Be Chaning People’s Minds About Abortion Bans

The 19th, September 19, 2022

Roe v. Wade’s overturn may have meaningfully shifted public opinion on abortion for the first time in years, a change that could affect what kinds of bans or restrictions abortion rights opponents can safely consider. Polling on abortion, while complicated to pull off, had long been relatively static. For decades, most Americans have identified as “pro-choice,” believing that abortion should be legal “under certain circumstances,” according to Gallup. Since the 1990s, around 60 percent of Americans have also supported the right to an abortion in the first trimester of pregnancy. And for just as long, polling has also found that support for abortions in the second trimester has consistently been lower than for those in the first, Gallup has found — falling from that 60 percent approval to somewhere between 25 and 30 percent of Americans. Public opinion on second-trimester abortions has informed how some Republicans — including South Carolina Sen. Lindsey Graham and Florida Gov. Ron DeSantis — have framed abortion access in the post-Roe world, pushing for laws that would ban abortion after 15 weeks of pregnancy. But sharp backlash to those proposals — alongside shifting public opinion data — suggests that when 15-week abortion bans go from theoretical to looming reality, Americans may be less likely to favor banning abortion in the second trimester. Republicans quickly distanced themselves this week from Graham’s bill for a 15-week national abortion ban, which only has three cosponsors. (A comparable bill in the House of Representatives has 86 cosponsors, which is sizable but still less than half of the Republican caucus.) That hesitation may reflect a nascent shift, some public opinion experts said. As voters are thinking about this, and as I think – more meaningfully – states pass these bans and they’re seeing women denied abortion care in cases they feel are appropriate and necessary, I think they are moving,” said Molly Murphy, a pollster and president at the Democratically-aligned firm Impact Research. “I do think there has been a shift, and that voters are more aware of what these bans do and what they mean.” A poll conducted in part by Impact Research in March — months before Roe v. Wade was overturned in the case known as Dobbs v. Jackson Women’s Health Organization — found that most Americans favored laws banning abortions after 15 weeks. A poll done in August, after the Dobbs decision was released, found the opposite.

Galvanized by Dobbs, More Doctors Are Distributing Abortion Pills by Mail

POLITICO, September 21, 2022

Doctors at online and brick and mortar primary care companies are slowly starting to prescribe medication abortion pills via telemedicine in states where it’s still legal following the Supreme Court’s Dobbs decision ending the constitutional right to the procedure. The FDA has yet to update its rules to make way for large retail pharmacies to dispense medication abortion, limiting how patients can get pills. In the meantime, these companies are leaning on two mail-order pharmacies to fill their prescriptions. “I don’t know, what’s taking them so long to come up with this plan,” said Ushma Upadhyay, director of research of the University of California Global Health Institute’s Center of Expertise in Women’s Health, Gender, and Empowerment. Last year, the FDA made the companies’ plans possible when the agency permitted doctors to prescribe mifepristone — the first of two pills patients take in the medication abortion regimen — via telemedicine and to ship it in the mail. But the FDA could reverse course if an anti-abortion president were to win election. “Post-Roe America demands that we reimagine where and how abortion care is delivered,” said Carolyn Witte, the co-founder and CEO of Tia, which provides telehealth appointments and abortion pills in California and New York. “We must shift from a siloed approach where abortion is treated as a separate issue to a whole women’s health care model.” Though primary care doctors could provide medication abortion, many are reluctant to do so. That’s because of the FDA’s certification rules for mifepristone distributors, the need to store the pills, the controversy surrounding abortion, and the possibility of being targeted by anti-abortion activists. Most U.S. abortions are induced with drugs, and the online firms offer advantages for patients as well as doctors: There is no location to picket and companies can obscure which physicians are prescribing to protect them from anti-abortion activists. Already, several online abortion clinics — including Choix, Hey Jane, and Aid Access — have physicians on staff certified to prescribe mifepristone. They rely on mail-order pharmacies like Honeybee Health to ship the pills. The FDA last year said it would use its enforcement discretion to permit online pharmacies to send mifepristone through the mail so long as they worked with doctors certified to dispense the drug. Now primary care organizations as well as maternity care companies like Millie Clinic in California and Viva Eve in New York, both of which offer in-person and virtual appointments, are providing medication abortion to patients.

New Abortion Laws Jeopardize Cancer Treatment for Pregnant Patients

Kaiser Health News, September 16, 2022

As abortion bans go into effect across a contiguous swath of the South, cancer physicians are wrestling with how new state laws will influence their discussions with pregnant patients about what treatment options they can offer. Cancer coincides with roughly 1 in 1,000 pregnancies, most frequently breast cancer, melanoma, cervical cancer, lymphomas, and leukemias. But medications and other treatments can be toxic to the developing fetus or cause birth defects. In some cases, hormones that are supercharged during pregnancy fuel the cancer’s growth, putting the patient at greater risk. Although new abortion restrictions often allow exceptions based on “medical emergency” or a “life-threatening physical condition,” cancer physicians describe the legal terms as unclear. They fear misinterpreting the laws and being left in the lurch. For instance, brain cancer patients have traditionally been offered the option of abortion if a pregnancy might limit or delay surgery, radiation, or other treatment, said Dr. Edjah Nduom, a brain cancer surgeon at Emory University’s Winship Cancer Institute in Atlanta. “Is that a medical emergency that necessitates the abortion? I don’t know,” Nduom asked, trying to parse the medical emergency exception in the new Georgia law. “Then you end up in a situation where you have an overzealous prosecutor who is saying, ‘Hey, this patient had a medical abortion; why did you need to do that?’” he said. Pregnant patients with cancer should be treated similarly to non-pregnant patients when feasible, though sometimes adjustments are made in the timing of surgery and other care, according to a research overview, published in 2020 in Current Oncology Reports. With breast cancer patients, surgery could be performed early on as part of the treatment, pushing chemotherapy to later in the pregnancy, according to the research. Cancer experts typically recommend avoiding radiation therapy throughout pregnancy, and most chemotherapy drugs during the first trimester. But with some cancers, such as acute leukemia, the recommended drugs have known toxic risks to the fetus, and time is not on the patient’s side, said Dr. Gwen Nichols, chief medical officer of the Leukemia & Lymphoma Society. “You need treatment urgently,” she said. “You can’t wait three months or six months to complete a pregnancy.”

As Abortion Bans Take Effect, Texas Revises Sex Education to Reduce Teen Pregnancy

NBC News, September 17, 2022

J.R. Chester got pregnant the summer before her senior year of high school. A bright student with good grades, she gave birth, graduated, and was pregnant again when she arrived at college that fall. She was a teen mom — like her mother, her grandmother, and her great-grandmother. Her school did not teach sexual health education, and preventing pregnancy was a foreign concept. Her sons are now teenagers. “If you don’t know your options, you don’t have any,” said Chester, now a program director for Healthy Futures of Texas, a nonprofit sexual health advocacy and education organization…While teen pregnancies have declined in the state and across the country in recent decades, Texas continues to have one of the highest state rates of teens giving birth at 22.4 births per 1,000 girls and women ages 15-19 — the lowest, in Massachusetts, is 6.1. Along with Alabama, Texas has the nation’s highest rate of repeat teen pregnancies. This fall, school districts across Texas are marking a shift to what educators call an “abstinence-plus” curriculum — the first time the state has revised its standards for sexual health education in more than 20 years. Although districts may choose their own curriculum and teach more than the state requires, the state’s minimum health standards now go beyond focusing on abstinence to stop pregnancies and include teaching middle schoolers about contraceptives and giving additional information about preventing sexually transmitted infections, such as the human papillomavirus (HPV) that has been linked to several cancers. Previously, a 2017 report showed 58% of Texas school districts offered “abstinence-only” sexual health education, while only 17% offered curriculums that expanded beyond that. A quarter of schools offered no sex ed. Research shows that sex education programs that teach about contraception are effective at increasing contraceptive use and even delaying sexual activity among young people. Abstinence-focused education programs, on the other hand, have not been shown to be particularly effective at curbing sexual activity among teens…These changes in sex education come as the state ratchets down abortion access following the Supreme Court decision in June overturning Roe v. Wade, which guaranteed a constitutional right to abortion. Texas has one of the nation’s most restrictive abortion laws. The question of how schools educate young people about their sexual health and development has taken on new urgency now that many state governments have enacted abortion bans.

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Note: The information contained in this publication reflects media coverage of women’s health issues and does not necessarily reflect the views of the National Partnership for Women & Families.