State legislature ignores real reproductive healthcare needs, showers funding on destructive fake clinics

As the legislature muddles its way through another contentious and lengthy budget process, one thing that remains painfully clear is that comprehensive reproductive healthcare — including affordable access to contraception and pre- and postnatal care — is still not a priority for some elected officials. This unfortunately seems to be what we can expect from a gerrymandered legislature that continues to treat this vital form of healthcare, especially for women and people who can get pregnant, as a political and ideological issue rather than an issue of health, safety, and economic security for families across the state.

As one of only 12 states that still stubbornly refuses to expand Medicaid, North Carolina received a “D” on the status of women’s healthcare in a 2019 report, with 13% of women in the state uninsured and the 11th highest infant mortality rate and 10th highest sexually transmitted infection rates in the country. Our state also has lost at least 10 labor and delivery units since 2013, particularly in rural areas, during the decade that our legislature has not meaningfully addressed the lack of access to affordable healthcare.

There has long been a clear and pressing need for access to quality, affordable reproductive health and maternity care in the state, but for the last decade legislative leadership has focused on:

  • Defunding reproductive safety net healthcare providers,
  • Attacking comprehensive sex education, and
  • Restricting access to both abortion and contraception.

One consistent budget allotment that makes clear the legislative leadership’s view of reproductive healthcare is the increasing amount of public dollars that have been funneled into anti-abortion fake clinics, otherwise known as “crisis pregnancy centers” or CPCs. While it’s often couched under the generic euphemism of “helping women,” the purpose of these fake clinics is unmistakable — toend access to all abortion by spreading anti-abortion and anti-choice propaganda and harmful myths and inaccuracies about sexuality, family, pregnancy, and gender roles.

CPCs deliberately misrepresent themselves as healthcare clinics, despite typically offering few substantive healthcare services. Having been provided direct funding from our state for almost a decade, it’s still unclear if or how they contribute to improved maternal and infant health outcomes. Their own reports to the state have often included broad, vague, and inconsistent metrics like the number of people seen, “educational events,” and referrals made; or generic “employee expenses” or the number of products and trainings purchased from anti-abortion organizations. Despite their claims, there is little evidence we’ve seen from these publicly funded fake clinics that they are improving actual healthcare outcomes.

Their websites often provide no additional evidence of their healthcare activities. While stating they provide “non-judgmental care,” what typically follows are pages of medically inaccurate information about abortion, pregnancy and contraception and language designed to shame people who have had abortions. While CPCs sometimes offer people access to baby care items, often used as incentives for their programs, these are not a substitute for quality prenatal and postpartum care. Coercing and shaming people into not accessing abortion or contraception, an obvious goal of CPCs, has no place in an equitable and patient-centered healthcare system.

One concrete number you may see from CPCs is how many people they claim to have diverted from accessing abortion. In addition to not knowing anything about how that outcome is measured, such actions do not constitute healthcare and tells us everything we need to know about CPC priorities – priorities they expect us to fund through our public health dollars. There is a longstanding and urgent need for affordable access to services for people in North Carolina who are experiencing an unplanned pregnancy, particularly people who have not had access to affordable and consistent quality, comprehensive healthcare. Surely the money being diverted to CPCs could be better used funding evidence-based, proven healthcare and safety net services.

Our goal as reproductive healthcare advocates is to make sure all people have the information, resources, and support they need to make decisions that are best for themselves and their families, including the decision to have an abortion. CPCs operate from an opposite stance. These fake clinics don’t take reproductive health any more seriously than the anti-abortion, anti-equity leaders at the legislature. Whether it’s false or co-opted narratives of reproductive oppression, misleading claims of providing actual healthcare, or moral justifications for the harm of deceiving or blocking people from seeking abortion, access to reproductive care is just one more political football anti-abortion lawmakers use to gain and keep power, creating a state that is neither responsive to the needs of its residents nor representative of its constituents’ priorities.

Tara Romano is the executive director of NARAL Pro-Choice NC.

After nearly a half-century, attacks on Roe v. Wade continue to jeopardize reproductive freedom

Today is the 48th anniversary of the U.S Supreme Court decision Roe v. Wade, a decision affirming that everyone in this country has the right to make the personal decision to access abortion free from government interference. People had been accessing abortion well before this 1973 court decision, but we’ve had 48 years of it being legal to do so. We’ve also had 48 years (and more) of false narratives, stigma, and harassment from elected officials and others opposed to this basic right.

For a large segment of the American population, there has never been a time when one could not legally access abortion. But with a vocal and ruthless anti-abortion minority – and to be clear opposition to legal abortion is a minority opinion – devoting the last 48 years to undermining this legal access, abortion in many places, including the South and Midwest, is virtually unobtainable for too many people.

The last four years in particular have moved us backwards. The extreme hostility of the Trump-Pence administration to bodily autonomy and reproductive freedom brought us constant attacks via administrative law and Executive Orders, an escalation in anti-abortion rhetoric, harassment, violence, and intimidation at abortion clinics, and an increasing diversion of healthcare tax dollars to anti-abortion fake clinics. While much of this damage to reproductive healthcare access can be undone going forward by the new Biden-Harris administration (something that will bring much needed relief for those who provide and access this care) it was the Trump administration’s appointment of three anti-abortion Supreme Court justices and more than 200 conservative federal judges that will be the previous administration’s lasting anti-choice legacy.

The Supreme Court’s recent decision in FDA v. American College of Obstetricians and Gynecologists was a 6-3 ruling demonstrating the anti-abortion justices’ willingness to continue singling out abortion care for restrictions that would never be placed on other healthcare procedures. The justices ruled that medication abortion can be restricted from telemedicine even when telemedicine options are being pushed for every other possible procedure due to a global pandemic that requires people to isolate.

While this case may seem minor in impact in places like North Carolina, where telemedicine has been unnecessarily banned for abortion since 2013, it is likely a precursor to more impactful cases to come. Read more

Partisan gerrymandering and the fight for reproductive freedom

Yesterday, the Supreme Court of the United States heard oral arguments in the North Carolina cases of Rucho v Common Cause and League of Women Voters v. Rucho. These cases are asking the Court to weigh in, again, on the constitutionality of partisan gerrymandering. The courts have often held that it’s up to lawmakers to decide when partisan gerrymandering is so political it effectively thwarts the will of the electorate. We won’t try to guess what the Supreme Court may decide, but we are watching these cases closely, with part of the argument having been handled by our friends at the Southern Coalition for Social Justice.

At NARAL Pro-Choice North Carolina, we’ve long advocated that voting rights are intricately connected to reproductive rights. Whether we are advocating for abortion rights; equitable access to contraception and prenatal care; affordable child care; paid family leave; or support for survivors of domestic and sexual violence, we know that our right to equitably access the ballot box to choose our elected officials is a key component of citizen advocacy, no matter the issue. A robust government of the people that allows for the exchange of ideas and truly values the input of diverse voices will lead us to a more just, equitable and democratic society.

Unfortunately, partisan gerrymandering of legislative districts robs us of a government by the people. It instead creates a government that is barely responsive to everyday citizens as it positions itself to coast by indefinitely on safe districts and uncontested races. When numerous candidates are continually running for election to the General Assembly without general election challengers, or lawmakers in “safe” districts believe they have some kind of mandate simply because they were drawn districts that cater to their ideology, we are left with a legislative body that feels compelled only to respond to other elected and government officials and special interests inside the Legislative Building. They then ignore the voices of the constituents outside of the building who rightly feel they have been left without any representation, and that the system has been rigged against them.

An example of how this rigging impacts policies can be seen in how leadership in the General Assembly has advanced restrictive abortion laws in the past decade. Despite North Carolina being one of a handful of states that legalized some types of abortion prior to 1973’s Roe v Wade Supreme Court decision, and also established a state abortion fund in 1978, North Carolina has recently become one of the most hostile states when it comes to abortion access. The majority of North Carolinians, like people across the country, support access to safe and legal abortion no matter their personal feelings on this issue. And many don’t believe the General Assembly should focus on restricting access to abortion rather than acting on issues such as access to affordable health care and supporting public education.

Despite the narrative of extreme polarization in our society, many North Carolinians share similar values. We believe in a living wage; on-the-job protections from discrimination; the expansion of health care access; the protection of reproductive rights; and free and fair elections, including independent redistricting. Rather than the opportunity for robust policy debate on issues, we have gerrymandered our way to a government by, of and for out-of-touch lawmakers chiefly concerned with holding onto their own power. And this is not what democracy looks like. We hope the Supreme Court also sees it that way.

Supreme Court hears arguments on law regulating fake clinics (aka “crisis pregnancy centers”) today

Oral arguments in NIFLA v Becerra are being heard today at the Supreme Court of the United States. At its core, this case is about the right and duty of states to regulate the commercial speech of agencies that claim to provide health services to the general public, specifically people experiencing unplanned pregnancies. This case arose from a California law, the Reproductive FACT Act, which represented an effort to protect patients from deceptive and misleading reproductive health information as well as to prevent unnecessary delays in prenatal, abortion and contraceptive care that may happen as a result of visiting fake medical clinics that have an anti-abortion ideology.

Sometimes known as “crisis pregnancy centers” or “CPCs,” these fake clinics often advertise their services directly to women experiencing an unplanned pregnancy. By offering free services like pregnancy tests and ultrasounds, and locating themselves in low-income communities and near college campuses, these centers often target people who traditionally have had less access to affordable, quality health care. And rather than make efforts to ensure low-income communities have access to the comprehensive and quality reproductive health care they need, 14 states around the country, including in North Carolina, have diverted tax dollars to these centers that pose as medical clinics and target vulnerable communities. Many of these clinics may not have any medical professionals on staff; they often are misleading about the services they provide; and they often spread medically inaccurate information about abortion and birth control.

In the AMA Journal of Ethics, a recent article entitled “Why Crisis Pregnancy Centers are Legal but Unethical”, Drs. Bryant and Swartz outline concerns about these fake medical centers that have been a key tool of the anti-abortion movement:

“Perhaps most worrisome, regardless of whether a particular location is licensed, CPCs engage in counseling that is misleading or false [8]. Despite claims to the contrary, these centers do not meet the standard of patient-centered, quality medical care [18]. The counseling provided on abortion and contraception by CPCs falls outside accepted medical standards and guidelines for providing evidence-based information and treatment options. For example, CPCs often suggest a link between abortion and subsequent serious mental health problems [3], while multiple studies have invalidated this assertion [19-21]. Similarly, centers cite debunked literature showing an association between abortion and breast cancer [22]. Although abortion has been shown to be safer than childbirth [23], it is portrayed as a dangerous or even deadly procedure [7].”

The article concludes that “Although crisis pregnancy centers enjoy First Amendment rights protections, their propagation of misinformation should be regarded as an ethical violation that undermines women’s health.”  These fake health centers often state they don’t take insurance; and people who have adequate insurance and regular access to health care providers likely are not the people who are accessing these clinics. These fake medical centers deliberately target low-income people in part because they know that we as a society turn a blind eye to substandard care received by people who can’t afford quality care. This should not be normal, and should not be tolerated. All people deserve access to factual, medically accurate, unbiased, non-judgmental and compassionate care, no matter their zip code or their income.

Let’s hope the Supreme Court agrees.

Follow #EndTheLies and #ExposeFakeClinics on social media to learn more about this case, and these fake health centers around the country.


Comment deadline is midnight tonight (Dec. 5) on Trump administration birth control rule

Tonight (at midnight) ends the public comment period for the Trump administration’s October 2017 rule that would give employers, health insurance providers and universities an opportunity to deny birth control insurance coverage for their employees and students. This new rule is in response to the Obama-era Affordable Care Act (ACA) provision that required health insurance plans to include coverage for FDA-approved-contraception methods with no co-pay for plan beneficiaries. This provision was a big benefit to people across the country who suddenly found their chosen contraception method more affordable, and therefore much more accessible.

From the introduction of this ACA provision, there was pushback from conservative forces, despite the fact that the original provision provided exceptions for religious institutions that did not believe in the practice of using birth control. For some employers the original exceptions were not enough, and they were able to get expansions of the ability to opt out of providing this benefit. And while it seemed like the balance between religious liberty and access to medical care had been achieved, the Trump administration, in an apparent concession to very conservative special interest groups, issued the October rule (effective immediately) that expanded the number of institutions that could claim a “religious or moral” exception to providing birth control coverage to its employees, and therefore drop it.

The Obama-era provision was a popular one in particular with low-income and young people who need to access contraception for both pregnancy prevention and other medical needs. This ruling that in effect makes it optional for many employers to offer the coverage at all has the potential to adversely impact the health and lives of many people, and can be seen as legitimizing discrimination, rather than preserving religious liberty. Despite what some suggest, this original provision is not offering “free contraception” to employees or students. All employer/university-sponsored insurance is provided in exchange for labor and/or cost-sharing (including paying partial premium costs, or tuition costs). Denying those entering into that deal the full range of benefits simply because they have uterus/ovaries is discriminatory, and will result in higher health care costs for this group.

The current Administration has suggested that this expansion of the exceptions to providing this coverage likely won’t impact that many people. Read more