1. Sofer, Dalia


Access to reproductive health services is increasingly limited.


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From 1973-the year the Supreme Court ruled in Roe v. Wade-until 2015, states enacted 1,074 measures to restrict women's access to abortion. Of these, 288 (27%) were enacted between 2010 and 2015. President Trump's election in 2016 intensified the threat to reproductive health services; in the words of Vice President Mike Pence, the administration plans to "restore the sanctity of life to the center of American law."

Figure. A flyer tape... - Click to enlarge in new window A flyer taped to the door of Planned Parenthood's Fort Wayne, Indiana, facility announces its July 9 closing. Photo (C) KPC Media Group.

Various actions at the federal level illustrate this change in government priorities. Last January, the Department of Health and Human Services formed a Conscience and Religious Freedom Division within the Office for Civil Rights to enforce "existing laws protecting the rights of conscience and religious freedom" for health care workers (see In the News, April, and Policy and Politics, June). And in April, the State Department's 2017 Country Reports on Human Rights Practices-a survey that tracks human rights violations around the world-deleted a section added by the Obama administration titled "Reproductive Rights," which outlined maternal mortality rates and access to contraception and abortion. The replacement section, titled "Coercion in Population Control,'' now documents incidents of "coerced abortion" and "involuntary sterilization."


At the judicial level, a 2015 California law aimed at promoting transparency for consumers was struck down last June by the U.S. Supreme Court. The state's Reproductive Freedom, Accountability, Comprehensive Care, and Transparency Act required antiabortion centers licensed to provide medical services to post notices informing patients of the availability of free or low-cost family planning services, including abortion, and unlicensed centers to clarify that their services don't include medical help. By a vote of five to four, the justices ruled that the law violated First Amendment protections of free speech by undermining the centers' antiabortion message.


The Supreme Court decision came just a month after the Trump administration revived a proposed rule that would deny federal funds to organizations whose services included providing abortions or making abortion referrals, even though federal funds are not used to pay for abortions. The rule, if finalized, would apply to Title X, which grants about $287 million annually for contraception, screenings for sexually transmitted infections (STIs), and other reproductive health services.


Among the organizations funded under Title X is Planned Parenthood. While Planned Parenthood's 600-plus centers make up just 13% of Title X facilities, they serve 41% of Title X patients. In 2016 the organization offered reproductive health services to 2.4 million patients; these included over 4.4 million screenings for STIs and about 618,000 breast exams and Pap tests.


In July, following what it called "intimidation and harassment" of patients and providers by antiabortion activists, the Planned Parenthood of Indiana and Kentucky (PPINK) facility in Fort Wayne, Indiana, shut down. "Hundreds of people just lost access to their trusted health care provider," Christie Gillespie, president and chief executive officer of PPINK, told AJN. "The closest PPINK health center is 70 miles away in Elkhart, Indiana, which is too far for many to travel. Other providers in Fort Wayne might not provide the same range of services or be able to absorb enough patients to fill the gap."


Gillespie added that Indiana's maternal mortality rate is "double the national average, and chlamydia and gonorrhea rates have increased statewide every year since 2013. Hoosiers," she said, "need better access to reproductive health care, not fewer providers."-Dalia Sofer