“Today, Rep. Trent Franks announced that he’s not content to deny the women of D.C. their constitutional right to safe and legal abortion so he’s extending his bill to prevent all of the women in America from exercising choices about how and when they have families.

“Rep. Franks is using this bill in a shameless effort to exploit the terrible tragedy in Pennsylvania where Kermit Gosnell was just convicted of murder for performing illegal abortions that resulted in killing of infants and women. The women of America deserve better.

“Gosnell was a criminal whose activities were made possible by the very kind of anti-choice policies Franks is advancing. By cutting funding, reducing access and imposing unnecessary restrictions on safe and legal abortion, anti-choice politicians have forced women – especially low-income women – into the waiting hands of unscrupulous operators like Kermit Gosnell.

“We will fight this senseless attack and protect the rights of all women.”

* For more on Rep. Trent Franks’ federal 20-week abortion ban, please see HuffPo.

Missouri’s 2013 legislative session closed on May 17, as the house and senate wrapped up their final day of voting. For low-income and uninsured women in the state, the end couldn’t come soon enough. Lawmakers made it a priority to block expansion of Medicaid and access to birth control, while at the same time funneling tax credits to so-called crisis pregnancy centers (CPCs), which provide misleading or outright inaccurate information and are often run by volunteers passing themselves off as health-care providers. Add into the mix a new law that will make it more difficult for women to access medication abortion services, and Missouri politicians proved yet again their willingness to deny women access to health care.

“The Missouri Legislature is following a disturbing trend in state legislatures across the country,” said Peter Brownlie, president and CEO of Planned Parenthood of Kansas and Mid-Missouri, and Paula Gianino, president and CEO of Planned Parenthood of the St. Louis Region and Southwest Missouri, in a joint press release following the session’s close. “Just months after women’s health was a determining issue in a historic election, 42 states saw hundreds of provisions introduced to restrict access to health care and to put politicians between a woman and her doctor. Yet again, we are seeing the wrong priorities come out of the Missouri Legislature on matters of women’s health. Instead of increasing access to preventive health care, the legislature is working to restrict access to birth control and non-surgical abortion while giving millions of tax dollars to groups that are known to provide misleading information to women about their pregnancies.”

The legislature has now made it legal for medical providers not only to refuse to offer care or fill a prescription, but to refuse to offer a referral as well, thanks to HB 457, an expanded “conscience” protection bill. The implications could be devastating for individuals in rural areas seeking access to emergency contraception in a limited window of time, who may need to travel great distances to find a hospital willing to provide the drug, or for those attempting to fill birth control prescriptions in areas with few pharmacy options. The state also passed a bill that forbids the practice of telemedicine as a means of delivering medication abortion, by prohibiting use of RU-486 unless the patient is in the physical presence of a doctor.

Also passed this year is an extension of a program that allows donors to crisis pregnancy centers to write the donation off on their taxes. CPCs in the state claim that donations to their groups began to drop when the original program expired. Crisis pregnancy centers in many states have been under fire for passing themselves off as medical centers, for refusing to mention up-front that they do not offer abortion nor contraception nor provider referrals, and for spreading medically inaccurate falsehoods by claiming, for example, that abortion increases the risk of cancer, that contraception has high failure rates, and that condoms do not prevent sexually transmitted infections.

The legislature also refused to expand Medicaid, which will continue to affect low-income uninsured women who need access to basic preventive medical care. Currently, Missouri’s Medicaid program covers only citizens at 32 percent of the federal poverty level. The expansion, which would have been fully funded by the federal government, would have raised the cap to 132 percent of the federal poverty level (a single person making $15,000 a year would quialify). Expansion would have allowed an additional 267,000 individuals in the state to be covered by Medicaid, according to the Missouri Budget Project.

Still, there were a few reproductive rights wins. The state’s medication abortion bill might have required even more trips back to the clinic, but an amendment was passed eliminating such language. A bill to revamp an “informed consent” rules never gained any traction, and a spousal consent bill never got introduced.

Now, the legislature rests for another year. Meanwhile, activists on both sides will watch to see if Democratic Gov. Jay Nixon will veto the medication abortion bill, sign it, or simply allow the bill to become law by not acting.

In 1973 the Supreme Court decided in the landmark case Roe v. Wade to recognize the constitutional right to abortion for all women. Forty years later, however, this guarantee remains an empty promise for thousands of poor women and women of color thanks to the Hyde Amendment, an annual appropriations measure first passed in 1976. This provision intentionally discriminates against poor women by prohibiting Medicaid, the health-insurance program for low-income individuals and families, from covering abortion care.

Because of the intersection in our country between race, ethnicity, and socioeconomic status, this restriction also has a disproportionate impact on women of color. Due to a number of root causes related to inequality, women of color are more likely to qualify for government insurance that restricts abortion coverage, more likely to experience higher rates of unintended pregnancy, and less likely to be able to pay for an abortion out of pocket. The Hyde Amendment therefore does not only undermine gender equity, but it also violates principles of racial and economic justice.

The Hyde Amendment discriminates against poor women

• Congress passed the Hyde Amendment in order to deny poor women access to abortion. Former Rep. Henry Hyde (R-IL), the law’s sponsor, admitted during the debate of his proposal that he was targeting poor women. “I certainly would like to prevent, if I could legally, anybody having an abortion, a rich woman, a middle-class woman, or a poor woman,” he said. “Unfortunately, the only vehicle available is the … Medicaid bill.”
• 1 in 10 women of reproductive age in the United States relies on Medicaid for their health coverage. By prohibiting Medicaid from covering abortion services, the Hyde Amendment has used the primary source of health care for low-income women to restrict access to abortion.
• Poor women face significant disparities when it comes to reproductive health.Compared with higher-income women, poor women’s rates of unintended pregnancy and abortion are each five times as high, and their unplanned birth rate is six times as high. These disparities are rooted in deeply entrenched inequities in the areas of health-insurance coverage, health care, and medically accurate sex education, as well as other health-promoting resources.
• Abortion costs between $300 and $950 in the first trimester, making it unaffordable for poor women without insurance coverage. In 2009 more than half of nonelderly adult women enrolled in Medicaid had family incomes below the poverty level; one-quarter had incomes below 50 percent of the poverty level. The monthly income for a family of three living at half the current poverty level is $813.75.
• One in four Medicaid-qualified women who seek an abortion is forced to carry her pregnancy to term because of cost. Many more are forced to delay their procedure for as long as two to three weeks while they raise money, with the costs and risks of the procedure increasing the longer they wait.

The Hyde Amendment discriminates against women of color

• A dissenting Supreme Court opinion recognized that the Hyde Amendment was discriminatory. Supreme Court Justice Thurgood Marshall’sdissenting opinion in Harris v. McRaenoted that the law was “designed to deprive poor and minority women of the constitutional right to choose abortion.”
• Women of color are disproportionately poor and therefore less likely to be able to pay out of pocket for their health care. According to 2011 census data, 25.5 percent of African Americans and 25 percent of Latinas are living below the poverty level, compared to only 10.4 percent of whites and 12.2 percent of Asians. Moreover, certain groups of Asian and Pacific Islander women face much higher poverty rates than are reflected in the aggregate census data. For example, 67 percent, 66 percent, and 47 percent of people of Laotian, Hmong, and Cambodian descent, respectively, live in poverty in the United States.
• Women of color are more likely to be enrolled in government insurance. In 2011, 40.9 percent of African American females and 36.3 percent of Latinas had government-based insurance, including 29.2 percent and 29.6 percent participation, respectively, in Medicaid. In contrast, 32.6 percent of white females and 24.4 percent of Asian American females got their insurance through a government program. While Asian and Pacific Islander women use Medicaid at lower rates for a variety of reasons—only 6 percent were enrolled in the program in 2004—participation is quite high among various subgroups. For example, 20 percent of women of Southeast Asian descent are covered by Medicaid.
• Women of color are disproportionately more likely to need an abortion. Black women had the highest unintended pregnancy rate of any racial or ethnic group and more than double that of non-Hispanic white women. The unintended pregnancy rate of Latinas is 78 percent higher than the non-Hispanic rate. These high unintended pregnancy rates are part of the reason women of color seek abortion at higher rates than non-Hispanic whites. Although they represent much smaller segments of the population as a whole, black and Latina women comprise 30 percent and 25 percent of women who have abortions, respectively. Data on Asian and Pacific Islander women’s utilization of health services, including abortion, is extremely limited, but one study has shown that 35 percent of pregnancies for Asian and Pacific Islander women end in abortion, compared to 18 percent for non-Hispanic white women.
• These health disparities mirror other health disparities that women of color experience. Inaddition to higher rates of unintended pregnancy and abortion, women of color face higher rates of reproductive cancers, HIV and other sexually transmitted infections, premature births, low birth weights, and maternal and infant morbidity and mortality. They also encounter poorer health outcomes for diabetes, cardiovascular disease, and obesity, among other health conditions.
• Root causes of inequality drive the health disparities women of color face. Differential access to treatment, lower levels of respect and competency from health care providers, lack of trust in the medical establishment, lack of accurate information, and a host of other socioeconomic factors lead to poorer outcomes along racial and ethnic lines for overall health indicators, specifically with regard to reproductive health.

The Hyde Amendment treats the rights of women in this country according to two different standards: whether you can afford to pay for your rights or not. That is not equality.

Repealing the Hyde Amendment and similar restrictions will not, by itself, ensure full equality for poor women and women of color. But doing so is a necessary precondition. Anyone who cares about fighting racism and poverty must realize that attacks on abortion—and especially on abortion coverage—are first and foremost attacks on poor women and women of color.

It does not take a rocket scientist to realize that in health-care settings a positive relationship between clinician and patient—one comprised of mutual understanding, respect, and trust—is beneficial to both parties. It is only common sense that when such a  relationship exists, however brief it may be, the provider develops more sympathy for the needs of the patient, and the latter’s overall well-being can improve if she or he senses personal interest and concern on the part of the former.

Arguably, this point is especially relevant in abortion care because of the extreme politicization and stigma that surrounds the procedure. Some patients, having been exposed to anti-abortion distortions, are terrified of the procedure (one provider told me of a patient who asked, “When are you going to use the steel ball with the knives on it?”) and some do not view abortion doctors as “real” doctors. Some physicians, in turn, depending on the circumstances of their particular facility, have little chance to interact with patients, except when she is on the procedure table, possibly under anesthesia. Therefore, these providers may have an inadequate understanding of the reasons that brought these women to the clinic. Indeed, several research studies of abortion staff done soon after abortion became legal in the United States have shown that those who had opportunities for verbal interaction with patients—for example, social workers and counselors—were more positively inclined toward patients than those whose interactions were confined to just physical care. My own research among abortion providing physicians has revealed that the aspect of this work many find most meaningful is simply talking to patients, and some are wistful that there is not more opportunity for this.

In the period immediately after Roe v. Wade, it was very common in most abortion settings for designated counselors or physicians to have the opportunity for open-ended discussion with a patient. This kind of encounter, which goes beyond offering the patient the requisite informed consent information and ascertaining she has not been coerced into the decision, has been difficult for many facilities to sustain over the years for various reasons, not the least being that in many states patient-doctor time is eaten up by doctors having to impart to patients legislatively mandated scripts about abortion, many of which contain blatant falsehoods. Nevertheless, most abortion facilities with which I am familiar make every effort to offer additional conversational time to patients who seem most in need of it.

What do these efforts to maintain meaningful provider-patient conversations have to do with Live Action, the anti-abortion group notorious for its undercover “investigations” of abortion clinics? For several years, Live Action operatives, pretending to be prospective abortion patients, have gone into clinics, questioning various levels of staff about abortion policies and procedures, and when their hidden cameras manage to catch a staff person making an inopportune comment, the organization triumphantly posts videos (typically highly edited) of these visits.

The latest Live Action “gotcha” moment is in a video of Dr. Leroy Carhart, one of the few providers in the United States who openly provides post-24-week abortions in selected circumstances, and as such is a longstanding target of the anti-abortion movement. In the video, Carhart is repeatedly grilled by a would-be patient, who portrays herself as 26 weeks pregnant, as to the procedure he would use in a pregnancy of that gestation. In response to the woman’s stated concern that a fetus whose demise has been caused by injection “would decay inside of her,” Carhart seeks to reassure her, at one point saying the fetus would soften like “meat in a Crock-Pot.” Predictably, Live Action, and subsequently other anti-abortion groups, have seized upon this statement and used it to further their campaign of what might be called the “Gosnellization” of individuals who provide later abortions—that is, to claim that Carhart and his colleagues are no different than the rogue doctor now on trial in Philadelphia for dangerous and illegal practices.

But Leroy Carhart and Kermit Gosnell could not be more different as abortion providers. As theNew York Times pointed out in its coverage of this incident, “[T]he video provides no evidence of illegal action or subpar medical techniques.” Tracy Weitz, my University of California, San Francisco colleague, further pointed out to the paper the evident concern that Carhart exhibited toward the (imposter) patient, and offered this context to his “Crock-Pot” remark: “Doctors struggle to find terminology to help a client understand what’s happening, and while it may seem wrong to us, it may be appropriate for that conversation.” (The recent film After Tiller also amply demonstrates Dr. Carhart’s compassionate relationship with patients.)

What will be the upshot of this latest Live Action incident? Dr. Carhart, who previously provided later abortions in the clinic of Dr. George Tiller in Kansas before Tiller was assassinated, will not be deterred from his “mission” to carry on his friend’s work, as the former military surgeon often puts it. In the years since he decided to devote himself full-time to abortion work, Carhart has had extremists burn down his barn with 17 horses inside, seen the state of Nebraska pass a law deliberately aimed at preventing him from performing abortions after 20 weeks’ gestation, and is subject to constant protestors at his two clinics as well as vilification in anti-abortion media.

But while Dr. Carhart will continue with his work, I do fear that a possible consequence of these well-publicized Live Action videos may be a chilling effect on the free and open conversation between clinic staff and patients that is such an important part of abortion care. Should this occur, I have no doubt the anti-abortion movement will declaim self-righteously about the “coldness” and “impersonality” of abortion facilities.

On Tuesday, attorneys for the state of Arkansas asked a federal judge to dismiss a lawsuit challenging the state’s 12-week abortion ban, arguing that the law, which criminalizes most abortions performed after 12 weeks, is in the best interest of women and doctors.

The lawsuit, filed by the American Civil Liberties Union of Arkansas and the Center for Reproductive Rights, challenges the 12-week law, arguing it denies patients “their constitutionally-guaranteed right to decide to end a pre-viability pregnancy” as guaranteed by Roe v. Wade. But attorneys for the state argue that the law is constitutional because it furthers the state’s legitimate interest in “protecting the life and health of the pregnant woman, protecting the life of the fetus that may become a child, and protecting the integrity and ethics of the medical profession.”

This case is the latest to directly challenge the viability standard set out in Roe v. Wade and later in Planned Parenthood v. Casey. The fight over Arizona’s 20-week ban is currently working its way through the federal court of appeals.

What’s emerging from the legal challenges in Arizona and Arkansas is a clearer picture of the legal strategy at work. In both cases, anti-choice legislators passed knowingly unconstitutional bills after first stacking the legislative testimony with junk science, which a court is bound by law to defer to and rely on when faced with the question of whether or not the restriction is constitutional.

In short, they are trying to game the system, to create no other alternative for the courts but to either upend precedent or endorse laws that do exactly that. Each pre-viability ban that gets passed is another shot, and the more shots they take, the greater the chances are that one of them will hit.

The high-profile murder case of Kermit Gosnell — a Philadelphia-area abortion doctor accused of performing gruesome, illegal late-term abortion procedures for vulnerable women — has ignited a firestorm of conservative coverage, particularly when right-wing outlets recently claimed the media’s pro-choice bias has deterred major outlets from devoting enough attention to Gosnell’s alleged crimes. Abortion opponents have leveraged the emotional outrage about Gosnell’s horrific case to insinuate that all abortion services can be equated to his illegal procedures, and all abortion clinics need much tighter regulations. But since the facts don’t back them up, the right wing media is happily twisting the truth to continue juicing their narrative about Gosnell.

Claiming that Gosnell’s case proves that late-term abortion is always a horrific act, anti-choice activists are hoping to use the buzz around the murder trial as an impetus to ban those services altogether. A Republican Congressman from Arizona has already revived his effort to force a 20-week abortion ban upon the nation’s capital by invoking Gosnell’s name, claiming that criminalizing late-term abortions in DC will help “keep attention” on the Gosnell case. And now, an anti-abortion group is touting a new investigation into late-term abortion clinics, claiming their research proves that murdering live babies is actually a rampant practice among other abortion doctors.

Live Action — an anti-choice group that has a long history of spearheading smear campaignsagainst abortion providers, particularly Planned Parenthood — provided the Washington Postwith the exclusive details about their six-month long investigation into abortion clinics. The group sent women to inquire about late term abortion procedures and recorded the exchanges that those women had with the staff at several clinics. Live Action’s president, Lila Rose, saysthe resulting videos expose the “truly gruesome, illegal and inhuman practices” that occur at these clinics.

But in reality, as Media Matters details, Live Action simply edited the transcripts of the exchanges to make it appear as if the abortion clinic staff is endorsing infanticide. The group’s undercover investigators are posing hypothetical scenarios to the abortion providers about what would happen if a late-term abortion procedure were unsuccessful and a baby were born alive. Such a situation is incredibly rare, and most late-term abortion providers say they have never seen it happen.

The tapes do not depict abortion doctors endorsing murdering live babies. Rather, the doctors are simply explaining that the situation almost never happens — but if it did, they would follow the standard medical procedures that are employed when a wanted baby is born very prematurely. In those cases, it is not always possible to save the baby despite the best efforts of medical staff.

Another reporter at the Washington Post followed up with Cesare Santangelo, a DC-based abortion doctor who unknowingly appeared in Live Action’s video. Santangelo, who has been an OBGYN in the District of Columbia since 1987, thought he was having a routine conversation with a client who was nervous about the medical procedure. He said he was “tripped up” when that client posed a hypothetical situation — a live baby being born after a failed abortion — while he was trying to reassure her. During the more than two decades that he has practiced abortion care, Santangelo has never experienced that, and he has no desire to commit crimes against a live baby. “Once the baby is born, it’s out of everybody’s hands, and the baby has rights, too,” Santangelo said. “I understand that and I support that.”

Santangelo explained that the majority of the clients who come to his clinic for late-term abortions have discovered serious fetal abnormalities, and are choosing to terminate a pregnancy that they would not have ended otherwise. Some of them are victims of rape and incest. That’s very typical for the few women who opt for late-term abortions, which is already a very rare procedure. On a national level, barely one percent of abortion procedures are performed after 21 weeks of pregnancy. Banning these type of services affects a very small number of women, but those women are the ones who are in the most desperate of circumstances.

This is not the first time that right-wing outrage has erupted over a manufactured controversy stemming from a totally hypothetical “live birth” scenario. At the beginning of this month, abortion opponents claimed that a Planned Parenthood affiliate in Florida openly endorsed murdering live babies. That false claim was driven by the exact same hypothetical situation that Live Action posed to abortion doctors like Santangelo. During a congressional hearing, anti-abortion state lawmakers demanded to know what Planned Parenthood would do if a baby was born alive following a botched abortion, even though the organization doesn’t actually perform that type of late-term termination procedure. When Planned Parenthood’s lobbyist wasn’t able to provide any concrete details in response — since it was an entirely hypothetical situation that is practically impossible at a Florida Planned Parenthood clinic — the right-wing media declared that the women’s health organization had endorsed infanticide.

But just as the statements made during that congressional hearing in Florida were taken totally out of context, Live Action’s new “investigation” is also based solely on taking abortion clinic employees’ words out of context. Abortion opponents are currently trying to make a case against reproductive rights by conflating issues that don’t actually have anything to do with each other — equating incredibly rare late-term procedures with first-trimester abortions, illegal acts with legal health care, and criminals with reputable abortion providers.

And, as many progressive outlets (including this one) have pointed out, this knee-jerk reaction to Gosnell’s alleged crimes is actually counter-productive. Pushing to tighten restrictions on all abortion providers ultimately makes it more difficult for women — particularly vulnerable, economically disadvantaged women of color — to access the reproductive care they need. And that drives those desperate women to put their lives at risk at illegal clinics such as Gosnell’s, rather than successfully accessing safe and legal abortion services at clinics like Santangelo’s.