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Women’s Health

The Unique Dangers of the Supreme Court’s Decision to Hear a Mississippi Abortion Case

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One of the most striking facts in Dobbs v Jackson Women’s Health Organization, a case now approved by the Supreme Court, concerns the identity of one of the parties. Jackson Women’s Health is the only licensed abortion clinic in Mississippi. Women seeking their services often have to drive hundreds of miles to the pink building on North State Street in Jackson and either travel twice or find accommodation – Mississippi has a twenty-four hour wait after mandatory entry to personal counseling. Girls under eighteen require parental permission or a court waiver. And when a woman arrives, she’s usually exposed to people shouting through megaphones that she’s murdering her child. The city tried to limit the noise reportedly heard by businesses on the street, but the ordinance was lifted after a challenge. “If there are demonstrators outside on the day of your procedure, please ignore them and come straight to the clinic,” advises the clinic’s website. “You don’t have to stop.”

Illustration by João Fazenda

Jackson Women’s Health has another distinction. There is every possibility that the case that bears his name – along with that of Thomas Dobbs, the Mississippi State Health Commissioner – either Roe v. Wade and Planned Parenthood of Southeastern Pennsylvania v. Casey, the two Supreme Courts, turns decisions that are the foundation of reproductive rights or that render them powerless. This case began as a challenge to a Mississippi law that banned abortions after fifteen weeks (from a woman’s last menstrual period), except in very restrictive circumstances. A woman would face a medical emergency that could cause “significant and irreversible impairment of an important body function” or threaten her life. The only other exception would be if doctors found that even if the fetus is brought to full delivery, it cannot survive. Rape and incest are not taken into account.

Crucially, fifteen weeks is well before the point at which a fetus would be viable outside the womb, and at that point the Supreme Court has found that a woman’s interest in control of her own body outweighs all other interests of the state. Mississippi bill so clearly contradicts the Court’s precedents that Judge James Ho, a Trump appointee on the US Fifth Court of Appeals, wrote in a 2019 statement that it was his “duty” to put it down, even if he railed about it Pain inflicted on “innocent babies”. Similar state laws are regularly struck down. Then why did the Tribunal take it?

The obvious, depressing answer is that Dobbs is being debated against Jackson Women’s Health in the term beginning October, with Amy Coney Barrett sitting in place of Ruth Bader Ginsburg, who passed away last September. It’s a good bet that Barrett, Neil Gorsuch and Brett Kavanaugh – the Trump trio – along with Samuel Alito and Clarence Thomas will try to severely restrict reproductive rights. You wouldn’t even need John Roberts. Groups working to restrict these rights clearly see this as a moment of opportunity. In recent months there has been a multitude of anti-election laws at the state level. The Guttmacher Institute issued 28 new legal restrictions in the four days between April 26 and 29. Perhaps the most pressing question now is not whether Roe and Casey can survive, but how reproductive rights can be maintained without them.

The specific question the Court has announced to consider is: “Are all premature abortion bans unconstitutional?” The wording is important. Casey allows states to regulate abortion in certain ways before it is even viable, as long as the rules don’t “place undue burden” on women. However, the burdens have become quite inadequate in recent years, from mandatory waiting times to approval requirements for clinic closings. It is no coincidence that there is only one clinic in Mississippi and few in Alabama, Arkansas, Louisiana, and other states. About ninety percent of the counties in the United States do not have an abortion clinic. Prior to the pandemic, the AP estimated that over two hundred and seventy thousand women traveled to another state to obtain an abortion in a five-year period. Even now, the reality of having access to abortion for a woman in the Northeast or California is in stark contrast to that for a woman in the South or Midwest. The Mississippi case is different and more radical because the state implausibly claims that its near-complete ban on abortion after fifteen weeks is nothing more than a ruling Casey envisions. Indeed, in its pleadings on behalf of the Court of Justice, the State strongly opposes the use of the word “prohibition” to describe the law.

One particularly shameless defense of Mississippi law is found in an Amicus Curiae letter submitted by Texas and seventeen other states. It is argued that the court should treat Mississippi law not as a profound conceptual shift from regulation to prohibition, but rather as a minor adjustment, given that it is already so difficult to obtain an abortion in this state. Jackson Women’s Health only offers abortions until the sixteenth week, and the Amicus Brief insists that the clinic “needs to explain why these women couldn’t schedule their abortions a week early”. That argument is doubly insincere because shortly after the Fifth Circuit lifted the fifteen-week ban, Mississippi passed an even more extreme case for abortions after six weeks. This law has been blocked by the courts. There are also pending challenges for near-total bans approved in Arkansas in March and Oklahoma in April – and against a law signed by Texas Governor Greg Abbott on May 19 that bans abortion after a heartbeat is detected. This can take as long as six weeks, and often before a woman knows she is pregnant.

And yet, as tough as the heartbeat law is, it only took Texas a week to beat it. Last Wednesday, the state parliament passed a so-called “triggering law” that would come into force if Roe was overturned. It would almost completely ban abortion, as would similar trigger laws that exist in a dozen other states such as Missouri, Tennessee, and Utah. (Some of these states also have heartbeat laws.) By comparison, about a dozen states have taken measures to ensure access to abortion to some extent. California, for example, still has a pre-Roe law that legalizes abortion on the books. More states need more robust trigger laws that would protect reproductive rights, and they are likely to need them soon. Some of the major conflicts in the coming years are likely to take place in state legislatures, which run in the spaces between landmark court cases. The Mississippi case doesn’t have to be the end. ♦

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Women’s Health

Why I Invested: Whitney Port on investing in prenatal vitamin brand Perelel

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Perelel, touting himself to be the first OBGYN-founded prenatal vitamin supplement brand to offer targeted nutrition at each stage of pregnancy, recently announced the completion of a $4.7 million seed fundraise with notable participation from celebrities in business, fashion, and wellness.

The company’s subscription-based business model spans a number of product offerings targeted for the particular life stage the customer is in, including a conception support pack; prenatal packs for first, second, and third trimesters; packs for postpartum and early motherhood; and daily vitamins for women of all reproductive ages. Perelel also has offerings for men, including a multi-support pack and additional supplemental products for iron, libido, and probiotic support.

The Hills star and Cozeco founder Whitney Port recently shared more with Fortune about her own prenatal experiences and subsequent interest to invest in the company.

  • Startup: Perelel
  • Location: Santa Monica, Calif.
  • Year founded: 2018
  • valuation: Declined to disclose
  • investment level: Seed
  • Number of employees: Nine
  • Other major investors: The seed round was led by Unilever Ventures with additional investors including Willow Growth Partners; Gaby Dalkin, CEO of What’s Gaby Cooking; Marissa Hermer, restaurateur and owner of the Draycott, Olivetta, and Issima; Rocky Barnes, founder of The Bright Side; Julia Hunter, dermatologist and founder of Wholistic Dermatology; Joan Nyugen, co-founder and CEO of Bumo; Aimee Song, founder of Song of Style and Two Songs; and Ali Weiss, chief marketing officer of Glossier

Why she invested, in her own words

Since striving for child number two, I’ve become much more conscious about the ingredients I put into my body. In my research on prenatal vitamins, I learned that most supplement brands on the market offer a one-size-fits-all approach to nutrition, which neglects essential dosages and nutrients during the different stages of pregnancy and postpartum. After multiple miscarriages, I learned there isn’t just one answer or one solution to fertility problems. Each miscarriage I’ve had occurred for a different reason.

So, as someone who can intimately relate to these multileveled issues that Perelel is tackling head-on in women’s healthcare, I was immediately drawn to the brand’s innovation and mission-driven business model. After the birth of my son, postpartum presented additional problem areas for me and I needed a boost; Perelel checked all the boxes I needed. Now I know countless women who are struggling similarly and would truly benefit from the product.

Perelel is much more than a business venture for me, and the value proposition goes further than a dollar sign. Its products are intentionally formulated for each stage of womanhood by a team of top women’s health doctors, including my reproductive endocrinologist, Dr. Andy Huang (who formulated their Conception Support vitamin packs).

Also, the intentionality behind building the brand community moved me. It’s much more than a customer base; it’s an intimately supportive network of women where we can lean on each other for emotional support and tap Perelel’s panel of doctors and experts for insight. Finally, for every subscription Perelel donates a supply of their own prenatal vitamins to underserved women in the US who lack access to high-quality prenatal care.

This is an installation of Why I Invested, a series featuring famous investors from all different backgrounds and industries, revealing what inspired them to invest their own money in a new business.

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​​While UI faculty are warned against even talking about emergency contraception, WSU will offer emergency contraceptives in vending machine

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Separated by just 8 miles, Washington State University and the University of Idaho remain vastly different places. Now in the post Roe v. Wade era, the differences are more apparent than ever.

This week, the University of Idaho warned faculty and staff that counseling students about abortion or contraception could lead to termination or result in a felony charge. The warning was delivered in a controversial memo that prompted a response from the White House. Meanwhile, across the state line, WSU’s student government announced funding for a contraceptive vending machine that will dispense pregnancy tests, condoms and Plan B, the so-called “morning-after” pill.

“WSU is part of a state system in (Washington) and Idaho is part of a state system in a state that is much more conservative,” said Mike Satz, former law professor and associate dean at the University of Idaho. “The workplace environment is very different for both schools and what it’s like to be a student is very different for both schools.”

The differences have led to confusion and frustration among students and faculty, according to multiple interviews and media coverage.

“It feels awful that my body is having to be used in a political fight,” said Alexandria Miller, a student at the University of Idaho.

Miller worries that the women’s health center on the UI campus will be restricted in the help they can offer students in need of contraceptives and counsel around pregnancy. The Idaho law mentioned in the memo also states that the university cannot dispense any emergency contraception except in the case of rape.

As of now, it is safe for Idahoans to travel to Washington to use resources, but that could change, Satz said.

“There are certain members of the legislature that have clearly shown their intent to want to control women’s choices, no matter where they are,” Satz said. “That is something that advocates for women’s health are looking at in Idaho because we’re very concerned about that.”

At WSU, a different political landscape

WSU’s Director of University Affairs Nikolai Sublett has been spearheading a way to bring an emergency contraceptive vending machine to WSU at a reasonable price. His inspiration came from an Instagram post.

Students were asking where to get Plan B and responses poured in saying that even though Plan B is accessible at places like Safeway, Walmart and Planned Parenthood, they are either sold out or are too far away from campus to be readily available, Sublett said.

Funding for the machine itself, which costs about $4,000, is coming from the budget of the Associated Students of WSU, while funding for the actual products will come from the student government’s Coug Health Fund, he said.

Sublett said emergency contraceptives will be priced at $15 a pill, $35 less than the usual name-brand price.

Excluding the $15 fee for the pill, bringing the vending machine to WSU will be no additional cost to students, he said. Sublett made a purchase request for the emergency contraceptives vending machine on Sept. 19 and hopes to get it ordered within the next two weeks, he said.

At least 22 universities around the country have vending machines for emergency contraceptives on their campuses, with at least 12 more in the works, according to an article from Bloomberg.

Safe sex supplies such as condoms, dental dams and lube are easily accessible on campus at WSU’s Women’s Center and the university’s Gender Identity/Expression and Sexual Orientation Resource Center, according to Amy Sharp, director of WSU Women’s Center.

Sharp said the only option for emergency contraception on campus costs $25 from the Cougar Health Services pharmacy, Sharp said.

“It just adds more accessibility for our students,” Sharp said.

Idaho employees unwilling to speak

Until recently, condoms have been made available on campus to prevent sexually transmitted diseases and pregnancy. Now, they are only advertised to prevent sexually transmitted diseases, Miller said.

“It’s almost considered offensive to talk about the facts of what a condom is used for,” she said.

In media reports, University of Idaho faculty and staff are requesting anonymity when they discuss the topic. The memo urged staff and faculty to refrain from speaking on these issues until they know more.

The fact that professors are asking for anonymity in interviews speaks to a toxic environment in which faculty and staff are afraid to speak, Satz said. He worries the memo could also damage faculty-student conversations for students seeking resources.

“I cannot tell you how many times as a faculty member I’ve had students come with really serious personal problems, and they came to me in my case, because I was one of the few faculty members of color on campus and they knew that they could trust me,” he said. “In this case, I think it’s going to be very damaging to those kinds of situations.”

Satz, who left the University of Idaho in 2020 and has co-founded the Idaho 97 Project, which advocates for sensitive public health measures and an end to hate, intimidation and disinformation, has been outspoken on the issue. This week, he posted a tweet noting the university memo and the Idaho law cite language that was originally written in 1887 – when Idaho was still a territory.

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Women’s Health

ER Goddess: Low-Income Women and Women of Color Will Bear th… : Emergency Medicine News

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figures:

abortion, bias

FU2-7figures

Half of American women seeking abortions live on incomes below the federal poverty level. (N Engl J Med. 2022;386[22]:2061; https://bit.ly/3zYFcRy.) It will be these women—women who are least able to support a pregnancy and a child—who will disproportionately bear the brunt of post-Roe abortion bans.

In anti-abortion states, only women with the financial resources, ability to take time off work, and pay for child care will be able to seek abortions elsewhere. What was formerly a right for all women is now in too many states a privilege for those with money and connections.

My patients generally don’t have money or connections. I work in an urban inner-city ED where the surrounding neighborhood has a lower per capita income, more single-mother households, and a child poverty rate higher than 99.9 percent of the neighborhoods in America. (Neighborhood Scout. http://bit.ly/2Oc37XD.) I recently saw a 12-year-old who is sexually active. Her mother, who had just learned her preteen was having sex, brought her in concerned that she could be pregnant. What will happen to this 12-year-old and other girls and women who come to my ED when they can’t access abortion?

The Turnaway study offers some unsettling insights into what life will be like for women after they are denied an abortion. (Foster, Diana Greene. The Turnaway Study: Ten Years, a Thousand Women, and the Consequences of Having—or Being Denied—an Abortion. New York: Scribner, 2021; https://bit.ly/3JsHBHz.) The prospective longitudinal study compared the trajectories of women who were turned away by abortion clinics because they were too far along to the trajectories of women who received abortions at the same clinic.

Still stigmatized

The two groups were similar in demographics and socioeconomics; what separated them was who got to the clinic in time and who didn’t. Interviews with the women every six months during the five years following their pregnancies revealed that receiving an abortion did not harm women’s health and well-being. On the contrary, carrying an unwanted pregnancy to term harmed their finances, health, and families.

The Turnaway study showed that women who were denied an abortion were more likely to end up living in poverty, be unemployed, and go through bankruptcy or eviction and less likely to have money for food, gas, or other basic necessities. Women denied an abortion were more likely to be with a partner who abused them and to end up as a single parent. They were less likely to agree with the statement, “I feel happy when my child laughs or smiles” and more likely to say they felt trapped as a mother.

Even teens could be criminalized for pregnancy if we continue on our current path of stripping women of their reproductive health rights. It sounds like a dystopian novel, but women have already been jailed for miscarrying, something that happens naturally in 12 to 15 percent of pregnancies of women in their 20s, a number that rises to about 25 percent by age 40. (Cleveland Clinic. July 19, 2022; https://cle.clinic/3oUNfIV.)

Brittney Poolaw was 19 when she presented to an Oklahoma ED having a miscarriage at about 16 weeks gestational age. She was asked about illicit drug use, and she answered honestly that she had used methamphetamine. The fetus tested positive for methamphetamine at autopsy. No conclusive evidence proved that methamphetamine caused her miscarriage, but she was sentenced to four years in prison for first-degree manslaughter. She was all of 21 by then. The autopsy reported that the miscarriage could have been caused by congenital abnormality or placental abruption, but this was apparently ignored. (BBC. Nov. 12, 2021; https://bbc.in/3Q3lKJ2.)

Brittney, a Native American, faced the same type of prosecution that many low-income women, drug-using women, and women of color will face if the current legal climate surrounding pregnancy and abortion persists. The majority of women with unplanned pregnancies reported to the Turnaway researchers that they had used contraception, but these women are still stigmatized, as if forgoing abstinence is a moral shortcoming and birth control doesn’t have a significant failure rate.

Supporting Women in the ED

Contrary to what lawmakers may assume, decisions to have an abortion are not casual but serious and agonizing, often made in order to take care of family. The Turnaway interviews showed that most women seeking abortion were already mothers, and their children were more likely to hit developmental milestones and less likely to live in poverty in the years after they terminated a pregnancy. Many who had abortions went on to have more children; their subsequent pregnancies were more likely to be planned and those children had better outcomes too.

Women who seek abortion after their state’s gestational age cutoff often don’t even realize they are pregnant until it’s too late, due to factors like irregular menses and lack of morning sickness, the Turnaway study found. Nonetheless, strangers will impose their morality on these women’s private reproductive health decisions.

At best, our low-income, marginalized patients left with no option but to carry an unwanted pregnancy will face the loss of life they had envisioned for themselves. At worst, they will face their own death from complications of pregnancy. None of the women in the Turnaway study who received an abortion died from it, but two women who were turned away died from complications of pregnancy. The risk of dying from childbirth is 50 to 130 times greater than the risk of dying from abortion, according to the Centers for Disease Control and Prevention. (N Engl J Med. 2022;386[22]:2061; https://bit.ly/3zYFcRy.)

Are we willing to sacrifice the people who gestate fetuses on the altar of fetal rights?

No matter our political or religious beliefs, we EPs need to be empathetic to patients who feel frightened and trapped by the disturbing trend of forced birth and criminal sentences for pregnancy outcomes. Our patients may not seek health care during a miscarriage or after an illegal abortion because they are too scared. We need to be ready to support them with whatever resources we can when they end up in our EDs. Sadly, we also need to be ready for more of them to come experiencing the medical emergencies that will inevitably occur when a common health care procedure becomes illegal and inaccessible.

dr Simonsis a full-time night emergency physician in Richmond, VA, and a mother of two. Follow her on Twitter@ERGoddessMDand read her past columns athttp://bit.ly/EMN-ERGoddess.

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