Judy Kahrl (center), with GRR! members at a dining room table work session. (Photo courtesy Judy Kahrl)
Judy Kahrl (center), with GRR! members at a dining room table work session. (Photo courtesy Judy Kahrl)
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America is the closest it has been since 1973 to charging a woman with attempted murder for seeking an abortion. 

Reproductive health care for low income Mainers is marching towards the budget guillotine.

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Nobody seems to want to talk about abortion,” said Judy Kahrl, 82, the founder of GRR!, Grandmothers for Reproductive Rights. Kahrl and a couple dozen other midcoast women have set out to change that.

“Abortion is a sticking point for many because it has become connected to religion,” she said. “It’s not a religious issue. It’s not a Republican or Democratic issue. Reproductive freedom is a human rights issue.”

Kahrl is no stranger to controversy.

Her father introduced contraception to American couples in the 1920s, then went on to start Pathfinders International, an organization that provides reproductive health care and family planning in 20 developing countries.

One of the things Kahrl noticed in her work in Africa was that older local women were effective teachers when it came to family planning. That paid off economically at the community level, too, when young women postponed marriage and pregnancy and continued with school or started small businesses, said Kahrl.

Back home in the midcoast, though, Kahrl could see that the topic of reproductive rights was off the table, particularly when it came to abortion. Those who opposed abortion based on religious belief had successfully created a culture of shame and silence that has become mainstream, said Kahrl. People who supported legal abortion shied away from the topic.

The result was that all those hard-won fights for access to birth control and legal abortion in the 1970s were being rolled back with little public debate, state by state, said Kahrl.

In 2012, she was getting increasingly frustrated about the lack of frank conversations and jokingly told a group of women friends — all grandmothers — that they should start an activist group to get the conversation back in the public eye.

They could call it GRR! for Grandmothers for Reproductive Rights, she said.

They all laughed.

And then they stopped laughing.

If not them, who?

In May 2013, the group of grandmothers set up an information table at the capitol in Augusta. They all wore bright yellow T-shirts with GRR! on the front. Curious passersby stopped to ask what it meant.

“We were so new at it then that we barely knew what to say,” said Kahrl.

Three and a half years later, the group of 40 grandmothers takes a two-pronged approach to outreach: education and advocacy.

The grandmothers hold discussions at kitchen tables, women talking to women at the community level. They get together to write batches of handwritten letters to legislators to expand the public conversation, put up information tables at fairs and other community events, meet with their elected officials and call them on the telephone.

It is community action at the most basic level.

A woman’s legal right to have an abortion was decided by the U.S. Supreme Court in the 1973 Roe v. Wade decision that declared that abortion is legal in every state, though states may restrict or ban abortions after the fetus is viable, or able to live outside the womb, except in cases where the mother’s health is in danger.

Efforts to overturn the Roe v. Wade law have been under way ever since.

The 1976 Hyde Amendment stripped all federal funding for abortions. This meant that Medicaid, the insurance policy for the poor, could not be used to pay for abortions. Almost 20 years later, it was amended to provide funding if the pregnant woman is a victim of rape or incest or her life is in danger.

Abortions Down 20 Percent

In 2017 birth control and sex before marriage are pretty much accepted in mainstream American culture. The Affordable Care Act increased access to health care for lower-income women, which contributed to the all-time low in the numbers of teenage pregnancies, according to Planned Parenthood’s president, Cecile Richards.

Fifty-five million women who did not have insurance that covered the costs of birth control now do under the ACA, according to Richards. That may have contributed to the decline in the number of abortions nationally; according to the Centers for Disease Control, abortion rates have gone down 20 percent since 2004.

The CDC analysis also shows that a growing number of abortions were done early in pregnancy.

According to the Guttmacher Institute, whose statistics are used for those in favor of legal abortion and those opposed to it, the most recent data analyzed indicate that 60 percent of abortions were done prior to the sixth week of pregnancy.

For reference, the embryo at six weeks is the size of a raisin. At eight weeks, it is the size of a grape. At those early stages of pregnancy, it is possible to do a non-surgical abortion known as a medical abortion, which is commonly referred to as the abortion pill.

Medical abortions are actually a combination of two drugs taken over two days under the care of a health care provider and with follow-up. While many medical abortions are done at home, the drugs are typically used only when women are less than eight weeks pregnant. They are not available from a pharmacy, only from a clinic or physician.

Abortion pills are not the same as the morning-after pill that women can take for up to 72 hours after unprotected sex. The morning-after pill prevents fertilization. The abortion pills are used to abort a pregnancy.

Medical abortions have a strong safety record when used with clinical oversight, according to the CDC. They are increasingly available through tele-medicine for women in early stages of pregnancy who do not have nearby access to a clinic.

That is the case in much of rural Maine where women are up to five hours away from the nearest clinic.

Cost is the biggest barrier for low-income and rural women in Maine, according to Nicole Clegg of Planned Parenthood of Northern New England.

In Maine, both a medical and a surgical abortion costs around $550. As with the federal law, late-term abortions are not legal, except in extreme cases when a woman’s health is endangered.

Add on the cost of transportation to a clinic, if necessary (or even the availability of transportation for some women), plus an overnight hotel stay, if needed, and that changes which Maine women get to decide their future and which don’t, according to Clegg.

Women: Criminally Pregnant

While the general public has avoided talking about abortion, lawmakers have been busy making it a crime.

More restrictions are coming.

On January 3, the Ohio Legislature passed a bill that would make it illegal for a woman to get an abortion after the sixth week of pregnancy. For some women, that is about the time they realize they have missed a period; they may be six weeks pregnant without knowing it.

Missouri’s new legislature just put forward 14 anti-abortion bills that are likely to find fertile ground in that conservative state.

In recent years, anti-abortion advocates have portrayed women seeking abortions as victims while portraying abortion clinics and abortion providers as culpable. The facts reveal that as a red herring; pregnant women will be punished for trying to get an abortion.

According to the Guttmacher Institute, 26 states have passed laws that are hostile to women seeking abortions; the core states are Idaho, Utah and Arizona in the West, most of the Midwest and virtually all of the South.

Nineteen states already have laws on the books that will go into effect if Roe v. Wade is overturned by the Supreme Court.

But women are already being criminally charged in some states.

Emily Bazelon in a 2015 article in the New York Times gave two examples of women who were charged with the equivalent of attempted homicide of an unborn child for acts committed while pregnant: a woman who threw herself down the stairs and a woman who attempted suicide.

A woman in Indiana is serving 20 years in prison for a self-inflicted abortion. The case was complicated, with conflicting medical opinions. The verdict, however, was not. The woman was found guilty of murder and child endangerment.

Vice President-elect Mike Pence, the former governor of Indiana and a six-term Congressman, is a Christian conservative. One of his top goals is to use his direct power or influence to criminalize abortion.

Two other Trump cabinet appointees — Jeff Sessions, the proposed attorney general who would serve as the top lawman of the land, and Tom Price, the proposed secretary of Health and Human Services — share similar views.

Pence championed the fight to strip all federal funding for Planned Parenthood, a non-profit reproductive health organization that runs health clinics across the country — a fight that may well be won before the week is out in the U.S. Senate, as it is near the top of the list of dismantling the Affordable Care Act.

To be clear, federal dollars do not pay for abortions at Planned Parenthood or anywhere else.

That has been against the law since 1976.

 


Planned Parenthood

Planned Parenthood does women’s health exams, breast cancer screenings and reproductive cancer screenings for men and women, and they test for and treat sexually transmitted diseases and offer a range of birth control options.

Their mission is to provide reproductive health services, regardless of the ability to pay. In Maine, 10,000 patients visited one of the four Planned Parenthood clinics in 2015, according to Clegg of the Maine office. Patients are charged based on income.

“Some pay nothing,” said Clegg.

Mainers received the equivalent of $3.5 million worth of free reproductive health care from Planned Parenthood in 2015, according to Clegg.

Many Planned Parenthood patients are on Medicaid, the health insurance program for low-income Americans. Maine’s version of the Medicaid program, MaineCare, is a blend of state and federal dollars. Medicaid/MaineCare reimburses clinics for health care.

Medicaid/MaineCare is just like any other insurance. A patient gets a service, like a cancer screening or an annual exam, and the clinic bills MaineCare. MaineCare reimburses the clinic for the specific service. If they don’t cover a service, they don’t reimburse the clinic.

They don’t reimburse for abortions.

In addition to other services, Planned Parenthood provides abortions. Three percent of those who visited a Maine clinic in 2015 were there for an abortion, according to Clegg.

Even though Planned Parenthood does not use Medicaid/MaineCare funds or any federal funds to pay for abortions, the organization was targeted by conservative lawmakers because they provide them.

Support for defunding Planned Parenthood increased after the organization was accused by an undercover anti-abortion activist of selling fetal tissue for profit, with the tissue to be used for scientific research.

As a result, Congress launched a $1.6 million, 15-month investigation into Planned Parenthood.

Conservative media like the National Review say the 413-page Congressional report, which was issued December 30, indicates illegal activity, while the Washington Post and Politico say the report indicates Planned Parenthood did not sell fetal tissue for profit or break the law.

Anyone can read the report and see for themselves.

The investigation came up empty.

Congress Takes Aim

Federal funds are an important part of the overall Planned Parenthood budget. In Maine, they account for 35 to 40 percent.

The Senate voted yes to the first step in repealing the Affordable Care Act on Thursday morning. The House will take it up on Friday, with House Speaker Paul Ryan, vowing to make zeroing out funding for Planned Parenthood an early part of the process of doing away with the Affordable Care Act.

Sen. Angus King, an Independent, voted not to move forward with repeal. Maine Republican Senator Susan Collins voted to go ahead.

The House will vote of the first steps to repeal the Affordable Care Act on Friday, January 20.

Collins has mostly supported funding Planned Parenthood in the past, but in August, 2015 she voted to defund it in what she characterized as a procedural move that would allow an investigation of Planned Parenthood to move forward. In December 2015, Collins ultimately voted to keep federal funding for Planned Parenthood, noting how critical the organization was nationally and in Maine to providing basic preventative health services to women.

Collins staff said Thursday that she continues to support funding for Planned Parenthood. She sits on one of four legislative committees (Senate Committee on Health, Education, Labor, and Pensions) that could ultimately craft the replacement to the Affordable Care Act, so it is possible that Collins will again champion Planned Parenthood — a position likely to put her in opposition to powerful and vocal Republican colleagues.

On the House side, Rep. Chellie Pingree, a Democrat, opposes defunding Planned Parenthood. Republican Rep. Bruce Poliquin flip-flopped on the 2015 vote, saying he opposed the defunding then voting for it.

National Ban on Abortion Possible

While Congress is poised to act on funding issues, and the president’s cabinet is stacking up as opposed to legal abortion on the regulatory end, the Supreme Court could have the largest single impact on legal access to abortion.

As it now stands, the court is evenly divided between those who support overturning Roe v. Wade and those who don’t. If the empty seat on the Supreme Court is filled by a conservative justice, Roe v. Wade could be overturned, throwing the question of legality back to individual states.

But it is still too soon to tell what will happen.

Immediately after Justice Antonin Scalia died almost a year ago, Republican leaders in the Senate said they would not fill the Supreme Court seat until after the election, an unprecedented partisan move that may have long-term implications for the division of powers and the authority of Supreme Court decisions.

Democrats have started to indicate they may also refuse to confirm a Supreme Court justice nominated by President Trump.

Maine Remains Moderate on Abortion

Unlike many other states, Maine has not adopted state laws to restrict legal access to abortion.

Effectively, though, access to abortion in Maine has already been restricted for many women of reproductive age since Maine has a large low-income population, according to Clegg.

Many women can’t afford the cost of the abortion, don’t have the transportation to a clinic, and can’t afford the overnight stay if they have to travel to an abortion clinic from a distant part of the state, she said.

The future of other affordable reproductive health care for low-income Mainers is marching towards the budget guillotine.

At the state level, Governor LePage has submitted his draft of the state budget that includes a $70 million cut to MaineCare. Those funds don’t go to abortion services, either, but they do go to health care for low-income women, including birth control and cancer screening.

At the federal level, 75,000 low-income Mainers could lose subsidized health insurance if the Affordable Care Act is dismantled.

Kahrl: Think Globally, Act Locally

Kahrl’s local call to action may seem a small gesture against such heavy political weight.

In fact, Kahrl is using some of the same tactics that the Tea Party used to gain influence that led to the 2010 elections of the conservative Republican lawmakers who now dominate the U.S. Congress: small local groups of committed vocal people who focus their attention on a small number of issues, who are informed about the issue, willing to call and write their legislators, meet with them, show up at their offices or when they hold town meetings, spread the word and make their voices heard.

“As women age, I think they get more radical,” said Kahrl. As one state legislator pointed out when meeting with Grandmothers for Reproductive Rights: you don’t mess with grandmothers.

“We are not career-focused,” said Kahrl. “We are not going to lose a job by taking a risk of speaking out.”

“It’s a different kind of power,” she said. “Our bodies are slowing down, but our intellects are willing, and, at this point, we don’t care what people think.”

The choices women make for themselves and their children about education, employment, health, and independence from abusive spouses shape individual lives and ripple through local and state economies, too, said Kahrl.

“This isn’t about us,” said Kahrl. “We’ve had our children and grandchildren. This is for them.”