Fight for Your Rights

News, Summer 2017

WHY ADVOCACY FOR REPRODUCTIVE RIGHTS IS CRUCIAL

BY SARAH WENGERT

An image that once lived largely in readers’ imaginations has been cropping up in statehouses across the nation. Even before Hulu’s 2017 television adaptation of Margaret Atwood’s “The Handmaid’s Tale” premiered, women in the iconic red robes and white wings began haunting legislative halls from LA to DC and Austin, Texas to Lincoln, Nebraska in an effort to stand up for reproductive justice.

As reproductive rights are eroded and jeopardized nationwide, understanding the multifaceted issue of reproductive justice and engaging in solutions that protect and foster it has become more crucial than ever to many advocates. “From the ACLU’s perspective, when we think about reproductive justice we cast a pretty wide net,” says Danielle Conrad, executive director, ACLU of Nebraska. “That means supporting all women and all choices, and working diligently on issues including comprehensive, age-appropriate, science-based sexual education, meaningful access to prevention and contraception, meaningful access to abortion care, standing up for the rights of pregnant and parenting employees in the workplace, and fighting for the rights of pregnant and parenting students in our schools.

We work diligently on reproductive justice issues and also on those special intersections with economic justice as well, like equal pay and family medical leave, which are inextricably intertwined with our reproductive justice work and women’s rights work.” As for the status of reproductive rights in Nebraska, Conrad says there’s both good and bad news.

“We have scored some important defensive victories beating back the most serious challenges and threats to reproductive justice in Nebraska in recent years. We just saw in this most recent tough legislative session really an unprecedented attack on prevention and contraceptive services for low-income and rural Nebraska women through the Title X program,” she says. “We were able to help lead a broad, diverse coalition of Nebraskans in fighting back against that ill-advised move that was sneakily inserted into the mainline budget bill. We’ve also, in recent years, been able to beat back Texas-style restrictions and TRAP laws, but that being said, we have so much work to do in the realm of ensuring that we protect and expand access for contraception care in Nebraska.”

Conrad, who represented Lincoln’s District 46 in the Nebraska State Legislature from 2007-2015, says Nebraska has seen a notable shift in its approach to reproductive rights in recent years. “If you look at this issue over just the last decade or so, Nebraska used to be kind of middle of the pack when it came to reproductive rights; not robust and meaningful access, but definitely not the most restrictive,” she says. “But Nebraska has shifted from middle-of-the-pack, to borderline hostile to reproductive rights, to now being classified as one of about 17 states considered extremely hostile, or the most restrictive, to reproductive rights in just a very short period of time. So, we have a lot of work to do to protect existing access and to try and restore and expand access to the full set of services within reproductive health for all Nebraska women.”

As headlines emerge announcing proposed and passed legislation restricting reproductive rights nationwide, examining the effects of such laws is essential. Texas, for example, severely cut family planning funding in 2011, from $111 million to $37.9 million. As a result, by 2014, 82 family planning clinics in Texas had closed, eliminating affordable health care access for thousands of people and leaving rural populations particularly vulnerable. The Texas Legislative Budget Board estimated the funding cuts and subsequent shuttered clinics and restricted access to health care would cost the state more than $230 million and lead to more than 20,000 unplanned pregnancies.

Colorado, on the other hand, has taken proactive steps to support family planning clinics and affordable contraception access through its Colorado Family Planning Initiative, and has seen a 50 percent decrease in teen birth rates and abortions—plus savings of at least $66.1 million. Trends in Texas have gone the other way. As of 2015, Texas had the fifth-highest teen pregnancy rate in the nation. Additionally, the Lone Star state ranks No.1 in repeat teen pregnancies and has the highest maternal mortality rate in the United States.
When harmful language reprioritizing Title X funding in Nebraska was placed within Nebraska’s mainline budget bill, LB 327, Conrad, the ACLU of Nebraska, the Women’s Fund of Omaha and Planned Parenthood, along with the clinics that would have seen their Title X funding cut, were instrumental in successfully advocating for reproductive rights.

“When it came to helping lead the way to protect Title X funding in the most recent Nebraska legislature session, we conducted our policy advocacy and grassroots engagement by working with key legislators and partners to really draw deeply upon our assets and our unique skills and strengths, and that’s compiling credible, timely legal and policy research about the issues before the legislature. We were able to do some rapid response to key legislative leaders about the legal and policy implications of moving forward with that ill-advised proposal in the mainline budget,” Conrad says.


Conrad says her team complemented those efforts by engaging with members of their network to spread the word on social media and via professional phone banks to help inform Nebraskans and empower them to contact their representatives at critical junctures in the debate. The language pertaining to Title X in LB 327 would have diverted funding from stand-alone clinics, meaning those that focus solely on family planning and related services, likely leading to a Texas-style closing of clinics that would have hit low income, rural Nebraskans particularly hard.

“LB 327 would have had a significant negative impact on rural Nebraska. More so than the Omaha metro area, simply because the prioritization would have likely shut down providers in areas where access to reproductive health care is already limited,” says Sofia Jawed-Wessel, Ph.D., assistant professor in Public Health and Women’s and Gender Studies at University of Nebraska Omaha (UNO), and associate director of the Midlands Sexual Health Research Collaborative. Jawed-Wessel says her job is to advocate for policies that promote healthy communities. She cautions that the type of language in LB 327 regarding reprioritizing Title X would have done the opposite.

“The direct impact would have meant 8,000 unduplicated patients at Planned Parenthood, and an additional 7,000 patients [at other clinics] across the state, would have lost affordable access to reproductive health care,” she says. “The remaining Title X providers would’ve been unable to absorb patient numbers and health care access in rural areas of the state would have become even more severely restricted. Those currently receiving Title X care in North Platte, for example, would have had to travel 340 miles to Gering for the services, and the city of Lincoln, while not technically ‘rural’ would have no longer had any Title X providers as a result of the proposal.” Traci Bruckner, research and policy director at the Women’s Fund of Omaha, agrees that rural Nebraskans would have been hit especially hard, noting that, for many who use Title X funding, it provides the only health care they have.

“If you take away that funding and hurt those people’s ability to receive that basic level of health care, that’s going to have an impact on their economic security, their future, their families and their communities,” Bruckner says. “It would make more economic sense to think about how we can increase access to health care rather than decrease access. Particularly when you look at the geography of our state—the vast expanse of open land and just how far people have to go to connect to health care—I think that’s problematic.

Women’s economic security and reproductive and general health care go hand in hand, that is why we engaged in the fight to preserve this funding, and we will continue to work with legislators and our partners to ensure Title X dollars are not cut.” According to numbers from the Nebraska Department of Health and Human Services (DHHS), in fiscal year 2016, Title X funding served 27,954 unduplicated users statewide, meaning users who rely on Title X funding and are not using other funds.

Of those users, 59 percent were uninsured, 12 percent had Medicaid, and 29 percent had private insurance. Additionally, 55 percent of these clients were 100 percent and below the federal poverty level. “This [funding] serves very low income women and families,” Bruckner says. “If women do not have access to the planning and contraception they need so they can have families when they’re ready to have them—at the same time the state cuts child-care subsidies, and the federal government wants to cut SNAP subsidies, and frankly all the provisions designed to help lift families out of poverty—the damages will be real and measurable. It all works hand in hand.”

If the Title X language had been maintained in the budget bill, the following clinics would have lost funding: People’s Family Health Services in North Platte and McCook, which was allocated $153,430 in Title X funds for 2017; Central Health Center in Grand Island and Kearney, which was allocated $328,235 in Title X funds for 2017; Family Health Services in Lincoln, Tecumseh, Crete, Beatrice, and Peru, which was allocated $234,988 in Title X funds for 2017; and Planned Parenthood in Lincoln and Omaha, which was allocated $380,908 in Title X funds for 2017.

“Just to give you a sense of the number of people who use those clinics, People’s Family Health Services has about 1,000 unduplicated users annually— that’s 1,000 people coming in the door for Title X services,” Bruckner says. “Central Health Center had about 4,000 unduplicated users, Family Health Services had about 1,500 unduplicated users and Planned Parenthood in Lincoln and Omaha had about 8,000 unduplicated users. So, those clinics together account for half of all unduplicated users of Title X in Nebraska.” Conrad agrees that such cuts would have disproportionately affected poor and/or rural Nebraskans, and she stresses the fact that Title X funding is for preventative care.

“To be very clear, Title X funding is focused on prevention, and these are the kinds of reproductive health issues that we should really be able to cultivate a lot of common ground around,” she says. “We’re not talking about abortion services when it comes to Title X. We’re talking about prevention, well-woman exams, breast cancer screenings, STI treatment and exams, and helping to prevent unintended pregnancies and thus the need for abortion. Historically, this has always been a program that’s enjoyed very broad support across the political spectrum because of that focus, and we just have to really continue to educate new policymakers, in the term limits era, about the need to protect this funding and to support all health care providers that provide quality preventative services to Nebraska women.”

Bruckner urges representatives of rural districts, in particular, to understand the negative effect such cuts would have on their constituents and the communities they serve. “Senator (Mike) Groene was the 25th vote on the amendment to strike the [Title X] language from LB 327, and it was largely because he was concerned about the impact it would have on the clinic in his district. Senator Groene even said in his statement on the floor that he looked at how they did this in other states and it shut down clinics like his in North Platte,” Bruckner says. “This issue isn’t going to go away. The governor even said he’s going to bring it back and continue to look for ways to re-prioritize Title X funding, and I think this issue will be won or lost by those senators representing rural areas, so it’s crucial that they understand what kind of impact that would have in their districts.”

Conrad agrees the issue will re-emerge and encourages advocates to stay engaged and prepared. “We have to be ready to again to make our case and to educate state senators about the critical importance of this funding and what it means for Nebraska women and Nebraska health care providers, and how changes to the status quo put critical health care services at risk, particularly for low-income and rural women,” Conrad says. In May 2017, Iowa made some legislative choices mirroring Texas’ path when they discontinued their federal Medicaid family planning waiver. This led to June 2017 closings of clinics in Bettendorf, Burlington, Keokuk, and Sioux City, which collectively have served 14,600-plus patients over just the past three years. As in Texas, younger, rural, minority and low-income women are projected to be hardest hit by the closings.

Burlington native and City Council member Annie Wilson calls recent reproductive rights restrictions “infuriating.” Wilson, now 27, got pregnant at age 17. She credits the Burlington Planned Parenthood for helping her have an ultimately healthy pregnancy. “Nothing compares to Planned Parenthood as far as compassionate care, overall friendliness and feeling welcome,” Wilson says. After her father passed away when she was 16, Wilson moved in with extended family and says she “was not living a very responsible, healthy life.” When she suspected she might be pregnant, Wilson visited the Burlington clinic for a pregnancy test. She says that being able to access affordable health care at a clinic where she wouldn’t feel judged was really important to her as a teen.

“I’ve always said, and I told my daughter this, that really I owe my life, and she owes her life, to Planned Parenthood,” says Wilson. “I think without them things would have been extremely different for both of us. It certainly was a learning experience and I think it helped shape me to be a more understanding, open individual in politics as well.” When it comes to her daughter, now 10, Wilson plans to have an open, nonjudgmental dialogue about reproductive rights. Like all parents, she just wants what’s best for her child.

“What’s most important is that she’s healthy and has all the right information,” she says. A more recent example of a Nebraskan who benefits from Title X funding is Samantha, a 27-year-old college student in Lincoln, Nebraska. She is grateful for access to affordable check-ups and contraceptives. With just one semester to go before graduation, she sees protecting her health and avoiding pregnancy as essential to her “life plan.” “I don’t make very much money, which is part of the reason I’m still in school,” says Samantha, who is funding her own education and will be the first in her family to graduate college.

“I work full-time and go to school, precisely so that I can make more money some day and contribute to my community. But right now, I really depend on this little bit of extra help. If I were to get sick or pregnant, that could derail everything.” Samantha’s not even sure what she would do without access to affordable reproductive health care—and she knows she’s not the only one. “When I think about folks even younger than me, who don’t have the means or the information or help they need, I really worry,” she says. “Lack of access keeps people poor, it keeps them from getting an education, it keeps them from living their lives on their terms. That’s why I do everything I can to stand up when it comes to this issue.”

While it makes for a poignant display, you don’t have to don a crimson Handmaid’s Tale-style ensemble to advocate for reproductive rights. Conrad says state lawmakers need to hear from all kinds of reproductive justice advocates. “We know from our experiences and from looking at the research that, overall, a majority of Nebraskans support reproductive rights and want Nebraska policymakers to stop playing doctor and to really trust women to make the best decisions for themselves and their families outside of undue political influence,” she says. “So what we need to do is to bring that silent majority forward and to make sure that those voices are heard in the halls of power.”

As a former state senator, Conrad emphasizes the importance and impact of citizens opening a dialogue with their elected officials. “Drawing upon my experience as a Nebraska state senator, I can tell you that we frequently hear from the governor’s office and from paid lobbyists, but who we don’t hear enough from as we’re working on these complex issues is from our constituents, from citizens of Nebraska,” she says. “You don’t need to be a policy expert on these issues to be really effective in that regard. I can tell you that some of the most powerful and persuasive messages I received from constituents were as simple as ‘Dear Senator Conrad, I live in your district and I’m concerned about reproductive health. I see you have LBX before you. What’s your position on it? I look forward to your response.’ Something just that simple can really make an important impact in getting the word out to elected officials and holding them accountable for their actions.”

Bruckner suggests bucking rigid partisanship and trying to find common ground with your representatives when contacting them about the issues you care about. “I think people should communicate with their senator on a regular basis and try and meet their senator at a values level,” Bruckner says. “Start off the conversation around some of the things you agree on, then use that common ground to create a relationship that allows you to better communicate in areas where you may have a difference of opinion.” Both Bruckner and Conrad also suggest staying closely connected with state and local organizations that fight for reproductive rights.

“I would suggest that people engage as much as they can with the organizations that have their backs on this issue,” she says. Conrad wholeheartedly agrees. “We definitely encourage people to get educated, get engaged, sign up for action alerts from reproductive justice organizations, websites, or social media pages so that you can stay abreast of what’s happening. Contact and volunteer for groups that are working on reproductive justice in Nebraska — groups like ACLU of Nebraska, Planned Parenthood of the Heartland, Women’s Fund of Omaha.

Get engaged with the leaders on these issues in Nebraska and they will help educate you about what you can do to make a positive difference.” Additionally, Conrad suggests writing a letter to the editor of your local newspaper. She says that state policymakers keep a keen eye on such platforms to stay in touch with what Nebraska’s thought leaders are saying about the issues of the day. “The bottom line is this: We’ve been able to secure important victories for reproductive rights in tough political landscapes like Nebraska, but that only happens by people coming together and speaking out, so we have to build upon those past successes and prepare for significant challenges that are before us on the horizon,” Conrad says.

“We absolutely can and will make a positive difference for reproductive rights in Nebraska, but we can only do it if we all work together. With groups like the Women’s Fund of Omaha helping to lead the way, I am confident that we will have a bold, bright future for Nebraska women.” W

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