DISPATCHES FROM THE WAR ON CHOICE: FIGHTING FOR REPRODUCTIVE JUSTICE IN LOUISIANA


Reproductive justice and pro-choice advocates in Louisiana were offered a moment of respite late in the evening of February 7, when the U.S. Supreme Court temporarily blocked the state of Louisiana from carrying out its latest restrictions on abortion providers. Initially enacted in 2014, Act 620 requires abortion providers to have admitting privileges at a hospital within 30 miles of the clinic, meaning the doctors administering the abortions must have an agreement with the hospital allowing them to practice onsite in case of complications. The decision was a close one; with four conservative and liberal judges on opposing sides, Chief Justice John Roberts broke the tie in favor of postponing a major Supreme Court decision on abortion rights at least until their next term, beginning in October.

Louisiana has presented SCOTUS with the first major national conflict over abortion rights since the retirement of Justice Anthony Kennedy, who was replaced by Justice Brett Kavanaugh. Kavanaugh’s stance—expressed in the sole written dissenting opinion—is consistent with an earlier dissent written while he was still with the District of Columbia Court of Appeals, in which he stated that “the government has permissible interests in favoring fetal life, protecting the best interests of a minor, and refraining from facilitating abortion,” and that “the government may further those interests so long as it does not impose an undue burden on those seeking an abortion.”

For those who are able to get pregnant, the question of “undue burden” is central to the case in question in Louisiana. Currently, the only abortion clinic in Louisiana with hospital admitting privileges is in Shreveport, and the closure of the state’s two other abortion clinics would leave Louisiana with only one clinic, located hundreds of miles from its two largest urban centers. In 2017, Judge John W. deGravelles (of the Federal District Court in Baton Rouge) struck down this law on the grounds that “when considered in the real-world context of abortion patients’ poverty and transportation challenges, providers’ fear of anti-abortion violence, pre-existing regulations, and other obstacles to abortion access, [Act 620] would impose unique burdens on Louisiana women.”

This legislation bears close similarities to the 2013 Texas House Bill 2, which imposed significant restrictions on abortion care providers, including requiring admitting privileges at hospitals within 30 miles of the clinic. Once signed into law it had a devastating effect on abortion access in the state of Texas, where the number of clinics dropped from 42 to 19. In 2016, the law was invalidated as unconstitutional by the Supreme Court, which focused particularly on the burden caused by requiring admitting privileges.

In spite of the clear parallels to the Texas precedent in Louisiana’s Act 620, the New Orleans-based 5th Circuit Court of Appeals ruled in September of last year to uphold this legislation, arguing that unlike its Texas counterpart, this law would not “impose a substantial burden on a large fraction of women” in Louisiana. As it is explained on the Louisiana Right to Life website: “The Louisiana law is simply a health and safety regulation.”

In the minds of reproductive justice advocates in Louisiana, this interpretation is a flagrant denial of the facts. Lakeesha J. Harris, Director of Reproductive Justice and Health at Women With a Vision (WWAV), explains, “Undue burden within their scope of privilege does not take into consideration poor women, people without the ability to travel, who cannot access private health care facilities. From our position [at WWAV], we are looking at women who sit at the margins and will not be able to have access for yet another health care measure; Black and Latinxs, these are people who cannot travel very far to access health care.” If 620 passed, the necessity of travelling longer distances would affect more than just Louisianans, since New Orleans and Baton Rouge clinics service people coming from all over the Gulf South. In Harris’ mind, this is an infringement of basic rights. “If you live in a state where you pay taxes and contribute to society, which we are all doing in different ways, you should be able to access health care where you live.”

Reproductive justice is a framework that takes a much broader view of health than just the question of access to abortion. It developed specifically out of a need to acknowledge the ways that women of color and other marginalized people are so often denied their basic human rights and care, thus contextualizing questions of reproductive rights within the larger social justice conversation. “Reproductive justice is about the ability for all people to be able to choose whether or not they want to give birth, and the complete belief that they have the autonomy over their bodies,” says Harris. “They should then get to raise their children in communities free of violence, and that the state should support those rights. For me in particular, and Women With A Vision, that means environmental justice, being free from the undue burden of wrongful incarceration, so fighting for prison abolition, and the right to health care in the way that they see it.”

“So much of abortion funding work is using the same concepts that doulas use every day, like believing the person you’re talking to is the expert on their life.”

Since Black and low-income women are facing an overwhelming set of external obstacles on a daily basis, lawmakers must consider the lasting impact of further restricting their agency. As Harris puts it, “Our communities, especially here in New Orleans, are in a constant stage of trauma everyday.” So often the burden of community care falls on organizations such as Women With A Vision, which provides community health care options such as acupuncture, massage, and independent counseling to people who cannot otherwise access these physical and mental health services. As they fill in the considerable gaps left by the state, this heightens a deeply felt sense that pro-life advocates are doing little to support life past infancy.

Though reproductive justice is an approach developed by and for the women of marginalized communities that bear the brunt of state restrictions, its ethos is echoed by other abortion access activists. For Amy Irvin, the executive director of the New Orleans Abortion Fund, supporting women’s right to choose is only one part of the work they do. “Much of what we’ve done is to provide a counter narrative to protest groups. We’ve been unapologetic about our support of abortion access, but we also support what’s good for women and families in other ways—equal pay, minimum wage, sex education—and we support them if they decide to bring more children into the world.”

In addition to providing funding to women who need it and advocating for abortion rights on the state level, the New Orleans Abortion Fund also seeks to dispel the pervasive stigma around abortion. They offer events that give women the opportunity to share their experiences with a like-minded community, along with more casual gatherings like SexEd Bingo, or the “Say Yes to the Vest” fashion show, where they partnered with local designers to “showcase the beauty of the escort vest.” To Irvin, this work is about community as much as it’s about advocacy. “When so many groups are being threatened, it’s important to find joy in camaraderie, self-care, and moving the narrative past shame. We have to find joy in the work we do so that we can stay in the work.”

In the view of Mary Lingwall, who also works with the New Orleans Abortion Fund, supporting women’s rights to abortion is part of a bigger picture: “Access to abortion is just one piece of the puzzle. Women in the Deep South do not have equal rights. They do not have rights to health care the way a white man would in New York or Dallas.” Lingwall has worked in women’s health since 2012, when an Austin, Texas based-organization called Whole Woman’s Health helped her through an abortion of her own, making her feel safe and seen, an experience that she says fortified her as a feminist and inspired her to do postpartum doula work. Lingwall sees the work she did with mothers and babies as completely compatible with abortion access advocacy. “So much of abortion funding work is using the same concepts that doulas use every day, like believing the person you’re talking to is the expert on their life. The abortion funder or doula’s purpose is to connect this person with resources, and activating a network that will help them make their own decisions.”

I am not pro-choice in spite of my faith, but because of it.”

Lingwall, like many others, believes that supporting abortion access is a deeply moral choice, one that is rooted in holding up entire communities. “It’s about believing that the community is responsible for the individuals that are in it. Abortion funding is like a radical form of insurance. Most of this funding comes not from millionaires, but from people who have needed this service before, believing that this community is responsible for the folks inside of it. Our hand is forced when politicians decide with no evidence that it isn’t health care, so we need to create our own radical health care.”

Living in Texas at the time of the 2013 passage of Texas House Bill 2, Mary Lingwall has seen firsthand what happens when lawmakers restrict abortion access: “It was dire. Abortion funds in the Rio Grande Valley saw the impact of people seeking self abortion medication in Mexico.” The stated purpose of laws requiring admitting privileges is to help women in the event that abortions go wrong; however, this is hardly ever the case. In Whole Woman’s Health vs. Hellerstedt (the case that overturned Texas House Bill 2), the Supreme Court ruled that “the great weight of evidence demonstrates that, before the act’s passage, abortion in Texas was extremely safe with particularly low rates of serious complications and virtually no deaths occurring on account of the procedure” and that “abortion, as regulated by the State before the enactment of House Bill 2, has been shown to be much safer, in terms of minor and serious complications, than many common medical procedures not subject to such intense regulation and scrutiny.” As the Supreme Court ruled, there is no medical evidence to suggest that abortions need to be treated like other surgical procedures.

Act 620 was written by pro-life Democratic legislator Katrina Jackson, who represents the area around Monroe. She is a member of the Health and Welfare Legislative Committee, and has served as Chair of the Louisiana Black Legislative Caucus. Throughout her career, she has shown sustained interest in the wellbeing of low-income women, and does not see abortion legislation as making a major difference in this arena. In a 2014 interview with the Clarion Herald, the official newspaper of the Archdiocese of New Orleans, Jackson stated, “You don’t solve a socio-economic problem by making abortion legal… We need to be legislating in areas that give women the opportunity to come out of that level of poverty. Why don’t we support equal pay for women? Why don’t we support higher education bills and public education? That’s where the cure is. To be pro-life is to care for the whole person.” If, however, she has fought with particular zeal for abortion restrictions in Louisiana, it is likely because for Jackson, an anti-abortion stance is central to her moral code. As she puts it in the same interview, “I will always be pro-life. It’s not a question of opportunity or being Democrat or Republican. It not [sic] a question of an agenda. It’s about always standing for the things of good.”

This uncompromising stance against abortion is shared by other representatives of the state. The 5th District Court of Appeals, for instance, initially framed its decision to uphold Act 620 as supporting women’s health, asserting that “Act 620 is premised on the state’s interest in protecting maternal health.” However, the same decision is very clear about the lens through which the State of Louisiana views women’s health, stating: “In addition to the concern for maternal health expressed at the hearing, Louisiana has an underlying interest in protecting unborn life. The state has codified its intent to ‘regulate abortion to the extent permitted.’” As Amy Irvin sees it, the 5th District Court is functioning as an “activist court,” ruling in favor of limiting abortion for its own sake rather than determining whether these restrictions are constitutional.

This approach is shared by Louisiana’s Attorney General, Jeff Landry, who has been extremely vocal regarding his support of Act 620. As his office wrote in an email statement: “The Attorney General has a strong pro-life record; he is committed to protecting women’s health and safety; and he is determined to defend the laws passed by our State Legislature. The AG remains hopeful that if the United States Supreme Court decides to take up this case, it will be to reaffirm that court’s rule on fact-specific cases; because the facts in our case show Act 620 is constitutional and consistent with our overall regulatory scheme for surgical procedures.”

Whether or not Act 620 is constitutional seems next to inconsequential for A.G. Landry, the 5th District Court of Appeals, and many Louisiana lawmakers, for whom challenging the perceived moral threat of abortion appears to be their top priority, regardless of whether or not they frame the issue as primarily concerning women’s health. For many such Louisianans, it is a matter of faith. The Clarion quotes Representative Jackson as saying that she would gladly defend this law as an attorney as well as a legislator: “When I can go into the courtroom and defend my faith, that will be a great day.”

However, religion is by no means a clear dividing line between these sides. For Glenn Northern, Domestic Program Director for Catholics for Choice (an advocacy organization that seeks to “uplift the voices of everyday Catholics,” many of whom vocally support abortion access), faith is no obstacle to a strong pro-choice stance. “I am not pro-choice in spite of my faith, but because of it. It is the values of my faith that make me pro-choice.” Northern, a lifelong Catholic who has been working in the women’s health field for many years, hopes to demonstrate that roughly 300 bishops in the United States “don’t represent 70 million Catholics on reproductive health issues.” While they may continue to speak out against abortion, Northern believes that the foundational tenets of Catholicism point in a different direction: “For Catholics the idea of conscience is critical, the inner voice that speaks to you; it is a responsibility and a gift. We are obligated to listen and respond to it, and others have the right to follow that too. We trust women—when individuals are presented with information and facts and a range of ideas we believe that they are capable of making good decisions, moral decisions.”

For Catholics for Choice, religious freedom means not being subjected to the religious beliefs of others. In their view, one of the greatest threats to religious freedom in our country is posed by the Catholic health care system. According to Northern, Catholic health care owns one out of six hospital beds in the country, and 17 healthcare facilities in Louisiana. In his mind, this is a crucial part of the admitting privileges question: “Access to health care should not be restricted based on religious objections. In this latest case, the danger is that Catholic hospitals will not give admitting privileges. We have a temporary reprieve, but the larger worry is that with the expansion of Catholic health care—rapidly growing across Louisiana and the nation—it is more and more difficult for individuals in rural areas to get care.”

According to a report issued by Catholics for Choice, people may come to Catholic hospitals, sometimes without knowing it is one, and be limited in their health care options: “Though Catholic health care is in some ways comparable to its secular counterparts, there is one major exception. Catholic facilities do not provide a full range of reproductive health care services and often don’t follow accepted medical standards. Instead, they follow the Ethical and Religious Directives for Catholic Health Care Services, a set of guidelines mandating that health professionals and hospitals follow standards set by popes, bishops, and Vatican councils.”

For Glenn Northern, this proscriptive approach is not necessarily a moral one. “One thing we would like to see is more moral leadership around this, politicians, advocates on the idea of conscience and letting women make their own moral decisions.” The principle of individual agency and body autonomy is echoed by many pro-choice and reproductive rights advocates. For Lakeesha Harris, pro-life rhetoric is more “pro-control over women’s bodies, not a pro-life tactic.” Certainly, the coalition of power-structures across Louisiana government are extremely controlling over the moral question of abortion, and are determined to make this decision for women all over the state. Their relentless advocacy for abortion restrictions has led to a case that is certain to have national consequences, pending the Supreme Court decision next term.

The outcome will affect women’s health across the South. According to Harris, this is a matter of considerable urgency, especially for Black women and marginalized communities: “Black women are dying in health care facilities. The maternal mortality rate has skyrocketed. When you sign legislation that takes away abortion access in this country, especially a Black Woman, it’s akin to sentencing many of us to a death sentence. You are gambling with our lives. What I am hoping for is that at the Supreme Court level, it is recognized that there is already precedence; we shouldn’t be going down this road. I hope that the court recognizes that women here in Louisiana are fighting for our lives every day, and we need them to help us.”


RESOURCES & SERVICES

The following are some organizations and points of contact relevant to people who can get pregnant and anyone who wishes to support them. Beware predatory “crisis pregnancy centers” that are designed to appear as real medical providers but are designed to obstruct your ability to access services, disseminate misinformation, and delay your access to actual comprehensive reproductive care.


The only three places you can get an abortion in Louisiana are:

Hope Medical Group
hopemedical.com
Abortion provider in Shreveport.

The Women’s Health Care Clinic  
womenshealthcarecenter.com
Abortion provider in New Orleans.

Delta Clinic
(225) 923-3242 or Toll Free at (800) 937-3242
Abortion provider in Baton Rouge.

OTHER RESOURCES:

Planned Parenthood
plannedparenthood.org
Health clinic providing a large range of services and care including STI testing, birth control, hormone therapy, PrEP, and more.

New Orleans Abortion Fund
Neworleansabortionfund.org
Operates a hotline, organizes and trains clinic escorts, funds abortions—volunteer and donation powered.

Reproductive Justice Action Collective
www.rejacnola.org
Disseminates emergency contraception, operates canigetanabortioninlouisiana.com, a network sharing resources related to reproductive justice.

Louisiana Trans Advocates
ltadraft2018.squarespace.com
Provides referrals to trans positive health care providers, funds name changes, and more.

CrescentCare
crescentcarehealth.org
CrescentCare Health Centers are federally qualified providers of health care to individuals, couples, and families that seek a “medical home” where they can consistently go for care, with a particular focus on underserved communities: the service industry, the LGBT community and slowly developing neighborhoods.

St. Thomas Community Health Center
stthomaschc.org
St. Thomas offers affordable care and accepts most insurance plans, Medicaid, Medicare and offers services on a sliding scale for uninsured and underinsured.

NARAL Pro-Choice America
prochoiceamerica.org/state/louisiana
Non-profit working to impact legislation and policy.

NOW Baton Rouge Escort Program
batonrougenow@gmail.com
Clinic escort program in and around Baton Rouge.

Lift Louisiana
liftlouisiana.org
Trans-inclusive reproductive justice activists seeking to educate, advocate, and litigate.

Louisiana Judicial Bypass Project
lajudicialbypass.wordpress.com
Provides legal support for minors seeking an abortion.

Women With A Vision
wwav-no.org
Advocacy, health education, supportive services, and community-based participatory research for marginalized women, their families, and communities. WWAV recently released a Comprehensive Contraception Reader, which is available as a downloadable PDF on their website.

Institute of Women and Ethnic Studies
iwesnola.org
Non-profit health organization focused on advocacy, health education, research and direct services.


illustrations Happy Burbeck