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Black women will suffer the most without Roe
Abortion rights activists protest outside the US Supreme Court on June 24, after Roe v. Wade was overturned. | Stefani Reynolds/AFP via Getty Images Black women seek abortions at the highest rate and will face greater rates of maternal mortality without the right to choose. The United States is now a country without a legal right to an abortion. In this new reality, Black women will suffer the most. Black women are more likely to live in areas where it’s harder to access contraception. They get abortions at the highest rates compared to women of other races, due to high rates of unintended pregnancy. The factors that lead some Black women to seek abortions are present from the day they are born, passed down from mothers who faced similar plights. Those born into poverty are less likely to have access to health care, let alone reproductive or maternal health care; when some Black women are able to seek care, they facemedical racism. For centuries, Black women have fought for autonomy over their bodies, against government-sanctioned abuse and abuse from intimate partners.The end of a constitutional right to legal abortion makes the fight harder. State-level abortion restrictions have already taken effect in at least eight states, and in total, 22 states have laws that impose very strict restrictions on abortions. Those states are home to 39 percent of the total US population, but 45 percent of Black women and girls under age 55. The consequences will be dire. The end of legal abortion will trap Black women in cycles of poverty. The consequences will also be deadly. Black women have the highest rates of maternal mortality and pregnancy complications, and those risks will only increase if more Black women have to carry unwanted pregnancies to term. Here are the numbers that show how alarming the situation is. Black women are nearly four times more likely to have an abortion than white women Black women make up the largest percentage of all abortions performed and have the highest abortion rate, according to 2019 data from the Centers for Disease Control and Prevention — the most recent year for which the CDC reported this information. Out of 629,898 abortions reported to the CDC for 2019, Black women accounted for 38.4 percent of them. By comparison, white women made up 33.4 percent of those abortions. Abortion rates were 3.6 times higher among Black women when compared to white women. The disparity can be explained by inequities in rates of unintended pregnancies, as well as other factors:unequal access to quality family planning services, economic disadvantage, and distrust of the medical system. Black women are more likely to live in “contraception deserts” and less likely to have access to health care Black people are less likely to receive comprehensive sex education, a key factor in preventing unwanted pregnancies. Evaluations of sex education programs have found that they can help young people delay the onset of sexual activity, reduce the number of partners, and increase contraceptive use. One study found that teens who received comprehensive sexuality education were 50 percent less likely to report a pregnancy than those who received abstinence-only education. According to one report, Black youth, low-income youth, and youth from single-parent households were less likely to get formal sex ed, and Black youth were more likely to receive abstinence-only education, “which is ineffective and stigmatizing.” This is despite the fact that another survey found that most Black people favor comprehensive sex education for young adults. Access to contraception like birth control and condomsalso reduces the rate at which women have unplanned pregnancies and seek abortions. Yet Black women are more likely to live in “contraception deserts,” areas where barriers to purchasing contraceptives are higher. As a result, Black women ages 15 to 49 are less likely than other racial groups to use birth control regularly. They are also less likely to use prescription contraception, such as birth control pills and long-acting reversible contraceptives (like an IUD or a birth control arm implant), the most effective forms of birth control after abstinence and permanent sterilization. Those between 18 and 24 tend to prefer condoms, which are a less effective way to prevent pregnancy. The racial gap in contraception access and use is rooted in social and structural racism and discrimination. For one, it’s difficult to access prescription birth control without health insurance. Black women and girls are uninsured at roughly twice the rate of white women and girls, according to data from 2020. Black women in the South, where a number of abortion bans will take effect, have the lowest rates of health insurance coverage among all Black women. Some Southern states like Mississippi have refused to expand Medicaid coverage, which has prevented Black women in those states from having better health outcomes. Black women in Medicaid expansion states have experienced fewer maternal deaths than those in non-expansion states. Overall, Black women have less access to quality health care, and less trust in medical professionals who might recommend birth control. The medical profession has a history of pressuring Black women and other women of color to limit their family sizes and consider tubal sterilization. After all, the American “father of modern gynecology” experimented on enslaved Black women in the 19th century without anesthesia. More than one-third of Black women in a 2005 survey believed that “medical and public health institutions use poor and minority people as guinea pigs to try out new birth control methods.” Researchers in a 2019 study found that Black women tend to live near pharmacies that “impede the purchase of contraception.” The obstacles are many: limited hours, fewer female pharmacists, fewer patient brochures on contraception, condoms that are difficult to access, and fewer self-check-out options. And when they obtain contraception, it’s more likely to fail: Another report found that Black women and women with low socioeconomic status also have higher rates of contraceptive failure than white and high socioeconomic status women, even when using more effective forms of contraception. Black women have high rates of unintended pregnancy In 2011, the latest year for which data is available, 48 percent of all pregnancies in the United States were unintended, meaning they were unplanned, mistimed, or unwanted at the time of conception. Black women are disproportionally at risk for unintended pregnancy: 63 percent of all pregnancies for Black women were unintended, compared to 42 percent for white women. The study found that women who experience unintended pregnancy have a significant risk of sickness and death. They are also more likely to be poor and to have inadequate access to reliable and affordable contraception. A majority of women seeking legal abortion services in states with bans are Black The 13 states with trigger bans — locations where abortion will be prohibited within 30 days of the Supreme Court’s decision in Dobbs v. Jackson Women’s Health, whichoverturned 1973’s Roe v. Wade — are mostly located in the South, where nearly half of the country’s Black population resides. In Mississippi, the state that filed Dobbs, Black women got 74 percent of abortions provided in 2019. In Alabama, where an abortion ban went into effect the day the decision came down,it was 62 percent;in Georgia, where abortions after six weeks may soon be banned if a judge grants the state’s request to allow a 2019 lawto take effect, 65 percent. Black women are alsoless likely to have the financial means to afford out-of-state travel for a time-sensitive abortion. Four in 10 Black women ages 18 to 44 could not afford more than $10 for birth control, according to a 2017 survey, while 46 percent of Black mothers of children under 18 said they could afford $10 or less. Black women are three times more likely to die from pregnancy-related causes than white women Black women have the highest maternal mortality rate in the United States — 55.3 per 100,000 live births for 2020, according to CDC data — which means they are more likely to die while pregnant, during delivery, or in the postpartum period. That year, Black women were 2.9 times more likely to die from a pregnancy-related issue than white women. And the rate has only increased in recent years, growing from 37.3 per 100,000 births in 2018 to 55.3 in 2020. The CDC attributed Black women’s high maternal mortality rate to factors like access to care, quality of care, prevalence of chronic diseases, structural racism, and implicit biases. Pregnancy complications are the sixth leading cause of death among Black women age 20 to 44, while pregnancy complications do not rank in the top 10 causes of death for any group of white women. Black women of all education and income backgrounds face the threat of dying in pregnancy and childbirth. A 2016 report found that Black college-educated moms were more likely to suffer severe complications in pregnancy and childbirth than white women who never graduated from high school. A full abortion ban could increase Black maternal deaths by 33 percent, compared to a 21 percent increase for the overall population, according to a recent study. Mississippi has some of the worst maternal mortality and infant mortality rates in the United States. The state’s maternal mortality rate is 33 maternal deaths per 100,000 live births. For Black women, that number is 51.9 deaths per 100,000 live births, nearly three times the white number, 18.9. And when Black women don’t die from pregnancy, their pregnancies have riskier complications. This is why some abortions are performed to save lives, though some anti-abortion activists want these exceptions removed from legislation. Rates of ectopic pregnancies — pregnancies in which the egg does not make it to the uterus and instead implants somewhere outside of it, like in a fallopian tube — arehigher for Black women, and are the fifth top cause of maternal death. Black women are disproportionately victims of sexual violence Black women face some of the highest rates of domestic abuse and violence, a factor that contributes to sexual and reproductive coercion — behaviors related to reproductive health that a partner uses to control the relationship. In one survey, 20 percent of Black women reported that they were made to have sex without a condom when they did not want to. The figure rose to 26 percent for Black mothers. The inability for Black women to get abortions can lead to greater intimate partner violence. One study found that homicide is the leading cause of death among pregnant and postpartum people, and that Black women were at greatest risk. Black women had a “threefold higher partner rate of partner homicide victimization” than white women, a researcher told The Lily, and pregnant Black women were “eight times more likely to be killed by their intimate partner than non-pregnant Black women.” Researchers explained that Black women’s high rate of unwanted pregnancy is linked to “partner conflict, stress, and violence.” The landmark decade-long Turnaway Study,which studied women who wanted abortions but were unable to obtain them, found that women who were “turned away” from abortions were more likely to experience continued domestic violence. On top of this, Black women are less likely to report abuse since they are less likely to be believed, causing psychological trauma. Medical professionals also tend to systematically undertreat them for pain due to medical biases. Abortion restrictions will trap Black women in a cycle of poverty Unintended pregnancies that lead to unwanted births create cycles of disadvantage for Black women. Since the pregnancies and births are unplanned, these women are often “forced to make compromises in education and in employment opportunities that subsequently lead to poverty and lower education attainment.” Being denied an abortion leads to an increase in financial distress that persists for years, according to a recent study. More than 80 percent of Black mothers are breadwinners, which means they are either the sole earners or earning at least 40 percent of their household’s income. Black women are twice as likely as white women to be the sole breadwinners for their families. Nearly one in four Black women live in poverty, and though they make up only 12.8 percent of all women in the US population, represent 22.3 percent of women in poverty. The gender wage gap, the gender wealth gap, and segregation into low-paying jobs all limit their employment opportunities. The cycle affects their children. The infant mortality rate for Black babies is twice that for whites. Pregnant Black women are more likely to receive inadequate or delayed prenatal care, and to have poor health outcomes such as low infant birthweight. Their children are also more likely to face developmental delays, poverty, poorer relationships with their mother, neglect, behavioral problems, and lower education achievement. States with abortion restrictions tend to have fewer policies that support parents raising children. While the US ranks near the bottom compared to peer countries for many of these measures, states with abortion restrictions in particular tend to not have paid family leave legislation, to rank especially low on women’s income, to have a lot of uninsured women, and to lack quality child care. These trends are sure to worsen the intergenerational cycles of disadvantage that many Black women are stuck in.
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vox.com
What if NASA actually finds life on Mars?
NASA’s Perseverance rover took this photo of the Martian surface in January. The robot is searching for signs of past life on the planet. | NASA/JPL-Caltech/ASU If there was life on Mars billions of years ago — even just microbial life — it could change our understanding of how life begins. Today, Mars is a wasteland. It’s a dusty desert, rough and pockmarked with craters. There’s no apparent life on its surface. But over the past decades, scientists have found evidence of a lost Mars, one that looked a lot more like Earth than like a hellhole. “You can see evidence of what Mars was like 4 billion years ago,” says NASA astrobiologist Lindsay Hays. Etched into its rocky surface, “you see things like the remnants of a huge river delta,” she says. You see evidence of past lakes. That gets the imagination going. “There may have been clouds in the atmosphere,” Hays says. “The surface would have been absolutely beautiful.” Past missions to Mars — including with robotic rovers, landers, and orbiters — have added on-the-ground evidence that this watery past is very likely. And that’s the most exciting thing for an astrobiologist like Hays: Where there was water, there could have been life. “One of the universal features that we see of life is that it needs water,” she says. There’s life that survives without light, life that survives without oxygen. Nothing that we know of lives without water. If there was water on the surface of ancient Mars, “well, then maybe there was life that was living in that water,” she says. A recent episode of Unexplainable — Vox’s podcast that explores big mysteries, unanswered questions, and all the things we learn by diving into the unknown — is about the search for a key piece of evidence that would confirm if there was life on ancient Mars. Perseverance, NASA’s latest rover that landed on the Red Planet in 2021, is currently exploring an ancient dried-up river delta. The hope is that some form of microbial life that lived — and died — billions of years ago is preserved in its sediments. (It’s less likely that anything is currently alive on Mars.) The rover is on the hunt for rock samples that may eventually be returned to Earth for precise study; they would become the first Mars rocks returned to Earth by a scientific mission (we have some samples of Mars rocks that arrived on Earth via meteorite). But ... what if we find it? What if evidence of past life on Mars is confirmed? Finding life on Mars could help us understand how common life is in the universe “The reason that I am interested in the search for life has to do with this concept of how interrelated life is on Earth,” Hays explains. Any two human beings are related by a common ancestor if you look far enough back in their family trees. But the same is true of all life. There’s a common evolutionary ancestor relating a human to a chimpanzee, a chimpanzee to a frog, a frog to an insect, an insect to a spore of fungus. All life on Earth is related, via the last universal common ancestor (or LUCA), a hypothesized microbe that lived billions of years ago. To Hays, that relationship raises an epic question. “So, knowing that all life on this planet seems to be all related to each other, what would life on a different planet be like?” she asks. It’s possible, though not guaranteed, if Perseverance finds evidence of past life on Mars that scientists could determine if it likely shares a common ancestor with life on Earth. (“All life on Earth shares certain similarities,” she says, “using DNA/RNA for ‘information’ storage and most of the same amino acids in their proteins. If we found life on Mars that shared those similarities,” then maybe it’s related to life on Earth. If life on Earth and Mars has a common ancestor, then that means possibly life started on one of the planets and then was somehow transported to the other (likely by meteorite). It’s possible that life didn’t start on Earth but instead on Mars, or perhaps even somewhere else in space. But if the Martian life seems very different from life on Earth, then it could mean that “life is so fundamental a process of the universe that you can have two different life-generating events in the same solar system,” Hays says. That means life might be even more common in the universe than we currently suspect. Hays does caution that answers to these epic questions may still elude us, even with the best of all possible rock samples. Scientific evidence is often ambiguous, and there is sure to be debate about any sweeping conclusion. But the fact remains: Mars is a hugely important place in our solar system to investigate these questions. And there could be, right now, a simple rock lying on the Martian surface, with epic evidence inscribed in it. Maybe, just maybe, our robot rover will find that rock, collect it, and show us how special life really is. Further reading 7 solar system mysteries scientists haven’t solved yet — Why is our moon so weird? What killed Venus? Big cosmic questions lurk in our celestial backyard. NASA’s Perseverance mission, explained Apollo astronauts left their poop on the moon. We gotta go back for that shit.
2 h
vox.com
What a lawsuit in Mississippi tells us about the future of abortion pills
Medication abortion — a combination of both mifepristone and misoprostol — account for more than half of all abortions in the US. A lawsuit over generic pills in Mississippi could determine how much states can regulate them. | Photo illustration by Olivier Douliery/AFP via Getty Images A mifepristone manufacturer has been arguing in court that state restrictions can’t preempt the FDA. As some states have moved to fully ban abortion in the wake of Dobbs v. Jackson Women’s Health, new questions emerged about abortion pills: Do stateshave the legal authority to outright ban drugs that have been approved by the U.S. Food and Drug Administration? An ongoing federal lawsuit in Mississippi could provide a glimpse at the answer. GenBioPro, the manufacturer of generic abortion pills,is fighting to overturn state restrictions that impede access to the abortion pill mifepristone. Their lawsuit, filed in 2020, hinges on an argument that many legal experts expect other states and advocates to make in the coming months: thatMississippi’s restrictions on medication abortion are unduly excessive, illegally pre-empting the FDA’s authority on drug safety. The FDA approved mifepristone for use in 2000. Over the next 18 years, more than 3.7 million women in the United States used the medication — sold under the brand Mifeprex — to end an early pregnancy. In 2016 the FDA reported mifepristone’s “efficacy and safety have become well-established by both research and experience, and serious complications have proven to be extremely rare.” Three years later the agency approved GenBioPro’s generic version. Today medication abortion — a combination of both mifepristone and misoprostol — account for more than half of all abortions in the US, and fights over accessing the pills are expected to be among the most fiercely contested in the post-Roe era. Just hours after the US Supreme Court overturned Roe, President Joe Biden gave a speech promising to protect a woman’s access to drugs approved by the FDA, including mifepristone. Biden announced he was directing the federal Department of Health and Human Services “to ensure that these critical medications are available to the fullest extent possible” and Attorney General Merrick Garland pledged to use the powers of the Justice Department to crack down on states trying to ban medication abortion. But the Biden administration has stayed quiet on the Mississippi lawsuit. The White House declined to comment on the case, as did the FDA and DOJ. HHS did not return requests for comment. Mississippi has urged for a dismissal of the case. Judge Henry Wingate, a Reagan appointee on the United States District Court for the Southern District of Mississippi, requested that both parties provide written submission on the impact, if any, of the Dobbs decisionon the lawsuit, and on Mississippi’s “trigger law” banning abortions, which is set to take effect next week. Submissions are due on Thursday. A ruling in favor of Mississippi could have implications for other jurisdictions seeking to ban abortion pills in a post-Roe landscape. If upheld, it “would also open the floodgates for states to substitute their judgment for FDA’s in other controversial areas of medicine — some of which we may be aware of — some of which we may not be,” said Delia Deschaine, a DC-based attorney who specializes in FDA regulation. “For example, if there were a group of individuals opposed to palliative care, a state could conceivably limit access to medications that are approved for use in that context. This then becomes a situation where the practice of medicine using pharmaceuticals unpredictably varies between states — which creates its own host of public health issues.” What it means to “pre-empt” the FDA Through the passage of the Federal Food, Drug, and Cosmetic Actin 1938, Congress empowered the FDA as the sole agency to approve drugs in the US. It’s responsible for reviewing a drug’s safety, weighing its risks and benefits, and regulating appropriate conditions for safe and effective use. Even though many reproductive health experts — including the American College of Obstetricians and Gynecologists — actually say the FDA has too many restrictions on mifepristone (for example, only certified pharmacies or providers can dispense the drug) everyone must abide by the agency’s determinations. But many red states, including Mississippi, have passed laws that go even further than FDA’s rules around mifepristone. For example, Mississippi requires a doctor to physically examine a patient prior to offering the drug, and for patients to ingest the medication “in the same room and in the physical presence of” the physician who gave it to them,rather than taking the medication at home. Experts say there is a “strong, though legally uncertain” argument that the Supremacy Clause of the US Constitution gives the federal government authority over these conflicting state rules. Indeed, GenBioPro has argued Mississippi’s law is “an impermissible effort by Mississippi to establish its own drug approval policy and directly regulate the availability of drugs within the state.” This idea — that federal regulation of drugs would take precedence, and a state cannot ban a drug that has been given federal approval — is known as the preemption argument. For now, legal scholars say it’s unclear how preemption arguments will play out in court. Courts often grant deference to the FDA, though there are relatively few examples involving drugs. The main precedent is a 2014 case where a federal judge struck down a Massachusetts effort to restrict the opioid Zohydro, since the FDA had approved the painkiller. “The fact that this case relates to a medication that is used in abortion is one reason we might see the district court take a different stance than other courts on this issue,” said Deschaine. Anti-abortion advocates maintain that states have the authority to restrict or ban mifepristone, because states can regulate medical practice, and the FDA lacks the authority to regulate abortion. Legal scholars also note that Congress has never explicitly said that FDA drug approval supersedes state law, though it has expressed that for medical devices. While the DOJ declined to comment on the GenBioPro case, Attorney General Garland’s recent public statements suggest the agency is thinking about the preemption argument. “The FDA has approved the use of the medication Mifepristone,” Garland said Friday, adding that, “states may not ban Mifepristone based on disagreement with the FDA’s expert judgment about its safety and efficacy.” What’s next for the GenBioPro lawsuit Gwyn Williams, an attorney representing GenBioPro, told Vox that in response to the judge’s request, their team submitted a statement reiterating their previous position that the legal issues decided by the US Supreme Court in Dobbs “do not affect GenBioPro’s claims, which are based on federal preemption and not on constitutional rights to privacy or abortion.” Williams says they expect the judge to issue his decision on dismissing the case soon. Paul Barnes, a Mississippi Assistant Attorney General representing the state, declined to comment. Greer Donley, a University of Pittsburgh law professor who specializes in reproductive law, told Vox that one reason why the court has been “pretty delayed” in issuing any rulings could be because the judge “might be trying to look for an opportunity to kick the case.” If Mississippi fully bans abortion statewide — which it’s set to do next week, though that trigger law is now being challenged in court — then the state’s mifepristone restrictions might become moot. “If there’s a statewide ban, then I can imagine the defendant saying the lawsuit is moot now because all these laws that regulate abortion providers are subsumed by the bigger abortion ban generally,” said Donley. But Donley says the preemption argument would still have broad merit, since the FDA still acts as a gatekeeper. “To earn the right to sell a drug product, manufacturers must produce years, if not decades, of expensive, high-quality research proving that the drug is safe and effective,” she wrote, along with law professors David Cohen and Rachel Rebouché in a legal article cited in the Dobbs dissent. “If they are successful, they can sell their product in every state; if unsuccessful, they cannot sell their product anywhere. If a state were to ban abortion, it would in effect ban the sale of an FDA-approved drug.” In other words, if it is impossible to comply with both state and federal law at the same time, there remains a plausible preemption argument. Deschaine, the attorney who specializes in FDA regulation, thinks upholding state restrictions on abortion pills could certainly affect whether other drug companies seek to go through the FDA approval process in the future. “The incentives for developing FDA-approved drug products are strong, but those start to erode the more fractured the regulatory scheme for these products becomes,” she said. “If a company does not believe that it will be able to market its product in all US states/jurisdictions, then it may not be willing to assume the risk of pursuing the drug approval pathway. Indeed, even absent those restrictions, that pathway is very costly and uncertain.”
2 h
vox.com
Google searches show people’s questions and fears in a post-Roe America
Protesters hold banners supporting abortion rights at the RiseUp4AbortionRights rally in Los Angeles on June 27. | Robert Gauthier/Los Angeles Times via Getty Images In Arkansas, people asked if abortion was legal in Texas. In Louisiana, they asked about Florida. When the Supreme Court overturned Roe v. Wade last Friday, many Americans were upset and confused — and they turned to the internet for answers. The 6-3 decision in Dobbs v. Jackson Women’s Health immediately made abortion illegal in eight states, and it will likely become so in nearly half of all states soon. It’s a move that runs counter to what the vast majority of Americans want — 85 percent think abortion should be legal in some or all instances — and it will have far-reaching consequences on everything from the health and economic status of women to the well-being of their existing children. To get an understanding of what’s on Americans’ minds after this historic ruling, we asked Google for the top trending questions people posed to the search engine since June 24, both in the states where abortion first became illegal following the Dobbs decision and nationally. (Trending searches show where there’s the greatest increase in searches, not the highest volume, and are a good way to sort out perennial searches from new ones.) What Americans asked sheds light on their anxieties and where the discussion may go next. In individual states where abortion became illegal (though the bans have since been challenged in court in several of those states), the questions often involved where exactly the procedure is legal or illegal and where else people could get an abortion. In Louisiana, the No. 1 trending search question was about whether abortion was legal in Florida. In Arkansas, people asked about Texas. In Kentucky, Missouri, and South Dakota, several of the top questions people Googled were related to abortion pills — if they’re illegal, how they work, and for how long they’re effective. As Vox’s Rachel Cohen pointed out, crossing state lines to have an abortion or having health care providers mail pills to people in states where abortion is illegal presents thorny and unanswered legal questions. Many others in states where abortion is illegal were confused about what the abortion ban meant when abortion is medically necessary. They asked if aborting an ectopic pregnancy, a life-threatening complication in which a fertilized egg implants outside the uterus, was banned (most states with abortion bans have exceptions when the life of the mother is at risk, but the decision could put doctors and patients in a tough situation). They also wondered if having a miscarriage, where the fetus needs to be removed, is considered an abortion (it’s a gray area, and the ruling could certainly make doctors more hesitant). People in Arkansas and Louisiana asked if the Bible talks about abortion (it’s not explicit). Those in Utah and Alabama wanted to know why abortion is illegal. On a national level, the trending Google search questions about abortion this last week were somewhat broader: How many abortions were performed in 2021? What does abortion mean? What percentage of abortions are medically necessary? Importantly, people across the country made it clear their concerns about the Supreme Court decision were about more than just abortion. The No. 2 trending abortion question: What does Roe v. Wade protect besides abortion? People also wanted to know if Roe v. Wade would affect IVF, LGBTQ rights, and interracial relationships. Google Other trending questions in related areas like women’s health this past week included whether the decision would affect access to condoms or birth control (it won’t, but some fear contraception could be a future target for the Supreme Court). People asked about the longest-lasting IUDs or getting their tubes tied. Nationwide search interest in the oral contraceptive levonorgestrel, IUDs, IVF, ectopic pregnancy, period tracking apps, and vasectomy reached all-time highs this month, according to Google. “Vasectomy near me” is also being searched more than ever. The Supreme Court decision in Roe v. Wade leaves a lot more questions than answers. And for now, Americans are forced to go online to try and figure it out. Here’s a full list of the top trending abortion questions on Google from June 24, when the Supreme Court decision overturning Roe v. Wade was handed down, to June 28: United States How many abortions were performed in 2021? What does Roe v Wade protect besides abortion? Is an ectopic pregnancy treated with an abortion? Is D&C the same as abortion? How many states have banned abortion? Is abortion legal in the Bahamas? Is it illegal to have an abortion now? Who made the abortion law? What percentage of abortions are medically necessary? What does abortion mean? Alabama Why is abortion illegal? How do abortions work? How to support abortion rights? How many babies have been aborted? What states do not ban abortions? How many black babies have been aborted since Roe v Wade? What percentage of abortions in the US are elective? How many abortions were performed in 2021? What percentage of abortions are black? Is D&C abortion? Arkansas Is it illegal to have an abortion now? How many states have banned abortion? What countries is abortion illegal? Is ectopic pregnancy removal an abortion? Where in the Bible does it talk about abortion? What state is abortion illegal? Is abortion legal in Texas? Is a missed miscarriage an abortion? What is the new abortion law in Arkansas? How many abortions in total in the US? Kentucky Is ectopic pregnancy abortion banned? Is D&C the same as abortion? Is it illegal to have an abortion? Which states have banned abortion? What is an abortion pill? Is an ectopic pregnancy treated with an abortion? When were abortions invented? Who pays for abortions in the US? How long is pill abortion effective? Where to read about the abortion law Louisiana Is abortion illegal in Florida? Is ectopic pregnancy removal an abortion? What does the Bible say about abortions? Who made the abortion law? What to say to your senator about abortion? What is a surgical abortion? How many abortions were performed in 2021? Who made abortions illegal? What states still allow abortions? What is an abortion? Missouri Which states have banned abortion? Is ectopic pregnancy abortion banned? How many abortions are there a year? How does the abortion pill work? Is an ectopic pregnancy treated with an abortion? Is D&C the same as abortion? Is the abortion pill legal in Missouri? What did Roe v Wade protect other than abortion? Is Missouri banning abortions? How many states allow legal abortions? Oklahoma How are abortions performed? Is it illegal to have an abortion now? What state is abortion illegal? Is a miscarriage considered an abortion? How many babies are aborted in the US every year? What is the new abortion law in Oklahoma? What countries don’t allow abortions? Was abortion a constitutional right? What did the Supreme Court rule on abortion? How many abortions take place a year? South Dakota How many abortions were performed in 2021? What countries is abortion illegal? Can you get an abortion in South Dakota? When was abortion legalized? Is a missed miscarriage an abortion? What states are abortions illegal in? Is abortion in the constitution? What is the new abortion law? Which states is abortion legal? Is Plan B an abortion pill? Utah What is elective abortion? What is the penalty for abortion now? When was abortion legalized? Is it illegal to have an abortion now? Why is abortion banned? How many abortions are there a year? How late can you have an abortion? How far along can you get an abortion? Is abortion a constitutional right in the United States? How many abortions were performed in 2021?
4 h
vox.com
The nontoxic social media app that tells you your toxic traits
Sounds about right. | Dimensional/Rebecca Jennings Personality tests are mostly bogus. Dimensional is fun anyway. I have a confession, which is that although I deeply dislike the way the internet encourages us to pathologize each other and ourselves — the overuse (and often misuse) of terms like “emotional labor,” “dissociation” or “sapiosexual” to label everyday phenomena, for instance — I love personality quizzes, which effectively do the same thing. In the parlance of personality quizzes, your everyday behaviors and thought patterns take on spectacular special meanings; you’re not just “adventurous” or “athletic,” you’re a Gryffindor. You’re not obsessive in love, you’re anxious-attached. You’re more than just playful and impulsive, you’re an Enneagram Type 7, a designation I share with Joe Biden, Paris Hilton, and Mozart. A few weeks ago, I made a new friend (I’m an extrovert!) who told me about an app she was obsessed with called Dimensional. Basically, you take a series of personality quizzes, and then the app compares you to your loved ones who are also on the app: how similarly you behave in the workplace, how compatible you are in love, whether you share the same values. I downloaded it immediately and then wrangled as many friends as I could to do the same. Like Co-Star, the wildly popular astrology app that sends its users wry daily missives like “Start a cult” or personal negs like “Maybe you just need a roll in the hay,” Dimensional contains a fair bit of Instagram bait. After you’re done with all the assessments — there are currently 10 of them, relating to things like “conflict style” and “values;” completing them all takes about an hour — Dimensional will serve you “stories,” or Instagram-ready slides listing your “worst habits in love” or “most toxic traits.” (“Taking it personally when other people want alone time” and “crushing on everyone” ripped me to shreds.) Its pleasant-looking UX is far from the most fun part about Dimensional. Once you’ve forced a friend to join, you can read an AI’s opinion of your relationship. On my best friend and me: “Rebecca not only loves when they’re told how someone feels about them, they usually need to hear these affirmations to feel appreciated. Mary Kate does not express gratitude or affirmation instinctively.” On another friend and me: “You’re the Bonnie and Clyde of relationships. You two seek independence from the world — not each other.” These little insights aren’t interesting to anyone but us, obviously. No personality test is, which is exactly why they’re such good respites from traditional social media: There are no photos, no liking, no performing for an imagined mass of invisible strangers. Rather than act as brands and media companies and megaphones, we reflect on our own humanness — and then, yes, upload that data into the cloud. We’ve endured more than a decade of discourse and academic research on whether anyone is really “themselves” on the internet, and we’re now at the stage where a crop of social media platforms have marketed themselves as “anti-Instagram” apps: no self-promotion, no ads, no chance at getting famous. Out of them all — Dispo, Poparazzi, BeReal — only the latter has seemed to transcend fad status, although it’s still early in its popularity. Dimensional doesn’t bear many similarities to these apps. For one, the entire premise of Dimensional relies on what is essentially a one-time experience: You take the quizzes, you wait for your friends to take them, then you compare. There’s a limit on how much time you spend there, which prevents it from attracting the kind of venture capital that helped early social media startups launch but demands growth — more users, more engagement, more ad dollars — at all costs. Paradoxically, that’s exactly what makes it so pleasurable to use: You can get burnt out by the neverending churn of your TikTok or Twitter feeds, but using Dimensional is more like reading an article starring yourself. Personality tests have always been a little cheesy and a little scoffed at, and probably for good reason. As my colleague Constance Grady has noted, the most famous, Myers-Briggs, revolves around dualities that don’t actually exist and uses dated Jungian theories as justification for its scientific claims. They satisfy human beings’ instinct for tribalism: Being sorted into a group makes us feel more comfortable. What’s more, we’ll start to identify with that group no matter what it actually is, a phenomenon known as the Barnum effect. We’ve been typifying people as far back as 400 BC, when Hippocrates believed that every person belonged to one of the four humors. The more modern roots of the personality quiz lie in women’s magazines, which started including many more front-of-book games and puzzles post-World War I. By the 2010s, an entire venture-backed media company relied on addictive quizzes to skyrocket its growth. Personality testing takes on a more complicated meaning in the age of Big Data. If you’re a person who has high “neuroticism” in your Big Five personality chart, you likely see an app like Dimensional as a field day for data privacy abuse. This is a fair concern: In the lead-up to the 2016 presidential election, the data firm Cambridge Analytica used widely shared personality quizzes to compile data on 87 million Facebook users without them knowing. With access to more intimate details than demographics or hobbies — what makes someone anxious, what they fear, how they form relationships — it’s not difficult to imagine a worst-case scenario. Even so, concerns over what information a relatively tiny app contains about you feel like missing the forest for the trees: What use is my “love language” compared to a constant log of where I go and who I associate with, which my smartphone already has? I can’t possibly be angry that Dimensional knows my ideal partner is “someone who tells me I’m hot” or that my elemental spirit is “Air” (???). I guess I can sort of be angry that Dimensional told me that I am lower on the “Thinking” function than 85 percent of users, which seems rude. Mostly, though, I’m reminded of what those little personality quizzes in women’s magazines meant to mid-century housewives, or to me, bored and alone in my room as a child. “They needed things to fill their time,” explains the New Yorker’s Maria Konnikova of the initial wave of magazine personality quizzes. “They needed other ways to signal, ‘I’m alive! This is me, this is who I am’ and quizzes were a way of doing that, whereas men had their careers.” This is what personality tests feel like to me — less exercises in narcissism and more opportunities to reflect, to think about the kinds of things we’re prevented from thinking about by the demands of modern life. “Look, it’s us,” I text my friends, one by one, as I send them Dimensional’s comparisons. Look how alive we are! This column was first published in The Goods newsletter. Sign up here so you don’t miss the next one, plus get newsletter exclusives.
6 h
vox.com
Anyone can fall for online scams — even you. Here’s how to avoid them.
Online scams will make your money fly away. | Denis Novikov/Getty Images From spam texts to payment app fraud to crypto tricks. Alison Giordano just wanted to help out a friend, but instead, she almost lost her Instagram account. The scam was pretty sneaky: A friend messaged Giordano (who, full disclosure, is a friend of mine) on Instagram asking if she could help her win a contest. The friend would send her a text with a link, and all Giordano had to do was take a screenshot of the text and send it back to her friend. Giordano did as instructed. Moments later, she got an email from Instagram saying someone logged into her account from a different location on a different device. A screenshot that causes your account to be hacked sounds like a lower-stakes but higher-tech version of The Ring, but what happened to Giordano is actually quite simple. There was no contest, and the text didn’t come from her friend. Giordano’s friend (or, almost certainly, someone who took over her friend’s account and was pretending to be her friend) went to Instagram’s password reset page and requested a reset link for Giordano’s account. That prompted Instagram to send a text to Giordano with a link to access her Instagram account. The URL of the link was in the text, so when Giordano took the screenshot and sent it back, the scammer simply entered the URL in their device, and that let them access Giordano’s account — no password or supernatural curses necessary. Fortunately for Giordano, she saw Instagram’s email almost immediately and was able to get back into her account before the scammer took it over. She blocked her friend’s account, changed her password, and enabled two-factor authentication. “I was just very naive and trusting,” Giordano tells me. “I felt pretty stupid when all was said and done.” She shouldn’t have. The Instagram messages came from what appeared to be a friend, and Giordano’s other friends have asked for her help with (real) social media-based contests in the past, so of course she didn’t think much of it. She certainly didn’t think sending a screenshot could compromise her account. Until we spoke, she didn’t even know how it happened — it took me a while to figure it out too, until this tweet warning about this kind of scam clarified things. If Giordano hadn’t seen that email from Instagram, her account might have been lost to her forever, probably going on to try to scam all of her friends. We’d like to think that scams happen to other people who aren’t as smart or savvy as we are. Many people who get scammed believe this, which is why the vast majority of them will never report it: Either they don’t know they were scammed or they’re ashamed to admit that it happened to them. But it could happen to anyone, including you. “The reason why these scams work is because some of them are good,” Yael Grauer, content lead for Consumer Reports’ Security Planner, tells Vox. “Even though I think education is important, there’s a reason social engineering is a thing. You can’t be perfect and on guard all the time.” Scammers prey on our biggest fears and strongest desires. They get better all the time, so it’s worth your time to learn how to recognize their tactics. The mediums scammers use may change, but many of the underlying strategies stay the same — which means the recommendations for how to protect yourself from them do too. Don’t panic ... When I got an email saying there was a new login to my Twitter account from Moscow, my initial response was abject terror (My checkmark! My DMs! My reputation!). At first glance, the email looked a lot like the login confirmation emails that Twitter actually sends. Even the email address it was sent from was very close to the one Twitter uses for such notifications. I admit that I almost clicked on the account restoration link. Then the adrenaline wore off, and I realized that the email came from “twitter-act.com” and not “twitter.com.” It was sent to my work email, which isn’t attached to my Twitter account, and it had a typo. Most importantly, I remembered that some of my co-workers had gotten similar phishing emails only a few days before. I actually knew to expect this one, but all of that fell out of my head for a few seconds — which was exactly the point. “It’s really, really hard for us to access logical thinking when we’re in a heightened emotional state, and it’s so hard to get out of that state once you’ve engaged,” says Kathy Stokes, director of fraud prevention at the AARP. “If you feel an immediate sort of visceral, emotional reaction to something coming your way, try to let that be your red flag.” Scammers know that emotions make their job easier. People get careless or let their guard down, which is why so many scams start with urgent messages asking you to do something immediately: dispute an erroneous charge on your Amazon account, fix your hacked social media account, avoid being arrested by the IRS police by settling a bill that for some reason can only be paid off in gift cards. In almost every case, a legitimate message doesn’t need you to respond within the next 30 seconds. So take that 30 seconds to calm down and think before you click anything. … and don’t engage If you get a message or call you weren’t expecting and don’t know, the best thing to do is ignore it. Even what appears to be a perfectly innocent wrong number text could be something more insidious: someone trying to scam you by starting up a conversation. I’ve gotten a few of those wrong number texts, and while I’d like to think they kept texting me back because of my sparkling wit and impeccable conversation skills, that almost certainly wasn’t the reason. “Someone texts something important enough for you to tell them it’s a wrong number and suddenly they’re like, ‘You sound like a great person,’” Grauer says. “For the most part, it’s almost always a scam.” Find your meet-cute somewhere else. That’s especially true for the texts and calls you know are scams. You may think it’ll be cathartic to respond to those by cursing out the people who are trying to steal your money, but the best thing you can do is block the number and move on with your life. Engaging with a scammer tells them your phone number or email address has a real person on the other end of it, which will only set you up to get more texts and calls and emails. “The basic rule of thumb is simply hang up, and call whatever enterprise you think called you directly,” Alex Quilici, CEO of robocall-blocking software company YouMail, explains. For example, if your “bank” calls, you should hang up, find the number of your bank on your debit card (or another official source, like its website), and call that number back. “That’s the 100 percent safe way to deal with the issue.” Even better is stopping scam calls and texts from reaching you at all. Phone companies now offer free spam-blocking services, which can identify and stop potential scam or spam calls. Some services can block potential spam texts: iOS devices have built-in text filters, and Google’s Messages app can warn you if a text seems suspicious. Don’t give out your password This should be obvious by now, right? Clearly not, since it’s believed that 90 percent of cyberattacks are the result of successful phishing schemes, where a hacker or scammer tricks victims into thinking they’re a trusted or known source to give their sensitive information to. Some are better than others. I’ve seen some knowledgeable people in my own life fall for email-from-your-employer attacks (they clicked the links, but I hope they all stopped short of giving out their passwords). That’s why most businesses will tell you that they will never ask for your password, and authentication texts will usually say something like “[Company] will never ask you for this code.” Also, you should really stop using two-factor authentication with texts, which are much less secure — use an authenticator app instead. Google makes a popular one for both iOS and Android. Scammers love to use social media to find victims, too. If you’ve ever so much as tweeted the word “hack,” you’ll get a series of what I like to call Twitter Scam Reply Guys, who will usually recommend that you contact someone they claim to know who can get your account back, as long as you give them your login credentials and/or pay them (don’t do this). Know where links are taking you A common way people get hacked or scammed is through malicious links, often in their email, texts, or DMs. Always check where a link is taking you before you click on it, and only go to websites you trust. That’s easier said than done, of course; it can be hard to see where a link is directing you on a smaller mobile device, and shortened link services may make it impossible to know where you’ll end up. If you get a text from FedEx about a package delivery with a link, for example, you may not realize that the website it’s sending you to isn’t FedEx. The best thing to do is go to a company’s website directly, rather than through a random link in a text you weren’t expecting in the first place. If you get a text that claims to be FedEx or Wells Fargo, go to FedEx.com or WellsFargo.com; don’t click the link on the text. And definitely don’t enter any of your sensitive information — like your credit card, social security number, or your password — on a site if you aren’t absolutely sure that it’s the site you think it is. Be very careful with payment apps Overpayment scams — when someone sends you more money than you were expecting and then asks you to give them back the difference — have stood the test of time. Once it was paper checks and wire transfers. Payment apps have made it even easier. In fact, peer-to-peer payment apps like Venmo, Zelle, and Cash App have made a lot of scams easier because it’s fairly seamless to send money through them, and those transfers are instantaneous. There’s a reason why those apps tell you over and over again to be sure that the person you’re sending money to is who you think they are: Once your money is sent, you often can’t get it back. These services don’t have the same protections as, say, a credit card or, in some cases, PayPal. One example of how scammers exploit these apps (and human decency) is to send money to random accounts (like yours), then claim they sent it to the wrong person and ask you to please send the money back. Being nice, you send the money back, only to later discover that the money that was sent to you came from a stolen credit card. Now you have to pay it back — all of it. If you’re the recipient of extra or unexpected funds, don’t just send the money back to wherever it came from, even if the sender gives you a convincing sob story for why you should. The best thing to do is contact the payment app and deal with the matter through them, rather than directly with whoever sent you the money. There are ways to protect yourself to a certain extent on these apps. Most will give you a way to verify that you’re sending money to the right person by confirming their email address or phone number first. Use these safeguards. Consumer Reports suggests connecting your peer-to-peer payment apps to a credit card instead of a bank account, as credit cards have more protections for fraudulent transactions. If the app won’t protect you, your credit card company might, though most payment apps make you pay a 3 percent fee on credit card transactions. It’s also a good idea to put a PIN code on those apps, so even if someone gets into your phone — say, if they ask to borrow it to make an emergency call — they can’t get into your apps and send your money away. This will add an extra step to using your payment app, but an easily remembered four-digit PIN takes about a second to enter and could save you a lot of money. Don’t use crypto Even in the best of circumstances, crypto is a loosely (or barely) regulated market that’s as volatile as it is hard to understand. That has helped make it a prime target for scammers and hackers. The decentralized aspect of crypto may be part of its appeal, but it’s a lot less appealing when you check your wallet one day and discover all your apes are gone. Maybe you’ll get lucky and OpenSea will freeze trading of your stolen NFT in time, or Coinbase will reimburse you if your crypto was stolen through its own security flaw. But don’t count on it. “The advice I give people is that if you don’t understand how it works, don’t get involved in it,” Sean Gallagher, a senior threat researcher at Sophos, says. “Considering that many people who consider themselves educated about crypto still manage to get scammed, it’s probably not a good idea for most people to get into cryptocurrency investing.” While crypto is relatively new, many people are getting scammed through some of the oldest tricks in the book. Stokes, of the AARP, says she has seen “a ton” of scams where someone gains a victim’s trust and claims they can help invest their money in crypto for a big return. The Federal Trade Commission recently reported that consumers lost $1 billion to crypto-based fraud between January 2021 and March 2022, with most of those losses coming from bogus investment scams — and most of those came from social media posts or ads. And those are just the losses people told the FTC about; again, most people don’t report being defrauded. These days, it’s easy enough to lose money in “legitimate” crypto investments. Why make it even riskier? Protect yourself from yourself One way to avoid getting scammed is to preemptively protect your accounts from your mistakes as much as possible. If Giordano had two-factor authentication on her Instagram account, the scammers wouldn’t have been able to get into it through the URL — they’d need the code from her authenticator, too. There are a few ways you can protect your accounts from getting hacked, including setting up two-factor authentication and using different passwords for everything via a password manager. You can lock things down even more by using hardware authenticators and anti-malware software, which you can get for mobile devices too. “That’s what security software is supposed to do,” Mark Ostrowski, head of engineering at cybersecurity company Check Point, says. It should protect you from “a lapse in judgment or if the scam is really, really, really, really good.” At a certain point, your security measures might feel like more trouble than they’re worth. I have to admit, things were easier when I didn’t have to juggle my password manager, two different authenticator apps, and text messages for the accounts where authenticator apps aren’t available. But I’d rather have to take an extra step to log into an account than go through getting hacked and (temporarily) losing $13,000, like I did that time hackers got into my bank account. You never know who has your password or how they got it. “There’s an ongoing usability versus security thing where it’s not fun, it’s time-consuming, it’s annoying,” Grauer, of Consumer Reports, says. It’s up to you to decide where the balance between usability and security should be, keeping in mind what you would lose if someone took over your accounts. After that, all you can do is try to keep these tips in mind, hope for the best, and don’t be too hard on yourself if you fall victim to the worst. “Having a healthy paranoia, I think, is important,” Ostrowski says, before confessing that even he has slipped up and clicked on a few links he shouldn’t have. “I hate to admit it, but I think everybody has, right?”
7 h
vox.com
Here’s why Netflix made you wait a month to watch the rest of Stranger Things
A scene from the fourth season of Netflix’s Stranger Things. | Netflix One chart that tells you a lot about the state of the streaming service. Netflix spends around $17 billion a year on new TV shows and movies. But its newest customers don’t think they’re getting their money’s worth: New data shows that Netflix subscribers are more likely to bail on the subscription service in the first month than are subscribers of any of its streaming competitors. That’s a new development, and it syncs with Netflix’s stunning news this spring that it lost 200,000 subscribers in the first three months of the year, and expects to lose another 2 million in the second quarter of the year. Those are the first subscriber losses the company has posted in a decade, and the results have led to a huge drop in its stock price, a scramble to find answers, and a fair degree of schadenfreude. The data that suggests what kind of problem Netflix is facing comes to Recode via Antenna, a research service that tracks consumer spending on subscription services. And it shows that by the end of April, 23 percent of Americans who signed up for Netflix had dropped the service within a month. That’s more new subscriber cancellations than any other competitive service Antenna tracks — including the likes of Apple TV+ and HBO Max, which used to have higher early churn numbers but have recently improved them. Antenna says its data comes from a panel of 5 million American consumers; the numbers don’t include free trials, or bundles and special offers like the one Verizon and Disney have done in the past. We still don’t know why Netflix subscribers are becoming Netflix cancelers, and there could be several reasons. It could be because of the company’s newest price hike, which went into effect early this year — at the same time that new subscribers began to churn out at a higher rate. It could be that after signing up to stream a specific new show or movie, customers looked around and couldn’t find other stuff they wanted to watch — or, at least pay for. It could be that they prefer Netflix rivals like Disney+ or HBOMax. Perhaps all of the above. But it’s certainly worrisome for Netflix, which used to offer subscribers a huge swath of Big Media’s best movies and TV shows, because Big Media wasn’t paying attention to streaming. That’s over now, and some of the best-performing stuff that used to be on Netflix — TV shows like The Office and Friends; movies like Disney’s Marvel franchise — are now on competitors’ platforms. So Netflix’s response includes a move to offer a cheaper version of the service with ads, and an admission that it has to get better at the programming it makes for itself. It also appears to be intentionally backtracking on its initial pledge to let viewers watch an entire season of a show at once. Instead, in the case of a few high-profile shows, like Ozark, it has released the newest season in two chunks, spaced months apart. It’s doing the same thing for the new season of Stranger Things: The first seven episodes came out on May 27, but the last two won’t come out until this Friday, July 1. That is: If you want to see all of Stranger Things season 4 right away, you need to subscribe to Netflix for at least two months, and likely for three. You can see the logic for that in the chart of Antenna data below, which tracks the churn of video subscribers who have signed up in the last three months. In this one, you can see that Netflix performs in the middle of the pack of its peers, which tend to release one new episode of a hit show every week. If Netflix can hang onto subscribers for a little bit, its relative performance improves. A Netflix rep declined to comment on Antenna’s data, but pointed me to the company’s commentary in its April earnings call, where it acknowledged “slight elevated churn” — but also said that its ability to hang on to customers “remains at a very healthy level.” The best news for Netflix, which still has some 220 million subscribers — much more than any competitor — is that the longer someone subscribes to Netflix, the more likely they are to keep subscribing. The company’s lifetime churn rate remains better than anyone else — though it has gone up in recent months as well: But hanging on to older subscribers won’t help Netflix that much if it can’t keep its new ones. And it needs new ones to keep investors at bay. Netflix was worth nearly $300 billion last fall; now it’s worth $84 billion, and that number could keep falling if Wall Street thinks its growth days are over. There’s no single magic bullet for that, and the task may get even tougher if a recession forces consumers to cut back on entertainment spending — and perhaps spend more time watching free entertainment options like TikTok. One of the reasons it’s fun to write about Netflix is that everyone’s a Netflix expert, because everyone uses Netflix. So: What are you seeing? Are you sticking with Netflix? Have you swapped it out for something else? If you’ve dropped it, what would you need to come back? Drop me a line at kafkaonmedia@recode.net and let me know. And if you’re reading this on a browser but would like to have it delivered to your inbox, free of charge: Good news! Sign up here for piping hot content (almost) every Wednesday.
8 h
vox.com
2 winners and 3 losers from the Colorado, Illinois, and New York primaries
Heidi Ganahl celebrates during a watch party celebrating her Republican primary win for Colorado gubernatorial candidacy on Tuesday, June 28, 2022. | Aaron Ontiveroz/MediaNews Group/The Denver Post via Getty Images Trump and his election lies were once again on the ballot in multiple states. The last big primaries of June took place on Tuesday as voters in Colorado, Oklahoma, Utah, Illinois, New York, Mississippi, and South Carolina headed to the polls. Former President Donald Trump’s election lies were, once again, on the ballot in several Republican primaries, while progressives faced off against moderates in key Democratic districts. Tuesday’s contests also included some tight gubernatorial match-ups, face-offs between Republican and Democratic incumbents due to redistricting, and some surprising runoffs in the South. Here are 2 winners and 3 losers from this week’s primaries. Loser: Democrats’ attempts to sabotage GOP primaries Democrats tried to meddle in several GOP primaries in Illinois and Colorado, with some voters switching party affiliation to vote for their preferred GOP opponent and Democratic Party allies spending exorbitant amounts of cash to boost extremist Republicans with mixed results. In Colorado’s House District Three, far-right Republican and QAnon supporter Rep. Lauren Boebert fended off a challenge from more traditionally conservative state Sen. Don Coram, despite thousands of Democrats renouncing their party affiliation to try to vote her out and support Coram. The seat is safe for Republicans, leading Democrats to try to boost the less extreme of the GOP options. Voters can cast ballots in the GOP primary in Colorado if they are registered with the party or unaffiliated with a party. There were at least 3,700 more unaffiliated voters in this year’s primary for District Three than in the last election cycle, but that didn’t turn out to be enough to oust Boebert on Tuesday. Michael B. Thomas/Getty Images Rep. Lauren Boebert speaks at an Illinois Save America Rally in June 2022. There were also unprecedented levels of Democratic spending to boost the prospects of far-right Republicans who were seen as making for weak opponents in the November general election. In the GOP primary for Colorado’s US Senate seat, Democratic groups spent roughly $4 million on ads designed to make far-right candidate Ron Hanks more appealing to GOP voters over his more moderate opponent, Joe O’Dea. Some Democratic strategists believed incumbent Sen. Michael Bennet might have had a better chance of beating Hanks than O’Dea in a state that Biden easily won in 2020. Hanks embraced Trump’s 2020 election lies, attended the rally held ahead of the January 6 insurrection at the US Capitol, and has said that all abortions should be outlawed. Despite the heavy Democratic spending, O’Dea nevertheless claimed victory on Tuesday. In the Illinois Republican primary for governor, however, the strategy of boosting the far-right candidate was more successful. Incumbent Democratic Gov. J.B. Pritzker and the Democratic Governors Association, which he funds using his billion-dollar fortune, spent almost $35 million total trying to paint state Sen. Darren Bailey, a pro-Trump Republican, as the most conservative candidate in the race. One television ad they paid for seems engineered to entice conservative GOP voters: It claims that Bailey tried to stop the governor’s Covid-19 mandates, embraces the Trump agenda, protects gun owners, and is “100% pro-life.” They also paid for ads attacking Bailey’s main GOP opponent, Mayor Richard C. Irvin of Aurora, a moderate suburbanite, arguing that he was a Democrat attempting to pass himself off as a Republican. Ultimately, Bailey handily won the nomination. He faces an uphill battle in a state that went for Biden by 17 percentage points and against an incumbent Democratic governor with a $132 million war chest. —Nicole Narea Winner: Trump and his 2020 election lies It was a good night for the MAGA crew, with Trump apologists and 2020 election deniers largely sailing to their party’s nominations in Illinois, Utah, Oklahoma, and Colorado. Utah Sen. Mike Lee, who enthusiastically backed Trump’s efforts to overturn the results of the 2020 election, fended off two more-moderate primary challengers who didn’t vote for the former president in 2020: former Utah House member Becky Edwards and political operative Ally Isom. Both of Lee’s opponents had criticized him for his unwavering loyalty to Trump, trying to tap into Utah Republicans’ discontent with the direction of their party. Oklahoma Gov. Kevin Stitt — who was endorsed by Trump in March and has embraced right-wing stances on guns, abortion, and other culture war issues — easily won the nomination. That’s despite strained relations with Native American tribes in the state and some Republicans in the state legislature after he vetoed key pieces of a budget deal earlier this year. The runner-up, the head of the Oklahoma Department of Veterans Affairs Joel Kintsel, didn’t even come within striking distance. In addition to state Sen. Darren Bailey, another Trump-endorsed Illinois Republican prevailed in House District 15, where Rep. Mary Miller ousted her colleague Rep. Rodney Davis in a member-on-member primary. They were facing off because the Illinois legislature, looking to maximize its Democratic delegation, redrew the state’s electoral map to eliminate Miller’s current district and turn Davis’s once-purple district into a safe Republican one. Michael B. Thomas/Getty Images Former President Donald Trump introduces Rep. Mary Miller to the crowd at a June 25, 2022, Save America Rally in Mendon, Illinois. Among the exceptions to the overall strong showing from Trump candidates was Oklahoma Sen. James Lankford, who won his primary despite refusing to embrace Trump’s election lies. He defeated Tulsa pastor Jackson Lahmeyer, who was endorsed by Trump’s former national security adviser Michael Flynn and who’d argued that the senator wasn’t sufficiently conservative. Though Trump-endorsed Boebert prevailed in Colorado, other vocal supporters of the former president didn’t fare as well in the state. In addition to Hanks, gubernatorial candidate Greg Lopez, House candidate Lori Saine in District Eight, and Secretary of State hopeful Tina Peters also lost their primaries. Lopez was known for floating a proposal to replace Colorado’s popular vote electoral system with a state-based electoral college to advantage rural Republican voters, and lost to establishment Republican Heidi Ganahl. Saine has echoed Trump’s claims about voter fraud in 2020 and also adopted strict anti-abortion and pro-gun rights positions. And Peters, the Mesa County clerk and recorder, was indicted for election tampering and misconduct because she tried to break into the county’s election equipment to look for nonexistent fraud. Overall, however, after a tough day for him in Congress, there was a lot for the former president to like about Tuesday’s election results. —NN Winner: The House progressive caucus While several progressive candidates posted disappointing performances on Tuesday, there were still some bright spots for Democrats’ left flank, particularly in Illinois. State House Rep. Delia Ramirez, a vocal champion of Medicare-for-All and the Green New Deal, won her primary against moderate Chicago Alderman Gil Villegas in Illinois’s Third Congressional District. Ramirez has sponsored legislation expanding Medicaid access and campaigned on finding ways to reduceviolence through community-based interventions. Jeff Schear/Getty Images/IL GND Coalition Democratic House candidate Delia Ramirez speaks at an April 2022 climate change event in Chicago. Ramirez wasn’t the only Illinois progressive to win on Tuesday. In the state’s First District, Jonathan Jackson, a nonprofit spokesperson and son of civil rights activist Reverend Jesse Jackson, also came out on top, beating 16 opponents, including Karin Norington-Reaves, a former Cook County official who had been endorsed by retiring First District Rep. Bobby Rush. Both Ramirez and Jackson were backed by Sen. Bernie Sanders (I-VT). Progressives were less successful, however, in other races. In the New York governor and lieutenant governor elections, progressive candidates Ana María Archila and Jumaane Williams lost by large margins to incumbents Kathy Hochul and Antonio Delgado, respectively. Former Illinois state Rep. Litesa Wallace, backed by progressive groups Our Revolution and Indivisible, was defeated by former broadcast meteorologist Eric Sorensen in Illinois’s 17th District. Incumbent Rep. Marie Newman, who was seen as the more liberal option in a member-on-member contest against Rep. Sean Casten, lost in Illinois’s newly drawn Sixth District.And organizer Kina Collins seemed poised to lose her second challenge to incumbent Rep. Danny Davis in Illinois’s Seventh District. Despite the losses they experienced this week, progressives still made notable gains in two safe Democratic seats that are set to add to their presence in Congress this fall. Those victories are likely to bolster a growing progressive caucus in the House of Representatives, helping their ideas to have even greater sway in the Democratic Party for years to come. —Li Zhou Loser: Giuliani (Andrew, not Rudy) Name recognition — and close ties to the former president — weren’t sufficient to get Andrew Giuliani, son of Trump adviser Rudy Giuliani, a win in the Republican primary for New York governor. Spencer Platt/Getty Images Defeated New York GOP gubernatorial candidate Andrew Giuliani greets supporters at his Manhattan watch party Tuesday night. Giuliani, a former Trump aide himself, had an early lead Tuesday night. But in the end, he came in second behind Rep. Lee Zeldin, a four-term lawmaker from Long Island who garnered a national profile for defending President Trump in his first impeachment proceedings. Zeldin and Giuliani ran on similar platforms, emphasizing how they’d be tougher on crime, including pushing back on the state’s bail reforms. Zeldin will be up against Hochul this fall and isn’t favored to win given the race’s “solidly Democratic” rating. —LZ Loser: Scott Pruitt Unlike fellow Trump Cabinet member Ryan Zinke, who recently won a Montana House primary, former EPA administrator Scott Pruitt didn’t fare so well in his attempt to run for Congress. Pruitt, a scandal-plagued Trump official who resigned after allegations of multiple ethical breaches — including using taxpayer money to take expensive flights and asking aides to complete personal chores — was among a long list of contenders vying to replace Sen. James Inhofe in his safe GOP seat in Oklahoma. Inhofe had announced his retirement earlier this year, setting up a special election for the rest of his term in November. During his campaign, Pruitt leaned into his track record as the head of the EPA, which included championing fossil fuels, leaving the Paris climate accords, and delaying new regulations on clean water and greenhouse gas emissions. Ultimately, he didn’t even come close: He received just over 5 percent of the vote, placing far behind House Rep. Markwayne Mullin and former Oklahoma House Speaker T.W. Shannon, both of whom advanced to a runoff. The outcome wasn’t necessarily a surprising one. Mullin, a small-business owner who voted against certifying the 2020 election, had long been seen as a frontrunner for the seat given his strong fundraising numbers and conservative bona fides. Pruitt, meanwhile, was fielding questions about ethical issues at the EPA even during his Senate campaign. —LZ
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Another 50 migrant deaths and an ever-climbing body count on the border
Police and other first responders work at the scene near San Antonion where officials say dozens of migrants were found dead in a truck on June 27. | Eric Gay/AP Including those found dead in a truck Monday, 290 people have died trying to cross the border in 2022. At least 50 migrants who were driven across the border in a tractor-trailer that was abandoned near San Antonio have died as of Tuesday, from apparent overheating. Rep. Henry Cuellar (D-TX), whose district includes San Antonio, told CNN that the truck had passed through a checkpoint north of Laredo, Texas, on Monday. Among the victims were 22 Mexicans, seven Guatemalans, and two Hondurans, with at least two children. Most of the bodies were recovered inside or around the trailer, though some were found strewn across the road up to 75 feet away. At least 16 others were found alive, suffering from heat exhaustion and dehydration as temperatures exceeded 100 degrees, and taken to nearby hospitals, where three later died. It’s the largest mass casualty event involving migrants crossing the US border in recent memory. But it’s by no means the only one: In the first six months of 2022, 290 people have died trying to cross the border, according to data from the International Organization for Migration, a division of the United Nations. Another 650 migrants died crossing the border in 2021, more than in any other year since the UN began tracking the data in 2014. Over the past two decades, the number of deaths is estimated to be just under 8,000 according to Border Patrol figures, though the actual number could be much larger since US immigration agencies have not kept complete records. President Joe Biden, in a statement on Tuesday, blamed smugglers who have “no regard for the lives they endanger and exploit to make a profit” for the tragedy. “This incident underscores the need to go after the multibillion-dollar criminal smuggling industry preying on migrants and leading to far too many innocent deaths,” Biden said. Immigrant advocates have argued that it’s the result of restrictive US border policies that have failed at their intended purpose of deterring migration. Trump-era policies, including the “Remain in Mexico” policy (otherwise known as the Migrant Protection Protocols) and pandemic-related border restrictions, have remained in place, effectively closing the border to the vast majority of migrants and asylum seekers and exposing them to danger in Mexico. Over the last six months, some 5,000 asylum seekers have been forced to stay in Mexico while awaiting their court hearings under the Remain in Mexico policy. The US Supreme Court is set to decide a case on whether the Biden administration can rescind that policy within the coming weeks. And the so-called “Title 42” policy has allowed the US to expel hundreds of thousands of migrants at the southern border under the guise of curbing the spread of Covid-19. The refugee advocacy group Human Rights First documented 8,705 reports of kidnappings and other violent attacks against migrants sent back to Mexico under those policies, as of January 2022. Those policies haven’t dissuaded migrants from continuing to attempt to cross the border without authorization. Immigration authorities have encountered migrants at the border more than 1.53 million times this fiscal year so far, already well exceeding the 977,000 total encounters in fiscal year 2019, before the Title 42 policy went into effect. But it has driven migrants to rely more heavily on smugglers and to resort to increasingly dangerous means of attempting to cross the border. “Cruel immigration policies like Title 42 have decimated our asylum system, and forced people to make unimaginable choices in their journey to seek safety and refuge in the US. Seeking asylum is a human right and President Biden should have ended Title 42 on day one of his administration,” the organization RAICES Texas, which was among the first legal service providers on the scene, said in a statement. What happens now to the survivors in San Antonio remains to be seen. The migrants could be sent to immigration detention and placed in deportation proceedings. So far, three people have reportedly been taken into police custody, one of whom was the driver.
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Think polarization is bad now? Wait till the post-Roe abortion wars get started.
Abortion rights supporters and anti-abortion activists confront each other in front of the US Supreme Court on May 4 in Washington, DC, as demonstrations rippled across the country in reaction to the leaked initial draft majority opinion indicating the Supreme Court would overturn Roe. | Kevin Dietsch/Getty Images Dobbs is the next stress test for America’s teetering democracy. In his decision overturning Roe v. Wadeand Planned Parenthood v. Casey, Justice Samuel Alito argues that the rulings that had protected abortion rights were not only poorly reasoned but actively harmful to American democracy. “Far from bringing about a national settlement of the abortion issue, Roe and Casey have enflamed debate and deepened division,” Alito writes in Dobbs v. Jackson Women’s Health. “It is time to heed the Constitution and return the issue of abortion to the people’s elected representatives.” There are reasons to doubt Alito’s history of the abortion wars. But, more importantly, there is no reason to believe that overturning Roe today will lower partisan tensions in the foreseeable future. As partisan divisions on abortion deepened over the years, the stakes of the issue became even higher, making each subsequent election more and more important to core Democratic and Republican voters. Abortion — and, more specifically, capturing the Court that could strike down the right to getting one — is one of the key reasons Republicans blockaded Merrick Garland, and eventually got on board with Trump despite their misgivings: He would give them the justices necessary to stop what their voters see as a modern-day Holocaust. Now, with the issue returned to state and federal legislatures, elections will actually loom larger than ever. “When it seems like the stakes can’t get any bigger, the end of Roe raises them,” says Lilliana Mason, a political scientist at Johns Hopkins University who studies polarization. Blue states and red states will soon be battling over out-of-state abortions and the national distribution of abortion pills; control over Congress and the presidency could lead to a federal law either legalizing or prohibiting abortion nationwide. The same logic that led Republicans to back an obviously undemocratic demagogue — the consequences are simply too grave for us to let the other side win — now applies on steroids to elections across the country. American democracy is already teetering on a cliff. The coming abortion wars will make it even harder for the country to step away from the brink. Asking if Roe polarized America is asking the wrong question In the six years before Roe came out in 1973, 17 states had reformed their abortion laws, with many following model legislation released by the American Law Institute, a nonpartisan organization of legal experts, in 1962. AP Anti-abortion and pro-abortion rights activists argue their viewpoints on the steps of the New Jersey State House in Trenton on April 30, 1973. That model was not exactly liberal by modern standards: It banned abortion with exceptions for rape and incest, the health of the mother, and cases where “the child would be born with grave physical or mental defect.” But it paved the way for liberalizing and modernizing abortion policy in the US. According to Mary Ziegler, a historian of abortion law at the University of California Davis, the spread of ALI-inspired bills “is what the anti-abortion movement mobilized to oppose.” The National Right to Life Committee (NRLC), America’s oldest and most influential anti-abortion group, was founded in 1968 — five years before the Roe ruling. Groups like the NRLC saw the ALI bill as unacceptable, a denial of the essential personhood of the fetus, and pushed for a total ban. During this pre-Roe struggle, politicians were already trying to figure out how to take political advantage of the emerging national division on the issue. “Richard Nixon was using abortion as a wedge issue in 1972, and already experimenting with how he could polarize the debate to his advantage,” Ziegler tells me. Indeed, Republican efforts on this front yielded one of the most famous attack lines in American history — describing Democratic presidential candidate George McGovern as standing for “amnesty, abortion, and acid.” The core of the political case against Roe is that it took these trends and supercharged them: turning fights over the presidency and Supreme Court nominations into winner-take-all conflict over abortion while preventing states from experimenting with legislation that could offer a compromise way forward. Whether the abortion debate would have become so deeply polarized absent these conditions is debatable; there are plausible arguments on both sides. But today, the most important question is not historical but forward-looking: whether repealing Roe can lower the temperature of popular conflict over abortion. And it’s difficult to imagine that being the case. In Between Two Absolutes, a study of public opinion on abortion by three political scientists, the authors argue that a Supreme Court ruling in 1989 that opened a wider door to state-level regulation of abortion (Webster v. Missouri Reproductive Services) turned abortion into a more salient and divisive issue. The reason, they argue, is that elections now had much greater influence over abortion policy — giving politicians more reason to emphasize abortion on the campaign trail and voters more reason to prioritize it. An analysis by Andrew Gelman, a political statistician at Columbia University, bears this theory out. Gelman finds that there was very little partisan polarization among voters on abortion until 1992, three years after Webster and the same year as Planned Parenthood v. Casey (which reaffirmed Roe but also further opened up room for state-level regulation). State-level conflict on abortion escalated after that, most notably producing a series of pre-Dobbs restrictions in Republican-controlled states after the GOP’s dominant performance in the 2010 midterms. Jose Luis Magana/AP Anti-abortion demonstrators rally outside of the US Supreme Court in March 2020. This record suggests that giving states more discretion on abortion does not produce compromise, despite the fact that most Americans have policy preferences somewhere between anti-abortion and abortion rights extremes. Instead, it creates opportunities for state lawmakers to push for more contentious bills — leading to more partisan conflict, not less. This shouldn’t really be surprising: It speaks to the ways that abortion is both a cause and a consequence of partisan polarization. As the parties have become more clearly split on abortion, anti-abortion Democratic voters have defected to the other side (and vice versa). The American primary system incentivizes most candidates for office to cater to the dominant opinion in their party, especially in the safe seats that make up the bulk of legislative districts at the state and federal level. So the two parties’ policy positions have grown concomitantly apart: Democrats are less likely to talk about abortion as a tragedy to be minimized, and Republicans increasingly likely to support bans with few exceptions. As the stakes for abortion policy become higher, it becomes harder and harder for people who care about the issue to imagine crossing party lines for any reason. For this reason, the notion of returning to a pre-Roe abortion politics seems fanciful. Neal Devins, a law professor at William & Mary and a longtime critic of Roe’s effect on the abortion debate, conceded as much in a 2016 paper, arguing that returning abortion to the states today would be more likely to cause more conflict rather than foster a national settlement on abortion. “Today’s political dynamic is far different than the political dynamic in 1973,” he argues. “Abortion now divides the parties in ways that stand against compromise and deliberation across parties or within parties.” How Dobbs could entrench polarization Political polarization is often a vicious cycle: When parties are deeply and bitterly divided, political actors tend to take aggressive actions that lead to even more intense partisan conflict. There is every reason to expect this to be the case in post-Dobbs America, as red states enact increasingly strict abortion restrictions and blue states try to help abortion seekers circumvent them. Texas’s state law, which will go into effect soon, will ban nearly all abortions, with very narrow exceptions for maternal health. Meanwhile, the California legislature is working on a bill that would provide funding for abortion seekers from states like Texas to travel there for an abortion if it isn’t legal at home. A draft bill in Missouri would apply its own laws to out-of-state abortions by residents. Angela Weiss/AFP via Getty Images Abortion rights activists rally outside the Planned Parenthood Reproductive Health Services Center in St. Louis, Missouri, after the US Supreme Court overturned Roe v. Wade on June 24. There are also likely to be conflicts between states and the federal government. In December, the Food and Drug Administration issued a ruling allowing abortion pills to be distributed by mail — prompting Republican state lawmakers to try to figure out what could be done to restrict their spread. In a post-Dobbs world, they’ll push even further. State politics are already increasingly national, with voters caring less about politicians’ stances on local issues than their party affiliation. With one of the most divisive national issues on the ballot in every cycle, the stakes of local elections in competitive states will become even higher — making them not only more nationalized, but also sources of greater partisan strife. In deep red and blue states, candidates will have primary incentives to propose even more aggressive legislation on the issue. As a result, extreme partisanship will become even more entrenched, and the polarization feedback loop will grow stronger. Justice Brett Kavanaugh, in his concurrence, signaled something almost resembling relief that the high court would be ridding itself of the abortion question and giving the abortion issue back “to the people and their elected representatives in the democratic process.” But Kavanaugh may find himself disappointed soon enough. The spread of novel state-level abortion laws will yield a tremendous number of lawsuits on largely untested legal questions — lawsuits that will eventually wend themselves toward the Supreme Court. With the Court still being a major player in the abortion wars, battles over its composition will still be (in part) proxy wars over abortion. Moreover, with Roe off the table, the battle for the White House and Congress becomes more than just a battle over who gets to appoint justices. The debate over passing a national law legalizing abortion everywhere — or prohibiting it — is already in full swing. Anti-abortion activists often compare abortion to slavery on a moral level, a comparison I fundamentally reject. But on a political level, it’s a more apt analogy: The issue is so charged, and crosses state lines so thoroughly, that political conflict over it is guaranteed to be bitter and zero-sum. One of the most important political science findings for our understanding our current era is that polarization threatens democracy by raising the stakes of elections. When voters and political leaders view their rivals as enemies, maybe even evil, and elections as existential events, the mutual toleration and forbearance at the heart of democracy wither away. Violating norms becomes imaginable; the boundaries of our politics get tested. In the Trump era, Republicans have already shown how far they’re wiling to go down this particular road. Protecting American democracy depends, at least in part, on figuring out some way to lower the stakes of partisan conflict: to make elections feel less like a zero-sum competition where one’s fundamental view of the country is on the ballot. The abortion wars heightened those stakes. Alito’s hopes to the contrary, the end of Roe won’t lead to a deescalation — and has every chance of making things worse.
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You shouldn’t have to ask your boss for an abortion
Activists with Rise Up 4 Abortion Rights protest outside of the US Supreme Court on June 21. | Anna Moneymaker/Getty Images Corporate America is an imperfect ally on abortion rights. Companies stepping up to say that they will support their workers in accessing abortions after the Supreme Court’s decision to strike down Roe v. Wade raises questions both logistical and existential. For example, do you really want to ask your boss at Dick’s Sporting Goods for $4,000 and a couple of days off to terminate a pregnancy? If you start to think about the situation beyond the press release, it can get pretty disturbing pretty quickly. It reinforces how supremely screwed up the entire post-Roe situation is, as well as the setup of the United States health care system. “It’s better than nothing, I’m not going to say it’s bad,” said Kate Bahn, director of labor market policy and chief economist at the Washington Center for Equitable Growth. “It’s a Band-Aid on a stab wound.” It’s a Band-Aid millions of people across the country, now stripped of their rights, would rather not need. How and whether all of this will work remains an open question; logistically, how companies will handle this could be complicated. It’s not yet clear how aggressive a post-Roe enforcement regime might be, or what lengths anti-abortion lawmakers will go to in targeting entities, including businesses, that support abortion care. Some experts warn that Florida Republican Gov. Ron DeSantis’s attack on Disney over the company’s tepid opposition to the state’s “don’t say gay” bill is a disturbing precedent. If abortion is criminalized in a state, courts might issue subpoenas trying to compel companies and health benefits programs to hand over information. Companies could also potentially be accused of aiding and abetting a crime and issued subpoenas in those cases. There are plenty of legal fights ahead and many unanswered questions. On an individual level, companies getting involved in abortion care puts an awkward onus on workers to go through their employers regarding a personal, private matter. It also underlines an often overlooked issue: the way health care in the US is so intertwined with and controlled by one’s employer. Whether or not a worker can get abortion support through their employer in a state where the procedure is outlawed now becomes a matter of luck, where they work, and in many cases, whether they’re covered by their employer’s health benefits plans or not. Some companies making announcements aren’t actually going to provide assistance to all of their employees. “We could probably guess that these types of benefits would be more available to high-income workers who would be better able to afford access to abortion services anyway,” Bahn said. “It’s a Band-Aid on a stab wound” At a broader scale, this is part of a troubling trend in the United States where the public increasingly leans on corporations to solve problems because the government will not. Companies — many of which have donated millions of dollars to anti-abortion politicians — aren’t going to save the people who have just lost what many believe is a fundamental constitutional and human right. “It seems abnormal to you that the state would take away fundamental human rights and you would have to count on capitalism to provide them,” said Linda Hirshman, a lawyer and author of multiple books about activism and social change. “You haven’t lived in a world where the democratically elected government was the adversary and the market economy was the ally.” An insufficient solution to an enormous problem After a draft of the Dobbs v. Jackson Women’s Health Organization decision was leaked by Politico in May, some companies began to announce their intentions to provide support to their employees where abortion access is restricted. Since the decision came down, major companies have reiterated and announced their positions. Disney, for example, has said it will extend its “family planning” benefit to workers who can’t get reproductive care where they live. The CEO of Dick’s Sporting Goods said on LinkedIn that the company would provide up to $4,000 in abortion travel expense reimbursement to workers enrolled in its medical plan and their family members. Amazon has told staff it will also pay up to $4,000 in assistance. A litany of major names, including JPMorgan, Bank of America, Meta, Warner Brothers, Reddit, and a multitude of others, say they will reimburse employees for reproductive care-related travel and otherwise support workers in need of such care. Vox Media, which owns Vox.com, has also made such a pledge. On Friday, CEO Jim Bankoff pledged to “support employees seeking access to critical health care, including abortion.” The company has put in place a $1,500 reimbursement of travel-related expenses for employees who have to travel more than 100 miles for “critical health care” needs. The benefit is also about to be enshrined in Vox Media’s new union contract. For many employees, it is reassuring to know that they have their employers’ support, and these measures will surely help many people. At the same time, this is a woefully insufficient solution, and it’s really unclear how any of this will work. “I don’t know what the individual processes will be like, but if someone is seeking reimbursement for travel, you know, do they have to go to HR? Or is it done through the insurance companies?” said Alejandra Caraballo, a clinical instructor at Harvard Law School’s Cyberlaw Clinic who has analogous experience with gender-affirming care. “What are the processes that they have to protect confidentiality, because that is particularly a huge concern, especially if you have a manager that is opposed to abortion.” I love my boss and really trust her. I also would not want to have to ask her — or anyone in Vox’s HR department — for a couple thousand dollars and two days off because of an unwanted pregnancy. It’s worth scrutinizing which workers will be covered by these policies companies are offering up and which ones will be excluded. If, say, a travel reimbursement is covered through the employer’s health plan, workers who aren’t on the health plan — like part-time employees or contractors — wouldn’t be covered. The company would have to deal with that separately, which some firms, such as Levi Strauss, have said they would. Amazon and Disney, which employ hundreds of thousands of people, did not respond to requests for more information about which workers would and wouldn’t be covered by their assistance programs. Dick’s pointed to its original statement and declined to comment further, as did Starbucks. “It’s not a real, just policy if it just covers your corporate headquarters employees,” said Sonja Spoo, director of reproductive rights campaigns at UltraViolet, a women’s advocacy group. “It’s not a real, just policy if it just covers your corporate headquarters employees” While many big-name companies have said they’ll help workers with abortion assistance, others have not. Walmart and McDonald’s did not respond to inquiries about whether they have any plans to support workers in need of abortion care. It’s a controversial issue, and a lot of companies do not want to get in the middle of it. This conversation also discounts the millions of people who work for small businesses, where what — if anything — they’ll do in the face of Roe’s repeal is a completely open question. Republicans aren’t just going to let this go Businesses saying they’ll cover travel expenses for abortions and providing other assistance are likely to quickly find themselves at odds with anti-abortion lawmakers and leaders. This could have consequences for the businesses in question and their employees. Some Republicans have made no secret of their desire to go after corporations they view as having progressive values. In May, Florida Republican Sen. Marco Rubio introduced a bill that would remove tax breaks for “woke” corporations. It would bar employers from deducting expenses related to abortion travel costs or gender-affirming care. In Texas, a group of Republican legislators have said they’ll introduce bills banning companies that pay for abortions in states where it’s legal from doing business in the state. Gov. DeSantis in Florida has provided a blueprint, after attacking Disney in the wake of its objection to the state’s “don’t say gay” bill and axing some of the benefits and breaks the company was receiving. “If you saw what happened with Disney, where DeSantis made a very public example of retaliating against Disney, there has been a culture of silence that has fallen. It’s very clear the playbook now is to attack corporations that do anything that goes against social conservatism in a very public way and get them to stop doing stuff like that,” Caraballo said. A state getting a major company to back down could have a chilling effect on everyone else. “All of the smaller companies will fall like dominoes.” Workers will have to depend on their employers to be brave, but this is a situation where state governments may have the upper hand. “At the end of the day, the state, which has a monopoly of force — that’s by definition — is more powerful than the market economy,” Hirshman said. Criminalization is also a major concern. If law enforcement believes a person had an illegal abortion, they may begin to issue subpoenas and warrants as part of their investigations, including from employers and their health benefits programs. “That’s going to be a really interesting problem,” said Lucia Savage, chief privacy and regulatory officer at Omada Health. “Right now, if a law enforcement agency wants to look at a medical record, they can do so with a court order. So changes in reproductive health law that make things illegal creates new criminal bases for that court order to be issued.” “The playbook now is to attack corporations that do anything that goes against social conservatism” There are all sorts of areas where the issue could get thorny; for example, with remote work. Say Texas tries to get a court order or issue a subpoena to investigate an employee who works from home in that state, but for a firm based in California. Would that subpoena be issued rightfully? And then there’s the company’s reaction, too. “Different employers are going to have different appetites for fighting that subpoena,” she said. In the mid-2010s, Apple fought hard to keep from unlocking iPhones, including that of a mass shooter in San Bernardino, California, despite multiple orders from law enforcement. In the abortion context, it’s not clear how many companies will be Apple. That was also a key function for customers, not a benefit to employees. The Supreme Court’s overturning of Roe will change work for women and people who can get pregnant, whether their employers offer reproductive support or not. Sometimes, separate workforce policies for women can work against them, meaning there could be unintended knock-on effects for these corporate policies. “If there’s a costly benefit that’s only available to women workers, is there a risk that could ultimately lead to a stigma or bias or discrimination?” Bahn said. She also pointed to evidence that reduced access to birth control and restrictions on abortion services can stifle women at work, making them less likely to move between jobs and into higher-paying jobs. “It changes how you think about your life if you live in a place where you don’t have control over family planning,” she said. Companies just aren’t going to save us here One complicated aspect of companies now saying they’ll help support workers needing reproductive careis that some of those same companies also played a role in how we got here in the first place. Namely, if you look at their donations, you’ll see plenty have given money to anti-abortion politicians who helped craft the laws they are now fighting against. Measures being taken now are less valuable than if companies had mobilized to really fight the political battle before. UltraViolet has launched a website that tracks corporate giving to anti-abortion candidates or their associated political action committees, and identified hundreds of thousands of dollars from firms such as Nike, Uber, Disney, and AT&T. All now say they’re going to reimburse abortion travel expenses. “They need to stop giving to anti-abortion politicians,” Spoo said. “Their rationale for giving might not be ideological, but their impact is.” She believes companies have a responsibility to help fund the way back to abortion rights, through lobbying and supporting local abortion assistance groups. Bahn echoed the sentiment. “If companies really cared, I think that they should put their support behind wide-scale policy changes. Some of it could be lobbying on Capitol Hill,” she said. How long companies stick to their guns here is also worth keeping an eye on. At the outset of the pandemic, corporations were very eager to tell us how they were supporting their customers and workers. A few months in, after everybody stopped looking, that support often petered out. Employers supporting workers in need of reproductive care is, generally, a good thing. But for so many people shocked, confused, and devastated by the Supreme Court’s decision, it really seems like we just should not be here in the first place. And, again, it’s worth questioning why health care is at all tied to work. The slogan goes, “My body, my choice,” not “My body, and after consulting with the HR department, my choice.”
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The anti-abortion “social safety net”
Anit-abortion activists celebrate outside the US Supreme Court on June 24, the day Roe v. Wade was overturned. | Matt McClain/Washington Post via Getty Images The right wants “crisis pregnancy centers” to replace abortion clinics. When the last abortion clinic in Texas closes its doors for good, Prestonwood Pregnancy Center will remain. So will Agape, with locations in Round Rock, Austin, Cedar Park, and Taylor. So will the Pregnancy Help Center, operating in Texas’s Brazoria County since 1990. These are pregnancy resource centers, also known as crisis pregnancy centers, and for many years, their main mission has been to convince people not to have abortions (the three centers above did not respond to Vox’s request for comment). But now that the Supreme Court has overturned Roe v. Wade, abortion bans are either in effect or imminent in Texas and more than 20 other states around the country. In the coming months and years, pregnancy resource centers will have a bigger role to play — one that has researchers and reproductive justice advocates worried. While many centers offer supplies like baby clothes and diapers, they’ve also been criticized for misleading pregnant people and spreading false claims about the dangers of abortion. In one congressional investigation, 87 percent of centers gave false or misleading medical information. Some centers have also been found to encourage people to delay an abortion decision until they are past the gestational limit, sometimes by misrepresenting state laws; one Texas woman even says she was told she could she could continue carrying an ectopic pregnancy — which are highly dangerous and almost never viable — if she was “careful.” “It’s dangerous because they position themselves as legitimate health care centers,” said Onyenma Obiekea, policy analyst for the Black Women for Wellness Action Project, a reproductive justice advocacy group. “You earn the trust of community members only to offer this disinformation.” As anti-abortion advocates and lawmakers plan for a post-Roe future, they’re increasingly talking about services people will need to get through unplanned pregnancy, childbirth, and parenting: things like diapers, formula, and help with food and rent. For a lot of conservatives, the go-to solution for providing those resources is pregnancy centers. In Texas and at least eight other states, the centers already get government funding, and experts expect that funding to grow as the facilities move into providing more kinds of services, like adoption. The centers are part of a kind of parallel social safety net, created by anti-abortion groups and suffused with anti-abortion values, that’s likely to get larger and stronger in the years to come. Though the centers don’t seem to serve large numbers of clients — yet — they do offer “basic things that financially struggling people need,” said Katrina Kimport, a professor at Advancing New Standards in Reproductive Health (ANSIRH), a group at the University of California San Francisco, who has studied the centers. However, critics say that in addition to spreading misinformation, they also promulgate a narrow vision of heterosexual, two-parent family life that may not be achievable or desirable for the people they aim to serve. At least as it stands now, “this is inadequate care.” Inadequate though it may be, the anti-abortion safety net is about to see an influx of power and money. Americans on both sides of the issue will have to reckon with what that means. Anti-abortion pregnancy centers are a big part of the right’s post-Roe plan Abortion opponents have long been criticized for ignoring the needs of babies after they’re born, as well as the harms of having to carry an unplanned pregnancy to term. Leading up to the end of Roe, however, conservative lawmakers and activists have started to speak more loudly and publicly about what abortion bans are going to mean for people facing pregnancies they didn’t intend. “We are certainly going to have to provide women’s health at a higher level,” Louisiana state Rep. Rick Edmonds, a Republican and a pastor, told the Louisiana Illuminator last month. “We are going to see more babies, not less. So we have to find a way to add resources.” It’s a concern for rank-and-file conservatives too. In a recent poll conducted for the Land Center for Cultural Engagement at Southwestern Baptist Theological Seminary, 62 percent of people who identified as “pro-life” agreed with the statement that a state that restricts abortion also “has a responsibility to increase support/options for women who have unwanted pregnancies.” Nicholas Kamm/AFP via Getty Images Fetus dolls in a basket at the pro-life Carolina Pregnancy Center in Spartanburg, South Carolina, in 2016. The attitude is a change for Republicans, who have often opposed government programs for parents and children. “The political winds are definitely shifting,” said Patrick Brown, a fellow at the Ethics and Public Policy Center (EPPC), a conservative think tank. There’s “a lot more room to run on what the government should be doing and what it should be spending money on.” Historically, however, the states that will ban abortion now that Roe has fallen also have the weakest support for children and families, often as a result of decisions made by Republican legislators. Reversing that, if lawmakers want to, will be no easy task. In some cases, conservatives are supporting policies that have been progressive priorities in the past, including an expanded child tax credit or child allowance (a version of which Republican Sen. Mitt Romney (R-UT) introduced in June) and extended Medicaid coverage for people after they give birth. (Some Republicans remain staunchly opposed to such policies, with one Mississippi state legislator recently arguing that “we need to look for ways to keep people off, not put them on” Medicaid.) Then there are pregnancy resource centers. The centers have been around since the 1960s, proliferating after 1973, when Roe established the right to an abortion nationwide. They were founded, mostly by evangelical or other Christian groups, on the idea that “one-on-one ministry to people who were pregnant could talk people out of abortion,” Kimport said. Given that the centers’ original mission was to stop abortion, you might imagine that many would close after the fall of Roe since the procedure will now be banned across much of the country. However, it’s already clear from public statements by the centers themselves and anti-abortion lawmakers that these facilities aren’t going anywhere. Instead, “what we will see is an attempt by abortion opponents and anti-abortion legislators to propose that these centers are the appropriate way for people who would want but cannot obtain an abortion to receive services,” Kimport said. That’s already happening. “If at some point Roe v. Wade is overturned, we’re going to have to step up and fund places like these centers to be able to reach out to all those women who are now going, ‘I need help,’” Arkansas state Rep. Cindy Crawford, a Republican, told the Associated Press in March. Edmonds, the Louisiana representative, is backing a bill that would earmark $1 million from the state budget to help the centers build an online service network. That’s on top of money that the centers already get from Louisiana and other states around the country as part of “alternatives to abortion” programs, which have been around since the 1990s and have grown in recent years. The largest, in Texas, received $100 million over two years in the latest budget cycle, and abortion opponents hope to see that grow further. “We always are working toward the increase in funding for the alternatives to abortion program,” said Amy O’Donnell, director of communications for the group Texas Alliance for Life. “Our goal is to help women remove obstacles that they may face in going through an unplanned pregnancy so that they can successfully give birth to the baby and then keep that baby with support or place that baby for adoption, if that’s their choice,” O’Donnell said. “With that, we recognize that they’re going to need support both before and after birth.” Critics say the anti-abortion safety net … isn’t one Pregnancy resource centers do offer some forms of support to the people who visit them. In a small study published in 2020, Kimport found that women who visited the centers got things like baby clothes and prenatal vitamins, as well as services like pregnancy tests. Especially for low-income people, the centers can fill some of the gaps in states where more conventional social services, from Medicaid to food stamps, have been cut to the bone. Katherine Frey/Washington Post via Getty Images Tere Haring, founder and executive director of Allied Womens Center in San Antonio, Texas, looks over donated items in October 2021. She says the center helps women with rent, utilities, diapers, clothing, and other needs for up to five years after a child is born. However, researchers and reproductive-rights advocates have deep concerns about the idea that pregnancy resource centers could step in to become a substitute for the right to an abortion. At the most basic level, the centers do not provide abortion, which is something a lot of people want. Reproductive rights groups argue that support during an unplanned pregnancy is no substitute for the choice of whether to carry that pregnancy to term. “There’s nothing that a crisis pregnancy center can offer that is equal to getting an abortion,” said Morgan Moone, strategic data and advocacy manager for the New Orleans-based Reproductive Justice Action Collective (ReJAC). “Abortion is providing opportunity; it’s providing autonomy over an individual’s body.” Moreover, people who are seeking abortion may not be interested in goods and services to help them carry the pregnancy to term instead. Kimport’s research suggests that pregnancy resource centers are not especially popular. During a two-year period of recruiting study participants at prenatal clinics, she and her team were able to find only 21 people who had been to such a center and were willing to talk about the experience (and only a handful who had visited one but didn’t want to talk). The majority of people who had visited the centers were not considering abortion; they just needed assistance continuing a wanted pregnancy. After Texas passed the restrictive abortion law SB 8, abortions among Texans fell by only about 10 percent, suggesting that most people in the state who wanted abortions found a way to get them — they did not visit a pregnancy center for support in giving birth and raising a child. Another concern is the actual services that pregnancy resource centers provide. Research from the University of Georgia has found that while the centers sometimes present themselves as medical providers and offer services like ultrasounds, they also often spread misinformation about abortion, such as the false claim that it causes breast cancer. The centers often are not staffed by medical personnel. One 2007 study conducted by the NARAL ProChoice Maryland Fund found that just 18 percent of Maryland centers had staff with medical training. In addition, anti-abortion centers may spread misinformation about sexually transmitted infections and contraception, or provide no information at all. “That’s harmful,” said Obiekea, of the Black Women for Wellness Action Project. “This is information about your health.” The centers are also not subject to the same ethical and privacy regulations that govern medical clinics. The centers can collect and store data on clients’ sexual and reproductive history, test results, ultrasounds, and more, according to Time. That data could then be turned over to law enforcement to sue or prosecute abortion providers or even pregnant people themselves. Most pregnancy resource centers remain affiliated with churches or other Christian groups, and Christian religious messages are typically part of their counseling. Anti-abortion advocates say the centers are still open to all, regardless of religion: “There are some who may look for an open-door opportunity to share their Christian views, but they are also very happy to navigate around that,” O’Donnell said. According to Kimport, however, while people don’t have to be Christian to visit a center, hearing the religious messages is typically “not optional.” Moreover, the centers’ programming is often “informed by a normative idea of gender, of families, that may or may not conform to what the clients want, are interested in, or are even able to achieve,” Kimport said. That includes “an expectation of monogamy, of marriage, of a two-parent home,” and of a male breadwinner and “female caretaker and primary caregiver,” which may not be realistic or desirable for many Americans. Overall, “it’s not a client-centered safety net,” Kimport said. “It is much more top-down-directed, and directed by people who, to the best of my knowledge, do not have experience in the delivery of basic services.” Then there’s the fact that diverting state funding to pregnancy resource centers can take away from the existing social safety net. In at least 10 states, for example, the centers receive money from the federal Temporary Assistance for Needy Families program — money that would otherwise go to non-religiously affiliated welfare programs for kids and parents in poverty. Such programs aren’t perfect; they, too, can employ a top-down approach that fails to center families’ needs. But pregnancy resource centers are not set up to act as a substitute. “These centers have not historically been tied into existing structures of the social safety net,” Kimport said. They typically don’t have social workers on staff and are not well-versed in navigating the complex web of government services available for low-income families. “People are not getting any kind of wraparound care.” Leah M. Willingham/AP A sign advertises free pregnancy tests and abortion information outside the Woman’s Choice Pregnancy Resource Center in Charleston, West Virginia, on June 17. The anti-abortion center is located next to Women’s Health Center of West Virginia, seen at left in the background, the only abortion provider in the state. The centers also aren’t always subject to the same kinds of reporting and transparency requirements that govern social safety net programs, leading some to question how they’re really spending their money. A 2018 investigation by the Austin Chronicle found that at a number of Texas centers, the overwhelming majority of state money was spent on counseling rather than on any kind of tangible goods like baby clothes or food. Some say it’s impossible to know how effective pregnancy resource centers will be as a part of the social safety net until they actually enter their new, post-Roe role. As Brown, the EPPC fellow, put it, “you can’t know until it’s live.” One thing, however, is clear: The anti-abortion movement is about to have its biggest chance in decades to shape American public policy, and pregnancy resource centers — along with churches and other religiously affiliated organizations like a Dallas-area “maternity ranch” for pregnant people and single moms — are a major part of the movement’s vision. Given this, some hope the centers can adapt to their new role and get better at supporting people, by offering more postpartum help, for example, or doing a better job of working with other services. “To the extent that this is the delivery system that states have decided to invest in, I hope the centers can grow from that,” Kimport said. Reproductive rights and justice organizations have also made some efforts to create resource centers of their own. All Options Pregnancy Center in Bloomington, Indiana, for example, offers diapers and wipes alongside referrals to abortion clinics and funding resources. Other advocates are working on providing information on all of people’s reproductive options, including abortion, even as it gets more difficult to access. “When we find ourselves at the crossroads of moments like this, where there’s a lot of confusion, where there’s a lot of fear, where there’s a lot of emotion, it’s easy to not know where to turn,” said Moore of ReJAC, the New Orleans reproductive justice group. To combat that feeling, the organization is working on raising awareness around where and when people can still get abortions, as well as how they can help others with money or transportation. The Black Women for Wellness Action Project, meanwhile, is backing a California bill that would fund community-based organizations that provide medically accurate sexual and reproductive health information. “It’s a challenge,” Obiekea said of the post-Roe landscape, but “not one that we’re backing down from.” “We absolutely believe in the power of an informed public,” Moore said. “It’s something that we believe is critical in ensuring that people can make the best decisions for their bodies, for their families, for their communities.”
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The Aftermath
Shantel Jones holds her son in New Orleans in March 2022. Both were affected by the closure of a local maternity ward. | Kathleen Flynn for Vox A series about the collateral health effects of the Covid-19 pandemic in communities around the US. Courtesy of the Jolley family The doctors are not all right Doctors need mental health support, but the medical profession often punishes them for getting it. By Julia Belluz Joseph Rushmore for Vox America isn’t taking care of caregivers 48 million people provide unpaid care to their loved ones in the US. Here’s how to help them. By Katherine Harmon Courage Nick Danielson for Vox They save skiers and hikers in the wilderness. Here’s how they think about resilience. Search-and-rescue responders have powerful new ways of recovering from trauma. by Christopher Tedeschi Michelle McLoughlin for Vox Maternity wards are shuttering across the US during the pandemic The closures could make giving birth more dangerous in the United States. by Dylan Scott Stephanie Strasburg for Vox Health care in jails and prisons is terrible. The pandemic made it even worse. America’s 1.7 million incarcerated people have a constitutional right to medical treatment. During the pandemic, many of them say they didn’t get it in time. by Victoria Law This series is supported in part by the NIHCM Foundation.
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Health care in jails and prisons is terrible. The pandemic made it even worse.
Clayton McCray, 27, stands by the Allegheny County jail in Pittsburgh, Pennsylvania, on June 5. McCray’s lower leg was amputated in 2020 after a wound on his heel became infected while he was incarcerated at the jail, he says. | Stephanie Strasburg for Vox America’s 1.7 million incarcerated people have a constitutional right to medical treatment. During the pandemic, many of them say they didn’t get it in time. This story is part of The Aftermath, a Vox series about the collateral health effects of the Covid-19 pandemic in communities around the US. This series is supported in part by the NIHCM Foundation. When 25-year-old Clayton McCray was sent to jail in September 2019, he had no idea the detention would end up costing him his leg. But that’s what happened, in large part because the pandemic exacerbated his poor medical treatment behind bars. A shooting injury eight years earlier had damaged his spine, initially leaving him paralyzed from the waist down. After surgery and years of physical therapy, he could once again jump, swim, and play basketball. “I fought hard to get to where I was,” he told Vox. But he still had a condition known as “drop foot,” or foot dragging. He needed orthotic insoles, regular treatment to remove dead tissue, and daily wound cleanings; without them, he was vulnerable to developing open wounds, and even bone infections. Clayton McCray worked hard to recover after a shooting injury left him paralyzed from the waist down, enduring surgery and years of physical therapy to be able to move again. When the pandemic hit, McCray was still in Pittsburgh’s Allegheny County jail awaiting a hearing for alleged drug possession. Suddenly, his already-spotty medical care became even sparser. By June 2020, he needed a wheelchair. Sometimes he couldn’t hop or crawl the short distance from his bunk to the toilet and urinated on himself. Meanwhile, the smell from his untreated wound filled the cell. Jail staff did not allow a specialist from the local hospital to examine McCray’s infected foot in person, he has claimed. “They blamed Covid,” McCray said. By September, the infection had progressed so far that his right leg had to be amputated below the knee. Health care in US jails and prisons was generally abysmal before the pandemic, and it appears to have fallen further,even for those who were not among the astronomical number of people sickened or killed by Covid-19 while incarcerated. As of 2018, approximately one in every 44 Black men in the US was locked up Basic requests for medical treatment often went unanswered as facilities stopped outside and specialist appointments and attempted to navigate severe staffing shortages, according to our reporting. Even as the initial crisis of the pandemic’s arrival has waned, many behind bars are still suffering the effects of denied or postponed care. These failures have potentially affected a massive number of people. McCray was one of 8.7 million who entered a US jail in 2020, more than half a million of whom were incarcerated at any given time (and more than 80 percent were, like McCray, simply awaiting their day in court). Another 1.2 million were in state and federal prisons. Put another way, more than 1 in every 150 adults in the US was behind bars on any given day, by far the highest rate of any country in the world. The alleged medical neglect also adds to stark racial health disparities in the US. People of color, particularly Black people, are much more likely to be arrested and have been up to seven times more likely to be incarcerated than their white counterparts. As of 2018, approximately one in every 44 Black men in the US was locked up. The Allegheny County jail rises on the banks of the Monongahela River in Pittsburgh, Pennsylvania, on June 5. Clayton McCray is suing the jail’s medical officials, alleging that jail health care staff failed to provide standard medical care. Data about medical care in carceral facilities is nearly impossible to come by. But two dozen people incarcerated in more than 15 facilities across 10 states during the pandemic have told Vox about frequent cancellations of appointments, months-long delays, denials of specialty treatment, lack of post-surgery follow-ups, and going months without daily medications. Over the course of three months of reporting, their stories have been backed up by documents, lawyers, and loved ones. As a result of this lack of care, some lost limbs, others lost their mobility, and all we spoke with lost their pre-pandemic level of health. When people are put behind bars, whether they are awaiting trial like McCray was or are serving a sentence, the loss of liberty itself is supposed to be the point, not going without basic health care. But this happens daily in jails and prisons nationwide. And the pandemic has made it far worse. Care, postponed Medical care behind bars is complex, with on-site nurses and physicians charged with addressing a vast range of issues, from checkups to substance use treatment to end-of-life care, often in overwhelming circumstances. Some jails and state prisons contract with private corporations to provide medical care, while others, in part, administer their own or rely on public or nonprofit providers. A few, such as New York City’s jail system, partner with the local health system. When people are put behind bars, the loss of liberty itself is supposed to be the point, not going without basic health care Oversight is extremely rare, and people in custody generally cannot change doctors or even seek a second opinion. And this is a particularly vulnerable population. Incarcerated people are more likely to have serious chronic health conditions than their outside counterparts; one study suggested they tend to have health needs similar to people 10 or 15 years older. Believe it or not, incarcerated people are the only US residents with a constitutional right to health care. In 1976, the US Supreme Court ruled that “deliberate indifference to serious medical needs of prisoners” violated the Eighth Amendment prohibition against cruel and unusual punishment. “Health care is constitutionally mandated, but it doesn’t mean it’s any good,” said Lauren Brinkley-Rubinstein, a health equity scholar at the University of North Carolina School of Medicine and co-founder of the Covid Prison Project. Arizona’s prison system has been sued for reportedly providing inadequate care. And a 2001 class-action lawsuit asserted that the California prison system’s medical and mental health care was horrific enough to be unconstitutional. The pandemic erected even more barriers between incarcerated people and medical access. Our reporting found that jail and prison officials frequently denied outside appointments and prohibited outside providers from entering, while in-house doctors and nurses prioritized Covid-19 over other concerns. Medical workers were in critically short supply as people called in sick — or quit and were not replaced. Incarcerated people are actually the only US residents with a constitutional right to health care A dire shortage of correctional officers also impeded care. Officers are needed to escort people to appointments and call in medical emergencies. Homer Venters, a court-appointed federal monitor overseeing health care behind bars, told Vox this spring that he routinely visits correctional facilities now where half of the correctional officer positions are still unfilled. California prison officials have admitted that the pandemic has caused a significant backlog of essential visits, with more than 10,000 overdue specialty appointments, approximately 6,000 overdue primary care appointments, and nearly 1,000 overdue ultrasound exams for end-stage and advanced liver disease, as of mid-2022. In New York City’s Rikers Island jail complex, detainees have missed nearly 40,000 appointments between January and April of this year alone. The availability of this type of data is exceedingly rare. The Allegheny County jail where McCray was held, for instance, was not able to provide Vox with its current backlog of appointments. And inside, many people are fearful of retaliation if they speak out, which makes these critical shortcomings even harder to track. But Vox spoke with 23 individuals incarcerated during the Covid-19 pandemic, and each reported negative health consequences from pandemic-related lapses. Here are three of their stories. McCray’s story In 2018, Clayton McCray had been back on his feet for years after his shooting injury, going out to dinner with family and friends and playing pickup basketball games. Around the end of that year, he entered Pennsylvania’s state prison system for a charge of drug possession. Within several months, the prison provided him with regular wound treatment and allowed his orthotic shoe, brace, cane, and insoles. When he was released 10 months later, he still had the full mobility that he had worked so hard to regain. Clayton McCray comes downstairs carrying his ankle and foot brace at his Pittsburgh, Pennsylvania, home on June 5. McCray says Allegheny County Jail staff confiscated his necessary insoles and brace while he was in jail awaiting trial for a minor drug charge, causing his foot to drag and a wound to form that became infected. Ultimately, his lower leg was amputated. In September 2019, McCray was arrested again on a minor drug possession charge. However, because he was on probation, he was ineligible for bail and was locked up at the Allegheny County jail in Pittsburgh while waiting for his hearing. Through December, medical staff, overseen by county and local health systems, provided the daily wound treatment he needed. But then, McCray said, those visits began to drop off. Charles E. Timbers Jr. worked as a nurse practitioner at the jail and remembers McCray. (Timbers was fired from the jail in 2020 for allegedly violating its social media policy.) “He had a hole in his foot where you could see the calcaneus [bone of the heel],” Timbers recalled. “He should have been on daily wound care,” he said of McCray, confirming that wound treatment became more sporadic. Then the pandemic hit. Medical attention became even scarcer. McCray sometimes went for several days without wound cleanings. And other crucial treatments, such as regular debridement to remove dead tissue from his foot, stopped altogether. Meanwhile, the pandemic closed Pennsylvania’s courts, and several of his court dates were postponed, extending — through no fault of his own — his time in jail. “There will always be an excuse as to why they can’t render adequate medical care” McCray often had to hop on his good foot or crawl on the dirty floor to get around his cell. He frequently fell. The pain and smell from his foot made it almost impossible to eat. It also kept him awake, and the only way he could snatch brief moments of sleep was to pull a blanket over his head to block the stench. Later that spring, jail doctors diagnosed him with osteomyelitis — a bone infection — but McCray says they didn’t tell him about the serious condition until weeks later. And the course of medication they gave him was too brief to effectively treat it. McCray filed numerousgrievances (formal complaints) to the jail about the alleged neglect and requested to be placed in the jail’s medical unit, which had round-the-clock health care staff. But these requests were denied. In June 2020, he went several days without showering because no correctional officers were available to escort him there. This lack of basic hygiene was especially harmful, he said, because of his infected open wound. In mid-June, five days after he lost a toenail on his infected foot, McCray was finally granted a five-minute video exam with a local hospital’s director for advanced wound healing, Elisa Taffe. A jail doctor held the phone to McCray’s foot. Although she had trouble examining him through the fuzzy video, Taffe told jail doctors that McCray was at high risk of complications and of developing osteomyelitis, which McCray had already been living with. McCray says he was in so much pain while in jail that he had to hop or crawl to retrieve his meal trays or use the toilet, and sometimes was unable to do either. One night in June, his body reached a breaking point. His chest was tight, his body felt inflamed, and he could not even hop to the sink for water. “I was in so much pain,” McCray said. The man in the adjoining cell called for an officer, but by the time staff responded, McCray was so ill he could not get out of bed and go to the door to speak to them. “They said they’d see what they could do,” McCray said. No one else came. (That month, 53 of the jail’s 150 health personnel positions were vacant.) Later that night, McCray recounted that he saw a mental health specialist making rounds and took drastic action, shouting a threat: “I’m harming myself!” An emergency team showed up, stripped him, gave him a suicide-proof smock, and brought him to a bare cell for suicide watch. “I was still in there crying, hurting, urinating on myself because I couldn’t make it [to the toilet],” he recalled. By the end of that month, he was finally moved to the medical unit. But the cumulative delays had already taken their toll. In August, McCray was briefly hospitalized for excruciating pain in his right foot and leg. Upon his return to the jail, workers there reportedly failed to provide him with more antibiotics to treat his bone infection, telling McCray they weren’t necessary because he would need an amputation. That September, one year after entering the jail, McCray underwent an amputation of his right leg below the knee. Two weeks later, after the multiple postponements, his court date finally arrived. He pleaded guilty to a misdemeanor drug possession charge so that he could be released and seek medical treatment outside. Had he contested the charge, he would have stayed in jail even longer while awaiting a formal trial. McCray walks toward the Allegheny County jail. After spending more than a year in jail waiting for his court date on a minor drug possession charge, he pleaded guilty so he could be released and seek medical treatment outside. Just two weeks earlier, his lower leg had been amputated. McCray is not alone. The Abolitionist Law Center, which is representing him, has filed three separate lawsuits against the Allegheny County jail alleging medical and mental health mistreatment between 2020 and 2022 so far. Jesse Geleynse, a spokesperson for Allegheny County, said in a statement to Vox that the county does not comment on pending litigation. “The Covid-19 pandemic has been a challenging and unprecedented time,” Geleynse said. He added that the jail has ensured “all incarcerated individuals continued to receive routine and emergency medical care,” and that cancellations of off-site medical care have come from the provider, not the jail. But internal emails from jail medical staff show that at least one of McCray’s outside appointments was canceled because of a lack of correctional officers, not by the hospital. And in a record from Taffe, the hospital wound specialist, she noted that any follow-up care she could provide was at the discretion of the jail. “There will always be an excuse as to why they can’t render adequate medical care,” stated McCray’s attorney, Jaclyn Kurin. The pandemic, she added, should not justify the jail’s reportedcontinual failure to treat McCray and others. Brown’s story Kim Brown was used to spending her days working for a chaplain and serving as a porter at Bedford Hills Correctional Facility, the New York state prison where she has been incarcerated for more than a quarter-century. On Wednesday evenings, she plays keyboard in a music class. She is normally healthy and prefers sleeping off ailments to seeking medication. Courtesy of Kim Brown Kim Brown poses for a graduation photo in 2009 while at Bedford Hills, where she earned a bachelor’s degree in sociology while incarcerated. But on the last day of 2020, she woke to pain unlike anything she had ever experienced. It seemed to double in intensity by the minute, and she quickly realized she needed medical help. At an outside hospital, a physician diagnosed Brown with kidney stones. Surgeons inserted a stent in her ureter to let the stones pass. They told her they would remove the stent in six weeks. About a month after the surgery, however, Brown had blood in her urine and was brought back to the hospital. They gave her antibiotics and returned her to Bedford with the stents still in. Over the following weeks, as Covid-19 cases remained high, she says prison officials halted outside non-emergency procedures. Among them was her surgery to remove the stents. By early March 2021, weeks after her stents were supposed to have been taken out, Brown started experiencing incontinence. Hoping to prevent accidents, she emptied her bladder whenever she could and layered several sanitary napkins as a makeshift diaper. “Stents do irritate the bladder,” said Denise Asafu-Adjei, an assistant professor of urology at Loyola University Chicago and practicing urologist. But, she said, when patients experience severe symptoms, such as Brown’s, a simple medication can usually fix it. As Covid-19 cases spiked, prison officials halted outside non-emergency procedures. Among them was Brown’s surgery. The stents were finally removed later in March. But Brown’s incontinence continued. More than a year later, she still risks incontinence if she’s not near a bathroom. It’s a chance she takes every other week when she shops at the commissary, the prison’s sole store, for toothpaste, bottled water, or the handful of fruits and vegetables she can’t get otherwise. She must stand in line for up to an hour, with no bathroom nearby. After each commissary wait, she said, “I have to take a shower when I come back.” Brown is now 55 years old, but the pandemic-related delay in removing her stents, she says, leaves her “feel[ing] like an old granny — and I’m not that old.” Prison staff have told her that there is nothing they can do. Her first parole hearing is in 2033 but, Asafu-Adjei said, Brown need not wait another 11 years for standard treatment. Medical workers at the prison could prescribe her oral medications or refer her to an outside urologist for other established interventions. But so far, none of that has been done. Brown isn’t the only incarcerated woman at Bedford who says their health has deteriorated precipitously during the ongoing pandemic. Taliyah Taylor started having painful infections in February 2020. Several different medications didn’t resolve the pain, but due to the pandemic, she had to wait eight months to see a specialist and another five months for his recommended diagnostic procedure. “I’m at a 8 regarding the pain,” she told Vox in late April 2022. “It doesn’t matter if I’m standing, sitting, or laying down.” Two other women at the prison told Vox about delays in surgeries and post-surgical care, impeding their mobility. She had to wait eight months to see a specialist and another five months for his recommended diagnostic procedure Rachel Connors, a spokesperson for New York’s Department of Corrections and Community Supervision, said that the department could not comment on Brown’s or Taylor’s experiences but that “all incarcerated individuals in DOCCS facilities receive the community standard of care.” She pointed out that appointments have been frequently canceled due to the pandemic for patients on the outside as well. “Specialty referral requests that were determined to be urgent or emergent were addressed by alternate means when necessary (such as via emergency department visits),” she said in a statement to Vox. But for Brown, Taylor, and others in the prison, initial setbacks have been compounded by additional delays. While outside patients can reschedule their own missed appointments, incarcerated people must rely on prison administrators to do so, even if the system is overburdened. Furthermore, they cannot typically get second opinions if medical providers tell them that nothing can be done. Junior’s story Junior entered Pennsylvania’s prison system in his late 20s and in good health. (Vox is identifying Junior by a pseudonym and not disclosing hisspecific medical condition because of his concerns about possible retaliation.) Junior is a sociable person, willing to lend an ear to anyone in need. He loves to write — poems, essays, and one-act plays — and has been teaching himself college-level math. Before his incarceration, he had been a popular DJ. When it came time for his next appointment, prison staff told Junior that it had been rescheduled. He was offered no explanation. After about a decade of being locked up, Junior was diagnosed with a serious degenerative disease, which brought constant pain, difficulty speaking, and the need for a wheelchair. He was eventually approved for a drug treatment, but it did little to better his condition. So when a doctor recommended that he be switched to a different regimen, he and his family pushed for months until it was finally approved. Shortly after the pandemic began, Junior was brought to an outside medical center for his first treatment and scheduled for follow-ups every six months. He noticed a dramatic improvement on day one of his new treatment. “Immediately, my speech got faster,” he told Vox in a phone call from prison. The pain also decreased dramatically, waking him less frequently. “Being able to go to sleep a full night means I’m not weak, sluggish, and fighting to stay awake during the day,” Junior said. “I can get something accomplished, either some writing or having the clarity to continue teaching myself calculus.” His mobility got better, and it took him less time to get dressed and accomplish other basic tasks. But when it came time for his next appointment, prison staff told Junior that it had been rescheduled. He was offered no explanation, which is typical in many jails and prisons. Medical records later indicated that his missed therapy was “due to Covid.” (Junior and his records confirm that he had not had Covid-19.) A lawyer for the Pennsylvania Department of Corrections said that outside specialists canceled the appointments. But no new one was offered. The pain returned, sometimes in bouts bad enough to bring tears to his eyes. Some days it prevented him from using the shower during his allotted 25 minutes out of his cell. His condition deteriorated once again. “I might have four or five days in a row where my speech mobility [was impacted], and I could hardly use the phone,” he said. Speaking with his loved ones allowed him to feel connected to the outside world. Otherwise, he told Vox, “being in the cell all day, that cell felt closer and closer to the grave.” The Pennsylvania Department of Corrections said that it could not comment on individual situations. In an email, DOC press secretary Maria Bivens told Vox, “The PA DOC continued to offer all outside medical visits where the community specialist was available. When community providers closed their offices or canceled appointments, we had to reschedule those appointments.” Jails and prisons are funded by tax dollars, which should entitle the public to know how they’re operating Unlike patients in the community, however, Junior could not reschedule the appointment himself. Instead, he had to wait and hope for prison officials to do it. In mid-2021, six months after that canceled follow-up, the prison finally sent Junior out for his long-overdue treatment. Over a year after his missed appointment, however, he says he’s still shaken by the experience of feeling his body break down again. “I’m still recovering from being in a situation where I couldn’t even move hardly,” he said. Even now, health care delays continue for many other incarcerated people. As of the beginning of June 2022, the Pennsylvania Department of Corrections has more than 560 overdue outside specialist appointments. That impacts about one in every 64 people in their system, and, as Junior’s experience illustrates, delay in specialty treatment can have dire consequences. Potential solutions Researchers and practitioners agree that the outlook for medical care behind bars is bleak, particularly since the pandemic began. However, no one knows the full extent of the problem. “We have little real-time data,” Brinkley-Rubinstein and Covid Prison Project director Meghan Peterson wrote in October 2021. National prison statistics are released with up to a two-year delay, while jail data are reported separately. Neither includes information about health care. Medical neglect is not supposed to be an additional punishment More transparency about how jails and prisons are — or aren’t — treating medical issues could help ameliorate conditions. Brinkley-Rubinstein reminded Vox that jails and prisons, including the privately run ones, are funded by tax dollars, which should entitle the public to know how they’re operating. Even family members often don’t receive word about serious illnesses, injuries, or deaths. Greater oversight could also improve health care. For example, in 2009, New York passed a law allowing the state’s health department to oversee HIV and hepatitis C care behind bars and to develop protocols that match community standards of care. That oversight markedly improved HIV and hepatitis care in the state’s prisons, bringing it more in line with treatment people would get on the outside. Such oversight, however, remains rare. Reducing the number of people in the system could also help. The beginning of the pandemic saw a rapid decrease in the number of people behind bars. For example, because fewer people got sentenced in the first year of the pandemic while courts were shut down, state and federal prison populations dropped 15 percent by the end of 2020 (the latest figures available) compared with 2019. Stephanie Strasburg for Vox Clayton McCray stands on the basketball court at his former grade school, where he used to play. He had “hoop dreams” growing up, he says, but feels unable to play anymore because of pain and mobility issues. In 2021, after years of advocacy, New York passed Less Is More, which prohibits re-imprisonment for technical parole violations (such as missing an appointment or violating curfew). Implemented in March 2022, the law resulted in the release of almost 1,000 people who can now seek medical attention outside. A similar rule in Pennsylvania could have kept McCray out of jail — and possibly saved his leg. Lawsuits can also force jails and prisons to improve health care, as California prisoners have repeatedly sought to do. But bringing them to court is difficult. In 1996, then-President Bill Clinton signed the Prison Litigation Reform Act requiring that a person first exhaust the system’s internal grievance procedure. The law also prohibits incarcerated people from suing for mental or emotional injury without physical injury. McCray, who has certainly suffered a physical injury, is now suing the jail’s medical director and staff and Allegheny County for allegedly failing to provide medical care and for numerous violations of the Americans with Disabilities Act. McCray sits in his Pittsburgh home on June 5. He’s still adjusting to life with a prosthesis and experiencing phantom pain where his leg once was. McCray has been home since October 2020. He now experiences phantom pain where his leg once was, keeping him awake at night. His prosthetic irritates his leg. And if his family goes out to a restaurant or a movie, the pain prevents him from joining them. Instead, the 27-year-old spends his days at home, feeling frustrated and depressed. For those behind bars, medical neglect is not supposed to be an additional punishment. But people’s experiences show that jails and prisons have often been doing just that. The pandemic has exacerbated that neglect with debilitating consequences. “There are so many stories that never get told,” McCray said. “It’s bigger than me. The excuse is that people are coming in with preexisting conditions.” But, he said, “the whole job of medical is to treat people, no matter what.” CREDITSEditors: Katherine Harmon Courage, Susannah LockeVisuals editor: Bita HonarvarCopy editors: Tanya Pai, Tim WilliamsFact-checker: Matthew Giles
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Biden’s chance to go bolder on abortion rights
Activists hope President Joe Bide will take more executive actions to protect abortion rights. | Yuri Gripas/Abaca/Bloomberg via Getty Images “This is not a time for speeches and hoping people will vote in November.” This past weekend, more than 30 Democratic senators had a message for President Joe Biden: They want him to do more to protect abortion rights, and they want him to do it now. “There is no time to waste,” they said in the letter, which was led by Sen. Patty Murray (D-WA) and sent one day after the Supreme Court announced its decision to officially roll back Roe v. Wade. “You have the power to fight back and lead a national response to this devastating decision.” This letter is the latest indication of growing pressure on the White House to take additional executive actions in response to the fall of Roe. While Biden is not able to reinstate the protections offered by Roe without Congress, lawmakers and activists have clamored for the president to take other steps, such as finding ways for the federal government to defend abortion access in every state. Many of these proposals would likely be challenged in court, but proponents emphasize that they’d like to see the administration give them a try before forgoing them completely. For months, some abortion rights advocates have felt that the White House hasn’t been doing enough to address the urgency of the situation, whether that’s weighing more ambitious policies or simply speaking out more forcefully on the subject. Many were disappointed, for instance, to find that Biden hadn’t used the word “abortion” in any presidential speech until recently. The White House has taken some initial steps — and signaled that further action is on the way — while stopping short of laying out a comprehensive strategy. In a statement on Friday, Biden said he would combat any efforts to prevent people from traveling across state lines for abortions and indicated that the Department of Health and Human Services would work to preserve access to medication abortions to the “fullest extent possible.” Activists, though, feel there are more avenues the White House should consider.“This is not a time for speeches and hoping people will vote in November,” said Renee Bracey Sherman, the executive director of We Testify, an abortion rights advocacy group.“It’s a time to get creative … to try something and see what happens.” What advocates and many Democrats want from the Biden administration The main thing that advocates and many Democrats want from Biden is to take more aggressive actions, even if they’re expected to face legal challenges. These actions — coupled with inclusive rhetoric about abortions — could send a powerful message about the Biden administration’s solidarity with those affected by the bans. As of early this week, nine states have already implemented trigger laws that include either bans on abortion or severe limitations in access. Additional ideas that have been suggested include a proposal championed by Sen. Elizabeth Warren (D-MA) and Rep. Alexandria Ocasio-Cortez (D-NY) that would establish abortion clinics on federal lands in states where there are existing bans. Because federal lands aren’t subject to states’ civil laws and there’s room to interpret criminal laws, clinics could theoretically establish themselves on places like military bases without having to deal with a state’s bans. “Even though the land is inside the border of a state, it wouldn’t be governed by the laws of a state,” Khiara Bridges, the faculty director of UC Berkeley’s Center on Reproductive Rights and Justice, previously told Vox. Experts note that there is a precedent for federal lands to operate under a different set of policies than state-owned ones. Drexel University law professor David Cohen told Vox that there are past cases when a state’s right-to-work laws have not applied to how companies approach unionization if they are located on federal lands. Still, it’s an idea that could face legal pushback depending on how federal funds are used. If the clinics are paying the federal government to rent the lands, such an arrangement could circumvent the issue of the Hyde Amendment, which bars the use of federal spending on most abortions. If federal funds are utilized to set these clinics up, their legal standing could be dicier. The Congressional Black Caucus has also called on Biden to declare a national public health emergency, much as he did during the pandemic. When it came to Covid-19, establishing a public health emergency helped prioritize federal dollars for resources like vaccines — though, again, that might be tougher with abortions due to the Hyde Amendment.The caucus as well as many activists believe such an action could help Biden demonstrate how serious the existing crisis is. Other ideas that have been floated include using federal money to provide vouchers to people traveling across state lines for abortions and enforcing the use of federal Medicaid dollars to provide coverage in the narrow instances in which they can be used. These schemes also face implementation questions, with the first possibly running afoul of the Hyde Amendment and the second facing uncertainty about enforcement. Where the administration could go from here Despite condemning the Supreme Court’s decision, the administration has repeatedly cautioned that there’s only so much it can legally accomplish. “We’re going to continue to see what else we can do,” White House press secretary Karine Jean-Pierre told reporters on Saturday. “I guess what I’m trying to say about the executive actions is that nothing could fill the hole that this decision has made.” That may be true, but many Democrats — lawmakers and voters alike — want to see Biden at least show that he’s fighting for people on the issue. So far, a key area of focus is medication abortion: On Friday, Biden said he’d be directing the Department of Health and Human Services, which oversees the FDA, to ensure that people could maintain access to medication abortion, though he offered few specifics on what this would entail. The FDA has already issued regulations that make it easier to obtain a medication abortion, policies that could counter state bans. In April 2021, it approved changes that enabled people to receive a prescription via telemedicine and get medication through the mail, a regulation the agency made permanent in December. Nineteen states, however, have passed laws that directly contradict the FDA’s regulations, requiring people to consume abortion pills with a clinician present. Legal experts argue that the Department of Justice could challenge these laws since federal regulations supersede state policies. Attorney General Merrick Garland has said that states can’t ban people’s access to medication abortions, though he has not yet detailed how the DOJ will enforce this. According to Politico Playbook, the administration is still reviewing other possibilities and faces constraints because of congressional inaction. Due to the filibuster, lawmakers have limited recourse to pass legislation in the Senate, where many bills can’t pass without 60 votes. With their one-vote majority, Democrats’ ability to pass any abortion rights legislation this term appears highly unlikely. With that avenue closed, many advocates and lawmakers have been clear that they’ll continue to lobby Biden to take a stronger and more decisive stance. “We’re going to be loud. We’re going to be relentless. Because, Mr. President, we need a plan to protect reproductive rights in America — and we need it now,” Murray said at a June press conference.
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