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On May 4, after almost three years here as the ACCESS Hotline Coordinator, I'll be leaving the organization to begin a graduate program in Social Work. I've spent the past few weeks trying to package up and organize all the information - the clinics, the rules of Medi-Cal and private insurance, the contacts and friends we have at community organizations. I've been trying to make it all somehow less overwhelming. I've spent so many hours trying to make this hotline slightly less messy. This has been, of course, a mostly futile effort. The hotline is, has always been and will always be, a little messy. It will be that way for as long as we are committed to helping address the broad and complicated needs of women. For as long as we remain a resource for women who want to talk about the fertility awareness method of birth control; about trying to get pregnancy as a lesbian couple; about seeking and paying for late term abortion. For as long as we are willing to plan out bus routes, pay for motel rooms, match up traveling women with volunteers for housing and rides. It's messy work. And it's full and exciting and everyday challenging work.
As much as I have sadness in leaving this job, I also have peace of mind. I know that we have found Efiya, a coordinator who brings new knowledge and perspective to this organization; who will strengthen and develop the hotline in new ways. I have peace of mind knowing that Mona is back in her office working towards our goal of community-based, practical support networks that will better meet the needs of all California women. And I have peace knowing that Parker is hard at work stabilizing our financial business, bringing in new sources of funding for this incredibly important work. I have joy watching our board of directors and volunteer networks growing stronger each day. And, finally, I have great satisfaction knowing that my work with ACCESS and the relationships I've had with the staff, volunteers, allies, and callers have shaped me, made me a better, stronger advocate for women and families always. Thank you!
I must say that I'm very excited, intrigued and inspired by the work of the ACCESS organization. I feel that empowering women with choices and accurate information is essential to community health. I look forward to growing with and contributing to ACCESS.
Two recent Supreme Court decisions affirm women's right to be free from harassment and intimidation when seeking health care.
The university hospital, working with police, targeted specific groups of pregnant women who entered the hospital for prenatal care or delivery to be tested for cocaine use. Over a 5-year period beginning in 1989, 30 women were arrested for "distributing a controlled substance to a minor," and many others ordered into mandatory drug treatment programs. Several of the women who were arrested gave birth in shackles or chained to their beds. Although the hospital reports that equal percentages of white and Black patients used cocaine (about 15% for each group), the vast majority of those tested and all but one of the women arrested were African American. 75 medical organizations, including the American Medical Association, as well as NOW, NARAL and the ACLU, signed onto amicus briefs urging the Court to draw sharp distinctions between police and medical providers.
While good news, the decision may not be cause for too much celebration. The majority opinion, written by Justice Stevens, is narrowly focused on the issue of searches without warrant or consent and does not address the underlying premise that a fetus is a person to whom the mother can do harm. Further, the opinion states that "state employees, like other citizens, may have a duty to provide the police with evidence of criminal conduct that they inadvertently acquire in the course of routine treatment," which could still deter people in vulnerable positions from seeking medical care. Columnist Ellen Goodman points out that Justice Kennedy's "very reluctant concurrence" goes further, stating, "There should be no doubt that South Carolina can impose punishment upon an expectant mother who has so little regard for her own unborn that she risks causing him or her lifelong damage and suffering."
This seems to open the door to policies not based on secret evidence collection. There have been numerous cases recently of women being locked up because judges disapproved of their behavior during pregnancy. One such case in California involved a woman with emotional problems who was detained after a deputy district attorney obtained a juvenile court order declaring her fetus a dependent child of the state. The woman was released by an appellate court after several months of unlawful detention.
The Court, concurring with the appeals court and the original judge who granted an injunction against the blockaders, said the law is an appropriate use of the Constitutional provision enabling Congress to regulate interstate commerce. Of course, the identification of women's health care as "commerce" may not make all of us feel that secure about the quality of services, but at least it puts it in a category the government considers worth protecting.
I feel pretty mixed about this decision, because there are many instances where activists have publicized the addresses of people who deserved to be harassed: Jessica McClintock, for instance, who had stolen the labor of Asian immigrant women in Oakland. Demonstrations at McClintock's home, as well as picketing her stores, resulted in her eventual agreement to pay the women the wages they were owed and to stop using sweatshop labor in the future. No one harmed or threatened McClintock.
I would love to find a website listing names and addresses of the officers of PG&E, for instance, and believe that people would use that information legitimately to hold them accountable, not to kill them.
On the other hand, anti-choice extremists have shown themselves to be willing to use violence against abortion providers, and perhaps that puts the Nuremberg Files in a different category. I'm just not sure the government or the courts would see it that way. Now we probably won't get a chance to find out. The website is back up, and for those who have the stomach for it and want to see exactly what horrors these extremists are up to, you can find it at http://lancasterlife.com/NurembergFiles/.
There have been a lot of exciting developments in the world of Practical Support. Read on and you will hear more about these developments, ways to get involved and a welcome to new volunteers. From past articles you may remember that we're trying to organize Practical Support in a different way. Our approach is to identify a community member interested in taking on the role of a regional Practical Support Coordinator. The regional coordinator will be the central connection between ACCESS, the communities we serve, and the regional volunteers. The places we have prioritized to work on this model are Butte County region, Sacramento, Fresno and the greater SF Bay Area. I am thrilled to say we have had the opportunity to pilot this model in Chico!!
After my trip through the Northern Sacramento valley last summer, Cathie Roach, a long time supporter of the Women's Health Specialists and community icon, was very interested in becoming the local regional coordinator. She took on the role and with the help of Erin Tolva (hotline coordinator at WHS) organized a series of meetings with potential Practical Support volunteers. Cathie and Erin have done a remarkable job bringing together an amazing group of women to form the Practical Support Network-Chico!! Cathie serves as our contact for Chico and for Women's Health Specialists directly to eliminate the barriers to abortion. What a success- KUDOS to the Practical Support Network Chico!
We envision that one day the entire Practical Support Network will be organized regionally with women in the community taking leadership in this way. Each regional network will be uniquely structured according to the community. As we move forward with our new model, we are still trying to meet direct Practical Support requests from hotline callers and we need your help.
Right now we are looking for volunteers in the Greater Bay area (especially for housing in San Francisco), Sacramento, and people who commute between these two regions. Late second trimester procedures are especially difficult to get these days if you have Emergency Medi-Cal (See Parker's article). There are only two clinics in California that accept this insurance, one in LA and the other in San Francisco. As a result, we are seeing more women than ever travel into the Bay Area. This is a crucial time to get others involved. Please spread the word about Practical Support! During the summer I will be traveling to the Sacramento and Monterey regions to strengthen the network in these areas. Contact me if you know people I should connect with who would be interested in getting involved directly or who could help me learn the lay of the land.
If you are wondering how to get out the word to friends or acquaintances I invite you to consider hosting a house party. It's a great way to relax, talk about abortion access issues and take action. It works well to hook up with someone you know to jointly plan a party. We can also hook you up with another interested Practical Support Volunteer to plan a party together in your area. Our fabulous long time volunteer Kate Raphael just hosted an extremely successful house party with 8 guests that raised $360 and brought in several potential new volunteers. As you can see there are many benefits to hosting a party besides having me over! If you are interested in talking more about the Practical Support development taking place or how to get involved, simply call me up at (510) 923-0822 or firstname.lastname@example.org.
Finally, thanks to all our long time supporters and Practical Support Volunteers. It is with your dedication and commitment that ACCESS exists. I would also like to welcome our newest Practical Support volunteers: In the Bay Area we have two women assisting as Regional Outreach Volunteers in the South Bay and Oakland. Welcome Yanin Senachai and Melanie Campbell! A shout out to: Fathilah Kamaluddin, Abigail Sawyer, Mary Jane Weatherbee, Alethea Paskos, Melissa Moran, Cara Cipollone and Kristie Zappa. In Chico, welcome Cathie Roach, Erin Tolva, Kelly Angel, Lynette Frost, Tatjana Rei, Lupe Villela, Jewel Fryer, Melissa Hormann and Mary Egan. In the Fresno and surrounding area welcome Rollande Girard, Vinh Ngo, Jan Slayter, Lynn Pulliam, Gabriela Zarco and welcome back Anne Merrill (former board member of CDRR &WHRC).
"Ivana" was interviewed in our Follow-Up project because she had called the hotline for help getting an abortion. Ivana told us she is newly emigrated from Russia and has trouble understanding English. She had been calling clinics for days but everyone talked so fast she couldn't understand what was going on or what she was supposed to do. When she called ACCESS, Becca reassured her that they would take it slow and go over everything until she understood. Ivana was so grateful to ACCESS for taking the time to explain how to get Medi-Cal and what the abortion would be like.
A man called from Shasta County to get abortion referrals for his daughter-in-law. He said she had been trying to find clinics and information, but all she got was Crisis-Pregnancy-Centers and a whole lot of hassle. Now she is scared and crying. ACCESS gave him lots of information about clinics, the safety of abortion and options for anesthesia, and encouraged him to have his daughter-in-law call herself if she wanted to talk.
"Mary" wanted to know if a woman needs her partner's consent to get an abortion. Her boyfriend is very abusive and has been threatening her a lot and telling her it's illegal to get an abortion without his permission. Becca assured her that having an abortion is her decision and helped her find clinics in San Jose. They also talked about the abuse and what support Mary has for staying safe. Mary was happy to take the domestic violence referrals Becca offered her. She said she would call ACCESS back if she needed anything else.
SFGH called for one of their patients. "Wilma" would have her husband with her for support but they don't have a car. Wilma and her husband said they'd take BART to the clinic and our new practical support volunteer Spike was able to do the ride home to Oakland. The morning of Wilma's appointment, another patient's ride bailed on her and SFGH called to ask Spike if she would have room for one more! Fortunately, she did, but then the woman worked out something else so she wouldn't have to wait all day.
"Stephanie" called from Calaveras County for abortion clinics in Sacramento. She thinks she is about 21 weeks pregnant. She applied for Medi-Cal for herself and her daughter and had been waiting for it to be approved, but it took weeks for her to get the card. No one told Stephanie she could get Emergency Medi-Cal quickly just to cover the abortion. Now she was shocked to learn that no clinics in Sacramento will accept her Medi-Cal. Even though ACCESS offered to help with travel, Stephanie said going to Los Angeles was out of the question. She said she'd call SFGH and let us know if she needed anything else.
"Wendy" called from Santa Cruz for an abortion referral. She's only a few weeks pregnant but can't use either of her local clinics. The Planned Parenthood won't take her private HMO; Choice Medical Group will, but they only do abortions at their clinic in San Jose. Her insurance also requires her to pay a big deductible, so Wendi was thinking of just paying cash at the PP. ACCESS was able to offer her another option: some private doctors who do abortions in her area and would accept the insurance. Wendy decided to do that so at least she'll have paid her deductible for this year.
As many of you already know, access to abortion for uninsured women in California is currently in a state of crisis. Although abortion is covered by Medi-Cal and there are no state laws interfering with the right to abortion (no 24 waiting periods, informed consent requirements or parental consent laws), the reality for many women is that abortion is 'legal but out of reach' - too expensive, too far away and just too hard to get.
Why this gap between rights and reality? The first problem is there aren't enough people who do abortions - more than 50% of the 47 northern and central California counties that ACCESS serves have no known abortion providers. Most clinics are in urban centers, which means women in rural areas often have to travel to get an abortion even if they are only a few weeks pregnant. In addition, too many women don't know they can get Medi-Cal to pay for an abortion if they can't afford it (1st trimester abortion costs about $400 in California, and the price goes up each week in the second trimester). Tragically, women are often delayed later and later into the second trimester as they try to scrape together money to pay for the abortion or work out a plan for getting to the closest clinic.
That's when the situation gets grim. Very few clinics in California do abortions after 18 weeks, and even fewer accept Medi-Cal for these later abortions. Let me give you some background info on Medi-Cal coverage of abortion: Thanks to a lawsuit by CDRR and the ACLU back in the 1980s, Medi-Cal is required to cover abortions as well as prenatal care for women with incomes less than 200% of the poverty level. If a woman is receiving welfare benefits or other public assistance, she is often enrolled in a managed-care Medi-Cal plan that is either county-based (like Alameda Alliance or Contra Costa Health Plan) or a private plan (like Blue Cross or Molina). If a woman is uninsured when she gets pregnant or she has another kind of insurance that will not cover abortion (such as Tricare/Champus military insurance), she can sign up for Emergency Medi-Cal. Emergency Medi-Cal is also what women under 21 receive when they need confidential services.
The problem is, although Medi-Cal is required to cover abortion, no abortion providers are required to accept it. And so as time goes by, more and more of them don't. Why? Mostly because the Medi-Cal reimbursement rate is so low - about $250-300 for a procedure that costs closer to $900 to perform. In addition, the process for getting paid by Medi-Cal is a hassle. When a clinic submits a claim to Medi-Cal for a second-trimester abortion, they have to attach a special surgical report in addition to the normal forms. This means that the claim has to be processed manually (by a person) instead of electronically, which can take several extra weeks. Clinics also report that their second-trimester claims are frequently rejected by Medi-Cal for technical reasons and have to be resubmitted, further delaying payment. These delays add insult to injury - if they're only going to pay you 30% of your costs, the least they can do is pay you fast!
The financial burden involved in accepting Medi-Cal combined with violence, protests and other stigma against abortion providers has resulted in a situation where many abortion clinics feel they cannot go on providing services as they have in the past. When I came to ACCESS almost 5 years ago, there were more than 10 providers in northern and central California who performed abortions to 24 weeks and accepted all types of Medi-Cal (the HMO plans as well as Emergency Medi-Cal). In the past two years we have seen most of those providers disappear. Two clinics that used to do abortions to 24 weeks closed completely. One stopped accepting Emergency Medi-Cal for 1st and 2nd trimester abortions. Another stopped taking any kind of Medi-Cal for abortions after 19 weeks. Several clinics stopped doing any abortions after 18 or 20 weeks.
Today, only two clinics - San Francisco General Hospital and Family Planning Associates in Los Angeles - still accept Emergency Medi-Cal for abortions to 23/24 weeks. Because of the increased demand, SFGH is frequently booked two weeks in advance - crucial time that a woman who is 20 weeks pregnant does not have to wait. If a woman with Emergency Medi-Cal cannot get a timely appointment at SFGH, her only options are traveling to Los Angeles, raising over $1,500 to pay a local provider or continuing her undesired pregnancy. For many women, this is simply not possible. In other words, women with money or private insurance can still get abortions to 24 weeks. Many women who are uninsured or have Medi-Cal cannot.
Not surprisingly, this crisis has led to a dramatic increase in the number of women who need assistance from ACCESS to find abortion services. Since January 1st, we have talked to more than 60 women facing this situation, women like 'Elena' and 'Sarah'.
Elena is 25 years old and married. She lives in Modesto and has Medi-Cal. Planned Parenthood estimated she was 15 weeks pregnant by date and pelvic exam, but when she went to her appointment 10 days later at the only abortion clinic in Modesto, their sonogram said she was over their limit of 18 weeks. They referred her to two clinics in Sacramento, but neither of those clinics will accept Medi-Cal anymore. Finally, one of the Sacramento clinics referred Elena to ACCESS, and we helped her make a plan for getting to San Francisco General Hospital. By the time she got to her appointment she was almost 23 weeks pregnant.
Sarah was referred to ACCESS by a clinic in Chico. She was 22 weeks pregnant and trying to get an abortion. None of the clinics in Sacramento will take her Emergency Medi-Cal, and SFGH couldn't see her in time because they were booked. Sarah took the bus 546 miles to Los Angeles to get her abortion - passing at least 5 clinics that would have seen her only two years ago.
At ACCESS we are committed to helping women get abortions without isolation or delay. We also know that helping individual women will not turn the political tide that is allowing access to abortion services to disappear, and we are fighting to combat this erosion of reproductive rights on a policy level.
Last fall, ACCESS/Women's Health Rights Coalition signed on as a supporting member to the California Coalition for Reproductive Freedom, a statewide coalition of reproductive rights lobbying groups. At the last meeting of CCRF, I was invited to make a special presentation about this crisis with Medi-Cal abortion providers. As a result, CCRF officially agreed to put combating the loss of Medi-Cal providers on their agenda for this year. Our primary goals are securing an increase in reimbursement rates for second-trimester abortions and getting rid of the surgical report that must be attached to claims. Lobbyists at CCRF are determining the best strategy for advocacy efforts - trying to get the most done with the least chance for opposition and controversy. Depending on what happens, we may need your help to protest and call on your local representatives. I will keep you posted.
I am cautiously optimistic about what we will accomplish in these efforts to improve abortion access for women with Medi-Cal. In the long run, however, I am thrilled with our growing relationship to CCRF because it offers us new opportunities to make change. By bringing what we see at ACCESS everyday to the attention of our political allies at the ACLU, ACOG, PP, NOW and CARAL, we are ensuring that women's real needs and experiences will inform efforts to create and challenge policy.
Special thanks to Kate Raphael for the design and layout of this newsletter! You may also download this issue in pdf form.