Here Are the Facts of New York’s Reproductive Health Act

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Sexual and reproductive health and rights discussions, especially in today’s world, can often be depressing, bleak, or just a bit of a downer. But on January 22nd, the 46th anniversary of Roe v. Wade, New York passed proactive legislation called the Reproductive Health Act (RHA), which modernizes a state law that previously limited when people could access legal abortion care. Laura McQuade, President and Chief Executive Officer of Planned Parenthood of New York City (PPNYC), sits down with us to talk about the new and exciting Reproductive Health Act.

There hasn’t been a lot of change in terms of access to abortion care in New York since the passage of the RHA. New York has protections for abortion care up to 24 weeks or viability, and have protections for life and health of the mother and if the pregnancy is not viable. All of these protections are currently under threat at the national level, but the RHA ensures that those protections were written into New York state law.

It is legal in the United States to have an abortion through viability (usually considered to be around 24 weeks) and there can be an exception if the health or the life of the patient is at risk, or the pregnancy is no longer viable. Those U.S. standards are now coded into New York state law through the RHA. The RHA also removes abortion care from the criminal code and places it into the public health code and now allows trained nurse practitioners, clinical nurse midwives, and physician assistants to help perform first trimester surgical abortions and medication abortions.

For the first time, we are facing a Supreme Court minority on abortion care. It is a matter of time before the court rules in a way that continues to gut and erode federal protections and allow individual states to strip away access to abortion. If Roe v. Wade is gutted, 22 states will move to make abortion fundamentally illegal due to a lack of judicial underpinnings at a federal level.

Links from this episode

PPNYC on Twitter
PPNYC on Facebook
Information on the Reproductive Health Act

Transcript

Jennie Wetter: Welcome to rePROs Fight Back a podcast on all things repro. I'm your host Jennie Wetter. In each episode, I'll be taking you to the front lines of the escalating fight over our sexual and reproductive health and rights at home and abroad. Each episode, I will be speaking with leaders who are fighting to protect our reproductive health and rights to ensure that no one's reproductive health depends on where they live. It's time for repros to fight back.

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Jennie Wetter: Welcome to rePROs Fight Back. So far on this podcast, we've spent a lot of time talking about the various attacks on sexual and reproductive health and rights and that can kind of be a downer and a bit of a bummer. Um, and so I'm really excited to take time today to talk about proactive things. Um, so we're going to talk about proactive legislation that was just passed in New York. Uh, so I'm really excited to have with me today, Laura McQuade from Planned Parenthood of New York City to talk about New York's new Reproductive Health Act that was just signed into law last month. Hi Laura. Thank you so much for being here.

Laura McQuade: Hi Jennie, it's great to be with you today. Thank you for having me.

Jennie Wetter: Again, I'm just so excited to be talking about good news for once. It's such a nice change.

Laura McQuade: We are too. We are too.

Jennie Wetter: So, um, before we talk about the new law, we should, maybe just talk a little bit about what did abortion access in New York look like before the reproductive health act?

Laura McQuade: To be honest, there's not a lot of change in access to abortion care in New York as a result of the RHA. Why? Because we really operate under the protections of federal precedent, right? We operate under Roe v Wade, Planned Parenthood v Casey, we operate under that law. And so, um, we had access here as we do across the country, contrary to popular belief, um, we have protections up to 24 weeks or viability and we have protection for life and health of the mother as well as if the pregnancy is not viable. However, as you've just alluded to, all of those are under threat at the national level. And what the Reproductive Health Act did was make sure that those protections that I just articulated were written into New York state law so that regardless of what terrible things may be coming down the pike from the federal government, we will have those written into law here in New York state. And I know we're going to go on to talk about some of the other things in the law, like allowing advanced practice clinicians like nurse practitioners and physician assistants to provide care, but those are some of the other pieces. But specifically around the legal piece of it, it's making sure that New Yorkers have in their own state law the protections of current abortion rights in the United States.

Jennie Wetter: And making sure it's ruled as a public health issue instead of a criminal issue, which actually true huge change.

Laura McQuade: Right. And again, as a reminder, New York passed its abortion law in 1970. It was one of the first laws legalizing abortion three years before Roe in this country. And at that time it was a law that was placed in the penal code. Um, it only gave, um, an exception for life, unlike life, health and viability, which came later under Roe. Um, and because it's at, in the criminal code and not the public health code, it came with a lot of barriers and restrictions for providers who oftentimes had fear of providing care even to the extent of the law here in New York state. So this is a big change for us.

Jennie Wetter: And so there's been a lot of discussion about the Reproductive Health Act since it passed and a lot of the opponents have been very um, vocal in saying what they say it does, which, you know, we even heard in the State of the Union, um, this, this last week talking about, you know, basically killing babies after they're born, which is obviously not what this does. So let's talk a little about, about what it actually does.

Laura McQuade: So what this law does, again, it is legal in the United States to have an abortion through viability, which is generally thought to be around that 24 week mark. And if there has to be an exception because of the life of the patient, the health of the patient or the viability of the pregnancy that is already the law here and it is now New York state law. But some of the other amazing things that that this did and why it was so needed...we just talked briefly about taking it out of the criminal code and putting it right where it belonged in the public health code. There is no other procedure, healthcare procedure, um, that is in the criminal code. So again, taking away that abortion exceptionalism and stigma, um, that has existed for so long. Um, the next piece is around who can provide abortion care. Right now in the state of New York, surgical abortion can be provided explicitly by physicians only. Um, and the change in this law actually opened that up to include advanced practice clinicians who include nurse practitioners, clinical nurse midwives and physician assistants who can provide medication abortion but also first trimester surgical abortion as long as they are trained and signed off on appropriately. Um, and so those are really the key components of what's written into this law and why we're so excited that we will have protection. But also what is really an expansion of care to communities that may not have physicians and rely on advanced practice clinicians to provide their care.

Jennie Wetter: There's so many pieces to pull apart here that are so important to talk about anything. One of them is, you know, the cavalier way that they've been talking about that they seem to think women make these decisions, that there's just like this huge group of women that are just putting off getting an abortion until right before they go into labor. Which one is just flat out not true, but also I think it's just important to talk about most abortions, the vast majority are in the first trimester and just that the way that the conversation has been happening has not been in a health helpful or truthful way.

Laura McQuade: But make no mistake that is a calculated conversation on their part, right? They know fundamentally well what this law says and does not say, but that's not sexy. That's not mobilizing of their base. And so they will stop at nothing... Flat out lies about what abortion care is and who seeks abortion care and how that is part of a narrative and they have absolutely no qualms about telling lies and spreading misinformation on a daily basis. So when you talk about abortion care and what it looks like, so more than 90% of abortions in the United States happen in the first trimester and then as the gestational age increases, that percentage gets smaller and smaller. So according to Guttmacher at this point, just over 1% of all abortions in the United States happen after the 21st week of pregnancy. And so they don't actually want to have a conversation about health care and what is actually happening. They want to go to the end of the spectrum that is so, it is so necessary and so needed. But it is rare. People make those decisions for reasons that I can't judge, but they have their reasons and they don't do it lightly. Any decision that we make about health care and seeking access to health care, women have the ability to make those decisions for themselves and they make them for the reasons that we don't have the right to say why they do or don't make those decisions. But I can tell you that nobody gets to our door having not thought about what is their health care situation, what are the implications of either decision that they have carrying a pregnancy to term or not. They have the ability to make those decisions.

Jennie Wetter: Yeah. I think the lack of ability to trust women in making these decisions so clear on the other side.

Laura McQuade: It absolutely is. It's ingrained in that conversation. It's also why women are also not given autonomy. Even in the restrictive laws, the laws are always against the physician because again, it's taking away that autonomy and decision making of the patient because you can, you can effectuate so much more control if you can actually take them out of the equation. Um, and every law that's passed, there's inherent belief that they have the right to do so.

Jennie Wetter: Yeah. And this isn't really relevant, relevant. Well, I mean other than relevant to the larger abortion conversation but not relevant necessarily in New York. Um, just like the shaming you see put into the laws and the lack of respect for women, right? So like a waiting period being like you need to like go home honey and think about this some more before you can make your decision or saying you need to have an ultrasound to like look at what you're doing. And think about this before you do it.

Laura McQuade: So you may not know this, but before I was the CEO of Planned Parenthood of New York City, I was the CEO of Planned Parenthood great plains, which provided abortion care, full sexual and reproductive health care in Missouri, Kansas, Oklahoma and Arkansas. And we had across those states, three different waiting periods, a 24 hour waiting period of 48 hour waiting period and a 72 hour waiting period. And part of it is about putting as many barriers in front of the patient as is humanly possible, putting as many barriers in front of the provider as is humanly possible. But the underlying theme is what you just highlighted: women are not capable of taking the information available to them, taking their own circumstances, synthesizing the two and making a decision. We, the state of Missouri, we, the state of Oklahoma, we need to guide you because you're incapable of making this decision on your own. So it really is a twofold. They get, they get, you know, killed two birds with one stone, um, in those laws.

Jennie Wetter: Okay. Anyway, back to the Reproductive Health Act. Sorry, that was a little bit of a sidetrack, but important to talk about where these laws are coming from.

Laura McQuade: Absolutely. And we're seeing them happen over and over and over again. Hundreds are being introduced annually.

Jennie Wetter: Yeah. It's that, although the good news was last year was the first year ever that a, there were more proactive laws introduced than negative laws and so that's something to look forward to. Hopefully that trend continuing.

Laura McQuade: Well, I think that's what's so exciting about the Reproductive Health Act and what has our opponents so fearful, right. First of all, the electorate is waking up to the importance of putting elected officials in office who believe in these issues and will vote on these issues. That's exactly what happened in New York state. We were only able to pass the Reproductive Health Act after we flipped the New York state Senate, which had been blocking this legislation for more than a decade to pro- sexual and reproductive health, majority in the Senate. Um, and so people are waking up, um, elected officials are waking up. And that is what is terrifying, those who have controlled this conversation for decades, who have taken over through an outsized minority state legislatures across the state. And so this is being driven by real fear of what could be happening when people realize the rights that are at stake and that they actually have some power to do something about it to effectuate change.

Jennie Wetter: So the one part of the Reproductive Health Act, we've kind of touched on, and I wanted to go back to was expanding who could provide abortions, because coming from a rural area that didn't have easy access to an abortion provider, this would be a real game changer for women who live in areas or people who live in areas that don't have easy access to a physician.

Laura McQuade: That is exactly right. I mean, there's been such a material change in the delivery of health care since 1970 when our law was passed, right. Nurse practitioners didn't exist. Um, certainly, um, and that creation of a whole other group of clinical providers in our country, um, didn't exist. So a lot of people say to me, well, why weren't they written into the law at the time? Well, they didn't exist. I don't think people realize the extent of care, primary care, sexual and reproductive health care that is provided by these advanced practice clinicians, particularly outside of large urban centers. Um, and so having more providers being able to provide first trimester abortion care and , um, through, through in clinic or medication abortion, which is what 90% as we just talked about, of all the abortions happening is a game changer for communities. Patients are having to drive as we know, we've heard the stories, Texas, Kansas where I worked Oklahoma hours to be able to reach, um, a physician who provides abortion care. And so, um, bringing care to patients and communities where the need is, is, is, is thrilling.

Jennie Wetter: Yeah, I mean, I can definitely see that. And again, going back to where I'm super familiar with this, Wisconsin is they're down to three clinics and it's Milwakee and Madison, which are very southern Wisconsin. So there are huge swaths of the state that they don't have access.

Laura McQuade: And so what we are, what we're hoping to do again, and we'll talk about this probably a little bit later about what are some things that we can be doing, um, to figure out how to change that landscape, particularly around, um, advanced practice clinicians providing care more care across the country.

Jennie Wetter: Um, and I think it, we touched on this a tiny bit, but maybe a deeper dive as to why it's so important to do this right now.

Laura McQuade: Why? Because for the first time, we are facing a Supreme Court minority on our issue. When President Trump announced his nominees for the court, before we even got to Brett Kavanaugh, the litmus test was who was going to be willing to overturn Roe v Wade. It was a litmus test in his selection of candidates to be considered. We know, despite the rhetoric on the other side, we know where Brett Kavanaugh stands on the Roe v Wade decision as a legal decision and where he stands personally on the issue of access to legal abortion in the United States. And there are countless cases sitting waiting to be determined whether the court will take them up. So it is, um, we believe a matter of time before the court rules in a way that may not overturn Roe, I'm not that naive, but the further gutting and erosion of the federal protection that will allow states to further restrict to the point that there is no access. Um, you mentioned Louisiana just a moment ago. And so what I think is the ultimate irony here is that campaigner Trump talked about how abortion was something that needed to be determined at the, at the state level. So what did we do here in New York? We went out and we passed the law that we wanted and needed for our citizens in the state of New York because we fear the loss of it at the federal level. And so I do think that's the ultimate irony that he says it's really a state's rights decision. And now that it's been decided at the New York in New York state, he's doing all that he can with his base to chill others from making those decisions at the state level. But that's what's coming. And it can be a year, it could be 18 months, but there will be some sort of erosion in the rights in a fundamental way, in fewer months than I care to contemplate.

Jennie Wetter: Yeah. And I mean, we're just really, when you think about it, it does... it's not going to take that much to quickly make abortion not a reality. In several states... what are we at seven states that only have one clinic? It doesn't take much to find, uh, you know, maybe a trap law, which is what their under consideration and in the Louisiana case, um, that would close that clinic and leave women with having traveled great distances because, you know, it's not just that state, it's often kind of this block of states where you could have women, particularly in the South that are going to have a long ways to go. And that's gonna really impact the women who are least able to afford it.

Laura McQuade: Right. And we have legal precedent in this country, not just around abortion care, but around other, um, fundamental civil and human rights issues that a person cannot be forced to leave the state to exercise their fundamental rights. Whether that's about access to health care, access to education. Again, I'm not a lawyer. I like to sometimes play one on TV, but, um, but that's a total, we're in a totally different legal environment now. And what we're seeing happening in Louisiana is a pullback of that earlier jurisprudence. And so we can't rely on that which we relied on previously. And again, I always like to do my shout out for, um, for the Midwest. I mean there was an abortion desert in the middle of this country. There was a sexual and reproductive healthcare desert in the middle of this country, um, that links right up with that abortion desert and sexual reproductive health care desert in the South. Um, we know that if Roe is materially gutted that 22 states will move to make abortion fundamentally illegal in their own states. And again, that's, we do not, we no longer have the judicial underpinnings for that protection at the federal level. And that's frightening.

Jennie Wetter: Yeah. Um, this is something you can really see. So, um, I work for the Population Institute and every year we do a 50 state report card on reproductive health and rights. So it looks at abortion, but it also looks at a number of other things like sex, education, access. And you do, you see this big red swath that goes right down the Midwest to the south of states.

Laura McQuade: You gave us some bad grades. You gave the state of Kansas an F.

Jennie Wetter: Yes.

Laura McQuade: Um, I'm trying to remember.

Jennie Wetter: There were 19 F's this year.

Laura McQuade: Yeah. So you gave the state when we were still there and now Kansas is in a different space, right? It's, it's fundamentally changing because of the electorate. Right? Having Laura Kelly sitting as the governor of Kansas, it's a huge difference. Makes a huge difference. But you, yes, I remember all too well that big fat red F Kansas got, I don't know whether it was 2015 or 2016 yet.

Jennie Wetter: They've had one most of the time we've done it, I guess that's okay. I've been watching Wisconsin who started at a B when we started doing it. So this is like our sixth year and they've had an F for I think, three years. So it doesn't take long to change it, but that also means it might not take long to change it back.

Laura McQuade: That is exactly right. And that is why, I mean, this is such a moment of empowerment in this country. We could talk for hours about the reasons that people laid dormant for far too long. And that's why we're sitting in this moment, but I'm trying, I am a glass half full kind of girl and what we saw mobilized in the midterm elections, what we saw mobilized in New York state that allowed us to be where we are today, not just on the Reproductive Health Act, right? Contraceptive coverage, protection of rights for our transgender community here in New York. More protection for immigrant communities, voter rights, right? You have a power in your electorate to effect change. It's such an opportunity out there. People are mobilized elections matter, getting smart on issues matter. There are things like fake news, right? And getting educated and really understanding what the facts are and then taking model legislation. The Reproductive Health Act is a model. Our friends on the other side, they have a model legislation playbook, the National Right to Life promulgates legislation that happens at the state that they put out to multiple states. Why don't we think about looking at model legislation, right? You need the electorate and the elected officials to do it. But there are a lot of things that we can be doing now to kind of move this, this forward. And I think that is what is really sparking some of the just hideous repulsive lies that the president um, spoke about in the State of the Union that we heard about from Cardinal Dolan right here in New York City the week before.

Jennie Wetter: Originally from Milwaukee.

Laura McQuade: And so it's fear that there will be real, real and material change.

Jennie Wetter: So we're talking about good things and so let's keep going. What else would you like to see? Like if you have your wishlist, what else would you like to see for proactive legislation in New York or there's broader.

Laura McQuade: Um, sex education is at the top of our list. Um, New York state and New York City, we are failing our youth and our teens and our young adults miserably. We are failing. It is the last thing on the bottom of anyone's list, right? We've got some kind of loose mandates at the state level here in New York City. You're required to have one class in middle school and one class in high school. And um, I have a high schooler and I always joke, I'm like, hmm, he's really good at calculus. He takes calculus, but what's the likelihood? How often is he going to use calculus after he leaves high school? But how often is he going to be in a relationship? How long often is he going to have sex? How often is his self esteem going to come into play in his own life and the lives of those he has a relationship with. And yet we have no mandates around that. We have an epidemic around consent, right around violence, not just violence against women. Um, it's pervasive in the LGBTQ community.

Jennie Wetter: Absolutely.

Laura McQuade: Um, and so that is a big, big bright shining star that we're focused on here in the state of New York is universal, I would say used to see K through 12, but universal pre-k through 12 sexuality education, big deal. If we could try to move that forward here, that would be amazing to see.

Jennie Wetter: And I feel like that's one of the things, there's a couple of states that always surprised me every year or you think I would remember doing the report card is going through and saying that New York isn't as strong as I would hope it would be.

Laura McQuade: We are not yet the state. We think we are. Um, I coined that phrase when I came back from the Midwest, right. You have your eyes open, you think you live in this bubble, right? And then you spend three years in for our issues, kind of the belly of the beast around sexual reproductive health care. And then you come back and you look and you see that you either have laws in place that look like TRAP laws, you have no educational standards in place and you're like, wow, we have a lot of work to do. Get Out, get mobilized, feel good about what we've done, but realize how much more there is to do. Even right here in the blue, purple, red, depending on where you live in this state. The state of New York.

Jennie Wetter: Great. So we always like to end the podcast focusing on what can people do to fight back. So we have listeners all over, um, in the US mostly. So what we could work in, do looking at what New York has accomplished and what you would like to see in New York accomplish, what can they do in their own states to push for proactive reproductive health care legislation?

Laura McQuade: I always start with the voting part. Yes. Okay. There is no seat. I don't care. I don't care where it is. There were seats that were turned over in New York state this year. People told us, people told other parts of, of, you know, people of the advocacy community, you will never take that seat. And we said, okay, we're still going to invest. And if we don't take it this time, we'll take it the next cycle. But we took seats that people said for years, you could never touch those legislatures. You talked about Wisconsin, right. Those seats weren't taken by accident. Right? Right. And if they can be taken, they can be taken back. And so and don't be discouraged if it can't be one cycle. Staying engaged is really hard. Yeah, it really is. It's exhausting. But I would say there is such a ground swell. There is support in number of corners. There's money for this work. There are organizations who have indivisible, right? All groups that have sprung up that are doing this work more than ever. Find the one that works for you and get involved and stay positive. A lot of this, they didn't take it in one cycle and we probably can't take it back in one cycle but, but work toward that. And I would also say it's hard not to be sucked into what media tells you. We want small, short answers to our questions. There are no small short answers to sexual and reproductive health. Um, right. Immigration, racial justice, economic justice, there's not a tweet or a sound bite for that. Um, it is hard work and it is passionate. It is commitment and stay smart. Stay dedicated and don't beat yourself up. If today all you can do is repost a tweet because whatever you can do on any given day is more than doing nothing and give what you can when you can stay smart, stay focused because we can do this. Um, and then I would say take advantage of things like model legislation. Like if you are more politically active and somehow you lobby or you're working in an organization, put a piece of model legislation in front of a supportive legislator, run it through, even though you can't, when that cycle start to build support for it. That's what we did with RHA. This was a piece of legislation that was written more than a decade ago. We updated it when we went into this cycle, but it wasn't the first time around when we had the legislature. So it's a long, okay. In the longterm we're dead, I get it in the medium. This is a medium term game for all of us and I would just encourage people to stay positive, to stay connected. Don't beat yourself up, don't beat others up and just keep moving forward.

Jennie Wetter: Great. I don't, there's no nowhere to go for that cause that is so positive and I think that is the perfect place to end.

Laura McQuade: Well, thank you so much for the opportunity to talk with you to talk about this important issue today. I'm so proud to have had the opportunity.

Jennie Wetter: I'm so grateful that you did it, so thank you Laura.

Laura McQuade: Thank you.

Jennie Wetter: For more information including show notes from this episode and previous episodes, please visit our website reprosfightback.com. You can also find us on Facebook and Twitter at rePROs Fight Back. If you like our show, please help others find it by sharing it with your friends and subscribing, rating and reviewing us on iTunes. Thanks for listening.

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