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The Infuriating and Inspiring Story Behind the Opening of a Red-State Abortion Clinic

Mother Jones

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Julie Burkhart wondered if her impression of Catholic nuns as quiet, meek, shy women was all wrong.

Burkhart is opening an abortion clinic in Oklahoma City, and it’s located in the same neighborhood as St. James the Greater Catholic Church. A few months ago, members of the church began holding lunchtime protests at the construction site, and one bold nun entered the clinic to harass construction workers. Then the nun demanded a meeting with Burkhart.

I went out and I told her, ‘Well, you’re never to walk onto this property unless you’re invited, and I don’t think we really have a lot to talk about,'” Burkhart said firmly.

Angry nuns aren’t the only problem that the clinic operator has had to contend with when trying to open the first new abortion clinic in Oklahoma since 1974. It’s been a time-consuming, costly enterprise in a state that has, Burkhart notes, a number of “prohibitive anti-choice laws.” Gov. Mary Fallin has signed 20 anti-abortion bills over the course of her six-year tenure, including measures that tripled the waiting period from 24 to 72 hours and banned the use of telemedicine to administer medication abortion. Although this year she vetoed one that would have made it a felony to provide abortions except in cases of miscarriage or when a woman’s life is in danger, she did so because the language in the legislation was “vague.” (Removing fetal matter after a miscarriage does not medically qualify as abortion, despite the legislation’s definition of it as such.) Legal experts contend the bill could not have survived a constitutional challenge anyway.

Burkhart’s clinic, Trust Women South Wind Women’s Center Oklahoma City, will be the only one in the state’s largest city. Since late 2014, women in Oklahoma seeking an abortion have had only two options—in Norman and Tulsa—130 miles apart. Her clinic will provide general reproductive health care—birth control, pap smears, pregnancy care, transgender care—along with abortion services for up to 21.6 weeks. When we spoke, she was getting ready to receive the final sign-off from the state regulators before the clinic opens its doors in August.

“Just because we happen to live in a more traditional, conventional, conservative part of the country, it doesn’t mean that people don’t need reproductive health care,” Burkhart says. “I think sometimes that gets lost because of the political attitudes here, but abortion is equal opportunity, whether you’re conservative or liberal or a Democrat or a Republican or whatever.”

The four-decade lull between the last opening of a new clinic in Oklahoma is representative of a broader trend: Clinics are opening at a much slower rate in recent years, due to mounting costly restrictions. According to an investigation by Bloomberg, at least 162 abortion providers have closed since 2011 and only 21 new clinics have opened, three-quarters of them by Planned Parenthood rather than private operators like Burkhart.

Oklahoma has been challenging, but Burkhart is no newcomer to the struggle for abortion rights. An activist for reproductive justice and a political consultant in Washington state, she moved to Wichita, Kansas, in 2002 and became chair of the Witchita Choice Alliance, an abortion rights group. There she began working with Dr. George Tiller, an abortion provider who also performed late-term abortions and was the target of violence by anti-abortion extremists for years. His clinic was bombed in 1986, and he survived being shot in both arms by anti-abortion activist Shelley Shannon in 1993.

Burkhart considers Tiller her “mentor” and remembers him as an encouraging, “solutions-oriented” man. She was the spokeswoman for his clinic in 2009, when the physician was murdered in the foyer of his Lutheran church while he handed out bulletins for the Sunday service. He was shot in the head by Scott Roeder, an anti-abortion activist with ties to Operation Rescue, an extremist anti-abortion group with headquarters in Kansas that had long protested Tiller’s clinic.

A few weeks after his death, Burkhart told the Oklahoman, she sat in his living room and told his widow, “We have to reestablish services.”

It took four years and the creation of a reproductive rights organization—Trust Women, an advocacy group that also provides women’s health care in underserved areas—but in 2013, Burkhart opened a new clinic in Wichita, in the same space where Tiller had practiced. The following year, she set her sights on Oklahoma, and from the very beginning she faced challenges.

First was the question of financing. In 2014, she began her yearlong search for a bank that would give Trust Women a mortgage and a small line of credit to begin construction on the property she had chosen. After being turned down by banks for nearly a year, she started to fear they would have to pay cash for everything. Eventually, she found a bank and was able to move forward.

She also ran into trouble with the state Department of Health when she submitted Trust Women’s application for a license, including the blueprints of her plans to outfit the clinic in compliance with the state’s health code, which, she says, are “one step down” from an ambulatory surgical center. In June, the Supreme Court decreed that requiring clinics to be outfitted as ambulatory surgical centers constitutes undue burden, but for now at least, Oklahoma’s state regulations are still in place. “We have giant operating rooms, both here in Kansas and Oklahoma,” she said, noting that historically, most first- and early-second-trimester abortions have been safely performed in doctor’s offices. Nonetheless, the Department of Health “would not sign off on any of our applications, even though I submitted all the corrective actions time and again,” Burkhart said. “We really complied with everything that they had brought to our attention, so they kept saying, ‘No, no, no.’ My attitude was like, ‘No that’s not gonna work for us.'”

She summoned her attorneys, and in late 2015, they met with the state’s counsel to get “on the same page.” It’s been a much smoother relationship since. The Department of Health told Mother Jones that it could not comment on the licensing process.

Burkhart and her architect recruited a team of subcontractors to build their clinic to code. They vetted each one and made sure they understood the nature of the project and that it could involve some personal risk. They found a tan brick former eye clinic across from a 7-Eleven and down the road from St. James the Greater Catholic Church, and they began gutting it in December. Construction started in January.

In March, anti-abortion activist Alan Maricle from the Oklahoma-based group Abolish Human Abortion (AHA) began demonstrating at the clinic, harassing the workers and filming his arguments to upload to a YouTube page. Maricle even went so far as to find the churches where two of the contractors worshipped, calling the pastors at those churches to see if they were “cool with it.” Maricle said both pastors stood up for the contractors—he also visited both churches but said he left without speaking to anyone.

“One of the things that sets AHA apart from the pro-life movement as it appears in virtually every other part of the country is this growing understanding of the complicity of the church in what we think of as the Holocaust,” Maricle says. “We see the churches being silent—they’re playing political games with this matter…This kind of mentality leads to good, Christian people thinking it’s okay to build abortion mills.”

Burkhart quickly set up meetings with local law enforcement and erected a fence around the building. That didn’t deter the flood of more protesters, but construction continued.

Burkhart estimates construction expenses—which became more costly due to state requirements—will run up to $650,000. Add to that the cost of purchasing the building, and the final bill for the facility alone is nearly $1 million. That doesn’t include what she’ll pay for staffing, equipment, and medicine. This marks a radical change from the situation before Targeted Regulation of Abortion Providers (or TRAP) laws were enacted. She calls those requirements “an added layer of bureaucracy and cost, meant to be punitive for abortion providers and either prohibit them from opening or cause them to shut down, as we’ve seen in Texas.”

Even finding an OB-GYN in Oklahoma can be a challenge, although Burkhart already has physicians lined up to work. The state suffers from a severe shortage of practicing gynecologists. The American Congress of Obstetricians and Gynecologists reported that in 2014, 48 counties out of the state’s 77 didn’t have a single OB-GYN, and there are approximately 1.87 OB-GYNs for every 10,000 women in Oklahoma, which is below the national average of 2.65 per 10,000 women.

And she’s painfully aware of the potential danger that comes with running a clinic. As opening day nears, she can’t help but think of her former boss. She remembers his encouragement, his determination, and the way he insisted on hugs after every meeting.

“I’ve really been missing him this week,” she said. “He was just such a wonderful person to work for, and…I always just felt like we were doing such good work.”

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The Infuriating and Inspiring Story Behind the Opening of a Red-State Abortion Clinic

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Chelsea Manning Could Face Solitary Confinement for Her Suicide Attempt

Mother Jones

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It has been a terrible month for Chelsea Manning, the transgender former US soldier serving a 35-year prison sentence for sharing classified information with WikiLeaks. Several weeks ago, the Army whistleblower tried to kill herself at Fort Leavenworth military prison, and on Thursday military officials announced that they were considering filing charges in connection with the suicide attempt.

“Now, while Chelsea is suffering the darkest depression she has experienced since her arrest, the government is taking actions to punish her for that pain,” Chase Strangio, one of Manning’s lawyers from the ACLU, said in a statement. “It is unconscionable and we hope that the investigation is immediately ended and that she is given the health care that she needs to recover.”

News of Manning’s suicide attempt was leaked to the media by a US official, while an unnamed source told celebrity news site TMZ that Manning had tried to hang herself. She was hospitalized in the early hours of July 5. After the incident, Stangio reported that Manning had experienced “past episodes of suicidal ideation in connection to her arrest and the denial of treatment related to gender dysphoria.” In 2015, the Army approved her request for hormone therapy after she sued the federal government for access to the medical treatment, but Strangio told Mother Jones that she continues “a challenge in court over the enforcement of male hair length and grooming standards.”

If convicted of the suicide-related charges, “Chelsea could face punishment including indefinite solitary confinement, reclassification into maximum security, and an additional nine years in medium custody,” the ACLU said in its statement, noting that Manning could lose her change of parole.

It wouldn’t be the first time Manning has been held in isolation. After she was first taken into custody in 2010, she spent nearly a year in solitary confinement. Following a 14-month investigation into Manning’s treatment—which included being held in solitary for 23 hours a day and being forced to strip naked every night—the UN special rapporteur on torture accused the US government of holding her in “cruel, inhuman, and degrading” conditions. There is a growing push in the United States to end or limit the use of solitary, since long stints in isolation have been shown to lead to disorientation, hallucinations, and panic attacks. Inmates in solitary are also more likely to engage in self-mutilation or to commit suicide.

Asked about the new investigation into the suicide-related charges, US Army spokesman Wayne V. Hall said he was looking into the matter but could not immediately comment.

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Chelsea Manning Could Face Solitary Confinement for Her Suicide Attempt

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Here’s a Cure for America’s Latest Zika Panic

Mother Jones

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Health officials have reported that four cases of Zika in Florida were likely spread from person to person by domestic mosquitoes. This is the moment Democratic politicians—and a few southern Republicans—have been warning about. The finding is bound to create a lot more scary rhetoric and dire headlines.

But here’s the thing: There’s no need to freak out—not yet, at least.

We knew this was going to happen. Back in May, I spoke with Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, who is leading US efforts to create a Zika vaccine. Here’s what he said:

It is likely that we will have restricted local transmission—small local outbreaks? My call would be that we will. Because we’ve had dengue and chikungunya, which are in the same regions of South and Central America and the Caribbean, and are transmitted by exactly the same mosquito. Historically we’ve had small local outbreaks of dengue in Florida and Texas, and a small local outbreak of chikungunya in Florida, which makes me conclude that sooner or later, we have going to have small local outbreaks of Zika—whether that’s five cases or 30—likely along the Gulf Coast.

This is exactly what we’re seeing. And why is this not a huge problem? Because we’re almost certainly not going to let it become one. Just as Fauci predicted, this likely outbreak—scientists haven’t actually found any infected mosquitoes yet—is highly isolated. According to the New York Times, the suspected “area of active transmission is limited to a one-square-mile area” near downtown Miami.

Aedes aegypti, the most likely culprit, is what University of California-Davis geneticist Greg Lanzaro calls a “lazy mosquito.” It doesn’t fly far. In its entire lifespan of two to three weeks, it might travel a few hundred meters, another expert told me. So it’s not coming for you. The mosquitoes that picked up the virus may be limited in to one small neighborhood.

Here’s what happens when we have such an outbreak: Mosquito-control workers and public health officials swarm all over it. Aegypti is an elusive little bugger, but you can bet that within that one square mile, eradication specialists and epidemiologists will be going house to house until they get to the bottom of this, figure out where the aegypti are breeding, and wipe them out.

Compared with, say, Puerto Ricans, Americans are also protected by our lifestyle. People in the Deep South tend to have air conditioning and screens on their windows. We also don’t usually store drinking water in open containers, as families often do in the tropics. We spend more time indoors, out of the heat. And all of this helps minimize contact with the mosquitoes. Consider that before Zika became a problem, as Fauci mentioned, we also had periodic outbreaks of dengue and Chikungunya, spread by the same mosquito. As I pointed out previously:

When was the last time you worried about Chikungunya or dengue—or malaria, for that matter? Those diseases are far scarier than Zika. WHO estimates (conservatively) that malaria infected at least 214 million people last year and killed 438,000, mostly children under five. Then there’s dengue, named from the Swahili phrase ki denga pepo (“a sudden overtaking by a spirit”)—which tells you something about how painful it is. Each year, dengue, also called “breakbone fever,” infects 50-100 million people, sickens about 70 percent of them—half a million very severely—and kills tens of thousands. Brazil, in addition to its Zika problem, is experiencing a record dengue epidemic. Health authorities there tallied 1.6 million cases and 863 deaths last year—and the 2016 toll is on track to be worse. Zika is seldom fatal.

This doesn’t mean we should ignore the latest news, of course. If you’re pregnant, especially in southern Florida, you’re probably already taking precautions to avoid mosquito bites, like using repellents and eliminating any standing water on your property. FDA officials are asking people in Miami-Dade and Broward counties to refrain from giving blood until we know what’s going on. But most Americans, even most southerners, have little reason to freak out.

Only one of the six scientists I interviewed was concerned that Zika might take off in the continental United States. “You would never see Zika virus, Chikungunya virus, or dengue virus sweep across the country the way West Nile did, even in the regions where these mosquitoes are,” UC-Davis epidemiologist Chris Barker told me. “Because that’s just not how it works in our country.”

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Here’s a Cure for America’s Latest Zika Panic

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Olympians prepare for a “petri dish of pathogens”

there’s something in the water

Olympians prepare for a “petri dish of pathogens”

By on Jul 28, 2016Share

The world’s greatest athletes head to Rio de Janeiro, Brazil, this week for the 2016 Summer Olympic Games. Those competing in Rio’s waters, though, will have more than just medals on the mind.

That’s because the waterways of Rio, as any resident of the embattled city probably could have told you, are dumping grounds for toxic chemicals, untreated sewage, garbage, and dead bodies. The contamination of Rio’s waters — including Guanabara Bay, where the sailing teams are practicing — is undeniable. And, as the New York Times reported yesterday, recent tests showed a “petri dish of pathogens,” including rotaviruses and drug-resistant super bacteria.

But this is the Olympics and the show must go on, despite public health concerns, a presidential impeachment scandal, and a host city that’s under a declared state of financial emergency. When it comes to water, the International Olympic Committee insists areas where athletes are to compete will meet World Health Organization standards. Still, to be on the safe side, as a 24-year-old Dutch sailing team member explained to the Times, “We just have to keep our mouths closed when the water sprays up.”

The water has been making Rio’s poor sick for decades. Hepatitis A, a waterborne disease, is widespread among residents of the city’s sprawling favelas. Lack of sanitation has also exacerbated the spread of the Zika virus. The Times reports that Brazil pledged to spend $4 billion to stem the flow of untreated sewage into its waters back in 2009, when it was angling for its Olympic bid. In fact, only about $170 million has been spent, a discrepancy that state officials blame on a budget crisis.

Meanwhile, at least 77,000 people faced forced, violent evictions from their homes leading up to the Olympic Games, despite having legal titles to their homes.

The Olympics are often, and controversially, hailed as an opportunity for development and improved infrastructure in the host country. But development, as David Zirin writes in an excellent article for the Nation, is most likely to benefit Brazilian elites, who view the Olympics as “a neoliberal Trojan horse allowing powerful construction and real-estate industries to build wasteful projects and displace the poor from coveted land.”

As for improved infrastructure, the fact that some of the world’s top athletes will have to compete in a “petri dish of pathogens” is pretty disheartening. If Rio’s waters weren’t cleaned up for some of the most highly valued bodies in the world, how much hope is there that they’ll be brought down to safe levels for the city’s actual residents, once the international media has packed up and gone home?

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Olympians prepare for a “petri dish of pathogens”

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Why California Needs to Legalize Recreational Marijuana

The United States has the highest incarceration rate in the world with 1 in every 111 adults in prison or jail as of 2014. And of the 2,224,400 Americans who were behind bars that year, 700,993 were arrested on marijuana law violations. With California spending nearly $50,000 per year on each inmate annually, increasing the California Wall of Debt even further, the legalization of recreational marijuana becomes not just a social issue, but a fiscal one in the Golden State.

The War on Drugs was started in 1971 by President Richard Nixon and its estimated that the United States is now spending approximately $51,000,000,000 on it annually. Its largely considered to be a failing program, but one way Americans can start to get a handle on this situation is by continuing to decriminalize, and even legalize, marijuana.

As of 2016, 25 states have some form of marijuana legalization. Four states as well as Washington D.C. have legalized recreational use of marijuana, and eight more states have marijuana legislation on the November ballot, including California. Voters in California will decide whether or not to legalize marijuana for recreational use and potentially collect over $1 billion in state and local taxes on its sales.

The combined savings of enforcing marijuana laws along with increased tax revenue could be a big step in the right direction for the California budget. In 2010, Proposition 19 was rejected by California voters, but the 2016 measure is said to have a better chance at passing with more regulation at the state level and multiple states that have already passed recreational use.

California legalized medical marijuana in 2003 with State Bill 420 which made it possible for people suffering from certain conditions to have legal access to medical marijuana. A few of the qualifying conditions include:

AIDS
Arthritis
Cachexia
Cancer
Chronic Pain
Glaucoma
Migraine
Seizures

According to Santa Rosa criminal lawyers Li & Lozada, who regularly represent individuals charged with marijuana related crimes in California, the confusion about the legality of medical marijuana use, sale, and cultivation is still a major issue across the country and until the federal law is changed, there will continue to be controversy regarding the legality of marijuana.

As President Obama stated to Vice News in March 2015, if enough states end up decriminalizing, then congress may then reschedule marijuana. California is widely considered an influencing state when it comes to marijuana legalization as it was the first state to legalize medical marijuana 20 years ago. There is no doubt that if the Golden State legalizes recreational marijuana this November, other states will follow suit.

Readers interested in supporting recreational marijuana legalization in California can sign the Care2 petition Support Marijuana Legalization in California!

Disclaimer: The views expressed above are solely those of the author and may not reflect those of Care2, Inc., its employees or advertisers.

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Why California Needs to Legalize Recreational Marijuana

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Four Ways Research Has Reframed the Abortion Debate

Mother Jones

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There has been little or no publicly funded research on abortion in the United States, so for years basic information about abortion was lacking—from how often patients have complications to what happens to women who want the procedure but can’t obtain it. Many of the new abortion restrictions were justified by assertions that often had no scientific basis—for example that clinics were teeming with incompetent and unscrupulous doctors, that abandoned patients were flooding emergency rooms, or that the psychological damage caused by grief and regret after abortions often persist for years and ruin women’s lives. The research initiative became more urgent after the high court held in 2007 that in cases of “medical and scientific uncertainty,” legislatures could have “wide discretion” to pass laws restricting abortion. Since then, a primary objective of abortion rights supporters has been to establish a high level of medical certainty—both about the safety of the procedure and about what happens when a woman’s reproductive options are drastically curtailed or eliminated. Over the last 15 years, a number of academic institutions and private organizations have received funding for abortion research, and here are four areas where their work has changed the conversation:

Mental health

Since the 1990s, abortion opponents have worked to advance the idea that abortion causes long-lasting psychological damage based on a combination of personal stories and (widely disputed) statistical analyses showing a correlation between abortion and mental health problems. “Emotional harm” has been cited by legislators in passing parental consent, mandatory ultrasound viewing, and waiting-period laws.

In 2008, Diana Greene Foster, a demographer and associate professor at the University of California-San Francisco, launched the Turnaway Study to examine what happens, emotionally and economically, to women who have had abortions and also to those who wanted abortions but couldn’t have them. Nearly 1,000 women seeking abortions in their first and second trimesters were recruited from 30 facilities in 21 states. About a quarter had been turned away because they just missed their clinic’s gestational limit (10 to 24 weeks). Researchers followed up every six months for five years. The key findings: Most women had abortions because they didn’t think they could afford another child, and they often turned out to be right. Of those who did have the procedure, 95 percent said it was the right decision, and their feelings—positive or negative—faded over time. Having an abortion did not lead to depression, PTSD, or other mental health problems, the project found. But being denied an abortion did seem to keep women tethered to abusive partners.

Complications

In justifying Targeted Regulation of Abortion Provider laws, or TRAP laws, abortion opponents have often argued that complication rates are high—up to 10 percent—and that clinics and doctors need to be held to especially rigorous standards. Two large-scale studies from California, though, appear to counter those claims.

One study looked at whether abortions could be performed safely by health care professionals without medical degrees. Nurse practitioners, certified midwives, and physician assistants received training, then were allowed to do first-trimester vacuum-aspiration abortions at 22 sites. After monitoring more than 11,000 procedures over four years, the researchers found little difference in the rate of complications between doctors and non-doctors, which was low for both groups—0.9 percent for physicians and 1.8 percent for non-physicians. In 2013, California legislators voted to let non-doctors perform the procedure.

In a more recent study, UCSF researchers analyzed billing data for 55,000 abortions and follow-up care covered by California’s Medicaid program, known as Medi-Cal. (California is one of 17 states that covers abortion and aftercare for Medicaid recipients.) The data showed that 6.4 percent of women who had abortions visited an emergency room within the following six weeks, but fewer than 1 percent of those visits were related to the abortion. Major complications, defined as hospitalizations, surgeries, and transfusions, occurred in fewer than one-quarter of 1 percent of all abortions.

Medication abortion

Abortion foes have watched with alarm as medication abortions have risen to nearly a quarter of all pregnancy terminations in the United States. Lawmakers have advanced measures that clamp down on how clinics prescribe the drugs and counsel patients.

One type of law has required doctors to follow outdated FDA guidelines from the 1990s for the abortion drugs mifepristone and misoprostol. Much research—some produced by the nonprofit Gynuity Health Projects, which is funded by the Susan Thompson Buffett Foundation—has shown that the drugs should be taken in lower doses and could be used later in the first trimester than those guidelines indicated. Over conservatives’ vociferous objections, the FDA revised the label in March.

Meanwhile, after Planned Parenthood in Iowa began using videoconferencing to counsel rural patients on how to use abortion drugs, the state tried to prohibit the practice. In June 2015, the Iowa Supreme Court rejected that ban. A key piece of evidence was a study of 450 Iowa women by the Buffett-funded Ibis Reproductive Health that found no statistical difference in complication rates for telemed patients versus women who met with doctors in person.

Other abortion restrictions

Beyond TRAP laws, researchers are studying the effect on women that other types of state laws that restrict abortion are having.

Many of these efforts are ongoing, but a new study of Utah’s 72-hour waiting-period law, which legislators said would give abortion seekers a chance to change their minds, found that it increased costs and logistical hassles but did not persuade most women. Of 300 patients surveyed, only 8 percent decided not to terminate their pregnancies, and most had been leaning in that direction anyway. Meanwhile, the average amount of time the surveyed women had to wait to have abortions wasn’t 72 hours, but eight days.

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Four Ways Research Has Reframed the Abortion Debate

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The Attempt to Keep Transgender People Out of Bathrooms Is Working

Mother Jones

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This year, states across the country have struggled with the question of whether transgender people should be allowed to use bathrooms corresponding with their gender identity rather than the sex listed on their birth certificate. In March, North Carolina enacted a law blocking trans people from public bathrooms of their choice, and lawmakers in many other states have considered similar legislation. Proponents of these bathroom bills say they want to protect women and girls from male sexual predators; opponents say the legislation discriminates against a vulnerable minority.

Some new statistics out Monday from the National Center for Transgender Equality show how bathroom access—or lack of access—can affect the health and safety of transgender adults. In the largest-ever survey of transgender people in the United States, the NCTE, an advocacy group, heard from more than 27,000 transgender adults in August and September 2015.

Fifty-nine percent of those surveyed said they’d avoided public bathrooms over the past year because they worried about potential confrontations.
Twelve percent said they’d been harassed, attacked, or sexually assaulted in a bathroom over the past year.
Thirty-one percent reported that they’d avoided drinking or eating over the past year so they wouldn’t need to use the bathroom.
Eight percent said they’d had a kidney or urinary tract infection or another kidney-related problem because they’d avoided using bathrooms.

Mara Keisling, executive director of the NCTE, says the statistics show how transgender people are affected by discrimination and violence, and “how trans people try to work around the harassment and discrimination we fear every time we use public bathrooms.” Keisling noted that in a majority of states, restaurant and store managers can legally prevent transgender customers from using bathrooms of their choice or can boot them from the premises for being trans.

The bathroom statistics were released Monday as preliminary findings of the 2015 US Transgender Survey. More data will be available later this year.

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The Attempt to Keep Transgender People Out of Bathrooms Is Working

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Is Zero Waste Just for the Young and Affluent?

Many online commenters complain about the fact that Zero Waste blogs tend to be run by primarily young, affluent females who have the time and money to run around town, visiting numerous stores in order to source their favorite local, organic ingredients in fancy glass jars and stainless containers, before heading home to DIY everything from bread and yogurt to toothpaste and body wash. (I realize I, too, am guilty of giving this impression.)

For many, Zero Waste has become synonymous with privilege and wealth because there is so little online discussion about how people who donotfit those categories can possibly attain Zero Waste standards. This is hardly fair.

Just because someone has very little money or lives with disabilities doesnt mean they dont care about the environment, nor have the willpower and desire to implement waste reduction in their personal lives. More bloggers should be asking, “How does Zero Waste benefit people with disabilities and low incomes? Is it even realistic for those with limited physical access and tight budgets?”

Ariana Schwarz addresses this topic in an excellent article called Is Zero Waste Unfair to People with Low Incomes or Disabilities? Schwarz believes that Zero Waste is not ableist or discriminatory toward the poor. In fact, it provides great opportunities to improve quality of life.

Take packaging, for example.So often we think of single-used packaging as convenient, and yetlesspackaging is typically more accessible. Imagine opening plastic blister packs, Tetrapaks, and Tupperware or other food storage containers, with their one-handed peel motion; twisting up deodorant tubes and toothpaste lids; and opening rigid plastic packaging (such as the type toothbrushes come in) or Ziplocs while suffering from arthritis or ALS. Compare that to cotton mesh drawstring bags, wide-mouth Mason jars, and flip- or swing-top glass bottles, where access is easier overall.

In terms of cost, Zero Waste can save precious money.Investing in reusables that require an initial investment can save significant amounts of money down the road, i.e. cloth diapers, a menstrual cup, safety razors, etc. Buying in bulk quantities reduces cost and the number of shopping trips. Many bulk stores have low-positioned bins with lids that are easier to open and access from a wheelchair than reaching the tops of supermarket shelves.

Having tight budgets encourages people to grow their own food in abandoned or under-utilized spaces to save packaging and cost. There are many farmers markets in the U.S. that accept SNAP cards and food stamps; in Georgia, aspecial programeven doubles SNAP at markets.

Health can improve through implementation of Zero Waste practices. One commenter on Schwarzs blog wrote:

Zero waste has been a savior in cost and mental peace of mind. My apartment building is falling apart and the carpet full of allergens, but cleaning with vinegar, baking soda, and soap have gone a long way for my health and wallet (cloth towels instead of paper help too). Our allergies are much improved. We’re hoping to get a bidet soon; there’s one on Amazon for barely more than a jumbo pack of toilet paper. Same for being mostly vegan life is much improved and costs are way down.

Keep in mind that embracing small challenges, such as saying no to single-use plastic containers, utensils, and grocery bags, sends a powerful message to whomever has offered it to you, regardless of physical or financial challenges, and its important not to underestimate that power.

Zero Waste practices can benefit everyone, but responsibility does lie with those who do not struggle with barriers to accessibility to push this lifestyle more into the mainstream and make it even easier for everyone to participate.

Schwarz writes: Could you volunteer to collect food that would otherwise go to waste and redistribute them to the needy? Petition local shops for more accessible bulk bins? Or assist handicapped or elderly persons in your community with the grocery shopping?

What are your experiences with Zero Waste living? Do you live with a disability or on a low income that makes it difficult to implement environmental practices? Please share any thoughts in the comments below.

Written by Katherine Martinko. Reposted with permission from TreeHugger.

Disclaimer: The views expressed above are solely those of the author and may not reflect those of Care2, Inc., its employees or advertisers.

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Is Zero Waste Just for the Young and Affluent?

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Homeless People Are Older and Sicker Than Ever Before. Here’s One Way to Help.

Mother Jones

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“Everything,” Tom Wesley answers when I ask what’s ailing him. Diabetes. Multiple heart attacks. Chronic liver failure. “They’ve told me I’m dying.”

Wesley, a towering man in a salmon-colored corduroy shirt buttoned just at the top, is only 54. But for most of his adult life, he lived on the streets. He refused to stay in shelters because he didn’t like the structure; he says he also spent a significant time behind bars for heroin possession. “You could say I was using heroin,” Wesley says with a smirk. “But I don’t know who was using who—it sure used me up.”

This article is part of the SF Homeless Project, a collaboration between nearly 70 media organizations to explore the state of homelessness in San Francisco and potential solutions.

He quit a few years ago—after losing two wives to overdoses. Around that time Wesley’s health problems started getting worse. Last year, a terrible pain in his abdomen brought him to San Francisco General Hospital, where he says he was admitted, via the emergency room, seven times in a matter of three months. At that point he was already used to the ER, having relied on it instead of primary care. “I wasn’t one for doctors,” he says.

Wesley’s experience isn’t unique. Sixty-six percent of the country’s chronically homeless people—those who have a disabling condition and who’ve been homeless for a year or more (or four times in three years)—are living on the streets. Chronically homeless adults have high rates of mental illness, substance use, and incarceration. They tend to be sicker than both housed people and other homeless people. And they’re less likely to use primary or specialty care to address their medical needs. Many make up the group of “super-utilizers“: patients who rack up huge medical costs from recurring yet preventable ER and hospital visits.

According to one estimate from the National Health Care for the Homeless Council, more than 80 percent of all homeless people have at least one chronic health condition. More than half have a mental illness. They are frequently the victims of violent crimes, and they’re more susceptible to traumatic injuries like assault and robbery. Their living conditions also make them more likely to have skin conditions and respiratory infections.

Perhaps it’s no wonder, then, that people experiencing homelessness have a life expectancy of between 42 and 52 years, compared with 78 for the general population. A recent study by Margot Kushel, a professor of medicine at the University of California-San Francisco, found that homeless people in their 50s develop geriatric conditions such as incontinence, failing eyesight, and cognitive impairment that are typical of people 20 years older. “When you see a homeless person in their 50s,” Kushel says, “you should imagine a 75-year-old.”

Kushel is also one of the founders of the San Francisco Medical Respite Program, a long-term medical shelter located on the edge of the city’s Tenderloin neighborhood that gives homeless people like Tom Wesley a place to recuperate after being in the hospital. With the homeless population in San Francisco and the rest of the country getting older—the number of homeless people age 60 or older in San Francisco increased 30 percent from 2007 to the 2014-15 fiscal year, and an estimated 31 percent of homeless people in the United States were older than 50 in 2014, a 20 percent increase from 2007—Respite and programs like it are seeing more people who are managing both chronic diseases and short-term illnesses. “We now have a group of homeless people that have more complex and co-occurring medical needs than ever before,” Kushel says.

For those homeless people who live on the streets or in a shelter—most of which are only open overnight—getting discharged from the hospital often means losing their meds, struggling to clean their wounds, or failing to make the specialist appointment across town. Others will get even sicker. Some will go back to the emergency room and start the process all over again.

“If you’re experiencing homelessness,” says Michelle Schneidermann, the medical director at Respite, “you’re thinking about where you’re going to get your next meal and how you’re going to keep yourself safe, not where you’re going to refrigerate your meds or make your next appointment.”

As a result, homeless people visit the hospital at rates up to 12 times higher than low-income people with housing. A 2007 study in Boston found that the majority of high emergency room users were homeless, according to the NHCHC. At one hospital, 16 homeless patients visited the ER a combined 400 times in one year. Hospital readmissions for homeless people are “strikingly high“; one study found that more than half of the homeless people it followed after discharge were readmitted to inpatient care within 30 days. Another recently published study found that homeless people had a 30-day readmission rate of 22 percent, compared with a rate of just 7 percent for housed people with the same health concern. And once in the hospital, homeless patients stay nearly twice as long as housed people.

This reliance on emergency medical services is extremely costly to San Francisco, which spends more on health care than on any other type of homeless service. According to the San Francisco Chronicle, the city spends $241 million annually on homeless services, including an average of $87,480 in medical costs per year for each of the sickest people on the streets, compared with $17,353 a year for each person in supportive housing. Another estimate, from 2004, places the cost of hospital care for the city’s homeless people at more than $2,000 per person per day, by far the priciest service. “People who are homeless use the most expensive parts of the health care system,” says Schneidermann, who notes that SF General discharges an average of 130 homeless people each month.

This is despite the fact that, in a city like San Francisco, health insurance and access to outpatient primary care clinics are relatively accessible, thanks mostly to Medicaid expansion. “Access to insurance is not the biggest problem” Kushel says. “Their chaos of life prevents even those with insurance from getting care.” Indeed, evidence shows that even with access to primary care and specialty doctors, homeless people still use emergency services at rates higher than everyone else. In one study based out of Canada, where health coverage is universal, people experiencing homelessness still had longer inpatient stays and cost the hospital more than housed patients.

“Appointment-based care is difficult for all of us, let alone someone who is homeless,” Schneidermann says. “That’s where medical respite comes in.”

The first medical respite programs for the homeless were founded in Boston and Washington, DC, in 1985, but the model gained currency in 2006, when an elderly woman in a hospital gown and slippers was spotted wandering on Los Angeles’ Skid Row. The woman, a homeless 63-year-old with dementia, had been released from a nearby Kaiser hospital, which was later sued by the city and forced to establish new discharge rules. At least four other hospitals were caught “patient dumping,” including once incident when a paraplegic man was dropped on Skid Row and was later seen dragging himself, along with a torn colostomy bag, down the street.

There are now nearly 80 homeless medical respite programs, more than twice as many as in 2006. San Francisco’s Respite was founded in 2007 by the city’s Department of Public Health to address the acute medical needs (think broken bone or stab wound) of homeless patients who’ve ended up in General’s inpatient care via the emergency room. But beyond that, it might just offer an emergency room alternative to reach the city’s sickest, most vulnerable homeless population.

With only 45 beds and a waitlist at least equal that, Respite prioritizes people who are both the sickest and also the highest users of the ER. More than a quarter of Respite clients have seven or more chronic illnesses, and the average stay is five weeks, a figure that has risen as the client population has aged. (The longest stay was almost eight months.)

A 2006 study that compared homeless people who’d gotten into respite programs with those who hadn’t found that the respite group had fewer ER visits the following year. Among those admitted to the hospital following an emergency visit, the respite group stayed an average of three days, compared with eight days for the nonrespite group. A 2009 study found that discharging homeless people from the hospital to respite was associated with a 50 percent reduction in their likelihood of readmission in the next three months.

The dining area at the San Francisco Medical Respite Program Mark Murrmann/Mother Jones

Still, despite evidence that medical respite programs reach the health system’s super-utilizers, only 10 respite centers nationwide are covered through Medicaid or Medicare. Instead, most programs rely on funding from hospitals, donations, or state and local governments.

And so Respite has its limitations. A quarter of its clients go straight from the program into permanent housing or long-term residential treatment. Another 50 percent are discharged back to a shelter with a case manager. The last quarter return to the streets.

The first time Tom Wesley was admitted to Respite, he was discharged to a single-room-occupancy hotel. He promptly ditched that setup, traveled to Cincinnati to see his children, and then returned to San Francisco’s streets. Shortly afterward, he was back in the hospital and then Respite, where he was diagnosed with chronic liver failure and moved into what he calls a glorified nursing home—a permanent supportive housing apartment just blocks away. Feeling like he’d tied up loose ends, he decided to stay.

When I meet Wesley in Respite’s foyer, in front of the room that houses the few dozen beds where the men stay, he’s been out for a few months already. He’s wearing a Golden State Warriors cap, and his eyes are blood red. We take the elevator up and walk to the facility’s small meeting space, past the dining room where patients receive three meals a day and the single-person rooms where women stay.

He grabs a seat with his back facing the bright light coming through a window. As he tells me about his connection to Respite, Wesley’s legs bounce up and down. “If there were more programs like this,” he says, “people wouldn’t be dying on the streets every day.”

Mark Murrmann/Mother Jones

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Homeless People Are Older and Sicker Than Ever Before. Here’s One Way to Help.

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Supreme Court: Texas Law Plainly Provided No Bona Fide Health Benefits

Mother Jones

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Today’s abortion decision is good news for supporters of reproductive rights, but it didn’t provide much guidance about what it means for a law to place an “undue burden” on women seeking abortions. The majority opinion ruled that Texas’s law failed the test laid out in Casey, which balances the burden a law places on women seeking abortions with the benefit the law confers. The problem is that HB2 so plainly provided no benefit that it wasn’t really a hard call. Here is Justice Breyer on the requirement that doctors performing abortions have admitting privileges at a nearby hospital:

When directly asked at oral argument whether Texas knew of a single instance in which the new requirement would have helped even one woman obtain better treatment, Texas admitted that there was no evidence in the record of such a case.

….That brief describes the undisputed general fact that “hospitals often condition admitting privileges on reaching a certain number of admissions per year.”…The president of Nova Health Systems…pointed out that it would be difficult for doctors regularly performing abortions at the El Paso clinic to obtain admitting privileges at nearby hospitals because “during the past 10 years, over 17,000 abortion procedures were performed at the El Paso clinic and not a single one of those patients had to be transferred to a hospital for emergency treatment, much less admitted to the hospital.” In a word, doctors would be unable to maintain admitting privileges or obtain those privileges for the future, because the fact that abortions are so safe meant that providers were unlikely to have any patients to admit.

And here he is on the requirement that abortion providers meet the requirements for surgical centers:

The record makes clear that the surgical-center requirement provides no benefit when complications arise in the context of an abortion produced through medication. That is because, in such a case, complications would almost always arise only after the patient has left the facility.

Nationwide, childbirth is 14 times more likely than abortion to result in death, but Texas law allows a midwife to oversee childbirth in the patient’s own home. Colonoscopy, a procedure that typically takes place outside a hospital (or surgical center) setting, has a mortality rate 10 times higher than an abortion.

The majority opinion relied primarily on reams of real-world evidence that made it crystal clear that HB2 provided no bona fide safety benefits. Unfortunately, that means that no real discussion of “undue burden” was required, so it’s not clear what effect this case will have as precedent. We’ll have to wait and see what lower courts do with it and how the anti-abortion forces rewrite their laws in order to get another crack at a different ruling.

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Supreme Court: Texas Law Plainly Provided No Bona Fide Health Benefits

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