Today, the Wisconsin Alliance for Women's Health released this statement in response to the Trump-Pence administration issuing a Title X gag rule. This rule would ban health care providers receiving Title X family planning funds from providing patients with all pregnancy counseling options or referrals for abortion care.  This latest attack is strongly opposed by the medical community. This rule will take effect in 60 days if unchallenged.
 
“The Trump-Pence Title X Gag rule requires healthcare professionals to censure what medically accurate medical information women are allowed to receive during their visit. The last thing women need is for President Trump to play doctor and decide what information they are or are not entitled to hear at their visits.
 
“This is another patriarchal political stunt by the Trump-Pence administration that takes medical decision-making power away from women. This administration is playing a dangerous game with women’s health to satisfy their dwindling base.  
 
“Wisconsin Alliance for Women’s Health strongly supports a woman’s right to make their own health decisions. We will continue to work to ensure all women have access to healthcare and access to medically accurate information. We vehemently oppose the Trump-Pence Title X Gag rule.”

MADISON – Wisconsin Alliance for Women's Health (WAWH) Executive Director, Sara Finger, released the following statement on February 7, 2019:
 
“Recently, and especially in the past 48 hours, we have witnessed a malicious disinformation campaign, advanced by anti-abortion activists who seek to make abortion illegal and stigmatize women and doctors. President Trump parroted blatant falsities about abortion care during his State of the Union address, using inflammatory language to score needed political points. Yesterday we saw Rep. Robin Vos and Assembly Republicans follow suit by staging a press conference in Madison to make their own inflammatory claims that are flat out false and offensive to women who face pregnancy complications. It’s important to remember that the people spreading this misinformation have one motive in mind -- to ban safe, legal abortion in this country.”
 
“While I don’t appreciate the artifice that was behind yesterday’s media stunt, I welcome this opportunity to talk reproductive rights and abortion laws in Wisconsin. Here in Wisconsin we have an archaic 1849 law on the books that criminalizes abortions. The U.S. Supreme Court is now controlled by an anti-abortion majority following the appointment of Justice Kavanaugh and the future of Roe v. Wade is uncertain. If Roe is overturned, then our 1800’s law kicks in, abortion becomes illegal in Wisconsin and doctors in Wisconsin could face jail time.”
 
“The Wisconsin Alliance for Women’s Health strongly supports a woman’s right to make her own health decisions. We will continue to work to ensure all women have access to healthcare and access to medically accurate information. We all deserve the rights, freedoms, and opportunities to control our lives at the most basic level: our bodies, our families, and our futures--and that requires the right and ability to have an abortion. It is disrespectful and dangerous that a body of mainly white male legislators without healthcare backgrounds believes they are entitled to dictate a woman’s personal healthcare decisions to score political points. Anti-abortion zealots will do anything to push their agenda to ban safe, legal abortion in this country — including making things up and making outlandish accusations that are not based in fact or medical science. These claims are horrifying and offensive.”
 
Facts:

• In 1849, Wisconsin made it a felony to have or provide an abortion. While that law became unenforceable after Roe v. Wade, Wisconsin never took its criminal abortion ban off the books. This law does not have exceptions for rape, incest, or the health of the mother.
• In 1973, the Roe v. Wade case declared the US Constitution protects the right to have an abortion.
• In 2016, in Whole Woman’s Health v. Hellerstedt, the Supreme Court added that while states can regulate abortion, those regulations have to benefit patient health more than they burden their access.
• Only 3 out of 131 Wisconsin state legislators have healthcare backgrounds and there are 95 men and 36 women in the State Legislature.

Last summer, the Pew Charitable Trust released a comprehensive report that analyzed Wisconsin’s existing substance use disorder (SUD) treatment systems and public policy landscape. The report includes 25 policy recommendations, several of which pertain to providing SUD treatment to pregnant and postpartum women.

Most importantly, the report acknowledges the barriers to pregnant women seeking treatment in Wisconsin that are posed by Wisconsin’s Act 292, which was passed into law in over 20 years ago and is commonly referred to as the “Cocaine Mom” law. This law gives the state almost unprecedented power over pregnant women who use or have admitted to past use of any amount of alcohol or a controlled substance. There is widespread agreement among medical professionals and advocates that the law deprives pregnant women of basic rights and ultimately undermines maternal, fetal, and child health.

Before getting into the specifics of the Pew report, some details about the specific provisions of Act are needed to provide context for why the law serves as a barrier to pregnant women accessing the medical care they need. An excerpt from and article written by WAWH Executive Director, Sara Finger, outlines the most relevant provision:

Under this law, pregnant women who are thought to use alcohol or drugs may be subjected to forced treatment without any proof that it is safe or even helpful for the pregnant woman or her future child. It gets worse. If the woman refuses the forced treatment, a court can then hold her in contempt and incarcerate her in a county jail, where she is likely to be denied access to pretty much everything recommended for pregnant women including healthy foods, and access to prenatal and other health care. The state can also begin proceedings to terminate her parental rights before she even gives birth. And while the state appoints a lawyer to represent fetuses at all stages of such proceedings, the woman has no right to counsel at important preliminary hearings where her rights are at stake.

In 2017, a federal district court initially struck down Act 292 on constitutional grounds, but the case was eventually dismissed by a federal appellate court because the plaintiff eventually left the state.

While the Pew report does not explicitly call for the full repeal of Act 292, it does state that clinicians and patients “report that this policy serves as a barrier to SUD treatment for pregnant women by potentially discouraging individuals from seeking SUD treatment for fear of repercussions” and that “[t]his barrier potentially puts pregnant women and their child at greater risk of harm than they would be if this policy did not exist.”

Pew does generally suggest that the Legislature make changes to state law to make it easier for pregnant women to “seek and receive evidence-based treatment,” which can certainly be interpreted to mean making changes to Act 292. The report says that state agencies work to address misunderstandings about Act 292 among clinicians, social service agencies, and law enforcement. Finally, Pew recommends that the Department of Health Services issue guidelines for health care providers that receive any type of public funding to align with best practices regarding the education, screening, and treatment of childbearing age women regarding SUD’s. 

In addition to recommendations regarding prevention and treatment for pregnant women, the report suggests several policy changes to improve SUD care for postpartum women, including:

• Earlier delivery of postpartum SUD care, ideally before the first regularly scheduled postpartum visit
• Integrating traditional postpartum care and SUD treatment programs, which could be accomplished through co-locating family planning, breastfeeding, psychiatric services, and home visiting programs.
• The Department of Health Services and Legislature should consider incentivizing such policies.

It is encouraging to see these critical issues regarding the intersection of the opioid crisis and women’s health finally being brought to the forefront by respected, nonpartisan organizations like Pew. WAWH is hopeful that this is indicative of a larger shift in the Wisconsin policy landscape regarding substance use disorders that will begin to prioritize patient health, medical evidence, and individual autonomy over the urge to promote the punitive policies that have helped land Wisconsin in its current predicament with opioid addiction.
If you’re interested in learning more about the background of Pew’s Substance Use Disorder Treatment Policy Recommendations for the State of Wisconsin, you can view the full report here.