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We've long been deeply involved in access to birth control, because we believe squarely people should be able to determine when or whether they they have children and and how to parent if they do.

And access to birth control is fundamental to that.

(MUSIC) Hello, I'm Cari Stein siitting in for Bonnie Erbe' Welcome to To the Contrary, a discussion of news and social trends from diverse perspectives.

This week, the future of women's reproductive health.

What will be the future of mifepristone, the abortion pill and even birth control?

Access to birth control is shrinking.

Today, our woman's thought leader is Fatima Goss Graves President of the National Women's Law Center.

And she'll address these issues and things all about women's reproductive health.

Hi, Fatima.

How you doing?

Hi.

Good to see with you.

Thank you.

So there was a decision, a Supreme Court decision to not have the ban on mifepristone go into effect, but to have it go through the process.

What did you think of the decision and what do you think will happen?

I should begin by saying this case should have never been there in the first place.

It should have been immediately dismissed out of hand.

And that is because the people who brought the lawsuit, the extremist groups, had no standing.

They had no injury to bring this case in the first place.

So the fact that we got all the way to waiting until very late in the night for the Supreme Court to decide that the case should be sent back was giantly worrisome.

So what will happen next is that the case will continue to proceed in the lower courts and access to mifepristone will continue to be available around the country in the way it was before this litigation even began.

And we're sort of clear now where anti-abortion extremists plan to go next.

Well, whatever happens to this case in the end, and we're also clear that we have a real problem with our judiciary.

The fact that we were in a situation where the district court judge, Judge Kacsmaryk and parts of the Fifth Circuit would have put their own personal views around abortion access in place of the FDA around this longstanding and widely used medication should worry everyone no matter where they fall on issues of reproductive health care.

Well, do you think that the Supreme Court was expecting the reaction that they got with the Dobbs case and what happened in the elections?

Is this becoming in the Supreme Court a political issue?

In the Dobbs decision the court said that one option is for people to exercise their rights politically if they disagree with the court's decision.

And since June, you have seen that happen again and again.

Every time abortion was squarely on the ballot, people voted in favor of reproductive freedom.

That was true with ballot initiatives to restore access to abortion care.

But that was also true around individual candidates who ran on abortion or not, and most recently saw that in the state of Wisconsin that just a few weeks ago held a state judicial election where abortion was squarely front and center in that campaign.

And and the candidate won overwhelmingly.

And so one of the things that I think is important here is the results of these elections actually are tracking where people are in this country on abortion access, whether you are in a state that has been expanding abortion care or in a state that has these bans, the actual people in this state are in support of abortion.

And so or.

At least the right to choose.

Well, actually, they're in support of abortion.

And they were especially in support of mifepristone.

people being able to access the care that they want and that they need, including abortion care.

They do not like these bans on abortion that states have been passing.

It is not a popular thing that is happening in this country and that is what I think you are seeing show up and why you're seeing Republicans not talking about it because it is not a popular outcome.

And so every time you have a situation where a state passes these extreme bans or in a situation like the effort to take mifepristone off the shelves, that was extraordinarily unpopular, this entire litigation.

And you did not have a lot of Republicans addressing it.

Even in Texas, the idea that you they've sort of put bounty hunters out there is not what you would expect in the United States.

It is deeply unpopular and also worrisome for people.

People worry about what is next.

People don't like the idea of their neighbors spying on each other.

People don't like the idea of politicians making medical decisions for them.

And they definitely don't like the idea that this sort of unstable situation we were we have been in where you don't know what your rights are day to day.

That isn't good for anyone in this country.

And I think I think it's being recognized.

What about the fact the idea of religion in this in the cases?

Is there a bit of putting religion into the equation, are people are are justices just going by their own backgrounds, their own opinions or following the law?

One of the things that I think we have to be worried about is the way in which religion is sometimes used as sort of a cudgel to limit other people's rights.

Actually, at the National Women's Law Center, we are co-counsel with Americans United in a case challenging Missouri's abortion ban.

And we represent a number of faith leaders in that litigation who are distressed that Missouri's abortion ban violates their own faith.

So we should have a more complicated and nuanced conversation around the role of religion.

But people don't want someone else making decisions about their fundamental rights based on religious views that they may or may not share.

That's not how we make these sorts of decisions in this country.

Do you think that the court was prepared for what the implications would be?

And they made this plan, but they didn't know all the different things that would happen because of it.

When you read the Dobbs decision, what's really clear is that they aren't thinking at all about what this will mean or what this will mean for the health of people who are pregnant, what this will mean for women's ability to participate in our society and our politics in our economy.

They aren't thinking about what this will mean for states around the country that have expanded access to care.

And immediately you have seen states pushing to go more and more extreme, right, almost this this terrible race to the bottom to decide who can pass the most cruel and harshest anti abortion law there is .

No one has asked for that to be the agenda.

That agenda is totally at odds with where people are in this country.

Do you think that the the justices thought about or will think about the political implications because there's definitely a loss of support?

Well, I'm sure the justices will say that they will not think about the politics.

But what I will say is that the politics are going to matter on this issue for sure.

They're going to play out in the 24 election.

You're going to see it come up in up and down ballots in local elections and national elections.

The politics absolutely will make a difference.

And I guess in some ways, perhaps the Dobbs decision opened the door for that when it said that the only solution for those of us who want to protect our fundamental rights is to participate politically.

I disagree with that deeply.

That's not how we think about fundamental rights in this country.

That's not why you have a constitution in the first place.

When we think about what it means to be sort of an equal citizen, that that is what the Dobbs decision said.

On the mifepristone ruling.

Alito and Thomas were the they were in dissent, and it was a pretty wide reaching dissent.

Tell me what you think about there, about the dissenting opinion.

The thing that you should understand when this Supreme Court hears these emergency appeals and what is sometimes called the shadow docket, and oftentimes decisions are made without anyone writing about them at all, they're just orders that are released.

In this case, Justice Thomas and Justice Alito each wrote separately to say that they disagreed and they thought that it should not have been stayed, that mifepristone should have been off the market.

The thing that was really disconcerting, especially about Justice Alito's opinion that he wrote, was one, the the language that he used to sort of criticize and effectively call his fellow justices hypocrites was really surprising to me.

And I and it did make me wonder what the reaction was for the the other justices that he sort of called out.

But more importantly, he also, with no evidence, really was disparaging to the Department of Justice in suggested that the Department of Justice wasn't planning to follow any order from the court.

That's a pretty giant accusation for a Supreme Court Justice to make about another branch of government without a record.

I was surprised when I read that.

You know, listen, Justice Alito has had these opinions that have been more and more extreme using language that is sort of partisan.

That alone has been unfortunate and not good for the court, I believe.

But this opinion, it felt like he took it even further.

And do you think he's thinking there's a thought there about their legacy of this court?

I don't know if he's thinking about the legacy of the court.

I do know that he and others have spoken out about their concern, that people have critiqued the court, that they have raised issues around the types of rulings, the process.

I don't think that's good for the court.

I imagine that the Supreme Court doesn't think it is good either to be in this place where it is becoming so disfavored by the American public that that's not a good thing in a democracy.

Foundation of our democracy includes things like the rule of law, includes people being able to be treated fairly.

An understanding of rights that are fundamental and our institutions that bring that forward are really, really important.

The Supreme Court being key.

It's not a small idea that that has been shaken in a lot of ways.

I actually think when you put some of their rulings with the confirmation processes and the reporting that has been out from The New York Times and ProPublica and others about Justice Thomas and Justice Alito, it's raising something that we have to pay attention to.

Our our court has to be respected, deferred to, and and consistently understood in that way.

If our democracy is going to function effectively.

But the the court actually sent it back to the Fifth Circuit.

Do you think they'll be seeing it again?

I think it's very possible, in part because the people who brought this lawsuit will continue their agenda no matter what the the court decisions say.

So this is not the end.

And whether it is this vehicle or another one, we're clear about their goal of ending access to abortion care everywhere in this country.

And that includes medication abortion.

And so it's a thing that people have to worry about, not only in the states that have been banning abortion, but even in the states that have been expanding access.

The goal is much bigger than some state by state strategy.

I'd like to turn to another part of of this debate about women having the right to decide whether they want a child or not.

And that would be birth control.

There's been a sort of to me at least it was surprising the fact that birth control, the access to it, is actually shrinking.

And I believe that the National Women's Law Center is involved in in this issue.

And we've long been deeply involved in access to birth control because we believe squarely people should be able to determine when or whether they they have children and and how to parent if they do to and access to birth control is fundamental to that.

You know, when the Affordable Care Act put in place a birth control benefit and making it so that people could access birth control without cost being a barrier, that was a huge jump in terms of people being able to really access birth control and really afford it.

And and one of the things that we know is that when you remove barriers like cost from the equation, then people can access what they want, what their providers recommend rather than something that is not what they wanted or something that might be less effective for them.

And so we have long been in favor of access to birth control and more options being out there, including options that will be new and innovative and changing over time as technology changes along with it.

Are pharmaceutical corporations behind that or are they because there are companies and there are policies that do not allow for birth control?

One of the things that we know is that is that there insurance companies are still routinely violating the Affordable Care Act's birth control requirement.

At the National Women's Law Center, we run a hotline called Cover Her.

And we hear from people every day who have been forced to pay out of pocket for birth control.

So we have been trying to sound the alarm on this issue for years.

And and one of the things that we hope will happen is that there will be more serious and meaningful enforcement so that people actually are able to access the full range of birth control options available to them.

But the other thing is that pharmaceutical companies haven't routinely prioritized women's health care.

And so it's not a giant surprise, I guess, that you see a falling behind in some ways in in terms of contraceptive offerings at a time that you should see an acceleration.

Some of this is related to the insurance companies, but some of it is just based on assumptions that, you know, doing that level in the investment is is less popular.

And so the large pharmaceutical companies have been less likely to invest in that way.

What we should be seeing is people having access to the range of contraceptive options that can make a difference in their lives.

And it's going to be different for each person.

Right.

And that's that is really one what you want to see is for people to be able to get that care that they want, that they need, that their providers are recommending.

With all these different changes.

You know, there have been teen teen births, have have dropped, and that was a goal for that to happen here in the country.

Do you think there's going to be a reversal of that?

We have to look at the full picture here.

And one of the things that we have worried about since the Dobbs decision is that it was a square attack on abortion access, of course, but it was also an invitation to attack birth control.

And so we're already seeing that play out.

We are seeing attacks on birth control coming in the states, running this sort of same playbook that they used to ban abortion in this country.

And beyond that, what we know is that people need the full range of reproductive health care options.

They need an ability to determine whether they have children and on what timing and and pacing and contraception is core to that.

Abortion access is core to that.

You know, contraception is remarkably effective and sometimes it is not right.

It is not 100% effective.

And that makes a difference.

What are the health care implications for women there or from what I read, there are now they call them contraceptive deserts and there are maternity deserts.

It sort of feels like they're coming after women.

One of the things to think about is there were there have long been places in this country, especially rural parts of the country, where it was hard to get access to health care, full stop.

And so we know that these sorts of bans and restrictions on abortion care were going to play out worse for people who have low income.

That was always a thing to worry about.

Now we also have to worry about providers leaving states.

It is hard to be a provider right now and understand that you need to consult a lawyer before getting the care that you need.

That's not going to have good outcomes for people.

We already have an outrageously high maternal mortality rate in this country.

That is more true for black women in this country.

Right now, we should be focused on ensuring that we are addressing that problem rather than taking steps and measures that will make their health care worse.

You hear that there are women as they make decisions about where they're going to go to the university, that they're considering, what the laws are about women's reproductive rights in those states.

That is one of the things that we have been hearing about and frankly, for good reason, that as families are thinking about where they want their children to go to college, whether you are in a state where access to care is free or not is on their minds, in part because of the sort of practical reality of accessing care, but also because of the bigger message that these states are sending about whether they value women.

It's not a small message or a subtle one.

It is one that is sort of giant and in-your-face.

And so I think schools are going to be monitoring this, especially state schools in some of these states and in other places are going to have to come up with strategies to ensure that people get the care that they need.

Do you think that the America the average American voter really understands what's what is going on with contraception and with abortion access?

I think the Dobbs ruling was a giant wakeup call for people in this country.

Before the draft leaked, opinion came out.

I think people didn't believe that it was possible that the Supreme Court would authorize taking away a 50 year old right.

Or that the folks who had such an extreme agenda could prevail at any point.

And now that reality has set in and folks know that we are in a time with abortion access.

Yes, but also with contraception, with broader decision points around how we form our families.

And and so I think we will see more and more people engaging on this issue going forward.

And that is something we welcome because it's going to take all of us.

If the mifepristone case comes back to the Supreme Court.

Do you think that the Supreme Court will limit access to it?

It is hard to make a prediction here on that point in part.

As I said, this this case was a terrible vehicle for the Supreme Court.

It was brought by people who were definitely not injured.

And if they got their way, you would have to believe that any judge anywhere could replace their own personal views for the science and rules at the FDA.

That would be a really dangerous proposition.

But I've seen a lot of really dangerous propositions come true.

And and so I stay alert around it.

We will be engaged not only with the litigation, but with ensuring that people are following it and understanding the range of threats before us.

Thank you so much for your time and your insight into these issues of the time.

We really appreciate it and we'd like to keep checking back with you as things come up.

Thanks for having me.

That's it for this edition of To the Contrary.

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