Waiting for the Title X Shoe to Drop

NFPRHA graphic on Guttmacher

Graphic via National Family Planning & Reproductive Health Association on Twitter.

Any day now, we expect the Trump administration to issue its Title X Funding Opportunity Announcement (FOA)—and to be honest, we’re a little nervous.

After all, the Department of Health and Human Services (HHS) political appointee overseeing the Title X program, Deputy Assistant Secretary for Population Affairs Teresa Manning, has publicly opposed the use of federal funds for family planning and stated that contraception is ineffective. The former anti-abortion lobbyist also opposes emergency contraception. What’s more, a memo leaked last month suggested that advisers to the Trump administration are seeking to slash Title X funding by half—and/or to promote the “fertility awareness” method of birth control in place of other, more effective forms of contraception.

The National Family Planning & Reproductive Health Association, of which we are a member, sees the likelihood of an attack on Title X as “High;” the Guttmacher Institute said in October: “Never in its history has the nation’s family planning safety net been in such jeopardy as it is today.”

You can see why we’re not exactly optimistic.

There are a few ways HHS could go after family planning providers through Title X:

  • By cutting or eliminating Title X funding altogether;
  • By altering the parameters of the grant to include so-called “crisis pregnancy centers” (which use tactics of misinformation and deception to prevent women from accessing abortion care) as eligible entities or “tiering” providers (giving preference to public health departments or primary care providers in order to shut out non-profit organizations like MFP);
  • By putting onerous conditions on Title X recipients—and their patients—such as requiring parental notification and consent for teens seeking contraceptive care, a policy repeatedly rejected by the Maine Legislature;
  • By instituting what’s known as the Domestic Gag Rule, which would bar Title X-funded health care providers from talking about abortion as one of three choices available to pregnant patients who come to us for comprehensive options counseling.

Under any of the above scenarios, the Maine Family Planning network of providers (18 MFP clinics, plus four Planned Parenthood sites, 20 Federally-Qualified Health Centers, and five school-based health centers) would be hamstrung in its ability to provide a full range of contraceptive and reproductive health care services to low-income, uninsured, and underinsured women, men, and teens around the state.

We are staying vigilant as the right wing’s latest attack on women’s health care looms. Stay tuned.

We’re Still Fighting

#ImStillFighting

I’m Still Fighting image via Physicians for Reproductive Health

Today, we celebrate Maine’s historic vote to expand Medicaid (MaineCare). The margin of victory (59 to 41 percent, as of this writing) and geographic distribution of votes (supportive communities stretched from towns bordering Canada all the way to southern Maine) clearly demonstrate that Mainers believe access to health care shouldn’t depend on where you live or how much money you earn. Tuesday’s vote means more low-income folks will benefit from a full range of critical health care services, including family planning and reproductive care, and thus brings us closer to realizing our overlapping goals of reproductive and economic justice.

But we’re still fighting. 

First, we must ensure that our elected officials act on the will of the people. Already, Gov. Paul LePage (R) is snubbing Maine voters, declaring Wednesday that his administration will block the expansion until the program “has been fully funded by the Legislature at the levels [the Department of Health and Human Services] has calculated.”

That’s not right—or legal.

According to Talking Points Memo:

Mainers for Health Care, the organization behind the campaign to expand Medicaid, said despite LePage’s bluster, he can’t stop the expansion train without violating state law.

“Under the state constitution, 45 days after the legislature reconvenes, Medicaid expansion will become the law of the state,” the group’s spokesman David Farmer told TPM. “According to the statute, the Department of Health and Human Services has 90 days after that to submit an implementation plan to the federal government, and the implementation itself will take place in mid-August of 2018.”

As Maine Family Planning community organizer Cait Vaughan reminded supporters in an email today, “we’ll need all of you to show up and make sure state legislators follow through on Medicaid expansion.”

Meanwhile, we must remember that until women can use their Medicaid coverage for all the medical services they need—including abortion—this victory remains incomplete. And so we’ll continue our battle to overturn the state’s ban on Medicaid coverage for abortions.

We’re fighting because the right to an abortion is meaningless if low-income or rural women can’t access one.

It’s appropriate that we participated today in the #ImStillFighting “tweetstorm” organized by Physicians for Reproductive Heath, marking one year since Election Day 2016—a year that has seen a wholesale assault on reproductive rights, the family planning safety net, and women’s health care.

See why other, like-minded organizations are Still Fighting, below:


Yes on Question 2 is a Vote for Women’s Health

Maine Family Planning is part of a statewide coalition working to pass Medicaid expansion on November 7th. Here, our community organizer Cait Vaughan shares a little more about why Yes on 2 is a vote for Maine women.

As the community organizer for Maine Family Planning, I’ve spent the last couple of months talking about little else but Medicaid expansion and the opportunity to vote YES on statewide ballot Question 2 on November 7th. Along with our incredible UMaine Orono intern and MFP volunteers, I have been making phone calls, speaking at events, engaging patients in the clinic waiting room, and (most importantly) knocking on doors to encourage Mainers to vote in favor of expanding this critical program. Back in May, I wrote about Medicaid as a feminist issue and how this joint federal and state-funded program is a crucial aspect of the family planning safety net. With Election Day rapidly approaching, I wanted to focus in a bit more on why we at MFP view expanding Medicaid—known as MaineCare in our state—as a vote in favor of women’s health and autonomy.

MFP serves roughly 21,000 patients each year across our 18 clinics that span 12 of the state’s 16 counties.  Roughly a quarter of our patients receive Medicaid right now, which makes sense, considering that women receiving Medicaid are more likely than those on private insurance to receive gynecological care at a family planning clinic or Federally Qualified Health Center (FQHC) instead of a private physician’s office. Women receiving Medicaid are also significantly more likely than those with private insurance or uninsured women to speak with their providers about important issues like contraceptives, sexual history, HIV, and domestic violence. Another 38% of patients who visit our clinics utilize the sliding scale payment option, largely due to a lack of access to health insurance.  This means that many women rely on us as their sole health care provider, and they are some of the folks who will be most positively impacted by expansion. While our clinicians provide excellent and compassionate care, patients need access to the full range of health care services in order to lead lives of dignity, opportunity, and self-determination. Those qualities truly encapsulate our greater mission as a health care provider and advocate in the feminist tradition of improving women’s lives.

One of our greatest contributions as a provider might be the advances we’ve made—via telehealth services—to improve access to sexual and reproductive health care in Maine’s rural and low-income communities. Voting Yes on 2 would allow us to go even farther. Half of the state’s current MaineCare recipients live in rural areas, and MaineCare provides coverage for many telehealth services (not currently inclusive of abortion care). Expanding Medicaid could complement the steps we’ve already taken to ensure that crucial health care services are available to our patients in rural towns like Fort Kent, Machias, and Rumford. MaineCare expansion can assist patients in overcoming economic barriers to health care that are compounded by geography and a sorely lacking public transportation infrastructure.

As a Title X provider, it’s also important to note that Medicaid has become the most significant public funding source for family planning services in the past decade. Medicaid’s funding for family planning outpaces even federal Title X, which is consistently targeted for cuts and has not been able to keep up with the rising costs of delivering care. We experience firsthand the many ways that access to a quality public health insurance program like Medicaid supports improvements in women’s health, the benefits of which have a ripple effect on our entire statewide community. We hope you’ll join us in voting Yes on 2 on Tuesday, November 7th and take an important step in making women’s health in Maine the way it should be.

If you’d like to volunteer a few hours of your time to support Yes on 2, you can join a special canvass of Friends of Repro Rights jointly led by Maine Family Planning & Planned Parenthood this coming Monday, October 30th in Augusta. Find full details & register here.

Sources/For More Information:

New Abortion Data: A Clarion Call to Family Planning Advocates

On Thursday, the Guttmacher Institute released a new analysis published in the American Journal of Public Health, giving insight into US abortion trends.

The data is fascinating and Maine Family Planning views it as a clarion call to continue and expand the work we’re doing in our clinics, in court, and in our communities.

The report from Guttmacher shows an overall decline in the US abortion rate between 2008-2014. Despite the 25 percent decline, abortion is still a common procedure in this country; one in four American women will have an abortion by age 45. Deep disparities remain among different demographic groups, with abortion increasingly concentrated among poor women and a long history of racism and discrimination contributing to differences in the abortion rate according to race and ethnicity.

These findings underscore the important work Maine Family Planning is doing to increase contraceptive use and abortion access around the state, as well as how much is at stake amid political attacks on reproductive health care nationwide. We see a declining abortion rate as a victory only if it is rooted in advances in comprehensive, affordable reproductive health care and the political and social conditions to support reproductive self-determination for everyone. Unfortunately, at least some of the recent decline can be attributed to politically-motivated & medically unnecessary state-level abortion restrictions that prevent women in many states from accessing care when they need it. Additionally, it’s clear that quality health care services remain financially out of reach for some Americans, rendering them unable to effectively plan pregnancies. As the hostile Trump administration continues its assault on health care, we fear these factors will only become more pronounced.

Our focus remains on empowering women to avoid unintended pregnancies via highly effective contraceptive methods, to be able to access abortion when they need to, and to make decisions based on their own visions of the families they want. Maine Family Planning is battling on many fronts to achieve full access to reproductive freedom: From offering comprehensive prevention programming in schools and long-acting reversible contraception (LARC) in our clinics; to providing innovative abortion care via telemedicine; to fighting in court to expand Medicaid coverage for abortions and overturn Maine’s burdensome law prohibiting nurse practitioners from providing abortion; to working with like-minded groups on the upcoming Yes on 2 vote to make Maine the first state to expand Medicaid by referendum. Guttmacher’s latest statistics prove that our work remains vital and necessary.

What Contraceptive Method is Best for Me? Part 3 – LARCs

So far in this blog series, we have focused on the two most common forms of birth control options used by teens; condoms and the birth control pill. For this post, we will be discussing LARCs. Of course, there are plenty of other birth control options, such as the Depo-Provera™ shot, the hormonal patch and NuvaRing®. These are also great options, but are much less popular than the condom, pill, and LARCs.

LARC is an acronym for long-acting reversible contraceptives. This means you get these types of birth control inserted into your body and basically don’t have to think about it again for anywhere between 3 and 12 years. Two great examples of long-acting reversible contraceptive options are the implant and the intrauterine device (IUD).

As with any birth control method, there are horror stories that scare teens away from taking the plunge and getting a LARC.  LARCs do seem like kind of a big deal, because you actually have to go to your doctor and have them inserted, but they are very safe and very effective. I, personally, have had both the implant and the IUD, and I can assure you, the insertion for each is not scary in the slightest bit.

For starters, let’s focus on the implant. The implant (Nexplanon®) is a little plastic bar that is inserted under the skin of your arm (around your bicep area) by your doctor. It contains the hormone progestin that works in two ways to prevent pregnancy; this hormone thickens your cervical mucus to keep sperm from reaching an egg, and it also works to prevent your ovaries from releasing an egg in the first place.

The implant can be a great option for teens because once it’s inserted, you never have to worry about it again for up to 4 years! Of course, using a condom as well is important because the implant does not prevent the contraction of STIs. Once the implant is inserted, it is nearly undetectable. You may have a tiny dot scar at the place of insertion, but besides that, nobody would ever know there was an implant in your arm. This is great for teens who don’t want people to know they are on a form of birth control!

The insertion process for the implant is simple! It is almost just like getting a shot. The implant is placed on the inside of your upper arm, and it is inserted through a needle. Before getting mine, my doctor went over the process and showed me the device used to insert the implant. It was nearly pain-free. The worse part of the process was getting a shot in my arm that numbed the area before the insertion! A lot of teens worry about birth control methods like the implant because it requires a doctor’s visit and a “procedure.” However, it is very simple, safe, and pain-free.

The implant can be expensive, but it is covered by most insurance plans! If you are not insured or do not want the implant to go through your parent’s insurance, check with your local Family Planning to see what options they might have for free or low-cost implants! The arm implant is over 99% effective, and it’s a great option for teens because there really isn’t any responsibility to maintaining that effectiveness like there is with the daily oral contraceptive.

The implant can cause some irregular bleeding or spotting for 3-6 months after insertion, but otherwise is very safe and free of any serious side effects. If you want more information about the implant, be sure to contact your local family planning clinic http://www.mainefamilyplanning.org/ or check out Bedsider for all the pros and cons of Nexplanon® here: https://www.bedsider.org/methods/implant#side_effects

The IUD is a bit different than the implant because it is a T-Shaped piece of plastic that is placed in your uterus. All IUDs work similarly by making your uterus too hostile an environment for pregnancy. There are hormonal IUDs that also use hormones to stop conception, and non-hormonal IUDs that prevent pregnancy without the use of hormones. The non-hormonal option is great for people who cannot have hormonal birth control!

There are four types of hormonal IUDs—Mirena®, Skyla®, Liletta®, and Kyleena™.  These hormonal IUDs are effective from anywhere between 3 and 6 years depending on which type is best for you. They vary in size as well, assuring that there is an IUD to fit every woman, regardless if they’ve had children or not.

There is only one type of non-hormonal IUD and it is Paragard®. Paragard® is made of plastic and copper and works for up to 12 years!

An IUD is a great birth control option for teens, because, like the implant, once it is inserted it will protect from an unwanted pregnancy until it is removed. Just like with the implant, it is important to continue to use condoms even after you have an IUD inserted. IUDs are excellent at preventing pregnancy, but they do not prevent STIs.

This can be a scary option for teens, because having an IUD inserted requires a doctor’s visit. You can get an IUD inserted at any point in your cycle, but it is best to do while you are on your period because that is the point during your menstrual cycle that your cervix is the most soft and open. Call your doctor or your local family planning clinic to find out if the IUD is a good option for you!

Like I stated above, I have had both an implant and an IUD. I, too, was terrified to take the plunge and get an IUD because I was worried that it might hurt! So, I want to tell you in detail how the whole insertion process works so you can know what to expect if you think an IUD is a good option for you.

Before getting an IUD, my doctor suggested taking Tylenol about an hour before my appointment. This is good because often there is some cramping after insertion, so the Tylenol makes that cramping a bit more bearable. Personally, I’ve always had pretty painful periods, so that’s the type of painful cramping I was expecting, and that’s just what it turned out to feel like. At the office, you’re asked to take your pants off and sit on the table with a sheet over yourself just like you would for a pap smear. Easy enough!

At my appointment, my doctor came in and explained in detail every little thing about the Mirena® IUD, and told me exactly how the insertion would be done. First, they would go in (using tools just like with a pap smear) and look at my cervix. The worse part of the whole process is a little pinch when they grab onto your cervix to steady it so they can get to your uterus. Honestly, the pinch was uncomfortable, but it wasn’t necessarily painful.

Once they’ve grabbed a hold of your cervix, the hard part is over! They first use a tool to measure your uterus (to make sure it’s the correct size for whatever IUD you have chosen,) and then they insert the IUD. Once it is inserted, they trim the little string attached to the device and you’re done! That little string will curl around your cervix in time. The string is there as a way to check that the IUD is still in the cervix where it belongs, and it comes in handy in 3-6 years when you’ll need to have your IUD removed.

If, after having an IUD inserted, your partner can feel it during sex, call your doctor. The string can be cut shorter if need be so that it can’t be felt during sex. Often if the string is cut too short in the first place, it can’t curl around the cervix and can poke your partner during sex.

You’ll usually have a follow up appointment in a month or so just to check that everything is all set. Often, this is a good time for the doctor to trim the string if your partner is feeling it during sex. After this checkup, your doctor will just check on that little string at your yearly exam.

After insertion of my IUD, I was a bit crampy for the rest of that day, but after that everything felt completely normal and suddenly I didn’t have to worry about taking a birth control pill at the same time every day anymore!

The costs for IUDs vary, but they are covered by most insurances. If you do not have insurance, contact your local family planning clinic to see if you can get an IUD for free or at a reduced cost.

IUDs are over 99% effective, and are the longest lasting form of birth control. This is also a great option because there are both hormonal and non-hormonal options. The Mirena® IUD is a good option for women who have heavy and painful periods, and it often stops women from having their period! As with any type of birth control, IUDs can cause some irregular bleeding in the first few months while your body adjusts, but this is normal. Lots of women stop having a period after the first few months of having an IUD.

If you have any questions, contact your local family planning clinic http://www.mainefamilyplanning.org/directories/24/clinic-locations or check out Bedsider for more detailed information about the pros and cons of IUDs here: https://www.bedsider.org/methods/iud#side_effects

Chynna is attending the University of Maine pursuing graduate work in the field of human development with a focus in human sexuality. She is originally from Maine and enjoys spending her free time taking her dog for walks on campus.

 

What type of contraception is best for me? Part 2 – The Pill

Let’s face it, even though condoms are the most accessible form of contraceptive for teens, they aren’t necessarily the “best” option out there. Condoms have to be used correctly every time you engage in sexual intercourse in order to prevent STIs and unplanned pregnancies. This is why it is highly recommended for people who are sexually active to “double up” on their birth control. This means that you use two forms of contraceptives instead of just one. The most common combination is using both condoms and oral contraceptives, i.e., the pill.

Condoms represent a barrier method of birth control, while the pill is a hormonal method. The pill works by regulating a woman’s menstrual cycle and preventing ovulation. In simpler terms, the pill prevents a woman’s ovary from releasing an egg. Without an egg, conception cannot occur because the sperm has nothing to fertilize. The pill also works by thickening cervical mucus to prevent sperm from entering the uterus in the first place!

If used perfectly, the pill can be up to 99% effective! However, in order to be as effective as possible, the pill needs to be taken every day at approximately the same time of day. This can be difficult, especially in the hectic life of a teen! That is why using a condom as well helps to be sure than no unwanted pregnancies will occur. Condoms are also still important, even if you are on the birth control pill, because the pill does not work to prevent the contraction of STIs.

In order to get started on the pill, you need to make an appointment with your doctor or your local Maine Family Planning clinic and get a prescription for a monthly supply of an oral contraceptive. There are many different kinds of the pill that have different doses of the hormones estrogen and progestin, which work together to prevent ovulation and thicken cervical mucus. You can work with your doctor to select the pill with a combination of hormones that is right for you.

Once you have a prescription for birth control pills, you can even sign up to have them delivered to you each month through the mail so you don’t have to worry about getting to a pharmacy to pick up your prescription on time each month!  Maine Family Planning’s Meds by Mail:  CLICK HERE

If you have questions about cost and insurance, as well as possible side effects, don’t be afraid to contact Maine Family Planning. They can answer any questions you may have about getting a prescription for the birth control pill!

Chynna is attending the University of Maine pursuing graduate work in the field of human development with a focus in human sexuality. She is originally from Maine and enjoys spending her free time taking her dog for walks on campus.

What type of contraception is best for me? 

Being a teen is hard, especially when you’re facing pressure from your friends to be sexually active and pressure from your parents to remain abstinent. 

The most important thing to remember when facing the issue of whether or not to be sexually active is that YOU and what YOU want is the most important. 

If your friends are pressuring you to be sexually active, that doesn’t mean you should be. If your parents are stressing that abstinence until marriage is the only acceptable thing, that doesn’t mean you have to remain abstinent. In this situation, it is most important to do what you feel is right for YOU at any given time. 

If you do plan to be sexually active, using proper precautions is crucial— especially if you do not intend to contract an STI or get pregnant!

As a teen, deciding what type of birth control is best for you can be difficult. The easiest, most inexpensive form of birth control for a teen to obtain is the condom. You can get condoms for free at most health clinics (including one of Maine Family Plannings eighteen sites HERE), and maybe even in your schools nurse’s office! You can also purchase condoms at any drugstore (like Walmart, Target, RiteAid, etc.) On average, you can get a box of 12 Durex condoms for around 6 bucks. You can also order condoms online at places like Amazon.com! This is an easy way for you to obtain condoms without needing to physically get to a drugstore. 

Condoms are a great birth control options for teens because they don’t require a prescription! This means you can get as many condoms as you need without having to make a visit to the doctor! Condoms aren’t necessarily the most effective form of birth control, but if they are used correctly every time, they can be up to 98% effective at preventing unwanted pregnancy or STI’s. 

Be sure to do your research on different types of birth control methods before engaging in sexual activity. Condoms are a great first step, especially for teens, because they are so easy to access and don’t require a doctor’s visit or the use of insurance. Check out these links for more information on condoms: http://www.mainefamilyplanning.org/page/2-766/birth-control

https://www.bedsider.org/methods/condom#details_tab

Chynna is attending the University of Maine pursuing graduate work in the field of human development with a focus in human sexuality. She is originally from Maine and enjoys spending her free time taking her dog for walks on campus.

Fighting for Medicaid is a Feminist Issue

Did you know that 1 in 5 American women in their reproductive years receive health insurance through the Medicaid program? In fact, Medicaid is a lifeline for nearly half of women in that age group who are below the federal poverty line, and nearly a third of Black women in that group (compared with 16% of white peers). Did you also know that LGBTQ+ people disproportionally experience poverty compared to heterosexual and cisgender people, making them more reliant on Medicaid for health care? Did you know that the Medicaid program covers care expenses for 51% of all births in the United States?

In this political moment, one of the country’s largest health care programs—designed to improve access and quality of life for low income people and those with disabilities—is under attack on both federal and state levels. Last month, the proposed American Health Care Act (AHCA) passed a vote in the House and stands to go up for a vote in the Senate. One of the many dangerous components of the AHCA is its targeting of the Medicaid program, which is an essential health care safety net for low income people, as well as a key facet of our nation’s family planning effort. Medicaid allows coverage for family planning services without copays, or penalties and red tape for choosing one type of contraceptive over another. The AHCA’s proposals to shift to a block grant or per capita cap structure for Medicaid would shift more costs to states, which would end up putting more costs on poor patients as well as their providers.

Unfortunately, Maine is also experiencing more localized attacks on our state Medicaid program, known as MaineCare. Maine is one of 19 states that have yet to expand Medicaid under the Affordable Care Act (ACA or Obamacare), due to Governor LePage’s multiple vetoes of this effort. Now, through a waiver application process, the Maine Department of Health & Human Services (DHHS) is attempting to enact rule changes that would place even more barriers to health care before poor and disabled Mainers, and result in potentially thousands more losing MaineCare coverage. Luckily, Maine’s “state plan amendment” has allowed for Maine Family Planning clinics to extend free reproductive health care services to low-income Mainers who are otherwise not eligible for MaineCare. However, the DHHS proposal to eliminate retroactive coverage would have negative effects on our ability to continue offering this service to people who fall through the cracks of our current health care system.

Opponents of these changes spoke passionately at a public hearing in Portland yesterday. One advocate with Homeless Voices for Justice—Dee Clarke—asked blatantly, “Why are you trying to hurt us?” Several mothers, including Clarke, spoke about raising their children on MaineCare, which allowed them to care for their families in the best way possible while facing the daily challenges of living in poverty. A nurse midwife spoke against the proposed $5,000 asset test as one change that would punish many women seeking prenatal care whose families operate small businesses. As she so poignantly put it, “You can’t sell off your small business or farm to afford prenatal care.”

Both the data and human stories make it clear:  Defending and expanding Medicaid is a feminist issue with major implications for women and LGBTQ+ health. The political attacks on Medicaid are fueled by classist stereotyping and stigmatizing of poor people, and the harm disproportionately falls on poor women. Cutting Medicaid means rolling back access to reproductive health care as well. It means more unplanned pregnancies, less healthy pregnancies, and more sick mothers and babies. Progressive Maine organizations are fighting to expand MaineCare this year, and Maine Family Planning is joining them. We continue to fight every day for the well-being of Maine women, teens, and LGBTQ+ people.

If you’d like to learn more about how to get involved in this effort, contact Community Organizer Cait Vaughan at 207-480-3518 or at cvaughan@mainefamilyplanning.org.

Self-Induced Abortion – Questions & Resources

In light of ongoing legislative attacks and widespread uncertainty about the security of abortion rights and access, conversations and resources addressing self-induced abortion (SIA) are increasing. We at Maine Family Planning want to serve as a resource for pregnant people in Maine who are considering their options with regards to an unplanned pregnancy.

It’s important to note that pregnant people have always found ways to terminate pregnancies—whether with the assistance of healers and caregivers, medication or natural remedies, or in a clinical setting like a doctor’s office or family planning clinic. MFP provides a safe and supportive clinical setting for anyone seeking to exercise their legal right to abortion. We offer both aspiration and medication abortion. We strive to be a trusted community-based resource that respects our patients’ dignity and unique needs, while providing education and counseling, in addition to reproductive health care services. It is our sincere hope and highest goal that all individuals living in the service areas of our 18 clinics who need abortion care will feel comfortable seeking out the compassionate professionals at MFP.

We also acknowledge the reality that barriers to accessing abortion exist across the country, and in Maine. Especially noteworthy are lack of public insurance coverage for abortion care, minimal private insurance coverage for abortion care , transportation, work schedules and child care needs that make scheduling appointments challenging, as well as abortion stigma. Some individuals have experienced trauma at the hands of medical providers, and thus lack trust in such institutions. For others, the antagonism of protestors is an insurmountable barrier. Even when clinics like ours provide excellent, nonjudgmental care—there are many reasons why someone might not be able or comfortable seeking out an abortion in such a setting, including a strong personal desire to control their own experience.

When people discuss SIA, they are often referring to self-administering of the pills mifepristone and misoprostol. Some women are acquiring such pills online and self-inducing at home or another location, often with trusted loved ones and caregivers present. Some women have faced legal persecution for such practices, or for the purchasing of pills—so we want people considering this method to both be aware of resources for accurate information on SIA, as well as the potential legal consequences.

Women face difficult—and sometimes seemingly impossible—choices each day in navigating management of their fertility. We know that desperate individuals can resort to self-harm and violent attempts to end pregnancies that they do not wish to carry. MFP advocates and organizes daily for the rights to bodily autonomy and self-determination for women and anyone who can become pregnant. This often means opposing legislative measures that attempt to unjustly surveil and criminalize pregnant people, and advocating fiercely for safe abortion access. We believe in responding to inquiries and concerns from Maine women with scientific and evidence-based answers. We encourage you to reach out to us, as well as seek accurate and feminist sources of information in doing your own research.

Here are some additional resources on SIA and pregnancy options:

I’m TTC and I Support Access to Abortion: Here’s Why

My husband and I are trying to conceive (“TTC,” as they say on the message boards). As many have chronicled before me, this can be a challenging journey. Seems like an odd time to get involved with an organization that provides abortion and contraception, a special sort of cognitive dissonance. But it’s not. Let me explain why, and why I support Maine Family Planning and all the services it offers.

The truth is that my husband and I are not trying to conceive, we are trying to start a family. The two are not precisely the same, because a family is far more complicated than a pregnancy. This understanding is at the heart of the “family planning” that Maine Family Planning provides.

My husband and I are very fortunate that we have some control over the way in which we build our family. This feels strange to write, as often I feel very out of control of this process, but in ways that matter, it is the truth.

First of all, we have been able to select a time in our lives when we feel we have economic and domestic stability. This is lucky. This is because we had sex education and access to contraceptives throughout our younger adult years. Not all Mainers have that. Maine Family Planning offers both education and contraceptives and works with women and men at all stages of their reproductive lives.

And that economic and domestic stability into which we hope to bring our children? Not all Mainers have that either. Which is why Maine Family Planning actively works, in direct and indirect ways, to improve health and economic circumstances for women so they can parent through difficult times. Take, for example, MFP’s behavioral health and chronic condition management services at their Ellsworth clinic. Or the Women, Infants, and Children Program (WIC), which provides supplemental food and farmers’ market vouchers for clients in Washington and Hancock Counties. These are much needed lifelines for a number of struggling Maine families. Furthermore, MFP works with state legislators and the Alliance for Maine Women to support bills that advance economic opportunities for low-income Mainers, especially women and mothers—bills like LD 1475, an Act to Reduce Child Poverty by Leveraging Investments in Families Today (more on that bill here).

Secondly, while my husband and I often feel helpless, we have lots of help—more medical providers than any one person wants in her life, to be honest. We are able to afford and access health professionals who provide testing, counseling, and care. If and when I should get pregnant, I will have them to answer my ten thousand questions about what pain reliever I can take and what fish I can eat and whether I should (or shouldn’t) go to the emergency room because I’ve had gas pains for three days straight. A luxury, right? It shouldn’t be. That’s why Maine Family Planning provides care and counseling to people wanting to start families and plan pregnancies.

But let’s get to the nittier, grittier stuff, the hard-to-wrap-your-head-around stuff, the “A” word: abortion. Although one of MFP’s prerogatives is increased access to abortion, its goal is not more abortions; its goal is stronger women and stronger families. The best way to decrease abortions is to prevent unintended pregnancy with education and contraception. (It is important to note here that not all abortions are because of unintended pregnancy; indeed many are medical decisions.) Still, until we live in that perfect world where unintended pregnancies don’t happen, MFP is here for Mainers—and has been for 45 years.

It’s possible that my husband’s and my journey to start a family will lead us to adoption. How could I possibly support an organization, then, that provides termination of pregnancies that might otherwise put children into the adoption system, children who might end up in my home? Unfortunately, this logic is based on a persistent fallacy that decreased abortion rates lead to increased newborn relinquishment. (Two articles about that here and here.) For many mothers, for many reasons, adoption is not necessarily an alternative to abortion. Furthermore, there are currently close to 2,000 children in Maine’s foster care system, with the need for homes far outpacing those available.

Last but certainly not least on the list of reasons I support Maine Family Planning: I hope to become a mother, in whatever way that unfolds. Because of this, I have thought long and hard about the world I want my children to live in, and I know I want it to be a world of choice and access. I believe my children should have at least the same kind of freedom and control over their bodies and reproductive choices that I’ve had over mine.

To support Maine Family Planning is to support Maine’s families, including perhaps eventually my own. We all have a stake in supporting MFP. I hope, one day, I’ll be able to explain that to my daughter.

Kathryn is a new MFP volunteer and advocate for reproductive rights and universal access to health care. She is a writer and teacher living in Maine.

On The Front Lines