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abortion

    HEALTH CARE

    DPH Launches Campaign on Risks at ‘Crisis Pregnancy Centers’

    But the state has little power to deny licenses to centers that mislead women

    By

    HYANNIS — In the year since medication abortion became available on Cape Cod for the first time since 2008, the landscape of access has continued to shift.

    The Your Options Medical mobile van, which relocated to Cape Cod from Southbridge last summer, is now licensed as a medical clinic by the Dept. of Public Health. Its host site is St. Francis Xavier Parish in Hyannis. (Photo by Sophie Mann-Shafir)

    Access to prescriptions for those needing abortions has not expanded, though CVS pharmacies have been filling such prescriptions since March. Meanwhile, an anti-abortion van belonging to a so-called crisis pregnancy center based in Revere has gained purchase as a state-licensed medical facility in Hyannis.

    Last month, Massachusetts launched a public education campaign sounding an alarm about the dangers of crisis pregnancy centers (also called CPCs).

    The centers “often mislead people about their options if they are pregnant and dissuade them from accessing abortions,” according to a press release posted by the state. The Healey-Driscoll administration’s initiative has allocated $1 million to expose the misleading advertising and limited services of CPCs.

    Designed by the state Dept. of Public Health (DPH) and the nonprofit Reproductive Equity Now Foundation, the campaign has put out radio and television ads and billboards in English and Spanish warning of the dangers of the centers. A 30-second video published as part of the campaign advises: “Whether you need pregnancy care or abortion care, avoid anti-abortion centers. They may look like medical clinics but can put your health at risk.”

    What’s in a Clinic?

    That the state would license clinics as legitimate medical facilities while simultaneously creating a first-in-the-nation campaign to educate people about their dangers reflects the fact that, according to a DPH spokesperson, there is no distinct licensure designation for crisis pregnancy centers or anti-abortion centers in Massachusetts. The department also confirmed that such places may be licensed as clinics if they offer medical services such as ultrasounds.

    “These crisis pregnancy centers have demonstrated they are not trusted medical providers, and I hope the state will take further action to rein in any deceptive activities that these facilities may be engaged in,” state Sen. Julian Cyr told the Independent on Tuesday.

    The DPH earlier put out information about the dangers and compliance requirements of anti-abortion centers in January, following what the DPH spokesperson wrote were “several complaints against anti-abortion centers.”

    The state’s January statement cautioned that most CPCs are not licensed and are instead funded and controlled by religious and/or advocacy organizations seeking “to advance an anti-abortion agenda.”

    At the end of May, the Independent received documents from the DPH showing that as of Feb. 19 of this year the Your Options Medical mobile van, which had been under DPH investigation since the fall, had its medical license officially re-approved, with St. Francis Xavier Church in Hyannis as its host location.

    Documents released this spring show that the van’s compliance issues were essentially bureaucratic: the clinic was cited by DPH for problems like parking in lots without formal approval from property owners and for advertising ultrasound and pregnancy testing services even when its operations were temporarily on pause.

    More CPCs Than Providers

    According to Reproductive Equity Now, there are currently 34 CPCs in Massachusetts — more than twice the number of clinics offering reproductive care. Nationwide, CPCs outnumber clinics that offer abortion as an option three to one, according to Planned Parenthood.

    There are currently four anti-abortion clinics that are also licensed as medical clinics by DPH: ClearWay Clinic’s branches in Worcester and Springfield, Care Net Pregnancy Resource Center in Fitchburg, and the Your Options Medical mobile van in Hyannis with its parent location in Revere.

    A frequent criticism of CPCs is that they strategically open near women’s health clinics in order to confuse patients seeking comprehensive care. Caroline Kimball-Katz, director of communications and marketing at the Planned Parenthood Advocacy Fund of Massachusetts, told the Independent that CPCs have set up shop very near two Mass. Planned Parenthood clinics, one in Worcester and one in Marlborough.

    “Patients sometimes are in the crisis pregnancy center for over an hour, sometimes multiple hours, before they realize they’re in the wrong place,” said Kimball-Katz. The experience “rattles a lot of patients and frankly can really break trust in the health-care system.”

    Julia Kehoe, CEO of the only clinic offering abortion prescriptions on Cape Cod, said she had not seen the Your Options Medical van parked near Health Imperatives and that it did not appear to be affecting her clinic.

    While reproductive health clinics are generally most concerned about stationary CPCs opening their doors nearby, one concern women’s health advocates have about the mobile CPCs is that they’re difficult to track, researcher Carly Thomsen told the Independent last fall. They don’t have to report their schedules or whereabouts and thus have an easy time dodging official scrutiny.

    On a June Friday in the late morning, the van was not parked at St. Francis Xavier. A secretary in the parish office who declined to give her name said the van is usually stationed there.

    “They’re under our auspices, but they don’t tell us when it’s being staffed,” the secretary said. She said information about the van spreads mostly by “word of mouth.”

    A schedule from last fall that Nancy Jamgochian, a licensed nurse affiliated with Your Options, sent to DPH lists four locations where the van planned to park during October and November. All were in Hyannis, including the Hyannis Transportation Center and Alberto’s Ristorante.

    Medication abortions on Cape Cod are available only at Health Imperatives, the seven-clinic organization with a branch in Hyannis. (Pregnancies past the 10-week gestational window require procedural abortions, and patients must leave the Cape for those.)

    Outer Cape Health Services still does not provide abortions, according to a person answering the telephone at its Provincetown clinic on July 19. Cape Cod Healthcare, which owns the Cape’s two hospitals and several other medical facilities, still provides abortions only in cases “when a woman’s life is in jeopardy,” according to a statement issued Sept. 30, 2022 that marketing and communications director Julie Badot sent again to the Independent this week. She confirmed that nothing had changed since then.

    Before Health Imperatives began providing abortions last summer, people in Provincetown seeking those services had to drive more than 100 miles to clinics in Boston or Attleboro. Trips to either place can take more than two hours.

    Health Imperatives began offering medication abortions in July 2023 and as of June 21 had provided 105, according to Kehoe.

    “That shows that there is the demand that we knew there to be,” she said.

    With the wealth gap growing, Kehoe said, she worries that it is getting harder for all people to access the high-quality care they deserve. Health Imperatives will provide services regardless of a patient’s immigration status or ability to pay. (Without insurance, the cost of a medication abortion is $400, Kehoe said.)

    With abortion access under threat nationally, Kehoe said “it is a very challenging time” for reproductive health. But she was grateful for the state’s campaign and the commitment to access among others here.

    “I can’t imagine a better place, with the public officials that we have here, and the advocates, and the health-care providers,” she said.

    HEALTH CARE

    Cape’s Only Abortion Care Clinic Prepares to Manage With One Medication

    Providers get ready to adjust, should Supreme Court restrict mifepristone

    By

    HYANNIS — Six months ago, Health Imperatives became the only clinic on Cape Cod to offer medication abortion, ending the Cape’s 15-year period as an abortion care desert. Now the organization, like others around the country, is facing a threat that could hinder its current approach to care.

    The U.S. Supreme Court in December agreed to hear a case brought by an anti-abortion coalition, the Alliance for Hippocratic Medicine (AHM), that seeks to restrict abortion by challenging the FDA’s approval of mifepristone, one of two pills used in most medication abortions. The court is expected to begin hearing oral arguments on March 26.

    Health Imperatives prescribes mifepristone along with misoprostol — to be taken 24 to 48 hours apart between 6 and 10 weeks of gestation. This regimen now accounts for more than half of abortions nationwide, according to the Guttmacher Institute.

    Mifepristone, which blocks progesterone, was initially approved as safe and effective for terminating pregnancy by the FDA in 2000 and has been endorsed by the World Health Organization, the American College of Obstetricians and Gynecologists, and the American Medical Association. Current data at the Guttmacher Institute show that mifepristone is now approved for this use in 96 countries around the world.

    Health Imperatives Director Julia Kehoe told the Independent that, if necessary, the organization’s clinics would continue offering medication abortions in the form of misoprostol alone.

    According to 2020 research published in the National Library of Medicine, misoprostol-only abortions are safe during the first trimester of pregnancy, with an efficacy rate between 85 and 95 percent.

    According to Kehoe, the Health Imperatives Hyannis clinic has prescribed medications for 45 abortions since July and for 175 across its seven locations in southeastern Massachusetts.

    Kehoe told the Independent last summer that the organization received 500 doses of mifepristone after Mass. Gov. Maura Healey issued an executive order to stockpile the medication across the state. Healey’s order followed a ruling in Amarillo, Texas, where U.S. District Judge Matthew J. Kacsmaryk — a Trump nominee with anti-abortion views — is the sole sitting judge, according to the Texas Tribune. That move initiated the fight over the drug that has reached the Supreme Court.

    If AHM’s lawsuit succeeds, the Court’s decision could limit access to the medication even in states like Massachusetts, where recent legislation aims to safeguard providers from national attacks on reproductive care. The ruling could prohibit mifepristone from being prescribed through telehealth and mandate that only physicians may write prescriptions for the drug, even in a state where physician assistants, nurse practitioners, and nurse-midwives can all provide abortion care.

    According to Kehoe, all 45 medication abortions prescribed at the Health Imperatives center in Hyannis included visits to the office, though some patients opted to take the pills at home.

    When patients come in with a pregnancy with a gestational age beyond the 10-week window, the clinic works with them, Kehoe said, referring patients elsewhere for procedural abortions. Procedural abortions are legal in Massachusetts up to 20 weeks and six days of a pregnancy.

    The closest provider offering procedural abortions is Four Women Health Services in Attleboro, 111 miles from Provincetown.

    To help abortion-seekers from the Outer Cape with logistical challenges, Health Imperatives used a grant from the state Dept. of Public Health last summer to hire “navigators,” Kehoe said. They work to reduce stress by helping arrange for transportation and hotel stays if needed, she said.

    Kehoe said that telehealth is also available for those who can’t make the trip. But strict eligibility requirements already exist for telehealth services, according to Dr. Danielle Roncari, vice president of medical services for the Planned Parenthood League of Massachusetts.

    To qualify for a prescription by telehealth, a patient’s last menstrual period must have occurred within 11 weeks and the patient can’t be in any pain, because that might indicate a potential ectopic pregnancy or another complication that could require direct medical intervention.

    Still Just One Clinic

    The question remains as to why Health Imperatives is still the only health center on Cape Cod to offer abortion services. Some other providers cite the Hyde Amendment, which prohibits the use of federal funds for abortion care.

    “We are just following the federal guidelines,” said Dr. Arshiya Seth, chief medical officer of the Community Health Center of Cape Cod, which runs five clinics on the Upper and mid-Cape.

    But federal guidelines don’t prohibit abortions outright, according to guidance by the Reproductive Health Access Project, a national network of primary care providers working to expand abortion, contraception, and miscarriage care.

    As a federally qualified health center, the Community Health Center of Cape Cod qualifies for specific reimbursement under Medicare and Medicaid. While the Hyde Amendment restricts these types of centers from using federal funding for abortion care, other funds can support this care, according to the Reproductive Health Access Project.

    Outer Cape Health Services, also a federally qualified health center, first cited the Hyde Amendment last year in explaining why it does not offer prescriptions for abortion medications. It changed its answer to say the reason is that its clinics are focused on primary care. OCHS Communications Director Gerry Desautels told the Independent on Jan. 18 that there has been no change since.

    Cape Cod Healthcare, the parent organization that operates both Cape Cod Hospital and Falmouth Hospital, also restricts abortion care.

    In a statement provided to the Independent by Communications Manager Lisa Connors on Jan. 8, Cape Cod Healthcare confirmed that it provides abortions only “when a woman’s life is in jeopardy” and “to preserve the health of the mother.” An ethics committee is not involved, the statement said. The decision is reached privately between patient and provider.

    If an abortion is not “urgent,” the statement continued, the pregnant patient is referred to “providers with a greater degree of expertise.”

    HEALTH CARE

    Mobile Anti-Abortion Unit Is Under DPH Scrutiny

    A ‘40 Days for Life’ campaign didn’t dissuade patients, says clinic director

    By

    HYANNIS — The anti-abortion van affiliated with Your Options Medical, which operates “crisis pregnancy centers” from a parent site in Revere, has been under review by the Mass. Dept. of Public Health (DPH) for at least two months. The investigation is ongoing.

    Joanne Liberles of Orleans engaged the public driving by. “It’s a little bit of a referendum,” she said. (Photo by Sophie Mann-Shafir)

    According to documents obtained by the Independent, DPH renewed the clinic license for the mobile unit on July 12. Then, on Aug. 30, DPH conducted an unannounced survey of the unit. Based on that visit, according to DPH, the state agency sent the facility a statement of deficiencies regarding the mobile unit’s operation.

    At a meeting of the Hyannis chapter of 40 Days for Life, an anti-abortion group, on Sept. 8, Your Options Medical’s director Teresa Larkin said that the mobile van had recently had “an issue” with DPH. She called it “the tip of the hand of somebody wanting to shut us down,” but added, “We believe it’s been resolved.”

    Your Options Medical submitted at least one correction plan to DPH; it was not approved. During the first week of November another plan was submitted; it was under review as of Monday, Nov. 6.

    The license renewal application submitted for the Your Options Medical mobile van on June 8 stated that it would operate “in the Southbridge area.” The van was relocated to Cape Cod two months later, shortly after Health Imperatives in Hyannis became the only clinic prescribing medication abortions on Cape Cod in early July.

    Larkin had told the Independent that she hoped the mobile unit would open its doors in September. She could not be reached for comment for this report.

    A review of a separate complaint about the Your Options Medical mobile unit is also underway, prompted by an Oct. 17 letter from the Boston-based organization Reproductive Equity Now. The letter, sent to DPH and the Executive Office of Health and Human Services, charges that

    Your Options Medical may be engaging in “deceptive practices and potentially endorsing out-of-scope diagnoses by registered nurses.”

    In a Sept. 29 letter to the editor of the Boston Globe, DPH Commissioner Robert Goldstein addressed Your Options Medical and the broader crisis pregnancy center phenomenon. “These organizations seek to prevent people from accessing abortion care,” he wrote, “often by providing inaccurate and misleading information, including about the physical and psychological effects of abortion.”

    Not So Peaceful

    The sidewalk outside Health Imperatives has been the scene of competing demonstrations in the past several weeks. A 40 Days for Life vigil ended on Sunday, Nov. 5. During its final two days, counterdemonstrators showed up to defend abortion rights.

    Julia Kehoe, the director of Health Imperatives, said that the clinic did not experience any change in the number of people seeking care during the 40 days, though patients were distressed by the vigil.

    Elaine Vermette of Hyannis protested abortion on her own, not as part of the 40 Days campaign. (Photo by Sophie Mann-Shafir)

    “It’s very upsetting when you’re coming in for a service and there’s someone there basically questioning your rights and decision,” Kehoe said, noting that the protests didn’t seem to change patients’ beliefs. “Quite the opposite,” she said.

    Before Health Imperatives began providing prescriptions for abortion this summer, the closest option for people on Cape Cod seeking abortions was in Attleboro — more than 100 miles from Provincetown.

    According to 40 Days for Life’s printed materials, the organization is “committed to ending the scourge of abortion through prayerful, peaceful, lawful vigils demonstrating truth, love & compassion.”

    The protestors bore signs about prayer and murder of the unborn and held a banner that read “God Is Pro-Life.” The banner blocked the sidewalk, and at least once the abortion protesters refused to clear the path for a pro-choice demonstrator trying to pass by. Periodically, they recited the rosary.

    A man who said his name was David Christopher prayed in tongues, holding a sign that said, “Ask me about abortion pill reversal.” When asked by a reporter what he thought about the pill reversal not being FDA-approved, he said, “I don’t know about that, I just know that it saves lives. Is killing the unborn FDA-approved?”

    Medication abortion consists of two FDA-approved drugs — mifepristone and misoprostol — taken 24 to 48 hours apart. Abortion pill reversals “are not based on science and do not meet clinical standards,” according to the American College of Obstetricians and Gynecologists.

    Elaine Vermette of Hyannis had taped a plastic baby doll to her sign. She had come on her own, not as part of the 40 Days campaign, to protest. “I’m totally against abortion,” she said. “I feel bad if women get raped, but it’s God’s decision whether she has the baby or not. If she doesn’t want it, she should give the baby up.”

    Marcia Goffin of Eastham was rallying for choice alongside other members of Indivisible Mass. Coalition’s Feminist Action Team, led by Laurie Veninger of Truro. “I’ve been doing this since before Roe, and I can’t believe we’re doing it again,” Goffin said.

    The Hyannis chapter of 40 Days for Life is led by Sheila Quinn. Participants in its protest had to sign a “statement of peace” that included a vow to “neither commit any act of violence, threaten or touch any person, nor display or discuss weapons.”

    A video obtained by the Independent from the last day of the protest shows Quinn grabbing Veninger by her backpack and tugging her backward twice. Quinn declined to comment for this article.

    Clergy for Choice

    A group of Christian, Jewish, and Unitarian Universalist clergy were present on Wednesdays throughout the 40 Days campaign. Margot Critchfield of Sandwich, a former Episcopal priest, helped organize the group.

    Clergy for Choice were a regular presence at demonstrations outside Health Imperatives in Hyannis over the past month. (Photo courtesy Laurie Veninger)

    “We wanted to make a statement so that people would know that the religious right does not represent all clergy or all faiths by any stretch of the imagination,” Critchfield said. “It shouldn’t be such an incredible thing, but people were surprised.”

    Critchfield and Kristen Harper, a Unitarian Universalist minister in Barnstable, published an op-ed in the Cape Cod Times about their group. “Being pro-choice means we believe women and trans men should have access to health care without judgment and impediment,” they wrote. “It means that we believe our bodies should not be controlled by or condemned by any faith community.”

    Debbie Mangen, a rabbi who lives in Barnstable, said what brought her to the demonstration was “a feeling of disempowerment.” She said the gathering was generally collegial until Sunday, which was “the first time I experienced people from the vigil coming up to us and either praying for us, calling us murderers, or calling us Satan.”

    David Freelund, the rabbi at Cape Cod Synagogue, was a fixture of Clergy for Choice each Wednesday during the campaign. That, he said, was because of “a firm belief that people should not be legislating their religious beliefs on other people.” He added that “it’s pretty solid from scripture that a fetus is not alive.”

    HEALTH CARE

    40 Days of Anti-Abortion Protests Planned at Health Clinic

    Cape chapter of a Texas group says it will hold prayer vigils

    By

    HYANNIS — For 15 years, people seeking abortions had to leave Cape Cod for care; the nearest clinic was over 100 miles away. But in July, Health Imperatives opened in Hyannis. It is the only clinic where women can get prescriptions for abortion pills on the Cape. A group fighting abortion rights is planning protests at that clinic beginning next week and continuing into November.

    That group is a local chapter of the Texas-based “40 Days for Life” campaign, whose slogan is “The beginning of the end of abortion.” They are planning what they’re calling daily “vigils,” from Sept. 27 to Nov. 5, gathering outside Health Imperatives bearing signs and reciting prayers.

    Julia Kehoe, executive director of Health Imperatives, said the clinic is aware of the protesters’ plans.

    “Our primary concern is the health and safety of our patients, so we are planning on having a police detail onsite,” said Kehoe. Police will be present at the beginning of the campaign, she said, and plans will evolve from there.

    “The police are also planning on driving by several times a day just to make sure that things are peaceful, which we’ve been assured they will be,” Kehoe said. She added that protesters will not be able to park in the Health Imperatives parking lot or draw closer to the building than the sidewalk in observance of the clinic’s buffer zone.

    That buffer zone has not been a sure thing since the Supreme Court struck down a rule establishing 35-foot protective areas around women’s health clinics. But under Massachusetts law, the police can enforce a 25-foot buffer if they see that patients’ access is impeded.

    The 40 Days for Life campaign is aware of the buffer zone rule. Its vigil “dos and don’ts” handout directs participants not to park in the Health Imperatives lot and not to “go on the grass or block the driveway of Health Imperatives parking lot.”

    That leaflet was distributed at an organizing meeting at Corpus Christi Parish, a Catholic church in East Sandwich, on Sept. 8. There, organizers “cast the vision” for the protesters, modeling the protest after others organized by the 40 Days group, which is headquartered in Bryan, Texas. It claims to have shut down 145 abortion clinics since it formed in 2007.

    A variety of printed materials were on offer at the meeting in East Sandwich, including two booklets of “prayers to end abortion,” a 40 Days-branded devotional guide, and a 40 Days-sponsored pamphlet about medication abortion.

    Medication abortions, which have been FDA-approved since 2000, consist of two pills: mifepristone, which blocks the hormone progesterone and keeps the fetus from growing, and misoprostol, which expels the fetus. The pills are taken 24 to 48 hours apart.

    The 40 Days brochure about medication abortion contains several statements not supported by science.

    “Abortion pills break a woman’s healthy reproductive system,” the brochure claims.

    The word “break,” said Dr. Nicola Moore, an abortion provider who lives in Truro, “suggests that something about the woman changes. Nothing about the woman changes in any permanent way.” In terms of harm to the woman, said Moore, there is none: “She has come to you asking for help with a pregnancy she doesn’t want, and you’re helping her.”

    The brochure also says that medication abortions are not safe, quoting testimony from people who describe intense and painful side effects.

    Moore drew a distinction between pain and danger. “The pill can be very unpleasant,” she acknowledged. “Labor can also be very unpleasant, and many more people get sick having a baby than using the abortion pill.”

    A 2012 study comparing the safety of abortion and childbirth in the U.S. found that childbirth was 14 times more likely to result in death than abortion. Citing that research, “The controversy surrounding pregnancy termination is exceptional in its treatment of abortion as anything but a medical procedure,” wrote Adebayo Adesomo in Scientific American last year.

    Anti-abortion centers, which have been called crisis pregnancy centers or CPCs, number more than 30 in Massachusetts. They advertise themselves as resources for pregnant women considering their options but do not offer abortion as an option. And although they refer to themselves as clinics, they are usually staffed by nonmedical personnel.

    The Mass. attorney general has issued warnings about CPCs’ limited service options, which are often unknown to their clients because of deceptive advertising.

    At the 40 Days vision meeting, Mass. Citizens for Life President Myrna Maloney Flynn of Northampton warned Sandwich parishioners about a state bill that she said would “censor” crisis pregnancy centers. She told the group that the legislation would require centers “to be very careful in terms of what words they used on their websites and in any kind of print promotion.”

    Flynn told the group she was referring to H.377, “An Act to Protect Patient Privacy and Prevent Unfair and Deceptive Advertising of Pregnancy-Related Services.” Submitted by Rep. Tram Nguyen of Andover, the bill would preclude limited-service pregnancy centers from making any claim to the media and on their own websites and materials that “is deceptive, whether by statement or omission.”

    A mobile van from the crisis pregnancy conglomerate Your Options Medical has been roaming Cape Cod since shortly after Health Imperatives began offering abortion services. The van’s exterior claims to offer immediate ultrasound results, which Your Options Medical’s Director Teresa Larkin told the Independent are “preliminary findings,” not actually coming from a registered physician.

    At the protestors’ vision meeting on Sept. 8, Larkin said that the mobile medical van recently had “an issue” with the Dept. of Public Health, which she said was “the tip of the hand of somebody wanting to shut us down. We believe it’s been resolved,” she said.

    According to DPH, a clinic renewal license for the mobile unit and its brick-and-mortar parent site in Revere was issued on July 12. Then, on Aug. 30, DPH conducted a clinic licensure renewal survey at the mobile unit. “Onsite inspections are unannounced without prior notice in order to determine compliance with regulations,” according to DPH. The Independent is awaiting results of the inspection from a public records request.

    “I would not be surprised that the Dept. of Public Health is bringing some scrutiny to crisis pregnancy centers, given that they’re masquerading with what services they’re providing,” said state Sen. Julian Cyr.

    While Health Imperatives director Kehoe said it is possible for patients to get abortion care in telehealth appointments, most prefer to come in person. From a medical perspective, she said, that’s also ideal: “It is preferable for people to come in for the first dose and speak with a provider,” said Kehoe.

    There are multiple organizations operating where the Hyannis branch of Health Imperatives is located. Kehoe said that gives patients a sense of security.

    “People will not know who is coming in for what service,” she said, “and people should not be nervous or let these protesters get in the way of their accessing whatever service it is that they need.”

    HEALTH CARE

    Mobile Anti-Abortion Center Is Coming to the Cape

    The move follows the opening of a Hyannis clinic offering medication abortions

    By

    The operators of a mobile “pregnancy resource center” plan to open its doors on Cape Cod later this summer, according to Joe Meeks, cochair of the Harwich-based Cape Cod Pro-Life Alliance.

    The unit, which has been in Western Massachusetts, has been relocated to Cape Cod, according to Teresa Larkin, executive director of Your Options Medical, which operates the mobile facility.

    Its impending arrival follows a recent development in access to reproductive health care: medication abortions becoming available on Cape Cod for the first time in 15 years. Larkin is hoping the mobile unit will begin operating “right after Labor Day,” she said, but that will “depend on when we can get staff trained and get the doctor on board.” The unit is not winterized, she said, so it will cease operations in early November and resume in the spring.

    Your Options Medical is a nonprofit that provides “free pregnancy confirmation services,” according to its website. The organization has three fixed locations in the state: in Brookline, Fall River, and Revere.

    Operations like Your Options Medical run what are commonly called “crisis pregnancy centers” (CPCs). They exist to dissuade women from having abortions.

    Research reported in Ms. magazine shows that women who seek medical services at clinics that do not offer abortions are often not aware of the operators’ mission. Deceptive advertising is a feature of these clinics, according to a report published this summer by the Center for Countering Digital Hate. Those ads boost CPCs’ standing on search engines, even when users are specifically seeking abortion services.

    “I’ve seen patients that have been to crisis pregnancy centers because they provide services that are attractive to pregnant women,” said Dr. Nicola Moore, an abortion provider who lives in Truro. Those services include abdominal ultrasounds.

    The Mass. attorney general warns of the risks of CPCs: “CPCs may appear to be reproductive health care clinics, but do NOT provide abortion care or abortion referrals, contraception, or other reproductive health care, despite what they may advertise.”

    These centers “all have the same goal of performing ultrasounds on women and then appealing to their guilt — or they try to bestow personhood status on the fetus,” said Laurie Veninger of Truro, who leads the Indivisible Mass Coalition’s Feminist Action Team.

    “They’re doing this under the guise that they are providing free resources,” said Carly Thomsen, a professor at Middlebury College and one of the few scholars whose research focus is mobile CPCs.

    Larkin said the Cape Cod mobile clinic will offer “pregnancy testing, counseling, and assessing needs for women that are testing positive for pregnancy.” She said that limited obstetric ultrasounds, detailing the location, gestational age, and viability of a pregnancy, will be available.

    Larkin confirmed that Your Options Medical does not provide abortions or referrals for them.

    The clinics do, however, refer callers to the Abortion Pill Reversal hotline. “It’s only beneficial if they’ve only taken the first pill, not the second,” Larkin said.

    Medication abortions consist of two FDA-approved pills: mifepristone, which prevents the pregnancy from growing by blocking progesterone, and misoprostol, which contracts the uterus. According to the American College of Obstetricians and Gynecologists, “Claims regarding abortion ‘reversal’ treatment are not based on science and do not meet clinical standards.”

    Carrie Baker, a professor at Smith College and contributing editor of Ms. magazine, sees the timing of the mobile unit’s arrival as telling. “The fact that they’re showing up right as there’s medication abortion available on the Cape shows that they are businesses trying to inject themselves and interfere,” she said.

    Thomsen said that mobile units “are known to park directly in front of abortion clinics, and they’re targeting high schools.”

    The fact that medication abortions are newly available on Cape Cod “maybe makes it more convenient” for Your Options Medical to set up now, said Meeks. The goal, said Larkin, is “to be able to offer another type of service to women who think that abortion is their only option.”

    Larkin denied that the unit would be stationed outside Health Imperatives, the Hyannis clinic offering medication abortions. “We believe in reaching a woman before she’s made her decision,” she said.

    Moore said that there has been a CPC “essentially across the street from nearly everywhere I’ve worked as a provider.”

    Your Options Medical offers “abortion recovery counseling” led by an advocate or nurse. Ninety percent of the facilitators have had abortions themselves, Larkin said. “A lot of women struggle with that decision that they made years ago,” she said, “and there needs to be space for that woman who feels guilt, shame, remorse over that decision.”

    The highly personal feel of most crisis pregnancy centers is, according to critics, part of the charade. “They try to appear as if they are mom-and-pop shops popping up in communities to help people,” Thomsen said. “They’re part of a well-funded, well-coordinated global industry.”

    Larkin said that Your Options Medical follows up with women who come to their clinics and decide to follow through with their pregnancies. “We work with a lot of agencies that supplement the resources we provide,” she said. Birthright, an international network of CPCs “with hundreds of centres throughout Canada, the United States and Africa,” according to its website, provides Your Options Medical clients with diapers, clothing, and cribs, Larkin said.

    Larkin said that sonographers at Your Options Medical all undergo “very intensive training that usually takes close to a year.”

    One of the places that trains staff, Larkin said, is Sparrow Solutions Group, a self-described “Christian business” that provides advice to what it calls pregnancy medical clinics (PMCs). “Our in-house team and our team of instructors and consultants are equipped by God to build and strengthen both sides of the PMC ministry,” its website says.

    Hard to Regulate

    There are about 32 CPCs in Massachusetts, according to an online database. Nationwide, there were 2,527 catalogued in 2020, and two-thirds of those “offered limited medical services,” according to a study from that year. Nationally, there were 3.2 CPCs per abortion facility.

    According to Thomsen, all mobile CPCs operate differently, which makes their schedules hard to predict. Some vans operate on a cycle with a certain number of locations in rotation, while others “go out every day and target certain areas,” she said.

    Moore said, “A mobile CPC is mobile because the organization that owns it hasn’t established a brick-and-mortar presence close to the place that provides abortion services.” In Houston, she said, she saw a mobile clinic that parked outside the same abortion clinic “every day of the week.”

    Part of what makes mobile units dangerous, according to Thomsen, is that their mobility makes their limited services harder to pin down. “They’re unregulated,” she said. “They don’t have to report their routes. They don’t have to report to anybody. There’s no database or repository of information.”

    Mobile CPCs are as trackable as they choose to be. Larkin said that once the mobile unit is operating on Cape Cod, it will have established routes so that clients can find it. She said the location involves questions of convenience and privacy. “There’s a fine line between being accessible and confidential,” she said.

    Meeks said, “The intention of the mobile clinic is to go where it’s needed.” He said that need is “based upon inquiries that we have from any woman that might need assistance” and that the van will accept appointments and walk-ins.

    Thomsen said that mobile CPCs have been known to gravitate specifically to underserved areas where many people lack health insurance and struggle to access medical care. “The idea is people would see them, and they would pop in,” she said. It’s in these places, Thomsen said, where people are “more vulnerable to the claims that CPCs make, including mostly bogus offers for services.”

    A Licensing Mystery

    Two of Your Options Medical’s four locations are licensed as clinics by the state Dept. of Public Health (DPH): the clinic in Revere and the mobile unit, which is licensed in Southbridge.

    Asked about licensing, Thomsen, who studies mobile CPCs, said, “I’ve been trying to figure that out for a couple of years.”

    The DPH said that “A crisis pregnancy center may be licensed as a clinic if it offers medical services.” Larkin said that the two medical services Your Options Medical provides are lab-quality testing and ultrasounds.

    The clinics’ licenses must be reapproved by the DPH every two years, Larkin said. “For a clinic, a lot of it is building-code related,” she added. She said their clinics get checked for handicapped accessibility, air circulation, and lighting. They also need to have an advising doctor and a list of policies and procedures, she said.

    “Mobile clinics are tricky because they’re moving from jurisdiction to jurisdiction,” said Baker. “They’re harder to license.”

    Larkin said that, at Your Options Medical, “All the ultrasounds are read by a registered physician” and that they are all either obstetricians or radiologists. She added that, comparing the licensed and unlicensed branches of Your Options Medical, “there really is no difference in terms of quality of service or how we operate.”

    Because nonprofit clinics that don’t provide abortions offer free services, while most abortion clinics charge, they can be appealing to low-income populations. A report in Vox found that 10 states (not Massachusetts) have redirected money from the Temporary Assistance for Needy Families program, designed to support low-income families and pregnancies, to CPCs.

    “They are not a social service,” Thomsen said. Their goal is “not lifting people out of poverty so they can make the reproductive decisions that they would make if they had every option available to them,” she added.

    Editor’s note: An earlier version of this article, published in print on Aug. 3, incorrectly described Dr. Nicola Moore of Truro as a “former” provider of abortion care. Dr. Moore is still practicing.

    REPRODUCTIVE HEALTH

    Hyannis Clinic Offers Medication Abortion, Ending Cape-Wide Drought

    After 10 weeks, women must still travel off Cape for care

    By

    HYANNIS — Since 2008, it has been impossible to get an abortion on Cape Cod. But as of last week, just over a year after the Supreme Court’s Dobbs decision, there is an oasis in this local care desert.

    With a $700,000 grant from the state Dept. of Public Health, Brockton-based Health Imperatives is now offering medication abortion at all seven of its locations, including in Hyannis.

    “We’ve provided comprehensive sexual and reproductive health care, including options counseling, for decades,” said Health Imperatives CEO Julia Kehoe. “Adding this medication makes it easier for us to integrate that into our clinics rather than always having to refer it out.”

    The medication abortion procedure consists of two pills taken 24 to 48 hours apart: mifepristone, which blocks progesterone to stop the pregnancy from progressing, and misoprostol, which flushes out the uterus through cramping and bleeding similar to a heavy period.

    The FDA first approved the drugs for abortion in 2000 and authorizes them for safe use through the first 10 weeks of pregnancy. Over half of all abortions in 2020 were medication abortions, according to the Guttmacher Institute.

    In April, after a federal judge in Texas overturned the longstanding FDA approval of mifepristone, Gov. Maura Healey issued an executive order to stockpile the medication in Massachusetts. Acquiring doses from that inventory was easy, Kehoe said.

    Health Imperatives currently has about 500 doses of mifepristone.

    “I am relieved and thrilled that these abortion services can be offered on Cape Cod again,” state Rep. Sarah Peake said. “Perseverance pays off.”

    Health Imperatives “moved heaven and earth to get this done,” state Sen. Julian Cyr said.

    When patients call the clinic, a counselor walks them through the process. After meeting with a nurse practitioner or a doctor, patients receive the mifepristone, which can be taken at the clinic or at home, as well as the misoprostol to take one or two days later. Staff will follow up after a few days by phone, Kehoe said.

    Other providers can also refer patients to Health Imperatives for medication abortion, which Kehoe said has already happened.

    Abortion medications are not prescribed at Outer Cape Health Services. Spokesperson Gerry Desautels repeated the false assertion that Outer Cape Health Services cannot offer abortions because it is a federally qualified community health center and therefore subject to the Hyde Amendment. The Hyde Amendment does not prohibit such centers from providing abortion services altogether.

    Last August, OCHS issued a statement backing away from its claim regarding the prohibition, stating that it did not offer abortion care because its current focus was “core primary care and behavioral health access.”

    Cape Cod Healthcare also does not offer abortion services, except “when a woman’s life is in jeopardy,” according to a statement released last September. CCH Communications Manager Lisa Connors told the Independent that “nothing has changed since then.”

    Every major insurance company in Massachusetts covers medication abortion, Kehoe said.

    Before launching the service on July 3, Health Imperatives staff underwent additional training not just on medication abortion procedures but also the safety protocols required to operate an abortion clinic.

    “Tele-abortion services” allowing people who can’t make it to a clinic to receive the medications in the mail are a possibility, Kehoe said.

    “Access is our number one priority in terms of providing health care in areas where it isn’t easy to get to the clinic,” Kehoe said — like the Outer Cape, where Hyannis is about an hour’s drive away.

    Those needing an abortion after the 10th week of pregnancy must travel off Cape for care. Health Imperatives will connect these patients to a clinic that provides surgical abortions. Kehoe said they’re working closely with the Eastern Massachusetts Abortion Fund to cover costs of transportation or the procedure itself. The nearest clinic to the Cape offering surgical abortion is in Attleboro, 110 miles from Provincetown.

    Outer Cape-based nonprofit Helping Our Women provides free transportation to and from health-care appointments in Hyannis and elsewhere. Women of reproductive age, usually defined as under 49, constitute a minority of their clientele, according to Executive Director Gwynne Guzzeau. But as they work and raise families, “their lives are part of the hidden story of what it’s like to be here year-round,” Guzzeau said.

    Locals should know that Health Imperatives “is a safe place to go” and “an important partner and important resource in the community” despite the distance, Guzzeau said.

    Sen. Cyr said he is curious to see data on the use of these expanded abortion services and the resulting scope of demand for surgical abortion, as well as where people seeking care are located. The data “will hopefully inform us about how to expand and buttress resources” for the Outer Cape and beyond, he said.

    Health Imperatives won’t release any use data for the first six months, Kehoe said.

    HEALTH CARE

    State Funding Increases Access to Abortion Pills

    Women seeking abortions beyond 10 weeks must still travel off Cape

    By

    HYANNIS — A Hyannis clinic and its affiliates are the beneficiaries of a $700,000 state grant that will enable the organization to begin offering abortion pills by July.

    Two medications, mifepristone and misoprostol, are used to cause a period to end a pregnancy of up to 10 weeks.

    Health Imperatives, which operates seven clinics in southeastern Massachusetts, is one of 11 community-based organizations to receive $4.1 million from the Dept. of Public Health as part of the state’s efforts to expand abortion services. The money will enable Health Imperatives, which has existed for 40 years in Hyannis, to prescribe and distribute the medications mifepristone and misoprostol. These medicines were approved by the FDA in 2000 to end pregnancies in the first 10 weeks. Mifepristone stops the flow of the hormone progesterone and misoprostol causes contractions, according to Carrie Baker, a professor of the study of women and gender at Smith College. (She wrote about telemedicine and abortions for the Independent in 2021.)

    Medication abortions accounted for 53 percent of all U.S. abortions in 2020, the most recent statistics available, according to the Guttmacher Institute. That number is up from 39 percent in 2017.

    The prescription service will be offered starting in July, after Health Imperatives clinics have purchased medical equipment, trained staff, conducted security assessments, and “enhanced our security measures,” said Julia Kehoe, the organization’s chief executive officer.

    The clinic will need ultrasound machines and other equipment to determine the amount of time since conception. Kehoe said the Hyannis clinic currently has 10 staff members including two nurse practitioners. Health Imperatives employs two medical doctors who provide “policy guidance and sometimes clinical practice at all seven sites,” she said.

    The state announced the new funding on Dec. 28; Kehoe said she needs to find out if the funds can be used to provide transportation to a surgical abortion clinic for women who are beyond 10 weeks of pregnancy. The closest provider of surgical abortions to Outer Cape Cod is Four Women Health Services in Attleboro, 110 miles from Provincetown. Some transportation funding has been allocated to other grant recipients that she has spoken with, said Kehoe.

    Abortions are legal under Massachusetts law up to 24 weeks. Anyone who wishes to end a pregnancy beyond 10 or 11 weeks must seek a surgical abortion. (According to Planned Parenthood, medication abortion works about 87 percent of the time in the 11th week of pregnancy.)

    Cape Cod Healthcare, which owns both Cape Cod Hospital and Falmouth Hospital, will not provide surgical abortions except “when a woman’s life is in jeopardy,” according to a statement from spokeswoman Lisa Connors. “We always do whatever is necessary to preserve the health of the mother, which includes offering abortion services,” the statement said. Connors would not comment further.

    Outer Cape Health Services also does not offer either medication or surgical abortions. The OCHS spokesperson did not return a call seeking comment.

    Last summer, OCHS’s Gerry Desautels told the Independent that the clinic’s providers would not write prescriptions for abortion medication but that its pharmacies would fill such prescriptions written by other providers.

    A study published in the Journal of the American Board of Family Medicine by researchers at the University of California found that most primary care or family doctors, like those at Outer Cape Health Services, will not prescribe abortion medications because of layers of state and institutional restrictions. These include regulations that require abortions to take place only in surgical settings, according to the study. Researchers also found that the Food and Drug Administration’s Risk Evaluation and Mitigation Strategy requirements related to dispensing mifepristone add to the regulatory burdens.

    The FDA’s regulations are a big hurdle for primary care doctors, said Kristina Shepherd, founder of Lilith Care, a Rhode Island-based company that offers the abortion pills by mail with a telehealth appointment to women living in Massachusetts, Rhode Island, and Hawaii.

    State Sen. Julian Cyr of Truro said the Health Imperatives grant is a major victory for the Cape, where abortion care has not been available since 2008. Because Health Imperatives has clinics on Nantucket and Martha’s Vineyard, islanders will now be able to obtain medication abortions without getting on a boat, Cyr said.

    Providing medication abortions in Hyannis will be a good way to see how many women seek them out, Cyr said. After monitoring use of the service for a year, he said, Cyr and state Rep. Sarah Peake will assess if there is a need for additional funding and political support for expanded services.

    “The Dobbs decision has profoundly changed the dynamic around abortion in a very positive way,” said Cyr, referring to the Supreme Court’s striking down federal protections for abortion rights. “There was a historic fear surrounding abortion in the pre-Dobbs environment. Post-Dobbs, everyone is reassessing.”

    Provincetown-based Helping Our Women (HOW) Executive Director Gwynne Guzzeau said making abortions available in Hyannis will save HOW money. The nonprofit drives women from the Outer Cape to medical appointments. It will cost less to go to Hyannis than to the Boston area for abortion care, Guzzeau said. About 40 percent of HOW’s clients are of child-bearing age; women don’t often come to HOW with reproductive health needs, she said.

    “But anything that improves access to abortion care, that is huge,” Guzzeau said.

    HEALTH CARE

    Abortion Rights Bill Lacks Cape Cod Access Expansion

    The bill protects reproductive health providers from prosecution by other states

    By

    Although women’s rights advocates are cheering the passage of a reproductive rights act, the new state law doesn’t do anything to improve the situation on Cape Cod, which has been called an “abortion access desert.”

    The law signed by Gov. Charlie Baker earlier this month protects out-of-state women seeking abortions from prosecution and was praised by the Outer Cape’s state legislators. It shields doctors from lawsuits for performing abortions on women from states that ban abortion and mandates insurance coverage for reproductive care and increased access to emergency contraception.

    “Frankly, it is a great piece of legislation,” state Rep. Sarah Peake of Provincetown said, adding a caveat. “What it doesn’t do,” Peake said, “is broaden abortion services across the Commonwealth. That is a separate issue and a separate struggle.”

    State Sen. Julian Cyr of Truro said that, while “the bill is very important from a rights perspective, it’s not an access bill.”

    The nearest clinic to the Outer Cape that provides comprehensive abortion care is in Attleboro, 110 miles from Provincetown.

    “I find it outrageous that women who live on the Cape have to travel off Cape, sometimes as far away as Boston, to access these services,” Peake said.

    Outer Cape Health Services (OCHS), the sole provider of health care on the Outer Cape, does not provide abortion services. Officials have offered conflicting reasons for that policy.

    OCHS is a federally qualified health center. Under the Hyde Amendment — first enacted in 1976 — FQHCs are prohibited from using federal funds to provide abortions. But the Hyde Amendment does not prohibit such centers from providing abortion services altogether.

    Gerry Desautels, an OCHS spokesman, first told the Independent that the Hyde Amendment prevents the organization’s practitioners from prescribing abortion medication.

    When the accuracy of that statement was challenged by a reporter, OCHS issued an amended statement: “Our current focus is to provide and sustain core primary care and behavioral health access to the community which can include referrals to other medical and specialty care providers. On-site abortion services are not being considered at this time.”

    Desautels noted that while OCHS providers don’t write prescriptions for abortion medication, OCHS pharmacies will fill those prescriptions written by other providers.

    Peake said the solution rests with Washington.

    Community health centers, she said, “are gagged, in effect tied up by the Hyde Amendment. It’s an outrage that the U.S. Congress has allowed [the Hyde Amendment] to stand.”

    Cyr said there are other issues beyond that amendment.

    “They’re having a hard time finding primary care physicians,” he said of OCHS. “To identify and recruit a provider who could administer abortions and all the logistics involved in that — that would be a very heavy lift.”

    Peake hopes that a solution to the Cape’s abortion access issues may be jump-started by the urgency over protecting abortion rights after the U.S. Supreme Court’s decision to overturn Roe v. Wade.

    “There is momentum for the efforts to curtail these services that will lead in the long run to us broadening access,” Peake said, “which I hope will include a provider, or two, or six, here in Barnstable County.”

    The Independent previously reported that the Mass. Dept. of Public Health (DPH) could potentially deny Cape Cod Hospital’s $137-million expansion plan because Cape Cod Healthcare — the hospital’s parent organization — restricts access to abortion care.

    The DPH reviews such plans and makes a “determination of need,” which includes access to care. But Cyr said that forcing or pressuring Cape Cod Hospital to review its abortion protocols is not within DPH’s power.

    “DPH’s ‘determination of need’ doesn’t have any teeth,” Cyr said. “Even if DPH wanted to [expand abortion access], I don’t think they have that authority.”

    Cyr said that expanded abortion access, especially on the Cape, probably won’t come in the form of a bill or mandate.

    “There are a lot of conversations about geographic access,” Cyr said. “But it’s something you can’t necessarily legislate. You have to either appropriate dollars for it or you have to work in coalition to make it happen.”

    Peake agreed: “Programs like this get established more through meetings, planning, and outreach after which any necessary regulations are changed or statutes are enacted,” she said. “Not by mandates without all of the upfront work taking place. That upfront work is ongoing.”

    Peake did not specify what work was currently going on. She said she was not directly involved in it.

    Both Cyr and Peake still have hope for the future.

    Although the legislative session ended Aug. 1, Peake said that abortion access on the Cape is “something that we can and will revisit next session.

    “Just because we may not be taking any more recorded votes in the legislature, that doesn’t mean the legislative work stops,” she said, adding that “where we are now is the conversation, education, information sharing, and community consensus building around this issue.”

    “We’re working hard to figure out a menu of solutions,” Cyr said. “And I’m hopeful that in the coming months we can identify a path forward to have abortion care on Cape Cod.”

    ACTIVISM

    A Statewide Trek to Protest Dobbs Ruling

    Andrew Fitch walked 325 miles in 24 days, ending in Provincetown

    By

    PROVINCETOWN — Andrew Fitch of North Adams was troubled on June 24 when he heard that the Supreme Court had overturned Roe v. Wade, which guaranteed abortion rights across the U.S.

    After creating a spreadsheet of ideas of what he could do, Fitch decided to walk 325 miles across the state, beginning in Williamstown and ending at the Pilgrim Monument in Provincetown. For each mile Fitch walked, he donated $1 to the National Network of Abortion Funds. Through fundraisers on Facebook and Instagram he was able to raise an additional $3,803, bringing his total to $4,128.

    Andrew Fitch in Provincetown after walking across the state. (Photo courtesy Andrew Fitch)

    Fitch, 37, doesn’t consider himself particularly athletic; this was his first epic trek. He packed five T-shirts, three pairs of underwear, two pairs of hiking socks, a pair of jeans, his laptop, and a journal. After three days he shipped the jeans and a few T-shirts home — they were adding too much weight — and bought hiking poles and Band-aids for his many blisters.

    In planning his route, Fitch made a point to avoid highways and stop in “charming” towns along the way. It was, Fitch said, an excellent way to “reconnect with my home state.” Fitch grew up in Marshfield and recently moved to North Adams after spending almost 10 years off and on in the Bay Area.

    Fitch had expected the trip to take two weeks, but it ended up taking three due to blisters and other injuries, including a dislocated knee “somewhere between Northampton and Worcester.” He stayed with friends and family most nights, securing a bed, shower, and most important: laundry.

    Fitch admitted to conceiving the idea to walk across the state before the Supreme Court’s Dobbs ruling that overturned Roe. But “it always seemed to me that it would be irresponsible to do something like this and not make it a fundraiser,” Fitch said.

    Fitch is a newcomer to walking across states, but not to social justice campaigns. He likes to keep his efforts unconventional, he said, like posters for abortion rights and human rights that he keeps in the windows of his buildings in North Adams.

    REPRODUCTIVE HEALTH

    Abortion Access Is Unclear on Cape Cod

    Nearest clinic with comprehensive care is 110 miles away

    By

    HYANNIS — Relying on a June 28 statement from Cape Cod Healthcare (CCHC), the Independent reported two weeks ago that abortion services are not available anywhere on Cape Cod. That, it turns out, is not the whole story.

    In response to requests from the Independent for additional information, CCHC, which owns the Cape’s two hospitals and most of its other medical facilities and practices, provided a new statement the next day confirming that it does, in fact, provide abortions in cases “where underlying medical issues and out of concern for the wellbeing of the mother, a higher level of care is required than could be achieved in a freestanding outpatient center.”

    The nearest clinic to the Outer Cape that provides comprehensive abortion care is in Attleboro, 110 miles from Provincetown. Others are in Boston, at least 114 miles away.

    Efforts by reporters and editors to get more information about the kinds of underlying medical issues that would qualify a patient for an abortion at Cape Cod Hospital were unsuccessful. Similarly, hospital sources would not explain how they arrive at those decisions.

    In a July 6 email to the Independent, CCHC Senior Vice President Patrick Kane wrote, “That’s a clinical decision based on many factors — age, health condition, family history, term of pregnancy and dozens of other factors — and our docs are not going to comment on hypotheticals.”

    Kane did not respond to a question asking whether Cape Cod Hospital has an ethics committee. Such committees often make decisions at hospitals on whether procedures are medically necessary.

    Kane and Marketing Communications Manager Lisa Connors also did not respond to questions about whether CCHC doctors would prescribe the abortion medications mifepristone and misoprostol, which are effective in the first 10 weeks of pregnancy. Kane told a reporter to stop trying to contact CCHC doctors directly because, he said, “our corporate policy requires that all employees direct media calls to our office.”

    A Letter to Baker

    Meanwhile, in a reaction to the Supreme Court’s reversal of Roe v. Wade on June 24, the Eastham Select Board has spoken out forcefully in favor of abortion rights and, at its meeting on July 11, signed a letter to Gov. Charlie Baker supporting his commitment to protect reproductive rights in Massachusetts.

    “The Eastham Select Board is proud of Massachusetts and its leaders for taking fast action and a critical stand during this trying time,” the letter read. “We, the Eastham Select Board, endorse the swift actions of Governor Baker and the State of Massachusetts and will stand by the Executive Order to protect access to reproductive health care services.”

    Eastham Select Board member Aimee Eckman said the lack of abortion access on the Cape is a serious problem, especially for those on the Outer Cape.

    “I’m shocked that hospitals don’t provide it,” Eckman said. “I don’t really understand why that is, especially when there are no services locally. The hospital is far enough from Provincetown as it is. [Abortion care] is health care, for god’s sake.”

    Fellow board member Suzanne Bryan agreed. “Even in a state that is liberal, it’s still not easy to access,” she said. “It’s just one piece of the larger puzzle of not having robust health services on the Outer Cape for younger people.”

    Access to Medication

    There are two different methods of getting an abortion, according to Planned Parenthood: the abortion pill or an in-clinic or in-hospital abortion. Ninety-five percent of all abortions in 2017 took place in clinics, according to the Guttmacher Institute. In recent years, medication abortions, available from pharmacies by prescription, have become much more common early in pregnancy.

    The abortion pill consists of two different drugs, mifepristone and misoprostol, which can be taken at home, and can cause side effects that resemble a heavy menstrual period. The process, according to Planned Parenthood, is similar to an early miscarriage. The medications can be taken up to 10 weeks into a pregnancy.

    The Independent has not been able to confirm whether medication abortion is available from Cape Cod’s doctors.

    Spokesman Gerry Desautels at Outer Cape Health Services said that its physicians do not prescribe abortion pills because OCHS is a federally qualified health center and therefore is prohibited from providing abortion services by the Hyde Amendment — legislation that bars the use of federal funds to pay for almost all abortions.

    The Independent contacted 17 providers of obstetrical and gynecological care on Cape Cod who are not associated with OCHS. Those who were reached declined to say whether they will prescribe abortion medication, while others did not respond to messages.

    The Washington Post reported in 2016 that doctors often face challenges from hospitals for speaking out about abortion services they provide. The Post noted that “hospitals comprise more than one third of the nation’s abortion providers” but that “most do this work quietly, compared to the more visible standalone clinics such as Planned Parenthood.”

    Massachusetts law places no restriction on abortions up to 24 weeks into a pregnancy, and abortion services are not restricted to obstetricians and gynecologists: physicians, physician assistants, nurse practitioners, and nurse midwives all may perform abortions.

    After 10 weeks of pregnancy, women can get an in-clinic abortion procedure. After 24 weeks, the law says that abortions may be performed only “to preserve the life of a patient,” “to preserve the patient’s physical or mental health,” or if there is “a lethal fetal anomaly or the fetus is incompatible with sustained life outside the uterus.”

    On July 6, Mass General Brigham, one of the largest hospital organizations in the state, issued a statement affirming its commitment to providing comprehensive abortion services.

    “The Supreme Court ruling does not change the right to an abortion for patients receiving care in Massachusetts,” the statement read. “Mass General Brigham will continue to provide high-quality care to all patients who come to us for care. We will do this no matter what state or country they come from. We respect the very personal, and sometimes very difficult, decisions that patients make together with their care teams.”

    ABORTION RIGHTS

    On the Front Lines in Waco, Texas

    Truro’s Dr. Nicola Moore has served women’s needs across the nation

    By

    TRURO — Every two weeks for the last five years, Dr. Nicola Moore has made the 1,800-mile trip from Massachusetts to the Planned Parenthood clinic in Waco, Texas, where she provides abortion services, birth control, and miscarriage management to women who live in one of the most conservative states in the country.

    Truro’s Dr. Nicola Moore has served women’s needs across the nation

    Moore grew up in Los Angeles and spent summers in her family’s cottage in Truro, where she still stays during the weeks when she’s not in Texas. She spoke with the Independent about the events of the past week.

    Planned Parenthood of Greater Texas stopped providing abortions on June 24, as soon as the Supreme Court decision overturning Roe v. Wade was announced. The organization’s lawyers are studying what is now legal in Texas, said Moore.

    Thirteen states have “trigger” laws in place banning abortion, written to go into effect if Roe was overturned, according to the Guttmacher Institute, a research organization focused on reproductive rights. The Institute expects as many as 26 states to ban abortion in reaction to the Supreme Court ruling. Many trigger laws have no exceptions, including in cases of rape or incest.

    Texas has both a trigger law and pre-Roe abortion ban on the books. “That pre-Roe law is what most of the abortion providers in Texas are studying,” Moore said.

    Meanwhile, the mood at the clinic has been “extremely sad.”

    “I’m just depressed,” said Moore. “It feels like the day after Trump was elected in November 2016, but a bit more hopeless, because more is known about what the future holds.”

    Most patients who come to the Waco clinic are the working poor, she said. “About half have no health insurance; most have young children,” she said. “Occasionally there will be an affluent patient, because this is the only place within 100 miles that provides abortion services.”

    Protesters frequently gather outside the clinic, yelling at the patients as they enter, Moore said. Some clinics have volunteers who escort patients inside. A fence at the Waco clinic keeps protesters out of the parking lot, so they have access to patients only as they drive in. A “tall and burly security guard” escorts women from their cars to the clinic and back again, said Moore, but many women are visibly shaken when they get inside.

    “It’s hard on the patients, who have never before been yelled at by strangers when they go to see a doctor,” Moore said. “We can tell how nasty the protesters are on a given day by how upset the patients are.”

    Moore said she has not herself been harassed, “other than being yelled at by name every day in Texas.” In fact, she is a frequent target of national anti-abortion groups.

    In 2017, Pro-Life Waco featured two photos of Moore. One was captioned, “Here is ‘Dr.’ Nicola Moore walking into PP in Waco to begin a day of shedding innocent blood.”

    Moore said that all her colleagues at the clinic live in Waco and care deeply for those who come seeking help.

    “Every woman has a poignant story,” she said. “Barely scraping by with the three children she already has; an abusive boyfriend she doesn’t want to be around forever; a disabled child who requires all her attention; a heartbreaking stillbirth, or a child’s death that leads her to say, ‘I just can’t be pregnant again’; a 40-year-old involved in a post-divorce fling who says, ‘No way.’ ” And the list goes on.

    “Many women I see in Texas say they don’t approve of abortion and that ‘I never thought I’d come here,’ ” said Moore. “No one wants an abortion — and no one ever expects to have one.”

    Although the abortion rate has generally declined since the 1990s, abortion is still a common experience for U.S. women. About one-quarter (23.7 percent) will have an abortion by age 45, according to a 2017 Guttmacher Institute analysis.

    Moore, now 66, has worked with Planned Parenthood in the Midwest and Southwest since 2009. Each clinic operates independently and requires her to be licensed in its state.

    “I want to work where I’ll be useful and where clinics have difficulty finding doctors,” she said. That has included clinics in South Dakota, Iowa, and Nebraska.

    She earned a B.A. from Yale University as well as a master’s in public health, then spent several years as a health-care administrator. At age 39, Moore entered medical school, graduating in 1999. She completed her residency in family medicine in Rochester, N.Y. and then spent a year as a research fellow focusing on reproductive health services.

    With her training completed, Moore says, she wanted to practice medicine in underserved areas. From 2003 to 2009, she worked predominantly in Zimbabwe.

    “Except in South Africa, abortion was illegal,” she said. “I did a lot of obstetrics there as a general doctor.”

    Every hospital had a ward for pregnant women who were experiencing pregnancy-related medical issues. Women came in bleeding, Moore said.

    “You couldn’t tell whether they were miscarrying or did it themselves,” she said. “The women were very sick, suffering from infections. I saw several women die.” Some were brought in wearing handcuffs, having been reported to police for trying to abort the fetus, said Moore.

    Her experience in Africa prompted her to seek training in abortion procedures. After returning to the U.S., she began working at Planned Parenthood clinics.

    “I wasn’t predestined to be an abortion doctor,” said Moore. “I landed in it because of a political commitment to choice, and I discovered that it’s interesting and very rewarding work.”

    While Planned Parenthood and other women’s rights organizations sort the issue out in court, Moore plans to keep doing whatever she can for those seeking help.

    “I’ll be back in Texas for one more week to do follow-ups on patients I treated last week,” she said on Monday. After that, “I’ll work at a Planned Parenthood in a state where abortion is legal, close to states where it is not.”

    Moore believes there will be money available from nonprofit organizations to help women cover the costs of traveling out of state and staying overnight, and for the abortion procedure itself.

    “The messier issue is for a woman to make the decision to leave her state rather than being able to go to a local clinic with local people taking care of her,” she said. “And in many cases, nobody knows: the boyfriend doesn’t know and the father doesn’t know.”

    Added to that may be a need to take time off from work and arrange care for other children. Making the arrangements is more complicated for women who don’t speak English, Moore added.

    Women seeking abortions come from all walks of life, she said: “They’re really just folks in a difficult situation who have made a decision that this is the best choice for them.”

    WOMEN'S HEALTH

    Abortion Services Still Missing on Cape Cod

    The nearest clinic is more than 90 miles away

    By

    WELLFLEET — Ever since the Women’s Health Center in Hyannis closed in 2008, abortion services have not been available anywhere on Cape Cod.

    The nearest abortion clinics are more than 90 miles away in Boston and Attleboro, according to state Sen. Julian Cyr.

    In a May 3 tweet, Cyr wrote that “on the Cape & the Islands, there is NO access to abortion — that MUST change.”

    Cape Cod Healthcare (CCH) owns the Cape’s two hospitals and numerous clinics and medical facilities but does not offer abortion services at any of them. Patrick Kane, CCH’s senior vice president for communications, would not directly respond to a question about the policy but said “we are working with our legal team” on an answer.

    CCH spokesperson Lisa Connors issued a written statement: “While Cape Cod Healthcare does not offer abortion services, our OB/GYN providers are available to counsel patients and provide multiple resource options within the state.”

    Cyr said he had not pushed CCH officials on the abortion issue in the last three years or so, and that the last time he had pressed them for an explanation of their policy they had told him, “We can’t touch this.” He suggested that one factor in CCH’s position may be the fact that a woman had died at the Hyannis abortion clinic before it closed in 2008. “That may be contributing to their allergy,” said Cyr.

    Transportation is one of the major barriers Outer Cape residents face in accessing health care, including abortions, according to Gwynne Guzzeau, executive director of the nonprofit Helping Our Women (HOW).

    “The burden of arranging transportation from this geographically isolated area extends to all women, regardless of their financial needs,” Guzzeau said.

    HOW provides transportation to health-care appointments — including abortions — in the Boston metropolitan area regardless of clients’ income. HOW’s other services, including funding for health-care fees up to $65 per month, require that participants’ income be 210 percent or less of federal poverty level.

    At the Eastham Select Board meeting on June 27, chair Jamie Demetri said that she had had an abortion off Cape. While she said her experience with Cape Cod Healthcare personnel was positive, she noted that, for those “not as mobile as I am,” getting help would probably have been more difficult.

    Demetri also expressed concern that there was no Planned Parenthood clinic on Cape Cod.

    Even if a Planned Parenthood clinic doesn’t offer abortions, it provides other services, such as birth control and testing for sexually transmitted diseases, that may be difficult to get for free or anonymously.

    “The nice thing about Planned Parenthood is it’s an automatic safe space,” Demetri said. “It’s a place that you can walk in and know you can get those services no matter what.

    “The only reason I was able to access any sort of birth control when I was young was because I had a supportive family,” Demetri said. “I also acknowledge that there aren’t a lot of families that do that. And I think, for those kids, that’s when access becomes an issue.”

    Cyr said on Tuesday that there has been “an active conversation underway with Planned Parenthood to open a clinic in Hyannis.”

    HEALTH

    Threat to Roe v. Wade Spurs Outer Cape Women to Action

    Lacking local access, but standing up for rights at state level

    By

    Outer Cape women activists
    Members of Cape Cod Women for Change attended a Joint Judiciary Committee hearing in Boston last June. Left to right: Sheila Mulcahy, Wendy Manley, Penny Duby, Janet Joakim, and Laurie Veninger. (Photo courtesy Laurie Veninger)

    Laurie Veninger of Truro is organizing Cape Cod women to lobby lawmakers on Beacon Hill on Thursday, Nov. 14 in support of a bill aimed at protecting and expanding abortion rights under current state law. The bill, S. 1209, is titled “An act to remove obstacles and expand abortion access.” As of Monday, 24 Cape Codders were signed up for the bus trip. They expect to join hundreds of activists from around the state.

    The action has been organized by the Roe Act Coalition, a Massachusetts group founded by NARAL Pro-Choice Mass., the A.C.L.U. of Mass., and the Planned Parenthood Advocacy Fund of Mass.

    It’s part of a nationwide movement to pass state laws to strengthen abortion rights. S. 1209 would be the first major overhaul of Mass. abortion law since 1974.

    Veninger is a leader of Indivisible Outer Cape and of Cape Cod Women for Change. She said that, with abortion rights protected at the federal level by the Supreme Court’s 1973 ruling in Roe v. Wade, state law has not been called upon to play a role — but that could now change.

    “For decades nobody’s been concerned with state law,” she told the Independent, “but now that there’s the possibility of losing Roe v. Wade, we’d revert back to these antiquated laws and language.”

    Mass. General Law chapter 112, section 12L provides that abortion is legal before 24 weeks of pregnancy “only if, in the best medical judgment of a physician, the abortion is necessary under all attendant circumstances.” Section 12M of chapter 112 bans abortion after 24 weeks unless it is necessary “to save the life of the mother, or if a continuation of her pregnancy will impose on her a substantial risk of grave impairment of her physical or mental health.”

    Proposed changes would replace sections 12L and 12M with a requirement that the state “shall not interfere with a person’s personal decision and ability to prevent, commence, terminate, or continue their own pregnancy,” and would expand abortion access after 24 weeks to include cases “of lethal fetal anomalies, or where the fetus is incompatible with sustained life outside the uterus.”

    S. 1209 would also change the use of terms like “mother” and “unborn child” to “person” and “human embryo or fetus.” Proponents of these changes argue that the older usages are inaccurate because a person is not a mother until after giving birth and a fetus is not a child until it is born.

    Cape Cod’s only abortion clinic, Woman Care in Hyannis, closed in 2008 after a patient died from wrongful anesthesia administration. Currently women who live on the Outer Cape must travel to either Attleboro or Boston to obtain abortion services.

    Outer Cape Health Services CEO Pat Nadle said that her staff can discuss abortion options with patients but do not offer referrals.

    “We are a federally qualified health center,” said Nadle in a phone interview. “If you take federal funds you have to abide by a certain set of requirements. One is that you cannot actively refer patients for pregnancy termination.” She added, “In most cases, patients refer themselves.”

    A federal program called Title X, established in 1970, protected women’s right to receive nondirective information about abortion. Earlier this year, the Trump administration changed the regulations governing Title X, including striking that protection. That move, however, does not appear to have changed Outer Cape women’s access to information.

    That’s because Title X funding, Nadle said, was put in place for patients without insurance or who could not afford reproductive or sexual health services.

    “Because we live in Massachusetts, pregnant women are automatically covered by Mass. Health, so we have never needed to tap into that funding source at Outer Cape,” Nadle said.

    Per its federal funding mandate, Outer Cape Health Services staff cannot provide abortions and do not prescribe misoprostol, a medication that can induce abortion in the first 10 weeks of pregnancy.

    Currently 13 states have passed laws that protect the right to abortion, while 19 have laws that would significantly restrict abortion access should Roe v. Wade be overturned. Many of the near-total bans on abortion (restricting the procedure to before the sixth week of pregnancy or even earlier) passed in 2018 and 2019 have been blocked by courts.

    “We are lucky that in Massachusetts women’s reproductive rights are not really a partisan issue,” said state Sen. Julian Cyr, who is a cosponsor of S. 1209. “The Roe Act is about continuing to make sure that we safeguard a woman’s ability to access reproductive health care and a woman’s right to choose in an increasingly hostile federal environment. We want to make it clear that we will continue to protect these rights regardless of what happens at the federal level.”

    Passing the Roe Act at the state level would not expand abortion access for women living on the Outer Cape, however, said Cyr.

    “For people who live on Cape Cod,” he said, “there’s already limited or no access to these services, and that is unfortunately unlikely to change.”

    Because of a reporting error, the print version of this article erroneously identified the Hyannis abortion clinic that closed in 2008 as a Planned Parenthood facility. It was not affiliated with Planned Parenthood.

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