Lourdes Rivera: Pregnancy Justice

0:00:00.3 Celeste Watkins-Hayes: I am Celeste Watkins-Hayes, the Joan and Sanford Weill dean of the Gerald R. Ford School of Public Policy here at the University of Michigan. I'm also founding director of the Center for Racial Justice, and I am delighted to welcome all of you this afternoon to our policy talks at the Ford School event.

0:00:17.5 CW: Today's event is supported through Gilbert S. Omenn and Martha A. Darling Health Policy Fund. Established in 2001 by their generosity, the fund provides funding for health policy faculty and health policy outreach activities, which allows the Ford School to address a spectrum of health policy issues.

0:00:39.3 CW: I sincerely thank Gil and Martha for their support. Thank you so much and thank you for being with us today.

[applause]

0:00:49.2 CW: This 2023 Omenn-Darling Health Policy Lecture features Lourdes Rivera, President of Pregnancy Justice. Her organization fights the ways that people's rights are threatened because of pregnancy or any pregnancy outcome, including pregnancy loss, abortion or birth.

0:01:07.7 CW: Through legal defense, public education, advocacy and research and documentation, it seeks to challenge harm caused by unfair state criminalization.

0:01:18.7 CW: Among many other achievements, her career has included leading legal and policy programs at the Center for Reproductive Rights and implementing the Ford Foundation's US and global grant-making strategy in sexual and reproductive health rights.

0:01:33.6 CW: Lourdes received her Law degree from Yale University, and also has been an adjunct professor at the Columbia University Mailman School of Public Health.

0:01:43.7 CW: Reproductive justice has been at the forefront of political and policy debates for more than 50 years and gained increased intensity after the Supreme Court's decision to overturn Roe v. Wade. The issues continue to animate public discourse and elections. We look forward to this important healthcare conversation.

0:02:05.4 CW: Today's discussion is moderated by the Ford School's James B. Hudak Professor of Health Policy, Paula Lantz, a nationally renowned social demographer and social epidemiologist who studies the role of public policy in informing public health and reducing social disparities in health.

0:02:21.7 CW: Professor Lantz was recently named a university diversity and social transformation professor for her exceptional contributions to diversity, equity and inclusion through research, teaching and service.

0:02:34.6 CW: There will be time for questions at the end. For those of us here in the room, please use the QR code that you have on the program that we've distributed.

0:02:42.0 CW: For those who are watching, please follow the link on the event page, which can also be seen in our social media posts about the event.

0:02:52.1 CW: We have two Ford School students here who will help us with facilitating the Q&A. 2023 Rebecca A. Copeland Fellows, Jennie Scheerer and Olivia Morris. Wonderful to have you with us.

0:03:03.5 CW: With that, please join me in welcoming Lourdes Rivera and Paula Lantz.

[applause]

0:03:15.6 Paula Lantz: Good afternoon everyone, thanks so much for coming to this conversation today. I'm really honored to have the chance to have a conversation with Lourdes. We chatted a little earlier today and then decided we're really gonna save the conversation to share with all of you.

0:03:35.8 PL: Lourdes, thank you so much for taking time out of your incredibly busy schedule to come to Ann Arbor on one of our typical November gray days, right? But thanks for coming and sharing your insights and expertise with our community today.

0:03:52.3 PL: I have some questions I'm going to ask her. We'll go back and forth a little bit, and then later we'll turn it over to all of you and get your questions and have more of a group conversation.

0:04:05.2 PL: Lourdes, we always, because we're educational institution and our students are at the forefront, I do wanna start with asking you to share with us a bit about your own career journey and what brought you to this relatively new position for you as president of Pregnancy Justice.

0:04:24.0 PL: When you were in law school, what were you envisioning your career would be? Did it pivot and change? It always does, right? And what were your personal entry points into reproductive rights and justice? 

0:04:35.5 Lourdes Rivera: Great. Well, first of all, thank you for having me here. I am so honored and delighted to be here with you all. It is such a great opportunity. I met earlier with a group of students and they were just phenomenal, so thank you so much.

0:04:50.5 LR: I like to start answering this type of question with my personal journey, because that really was the driver for me wanting to do this work.

0:05:03.3 LR: So my grandmother, my abuela, Carmen, she was born in the southern coast of Puerto Rico, to a family that basically, they were slave plantation workers on a sugar cane plantation. She was born about 20 years after slavery was abolished in Puerto Rico.

0:05:27.0 LR: But she did not have a lot of agency. She had 14 pregnancies, 10 live births, and nine children that lived into adulthood. So I'm sure her life could have been extremely different.

0:05:42.5 LR: And I have to tell you, abuela Carmen was a tough cookie. She outlived my grandfather, like 50 years. But still, that was quite an experience for her.

0:05:55.6 LR: And Puerto Rican women on the island and in the US also have a history of reproductive oppression. One-third of my mother's generation were sterilized without informed consent.

0:06:09.3 LR: Puerto Rican women's bodies were used to develop the pill with experimentation. Again, without informed consent. And this was a history that I later learned in college that it was a shared experience with other women of color, with poor women, women with disabilities.

0:06:32.3 LR: Fannie Lou Hamer, civil rights activist, called sterilization abuse the "Mississippi appendectomy" because it was so common for Black women's bodies as well. Chicana women on the West Coast, indigenous women really had similar experiences.

0:06:48.0 LR: So this was one entry point, and for this role in particular, I feel like all roads have led here. I also grew up in Bedford-Stuyvesant, Brooklyn, which if people know about it now, it's more gentrified, but in the '70s and '80s, it was a place where the War on Drugs was really wielded against our community.

0:07:17.1 LR: Rather than investing in harm reduction and treatment and investment in schools, desegregation, housing, it really was an approach about surveillance and policing and incarceration, so much so that able-bodies, swathes of able-bodied people were removed from my community.

0:07:40.6 LR: So all of these things really informed my career trajectory, my interest and passion for social justice, and later reproductive justice in particular, that gave me a framework to put these things together.

0:07:55.4 LR: In terms of law school, I actually was going to go to medical school. And I, funny story, I couldn't get over the sight of blood. [chuckle] So I needed a plan B, and that plan B was law school.

0:08:10.5 PL: And no blood in law school.

0:08:11.0 LR: No blood in law school. At least not on a daily basis.

[chuckle]

0:08:18.1 LR: And I ended up being a health lawyer, low income health lawyer, working on Medicaid issues. And I brought in the reproductive health piece into the work that I was doing, just because it's always been part of the fabric of my experience.

0:08:39.7 LR: So I will pause there, but that's really my formation. Oh, the one last thing I would say is, my first repro job in the movement was at the ACLU Reproductive Freedom Project as a law student intern and Lynn Paltrow, who's the founder of Pregnancy Justice, was my supervisor. [chuckle]

0:09:06.4 LR: So all roads have led here.

0:09:08.0 PL: So you were an intern in the organization you are now leading? 

0:09:12.8 LR: No, no, no, this was before she founded the organization.

0:09:15.2 PL: Oh, okay.

0:09:16.6 LR: But that's when I first made that individual contact with her.

0:09:20.3 PL: That's why internships are important.

0:09:22.0 LR: Yes they are. Relationships are important.

0:09:25.2 PL: Relationships. Great. Well, please tell us more about your organization, Pregnancy Justice. What is your mission, what are your key advocacy issues? 

0:09:37.4 LR: Sure. Well, we heard a little bit about it in introduction. Pregnancy Justice advocates for and defends the rights of people who are pregnant, pregnant women who are criminalized or penalized because of their pregnancy status and across pregnancy outcomes, whether it's abortion, stillbirth, miscarriage or live birth.

0:10:07.1 LR: And this usually comes up in the context of a pregnant person or a pregnant woman who is using substances and for some reason that is detected and reported to the family policing system, child welfare system, or directly to law enforcement.

0:10:28.4 LR: But there are other fact patterns here as well. Any type of action or behavior that government officials or local law enforcement deem to be harmful to one's own pregnancy or to the fetus, can really subject someone to surveillance and criminalization. Or potentially the loss of one's newborn or children.

0:10:57.2 LR: So it really... While the typical pattern now is in the context of substance use, it's certainly not the only, and it's expanding to other types of actions.

0:11:11.0 PL: What kind of work does your organization do? 

0:11:13.5 LR: We provide criminal legal defense. We work with local counsel, public defenders, we also do policy advocacy reform. We challenge junk science, because a lot of the criminalization and surveillance is really based on stereotypes and stigma and not evidence.

0:11:37.0 LR: So we also do legal and social science research with partners, and I understand that that is something that you all do and is really important to really generate that evidence.

0:11:52.5 LR: Not just for legal procedures in the court system, but also to help really inform narratives. The narratives that we're, the stories that we're telling publicly to really debunk the junk science, to really debunk the stigma and the stereotypes.

0:12:15.2 PL: We were talking a little bit earlier today about a case that you have regarding a woman in Alabama. You wanna share that? 

0:12:23.8 LR: Yes. Well, maybe I should first share some of the findings from the study because I think it puts a lot of context for that particular case. So we just released a report in September called The Rise of Pregnancy Criminalization.

0:12:40.3 LR: I should preface that by saying that pregnancy criminalization has been happening since Roe, since 1973, and perhaps before then. We did a prior research project that found around 413 cases of pregnancy criminalization or forced medical intervention between the years of 1973 and 2005, so they were about 413 cases. The report that we just released found almost 1400 cases in about half the time.

0:13:20.6 LR: So there's a trend of acceleration of pregnancy criminalization. And what's driving this, what's driving this acceleration are two things. One is the ideology of fetal personhood is gaining traction and being embedded in our state laws, and also providing a justification for aggressive prosecutors to even apply existing laws that were not meant to apply to pregnancy, beyond what the law was meant for.

0:14:00.7 LR: And then the second driver is the opioids and methamphetamine crisis. I think that we've had... We've made progress as a society in understanding drug use as a health, mental health and a public health issue, but except for people who are pregnant.

0:14:21.3 LR: And this is where the War on Drugs comes back. Those punitive approaches that were used against Black and Brown communities in the '70s and '80s are being applied to people who are pregnant.

0:14:34.5 LR: And the interesting thing we found with this research is that we had the hypothesis in the second research that we were gonna continue to find Black women to be the highest number or highest prevalence of people being criminalized. And indeed they are over-represented.

0:14:55.7 LR: But the highest number of people in proportion are actually White women. So the War on Drugs is actually coming home to roost on poor White people as well. So it's a story about the criminalization of poverty and the criminalization of race, in addition to criminalization of pregnancy.

0:15:19.4 LR: So the case we filed in Alabama... And Alabama is responsible for about half of these cases. So Alabama has a judicial opinion, a fetal personhood judicial opinion and statutory law.

0:15:40.4 LR: And there's one particular county in Alabama, Etowah County, where it's very aggressive. So there are people in prison who are pregnant for harming their fetuses.

0:15:55.3 LR: And so our client has been in jail and is in jail. She was in jail waiting for pre-trial. So it's pre-trial. And while she was there, she was refused prenatal care, she was refused access to her prescribed mental health medication.

0:16:20.2 LR: She went into labor and delivery and no one assisted her. She delivered herself after 12 hours of laboring and delivering. She caught her baby. She delivered in a prison shower and then she passed out in her own pool of blood. Right after she handed her baby to prison officials. And when she woke up, they were taking pictures with her baby while the baby was still connected to her umbilical cord.

0:16:50.2 LR: So we filed a federal district court case asking for damages on behalf of our client. Because this is just cruel, degrading inhuman treatment. It's akin to torture. If you hold it up against International Human Rights standards, this would be recognized as torture.

0:17:19.7 PL: It's shocking and shameful.

0:17:20.8 LR: Yeah.

0:17:24.3 PL: I think a lot of people might think that forced sterilization is a thing of the past. Do you want to tell us a bit about how you see the problem and well into the 21st century here? 

0:17:37.8 LR: Yes. Sadly, this is an issue that still crops up every now and then. The not too far distant past, women in California prisons were being sterilized. I think we've all heard more recently, the Georgia detention center where women were being subjected to gynecological procedures that they didn't need without informed consent. So every now and then it pops up.

0:18:11.5 LR: During the War on Drugs, Black women and Brown women in particular who were struggling with substance use, were being pressured to become sterilized. Instead of being offered substance use treatment and support, and the social supports that people need to address substance use, the answer was, "Well, just be sterilized and then you can go off and continue using drugs and we don't care about you anymore." Right? So it keeps coming up as an issue.

0:18:49.6 LR: And the other thing about the War on Drugs is that it was really maligning Black and Brown women, Black and Brown communities. It was the myth of the crack baby. That we were gonna have thousands and thousands of crack babies. Well, that never materialized because that was based on junk science.

0:19:08.9 LR: And so we see these patterns replay in different ways throughout history, but we have these opportunities to just, to break these cycles.

0:19:25.7 PL: Yeah. In these interconnections between assaults on reproductive rights and wars on drugs and really focusing on marginalized populations, can you talk a little about how you see the pipeline for these things happening that sometimes involve clinicians and other healthcare workers, and people who work for departments of Children Services and Child Protection Services? 

0:19:54.9 LR: Yeah, absolutely. So in our experience and in our data set, we found that around 40% of these cases that end up in... That end up in arrests, are initiated by healthcare professionals.

0:20:12.1 LR: So what happens is people share their drug use history in, either in the context of a prenatal care visit, because they want help, they're trying to get appropriate healthcare for good health outcomes.

0:20:28.0 LR: Or during labor and delivery, people are tested. There the babies are tested without their informed consent. And then next thing they know, there's a law enforcement officer at their bedside, right? 

0:20:43.8 LR: Or there's a Child Protective Services person at their bedside, taking the infant away and investigating their home and taking the rest of their children away. So these are things, these are patterns that we're seeing.

0:21:00.4 LR: And I think it's a combination of things. People believe they're doing the right thing. And again, it's not necessarily based on evidence. Major medical... All the major medical associations say either that you should not be testing people just indiscriminately, that there has to be a particular medical need to do it. What is the particular medical need? 

0:21:25.0 LR: And then secondly, they oppose criminalization of pregnancy. Because it really is counterproductive to good health outcomes, maternal health outcomes and infant health outcomes. Just think about it. If you know that you're gonna get locked up because you went to the doctor, are you gonna go to the doctor? No.

0:21:47.9 LR: And it's really important for people who are pregnant to receive prenatal care for good maternal health and infant health outcomes. It's really important for people with substance use issues to be able to receive appropriate substance use treatment and supports if they're ready for that.

0:22:08.7 LR: So it's a really counter-productive thing. So I think people really have to examine, the health professionals really need to examine, is this based on evidence? Is this best practice? So that's one thing.

0:22:26.6 LR: The other driver of this, I think, is an over-interpretation of mandatory reporting laws. There are people who are mandatory reporters for child abuse and neglect, but one positive tox screen does not mean that there's child abuse and neglect happening. There should be other evidence.

0:22:53.4 LR: And just based on that one tox screen, people are getting reported. And then they just spiral, their lives just spiral out of control because now they're involved with law enforcement and with Child Protective Services. Unnecessarily.

0:23:12.4 LR: And that's a really big pattern that we've seen.

0:23:16.8 PL: On that issue, what do you recommend? Are there clinical guidelines that need to be changed, different kinds of training? I think probably good, well-intentioned people are erring on the side of caution, right? 

0:23:28.9 LR: Absolutely, absolutely. And I'm not subscribing ill intent on this, I just think that people just really need to... I think it is a matter of training. I think it's a matter of hospital policies really... I mean, health facilities should operate the evidence, right? 

0:23:50.0 LR: So on our website, we actually have guidance for health professionals, for lawyers, for public defenders, for social workers in Child Protective Services. So we have materials on our website with guidelines, recommended guidelines.

0:24:09.8 LR: We are advocating for stronger protections within HIPAA, which is the federal statute that protects medical information, to make it harder to transmit medical, private medical information to law enforcement.

0:24:27.3 LR: And we're advocating to either reform or clarify federal law, which is... The federal statute is called CAPTA, which is the federal statute that came about under the Nixon administration, that states misinterpret as federal law requiring that individual people have to be reported to Child Protective Services.

0:24:54.0 LR: And in fact, that's not the case. The reporting is data collection, or so that individuals can receive a safe plan of care. And that could be done with through discharge planning, with referrals, but yet it's being interpreted as you have to report that person.

0:25:15.4 LR: So I think there's a lot of education that can be done and also some clarification of policy.

0:25:23.7 PL: Great, thank you. Well, let's talk about a Supreme Court decision that came down last summer, in Dobbs, and what the legal landscape for abortion policy is in the US right now.

0:25:42.8 PL: Of course, everyone here knows what happened in Ohio yesterday, so let's maybe first get your reaction to that? 

0:25:49.5 LR: Yes. Yes, we can clap. We can clap.

[applause]

0:25:52.5 LR: We're happy about that. Yeah. Well, the Dobbs... Let me start by saying that Roe v. Wade and Planned Parenthood v. Casey had established a national floor of legality. It did not guarantee access. Everybody understood, understands that Roe and Casey did not guarantee access.

0:26:22.0 LR: Because there was a lot of wiggle room, I used to call it, when we were still in that space, I used to use the analogy of the the carnival game, whack-a-mole, where the states kept passing restrictions and then you would try to go to hammer it with a lawsuit. And so that was the landscape then.

0:26:44.0 LR: What the Dobbs decision basically did was kick the question of legality back to the states. So now we have just utter chaos, where we have 14 states where abortion is completely banned. There's a handful of other states where there are bans that are so far blocked by courts.

0:27:15.3 LR: And for those people in those states, it is really difficult for them to access needed abortion care, and many of them can't and we're seeing people in obstetric emergencies not being able to access the care that they need.

0:27:33.9 LR: There are these so-called exceptions to save the life of the mother, that's how it's framed, but that doesn't... I mean, there are physicians in the room who can say better than me, that that is a useless framing in the law, because how close to dead do you have to be in order for a doctor to safely for themselves be able to intervene without it be a felony? 

0:28:04.5 LR: So it's very difficult for doctors to provide practice medicine in that landscape, and the result is that doctors are leaving those states, creating obstetric deserts, or expanding the deserts that were already there. Because in many of these states, those restrictive environments short of a ban, was really difficult to practice in. So those are those states.

0:28:40.3 LR: And maternal mortality before Dobbs was already on an upward uptick for everyone, but especially for Black and indigenous women. This just exacerbates that situation.

0:28:55.8 LR: And now we're starting to see an increase in infant mortality, which is a reverse trend from what was happening before.

0:29:07.2 PL: And the US, compared to every other high income, even middle income countries, is terrible on those metrics and they're going in the wrong direction.

0:29:14.8 LR: Absolutely. Yeah. And we spend so much money on healthcare in this country compared to other countries, and yet our indicators are just atrocious. And I also think...

0:29:30.7 LR: So it's like a combination of punishing people when they're trying to access healthcare, and then the abortion bans are creating these abortion deserts and fear among doctors to be able to provide the healthcare that they were trained to provide. So all of these factors are really contributing to those health indicators.

0:29:53.6 LR: And then of course, there's racism that Black and Brown women experience. That also impacts their health outcomes and their maternal health outcomes. But this is just a terrible overlay.

0:30:09.9 LR: So that's the bad news. The good news is, are things like Ohio, right? There are 25 states where abortion is legal, including 20 states in the District of Columbia, where there are new protections, like Ohio, like Michigan, like statutory laws that have been passed to strengthen abortion access.

0:30:35.6 LR: The one thing I will say is, those laws and ballot initiates are super great for abortion access, for contraception access. The language in Michigan and Ohio is very expansive. We need to puzzle through a little bit more about what this means for pregnancy criminalization.

0:30:58.4 LR: It doesn't necessarily fully protect people against pregnancy criminalization against prosecutors who, for example, are equating the womb to a meth lab.

0:31:07.8 LR: Because that's how this comes up, interpreting statutes that were meant, for example, to protect children who were being taken to meth labs, which that's a really bad idea, and that should not happen.

0:31:28.9 LR: But a womb is not a meth lab, but that's how the laws are being interpreted.

0:31:35.6 PL: So we were talking about this earlier how, yeah, it's great that in both Michigan and Ohio there were citizen-initiated ballot initiatives to change the state constitution. So that's great.

0:31:49.5 PL: However, there are only 18 states where citizens have that power, and right before we came down here, I looked up here's some of the other states that have the power to do it, but have very restrictive abortion policies in place or maybe enjoined by the courts, but it doesn't look so good.

0:32:10.7 PL: So we have Arkansas, Mississippi, Missouri, both of the Dakotas and Oklahoma.

0:32:16.6 LR: Arizona, Florida. Did you get those? 

0:32:19.9 PL: They don't have... The citizens don't have the power to do a constitutional amendment in those states.

0:32:22.8 LR: Oh, okay.

0:32:26.7 PL: Well, Florida is weird because they can do it every two decades or something.

0:32:30.7 LR: Right. And you need... It's a 60% threshold. But the advocates are working on something there, but it's gonna be a high bar, 'cause you get 60% of the vote.

0:32:39.6 PL: Yeah. So while that the strategy that worked in Ohio and Michigan is great, again, there aren't a lot of states that have that. So what are you seeing as other kinds of strategies where it's gonna be a hard haul? Either through legislature or changing the constitution? 

0:32:58.3 LR: Right. It's gonna be a longer haul. But I think... I'm actually optimistic. Remember prohibition? Prohibition was like an actual constitutional amendment, but it was so unpopular that it didn't last.

0:33:11.0 LR: I'm optimistic, and I don't know if this is gonna come to pass, but I just don't think that this is going to... The Dobbs decision is going to crush under its own weight. Just because it is so unpopular.

0:33:28.3 LR: Ohio voters are not the most progressive bunch, and yet they are supporting abortion rights. Same for Kansas voters. So I think I really am optimistic that it's just, long-term, this is just not gonna stick.

0:33:53.0 PL: So we all need a long-term perspective. That's great. So back to thinking about your organization and your work in general. You really approach your reproductive justice work from a human rights perspective.

0:34:08.7 PL: And love it if you could unpack that a little more and talk about that for our audience? 

0:34:14.2 LR: Sure. I'm afraid I'm gonna get into my adjunct professor mode here. [chuckle] So just a really big picture human rights detour.

0:34:28.0 LR: So human rights come from international human rights treaties, from political documents that get voted on at the UN in these regional human rights mechanisms. And there are a number of these political documents and human rights treaties that have been interpreted by the treaty monitoring bodies as undergirding reproductive rights.

0:34:56.1 LR: And this includes, the rights include... They're like 18 of them, but I'm gonna just mention a couple of them. The right to life, the right to health. The right to be free from cruel, degrading and inhuman treatment. The right to be free from race discrimination. And these rights have been interpreted to require member states, which are countries, to ensure access to safe abortion.

0:35:33.6 LR: And I love talking about that because especially with the right to life, because of the rhetoric that we hear here in the US, but we know... All we have to do is look at what's happening with these obstetric emergency services.

0:35:45.7 LR: When you ban abortion, it endangers the life of the people who are carrying the pregnancy. And human rights apply to people who are born. That's just the structure of the framework. So that's one piece.

0:36:01.9 LR: So even though the US has not ratified all these treaties, they've ratified some and the courts don't care, but yet it's an important framework for us to use. And in our advocacies and advocacy framework, these are human rights. So that's one thing.

0:36:20.9 LR: I also like to talk about the origins of reproductive justice, because reproductive justice is a US expression of human rights. And it came about because Black women and other women of color went to these international human rights conferences in Cairo and Beijing in 1994, 1995.

0:36:44.8 LR: There were these international conferences on development and women's rights, where the women from the global south pushed the global community, the global development community away from population control, like the stuff that was justifying sterilization abuse and using women's bodies as guinea pigs and all that other stuff, to human rights and reproductive rights, to women's rights. And so really forced the global community to reproductive rights in a human rights framework.

0:37:23.5 LR: So Black women, women of color were in these spaces encountering the women from the global south, and they recognized the... Gave the language of the experience that they were having here in the US, but they didn't have the language.

0:37:37.6 LR: So upon going back to the US, Black women coined the phrase "reproductive justice" as this US expression of human rights. And it was an answer to the sole focus of abortion rights and contraception by the mainstream feminist movement, but also a response to the civil rights movement that ignored gender. Because it recognized the intersectional experience of Black women and women of color. So that was reproductive justice.

0:38:17.7 LR: And reproductive justice is defined by SisterSong, SisterSong Women of Color Collective, is the human right to bodily autonomy, the human right to not just not have a child, but the right to have a child and to be able to raise our children and safe and sustainable communities. And that is the framework that to me, very early on...

0:38:43.0 LR: You know, one of the things, I don't know if it's in my resume, but I was not a super... Kind of second generation board member of SisterSong, and then also a co-founder of California Latinas for Relative Justice.

0:39:01.2 LR: Precisely because in the spaces that we were working in, in the reproductive rights, the mainstream reproductive rights movement, and I did a lot of work like within the Latino Health folks, like we can't talk about gender, and then we can't talk about race here.

0:39:22.3 LR: And so that reproductive justice space was really critical for me throughout my career, but then also, it's really integral to the work that we do at Pregnancy Justice.

0:39:35.4 PL: That's great. And thinking about the work that you're doing at Pregnancy Justice and also other work you've done, it's hard work.

0:39:46.9 LR: It is.

0:39:47.5 PL: Now I wanna talk a little bit about leadership. So here at the Ford School we have invested a lot and been active in terms of developing leadership among our students, but also faculty and staff.

0:39:58.6 PL: And leadership is defined not as running an organization, but basically just having a positive impact on communities and organizations and on the world, about things you care about.

0:40:11.9 PL: So what do you see as the most important leadership traits for someone who's working on really politically volatile issues that get just to the heart of human rights issues, day after day after day? How do you...

0:40:28.6 PL: How do you keep doing this work? And again, what kind of advice do you have for others who want to have that impact? 

0:40:34.1 LR: So I define leadership more of like how you show up every day. It's not the fancy title, but it's really how you show up in the space every day. With humility. With a lot of humility. I've learnt humility along along the way and always regret it when I didn't show up with humility. So humility is a really important trait.

0:41:00.2 LR: Having to deeply listen. Because even though I come from a particular community, even today, I don't have the same challenges in my personal life as people who still live in communities like the ones I grew up in. So deep listening.

0:41:19.5 LR: And the willingness to engage and talk to each other. Right? I get really dismayed by the arguments that happen in social media. Rather than people face-to-face being in principled struggle with each other. That is so important and so key. People can disagree, but we have to be in principled struggle with each other for the health of our movement.

0:42:04.1 LR: The willingness to develop relationships with people, like I was talking about before. That's really critical. But then also, and I can't take credit for this, this comes from The Management Center, and they published this really great management book, I recommend it to everybody.

0:42:28.0 LR: But they really articulated a framework for organizational culture that really resonates with me. It has three components. One is collective purpose. Why are we here? What is it that we're here to do together to achieve? What is the mission? What are the priorities? What are the objectives? Not my personal agenda, but why are we here together? 

0:42:50.1 LR: The second one is caring for people, which is fair policies and practices that are transparent, like paying people good salaries, the good benefits that people need. But treating each other with dignity and respect.

0:43:09.1 LR: Not address... Not like expecting employers to address your every single individual need, because nobody can do that. It's really fair policies and practices.

0:43:19.5 LR: And then the third one is commitment to excellence. I'm not talking about perfection. Perfection is poison. I'm talking about doing your best. With rigor, with diligence. With owning, mitigating and learning from mistakes. And understanding that we're gonna make mistakes and being okay with that. As long as we own, mitigate and learn.

0:43:45.7 LR: So really... And then that gets embedded on values like integrity. Showing up with integrity is a really important leadership quality, I think. 'Cause we have to be able to trust each other.

0:44:04.2 LR: It doesn't mean we don't make mistakes and we don't argue and we don't have conflict, but we have to be in conflict with each other with integrity.

0:44:13.3 LR: So those are the kinds of things that I think about in leadership.

0:44:17.5 PL: That's great. Thank you so much for that. I think now it's a good time to turn to all of you, and I'm sure a lot of questions have been coming in, right? 

0:44:29.8 PL: So we're going to have again, our two current Rebecca Copland scholarship awardees, Jennie Scheerer and Olivia Morris, moderate this next phase of the program.

0:44:40.6 PL: Could you both please quickly introduce yourselves and then we'll get into the questions.

0:44:45.2 Olivia Morris: Yeah. Sure. Thank you for that great conversation. I'm Olivia Morris and I'm a dual master's student with the School of Social Work in the Ford School. Jennie, you wanna...

0:44:56.9 Jennie Scheerer: Yes. Thank you so much for being here. I really appreciate this conversation. I'm Jennie Scheerer. I'm a dual degree master's student here at the Ford School and at the School of Public Health, and I'm very interested in setting reproductive health policy.

0:45:13.5 OM: And people can keep sending in questions and we'll be monitoring them, so I'm just looking over that. But just to start this Q&A off a little bit, my interests are really in opioid reform and government payer insurance.

0:45:33.1 OM: And so I was curious your thoughts on what role should government play in supporting pregnant and postpartum people in going against pregnancy criminalization? 

0:45:48.6 OM: We also received a question online that has to do with this. How can social services and legal entities balance the protection of pregnant people perhaps who do have opioid use disorder, and the needs of the children perhaps already in the mother's family or? Yeah.

0:46:10.7 LR: Well, I think, first of all is being driven by best practices and evidence. So again, the patterns that we see is that people are being sucked into Child Protective Services investigations and just outright criminalization based on one positive tox screen. There is no evidence that that one tox screen equals being a bad parent. You can be a bad parent and not use any substances. Right? 

0:46:50.2 LR: So I think that we have to really examine what the stereotypes are and really look at the medical evidence. And we do have a fact sheet on our website that lays this out. I recommend folks to take a look at that.

0:47:10.0 LR: And we do have some guidance for people within Child Protective Services and child welfare and social workers about what are the steps that they can take to try to disrupt.

0:47:24.8 LR: Unless there's additional actual evidence that there is child abuse, people shouldn't be investigated. People should not be reported. Because just that step ruins people's lives and leads to family separation.

0:47:45.0 LR: There is known harm to children in foster care. There is known harm, and it's intergenerational harm, that happens to parents and children. The children in foster care then become the next generation of people who are policed and tested and then have their children taken away.

0:48:10.8 LR: There was just a hearing at the New York Assembly precisely on this. And hearing the voices of 15... They happen to be women. 15 women who testified about their personal experience precisely around this and being in that intergenerational harm space because of the interventions of the state.

0:48:36.3 LR: It was just, you can't tell me that you're protecting children if that's the outcome, right? So really, what is the evidence? And so that is what I would say.

0:48:49.6 OM: Thank you.

0:48:50.8 LR: So in the role of government, there is a role of government to provide resources, funding, evidence, guidance, fund research. There's a lot that can and should be done by government.

0:49:07.7 LR: There aren't enough drug treatment programs for people who are pregnant and people who are primary caretakers of children. That's been true since the 1990's when I first dipped my toe in this area, and it's still the case. So why is that? 

0:49:29.5 OM: Thank you for addressing both parts of that question.

0:49:33.1 JS: Yeah, thank you. Just a quick follow-up to that question. What are your thoughts on programs like, there are some visiting programs or things like that where there's run by the state, but reach pregnant people and postpartum people in their homes? 

0:49:52.0 LR: I think it really depends on what their mandates are. Because there is a danger that... Like the more you test and investigate, the more you find stuff. And it doesn't mean that it's not happening in other people's houses, and those kids turn out fine. So there's a danger of that.

0:50:15.1 LR: And those programs could potentially provide really important support, so they have to be carefully tailored and the confidential... What is their mandate? I think is a big question for me.

0:50:30.9 LR: I would need to take a look at this a little bit more, but I would be cautious and understanding that they potentially can provide important support.

0:50:45.5 JS: Thank you. So another question from the audience. What advice would you give to students who are interested in doing this work? What resources do you know of that might be available on campus? And how do students get started in work about reproductive justice? 

0:51:02.7 LR: Well, I don't know what resources are here on this campus, but usually they're various resources. There are organizations, Advocates for Youth and URGE, that work with young people in college students. I would really recommend reaching out to them. They're phenomenal.

0:51:27.9 LR: There are usually some campus chapters in different states, they have different priority states. But I'm sure if you're really interested, you wanna build a chapter, they might be very interested in talking to you. So I think those two groups would be a good starting place.

0:51:45.3 LR: But there might be existing organizations and resources. So if for example, if you're in law school, there's the If/When/How Lawyering for Reproductive Justice chapters, so there are some existing things like that.

0:52:05.4 LR: What was the other part of the question? 

0:52:08.1 JS: How do students get started in the work of reproductive justice? I feel like you...

0:52:12.3 LR: Yeah. So reaching out I think, to some of those groups.

0:52:15.7 PL: I wanna jump in 'cause the question I get from students a lot is, "Do I have to go to law school?"

0:52:21.6 LR: No, you don't.

[laughter]

0:52:23.4 PL: Right? Some of you are thinking about that, "Do I have to go to law school if I wanna be involved with work that intersects with civil rights and human rights and justice issues, reproductive justice and others?"

0:52:37.3 LR: You don't have to go to law school. Look, being a lawyer can be very useful in many ways, but it's not for everybody, and it's not necessary for to do this work in very meaningful ways. There are many different roles.

0:52:50.1 LR: Again, I'm harping on this because I know who's in the audience. Go do research. Produce the evidence that we need to bring to the court, to bring to the court of public opinion, to bring to policy makers.

0:53:07.9 LR: Especially when we operate in this fact-free world that we're operating in, that evidence continues to be really, really critical. Help communities do their own research, to tell their own stories, to define the problems from their perspective.

0:53:29.1 LR: So there's a lot that can be done. Learn how to raise money for organizations. Development is a career. It's really important to be able to raise resources for this work, especially the groups on the ground, for the grassroots organizations doing that hard work, which they don't often have that capacity.

0:53:56.9 LR: So there are so many different ways. Do communications work. Strategic communications work is really critical. So there's so many different roles that it's...

0:54:08.8 LR: So we have somebody on staff as a social worker, because that's a skill set that's really... That kind of skill set helps us bridge those relationships with our state partners, with our RJ partners. With our clients even.

0:54:30.1 LR: So there's so many things that you can do that's not going to law school.

0:54:36.6 OM: We just received a question that really connects to your emphasis on research and evidence. How do you work with opposing policy makers or advocates when they do not listen to evidence-based policy? 

0:54:50.8 OM: How can you frame protection against criminalization of pregnancy so it is understood within the opposition's value or morality-based arguments? 

0:55:09.6 LR: Throughout my career, I have worked with people from different political spectrums in a very non-partisan way. I think it's harder to do in the current landscape, but it's not impossible. And it continues to be important to try. It continues to be important to try to break through these ideological camps.

0:55:38.7 LR: And I can't believe, for example, like the vote we saw in Ohio, those were not just Democrats, it was people across the political spectrum. And we have to...

0:55:52.0 LR: And I should say we're nonpartisan, C3, so that's just the public service announcement. But it's really important to have the conversations and not just talk to ourselves in the ways that we are used to talking to ourselves.

0:56:15.4 LR: I have like a little focus group, I have a big extended family. If they don't understand what I'm talking about, I've failed. Right? I have a beloved family member that if things weren't so ideological in the way they are, that person would be voting Republican. So that family member who is my beloved family member is like my little focus group. So we have...

0:56:43.6 LR: These are... The people who don't agree with us are people in our communities, in our own families. We have to be able to have these conversations. Right? 

0:56:57.2 JS: Thank you. Yeah, and kind of going off of that, how can anti-abortion supporters understand pregnancy justice and maintain their moral obligations while still understanding the needs to protect human rights? 

0:57:10.6 LR: Say that part again, about the moral obligations? 

0:57:13.6 JS: How can anti-abortion supporters understand pregnancy justice and maintain their moral obligations while still understanding the need to protect human rights? 

0:57:23.3 LR: Sure. Sure. Well, I would say that perhaps looking at the definition of reproductive justice and see if there's a space in there that would feel comfortable to work in.

0:57:46.1 LR: Because again, reproductive justice is not just the right to not have a child, it's the right to have a child and to be able to raise our children in safe and sustainable environments.

0:58:03.2 LR: People make decisions about their own lives that I myself would not necessarily make myself or agree with, but you know, the question that I would pose back is, can you live with people making their own decisions, even if it makes you uncomfortable, but still find some places where we can work together to ensure safe and sustainable communities? 

0:58:43.9 LR: Now, this makes me remember, I did a podcast with a young person who... I forget how the question was posed, but basically my response to them was like, "Wait a minute. If people actually had different choices, like had social supports, had access to healthcare, had support to continue with their education, they actually might decide to keep their children."

0:59:14.4 LR: 'Cause people actually want... Some people want to have children. Or feel...

0:59:19.1 PL: I think it's random, it's 60% of women, or people who have abortions are living in poverty.

0:59:27.0 LR: Or also parents.

0:59:28.0 PL: Yeah, and already have kids.

0:59:28.4 LR: Right, they're also parents. So advocate for policies, perhaps spend your energy advocating for policies that help communities thrive, because then people make different decisions in that context. Rather than just focusing on preventing people from making decisions.

0:59:52.3 JS: Thank you.

0:59:58.6 OM: This question connects perhaps to some of the expansion of welfare policies that you just discussed. How are immigration laws potentially intertwined with the concept of pregnancy criminalization? And how does this concept marginalize those individuals even further? 

1:00:20.8 OM: So part of me is thinking about barriers to accessing certain welfare programs, if, depending on your status. But elaborate on that? 

1:00:31.6 LR: I do think there are current policies now that prevent people from accessing healthcare. There's a five-year ban on legal immigrants from accessing programs, for example. That impacts health status and healthcare of not just they themselves, but of their children who are born here or being raised here.

1:01:02.5 LR: And again, people are not coming here so that they can sign up for Medicaid. Let's just be real. People are not coming from Venezuela, risking their lives to... And I have to say, this is not... I don't work on immigration policy, but I just read the newspaper and I know people, right? 

1:01:30.4 LR: So people are not risking their lives coming through mountains and deserts and hopping on trains and crossing rivers and going through barbed wire so they can sign up for Medicaid. It's absurd. It's absurd.

1:01:45.4 LR: People are coming here because their countries are in crisis and they are in danger. That's why they're here. So perhaps we should have a more humanitarian approach and a human rights approach, and then help to try to understand why people are coming and help maybe partner with the global community. Try to help address that issue that's like the push.

1:02:19.5 LR: So that's what I would say.

1:02:24.2 JS: Thank you. So this person is saying that they appreciate your mention of generational trauma at the hands of the state due to racial stigma and the stigmatization of opiate misuse.

1:02:37.6 JS: Could you speak a little bit more about the role that education can and should play in enhancing access to comprehensive reproductive services? 

1:02:46.8 LR: Yeah. We have a whole other problem in this country where the answer to young people's sexuality is to deny them comprehensive sexuality education.

1:03:06.0 LR: And we see examples in other countries where young people who actually get comprehensive sexuality education, again, that's human rights based, that talks about relationships and power dynamics in relationships, and understands that there's many different genders and embraces the fact that there's gender diversity and all of these things, that they're better health outcomes.

1:03:38.2 LR: It's just, again, the evidence is there. So are we gonna continue to ignore the evidence and hurt young people? Versus embrace the evidence and provide what they actually need, which is education and services, so that they can make the best healthcare decisions for themselves and have better health outcomes.

1:04:01.0 LR: It's not rocket science. [chuckle] But here we are, so.

1:04:09.9 OM: For this next question, I'm gonna shift a little bit to talk more about the role of courts. Before you spoke about the changing landscape post-Roe and now more of an emphasis on state law and state policy.

1:04:33.3 OM: How has this impacted or shifted Pregnancy Justice's litigation strategy? Are you choosing the types of cases you take? And how much of that is impacted by this landscape shift? 

1:04:53.0 LR: That's a great question. It's a little bit of a yes and no. So we actually have an intake system where people just reach out and tell us what's happening, and we assess is this the kind of case that is within our expertise.

1:05:12.5 LR: And we do also think about, is there a way of not just providing individual legal assistance, but can we leverage this to make bigger policy change and impact, either by setting a precedent that impacts more people, or bring such attention to what's going on that it's just indefensible. I'm just giving you a couple of different examples.

1:05:43.0 LR: And we also work a lot with public defenders and local counsel who reach out to us. We do a lot of training of legal networks. We work with pro bono folks. We have 15 lawyers from Sullivan & Cromwell, and also the Southern Poverty Law Center on this Alabama case with us.

1:06:08.4 LR: So there are a lot of folks that are very interested in working, and a lot of the things that we don't do that we share or refer out, we connect with those resources. That's a way of expanding our capacity.

1:06:24.9 LR: The Alabama case, we did decide to file in federal court because we could ask for damages. We made the assessment that in Alabama, the federal court was actually a less hostile environment than in the state court.

1:06:40.7 LR: So these are the kind of strategic decisions you make in choosing your venue. Where can you make more progress? And I have to say that, and this was something that we talked a lot about when I was at the Center for Reproductive Rights, you can't make an assumption that just because this judge or that judge was appointed by a Republican or not, that they're gonna rule against you.

1:07:05.3 LR: We won cases before judges that were appointed by different administrations, and we lost cases that were appointed by different administrations.

1:07:19.2 LR: And the other thing I would say just globally about the courts, 'cause I know there was a lot of feeling that after losing Roe that we should just kind of pull away from a court strategy. And yes, I think that it's a more surgical strategy, but we cannot cede the space of the courts. The courts are a important pillar of democracy.

1:07:41.1 LR: That's like the bigger framework here, is democracy, and the courts being an important institution as part of our democratic system. And we have to keep advocating for rights. For civil rights, for constitutional rights, for statutory rights and statutory interpretation.

1:08:07.8 LR: And there might be periods where we're gonna be losing, but it's still important to do. We have to be selective and not just kind of willy-nilly and naive about it, but we can't just abandon the courts.

1:08:20.9 LR: And yes, there are many other strategies that as a movement we also need to employ and invest in, and perhaps step on the gas a little bit more in other strategies as well. Or moreso sometimes. It just depends.

1:08:40.0 OM: Thank you.

1:08:40.4 JS: So staying on the topic of Pregnancy Justice's work. Someone from the audience is wondering, why do you focus on pregnancy justice rather than reproductive rights and reproductive justice more broadly? 

1:08:56.2 LR: This is a awesome question. Pregnancy Justice, which used to be called National Advocates for Pregnant Women, was founded by Lynn Paltrow, my predecessor, because when she was working in some of the reproductive rights organizations, nobody else was doing these types of cases.

1:09:17.9 LR: But she was getting these phone calls of people being... People being criminalized because of their pregnancy status, but it was outside the context of abortion.

1:09:28.0 LR: And don't get me wrong, we're supportive of abortion, we write amicus briefs and sometimes we represent people who are being criminalized because of pregnancy, perceived abortions or pregnancy loss.

1:09:42.9 LR: But nobody was looking at people being criminalized because of their pregnancy status. And then the growing and kind of like the infiltrating of the fetal personhood ideology, that by the way, helped to undermine and overturn the right to abortion.

1:10:09.0 LR: So somebody... So NAPW, now Pregnancy Justice, was minding the store over here, right? And now we're front and center with criminalization because it's the same continuum. So it is reproductive justice.

1:10:30.4 JS: Thank you.

1:10:31.4 PL: Probably have time for one more question.

1:10:36.7 OM: Yeah.

1:10:40.1 PL: Maybe two.

1:10:42.3 OM: Okay.

[laughter]

1:10:42.6 OM: Yeah, now the pressure's on.

[laughter]

1:10:43.7 PL: Just do two. Just do two.

1:10:49.4 OM: Yeah, yeah. I'll consolidate a few of these.

1:10:56.3 JS: There's a lot of questions, so.

1:11:00.6 OM: Yeah. Just because we've talked a lot about both the human rights perspective, building relationships with your community to share information and also the importance of research, in your work experience, what are the hallmarks of good relationships between researchers and community-based organizations or communities for research projects? 

1:11:35.0 LR: Oh my goodness.

[chuckle]

1:11:37.6 LR: I don't know if I can fully answer that, but I'll give it a shot. And I was just do this from my personal experience in the very different roles. And I'll answer it this way.

1:11:48.0 LR: So here's a very early lesson that I learned as a young lawyer, and I think it would apply to researchers too. So as a young lawyer, we were looking to bring a case around lead poisoning prevention. This was in LA, in the context of Medicaid.

1:12:08.0 LR: So I was sent to go find plaintiffs. The community groups that I talked to... How can I say? They kinda handed me my rear end. Because their perspective was, "You lawyers come to our communities, you file your lawsuits, you do your press releases, you go away and nothing changes." So it's like, "Oh yeah," because I used to be on that side of the table and that was a good reminder.

1:12:47.2 LR: So that started a whole long period of me sitting down with the community over spaghetti dinners for months and months and months, to understand what their agenda was. And to create a strategy that they were leading and that I was supporting.

1:13:10.6 LR: And we actually... You know, there was the spectre of litigation, which was helpful to them as we were engaging with the state agencies, but the strategy that they were leading and that I was supporting actually resulted in more than had we just filed a lawsuit.

1:13:33.0 LR: Sometimes lawsuits can be very useful, but sometimes you need to take the back seat. And so what I would say to researchers in terms of building those relationships, you need time, you need humility.

1:13:51.1 LR: And sometimes like... People have skills in communities and you need to honor those skills. And institutions like this actually need to educate people from those communities so that they can go back and do that research. The affirmative action case is a whole other thing that we can talk about some other time.

1:14:16.1 LR: But having that humility and deep listening, like I was talking about before, how you show up, that's really critical. Rather than going in with like, "This is my research agenda, and can I just interview 10 people."

1:14:32.0 LR: It's really spending the time to figure out, what is your agenda, how can I be helpful to you? 

1:14:39.2 JS: Thank you.

1:14:41.7 OM: Yeah.

1:14:45.2 JS: Okay, so I guess as a closing question, what do you wish that someone told you when you were early in your career or even as a younger person, about how to navigate a society that not only limits female reproductive rights and all reproductive rights for people with uteruses, and is also disempowering towards these people in general? 

1:15:12.8 LR: Oh my goodness, I don't know if I can remember back that far.

[laughter]

1:15:18.8 LR: I think one thing I would say is, you need to have the long view. Right? I am very conscious of the fact the work that I'm doing today, I may not see results until after I retire.

1:15:42.8 LR: But it's important to have the long... Well, two things. It's important to have the long view, and it's important to understand that you also need to on that path, create moments of wins that are meaningful to the communities that are most impacted.

1:16:10.2 LR: So I had to learn that along the way, of thinking like that. Like, what is the outcome that we're trying to achieve? And that the strategy, the specific activities, that's less important. Because it could be... Those things pivot depending on what the landscape is.

1:16:34.6 LR: It's like, what is it that you're trying to change? What is the change you're trying to make? And really keeping an eye on that. And sometimes it's mid-view, sometimes it's long view, but we need also as movements, we need longer view strategies.

1:16:54.8 LR: And the other thing is, social justice work is not linear. You have forward movement, you go sideways, you step backwards, but overall it goes forward. And I know it feels like we're in this moment that it's backwards, but then you get Ohio. Right? 

1:17:11.8 LR: So that's the other thing, do not get discouraged. You have to have optimism. Because if you despair, we've already lost. And even in losses, you have to think about how can we turn this around into a win? And in what sphere. 'Cause we lost in a court, but we're winning in the court of public opinion, right? 

1:17:44.4 LR: So you have to be nimble, is the other thing.

1:17:48.8 JS: Thank you so much. It's very inspiring.

1:17:51.4 PL: Thank you. And apologies for what I'm sure are a number of great questions we didn't get to really at the last moments of time here. Is there anything that you wished you would have had the opportunity to say? 

1:18:05.2 LR: I wanna share, I wanna share a quote from the Mexico Supreme Court when they ruled this past year that abortion criminalization was unconstitutional under the Mexico Constitution.

1:18:25.6 LR: And it said, "The criminalization of abortion constitutes an act of violence and discrimination based on gender, as it perpetuates that women and pregnant individuals can only exercise their sexuality for procreation and reinforces the gender role that imposes motherhood as a compulsory destiny."

1:18:48.4 LR: And I think that's true also around pregnancy criminalization, because it's punishing people who are not guaranteeing like the perfect conditions for a pregnancy because they're not... They're not living out their gender role of motherhood above all else.

1:19:12.8 LR: So the Mexico Supreme Court got it, we should get it too. [chuckle]

1:19:16.3 PL: So very, very Catholic country. As well.

1:19:18.7 LR: Yes, very, very Catholic country. The last thing I will say, which I should have said on top. Pregnancy... Just a note on language. We use "pregnant people", "pregnant women", "pregnant person", for three reasons.

1:19:32.9 LR: One is sexism and the gender binary is very real, and we have to acknowledge that. It's a through line in our work, is that imposition of trying to impose that gender binary.

1:19:50.4 LR: Secondly, because of all the issues that we were talking about, it's really important to assert the personhood of the person who's carrying the pregnancy. In a context where the person who the fetuses are supposed to override, the person who's the person carrying the pregnancy.

1:20:06.9 LR: And then the final reason is we understand that, and we know that not everybody who is pregnant, becomes pregnant, identifies as a woman and it's important to be inclusive.

1:20:18.3 LR: So for all of those reasons, we use those terms depending on the appropriate context.

1:20:23.7 PL: So thank you.

1:20:24.8 LR: Thank you all.

1:20:24.8 PL: And I'm so sorry we don't have any more time. But thank you all for coming, and thank you so much for joining us today.

[applause]