    [Senate Hearing 118-560]
    [From the U.S. Government Publishing Office]

                                                            S. Hrg. 118-560

                        THE ECONOMIC AND HEALTH IMPACTS OF
                          THREATS TO REPRODUCTIVE RIGHTS

    =======================================================================

                                 FIELD HEARING

                                  BEFORE THE

                                SUBCOMMITTEE ON
                                ECONOMIC POLICY

                                     OF THE

                                  COMMITTEE ON
                       BANKING,HOUSING,AND URBAN AFFAIRS
                              UNITED STATES SENATE

                        ONE HUNDRED EIGHTEENTH CONGRESS

                                 SECOND SESSION

                                       ON

     EXAMINING THE ECONOMIC AND HEALTH IMPACTS OF THREATS TO REPRODUCTIVE
                                     RIGHTS

                                   __________

                                  MAY 29, 2024

                                   __________

      Printed for the use of the Committee on Banking, Housing, and Urban
                                    Affairs

    [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

                    Available at: https: //www.govinfo.gov /

                                    __________

                       U.S. GOVERNMENT PUBLISHING OFFICE
    58-646 PDF                  WASHINGTON : 2025

    -----------------------------------------------------------------------------------

                COMMITTEE ON BANKING, HOUSING, AND URBAN AFFAIRS

                           SHERROD BROWN, Ohio, Chair

    JACK REED, Rhode Island              TIM SCOTT, South Carolina
    ROBERT MENENDEZ, New Jersey          MIKE CRAPO, Idaho
    JON TESTER, Montana                  MIKE ROUNDS, South Dakota
    MARK R. WARNER, Virginia             THOM TILLIS, North Carolina
    ELIZABETH WARREN, Massachusetts      JOHN KENNEDY, Louisiana
    CHRIS VAN HOLLEN, Maryland           BILL HAGERTY, Tennessee
    CATHERINE CORTEZ MASTO, Nevada       CYNTHIA M. LUMMIS, Wyoming
    TINA SMITH, Minnesota                J.D. VANCE, Ohio
    RAPHAEL G. WARNOCK, Georgia          KATIE BOYD BRITT, Alabama
    JOHN FETTERMAN, Pennsylvania         KEVIN CRAMER, North Dakota
    LAPHONZA R. BUTLER, California       STEVE DAINES, Montana

                         Laura Swanson, Staff Director

                   Lila Nieves-Lee, Republican Staff Director

                           Elisha Tuku, Chief Counsel

                      Amber Beck, Republican Chief Counsel

                          Cameron Ricker, Chief Clerk

                          Shelvin Simmons, IT Director

                           Pat Lally, Assistant Clerk

                                     ______

                        Subcommittee on Economic Policy

                     ELIZABETH WARREN, Massachusetts, Chair

                    JOHN KENNEDY, Louisiana, Ranking Member

    JACK REED, Rhode Island              MIKE ROUNDS, South Dakota
    ROBERT MENENDEZ, New Jersey          THOM TILLIS, North Carolina
    CHRIS VAN HOLLEN, Maryland           CYNTHIA M. LUMMIS, Wyoming
    TINA SMITH, Minnesota                STEVE DAINES, Montana
    JOHN FETTERMAN, Pennsylvania

                  Gabrielle Elul, Subcommittee Staff Director

            Jennifer Newman, Republican Subcommittee Staff Director

                                      (ii)

                                C O N T E N T S

                                  ----------

                            WEDNESDAY, MAY 29, 2024

                                                                       Page

    Opening statement of Chair Warren................................     1

    Opening statements, comments, or prepared statements of:
        Senator Edward J. Markey of Massachusetts....................     3

                                   WITNESSES

    Andrea Joy Campbell, Attorney General, Commonwealth of
      Massachusetts..................................................     4
        Prepared statement...........................................    29
    Rebecca Hart Holder, President, Reproductive Equity Now..........     7
        Prepared statement...........................................    30
    Kathryn Fay, Fellow, Physicians for Reproductive Health, and
      Physician, The Brigham and Women's Hospital....................     9
        Prepared statement...........................................    35
    Carol Rose, Executive Director, ACLU of Massachusetts............    11
        Prepared statement...........................................    37

                  Additional Material Supplied for the Record

    Statement submitted by SBM.......................................    41

                                     (iii)

       THE ECONOMIC AND HEALTH IMPACTS OF THREATS TO REPRODUCTIVE RIGHTS

                                  ----------

                            WEDNESDAY, MAY 29, 2024

                                   U.S. Senate,
      Committee on Banking, Housing, and Urban Affairs,
                               Subcommittee on Economic Policy,
                                                            Boston, MA.
        The Subcommittee met at 2:10 p.m., in room 900A, 15 Sudbury
    Street, Boston, Massachusetts, Hon. Elizabeth Warren, Chair of
    the Subcommittee, presiding.

              OPENING STATEMENT OF CHAIR ELIZABETH WARREN

        Chair Warren. This hearing will come to order.
        We're holding this hearing because reproductive freedom,
    even here in Massachusetts, may disappear. In 2022, far right
    Supreme Court Justices took away the constitutional right to an
    abortion, completing the job that Donald Trump sent them there
    to do. In overturning Roe v. Wade, the Supreme Court abandoned
    almost 50 years of precedent.
        In some States, the Court's decision revived abortion bans
    laying dormant since the 19th century. In other States, the
    decision triggered new abortion restrictions prewritten to go
    into effect the day that Roe v. Wade was overturned. The
    results have been horrifying.
        A 10-year-old rape survivor was forced to leave her State
    to get the abortion she needed. Pregnant women have been turned
    away from emergency rooms and forced to wait until they are
    even closer to the brink of death before doctors will treat
    them. And nearly one in five patients have been forced to cross
    State lines for abortion care.
        As other States race to ban or significantly restrict
    women's reproductive rights, Massachusetts moved in the
    opposite direction. Our Commonwealth stepped up to protect
    reproductive freedom.
        In 2022, Massachusetts lawmakers passed a novel shield law
    to protect abortion providers in Massachusetts from out of
    State legal actions when they provide care to people residing
    in States with abortion bans. In 2023, Attorney General
    Campbell set up an abortion legal hotline. Also last year after
    a Federal court ruling in Texas that temporarily blocked the
    FDA's approval of mifepristone, Governor Healey issued an
    Executive order protecting medication abortion and initiating a
    process to stockpile the drug.
        Our Commonwealth is working hard to protect reproductive
    rights. And the Biden administration is using every tool it has
    to defend women's freedom to make decisions about their own
    bodies. But recent legal challenges are a reminder that these
    safeguards will not be enough to protect women from right-wing
    politicians who are determined to rip away their reproductive
    freedom no matter where they live.
        First, whether a doctor is legally allowed to protect your
    health is on the docket. This year, the Supreme Court will
    decide whether Idaho's total abortion ban prohibits doctors
    from providing, quote, ``stabilizing treatment,'' close quote,
    to patients who require an emergency abortion in violation of
    Federal law protecting access to emergency treatment. If the
    Supreme Court rules in favor of Idaho, you can bet that
    Republicans in Congress will try to make these restrictions the
    law of the land.
        In another case before the Supreme Court, Republicans have
    asked judges to review steps the FDA took to expand access to
    abortion medication, mifepristone. Republicans understand that
    medication abortion now accounts for nearly two-thirds of
    abortions nationwide. And they are willing to take down the
    entire drug regulatory system in order to curb access to this
    FDA-approved medication. If the Supreme Court rolls back these
    policies, no one will be able to access medication abortion
    over telehealth or at their local pharmacy no matter where you
    live, in Alabama or Massachusetts or any other State in the
    United States.
        These two challenges to abortion rights are in Trump's
    Supreme Court. But there are other threats as well. Republicans
    intend to put in place a nationwide abortion ban.
        There is already a bill in the House of Representatives,
    the Life at Conception Act, that has the support of the
    majority of the Republican Caucus, including Speaker Mike
    Johnson. This bill would create something called fetal
    personhood, requiring full legal protection for any fertilized
    egg, outlawing abortion and IVF and possibly some
    contraception.
        But a future Trump administration doesn't even need
    Congress to enact a nationwide ban. The Heritage Foundation is
    calling for enforcement of a 19th century law that criminalizes
    the mailing of anything, quote, ``designed or intended for
    procuring an abortion.'' Now to be clear, many lawyers think
    this law is unenforceable.
        But that will stop Donald Trump from intentionally
    misapplying the law to get the results his extremist base
    wants. And it will not stop radical courts from letting him do
    exactly that. If they succeed, these efforts won't be limited
    to the States where abortion is already restricted. They will
    be used to block abortion everywhere, including right here in
    Massachusetts.
        I am furious that millions of women have lost fundamental
    rights. I am furious that their freedom to make their own
    decisions has been taken away by a small number of extremists.
    I am alarmed by what the radical Supreme Court and
    congressional Republicans are prepared to do to unravel under a
    future Trump presidency. And that is why we are holding this
    hearing today, to hear firsthand about the impact of these
    threats and to discuss what we can do to fight back.
        With that, I want to pause and ask my good partner in all
    kinds of trouble, Senator Markey, if you would like to make
    some opening remarks.

             OPENING STATEMENT OF SENATOR EDWARD J. MARKEY

        Senator Markey. Thank you, Senator Warren. And thank you so
    much for your leadership on this issue and so many other
    issues. This is just such an incredibly important hearing.
        And you brought the Massachusetts all-star team together,
    the national leaders who come from our great State, Attorney
    General Andrea Campbell, Carol Rose, Dr. Kathryn Fay, and
    Rebecca Hart Holder. Thank you all so much for appearing today.
        On June 24th, 2022, the Supreme Court majority overturned
    Roe v. Wade and placed the bodily autonomy of millions in the
    United States in immediate jeopardy. Today, that has left us
    with 21 States that have restricted the right to abortion. And
    the Supreme Court has two more cases before it that could
    imperil abortion care nationwide, including here in
    Massachusetts.
        This is due to a majority on the Supreme Court fueled by
    decades of advocacy by radical Republicans and right-wing
    extremists. We are in a multigenerational war that is rooted in
    the Nation's history. In 1927, the Supreme Court in Buck v.
    Bell approved forced sterilization in a decision steeped in
    ableism.
        Federal funds were used to sterilize 100,000 to 150,000
    women, half of whom were Black. This would later be called the
    Mississippi appendectomy. But this cruelty knew no geographic
    bounds. Across teaching hospitals in New York and here in
    Boston, this was done to poor Black and Puerto Rican women as
    practice for medical students here in our city.
        Right-wing extremists and radical Republicans aren't just
    waging a battle against the constitutional right to an
    abortion. They're in a war against reproductive justice and
    American freedom. Roe provided an opportunity to unwind that
    history and provide people with true reproductive freedom and
    choice.
        But with Dobbs, the Supreme Court majority allowed the
    roots of injustice to grow deeper in America's soul. Dobbs
    showed right-wing extremists that the playbook in their war on
    reproductive rights might work.
        Their playbook is three steps. First, spread disinformation
    and hate for people who need care and the providers giving it.
    Second, use statehouses and local judges to translate the
    disinformation into laws, stripping people of their right to
    care and placing providers at risk. And finally, number three,
    leverage State and local efforts to create national bans on
    care.
        But we won't let them win. American's health and freedom is
    too important. The right-wing extremist playbook opened the
    door for abortion bans to steadily creep into threats to in
    vitro fertilization and the right to contraception.
        And today, threats to birth control medication that is
    essential for American's health care and their economic and
    social freedom are real and they are imminent. Across the
    country we are seeing dangerous misinformation about gender-
    affirming care translating into threats to patients and
    providers here in Massachusetts. And State and local laws
    nationwide undermining access to essential care for transgender
    people.
        And now Members of Congress are working relentlessly to
    place national restrictions on this care. We will show radical
    Republicans that their playbook will not work. States like
    Massachusetts will act as a safe haven with resources and legal
    protections for patients and providers.
        And in Congress, we will work to expand the Supreme Court
    and confirm judges at every level of the Federal bench who
    support bodily autonomy, freedom, and justice. We will fight to
    protect the right to essential health care by law. And we will
    make radical Republicans reveal what GOP really stands for,
    Grossly Oppressive Politicians, trying to intervene in the
    decisions of citizens in our country.
        Next week, the U.S. Senate will hold a vote on my bill, the
    Right to Contraception Act. This bill protects people's right
    to get birth control and providers' rights to give it.
    Republicans have blocked Senate passage of this bill by
    unanimous consent twice, in 2022 and 2023.
        But now this is the first time that the bill has come up
    for an actual vote. And members of the Senate Republicans will
    be forced to go on the record on what they support, the right
    to contraception or the right to contravene.
        Preserving Americans' health and freedom through the right
    to contraception should be an easy answer. Radical right-wing
    extremism has made it hard. The arc of the moral universe will
    not bend toward justice because of this Supreme Court majority
    and radical Republicans but in spite of them.
        And while extremists are fighting to strip away Americans'
    freedoms, many of you in this room are righteously fighting for
    that freedom. You have not given up and neither will we. It is
    because of you that we will win this fight, and we will fight
    until we win.
        So thank you, Senator Warren. Thank you for conducting this
    just historically important hearing.
        Chair Warren. Thank you, Senator Markey.
        I'd like to introduce our panel today. I want to welcome
    our witnesses who are here. We have the Honorable Andrea Joy
    Campbell, Attorney General for the Commonwealth of
    Massachusetts, Ms. Carol Rose, executive director of the ACLU
    of Massachusetts, Dr. Kathryn Fay, a fellow with Physicians for
    Reproductive Health and physician at Brigham and Women's
    Hospital, and Ms. Rebecca Hart Holder, I moved around as I said
    that, president of Reproductive Equity Now.
        What I'd like to do is have each of you speak for about 5
    minutes if you could. And we'll take that as your opening
    testimony. And perhaps we could start with you, General
    Campbell.

          STATEMENT OF ANDREA JOY CAMPBELL, ATTORNEY GENERAL,
                     COMMONWEALTH OF MASSACHUSETTS

        Ms. Campell. Thank you, Senator Warren, for your
    leadership. Thank you as well, Senator Markey, for your
    leadership and, of course, the opportunity to testify before
    you.
        It is no secret how dire the State of reproductive health
    care access currently is, not only in parts of Massachusetts
    but, of course, across the country. While I have the honor and
    I would say the privilege of serving as the Attorney General of
    Massachusetts which has long been, of course, a beacon in the
    pursuit of reproductive justice, I recognize that much work
    remains, not just at the State level but also locally and
    nationally. I look forward to working with each of you and, of
    course, my colleagues across the country who are on the front
    lines to continue this fight to ensure that people could access
    the health care they so desperately need. And we will not only
    fight. We will win.
        When the Supreme Court struck down Roe in 2022, it
    eliminated 50 years of legal precedent that recognized the
    basic right to abortion. The effects of this decision were
    immediately felt across the country as so-called trigger bans
    went into effect, leaving patients suddenly without access to
    critical and sometimes lifesaving care.
        Today, nearly half the States in the country have banned or
    severely restricted access to abortion care. The result has
    been devastating, leaving hundreds of thousands of people
    without access to comprehensive reproductive health care in
    their States and enforcing people to delay or forego abortions
    which all too often threatens their health, wellbeing, and
    financial security. It also exacerbates existing health
    disparities, disproportionately impacting Black and Brown
    people, low-income earners, indigenous people, young people,
    and those living in rural communities. Patients traveling
    across State lines for care must do so with the knowledge that
    they may be subject to digital surveillance or even
    prosecution, not only of themselves but of their friends, their
    families, and helpers.
        Beyond these strains, the expansive scope of some of these
    abortion bans threatens providers across State lines. Even in
    Massachusetts, providers face increased risk of civil and
    criminal liability through bounty hunter schemes and reported
    travel bans. These schemes also target those who assist
    patients with accessing abortion care causing significant fear
    across the country.
        To meet this latest cruel moment in our Nation's history, I
    along with my colleagues in State government and other
    Attorneys General nationally, we have stepped up to ensure
    people can continue to access reproductive care in our States.
    In 2022, in response to Dobbs, my office under now-Governor
    Healey, of course, worked with our State legislature to codify,
    enhance protections to reproductive health care broadly as well
    as gender-affirming care. While this legislation made many
    significant improvements to our reproductive health care
    landscape, one of the most impactful was its insurance mandate,
    requirement coverage for abortion and abortion-related care
    without cost-sharing.
        This legislation also included the Nation's leading
    abortion care protection law, sometimes referred to as the
    shield law, that puts in place critical protections for people
    who provide access or facilitate access to abortion and gender-
    affirming care here in the Commonwealth. It was the first such
    law in the country to protect providers licensed and physically
    present in Massachusetts from the effects of out-of-State
    abortion bans, regardless of the patient's location at the time
    the care was provided.
        Since we passed our law, six States have passed comparable
    protections. And these laws have helped thousands of patients
    access abortion care in these States, including Massachusetts.
    To operationalize the shield law, my office, in collaboration
    with the ACLU of Massachusetts are delighted to be here with
    Carol, Reproductive Equity Now, delighted to be here with
    Rebecca. The Women's Bar Association, and five incredible law
    firms launch an Abortion Legal Hotline to provide free,
    confidential legal advice and resources to health care
    providers, helpers, and patients seeking care from
    Massachusetts providers.
        While I'm proud of how we in Massachusetts have met this
    moment, challenges still exist on many fronts. Efforts are
    ongoing at the State and Federal level as you've described to
    curb reproductive freedom. Similar battles are also ensuing in
    courts across the country and not just about abortion care as
    you also remarked but also about contraceptive access, gender-
    affirming care, and other private health care concerns.
        To confront these threats, I have formed a reproductive
    justice unit within my office, which focuses on advancing
    reproductive justice at the State and national level. In its
    short tenure, this unit has established itself as a trusted
    partner and resource among community organizations, health care
    providers, and advocates as well as colleagues across attorney
    general offices nationally. It has been extremely
    intersectional in its work, not merely just talking about
    access to abortion care, maternal health disparities, gender
    affirming care, and health care generally.
        I'm really proud of the work of the unit thus far,
    including Sapna who's our executive director of that unit. Our
    collaboration with other AG offices also extends into other
    avenues. I have been asked and had the immense honor or
    chairing the Reproductive Rights Working Group within the
    Democratic Attorneys General Association which will work to
    develop and defend shield laws through the country, work
    together, of course, to share information with each other in
    real time, develop best practices, and work daily to protect
    individual access to abortion, contraception, and the full
    spectrum of reproductive health care.
        I also continue, of course, to defend State and Federal
    laws protecting abortion access as you mention, of course, as
    high as the Supreme Court. We will continue to do our part.
    This decision has the potential to undermine--I should take a
    step back.
        We've also specifically--and I want to, of course, mention
    one case, advocated in support of the FDA in the Food and Drug
    Administration v. Alliance for Hippocratic Medicine, which we
    all know is a right-wing effort targeting FDA's approval of
    mifepristone, which is a safe and effective drug that has
    benefited over 3 million Americans. This decision has the
    potential to undermine not just FDA's drug approval process in
    this context but, of course, with respect to almost any other
    drug we can think of. To ensure that pregnant people continue
    to access this medicine, I along with 23 other attorneys
    general filed an amicus brief urging the Supreme Court to
    reverse the 5th Circuit's decision and to uphold the FDA's
    decision to permit medically appropriate access to
    mifepristone.
        Since Dobbs, we've also seen renewed efforts to provide
    fetuses and embryos with personhood status. This legislative
    session alone, at least 14 States have filed bills to provide
    fetuses with personhood status. These laws will have many
    unintended consequences, including effectively eliminating a
    pregnant person's right to make medical decisions for their own
    health, mitigating access to assisted reproductive technologies
    like IVF, and even restricting people's rights to
    contraceptives.
        These types of laws are dangerous, and they're already
    creating confusion and fear for providers and patients alike.
    I'm grateful to the providers in Massachusetts. Thank you for
    your leadership and also for the work that we continue to do
    across the country.
        I have to quickly remark. It was most recently in Texas
    with other democratic AGs. And we had the honor and privilege
    of listening to providers, including a mother shared her
    horrific story of attempting to access care.
        This is truly the issue of our generation to solve. And as
    doom and gloom and dark as it may seem right now in Texas in
    terms of their rights and frankly lack of access to a legal
    abortion and other reproductive health care, and the fear and
    confusion that's being created in that State, I was really
    proud to listen to these providers who are on the front lines
    doing the work every single day, including along the border to
    ensure folks have access to health care. And the fact they're
    looking to not only Massachusetts but other democratic AGs in
    other States to help them provide that care.
        We will do our part. I'm really delighted to be here with
    each and every one of you. Thank you again, Senator Markey. And
    thank you again, Senator Warren, for your leadership in hosting
    this hearing. Thank you.
        Chair Warren. Thank you, General Campbell.
        Ms. Hart Holder.

       STATEMENT OF REBECCA HART HOLDER, PRESIDENT, REPRODUCTIVE
                               EQUITY NOW

        Ms. Hart Holder. Thank you, Senators. Thank you for
    inviting me to testify today.
        It's been almost 2 years since Donald Trump's Supreme Court
    overturned Roe v. Wade and unleashed a public health, racial
    justice, and gender equity crisis in our country. And I'm going
    to talk a little bit about the impact here in Massachusetts. We
    have felt a growing tidal wave in our Commonwealth.
        We know that providers have already seen patients from
    Alabama, Arkansas, Florida, North Carolina, South Carolina,
    Tennessee, Mississippi, Texas, Wisconsin, Louisiana, Georgia,
    and the surrounding New England States. And we know anecdotally
    from colleagues in New Hampshire that they are seeing some
    patients from Massachusetts because of increased waiting times
    here. But I do want to remind us all that providers in
    Massachusetts began seeing patients from out of State well
    before the Dobbs decision was leaked.
        When the Supreme Court failed to enjoin Texas law SB8 in
    2021, almost immediately our providers started seeing patients
    from the southwest. And that's why we joined with our partners
    at Planned Parenthood and the ACLU of Massachusetts before the
    Dobbs decision was even leaked to put forward the Beyond Roe
    agenda for Massachusetts which is a 21-point plan to make clear
    that we have to go beyond Roe v. Wade to ensure equitable
    access to reproductive health care for all the people in our
    State. As Attorney General Campbell said, weeks after Roe fell,
    the Massachusetts legislature acted boldly to pass a
    reproductive health care package that included several of our
    key recommendations in the Beyond Roe agenda, including Best in
    the Nation shield law protections for abortion providers and
    patients and offering a shield for providers offering care via
    telehealth regardless of the patient's location.
        To help providers make sense of how they're protected under
    the shield law, we partnered with the Massachusetts Attorney
    General's office, the ACLU of Massachusetts, and five private
    law firms to launch the abortion legal hotline. It's a free and
    confidential resource for patients and providers to learn more
    about their rights to provide or obtain abortion care. And I
    just want to give you a little insight into the kinds of calls
    we're getting.
        So far, we've gotten over 120 calls to the hotline. And
    we've helped providers understand how they can provide
    telehealth abortion care to patients in banned States. We found
    counsel for people negatively impacted by anti-abortion centers
    or crisis pregnancy centers. We've helped providers establish
    long-term relationships with pro bono legal counsel. And we've
    aided patients seeking abortion care in our State.
        But even as people come to Massachusetts for care, people
    in our State are still being turned away because there's a big
    difference between the legal right to abortion and a person's
    ability to actually access that care. Researchers estimated
    that in the first 4 months post-Dobbs at Planned Parenthood in
    Massachusetts, there was a 37 percent increase in patients
    traveling from out of State. That's a number we only expect to
    grow as we get more data.
        That means our clinics are contending with more patients,
    more appointments. Our funds are paying for more care, and our
    health system is facing more and more strain. And we know that
    access deserts exist in our State, particularly in western
    Massachusetts and southeastern Massachusetts and particularly
    as applied to in-clinic care.
        And as the Attorney General said, we know it
    disproportionately impacts low-income people, BIPOC
    communities, LGBTQ people, and people in rural communities. And
    I want to be clear that travel and transportation barriers
    persist. And it really highlights the fact that the
    reproductive justice crisis is also a transit justice crisis
    and an economic justice crisis.
        Restrictions on abortion care throughout pregnancy also
    continue to send patients out of our State for care. All the
    while severe maternal morbidity has nearly doubled in
    Massachusetts from 2011 to 2020 with Black mothers experiencing
    the worst rates of complications. Abortion access is
    intrinsically connected to maternal health, and we cannot
    address these crises in a silo, especially when more than 30
    anti-abortion centers throughout Massachusetts continue to spew
    medical disinformation and dissuade patients from accessing
    abortion care and put public health at serious risk.
        And as anti-abortion extremists become more creative with
    their attacks by the day, reproductive equity advocates are
    called to constantly wear new hats. For example, thanks to our
    work with the ACLU, we are becoming digital privacy experts.
    But we have to do more to protect abortion providers and
    patient location data and personal information before it is
    weaponized by hostile actors in other States. So we have to
    pass the Location Shield Act here in Massachusetts. And we have
    to pass Senator Warren's Health and Location Data Protection
    Act in Congress.
        In a post-Roe world, Massachusetts has a critical role to
    play with strong legislative and executive partners and an
    unwavering congressional delegation. We've been able to go on
    offense to protect and expand access to care. We have to work
    together to ensure that as many patients are able to access
    care as possible by sharing strategies, policy ideas, and
    playbooks across State lines in red, blue, and purple States.
        Post-Dobbs, Massachusetts and New England can and must lead
    the way for reproductive equity. And I just want to be clear
    that you never see a sign that says, ban abortion, in the 21
    States that have banned abortion post-Roe. The goal is to ban
    abortion in all 50 States, and we have to be extremely clear-
    eyed about this.
        But it will not end in abortion. As Senator Markey said, it
    includes contraception. It includes IVF. And if Donald Trump is
    elected President this November, they will enforce a national
    abortion ban.
        So our work continues to ensure the full spectrum of
    reproductive health care for all people. And I'm delighted to
    be here today with my partners and friends. And thank you for
    the opportunity to testify, Senators.
        Chair Warren. Thank you very much. Appreciate, Ms. Hart
    Holder.
        Dr. Kathryn Fay.

     STATEMENT OF KATHRYN FAY, FELLOW, PHYSIICANS FOR REPRODUCTIVE
        HEALTH, AND PHYSICIAN, THE BRIGHAM AND WOMEN'S HOSPITAL

        Ms. Fay. Thank you. Good afternoon, Senator Warren and
    Senator Markey. Thank you for holding today's hearing on
    abortion and for the opportunity to speak to you about access
    to this critical care.
        My name is Dr. Kathryn Fay. I use she/her pronouns. I'm a
    board certified, fellowship trained obstetrician, gynecologist
    specializing in family planning.
        I provide full spectrum sexual and reproductive health
    care, including abortion. And like many in medicine, I've
    completed my training in other States, in my case, Illinois and
    Utah. Now as a resident of Massachusetts, I bring a firsthand
    account of the ways that State policy supports or obstructs
    quality health care.
        I'm here today as a fellow with the Physician's for
    Reproductive Health, a network of physicians from across the
    country working to improve access to comprehensive sexual and
    reproductive health and as a physician at the Brigham and
    Women's Hospital. In Massachusetts, I'm able to provide care
    based on what patients and I decide together as safest and
    healthiest for their lives using my clinical training and
    following best medical practices without political
    interference. Massachusetts has been and continues to be a
    leader for access to reproductive health care.
        And we've heard today about legislation, both before and
    after Dobbs has been enacted. And I highlight this because it's
    in contrast to my experience working in Utah which prior to
    Dobbs employed numerous tactics to hinder and stigmatize those
    seeking abortion care policies which have grown only more
    extreme in the interim. I'm grateful to live and practice
    medicine in a State that's supports the broad scope of sexual
    and reproductive health care.
        In the past few months, I've cared for people who needed
    lifesaving abortion to be in treatment for a new cancer
    diagnosis and people who needed an abortion in the setting of a
    life-threatening hemorrhage. I've cared for people who sought
    abortions in the settling of fetal anomalies, abusive partners,
    housing instability, sexual assault, contraceptive failure. The
    indications are endless and all of them valid.
        However, the Supreme Court's decision in Dobb's has wreaked
    havoc on the lives of people across our country who are seeking
    care for similar reasons. As States continue to restrict
    abortion access, patients are having to travel farther and
    farther distances, putting their health and lives at risk. I
    have cared for people who traveled long distances to
    Massachusetts with ruptured membranes, a diagnosis for which
    standard medical care is immediate intervention with an
    abortion because of the threat of sepsis and hemorrhage.
        Overall, there is an estimated 4,500 more abortions
    provided in the Massachusetts formal health care system in 2023
    compared to 2020. Last year, 1 in 15 people who received
    abortions in Massachusetts were from out of State. For these
    patients who have the resources to travel, at the very least,
    they're being forced to leave their support systems and
    communities. I think about all the people who are unable to
    make the expensive, complex, risk-laden journey to essential
    care.
        People have been forced to remain pregnant since Dobbs, and
    there are strong data to show the enduring harms of being
    denied a wanted abortion. Everyone deserves access to care in
    their community in a manner that is best for them with people
    they trust. The ripple effects of abortion bans will continue
    to impact other aspects of essential care such as miscarriage
    care.
        Further, medical trainees and clinicians are reconsidering
    their choice of institutions because of hostile State laws, a
    finding that extend beyond the specializing in obstetrics and
    gynecology. The quality of care in these States will be
    jeopardized for generations to come through, for example, the
    creation of maternity care deserts evidenced in Idaho which has
    already experienced closure of labor and delivery units from
    short staffing.
        Additional changes to the abortion landscape will happen
    this summer when the Supreme Court is said to issue decisions
    on two landmark cases. The court's decision and FDA v. AHM will
    impact access to mifepristone, not only affecting pregnant
    people's access to abortion care but also early pregnancy loss
    and stillbirth management. Additionally, the Supreme Court is
    considering whether EMTALA preempts State abortion bans.
        People should have access to abortion care without barriers
    or delay, of course including in emergency circumstances.
    Likewise, clinicians should be able to practice without
    performing the calculus of what State law permits and instead
    focus on applying their medical training to provide the
    necessary care that is right for the patient. Abortion
    restrictions only serve to burden and endanger patients and
    clinicians. They do not make abortion any safer.
        These restrictions represent a national movement that
    threatens care. If not just for the general moral good, I am
    here today advocating for the status of care in Massachusetts.
    Since Roe, there has been steady chipping away of sexual and
    reproductive rights that has jeopardized reproductive justice
    and health for all.
        Dobbs was a clear and devastating loss. But it does not
    represent an end point. I worry about the loss of mifepristone,
    a Federal abortion ban, and threats to contraception and
    assisted reproductive technology, all hazards that will
    transcend State lines.
        Abortion without stipulation is lifesaving, necessary,
    compassionate, essential health care. Thank you for having me
    here today. I look forward to your questions.
        Chair Warren. Thank you, Dr. Fay.
        And Ms. Rose.

         STATEMENT OF CAROL ROSE, EXECUTIVE DIRECTOR, ACLU OF
                             MASSACHUSETTS

        Ms. Rose. Thank you, Senators, for your leadership and for
    holding this incredibly important hearing and for inviting me
    to testify. Since the Supreme Court overturned Roe v. Wade, as
    we've heard, Massachusetts elected leaders at every level of
    Government have taken bold and timely steps to protect access
    to reproductive health care in our Commonwealth. Just a month
    after the Dobbs decision, State lawmakers passed the shield law
    that we talked about to offer legal protections to abortion
    providers, patients, and helpers in our State that also cover
    gender-affirming care.
        And as you've heard, Attorney General Campbell worked with
    a number of us in groups to help launch the abortion legal
    hotline to help people understand their rights. And then in
    response to the Texas lower court decision and the challenge
    mifepristone access nationwide, Governor Maura Healey acted to
    ensure that providers can continue to dispense medication
    abortion in Massachusetts. And now the legislature we hope will
    be passing the Location Shield Act through the legislature to
    protect the privacy of people seeking health care here in
    Massachusetts.
        But while Massachusetts lawmakers including you have been
    shoring up protections for reproductive justice in our State,
    we are not safe. Aggressive anti-abortion efforts at the
    Federal level threaten the rights of all people, including the
    people of Massachusetts. Efforts to ban abortion nationwide
    directly threaten core Massachusetts values.
        It threatens the policies that have been carefully
    considered and enacted by our States elected leaders. And most
    importantly, it threatens the fundamental access to
    reproductive health care and bodily integrity for the people of
    our Commonwealth. Among the tactics that are being pushed by
    extremists in Congress right now are efforts to impose a 15-
    week abortion ban.
        And if enacted, this ban would make all abortions in every
    State, including Massachusetts, illegal after 15 weeks with
    only limited exceptions and would subject providers to criminal
    penalties for failure to comply. We need only look to the
    States where these bans have already been imposed since Roe's
    overturn to witness the chaos and the suffering that ensues
    from such a ban. Hundreds of clinics have been forced to close,
    leaving millions of people without access to reproductive
    health care.
        Patients have been denied, critically needed emergency
    abortion care, endangering their lives and their health. And
    the harms of forced pregnancies, of course, as others have
    said, fall disproportionately on people from communities of
    color, people with low incomes, immigrants, young people, LBGTQ
    people, and people with disabilities. It's simply cruel and
    unfair to expect survivors of sexual assault or incest or
    someone in the middle of a medical emergency to beg for
    permission to access the medical care that they need.
        Extremists also are pushing radical Federal legislation to
    give legal rights to embryos and fetuses. Now the tactic isn't
    new. Anti-abortion politicians have long been building these
    personhood language into their draconian State laws.
        But now as you know, extremists in Congress are trying to
    impose this radical idea on every State by pushing the so-
    called Life at Conception Act with the intent to make all
    abortions illegal nationwide, including here in Massachusetts.
    As is often true of policies that ban or restrict abortions,
    these so-called personhood laws also threaten other forms of
    reproductive health here, including access to contraception,
    infertility treatments, miscarriage and stillbirth care,
    purporting to make embryos and fertilized eggs ``people'',
    quote-unquote, under law cause chaos and confusion that would
    disrupt access to many kinds of essential health care in the
    Commonwealth and nationwide. The strategy to ban abortion in
    all 50 States doesn't end with proposed Federal legislation.
        These extremist politicians also want to misuse a 150-year-
    old law known as the Comstock Act to circumvent Congress and to
    engineer a backdoor national abortion ban. The Comstock Act was
    passed in 1873. That was 50 years before women even had the
    right to vote.
        This is a Victorian anti-vice measure that was anti-sex in
    any form. And it was adopted to, quote, ``prevent the males
    from being used to corrupt public morals,'' end quote. Now
    despite this, some people are now trying to use the Comstock
    Act as a backdoor access to try to achieve bans on mailing of
    any kind of mifepristone or other drugs that would be used for
    abortion care.
        But this view of the Comstock Act is simply wrong as a
    matter of law. The U.S. Department of Justice, Congress, the
    U.S. Postal Service, in every appeals court that has considered
    the issue up till now agree the Comstock Act does not prohibit
    the mailing or the delivery or the receipt by mail of
    mifepristone or misoprostol where the sender does not intend
    that the recipient of the drug used them lawfully. And there
    are many uses, including abortion care for which these
    medicines can be used.
        There are many ways in which recipients in every State are
    using these drugs without violating State law. And the mere
    mailing of drugs to a particular jurisdiction is legally an
    insufficient basis for concluding that the center intends them
    to be used unlawfully. Massachusetts leaders have time and
    again upheld the will of the voters by taking bold actions to
    protect the bodily integrity of our people.
        We applaud their and your tireless efforts to ensure a
    future where every person in every State can access
    reproductive health care that they need when they need it.
    Thank you. And I'll look forward to hearing your questions.
        Chair Warren. Thank you, Ms. Rose. I want to start with our
    response to losing Roe v. Wade, our response here in
    Massachusetts. But to do that, I want to call out two of our
    State representatives who are here right now, Vanna Howard and
    Marjorie Decker.
        If you both just stand up so everyone gets a chance to see
    you. These are women who help protect abortion at the State
    level here in Massachusetts and expand that protection. And we
    are very grateful to you for that.
        So 2 years ago in an instant, Roe v. Wade disappeared.
    Republican politicians had schemed for decades to try to force
    their unpopular agenda on the rest of America. They decided
    that Government, not the person who is pregnant but Government
    should make a private health care decision and deny women the
    right to control their own bodies and their own futures.
        After the decision, dozens of Republican State legislatures
    raced to ban or restrict access to abortions. Several States
    made it illegal to give, receive, or help another person get
    vital reproductive care. But Massachusetts stood up to protect
    reproductive freedom.
        The State led by two of the women who are here today passed
    a groundbreaking shield law to protect health care providers
    from unjust investigations and legal actions by anti-abortion
    States and advocates. And that was just the start. I'm so glad
    that Attorney General Campbell is with us today to talk about
    Massachusetts' leadership on reproductive rights.
        So let's start with the shield law that Massachusetts
    adopted in 2022. Attorney General Campbell, how does the shield
    law protect reproductive freedom?
        Ms. Campbell. Thank you, Senator Warren. I too want to that
    the leadership and, of course, those in the legislature for
    their leadership in quickly passing this and again making our
    State leadership historic, right? We always tend to be the
    first. And in this case, that wasn't any different. And since,
    other States have followed.
        And what we saw, of course, in the wake of the Dobbs
    decision and as abortion and gender-affirming care ban started
    going into effect across the country, as my office and team
    members, of course, heard from providers who were here seeking
    to help about the need for affirmative protections from
    potential cross border effects of these bans. And so the law is
    a good one and one that other States are looking to model. And
    I'll just a share a few points that I think are worth
    highlighting about the shield law that are impactful.
        This law, it protects licensed providers who provide care
    in Massachusetts by a few different things. One is prohibiting
    in-State provider licensing bodies from imposing consequences
    for violating another State's abortion ban. It bars adverse
    impacts to medical malpractice insurance premiums based on
    actual or perceived liability for violations of another State's
    abortion ban which is really important.
        It creates a new cause of action under our civil rights
    statute to counteract any out-of-State abusive litigation
    concerning the provision of abortion care. It also does other
    things that are equally important. It prohibits law enforcement
    from cooperating in out-of-State investigations concerning
    those who may be providing abortion care or gender-affirming
    care.
        And I'm going to continue, and I think we all have, lifting
    up gender-affirming care which is also sadly under threat in
    this country. It also prevents our State courts from enforcing
    provisions like subpoenas or other legal processes associated
    with abortion or gender-affirming care and investigations or
    litigations. It bars extradition in criminal cases which we
    know is important as we see more States looking to criminalize
    folks in this context.
        But it bars extradition in criminal cases involving
    protected reproductive health care, including abortion and
    gender-affirming care. And all of these protections apply not
    just to providers but those who we deem to be helpers
    regardless of the patient's location at the time the care was
    provided which is really important, meaning that providers are
    protected when they interact with a patient located in a State
    that has an existing abortion ban. And hence why that hotline
    is also really important----
        Chair Warren. We're going to come to that.
        Ms. Campbell. ----for folks to be able to call that too.
    And I know there's supposed to be time constraints which I am
    not looking at any of those.
        Chair Warren. That's OK.
        Ms. Campbell. I see this thing, and I guess I should. But
    those are just some of these examples.
        Chair Warren. So basically what Massachusetts did is the
    legislature said, let's figure out every way we can to protect
    those involved in providing abortion care or gender affirming
    care and make sure that no matter what happens in another State
    that we will still protect anyone providing that care from here
    in Massachusetts and anyone. We will protect their license. We
    will protect them under insurance policies. We will protect
    them from attacks from other States and other State
    governments. Fair enough?
        And the benefit of this is Massachusetts went first. New
    York, Vermont, Colorado, Washington State, then followed past
    similar laws. And because of shield laws like ours, over 40,000
    people living in anti-choice States have been able to access
    abortion with the help of providers who are practicing in other
    States.
        Now Massachusetts did not stop there. And this is where I
    want to give special thanks to our Attorney General. In 2023,
    Attorney General Campbell and leaders from our legal community
    launched a hotline.
        You mentioned it during your testimony. And the idea was to
    give patients and providers free confidential legal advice
    about abortion access. Can you just dig in a little deeper on
    that and explain how the hotline is helpful to those who call
    in?
        Ms. Campbell. Absolutely. One, I want to just say the
    number because I think we should say it.
        Chair Warren. Good.
        Ms. Campbell. It's 833-309-6301 which is really important.
    And it's available not just to folks, of course, who are in
    Massachusetts but folks who are outside of Massachusetts. And I
    invite my other panelists to also chime in.
        But it's free. It's confidential. So it allows folks in a
    landscape that is changing every single day. It seems like
    every moment to get up-to-date information as to what their
    rights are here in Massachusetts, what's available to them, and
    possibly also what is happening in the State they may be
    calling from or somewhere else.
        And the purpose of that was to allow folks to get real
    information in real time. But I would also say for folks who
    might be in some dire circumstances medically to be able to
    call a hotline or someone else to get information to help them
    in real time access to critical care they may need, whether
    it's in the context of abortion care, gender-affirming care, or
    something else within the spectrum of care that is critically
    important.
        Chair Warren. OK. So let me follow up with that. Ms. Hart
    Holder, you lead Reproductive Equity Now. This is the
    organization that actually runs the hotline. And you're telling
    a story in your testimony a little bit about who comes to
    Massachusetts for help.
        Can you talk just a little bit more about who's calling in
    to the hotline and what it is that they're telling you? You're
    on the front line. You see this every day.
        Ms. Hart Holder. Yeah, thank you, Senator Warren. So I want
    to start by kind of saying confusion is the point here. And
    that is what we are hearing on the hotline overwhelmingly from
    patients, whether they're in Massachusetts or whether they're
    looking to access care in Massachusetts, whether that's via
    telehealth or they are from Massachusetts originally but they
    live in Texas. Or their best friend lives here and is going to
    get them on an airplane to help them out.
        It's just tremendous confusion about what is legal and what
    is not legal. So a lot of the calls that we get are just simply
    is it legal to get an abortion in Massachusetts? Where can I
    find care? I want to make sure I'm not going to an anti-
    abortion center or a crisis pregnancy center.
        And that has been, I think, a tremendous theme that we have
    heard over and over. I also want to note that we get a lot of
    calls from within New England because we are small States. Our
    borders are porous.
        Maybe you live on the border and it is easier for you to go
    grocery shopping in Connecticut than it is in Massachusetts.
    And it might be easier to access care in Connecticut than it is
    in Massachusetts just because of where you live geographically.
    So one of the things that we can do is help point you to the
    closest provider.
        The other thing that is incredibly important is that as
    patients travel from States with hostile legislatures, our
    hotline has really served as a clearinghouse for providers to
    understand what their risk is. And I really think it's so
    important and I can't say strongly enough how important it is
    to have some of the best lawyers in Massachusetts through the
    private bar and the leaders at the ACLU of Massachusetts as
    backstops for our providers. To know that they are there and
    they are offering that pro bono legal counsel is incredibly
    important.
        A lot of the calls that we've gotten are about risk
    mitigation. If I want to send--if I want to be a provider that
    is sending medication out of State to patients in banned
    States, how do I mitigate my risk? That's an incredibly
    important role that the hotline has provided.
        And I do want to say every single month the number of pills
    that are mailed--abortion pills that are mailed across State
    lines--increases. And anecdotally from conversations that I'm
    having with providers who are operating thanks to the
    protection of the shield law, we are providing a significant
    proportion of that medication. So this hotline and our
    providers who have stepped up and who are so incredibly brave
    are making a real impact in the lives of people in banned
    States.
        Chair Warren. So thank you very much. I'm always proud to
    be from Massachusetts but never more so than when I talk to
    people who are on the front lines in this fight. Thank you.
    Let's go to Senator Markey for some questions.
        Senator Markey. Beautiful.
        Chair Warren. And then I'll come back for some more.
        Senator Markey. Thank you. There are some people who would
    argue that State protections for abortion are enough. Each
    State should be able to make up their own mind, each State
    legislature.
        And the Massachusetts legislature was the national leader
    in response to Dobbs. Massachusetts passed the ROE Act last
    year to protect patients in several of those workers, to
    providers who now work in this area with us here today. We
    thank you for your work to provide a hotline to support
    people's right to an abortion.
        And in the days after Dobbs, people in the Commonwealth
    locked arms to fend off attacks on the right to abortion. And
    for that, I think we're very proud. But that unfortunately does
    not make us immune to the national threats with which we face.
    So Attorney General Campbell, when U.S. District Judge Matthew
    Kacsmaryk appointed by President Donald Trump decided that the
    Food and Drug Administration didn't appropriately approve safe
    evidence-based medication, abortion drugs, what kind of threat
    did that unleash on the right to abortion across our whole
    country?
        Ms. Campbell. Thank you, Senator Markey. And we can't
    stress enough. I think Rebecca spoke to this a little bit.
    Access to a medication abortion is the top issue that people
    are talking about because it is effective. It is safe. And it
    is the tool that is easiest to provide care in the context of
    what we're seeing across the country, including in Texas where
    I just was and, of course, heard stories of folks who needed
    this care and how they could access care outside of Texas and
    make it easy is challenging.
        And so this is a tool that's safe and effective and allows
    for greater accessibility. I just want to also stress decades
    of research--not just summaries, but decades of research have
    established this as being safe and effective, safer than many
    commonly used prescribed drugs. It has been used by millions of
    Americans and accounts for 63 percent of abortions in the
    United States which I think are figures that are often lost
    sometimes in the conversation or with average folks.
        And so these anti-science, right-wing attacks not just to
    push a national ban but to attack these essential medications.
    We're seeing, of course, as a part of the larger effort to
    dismantle a system that we know is working and to provide
    critical health care. What we're doing--and I'll stress
    obviously all of us working in partnership at every level of
    Government but particularly AGs in this moment in time and
    democratic AGs across this country.
        And I have to look at my colleagues because we will not be
    effective in this fight if we don't work across State lines.
    And we're seeing that as being extremely important. But as we
    do this work, we've done a few things. We worked extensively
    together to fight back against legal attacks on medication
    abortion.
        For example, we joined an amicus brief in the Alliance case
    as I mentioned that argues in support of the FDA and Danco
    pharmaceuticals, which manufactures, of course, mifepristone.
    We're working hard to implement the shield law which I think is
    equally important to this conversation, particularly as folks
    look to criminalize just the mailing process of medications. So
    our shield laws are going to become even more important in
    helping other States draft those and pass those will be
    important.
        And then one last piece I want to mention is telehealth
    abortions which I think was hinted at by so many folks on the
    panel but now account for nearly one in five abortions in the
    U.S. And nearly 8,000 per month are provided as a result of
    laws like ours. And so these tools are effective and will work.
        So in the face of right-wing extremists including right-
    wing judges who are politicizing our courts at every level,
    we're going to continue to step up and work in partnership. And
    those are just some examples----
        Senator Markey. Thank you so much.
        Ms. Campbell. ----of how we do it.
        Senator Markey. And Ms. Hart Holder, Republicans have
    introduced a bill to ban abortion nationally at 15 weeks. If
    Donald Trump is President and they control the House and the
    Senate, what impact would that have on patients here in
    Massachusetts?
        Ms. Hart Holder. A ban is a ban is a ban. A 15-week ban
    will impact the ability of patients to access care post-15
    weeks here in Massachusetts. But it's not just that.
        It means that it will impact people who are coming here,
    make our wait times longer, make it more difficult for folks
    who travel here and for people who live here to access care.
    And I just want to really say how incredibly outrageous it is
    that Mr. Trump and other Republicans think that this is some
    kind of a compromise. There is not compromising on our bodies.
        There is no compromising on our deeply personal decisions
    about if, when, and how to become a parent. So I also want to
    be really clear that it is a farce to think that is the end of
    what they will do. There are no anti-abortion forces who just
    simply want a 15-week ban.
        They want to fully ban abortion care with no exceptions.
    And we have to be very clear-eyed that that is just an opening
    salvo. That is a test to see if they can do it because they
    will go farther and the risk is dire in a Trump administration.
        Senator Markey. Thank you. And if I may, Ms. Rose, Idaho
    has enacted a law that prohibited school-based clinics from
    abortion-related activities, including dispensing emergency
    contraception. Emergency contraception like Plan B is not
    abortion. So how are we seeing these overbroad abortion bans
    translating into threats to other reproductive care?
        Ms. Rose. That's right, Senator. They are trying to--
    they're not stopping at abortion. This isn't even about
    abortion. This is about control over people's bodies.
        It's about the Government having the right to what kind of
    care you're going to achieve. If they are able to do this, Plan
    B is not abortion medicine. It's a contraceptive medicine.
        And they are trying to go after contraception. They're
    trying to go after all aspects of our bodily autonomy and our
    bodily integrity. And that's why I'm so glad that you are
    pushing this Right to Contraception Act that's going to be
    voted on I think next week because it's important that we see
    the broader picture, whether it's maternal child health care,
    access to abortion and gender-affirming care, access to
    contraception, IVF.
        All of these things are interrelated. And they won't stop
    at just, say, a 15-week abortion ban. They're going to try to
    do whatever they can to try to permit people in the Government
    to determine our fate and our futures.
        Senator Markey. Thank you.
        Chair Warren. Thank you, Senator Markey. And thank you, Ms.
    Rose, for that. So I think the point that all of you are
    driving toward is that no one is stopping with just overturning
    Roe. No one is stopping with just--there are 21 States that
    have restricted abortion, that this is a juggernaut that's
    moving and that it is urgent for us to fight back.
        So I want to talk about one of the pieces that the right-
    wing extremists have advanced. And that is the so-called Life
    at Conception Act. This is backed by a majority of Republicans
    in the House of Representatives. They are cosponsors, a
    majority of them, on this bill, including Speaker of the House
    Mike Johnson. So Ms. Rose, what would the Life at Conception
    Act mean for a woman seeking an abortion right here in
    Massachusetts if Life at Conception became law?
        Ms. Rose. Well, if Life at Conception becomes law, then a
    whole lot of other things are going to become illegal. That
    includes contraception, IVF, not just abortion care.
        Chair Warren. But what does that do to abortion care? If
    you do the Life at Conception, can you do abortion care here--
    --
        Ms. Rose. No.
        Chair Warren. ----in Massachusetts? No.
        Ms. Rose. Right. Not at all.
        Chair Warren. It's over at that point.
        Ms. Rose. Then it's over.
        Chair Warren. Yeah.
        Ms. Rose. And I think it's really important to recognize
    that the implications aren't only on all of us and our bodily
    integrity but also on people who need medical care for other
    reasons. And I'll defer to the doctor on this. But in addition
    to banning types of birth control and IVF treatment, it would
    ban research that relies on stem cells.
        It could impact therapies for disabilities for people
    seeking cures for various diseases. It could deny access to
    cancer or other treatments if a patient is pregnant. And it
    would just impact thousands of laws in so many different ways
    that we can imagine from interrogating criminalizing people for
    their actions while they're pregnant, to creating health and
    legal nightmares for anything when property and inheritance
    rights are granted.
        And who can file a lawsuit? So it's this notion that life
    begins at the moment of fertilization. It's really dramatic and
    huge and sweeping and would create tremendous chaos, even more
    than we have right now since Roe was overturned.
        Chair Warren. OK. So we currently have a bill pending in
    the House of Representatives signed on to by a majority of
    Republicans already, including the Speaker of the House, that
    would not just ban abortion here in Massachusetts as well as
    every other State in the Nation but also have these additional
    impacts throughout our health care system. Dr. Fay, could you
    just say a word to explain to everyone why this Life at
    Conception bill if it were turned into law could make some
    forms of contraception illegal?
        Ms. Fay. Sure. Different forms of contraception have
    different mechanisms of action. And if life were to begin at
    conception, it would depend on the definition that someone is
    using as their own personal philosophical beliefs of when
    fertilization and what significance that has to folks. And that
    may interfere with what forms of contraception are acceptable
    depending on what point its contraceptive effect is implicated.
        Chair Warren. So not to put a too fine a point on this. But
    for example, as I understand it, an IUD, an egg may be
    fertilized. It simply never implants. And under a Life at
    Conception law, would IUDs potentially be banned across the
    country?
        Ms. Fay. That would definitely be a concern. IUDs function
    to incompletely suppress ovulation but also can have a post-
    fertilization effect in which case we would worry that one of
    these essential tools that we have as clinicians and supporting
    people's contraceptive goals would be eliminated.
        Chair Warren. OK. And why would a Life at Conception law
    interfere with a couple's ability, for example, to use IVF in
    order to have a baby that they very much want?
        Ms. Fay. Yeah, there would be scenarios that don't make
    medical sense where personhood or life is attributed to, for
    example, stored embryos that people are using as part of their
    family building goals.
        Chair Warren. So what I'm understanding here is that we
    have this bill pending in the House of Representatives right
    now that would ban--effectively ban abortions, some forms of
    contraception, IVF, not just in States that signed on but in
    all States. So Attorney General Campbell, but we have protected
    abortion. Would that be enough to protect us from a Life at
    Conception law?
        Ms. Campbell. No.
        Chair Warren. Why not?
        Ms. Campbell. Well, one, certain laws trump our laws. So it
    doesn't really matter at some level what we do within the
    State. And obviously, that's not finite in every context.
        But I think you raise a point that everyone should be
    mindful of as we talk about access to reproductive health care
    and the full spectrum of care. It isn't just abortion care.
    It's contraception. It's birth control.
        If you are pregnant and you go to a screening, for example,
    and you get information that is not what you want to hear about
    your pregnancy and you may choose in consultation with your
    provider to make a decision about continuing with your
    pregnancy. In some States, you're not allowed to proceed as you
    and your family or you or the mother and the husband or partner
    may want to proceed. So everyone should care about this issue
    because you never know, particularly in the future for mothers
    or those who choose to at some point become pregnant what your
    reproductive journey will be.
        And so all of these threats, whether at State level,
    national level, all interfere with a very personal decision and
    will ultimately become a very personal process for you and your
    family. And we're seeing the barriers just continue to stack
    up. And even for progressive States like Massachusetts, we are
    also in trouble if some of these national measures proceed.
        Chair Warren. I think you put it very powerfully. I want to
    hold in my heart everyone who needs reproductive care, whether
    it's IVF that they're looking for, contraception, if they're
    looking for abortion care at any point as you put it in the
    reproductive care journey. And I am very grateful to our
    legislature in Massachusetts.
        I'm grateful to our Attorney General. But if our Federal
    Government steps out and passes a law like this Life at
    Conception law, all of our work goes away. And that means we
    need to be ringing not just a few alarm bells. We need to ring
    every alarm bell possible. Thank you. I appreciate it, Attorney
    General. Senator Markey, back to you.
        Senator Markey. Thank you. Attorney General Campbell, Texas
    received permission from the Trump administration to exclude
    emergency contraception from Medicaid funded family planning
    programs. Why is it important to protect and guarantee access
    to contraception, especially when we see limits to coverage for
    our contraception disproportionately impact access for low-
    income women and women of color in our country? We know those
    discriminatory practices continue to exist in our country. So
    why is it important to keep that access open?
        Ms. Campbell. Well, first of all, I think we've all
    stressed this. Thank you for your leadership and, of course,
    the vote that is coming up next week with respect to your
    legislation. I think we all have been attempting to frame--and
    I want to move away even from talking points, right, why it's
    important for folks to look at the full spectrum of care.
        You don't know what you may need at any given particular
    time until you go in and consult a medical professional. And in
    that personal conversation and engagement, you and your doctor
    choose to make a decision about your reproductive health
    journey or any other health journey for that matter. And so
    access to these medications and many of these, of course, we
    know from decades of research and personal stories to be safe,
    to be effective is essential as we look at the full spectrum of
    care.
        And it is sadly in some States that we're seeing not only
    barriers to access in this are outright banned from usage,
    we're also seeing crisis pregnancy centers or other entities
    being cropped up. And in Texas since we're speaking of Texas,
    these entities funded by the State itself that is providing
    confusion and misinformation to folks as they're seeking care
    along the spectrum. And we know sadly whether it's women or
    people of color or Black women or Brown women or poor folks who
    have disproportionately over the course of centuries been
    blocked access to this critical care.
        This is a fight that we should all pay attention to. That's
    one piece. And whether it's happening within a particular State
    or the national level, when we choose to make these decisions
    with our doctors, no one--no third party whether it's the
    Government or some individual somewhere--should stand in the
    way of us being able to do what we need for our own health.
        Senator Markey. Great. Thank you. And Ms. Holder, when
    former President Donald Trump was asked whether he supports
    restrictions on a person's right to contraception, he said,
    we're looking at that. We're looking at that. So do you think
    we should be worried if Donald Trump is President again and
    he's thinking about whether or not access to contraception is
    something that should be legal across the country? Is this
    something that should be at the top of the list of issues for
    people all across the country?
        Ms. Hart Holder. Yes. As the great Maya Angelou says, when
    someone shows you who they are, you should believe them. Donald
    Trump is showing us exactly who he is by essentially refusing
    to answer that question and sort of giving us a hat tip to the
    fact that they're looking at it. If you look at Project 2025
    which is a 900-page The Heritage Foundation playbook about what
    the first year of a Trump administration would look like, they
    are very clear that they are trying to conflate abortion with
    contraception.
        They are not the same thing. They know that contraception
    is extraordinarily popular nationwide. They know that if they
    try to ban contraception, they will lose in the court of public
    opinion.
        So they're trying to make us think that putting an IUD in
    is abortion or using emergency contraception is abortion. That
    is not backed up by science or data or any real doctor that any
    of us have ever spoken to. So it's really important that again
    when we think about--as Senator Warren said to me earlier, when
    we think about the States as laboratories of democracy which
    certainly Massachusetts is, Louisiana is just as much a
    laboratory for anti-abortion laws that are going to be a
    template for the rest of the Nation and eventually a Federal
    law. We have to be really clear-eyed that Donald Trump wants to
    come after contraception.
        Senator Markey. Right. And the correct answer is Donald
    Trump. No, there should be no restrictions on the access to
    contraception in our country. And I think he's going to be
    taught that lesson this year. I think it's coming his way.
        And just one final question on this round if I may.
    Abortion is part of a broader array of reproductive care. And
    all reproductive care is essential to people's health. Millions
    of people across the country rely upon reproductive care like
    birth control for their social and economic freedom and to
    treat health conditions like polycystic ovarian syndrome or
    endometriosis or to prevent cancer. Dr. Fay, please describe
    why access to contraception is absolutely essential to your
    patients.
        Ms. Fay. Sure. Thank you. So contraception is one of our
    primary tools in helping people decide if and when they want to
    have a family. But also, as you said, the majority of
    contraceptive users have used contraception for its non-
    contraceptive benefit.
        So to help with things like painful or heavy menses or to
    treat pre-cancerous conditions. And so loss of access to
    contraception would, of course, affect both of those purposes
    for use. And further, if there is restriction in terms of what
    options there are for contraception, I have folks coming to me
    with a variety of indications or comorbidities or preferences
    that would already narrow the scope of options available to
    them. And so I need the entire suite of contraceptive methods
    available to help find the best fit for my patients and do
    right by them.
        Senator Markey. Thank you. Thank you, Senator Warren.
        Chair Warren. Thank you. So it's pretty clear that
    Republicans are openly marching toward a nationwide abortion
    ban. And despite what Donald Trump says about abortion can be
    decided State by State, his Republican cronies in Congress have
    already introduced legislation to ban abortions at 15 weeks.
        And Trump has refused to say that he would veto such a ban.
    So I just want to talk for a minute because I really want to
    talk about the pieces of legislation that's already out there
    for us to see. They're not just a dream. They're not just
    someone's imaginary concerns. These are things that people are
    already signing on to and vetting and trying to move forward.
    So Dr. Fay, could you just say a little bit more about what a
    15-week nationwide abortion ban would mean for patients right
    here in Massachusetts?
        Ms. Fay. Sure. The number 15 weeks doesn't correlate to
    anything clinically significant. It doesn't have a medical
    meaning. And there are people who come to me with innumerable
    reasons for needing abortion care after 15 weeks which they
    would be denied.
        And there's excellent data to show what happens when people
    are denied a wanted abortion, including enduring financial
    hardship, increased risk of physical violence in a setting of
    intimate partner violence, and health consequences. In fact, we
    know that places with the most restrictive abortion policies
    are also the places with the worst figures around maternal
    morbidity and mortality. So surely such a ban would contribute
    or exacerbate what we already recognize is a national health
    crisis.
        Chair Warren. So in other words, if we had a 15-week
    nationwide abortion ban, maternal mortality rates would likely
    increase?
        Ms. Fay. There is a very short line that I think would be
    drawn between those two events.
        Chair Warren. So this would--a 15-week abortion--nationwide
    abortion ban would force women to carry pregnancies to term
    even if it had serious consequences to their health. Now many
    supporters say, oh, but there are exceptions. We read this all
    the time.
        There are exceptions in the case of the necessary save a
    life of a pregnant woman or in the case of rape or incest. Dr.
    Fay, you're out there on the front lines practicing OB/GYN.
    What does it mean to have exceptions? Is that good enough? Does
    that provide meaningful access for people in trouble?
        Ms. Fay. No, abortion bans do not work. Such legislation is
    not compatible with medical practice. No list of exceptions
    would ever be sufficient to substitute the nuance that's needed
    to practice good medical care.
        Chair Warren. OK. So you're telling me it's hard to figure
    out where the lines are. What's the consequence when it's hard
    to figure out where the lines are? Ms. Hart Holder?
        Ms. Hart Holder. The consequence is that providers are
    afraid to offer care. And in some States where there are
    criminal penalties, they're afraid to provide care because they
    can go to jail. So that means that people don't get that care.
        We're seeing this in Texas. We're seeing it in Tennessee.
    There are very brave women coming forward saying that for
    whatever reason, they needed abortion care either later in
    pregnancy or because they fell under some kind of an exception
    in a State that has an outright ban. And they simply could not
    get that care because the exceptions were so opaque that
    providers couldn't actually operate them. What it tells us is
    exceptions just don't work.
        Chair Warren. And Dr. Fay, you're shaking your head. I take
    it you agree with that?
        Ms. Fay. Definitely. I think such exceptions work in effect
    to just cause moral distress for clinicians in watching to wait
    if someone might become sick enough. But really the lack of
    clarity and the ask of interpreting something with such
    subjectivity is paralyzing. And people are putting and pitting
    their risk of criminalization or professional good standing
    against their good medical sense and obligation and duty to
    patients.
        Chair Warren. Right. So instead of a doctor and a patient
    in an examining room, it's a doctor, patient, a legislator, and
    a lawyer----
        Ms. Fay. Yes.
        Chair Warren. ----in order to make what is supposed to be a
    health care decision----
        Ms. Fay. Yes.
        Chair Warren. ----that should belong to the person whose
    health is most affected. We've talked about--Yes, please. Go
    ahead----
        Ms. Campbell. I just want to quickly----
        Chair Warren. ----Attorney General Campbell.
        Ms. Campbell. I think all of us are putting ourselves in
    spaces to hear real stories from real folks who are navigating
    this, whether it's providers in real fear of going to jail and
    having to decide if you provide that critical care or not and
    then hearing from patients. And most recently, a group of
    Democratic AGs heard from a patient who sadly got a diagnosis
    during her pregnancy and this was her second pregnancy after 20
    weeks and wanted to make the decision with her husband that
    they did not want to carry that baby to term. And this is in
    Texas and sadly couldn't get any care in Texas so had
    fortunately the resources to go elsewhere to get that care.
        But what she so remarkably spoke of was her privilege as a
    white woman who had access to these resources and another
    mother who was a mother of color who did not. And sadly, that
    mother could not go to another State for care. She couldn't
    afford it, including the childcare for her current child.
        And so she had to carry her baby to term knowing that the--
    I think she knew it would be a girl, the girl that she would
    birth ultimately would die. And sure enough, within a short
    period of time after carrying the baby to term, unable to get
    the care she so desperately needed, carried the baby to term,
    gave birth I believe at her home only to hold that child and to
    watch that child die in her arms. That's the state of affairs
    right now in this country, the United States of America.
        And as one AG remarked, anywhere else, this would be a
    human rights violation. So that's the magnitude of what we're
    all hearing and dealing with. And it's very traumatic for each
    of us as we do this work.
        But I just thought it was so important as we talk about the
    fear of providers and what folks on the front lines are seeing
    and feeling. There's nothing like hearing these stories in real
    time from actual folks who have experienced this and had the
    courage to come forward to share their testimony on the very
    points that you're trying to make that we're all in trouble
    when we say, oh, there's just some exceptions. No, they don't
    work. They're not effective. They're not impactful because they
    are not flexible to deal with what a patient and a provider are
    dealing with in that moment in time.
        Chair Warren. Right. And the point you make which is so
    powerful, those with the fewest resources----
        Ms. Campbell. That's right.
        Chair Warren. ----will be hit the hardest. Those who have
    the most resources may be able to navigate through. But those--
    --
        Ms. Campbell. Exacerbating existing disparities.
        Chair Warren. ----who can't get out of State, those who
    can't get help, those who don't have lawyers----
        Ms. Campbell. That's right.
        Chair Warren. ----standing beside them and lots to back
    them up are the ones who will suffer most from this. We have
    talked about two pending bills that Republicans are already
    pushing forward. I want to mention one last thing and it's the
    last question I'll have today and that is even if the
    Republicans can't take the House and the Senate in order to
    pass something through Congress, if Donald Trump were in the
    White House, what could be the consequences for reproductive
    care?
        And Ms. Rose, you talked about The Heritage Foundation and
    how it is pushing the idea that it might be possible to use an
    old law from the 1800s, the Comstock Act, in order to restrict
    abortion nationwide. You've spoken to that. So I want to ask
    Ms. Hart Holder, you are now on the front lines trying to make
    sure that there is access to abortion here in Massachusetts. If
    Donald Trump were in the White House and he follows the advice
    of The Heritage Foundation and satisfies his extremist base,
    what would be the consequence here in Massachusetts?
        Ms. Hart Holder. Yeah, if he attempts to resurrect the
    Comstock Act, which as Carol pointed out is a zombie law from
    1873 that should frankly stay dead and it is shameful that the
    Republicans are trying to resurrect it. And it really goes to
    show you that they will use any means necessary to ban
    abortion. If he does that, there are kind of three sets of
    major consequences.
        One, it will impact our ability to mail medication abortion
    across State lines. So those 8,000 pills a month that are
    getting to people in banned States, that ends. It will impact
    the ability of pharmaceutical companies to mail medication
    abortion into States like Massachusetts that have codified the
    right to choose.
        Chair Warren. So let me just make sure I'm following you
    here. First, we can't help others.
        Ms. Hart Holder. Right.
        Chair Warren. But second, we can't even help ourselves----
        Ms. Hart Holder. We can't help ourselves.
        Chair Warren. ----because our pharmacies won't be able to
    get the mifepristone----
        Ms. Hart Holder. Exactly.
        Chair Warren. ----or whatever other drug is necessary.
        Ms. Hart Holder. Exactly, because obviously--and I'm
    talking to a former law professor here. But the Federal
    Government regulates intrastate commerce. And therefore, we
    will have a big problem with the U.S. mail and getting
    mifepristone and misoprostol.
        The other thing is that the Comstock Act would outlaw the
    tools and devices that help in abortion care. So that could
    also impact a clinic's ability to procure the medical
    instruments that they need to offer in-clinic aspiration or
    surgical abortion care. So the impact on States like ours would
    be profound. The Comstock Act simply must be repealed. It is a
    relic of a different time that was wrong then and it's wrong
    today.
        Chair Warren. And we can't have a President of the United
    States who's willing to use it.
        Ms. Hart Holder. That's right.
        Chair Warren. Thank you. Senator Markey.
        Chair Warren. Thank you. And we know that The Heritage
    Foundation 2025 report is going to be his working document. He
    doesn't want to waste time the way he did in 2021. This time,
    he's going to be ready to go.
        And they've already developed all the policies that he's
    going to start to implement. So there won't be this first year
    training wheels on this Trump administration. He's absolutely
    going to start on January 21st to look at every regulation,
    every rule, every agency and just begin to try to roll back
    personal protections, roll back civil rights.
        And again, as you said, Ms. Holder, Maya Angelou said,
    believe someone when they tell you who they are. Well, The
    Heritage Foundation is who he is and we should believe it.
    That's going to be what we're fighting, and we're going to have
    to be doing it on all fronts. And Ms. Hart Holder, in your
    written testimony, you state that the right to reproductive
    care is not real unless every individual is able to safely
    access that care with autonomy and dignity. How can that apply
    to gender-affirming care?
        Ms. Hart Holder. Thank you. Thank you for that. Great
    question.
        Senator Markey. Can you just move in the microphone a
    little?
        Ms. Hart Holder. Reproductive equity not only calls us to
    fight for reproductive health care access for everyone but also
    demands that we fight to protect bodily autonomy and the right
    to self-determination. And that includes medically necessary
    gender-affirming care. It's about eliminating all the ways that
    all people, including LGBTQ people, are denied access to health
    care, to their rights, and to their dignity.
        And I just want to be really clear that if you look at a
    Venn diagram of the anti-abortion movement and the anti-LGBTQ
    movement, it is a circle. It is not a mistake that right after
    Dobbs, the Texas legislature went after trans kids. It is the
    same people. They are fighting the same fight. And it is simply
    about controlling what we do with our bodies.
        So we have to be inclusive and expansive in what our
    reproductive equity calls us to fight for. I also think it's
    important to note that the fall of Roe v. Wade not just
    threatens access to abortion and access to contraception. But
    the right to privacy underpins the right to marriage.
        It is a necessary precursor to eliminate Roe in order to
    get to attacking LGBTQ families. So I think we just absolutely
    have to see this as all part of one anti-democratic fight that
    is coming after our ability to decide what to do with our
    bodies and who we love.
        Senator Markey. Yeah, you are just so right. So this is a
    playbook that they have. And they're kind of experimenting with
    it in Texas and some other States. But it's only so they can go
    nationwide. They're not going to stop until what they're doing
    at the statewide level successfully is implemented across the
    whole country.
        And they're using children and teenagers as experiments and
    as part of all of their efforts. Trying to stoke fears, build
    momentum so that they can ultimately pose real threats to
    patients, to families across the country. And they're starting
    in Republican-oriented city councils and State legislatures all
    across the country. But ultimately their goal is to go
    national. So Attorney General Campbell, how have you seen
    threats to gender-affirming care play out here in Massachusetts
    as an example of how our own State is not immune to these
    threats?
        Ms. Campbell. Thank you, Senator Markey, for the question.
    And also, I appreciate you and Senator Warren and this panelist
    and others who are always intersectional in talking about
    reproductive health care but also threats to gender-affirming
    care right now. I feel like every day it seems I along with
    other AGs across the country are filing some brief in support
    of not just access to gender-affirming care and speaking to
    from the lens of our providers the experts of why this care is
    critically important for LGBTQ+ folks as well as youth and
    trans youth.
        But as we see the increase in attacks not just on gender-
    affirming care but the community as a whole, and we all look
    forward to Pride Month soon in celebrating these communities. I
    want to just highlight a couple of points that I think are
    important. Many of these attacks, of course, include banning or
    severely restricting access to gender-affirming care.
        We know that gender-affirming care is medically necessary.
    It is safe health care that is backed like all the other things
    we've been talking about today, decades of research and
    supported by every major medical association in this country
    representing over 1.3 million U.S. doctors. Yet the onslaught
    of attacks on gender-affirming care threatens the ability for
    transgender and non-binary folks, particularly young people as
    I mentioned, to be their authentic selves.
        This is about freedom. This is about civil rights. And we
    want to make it clear in Massachusetts and I think we've done a
    great job with our health care providers but also within our
    schools and local municipalities to ensure that people have the
    legal right to receive gender-affirming care.
        Our law protects and ensures safe access to that care. And
    we also want to support and lift up those community-based
    organizations that are providing this care and respective
    communities as far as Western Mass. It's also ensuring gender-
    affirming health care is accessible and affordable by
    prohibiting insurers from excluding it from their coverage
    which also is equally important and something we have been
    working hard at. And last, I will stress it's lifesaving care.
        And we've heard that through some really incredible
    personal testimonies. And whether you are a Massachusetts
    resident wanting to come here living elsewhere, we've also
    shared that in our advocacy. And we know that young people in
    particular live in different settings.
        Some are within State custody. Some are incarcerated. We
    fight to provide access to health care, including gender-
    affirming care. We want to make sure we're doing it in all
    settings so that folks receive the care they so desperately
    deserve. So thank you.
        Senator Markey. Thank you. And I want to give you, Ms.
    Rose, the final word on this subject in terms of the need to
    ensure that gender-affirming care is protected nationally to
    take what we're fighting for here in Massachusetts and make
    sure that those are protections that people all across the
    country have.
        Ms. Rose. Absolutely. And I think to your point, all of
    these issues are intersectional. So when we're talking about
    abortion care, when we're talking about gender-affirming care,
    we're talking about contraception. We're also talking about
    racial justice. We're also talking about marriage equality and
    LGBTQ equality.
        We're also talking about women's rights. We're talking
    about socioeconomic justice. So all of these things are of a
    piece. And they're all under attack by the far-right in this
    country right now.
        And they're using abortion as an attempt to get at all of
    these other issues as well. And we must keep our eye on the
    larger ball of what's happening here because these aren't
    separated. And we have seen already here in Massachusetts with
    things like book bans.
        I mean, I think the American Library Association said that
    we rank fourth in the country for efforts of book bans. I think
    we are seeing efforts to ban--because we have so many school
    districts, I think. We have efforts to ban drag shows and these
    kinds of things.
        So these are all of a piece. And I think for the ACLU as a
    multi-issue organization, we're always looking at those
    intersections. And the sad thing we're seeing right now is
    increasingly they're becoming a circle as Rebecca said.
        And I think it's tremendously important as both a matter of
    health care but also as a matter of law and as a matter of
    national politics that we do sound the alarm, that we let
    people know that all of these things are under attack. And when
    one of our rights are under threat, all of our rights are under
    threat. So I'm so grateful to the two of you for helping us
    here in Massachusetts to both lift up what our local lawmakers
    have done but also to help us all to sound the alarm that the
    work isn't done and we have to think nationally, act
    nationally, as well as thinking and acting locally. Thank you.
        Senator Markey. Thank you.
        Chair Warren. You good?
        Senator Markey. I'm good. Thank you.
        Chair Warren. All right. So I just want to say again thank
    you to our four witnesses for being here. We will make a record
    of this. I appreciate your coming here to testify, but I
    appreciate even more the work you are doing every day to
    protect people here in Massachusetts but to protect people
    around the country.
        The threats are real. I am grateful to all of you who came
    today and for everyone who is focused on this issue and
    understands the immediate threat posed by all of the different
    ways in which extremist legislators and extremist jurors are
    hoping to impose an agenda on the rest of America that it does
    not want. It is our responsibility to fight back, and that
    starts by getting information out about what is happening and
    making a very visible commitment that we will not go away.
        We will continue to raise this issue over and over. So
    thank you all very much for being here. This hearing is
    adjourned.
        [Whereupon, at 3:42 p.m., the hearing was adjourned.]
        [Prepared statements and additional material supplied for
    the record follow:]
                   PREPARED STATEMENT OF ANDREA JOY CAMPBELL
                Attorney General, Commonwealth of Massachusetts
                                  May 29, 2024
        Thank you, Senator Warren, for your leadership. Thank you as well,
    Senator Markey, for your leadership and, of course, the opportunity to
    testify before you.
        It is no secret how dire the state of reproductive health care
    access currently is, not only in parts of Massachusetts but, of course,
    across the country. While I have the honor and I would say the
    privilege of serving as the Attorney General of Massachusetts which has
    long been, of course, a beacon in the pursuit of reproductive justice,
    I recognize that much work remains, not just at the State level but
    also locally and nationally. I look forward to working with each of you
    and, of course, my colleagues across the country who are on the front
    lines to continue this fight to ensure that people could access the
    health care they so desperately need. And we will not only fight. We
    will win.
        When the Supreme Court struck down Roe in 2022, it eliminated 50
    years of legal precedent that recognized the basic right to abortion.
    The effects of this decision were immediately felt across the country
    as so-called trigger bans went into effect, leaving patients suddenly
    without access to critical and sometimes lifesaving care.
        Today, nearly half the States in the country have banned or
    severely restricted access to abortion care. The result has been
    devastating, leaving hundreds of thousands of people without access to
    comprehensive reproductive health care in their States and enforcing
    people to delay or forego abortions which all too often threatens their
    health, wellbeing, and financial security. It also exacerbates existing
    health disparities, disproportionately impacting Black and Brown
    people, low-income earners, indigenous people, young people, and those
    living in rural communities. Patients traveling across State lines for
    care must do so with the knowledge that they may be subject to digital
    surveillance or even prosecution, not only of themselves but of their
    friends, their families, and helpers.
        Beyond these strains, the expansive scope of some of these abortion
    bans threatens providers across State lines. Even in Massachusetts,
    providers face increased risk of civil and criminal liability through
    bounty hunter schemes and reported travel bans. These schemes also
    target those who assist patients with accessing abortion care causing
    significant fear across the country.
        To meet this latest cruel moment in our Nation's history, I along
    with my colleagues in State government and other Attorneys General
    nationally, we have stepped up to ensure people can continue to access
    reproductive care in our States. In 2022, in response to Dobbs, my
    office under now-Governor Healey, of course, worked with our State
    legislature to codify, enhance protections to reproductive health care
    broadly as well as gender-affirming care. While this legislation made
    many significant improvements to our reproductive health care
    landscape, one of the most impactful was its insurance mandate,
    requirement coverage for abortion and abortion-related care without
    cost-sharing.
        This legislation also included the Nation's leading abortion care
    protection law, sometimes referred to as the shield law, that puts in
    place critical protections for people who provide access or facilitate
    access to abortion and gender-affirming care here in the Commonwealth.
    It was the first such law in the country to protect providers licensed
    and physically present in Massachusetts from the effects of out-of-
    State abortion bans, regardless of the patient's location at the time
    the care was provided.
        Since we passed our law, six States have passed comparable
    protections. And these laws have helped thousands of patients access
    abortion care in these States, including Massachusetts. To
    operationalize the shield law, my office, in collaboration with the
    ACLU of Massachusetts are delighted to be here with Carol, Reproductive
    Equity Now, delighted to be here with Rebecca. The Women's Bar
    Association, and five incredible law firms launch an Abortion Legal
    Hotline to provide free, confidential legal advice and resources to
    health care providers, helpers, and patients seeking care from
    Massachusetts providers.
        While I'm proud of how we in Massachusetts have met this moment,
    challenges still exist on many fronts. Efforts are ongoing at the State
    and Federal level as you've described to curb reproductive freedom.
    Similar battles are also ensuing in courts across the country and not
    just about abortion care as you also remarked but also about
    contraceptive access, gender-affirming care, and other private health
    care concerns.
        To confront these threats, I have formed a reproductive justice
    unit within my office, which focuses on advancing reproductive justice
    at the State and national level. In its short tenure, this unit has
    established itself as a trusted partner and resource among community
    organizations, health care providers, and advocates as well as
    colleagues across attorney general offices nationally. It has been
    extremely intersectional in its work, not merely just talking about
    access to abortion care, maternal health disparities, gender affirming
    care, and health care generally.
        I'm really proud of the work of the unit thus far, including Sapna
    who's our executive director of that unit. Our collaboration with other
    AG offices also extends into other avenues. I have been asked and had
    the immense honor or chairing the Reproductive Rights Working Group
    within the Democratic Attorneys General Association which will work to
    develop and defend shield laws through the country, work together, of
    course, to share information with each other in real time, develop best
    practices, and work daily to protect individual access to abortion,
    contraception, and the full spectrum of reproductive health care.
        I also continue, of course, to defend State and Federal laws
    protecting abortion access as you mention, of course, as high as the
    Supreme Court. We will continue to do our part. This decision has the
    potential to undermine--I should take a step back.
        We've also specifically--and I want to, of course, mention one
    case, advocated in support of the FDA in the Food and Drug
    Administration v. Alliance for Hippocratic Medicine, which we all know
    is a right-wing effort targeting FDA's approval of mifepristone, which
    is a safe and effective drug that has benefited over 3 million
    Americans. This decision has the potential to undermine not just FDA's
    drug approval process in this context but, of course, with respect to
    almost any other drug we can think of. To ensure that pregnant people
    continue to access this medicine, I along with 23 other attorneys
    general filed an amicus brief urging the Supreme Court to reverse the
    5th Circuit's decision and to uphold the FDA's decision to permit
    medically appropriate access to mifepristone.
        Since Dobbs, we've also seen renewed efforts to provide fetuses and
    embryos with personhood status. This legislative session alone, at
    least 14 States have filed bills to provide fetuses with personhood
    status. These laws will have many unintended consequences, including
    effectively eliminating a pregnant person's right to make medical
    decisions for their own health, mitigating access to assisted
    reproductive technologies like IVF, and even restricting people's
    rights to contraceptives.
        These types of laws are dangerous, and they're already creating
    confusion and fear for providers and patients alike. I'm grateful to
    the providers in Massachusetts. Thank you for your leadership and also
    for the work that we continue to do across the country.
        I have to quickly remark. It was most recently in Texas with other
    democratic AGs. And we had the honor and privilege of listening to
    providers, including a mother shared her horrific story of attempting
    to access care.
        This is truly the issue of our generation to solve. And as doom and
    gloom and dark as it may seem right now in Texas in terms of their
    rights and frankly lack of access to a legal abortion and other
    reproductive health care, and the fear and confusion that's being
    created in that State, I was really proud to listen to these providers
    who are on the front lines doing the work every single day, including
    along the border to ensure folks have access to health care. And the
    fact they're looking to not only Massachusetts but other democratic AGs
    in other States to help them provide that care.
        We will do our part. I'm really delighted to be here with each and
    every one of you. Thank you again, Senator Markey. And thank you again,
    Senator Warren, for your leadership in hosting this hearing.
                                     ______

                   PREPARED STATEMENT OF REBECCA HART HOLDER
                       President, Reproductive Equity Now
                                  May 29, 2024
        Senators Warren and Markey, my name is Rebecca Hart Holder and I am
    the president of Reproductive Equity Now. As a State and regional
    organization, Reproductive Equity Now works in Massachusetts and across
    New England to make equitable access to the full spectrum of
    reproductive health care a reality for all people regardless of their
    gender, age, race, ethnicity, zip code, income, immigration status,
    disability, or sexual orientation. Advancing reproductive health,
    rights and justice by working to eliminate barriers to abortion care is
    central to our mission.
        Thank you for the opportunity to submit written testimony regarding
    the economic and health impacts of threats to reproductive rights, and
    specifically, the state of abortion access in Massachusetts and
    nationwide. In this testimony, I will discuss (I) Massachusetts'
    abortion access landscape and the bold State leadership that allowed us
    to prepare for Roe's fall and react with a bold post-Dobbs response,
    (II) barriers to care remaining in Massachusetts, and (III) how ongoing
    threats to abortion and the full spectrum of reproductive health care
    nationwide position Massachusetts to act as a regional and national
    leader to protect and expand access to abortion care.
    Massachusetts Acted Boldly in the Wake of Dobbs To Protect Providers,
            Helpers, and Patients
        In the last 2 years since Donald Trump's Supreme Court overturned
    the constitutional right to abortion, 21 States have banned or severely
    restricted access to care across our country. \1\ One in three women of
    reproductive age currently live in a State without abortion access, and
    patients are traveling farther than ever before for care--if they can
    afford to travel at all. \2\ While Roe stood, approximately 18,000
    people lived in counties that were more than 300 miles away from the
    nearest abortion provider, but today, that number has increased to 16
    million. \3\
    ---------------------------------------------------------------------------
         \1\ ``Tracking the States Where Abortion Is Now Banned'', N.Y.
    Times (last updated May 1, 2024 4:40 p.m.), https://www.nytimes.com/
    interactive/2022/us/abortion-laws-roe-v-wade.html.
         \2\ Geoff Mulvihill, et al., ``A Year After Fall of Roe v. Wade,
    25 Million Women Live in States With Abortion Bans or Restrictions'',
    PBS: Newshour (June 22, 2023, 8:07 p.m.), https://www.pbs.org/newshour/
    politics/a-year-after-fall-of-roe-v-wade-25-million-women-live-in-
    states-with-abortion -bans-or-restrictions.
         \3\ Clare Trainor, et al., ``One Year Without Roe v. Wade: How
    Access to Abortion Has Changed'', Rueters (June 21, 2023), https://
    www.reuters.com/graphics/USA-ABORTION/DISTANCE/zgpobowdqvd/.
    ---------------------------------------------------------------------------
        Here in Massachusetts, we have no doubt felt the tidal wave of
    patients coming to our Commonwealth to access abortion. We know that
    providers have already seen patients from Alabama, Arkansas, Florida,
    North Carolina, South Carolina, Tennessee, Mississippi, Texas,
    Wisconsin, Louisiana, Georgia, the surrounding New England States, and
    more, and this cascading impact of bans reverberating in Massachusetts
    began long before the Dobbs decision. \4\ When the Supreme Court upheld
    Texas' outrageous SB8 abortion ban in 2021, Massachusetts providers
    began to see patients traveling from the Southwest immediately. \5\
    ---------------------------------------------------------------------------
         \4\ Martha Bebinger, ``How the Dobbs Abortion Decision Is Playing
    Out in Massachusetts, One Year Later'', WBUR (June 23, 2023), https://
    www.wbur.org/news/2023/06/23/abortion-supreme-court-one-year-
    massachusetts.
         \5\ Id.
    ---------------------------------------------------------------------------
        Even before the Dobbs case had made its way to the U.S. Supreme
    Court, Massachusetts took action to codify the right to abortion into
    State law. With the passage of the ROE Act, Massachusetts also saw the
    importance of expanding access to abortion, not just protecting its
    legality. \6\ The ROE Act also repealed parental consent requirements
    for 16 and 17 year olds, expanding access to abortion care for young
    people who cannot afford the delay or difficulty of having to go
    through judicial bypass. \7\ The law also expanded the scope of
    practice for advanced practice clinicians, including nurse
    practitioners, certified nurse midwives, and physician assistants, to
    provide abortion care. \8\
    ---------------------------------------------------------------------------
         \6\ An Act Providing for Access to Reproductive Health Care
    Services, 2020 Mass. Acts ch. 263.
         \7\ Id.
         \8\ Id.
    ---------------------------------------------------------------------------
        This landmark legislation laid the groundwork for our response to
    the Dobbs decision--we understood what was to come when the Supreme
    Court ultimately ruled to eliminate reproductive health care access
    across our country. We joined with partners at Planned Parenthood
    Advocacy Fund of Massachusetts and the ACLU of Massachusetts before the
    Dobbs decision was even released--or leaked--to put forward the Beyond
    Roe Agenda for Massachusetts--a 21-point plan predicated on the idea
    that Massachusetts has both an obligation and an opportunity to go
    ``beyond Roe v. Wade'' and ensure equitable access to reproductive
    health care for all people in our State. \9\ Our recommendations ranged
    from ways to continue expanding access to reproductive health care in
    the Commonwealth, such as investing in the grassroots work of abortion
    funds and eliminating cost sharing for reproductive health care; to
    supporting providers, helpers, and patients and protecting them from
    the harmful reach of hostile States seeking to prosecute and
    criminalize care beyond their State borders; and finally, to deploying
    research and education efforts to ensure the Commonwealth understands
    the size and scope of the crisis we continue to face, in order to
    deploy the resources needed.
    ---------------------------------------------------------------------------
         \9\ ``Massachusetts Beyond Roe: An Agenda for Abortion Access and
    Reproductive Equity'', Beyond Roe Coalition, https://massbeyondroe.com/
    (last visited May 28, 2024).
    ---------------------------------------------------------------------------
        Mere weeks after the Supreme Court issued its decision in Dobbs v.
    Jackson Women's Health Organization in June 2022, the Massachusetts
    Legislature acted boldly to pass a reproductive health care package
    that included several of our recommendations, including best-in-the-
    Nation shield protections for abortion providers and patients, mandated
    insurance coverage without cost-sharing for abortion and abortion-
    related care, expanded access to medication abortion for public college
    and university students, a statewide standing order to ensure access to
    no-cost emergency contraception without a prescription, expanded access
    for care later in pregnancy to prevent patients from having to travel
    out of State, and an expanded confidential address program to protect
    the personal addresses of abortion providers. \10\ This shield law also
    specifically protected Massachusetts providers who offer care via
    telehealth, by ensuring that providers' licenses are protected from
    medical malpractice insurance rate hikes, from out-of-State hostile
    litigation related to reproductive health care and gender-affirming
    care that is legal in Massachusetts, and from professional or
    disciplinary repercussions from a professional board of registration,
    all regardless of the patient's location, whether in Massachusetts or
    elsewhere. \11\ This unique protection has now been modeled in shield
    legislation passed in California, Colorado, Maine, New York,
    Washington, and Vermont. \12\ The legislature has also invested nearly
    $20 million for reproductive health care access, security, and
    infrastructure, including grants to abortion funds and providers, which
    has helped us expand access to care and support patients traveling from
    afar to afford their care.
    ---------------------------------------------------------------------------
         \10\ An Act Expanding Protections for Reproductive and Gender
    Affirming Care, 2022 Mass. Acts ch. 127.
         \11\ Id. 1, 4, 20, 23, 32-39. Specifically, the Massachusetts
    Shield Law amends M.G.L. ch.13 105 to add new protections for genetic
    counselors; amends M.G.L. ch.112 to add a new section to insulate
    physicians; amends M.G.L. ch.112 9H to protect physician assistants;
    amends M.G.L. ch.112 32 to insulate pharmacists;amends M.G.L. ch.112
    77 to insulate nurses; amends M.G.L. ch.112 128 to protect
    psychologists; amends M.G.L. ch.112 137 to insulate social workers.
    See 2022 Mass. Acts ch. 127 5, 10-11, 14-17.
         \12\ In addition to Massachusetts, California, Colorado, Maine,
    New York, Washington, and Vermont have enacted telehealth shield laws.
    See 2023 Cal. Stat. ch. 260; 2023 Colo. Sess. Laws ch. 68; 2024 Me.
    Laws ch. 648 ; 2023 N.Y. Laws ch. 138; 2023 Wash. Laws 193; 2023 Vt.
    Acts & Resolves 14 & 2023 Vt. Acts & Resolves 15.
    ---------------------------------------------------------------------------
        The provision of medication abortion via telehealth combined with
    shield law protections is crucial for keeping access to abortion across
    the Nation. Patients are increasingly opting for medication abortion.
    Massachusetts Department of Public Health data from 2022 indicates that
    medication abortion accounts for more than 50 percent of abortions in
    Massachusetts and newly released national data indicates that in the
    U.S. health care system, the use of medication abortion has risen from
    53 percent in 2020 to 63 percent in 2023. \13\ While Massachusetts data
    for 2023 has not yet been published, newly released data from the last
    few months of 2023 indicate that nearly 1 in 5 abortions across the
    Nation (or roughly 17,000 per month) are medication abortions accessed
    via telehealth. \14\ New data indicates that in addition to traveling
    to Massachusetts for care, many patients are also being given care
    under the Massachusetts Shield Law without ever traveling to the
    Commonwealth. Telehealth medication abortions by providers utilizing
    shield law protections, such as those enshrined in Massachusetts law,
    averaged 8,000 per month from October to December 2023, comprising
    nearly half of all telehealth abortions. \15\ Massachusetts providers
    are utilizing these groundbreaking shield law protections to ensure
    patients can receive abortion care, regardless of their location. \16\
    ---------------------------------------------------------------------------
         \13\ Massachusetts Department of Public Health, ``Abortion Tables
    (2022)'', https://drive.google.com/file/d/
    1Onw0uKtPAn1gjh98N33TOpY3TCWdia6I/view?usp=sharing ; See also,
    ``Monthly Abortion Provision Study'', Guttmacher Institute, https://
    www.guttmacher.org/monthly-abortion-provision-study (last visited May
    1, 2024).
         \14\ ``#WeCount Report: April 2022 to December 2023'', Society of
    Family Planning (May 14, 2024), https://societyfp.org/wp-content/
    uploads/2024/05/WeCount-report-6-May-2024-Dec-2023-data--Final.pdf.
         \15\ Id.
         \16\ Based on conversations between Reproductive Equity Now with
    providers offering telehealth abortion care through the Massachusetts
    Shield Law conducted on April 22, 2024, telehealth abortion providers
    operating under the Massachusetts Shield Law estimate conservatively
    that 3,500 medication abortions are provided each month by
    Massachusetts clinicians, primarily to patients located in States with
    severe abortion restrictions or bans.
    ---------------------------------------------------------------------------
        Our work to protect patients, providers, and all those involved in
    abortion access in Massachusetts has not stopped at passing
    legislation. Immediately after the passage of the shield law,
    Reproductive Equity Now began to field questions from providers about
    its impact, their risks, and how to protect themselves and their
    families. Their confusion and concern made it clear that we needed to
    stand up a resource to connect them with pro bono services.
    Reproductive Equity Now partnered with the Massachusetts Attorney
    General's Office, the ACLU of Massachusetts, and five private law firms
    across the State--Foley Hoag, Goodwin Procter, Goulston & Storrs,
    Mintz, Levin, Cohn, Ferris, Glovsky & Popeo, and Ropes & Gray--to
    launch the Abortion Legal Hotline--a free and confidential resource for
    patients and providers to learn more about their rights to provide or
    obtain care. This hotline now offers live translation services, and to
    date, we have trained over 150 lawyers who stand ready to provide legal
    analysis and support to callers. Since the hotline was launched last
    year, its website has been viewed over 4,300 times and it has helped
    over 120 callers, many of which were providers, enabling them to
    continue to serve countless patients across the Commonwealth and
    beyond.
    Barriers to Care Remain in Massachusetts
        Even as people come to Massachusetts for care, patients in our
    State are still being turned away. And that is because there is a big
    difference between the legal right to reproductive health care and a
    person's ability to actually access that care. Patients continue to
    travel to Massachusetts to seek abortion care, and preliminary data
    suggests the number of patients traveling to Massachusetts is
    increasing. In 2022, the year Roe fell, there was a 16 percent increase
    in the number of out-of-State patients receiving abortion care in
    Massachusetts, with 792 out-of-State patients documented in 2021
    compared to 920 out-of-State patients in 2022, accounting for just over
    5 percent of all abortions in Massachusetts in 2022. \17\ State data
    does not capture where out-of-State patients are traveling from.
    Similarly, a study by researchers at Brigham and Women's Hospital, the
    Harvard T.H. Chan School of Public Health, and the ASPIRE Center for
    Sexual and Reproductive Health at Planned Parenthood League of
    Massachusetts estimated that in the first 4 months post-Dobbs, our
    State saw a 37 percent increase in patients from out of State--a number
    we expect to only grow. \18\ Researchers reported the increase was
    driven largely by people outside of New England, with a notable number
    of patients traveling from Texas. \19\ This data indicates that
    Massachusetts' health care system is facing new strain under the influx
    of patients, as our clinics are contending with more patients and
    appointments than ever before, Massachusetts abortion funds are seeking
    to fund exponentially more care. This demands continued bold investment
    to support our patients in Massachusetts.
    ---------------------------------------------------------------------------
         \17\ Massachusetts Department of Public Health, ``Abortion Tables
    (2022)'', https://drive.google.com/file/d/
    1Onw0uKtPAn1gjh98N33TOpY3TCWdia6I/view?usp=sharing.
         \18\ Brianna Keefe-Oates, et al., ``Use of Abortion Services in
    Massachusetts After the Dobbs Decision Among In-State vs. Out-of-State
    Residents'', Jama Open Access (Sept. 6, 2023), https://jamanetwork.com/
    journals/jamanetworkopen/fullarticle/2808962.
         \19\ Jessica Bartlett, ``Number of Out-of-State Travelers Seeking
    Abortions at Mass. Planned Parenthood Grew 37% After Dobbs'', The
    Boston Globe (Sept. 6, 2023, 6:55 p.m.), https://www.bostonglobe.com/
    2023/09/06/metro/number-out-of-state-travelers-seeking-abortions-mass-
    grew-by-37-percent-after-dobbs/.
    ---------------------------------------------------------------------------
        Access deserts, or areas where in-person abortion clinics are more
    than 50 miles away, still exist throughout Massachusetts--particularly
    for in-clinic abortion care in Western and Southeastern Massachusetts.
    Travel and transportation barriers to abortion appointments persist,
    highlighting that the reproductive justice crisis is also a transit and
    economic justice crisis. And restrictions on abortion throughout
    pregnancy continue to send patients out of State for care. Low-income,
    communities of color, LGBTQ people, and young people continue to face
    the steepest barriers to abortion.
        Meanwhile, the Commonwealth is facing a critical juncture with
    regard to addressing a worsening maternal mortality and morbidity
    crisis. Severe maternal morbidity nearly doubled in Massachusetts from
    2011 to 2020, with Black mothers experiencing the worst rates of
    complications. \20\ Additionally, with just one free-standing birth
    center located in Western Massachusetts compared to 400 across the
    country, out-of-hospital birthing options are few and far between,
    eliminating a real ``choice'' in birth setting. \21\ And while the
    State may be a national leader with regard to securing abortion access,
    Massachusetts ranks 32nd in the Nation with regard to our integration
    of midwifery care into our health care system, \22\ despite research
    proving that the midwifery model of care can improve birthing
    experiences, lower cesarean rates, lower rates of premature birth and
    infant mortality, increase breastfeeding rates, and more. \23\
    Licensing Certified Professional Midwives under a Massachusetts Board
    of Midwifery is a critical way to unlock a key midwife workforce
    specifically trained in out-of-hospital births, improve access to
    tangible choice of birth settings, and expand maternity care providers.
    Even in hospital settings, hospitals with a higher proportion of
    midwife-attended births in Massachusetts were more likely to see
    shorter inpatient stays, lower cesarean and episiotomy rates, and lower
    spending on maternity services. \24\
    ---------------------------------------------------------------------------
         \20\ Massachusetts Department of Public Health, ``Data Brief an
    Assessment of Severe Maternal Morbidity in Massachusetts: 2011-2020''
    (July 2023), https://www.mass.gov/doc/an-assessment-of-severe-maternal-
    morbidity-in-massachusetts-2011-2020/download.
         \21\ Shira Schoenberg, ``Hoping To Deliver at a Massachusetts
    Birth Center? Good Luck'', Public Commonwealth Magazine (Nov. 20,
    2022), https://commonwealthmagazine.org/health-care/hoping-to-deliver-
    at-a-massachusetts-birth-center-good-luck/.
         \22\ Massachusetts Health Policy Commission, ``Certified Nurse
    Midwives and Maternity Care in Massachusetts Report Findings'' (Oct. 6,
    2021) https://www.mass.gov/doc/certified-nurse-midwives-and-maternity-
    care-in-massachusetts-1062021/download.
         \23\ Kathleen Sebelius and Tommy Thompson, ``If We Want To Save
    Black Mothers and Babies, Our Approach to Birthing Care Must Change'',
    Time Magazine (Apr. 13, 2023, 7:00 A.M.), https://time.com/6270915/
    black-mothers-childbirth-care-midwife/.
         \24\ Massachusetts Health Policy Commission, supra n. 22.
    ---------------------------------------------------------------------------
        The right to reproductive health care, including care for
    pregnancy, delivery, abortion, and miscarriage care, is not a real
    right unless every individual is able to safely access that care with
    autonomy and dignity. That right must include the right to choose where
    and how to give birth. Just as we affirm a pregnant person's choice
    about whether and when to carry a pregnancy to term, we must also
    affirm their choice of maternity care provider and birth setting.
        Abortion access is intrinsically connected to maternal health, and
    we cannot address these crises in a silo. Especially when more than 30
    anti-abortion centers, or so-called ``crisis pregnancy centers''
    throughout Massachusetts continue to spew medical disinformation,
    dissuading patients from accessing abortion and putting public health
    at serious risk. \25\ These facilities, which outnumber legitimate
    abortion providers in the State by more than double, \26\ purport to be
    full-spectrum reproductive health clinics, but actually exist to
    dissuade people from accessing abortion, often using deceptive
    practices. In Massachusetts, one of these centers, Clearway Clinic in
    Worcester, is currently facing a lawsuit for misdiagnosing a patient's
    ectopic pregnancy, forcing her to later undergo emergency life-saving
    surgery that resulted in the loss of a fallopian tube. \27\
    ---------------------------------------------------------------------------
         \25\ Frequently, AACs are religiously affiliated and do not
    provide abortion or contraception or make referrals for abortion or
    contraceptive care, though some do provide pregnancy tests, STI
    testing, and ultrasounds. See Melissa N. Montoya, et al., ``The
    Problems With Crisis Pregnancy Centers: Reviewing the Literature and
    Identifying New Directions for Future Research'', Int'l Journal of
    Women's Health (June 8, 2022), https://www.ncbi.nlm.nih.gov/pmc/
    articles/PMC9189146/.
         \26\ ``Reproductive Equity Now'', New England Abortion Care Guide,
    https://reproequitynow.org/abortioncareguide (last visited May, 28,
    2023).
         \27\ Praveena Somasundaram, ``Clinic Missed Ectopic Pregnancy
    Signs, Endangered Woman's Life, Suit Says'', Washington Post (July 3,
    2023, 3:33 a.m.), https://www.washingtonpost.com/nation/2023/07/03/
    crisis-pregnancy-center-lawsuit-massachusetts/.
    ---------------------------------------------------------------------------
        As anti-abortion extremists become more creative with their attacks
    by the day, reproductive health care advocates must also wear new hats,
    including as digital privacy experts. The State and Federal Government
    can and must do more to protect abortion providers and patients'
    location data and personal information before it is weaponized by
    hostile actors in other States. Efforts to criminalize abortion care
    are ever-evolving, and prosecutors and bounty hunters alike are well
    aware of the opportunity to use digital information to bolster their
    evidence. Already, we have seen data brokers use location information
    to create heat maps of where people visiting Planned Parenthood clinics
    came from, how long they stayed at the clinic, and where they went
    afterwards. \28\ While our statute prohibits Massachusetts law
    enforcement agencies from engaging in hostile out-of-State
    investigations, \29\ it does not prohibit law enforcement or
    prosecutors in other banned States from purchasing location data, which
    will allow them within minutes to identify every single phone--and
    therefore every single patient--that may have traveled across State
    borders to seek abortion care. As the cellphone location market remains
    unregulated, the widespread availability of granular cellphone location
    information enables anyone with a credit card--even an anti-abortion
    extremist thousands of miles away--to track people seeking abortion
    care in the Commonwealth. This exposes people seeking care from gravely
    serious threats to their personal safety and puts health care providers
    at risk of personal harm. We must pass the Location Shield Act in
    Massachusetts and Senator Warren's Health and Location Data Protection
    Act in Congress to secure digital privacy before location information
    is weaponized to criminalize care provided in Massachusetts.
    ---------------------------------------------------------------------------
         \28\ Joseph Cox, ``Data Broker Is Selling Location Data of People
    Who Visit Abortion Clinics'', Vice (May 3, 2022, 12:46 p.m.), https://
    www.vice.com/en/article/m7vzjb/location-data-abortion-clinics-
    safegraph-planned-parenthood.
         \29\ 2022 Mass. Acts ch. 127 20.
    ---------------------------------------------------------------------------
    Amidst National Threats, Massachusetts Is Poised To Play a Leading Role
            in Protecting Abortion Access
        Anti-abortion extremists' end goal is not to ban abortion in 21
    States; they want to ban abortion nationwide. Donald Trump, the leading
    Republican candidate for President, has bragged about his role in
    overturning Roe v. Wade, \30\ said that pregnant people should be
    punished for accessing abortion care, \31\ and hinted that he will sign
    a national abortion ban if elected president this November. \32\ Just
    last week, Trump suggested that he would be open to restricting access
    to contraception nationwide. \33\ And after the Alabama Supreme Court
    ruled this April that frozen embryos are ``extrauterine children,''
    effectively ending in vitro fertilization in the State, it's clear that
    the anti-abortion movement will use fetal personhood statutes to
    attempt to ban not only abortion nationwide, but assisted reproduction,
    too. \34\
    ---------------------------------------------------------------------------
         \30\ ``Trump Says He's Proud of Role in Overturning Roe v. Wade'',
    CBS News (Apr. 8, 2024), https://www.cbsnews.com/video/trump-says-hes-
    proud-of-role-in-overturning-roe-v-wade/.
         \31\ Pema Levy, ``Trump Says States Could Prosecute Women for
    Abortions Under His Watch'', Mother Jones (Apr 30, 2024), https://
    www.motherjones.com/politics/2024/04/donald-trump-abortion-
    prosecutions/.
         \32\ Michelle L. Price, ``Trump Suggests He'd Support a National
    Ban on Abortions Around 15 Weeks of Pregnancy'' (Mary 20, 2024, 8:06
    a.m.), AP News, https://apnews.com/article/trump-abortion-ban-15-weeks-
    91a9e0ce87d11dff0fa761f327bd0566.
         \33\ ``Trump Says He's `Looking at' Restricting Birth Control
    Access'', MSNBC: All In (May 23, 2024), https://www.msnbc.com/all-in/
    watch/trump-says-he-s-looking-at-restricting-birth-control-access-
    211503685938.
         \34\ Alander Rocha, ``Alabama Supreme Court Ruling Could End IVF
    Treatments in State'', Alabama Reflector (Feb. 19, 2024, 2:43 p.m.),
    https://alabamareflector.com/2024/02/19/alabama-supreme-court-ruling-
    could-end-ivf-treatments-in-state/.
    ---------------------------------------------------------------------------
        In a post-Roe world, Massachusetts has a critical role to play in
    protecting against these attacks and advancing reproductive equity.
    With strong legislative and executive partners, and an unwavering
    congressional delegation, our State has the ability to go on offense to
    protect and expand access to care. Advocates, elected officials, and
    leaders in Massachusetts must work with partners in red, purple, and
    blue States to ensure as many people are able to access the
    reproductive health care they want and need in this ever-changing
    abortion landscape. Our movement is strongest when we share strategies,
    policy ideas, and playbooks across State lines, and Massachusetts--and
    the New England region at large--can lead the way for reproductive
    equity.
                                     ______

                       PREPARED STATEMENT OF KATHRYN FAY
    Fellow, Physicians for Reproductive Health, and Physician, The Brigham
                              and Women's Hospital
                                  May 29, 2024
        Good afternoon, Senator Warren and Senator Markey. Thank you for
    holding today's field hearing on abortion and for the opportunity to
    speak with you today about access to critical care. My name is Dr.
    Kathryn Fay and I use she/her pronouns. I am a board-certified,
    fellowship trained, obstetrician and gynecologist specializing in
    family planning. I provide full spectrum sexual and reproductive health
    care, including abortion. As is typical of many in medicine, I
    completed my training in other States, in my case Illinois and Utah.
    Now, as a resident of Massachusetts, I bring a firsthand account of the
    ways State policy supports or obstructs quality health care. I am here
    today as a fellow with Physicians for Reproductive Health, a network of
    physicians from across the country working to improve access to
    comprehensive sexual and reproductive health care, and as a physician
    at The Brigham and Women's hospital.
        In Massachusetts I am able to provide care based on what patients
    and I decide together is safest and healthiest for their lives using my
    clinical training and following best medical practices without
    political interference. Massachusetts has been and continues to be a
    leader for access to reproductive health care. Prior to the Supreme
    Court's decision in Dobbs, which overturned the constitutional right to
    abortion, the Commonwealth of Massachusetts enacted laws establishing a
    statutory right to abortion. Since the Dobbs decision, Massachusetts
    has enacted additional legislation to further protect and increase
    access to reproductive health care. These new laws make abortion care
    more affordable by allowing State Medicaid funds to cover abortion and
    requiring private health insurance plans to provide coverage for
    abortion and abortion-related care without cost-sharing and protects
    providers like me from investigations by other States for simply
    providing safe, essential, necessary medical care. I list these
    legislative changes because they are in contrast to my experience
    working in Utah, which, prior to Dobbs, employed numerous tactics to
    hinder or punish those seeking abortion care, policies which have only
    grown more extreme in the interim.
        I am grateful to live and practice medicine in a State that
    supports the broad scope of sexual and reproductive health care,
    including contraceptive care. In the past few months, I have cared for
    people who needed life-saving abortion care to begin treatment for a
    new cancer diagnosis and people who needed an abortion in the setting
    of life-threatening hemorrhage. I have cared for people who sought
    abortions in the setting of fetal anomalies, abusive partners, housing
    instability, sexual assault, contraceptive failure; the indications are
    endless and all of them are valid. However, we cannot ignore that the
    Supreme Court's decision in Dobbs has wreaked havoc on the lives of
    people across our country seeking care for similar reasons, and on the
    clinicians who are doing their best to care for their communities.
    There is no safe State as long as threats to sexual and reproductive
    health care continues.
        As States continue to ban abortion, patients are having to travel
    farther and farther distances away from their homes and their
    communities putting their health and lives at risk. I have cared for
    people who traveled to Massachusetts with pre-viable ruptured
    membranes, a diagnosis for which standard medical care is immediate
    intervention because of the threat of maternal sepsis and hemorrhage.
    Overall, there were an estimated 4,500 more abortions provided in
    Massachusetts formal health care system in 2023 than in 2020, last year
    1 in 15 people who received abortions in Massachusetts were from out of
    State. \1\ \2\ I am consistently seeing patients from across the
    country. I am grateful to be able to care for the people who make it to
    me, but I can't help but think about all of the people who are unable
    to make the expensive, complex, risk-laden journey to essential care
    and have been forced to remain pregnant. I know people have been forced
    to remain pregnant since Dobbs, and there are excellent data to show
    the enduring harms of being denied a wanted abortion. The Turnaway
    Study shows us that when a woman is denied an abortion it creates
    economic hardships and insecurity that lasts for years, the financial
    wellbeing and development of existing children is negatively impacted,
    and the pregnant person is more likely to endure ongoing intimate
    partner violence. \3\ For the patients who have the resources to
    travel, at the very least, they are being forced to leave their support
    systems and communities. This is unacceptable. Everyone deserves to
    access care in their own community, in a manner that is best for them,
    with people they trust.
    ---------------------------------------------------------------------------
         \1\ Guttmacher, Monthly Abortion Provision Study, https://
    www.guttmacher.org/monthly-abortion-provision-study.
         \2\ Kaiser Family Foundation, Massachusetts Abortion Data, https:/
    /www.kff.org/interactive/womens-healthprofiles/massachusetts/abortion-
    statistics/.
         \3\ ``The Harms of Denying a Woman a Wanted Abortion. Findings
    From the Turnaway Study'', Advancing New Standards in Reproductive
    Health (ANSIRH) University of California San Francisco, https://
    www.ansirh.org/sites/default/files/publications/files/the-harms-of-
    denying-a-woman-a-wanted-abortion-4-16-2020.pdf
    ---------------------------------------------------------------------------
        As more States continue to ban or severely restrict access to
    abortion the ripple effects will continue to impact other types of
    essential health care harming the overall health and wellbeing of
    people across the country. For example, other types of care we have
    already seen impacted include: contraceptive care because of
    intentionally vague language being misconstrued to limit access to
    emergency contraception and intrauterine devices or IUDs; miscarriage
    care as the treatments used to help manage a miscarriage are the same
    used to provide an abortion; ectopic pregnancy care as health care
    institutions and providers are worried about being held criminally
    responsible for providing the emergency care patients need.
        It is only nearly 2 years since the Dobbs decision and threats from
    the courts continue. The Supreme Court is set to issue decisions this
    summer in what will be two landmark cases impacting abortion care. The
    Court's decision in FDA v. AHM will impact access to mifepristone, one
    of two FDA approved medications used in medication abortion care. The
    FDA first approved mifepristone in 2000 and today medication abortion
    accounts for 63 percent of all U.S. abortions. \4\ Mifepristone is a
    safe and effective medication that I rely on using for patient care
    every day. Restrictions on mifepristone will not only have devastating
    impacts on pregnant people's access to abortion care but also early
    pregnancy loss and stillbirth management, among the other evidence-
    based uses of mifepristone. Additionally, the Supreme Court is
    considering whether EMTALA preempts Idaho's abortion ban in situations
    in which abortion is required to stabilize an emergency medical
    condition that would otherwise threaten serious harm to the pregnant
    person's health. People should have access to abortion care without
    barriers or delay, including in emergency circumstances. Likewise,
    clinicians should be able to practice without performing the calculus
    of what State law permits or what actions might threaten their medical
    license, and instead focus on applying their medical training to
    provide the necessary care that is right for patients. There are
    countless stories of my colleagues in other States being forced to
    navigate impossible situations that put patient safety and State
    legislation at odds. \5\
    ---------------------------------------------------------------------------
         \4\ Jones, R.K., Friedrich-Karnik A., ``Medication Abortion
    Accounted for 63% of All U.S. Abortion in 2023--An Increase from 53% in
    2020'', Guttmacher, https://www.guttmacher.org/2024/03/medication-
    abortion-accounted-63-all-us-abortions-2023-increase-53-2020.
         \5\ Grossman D., Joffe Carole, Kaller S., et al., ``Care Post-Roe:
    Documenting Cases of Poor-Quality Care Since the Dobbs Decision'',
    Advancing New Standards in Reproductive Health (ANSIRH) University of
    California San Francisco, https://www.ansirh.org/sites/default/files/
    2023-05/Care%20Post-Roe%20Preliminary%20Findings.pdf.
    ---------------------------------------------------------------------------
        Abortion restrictions only serve to burden and endanger patients
    and clinicians, not make abortion any safer. These restrictions
    represent a national movement that threatens health care. If not just
    for the general moral good, I am here today advocating for the status
    of care in Massachusetts. Since Roe, steady chipping away of sexual and
    reproductive health rights has jeopardized justice for all. Dobbs was a
    clear and devastating loss, but it does not represent an end point. I
    worry about the loss of mifepristone, a Federal abortion ban, and
    threats to contraception and assisted reproductive technology, hazards
    that will transcend State lines. Abortion, without stipulation, is
    life-saving, necessary, compassionate, essential health care.
        Thank you for having me here today. I look forward to your
    questions.
                                     ______

                        PREPARED STATEMENT OF CAROL ROSE
                   Executive Director, ACLU of Massachusetts
                                  May 29, 2024
        Chair Warren, Ranking Member Kennedy, and Members of the Committee,
    thank you for holding this hearing and inviting me to testify. My name
    is Carol V. Rose, and I am the Executive Director of the American Civil
    Liberties Union of Massachusetts.
        In post-Dobbs America, authoritarian politicians and civil
    litigators in search of private bounties \1\ seek to control--and
    plainly deny--reproductive health care and personal bodily autonomy by
    expanding and misusing criminal and civil laws. \2\ At the same time,
    the U.S. Supreme Court is considering two cases brought by extremists
    seeking to restrict or even eliminate access to medication abortion and
    to abortion care during medical emergencies. Massachusetts lawmakers
    are working to shore up protections for reproductive freedom in our
    State, but aggressive anti-abortion advocacy at the Federal level
    nonetheless threatens the rights of all residents of the Commonwealth.
    ---------------------------------------------------------------------------
         \1\ Erin Coulehan, ``Abortion `Bounty' Laws in States Like Texas
    and Oklahoma: How They Work'', Teen Vogue (July 7, 2022), https://
    www.teenvogue.com/story/abortion-bounty-laws.
         \2\ Interactive Map: U.S. Abortion Policies and Access After Roe,
    Guttmacher Institute (May 15, 2024), https://states.guttmacher.org/
    policies/-gl=1*1osd3uo*-ga*MTEzNDI1MTE2Ni4xNjgw
    MTAzNjY5*-ga-PYBTC04SP5*MTY4NjkyNzg4OC41NS4xLjE2ODY5Mjc4OTEuMC4wLjA.
    ---------------------------------------------------------------------------
        Just 1 month after the Supreme Court overturned Roe v. Wade,
    Massachusetts lawmakers passed a ``shield law'' to offer legal
    protections to abortion providers, patients, and helpers in our State.
    \3\ An Act Expanding Protections for Reproductive and Gender-Affirming
    Care takes steps to protect providers' professional licenses and
    malpractice insurance, while also prohibiting extradition to other
    States for those who provide lawful care in Massachusetts and ensuring
    our State courts do not become a venue for hostile-State claims. \4\ To
    help people understand their rights under the new State law,
    Massachusetts Attorney General Andrea Campbell--together with the ACLU
    of Massachusetts, Reproductive Equity Now, Women's Bar Foundation, and
    several law firms--launched the Abortion Legal Hotline in January 2023.
    \5\ This is a free and confidential resource that connects
    Massachusetts-based health care providers, helpers, and patients
    obtaining care in the State with legal advice and resources about
    access to abortion and other forms of reproductive health care.
    ---------------------------------------------------------------------------
         \3\ Alison Kuznitz, ``Massachusetts Abortion Protections Bill,
    Shielding Providers and Patients, Signed Into Law by Gov. Charlie
    Baker'', MassLive (July 29, 2022), https://www.masslive.com/politics/
    2022/07/massachusetts-abortionprotections-bill-shielding-providers-and-
    patients-signed-into-law-by-gov-charlie-baker.html.
         \4\ An Act Expanding Protections for Reproductive and Gender-
    Affirming Care, Chapter 127 of the Acts of 2022 (July 29, 2022),
    https://malegislature.gov/Laws/SessionLaws/Acts/2022/Chapter127.
         \5\ Abby Patkin, ``With New Mass. Hotline, Free Abortion Legal
    Advice Is Just a Call Away'', Boston.com (January 30, 2023), https://
    www.boston.com/news/health/2023/01/30/massachusetts-abortion-legal-
    hotline-launch-reproductiverights-access/.
    ---------------------------------------------------------------------------
        Two months later, in response to a Federal court ruling out of
    Texas in a case challenging mifepristone access nationwide,
    Massachusetts Governor Healey announced several steps to protect access
    to medication abortion in the Commonwealth. She directed the University
    of Massachusetts and health care providers to purchase and stockpile
    approximately 15,000 doses of mifepristone. Governor Healey also issued
    an Executive order confirming that the 2022 shield law applies to
    medication abortion, including mifepristone, \6\ and the Department of
    Public Health and Board of Registration in Medicine quickly issued
    implementing guidance. \7\ Collectively, these actions help to ensure
    that providers can continue to prescribe and dispense mifepristone in
    Massachusetts.
    ---------------------------------------------------------------------------
         \6\ Executive Order 609, ``Protecting Access to Medication
    Abortion Services in the Commonwealth'', (April 10, 2023), https://
    www.mass.gov/doc/protecting-access-to-medicated-abortion/download.
         \7\ Board of Registration in Medicine, ``Guidance Implementing
    Executive Order 609 Regarding Reproductive Health Medications'', (April
    10, 2023), https://www.mass.gov/news/guidance-implementing-executive-
    order-609-regardingreproductive-health-medications.
    ---------------------------------------------------------------------------
        Since the Supreme Court overturned Roe, Massachusetts lawmakers at
    every level of Government have taken bold, timely steps to protect
    access to reproductive health care in our Commonwealth. However, anti-
    abortion judges and politicians have made clear that they do not intend
    to stop at ending Federal constitutional protections for abortion care.
    Their goal is to eliminate access to abortion and other forms of
    reproductive health care in all 50 States, including in the
    Commonwealth. This anti-democratic cadre remains intent on banning
    abortion and other essential health care nationwide, threatening core
    Massachusetts values, as well as State laws and policies that have been
    carefully considered and adopted by our State's elected leaders, and--
    most importantly--fundamental access to reproductive health care and
    bodily integrity for the people of the Commonwealth.
        We are alarmed by authoritarian politicians in Congress who are
    pushing Federal policies to restrict the reproductive freedoms we have
    fought so hard to protect here in the Commonwealth. Anti-abortion
    politicians at the Federal level have not been covert about their plans
    to ban abortion nationwide. A national abortion ban would pose a direct
    and dire threat to reproductive freedom in Massachusetts, and anti-
    abortion politicians in Congress have deployed a variety of tactics in
    service of their campaign to ban abortion nationwide.
        One key tactic proposed by anti-abortion extremists in Congress is
    a proposed national 15-week abortion ban. If enacted, a nationwide
    abortion ban like the one proposed in Congress \8\ would make all
    abortions in every State, including Massachusetts, illegal after 15
    weeks with only limited exceptions. This extreme bill goes even further
    by subjecting doctors and health care providers to criminal penalties
    for failure to comply with the ban.
    ---------------------------------------------------------------------------
         \8\ Graham Introduces Legislation to Protect Unborn Children,
    Bring U.S. Abortion Policy in Line with Other Developed Nations, U.S.
    Senator Lindsey Graham (September 13, 2022), https://
    www.lgraham.senate.gov/public/index.cfm/2022/9/graham-introduces-
    legislation-to-protect-unborn-childrenbring-u-s-abortion-policy-in-
    line-with-other-developed-nations.
    ---------------------------------------------------------------------------
        It is important to highlight the harms of an enacted national
    abortion ban on the people of Massachusetts. In the nearly 2 years
    since Roe was overturned, abortion bans in dozens of States across the
    country have created chaos and suffering for patients and providers. In
    States with abortion bans, clinics providing essential health care have
    been forced to close, leaving millions of people without access to
    abortion care as well as other reproductive health care. \9\ Patients
    have been denied critically needed emergency abortion care, creating
    serious risks to their health and against their doctors' medical
    judgment. \10\ Under a national ban, people in Massachusetts would be
    forced to carry pregnancies against their will, and doctors and health
    care providers would have to choose between providing essential health
    care and potentially facing criminal charges and even jail time.
    Forcing someone to carry a pregnancy against their will has life-
    altering consequences, from enduring the health risks of continuing a
    pregnancy and childbirth, to making it harder to escape poverty,
    achieve education or career goals, and making it more difficult to
    leave an abusive partner. These consequences fall disproportionately on
    communities of color, people living on low incomes, undocumented
    immigrants, young people, LGBTQ people, and people with disabilities.
    These harms, especially the serious health risks of being forced to
    give birth, fall hardest on Black women, who are already three times
    more likely than Wwhite women to die during childbirth or shortly
    after. \11\
    ---------------------------------------------------------------------------
         \9\ See Marielle Kirstein, et al., ``100 Days Post-Roe: At Least
    66 Clinics Across 15 U.S. States Have Stopped Offering Abortion Care'',
    Guttmacher Inst. (October 6, 2022), https://www.guttmacher.org/2022/10/
    100-days-postroe-least-66-clinics-across-15-us-states-have-stopped-
    offering-abortion-care.
         \10\ See, e.g., NWLC Files EMTALA and Sex Discrimination
    Complaints on Behalf of Mylissa Farmer, Nat'l Women's L. Ctr. (November
    8, 2022), https://nwlc.org/resource/nwlc-files-emtala-and-sex-
    discriminationcomplaints-on-behalf-of-mylissa-farmer/; Caroline
    Kitchener, ``Two Friends Were Denied Care After Florida Banned
    Abortion. One Almost Died'', Wash. Post (April 10, 2023, 6:00 a.m.),
    https://www.washingtonpost.com/politics/2023/04/10/pprom-florida-
    abortion-ban/; Sam Karlin, ``Louisiana Woman Who Was Denied an Abortion
    for a Fetus Without a Skull Gets Procedure in New York'', The Advocate
    (September 14, 2022), https://www.theadvocate.com/baton--rouge/news/
    louisiana-woman-who-was-denied-an-abortion-for-a-fetuswithout-a-skull-
    gets-procedure/article-b23b2b48-3458-11ed-bd50-27875e9118ec.html.
         \11\ See Priya Krishnakumar and Daniel Wolfe, ``How Outlawing
    Abortion Could Worsen America's Maternal Mortality Crisis'', CNN (June
    24, 2022), https://www.cnn.com/2022/05/10/us/maternal-mortality-roe-
    wade-abortionaccess/index.html.
    ---------------------------------------------------------------------------
        And while the current proposed bill for a national abortion ban
    includes very narrow exceptions for rape or incest, or for the life and
    health of the pregnant person, we've seen already in States with
    abortion bans how little these exceptions do to ensure that people can
    get essential health care. We've heard heartbreaking stories of women
    who were denied medically necessary abortion care and faced life-
    threatening consequences, despite their State bans having narrow life
    and health exceptions. \12\ It is cruel and unfair to expect survivors
    of sexual assault or incest, or someone in the middle of a medical
    emergency, to plead for permission to access the care they need and
    their doctors authorize. Everyone should be able to get the abortion
    and reproductive health care they need, when they need it.
    ---------------------------------------------------------------------------
         \12\ See, e.g., Cox v. Texas, Center for Reproductive Rights
    (December 12, 2023), https://reproductiverights.org/case/cox-v-texas/;
    Zurawski v. State of Texas, Center for Reproductive Rights (March 6,
    2023), https://reproductiverights.org/case/zurawski-v-texas-abortion-
    emergency-exceptions/; Medical Emergency Exceptions to State Abortion
    Bans: Idaho, Tennessee, and Oklahoma, Center for Reproductive Rights
    (September 12, 2023), https://reproductiverights.org/case/emergency-
    exceptions-abortion-bans-idaho-tennessee-oklahoma/.
    ---------------------------------------------------------------------------
        Not content with a national abortion ban at 15 weeks, extremists in
    Congress are also pushing radical Federal legislation that would give
    legal rights to embryos and fetuses. These efforts are just the latest
    in a long history of anti-abortion extremists attempting to strip
    people of their reproductive rights by expanding legal rights for
    embryos and fetuses. For decades, anti-abortion politicians have
    incorporated this so-called ``personhood'' language into State laws.
    \13\ Extremists in Congress have expanded the reach of this threat to
    States with protections for abortion and other forms of reproductive
    health by pushing Federal legislation, including the Life at Conception
    Act. \14\ This extreme piece of Federal legislation would extend rights
    to embryos and fetuses with the intent to make all abortion illegal
    nationwide, including in Massachusetts where such care is protected.
    ---------------------------------------------------------------------------
         \13\ See Megan Messerly, `` `Scratching Their Heads': State
    Lawmakers Take a Closer Look at Personhood Laws in Wake of Alabama
    Ruling'', Politico (February 29, 2024), https://www.politico.com/news/
    2024/02/29/states-fetus-personhoodalabama-ivf-00143973#:.
         \14\ H.R.431--118th Congress (2023-2024): Life at Conception Act,
    (January 20, 2023), https://www.congress.gov/bill/118th-congress/house-
    bill/431.
    ---------------------------------------------------------------------------
        But that is not all. As is often true of policies that ban or
    restrict abortion care, so-called ``personhood'' laws also threaten to
    impact the ability to access other forms of reproductive health care,
    including contraception, infertility treatment, and miscarriage care.
    Purporting that embryos and fertilized eggs are ``people'' under the
    law would cause chaos and confusion that would disrupt access to many
    kinds of essential health care in the Commonwealth and nationwide.
        The strategy to ban abortion in all 50 States doesn't end with
    Federal legislation. Extremist politicians and their supporters have
    even threatened to attempt a back-door national abortion ban,
    circumventing Congress, by misusing a 150-year-old law known as the
    Comstock Act.
        The Comstock Act, named after ``a prominent anti-vice crusader who
    believed that anything remotely touching upon sex was . . . obscene,''
    \15\ was passed in 1873--less than a decade after the end of the Civil
    War and nearly 50 years before the ratification of the 19th Amendment.
    The Comstock Act restricts using the mail and common carriers to send
    and receive certain ``obscene'' items. Anti-abortion extremists claim
    that it is a national abortion ban already on the books, just waiting
    to be enforced by a radical anti-abortion President. This view of the
    Comstock Act is wrong. For decades, the Department of Justice and every
    court of appeals to consider the issue have held that the Comstock Act
    only applies in the context of unlawful abortions. The only court to
    ever conclude differently is the district court in Alliance for
    Hippocratic Medicine v. FDA, the anti-abortion plaintiffs' hand-
    selected jurist--chosen for the purpose of obtaining rulings that
    advance their radical agenda.
    ---------------------------------------------------------------------------
         \15\ Bolger v. Youngs Drug Prods. Corp., 463 U.S. 60, 70 n.19
    (1983).
    ---------------------------------------------------------------------------
        Threatening to misuse the Comstock Act is thus another effort by
    anti-abortion extremists to manipulate the law in service of their goal
    of banning abortion in all 50 States. If anti-abortion extremists get
    their way, the Comstock Act could be misused to ban the shipping of any
    medicines and medical supplies used for abortion, contraception, IVF,
    and miscarriage care, threatening access to reproductive health care
    nationwide--even in Massachusetts and other States where reproductive
    rights are protected.
        By pushing policies to override State protections for abortion and
    other reproductive health care, authoritarian forces clearly seek to
    ban access to contraception and abortion care nationwide. Massachusetts
    elected leaders have, time and again, upheld the will of the voters by
    taking bold action to protect the bodily integrity of our people,
    including access to abortion care, contraception, miscarriage care, and
    IVF. We applaud tireless efforts by Massachusetts elected officials to
    defend and preserve the right to body integrity free from Government
    interference, and to ensure a future where every person in every State
    can access the reproductive health care they need.
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