Nonfiction: A Professional Troublemaker’s Guide for Young Activists


Cecile Richards at a House Government Oversight committee hearing.

Stephen Crowley/The New York Times

Standing Up, Speaking Out, and Finding the Courage to Lead
By Cecile Richards with Lauren Peterson
304 pp. Touchstone. $27.

Cecile Richards — the outgoing president of Planned Parenthood — may look calm and unflappable with her trademark blue suits and neat cap of golden hair, but she’s a troublemaker from way back. As a sixth grader in Dallas she refused to say the Lord’s Prayer in class. As a junior high schooler in Austin, she wore a black armband to express solidarity with the Moratorium to End the War in Vietnam, infuriating the principal. The rest is history. “Make Trouble” takes us through Richards’s life in activism and politics: Before Planned Parenthood, she had a full and varied career that included union organizing, starting the progressive organization America Votes and working for Nancy Pelosi. But there’s lots more, including loving depictions of family and friends, from the legendary Texas journalist Molly Ivins to her mother, Ann Richards, the “frustrated housewife” who became the beloved first (and so far only) woman governor of Texas.

Richards paints some vivid pictures of life in politics, too. For example, despite misgivings, she reached out to Ivanka Trump after hearing that she might want to help Planned Parenthood. They met at a Trump golf club in New Jersey, where Ivanka and her husband, Jared, offered her a deal: If Planned Parenthood stopped performing abortions, funding for birth control might go up. “Jared and Ivanka were there for one reason: to deliver a political win. In their eyes, if they could stop Planned Parenthood from providing abortions, it would confirm their reputation as savvy dealmakers. It was surreal, essentially being asked to barter away women’s rights for more money.”


Books by public figures, especially when written with help from others — Lauren Peterson is a speechwriter — are often pretty deadly, but “Make Trouble” manages to be genial, engaging and humorous. (“It was almost like dealing with kidnappers,” is how Richards describes the months of waking to find yet another doctored video claiming to prove that Planned Parenthood sold fetal tissue.) She’s good at sharing credit and giving praise — especially to her husband, the longtime labor organizer Kirk Adams, who was always game to move to a new city, take on a new adventure and pitch in with raising their three children. Her portrait of Nancy Pelosi as a nice person, a thoughtful boss and a brilliant strategist largely responsible for the passage of the Affordable Care Act (without the Stupak amendment that would have banned insurance coverage for abortion) is a pleasant corrective to the increasingly common view of her as an incompetent witch.

As its title implies, this is not just a memoir but a call to action. Richards wants you to know that you too can make social change. She also wants you to know that a life of social activism is fun. She offers career advice (“never turn down a new opportunity”) and even travel tips (“try to know where the best ice cream is in any given airport terminal”). Considering how often progressives are portrayed as joyless scolds, this is a message that needs to get out more. There’s a lot of satisfaction in activism, even if you don’t win every battle.

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They Were Jailed for Miscarriages. Now, Campaign Aims to End Abortion Ban.

El Salvador’s health ministry has thrown its support behind changing the law, and doctors have begun speaking out, arguing that the ban ties their hands in treating high-risk pregnancies. International organizations have condemned the ban as a violation of women’s rights, and Chile, which relaxed its law in August, set an influential example.


At a march on International Women’s Day last month in San Salvador, one sign called for the release of women who have been imprisoned after suffering miscarriages or stillbirths.

Fred Ramos for The New York Times

“There’s a wide spectrum of grays, and we need to have a dialogue on the issue,” said Johnny Wright Sol, a lawmaker who broke from the right-wing Arena party last year and proposed a bill to permit abortion when the mother’s health is at risk or for a minor who has been raped.

“It’s a very conservative approach,” Mr. Wright said. “It’s a minimum standard at a level with the modernity of the 21st century.”

A separate bill would expand exceptions to the ban to include abortion in all rape cases and those involving an unviable fetus. Supporters hope to bring a vote before the legislative Assembly’s term finishes at the end of April, and before the new, more conservative Assembly that was elected last month is seated.

Advocates have paired their lobbying with a social media campaign focused not just on women’s health, but also on the harm done to families when a mother is prosecuted or her life is at risk. El Salvador’s largest television channels refused to run ads, but the campaign has bought radio spots, persuaded journalists to cover the issue and organized support from doctors, legal experts and economists, said Keyla Cáceres, a campaign organizer.

Lorena Peña, a lawmaker from the leftist Farabundo Martí National Liberation Front who proposed the bill with the broader exceptions in 2016, said there was “less fundamentalism now” about the issue. “The debate has been much wider.”

Whatever happens over the next couple of weeks — Ms. Peña said right-wing legislators feared that breaking ranks to support the changes would alienate their wealthy conservative backers — the campaign will continue. “I’m not pessimistic,” she said. “It’s not written in stone that it can’t change.”

Mr. Wright argued that resistance to changing the law “responds to a violent society, to machismo, to poverty,” rather than to the conservatism of Salvadoran society. “As a politician the easy way out is to say, ‘I’m pro-life and I’m against abortion,’” he said. “It’s a way of not delving deeper into the issues that are causing so much of our problems.”


A plastic fetus in an exhibition against abortion last month in Antiguo Cuscatlán, El Salvador.

Fred Ramos for The New York Times

Even if the public discussion has won the sympathy of some undecided legislators, many of them argue privately that abortion is not that important to Salvadorans, whose greatest worry is crime, said Morena Herrera, a longtime women’s rights activist who leads the Citizens’ Group, an organization that supports the exceptions to the abortion ban.

“That shows how they value the problems that poor women face,” she said. “If we don’t succeed with the change now, we are condemning another generation of girls to live with this injustice, this uncertainty.”

Abortion is punishable by up to eight years in prison, but a good lawyer can win a reduced sentence or house arrest, said Ms. Peña, the lawmaker. Poor women who suffer late-term miscarriages or stillbirths have been convicted of aggravated or attempted homicide in trials that seem to push them all down the same hall of mirrors.

Ms. Vásquez, 34, was at her job as a school cafeteria cook when she began bleeding and asked for medical help before losing consciousness and suffering a stillbirth. Prosecutors initially charged her with abortion and then changed the accusation to aggravated homicide. She never met her public defender.

She was released in February after the Supreme Court commuted her sentence.

Four weeks later, Maira Figueroa Marroquín left Ilopango after the government commuted her 30-year sentence. In 2003, when she was a 19-year-old maid, Ms. Figueroa began bleeding heavily at work toward the end of her pregnancy and, like Ms. Vásquez, was charged first with abortion and then aggravated homicide, according to the Citizens’ Group.

In its verdict, the court acknowledged that there was no direct proof of a homicide, but it said that the “demonstrated facts” had led to its conclusion. She served almost 15 years.

Since 2015, lawyers have won the release of five women. But 24 women convicted of aggravated or attempted homicide remain in jail and another is on trial, said Elida Caballero Cabrera, the advocacy adviser for the Center for Reproductive Rights in Washington.


A march against abortion in San Salvador on Saturday.

Fred Ramos for The New York Times

In a recent study that looked at how anti-abortion rhetoric had seeped into these prosecutions, Jocelyn Viterna, a Harvard sociologist, and José Santos Guardado Bautista, a lawyer in the Salvadoran attorney general’s office, found that the words “abortion” and “homicide” were used interchangeably by news reports and high-ranking legal officials.

It was “not surprising that this same blurring of abortion and homicide in cultural discourse became institutionalized” in the country’s judicial system, they wrote.

Anti-abortion groups say that the cases of the imprisoned women are unrelated to the abortion ban, and that the main concern should be improving health care for pregnant women. “If there was any injustice against these women, it was an error in the legal process,” said Sara Larín, the spokeswoman for a Catholic anti-abortion group Vida SV.

Activists who oppose relaxing the ban have begun their own campaign, arguing that El Salvador’s falling rate of maternal mortality shows that doctors can manage high-risk pregnancies without lifting the ban.

In cases of rape, “removing the child won’t remove the trauma,” said Dr. Mario López Saca, the medical adviser of the El Salvador Bioethics Association, a group that argues that human life begins at conception. When a fetus is unviable, palliative care is the best option for the mother, Dr. López Saca said, adding, “Abortion is a cowardly solution.”

But the health minister, Dr. Violeta Menjívar, has said that between 2011 and 2015, 13 women died from ectopic pregnancies, in which the embryo develops outside the uterus with no possibility of survival. Another 36 women died during that period when their chronic illnesses were exacerbated by pregnancy.

In 2015, 1,445 girls aged 10 to 14 became pregnant, according to the ministry’s statistics. Girls and young women face a high risk of rape in the home and by gangs, the government says.


Women at risk of giving birth prematurely had their weight checked El Hospital de La Mujer in San Salvador.

Fred Ramos for The New York Times

Dr. Guillermo Ortiz Avendaño, who led the unit overseeing high-risk pregnancies at the National Women’s Hospital in San Salvador for 20 years, said the argument about mortality rates was misguided.

The improvement has resulted from new protocols for complications at the very end of pregnancy, he said, and the ban prevents doctors from offering swift treatment at early stages. “It’s absolutely reproachable from the medical point of view,” Dr. Ortiz said of patients whose lives are at risk. “We are waiting until her condition is critical to be able to intervene.”

“When just one woman dies, it’s 100 percent of all the cases for her family,” added Dr. Ortiz, who is now a medical adviser for Ipas, a North Carolina reproductive rights group.

Dr. Victoria Ramírez, a gynecologist who supports a change in the law, said the abortion ban was never questioned during her training. But she now chafes at its restrictions.

Recently a 16-year-old mentally disabled girl who had been raped arrived with a high-risk pregnancy at the provincial hospital where Dr. Ramírez practices. “I couldn’t give her any options,” she said. “As doctors we are trained to do triage, and in this case I couldn’t.”

The girl, who was poor, went into labor about two months early and was taken to San Salvador, where specialized doctors saved both mother and baby after a dangerous birth. But the premature child will have severe developmental problems and no means of support, Dr. Rámirez said.

“When a woman is pregnant, she loses all her rights,” Dr. Rámirez said, “because the baby has more rights than she has.”

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F.D.A. Restricts Sales of Bayer’s Essure Contraceptive Implant


Dr. Scott Gottlieb, commissioner of the Food and Drug Administration, did not accede to demands to remove Essure, the troubled contraceptive implant, from the market. Instead, he ordered its manufacturer, Bayer, to limit sales.

Drew Angerer/Getty Images

WASHINGTON — The Food and Drug Administration on Monday said it would require Bayer to restrict sales of its Essure birth control implant to medical practices like doctors’ offices that agree to fully inform women about the device’s risks.

Since the implant became available 16 years ago, thousands of women have sued Bayer, Essure’s manufacturer, with many claiming they suffered severe injuries, including perforation of the uterus and the fallopian tubes from the metal implant.

Two years ago, the F.D.A. declined to pull the device off the market, and instead ordered placement of a “black box warning” on the product package that said it could cause those types of injuries. The warning also noted that the implant can travel into the abdomen and pelvic cavity, causing pain and possibly requiring surgical removal.

Consisting of two small coils, made of a nickel alloy and a polyester-like fiber, the device is placed in the fallopian tubes through the vagina, and is designed to create an inflammatory response that causes scar tissue to form and block the tubes.

The F.D.A. said on Monday that from Nov. 4, 2002, when Essure was approved, through December of last year, the agency had received 26,773 reports of adverse events related to the device, although some might be duplicates.


The Essure contraceptive device works by creating an inflammatory response in the fallopian tubes, causing scar tissue to form that blocks the tubes.

Bayer Healthcare Pharmaceuticals, Inc.

The most frequently reported problems, the F.D.A. said, were pain, menstrual irregularities and headache. Most reports listed multiple conditions suffered by individual patients. There were also reports of deaths, pregnancy loss, ectopic pregnancies and other serious problems.

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Nazi-Era Abortion Law Strains German Coalition

“I am holding the chancellor to her word,” Ms. Barley told Die Zeit weekly. Earlier, she had indicated how a solution might look: instead of repealing the law, changing the wording so that overt advertising remains illegal, but allowing doctors to provide factual information about the procedure.

“Doctors need legal certainty,” Ms. Barley wrote on Twitter. “Women affected need support in a situation of personal crisis.”

But conservative forces within Ms. Merkel’s party appear intent on keeping the debate focused on the moral issue of abortion. On March 18, the new health minister, Jens Spahn, accused those seeking to overturn the law of caring more about protecting the lives of animals than of unborn humans.


Conservative forces in Chancellor Angela Merkel’s party appear intent on keeping the debate focused on the moral issue of abortion.

Kay Nietfeld/DPA, via Associated Press

Dr. Hänel considers such arguments similar to those promoted by activists who have increasingly sought to bring legal proceedings against doctors who provide abortions. According to the most recent statistics published by the Federal Criminal Police, such complaints were filed against 35 doctors in 2015, up from 27 in 2014.

Not all have led to formal charges and even fewer to convictions, but Dr. Hänel and other doctors see a trend that they say aims to prevent them from providing a legally allowed medical procedure.

“I can’t believe that in this day and age the language and mind-set of the time when abortions were illegal continue to play a role in a country that is otherwise viewed by the rest of the world with respect,” Dr. Hänel wrote on March 19 in an open letter to Ms. Merkel. “I am ashamed and I hope that we can resolve this problem.”

This is not the first time Germans have struggled with the issue of abortion. The procedure was illegal in West Germany until the 1970s, when women took to the streets to demand the right to decide what happens with their bodies. In 1974, a law was passed legalizing abortion in the first trimester, but the country’s highest court overturned that ruling the following year.

A compromise requiring permission from a doctor in order to be allowed an abortion was further eased in the 1990s, after East Germany — where abortion was allowed in the first 12 weeks of pregnancy — was absorbed into the West, leading to the current legal agreement. Under that arrangement, abortion is a crime, but will not be prosecuted in the first 12 weeks if a woman undergoes counseling and a three-day waiting period.

In neighboring Austria, Christian Fiala, a gynecologist, has advertised for years that his clinic offers abortions. “Unwanted pregnancy?” reads a billboard in the University station of Vienna’s subway that includes his clinic’s name and telephone number. A decade ago, he began collecting the names of German doctors who perform abortions and publishing them on his website, which is based in Austria and therefore not subject to German restrictions.

“Information is absolutely essential, because women who find themselves unexpectedly pregnant need information urgently,” Dr. Fiala said. “This has nothing do with advertising that would make it easier for a woman to decide to have an abortion just because she sees a poster somewhere. That idea is not only completely absurd, it is pretty sexist.”

The Netherlands requires a five-day waiting period for an abortion to be carried out in the first 12 weeks, while in Belgium that time period is six days. In neighboring France, a woman seeking an abortion must take part in two consultations with a doctor or midwife. But unlike in Germany, this information is publicly available.

“Germany is the only country in Europe where doctors are not allowed to provide information about abortions,” Dr. Hänel said.


Kristina Hänel, center right, at a rally in Berlin last year against a German law that makes it a crime for doctors to publicly advertise that they perform abortions.

Kiietzmann Björn/Action Press, via Shutterstock

In November, an administrative court found Dr. Hänel guilty of violating the law, because her website allows prospective patients to request and receive a two-page printable handout detailing the legal requirements, anesthesia options and potential risks of the procedure.

Instead of quietly removing the information or accepting the fine of 6,000 euros, or about $7,400, Dr. Hänel has challenged the ruling and is vowing to take it to the country’s highest court if needed. To raise awareness, she launched a petition demanding a “right to information about abortion.” She pointed out that the law had been introduced by the Nazi Party in the 1930s to criminalize Jewish doctors.

Immediately, the center-left Social Democrats rallied to the issue. In February they insisted that “Doctors must be able to inform women about terminating a pregnancy.”

But that was before it was clear that the party’s members would approve entering into yet another government under Ms. Merkel’s leadership. It was also before key members of Ms. Merkel’s conservative Christian Democratic Union made clear that they would not support any changes that could be viewed as easing the abortion law.

Hours before the March 14 vote in Parliament on the new government, Ms. Merkel appeared alongside the Social Democrats’ parliamentary whip in a meeting of the center-left caucus. She urged the Social Democrats to rescind their bill to rescind the abortion law, promising instead to seek a compromise through her new government.

The left-leaning party agreed, angering supporters and women who had joined protests calling on the government to rescind the law.

“Unbelievable!” wrote Lisa Paus, a Green party lawmaker who supports abortion rights. “A fatal signal to women,” wrote Ulle Schauws, another Green lawmaker. She pointed out that if the Social Democrats were willing to break with Ms. Merkel’s party and join with the Greens and the Free Democrats, they would have enough votes to change the law.

Last week, the leader of the youth wing of the Social Democrats, Kevin Kühnert, called for lawmakers to be allowed to vote based on their conscience, instead of along an agreed party line, on whether to rescind the law. That is how Germany swiftly ushered in same-sex marriage last spring, after years of failed attempts.

“The majority in Germany supports a change to the law,” Dr. Hänel said. “But those who are against it are very loud.”

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Editorial: An Ohio Bill Would Ban All Abortions. It’s Part of a Bigger Plan.


Sally Deng

While Donald Trump once said he was “very pro-choice,” since the start of his presidential campaign his stance on abortion has been consistent: It should be banned, no matter the consequences to women. At times, he has even veered to the right of the mainstream anti-abortion movement, as when he said during a primary season town hall event that women who seek abortions should face “some form of punishment.” Most anti-abortion politicians profess to want to protect women, even when they pass laws that harm them.

Now legislators in one state want Mr. Trump’s cruel vision to become reality. Ohio lawmakers have proposed legislation to ban all abortions, period, with no exceptions for victims of rape or incest or to save a woman’s life.

Carrying to term a pregnancy against one’s will is punishment enough — in fact, it can amount to torture, according to the United Nations Human Rights Council. But the Ohio bill would not only cut off access to the procedure, it would also open the door to criminal charges against both abortion providers and women seeking the procedure. One of the Republican co-sponsors of the legislation, State Representative Ron Hood, said it would be up to prosecutors to decide whether to charge a woman or a doctor, and what those charges would be. But they could be severe. Under the bill, an “unborn human” would be considered a person under state criminal homicide statutes. Thus, a prosecutor could decide to charge a woman who ended a pregnancy with murder. In Ohio, murder is punishable by life in prison or the death penalty.

How’s that for pro-life?

If this all sounds legally unsound, that’s because it is. The Ohio bill is “blatantly unconstitutional,” said Brigitte Amiri, a senior staff attorney at the American Civil Liberties Union’s Reproductive Freedom Project, which has challenged anti-abortion laws in the state. “This isn’t a hard one.”

That’s because the Supreme Court’s Roe v. Wade decision made abortion legal up to the point of fetal viability, which has shifted over time due to medical advancements in treating premature babies, but now occurs at about 24 weeks of pregnancy. Any ban on abortion before that time — say, at 15 weeks, as would be the case under a law that was passed and legally blocked in Mississippi last week — is generally considered unconstitutional.

This rash of radically unconstitutional bills is appearing by design. The anti-abortion movement has been trying to pass pre-viability abortion bans, like the Ohio bill, hoping that efforts to overturn them would lead to a challenge of Roe v. Wade that would end with the 45-year-old decision’s reversal in the Supreme Court.

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