Last February, AJ, a single mother in Mississippi, found herself at the back of an abortion clinic in Memphis, Tennessee, where two police officers threatened to charge her with fetal homicide.

It was yet another unexpected turn in a week of surprising events for AJ, whose name we have agreed to conceal for the sake of her family’s privacy.

Days earlier, AJ had received the kind of news that most parents of teenagers hope never to hear. Her 17-year-old daughter, a student at Lake Cormorant High School, texted her to say she thought she was pregnant.

Mother and daughter discussed the realities of raising a baby as a single teen in a low-income household. Initially, AJ’s daughter said that she wanted to have an abortion, but she cried when they went to the clinic, so AJ took her home. After more conversations, the daughter again decided to have an abortion, and AJ scheduled an appointment at CHOICES, a clinic in Memphis, half-an-hour’s drive across the border from their home in Mississippi.

As they sat in the clinic waiting room, her daughter was distracted, texting on her phone with a woman in Hernando, Mississippi, whom AJ did not know. The woman had—to AJ’s consternation—been trying to persuade AJ’s daughter not to have an abortion. Her messages kept flashing up on her daughter’s phone. It’s wrong to have an abortion. God is not going to forgive you for this.

“Her mind was solely made up with the procedure that the clinic was going to do,” AJ recalled, “but when she had someone up in her ear telling her, don’t do this—I think the lady did really get in her head.”

Now AJ found herself being stared down by two police, with nervous clinic staff telling her they were unable to provide her daughter’s abortion at that time.

“The police explained that someone had called them saying that my daughter was there unwilling to have the procedure done,” AJ recalled in an interview with Rewire. “So when the police talked to me, they said that if I had forced her to do it they were going to bring fetal homicide charges against me. So we left, and came home.”

AJ was shaken by the encounter, and it would take several weeks and significant legal wrangling before she could make sense of how events had spiraled from what should have been a simple medical appointment into a serious brush with the law.

With assistance from her lawyer, over the course of the next few days, AJ would learn that in addition to the anonymous phone calls that had been made to the clinic while she and her daughter waited for her procedure, people unknown to AJ had faxed her daughter’s personal information—her name, medical information, and even her social security number—to countless numbers of doctors, police, and other strangers in at least two states, without AJ’s knowledge or consent. She would discover that her daughter had been picked up from school and driven across the state border by a person that AJ did not know. And before the saga was resolved, AJ would even find out that an attorney she’d never heard of had purported to represent her daughter, and had sent threatening letters to the abortion clinic, directly interfering with her daughter’s medical treatment.

A Rewire investigation has found that at the center of the drama that unfolded in AJ’s life was a document produced by Life Dynamics, the prominent anti-choice group that is based in Denton, Texas, which receives the majority of its funding from the fracking billionaires Dan and Farris Wilks. The Wilks brothers are also the main backers of Sen. Ted Cruz’s presidential campaign.

The document is a bogus “notice” that tricks women into believing they have signed away their legal rights to receive an abortion. Providers throughout the country have told Rewire that this document has been used for years to deceive and intimidate both patients and providers by threatening them with legal action should they go through with obtaining or providing an abortion.

In AJ’s case, the tactic did not work. But her story is an illustration of the intrusive and dishonest techniques used by anti-choice activists to deprive women of their constitutional rights. Abortion providers familiar with the document worry that, for each of the women who ultimately receive the care they desire, countless more may be too intimidated to try.

School Employees Introduce Student to Anti-Choice Activist

The involvement of anti-choice activists in AJ’s daughter’s life began with an innocent conversation between the daughter and a teacher at her school in early February 2015. Rewire was not able to speak directly with the daughter, but confirmed many of the details of AJ’s account with documentation provided by AJ’s attorney, Latrice Westbrooks. Rebecca Terrell, the executive director at CHOICES in Tennessee, also confirmed that the incident involving the police occurred in February last year.

When the daughter confided to her teacher that she was pregnant, the teacher informed another school staff member, and that staffer then contacted a third woman—a stranger to AJ’s daughter, and not a member of school staff—who arranged to meet the girl after school. To this day, AJ has been unable to learn this woman’s identity.

On February 19, the unknown woman drove AJ’s daughter—a minor—across state lines to Millington, Tennessee, where they visited a clinic called Confidential Care for Women, which is a crisis pregnancy center.

Crisis pregnancy centers have a long track record of providing false information to women. Their names and marketing materials are designed to trick the public into thinking that these centers provide abortion when, in reality, they are run by anti-choice groups who deliberately mislead women, and stall for time, in the hopes of diverting them from accessing abortion care. These centers have been the focus of numerous investigations by congressional committees, cities, and independent investigators who have all caught them lying to women about the risks of abortion procedures, as well as misleading them on the types of services crisis pregnancy centers actually provide.

While AJ’s daughter was at Confidential Care for Women, staff performed an ultrasound and had her sign a document titled, “Patient Notice of Intent.”

As AJ would eventually discover, it was that document that created astonishing difficulties in attempting to secure her daughter’s medical care.

The notice is a boilerplate document drafted in small-print, ersatz legalese.

It states:

I have decided to continue my pregnancy to term. However, I am being subjected to coercion by others that is meant to compel me to terminate my pregnancy against my will.

The document then says that if the person who signed it is “brought” to a health-care facility to obtain an abortion, their presence would be a result of “threats, intimidation, force or threats of force.” It also threatens civil and criminal action against “all participating members of the healthcare facility’s medical staff and non-medical support staff” for a laundry list of 15 offenses, including wrongful death, sexual assault, child abuse, and fetal homicide.

The form lists Sheila Williams as the “contact person at the pregnancy center.” In a telephone interview with Rewire, Williams, who said she is the “client services person” at Confidential Care for Women, confirmed that her center continues to have patients sign these notices of intent, but declined to say why, other than that they are “self-explanatory.” Williams repeatedly sought to learn the identity of the patient who was the subject of our call; we declined her requests.

Crucially, the document claims “it is probable that a person or persons whose objective is to prevent me from either withholding or withdrawing my consent for an abortion will accompany me to this facility.”

That last claim appears to be what prompted police to threaten AJ with charges of fetal homicide if her daughter obtained an abortion.

(Read a redacted copy of the document here.) 

“They said they would bring legal actions against me,” AJ told Rewire. “They were saying there’s nothing I can do because if she’s a teenager and she doesn’t want to have an abortion, it’s wrong for me to force her to have it. And I wasn’t forcing her, I was just letting her know what it’s really going to be like to have a baby.”

Deceptive Form Produced by Group Tied to Fracking Billionaires

The form is copyrighted to Life Dynamics, a Texas-based group dedicated to ending legalized abortion in the United States. Life Dynamics is known for its ongoing anti-choice activities. Over the years, the organization has sent DVDs to thousands of lawyers across the country, urging them to sue abortion providers. And through its “Spies for Life” program, it seeks to enlist the public as spies on abortion clinics, and unsubtly encourages activists to trawl through abortion providers’ trash.

According to the most recent available public tax filings, between 2011 and 2013, Life Dynamics received the majority of its funding from Dan and Farris Wilks—the Texas fracking billionaires—via the Thirteen Foundation, one of the vehicles they use to make charitable contributions. While the brothers have scattered their wealth throughout the fundamentalist Christian world, the other major current beneficiary of their largesse is the presidential campaign of Republican Sen. Ted Cruz.

A spokesperson for Life Dynamics declined to answer our questions for this story.

Lawyers told Rewire that the type of document signed by AJ’s daughter would not have any legal force, especially when signed by a minor.

But that hasn’t stopped anti-choice groups from using the documents, according to multiple providers from different regions of the country, who said they are familiar with these phony notices.

Vicki Saporta, president and CEO of the National Abortion Federation, told Rewire that providers all across the country have contacted her group about these forms. She ticked off states in which clinics had shared them with her recently: Arkansas, Georgia, Kentucky, and Maryland to name a few. Terrell from CHOICES in Memphis told Rewire that her clinic receives multiple such forms every year, and Lori Williams, clinic director at Little Rock Family Planning Services in Arkansas, said her clinic also regularly receives these forms.

The forms are frequently given to minors, who later report that they were coerced into signing them by people such as their boyfriend’s parents, who oppose abortion for their own religious or political reasons.

“It’s just another tactic to intimidate and coerce women into not choosing to have an abortion—tricking women into thinking they have signed this and discouraging them from going through with their initial decision and inclination,” Saporta said.

Saporta and multiple providers told Rewire that the tactic frequently fails, as long as a girl or woman makes it to a clinic. Staff are well trained when it comes to the informed consent process, and support their patients to make their own decisions, whether or not that results in an abortion. In this particular case, CHOICES faced the unusual situation that police were present while a patient was seeking care, and according to Terrell, there was confusion as to who had called the police.

What worries providers are the girls and women who never come to the clinic, believing they have signed their rights away.

“The ones who do come and say that they do want to obtain an abortion, the clinics do their own informed consent process and take the time to ensure that the woman is not being in any way coerced,” Saporta said. “You don’t know about how many women don’t come to the clinic to attempt to obtain care.”

Single Mom Faces More Legal Threats From Anti-Choice Activists

After returning home from that visit to the clinic, AJ and her daughter spent the next few days discussing her daughter’s options. At one point, her daughter appeared to vacillate, saying she might want to continue her pregnancy. AJ talked with her about what that would entail—what it would mean for her daughter’s social life, for her studies, and for her future. She also explained the financial reality of having a baby: AJ was already struggling to support herself and her daughter by working 64 hours per week between two jobs as a card dealer at local casinos.

Ultimately, the 17-year-old decided that she wanted to terminate her pregnancy, and AJ made another appointment at CHOICES, for February 21, 2015.

But when they arrived, CHOICES staff again told AJ they could not perform the abortion. Minutes before, the clinic had received a threatening legal notice from an attorney in Tupelo, Mississippi, named Stephen M. Crampton, who claimed to be representing AJ’s daughter.

“Be advised that this office represents [REDACTED], age 17,” the fax read. “Her mother is transporting her to your clinic as I write.” Crampton purported to put the clinic on “legal notice that any procedure you administer would be against [REDACTED’s] wishes and her constitutional right to choose, and you will face legal consequences if you choose to ignore her stated choice.” (Emphasis in original.)

Crampton named Cathy Waterbury as the employee at Confidential Care who had faxed through the notice of intent to CHOICES. Waterbury has since left Confidential Care, according to Williams, but she is listed in federal tax filings as the chief officer of a Tennessee nonprofit, Heart to Heart, which describes its mission as “abortion alternatives.” Heart to Heart is based in Millington, Tennessee—the same town listed on the notice as Confidential Care’s address. The documents also list the same phone number for both Confidential Care and Heart to Heart. We attempted to contact Waterbury through publicly listed phone numbers, but were unable to reach her.

AJ had never heard of Williams, Crampton, or Waterbury. This brought to five the total of unknown adults who had interfered with AJ’s daughter’s health decisions without AJ’s knowledge, in addition to the two school staffers. AJ would later learn that Crampton had been in contact with her daughter while she was wrestling with her decision about whether to continue her pregnancy.

The involvement of an unknown attorney in her child’s health decisions would be troubling enough, but Crampton is not just any neutral lawyer, seeking to do his client’s bidding. Based on his online profiles, Crampton is in fact special counsel to the Thomas More Society, a Chicago-based nonprofit law firm that represents anti-choice extremists, including David Daleiden, the activist who has recently been indicted by a Texas grand jury for his role in creating the deceptive attack videos against Planned Parenthood last summer. Neither Crampton nor the Thomas More Society responded to our requests for comment.

For all the strangers that AJ could identify who had been given sensitive information about her daughter’s health, the document that Confidential Care had AJ’s daughter sign indicated that—contrary to what their name would suggest— they could have disseminated it to an almost infinite number of third parties.

In addition to the legal threats it contained, the notice of intent also included a section that permitted Confidential Care to “immediately forward copies of this document to the following”:

1. Every abortion clinic or other abortion provider to which I might be taken;

2. Every law enforcement entity (police department, sheriff’s department, district attorney’s office, etc.) with jurisdiction where I might reside and those with jurisdiction where the abortion might be performed; and

3. My legal counsel and/or the legal counsel representing the Pregnancy Center.

AJ learned that Confidential Care had already faxed a copy of the notice to CHOICES, apparently on the same day that her daughter had visited Confidential Care. AJ does not know who else received a copy.

That was particularly worrisome because the document did not just inform all recipients of AJ’s daughter’s pregnancy, but it also contained the girl’s full name, her full address, and even her date of birth and her social security number.

Williams, of Confidential Care, was unapologetic about distributing this private information about a minor to third parties. “I am fully aware of what we sent out,” she told Rewire.

When pressed on the fact that this case involved a minor—who was not legally competent to sign such a document—Williams pointed to language in the document that asserts that the minor gives permission to the pregnancy center to “provide this document to every city, county or state social service agency responsible for the protection of underage children with jurisdiction where I reside and those with jurisdiction where the abortion might be performed.”

Williams then asked again for the patient’s name, saying, “I have concerns for patient confidentiality.”

Williams declined to answer questions about whether she and her center are bound by federal patient privacy laws. She said that someone else from her organization would answer those questions, but we never heard back from any other Confidential Care representative.

Abortion providers say that when they receive these notices, they almost always contain this level of personal information—a practice that disturbs Vicki Saporta of the National Abortion Federation.

“It’s particularly unconscionable that they indiscriminately send out patient information,” she said. “If she had concerns about patient confidentiality then she would not be having the patient sign the form to begin with and sending it all over town in violation of the patient’s confidentiality.”

At this point, AJ decided she needed a lawyer. She contacted Latrice Westbrooks, who knew she had to act fast because AJ’s daughter’s pregnancy was approaching the end of the first trimester, and mother and daughter were concerned that it might soon become more difficult for her daughter to obtain an abortion at a local clinic.

Despite multiple phone calls, Crampton never replied to Westbrooks. Ultimately, she had to draw up legal paperwork to prove to the clinic that Crampton was not AJ’s daughter’s legal representative, and that the document the girl had signed was not legally binding. As soon as the clinic was satisfied that it was legally able to do so, staff provided AJ’s daughter with her abortion.

Westbrooks says the clinic’s cautious response was understandable, given the threats they had received and the general atmosphere of intimidation currently surrounding abortion care, especially in the South. However, she says that the tactics used by the various anti-choice activists are alarming.

“My main concern here is that a minor was taken advantage of, and that school officials took the decision out of the hands of the parent and guardian and took it upon themselves to make a health-care decision on their behalf,” Westbrooks told Rewire. “It’s important for people to know that they have a choice to change their mind—whether it’s to keep their child or terminate their pregnancy—and not to let someone force them into making any kind of health-care decision.”

Westbrooks said that her client does not currently plan to take legal action against the school; neither the school nor the district replied to Rewire’s requests for comment.

While AJ’s daughter eventually obtained the care she wanted, AJ says the situation took a toll on her. Throughout the course of less than a month, AJ found herself threatened by police, and ensnared in a web of anonymous strangers who sought to impose their own ideological views on her daughter’s life.

“I’m truly a strong person,” she told Rewire, “but that really got the best of me.”

In 2014, Jennifer Whalen, a nursing home aide, was sentenced to between 12 and 18 months in jail. Her crime? Trying to obtain medication abortion pills for her teenage daughter, who was facing an unwanted pregnancy. Whalen, who was charged with “performing an illegal abortion,” bought the pills online because the nearest clinic from her home was 75 miles away, and because Pennsylvania has a 24-hour mandated waiting period requiring patients to make two visits to a clinic to obtain an abortion. Without health insurance, and facing loss of income from time off, the costs—of two round-trips to the clinic, a possible overnight stay in Harrisburg, and the procedure itself—became insurmountable. Out of desperation, Whalen turned to the Internet.

Whalen was arrested for a simple reason: Her daughter was pregnant and did not want to be.

Earlier this week, GOP presidential candidate Donald Trump asserted that women who have abortions should face “some form of punishment.” He since “walked it back,” political parlance for being too honest or saying the wrong thing at the wrong time. In response to his initial statement, however, the GOP and leaders of anti-choice groups collectively fell all over themselves criticizing Trump for what they declared to be a position outside the “mainstream” of their movement. Their outcry was political theater at its most insidious: Anti-choice leaders know that their real intentions—to ban abortion and punish women who have them—is a deeply unpopular opinion. So they feign concern for women by talking about “safety,” and “caring,” and “life.” No matter how much they dissemble, however, there is only one reality: The laws and policies pushed by the anti-choice movement and the politicians it supports already punish women both explicitly and implicitly, including by sending them to prison.

The anti-choice movement seeks to punish women through a web of entrapment that, spun just a little bit at a time, harms women in ways that are less noticeable to the rest of us because they don’t make headlines until women start ending up in jail.

First, anti-choice legislators pass laws to mandate medically unnecessary waiting periods, driving up the costs of abortion care and insulting the intelligence of women who don’t need to be told to wait to figure out how to deal with their own realities. Then, they pass laws to require clinics to mimic ambulatory surgical centers, though abortion is among the safest procedures a person can obtain and there is no reason not to do them in a clinic. This forces many clinics to close because providers can’t recoup the costs of medically unnecessary building renovations, and in turn it leaves women in large swaths of a state without access to care. Then, having cut off many avenues to legal safe abortion care, lawmakers pass laws to make medication abortion inaccessible, again on medically unnecessary grounds. They also pass laws mandating that only doctors can perform abortions, even though nurses and nurse practitioners are perfectly capable of being trained to perform early abortions safely and effectively, as well as to administer medication abortion. Finally, they pass laws making self-induced abortion a crime. Put these together and the anti-choice movement has made a safe, legal abortion virtually impossible to obtain. So when, in desperation, women go to any length to end an unintended pregnancy, legislators punish them further by making them criminals and putting them into jail.

It should not be surprising then that in many states, including Georgia, Louisiana, Mississippi, Texas, and Utah, where a raft of laws similar to those mentioned above have been passed, women are taking matters into their own hands and paying the price of anti-choice laws. For example, a recent study estimated that in Texas, where abortion access has been severely limited as a result of the omnibus legislation known as HB 2, between 100,000 and 240,000 women have attempted to self-induce. Many of these women, already vulnerable because they are poor or undocumented or are made subject to racial profiling, are policed every day at medical centers and at border crossings where they go to seek medication to terminate a pregnancy. Medication that, by the way, taken correctly is completely safe and could be used for self-induction were it legal.

Women who attempt to self-induce abortion are now routinely charged with crimes. In Georgia, Kenlissia Jones was arrested in 2015 for allegedly using misoprostol to self-induce her abortion. Jones was originally facing two charges: “malice murder” and “possession of a dangerous drug” (i.e. the misoprostol). The murder charge against Jones was dropped, but she still faces punishment for the drug charge. That same year in Arkansas a nurse, Karen Collins, was arrested and faced the charge of “performing an unlicensed abortion” (a class D felony in her state) for allegedly providing a drug to a woman that would allow her to terminate her pregnancy. And in Tennessee, Anna Yocca was charged with attempted murder for a failed self-induced abortion attempt with a coat hanger. Prosecutors later dropped the attempted murder charge but said they would still pursue criminal charges against Yocca, likely for aggravated assault.

These cases are the product of anti-choice laws promoted relentlessly by Americans United for Life, the Susan B. Anthony List, the National Right to Life Committee, the Family Research Council, and others. The fact that the use of these laws to harass, frighten, indict, and imprison women is never protested by anti-choice groups tells you everything you need to know about the movement’s intentions. Punishment.

Moreover, those who seek to outlaw abortion are forever finding new and creative ways to punish women. Feticide laws, for example, were ostensibly created to allow for the prosecution of third-party actors who were violent toward pregnant women and, in turn, harmed a fetus. According to the National Conference of State Legislatures, 38 states now have feticide or “fetal homicide” laws on the books, and in 23 of these states, these laws can be applied at any stage of pregnancy. While these laws were not originally created with the intent of criminalizing pregnant women for actions they took during their own pregnancy, they are now widely used to do just that. “Pro-life” prosecutors are arresting and indicting women under such laws when they deem that either an action or lack of action by a pregnant woman causes harm to a fetus or leads to pregnancy loss. In fact, these are de facto fetal “personhood” laws of the kind promoted by anti-choice organizations such as Susan B. Anthony List.

There is Bei Bei Shuai, who was charged with murder and attempted feticide for attempting suicide while pregnant. Shuai sat in jail for 435 days until she was released on bail (where she remained under surveillance by an electronic ankle monitor). In August 2013, nearly two and a half years after her prosecution began, she accepted a plea deal to the misdemeanor charge of “criminal recklessness.”

There is Purvi Patel, who was charged with neglect of a dependent and feticide after having a pregnancy loss that the state deemed was a self-induced abortion. She is currently serving a 41-year sentence while her case is on appeal. In three states—Wisconsin, Minnesota, and South Dakota—laws on the books allow for the involuntary civil commitment of pregnant women for “not following doctors’ orders.” Recent cases in which these laws were applied include those of Alicia Beltran and Tamara Loertscher in Wisconsin. As ProPublica has noted in “How States Handle Drug Use During Pregnancy,” hundreds and potentially thousands of women in three states—Alabama, South Carolina, and Tennessee—have faced criminal prosecution under “chemical endangerment laws” that allow for the criminal prosecution of drug use during pregnancy. The anti-choice movement has pushed for and supported these laws.

This is not punishment?

And then consider AJ, a woman on whose case we reported earlier this week. AJ’s teenage daughter became pregnant. Her teacher somehow insinuated herself into the daughter’s decision-making process. Unbenownst to her mother, the teacher called another person, a stranger to this teen, who took her to a so-called crisis pregnancy center, at which the young woman was pressured under threat of “hell and damnation” to sign a document stating she did not want an abortion. These anti-choicers sent the document, containing a raft of personal information including address and social security number, to clinics and police stations in the surrounding area. When AJ’s daughter later decided, after confiding in her mother, that she did in fact want to terminate the pregnancy, they went to a clinic in Memphis, Tennessee. There, AJ found herself threatened with arrest for feticide for “coercing” her daughter to have an abortion. While there was no substance to this charge, the whole episode frightened a teen and her mom and further delayed her abortion. There are several layers of “punishment” here, including frightening a young woman with lies, tricking her into signing a bogus legal document, seeking to get her to delay the abortion until it was too late, and then threatening to arrest her mother.

There are innumerable other ways in which the anti-choice movement is actively punishing women, by, for example, supporting monitoring and harassment of women outside clinics and hospitals, making immigrant women fear arrest, and denying women access to abortion for severe fetal and developmental anomalies while slashing state funding of support for children who are severely disabled.

I could go on. The fact that these laws and policies are passed and employed throughout the country, that they  infantalize, criminalize, and otherwise treat women as children without agency is part of an overall agenda aimed at punishing women and is becoming deeply entrenched in the U.S. legal system as a direct result of the advocacy of anti-choice groups.

The anti-choice movement is built on lies. And those lies continue to be perpetuated both by its leaders, and by a media unable, unwilling, or too self-absorbed and preoccuppied with access to politicians to actually understand and report on what is happening throughout the country.

While attending UC San Diego (UCSD), Ireri Lora used her school ID at the university’s medical school to access birth control and other services.

Lora, who was undocumented then, told ​Rewire​, “Sometimes you would see border patrol agents walking around or parked in their trucks, but they were always parked directly in front of the main hospital entrance. They would take people straight from the hospital [to a border patrol station], and they wanted us to see them do that.”

This behavior wasn’t unique to the UCSD hospital, Lora said. An acquaintance whose family members worked for border patrol in San Diego had told her that federal agents would drive around the perimeter of hospitals and park outside of them, presumably to intimidate non-citizens.

Every time Lora had to get her birth control prescription filled, she would make sure multiple people in her life knew where she was going so that if trouble arose, they would answer her call immediately.

California is often referred to as one of the best states for reproductive rights in the country, and for good reason. NARAL Pro-Choice America gives California an A+ on choice-related laws, and the state legislature is actively trying to expand access to care.

There are, however, California residents for whom none of this matters.

The reasons vary, but what is true across the board is that the more your identity is layered by race, gender, sexuality, and immigration status and the further your income falls below the federal poverty line, the less access you will have to sexual and reproductive health-care services—even in California. There are community-based groups working to fill this gap, but resources are in short supply for those fighting to expand access to undocumented people.

Stifled by Fear of Deportation

In August 2015, when Blanca Borrego, an undocumented mother of three, was arrested by sheriff’s deputies at her gynecologist appointment in Atascocita, Texas, some in the media rightly expressed outrage. But undocumented communities knew it wasn’t an isolated incident and that immigrants are detained and deported for seeking care all the time. Borrego was yet another example confirming some of their biggest fears.

“The fear that accessing [health] services will get you deported is very real in undocumented communities and what happened to Blanca [Borrego] isn’t at all unusual, so it’s not an unfounded fear,” said Alma Leyva, a research coordinator at the UCLA Labor Center’s Dream Resource Center, a national source for research, education, and policy on immigration issues. “She was insured and had been in the country for a long time. A lot of people think, ‘If that could happen to her, why couldn’t it happen to me?'” Leyva told Rewire.

Nearly three years ago, the Dream Resource Center sought to document the experiences of immigrant youth and their families in navigating California’s health-care system as part of its 2013 Healthy California Survey Project. From June 2013 to August 2013, a research team comprised of 37 immigrant youth surveyed 550 undocumented and “DACA-mented” young people. What resulted was Undocumented and Uninsured, the first statewide research project by and about immigrant youth on health access.

As the report explains, while Deferred Action for Childhood Arrivals (DACA) recipients under the age of 21 are eligible for Medi-Cal—the state’s free or low-cost health coverage for children and adults with limited income and resources—that doesn’t resolve a primary reason undocumented people and DACA recipients do not seek care: fear.

National policies contribute to high numbers of deportations and increase immigrant communities’ mistrust, such as the Priority Enforcement Program (PEP), which requires that all fingerprints of arrested persons taken by local law enforcement be sent to ICE to check against immigration databases, and Section 287(g) of the Immigration and Nationality Act, which allows DHS to “deputize selected state and local law enforcement officers to perform the functions of federal immigration agents.”

According to the Undocumented and Uninsured:

The police and Immigration and Customs Enforcement (ICE) are not only in immigrant neighborhoods but also in the minds of undocumented people, triggering constant anticipation of harm and hypervigilant behavior. Emerging research indicates that immigrant youth experience feelings of shame, anger, despair, marginalization, and uncertainty stemming from discrimination, anti-immigrant sentiment, xenophobia, fear of deportation, and institutional barriers. Daily economic uncertainties elevate the risk of anxiety, depression, and vulnerability to mental illness for immigrant youth. Emotional traumas manifest in poor physical and mental health, which often goes untreated.

Leyva told Rewire that she has heard stories “where an undocumented youth was asked by a doctor to relay really complicated medical jargon to their mom as she was giving birth. They were so afraid they wouldn’t translate the information properly that it would be dangerous to their mom,” she said.

“There is anxiety around simple check-ups and fear around obtaining resources to get healthier. We’ve come to believe that this is just the price of being undocumented in this country, and that’s not OK. We too deserve the right to not just survive, but to live full, healthy lives. Health care is a right, not a luxury,” Leyva said.

Dire Circumstances in Rural California

Lora became a legal permanent resident in 2015, but while living in San Diego as an undocumented college student she said her “biggest fear” was a scenario like what happened to Borrego in Texas. In 2009, while working on college campuses and connecting with undocumented families, Lora learned that it was a universal fear among undocumented women.

“When I asked the moms [I worked with] if any of them, about 20 in all, had visited any particular clinics, they all shared that they were scared to because they heard border patrol patrolled the area or that vans waited outside to get people who were leaving the clinic, especially if the clinic was one that primarily served the Latino community. Fortunately, none of the mothers I ever worked with had been stopped by border patrol for seeking services, but that environment made them too scared to go to a clinic,” Lora said.

By that time, she and a friend had started a program where they brought different workshops onto campus based on the expressed needs of the community. Overwhelmingly, Lora said, undocumented mothers requested workshops about sexual education and birth control.

Lora worked with local community clinics from the Barrio Logan area of San Diego to do biweekly workshops in Spanish about sexual health. That experience led her to ACCESS, an Oakland-based organization “founded in 1993 by clinic escorts who were moved to action after witnessing the many barriers women were facing—especially young or poor women—to actually obtain an abortion.” ACCESS further explains on its website that the organization combines direct services, community education, and policy advocacy to promote reproductive options and access to quality health care for California women. It is one of the only organizations in California that helps to provide abortion access to undocumented women while also using a reproductive justice framework created by women of color for women of color.

Lora, who is now on ACCESS’ board of directors, began working with the organization as a healthline intern. The healthline, as Lora explained, empowers callers by giving them all of the information they need to advocate for themselves. It was at this time Lora learned of the very specific barriers undocumented women living in rural areas face.

“They always voiced fears about visiting any government agency to get Medi-Cal or a clinic like Planned Parenthood because they thought they’d be deported or profiled for showing a foreign ID,” Lora said.

Vanessa Gonzalez-Plumhoff, Planned Parenthood’s director of Latino outreach and engagement, made it clear that the health-care provider would not put a patient in harm’s way. She told Rewire that Planned Parenthood is serious about addressing the needs of the undocumented community, asserting that Planned Parenthood will provide health care no matter what, regardless of immigration, citizenship, or income status.

The reason why the services provided to undocumented women may differ by location, Gonzalez-Plumhoff said, is because of the legislative, political, and financial climate of a particular area. As reproductive health care continues to be attacked, it limits what services are made available from clinic to clinic.

Unlike most states, California allows low-income women to obtain public funds for abortion and also provides them with co-pay-free family planning services. Abortions are legal up to viability and California’s AB 154, which took effect in January 2014, increased the number of abortion providers in the state. The law authorized nurse practitioners, certified nurse midwives, and physician assistants to perform vacuum aspiration abortion, which previously only doctors were allowed to do.

But, like in most states, there are districts in California where abortion providers are nonexistent. According to the LA Times, UC San Francisco’s Bixby Center for Global Reproductive Health is largely responsible for the passage of AB 154, but just a handful of the clinicians trained under the six-year study are practicing in remote corners of California. Schools like the UC San Francisco School of Nursing are developing new training programs, but at this point, half of California’s 58 counties currently have no readily available provider. And even when new programs roll out in rural communities, they will only benefit women seeking abortions during the first trimester, leaving out a segment of the population at risk of fetal anomalies or later pregnancy complications.

The process of obtaining an abortion as an undocumented woman living in a rural area is complicated. Lora said these women often work in the fields and live in migrant camps, which makes obtaining the passport that some clinics require as a valid form of ID challenging—and that’s mostly because of the lack of transportation, which Lora said is a “huge barrier” for undocumented women seeking such identification.

In addition, these women often have to travel to reach one of the few clinics providing later abortion care in the state.

“A lot of clinics near women in rural areas only offer abortion until the first trimester,” Lora said. “By the time they’re referred to us, they’re often beyond that point, so they have to get transferred to a clinic that’s even farther away. Transportation comes up again and again.”

This is where ACCESS’ “practical support” program comes in. The organization has a shoestring budget of $860 a month to provide both transportation and housing to women seeking abortions, but its network of volunteers willing to open up their homes or donate money for bus tickets, gas, and motel rooms helps to make this work possible.

One of the toughest cases Lora ever handled on the Spanish healthline was an undocumented rape survivor who lived in a rural area. Her family didn’t know of the rape or the resulting pregnancy. By the time ACCESS could walk her through all of the steps, she was in her 20th week. Following the multi-week process, which included acquiring an appointment and bus tickets, she then had to come up with a lie to tell her family as to where she was going for two days.

“The information is not accessible and the barriers can seem endless. That’s why it’s especially upsetting to me when ACCESS constantly hears this misconception that people in California—and women of color in particular—purposefully wait until the last minute to get abortions. It’s simply not true. Most of the women I’ve spoken to were very clear that they wanted to terminate their pregnancies early on, but they were forced to wait weeks because of limited access to information, limited access to clinics, and because of transportation barriers and language barriers,” Lora said. “If abortion was as accessible in California as they paint it to be, all women who wanted to terminate their pregnancies would be able to do it in a week.” 

Community Groups Are Working to Replace Fear With Trust 

There is no telling how many women ACCESS has helped, but what is clear is the ripple effect of the progress the group is making. ACCESS alumna La Loba Loca, who identifies herself as a queer, machona, brown South American migrant, formed Autonomous Communities for Reproductive and Abortion Support (ACRAS) three years ago. La Loba Loca’s collective, comprised of mostly queer people of color, provides free and low-cost abortion support to Angelenos. Her personal project, Serpiente Birth & Spectrum Services, supports individuals and families during life transitions through bilingual full-spectrum companionship and doula work. 

La Loba Loca takes a multifaceted approach to her companion work, coupling an academic framework with traditional knowledge gained through personal research and non-Western education, which she calls “abuelita knowledge.”

“I got into birth work because of abortion. To me, there’s no place people can go that will holistically support them getting an abortion,” La Loba Loca said. “I want to normalize abortion as just another aspect of reproductive health and remind people of the ways our grandmothers took care of their health and well-being outside of the medical industrial complex. It’s medicine and knowledge that is generational and that shouldn’t be lost.”

Above all else, ACRAS works to share knowledge and resources within communities. La Loba Loca has tirelessly compiled documents about abortion and reproductive health for the purpose of being used by undocumented people who don’t have easy access to clinics and hospitals. “The idea was also to include people in the collective who have historically been left out of these conversations or who have been denied the same kind of access to reproductive justice as other people,” she said.

La Loba Loca has been a major proponent of queer and trans people of color receiving the proper training to be both birth and abortion companions. The language used around reproductive justice isn’t inclusive, she said, and it can make queer and trans people of color afraid to discuss their bodies and their needs and afraid to access services.

“I’m hearing a lot of queer and trans people try to figure that out, just because accessing abortion as a queer or trans person can be difficult or when you do obtain one, it can be dehumanizing,” she said. “Right now, there are queer and trans people doing reproductive justice work, but it’s very isolating and frustrating to never receive the funding that’s needed to provide education for and about different bodies.”

To La Loba Loca, the answer to the lack of access and the poor treatment that undocumented people and other low-income communities of color often receive at clinics and hospitals is not working to change these systems, but rather using community-based resources to find ways around the structural hurdles. Roxana, an ACRAS member who requested that Rewire not use her last name, said that the road to sexual and reproductive justice has been built on the backs of women of color and the long history of institutions being harmful to communities of color who are already vulnerable is not something that can easily be overcome.

“I think of the Latinas in L.A. who were coerced into sterilization in the 1970s and how that distrust lingers in the community,” Roxana said. “The trauma stays, and it continues to be a barrier that scares people from going to an institution that historically been violent to people who look like them. It’s only harder when you’re undocumented.”

Like Lora, Roxana realized through her work that immigrant communities, Latino communities, and undocumented communities are all in need of sexual and reproductive health information that is in their language and that comes from people they trust.

At an ACRAS workshop around reproductive justice, according to Roxana, the age of attendees ranged from 15 to 65. A woman specifically asked if it was OK that her teenage daughter was there because she wanted her to have the information that she never did. ACRAS workshops bring a LGBTQ lens and the mother and her daughter were eager to learn about reproductive health for different communities and learn about gender and sexual identities that go beyond the binary. Roxana said the interest is there; it’s just a matter of providing it in a way that’s accessible.

“We’re having real conversations about real experiences and for me, as a person who does this work, it’s very political and very personally meaningful. It’s heart work; it comes from the heart,” Roxana said, growing emotional. “I want to go beyond ‘your body, your choice.’ I’m not really into that, especially because for a lot of us, what happens to our bodies isn’t a choice. For me, it’s more like ‘I got your back.’ ACCESS and collectives like ACRAS serve a very important purpose in our communities. We’re creating alternatives to a system that wasn’t meant for us and we’re providing access to people whose existence was never even considered. We have each other’s backs.”