Why Abstinence Pledges Don’t Work

Why Abstinence Pledges Don’t Work

Girls who take virginity pledges have more risk for STIs and unplanned pregnancy

Justin J Lehmiller Ph.D.     04.04.2017        Psychology Today

123RF.com/Sergejus Bertasius

In the United States today, 37 states mandate that information on abstinence be provided in sex education courses. It is not uncommon for students in those states to be asked to take “purity” or virginity pledges as part of their curriculum.

Students are encouraged to take these pledges in order to both reduce the spread of sexually transmitted infections and to prevent unintended pregnancies. As it turns out, however, abstinence pledges don’t necessarily accomplish either one of these things. In fact, a recent study published in the Journal of Marriage and Family suggests that they may do precisely the opposite!

In this study, researchers utilized data from a nationally representative, longitudinal survey of adolescents (Add Health). Data were collected at several intervals between 1994 and 2008, and all participants were adolescents in grades 7-12 at the time the study began.

For this particular publication, researchers focused on two subgroups. First, they looked at how taking a virginity pledge was associated with likelihood of being diagnosed with HPV specifically among sexually active women who provided urine samples in 2001-2002 that were tested for this virus. There were 3,254 women in this analysis, of whom 15% reported having taken a previous virginity pledge.

Second, they looked how taking a virginity pledge was associated with becoming pregnant outside of marriage among girls who were in grades 7 and 8 when the study began and who had not yet had intercourse at that time. There were 1,335 women in this analysis, of whom 23% reported having taken a previous virginity pledge.

So what did they find? Among women with two or more sex partners, those who had taken virginity pledges were more likely to have tested positive for HPV than those who hadn’t taken such pledges. The biggest difference was among women with 6-10 partners—in this group, 51% of pledge takers had contracted HPV compared to 33% of those who had not taken a pledge.

In addition, pledge takers were significantly more likely than non-takers to become pregnant outside of marriage within six years of their first sexual intercourse—30% vs. 18%, respectively. In both groups, the vast majority of these pregnancies were unplanned (75-80%).

So how do we explain this pattern of results? The authors of the research argued that “both sets of results are consistent with the notion that pledge breakers were less likely to be consistent users of condoms; as their exposure risk increased, they had increased risk of negative health outcomes.”

It seemed that those who took virginity pledges were less prepared when it came to practicing safe sex, perhaps because abstinence-only sex education courses have a tendency to downplay the effectiveness of condoms and contraceptives. However, it could also be that perhaps these folks were simply less prepared to communicate about sex in general with their partners.

Whether the same could be said of men who do and don’t take virginity pledges remains unclear because they were not considered in this study. Also, it’s important to note that virginity pledges probably don’t increase the risk of STIs and unintended pregnancies for everyone. Some folks, particularly those with a high degree of religious commitment, may be less inclined to break pledges of this nature and, therefore, may actually have better sexual health outcomes.

That said, it appears that abstinence pledges often have unintended consequences. Indeed, when these pledges are broken, women’s risk of negative outcomes is higher than it would be if they had never taken such a pledge in the first place.

Yes means know

[Excerpts from]
Yes means know: Respect, ravishment, and the non-con job of being a wanton woman
A conversation with the best in the bizz about consent, slut-shaming and “Guys We F*cked”
By Emily Jordan   Salon

 Of course, James has always been a radical. Or at least, she’s lived what her many loyal fans call her “double life.” Her father is poet and author Robert Bly. After graduating from Harvard University, James got her M.Phil. from Oxford University, a Ph.D. from Yale, eventually becoming a Shakespeare professor. She’s also published a whopping 26 romance novels, 23 of which have hit the bestseller list. Her newest novel, the brightly entertaining “Seven Minutes in Heaven,” about a woman who runs an agency for governesses and against her better judgment, falls for a demanding rake, was just released in January and hit the NYT and USA Today Bestseller lists. Its central plot point, a sexy kidnapping, is the focus of our meeting. How does one write things like kidnappings responsibly and yet still keep the heat? What are the ways that this trope has evolved over time? And whatever happened to the alpha brutes? Are they so 2007?

“Our culture continues to change in terms of eroticism,” James informs me, futzing in her bag. “On one level, it has something to do with economics — we’re all exhausted! It’s the ‘Fifty Shades’ question: how far would you go for someone who’s solvent and owns a car? Because in a contemporary romance, the girl can make love to 15 people. The parameters are defined by her. This is refreshing and fun to see. But in a historical romance, for instance, which is what I write, slut-shaming isn’t a viable thing. Because there’s no space in which you wouldn’t be shamed in the Regency period. It’s like being gay before the Wilde trials. You can’t say ‘gay’ in Shakespeare’s time. These words— slut-shaming, rape, gay— didn’t have the meaning and impact that they do today. You have to remember how culturally specific sex is. When Keats says ‘shagging’ we don’t know what he means. We think of ‘Austin Powers’ but that isn’t it.”

In other words, if you once obsessed about the incestuous flowers in V.C. Andrews’ infamous attic, or followed Luke and Laura over the summer with “General Hospital,” the sticky pickle of soft-pedaling sexual assault has possibly fallen on literary hard times. Or has it?

For starters, if you live in a culture where women are chattel and have no agency, a woman is an entropic force. She is merely a dowry. She can only give birth to the people who get to own the property and then quietly die. She is even not a separate gender, but the absence of maleness defined for and by men. So the assertion, or rather, insertion, of maleness through marriage or, in the worst case scenario, rape or war, is a negation of the woman’s absence by filling her. She can neither grant nor take away consent. This is the rub.

It makes sense, therefore why the honorific ‘Ms.’ was so essential to Gloria Steinem and all the other white second-wave feminists as a redefinition of women’s social identity. It was no longer “who squirted me into my mother?” or “who’s squirting other people into me?” Suddenly, you had your feminism. What’s more, the Pill became widely available. At first glance it would seem that “bodice rippers” (a term no longer in parlance for obvious reasons) were a secret bedroom backlash against the “The Feminine Mystique” and “the Female Eunuch.”

****

Hutchinson throws in, “I added the tagline, “The Anti Slut-Shaming Podcast” because we like to do comedy with a purpose as often as possible. Using humor is the best way to make a statement and have that statement really sink into your brain to make you think or reassess. I love talking about sex and was always so turned off the the clinical, dry approach most people use when approaching the topic. So many people have a stick up their ass when it comes to talking about sexuality, which makes sense given how little we hear candid, overly honest conversations about it.”

“I feel like ‘slut’ is a very vague concept,” Fisher continues. “Once you really know a human being, it’s hard to think of them as any shitty word and that goes for all words with historically negative connotations. When you hear a person’s story, their actions make a lot more sense — sexual stories are no different. Our intention was to be very honest about what we’ve done without apologizing for it. Slut-shaming is thinking less of someone, usually a woman, for the amount of sex, sexual partners, and kind of sex she has. I also think the real power in slut-shaming comes from creating a cloud of shame around people so they can be controlled. Once a person is free in any way (including sexually), they are less easily controlled. And that’s no good. Especially for women.”

For Sarah MacLean, the idea of “policing women’s kink,” is the worst kind of feminism. Yet the romance writer’s job is still to pepper consent markers throughout any sex scene or even prior. In other words, no means no, but by all means, talk dirty to me! Another method is establishing clearly delineated boundaries and safe words, as in Lilah Pace’s controversial “Asking for It”—a novel in which the protagonist has fantasies of being raped and chooses to enact them safely with a partner— or other romance novels that push the boundaries of sexual consent, (like pretty much all the books on your bookshelf by any Western author, because, rape culture).

[See full article]

Trouble for Sperm

Are chemicals putting your sperm in trouble?

By Nicholas Kristof MARCH 11, 2017   – New York Times

The New York Times/Donnelly

Let’s begin with sex.

As a couple finishes its business, millions of sperm begin theirs: rushing toward an egg to fertilize it. But these days, scientists say, an increasing proportion of sperm — now about 90 percent in a typical young man — are misshapen, sometimes with two heads or two tails.

Even when properly shaped, today’s sperm are often pathetic swimmers, veering like drunks or paddling crazily in circles. Sperm counts also appear to have dropped sharply in the last 75 years, in ways that affect our ability to reproduce.

“There’s been a decrease not only in sperm numbers, but also in their quality and swimming capacity, their ability to deliver the goods,” said Shanna Swan, an epidemiologist at the Icahn School of Medicine at Mount Sinai, who notes that researchers have also linked semen problems to shorter life expectancy.

Perhaps you were expecting another column about political
missteps in Washington, and instead you’ve been walloped with
talk of bad swimmers. Yet this isn’t just a puzzling curiosity,
but is rather an urgent concern that affects reproduction,
possibly even our species’ future.

Andrea Gore, a professor of pharmacology at the University of Texas at Austin and editor of the journal Endocrinology, put it to me this way: “Semen quality and fertility in men have decreased. Not everyone who wants to reproduce will be able to. And the costs of male disorders to quality of life, and the economic burden to society, are inestimable.”

Human and animal studies suggest that a crucial culprit is a common class of chemical called endocrine disruptors, found in plastics, cosmetics, couches, pesticides and countless other products. Because of the environmental links, The New Yorker once elegantly referred to the crisis as “silent sperm,” and innumerable studies over 25 years add to the concern that the world’s sperm are in trouble.

And so are men and boys. Apparently related to the problem of declining semen quality is an increase in testicular cancer in many countries; in undescended testicles; and in a congenital malformation of the penis called hypospadias (in which the urethra exits the side or base of the penis instead of the tip). These problems are often found together and are labeled testicular dysgenesis syndrome.

There is still disagreement about the scale of the problem, and the data aren’t always reliable. But some scientists are beginning to ask, At some point, will we face a crisis in human reproduction? Might we do to ourselves what we did to bald eagles in the 1950s and 1960s?

“I think we are at a turning point,” Niels Erik Skakkebaek, a Danish fertility scholar and pioneer in this field, told me. “It is a matter of whether we can sustain ourselves.”

One recent study found that of sperm donor applicants in Hunan province, China, 56 percent qualified in 2001 because their sperm met standards of healthiness. By 2015, only 18 percent qualified.

“The semen quality among young Chinese men has declined over a period of 15 years,” concluded the study, which involved more than 30,000 men.

Perhaps even more alarmingly, Canadian scientists conducted a seven-year experiment on a lake in Ontario, adding endocrine disrupting chemicals and then observing the impact on fathead minnows. The chemicals had a devastating impact on males, often turning them into intersex fish, with characteristics of both sexes but incapable of reproducing.

The crisis for male reproductive health seems to begin in utero. Male and female fetuses start pretty much the same, and then hormones drive differentiate of males from females. The problem seems to be that endocrine disrupting chemicals mimic hormones and confuse this process, interfering with the biological process of becoming male.

How should we protect ourselves? Swan said she avoids plastics as much as possible, including food or drinks that have touched plastic or been heated in plastic. She recommends eating organic to avoid pesticide residues, and avoiding Tylenol and other painkillers during pregnancy. When in doubt, she consults guides at ewg.org/consumer-guides.

Yet this isn’t just a matter of individual action, but is also a public policy issue that affects tens of millions of people, their capacity to reproduce and their health and life expectancy.

What’s needed above all is more aggressive regulation of endocrine disrupting chemicals. The United States has been much slower than Europe to regulate toxic chemicals, and most chemicals sold in the U.S. have never been tested for safety.

The larger question is why we allow the chemical industry — by spending $100,000 on lobbying per member of Congress — to buy its way out of effective regulation of endocrine disruptors. The industry’s deceit marks a replay of Big Tobacco’s battle against regulation of smoking.

If you doubt the stakes, look at the images with the online version of this column of a hapless sperm swimming in circles, and remember this: Our human future will only be as healthy as our sperm.

Reproductive Health Crisis

From The Guttmacher Institute’s Reproductive Health In Crisis:

“Social conservatives now control the White House, Congress and most state governments, and their actions could put sexual and reproductive health and rights at grave risk, both in the United States and across the globe. The Guttmacher Institute is examining the dangers ahead and the potentially devastating consequences for women and their families.”

More on the Institute’s blog and policy analysis here.

Paul Ryan: GOP Will Vote to Defund Planned Parenthood

Paul Ryan Says the GOP Will Vote to Defund Planned Parenthood

Paul Ryan Democrats plan to “stand against this with every fiber of our beings.”

By Becca Andrews January 5, 2017   MotherJones

During a news conference on Thursday, House Speaker Paul Ryan (R-Wis.) said the process to dismantle Obamacare will include stripping all federal funding for Planned Parenthood, but he did not provide much further detail.

His remarks come two days after a Republican-led House investigative panel released a report that recommended the health care provider be defunded.  The investigative panel—created to examine allegations that Planned Parenthood was selling fetal tissue for profit—was then disbanded, because it was not reauthorized for a new Congress. Planned Parenthood was never found guilty of any wrongdoing at the state or federal level, despite multiple GOP-led investigations.

Democrats immediately denounced the move. “I just would like to speak individually to women across America: This is about respect for you, for your judgment about your personal decisions in terms of your reproductive needs, the size and timing of your family or the rest, not to be determined by the insurance company or by the Republican ideological right-wing caucus in the House of Representatives,” said House Minority Leader Nancy Pelosi (D-Calif.). “So this is a very important occasion where we’re pointing out very specifically what repeal of the [Affordable Care Act] will mean to women.” Read More

Missouri GOP legislators emboldened by Trump

A Wave of Anti-Abortion Laws Is About to Hit This State

GOP legislators in Missouri have been emboldened by Trump.

By Hannah Levintova  MotherJones   01/5/2017

In November’s election, Republican Eric Greitens was elected to replace Democrat Jay Nixon as governor, making Missouri one of four states with a new trifecta in which the GOP controls all branches of government. Wasting no time, Missouri lawmakers prefiled 14 anti-abortion bills for the legislative session that started Wednesday.

The proposals include a personhood bill, religious liberty protections for crisis pregnancy centers, several measures blocking fetal tissue research, a chemical endangerment bill, and a bill regarding fetal burial similar to those passed this year in Indiana and Texas.

“I believe that the Republican leadership wants to focus on other issues that are priorities,” says Alison Dreith, executive director of NARAL Pro-Choice Missouri. “But the legislators who are obsessed with further restricting access to abortion…are emboldened by the new Republican trifecta. They might be emboldened by the new Trump presidency.”

In Missouri, it is not unusual for lawmakers to prepare many abortion bills before the legislative session begins, but since 2014 lawmakers have never prefiled more than 10 bills. “This legislative session is going to be the fight of our lives,” said Elise Higgins, interim director of public policy and organizing at Planned Parenthood Great Plains, the regional affiliate that provides care in Missouri, Kansas, Oklahoma, and Arkansas.

The state has a long history of curbing access to abortion. Between 2011 and 2015, political pressure and abortion restrictions shut down four providers, and now only one abortion clinic remains to serve Missouri’s more than 2 million women. Year after year, legislators have filed dozens of anti-abortion proposals—31 in 2014, 27 in 2015, and 28 last year—with mixed success. The Show-Me State has also been a testing ground for new approaches to restricting abortion—a legacy that dates back to the 1989 Webster case decided by the Supreme Court. That ruling, which upheld a Missouri abortion law, allowed states to impose far more restrictions on abortion care than had previously been permitted under Roe v. Wade. This is what gives the current list of measures potential for national consequences. Read More

Some Good News for Sexual-Assault Victims

“You matter. What happened to you matters.”

The Department of Justice announced more than $38 million in funding on Monday to help state and local agencies address the backlog of untested sexual-assault kits. The funding, part of a national initiative launched last year, will go toward increasing the inventory and the testing of kits, training law enforcement officers on sexual-assault investigations, helping police departments collect DNA that could lead to the identification of serial sex offenders, as well as several other efforts.

Sexual-assault kits, more commonly known as rape kits, are the DNA swabs, hair, photographs, and detailed information gathered from victims of sexual assault and used as evidence for the prosecution of rapists. The forensic exam can often be long—from four to six hours—and, as activists note, invasive, but it can provide key evidence for identifying assailants. But getting the contents of a rape kit tested is expensive, costing between $1,000 and $1,500 on average. Lack of funding in police departments, as well as murky protocols around testing, has created a backlog of more than 400,000 untested kits across the country, according to a 2015 estimate. As a result, victims may never see their cases prosecuted, and serial rapists could go on to commit more crimes. New York, among other states, is still in the process of counting the number of untested kits it has, while others simply do not know how many untested kits there are, according to the Joyful Heart Foundation’s Accountability Project.

This round of funding could go a long way toward helping cities and police departments close cases, identify serial offenders, and better handle sexual-assault cases in the future. (Last fiscal year, the DOJ awarded nearly $80 million in grants to state and local agencies in 27 states, but there are still states that have yet to participate in the initiative.) After Detroit received a pilot grant to test rape kits, its police department has been able to make DNA matches, identify potential serial rapists, and secure convictions against perpetrators. In a 2011-13 DOJ-funded study on rape kit testing in Detroit, researchers had found that in many cases, law enforcement stopped investigating cases after minimal effort and were biased in how they conducted sexual assault investigations, with officers expressing “negative, victim-blaming beliefs about sexual assault victims.” The DOJ later released guidance on how police departments could better address gender biases in how they investigate sexual assault and domestic violence. A study this June by Case Western Reserve University of nearly 5,000 rape kits collected in and near Cleveland found that serial rapists are more common than previous research has suggested.

Maile M. Zambuto, CEO of the Joyful Heart Foundation, a sexual-assault advocacy organization, applauded the new funding in a statement. “Testing rape kits sends a fundamental and crucial message to victims of sexual violence,” she said. “You matter. What happened to you matters.”

Dark Day in Abortion Rights History

Anniversary of a Dark Day in Abortion Rights History

Forty years later, the Hyde Amendment still won’t go away. This Supreme Court case explains why.

By Nina Liss-Schultz and Hannah Levintova

09/30/16  Mother Jones

For decades, millions of low-income women have been prevented from getting Medicaid coverage for their abortions—a reality that disproportionately affects abortion access for women of color. The reason? The Hyde Amendment, an appropriations rider preventing the use of federal funding for most abortions. It was first passed in the House 40 years ago today.

Even in 1976, abortion rights advocates recognized that this amendment would prove detrimental to women’s reproductive health care access. Soon after its passage, the American Civil Liberties Union and other groups launched a movement to circumvent Hyde by restoring Medicaid coverage for abortions through state constitutions. Today, 15 states provide public funds for abortion coverage. But efforts to repeal the federal funding ban have gained new momentum over the last year, beginning with the introduction of the EACH Woman Act in Congress in July 2015. The bill has been stuck in committee, but this summer another proposal to repeal Hyde cropped up, this time in the Democratic Party platform, a first. Hillary Clinton also announced her support for a repeal. Now, Democrats are trying to use this momentum—as well as the Supreme Court’s historic decision in Whole Woman’s Health v. Hellerstedt, striking down two abortion regulations in Texas—to rejuvenate debate about the country’s ban on public funding for abortions.

Read full article

Finally Official: Limiting Abortion in the Guise of Helping Women is a Sham

It’s Finally Official: Limiting Abortion in the Guise of Helping Women is a Sham

The supreme court ruled Monday against abortion restrictions that effectively prevent women from being able to secure the procedure

By Jessica Valenti, The Guardian  June 27, 2016

Amy Hagstrom-Miller, president and CEO of Whole Woman’s Health, and Nancy Northup, president and chief executive of the Center for Reproductive Rights, wave in celebration as they walk down the steps of the supreme court. (Photo: Kevin Lamarque/Reuters)

Amy Hagstrom-Miller, president and CEO of Whole Woman’s Health, and Nancy Northup, president and chief executive of the Center for Reproductive Rights, wave in celebration as they walk down the steps of the supreme court. (Photo: Kevin Lamarque/Reuters)

 

In a major victory for American women, the US supreme court sent a powerful message on Monday in its Whole Woman’s Health v Hellerstedt decision: that laws purporting to protect women’s health while limiting access to abortion are an unconstitutional sham.

In a 5-3 decision, the court struck down a Texas law, called House Bill 2, responsible for shuttering more than half of the state’s clinics. The restrictions mandated that clinics become ambulatory surgical centers, adhering to wholly unnecessary hospital-like standards, and that doctors have admitting privileges at a nearby hospital even though hospitalization is almost never necessary after ending a pregnancy. The goal wasn’t to make abortion safer, of course, just impossible to obtain.

Ending a pregnancy is such a safe procedure that doctors would never be able to admit enough patients to a hospital in order to keep admitting privileges, and because abortions are so safe and common, maintaining the standards for a surgical center simply drained clinics of their resources. And anti-choice legislators know as much.

The court’s decision made clear the justices were not fooled, noting in the majority decision that “when directly asked at oral argument whether Texas knew of a single instance in which the new requirement would have helped even one woman obtain better treatment, Texas admitted that there was no evidence in the record of such a case.”

And in Justice Ruth Bader Ginsburg’s concurring opinion, she wrote it was “beyond rational belief that HB 2 could genuinely protect the health of women, and certain that the law ‘would simply make it more difficult for them to obtain abortions.’”

Lead plaintiff in the case, Amy Hagstrom Miller, founder and CEO of Whole Woman’s Health, released a statement saying that her clinics “treat our patients with compassion, respect and dignity – and today the supreme court did the same.”

She continued, “I want everyone to understand: you don’t mess with Texas, you don’t mess with Whole Woman’s Health and you don’t mess with this beautiful, powerful movement of people dedicated to reproductive health, rights, and justice.”

The ruling represents a significant loss for anti-abortion groups, who have been pushing Targeted Regulation of Abortion Providers (Trap laws) over the last decade: as of this year, 24 states have some sort of law or policy that restricts abortion access through targeting the way providers work.

But the Whole Woman’s Health decision – which laid bare the way that these mandates constitute an undue burden on women seeking abortion – stands to put that years-long strategy in jeopardy. It will be that much harder for anti-choice legislators to shroud their policies in rhetoric about protecting women when the highest court in the country has essentially called the tactic nonsense.

For pro-choicers, the decision isn’t just a win, but a sticking point in the upcoming presidential election. Pro-choice organizations wasted no time releasing statements that tied the decision to how a Donald Trump presidency would be disastrous for women. Ilyse Hogue, president of Naral Pro-Choice America, says that Trump “is committed to appointing justices who will once again make abortion illegal across the country”. Stephanie Schriock, president of Emily’s List, noted that “extremist Republicans like Donald Trump should take note… women are paying attention and you’ll be hearing our voices loud and clear come November.”

Before November comes, though, American women can do some much-deserved celebrating in the wake of Monday’s decision. A strategy that aimed to limit our rights while invoking our protection has been proven impotent. A law that put tens of thousands of us in danger has been overturned. It is, finally, a good day.

Supreme Court decides a pro choice victory

From MSN  June 27, 2016

Supreme Court strikes down Texas abortion clinic regulations

"We're thrilled that justice was served and our clinics stay open," said lead plaintiff Amy Hagstrom Miller. (Photo: AFP/Getty)

“We’re thrilled that justice was served and our clinics stay open,” said lead plaintiff Amy Hagstrom Miller. (Photo: AFP/Getty)

WASHINGTON (AP) — The Supreme Court struck down Texas’ widely replicated regulation of abortion clinics Monday in the court’s biggest abortion case in nearly a quarter century.

The justices voted 5-3 in favor of Texas clinics that had argued the regulations were a thinly veiled attempt to make it harder for women to get an abortion in the nation’s second-most populous state.

Justice Stephen Breyer’s majority opinion for the court held that the regulations are medically unnecessary and unconstitutionally limit a woman’s right to an abortion.

Texas had argued that its 2013 law and subsequent regulations were needed to protect women’s health. The rules required doctors who perform abortions to have admitting privileges at nearby hospitals and forced clinics to meet hospital-like standards for outpatient surgery.

Breyer wrote that “the surgical-center requirement, like the adm


itting privileges requirement, provides few, if any, health benefits for women, poses a substantial obstacle to women seeking abortions and constitutes an ‘undue burden’ on their constitutional right to do so.”

Justices Anthony Kennedy, Ruth Bader Ginsburg, Sonia Sotomayor and Elena Kagan joined Breyer.

Chief Justice John Roberts and Justices Samuel Alito and Clarence Thomas dissented.

Thomas wrote that the decision “exemplifies the court’s troubling tendency ‘to bend the rules when any effort to limit abortion, or even to speak in opposition to abortion, is at issue.'” Thomas was quoting an earlier abortion dissent from Justice Antonin Scalia, who died in February.

Abortion providers said the rules would have cut the number of abortion clinics in the state by three-fourths if they had been allowed to take full effect.

When then-Gov. Rick Perry signed the law in 2013, there were about 40 clinics throughout the state. That number dropped to under 20 and would have been cut in half again if the law had taken full effect, the clinics said.

Texas is among 10 states with similar admitting privileges requirements, according to the Center for Reproductive Rights. The requirement is in effect in most of Texas, Missouri, North Dakota and Tennessee. It is on hold in Alabama, Kansas, Louisiana, Mississippi, Oklahoma and Wisconsin.

The hospital-like outpatient surgery standards are in place in Michigan, Missouri, Pennsylvania and Virginia, and it is blocked in Tennessee and Texas, according to the center, which represented the clinics in the Texas case.

Texas passed a broad bill imposing several abortion restrictions in 2013. Texas clinics sued immediately to block it claiming it impermissibly interfered with a woman’s constitutional right to an abortion. The clinics won several favorable rulings in a federal district court in Texas. But each time, the New Orleans-based 5th U.S. Circuit Court of Appeals sided with the state, at first allowing challenged provisions to take effect and then upholding the law with only slight exceptions.

The Supreme Court allowed the admitting privileges requirement to take effect in most of the state, but put the surgical center provision on hold pending the court’s resolution of the case.

The justices split largely along liberal-conservative lines in their emergency orders, with the court’s conservative justices voting repeatedly to let the law be enforced.