Each spring, as reliably as the changing of the seasons, Japan releases grim new population data that prompts handwringing in the press and vows by politicians to address the country’s demographic crisis.

It’s “now or never” to tackle declining births and the shrinking population, the country’s leader warned last year – nearly eight years after his predecessor had pledged to “confront the demographic problem head on.”

This year is no exception. The number of new births fell for an eighth consecutive year in 2023, reaching a record low and representing a 5.1% decline from the previous year, according to preliminary data released this week by the government.

The demographic crisis has become one of Japan’s most pressing issues, with multiple governments failing to reverse the double blow of a falling fertility rate and swelling elderly population. More people are dying than being born each year, causing the population to fall rapidly – with far-reaching consequences for Japan’s workforce, economy, welfare systems and social fabric.

Japan is far from the only country with this problem. Its East Asian neighbors, including China, Hong Kong, Taiwan, and South Korea face similar issues, as do several European nations such as Spain and Italy.

A day after Japan released its preliminary data this week, South Korea released its own figures showing its fertility rate – the world’s lowest – dropped yet again in 2023.

Unlike many developed countries with low fertility rates, such as the United States, Japan and other East Asian nations have shied away from using immigration to bolster their population.

But Japan’s crisis is unique in that it’s been decades in the making, experts say – meaning its impact is particularly evident now, with relief unlikely to come anytime soon. So whatever path Japan takes will likely offer a roadmap for other countries facing unchartered territory, and a glimpse into their potential future.

‘Not reversible’

The first thing to understand about Japan’s population crisis is that it’s only partly behavioral, said James Raymo, professor of sociology and demography at Princeton University.

A much bigger part of the problem has to do with Japan’s history and how that has shaped its population structure, he said.

For a population to remain stable, it needs a fertility rate of 2.1, defined as the total number of births a woman has in her lifetime. A higher rate will see a population expand, with a large proportion of children and youth, as seen in India and many African nations.

But in Japan, “that measure of fertility has been below 2.1 for 50 years,” Raymo said. It fell below that level after the 1973 global oil crisis pushed economies into recession, and never climbed back up.

As of last year, Japan’s fertility rate sat at 1.3. It has stayed relatively flat for a while, meaning the average Japanese woman today is having roughly the same number of children as five or 10 years ago.

The real problem is that the fertility rate has been consistently low for so long. A country can recover if that rate only dips for a few years – but when it stays under 2.1 for decades, you get a population with much, much fewer young people than older adults.

Because of that skewed ratio, the total number of babies being born each year will continue to fall – even if women start having more kids – because the pool of women of childbearing age is already so small, and shrinking each year.

“It has to continue – it cannot not continue,” Raymo said. “Even if all of a sudden Japanese married couples started having three children on average … the population would continue to decline. The number of births would, for a while, still continue to decline. It’s not reversible.”

That means even if Japan manages to boost its fertility rate dramatically and immediately – which experts say is unrealistic – its population is bound to keep decreasing for at least several more decades until the skewed ratio balances out, and the babies being born now reach childbearing age themselves.

Official projections echo this prediction. According to models by the government’s Institute of Population and Social Security Research (IPSS), which were most recently revised last year, the population will fall 30% by 2070. At that point, the number of people age 65 and over will account for 40% of the population, it forecast.

What we’re seeing now “is zero surprise … and it will structurally continue for the foreseeable future,” Raymo said.

‘Drifted into singlehood’

There are many reasons for Japan’s low fertility rate – but the main problem is that people aren’t getting married in the first place, Raymo said.

Single parents, or children born to unmarried mothers, are far less common in Japan than many Western countries. Thus, fewer marriages means fewer babies overall.

The number of marriages in Japan declined nearly 6% in 2023 from the previous year – dipping below 500,000 for the first time in 90 years, according to the preliminary data released this week. Divorces also rose 2.6% last year.

Experts have pointed to Japan’s high cost of living, stagnant economy and wages, limited space, and the country’s demanding work culture as reasons fewer people are opting to date or marry.

Japanese people’s “willingness to form a family … has declined considerably,” according to a 2022 survey by the IPSS. Among single adults who have never wed, fewer say they intend to get married compared to previous years – while more say they wouldn’t be lonely even if they continued living alone. About one third said they did not want a relationship.

For women, economic costs are not the only turn off. Japan remains a highly patriarchal society in which married women are often expected to take the caregiver role, despite government efforts to get husbands more involved.

For all these reasons, many people are “ambivalent about marriage,” postponing it for years – “and then they’re 35, they’re 40, and they’ve sort of drifted into singlehood,” Raymo said.

Many of these issues are also plaguing other East Asian nations with their own population woes. Marriage rates have plummeted in China, where women are more educated and financially independent than ever. In South Korea, only one third of young people feel positively about marriage, according to polls, with many saying they don’t have enough money for marriage or feel it’s simply not necessary.

Most East Asian nations have also declined to legalize gay marriage, parenting and adoption rights, making it far harder for LGBTQ citizens to become parents.

What does Japan’s future look like?

The impact of the population crisis is evident.

Industries are feeling labor shortages; jobs are hard to fill, with fewer young adults entering the workforce; some rural communities are dying out, with one village that went 25 years without any new births.

Even in cities, things are changing – with many service jobs occupied by young immigrants, or students from countries such as China or Vietnam, Raymo said.

The government has spent years pushing various initiatives to encourage marriage and childbirth, such as enhancing child care services or offering housing subsidies. Some towns are even paying couples to have kids.

But given the decline is expected to continue for at least several decades, Japan will likely feel the blow to its pension and health care systems, and other social infrastructure that is difficult to maintain with a shrinking workforce.

That’s not to say Japan is doomed, Raymo asserted – the fertility rate will likely even out at some point, and the country will adjust. But that will take time, and Japan needs to prepare itself for “a really bumpy ride to a new equilibrium.”

There are a few ways that ride could play out. We could see a “massive mechanization of society,” meaning human labor being replaced by machines, Raymo said. As the population falls, some problems like the high cost of living, or overcrowding in Toyko could begin to ease. One theory suggests that fewer people means less competition for things like university admission and jobs.

But for now, this is all speculation. No country has been in this position before. And, Raymo said, the “only likely large-scale response” the government can implement is “mass immigration on a level Japan has never experienced.”

Immigration is a controversial issue in Japan, a largely conservative country that perceives itself as ethnically homogenous. It has historically failed to integrate previous waves of foreign workers and has instead relied on temporary fixes such as employing foreigners on student visas. Foreign residents and Japanese nationals of mixed ethnicity have long complained of xenophobia, racism and discrimination.

Japan may not have a choice, however. A 2022 report by a Tokyo-based research organization found that Japan needs about four times as many foreign workers by 2040 to achieve the government’s economic goals.

And authorities have shifted that direction in recent years, creating new visa categories and considering proposals to allow certain types of skilled workers to stay indefinitely. The IPSS’ models predict that by 2070, “the pace of population decline is expected to slow down slightly, mainly due to the increase in international migration.”

Decades down the line, the new Japan “might be a slightly poorer country, and a slightly less generous country in terms of policy support for elderly and families,” Raymo said.

“I can imagine a much smaller and a much different Japan,” he said. “But I don’t imagine an empty Japan.”

MONTGOMERY, Ala. — Facing public pressure to get in vitro fertilization services restarted, Alabama lawmakers moved closer to approving protections for fertility clinics that shut down after a state court ruled that frozen embryos are the legal equivalent of children.

Both chambers of the Alabama Legislature advanced bills Thursday that would shield clinics from prosecution and civil lawsuits. Each bill now moves to the opposite chamber for debate. Bill sponsor Rep. Terri Collins said they are aiming to get the measure approved and to the governor on Wednesday.

“This would at least keep the clinics open and the families moving forward,” Collins said. She described the legislation as a temporary fix while lawmakers weigh if additional action is needed.

The Alabama Supreme Court ruled in mid-February that three couples who had frozen embryos destroyed in an accident at a storage facility could pursue wrongful death lawsuits for their “extrauterine children.” The ruling, treating an embryo the same as a child or gestating fetus under the wrongful death statute, raised concerns about civil liabilities for clinics. Three major providers announced a pause on IVF services.

Republicans’ proposal focused on lawsuit protections instead of attempting to address the legal status of embryos. The legislation would shield providers from prosecution and civil lawsuits related to the “damage to or death of an embryo” during IVF services.

The bills advanced with broad bipartisan support. Representatives voted 94-6 for the proposal, and state senators voted 32-0 for it.

Some Republicans said they want to consider future restriction on what happens to unused embryos.

Republican Rep. Ernie Yarbrough of Trinity tried unsuccessfully to put an amendment on the bill that would prohibit clinics from intentionally discarding embryos that are unused or after genetic testing.

Republican Rep. Mark Gidley of Hokes Bluff said he wants lawmakers to consider putting regulation on fertility clinics.

“This is what is important to me and a lot of members of this House. Understand, that once that is fertilized, it begins to grow, even though it may not be in a woman’s uterus,” Gidley said.
A Democratic lawmaker said the state, which has a stringent abortion ban with no exceptions for rape, has spent too much time interfering with the decisions of women.

“I am so tired of folks telling me as a female in Alabama what I’m going to do with my own body. It’s time that we stop this,” Democratic Rep. Barbara Drummond of Mobile said. She said a woman texted her this morning asking if the state would take “custody” and responsibility of her frozen embryos if they are now considered children.

Democrats in the Alabama Senate had unsuccessfully tried to amend the bill to state that a human embryo outside a uterus can not be considered an unborn child or human being under state law. Sen. Linda Coleman-Madison, a Democrat from Birmingham, said that was the most direct way to deal with the issue. Republicans blocked the amendment from coming up for a vote.

Rep. Chris England, a Democrat from Tuscaloosa, said lawmakers may be able to provide a temporary solution through legislation but a long-term solution must address the 2018 constitutional amendment, which he said essentially established “personhood” for embryos.

“There are far-reaching ramifications of personhood,” England said.

More than 200 IVF patients filled the Statehouse on Wednesday pressuring lawmakers to get IVF services restarted in the state. They showed lawmakers babies created through IVF treatment or described how the ruling halted their path to parenthood.

LeeLee Ray underwent eight miscarriages, one ectopic pregnancy and multiple surgeries before turning to surrogacy in hopes of having a child. She and her husband found a surrogate through a matching program, but now can’t have their embryos transferred to her and are unable to move their embryos out of state.

“I’m just frustrated. We had a light at the end of the tunnel,” Ray said Wednesday.

Mary Delgado’s first pregnancy went according to plan, but when she tried to get pregnant again seven years later, nothing happened. After 10 months, Delgado, now 34, and her partner, Joaquin Rodriguez, went to see an OB-GYN. Tests showed she had endometriosis, which was interfering with conception. Delgado’s only option, the doctor said, was in vitro fertilization.

“When she told me that, she broke me inside,” Delgado said, “because I knew it was so expensive.”

Delgado, who lives in New York City, is enrolled in Medicaid, the federal-state health program for low-income and disabled people. The roughly $20,000 price tag for a round of IVF would be a financial stretch for lots of people, but for someone on Medicaid — for which the maximum annual income for a two-person household in New York is just over $26,000 — the treatment can be unattainable.

Expansions of work-based insurance plans to cover fertility treatments, including free egg freezing and unlimited IVF cycles, are often touted by large companies as a boon for their employees. But people with lower incomes, often minorities, are more likely to be covered by Medicaid or skimpier commercial plans with no such coverage. That raises the question of whether medical assistance to create a family is only for the well-to-do or people with generous benefit packages.

“In American health care, they don’t want the poor people to reproduce,” Delgado said. She was caring full-time for their son, who was born with a rare genetic disorder that required several surgeries before he was 5. Her partner, who works for a company that maintains the city’s yellow cabs, has an individual plan through the state insurance marketplace, but it does not include fertility coverage.

Some medical experts whose patients have faced these issues say they can understand why people in Delgado’s situation think the system is stacked against them.

“It feels a little like that,” said Elizabeth Ginsburg, a professor of obstetrics and gynecology at Harvard Medical School who is president-elect of the American Society for Reproductive Medicine, a research and advocacy group.

Whether or not it’s intended, many say the inequity reflects poorly on the U.S.

“This is really sort of standing out as a sore thumb in a nation that would like to claim that it cares for the less fortunate and it seeks to do anything it can for them,” said Eli Adashi, a professor of medical science at Brown University and former president of the Society for Reproductive Endocrinologists.

Yet efforts to add coverage for fertility care to Medicaid face a lot of pushback, Ginsburg said.

“So right there, as a country we’re making judgments about who gets to have children,” Collura said.

The legacy of the eugenics movement of the early 20th century, when states passed laws that permitted poor, nonwhite, and disabled people to be sterilized against their will, lingers as well.

“As a reproductive justice person, I believe it’s a human right to have a child, and it’s a larger ethical issue to provide support,” said Regina Davis Moss, president and CEO of In Our Own Voice: National Black Women’s Reproductive Justice Agenda, an advocacy group.

But such coverage decisions — especially when the health care safety net is involved — sometimes require difficult choices, because resources are limited.

Even if state Medicaid programs wanted to cover fertility treatment, for instance, they would have to weigh the benefit against investing in other types of care, including maternity care, said Kate McEvoy, executive director of the National Association of Medicaid Directors. “There is a recognition about the primacy and urgency of maternity care,” she said.

Medicaid pays for about 40% of births in the United States. And since 2022, 46 states and the District of Columbia have elected to extend Medicaid postpartum coverage to 12 months, up from 60 days.

Fertility problems are relatively common, affecting roughly 10% of women and men of childbearing age, according to the National Institute of Child Health and Human Development.

Traditionally, a couple is considered infertile if they’ve been trying to get pregnant unsuccessfully for 12 months. Last year, the ASRM broadened the definition of infertility to incorporate would-be parents beyond heterosexual couples, including people who can’t get pregnant for medical, sexual, or other reasons, as well as those who need medical interventions such as donor eggs or sperm to get pregnant.

The World Health Organization defined infertility as a disease of the reproductive system characterized by failing to get pregnant after a year of unprotected intercourse. It terms the high cost of fertility treatment a major equity issue and has called for better policies and public financing to improve access.

No matter how the condition is defined, private health plans often decline to cover fertility treatments because they don’t consider them “medically necessary.” Twenty states and Washington, D.C., have laws requiring health plans to provide some fertility coverage, but those laws vary greatly and apply only to companies whose plans are regulated by the state.

In recent years, many companies have begun offering fertility treatment in a bid to recruit and retain top-notch talent. In 2023, 45% of companies with 500 or more workers covered IVF and/or drug therapy, according to the benefits consultant Mercer.

But that doesn’t help people on Medicaid. Only two states’ Medicaid programs provide any fertility treatment: New York covers some oral ovulation-enhancing medications, and Illinois covers costs for fertility preservation, to freeze the eggs or sperm of people who need medical treatment that will likely make them infertile, such as for cancer. Several other states also are considering adding fertility preservation services.

In Delgado’s case, Medicaid covered the tests to diagnose her endometriosis, but nothing more. She was searching the internet for fertility treatment options when she came upon a clinic group called CNY Fertility that seemed significantly less expensive than other clinics, and also offered in-house financing. Based in Syracuse, New York, the company has a handful of clinics in upstate New York cities and four other U.S. locations.

Though Delgado and her partner had to travel more than 300 miles round trip to Albany for the procedures, the savings made it worthwhile. They were able do an entire IVF cycle, including medications, egg retrieval, genetic testing, and transferring the egg to her uterus, for $14,000. To pay for it, they took $7,000 of the cash they’d been saving to buy a home and financed the other half through the fertility clinic.

She got pregnant on the first try, and their daughter, Emiliana, is now almost a year old.

Delgado doesn’t resent people with more resources or better insurance coverage, but she wishes the system were more equitable.

“I have a medical problem,” she said. “It’s not like I did IVF because I wanted to choose the gender.”

One reason CNY is less expensive than other clinics is simply that the privately owned company chooses to charge less, said William Kiltz, its vice president of marketing and business development. Since the company’s beginning in 1997, it has become a large practice with a large volume of IVF cycles, which helps keep prices low.

At this point, more than half its clients come from out of state, and many earn significantly less than a typical patient at another clinic. Twenty percent earn less than $50,000, and “we treat a good number who are on Medicaid,” Kiltz said.

Now that their son, Joaquin, is settled in a good school, Delgado has started working for an agency that provides home health services. After putting in 30 hours a week for 90 days, she’ll be eligible for health insurance.

One of the benefits: fertility coverage.

(KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.

Meanwhile, a narrow tube protruded from her forearm into a blood bag dangling below. She was the latest donor to try mixed reality technology at a blood drive at the Field Museum on Tuesday. 

“It feels like I’m on drugs, in a cool way,” Peterson, 33, said with a laugh. “You’re in this beautiful forest. It helps to distract you.”

The technology, launched by Abbott and Blood Centers of America last year, is designed to ease the experience of blood donation. Participants wear lightweight headsets as they give blood, while a soothing voice guides them through a glowing garden. 

“Blood donation, we wanted to reframe it as an experience,” said Alex Carterson, divisional vice president of medical, clinical and scientific affairs at Abbott. “Mixed reality offers this innovative, immersive digital experience while giving blood.”

The technology comes amid one of the most severe blood shortages in U.S. history. The American Red Cross said Jan. 7 it was experiencing the lowest number of blood donors in two decades. Only about 3% of the eligible U.S. population donates blood, according to Abbott. 

Meanwhile, someone in the country needs blood every two seconds. It’s crucial for traumatic injuries, chronic illness and cancer patients — a single blood donation can save up to three lives. Because red blood cells have a 42-day shelf life, it’s always in demand. 

“There’s always a blood shortage,” Carterson said. “We go through cyclic periods of needing more donors, and this was a way for us to address the overall need for blood.”

The Tribune asked nine of some of the largest hospitals in Illinois if they have felt the effects of the ongoing blood shortage. All said they are at working levels, but many still have below optimal supply, particularly of O-negative red blood cells. 

The fact that the impact on most hospitals is minimal speaks to suppliers’ ability to effectively distribute the blood, said Amy Smith, area vice president of Versiti Blood Center.

“We prioritize where that blood is needed, and make sure that every patient that’s in immediate need gets that blood,” Smith said. 

The shortage was particularly exacerbated during the COVID-19 pandemic. Many people were less inclined to donate. Events that target first-time donors, such as blood drives at schools, were also canceled.

“It’s important, because blood is perishable and can’t be stockpiled, that people continuously give,” said Joy Squier, a spokesperson for the Illinois Red Cross. 

It’s added to the growing problem of blood donors aging out. Over the last decade, blood centers have lost about 30% of donors under the age of 30, according to Abbott. 

“We can’t keep doing the same thing in recruiting blood donors and expecting a different result,” Smith said. “We need to come up with innovative ways for a great customer experience.”

Abbott’s mixed reality technology could incentivize more donors, particularly younger donors, Carterson said. A recent study surveyed nearly 300 donors after using the headsets — 89.2% said they would be likely to donate again. Of those who reported pre-donation anxiety, 68.4% reported that their stress decreased. 

It’s key that the headset is mixed reality, not virtual — donors still are aware of their surroundings, and staff can monitor them. 

“The feedback that we’ve gotten has been universally really positive,” Carterson said. 

It’s still unclear if, and how fast the headsets could be implemented across more blood centers nationwide. Currently, they’re available at several blood donation sites in Illinois, New York, Texas and Ohio. 

“We would like it to become available as widely as possible,” Carterson said. “Everybody needs blood at some point. We want to make sure that we have a safe, sustainable supply.”

Burt Blanchard, a Forest Park resident, started donating blood after he broke his neck in a car accident. He spent a month in a hospital, and blood donations saved his life, he said. The 57-year-old now makes it a habit to donate. 

He looked around curiously after a headset was fitted on him Tuesday. For several minutes, he described images of vibrant flowers playing through his glasses. 

“I just think about others in need,” Blanchard said. “But this is a fun thing on top of it.”

As a urologist, I’ve learned to read the subtle signs in urine that can speak volumes about our well-being. It’s not just about frequency or urgency; it’s also about understanding the color, clarity and odor of urine to unlock health insights.

The many colors of urine

Urine varies in color from pale yellow to deep amber, primarily due to urochrome, a byproduct of the normal breakdown of red blood cells. As these cells age, they are broken down, and urochrome is made, which is then filtered by the kidneys and gives urine its color. The intensity of this color is a direct reflection of your hydration levels. The more hydrated you are, the lighter your urine.

What color is healthy urine?

Ideally, urine should be clear enough to read a book or text through (but there is no need to test my example). Yet it’s essential to find a balance.

Drinking too much water can lead to overhydration, which dilutes vital electrolytes and can cause water intoxication, a rare but serious condition that lowers blood sodium levels to dangerous lows. This risk is particularly relevant for athletes and individuals engaged in extended physical activity.

On the other hand, insufficient water intake risks underhydration, which can result in dehydration, fatigue, and weak cognitive and physical performance.

How much water should you drink?

When it comes to hydration, there’s no one-size-fits-all recommendation, but as a urologist, I can provide some guidelines to help you find what might work best for you. The US National Academies of Sciences, Engineering, and Medicine suggest about 15.5 cups (3.7 liters) of fluids a day for men and 11.5 cups (2.7 liters) for women, which includes all beverages and food. However, individual needs can vary greatly based on factors such as body weight, activity level and health status.

For a more personalized approach, I recommend starting with 30 milliliters (or 1 ounce) of water per kilogram (2.2 pounds) of body weight per day. This accounts for individual body mass differences and can be adjusted based on your daily activities. If you’re more physically active, or if you live in a hot climate, you might need to increase your water intake by 500 to 1,000 milliliters  (about 17 to 34 ounces) per day.

It’s also important to adjust these recommendations for specific health conditions. For instance, patients with kidney stones might need more water to help manage their condition, while those with heart or kidney problems may need to limit their fluid intake.

Gender, age and health status also play critical roles in determining the right amount of water for you. Men typically require more fluids than women due to larger average body size, and older adults may need to pay more attention to hydration due to a decreased sense of thirst.

Regardless of these guidelines, the best indicators of adequate hydration are rarely feeling thirsty and having light yellow urine. Listen to your body and adjust water intake based on thirst, the color of your urine, and how you feel, ensuring you stay well-hydrated for optimal health.

What your urine color is telling you

Red or pink: Sometimes, eating foods such as beets or berries can turn your urine red or pink. However, if you notice that your urine remains red or pink over time, it could mean there is blood in it. This change is something you shouldn’t ignore, and it’s a good idea to talk to a doctor about the change as it may be a red flag for cancers of the bladder and kidneys or benign conditions such as an enlarged prostate.

Dark brown or tea-colored: Urine that looks dark brown or like tea could be a sign that you’re not drinking enough water. If you’ve been drinking plenty of fluids and your urine is still dark, it might be a sign of liver problems or other health issues.

Blue or green: Seeing blue or green in your toilet bowl might be surprising, but it could be due to certain medications or dyes in foods.

Vibrant yellow: B vitamins can infuse your urine with a vibrant yellow shade. This effect, while harmless, is a good reminder of how diet and supplements can influence bodily functions.

What does your urine clarity mean?

Cloudy urine can be a sign of an infection or a problem with your kidneys.

Additionally, it’s worth noting that the presence of semen in urine can also change the clarity of urine, making it appear cloudy.

A cloudy appearance is often benign and resolves on its own and could be natural or a side effect of medications or surgeries for an enlarged prostate.

What does your urine odor say?

Consuming certain foods, particularly those that are spicy or contain strong ingredients, can also affect the odor of your urine.

Foods such as asparagus, coffee and some fish can produce a distinctive smell due to the specific compounds they contain, which are excreted in the urine.

A urinary ‘report card’

When it comes to understanding your health, your urine can act like a daily report card. Paying attention to its color, clarity and odor offers valuable clues that might indicate underlying health issues.

If you notice changes in your urine that don’t go back to normal, it’s better to be safe and talk to a health care provider.

Remember, catching potential health issues early can make all the difference. So, before you flush next time, take a quick look — it could be more informative than you think.

The-CNN-Wire
& © 2024 Cable News Network, Inc., a Warner Bros. Discovery Company. All rights reserved.

PARIS — France’s Senate on Wednesday adopted a bill to enshrine a woman’s right to an abortion in the constitution, clearing a key hurdle for legislation promised by President Emmanuel Macron in response to a rollback in abortion rights in the United States.

Wednesday’s vote came after the lower house, the National Assembly, overwhelmingly approved the proposal in January. The measure now goes before a joint session of parliament for its expected approval by a three-fifths majority next week.

Macron said after the vote that his government is committed to “making women’s right to have an abortion irreversible by enshrining it in the constitution.” He said on X, formerly Twitter, that he would convene a joint session of parliament for a final vote on Monday.

Macron’s government wants Article 34 of the constitution amended to specify that “the law determines the conditions by which is exercised the freedom of women to have recourse to an abortion, which is guaranteed.”

The senate adopted the bill on a vote of 267 in favor, and 50 against. “This vote is historic,” Justice Minister Eric Dupond-Moretti said. “The Senate has written a new page in women’s rights.”

None of France’s major political parties represented in parliament has questioned the right to abortion, which was decriminalized in 1975. With both houses of parliament adopting the bill, Monday’s joint session at the Palace of Versailles is expected to be largely a formality.

The government argued in its introduction to the bill that the right to abortion is threatened in the United States, where the Supreme Court in 2022 overturned a 50-year-old ruling that used to guarantee it.

“Unfortunately, this event is not isolated: in many countries, even in Europe, there are currents of opinion that seek to hinder at any cost the freedom of women to terminate their pregnancy if they wish,” the introduction to the French legislation says.

Surk reported from Nice, France.

BETHESDA, Md. — President Joe Biden spent about 2 1/2 hours at Walter Reed National Military Medical Center on Wednesday for an annual physical that will be closely watched as the 81-year-old president seeks reelection.

The oldest president in U.S. history, Biden would be 86 by the end of a second term, should he win one. After his last exam, performed in February 2023, doctors declared Biden “healthy, vigorous” and “fit” to handle his White House duties. But voters are approaching this year’s election with misgivings about Biden’s age, having scrutinized his gaffes, his coughing, his slow walking and even a tumble off his bicycle.

After he returned to the White House, Biden attended an event on combating crime and suggested that when it came to his health, “there is nothing different than last year.”

He also joked about his age, gesturing toward the assembled press corps and telling police leaders at the gathering, “They think I look too young.”

Former President Donald Trump, 77, is the favorite to lock up the Republican nomination later this month, which would bring him closer to a November rematch against Biden. Trump was 70 when he took office in 2017, which made him the oldest American president to be inaugurated, until Biden broke his record by being inaugurated at 78 in 2021.

A recent special counsel’s report on the investigation into Biden’s handling of classified documents repeatedly derided Biden’s memory, calling it “hazy,” “fuzzy,” “faulty,” “poor” and having “significant limitations.” It also noted that Biden could not recall defining milestones in his own life such as when his son Beau died or when he served as vice president.

Still, addressing reporters the evening of the report’s release, Biden said “my memory is fine” and grew visibly angry as he denied forgetting when his son died of brain cancer in 2015 at the age of 46.

White House press secretary Karine Jean-Pierre said Wednesday that Biden’s physician, Dr. Kevin O’Connor, was one of a team of 20 different medical specialists who helped complete the physical and told her he “was happy with how everything went.” She said O’Connor would release a “robust, comprehensive” memo on the physical later in the day.

Asked why he wasn’t undergoing a cognitive test as part of the physical, Jean-Pierre said that O’Connor and Biden’s neurologist “don’t believe he needs one.”

“He passes a cognitive test every day, every day as he moves from one topic to another topic, understanding the granular level of these topics,” Jean-Pierre said, noting that Biden tackled such diverse issues as Wednesday’s crime prevention event before his planned trip to the U.S.-Mexico border on Thursday and next week’s State of the Union address.

“This is a very rigorous job,” she added, “and the president has been able to do this job every day for the past three years.”

Biden’s last physical showed that the president had a lesion removed from his chest over the previous year, but the results then otherwise largely matched the findings after Biden’s previous exam in November 2021. That report said his occasional coughing was due to acid reflux, while his stiffened gait was the result of spinal arthritis, a previously broken foot and neuropathy in his feet.

The White House also announced last summer that Biden had begun using a continuous positive airway pressure, or CPAP, machine at night to help with sleep apnea — which could be reflected in the final report released later Wednesday.

The president had a colonoscopy in 2021, in which a 3-millimeter “benign-appearing polyp” was identified and removed.

Many Americans, including Democrats, have expressed reservations about Biden seeking a second term during this fall’s election. Only 37% of Democrats say Biden should pursue reelection, down from 52% before the 2022 midterm elections, according to a poll from The Associated Press-NORC Center for Public Affairs Research.

Trump has indeed had his own share of verbal miscues, mixing up the city and state where he was campaigning, calling Hungarian Prime Minister Viktor Orbán the leader of Turkey and repeatedly mispronouncing the militant group Hamas as “hummus.” More recently, he confused his Republican primary rival Nikki Haley with former Democratic House Speaker Nancy Pelosi.

While he was president, Trump’s annual physical in 2019 revealed that he had gained weight and was up to 243 pounds. With his 6-foot, 3-inch frame, that meant Trump’s Body Mass Index was 30.4. An index rating of 30 is the level at which doctors consider someone obese under this commonly used formula.

Weissert reported from Washington.

ST. LOUIS COUNTY, Mo. — The first time Hailey Hall went to college, it was 2008. She lived in Georgia and had been diagnosed with autism four years before.

In high school, the diagnosis meant she had access to smaller classes and a therapy group that helped with social skills. But when college started, that all stopped.

“I was responsible for everything,” said Hall, 35, who lives in Ballwin. She ended up dropping out.

Since Hall was diagnosed two decades ago, the number of children with autism has shot up from 1 in 125 to 1 in 36. Now, college administrators across the country are responding, training staff, adapting to learning differences and promoting self-advocacy. A few local universities are even touting some success: Small steps, they say, appear to be working.

Webster University has a resource center where students learn strategies to cope with the rigors of college.

St. Louis University assembled a sensory room, with a tabletop fountain and a miniature rock garden. It had hundreds of visits last year.

And the University of Missouri-St. Louis has a two-year program that fosters interpersonal and life skills.

“It’s a retention issue,” said Jonathan Lidgus, the director of UMSL’s Office of Inclusive Postsecondary Education. “What can we do to help them persist through their undergraduate degree, to help them unlock their next steps?”

Autism spectrum disorder, a developmental disability, has no correlation with intelligence, and is marked by difficulty with social interactions, communication deficits and repetitive behaviors.

And, for many, it makes college difficult: The rate of completion for autistic students lags that of the general postsecondary population, 39% to 59%, according to the National Institutes of Health.

In elementary and secondary schools, adaptations — as mandated by the federal Individuals With Disabilities Education Act — have become routine. Fidget toys and movement breaks reduce stress and improve concentration. Visual cues and written instructions clarify daily expectations.

After high school, the legal framework around disability changes. Adult students are covered by the Americans With Disabilities Act, which prohibits discrimination but has no metrics for individual progress. The onus to articulate needs and ask for assistance shifts from the school to the student.

Higher education has been inching toward inclusion, advocates say, but there is a long way to go. And the measures taken — like classroom modifications or informational campaigns — are mostly voluntary.

“Colleges have been slow to catch on,” said Lee Burnette Williams of the College Autism Network, a national advocacy and research nonprofit.

“It feels like those students have just fallen off a cliff of support,” said Burnette Williams. “What inevitably happens is they don’t succeed.”

Almost all campuses have an office that provides resources to students with documented disabilities, but comprehensive support programs for autism are rare. The first one, at Marshall University in West Virginia, opened in 2002.

Today, there are about 100 such programs, according to the College Autism Network.

‘Everything looks so different’

The transition to college is a jolt for almost any 18-year-old. No one checks to make sure you are studying, or even attending class. Sleeping and eating habits fluctuate. The guardrails of childhood are gone.

Autistic students often also struggle with isolation, unpredictable schedules and an increased emphasis on grades, experts say.

“Everything looks so different,” said LaToya Griffin, the academic coordinator at Webster University’s resource center, known as the Reeg. “We are teaching students to self-advocate so they can come on the campus and thrive.”

Dara Massey, 24, earned her associate’s degree before enrolling at Webster in the fall of 2022. Getting her point across to professors and classmates has always been a challenge.

“I sometimes ramble,” said Massey, who lives in Ferguson.

But the Reeg has given her strategies: Take a deep breath. Write it down. Massey, who is majoring in animation, expects to graduate this spring. Her drawings help her communicate, too.

“I like creating characters to tell different stories,” she said.

Three years ago, SLU’s Center for Accessibility and Disability Resources applied for a $3,000 grant to build a sensory room on campus. The therapeutic spaces — commonplace in grade schools — house items like bean bags, weighted blankets and bubble tubes that people can use to calm themselves or regain focus.

Occupational therapy professor Sarah Zimmerman enlisted her students to design SLU’s version, which includes a “cocoon” swing and adjustable music and lighting.

“There’s not a lot of areas to decompress and recharge,” said Zimmerman. “Why would that not benefit our kids in college?”

It took some time for the room to catch on. In its first year, only five students visited. Last year, more than 230 students accessed the space, signing up for 30-minute slots with an app.

Kayla Baker, a junior from Overland studying education, makes regular appointments there for “an escape from the day-to-day stressors that come with autism.”

As she goes about her routine, little things — things many people are oblivious to — drain her: small talk, eye contact, background noises.

“Those are all checklist items I have to manually consider throughout the day,” said Baker, 21. “Even with all the accommodations in the world, I can never not be autistic.”

The long-term goal is to build another sensory room at the opposite end of campus, said Kendra Johnson, the director of SLU’s resource center.

“It’s expensive to start, and you have to replenish it,” Johnson said. “But it would be very beneficial.”

‘Life-changing’

The Link program, for autistic students at UMSL, launched five years ago. It follows the model of the university’s Succeed initiative, which serves students with intellectual disabilities.

Each semester, a couple dozen students enroll in Link, at a cost of about $2,600, plus regular tuition. The program, which lasts two years, goes beyond academics, covering independent living, interpersonal skills and career planning, said Lidgus, the UMSL director.

When students complete Link, they earn a certificate or continue on toward a four-year degree.

For a long time, a credential of any kind seemed out of reach for Conner Stewart, 24.

“School is not that easy,” said Stewart, who lives in the Central West End.

But Link, which he finished last year, benefited him inside the classroom — with tutoring and extended test times — and out. Stewart learned to navigate the MetroLink, buy groceries and manage his money. He practiced writing a resume and doing interviews and then landed a job at the St. Louis Zoo.

Stewart still meets with a coach once a week. Now he is working toward a bachelor’s in history, though his childhood on a farm and his work at the zoo are pulling him toward something with animals.

The college experience is not always rosy. Some professors are not as understanding. Some classmates are not as friendly. But most are. And Link has put Stewart on a path he likely would not have considered otherwise.

“It’s been life-changing,” said his mom, Charlene Stewart of Millstadt.

‘A sense of belonging’

Hall, who dropped out of Georgia Gwinnett College more than a decade ago, never thought she’d return. But her husband encouraged her to give it another go, and she enrolled in St. Louis Community College in 2022. On the Meramec campus tour, she saw the Access Office for students with disabilities.

The number of autistic students using the Access Office has almost tripled over the last decade, from 54 to 158, according to director Amy Bird. A true count of autistic students is difficult because it’s up to them whether they disclose a diagnosis.

The Access Office staff identifies, in partnership with the student, what kinds of interventions will facilitate their learning, from wearing headphones during lectures to adding closed-captioning to films. “Instructor notification forms,” which outline needed accommodations, provide a directive to professors who might otherwise be left in the dark.

But the office’s purpose is not just about academic success, said Bird.

“Everyone wants a sense of belonging,” she said. “Finding your people when you’re here is important.”

The space has become a touchstone for Hall, who is studying fine arts. She works there a few hours a week as an assistant and checks in with Bird or other staff members on her off days.

“They’re very happy to have me there,” said Hall, “which is a nice feeling.”

©2024 STLtoday.com. Distributed by Tribune Content Agency, LLC.

It was about midnight in June 2022 when police officers showed up at Angela Collier’s door and told her that someone anonymously requested a welfare check because they thought she might have had a miscarriage.

Police body camera footage obtained by KFF Health News through an open records request shows that the officers then told Collier — who was 29 at the time and enrolled in online classes to study psychology — to turn around.

Instead of taking her to get medical care, they handcuffed and arrested her because she had outstanding warrants in a neighboring county for failing to appear in court to face misdemeanor drug charges three weeks earlier. She had missed that court date, medical records show, because she was at a hospital receiving treatment for pregnancy complications.

Despite her symptoms and being about 13 weeks pregnant, Collier spent the next day and a half in the Walker County Jail, about 80 miles north of Houston. She said her bleeding worsened there and she begged repeatedly for medical attention that she didn’t receive, according to a formal complaint she filed with the Texas Commission on Jail Standards.

“There wasn’t anything I could do,” she said, but “just lay there and be scared and not know what was going to happen.”

Collier’s experience highlights the limited oversight and absence of federal standards for reproductive care for pregnant women in the criminal justice system. Incarcerated people have a constitutional right to health care, yet only a half-dozen states have passed laws guaranteeing access to prenatal or postpartum medical care for people in custody, according to a review of reproductive health care legislation for incarcerated people by a research group at Johns Hopkins School of Medicine. And now abortion restrictions might be putting care further out of reach.

Collier’s arrest was “shocking and disturbing” because officers “blithely” took her to jail despite her miscarriage concerns, said Wanda Bertram, a spokesperson for the Prison Policy Initiative, a nonprofit organization that studies incarceration. Bertram reviewed the body cam footage and Collier’s complaint.

“Police arrest people who are in medical emergencies all the time,” she said. “And they do that regardless of the fact that the jail is often not equipped to care for those people in the way an emergency room might be.”

After a decline during the first year of the pandemic, the number of women in U.S. jails is once again rising, hitting nearly 93,000 in June 2022, a 33% increase over 2020, according to the Department of Justice. Tens of thousands of pregnant women enter U.S. jails each year, according to estimates by Carolyn Sufrin, an associate professor of gynecology and obstetrics at Johns Hopkins School of Medicine, who researches pregnancy care in jails and prisons.

The health care needs of incarcerated women have “always been an afterthought,” said Dana Sussman, deputy executive director at Pregnancy Justice, an organization that defends women who have been charged with crimes related to their pregnancy, such as substance use. For example, about half of states don’t provide free menstrual products in jails and prisons. “And then the needs of pregnant women are an afterthought beyond that,” Sussman said.

Researchers and advocates worry that confusion over recent abortion restrictions may further complicate the situation. A nurse cited Texas’ abortion laws as one reason Collier didn’t need care, according to her statement to the standards commission.

Texas law allows treatment of miscarriage and ectopic pregnancies, a life-threatening condition in which a fertilized egg implants outside the uterus. However, different interpretations of the law can create confusion.

A nurse told Collier that “hospitals no longer did dilation and curettage,” Collier told the commission. “Since I wasn’t hemorrhaging to the point of completely soaking my pants, there wasn’t anything that could be done for me,” she said.

Collier testified that she saw a nurse only once during her stay in jail, even after she repeatedly asked jail staffers for help. The nurse checked her temperature and blood pressure and told her to put in a formal request for Tylenol. Collier said she completed her miscarriage shortly after being released.

Collier’s case is a “canary in a coal mine” for what is happening in jails; abortion restrictions are “going to have a huge ripple effect on a system already unequipped to handle obstetric emergencies,” Sufrin said.

‘There Are No Consequences’

Jail and prison health policies vary widely around the country and often fall far short of the American College of Obstetricians and Gynecologists’ guidelines for reproductive health care for incarcerated people. ACOG and other groups recommend that incarcerated women have access to unscheduled or emergency obstetric visits on a 24-hour basis and that on-site health care providers should be better trained to recognize pregnancy problems.

In Alabama, where women have been jailed for substance use during pregnancy, the state offers pregnancy tests in jail. But it doesn’t guarantee a minimum standard of prenatal care, such as access to extra food and medical visits, according to Johns Hopkins’ review.

Policies for pregnant women at federal facilities also don’t align with national standards for nutrition, safe housing, and access to medical care, according to a 2021 report from the Government Accountability Office.

Even when laws exist to ensure that incarcerated pregnant women have access to care, the language is often vague, leaving discretion to jail personnel.

Since 2020, Tennessee law has required that jails and prisons provide pregnant women “regular prenatal and postpartum care, as necessary.” But last August a woman gave birth in a jail cell after seeking medical attention for more than an hour, according to the Montgomery County Sheriff’s Office.

Pregnancy complications can quickly escalate into life-threatening situations, requiring more timely and specialized care than jails can often provide, said Sufrin. And when jails fail to comply with laws on the books, little oversight or enforcement may exist.

In Louisiana, many jails didn’t consistently follow laws that aimed to improve access to reproductive health care, such as providing free menstrual items, according to a May 2023 report commissioned by state lawmakers. The report also said jails weren’t transparent about whether they followed other laws, such as prohibiting the use of solitary confinement for pregnant women.

Krishnaveni Gundu, as co-founder of the Texas Jail Project, which advocates for people held in county jails, has lobbied for more than a decade to strengthen state protections for pregnant incarcerated people.

In 2019, Texas became one of the few states to require that jails’ health policies include obstetrical and gynecological care. The law requires jails to promptly transport a pregnant person in labor to a hospital, and additional regulations mandate access to medical and mental health care for miscarriages and other pregnancy complications.

But Gundu said lack of oversight and meaningful enforcement mechanisms, along with “apathy” among jail employees, have undermined regulatory protections.

“All those reforms feel futile,” said Gundu, who helped Collier prepare for her testimony. “There are no consequences.”

Before her arrest, Collier had been to the hospital twice that month experiencing pregnancy complications, including a bladder infection, her medical records show. Yet the commission found that Walker County Jail didn’t violate minimum standards. The commission did not consider the police body cam footage or Collier’s personal medical records, which support her assertions of pregnancy complications, according to investigation documents obtained by KFF Health News via an open records request.

In making its determination, the commission relied mainly on the jail’s medical records, which note that Collier asked for medical attention for a miscarriage once, in the morning on the day she was released, and refused Tylenol.

“Your complaint of no medical care is unfounded,” the commission concluded, “and no further action will be taken.”

Collier’s miscarriage had ended before she entered the jail, argued Lt. Keith DeHart, jail lieutenant for the Walker County Sheriff’s Office. “I believe there was some misunderstanding,” he said.

Brandon Wood, executive director of the commission, wouldn’t comment on Collier’s case but defends the group’s investigation as thorough. Jails “have a duty to ensure that those records are accurate and truthful,” he said. And most Texas jails are complying with heightened standards, he said.

Bertram disagrees, saying the fact that care was denied to someone who was begging for it speaks volumes. “That should tell you something about what these standards are worth,” she said.

Last year, Chiree Harley spent six weeks in a Comal County, Texas, jail shortly after discovering she was pregnant and before she could get prenatal care, she said.

I was “thinking that I was going to be well taken care of,” said Harley, 37, who also struggled with substance use.

Jail officials put her in the infirmary, Harley said, but she saw only a jail doctor and never visited an OB-GYN, even though she had previous pregnancy complications including losing multiple pregnancies at around 21 weeks. This time she had no idea how far along she was.

She said that she started leaking amniotic fluid and having contractions on Nov. 1, but that jail officials waited nearly two days to take her to a hospital. Harley said officers forced her to sign papers releasing her from jail custody while she was having contractions in the hospital. Harley delivered at 23 weeks; the baby boy died less than a day later in her arms.

The whole experience was “very scary,” Harley said. “Afterwards we were all very, very devastated.”

Comal County declined to send Harley’s medical and other records in response to an open records request. Michael Shaunessy, a partner at McGinnis Lochridge who represents Comal County, said in a statement that, “at all times, the Comal County Jail provided Chiree Harley with all appropriate and necessary medical treatment for her and her unborn child.” He did not respond to questions about whether Harley was provided specialized obstetric care.

‘I Trusted Those People’

In states like Idaho, Mississippi, and Louisiana that installed near-total abortion bans after the Supreme Court eliminated the constitutional right to abortion in 2022, some patients might have to wait until no fetal cardiac activity is detected before they can get care, said Kari White, the executive and scientific director of Resound Research for Reproductive Health.

White co-authored a recent study that documented 50 cases in which pregnancy care deviated from the standard because of abortion restrictions even outside of jails and prisons. Health care providers who worry about running afoul of strict laws might tell patients to go home and wait until their situations worsen.

“Obviously, it’s much trickier for people who are in jail or in prison, because they are not going to necessarily be able to leave again,” she said.

Advocates argue that boosting oversight and standards is a start, but that states need to find other ways to manage pregnant women who get caught in the justice system.

For many pregnant people, even a short stay in jail can cause lasting trauma and interrupt crucial prenatal care.

Collier remembers being in “disbelief” when she was first arrested but said she was not “distraught.”

“I figured I would be taken care of, that nothing bad was gonna happen to me,” she said. As it became clear that she wouldn’t get care, she grew distressed.

After her miscarriage, Collier saw a mental health specialist and started medication to treat depression. She hasn’t returned to her studies, she said.

“I trusted those people,” Collier said about the jail staff. “The whole experience really messed my head up.”

___

(KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.

The pitch feels noble, visceral: Prevent newborns from being discarded in dumpsters, and do it in a way that shields the mother and protects her anonymity while safeguarding the baby’s health and future.

In a growing number of states, the answer to the rare occurrence of illegal infant abandonment is a baby drop-off box. It’s an infant incubator secured behind a small door in the exterior wall of a public facility such as a hospital or fire station. A person can walk up to the box, open the door, place an infant into the bassinet inside, close the door and walk away.

The bassinet is temperature controlled, ventilated and equipped with alarms that alert emergency responders, who arrive within minutes. The baby is placed into foster care or for adoption, and the parent is not prosecuted for abandonment.

Installing baby boxes has become increasingly popular as lawmakers, including those in states with the most restrictive abortion laws, look for ways to show support for pregnant women and new parents.

But a growing chorus of experts and adoption advocates argue that however well-intended, baby boxes are a gimmick, unsupported by scientific research, that won’t address the real problems facing parents and newborns. They also worry about the inability to establish informed consent or medical histories.

“I think what legislators hear is, ‘If you don’t do this, there will be dead babies abandoned on the streets of your city,’” said Gregory Luce, a Minnesota attorney and founder of the Adoptee Rights Law Center who has been a vocal opponent of baby boxes.

“They don’t want that to happen on their watch, whether they’re Republicans or Democrats, so they pass it without further investment in prenatal or postnatal services for women, or mental health services, or services for women in crisis.”

At least 19 states now allow the use of newborn drop-off boxes, though more than half the incubators that have been installed are in Indiana, the home state of the company that makes them. Lawmakers have introduced bills this legislative session in 15 more states: Colorado, Georgia, Idaho, Indiana, Maryland, Michigan, Minnesota, Nebraska, New Hampshire, New Jersey, New Mexico, South Carolina, Tennessee, Washington and Wyoming.

Baby boxes have proven surprisingly bipartisan, despite their ties to the conservative anti-abortion movement. And they’re media-friendly: The surrender of infants into the boxes regularly makes the local news, and cities often hold ribbon-cutting-style ceremonies when a box is installed.

“We know [baby boxes] work because we’ve seen it,” said Tennessee Republican state Rep. Ed Butler, the sponsor of a baby box bill in his state. “My objective is to save a baby’s life, end of discussion.”

But Lori Bruce, a bioethicist at Yale School of Medicine, described baby boxes as a poor solution to infant abandonment, “because we know things like prenatal care are more integral to the health of an infant, as well as to the birthing parent.”

She would like to see states consider allowing women to labor and deliver at hospitals anonymously — as Jane Does — so they can relinquish their newborns in a safer setting.

Babies in boxes

The overwhelming majority of the more than 200 active baby boxes currently in place in at least 15 states are provided by one company: a nonprofit called Safe Haven Baby Boxes Inc.

Monica Kelsey is the founder. An adoptee herself, she is closely aligned with the anti-abortion rights movement and travels around the country, speaking at news conferences when infants are surrendered, holding “blessing” ceremonies to dedicate new boxes, and spreading baby box awareness to more than 800,000 followers on her popular TikTok account.

“I do think women and men are scared when they get into a moment of crisis and they freak out, not knowing what to do,” she told Stateline. “We’re out there in the public every single day, educating and bringing awareness that they have options, so when they do have a crisis, they will come to us.”

The nonprofit says 42 babies have been surrendered to its baby boxes since the first one opened in Indiana in 2016. There’s no national database of infant abandonments — legal or illegal — and many states don’t track those numbers.

States began passing so-called safe haven laws more than two decades ago. Texas passed the first safe haven law in 1999, and soon every state had its own version. For some in the anti-abortion rights movement, safe haven laws — and by extension baby boxes — are an answer to critics who say restricting abortion rights will lead to more unwanted babies. U.S. Supreme Court Justices Amy Coney Barrett and Samuel Alito both cited safe haven laws during the landmark Dobbs v. Jackson case that ended the constitutional right to abortion.

Michelle Oberman, a law professor at Santa Clara University in California who has studied state safe haven policies, said states have different rules for drop-off locations and how old a surrendered infant can be, and varying protections for parents when an infant tests positive for illegal substances. Some laws require surrendered infants to be placed into foster care, while others fast-track them into adoptions. Few, if any, require the kind of oversight that would ensure the infant surrenders are truly voluntary and not coerced, she said.

“It feels to me like such a limited and heartless response to say, ‘We don’t care that you’re unhoused, addicted or mentally ill — just drop off your baby and we’ll let you go on your way,’” Oberman said. She wants states to gather better data on newborns who are surrendered, including where and under what circumstances, and use that data to write bills that would support parents in crisis.

Safe haven laws aren’t tailored for the communities most likely to use them, nor designed for people who don’t feel comfortable walking into a hospital, Bruce said. People with low incomes and communities of color are disproportionately affected by the kinds of crises — housing instability, domestic violence, lack of access to treatment for mental illness or substance use — that might influence a person to surrender their infant.

A 2019 study from the University of Southern California’s Keck School of Medicine and Children’s Hospital Los Angeles looked at infants who had been safely surrendered in Los Angeles County and found the majority were surrendered in lower-income communities. More than half of the infants had medical issues requiring monitoring or specialized care.

Using taxpayer dollars

Safe Haven Baby Boxes are typically paid for through private donations and nonprofit organizations, though local municipalities may be on the hook for continuing annual maintenance and fees.

Most state baby box laws simply allow the boxes, but some legislators are pushing their states to spend taxpayer money to fund them.

In Tennessee, lawmakers this year introduced a bill that would require a “newborn safety device” such as a baby box to be installed at a safe haven location in each of the state’s 95 counties. As currently amended, the bill would create a $2 million grant program to help each county pay for leasing and installation — about $21,000 per box.

“I support face-to-face handoff because that’s likely the best option,” said Butler, the Tennessee lawmaker who sponsored the bill. “But what I don’t want to happen is that because the mother is in a bad place, she’s leaving her baby in a dumpster or behind a shopping center somewhere.

“I believe Safe Haven Baby Boxes provide an anonymous, private moment for that mother to surrender that child with nobody asking why they’re doing it, with no shame,” he said.

Lawmakers in Nebraska sponsored a bill that would set aside $15,000 in grants to help safe haven locations install baby boxes, plus another $50,000 for the next fiscal year and $10,000 per year after that for a public awareness campaign about the state’s safe haven law.

Wyoming lawmakers filed a bill that would allocate $300,000 for a one-year grant program to help safe havens such as police and fire departments purchase and manage baby boxes.

And a bill in New Jersey sponsored by a Democrat would require all newly constructed police stations, fire stations and hospitals to provide a baby box.

Marley Greiner, a co-founder of the adoptee rights organization Bastard Nation who also runs a site dedicated to tracking and opposing baby box legislation, argues that baby boxes can create a parallel child welfare system that doesn’t allow for informed consent for the birth parents nor a full record of identifying information and social and medical histories for the newborn.

In contrast, Greiner said, when a parent surrenders an infant to a worker at a hospital or fire station, there is direct interaction with a professional who can ask for medical information about the infant and can assess whether the parent needs medical care or other supports.

A parallel system

With 115 baby boxes, Indiana accounts for more than half of the nation’s 205 baby boxes. The home base for Safe Haven Baby Boxes Inc., is Woodburn, Indiana, where Kelsey’s husband, Joseph Kelsey, the company’s chief operating officer, is the town mayor.

In 2022, Indiana legislators approved $1 million to help communities install and promote Safe Haven Baby Boxes.

In April 2023, they passed another law that, among other things, allows baby box operators to place surrendered babies directly with a private adoption agency, skipping state child protective services. Last August, officials at a fire station in Carmel, Indiana, placed a baby that had been surrendered in their baby box with an adoptive family within 12 hours. Officials said it cuts out a layer of bureaucracy and gets the baby to a family more quickly.

“This creates an avenue of off-the-record surrenders, a problematic issue that could obviously lead to corruption,” said Luce, the attorney with Adoptee Rights Law Center.

Even Kelsey is concerned about the intersection between private adoption agencies and her baby boxes. She cut ties recently with an Alabama nonprofit that had provided funding for the lease and installation of several baby boxes in that state, after learning the nonprofit also facilitates adoptions.

“Some of the adoption agencies might get ticked off at us, but we’re not here to supply babies for them,” Kelsey said. “We’re here to help moms.”

In New Mexico, lawmakers are scrambling to change the state’s safe haven law after learning officials there tried to find the parents of each of the four infants surrendered in New Mexico baby boxes, as directed by that law. State officials also noted that the Federal Indian Child Welfare Act requires the state to attempt to identify any infants with Indigenous heritage and return them to their tribes, a further challenge to baby boxes’ promise of anonymity.

Stateline is part of States Newsroom, a national nonprofit news organization focused on state policy.

©2024 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.