When Roe v. Wade was overturned in June 2022, many considered it to be a huge victory for the pro-life movement. Yet, recent data shows that abortions have continued to rise, suggesting that we still have a long way to go in making our country a place that is truly welcoming to new life and supportive of the mothers who bear it into the world

It’s no secret that the United States can be a difficult place to be pregnant and raise a child, especially for those with fewer resources. There are a myriad of hurdles that new parents face: a lack of federally mandated paid parental leave, exorbitant hospital bills that can be difficult to pay under our insurance system, the rising cost of already expensive childcare, and a startling maternal mortality rate, especially for Black women. These are all massive, crucial issues that must be addressed if we are to more fully welcoming to new life.

In this (very much non-exhaustive) list, I hope to highlight a few related, but lesser-known, policies and procedures that make it more difficult for women to welcome life and to bond with their new babies.

1. Women in prison are sometimes forced to give birth in chains, and are often separated from their babies after 24 hours.

The United States has the highest rate of incarceration of women in the world, and many women are subjected to sexual abuse while in prison. A 2014 federal investigation found that more than a third of the staff at the Julia Tutwiler Prison for Women in Alabama – the subject of a recent FRONTLINE documentary about pregnant inmates – had sex with inmates. According to the Pregnancy in Prison Statistics Project, about 58,000 pregnant women are admitted to jails or prisons each year, and thousands of those women give birth while still incarcerated.

The treatment of these women varies, depending on which prison they are in. Thirty-seven states have passed laws that forbid the shackling of women while in labor and delivery, and in 2018 the federal First Step Act included a provision that prohibited the use of restraints on pregnant women in custody of the Federal Bureau of Prisons and the U.S. Marshals Service. But the laws that do exist still make exceptions for “public safety,” and in practice, a 2018 survey of nurses who had cared for incarcerated pregnant women found that 82% of those nurses reported that their patients were shackled at least some of the time. The medical community widely opposes this practice because it interferes with the care they are able to provide birthing women.

Another crucial issue with the treatment of incarcerated pregnant women is how quickly they are separated from their babies. Most women only have 24 hours with their baby before being separated and sent back to prison, a practice that can cause severe emotional and behavioral problems in later life for children. Due to the 1997 Adoption and Safe Families Act (ASFA) that requires states to terminate parental rights to children who have been in foster care for 15 of the last 24 months, this separation sometimes becomes lifelong.

What can we do for incarcerated pregnant women?

There are a few innovative programs that are reaching out to incarcerated pregnant women to provide education and support. Examples include the Minnesota Doula Project and the Alabama Prison Birth Project, which provide doula support to pregnant inmates. Some prisons have started providing lactation rooms to promote breastfeeding, where women can go to pump milk that is sent to their babies. Some states provide prison-based nursery programs that house mothers and their newborns in special units, and Massachusetts allows mothers to keep their infants with them for up to 24 months in correctional residential programs in the community. Advocating for these programs to be more widespread – or being trained as a doula if you live in a state where these exist – would be a big step forward.

Because of the high percentage of women who are incarcerated on drug-related charges, finding ways to treat addiction is also crucial. According to the PIPS Project, there are an estimated 8,000 admissions of pregnant women with opioid use disorder into prisons and jails each year, but long-term treatment using medication is still uncommon.

As one mother in the Tutwiler documentary poignantly said, “A lot of us have been abused our entire lives. And we enter into relationships of abuse, and then DHR [Alabama Department of Human Resources] wants to step in and say we can’t have our children because they’re going to enter into relationships of abuse. Well, help us, you know? Don’t just throw us off into prison or take our children. Actually help us.”

2. Pregnant teens in foster care are often separated from their children because there is no one willing to care for them together.

Teens in foster care are twice as likely to become pregnant as their peers, and 11 times more likely to lose custody of their child within the first week of life. In order for them to stay together, they must find a foster home that agrees to take in both the mother and the baby, which is uncommon. If that does not happen, they are placed in separate foster homes. This separation, as previously noted, is detrimental to the baby’s development, and also creates additional trauma for the teen, who has likely already had a fair share.

What can we do for pregnant or parenting teens in foster care?

One big step would be becoming a foster parent who is willing to house pregnant teens, and both mother and baby after birth.

We can also donate to organizations that are working to support youth in foster care, and advocate for more programs that are specifically designed to serve pregnant and parenting youth in foster care. St. Anne’s in Los Angeles offers one such program, which aims to keep mothers and babies together while providing services to help mothers heal from trauma, transition to adulthood, and keep their children safe and healthy.

3. A mother cannot apply for child support until after a baby is born. 

Pro-choice advocates have fairly pointed out the hypocrisy of this, because if we are going to acknowledge that a baby is a person from the moment of conception, that means a father is a father from that moment, as well.

Pregnant women face many additional financial burdens, from the cost of prenatal care and nutrition to the hospital bills for giving birth, but right now there is no guarantee that the father of the child they are carrying will be legally required to assist with those costs.

What can we do about child support laws?

Advocate for Congress to pass the recently proposed bills that work to address this issue. These include the Providing for Life Act, which includes incentives for states to establish rules requiring the father to cover half of a woman’s pregnancy costs and strengthens child support enforcement. Similarly, Unborn Child Support Act would require states to apply child support obligations to the time period during pregnancy.

4. Closures of maternity wards in low-income areas are creating “maternity deserts.”

The New York Times recently reported on the trend of hospitals deciding to close their maternity wards when they run into financial stress. This is particularly the case in low-income communities, where there is no financial gain in providing those services since Medicaid does not pay hospitals as well as private insurers do.

While this happens in cities like Washington D.C., the trend that The New York Times was noticing is particular to rural and tribal communities. According to one study in Louisiana, women living in these “maternity desserts” are three times more likely to die during pregnancy or during the year after giving birth.

What can we do to alleviate “maternity deserts”?

We can support organizations that specifically reach out to the underserved populations who are most impacted by these closures, such as the Ttáwaxt Birth Justice Center on the Yakama Nation Reservation, which provides women with pre- and post-natal care that is based in Native culture. Another example includes Abide Women’s Health Services in Dallas, Texas, which works to combat the disparities in Black maternal and infant health. We can also hold Catholic hospitals accountable when they choose to close maternity wards in underserved communities.

5. Many pregnant college students do not know their rights under Title IX.

While Title IX guarantees women equal access to education, there is no guarantee that those rights are communicated to students or faculty.

Currently, the Department of Education only recommends – but does not require – that schools “make clear that prohibited sex discrimination covers discrimination against pregnant and parenting students.” As a result, many students still lack the resources needed to practically carry a pregnancy to term. Plus, once a child is born, the majority of residence halls do not allow children in them, which means that students can have a difficult time finding housing (and childcare) while they are in classes.

Catholic colleges are not immune to this issue. As FemCatholic reported in 2022, only 16 of the 29 Catholic colleges who responded to us (we reached out to 180) said that they were aware of at least one pregnant student on their campus in the past year. Of course, that does not mean that pregnancies are not occurring – only that the students who do become pregnant likely drop out before telling anyone, choose to end the pregnancy, or struggle through the journey of being a pregnant and parenting college student without accessing the resources available to them.

What can we do for pregnant and parenting college students?

There are some policies in the works – or which were recently passed – that have aimed to address this issue.

In Texas, two bills went into effect on September 1: Senate Bill 412 enshrined federal protections for pregnant women and parenting college students into Texas state law, and Senate Bill 459 offered priority class registration for parenting college students.

On a national level, proposed updates to Title IX passed by the Biden administration include a requirement that any employee of the school who learns of a student's pregnancy must provide them with information about how to contact the Title IX Coordinator, who must then provide the student with information about a voluntary leave of absence with reinstatement of academic status; a clean, private space for lactation; and other available resources to prevent discrimination. In addition, the previously mentioned Providing for Life Act includes the “Pregnant Students' Rights Act” which requires schools to ensure expecting moms are told about all of the resources available to them.

On a school by school basis, there are some programs out there that we can support and also advocate for expansion to other colleges.

One example at a secular university is the Baby Steps program at Auburn University, which provides housing, support, and community for pregnant and parenting students. The organization is currently raising money to start a program at the University of Alabama, as well. Two Catholic schools with similar longstanding programs are the College of St. Mary in Nebraska and MiraVia residence on the campus of Belmont Abbey College in North Carolina.

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The extensive list of difficulties facing women and families in our country can feel daunting, and I know I often have a hard time knowing where to start when I want to help. I hope that this list can provide a few ideas of concrete ways to advocate for greater justice and to donate our time or money to organizations that are committed to helping women welcome new life.

In a culture that claims to be sexually liberated, many women struggle to talk honestly about their sex lives. There is pressure to exaggerate positive sexual experiences, as well as embarrassment around sexual struggles. In Christian circles, talking about sex can often feel shameful, even for married women. While there is a wealth of information available regarding how to achieve or avoid pregnancy, accurate information about achieving a full and satisfying sex life is woefully difficult to find. This is why it’s so important to talk openly about sex with trusted friends. As uncomfortable as it might be at first, there is a wealth of wisdom available to us through other women.‍

“What lubricants are conception-safe?”
“Is it bad if I usually don’t have an orgasm?”
“What kind of foreplay is allowed by the Church?”
“What sex positions work with a curved penis?”

These were just a few of the questions that emerged from a cardboard shoe box covered in pink and purple glitter. The “Question Box” is by far the best thing I’ve ever done at a bachelorette party, surpassing even the mechanical bull on 6th Street in downtown Austin.

The decorated shoebox sat unobtrusively on the kitchen counter next to a stack of notecards. Throughout the day, anyone was welcome to discreetly drop an anonymous question about sex into the box. Later that night, while enjoying a bottle of sparkling wine, we read the questions out loud, one by one, and tried to answer them as a group.

Some of the questions were funny, some were medical in nature, and some were genuinely thought-provoking. There was something almost sacred about a group of women coming together to share wisdom in a safe and supportive environment. It made me wonder why we don’t do this more often.

So, if you’d like to have a candid conversation with your female friends about sex, here are a few key guidelines:

1. Respect Boundaries

There will always be aspects of intimate relationships that are kept between husband and wife. Honest conversations about sex aren’t gossip columns or Cosmo cover stories. They don’t need to be salacious or obscene.

Different women will naturally have different levels of comfort when it comes to sharing personal details about their sex lives. Especially in Christian circles, it’s likely that this will be the first time that some women have shared anything about their intimate relationships. Don’t let curiosity tempt you into pressing for further details aside from what is absolutely necessary. And – this is essential – absolutely anything said in confidence needs to be kept in confidence. Make yourself worthy of your friends’ trust.

It’s also important to keep in mind the other party in any sexual relationship. Men are entitled to privacy and respect, as is everyone. Conversations that devolve into personal criticisms or even mocking of husbands aren’t healthy, kind, or empowering. A fruitful conversation isn’t only geared toward female bonding, but also toward stronger marriages and improved intimate relationships.

2. Be Intentional

Talking about sex can be awkward, especially for women who have been told for most of their lives that doing so is inappropriate. When starting a conversation with your friends, it can be tempting to wait until a moment when it “feels natural,” and then attempt to talk spontaneously. But this runs the risk of catching people off guard, which can lead to embarrassment and shutting down.

What worked so well about the “Question Box” was that it allowed everyone to warm up to the idea of having a conversation about sex. We had time to think about the questions we wanted to ask, and then we created a safe and comfortable environment in which to ask them.

Let your friends know that you would like to start a conversation about sex, and pick a suitable time and place to do so. A girls’ night at someone’s house, for example, is probably more appropriate than a restaurant or bar. Come to the conversation with a few of your own thoughts and questions already prepared, and set the tone for a respectful and vulnerable conversation. If you show that you are open, your friends will be more comfortable to open up, as well.

3. Normalize, Normalize, Normalize

No matter what topics are brought up in a conversation about sex, the most important thing is for women to know that they are not alone.

Many women who were raised in purity culture find themselves surprised by the nitty-gritty reality of sex. Others who experienced exposure to pornography may be surprised to learn just how difficult it can be to experience sexual pleasure.

No matter what the situation, assuring your friends that what they are going through is, in fact, extremely common can go a long way toward lifting the burden.

3. Follow Up

Once the first conversation has taken place, talking about sex will be easier and more natural. Hopefully, you can get to a point with your friends where it is appropriate to bring up sex within a casual conversation.

If you know a friend is struggling with a particularly difficult sexual issue, it’s good to follow up. This may be as simple as, “Hey, how are things going with that issue we talked about?” or “Did you ever visit that pelvic floor physical therapist I recommended?”

A one-and-done conversation is rarely enough to counteract a lifetime of embarrassment or shameful feelings around sexuality. Little by little though, these barriers can fall away. By keeping the lines of communication open, you can create a lasting support system and let your friends know that you really care.

4. Have Fun

Conversations about sex are going to evoke giggles. They’re going to result in a few shocked silences and a little nervous laughter. Allow this to happen.

As long as no one is being laughed at, embrace whatever emotions come up. This doesn’t have to be a deathly serious experience. It can – and should – be fun. Talking about sex will bring you closer to your friends and root you more in your femininity. There is joy in discovering ourselves more deeply, with respect and candor.

So go ahead and pour yourself a cocktail, light a candle, and bring out the snacks. It’s time for a little girl talk.

St. Teresa of Calcutta may be one of the most recognizable saints in modern history. Known worldwide as Mother Teresa, her dedication to serving the poor and the marginalized gained her international recognition, while her kind smile and prayerful presence marked her early on as someone who was close to God. Her holiness was so well known that her cause for sainthood was opened only two years after her death in 1997, accelerating the regular 5 year waiting period. However, when her private writings were published in 2007, in the book Come Be My Light, Mother Teresa’s complex interior life was revealed. While it is impossible to know for sure what Mother Teresa suffered, her story brings to light questions about the relationship between faith and mental health.

How Can We Tell the Difference Between Spiritual and Psychological Suffering?

Underneath her countenance of radiant light, Mother Teresa suffered from a sense of spiritual separation from God, an experience that stayed with her for decades. Many see her experience as a purely spiritual one, described as what St. John of the Cross called the “dark night of the soul.” Others view her experience through a psychological lens, postulating that she might have suffered from depression.

According to Beth Hlabse, a counselor and program director for the Fiat Program on Faith and Mental Health at Notre Dame, “the dynamic is complex.” She explained, “It would be a false fragmentation, however, if we failed to recognize the spiritual and psychological present in both experiences. We’re an integral unity of body-soul; hence, the Lord is present with us in depression in a manner which for many is not unlike the ‘dark night,’ in that it’s hard to perceive His presence.”

In order to distinguish between the two, Hlabse puts the primacy on experience. “The question of distinction is often asked by those trying to discern whether their experience – or the experience of someone they care for – is one or the other.”

Where Does Mental Illness Come From?

In a passage from Matthew’s Gospel, Jesus tells His disciples, “For this reason I say to you, do not be worried about your life, as to what you will eat or what you will drink; nor for your body, as to what you will put on. Is life not more than food, and the body more than clothing?”

At first glance, it would seem that Jesus is commanding us to choose to not be anxious. However, for those with a mental illness, making that choice is not so simple. Hlabse explained that the emergence of mental illness, as with many other physical illnesses, begins with certain genetic predispositions.

In her words, “The predominant theory to explain the emergence of mental illness is that of epigenetics, meaning that all people have certain genetic vulnerabilities to disease and illness.” However, these vulnerabilities aren’t the end of the story. Hlabse said, “Whether or not these genes are expressed (versus remaining dormant) is a function of the amount of stress placed on our person – primarily our nervous system – through our environment and development. Hence, it’s not nature or nurture; it’s both.”

Perhaps the most prevalent of these stressors have to do with our relationships. Hlabse explained that relationship is one of our most basic needs, and what’s more, “we never mature out of these needs.” This need for relationship is not only psychological, but also spiritual. We were, at our most basic level, created for it. As Hlabse put it, “To be made in God’s image and likeness means to be created in the image of God, who is Love, who is perfect Relationship: Father, Son, and Holy Spirit.”

However, with the introduction of original sin, human relationship became fractured, meaning that this need of ours could no longer be met fully. Hlabse calls this fracturing our “original woundedness.” She said, “Today, we still long for communion, but we live in the reverberating effects of original sin, of our fractured relationships, and we continue to sin – to wound our relationships.”

This loss of connection also plays a part in the expression of mental illness. Hlabse said, “If we consider original woundedness and its reverberating effects – together with the theory of epigenetics – we behold the reality of why we still hurt, despite all our technological progress as people.”

Is Mental Illness My Fault?

The reality of both the beauty of the relationship we were made for and the hurt we experience when it’s broken is expressed acutely in the Psalms. Jesus Himself used the Psalms to express His profound suffering on the Cross, exclaiming the beginning of Psalm 22: “My God, my God, why have You forsaken me?” Even though He was sinless, Jesus felt a kind of separation from God, His Father, which He chose to express using the words of Scripture.

While describing the various factors that predispose someone to mental illness, Hlabse concluded that, like with any illness, “Perhaps, most simply, we can remember that mental illness is not the result of a personal or familial deficit.” Jesus said something similar in an encounter with a blind man. In the Gospel of John, it says, “As he passed by he saw a man blind from birth. His disciples asked him, ‘Rabbi, who sinned, this man or his parents, that he was born blind?’ Jesus answered, ‘Neither he nor his parents sinned; it is so that the works of God might be made visible through him.’” Jesus declared that bodily illness is not the result of someone’s moral weakness or a consequence for their sins, but rather an opportunity for God to show His glory.

Not only does Jesus proclaim that the man’s illness is not the result of a personal failing, but He further proclaims that the man is worthy of healing. John’s Gospel continues, “When [Jesus] had said this, he spat on the ground and made clay with the saliva, and smeared the clay on his eyes, and said to him, ‘Go wash in the Pool of Siloam’ (which means Sent). So he went and washed, and came back able to see.” Jesus offered the blind man a personal, intimate connection that — when accepted by the man — resulted in his physical healing.

This healing, in turn, helped restore the blind man’s relationship with God. After the man was thrown out of the temple for calling Jesus a prophet, Jesus sought him out and asked him, “‘Do you believe in the Son of Man?’ He answered and said, 'Who is he, sir, that I may believe in him?’ Jesus said to him, 'You have seen Him and the one speaking with you is He.’ [The man] said, ‘I do believe, Lord,’ and he worshiped him.” As the man’s physical health was restored, so too was the even deeper wound of his fractured relationship with God.

Does God Want to Heal Mental Illness?

Hlabse explained that Jesus offers the same healing to us, providing physical and spiritual avenues to restore those with mental illness.

The first of these avenues is written into our biology. Hlabse said, “Across the board, persons’ experience of illness – their capacity to experience interior freedom amidst chronic diagnoses – changes. This is reflected neurobiologically through neuroplasticity (the change of our neural architecture over time).” With the help of a counselor and good tools, a person with mental illness can start to alleviate symptoms and suffering through retraining the brain.

Hlabse also stressed the importance of relationships in this process. “Neuroscience helps us to understand that relationships are centrally important to the neuroplastic change that supports our living a meaningful life amidst symptoms. The ‘relationship’ with a therapist should bear fruit in helping us cultivate healthier relationships within our families and communities.” The support of family, friends, and other loved ones is critical for encouraging the brain to heal and the suffering individual to find peace.

Another place where those suffering with mental illness can find relationship and healing is in the Church. Hlabse said, “Our faith also upholds a vision of healing, which includes but is not limited to miraculous cure – the remission of symptoms. Our Catholic faith tradition understands healing as the restoration of the communion that was fractured with original sin, and from this communion, new fruit is born. There is not just recovery but transformation.”

For Hlabse, the Eucharist is a primary source for restoring relationship. She explained, “As I prepare to receive the Eucharist, I uplift my wounds and illness – and the wounds and illness of those I love – praying for the restoration of communion.” By embracing the sacraments and spending time with Jesus in prayer, our need for relationship can be fulfilled as God intended it to be from the beginning.

We Should Embrace Faith and Science When Healing from Mental Illness

How, then, can we understand Jesus’ command to “not be anxious” in light of the rest of Scripture and the reality of mental illness?

Hlabse responded to this question by remarking, “As people, we cannot prevent worry or anxiety or another form of mental illness. We are vulnerable to it – by nature of original sin and epigenetics – and we cannot become invulnerable. Our Lord is asking us to respond to our worry, our anxiety, our illness through a posture of trust.”

She went on to reiterate that this trust happens through embracing both faith and science. “Our Lord is inviting us still to utilize these resources, but at once to trust ultimately in Him. No technology nor scientific finding can eradicate fully our vulnerability to illness. . . .Our Lord reminds us that the ultimate horizon is communion with Him, Love itself.”

Hlabse concluded our interview by offering Psalm 139 as a source of support for anyone suffering from a mental illness, saying, “In the midst of mental illness, we can feel as though our illness is all of us, consuming our identity because of the way mental illness impacts our self perception – and that it is determinative of our future. Neither is true. The psalm reminds us of our ultimate identity as God’s beloved, created in, through, and for Love. It teaches us that ‘even the darkness is not dark for [God].’”

“Abortion”: The word that’s been on everyone’s minds (and social media threads) since last summer. This word has led to heated discussions around the dining room table. It has inspired protests and marches. It has turned brother against brother and sister against sister as we have fought over the place that abortion should have in today’s America. But at least we know what we’re fighting about – right?

As it turns out, maybe we don’t. In the medical community, the word “abortion” encompasses a wide variety of conditions, only some of which involve the willful termination of a pregnancy. This is in stark contrast to the way most people use the word, which leads to the question:

What actually is abortion?

Editor’s Note: Please read with discretion, as this article contains discussion and descriptions of pregnancy loss. 

How Doctors Define “Abortion”

As alluded to above, the answer seems to depend on the source. According to Wikipedia, abortion is simply “the termination of a pregnancy by removal or expulsion of an embryo or fetus.” In the legal source Wex Law (powered by Cornell University), however, abortion is defined as “the voluntary termination of a pregnancy.”

In medicine, the picture is even more complex. Abortion can be separated into two broad categories: induced and spontaneous.

Induced abortions are elective, making them the primary subject of current abortion discourse. When the word “abortion” comes up in conversation, this is what usually comes to mind. Some terms falling under the umbrella of induced abortion include elective abortion, termination of pregnancy, pregnancy interruption, and therapeutic abortion.

The spontaneous abortion category covers all other situations in which a pregnancy loss has occurred, might occur, or is in progress. Anything under this category is usually called a “miscarriage” in layman’s terms.

When a pregnancy loss has occurred, it is called a “missed abortion” in medical literature. This is the phrase that is usually recorded in a patient’s medical history following diagnosis.  According to the Merck Manual – a widely used resource for medical professionals – a missed abortion is the “death of an embryo or a fetus that is not expelled and that causes no bleeding or cervical dilation.” It often exhibits little or no symptoms. A woman might have gone in for an appointment one week and the baby had a steady heartbeat; but the next week, a heartbeat can’t be detected. Per standard medical protocols, a doctor would record this event as a “missed abortion.”

If a spontaneous abortion (miscarriage) might occur, but the pregnancy is still currently progressing, the medical term used is a “threatened abortion.” Per Medline Plus – an online resource for patients run by the National Library of Medicine (NLM) – the initial sign of a threatened abortion is often cramping, and may or may not be accompanied by abdominal bleeding. In these cases, the pregnancy is somewhat in danger, but may still go to term. Someone experiencing this during her pregnancy might be considered “on watch,” but no medical intervention would be necessary just yet.

Once intervention is needed, the medical term used is an “incomplete abortion.” In this situation, a miscarriage is actively underway, but has not yet been completed. The woman would likely experience cramping and moderate to heavy bleeding, and she might be in need of immediate medical care. According to the NLM, “saturating more than one pad an hour suggests heavy bleeding and requires emergent attention.” 

Medical Interventions for “Missed” or “Incomplete” Abortions

For a missed abortion or an incomplete abortion, medical intervention might be necessary. The available tools to care for women experiencing these losses include both medical and surgical approaches. From a medical perspective, a patient might choose to take the drug Misoprostol (which induces cramping) to help to remove any remaining uterine contents, with or without the assistance of the drug Mifepristone. A patient might also undergo a surgical procedure such as a Dilation and Curettage (D&C), during which the patient goes under general anesthesia and the doctor removes the remaining uterine contents.

These care practices are essential for the physical health of the mother if the miscarriage is not completed naturally, as they help prevent infection and sepsis. However, they are also contributors to the patient’s emotional health, as the physical process of resolving the pregnancy helps give closure to grieving parents.

Critically, these procedures are the same ones used during elective abortions.

Precise Definitions of “Abortion” Are Even More Important When the Same Medical Interventions Are Used

The commonality of these medical protocols across varying clinical contexts – combined with the disconnect between the medical, legal, and general understandings of “abortion” – leads to several potential consequences for both patients and physicians.

Clinical trials of medical management for miscarriages indicate that Mifepristone and Misoprostol are more effective than Misoprostol alone. However, despite studies demonstrating its benefit outside of an elective abortion context, because of Mifepristone’s association with (and FDA approval for) elective abortion, procuring the medication for any other medical purpose is difficult. Additionally, the current precarity of Mifepristone’s FDA approval status, as well as state-by-state legislation differences, might further challenge access to the medication. Walgreens’ recent decision to not distribute the drug in certain states is a prime example. As the legal battle over elective abortion continues, the way states distinguish (or don’t) the use of Mifepristone in different medical contexts could have a broad-reaching impact for women who have suffered miscarriages. This has the potential to greatly increase a patient’s potential health risks and emotional distress. 

Confusion over terminology among medical professionals and laymen might also impact patients after their pregnancy losses. When a physician sees a patient, they indicate the patient’s diagnosis and treatment using internationally standardized codes called “ICD 10 codes.” These codes might appear on a patient's bill; because “abortion” in medical language encompasses both elective and spontaneous events, the word “abortion” will appear on that bill. For someone who is already experiencing grief after loss, seeing their experience connected with such a charged word may only add to their suffering. If physicians clarify the distinction between “abortion” terms with their patients, this might help bring them peace.

Without a Precise Definition of “Abortion,” Providing Good Medical Care Gets Complicated

Physicians might also find themselves in the crosshairs when the medical, legal, and general worlds collide over the topic of abortion. A woman might be suffering an incomplete miscarriage. She has an open cervix, is bleeding heavily, and is in need of immediate medical care. However, an ultrasound detects the fetus’s heartbeat. The baby is still alive for the moment, but will in all probability not survive. This situation is sometimes referred to as an “inevitable abortion.”

In this scenario, because the woman’s life is in critical, immediate danger, the physician has to make a decision about what to do. A D & C may be performed, saving the life of the mother but, unfortunately, leading to the loss of the child. The doctor’s action in this example is not an elective abortion (and is morally acceptable in the eyes of the Catholic Church). However, because of the case’s similarity to an elective abortion, a physician might still land in complicated legal ground as a result.

Affirmative defense – a law requiring physicians to prove in court that they had to perform an abortion to save a woman’s life – is in effect in Tennessee. This means that a physician would potentially need to defend their actions during the clinical example given above in a court of law. Because of the muddiness that can exist in this kind of scenario, it might be difficult for physicians to make that defense clear. Doctors who treat inevitable abortions in states where elective abortion is illegal may fall under similar legal fire.

Nuance, Clarity, and Precision Are Essential When We Talk about “Abortion”

The United States is still responding to the overturn of Roe v. Wade. Discussions are still being had. Votes are still being cast. Laws are still being written. Amid this ongoing process, nuance, clarity, and precision have important roles to play.

Remembering the many definitions of the word “abortion” is critical to moving forward. With so many implications, moral undertones, and implicit emotional reactions associated with the term, forgetting important distinctions can lead to equivocating what are actually different experiences. By going back to these precise terms, perhaps we can re-enter the abortion discourse in an intelligent, educated, and more compassionate way.

Abortion is a difficult topic. There are so many hearts, minds, and souls tangled up in it because the related legal decisions affect medical care for all women, beyond those seeking elective abortions. Starting a dialogue about these decisions and what their consequences could be is challenging, and making them better won’t happen overnight. But, maybe understanding what we mean (and don’t) when we talk about abortion is a good place to start.

The “abortion pill” has come under fire over the past year, in both the courts and the media. The two sides of the proverbial aisle paint this drug with contradictory characters, either championing it as perfectly safe or condemning it as practically deadly. In the middle of this competing rhetoric, we’re losing key information about what the “abortion pill” is, leading to situations where women are critically underserved or, at times, even in danger. But if we look past the rhetoric to understand the nuance surrounding this medication, we can paint a more accurate picture of the “abortion pill” and provide better care for women.

What Is the “Abortion Pill”?

Despite the name, the “abortion pill” is normally not a single medication; it is typically administered as a set of two medications, taken in series. The first pill is mifepristone and the second is misoprostol.

Mifepristone acts as a progesterone receptor antagonist, meaning that it blocks the effects of progesterone, a critical hormone for maintaining pregnancy. Mifepristone also induces other effects, including increased uterine contractions and death in decidual tissues, which make up part of the placenta.

Misoprostol, which is taken after mifepristone, further induces contractions to remove uterine contents. Misoprostol may also be taken as a single medication, though this is less common.

Discussions around abortion and “abortion pill” regulation typically center on mifepristone because the FDA approved it specifically as an abortifacient in 2000. In contrast, misoprostol was originally approved in 1988 for prevention of gastric ulcers. Because of this, misoprostol does not have the same legal requirements for regulation, although patients may receive questions at the pharmacy about reasons for use.

Due to the legal complexity surrounding it, mifepristone will be the focus of this article.

Mifepristone’s Political Status Limits its Accessibility for Women Suffering Miscarriage

Just as the phrase “abortion pill” inaccurately describes the two-medication regimen, it also does not fully encompass mifepristone’s clinical uses.

While the mifepristone/misoprostol drug combination has only been approved by the FDA for medication abortions, the two drugs are also used in other medical contexts. “Off label” use of FDA-approved medications is permitted by the FDA, and a number of drugs are commonly prescribed off label.

Of particular note is the use of mifepristone after a miscarriage. Using mifepristone as part of post-miscarriage care has been demonstrated to be more effective than misoprostol alone. And, because approximately 10-15% of pregnancies result in a clinically recognized miscarriage, mifepristone is potentially applicable to a large number of clinical situations. However, due to its FDA approval status as an abortifacient, the drug has regulation and access barriers that limit why physicians are able to dispense it. As a result, women who have experienced miscarriage often have difficulty accessing this medication.

Because mifepristone has been approved for elective abortions, it is possible that changes in legislation that limit access to the drug may also limit access for other medical needs.

Alabama and Arizona are among the first states to call for a nearly complete ban on access to mifepristone in the past year. Additionally, a lawsuit was filed in Texas against the FDA, calling for the overturn of their decision to approve mifepristone. This lawsuit was filed in November by the Alliance for Hippocratic Medicine (AHM), an organization composed of several largely Christian medical associations, including the Catholic Medical Association. The group claimed in their motion that the 2000 accelerated approval of the drug was unlawful and put women at serious medical risk. In April of this year, the judge ruled to hold mifepristone’s status of FDA approval, introducing the possibility of removing mifepristone access in the United States because of its abortifacient classification. Notably, the drug’s use in miscarriage management was not mentioned in the judge’s official Memorandum.

In response to this decision, the Supreme Court has ruled to temporarily protect mifepristone access while the appeals process plays out. It seems likely that this case will return to the Supreme Court later this year, where a final verdict will be made. The outcome of these legal battles will play a critical role in establishing physicians’ avenues of care for patients of all kinds, and wholesale restriction on these medications may leave physicians and pharmacies treating early pregnancy loss with few options.

Because of this possibility, the American College of Obstetricians and Gynecologists (ACOG) – along with 48 other organizations including the American Medical Association (AMA) – submitted a Citizen Petition to the FDA in October, calling for approval of mifepristone for miscarriage management. The outcome of this petition, and the impact of state-by-state legislation on access to these drugs, remains to be seen. The ACOG and AMA have also provided amicus briefs on behalf of the FDA in the current court case. In the event that FDA approval of mifepristone is reversed, there are limited circumstances under which physicians may still prescribe it. How these circumstances would apply to mifepristone, particularly in cases of pregnancy loss, is a matter for future discussion.

Changes in Mifepristone Access May Lead to Unregulated Administration, Putting Women at Risk

While mifepristone is currently approved by the FDA, like many drugs, there can be risks involved in using it, as well as circumstances under which it would be ill advised or dangerous to do so.

Because of this, the FDA requires that physicians fulfill certain certification requirements before being able to prescribe it (in the mifepristone/misoprostol combination form) so they know what to look out for as potential risk factors for their patients. As part of that certification, prescribers are required to read Prescribing Information on Mifeprex, which provides directions for administration, information on drug interactions, and risk factors (discussed below). Physicians are also required to submit a Prescriber Agreement Form to obtain certification, acknowledging that they understand the risks of the medication and have the ability to assess those risks and provide medical intervention if necessary. When physicians prescribe mifepristone with misoprostol to a patient, they must go over a Patient Agreement Form to ensure that the patient also knows what the risks are.

In the wake of post-Roe legal changes to drug access, there is some concern that women will seek these medications without physician oversight, either for elective abortion purposes or for other medical reasons. Without a physician/patient interface, drug administration without assessing risk factors and without appropriate knowledge of potential complications is a real possibility. A recent review by physicians at MedStar Washington Hospital Center and Georgetown University outlines these risks and complications, particularly for physicians in emergency departments who may be treating women who have self-administered the medications.

One of the primary concerns is diagnosing ectopic pregnancy, a life-threatening condition that requires early detection and intervention. Women using IUDs are at particular risk for ectopic pregnancy. Other risk factors include a history of bleeding disorders or use of anticoagulants/antiplatelet drugs, as this may result in serious or life-threatening bleeding with drug administration. Mifepristone/misoprostol use also comes with its own risks, particularly the possibility of infection if uterine clearing is incomplete. Lack of follow-up with a physician may preclude infection treatment, leaving women at risk for sepsis. There are also some risks associated with overdose of these medications, but overdose data are currently limited.  

Furthermore, acquiring these medications from a non-healthcare source introduces the possibility of taking counterfeit, mislabeled, or contaminated medication. The FDA strongly cautions against purchase of mifepristone over the Internet because “drugs purchased from foreign Internet sources are not the FDA-approved versions of the drugs, and they are not subject to FDA-regulated manufacturing controls or FDA inspection of manufacturing facilities.” The safety and efficacy of any off-market drugs cannot be guaranteed, and the source of a drug should be considered carefully before use.

Mifepristone is Currently Underexplored in Other Medical Contexts, Limiting Women’s Treatment Options

FDA regulations on mifepristone also limit its potential for use in other diseases. In addition to mifepristone’s established uses in elective abortion and management of early pregnancy loss, it has also been FDA approved for treatment of Cushing’s disease, and has been researched for treatment of a number of gynecologic uses, including breast and ovarian cancers and endometriosis. However, it has not been widely used in treatment of these diseases, in part due to current access restrictions. 

Mifepristone has also been studied for potential application in non-gynecological diseases such as insulin resistance, glaucoma, and various psychiatric diseases. Because the dosages studied for these diseases are lower than what is currently available to clinicians, it cannot be prescribed off label for these conditions. As a result, clinical research studies for these applications are only preliminary. Important considerations for further scientific study and clinical use include the potentially contraceptive impact of mifepristone on the woman’s reproductive cycle at lower dosages, as well as the effects of long term exposure to the medication. Both of these considerations require more extensive study and serious thought when mifepristone is explored as a medical intervention.

Women’s Experiences of Pain Have Been Overlooked in Conversations About Mifepristone

While FDA documentation describes the medical risks involved in taking mifepristone, the experience of taking the medication – including pain and pain management – appears to be largely absent.

The “Prescribing Information” notes the possibility of serious pain, but does so primarily as an indicator of infection or ectopic pregnancy, rather than a symptom on its own. The document also states that “abdominal pain/cramping is expected in all medical abortion patients and its incidence is not reported in clinical studies.”

Indeed, the Medical Review document submitted as part of the 2016 FDA approval of the current medication abortion regimen reports on page 69 that only two of the clinical studies submitted in support of approval reported on the pain experiences of participants. The Medical Review also states that abdominal pain “should only be considered adverse events if the amount of … pain exceeds what would be expected for such a process.” While guidelines of what qualifies as excessive pain would be critical information for physicians and patients, there is no indication in this document that any such delineation was probed in clinical studies – and the statement was not elaborated. The Prescriber and Patient Agreement Forms also offer no such guidelines, nor do they offer recommendations for patient pain management. 

The lack of standard guidelines on pain management leads to inconsistent practices for patient counseling and treatment. As a result, some women find a disconnect between the information they receive at the clinic about taking the drug and what they actually experience. In a recent survey conducted by FemCatholic, women recounted their experiences with the mifepristone/misoprostol combination medication. Of the women who responded, severe pain and trauma around the event were commonly reported. One woman was told by her doctor that “it would be uncomfortable, but if [she] took it before bed, [she] should be able to sleep through it.” Instead, she experienced hours of what she described as “the worst pain [she’d] ever felt.”

The respondent went on to call for increased dialogue about women’s pain experiences and pain management when taking these medications. She said, “[t]o not acknowledge the range of pain possible from woman to woman is an injustice … It’s as if because not all women have reactions of the same severity, the easier way is just to ignore that it happens at all. It’s also quite possible that the amount of women who do have a severe reaction is higher, but many just do so silently, assuming this is how it’s ‘supposed’ to be. We’ll never know unless we talk about it more.”

So, What’s the Real Story of the “Abortion Pill”?

The “abortion pill” is, in fact, a two-drug combination wherein one drug (misoprostol) is FDA approved for a non-abortion purpose, while the other (mifepristone) is FDA approved for medication abortion. Mifepristone can be used for medication abortion, but is also used to treat other medical conditions. Crucially, its potential to treat other medical issues has by and large gone unexplored due to its association with abortion. Mifepristone’s regulation and access change frequently, impacting patients of all kinds. Taking it comes with serious risks and, when it comes to the women who take it, more can be done to provide adequate counsel and care. 

In short: Like most things, the real story is a lot more complicated than what the surface seems to be.

December 23, 2022 marked a critical day for the emergency contraceptive levonorgestrel, more commonly known as Plan B. Since it was brought to the market, Plan B’s mechanism of action (MOA) has been the subject of much debate. The manufacturers of Plan B have long claimed that its primary MOA is delaying ovulation, thereby preventing pregnancy by ensuring that sperm and egg cannot come into contact. However, at the time of FDA approval in 1999, additional mechanisms for preventing pregnancy could not be ruled out – including those that would lead to an abortion. As a result, the possibility of an abortive mechanism has been indicated on Plan B’s drug label, making it a subject of controversy in the pro life community. However, after reviewing an application by Foundation Consumer Healthcare (the makers of Plan B), the FDA approved a change to the drug’s labeling material, removing abortion as a potential MOA for the first time since the drug’s initial approval.

Please read with discretion: This article contains discussion of sexual assault and abortion.

Could Changes to Plan B’s Drug Label Impact Catholic Healthcare for Victims of Sexual Assault?

According to the Decisional Memorandum, “Data are strong for a mechanism of action of delay or prevention of ovulation, and data are weak to speculative regarding any postovulatory mechanistic effects, such as on fertilization or implantation.” The Memorandum also contains a summary of the research submitted to the review team and of the team’s interpretation of that research. The FDA updated the Plan B information page on their website to state, in no uncertain terms, that in their professional opinion, Plan B is not an abortifacient.

For the majority of Catholics, the change in Plan B’s drug label does not have a particular impact. Because Plan B and generic forms of levonorgestrel are contraceptive, it is not permissible for Catholics to use within the context of consensual sexual encounters. As stated in the USCCB Ethical and Religious Directives for Catholic Health Care Services, “Just as the marriage act is joined naturally to procreation, so procreation is joined naturally to the marriage act.” 

However, when it comes to contraception use there is one critical exception: instances of sexual assault.

Directive 36 of the same USCCB document states, “Compassionate and understanding care should be given to a person who is the victim of sexual assault. . . . A female who has been raped should be able to defend herself against a potential conception from the sexual assault.” Because sexual assault is not a consensual, unifying act, emergency contraception (EC) is permissible.

The USCCB document goes on to clarify that “if, after appropriate testing, there is no evidence that conception has occurred already, she may be treated with medications that would prevent ovulation, sperm capacitation, or fertilization. It is not permissible, however, to initiate or to recommend treatments that have as their purpose or direct effect the removal, destruction, or interference with the implantation of a fertilized ovum.” In other words, a method that prevents conception – but does not cause an abortion – may be used to treat a victim of assault.

Because the MOA of Plan B included the possibility of abortive action, its applicability for treating victims of assault according to the USCCB directive has, to date, been unclear. As a result, Catholic healthcare settings have differed in their policies regarding its use.

A 2005 nationwide survey of Catholic hospitals revealed that, of the 597 hospitals surveyed, 23% said that they would provide EC only to assault victims and 55% said that they would not provide EC under any circumstance. In order to mitigate the possibility of the drug having an abortive effect, other Catholic hospitals implement the “appropriate testing” prerogative in the USCCB directive by developing protocols to test for pregnancy or ovulation prior to dispensing Plan B. These protocols are not universally applied, however, as individual hospitals decide which protocols to use and how.

The FDA’s assessment of Plan B’s MOA has the potential to provide needed clarity in understanding the drug’s applicability to caring for victims of assault. If this new assessment is accepted by Catholic physicians, this would open the door to creating a standard of care for such cases within Catholic healthcare.

However, this outcome appears, at present, unlikely.

Many Catholic Physicians Remain Uncertain About the MOA of Plan B

As new studies exploring Plan B’s MOA have been published, the predominant interpretation among the authors has been that Plan B is not an abortifacient.

Studies of Plan B’s efficacy in preventing ovulation (its proposed primary mechanism), as well as studies of endometrial lining and hormonal changes following Plan B administration, led those scientists to the conclusion that Plan B acts by inhibiting or preventing ovulation, but would not affect a baby’s implantation in the uterus if conception did occur. In assessing the scientific literature, the FDA came to the same conclusion.

However, several Catholic physicians have voiced concerns over these studies, highlighting the studies’ limitations and offering alternative interpretations. One 2017 analysis of the scientific literature, published in the journal for the Catholic Medical Association (CMA), asserts that Plan B may not be as effective at preventing ovulation as it is marketed to be, and that it may indeed cause changes that would impact a pregnancy post-fertilization (i.e. that there is a possibility of having an abortive effect). A 2014 publication written by Dr. Kathleen Raviele, an OB/GYN and former president of CMA, emphasized that Plan B’s effectiveness at delaying ovulation is greatly diminished in the 1 to 2 days immediately prior to ovulation – calling to question whether the pregnancy prevention rate of 7 out of 8 women (as stated on the Plan B website) can be fully accounted for by ovulation delay.

Because of these lingering questions, the CMA issued a statement in 2015 that, as an association, it does not recommend Plan B for use as EC in cases of rape. The FDA’s decision to change Plan B’s drug label has not changed that opinion.

In an interview with Dr. Raviele, she explained that “[t]he FDA did not make that decision based on any new research” that fully addressed the CMA’s concerns. The National Catholic Bioethics Center (NCBC) released a statement in February of this year, echoing Dr. Raviele’s words. The NCBC said that “the FDA did not address all factors relevant to how LNG-EC can impact human life after fertilization” and that the organization would “maintain its longstanding position that Catholic health care institutions and professionals should ensure with moral certitude (that is, by excluding any reasonable doubts), at a minimum, that LNG-EC [Plan B] is not dispensed when it could not prevent ovulation but may well cause the death of an embryo.”

Notably, Catholic physicians may not be completely united in the CMA’s assessment of Plan B’s MOA.

Regarding the 2015 CMA statement, Dr. Raviele stated, “I can guarantee that many members may not agree with it . . . but the CMA has always been faithful to the Magisterium and this statement is in keeping with our mission.”

A 2022 publication in the CMA journal also argued that Catholic hospitals’ differing policies towards Plan B administration demonstrate that “reasonable disagreement exists among thoughtful Catholics on this issue.” In a follow up interview on this article, author Dr. Brummett elaborated on this thought, saying, “Whether there is ‘sufficient’ scientific evidence to ‘establish’ that [Plan B] has no abortive MOA depends upon what one believes to be at stake ethically speaking. For example, if you have heartburn, and I offer you a home remedy that I have seen work in a few friends, you might be open to trying it on the basis of that anecdotal evidence. However, if one believes that abortion is the murder of an innocent human life and therefore absolutely evil, then one's standard for ‘scientific proof’ might be very difficult, or even impossible, to meet. One might always demand another study, on another population, under another set of conditions in order to be satisfied.” Because further clinical studies would also be considered unethical to Catholics, differences in opinion in Catholic healthcare over Plan B’s MOA may never be fully settled.

While Plan B May Not be Universally Adopted in Catholic Healthcare, Other Avenues of Care are Available

While Plan B may not be able to be universally adopted in Catholic healthcare settings, it is still possible for Catholic physicians to provide compassionate care for victims of assault.

In the CMA 2022 article, Dr. Brummett and his colleagues argue that individual physicians should be allowed to follow their own conscience, calling for “Catholic leadership at hospitals that prohibit emergency contraception for rape victims to accommodate physicians who wish to provide levonorgestrel as a matter of conscience.” Permitting physicians within a Catholic hospital setting to draw their own conclusions from the scientific literature and to make care decisions accordingly has the potential to help resolve the conflict.

However, Dr. Raviele explained that one caveat to this approach is ensuring that physicians are able to balance their interpretation of scientific literature with ethical decision making. As she puts it, “The most important thing is that the physician’s conscience is well formed, and in many cases a physician’s conscience is not well formed.” As an alternative for physicians in Catholic hospitals that do not dispense Plan B, Dr. Raviele also suggested conducting a conscientious referral to a pharmacy, where Plan B is available over-the-counter.

Dr. Raviele’s 2014 article also highlighted another potential treatment option for victims of assault, which may have a higher certainty of preventing conception without causing abortion if taken before ovulation. Meloxicam, a non-steroidal anti-inflammatory drugs (NSAID), is a partially selective COX-2 inhibitor and an effective anovulant, preventing ovulation in 91% of women according to a 2010 study. A 2022 study also demonstrated no significant difference in endometrial line striping, indicating that implantation may not be significantly affected. Scientific exploration of meloxicam as an EC method remains preliminary. Nevertheless, it may be worth exploring as an alternative.

For Catholic Doctors, Providing Compassionate Care to Victims of Assault is a “Landmine of Conscience”

For Catholic doctors, providing compassionate, conscientious care to victims of sexual assault often calls for making difficult decisions between opposing goods. It involves looking carefully at the science of the treatments available, and balancing the interpretation of that data with moral imperatives.

It is, in Dr. Raviele’s words, a “landmine of conscience.” But, no matter the challenges, it is a landmine worth walking into.

Catholic publisher Ascension Press has announced a new 12-week paid maternity leave policy. Senior staff at Ascension credit FemCatholic’s reporting on the issue last year as an inspiration and guidance in creating these policies.

The new policies, which took effect March 1, 2023, include 12 weeks of paid leave for new mothers, 6 weeks of paid leave for fathers, and 6 weeks of paid leave for adoptive parents.

Employees must have worked 12 consecutive months at the company to be eligible for these policies. If they have worked at Ascension Press for less than a year, the employee is pro-rated the number of weeks of maternity leave in accordance with how much they have worked (e.g., 3 paid weeks for 3 months of work, 6 weeks for 6 months, etc.).

Advocating for a Change in Maternity Leave Policies

The United States is the only developed nation without guaranteed paid maternity leave. The Family Medical Leave Act mandates 12 weeks of unpaid leave for workers, yet approximately one in four new mothers go back to work 2 weeks after giving birth, according to a 2012 report.

Ascension Press leaders cited the FemCatholic reports of 2022 as a strong incentive to update their policies. “At least three people brought in FemCatholic’s reporting as advocating for a change,” said Cassie Schmidt, Manager of People & Culture (human resources).

Schmidt was one of the first employees to use the adoption leave this past May, when she adopted two children already in her home through foster care.

In November 2021, human resources surveys made it clear that employees felt a need for a new maternity and paternity leave policy, Schmidt said. Ascension Press’ staff is 72% female and nearly two-thirds of the company’s employees are working parents.

Ascension Press saw family leave as an important issue for employee satisfaction, but realized their leave policies could better reflect their company commitment to pro-life and Catholic values, Schmidt said.

In particular, FemCatholic’s reporting on deficiencies in short-term disability schemes to cover maternity leave helped Ascension’s leadership understand why their current short-term disability insurance plan was not enough for mothers, Schmidt said.

“They were definitely moving in the direction [of 12 paid weeks] and FemCatholic’s reporting dropped at convenient cadence to help push them forward,” said Lauren Joyce, Communications Manager, who was one of the Ascension employees who brought forward FemCatholic’s report in support of policy changes.

Previously, Ascension Press’ policy had been one week of paid leave for new mothers and fathers, and mothers who gave birth vaginally or via cesarean section could apply for short-term disability leave that would cover 60% pay for up to six weeks. Adoptive parents and families who had suffered a miscarriage or stillborn child did not have any paid leave. Mothers now receive up to 12 weeks of paid leave after a pregnancy loss, and their spouses receive 6 paid weeks.

Paid Leave Supports Family Bonding and Health

In the past decade, Ascension Press has nearly doubled its staff. It is now a fully remote company of 92 full- and part-time employees living in 32 states, and brings in a yearly revenue of more than $20 million. Jonathan Strate, president and chief executive officer says that their decision to offer these policies is not based on the policies’ price tag.

“The cost is definitely a consideration,” Strate said in a phone interview. But he noted that Ascension Press’ turnover rate hovers around 5%, which is extremely low. Strate said policies that show employees they are valued as persons and that prioritize their families save company costs by reducing turnover. “It actually might be more expensive to not have these programs,” he added.

Strate is a father of six, and he noted that unpaid leave is impractical for families trying to save up for the necessary items for the new baby, especially young families. His experience as a dad inspired the 6-week paternity leave.

“Usually as a father, paternity leave is not very long, maybe about a week,” he said. Often, parents feel the urge to get back to work, especially if one spouse is on unpaid leave. “But, when you do that, you miss out on the baby-bonding time, and that’s only going to happen once,” Strate added.

Besides parental bonding, family leave is a health issue. Strate said he was struck by the stat that 47% of infant deaths (deaths for children under five years old) happen in the first 28 days of life.

“If a mother and father are home with the baby during that time, they’re more likely to catch the signs that something might be off,” Strate said.

“Besides the physical healing, in the ‘fourth trimester,’ you’re working through bonding with the baby, relationship changes, sleep deprivation, and maybe other issues: emotional changes, pelvic floor issues,” said Dr. Suzanne Bovone, MD, an OB/GYN practicing at Stanford Health, in a phone interview. She noted that patients who experience a lot of prenatal care often find themselves piecing together medical help on their own during the 12 weeks after the baby is born, a period which is increasingly becoming known as the “fourth trimester.”

“I wish we had dedicated services provided in that postpartum period to mental health, lactation, pelvic floor, sexual function, but it’s all segregated,” she said. “Patients have to go find it for themselves, and that takes time – and patients’ insurance might not cover it,” she added.

“If everyone was guaranteed 12 weeks’ full salary, that would be phenomenal. Six months would be great,” she said.

The American Academy of Pediatrics recommends at least 12 weeks of paid leave for the health of the mother and to reduce infant mortality. The World Health Organization's recommendation is, at the very least, 14 weeks of paid maternity leave.

“The more you dig into these stats, the more you see this is an important time that can’t be made up later,” Strate said. Of Ascension Press’ recent policy change, he said: “It’s a very pro-life policy, and we think it sends the right message.”

My hopes for the Barbie movie were as high as a pair of hot pink pair stilettos. Naturally, I was terrified they would snap and twist my ankle. As the theater filled with adults in bubble-gum-colored skirts and cowgirl hats, the electric murmur of anticipation grew. We’d all seen the ads, the memes, and the YouTube walk-throughs of the elaborate Barbie Dreamhouse sets. We expected to be blown away, which is a lot to ask from a movie about a doll. My greatest fear was that we’d already seen everything worthwhile about this film. Imagine my glee when the opening moments caught me completely by surprise.

Writer/Director/Actor Greta Gerwig has proven herself to be a master of women’s stories, with a filmography that includes instant classics such as Frances Ha (2012), Lady Bird (2017), and Little Women (2019). In Barbie, she has created something original, combining all of the hopefulness, imagination, nostalgia, and baggage of the ubiquitous toy into a pink fantasia of topsy-turvy feminist critique. She asks you to look deep into the eyes of your childhood doll, remembering all the times you had together and all the dreams you shared – and then she yanks it from your hands and whacks you upside the head with it.

“Thanks to Barbie, all the problems of feminism and equal rights have been solved,” intones the voice of Helen Mirren in the first moments of the film. “. . .At least, that’s what the Barbies think.” 

This juxtaposition lays out the essential conflict of the story: Barbie (Margot Robbie) is living a perfect life in Barbieland when she suddenly becomes plagued with uncontrollable thoughts of death. In the hopes of undoing this horrible malfunction, Barbie and her wannabe boyfriend Ken (Ryan Gosling) venture into the Real World on a quest to make the little girl who plays with her happy again. Once they get to the Real World, they discover that women aren’t actually doing all that well. Chaos ensues.

Barbie is a visual delight and a joyous romp through the pangs of girlhood. It’s also a surprisingly astute critique of modern feminism.

While not ground-breaking by any measure, Barbie correctly identifies the essential trap of womanhood: Be pretty, but not too pretty. Smart, but not too smart. Successful, but not ambitious. Whether we have no children, are working moms, or stay-at-home moms, we’re doing motherhood wrong. We’re going about our careers wrong or we’re dating wrong. As angsty preteen Sasha (Ariana Greenblatt) quips, “Women hate women. And men hate women. It’s the only thing we all agree on.”

It’s also really hard to be a man. Barbie arrives at the perfect moment, when conversations about positive masculinity are at the forefront. Ken, who has always defined himself in relation to Barbie, must come to terms with his own identity. If he is neither desiring Barbie nor subjugating her, then what is he doing? Can Ken exist without Barbie’s adoration? Is he really “Kenough” on his own? (The Ken puns in this movie are exquisite, by the way.)

Men and women are not the same, but we need not exist in conflict. The essential lie of patriarchy has always been that subjugation of the other is the key to survival. In reality, most men don’t thrive under a patriarchal system, as Ken quickly discovers.

Men and women actually need each other, and not only romantically. We need each other because we are human. We need to be seen and cherished, not because of our career status, our physical attractiveness, or even our personal achievements. We need to be seen and cherished for our essential human dignity, and nothing more. Barbie gets that. Pretty good for a movie about a doll.

On July 22, Catholics celebrate the feast day of St. Mary Magdalene, which Pope Francis elevated from a Memorial to an official Feast in 2016. This change in status puts her liturgical celebration on the same level as those of Jesus’s twelve apostles. It signifies that Mary Magdalene is a pivotal figure in Christianity — and yet, there are vastly different perceptions of who she is because of a complicated history that has filtered down from the Church into pop culture. So, who was Mary Magdalene, really? Let’s start with what the Gospels tell us.

Fact: What the Gospels Tell Us About Mary Magdalene

Jesus rid Mary Magdalene of seven demons.

Luke 8:2 and Mark 16:9 tell us that Jesus healed Mary Magdalene of seven demons. In both cases, the Gospel writer mentions it as an aside, or as a way of explaining who Mary is, rather than including a full story about it. Neither gospel offers any further explanation or interpretation of the “demons” within the text, but traditionally “demons” can be interpreted to represent either a physical or moral malady.

Mary Magdalene was a close follower of Jesus.

The four Gospels agree on the overall arc of the story of Jesus’s ministry, but they are geared toward different audiences and sometimes contain different stories. Yet, all four Gospels agree about the fact that Mary Magdalene was a close follower of Jesus.

The Gospel of Luke includes her in a group of “women who had been cured of evil spirits and infirmities” (Luke 8:2) who traveled alongside Jesus and his apostles, and who “provided for them out of their resources” (Luke 8:3). The footnote in my New American Bible notes that it would have been very unusual to associate women with Jesus’s ministry in this way given the typical attitude of first-century Palestinian Judaism toward women, which would have cautioned against speaking with women in public.

Mary Magdalene was at the foot of the cross.

This is another element of the crucifixion story that is common across all four Gospels. While the majority of Jesus’s male apostles fled the scene when Jesus was sentenced to death, Mary Magdalene was among a small group of women who stood by Jesus’s side as he died.

Mary Magdalene was present at Jesus’s tomb on Easter morning.

Once again, all four Gospel writers agree upon this fact, even if the stories are slightly different. In Matthew, Mark, and Luke, Mary is among a group of women who had returned to the tomb but found it empty. After meeting an angel who told them the news of Jesus’s resurrection, the women are sent to tell the disciples. In the Gospel of John, it was Mary Magdalene alone who discovered the empty tomb.

Not only was Mary the first witness to the empty tomb, but she was the first one to whom the Risen Jesus appeared. Jesus calls Mary by name before instructing her to “go to [his] brothers and tell them, ‘I am going to my Father and your Father, to my God and your God” (John 20:17). She does as she is told, and is the first to tell Jesus’s disciples, “I have seen the Lord” (John 20:18). For this reason, she is often called the “Apostle to the Apostles,” a title first coined by St. Thomas Aquinas.

For many Catholics who are most familiar with the Easter story as it is proclaimed from the Gospel on Easter Sunday, the part of the story where Jesus appears to Mary Magdalene is unknown. This is because even when the Gospel reading for Easter Sunday Mass is from the Gospel of John, the reading ends before the passage with Jesus’s appearance to Mary Magdalene.

Fiction: The Myths About Mary Magdalene

Beyond these facts, we can’t say anything about Mary Magdalene for sure. This means that several common myths about her are, at the very least, unproven, and at the very worst, ill-intentioned. Let’s look at a few.

Mary Magdalene was a prostitute. 

There is nothing in the text of the Bible to support this common perception of Mary Magdalene. As stated above, two of the Gospels mentioned that she was healed from seven demons, but neither of them mention sins caused by those demons, let alone specifically sexual sins. So, where did this idea come from?

In 591, Pope Gregory the Great conflated Mary Magdalene with an unnamed sinful woman in Luke chapter 7, as well as with Mary of Bethany (Martha’s sister). The text of Luke 7 does not label the sins that the “sinful woman” had as sexual, nor does it name her as Mary Magdalene. Yet, this statement from his homily became Church teaching.

In 1969, as a part of a revision to the liturgical calendar and practices, the Church acknowledged that these were three distinct women who should be separated. However, it is hard to undo more than a millennium’s worth of damage in a small portion of a text that the majority of Catholics would not read — so this caricature of Mary Magdalene still remains in many people’s imaginations.

Mary and Jesus had a romantic relationship.

For people who encounter the story of Mary Magdalene mostly through pop culture, this might be the most prevailing myth about her thanks to The Da Vinci Code and Jesus Christ Superstar.

I have always thought the development of this trope of a romantic relationship between Jesus and Mary Magdalene was due to a misguided assumption that men and women cannot have close friendships or working relationships without there being romantic or sexual tension. If not that, then a related sexist attitude that cannot accept a woman on her own terms, and must define her by the man she spends the most time with.

I still think that is part of it, but it turns out that these pop cultural interpretations aren’t entirely without textual basis. They can be traced back to an apocryphal gospel (meaning that it was not chosen by the Church to be included in the Bible) known as the Gospel of Phillip. It referred to Mary as “Jesus’s companion” and stated that Jesus loved her most out of all of the disciples. It also stated that Jesus would kiss Mary, but damage to the text caused the word that describes where he would kiss her to be unreadable. Some scholars filled in that missing word as mouth, which furthered the interpretation of their relationship being romantic.

Mary Magdalene: Prototype for Female Leadership in the Catholic Church?

Mary Magdalene’s presence in the history of Christianity has been tumultuous, to say the least. Many (maybe all?) of the decisions about how her story was integrated into the tradition of the Church were made by men, which has led some to blame misogyny for the fact that she was mistakenly viewed as a quiet, repentant prostitute for more than a millennium, and for the fact that the story of Jesus’s appearance to her and commissioning of her to the Apostles has been left out of the Easter lectionary.

In a world where women are simultaneously over-sexualized and punished for being too sexual, it feels like a familiar framework to see a woman who is identified purely by her (unproven) sexual sins, while her leadership role is downplayed.

We don’t know anyone’s true motivation for these decisions, but the effects remain the same. A woman who ought to have been celebrated from the beginning as someone who closely followed Jesus, provided for him and his disciples, and was the first to proclaim his resurrection was instead largely silenced and discounted. Thankfully, the Church has clarified its tradition, and with the help of Pope Francis’s elevation of her Memorial to a Feast, she is quickly becoming viewed more as the prototype for what female leadership in the Church could look like.

Dear Therapist,

My girlfriend is a devout Christian and she’s strongly considering becoming Catholic, but she’s been on birth control for about 5 years due to debilitating periods and she’s nervous to go off of it. “I understand logically why the Church doesn’t allow it, but I’m still not entirely sure I agree,” is sort of the summation of her position. For some reason, I don’t like thinking about the fact that she’s on it, even though she isn’t doing anything immoral since we aren’t sexually active. Is it best that I not bother bringing it up? And if so, should I just avoid dwelling on it? It’s become a touchy subject for her so I want to approach it as wisely as possible, but also don’t want to ignore it, especially if we end up getting married. I’d really appreciate any thoughts you might have.

Sincerely,
Anonymous

Response from Regina Boyd, LMHC

Hi Anonymous,

It sounds like she is someone you see yourself marrying, which makes this conversation important for your future. 

Let’s first look at the facts. Your girlfriend has a medical condition and she is using something prescribed for relief from debilitating periods. That prescription drug is also used as a form of birth control, but that is not why she is using it.

Catholics who strive to form their conscience with Church teaching may bristle at the thought of using birth control, but let’s take a look at this passage from Humanae Vitae by St. Pope Paul VI:

“. . . the Church does not consider illicit the use of those therapeutic means necessary to cure bodily diseases, even if a foreseeable impediment to procreation should result there from—provided such impediment is not directly intended for any motive whatsoever.” (Humanae Vitae 15)

Your girlfriend is treating a disease with a drug that will create a “foreseeable impediment to procreation.” In the words of a pope and a saint, “the Church does not consider [this] illicit.”

Now, let’s talk about your relationship. If she is someone you hope to marry one day and you’ve been dating for a reasonably long time, it is important to have conversations about what you both want in marriage. 

What are your hopes, dreams, and visions? What do you each believe about the role of a husband and wife, and are you each comfortable with that? For example, do you desire a wife who solely raises children, or one who works outside of the home, as well? What does she envision her role to be and what does she desire in a husband? How many children would you hope to have? Do you want to raise your children in the Catholic faith?

These are all questions I suggest couples have BEFORE getting married. These are not topics you want to figure out as you go along. Part of discernment for marriage is seeing if your visions align. If they are not aligned, can you compromise and still feel comfortable? If your non-negotiables simply don’t match up, then it may be time to reconsider this relationship.

I’d also encourage you to think about why you are uncomfortable with her treating a disease with birth control, even though such use is not necessarily sinful. Have you expressed your concerns about birth control to her in the past, and if so, what were you trying to accomplish? Were you trying to ensure she lives according to your vision for marriage? Does she hold this same vision? Were you concerned about the health risks associated with birth control, or was it something else? Getting to the root of your sense of urgency may provide clarity on how to proceed.

If you desire to use natural family planning in marriage and you’ve been dating long enough to have conversations about the future, I’d consider sharing your vision for marriage with her. This will give her insight into your heart and help both of you discern how to move forward in the relationship. Of course, there’s no need to proceed with a judgmental tone, but rather in a way that expresses your hopes and dreams for your future family. Hopefully this is something that she will take into consideration if she sees you in her future.

Because you aren’t engaged, there is no rush. You have time to discuss your position and discern stronger commitments. Once you’ve been clear about your desires, and you’ve listened to her perspective, I would recommend taking a step back from this conversation — especially considering how frustrating it likely is for her. No one likes to be sick, and she is probably tired of dealing with her condition. 

You will now have more information to help in your discernment process. Is she open to taking steps toward becoming more aligned with your views? Is she willing to learn more about your beliefs? Is she respectful of your beliefs, even if she doesn’t agree? Is this someone who you would want to raise your children, even if her belief and position on this issue never change?

The answers to these questions should inform how you move forward. 

In the meantime, give her some space. It sounds like when you discuss this topic, it leads to frustration and tension. This may be because she either is not clear on how important this is for you, or holds a different viewpoint. Space conveys your respect for her free will and shows your willingness to accept her, even if she makes different decisions than you do. This can help facilitate more trust within your relationship.

Wishing you all the best!

If you’re anything like me, you never expected anyone to cross a boundary in a way that allowed you to rightly accuse them of sexual assault. I knew the statistics as a teenager. I kept my keys in my fist like I was Wolverine. I wrote a whole speech for a class about the dangers to women that come from toxic masculinity. A family trip to New Orleans at age 15 gave me a souvenir of a catcall, and a school trip to Nashville one year later came with a memento of a stranger tapping me under my skirt. Afterwards, I wrote a school assignment about street harassment. I could recognize those experiences as assault – I knew those strange men were out of line. But when my first boyfriend was outraged on my behalf after I shared those experiences with him, I never expected him to cross that boundary, too.

Please read with discretion: This article mentions sexual assault, rape, and domestic abuse.

Talking About the Saints Who Survived Assault and Abuse

The experience of sexual assault drastically changed my relationship with God. The day that I realized it wasn’t my fault, my prayers shifted rapidly from blaming myself – asking God what I could have done to save the relationship – to vitriolic cries, asking God why He just let it happen. The most violating experience of my life happened in my childhood home while my parents were upstairs. My parents were at least ignorant at the time. God had no such excuse.

As I was spiritually thrashing in the pain of feeling forsaken, a particular saint started to get under my skin: Maria Goretti.

One of my earliest friends in college had chosen her as a Confirmation saint, and she told me that she really admired Maria Goretti’s purity. I remember being polite, but internally scoffing a bit. “What an odd thing to value,” I thought. I knew some young Catholics who didn’t want to kiss people or even talk to someone they liked if it gave them impure feelings or thoughts. If that’s what “purity” looked like – hard pass.

At that time, the worst for me was yet to come. Now, I wonder whether Maria Goretti made an appearance a few months prior as a sign that she was praying for me.

I had major complaints about how the Church holds up saints like Maria Goretti, Agnes, Rita of Cascia, Monica, and Dymphna as examples of virtue in cases of sexual assault, rape, and domestic abuse. Perseverance in an abusive marriage has been glorified as the better option to divorce. Does a woman’s life have less value than a sacrament? Three of the five women I mentioned are martyrs – it’s a reality that men who abuse women often take those women’s lives. Is dying at the hands of your abuser holiness? All I remember the Church teaching me on matters of abuse was that it was better to persevere for the sake of the relationship than to flee for the sake of yourself.

Maria Goretti’s and My Shared Experience

However bitter I was about purity being overrated, Maria Goretti was a lot like me.

Maria Goretti experienced her abuse before the age of 18. Currently in the United States, “[f]emales ages 16-19 are 4 times more likely than the general population to be victims of rape, attempted rape, or sexual assault.”

She knew her attacker, and I knew mine. In fact, “victims know their attackers in 8 out of 10 cases.”

She was attacked at her home, as was I – and “55% [of assaults] occur at or near the victim’s home.”

And I could guess from the statistics that if you’re reading this, you might have a lot in common with Maria Goretti, too.

A recent tweet by Sheila Gregoire, Christian marriage blogger and author of She Deserves Better, caught my eye with something I needed to hear when my first boundary was pushed: “I wish male evangelical authors would stop talking about ‘pushing past a girl's boundaries’ when making out, like that's normal. Pushing past boundaries means pushing past her ‘no.’ That means you are committing sexual assault. Call it by its real name.”

It took 15 months and reading St. Thomas Aquinas for me to call it by its real name. Violence is not only physical force – Aquinas says that it “effects something against the will.” I processed this new definition and thought, “In what world is making out not even vaguely sexual? If an act falls under the definition of ‘sexual’ and is contrary to the will, it is therefore sexual violence.” Suddenly, I had the power to call my experience assault – and my suffering finally made sense.

An Involuntary Trauma Response Has Little to Do with Holiness

For the longest time, I blamed myself for freezing in that moment, for not crying out like Maria Goretti did – but responses to assault are unique to each experience.

Psychologists have discovered four main trauma responses. You've likely heard of fight and flight, but maybe freeze and fawn are new to you. “Freeze” is what happens when your body needs time to plan for action, but without this plan, you’re stuck in a state of inaction. “Fawning” is an attempt to pacify the threat to you so that you avoid harm. These responses usually kick in without a conscious thought process because threats rarely leave time for you to think.

Maria Goretti clearly had a fight response: She cried out, "No! It is a sin! God forbids it!" as her attacker, Alessandro Serenelli, made advances. That's incredible courage – and it's courage I don't have to be jealous of. I don’t have to feel like God loves me less because I froze in the moment of my assault. An involuntary trauma response has little to do with holiness. My body and my mind protected me the best way they knew how.

Looking for God In the Aftermath of Sexual Assault

I was afraid to ask God where He was when I was assaulted, but when I finally did, He answered me immediately with a single word: “Weeping.”

His brief response to my prayer was strikingly similar to the shortest verse in Scripture: “And Jesus wept.” In the Gospel, Jesus wept for his friend Lazarus, who had died. Jesus knew Lazarus was ill, but he waited to journey to his friend. In the meantime, Lazarus died. And when Jesus did arrive, he was met with the cries of, “Lord, if you had been here, [Lazarus] would not have died!”

I placed myself in Lazarus’ position, with abuse being its own illness and assault being a sort of death – one that warrants the tears of God to fall to the earth, on my behalf. For the death to my voice, Jesus wept. For the death to my body, Jesus wept. For the death to my free will, Jesus wept. And he weeps for you reading this, whether your experience of sexual violence was last night, last year, or last decade.

The fight in me came out after the assault. The courage it took to confront my abuser and say I had feelings in line with a survivor of sexual assault because of what he did – that was more than a instinctive fight response. It was courage, and it’s courage I share with Maria Goretti. I'm sure it's courage that she shares with you, too, no matter what your experience was like. Even if no one but God knows what happened to you, the choice to keep living each day is a courageous one.

Being in an abusive relationship had the worst impact on my mental health among all other experiences in my life. Before finding a therapist, there were days when I didn't want to live. My mental health deteriorated to the point that I almost walked into moving traffic. I had dreams that made me wake up convulsing – it was so unusual that I wondered whether it was demonic. Even almost a year after I was out of the relationship, with PTSD still haunting me, there were days when I asked God to take me in my sleep. Seeking support, going to therapy, and healing all take courage.

After Sexual Assault, Forgiveness Can Be Complicated

Forgiveness is something we might pressure ourselves into on account of our faith, and I want to encourage those reading: After someone else just violated your will, you do not need to force yourself to do anything. Forgiveness is good and freeing, but it’s hard, and you can take the time you need with it. You don’t have to repress your emotions in the name of forgiveness. You might need to forgive continuously for your whole life, and even then still never do it perfectly.

Honestly, forgiveness is harder for me now than it was initially because I’ve done a lot to alleviate the need to fawn and preserve the relationship I once had. The good news is that I can now offer real forgiveness that isn’t borne of an involuntary trauma response.

Forgiveness requires grace. It can even take a miracle. I think that Maria Goretti’s forgiveness was both courageous and miraculous. In the moment of the attack, she was afraid for her attacker’s soul, that he would go to Hell for what he did.

In time, I saw that Jesus also wept for the man who assaulted me. It grieves Jesus to see the hearts of men in such a state that they destroy the women around them with abuse. When I think of my own abuser, I find myself praying for him to have a conversion, at least to see his wrongdoing for what it is and to never harm someone that way again.

If you have experienced sexual assault and would like support, here are a couple of resources:

RAINN (Rape, Abuse & Incest National Network)

Dial 988 for the Suicide and Crisis Lifeline

Amid the heated debates and political wrangling that surround the influx of migrants into the United States, the human element often gets lost. Politicians detach themselves from the harsh realities of the perilous journey, reducing the matter to a mere logistical nightmare or an opportunity for political posturing. However, against this political backdrop, a group of remarkable women refuses to turn a blind eye to the suffering and dedicates themselves to making a tangible difference along the border.

Please read with discretion: This article contains descriptions of violence, including exploitation and discrimination faced by migrants. It discusses mental health challenges, references to death and mortality, human rights violations, challenging living conditions, and policy changes related to migration.

Agents of Compassion: The Franciscan Sisters of Mary Immaculate

In the vibrant border city of Piedras Negras, nestled along the Texas-Mexico border, the Franciscan Sisters of Mary Immaculate embrace the Church's call to serve those in dire need. These religious sisters embody empathy and service. With an impressive 130-year history of advocating for human rights, their congregation has taken on a new and crucial mission: providing vital assistance to migrants and refugees in their time of need.

Piedras Negras has become a focal point of the migrant crisis, witnessing a significant influx of individuals from around the world over the past decade, all driven by the aspiration to enter the United States. Unlike other points of entry into the United States, Piedras Negras provides a safer passage for migrants due to diminished cartel activity. However, the convergence of people presents humanitarian concerns and logistical complexities for both the Mexican and American governments. Recent policy changes, including the expiration of Title 42 and modifications to border crossings, have further compounded the challenges in this region.

At the heart of their unwavering commitment lies the Frontera Digna migrant shelter, where three remarkable sisters – Sisters Isabel Turccios from El Salvador, Carmen López from Panama, and Yudi Calvache from Colombia – fulfill their congregation's mission.

During the pandemic, I had the opportunity to meet these sisters while teleworking for the Centers for Disease Control from my hometown, shortly after completing my graduate studies in global health and complex humanitarian emergencies. In response to a call from the diocese to enhance pastoral outreach to migrant communities, I volunteered at the migrant shelter under their guidance. Through firsthand experience, I have witnessed the positive influence that they have on the lives of migrants seeking refuge in Piedras Negras.

Alongside a formidable network of volunteers and collaborators, this dynamic trio exemplifies the core values of their institute, which was founded by Mother Caridad Brader Zahner in Túquerres, Colombia, in 1893. The congregation’s enduring commitment to serve the marginalized is ingrained in their work.

By exploring the extraordinary apostolate of this congregation, we uncover the impact that they have on the lives of migrants who face immense challenges and perils, providing them with support, shelter, and hope.

A Haven of Hope: Life at the Frontera Digna Migrant Shelter

Stepping inside the Frontera Digna shelter, you experience the transformative power of empathy and hope in the face of seemingly insurmountable adversity.

For 25 years, Frontera Digna has welcomed individuals from countries all over the world who have endured perilous journeys through Central America and Mexico, often facing violence, exploitation, and discrimination.

The shelter serves as the starting point for many in the legal migration process into the United States. However, the uncertain and lengthy waiting period for appointments leads to anxiety and frustration among those seeking legal entry. During this challenging time, Sisters Isabel, Carmen, and Yudi extend their compassionate touch to those in search of refuge, providing much-needed support and encouragement.

Sister Isabel, the shelter's director, ensures smooth operations and advocates for the safety of migrants. Her dedication to their well-being is evident as she states, "We wanted to have open doors and attend to the most urgent needs." Meanwhile, Sister Carmen López takes charge of logistics, providing personalized attention and connecting migrants with essential resources. Sister Yudi, in turn, fosters a sense of family and community, nurturing the well-being of those who have sought refuge within the shelter's walls. The Sisters aim to provide comprehensive care to the migrants, addressing their physical, mental, and psychological well-being.

The large number of migrants seeking refuge at the shelter reflects the urgent demand for the sisters’ support. Sister Isabel highlights that while the shelter accommodates around 150 people, there are approximately 180 staying overnight right now. In warmer weather, some migrants set up tents outside the shelter, but the challenges intensify during winter when energy constraints expose them to sub-freezing temperatures.

The Sisters infuse the shelter with a deep and vibrant liturgical life, supporting the spiritual well-being of both the residents and the community at large. During major Catholic holidays like Holy Week and Christmas, the shelter opens its doors and invites everyone to join in the celebrations, fostering a sense of unity and shared faith among migrants, refugees, and the broader community. Additionally, the sisters commemorate special days dedicated to raising awareness about their cause, including the Day of the Migrant, the Day of the Refugee, and other events focused on combating human trafficking. These occasions serve as powerful reminders of the inherent dignity and worth of every individual, regardless of their circumstances.

The sisters' dedicated work at Frontera Digna creates a refuge, offering solace during the challenging migrant journey. The care and support provided within its walls give hope amid adversity. However, the sisters acknowledge the need for collaboration, relying on a vast network of partners and allies who share their commitment to comprehensive migrant care.

United in Purpose: Allies and Collaborators in Action 

The efforts of Frontera Digna are not carried out in isolation, but rather are fortified by strong partnerships. One critical ally is the Hospital General Dr. Salvador Chavarría Sánchez, which plays a pivotal role in ensuring that migrants have access to medical attention, ranging from specialized care for pregnant women and survivors of sexual assault to surgeries and other crucial needs. Sister Isabel emphasized the importance of this collaboration, stating, "Our collaboration with General Hospital Salvador Chavarria [sic] is crucial in providing migrants with the medical care they require. Together, we are able to address their diverse healthcare needs and ensure their overall well-being."

Despite establishing a working relationship with local authorities to handle legal matters, the sisters face the challenge of limited government support. Currently, this support extends to contributing to utility expenses and covering the costs of two staffed roles. To sustain the shelter, they rely heavily on their own resources as well as the generosity of individuals and organizations.

In dire circumstances, Frontera Digna has witnessed the incredible support of the people of Piedras Negras, especially during challenging times like the pandemic. The community –  including respected members like Monsignor José Guadalupe Valdés, a long-time defender and advocate of migrants’ human rights, and Mr. Daniel Campos, a long-time supporter of the shelter – has rallied around the sisters.

Their collaboration with local parishes, organizations, and individuals in the community is a testament to the strength of collective compassion. Their partners have provided invaluable assistance through acts of solidarity, donations, and unwavering support. Sister Isabel reflects on the heartwarming support they receive, emphasizing, "It is through the support of our community that we are able to forge ahead and continue our mission."

Esteemed international organizations like Doctors Without Borders, the United Nations High Commissioner for Refugees, and the International Red Cross also enhance the support network available to those seeking a better life. Sister Carmen explained, "Our collaboration with these international initiatives allows us to create a comprehensive support system. We can fully embrace the migrant community and provide comprehensive services to address their trauma, offer respite, and restore hope."

Through the combined efforts of the sisters and their valued partners, migrants and refugees receive support amid their challenges. As one migrant who has transitioned beyond the shelter shared, "The care we received from the sisters was invaluable. Their compassion and support gave us hope when we needed it the most. We would not have been able to continue without them."

Sister Isabel reflected, "I believe that where we have the biggest impact on the migrants that arrive at our shelter is in the warm reception and hospitality we provide. We give them the attention they deserve and ensure we are available as a listening ear. And that is something that stays with them."

The path forward is not without obstacles. The number of migrants seeking shelter continues to rise, and recent policy changes have stalled the migration process. This has created a daunting challenge for the sisters, who must now accommodate an increasing population while simultaneously navigating a stagnant migration process.

From Desperation to Hope: Migrants' Stories and the Sisters' Call for Change

The sisters, along with their dedicated team, persevere in the face of ongoing challenges as they assist migrants and refugees. They emphasize the urgent need for systemic change and highlight the importance of collective efforts to address the complex issues surrounding migration.

Conversations with migrants provide insight into their experiences, shedding light on the hardships they face. The sisters, deeply unsettled by a migrant's account, learned that the area they traversed through the Darien Gap is known as a place "dedicated to the Devil." Altars adorned with skulls and gold chains are offered to the cult of Santeria, adding to the ominous nature of the journey. Another migrant shared a distressing experience where their son, who already suffered from schizophrenia, was confronted with the shocking sight of dead bodies along the road, left abandoned without care. After this traumatic experience, the young boy's mental state deteriorated significantly, leading to a six-month stint at a mental health facility in Honduras. These chilling revelations emphasize the treacherous conditions, spiritual weight, and profound impact on mental well-being that accompany the passage through the Darien Gap.

A Venezuelan woman and her three children also recounted their 5-day journey through the Gap, marked by hunger, dehydration, and the unforgiving mountainous terrain. They described it as a place filled with horror and death, where everything speaks of mortality. She said, "It's horrifying. Full of death. Everything is death. Everything speaks of death." Their firsthand account serves as a stark reminder of the physical and emotional challenges confronted by migrants.

Upon entering Mexico, migrants continue to face a host of challenges. Corruption, rampant crime, and exploitation permeate their lives. Migrants exist in a constant state of fear and danger, as they must constantly safeguard their lives in an environment that offers little respite or security.

The Frontera Digna shelter itself grapples with security concerns due to its location in a dangerous area along the Rio Grande River. Migrants come into the shelter reeling from the physical and emotional challenges they face along the migrant route. The sisters bear witness to each of their stories, recognizing the violence, abuse, and exploitation that has been carried out against them. The sisters often feel helpless in their inability to provide the justice and protection these individuals deserve.

"They live in a terrifying reality of never being at ease because they have to protect their lives because they are constantly in danger," Sister Isabel states. These experiences underscore the urgent need for comprehensive reforms in migration policies, law enforcement, and support systems.

Forging a Compassionate and Just Future: The Legacy of Frontera Digna

The sisters face new challenges as the Title 42 policy expires, which results in a decrease in the number of people able to leave the shelter. This has placed a strain on their ability to provide care and support. Previously, the shelter operated efficiently, with migrants moving through the system and into the United States at a steady pace. However, with the removal of Title 42, the situation has changed drastically, leaving the shelter overcrowded and overwhelmed.

Despite these obstacles, the sisters remain resolute in their mission. The impact of their work is felt deeply, as expressed through the heartfelt gratitude of the migrants who have experienced the shelter's care. Fondly referred to as "La Casa de Las Monjitas" (The House of the Little Nuns), the shelter has earned a reputation for its warmth and hospitality. Countless messages of appreciation pour in, testifying to the enduring influence of the sisters' dedication and the difference they make in the lives of those they serve.

In addition to their service, the sisters raise awareness through community education and advocacy. Their efforts are bearing fruit, as the local community increasingly recognizes and supports the sisters and their work. This growing recognition is accompanied by a deeper empathy for the harsh realities faced by migrants.

Integral to their advocacy is the facilitation of direct interactions between the local community and the migrants. Visitors from the city and the United States are welcomed warmly and given tours of the shelter, providing them with an opportunity to meet the shelter residents, dispel misconceptions, and witness firsthand the humanity and resilience of those who seek refuge. These interactions foster understanding, dismantle fears, and erase stereotypes.

The Franciscan Sisters of Mary Immaculate strive tirelessly to dismantle networks of corruption that exploit and victimize migrants. They work towards a society that upholds the dignity and rights of every individual, forging ahead with a vision for the future, one where migration is approached with empathy, human rights are protected, and the inherent dignity of every person is recognized. Through their steadfast love and dedication, they are building a lasting legacy of solidarity, inviting us all to reflect on how we can contribute to a more compassionate and just world.