Developing nations around the world aren’t doing enough to ensure that women have access to the family planning services they need, a new report from the Guttmacher Institute finds. The women who want to prevent pregnancy but don’t have access to modern forms of birth control are concentrated mostly in poorer countries, and those countries are lagging far behind wealthier nations when it comes to ensuring women’s ability to use the contraceptive services of their choice.

And the problem is getting worse. Between 2003 and 2012, the total number of women in need of birth control because they wanted to avoid pregnancy increased from 716 million to 867 million — and most of that growth was among women in the 69 poorest countries, where birth control is already more difficult to come by. About 222 million women in developing countries want to use birth control but aren’t currently able to access a modern contraceptive method, and nearly three quarters of those women live in the world’s poorest countries.

“Unless the adequacy of family planning services improves more rapidly than it has in the past decade, he number of women with an unmet need for modern contraceptives will continue to rise, especially in the 69 poorest countries,” Jacqueline E. Darroch, one of the study’s authors, explained in a statement.

Last year, the United Nations declared access to contraception to be a “universal human right.” But that right isn’t being realized for millions of women around the world — and the continued failure to ensure better access to modern birth control results in serious consequences for women in developing nations. Higher rates of unintended pregnancies lead to higher rates of preventable deaths from unsafe abortions, as well as higher rates of infant deaths around the world. Furthermore, giving women the family planning resources they need is an important step toward helping those women achieve economic success and independence.

Unfortunately, persistent class divides plague contraception access even in wealthy nations. Here in the United States, poorer women still struggle to access the birth control method of their choice — and research has demonstrated that when cost barriers are removed, those low-income women choose more effective methods than they would have otherwise.

The states home to the United States’ harshest abortion restrictions, North Dakota and Arkansas, are both facing legal challenges over their new laws — and in both states, those battles have begun to advance this week.

In North Dakota, reproductive rights activists filed a lawsuit on Wednesday to challenge a measure that threatens to shut down the last remaining abortion clinic in the state. And in Arkansas, a district judge sided with abortion providers on Wednesday, denying the state’s request to drop the lawsuit against its new 12-week abortion ban and allowing the doctors’ challenge against it to continue.

The Center for Reproductive Rights, a New York-based group that assists with litigation to defend women’s right to legal abortion, is also preparing to file suit against several other new anti-choice laws in North Dakota — including a measure that criminalizes abortions after just six weeks of pregnancy. Taken together, all of the new restrictions that North Dakota enacted this session would make it more difficult for women to terminate their pregnancies there than anywhere else in the country.

“‘With their relentless campaign to end safe and legal abortion in North Dakota, lawmakers have effectively told the women of their state, ‘We don’t care about your health, we don’t care about your safety, and we sure don’t care about your constitutional and human rights,’ ” the group’s president, Nancy Northrup, said in a statement this week. “Our message back to politicians hostile to reproductive rights in North Dakota and nationwide is crystal clear: We are going to fight back relentlessly against your attacks on the women of your state.”

When anti-choice lawmakers in North Dakota and Arkansas enacted the new abortion bans earlier this year, they were fully aware that those laws would spark court battles. In fact, North Dakota Gov. Jack Dalrymple (R) even admitted that he decided to sign an unconstitutional six-week abortion ban exactly because he wanted to entangle his state in a legal fight that could “discover the boundaries of Roe v. Wade.” This session, Republican lawmakers — who used to prefer to indirectly undermine women’s reproductive rights — are now favoring more direct attacks that they hope could eventually land the abortion issue back in the Supreme Court.

Of course, those fights don’t come without a cost. North Dakota’s attorney general has already requested an addition $400,000 dollars to defend its abortion bans in court. If abortion-related lawsuits drag on over several years, as they have in Kansas, costs can top $1 million dollars.

North Carolina is advancing a measure that would effectively allow personal beliefs to trump women’s access to birth control. Under HB 730, employers in the state could decide not to include contraceptives in their workers’ insurance plans for any reason — a direct violation of the popular Obamacare provision that stipulates women should receive birth control coverage at no additional cost to them. But as lawmakers debate HB 730, women’s health advocates in the state want them to know they’re not willing to be dragged back to the 1960s without a fight.

“We love a good vintage look — but not when it’s running the state legislature,” the local Planned Parenthood affiliate explained in a press release. That’s why Planned Parenthood supporters dressed up in 1960s clothing to attend a House committee hearing about HB 730 on Wednesday.

The 1960s apparel is intended to communicate that state lawmakers are trying to turn back the clock to past decades, when women didn’t have the freedom to control their own reproductive decisions. Planned Parenthood raised awareness about HB 703 with a Mad Men-themed event in advance of the committee hearing, and then sent dozens of vintage-garbed supporters to Wednesday’s debate (all photos courtesy of Planned Parenthood Action Fund of Central North Carolina):

“We like watching Mad Men — but we don’t want to live in it,” Paige Johnson, the president of public affairs for the Planned Parenthood of Central North Carolina, pointed out. “Women’s preventive care — including birth control — is basic health care. Politicians and bosses have no business denying women access to this basic health care. This shouldn’t be a revolutionary idea, but unfortunately it is to some.”

North Carolina lawmakers aren’t the only ones to consider a foray into 1960s-esque policies. Even though a similar law in Missouri allowing employers to deny birth control coverage was recently struck down by a federal judge, that hasn’t stopped other states from attempting the same method to restrict women’s access to affordable birth control.

And unfortunately for the women in North Carolina, this is hardly the only measure currently being considered in the legislature that could pose a threat to women’s health. State lawmakers are also considering including biased misinformation about abortion in sex ed classes, imposing unnecessary restrictions on abortion clinics that could force them to close, and forcing teens to get a notarized note from their parents before getting tested or treated for STDs.

Monday’s news that illegal abortion provider Kermit Gosnell has been convicted of first-degree murder has already inspired a flurry of reactions, including several calls to tighten restrictions on legal abortion clinics across the country. Throughout Gosnell’s high-profile murder trial, anti-choice activists have consistently pushed the message that abortion still lacks proper regulations — despite the hundreds of state-level restrictions that continue to be piled onto this aspect of reproductive health care — in an attempt to portray all abortion procedures as inherently dangerous and barbaric.

And now, abortion opponents are continuing to suggest that Gosnell is not an outlier, criticizing the pro-choice community for failing to implement the policies to prevent other unscrupulous providers from repeating his crimes. “Despite the blood-soaked horror of Gosnell’s clinic, Democrats refuse to loosen their embrace of unrestricted, unregulated, taxpayer-funded abortion on demand,” Rep. Steve Stockman (R-TX) said on Monday, suggesting that Gosnell’s case reveals that Democrats “worship” abortion.

But in reality, there’s no such thing as taxpayer-funded abortion on demand. Under the Hyde Amendment, federal dollars are not allowed to fund abortion services. In an ironic twist, the lack of federal funding for abortion services is actually a big contributing factor to the issues at the heart of the Gosnell case. And addressing the public funding ban under Hyde is the real policy solution that could prevent other bad actors like Gosnell from preying on vulnerable women.

Blocking public funds from covering abortion makes for a nice talking point for the anti-choice lawmakers who like to decry the immorality of “taxpayer-funded abortion.” But in practice, the Hyde Amendment means that the low-income women on Medicaid are forced to cover the entire cost of abortion out-of-pocket because their health care plan won’t help cover it. That contributes to a vicious cycle of poverty. Low-income women are more likely to lack access to affordable contraceptive and family planning services, and therefore have higher rates of unintended pregnancies and abortions. They’re more likely to struggle to pay for an abortion. And they’re more likely to slip further into poverty if they’re unable to obtain the abortion they wanted to have.

That’s how the Hyde Amendment, as well as the subsequent state-level bans on public funding that have been modeled on the federal law, ensures that reproductive rights are deeply divided by race and class. Despite the fact that Roe v. Wade has been in place for 40 years, each woman’s access to abortion care is largely dependent on her privilege — and the underprivileged women in the U.S. are paying the biggest price.

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On Monday, illegal abortion provider Kermit Gosnell was convicted of first-degree murder for the barbaric crimes he committed in his unsanitary Philadelphia-area clinic. Throughout his high-profile murder trial, anti-choice activists claimed that Gosnell’s case proved that abortion is always an inherently dangerous procedure — attempting to conflate incredibly late-term abortion services with first-trimester medication abortions. Even though their claims often fly in the face of scientific fact, abortion opponents have been largely successful at obscuring the medical realities of different types of abortion procedures.

That’s partly why restrictions on the abortion pill, which is medically known as mifepristone, are advancing across the country. Despite the fact that mifepristone is perfectly safe for women to take outside of the doctor’s office — an option that many women prefer, since it allows them the added privacy of taking the medication in their own home — anti-choice Republicans claim that more restrictions are necessary to protect women’s health. But these kind of restrictive state laws actually drive up the cost of the abortion pill, and don’t do anything to improve reproductive health care.

Here are five states where anti-abortion lawmakers are advancing medically unnecessary restrictions on the abortion pill, ultimately inserting themselves between a woman and her doctor:

1. MISSOURI: On Monday, Missouri lawmakers gave final legislative approval to HB 400, a measure that requires doctors to be physically present to administer the first dose of mifepristone and schedule an in-person follow-up appointment two weeks later. Critics of the legislation say it will interfere with women’s relationships with their doctors, as well as impose a serious burden on the women who must travel from different parts of the state to terminate a pregnancy. According to Paula Gianino, the CEO of Planned Parenthood for the St. Louis region and southwest Missouri, about 1 in 5 patients seeking an abortion at her clinic travel at least 100 miles.

2. NORTH CAROLINA: Anti-choice Republicans in North Carolina are currently pushing a package of anti-abortion bills intended to limit reproductive rights from several different angles. The most far-reaching measure is SB 308, which would require the clinics that administer medication abortions to adhere to the same standards as surgical facilities, including making costly updates to the building and requiring physicians to obtain admitting privileges from local hospitals. That’s a common method of attacking abortion clinics, and it often forces them to either stop providing the abortion pill or shut down altogether.

3. INDIANA: Earlier this month, Indiana lawmakers successfully pushed through SEA 371, a measure that is solely intended to prevent a Planned Parenthood clinic in the state from providing the abortion pill to its patients. Just like North Carolina’s proposed bill, the new law in Indiana requires clinic that administer medication abortions to make costly and unnecessary updates to their facilities under the guide of “protecting women’s safety.” When Gov. Mike Pence (R) signed the bill into law at the beginning of May, he repeated the popular anti-choice myth that the abortion pill is “dangerous” — despite all scientific evidence to the contrary.

4. MISSISSIPPI: At the end of April, Gov. Phil Bryant (R) approved SB 2795, which will require women to take the abortion pill in the presence of a physician as well as come in for a follow-up physical examination two weeks later. The measure takes effect on July 1 of this year — and it could represent a significant burden for women in the state. There’s only one abortion clinic left in all of Mississippi, and it’s fighting to remain open as anti-choice Republicans keep trying to shut it down.

5. LOUISIANA: Last month, the Louisiana Senate approved SB 90, a measure that would require a doctor who has completed a residency in obstetrics or gynecology to be physically present when administering medication abortions. If the bill becomes law, doctors who violate the new rule could be fined $1,000, imprisoned for two years, or both.

Requiring doctors to be physically present to administer the pill, even though most clinics don’t currently use that protocol, is a thinly-veiled attempt to ban abortion procedures conducted with the help of internet technology. Allowing doctors to prescribe mifepristone over a video conference helps improve low-income and rural women’s access to abortion services, since they may not be able to make a long trip to the nearest abortion clinic. Studies have shown that this type of abortion procedure is safe and effective. Nonetheless, anti-choice lawmakers continue to launch attacks at so-called “webcam abortions.”

Oscar-winning actress Angelina Jolie shared the story of her preventative double mastectomy, a decision she made after discovering she carries a gene that gives her an extremely high risk of developing breast cancer, in a New York Times op-ed published on Tuesday. Her public announcement coincided with National Women’s Health Week, a government initiative to encourage U.S. women to better safeguard their health and seek out preventative care. In Jolie’s editorial, she explains that she hopes other women might benefit from learning about her experience.

Jolie is one of the few woman who carries a rare gene mutation, BRCA1, that predisposes her to breast and ovarian cancers. While the average woman has about a 12 percent risk of developing breast cancer at some point in her life, those with a BRCA1 mutation have an average 65 percent risk. After Jolie underwent the blood testing that revealed her own genetic mutation, her doctors estimated that she had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer.

The actress — whose own mother passed away from cancer — wrote that she decided to take preventative measures with her own six children in mind. “Once I knew that this was my reality, I decided to be proactive and to minimize the risk as much I could,” Jolie writes. She shares step-by-step details about the mastectomy procedure and recovery process in her op-ed.

“I choose not to keep my story private because there are many women who do not know that they might be living under the shadow of cancer,” Jolie explains. She notes that although the word “cancer” still tends to strike fear into people’s hearts, and often produces “a deep sense of powerlessness,” she wants other women to know that they have options. And she also hopes to communicate that the health issues that impact women’s anatomy — even breasts, which have become somewhat of a cultural signifier for femininity — don’t serve to diminish womanhood. “I do not feel any less of a woman. I feel empowered that I made a strong choice that in no way diminishes my femininity,” Jolie notes.

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Kermit Gosnell — the Philadelphia-area abortion doctor who preyed on vulnerable women in his illegal, unsanitary clinic — has been found guilty of murder. On Monday afternoon, a jury convicted him on three counts of first-degree murder for delivering live babies and severing their spinal cords. Gosnell also received one count of involuntary manslaughter for the death of a 41-year-old woman who overdosed on the drugs she received while undergoing an abortion.

There were over 250 counts against Gosnell. Many of them were related to Pennsylvania state law, which criminalizes abortion procedures after 24 weeks of pregnancy. The incredibly late-term, barbaric procedures that Gosnell performed were in clear violation of that law — as well as the laws that govern other types of legal late-term abortion clinics in states where later procedures are permitted.

Over the past several months, Gosnell’s high-profile murder trial has become somewhat of a rallying cry for the anti-choice community, which has attempted to twist the facts to make it appear as if all abortion providers are guilty of Gosnell’s crimes. In reality, however, Gosnell’s illegal clinic is an example of the desperate measures that women will resort to when they don’t have access to safe, affordable abortion care.

In a statement in response to the Gosnell verdict, NARAL Pro-Choice America President Ilyse Hogue noted that “justice was served,” and expressed hope that “the lessons of the trial do not fade with the verdict.”

“Anti-choice politicians, and their unrelenting efforts to deny women access to safe and legal abortion care, will only drive more women to back-alley butchers like Kermit Gosnell,” Hogue explained, noting that Pennsylvania has received an ‘F’ ranking from the organization because of the state’s multiple medically unnecessary barriers to legal abortion care. “It is my sincere hope that the women in Gosnell’s clinic did not suffer in vain and that Pennsylvania, and every state, will step up and join us in making the protection of women’s ability to get, safe, high quality, and legal abortion care a top priority.”

Ironically, abortion opponents — who falsely claim that the mainstream media has ignored Gosnell’s salacious story because of a perceived pro-choice bias — have taken exactly the opposite approach. Anti-choice Republicans have rushed to leverage the emotional outrage surrounding Gosnell’s crimes to push for more abortion restrictions across the country. Nevertheless, public opinion on abortion rights has remained unchanged by the ongoing media attention to the Gosnell trial.

Despite the fact that Roe v. Wade has been in place for over 40 years by now, women’s reproductive rights still aren’t safe. Anti-choice activists are chipping away at women’s access to reproductive health care from all angles — piling on dozens of state-level restrictions, driving up the cost of abortion services, and ultimately enacting as many barriers as possible for women seeking to terminate a pregnancy. But the players in the fight over women’s reproductive health isn’t limited to lawmakers. In fact, the next big threat to women’s legal abortion access could be the unelected hospital officials at Catholic-affiliated institutions.

The Catholic Church has a huge hospital network across the country, with more than 600 hospitals organized under the Catholic Health Association (CHA). The CHA estimates that about one in six patients in the U.S. is cared for in a Catholic hospital. But, since the care provided in those Catholic-affiliated institutions must adhere to the Church’s strict pro-life teachings, those patients can’t receive any abortion services or end-of-life care.

So, when secular hospitals merge with Catholic-affiliated ones, it brings up questions about the implications for patients’ access to that type of health care. As the unfolding situation in Washington state illustrates, hospital mergers can impact even the residents of largely progressive states that have embraced reproductive rights:

Washington is heavily Democratic, leaning left especially on social issues. A majority of voters even put into law a statutory right to abortion in 1970 — the only state ever to do that. The governor, Jay Inslee, a Democrat, is pushing the Legislature even now to pass a law at a special session on Monday requiring health insurers to pay for elective abortions, another first for the state if it makes it to Mr. Inslee’s desk.

But now a wave of proposed and completed mergers between secular and Roman Catholic hospitals, which are barred by church doctrine from performing procedures that could harm the unborn, is raising the prospect that unelected health care administrators could go where politicians could not.

The merger wave is mirrored around the country, driven by the shifting economic landscape in health care and the looming changes in federal regulation. Previous Catholic takeovers in Kentucky, Illinois and Pennsylvania have made news and drawn scrutiny.

The CHA has a long history of providing health care for the Americans who need it, particularly those in rural areas without much access to services. Catholic social teaching promotes caring for the poor and serving the underserved, and the Catholic hospital administrators in Washington say that denying them the ability to expand their practice would effectively threaten health care services to millions of Americans in the state who would have nowhere else to turn. “The Catholic health system is in many of the communities we’re in because other health care providers have not wanted to serve those communities and have not had a commitment to serve every human being,” Peter Adler, a senior vice president a Catholic hospital system based in the Pacific Northwest, told the New York Times.

But for the Americans who support abortion rights, “serving every human being” includes providing reproductive health care to the women who need it. And recent hospital mergers have resulted in halting abortion care — even when doctors were under the impression that merging wouldn’t prevent them from continuing to perform abortions. That’s especially concerning in Washington — since, if all the proposed mergers go through, almost half of the hospital beds in the state would be controlled by Catholic hospitals.

There is already an increasing shortage of abortion providers, and abortion clinics are being forced to close across the country as anti-choice lawmakers advance stringent legislation intended to target them. If the health care sector continues to deal with financial pressure by merging secular hospitals with Catholic institutions, women across the United States will have even fewer places to turn to receive reproductive care — even if they didn’t cast their ballot for that position.

Beatriz, a 22-year old El Salvadorian woman who is identified in the press only by her first name, is dying. She suffers from lupus, a chronic auto-immune disease that causes body’s immune system to destroy its own healthy tissue, and her condition typically worsens when she is pregnant. Since Beatriz is now about 23 weeks pregnant, her doctors say she is at “high risk of death” if she continues to carry the fetus — which has no chance of surviving, because several ultrasounds have revealed that it’s missing a big part of its brain and skull. If the deeply conservative El Salvadorian government has its way, however, neither Beatriz nor her baby will survive.

In El Salvador, abortion is illegal under all circumstances — without even a narrow medical exception to save the woman’s life — and punishable by up to 30 years in prison. So even though medical professionals agree that an abortion is necessary to save Beatriz’s life, they can’t actually administer the procedure because they’re too afraid of the legal consequences in the Catholic-dominated country.

El Salvador’s attorney general could grant Beatriz and her doctors protection from prosecution, but he has so far refused to do so. Without any other legal options available to her, Beatriz’s case has made it all the way up to El Salvador’s Supreme Court, which is currently considering whether to grant her permission to receive the health care that will keep her alive. But as those deliberations stretch on, the ultimate decision may come too late for Beatriz.

Fifteen different doctors from the National Maternity Hospital first determined that Beatriz needed a life-saving abortion back when she was 13 weeks pregnant — which was ten weeks ago. She is being forced to keep waiting while the nation’s highest court considers the forensic evidence in her case. Instead of issuing a final decision, the Supreme Court ordered further testing last week, recommending that Beatriz continue with her pregnancy and see what happens. “The delays are unconscionable,” an Amnesty International spokesperson told Al Jazeera.

Women’s health advocates are drawing parallels between Beatriz’s case and the tragic death of Savita Halapannavar, the 31-year-old woman who died in an Irish Catholic hospital after being denied a life-saving abortion. Activists flooded the streets of Ireland after Savita’s death, declaring that a woman should “never again” be denied the health care she needs to stay alive. Nevertheless, in other conservative Catholic countries like El Salvador, there’s nothing to stop Savita’s story from repeating itself.

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