Across the country, legislators propose and pass restrictions on abortion rights and contraception access so frequently that most of them never make the national news. For decades, pro-choice groups have pushed back against anti-abortion laws, but those laws ramped up over the past three years: There have been more abortion restrictions in that short period than in the previous decade. The anti-choice strategy is a piecemeal one, focusing on state-level restrictions to abortion access instead of trying to outlaw the procedure wholesale, and stacking the courts with conservative judges. Or, as the anti-abortion Americans United for Life describes it, "a systematic and strategic state-by-state effort, taking tactical steps that provide incremental gains today while laying the groundwork for much larger gains in the future."

But women's rights groups are fighting back. Last year, Sens. Richard Blumenthal and Tammy Baldwin, and Reps. Judy Chu, Lois Frankel, and Marcia Fudge introduced the Women's Health Protection Act, which reaffirms the Supreme Court holdings in Roe v. Wade, the case legalizing abortion, and Planned Parenthood v. Casey, which upheld the right to abortion and said that states could not place undue burdens on women seeking the procedure. The Women's Health Protection Act limits the ability of state legislatures to curtail abortion access, a crucial step in light of situations like that in Texas, where anti-abortion and anti-contraception laws are closing dozens of family planning clinics, and in Ohio, where politicians are trying to ban insurance coverage of some forms of birth control.

On Tuesday, the Senate Judiciary Committee will hear testimony on the Women's Health Protection Act. Organizations dedicated to health care access and women's rights have been instrumental in supporting this bill, and three of their leaders — Nancy Northup, the president and CEO of the Center for Reproductive Rights, Cecile Richards, the president of Planned Parenthood Federation of America and the Planned Parenthood Action Fund, and Ilyse Hogue, the president of NARAL Pro-Choice America — spoke with Cosmopolitan.com about conservative politicians coming after your birth control, why pro-choice groups are going on a very public offensive about what should be a private decision, and why this act is so crucial.

Why do we need the Women's Health Protection Act given the state of reproductive rights today?

Nancy Northup: In the last three years there have been over 200 restrictions on access to abortion service enacted at the state level. This has created a crisis in the country, and it's hurling us toward returning to the landscape before Roe v. Wade, where women in some states have access and some don't. There are 3 dozen cases going through the courts on a whole range of access issues, so we are probably headed toward a showdown in the Supreme Court on the protection of women's constitutional rights. The Women's Health Protection Act stops the kind of underhanded tactics that are being introduced in the states, where anti-choice politicians [are] trying to do by the back door what they can't do in the front, which is to make abortion illegal.

Cecile Richards: Not only are some of these legislators focused on making abortion illegal, they're making it completely unavailable even if it is technically legal. Down here in the state of Texas, the situation today is case in point of what happens when politicians begin to make decisions for women and their health care. From the vantage point of Planned Parenthood, as the nation's leading health care provider, we're seeing the impact that these kinds of restrictions have on women firsthand in our health centers. It's not only cutting women off from access to safe and legal abortion, but it's ending women's access to basic preventative health care, including family planning. Here in Texas, dozens of health centers were shuttered. Now we're seeing dozens of abortion providers closing down. There are wide, vast areas of the state of Texas where there will be no abortion providers left. The only provider in Corpus Christi, who was already seeing an increased load of patients from the Rio Grande Valley, had to close down his services. And these kinds of restrictions are disproportionately felt by the women who already have the least access to health care overall. The Women's Health Protection Act would help to ensure that women's access doesn't depend on their zip code.

Ilyse Hogue: I'm gonna do a little silver lining: I truly believe that the momentum is shifting. We know consistently that 7 in 10 Americans say they believe in the rights and values stated in Roe v. Wade and they support legal access to abortion. Americans trust ourselves, our families, our doctors, and our neighbors to know our own unique situations more than we trust politicians sitting in a statehouse to legislate the most important decisions of our lives. Seven in 10 Americans support these values, but if you look at governor's races, only 3 in 10 governors do. We have a huge gap between what the electorate wants and what they're getting. That's an advantage for us if we use it correctly.

I get asked all the time, "If we have public opinion on our side and we had the momentum of Wendy's filibuster, why are we losing?" The one reason I point to is because the elected officials who run and win and legislate women's rights out of existence don't run on that platform. They have to bend the rules to make their legislation happen — Rick Perry had to go into special session, in North Carolina they had to attach the bill to a motorcycle safety law, they put them deep in the budget. They know this is a vulnerability. The more we are aggressive to force them to talk about these things, the more we will see the support we saw for Wendy translate into a difference at the ballot box. As people learn about the Women's Health Protection Act, they say, "Thank god." Thank god we finally have a vehicle that starts to reverse the horrific decisions we're seeing at the state level and brings our country back in line with the values we hold dear.

Pro choice signs outside a clinic in the Bronx in 2011. Getty Images

Do you see ambivalence among even pro-choice Democrats in addressing reproductive rights directly and using the word "abortion"?

Richards: Years ago, we really saw a reluctance and ambivalence among candidates when it came to being forthright in their support for abortion rights and women's rights. I believe that has changed pretty dramatically. We've been able to demonstrate that candidates running for office are in a better position when they are for abortion rights and women's rights — it's better policy, and it's better politically. What we saw in the presidential election, in key Senate races, and in the Virginia governor's race was that candidates began to understand that they cannot win without women, and women don't vote for people who want to take away their rights. At Planned Parenthood, one of the things that's been important is to talk about abortion access as a fundamental issue for women that goes beyond this binary pro-choice/pro-life language that has been used for decades. It doesn't reflect how women experience abortion or pregnancy. When you talk to people about whether women should be able to make their own decisions about pregnancy — whether it's to have a child or have an abortion or give a child up for adoption — folks in this country, even in tough states, are overwhelmingly supportive of women being able to make their own decisions. I hope, and what I'm seeing, is that people running for office are speaking more authentically about these issues and getting away from these catchphrases and political jargon.

Northup: One in three women in the United States decides to have an abortion in the course of her lifetime. I always remind office holders that they have any many constituents — whatever party they are, wherever they live — for whom this constitutional right to access safe abortion services was very important to their health and well-being. We are heartened by the fact that there are more than 150 cosponsors on the Women's Health Protection Act, and that number will continue to grow. That also reflects that office holders are willing to look at how there has been a chipping away at the protections in Roe for years, and now that chipping away has turned into a sledgehammer, and their constituents expect them to step up and do something.

Hogue: Change comes last in politics. It's the most risk-averse sphere we operate in, which is why there's so much to be gained from all of the culture work being done right now to destigmatize abortion. We're starting to see more and more elected officials and politicians understand that there is a connection between the laws that are driving abortion restrictions and a stigma around women generally. We see politicians increasingly emboldened to stand up against the whole suite of ideologies that drive not only abortion restrictions but contraception restrictions and give you people like Todd Akin. We see people emboldened to talk about abortion as a part of health care women experience in their lives.

Decades of work have gone into making the word "abortion" taboo. That's not going to change overnight. But what does change that is when you have someone like Wendy Davis speak for 11 hours. And that was a filibuster with narrow strictures; it was not a Ted Cruz "I'm going to stand up and read Dr. Seuss" situation. It was an 11-hour, must speak only on topic, only on abortion — and she was rewarded the way she was. That sends a signal that voters do care about supporting elected officials who are going to stand up for reproductive health care. Abortion is a medical procedure. The values that lead us to fight for equal access to abortion across the country are very mainstream American values: self-determination, freedom, and autonomy.

Northup: The Constitution is on our side on this issue. The Supreme Court has said exactly what Ilyse is saying about a core American value. In Planned Parenthood v. Casey, the court said it's the promise of the Constitution that there is a realm of personal liberty, which the government may not enter. When we remind people that this is the heart of this issue, they are with us.

Richards: We're all trying to figure out the same thing, which is: How do you take a procedure which is so common, so safe, but is such a target and talk about it in a way that is open and takes away stigma and shame? Earlier this month, we got word that NBC refused an ad for [the film] Obvious Child because it used the word "abortion." People immediately pushed back, and NBC was completely unprepared. Whether this was just a mistake someone made or not, the fact that they actually put out a statement that they would take that kind of advertising and not have a policy against using the word "abortion" was an important sign. The efforts we are all making to call out anything, and certainly anything in mainstream media, that treats abortion as a word that can't be uttered, are working.

Hogue: That's similar to what we found when we had the conversation with TED about their refusal to host abortion talks. When we raise the issue in the cultural realm or the political realm, people are quick to respond. It's that they're not used to it being raised.

Pro choice rally on Capitol Hill in 2013. Getty

Reproductive rights groups spend a lot of time defending women's rights from encroachment and attack. Does a proactive bill like the Women's Health Protection Act signal a shift in pro-choice strategy?

Northup: It's been a movement-wide commitment to go on offense. The reason we ended up on defense for so many years is that this is a personal decision people make, so it is reasonable for people to think they should be able make these decisions and not be out there in public day in and day out fighting. But the vicious attacks we've seen in the last three years have necessitated an even more robust response. There has been a coordinated commitment to be on offense on the state level, in the courts, on public opinion, and on the culture front.

Richards: I want to give enormous kudos and credit to the folks pulling us together to say not just what are we against, because we deal with a lot of what we're against every day in the state legislatures, but what are we for. This bill is vitally important, and there are a few external factors that are accelerating this work. One is the fact that the 2010 elections completely realigned this country in the state legislatures and in Congress. Despite the fact that the Tea Party was in theory a party of less government, it's actually for less government in every way except when it comes to your vagina, and then it's for more government in every way. The other piece of it is, abortion is not only a procedure many women in America have, but it's extremely safe. Many of the bills we are dealing with are being done under the guise of being good for women, but actually have dramatically negative impacts on women's health. The TRAP legislation targeting abortion providers [Targeted Regulation of Abortion Provider bills, which shoulder abortion clinics with unnecessary restrictions], whether it's waiting periods or forcing providers to build ambulatory surgical centers or have admitting privileges, which judges have already said have nothing to do with women's health, have been part of a concerted effort on behalf of opponents of abortion to characterize it as something less than safe. That is not true. It's important to not only destigmatize women and their decision, but to set the record straight that this is a very safe procedure, and the legislation is driving it underground and behind closed doors and into the back alleys, where women will be dramatically less safe.

Hogue: A study was conducted in Texas that showed that 7 percent of women needing abortion care in Texas were attempting to self-abort before they got to a clinic. So it's not theoretical. It's actually happening, which is driving a sense of urgency.

Have you also seen a shift in anti-abortion strategy?

Hogue: They have a couple of strategies they are sticking to, one of which is bullying. Part of the reason people have wanted to avoid publicly talking about the issue is because it makes you an immediate target, and the vitriol on the other side is really, really ugly. Another strategy is misleading people in terms of safety and access. State by state, if they can't get a straight-out ban, they make it next to impossible for clinics to be able to operate.

Northup: While they have pushed these targeted regulations of abortion providers bills for years, which regulate the widths of hallways and the length of the grass and whatnot, the recent shift has been along the lines Cecile is talking about — to create this completely untruthful, devious suggestion that one of the safest medical procedures is in fact unsafe and needs to be done in mini-hospitals, which is what the ambulatory surgical center bill in Texas requires. They've also grabbed onto this strategy of requiring that providers have admitting privileges at local hospitals, which sounds quite unobjectionable on its face but is completely underhanded. They know that these hospitals can't or won't comply for whatever reasons, and that abortion providers have very few patients in need of hospital admissions, and so the providers would not be on the roster for getting such privileges. It completely hands over to a third party, a hospital, the ability to deny services to their community. These purported health and safety laws are in fact closing clinics and shutting off services. It is undemocratic, it is untransparent, and it's devious. And it's important for us to ensure that the public sees that's the case and that the courts see through it.

Richards: Not that the whole world changed in 2011, but a lot of it did. That was the first time we ever faced a federal bill to defund Planned Parenthood, which had nothing to do with abortion, because there are no federal funds for abortion — it was about family planning and STD tests. But it was clearly a tactic to go after Planned Parenthood because of our provision of abortion services.

Supporters hold up signs at Cecile Richards speaks at 2012 Democratic National Convention. Getty Images

Abortion gets a lot of airtime, but what other attacks on reproductive rights are you seeing?

Richards: Years ago, we tried to make the case that it's not just about abortion. The politicians who are fighting against abortion don't want women to have access to birth control. It was hard to convince people that was true, but lo and behold, it is. What we have seen has been just incredible. We saw efforts from Congress to shut down birth control access, and thank goodness for Sandra Fluke, who helped demonstrate to the public what was happening. We're seeing it in Ohio now, where politicians are trying to limit the kinds of birth control women can buy and redefining how birth control works. We [saw] it in the Supreme Court decision allowing employers to say they won't provide family planning services because of their personal objections. This is the tip of the iceberg. Abortion gets most of the limelight, but this is about a much more fundamental question: Do politicians have the right to make decisions for women about their childbearing?

Northup: They are pushing complete falsehoods with their argument that IUDs and emergency contraception, which are both important parts of women's choice of contraception, are in fact causing abortions. It is an attack not just on abortion services but access to the full range of good, reliable, effective, contraceptive methods.

Hogue: These people are not actually anti-abortion. If they were, they would join hands with us and fight for universal rights to contraception and sexual health education. What they are is anti-women and anti-science and anti-family. We are doing a lot of work looking at the groups behind the politicians who drive these agendas. We want the American people to understand that, for example, the Susan B. Anthony list that just issued an attack ad on Kay Hagan not only opposes abortion but contraception, IVF, and stem cell research. Jodie Laubenberg, who introduced the 20-week abortion ban in Texas, basically pulled that part and parcel off of Americans United for Life's model legislation. The infrastructure behind the politicians has a very clear agenda, and it's not one most Americans can stomach, much less agree with.

What emerging issues in the reproductive rights sphere should we be paying attention to?

Northup: Over-the-counter access to contraception generally.

Richards: We have several cases in federal court on the question of admitting privileges, which in these decisions will mean the difference between women in whole sections of the country having access to safe and legal abortion or not. But I do think the attacks on birth control are going to continue. The other piece of this is, I'm sitting here in Texas, and we're going to be down to seven or fewer abortion providers in the state by the fall. We are only now beginning to see the importance of covering the real impact on the lives of families in this country who don't lose a legal right, but lose access to a legal procedure.

Hogue: Maybe to end on a positive note, we should also be watching for more initiatives like the Women's Health Protection Act. I really do see people mobilizing all over the country not just to fight bad bills but to actually promote and protect and expand women's reproductive rights and freedoms. We've seen it in legislation in New York, Washington, and Colorado. We need to keep an eye on strategy, as we [just saw] two decisions come down from the Supreme Court that go straight to the heart of safety and access. We know that the anti-choice lobby has been really smart about looking at the courts. We are starting to see the pro-choice majority in this country say, "Hey, the constitutional question here has been decided, and the courts are supposed to be a pathway to justice and not a way to power the war the right is waging." We are looking at a lot of litigation in the next 10 years, and so we are going to be paying close attention to make sure that judges who get on federal courts are committed to upholding the Constitution and the rule of law as opposed to putting their own ideology first.

Northup: Where this has to end is with stronger legal protections. Either the Supreme Court has got to be clear in their next case, which is coming, that Casey meant to have strong protections and these states are violating them, or Congress is going to have to step up with the Women's Health Protection Act. But one or the other has to happen if we're going to get away from this situation where your zip code determines your rights.

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Jill Filipovic senior political writer Jill Filipovic is a contributing writer for cosmopolitan.com.

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