It’s a seemingly triumphant moment to be an abortion opponent. President Trump has filled his administration with antiabortion conservatives, GOP majorities in Congress are friendly to the cause and states across the country are cracking down on abortion wherever possible.

Today, the Senate has teed up a bill banning abortion about midway through pregnancy, based on the idea that a fetus can feel pain. While Senate Democrats are certain to block it, the measure has been passed multiple times by the House and represents the biggest federal legislative push by abortion foes in recent years.

But for activists, their movement’s newfound momentum is also bringing a long-simmering question back to the forefront: How do they move beyond the infighting that has long fractured them internally and unify to maximize the moment?

This question was the subject of heated debate at a private Jan. 17 meeting convened by antiabortion leaders as part of several events leading up to the annual March for Life abortion protest, where attendees grappled over their core mission and even over how to define the term “pro-life." Some participants felt the term should apply strictly to only those people who are against abortion specifically, for fear of diluting the movement's mission.

Others argued "pro-life" should be interpreted more broadly as helping people flourish at every stage of life, including until natural death, through supporting policies or programs that help low-income individuals access health care, food assistance or job training or even by taking a softer line toward undocumented immigrants. Russell Moore, president of the Southern Baptist Convention's Ethics and Religious Liberty Commission, has become a prominent advocate for this view, often telling fellow evangelicals they should also support immigrants who, like the unborn, are "made in the image of God."

Kristan Hawkins, president of Students for Life, which operates student activist groups at around 1,100 schools nationally, said the disagreements at the private meeting were palpable in the room. “I started a huge fire because I started talking about what is our goal as a pro-life movement and what is the definition?” she told me.

Hawkins is in the camp of activists who want to define “pro-life” as specifically opposing the abortion procedure. To her, it’s the only way to bring more diversity into a movement traditionally made up of white, politically conservative Republicans. While 65 percent of Americans  who identify as Republicans say abortion should be illegal in all or most cases, that view is held by just 22 percent of self-identified Democrats, according to a Pew poll last July.

Many of the students her group is trying to reach are politically liberal and find many of Trump’s policies distasteful. Hawkins says the more she can detach the abortion issue from GOP politics, the better chance of winning over these students. She doesn’t even use the terms “pro-life” or “pro-choice” anymore in talking to students because they either haven’t heard those terms or find them too politically charged. 

“Expanding [the definition] limits the number of people we can get to agree with us on this issue,” Hawkins said, adding that “it was really interesting to see the people in the room who balked” at her suggestion to keep the use of “pro-life” narrow.

Abby Johnson, a former Planned Parenthood worker who founded the antiabortion group And Then There Were None, agrees with Hawkins that tying the abortion issue to partisan politics makes it even harder to move the diversity needle.

“I think the pro-life movement needs to do its very best to separate itself from ties to the GOP,” Johnson told me. “We’re closing the tent if we only allow people with a certain collective thought to come together.”

Other abortion foes worry their movement is viewed only as “pro-birth.” Critics charge that conservatives and abortion foes who back Trump policies stripping government benefits from the poor or undermining protections for undocumented immigrants care little about the lives of underprivileged Americans. Religious environmental activists have urged the broadening of the term "pro-life" to include policies that affect water and air quality, which in turn can affect pregnant women and the health of their fetuses.

Abortion rights groups noted that as the March for Life was being held, just down the street Republicans in Congress were refusing to reinstate President Barack Obama’s Deferred Action for Childhood Arrivals and using lapsed funding for the Children’s Health Insurance Program as a bargaining tool in a spending bill.

“If Republicans care so much about the health of women and children, they are welcome to work with us on policy that insures more people, restores funding to [CHIP] and do something to address the obscene rates of maternal mortality in this country,” said Ilyse Hogue, president of NARAL Pro-Choice America.

“We’re here if they want to call about any one of those things, but we won’t hold our breath,” Hogue added.

Even Pope Francis has criticized Trump for claiming to be “pro-life” even as he sought to end DACA, which allowed hundreds of thousands of young undocumented immigrants – brought to the United States when they were very young by their parents – to remain in the country.

“If he is a good pro-life believer, he must understand that family is the cradle of life and one must defend its unity,” Francis told reporters in September. 

Roland Warren, president of the chain of CareNet pregnancy centers, was also at the strategy meeting of antiabortion activists. He’s among those who believe “pro-life” should mean a lot more than just eliminating abortion. Making abortion illegal shouldn’t be the end goal but instead a “tactic” to help people live “abundant” lives, he said.

CareNet centers advise women to continue their pregnancies but then help provide them with resources to care for their babies. Warren, who is African American, says making abortion illegal but then not assisting parents to care for their children is like making slavery illegal but not bringing equal rights and resources to black people.

“The slaves went off the plantations as slaves and went back on as sharecroppers,” he said. “The goal should have been that black people are able to be part of the fullness of what it means to be an American.”

Indeed, there is a sharp and persistent tension between focusing on policies for the unborn – something long championed by Republicans – versus supporting government assistance for women and children after birth, something most Democrats fight for.

And the debate around “pro-life” is just one of the divisions among abortion foes, who have at times butted heads over whether to take an incremental approach against abortion (like passing waiting period or parental notification laws at the state level) or whether to insist on more aggressive legislation (like state laws banning abortion once a heartbeat can be detected). Because activists believe the issue is one of life and death, emotions are high and the movement is often fraught with internal tensions.

“Everybody believes what they’re doing to solve the problem is the right thing to do,” said Erin Brownback, who provides communications consulting to several antiabortion groups. Some activists tend to be suspicious of others who take a different approach, she said.

“That’s why it ends up being fractured,” said Brownback, a distant relative of Kansas Gov. Sam Brownback (R), who will officially resign his seat this week to become the U.S. ambassador at large for religious freedom.

Another big reason for divisions in the antiabortion crowd is the lack of a clear leader in contrast to the abortion rights movement, where Planned Parenthood has risen to prominence. Its leader, Cecile Richards, announced last week she'll be stepping down after more than a decade.

“A lot of people would be in agreement with this idea that Planned Parenthood is a leader in their field, and it’s not clear who the pro-life leader is,” Brownback said.

Brownback, who is working on a PhD in social transformation, has been pitching her clients on strategies based on her research on successful social movements. One of the keys, she says, is telling narratives. Another is finding ways to monetize the movement by finding corporate partners who might be persuaded to spread an antiabortion message.

“We have not leveraged the messaging power of those who make money every time a child is born,” Brownback said. “Think of adoption agencies, charter schools, day cares. We have not built liaisons with them to get them to carry our messaging, knowing they stand to financially gain.”

Yet whatever weaknesses plague the antiabortion movement probably won’t get in the way of more actions by the Trump administration to craft policies deeply pleasing to conservatives, not just on abortion but on religious freedom issues as well (I detailed the actions the administration has already taken in this Health 202).

Activists’ internal angst certainly wasn’t apparent at the March for Life, where attendees clapped and cheered as Vice President Pence introduced Trump as “the most pro-life president in American history.”

“Can we just thank God for giving us a pro-life president back in the White House?” House Speaker Paul D. Ryan (R-Wis.) said.


AHH: Trump has rightly identified the country is experiencing a boom in illegal narcotics production, with seizures of methamphetamine and heroin at the U.S.-Mexico border surging, cocaine use spiking again and the opioid epidemic pushing overdose deaths past 60,000 people annually. But major U.S. cities don't seem to be experiencing the "American carnage" the president and Attorney General Jeff Sessions seem to feel is the result of increased drug use, The Post's Nick Miroff reports. In Atlanta, Houston, Los Angeles and other hubs of the drug trade, the homicide rate decreased last year. Such cities appear to be getting safer even as they are flooding with dope.

Nowhere is this trend more pronounced than in New York City. "Inundated with heroin and fentanyl, the city tallied nearly 1,400 fatal overdose deaths in 2016, a record," Nick writes. "But police reported just 290 homicides last year, the lowest total since 1951 and an 87 percent drop from 1990, when there were 2,245 killings...the odds of being killed in New York City are about the same today as they are in Montana or Wyoming, even at a time of record-breaking narcotics seizures."

Today, Sessions is set to deliver a speech in Pittsburgh on two of his signature issues: violent crime and the opioid epidemic. "He has implemented a tough new charging and sentencing policy, urging federal prosecutors to use every available tool to crack down on violence," Nick writes. "And late last year he announced that anyone who illegally possesses, imports, distributes or manufactures fentanyl — a powerful synthetic opioid — can face criminal prosecution."

OOF: The U.S.-led coalition against the Islamic State says it is revising its guidelines on the use of wireless and technological devices on military facilities. In what appears to be a major security oversight, soldiers who use fitness devices such as Fitbit and Jawbone are revealing highly sensitive information about the locations and activities of soldiers at U.S. military bases, The Post's Liz Sly reports.

The Global Heat Map, an interactive online map published by the GPS tracking company Strava, uses satellite information to map the locations and movements of subscribers to the company's fitness service over a two-year period, by illuminating areas of activity, Liz reports. The map, which shows a pattern of accumulated activity between 2015 and September 2017, becomes almost entirely dark in war zones and deserts in countries such as Iraq and Syria -- except for scattered pinpricks of activity.

"Zooming in on those areas brings into focus the locations and outlines of known U.S. military bases, as well as of other unknown and potentially sensitive sites — presumably because American soldiers and other personnel are using fitness trackers as they move around," Liz writes.

The Central Command press office in Kuwait said it's refining existing rules on the privacy settings to be applied to devices such as fitness trackers and encouraging commanders to enforce existing rules. "The rapid development of new and innovative information technologies enhances the quality of our lives but also poses potential challenges to operational security and force protection," said its statement provided to The Post. "The Coalition is in the process of implementing refined guidance on privacy settings for wireless technologies and applications, and such technologies are forbidden at certain Coalition sites and during certain activities."

OUCH: The Health 202 doesn't believe in flu-mongering, but we gotta admit this year's flu season is shaping up to be the worst in nearly a decade. It’s more intense than any flu season since the 2009 swine-flu pandemic, per the Centers for Disease Control and Prevention; almost 12,000 people have been hospitalized (an increase of 3,000 in the past week) and 37 children have died so far, our colleagues Lena Sun and William Wan report. Officials warn the pediatric death count may approach or exceed the 148 deaths from the 2014-2015 flu season, which ended with 56,000 flu-related deaths and 710,000 hospitalized.

“In California, some hospitals have pitched tents outside their emergency rooms to cope with the crush of patients; some facilities there have flown in nurses from out of state,” Lena and William write. “Doctors have worked double and triple shifts. In Chicago, a shortage of patient beds has left ambulances idling outside hospitals. In New York, state leaders this week issued an emergency order allowing pharmacists to give vaccines to children.”

A flashback: Our colleague Ashley Halsey III writes about the 1918 flu season, which was called “the greatest medical holocaust in history.” Experts believe from 50 to 100 million people died across 15 months, with a crush of deaths over a 10-week period in the autumn of 1918, Ashley writes.

“As the country muddles through a particularly nasty flu season — one that the Centers for Disease Control says has killed 24 children in the first three weeks of January and 37 since the start of the flu season — the 1918 nightmare serves a reminder," Ashley writes. "If a virulent enough strain were to emerge again, a century of modern medicine might not save millions from dying.”


— Tomorrow, President Trump is scheduled to deliver his first official State of the Union address. Happily for The Health 202, more than four in five voters want the president to address his plans for health care, according to a Politico/Morning Consult poll released over the weekend. When asked what issues Trump should discuss, the largest percentage of voters said it's “very important” they hear about improving the health-care system — slightly more than wanted to hear about improving the economy and creating jobs.

Did voters believe Trump when he tweeted he was a “stable genius” a few weeks ago? Most didn't, at least according to the poll, in which 43 percent said the president is knowledgeable (44 percent said he isn't) and 36 percent said he's stable. And it gets worse. Just 35 percent of respondents said Trump is “honest” while 34 percent said he's “trustworthy.”

We're on the lookout for hints about what health-care topics Trumps is mulling over for tomorrow's speech (if you hear any rumblings, please shoot us a note). Meanwhile, advocates for the Affordable Care Act are eager to trumpet all the ways they say Trump has undermined it after a year of attempts by Republicans to repeal and replace it. This morning, the group Protect Our Care will send a memo to allies detailing actions the administration has taken related to the ACA and urging the president to stop attacking the law.

“While the Trump administration and its Republican allies in Congress had some success last year in their partisan war on health care, the Affordable Care Act is still here, and it is working,” says the memo, shared first with The Health 202. “The reason the law survived is simple: the American people made their voices heard last year at town halls, rallies and the voting booth, thwarting the partisan repeal effort in Congress.”


--In a weird twist, there's a possibility that giving states more leeway to enact requirements for Medicaid enrollment could entice more conservative-run states to expand their programs, my colleague Jeff Stein reports. Republican lawmakers in a half-dozen states are launching fresh efforts to expand Medicaid, as party holdouts who had blocked the expansion say they're now open to it because of guidelines from the Centers for Medicare and Medicaid Services allowing states to require non-disabled recipients to work or volunteer.

"In Utah, a Republican legislator working with the GOP governor says he hopes to pass a Medicaid expansion plan with work requirements within the year," Jeff writes. "In Idaho, a conservative lawmaker who steadfastly opposed Medicaid expansion in the past says the new requirements make him more open to the idea. And in Wyoming, a Republican senator who previously opposed expansion...says he's ready to take another look at fellow Republicans' expansion efforts in his state...Moderate Republicans in North Carolina, Virginia and Kansas are similarly renewing calls to take up Medicaid expansion, though it's unclear if there will be quite enough conservative support or whether Democrats would consider voting in favor of work requirements."

--A few more good reads from The Post and beyond:

Like many pot shops in California, the Urbn Leaf in San Diego bulked up its inventory before legal sales began on Jan. 1, stockpiling enough marijuana to last for months because no one knew what the era of legal pot would bring.
Bridgette Adams became famous for freezing her eggs. Then, she tried to use them
Ariana Eunjung Cha, Carolyn Van Houten and Katherine Lee
Health & Science
I went to pull the blankets up and realized I couldn’t move. I tried to scream, but no words came out.
Jennifer Hassan
The Super Bowl champ’s diet is very healthy — just not for the reasons he claims.
The agency said on Friday it was evaluating other animal studies and would retire the remaining monkeys to a sanctuary.
New York Times
Humira represents about two-thirds of AbbVie's revenue.

POST PROGRAMMING ALERT: The Washington Post is hosting an event on the eve of President Trump’s first State of the Union Address, featuring House Minority Leader Nancy Pelosi (D-Calif.), Kellyanne Conway, counselor to the president, and several other lawmakers and political analysts. The program begins at 2:30 p.m. Sign up to get a notification when the event stream begins, which will be live here.  

Coming Up

  • President Trump delivers his first State of the Union address on Tuesday.
  • The Senate Health, Education, Labor and Pensions subcommittee on primary health and retirement security holds a hearing on small business health plans on Tuesday.
  • The House Energy and Commerce Subcommittee on Health holds a hearing on the Compounding Quality Act, including FDA commissioner Scott Gottlieb, on Tuesday.
  • The FDA Opioid Policy Steering Committee is meeting on Tuesday.
  • The Bipartisan Policy Center holds an event on “A Policy Roadmap for Individuals with Complex Care Needs” on Wednesday.
  • Health Affairs holds an event on health spending on Thursday.
  • The Senate Health, Education, Labor and Pensions committee holds a hearing on the opioid crisis on Feb. 8.



This is what happens when sleep paralysis strikes: 

Hillary Clinton made a surprise video appearance at the Grammy's to mock Trump by reading from "Fire and Fury:"

Watch Will Ferrell on SNL playing George W. Bush: