Editor's Note: This article was updated at 10:40 pm on July 14th, 2009 to reflect information provided in a Miami Herald article citing White House sources confirming Benjamin's pro-choice perspective and her clinics commitment to referring patients in need of abortion care. See the entry at the end of the article. The title was subsequently changed to reflect this update.
A further update clarified restrictions on abortion under Alabama law.
Regina Benjamin, Obama's pick for surgeon general, is certainly an advocate for her patients. In 1995 the New York Times reported that one of her patients, Emile Lyons, then 79 years old, called her an angel. He was suffering from an abdominal aneurysm and being rushed to the hospital. As he was loaded into an ambulance, he noticed a familiar face, his family doctor. Benjamin had climbed into the ambulance to ride with him on the 30-minute journey to the hospital in Mobile, Alabama.
Benjamin has impressive credentials for the position of surgeon general. Her general practice clinic, Bayou La Batre, is based in rural Alabama. A woman who has both her M.D. and M.B.A. (the Times profile noted that she made a 250-mile round-trip commute to New Orleans twice a week to earn her M.B.A.), she also has impressive public policy credentials. She worked on Kaiser Family Foundation's Commission on Medicaid and the Uninsured, served on the American Medical Association's Women in Medicine Panel from 1986 to 1987, was president of the AMA's Alabama chapter (the first black woman) from 1997 to 1998, and has served on local and state government health boards. She even made Time's list of young leaders to watch in 1994. She also is the recipient of a MacArthur Foundation "genius grant."
But the announcement of Benjamin as the surgeon general pick was met with silence from pro- and anti-choice groups alike, largely because it remains unknown where, exactly, Benjamin stands on reproductive health and rights. The White House refused to answer questions about reproductive rights at a press conference where they announced her nomination on Monday. She also hasn't worked with Planned Parenthood or the ACLU in Louisiana, and has kept her distance from abortion-related discussions in the press.
In fact, the only statement Benjamin has made on public record about abortion came on the heels of a debate over the American Medical Association's official policy on abortion at a conference in December 1996. The AMA's governing body voted to re-affirm the organization's policy that the "termination of pregnancy is a medical matter between the patient and physician, subject to the physician's clinical judgment, the patient's informed consent and the availability of appropriate facilities."
During the conference, on Dec. 10, 1996 the AMA discussed whether they should recommend training doctors in how to perform abortions. The organization urged doctors to learn "more than just the ethics of it," according to a report by the Associated Press. The report quoted Benjamin, who was then a delegate to the AMA, as saying, "We are adopting a policy that medical school curriculum provide the legal, ethical, and psychological principles associated with abortion so students can learn all the factors involved."
That is the extent of Benjamin's known position on abortion. Some have discussed whether her religion, practicing Catholicism, might affect her position on this issue, but many who identify as Catholic or practice Catholicism also identify as pro-choice. (A poll conducted by Catholics for Choice shows that about three-quarters of Catholics don't believe they must endorse the views put forth by the Pope.) It's hard to tell whether she falls into the more traditionalist camp of Catholics or has views more in line with the majority of more progressive Catholics in the United States.
The state of Alabama, where Benjamin has done much of her work, makes it extremely difficult for women to obtain abortions. While the state's climate regarding choice on its face can't provide clues about Benjamin's own positions, it's worthwhile considering the reality of reproductive health access in her state. Alabama's governor and state legislature are both anti-choice. NARAL Pro-Choice America has determined that 93 percent of Alabama's counties do not have an abortion provider; this includes six of the state's major metropolitan areas. In fact, abortion rate for Alabama women has been falling since the mid-1990s. The Guttmacher Institute reports that the abortion rate was 11.8 per 1000 women in Alabama in 2004, down more than 22 percent since 1996. Alabama has passed laws that ensure contraception for low-income women through Medicaid.
Elizabeth Nash, a public policy associate at Guttmacher, notes that laws in Alabama are extremely restrictive on abortion.
Guttmacher Policy Brief on Alabama indicates that the following restrictions on abortion care were in effect as of January 2008:
- The parent of a minor must consent before an abortion is provided.
- A woman must receive state-directed counseling that includes information designed to discourage her from having an abortion and then wait 24 hours before the procedure is provided.
- Public funding is available for abortion only in cases of life endangerment, rape or incest.
The state will only pay for abortions under Medicaid in cases of rape, risk to the mother's life, or incest; women who choose abortions must have an ultrasound performed with an option to view it. The state also allows the sale of the infamous "choose life" license plates.
But despite the fact that Benjamin has remained largely silent on abortion rights, she certainly advocates for women who are uninsured. According to the results from the Kaiser Commission on the Uninsured to which Benjamin was a consultant, 41 percent of poor women (those at or below the federal poverty line) are uninsured. Of women that qualify as near poor (below 200 percent of the poverty line and excluding those under it) 31 percent are uninsured.
Current president of the Medical Association of the State of Alabama Dr. Jorge Alsip has been a colleague of Benjamin's in various capacities, including occasionally running into her at church, for more than 15 years. He noted that while she doesn't work specifically on women's issues, she has worked on insuring access to underserved areas. "Her clinic's certainly providing care to an underserved community. A lot of times that falls onto women ... so she's supporting them in that way," Alsip said. "Just knowing her and knowing her practice, I think providing health care coverage to the uninsured is going to be at the top of her list, [as well as] eliminating health care disparities and trying to get health care to the underserved areas."
It's certain that, if done right, health care reform will in a broader sense be a win for women. Still, reproductive rights and access to reproductive health services have not been significant parts of the debate over health care reform. In many ways, what Obama is doing with a pick like Benjamin is side-stepping reproductive issues. She is an outstanding candidate with an impressive resume, free of any reference to pro-choice groups. By choosing a woman who rebuilt her rural clinic three times after it was destroyed by hurricanes and fire, pursued a medical degree despite never encountering a black doctor before college and became a strong advocate for the uninsured in rural areas, Obama has offered a candidate that may be difficult to criticize. And in what may be a political bonus for Obama, she also has managed to largely avoid the abortion question in the public sphere. This might be good for the Obama administration, which doesn't want to get bogged down in debates over abortion at the cost of reforming health care, but it does little to improve access to reproductive health services more broadly or abortion care more specifically for women in Alabama....or nationwide.
UPDATE 7-14-09, 10:40 PM:
Regina Benjamin's Bayou La Batre Rural Health Clinic doesn't perform abortions. A clinic employee who declined to be identified said by telephone that patients seeking information about abortions would be referred to providers in the state.
But White House spokesman Reid Cherlin said Benjamin "supports the president's position on reproductive health issues."
Obama supports abortion rights and public funding of contraception and sex education.
Cherlin continued: "Like him she believes that this is an issue where it is important to try and seek common ground and come together to try and reduce the number of unintended pregnancies. As a physician, she is deeply committed to the philosophy of putting her patients' needs first when it comes to providing care."
Benjamin also was a board member of Physicians for Human Rights, an international group that has advocated access to safe abortions in its investigation of human rights conditions in some countries.
