Eesha Pandit's blog

The First of All Liberties: Health Care For All Women’s Needs

2009-11-11T07:00:00-05:00

This article first appeared in On The Issues Magazine and is reprinted here with permission from the editors.

Why care about women’s health in health care reform? I think it’s critical for reproductive justice advocates to also become health care advocates in today’s world, but the reasons why were best captured by the 19th century Swiss poet and philosopher Henri Frederic Amiel. He wrote: “In health there is freedom. Health is the first of all liberties.”

Reproductive justice advocates have a unique opportunity to bring together disparate social justice movements to forge a compelling case for health care reform that meets women’s needs.

The Cost of Fittin In 2009; ©Helene Ruiz

This is a tall order. Health care is a matter of life and death, especially for our most marginalized communities. The U.S. health system is broken. It is hard to access, it is expensive to use, it is profit driven, it leaves vulnerable communities without a safety net. It will take quite a lot to get it where it needs to be, but without the voices of reproductive justice advocates, it will never fulfill its promise: to keep us healthy.

Adversaries Play With Women’s Health

When I heard President Obama’s call to action on healthcare in February 2009, I thought about what true health care reform would mean for the communities that I live in, work in and advocate for. The potential, of true reform, seemed limitless.

The discussion over health care began with five reform plans, each emerging from a relevant U.S. House or Senate committee that has jurisdiction over health care in some way. These will be drawn down into one bill from each house and then, ultimately, one bill from all of Congress that the president will either sign or veto.

In fact, the House of Representatives passed its bill, H.R. 3962, last weekend and the Senate is expected to begin deliberations on its final version of reform soon.

In this entire process of bill writing, there is only one health care service, deemed both safe and legal, that is being targeted for explicit exclusion in some of the bills. That is, of course, abortion.

Since this debate began, an onslaught of opposition to reform has emerged. Opponents have made a clear target out of women’s reproductive health care needs.

The National Association of Evangelicals (NAE) says, “Abortion is not health care. Any health care plan which includes coverage for elective abortion should be rejected. This includes abortion referral, payment for abortion, or the training of medical personnel for abortion practices.”

Furthermore, the NAE battle lines extend to any reproductive health care. It writes: “Persons who engage in behavior which adversely affects their health, such as smoking, drug and alcohol abuse, promiscuity and over-eating, should be responsible for the additional medical liability.”

Yet again, the politics of exclusion are masquerading as the ethic of personal responsibility. The behaviors noted by NAE are a means of differentiating between those communities that “deserve” health care and those that do not. This pattern has occurred before -- in the “War on Drugs,” in “Welfare Reform,” and in countless other efforts to paint low income people, people of color and poor people as not deserving of social services through some fault of their own. It should not taint the effort for health care reform.

Health and Justice

What does it mean to be healthy? Why is it, as Amiel asserted, “the first liberty?”

A measure of health is often made by assessing physical needs. This is central and inexorable. But, as reproductive justice advocates know, it is more, as well.

A woman’s ability to control her body and its reproductive capacity is central to securing overall health. Access to abortion and contraception are the tip of a very large iceberg of needs.

Acknowledging a history of eugenics and population control, the reproductive justice approach aims to ensure that women have all the medical and social resources they need to have children, or not, as well as the right to control if, when and how they become mothers. This awareness, while including access to abortion and contraception, extends to other needs, as well:

1. Maternity care, including pre- and post-natal care and infertility treatment;
2. A range of birthing options including midwives, doulas and alternative care providers;
3. Mental health services;
4. Preventative care, including but not limited to, Pap smears, vaccinations (such as HPV), childbirth education and mammograms;
5. Services that are ethnically and culturally competent;
6. Care that is sensitive to people of all different genders and sexual orientations and addresses their unique concerns;
7. Health care services that are economically and physically accessible to women and their families.

The reproductive justice movement thinks more broadly about the political, cultural, economic, racial, institutional and environmental factors that pertain to bodily health. A reproductive justice-based approach considers not only what illness a woman might have, but also the social factors (environmental toxins, access to preventative care, community health education, and so on) that make her more or less prone to getting sick and more or less able to afford treatment.

This comprehensive approach changes the meaning of “health” rather dramatically. “Health” no longer simply refers to whether or not a person is sick or whether or not a woman can get reproductive health care. Instead, it diagnoses the factors that contribute to, or detract from, overall wellbeing, not merely for a single woman, but also for her family and the community in which she lives. This is what Amiel means, I believe, when he says that in health there is freedom.

From Our Archives: Spring 1994

Reaching Out to Social Justice Partners

A vision of women’s health that utilizes the reproductive justice framework incorporates the leadership of women of color, poor women and young women who can determine their own needs and decipher a course of action based on their lived experiences.

Strategic considerations mean advocating for health care that is not exclusionary on the basis of race, gender, age, sexuality, ability or citizenship. Expanding the current healthcare systems will not be sufficient -- we must acknowledge and actively address the disparities that exist, mobilizing people from allied social justice and human rights organizations to think of “health” as expansively as possible. Finally, we must integrate broad-based grassroots organizing into advocacy and use it to inform our legal strategies.

The past eight years have been tough, and reproductive justice advocates have been stemming the tide of anti-women legislation, holding back the onslaught of regressive policies.

Looking ahead requires a shift in perspective, one that I am just beginning to make myself. It is a shift from defense to offense, from protection to progress.

I consider that we have an opportunity to be visionaries. To actually make changes in the service of our vision. To hold our legislators accountable to our needs. To secure health care as the first of all liberties.

Raising Women's Voices to "Health Czar" Tom Daschle

2009-01-16T08:00:00-05:00

When Tom Daschle and the Obama health policy team sit down to discuss how we can fix our broken health care system, they need to make sure the table is big enough for the multiplicity of perspectives that matter.

Women want more than a White House Summit and C-SPAN broadcasts to meet the needs of our grassroots communities. We want representation in the health policy conversations. We want reproductive health and community health experts to have the chance to weigh in. We want to see midwives and low-income women involved and not simply the insurance industry and big pharma. We want a big table, because we have big problems to address.

This is what women told Raising Women's Voices in two sessions that we held in late December. President-Elect Barack Obama and the transition team asked Americans to get together over the holiday season for community discussions about how to reform our health care system. Raising Women's Voices for the Health Care We Need responded. We called up our friends and colleagues around the country and in New York City to respond to the Obama team's request.

Because we know that women are extremely busy during the holidays, we decided to make it easy for our colleagues who care about women's health issues to join in this important discussion. We held two events with women's and reproductive health organizers and activists.

Our colleagues shared a tremendous amount of wisdom with us, and we, in turn, shared it with the Obama team and Tom Daschle.

What is health care? What should health care be?

In the New York City area, we asked these very questions by organizing a "Drinks with Tom Daschle" session as part of a monthly "Reproductive Health Happy Hour" held at a pub in the East Village. We even brought a cardboard cutout version of Tom so participants could feel like they were talking directly to our incoming administration

Those were the questions we asked. Here's what advocates responded:

For our colleagues working on women's health in communities across the country, we hosted a "virtual" community discussion by telephone. On December 18, we brought together in a conference call 35 women's health advocates from 10 states. Here is what participants asked us to tell the incoming administration.

The Problems: What are the concerns of women? What trends are we seeing?

Many of our colleagues told us about the problems they see in the existing system. While the Obama transition team asked us to choose among five possible issues (a. cost of health insurance; b. cost of health care services; c. difficulty finding health insurance due to a pre-existing condition; d. lack of emphasis on prevention; and e. quality of health care), women told us there was more to address.

They mentioned health disparities, difficulty navigating within a fragmented system and the refusal by some health providers to deliver needed reproductive health care.

"People are not getting the health care they need and deserve," one woman said. "They can't find it and no one coordinates it."

One of our activists said: "Seeing my doctor shouldn't be so complicated."

Another participant cited the enormous number of uninsured Americans and the problems that even those with health insurance have in figuring out how to obtain care: "We have a health industry, not a health care system," she said.

Our participants were also acutely aware of the effect that the economic crisis is having on women, in particular. They cited a number of reasons why women are especially vulnerable to accumulating medical debt:

On average, women earn less than men and have less disposable income, and therefore are more likely to go into medical debt if faced with large medical bills.
Women are also more likely to be employed part time or be employed in the service industry sector, without the benefit of health insurance coverage.
Women move in and out of the workforce to have babies and take care of relatives, thereby losing health coverage.
About one quarter of women receive their health coverage through a spouse's employer, and thus are vulnerable to losing coverage upon divorce or death of a spouse.
Women are more often the head of a single-parent household, struggling to ensure that children receive health care and deferring our own health care needs until they become serious and costly.
Even with insurance, many women find that not all of our reproductive health needs will be covered. Or, we find that deductible and co-pays are going up. Contraception costs, specifically, increased significantly because of the Deficit Reduction Act's effect on low-income women's access to contraception.
Middle-aged women too young to go on Medicare could experience a five to 10-year gap in coverage due to job loss, divorce, family care giving responsibilities or health reasons. These women are especially vulnerable to medical debt as the individual market is unaffordable.
Elderly Americans -- more than half of whom are women -- are so overwhelmed with medical costs that they are skipping doctor visits or medication schedules to save money. Part D coverage gaps, and the failure of the federal government to allow Medicare negotiations with drug companies for Part D coverage, were both cited as problems.

The Solutions: We acknowledged the problems and moved into talking about solutions.

Our participants told us that health care should include:

... all people.

... comprehensive reproductive health care, including birthing options and abortion care

... a strong role for the government

... an well-funded and viable approach to reducing disparities.

Several participants said greater reliance on a primary care treatment model would make it easier for women to find a doctor who could treat them across the stages of their lifespan and could make referrals to qualified providers for specialty care.

They also told us that one way to ensure the diverse needs of diverse groups, is to expand the health care reform policymaking table. They want to see the following people represented:

Experts on the particular health needs of women and the ways that women interact with the health system. For example, researchers from organizations like the Guttmacher Institute and the National Institute for Reproductive Health;
Immigration reform experts to integrate the issue with health care reform, because immigration policies currently are seriously affecting the ability of immigrant women and their families to access health care;
Representatives of the LGBT community, to ensure that health services and the structure of health coverage suits the needs of LGBT families;
Low-income women who have had public health insurance, to serve as experts in the current pitfalls and problems of Medicaid, Medicare and other public programs, and how these problems could be addressed;
Single-payer advocates;
Family practice and primary care providers, especially those with experience treating women's health issues across the lifespan. (One participant noted that "The AMA does not speak for primary care providers!");
A variety of advance practice providers (family practice, nurses, midwives, public health nurses), in addition to physicians;
Pharmacists (not representatives of the pharmacy industry, but rather individual practicing pharmacists and people from pharmacy schools);
Representatives of both rural and urban health care consumers, who can speak to the particular health access issues facing each of these groups.

As you see, women and women's health advocates have perspectives that are critical to ensuring successful and comprehensive health care reform that meets the needs of women. We have and will continue to share our ideas and strategies with the Obama Administration and we expect that health care reform that takes these ideas and strategies into serious consideration will help us achieve reform that meets the needs of women and our families. We're ready to sit down at that big table.

Raising Our Voices for the Health Care We Need

2008-10-13T08:00:00-04:00

Readers: We want you to share your story! In partnership with Raising Women's Voices, an advocacy organization working on behalf of women's health care reform, RH Reality Check is collecting real life stories that reflect how the health care system has impacted real women's lives. We want to hear from you! Share your stories in the comments section of this post and we hope you'll allow RWV to contact you should they wish to use your story in their advocacy efforts. By commenting, you are giving permission to be contacted by RWV.

Pregnancy. Birth control. Aging. Disability. Cancer. Sexuality education.

There are many arenas in which health care is essential to our lives. These are, of course, policy issues. The bills and acts that come before Congress on health care issues are directly connected with women's lives. You see a lot of policy analysis on RH Reality Check precisely because policies affect whether we can get the care we need when and how we need it.

As important as policy analysis, however, are the stories of real women and their families that demonstrate why we need to ensure that everyone has access to quality, affordable healthcare. These voices are critical to the work of Raising Women's Voices for the Healthcare We Need, a partnership between the Avery Institute for Social Change, The MergerWatch Project and The National Women's Health Network. Our policy analyses are based on the stories of diverse groups of women, and are stronger and deeper as a result.

Now RWV is partnering with RH Reality Check to raise your voices. We offer you this space to tell us about your experiences of healthcare. Tell us the good, the bad and the ugly. We depend on you. Your stories have and will continue to enrich our advocacy efforts.

The Question: We have heard for weeks about Sarah Palin's exceptional delivery of her son Trig. As a governor of Alaska, Palin had access to comprehensive health care and many resources and options about how to handle her pregnancy and childbirth. Before, during and after the birth of her son she received medical care and attention that met her diverse needs. Have you all had similar pregnancy and childbirth experiences? Or have you encountered obstacles? What were those obstacles? Could you choose your provider, and type of care? Were you able to take maternity when and how you needed? Tell us. We have a suspicion that there are many different types of stories out there and we think policy makers should hear them.

Here are some stories RWV has already gathered.

A woman from Texas recalls her son's birth:

When I had my son - I had him in Houston - my doctor was a female but had been trained by a very male dominated organization. I had a doctor's appointment because my son was late, he didn't want to come out. I had a doctor's appointment on my due date and she said, "You have an appointment for an induction tomorrow." I said, "No, I don't." And she said, "Yes. You do." ... She said this despite the reccomentdation of her own academy that said inductions were to occurr two weeks after the due date. No one told me [about my appointment], no one got my permission to schedule it. I went to the doctor and told her that if she wasn't going to do it my way that I was going to find someone else to do it... I got told that it was HER responsibility to make sure my child came out okay. And I explained to her that it wasn't her responsibility, he was my responsibility. And that I had spent more time with the nurses than I had with my own doctor... The problem was that I knew she dealt with a lot of low income women, I wasn't exactly high income, but it was the perception that we're not educated enough to understand what's going on with us, so we shold just do what the doctors say. And I think there's a really big misperception that low income people have no idea about their choices and what rights they have. I think sometimes they just get walked over.

A young graduate student tells her story:

I wanted a midwife or a doula for a homebirth. A homebirth nurse was covered by my insurance but not a midwife, and was only covered with a doctor's permission. My insurance provider didn't know what a doula was! I was so frustrated. I wanted the nurse I knew and wanted, not one that was randomly assigned to me. And I needed to ask just the right questions to get the information I needed. The process was so confusing and I didn't receive all by birthing options up front. The options that were told to me were always the ones that made the hospitals some money. Eventually, I wound up going to a birthing center and having a doula, which I payed for myself. This was not my ideal option but was the closest I could get to what I wanted.

Let's raise women's voices for the health care we need. Share your stories - short or long in the comment section. We want to hear from you! While this week our post focuses on pregnancy and childbirth stories, we welcome any health care stories you want to share.

Health Care - Right or Responsibility?

2008-10-10T08:00:00-04:00

"Quick discussion: Is health care in America a privilege, a right, or a responsibility?"

Posing that question during the second Presidential debate, NBC's Tom Brokaw asked the two candidates to reveal their basic views about health care reform in America.

"I think it's a responsibility," responded John McCain. An unsurprising answer from the Senator from Arizona, given that his approach places the burden on individuals to purchase their own health insurance coverage in the open market, albeit with the assistance of a proposed $5,000 tax credit.

He continued, claiming,

"I think it's a responsibility, in this respect, in that we should have available and affordable health care to every American citizen, to every family member. And with the plan that -- that I have, that will do that. But government mandates I -- I'm always a little nervous about. But it is certainly my responsibility. It is certainly small-business people and others, and they understand that responsibility. American citizens understand that. Employers understand that."

Brokaw then turned to Barack Obama, who replied,

"Well, I think it should be a right for every American. In a country as wealthy as ours, for us to have people who are going bankrupt because they can't pay their medical bills -- for my mother to die of cancer at the age of 53 and have to spend the last months of her life in the hospital room arguing with insurance companies because they're saying that this may be a pre-existing condition and they don't have to pay her treatment, there's something fundamentally wrong about that."

Viewers who were participating in a live CNN debate poll responded with an overwhelmingly positive response to Obama's declaration of health as a right. Why?

Today, about 46 million people are without health care, and tens of millions are woefully under-insured. Today, people stay in dead-end jobs just so they and their families can retain health coverage. Today, women are still being denied health care if they've got breast cancer and many others must fight to control their own pregnancies and births.

In this environment, the difference between a candidate who says that health care is "a right" versus one who says that it is "a responsibility" is extremely significant. McCain's attempt to tie the Obama health plan to socialism, in the vein of the "Harry and Louise" attack ads that helped sink health care reform in 1992, isn't garnering the support that he hopes. Instead, the Obama campaign is apparently succeeding in communicating that their plan does not turn health care into a government program, but instead strives to insure that all children are covered and that all adults get quality, affordable coverage.

Both senators noted the "fundamental difference" between them on health care. Undecided voters in Ohio, women in particular, noticed the difference as well and turned their dials toward Obama.

But what does it really mean for Americans, for patients and health care consumers, if health care is a right? If it's a responsibility?

If a responsibility, it could be a personal responsibility or a political one.

A look back at McCain's earlier comments suggests that for him, health care is a matter of personal responsibility. In fact, his campaign has said as much. Back in April, CNN reported:

McCain's policy director, Douglas Holtz-Eakin, told reporters Monday night that as president, McCain would fund public education programs and use "the bully pulpit" to encourage health attitudes among children and adults.

He said a major plank of McCain's health care plan is simply "a focus on personal responsibility, and the kinds of things that can help you get better outcomes just by taking care of yourself.

Apparently, for McCain, health care as a "responsibility" means taking care of yourself. And if health care is instead a right? Let's look at some examples of well-established rights.

Because we determine that everyone deserves the right to a fair trial, we ensure that everyone accused of a crime has access to a lawyer, regardless of whether or not they can afford one. We hold a national system of public defenders and judges responsible for this.

Because we determine that everyone has the right to speak their mind, we ensure that there are public places and spaces for them to do so without threat of harm. We enlist public safety officials and open spaces like our houses of Congress to foster civic participation.

If health care is also a right, then our government has a responsibility to ensure that we can exercise that right -- just the same as the right to a fair trial or free speech. In this way, the right to health care implies a political responsibility, not simply a personal one.

McCain's argument that health care is a personal responsibility offers a complicated type of moralism. In his view, good employers should not be required to provide health care to their employees. They should want to. From a sense of duty and the kindness in their hearts, they will provide health care to their employees. Government's role in all this, per McCain, is to encourage their charity by offering tax incentives.

McCain asserted, "[What] is at stake here in this health care issue is the fundamental difference between myself and Senator Obama. As you notice, he starts talking about government. He starts saying, government will do this and government will do that, and then government will, and he'll impose mandates."

To McCain's accusation, Obama replied, "[The] reason that it's a problem to go shopping state by state -- you know what insurance companies will do, they will find a state -- maybe Arizona, maybe another state, where there are no requirements for you to get cancer screenings, where there are no requirements for you to have to get pre-existing conditions, and they will all set up shop there."

Then Obama pinned McCain's approach to health care onto his approach to the economy, his belief in deregulation and the increasingly evident myth of the trickle down.

"That's how in banking it works," said Obama. "Everybody goes to Delaware, because they've got... pretty loose laws when it comes to things like credit cards. And in that situation...the protections you have, the consumer protections that you need, you're not going to have available to you."

"That," he concluded, "is a fundamental difference that I have with Senator McCain. He believes in deregulation in every circumstance. That's what we've been going through for the last eight years. It hasn't worked, and we need fundamental change."

If Obama's belief that health care is a right wins him increased support from Americans, especially from swing voters, this could herald a major shift in American politics. A shift from thinking of health care as personal responsibility to recognizing it as a right is, indeed, a fundamental change. The fact that viewers responded so positively to Obama's assertion that health care should be a right suggest that the country might just be ready for this change. That is perhaps the most remarkable development of this election.

Women all around the country tell the group I work with, Raising Women's Voices for the Health Care We Need, that health care is a right. They say that they need help in securing this right for themselves and their families. They tell us it is not a mere matter of insurance policies and coverage concerns. Access to health care affects their children, their partners, their parents, their ability to work, to thrive, to take care of their families and themselves. Their very well-being depends on it. If that doesn't sound like the basis of a human right, I don't know what does.

Stem-ing the Debate

2007-11-30T09:18:37-05:00

Embyonic stem cells, a rare and precious resource in the scientific community, are about to get a change in status. Researchers from Japan and Wisconsin have discovered a way to produce stem cells without the embryos. They were able to create the cells by re-programming mature adult stem cells. These mature, adult cells are called "pluripotent stem cells," and can potentially become every other kind of cell, debunking the idea that only embryonic stem cells are capable of this feat.

Currently, federal funds are allowed to be used for those stem cell lines created on or before August 9, 2001, per the Bush administration policy instituted on that date. The new finding is being heralded as the solution to the problem of limited access to stem cell lines. From Richard Hayes of the Center for Genetics and Society in the LA Times:

In general, Republicans have equated medical research using single-celled clonal embryos with murder, while Democrats have promoted state ballot initiatives enshrining human embryo cloning as a constitutional right and committing billions of taxpayer dollars to a procedure that could open the door to socially pernicious applications, threaten women's health and exacerbate healthcare inequities.

Now we have a chance to put the cloning debate behind us.

Hayes goes on to argue that with the cloning debate on the back burner we can get to the matter of addressing the implications of genetic technologies. But before I get to that, a little primer on the new developments:

There are indeed several benefits to this new research finding. Specifically, according to Joshua Trojak, acting executive director of the New Jersey Commission on Science and Technology, the new finding could "make it easier for scientists to collaborate across state lines." Currently, collaborative research among states is challenging given that each state that funds embryonic stem cell research has separate rules, regulation and restrictions. Further, states that have severely restricted or no access to these cell lines are likely to commit funding for research using the new technique.

This might have some negative implications for scientific research if the new technology eclipses current research on embryonic stem cells. According to the Post, Richard Murphy, interim director of the California Institute of Regenerative Medicine , claimed that will be "two parallel tracks of research" involving embryonic stem cells and stem cells derived from adult cells via the new technology. In an effort to make these distinctions clear, NIH Director Elias Zerhouni said research using the new methods would be eligible for federal funds with the "only limit [being] the quality of the science" (Washington Post, 11/22). On the international front, German Research Minister Annette Schavan announced that the German government will double its funding for stem cell research from five million euros, or $7.4 million, to just under 10 million euros, or about $14.8 million.

Assuming that these issues can be reconciled and the procedures are effectively compatible, where do we go from here? There are several critical issues to keep in mind as stem cell research becomes commonplace:

§ Biomedical research for health care advancements must be ethical and responsible to the needs of patients and marginalized communities. Medical decisions should be made by patients based on their personal values, beliefs and community needs.
§ We cannot abandon social justice and equality of care as technologies become readily accessible. There are existing gender/sexuality race and economic disparities that affect health care -- new technologies should aim to close these gaps and not exacerbate them.
§ As genetic therapies increase, we must keep in mind the history of race and gender based eugenic concerns.
§ We must also create and maintain strong relationships with activists in the disability rights community to ensure that their concerns are represented.

As technologies become less controversial and increasingly supported women's health and reproductive justice advocates must keep vigilant watch to ensure that they meet the needs of our bodies and communities.

Polluted Pregnancy

2007-11-06T07:07:54-05:00

Time for our latest hypocrisy watch. In this installment, we're calling out those who claim to care about pregnant women and their developing fetuses, but, instead of defending the well-being of pregnant women, repeatedly succumb to the deep pockets and heavy hands of big business.

According to Andrea Kavanagh, director of the Environment Trust's Pure Salmon Campaign, the National Healthy Mothers, Healthy Babies Coalition's (NHMNBC) recent recommendations for fish and seafood consumption for pregnant and breast-feeding women are "misleading" and a "classic example of industry-driven marketing under the cloak of scientific research."

The guidelines, released earlier this month, recommended that pregnant and breast-feeding women should consume at least 12 ounces of fish and seafood weekly for optimal brain development of fetuses, infants and young children. However, these guidelines conflict with current FDA and EPA guidelines.

In 2005, both agencies issued separate warnings advising young children, pregnant women, nursing women and women of childbearing age to avoid consuming swordfish, king mackerel, shark and tilefish because of high mercury levels. The warnings also recommended that those groups consume no more than 12 ounces of fish weekly and eat no more than six ounces of canned albacore tuna weekly.

Mercury, a highly toxic heavy metal, is particularly dangerous for infants and children, and it can be passed from pregnant women to their fetuses. Consumption of fish is one of the well-established means by which humans are exposed to mercury. Knowing this, why would the NHMNBC support an increase in the advised amount of fish consumption for pregnant and breast-feeding women?

Apparently, the coalition accepted a $60,000 grant from the National Fisheries Institute, a fishing industry trade association, to help fund the research. The coalition, a not-for-profit group with nearly 150 members, including the American Academy of Pediatrics, March of Dimes, and the CDC.

In a move that has angered many of these member organizations, the "researchers who developed the report ... didn't bother to vet its decidedly contentious findings and advice with the coalition's wider membership before public release," Kavanagh writes.

Claim to care about "unborn" children, then actively promote the industries that pollute the environment with toxins that cause serious developmental diseases - it's textbook hypocrisy.

In the past six years, however, we've become accustomed to such schemes and inconsistency. In late 2003, one month after the President and all his men signed the "Partial Birth Abortion Ban," he also signed EPA legislation that would delay implementing mercury regulations, giving utilities corporations more time to cut their mercury emissions. The change purportedly resulted in more children being exposed to nerve damage and developmental diseases, while giving the corporations and industries and easy out. The cost: the health of women and the safe fetal development.

Then, in April of 2004, President Bush signed the Unborn Victims of Violence Act, a bill that creates a separate federal offense if bodily injury or death of a "child in utero" occurs during the commission of certain crimes. He signed this bill claiming that it was in the interest of protecting women and their unborn children, but did not flinch in the following weeks, when he pushed legislation to undercut domestic implementation of the Stockholm Convention on Persistent Organic Pollutants (POPs). These self-proclaimed "friends of the fetus" were making it more difficult, to regulate new POPs as and when they are identified and would have allowed the EPA to ignore treaty decisions when evaluating the safety of new POPs. March of Dimes has warned that "high levels of exposure to pesticides may contribute to miscarriage, preterm delivery and birth defects ... and may affect development of the fetus' reproductive system."

Last year, a Bush Administration proposal to promote pesticide experimentation upon humans drew harsh criticism from legislators. The proposal, inconsistent with federal law, would have allowed manufacturers to conduct testing of pesticides upon both pregnant women and children.

While conservative, anti-choice activists and lawmakers continue to stress how much they value children and families, their lawmakers are consistently granting immunity to industry and corporations whose policies will endanger those very families. While such pundits and lawmakers emphasize the responsibility of individual pregnant women to ensure the safety of their fetus, often at risk of prosecution, they are giving a free pass to businesses that directly endanger pregnant women and their fetuses.

This time, the "selective repackaging of science, combined with slick marketing to sell more fish to pregnant women and women of childbearing age, show the height of corporate irresponsibility," says Kavanagh, concluding that the report is "one fishy marketing scheme that consumers should throw back."

And if our lawmakers allow such irresponsibility, perhaps we should throw them back as well.

Linking Abortion to Crime Reduction in Rio

2007-10-30T08:12:06-04:00

Last week, the governor of Rio made a controversial statement. Sergio Cabral, governor of Rio de Janeiro, claimed that legalizing abortion might help reduce violence in the city, the Kaiser Network reported.

Drawing on the argument made in 2001 by economist Steven Levitt and journalist Stephen Dubner of "Freakonomics" fame, which links a decline in criminal violence in the 1990's U.S. to the legalization of abortion in 1973, Cabral made a case for legalizing abortion. Current law bans abortions, except in the case of rape or to save the life of a pregnant woman. Cabral noted that abortion is accessible to wealthy women, who are able to pay for illegal services. It is low-income women, who often live in areas rife with crime, that are left without any recourse if they need to end a pregnancy.

The governor continued on to claim that in affluent areas of Rio de Janeiro, the number of children per woman is similar to that of Sweden, whereas the number of children per woman in impoverished areas of the city is similar to that of Zambia or Gabon. "That's a factory for producing marginal people," Cabral said to the EFE News Service, again linking abortion accessibility to a decrease in crime, per the "Freakonomics" theory.

The Levitt-Dubner theory goes like this: the major decline in urban violent crime rates have happened approximately eighteen years after the 1973 passage of Roe v. Wade. In states where abortion was legalized earlier, these declines happened earlier. The reduction in the rate of violent crime, according to this analysis, affected the generation of people born after the legalization of abortion. Levitt and Dubner explain this analysis by assessing the reasons that people have abortions: poverty, living in an environment where it is undesirable to raise a child, economic concerns, etc. Now here's the leap: an unwanted child has a greater chance of becoming a criminal. And, Levit and Dubner believe, those unwanted children live in environments that facilitate criminal and violent behavior. Therefore, by legalizing abortion the US a large number of unwanted children, likely to become criminals, were never born, and the crime rate fell.

This theory has been debated and argued from all angles for several years now. Steven Levitt explained the theory further in 2004. For a pithy summary on the main debates and rebuttals, see here. Despite admitting to a couple of mistakes, the authors maintain the relevance of their theory. I don't want to get involved in the causation vs. correlation debate, or sucked into statistical economic analysis. Those debates are better left to economists.

Instead, from the reproductive justice perspective, this theory troubles me for a few reasons, none of which I found on the blogs or in the rebuttals. Given that the argument has resurfaced, this time in Brazilian politics, now might be just the time to mention them.

Steven Levitt has repeatedly asserted that the theory did not aim to have racial implications, especially in response to the outrageous comments made by William Bennett. Cabral, however, implicitly made this issue into a racial one by offering a demographic comparison between Sweden and Zambia/ Gabon in relation to what is going on in Rio. When you talk about poverty and inaccessibility of abortions, are women and families of color merely the relevant demographic because they are disproportionately poor and unable to access abortions, especially if illegal? Not exactly. In addition to being the demographic most affected if abortion is illegal, poor women of color have also suffered from sterilization abuse. They are also most frequently negatively affected by the foster care system. In other words, for poor women of color, the right to have and keep their children is as significant as the right not to. The question on my mind, is one that's missing from the debate as yet: how do these factors affect whether their children become criminals or not? Do they? Are the children of poor women of color who want their kids also more likely to become criminals? It is that last question that I'm sure the supporters of the theory would be uncomfortable making, because of its obvious racist implications. Namely, if women of color who want their kids raise criminals, and women of color who don't want their kids raise criminals then real culprit is not the lack of access to abortion, but the woman of color herself. Somehow, I don't think that's where the theory intended to lead us.

In addition, over 60% of women who have abortions have already had one or more child. The Levitt-Dubner analysis links the propensity to become a criminal with the factors that make women decide they want abortions. On their account, the reasons that women want abortions, like poverty and other environmental factors, are the reasons that people become criminals. According to the most recent Guttmacher report on women in the US:

On average, women give four reasons for choosing abortion. Three-fourths of women cite concern for or responsibility to other individuals; three-fourths say they cannot afford a child; three-fourths say that having a baby would interfere with work, school or the ability to care for dependents; and half say they do not want to be a single parent or are having problems with their husband or partner.

If 60% of these women already have children, are those children more likely to be criminals as well, given that they are being raised in a similar environment that the "unwanted child" would be raised in? Do these reasons, cited most by women who want abortions, line up with the reasons given by Levitt and Donahue? If not, what are the implications for their theory?

Ultimately, in raising these questions I aim to get at one element of this analysis that irks me. The analysis focuses on social factors that result in crime and links it with the social factors that result in women wanting abortions. These factors are not arbitrarily linked. In reality, the fulcrum on which the theory rests is the woman and her life. Poor women, women of color, and women who don't have access to reproductive rights do not live in a vacuum. They live in our communities, and they live in all regions of our countries. Cabral is using this theory to draw attention to the reasons that women need abortions, and the fact that those conditions also foster violence and despair. This is certainly an important claim, and one that needs closer investigation. However, by grounding the need for legal abortion in such a theory, Cabral is obscuring the most important factor of all -- the woman. They need access to safe and legal abortions as well as the entire range of reproductive and sexual rights not simply so that they don't raise criminals, but so that they can have control over their bodies; so that their communities are secure, and so that they and their families might enjoy a life without coercion.

Vote, Run, Win

2007-10-22T08:17:13-04:00

Despite what some people want you to believe, women are not fairly represented in public office. In fact, the US ranks 82nd worldwide in the percentage of women in our legislature. I can't say it more plainly than this: the gains women are making are simply not enough.

Women hold 86, or 16.1%, of the 535 seats in the 110th US Congress. These seats are 16 of the 100 seats in the Senate and 70 of the 435 seats in the House of Representatives. These numbers do not demonstrate equity -- they scream of disparity. In state government, 76 women hold 24.1% of the 315 available positions. Among these women, 45 are Democrats, 28 are Republicans, and 3 were elected in nonpartisan races. For women of color, the situation is worse in statewide politics, where they comprise only 4.7% of the total 7,382 state legislators.

Sixteen percent. Twenty-four percent. Four point seven percent.

We all know, and have known for a long time, that women are not adequately represented in the world of politics. But given that during this election cycle there is a high profile female candidate for President, we might be lulled into thinking that things are improving steadily.

I urge you to stop and consider those numbers. Actually, I encourage outrage at those numbers. The marginal improvements in women's representation are not sufficient. If women are not participating in political life, how can we expect women's interests to be adequately represented in our local, state and national politics? The issues at stake are about equality and reproductive rights, yes. But they are also about poverty, race, children, health care, schools, and the environment. They are issues as varied and complex as the portion of the population they pertain to.

Jennifer Lawless, a professor of political science at Brown University, has researched this problem. She writes,

I've identified three basic barriers women face: family roles, what it means to be a "qualified" candidate and recruitment efforts... We must think creatively about how to integrate family with politics, as well as be cognizant of the double bind that even highly successful, professional women face. We must identify and condemn the kind of sexist behavior that leads women to feel that they must be twice as good to get half as far in the political sphere. But perhaps most easily, realistically, and concretely, we must recruit more women to run for office.

Women win elections at the same rate as men. Yet they simply don't run for office as frequently. Today, though, I offer a bit of encouragement. In the face of these dismal statistics, She Should Run, a project of the Women's Campaign Forum, is taking names. That is, they are taking nominations to encourage pro-choice women, leaders in their communities, to run for elected office.

[T]he She Should Run campaign [is] a comprehensive effort to gather nominations of 1,000 pro-choice women who should run for public office. We are committed to ensuring these women get the essential encouragement they need and to providing them access to key campaign education and resources.

What we need from you are the nominations. Maybe your child's teacher has some excellent ideas about education reform. Maybe your aunt is a tireless community activist. Maybe your lawyer has talked about running for office but never taken the leap. Research shows these women are much more likely to run if someone asks them to.

Ilana Goldman, President of the Women's Campaign Forum, explained the rationale to me. "Women tend to run when asked," she noted. "Especially when they are encouraged by someone close to them, a trusted source. This project is creating a mechanism for more women to get that ask."

The project is not simply about getting women nominated to run, but will also support them throughout the process by offering trainings, educational support, local resources, and state party contacts. Goldman says that they women that of the 875 women that have been nominated thus far, "they have, on average, 20 years of experience and are deeply ingrained in their communities." Given that "women often think they need to have certain professional and skill boxes checked off before getting involved in politics," She Should Run encourages women to harness the skills they already have and acquire the support they need in order to run a successful campaign.

This project is a few months old, and just shy of their goal to get 1000 women nominated. Projects like this one will likely be a critical part of raising women's participation in public life. Such grassroots efforts, focused on the local efforts of women who are committed to improving their communities and ensuring that our laws and policies work for us, are exactly what we should advocate. Beyond tearing down the gender disparity and depressing statistics I mentioned earlier, and instead of supporting the wealthiest and most connected political hopefuls, this kind of organizing brings people with experience, expertise and passion to the forefront. It's great for women, and a perfect example of democracy at work.

Know someone who would be a great candidate? Submit nominations here.

Thinking of running yourself? For a step-by-step guide, see here.

SCHIP: Just the Beginning

2007-10-09T08:49:44-04:00

Last week, President Bush vetoed a proposal that would extend the State Children's Health Insurance Program (SCHIP). SCHIP, instituted in 1997, is a program designed to reduce the number of uninsured children by providing subsidized insurance to children of the working poor.

A little background: Jointly financed by the federal and state governments, SCHIP is administered by the states, which determine the design of its program, eligibility groups, benefit packages, payment levels for coverage, and administrative and operating procedures. The program benefits became available on October 1, 1997 and consisted of $24 billion dollars in matching federal funds over a period of 10 years. Medicaid covers approximately 28 million uninsured children. SCHIP aims to extend coverage to 5 million "targeted low-income" children who are ineligible for Medicaid, typically from families with income up to 200 percent of the federal poverty level. In 2007, this comes to about $41,000 for a family of four.

There is broad consensus that the program has helped reduce the rate of uninsurance among low income children by almost a third (perhaps such a program could benefit adults, whose rate of uninsurance has steadily climbed). Despite this, the number of uninsured children is relatively staggering-- an estimated 9 million (up 600,000 from 2005 to 2006). Some of those are children that were the intended "targets" for SCHIP. It's been a decade and about 30 percent of eligible children have yet to enroll, according to a new government study. For an excellent primer on the specifics of SCHIP and the debate see this issue brief from the Kaiser Commission on Medicaid and the Uninsured.

Now for the politics:Read More... Early this year, emboldened by their gains in Congress the Democrats began an effort to expand the program, based on its successes and keeping in mind its previous bipartisan support. If SCHIP funding levels remain the same, many states run the risk of losing coverage for many uninsured children. In July, the Senate voted to allocate $35 billion over the next 5 years; the House later voted, by a far narrower margin, to increase the program by $50 billion. With funding set to expire on Sept. 30, in mid-September the House and Senate agreed on a compromise bill including the Senate's proposed spending increase, which officials estimated would allow the coverage of about four million additional children. This is the bill that President Bush has just vetoed.

With the House vote at 265-149, the supporters of the bill will likely be unable to override Bush's veto, scheduled for October 18, 2007. In anticipation of the veto, Democratic leaders folded an extension of the S-CHIP program at its current funding level until mid-November into a stopgap budget measure recently passed.

What are the reasons given by President Bush, for vetoing the expansion of a successful program? On Wednesday in Lancaster, PA he said,

"I believe in private medicine. I believe in helping poor people, which was the intent of SCHIP, now being expanded beyond its initial intent. I also believe that the federal government should make it easier for people to afford private insurance. I don't want the federal government making decisions for doctors and customers."

This, of course, is not what SCHIP does. Under it, children are covered by private insurance, and have choices as to which private company they use. "Typically, children have a choice from among competing private health-insurance companies," Stan Dorn, a senior research associate with the Urban Institute, a non-partisan, DC-based research group, said in an NPR interview. "There's no federally specified benefits package. There's no individual entitlement," says Dorn.

There are also other myths, spoken as fact by President Bush, reported on by Julie Rovner of NPR.

Strangely, what is missing in all this coverage of SCHIP is the awareness children's poverty does not occur in a vacuum. We hear nothing about the rest of their families, poor and likely uninsured themselves. Family income and parent's employment status are perhaps the most important determinants of whether children have health care coverage and of the specific type of coverage they have. Children in mother-headed families are less likely to have insurance. As are children whose parents' jobs do not provide adequate coverage for their dependants.

What we have here is not a simple plan to insure poor children; it is a commentary on the state of this nation's working poor, many of whom are women. Poor pregnant women face these discrepancies before their children are born. Low-income women are consistently subject to poor or non-existent pre- and neo-natal care. If the Republicans truly cared about the welfare of pregnant women and the healthy children they hope to have, they would be at the forefront of such legislation.

There are so many people in the US who, despite earning well above the federal poverty level are unable to provide health care for their families and young children. Nonetheless, last week we heard the president complain that SCHIP would cover children who don't need government help. "This program expands coverage, federal coverage, up to families earning $83,000 a year. That doesn't sound poor to me," Bush said in Lancaster. Despite the fact that this is not true (the bill actually places limitations on income level eligibility), it demonstrates the administration's cavalier attitude toward the fact that many families who earn well above poverty levels are also unable to cover their children.

This debate on SCHIP seems to be a harbinger for the bigger debate about national health policy that has already become a staple issue in the presidential campaigns. It is being reported as a debate between two competing visions of universal coverage: federal or privatized. Allowing this framing of the debate is concession to party-politics. Republicans speak the words "socialized healthcare" with such loathing that you'd think it was the plague itself. Democrats are bending over backwards to make sure we don't think that they're actually advocating socialized healthcare. Yet the system of private coverage is disastrous and has left almost 50 million Americans in the lurch. Perhaps we'd gain more ground if we pushed our legislators outside the useless parameters of this bipartisan debate and into a conversation about how to solve the problem that when many people in our country get sick, they aren't able to get better.

Woman vs. Fetus Myth

2007-10-02T08:07:43-04:00

Last week the Missouri Court of Appeals in Kansas City ruled that a pregnant woman cannot be prosecuted for causing indirect harm to her fetus under a state law that allows criminal and civil action against a person who harms a woman or her fetus, the St. Louis Post-Dispatch reports.

In this case, Janet Wade and her newborn infant, tested positive for marijuana and methamphetamine use. The state law says that the life of a human being begins at conception and that fetuses have "protectable interests in life, health and well-being." This law, enacted in 1986, has been used successfully in murder, manslaughter and wrongful death lawsuits against people who have caused a fetus' termination. Here, the court dismissed the charges against Wade because of a clause in the legislation stating, "Nothing in this section shall be interpreted as creating a cause of action against a woman for indirectly harming her unborn child by failing to properly care for herself or by failing to follow any particular program of prenatal care."

As can be imagined, this case brings out some longstanding points on contention about fetal rights and women's health. I'd like to take this opportunity to challenge those who make this into a debate about women versus their fetuses. This false dichotomizing has continued for far too long, and it's time to set the record straight about some of the myths spread by conservative activists who masquerade their contempt for women as concern for fetal rights.

St. Charles County Prosecutor Jack Banas found the MO court's decision devastating. "The way this is decided, essentially, it opens the door for a person who is pregnant to kill the child up until the moment of birth by just literally consuming too much alcohol or too many different types of drugs," Banas said.

This type of assessment of the situation leaves out a very significant component of the debate. Many of the women who Banas would like to charge with murder or manslaughter are not women who want to terminate their pregnancies. They are drug or alcohol addicted and they need treatment, not prosecution. I recently spoke with Lynn Paltrow, executive director of National Advocates for Pregnant Women (NAPW), who said, "Pregnant women have no more power to end their addictions than Rush Limbaugh does his."

This approach of prosecution and not treatment has the inevitable effect of preventing women from seeking the treatment they want and need, in order to have healthy babies. The medical community is in overwhelming consensus on this point, as are advocates working for just drug polices.

"Pregnant women will be likely to avoid seeking prenatal or open medical care for fear that their physician's knowledge of substance abuse or other potentially harmful behavior could result in a jail sentence rather than proper medical treatment." - Report of American Medical Association Board of Trustees, Legal Interventions During Pregnancy, 264 JAMA 2663, 267 (1990).

"Pregnant women should not be punished for adverse perinatal outcomes. The relationship between maternal behavior and perinatal outcome is not fully understood, and punitive approaches threaten to dissuade pregnant women from seeking health care and ultimately undermine the health of pregnant women and their fetuses." - American College of Obstetricians and Gynecologists Committee Opinion 321 (Nov. 2005).

In fact, many of the claims about fetal health and protection are made on the basis of faulty science. The phenomena of crack babies and meth babies are, according to much scientific investigation, fabrications. This is something that many find hard to believe, proving yet again the success of conservative posturing. This posturing effectively sidesteps the dangers to pregnant women by environmental and workplace hazards, not to mention cigarettes and alcohol, to reserve its harshest punishment for women addicted to crack and methamphetamines - drugs found in low income communities and communities of color.

"Throughout almost 20 years of research, none of us has identified a recognizable condition, syndrome or disorder that should be termed ‘crack baby'... We are deeply disappointed that American and international media continues to use a term that not only lacks any scientific basis but endangers and disenfranchises the children to whom it is applied." - From an open letter to the media from the nation's leading medical doctors and scientists. See the entire letter here. See a similar letter regarding "meth babies" here.

With all this scientific consensus, why to conservative lawmakers continue to push for the criminalization of drug addicted pregnant women? These cases are not rare, and despite recent victories, are not going away. Paltrow brings this analysis home, "The fetal rights arguments are made not to advance child health, but to control pregnant women... The idea that illegal drugs are uniquely dangerous is [an argument] based on junk science. It perpetuates a cycle of state power over poor people through the criminal justice system. These cases reflect the power of the state to say, ‘upon becoming pregnant you lose your civil rights.' "

Challenging the abuse of this system amounts to reclaiming both civil rights AND the culture of life. To do this, however, we must adamantly refuse to make this a debate between women's rights and fetal rights. The facts show that these are, medically and socially, the same thing.

For more analysis see:

Punishment and Prejudice: Punishing Drug-Addicted Pregnant Women, By Lynn Paltrow

Women and the War on Drugs by The Drug Policy Alliance

The Constitutional Rights of Pregnant Women, by Jill Morrison of the National Women's Law Center for Feministing.com

Criminalizing Motherhood by Silja J.A. Talvi for The Nation

Just A Hoax? It Resonates for a Reason

2007-09-24T08:47:00-04:00

Rachel, 15, from the Northeast "says she doesn't have to choose between marriage and a career like other girls because being married is the only career she's interested in. She's ready to stand by her man and support him in every way possible." How much will it cost to make her your bride? $19,995.

Makayla, also 15, from the Midwest, is "a traditional girl, a homebody who cooks like a chef and decorates like Martha Stewart. She also has a cheerful, upbeat outlook on life and spends a lot of time laughing. She says she is looking for a man with a sense of humor to take care of." Her cost? $24,995.

If you haven't already heard about the service from which these listings are taken, called Marry Our Daughter, don't worry just yet. It's been exposed as a hoax. It's worth noting, however, that the site certainly managed to fool a lot of people, garnering more than 60 million hits in its first week. Very well done, and awfully realistic, it contains testimonials from satisfied families, instructions on signing up your own daughter and a way to "propose" to those already listed. Claiming to be a "service assisting those following the Biblical tradition of arranging marriages for their daughters," the site has received thousands of angry letters, and - hold on to your seats- has also received thousands of proposals.

Why would someone do this? Site creator John Ordover claims he was trying to draw attention to marriage laws in the states. In the US, laws regarding the legal age for marriage vary by state and often conflict with statutory-rape laws. In cases with parental permission, girls as young as 13 can be legally married in states where the legal age of sexual consent is 17. In Newsweek, Jessica Bennett quoted Ordover:

"This is an issue that people are extremely complacent about, and I said, 'I think I can find a way to get people to care, or at least start talking about it'," Ordover says. He hopes the site will generate controversy and spur outraged readers to pressure their local legislators to elevate the marriage age...

He bills it as "an experiment in Viral Politics" in a letter he plans to send out when he officially comes clean. "If we fooled you or disgusted you, you have every right to be angry at us for what we did. But we ask you to direct that anger energy where it will do the most good: toward those in your state who can change the law, your Governor and state representatives."

This hoax is intriguing for several reasons, but primarily because it's believable. As Jessica Valenti points out, in this world of abstinence only sex-ed and purity balls, many young women are being told to measure their worth in terms of their value as future brides, just as Marry Our Daughter suggests. (For an amusing take on purity balls, see Amanda Marcott's Reality Cast segment.) Their value as young women lies in their virginity and marriageability - and so this website, on some level, strikes a chord.

But on Marry Our Daughter, women don't just land a husband by being appealing virgins - they manage to extract a generous fee for their parents. The cost of ranges from $3,995 to $99,995 per girl, with most around the $25,000 mark. And at first this element of the website might not tip you off - after all, mail-order-bride sites are legal under international law, as long as the bride is of age. But "if the parent is accepting money on behalf of the child, irrelevant of whether the child is of consensual age, it's definitely trafficking"-and would fall under state and U.S. trafficking laws, says Suzanna Tiapula, an senior attorney with the Center for the Prosecution of Child Abuse at the National District Attorney's Association.

What is really telling about the element of monetary exchange is that it wasn’t necessary for Ordover to make his point about the age of consent. Just the fact that parents might agree to get their young, underage daughters married “in the Biblical tradition” would have served to point out that this sort of arrangement would be legal in many states and made the hoax effective.

So then what might we learn from Ordover's inclusion of the "bride price?" Simple. While we don't all know about anti-trafficking regulation, we all know, at some level, that a young woman's social and economic worth is tied up in her sexuality. We know that women make less than money than men, that they face the pressure to be married long before most men, and that they are more likely to live in poverty if they aren't married. Social realities like abstinence only-sex education reinforce these assumptions and link women's worth to their age and sexuality. Young women are denied control of their sexual and reproductive lives by policies and social practices that strip them of their agency. So it makes sense that even if the site would be found illegal if brought to court, many folks didn't blink when they came across a site in which young women were purportedly being sold. This, then, is as much a commentary about the economic and social status of young women in the US as it is about age of consent legislation in our states.

Unanimous Responsible Jurisprudence

2007-09-17T08:30:00-04:00

This Wednesday we were all witness to the responsible judicial reasoning of the New Jersey Supreme Court.

The New Jersey Court has always avoided politicizing reproductive health. This most recent case, brought by a woman who was seeking to charge her doctor with medical malpractice, centered on the claim that doctors should be required to tell any woman seeking an abortion that the procedure would result in "killing an existing human being."

The court rejected this claim by finding, in a unanimous decision, that the plaintiff's doctor had "no legal duty" to tell her that her six-to-eight-week-old embryo was "a complete, separate, unique and irreplaceable human being." Justice Barry T. Albin, in the 5-to-0 decision, found:

There is not even remotely a consensus among New Jersey's medical community or citizenry that the plaintiff's assertions are medical facts, as opposed to firmly held moral, philosophical and religious beliefs, to support the establishment of the duty she would impose on all physicians.

The story goes something like this: Rose Acuna went to see Dr. Sheldon C. Turkish, the doctor who had delivered her second child, in 1996, about the development of a pregnancy. According to Acuna, Turkish claimed that Acuna "needed an abortion because (y)our kidneys are messing you up." Acuna asked Turkish whether "the baby was already there." Turkish allegedly replied, "Don't be stupid, it's only blood." Acuna then signed a consent form, and Turkish performed the abortion. Bleeding continued, however, and seven weeks later Acuna went to a hospital. She was diagnosed with an incomplete abortion and had a second procedure. Now 40, Acuna is claiming that she suffered emotional distress for the death of her unborn child, due to the misinformation given her by Dr. Turkish.

Dr. Turkish contests Ms. Acuna's description of the events. According to court papers, Turkish denied having made the "don't be stupid" remark, saying that he probably told her that a "seven-week pregnancy is not a living human being," but rather that it "is just tissue at this time."

Here, of course, is the real question. It is a baby? Or is it merely tissue? This case brings a pressing political issue into sharp relief: If doctors are supposed refrain from providing moral judgement, where is the line between science and public morality? This case is a harbinger for similar cases pending in South Dakota and Illinois. In South Dakota, Planned Parenthood is challenging a 2005 law that requires abortion doctors to tell women several things, including that an abortion ends human life. Mrs. Acuna's lawyer, Harold Cassidy, is also involved in the Illinois case in which his client alleges that Planned Parenthood of the Chicago Area has deceived women seeking to undergo abortions.

While reproductive rights groups celebrate a victory in which women's health and well-being doesn't succumb to unjustified politicization, some groups are spinning a tale about lies and deceit, and on top of it all calling the decision a "ruling against choice." From Walter M. Weber of the National Review:

The court declared that there was "clearly no consensus" on whether an embryo is, as matter of "biological fact" a "human being." Why? Because there is "moral, theological, [and] ideological" disagreement over the status of unborn children. But Acuna wasn't asking the doctor for "moral, theological, or ideological" information. She wanted the cold, hard, medical facts. Then she could apply her own value system in responding to those facts. The state supreme court admitted that its decision ultimately represented a "value judgment" by the court. One shudders to think what "value" justifies subordinating a woman's supposed right to "choice" to an abortionist's callous and patronizing deception.

This way of framing the issue is very telling - read the article and you'll see some interesting tactics. Portray the doctor as a goon. Portray the woman as a tragic and complacent victim. Twist the language of choice enough so that it's completely unrecognizable.

Ed Barocas, legal director of the ACLU of New Jersey, which filed a friend-of-the-court brief, said, "Today's victory sends a message that New Jersey will not tolerate back door efforts to curtail reproductive rights or free speech...We will not allow the anti-choice lobby to force its moral or theological beliefs upon others." Drew Britcher, a representative of the New Jersey Obstetrical and Gynecological Society added that, "The court struck the proper balance between the law of informed consent and the law that relates to an obstetrician or other physician's duty in advising the person who's pregnant."

This certainly isn't the last time we can expect to see these issues crop up in legal disputes. This is dodgy terrain: Should we tell doctors what to tell women? Or what not to tell them? Advocates of reproductive freedom know very well that this tactic has been used to deceive women in the past. Poor women and women of color especially have long faced sterilization abuse and battled against coercive contraception tactics. Our job is to find a way to differentiate between coercion and adequate information. No easy task, but one that we're clearly going to have to reckon with.

Mind the Gap: Racial Health Disparities Persist

2007-09-10T11:31:19-04:00

I’ve reported before about racial health disparities in the US, and unfortunately, I am back at it. Last week saw the release of several studies regarding racial discrepancies in infant and maternal mortality. In Maryland, the state’s Joint Committee on Children, Youth, and Families found that Black population suffers from higher rates of infant mortality, low birth-weight and teenage births. In North Carolina the infant mortality rate among minorities dropped to a historical low in 2006, but racial disparities between blacks and whites still remain, the Citizen-Times reports.

But it's a study out of Alabama that might be the one that gets at the crux of the issue. The Alabama Department of Public Health released a report that shows a link between birth outcomes and health insurance, as reported by the Decatur Daily. The report, by the department's Center for Health Statistics, examined birth certificates for 60,262 live births, and among other things:

Infants born in Alabama in 2005 were more than three times likely to die in the first year if their mothers paid for their deliveries out-of-pocket than those with private health insurance;
Infants in deliveries covered by Medicaid were 40% more likely to have low birth-weights and 60% more likely to die than infants with private insurance;
White women were more likely to have private health insurance than minority women;
Medicaid covered deliveries for nearly four out of every five births among teenage girls and 40% of births involving women ages 20 to 34;
Private insurance covered nearly 80% of births among women ages 35 and older; and
Nearly all women with private insurance received prenatal care within the first trimester, compared with 74.7% of women with Medicaid.

Now whether Medicaid has merely become a marker for things like education, age, race and economic status, is up to debate. What is clear, though, is the fact that these factors do indeed affect access to reproductive healthcare, and that Medicaid is not a sufficient solution for social inequities.

This, of course was no surprise. The US does not have an enviable record on the matter of infant mortality, which is directly connected to maternal mortality and the status of women in a society. And we already know how important a healthy mother is and many of the challenges they face in securing their own health and the health of their infants.

In a report from Save the Children released this May, entitled State of the World’s Children, 125 nations were ranked according to 10 gauges of well-being -- six for mothers and four for children -- including objective measures such as lifetime mortality risk for mothers and infant mortality rate and subjective measures such as the political status of women. Among industrialized nations, the US was second to last (ranked only above Latvia). Charles MacCormack, president and CEO of Save the Children, said the report "illustrates the direct line between the status of mothers and the status of their children.” He also encapsulated the lesson rather efficiently by saying, “In countries where mothers do well, children do well."

But this seems rather obvious, no? Looking at the studies from Maryland, North Carolina, and Alabama it is clear that access to comprehensive reproductive health care is critical to maternal and infant health. What these studies find, in no uncertain terms, is that in the US race and economic status are relevant factors in whether mother and baby survive. This is a lesson, alluded to by the international studies, that is one our policy makers need to hear. If we want to improve the success of new mothers and their children in the United States, it is a lesson we cannot ignore.

Making Sense of Larry Craig

2007-09-04T08:24:50-04:00

Political scandals are hardly rare, but due to a high-stakes election, these days they are the stuff of which October surprises are made. While scandals of all stripes are relevant in the political discourse, I'd like to focus in on the particular phenomenon that causes us to shake our heads knowingly and with no small bit of disdain: the political sex scandal.

Of late, we've heard about the various meanderings of Mark, Bob, Dave and Larry - quite a cast of characters. Since many political analyses have been offered, each with it's own political spin, I'd like to take a few steps back and think on what be might made of all these scandals. Aside, of course, from the inevitable banter on the political talk shows about the ramifications (read: how many seats lost or gained) and the late night one-liners shooting for cheap thrills (read: Brokeback Bathroom).

The common thread here is, of course, sex. The scandals run the gamut of political parties, even if these days they seem to be plaguing the GOP (who's forgotten M. Lewinsky?). And they run the spectrum of activities - adultery, gay sex, kink, solicitation, pedophilia. Take a close look at my brief list. Only some of these activities are illegal, and depending on your perspective, only some are immoral.

Now, I'm never one to use shame or societal disgrace to chastise anyone's sexual choices, no matter how far from the mainstream they are. Those are the tactics of hate and divisiveness. Those are the tactics that make us fear each other, our own sexuality and our bodies. They never promote understanding and are rarely based on viable concepts of health, harm and bodily integrity.

But those are the tactics often employed, by both parties, to translate these events into votes. The concepts of health, harm and bodily integrity often fall away, when they should be our central means of assessing what we sanction and what we don't. What is it about sex that lends itself so easily to shaming and disgracing? And though it might be effective, is it the solution? What does it mean for reproductive justice if "immoral" sex is the highest dishonor? Granted, often illegal activities are the ones that result in the dishonor, but I'm forced to ask: Do we publicly shame other misdeeds in quite the same way? What about other types of political scandals involving money or drugs? Are those more easily glossed over and forgiven?

I grant that there are many types of scandals that have ended careers and brought shame. But there are a couple of things here that might help us understand what's really going on in the recent spate of Republican sex scandals. Firstly, as Scott Swenson observed, the Republican Party is trying to save face by shunning and shaming its wayward Senators and Congressmen. They are making no attempts to explain away the behavior or minimize the shock. In their opinion, it seems the party base may tolerate something like money philandering, but will never abide a sexual deviant. A clear commentary on how the "family values" platform functions and what is its most significant component. [One article not to be missed, on a possible reading of this, is a great piece from Susie Bright for AlterNet.]

Secondly, the response of progressives has been to point out the hypocrisy within the party's ranks - asserting that they claim to be about family values, yet their own spokespeople do not, and perhaps cannot, live that life. On some counts, the disgust is warranted. Voting against LGBT rights while soliciting gay sex is certainly spiteworthy. On the other hand, sexual deviance itself is not. The distinction is very important for those of us that advocate for reproductive and sexual freedom. We cannot let our disgust for the hypocrisy or lawbreaking be interpreted as disgust for the sexual expression. This is a small but often understated distinction, but as is the case with these types of distinctions, it is the difference between family values and "family values." It is also the perfect way to challenge conservative ethics not on the missteps of its legislators, but on its very principles and foundations.

Amnesty Affirms Limited Pro-Choice Commitment

2007-08-28T08:30:45-04:00

In a move that has garnered both praise and condemnation, Amnesty International (AI) has decided to support access to abortion for women in cases of rape, incest or violence, or where the pregnancy jeopardizes a mother's life or health. The initial decision was taken in April, but was confirmed when the AI international council meeting in Mexico gave it overwhelming support.

Amnesty International officials said the organization would "support the decriminalization of abortion, to ensure women have access to health care when complications arise from abortion and to defend women's access to abortion . . . when their health or human rights are in danger."

The London-based human rights organization was founded to defend and aid prisoners of conscience. Delegates from AI are defending this change as part of a larger global drive against violence, discrimination and abuse targeting women, including rape as a "weapon of war" in conflicts such as the one in the western Sudan region of Darfur.

"There are many human rights issues involved in organized sexual violence targeting women," said A. Widney Brown, Amnesty's senior director for international legal issues, in a telephone interview from New York yesterday.

She said the new policy would not detract from Amnesty's focus on political repression, but added, "We can't as an organization look only at human rights issues that implicate men."

Not all AI members and supporters think this is a good move. A leading British Bishop has resigned. And in a case of rather shaky reporting the Times Online is claiming that pop stars Christina Aguilera and Avril Lavigne affiliated with Amnesty may pull out because of their anti-choice views.

In response to the AI policy shift, the Vatican's Secretary of State, Tarcisio Bertone, said that the Vatican maintains that abortion should not be available to rape victims. AI's response includes a moving explanation of why women's reproductive rights are indeed human rights:

Amnesty International finds it unacceptable for women to be imprisoned for seeking or obtaining an abortion, or for women to be denied access to abortion services even when the UN Committee on Human Rights has held that forcing a woman to carry a pregnancy to term that was a result of sexual violence in armed conflict is a form of torture; and in non-conflict situations cruel, inhuman and degrading treatment. Amnesty International finds the preventable death of 70,000 women per year -- and the denial of medical services in a range of circumstances from ectopic pregnancies to complications from unsafe abortions -- to be unacceptable. These are a violation of a woman's right to life, right to health, right to be free from torture and cruel, inhuman degrading treatment and punishment and the right to non-discrimination.

See more about AI's position on reproductive and sexual health here.

Interestingly, a poll taken by an anti-choice organization in the UK seems to show significant agreement with AI's move:

Do you agree that AI should develop policy to enable research and action to achieve the following:

decriminalization of abortion

access to quality services for the management of complications arising from abortions

access to abortion in cases of rape, sexual assault, incest, and risk to a woman's lie

Respondents replied:

    Yes: 45.4%

No: 45.7%

    Undecided: 8.0%

    No answer: 0.8%

Those numbers are pretty close, and if you look at the other questions it becomes clear that for an organization called the "Pro-Life Alliance," the opposition to Amnesty's decision is decidedly not overwhelming. Perhaps all the press coverage that is reporting Amnesty's position as radical and alienating is off the mark.

While I'm sure we would like to see Amnesty International go all the way and support a woman's right to choose in all circumstances, their new stance is significant for international human rights organizing. Seeing women's reproductive rights as human rights, is not only a deep theoretical shift, but it also gives advocates on the ground international human rights tools they have been denied thus far.