Item: An article in Politico, describing the Catholic Church’s role in the passage of the controversial Stupak-Pitts amendment in the House health reform bill (which massively restricts the possibility of abortion coverage by private insurance companies) states: “Success in the House came after the Church ran a classic lobbying operation: deploying paid staff to Capitol Hill, tapping influential bishops to make private appeals to key congressional leaders and distributing bulletin inserts to 19,000 parishes with easy instructions—and sample wording—for sending a message to local representatives.”
Item: From a recent Washington Post story: “The Catholic Archdiocese of Washington said… that it will be unable to continue the social service programs it runs for the District if the city doesn't change a proposed same-sex marriage law, a threat that could affect tens of thousands of people the church helps with adoption, homelessness and health care.”
Item: 143 Catholic and evangelical leaders recently signed a manifesto stating their intention to disobey laws with which they disagree on abortion and gay marriage. As the manifesto states,
“We pledge to each other, and to our fellow believers, that no power on earth, be it cultural or political, will intimidate us into silence or acquiescence.
What to make of all this? The Republicans’ intention to run their campaigns on bread and butter issues, especially taxes, suggests that the long and successful run of electoral victories based on abortion and other “hot button” social issues may have run its course with a public deeply concerned about the economy. At the same time, as the above examples show, conservative Catholic and Protestant clergy have apparently decided to significantly ramp up their own direct involvement in politics.
In particular, the Catholic Church‘s aggressive role in promoting the Stupak amendment has drawn concern from both Catholics and non-Catholics alike. The group Catholics for Free Choice has decried the seeming willingness of the Bishops to let the entire health care bill –historically a key priority of the church— go down in flames if the abortion fight does not go their way.
Others point to the Church’s disproportionate focus on abortion in the health care reform deliberations and its corresponding neglect of immigrants’ access to health care. The Politico article quotes one of the Catholic legislators lobbied by the Church as saying the efforts of the Church’s lobbyists regarding immigrants were “not even close” to those on abortion.
Most fundamentally, however, the Church’s recent political activism on both gay marriage and abortion raises disturbing issues about the current state of play regarding church/state separation in the United States. The U.S. is neither a “Christian nation” as fundamentalists like Pat Robertson have long-declared it to be, nor one where its citizenry should be ruled by Catholic teachings, as the Bishops appear intent on achieving. But evangelical Protestants have long been tied to the Republican party. With Democrats in power, the Catholic Church is inevitably more influential at this moment, given its historical support of many of the issues favored by Democrats (with abortion being a glaring exception). As if the coming deliberations in the weeks and months ahead over health care reform were not complicated enough, these negotiations also challenge the Democratic Party to reaffirm a strong commitment to church/state separation.
Its not like we haven’t experienced this type of church/state dilemma before. During the Depression years Eleanor Roosevelt, aware how devastating unwanted pregnancies were to impoverished families, and impressed by the efforts of Margaret Sanger, lobbied her husband, Franklin D. Roosevelt, to support birth control. FDR refused, afraid of alienating urban Catholics, an important part of his New Deal coalition.
But that was then. Now, those who support reproductive justice are a crucial part of the Democratic base. Moreover, Catholic voters make use of contraceptive and abortion services at about the same rate as other Americans. Democratic leaders will be doing both the right thing, as well as the politically strategic one, if they keep religion out of public policy.
]]>This article appeared in the Fall 2009 issue of Ms. Magazine and is reprinted here with permission from Ms.
“Our medical experts have determined that your life was not in danger and you could have carried the pregnancy to term. And, by the way, you owe us $9,000.”
Her voice
breaking, D.J. Feldman, a Washington, D.C. federal employee, recently
spoke to the press about her struggles with her insurance company after
she aborted a much-desired pregnancy because of a fetal diagnosis of
anencephaly (the absence of a major portion of the brain, skull and
scalp). The insurance would only cover abortion in the case of rape,
incest or a threat to her life, so the fact that if Feldman had
continued the pregnancy, it would have been both physically and
emotionally grueling—resulting either in a fetal demise, a stillbirth,
or a live birth of a newborn who would quickly die—had no effect on the
insurance company’s decision.
The primary culprit in this situation is not really Feldman’s insurance carrier, however, but the U.S. Congress. For decades it has imposed such unconscionable restrictions on abortion coverage for federal employees, as well as on women in the military, Native Americans using government provided health facilities and women on Medicaid in a majority of states.
Feldman is speaking out now because of her outrage that the notorious Stupak-Pitts amendment to the House health reform measure would extend such federal bans on abortion coverage to the millions of women who are enrolled in the private insurance market. Under this amendment, any insurance plan that wishes to be part of the new national health-care exchange would be prohibited from offering abortion coverage, although most insurance plans currently offer this coverage.
As Nancy Northrup, president of the Center for Reproductive Rights, which organized the press conference at which Feldman spoke, put it: “The ban on abortion coverage represents an enormous and unprecedented incursion into the terms of the private insurance market….Stupak-Pitts would regulate abortion coverage for people working for private employers or those who are self-employed.”
The press conference also featured a television advertisement that has just been produced by the Center which effectively points to the unfairness—if not the absurdity—of such a ban. The ad will run on MSNBC, other cable stations and media websites.
As traumatic as D.J. Feldman’s story is, she acknowledges that she is more fortunate than many other women in her situation, since she and her husband were able to pay for her abortion themselves. But she doesn’t want other women forced into a similar situation, especially those without extra financial resources. Feldman has not only spoken to the press but also visited various Congressional offices to speak against Stupak-Pitts. “I realized I had a moral obligation to speak out,” she said.
]]>"It comes down to who is the patient. Is the woman the patient, or is the fetus the patient? One or other is the patient. I've never heard a fetus talk to me. I've heard thousands and thousands of women share their pain, their desperation, and their hopelessness."
These words were spoken to me some twenty years ago by Dr. George Tiller, as I was researching a book on abortion providers' experiences before and after Roe v Wade. Tiller, who was brutally assassinated in his church on May 31, was one of the most compassionate-- and feminist-- individuals I have ever encountered. "Trust women" was his well-known motto, prominently displayed at his clinic in Wichita, Kansas.
He was asked repeatedly by friends how he could continue his work in the face of the unending violence and legal harassment that he endured in the years leading up to his murder: his home and office were frequently blockaded (I recall hearing that he and his wife had to be helicoptered out of their house to attend a child's wedding, as antiabortion fanatics were surrounding his home); he was shot in both arms in 1993; and he was subjected to numerous lawsuits brought by a grandstanding anti-abortion Attorney General in Kansas and by Operation Rescue operatives, all of which he ultimately won, but which took a huge toll, financially and emotionally. His answer was always the same: "Where else can these women go?"
Tiller's answer was not a rhetorical one. He was one of the very few physicians in the United States who provided abortion care well into the third trimester of pregnancy. It is this fact that made him so reviled in antiabortion circles, and unquestionably the most controversial abortion provider in the country. Operation Rescue relocated their offices to Wichita a few years ago, with the specific intent of closing him down. Each day, the women who came to him from all over the U.S., and from abroad as well, had to go through a gauntlet of protestors holding grotesque posters and screaming about "Tiller the baby killer."
It is hardly surprising that antiabortion zealots would find Dr. Tiller such a convenient target, focusing on his late term procedures. What has been more surprising, and disappointing, to me has been the inadequate coverage of Tiller's work in most of the mainstream media in the days since his murder. I myself have spoken to a fair number of reporters, have read numerous stories from papers across the country, and consumed a great deal of television and radio reporting on this event. I have been struck that although all reporters mention that he offered late term abortions, as a way of explaining his notoriety in antiabortion circles, remarkably few of these print or radio and television journalists explained why Tiller did this, and who actually were the recipients of these procedures. The fact that so many of those reporting on Tiller were so oblivious of the circumstances of his patients is in itself a powerful indication of the marginality of both abortion providers and patients in American culture.
In simplest terms, many of those who came to George Tiller's clinic for late second or third trimester abortions were women (and their partners) who were carrying much wanted pregnancies that had gone horribly wrong. These were women in many cases who had already set up cribs and had baby showers. Some of these women had fetuses with heartbreaking anomalies, that were discovered only later in pregnancy, such as anencephaly, a lethal birth defect in which most of the brain and parts of the skull are missing. Other women had themselves become very ill in the course of a pregnancy, such as the onset of cancer, which demanded a course of chemotherapy. Tiller, himself a practicing Christian, had set aside a space in his clinic -- a Quiet Room -- for grieving parents, who could if they wished, be counseled by a chaplain on staff, and participate in a baptism or other blessings for the lost pregnancy.
In a perceptive piece written immediately after Tiller's death, the journalist Michelle Goldberg points out the irony that many of the procedures that he performed, for wanted pregnancies that had gone terribly wrong, "are as far away from the much-reviled concept of 'abortion on demand' that one could get... Almost anyone of childbearing age could end up needing Tiller's services."
To be sure, not all of the abortions that Tiller performed were for difficult medical situations. Some were for wrenching social situations. Tiller was commonly referred to as "Saint George" within the abortion providing community, not only because he persisted in his practice for so long in the face of constant threats, but because he took on cases no one else would. To relate just one of numerous instances I have heard, a clinic director in the deep South was faced with a situation of a young girl, brought to the clinic by her mother: "a very pregnant eleven years, blond, blue eyes, and small... too far in the pregnancy for us to help." The girl had been raped by a relative. The solution chosen was a familiar one in the abortion providing world. The clinic staff donated money to the indigent family for travel expenses, sent them off to Wichita, and Tiller performed her abortion for free.
Why did Dr. Tiller receive a constant stream of referrals from his colleagues across the country? Why are there only one or two other doctors remaining in the U.S. who have a practice similar to his? The answer lies in a combination of highly restrictive state laws and hospital regulations governing later abortions, inadequate training opportunities for these more complex procedures, and, of course, the kind of unbearable scrutiny that likely awaits anyone willing to undergo this work.
In the wake of this horrific murder, many have rightly called for a more widespread condemnation of the violence that has plagued the abortion providing community for years. As Gloria Feldt, former president of Planned Parenthood aptly put it, "George Tiller needs more than candlelight vigils," and his death demands "massive outrage" from all sectors of society, particularly political leaders.
But I also believe that another response to this killing must be to demand that the mainstream medical community acknowledge the reality that there will always be some women who need abortions later on in pregnancy. Local medical institutions must make provision for these cases -- especially since these women can no longer be sent off to Kansas, out of sight and mind of "respectable" doctors and hospitals. In the abstract, late term abortions are understandably distasteful to many. When considered in the context of real women's lives, however, these procedures are essential. This is what George Tiller understood. This will hopefully be his legacy.
This piece was originally published in the Beacon Broadside.]]>
"Each generation has its own favorite brand of horror stories. Its own special set of circumstances that prick its conscience and goad it to action."
These words were written by the historian David Rothman 30 years ago, in an essay called "The State as Parent." Rothman's argument is that Progressives of the early 20th century saw the social ills of that period -- desperate poverty which led to children begging on the streets and widows having to place their children in orphanages, unregulated workplaces that were both unsafe and exploited child laborers -- as issues that cried out for state intervention. But progressives (with a small "p") in the 1970s saw too much state intervention as the problem. The horror stories for the latter were the threat to individuals' and families' autonomy, because of the social policies of confining against their will those who were "different" -- the mentally ill, or the homeless -- or the too quick willingness to transfer children from parental to state custody because of dubious charges of neglect.
Rothman's intriguing formulation leads me to ask myself, At this moment, what are the emblematic "horror stories" demanding action for reproductive justice activists? For the dismal period of the Bush years, the horror stories have been endless, and are well known. The glue that tied all the Bush-era reproductive atrocities together -- from the global "gag rule," to the unqualified ideologues appointed to crucial government positions, to the provision of health care to fetuses but not to the pregnant women carrying these fetuses -- was the commitment to reward the Religious Right fanatics that made up the President's base.
But as we enter a new era, with the end of the Bush presidency coinciding with the worst economic crisis since the Great Depression, I see different types of reproductive horror stories emerging. These stories transcend the abortion divide. They speak squarely to the economic devastation facing Americans across the political spectrum, and how this crisis impacts people's reproductive lives. Three recent items in the news serve as examples.
The first is the story of Starla Darling, a pregnant Ohio woman, who was informed she would soon lose her job and her health insurance. She rushed to a hospital, requested a medication to induce labor, and had an emergency Caesarean section, two days before her health insurance expired. Not only was Darling upset about having a C-section birth -- "I was forced into something I did not want to do" -- her insurance company refused to pay for the birth. Now this unemployed woman, two months behind on her rent, is facing medical bills of more than $17,000.
The second story, from the Wall Street Journal, concerns the increase in women seeking to donate eggs or serve as surrogate mothers, a rise attributed to economic hard times. "Whenever the employment rate is down, we get more calls," said an said a spokeswoman for an agency in Chicago, who reported a 30% rise in calls. "We're even getting men offering up their wives."
One of the most high profile recent cases of women using their eggs and uteruses to cope with economic difficulties came to light in a much-discussed New York Times magazine story of a Times writer who hired a middle-class woman, from a two-earner household, as a surrogate mother. The story revealed that the woman who served as a surrogate was doing so to help pay for her daughter's college tuition. The daughter in turn was contributing to her college costs by selling her eggs.
These stories are particularly striking to me because in each case, the economic crisis is driving women to do things with their bodies that they otherwise would not do (a phenomenon, of course, that always rises in economic hard times). True, some women prefer elective C-sections to vaginal birth, but Starla Darling clearly was not one of them. With egg selling and surrogacy, the motivations are always a little murky -- is it altruism and/or a desire for financial compensation? -- but the current spike in inquiries is making clear that many women are now drawn to this option because of the latter, and that seems the case with the mother-daughter pair mentioned above.
What other kinds of economically driven reproductive horror stories might we expect in the immediate future, as more people are thrown into poverty?
The main lesson for reproductive health scholars of the Great Depression of the 1930s was the dramatically lowered birth rate (in an era in which both contraception and abortion were illegal). We can speculate that the period just ahead will similarly be one in which people will try desperately to limit family size. There will be more demand for both contraception and abortion. There will very likely be a rise in attempts at self-induced abortion, as women find that they can't afford to pay for the procedure, or, depending on where they live, simply can't afford to get to an appropriate facility.
Sadly, some people will miss the opportunity to have the number of children they wish for. Even more sadly, some will likely forego childbearing altogether. A higher proportion of children will be born into families that will not have the resources to adequately take care of them. Incidents of infant and child abandonment, even infanticide, may well rise.
The challenge facing the new Obama presidency with respect to reproductive justice is therefore a complex one: undoing the many limitations on contraception and abortion put in place by the Bush administration and making it possible for the economically distressed to have a full range of reproductive options, including having and raising children. Hopefully, in the early 21st century, we will rediscover what Progressives concluded 100 years ago -- that times of massive economic dislocation call for an activist government which helps people have the family lives they wish for.
]]>Ultrasounds have become one of the key weapons of anti-abortion legislators. A number of states require abortion providers to make ultrasounds available; a handful of others make viewing mandatory, but Oklahoma is the first state, according to the Center for Reproductive Rights, that requires a woman to hear the description of an ultrasound image.
The Oklahoma law has the added perverse feature of preventing a woman from suing her doctor if he or she intentionally withholds other information about the fetus, such as an anomaly. So, women are forced to hear something they may not choose to hear, but are not entitled to information that would be presumably of critical importance to them. Such is the state of public policy when it is in the hands of anti-abortion fanatics.
The Center has filed a challenge against the law, on behalf of a clinic in Tulsa, Reproductive Services, arguing that this law "profoundly intrudes upon a patient's privacy, endangers her health, and assaults her dignity."
This Oklahoma law is particularly interesting to me, because I am in the midst of writing a book on contemporary abortion provision. I have been of course documenting the many assaults–-physical, legal, and cultural-–on abortion providers, but I also have been writing about what constitutes good abortion care. After interviewing and observing numerous providers, and participating in their listserv discussions, I realize that one of the core principles of this field is that all women can't be treated alike. One-size-fits-all policies just don't make sense, given the different needs and backgrounds of abortion patients. I have been continually struck by the accounts I have heard of providers attempting to "meet the woman where she is at," to quote a phrase frequently used in this field.
For example, the fact that abortion providers are predictably appalled by the Oklahoma law does not preclude their recognition that some abortion patients do in fact wish to see their ultrasound. And these women's requests are honored. Common sense.
But it is not common sense-–or common decency-–that is driving the Oklahoma legislators who passed this law. Rather, the intent here, as with so many of the hundreds of anti-abortion bills that have been passed, is to harass patients and make operations difficult, if not impossible, for the provider community. In the case of Reproductive Services, the clinic challenging the law, the legislators may be successful. An article in the Tulsa World quotes the administrator of the clinic saying her facility will probably not be able to survive financially if this law is upheld, because of the added costs. The clinic, incidentally, also provides contraceptive services and adoption counseling and referrals.
As one of the wisest women I know in the abortion providing community frequently says, when confronted with such blatantly cruel legislation, "Dude, where's our country?"
]]>This post first appeared on the Beacon Broadside.
So an administration that has done everything in its power to oppose abortion-making sure its appointments to the Supreme Court and other key positions are reliably anti-abortion, signing a bill banning a rarely used but sometimes medically necessary abortion procedure and so on -- now goes after the main thing that can prevent unwanted pregnancies? In true Chelm-like fashion, this Administration is proposing a policy that virtually assures there will be more abortions.
Specifically, the proposed rule advocates a dramatically broadened interpretation of the Weldon Amendment, a 2004 measure which prohibits recipients of federal funds from "discriminating" against individuals or institutions who refuse to provide abortion services or be otherwise involved in abortion care, including referrals. Here is the wording from HHS [pdf]: "the Department proposes to define abortion as any of the various procedures- including the prescription and administration of any drug or the performance of any procedure or any other action-that results in the termination of the life of a human being in utero between conception and natural birth, whether before or after implantation."
This definition of when pregnancy begins -- and therefore what constitutes an "abortion" -- is at odds with a longstanding consensus within the medical community which defines pregnancy as beginning with implantation into the uterine wall, and not fertilization. Jessica Arons, in an excellent posting on Science Progress, points out a number of compelling scientific reasons why implantation is the medical marker for pregnancy: there is actually no way to know if a woman is pregnant prior to implantation; fertilization itself is a process that can take up to 24 hours, and anywhere from one third to one half of all fertilized eggs never begin or complete implantation.
But this HHS proposal of course is not about science, but about politics. This proposal, if implemented, could potentially wreak havoc with the country's family planning programs for low income women and teens, dissemination of Emergency Contraception in hospital ERs, and the ability of women in various places to pick up their monthly packet of birth control pills at their local pharmacy, to name just a few. The proposal very cleverly speaks to two main policy objectives of the Religious Right: to change the cultural -- as well as bureaucratic -- understanding of contraception, and to further the cause of "health worker refusals" -- the growing movement of individuals who withhold access to various medications and procedures with which they have political disagreement.
How did we arrive at such a surreal and backward turning moment in public policy, nearly 50 years after the discovery of oral contraception- an invention, in the words of Economist magazine, that "defined a century" -- and more than 40 years after the Supreme Court, in the Griswold decision, legalized birth control? Not so long ago, contraception was seen by many politicians as "common ground" between the supporters and opponents of abortion. One of the most enthusiastic supporters of Title X (the leading government program that funds family planning services for low income women and teens) when the program was established in 1970, was George H.W. Bush. Then a Congressman from Texas, he was nicknamed "rubbers" because of his promotion of contraception.
But this common ground approach did not last long after the election of Ronald Reagan in 1980, and the rise of the Religious Right as a powerful force in the Republican Party. Rightwing extremists began to reframe contraception as "supportive of the abortion mentality," and not as something that actually might reduce the need for abortions. Opposition to publically funded family planning, as well as abstinence-only sex education (programs that are forbidden to even mention birth control methods, except to give misinformation about their effectiveness) joined abortion as key domestic targets of these religious conservatives. The elevation of contraception to actual abortion status was a logical next step in a presidential administration that has often shown contempt for scientific findings when they are inconvenient. (Think of the Bush administration's record on climate change).
Meanwhile, just in the last few days, the highly respected Guttmacher Institute, which specializes in reproductive health issues, issued a report stating that without the publically funded contraceptive services currently provided to seven million women each year, the number of unintended pregnancies and abortions in the U.S. would be 50% higher. In other words, 1.4 million pregnancies and 600,000 abortions are averted each year because of these programs.
The Religious Right for years has tried to get rid of Title X altogether, and has managed to keep the program greatly underfunded. The HHS proposal, if it went into effect, offers a new line of attack: Title X sites would quite likely be faced with an orchestrated campaign of applications by religious conservatives who would invoke their newfound right to refuse to dispense contraception.
It is not clear, as of this writing, what will be become of the HHS draft proposal. Predictably, the reproductive health community is appalled and the Religious Right is thrilled with the prospect of it becoming policy. The Bush administration could order this regulation to be implemented- which would not require Congressional approval. The next president, if he is so inclined, could overturn it. Barack Obama has joined with lawmakers from both parties in a letter of outrage to HHS. John McCain, on the other hand, has "declined to comment" on the matter. One hopes that the 98% of heterosexually active women who have used at least one contraceptive method will note these differing positions. Chelm is charming as folklore, not as reality.
]]>This article first appeared on the Beacon Broadside.
McCain appeared incredulous that Bush could support such an extremist platform, without those exceptions. In 2007, McCain reaffirmed his commitment to change the Party's platform to reflect these changes.
That was then. Now it is widely assumed that McCain will drop his call for these changes. In the words of Tony Perkins, head of the Family Research Council, for McCain to continue to call for a revised platform, "would be political suicide...I think he would be aborting his own campaign because that is such a critical issue to so many Republican voters."
Are Perkins and other Christian conservatives courted by McCain, such as Senator Sam Brownback, co-chair of the nominee's Justice Advisory Committee, correct in their view that a challenge on the abortion plank would doom his run for the presidency?
This question, of course, captures the larger dilemma swirling around
McCain's candidacy -- go too much to the Center and lose the base, swing
too much to the Right and lose the independents and moderate
Republicans (yes, there still are some left). Which is more costly a
strategy for him? Or put another way, how long can McCain get away with
at one moment seeking the endorsements of right-wing preachers whose
statements are every bit as incendiary as those of the Rev.
Jeremiah Wright, and at the next, go on the Daily Show and act like a
very charming and hip person who could not possibly believe the
outrageous positions he is forced by circumstances to take?
McCain's "maverick" image has misled a considerable number of voters into believing he is for abortion rights.
In fact, he has long been opposed to abortion. The differences now is that the "straight talker" appears more than willing to overlook his previous more thoughtful positions in order to please his extremist friends. Several years ago, McCain was on record as saying reversing Roe would not be a good idea, because of the likelihood of women resorting to illegal and dangerous abortions; today, he calls for the immediate overturning of Roe.
While McCain struggles to keep both the right and the center happy, it is our job, as progressives, to let the American people know what his party -- and presumably, he -- is capable of supporting. The utterly draconian nature of the Republican party's official position on abortion has not gotten the attention it deserves, either from the media or, surprisingly, from abortion rights advocates themselves. No exception for the life of the woman?!
Recall that South Dakota voters in 2006 voted down a ban on abortions that had a life exception, but did not have one for rape and incest. Assuming there are reporters and debate moderators willing to call him on it, how possibly will McCain defend a position on abortion that, even if symbolic, is breathtaking in its callous disregard for women?
There is no question that in the coming general election campaign Barack Obama (assuming he will be the Democratic nominee) will be targeted by antiabortion forces because of his support for abortion rights. In particular, we can expect that Obama's expressed disagreement with the most recent Supreme Court decision on abortion, Gonzales v. Carhart, will be relentlessly revisited in TV and radio ads to selected audiences. Obama's statement after the decision voiced his concern that the Court for the first time upheld an abortion law that did not allow an exception for women's health.
Since this decision involved a ban on a rarely used procedure, that has been successfully sensationalized for years by opponents as "partial birth abortion," and which many Americans find upsetting, we can expect Republicans to hammer him on this point.
But I believe that if Americans are told that John McCain, and the party for which he is a standard bearer, stand behind the proposition that it is preferable that women die, rather than have an abortion, that will be substantially more upsetting. Words matter. If McCain insists on placating the fanatics in his party, let him start paying a price.
]]>Later on Thursday, Yale University issued a statement announcing that Shvarts' project did not involve actual pregnancy or induced miscarriage. But even before their statement, I was skeptical. Most puzzling to me was her claim to have used "abortifacient drugs that were legal and herbal." If she had really terminated her own pregnancies repeatedly, she could have been subject to legal prosecution -- as occurred recently to a number of poor, mainly immigrant women who have tried to terminate their unwanted pregnancies by themselves, in situations vastly more grave than Schvarts' "senior project."
Even though Schvarts did not actually become pregnant and self-abort, this is a disturbing and irresponsible project. Shvarts told the Yale Daily News that her project was not designed for "shock value" and it was not her intention to "scandalize anyone." She also told the paper that she "believes strongly that art should be a medium for politics and ideologies, not just a commodity."
It is very hard to take such statements seriously. If she truly believed that claiming to get herself pregnant "repeatedly," only to then terminate those pregnancies, would not shock and scandalize, then she clearly has not a clue about reproductive politics, and should not be sticking her nose, er, her uterus, into a highly charged issue she knows nothing about. Art should be a medium for politics, but the responsibility of the artist is to know something about the politics with which she is engaging.
What useful "conversation" has Shvarts provoked with this project -- other than the fact that not all ideas for performance art are good ones? Does anyone -- on either side of the abortion debate -- gain any new insight from her work? All that seems to be accomplished with this project is a highly visible trivialization of the issue of abortion and a phenomenal insensitivity to women who suffer repeat miscarriages.
As someone who has been a college professor for over thirty years, I know it is not uncommon for eager students to have fanciful ideas for projects, and some of these, for various reasons, simply should not take place. It is the job of faculty mentors to give appropriate guidance and to point out that not everything that is "provocative" is necessarily worth doing. The Yale art department, and her advisor in particular, has failed Aliza Shvarts big-time. And in ways that clearly Ms. Shvarts does not understand, her "artistic" contribution to politics fails the rest of us.
]]>Linda and her mother didn't know how soon they would be calling on Fran to make good on her promise of help. The second encounter was hardly pleasant. As Linda tells it, "Not five minutes after the nurse leaves, someone else comes into the room -- it's Ann Marie Starr, my stalker!" This Ann Marie, it turns out, is head of the local antiabortion forces, and for years has not only protested at Linda's clinic, but periodically follows Linda around town. "If she sees me in the grocery store, she'll start screaming at me … I just wait for the manager to throw her out."
Ann Marie, a regular volunteer at the nursing home, apparently had seen Linda's car in the parking lot, and had tracked down the location of her mother's room. "She started hassling my mother, telling her she'd pray for her, but given what I'd done, she might have to go to hell anyway. My mother begged her to leave, but Ann Marie refused, and started yelling about her 'right' to be there." The bizarre episode ended when Fran, hearing the uproar, rushed back to the room. "Fran is a good-sized woman and she just physically dragged Ann Marie out of there."
In reflecting about this incident, I began to see an aspect of the unending abortion wars in America I had not fully appreciated before. That those who provide abortions, either as clinicians or administrators, can be relentlessly pursued in their communities by their opponents -- hounded not only at their workplaces, homes and churches, but virtually anywhere where they might be spotted, as this nursing home story shows -- is hardly news. And while presumably any nurse, whatever her personal history, would have stepped in to remove an unwanted intruder, Fran's participation in this drama reminded me that there are millions of supportive "civilians" aiding the community of abortion providers in this war, many with a history of deep gratitude for the abortions they or a loved one once received.
Linda's recollections to me about the nursing home incident came in the context of a larger conversation about the various acts of threatened or real violence her clinic had faced over the years, and the many outsiders who were unwittingly drawn in. She told me of a sobering meeting with an FBI agent, which led to her informing her Fed Ex driver, her UPS delivery person, and her postman of the possibility that they might be handling dangerous mail. Indeed, when her clinic was among the hundreds of abortion clinics receiving letters claiming to contain anthrax, it was her postman who was the first to handle that letter. He was subjected to various precautionary medical procedures until the substance could be definitively ruled as harmless. When antiabortionists (led by Ann Marie, she suspects) attacked her clinic with an infusion of butyric acid -- a colorless liquid with an extremely unpleasant vomit-like odor -- it inconvenienced all the tenants in the building in which her facility leased space. When her clinic received a package that looked suspicious enough to call the bomb squad, again all those in her building were put on alert.
To my considerable surprise, Linda told me that in all in the above instances, these outsiders were very supportive and showed no rancor toward her or the clinic. The postman told her "he was just doing his job," and the other tenants in the building saved their anger for "the crazies" who were massively disrupting everyone's day.
To be sure, not all past abortion patients remain as grateful as Fran, the nurse in this story, as the existence of groups like Women Exploited by Abortion makes clear. And even if most of the millions of former abortion patients do remain pro-choice, the beleaguered abortion providing community understandably wishes that this "silent majority" was more often outspoken, for example by pressuring politicians to support legal abortion.
Nevertheless, speaking with Linda made me realize that the antiabortion movement would be much farther along in its goal to stop abortion care were it not for the largely overlooked determination of many everyday decent Americans to stand with the provider community against its foes.
*All names in this article have been changed.
]]>Huckabee of course would help McCain where he is weakest--among Republicans who identify as evangelicals, about one third of the Republican electorate. Unlike McCain and Romney, who have changed their positions to one degree or another on abortion, Huckabee has been consistently and fervently anti-abortion. He has also a long record of opposition to gay marriage. Most pertinently, he will not avoid speaking about these issues that still have considerable power to mobilize an important bloc of voters.
Is there a downside to McCain choosing Huckabee as his running mate? After all, Huckabee is on record as not believing in evolution, as wanting to abolish the IRS, as wanting the Constitution to more accurately reflect "God's law," -- not positions held by most Americans. So yes, there are some negatives.
But recall that the vice-presidential candidate doesn't usually play a very high profile role in national elections. There will be likely only one vice-presidential debate, i.e. only one time where Huckabee would have to spin for voters his disbelief in evolution and various of his other controversial statements. Bottom line, McCain would probably gain more than he would lose by such a choice. And if the Republicans are victorious, we would have a 71 year old president and a vice-president--the proverbial one heart beat away from the presidency--who might well make Bush's policies on reproductive and sexual health look reasonable.
]]>Huckabee of course would help McCain where he is weakest--among Republicans who identify as evangelicals, about one third of the Republican electorate. Unlike McCain and Romney, who have changed their positions to one degree or another on abortion, Huckabee has been consistently and fervently anti-abortion. He has also a long record of opposition to gay marriage. Most pertinently, he will not avoid speaking about these issues that still have considerable power to mobilize an important bloc of voters.
Is there a downside to McCain choosing Huckabee as his running mate? After all, Huckabee is on record as not believing in evolution, as wanting to abolish the IRS, as wanting the Constitution to more accurately reflect "God's law," -- not positions held by most Americans. So yes, there are some negatives.
But recall that the vice-presidential candidate doesn't usually play a very high profile role in national elections. There will be likely only one vice-presidential debate, i.e. only one time where Huckabee would have to spin for voters his disbelief in evolution and various of his other controversial statements. Bottom line, McCain would probably gain more than he would lose by such a choice. And if the Republicans are victorious, we would have a 71 year old president and a vice-president--the proverbial one heart beat away from the presidency--who might well make Bush's policies on reproductive and sexual health look reasonable.
]]>The problem--and there are, to be sure, worse problems in politics--is that Berkeley is full of people who have passionate lifelong commitments to all three of the social movements represented by the candidates. Though the contest might now be constructed, at the simplest level, as between the feminist movement and the civil rights movement, John Edwards' support of the labor movement resonated deeply in this community. So though on one level, many are ecstatic at the history-making nature of this race--whoever is ultimately the Democratic nominee will be precedent-making, and a tribute to the staying power of the social movements of the 1970s--many are also agonizing over for whom to vote.
Endless discussions, similar to those already reported on RH Reality Check, are held among friends and acquaintances. "She's more experienced and ‘ready' ." "Yes, but he's more electable. He'll bring in the youth vote." "Yeah, but you can't count on the youth vote. She can better take the dirt the Right will throw at whoever is nominated," and so on.
The reality is that there are very slight differences between these candidates on matters of domestic policy. They are very close on most issues Californians hold dear--environmentalism, reproductive rights, support for labor, and education. Perhaps the one non-trivial difference is their respective health care plans (hers calls for a mandate for all who can to purchase coverage, his doesn't).
The main difference of course is their historic position on Iraq. And this seems to be pushing many Berkeleyites to Obama's corner. Obama signs outnumber Clinton signs in all the neighborhoods I've walked in the last week. If Obama indeed carries the city on the basis of foreign policy, it will hardly be surprising. Berkeley is a city noted for the intense involvement of its city government in national and even international issues, periodically voting, for example, against nuclear weapons. Most recently the City Council voted 8-1 to declare Marine recruiters were "unwelcome" in Berkeley (a move some Council members are now rethinking).
In such a thoroughly Democratic environment as Berkeley, and the surrounding Bay Area, one presumes that whoever wins the nomination will ultimately get the support of most voters. But some have concerns that Obama supporters have been more deeply critical of Clinton than vice versa. For example, Robert Scheer, a long time progressive journalist in California, in an article promoting Obama on the basis of his anti-Iraq stance, was devastating on Clinton's record, and finished his article by reluctantly admitting that "Hillary would probably be better than the Republicans." "Probably"?! No difference between her and McCain who wants to stay in Iraq indefinitely? Not to mention their differences on tax cuts and reproductive rights? This statement is frighteningly reminiscent of the Ralph Nader pronouncement that Gore and Bush were essentially the same. One hopes that political purity among some on the Left will not snatch defeat from the jaws of victory again.
]]>The problem--and there are, to be sure, worse problems in politics--is that Berkeley is full of people who have passionate lifelong commitments to all three of the social movements represented by the candidates. Though the contest might now be constructed, at the simplest level, as between the feminist movement and the civil rights movement, John Edwards' support of the labor movement resonated deeply in this community. So though on one level, many are ecstatic at the history-making nature of this race--whoever is ultimately the Democratic nominee will be precedent-making, and a tribute to the staying power of the social movements of the 1970s--many are also agonizing over for whom to vote.
Endless discussions, similar to those already reported on RH Reality Check, are held among friends and acquaintances. "She's more experienced and ‘ready' ." "Yes, but he's more electable. He'll bring in the youth vote." "Yeah, but you can't count on the youth vote. She can better take the dirt the Right will throw at whoever is nominated," and so on.
The reality is that there are very slight differences between these candidates on matters of domestic policy. They are very close on most issues Californians hold dear--environmentalism, reproductive rights, support for labor, and education. Perhaps the one non-trivial difference is their respective health care plans (hers calls for a mandate for all who can to purchase coverage, his doesn't).
The main difference of course is their historic position on Iraq. And this seems to be pushing many Berkeleyites to Obama's corner. Obama signs outnumber Clinton signs in all the neighborhoods I've walked in the last week. If Obama indeed carries the city on the basis of foreign policy, it will hardly be surprising. Berkeley is a city noted for the intense involvement of its city government in national and even international issues, periodically voting, for example, against nuclear weapons. Most recently the City Council voted 8-1 to declare Marine recruiters were "unwelcome" in Berkeley (a move some Council members are now rethinking).
In such a thoroughly Democratic environment as Berkeley, and the surrounding Bay Area, one presumes that whoever wins the nomination will ultimately get the support of most voters. But some have concerns that Obama supporters have been more deeply critical of Clinton than vice versa. For example, Robert Scheer, a long time progressive journalist in California, in an article promoting Obama on the basis of his anti-Iraq stance, was devastating on Clinton's record, and finished his article by reluctantly admitting that "Hillary would probably be better than the Republicans." "Probably"?! No difference between her and McCain who wants to stay in Iraq indefinitely? Not to mention their differences on tax cuts and reproductive rights? This statement is frighteningly reminiscent of the Ralph Nader pronouncement that Gore and Bush were essentially the same. One hopes that political purity among some on the Left will not snatch defeat from the jaws of victory again.
]]>Twenty years later, Mike Huckabee, running for the Republican nomination, makes no such missteps. With none of the discomfort that Bush I showed, Huckabee at his rallies gets the party line of the antiabortion movement right: if Roe is overturned, doctors who perform abortions should be punished, while the recipients of such abortions must be seen as "victims."
But Huckabee, a former Baptist preacher and the candidate of choice of evangelicals, is an exception in the clarity and consistency of his position on abortion. There is a long history of "evolution" on abortion from politicians in both parties. For example, Bill Clinton and Al Gore, both from Southern states, had mixed records of support for abortion early in their careers before they each went on to become staunch allies of the abortion rights movement. But in the campaign of 2008, it is mainly the Republican candidates who are squirming.
Mitt Romney’s notorious flip-flops on the issue--reminiscent of another hapless Massachusetts politician, Romney was for abortion before he was against it–-may ultimately be seen as a key factor that led to voter disillusion with his candidacy.
Rudy Giuliani, who is attempting the daunting task of winning a Republican nomination with a record of support for abortion and gay rights, astonished observers across the political spectrum with his nonchalance when he stated, in response to a question about his feelings were Roe to be overturned: “It’d be ok to repeal it. It would also be ok if a strict constructionist judge viewed it as precedent.”
Fred Thompson, in the early stages of his campaign, first denied and then admitted that he had worked briefly as a lobbyist for an abortion rights group. The “straight-talking” John McCain has also changed his position on abortion. Several years ago, he was on record as saying reversing Roe would not be a good idea, because of the likelihood of women resorting to illegal and dangerous abortions; today, he calls for the immediate overturning of Roe.
The abortion issues in the Democratic campaign have thus far been much more low profile. To be sure, Dennis Kucinich, who for most of his political career was against abortion, suddenly became converted to a prochoice position when he first ran for president. And in the final days of the New Hampshire primary, the Clinton campaign sent out a mailing accusing Obama of not being a sufficiently reliable prochoice vote when he served in the Illinois legislature.
But in fact, the positions of the top three Democratic candidates are nearly identical on abortion. All three spoke out against the most recent Supreme Court decision on abortion, Gonzales v Carhart, announced in April 2007--decrying the fact that for the first time the Court held that an exception to protect the health of a woman was not constitutionally necessary in abortion legislation. But since Gonzales also upheld a ban on intact Dilation and Extraction, a rarely used method of performing certain second trimester abortions-- sensationalized by opponents as “partial birth abortions”–-it is certain that antiabortion forces will target whoever becomes the Democratic nominee for his or her statement on that case.
So how big a role will abortion play in the upcoming election? An economy in recession, not to mention ongoing wars in two fronts, presumably will command far more attention than abortion. But abortion plays too central a role in American politics to disappear altogether as an issue. In particular, if Mike Huckabee is the nominee (or, more likely, the vice presidential candidate), then abortion will inevitably have a higher profile. Even if Huckabee is not on the ticket, if either McCain or Giuliani becomes the presidential nominees, he will likely choose a running mate who can energize the Religious Right segment of the party–and that means talking about abortion.
What can the Democrats do? This time around, the Democratic candidates have an excellent opportunity to do more than be defensive about their support for abortion, especially the controversy around later abortions, which account for a tiny proportion of all abortions performed in the U.S.(90% of all abortions occur within the first ten weeks of pregnancy and less than 2% occur after 20 weeks).
The record of the Bush presidency with regard to sexual and reproductive policies is so egregious, because of the relentless quest to please the Religious Right, that there is a real opening to expose the extent to which the Republican party is out of step with mainstream values of the American electorate.
If baited about "partial birth abortions," here is how a nominee might respond. "Leading medical organizations have testified that sometimes this banned method is the safest one for the woman--and I want women to have access to the safest procedure possible. But this infrequently used procedure is not the main issue here. I want to know if my opponent, should he be president, will continue to support abstinence only sex education--on which our government has wasted over a billion dollars to date, and which has repeatedly been shown to be ineffective. I want to know if my opponent, on record as opposing abortions, will continue George Bush’s policy of cutting funding for family planning programs? I want to know if my opponent agrees with the Bush policy of posting incorrect information about condom effectiveness and other reproductive health issues on government websites? I want to know if my opponent will continue with the Bush policy of making one third of all U.S. HIV/AIDS assistance funds in the developing world go to abstinence programs–-a policy decried by public health experts? And since we are talking about reproductive issues, why is my opponent on record as supporting George Bush’s veto of the expansion of S-Chip–-that wonderful health care program for children?"
In short, abortion is best defended when it is discussed in the context of a larger vision of reproductive justice–one that speaks to the many different ways a compassionate government can help its citizens to achieve the family lives they wish for. And the woeful Bush record of the last seven years offers a perfect opportunity to present this vision.
]]>This article originally appeared on the Beacon Broadside.
Let us apply a similar thought experiment to Jamie Lynn Spears, the younger sister of Britney, who is a star in her own right of a television show for young teens. Spears, as everyone on the planet presumably now knows, is pregnant at the age of 16. She has announced that she will continue with her pregnancy. While Spears has been subject to some criticism from conservatives because of her sexual activity, she has repeatedly been praised by various anti-abortion spokespersons, including presidential candidate Mike Huckabee, for her decision to not end her pregnancy.
For the sake of argument, let us assume that Jamie Lynn actually prefers to have an abortion, an option chosen by nearly half of teenagers faced with unintended pregnancies. Just as the imaginary Judith Shakespeare's talents would have been met by a society deeply hostile to women writers, so too the real Jamie Lynn's decision to end this pregnancy would take place in a society deeply polarized around abortion.
Such a move would, at a minimum, be a career-ender. Abortion has become so stigmatized in the contemporary United States that public admission of an abortion by someone in Spears' position would most likely mean the loss of acting roles, personal appearances, endorsements and so on. Admittedly, Spears' current career prospects are uncertain, with her television show on hold; but given reports that her mother, Lynne Spears, has already arranged the sale of the first baby pictures to a fan magazine, it is quite conceivable --no pun intended-- that Jamie Lynn might be able to create a new celebrity persona as teenage mom.
Moreover, were Jamie Lynn to seek out an abortion in Louisiana, her home state, her mother would have to give consent, as is required by that state's laws. And that would seem highly unlikely, in light of Lynne's marketing plans for her forthcoming grandchild.
But loss of career opportunities would only be the beginning of Spears' difficulties if news of an abortion became public. She would be denounced in the pulpits of evangelical preachers, castigated on various websites and right-wing television shows, and receive abusive and threatening phone calls and letters. Every public outing-say, an evening with friends in a restaurant -would carry the risk of strangers coming up and screaming epithets in her face.
This worry about exposure as an abortion recipient is not limited to celebrities. Attempts to "out" abortion recipients are a tactic with a long history in the antiabortion movement-- for example, the many instances of photographing the license plates of cars in clinic parking lots. So fearful are some women of having their abortions revealed that clinic administrators report that often patients with insurance plans that cover the procedure prefer to pay cash, so there is no paper trail of their abortion.
The fact that a history of an abortion can taint one's identity-or serve, in sociological parlance, as a "discrediting device"-- is a serious problem that goes well beyond the travails of Jamie Lynn Spears. Consider, for example, the world of electoral politics. The most recent data suggests that more than one third of American women will have an abortion by the time they reach the age of 45. Some portion of these women, no doubt, will run for elective office. Will the standard "oppositional research" that is part of modern politics now routinely include attempts to find out if women candidates have ever had an abortion? Will such information be enough to derail their campaigns?
Given the immense success that the antiabortion movement has had in the decades since Roe v Wade in demonizing abortion, it is no simple matter to visualize how to destigmatize the procedure, as well as those who receive and provide it. One promising start, however, comes from a still relevant quote made some years ago by Rachel Atkins, then the director of a women's health center in Vermont. Speaking to a New York Times columnist about the women in her waiting room, Atkins said, "The country really suffers from thinking that there are two different kinds of women -- women who have abortions and women who have babies. They're the same women at different times."
To be sure, not all abortion recipients currently or eventuallyexperience motherhood-though this is an accurate description of most. But Atkins' perceptive comment reminds us that abortion is just one of several significant reproductive events that women will experience in their life times. And whether an unwanted pregnancy occurs to a famous 16 year old like Jamie Lynn, or-- as is far more common-- a poor teen of color, an ambitious college student who one day wants to run for office, or a waitress who has all the children she can care for, we should strive for a culture in which abortion is recognized as an honorable option.
]]>And it is no surprise that the Republican candidates for president support abstinence-only programs. This issue remains of great symbolic importance to the Religious Right base of the Republican Party. Though some observers say this movement is in decline, evangelicals remain very influential in the nominating process (witness Mike Huckabee’s recent meteoric rise), and candidates cannot afford to offend them on this issue. (And to be sure, abstinence-only is more than just symbolically important to many on the right; as The Nation so ably detailed, in "The Abstinence Gluttons," those who receive contracts to deliver these programs are raking in millions).
But Democrats supporting "abstinence-only," especially after the November 2006 election, when they regained control of the House and Senate?! A powerful Democratic committee chair proposing to give even more to these programs than the Bush administration has asked for?! No, this is not a Saturday Night Live or Jon Stewart parody. This is Washington politics. In a move that stunned advocates for comprehensive sex education—that is, programs that include discussion of both abstinence and birth control options—Congressman James Obey of Wisconsin, the chair of the House Appropriations Committee, proposed increasing by $28 million the current abstinence-only allocation of $113 million. Obey made this move in order to lure Republican votes for Congress’s main domestic spending bill. (In fairness, an equal increase was suggested for Title X, a federal family planning program that has been consistently under-funded during the Bush years.)
This (mis)appropriation may not see the light of day, given the wrangling taking place on the hill, but whatever transpires in the next few weeks, reproductive justice advocates are deeply demoralized to see how casually an issue of such intense importance could be horse traded away. As James Wagoner noted on RH Reality Check:
With one breathtakingly cynical move, the Democratic leadership has now stamped its brand on one of the biggest ideological boondoggles in congressional history. More disturbingly, they have placed the health and safety of young people at risk by promoting programs that spread ignorance in the era of HIV/AIDS. Placing politics before public health and ideology over science have now become bipartisan follies.
What exactly is abstinence-only sex education, and why are its opponents so distressed over Obey’s cynical maneuvers? Briefly, this form of sex education has its roots in the Reagan era of the 1980s, when a newly formed Religious Right started to expect payback in the domestic policy realm for its work on behalf of Reagan’s election. The Reagan administration funded programs known colloquially as “Chastity Centers,” typically administered by church-affiliated groups, and then, as now, such programs became embroiled in lawsuits over issues of church/state separation.
Abstinence-only funding received major boosting as part of the landmark 1996 welfare reform measure (the Personal Responsibility and Work Opportunity Reconciliation Act). The administration of George W. Bush increased abstinence funding even more. In total, in the words of Congressman Henry Waxman, one of the program’s leading critics, "American taxpayers appear to have paid over one billion dollars for programs that have no impact."
Abstinence-only programs infuriate its critics both for what such programs don’t say and what they do say. Programs receiving federal funding are not allowed to mention contraception "except to point out (grossly inaccurate) failure rates. Abortion, needless to say, cannot be presented as an acceptable option in the face of unwanted pregnancy, though many programs are able to get away with unsupportable statements about high suicide rates of abortion patients and the discredited link between abortion and breast cancer.
What abstinence-only programs must address includes the following: "a mutually faithful monogamous relationship in the context of marriage is the expected standard of human sexual activity," "sexual activity outside the context of marriage is likely to have harmful psychological and physical effects," "bearing children out of wedlock is likely to have harmful consequences for the child, the child’s parents, and society."
In a devastating exposé of abstinence-only programs, Waxman’s staff found widespread misinformation and outright lies being told to young people. Most notoriously, some programs were teaching that HIV could be spread by "sweat and tears." Overall, the report concluded that, "over 80% of the abstinence-only curricula contain false, misleading, or distorted information about reproductive health." (Complete report)
Meanwhile, according to James Wagoner, every day in the United States some ten thousand young people get an STD, two thousand become pregnant and fifty-five contract HIV. These threats to young Americans’ health and well-being are what your tax dollars are not addressing. At least not in the thirty-six states that still accept abstinence-only funding.
]]>This article first appeared on the Beacon Broadside.
"I actually went down on my knees begging him-but I think he felt he had been doing too many lately, and his hospital had been breathing down his neck. I walked out of there shaking...."
"I groveled and flattered him as much as I could. I sweet talked him. Finally he caved."
These are two stories of women physicians imploring male colleagues on behalf of patients who need abortions. The two events took place more than forty years apart, but the dynamics are eerily similar. The first speaker, Dr. Ethel Bloom (not her real name), now a retired general practitioner, is recounting for me her memories of what it meant to be an abortion-sympathetic doctor before Roe v Wade.
The daughter of her best friend, about to leave for college, had become pregnant. Dr. Bloom tried to obtain an abortion for her from an ob/gyn colleague who occasionally took risks and did abortions in his hospital, violating the rules of that time by claiming "medical necessity." (Bloom's gutsy, and ultimately successful, strategy for obtaining an authorized abortion in this case was to lie to another doctor that the young woman had tested positive for rubella, also known as German measles. The hospitals in the area had just begun to approve abortions for women with rubella, as evidence accumulated of the severe birth defects associated with the disease. As the first generation of tests were expensive, Bloom gambled -- correctly -- that the hospital would not retest her.
The second speaker, Dr. Margaret Riley (not her real name), is a vibrant and witty ob/gyn in her forties. In a just world, a woman like this would not have to "grovel," as she put it, before colleagues to get needed care for her patients. She currently is the medical director of a freestanding abortion clinic in an East Coast state and I recently heard her speak at a conference. A small portion of the patients who come to her clinic are too sick to have their abortions performed there safely and require having the procedure done in a hospital. This is when the groveling starts, as Riley has to deal with individuals and institutions beyond the clinic.
The case she discussed at the conference concerned a 17-year-old teenager with a history of recurrent pulmonary embolism (blood clots in the lungs). When the teen became pregnant, her hematologist suggested termination as the safest course, as pregnancy could dangerously exacerbate her condition, possibly leading to death. With the hematologist's backing, Dr. Riley arranged to perform the abortion in a local hospital. The young woman was admitted to the hospital, and prepared for surgery.
Literally as she prepared to leave for the hospital to do the procedure, Dr. Riley was informed by a clinic staff member that someone from the patient's insurance company had just called to announce that the company refused to authorize payment for the abortion. An in-hospital procedure would cost thousands of dollars, money which the family of the teenager did not have. Riley called the medical director of the company. "He said they would only pay if the ‘condition is life-threatening.' Of course, I wanted to shout, ‘You moron! Don't you know pregnancy in a patient with pulmonary embolism is life threatening?!' But I restrained myself. I calmly kept telling him how sick she was. I told him that the she had been on the pill but had to go off because of her condition....Finally, the breakthrough came when I got the hematologist to call him, and confirm how sick she was. Then he agreed. Of course, he thought that I, the abortion doctor, was doing this just for the money -- but a hematologist, well that was a a different story."
This case of the 17-year-old with pulmonary embolism was just one of several that Dr. Riley discussed which described the challenges she faces when advocating with gatekeepers for women too sick for clinic abortions. The negotiations that Riley has to undertake routinely with hospital administrators, insurance executives, and physicians in other specialities in such instances gives us yet another window into the chaotic and Kafkaesque world that is contemporary abortion provision, even as Roe remains technically legal. Some of those with whom Riley must plead are quite upfront with her on their anti-abortion views, others have different motivations. When I asked her, in a follow-up interview, whether she thought the insurance director was motivated primarily by anti-abortion sentiments or by a desire to cut costs, she gave an answer that seemed to encompass both: "I think it was sexism actually."
Margaret Riley's situation, in fact, is in some respects better than that of her fellow clinic directors in other areas. She operates in a fairly liberal state, and over the years, has worked out an "understanding" with a local hospital that usually lets her perform abortions for very ill patients in its facilities. But in other places, hospitals' refusals to deal with seriously ill women seeking abortions is so egregious that a new term has entered the vocabulary of abortion advocates -- "ambulance cases." Mainly, but hardly exclusively, occurring in Catholic hospitals or hospitals which have merged with Catholic institutions, the phrase refers to situations in which very ill women are sent from one hospital to another in an ambulance because the first hospital refuses to treat them. Here the pleading done by abortion providing ob/gyns with members of hospital ethics committees or heads of departments often falls on deaf ears.
Two particularly notorious cases occurred a few years ago in a Chicago suburbs, in a community hospital that merged with a Catholic institution. In the first case, a woman with an ectopic pregnancy -- a potentially life threatening situation -- was discharged from the hospital and sent by ambulance to another hospital. Because a fetal heartbeat was detected, the first hospital refused to perform an abortion (though they did offer to remove her fallopian tube, which would have compromised future fertility).
In the second case, a patient's water membrane burst prematurely at 18 weeks, putting her at risk of chorioamnionitis, an infection of the uterus that can cause high fever and is associated with sterility. Though the typical course in such situations is to induce labor before the infection develops, the hospital refused to do so until the patient developed a fever. The frustrated admitting physician sent the patient to another hospital for immediate treatment.
As Leo Tolstoy famously said at the beginning of Anna Karenina -- "all unhappy families are unhappy in their own way" -- we can say of the contemporary abortion scene, that all sites of provision are deeply challenged in their own way. The clinics, of course, have no shortage of problems, facing onerous restrictions and constant harassment. But hospital-based abortion care, especially when very ill patients are involved, pits the abortion provider against a host of more powerful forces, some truly astonishing in their disregard for women's health and wellbeing. And proud physicians like Margaret Riley are resigned to the fact that they will be doing a a lot of begging.
]]>