RHRealityCheck.org's Common Ground Discussion

DeGette Statement on Abortion Coverage In Senate bill: "A Common-Sense Provision"

Amie Newman — Thu, 19 Nov 2009 13:24:24 -0500

U.S. Rep. Diana DeGette (D-CO), head of the Pro-Choice Congressional Caucus, praised the Senate health care bill released last night for its common sense approach to abortion coverage in health reform:

“I am pleased that the U.S. Senate has maintained current law when addressing the abortion issue. By adopting a common-sense abortion provision, the U.S. Senate ensures that no federal funds will be spent on abortion coverage while not further restricting a woman’s right to choose. The health care bill is about providing access to quality health care to over 36 million Americans. I encourage the U.S. Senate to work towards producing a bill that works for everyone.”

Rep. DeGette collected over forty of her House colleagues signatures on a petition that warned they would not vote for health care reform legislation that includes the Stupak Amendment. DeGette also says, in an interview with Brian Beutler at TPM, that many of the anti-choice House Democrats who voted for Stupak didn't understand the full impact Stupak would have on abortion coverage:

DeGette says she's spoken in private to many of the pro-life Democrats who voted for the Stupak amendment, some of whom have acknowledged that they didn't realize what they were voting for.

"I will say that I have spoken privately with several pro-life members about the Stupak amendment, and they acknowledged that the Stupak amendment goes far beyond where they thought it did," she told me.

Now that the Senate bill has been released, preserving private abortion coverage while maintaining the status quo in regards to federal funds for abortion, what are the prospects for what abortion coverage will look like in a final health care reform bill?

On Tuesday, DeGette told The Atlantic, "We're still willing to talk about language...If there's language that can augment or supplant or replace the Capps amendment, that can have the effect of preserving the status quo, then we would accept that."

Reconsidering Ellsworth

Rachel Laser — Mon, 16 Nov 2009 08:00:00 -0500

Supporters of health care reform have been determined not to let the delicate issue of abortion trip up comprehensive legislation. The key to that effort has been to seek the goal of “abortion neutrality,” which means that the legality, cost, and availability of abortion, as well as the federal role in abortion, is no greater or no less than if there were no bill.

The Stupak-Pitts Amendment, which was included in the final version of the House bill, is not abortion neutral, and it would disrupt the delicate federal balance already in place. By upsetting this balance, health care reform is now in jeopardy. The pro-life Ellsworth Amendment, which was rejected in the House in favor of the Stupak Amendment, offers a far better approach that adheres to common ground.

Rep. Ellsworth’s amendment builds off of an earlier good faith attempt offered by pro- choice Rep. Lois Capps that was included in the Energy and Commerce Committee’s draft bill. The Ellsworth Amendment would have moved the bill in a pro-life direction, but it still would have achieved abortion neutrality. Rep. Ellsworth has a 100% score with National Right to Life and Rep. Capps has a 100% NARAL rating. Each deserve to be commended for trying to strike this delicate balance.

Below is an analysis of how the Stupak-Pitts amendment fails to achieve 'abortion neutrality' as well as the common ground potential of the Ellsworth amendment.

The Stupak-Pitts Amendment Violates Abortion Neutrality in Three Ways

1. The Stupak-Pitts Amendment changes a decades-long balance of existing federal law on abortion coverage.

The Hyde Amendment, which has been on the books for over 30 years, prevents federal funds from being used to pay for abortion in the Medicaid program, except for cases of life endangerment, rape or incest. The Stupak-Pitts Amendment goes much further, by preventing even private premiums from being used to pay for abortion in the Exchange. The Stupak-Pitts Amendment prohibits health insurance plans in the Exchange that receive any federal funding from covering abortion, even with segregated private funds. Because all Exchange plans will likely receive federal tax dollars through subsidies to individuals, individuals will not be able to purchase health insurance that covers abortion, even with their own premiums. The fact that the millions of Americans participating in the Exchange will not have abortion coverage is also a dramatic change from the status quo, since the majority of Americans with health insurance have plans that include abortion coverage.

The logic of the Stupak-Pitts Amendment also rejects the current non-controversial scheme whereby year after year, hundreds of billions of dollars are consistently used to subsidize health insurance policies that cover abortion. Until the Stupak-Pitts Amendment emerged, none of this funding was deemed controversial in any way by pro-life stalwarts from President Ronald Reagan to President George W. Bush.

The employer deductibility of health coverage has yielded trillions of dollars in federal tax subsidies for insurance plans, whether or not they covered abortion. Flexible Savings Accounts (which started in 1978 and grew in popularity under President Reagan) allow for individuals to deduct the direct cost of abortions from their taxable income. Health Savings Accounts (which started under President Bush) allow for tax-favored savings to be used to pay for abortions.

Each of these tax subsidies has, at one time or another, received the support of nearly all members of Congress—whether ardently and unequivocally pro-life or pro-choice. Yet as far as we can tell there has never even been a debate about whether these subsidies could cover plans that offer abortion coverage, even though most do.

2. The Stupak-Pitts Amendment changes longstanding policies regarding the segregation of funds.

Supporters of the Stupak-Pitts Amendment dismiss efforts at finding a compromise on abortion in health care reform through the segregation of funds as an “accounting trick.” Whether or not one believes this argument, supporters of the Stupak-Pitts Amendment must now reconcile this view with longstanding policies that allow the segregation of funds in order to let religious organizations accept federal money.

The reasoning of the Stupak-Pitts Amendment would call into question countless activities by religious organizations that rely on federal funds, including Head Start, homelessness relief, food banks, substance abuse counseling, prison fellowship, afterschool programs for troubled youths, adoption services, ESL programs for immigrants, and veterans’ services.[ii] Of course, in the context of abortion, the segregation of funds is also accepted in Medicaid, where 17 states supplement the federal program with abortion coverage.

3. The Stupak-Pitts Amendment means no plans in the Exchange would offer abortion coverage.

Even though there is a provision in the Stupak-Pitts Amendment that would allow the purchase of separate supplemental coverage of abortion, it is implausible that insurance companies would offer this coverage. Unintended pregnancies are unplanned by definition, so demand would likely be low. And unlike other medical procedures, abortions are relatively inexpensive. That is why in the five states where abortion coverage is prohibited except through such “riders,” there are only isolated examples of insurers actually offering such coverage, and even then only as part of a small group package, rather than to individuals.

The Ellsworth Amendment: A Common Ground Solution

Representative Brad Ellsworth, who has a 100% rating with National Right to Life, has drafted a compromise solution, which built off of an earlier plan from (100% pro-choice) Representative Lois Capps. Unlike the Stupak-Pitts Amendment, the Ellsworth Amendment meets the test of abortion neutrality.

The Ellsworth Amendment strengthens the pre-existing protections against federal funding for abortion in the House bill by:

Ensuring that no future federal dollars can ever be designated to fund abortions in the Exchange;

Making permanent strict Hyde limitations on the pro-life plans in the Exchange;

Increasing protections for pro-life insurance plans by adding a non-discrimination requirement; and,

Strengthening the guarantee of segregation of funds by requiring compliance with three separate standards of accounting.

The Ellsworth Amendment was not endorsed by any of the major pro-life or pro-choice groups. That’s probably the best indication that it achieves common ground.

For more information about the Ellsworth Amendment, see our memo Achieving Abortion Neutrality in Health Care Reform.

Peace & Persuasion

Cristina Page — Mon, 09 Nov 2009 07:00:00 -0500

Of all the domestic pursuits of Obama's first year, his common ground efforts on abortion have possibly been the most thankless. At some points it appeared the only common ground he had inspired was to unite both sides against it. Yet, each has much to gain by Obama's peace plans. Obama's mission may be to usher in a new way to think about political conflict - an aspiration so lofty it earned him the Nobel Prize for the aspiration alone. His goal seems to be to appeal to and, simultaneously, to foster a moderate middle, a reasonable group that can talk to, rather than past, each other. If he's going to succeed in the abortion conflict he's first got to confront those who perceive common ground as a threat.

Obama's message has met with resistance, not only from the extreme right which reflexively opposes everything he does, but liberals too have been hesitant, and even distrustful, of common ground language. Rev. Carlton Veazey, of the Religious Coalition of Reproductive Choice, called attempts at common ground "troubling." Eleanor Smeal, president of the Feminist Majority Foundation, suggests history is doomed to repeat itself summarizing plainly, "I tried a common-ground thing in 1979." The pro-choice movement has reason to be cautious. For many pro-choicers, there's no evidence to suggest the anti-abortion establishment is suddenly going to embrace prevention of unintended pregnancy (there's not one pro-life group in the US that supports contraception after all,) or rally behind supports for struggling families (those voting against social programs on which struggling families support, Like WIC, Medicaid, unemployment insurance, Head Start, are almost exclusively pro-life elected officials.) The May murder of Dr. Tiller remains fresh in our minds--so joint anti-violence efforts, while critically needed, feel a little hard to picture. The health care reform debate, with abortion serving as the primary derailing issue, offers another opportunity to grow jaded about common ground prospects.

But the search for common ground offers a rare opportunity. Obama has, if not awakened, then given voice to what appears to be a long silent majority of reasonable pro-life Americans. His common ground call has appealed to moderate pro-lifers most of whom support contraception and sex education, even if they don't trumpet it. And, most importantly, Obama's common ground charge may, at last, be pushing to the margins the extremists who have for so long dominated the headlines (and the fundraising) on the right.

Twice as many young white evangelicals voted for Obama than did for Kerry in 2006 (32% vs. 16%) and] Obama also won the majority of the Catholic vote. Undecided voters were moved by Obama's common ground vision. Indeed, the majority of Americans, including those affiliated with traditionally pro-life faiths, believe in common ground. According to a 2008 poll by Faith in Public Life, 53% of Americans believe political leaders can find common ground while staying true to their core beliefs. Majorities of white mainline Protestants (59%), Catholics (55%), and the unaffiliated (52%) believe common ground on abortion is truly possible.

What's troubling is that Obama has come up short in appealing to the very liberals who have been most receptive to his policies and his ambitions. And that could be unfortunate for the left leaning as well as for Obama. After all, Obama's broad strokes common ground plan reads like the agenda of a Feminist Majority conference: Preventing unintended pregnancy; supporting poor women with wanted pregnancies; expanding reproductive choice by making adoption more available; improving maternal and infant health; preventing violence in the abortion conflict. Inroads in any one of these areas, let alone all of them, would be worth a break in the hostilities. Hardliners on the right would be unlikely to mount an opposition effort to any either.

With his speech at Notre Dame, Obama spoke directly to pro-life Americans. He was not dissuaded by extremist groups protests over his appearance or their attempts to portray him as "the most pro-abortion president ever." One of Obama's greatest talents as a leader is his deep trust in the American public's ability to see through artifice and hyperbole. As ABC News reported, Obama went to Notre Dame and "entered the arena to thunderous applause and a standing ovation from many in the crowd of 12,000." Despite what the anti-abortion protests outside would suggest, the vast majority of pro-life people there were open to what he had to say and could see there are shared goals pro-lifers and pro-choicers seek. He didn't allow the extremists shouting outside the door to define the day.

There are many more such "teachable moments," as Obama himself likes to say, that haven't been taken full advantage of. Obama must continue to speak directly to the pro-life public, translate how his policies serve their greater goals. Take healthcare reform. The states with the most uninsured tend to also be the most "pro-life" politically given the pro-life campaigns against healthcare reform a disturbing angle. Industrialized nations that provide their citizens with universal health insurance (the US is the only one that does not), like those of Western and Northern Europe, have the lowest abortion rates in the world-- that's unlikely to be a coincidence. Pro-life Americans are able to do the math when informed that it costs a pregnant woman without health insurance is $6,000-$8,000 for delivery alone while an abortion will cost her about $400. The pragmatic pro-lifer gets it and is interested in more constructive ways to be pro-life than yelling while holding a sign. Obama can tap that desire.

Common ground is a great idea and a great possibility. The task ahead for Obama is to first convince those who stand to benefit the most by it.

Pro-Life Means Guaranteed Maternity Care for All

Mary Krane Derr — Wed, 04 Nov 2009 07:00:00 -0500

The US media furor over the following Congressional exchange has died down.

Senator Jon Kyl (R-Arizona): I don’t need maternity care.
Senator Debbie Stabenow (D-Michigan): I think your mom probably did.

But this argument and public reactions to it involve issues far too important and enduring for just a flash of media attention, issues essential to the search for common ground and the fostering of universal human rights. Pro-choicers have called Senator Jon Kyl to task for this statement, pointing out its utter hypocrisy for someone who carries the label of “pro-life.” While we have not gotten much attention for it, there are also (surprise!) many pro-lifers-- like yours truly--who discern and deplore the same contradiction.

On October 7, a group of Arizona mothers stormed Kyl's office, criticizing him and other Republican politicians for their trivialization of women's need of maternity care and of women's status in general. They raised concerns that anyone serious about common ground must take to heart, whatever their own abortion stance or party affiliation.

There is plenty of scientific evidence to back up the outrage against Kyl. According to data gathered by UN agencies like UNFPA, the US ranks 29th globally in infant mortality and 41st in maternal mortality, in large part because of racial and class disparities in health care access, and because of US providers who have economic incentives not to follow the best practices available. In its statement in support of healthcare reform, Childbirth Connection points out that 85% of US women give birth at some point in their lives and 4.3 million do so in any given year. Twenty-three per cent of hospital discharges are of childbearing women and newborns, who account for a far larger proportion of total hospital charges than any other group of patients. As well as involving so much of the population and the health services sector, maternity care offers unique opportunities to improve the life courses and health outcomes of mothers, fetuses, and newborns.

Globally embraced documents of the universal human rights movement also support the outrage against Kyl. The Universal Declaration of Human Rights identifies “medical care and necessary social services” as human rights, and “motherhood and childhood” as “entitled to special care and assistance.” CEDAW, the Convention of the Elimination of All Forms of Discrimination Against Women, asserts the responsibility of states to “ensure to women appropriate services in connection with pregnancy, confinement and the post-natal period, granting free services where necessary.” According to the Convention on the Rights of the Child, states have a responsibility to implement every child’s right to 'special safeguards and care…before as well as after birth.” This includes the “diminish[ment] of infant and child mortality” and the ensuring of “appropriate pre-natal and post-natal health care for mothers.”

As a prolifer who affirms all of these universal human rights, I also recognize another dimension to guarantee maternity care for all, something that concerns pro-choicers, too, for different but often overlapping reasons. Along with being a right on its own, guaranteed maternity care is also, not one whit less importantly, an indispensible way to alleviate situational pressures upon women towards abortion, especially though not entirely upon the poor; women who have disabilities or who carry disabled babies; women of color; immigrants and refugees; and students.

According to the Guttmacher Institute, 57% of US women who have abortions are economically disadvantaged. Lack of access to free/affordable health care, including family planning services and both maternity and pediatric care, is both a cause and consequence of economic disadvantage. This also helps to explain, for example, the fact that African American women have five times as many abortions as White women.

Many women’s and children’s own life and death stories also validate the right of maternity care. I vividly remember how challenging it was for me in 1986-87 as an impoverished student with disabilities to hold onto the insurance my daughter and I so desperately needed throughout and beyond that medical and emotional rollercoaster of an unplanned, high-risk pregnancy. Two decades later, when my college student daughter became pregnant herself, she and her baby were also subjected to insanely uncertain coverage. My grandson is a year and a half now, but we are still fighting the plan’s refusal to pay for emergency asthma treatment in the eighth month of pregnancy. And yet we were all the "lucky" ones. This inter-generational story is but one deep source of my conviction--as a pro-lifer--that US society must stop already in its dismissal of maternity care, a matter of life and death, as some lightweight thing that one can access only via fluke.

To regard maternity care as simply an option that “I don’t need” is to wash one’s hands of collective responsibility for mothers and babies and therefore to have complicity in those situational pressures towards abortion. This responsibility extends beyond those who are mothers or wish to become mothers, to every member of society. Countries that regard maternity care as everybody’s business and everybody’s concern, such as the Netherlands, have abortion rates that are a small fraction of the high US rate.

So why does John Kyl have a 100% rating from the National Right to Life Committee? The rating criteria focus primarily on issues of abortion’s legal status and its funding. Yet prolifers do not all necessarily think the same way about these issues. Most of all, measures to alleviate the root causes of abortion, such as guaranteed universal maternity care, are conspicuously and absurdly absent from NRLC’s rating criteria, as if they did not belong at the very heart of what it means to be prolife.

In the name of pro-life, Jon Kyl does need to affirm American women’s universal human right to access maternity care. As Senator Debbie Stabenow and Kyl's own maternal constituents tried to remind him, every single one of us grew inside the body of a woman who needed access to proper health care to keep both herself and her baby alive and well.

I only need to look at the faces of my daughter and grandbaby and my own in the mirror to know that universal maternity care is a moral and political imperative. One that a heated but relatively small moment of media attention all by itself cannot make a reality, even if it points the way.

Pro-life Pretense

Cristina Page — Wed, 21 Oct 2009 08:00:00 -0400

President Obama’s still-to-be released common ground agenda in the
abortion conflict is already having a profound and largely overlooked effect: it has exposed deep fault lines in the pro-life movement.
Obama’s focus on reducing the need for abortion has been embraced by
some practical-minded pro-lifers who are tired of decades of
intransigence, and who also appear jaded by the counterproductive
“culture of life” sloganeering of President Bush. Pro-choice Bill
Clinton presided over the most dramatic decline in abortion rates in
the history of our country after all. Pro-lifers Reagan, Bush I and
Bush II did not. For an emerging movement of reasoned,
results-oriented, non-ideological pro-lifers results count. If a
pro-choice president produces pro-life outcomes, they ask, are they
any less worthy?

For the traditional pro-life establishment, however, they are. In
fact, to them, Obama’s common ground call is perceived as a threat.
Since Obama takes them, their beliefs and their proposals seriously
they have been forced to justify some fundamental hypocrisies,
the kind that have in the past led to rhetorical victories and little
progress (unless you count fundraising). Consider, for example, the
clash between pro-life rhetoric and reality when it comes to crisis
pregnancy centers, a much-cherished initiative of the old guard
pro-lifer. A recent report, “A Passion to Serve, a Vision for Life,”
released by the Family Research Council is a valentine to the nation’s
3,000 crisis pregnancy centers (CPCs). It commends them for
communicating “to women and their families that their lives are
valuable and that their needs – emotional, psychological, medical,
spiritual and practical – can and will be met .”

The report details the intense efforts CPCs undertake to persuade
women to not choose abortion. The main message broadcast to those
coming to a center is: “support is available, you do not need to
discontinue this pregnancy for financial reasons.” But beside the
ultrasound image women are provided and medically inaccurate pitch
against abortion, the most persuasive arguments available to CPCs, as
any staff or volunteer will readily admit, is that women facing crisis pregnancies can make it work by depending on a network of publicly-funded social services. For the vast majority of women convinced to become mothers, CPCs are a gateway to the welfare system.

Theoretically, a pro-life, common ground approach then would be to
take seriously the benefits of CPCs as, essentially, referral agencies
to services which can support women who really do want to keep a
pregnancy. And also to say, "Let’s make sure the right social services
are in place – those that women really need – and that they are
well-funded."

And here’s where that old-guard rhetoric runs into the brick wall of
common ground (and fact-based) reality. The Family Research Council
valentine to crisis pregnancy centers may sound pretty, and even
compelling, but on closer examination is it sincere? In effect, groups
like the Family Research Council as well as most pro-life politicians
have been two-timing their devoted crisis pregnancy center partners.
While professing their love for their work, they batter the social
programs on which the crisis pregnancy center movement places its
trust.

The Family Research Council carefully details in its report the many
federal and state-sponsored programs to which CPCs direct women
including: Head Start, Medicaid, Local Health Departments, Legal Aid,
State Children’s Health Insurance Program (S-Chip), State Health
Departments, Women Infants & Children (WIC), and the Department of Job and Family Services.

Yet when it’s suggested that support for these very agencies should
merit pro-life support, the Family Research Council lines up in
opposition. Michael New, a senior fellow at the Family Research
Council, recently launched an attack on the progressive, pro-common
ground, pro-life group, Catholics in Alliance for the Common Good
(CACG) for suggesting just that. CACG conducted a study linking states
that provide more generous services to the poor with lower abortion
rates. CACG suggested that to reduce abortion rates pro-lifers should
consider the policies traditionally championed by Democrats--
extending publicly-funded social services to poor pregnant women--
rather than exclusively focus on restricting abortion. But suddenly,
the programs that are so effective when used as resources by crisis
pregnancy centers, are suspect. New writes,

“[The study’s] questionable methodology and inconsistent results
should give pro-lifers serious pause before they enthusiastically
embrace higher welfare benefits as a strategy to reduce abortion.
Furthermore, there is little peer-reviewed research which indicates
that more generous welfare benefits have a significant impact. [Other
studies] find that welfare benefits only have a marginal impact on
abortion rates. However, as I will discuss later in the response,
there exists plenty of evidence from studies in reputable peer
reviewed journals that various types of pro-life laws reduce abortion
rates.”

New himself didn’t miss the chance to praise the work of crisis
pregnancy centers; he weighed in when the Family Research Council
report came out, writing, “PRCs have offered real alternatives to
literally millions of women facing crisis pregnancies. Countless women
regret their abortions. However, the testimonials in FRC's latest
report are evidence of the positive impact of the life-affirming
options offered by many pregnancy-resource centers.” Of course, the
“life-affirming” options are now no more than a euphemism for the
“welfare” which, according to New, has a “marginal impact on abortion
rates.

New’s attack on the Catholics in Alliance for the Common Good’s policy
proposal is a reflection of an all-consuming hypocrisy plaguing an
ideologically entrenched pro-life establishment. Crisis Pregnancy
Centers rely on a welfare system to support the women they persuade
to become mothers while pro-life groups and politicians actively
undermine the very programs and agencies that are the only resources
available to support many women who want to have a child, as CPCs
know.

In 2007, The Children’s Defense Fund published its Congressional
Scorecard on the best and worst legislators for children. The
organization scored congressmembers votes on many of the policies that
help pregnant women decide whether to parent or abort. The votes were
on Head Start, increasing the minimum wage, reauthorizing and
increasing funding for S-CHIP, increasing funding for children with
disabilities, job training, Medicaid funding, helping youth pay for
college, and tax-relief for low-income families with children. Based
on their votes on these issues, the Children’s Defense Fund ranked 143
congressmembers as ‘the worst” for children. Of the 143 worst
legislators, 100% are pro-life.

The long-established, and long-dominant pro-life complex speaks out of
both sides of its mouth, praising crisis pregnancy centers and yet
disparaging the social services upon which they rely. In the upcoming
months, the Obama administration will be revealing its common ground
agenda and one part of it promises to be supports for pregnant women.
It is just the sort of agenda designed to appeal to a nascent
pragmatic and moderate pro-life movement. Let’s hope this rising voice
of reason can lead the crisis pregnancy center movement to support an
administration plan to help struggling families and indigent pregnant
women. Praise for CPCs can’t come packaged with attacks on the very
supports they rely upon. It not only defeats common ground; it defeats
reason.

Joseph Schiedler, president of the Pro-life Action League, wrote an
op-ed in USA Today claiming pro-lifers who embark on the search for
common ground betray the pro-life cause and, in making his case,
reveals the classic characteristics of pro-life schizophrenia. He
writes,

“There is no evidence that increasing social programs — such as
low-cost health care and day care, college grants and maternity homes
— will impact a woman's abortion decision. It is rare in our
experience to find a woman who says the reason she is choosing
abortion is that she doesn't have day care, or that she'd rather go to
college…More than 3,000 pregnancy centers in the U.S. are ready to
help a woman with material needs, emotional support, counseling and
medical care. Anyone who wants to stop abortion should promote these
centers.”

Once we begin to till the soil of common ground, these contradictions
and inconsistencies will become clearer. It is then that pragmatic
pro-lifers may realize there will be unlikely partners along the path
to genuine pro-life victories.

Protecting Reproductive Rights at Delivery

Jill Alliman — Thu, 08 Oct 2009 07:00:00 -0400

When one thinks of the term “reproductive rights,” one’s first thought usually goes straight to issues of abortion or contraception. An often-overlooked reproductive right, however, is a woman's right to a non-interventional vaginal birth in her chosen setting, and with the provider, of her choice. Yet, at least 84 percent of women will experience childbirth at some point in their lives. At the present time, this important reproductive right is endangered.

An estimated 4.3 million births take place in the U.S. every year. Fewer than 10 percent of these births are attended by midwives and only about one percent take place outside of hospitals. Childbirth is the most common reason for hospital admission in this country. The cost of this care is a staggering $86 billion dollars per year,

Yet, despite the financial resources commanded by hospital-based birth services, many health care providers, public health experts, economists, and activists are alarmed at the state of U.S. maternity care, which is driven by high rates of unproven medical interventions. These interventions – such as mandatory electronic fetal monitoring, labor induction and epidural anesthesia -- have over-medicalized childbirth and contribute to a national c-section rate of almost 32 percent -- a shocking 51 percent increase in the last 10 years. Twenty percent of those c-sections are primary, meaning the woman has not had a previous c-section.

The c-section rate in the U.S. is among the highest in the world, second only to Brazil. Women and their health care professionals have good reason to be concerned about high rates of cesarean section, because c- section is associated with a two-to five-fold increase in the risk of maternal death during childbirth. Studies by the Centers for Disease Control (CDC) and March of Dimes strongly indicate that babies born by c-section are also at a higher risk of death or morbidity, including asthma and other respiratory problems. Babies born by c-section also account for higher rates of admission to hospital neonatal intensive care units (NICUs).

It should be no surprise, therefore, that an increasing number of pregnant women wish to opt out of the risks they consider inherent in hospital birth. Many of these women seek a safe place where pregnancy is not viewed as an illness and they can experience natural childbirth. An important option for natural childbirth is the freestanding birth center*-- an out-of-hospital facility where unmedicated vaginal birth without unnecessary interventions is supported and encouraged. Studies show that women who are admitted to a freestanding birth center in labor have a c-section risk of less than 10% compared to the overall cesarean rate of 31.8 percent. Birth centers can play an important role in avoiding the first c-section, which often leads to c-sections in later births because of the present unwillingness of many obstetricians and hospitals to support vaginal birth after cesarean delivery, also known as VBAC (pronounced “vee-back”).

The American Association of Birth Centers (AABC) believes that access to high quality maternity care and the choice to have a natural vaginal birth are basic reproductive rights for all women. These rights are protected in freestanding birth centers using the midwifery model of care. This is an issue that all reproductive rights activists can support, regardless of one’s beliefs about abortion. Those women who choose to carry their pregnancies to term have the right to high quality care with the provider of their choice and in the setting of their choice during pregnancy and childbirth. A recently-published Milbank report, Evidence-based Maternity Care: What It Is and What It Can Achieve, has publicized the fact that unnecessary medical interventions in pregnancy and birth are not only costly, they do nothing to improve the health of mothers or babies.

Recent federal action, however, during the Bush administration, has threatened access to birth centers for women on Medicaid. The Centers for Medicaid and Medicare Services (“CMS”) denied federal payment to states to cover the federal share (about one-half) of state Medicaid payments to birth centers. These CMS denials began in Washington, Alaska, South Carolina, and Texas, at which point the AABC took action by working to encourage passage of legislation that would specifically add birth center services to the list of all services covered by Medicaid.

The Birth Center Medicaid Reimbursement Act has been introduced and has won bi-partisan support from many members of Congress, including strong sponsors from the Senate and House committees that are handling health care reform. However, given the many swirling issues of political debate over health care reform at the present time, this bill needs even wider support to insure passage this year.

Nearly half of all births in the United States are paid for by Medicaid. Access to maternity care is vital for women in underserved communities, and access to birth center care has been shown to lead to better outcomes for women who are vulnerable to poor outcomes as a result of various socio-economic factors. The birth center is the facility where all women can access care by midwives, and where the right to a natural vaginal birth can be preserved and protected. If birth centers do not have equal footing with hospitals under the federal Medicaid program, low income women will not have access to this option and states will not realize the cost-savings associated with birth center care. Economist David Anderson, PhD, has calculated that an increase of just 5 percent in birth center deliveries could result in cost savings of $675 million per year.

In one rural Tennessee community, the twenty-five year old Women’s Wellness and Maternity Center insures access to care for women, 80 percent of whom are on Medicaid. Another birth center, this one in Houston, Texas, estimates that 95 percent of its clients are Medicaid recipients. Without this access point, women would be entering prenatal care later and missing out on access to the kind of specialized care birth centers can provide, including group prenatal care with midwives, increased education about pregnancy and birth, and access to a counselor and outreach worker – all of which are available in the birth center. Typical birth center outcomes such as c-section rates as low as five percent and an 85 percent breastfeeding rate add to the benefits of the community birth center.

Without passage of the birth center bill, however, the right of low income women to access this excellent care is threatened and the continued survival of birth centers in some communities is likewise at risk, which could result in lack of access by all women, including those with health insurance. We need the help and support of across the spectrum on this issue which is truly one on which all can find common ground.

To find out more about the Medicaid Birth Center Bill and how a woman’s right to choose a normal vaginal birth can be protected in birth centers, go to: http://www.birthcenters.org.

*What Is a Birth Center? Freestanding birth centers are health care facilities, usually licensed by the state in which they are located, which provide a warm, caring, and home-like setting for childbirth. AABC likes to say that birth centers are “maxi-homes,” rather than “mini-hospitals.” Birth centers are typically operated and staffed by midwives (and some physicians) whose focus is woman-centered throughout the pregnancy and birth, offering prenatal care, childbirth education, labor and delivery services, post-partum and infant care and, often, well-woman primary care and family planning services.

How to Stop the Abortion War Killings

Mary Krane Derr — Wed, 30 Sep 2009 07:00:00 -0400

On May 31, 2009, abortion provider Dr. George Tiller was shot in cold blood inside his Wichita, Kansas church. The suspect, Scott Roeder, reportedly cites his antiabortion views as a motive. On September 11, 2009, Jim Pouillon was shot in cold blood in front of Owosso, Michigan High School while engaged in an antiabortion protest. The suspect, Harlan Drake, reportedly stated an objection to Pouillon’s use of aborted fetus photos in his protests outside the school.

Drake also allegedly killed Mike Fuoss, a gravel pit owner, who upset Drake for undisclosed reasons. Last week, Tonya Johnson, an Arlington, Tennessee schoolteacher in her eighth month of pregnancy, was shot to death with her baby. The suspect is her boyfriend, Terence Nelson, who reportedly was enraged at her refusal to have an abortion.

Pro-lifers and pro-choicers in the U.S. are bickering over whose side has the most martyrs and whose has the most blood on its hands. This is disrespectful towards the dead. It is also unfortunate and unnecessary and could even set the stage for further homicides. Unfortunately we cannot join together in raising the dead. Yet there are many other and better responses that both "sides" can together have to abortion war killings.

We can listen more respectfully and profoundly to one another and our self-definitions. In response to Pouillon’s murder, or that of Tonya Johnson, many pro-choicers feel a deep, visceral sense that this action is dissonant with their movement and their values. This is exactly how peaceful abortion opponents —the vast majority— feel about the killings of abortion providers. No one wants to be blamed for or associated with actions they deem antithetical to their most cherished values. And if neither “side” is about killing those who disagree, what, then, are pro-lifers and pro-choicers each about, as they themselves see it?

Pro-lifers say they are about respecting life, which can and often does encompass respect for women’s right to make non-abortion choices. Pro-choicers say they are about fostering sexual/reproductive choice, which to their view is crucial to respect for life, especially women’s lives. In other words: there is a lot of overlap possible here. If we approach one another not only without weaponry, but with active, outspoken disavowal of weaponry, we are all the more readily to discover and build upon those areas of overlap.

We can-- and must!--cooperate in the prevention of further homicides. Living as I do in an urban neighborhood with rampant gun violence, I cannot help but relate all the abortion war killings over the decades to the larger picture of gun violence in the U.S., to the thousands of deaths and injuries annually. Bringing up gun control in the context of abortion may have the sound of pouring gasoline onto an already raging fire. I do acknowledge that this is tricky. There are many pro-choice liberals who support gun control and pro-life conservatives who oppose it. There are also pro-choicers who invoke gun rights out of respect for personal choice, and pro-lifers like me who support gun control out of respect for life.

But no matter how tricky it may be, if we all agree that killing one another is not the way to address our disagreements, we must therefore assume the responsibility to prevent further killings. Even if we are not personally responsible for the homicides themselves in any way! That means personally committing to alleviate the reality of gun violence, or, as some would have it, the reality of people who abuse their Second Amendment freedoms.

Now, I passionately advocate gun control and my vision of reverence for life goes beyond humans, born and unborn, to eco advocacy, vegetarianism, and a general opposition to hunting and fishing. But no doubt, along with like-minded pro-lifers, and pro-choice gun control advocates, there are also avid hunters, fishers, and gun bearers, both pro-life and pro-choice, who ask the same question as I do: How did people like suspects Scott Roeder, Harlan Drake, and Terence Nelson get their hands on guns? How is it that their plans for violence were not thwarted in time?

Even those of us who are sickened beyond measure at even the thought of wounding or killing must deal with such questions.

We can find reciprocally acceptable ways to disagree with one another. Not killing one another is the most basic and necessary form of nonviolence between pro-choice and pro-life. But the practice of nonviolence towards one another hardly stops there. Nonviolence needs also to be present in our speech towards one another. Without treading on one another’s freedoms of speech and association, pro-lifers and pro-choicers need to work out a better understanding of how to express our disagreements.

How to begin or continue in that process? Pro-lifers and pro-choicers alike have had quite parallel reactions to Jim Pouillon’s killing: a combination of horror over his murder and profound objection to his particular means of protesting abortion. No doubt to the immense relief of pro-choicers, I am one of many pro-lifers who object to the indiscriminate brandishing of giant, bloody fetus photos in the public space. Yes, disturbing images are a valid part of many political causes, including the peace movement, and eco advocacy/animal rights. Pro-choicers themselves sometimes resort to coat hanger imagery to convey the urgency of their cause.

I am not advocating legal censorship by any means, but I personally think it is better, in general, for activists to offer people a choice about whether, when, and where to view such images. Fear and disgust are not the only or even the most positive ways to appeal to people's hearts and minds anyway, especially in a culture that is so deeply polarized and already saturated to the point of desensitization with graphic images.

Even as I am sickened by Pouillon's murder, even as I oppose abortion, and even as I understand the desperation and despair of some protestors who feel that no one really cares enough about a matter of life and death...I would recommend something different for people who wish to protest abortion in any sign-holding kind of way—by no means the only way to take real action. They can stand quietly under placards that non-judgmentally offer substantive help with preventing and going through with difficult pregnancies. And they must be fully prepared to give such help at every level from the individual to the global—whether they pass out condoms; offer to personally pay a woman's back rent or offer her an open adoption of her child; give referrals to sound programs, including ethically run pro-life pregnancy centers, that aid with basic needs like food, clothing, shelter, and health care; gather signatures in support of prenatal care coverage, birth mother’s rights, or UNFPA funding; and/or do something else. I know many pro-lifers who commit such deeds constantly, but behind the scenes. Pro-choicers who truly believe in choice also are deeply engaged in creating and offering the other choices.

Since the shooting, Pouillon's son James M. Puillon has come forward and stated that the murdered protestor was not motivated by concern for the unborn, but by hostility and violence towards women, including his late ex-wife. If this characterization is indeed true, it raises another, connected issue around bringing anti-abortion beliefs into the public sphere.

Pro-life and pro-choice do have valid disagreements over the exact parameters of universal human rights in regard to abortion. But even as we apply a universal human rights approach differently, we can agree that hatred of women has no place on either; whether the misogyny hides behind an allegedly pro-life but woman-blaming “concern” for unborn children, or whether it hypocritically seeks to clothe male coercion and violence in the rhetoric of pro-choice.

When we agree on the importance of women’s rights, we can cooperate on alleviating such unfortunately widespread problems as the heightened rate of domestic violence during pregnancy. We can and must ensure that no more pregnant women and their babies suffer injury and even death, whether the perpetrators have the motive of coerced abortion or another motive.

We can and must draw on wisdom such as that gathered by the kNOw MORE campaign of the Family Violence Prevention Fund, which documents the links among domestic violence and reproductive health dilemmas like unintended pregnancy, abortion, and unsupported motherhood. The rights and well-being of women from a universal human rights perspective, open to people of all faiths and none, must be central to abortion discourse, or we will go nowhere.

We may not agree precisely about the nature and status of prenatal lives, or about the roles of abortion in female lives and welfare, but we are disagreeing within a shared and humane framework that highlights commonalities. As a pro-lifer, I am also well aware that if one wishes to help the unborn, then one must attend abundantly and simultaneously to the needs of the already born too, especially women. Pitting the unborn against the born, as if prenatal lives just simply floated around in the air somewhere and then mattered no more after their purportedly invisible, inert mothers birthed them…that does not help a soul.

A universal human rights approach also brings something else quite valuable to common ground. Throughout almost all the world--most thankfully, in my personal, abolitionist view—this framework rejects the death penalty as a solution to societal problems and conflicts, whether it is administered by vigilantes or through legal due process.

I cannot claim to have all the answers. But I do know that if pro-lifers and pro-choicers get further and further caught up in ad hominem arguments over who is more bloodthirsty, we will harden even further against one another. Meaning that violence becomes more likely to happen again in the name of the abortion war, even if we fervently hope that it does not.

Separating Fact from Fiction on the Ryan-DeLauro Bill

Dr. Joel C. Hunter with David Gushee and Ronald Sider — Wed, 23 Sep 2009 07:00:00 -0400

We are pro-life evangelical Christians with long records of ministry and scholarship in which we have stood up for the unborn and for a society in which every child is welcomed into life and provided the opportunity to flourish. But we also recognize the legal and cultural realities in our nation right now in relation to abortion law.

We believe it is appropriate for us as Christians to support practical strategies that can reduce the demand for abortion even as we continue to hope and work for broader legal and cultural changes. And we feel compelled by our faith in Christ to look for the best in other people, to seek common ground where we can, and to be open to the surprising winds of God's Spirit that sometimes blow us into common effort with surprising partners.

Policies that support pregnant women and families, encourage adoption, and decrease unintended pregnancy embody compassionate pro-life values, and if enacted will ensure that fewer abortions occur and more children grow up in loving, healthy homes. A bill recently introduced in Congress, the Preventing Unintended Pregnancies, Reducing the Need for Abortion, and Supporting Parents Act (H.R. 3312, referred to as the Ryan-DeLauro Bill) advances this common-ground vision. Not surprisingly, it has gained support from numerous pro-life leaders, including the three of us.

We believe that this national effort to find common ground on abortion-reduction strategies fits with our commitments and hopes. We don't expect everyone to agree with us on these strategies. But we do think it is legitimate to expect at least our fellow Christians to portray such efforts accurately. That is not too much to ask.

However, some commentators have made inaccurate claims about the Ryan-DeLauro bill, and it is essential to clarify the facts. A recent article from Baptist Press, the Southern Baptist Convention’s in-house news agency, included several statements about the bill that do not reflect its content. Similar inaccuracies have been repeated in other conservative religious publications.

The Baptist Press article, among other things, cited claims by unnamed “major pro-life leaders” that the Ryan-DeLauro bill will expand federal funding for abortion.

This is false. As pro-life advocates know, the Hyde Amendment, which has been federal law for over 30 years, prohibits federal funding of abortion, except in the rare cases of rape, incest, or where the life of the mother is in danger. The Ryan-DeLauro bill does not repeal, revise or bypass the Hyde Amendment. In fact, the bill intentionally does not even address the issue of abortion funding. The bill does expand access to family-planning services for low-income women, but it does so by increasing funding for programs that in turn prohibit federal funds from being used for abortion -- namely, Title X and Medicaid. Under Center for Medicare and Medicaid Services policy, abortion "may not be claimed as a family-planning service" under any circumstances and the Department of Health and Human Services states that, “by law, Title X funds may not be used in programs where abortion is a method of family planning.”

The Baptist Press article also claims that the Ryan-DeLauro bill will broaden access to Plan B, the “morning-after pill.” As with abortion funding, this bill intentionally does not include any mandates one way or another with respect to Plan B. Under Medicaid, the decision to distribute or cover Plan B is left to states. Under Title X, the decision is left to individual clinics.

The article also alleges that the Ryan-DeLauro bill will result in more, not fewer, abortions. However, the bill contains a litany of policies that address key documented factors affecting the incidence of abortion -- both through prevention of unintended pregnancy and support for pregnant women. According to the Guttmacher Institute, which pro-life and pro-choice leaders alike cite as a credible source, half of all pregnancies are unintended and four in ten unintended pregnancies end in abortion. Thus, the many prevention policies in Ryan-DeLauro -- including sex education with an abstinence emphasis, increasing access to contraception for low-income women and enlisting parents in communicating with their teens about their values concerning healthy relationships -- are essential to decreasing unintended pregnancies and abortions in America.

In addition, three-fourths of women who obtain abortions say they cannot afford a child, and three-fourths say having a baby would interfere with work, school or the ability to care for dependents. The huge number of support policies for mothers in the Ryan-DeLauro bill -- such as assistance for pregnant and parenting students, expanded health care for pregnant women and children and increased child care for low-income families -- are also crucial for reducing abortions throughout our country.

Common-ground efforts to reduce abortion by addressing the circumstances that lead to it are consistent with the conviction that all life -- the unborn, pregnant women, infants and children -- is sacred. Honest dialogue about this innovative approach is imperative for those of us who aspire to protect life in concrete ways.

Plainly misrepresenting the content of the Ryan-DeLauro bill, and asserting in defiance of logic and evidence that it will increase rather than reduce abortion, does nothing to protect life. In fact, it does the opposite.

The Truth About the Capps Amendment

Rep. Lois Capps — Thu, 17 Sep 2009 08:00:00 -0400

This article was originally published on Huffington Post.com

Enacting comprehensive health insurance reform is no easy task - if it was, we'd have done it decades ago. Making it more difficult is the blatant misinformation being spread by some opponents of reform as well as people who perhaps just don't know better. A case in point is the House health reform bill's provision continuing the policy of restricting the use of federal funds to pay for abortions. There is a lot of misinformation about this provision, some of it probably the result of honest mistakes and some of it based on outright fabrications.

In an attempt to try to find a compromise for dealing with abortion services in the legislation, I offered an amendment that would essentially continue this ban - even though I personally oppose the Hyde Amendment - that was supported by Energy and Commerce Committee Members whose records span the pro-life and pro-choice spectrum. Our hope was that we could continue the current ban on federal funding for abortion so the issue wouldn't bog down the overall health reform legislation.

Unfortunately many -- from politicians to pundits -- misunderstand or intentionally misrepresent my amendment as a significant departure from current law. This couldn't be further from the truth. In fact, many independent fact checkers and even the non-partisan Congressional Research Service have found the amendment preserves the status quo in federal abortion policy.

As I mentioned earlier, under my amendment no federal funds may be used to pay for abortions that are not allowed by current law (the Hyde Amendment, which makes exceptions in the case of rape, incest, or to protect the life of the woman). The only funds that may be used to pay for other abortion services are from private funds generated by the policyholders' premiums, whether the policyholder is covered by a private plan or the public option.

My amendment ensures that no doctor or hospital or even insurance plan can be required to participate in providing or covering abortion services. In fact, my amendment goes beyond current law in this regard. Currently, existing statute known as the "Weldon Amendment" prohibits the government from discriminating against health providers and insurance companies who refuse to perform or pay for abortions. My amendment extends that to ensure that no private insurance plan operating in the Exchange may discriminate against health providers who refuse to perform abortions.

My amendment also ensures that in each region of the country, there is at least one plan in the Health Exchange that offers abortions services but also one plan in the Health Exchange that does not offer abortion services. This actually gives consumers who object to participating in a plan that covers abortion and are getting coverage through the Exchange a choice of insurance coverage greater than what most Americans have in the current employer-based health insurance market. Today, nearly 90 percent of employer-sponsored private health insurance plans cover abortion services.

Some people have gone so far as to claim my amendment would mandate abortion coverage in all insurance plans. This is simply untrue. My amendment specifically prohibits abortion from being included as part of the essential benefits package.

No one - not the Secretary of Health and Human Services nor the Health Benefits Advisory Committee - can make abortion a part of the essential benefits package. Private plans participating in the Exchange can choose to provide coverage for abortion or they can choose not to. And while the Secretary may choose to allow the public plan to cover abortions not allowed by the Hyde Amendment, coverage for those services must be paid for with segregated private funds. No Federal funds may be used. Importantly, while opponents of the bill's provision make much ado about the idea of segregating funds, it's hardly a new concept: the 17 states that currently cover abortion in their Medicaid programs already do it by only paying for those services with state dollars, which are kept separate from federal funds.

Having worked on public health issues most of my life I understand the strong beliefs generated by choice issues. But having strongly held beliefs doesn't give one license to distort the facts at hand. My amendment offers a common ground solution to a very challenging policy question - namely how do we deal with abortion services in health reform legislation. By adhering to current law which prohibits Federal funds from being used to cover abortions other than in the case of rape, incest or a threat to the life of the woman, we have found a way to move forward in our efforts to protect and provide health insurance for millions of Americans without being sidetracked by re-debating the issue of abortion.

Pro-Life and Pro-Choice College Students Join Forces

Helen Whalen-Cohen — Tue, 15 Sep 2009 08:00:00 -0400

Can there be shared goals between those who are pro-life and those who are pro-choice? According to one group of committed feminists, there can.

Recently, I attended a Capitol Hill briefing hosted by Feminists for Life. The briefing was attended by students and graduates on both sides of the abortion debate, who met to discuss the lack of resources and support on campus for pregnant and parenting students. Could it be that these two groups share more common ground than we might first suppose?

First we heard from Chaunie Brusie, recent graduate and student mother who discovered she was pregnant a few weeks into her senior year of college. Her experience was an all-too-rare success story because she challenged the status quo on her campus, finding, gathering and advocating resources so that other pregnant students would have more support than she did. She faced many challenges, but with support from her family and friends, Chaunie was able to graduate on time and deliver her daughter a week later. She now works to transform other campuses as FFL’s College Outreach Program Coordinator.

Facing similar challenges and a lack of support from university administrations, it is easy to see why many women do not feel they have any “choice” at all. Regardless of our philosophical differences and opposing views about abortion, we should all be able to agree that women who choose to continue their pregnancies, whether they raise their children themselves or make an adoption plan, deserve better than that.

Cayce Utley, the National Program Director at Feminists for Life, reviewed findings from FFL’s groundbreaking study “Perception is Reality,” confirming that Chaunie’s experience was, unfortunately, all too common. On many campuses, if resources including financial aid, health insurance that included maternity coverage and the option for additional riders, and affordable housing even exist for student parents, they are usually difficult to navigate or hidden entirely beneath a mountain of bureaucracy. How can a student facing an unplanned pregnancy feel that she has any options at all when such necessary resources are hidden or nonexistent? Or when policies are not officially established or widely publicized? When there is no central place on campus campus to which student parents can go for assistance?

Is it surprising that women feel that they cannot keep their children without sacrificing their education? As one student reported to Ms. Utley about her school, “it feels like an unspoken rule at my school that if you do get pregnant, your college experience here is over.”

Serrin Foster, the president of Feminists For Life, hosted the first of many FFL Pregnancy Resource Forums in 1997. At the briefing, she asked student activists from across the country for a show of hands: How many campuses have family housing? About one in six raised a hand. How many have child care options? Maybe one in four. When Serrin asked if students had maternity coverage in their student health care plan, not a single hand went up. “We should all be outraged by the lack of resources for pregnant women,” she said. “This is not the 1600s when only white single men went to college. And yet little has changed from the time when my father graduated from college with me in his arms. We can’t gloss over our shared goals any more.”

Serrin and others highlighted progress made at schools across the country. Most of this work was initiated by students who heard Feminists for Life’s message and advocated meeting the needs of pregnant and parenting students on their campuses. Serrin also spoke of the need for all colleges and universities to establish clear policies and communication procedures in order to support of “the rest of the choices” for pregnant students.

Although those of us in attendance at the Feminists for Life briefing may have had ideological differences, we were able to put them aside to talk about truly pro-woman solutions for pregnant students. Several interns from the Feminist Majority Leadership Association had interesting questions and helpful suggestions, and together we discussed ways to improve pregnancy support and services on campus. One Feminist Majority intern offered advice on ways to publicize resources and support for pregnant and parenting students through peer to peer counseling. We were all invited to visit a local pregnancy resource center, and I hope we are able to go together.

Rather than an aggressive debate that leads nowhere, Feminists for Life promotes collaboration between the pro-life and pro-choice camps. RH Reality Check and FFL are both creating venues where those on both sides of such a contentious issue can work together to explore real-world solutions.

As Chaunie said, we cannot allow a lack of resources and support to terminate a pregnant student’s education. The commitment of activists on both sides of the abortion debate who attended FFL’s Capitol Hill briefing convinced me that we are ready to work together, and we must.