Do you frequently believe that you have seen it all in the arena of attacks on reproductive health? And then you realize you can still get surprised?
Well, count me in. According to the Guttmacher Institute [3], by the end of the first quarter of 2007, just over 1,000 measures relating to reproductive health and rights had been introduced in state legislatures across the nation.
One thousand measures. Wow. What's up with our state governments? Do they think we won't pay attention if these abortion, sexuality-education and contraceptive restrictions (and yes, most of them are restrictions) come upon us incrementally on a state by state level?
Well, we are paying very close attention. One of the more oppressive bills that has popped up in Georgia, Texas [4] and other states [5] would actually force pregnant women to view their ultrasounds before receiving abortions. Talk about attempting to instill fear and guilt in women.
As the executive director of a women's health center [6] for many years, I am fully aware that, per clinical standards set by the National Abortion Federation [7] for its members, abortion providers are encouraged to perform fetal age ultrasounds on all women prior to their abortions. This has evolved as the optimal standard of care in the United States and it is an excellent and safe medical approach. Our staff consistently asked women if they wanted to view the ultrasound. Many did and many did not. Some said that viewing the ultrasound would affirm their decision. Some cried; some stared. Many women stated that they were simply curious. Some said it would be too painful to see their fetus, yet and yet others wanted the ultrasound picture to take with them for their journals or to use in a ritual as part of their healing processes. The choice to see the ultrasound was made by each woman, based on her emotional needs and decision-making process. It was purely voluntary, as it should be.
Christopher Estes, MD, a fellow in family planning at Columbia University in NYC, always offers his patients an opportunity to see the ultrasound. The majority accept. He has never seen a single patient change her mind due to viewing the ultrasound, and these are women of every age, race, and background. The most common reactions he has observed are: "Oh, that's it?" or "Wow, it's really small—not much there."
Kathy, the former director of a clinic in Baltimore, Maryland (she prefers to use her first name only now for safety reasons), had a slightly different approach. She did not offer to show ultrasound images unless the women asked or seemed interested. She describes her approach to patient care as based on trusting women; the clinical approach at her clinic was patient-led. Providing informed consent appropriately, with the level of detail about the fetus guided by the woman, always included the option to view the ultrasound. Like Dr. Estes, Kathy also never saw a woman waver from her abortion decision based on the ultrasound image.
"Jane," a clinic sonographer in the South with more than 17 years in abortion provision (she also requires anonymity at this time), always offers women the opportunity to see the ultrasound. As is true with other abortion and women's health providers, her experience is that most do voluntarily view it. When performing ultrasounds, she gives a brief description of the pregnancy and what she is seeing and measuring. If the woman then chooses to see the image, the woman has been educated and is better prepared for what she is about to look at. If the woman doesn't choose to see it, she has been given accurate and important information that will aid her decision and contribute to learning more about her body and her pregnancy. This is all a key part of the thorough pre-abortion care counseling, accurate information-sharing, unbiased informed consent, and careful medical and clinical assessment of the woman and her pregnancy. "Jane" describes mandatory ultrasound viewing for women considering, or having, abortions as a violation of women's constitutional rights and cruel and inhuman. "Forcing women to view the ultrasound seems akin to rape to me, as is forcing a woman to do anything she does not want to do. Holding her hostage to view the ultrasound as a condition to have her abortion is blackmail."
These and other numerous dedicated providers to whom I have spoken over the years trust that women choosing abortion know what they want and need. Apparently, the legislators of the 1,000 reproductive health-related bills don't. As Dr. Estes says, the voluntary viewing of the ultrasound image of her pregnancy is not a deterrent to a woman when she is making a decision about her life and future. But he knows what clearly is: biased and inaccurate counseling and distorted information full of lies about pregnancy, abortion, and contraception that are designed to frighten and intimidate women from freely choosing abortion, all of which are the experiences of women who go to crisis pregnancy centers [8]. So true!
I have an idea. Let's get our legislatures to focus their next 1,000 reproductive health-oriented bills on regulating crisis pregnancy centers. After all, millions of our tax dollars from the Bush administration's "abstinence-only" efforts goes to these centers around the country and funds the purchase of ultrasounds. Let's make sure that women receive non-evangelical, non-punitive, and truly accurate evidence-based medical information when they go there.
Now, that would demonstrate respect and trust for women, would be non-coercive, and would let women make their pregnancy choices free of fear and intimidation. But, apparently, that is not the goal of our legislators in far too many states. All they care about is mandating medical care, forcing information down women's throats, and robbing respectful choices and quality abortion care from women.