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Daily BeastNational Right to Life, Family Research Council, and other anti-abortion organizations have been enthusiastically spreading the word about a study published in the New England Medical Journal showing that a fetus can be viable if born at 22 weeks gestation with advanced medical intervention. A New York Times article about the study was very clear that survival was for a “tiny minority” and that 24 weeks remains the medically and scientifically accepted point of viability.  Nonetheless, as all sides in politically polarized issues tend to do, abortion opponents have focused on sharing the headline of the study and not the details. Although coincidental, the publication of the study is perfectly timed with the U.S. House of Representatives passing the 20-week abortion ban, which the Senate will now consider.

Predictably, those who oppose abortion see the study as the proof needed to ban late term abortions, also suggesting that viability age should be lowered. They are appealing to our hearts through survival babies, giving the false impression that at 22 weeks most fetuses can survive outside of the womb. Many who believe that late term abortions must be legally available might even agree with them if the study was conclusive. It is not.

There are important medical-scientific limitations to babies born before 24 weeks. When pregnant women either go into labor early or a medical complication otherwise comrpomises the pregnancy, doctors discuss available medical interventions and the prospective outcomes of each on the fetus. Not all hospitals have the technology or equipment most able to produce a live birth and not all parents choose to have those interventions. Indeed, it is those very women who may choose a late term abortion to save their own lives or spare their wanted child a life of poor health. Much as they felt joy at being pregnant, life offered them a heartbreaking complication. No one has the right to judge the decision they make, certainly not Congress or political opponents of abortion.22 week fetus

In a column for the Daily Beast, Cornell Professor of Pediatrics Jeffrey Perlman noted in more eloquent terms that the study had serious biases and design flaws and should not lead to lowering the age of viability. For that to make sense, a randomized study with and without medical intervention would be necessary. Perlman also pointed out that the research would have to account for  a range of factors, such as gender differences in fetal development and accurate estimates of the age of the fetus to name a couple.

I am personally very grateful for the medical advances that have made it possible for premature babies to survive and live healthy, productive lives. I have significant reservations about the use of technology to force life too early to ensure health and quality, just as I do with sustaining life too long when people are confined to a bed with no consciousness and only technology allowing them to breathe.  All of us know of children born with disabilities or conditions that require lifelong care. That happens and to full term as well as premature babies. Families accept and embrace the children, adjusting and growing with the child. The acceptance that society places on these children and the value they place on supporting them and their families is evident through public policies, including the Americans with Disabilities Act and various educational reforms.

If a 22-week-old fetus can receive medical assistance and survive, how should medical experts and ethicists respond in the future, if at all, to the prospect of lowering the stage of viability if technology continues to advance? Are we concerned about the financial and social/personal costs associated with using the technology? There are high costs for the medical technology and there are high costs to care for babies born so early that they must receive medical care throughout life however long or short. What about 22-week gestational stage babies born addicted to drugs? Are we going to complain about the public assistance their moms receive? Will Congress thwart programs that support the care for these babies?

Doctor with laptop and pregnant woman in doctor's officeFor pregnant women in the wrenching situation of unexpectedly delivering a 22-week-old fetus, this study might offer hope if they happen to be at a hospital with the technology and expertise to offer medical intervention that might allow survival of the fetus. For other pregnant women, if this study is improperly used for political gain, and it already is**, instead of hope, it will further erode their options to make decisions they consider best for them and the baby they wanted and may even allow a physician to place priority on the life of the fetus over the woman. Which life is more important?

Instead of having implications for late term abortions and viability, the real issues to come from the study involve ethics and social support. A 22-week-old fetus is not naturally viable. An abortion at 20-22 weeks gestation may well save a woman’s life or spare a baby a life of pain. Nothing has changed in that regard.

** 5/15-15 update: Political misuse of the study has begun. See http://black.house.gov/press-release/rep-black-lauds-upcoming-house-vote-pain-capable-unborn-child-protection-act and http://www.nytimes.com/2015/05/15/opinion/an-abortion-bans-bogus-arguments.html?_r=0

It seems that pro-lifers just can’t wait for an ambulance to arrive at an abortion clinic.

I was glancing at some newsletter recently and there was yet another grainy picture of an ambulance in front of a facility in Texas and the headline was something like “Another Women Injured at Women’s Health Services.” The accompanying article seemed to relish the fact that there was an emergency at the local abortion facility.

Let’s get something straight here. Abortion is surgery. Actually, it is one of the safest surgical procedures that one can perform, particularly when done in the early stages of the pregnancy. In fact, there is a plethora of evidence that shows that giving birth is much more dangerous than having an abortion. But, over the years, the pro-choice folks have been reluctant to raise this issue because it could be interpreted to mean that we favor abortion over childbirth. And don’t me started on that one.

So, abortion is very safe but, let’s face it, accidents do happen. Doctors – including abortion doctors – are human, nurses are human, anesthesiologists are human And, yes, patients are human in that they sometimes do not reveal important information to their doctor about their physical health. Mistakes are made in the operating room and, when it happens, the clinic staff needs to take the appropriate steps to insure that the patient is properly cared for at a local hospital. And that means they might have to call for an ambulance.

But when they do what’s best for the patient, those blasted pro –lifers are out there ready to take their pictures. The real coup, of course, is if they can get a picture of the actual abortion patient so they can plaster her face all over the internet. Indeed, I can’t prove it but I gotta believe that when the protestors hears the sirens they probably get all lathered up with excitement that they’re gonna see a patient being sent to the ER.

So, that’s why there are some clinics that at times have hesitated to call the local ambulance. They should be able to do it without hesitation but they’ve got to be thinking that, first, pictures will be taken of the patient and, second, the clinic’s name will be circulated throughout the community. I’m not excusing those clinics that might react that way but over the years I’ve come to understand how some might hesitate before exposing a patient to the voyeurs out front of their facility.

Hey, why don’t you pro-lifers station yourself outside the birthing center in your local community and take their pictures? You’ve got a lot more material to work with.

In a recent Daily Beast article concerning abortion-related comments between Rand Paul and Debbie Wasserman-Shultz, Samantha Allen wrote, “By turning late-term abortions into a metonym for the issue as a whole, [Rand] Paul is clearly attempting to challenge the American consensus on the legality of abortion earlier in pregnancy. It’s a tactic as old as Roe: make first-trimester abortions guilty by association with the more easily demonized late-term procedures.” Nothing new was said here about the intent to frame all abortions as happening in the third trimester. “Metonym” is what caught my attention.

It is metonyms that keep the average person confused about abortion. Since most people, politicians and regular voters included, do not go out of their way to educate themselves about abortion and the numerous complexities of the debate, they are influenced by metonyms.

Not to be confused with a metaphor, a metonym is “a word, name, or expression used as a substitute for something else with which it is closely associated.”  We use metonyms all the time. Online sources cite “Washington” as an often used metonym for the federal government, “sweat” for hard work, “plastic” for credit card and so on. Most of us take care in everyday conversation to avoid metonymic usage if it will misinform. That is not the case in politics and, after reading Allen’s article, I realized how pervasive metonyms are in the language used to discuss abortion, primarily by those opposed to abortion.

What is the most destructive are the efforts to present abortion as something it is not. Achieving public policy objectives through false data and building public support by misleading the less passionate into a belief system based on ideology presented through using inaccurate and incorrect word choices is wrong, yet never effectively challenged.Embryos-Human

Responding to the same Rand Paul – Debbie Wasserman-Schultz comments, Casey Mattox shared in the Federalist that Wasserman-Shultz and the Democrat Party support abortion “through all nine months of pregnancy.” He later states, “Democrats are big on abortion euphemisms. When they say, as Wasserman-Shultz did, that abortion should be a woman’s ‘choice’ through all nine months, they want you to focus on something other than the reality of what abortion is. Simply put, there is no clean and humane way to kill a seven-pound, full-term baby.”

I am not sure what specific euphemisms Mattox had in mind, or if he incorrectly thinks that correct terms, such as blastocyst, embryo, or fetus, are euphemisms and that pro-choice advocates should use his preferred set of ideological words or metonyms. All pro-choice people I know would agree that it is inhumane to kill a full-term baby. We also tend to believe it inhumane to have public policies that would force a woman to compromise her health or die in order for a fetus to evolve into a born person. Mattox used the “choice” term in the context of the abortion debate as a metonym for “abortion on demand at all stages of pregnancy for any reason.”  Sadly, the dispassionate all too often believe such rhetoric.

Over the years, many of us have written about the language used to discuss abortion. Often divisive and steeped in emotion, the language is powerful. The terms “pro-choice” and “pro-life” have always created barriers to productive discourse about abortion to the point that many people now refuse to be categorized as one or the other.

Decoding Abortion Language imageFetus and unborn baby are frequently used as metonyms for blastocysts and embryos. Abortion opponents use murder metonymically for the abortion procedure itself.  Decoding Abortion Rhetoric: The Communication of Social Change (Celeste Michelle Condit 1990) discussed how metonymic language shaped public policy on abortion. That was 25 years ago and metonyms continue to define each and every facet that leads to abortion-related public policy today. Another book, Lexical and Syntactical Constructions and the Construction of Meaning, published in 1995, also discussed the metonymy of abortion language. When “embryo” is used by abortion opponents, it is as a metonym for stem cells, which has dramatically limited potentially lifesaving research. As author Mark Bracher stated in yet another book, Lacan, Discourse, and Social Change: A Psychoanalytic Cultural Criticism (1993), “Insofar as antiabortionist discourse convinces its audience, through such operations of metaphor and metonymy, that the fetus is an instance of human life, it succeeds in positioning abortion…” (p105).

Metonymy has positioned abortion in public policy outcomes. What it cannot accomplish is altering the experiences so many Americans have had, directly or indirectly, with abortion. Abortion polls that both sides use to claim victories from time to time are not reliable. What is reliable are the personal and family experiences people have with abortion rights and access.  Those experiences reject the metonyms and steer people to the belief that abortion is a personal decision between a woman and her medical provider.

As a regular reader of LifeNews.com, I was shocked when I opened their latest newsletter.

“Our office had been bombed!” screamed the headline. Oh, no, I thought to myself. Some pro-choice nut ball has finally gone off the deep end and blew up their offices. I was a little surprised that I hadn’t heard anything in the mainstream media. Even the normal left-leaning newspapers would have certainly carried the story of the first bombing of a pro-life facility, no?

I anxiously started reading, not looking forward to the information about the carnage, the destruction, the lives lost. And then once I got past the red exclamation points and the bold lettering, I got to the real story.

“No, we were not the victim of the kind of bombing you see on the nightly news that claims people’s lives and causes them to live in fear of terror. Instead, LifeNews has been the victim of pro-abortion glitter bombs.”

“Glitter bombs?”

WTF is a “glitter bomb?”

Well, according to this report, a glitter bomb is a letter that was sent to their offices and “when our staff opened the letters, glitter poured out and it went everywhere and made a huge mess.” They mentioned that several of these nasty life threatening devices had been sent over the last few weeks.

I have to say that I found it incredibly ironic that LifeNews said that they were not the target of the “kind of bombing you see …that claim people’s lives and causes them to live in fear of terror.” Phew, I certainly feel better about that. I mean, I certainly would not want the staff at LifeNews to live in fear like the dozens upon dozens of abortion clinics that were bombed over the decades. And I would never want them to experience the feeling of opening their front door in fear that the building might blow up or they would be hit with the dangerous scent of butyric acid. We would not want LifeNews staffers to have to check the bottom of their cars every morning for explosive devices or have to wear a bullet proof vest to work, would we?

As you probably have guessed right now, LifeNews used this horrifying incident to raise money. Yep, that’s what it always comes down to, doesn’t it? Their plea is that these “intimidating” acts are evidence that they have been an “effective force” in fighting the baby killers in our midst. So, despite living in constant fear of getting some glitter on their shirt, they will courageously press on with the cause which, of course, costs money. Please help us by sending $50, $100……….. You know the pitch.

Meanwhile, however, to be fair I could not ignore that a woman who police say threw some kind of Molotov cocktail at a group of women praying in front of a Planned Parenthood clinic in Austin was recently charged with aggravated assault. Fortunately, no one was injured. This nut ball was 52-year-old Melanie Toney and she was pulled over less than three miles away from the clinic. Lock her up and throw away the key for a while.

A few days ago, those of us in the pro-choice movement took a moment to remember Doctor David Gunn. On March 10, 1993 Doctor Gunn became the first abortion doctor in the United States to be assassinated by a “pro-life” zealot. His murderer, whose name I will not even use, is serving a life sentence in a jail in Florida.

Doctor Gunn travelled throughout the southwest, going from clinic to clinic to serve women who needed abortions and other reproductive health services. Weeks before his murder, he had told people that the anti-abortion protestors were getting more aggressive and to protect himself he started carrying a gun in his car. On that day, as he was entering the back entrance to the Pensacola Women’s Services, his calmly walked up behind him and shot him in the back. Doctor Gunn’s revolver was still in his glove compartment.

To many of us who represented abortion providers, this murder was not a terrible shock. We knew it was coming, we just didn’t know when it would take place or who it would be. The clinic bombings, the stalking, the ugly “Wanted” posters were increasing day by day. The tension was palpable. So, when the call came into my office in Alexandria, after I gasped I had to say I wasn’t too surprised. Over the next few weeks, the media was all over the story. Clinics across the country went on “red alert,” hiring security guards and buying bullet proof vests (one company actually called my association to see if we were interested in a group purchasing deal).

So, as this sad anniversary passed, I found myself wondering what did this assassin think he accomplished when he murdered Doctor Gunn?

I suppose that after all of these years he would probably still say that he had murdered a “murderer” who was going to “kill babies” that day. The funny thing is that after David’s murder, the staff at the clinic were on the phone setting up appointments for women in other clinics in the area. The director of a clinic in Mobile told me that she was “mobbed” with patients over the next few weeks. And, yes, a few doctors across the country who were always a little skittish about their work did decide to accelerate their retirement. But, again, when they retired the women found another doctor and another clinic to go to.

Over the last decade, the number of abortions performed in this country have decreased. Clinics are closing because they cannot see enough patients to pay for the rent, insurance, medical equipment and salaries. And that’s the good news. We all would love to see the day when women are not confronted with an unwanted pregnancy and forced to make a difficult choice, be it abortion, childbirth or adoption.

And, fortunately, the murders have stopped as well. Doctor Tiller in Kansas was the last abortion doctor to be murdered and it has been rather quiet since then. That tells me that when the violence really started to escalate in the 1990’s a lot of the motivation was mere copy-cat killings. And my hope is that we’ve seen the end of these senseless killings.

But the remaining doctors know they cannot let their guard down.

One of the funniest shows on television is “Veep,” an HBO production that stars Julia Louis Dreyfus as Vice President Selina Meyer. I was recently binge-watching the show and came across one that dealt with abortion. Meyer had just declared that she was running for President and during her campaign the current President came out to declare his support for making abortion illegal after 20 weeks. That put Meyer in a tough position because she was totally pro-choice but was uncomfortable butting heads with her President.

So, she and her aides sit down to try to craft a position on abortion that doesn’t go too awry from the President’s position but does not tick off the pro-choice groups. Staff starts throwing out different cut off dates. “How about 22 weeks?” says one aide. “That will keep you somewhat aligned with the Prez but you can tell the pro-choicers that you are more liberal on the issue.” She doesn’t buy it. Then they discuss 23 weeks, 24 weeks. Meyer keeps shaking her head, frustrated at the difficult and totally silly conversation.
She then suggests inviting lobbyists from both sides of the issue to try to craft something in the middle, hoping to assuage both Planned Parenthood and the local bishop. The efforts prove useless.

Finally, in exasperation, the VP screams out “I just want the fucking government to stay out of my snatch!!”

It was friggin hilarious and the episode captured some of the more ludicrous political situations that occur in the halls of Congress when the professionals start trying to craft positions on abortion. They try to cater to both sides and paddle right down the middle – and they always get creamed.

I’m reminded of my good friend, former Congressman Jim Moran. Jim was first elected here in Northern Virginia and his main campaign issue was that he was pro-choice. His team actually produced an award-winning commercial touting his pro-choice credentials. He won year after year in a landslide and became a leading spokesman for the pro-choice movement.

But Jim was also a good Irish Catholic boy from Boston and one day he called me to ask questions about something called “partial birth abortion.” He confided in me that he was horrified by the procedure and I had to candidly tell him that any abortion, especially one on a more developed fetus, was not pretty. He finally told me he would vote to ban the procedure.

It pained him to oppose his friends in the pro-choice movement but he at least had the courage to tell them up front what he was doing in advance and he gave a speech in the House of Representative explaining his position. After he voted with “the enemy,” the pro-choice shit hit the fan. Ultimately, the major groups decided to not contribute one dime to his next campaign (where they had maxed out in the past). Oh, Jim won his re-election handily but he lost some good friends who didn’t think he should have a conscience and was instead a traitor to the cause. It hurt him deeply and after he got over the pain, he felt anger.

The point is that anyone who seeks a middle ground on the abortion issue is going to tick off both sides. You can’t win. In retrospect, maybe Jim just should have issued a press release saying “the government should just stay out of women’s snatches.”

Congressional-sealCongress began the 2015 session proposing more anti-abortion legislation, keeping in step with legislators at the state level doing the same. Abortion rights have been chipped away so continuously, many of us have come to expect more, no matter how ludicrous.

The proposed laws calling for intrusive, expensive, and uncomfortable (even painful)  transvaginal ultrasounds and mandated scripted information containing unscientific , inaccurate or incorrect information to abortion patients serve no purpose but to promote anti-abortion propaganda and delay access to abortion services.  Some proposals are truly bizarre. An addendum to legislation in North Carolina that passed in 2013 is currently being pushed by some politicians to “…[establish] governing and quality assurance boards and [designate] a chief executive to handle day-to-day operations…”  Exactly what will an additional layer of bureaucracy in a medical practice accomplish for women’s health?

restrictions-2011-2013_smWhen asked to describe the benefits of these laws, the answers are generally the same and women generally have reactions of disbelief to their claims:

Women need to be “properly” informed. Once they are provided the right information, they will be less likely to have an abortion. Uh, yeah, even we women know that we really just do not know what we are doing when it comes to pregnancy, abortion, or other decisions involving our reproductive lives. Yep. We women need the wisdom and personal, often religious, convictions of politicians before we can feel confidence in our decision. We should not trust ourselves or our medical care providers.

It protects women’s health. Abortion is such a dangerous procedure with two victims – the pregnant mom is scarred for life and her child is killed. Can you please just give specifics about how it actually protects women? Are you saying that childbirth is safer or, really, be honest, are you just trying to put another barrier in place to stop women from choosing to have an abortion? Or, are you thinking illegal abortion would be better somehow?

We care about women and children. Oh, I know, I know…you will eventually convince me to give birth whether I am a healthy young woman, a 46-year-old woman with four children and no desire for more, a woman with chronic health conditions, a 13-year-old unprepared for pregnancy and parenting, an 11-year-old pregnant as a result of repeated sexual molestation from a male relative, or any other woman in any other circumstance. You care so much that you will promise to support me spiritually, emotionally, and financially until my offspring become adults. Oh, wait…I forgot, most of you actually stop supporting women once we give birth, once the fetus becomes a child.

preg patientsIf we assume for a moment that those who support abortion restrictions are sincere in their claims that they believe women should be properly informed, that the laws protect women’s health, and that they care about women and children, then they should also support other reproductive healthcare-related proposals that have the same goal in mind. If the premise of restrictive abortion laws is really about informing and protecting women, then laws must be developed to ensure that all women who get pregnant and plan to give birth are aware of the risks involved. All medical practices that have pregnant women as patients must arrange for structural modifications to their facilities to ensure women and the government that they can properly respond to medical emergencies that might arise. The medical providers of pregnant women must also be required to make specific, politically dictated statements about the range of risks involved in pregnancy and childbirth although, unlike the “abortion information,” statements can be based on empirical data and medical facts.

acogResearch by Elizabeth G. Raymond, MD, MPH and David A. Grimes, MD and published in the American College of Obstetrician and Gynecology’s Obstetrics & Gynecology (February 2012), concluded, “Legal induced abortion is markedly safer than childbirth. The risk of death associated with childbirth is approximately 14 times higher than that with abortion. Similarly, the overall morbidity associated with childbirth exceeds that with abortion.”  (Full PDF article available at no charge through embedded link.) While I am not interested in shattering the joy of women learning of a wanted positive pregnancy test, fair is fair. There are risks associated with pregnancy and childbearing for which women should receive appropriate medical information. Given the political and religious propaganda out there, the chances are that a lot of women think that pregnancy and childbirth are safe. If women cannot be respected as able to independently make decisions about abortion, how can we possibly believe them able to make decisions concerning pregnancy and childbirth?

In addition to pregnancy and childbearing putting women at a higher risk of death than abortion, there are numerous risk factors that require medical attention and monitoring, including prior to conception. Rh incompatibility, kidney disease, diabetes, polycystic ovary syndrome, and autoimmune diseases are among the many conditions that can dramatically complicate the health of pregnant women and their babies. Age and lifestyle are other factors that obstetricians must consider during preconception consultations and prenatal treatment practices. The latest blow to pregnant women and fetal wellbeing is research concerning the influence of the time interval between the delivery of the first baby and conception of the second.  “[A]n interval of less than 12 months causes an increased risk for severe preterm birth in women who already suffered preterm birth in their first pregnancy” was the primary finding of the research, which will be presented this week at the Society of Maternal-Fetal Medicine’s annual meeting.

Obesity is one of the most common risk factors for women in developed countries. According to research published in Science Daily (July 2010), “The heavier the woman, the higher the risk of induced preterm birth before 37 weeks, with very obese women at 70% greater risk than normal weight women.  Overweight or obese women also had a higher risk of early preterm birth (before 32 or 33 weeks). Again, the heavier the woman, the higher the risk of early preterm birth, with very obese women at 82% greater risk than normal weight women.”

CDC pregnancy-related-death-2010_600pxAll proposed Pregnancy and Childbearing Risk Awareness legislation should reach far to include all possible complications – just as restrictive abortion legislation underscores improbable complications such as a perforated uterus or death. For example, maternal mortality is on the rise in the United States, with roughly 18 out of 100,000 women dying from pregnancy-related complications in 2013; between 1998 and 2005, the figure was much lower, with roughly eight deaths per 100,000 pregnant women. In 2011, the Center for Disease Control reported 17.8 deaths per
100,000 pregnant women, noting also significant racial disparities with a rate of 12.5 per 100,000 white women and 42.8 per 100.000 black women. The death rate from abortion is one for every one million abortions performed at eight weeks or less, one for every 29,000 abortions performed at 16 to 20 weeks gestation, and one for every 11,000 abortions performed at 21 weeks or later. Obviously, far more women die due to pregnancy-related complications than abortion complications, even at the later stages of gestation. It is only appropriate to ensure that women have the correct information so that they can decide if they really want to be pregnant and if motherhood is actually worth such possible health concerns.

Those of us who believe that reproductive justice is critical to achieving social and economic equality for women know that women can and do think for themselves in every sphere of life and most especially their reproductive lives. We also make many household and relationship decisions, not to mention educational and career decisions. We do not need politicians, pastors, or “sidewalk counselors” to help us make informed, personal decisions nor do we need them to create laws to try to impose their views on us. If they feel they must be a part of our reproductive lives, they should go about it fairly and provide complete and accurate information on abortion and pregnancy.

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