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.

GOP out of bedroomA US News and World Report article (12/31/14), What the Battle Over Abortion Will Look Like in 2015, should remind all of us concerned about reproductive justice that Republicans will control the Senate and the House of Representatives beginning this month. As much as Republicans claim to favor small and less government, we all know that when it comes to issues relative to human sexuality, they espouse as much government intrusion and regulation as possible. Although many Republicans are pro-choice, the party continues to allow its extreme right wing and Tea Party darlings to steer the votes and priorities. Reproductive decisions, sexual orientation, and even personal sexual activity preferences are of greater concern to John Boehner, Mitch McConnell, and friends than ensuring that every child has food to eat, that people are working and earning a fair wage, or that the U.S. government is protecting business from cyber-attacks, and so on. It makes no sense, but it is a reality.  It is reasonable to expect more attacks on reproductive rights in 2015.

Rick BrattinThe Republicans are on a roll. Just last month Missouri Republican Rick Brattin reintroduced a bill to require women seeking abortion to get permission from the father of the zygote/embryo/fetus.  According to Mother Jones, Brattin’s bill would exempt “legitimate rape” victims. For a pregnancy resulting from rape to be exempted and the claim of rape “legitimate,” a police report must have been filed immediately after the rape. Oh yes, the Republicans are on a roll, seemingly even including distinctions about rape – Todd Akin style. Always claiming that the legislation is to “protect women,” these mostly male representatives apparently believe they know more about what is best for women’s health than, well, legitimate women.

Thomas State legis LoCPro-choice Americans have got to step up to the plate in 2015.  They must resolve to at least let their elected
representatives know their views. As fellow blogger and former lobbyist Pat Richards can confirm, it is very easy to contact members of Congress.  One website that provides direct contact information of each congressional member is https://www.congress.gov/members. For state and local legislative representatives, The Library of Congress Thomas website provides links to each state legislature. Pro-choice people need to take a page from the playbook of the zealously anti-choice organizations like violence-promoting Operation Rescue and the various evangelical groups that pressure church members to attend sessions to write emails and make phone calls en masse. It can make a difference in the extent to which a member of Congress maintains interest in sponsoring or defending restrictive anti-abortion or other family planning legislation.

During my years directing a clinic, countless state and federal legislators shared with me that the primary reason they hesitated to have a stronger public pro-choice position was because they seldom heard from their pro-choice constituents, but they constantly heard from the anti-abortion groups. That needs to finally change – there is too much to lose if it does not.  While NARAL and Planned Parenthood supporters often initiate outreach activities, they simply cannot compete with the church-sanctioned and sponsored groups in terms of numbers. It is also worth noting that politicians actually like to hear the views of individuals speaking from the heart instead of an organized script.

minds changeAs much as we may see reproductive rights as an issue in which people do not change their positions, there are studies that illustrate that people do change their minds about polarizing issues such as abortion and gay rights. Minds change through personal experience or learning about the firsthand experience of someone they know, love, or in some way care for. Minds can change when we interact with others with whom we share general values and recognize that on polarizing issues with which we disagree, things are not so black and white, all or none propositions. No one should be fooled into believing that when minds change about abortion it is only to the anti-choice position. National Right to Life has done some great messaging in that regard. In fact, pro-choice groups could do the same.

Maria Rivera

Maria Rivera/Photo from Trust.org

In 2015 we can probably expect to see more legislation proposed to ban abortion as early as 12 weeks, more verbatim scripting for medical professionals to impose on patients regardless if true, and more unnecessary and invasive ultrasound or other testing. Before you know it, every woman who miscarries will be subjected to a law enforcement report and inquiry. Think that sounds extreme? Just take a few minutes to learn about Maria Teresa Rivera in El Salvador where all abortion is banned. She did not even know she was pregnant when she miscarried, but the judge did not believe her and sentenced Rivera to 40 years in prison for aggravated murder. Each and every anti-abortion bill proposed in the U.S. under the guise of women’s health is another step towards a total ban.

Time is of the essence for reproductive justice. When and whether to have children is a personal choice. Abortion is a personal choice in which women do not benefit from, and can be harmed by, governmental interference. Medical professionals do not need the input of politicians in the private relationships they have with patients. Please, be it resolved that you will share your pro-choice position and dedication to reproductive justice with your elected representatives beginning this first month of 2015.

Discussing the nuances of the case of Marlise Munoz, the legally dead pregnant Texas woman kept alive for weeks over her and her family’s wishes, my recent conversation with a pro-life friend continually circled back to one question of his: “But why wouldn’t she want the baby?”

Of course, the answer seemed obvious to me, but later I reflected more on his question, and realized why the concept seemed so absurd to him. To most pro-lifers, I think, it is incomprehensible that a woman who initially wanted a pregnancy might want to later terminate for almost any reason.

Abortion, after all, is for those women, way over there, the ones you’ve heard about but never met, despite the fact that 3 in 10 American women will have an abortion by age 45, and that 65% of women who had abortions in 2008 were Protestant or Catholic. To pro-lifers, it’s the domain of “amoral” women making an “irrational” decision they’ll regret when they get to know what having a child is truly like, despite the fact that most women who have abortions already have at least one child. And they claim it’s physically and psychologically harmful, despite the much lower risk of physical complications compared to pregnancy, and the thorough debunking of the largest study purported to show a causal link between abortion and mental illness.

None of these claims are new or uncommon, and none are really reflective of reality. But for those who desperately cling to them, the eminently insulting pro-life motto of recent years, Women Deserve Better, is perhaps more understandable (if not more palatable). But what explains the huge dichotomy between reality—at least, what little of it we can interpret from statistics—and the pro-life mythos of the woman who chooses abortion?

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Well, for one thing, these stereotypes are pervasive because that’s what we tend to see. What else except the self-evident “truth” of such claims would explain the dearth of stories about elective abortion in the media—stories that humanize it and display its depth as an issue? A recent analysis of television and movies that portrayed abortion showed that 9% of women who had or even contemplated an abortion died, a gross over-exaggeration of the procedure’s risk. (The actual risk of death from legal abortion is less than 1 per 100,000.)

And in public venues (like, say, slots for public testimony before legislatures considering abortion restriction bills), it is clearly only deemed “acceptable” when a woman who had an elective abortion appears regretful, wringing her hands and gnashing her teeth. Relatively very few women are willing to testify about purely elective abortions they have obtained, even if they do not regret them, and not without cause. When they do publicly discuss it, they risk serious consequences, like Lucy Flores, the Nevada legislator who told the story of her abortion as a teenager in support of a sex education bill and was summarily subjected to a torrent of death threats.

Even more subtle and pervasive than death threats is social ousting. Only days ago I had a conversation with another friend who, while she supports legal abortion, followed that up with the postscript that abortion is still “murder” and in “scenarios where I would not support her decision [I] would most likely be forced morally to cut ties with her.” Every time a friend, neighbor, or relative expresses such a sentiment (despite the high likelihood of unwittingly saying it to someone who has had an abortion), the idea that it is unacceptable to speak about the importance of abortion to the lives of real women is reinforced.

There are sadly far, far too many examples to name, but every time a politician describes abortion as an evil only terrible sinners might contemplate, he effectively silences women as well. Being told, for instance, that you are morally inferior to a rapist since “at least the rapist’s pursuit of sexual freedom doesn’t result in anyone’s death” (I’m looking at you, Rep. Lawrence Lockman) tends to have that effect.

In turn, shame-induced silence propagates the impression of absence. The void is filled by the “socially acceptable” hand-wringers and teeth gnashers who, while they certainly represent a portion of women who obtain abortions, are not reflective of the whole, or even the majority. Pro-lifers continue seeing exactly what they expect to see, and continue advancing (and believing!) the notion that abortion is tangibly harmful, not only to fetuses, but to women.

And, very, very slowly, the pro-choice movement loses ground in the culture war.

The number of people who labeled themselves “pro-choice” in the Gallup poll on abortion, which has been tallying the estimated percentages of pro-choice vs pro-life citizens since 1995, reached an all-time low of 41% in 2012. Other polling has shown an increasing number of pro-lifers among Republicans, and more disturbingly, an increase in the number of Democratic men who oppose abortion as well. While these numbers are more complicated than they appear (for instance, a personally pro-life person may still support some or all legal abortion despite his or her views), the trends over time still have a story to tell.

The Overton window is a political theory that describes a narrow range of political beliefs that are considered acceptable. The silence of women caused by systematic social shaming and a climate of public threat, combined with an increasing number of openly hostile public remarks about abortion, seems to have shifted this window significantly further to the right in the last decade. As claims of dubious medical credibility and offensive remarks about the character of women who choose abortion become more mainstream, support of abortion up to viability is slowly coming to be perceived as an extremist view.

So how can we reverse the trend?

End the silence.

 

Sources:

1) Gallup polling on abortion, trends over time: http://www.gallup.com/poll/154838/pro-choice-americans-record-low.aspx

2) The Pew Research Religion and Public Life Project on support for legal abortion: http://www.pewforum.org/2009/10/01/support-for-abortion-slips2/

3) Guttmacher Institute factsheet, Induced Abortion in the United States: http://www.guttmacher.org/pubs/fb_induced_abortion.html

4) Guttmacher, Characteristics of US Abortion Patients, 2008: http://www.guttmacher.org/pubs/US-Abortion-Patients.pdf

5) CDC Abortion surveillance for 2009: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6108a1.htm

6) Slate, “Characters Who Have, or Just Think About Having Abortions, Often Die”: http://www.slate.com/blogs/xx_factor/2014/01/17/abortion_in_movies_and_on_tv_often_results_in_death.html

7) Article on Lucy Flores, Nevada assemblywoman who received death threats following her testimony about her abortion at 16: http://www.policymic.com/articles/33199/lucy-flores-abortion-nevada-lawmaker-faces-death-threats-after-talking-about-her-abortion

8) An excellent article I recommend, “Abortion as a Blessing, Grace, or Gift: Changing the Conversation on Reproductive Rights and Moral Values” http://rhrealitycheck.org/article/2014/04/03/abortion-blessing-grace-gift-changing-conversation-reproductive-rights-moral-values/

9) A great TedX talk on abortion stigma: https://www.youtube.com/watch?v=FxI6HGpaP3Q

Pregnancy as an “inconvenience”

One of the greatest falsehoods of the pro-life movement is that pregnancy is merely an inconvenience, a period of temporary discomfort. This is more than a mere talking point; it’s a dangerous lie. Pregnancy is actually a life-threatening condition for many women.

The maternal mortality rate (MMR) is significantly higher in the US than in other developed countries, and the number gets even more pronounced when divvied up into demographics. The 2010 MMR in the US was 21 maternal deaths out of 100,000 live births, a number higher than 47 other countries listed by the CIA’s WorldFact report on maternal mortality. Compare this to the US Dept. of Health and Human Services’ goal for 2010 of 3.3 deaths per 100,000, and about seven times as many women are currently dying from pregnancy-related causes in the US than should be.

Shockingly, not only has the maternal mortality rate not fallen since the mid-1980s, it has actually steadily risen (the MMR in 1987 was 6.6!). But racial disparities in the MMR reveal even more appalling numbers: in 2007, black women were 2.7 times more likely to die of pregnancy-related causes than white women. A 2005 paper on the preventability of pregnancy-caused deaths in North Carolina showed that while 33% of deaths among white women were preventable, a full 46% of deaths among black women were preventable.  This is probably reflective of wider disparities: minority women are more likely to experience an unintended pregnancy, to be poor, and to receive care at lower quality medical centers than white women.

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Even worse, most of these figures are likely underestimated. A 2005 study compared actual rates of pregnancy-caused death to purported rates on death certificates in four regions and found a prevalent underestimation of pregnancy as a cause of death. In Massachusetts, death was inaccurately accorded to a cause other than pregnancy in 93% of the cases studied.

While the maternal mortality rate is increasing, the rate of severe pregnancy complications is also increasing. A 2009 study analyzing trends in the rates of severe obstetric complications showed a “20% increase in rates of renal failure, respiratory distress syndrome, shock, ventilation, and an approximately 50% and 90% increase in pulmonary embolism and blood transfusions, respectively” from 1998-2005. Although there was a correlation between increasing rates of (often unnecessary) caesarian section and severe complications, this only partially explained the dramatic rise in severe obstetric problems experienced by American women since 1998.

In addition, the infant mortality rate is also relatively high in the US compared to other developed countries. Despite substantial decline over the course of the 20th century, the rate of infant death has stagnated in recent years and the US international ranking for infant mortality fell from 12th place in 1960 to 30th in 2005. Abysmally, a Save the Children report recently showed that the US has the highest first day infant death rate of all industrialized nations studied in the report, 50% more than all other industrialized nations combined. And, as with the maternal mortality rate, racial disparities in the infant mortality rate are stark: according to the National Vital Statistics Reports for 2009, the mortality rate for black infants was 12.71per 1,000 live births, compared to 5.32 for white infants (and the report noted that the former is likely an underestimation).

And yet, as part of so-called “informed consent,” pro-life groups routinely tout the fallacious risks of abortion with pseudoscientific claims (e.g. increased risk of breast cancer, infertility, depression, and death) while understating the risks of childbirth. Among first trimester abortions, which comprise the vast majority of abortions, the risk of serious complications is less than .5%.  However, more than 50,000 women per year suffer from severe maternal morbidity (SMM), potentially life-threatening conditions associated with pregnancy. The rate of SMM is also increasing over time, more than doubling from 1998 to 2011. This does not include more minor complications, which are far more common in pregnancy (94.1% of the pregnancies in 2008) than first trimester abortion (2.5%).

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What should we be doing?

 First, and perhaps most importantly, we need to gather information. Why, besides increased caesarian sections, are the rates of severe obstetric complications increasing? Why is the maternal mortality rate increasing so steadily despite the $86 billion spent on pregnancy and childbirth in the US per year? How can we standardize data collection to ensure accurate information on maternal health outcomes across the board? What programs can hospitals institute to reduce the rate of mortality for women and infants?

Although we have some notion of risks associated with maternal and infant death, our data is far from complete. In 2011 the Maternal Health Accountability Act was introduced to provide grants to create state-level maternal mortality review committees to standardize data collection and eliminate disparities in health outcomes. The bill unfortunately died in a Republican-controlled committee.

Otherwise, we are aware of many of the risks and should be able to address at least some with public policy. Higher risk of infant mortality is associated with preterm birth, which is associated with teen pregnancy, unplanned pregnancy, and poor/minority mothers.

These risk factors overlap significantly; for instance, teen mothers are more likely to be poorer, less educated, and to receive less prenatal care than mothers in other groups, and 70% surveyed in a 2004-2006 North Carolina study indicated that their pregnancies were unintended. Similarly, poor and minority women are less likely to receive prenatal care, and minority women are more likely to be poor and have higher rates of unintended pregnancy than other women as well. As for maternal mortality, disparities in access to prenatal and labor care and family planning; poverty; and minority status are all major risk factors, and these also often overlap.

While the problem is systemic, it can be tackled in very specific ways. One of the most important steps in tackling poor health outcomes for mothers and infants is to reduce unplanned pregnancy, which is indirectly associated with both infant and maternal mortality, since the groups at highest risk of dying of pregnancy complications and/or losing an infant are also at very high risk of unintended pregnancies. The major means of accomplishing this goal are to offer comprehensive sex education to adolescents, to increase public funding to family planning clinics, and to make access to reliable contraceptives as universal as possible.

Every one of these things has been directly evidenced to reduce the rate of unintended pregnancy. Comprehensive sex education is associated with reduced rates of teen pregnancy. Conversely, abstinence-only education has not been correlated with lower rates of vaginal intercourse, and states with abstinence-only or non-requisite sex education programs consistently have some of the highest rates of teen pregnancy in the nation. But that doesn’t stop pro-life politicians from routinely insisting on abstinence-only programs, despite their marked failure year after year.

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For six in ten patients using publicly funded family planning services, it is their primary source of health care. An estimated 1.94 million unintended pregnancies and 810,000 abortions are prevented each year by use of public family planning clinics, but as I noted in my last article, they only meet a paltry 40% of the need. Increasing funding to family planning clinics, and therefore access to preventive services and contraceptives, would further decrease the rate of unplanned pregnancy. However, Republican politicians in numerous states consistently cut funding to family planning and women’s health services.

To give an example of the cognitive dissonance so prevalently present between stated pro-life ideology and the consequences of implementing pro-life laws, let us take Texas for an example. In 2011, as part of a sweeping pro-life agenda to shut down Planned Parenthood (the ultimate abortion scapegoat, despite 97% of its services being non-abortion related), Texas slashed family planning funds by 2/3 and barred Planned Parenthood from receiving funds from the Texas Women’s Health Program, resulting in a 77% reduction in the number of patients using family planning clinics, in a state that ranks first in the nation for the number of uninsured, 8th for poverty, and 3rd for teen pregnancy.

The maternal mortality rate has quadrupled in Texas in the last 15 years to 24.6, and even after improvement from 2009, the 2010 demographics are abysmal and much higher than the national average (27, down from 30.8, for white women, and 53.9, down from 66, for black women). For reference, that means black women are statistically better off giving birth in Mexico or Kazakhstan than Texas, and that white women would be better off in Saudi Arabia.

In addition, despite the incredibly high teen pregnancy rate, Texas schools stress abstinence education, do not require contraceptive education, and do not require that sex education be medically accurate. The budget cuts for women’s health care have also decreased the number of clinics that offer preventive healthcare for sexually active teens without parental consent or notification.

Every policy outlined above is one that increases the rate of unintended pregnancy, especially in populations more highly prone to infant mortality (teens) and maternal mortality (poor and minority women). Far from being “pro-life,” Texas has implemented a set of policies that will result in the unnecessary deaths of women and infants. It has instituted legislation that directly decreases access to contraceptives, preventive screenings, checkups, and prenatal care. These in turn lead to increased rates of poor health outcomes for pregnant women, as well as unintended pregnancy among the groups least likely to want or afford pregnancy or children. Simultaneously Texas has instituted sweeping anti-abortion policies that vastly remove access to abortion for women who can’t afford prenatal care or postpartum checkups.

The state ironically takes no responsibility for its own role in making women’s lives worse, exhibiting Orwellian double-speak about personal responsibility even as politicians systematically remove the resources women would otherwise use to BE personally responsible for their reproductive destinies.

All of Texas’ legislative actions aimed at shuttering the Planned Parenthoods in the state are particularly cruel considering they have also declined to expand Medicaid, leaving many poor and minority women nowhere to turn for contraceptives, preventive healthcare, and prenatal care. The Texas Policy Evaluation Project’s survey of low-income women following Texas’ 2011 budget cuts found that “now more than ever disadvantaged women must choose between contraception and meeting other immediate economic needs.”

Texas, sadly, is not alone. Many other states are likewise instituting anti-abortion restrictions while failing to address the unmet need for family planning, expand Medicaid, increase access to prenatal and postpartum care, or offer comprehensive or medically accurate sex education. Far from being an “inconvenience,” pregnancy is a condition fraught with major risks of health complications for both mother and infant. And when legislators intentionally limit abortion access while failing to address the increased risks of maternal and infant death that accompany high unintended pregnancy in poor, uneducated, teen, and minority women, they really don’t deserve to be called “pro-life.”

 

Sources:

1) “Deadly Delivery: The Maternal Health Care Crisis in the USA.” Amnesty International.  http://www.amnestyusa.org/sites/default/files/pdfs/deadlydelivery.pdf

2) Berg CJ, Harper MA, et al. Preventability of pregnancy-related deaths: results of a state-wide review. http://www.ncbi.nlm.nih.gov/pubmed/16319245

3) Hasnain-Wynia R, Baker DW et al. Disparities in health care are driven by where minority patients seek care: examination of the hospital quality alliance measures. http://www.ncbi.nlm.nih.gov/pubmed/17592095

4) MacDorman MF, Mathews, TJ. The Challenge of Infant Mortality: Have We Reached a Plateau? http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2728659/

5) “Surviving the First Day: State of the World’s Mothers 2013″. Save the Children: http://www.savethechildrenweb.org/SOWM-2013/files/assets/common/downloads/State%20of%20the%20WorldOWM-2013.pdf

6) CIA World Factbook rankings of countries by maternal mortality rate: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2223rank.html

7) Kochanek, K., Xu, J., et al. Deaths: Preliminary Data for 2009; National Vital Statistics Reports. http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_04.pdf

8) Xu, J., Kenneth, D., et al. Deaths: Final Data for 2007; National Vital Statistics Reports. http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_19.pdf

9) Gaskin, Ina. Maternal Death in the United States: A Problem Solved or a Problem Ignored? Journal of Perinatal Education, 2008.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2409165/#citeref9 

10) Deneux-Tharaux, C, Berg, C, et al. Underreporting of Pregnancy-Related Mortality in the United States and Europe. 2005: http://opac.invs.sante.fr/doc_num.php?explnum_id=4060

11) CDC fact sheet on Severe Maternal Morbidity in the US: http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/SevereMaternalMorbidity.html

12) National Abortion Federation fact sheet on the risks of abortion: https://www.prochoice.org/about_abortion/facts/safety_of_abortion.html#n5

13) Elixhauser A, Wier M. Complicating Conditions of Pregnancy and Childbirth, 2008. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb113.pdf

14) “Unintended Pregnancies: 2004-2006 N.C. Pregnancy Risk Assessment Monitoring System (PRAMS)”  http://digital.ncdcr.gov/cdm/ref/collection/p249901coll22/id/22589

15) An epidemiological review of the effects of comprehensive, abstinence-only, and lack of sexual education on the likelihood of teen pregnancy and rate of intercourse: http://www.jahonline.org/article/S1054-139X(07)00426-0/abstract

16) Teen pregnancy rates by state: http://www.livescience.com/27417-teen-pregnancy-rates-by-state.html AND, for comparison, a brief on state policies on sex education: https://www.guttmacher.org/statecenter/spibs/spib_SE.pdf

17) Guttmacher news release on unintended pregnancies and abortions prevented by the use of publicly funded family planning services: https://guttmacher.org/media/nr/2009/02/23/index.html

18) 77% fewer Texas clients for family planning clinics: http://rhrealitycheck.org/article/2013/11/21/after-budget-cuts-texas-family-planning-program-serving-77-percent-fewer-clients/

19) Texas has highest uninsured rate and ranks 8th for poverty: http://dfw.cbslocal.com/2013/09/17/texas-has-highest-uninsured-rate-high-poverty/

20) “Republicans Offer an Obamacare Alternative,” Time Healthcare online: http://swampland.time.com/2014/02/03/obamacare-republican-alternative/

21) The Texas Policy Evaluation Project, “Low-Income Women’s Attitudes About Affordable Family Planning Services” http://www.utexas.edu/cola/orgs/txpep/_files/pdf/TxPEP-ResearchBrief-WomensAttitudesAboutFPServices.pdf

Anti Abortion Terrorism

Anti Abortion Terrorism

It’s quite possible that I met Lee Ann Nichols just a few weeks before she was killed at an Abortion office..

As a staff person for the National Coalition of Abortion Providers, in early December, 1994, I had gone up to the Boston area to visit a number of member clinics.  One of my first stops was the Preterm Clinic on Commonwealth Avenue.  As always, I was escorted around by the administrator and introduced to all the staff people.  Lee Ann was the receptionist but I just can’t remember if I met her.

Just a few months after Paul Hill murdered Doctor Baird Britton and his bodyguard, pro-life terrorist John Salvi also took the law into his own hands in a shooting spree at two clinics in the area.  Witnesses had testified that Salvi had been a somewhat regular presence in front of Preterm and the Planned Parenthood clinics. As for his mental state, letters released after his arrest indicated his belief in conspiracies by the freemasons, the Vatican and the KKK, which he thought was targeting Catholics.   Salvi’s mother later said that her son had told her that he “was the thief on the cross with Jesus.” He also told her that “…the mafia and KKK are out to get me.”

Anti Abortion Terrorism

Anti Abortion Terrorism

On Decebmer 30, 1994, John Salvi calmly walked into the Planned Parenthood facility and shot Shannon Lowney, the receptionist.  He then walked over to Preterm where he killed Nichols and engaged the security guard, Richard Seron, in a gun battle.  After that, Salvi dropped a bag containing a second gun and 700 rounds of ammunition and fled the city.  A nationwide alert was put out and the NCAP office was inundated with calls from clinics all along the east coast asking what security precautions they should take.  The next day, 1,200 miles away in Norfolk, Virginia, the Reverend Donald Spitz and his followers ended their regular protest outside the Hillcrest Clinic and fifteen minutes later, Salvi suddenly appeared at the building’s main entrance.  He sprayed the lobby with a hail of bullets but no one was hurt.  Within 10 minutes, police surrounded a pick-up truck and Salvi was arrested.

At one point, the Boston Globe reported that Salvi had a piece of paper with Donald Spitz’ name on it.  Spitz was “follower” of Paul Hill and espoused the “justifiable homicide” theory.  Spitz was never charged with aiding Salvi in any way but Salvi’s trial gave Spitz a lot of national attention because he stood outside the courtroom defending Salvi’s actions.

I had met Spitz a few times and I always thought that, like Paul Hill, he loved the media spotlight.  So, this particular case was ripe for him and his ego.  He knew folks would be outraged if he said he supported Salvi and some pro-choice folks were apoplectic that he was out there applauding Salvi’s rampage.  Still, I was one of the few that suggested that he was within his Free Speech rights and that we should just ignore him and not give him the attention he desired.

About two years later, after he was convicted of murder, Salvi was found dead in his prison cell.  The official report said that his death was a suicide but there was some controversy because other reports claimed that he was found with his hands and feet tied together, cotton shoved in his mouth and a bag placed and tied over his head.

For the abortion provider community, this new outrage upped the ante even more because now someone had just decided to walk into a clinic and start shooting.  He was not necessarily targeting a doctor.  Indeed, I remember talking to some clinic line staff who very privately expressed some “comfort” that the assassins until then had “just” been targeting the doctors.  But this was different.  Suddenly, parents and loved ones of clinic staff were asking their loved ones to leave the potentially dangerous situation.

It seemed that no one was safe anymore.

 

No More Bullying Abortion Facilities

About ten years ago, I attended the funeral of Norma Stave, a good friend who, with her husband Carl, was the co-owner of two abortion clinics in Maryland.  Carl was the main physician who performed the abortions.  When I arrived at the church, Carl came up to me and asked at the last second if I would deliver a eulogy.  I had always been comfortable talking in front of audiences but this was a different animal.  Still, I was able to get through it, using my few minutes to praise Norma for her devotion to women in need.

Skip ahead a number of years.  Carl died shortly after Norma and their son, Todd, ultimately became the landlord for their two buildings.  About eight months ago, Todd’s clinic in Germantown, Maryland attracted national attention when they hired Doctor Lee Carhart, a physician who worked for the late George Tiller and who vowed to continue George’s work by offering late term abortions.

Victim of Anti-Abortion groups

Victim of Anti-Abortion groups

Soon thereafter, local anti-abortion advocates learned that Todd owned that building where Lee worked.  They quickly organized a number of protests, accomplished their goal of getting publicity in the local papers and have been a continual presence ever since.  Then, looking for another angle to get their names in the papers, they decided to crawl deeper into the gutter.  They learned where Todd’s 11 year old daughter was going to school and at a Back to School night, they stood outside the school with a banner that read “Please Stop Killing the Children” and the usual photos of aborted fetuses.   Then, these wackos actually put Todd’s picture, phone numbers and email addresses online and urged their followers to contact him with their “prayers.”  Todd was inundated with calls and emails.  Nice, huh?

But Todd decided to fight back.  He compiled a list of the people who were calling and emailing him and he sent that list out to 20 of his friends, urging them to call those people.  He told them to not argue with them, to just be polite and tell them that “the Stave family thanks you for your prayers.”  Well, those 20 friends passed on the info to their friends, and so on and so on and within two days they had 5,000 pro-choice folks making calls.  Interestingly, the calls and emails to Todd’s house came to an abrupt halt.

Hmmmmmm…Is Todd on to something here?

Abortion

Abortion Rights

I talked to Todd last night.  He tells me that he has actually established a group called “Voice of Choice” (www.VoChoice.org) which seeks to organize a “person to person counter campaign against anti-choice bullying.”  The people who volunteer are notified when a certain anti-abortion advocate is harassing a doctor and are given that person’s phone and/or email.  Then they start contacting that person.  Todd says they have successfully stopped the harassment in two cases already.

I have no doubt that there are some pro-choicers out there who might feel uncomfortable about stooping to the tactics normally used by the anti abortion folks.  Indeed, whether or not to use these kinds of aggressive tactics has been the subject of many conversations within the pro choice movement for years.  In fact, Todd told me that some national pro-choice groups have been reluctant to cooperate with his organization.

When I was in the movement, I always came down on the side of those who did not support stooping to their level.  I thought it was beneath us, that we had to take the high road.  And maybe I’m just getting old and cranky.  But now I say screw it.  As long as it’s legal, go get the bastards, Todd!

Mississippi

Mississippi.    

Is there a more pathetic state in the Union?   I mean, does anyone know of a state that is more regressive in terms of income, health, education, baseball teams?   Indeed, can you name a Third World country that is as bad as Mississippi?    

And, now, to push the state even further into the dark ages, their voters on Tuesday will probably pass a resolution that will totally outlaw abortion.  The specific question that the voters will be asked to approve says:  “Should the term ‘person’ be defined to include every human being from the moment of fertilization, cloning or the equivalent thereof?”   Now I can’t imagine anyone in that state who knows what the term “thereof” means, but the gist of this measure is there will be no more abortions and lots more kids to add to the misery that is life in Mississippi.  Indeed, the person who is spearheading this effort, a guy named Les Riley, is the founder of “Personhood Mississippi” and he is the father of TEN children.  I guess old Les is hoping that others in his neck of the woods will bear the same number of kids, if not more, so they can get the classroom sizes up to at least 50 kids per room which would push their rate of academic achievement below that of Somalia.  Quite a role model, that Les!

The interesting thing about this resolution is that many “mainstream” pro-life groups actually oppose it because they are smart enough to realize that it is too extreme.  But, it ain’t too extreme for the Bubbas in Mississippi.  Indeed, outlawing abortion ain’t enough for these folks.  An analysis of the resolution shows that certain forms of birth control would be outlawed (thus creating even more children living in poverty) and it would limit in vitro fertilization.  But, for now, let’s stick to the abortion side of the equation. 

This is Johnny, oh wait, Marie, oh wait "it" has no sex yet.

When the measure passes, the next day Planned Parenthood will challenge it in court and the lower courts will grant an injunction prohibiting the measure from going into effect.  Here’s the thing, however.  Let’s say Mitt Romney (or one of the other Republican nominees) becomes President in 2013.  Despite his previous support for the right to choose, he has now courageously “seen the light” and is all of a sudden pro-life.  What a guy, a true Profile in Courage.  As President, he would be beholden to the pro-life movement and

sooner or later some more Supreme Court judges are going to kick the bucket.  That means that Romney (or, conversely, Obama) might get to make 2 or 3 appointments.  If it’s Romney, you know damn well he is going to appoint judges who are pro-life and that could tip the scales. 

Yes, many lawyers suggest that the court could not uphold a measure like this because of “legal precedent.”  That’s garbage.  It might have been the case years ago when our judicial system, not to mention the executive and legislative branches, were more deferential to their body’s previous actions but not anymore.  I am convinced that when the Supreme Court gets this (or any other) case, the justices, with the possible exception of Justice Kennedy, make up their minds immediately, then instruct their clerks to construct their rationalization.  If you think they sit there objectively, listening intently to the arguments of the learned counsel then come to a decision, you’re in La La land.  I mean, think about it.  Do you really think Clarence Thomas and Anton Scalia would NOT find a way to uphold the Mississippi law?  

So, this case will ultimately make it to the Supreme Court in a few years.  And that makes the next Presidential election so extremely important when it comes to abortion rights.  I feel like we’ve been through this drill before, but this time it’s extremely serious. 

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