A while ago on the Abortion.com Facebook page I saw the following comment: “I guess pro-choice people don’t think twice about stabbing a baby in the head …  that has taken a breath! Or even twisting their heads off!” It got me thinking: how does one combat this level of ignorance? Then the deeper implication: how can there ever be real dialogue in the abortion debate when such ignorance is so commonplace? The answer, I hope, is that by injecting critical thinking and evidence into a dialogue so lacking in either, I can change that trend.

My name is Heather Cale, and I care about this topic because as a medical student, I want abortion to be treated like any other medical matter: in an evidence-based manner. I consider myself strongly pro-choice, but that alone does not determine the extent of my views. Abortion is investigated as rigorously as any other medical procedure; that means it is my responsibility as a future physician to analyze the data objectively, and not through the lens of my personal views.

So far, most relevant evidence strongly supports continued access to abortion, including that restrictive abortion laws are not associated with lower rates of abortion, but are associated with much higher maternal mortality and morbidity rates. However, not enough research has been conducted in some important areas. For instance, a widely touted JAMA systematic review on fetal pain concluded that fetuses most likely become pain-capable somewhere in the third trimester, but admitted the evidence is limited and inconclusive. Newer evidence indicates it may also incorrectly assume that requirements for pain perception are identical for fetal and adult brains.

Unfortunately, abortion has become so politicized that many on either side either completely disregard any evidence that doesn’t further their own agendas, or even manipulate evidence to fit their beliefs. This attitude is exemplified by organizations like WECARE. Most people are unaware of WECARE, but Priscilla Coleman, its Director, is the author of a large percentage of articles that purport to find negative associations with abortion even where none exist. In 2009, she published a headline-making study purporting to link abortion to “anxiety, mood, and substance abuse disorders.” The study was then thoroughly debunked by UCSF’s Julia Steinberg, who showed that Coleman’s results could not be duplicated, and her methodology, among other egregious errors, failed to control for prior mental health and violence experiences. The journal that published both the original article and its critique even offered a commentary agreeing with the merit of the latter and stating that Coleman’s paper “does not support assertions that abortions led to psychopathology.”

ImageFlawed, debunked, or superseded evidence then becomes perpetuated by professional medical organizations with definitive religiopolitical stances (like the Christian Medical & Dental Associations) in a vicious trickle-down cycle. The CMDA continues to publicize articles incorrectly linking abortion with breast cancer or mental health disorders (Coleman is the author of many) while completely ignoring any opposing evidence that defeats those stances. These studies are also perpetuated in so-called “Crisis Pregnancy Centers,” where workers routinely give pregnant women scientific misinformation in an attempt to dissuade them from choosing to abort. Finally, the spread of misinformation ends with the public and political sphere. That single debunked study by Coleman alone was, according to a piece in the New York Times, “[responsible] for ‘informed consent’ laws in at least eight states.” Is it any wonder, then, that ignorance abounds in the abortion debate? Image

Science is not liberal or conservative; it is objective or non-objective, evidence-based or not. Science doesn’t work by deciding the validity of a source based on its conclusion rather than the evidence which supports it, or by manipulating evidence to fit a decided conclusion. I can understand what cements this rigid unwillingness to consider evidence that doesn’t help one’s political cause: the fear of giving up hard-fought-for victories to a political enemy. That fear isn’t just limited to the pro-life side, either.

However, in a debate so riddled with religious fervor and emotional rhetoric, rationality must be the path forward, and that means both sides must at least be willing to recognize evidence that may not aid their “cause.” Here is where I hope to instigate some change: to see abortion treated as a medical procedure with deep-running bioethical considerations rather than a billboard slogan, to see evidence considered on its own merits rather than its political implications. In short, I hope to bring logic back to a debate overrun with emotion, religion, and politics. Wish me luck.

 

 

For the much touted 2005 JAMA review on fetal pain indicating it most likely begins in the third trimester: http://jama.jamanetwork.com/article.aspx?articleid=201429

 

For one of multiple related articles indicating that fetal brains may be capable of primitive pain sensation that does not require thalamocortical circuits related to pain perception: http://www.ncbi.nlm.nih.gov/pubmed/17905181

 

For some heavier reading detailing the connection between unsafe abortion and maternal morbidity and mortality, try the most recent edition of “Unsafe Abortion: global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008” by the World Health Organization: http://www.who.int/reproductivehealth/publications/unsafe_abortion/9789241501118/en/index.html

 

For more on how rates of abortion are estimated to be comparable in countries where it is legal and illegal, but there are much higher rates of unsafe abortion (and 97% of associated deaths) where it is illegal, see “Induced abortion: estimated rates and trends worldwide.” http://media.mcclatchydc.com/smedia/2007/10/17/13/Chang-Guttmacher_Institute_abortion_report.source.prod_affiliate.91.pdf

 

For more on the New York Times piece citing the states in which Coleman’s study was used as the basis for informed consent laws: http://takingnote.blogs.nytimes.com/2012/03/14/remember-that-study-saying-abortion-makes-you-crazy/

 

For more on Coleman’s paper in the Journal of Psychiatric Research, Steinberg’s analysis, and the journal’s commentary, see: http://healthland.time.com/2012/03/08/study-linking-abortion-to-mental-health-problems-is-flawed/

 

 

 

Yellow Pages Search "The Old Days"

Once a woman decides to have an abortion, the next step is to find a facility in her area that actually can perform the abortion.  In years past, most women would go to their closet, get out the Yellow Pages and let their fingers do the walking to the “Abortion” category.  Once there, she would see a number of ads placed by the clinics.

What a lot of women didn’t realize, however, was that a number of the ads were actually placed by anti-abortion facilities or “crisis pregnancy centers.”  The ads were slick, never really saying whether or not they performed abortions.  The goal was to try to get unsuspecting women to come to their facility where they would then try to dissuade them, often using hard-handed and questionable “information” to do so.  The abuses are pretty well documented.  Indeed, once these “phony abortion clinics” were exposed, the Yellow Page Association was forced to create a new separate category entitled “Abortion Alternatives” for anti-abortion facilities.  I am intimately aware of the course of these events because I was on the staff of the National Coalition of Abortion Providers at the time – the organization that spearheaded the effort to make sure women knew exactly who they were calling.

Today, most patients do not go to the Yellow Pages for abortion services.  Heck, they don’t go to the Yellow Pages for anything anymore.  Instead, they go to Al Gore’s Internet.  And now, the problem of sketchy advertising is rearing its ugly head again.

A woman who has decided to have an abortion will probably do a Google Search for “abortion” or “abortion services” or “abortion clinics.”  If she were interested in getting the pro-life perspective, she might search for “pro-life” or “anti-abortion information” or words to that effect.  But if she wants the abortion, she will do her search, get to that page and immediately sees a number of ads listed in the “sponsored links” section.  That means those facilities are actually paying Google to be advertised in those prominent positions.  And, lo and behold, included in some of the sponsored links are some anti-abortion crisis pregnancy centers!  Then, when you click into their ad and get to their website, it’s the same old story.  They use phrases like “abortion counseling,” “abortion stories,” and “abortion information.”  I searched and searched and found nothing that says “we are anti-abortion.”

Now, I get that the cpcs could argue that they are in fact providing “abortion information” or “counseling.”  But I think the more honest approach would be to say you are providing “anti-abortion counseling.”   Also, I’m sure the pro-lifers who read my world famous blog will come up with examples of how the advertising for the clinics can be “deceptive.”  Indeed, if you DO have examples let us know and we’d be happy to respond.

The point is why do folks play such games with women who are in very emotionally sensitive situations?  Why not be totally up front about what you want to offer?  Then let the women make up their minds if they want to utilize your services.   Meanwhile, I think it would very interesting if someone (perhaps those that manage www.abortion.com) sent an inquiry to the folks at Google and the other search engines asking them to devise something like the Yellow Page folks did years ago so the Internet advertising was just a little more “honest.”

Don’t the women deserve that much?

Sex Selective Abortions

After getting my kids off to college this weekend, I actually sat back and read the newspaper!  Thumbing through the New York Times, I came across an article about a new medical test that would help couples identify the sex of their unborn baby much earlier in the pregnancy.  Today, you have to wait until about 15 weeks or so to get a definitive answer.

This is a great scientific advancement so, of course, the pro-life groups are up in arms and expressing grave concern.  That’s because they think that women will start aborting fetuses because they wanted a boy instead of a girl or they already had three girls and were hoping to mix it up a bit.  And, of course, if the male has anything to say about it, he would abort that silly little girl over the next Derek Jeter.

Let’s all acknowledge that in certain cultures boys are preferred over girls and the practice of sex selection abortions is rather common in some of those cultures.  And, to be honest, while the idea of aborting a fetus because of its sex feels rather strange to me, I still have to support the woman on this one.  As I have always said, up until the point of viability the women should be able to abort no matter what the reason, no matter how uncomfortable it might be for others.  That’s because, if you start carving out exceptions such as sex selection, then you’re on a slippery slope and our lawmakers would soon be looking at other exceptions.

Of course, those who were raised in other cultures wind up coming to the United States so it is quite possible that a woman, for example, from India might want an abortion here in the U.S. because she knows she’s having a girl.  This new test will allow her to identify the sex much earlier which would allow her to have an abortion earlier in her pregnancy.  And, if you are going to have an abortion, earlier is always better than later, no?

So, yes, this new test might “encourage” a woman, particularly one from the East, to have an abortion for purposes of sex selection.  But let’s be real about this.

The fact is that when a woman goes into an abortion facility, after signing the paperwork, getting some medical tests, etc. she is then seen by a counselor.  The counselor discusses with her the abortion process, she reviews her other options, she talk about birth control and, well, sometimes they just plain talk.  But in the vast majority of reputable abortion clinics, the counselor does not ask why the woman is having the abortion.  There is no reason to know.  It would not change the abortion process.  That issue is left to the woman and anyone else she wishes to have involved in the decision.  Sure, a woman might just voluntarily offer why she was having the abortion but that question is not on the counselor’s “must ask” list.

So, in the future if a woman takes this new test and it indicates she is having a girl and she decides she does not want a girl, she may abort.  Personally, I think that would be a rare circumstance, i.e., to abort just because of the sex.  Even if you prefer a boy, when you learn that it’s a girl you perspective can change rather rapidly.  But if she wants to abort for that reason, no one is gonna know unless she decides to voluntarily talk about it.

Meanwhile, however, pro-life legislators have already indicated that they will be introducing measures prohibiting sex selection abortions.  I say go for it boys.  I think it’s a waste of time but if that’s where you want to spend your resources, go knock yourself out.  That’s because the reality is that, if you pass a bill prohibiting sex selection abortions, a woman will simply go to the clinic and, in the very unlikely event that she is asked why she is having an abortion, she’ll just make up another reason.

Duh…….

Emotional Terrorists

It seems that every once in a while, we get a new, energized abortion rights advocate who starts screaming about how every pro-lifer is a “terrorist.”  They usually also add how the Catholic Church has murdered more people than any other religion in the world, but I don’t have the time or energy to research what the Catholic Church has done over the centuries so I don’t opine on those comments.  However, I do have some experience in the world of abortion, so I would like to chat a little about whether or not all pro-lifers are “terrorists.”

I guess the first thing one needs to do is define “terrorist.”  In my head, the true terrorists are, of course, the folks who fly crowded airplanes into buildings, who blow themselves up in crowded market squares and who plot the death of innocent civilians or government workers.  You know who I am talking about:  Bin Laden, Timothy McVeigh, and that nut ball up in Norway who recently killed all of those kids.   Then there are the Micheal Griffins, James Kopps and Paul Hills of the world.  True terrorists, they.

But then, way on the other end of the spectrum, are those pro-lifers who just sit in their house, avoiding all demonstrations and who rarely opine about their position on the abortion issue.  They might pray at home or in church for an end in abortion and send some money to their local pro-life organization, but I have a very tough time calling them “terrorists” and I suspect that most pro-choicers would also be reluctant to affix that label to them.

Where I get stuck is when I think of those folks who go to their local abortion clinic on a regular basis and publicly demonstrate.  Are they “terrorists?”  Let’s talk about their motivations and their actions.

I guess your average protestorgoes to the  clinic in the hopes of stopping an abortion, whether it is by engaging in prayer (don’t even ask me how that would work) or, if they chance, talking one on one with the women as they approach the

Angry Protestors = Terrorism?

abortion facility.  Once they identify the woman, they might start screaming at them.  Some even resort to the use of a bullhorn.  Now, a woman who has made an appointment for an abortion usually is warned by clinic staff that there may be protestors outside so when she sees the anti-abortion folks out front, she knows they smell blood.  Then scream at her that she is “killing your baby!”  They may make a crying baby sound and shriek “Mommy, don’t let them pull my legs off!”  Sometimes it is just a simple “Murderer!”  The woman may have been warned, she may have seen demonstrations on television, but she is rarely prepared for this scene.  And, to top it off, she doesn’t want to be at the clinic in the first place.

Over the years, I have seen this scenario played out in the front of many clinics.  The unique perspective that I have, however, is that on a number of occasions, I have walked with the women passed the protestors into the actual clinic.  Some gave me permission to accompany them through the entire abortion process.  I have seen (and the protestors haven’t) how upset the women are when they sign in, whose blood pressure has risen because they are so angry at these strangers outside the clinic who don’t know her or anything about her personal situation.  I’ve seen women who have already shed a few tears as she contemplated her decision shed even more tears in the waiting room.  And then, after all of the theatrics outside, I’ve then seen them have their abortion.

Not all pro-lifers are terrorists.  That’s a silly statement.  But I would conclude that to the women who walked the anti-abortion gauntlet, who could feel the hatred, who heard the screaming, who would prefer to be just with alone with their loved ones – I would say that those particular women were indeed “terrorized.”

Pro Life Bumper Stickers

Like most Americans (the sane ones, at least), I watched in horror as our elected officials almost brought our country to the economic brink a few weeks ago with their outright silliness over legislation to raise the debt ceiling.  Despite the fact that every Congress has gone through this drill many times (including under Reagan and Bush), this time around the young Tea Partyers decided it was time to draw the line in the sand – the economy be damned.

They cried that they had been sent to the Congress to send the message that we needed to get control of the “reckless” spending that was running rampant in our federal agencies.  So, screw your silly debt ceiling, they shouted!  I don’t care, Mr. President, if you are cutting a few trillion dollars in spending.  It’s not enough!  And, while you’re at it, don’t even think about raising any taxes, even on the billionaires who could care less if they had another $1,000 or so taken out of their paycheck.   There will be no compromise – and let the chips fall where they may!

What a friggin mess.  It was a game of machismo and Obama, because he actually believes in governing this country, had to blink.

And so it is with the debate over abortion.  As followers of this award-winning blog have seen in the past, the “debate,” and I use that term loosely, generally boils down to a cyberspace shouting match where no one gives any ground, where no one dares say “hey, you got a point there,” lest they be accused of treason.  Yes, there are some who have a bottom line but at times do show that they are at least hearing the other side.  But, for the most part, it is dueling academic reports and quotations.

So, for example, a pro-lifer will make their argument invoking Genesis (“and Adam begat Cain who then begat Tommy after he smote his bro Abel all the while declaring that there shall be no abortion”) or St. Luke the Meek (“ye shall never abort a possible Savior”).  They will spend hours insisting that their book is the only one worth shit, that it is the all knowing edition that lays out everything that must be obeyed – even if you wear a turban.  It is the WORD of the munificent and compassionate God, pure and simple and, if you stray from his oh-so-loving WORD, you will spend ETERNITY SURROUNDED BY FLAMES IN HELL.  Sorry, but those are the rules.

Then there are the pro-choicers who quote their own Gods or, to be more exact, Goddesses.  Steinem, Abzug, Friedan, Madonna.  Theirs is the word, the woman’s body is sacrosanct, it’s our way or the highway.  They believe that every anti-abortion person is a true nut ball or, worse, a terrorist.  The crisis pregnancy centers are all run by freak-a-zoids who don’t give a crap about women and who, once they talk that woman into having the baby, will disappear forever.  Adios, mama, you’re on your own!  Meanwhile, the pro-choicers will insist that that damned thing floating around in there is a fetus.  It ain’t a baby you idiot!   It doesn’t matter that the mother calls it a baby when that eight week fetus is wanted.  Nope, when we’re contemplating abortion, it’s a fetus, pure and simple.

The problem in this country is that we live in a bumper sticker world where no one dares to give ground any more.  I am right and you are wrong.  End of story.  Indeed, when was the last time you ever heard anyone say “hey, you got a point there, I wanna think about that.”  OMG!  Hey, we got a wimp over here folks!  A flip flopper!  Off with her head!

So, much like we saw in Congress, the abortion debate has become one intractable mess.

Well, I’m sorry but no one has the monopoly on wisdom on this or any other issue.  The truth is always somewhere in the middle.  To be sure, I am totally pro-choice but, damn it, at 24 weeks it sure looks like a baby to me.  And while I still support the right to abort it, it pains me to see it happen.  On the other hand, to the pro-lifers out there, you are never gonna convince me that a 6 week fetus is a baby or a “person” as some of you would suggest.  Get real.

I say we toss aside the bumper stickers for a bit.

Let’s start thinking and actually TALKING for a change.

seek the truth about abortion

Seek Truth about Abortion

She was 19 and he was 21.   She just graduated high school and was working to save so money so she could ultimately attend the local community college.  She had dreams of owning her own nail salon.  He took construction jobs whenever available and had thoughts of being a site manager.  They were both good Catholics so they used the rhythm method for birth control.

Then she got pregnant.

They struggled with what to do.  They were too intimidated to go to their priest so, instead, they talked to a friend or two and some family members.  Ultimately, they decided to have an abortion.  At the time, she was nine weeks pregnant.  It was a very sad occasion for both of them but neither could envision how they could raise a child on their income and cringed at the thought of sending their child to a public school in the Bronx.  She knew, of course, that she could put the baby up for adoption but could not imagine carrying the child until birth then handing it over to another family.  She did not want to spend each day wondering what her child was doing in some other part of the country.   It was all a very sad occasion but they did what they thought was best at that moment.

Nine years later, things had changed.  They made their way out of the Bronx and started making a comfortable living in Pennsylvania.  She was a civil servant and he ran a local hardware store.  Then, she became pregnant again.  And this time they had their baby.

After giving birth, she started thinking more about her abortion and a transformation of sorts took place.  She started thinking that if she had had that first child maybe things would have turned out differently.  Maybe there could have been a way for her to finish college and turn things around.  She couldn’t stop saying to herself:  “what if?”   She started reading pro-life literature and discovered resources for women who had come to regret their abortion.  She dove in head first, joining organizations and attending rallies.

Like the others who had had similar experiences, she never went out and said that abortion should be a crime, that we should throw women and the doctors in jail for participating in the procedure.  No, their approach was more subtle than that, on its face more “caring.”  Because they knew that women knew absolutely nothing about their reproductive lives, they merely wanted to talk to them about the affects of abortion, the dangers.  They just wanted women to know the “truth.”   Their compassion for these women was dripping off the walls.

Of course, they never talk about the millions of women who have had abortions and who, dare I say it, are actually okay today!  They don’t’ talk about the person in my family who over the course of 12 years had two abortions and today has the

Anti Choice Manifestation on Abortion.ws

Anti Choice Manifestation

most amazing family.  Yes, in private conversations she will admit that she might think about the two abortions at times, but only fleetingly.  It certainly has not affected her to the point where she wants to go out and join some pro-life organization or seek counseling.  No, we can’t talk about those women.

Make no mistake about it – these women who have had abortions and now say they are total basket cases have one goal in mind – to make abortion illegal in this country once again.  They want to back to the days when women, despite the laws, sought out abortions, often with disastrous consequences.  Don’t let the sweet talk fool you.  In the back of their minds, they are thinking:  “You are killing a baby, my dear” but they will sugarcoat it by dangling before you the prospect that you will be totally paralyzed with guilt for the rest of your life if you get that abortion.

The irony, of course, is these women who now regret their abortion, including the one above, actually had an abortion!   They made the decision based on their moment in time, based on whatever information they could gather.  And this morning, there is a woman who is facing the same situation.

I have absolutely no problem if that pregnant woman wants to read volumes of pro-life literature.  She can go, if she wants, to a crisis pregnancy center and talk to their “counselors.”  The more information (if truthful), the better for her decision making process.

But, make no mistake about it.  Behind all the nice talk and the offers of assistance, the bottom line is that these women who now regret their abortions thought they were doing the right thing at the time.  And they now want to take away that decision making process from the hundreds of thousands of women each year who are in the same position.

Stop Bullying Women

For many years, anti-abortion activists have lobbied their state legislatures to pass laws that require abortion clinics to share certain information with their patients.  These so-called “Right to Know” laws take many forms:  giving the patient a brochure that shows the stages of fetal development, taking an ultrasound and showing it to the woman, reciting a script to the patient that is a litany of things that can go wrong with an abortion, etc., etc.

Although the pro-choice movement regularly opposes these laws, I have written in the past about how the affect of these laws on the woman is rather minimal.  For example, most women casually look at the brochures, if at all, then toss them into

the garbage.  I’ve been in the rooms with woman as they observed their ultrasound, asked questions about the fetus then proceeded to have the abortion.  It’s all a rather big waste of time if you ask me, but if the anti-abortion movement wants to spend their time on this kind of stuff, go for it.  And, after all, it’s all well-intentioned, isn’t it?  Sure, they would prefer to make that woman’s act totally illegal, but since they can’t do that they want to make sure that a woman is making an informed choice.  How compassionate of them, huh?

Meanwhile, up in New York City, the City Council has taken a great interest in the activities of a number of “crisis pregnancy centers” that, according to testimony provided in a hearing, are engaging in “deceptive” practices designed to convince the woman that they are actually medical facilities.  It seems that the staff in some of these cpcs a

Ultrasound Before Abortion Procedure

re doing some interesting things.  For some reason, they are collecting personal and insurance information in the waiting room, the consultations are taking place on examination tables with the woman in the stirrups and “scrub suited consultants” are giving free pregnancy tests and ultrasounds.   On its face, it sounds a little deceptive to me but I’m sure these reports are not accurate because we’ve been told so many times that cpcs do not engage in this kind of behavior.

Still, this crazy ole City Council is concerned about this alleged behavior so they passed a law requiring the cpcs to post signs saying they have no doctors on site and don’t’ give advice about abortions or birth control.  Sounds kind of like the “Right to Know” laws that are being imposed on abortion clinics.

But, lo and behold, here comes the Alliance Defense Fund, a conservative Christian advocacy group, and they challenge the law, saying it would have violated the center’s right to free speech.  And, recently, a local judge agreed with them and slapped an injunction on the new law.

Putting aside all the legal mumbo-jumbo and the current status of the law, what I cannot sort out is why anti-abortion advocates want abortion clinics to inform women of everything but the kitchen sink, but when the NY City Council wants to ask them to give out just a little information about their centers, they balk at the idea?

Somebody help me here, please!