Medical Abortion under Pressure in Ohio

Ohio's Democratic, pro-choice Attorney General, Richard Cordray, is sticking up for a state law that restricts the use of medical abortion (RU-486, aka mifepristone or the "abortion pill") to a narrower window of time than good medical practice currently requires.

According to the Columbus Dispatch, a 2004 Ohio law limits the use of RU-486 to the first seven weeks of pregnancy, while doctors commonly use it up through the ninth week. The original FDA approval covered only the first seven weeks, but subsequent experience with vastly larger numbers of women has shown it to be safe and effective for two weeks beyond that window. Doctors have been prescribing it off-label through the ninth week, in line with current medical knowledge. The Ohio law has never been implemented because Planned Parenthood sued to block it. This week, the Ohio Supreme Court heard arguments on whether the law should be allowed to take effect; the case has not yet been decided.

So what stake does the Ohio AG have in this? The Dispatch reports:

Anne Berry Straight, an attorney in Cordray's office, said she's not asking the court to set medical policy, only to recognize that lawmakers had the right to regulate the drug. ...

Straight pointed out that Ohio lawmakers already have banned the use of anabolic steroids for muscle-building and amphetamines for weight loss.

[Ohio Supreme Court] Justice Terrence O'Donnell said the court shouldn't be put in the position of playing surgeon general for Ohio.

"The court is going to micromanage the practice of medicine if we start getting into managing off-label uses like we're being asked to do (with RU-486)," O'Donnell said.

I'm not sure why either the courts or the legislature are mucking around with the fine points of medical policy! Whatever happened to the notion that doctors and public health experts should be regulating drugs? Neither the legislators nor the justices have the slightest qualifications. Heck, as a historian of medicine, I'm way more qualified than they are! Seriously!

For instance, you only need a dollop of medical knowledge to understand the difference between a medication that the FDA found to be safe and effective (RU-486) and drugs that are notorious for being abused (anabolic steroids and amphetamines). One of these things is not like the other; one of these things doesn't belong! Geez, my legislators need to watch more Sesame Street. (And no, I'm not saying that the FDA's process is perfect. It's often deeply screwed up. In this case, though, the FDA approved RU-486 in spite of intense political pressure to ignore the science.)

None of the statements from the AG's office explain why Cordray believed he had to stick up for the legislature's right to make medical policy. I understand that it's a constitutional issue as well as a matter of women's health, but I cannot fathom why the AG would have a stake in it. I do know that Cordray has publicly supported abortion rights, and I seriously fail to understand why protecting the scope of legislative power would trump his commitment to women's health.

Letting Kids Be Kids (Even When They're Parents)

I'm still on my soapbox about leaving Bristol Palin alone, and so all I've got to say on the announcement of her canceled engagement to Levi Johnston is that I'm glad if they're following their hearts, and I wish them both the best.

But all the angst-y right-wing commentary on the non-wedding of the season is fair game. Not to mention easy pickins! Here's what Lisa Schiffren of the National Review had to say (via Hugo Schwyzer):

I certainly don’t know if they should have gotten married. You’d have thought so . . . even if it didn’t last forever. Better odds for the kid. [My emphasis.] If the parents didn’t like it, well, they should have thought about that when they were drinking and fooling around. But, as we all know, shotgun marriages lead to plenty of unhappiness, some of the time. And very young marriages have a lousy track record. So parents of the expecting teens are not willing to push. And maybe they are sometimes right. Still, the default position of the girl, left on her own with the baby, now in serious and immediate need of further education and a set of remunerative skills with which to support herself and Tripp, which will be harder to acquire with her maternal responsibilities, isn’t much of a happy picture either.

For all of the high-minded discussion of marriage policy on these pages and elsewhere, to me it looks very late. That train left a while ago. Even Corner readers, who will discuss choosing life vs. abortion, with endless passion, do not get so worked up about marriage. Which is why all I have to say is, “poor girl.”

Hugo rightly points out the pity, condescension, and ethical bankruptcy in Schiffren's position. Amanda Marcotte argues that the pressure put on Bristol and Levi to redeem her pregnancy through coerced marriage reveals how ultimately, conservative anti-sex fury punishes men, too, by pushing them into unwanted and possibly loveless marriages.

Yes to all that. But I think the punishment goes deeper than the shotgun marriages that even Schriffren can't quite stomach. Schiffren unwittingly exposes this deeper dimension when she writes: "Better odds for the kid." I read that and thought: Which kid? Because Tripp is not the only child in this story! Bristol was 17 when she became pregnant!

In my book, that's still a kid. But in the anti-sex reactionary playbook, as soon as you have sex and get caught out - that is, if you turn up pregnant - you're disqualified from being a kid anymore. And since abortion isn't an option, you've got no choice but to plunge pell-mell into adulthood, whether you're 17 or 13.

I understand that a young parent will have to grow up faster than usual and meet the challenges of parenthood. Having had two babies, I know that babies impose their own limits and constraints, and unless you give your child up for adoption, your old freedom is toast. That doesn't mean young teen parents will instantly grow up, however. They are still kids - cognitively, emotionally, behaviorally - even if they rise to the challenge. This is why a pregnant child should always have the option to terminate, with or without parental permission; no one should be forced to grow up so fast. But if she does choose to carry the pregnancy to term, she deserves massive support to let her finish her education and maybe even have some fun once in a while. She deserves to enjoy whatever vestiges of childhood remain.

Imposing premature adulthood on pregnant girls and their partners as a punishment is just the flip side of seeing a baby as a righteous punishment for having sex. Both attitudes betray a profound contempt for children.

Personhood Provocateurs in North Dakota

Photo of North Dakotan Badlands by Flickr user JJSchad, used under a Creative Commons license. This somewhat gratuitous picture is included lest you think North Dakota boasts nothing but snow and gophers and pro-life zealots.

North Dakota's new "personhood" law, which made it halfway through the legislative process on Tuesday, may no longer be the reproductive folly du jour, but it's still preoccupying me. Why would my home state even consider such a silly law - one that, much like Colorado's failed Proposition 48 last fall, could criminalize not just abortion but also most forms of birth control, IVF, and even normal miscarriage and menstruation? How the heck did this happen?

My husband said to me, "Curb your patriotism." But it's not just loyalty that's got me wondering. North Dakotans are churchgoing and God-fearing, yes; but they're also deeply pragmatic. Or at least they used to be when I lived there.

That's not just childish nostalgia speaking, by the way. Not even the abortion controversy has historically negated North Dakotan's basic pragmatism. Faye Ginsburg's wonderful ethnography, Contested Lives: The Abortion Debate in an American Community looked at activists on both (or actually, all!) sides of the issue in Fargo during the 1980s. While she found plenty of drama and conflict, she also found that activists of all stripes shared a basic set of values regarding family and women as nurturers.

Perhaps the growing season in North Dakota is just too short for extremism to thrive.

Leslie Unruh, you say? Nope. She belongs to South Dakota.

So what planet did HB 1576 come from? How did a bunch of part-time legislators dream up the idea of conferring legal personhood on fertilized eggs even prior to implantation? Because that's what the text of the bill does:

[F]or purposes of interpretation of the constitution and laws of North Dakota, it is the intent of the legislative assembly that an individual, a person, when the context indicates that a reference to an individual is intended, or a human being includes any organism with the genome of homo sapiens.

If this language is eerily reminiscent of the Colorado referendum, that's because this is not an indigenous product of North Dakota. It's written and promoted by the same people who brought us the Colorado foolishness.

In other words, the Colorado referendum wasn't a one-off. It has spawned an apparently new tentacle of the pro-life movement, Personhood USA, whose ultimate aim is to pass "personhood" laws in as many states as possible, ultimately setting up a judicial confrontation with Roe v. Wade. Here's their call to arms:

The fight for life is raging nationwide right now like never before and we wish to thank you for your conscientious decision to support every preborn child's right to life. We are Personhood USA and our goal is simple: Together, we will glorify Jesus and then stop the dehumanizing of and destruction of preborn people.

The organizers that got personhood on the ballot in Colorado, would like to help in North Dakota as well. By getting personhood on the ballot, we force the question that the pro-death side does not want to answer, "when does life begin"?

Personhood USA claims grassroots support, and I have no doubt that North Dakota has its fair share of pro-lifers (even if the North Dakota League for Life's website is pretty rinky-dink and years out of date). Here's how Personhood USA describes its campaign in North Dakota:

"North Dakotans have gotten used to cold temperatures like -44 degrees, but they haven't gotten used to child-killing. We applaud and support their efforts to protect every baby by love and by law," commented Cal Zastrow, who, along with his family, worked on the North Dakota bill on the grassroots level.

Reading this, you might reasonably believe that Cal Zastrow is part of a burgeoning pro-life movement among North Dakotans. That's the implication, right? But Zastrow would be a mighty unusual name among all those grandchildren of Germans and Norwegians. So I couldn't resist googling Cal Zastrow. He's from Michigan - two states over! No, Personhood USA didn't lie about this; it just used the term "grassroots" to insinuate. Here's how Michigan Citizens for Life describes him:

Cal Zastrow resides in Kawkawlin [Michigan] with his wife, Trish, where they homeschool their children. They are missionaries to the preborn who speak in churches, schools, and on the streets. Cal trains pro-life activists and conducts seminars to make the killing of preborn children unthinkable and unavailable through peaceful means.

Ordinarily I include links to groups like this just for substantiation, not because I think you need to waste any time going there, but Cal Zastrow has a such a dorky, douchey picture that he's worth a visit if you're in a snarky mood. Also, maybe you'll discover WTF it means to be a missionary to the preborn. I'm still mystified.

So the success of the personhood bill in North Dakota depended crucially on the work of a provocateur from out of state.

I have to admit, though, that the bill's sponsor, Dan Ruby, is a completely homegrown zealot who claimed "This language is not as aggressive as the direct ban legislation that I've proposed in the past." Nor can I claim that the 51 legislators who voted for the bill (against 41 opponents) were bussed in from out of state.

What are the prospect for this bill actually becoming law? According to Kay Steiger at RH Reality Check, the bill's introduction caught Planned Parenthood - the only pro-choice group with any presence in North Dakota - by surprise. That surely won't still be the case when it comes before the state senate in a few weeks. At that point, Tim Stanley, senior director of government and public affairs for Planned Parenthood Minnesota, North Dakota, and South Dakota, hopes for a better outcome:

The personhood bill will go on to the state Senate by the end of the week, and Stanley says it is likely not to be voted on until the end of the legislature's session, in April. Stanley believes that ultimately North Dakotans may not want to draw national attention with a challenge to Roe. If the bill does pass, Planned Parenthood's affiliate will begin reaching out to the medical and religious community to begin building a coalition of support to fight the measure.

"My experience had been that this legislature is grounded in reality, as opposed to some other legislatures," Stanley said. "South Dakota is not the most rational legislature when it comes to this kind of stuff. They're known as being slightly out there and willing to take those high-profile risks to fight this fight. My feeling is that North Dakota is just slightly more reticent to do that. To their credit they're not a state that looks [for] and seeks undue attention."

(Source: RH Reality Check)

See, North Dakota doesn't just have the prettier badlands, it also has a more level-headed legislature than South Dakota. And again - Dan Ruby is no Leslee Unruh! I'm hoping the state senate is rational enough to realize how ruinous it would be to litigate the "personhood bill" all the way to the Supreme Court, as required by the bill's second paragraph.

But even assuming this bill dies before the tulips are blooming in Bismarck, Personhood USA won't stop its quest. According the the American Life League, similar "personhood" legislation is pending in 15 other states. Even if there's good reason to be relatively sanguine about the North Dakota state senate stopping this foolish bill, odds are good that it will pass somehow, somewhere, and ultimately land in the laps of the SCOTUS.

Another ominous aspect of this: the "personhood" movement is trying to shift the discourse. To some extent, they're already succeeding. Just look at how RH Reality Check and I are both repeatedly referring to the bill and the movement within their frame: "personhood." Repeat it often enough, and people may start believing that a fertilized egg is indeed a person.

The Sins of the Mother: Can We Just Leave Bristol Alone?

Look. I never thought Sarah Palin should get a free pass on 1) using motherhood as one of her chief qualifications for public office and then 2) telling America we had no right to know anything about her family. I sharply criticized Palin for getting on an airplane while leaking amniotic fluid. I thought it was reasonable for people to criticize her for marketing herself as a perfect mother when, clearly, she's not.

But back in September, when Bristol Palin turned up pregnant, I also wrote that criticizing her was out of bounds:

There's no room for schadenfreude. She shouldn't be made the poster child for the failure of abstinence-only approaches to teenage sexuality; we have too many such poster children already. She's going to face the difficulties of early motherhood with the added burden of publicity. She'll also find deep joy in her baby, I'm sure - a point too rarely mentioned for all the moralizing about "teenage mothers." She's embarking on an amazing adventure in one of the hardest ways possible. I wish her well.

Now that Bristol has given an interview and basically said, yes, it's hard but I love my baby, I don't really have anything more to say about her - except that I really feel for her when she lets slip that she mourns a chance to just be herself, for herself.

But darn it, too many people that I otherwise like and respect are amplifying the Bristol interview and making her into, well, the poster girl for the bankruptcy of abstinence-only education. Sure, Bristol herself said it doesn't work. That's worth reporting. But Rebecca Traister at Salon goes on to comment:

Bristol went on to make more (perhaps unwitting) feminist points about what, exactly, the responsibilities and consequences are for young women who choose (or are forced down) the path she took.

At Pandagon, Amanda Marcotte quotes Traister's article approvingly, adding:

For the rest of us [non-prolifers], of course, the whole thing is a horror show.

Both Rebecca and Amanda then go on to give Sarah Palin the drubbing she deserves. I'm all for that. I just wonder: Can't we call out Palin on her hypocrisy and failed policies without dragging Bristol any deeper into it? I mean, Amanda sees the problem when it's coming from the opposite direction:

Abstinence-only had been sold to the country as a teenage pregnancy prevention program, but the right wing reaction to Bristol made it clear that it was a teenage pregnancy inducement program, and Bristol was the poster child for its intended effects. [my emphasis]

Analytically, I agree with Amanda 100 percent on what the 'wingers were up to. Yet I think we can make this argument without making Bristol the poster child for a feminist critique of wingnutty views on sexuality. Otherwise, we're reversing the terms, not redefining them.

And we can certainly condemn the failures of abstinence-only without endorsing statements that hold Bristol up as a "perfect example " and assume we know just what went down between Bristol and her mother. In fact, we don't know whether Sarah Palin forbade Bristol to have an abortion.

Let's not make Bristol pay for the sins of her mother.

My Pro-Life Reflections on the 36th Anniversary of Roe

Today is Blog for Choice Day, marking the 36th anniversary of Roe v. Wade. The official topic is what action we'd most like to see the Obama Administration take on reproductive justice. My official response is brief because I think the first steps are pretty straightforward:

• Repeal the Mexico City policy aka the Global Gag Rule.
• Reverse the HHS "conscience clause" that allows health care providers to capriciously deny any service, including birth control (see the recent case of a nurse who removed an IUD against the patient's will although the new rule is not yet even in effect!).
• Require age-appropriate comprehensive sex education in every school in America.

How's that for a start?

But I'm not in an especially policy-wonky mood today, and to be honest, I'm not much worried about Obama dropping the ball on women's health. He's more likely to be too timid on the economy or Iraq.

Instead, I'd like to tell a story. It's a morality tale with a somewhat unlikely lesson: that the decision to terminate a pregnancy can be profoundly pro-life. While I promise it'll loop back to reproductive rights, the story begins with one man's health crisis.

In August 2004, a family of four was vacationing in Berlin, Germany. One evening, the man complained of severe pain in his limbs. The pain rapidly grew worse. Within a few hours, the agony was so overwhelming that he could hardly speak, hardly walk. The woman woke the downstairs neighbor, asked him to guard the children, and rushed to the ER, where her husband was admitted.

Several days passed, and the husband was losing his ability to walk. His left hand was paralyzed and most of his right arm. He was in excruciating pain, 11 on a 10-point scale, no matter how much morphine he got. The doctors had no explanation, no name for what was happening. An Austrian neurologist was sanguine that he'd recover fully, but he gave no diagnosis and the paralysis continued to progress. Besides, the doctors' attention was monopolized by a suspicious "Raumfordering," whatever that was. (The doctors did rounds at 7 a.m. and wouldn't answer phone inquiries, while the husband was too drugged to be a very reliable reporter, so the wife felt very much in the dark.)

The wife spent her nights googling various symptoms, wondering if it was Guillain-Barre (it wasn't) or any number of other nerve disorders. (A few years later, a neurologist in Columbus gave the most plausible explanation: MADSAM, a disorder in which the the myelin of peripheral nerves is attacked and destroyed.) All that googling revealed just one thing: a Raumforderung is a mass. Her husband had a chest mass. A day or two later, the cancer diagnosis was confirmed.

About a week into this adventure, she realized her period was several days late.

She knew that if she were pregnant, she couldn't go through with it. Her husband was lying in the hospital with cancer and paralysis. The hospital called her daily demanding an immediate cash payment of 10,000 euros (roughly $12,000) because they had no contracts with the family's American insurer. She had two very young children, aged four and 14 months. Her mother was in California, an ocean and a continent away. Her best girlfriend in Berlin was helping with the kids but had to return to work again. She was drowning already; how could she stay afloat with the heavy fatigue and the 24/7 nausea that she vividly recalled from her two pregnancies?

Any abortion under those circumstances would have been a pro-life abortion. It would have been to protect the lives of her family - including her own - in a situation where time, energy, and money were already unbearably strained. (In fact, she had to appeal to her dad for money, and bless him, he wired what was needed.)

--------------

As you've probably surmised, that woman was me. As it turned out, I wasn't pregnant. I hadn't eaten, I hadn't slept, and I'd lost close to ten pounds in just over a week. Anyone in a calm state of mind probably would've done the math and realized that the stress had made me late. I wasn't calm, I was overwrought, and so nothing computed.

As sure as I felt about the decision I would have made, I also knew that ending a pregnancy would've been wrenchingly hard. Having already carried two babies, I knew how your heart expands along with your belly. However. From experience, too, I knew that time, energy and money aren't so stretchy. They're finite. And I was already beyond my limits.

Every woman who has a pregnancy scare has her own story to tell. I got lucky. My decision stayed in the realm of the hypothetical. For others, the scare will reveal an actual pregnancy, and they'll have to choose. For some, the decision will be easy and obvious; for others, it will be agonizing. Most who choose abortion will see it as the lesser evil.

Women's reasons for deciding to bear a child - or not - may not be evident to an outsider. Most of them won't have a mate in the throes of a life-and-death health crisis. But many will have young children and feel utterly unable to cope with more. Many will have serious money worries. Some will have good reason to fear a parent or spouse. Each story is different.

And unless we know every constraint on a woman and every wish and fear in her heart, we pass judgment at her - and our - peril. Because sometimes, the most pro-life decision she can make will be to end an unplanned pregnancy and nurture those lives that already depend on her. Including her own.

The Greying of Abortion Providers: Doing the Math

Anyone who follows reproductive politics is likely aware that the doctors who provide abortion services have been rapidly aging. Now, a new survey of abortion clinics helps us quantify the situation. It reports that nearly two-thirds of providers (63 percent) are aged 50 or older.

The survey has some limitations. It looks only at clinics and not at doctors who provide occasional abortion services as part of a broader ob/gyn practice. The survey was circulated in 2002 and I have no clue why results are only now being published.

Still, the statistic on the aging of abortion providers seems solid enough that I decided to do the math and try to project what it means for the future availability of abortion services.

Let’s say we have 100 doctors. Assuming an average retirement age of 65, over the next 15 years 63 will retire, leaving 37 still in practice. This assumption is subject to error because while some providers may stay on past age 65 for lack of a successor, others may retire earlier due to burnout or fears for their personal safety.

Now let’s assume that the rate of entry into practice has been linear over the past 25 years – in other words, that the 37 younger doctors began practicing over the past 25 years and trickled into the field at a steady pace. This is probably optimistic. Training in abortion techniques has become less common in medical schools, and it’s more likely that the number of entrants per year has declined steadily over time.

Over the course of the next 15 years, the retirees will be replaced by (37 divided by 25 for the number of entrants per year) x (15 years) = 22 new doctors. Instead of the original 100 doctors, we’ll have only 59.

In other words, we can expect the number of abortion providers to decrease by about 40 percent over the next 15 years.

However you do the math: The current shortage of abortion providers is on course to become an all-out crisis.

Let's make one further assumption: A safe abortion, performed by a qualified, trained doctor, is preferable to an unsafe one. So I won't respond to comments that demonize abortion in general; that's not what this post is about. While I recognize that some opponents of legal abortion may see the provider shortage as an another route toward reducing the number of abortions, that idea belongs in fantasyland. There are much more effective strategies for reducing abortions that don't put women's health at risk.

Bush's Christmas Gift to Women

As any beginning student of the German language learns, the word "gift" is a false cognate. In German, it means "poison." That double meaning seems just about right to describe George Bush's parting gift to women: the new HHS rule that allows health providers to refuse women basic health services.

Jill at Feministe has a great analysis of what's really at stake in this rule. Here's the short version (but you should really go read her whole post):

It’s being framed as about abortion, but here’s the thing: There are existing laws that protect health care workers from performing or assisting with abortion. Under current U.S. law, no one can be forced to partake in an abortion procedure if they have a moral objection.

This is about birth control.

Yep. I have just two things to add, both in connection with the Nativity story.

First, a film I often use in the classroom - Sacred Choices and Abortion: 10 New Things to Think About - starts from the premise that "Mary Had a Choice." And it's true that the Gospels don't say that God impregnated Mary against her will. They don't suggest that the Holy Spirit essentially raped her. God asked Mary if she was willing. She had a choice. She said yes. She could have also said no.

Imagine if Mary instead had to convince an intransigent pharmacist to prescribe Plan B for her after unprotected sex with Joseph? I'm not being flip about this. I sincerely think that the HHS rule doesn't protect the Christian faith; it conflicts with it.

Secondly: Over twenty years ago Margaret Atwood made a poetic plea for all women to have the same reproductive choices as Mary. I would like Bush and his minions to have to write out this poem over and over again until they knew it by heart - until they took it into their hearts. I realize that would take a miracle on par with the virgin birth.

(Warning: This is a poem, but it vividly depicts sexual violence, so it's not for you if you're easily triggered.)

Christmas Carols

Children do not always mean
hope. To some they mean despair.
This woman with her hair cut off
so she could not hang herself
threw herself from a rooftop, thirty
times raped & pregnant by the enemy
who did this to her. This one had her pelvis
broken by hammers so the child
could be extracted. Then she was thrown away,
useless, a ripped sack. This one
punctured herself with kitchen skewers
and bled to death on a greasy
oilcloth table, rather than bear
again and past the limit. There
is a limit, though who knows
when it may come? Nineteenth-century
ditches are littered with small wax corpses
dropped there in terror. A plane
swoops too low over the fox farm
and the mother eats her young. This too
is Nature. Think twice then
before you worship turned furrows, or pay
lip service to some full belly
or other, or single out one girl to play
the magic mother, in blue
& white, up on that pedestal,
perfect & intact, distinct
from those who aren’t. Which means
everyone else. It’s a matter
of food & available blood. If mother-
hood is sacred, put
your money where your mouth is. Only
then can you expect the coming
down to the wrecked & shimmering earch
of that miracle you sing
about, the day
when every child is a holy birth.

From Margaret Atwood, Selected Poems II: 1976 - 1986, p. 70.

Atwood holds the copyright on this, of course, and if anyone objects to my reprinting it in its entirety, I will take it right down. She was describing truths from history and nature, but as usual, she was also all too prescient about the future.

Photo by Flickr user andy castro, used under a Creative Commons license.

For the "Health" of the Mother

Remember John McCain's use of air quotes in the presidential debates when he talked about abortions to preserve women's "health"? Remember how the Bush Administration is trying to push through a "conscience clause" for providers of reproductive health services that's so capacious, it would likely redefine birth control pills as abortifacients? Remember how women used to routinely die in this country during childbirth? (Okay, so you need a longer memory for that last point. A century ago, the lifetime risk of death in childbed was about 1 in 20. 'Course, that only applied to women, which might explain why McCain sees "health" as a non-issue.)

Well, as Tracy Clark-Flory reports at Broadsheet, the Bushies are making one last push during these lame duck days to put that new rule in place. The only good thing about this? The ensuing discussion is shedding light on the barriers women already face in getting decent, equitable, timely reproductive health care. From the L.A. Times:

In calling for limits on “conscientious refusals,” ACOG [American College of Obstetricians and Gynecologists] cited four recent examples. In Texas, a pharmacist rejected a rape victim's prescription for emergency contraception. In Virginia, a 42-year-old mother of two became pregnant after being refused emergency contraception. In California, a physician refused to perform artificial insemination for a lesbian couple. (In August, the California Supreme Court ruled that this refusal amounted to illegal discrimination based on sexual orientation.) And in Nebraska, a 19-year-old with a life-threatening embolism was refused an early abortion at a religiously affiliated hospital. [My emphasis.]

That last case was new to me, so I hunted it down - first via the ACOG report and then the ACLU analysis that ACOG footnoted (both are pdf files). The ACLU report had the details. Here's the story:

In the spring of 1994, a nineteen-year-old woman in Nebraska, Sophie Smith [not her real name], was admitted to the emergency room of a religiously affiliated hospital with a blood clot in her lung. Tests revealed that Smith was approximately ten weeks pregnant, and the clotting problem resulted from a rare and life-threatening condition exacerbated by the pregnancy. The hospital immediately put her on intravenous blood-thinners to eliminate the existing blood clot and to help prevent the formation of more clots that could kill Smith instantly if they lodged in her lungs, heart, or brain.

Smith’s doctors told her that she had two alternatives. She could stay in the hospital on intravenous blood-thinners for the remaining six-and-a-half months of the pregnancy. She would also need a procedure in which a doctor would insert into one of her primary veins an umbrella-like device designed to catch blood clots before they reached a vital organ. Or she could have a first-trimester abortion, switch to oral blood-thinners, and be released from the hospital.

Smith decided to have an abortion. She wanted to go home to her two-year-old child. Because she was poor, Medicaid was covering her medical expenses but would pay for an abortion only upon proof that it was necessary to save her life. Four doctors at the hospital certified that Smith needed a lifesaving abortion, and Medicaid agreed to cover it.

On the morning Smith was scheduled to have surgery, however, the hospital’s lawyer appeared in the operating room. He announced that the hospital would not permit an abortion – lifesaving or otherwise – to take place on its premises. The procedure was canceled, and Smith was wheeled back to her room.

Ten days of dangerous delay followed. Smith wanted to be transferred to a facility that would perform the abortion, but moving her increased the risk that she would throw a life-threatening blood clot. Moreover, because the blood-thinners she was taking made her prone to excessive bleeding during surgery, Smith’s doctors felt that it was in her best interest to be treated in a hospital. The hospital, however, stood by its decision not to let the abortion take place in its facilities. Notwithstanding the risks, Smith was ultimately transferred by ambulance to her doctor’s office. He performed the abortion and sent Smith back to the hospital, which provided follow-up care.

Even in a culture where a presidential candidate feels free to mock women's health, this story is shocking. It wasn't just Sophie Smith's health that hung in the balance; it was her very life.

I know someone who died in her twenties from a pulmonary embolism. One of my grandfathers died - long before I was ever born - from an embolism. If even Medicaid judged the situation to be life-threatening, you'd better believe it was. An embolism is an immediate life-or-death emergency, not some remote risk.

And yet this hospital saw fit to risk the Smith's life. Of course, if she had died, she wouldn't have been much use to her potential child, either - not to mention her actual one! But I guess that didn't occur to these morally pure hospital administrators. She did survive, but due to luck, and no thanks to the "care" she received.

Historically, of course, the woman's life was always chosen first - not because women had higher standing in the past (they didn't) but because they typically had family members who depended on their care. Even the Roman Catholic Church was on board with this policy until about 1900. After that, it began to revalue the "innocent" life of the fetus as worthier than that of the presumably sinful mother.

In Smith's case, you have to wonder if any particular "sins" exacerbated her situation. She was young. She was obviously poor enough to qualify for Medicaid. She may have been married, though given her youth, odds are that she wasn't. I'm guessing that an educated, middle-class married woman in her thirties might have had better luck. But then again, maybe not.

And remember: Smith's ordeal happened in the mid-nineties. The climate for reproductive choice has only deteriorated since then, with the emergence of new tactics such as pharmacists' concerted refusals to fill birth control prescriptions. Anyone want to imagine what new scenarios might emerge if Bush manages to ram through this new rule?

As Clark-Flory notes, Hillary Clinton and Patty Murray have vowed to fight the rule. An Obama administration won't let it stand. But repeal will take time and political capital, and it leaves women's health advocates fighting a stupid, unnecessary rear-guard battle.

Update 12/4/08: I corrected the text to keep the blame focused on the hospital administrators, where it belonged, not on the doctors. Thanks for pointing out the slippage, moioci.

South Dakota's Less-Famous Loony Abortion Law

Bad abortion laws in South Dakota are a lot like a game of Whac-a-mole. You knock one down and another one instantly pops up.

You probably heard about the latest attempt to ban abortion via referendum in South Dakota, which went down to defeat on November 4. I'm willing to bet you're less familiar with another batshit abortion law that was passed there in 2005 and finally went into effect last July after a judge lifted an injunction against it. I only heard about it now through my nerdy reading habits.

According to the latest New England Journal of Medicine, South Dakota's new law mandates that

physicians in South Dakota must tell any woman seeking an abortion that she is terminating the life of "a whole, separate, unique, living human being" with whom she has an "existing relationship," that her relationship "enjoys protection under the United States Constitution and under the laws of South Dakota," and that abortion terminates that relationship along with "her existing constitutional rights with regards to that relationship." ...

The law also requires that doctors give pregnant women a description of medical and "statistically significant" risks of abortion, among which it includes depression and other psychological distress, suicide, danger to subsequent pregnancies, and death. Physicians must tell women the approximate gestational age of the fetus and describe its state of development.

Information is good, right? But this isn't information, it's propaganda.

Take, for instance, the law's characterization of the fetus. Since when is a fetus a "separate" being? I'll gladly grant the rest - that it's unique and human and alive - but "separate" only applies once the fetus is born. Until then, it's intimately tethered to a woman by its umbilical cord. This is an elegant and wondrous system. But separate, it's not.

The only reason this law can claim "separate" status for the fetus is that we've grown used to seeing disembodied fetuses. Intrauterine photography is pretty amazing. It's also deeply deceptive, because it routinely effaces not just the womb but the woman - a woman who most assuredly is a separate, unique human being. (See Barbara Duden and Valerie Hartouni for more sophisticated versions of this argument.) When we see a fetus floating through what appears to be a starless universe, it's very easy to imagine that the fetus is an autonomous person - and to forget about the personhood of the woman whose universe it inhabits.

The legally protected "relationship" between woman and fetus that this law posits is entirely nebulous, as the NEMJ argues. The law's vagueness opens up doctors to second-degree misdemeanor charges, which of course is the editorialists' main concern. The NEMJ doesn't directly address the impact of this "relationship" language on women, though it does make a connection to the new paternalism espoused by pro-life activists and enshrined in Gonzales v. Carhart:

In the U.S. Supreme Court's most recent abortion case in 2007, Gonzales v. Carhart, Justice Anthony Kennedy noted that "some women come to regret their choice to abort the infant life they once created and sustained." Had these women been better informed, he suggested, they might have chosen not to abort and thus been spared the "grief more anguished and sorrow more profound" caused by discovering how their pregnancy had been terminated. Many commentators interpreted Kennedy's words as an invitation to state legislatures to amend abortion statutes to add informed-consent requirements. South Dakota appears to have answered this invitation.

(Source: NEJM)

This language affects far more than just the doct0r-patient relationship. It shapes the cultural image of the women who are unhappily pregnant. By using terms like "right" and "protection," the new law casts these women as the victims of abortion - as mere pawns manipulated by husbands, lovers, and doctors. This has been a tactic embraced by anti-abortion activists for the past several years. Since it bore fruit in Carhart v. Gonzales, we can expect the victimization thesis increasingly to permeate anti-abortion rhetoric.

At the same time, the "relationship" palaver imputes a mother-child relationship where none exists - not yet and maybe not ever. If a woman rejects the victimization frame and fully owns her decision to terminate her pregnancy, this instantly triggers the bad mother frame. This language is an attempt to invoke mother guilt, pure and simple.

Even the "medical" information is a load of ideological crap:

The purported increased risks of psychological distress, depression, and suicide that physicians are required to warn women about are not supported by the bulk of the scientific literature. By requiring physicians to deliver such misinformation and discouraging them from providing alternative accurate information, the statute forces physicians to violate their obligation to solicit truly informed consent ...

(Source: NEJM)

Yep. And it's not just psychological risks that the law fabricates; it also suggests that abortion is physically perilous. In fact, the opposite is true. A woman is over twenty times more likely to die from a full-term pregnancy than from a first-trimester abortion, according to the ACLU. (For more on the strong safety record of early abortions, see the Guttmacher Institute's Fact Sheet on Induced Abortion in the United States.)

Of course, medical and legal facts and logic had nothing to do with the framing of this law. It's an attempt to intimidate women. From that angle, South Dakota's consent requirements are sadly incomplete. Why not round out this "information" with the risk of a vengeful god casting thunderbolts at women who abort?

Taking "Anti-Life" Seriously

Ever since I finished yesterday's post, which is sort of a smorgasbord of weird medical news, I've been mulling over how those three news items are related on a deeper level than their oddness and/or inexplicability.

I do think they've got a real common demoninator. The American culture, birthplace of the "pro-life" movement, is indeed anti-life in a host of ways - though not for the reasons that the anti-abortion leadership adduces. I'm not referring to their overt hypocrisy - their support of war and the death penalty, just for example - though of course that's part of it, and one that plenty of "pro-life" Catholics would condemn just as much as I do.

No, I think what's at stake here in the anti-life position is bigger yet: a kind of gendered denial of our very embodied humanity, which grossly distorts our views on sexuality, pleasure, and generativity. While I'm sure this has its roots in the medieval Christian church's condemnation of sexual pleasure, by now it has assumed distinctly modern forms. It's a stubborn insistence - even in the midst of the richest, most consumption-oriented society the world has ever known - on hating and mortifying our own flesh. This hating-on is bigger than sex and sexuality; bigger than gender and genitals; but it routinely zeroes in on our human capacity for engendering pleasure and indeed life itself.

And so (to hark back to yesterday's themes) too many women remain impervious to reassurances (from partners, the women's health movement, or even doctors) that our bodies are okay just as they are. Powdering one's otherwise healthy, moist ladyparts thus remains an imperative for some women even though it can make them sick. Even though it can kill them.

And so some men prize a rock-hard erection not primarily for the pleasure it can give two partners but because it stands as evidence of manliness, power, autonomy. Not because it lets them merge with another person but because it's a badge of virile individualism and self-sufficiency. Not because it affirms life and joy but (as Susan Bordo suggested a decade ago in her article "Pills and Power Tools") because it's an inert symbol of a drill or missile. Drill baby drill, indeed.

And so the vulnerable bodies of babies aren't worth the public dollars it would take to protect them, even though we creatively finance the Iraqi occupation and air raids on Afghan weddings.

Eros and thanatos may be forever at odds. At the moment, though, I'd say thanatos is winning.

More on Colorado's Zygotemania

Diana Hsieh of the Coalition for Secular Government left a lengthy comment on my post on Colorado's proposed Amendment 48, which would give a fertilized egg the full rights of legal personhood. Her analysis is so helpful that I thought I'd better rescue it from the obscurity of the Kittywampus comment corner:

You might be interested to read an issue paper published by the Coalition for Secular Government: "Amendment 48 Is Anti-Life: Why It Matters That a Fertilized Egg Is Not a Person" by Ari Armstrong and myself. It's available at:

http://www.seculargovernment.us/docs/a48.pdf

We discuss some of the serious implications of this proposed amendment, such as:

* Amendment 48 would make abortion first-degree murder, except perhaps to save the woman's life. First-degree murder is defined in Colorado law as deliberately causing the death of a "person," a crime punished by life in prison or the death penalty. So women and their doctors would be punished with the severest possible penalty under law for terminating a pregnancy -- even in cases of rape, incest, and fetal deformity.

* Amendment 48 would ban any form of birth control that might sometimes prevent the implantation of a fertilized egg in the uterus -- including the birth control pill, morning-after pill, and IUD. The result would be many more unintended pregnancies and unwanted children in Colorado.

* Amendment 48 would ban in vitro fertilization because the process usually creates more fertilized eggs than can be safely implanted in the womb. So every year, hundreds of Colorado couples would be denied the joy of a child of their own.

Our paper also develops a strong defense of abortion rights -- not based on vague appeals to "choice" or "privacy" -- but on the fact that neither an embryo nor fetus qualifies as a person with a right to life.

An embryo or fetus is wholly dependent on the woman for its basic life-functions. It goes where she goes, eats what she eats, and breathes what she breathes. It lives as an extension of her body, contained within and dependent on her for its survival. It is only a potential person, not an actual person.

That situation changes radically at birth. The newborn baby exists as a distinct organism, separate from his mother. Although still very needy, he lives his own life. He is a person, and his life must be protected as a matter of right.

So, we argue, when a woman chooses to terminate a pregnancy she does not violate the rights of any person. Instead, she is properly exercising her own rights over her own body in pursuit of her own happiness. Moreover, in most cases, she is acting morally and responsibly by doing so. ...

The sad fact is that Amendment 48 is based on sectarian religious dogma, not objective science or philosophy. It is a blatant attempt to impose theocracy in America. That's definitely a scary thought.

Many thanks, Diana, for this careful and systematic analysis. I'd add that this is also an attempt to seize control over women's bodies - both our sexuality and our reproductive potential - in a rearguard action to defend patriarchy.

Personhood for Zygotes!

Photo of billboard spotted in Cleveland by Flickr user Austin Kleon, used under a Creative Commons license.

I'm betting most of you have heard that Leslee Unruh is taking another crack at effectively outlawing abortion in South Dakota. But only very recently did I hear about a ballot initiative in Colorado that's equally loony. Julie at A Little Bit Pregnant describes it thus:

Next month Coloradoans will vote on whether to amend their state Constitution "to include the pre-born from the moment of fertilization as having their 'personhood' clearly established."

This description comes from Colorado for Equal Rights, the force behind proposed amendment 48, "Equal Rights" in this case being as much of a creepy buzzwordy misnomer as "pre-born." The thrust of the measure, say its supporters, is "to define a person in Colorado as a human being from the moment of fertilization."

Oy. There's so much wrong with this, and I have so little time. (I'm slowly digging through 80 essays that demand to be graded.) But just for starters:

Your average zygote will not implant, and that sorta puts a crimp in its personhood. At the Berkshire Conference last summer, I learned the following from Lara Friedenfels' presentation (and this is my paraphrase, not hers):

Of 100 meetings of egg and sperm, 57 never implant (and thus wouldn't result in a positive test). Of the 43 that do implant, 10 miscarry before a doctor would declare the woman pregnant. ... Of the 33 that continue, 4 will miscarry "clinically" and 29 will reach full term (give or take a few weeks).

What does this Colorado initiative plan to do to save those 57 persons who are shed before they ever implant?

Do the backers of this initiative care that implantation, not fertilization, is the medically recognized start of pregnancy?

Have they considered that whether fertilization has occurred is unknowable until sometime after implantation, and thus the existence of such "persons" will be completely speculative until post-implantation?

Are Colorado voters aware that if this measure passes, it won't just call legal abortion into question, it would lay the groundwork for potentially outlawing many forms of contraception, stem cell research and therapies, and infertility treatments, as Julie points out?

I have no problem granting that life begins at implantation, or even at fertilization. I'll grant, too, that it's human. After all, it's human DNA that starts to replicate, and keeps replicating - barring failure to implant, or miscarriage, or incompatible-with-life developmental anomalies, or the formation of a molar pregnancy ... As Lara's statistics show, this is a precarious process and less than a third of fertilized eggs result in an actual baby. I would never belittle the significance of pregnancy loss, but surely none of us would equate a hydatidiform mole with a person?

Isn't it possible to grant that the zygote is human and alive, without erasing its very real differences from a social or legal person?

How about if we instead take a developmental perspective and recognize that while an embryo is not nothing, it's also not a person? It's a clump of cells with amazing potential that - with some luck, if all goes well - will attain full personhood when it leaves its mother's body. No more. And no less.

Criminality versus Dumb Decisions

Earlier this week Lynn Paltrow, executive director of National Advocates for Pregnant Women, published an open letter to Sarah Palin in Alternet, asking her to reconsider her position on abortion:

According to press reports your water broke while you were giving a keynote speech in Texas at the Republican Governors' Energy Conference. You did not immediately go to the hospital – instead you gave your speech and then waited at least 11 hours to get to a hospital. You evaluated the risks, made a choice, and were able to carry on your life without state interference. Texas Governor Rick Perry worried about your pregnancy but didn’t stop you from speaking or take you into custody to protect the rights of the fetus.

After, Ayesha Madyun’s water broke, she went to the hospital where she hoped and planned to have a vaginal birth. When she didn’t give birth in a time-frame comfortable to her doctors, they argued that she should have a C-section. The doctors asserted that the fetus faced a 50-75 percent chance of infection if not delivered surgically. (Risks of infection are believed by some health care providers to increase with each hour after a woman’s water has broken and she hasn’t delivered).

The court, believing, like you that fetuses have a right to life, said, "[a]ll that stood between the Madyun fetus and its independent existence, separate from its mother, was put simply, a doctor's scalpel." With that, the court granted the order and the scalpel sliced through Ms. Madyun's flesh, the muscles of her abdominal wall, and her uterus. The core principle justifying an end to legal abortion in the US provided the same grounds used to deprive this pregnant and laboring woman of her rights to due process, bodily integrity, and physical liberty. When the procedure was done, there was no evidence of infection.

(Read the whole thing here.)

Paltrow doesn't specify how many hours passed before Madyun's doctors pressed for a c-section. An old New York Times article says she'd been in labor for two days and in the hospital for 18 hours. Rachel Roth's excellent study Making Women Pay: The Hidden Costs of Fetal Rights states it had been 48 hours since her water broke. That's long enough that Madyun's decision starts to look fairly foolish by my standards and by most medical guidelines.

But here's the thing: People do lots of things that are stupid, risky, macho, or otherwise blameworthy. Some of these risk other people's lives as well as their own. Not all of these things are illegal. One example would be driving while very sleepy or distracted.

This is naturally true for childbearing, as well. Some people choose unassisted home birth, where the father catches the baby and no midwife or other trained assistant is present. Many of the people who propagandize for unassisted birth believe that birth, like sex, should only involve the couple; some of them also subscribe to right-wing religious ideologies. This is loony and irresponsible, in my view. (Not to mention it's asking a hell of a lot of the father!) Still, it's not illegal. Nor should it be. Imagine the mess if every baby born after a precipitous labor triggered a court case.

Another example Paltrow cites is of a woman who insisted on a VBAC at home. There are good reasons that no reputable doctor should condone this. If you give birth vaginally after a cesarean, there's a heightened chance of uterine rupture, which endangers the mother's life as well as the child's. If that occurred at home, odds are great that you'd bleed out before you could get help.

This woman, too, was forced by court order to have a c-section. This goes against our law on medical treatment in every other instance. A person cannot be forced to have surgery or undergo radiation even if they would surely die without the treatment. No one can be forced to donate a kidney - even if he or she is the parent of the patient needing a transplant.

If you believe humans have a right to bodily integrity and autonomy, you cannot legislate women's childbearing decisions. You certainly can argue that these people have an ethical obligation to make wise decisions and that some decisions are so irresponsible as to be unethical. However, unless you want to reduce the woman to an incubator and deprive her of basic rights of personhood, the law has no place intruding on ethics.

This is a long-winded way of saying that it's possible to fully agree with Paltrow's arguments and still maintain that Sarah Palin's choice to board a plane while she was at astronomical risk of going into active labor was a foolish decision. She wasn't taken to task for it legally, nor should she be. Her privilege protected her from any legal action. (Women subjected to forced childbearing decisions have been disproportionately young, poor, unmarried, and non-white.) If we trust women to make their own reproductive decisions, we have to acknowledge that while most women are remarkably altruistic and sensible, there will always be some who make decisions that we personally would never countenance.

But Palin's privilege shouldn't stop us from regarding her choice as 1) reckless and 2) completely hypocritical for someone who preaches the sanctity of fetal life. What's legal - and should remain legal - is not always ethical in every situation. We have a right to demand leaders that understand this distinction.

Choice, Schmoice

Because I'm still trying to perk up, here's Samantha Bee at the Republican Convention, tormenting the poor delegates with the oxymoron of "choosing" in an anti-choice party.



(h/t Feministing)

Why the GOP *Needs* Roe

Yeah, we all know that overturning Roe v. Wade is so firmly anchored in the GOP platform by now, the party's edifice would collapse without it.

But here are three reasons why the Republicans desperately need Roe to remain in force:

1. Legal abortion mobilizes the Religious Right like perhaps no other single issue. It forges activists and brings voters to the polls. (Gay marriage has served them well, too, but it doesn't resonate as well with young evangelicals, who are more inclined than their elders to live and let live.)

2. If Roe were overturned, you'd see a backlash against the backlash. Suddenly most American women (and many of the men) would recoil against stories of 12-year-olds forced to carry to term or women bleeding out after taking RU-486 without supervision. They might also realize that Roe protected their own right to self-determination and didn't just enable the loose morals of that slut down the street.

3. Without Roe, the 'wingers couldn't crow about the morals of conservative women like Sarah Palin who "choose life" or "decide not to abort." Oodles of commentators have noted the hypocrisy of this. If choice were illegal, the opportunity to show one's superior virtue would evaporate.

I'm not foolhardy enough to say "bring it on" - the short-term human costs of overturning Roe would be unacceptable. I'm just saying that the Republicans benefit from a synergy that relies on abortion remaining legal, safe - and not especially rare.

What Palin's Pregnancy Says about Her Poor Judgment

We here at Kittywampus typically think it's far more fun to debunk rumors and conspiracy theories than to spread them. But I've been sick for the past few days with something flu-ish, and while sprawled on the sofa feeling sorry for myself, I've had too much time to read about Sarah Palin. And since I'm a historian of childbirth, the oddities in her pregnancy story set me wondering.

For one, no one on her staff suspected she was pregnant until she announced it at seven months. For another, Palin flew back to Alaska from Texas after her water broke; her son Trig was born a few hours after she reached the hospital. Let's say that again: Palin chose to get on an airplane and travel for at least eight hours after her water broke, risking a preterm birth while in the air.

These improbable details come from Alaskan news reports last spring; they're the closest I'll come to hard facts in this post. But as soon as I started Googling for more information, I learned they've spawned an even weirder rumor: that baby Trig is actually the son of Palin's oldest daughter, Bristol.

I'm only going to touch briefly on the rumor. I think the alleged facts as presented by Palin may actually be more damning. I also have qualms about digging into the private life of a minor child. The issue here is Palin's conduct, not her daughter's. And even Palin's behavior in this regard might be off the table - except she wants to make my uterus part of the public domain, so why should hers be private? Especially when her conduct was downright reckless by just about any standard?

Here's the main evidence for the rumor: Bristol was allegedly out of school due to mono for at least four months - a point that is unconfirmed - in order to hide her pregnancy. If the baby were Bristol's, it would explain why her mother had to hurry back from Texas to Alaska. There are pictures of Bristol that show what could be a baby bump, but might also simply be a belly, as well as photos of an incredibly svelte Sarah two months before her supposed due date. (For more details, see the diary at Daily Kos and a post at Menstrual Poetry, which lay out the most persuasive version of the case.)

The most compelling visual evidence is this photo taken when Palin claimed to be seven months pregnant:

(See the Daily Kos for more photos.)

I don't see even the shadow of a baby bump - and by seven months, you should. During my second pregnancy, my students started speculating was-I-fat-or-pregnant when I was just shy of five months, days before I told them. By seven months, strangers were predicting my baby's sex from the shape of my belly.

Granted, a few women don't show until very late in pregnancy. Most of them are fat to start with. Governor Palin is quite trim. She also had four previous pregnancies, and very few women show less with successive babies. It is possible to be petite and hide a pregnancy until the seventh month; my father's second wife did this in the early 1960s, basically by starving herself. So we'll give Palin the benefit of the doubt. Let's say she restricted her calories and has tremendous abs.

Assuming for just a moment that the rumor is true: As an advocate of abstinence-only education and a foe of abortion, Palin would've had ample reason to insist her daughter carry out the pregnancy - but in secret. This isn't just a plot line from Desperate Housewives. It's a time-honored way for highly religious parents to deal with the personal shame and public embarrassment of a pregnant, unwed teenager. Palin's public position would only have amplified the crisis. Perhaps they'd arranged for an adoption but the Down's diagnosis scuttled the deal - which might explain why Palin announced she was expecting so late in the game. (While the incidence of Down syndrome is exponentially higher in 44-year-olds than in 17-year-olds, it can occur with very young mothers, too. A routine ultrasound could have triggered suspicion if the nuchal fold - a fold in the neck - were unusually thick; so could routine blood testing.)

On the other hand, assuming the rumor is false: Perhaps Palin's fitness routine kept her unusually trim. She might well have kept mum about her pregnancy because she's the sort of high-achieving woman who thinks she has to prove she's ten times tougher than a man. We know she went back to work right after her daughter Piper was born, and we know she likes macho sports like hunting, so this would be in character for her.

But either way - whether the rumor is true or false - Palin's judgment looks pretty poor. If it's true, she's shown herself capable of lying on a grand scale. Yes, this is a family matter, but she has allowed baby Trig to become a political statement - a public symbol of her pro-life views. And do we really need another vice president with a Cheneyesque propensity for cover-ups?

But let's assume the rumor is false - as one must, for Bristol Palin's sake, until some enterprising reporter manages to locate a birth certificate and medical records. (Actually, Palin herself should release all these records and put the rumor to rest. I've found one response to the Daily Kos material with pictures purporting to debunk the rumor, but the appearance of a belly in one photo doesn't explain its absence in others.)

If Palin actually flew from Texas to Alaska after her water broke - and medically, there's no difference between a "leak" and a "break" - it was incredibly irresponsible. Alaska Airlines doesn't bar flying in late pregnancy, so it was entirely Palin's judgment call. Here's how the Anchorage Daily News reported it at the time:

Palin was in Texas last week for an energy conference of the National Governors Association when she experienced signs of early labor. She wasn't due for another month.

Early Thursday -- she thinks it was around 4 a.m. Texas time -- she consulted with her doctor, family physician Cathy Baldwin-Johnson, who is based in the Valley and has delivered lots of babies, including Piper, Palin's 7-year-old.

Palin said she felt fine but had leaked amniotic fluid and also felt some contractions that seemed different from the false labor she had been having for months.

"I said I am going to stay for the day. I have a speech I was determined to give," Palin said. She gave the luncheon keynote address for the energy conference.

Palin kept in close contact with Baldwin-Johnson. The contractions slowed to one or two an hour, "which is not active labor," the doctor said.

"Things were already settling down when she talked to me," Baldwin-Johnson said. Palin did not ask for a medical OK to fly, the doctor said.

"I don't think it was unreasonable for her to continue to travel back," Baldwin-Johnson said.

So the Palins flew on Alaska Airlines from Dallas to Anchorage, stopping in Seattle and checking with the doctor along the way.

"I am not a glutton for pain and punishment. I would have never wanted to travel had I been fully engaged in labor," Palin said. After four kids, the governor said, she knew what labor felt like, and she wasn't in labor. ...

They landed in Anchorage around 10:30 p.m. Thursday and an hour later were at the Mat-Su Regional Medical Center in Wasilla.

Baldwin-Johnson said she had to induce labor, and the baby didn't come until 6:30 a.m. Friday.

"It was smooth. It was relatively easy," Palin said. "In fact it was the easiest of all," probably because Trig was small, at 6 pounds, 2 ounces.

Palin said she wanted him born in Alaska but wouldn't have risked anyone's health to make that happen.

"You can't have a fish picker from Texas," said Todd.

(Source: Anchorage Daily News. See also the Fairbanks Daily News-Miner.)

It doesn't matter if Palin was not in labor upon boarding the plane. She could very easily have gone into active labor in transit. Between the time her water broke until she arrived in the hospital, nearly 16 hours passed.

Palin's version of the story raises a host of questions:

• Why would you deliver your speech as scheduled instead of getting checked out by a doctor?
• Why would you then board a plane without at least being examined by an obstetrician for any signs of fetal distress?
• Why would you simply inform your physician, rather than asking whether it was advisable to fly?
• Given that the drop in air pressure can bring on contractions, why would you take a very significant chance on your baby being born on an airplane?
• Why would you do this knowing he was a month early?
• Why would you risk it knowing he had Down syndrome, which can affect the heart and other organs in ways that aren't obvious prior to birth?
• And why would you take the extra time to drive to Wasilla's little hospital, rather than proceeding directly to a major medical center in Anchorage, equipped to handle prematurity and other complications?

You don't have to take my word that Palin was taking a massive risk. At TPM Cafe, a doctor writing under the name of Steevo calls it "incredibly poor judgment." (Steevo's whole post is very informative.)

Regular readers know that I'm not terribly quick to judge or blame mothers. But this incident is not just a parenting issue; it's a matter of basic sense and judgment. If we accept Palin's version of events, she was highly irresponsible. This was batshit crazy.

And quite apart from Palin's position on the issues - which are awful enough - this is not the kind of judgment I want to see in the White House. Eight years of recklessness have been - as Obama said in his great speech - ENOUGH.

Update, 8/31/08, 9:15 p.m.: Reader Molly pointed me to this post by Andrew Sullivan, which suggests the story is moving up the food chain. I highly recommend this excellent, very reasonable analysis by Skeptic Dad. And man, I can't believe the traffic this post is generating. Maybe I ought to cover gossip more often?!

Update 9/4/08, 9:30 p.m.: This post has now eclipsed my all-time greatest hits: the Duggars' 18 kids, the health benefits of ejaculation, and the finger length-testosterone link. If you've made it this far through this post (written fuzzy-headed while I fought a mild flu), you might want to read my somewhat less rambling followups exploring the medical reasons why hopping that flight was foolhardy, and what such macho behavior suggests about Palin's flavor of feminism.

Huckabee Nostalgia

I never thought I'd feel wistful about Mike Huckabee not getting the VP nod. I didn't really think he'd have a chance. He's too extreme in his religious beliefs. He's too retrograde on women's rights.

Ha! After just a day, such troubling questions have arisen about Sarah Palin that I'm wallowing in nostalgia for Huckabee.

Let's run the comparison. First, Palin and Huckabee are both strikingly good-looking. Let's call that a wash even though Huckabee has never been profiled in Vogue. (Neither has ever been on the cover, though a convincing photoshopped fake of Palin as a cover girl made the rounds yesterday.) And yeah, I realize appearance shouldn't even be an issue, but as figleaf points out, John McCain saw Dan Quayle's looks as a great source of electoral appeal, so maybe McCain thinks Palin's beauty will draw some votes.

Now, Quayle was so dumb that he squandered any potential sex appeal as soon as he opened his trap. My first impression of Sarah Palin is that she's brighter than Quayle - although I cringed all the way down to my toenails when she said "nucular" in her first big speech yesterday. My guess is that behind the pretty facade, Palin - much like Huckabee - is reasonably smart and very politically savvy. After all, she mounted a bloodless coup within Alaska's political establishment and defeated a sitting Republican governor in the 2006 primary.

Palin was surely more palatable than Huckabee to the Grover Norquist types because she doesn't seem to share his concern for social justice - the quality that I liked best in Huckabee, along with his sideline as a rock musician. Her plan for lifting Alaskans economically seems to be further exploitation of the state's natural resources. Kinda hard to generalize that to the whole country. (On energy policy, she most closely resembles Dick Cheney - minus the evil scowl.)

When it comes to religious extremism, Palin may just top Huckabee. Especially on the grassroots level, the religious right would have been happy with Huckabee as the VP candidate. But Palin put James Dobson over the moon, according to an AP story:

Focus on the Family founder James Dobson, who initially said he could not vote for McCain but has since opened the door to an endorsement, called Palin "an outstanding choice that should be extremely reassuring to the conservative base" of the GOP. Dobson added that the ticket "gives us confidence he will keep his pledges to voters regarding the kinds of justices he would nominate to the Supreme Court."

Now, the AP is also reporting that while Palin's office says she does not identify herself as a Pentecostal, she has attended more than one church affliated with the Assemblies of God. Last I checked, the Assemblies of God were at the very heart of Pentecostalism. Why might Palin play this connection down in favor of saying she attends a nondenominational church? In a very even-handed assessment, Professor John Fea, a historian of religion in America at Messiah College, notes that public figures sympathetic to Pentecostalism tend to fly under the radar with the more radical elements of their faith, lest they alienate even other committed evangelicals. He expects Palin will likely do the same.

And that's where it gets scary. Maybe Palin herself does not believe that the Rapture is imminent. Maybe she doesn't believe in demonic possession or exorcism. Maybe she has never spoken in tongues. Maybe she's as skeptical as I about faith-healing. I realize there's a fair amount of variety within Pentecostal and Charismatic Christianity, and maybe Palin doesn't buy the whole package.

But given her church-going history, Palin needs to clarify her beliefs. While I generally think faith is a private, personal matter best kept out of the public arena, her beliefs becomes our business if she thinks demons are at work in our lives. Or if she believes the Apocalypse is nigh and that we ought to be hurrying it along. Or if she embraces dominion theology - which basically calls for theocracy - as blogger Dogemperor thinks is possible. (My understanding of Pentecostalism isn't deep enough to evaluate Dogemperor's arguments, but I'm inclined to be convinced because his/her analysis of Feminists for Life is spot on.)

Even if Palin only believes in the warmer, fuzzier elements of Pentecostalism, like faith healing, I'm still, well, skeptical. We've already had one president who was completely divorced from the reality-based community. We sure don't need another. And on the whole, Pentecostalism is more loosely tethered to reality than Huckabee's Southern Baptist church.

When it comes to reproductive rights, Palin is about as reactionary as Huckabee, who said he would sign a bill like the one in South Dakota that would have permitted abortion only to save a woman's life. During her gubernatorial campaign, a staffer said Palin would ban abortion even in cases of rape and incest. However, he also said she'd allow a health exception, which is a loophole that nearly every hardcore anti-abortion activisit wants closed. I have a feeling Palin will be forced to back away from the health exception. Interestingly, she told the press back in 2006 that she favors contraception - which despite being the obvious way to reduce abortions won't sit well with much of the "pro-life" establishment. I'm curious whether she'll stick to her guns.

As I mentioned yesterday, Palin has been lionized by pro-lifers for knowingly giving birth to a baby with Down syndrome. In comments, Heather rightly pointed out that I'd parroted their way of framing her decision (she chose to have the baby "anyway"), which offends many within the disability community. But that is fairly consistently how the pro-lifers view it - as a noble sacrifice:

Palin has been held up by many evangelicals as a model for her decision to give birth to her fifth child in April after learning that he has Down syndrome.

"I think that's a plus in her favor with conservatives," said the Rev. Don Argue, a past president of the National Association of Evangelicals and chancellor of Northwest University in Seattle. ...

[Dobson] called her refusal to abort her fifth child "bravery and integrity in action."

(Source: Yet another AP article.)

Of course, if - like Dobson - you believe there's only one moral response, why single Palin out for unusual bravery?

And why celebrate her "choice"? If McCain and Palin (and Huckabee) have their way, there will be no choice. Period.

Ugh. I think my Huckabee nostalgia has been cured. But I don't feel one bit better.

McCain's Palin-eolithic VP Pick

Wow. John McCain has picked Alaska Governor Sarah Palin as his running mate.

Sarah Palin? WTF??? That's pretty much what the media is saying, too. Palin is so obscure that the reporters on MSNBC admit they're reduced to consulting the Wikipedia's article on Palin, just like me. I was slightly shocked to see that Palin is a few months younger than me - talk about feeling old! - and amused to read that she's a former runner-up for Miss Alaska.

But I actually had heard of her once before this. What jogged my memory was the story of her giving birth to a baby with Down syndrome earlier this year. It was her fifth child. She knew the diagnosis in mid-pregnancy and chose to carry on anyway.

And this, I'm thinking cynically, is her main qualification. She has served as governor for just two years. We all know that lots of social conservatives dislike McCain. Palin is not just red meat for them, she's prime rib. She's a member of Feminists for Life, which mixes a little feminism with lots of "life." As a mother, she has lived her anti-abortion beliefs. (Gotta give her some grudging credit for not being hypocritical.) Oh, and she's a hunter who enjoys mooseburgers (the TV reporters are grooving on that tidbit).

I'm sure McCain is hoping Palin's XX chromosome will help him pick off some votes among centrist women - and maybe even bait a few of those near-mythical PUMAs into voting for a woman candidate. If so, they'd have to be just about delusional to think that Palin - a radical social conservative - is at all fungible with Hillary Clinton. As Debbie Wasserman Schultz just said on MSNBC: "I know Hillary Clinton, and Sarah Palin is no Hillary Clinton."

Palin may be a new, fresh face who made her name as a reformer, but her actual positions on the issues are hard to distinguish from the same old paleo-wingnuttery.

And my goodness, don't the Republicans have better-qualified women? Kay Bailey Hutchison? Christine Todd Whitman? Olympia Snowe? Debra Pryce? Even (shudder) Condi Rice? Oh, whoops! These gals have actual records that might get dragged into the election.

I would have had the same beef if Obama had picked, say, Evan Bayh. Sure, the vice presidential candidate should help corral votes, but they should also be prepared to lead should the president die or become seriously disabled - which in purely actuarial terms is not irrelevant when the president is 72 years old and counting.

The choice of Palin reminds me a little of Mondale selecting Geraldine Ferraro - mere tokenism. We all know how that turned out.

Finally, at the risk of sounding totally judgmental and anti-feminist: I do not think any parent of a four-month-old baby should sign onto a nationwide campaign, even if said baby is totally healthy. A baby that small is so damn needy. I can totally see how the temptation was irresistible; Palin won't be handed this chance again. I realize that if women are going to move up in politics, they can't wait until they're postmenopausal to launch their careers.

But caring for an infant can't be totally outsourced. I'm sure the baby will travel with Palin. They'll hire the best nannies. Even so, I think if you bring a child into the world, you need to be present for them when they're little. A child with special needs will need more than that, as Dan Conley argues eloquently at Open Salon.

For me, feminism also means caring for the weakest among us, and one corollary to that is that both parents need to be willing to reshuffle their priorities to ensure their children's needs are met. How can you do that with an infant while campaigning for the vice-presidency?

And how does that accord with anyone's "family values"?

Young, Pregnant, Desperate? Pick Your Judge Carefully

Photo by Flickr user mindgutter, used under a Creative Commons license.

Parental notification laws for young women and girls seeking abortions are a crappy idea. Most states have them by now, but that still doesn't make them smart.

As a mother, I know that if I want my kids to come to me with serious problems someday, I have to build a foundation of trust. If either of my boys ever got a girl pregnant, they'd need to know that they could come to me for advice and counsel. They'd need to feel enough love and respect that they could trust me to support them. And so my job of establishing that trust starts now, while they're still little kids.

Because you can't legislate love, trust, and respect. You've gotta earn it.

Realistically, though, some families are just dysfunctional. Sometimes a pregnancy is a result of incest. Sometimes a girl fears being thrown out of the house, or beaten, or belittled. In those cases, parental notification laws don't repair anything; they just make a pregnant girl's life much more difficult. And if we're stuck with those laws, then judicial overrides are indispensable.

In Ohio, pregnant teenagers under 18 do have the option of taking their case to a judge - but as yesterday's Columbus Dispatch reports, it matters crucially which judge hears your case:

The bypass hearing is "not something a lot of people know about, I admit," Judge Dana Suzanne Preisse said.

"The average age is 16 or 17, and some are weeks from their 18th birthday. They have to prove to the court they are emotionally mature and intelligent enough to make this decision on their own."

After 18, parental consent is not needed for an abortion.

Judge Kim Browne said she spends 20 minutes with each teen and her attorney.

"I don't think I'm playing God at all," said Browne, who has never denied a request. "That is their choice. That's the decision they are going to have to live with. ...

Judges don't ask for the teens' names or schools, or who the father is. Sometimes, a clean driving record and good grades are enough to convince a judge of "sufficient maturity," the key phrase in the Ohio Revised Code. ...

Some former judges, including Carole Squire and the late George W. Twyford, usually denied the requests on moral grounds, court officials said.

"I don't think it's appropriate for a family court judge to flagrantly disregard the parents' authority," Squire, a Domestic Relations judge from 2000 to 2006, said last week.

"I don't believe (judges) are applying the law correctly. Good grades in school is not dispositive of being sufficiently mature."

As her conservative stance became known, fewer bypass hearings came her way, she said. ...

Preisse has denied only one request, she said.

"I feel I'm elected by the people to follow the statute," even if it goes against her own moral standards.

(Source: Columbus Dispatch)

I don't know where "playing God" enters into this. Why is that even part of the discussion? Why does a judge - even a liberal judge - feel compelled to defend herself against this potential charge? This is a human decision, affecting human lives.

Why does a judge feel she needs to make clear that she herself is more moral than the girls over whose fate she presides? Even though she has only turned down one case, why does she presume that her personal anti-abortion stance is more moral than the decisions these girls have made?

It's also misleading to couch this decision in terms of parental authority. If no action is taken, these girls will become parents themselves! How can a judge deem a girl too immature to make the abortion decision - but then lock her into a parental role, which will demand far more maturity from her?

And how does a scared sixteen-year-old figure out in advance which judge will give her a fair hearing, and which one will dismiss her case out of hand?

Lots of questions, no good answers - all spawned by legislation that's basically misguided from the get-go.