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.

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?

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.

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.

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.

A Glimpse at a Post-Roe World

When discussing abortion in the classroom, I often ask my students what it would take for Roe to be overturned (answer: one more anti-Roe justice on the Supreme Court) and what a post-Roe world would look like. They often assume that we'd just revert to the pre-Roe situation: Women who could afford it would travel to states where abortion remained legal. Those who couldn't would reach for a coat hanger or knitting needle.

Only the first half of this scenario is plausible. The second half doesn't even accurately reflect history. Most abortions performed before abortion's legalization involved a doctor, midwife, or other black-market provider. Many of these abortionists were medically competent, and some were even caring. Only a minority of illegal abortions were self-induced, and by no means did they all involve sharp instruments. Other common techniques included poisoning oneself just enough to expel the fetus (eating match heads was one way to do it), inflicting blows to the abdomen, or trying to overheat/overcool one's body. Obviously, the more effective of these methods carried their own risks: The line between poisoning the fetus and fatally poisoning oneself was thin and treacherous.

In a world without Roe, women would not simply revert to the old methods. Most of them would turn to the Internet for help. Just as many senior citizens now import their Lipitor from Canada and ED patients order those little blue pills from India, unwillingly pregnant women would get their RU-486 online.

This is already happening in countries where abortion is harshly restricted, as Kate Harding reports on Salon's Broadsheet, relying on a BBC story. Among the more reliable services providing medical abortions is one called Women on Web:

Women on Web will send abortifacient drugs to women less than nine weeks pregnant in countries "where abortion is heavily restricted" -- also providing proper instructions, paperwork signed by a doctor and e-mail support. Audrey Simpson, director of the Family Planning Association of Northern Ireland, calls the site "very helpful and reputable" -- while being careful to add that her organization doesn't encourage breaking Irish law.

Unfortunately, at-home abortions are not without risks, even when they don't involve the proverbial rusty coat hanger. Besides Women on Web, there are rogue sites out there, sending "unmarked bottles with no instructions or paperwork," according to one woman who eventually used WoW. ... And the British Journal of Obstetrics and Gynaecology recently published a survey that found even among Women on Web clients, almost 11 percent had required a surgical follow-up.

This shows a real parallel to women's historical experiences in those countries that now have relatively liberal abortion laws. Incomplete abortions were a fairly common event in the illegal era. But once an abortion was in progress, a doctor would be obligated to help the woman, even if he knew or suspected that she wasn't just suffering a spontaneous miscarriage.

I'm not entirely sanguine about any of this. Liberal abortion laws save women's lives. Period. But I think that we proponents of reproductive justice serve our cause poorly if we don't recognize how a post-Roe world would differ from the pre-Roe situation. These differences - and not just historical amnesia - may help explain why the coat-hanger symbol is losing its resonance among young women. And I think we also need to recognize how resourceful women can be when faced with sharp restrictions on abortion rights.

The Wages of Sex, According to Rod Parsley

From I Can Has Cheezburger?

The Columbus Dispatch reports that Rod Parsley’s world-domination enterprise, aka his “church,” has established an anti-abortion counseling center in Columbus, located conveniently just across from a Planned Parenthood clinic.

Parsley's center looks like a doctor's office, though there is just one medical professional employed there, a registered nurse. Other nurses and doctors will volunteer their services there, [director Debbie] Stacy said. …

It will offer free pregnancy tests and ultrasounds to encourage women to give birth, Stacy said. It also will make referrals for other medical services, but not for abortions.

(Source: Columbus Dispatch)

This is nothing new, of course. Such “crisis pregnancy centers” exist all over the United States. But the Dispatch report offered this one truly telling detail:

Inside, women will find a portable ultrasound machine and pamphlets about sexually transmitted infections, RU-486, sometimes called the "abortion pill," and how to say no to unwanted sex. The reading material all focuses on abstinence. The center does not distribute information about birth control.
(my emphasis)

And this too, is nothing new. It's just one more piece of proof that for doctrinaire opponents of reproductive justice, the point is not saving "unborn lives." It's making sure that if you do indulge in sex, you'll be penalized for it - with a baby.

I'm sure the resulting babies will be thrilled to know that they were their mom's punishment for bonking without a license.

The Pregnant Gaps in "Juno"

I'm probably one of the last people in the United States to see Juno. I clearly need to get out more. Last night I finally rented the DVD - under pain of embarrassment since tomorrow's class will discuss abortion. I enjoyed the snappy dialogue and the wiseass humor, especially from Juno's parents. And I really didn't read it as glorifying teenage pregnancy or demonizing abortion, as did many commentators who actually go see movies while they're still in the theater.

But two things bugged me about it enough to require venting - two holes in plot/motivation big enough that you could drive a truck through them (or at least walk through them sideways while nine months pregnant).

(If you're one of the remaining five people who haven't seen the movie, you might stop here, because the rest of this post is full of spoilers. Sorry.)

First, I didn't buy Juno's motivations for walking out of the abortion clinic with her pregnancy intact. I'm not suggesting she should've had the abortion. That would be a doctrinaire and anti-choice position. I just wasn't convinced that anyone changes their mind just because the clinic's receptionist is a goth version of a twit with boundary issues, or because the other people in the waiting room appear to be basket cases.

What if it'd been clearer that Juno chose as she did in order to buck the pressure to be a conformist high schooler - to hide the pregnancy and pretend it never happened? That would be in character for her since later in the movie, she reacts to the stares at school with a "fuck 'em if they can't take a big belly" attitude. As it is, her decision seems capricious, which doesn't fit with Juno's smarts and savvy.

Juno's decision also just doesn't make emotional sense more generally. I don't believe that abortion is always a hard and fraught decision. Even when a woman is sad about deciding to abort and grieves her loss afterward, the decision itself might be clear to her and not a struggle at all. The same can be true for deciding to carry on with the pregnancy. I don't think, though, that it often hinges on completely random factors, as Juno's choice apparently does.

The second thing that left me feeling perplexed and unconvinced is how easily Juno gives up her baby at the end. Given how important it was for her to get to know the potential adoptive parents, can we really believe that she just puts the whole experience behind her as soon as she's "squeezed the baby out of her vag," as she would say? She could easily have decided in favor of an open adoption, which would ring more emotionally true with her behavior while pregnant.

Again, I'm not saying that she should have appeared tormented about relinquishing her baby. Having carried two of them to term, though, I know that it would be really hard not to form some sort of bond with the developing fetus. Juno doesn't use the term "fetus," anyway; to her, it's a baby from early on. When she goes for an ultrasound, you see her eyes shine with the wonder of it. She's not immune to that natural bonding that occurs gradually as you live with this strange, bony, watery creature inside you and feel its movements. So it would be much more convincing if she'd not just shrug it all off in the end but instead show a flash of wistful what-ifs.

Lacking that, I got wistful on her behalf, imagining how hard - how impossible - I would find it to grow a baby, give birth, give it away, and then forget about it. Interestingly, this isn't just the reaction of a sentimental old mama. One of my young male students reacted the same way about the ending. I think a lot of pro-life people want to believe in that pat ending, though, and that's why they advocate adoption as a one-size-fits-all solution. If only it were that easy.

LOLkitteh from I Can Has Cheezburger?

Reproductive Rights Are Human Rights

My friend The Political Cat posted his thoughts yesterday on why the right to contraception ought to be regarded as a human right. His argument emphasizes the ways widespread use of contraception serves a common good. Some of these are global: overpopulation, declining resources, pollution, global warming, and the violence that each of these can provoke. TPC also strongly advocates reducing child abuse and neglect by preventing unwanted births in the first place. When I commented that "This post cries out for the bookend to it - the individual-rights argument," TPC tossed the job back to me. :-) So here goes.

I generally prefer the term reproductive rights because it's broader than just legal, affordable access to both contraception and abortion. It also encompasses freedom from coerced sterilization or abortion as well as support for needy pregnant women and new mothers. Here, to stay roughly parallel to TPC's post, I'll focus mostly on freedom from unwanted pregnancy.

Reproductive rights are a fundamental human right. Without the ability to decide freely whether one wants to share one's body with another and nurture and sustain it at considerable cost to oneself, a woman is not a free human being. She's a slave. And we outlawed slavery 150 years ago.

Unplanned, unwanted pregnancy doesn't just reduce women's freedom to do the fun things in life, as anti-feminists often argue. Its penalties are not trivial and frivolous. It interrupts and often ends educations, makes it impossible to perform certain types of paid work, and puts both mother and child at long-term risk for poverty.

American society guarantees bodily autonomy and integrity more solidly and consistently for men than for women. There's no broad consensus on women's reproductive rights, as evidenced by the deep cleavages on abortion, escalating controversy over the right to buy birth control pills (!) at any pharmacy, and nonsensical legal restrictions on both abortion and Plan B (the morning-after pill). By contrast, while plenty of wingnuts deride condoms as useless, no one is trying to pressure pharmacies and other stores to stop selling them.

This double standard was dissected over a generation ago by the philosopher Judith Jarvis Thomson, whose 1971 essay "A Defense of Abortion" famously proposed a thought experiment in which a virtuoso violinist with kidney failure was hooked up to another person's kidneys for nine months against that person's will. Without using the other person as a human dialysis machine, the violinist would die. Of course no one would insist that the second person had an obligation to permit this. No one, Thomson argued, has the right to another's body. While her analogy is obviously imperfect, the disanalogies are not strong enough to invalidate her argument. (See Wikipedia for a nice summary of objections to Thomson and the rebuttals to them. Note also that her argument generously posits that the fetus is a full social and legal person; if you don't grant that premise, then there's no reason to restrict abortion on ethical grounds and her whole argument becomes unnecessary.)

I'd like to extend Thomson's reasoning with a more explicit analysis of how gender plays into this. (I'm basing my thoughts partly on arguments that Susan Bordo makes much more eloquently in her essay "Are Mothers Persons? Reproductive Rights and the Politics of Subject-ivity," in Unbearable Weight: Feminism, Western Culture, and the Body.) Here's a particularly crass example. Abortion opponents often argue that women need to bear the consequences of choosing to have sex. As soon as fertilization has occurred, they grant the fetus an absolute right to life, which logically entails significant bodily sacrifices from the woman. Yet they never argue that fathers have a legal obligation to make sacrifices for their born children that would impinge on their own bodily autonomy and integrity.

If, say, a child needs an kidney donated or even simply a life-saving blood transfusion, most people would agree that a parent who's a match has a special obligation to donate the needed body parts or fluids. Most parents would do so - without hesitation. But no law compels any parent to donate any part of his or her body. And why not, if the foes of legal abortion believe that a mother has such an obligation to sustain her fetus that she must allow it the use of her entire body for nine months, running non-trivial physical risks in the process? Why would they legally require mothers to make sacrifices far greater than mere blood donation, yet fathers are let off the hook entirely? This inconsistency, Bordo suggests, stems from a belief that mothers are not full persons, either socially or legally.

These are not just abstract philosophical questions. Without reproductive rights, women's health suffers grave harm. Worldwide, millions of women have died of botched and self-induced abortions where the procedure is illegal. When Roe v. Wade made abortion legal throughout the United States in 1973, the number of live births remained steady while maternal mortality plummeted. This indicates that legalization didn't actually increase the number of abortions, at least initially, but it did save thousands of women's lives each year. In those countries where it remains illegal, abortion often accounts for the lion's share of maternal mortality.

Without reproductive rights, children's lives suffer, too, and not just from the abuse and neglect that TPC deplores. As I've argued elsewhere, children in developing countries fall deeper into poverty and face higher risks of being orphaned where their mothers have poor access to contraception and abortion.

So the stakes are high. This is why Human Rights Watch has defined reproductive rights as human rights. Yet, seeing how some of their putative defenders have weenied out in recent years, you might conclude that reproductive rights are a fringe issue here in the U.S. One of the highest ranking Democrats, Senate Majority leader Harry Reid (D-Nevada), opposes abortion rights - no big shock, given that he's a Mormon. More surprisingly, much of the Democratic leadership seems to think his position is just hunky-dory.

Reproductive rights are not a fringe issue. They affect the 51% of the population that has the present, past, or future capacity to become pregnant. Unless you're pretty sure a woman sheds her personhood as soon as she becomes a potential mother, why wouldn't she deserve the same legal right to bodily autonomy and integrity as any man?

Image by Flickr user stormbear, used under a Creative Commons license.

On Drives and Driving

I often hear from students who are concerned about women "using abortion for birth control" that if people aren't prepared to accept a pregnancy, they shouldn't be having sex. Not all of these students are Catholic, so this assertion doesn't merely reflect the Vatican line.

These are people who are just a couple of years out of high school. Viewed through the lens of (im)maturity, their position probably makes a lot of sense in their own lives. Plenty of young people make the leap into sexual activity before they're old enough to know their own desires. Too many begin before they can untangle their desires from those of friends or potential partners. Waiting is a good thing.

But as a prescription for a lifetime? Well, I suppose you could mandate lifelong abstinence (even within marriage!), which is the logical extension of "no sex if you can't handle a pregnancy." Or you could decree that everyone gratefully embrace as many babies as God sends us. That'll work just great – in a theocracy. (Speaking of which, see Blue Gal if you want to join in Blog against Theocracy on Easter weekend.)

Realistically, people will have sex, for all sorts of reasons – some of which you or I may not like – without being prepared to "accept" a resulting pregnancy. Thousands of years of human history show that apart from a select and diminishing few, most humans are not interested in a celibate life, and most don't couple only because they want a child.

But beyond this pragmatic level, people also have a right to sexual expression. Of course we aren't entitled to a partner; that requires some effort, patience, and luck. But the drive to seek sexual happiness is a basic part of being human, and the pursuit of it thus ought to be considered a basic human right.

It occurred to me only after discussing this with my classes last week that driving is a good analogy to sexual activity. Yeah, you could survive without driving a car, just as you'd survive without sex. But in most parts of the United States other than a few cities, your life would be terribly circumscribed. You would be dependent in a host of ways, almost infantilized.

Sex and driving have a whole lot in common. They're both part of a fulfilling adult life, and they're both risky. Both can be approached responsibly or recklessly. Oh, and they're both fun.

By a funny coincidence, just a few hours after the comparison occurred to me it also popped up in the highly entertaining novel I'm currently reading, The Abstinence Teacher by Tom Perrotta. The title character, Ruth – a sex educator in the public schools who's pressured to teach an abstinence only curriculum – is under orders to begin a lesson with the all-caps slogan, "THERE IS NO SUCH THING AS SAFE SEX." Ruth reflects:

Well, of course there wasn't, not if you defined safety as the impossibility of anything bad ever happening to anyone. There was no such thing as risk-free automobile travel, either, but we didn't teach of kids to stay out of cars. We taught them defensive driving skills and told them a million times to wear their seat belts, because driving was an important part of life, and everyone needed to learn to do it as safely as possible.

I was lucky. I first learned to drive on dirt section-line roads in North Dakota, a set of parallel ruts leading in a perfectly straight line over and beyond the horizon. By now I've driven in Los Angeles, New York, and Berlin, but I'm still grateful for my gentle introduction.

Now imagine if we taught our children that driving is sinful; that it's sure to kill you; that air bags are a bad idea because they can't promise perfect safety. (Hmm. I actually remember hearing that last one when I was a kid.) Imagine if the U.S. withheld foreign aid from countries that offer comprehensive driver's ed. Imagine telling people who get in an crash that they deserved it because they're bad people and shouldn't have been driving in the first place.

We'd put the brakes on that imaginary world. Wouldn't we?

Bad driver LOLcat from I Can Has Cheezburger?

Abortion and Moral Complexity

Earlier this week, journalist and Feministing blogger Courtney Martin published a piece at Alternet in which she discussed her own reservations about abortion. She begins with the story of how she accompanied a friend who was getting an abortion. While in the waiting room, she was disturbed by the apparent lack of remorse of a woman who was chatting on her cell and herding her toddler. Martin remarks:

I was unequivocally pro-choice, but I hated that woman in her 30s because she seemed (I didn’t ask) to have such an uncomplicated relationship with abortion. I was jealous. Past my conviction that abortion should be legal and safe, my own feelings were a mess.

Martin admits that her reaction wasn't necessarily fair, but she still uses this woman as a projection screen for her own doubts and anxieties. Amanda Marcotte at Pandagon rightly takes her for task for this.

My own reading of the scene Martin describes is that of course the woman appeared ordinary and unruffled; she was waiting for a doctor, and that's just not a situation where most people allow themselves to lose it. I'd bet no one saw how conflicted Martin and her friend may have felt, either.

Having spent tons of time in oncology wards and waiting rooms - not as a patient but as a caretaker - I've been repeatedly amazed at how calm people are even in the face of medical catastrophe. You'd think you'd occasionally see someone rant and rage against the dying of the light, but no, people sit stoically, chit-chat about mundane things, and wait.

I can imagine that a similar dynamic obtains in abortion facilities, too. Whatever turmoil a woman might feel while she waits, be it sorrow, guilt, or even happiness, she'll put up a impassive front because anything else violates the norms of medical institutions.

That's just one more reason why Courtney has no basis for her projections - apart from the fact that she didn't know jack about that woman and her situation.

Still, I'm frustrated by how hard it is, even among feminists, to discuss the moral complexities abortion holds for some women. This issue seems to rear up every year or two. One year it's Naomi Wolf who urges us to ponder the morality of abortion, then it's Frances Kissling, and now it's Courtney. Feminists should be able to discuss the morality angle without immediate accusations of betraying our own cause. Amanda Marcotte's protestations to the contrary, the comments thread under her post on this topic already shows how quickly feminists feel judged by fellow feminists. (I posted an earlier version of this on that thread and fully expect someone will pounce on me.)

I myself find abortion morally unproblematic in early pregnancy. But I worry that if feminists can't acknowledge and address other women's qualms, we end up preaching to the choir and alienating people who are in the mushy middle, where a majority of young women (and men) find themselves.

As a teacher of women's studies, I have both the opportunity and the responsibility to promote real dialog on this. Most of my students say they wouldn't choose abortion themselves (though of course some of them will decide otherwise when faced with an actual pregnancy). But most can also be readily persuaded that women, rather than government, ought to make the decision. While I in no way view my role as providing "conversion experiences," I'll admit I'm glad when young people who initially say they're pro-life realize their actual position is more complex. If they learn to distinguish the personal level from policy, it's real progress.

Here's an example of where feminists should reasonably be able to concede that moral complexity exists: While I agree that it's ludicrous to endow a fetus with personhood, I'm wholly unconvinced when Marcotte equates a fetus with a tumor or with the whole universe of children-never-conceived due to birth control.

The vast majority of abortions are performed when the fetus is basically brainless, and thus those abortions have the moral weight of removing tumors or tapeworms. The potential person argument has no sway over me, because if not allowing a potential person to come into being is wrong, all forms of birth control, including abstinence, are wrong.

Unlike a tumor, a fetus is at least a potential person. And unlike the "unconceived," a fetus is not an abstract and infinite potential person, it's a concrete, specific one. It's got DNA and it's human, though it's not yet an actual person, which is of course a crucial distinction. Its gradual development toward fully realized personhood is one reason why even most staunchly pro-choice people see a difference between abortion at 2, 12, 20, and 30 weeks. We should be able to acknowledge this without fearing that it hurts the case for abortion rights.