Friday, November 30, 2012

Mississippi's only abortion clinic is TRAPed

The state of Mississippi has enacted a classic "TRAP" law and it might shut down the state's only abortion clinic.

A TRAP law is a targeted regulation of an abortion provider-- essentially, imposing regulatory requirements on an abortion clinic that the clinic cannot meet. Instead of directly outlawing abortion, one regulates abortion providers out of existence. The regulations are framed as common sense medical protections for the women that would receive abortions. This is a popular conceit and a favorite of pro-life activists, who charge that the uncaring abortion industry injures many women through shoddy medical practices.

Mississippi's version would achieve its intended effect by requiring all abortion doctors operating in the state to have hospital privileges, on the premise that this would be useful in case a problem occurred during the abortion procedure that would require a women to receive emergency or follow-up treatment at a hospital. 

The problem is that no hospital around the targeted clinic, in Jackson, will offer abortion doctors admitting privileges. 

This kind of regulation strikes me as clearly unconstitutional, for two reasons. One, these regulations are simply unnecessary. Doctors at abortion clinics do encounter complications on occasion and commit outright malpractice on occasion. What is not clear is that the nature of their work-- abortions-- leads to a greater proportion of patients encountering problems requiring hospitalization than doctors performing similarly dangerous/not-dangerous medical procedures in clinic settings. 

Two, everyone knows that the true motivation for Mississippi's law is to shut down the Jackson clinic. My reading of the Casey case (the 1992 Supreme Court decision that updated and modified Roe v. Wade) is that regulations that place a substantial obstacle in the path of women attempting to obtain an abortion, primarily to make acquiring an abortion more difficult, are unconstitutional. 

Advocates for the TRAP law at issue, like state representative Sam Mims, have not done a great job of sticking to the talking points:
"We're protecting the health of women by giving them professional care," he said.
Okay, that's not bad. But then this:
"I believe life begins at conception and I think a lot of Mississippians do as well. If this legislation causes less abortion, then that's a good thing," Mims added. (Source: CNN)
What do you think is the primary purpose of the law?

A federal district court judge imposed a temporary injunction against the law in July of this year. At the same time, however, the state was allowed to continue developing administrative regulations and procedures that would be used if the law is ultimately judged constitutional. While the lawsuit on constitutionality proceeds, it appears that Mississippi is ready with its regulations to shut down the clinic, as the clinic has failed to meet the administrative requirements. So the immediate question is if the federal district court will grant another temporary injunction, keeping the clinic open, until the status of the law is fully resolved.

Links:

Article at CNN (the page also includes links to other articles plus video reports) (November 28, 2012): Mississippi's only abortion clinic faces threat of shutdown 

Article at CNN that provides a more detailed description of the earlier injunction fight (July 13, 2012): Mississippi's sole abortion clinic can stay open for now

Federal District Court order providing a partial injunction against the Mississippi TRAP law: Jackson Women's Health Organization v. Currier, No. 3:12cv436-DPJ-FKB (SD Mississippi 2012)

Thursday, November 29, 2012

How exceptions to abortion bans work in practice

The much awaited report of the Irish government "Expert Group"recommending how to implement exceptions to Ireland's abortion ban was issued this week. I have yet to read it, but when I do, I'll provide an analysis.

In the meantime, one of the attorneys who participated in the famous "A, B and C" case has written an interesting essay about legal exceptions to abortion bans. In A, B and C v. Ireland (2010) the European Court of Human Rights, consistent with the Supreme Court of Ireland, demanded that Ireland adopt at least a life-saving exception to its total legal ban on abortion-- which the Irish government has not done.

In the wake of the death of Dr. Savita Halappanaver and resulting public pressure, the Irish government has finally produced a set of recommended legal and medical guidelines for doctors for implementing a "life" exception.

The attorney and author of the Slate article, Julie F. Kay, expresses skepticism that a narrow life exception will do much good, because doctors will still be quite worried about acting outside its bounds. This is especially the case, she asserts, where the exception merely covers threats to a pregnant woman's life and not her health as well:
In medicine there are rarely bright lines. There are, for instance, no guidelines for doctors on the distinction between a medical procedure necessary to preserve a woman’s life versus a procedure that would merely protect her health. Should a pregnant woman sit in a doctor’s office or a hospital bed waiting for her health to decline to the point where her doctor feels that an abortion is inarguably legal, at which point it may be too late? (Emphasis in original.)
Kay also suggests, to her American readers, that pro-life legislators and activists would like to make the United States legal and social landscape more Irish, and that this is a real danger:
This is coming soon to a medical theater near you. Anti-abortion zealots in the United States seek to replicate Ireland’s draconian laws by enacting fetal personhood legislation and emphasizing exceptions that in practice are unworkable. In the last election, moderate Republican candidates only had to support legal abortion in cases of rape, incest, and life of the woman to be considered reasonable. As we’ve seen from Halappanavar’s story, there’s nothing reasonable about that. 
I think Kay is correct that, in the area of abortion, it is difficult to craft exceptions to an abortion ban in precise legal language that clearly applies to some situations but not others, in particular regarding the concept of 'threats' to 'health' and 'life.' In addition, some exceptions, like ones for pregnancies caused by rape or incest, are hard to objectively validate. How, for example, are the authorities to verify that a pregnancy was the result of rape?

Given the difficulty in crafting legally unambiguous exceptions and the difficulty in verifying the requisite conditions for the application of some exceptions, legal authorities and doctors in a given society tend to adopt one of two practices:
  1. The authorities signal that they are going to police exceptions to a general abortion ban strictly, to avoid abuse of ambiguous language. Under this paradigm, the legal exceptions disappear as realistic options. The exceptions are not opportunities to provide abortions to women that need them; instead they are ambiguous traps for unwary doctors and medical personnel. This is Ireland's situation. When it comes to exceptions for rape-caused pregnancies, the authorities traumatize rape victims by interrogating them about the validity of the sexual assault to ensure that they are not 'faking.' This happens in some Central and South American countries-- and used to happen in the United States. 
  2. The authorities-- and/or judges, employing the general principle that people can't be prosecuted under vague criminal prohibitions-- police the use of legal exceptions loosely. The exceptions, then, in practice become general allowances of abortion, and abortion is widely legal despite the letter of the law. As for rape and incest exceptions, there is little to no appetite to question the word of the pregnant woman applying for an abortion under these circumstances. This is the general state of things, I believe, in most European countries, including the UK, where many Irish women go to have abortions. 
Pro-life groups tend to worry about the second set of practices, and so oppose attempts in countries like Ireland to liberalize abortion laws. In the United States, some pro-life activists want any life exceptions under a hoped-for post-Roe regime to be limited to threats to the physical life of the mother. Similarly, I believe the argument that abortions are never medically necessary is motivated by a desire to avoid the creation of any exceptions to a general abortion ban that could be abused. 

Pro-choice activists like Julie F. Kay, on the other hand, worry about the first set of practices, and so worry about the narrowing of abortion laws to a general ban with exceptions 'allowed.' 

Who is right? I think it depends on the country and its history. Since the early 1970s, American judges, in particular the federal judges, have largely fallen into the second camp-- loose application of exceptions. For example, people forget that the first U.S. Supreme Court decision on abortion, United States v. Vuitch, 402 U.S. 62 (1971), was decided largely on vagueness grounds. 

In that case, the Supreme Court examined the abortion law of Washington, D.C., which had a "life and health" exception to a general abortion ban. The Supreme Court upheld the exception as constitutional by construing it as being very broad in application, and essentially placed the decision as to when it should be applied in the hands of physicians. The Supreme Court also held that if the government wanted to prosecute a doctor for performing an abortion outside the scope of the "life or health" exception, the prosecution had to prove beyond a reasonable doubt that the abortion did not fall within the bounds of the exception-- a very difficult task, given that the term "health" was construed to include "psychological as well as physical well-being . . ."

This seminal though (now) little known case is, I think, representative of the legal paradigm in the United States. Even if Roe were overturned, I think exceptions to resulting abortion bans (and there would be some) would end up being very broadly construed and applied by judges. 

Links:

Pdf copy of the Report of the Expert Group on the Judgment in A, B and C v. Ireland (November 2012)

Article in Slate written by an attorney who participated in the A, B and C v. Ireland case (November 28, 2012): Exceptions Don't Work: What the Irish Abortion Tragedy Means for the United States

Wednesday, November 28, 2012

The Ohio heartbeat bill is dead

The proposed Ohio law that would have banned abortions of any fetus that had a heartbeat-- in other words, after about six weeks of gestation-- has been set aside by the Ohio legislature.

That is the right move. The law had no chance of being upheld as constitutional. From the time of the Roe era, pro-life groups have been trying to use scientific evidence of the humanity of the unborn to restrict abortion, and it has largely been a failure, in particular when used to justify near-total bans on abortion. As I discussed in my own dissertation, the 'humanity' of the unborn is one consideration but not the primary or major consideration regarding abortion rights or restrictions. To point that out drives pro-life activists crazy and sounds terribly unfeeling toward the unborn. Still, that is the way the law has been structured and interpreted, and the many consequences (intended and unintended) that would result from changing the paradigm have kept judges cautious.

The 'scientific evidence' tactic might work better when attached to legislation that attempts to nip at the edges of abortion rights, like bills grounded in the concept of 'fetal pain' or even 'partial-birth abortion' bans that rest on the conclusion that this particular technique of late-term abortion is never medically indicated.

Another interesting angle to the story is the differing agendas of the legislators and the activists. The pro-life activists appear to be terribly disappointed that the bill is not going to go forward. The (Republican) legislators, on the other hand, perhaps reading the national mood and interpreting the results of the 2012 election cycle, appear to want to dial back on reproductive politics-related issues for now. What does the Republican President of the Senate want?
“I want to continue our focus on jobs and the economy,” Niehaus told reporters. “That’s what people are concerned about.” (Source: The Washington Post)
Note also U.S. Senator John McCain's recent comment that, when it comes to abortion, Republicans should "leave the issue alone"-- and the pro-life movement reaction:
The Susan B. Anthony (SBA) List and Personhood USA, both groups that oppose abortion rights, attacked McCain after he spoke about the issue on "Fox News Sunday."
... 
On Tuesday, the SBA List called on McCain to rethink his comment in light of his stated opposition to abortion rights. 
"He should figure out why he decided to take that position [to oppose abortion rights] in the first place," said SBA List President Marjorie Dannenfelser. 

...

Personhood USA took a more direct tact in an earlier statement, calling on the GOP to "drop" its former presidential candidate over his desire for a de facto truce on abortion.  

"We will never be successful if we compromise," said Jennifer Mason, the group's communications director.  (Source: The Hill)
Links:

Associated Press article published in The Washington Post (November 27, 2012): Ohio Senate puts end to bill that would have banned abortions after 1st fetal heartbeat

Article in The Hill (November 27, 2012): Anti-abortion rights groups slam McCain

Tuesday, November 27, 2012

Is overpopulation a myth?

It is, according to the Population Research Institute (PRI), a pro-life organization "which works to end coercive population control, and fight the myth of overpopulation which fuels it." The current president of PRI is Steven W. Mosher, a well-known pro-life activist who cut his teeth exposing and protesting the problems of China's one-child policy, in particular forced abortion.

As I pointed out in an earlier post, the idea that there is no population problem is one of the pro-life 'narratives' that crops up all over the place. Here is the first of six videos in a PRI-produced series (for the complete series, visit the video series home page):


So let's look at the major assertions:
  1. The population scare prompted the creation of the UN Population Fund (UNFPA).
  2. Those who support population control are the "haves" trying to wipe out the undesirable "have nots."
  3. The world population will peak in a 30 years or so and then start to decline. 
  4. All of the world's population could live in a land mass the size of Texas. 
Taking the third assertion first, yes, world population might level out or even decline in 30 years, but why? In large part, if this occurs, it will be due to family planning programming, much of it prompted, funded, and implemented by the UNFPA in the 1970s and beyond. It is rather ironic, therefore, that PRI is criticizing population control policy by citing population trends largely brought about by population control policies.

As for the first and second assertions, the charge that the population control/family planning movement is primarily about population control and killing off the "have nots" is at least 30 years out of date.

Until the mid- to late-1970s, the family planning movement was mainly about population numbers, and some of their tactics, as discussed in Michelle Goldberg's book The Means of Reproduction, were not admirable. The implementation of China's one-child policy, of course, is a real-life dystopian example of the dangers of single-mindedly and ruthlessly focusing on population control. These problems led to charges that population control was the project of first-world elitists looking to kill off  the 'undesirables' of the third-world (and the poor of their own countries).

The contemporary family planning movement is still about population control, but only to an extent. For decades, family planning has been primarily about women's rights. Family planning as advocated by the UNFPA is not about controlling or reducing the size of a given population directly. Instead, family planning is about giving individual women (and couples) the autonomy to make their own decisions about pregnancy, number of children, and pregnancy spacing.

Increasing women's rights and promoting gender equality is the right thing to do as its own end. It also produces several positive side effects, among them a reduction in the birth rate to manageable levels-- the kinds that the PRI trumpets. There is, furthermore, a strong correlation between effective family planning and development in third world countries. Ironically, in the places, primarily in Europe, where birthrates are below replacement rate, it is because of gender inequity and a lack of social and state support for working women, not because of family planning per se. European countries with excellent family planning and state support for working mothers (like the Scandinavian countries and France) have sustainable replacement rates (1.7-2.1). As Goldberg asserts, women's rights-based-family planning is the solution to birthrates that are too high and birthrates that are too low.

Finally, the last assertion, about the population and Texas, suggests that there is plenty of space and resources to go around in the world. It may be physically possible to cram the whole world into Texas-- a thought sure to make Texans shudder-- but this has no bearing on the reality of human beings living on the planet in proximity to one another, producing and distributing goods, and engaging in sustainable use of the world's resources.

The world's population is not evenly distributed. The countries that have the highest birth rates in the world right now are the ones that are least equipped, politically and economically, to sustain growth in their populations. While the world overall probably produces enough food to feed everyone-- so that the phenomenon of malnutrition and starvation is a collective moral failure-- the PRI video does not note the obvious: politics, from the beginning of humanity, has gotten in the way of distributing the world's resources properly and justly. Ironically, the domestic and international policies that might change the state of things-- move some of the surplus of the "haves" to the "have nots"-- are opposed by many pro-life Americans.

To possess a 'fair and balanced' view of population issues, I suggest supplementing PRI's video series with a read of the recently released UN report on the State of World Population. It is an excellent primer on women's rights-based family planning.

Links:

The homepage for the PRI video series, with additional information: Overpopulationisamyth.com

Homepage of the Population Research Institute

Homepage of the United Nations Population Fund (UNFPA)

Homepage for Michelle Golberg's The Means of Reproduction

Monday, November 26, 2012

A Catholic EU health commissioner

The European Union Parliament approved a controversial choice for their top health official:
The European Parliament backed a devout Catholic as EU health commissioner on Wednesday, brushing off critics who fear the Maltese politician could row back on EU policies on stem cell research, abortion and gay rights.

Greens, Liberals and Socialists in the European Parliament had said they would vote against Tonio Borg, a former foreign and justice minister in Malta, saying his beliefs could influence EU policy.

As commissioner, Borg's remit would include access to healthcare and contraception and the control of sexually transmitted diseases.

Borg, who was in Malta on the day of the vote according to an EU Commission official, told EU lawmakers before the vote that his personal views would not affect his role as health commissioner. (Source: Chicago Tribune)
Or is he a controversial choice? I don't know anything about Mr. Borg or the powers that come with his portfolio as health commissioner-- he could be a figurehead that oversees a largely entrenched and independent bureaucracy, for example. I don't think the fact that he is Catholic, by itself, should disqualify him from the position. While the Catholic Church has obviously influenced reproductive politics in many countries over a long period of time, lay Catholics, even "devout" ones, obviously disagree with the Church on many issues and are capable of exercising independent judgment.

The question of how Christians can or should reconcile the requirements of their faith with the messy business of politics has been debated since St. Augustine of Hippo in the fifth century. Politicians and bureaucrats having to figure out how to reconcile personal beliefs with their professional responsibilities is nothing new.

I wonder if the fact that Mr. Borg is from Malta, one of the few countries in Europe (or anywhere) that bans abortions without exception, is leading to increased concern about his candidacy. For this reason, the timing of Mr. Borg's appointment, on the heels of the controversy in Ireland over a similarly absolute abortion ban, is poor.

Links:

Reuters article published in the Chicago Tribune about the EU Health Commissioner from Malta (November 21, 2012): EU lawmakers approve abortion critic as top health official

Sunday, November 25, 2012

The irony of the inquiry into Dr. Halappanavar's death

The Associated Press (via The Washington Post) reports that the composition of the panel that is investigating Dr. Savita Halappanavar's death in Ireland has changed:
Prime Minister Enda Kenny told lawmakers he hoped the move — barely 24 hours after Ireland unveiled the seven-member panel — would allow the woman’s widower to support the probe into why Savita Halappanavar, a 31-year-old Indian dentist, died Oct. 28 while hospitalized in Galway. 
Kenny’s U-turn came hours after her husband, Praveen Halappanavar, said he would refuse to talk to the investigators and would not consent to their viewing his wife’s medical records because three of the Galway hospital’s senior doctors had been appointed as investigators.
Kenny said that the three doctors would be replaced by other officials “who have no connection at all with University Hospital Galway. In that sense the investigation will be completely and utterly independent.” 
This makes sense. Why conduct an inquiry at all if it can be accused, right from the start, of a conflict of interest?

As I discussed in an earlier post, the mainstream press and the pro-life press are reporting things rather differently. The mainstream narrative assumes that Dr. Halappanavar's death is the result of bad laws-- a failure to implement clear legal guidelines to guide doctors. The pro-life narrative is that Dr. Halappanavar's death is the result of bad doctors. Their assertion is that medical guidelines published by the Medical Council  clearly allow for an abortion in Dr. Halappanavar's case, so Ireland's pro-life laws do not need to be changed. Instead, incompetent doctors at University Hospital Galway are at fault. (What Catholic doctrine recommended in this situation is, it seems to me, opaque.)

From the standpoint of politics, the irony of kicking the Galway doctors off of the investigative panel is that if the doctors from University Hospital Galway were inclined to engage in a whitewash, they would likely have blamed bad laws. Saying that Dr. Halappanavar's death was caused by bad laws is a way of shifting accountability away from the Hospital and its doctors. Therefore, a panel composed of doctors looking to stick up for one another might have made the liberalization of Ireland's abortion laws more likely, actually.

It is possible that the investigative panel will look at Medical Council guidelines and conclude that Dr. Halappanavar's doctors were primarily at fault, guilty of incompetence and/or fatal diffidence in the face of Catholicism. Given the mainstream press narrative, a panel report that blames 'a few bad apples' and  does not recommend wider legal change is going to come as a nasty shock and itself seem like a whitewash.

Links:

Associated Press article, published in The Washington Post (November 20, 2012): In U-turn, Ireland drops 3 doctors from probe into hospital death of woman denied abortion 

Reuters article (November 23, 2012): Ireland opens new probe into death of woman denied abortion

A balanced analysis of the politics of the inquiry, in The Irish Times (November 24, 2012): Time for political focus on abortion not procrastination 

Saturday, November 24, 2012

Declining abortions in the United States

Reporters, analysts, and advocates are all discussing newly released abortion data from the Centers for Decease Control and Prevention (CDC):
After years of holding steady, new Center for Disease Control data shows that the United States abortion rate has fallen to an all-time low. It dropped 5 percent between 2008 and 2009, the most recent years for which data is available, the largest decline in the past decade. (Source: The Washington Post
So, why did abortions go down so much between 2008 and 2009? Analysts and pundits have offered the following explanations:

Better contraception = fewer abortions. More women are using more effective methods of contraception. As a result, fewer pregnancies that do occur are unwanted, and therefore fewer pregnancies are terminated. A recent, much-discussed study indicated that, when women have greater access to more effective contraception-- when it was provided for free-- pregnancy and abortion rates went down.

From the CBS News report:
Some cite a government study released earlier this year suggesting that about 60 percent of teenage girls who have sex use the most effective kinds of contraception, including the pill and patch. That's up from the mid-1990s, when fewer than half were using the best kinds.
Experts also pointed to the growing use of IUDs. The IUD, or intrauterine device, is a T-shaped plastic sperm-killer that a doctor inserts into a woman's uterus. A Guttmacher Institute study earlier this year showed that IUD use among sexually active women on birth control rose from under 3 percent in 2002 to more than 8 percent in 2009.
IUDs essentially prevent "user error," said Rachel Jones, a Guttmacher researcher.
Ananat said another factor for the abortion decline may be the growing use of the morning-after pill, a form of emergency contraception that has been increasingly easier to get. It came onto the market in 1999 and in 2006 was approved for non-prescription sale to women 18 and older. In 2009 the age was lowered to 17.
If this is true, then we should expect to see continued declines in unwanted pregnancies and abortion rates in the future. More specifically, in surveys, we should see women identifying a lower percentage of pregnancies as being "unwanted." I'm not sure the survey evidence, at least, is there. My impression is that roughly half of all pregnancies in the United States have been reported as "unwanted" for a while, without big swings over time.

Also, what explains the size of the change from 2008 to 2009, relative to other years in which LARC use has been increasing steadily? Better contraception makes a lot of sense, but it does not appear to provide a complete explanation.

The Great Recession did it. A professor at Duke University, Elizabeth Ananat, was quoted in a few articles as suggesting that women "stick to the straight and narrow [during hard economic times] ... and they are more careful about birth control." Also from the CBS News report: 
You might think a bad economy would lead to more abortions by women who are struggling. However, John Santelli, a Columbia University professor of population and family health, said: "The economy seems to be having a fundamental effect on pregnancies, not abortions."
The reporter for the Washington Post cited a 2004 study that seems to contradict Professors Ananat and Santelli:
A 2004 paper in the journal Health Economics looked at the relationship between the economy and abortion rates at the state level. It found that, “As the economy moves into recession, a 1-point rise in the unemployment rate leads to about a 3 percent increase in abortion rates.” 
(Note that the linked study is actually from 1994, and is a working paper from the National Bureau of Economic Research.)

The idea that hard economic times influence women to make more of an effort to avoid unwanted pregnancies is intriguing, but I find it hard to swallow. If this were the case, wouldn't women living under difficult economic conditions in the United States always have fewer unwanted pregnancies than American women who are relatively well-off? I think the evidence, generally, indicates an opposite correlation between poverty, unwanted pregnancy, and abortion.

Furthermore, if this hypothesis is accurate, wouldn't the correlation hold over several economic cycles? This hypothesis, for example, would predict that the percentage of pregnancies that are "unwanted" would go up during good economic times and down during bad economic times. It doesn't seem to me that the economic performance of the United States from 1980 to now (up and down) matches up with trends in abortion rates during that period (slow and steady decline).

Restrictive abortion laws. This explanation is favored by pro-life activists and scholars like Michael J. New: Laws that make getting an abortion more difficult (waiting periods, defunding Planned Parenthood so it shutters abortion clinics, etc.) lower the number of abortions. 

Is there a correlation between ease of abortion access and the number of abortions? Maybe:
Mississippi had the lowest abortion rate, at 4 per 1,000 women of child-bearing age. The state also had only a couple of abortion providers, and has the nation's highest teen birth rate. New York was highest, with abortion rates roughly eight times higher than Mississippi's. New York is second only to California in number of abortion providers. (Source: CBS News)
Three comments on this. First, we don't know if women in Mississippi get fewer abortions, period, or fewer abortions in Mississippi (i.e., women might travel to get an abortion) or fewer abortions with abortion providers who report what they do (i.e., as in third-world countries, Mississippi women might self-abort or go to off-the-books abortion providers). So the number of reported abortions within a state does not tell the whole story of what is happening with pregnant women in that state. 

Second, this hypothesis does not explain why there is such a large and unexpected change between 2008 and 2009. Was there an increase in the implementation of abortion restrictions between 2008 and 2009 so pervasive that it caused such a precipitous drop? 

Third, not all states enacted greater abortion restrictions, so how can a national trend be explained by a phenomenon that only occurred in selected states? 

Americans are becoming more pro-life. Pro-life scholar Michael J. New suggested, in a post-election analysis, that Americans are becoming more and more pro-life in orientation. If this were the case, more women might decide to carry an unwanted pregnancy to term, thus lowering the number and rate of abortions. 

This assertion is not accurate. For example, surveys show that a high majority of Americans continue to believe that abortion should be legal in the early stages of pregnancy. Given that approximately 90% of abortions occur in the first 12 weeks of pregnancy-- in 2009 as in other years-- this cannot explain the change in abortion numbers from 2008 to 2009. 

One would also have to explain why 2009-- the year after Americans elected a pro-choice president and pro-choice Congress-- was such as banner year in the culture wars that abortions dropped severely as a result. 

So: What caused the numbers to change between 2008 and 2009? I don't think there is a single good answer-- yet. It may not be an explainable or useful phenomenon until we see what happened in 2010, and 2011, and so on-- was this an anomaly or a trend? While intriguing, we have to be careful to avoid over-reading the results of this single-year event. 

Links:

Article in The Washington Post (November 23, 2012): Surprise! The abortion rate just hit an all-time low

Articles on the CBS News site (November 21, 2012): U.S. abortion rates down 5 percent during Great Recession, biggest one-year decrease in a decade

Report from the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report (MMWR)(November 23, 2012): Abortion Surveillance-- United States, 2009

Study (mentioned in the CBS News report and The Washington Post article that indicated that LARC use has gone up between 2002 and 2009) published in Fertility and Sterility (July 13, 2012): Changes in use of long-acting contraceptive methods in the U.S., 2007-2009

Study from the National Bureau of Economic Research Working Paper Series (1994): State abortion rates: The impact of policies, providers, politics, demographics, and economic environment

Tuesday, November 20, 2012

A Thanksgiving break

I will be away from the computer over the Thanksgiving holiday, so please use the links on the right side of the page to get news and analysis on reprodutive politics for the next few days.

I will be back on Saturday, November 23 with new posts on the contraceptive mandate (some new court decisios have come in) and part two of my analysis of the changing model of abortion care in the United States.

Have a great Thanksgiving!

Monday, November 19, 2012

More arguments over denying Dr. Halappanavar an abortion in Ireland

The death of Dr. Savita Halappanavar in an Irish hospital is provoking a great deal of analysis and argument.

The editor in chief of RH Reality Check, Jodi Jacobson, wrote two insightful articles. Among her observations:
  1. The unwillingness of Irish politicians to create clear legal guidelines for abortion in life-threatening situations is unacceptable. In Dr. Halappanavar's case, however, the primary problem was that she was a patient in a Catholic hospital. Given the clear medical needs of Dr. Halappanavar, Catholic doctrine, and not Irish law, was the primary culprit in causing Dr. Halappanavar's death.
  2. This is not an isolated case: In other countries with restrictive abortion laws (and cultures), women have died as a result of being denied an abortion.
Could this happen in the United States? One would think, "no," given our relatively open laws and high public support for life-saving abortion care. But consider Jacobson's suggestion: This might have been less a problem of Irish law than a problem of a Catholic institution unwilling to violate Catholic doctrine. 

In fact, wrote Katha Pollitt in The Nation, there has been a case like this in the United States, but with better results, due to the good wisdom of a hospital administrator:
If you think it couldn’t happen in the United States, you haven’t been paying attention. After all, in 2010, Sister Margaret McBride, an administrator in a Catholic Hospital in Phoenix, was fired and excommunicated after she approved a first-trimester abortion for a woman with life-threatening pulmonary hypertension. What happens in Catholic hospitals when there’s no Sister Margaret willing to risk the bishops’ wrath? With conscience clauses expanding to cover not just individual doctors but whole hospitals, a pregnant woman may find her care is being dictated not by standard health protocols but by a religion she doesn’t even follow. Savita was a Hindu, after all. What about her conscience?
On the question of medical necessity, Dr. Jen Gunter, an OB/GYN who blogs, analyzed Dr. Halappanavar's case and concluded that "there is no medically acceptable scenario at 17 weeks where a woman is miscarrying AND is denied a termination. . . ." She also writes, "As Ms. Halappanavar died of an infection, one that would have been brewing for several days if not longer, the fact that a termination was delayed for any reason is malpractice." I think it is going to be very hard for the pro-life movement to continue suggesting that abortions are never "medically necessary." 

The pro-life media has been relatively quiet on this case, perhaps because there is almost nothing to be said that would be to the benefit of the pro-life movement. The author of an interesting article in LifeNews.com, Evelyn Fennelly, suggests that performing an abortion in Dr. Halappanavar's case would not have violated Catholic doctrine and would have been consistent with current Irish Medical Council guidelines. Therefore, Catholic doctrine and Irish abortion law are not to blame for the tragedy-- bad doctoring is.

I'm no expert on Catholic doctrine, but my understanding is that intentionally and directly killing the fetus as the means of addressing a medical complication is not permitted. The death of a fetus is only acceptable when it is the incidental effect of other forms of medical treatment.

So, for example, in the case of an ectopic pregnancy, removing the embryo from the fallopian tube is an abortion and impermissible. Removing the entire fallopian tube, however, which incidentally kills the embryo, is morally acceptable. Semantics? Angels dancing on the head of pin?

In the case of Dr. Halappanavar, if doctors would have hastened her miscarriage by performing a "D&E" (removing the contents of the uterus), wouldn't this have violated Catholic doctrine, as killing the fetus would have been the means by which Dr. Halappanavar's medical condition was resolved?

If readers know more about Catholic doctrine, I invite them to weigh in. Interestingly, one of the articles Ms. Fennelly cites to support her position that an abortion would have been morally justified in this situation (from Catholic.net) appears to undermine it, by making the direct-is-wrong, incidental-is-okay distinction. But another writer cited by Ms. Fennelly, writing at CatholicHerald.co.uk, seems to think that Catholic doctrine obviously would allow direct-yet-life-saving abortions.

So isn't this the point? It does not seem to me clear at all that there is an obvious consensus on what Catholic doctrine allows in cases like Dr. Halappanavar's.

Setting aside Catholic doctrine, the Medical Council guidelines quoted by Ms. Fennelly do seem to allow for abortion as a direct form of medical treatment (the relevant language is on page 21):
In current obstetrical practice, rare complications can arise where therapeutic intervention (including termination of a pregnancy) is required at a stage when, due to extreme immaturity of the baby, there may be little or no hope of the baby surviving. In these exceptional circumstances, it may be necessary to intervene to terminate the pregnancy to protect the life of the mother, while making every effort to preserve the life of the baby.
Furthermore, Ms. Fennelly quotes a few doctors who seem to say that a therapeutic abortion would have been justified in Dr. Halappanavar's case. Three considerations, however:
  1. Jodi Jacobson's point still stands: If Catholic doctrine does not permit abortion in Dr. Halappanavar's case, then Irish law and Medical Council guidelines are irrelevant in a Catholic hospital. 
  2. It is not clear that the Medical Council's guidelines are pegged to Irish law. In other words, doctors might think it appropriate to follow the Medical Council's guidelines but be unsure if, in following those guidelines, they are violating the criminal law. Therefore, they might still hesitate to do the right thing.
  3. The stated opinion of one or two doctors about what is or is not legally permitted does not indicate if Irish legal guidelines are clear enough for all reasonable doctors to come to the same conclusion.
Links:



Article in The Nation (November 14, 2012): When 'Pro-Life' Kills


Sunday, November 18, 2012

The UN's new "State of World Population" report

The United Nations Population Fund (UNFPA) recently released its 2012 "State of World Population" report. Consistent with decades of evidence, it reaffirms and emphasizes that family planning-- the ability of a family to control the number and timing of the children it has-- is fundamental to the economic vitality, development, and stability of a society.

Narrowly conceived, "family planning" is control over pregnancy-- i.e., access to and use of effective contraceptives. As the report notes, however, family planning is only one of a "broad range of services [that] must be provided to ensure sexual and reproductive health":

  • primary care as well as antenatal care, safe delivery and post-natal care;
  • prevention and appropriate treatment of infertility;
  • management of the consequences of unsafe abortion;
  • treatment of reproductive tract infections;
  • prevention, care and treatment of sexually transmitted infections and HIV/AIDS;
  • information, education and counseling on human sexuality and reproductive health;
  • prevention and surveillance of violence against women and care for survivors of violence; and
  • other actions to eliminate traditional harmful practices, such as female genital mutilation/cutting.

A key but tricky variable in enhancing a society's sexual and reproductive health is gender equality. It is difficult to have effective family planning, etc., without some movement toward gender equality within a given society, yet emerging gender equality is more likely to occur with improved family planning. It is a kind of chicken-and-egg problem: gender equality and sexual/reproductive health positively reinforce one another, but which comes first? 

The answer of the international family planning movement appears to be family planning, led by governments and international organizations. They have the resources to improve the quality of the "services" listed above; the material benefits those services provide then lead to cultural changes regarding gender. 

The debate in the United States operates on a slightly different plane. Perhaps because the U.S. is such a wealthy country and gender equality is in a relatively advanced stage, American public discourse focuses on the ideological implications on things like contraceptive mandates and its threat to political and religious freedoms. 

In poor, economically underdeveloped countries where gender inequality is high, issues of sexual and reproductive health are thrown into stark relief. Rush Limbaugh can advise Sandra Fluke to pay for her own contraceptives, thank you very much, but in many societies achieving the most basic benefits of family planning is impossible without the assistance and intervention of governments and international organizations.

In reality, the overall wealth and progressiveness of the United States can mask the real and serious family planning problems that exist for many American women and families. In addition, it can cause us to evaluate the family planning needs of developing countries in a wholly unrealistic way. 

If you want a quick, readable, and eye-opening basic education in family planning, I recommend this report. I also recommend Michelle Goldberg's insightful and enjoyable book on international family planning, The Means of Reproduction One of the many virtues of Goldberg's book is that, in addition to examining the experience of developing countries, she also examines the varying successes and challenges of several European countries. If more Americans read works like these, we might have different policies regarding family planning-- internationally and domestically.

Links:

United Nations Population Fund (UNFPA) report (November 14, 2012): The State of World Population 2012

At Amazon.com: The Means of Reproduction, by Michelle Goldberg

Article in The Guardian (November 14, 2012): Family planning must be development priority, says UNFPA report 

Article in the New York Daily News (November 14, 2012): Contraception could save world $5.7 billion, says UN report

Saturday, November 17, 2012

The exception of Scott DesJarlais

The news about Republican House member Scott DesJarlais just gets worse and worse. As it turns out, not only did he cheat on his wife with a patient and pressured his pregnant patient-girlfriend to have an abortion, he cheated on his wife six times, with patients and co-workers, prescribed drugs to one of his patient girlfriends, and successfully advocated for his own wife to have an abortion.

For a 'family values' and 'pro-life' conservative, that is quite a record.

The great irony in all this, of course, is that Representative DesJarlais was reelected, despite all of the things he's done, while Republican Senate and House candidates (Akin, Mourdock, Walsh, and Koster) lost their races not for what they did but what they said (inflammatory, insensitive, and just plain factually incorrect things about abortion and/or rape).

In this election season, words spoke louder than actions.

Is there anything to be learned from the utter hypocrisy of Representative DesJarlais? He could simply be a shameless liar, peddling family values while not much caring to live them himself.

Alternatively, considering abortion specifically, one could see here an example of the phenomenon of someone being pro-life except in their own self-justified situation:
During the trial, DesJarlais said the first time he urged his ex-wife to get an abortion, it was because she was on medication on which she wasn’t supposed to get pregnant. The second time, he said it was because “things were not going well between us and it was a mutual decision.” Both abortions occurred before the couple was married in 1995. (Source: The Washington Post)
Many pro-choice accounts describe this kind of "okay for me, but not for thee" behavior among people who are ostensibly pro-life. 

Now, the most likely explanation for Representative DesJarlais' behavior is that he is a narcissist and a sociopath. Still, the "it's okay for me in my situation" phenomenon recommends a type of strategy for the pro-choice movement, which is to get pro-lifers to put themselves in the shoes of a woman/family that might consider having an abortion. I think pro-choicers tend to win the argument when getting down to concrete and complicated real-life situations. For how horrible DesJarlais is as a person, his explanations for why his wife had two abortions are not all that different from those given by most women.

Links:

Article in the Washington Post (November 15, 2012): Rep. DesJarlais admitted to affairs with two patients during divorce trial  

Fact sheet created by the Guttmacher Institute (August 2011) that describes the most common reasons why women have abortions: Facts on Induced Abortion in the United States

Friday, November 16, 2012

A medically necessary abortion denied in Ireland

Limited access to abortion in Ireland is causing further scandal.

An Indian woman who lived in Ireland, Dr. Savita Halappanavar, died because doctors delayed addressing complications from her miscarriage at 17 weeks of pregnancy. Dr. Halappanavar was in the process of miscarrying. The process of miscarriage introduces the danger of serious infection, with the risk increasing over time. The indicated treatment, then, is to hasten the end of the pregnancy-- i.e., perform an abortion. Dr. Halappanavar's doctors did not, and she died of septicemia.

The first thought that came to mind after reading about this tragedy was that Dr. Halappanavar's sad and avoidable death is direct evidence against the assertion that an abortion is never "medically necessary" to save the life of a pregnant woman.

Given that the Dr. Halappanavar's unborn child, at 17 weeks, was pre-viable and 100% certain to die-- she was, after all, in the process of miscarrying-- why wouldn't doctors speed up the end of the pregnancy? Because the fetus was still alive, and to speed up the miscarriage would constitute an abortion.

There are three explanations for the doctors' behavior.

First, to intentionally kill the fetus, even though its death was inevitable, is against Catholic doctrine. It is not clear, however, that the doctors were motivated directly by their Catholicism-- or even if they are Catholic-- although one doctor did reportedly tell Dr. Halappanavar, "this is a Catholic country."

Second, the doctors did not believe that hastening the end of the pregnancy was medically indicated. This, according to a medical expert interviewed by The New York Times, is implausible:
During a miscarriage, the cervix is opened, exposing the woman to infection, and the longer the miscarriage persists, the greater the risk, said a prominent medical commentator here, Dr. Muiris Houston. While Dr. Halappanavar’s death was “on the rare end of the spectrum,” and the facts surrounding the case are not all known, Dr. Houston said, she “undoubtedly needed to go to theater,” meaning to surgery.
“If she had gone to theater earlier she might still have died, but perhaps not,” he said. “Medicine is now increasingly driven by guidelines, and the question must be, ‘Did the hospital have protocols in place when a woman presented with such a condition?’ 
Third, and more plausible, doctors were afraid of violating Irish criminal law.

As discussed in an earlier post, the problem in Ireland is not that it lacks a medical necessity exception to its general abortion ban. It has one, as ordered by the Irish Supreme Court in 1992 and the European Court of Human Rights in 2010. Instead, due to strong social and political pressure, the Irish government has never actually passed laws and regulations to implement the exception, so that Irish doctors and hospitals would have a clear sense of when and how they can legally terminate pregnancies. As a result, I speculate that hospitals do not develop protocols like those suggested by Dr. Houston, because there are no clear legal guidelines to which to peg hospital guidelines.

Furthermore, as a general rule, when the criminal law is unclear-- when one is not sure what is or is not legally prohibited-- it has a 'chilling effect' on behavior. People who might run afoul of a law go out of their way to avoid breaking it. In Ireland, doctors are 'chilled' from performing any abortions because they are worried about being criminally prosecuted and having their medical careers ruined.

Blame in this case, then, should fall on the doctors, who should ultimately have put the interests of Dr. Halappanaver first. But blame also rests with Irish politicians, who have left doctors, hospitals, and, most importantly, women, in legal limbo, with tragic results.

POSTSCRIPT 1: Dr. Halappanavar's death could serve as a catalyst for the Irish government to develop and implement legal guidelines for medically necessary abortions. The government is making noises in that direction, although they have delayed and failed before.

POSTSCRIPT 2: Because Dr. Halappanavar was Indian, the Indian public and government have expressed general outrage, and the Indian government has talked directly to the Irish government. India legalized abortion in limited circumstances in 1972 (life, rape, contraceptive failure, etc.). There has been very little public opposition to abortion in India, so there is likely to be little sympathy for Irish abortion bans rooted in Catholic culture and doctrine.

Links:

Article in The Guardian (November 15, 2012): Irish abortion: external investigator to head inquiry into woman's deathhttp://www.guardian.co.uk/world/2012/nov/15/external-investigator-irish-abortion-death

Article in The Guardian (November 13, 2012): Scandal in Ireland as woman dies in Galway 'after being denied abortion' 

Article in The New York Times (November 14, 2012): Hospital Death in Ireland Renews Fight Over Abortion

Article in The New York Times (November 16, 2012): From India, Pressure on Ireland Over Abortion Laws

Article in the New York Daily News (November 14, 2012): Ireland probes death of ill abortion-seeker from India

For a sense of Indian law and culture regarding abortion (and a fascinating discussion of the problem of sex-selective abortion in India), read The Means of Reproduction, by Michelle Goldberg

Thursday, November 15, 2012

Update on forced abortion case in Nevada

In Nevada, a county judge was fighting with the parents of a mentally-impaired adult woman over whether she should abort her pregnancy. I wrote an earlier post summarizing the case and the issues involved. 

The Associated Press now reports:
     A Washoe County district judge has decided against forcing a mentally impaired Nevada woman to have an abortion after all the parties involved reached a tentative agreement to help her through her high-risk pregnancy. 
     The 32-year-old woman's legal guardian told KRNV-TV on Wednesday that Judge Egan Walker had agreed that the woman wants to carry the pregnancy to term and that the evidence doesn't show it's medically necessary to abort the baby. 
     After taking the abortion option off the table, Walker said he plans to hold additional medical evidentiary hearings in the weeks ahead to determine the safest way to proceed.
It is hard to know what motivated the judge to rule this way, precisely. One thing I think is clear is that this was the risk-averse choice, politically and legally. To order an adult woman, of any mental state, to have an abortion, over the objection of her pro-life parents, would have set up the judge for months of legal and political controversy.

While I have doubts about whether a person with the capacity of a six-year old can truly "want" anything regarding pregnancy and childbirth, the pregnant woman at issue is saying that she wants to go through with the pregnancy, and obviously her parents want that, too. (On that point, note that a Reno news station reports that an investigator with the county public guardian's office doubts that the pregnant woman has an opinion about her pregnancy beyond repeating what seems to please others.)

It sounds like the pregnant woman and her unborn child are both at some medical risk from the pregnancy. Setting aside the legal obligation of the judge to act in the best interest of the pregnant woman, from a purely strategic standpoint, if the pregnancy becomes medically fraught at some point, the judge can say he is not to blame-- and the parents won't blame him, either: He reluctantly agreed to let the pregnancy go ahead, consistent with their wishes.

Links:

Article by the Associated Press, on Fox News.com (November 15, 2012): Nevada judge won't force impaired woman to have an abortion

News report (video and text) by KRNV Reno News 4 (November 5, 2012): Previously confidential document sheds new light on Reno abortion case

Article in LifeSiteNews.com (November 14, 2012): Forced abortion no longer an option in case of pregnant disabled woman, judge rules
Note two things about this particular article: 1) Only the pro-life news sites publish a photograph of the judge in the case. Why is that, do you think? 2) The lawyer for the parents now wants to change guardianship laws to limit the power of judges to intervene in  cases like these. Is that a good idea? 

Wednesday, November 14, 2012

Changing the model of abortion access in the United States: Part I

This post is the first of a two-part discussion on how abortion services are provided in the United States and how that model might be improved.

The right of abortion in the United States is a 'negative' right: A government's power to prevent a woman from obtaining an abortion is limited. Put another way, the right of abortion in the United States is a right of government non-interference.

It is not, however, a right to abortion: Governments are not required to help women obtain abortions, only stay out of the way. It falls on individual women, civic groups, and the market to determine how easy or difficult it is for women in practice to access abortion services.

Since Roe v. Wade in 1973, pro-choice activists, journalists, and scholars have noted that abortion access has been spotty, in particular for poor women and women who live in rural areas. A long-standing topic of discussion in the pro-choice community is how to improve access.

In recent years one much-discussed solution-- in the U.S., Europe, and third world countries-- has been the provision of "medical" abortions-- abortions that occur after taking one or more drugs that induce miscarriage. Planned Parenthood, for example, has been attempting to provide medical abortion drugs remotely to women in rural areas: The patient goes to a local medical center and talks to a medical professional remotely via a video conference call; the medical professional then pushes a button and a drawer with the appropriate abortion drugs opens for the patient.  The woman takes the drugs and the abortion occurs at home.

More recently, a group of doctors and researchers has been discussing moving the provision of "surgical" abortions (vacuum aspiration, etc.) out of abortion clinics and into private doctor's offices.

The United States is unusual in that most abortion services are provided through free-standing clinics rather than in hospitals or doctor's offices. The American clinic model evolved in the early 1970s for a couple of reasons.

First, in states that legalized abortion before Roe v. Wade, like New York, there was a tremendous demand for legal abortions and hospitals were seen as incapable and/or unwilling to meet the needs of women. Clinics were created as the best means to handle all of the requests for abortions.

Second, hospitals were not seen by pro-choice activists as good partners for providing abortion services. In the era before Roe, when some states adopted more liberal abortion laws-- but not abortion on demand-- many hospitals created panels or boards whose responsibility was to determine which requests for abortions were to be approved or denied. These boards were often frustrating obstacles for women wishing to obtain an abortion, as many were a) cautious about approving abortions that might run afoul of the law, b) cautious about approving too many abortions, and c) seen as insensitive to the needs and interests of pregnant women.

Third, in many areas, hospitals are going to be hostile to providing abortion services regardless of its legality. No change in the law, for example, is going to compel a Catholic hospital to provide abortions.

Advocates for access to safe, legal abortions, therefore, turned to a system of clinics that would a) ensure the provision of services in a given area, b) meet demand, c) make the process easier, and d) provide abortion services in a way that was woman-centered and sensitive to the needs of pregnant women.

The clinic model has had several unintended consequences.

First, clinics have been seen by pro-life groups as existing 'only' for abortion, and, especially when an abortion clinic is a for-profit corporation-- as some are-- they are seen as abortion 'mills,' existing solely to make a buck off of exploiting vulnerable women.

Second, clinics are magnets for pro-life activism. It is easier to protest or blockade a clinic than a general practice office or a hospital, because the focus can be on that one office and its primary service.

Third, even when a clinic provides many services for women-- as Planned Parenthood clinics do, for example-- all women who enter the clinic are seen as there for abortions-- especially as pro-life activists figure out on what days of the week abortions are provided.  Those women are then targeted by pro-life activists. This makes the experience of women seeking an abortion much more difficult and traumatic.

Fourth, doctors who perform abortion services at free-standing clinics are more easily identified and targeted for pro-life activism.


So that is the state of things. In part II on this topic, I'll discuss plans by doctors, scholars, and activists to lay the groundwork for an alternative to the clinic model.

Tuesday, November 13, 2012

Pro-life narratives

After reading American pro-life books, articles, blogs, and news sites for a while, one starts to notice recurring narratives: assertions, stories, themes, and ideas that are worked into whatever is being discussed. Taken as a whole, these narratives draw a picture of the world view of pro-life activist.

I started working on a list, and I thought I'd share it with you. Items are in no particular order. Take a look and let me know what you think. 

Pro-life narratives:
  1. Abortion causes breast cancer. This is an example of how abortion does not empower women, but harms them. 
  2. Many women who have had an abortion deeply regret it. Women are fooled into thinking that an abortion is what 'they' want, when in fact they will come to realize that they have been exploited. 
  3. There has been an increase in the abortion rate since, say, the 1950s, and that is due to the 'sexual revolution,' including the invention of birth control pills and the promotion of a culture of sexual permissiveness. 
  4. Many contraceptives are actually "abortifacients," in other words, methods that sometimes or often 'work' by killing a conceived child rather than preventing conception. Inter-uterine devices (IUDs) and birth control pills fall into this category. 
  5. There is not a population problem in the world. In fact, declining birth rates in developed countries, leading to populations demographically dominated by the elderly, are going to cause widespread problems. And in the third world, family planning organizations push 'population control' in coercive ways that undermine traditional cultures and families. Population control is a form of imperialism. 
  6. Abortion 'mills' are cold, profit-obsessed businesses. The drive for profits in the 'abortion industry' leads to all sorts of abuses of pregnant women. Some clinic employees are well meaning feminists, but they are themselves fooled by the rhetoric of the pro-choice movement and unaware of their own exploitation by the abortion industry. 
  7. Women are generally not empowered by the right of abortion. Instead, a pregnant woman who 'seeks' an abortion is often the misinformed victim of a man-- a boyfriend, husband, father, or abortion doctor. Her situation is made worse by the rapacious abortion industry that wishes to exploit her for profit. Legal regulations that promote 'informed consent' attempt to help women make their own choices about abortion or carrying a pregnancy to term. 
  8. When laws that make abortion illegal have exceptions, especially 'life' and 'health' exceptions, the exceptions become giant loopholes that swallow the general prohibition. 
  9. Fetuses feel pain and are tortured during the abortion process. 
  10. Abortion doctors as a whole are the worst doctors. No good, respectable doctor would work in the abortion 'industry,' especially because of the stigma. Therefore, dangerous, unscrupulous doctors become abortionists (for example doctors that have been cited for malpractice or had their licenses suspended). 
  11. Abortions are not as safe as advertised. There are many stories of vulnerable women being permanently maimed or killed by an incompetent abortionist. 
  12. The pro-choice movement is racist, rooted in a eugenicist past. Margaret Sanger, founder of Planned Parenthood, is often cited as someone who had ties to the eugenics movement of the early 20th century. The current pro-choice movement targets African-American women for abortions. Pro-lifers often compare their movement to the civil rights movement. 
  13. If people can see what goes on inside the womb, they would recognize that the unborn are human beings from the moment of conception. If people learn what truly happens during an abortion procedure, they will be morally repulsed by abortion and become pro-life. The pro-choice movement does its best to hide the humanity of the unborn and paper over the gruesome cruelty of abortion. 
  14. Increased access to and use of contraception does not lower abortion rates; it raises them. Because contraception has relatively high failure rates, people who have bought into the sexual revolution will have more sex (especially outside of stable married relationships) and therefore more unwanted pregnancies. This will in turn increase the number of abortions.
  15. Planned Parenthood and other pro-choice organizations promote sexual behavior among young people in order to get them 'hooked' on sex. They do this knowing that contraception will fail, thus creating more unintended pregnancies for the abortion industry to abort. They are like drug pushers-- once people are addicted to sex, they will come back for more. This produces a steady stream of abortion clients for the abortion industry. 
  16. Abortion promotes a 'culture of death.' The 'culture of death' is a culture that promotes desensitization to life and an elevation of utilitarian values of convenience for selfish individuals. In the culture of death, lives, including those of the unborn, infants, the old, and the infirm, are to be shoved aside if they prove inconvenient to others. Abortion, therefore, is not just harmful in itself, but will lead eventually to the acceptance and legality of assisted suicide, euthanasia, and infanticide. The ultimate stage of evolution in a culture of death is government promotion and enforcement of these things-- in other words, they will go from being 'choices' to 'mandates.' Pro-lifers often compare their work to that of the Allies fighting the Holocaust. 
Feel free to suggest some more! You are also welcome to send me items for a similar American pro-choice list. 

Monday, November 12, 2012

Contraception and sex education in the Philippines

Legal change on contraception and sex education may be arriving in the Philippines, which has a birthrate almost double that of the United States:
After years of discussion in the Philippine Congress, the House of Representatives finally decided in August to end debate on a reproductive health bill that would subsidize contraception and require sex education in the Philippines, a country with one of the highest birthrates in Asia. If it passes in the House, which returned to session on Monday, the bill will also need to be approved by the Senate. (Source: The New York Times)
The reasons for teaching women and men the basics of human reproduction and making contraception free and available are hard to dispute. First, women should have more control over the timing and spacing of pregnancies as a matter of personal autonomy and dignity. Second, a basic tenet of international development is that poor countries do better economically and developmentally when birthrates go down. Lower birthrates are also correlated with increased gender equity, as the girls in the family are less likely to get shorted on family resources when there are a smaller number of children. Third, the health of children and mothers improve. There are more resources within the family and from the healthcare system available to each child. And mothers, able to space their pregnancies and limit the overall number of children they have, live healthier lives and have lower maternal mortality rates.

While the American debate over the 'contraceptive mandate' revolves around religious conscience and the supposed subsidization of sexual license for women, in the Philippines the logic of government-funded contraception is hard to rebut: Women are largely too poor to pay for contraceptives themselves. If contraception is not provided for free, then it will not be used. As one woman stated:
“I don’t want to have any more babies,” she said, wiping tears from her eyes. “I would take the pills, but we don’t have money to buy those. We’ll try ‘control,’ ” she said, using the local term for abstinence. (Source: The New York Times)
The Philippines is a heavily Catholic country where the Church is still powerful, so there is going to be a fight over contraception and sex education. According to Church doctrine, having control over family planning beyond what 'the rhythm method' allows is not acceptable-- and even the rhythm method is difficult to do where sex education is not provided. That leaves abstinence and coitus interruptus as a couple's methods for preventing pregnancy-- assuming the husband goes along with it.

Furthermore, the Church in the Philippines is apparently under the mistaken impression that the country's high birth rate is a key to reducing poverty in the country:
“Our country’s positive birthrate and a population composed of mostly young people are the main players that fuel the economy,” said Jose Palma, the president of the Catholic Bishops’ Conference of the Philippines.
If the Philippines had a low birthrate and declining population, coupled with a wealth of natural resources-- like Russia, say-- then, yes, a higher birthrate might seem like a good thing. In the country as it actually is, this makes no sense. Contraception and sex education does.

Links:

Article in The New York Times (November 9, 2012): Manila Hospital, No Stranger to Stork, Awaits Reproductive Health Bill's Fate

Article in the National Catholic Reporter (November 11, 2012): Condoms pit bishops against health workers in Philippines

Guttmacher Institute "In Brief" fact sheet (pdf)(May 2010): Facts on Barriers to Contraceptive Use In the Philippines 

Sunday, November 11, 2012

Will the outcome of the 2012 election change much in reproductive politics?

I would say the answer is "no."

Most of the people I know who are interested in politics are still digesting and analyzing the 2012 election cycle, which, to many people's surprise (and, for some, despair), went Democratic/liberal on several fronts: President, Senate, state races, state initiatives on same-sex marriage and marijuana, and taxation in California. All of the Republican candidates who made controversial statements about abortion (Akin, Mourdock, Walsh, and Koster) lost their races. And so on.

Especially in the amplification chamber of the contemporary 24/7 media, it is normal to over-read election results. In this case, while I do think the election is a wake-up call to the Republican party-- or should be a wake-up call-- there is nothing that occurred in this election cycle that cannot be fixed-- fixed, that is, if the Republican party and conservatives don't under-read the election results.

Looking at reproductive politics specifically, people who are pro-choice would like the message of this election cycle to be the following: The pro-choice perspective is vindicated, and the 'war on women' is a loser.

In terms of the election cycle actually indicating this, and serving as an impetus for pro-lifers to alter their perspective and behavior, I think this is a big over-read.

Why?
  1. Consider the House of Representatives. They are reelected in such high rates-- and are, as a whole, rather ideologically extreme-- because many of them are in safe districts. Over 90% of House districts are either in a very liberal or conservative part of the country or drawn in a way to make them essentially non-competitive, both in the conservative and liberal directions. Representatives elected in these safe districts have no incentive to moderate their views on reproductive issues, because that is not what the voting bloc that elects them to office wants. This is why, when it comes to budgetary and fiscal cliff issues, the House Republican caucus is not going to get any message from the 2012 election cycle-- their very conservative constituencies don't want them to play nice. 
  2. For the same reason, one is likely to see just as many extreme pro-life legislative proposals at the state level as before, where state demographics combine with safe districting to create strong pro-life legislative bodies.
  3. Outside of evangelical Protestants, most religious voters went for President Obama. Catholic voters, for example, went 50-48% for President Obama, according to Fox News exit polls. That does not necessarily spell long-term trouble for the pro-life movement or candidates, however. The exit polls indicate that there was a major split among white and non-white religious voters. White religious voters went very heavily for Mitt Romney, while non-white religious voters went very heavily for President Obama. Non-white voters, for example Hispanic-Americans, are not necessarily voting for President Obama because they are pro-choice. Instead, the main message of this election cycle regarding minority voters could be that the Republican Party is perceived as racially intolerant. If the Republican Party fixes its image problem with minority voters and learns how to frame life issues better-- or at least put a lid on the Todd Akins of the party-- then pro-life-leaning religious minority voters might vote Republican in higher numbers. That being said, consider point #1: Do Republicans in safe districts with a relatively small percentage of minority voters have an incentive to change?
  4. Public opinion on reproductive issues has been remarkably steady for the last 40 years, a few exceptions notwithstanding. I am skeptical that Americans are shifting over widely to the full-scale pro-choice perspective. Instead, I think that, on specific issues and in specific election cycles, one party tends to do a better job of framing and selling than the other party. Democrats, in this election cycle, have done a good job selling the pro-choice perspective and masking the things about the full pro-choice perspective that Americans as a whole don't like (for example, legal abortion for any reason up to fetal viability). Republicans, on the other hand, have managed to emphasize all of the things that Americans as a whole don't like about the pro-life perspective-- apparent insensitivity to rape victims and apparent hostility to effective contraceptives, to name two. With better framing, the normal balance of things should be restored in later election cycles-- if Republicans have an incentive to do so. 
  5. The pro-life "elite"-- people and organizations who lobby, do election work, engage in activism, and occupy media space-- are going to modify the packaging of their views a bit, but their core beliefs are not going to be shaken at all by the 2012 election. 
In short, the 2012 election cycle has not altered the variables that would effect changes in elite beliefs or behavior, and there is little evidence that American public opinion has actually shifted.

One way in which the 2012 election cycle might affect the Republican Party is to lay bare rifts in the incentive structures between different types of Republican elected offices. Relatively local officials (people elected in districts, like House members or members of state legislatures), as noted, usually pander to their safe districts and can be extremely pro-life without recourse. Officials elected state-wide and nation-wide (governors, Senators, and Presidents)-- in other words, in 'districts' that cannot be drawn more safely-- have to win over more diverse and moderate blocs of voters. They will have an incentive to promote a more moderate pro-life vision. This will put them in conflict with their district-based compatriots, as well as the hard-core activists of the pro-life movement.