Category Archives: abortion

Access denied: A different kind of de facto segregation

blog for choice iconIt’s interesting that “Blog for Choice” day falls right after Martin Luther King Jr’s holiday. It has me thinking about intersections and parallels of civil rights issues. For those who’ve studied segregation, the terms “de facto” and “de jure” are familiar. They mean “in fact” and “by law” and they are used to describe the reality of segregation in the United States today. Segregation in schools, for example, has been illegal since Brown v. Board of Education in 1954 yet there is a great deal of de facto segregation in American schools.

I mention the terms because I think there is a similar phenomenon going on with access to abortion services. Abortion services, since Roe v. Wade in 1973 have been legal — with restrictions — across the United States, and states have not been allowed to ban abortion outright. (Note: some have come perilously close.) But, abortion services are not accessible in many places, and so there is a kind of de facto abortion ban over much of the country.

I think about this on “Blog for Choice” day, because the right to choose to have an abortion is not very real for the women living in the overwhelming majority of counties without abortion services, for whom the cost of abortion is not only the price of the procedure and any attendant health care costs, but also the price of the travel and the cost of days away from work.

Recently, the Guttmacher Institute published the results of its study, “Abortion in the United States: Incidence and Access to Services, 2005” (PDF) and they found that the rate at which women have abortions has continued to fall since 1990. In 2005 there were 19.4 abortions per 1000 women aged 15-44. For comparison, in 1990 there were 27.4 and in 1995 there were 22.5. In raw numbers, this means that 1,206,200 abortions were performed in 2005, about 400,000 fewer than in 1990. (Table 1, p. 9)

This all sounds like good news, and it may be good news. Reducing the number of abortions as a result of reducing the number of unintended and unwanted pregnancies is certainly a good thing. But the report also indicates that the number of abortion providers continues to drop (though that drop has slowed). Taking the whole country into account, 87% of counties have no abortion providers, and what part of the country you live in matters a lot. If you’re in the northeast, where I am, you’re the luckiest. Only a bit more than half of counties have no providers (and we’re pretty densely populated, and counties are packed together, and transit options are not so terrible). If you live in the midwest, though, are among the least likely to have access. Ninety four percent of counties in the midwest have no abortion providers. Obviously that puts an enormous research and travel burden on the woman seeking an abortion. In the south 91% of counties have no provider and in the west 78% have none. (Table 3, p. 11)

Could this be among the reasons that, as reported in the New York Times this past December, the number of births per 1,000 women rose in nearly all age groups last year, ending a decline in teen births that had been going on since the early 1990s and rising above the replacement rate in general for the first time since 1971. As with most social phenomena, this one no doubt has many causes, and actually immigration (immigrant women tend to have more children, for an intersecting number of reasons) is no doubt a bigger cause. But I wonder whether we have reached a level of no-access that more unintended pregnancies are resulting in births than used to.

Amanda Marcotte made some interesting speculations about what else this could mean last week in her post “Could it be easier to force childbirth when abortion is legal“. She wonders whether, because there is no outrage over a legal prohibition in many of those areas, there is less organizing around issues of access. Certainly there are women’s health organizations and abortion access organizations that are trying hard to increase access for women who live in regions without their own providers, but it might be a good deal harder for those activists to drum up support (especially volunteers and money) because there is no legal issue for people to fight.

The theme for this year’s Blog for Choice is “why it is important to vote pro-choice.” I would extend that to “why it is important to vote, talk, agitate and live pro-choice.” Voting goes an important distance toward protecting legal rights. We certainly cannot afford another Supreme Court Justice who is opposed to abortion or weak on privacy rights, for example. But until the rights that are protected by law are made real by ensuring access (geographic and financial) to abortion services, they are pretty unevenly distributed, available to women with privilege to travel if needed, or with the good fortune to live in a place with providers.

The law is only the foundation for our rights. Real live access — to abortion, to education, to opportunity or to anything else — depends on much more than the law. We all need to walk the walk so that it is safe for people to provide the services that the law says we have a right to use.

And that is not a matter of voting. That is a matter of speaking up in the eleven months of the year that there are no elections. It is a matter of declaring that we will not tolerate the infringement of anybody’s rights, regardless of where they live or how much money they have.

It is a matter of finally understanding that class and race and gender and geography all intersect in ways that put some US residents at much greater disadvantage than others, and it is about all of us understanding that such inequality is wrong.

And that goes beyond voting. That means we need to act.

Now.Loudly.

Without rest, until we all are free.

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This post is also published on SexInThePublicSquare.org – it’s like this blog, only with a whole lot more going on!

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Verizon to customers: NARAL 2 CNTRVRSL 4 U

The New York Times reports this morning that Verizon has rejected a proposal by Naral Pro-Choice America to use its network for sending text messages to people who sign up for them. Other cell phone networks have accepted the proposal which allows subscribers to sign up to receive text message updates from NARAL.

According to a communication with Verizon that NARAL gave to the times, the company’s policy is to reject proposals from groups that “promote an agenda or distribute content that, in its [Verizon’s] discretion, may be seen as controversial or unsavory to any of our users.”

There are at least three very troubling pieces of this rationale.One is that a communications company should be allowed to censor the legal content that is transmitted over its network in the first place. This would seem to erode the “common carrier” rule and tremendously limit free speech. Cell phones now are as important to political activity, community organizing, and ordinary everyday life as landlines and the US mail have been in the past and we would never accept such a limitation from either of them. Can you imagine if Verizon’s landline division made a ruling saying that NARAL could not phone anybody who uses a Verizon phone service? Why should text messages be any different? (Sunburnt Kamal, I think we really need your “on the Internet there are no sidewalks” essay! Can you include cell networks too?)

Beyond that, even if Verizon’s policy is legal, applying it in this way is illogical. The messages sent by NARAL would only be sent to people who requested them by texting a 5 digit code specfically subscribing them to the updates. These are people who, by definition, would not find the messages controversial or “unsavory.”
Last, until I’ve had more coffee and thought a bit more about this, it would seem that just about anything could be “seen as controversial” by some user or anyother and Verizon’s policy is written to reject any program that might be seen as controversial to any of their users. To really be consistent then, they should accept no text message advocacy programs at all. Presidential candidates use these programs and have not, apparently been rejected by Verizon and yet presidential politics is by its nature controversial. Even the Repblican National Committee has such a program.

Jeffrey Nelson is Verizon’s media contact for Public Policy and Regulatory Affairs and he’s is quoted in the Times article indicating that Verizon might be considering a change in its policy:

“As text messaging and multimedia services become more and more mainstream,” he said, “we are continuing to review our content standards.” The review will be made, he said, “with an eye toward making more information available across ideological and political views.”

Want to let him know that you don’t think that a communications company ought to be restricting the kinds of information its customers can access? His phone and email info are on this Verizon Wireless Media Contacts page but in case you don’t want to go look him up yourself, his email is jeffrey.nelson (at) verizonwireless (dot) com and his phone number is 908-559-7519.

Note: This post is also published on our community-building web site, SexInThePublicSquare.org. Drop by and check it out!

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“Do it ourselves” Abortion Reduction Policy

Atul Gawande had a very clear, concise, mostly very smart and only partially problematic op-ed in yesterday’s New York Times about how to reduce the number of abortions in the US (TimesSelect registration required). He started out by dispelling some of the myths we have about who has abortions and why. For example, on the upsetting side, roughly half of pregnancies are unintended, and four in 10 unintended pregnancies end in abortion. On the optimistic side, teens are getting the message about contraception:

“Pregnancies at age 15 to 17 are down 35 percent since 1995, according to federal data; one-fourth of the drop is from delaying sex, and three-fourths is from increased use of contraceptives. Today, just 7 percent of abortions occur in minors.”

and

“Forty-five percent of abortions occur in adults ages 18 to 24; 48 percent occur after age 25. Most are in women who have already had a child. The kids are all right. We are the issue.”

Consistent and correct use of contraception appears to be the biggest problem:

“92 percent of abortions occur in women who said they used birth control. Six in 10 used contraception the month they got pregnant. The others reported that they had used birth control previously but, for one reason or another, not that month. (Many, for example, say they didn’t expect to have sex.)

Gawande then asserts that the “trouble appears to be blindness to how easy it is to get pregnant and what it takes to make birth control really work.” I would disagree: the trouble is not blindness to how easy it is to get pregnant. It is wishful thinking of the “it won’t happen to me” variety, and a difficulty accepting one’s own likelihood of having sex. It is also fear of the stigma attached to being willing to have sex without a committed relationship. Another problem is the difficulty women have with requiring their male partners to use condoms, and the difficulty some men have using them. Then there is the forgetting of the many ways to have sex that can’t result in pregnancy in the first place! Lets get more creative with our hands and our mouths and the rest of our bodies! Lets buy sex toys. (Wow, did I actually just recommend a consumer-based solution to a problem? Yikes!)

Gawande is right, though, that the number of unwanted pregnancies in the United States — and thus the number of abortions — could be dramatically reduced if we were a more sexually honest and open society. If we — men and women — were honest with ourselves and with each other about the situations in which we are willing to have sex, and about the degree to which we do not want to be responsible for a child, I think we would have an easier time consistently and correctly using contraception. Imagine….

…if we were more honest with ourselves about how the contraception we do use makes us feel, and more willing to talk to each other about our contraceptive methods, we would be better able to find the methods that would work best for us.

…if we were more willing to admit that we simply won’t stop having sex just because we aren’t ready, able or interested in raising children.

…if we could acknowledge sexual pleasure as a basic human right and not a privilege for the middle and upper classes.

Then perhaps we would — as a society — realize our moral imperative to improve access to contraception and safer sex education and supplies for those who need them.

Gawande believes that politics precludes government from helping to create that society and that ultimately we need a “do it yourself” approach. I’m not willing to let government or the politicians who control it off the hook quite so quickly, but I agree that there is much we can change about this society if we “do it ourselves.” And among the things we can change through grassroots community-based activism is, in fact, the government.

Among the things the government could do better, or do at all:

  • Offer incentives for research and development of long-lasting contraceptives that have fewer risks and side effects.
  • Provide contraceptives free, and without any burdensome monitoring, to women and men who want them.
  • Require that sex education programs offer clear, accurate information about the effectiveness of contraceptives and about their correct use.
  • Support programs that help parents learn how to talk to their kids about sex.

But Gawande is right that, absent some sea change in what we as individuals and communities demand of our government, these things are not going to happen quickly. We need to take up the lead of organizations like Planned Parenthood which already offer workshops on how to talk about sex, and start branching out in our communities and among our friends to “do it ourselves.” Imagine if we each had at least one conversation a week with someone about the right to sexual pleasure, or he right to sex without fear of pregnancy or disease.

Try it out. Start with yourself and make a list that honestly accounts for the ways you like to have sex, the people you like to have it with, and your own risks of pregnancy. (Yes, this applies to men too. Women don’t get pregnant on their own!) Any unpleasant surprises on your list? If so, acknowledge them and make a plan to reduce your risks. Then, be courageous: share your list with someone. And share this post. Next week try a conversation with someone else. Ask someone how they feel about the right to have sex because it feels good. Discuss whether we should take a punitive attitude toward sex for pleasure.

And stay tuned here. This blog has been part of my attempt to create more open space for reasonable and productive conversations about sex. But you’ve inspired me to do more, and I’ve decided to expand the public square:

Coming soon to a computer near you: SexInThePublicSquare.org!

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The New Anti-Abortion Law — Bad News For Women’s Health and Doctor’s Ethics

In an earlier post I discussed the Supreme Court’s analysis of the so-called Partial Birth Abortion Act, concluding that the Court’s decision to uphold the Act was intellectually dishonest and inequitable. This post is about the purposes of the Act, as described by Congress, and the Act’s probable consequences for the practice of medicine and the health of women.

Understanding the Act requires some minimal understanding about abortion procedures. (This explanation is more or less lifted directly from my earlier post on the Carhart decision.) The Act targets the procedure used in essentially all abortions taking place after first trimester and before viability. (Viability is the point in pregnancy when, given the current state of medicine, a premature infant has a fifty percent chance of survival. At present, viability occurs around the 23rd week.) The procedure is referred to as “dilation and evacuation” or “D&E”. A D&E is performed by first dilating the patient’s cervix for a period from a few hours to a few days. The physician then removes the fetus, placenta and related material from the uterus through the cervix, and out of the body. Often, the fetus must be removed from the uterus in pieces. Sometimes, though, the fetus can be removed from the cervix intact (called an “intact D&E” by the Court). Because the fetus is not destroyed during the intact D&E process, the physician must ‘kill’ (the word used in the Act), the non-viable fetus. The loaded term “partial-birth abortion” is thus an obvious mischaracterization of this procedure. The nonviable fetus cannot be “born,” either partially (whatever that might mean), or otherwise.

The Act makes it a crime for a physician to knowingly perform an abortion using the following procedure:

1. The physician removes the intact fetus from the woman’s body to a particular point:

In a head-first position, to the point where the entire head is outside the woman’s body;

in a breech (foot-first) position, where any portion of the fetus past the navel is outside the woman’s body; and,

2. The physician then takes an overt act that kills the fetus.

(This is my summary of the Act. The full Act can be found here.)

The Act provides no exception to preserve the health of the woman undergoing the procedure.

The Act won’t stop a single abortion from taking place. Justice Ginsburg noted during oral argument, “[W]e’re not talking about whether any fetus will be preserved by this legislation… It doesn’t preserve any fetus because you just [terminate fetal life] inside the womb instead of outside.” The US attorney defending the Act agreed with Justice Ginsburg. In other words, in order to be compliant with the Act, a physician must terminate the fetus’ life prior to delivery, even in cases where the physician believes it is safer for the mother to do otherwise.

Whether an intact D&E’ is considered medically necessary depends on a number of factors, including the age and health of the woman, especially if the woman has an underlying medical problem; the condition of the fetus; and the sophistication of the medical facilities available. Under the Act, a doctor is no longer allowed to make this decision. With the Act, Congress has overruled the the physician’s medical judgment, as well as her ethical obligation to provide the best possible medical care. Is appears the Hippocratic Oath has joined the Geneva Conventions as “quaint” obligations our government has decided can be ignored.

The trade-off Congress made in the Act and the Supreme Court appears hardly rational: Physicians must choose between following the law, on one hand, or providing the best possible care to preserve the health of the mother. What exactly has Congress achieved in return? Nothing, it seems. Abortions will not be reduced. But the Act will make abortions more dangerous and more difficult to obtain. Some physicians will likely withdraw from the practice of performing intact D&E’s rather than risk criminal charges. The health of some women will be harmed as a result, because they will not be able to obtain the best possible care. And, perhaps most troubling, those seeking to limit reproductive rights have established that their political agenda can override concerns about privacy, personal autonomy, and women’s health.

Tom Joaquin

TheFreeLance Continue reading

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The Lie at the Heart of Gonzales v. Carhart

(My source for the quotations and information is Justice Kennedy’s majority decision and Justice Ginsburg’s dissent in Gonzales v. Carhart. These documents can be found here.)

Tom Joaquin
The Free Lance

By now, most people are aware of the summary holding in Gonzales v. Carhart: for the first time since Roe v. Wade, the Supreme Court left standing a law proscribing a particular abortion procedure without an exception to safeguard a woman’s health. Standing alone, this is a terrible result, but understanding the rationale of the decision was made is more frightening still.

In upholding the “Partial-Birth Abortion Act” (referred to here as just “the Act”), the Supreme Court’s new majority drew upon old lies about the emotional fragility of women, and the need to protect them from their own decisions. The Court used this old myth to bypass forty years of precedent safeguarding reproductive rights. The Court allowed Congress to place political values over best medical practice, and to put women’s lives at risk. The Court’s willingness to put aside legal precedent and scientific fact in this case may encourage more attacks on constitutional rights in the future.

Understanding Carhart requires some minimal understanding about abortion procedures. The Act targets the procedure used in essentially all abortions taking place after first trimester and before viability. (Viability is the point in pregnancy when, given the current state of medicine, a premature infant has a fifty percent chance of survival. At present, viability occurs around the 23rd week.) The procedure is referred to as “dilation and evacuation” or “D&E”. A D&E is performed by first dilating the patient’s cervix for a period from a few hours to a few days. The physician then removes the fetus, placenta and related material from the uterus through the cervix, and out of the body. Often, the fetus must be removed from the uterus in pieces. Sometimes, though, the fetus can be removed from the cervix intact (called an “intact D&E” by the Court). Because the fetus is not destroyed during the intact D&E process, the physician must ‘kill’ (the Court’s word), the non-viable fetus. The loaded term “partial-birth abortion” is thus an obvious mischaracterization of this procedure. The nonviable fetus cannot be “born,” either partially (whatever that might mean), or otherwise.

The Court notes that many physicians testify that trying to remove the fetus intact is sometimes medically necessary and always preferred medical practice. Removing fetal material in pieces take longer, thus extending the time the patient must stay under anesthesia. Many small pieces of material raise the risk of uterine damage, as well as the possibility of post-surgical complications resulting from failure to remove all of the material.

The line drawn separating intact D&E’s from all others appears to originate with Congress and the Court. In any case, Congress finds the “intact D&E” procedure distasteful. Well, perhaps more than just distasteful. According to the Court, Congress says the intact D&E is a “gruesome and inhumane procedure that is never medically necessary and should be prohibited”.

Congress, however, cannot constitutionally pass a law with the primary goal of prohibiting an abortion procedure. As Justice Ginsberg points out in her excellent dissent, Congress must consider all that troublesome precedent about a woman’s right to choose, and the idea that a woman’s decision to bear a child is central to her “‘dignity and autonomy,’ her ‘personhood,’ ‘destiny,’ and her ‘conception of her place in society’”. According to over forty years of developed precedent, a law cannot constitutionally place “a substantial obstacle in the path of a woman seeking an abortion before the fetus attains viability.”

But there is a loophole: Congress can pass a law that makes it more “difficult and expensive to obtain an abortion,” as long the law’s primary purpose is not specifically to interfere with the right to have an abortion. For the Act to pass constitutional muster, Congress needs a convenient fiction about the Act’s purpose. Fortunately for Congress, the new majority in the Court is happy to oblige.

According to the Court, the Act is intended to protect “mothers,” who are emotionally sensitive and liable to regret their decision to have an abortion. There are no “women” in the Carhart decision. There are only ‘mothers, a group that includes women whose pregnancies were terminated.

The Court begins by adopting nostrums from Congress: “Respect for human life finds an ultimate expression in the bond of love a mother has for her child.” Because of the importance of this “bond of love,” the Court decides that, although there is “no reliable data to measure the phenomenon, it seems unexceptional to conclude some women come to regret their choice to abort the infant life they once created and sustained. Severe depression and loss of self-esteem can follow.”

The Court then supposes, again without any factual support, that “some doctors may prefer not to disclose precise details of the means that will be used” for performing the abortion. The physician’s postulated failure to be frank about the procedure can compound already existing emotional difficulties: “It is self-evident that a mother who comes to regret her choice to abort must struggle with grief more anguished and sorrow more profound when she learns, only after the event, what she once did not know: that she allowed a doctor to pierce the skull and vacuum the fast-developing brain of her unborn child, a child assuming human form.”

This overheated language distracts from real problems with the Court’s argument. First, the story about the emotional damage that can result from having had an abortion just isn’t true. In her dissent, Justice Ginsburg provides a long list of studies from respected sources debunking the “idea that having an abortion is any more dangerous to a woman’s long-term mental health than delivering and parenting a child that she did not intend to have.”

Secondly, if a woman does come to regret her decision to terminate her pregnancy, is it likely she would prefer to learn her abortion was performed by removing the fetus from her uterus in pieces, or that it was removed intact, the safest possible method

Finally, wouldn’t it make more sense simply to require physicians to inform women of the abortion method to be used along with other information currently required by law to be provided the patient?

The Court doesn’t discuss these issues because the truth is less important than upholding the Act and setting the stage for future cases. The old argument about protecting the life of the unborn doesn’t need to be raised anymore to attack abortion. The new argument that abortion should be done away with is based upon the offensive lie: Women are emotionally fragile, and might decide on abortion, even though abortion separates them from participating in the “ultimate expression” of “respect for human life.” They may later come to regret that decision, leading to emotional illness. Learning about how the abortion was carried out will further damage these women emotionally. Therefore the practice must be eradicated.

This argument is sufficient to prohibit one method of performing abortions. Is there any reason why it won’t work to ban others?

 

This is the first of two posts discussing the Carhart case. In the next post, I’ll discuss the mechanics of the Act itself, how it allows Congressional opinion to overrule science, and the danger this poses to the health of women.

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The Supreme Court thinks Congress knows more about women’s health than does the American College of Obstetricians and Gynecologists

And: Why I continue to be grateful for the lessons I learn from my mother

My mother, from whom I learned so much about social justice, freedom of thought, women’s potential, and the need to stand up for those who can’t stand up for themselves, sent the following news release from the American College of Obstetricians and Gynecologists. (The addition of bold and italic styles are mine, just for emphasis.)

ACOG NEWS RELEASE

For Release: April 18, 2007
Contact: ACOG Office of Communications
  (202) 484-3321
  communications@acog.org

ACOG Statement on the US Supreme Court Decision Upholding the
Partial-Birth Abortion Ban Act of 2003

Washington, DCDespite the fact that the safety advantages of intact dilatation and evacuation (intact D&E) procedures are widely recognized—in medical texts, peer-reviewed studies, clinical practice, and in mainstream, medical care in the United States—the US Supreme Court today upheld the Partial-Birth Abortion Ban Act of 2003.

According to the American College of Obstetricians and Gynecologists’ (ACOG) amicus brief opposing the Ban, the Act will chill doctors from providing a wide range of procedures used to perform induced abortions or to treat cases of miscarriage and will gravely endanger the health of women in this country.

“Today’s decision to uphold the Partial-Birth Abortion Ban Act of 2003 is shameful and incomprehensible to those of us who have dedicated our lives to caring for women,” said Douglas W. Laube, MD, MEd, ACOG president. “It leaves no doubt that women’s health in America is perceived as being of little consequence.

“We have seen a steady erosion of women’s reproductive rights in this country. The Supreme Court’s action today, though stunning, in many ways isn’t surprising given the current culture in which scientific knowledge frequently takes a back seat to subjective opinion,” he added.

This decision discounts and disregards the medical consensus that intact D&E is safest and offers significant benefits for women suffering from certain conditions that make the potential complications of non-intact D&E especially dangerous. Moreover, it diminishes the doctor-patient relationship by preventing physicians from using their clinical experience and judgment.

“On behalf of the 51,000 ACOG members who strive to provide the very best possible medical care to the women we serve, I can only hope that in the future, science will again be at the core of decision-making that affects the life and well-being of all of us,” said Dr. Laube.

# # #

The American College of Obstetricians and Gynecologists is the national medical organization representing over 51,000 members who provide health care for women.

~~~~~~

She sent this as part of a comment on a different post, and I asked her if I could reproduce some of that here. She agreed.

What I was most touched by in her comment was that she seemed to be identifying a concern that goes beyond this monumental decision and points to a problem with so much of our approach to social policy as a nation: we seem to be unable, as a country, to act compassionately. She fears that the rhetoric on both sides of this issue miss, sometimes, the concerns of people like her who feel pain at the thought of the loss of an aborted baby and who also feel pain at the fate of unwanted children who are born into situations over which they have no control.

Her comment points to problems that our abortion debates in the US so rarely touch on with the depth they require: that our economic system and political system are not oriented toward being supportive of working families. Our lack of universal health care, of living wages, and of inclusive, family-friendly workplace policies for example, put pregnant women under strains that they should not have to face and cause families to suffer financial hardship and the interpersonal stresses that come from that. Politicized health care policy keeps effective contraception out of the hands of people who need it most resulting in more unwanted pregnancies all while restricting women’s ability to deal with them.

We in the US have become well-socialized into a system that pits against each other groups that actually share many common interests, and does so in a way that a privileged few benefit while the rest of us fight each other. That so many feel so threatened makes it harder for us to feel compassion for one another. And without that compassion it is hard to imagine policies that can ease the conflicts. It is a truly dangerous cycle.

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More on the Awfulness that is Gonzalez v. Carhart, the first successful nationwide banning of an abortion procedure

As if the outcome of the decision weren’t bad enough, there are aspects of the majority opinion that are especially offensive. For example:

The Act also recognizes that respect for human life finds an ultimate expression in a mother’s love for her child. Whether to have an abortion requires a difficult and painful moral decision, Casey, 505 U. S., at 852-853, which some women come to regret. In a decision so fraught with emotional consequence, some doctors may prefer not to disclose precise details of the abortion procedure to be used. It is, however, precisely this lack of information that is of legitimate concern to the State. Id., at 873. The State’s interest in respect for life is advanced by the dialogue that better informs the political and legal systems, the medical profession, expectant mothers, and society as a whole of the consequences that follow from a decision to elect a late-term abortion. The objection that the Act accomplishes little because the standard D&E is in some respects as brutal, if not more, than intact D&E, is unpersuasive. It was reasonable for Congress to think that partial-birth abortion, more than standard D&E, undermines the public’s perception of the doctor’s appropriate role during delivery, and perverts the birth process. Pp. 26-30.

Where to begin!

  • “The Act also recognizes that respect for human life finds an ultimate expression in a mother’s love for her child.” Oh really? Not in our love for one another? Not in our efforts to end human rights abuses or to demand social justice or equality? Specifically, the ultimate expression of respect for human life is the the love of mothers for their kids? This is a philosophy of human love and respect for life that is much more useful for controlling women’s sexuality than for protecting the dignity of full human life.
  • “In a decision so fraught with emotional consequence, some doctors may prefer not to disclose precise details of the abortion procedure to be used. It is, however, precisely this lack of information that is of legitimate concern to the State.” Congress thinks that it is protecting women from doctors who won’t tell them the whole truth about abortion procedures and thus might lead them into decision that they will regret later? Oh come on.
    • First of all, it’s true that women sometimes regret their decisions. But women also regret their choices to give birth. Lots of difficult life decisions and life circumstances lead to regrets. Therapy and good friends and appropriate care and a society that offers compassion instead of stigma can all help. And when it comes down to it, it seems less damaging to cope with the regret of having an abortion than the regret of having a child!
    • Second, it’s hard to imagine that there are lots of doctors out there lying to women so that they can do abortion procedures that the women might not like. A woman seeking a late-term abortion is not in a happy place, to be sure. Her doctors are likely trying to make her situation as tolerable as it can be. Doctors are not infallible by any means, but they are generally well intentioned.
    • Third, it is hard to credit Congress, at this point, with being the “full disclosure, complete information” people! Please! Especially when dealing with issues of life and death. Issues like, oh, say, war. Sure we’ll send your kids off to war without bothering to know or share complete information. But don’t let those doctors try to make a woman’s difficult situation any easier to handle.
  • “It was reasonable for Congress to think that partial-birth abortion, more than standard D&E, undermines the public’s perception of the doctor’s appropriate role during delivery, and perverts the birth process.” Congress thinks that it is acceptable to determine what procedures doctors can perform based not on the medical integrity of the procedure but based instead on the public’s perception of the procedure? Congress is afraid that if doctors perform abortions the public will lose faith in those doctor’ abilities to deliver babies?

Actually, there is a telling bit of text there: “undermines the public’s perception of the doctor’s appropriate role during delivery.” Are they afraid we’ll go back to a system of midwifry where women helped each other through birth and where the beginnings and endings of life were not quite so medicalized as they are today? Where experts and organizations had less control over our lives, and especially over women’s lives?And then there is the sentence that Feminist Law Profs call the scariest sentence in the decision:

The Act’s failure to allow the banned procedure’s use where ” ‘necessary, in appropriate medical judgment, for preservation of the [mother’s] health,’ ” Ayotte v. Planned Parenthood of Northern New Eng., 546 U. S. 320, 327-328, does not have the effect of imposing an unconstitutional burden on the abortion right.

The rationale? Because if the mother’s health was truly in jeopardy the doctor could inject the fetus with something that would kill it and then do a D&E instead of an “intact D&E” and the procedure would be legal because the extraction would be of a dead fetus and not a living fetus. This is about the most twisted logic I can imagine: It’s all about where you kill the fetus? It’s all about the public image of the procedure? (A public image that was very skillfully manipulated by anti-choice activists who framed the issue as “partial birth abortion,” in the first place.)

No, it isn’t really all about those things. It’s also really about beginning to chip away at access to abortion. Period. It’s really about forcing women to continue pregnancies that they do not want to or cannot continue and it is about continuing to exert as much control as possible over women’s lives.

Register your outrage!

Act out! Speak up! Plan rallies. Write about it. Leave comments here and on the other feminist and pro-choice blogs that are mobilizing. Support organizations like Planned Parenthood and NARAL and legislation like the Freedom of Choice Act. Support research by organizations like the Guttmacher Institute and SIECUS which both offer sane, rational, well-grounded information about sexuality and reproductive health.

It won’t stop here.

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