Category Archives: reproductive freedom

Prevention bill(s)* still stuck in committee while Democrats increase Abstinence-Only Funds

File this under “with friends like these…”

What has happened to the Prevention First Act (H.R. 819/S. 21)? Why are these bills stuck in committee while the Democrats are INCREASING funding for abstinence-only education? Don’t they at least have an obligation to hold the line on such misappropriate of funds? We’re talking about the spending of 141 million dollars on programs that we know don’t work and that actually put our communities at risk. And we’re talking about the party in control, the one that is supposed to be friendly to smart sexual health policy, granting this increase in spending and as a result teaching kids that abstinence-until-marriage is the only legitimate approach to sexuality and that condoms don’t work well.

James Wagoner at RH Reality Check, expresses his outrage about this far more articulately than I could express mine. He writes:

I am constantly told that it’s not “politic” to call out our friends on an issue like sex education. There are bigger fish to fry. I’m not buying that anymore. Not when ten thousand young people get an STD, two thousand become pregnant and fifty-five contract HIV every single day in this country. Not when poll after poll shows this issue to be a political winner, not a loser, for Democrats. Not after Democrats exploited this issue in opposition and now, with control of Congress, act like it’s an insignificant chit to be bartered away at the whim of a recalcitrant committee Chairman.

It is now time to call this what it truly is. A stunning disgrace.

A stunning disgrace, indeed. And this is not a new story. We wrote about this here back when the Dems in the House of Representatives voted to approve the increase when they passed the Labor/Health and Human Services appropriations bill. But its in the news again because the bill has just come out of the Democrat-controlled conference committee and the increase is intact. And the increase is outrageous. SIECUS reports that the Senates version of the bill would have reduced funding for abstinence-only programs. Why didn’t they hold that position in the conference committee?

We’re nearing election day and it is important to remember that the Democrats are not so clearly our friends. And they ought not be allowed to continue to get away with hurting us just because the Republicans might hurt us worse.

You know, it really starts to feel like an abusive relationship, doesn’t it? You know, the kind where you are being beaten but feel trapped because if you leave you’ll be worse off?

We need shelters for the battered body politic. I think they’re called multiple-party systems. You know, where real choices are possible.

Maybe that would be a truly “pro-choice” system.

I think we need to start building one.

Now.

*The Prevention First Act is only one of a slew of bills that were introduced to try to make sane sex ed and contraception policy. The REAL (Responsible Education About Life) Act is another that is stuck in committee. For a look at the whole list, depressing though it is that none are moving, click here.

Note: This piece is also published on my blog at our community-building site, SexInThePublicSquare.org. Drop by and join in!

Photo of “Condom Police” sign not taken in the US no matter how much it may feel that way. The sign was photographed in Vanuatu by “Phnk“, posted on Flickr and used here under a Creative Commons Attribution-Noncommercial license.

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Filed under abstinence only, Education, Health, News and politics, public discourse, reproductive freedom, sex, sex and health, sex and the law, sex education, sexuality, sexuality and age

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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Filed under abortion, activism, censorship, civil rights, Education, feminism, New York Times, News and politics, pro-choice, public discourse, reproductive freedom, sex, technology

Democrats vote to increase funding for abstinence-only “education”

I don’t know how I missed this item posted on the Advocates for Youth web site last week:

Democrats INCREASE Funding for Discredited Abstinence-Only Policy
Ignore Findings that Programs Don’t Work

WASHINGTON, DC (July 19, 2007) Today, by a vote of 276 to 140, the House of Representative passed the Labor-HHS Appropriations Bill which included an unprecedented $27.8 million increase for failed abstinence-only-until-marriage programs, bringing the total annual funding for Community-Based Abstinence Education (CBAE) to $141 million.

“In one spectacularly cynical move, the Democrats turned their backs on science-based public health and chose political expediency over the health and well-being of young people,” said James Wagoner, president of Advocates for Youth. “With friends like these, who needs conservative Republicans?”

Democrats who have been ardent critics of abstinence-only voted to increase the very programs they opposed when Republicans controlled the Congress.

“With this vote, reproductive health ‘champions’ like Representative Nancy Pelosi and Nita Lowey have aligned themselves with ultra-conservative abstinence-only proponents,” added Wagoner. “They are now complicit in funding programs that promote ignorance in the era of AIDS.”

Since 1982, Congress has allocated over $1.5 billion for abstinence-only-until-marriage programs that censor information about birth control and the health benefits of condoms in the prevention of sexually transmitted diseases. A 10-year congressionally mandated evaluation conducted by Mathematica Policy Research, Inc. and released in April, 2007, found that “youth in the [abstinence-only] program group were no more likely than control group youth to have abstained from sex and, among those who reported having had sex they had similar numbers of sexual partners and had initiated sex at the same mean age.”

“It’s becoming increasingly difficult to tell our friends from our opposition these days,” concluded Wagoner. “The majority of Democrats say they oppose these ineffective programs because they withhold life-saving information, yet they failed to act on those beliefs. Shame on them!”

Cynical? Cynical doesn’t even come close.

Now I know these provisions are buried in huge appropriations bills. And this one is interesting because in at least some states (New York, California, I haven’t checked them all!) it is the Democrats who tended to support the bill and Republicans who tended to it. So clearly the vote wasn’t “about” abstinence-only “education.” It was more likely about the funding of things like public schools and hospitals, for museums and libraries, public broadcasting, programs for the blind, for Medicare, for the National Labor Relations Board, and other important stuff. (Click here for the text of the bill, its provisions, and the programs it funded.)

But Democrats certainly had an opportunity in moving the spending bill through the House to amend it or alter provisions to which they objected, and they certainly could have cut funding for abstinance-only programs and allocated money instead for comprehensive sex education programs (which, by the way, also promote abstinence as the best policy for teens).

Here is the section of the bill that deals specifically with “abstinence education”

Provided further, That $136,664,000 shall be for making competitive grants to provide abstinence education (as defined by section 510(b)(2) of the Social Security Act) to adolescents, and for Federal costs of administering the grant: Provided further, That grants under the immediately preceding proviso shall be made only to public and private entities which agree that, with respect to an adolescent to whom the entities provide abstinence education under such grant, the entities will not provide to that adolescent any other education regarding sexual conduct, except that, in the case of an entity expressly required by law to provide health information or services the adolescent shall not be precluded from seeking health information or services from the entity in a different setting than the setting in which abstinence education was provided: Provided further, That within amounts provided herein for abstinence education for adolescents, up to $10,000,000 may be available for a national abstinence education campaign: Provided further, That in addition to amounts provided herein for abstinence education for adolescents, $4,500,000 shall be available from amounts available under section 241 of the Public Health Service Act to carry out evaluations (including longitudinal evaluations) of adolescent pregnancy prevention approaches: Provided further, That up to $2,000,000 shall be for improving the Public Assistance Reporting Information System, including grants to States to support data collection for a study of the system’s effectiveness.

We are now spending almost 137 million dollars to teach teenagers that abstinence is the only acceptable method of preventing STDs and pregnancy, and we are prohibiting organizations that accept grants from this allocation from offering “any other education regarding sexual conduct.”

Ironically, or not, this same bill in Title V section 517 b provides that “None of the funds made available in this Act may be used to disseminate scientific information that is deliberately false or misleading.”

Click here to find out how your legislators voted (once there, click on your state to see each of your legislators’ votes) and then call them or email them and let them know you’re outraged that they didn’t address the problem of abstinence-only funding but instead voted to increase funding for the very programs they claim are harmful to kids. You can use the “Speak Out!!” box on the left side bar to find contact info for your representatives.

By the way, this same bill in Title V section 507, continues the ban on spending federal money to provide abortions (so they aren’t covered for poor women, or for women insured under federal health insurance programs).
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This is posted here and also at SexInThePublicSquare.org

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The good news and bad news about the new teen birth rate data

A new study by the Federal Inter-agency Forum on Child and Family Statistics reports that the teen birth rate is at an all time low. The current birth rate for teens between 15-17 in the US according to the study is 21 per 1000.* (That’s down from a high of 39 per 1000 in 1991). The same report gives a teen pregnancy rate of 44 per 1000 in 2002, the most recent year for which they give a rate, and some of the drop is attributable to an increase in condom use. You can see a PDF version of the report here.

Any drop in the teen pregnancy rate, the teen birth rate, and any increase in the rate of condom use is certainly very good news. But the good news is hardly unqualified. There is a fair bit of bad news that surrounds those important bits of good news.

One bit of bad news is that the teen pregnancy rate in the US is still much higher than it is in other western postindustrial societies. In the Netherlands and in Switzerland there were only 5 births per 1000 women between 15 and 19 in 2002 according to UN data. (There were 53 per 1000 young women in the US that same year according to the UN figures). The UN data I found did not report pregnancies, only births. Data from the Guttmacher Institute indicate that the pregnancy rate in the Netherlands was 12 per 1000 in 2001.

Another bit of bad news is that in the US there are significant differences in birth rates for girls of different racial and ethnic groups. The lowest teen birth rate is found among Asians (including Pacific Islanders). That group has 8 births for every 1000 girls between 15 and 19. For non-Hispanic White teens, the rate is 12 per 1000, for Native Americans (classified as American Indian/Alaska Native) the rate is 31 per 1000, for non-Hispanic Blacks it is 35, for Hispanics it 48 per 1000.

These differences must reflect, at least in part, access to health care, contraception, accurate sex education, and abortion services. The differences are not likely to be primarily related to differences in sexual activity between groups. A study published by the National Center for Health Statistics reporting on National Survey of Family Growth data from 2002 finds that Hispanic girls between 15-17 are less likely than their non-Hispanic black or white counterparts to have had sex. The same is true for 18-19 year olds. In the first age group 30% of non-Hispanic white girls, 41% of non-Hispanic black girls, and 25% of Hispanic girls report having had sexual intercourse with a male. In the second age group 68% of non-Hispanic white girls, 77% of non-Hispanic black girls, and 59% of Hispanic girls report having done so (p. 24). And, of those girls who had had sex in the previous four weeks, 19% of non-Hispanic white girls had had sex 4 or more times in that period compared with 13% for both black girls and Hispanic girls.

Why do white girls have lower pregnancy and birth rates if they’re having sex more frequently? This same study found inequality in use of contraception (which may provide some support both for the observation of unequal access and also of the observation of cultural barriers to use). White girls were more likely than either other group to be on the pill at the time of their first intercourse (18% compared to 13% of black girls and 10% of Hispanic girls), and were also more likely to use both pills and condoms together during their first time (15% compared to 9 % for black girls and Hispanic girls). This may speak at least in part to their access to multiple methods of contraception and to their ability to gain access to birth control pills before becoming sexually active.

In fact, when asked whether they had ever used specific methods of contraception, the study found that only 37% of Hispanic girls had ever used birth control pills (compared to 68% of white girls and 55% of black girls). Given an intersection between ethnicity and religion, and the prohibitions against contraception by the Catholic church, some of this difference might be explained by religion and culture. But given that Catholics around the world use birth control pretty regularly, I think that inequality of access to health care and prescriptions is a big part of the story.

There is no teen sex crisis in the United States, but there is a sex education and sexual health care crisis in the United States. If we want to bring our levels of teen pregnancy and teen births down to rates that are in line with those of countries like the Netherlands, we need to start addressing teens sexual health as a serious matter, treating teens with respect, and giving them the tools they need to make smart decisions and creating an environment in which those decisions are respected.

We need to do this while paying attention to race, class and ethnic inequality. Teen parenthood is associated with long term disadvantage for parents and for their children. Girls who become parents in high school are less likely to finish high school, and less likely to go to college. Children who start their lives in poverty are less likely to make it into the middle class. They’ve got all kinds of structural factors working against them.

The answer is definitely not to continue promoting abstinence-only sex education. The answer is complicated, but it certainly requires promoting sound, accurate sex education where the values of abstinence are taught in conjunction with the importance of contraception, relationships skills, and emotional well-being. It involves providing support for teen parents so that they are not so disadvantaged. It involves making sure that access to emergency contraception is secured for everyone, and that abortion remains a legal option for young women. It involves providing equal access to health care. And it involves the acknowledgment that we can’t talk about inequality without talking also about sex.

*The original version of this post incorrectly labeled that rate as the “teen birth rate” which would have been the rate for girls between 15-19. The error was brought to my attention by a very careful reader, Carole Joffe, of UC Davis, who continued:

“…the overall figures from 15-19 (birthrate) was 40/thousand–in fact, nearly identical to the year before. This fact aside, I think your analysis of the Report is right on. I look forward to reading more of your postings. Best wishes from a fellow sociologist, Carole.”


Return to the corrected sentence.

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Filed under abstinence only, culture, Education, Family, feminism, Gender, Health, inequality, moral panic, News and politics, reproductive freedom, sex, sex and health, sex education, sexuality, sexuality and age

Thoughts on Fathers Day

What are you doing for Fathers Day? My partner, a father of five children all adopted or conceived long before I entered the picture, is off sailing for two days on the Schooner Pioneer and enjoying parts of the Clearwater Festival. (Check his blog for an account, probably Tuesday.)

Our fathers and grandfathers have all passed away (my father when I was a child, my partner’s father just a few months ago) but my partner is himself a father and today I thank him for helping to shape the lives of five truly unique and wonderful individuals. I am honored to know them, and glad that they came into my life as adults so that we could develop relationships based on something other than a step-parent/step-child dynamic. (Don’t get me wrong, step-families can be wonderful! I had an amazing step-mother myself for a while, but I’m grateful for having the chance to know these people without the inevitable difficulties that come with any kind of parent/child relationship.)

I thank my partner too, on Fathers Day, for having done his child-raising before our relationship began, because this has freed me to decide not to be a parent without denying him his chance at parenthood.

Neal Watzman commented back in May on my Mothers Day Post, pointing out that the things I wished for mothers were equally applicable to fathers. I absolutely agree, and today I’m giving you a very slightly modified version of that post, tailored for fathers.

-Sexual openness, sane sex laws, and training in communication about sex so that men can enjoy their sexuality and share it fearlessly with their partners. Through sex we express desires, we communicate, we connect, and we feel pleasure. If men are socialized into a restrictive — albeit privileged — sexual role, they are less likely to be able to experience the fullness of their sexualities or to share themselves as openly, without shame, with partners. In fact, the privilege that comes from masculinity (with all its restrictiveness) makes it even harder for men to challenge the limitations placed on them, making it all the more difficult for them to experience their sexuality fully, openly and shamelessly.

-Access to contraception and recapturing the right to abortion when needed — without restriction — so that all motherhood is by choice. Men need this security as much as women do, and men need easy, affordable access to reproductive health care and education about “women’s health care” so that they can support their women parters when their women partners need care.

-High quality, affordable — dare we even say government subsidized — child care so that all parents who work outside the home — including those for whom work is a necessity and not a choice — can do so without economic penalty or fear for the safety of their children.

-Realistic part-time and flexible work options so that parents have more choices about how to divide the labor of wage-earning and child-care. I don’t mean part time with no stability and low pay. I mean part time with reasonable wages that would exceed the child care costs incurred while working those more flexible hours.

-Universal health care — not just health insurance — so that employers are no longer the ones who provide our access to health care. This isn’t just a matter of concern for the poor, either. Plenty of middle income people end up financially devestated even if they do have health insurance because the part of the medical bills that the health insurance doesn’t cover is still more than they can afford. (This is especially awful for people who have fallen prey to the “two income trap” where two parents are both working to pay for meeting the basic needs of the family and then one gets sick and the other can’t make up the difference.) Oh, and of course this health care has to cover treatment for addictions and mental illness just as it covers physical illness.

-Fair wages for all workers. This means eliminating the wage gap, guaranteeing equal pay for equal work, and providing living wages to all workers. Living wages mean that parents can work reasonable hours and spend time with their kids. And we also need reasonable paid leave policies so that people don’t lose out when they need to take care of a child.

-Marriage rights for all fathers. To exclude fathers with male partners from marriage is to exclude their children from the kinds of benefits that marriage confers on couples. While I would still dispute that these benefits ought to be attached to marriage in the first place, as long as they are attached, marriage needs to be available to all who want it.

-Peace. The costs of wars, in dollars and in lives, is too great to justify, and the paying of that cost is keeping us from doing the kinds of things suggested above — things that would make economic security a reality for many more people. War touches everybody, but in the United States men still bear the largest part of the awful burden of actually killing people in war. Men need peace because we all need peace, and men need peace so that they can stop killing people.

All people, regardless of economic status, must be entitled to sexual freedom but sexual freedom feels like a luxury when you are too exhausted from working your second job and making sure the kids got to school to even think about having sex with your partner. When we work for sexual freedom we must take into account the needs of the poor and working class as well as the needs of the middle class and the wealthy.

Health care, child care, contraception, fair wages, peace, and sexual freedom. They’re all connected.

Happy Fathers Day!

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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

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