Playing Political Games In Doctors’ Offices

By Kellie Freeman Rohrbaugh

Over 700,000 Missourians don’t have access to adequate health care coverage. The fact that women experience this disparity more intensely than men, is further compounded if they live in rural Missouri. Politicians in Jefferson City just don’t understand the struggles of women and families living in “outstate Missouri.”

In order to access health care, rural Missouri women make an appointment, often well in advance, make sure they have time off work and childcare, and then fill the gas tank for the long ride into the doctor’s office. The last thing anyone wants to deal with is more politicians and lawyers telling them how and when to talk to their doctor.

But it seems another aspect of women’s health care has just gotten more complicated.

In April the Missouri House passed a proposal which includes a laundry list of provisions restricting abortion -- many of which will have a disproportional impact on rural women.

Missouri already has some of the nation’s strictest laws regarding abortion. One of these is a 24-hour waiting period between counseling and the procedure. Right now, women living in rural Missouri can talk to their own physician before meeting with the doctor who will perform the procedure. This proposal takes away that option by mandating that the counseling and abortion care be done by the same physician. Living in a rural area this will cause delays of several days or even weeks -- pushing a woman’s procedure later into her pregnancy. This is not good medical practice and it is awful public policy.

The action by the House forces politics further into the exam room by requiring doctors and counselors to use brochures and videos produced by state bureaucrats. Another outrageous provision forces health care workers to post signs that carry false promises of state-backed assistance in carrying a child to term and providing for that child once born.

A responsible government should promote medically accurate information for women to make responsible decisions. Bureaucrats feeding doctors lines to recite isn’t going to help women get the care they need. The government should not invade the privacy of the doctor-patient relationship -- nor order women where to go for their medical care.

Perhaps the most egregious part of the process has been the sponsors going on and on about how much they care about women’s health. They certainly don’t think women can make their own decisions because the proposal actually takes away the rights of women who have been victims of domestic abuse or even rape.

The bill redefines coercion in this way, if a woman facing an unintended pregnancy reveals that she is the victim of domestic abuse or even rape, it becomes a crime for the doctor to provide her with abortion care. It is telling that most domestic violence experts are opposed to this provision, and are asking "how does your status as a battered woman take away your ability to make up your own mind?"

There’s nothing in the proposal that addresses the real issues that women who are victims of rape or abuse face. It just takes away their ability to act on their own behalf in the doctor’s office.

The idea that women are being forced into abortions by abusers is entirely false. Missouri statute already requires women to sign a consent form stating that her decision is free and voluntary. But beyond that measure, Planned Parenthood’s trained staff goes through medical and social histories with each patient to determine that it is her own decision to have an abortion. If at any time a counselor determines that there are pressures from someone else, the procedure is not performed. Like all health care providers, Planned Parenthood is subject to mandatory reporting policies, and required to report sexual assault or domestic abuse.

This plan will infringe upon the doctor-patient relationship and further restricts abortion care in Missouri. Using emotionally-charged language hides the proposal’s true intentions and further burdens victims of domestic abuse. It does nothing to help women in need and instead is merely using scare tactics to win elections.

If the political leaders in Missouri were serious about reducing the need for abortion, they would not enact measures that put further strain on rural women and victims of domestic violence who are seeking health care. It’s time to put prevention first and focus on common sense solutions such as increasing access to contraception and other family planning services.
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Rohrbaugh is public affairs director of Planned Parenthood of Southwest Missouri.
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Copyright (C) 2008 by the Missouri Forum. 5/08

How the Christian Right Goes Wrong

By Cristina Page

New research reveals that female students in programs that promote abstinence exclusively are more likely to get pregnant than those in programs that teach about the full range of contraceptives as well as abstinence. The news, published in the April issue of the Journal of Adolescent Health, is just the latest proof that the $1.5 billion dollar “just say no to sex” experiment on our teens has failed. And while Christian conservatives defend their approach even in the face of this latest devastating news, it’s time to ask them one simple question: Shouldn’t the results matter?

At current rates, half of all teenagers will have sex before graduating high school and 95 percent will before marrying. These statistics infuriate the abstinence-until-marriage proponents. Their hope is that, by keeping teens in the dark about protection, ignorance will somehow lead to temperance. Those most committed to the abstinence approach seem to have paid most dearly though. Earlier findings by researchers at Yale and Columbia Universities revealed that teens taking part in virginity pledge programs (they pledge to stay virgins until marriage) are more likely than their non-pledging peers to engage in risky unprotected sex. The study also showed virgin pledgers were six times more likely to have oral sex and male “virgins” are four times more likely to have anal sex than those who do not take the pledge. These “virgins” had the same rate of STDs as other teens but were much less likely to be treated for them.

Southern school districts, which are five times more likely to use the abstinence-only approach than northeast schools, have much to show for investing in the abstinence-only. Today, southern states lead the nation in the acquisition of STDs, are home to the highest rate of new HIV/AIDS cases, and have the highest percentage of teen mothers in the country. The damage is so staggering that 17 states have opted to reject federal funding for abstinence only. In the long term, they concluded, the costs of their failure outweigh any benefits.

Abstinence is not the only policy that Christian conservatives pursue despite evidence that it doesn’t work. In fact, much of the movement’s policies have, even by their own standards, led to perverse outcomes. Consider the drive to outlaw abortion. Last year, 11 states moved to ban abortion immediately and create a case to test Roe vs. Wade in the Supreme Court. But, if ending abortion is the goal, banning abortion is quite possibly the worst strategy. The countries with the highest abortion rates in the world are those that have banned abortion. Take Latin America, where most countries have outlawed abortion yet have the same rate or- as in the case of Peru, Chile and the Dominican Republic -- rates twice as high as the United States. And where on earth have the lowest abortion rates been achieved? In countries with the strongest pro-choice policies; like the Netherlands, Germany and Italy where abortion is not only legal, but in several cases available free of charge. This pro-choice policy/lower abortion rate trend has been true in our country as well. We witnessed the most dramatic decline in abortion in the history of our country under our first pro-choice president, Bill Clinton. These declines continue today and notably where it is falling sharpest is where the strongest pro-choice policies, namely prevention through wider access to contraception, have been adopted.

And while banning abortion has failed to stop abortions, limiting abortion rights has also produced undesired outcomes. A favorite tactic of the “right to life” movement is to impose mandatory delay policies on abortion. A woman must receive information about her right to an abortion and then must wait 24 to 48 hours before receiving a procedure. Sounds harmless enough. However, while these policies have had little effect on the frequency of abortion they have dramatically increased late term abortions. In the year after Mississippi passed a mandatory delay law, second trimester abortion increased statewide by 53 percent. Nearly half the number of women presenting for an abortion late in pregnancy these days cite pro-life restrictions as the cause.

The danger of policies guided by ideology is that the means often are the end. There is no better example of the deleterious effects of policies based on wishful thinking than in the reproductive rights debate. We need to respect people’s ability to make their own life decisions and not impose our values and views upon them. If Americans were to set aside the catchy sound bites and suspiciously simplistic reasoning and instead judge by results, most would find the pro-choice movement is a more comfortable home for their stated values.
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Page is the author of How the Pro-Choice Movement Saved America: Freedom, Politics and the War on Sex and spokesperson for BirthControlWatch.org
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Copyright (C) 2007 by the American Forum. 4/08

Abortion Stakes Are Personal For Reporter

By Allison Stevens

(Click here to listen to a Public Service Announcement distributed by American Forum, discussing concern over the threat to women's health.)



I'm a lucky woman. Today I hold in my arms my newborn son, born in good health - both his and mine. As the Washington bureau chief for a news site that covers issues important to women, I often cover the ideological warfare over reproductive rights.

A frightening moment at the beginning of my pregnancy gave me an almost visceral perspective on the most recent Supreme Court battle over abortion, one that has already inspired lawmakers in a number of states to enact or contemplate action to further limit a woman's right to make decisions about her reproductive life based on the best medical option for her particular circumstances.

My pregnancy officially began the way many end: with a late-night trip to the hospital. Last October, before I was able to confirm with my doctor the positive results of an at-home pregnancy test, I headed to the emergency room after I experienced some bleeding, a sign of possible miscarriage.

When, during my emergency ultrasound, I first laid eyes on that tiny white egg, I had the kind of reaction that opponents of abortion say often accompanies ultrasounds: a deeper connection to the growing life within me.

With a good report, I quickly resumed my work schedule, covering a Supreme Court case challenging a ban passed by Congress on the abortion procedure known to doctors as "dilation and extraction."

The 2003 law banning the "D&X" abortion procedure does not include an exception for the health of the woman, which the justices who decided Roe v. Wade, the 1973 ruling that legalized abortion, deemed a necessary caveat in the limitations they put on legalized abortion -- and one retained in subsequent decisions by the high court in later laws concerning abortion.

I listened as the justices gamely debated the merits of protecting women's health during pregnancy, a condition only one--Ruth Bader Ginsburg--had ever experienced.

That debate was, for me, a different kind of ultrasound, a look into the minds of those who have the ultimate say over my reproductive life. Like its medical counterpart, this inside look intensified my feelings about my pregnancy: I became more acutely aware of my health--and my vulnerability--as a pregnant woman.

In the first pregnancy book I read, the classic "What to Expect When You're Expecting," I encountered a long list what could go wrong with the fetus, and me. Scariest was the chapter on possible complications, which covered everything from such relatively benign problems as gestational diabetes to pregnancy-related cancer, comas and seizures, as well as a disease that can cause permanent damage to a pregnant woman's nervous system and other organs. Women over 35 are more likely to have problematic pregnancies, and the results of prenatal tests such as amniocentesis are generally not released until mid-pregnancy.

During the banned procedure, also known as an "intact dilation and evacuation" abortion, the fetus is partly brought out of the uterus before it is aborted. In her dissent to the 5-4 decision, Ginsburg noted that this procedure is safer for many women because it reduces the number of times a physician must insert medical instruments into the uterus, which can damage or puncture the uterine lining. It also decreases the likelihood that fetal remains will be left in the uterus, which can cause infection, hemorrhage, and infertility, and it is faster to complete than other procedures, potentially reducing bleeding, the risk of infection and complications due to anesthesia, she said.

Moreover, the procedure's ban "saves not a single fetus from destruction, for it targets only a method of performing abortion," Ginsburg said.

The decision has implications even beyond its immediate scope. Doctors may be more reluctant to perform other, legal procedures for fear they will be perceived as violating the law. And it paves the way for anti-choice legislators to pursue more restrictions to abortion that lack exceptions for women's health.

Louisiana just passed a new law banning an abortion procedure, and conservatives in the Kansas legislature have commissioned a study of how the court's decision could impact the practice of abortion in that state.

My ultrasound may have served to make my pregnancy real for me. But the decision of five men to disregard its possible impact on my health, while the only woman on the bench took assessed in real terms the physical risks involved with pregnancy made real for me the power men still hold over my body and my health.
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Stevens is Washington bureau chief at Women's eNews, a nonprofit independent news agency that covers issues of particular concern to women and provides women's perspectives on public policy. Stevens gave birth to her son, on July 18.
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*A version of this article originally appeared on womensenews.org a non-profit independent news agency that covers issues of particular concern to women and provides women's perspectives on public policy.

Birmingham Blues And Birmingham Strength

Marcy Bloom at RH RealityCheck offers another account about Operation Save America's "Siege of Birmingham" and their attempts to shut down the same abortion clinic that was bombed in 1998 by the terrorist Eric Robert Rudolph.

In Marcy's account, Jeff Lyons, husband of Emily Lyons, one of the victims of Rudolph's bombing, recounts that terrible day:

Jeff Lyons, Emily's devoted husband, showed me the locations where both Emily and Sandy had been standing when Eric Rudolph's hateful bomb detonated in front of the clinic on that January day almost 10 years ago. Sandy was blown apart; in fact, he was decapitated. Blood and body parts were everywhere. It was tough to imagine. Jeff said that for many years, when it rained and the soil of the garden in front of the clinic shifted, pieces of Emily's pink scrubs and Sandy's blue uniform came up though the grass. Reminders of violence and hate linger for a long time in many places and in many lives.

This is part 2 of Marcy's account. You can also read part 1.

--Rachel Joy Larris

Legislature Attacks Reproductive Rights Again

by Ann O'Hanlon

RICHMOND, VA.--Here we go again. Extremist state legislators are taking the issue of abortion and using it to distract us as they quietly impose their alarming, turn-back-the-clock agenda on women's issues.

So far, by one or two votes, most of their radical proposals have failed to make it to the governor's desk and because of this do not receive much media or other public attention. But no one who cares about family privacy or the rights of women should be complacent. Right now, one Senate committee -- a committee whose members believe that the most intimate personal decisions should be made without intrusion from government -- is all that prevents these proposals from becoming law.

If those committee members weren't there -- and one day soon some of them will not be -- many forms of birth control, including the pill and the IUD, would be subject to Virginia's strict abortion laws or be made entirely illegal. An exaggeration? Not at all. Here's why.

Pregnancy begins when a fertilized egg implants in the uterus. Ask the American Medical Association, the American College of Obstetricians and Gynecologists, even the Code of Federal Regulations of the U.S. Government. That's the definition. But every year, the extremists who want to regulate a woman's uterus try to write into Virginia law that a pregnancy begins the moment fertilization occurs. Beyond that, they try every year to legally define that moment as the beginning of life.

When and if they are successful, that moment of fertilization could be equivalent to the moment of childbirth under law. Anything that stopped the fertilized egg from implanting in the uterus could be construed as the legal equivalent of an abortion. This includes the birth control pills that 12 million American women use.

So as our state legislature meets for all of six weeks this calendar year to grapple with issues that truly need government attention, such as education and transportation, some politicians have thrown the following backward-looking proposals into the mix:

* A proposal that defines life as starting at fertilization;

* A proposal to dangerously misinform our young people in public schools' Family Life Education classes, including inaccurate statements on abstinence and contraception; and

* A proposal to ban all abortions (except those where the mothers life is in danger) should the U.S. Supreme Court overturn Roe v. Wade.

The sponsors of these proposals are legislators who are rightly troubled by the actions some pregnant women take to either intentionally or unintentionally harm their pregnancy. But rather than work to understand and help such women, who may have mental illness or an addiction and nowhere to turn to for help, the proposals would instead intensify the charges and punishments exacted upon these women.

What we need are bills that increase prenatal care for women in poverty and enhance substance abuse screening of all pregnant women with follow-up care if appropriate, or at the very least require treatment or counseling for the woman in conjunction with her court-ordered punishment.

So while these extremists in Richmond constantly use that divisive word -- abortion -- as their bumper sticker and their public face, make no mistake, what they are working on is an intrusion into more than just a woman's privacy, it is an intrusion into family privacy and family choices concerning birth control.

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O'Hanlon is the executive director of NARAL Pro-Choice Virginia.