U.S. Supreme Court to Overturn Roe v. Wade

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abortion, abortion laws, anti-abortion movement, reproductive health, U.S. Supreme Court

Law students demonstrate at the U.S. Supreme Court after learning of the leaked anti-abortion decision.

For many months, ever since far-right jurists became the majority on the U.S. Supreme Court, it has been expected that the Court would soon either drastically curtail or entirely overturn the historic 1973 decision Roe v. Wade that recognized women’s abortion rights.  On May 2 the most dire predictions were confirmed.  A 90-page draft copy of Justice Samuel Alito’s majority ruling completely overturning Roe v. Wade was leaked to the press.  That the draft document made its way into the media prematurely is an unprecedented scandal in and of itself.  But the contents of the document are far more shocking than the circumstances in which it became known. In the most dramatic rejection of women’s rights in recent U.S. history, the Court majority will reverse Roe v. Wade and the past fifty years of Federal court decisions reaffirming reproductive rights. The U.S. will join Poland, Nicaragua and El Salvador as one of only four countries that have rolled back access to abortion during the last three decades.  Meanwhile, since 1994 fully fifty-nine countries have expanded the conditions under which abortion is legal. 

This blog has quite a number of readers from outside of the U.S., so it bears repeating that the Supreme Court decision will not criminalize abortion in the entire U.S.  The woman-friendly “blue” states, including most states in the northeast and coastal west of the country, will keep abortion legal and accessible.  But their resources are likely to be strained by having to accommodate women fleeing the draconian restrictions in the misogynist “red” states.  The hospital system of my state of Washington, for example, has been greatly taxed by an influx of seriously ill Covid-19 patients who contracted the virus in the neighboring state of Idaho, where the anti-mask and anti-vaccine movement is strong, and is generally supported by Republican political authorities. Now, with the Supreme Court opening the door to anti-abortion legislation in Republican-controlled states, clinics in Washington are anticipating an increase of Idaho women fleeing to our state to escape Idaho’s abortion ban. 

As many commentators have noted, the woman-friendly states generally protect access to a full range of reproductive health options.  In addition to abortion, often with state-assured financing for poor women, such states also provide access to low cost or free contraceptives, prenatal and postnatal care, and other services for infants and children.  Meanwhile, the misogynist states such as, for example, the anti-abortion stronghold of Mississippi (whose recent legislation restricting abortion Alito cites favorably), have some of the worst statistics in the country on women’s and children’s health and welfare. 

In the ruling Justice Alito blames his predecessors’ decision in Roe v. Wade for inflaming divisiveness in the U.S. over the abortion issue. The truth of the matter is that it is the extremist anti-abortion decision by Alito and his confederates that will lead to disputes and conflicts among the states. By throwing decisions on abortion legality exclusively back into the hands of the individual states, the U.S. Supreme Court is exacerbating the already immense divide between the roughly half of the country whose policies and laws provide for reproductive health rights, and those deeply misogynist regions with blatant disregard for the health and welfare of women.  

There is widespread agreement among historians that the worst decision ever made by the U.S. Supreme Court was the Dred Scott decision of 1857, which held that a Black person could not have the rights and protections of a citizen, even in a free state where slavery was not permitted, and, moreover, could be taken to a slave state and re-enslaved. According to the Wikipedia article on the Dred Scott decision, “Although Taney and several other justices hoped the decision would permanently settle the slavery controversy, which was increasingly dividing the American public, the decision’s effect was the complete opposite. Taney’s majority opinion suited the slaveholding states, but was intensely decried in all the other states. The decision inflamed the national debate over slavery and deepened the divide that led ultimately to the Civil War.” Apparently Alito and his fellow rightists on the Court would rather disregard the lessons of history.

Backlash Against the Misogynists

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abortion access, abortion laws, Citigroup, Lyft, Maryland, reproductive health, Texas, Uber, Yelp

According to the Guttmacher Institute, the year 2021 saw the passing of the largest quantity of anti-abortion legislation since 1973, when a woman’s Constitutional right to have an abortion was established in the U.S.  And the U.S. Supreme Court still seems on track to either drastically weaken or overturn Roe v. Wade this summer.  Amid all the depressing news, however, there are some bright spots.  Most of the positive developments are outside of the U.S.—the vocal and successful women’s reproductive rights campaigns in various countries of Latin America, for example.  But a few recent actions in the U.S., including several by companies in the state of Texas, have pushed back against the vicious misogyny of many state legislators and their supporters.

Citigroup, a major financial enterprise with over 8,000 employees in Texas, has announced that it will pay travel costs for any of them who are affected by SB-8.  This is the Texas law that not only bans abortion after six weeks, but also threatens lawsuits against anyone involved in assisting someone to circumvent the law (for example, by facilitating travel of a Texas resident to a more woman-friendly state). 

The transportation companies Lyft and Uber have also announced policies in defiance of SB-8.  They have offered to pay expenses for any of their Texas-based drivers who might get sued for taking a woman to an abortion clinic.

Yelp, the online search and review company, has said that their over 200 employees in Texas will be reimbursed for expenses if they need to travel out of state for abortion care.  Moreover, representatives of Yelp have stated that the reproductive health guarantees offered to their Texas workforce will be extended to their employees in any state who might face “current or future action that restricts access to covered reproductive health care.”  Employees will be able to submit their requests for reimbursement of abortion-related medical expenses directly to Yelp’s health insurance provider, so neither fellow Yelp workers nor officious misogynists trying to enforce SB-8 or similar legislation will be able to track the persons involved.  This latest action builds upon several years of Yelp’s efforts in support of abortion rights.  The company does not allow anti-abortion entities of the “crisis pregnancy center” type to portray themselves neutrally or masquerade as abortion clinics.  And in the months leading up to the passage of SB-8 Yelp offered to double-match employees’ donations to reproductive health rights organizations opposing the legislation.

Yelp and Citigroup will support the expenses of employees in Texas who need to travel out of the state for abortion or other reproductive health needs; Uber and Lyft will cover the expenses of any driver who is sued for transporting a woman to get an abortion.

Meanwhile, back in the state of Maryland legislators are the latest to take a stand in defense of reproductive health rights.  A bill scheduled to take effect July 1 of this year allows nurse practitioners, nurse midwives, and trained physicians’ assistants to perform abortions, requires insurance providers to cover abortion costs, and apportions $3.5 million per year for abortion training.  Maryland’s Republican governor Larry Hogan vetoed the bill, but under the leadership of the Speaker of Maryland’s House of Delegates, Democrat Adrienne A. Jones, the House overrode the veto by a vote of 90 to 46; and the state Senate concurred with a 29 to 15 override.  Maryland joins California, Colorado, Connecticut, Hawaii, Illinois, Maine, Massachusetts, Montana, New Hampshire, Oregon, Vermont, Virginia, Washington and West Virginia in permitting abortion to be performed by medical professionals other than physicians, and it is one of sixteen states that provide at least some state funds for abortions.

Sources for this piece include the Guttmacher Institute website and April 10 and April 12 articles in the New York Times.

Adrienne A. Jones, Speaker of the Maryland House of Delegates

Dr. F. J. Taussig, Abortion, and the Washington University Medical School

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abortion, anti-abortion laws, Frederick Taussig, medical training, reproductive health, University of Washington (Seattle), Washington University in St. Louis

Washington University in St. Louis, Missouri has a world-renowned medical school and affiliated teaching hospital.  In the early 20^th century, one of its most distinguished professors was the obstetrician and gynecologist Frederick J. Taussig. 

Prominent American gynecologist Dr. Frederick J. Taussig (1872-1943)

Taussig wrote extensively on abortion, and his work was frequently cited by other experts; I read both of his major treatises when I was writing Sex and Herbs and Birth Control and purchased my own copies on E-Bay.  Taussig was a careful observer, and unlike most physicians of his era he was willing to acknowledge the superior skill of midwives in providing safe abortions.  Taussig also believed that more married men should take responsibility for contraception by having a vasectomy, since it was an outpatient procedure and “perfectly harmless.”  He lamented that “it is as yet difficult to persuade many men to undergo this slight sacrifice for the sake of their wives.”

In 1910, when Taussig published his first major treatise, like most of his professional colleagues he was vehemently opposed to the legalization of abortion.  But over the course of his career (and under the influence of his wife Florence Gottschalk, who was a prominent Suffragette) Taussig began to advocate wide-ranging reform of the law codes.  He put his support for legalization firmly in a feminist context.  In his 1936 volume on the subject, Dr. Taussig noted: “With the spread of the Woman’s Suffrage Movement throughout the world and the newer independence of women, the revolt of womankind against the age-long domination of man has finally materialized.  There can be no question that more consideration must be given to the right of women to control their own bodies…. Thus far all laws and social regulations on abortion have been man-made, and women, who are the chief sufferers, have had no chance to express their views in any referendum.”

Dr. Taussig’s 1936 book was extremely influential among physicians and others with an interest in maternal health.  His comprehensive scientific treatment of both spontaneous and induced abortion along with his sensitivity to social context made his work the standard reference on the subject for decades, as both supporters and opponents of abortion law reform have acknowledged.

The most important book on abortion in the pre-War period (published in 1936)

Dr. Taussig insisted on viewing abortion as a necessary component of gynecological training, and under his tutelage medical students gained the expertise they needed to safely perform abortions and tend to complications of pregnancy. 

It is a terrible irony that the Washington University School of Medicine, after so many years of being a national leader in women’s reproductive health, is now increasingly under attack by the Missouri State Legislature for its efforts to provide the next generation of physicians with the training they need.

The American College of Obstetricians and Gynecologists (ACOG) recommends standardized education on abortion in all residency programs (in which U.S. physicians-in-training work in a teaching hospital for three years to gain practical experience in their specialty after they finish medical school).  But it is a sad fact that fully half of U.S. medical schools do not offer training in abortion care, or at most offer one lecture on abortion and contraception combined.  In order to keep their accreditation, hospitals with residency programs in obstetrics and gynecology are required to either provide abortion training themselves or allow their residents to go out of state to obtain it.  As it stands now, Washington University students need to go to Illinois for their abortion training.  Yet state legislators want to tax the university’s endowment on the grounds that, as Republican Mike Moon put it: “Washington University is a premier institution which trains students to perform abortions… These students are then hired to murder developing human babies across our nation. They won’t stop on their own. This [bill] will place a financial hardship on their ability to train these students.”

States such as Missouri, Texas and Idaho are not only greatly restricting the conditions under which abortion can be legally obtained.  They are also threatening to prosecute anyone who teaches abortion techniques, seeks an abortion outside of the state, or performs an abortion on a state citizen regardless of where the procedure is done.  Whether or not such laws will withstand court challenges, and whether or not the laws could be enforced in practice, they have an intimidating effect on medical professionals as well as on women seeking a full range of reproductive health options. 

The competition to obtain a place in a residency program in a woman-friendly state in which training in abortion is not under attack has become more severe.  As medical reporter Sarah Varney put it: “Increasingly, aspiring obstetricians and gynecologists who want training in abortion procedures are seeking out teaching hospitals and universities that champion that training as a vital skill in women’s health care, creating a crush of qualified applicants for prized spots in Seattle, San Francisco, and New York…”

The medical school of the University of Washington (UW) in Seattle is offering Zoom classes on contraception and abortion to medical students in Idaho, one of the many states that are drastically restricting abortion and access to abortion training.  As of two years ago UW stopped reserving a few spots in their program for residents choosing not to learn abortion care.  “If we live in a state where abortion care is legal, we need to recruit medical students into our program that want to provide abortion care,” said Dr. Alyssa Stephenson-Famy, an associate professor of maternal-fetal medicine in the department. “We should not waste our spots on people not willing to provide abortion.”

It bears stressing that state legislators are delusional if they think that obstetricians and gynecologists can be properly trained without understanding abortion care techniques.  ACOG requires abortion training for medical residents because adequate care of pregnant women is impossible without knowledge of the basic procedures.  Obstetricians must be capable of expertly cleaning out a woman’s uterus in the event of a miscarriage or if fetal heartbeat ceases.  As Dr. Eve Espey, a professor of obstetrics and gynecology at the University of New Mexico, has observed: “Any obstetrician who says there is never need for abortion care is not telling the truth about obstetrics.”

Sources: Sarah Varney, “Fewer medical students trained for abortion procedures,” NBC News online, March 22, 2022; Frederick J. Taussig, The Prevention and Treatment of Abortion (1910) and Abortion: Spontaneous and Induced (1936).

With a Little Help from Their Friends

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abortion, abortion access, abortion laws, Colombia, Dr. Jorge Villareal, Latin America, Oriéntame, reproductive health, Roe v. Wade

Latin American reproductive health rights activists have logged another victory.  Last week the Constitutional Court of Colombia (the highest court in the country) voted five to four to decriminalize abortion in the first twenty-four weeks of pregnancy.  Colombia thus joins Mexico and Argentina in decriminalization, which means that three of the four most populous countries of the region have taken a major step toward making abortion legal and accessible.  (Brazil’s vocal feminist movement is pushing for legalization, but so far has had no success.)

Colombian reproductive health rights activists are quick to point out that their victory owes a lot to their relationships with activists in other parts of Latin America.  The Colombians consulted with movement lawyers from Mexico, adopted street theatre performances originating in Chile, and wear the distinctive green kerchiefs first used by women activists in Argentina.

Latin American feminists know that the constant sharing of strategies and tactics across the region has made all of their movements stronger and more vibrant.  They contrast their recent successes with the string of TRAP laws in many U.S. states and the ominous probability that the U.S. Supreme Court will reverse Roe v. Wade this summer.  Catalina Martínez Coral, a lawyer and member of Causa Justa, the coalition of abortion rights groups that brought the relevant case to the Colombian Constitutional Court, noted that the waves of feminist activism are “now an inspiration going south to north… We are going to inspire people in the United States to defend the rights set out in Roe v. Wade.”  Serra Sipel, the chief global advocacy officer at Fòs Feminista, an international alliance of reproductive rights groups, agrees, saying “We in the U.S. can really learn a lot” from Latin American feminist organizations.

Some of the roots of Colombia’s reproductive rights movement can be traced back to a visit to the U.S. by the eminent Colombian obstetrician/gynecologist Dr. Jorge Villareal Mejía.  Dr. Villareal toured some of the first legal abortion clinics that opened after the Roe v. Wade decision and decided to find a way to offer similar services in his homeland.  In 1977, he opened the first of his Oriéntame clinics in Bogotá.  The clinics offered a full range of reproductive health services, including abortion.  They charged on a sliding scale, and their promotional materials delicately urged their more affluent clients to contribute to the costs of procedures for poorer women.

Dr. Jorge Villareal Mejía (1927-2001)

I have known about Oriéntame since the early 1990s. Before full legalization of abortion in Colombia I referred to it by a pseudonym in my writing, in particular in my book Sex and Herbs and Birth Control.

Under Dr. Villareal’s direction the clinics pursued a remarkable two-pronged strategy.  On the one hand, Oriéntame skirted the question of illegality of abortion by labeling its services as “walk-in patient treatment of incomplete abortion.”  As a medical director of the organization once explained to me, a sympathetic Jesuit priest reconciled his support for Oriéntame with the Catholic view of abortion as a sin by reasoning that once a woman decided in her mind to have an abortion, she had begun the process.  Oriéntame personnel were merely aiding her to complete her abortion safely.  And indeed, in the forty-five years of their existence the clinics have performed close to a million abortions with a vanishingly small number of serious complications.

The second aspect of Dr. Villareal’s vision involved a brilliant outreach program.  To quote from Sex and Herbs and Birth Control (in which I referred to Oriéntame as CRH, or Centers for Reproductive Health): “CRH offers scholarships to midwives and doctors from other areas of Central and South America who might want to set up similar clinics.  They have trained over 600 physicians, nurses, physicians’ assistants, and traditional as well as licensed midwives in vacuum aspiration abortion techniques; their students perform abortions in clinics in Bolivia, Colombia, Ecuador, Guatemala, Mexico, Paraguay, Peru, Uruguay, Venezuela, and elsewhere…. In Peru I met a director of the country’s society of women obstetricians who had attended the program and was an enthusiastic advocate of the idea; I’ve run into CRH graduates in Nicaragua and Chile as well.”

Oriéntame personnel have not only trained numerous reproductive health specialists from all over the region in the latest abortion techniques.  They have also shared their expertise in how to make use of the legal exceptions in various law codes to increase women’s options.  As Giselle Carino, an Argentinian activist in Fòs Feminista, noted: “Without a doubt, we learned from the Colombians.”

Although for large portions of its history Oriéntame managed to steer clear of police harassment, a spate of incidents in 1994 encouraged Dr. Villareal’s daughter Cristina, who was taking over directorship of the organization from her father, to reach out to feminist groups in order to unite with medical practitioners to try to change Colombia’s laws.  Cristina Villareal joined with others to form the coalition La Mesa por la Vida y la Salud de las Mujeres.  In 2006 the group’s efforts caused a broadening of legal exceptions in which abortion was permitted in Colombia, and full decriminalization through twenty-four weeks was achieved in late February of this year.

Oriéntame and its international training program continue to offer reproductive health services in Colombia, train physicians, midwives, and healers, and advise affiliates on the best ways to navigate legal pitfalls.  But, as feminist activists in Latin America know and their counterparts in the U.S. are finding out, it does not pay to be too complacent.  As Cristina Villareal warns, “This is a battle that is never completely won… You can’t let your guard down.”

Sources for direct quotes are February 21 and 23, 2022 New York Times articles by Julie Turkewitz.  Additional information can be found at https://orientame.org.co (Spanish) and https://orientame.org.co/en (English).

“Fetus-Centered” yet High Infant Mortality

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abortion, abortion access, abortion laws, Caesarian sections, infant mortality, maternal mortality, prenatal care, reproductive health, U.S. Supreme Court

January 23, 2022 marked the forty-ninth anniversary of the landmark U.S. Supreme Court decision Roe v. Wade. Unfortunately, given the current right-wing composition of the Court, Roe v. Wade is unlikely to make it to the fiftieth anniversary.  The Court is expected to uphold a Mississippi law prohibiting abortion after fifteen weeks from a woman’s last menstrual period, which is at approximately thirteen weeks of fetal gestation.  Mississippi’s governor has repeatedly boasted that the state will continue its efforts to make Mississippi “abortion-free,” and he and his supporters have drafted a number of anti-abortion laws that will go into effect as soon as Roe v. Wade is overturned.  Conspicuously absent from any of this bluster is any attempt to improve the lot of pregnant women, including those who wish to bring their pregnancies to term.  Mississippi does a horrendous job of protecting pregnant women, mothers, and newborns.

Mississippi is not the only state whose legislators are eagerly awaiting the demise of Roe v. Wade.  It is also not the only state whose politicians style themselves as “protectors” of pregnant women and their fetuses.  As in other states in this category, the sanctimonious pronouncements hide a sordid reality of neglect and unconcern for those the grandstanders claim to value.  Mississippi is woefully inadequate in providing prenatal care to its large population of uninsured pregnant women, ranks worst in the nation in health care access and quality, and has the second-highest rate of teen pregnancies in the U.S. (after Arkansas).  It also has high rates of infant mortality, premature births, and low-birth-weight infants. 

As it turns out, the same coercive circumstances that make abortion access difficult or impossible in many parts of the U.S. also contribute to bad outcomes for pregnant women and newborns.  It’s well known that the U.S. has the highest rates of maternal and infant mortality in the industrialized world.  The rates vary widely by region of the country and economic circumstances, with anti-women states like Mississippi leading the way and with the greatest negative impacts on women of color and the poor.  Despite pious platitudes about protecting women and “the unborn,” these states stand out for their callous treatment of women seeking to carry their pregnancies to term.

Recently, I reviewed a book by Louise Marie Roth titled The Business of Birth: Malpractice and Maternity Care in the United States (New York University Press, 2021).  I confess, I wasn’t super-enthused at first.  The subtitle seemed to suggest a rather narrow focus on the intricacies of U.S. tort law and the details of malpractice suits stemming from unfortunate outcomes for pregnant women and newborns.  However, in reality the book has a much broader scope.  The author paints a fascinating, albeit often distressing, picture of the complex interactions of medical practitioners, hospital administrators, insurance providers, malpractice attorneys, and state legislators.  Often the result is a toxic mix of circumstances leading to huge numbers of unnecessary Caesarian sections and chemically induced deliveries, coercion of pregnant women (especially poor, rural, and minority women), outrageously expensive pregnancy care, and, as noted above, the highest rates of maternal and infant mortality in the developed world.  Roth supplements her analyses of changes in law codes and standards of care with interviews with obstetricians, nurse-midwives, lawyers, and insurance adjusters.  The upshot is that less affluent and less educated women can be pressured into episiotomies and repeated Caesarian sections, rendered virtually immobile during labor by the exigencies of constant electronic fetal monitoring, and have their deliveries artificially induced on a Friday so obstetrical staff don’t need to come in on the weekend (resulting in the weekend birth decline notable in many U.S. hospitals).

Roth describes the misleading and often false information medical personnel cite to compel women to consent to procedures that in many cases are unnecessary, expensive, and possibly harmful.  Repeated Caesarian sections, for example, present increasing risks of future pregnancies ending in miscarriage or stillbirth, yet hospital administrators urge or even force them on women ostensibly because of overblown fears of malpractice suits.  But nervousness about legal liability is only part of the story.  In the period 1995 to 2015 the odds of a Black woman with low risk of delivery complications being given a first-birth C-section were 35% higher than for non-Hispanic white women.  The odds of being coerced into repeated C-sections were also higher for Black women. 

There are obvious parallels to the plethora of misinformation pushed on women seeking abortion in many states.  In fact, Roth makes it abundantly clear that the same forces that constrain women’s access to abortion work to prevent many pregnant women’s access to the best care for themselves and their newborns.  

Reproductive health regime	Fetus-centered	Woman-centered
	Mississippi	Oregon
Infant mortality (per 1000 live births)	11.46	5.99
Maternal mortality (per 100,000 live births)	20.8	12.8

Roth distinguishes between fetus-centered and woman-centered reproductive health regimes and persuasively argues that pregnant women and their offspring are better served in states that protect abortion rights “and prioritize women’s rights over fetal life” (p. 10).   She gives numerous examples of both types of reproductive health regimes.  Particularly striking is her comparison of Oregon and Mississippi.  Oregon has no TRAP laws, requires comprehensive health insurance to cover prescription contraceptives and abortion, permits nurse practitioners to provide both medical and surgical abortions, and covers abortion services for the poor with state funds.  The state, emphatically a woman-centered reproductive health regime, has below-average rates of teen pregnancy and infant mortality, good state-supported prenatal care, and above-average maternity care outcomes.  By contrast Mississippi, the epitome of a fetus-centered reproductive health regime, has a large number of TRAP laws, long mandatory waiting periods, and extreme anti-abortion measures that are set to become law as soon as Roe v. Wade is overturned (which will probably happen this summer).  And, Roth would argue, not coincidentally, Mississippi has some of the worst maternal and infant mortality statistics in the country.

Women of Texas: South of the Border for Reproductive Rights

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abortion, abortion access, abortion laws, Mexico, reproductive health, Supreme Court of Mexico, Texas, U.S. Supreme Court

The U.S. border with Mexico

As anyone knows who follows the status of women’s reproductive rights in the U.S., access to safe, legal abortion is becoming more and more difficult.  Onerous laws are increasingly widespread, especially in Republican-dominated states.  The worst of them is the recently passed Texas SB-8, which prohibits all abortion after fetal heartbeat can be detected (approximately six weeks gestation)—a time at which most women are not even aware that they are pregnant.  Moreover, SB-8 deputizes private citizens to sue not only anyone who performs an abortion, but also anyone who “aids and abets” the procedure, be they clinic staff, counselors, nonprofit employees who arrange financing, even Uber drivers taking women to appointments.  The law has been described as a “bounty hunter system.”  Plaintiffs, who do not have to show any connection to the abortion recipient nor do they even have to live in Texas, are awarded $10,000 plus legal fees if they win their case; successful defendants get nothing.

Abortion rights protest in Washington DC

Health rights activists fear that the Supreme Court, whose three Trump appointees are extremely reactionary, will overturn the landmark 1973 Roe v. Wade decision affirming women’s constitutional right to abortion. In response to appeals to block the Texas law pending judicial review, the Supreme Court ruled 5-to-4 to let the law go into effect. The dissenting justices included the normally quite conservative Chief Justice John Roberts, who called SB-8 “not only unusual, but unprecedented,” and said that the law should have been blocked while appeals were underway.  Justice Sonia Sotomayor labeled SB-8 “a flagrantly unconstitutional law engineered to prohibit women from exercising their constitutional rights.”  Justice Elena Kagan called her five colleagues’ refusal to block the Texas law “unreasoned, inconsistent and impossible to defend.”

Justices Sonia Sotomayor (above) and Elena Kagan (below) of the U.S. Supreme Court

On September 9 Attorney General Merrick Garland announced that the U.S. Department of Justice was filing a challenge to SB-8, which he called “clearly unconstitutional” in part because it allows individuals to infringe upon the constitutional rights of others.  Meanwhile, however, abortion services in Texas are in complete disarray.  Dr. Bhavik Kumar (a Planned Parenthood physician who is one of the plaintiffs in a lawsuit against SB-8) has had to turn away numerous panicked women whose pregnancies are past the SB-8 cut-off, and he worries that they will have to resort to unsafe means to end their pregnancies.  Dr. Kumar stresses that it’s plain to all who know anything about women’s reproductive decision making that “banning abortion does not change the need for abortion.”  The women Dr. Kumar’s clinic usually helps will have to go elsewhere.

A Great Step Forward in Mexico

Ironically, for many Texas women, the closest accessible, safe, and reasonable abortion possibility might be across the border in Mexico.  At the same time that five U.S. Supreme Court justices are callously displaying their disregard for the safety and constitutional rights of women, on September 7 the Mexican Supreme Court, in a unanimous decision, ruled that making abortion a crime is against the constitution.  Mexican Chief Justice Arturo Zaldivar noted that the decision “is a watershed in the history of the rights of all women, especially the most vulnerable.”  The decision opens the way for challenges to the laws in most Mexican states that criminalize abortion, and also allows activists to petition for the release of women jailed for the procedure.  Mexican feminist organizations are hopeful that the twenty-eight states that ban abortion under most circumstances will soon be compelled to join Oaxaca, Hidalgo, Veracruz and Mexico City in allowing first trimester abortion.  Mexico will become the fifth Latin American country (joining Argentina, Cuba, Guyana and Uruguay) to decriminalize the procedure.

Chief Justice Arturo Zaldivar of the Supreme Court of Mexico

Some feminists are fully aware that the unanimous decision of Mexico’s Supreme Court stands in stark contrast to what Justice Sotomayor called the “stunning” irresponsibility of her Supreme Court colleagues in the U.S.  Paula Avila-Guillen, executive director of the Women’s Equality Center, said that the Mexican decision is a bright spot in the fight to protect women’s reproductive rights worldwide.  Avila-Guillen saw reason for optimism in Latin America “even as we see the U.S. Supreme Court and Texas walk women back into darkness.”  She also pointed out that the Mexican court’s decision specifically struck down the state of Coahuila’s anti-abortion law.  Coahuila borders Texas, so it could very well be that Texas women will be among those to benefit from Mexico’s ruling favoring women’s reproductive rights.  Avila-Guillen mused: “Could the safest way for Texan women to have access to a safe, legal abortion soon be to make their way to Mexico?”

(Sources consulted include pieces in The New York Times, Axios, CNN and NPR.)

The Outrage of El Salvador

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abortion, abortion laws, anti-abortion movement, El Salvador, fundamentalism, human rights, misogyny, reproductive health

Maira Veronica Figueroa Marroquin (center) released after 15 years in prison

The government and legislature of El Salvador have once again shown their blatant disregard for women’s health and wellbeing by adjourning without voting on proposals to weaken the country’s draconian anti-abortion law. El Salvador is one of the remaining five countries in Latin America and the Caribbean to completely ban abortion under all circumstances. The situation is made even worse for women because the law is enforced with exceptional severity and arbitrariness.

In mid-April 2018 the Spanish-language cable network Univision aired a segment on “Primer Impacto” chronicling Salvadoran women’s rights activists’ attempts to get justice for women imprisoned under the law. At least two dozen women who suffered miscarriages or stillbirths late in pregnancy while not under a doctor’s care (in other words, women from the impoverished majority of the population) were initially charged with abortion, a crime bearing a sentence of up to eight years for both the woman and the abortionist. But prosecutors wound up getting the women charged and convicted of aggravated homicide, and they were sent to prison for up to thirty years. Protests by feminist and human rights organizations within El Salvador and throughout the world have succeeded in freeing five of the incarcerated women. But so far the Salvadoran government and judiciary have refused to review most of the cases. Meanwhile, the proposals to grant exceptions to the ban on abortion when the woman’s life is in danger or when a minor is pregnant as a result of rape have once again been stymied.

The bitter ironies in the Salvadoran situation are many. The tiny, densely-populated country has been experiencing an unprecedented upswing in violent criminal activity, in part because of deportations from the U.S. of Salvadoran gang members from Los Angeles, Washington D.C., and elsewhere (young men born in El Salvador but reared and introduced to crime in the U.S.), and in part because of the large numbers of ex-military and ex-paramilitary individuals left unemployed after the end of the U.S.-bankrolled counter-insurgency war against earlier movements for social justice and national liberation. Yet the government seems more concerned with policing women’s bodies and enforcing one of the harshest anti-abortion laws in the world than in trying to control criminal violence.

Another irony: Salvadoran anti-abortion fanatics have had the unmitigated gall to portray supporters of weakening the anti-abortion law as being under the influence of foreigners. The reality is that worldwide most of the funding of the most strident anti-abortionists comes from Catholic or Protestant fundamentalist organizations based in the U.S. The present Salvadoran outright prohibition is only twenty years old and was enacted in 1998 at the instigation of U.S.-based anti-abortion groups. Earlier Salvadoran anti-abortion legislation was not as sweeping, and enforcement was not so vicious.

In the early to mid-1990s it was possible to have discussions of the harmful public health consequences of illegally induced abortion without participants being intimidated and shouted down by anti-abortion zealots. I myself attended conferences in 1993 and 1994 in San Salvador at which speakers addressed the lack of sex education in Salvadoran schools, the horrible consequences for women’s health of abortion under unsafe conditions, the enormous costs to Salvadoran taxpayers, the need for freely distributed contraception, the injustice of safe clandestine abortions being available to affluent but not to ordinary women, and Salvadoran indigenous women’s use of native plants for abortifacient purposes. These conferences were well-attended and well-publicized, and both were co-sponsored by the Salvadoran Women Doctors’ Association. But by the late-1990s throughout Central America the situation had changed. Anti-abortion fanatics, largely funded by U.S.-based organizations, increasingly made it their business to harass legislators, gynecologists, and women’s health clinic personnel. The atmosphere of belligerence and intimidation has deterred many doctors from performing abortions in circumstances in which they would have had no qualms about performing them in the days before the anti-abortion zealots became so threatening. In the words of the independent legislator who proposed one of the bills that would have softened the ban, “There is a lot more tolerance for corruption than there is for discussion on abortion.”

And so the outrage continues. Groups of self-righteous misogynists directed from the U.S. hypocritically and sanctimoniously proclaim their love of (embryonic) life, while Salvadoran women die from clandestine abortions under unsafe conditions, and at least twenty Salvadoran women languish in prison because they couldn’t afford doctors to bear witness to their miscarriages.

“Lies, Damned Lies, and Statistics”

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abortion, birth control, contraception, Cuba, Gender Inequality Index, maternal mortality, reproductive health, South Korea, statistics, teen pregnancy, UNDP, UNIFEM

These famous words, which Mark Twain attributed (probably erroneously) to British Prime Minister Benjamin Disraeli, have served as a warning that statistics, if used carelessly, can be as misleading as outright lies.

In the mid-1990s I was asked by the United Nations organization UNIFEM to examine cross-cultural statistics on women’s participation in science, technology and medicine (STM). The goal was the compilation of tables for the UN fact book The World’s Women: 1995 .

This being well before the days of easy internet data searches, UNIFEM sent me cartons and cartons of policy papers, data sheets, and women’s organization pamphlets. I poured over the materials for months, trying to contrive tables that would fairly put the status of women in STM in each country in comparative perspective.

I was forced to conclude that the task was impossible. Some data sets only included the percentage of women in STM in tertiary institutions, while others only included women in government research institutes; some collections lumped together women of different ranks or in different scientific specialties, while others meticulously differentiated ranks and subfields; some included even the social sciences and humanities in their definitions of “science,” while others included the physical sciences but not mathematics or engineering. Ultimately, I wrote a piece (the only signed one in the volume) explaining the absurdity of trying to derive meaningful comparisons from such sources.

We find a different sort of methodological morass if we examine the UN’s comparative Gender Inequality Index (GII) (Human Development Report,
United Nations Development Program, 2016). The GII is calculated from three components, one of which is purportedly a measure of reproductive health; it is that component that I’ll discuss here.

The reproductive health component of the GII is computed by combining two indicators: maternal mortality per 10,000 live births and teen pregnancy rates per 1000 women. Once could ask: What about other indicators that in some countries are much more significant than maternal mortality and teen pregnancy rates in assessing the situation? At the very least, the data should include availability of contraception and legality/accessibility of abortion. In the United States one should also track the number of abortion doctors harassed or murdered, the number of clinics and schools intimidated out of offering birth control and abortion information, the number of states with outrageously restrictive TRAP laws, the number of raucous demonstrations at abortion clinics, the number of “Crisis Pregnancy Centers” staffed by anti-abortion zealots masquerading as neutral reproductive health advisers, the decreasing availability of abortion and certain forms of contraception, and so on.

The likely explanation for the UNDP’s use of maternal mortality and teen pregnancy and nothing else is that those are the data that are readily available from most countries of the world with some degree of accuracy (although the ratio of reported teen pregnancy to actual teen pregnancy undoubtedly varies widely from country to country). This is the typical reason why “proxy data” are used: you use the data that’s easiest to get, not the data that would really be most revealing, and you hope that the proxy data at least correlate with what you’re trying to measure.

In the case of the UNDP’s proxy data for reproductive health, what they do correlate with is the overall wealth and level of development of a country. More than anything else, low maternal mortality means a relatively affluent population and a highly developed health care system.

Similarly, the use of teen pregnancy rates skews the results in favor of the wealthier countries, where in fact it’s reasonable to expect that a low teen pregnancy rate signifies widespread availability of birth control as well as adequate sex education in the schools. But note that `teen’ is defined to include 18- and 19-year-olds. In many low-income countries where most men and women do not go to college and a high proportion of the population is rural, early marriage and child-bearing are culturally accepted and not correlated with failure in life. (This was the case in the U.S. until well into the 20th century.) Why then should the GII penalize low-income countries for a high teen pregnancy rate?

Because of what is counted, and equally importantly, what is not counted, there are some curious oddities in the GII rankings. Take South Korea, for example, which ranks tenth in the world in the GII. Because South Korea has a reported teen pregnancy rate of 1.6/1000 (the lowest in the world) and a maternal mortality rate of 1.1/10,000, the reproductive health component of its GII appears close to ideal, and that leads to its high GII ranking. But abortion is almost completely banned in South Korea. Doctors have been prosecuted for performing the procedure, the illegal abortion industry is booming, and there is a large black market in abortion pills obtained illegally over the internet. Women activists have been trying to get the draconian abortion laws revised for years, and have only recently succeeded in convincing the legislature to revisit the issue.

To cite another example, Cuba has a GII ranking of 62 out of 159 countries, while the U.S. ranking is 43. Why does Cuba come out poorly compared to the U.S.? By far the main reason, ironically, is Cuba’s reproductive health component, which is greatly affected by its relatively high teen pregnancy rate of 45.6 per 1000 vs. 22.6 for the U.S. Meanwhile, Cuba has a health care system that is a model for developing countries, and it is the only country of Latin America that has had unconditional reproductive freedom for women for over half a century. (In addition, women constitute 48.9% of the Cuban legislature and 27% of the Cuban Academy of Sciences; the latter figure is the highest percentage in the world.)

My point is not to castigate the UNDP for using statistical methodology that favors the wealthy countries and underrates low-income countries such as Cuba that have progressive traditions in women’s health and women’s rights. Rather, the lesson here is that issues of reproductive health and gender equity are far too complicated to be captured by a single number, especially one that’s computed from proxy data.

Professional Women’s Basketball Team Takes a Stand for Women’s Reproductive Health

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Black Power salute, Colin Kaepernick, John Carlos, Mexico City Olympics, Muhammad Ali, Planned Parenthood, reproductive health, Seattle Storm, Tommie Smith, women's basketball

Occasionally athletes make the headlines because of their visible and vocal commitment to progressive political causes. In 1967 Muhammad Ali refused induction into the U.S. army, saying that he had no quarrel with the Vietnamese people; he was vilified in the press and (temporarily) stripped of his heavyweight boxing title. In 1968, runners Tommie Smith and John Carlos, winners respectively of Olympic gold and bronze medals in the 200-meter dash, drew the ire of conservatives by raising their fists in the Black Power salute during the award ceremony. In 2016, quarterback Colin Kaepernick and later several other U.S. football players began kneeling during the national anthem (which is played before U.S. sporting events) to protest racist violence and show their support for the organization Black Lives Matter.

Black Power salute at the Mexico City Olympics, 1968.

The most recent example of people in the sports world taking a courageous stand on principle concerns the fight to maintain women’s access to reproductive health care. As discussed in previous blog posts, in the U.S. there have been massive and increasing attacks on women’s reproductive health. Misogynist Republicans at the state and federal levels have been assiduously working to defund Planned Parenthood, despite the fact that for many low-income women, the organization provides their only access to health screening exams. In the face of this concerted assault, the Seattle Storm, a professional women’s basketball team which is one of the very few sports teams owned by women, has announced a pathbreaking formal partnership with Planned Parenthood.

On July 18, 2017 the Storm will have a “Stand With Planned Parenthood” rally before their game with the Chicago Sky. Five dollars from the sale of each ticket will go to Planned Parenthood of the Great Northwest and the Hawaiian Islands, and there will be a fundraising auction as well.

Interestingly, the Storm ownership group does not think that their action will be particularly controversial among their fans. In an interview with The New York Times, co-owner Dawn Trudeau noted that the team owners, their audiences and their players share a progressive outlook. Trudeau sees the partnership with Planned Parenthood as a way to “make a meaningful impact on the national health care debate.” According to the Times article, reaction among coaches and players on other professional women’s basketball teams has been very positive. Chicago Sky player Imani Boyette noted that “Planned Parenthood is vital for women who don’t have access to standard health care. I was a P.P. patient in high school because I didn’t have health insurance. Taking a stand for things that affect the underprivileged, as a league and [as] women of privilege, is how change happens.”

As readers of Sex and Herbs and Birth Control know, I am not uniformly positive about Planned Parenthood’s role historically or internationally. Margaret Sanger, the founder of Planned Parenthood, often consorted with racists and eugenicists in her efforts to get funding, and International Planned Parenthood often acts in culturally inappropriate ways. But at present in the United States, Planned Parenthood plays a crucial role in women’s health, and efforts to defund the organization must be resisted. As Boyette notes, Planned Parenthood is often the only recourse for women without health insurance, and is their best option for obtaining mammograms, Pap smears, STD-screening, and low-cost contraceptives.

Cautious Optimism after a U.S. Supreme Court Decision

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abortion, abortion access, abortion restrictions, anti-abortion movement, reproductive health, Texas, TRAP laws, U.S. Supreme Court, Uruguay

Over the past few days, the news media as well as social media platforms such as Facebook and Twitter have been abuzz with news of the U.S. Supreme Court’s 5-to-3 decision in the Whole Women’s Health v. Hellerstedt case. The court struck down the Texas state legislature’s 2013 restrictions on abortion clinics; these restrictions had already caused half the abortion clinics in Texas to close, and threatened many more. A June 27 article in The New York Times called the decision “the court’s most sweeping statement on abortion since Planned Parenthood v. Casey in 1992, which reaffirmed the constitutional right to abortion established in 1973 in Roe v. Wade.”

Justices Sotomayor, Ginsburg, and Kagan. There was a gender gap in the 5-to-3 decision. The women justices voted 3-to-0 to throw out the Texas TRAP law; the men voted 3-to-2 in favor of the Texas restrictions.

People interested in women’s reproductive health have heralded the decision as signaling the likely end of most of the so-called TRAP laws (targeted restrictions on abortion providers) so beloved by right-wing state legislators all over the country. Indeed, anti-abortion forces view Whole Women’s Health v. Hellerstedt as a shocking defeat. (The Washington Superior Court ruling against the Skagit County hospital district for failing to provide abortions that I was so pleased about last week seems like very small potatoes in comparison.)

I have to admit that when I first heard of the Court’s decision, I was as ecstatic as anyone else, and did not particularly cavil at the descriptions of Whole Women’s Health v. Hellerstedt as being a death-blow to the U.S. anti-abortion movement. Upon reflection, however, my enthusiasm has become more measured. Such court decisions are welcome, of course. But history has shown us that one cannot rely upon the courts to ensure fair treatment. After all, the Miranda v. Arizona court decision of 1966 (which limited police powers and required that arrested persons be informed of their right to a court-appointed lawyer) has not notably resulted in equal justice for the poor. And anyone who knows anything about the recent history of abortion in the U.S. is well aware that neither Roe v. Wade nor Planned Parenthood v. Casey ensured access to abortion for women of scarce resources outside of certain major metropolitan centers.

Anti-abortion zealots are already regrouping, and strategizing about what their next moves will be. Their onslaught against the health rights of women over the past few decades has been unceasing, and there is no reason to assume that they will view Whole Women’s Health v. Hellerstedt as anything other than a temporary setback. The TRAP laws have certainly been an effective tactic. But women are also denied access to abortion through intimidation of health care professionals and patients at the doors of clinics, cuts in funding to clinics that provide reproductive health services to the poor, and the failure of more than a handful of medical schools to require their students to learn procedures to terminate pregnancy.

It is, of course, far better for abortion to be legal than illegal. But that is not the end of the story. Sometimes a place where abortion is illegal can have better access than certain other places (such as many rural regions in the U.S.) where it is legal. Take, for example, the South American country Uruguay, which in 2012 became the second country in Latin America and the Caribbean (after Cuba) to legalize abortion under a broad range of circumstances. Interestingly, already for a decade or so before legalization, Uruguay had succeeded in drastically reducing maternal mortality from unsafe abortions by means of “before” and “after” appointments for poor women at the public hospital. Physicians would see women contemplating illegal abortions to instruct them in the correct administration of misoprostol/Cytotec, though they would not provide information on how to acquire the drug (which in any case was freely available over the internet). After the women self-aborted chemically, Uruguayan physicians would confirm completeness of the procedure and if necessary perform a uterine aspiration if there were any complications. This subtle skirting of Uruguay’s abortion prohibitions has come to be known as the “Uruguay Model,” and has been informally adopted by doctors in other countries with restrictive abortion laws, such as Uganda, Tanzania, and elsewhere. See the article by Patrick Adams in The New York Times.