A Tale of Two Books

Tags

abortion, abortion restrictions, anti-abortion movement, Crisis Pregnancy Centers, misleading advice, obstacles to abortion, TRAP laws

Recently, I reviewed two books for a librarians’ journal. Although both examine the experiences of U.S. women who wish to terminate undesired pregnancies, the two books couldn’t be more different. Obstacle Course: The Everyday Struggle to Get an Abortion in America, by David S. Cohen and Carole Joffe, is as straightforward as its title. Using first-person accounts by abortion providers, clinic volunteers, reproductive rights activists, and women seeking abortion, the authors chronicle the difficulties that confront women in most parts of the country: a distressing tangle of TRAP laws, long waiting periods, harassment by anti-abortion protesters, and state-mandated falsehoods that physicians must deliver to their patients before an abortion. These obstacles—which of course disproportionately affect women of color, rural women, and the poor—make accessing abortion far more time-consuming, expensive, risky and stressful than it needs to be (and certainly far more difficult than it is in any other industrialized country).

Cohen and Joffe don’t just focus on the negative, however. They also describe the situation in areas of the U.S. where abortion access is routine. In these places reproductive health clinics are not subject to TRAP laws, women seeking abortions are rarely harassed or stigmatized, and state financial assistance is available. Also, in some states early abortion is possible via telemedicine, and in a few jurisdictions abortion by means of medication can be overseen by physicians’ assistants or nurse practitioners. Obstacle Course is readable, nuanced, and comprehensive; if I were still teaching, I would happily assign it to undergraduates.

The second book, The Pro-Life Pregnancy Help Movement: Serving Women or Saving Babies, by Laura Hussey, has a title that immediately reveals the author’s anti-abortion bias (“pro-life” and “saving babies”). Hussey frankly admits her early involvement in anti-abortion activism and her belief that human life begins at conception. Given her own anti-abortion advocacy, it is not surprising that Hussey’s treatment of the crisis pregnancy centers (CPCs) is admiring and uncritical. Because the CPCs have received negative press for their deceptive practices and intimidation techniques used against women seeking abortion, they have been rebranded by their supporters as “pregnancy help centers.” Hussey not only accepts the rebranding, but styles the women she surveys as benevolent, religiously-motivated “social reformers” whose opposition to abortion stems from their deep desire to serve women.

In Hussey’s account, CPC personnel distance themselves from the more extreme wings of the anti-abortion movement. Interviewees claim, for example, that they avoid what they euphemistically term “sidewalk counseling” but which personnel and patients at abortion clinics see as traumatizing harassment. CPC employees also claim that their work is non-political, and that they have nothing to do with lobbying for TRAP laws, mandatory pre-abortion viewing of ultrasounds and anti-abortion videos, and other barriers to abortion access so ably chronicled in Obstacle Course. (By the way, Karissa Haugeberg paints a very different picture of the women of the CPCs and their support for and in some cases participation in violent anti-abortion activities; see my review of her Women Against Abortion in this earlier post.)

There are numerous questionable aspects of Hussey’s laudatory treatment of the CPCs. To my mind, most damning is her refusal to take a stand on the junk “science” that the CPCs disseminate to their clients. CPCs routinely claim that abortions cause breast cancer, are more dangerous than carrying a pregnancy to term, negatively affect women’s long term mental and physical health, and so on.

These false claims have been refuted by professional bodies ranging from the World Health Organization to the American College of Obstetricians and Gynecologists. Yet Hussey portrays the CPC propaganda as having equivalent weight to those refutations. This stance is inexcusable. By spreading medical misinformation, the CPCs give the lie to their claims to be serving the interests of women.

 

U.S. Politicians Use Pandemic As Excuse to Attack Abortion Rights

Tags

abortion restrictions, COVID-19, misogyny, pandemic, Supreme Court, Texas, TRAP laws, United States

Amy Hagstrom Miller, founder and CEO of Whole Women’s Health. Miller was the lead plaintiff in suing Texas to stop newly passed extremely restrictive laws designed to force the closure of abortion providers. In 2016 the U.S. Supreme Court ruled that those laws were unconstitutional. See the post “Cautious Optimism after a U.S. Supreme Court Decision”

It’s happened again. All reputable commentators are agreed that the medical and social consequences of the coronavirus pandemic will disproportionately affect the poor and people of color. Yet politicians in Texas, Ohio, Mississippi and elsewhere are seizing upon the excuse of the pandemic to make further attacks against the reproductive rights of the most vulnerable populations. Texas, for example, has banned all abortions other than to save the life of the woman on the grounds that abortion is a “non-essential surgical procedure.” First, this ignores the fact that an increasing number of abortions are not surgical at all; rather, they are medical. Moreover, the “non-essential” designation by the Texas attorney general flies in the face of the opinion of the experts of the American College of Obstetricians and Gynecologists (ACOG) and the American Board of Obstetrics and Gynecology, who have issued a statement warning against calling abortion non-essential. On the contrary, these highly-respected physicians say that abortion should be viewed as “an essential component of comprehensive health care” and as such should not be subject to COVID-19 restrictions. But of course, the Texas lawmakers and their ilk are less concerned with the public health of their most vulnerable citizens than they are with pushing through increasingly extreme anti-abortion measures.

Amy Hagstrom Miller (pictured above) is the founder and CEO of the Whole Women’s Health group of clinics, three of which are in Texas. Ms. Miller said that her clinics were forced to cancel more than 150 scheduled abortion appointments in one day, despite the tearful pleas of desperate women who needed the procedure, some of whom had traveled hundreds of miles because many abortion providers in Texas have been forced out of business by the state’s TRAP laws.

Ms. Miller and other reproductive rights advocates and health professionals have noted that it is absurd for the Texas officials to claim that their bans on abortion are intended to free up medical personnel and facilities to deal with the coronavirus pandemic. If it weren’t for draconian restrictions on abortion providers (insisting that the pills used for medical abortion be administered by a physician in person, demanding that patients make two or even three visits to a clinic for ultrasounds and anti-abortion propaganda lectures, for example), clinics could provide early (up to 11 weeks) abortions with one quick visit. Indeed, as some physicians have observed, the procedure for administering early medical abortion could even be handled online. Thus, the rational non-political response would have been to suspend enforcement of the TRAP laws for the duration of the pandemic.

Many women are likely to think that the coming months are not a good time to have another child. Because of the economic impact of the pandemic, which has already caused massive unemployment and especially affects poor and working-class women, the demand for abortion will probably increase. In addition, there are reports that pregnant women are at higher than average risk from COVID-19, especially if they have hypertension, which often occurs during pregnancy, or gestational diabetes. There are also predictions that the pandemic could last for as long as 18 months, particularly if there are two or three waves of infection. In that case some health care systems in underserved regions would be hard-pressed to handle routine medical matters such as prenatal care and childbirth.

In Ms. Miller’s words: “Abortion is essential health care, and it is a time-sensitive service, most especially now in this public health crisis when many people are already financially insecure and futures are uncertain.” She added: “We cannot sit idly by while the state is forcing Texans to be pregnant against their will” (quoted in the Huffington Post).  On March 25, Women’s Whole Health once again sued Texas in federal court. We can only hope that they will be successful. But time is running out for those women whose appointments have been canceled. They will be forced to spend more time, energy, and money in an attempt to secure the procedure in another state that adheres to the ACOG recommendation that abortion be considered an essential part of health care.

As of this writing, it seems that the epidemic has run its course in China with a death toll of under 3,300. In the U.S. projections are grim. A March 25 report from the University of Washington Institute for Health Metrics and Evaluation gave an estimate of 40,000 to 160,000 deaths, assuming a nationwide lockdown. One of the reasons for the human tragedy that’s being played out in the U.S. is that many politicians have refused to respond promptly and appropriately to the pandemic. Instead, they see COVID-19 as an opportunity to advance their anti-women agenda by attacking reproductive rights.

Cautious Optimism after a U.S. Supreme Court Decision

Tags

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.