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Why Did She Wait So Long? Later Abortions and the Implications of the New Nebraska Ban

6:59 am in Uncategorized by RH Reality Check

Written by Susan Yanow and Kimberly Bullard for – News, commentary and community for reproductive health and justice.

*The stories in this article are true summaries of women who presented for services at the ParkMed Physicians clinic in New York during 2009.  Details have been changed to protect the anonymity of the women.

At 17, Rachel* was a high school senior when her steady boyfriend forced her to have sex. Rachel’s period was not regular, and like her family, Rachel had always considered herself pro-life. When she finally realized that she was pregnant and thought about her strong desire to go to college and her life goals, she realized that for her, abortion was the right decision.

Rachel called the nearest clinic and was informed that her state had a parental consent law, requiring her to get the consent of a parent or a judge because she was under 18. For the next three weeks Rachel feared telling anyone, especially family, but after much deliberation and anxiety she finally told her mother. While her mother was initially angry, within a few days she agreed to help Rachel get an abortion. They called the nearest clinic and got the first available appointment, one week away.  At the appointment, Rachel and her mother were shocked when the ultrasound showed that Rachel was already five months (20 weeks) pregnant. The clinic did not offer abortions past 14 weeks. They referred her to a clinic five hours away, but because of limited physician availability that facility had no appointments for three weeks. They also learned that the clinic could not accept the health insurance that Rachel’s family had. Since Rachel’s procedure would take two days to perform, they would also need to make arrangements to stay in a hotel. Rachel and her mother spent the next three weeks borrowing $2,500 to pay for the travel, hotel, and abortion. On the day that Rachel finally had her abortion, she was 2 days shy of 24 weeks pregnant.

Rachel’s story is more common than many might think. “Pro-choice” or “pro-life,” most people do not realize that although only one percent of abortions occur at 21 weeks or later, this one percent represents about 11,000** women in the United States who get later abortions every year.[1],[2] Many of these women must raise $2,000 to $4,000 to get the abortion they need. These women are disproportionately young and poor, and many already have a job. Some struggle to cover the cost of birth control pills, in addition to food and the next month’s rent. Pulling together the money for an abortion takes time and sacrifice. 

This is compounded by the fact that the nearest abortion provider is often in another state. In addition to various state regulations that restrict access to abortion care, such as waiting periods and parental consent laws, only a few facilities nationwide provide abortions late in the second trimester. Since these abortions usually require two or more days to complete and are not widely available, women who must travel to these providers have to make extensive arrangements for travel, childcare, and accommodations. These all add to the cost for the woman, and as she scrambles to put all the pieces together, the cost of her abortion continues to rise. At 10 weeks the average abortion costs $450.  Each additional week may add $100 or more.  Studies have found that many women who obtain later abortions tried to have the abortion sooner but could not overcome these financial, geographic, and political barriers. [3][4]

For Rachel, being unfamiliar with the symptoms of being pregnant, having irregular periods, her ambivalence about abortion coming from growing up in a “pro-life” family, and being in denial about the fact that her boyfriend had raped her all contributed to late recognition of her pregnancy.  Restrictive policies, a delayed referral, and needing to travel to find a provider who could help her pushed her to present much later for the abortion she needed.

Diana* already had special-needs three year-old twins when she found herself pregnant a second time.  She brought up the idea of abortion with her abusive, alcoholic husband who angrily rejected the idea, despite their current financial and emotional strain.  He demanded she deliver a son for him, a “normal one,” not some “freak show” like before, and punched and kicked her when she argued.

During Diana’s 20th week of pregnancy, after weeks of fear and contemplation, she secretly borrowed money for an abortion from her sister.  Before bed that night, she hid clothing and her purse in the bathtub, planning to slip away with the twins in the pre-dawn hours.  When her husband caught her attempting to leave, he beat her ferociously. Three weeks later, her bruises still present, Diana found another opportunity to leave, this time leaving the twins with her sister. She feared for their safety and her own, but was resolute in her decision to terminate her pregnancy.

She took a bus to New York City, now 23 weeks pregnant, but the abortion was more expensive than planned. A friend offered to contribute, and together they spent another few days raising the additional $300. Diana was lucky; in spite of the delays and obstacles, she found help raising the money and was able to get to New York City where there are abortion providers who could take care of her.

Diana’s story, like Rachel’s, is a typical example of “the perfect storm”- the intersection of life situation, funding and regulatory barriers, scrambling to find a provider and needing to travel – all circumstances that may lead a woman to seek an abortion later in her pregnancy. However, most Americans are unaware of how women find themselves in the center of this storm. According to a 2010 Gallup poll, 45 percent of Americans consider themselves to be pro-choice. Nevertheless, only one quarter of Americans support women’s right to end an unwanted pregnancy in the second trimester.[5] Many Americans become uncomfortable with later abortion because they focus on the developmental level of the fetus rather than on the rights of the pregnant woman, overlooking the myriad reasons that women need later abortions. Without the full picture of women like Rachel and Diana, it is easy to assume that women who obtained later abortions had total control over when to come for abortion care and simply chose to delay. These women are often misjudged as careless and immoral and of not taking responsibility for presenting earlier for abortion care.

The reality is that women need later abortions for many of the same reasons women need any other abortion. A woman or girl is not yet ready to start a family; she’s about to start college; she’s just lost her job; she was raped; she needs to look after her existing children.  Later abortions, like earlier abortions, happen because birth control fails, because the choice of when and how to be sexual is not always a woman’s choice, because obtaining health insurance is slow or out of reach, or because the decision to fully commit to the children that she already has is a moral decision that women take seriously. For some women, a diagnosis of fetal anomaly comes late in pregnancy, for some it comes earlier.  For others, partners leave, houses disappear in hurricanes or floods and their new situation means they no longer feel they can parent a new child. Women who seek early and later abortions alike do not make a decision about a pregnancy in isolation; each woman’s decision is impacted by her location, health, socioeconomic status, race, nationality, religious beliefs and family circumstances.

In April 2010, the Nebraska legislature banned abortions after 20 weeks of pregnancy for all reasons except for the life and physical health of the mother. This law will go into effect on October 15.  What little public discussion there has been about this new law has centered on the constitutionality of the ban or the scientific credibility of the reasons for the ban.  Scarce attention is being paid to the women whose abortions will be prohibited if the ban is allowed to go into effect.

The stories of the women who need later abortions must be placed at the center of the debate.  The Rachels and Dianas of Nebraska have lost access to the abortions that they need. While we may not all agree with the decisions these women make, we can develop empathy and understanding for their situations, along with the awareness that these women are struggling to do the best they can with time against them.  Support for women seeking later abortions needs to start with each of us.

*The stories in this article are true summaries of women who presented for services at the ParkMed Physicians clinic in New York during 2009.  Details have been changed to protect the anonymity of the women.

**Estimated from CDC data containing all states but CA, LA, and NH, plus Guttmacher State Profile data for CA, LA, and NH.

[1] Centers for Disease Control and Prevention. Abortion Surveillance–United States, 2006. Surveillance Summaries, 27 November 2009. MMWR 2009;58(No.SS-8).

[2] Guttmacher Institute. State Center. Accessed 30 July 2010. At:

[3] Finer LB, Frohwirth LF, Dauphinee LA, Singh S, Moore AM. Timing of steps and reasons for delays in obtaining abortions in the United States. Contraception. 2006 Oct;74(4):334-44.

[4] Drey EA, Foster DG, Jackson RA, Lee SJ, Cardenas LH, Darney PD. Risk factors associated with presenting for abortion in the second trimester. Obstet Gynecol. 2006 Jan;107(1):128-35.

[5] Gallup Poll News Service. Abortion. Accessed 21 July 2010. At:

Nebraska and the Falsehood of Fetal Pain

10:21 am in Uncategorized by RH Reality Check

Written by Susan Yanow for – News, commentary and community for reproductive health and justice.

In August I cheered the injunction against Nebraska’s so called “Women’s Health Protection Act.”  This misleadingly named law would have required physicians to present all research about possible health risks related to abortion, even if the information is outdated, false or misleading, to every woman seeking an abortion.  Stopping that law was a victory. But Nebraska is not done with its attacks on women’s rights.

On October 15, Nebraska will enact another law that will have a chilling impact on women’s abortion access.  This law will ban abortions 20 weeks after conception or later, with exceptions only in cases of medical emergency, the pregnant woman’s imminent death, or a serious risk of “substantial and irreversible physical impairment of a major bodily function.”  The bill is based on unsubstantiated and misleading “science” that claims that a fetus can feel pain at 20 weeks.  It is also the first law in the country to exclude a woman’s mental health as a reason for an abortion.  Before this law is replicated in other states, advocates have to prepare us to fight this blatant attack on our right to abortion.

As advocates, we need to be able to talk about the reliable science of fetal pain and the connection between physical and mental health. We need to educate others, and ourselves and combat the use of pseudoscience and unsubstantiated “facts” as tools in the war to limit access to abortion.

The question of whether or not a fetus feels pain during an abortion can be a troubling one to some women and clinicians. The science of what a fetus experiences is complicated – without verbal reports and direct access to the mind of a fetus, scientists can only make inferences about what fetuses are able to experience. What is known is that to experience pain, the brain and nervous system must be developed enough to both react to a noxious stimulus and to have the enough neurological development and organization to experience the stimulus as “pain.” Authorities in both the U.S and Great Britain have conducted thorough reviews of all available studies of fetal pain. Both groups of experts have found that there is no evidence that fetuses develop the neural pathways necessary to feel pain until well into the third trimester. In fact, there is increasing evidence that the fetus never experiences the state of true wakefulness that is necessary for the experience of pain.  Instead, new research shows that the fetus is kept in a continuous sleep-like unconsciousness by the presence of specific chemicals in the uterine environment.  This makes sense; if a fetus inside the uterus could experience pain in the way that a baby can outside of the uterus, the sensation of having its head squeezed through the vaginal canal during birth would be excruciating!  These facts should be very reassuring to women who seek abortions and are concerned about fetal pain.  Advocates need to use these facts to counter those who would use claims of fetal pain to limit our rights. (For more information on Fetal Pain, see this fact sheet and these articles).

While the question of fetal pain is complicated, the concept that preserving a woman’s mental and emotional health is not a “good enough” reason for an abortion is infuriating.  Mental health is as important to women’s well-being as is physical health. Our brains and bodies are connected, and this interconnectedness is well recognized in medicine and in health care legislation. Roe v. Wade recognized the threat to a woman’s mental health as a legitimate reason for ending an unwanted pregnancy.  The Nebraska ban, however, will disallow mental health as a reason for abortion after 20 weeks.  The Nebraska legislature has decided that avoiding theoretical fetal pain (based on discredited scientific theories) outweighs the emotional well-being of a pregnant woman.  Nebraska’s law limits a woman’s right to abortion through the second trimester as codified in Roe v. Wade and presents a clear challenge to Roe.  Once in place, this law will limit the practice of Dr. Leroy Carhart, who currently is the only provider in Nebraska and most surrounding states who provides abortions to 24 weeks (and later for fetal anomalies).  The Nebraska ban will mean more delays, travel, expense and barriers for women in the heartland of our country who need later abortion care.

This is yet another attempt to erode our right to abortion, law by law, week by week. What happens in Nebraska unfortunately won’t stay in Nebraska.  Get the facts and be prepared for similar controversies over fetal pain and mental health in your state. 

How Nebraska’s Anti-choice Legislators “Protect” Women’s Health

8:34 am in Uncategorized by RH Reality Check

Written by Carol Joffe for – News, commentary and community for reproductive health and justice.

“Informed consent is a legal and ethical obligation…Informed consent includes informing the patient about her medical condition, available treatment options, and the benefits and risks of these alternatives……

…the woman should initially be questioned alone about her decision and afforded an opportunity to disclose coercion.  If a patient expresses doubts or misgivings, her options and feelings warrant more extensive exploration.”

The above passage  is from the chapter on “Informed consent, patient education and counseling” which appears in a recent edition of the leading textbook on abortion care in the United States, Management of unintended and abnormal pregnancy.  As the first part of the quoted material makes clear, the expected standard in abortion provision, as with all other medical procedures, is to provide information about the medical aspects of the care to be received, including any risks.  The second portion of the passage is a reaffirmation of what has been the cardinal principal of abortion counseling for nearly 40 years, since the beginnings of legal abortion in the U.S. in the early seventies: The decision to have an abortion must be made by the pregnant woman herself. Finally, the above excerpt contains the straightforward statement that some women presenting for an abortion may need more in-depth discussion of their decision than others do.

Hardly surprisingly, none of this readily available information about the actual practices followed in facilities providing abortion care seems to matter to anti-choice politicians in their zeal to pass legislation the only purpose of which is to make access to and provision of abortion care as difficult as possible for provider and patient alike.  A particularly egregious recent example of this is a bill passed in Nebraska this spring, LB594, the Orwellian-named “Women’s Health Protection Act.”  This Act, which has just been challenged by Planned Parenthood of the Heartland (which covers both Nebraska and Iowa), stipulates that before a patient can receive an abortion, she must be evaluated to “identify any compulsion to consent to the abortion,” as well as be screened for a variety of “risk factors.”  The former is harmless enough, as abortion regulations go, since, as mentioned, abortion providers already ask patients about coercion. It is the latter requirement, the mandated screening for risk factors, where things get surreal—and for providers, impossible to fulfill.

As LB 594 reads:

“Risk factor associated with abortion means any factor, including any physical, psychological, emotional, demographic, or situational factor for which there is a statistical association with one or more complication of abortion….” 

The Act goes on to say that such “information on risk factors shall have been published…in… peer reviewed journals.”  This requirement is simply absurd. To actually fulfill the vaguely stated demands of this law, abortion providers would have to review hundreds of articles, many with ambiguous, if not outdated or irrelevant findings, and figure out how to apply these studies to their patients.  For example, as pointed out in a recent RH Reality Check post, would providers have to take into account a study in Nigeria that concluded Protestant women ran a higher risk of heavy bleeding after abortion?

The most serious problem with this deeply cynical law (which, not incidentally, calls for thousands of dollars in fines for providers who do not fully comply) is that so much of abortion research is highly contested. This is especially true in the area of the alleged mental health effects of abortion. The antiabortion movement has for years waged a campaign to prove that abortion leads to mental illness—the so-called “postabortion syndrome”—and researchers associated with the movement have managed to get articles making this claim into various peer-reviewed journals, in spite of the repeated refutations of this syndrome by mental health professions.  “Peer reviewed journals” it should be noted, refer to hundreds of publications, with vastly different reputations in the medical community.  Should this law go into effect, an antiabortion lawyer seeking damages for his or her client presumably would have little trouble locating a journal article somewhere that demonstrated a “risk” that the abortion provider ignored.

Not only is Nebraska’s Women’s Health Protection Act impossible for providers to comply with, this legislation is not necessary.  With respect to physical health, the excellent safety record of abortion since Roe is well documented. With respect to mental health, the best predictor of a woman’s mental health status after an abortion, psychological experts have concluded, is her mental health before an abortion, and as suggested, there is no support for the existence of “post abortion syndrome.”  Moreover, as I found while researching my recent book, Dispatches from the Abortion Wars, abortion providers all over the country take seriously the message contained in the textbook chapter on abortion counseling quoted at the beginning of this post: Some portion of abortion patients merit further discussion of their abortion decision, and may not be suitable candidates for an abortion, at least not at the time of their initial clinic visit.

One of those whom I observed and subsequently wrote about is Lee Carhart, who, as it happens, is one of the few remaining abortion providers in the state of Nebraska. (Dr. Carhart is a well-known and controversial figure in that state and beyond. He was the lead plaintiff in two Supreme Court cases challenging the ban on so-called “partial birth abortions,” and formerly worked part-time with Dr. George Tiller in Kansas, before the latter’s assassination in 2009.  It is widely believed that yet another recent Nebraska law, which bans all abortions after 20 weeks gestation–on the basis of scientifically inaccurate claims of “fetal pain”– was intended specifically to limit Carhart’s practice).

My observations of Dr. Carhart and his wife, Mary, who works with him in his clinic outside Omaha, took place at a workshop called “Promoting Post-Abortion Well-being” held during a national conference of reproductive health clinicians. At this workshop, both Carharts spoke of the importance of the abortion patient “owning her decision,” that is she must enter the abortion experience with both knowledge and acceptance of what she is doing. Similar to many other providers whom I have interviewed, the Carharts ask each of their patients to fill out a questionnaire, asking such questions as “Whose decision was it for you to have an abortion?”  Patients are also asked to circle words that best describe how they are feeling about their abortion and how they anticipate feeling afterwards. The small number of patients whose answers raise red flags to staff are given additional counseling, and are often sent home to further consider their options. As Dr. Carhart said, of a hypothetical patient who displays a worrisome levels of ambivalence, “She doesn’t have to decide today.”  Most of those who are sent home by the Carharts and urged to think more about their abortion decision return later to the clinic; some don’t.

Whether this ridiculous law is upheld or not, the Women’s Health Protection Act like similarly extreme laws passed recently in various states, serves useful functions for the antiabortion movement.  Such laws, we can reasonably assume, exert a chilling effect on some young physicians who contemplate offering abortion care. One of these laws, it’s proponents fervently hope, may reach the Supreme Court and possibly become a vehicle to reconsider Roe. But even if they are ultimately overturned, these kinds of laws reaffirm to the general public the controversy and stigma surrounding abortion.  Furthermore, laws such as the Nebraska one  help reinforce untruths about abortion, such as the validity of post-abortion syndrome. One thing is clear—its name notwithstanding, this law does nothing to protect women’s health.

Not a Moment to Lose: We Must Protect Abortion Providers’ Rights

6:44 am in Uncategorized by RH Reality Check

Written by Dr. Suzanne Poppema for – News, commentary and community for reproductive health and justice.

When Physicians for Reproductive Choice and Health was founded in 1992, it was a dangerous time for abortion providers. Several of my colleagues had been shot by anti-choice extremists, some murdered, and many clinics were bombed or blockaded by protestors. I wore a bulletproof vest to work at my abortion clinic outside Seattle. It sometimes felt like providers were an endangered species.

Physical violence ebbed over the next decade, but that proved to be a temporary lull. In the past few years, I’ve seen one colleague’s clinic destroyed by arson, while my friend George Tiller was murdered last spring. It isn’t just violence that affects abortion providers today, though—we are also the targets of pointless state laws that limit women’s access to health care. The number of anti-abortion laws this year—about 370—may be a record high.

After LeRoy Carhart declared his intention to continue Dr. Tiller’s work and provide later abortions to women who need them, the state of Nebraska passed a law banning abortions after 20 weeks. Their ostensible reason—that the fetus can feel pain at that point—contradicts the best scientific evidence about fetal development. The real goal of this law was clear from the beginning: to make it impossible for Dr. Carhart to offer women abortions later in pregnancy.

Nebraska wasn’t the only state this spring to target abortion providers and the women they serve. Oklahoma stood out with a series of bills aimed at making abortion more difficult, including a mandatory ultrasound and a lengthy questionnaire doctors must complete before a woman can have an abortion. Meanwhile, Arizona, Mississippi, and Tennessee have blocked women from buying insurance policies that cover abortion, and more states are considering similar bans.

In light of the many restrictions and fears abortion providers must live with every day, Physicians for Reproductive Choice and Health has introduced an Abortion Provider’s Declaration of Rights. The aim of the declaration is simple: to state that abortion providers deserve the same treatment and protections that other physicians enjoy as a matter of course.

Among the rights spelled out in the declaration are: the right to practice medicine free from fears of violence, harassment, and intimidation; the right to give patients complete, medically accurate information about the procedure; and the right to continue their training and conduct research on abortion methods. All are basic rights taken for granted in any other field of medicine, but denied to abortion providers.

While a part of me is discouraged that we need to enumerate these rights, I also know that there is strength in numbers. Among the first signers of the petition were Jeanne Tiller, Dr. Tiller’s wife; his daughter, Rebecca Tiller-Bunting; Dr. Carhart; and other prominent abortion providers. More than 800 people have signed the petition to date, and I urge you to add your name. Together, we can show the extremists and anti-choice politicians that there is a strong community committed to protecting abortion providers and the women they serve.

Nebraska Abortion Laws Reveal Mental Health Misogyny

7:00 am in Uncategorized by RH Reality Check

Written by Amanda Marcotte for – News, commentary and community for reproductive health and justice.

There was a lot of wry joking in the feminist blogosphere this week about the fact that the Nebraska legislature passed a law restricting abortion on mental health grounds (based in a complete disregard for science) and another law restricting abortion so that women who need it for mental health reasons can’t  have it.  This contradiction was rightfully taken as evidence that anti-choicers don’t care about women’s mental health, unless they can use it as a pick to chip away at women’s rights.  But I’d like to argue that the two laws do actually show an intellectual consistency in the anti-choice worldview, one that is fundamentally misogynist.

Feminism is often referred to as the belief that women are human beings.  What we mean when we say this is that our society centers men as the standard issue human beings, and casts women as something other than that.  But what exactly?  Does a patriarchal society cast women as animals?  Demons?  Plants?  At various times in history, you’ll get different answers, but I’d say the modern sexist conception of women is as high-functioning robots that dispense sex, housework, ego-soothing, and offspring for men. Sometimes this model gets disturbingly explicit. (Note the emphasis on shutting up any “output” that might come from a woman’s unnecessary intellectual capacities, i.e. opinions formed in her brain and issued from her mouth.)  Different kinds of sexists put emphasis on different “functions” of the bots we call women—some are more interested in their sexual functions, some in how efficiently they run a household—but this is the common denominator.  Women’s internal lives, hopes, dreams, and well-being are considered secondary to their functions, if relevant at all.

In the anti-choice flavor of sexism, women are cast as baby-making machines.  It would be interesting to analyze how anti-choicers see themselves in a pitched battle over possession of female bodies with men who see women as sex dispensers, but that’s a topic for another post.  The important thing is that if you see women as baby machines, then protecting a woman’s right not to have a baby makes about as much sense to you as protecting a car’s right not to drive or protecting a refrigerator’s right not to chill your food.

Under this model of understanding, “mental health” is related strictly to how well the operating system in the brain handles the task of keeping the uterine functions working.  A brain that says it doesn’t want a baby is broken by definition, and a brain that wants babies is healthy by definition.  You don’t worry about whether your car is depressed or suicidal, after all.  You just worry about whether or not it drives.  Under this model, assuming all women who want abortions are mentally ill (or will be) is perfectly consistent with believing that there’s no reason to allow a woman with mental health issues to have an abortion for her own good.

In case the misogyny underlying this viewpoint isn’t obvious enough, consider then how suicide fits in to all this.  Many women who need abortions for mental health reasons are threatening suicide, which of course is linked in the real world to actually attempting suicide.  But the Nebraska law explicitly excludes potential suicide as a reason for an abortion.  Under the belief that women are human beings, this seems like a cruel disregard for human life.  Under the belief that women are baby machines, though, this makes perfect sense.  If your car was threatening to crash itself so that it had to be totaled so that it didn’t have to drive anymore, in your view it’s about the same thing.  Either way, car’s not driving, so the car is worthless.  I suppose a totaled car can at least be taken to the dump and gotten out of your hair. 

Jessica Valenti discovered a great example of this kind of thinking.  Jessica earlier blogged about a bit of sign protest against the “Abortion Changes You” ads on subways.  The prankster changed an anti-choice sign to read, “Now I can go to college & fulfill my dreams”.  Anti-choice blogger Lori Ziganto completely lost it at the suggestion that a woman might have a good reason to go to college and get an education, dropping the sexually charged word “co-ed” and hinting that college was just about having fun.  Sexy, sexy fun.  Ziganto seems to imagine that there isn’t much to women besides that which happens in or around their uteruses, so if they aren’t baby-making, then they’re sleeping around.    Hey, Penthouse portrays “co-eds” as air-headed bimbos with their legs permanently spread, and Penthouse would never lie, would they? 

It’s mind-boggling to think of how grim a person you must be to come so unhinged at the idea of college kids having some fun, but more than that, it was startling how naked Ziganto’s contempt for women’s education was.  Most anti-choicers know better than to just lay it out there like that.  Most of them, you have to judge by their actions.  But even by that measure, it’s easy to see this belief that women’s minds and well-being are irrelevant is built in to anti-choice policy ideals.  If there’s ever a conflict between the baby-making functions and a woman’s hopes, dreams, responsibilities, or well-being, the former will always win with anti-choicers. 

In the feminist worldview, one where women are human beings, it’s appalling to reduce women to their baby-making functions.  Pro-choicers believe that having children can be a wonderful, powerful thing when desired, but we would never reduce women to a function, whether it’s reproductive, sexual, or chore-based.  We imagine women as full human beings just like men, and that they share the same full rights to self-determination and the pursuit of happiness.  Because of this, we think the stuff that happens above the neck is important in and of itself, more important even than what happens in the uterus.


Caution: Pregnancy May Be Hazardous to Your Liberty

6:25 am in Uncategorized by RH Reality Check

Written by Lynn Paltrow and Farah Diaz-Tello for – News, commentary and community for reproductive health and justice.

While our country stands at a deadlock over legislation to ensure that millions of uninsured people have health care coverage, we can at least feel confident that some state legislators are hard at work, making it more difficult for women to access health care and much easier for states to put them, and the people who help them, in jail.

In Mississippi, legislators proposed a law, HB 695, which would make many forms of midwifery a crime.  That is clearly bad for pregnant women and for babies for at least one very simple reason. As the White Ribbon Alliance for Safe Motherhood pointed out after Hurricane Katrina, when hospitals shut down as a result of a disaster, midwives are among the few who know how to deliver babies without electronic fetal monitors, surgical theatres or epidurals. For this reason, the Alliance highlighted the need to protect (not criminalize) midwives who have the skills needed under such circumstances.

When disasters hit, however, it is not only the women who are going to term who are in trouble. As the National Network of Abortion Funds found out after Hurricane Katrina forced abortion providers to close their doors, many women were also left without access to urgently needed abortion services.

If Utah lawmakers have their way, a woman under similar circumstances who attempts to take matters into her own hands could be charged with murder under House Bill 12, the state’s effort to outlaw “self-abortions.”

Right-to-life organizations have long maintained that if abortion were outlawed, only doctors who performed the abortions would go to jail.  But Utah’s proposed law ensures that women themselves, and not just those who help them, will be incarcerated for a minimum of 15 years. (Since 61 percent of women who have abortions are already mothers, a woman convicted under this law would, with any luck, be out of jail in time to see her son or daughter graduate from high school.)

Even without such a law, police officers in Iowa recently arrested a woman in her second trimester of pregnancy for the crime of attempted feticide after she tripped and fell down a flight of stairs. The county attorney’s office dropped the case only after they decided that their unprecedented interpretation of the feticide law should only be applied to pregnant women in their third trimester. But in Utah, the law would expressly apply to pregnant women at all stages of pregnancy. So, if you are pregnant and clumsy in Utah, you could be charged with attempted murder, even in the first trimester.

As a sign-on petition opposing the Utah bill points out, pretty much any woman who suffers a miscarriage or stillbirth and is engaged in an activity that she “should have reason to know” would endanger her fetus can now be charged with murder or attempted murder.

Suffer a pregnancy loss after a car accident you may have caused?  Murder.  Follow your doctor’s advice to treat your cancer despite the risks it might pose to your unborn child? Attempted murder.

Bizarrely, the Utah law has an exemption that protects women who “fail to follow medical advice,” but nothing in the law protects women who do follow medical advice. Thus women who disagree with a doctor’s advice to have cesarean surgery can’t be prosecuted, but a woman who takes prescription medications that may risk harm to an unborn child could end up behind bars.

Meanwhile, in Kentucky, House Bill 136 would create a new crime just for pregnant women. According to this law, “[a] woman is guilty of substance endangerment of a child prior to birth when, knowing she is pregnant, she causes her child to be born” with controlled substances or alcohol in the child’s bodily fluids. What that means is that, if this law is passed, it would literally be a crime for a pregnant woman to give birth if the child she gives birth to has any amount of a controlled substance or alcohol in its body.

It is well known that laws which threaten to punish women who carry their pregnancies to term in spite of a drug or alcohol problem place substantial pressure on women to have unwanted abortions. This is because it is hard for people to overcome an addiction quickly (just ask Rush Limbaugh). For pregnant women who face many barriers to treatment, there is no guarantee that they will be cured quickly enough to be sure they won’t be arrested if they go to term. Such laws are also known to deter women from care, increasing the risks to maternal, fetal and child health. It would be nice to think that Kentucky legislators did not mean to make it a crime for some woman to cause their children “to be born,” but the fact that this law has been proposed over the objections of every leading health group makes us wonder.

And finally, we wonder about Nebraska’s commitment to protecting fetuses from pain. Nebraska House Bill 1103 would protect some fetuses from pain by banning virtually all women from obtaining abortions after the 20th week of pregnancy.  Although abortions after 20 weeks of pregnancy are extremely rare (constituting only 1.5 percent of all abortions), and the doctors who perform them are heroes to the women who need such procedures, this law would make those doctors criminals.

The Nebraska legislators who support this bill claim that after 20 weeks of pregnancy an unborn child is capable of experiencing substantial pain. Certainly, if this is true, then fetuses must also suffer pain from forceps deliveries, internal electronic fetal monitoring (requiring the insertion of sharp metal wires into the delicate fetal scalp) and from chemically induced labor in which the fetus is subjected to repeated, violent maternal uterine contractions and then forced through the narrow vaginal canal. If Nebraska legislators were truly committed to preventing fetal pain, then they should also ban pitocin-induced vaginal births and other fetal-pain inducing delivery techniques and arrest the doctors who carry them out.

The lawmakers supporting these bills claim that they are trying to bar bad things from happening to pregnant women and the unborn. But whatever their stated good intentions, make no mistake, these bills are really about putting pregnant women and the people who support them behind bars.

A Closer Look at Nebraska’s Proposed “Fetal Pain” Ban

6:50 am in Uncategorized by RH Reality Check

Written by Robin Marty for – News, commentary and community for reproductive health and justice.

By introducing the "Abortion Pain Prevention Act," Nebraska Senator Mike Flood has stepped away from his role as legislator and has instead positioned himself as a health authority…despite having no medical background.

But when it comes to determining when a fetus can feel pain, apparently your own anti-choice views have as as much influence on your opinion as actual medical science. In Nebraska, the debate between science and ideology could help determine the fate of the "Abortion Pain Prevention Act," which would ban all abortions in the state performed after 20 weeks conception, except in cases of potential maternal death.

According to state Sen. Flood, 20 weeks conception (or 22 weeks as most people track a pregnancy), is the point at which the fetus can feel pain, according to the Senator and based on conversations he has had with doctors.

Of course, the doctors with whom he conferred are on the record as being anti-choice.

As Dr. Jean Wright, Chair of Pediatrics at Mercer University School of Medicine has observed, 35 years ago neonatology was in its infancy:
“The understanding of the physiology of the pre-term infant, the equipment, medications, physicians, and specialized units available to care for them were present, but limited. By contrast, today there are thousands of neonatologists, hundreds of Neonatoal Intensive Care units, and breaking discoveries in the world and womb of the developing fetus.” As an example, what was at one time unthinkable, today children are born and survive at just 23 weeks gestation, as medical science continues to push the frontier of fetal viability.

Dr. Jean Wright was a featured speaker at the Focus on the Family Conference of Medical Professionals and Spouses in 2008.

The Omaha World Herald interviewed numerous doctors to try and get a consensus from the medical community on exactly when a fetus feels pain. No recognized medical authority supports the contention of fetal pain.

The article also, interestingly enough, stated which of the doctors it questioned consider themselves to be anti-choice. Four out of five of the doctors who stated that a fetus can feel pain before the typically assumed 27-week point in development told the reporter that they are anti-abortion or at least support restrictions on women’s rights to choose abortion (the fifth, Dr. Roland Brusseau, a perdiatric aenesthsiologist, did not offer his position one way or the other).

The contention that fetuses can feel pain is based on the response to needles, indicating the fetus may feel the stimuli. But, as the Herald article points out, the reflex doesn’t mean that the needle can actually be "felt." Indeed there is no evidence a fetus can feel pain earlier than the third trimester. According to the article:

[I]n a review of fetal pain literature, University of California-San Francisco physicians reported in 2005 that “fetal perception of pain is unlikely before the third trimester,” or about 27 weeks into the pregnancy.

The review, published in the Journal of the American Medical Association, said reflex movement isn’t proof of pain, because it can occur without the brain being developed enough for conscious pain recognition.

The American College of Obstetricians and Gynecologists’ position is that it “knows of no legitimate scientific information that supports the statement that a fetus experiences pain at 20 weeks’ gestation.”

It’s a good thing anti-choice advocates don’t let things like "scientific facts" or "studies" get in the way when creating legislation that affects women’s human rights, their health and lives.