Abortion and Censorship: A Slippery Slope
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Call it censored, call it buried, call it lost -- the search term "abortion" was all of the above for approximately a month on POPLINE -- a publicly-funded database that its administrators describe as "Your connection to the world's reproductive health literature."
Last week, researchers at the University of California, San Francisco, uncovered this ironic situation while trying to "connect" to "reproductive health literature." Health care providers, researchers, and advocates around the country were alarmed to learn that POPLINE (POPulation information onLINE), had rendered the search term "abortion" a stopword -- which directs the database to ignore the term when used in a search. UCSF librarians discovered this deliberate restriction when they were unable to find a single document containing the word "abortion" in POPLINE's database, and contacted the administrators at the Johns Hopkins Bloomberg School of Public Health to ask them why. Simply put, the UCSF librarians were told that "abortion" was eliminated as a search term by the POPLINE administrators so that the latter could examine the database for information " that might not have been consistent" with guidelines from a government agency that funds the project. And our UCSF colleagues were then given some mystifying, convoluted search term suggestions for finding medical literature on the subject, including "fertility control, post-conception" and "pregnancy, unwanted."
By Friday morning, news of the self-censorship had spread like a virus. Countless members of the medical, scientific, and advocacy communities responded and by early Friday evening, Hopkins Dean Michael J. Klag issued a statement unequivocally denouncing the administrators' decision to censor the word abortion and promising to get to the bottom of it. By Tuesday, he issued a follow up statement citing his opposition to the decision and his speedy response, while blaming "an overreaction on the part of POPLINE staff" to a search by USAID [United States Agency for International Development] officials who "found two items in the POPLINE database that advocated for abortion.â€
So let's pause for a moment and review what happened: a vigilant literature search on the word "abortion" by unidentified Federal employees at USAID resulted in finding two abortion articles in the POPLINE database that they deemed to feature inappropriate advocacy. Once notified by the Feds, Hopkins administrators immediately made abortion a stopword -- an additional step not requested by USAID, but implemented to allow administrators to search for other material that might have been inconsistent with the agency's guidelines -- effectively ending access to abortion research to health professionals and the public on their 30-year-old database.
While giving credit to Dean Klag for his quick response to an untenable situation, there are two important questions that remain: Why are Federal employees at USAID so attentively monitoring scientific research articles on the POPLINE database for the word "abortion"? And why are Hopkins administrators so afraid of them? The Dean states that USAID is prohibited by law from funding any abortion activities or supplies. This is all the more reason for concern by researchers, civil libertarians, health care providers, and patients who deserve the best possible care. But the incident simply points to a larger problem: Federal policy regarding comprehensive reproductive health care is inadequate.
The Real Impact of Limiting Access to Information
The medical and scientific needs of the reproductive health professional community were impeded by POPLINE's decision to remove abortion as a search term on its publicly funded database. If this action had gone unchecked, the decision would have limited the medical and scientific community's ability to access information on a range of patient care scenarios, including women experiencing both wanted and unintended pregnancies.
A clinician seeking information while providing abortion care services would have been unsuccessful in accessing key medical and scientific literature on the topic -- potentially endangering the patient. Women with wanted pregnancies and their health care providers looking for information on spontaneous abortion (miscarriage), inevitable abortion, incomplete abortions, missed abortions, and related medical information would have also been denied this key data.
Unsafe abortion practices claim thousands of lives worldwide every year and any public health student, policy maker, or provider seeking vital information on the topic of unsafe abortion would have also come up empty-handed.
Ideology Trumping Science Is About More Than Just Abortion
The specter of ideology trumping science goes way beyond POPLINE and abortion. There is more visible political opposition to important health classifications like family planning, sexuality, and reproductive health than we have seen in years. Political posturing can get in the way of science, public health, and patient care -- even POPLINE's reputation is potentially at risk.
Over the last seven years, we have witnessed an intentional blurring of the lines between opposition to abortion and a more general objection to contraception. For example, many of President Bush's anti-choice family planning political appointees have been openly anti-contraception as well. Bush's 2002 appointment to a key FDA panel, Dr. Joseph B. Stanford, complained about contraceptive use even among married couples. And more recently Bush appointed Susan Orr as the acting deputy assistant secretary for population affairs to oversee family planning funding for clinics serving poor women, even though she previously worked to limit access to contraception as the senior director for marriage and family care at the Family Research Council, an organization well-known for its anti-contraception stance.
And now the term "reproductive health" is being targeted. At the United Nations, there are unbelievably rancorous debates about whether or not to include the terms "sexuality" and "reproductive health" in treaties because many politicians view them as faux terms for abortion.
It may have been that POPLINE staff made the decision based on fear of losing their USAID funding. USAID does have a history of basing reproductive care funding decisions at least partly on ideology and politics. For example, they have withheld funding from developing countries if potential grantees provide abortion services or give abortion referrals to women.
It's also possible the suggestion came from above. With the Bush administration's history of attempting to (and often succeeding in) restricting access to abortion services and information at every possible turn, it's not so unlikely they'd attempt to scrap the word altogether.
The bottom line is that even self-censorship of a specific term like "abortion" in a scientific setting -- especially as a result of Federal government monitoring -- sets a dangerous precedent. We must follow the example of our UCSF colleagues and make preserving access to reproductive health science a part of our own work plans. It's scary enough to consider the possibility that ideological searches are being performed by anonymous government employees who troll our scientific databases for the word "abortion." "Contraception," "sexuality," and "reproductive health" are the next stopwords, unless we remain vigilant and protest loudly.
This column first appeared at Science Progress, a publication covering progressive science and technology policy, and was written by Pablo Rodriguez, MD, Board Chair of the Association of Reproductive Health Professionals (ARHP), Wayne C. Shields, ARHP President and CEO of ARHP, and Jennifer Aulwes, ARHP Media and Policy Manager.
Dr. Pablo Rodriguez is associate chief of obstetrics and gynecology at Women and Infants' Hospital in Providence, medical director of Planned Parenthood of Rhode Island, and is a clinical assistant professor at Brown University's Program in Medicine. He is the Board Chair of the Association of Reproductive Health Professionals.