Carole Joffe

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Abortion Politics in the Nursing Home

Linda Johnson went to a nursing home one day to visit her elderly mother, who was recuperating from heart disease. During this visit, Linda had two unexpected encounters. The thing you have to know about Linda to appreciate both these incidents is that she has run an abortion clinic in a mid-sized Southern city for many years. The first encounter was a very pleasant one. "This nurse, 'Fran' was on her nametag, came into my mother's room. She closed the door carefully, and hugged me! She said, 'don't you remember me?' I said, 'well, no I don't.' She said, 'I was your patient many years ago. You saved my life. I was in a relationship that was really bad, and you told me to do what I needed to do. And it all worked out.' She then turned to my mother and repeated, ' 'Your daughter saved my life. If there is anything you need, just let me know.' Then she left."

Linda and her mother didn't know how soon they would be calling on Fran to make good on her promise of help. The second encounter was hardly pleasant. As Linda tells it, "Not five minutes after the nurse leaves, someone else comes into the room -- it's Ann Marie Starr, my stalker!" This Ann Marie, it turns out, is head of the local antiabortion forces, and for years has not only protested at Linda's clinic, but periodically follows Linda around town. "If she sees me in the grocery store, she'll start screaming at me … I just wait for the manager to throw her out."

Ann Marie, a regular volunteer at the nursing home, apparently had seen Linda's car in the parking lot, and had tracked down the location of her mother's room. "She started hassling my mother, telling her she'd pray for her, but given what I'd done, she might have to go to hell anyway. My mother begged her to leave, but Ann Marie refused, and started yelling about her 'right' to be there." The bizarre episode ended when Fran, hearing the uproar, rushed back to the room. "Fran is a good-sized woman and she just physically dragged Ann Marie out of there."

In reflecting about this incident, I began to see an aspect of the unending abortion wars in America I had not fully appreciated before. That those who provide abortions, either as clinicians or administrators, can be relentlessly pursued in their communities by their opponents -- hounded not only at their workplaces, homes and churches, but virtually anywhere where they might be spotted, as this nursing home story shows -- is hardly news. And while presumably any nurse, whatever her personal history, would have stepped in to remove an unwanted intruder, Fran's participation in this drama reminded me that there are millions of supportive "civilians" aiding the abortion providing community in this war, many with a history of deep gratitude for the abortions they or a loved one once received.

Linda's recollections to me about the nursing home incident came in the context of a larger conversation about the various acts of threatened or real violence her clinic had faced over the years, and the many outsiders who were unwittingly drawn in. She told me of a sobering meeting with an FBI agent, which led to her informing her Fed Ex driver, her UPS delivery person, and her postman of the possibility that they might be handling dangerous mail. Indeed, when her clinic was among the hundreds of abortion clinics receiving letters claiming to contain anthrax, it was her postman who was the first to handle that letter. He was subjected to various precautionary medical procedures until the substance could be definitively ruled as harmless. When antiabortionists (led by Ann Marie, she suspects) attacked her clinic with an infusion of butyric acid -- a colorless liquid with an extremely unpleasant vomit-like odor -- it inconvenienced all the tenants in the building in which her facility leased space. When her clinic received a package that looked suspicious enough to call the bomb squad, again all those in her building were put on alert.

To my considerable surprise, Linda told me that in all in the above instances, these outsiders were very supportive and showed no rancor toward her or the clinic. The postman told her "he was just doing his job," and the other tenants in the building saved their anger for "the crazies" who were massively disrupting everyone's day.

To be sure, not all past abortion patients remain as grateful as Fran, the nurse in this story, as the existence of groups like Women Exploited by Abortionmakes clear. And even if most of the millions of former abortion patients do remain pro-choice, the beleaguered abortion providing community understandably wishes that this "silent majority" was more often outspoken, for example by pressuring politicians to support legal abortion.

Nevertheless, speaking with Linda made me realize that the antiabortion movement would be much farther along in its goal to stop abortion care were it not for the largely overlooked determination of many everyday decent Americans to stand with the provider community against its foes.

Child Health Care Tangled in Anti-abortion Politics

A different version of this article originally appeared on RHRealityCheck.org.

Whether out of genuine compassionate conservatism or a fear of voter retaliation, two ordinarily reliable right-wing Republican senators, Orrin Hatch and Chuck Grassley, have "implored" George Bush not to follow through with his promised veto of the expansion of SCHIP, the State Children's Health Insurance Program that began in 1997.

SCHIP, a hugely popular program across the political spectrum, provides health care for children whose parents make too much to be eligible for Medicaid but are too poor to purchase private insurance on their own. While the House and Senate bills are somewhat different, each would increase funding substantially more than the Bush administration is offering. The Senate proposed a $35 billion boost over the next five years, compared to Bush's $5 billion increase. To put these increased costs into perspective, the Senate bill would cost less in the next five years than the government will spend in the next four months in Iraq.

Bush's Orwellian reason for opposing the expansion of SCHIP is that the program works too well. Namely, that people would get the idea that perhaps a proper role of government is to provide health care to its citizens.

"My concern is that when you expand eligibility ... you're really beginning to open up an avenue for people to switch from private insurance to the government," Bush said in an interview with Washington Post reporters.

But Bush's deplorable response to expanding SCHIP is not just about opposing government-provided services. Like so much else in his presidency, the Bush administration's record on SCHIP is also entangled in anti-abortion politics.

In 2002, his Department of Health and Human Services issued a regulation that stipulated "unborn children" -- but not the pregnant women carrying them -- were eligible for SCHIP funds. This move contradicted well-established standards within the medical community. Both the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics have stated that the pregnant woman and her fetus should be treated together.

Immediately after this regulation was issued, health care providers feared that funding for crucial pregnancy-related services that did not directly relate to the "unborn child" -- such as pain medication during delivery and postpartum services -- would be denied to women under SCHIP. The twelve states that have elected to use SCHIP funds for pregnancy care have largely managed to get around this restriction through various maneuvers; however, some gaps remain. In Texas, for example, the SCHIP program does not pay for certain services that could affect a woman during her pregnancy, such as cardiac care and asthma management. And although that state does pay for postpartum care, it does not provide for family planning services at that visit, which is an expected standard of care, according to medical guidelines.

Why did the Bush administration propose this cruel and absurd policy in the first place? The availability of services to poor pregnant women was not the point. The distinction that this SCHIP regulation drew between the "unborn child" and the pregnant woman can only be understood as part of a larger antiabortion strategy (enthusiastically supported by the Bush administration) to lay the groundwork for establishing a legal basis for "fetal personhood."

The SCHIP measure is akin to the "Unborn Victims of Violence Act" passed by Congress and the "fetal pain" legislation that has been introduced at the federal level and passed in several states. Such legislation requires doctors to offer women getting abortions in the second trimester anesthesia for the fetus, even though an exhaustive review of the literature by respected researchers -- one that was published in the Journal of the American Medical Association -- concluded that fetuses were incapable of feeling pain until the 29th week of gestation.

SCHIP's privileging of the health needs of the fetus over that of the mother is echoed in the recent Supreme Court decision, Gonzales v Carhart. There, the Court (with the help of Bush's two appointees) ruled that it was appropriate to override the medical community's judgment about patient safety and ban a certain procedure "in order to promote respect for ... the life of the unborn." And, most stunning of all, for the first time since Roe v Wade, the Court held that considering the health of a pregnant woman is no longer constitutionally necessary in abortion law.

The saga of George Bush's treatment of SCHIP therefore represents a perfect marriage of two of the main pillars of his presidency: a full throttle opposition to effective government programs, and a relentless promotion of measures favored by his Religious Right base.



The Loneliness of the Abortion Patient

"I think that people should be held accountable for their actions and a lot of times it's the convenience of the situation that makes it easy ... to get an abortion, and if I wasn't the person that I was, I mean this would be real easy for me, just real simple. ..."

Jessie is a 23-year-old woman, the mother of two children, having her third abortion. Her comments are drawn from a small interview study (16 women interviewed thus far) we are conducting to understand the impact of state-imposed regulations on women having abortions in two highly regulated states. In our talks with Jessie and other women, we uncovered a striking sense of isolation among many abortion patients. Rather than expressing solidarity with others experiencing unwanted pregnancies, nearly all our respondents took pains to distinguish themselves as different from other women getting abortions.

Though there were some expressions of sympathy, we also heard disparaging remarks about women who were too careless about contraception and were obtaining abortions too "easily." "I am a Christian; I am not doing this casually," one woman said, with the clear suggestion that others in the waiting room were not so thoughtful or moral. Perhaps the starkest example of isolation came in one woman's response to the question of whether she would "ever consider being part of a group that supports people who get abortions?" Her answer was an emphatic "no!" As she put it, "I wouldn't support them (other abortion recipients) because ... it [might become] a habit for everyone." The speaker was a 20-year-old mother of one, who was about to have her second abortion.

The situation we describe is very different from the one that existed in the United States in the 1970s, around the time of legalization of abortion. Then, many women seeking abortions felt part of a larger movement. "Second wave" feminism was flourishing and women's health issues were a central focus of the movement. People still had fresh memories of when abortion was illegal, and thousands of women died and many more were injured from unsafe abortions. Rather than being ashamed, many abortion patients of the pre-Roe v. Wade era recall feeling entitled to having this once dangerous procedure done in a professional and women-centered setting.

The new occupation of "abortion counselor" was established in this period -- someone who explained the procedure to the patient and accompanied her throughout her stay at the clinic. Feminist health activists pressured the newly established clinics to keep prices low and to make sure doctors were sufficiently respectful to their patients. In short, for many patients in the early years of legal abortion, the experience was both "personal and political," in that there were constant reminders that this medical procedure was tied to a larger movement. In contrast, in many of today's clinics, the staff is so busy complying with state-imposed "informed consent" requirements, which often involve telling patients downright lies -- for example, the supposed link between abortion and breast cancer and other distortions of risks of the procedure -- that there is rarely the opportunity to impart a positive political message about reproductive justice.

We are not suggesting that there no longer exists a movement for abortion rights. Today, there continues to be an extremely hardworking, multifaceted "reproductive justice" movement, as it is often now referred to. There are dedicated healthcare providers who resolutely go forth each day to provide abortion care, often risking their personal safety. There are lawyers who work tirelessly to stem the tide against the various restrictions imposed by anti-abortion politicians and by the Supreme Court ( as in the recent egregious case, Gonzales v. Carhart, which banned a type of abortion that is sometimes medically necessary to care for women in the second trimester of pregnancy, and which imposes stiff criminal and civil penalties for providers who perform the procedure). There are advocates who engage in crucial activities, ranging from raising money to help low-income women obtain abortions, to organizing political campaigns, such as the recently successful one in South Dakota, in which voters defeated a measure to ban nearly all abortions.

Yet a clear gap -- of class, income and education -- exists between those who work in this increasingly professionalized reproductive justice movement and those women who now form the majority of abortion patients. A recent study from the Guttmacher Institute, the leading research organization on reproductive health issues, paints a dramatic picture of the divide between nonpoor and poor women: "The abortion rate among women living below the federal poverty level is more than four times that of women living above 300 percent of the poverty level." Not surprisingly, there is a similar gap in access to contraception, leading the Institute to speak of "Two Americas" for American women with respect to the ability to control their reproductive lives. (http://www.guttmacher.org/media/nr/2006/05/05/index.html)

The women we encountered in the waiting rooms of three abortion clinics, located in the South and Midwest, have little experience with the contemporary reproductive justice movement, or indeed of politics in general. But they are highly aware of the shame and stigma surrounding abortion. Some spoke of their fears of being recognized in the waiting room by acquaintances. Others, when asked if they would have preferred to have their abortions performed by their own doctors, in their home towns, rather than undertaking a drive of several hours to a clinic, recoiled at the thought. "I don't think that I would be comfortable going to my ob-gyn for an abortion, knowing that's the same man that delivered my children. ... I would think he would think of me differently. ... I mean, he sees me in one light, and that's the way I want him to see me."

None of the women interviewed said they thought abortion should be illegal. But many expressed ambivalence about their decision to have one. An unmistakable sense of sadness hovered around our conversations. Ultimately, these women made the decision to have an abortion for the same reasons women always have: Their recognition that they could not adequately care for a child at this moment in their lives. This seemed especially true for the more than half of our interviewees who already have children.

Most of all, the abortions sought by our interviewees seemed to symbolize for them their personal failures to achieve the lives they wish they had. As Linda (who already had two children) said wistfully, when asked if there were circumstances under which she would not have had the abortion, "If my old boyfriend would still be with me, not caring I was pregnant ... or, if I had the money and my own house, my own car, maybe I wouldn't care about having a man beside me, and I could just move on with my kids."

The stories of the women we met in the clinics are so grim -- with tales of unreliable male partners, minimum-wage jobs that don't allow them to properly care for the children they already have, broken-down cars and inadequate social support -- that it becomes clearer than ever that "reproductive justice" means far more than accessible contraception and abortion. Affordable housing, living wages, better child care, intimate partner violence programs and universal health care are things the movement must fight for in order to give these women and their children a shot at a decent life. And if that weren't enough, a challenge of a different nature is to make the lonely women in the waiting rooms feel part of that struggle.

Abortion Hotlines Feel the Crunch

"It's a sad calculus ... It helps if they are farther along in pregnancy rather than earlier. Or if they are living with their batterer, and he would know if they'd pawn anything. Or, if they are homeless ... like we got this call last week from a woman whose house burned down and her three children were taken away. We were able to get some money for her."

Laura, the case manager at the hotline of the National Abortion Federation, is explaining to me the triage that occurs in the effort to help desperate women raise money for abortions they can't afford. Most of the hotline's approximately 100 callers per day are simply looking for a referral to an abortion provider in their area. But a sizable minority seek the hotline's assistance in raising money from the various nonprofit abortion funds around the country and from NAF's own small discretionary fund.

Because there is not enough money to go around, being poor is not enough. "You have to have 'extenuating circumstances'" Laura says. Not surprisingly, rape is one such extenuating circumstance which the various abortion funds respond to. In fact, if state governments were obeying the law, the hotline would have to raise far less money for rape victims. The Hyde Amendment, a measure passed in Congress shortly after Roe v. Wade, forbids the use of Medicaid funds to pay for abortions but makes exceptions for rape, incest and threats to the life of the mother. Many of those rape survivors who asking the hotline for help are on Medicaid.

The problem however is that numerous state Medicaid programs simply refuse to enforce this provision. Fighting with anti-abortion state bureaucrats often drags on indefinitely and pushes women later into pregnancy — making the procedure even more expensive and a provider more difficult to find. Therefore last year nearly 28 percent of the $136,000 that the hotline helped raise went to those who are theoretically eligible for state funding.

But even those sufficiently high on the "extenuating circumstances" spectrum to qualify for financial aid often don't get enough to pay for their abortion. First trimester abortions costs range from about $300 to $500. Second trimester ones can cost over $2,000. As I sit and listen to Laura work the phones nonstop, I realize that much of what she does is a quite unique, and certainly challenging, form of financial counseling. Her task is to instruct her often indigent callers in the delicate art of fundraising.

"Could you ask your friends for $40? If they say 'no,' maybe ask for 20 or even 10?" I hear her ask in her calm voice. Later she tells me that this woman has been evicted from her house for lack of rent, and is crashing with her three children at a friend's. To another caller, I hear her say, "Well, do you have anything you might pawn? Some jewelry? A TV set?" And to another, "Is it possible you could postpone your car payment until after the abortion?"

Laura's case management is strikingly labor intensive. She averages about 15 phone calls per case -- with the client herself, with the various abortion funds, with the clinic that is the potential site of the abortion -- whether in the end the woman successfully obtains sufficient funds for an abortion or not.

After blocking the callers' names and other identifying information, Laura shows me some of the intake forms of the past month. The meticulously kept log of each call made or received hints at lives lived at the edge. For example, in response to the item on the form that asks about possible funds to be raised from the "man involved with pregnancy," I see the stark one-word response, "Crackhead,” recorded verbatim by a hotline staffer while talking to the patient. "No idea where he is," reads another response, and a third, "Has nothing." The hotline staff assures me, however, that there are numerous instances of "good guys" -- fathers and husbands and boyfriends -- who actively participate in the search for funding.

In response to the question about "items to pawn," one form’s entry reads, "No TV." Another simply says, "House robbed, nothing left." There are numerous references to domestic violence, and an over-representation of pregnancies resulting from rapes. (Nationally, about 1 percent of all abortions occur because of rape).

Sometimes the grim realities of the callers' lives means that even seeming victories can include defeats. Consider, for example, the case of a woman from a Southern state, a mother of five, who lives in a mobile home. Believing herself to be 15 to 16 weeks pregnant, she obtained a tentative appointment at a clinic, which informed her the cost would be $450. Through a combination of Laura's calls to various funds and the patient's own fundraising -- I see a notation about "yard sale" in the file -- they were able to cobble together the necessary money. Reading this, I can visualize Laura and Rachel, the hotline’s director, pumping their fists in the air and going "Yesss!" as they once again have been able to help.

But there in the chart, I see a subsequent entry: "Patient called to leave message -- said she lost her ride to clinic." By the time the woman did make it to the clinic, according to Laura's crisp notes, "Pt sono'ed [had an ultrasound] at 18 weeks [gestation age], and clinic raised cost by $440. Pt decided to continue pregnancy since she didn't have sufficient funds to have abortion."

Talking to Laura and Rachel about this case, they confirm that this is not an uncommon thing. Many of the women who call her do not have cars and are dependent on sometimes unreliable friends and relatives to get them to their appointments. The problem of "sono'ing over," as the hotline staff puts it, is a serious one. Either the patient's pregnancy has advanced past to the point where the providing facility no longer performs abortions, or -- as in the case above -- the cost has become prohibitive. (While some might find the clinic's response coldhearted, in fact abortion costs have remained remarkably flat since 1973 -- and many clinics already offer a considerable amount of subsidized care.)

To be sure, there are unqualified triumphs in the hotline room as well, when patients beat the odds with a combination of luck and tenacity. Laura tells me of a woman from a mid-Atlantic state with a mind-numbing series of problems. Already the mother of several young children, she was in the midst of a difficult divorce from an abusive husband, against whom she had acquired a restraining order. "My husband would kill me if he found out I was pregnant," she said. She was about to be evicted from her home, because of difficulty in paying the rent. She had become pregnant after being given a "date rape" drug. The woman had duly reported the rape to police and was determined to get her state's Medicaid program to pay for her abortion.

This involved a massive effort on the patient's part. Though so poor that her phone was disconnected (communications with the hotline took place via a neighbor's phone), she managed to find a public internet connection and download the necessary form for a Medicaid payment for an abortion involving a rape. Then she embarked on a Kafkaesque series of phone calls with state Medicaid officials, all of whom were determined to prevent approval of her abortion. Through the help of a public interest lawyer in the hotline's network, the patient finally was able to access someone high enough, and sympathetic enough, in the Medicaid hierarchy who could approve her request.

The next obstacle was to find a provider in her rural area who would accept a Medicaid-paid abortion. Neither her "anti-abortion" primary care doctor nor her equally anti-abortion OB/GYN were any help. Finally, after much frantic calling around, with the hotline's help she located a clinic that performed her abortion. "And all this calling and arranging happened in just four days!" Laura marveled.

The stories of many of the women asking the hotline for financial help suggest situations so challenging that affordable abortions would hardly solve their problems. In the long run, only in a society that provides what is now lacking in contemporary America -- affordable housing, living wages, better child care and domestic violence programs, and above all, national health insurance -- would these women and their children have a shot at a decent life.

In the short run, however, accessible and affordable contraception and abortion would make an enormous difference. The Centers for Disease Control states in a recent report that 98 percent of heterosexual women use contraception "at some point." But this number masks the fact that use of birth control use is gradually decreasing, especially among poorer women. The Guttmacher Institute, the leading research organization on reproductive health, has pointed out that, between 1994 and 2001, 33 states cut funds for birth control and that half of all poor women who need birth control services are unable to afford them.

In what might seem like a ray of hope, House Democrats have just introduced legislation, the Reducing the Need for Abortions and Supporting Parents Act, that would require states to cover contraceptives for women with incomes of up to 200 percent of the federal poverty level. The bill would also establish grants for sex-education programs that include information on both contraception and abstinence. It also contains various other family-friendly measures, including increasing funding for health care for low-income women with children, providing no-cost visits from nurses to teens and women who have given birth for the first time, expanding tax credits for adoption and increasing child care funding.

No Republicans publicly support this effort, and it is opposed by the Democrats for Life caucus, "because of the pregnancy prevention emphasis." This lack of support for what should logically be common ground in the abortion wars reflects the new aggressive stance by much of the anti-abortion movement. Contraception itself is now being reframed as another form of abortion. This bill has virtually no chance of passing in the current political climate. And the calculus for the hotline callers just keeps on getting sadder.

Reproductive Regression

"Most commonly, they ingest a whole bottle of quinine pills, with castor oil…we try to get them to the ER before their cardiac rhythm is interrupted…Sometimes they douche with very caustic products like bleach. We had a patient, a teen, who burned herself so badly with bleach that we couldn't even examine her, her vaginal tissue was so painful…."
"Our local hospital tells me they see 12-20 patients per year, who have already self-induced or had illegal abortions. Some make it, some don't. They are underage or poor women mostly, and a few daughters of pro-life families…"
If you assume the quotes above come from a veteran of the abortion rights movement, talking about the "bad old days" before Roe v. Wade, when desperate women suffered death and injuries because abortion was illegal, you'd be partly right. The speaker is a longtime worker in reproductive health, whose involvement with abortion started before Roe. But the situations she describes are occurring now. 

Jen (not her real name) is administrator of a women's health clinic in the South that provides abortions. She has noted with alarm the recent rise in illegal abortion in her community. For some of the women she sees -- after their initial attempts at abortion fail -- whether Roe v. Wade is technically still the law of the land is beside the point. The combination of the procedure's cost, the numerous regulations that her state imposes and the stigma surrounding abortion is leading a growing number of women to choose self-abortion or an untrained practitioner over legal abortion. Finding accurate data about the number of cases is almost impossible.

However, Jen's abortion-providing colleagues in other parts of the country, who communicate their experiences through a listserv, share her observation of a recent perceptible rise in illegal abortion in their clinics as well. Indeed, in another eerie echo from the pre-Roe era, the increase in illegal abortion in Jen's area is so significant that a doctor from the hospital mentioned above contacted her. He asked for her help in setting up a special ward for the treatment of illegal abortions when Roe is overturned, because he knows the caseload will mushroom then. "He didn't say 'if' -- he said 'when,'" Jen said. "Chills ran down my spine."

Why is all this happening when abortion is still legal?  Though the cost of abortion has remained remarkably flat since Roe -- the cost of a first-trimester abortion at Jen's clinic is $380, actually less than it was 20 years ago, adjusting for inflation -- it's still too much for a woman who, as she puts it, "is on assistance, has two or three kids already and has no money whatsoever."  Teenagers in the state where Jen works also need parental consent before they can have an abortion. And for many teens and adult women alike, the overwhelming culture of shame that hovers around abortion prevents many from going to a clinic.

The physical tragedies we are witnessing due to the return of illegal abortion are compounded by the social ones. Recently, two teenage couples, one in Michigan and the other in Texas, faced unwanted pregnancies. Both states have parental consent provisions; in both cases, the young couples received misleading information (in one instance from an anti-abortion "Crisis Pregnancy Center;" in the other, from a private physician's office) about how to obtain a legal abortion. In Michigan, the young man, with his girlfriend's approval, hit her abdomen repeatedly with a baseball bat until she miscarried; in Texas, again with the girlfriend's consent, the male stomped on his girlfriend's belly, producing a stillbirth of twins. Both young men were arrested, and the Texan, Geraldo Flores, is now serving a life sentence for fetal homicide.

In America's heartland, abortion is both difficult to access and often ground zero in the culture wars. South Dakota and North Dakota, for example, share the distinction (along with Mississippi) of being the states with only one remaining abortion clinic. South Dakota in fact, is currently engaged in a contest with Indiana to become the first state to ban abortion outright. Legislators in each state have introduced bills that they hope might become the vehicles for a friendlier (i.e., featuring two Bush appointees) Supreme Court to overturn Roe altogether.

And if one needed any convincing of the level of stigma associated with abortion in some Midwestern communities, consider how the issue recently factored in the confirmation process for an assistant police chief in Fargo, N.D. The candidate for the job was "outed" by a local anti-abortion activist for having gone through a (legal) abortion some 15 years ago, at the age of 24, with his then-18-year-old girlfriend. The police officer publicly expressed his deep "regret and shame" over the incident, and the mayor of Fargo called the abortion an "error in judgment." Only then did the appointment go forward.

To add an element of absurdity to the tragedies mentioned above, the very policies that could reduce unwanted pregnancies -- and thus abortions, legal and otherwise -- are resisted at every turn by right-wing extremists and their allies in the Bush White House.  Funds for family planning services are cut back while millions of dollars of federal funding are spent on "abstinence only" sex education.

Emergency Contraception (EC), a higher-than-normal dose of regular birth control pills that can prevent a pregnancy if taken within 72 hours of unprotected sex, sexual assault or birth control failure, is denied over-the-counter status by the FDA, even though the agency's own panel of experts voted overwhelmingly to make EC available without a prescription. Researchers estimate that EC prevented some 51,000 abortions in 2000 -- the last year for which such data is available -- and OTC status would make this option far more accessible.  

The latest front in the abortion war is the pharmacy. There are increasing incidents of anti-abortion pharmacists who are refusing to dispense both EC and regular birth control pills. Even in liberal California, where recently 70 percent of the population supports legal abortion, these pharmacist refusals are taking place. And Wal-Mart pharmacies -- often the only pharmacy in rural areas -- have long refused to fill prescriptions for EC.   So, given the current realities of American society -- where teens take matters in their own hands to end a pregnancy, where anti-abortion lawmakers cut funds for contraception, where "pharmacists for life" lecture married women while refusing to refill their birth control prescriptions -- am I suggesting that American women really are in the same boat as they were before Roe? The answer, of course, is no -- or more correctly, not yet.

The number of illegal abortions in the United States -- and attendant injuries and deaths -- currently is nowhere near where it was in the 1950s and 1960s.  Most unwanted teengage pregnancies obviously do not have as their outcome a life sentence in prison. Most public officials do not have to undergo humiliating questioning about past abortions in order to get a desired promotion. Rather, these incidents are cautionary tales. They are harbingers of what the American reproductive landscape could quite quickly become -- unless Americans demand a return to common sense and repudiate the madness that a powerful minority seeks to impose on us. 
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