Here we are, forty years on from Roe, and there is widespread agreement: abortion rights are as flimsy as ever, and access for 80% of America is a joke. Women are turning to DIY methods to avoid the clinic humiliations and logistical nightmares. Planned Parenthood is scrapping the word “choice” from their verbiage. Time magazine reports generational “infighting” that threatens to tear down the pro-______ establishment.
Yes, now is a good time to admit failure. But the failure is much bigger than simply abortion rights: we've failed to protect pregnant women's rights.
Last week, the National Advocates for Pregnant Women released a report whose title is as frightening as its contents: “Arrests of and forced interventions on pregnant women in the United States 1973-2005” published in the Journal of Health Politics, Policy, and Law. The report documents more than 400 cases where women have been locked up in jail or psych wards or forced to undergo medical intervention while carrying wanted pregnancies (and they've unearthed 250 more in the last 7 years, which did not make it into the report).
Some highlights: A woman gets pregnant while on Depo Provera, miscarries, and is imprisoned for a year on murder charges; a woman is involuntarily committed because she failed to get a recommended follow-up test for gestational diabetes; a woman planning a home birth is court-ordered to undergo a cesarean and taken against her will to the hospital for forced surgery.
These cases are largely based on legal theory that gives a woman's pregnancy more constitutional rights than herself, theory which has given rise to “fetal personhood” campaigns and “unborn victims of violence” acts. Women are being charged with “child” abuse in utero because of something they swallowed or snorted, or forced to undergo medical intervention on behalf of their fetus. Just last week, the Supreme Court of Alabama held up the conviction of a woman who gave birth prematurely based on a statute that makes it a crime to bring a child to a meth lab. In other words, she was the meth lab.
Yes, it's sad and disturbing when pregnancy mixes with addiction, depression, selfishness, or ignorance, but so far it's not illegal—and for good reason. If we treat fertilized eggs, embryos, and fetuses as separate individuals, explains NAPW founder and study coauthor Lynn Paltrow, then pregnant women's rights go out the window. “We are not just talking about abortion rights, we are not just talking about reproductive rights,” says Paltrow. “We are talking about whether or not, in the guise of trying to end abortion, we are going to remove pregnant women from the community of constitutional persons.”
While it's true that anti-abortion forces are advancing these legal theories, it turns out that medical staff—doctors, nurses, midwives, social workers—are in many cases the police informants. And poor women and women of color are disproportionately reported. NAPW calls this a "Jane Crow system of law, establishing a second class status for all pregnant women and disproportionately punishing African American and low-income women."
Such policing of pregnant women is worst in the south, but it's happening all over the country. Even in New York City it recently came to light that more than a dozen hospitals have been drug testing new mothers without their consent and turning them over to child protective services--for marijuana.
A far cry from bedside manner, the report details “bedside interrogations reminiscent of the days before Roe when women suspected of having illegal abortions were subjected to humiliating police questioning about intimate details of their lives while lying, and sometimes dying, in their hospital beds."
These may be the worst cases of medical and prosecutorial overreach, but violations of women's rights happen every day in maternity wards across the country: women in labor are told they're not “allowed” to eat, walk around, or be in an upright position while they deliver. Women are told they “have to” be induced, they “can't” go a week past their due date, they “won't be permitted” to hold their baby immediately after giving birth. Hospitals have “banned” vaginal birth after cesarean, telling women they “have no choice” but to schedule surgery.
Such common practices are a bald reversal of modern medical ethics, which hold that permission is the patient's to give, not the clinician's to take away.
Medical practice mirrors a culture at large that routinely disrespects women's bodily intergrity. How else to explain the perniciousness of rape and the victim-blaming justifications? In media, we have no qualms digitally lipo-suctioning an inch off an actress's waist and thighs or doubling her cup size. The public feels entitled to police breastfeeding—both to demand that women do it and also that they hide it from public view.
An early feminist health book was titled: “Woman's Body: An Owner's Manual.” Do we even hold the title anymore?
If the anti-abortion movement's winning strategy has been "fetal separatism," abortion-rights advocates' losing strategy has been abortion separatism. With our attention turned entirely on a procedure rather than on a broader notion of bodily integrity and reproductive justice, we've had our backs turned to a reproductive police state in which pregnancy threatens to criminalize us all. We have got to think bigger.
Finally, a feminist health campaign telling it like it is: American women are being thrown under the bus for an insurance industry-friendly motion towards "health reform." Enough with the handwringing, Jane Fonda seems to say in this video for the "Not Under the Bus" campaign. It's time for women to stop that bus and start driving it.
The healthcare bill currently headed for conference committee station in Congress is troubling to progressives on several accounts, but for women, it will have the ironic effect of making a medical procedure less accessible. The Senate's abortion "compromise," extorted by Ben Nelson of Nebraska (along with a pile of cash for his state), ostensibly means that women who want full coverage will have to write two checks: one to cover abortion, and one to cover everything else.
Analysts worry this will amount to a Stupak-like ban on all insurance coverage for abortions – how many insurers, not to mention employers, are going to put up with separate checks? And that's only a question for "blue" states that won't ban abortion coverage entirely. If the expected happens, it will mean that women will have to pay more out of pocket and travel even longer distances to exercise what Roe versus Wade supposedly codified as a "right."
Last month, feminists were shocked at Stupak-Pitts, then outraged. Now, Jane Fonda is looking outright panicked on Youtube: "Help end discrimination against women," she pleads. It may well turn out that the decade's greatest threat to abortion access wasn't George Bush, but Obamacare.
Odd as it is to say, I find Fonda's panic somewhat comforting. In both its boldness and its generality, it signals the women's movement to regroup at square one, to focus on women rather than on a procedure. After all, the right to abortion is based on broader Constitutional rights to autonomy and bodily integrity and the privacy to make decisions about what happens or doesn't happen to one's body. And if we apply these rights broadly, not only to a woman's "right to choose" to terminate a pregnancy but also her right to choose to carry that pregnancy to term, and her right to choose what happens or doesn't happen to her body at the time of childbirth, then we would see that all pregnant women are being denied these rights.
Case in point: Joy Szabo of Page, Arizona, pregnant for the fourth time. In order to exercise her rights, she sought long and hard for a provider and had to travel 300 miles away from her family for care. But Szabo wasn't seeking an abortion; she was seeking a vaginal birth. You see, Szabo gave birth previously by cesarean section. She is among the hundreds of thousands of U.S. women who seek vaginal birth after caesarian (Vbac) each year, though nearly half of hospitals won't allow it. Szabo was denied the right to deliver at her local hospital unless she delivered surgically. She was even threatened with a court order. You thought abortion was controversial? Ask a nurse about Vbac.
Szabo also told it like it is: "Page Hospital: Enter my body without permission, sounds like rape to me," she wrote in lipstick on the back of her minivan. Szabo's ordeal ended happily on 5 December, when she gave birth vaginally in Phoenix. But the majority of American women in this situation are scheduling repeat surgery — either on their doctors' recommendation or insistence — though research has shown it is more likely to result in a baby's admission to neonatal intensive care for prematurity and breathing problems, to say nothing of the risks to mothers.
The Vbac ban is only a subset of a much larger problem. Decades of research tell us that optimal maternity care is something very different from what most American women receive. Optimal care means that the physiological birth process is supported with minimal intervention: labour begins spontaneously, women are free to move around and push in upright positions, and providers avoid surgical intervention unless absolutely necessary.
Meanwhile, the majority of labouring women are confined to hospital beds, strapped to mandatory but ineffective fetal monitors, induced or sped up with artificial hormones, and consequently experiencing unnecessary pelvic trauma and the highest cesarean section rate on record, at 32% (10-15% is considered the maximum we would expect for health reasons). If you question whether this has anything to do with women's bodily integrity, talk to a woman who's had an infected caesarian scar or an episiotomy that tore further into her perineum.
Perhaps the biggest loss for women's health reform is that with all the drama over abortion, maternity care has remained a huge blindspot — and a costly one, at that.
The US spent $86bn on maternity care in 2006 and another $26bn caring for babies born preterm, now also at a record high of 12%. Prematurity is a leading cause of infant death, yet the majority of premies are induced or surgically delivered too early. This over-medicalisation means that childbirth costs Americans more than twice per capita what other countries with better outcomes spend. Medicaid picks up nearly half the bill in the US. If we gave just a little attention to improving care, we could literally save billions.
"Improve quality and reduce costs" — this has been Obama's mantra for health reform. How is it that instead of addressing real threats to women's and babies' health, "reform" has led us toward rolling back abortion access? Advocacy groups have been defending "abortion rights" and, to a lesser extent, "birthing rights," but it's possible that such a single-issue focus has helped to marginalise. To what other bodily system or medical procedure do we attribute rights? We don't have endocrine rights or MRI rights; men don't have testicular rights or Viagra rights. Rights belong to human beings. We have rights.
Or do we? A society that would force a woman to carry an unwanted pregnancy would also force her to have major abdominal surgery. Women won't get real health reform until we reform this fundamental lack of respect for women. The bus stops here.
Five feminists committed a crime in broad daylight Sunday afternoon before some 100 cheering accomplices at Rockefeller Plaza, and they blamed the Food and Drug Administration for making them do it. The offense? Giving a friend the emergency contraceptive known as the "morning-after pill," which still is available only by prescription. It remains off-limits without a doctor's note despite 20 years of scientific data showing it to be "safer than aspirin," according to activists.
"Women should not have to rely on luck to control their reproductive lives," declared Erin Mahoney, one of the chief conspirators of the post-Valentine's Day action and co-chair of the NOW-NYS (National Organization for Women) Reproductive Rights Task Force. Mahoney then raised a pill in her fist, demanded that the drug be available over-the-counter, and handed it (illegally) to the next speaker.
"We're just making public what women already do," said Alexandra Leader, another organizer and chair of the feminist group Redstockings Allies and Veterans, in an interview prior to the action. Mahoney, Leader, and a dozen others spoke out to the crowd of women and men about doctors refusing to prescribe it, pharmacists refusing to carry the drug, and the ordeal of getting a quick appointment at Planned Parenthood just to obtain a prescription. Stephanie Morin, a law student and member of the task force, recalled an ex-boyfriend's "annoying habit" of "losing the condom" during sex and being deemed irresponsible when appealing to the campus infirmary. Beyond simply demoralizing women, such obstacles mitigate the effectiveness of the drug, which works best in preventing an egg's fertilization and implantation within 24 hours of intercourse.
More than 400 other women around the country joined the conspiracy, said organizers, signing a pledge to "give a friend the morning-after pill on February 15 -- or any day they need it," and Dr. Linda W. Prine was on hand at the New York rally to aid and abet. She wrote out prescriptions -- with twelve refills -- to anyone who asked, including this reporter. "I also provide abortions," said the local family practitioner, "so I know what women go through when they have an unplanned pregnancy. I'm here because I want to prevent that in any way I can."
The "MAP Conspiracy" pledge was delivered last week to FDA commissioner Mark McClellan, who had been due to grant or deny over-the-counter status to "Plan B," manufactured by Barr Laboratories, by February 20 but announced on Friday that he was delaying the decision for 90 days. The pill, not to be confused with the home-abortion drug RU-486, is essentially a megadose of the same hormones contained in ordinary birth-control pills, but is much safer, with nausea as the only common side effect. It's stocked on drugstore shelves in 38 countries, including Canada.
On December 16, 2003, two separate FDA advisory committees recommended that Plan B make the leap to being over-the-counter; they are supported by the editorial pages of some 60 newspapers, 76 members of congress, and more than 70 feminist groups and health organizations, including the American Medical Association and the American College of Obstetricians and Gynecologists. "How often do you get organized medicine saying 'You shouldn't have to come to us to get this drug,'" said Richard Gottfried, chair of the New York State Assembly Health Committee, at today's rally.
The committee has sponsored a bill that would make MAP over-the-counter in New York, but it has yet to survive the state Senate. Also supporting the action was Democratic congresswoman Carolyn Maloney, who relayed through a spokesperson: "It seems that the FDA has thrown the cold, hard, scientific facts out the window to bow to political pressure. They've injected ideology into a scientific matter, and it's going to hurt women's health in the long run."