As
jury selection continues in the Wichita, Kan., trial of Scott Roeder --
whose alleged murder of late-term abortion provider Dr. George Tiller
was lauded by the extreme antiabortion group Army of God -- the title of sociologist and reproductive rights historian Carol Joffe's new book becomes all the more chillingly apt. In "Dispatches From the Abortion Wars,"
Joffe shows that the battles over abortion rights in the United States
are being "fought on numerous fronts": not only with guns, bombs and
fire, and not only in foreign relations, national politics and state legislatures.
Antiabortion
forces, Joffe writes, also deploy the psychological weapon of
antiabortion stigma, a potent contaminant of conscience and community
that has led to, among other things, "a chronic shortage of [abortion]
providers" and even antiabortion hospital practices "that put women's health at unacceptable risk." (One Onion-esque
example: a woman whose deep-vein thrombosis made her too sick for a
clinic abortion. She was cleared for a hospital procedure only after
much negotiation; there, her OB tried to persuade her to continue her
high-risk pregnancy by making her take a tour of the newborn nursery.)
Even when we win, we lose, Joffe argues, observing that even
preposterous doomed-to-fail "fetal personhood" initiatives, simply by
dint of being out in the cultural ether, "reinforce the idea that
abortion is a contentious and stigmatizing issue." And all of this is
an important thing to remember, today especially, the 37th anniversary
of Roe v. Wade.
Joffe makes clear that her target is
not your average private citizen who votes, or even campaigns,
"pro-life." It's the antiabortion (and -contraception) movement's
fanatic fringe, whose "violent actions and extremist political
positions ... have had significant consequences [and] have established
the contours of the abortion wars" -- at very least, by making the
less-loony hard-liners appear reasonable by contrast. Her argument,
based on hundreds of interviews with providers and patients -- not to
mention 30 years of reproductive health research -- is unapologetically
one-sided.
"I see myself as a war correspondent,
embedded with troops on one side of the conflict," she writes. Her
goal? "To show the costs of these wars. They are costly, obviously, for
those seeking abortions and those providing them. But I believe these
wars have also proved costly for American society as a whole, causing a
degradation of our political culture. The abortion wars have not only
brought an unprecedented level of violence and terrorism to health care
institutions; they have also led to a culture of lies about science and
medicine at the highest levels of government. I have come to understand
the abortion wars as a brilliant distraction that drains energies and
resources away from other social needs, including the adequate
provision of services that would allow people to have the intimate and
family lives they wish for."
Ironically, of course,
the abortion wars are "counterproductive, leading to more unintended
pregnancies and therefore more abortions," Joffe notes. The savvier
fanatics can't not know that. Maybe, then, that draining distraction
was the objective all along. So, in that sense, have we already lost?
Salon talked to Joffe about strategies on both sides of the conflict,
and about where she does in fact find hope for peace.
You
describe one young doctor who's afraid to "come out" to senior
colleagues as having had abortion training and another relocating to
the South who asks colleagues how to "discreetly" get in touch with
other providers. How pervasive is antiabortion sentiment in the medical
community?
What my research has
suggested is that most medical professionals are not against abortion.
They are against controversy. Even those who want to provide abortions
find that they can't because even their pro-choice colleagues or
potential partners "don't want to get involved." They also wind up
marginalized or even ostracized by peers who succumb to pressure by
local antiabortion groups.
One of my great regrets
about this book is that it was in production too late to include the
Krispy Kreme controversy, where they announced last Jan. 20 that in
honor of Obama's inauguration they'd give every customer a "free
doughnut of choice." The American Life League, one of the real wingnut
groups, went crazy, issuing a press release
saying Krispy Kreme was endorsing Obama's support for abortion rights.
Krispy Kreme had to immediately issue their own press release saying,
"We didn't mean that at all -- just come in and get a doughnut."
In other words, we live in a culture where potential controversy lurks around every
corner. This will inevitably have an impact on health professionals who
are sympathetic to the need for abortion but therefore not interested
in providing it. Even when they are, it's hard. I think my most
poignant example is the doctor who wondered whom it was "safe" to tell
that she'd had abortion training. It's like a classic coming-out story.
This is not normal. This shouldn't be. Again and again the stigma helps
reinforce the idea that abortion care is different from any other part
of medicine. If you're training to be a cardiologist you don't have to
worry if you blurt that to someone by mistake.
Never
mind the fact that they could get shot. You write that before Roe, it
was sheer illegality that kept doctors from identifying themselves to
one another. Now, it's stigma, and threats to personal safety. What
other comparisons can you make between the pre-Roe era and now?
Yes,
one major similarity is that culture of secrecy, though now it's for
different reasons. Many providers today are marginalized just as they
were before Roe [i.e., pre-Roe, those who performed abortions out of
"medical necessity," whether strictly conforming to the legal
definition or not]. But as before Roe, when it becomes known who does
abortions, your colleagues who normally ignore you, when they have a
patient with serious medical issues [requiring abortion], guess who
they call: the doctors they don't invite to their cocktail parties.
There's both this distance from and dependency on abortion providers
that's so striking. I remember the very first time I spoke with George
Tiller in 1998, before he'd become so controversial. I asked him about
the reactions of his colleagues, and he said to me that some are
realizing that the world is not as black-and-white as they'd thought.
These were his colleagues in Wichita who thought of themselves as
strongly antiabortion until they had a patient with [a baby who had] anencephaly at 26 weeks pregnant. Then they realized they did need Dr. Tiller's services.
There
is also the continued difficulty -- even cruelty -- faced by women
trying to get medically necessary abortions in hospitals, which I
really had not been fully aware of. In the book, I compare the
experiences of two doctors who had to beg medical officials for a
patient to get an abortion. In the first case, the OB had reason to
hesitate, given that it was the 1960s and he was afraid he'd get
caught. But the second was in 2007, and all the doctor wanted was what
should have been routine approval for a patient in a very serious
condition. Even though abortion is legal its provision is not something
that can be taken for granted, even in a hospital. You have to beg
people.
One difference, though, is the change in
strategy of the antiabortion movement -- at least since the period
right after Roe. Then, women who got abortions were demonized as
"sluts" and, bizarrely, given that we didn't have much advanced
fertility technology then, "lesbians." But that couldn't last, in part
because so many women, including those who were ostensibly anti-choice,
were getting abortions. Now the focus is on women as victims. "Abortion
hurts women" is one of the big messages, and now the providers are the
villains.
Why does abortion occupy such a polarizing place in America, as opposed to, say, in European democracies?
This
comes up again and again, and I don't think there's one answer. It's
not that there's no antiabortion sentiment in Europe. It's just that it
hasn't developed into this huge movement against women and providers.
One big difference is that there's no equivalent elsewhere of the
theocratic elements that control so much of our culture right now. And
those countries for whatever reason do not seem to have the sexual
schizophrenia we do here, where we have thongs for girls but "Our
Bodies, Our Selves" banned from libraries. We are a society deeply
conflicted about sexuality, especially female sexuality.
Also,
where you have national healthcare you can get birth control when you
want it, and abortions are often delivered through the same system as
other services so you can't actually surround a clinic the way you can
here. But more to the point, abortion is part of a healthcare system.
And what happens? The rates of unintended pregnancy and abortion are
much lower. It's a model that's staring us right in the face.
Historically
speaking, the abortion issue took on a life of its own here when the
then-new right realized that opposition to the first federally funded
childcare bill in 1971 had galvanized a major political force. But
childcare itself didn't have good staying power because of the number
of women entering the labor force who needed childcare themselves. So
the passage of Roe v. Wade turned out to serve as the perfect
"battering ram" -- I love that image, from the political scientist
Rosalind Petchesky -- for a whole range of right-wing issues.
There's
much discussion right now about how essential it is for abortion to be
covered by health insurance. But you say many women don't use the
coverage they have. Why?
It's back to
the stigma. They don't want the paper trail. They may not want their
husbands or partners or parents to somehow find out. They're worried
their employers will find out ... At the same time, I interviewed a
woman who had a $17,000 hospital bill relating to a late-term abortion
and was not sure her insurance company would pay. She was still
negotiating. At the saddest moment in her life she and her husband were
facing financial disaster. Among all abortions these constitute a
relatively small number, but not as small as we think. One hundred and
fifty thousand abortions take place after 20 weeks. These women will
also face enormous difficulties if their insurance is taken away.
What will it take to normalize abortion within the larger healthcare setting? Is that even possible?
The healthcare reform discussions have shown us exactly how not
to normalize it. I am heartbroken about how abortion has only been
further stigmatized by what we've seen over the last few months. What
it would take, first of all, is a healthcare bill that paid for
contraception -- we don't even know if that's going to be a fight --
and to have the Hyde Amendment repealed so that poor women can have
access to the full range of reproductive care, and to have medical
schools routinely teach abortion. Which, actually, they are doing a
better job of now than they were a number of years ago.
OK, so that's something. Any other cause for cautious hope?
Well,
when Dr. Tiller was murdered, I had to go back through the manuscript
and write about him in the past. Obviously, that dampened some of my
optimism. But I do find cause for optimism in the dogged determination
of the provider community, even when -- as in the case of Tiller's
staff, whom I've interviewed since the book came out -- who always had
to order their pizza without giving a name and then go pick it up
because the place wouldn't even deliver to them. These are people who
in the middle of all the craziness found an imam to come instruct them
in the details of burial of ashes [the clinic cremates fetal remains]
so that they could fully serve their Muslim patients. I know it sounds
schmaltzy, but when there are people like this in the field, I can't
not be optimistic. Just as a powerful abortion rights movement has
begun to emerge within American medicine, social movements create other
social movements. The very virulence and aggression of the antiabortion
movement in many ways makes the provider community that much stronger.
There's also the example of the Jennifer Boulanger, a clinic director in Allentown who decided to go public -- she was on Rachel Maddow
-- about threats she'd received, and she actually began to get
unanticipated support from people in the area who were outraged. Even a
local Lutheran pastor developed an informal network that meets
periodically to talk about how to bring peace to the community. The
message is, "Let us disagree, but peacefully." That's really the hope.
That what I call the "civilians" in the abortion wars will come forward
and stand together to stop the bullies.
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