There is hope

As an abortion provider, I long ago "opted out of the war", as Peg Johnston in her cogent essay, labeled it.  Because of the continued stigmatizing efforts of the far right, opting out is ever more difficult.  However, Carole Joffe sees reason for hope in her new book. 

Lu

Abortion

Can we ever win the abortion wars?

The fanatical fringe has hijacked medicine and wrought terror. But there is hope, says the author of a new book

By Lynn Harris

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.

Comments

[Simon Whitney]

Dear Brettongarcia

In your book which purports to say that Catholic teaching and theology has not been against abortion to the extent that current opposers would have us believe, you state that Thomas Aquinas did not consider the foetus to be fully human.

Does Aquinas go on to say that abortion is therefore permitted?

If he does, can you supply the relevant references?

[brettongarcia]

Want a resource, to argue on their own terms, against Catholic anti-abortionists? I've just finished the rough draft of a 700-page theological/Catholic justification of abortion, against "Catholic" anti-abortionism.

See "Brettongarcia's Blog," at Wordpress.

[Kyra]

I wanted to address the question in the first comment (from saltyC)to hopefully clarify some positions of those who are anti-abortion. I am anti-abortion and Catholic, voted for Obama and consider myself a feminist so I guess in a way I don't really fit in any one particular group. But hopefully I can clarify some concepts.

Anyway, to saltyC's question "Are all embryos human?"...it is scientific and medical fact that each embryo (whether it is growing inside a woman or a petri dish or is frozen somewhere)has it's own unique DNA that is a combination of a woman's egg and a man's sperm. Each embryo has a predetermined sex (male or female) and all of the characteristics it will have if it grows to be a child are present from the moment the embryo forms (e.g. male with blonde hair, female with brown eyes, etc.)

So my position (and the position of most anti-abortion people that I know of) is that the embryo IS a unique human life because it has all of those characteristics, despite the fact that it is not breathing, can't feel yet, isn't viable etc. Because every embryo is considered to be a human life, we define "abortion" as any act or process that leads to the deliberate destruction of an embryo. Interestingly, wikipedia allows for the definition of "abortion" to also include miscarriage. Anti-abortionists would make the distinction that miscarriage is natural whereas abortion is deliberate. It would be similar to the distinction between a person being murdered versus dying of natural causes. Additionally, for those who are anti-abortion, the distinction between embryo-fetus-baby is considered to be one of semantics only, rather than a real, scientific one.

Hopefully now I can clarify some additional positions regarding fertility clinic procedures, IVF, and birth control because I know it seems like there are a lot of misunderstandings regarding these issues.
In regard to IVF, fertility- Practices that are of concern to many anti-abortionists from an ethical standpoint would include:
-- the creation of more embryos than are going to be implanted, if the unused embryos are then eventually discarded. This would be considered the unnecessary killing of human life, as each embryo is thought to be a human individual (from a scientific standpoint and not because the Bible says so).
-- PGD or pre-implantation genetic diagnosis which allows parents to find out if the embryo has certain hereditary medical conditions, certain chromosomal or genetic abnormalities, etc. so that any "flawed" embryos can then be discarded. Certainly there is nothing unethical about the testing itself, but concern is in how the information would be used and abused if widely available. For example, even now 90% of all fetuses diagnosed with Down's Syndrome are aborted.
There is further concern that the procedure of abortion can be abused to deliberately wipe out specific populations, for example in the book Half the Sky it is detailed that in many cultures, when women have access to abortion services they specifically abort female fetuses, which is one of the practices that has led to the gender ratio disparity in countries such as China and India (105-107 boys for every 100 girls). As a feminist I find this particularly tragic. A poll in American Baby magazine (2008) also found that if women had access to "gender selection" procedures, 92% would want their first (or only) child to be male.
--Selective Reduction, which is a procedure in which one or more fetuses are aborted in a woman who is carrying multiples in order to allow the remaning fetuses to have a better chance of survival. This would only be considered ethical if it were medically necessary (i.e. the mother's and children's lives would be in danger if the preg. were continued as is).

I hope that clarified some things and wasn't too long and intensely boring :) I think for myself, I would appreciate some more posts regarding the current legal and medical definitions of what constitutes "human life". I apologize ahead of time if this has already been covered in detail as I haven't had opportunity to look at the majority of the website.

Medically:
Specifically, I was wondering how the issue is approached in the area of medical ethics. What parameters determine when it is "too late" for a woman to have an abortion from a medical standpoint? Does it have to do with the fetus' gestational age/weight/capacity for viability? I remember reading somewhere that numerous studies have been done trying to determine at what point in gestation a fetus has a nervous system well developed enough to feel pain and it was found to be somwhere between 18-26 wks but I'm not sure if that has changed? Are there uniform guidelines that the medical community follows or does it vary according to what are the state laws, or does it even vary by hospital? Do such medical studies inform current and future laws?

A specific example comes to mind for me...please no one laugh..there was an episode of Grey's Anatomy I saw once where a woman was in labor very prematurely and delivered an extremely small baby. She did not actually want to be pregnant and if I remember right she either had intended to get an abortion or had a botched one. The doctor was required to weigh the baby on the scale and if he was over a certain weight they were required to treat him as medically viable and try to save him. I was wondering from a medical standpoint is this an accurate representation of the decisions doctors have to make? Is the determining factor the gestational age, or the weight, or what?

Legally:
There seems to be a lot of ambiguity in the area of law as well. For example, I can think of two cases where pregnant women suffered injuries that resulted in miscarriages and the men who injured them were found guilty of manslaughter. In the first, a woman was hit by a drunk driver (this was in NJ) and the second example was the female bank teller who was preg. with twins and was shot by a bank robber and lost both babies. Sometimes it seems to me as though the law and society say that, for example, a 24 week old fetus is a human being when the mother wants him, but not a human being if she doesn't. It doesn't make sense to me.

I was also really surprised to read most of what was featured in the profiled author's book. I had no idea there was such a stigma against abortion in hospitals and that practices were so varied. I personally know of two women (a friend and an aunt) who were told after amniocentesis that their fetuses would most likely have Down's Syndrome, and they were counseled to abort. In both cases they were being seen by doctors in Catholic hospitals too, which was definitely surprising to me. Incidentally, both boys were born and neither had any medical issues whatsoever. Does anyone have any input as far as what goes on in Catholic hospitals or if there is any real difference in practices?

PS-Sorry this was so long! I will email with questions in the future it's just that these were the main issues on my mind.

[saltyC]

A. Abortion is not murder, it's not even killing: it's deciding not to continue the process of creating a child.
B.The bible is explicit that life begins at first breath: Genesis 2:7
C. Really? all abortions reversed? How about just ten years' worth: 420 million couples waiting to adopt? Really?
D. If Jesus Christ was so worried about abortion, he would have mentioned it instead of zip.

One question: Are all embryos human, or just the ones inside women, cause I didn't hear your condemnation of fertility clinics. Oh yes, it's all about s-e-x.

[Christ child]

The abortion wars can be won... by stopping and reversing the legalization of abortion. Life begins at conception and abortion is MURDER. Read Exodus 20 v 13 and there is no small print, like babies in the womb, old people etc. God says thou shalt not murder and that is that. Blessed are those who accept Jesus Christ as saviour and experience His peace, love and the freedom that His forgiveness gives. I pray that the killings will stop! Did you know that statistically if all the abortions in the world were reversed, there would still be a back log for adoptive parents. If there is such a demand, why are we killing children? Lets give these children to people who can love them and care for them.

[bonnie moss-rhodes]

Dr. Tiller was methodically stalked by a man (and I use that term loosely)with the intent if killing Dr. Tiller. No luck involved. A planned assasination carried out by plan.

If any luck was involved it is that both of the other two men did not get shot after the murderer pointed a gun at them and told them he would shoot them.

[Pandora]

Well OCS used the flower pot analogy to rationalize the death of Alexandra Nunez.

It's equally appropriate, both were just unlucky.

[bonnie moss- rhodes]

No pandora. I think anyone who is stalked by a unstable moron intent on killing him is much more likely to be killed by the moron. Especially if the moron has been pretty much a loser who was egged on by extremist idealogues.

In fact according to the morons own statements Dr. Tiller was more apt to be shot by rifle at the clinic by the moron, had his hands severed from his body, or murdered in his home.

A premeditated planed out murder verses the possibility of a falling flower pot. I guess it is a rather pathetic attempt to make an act of terror seem less than what it was. Or maybe pandora has a need to pretend that she is part and parcel of a extremist group that like the 9/11 morons or the gunman at Fort Hood are willing to bend their religion and beliefs to fit murder.

Highlight of the day roeder stating that only "god" has the right to take a life ....

At least there seems to be no more availability for a lessor charge.

I also have to wonder how he would have justified shooting the two men he pointed the gun at. I was always taught that you never point a gun at someone unless you intend to use it. If they had not stopped he stated he was going to shoot them. How would he have used a medical procedure to justify that?

[Pandora]

I don't know why OCS is so upset over what happened to Dr Tiller. He was just unlucky. He could just as easily have been hit by a falling flower pot as shot by an anti-abortion killer.

[OperationCounterstrike]

Julie, so make a counterproposal. You object to counterterror, OK. But we cannot just go on letting government take care of the problem. We've been doing that for two decades and the problem has only gotten worse.

What NEW approach do YOU have to suggest? How would you STOP the terror, if not with counterterror?

I am eagerly awaiting your answer. --OC.

[Julie]

Dammit, OperationCounterstrike, enough already!
Exposing these hypocrites for the sexist, anti-choice pigs they really are will be MUCH more effective than drawing their blood. Don't give them the freaking 'victim' card to play while they victimize the reproductive rights of other Americans.

[Pandora]

xyz

[Ihateproliars]

Boycott the Super Bowl this year. Thanks to those scumbags Focus On The Family brainwashing Tim Tebow into their garbage, there will be an anti-choice commercial airing during this event which is watched by millions of people. How is it that anti-choicers are allowed to shovel their political BS on national primetime, but we have yet to see one Planned Parenthood commercial?

[OperationCounterstrike]

There's only one way to solve this problem. We have TRIED letting government protect us, and it has not worked. The terror against us is regular and increasing.

Our non-response, our peacefulness and willingness to follow channels and let government take care of our problem, sends a message of weakness to the enemy. It encourages bullies, and anyone who has ever seen clinic-protesters at work knows that right-to-lifers are bullies.

The way to handle a bully is punch him in the nose.

It's time to try a new approach.

We must arrange for each right-to-lifist act of terror to be answered in kind. When they kill Dr. Tiller, we must see to it that an equally famous right-to-lifer, like Professor Robert P. George or Father Frank Pavone or former Kansas Attorney General Phill Kline or Paul Hill's wife and kids, gets killed.

We must also regularly terrorize ordinary, non-famous right-to-lifers, low-level protesters and whatever. RTLs must be made to see that the counterterror against them will affect ALL of them.

Right-to-lifers will not stop the terror until they FEAR terror.

You know in your heart this is true. Not just true; it's totally obvious to anyone who can look at the thing objectively.

Where else in the WHOLE WORLD is there a completely one-sided terror war? In the Muslim world, Sunnis kill Shi'ites AND Shi'ites kill Sunnis. In Israel, Palestinians rocket Israel AND Israel invades Gaza. The ONLY totally one-sided terror-war in the WHOLE WORLD is the abortion-war in USA! And it will continue this way until pro-choicers show they have some balls and start sharing the pain with the enemy.

"I've bought a big bat. I'm all ready, you see.
Now MY troubles are going to have troubles with ME!" --Dr. Seuss.

[Jackie B]

We need to be vigilant about the varied attacks. I think we need to pay the most attention to two things: health care legislation and the media. Tonight for example the Pregnancy Pact is the top search on YouTube and it is a movie on Lifetime talking about teenagers that decide to have babies !!! Just the type of example other teenagers need! Another example is a recent webseries at www.bumptheshow.com where they let the audience determine the decision for the women who are pregnant - needless to say the anti-choice crowd is all over it already.