On Making Abortion “A Thing of the Past”

This first appeared on Huffington Post

“One day our country will be abortion-free,” says Pro-Life Mississippi board member Tanya Britton.

Rose Mimms, Director of Arkansas Right-to-Life, wants to “make abortion unthinkable.” Read: impossible.

Texas Gov. Rick Perry’s stated goal is “to make abortion a thing of the past.”

We have been here before. None of the above zealots are old enough to remember exactly what it was like, but I could describe for them the time when abortion was unthinkable, impossible and illegal and the country was what Britton would describe as “abortion-free.” It was only legal-abortion-free, of course, and this is what that was like:

Women died. By the untold thousands. They died of sepsis most often, a singularly terrible way to die. They also died of things like puncture wounds, desperately trying to end what was a torment to their bodies and souls. They had found themselves with unintended pregnancies – most often caused either by uncaring and irresponsible husbands or by inexcusable acts of rape, incest or circumstances over which the women themselves had no control.

Women of means died less often; they could generally access a safe abortion, even if it meant traveling to a more enlightened country than these United States. Primarily, those who died had little money and less power; often they already had more children than they could care for. Those who denied them the right to an abortion did little or nothing to help them care for present or future children.

So here we are again.

Abortion opponents can make it impossible, unthinkable, illegal; they cannot make it a thing of the past. Because women desperate to end unwanted pregnancies will always, always, always find ways to do so. Some of them, as is already happening, will die trying.

At least Britton, Mimms and Perry are honest about their goals. Others continue to obfuscate. Hobby Lobby and Conestoga Wood Specialties would have the Supreme Court believe that their corporate religious sensibilities are offended by employees’ having the right to terminate a pregnancy before it actually begins, since they equate contraception with abortion. In state after state laws are being passed that are medically unnecessary, scientifically inaccurate, and constitutionally illegal, all in the name of “protecting women” or “protecting the rights of the unborn.” In reality, every law is designed as another step toward making abortion “unthinkable,” impossible and again illegal.

Until they can make it illegal again, making it inaccessible is enough. Again, women of means are seldom being harmed; women without money or power are suffering and dying.

It is not possible to “end abortion.” Not even religious extremists in other countries are able to do that, even though in many countries religious extremism attempts to rule women’s lives. Every day, women in Kenya and Afghanistan die trying to end unwanted pregnancies.

As George Santayana put it, “Those who cannot remember the past are condemned to repeat it.” Unless we remember the tragedies women faced when abortion was “a thing of the past,” we will be condemned to watch those tragedies return.

Women will die.

Hanging out with a hero

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I first met Willie Parker three or four years ago, researching my then work-in-progress book Perilous Times: an inside look at abortion before – and after – Roe v Wade. Couldn’t believe his generous affability and apparent fearlessness in the phone calls and emails we traded, his willingness to be quoted, identified, you name it — despite the obvious dangers facing abortion providers in areas of the country where opposition is fierce and hostility strong. It matters not to Willie Parker. He is dealing with real, live women and the injustice they face when denied control of their own bodies.

Fast forward to May, 2014. In an earlier email exchange the remarkable Dr. Parker had mentioned being briefly in California around this time and hopefully having a chance to meet. I held him to that, and managed to get him over for a visit. Here’s the report of that visit that appeared just now on Huffington Post:

It’s not every day you get to hang out with your hero.

For anyone invested in reproductive justice today, Willie Parker, MD, MPH, MSc, is at the top of the hero list. My own such list is long, thanks to the many people I’ve met in recent years who are tirelessly at work keeping justice alive for women everywhere — but Willie Parker is #1.

Parker holds degrees from Harvard and the Universities of Iowa and Michigan; has served as Medical Director of Planned Parenthood of Metropolitan Washington DC, Associate Medical Director of Family Planning Associates Medical Group in Chicago and Assistant Professor of Obstetrics and Gynecology in the John A. Burns School of Medicine at the University of Hawaii. His list of writings, honors, accolades and nonprofit board jobs is longer than my hero list, but in Real Time he is simply Willie. A man who believes ferociously in a woman’s right to make her own decisions, whatever her race or socioeconomic status, whatever her unique circumstances and needs.

This does not make Willie Parker an “abortion on demand” physician. Once the fetus has the possibility of survival — with or without “extraordinary support measures” — he will not perform an abortion. But Parker believes in a woman’s right to make her own healthcare decisions and to control her own body, and knows it is women of color and women without money or resources who are most often denied these rights. That’s where the complex issue becomes a simple matter of justice.

Parker sees what he does — which is, provide abortions up to 24 weeks and six days — purely through the eyes of the woman who seeks him out. She is usually a woman of color, African-American or Latino. More often than not she is someone who already has more children than she can care for. Sometimes she is still barely more than a child herself, unmarried, abused by a casual acquaintance or a favorite uncle. She has a story.

Once the woman with a story — and an unintended pregnancy — reaches Willie Parker, she’s in a safe harbor. He listens to her story, calms her fears, holds her hand.

Such women may be safe, but the abortion provider is decidedly not. Especially when he’s a big, affable, outgoing, very dark-skinned, gray-bearded guy like Parker.

“I sort of hide in plain sight,” he laughs. Walking around in casual clothes and a friendly grin, as he customarily is, he hardly looks the part of a multi-degree, high-powered physician. It was probably little comfort to the white, business-dressed reporter leaving a building with Parker recently when the latter remarked with a smile, “If they’re coming after the doctor, they’re gonna shoot you.”

Parker, grounded in Christian tradition and secure in his faith, says he is uniquely blessed by the certainty of knowing that his core moral, ethical and social beliefs come together with his education and skills. So yes, he will go right on being a very public advocate for reproductive justice — including the current fight to preserve the one remaining abortion clinic in Mississippi — and no, he’s not worried about personal danger.

“I don’t think about how I’m going to die,” he says. “I think about how I’m going to live.”

This is what makes hanging out with Willie Parker such a lovely way to spend an afternoon.

Can 70% of us be wrong?

Depending on which poll you read, anywhere from 55% to 70% of the people of these United States believe that abortion should be safe and legal. At the high end of that percentage are those who believe Roe v Wade should remain the law of the land.

How, then, could we be where we are? Today, more than half of the states have restrictions that effectively deny many women access to safe and legal abortion, never mind the Constitution.

Reproductive justice organizations, though, are far from caving.

Donna Crane, Vice President for Policy, NARAL Pro-Choice America, recently met with groups of supporters in the San Francisco Bay area to go over details of all this, and to reassure supporters that “although these (restrictive state laws) keep happening and we are losing ground, we’ve not lost power.” That power, Crane says, comes from the solid, and growing, percentage of people who want to keep abortion safe and legal and believe it is a woman’s right to control what happens to her own body.

“The public,” Crane says, “is not the problem. The problem is that our opponents have figured out how to get their way: they have switched (from working to overturn Roe v Wade) to the state legislatures. And there is a disconnect with American values.”

Crane outlined the dramatic increase in TRAP laws (Targeted Regulation of Abortion Providers), state regulations designed to put unnecessary burdens on abortion providers – but not other medical professionals – as a way to drive doctors out of practice and to make abortion care more difficult and expensive to obtain. Anti-choice measures in the states have increased from 18 in 1995 to a cumulative total of 807 by 2013. They include such requirements as unnecessary hallway widths in clinics, forced untrasounds, repeat visits and forcing physicians to lie to their patients. That’s just to name a few.

To this writer, none of this is about one side winning and the majority losing, it’s simply about justice. Anybody, anywhere with money and resources can access safe and legal abortion. But if you’re poor, down on your luck, living in a remote or impoverished area, and you want or need to terminate an unplanned pregnancy? Forget it. Legislators don’t have time for you; you probably don’t vote much. Politicians don’t care about you; you aren’t funding their campaigns. Anti-choice forces don’t care about you, only about your fetus. For you, there is no justice.

NARAL, however, has your back. Now we just need to get the rest of the 70% out front.,

 

Introducing a new abortion provider

I’ve gotten to know the author of the following essay in recent months, and was delighted to have seen him honored with a 2014 Unsung Hero Award from the National Abortion Federation.  With re-publication of his blog (from sherights.com) it’s my pleasure to introduce Boomers & Beyond readers to a future physician — who represents the future hope of women’s rights and women’s health.

 

WHY I’M BECOMING AN ABORTION PROVIDER — by Sarp Aksel

Growing up, I was quickly labeled an ana kuzusu – Turkish for “mamma’s boy.”

This came from a love for my parents’ holiday parties. Each year, the gatherings brought promises of leftover turkey, börek, and Rus salatasi – a delightfully creamy potato salad I was only allowed to indulge during the peri-holiday period. They were also occasions for storytelling. While my dad would entertain the men with the latest happenings in Turkish futbol – a constant stream of scandalous player trades, colorful diatribes of overly glorified coaches against crooked referees, and frequently contested league rankings – I often found myself cozying up to my mother and her friends. Their tales had power and emotion, and they meant so much more to me.

Even at that young age, I recognized that it was a privilege to be allowed into their space. Those evenings weren’t to be taken for granted and I was grateful to be included. Still, I wasn’t always sure if I was welcome.

As a feminist man and future obstetrician-gynecologist, I recognize that I am not, and nor will I ever be, in a position to fully understand the myriad factors that women must consider when tackling certain challenges. This does not mean I cannot be present and supportive. It would be arrogant at best and offensively misogynistic at worst to be anything other than an observer, a supporter and a witness to the uniquely difficult decisions that women face. This means that I believe whole-heartedly in the principle of autonomy as it pertains to healthcare and women’s dominion over their bodies and healthcare decisions. It requires having a profound respect for female autonomy, particularly of bodily integrity.

The slogan “Trust Women” is well known in the reproductive rights movement. While I am an ardent supporter of Dr. George Tiller’s dictum, I have recently found myself questioning its relevance. As a pioneer and hero to #FeministMen, Dr. Tiller was steadfast in his commitment to woman-centered care. His clinic in Wichita for decades served as a beacon of hope for women who had no other options – and continues to do so to this day. And yet, I can’t help but wonder – why do we still need to be told to trust women? Why are we still suspicious of a women’s ability to govern her own healthcare decisions?

Unfortunately, across our country we see politicians legislating abortion care from mandating ultrasounds to waiting periods and counseling requirements that often contain scientifically inaccurate information. They find themselves compelled to make decisions on behalf of women about matters that they deem women incapable of resolving on their own.

But really I’d prefer to keep legislators out of the conversation entirely. For me, identifying as a feminist provider means actively rejecting the notion that anyone other than the woman is the expert of her life-defining circumstances.

This means asking a woman how she feels about an unexpected positive pregnancy test without making assumptions about what that test result means to her.

It means being there for her as an objective source of medical information regardless of what birth control method she chooses, if she chooses one at all.

And it means advocating for women on a public policy level to ensure that women have unfettered access to comprehensive reproductive healthcare, including abortion and contraception.

My interest in women’s health sprang from years of working as a teenager at a specialty-maternity hospital in upstate New York – with women, for women. On my first day, an energetic young woman was orienting me to the facilities, my responsibilities, and my colleagues. A couple hours into the day, my supervisor noticed me trailing uncomfortably behind her through the hospital’s hallways. After several attempts to get at the cause of my odd behavior, she finally stopped to ask me what was wrong. With much hesitation I answered:

“I need to use a restroom, but this is a women’s hospital.”

She gave me a reassuring grin, placed her hand on my shoulder, and pointed me down the hall.

“Of course we have a men’s restroom.”

And just as there was room for men in a women’s hospital, there is room for men in the feminist movement. After all, feminism is synonymous with humanism.

Aksel_headshotAbout the author: Sarp Aksel is a member of the M.D. Class of 2015 at the Albert Einstein College of Medicine, and is currently applying for residency training in obstetrics and gynecology. As an advocate for comprehensive medical education, he has developed tools to help students raise awareness and fill curricular gaps in sexual and reproductive health training, including abortion and contraception. He is also the immediate past president of Medical Students for Choice, where he served as chair of the international nonprofit’s board of directors,

Ahead for women: good news & bad

The years ahead could be not good times to be a woman.

Childcare support? Abortion access? Equal pay? Contraception coverage?

How we will fare in the years ahead — those of us who are females of the species — is an open question; and some of the answers being bandied about are not pretty.

Paul Ryan’s budget would repeal benefits and protections currently enjoyed by millions of women, forcing us to pay out-of-pocket for potentially life-saving things like mammograms and cervical cancer screenings. Cuts in food stamps would hit women disproportionately, cuts in Medicaid would have a similar impact: women make up 70 percent of Medicaid’s adult beneficiaries. Prescription drug costs? Up, thanks to the re-opened Medicare drug coverage gap, the late and un-lamented donut hole. The list goes on, almost as glaringly as the list of benefits to the super-rich goes up. There are not a lot of women, especially single head-of-household wage earners, among the super-rich.

At a recent Planned Parenthood Shasta Pacific (CA) gala, former Michigan Governor and Current TV host Jennifer Granholm ticked off these and other ways GOP policies take from women and give to the super-rich. But Granholm, in a conversation with CA Attorney General Kamala Harris moderated by San Francisco Chronicle columnist Carla Marinucci, framed the opposing political policies as overall good news. With the GOP’s social and economic attacks on women in such sharp focus, she said, they can be seen for what they are — and defeated.

One can hope.

There are plenty of smart, honorable registered women Republicans. Whether they will worry about senior women having to pay more for drugs, or low-income women losing health benefits, or all women continuing to have to work three months more per year just to make what men make, that’s one of the questions still open. Reproductive justice? All women lose when reproductive rights diminish.

But at another meeting last week the focus was on distaff good news. The National Abortion Federation held its annual meeting, complete with continuing medical education for physicians, nurses and all those who will enable the progress and preservation of reproductive rights in the years ahead. This writer was fortunate to be invited to the Membership and Awards Luncheon, surrounded by extraordinary men and women including several award winners I am privileged to call friends. NAF President and CEO Vicki Saporta was among the speakers, and her report was one of optimism. My own optimism about the future for women in the US.is centered in three of the award winners whom I quite fortunately happen to know. They include:

Maggie Crosby, Senior Staff Attorney with the ACLU of Northern California, honored for her decades-long fight for reproductive justice — or, more accurately, her repeatedly successful fights for reproductive justice wherever it was about to be compromised.

Beverly Whipple, an extraordinary woman whose story — at least some small snippet of it — is included in Perilous Times. Whipple was leaving immediately after the NAF meeting for an extended motorcycle trip around Europe with her partner, but they slowed down long enough for a table-full of us to celebrate at the awards luncheon. More on Beverly Whipple in a few days.

Sarp Aksel, Past president of Medical Students for Choice and current Executive Clinic Chair of the ECHO Free Clinic at Albert Einstein College of Medicine in New York City. For those of us in despair about the future of abortion rights, Sarp Aksel is the face of hope. Bright, highly skilled and highly trained, and totally committed to women’s health and autonomy, Aksel is representative of the men and women determined to protect women’s reproductive rights.

Those who would take away women’s right to choose or ability to earn might well make gains for the super-rich in the near future. But they will have to contend with people like Saporta, Granholm, Crosby, Aksel and a host of other fighters for justice… including most of the women of America.

Wanted children, planned families… Why not?

This article first appeared on Huffington Post

The wanted child, the planned family. Can anybody argue that the wanted child and the planned family are not infinitely better off for everyone: child, family and society in general?

So why are we fighting these battles?

The Supreme Court, for example, is taking up the question of whether Hobby Lobby — which presumably prefers unwanted children and unplanned families — can refuse to provide contraceptive insurance for its employees because doing so would somehow offend (the Religious Freedom Restoration Act uses the word “burden”) the religion of its corporate soul. Assuming corporations have a soul, which may or may not be true for Hobby Lobby — this is subject to individual opinion. The RFRA is, of course, also about people, but the Court has already hopelessly blurred the line between people and corporations.

This writer is not a Supreme Court judge, which most U.S. citizens would deem a good thing. But can we think this through? Hobby Lobby goes to a church that thinks sex should occur strictly for purposes of procreation, and conception should therefore never be prohibited. Never mind any Hobby Lobbyists who may have planned their own families; Hobby Lobby still finds it offensive that he should be required to help an employee plan his or her own family. Excuse me?

In particular, Hobby Lobby does not want poor people to plan their families. People of means (and Hobby Lobby is definitely a corporate person of means) have plenty of access to contraceptives enabling them to plan their families. Poor people could use a little help. According to a report recently completed by the Guttmacher Institute (full disclosure, this writer supports the Guttmacher Institute; Hobby Lobby does not), almost nine million disadvantaged women every year get help protecting their health and planning their families through the successful U.S. family planning effort. This effort — which includes funding for contraceptives — substantially reduces the rates of unintended pregnancy. In the process it saves us taxpayers some $10 billion per year.

Some of the details of the Guttmacher report, excerpted below, are worth noting:

• Nearly nine million women receive publicly funded family planning services each year. Three-quarters of these women (6.7 million) received this care from safety-net health centers and about 2.2 million from private physicians. Of these nine million women, 4.7 million obtained care from a health center that receives some funding through Title X.

• Publicly supported contraceptive care enables women to avoid 2.2 million unintended pregnancies each year; absent these services, U.S. rates of unintended pregnancy, unplanned birth and abortion would be two-thirds higher than they are.

• Underscoring the critical role these safety-net providers play in women’s lives, six in 10 women receiving contraceptive care at a health center consider that provider their usual source of care. For four in 10 women who visit a reproductive health-focused health center despite having other options, that provider is their only source of medical care throughout the year.

• Every public dollar invested in helping women avoid pregnancies they did not want to have saves $5.68 in Medicaid expenditures that otherwise would have gone to pregnancy-related care; in 2010, that amounted to a net government savings of $10.5 billion. Safety-net providers that receive some funding from Title X accounted for $5.3 billion of those net public savings.

Dollars saved, wanted children, planned families, individual rights and everything else aside, Hobby Lobby insists that provision of contraceptive coverage infringes upon its religious rights.

It is encouraging to note, though, that 47 religious organizations, through their leaders, have weighed in on the side of wanted children and planned families. They are Christians, Muslims, Jews, and others.

This Presbyterian is proud to join them.

Laboratories of the States: The good… and then, the very bad and ugly

This essay first appeared on Huffington Post

Will a few states rule the United States? Or fundamentally change it? And if so, who are the winners and losers? Depending on your point of view, this “laboratory-of-the-states” business is good news today… or not.

The metaphor dates to the dissenting opinion of Supreme Court Justice Louis Brandeis in a 1932 case, New State Ice Company v. Liebmann and is often used today to assert the success of one social program or another. The best most recent — and decidedly successful — laboratory-of-the-state demonstration is Oregon’s Death with Dignity law. This writer’s extraordinary attorney friend Kathryn Tucker published a paper in the 2008 Michigan Law Review, when she was Director of Legal Affairs for Compassion & Choices, titled “In the Laboratory of the States.” Tucker wrote, “Because Oregon’s Death with Dignity Act has proven both useful and harmless, this Article concludes that it is time for other states to follow Oregon’s lead and enact their own legislation to allow their citizens an alternative to what otherwise could be a prolonged and painful death from terminal illness.”

Tucker deserves much of the credit for expanding the Oregon law into the movement that now seems a clear national trend, along with Compassion & Choices (full disclosure: this writer has long been a C&C supporter, volunteer and local board member). Washington and Vermont have passed similar bills and Montana wisely concluded that it’s none of the state’s business what a doctor and patient decide to do, making physician aid in dying now legal in those states. A handful of other states have pending bills and still others are mounting strong movements. So Oregon’s laboratory of success is likely to be the nation’s overall policy in the foreseeable future, and we’re all better off for that. (Opposition has come from religious and political forces that hold onto a belief that God requires some sort of existential suffering be visited upon Her dying creatures.)

The laboratory-of-the-states pathway is both effective and well trodden, said San Jose State Professor/author Larry Gerston at a recent Commonwealth Club political panel event. The panel was looking at other current trends, but Gerston specifically cited the Oregon Death with Dignity model as an example of how it all works.

Now — what if Texas becomes a laboratory for the denial of reproductive rights?

In Texas, just for a rough overview, recent laws have passed requiring parental notification and now parental consent; requiring abortions to be performed in ambulatory surgical centers with hospital-grade operating rooms; requiring women who seek abortions to submit to ultrasounds and then wait 24 hours for the procedure. The list of harsh, medically unnecessary restrictions and requirements is long, and a clear violation of both ‘best medical practice’ and women’s rights.

It is worth noting who are the winners and losers in these state laboratories. In Oregon, the winners are we the people everywhere. Few of us would turn down the right to a humane and compassionate death, which is made a possible choice by death-with-dignity laws. Losers? No one. No one is compelled to choose a hastened death, anywhere, any time.

In Texas, however, the scorecard is seriously skewed. The winners are archconservatives that have learned that this is a good way to get votes. Winners also include those, men and women alike, whose religion teaches that life begins at conception and thus all abortion is wrong. This writer can appreciate those who hold such views, but it is not possible to uphold the rights of a fetus without denying the right of the woman in whose body it resides. Many of us come down on the side of already-alive women and on the doctrine of church/state separation.

And the losers in Texas: women. All women. Primarily they are women without money or resources, who are frequently disadvantaged and disproportionately women of color. These women are already turning to desperate measures to end unwanted pregnancies; increasingly they are turning up in emergency rooms with failed attempts to self-abort. To a lesser degree, but still worth considering, the losers include those — men, women, boys, girls — who need the other services provided by rapidly closing clinics: birth control, sex education, STD testing, breast cancer screening and many other critically important needs that will now go unmet.

It’s hard to contemplate the win-lose picture of this Texas laboratory. But if it indeed becomes a laboratory-of-the-states argument in upcoming Supreme Court cases, and elsewhere, the losers will be all of us. You and me. We the people.

The (Abortion Docs) Holiday that Wasn’t

This post first appeared on Truthout.com as a SpeakOut essay

With abortion providers and abortion rights fast disappearing, it is particularly regrettable that the National Day of Appreciation for Abortion Providers came and went on March 10 with little fanfare. It was well worth celebrating and its passage is worth noting.

The day did indeed get some good coverage, including at least one excellent blog post noting the degree of vilification and abuse that providers suffer today. And it raised the hackles of a few on the right fringe: a blogger on Free Republic, for example, called it “the most disturbing holiday of the year,” – tossing in the opinion that abortion providers are “people who make lucrative piles of money for tearing babies apart.”

Not exactly. Abortion providers, many of whom work hard to keep services available to the mostly poor and voiceless women who are victims of today’s fringe politics, would be surprised to hear themselves described as making “lucrative piles of money.” What they do is in fact poorly compensated in dollars but richly rewarded by the gratitude of women who seek their services.

A National Year of Appreciation for Abortion Providers – while their ability to provide this fundamental women’s healthcare need remains – would be appropriate.

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