Birth control and poverty

I believe that women and families have the right and responsibility to control the timing and number of births. Contraceptive methods that cannot reasonably be construed as abortion (e.g. hormonal contraceptives, intra-uterine devices, condoms) are generally available in the West and other relatively wealthy countries.

However, hormonal contraceptives and condoms have ongoing costs. Ideally, condoms shouldn't be used as ongoing birth control. That leaves hormonal contraceptives. However, to the growing number of people in the US who are uninsured or underinsured, the ongoing costs of contraceptives can be a barrier.

A recent Chicago Tribune article discusses family planning in a recession. The picture isn't good. One woman decided, with her husband, to end her pregnancy as they couldn't afford it. Ironically, affording the abortion, which was not covered by her insurance, was also a stretch. One Planned Parenthood clinic interviewed said that January was a record month for abortions (although one month at one clinic isn't necessarily conclusive, it's not a stretch that a similar trend could emerge nationwide).

Adoption agencies and the National Network of Abortion Funds (which provides financial assistance for abortion) reported increased demand for their services. In addition, women are waiting until later in their pregnancies to get abortions, as they need to raise the funds.

Another Planned Parenthood clinic reported that women were seeking longer-acting contraceptives. A monthly supply of birth control pills costs my fiance, who is insured, a $10 copay (copays are a flat rate one pays with medication or medical services; they are a form of cost-sharing). Our income at present is low as we are both searching for permanent jobs; $10 monthly is not an insuperable barrier now but it could be if our wages remain low.

However, many poor families are uninsured and will face a higher cost. That cost could be a sufficient barrier to them that they might switch to condoms or not comply fully with the medication regimen. However, either of these will increase the chances of pregnancy.

The folks who say they would like to ban federal funding for Planned Parenthood have yet to present an adequate solution for poor women and families. Frankly, some of the anti-abortion crowd would be inclined to let them starve. I think all of us would rather that families not be forced to resort to abortion. It is a difficult decision for everyone, contrary to what some might think.

To help reduce the number of abortions, the US needs an adequate safety net that delivers a reasonable amount of cash and non-cash assistance (the latter might include food, housing, childcare) and ensure that jobs at the bottom are delivering an adequate wage. The best way to do that is through provisions like the Earned Income Tax Credit and the new Making Work Pay credit.

Another perspective on Roe v Wade

Rev. Elizabeth Kaeton has another reflection on the anniversary of Roe v Wade, as a then-Roman Catholic.

Later that evening, I came back to see her for our nightly drink. For as long as I could remember, she and my grandfather had a glass of brandy or schnapps (apricot was her favorite) before they went to bed. These days, she warmed it and put it in her evening latte - her own "dessert coffee".

She poured me a glass of wine. Red. "Good for the baby's blood. Good to build up your milk for the baby." Bad for fetal alcohol syndrome, but we didn't know about that then, so we had no worries.

I asked her about abortion. What she thought about the decision of the Supreme Court. What that meant to her.

It was then she told me about a friend of her's with whom she shared a room when she worked as a domestic in Boston in the early days of her immigration to this country.

The girl had been flattered into having an affair with one of the sons in the house - one she thought loved her and would marry her. Until, of course, she got pregnant. Then, he gave her some money and took her to a man near Chinatown who would, he said, "take care of everything."

She died three days later of an infection and bleeding that could not be stopped.

My grandmother looked around to be certain that no one was around and then she whispered to me, "The Supreme Court did a very good thing for women today," she said. "It is not something that should be used carelessly, but only when necessary."

"But," I said, "what about the Church? They say it's murder and its a sin and you will burn in hell for eternity."

A look of revulsion came over her face, "Yes, yes, that's what they want us to believe. But then, every year on the fourth of July, they dress men up in uniforms and parade them down the street and everyone cheers because they have killed - they have killed many men and women - some of whom are pregnant - as well as their living children. And everybody cheers and Father blesses them with Holy Water when they march by because they have done these things in the 'name of God'."

"When it is convenient for them, it is okay," she hissed, "but they would rather protect and defend the lies men tell than to allow her to make a decision about her own body, her own life, her own future, in the name of God."

It was then that I heard for the first time what I would later see in posters supporting the decision of Roe v. Wade. The logic is so simple as to be considered simplistic, but there is also great wisdom inherent it the logic.

My grandmother said, "If you don't want to have an abortion, don't have one." Then, she added, "But, if a woman needs to have an abortion, that is between her heart and God, and no one - NO ONE - should make that decision for her or have the right to take away her right to make that decision for herself."

Palin's privacy versus her public stance

Timothy Rutten, writing for the Los Angeles Times, has some harsh words about Sarah Palin's reproductive rights stance. Sarah Palin, the sitting governor of Alaska, is the recent Republican nominee for Vice President.

Palin's daughter and herunbornchild's father are entitled to privacy as children -- and that's what they are -- and as individuals. They ought not to be pursued by reporters, nor should their friends and teachers be grilled for details about their private lives. Nobody asked them whether they wanted to be made symbolic caricatures in a national debate over the fulfillment of two strangers' political ambitions, and they shouldn't be treated as if they had.

That said, the fact of Bristol Palin's situation and the way in which she and her family have chosen to deal with it are legitimate issues, because they involve public policy issues on which Sarah Palin, candidate for vice president, has taken political positions. Palin, for example, opposes sex education in schools, including all access to contraceptive information for adolescents. Similarly, she believes that abortion should be illegal.

But Palin and her family dealt with two personal situations in just the way all Americans are entitled to meet them. When Sarah Palin and her husband discovered that their unborn son would be born with Down syndrome, they were free to make the decision that she would carry their boy to term. When they found that their 17-year-old daughter was pregnant by her high school boyfriend, they were free to reach a decision that the daughter, too, would keep her child and that she and the boy would marry. (They were free to do that even though many, perhaps most, Americans no longer regard teenage marriages as particularly desirable. Most people long ago put away the notion of a boy "making an honest woman" of the girl.)

The point is that the Palins were able to make all these decisions according to the dictates of their own consciences, formed by their own religious convictions, within the privacy of their own family and according to its values and traditions. What they decided is nobody's business but theirs; the fact that they were free to arrive at their own decision is everybody's business.

The particular brand of social conservatism in which Sarah Palin quite evidently believes deeply would deny other American families and other American women the freedom to make these same intimate decisions according to the dictates of their own consciences, religious convictions and traditions.

Personally, I do like Sarah Palin. She is relatively young, and feisty. She's a mould-breaker.

However, in addition to her stance on reproductive rights, she's a global warming denier. Time Magazine reported that she had a librarian fired who refused to cooperate in banning books.

If I were a young, moderate Republican, I'd definitely see Palin's nomination as a sign of hope, in some ways, for the party. I can't say that I would then vote for her, because I am not a moderate Republican. I can say that I would not even consider voting for her.

Mexico City struggles with abortion

In most of Latin America, abortion is illegal in most or all cases.

Rich women can fly elsewhere.

It is poor women who are in jeopardy, as they go to illegal clinics. Having an abortion by an unskilled practitioner can place their health in jeopardy.

As the NY Times reports, Mexico City recently legalized abortion. However, 85% of the gynecologists in the city's public hospitals declared themselves conscientious objectors, the conservative Federal government has challenged them in court, and abortions have been in practice very difficult to obtain.

Alejandra, 24, who works for the city’s women’s institute, said that when she went to get an abortion last year at a public hospital, a social worker there told her that she would need to pay for her own ultrasound, which is supposed to be free, and that she would need to be accompanied by a family member. Scared off by the description of the risks and the procedure, she fled the hospital.

She ended up taking pills to induce an abortion, without seeing a doctor, and developed a serious infection. She asked that only her first name be used because she said she recently received a death threat for speaking at a city event celebrating the new law. Another woman, a 27-year-old high school literature teacher, who spoke on condition of anonymity, said her friends told her that they were treated like prostitutes at public hospitals. She also took abortion pills but said they were ineffective, requiring her to visit a doctor to complete her abortion.

To speed up treatment, officials are moving low-risk abortions out of overworked public hospitals into three smaller public clinics, based in part on models in Britain and the United States. The smaller staffs there should be more supportive, they hope.

Contraceptives are apparently legal. One doctor quoted in the text objected to abortions. She said that women were irresponsible not to use contraceptives. Of course, poor women may face barriers that make it impossible to use contraceptives.

Another gynecologist quoted said the following:

Those who have chosen to perform abortions say it has not been easy. Dr. Laura García was the only one of 13 gynecologists at her hospital who agreed to offer abortions last year. Some days, she says, she performs as many as seven or eight surgical abortions.

“I became a warrior there defending my convictions,” said Dr. García, who moved to a new hospital in May where the city plans to have abortions performed for minors.

She said she had been insulted by colleagues and chased down the street by abortion opponents. But she said that having witnessed what happened to women before abortion became legal — she saw cases of septic shock and uncontrolled bleeding from botched abortions — helped her continue her work.

“I am contributing to rescuing women’s rights,” Dr. García said. “In Mexico, women have always been marginalized.”

She added: “I am a Catholic, but I have convictions. I don’t think I’m going to hell. If I go, it will be for something else.”

Sen. McCain doesn't seem to remember how he voted on birth control

Folks who are pro choice should consider that Sen. McCain is probably not going to be an ally of women's health.

Abortion is under siege (in the UK)

By Rachel Johnson, writing for the Times

I am sitting with an abortionist in a counselling room in a central London clinic. Downstairs, on a padded surgical bed covered with blue paper, 5,000 pregnancies a year are ended. In the waiting room sit women and their male lovers. None of them is leafing through the magazines provided, but some are clutching Kleenex.

All look haunted. Don’t panic. This isn’t going to be a Me and My Abortion article, a grim Tracey Eminish journey through my harrowing gynaecological history.

I’m here because it’s the 35th anniversary of Roe v Wade in the US, a country where a woman’s right to choose is far from constitutional and remains under constant attack from the pro-life, evangelical Christian Bible Belt and the Catholic church; a country where schoolchildren are encouraged to adopt, name and pray for the souls of blastocytes destined for termination, and where a bill signed by Governor Mike Rounds, in South Dakota almost two years ago, made abortion illegal in most cases, including rape or incest.

I’m here because the pro-life lobby is also making hay in Britain. Antiabortion lobby groups are attempting to hijack the Human Fertilisation and Embryology Bill currently going through the Lords, in the hope of introducing an amendment that would chop the time limit on legal abortion from the current 24 weeks down to 20 weeks. To commemorate the 40th anniversary of the Abortion Act last year, there was a rally in Westminster and a ghoulish “service of remembrance” for the estimated 6.7m foetuses destroyed since 1967.

There are also upsetting stories around that women are airily opting to abort for abnormalities as minor as cleft palates, webbed toes and club feet, stories that do not stand up on examination, but are designed to add to the impression that our abortion rate is immorally high; that women are treating abortion, even at advanced stages of pregnancy, as a form of contraception; and that women are choosing to kill their own babies because of some minor, indeed cosmetic, defect.

But I am here, above all, because there has been a war of attrition between the pro-life and the pro-choice campaigns on both sides of the Atlantic for decades, and if I am going to discover what is really going on, I need to report from the front line of this war – the abortion clinic.

So here goes, taking each of those three charges in turn.

Yes, the abortion rate here is high (though curiously it’s even higher in the US). But the fastest rising rate of abortion is for under18s. Deanna, who manages the Marie Stopes clinic I am in, says: “Business is growing all the time, really, because of binge drinking and teenage pregnancy, coupled with the fact that lots of girls are simply clueless about contraception.” So it would seem that the protesters should not be tough on abortion, but the causes of abortion.

Two, women choose abortion as a form of contraception. Frankly, I don’t know anyone who would choose foeticide as their preferred form of birth control. I do know lots of women, however, who have taken responsibility for not bringing another baby into the world when the resources – emotional, psychological and physical – sadly aren’t there for it.

And as for late-term abortions, there is no evidence that these are being sought for trifles such as webbed toes alone. There were 136 terminations beyond 24 weeks in 2006. All of them were for what is called a “ground E” case – meaning if the child was born, it would be seriously handicapped.

Meanwhile, about 1,100 women had an abortion between 22 and 24 weeks: teenagers who panicked and hid their pregnancy; women who had no idea they were pregnant because they were on the contraceptive pill. One wonders what on earth these girls and women would have done if safe, legal procedures weren’t available for them.

“I didn’t go through uni and med school thinking, ‘Yes! I want to be an abortionist’,” says Dr Kate Worsley of Marie Stopes International, who has carried out many. “But it’s a small aspect of medicine that’s most needed to be done well.” According to the World Health Organisation, unsafe abortions kill more than 66,000 women worldwide every year. The Lancet has called it one of the most neglected public health issues of our time.

British women are lucky. The law gives us strength and legitimacy to decide what is best for us and our families, and control over our reproductive destinies. Any changes to return that power to MPs or lords (few of whom will face the experience of abortion themselves) will erode trust in women to take responsible decisions about their own pregnancies. As the American feminist Florynce Kennedy said: “If men could get pregnant, abortion would be a sacrament.”

I came away from the clinic with nothing but respect for the doctors – trained, after all, not to take away life but preserve it – sympathy for their patients and more than ever convinced that the decision to end a pregnancy, whether wanted or unwanted, is never undertaken lightly by the woman who needs the termination or the doctor who performs it.

“Every day, women leave the procedure room,” says Worsley, “and they always turn and say, ‘Thank you’.”

I understand why.

Remembering the politician who banned anti-abortion websites

Declan McCullagh has this article posted on his blog, The Iconoclast.

Henry Hyde, the former Illinois congressman who led attempts to impeach President Bill Clinton and was a longtime foe of abortion, died on Thursday. He was 83.

The Associated Press has already published an extensive obituary of Hyde, a Republican who retired from Congress at the end of the last session. What the AP doesn't mention is Hyde's authorship of a federal law--still on the books today--making it a felony to distribute information over the Internet that relates to obtaining an abortion.

Hyde's successful amendment to an unrelated telecommunications bill in 1996 extended the Comstock Law to "interactive computer services." The amended language is here:

Whoever...knowingly uses any...interactive computer service...for carriage...any drug, medicine, article, or thing designed, adapted, or intended for producing abortion, or for any indecent or immoral use; or any written or printed card, letter, circular, book, pamphlet, advertisement, or notice of any kind giving information, directly or indirectly, where, how, or of whom, or by what means any of such mentioned articles, matters, or things may be obtained or made...shall be fined under this title or imprisoned not more than five years, or both, for the first such offense and shall be fined under this title or imprisoned not more than ten years, or both, for each such offense thereafter.

I've highlighted the most relevant portions of the Hyde Abortion Web Ban in bold. Another section of that law, for which Hyde was not responsible, bans the transmission of any "matter of indecent character" (goodbye, Goatse) and any "filthy phonograph recording, electrical transcription, or other article or thing capable of producing sound" (so much for a large percentage of rap MP3s and MySpace profiles of bands).

The Hyde Abortion Web Ban was never challenged by groups like Planned Parenthood, the American Civil Liberties Union, or People for the American Way, all strong supporters of the right of women to have an abortion. It remains the law of the land today, even though it criminalizes things like discussing RU-486, not to mention online pharmacies actually dispensing it. (Hyde, for his part, entered into a House floor exchange with Rep. Nita Lowey, a New York Democrat, and said that he never meant the law to ban discussions of abortion.)

So were the ACLU and its ideological pro-choice allies slacking? Not exactly. What happened is that after the Hyde Abortion Web Ban got glued onto the Telecommunications Act, the Clinton administration decided not to enforce it on grounds that it violated the free-speech rights protected by the First Amendment. Instead of vetoing the measure, which would have been a cleaner solution, President Clinton said in a signed statement that the Hyde Abortion Web Ban was "unconstitutional."

Attorney General Janet Reno then wrote in a letter to Vice President Al Gore: "This is to inform you that the Department of Justice will not defend the constitutionality of the abortion-related speech provision of (the law) in those cases, in light of the Department's longstanding policy to decline to enforce the abortion-related speech prohibitions (in the related statutes) because they are unconstitutional under the First Amendment." The Bush Justice Department has not prosecuted anyone under it either.

But because the law still exists, a future Justice Department could prosecute Americans under it, especially if a future Supreme Court takes a more restrictive view of free speech and abortion rights. Henry Hyde may have his revenge yet.

Latin America's complete abortion bans are harmful to women's health; ectopic pregnancies a special challenge in L. Am.

Several Latin American countries have imposed complete bans on abortion, even to preserve the mother's health. Such bans are anathema to me, as someone who values reproductive freedoms.

However, the particular situation in countries like Nicaragua and El Salvador ought to concern those who consider themselves to be pro-life.

In April 2006, the New York Times published a long and heart-wrenching article on the abortion situation in El Salvador in April, 2006. Interestingly, Archbishop Oscar Romero is mentioned; they say that while he was opposed to abortion, as expected, he acted as if he were more concerned with poverty and government oppression. In his time, the country allowed exception to save the life of the mother. That exception has now, astonishingly, been overturned, and stricter criminal penalties and surveillance have been introduced.

The result is now a culture of fear. Women coming in with uterine lacerations indicating an unsafe abortion are required to be reported to the police. Several women have been charged with homicide. And doctors are now required to put the fetus' lives above women's lives in the hospital, which is of particular concern when women present with ectopic pregnancies.

The reported attitude seems to be that now, technology is advanced enough that abortions aren't necessary. From this AP article:

"When two lives are in danger, you must try to save both the woman and the child. It's difficult to say now that it isn't possible to save both."

Henry Romero, a priest who led El Salvador's anti-abortion campaign

More damningly, from the NY Times article:

Julia Regina de Cardenal runs the Yes to Life Foundation in San Salvador, which provides prenatal care and job training to poor pregnant women. She was a key advocate for the passage of the ban. She argued that the existing law's exception for the life of the mother was outdated. As she explained to me, "There does not exist any case in which the life of the mother would be in danger, because technology has advanced so far."

These attitudes are incredible. Ectopic pregnancies occur in about 1% of all pregnancies, when the fertilized egg implants in the fallopian tube, not the uterine wall. There is a recorded case where a pregnancy implanted in the abdomen, outside the uterus, and was successfully delivered; perhaps this is what fuels the attitudes above. There is no technology that can save an ectopic pregnancy in a fallopian tube. About half of such pregnancies spontaneously resolve, with the embryo dying and being reabsorbed; previous ectopic pregnancy is a risk factor for future ectopic pregnancy.

If the pregnancy doesn't spontaneously terminate, the tube may rupture, and this poses a grave risk to the health of the woman. In US Catholic hospitals, ectopic pregnancies may be treated by removing the affected section of the fallopian tube. Direct abortion is never allowed in Catholic medical ethics. However, an action intended to save the life of the mother that nonetheless causes a pregnancy to end is acceptable, if not exactly something to be happy about. I have read one Catholic ethics opinion that states that using methotrexate, a cancer drug, is also acceptable, but I have read several that suggests it is not. The positive opinion argued that methotrexate did not attack the embryo directly, it attacked the tissues that connected it to the fallopian tube. In any case, treatment with methotrexate will kill the fetus and cause its spontaneous reabsorption.

The two articles describe a culture of fear in Latin America among doctors. They fear that typical treatments for ectopic pregnancies might be considered abortion, which has severe criminal penalties. It seems they are waiting for either the fetal heartbeat to cease or for the tube to rupture; the latter is a medical emergency. Eliette Valladares, a doctor and researcher with the Pan American Health Organization, contends that at least 3 Salvadoran women have died because of the ban and 12 are under investigation. Hemorrhaging is not an uncommon cause of death, and with less advanced medical equipment, it can be difficult to tell.

According to Sara Valdés, the director of the Hospital de Maternidad, women coming to her hospital with ectopic pregnancies cannot be operated on until fetal death or a rupture of the fallopian tube. "That is our policy," Valdés told me. She was plainly in torment about the subject. "That is the law," she said. "The D.A.'s office told us that this was the law." Valdés estimated that her hospital treated more than a hundred ectopic pregnancies each year. She described the hospital's practice. "Once we determine that they have an ectopic pregnancy, we make sure they stay in the hospital," she said. The women are sent to the dispensary, where they receive a daily ultrasound to check the fetus. "If it's dead, we can operate," she said. "Before that, we can't." If there is a persistent fetal heartbeat, then they have to wait for the fallopian tube to rupture. If they are able to persuade the patient to stay, though, doctors can operate the minute any signs of early rupturing are detected. Even a few drops of blood seeping from a fallopian tube will "irritate the abdominal wall and cause pain," Valdés explained. By operating at the earliest signs of a potential rupture, she said, her doctors are able to minimize the risk to the woman.

One doctor, who asked to remain anonymous because of the risk of prosecution, explained that there are creative solutions to the problem of ectopic pregnancies: "Sometimes when an ectopic pregnancy comes in, the attendant will say, 'Send this patient to the best ultrasound doctor.' And I'll say, 'No, send her to the least-experienced ultrasound doctor.' He'll say, 'I can't find a heartbeat here.' Then we can operate."

This doctor also told me that there are ways to avoid reporting an abortion. "I can only say what I saw when I examined the patient," the doctor said. "If I can see lacerations or cuts, I cannot say what that means if the patient says, 'I have done nothing.' I can describe what I saw, but I cannot say she has or has not had an abortion."

The doctor pondered a hypothetical situation: "If the patient says, 'Yes, I did it, but please keep that between us'?" There was a pause. "I keep that promise. The confidentiality right is more important than the legal duty to report."

Ectopic pregnancies aside, complete abortion bans drive poor women underground. Rich women can fly elsewhere, as they have always done. Many women seek clandestine, unsafe abortions performed by non-medical personnel, and many die.

In prosecutors' offices in El Salvador, as in prosecutors' offices anywhere, longer sentences are considered better sentences. "The more years one can send someone away for," I was told by Margarita Sanabria, a magistrate who has handled several abortion cases, "the better it is for the prosecutors." She cited this motivation to account for what she has observed recently: more later-term abortions being reclassified as "aggravated homicide." If an aborted fetus is found to have been viable, the higher charge can be filed. The penalty for abortion can be as low as two years in prison. Aggravated homicide has a minimum sentence of 30 years and a maximum of 50 years.

The issue of proving viability after an abortion is a tricky one, of course. There is no legal standard. But many of the people I talked to in El Salvador, including Tópez, the prosecutor, said there was a rule of thumb: if an aborted fetus weighs more than 500 grams, or a little more than a pound, then you can argue that the fetus was viable. When I mentioned this to Judge Sanabria, she said she wished she had known more about the rule before. She recalled one case, that of a 20-year-old mother named Carmen Climaco, whose abortion of a fetus estimated at 18 weeks had been recast by the prosecutor as aggravated homicide. The judge admitted that if she had known this rule of thumb, she might not have sent the case to trial. "I feel bad about it," she said.

But the case did go to trial, and the prosecutor won a conviction for aggravated homicide. At trial, the evidence included lifting Climaco's fingerprints from the fetus, which was found under her bed. The prosecutor's accusation was infanticide by strangling.

The women's prison where convicted murderers are sent is in the outer district of Tonacatepeque. I visited it in January. It's an old, creaky facility that inspires the kind of dread that comes of seeing concertina wire and much-painted cinder blocks, made all the creepier by a paint choice of baby-boy blue. Inside the first gate is a neutral area. It's filled with almond trees that provide a flickering shade on a hot winter afternoon. All the women are kept in a deeper jail, walled off inside. Through a small window, I could see an open area crisscrossed by laundry lines and arrayed by different women lying around smoking.

I was there to see Carmen Climaco. She is now 26 years old, four years into her 30-year sentence. She has three children, who today are 11, 8 and 6 years old. We talked about them for a while. Since she was the only person in the family who worked, her children's financial situation is precarious; they now stay with their grandmother. Climaco said she lives for their visits, which are brief and come only twice a month. She was dressed in red jeans and a white polo shirt. We sat with an interpreter in the half-shade in green plastic yard chairs. Climaco had a paper napkin with her that she folded and folded into a familiar-looking pill. She had light brown hair, and occasionally a smile steadied her trembling lips.

"I became pregnant at a time when my smallest child was in the hospital," she said. "I never thought I could get pregnant because I had been sterilized. Suddenly I saw two doors shutting at the same time. There was nothing I could do. My mother said she'd toss me out of the house if I got pregnant."

Her story came out in fits and starts. She said that she was innocent and had never done anything illegal. Then she said, "I keep asking God to pardon me for what I've done." She said that the day it happened, she felt dizzy and collapsed at home. She woke up covered in blood. "I stood up and it felt like something fell out of me." It took her a while to understand just what had happened. "I put my hand on its throat to see if it was moving," she said, "which is why my fingerprints were found on its neck."

I spent the better part of an hour watching Carmen Climaco's face, listening to her whimpering pleas to Jesus Christ for forgiveness and tiny prayers to me to believe in her innocence. Like anyone serving time in prison, she has inhabited the details of her story to the point that they no longer sound true or false. She has compressed her story into a dense, simple tale of innocence — she just woke up covered in blood — to hold up against the public accusation of baby-strangling. I kept looking at her face, incapable of seeing the innocent girl she described or the murderer the prosecutor sent to prison. The truth was certainly — well, not in the "middle" so much as somewhere else entirely. Somewhere like this: She'd had a clandestine abortion at 18 weeks, not all that different from D.C.'s, something defined as absolutely legal in the United States. It's just that she'd had an abortion in El Salvador.

A doctor who practices at Planned Parenthood in the US, and who recently lectured at one of my classes, spoke of the protesters who hold up the signs with all the gory pictures of torn-apart fetuses. She also said the pro-choice side ought to own those images.

We ought to do that, because I don't think anyone is pro-abortion. I think we can both agree that we would all be better off if there were no abortions. I think we all have reverence for human life, whenever it begins. Even if we say that human life may not equal human personhood and full rights before a certain point in development, I think we all respect human life. And I think that because of pro-life arguments, we are afraid to say that. But reproductive rights, under which I filed this post, is much more than abortion rights. If we want fewer ripped-apart fetuses, we should use comprehensive sex education, access to contraception, and access to abortion. Fewer women will have unintended pregnancies, and if they do, they will seek abortion earlier, when it is less morally problematic.

That, however, was a bit of an aside. I think that anyone with the least bit of sense, pro-choice or pro-life, should agree that ectopic pregnancies should be handled as they are in US Catholic hospitals. I believe that the handling of ectopic pregnancy in El Salvador, and presumably in other Latin American countries, is in contravention of Catholic medical ethics as practiced in the US, as well as being damn stupid.

Weiwen's World News, 11/6

The Rev. Drew Phoenix of St. John's United Methodist Church in Charles Village, Maryland, is a transgender man. Some clergy moved to remove him, but the United Methodists do not have laws against transgendered people serving in ministry. Their highest judicial body decided last Tuesday that there is no impediment to him continuing to serve as pastor. I believe this is a wise decision. Rev. Phoenix thinks the church will continue moving towards full inclusion. I suppose this can be seen as a stepping stone.

The Rev. Kevin M. Baker, who had raised questions about Phoenix's name change when it was announced at the Baltimore- Washington's annual meeting in May, said he wasn't surprised by the Judicial Council's decision.

However, "it seems to me that we need more discussion on this issue," said Baker, pastor of Oakdale Emory United Methodist Church in Olney. "We need a chance to talk about the implications of it."

He said he wishes that the Judicial Council had called for more examination of theological issues raised by transgender people. For example, it's unclear to Baker whether transgender clergy could be married. United Methodism does not perform marriages of gays or lesbians and requires unmarried clergy to remain celibate.

"This just is, in my opinion, another chink in a long fence of issues that we're not dealing well with in the church," such as pornography and divorce, he said.

I felt the choice of the fence metaphor was an interesting one. Christianity has relied too much on the metaphor of division: the profane versus the sacred. However, I believe that Jesus came to welcome all. Even if he kept to the profane vs sacred metaphor, he deliberately chose to move the fence to include people, rather than to keep them out.

Bishop Trevor Mwamba of Botswana has sharply criticized Bishop Nolbert Kunonga of Zimbabwe, whose name was mentioned in infamy several times previously here. Kunonga has moved to take his diocese out of the Province of Central Africa; both bishops are in this province.

Apparently, Kunonga has moved to withdraw his diocese because some other bishops support "full Christian rights" for LGBT people. I do not believe that Bishop Mwamba allows same-sex marriages to be blessed, or ordains partnered LGBT people, but he has committed to the listening process and reconciliation demanded by the Windsor Report, and presumably supports legal protections against discrimination. He feels that Kunonga is using LGBT people as a scapegoat in his quest for personal power. Kunonga, in turn, had accused Bishop Mwamba of being an "avowed homosexual" in print.

Clerical Whispers, a blog by an Irish Catholic priest, reports on Fernando Lugo, a RC bishop who resigned his orders to run for political office in Paraguay. Lugo is reportedly very supportive of the poor. The RC hierarchy is displeased. The Catholics view ordination as a lifelong sacrament, so Lugo is still a priest in their tradition. However, from a secular standpoint, he does not exercise his authority in the church, so there are hopefully no grounds for the government to challenge his candidacy; Paraguayan laws forbid religious leaders from seeking office.

Additionally, the blog reports that Bishop Martinus Muskens took an early retirement amidst controversy over his promotion of condoms for the purpose of AIDS prevention. Madpriest asks, sarcastically, whether he jumped or whether he was pushed. Muskens said that use of condoms is permitted by the Catholic doctrine of lesser evil.

Lifesite (urk) describes condom promotion in Uganda as "the imposition of the international condom campaign". They quote Martin Sempa, a minister and AIDS activist, who says that abstinence must remain the main thing. In fact, Uganda is about 42% Catholic and 35% Anglican, so their assertions do bear a second look.

Lifesite argues that Uganda was a major AIDS success story (this is true, although some dispute the statistics) due to high level political commitment, and the religiosity of the populace. They argue that since the condom campaign was "imposed", Uganda's AIDS prevalence has risen. I don't have data to support or refute their contention right now. But I will say that people have sex. They have it before they are married, and they also have sex outside of marriage. Perhaps Ugandans decreased rates of non-marital sex during the initial outbreak, but they may now be reverting to the mean. Human Rights Watch also argues that abstinence education in Uganda takes part in exclusion about provision of condoms. Sex education has in fact spread false information about condom ineffectiveness, or has left out information about condoms at all.

Interestingly enough, to promote religious tolerance, Bishop Muskens (he's still a Bishop in my book) asked Danish Catholics to pray to God using the name Allah. The latter simply means God in Arabic; it is not any sort of special name. Wikipedia reports that Arabic Christians say Allah as well, and that in fact their use of the term predates Islam by several centuries. Neither contention should surprise anyone.


Addition: Lastly, a US judge has dismissed a key part of Johnson and Johnson's suit against the American Red Cross, namely J&J's contention that ARC agreed to never sell products with the red cross on them.

Abortion in Malaysia

From The Star, a Malaysian newspaper. Malaysia is a Muslim country. Note the difference between their definition of abortion and the way the Roman Catholic Church might do so - Malaysia forbids any abortions after the third trimester. I believe that Islam has no opinion on abortion before the quickening, or the fetus' first movement. Singapore allows abortion on demand before 24 weeks, or any time the life of the mother is threatened.

Thursday, April 17, 2003
The process of elimination
By LI EE KEE

ABORTION is defined as the expulsion of the conceptus – the product of conception at any point between fertilisation and birth – before the 24th week or the loss of a foetus weighing 500gm or less.

While abortion is traditionally seen as being induced, it can also be spontaneous. When a mother suffers a miscarriage, her situation is medically termed as an abortion but when dealing with patients, obstetricians and gynaecologists refer to it as a miscarriage.

Malaysia’s Abortion Act 1967 makes abortion or termination of pregnancy illegal. However, there are circumstances in which it is permissible. According to Pantai Medical Centre consultant obstetrician and gynaecologist (OBGYN) Dr Nor Ashikin Mokhtar, a pregnancy may be terminated if two registered medical practitioners are of the opinion, formed in good faith, that continuation of pregnancy will endanger the mother’s life.

“For instance, if she has breast cancer, cancer of the womb or renal failure. The mother’s safety and well-being is always priority because we have to take into consideration her family and existing children whom she has to care for. If the pregnancy were to continue, it would deprive them of a mother,” she says.

Termination of pregnancy is also advised to prevent grave permanent injury to the physical and mental health of the mother.

“Victims of rape or incest who become impregnated as a result are permitted to abort their child as long as there is a mental assessment from a psychiatrist that shows if the girl were to continue with her pregnancy, it would affect her psychologically, maybe causing her to lose her mind.

“Also, if the foetus is diagnosed with gross physical or mental abnormalities, like severe anencephaly where the baby is without a brain or skull, or part of it is missing, an abortion is advised. Because when the baby is born, it may only live for a few hours,” she adds.

Various techniques are employed in an abortion procedure, all of which depends on the stage of gestation. They can be grouped as either medical or surgical termination.

Medical termination is for pregnancies less than nine weeks old. This can be done with a Mifepristone tablet (a hormone tablet that blocks production of progesterone produced by the mother’s body to maintain early pregnancy). It causes bleeding, pain and expulsion of the conceptus within 24 to 48 hours. The tablet is not available in Malaysia.

“With oral medication, the abortion can be incomplete and has to be supplemented with a surgical technique like curettage. Again depending on the period of gestation, if it was between five to six weeks, it may come out with the menses. Between eight to nine weeks, the abortion may be incomplete and a surgical termination like D&C (dilatation and curettage) is needed.”

Under surgical termination, pregnancies less than 12 weeks old can be aborted via a suction curettage or D&C.

Beyond 12 weeks, the procedure for termination of pregnancy is more complex, where it’s almost like an induction of labour. All surgical termination procedures are done under general anaesthesia because the patient is relaxed, making the cervix easier to dilate.

Only doctors who have undergone obstetrics and gynaecology training/posting and have been taught or have performed these procedures, as part of their training supervised by the consultant OBGYN is capable of performing an abortion surgery safely.

Although abortion appears to be a minor operation – if done correctly, it takes only 10 to 15 minutes – Dr Nor Ashikin says that complications can and do occur anytime, anywhere.

“A life is at stake, particularly if you are talking about teenagers. It might affect them and their future pregnancies. The worse case scenario is death because if it is a forceful rather than gradual dilatation of the cervix, the girl can go into shock. Bear in mind that the cervix for those who have not delivered before is the size of a pinhole and you are trying to dilate it to about six to seven millimetres in diameter. If it is forceful dilatation or performed by someone untrained, it can tear the cervix where the immediate effect of which is haemorrhage. Uncontrolled and if the clinic is not properly equipped with blood supply for instance, the girl can die.”

Dr Nor Ashikin adds that in the long term, the muscles of the cervix will become weak or damaged.

“She must be prepared for the reality that she might not be able to conceive when she wants to because when there is tear or perforation resulting in continuous bleeding or severe infection, sometimes the uterus has to be removed. Should she get pregnant, she’ll find that she is likely to have recurrent spontaneous miscarriages or go into pre-term labour.”

An incomplete abortion without supplementation can lead to prolong bleeding, causing infection and damage to the ovaries, fallopian tubes, uterus and eventually resulting in infertility.

Uterine perforation can also take place because the uterus is usually anteverted (tilted forward) and instruments like the curette are stiff. As it is inserted, it might perforate the cervix or the wall of the uterus, which can result in a haemorrhage; perforate the bladder, which can cause urine leakage; or puncture any of the intestines, as they are located behind the uterus.

Between a D&C and suction curettage, the latter is safer because it uses a plastic tube, which is softer and thus able to follow the curve of the uterus. The degree of complication also depends on period of gestation with complications less likely to occur if the pregnancy is still in its early stages. And an abortion conducted legally in a hospital will have a smaller percentage of complications.

“These are the risks girls have to know they are taking and whether it’s worth taking them. Many think it’s an easy way out, as contraception. But I don’t think they actually realise what they are in for. They are desperate people who try to solve the problem with desperate measures,” says Dr Nor Ashikin.

“Youth must be more responsible, in the sense if they feel they are sexually active, they should understand the consequences and be prepared to take the risk, although I don’t think that is the right attitude. Abortion is not the answer and this is where sex education is important for teenagers.

“It’s hard making these comments but as a parent, I feel that moral and religious guidance are very important to guide our teenagers because of exposure to the media and Westernisation.

“Any girl who finds herself pregnant, should first go to her parents and discuss it with them. I know as teens, they’re at that rebellious stage where they think their parents are their worst enemy. But your parents are your best friends who always have your best interest at heart. If not, talk to counsellors who can understand and help you,” she advises.

Temporary Aid for Needy Families controls women's reproduction

From Learning from the history of poor and working-class women's activism, Mimi Abramovitz, dated 2002. TANF is Temporary Aid for Needy Families, and American program. Note the "temporary" - it's designed to be a short term thing. It makes the American public, which believes in hard work, feel good, but it fails to meet the needs of many. That's actually another story; here, Abramovitz examimes how TANF has been used to control reproduction.

TANF's work requirements have captured most of the public interest, but welfare reform also directs our attention to what might be termed the point of reproduction - long a site for activism for the feminist movement and many middle-class women. In its effort to promote marriage as the foundation of a successful society, welfare reform stigmatizes single mothers and unduly controls the marital, childbearing, and child-rearing choices of poor and working-class women. To this end, TANF includes the family cap noted earlier but also an illegitimacy bonus, which provices extra funds to the five states that reduce their nonmarital birth rates without increasing abortions, and abstinence-only funds for school programs that try to limit teen pregnancy by replacing comprehensive sex education with abstinence-only programs. The ferofmers built support for these harsh policies by evoking racialized stereotypes of hypersexed black women who have additional chuldren to increase their welfare grants. The new Fatherhood and Marriage initiative, currently under discussion in congress, suggests that family values will become a major issue during the upcoming reauthorization debate.

Madison, Wisconsin: emergency contraception bill public hearing set

From Madison Capital Times, Compassionate Care hearing Thursday, 10 a.m., 225 Northwest, State Capitol

Months after the state Senate passed a bill that would require hospitals to dispense emergency contraception to rape victims, the bill will get a hearing Thursday before a state Assembly committee.

Rep. Mark Gundrum, R-New Berlin, chairman of the Assembly Judiciary and Ethics Committee, said in June that he had no plans to schedule a public hearing on the bill. But in an interview Tuesday he said he had always left the possibility open: "I had no idea if or when, but now's the time." [Editor: Non US readers should note, bills that fall under a certain legislator's committee can be stalled by that legislator if s/he is inclined to do so.]

Republican colleague Terry Musser, who is the bill's main sponsor in the Assembly, says the move is a sign of widespread public approval for the bill and mounting pressure for its passage within the party.

Gundrum, a devout Catholic who has been endorsed in his Assembly campaigns by Pro-Life Wisconsin, which opposes all forms of birth control and is opposed to the Compassionate Care for Rape Victims bill, said he reviewed the bill and decided it "merits more discussion."

He said he is particularly interested in listening to testimony related to the "constitutional issues related to the bill."
Gundrum said there is a concern that the bill "mandates what doctors must tell patients, which is a First Amendment free speech issue" and that it violates religious freedoms guaranteed under the U.S. Constitution. "I've been contacted by a lot of doctors with moral objections about being forced to do this," he said, noting the Milwaukee Catholic Doctors Guild opposes the bill.

The bill would require a hospital to give a sexual assault victim information about emergency contraception and, upon her request, the medication itself. Most often marketed as Plan B, emergency contraception is essentially a high dose of birth control pills that is highly effective at preventing pregnancy if taken within 72 hours of intercourse.

Earlier this year, the Wisconsin Catholic Conference, the public arm of Wisconsin's bishops, said it did not object to the bill, a stance that many cited as a reason that some Republicans have publicly supported it.

Rep. Musser, R-Black River Falls, said he does not believe there are constitutional roadblocks in the bill. "I think it's more smokescreens than anything else," Musser said this morning.

Chris Taylor, public policy director for Planned Parenthood of Wisconsin, which supports the bill, also dismissed any constitutional concerns about the bill.

"Nine other states have passed this law and there has never been a constitutional challenge," she said. "The state clearly has the right to regulate health care professionals and entities to protect the safety, health and life of patients," she said.
Taylor said hundreds of bill supporters have contacted Assembly Speaker Mike Huebsch, R-West Salem, protesting his referral of the bill to Gundrum rather than to Republican Rep. J.A. "Doc" Hines of Oxford, who chairs the Assembly's Public Health Committee. Hines had said he would promptly hold a hearing on the bill.

Musser said Gundrum finally bowed to pressure within his own party and from the public to schedule a hearing on the bill.
Musser said he urged Gundrum to hold a hearing so that the constitutional issues he was raising about the bill could get discussed.

"I had never heard of them before so I said let's have a hearing," Musser said. "It's hard to respond to scuttlebutt."
Taylor said Gundrum and other Republican leaders finally "saw the writing on the wall."

"He underestimated support for this bill," Taylor said. "So did Huebsch."

Musser said the bill would pass the Assembly if it gets passed out of Gundrum's committee.

"I think it would be like the Senate," he said. "If we got a straight up or down vote on this, the Assembly would be overwhelmingly for it."

jdavidoff@madison.com

"Morning after" pill sales nearly double

From CNN Money

WASHINGTON (Reuters) -- Sales of the Plan B "morning-after pill" nearly doubled in the past year, exceeding expectations after the U.S. government allowed adults to buy the emergency contraceptive without a prescription.

A three-year battle ended last August when the Food and Drug Administration decided that women and men, 18 and older, could buy the Barr Pharmaceuticals Inc. (up $0.16 to $52.22, Charts) product without a doctor's order if they showed proof of age at a pharmacy.

"More women know about it, and it's just becoming much more part of their mainstream reproductive health care," Planned Parenthood President Cecile Richards said.

For Big Pharma, drugs are a hard global sell
Plan B pills contain higher doses of progestin, a hormone used in prescription birth-control pills for 35 years. Two Plan B pills reduce odds of pregnancy by 89 percent if taken within 72 hours of sexual intercourse, studies show.

Plan B sales hit about $40 million a year when the product required a prescription for all women. Industry analysts and Barr projected nonprescription access for adults, approved in August 2006, could boost sales to about $60 million in 2007.

The popularity of Plan B has exceeded those estimates.

Barr launched the nonprescription version last November, and the company predicts 2007 sales will reach about $80 million.

"We believe [sales] will continue to grow," Barr spokeswoman Carol Cox said.

Opponents of wider access say that is exactly what they had feared. Conservative and religious groups argued that easy availability would promote promiscuity and sexually transmitted diseases among teens and others.

Wendy Wright, president of Concerned Women for America, a group that opposed Plan B sales without a doctor's order, said minors may be obtaining it without a prescription or some women may be using it more than once.

"The high sales may indicate that our concerns are occurring," Wright said.

Some organizations want states to effectively limit Plan B access, but those efforts largely have failed to advance.

Family-planning groups say some women have reported trouble getting Plan B, with some pharmacists declining to dispense it or stores refusing to carry it.

Genevieve DeLucchi, 26, of North Carolina, said the first two pharmacies she visited last year did not have it in stock. She was able to buy it at a third.

After that, DeLucchi became a volunteer shopper for Planned Parenthood to gauge availability at stores. At some pharmacies she found "a lot of them had it, but they didn't know what to tell" customers about how to use it, or seemed reluctant to discuss it.

Barr and other backers want the age limit for non-prescription sales removed. Legal challenges on both sides are pending.

The Center for Reproductive Rights said a judge in New York may rule soon on its argument that the FDA's decision-making was flawed and Plan B should be available without a prescription to women of all ages.

Concerned Women for America and other groups challenged the FDA decision last April in federal court in the District of Columbia. They want a doctor's order for all sales.

ACLU: Hospital Mergers and the Curtailment of Reproductive Health Services

In a 1995 article, the American Civil Liberties Union details the fact that although Catholic hospitals often do very good work in the community, they are also subject to the doctrine of the Roman Catholic Church, which is one of the world's biggest enemies of women's reproductive rights and women's health. In the past, some Catholic hospitals would provide services that were technically proscribed, but the Catholic bishops had started cracking down on these services at the time this article was published.

And yes, I am interning at a Catholic hospital system.


Women's health care in the United States is at serious risk due to a declining number of reproductive health care providers. The most recent data indicate that 84% of U.S. counties have no abortion provider at all. While other reproductive health facilities are not as scarce, the violence directed at "women's health clinics," as well as other factors, has contributed to a shortage of services in general. In this context, the growing number of religiously controlled hospital mergers, joint ventures and affiliations is cause for alarm because it has curtailed reproductive services. These business relationships often require non-sectarian health care facilities to observe religious prohibitions against providing certain reproductive services. Although religiously controlled mergers may be motivated by economic considerations, and not necessarily the desire to curtail reproductive services, their impact on the availability of necessary health care is serious and far-reaching.

Religiously controlled hospitals comprise a significant percentage of all health care providers in the United States.

Many Americans depend on religiously controlled facilities for their health care. The Catholic health care system alone is the largest single private sector health care provider in the United States. It includes more than 600 hospitals, 200 health care centers, and 1,500 specialized care facilities, such as drug treatment centers. Catholic hospitals serve approximately 50 million patients a year.

Many religiously controlled hospitals do not provide basic reproductive health services.

Most religiously controlled hospitals do not provide services proscribed by their religious doctrine. For example, Catholic health care facilities, usually operated by religious orders, are subject to the control of the Roman Catholic Church. They are prohibited by church doctrine from providing a variety of basic reproductive health services: abortion, sterilization, contraceptive services and supplies, most forms of assisted reproduction, comprehensive AIDS prevention and condom distribution, and "morning-after" pills for rape victims (which prevent implantation of a fertilized egg). In 1971 the National Conference of Catholic Bishops' Committee on Doctrine codified these prohibitions as a set of incontrovertible rules in the Ethical and Religious Directives for Catholic Health Facilities. The Directives were updated in 1994, but the prohibitions remained. In recent years, American Bishops have been pushed to enforce doctrinal restrictions, and even hospitals that have disregarded some directives in the past have found or may find themselves subject to tighter control by the Bishops.

Patients are often not informed of policies that deny women reproductive health services.

Patients at religiously controlled hospitals often have no idea that they may be denied essential health services. Emergency patients or others who request prohibited procedures face serious physical and psychological risks. In one such case, a woman in Oregon went to a Catholic hospital to give birth and requested that she be sterilized after the delivery. Doctors did not perform the requested procedure, but failed to inform her that it had not been performed. Believing she had been sterilized, the woman later faced an unwanted pregnancy.

Religiously controlled hospitals evade a legal obligation to provide essential reproductive health services.

In an attempt to justify their failure to provide services otherwise required by law, religiously controlled institutions often invoke statutory "conscience clauses" that allow entire institutions to claim religious or moral objections to offering specific services. The individual religious and conscientious choices of patients concerning their medical care are thus subordinated to the institutional "conscience" of hospitals. Federal, state, and local governments facilitate this denial of essential health care services by granting tax-exempt status to religiously controlled hospitals.

Mergers with religiously controlled hospitals restrict women's access to reproductive health care services, even at non-sectarian institutions.

All patients, regardless of their religious affiliations, are profoundly affected by the refusal of religiously controlled hospitals to provide reproductive services. This is especially true in communities where a religiously controlled or religiously affiliated institution is the sole provider in the area. Low-income and minority women with few resources to obtain alternative medical care are the most vulnerable. For example, in 1992, 14 Catholic hospitals in the Chicago area denied 1,004 rape victims access to the morning-after pill. Of these 1,004 rape victims, 45% were low-income women seeking services in Catholic hospitals in poor and minority communities. The growth of religiously controlled health care systems in the last ten years has been extraordinary. Religiously affiliated networks now include everything from laboratory facilities to outpatient clinics, from insurance companies to individual doctors' practices. Indeed, for a growing number of Americans, religiously controlled systems are now the sole source of medical care.

Clinics that provide abortion services must be affiliated with hospitals.

Although 93% of abortions are performed in clinics or physicians' offices, hospitals have a vital role in maintaining women's access to this essential reproductive service. Abortion clinics are required by law in most states and by professional standards to be affiliated with local hospitals so that they can transfer a patient to a nearby full-service hospital for emergency care. Religiously controlled hospitals that refuse to provide clinics with this necessary back-up service effectively preclude them from performing abortions. In addition, hospitals must also provide abortions to women with critical needs. The 1% of all abortions performed as inpatient hospital procedures are cases involving serious complications, such as life-threatening conditions or fetuses with severe anomalies. In rural areas, where religiously controlled hospitals are often the primary or sole medical providers for families, their refusal to offer emergency services or perform medically complicated abortions is particularly problematic.

Mergers with religiously controlled hospitals have devastating economic consequences for women.


The scarcity of reproductive health services at religiously controlled hospitals not only poses health risks, but also has detrimental economic effects on women. Because these hospitals are forbidden from providing a wide variety of health services, women who need reproductive health services must find them elsewhere. The expenses associated with health care obviously increase when the cheapest and most convenient hospital will not provide needed reproductive services. For low-income women with no health insurance or those who receive Medicaid, these added costs could prevent them from obtaining the health care they need.

Right Wing Watch: Doctors' conscience as refusal to provide medical care to lesbians

Right Wing Watch has this story about a conservative legal foundation defending infertility clinic doctors (I think, they could have filed suit on behalf of them) at a clinic near San Diego, who refused to provide treatment to a lesbian. It's worth noting that significant federal subsidies go into medical education, and I don't just mean federal loans. Perhaps students who can't follow federal and state laws should be allowed to take a different version of the Hippocratic oath, and allowed to pay for the full cost of their education, plus subsidize the hospital that they do residency at.

While in some states, the Right is attempting to establish so-called “conscience clauses” to allow pharmacists to refuse to fill prescriptions for contraceptives, one case in California finds a medical clinic – and the Religious Right – attempting to expand that principle to “conscience”-based discrimination against patients, rather than the services they seek. Doctors at an infertility clinic north of San Diego refused to provide a woman with artificial insemination services, citing their religious conviction against birth out of wedlock – and, according to the woman, citing her sexual orientation. California law prohibits discrimination on the basis of sexual orientation.

The right-wing Alliance Defense Fund, which is representing the clinic, claims this is a case about the right “to exercise your faith as a Christian.” The woman’s lawyer warned that “The next case may be about whether a doctor is willing to do a pap smear” for a lesbian.”

Other right-wing groups have filed amicus briefs in the case. Peter Ferrara of the American Civil Rights Union defended the doctor’s decision because, he said, it was based on “a commonly held view, well grounded in Christian tradition.” Brian Rooney of the Thomas More Law Center warned that the case “smacks of Nazi Germany when Hitler forced doctors to do diabolical acts that were like this.”

Religion & Ethics story: Down's Syndrome

This story comes to us courtesy of Kendal Harmon's blog.

This is tagged under reproductive rights, which isn't a very precise way to do things. I mean for my readers to consider carefully what they would do.

As I once told a reader on Harmon's blog, if my hypothetical wife and I found out that our unborn kid had Tay-Sachs, for which the prognosis is extremely poor, I would be in favor of an abortion. But it turns out that the prognosis for Downs is actually not bad. I do know one couple at my church whose kid has a much more severe developmental disability than Downs. They love Alex very much, but he will definitely die before they do, and he has severe physical and cognitive disabilities.

I don't think it ever really is the right thing to do, but in some cases abortion is justifiable.




KIM LAWTON, guest anchor: Expanding medical technologies continue to create a host of new ethical dilemmas. For example, researchers can now detect early in a pregnancy if a fetus has Down syndrome. The condition usually results in some degree of physical and mental disability. Armed with that information, some expectant parents face the wrenching decision of whether to terminate the pregnancy. Bob Faw reports.

BOB FAW: On the playground at recess, six-year-old Benjamin Allard couldn't be happier. And in Mrs. Logan's kindergarten class in Franklin, Massachusetts with his circles and colors, Benjamin also flourishes ...

UNIDENTIFIED TEACHER (To Benjamin): What are you going to take?

BENJAMIN: Green.

FAW: ... even though Benjamin has Down syndrome.

BETH ALLARD: Just like any other child, you give him an opportunity, and work with them, and they can do whatever they aspire to do.

FAW (To Ms. Allard): Even if they're different?

Ms. ALLARD: Yeah.

FAW: Now Beth Allard marvels at her son. But when she remembers what her pediatrician told her when she was pregnant at 36, she can only shudder.

Ms. ALLARD: She said, "I just want to let you know what your life's going to be like. He's going to make your life hell. He won't be able to read or write or do anything. He may not be able to speak." The reason I considered terminating the pregnancy was, well, my doctor's telling me this. And I don't know much about it, so maybe she's right and I really need to do this.

FAW: Largely because of her Catholic faith, Beth Allard decided to continue her pregnancy.

ELLEN WIXTED (Talking to Husband): My concern is that if I do that ...

FAW: Seven years ago, faced with the prospect of giving birth to a child with Down syndrome and heart defects that often afflict those infants, Ellen Wixted, 35, chose to abort her baby.

Ms. WIXTED: I just couldn't imagine having all of the normal stresses of being a parent and on top of that, you know, raising a child with really, you know, potentially very severe physical disabilities as well as an unknown degree of mental retardation. All I could envision was a spiral of, sort of not being able to work, not being able to work in the studio, not being able to, you know, have a normal life. What that led to logically was ending the pregnancy, which I felt was morally wrong.

FAW: Now, with two children born later, Ellen Wixted says that decision to abort haunts her as much today as it tormented her then.

Ms. WIXTED: It was hard to get out of bed in the morning. It was hard to -- it was hard to function at all, really. And, you know, my husband is incredibly supportive, and it was still the hardest thing I think I've ever gone through.

FAW: Two women and two different responses to Down syndrome -- a genetic abnormality in which an extra chromosome generally results in mild or moderate retardation and other health problems.

Ms. ALLARD (To Benjamin): How about this foot over here? Bend that knee.

FAW: Every year 5,000 babies are born with the defect, many to older women. Recently, using ultrasound and blood tests, doctors developed a new technique to identify the condition in the first trimester. Advocates for the disabled, however, worry that the test, administered before some feel human life has fully begun, will be used to abort more Down syndrome babies.

BEVERLY BECKHAM (Newspaper Columnist): What troubles me is this first trimester test just is like a missile that targets children with Down syndrome. So, what if other children aren't born with Down syndrome? Then maybe Lucy will be an endangered species?

FAW: The light of Beverly Beckham's life in Canton, Massachusetts is her two-year-old granddaughter Lucy, her Lulu Belle, who has Down syndrome. Fifty years ago, children with Down syndrome were labeled "mongoloid."

(To Ms. Beckham): Years ago we would institutionalize kids like this?

Ms. BECKHAM: Right. And now we kill them. I think that all of this money spent trying to find them and eliminate them would be far better spent trying to educate and take care -- provide.

FAW: In one sense, Lucy's birth was unusual. Doctors estimate that when faced with the prospect of giving birth to a child with Down syndrome, 80 percent of mothers choose to terminate their pregnancies.

UNIDENTIFIED DOCTOR (To Child): Should we do some colors?

FAW: This clinic at Children's Hospital in Boston provides early intervention for children with Down syndrome. Its director, Dr. Allen Crocker, is troubled that so many women choose not to give birth to babies with the condition.

Dr. ALLEN CROCKER (Senior Associate in Medicine, General Pediatrics, Children's Hospital, Boston): There is a broad failure to understand the meaning of this kind of special person. I see joy, both in myself and in them. And when I stand back and look at the larger scene, we are all the richer for having a diverse society.

FAW: For three decades, geneticist Elsa Reich has been counseling pregnant women. Doctors, she argues, should tell expectant mothers medical facts, not try to influence moral choices.

Professor ELSA REICH (Genetic Counselor): Now who am I to say, you know, "Of course you can cope with it. Other people do, so you can cope with it, too"? You know, I think that it is their judgment to make.

FAW: Reich says expectant mothers worry about the cost of raising a Down syndrome child -- about how that child will affect siblings, and mostly how the child will cope.

Prof. REICH: And the older parent feels that, worries -- who's going to take care of that child when I am not here anymore? I think, you know, we think of our society -- we're very fast moving. How is this child going to get along in this society?

FAW: Adults with Down syndrome may surprise us, but not themselves. Twenty-four-year-old Sujeet Desai in Rome, New York, is an accomplished musician who gives concerts and lectures. And 29-year-old Carrie Bergeron has a gift -- working with small children. Both Carrie and Sujeet have Down syndrome. This summer, they plan to get married.

SUJEET DESAI (To Ms. Bergeron): To us.

CARRIE BERGERON (To Mr. Desai): To us. Cheers. I just wanted to tell everybody else who has Down syndrome and special needs that they can have dreams, and they can accomplish their dreams in any way they can.

FAW: Carrie and Sujeet are lucky. They benefit from a state program which provides housing and special assistance. Many states don't offer that kind of support. But they insist their so-called "handicap" is in the way we look at them, not in who they are.

Ms. BERGERON: I don't think it's a handicap. It's just that we are special no matter what we are, because we are a person first.

FAW: Special and different. Like most people with Down syndrome, six-year-old Benjamin Allard knows he is not like everybody else.

Ms. ALLARD: He gets himself ready in the morning, and he came downstairs and I said to him, "Oh, look at you! You look so handsome today!" And he said, "Mommy, I'm not handsome, I'm different." And that -- that broke my heart.

FAW: Physically they are different, too. When just two months old, Lucy had to have open-heart surgery. Carrie has had heart and respiratory problems. In 1983, the life expectancy of someone with Down syndrome was just 25. Now it is 56.

Dr. BRIAN SKOTKO (Harvard Medical School): There are some who have more challenges in school than others. They might need extra support in the classroom. And what research is showing -- that when that support is provided, they're excelling.

FAW: Dr. Brian Skotko, who surveyed more than 1,000 pregnant women given prenatal tests, concluded many doctors are insensitive -- ignorant about Down syndrome and the potential of those born with the defect. Dr. Skotko's fear and the fear of others is not that those prenatal tests will reveal genetic abnormalities. The fear is that those tests will be used to "search and destroy" those with disabilities.

Ms. BECKHAM: Society is saying everybody has to be perfect. I don't believe that you can test away everything -- you can test away all of the things that make life hard. I think that women aren't given a real indication of how not horrible this is.

FAW: For now, though, women will continue to agonize on bringing into the world a child like Benjamin. Or, as Ellen Wixted did, deciding not to.

Ms. WIXTED: I wouldn't have done it differently. And I am no more morally at ease with that now then I was then. I would make the same decision and I would feel equally awful about it.

FAW: A choice with consequences -- then and now.

(To Ms. Allard): Do you ever just shake your head and think you did come close to losing him?

Ms. ALLARD: I can't even think about it. Yeah. Because I just -- I can't imagine life without him.

LAWTON: Since that story first aired, Carrie and Sujeet did in fact get married in a Hindu wedding and a Christian ceremony a week later.

Catholic Cardinals vs Catholic Healthcare

Christopher Zehnder, writing for Crisis Magazine, offers an analysis of what he thinks is ailing Catholic healthcare. I'm going to quote the last two sections of the article.

Disrupted Directives

Part of the problem has been the Ethical and Religious Directives for Catholic Health Care Services, a publication issued by the National Conference of Catholic Bishops (NCCB) in 1994. The appendix to the Directives contained a section addressing cooperation in immoral acts. Some ethicists criticized the section on cooperation, saying it was far too unclear. The National Catholic Bioethics Center (NCBC) in Boston faulted the bishops for not clearly distinguishing between material cooperation, which is sometimes permissible, and implicit formal cooperation, which is never permissible. The NCBC also claimed that the bishops did not directly address institutional cooperation but only individual cooperation.

The Directives’ section on cooperation allowed for much misinterpretation. For instance, spokespersons for St. Vincent’s in Little Rock claimed the Church’s principle of cooperation permitted participation in an act of wrongdoing in times of "duress," when it was done in order to preserve a greater good. In the case of St. Vincent’s, managed-care companies were said to be applying duress, and the greater good was the hospital’s "financial health." Bayley told me that the Catholic bishops told CHW, "If you need to cooperate with providers who provide sterilization, if you need to do that to make your !hospital system secure—to be sure that your mission goes forward into the future—about that you can negotiate, about that you can cooperate."

Last year the U.S. bishops began revising their Directives at the request of the Congregation for the Doctrine of the Faith, which was particularly concerned about the section on cooperation. The resulting revision, which the NCCB issued on June 15, 2001, remains basically unchanged from the 1994 edition. The bishops added directives on partnerships in Catholic health care and omitted the entire section on cooperation in the appendix. The bishops now said that "reliable theological experts should be consulted in interpreting and applying the principles governing cooperation, with the proviso that, as a rule, Catholic partners should avoid entering into partnerships that would involve them in cooperation with the wrongdoing of other providers."

Rev. Germain Kopaczynski, director of education at NCBC, says that in deleting the section on cooperation, the bishops were responding to criticism that the appendix "was spawning more questions than answers." Was it an adequate response? The Church rarely makes "draconian revisions," Father Kopaczynski says. "I think [the bishops] tried to address the legitimate concerns—that proper doctrine is safeguarded—without changing the document so drastically that people would find themselves lost in it. In a sense, it was a minimalist way of trying to handle the abuses that were taking place."

As for referring the question of cooperation to "reliable theological experts," Father Kopaczynski notes that in the general introduction to the Directives, the bishops say that "in the absence of a determination of the magisterium, but never contrary to Church teaching, the guidance of approved authors can offer appropriate guidance for ethical decision-making." Father Kopaczynski thinks that the "approved authors" perhaps refers to the "classical authors, those who have already gone home to the Father; whereas the ‘reliable theological experts’ might be those who are still among the living. That is open to some interpretation," Father Kopaczynski says. "Depending on who the experts are whom you consult, you might get a latitudinarian or a narrow interpretation of the document. You might want to say, ‘This theological expert is reliable to me’—but would he be reliable to somebody else?"

!l-250Father Kopaczynski thinks that the new Directive 70 should be the litmus test in judging the reliability of a theological expert. That directive states: "Catholic health organizations are not permitted to engage in immediate material cooperation in actions that are intrinsically immoral, such as abortion, euthanasia, assisted suicide, and direct sterilization." The footnote to this directive cites the 1975 "Reply of the Sacred Congregation for the Doctrine of the Faith on Sterilization in Catholic Hospitals": "Any cooperation institutionally approved or tolerated in actions which are in themselves, that is, by their nature and condition, directed to a contraceptive end...is absolutely forbidden. For the official approbation of direct sterilization and, a fortiori, its management and execution in accord with hospital regulations, is a matter! which, in the objective order, is by its very nature [or intrinsically] evil."

In their "Statement on Cooperation, An Examination of the Fundamental Principles," the ethicists at the NCBC define immediate material cooperation as "any willful, intentional contribution to the circumstances essential to the principal agent’s immoral action, though that action may not be intended by the cooperator." If one applies this definition to Catholic health-care systems, even secular hospitals that remain secular after their purchase by a Catholic party may not offer abortion, euthanasia, assisted suicide, or direct sterilization.

An Uncertain Prognosis

Last year, when it became clear that the new directives would be more stringent on cooperation with sterilization, the CHA presented the bishops with a list of concerns expressed by Catholic health-care professionals. (Catholics for a Free Choice, on whose Web site this list appeared, claimed that CHA itself expressed these concerns. But Fred Caesar, CHA’s senior director for public affairs, said the list, though presented by CHA, did not express that organization’s concerns; rather, CHA "was reporting what had been expressed by Catholic health-care leaders in a meeting with the drafting committee of the National Conference of Catholic Bishops.")

!Among the concerns were the following: "The revision could result in another Humanae Vitae-type division within the church.... [It] will likely affect Catholic health care’s ability to approach potential partners [who] do not share our views on sterilization as an intrinsic evil.... There is a likelihood of the loss of OB/GYN services in many of our hospitals.... Some will see the proposed change as an attempt to impose our religious beliefs upon the community.... Women and children, especially the poor, will be most affected by these revisions.... The proposed revisions could jeopardize Catholic health care’s ability to carry on our mission by eliminating our presence in some areas, weakening our influence on moral issues, especially life issues.... Sponsors will be forced to consider whether or not to continue their health care ministry as Catholics, [and] the revisions may also create serious conflict !within religious congregations."

Insofar as this list of concerns reflects the attitude of Catholic health-care providers, there would seem to be little likelihood that they will obediently embrace the more stringent directives. One is left to ask how a Humanae Vitae-type division would be possible in a system where everyone followed Church teaching. Is the loss of OB/GYN services more serious than the sacrifice of Catholic principles? How will women be affected, except positively, by Catholic hospitals treating them according to their true human dignity? And how Catholic are the sponsors who will abandon their Catholicity because they are called to follow Church doctrine? The list of concerns presented by CHA may reflect an "unequal yoking"—not only of Catholic with non-Catholic institutions but of Catholics with anti-Catholic positions.

And of course, I'm going to offer my analysis.

The Catholic magisterium claims authority from God. They say that birth control, sterilization, sex not for procreation, and abortion are all abominations. They do not have the faintest idea what they are talking about because they are all me. If they ordained women and married men, I bet you they would reconsider their positions on birth control, sterilization, and sex not for procreation. I can respectfully disagree with them on abortion. But the cardinals will never have to be in the position of a hyopthetical woman in, say, Nicaragua. She has been pregnant ten times; this many pregnancies presents a health risk. She and her husband should engage in family planning, and should consider using contraceptives or getting sterilized. But wait, the cardinals think that's a sin!

I am glad for the Catholics involved in the healthcare system, who are much more thoughtful than their cardinals. They would rather continue providing services than following a bunch of old, mainly White men, who will never face the choices assiociated with sex and pregnancy. Some are probably pro-choice in their private lives, many are probably neutral, and many are probably pro-life but determined to let people choose for themselves.

Doctors who practice in Catholic hospitals must abide by their codes of conduct, which preclude abortion, sterilization, or, more recently, removing feeding tubes from comatose patients. This alone makes me a little uncomfortable. I am confident that social justice is a tradition that runs very deep within Catholicism. But I am not confident in the direction that the current pope is taking, and am concerned at how Catholic health systems could be affected.

Connecticut requires all hospitals, including Catholic ones, to dispense emergency contraception

The Connecticut state Senate overwhelmingly approved a bill Wednesday April 25 that would require all hospitals — including the four Catholic facilities — to provide the Plan B emergency contraceptive to rape victims. The abortifacient drug is also known as the morning after pill.

“This bill is a violation of the separation of Church and State,” wrote Bishops Henry Mansell of Hartford and William Lori of Bridgeport in a letter to lawmakers on Wednesday. “The Catholic Bishops of Connecticut are responsible for establishing and determining what moral guidelines Catholic institutions should follow; not the Connecticut General Assembly.”

“Senate Bill 1343 should contain language that respects the religious beliefs of Catholic hospitals and not force them to cooperate, either directly or through a third-party contract, in an abortion,” they said.

The bill, which passed 32-3, now heads to the House, where it appears likely to pass, reported the Journal Inquirer.

The bill allows hospitals to first give patients a pregnancy test. Those with religious or other objections could hire an outside physician to administer the contraceptive rather than assign that duty to hospital staff.

The Connecticut Catholic Conference rejected the measure, saying that hiring a physician outside of regular staff would not undo the ethical concern.

"It is clear to us that this approach would involve the hospital in a way that would violate Catholic moral principles of cooperation," the bishop wrote. "It would still involve Catholic hospitals in the performance of early abortions by administering Plan B when the medication cannot act solely as a contraceptive."

The state's four Catholic hospitals — St. Francis, St. Raphael, St. Vincent, and St. Mary — do not provide the contraceptive if a woman is ovulating or pregnant.

The Catholic hospitals have argued that the Plan B contraceptive could cause an abortion by preventing the implantation of a fertilized egg. Catholic teaching holds that human life begins at conception.

“Catholic hospitals provide emergency contraception to rape victims in the vast majority of cases,” the bishops noted in their letter. “In fact, it is an extreme rarity when this medication would not be provided.”

Senate Minority Leader Louis DeLuca (R-Woodbury), Sen. Daniel Debicella (R-Shelton), and Donald DeFronzo (D-New Britain) opposed the bill.

DeLuca had proposed an amendment, which was endorsed by the Catholic Conference, would require every hospital to have a written protocol for dealing with rape victims. Hospitals would be allowed to refer such patients to other facilities, but would have to report their reasons for doing so to the Department of Public Health.

“Catholic hospitals, in those rare cases, would provide the patient information on where the medication is available and provide transportation to another hospital if the patient requests a transfer. Outside rape crisis counselors are also available from outside the hospitals if the patient requests their support,” the bishops said.

DeLuca did not succeed in getting the amendment passed.

Justice Anthony Kennedy's misguided attempts to "protect" women

I commented earlier on how the Supreme Court of the US banned intact dilation and extraction, aka partial birth abortion. One of the reasons that Justice Anthony Kennedy gave in his majority opinion was that the State had the right to protect women from making an uninformed decision to undergo this procedure. He argued that they would experience regret.

Justice Ruth Bader Ginsburg, in her dissent, wrote that the answer to this concern was to give women more information. She also wrote:

"Instead, the court deprives women of the right to make an autonomous choice. . . . This way of thinking reflects ancient notions about women's place in the family and under the Constitution -- ideas that have long since been discredited."

Indeed, the only reason to restrict this particular abortion procedure should be that, given the fetus' development at this stage of pregnancy, intact dilation and extraction is the same as murder (a contention which, by the way, I don't agree with). Here, it is not warranted for the State to protect people from themselves.

Supreme Court backs ban on "partial birth" abortion

Yesterday, the Supreme Court, by a 5-4 margin, backed a Federal ban on intact dilation and extraction, a later-term abortion method. The conservative 4 plus Anthony Kennedy, a moderate, voted with the majority. Justice Ruth Bader Ginsburg, the only woman now serving, wrote in her dissent that the decision was "alarming," and that it "cannot be understood as anything other than an effort to chip away at a right declared again and again by this court." Previously, several states had banned partial birth abortion, not all of them including provisions for use to save the mother's life. Multiple federal courts had found the bans unconstitutional.

Partial birth abortion is better called intact dilation and extraction. It is not used often. The same technique is used to remove a dead fetus (but this would not be banned under any of the state laws). Guttmacher institute reports that in 1996, D&X procedures accounted for only 0.03 to 0.05% of all abortions. The large majority were performed between 20 and 24 weeks gestation. Another procedure is called dilation and evacuation; it involves dismembering the fetus in the womb, and then evacuating the uterus. Most partial birth abortion bans are worded to cover this procedure as well.

It is important to realize that this is a rarely-used procedure. There are other methods of late-term abortion, and abortion in the first and second trimesters is generally legal. However, abortion rights are being eroded gradually, with parental consent laws, South Dakota's complete abortion ban, and now this. Abortion opponents generally intend to reduce abortion access gradually. American opinion is split on the issue, but a complete ban this minute would probably be opposed by a majority.

The Episcopal Church expressed "grave concern" over the use of partial-birth abortion, except in extreme situations. Is is logical to single this procedure out? The other option is inducing birth early; fetuses are generally not or borderline viable at 24 weeks and earlier. There is concern over the fetus experiencing fear and pain in partial birth abortions. And they do basically take the equivalent of a bullet to the brain. It's a quick death, and their nervous systems are rudimentary, but this is a concern. However, fetuses born by induced labor will also experience fear and pain. Should the Episcopal Church not have expressed concern over all late-term abortions? In any case, the Church has also voted to uphold reproductive rights in general; expressing grave concern over one abortion technique is not the same as saying that technique should be banned.

Expressing concern over late-term elective abortions would arguably not be a major infringement on the right to choose. These only account for a small fraction of all abortion cases. A lot of them fall surely into emergency categories, such as mother's or fetus' life in danger, and would be allowable in any case. (It should be noted that currently, most IDX procedures are performed electively, not for medical necessity.)

However, the current political climate is not friendly to the right to choose. Any sort of restriction on the right to choose could be seen as a stepping stone to further restrictions. It would be best if we left the decisions up to the women involved. I think it's also worth remembering that those who support reproductive choice would also rather abortions were used only when medically necessary, not as a means of contraception. That's why they invented the condom and the Pill. State bans on one particular abortion procedure are only one part of the story.

Recent edit: the ban that was found constitutional was a federal ban, not a state ban.