Thursday, March 29, 2012

Reproductive Rights -- and wrongs

The “debate” on reproductive rights has taken a turn to the far right with recent laws passed in several states that create greater obstacles for women who wish to obtain abortions. Probably the most famous commentary is a series of Doonesbury strips that ran (or didn’t run, or ran on the editorial page, depending upon your hometown paper) from March 12-16. Its focus is the Texas law requiring, among other things, that women have a transvaginal ultrasound examination before obtaining an abortion. It also requires that they receive “counseling” scripted not by their physician but by the state legislature and governor (see the final strip in the series, March 16).

Unquestionably, the “Doonesbury” strips are effective but face an uphill struggle in the effort to counterbalance the extremely well-funded efforts of right wing organizations. Their “think tanks” have been writing bills that are introduced in many states with virtually identical language. For an excellent discussion, see Paul Krugman’s “Lobbyists, Guns, and Money” (itself a parody of the title of a Warren Zevon song), about the American Legislative Exchange Council, ALEC, in the NY Times, March 26, 2012. Kansas, my home state, is in the process of passing a bill that will require doctors to inform women of the increased risk of breast cancer from having an abortion. This might seem reasonable, except that it is simply not true.  How can they get away with this? Well, we can examine the syllogism, which goes something like this: there is a somewhat higher rate of breast cancer in women who have never had a term pregnancy, so if you have an abortion instead of carrying to term you might be in this higher risk group. Of course, this misses a whole lot of bases. Women who have abortions frequently have had previous term pregnancies (which sometimes contributes to why they want the abortion), and or they may have term pregnancies later. Even if they never have a term pregnancy, no one has ever studied whether having a pregnancy at all (even one ending in abortion) puts one in the higher or lower risk group, or in the middle. Most important, for this discussion, most of women who never get pregnant do not get breast cancer, and many (probably most) women who do get breast cancer have had babies. Having a term pregnancy, or multiple pregnancies, is not protective.

Of course, this is not really the issue. The issue is that anti-abortion forces wish to prevent abortions by making it more difficult for women to obtain them. Thus, the veracity of the information that the laws written by ALEC promote is not important to its supporters. There has been some discussion about the fact that these laws that affect women but are written and passed primarily by male lawmakers. The suggestion is that it indicates a profound misogyny. I agree. These guys are often flagrant hypocrites who indulge in sexual (as well, of course, of financial) shenanigans, but feel no compunction about limiting the rights of women. This view is prominent in both the Doonesbury cartoons and in this creative effort by Salt Lake City Dispatch political cartoonist Pat Bagley in which he attaches the “I thee rape” Doonesbury, not run by that paper, to his own critique of this hypocrisy. It is the same misogyny which not only leads to abortion restrictions, but to restrictions on the availability of contraceptives, one of the two things that actually reduces the abortion rate (the other being accurate and widespread sex education, another “no-no” for the right), through insurance plans.  While, of course, ensuring that that these same plans cover Viagra and other drugs that help old guys get erections. It is part of worldview that sees men and women as not only different, but hierarchically related with men firmly in control. Women are subsidiary, not supposed to make noise, do what they are told, and certainly not make any decisions about their own lives, health or reproduction.  

Those who oppose abortion, but also support contraception and sex education, have a coherent position. The imaginary story line is that once a woman is forced to have a baby, she will want to keep it and care for it and be able to do so, or, at least put it up for adoption where someone else will do so. But while sometimes one of these two things happens, it is obviously a fantasy to think that it is the norm. We all hope that all children can be brought up in a loving, supportive, and financially secure family, whether birth family or adoptive, with all options open to them. But this is simply not the case for too many children, and those opposed to abortion are not doing anything to make it more likely by cutting support for health care, childcare, and education. Which is, of course, one reason it is hard to call them pro-life (along with their support for war and capital punishment).

Another part of the Kansas law forbids state employees from doing abortions. This might seem unnecessary, since it is already state law that abortions cannot be performed (with some rigid exceptions to save the life of the mother) at the University of Kansas Hospital, the only state owned facility. It also might not prevent medical school faculty from doing abortions at other facilities for which they are paid with funds that come from the physician practice plan rather than the state. It does, however, directly affect residents, physicians in training, especially in obstetrics and gynecology (OBGYN). The accrediting body for OBYN requires that residents receive training in abortion (which they may opt out for religious or moral reasons) and in evacuating the uterus when there are stillbirths (which involves the same procedure), which they may not opt out of. Currently, OBGYN residents at KU who do not opt out of abortion training receive this in an out-of-state program, but if this bill passes intact it would forbid them from doing that, as the residents are state employees. This would put the entire OBGYN training program in jeopardy, and it would likely be placed on probation, potentially closed, a problem noted by even some usually anti-abortion legislators. But to the anti-abortion movement, this is not a problem. They see this collision course as desirable and hope that a series of such state laws would force the OBGYN accrediting body to eliminate this requirement. Then, ultimately, there would be no one being trained to do abortions, there would be no one doing abortions, and voilà! -- there would be no abortions! Without the admittedly effective, but messy, need to encourage crazy people to assassinate them, as was done with Kansas physician George Tiller.

According to the Kansas City Kansan article, “Brownback mum on KU Med Center, abortion issue,
Gov. Sam Brownback refused to say where he stood over legislative efforts aimed at stopping Kansas University Medical Center medical residents in obstetrics-gynecology from training in abortion-related procedures. “I’m studying the issue,” Brownback said at a news conference. Abortion rights advocates, and even some legislators who have opposed abortion, say the medical residents need the training to maintain KU’s accreditation and to be able to handle emergency pregnancies. But anti-abortion advocates disagree. Brownback has signed into law several anti-abortion measures and has welcomed the Legislature’s work in this area.” Yes, he has. Funny he hasn’t yet read the one-page bill.

Of course, the biggest flaw in this logic, beyond its complete arrogance and lack of respect for women, is the assumption that eliminating officially sanctioned training of physicians in abortion would end, or even significantly decrease, the number being done. What it would do is to decrease the safety of abortions, to increase the number of women who seek and obtain “back alley” abortions. It would, quite simply, kill many women.

But the proponents of such policies and legislation seem to have no problem with that. They are, after all, not fetuses.

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