Archives for posts with tag: abortion

Is this a bowl of eggs or a a bowl of chickens?

fetilized eggs

The eggs are fertilized, so by the logic of those who believe a fertilized human egg is the equivalent of a human being, this is indeed a bowl of chickens.

And this is a fried chicken:

fried egg

 

The claim that fertilized eggs are human beings reminds me of the joke (often attributed to Abraham Lincoln),

Q: If you call a tail a leg, how many legs does a dog have?

A: Four, because calling a tail a leg doesn’t mean it is one.

One of the main arguments in Hobby Lobby’s case against providing comprehensive contraception is that  morning after pills and IUDs are abortifacients.  Many have pointed out that morning after pills (which are NOT the same as the pills that actual do induce abortion) work by preventing ovulation, and IUDs generally work by thickening cervical mucus and otherwise creating an inhospitable environment for fertilization to occur.  Olga Khazan offers a concise explanation of the whole thing at The Atlantic.

The only method that could possibly meet any definition remotely connected to abortion is the Paraguard IUD, which when inserted up to 5 days after intercourse, appears to prevent pregnancy in ways that no one has entirely determined.  It is remotely possible that one of these ways could be to prevent the implantation of a fertilized egg.

This hypothetical fertilized egg has not developed into an embryo, much less a fetus, even less a baby (or child, adolescent, adult or senior citizen).  You can see slide show showing the process of ovulation to implantation here.  The passion with which some defend the life of a fertilized egg is mirrored only by the passion with which some defend an elephant fetus as a human being (seriously, click the link–the anti abortion crowd passionately defended the humanity of the elephant fetus).  Just in case you are curious, here is a photo of a fertilized human egg:

fertilized egg

And here is a photo of an elephant fetus:

elephant fetus

By the logic of the “personhood” movement, the top image is a person and the bottom image is an elephant.

There are many problems with assigning human status to fertilized human eggs (or elephant fetuses).  But the greatest problem comes when a woman becomes not a human being in her own right, but the vessel for the development of potential humans.

Thus, the argument that Hobby Lobby and others with their beliefs make is that it is immoral for a woman to make her body inhospitable to the implantation of a fertilized egg.  We already know that the methods of contraception that they claim prevent implantation actually prevent fertilization in the first place.  But let’s go ahead and pretend that implantation of a fertilized egg might be prevented.

Why is this a problem?  About half of fertilized eggs do not implant even when a woman is not using any form of contraception at all.  By the logic of the anti-IUD crowd, women should be banned from doing ANYTHING that might interfere with implantation of fertilized eggs.  This might include things such as being underweight.  If a fetilized egg is more likely to implant in heavier women, shouldn;t we force all women to be the ideal weight for implantation?  In fact, if a fertilized egg is a person, and that “person” has the indisputable right to grow inside of another person until it decides it can survive on its own, perhaps we should force all fertile women to take drugs that make implantation more likely.

If women use contraceptives, including IUDs, they are actually less likely to expel fertilized eggs because the eggs are less likely to become fertilized in the first place.  Libby Anne at Love, Joy, Feminism has a great explanation of how using birth control is the best way to prevent the deaths of fertilized eggs/zygotes/blastocysts.  And as I have argued, if we really believed fertilized eggs to be human, we would insist on funeral services and other respectful disposal of them instead of allowing them to pass along with ordinary vaginal discharge (the fertilized egg would be expelled before menstruation; implantation occurs about 5 days after ovulation, but menstruation occurs about two weeks after).

Believing that a fertilized egg is a person does not make it so.  Believing that morning after pills and IUDs cause abortions does not make it so.  And believing that a woman is an obligatory vessel not deserving of human rights does not make it so either.

 

Dr. Patrick Johnson is the director of Personhood Ohio, “an organization committed [to] the restoring the personhood rights of unborn children through an amendment to the Ohio constitution.”

Dr._Patrick_Johnson

In case you are wondering if a woman is a person in Johnson’s intolerant mind, here is the Personhood Ohio argument against abortion:

The Ohio constitution states the following:

Article 1, Section 1: All men are, by nature, free and independent, and have certain inalienable rights, among which are those of enjoying and defending life and liberty, acquiring, possessing, and protecting property, and seeking and obtaining happiness and safety.

Article 1, Section 16: All courts shall be open, and every person, for an injury done him in his land, goods, person, or reputation, shall have remedy by due course of law, and shall have justice administered without denial or delay.

Thus (according to Personhood Ohio):

The Ohio Personhood Amendment will insert Section 16(b):

“Person” and “men” defined:

(A) The words “person” in Article 1, Section 16, and “men” in Article 1, Section 1, apply to every human being at every stage of the biological development of that human being or human organism, including fertilization.

Apparently if one gives constitutional rights to defend life and liberty and obtain happiness and safety to fertilized eggs but not women, then we have personhood.  Because everyone knows that women are not people.

In any case, Johnson has a new obsession, and that is preventing children and married men from seeing women’s breasts.  here is another area in which a woman’s breast becomes separate from the human breast.  All people have nipples and breast tissue.

There are innumerable arguments about the sexualization of women’s breasts being a social construction.  Here are a few points:

In many indigenous societies, women go topless as a matter of course, and the exposure of breasts is incidental to existing.  Here is a woman farming in Cameroon:

woman farming

In the Victorian era, when women’s sexuality was repressed and showing an ankle was scandalous, breastfeeding was a sign of mothering, which was not considered sexual.  Thus, the ankle, not the breast, was sexualized:

victorian breastfeeding

Throughout history, Mary, who was so desexualized that many worship her as a virgin, has been depicted breastfeeding with exposed breasts:

Maria-Lactans-Mary-and-Child-detail-by-Gerard-David-1490-640x784

And going topless on the beach is typical for women of all ages and sizes in much of Europe (not just for the stereotypically sexy).

Yet we have worked Americans into such a tizzy about human women’s breasts that I once had a class of fifth graders completely freak out when exposed to this image:

nude-with-oranges-1951-1

This is just black lines.  The person represented doesn’t even have a face.  Yet the very idea of a breast is somehow outrageous.  It is somewhat like thinking one must dress a zucchini in a burquah.  Or like the Shel Silverstein poem about putting a bra on camel humps.

Men have breasts, and while people might not like to see them when they are large, they can be exposed with no one challenging the legality of exposure:

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Yet a flat chested women’s breast are somehow obscene:

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Women’s and men’s breasts are not particularly different.  It is actually possible for men to breastfeed.  Seriously.  There’s even a very short, highly amusing movie about it, “Milk Men,” which you can watch here.

But preventing women from exposing their breasts, particularly when exposure is incidental to breastfeeding, is a way to have men define women’s sexuality and thus demand to control women’s bodies.  When people tell women to cover up, sit in toilet stalls, or stay home because they are feeding babies, they are telling women that they cannot be female in public.  They are privileging certain people’s perceptions of a woman’s body over the actual woman in that body.

People have nipples.  Everyone is born with them.  It is not an exciting concept:

nipples

Can you even be certain which of these belong to women and which to men?

Then whose body will you know to control?

There are two legal ways to have an abortion in the United States, through surgery or medication.  Medication abortions are those induced through taking mifepristone pills (which were called RU486 when they were developed).  Mifepristone is not Plan B (levonorgestrel, a synthetic form of progesterone) or Ella (ulipristal acetate, which suppresses progesterone production). Plan B and Ella have nothing to do with abortion; both stop ovulation in order to prevent pregnancy.  Mifepristone causes the expulsion of an embryo in an established pregnancy, much like a spontaneous miscarriage.

There are three main restrictions put on medical abortions in the United States:

  1. Pills must be provided by a licensed physician (not a nurse practitioner, nurse midwife, or other qualified health practitioner)
  2. Pills must be provided through an in-person patient-physician visit
  3. Pills must be provided according to the original FDA protocol (much lower doses of the pills have since been found to be effective)

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White states have the least restrictive policies, and dark green states have the most restrictive.  You can find an interactive version of this map at the Mother Jones website (the map does have some inaccuracies; Iowa and Arizona in particular currently have stays against some of their restrictions).

Restriction #1: Licensed Physicians 

That the pills can only be provided by a licensed physician is a restriction that is not solely promoted by opponents of abortion. It is a restriction in place in states that receive an “A” from NARAL Pro-Choice America on choice related law (find your state’s laws and grade here).

Physicians often oppose legislation that would allow medical practitioners who are not physicians–including midwives, advanced practice nurses, or pharmacists–to provide care that is within their scope of training.  Doctors often make the same argument that abortion opponents make: that they are trying to keep women “safe”  (e.g. doctors protect women from midwifery care in New York; doctors protect people from receiving primary care from nurse practitioners in Texas; doctors protect people from vaccination by pharmacists in Florida).

In her novel The Handmaid’s Tale, a story of a futuristic society in which the United States is taken over by the Christian Right, the characters identify differences between “freedom to” and “freedom from.” If you haven’t read the book, go get it and read it immediately.  In any case, Aunt Lydia, who trains women to accept their role in the new society, says,

There is more than one kind of freedom…Freedom to and freedom from. In the days of anarchy, it was freedom to. Now you are being given freedom from. Don’t underrate it.

“Freedom to” gives women agency and choice.  “Freedom from” restricts them in exchange for safety and protection.  In the novel, “freedom from” involves wearing burkah-like clothing, not being allowed to read, and bearing children for religious couples with political standing.  This supposedly frees women from rape, responsibility, and thinking.

In any case, the paternalistic “protection” of making physicians the only practitioners who can provide medication abortions seems to have an underlying agenda–moral or financial–that has nothing to do with women’s health.

Restriction #2: In-Person Physician Encounter

Telemedicine is increasingly used to serve rural communities in particular.  Many people in rural areas are far from hospitals and other sources of medical care.  You can see in this map that there are large areas without critical access.

hospital access

To provide needed care in the Mountain West, St. Luke’s Health System has established a virtual intensive care unit, which monitors 69 critical care beds in 5 hospitals and provides critical care consultation in 5 emergency departments in Idaho.  Here is a video about it:

Critical care is being offered to people on the brink of death through telemedicine, but some states have seen fit to decide that medication abortions offered through telemedicine are dangerous.  Over the past year, this restriction has generated attention in Iowa, where Planned Parenthood has safely offered medication abortions through telemedicine to thousands of women since 2008.  In September 2013, the Iowa Board of Medicine, made up of political appointees, voted to ban telemedical abortions, in addition to imposing other restrictions and requirements.

Delaying access to abortion care narrows women’s options, as medication abortions are only considered safe through the first 9 weeks of pregnancy.  After 9 weeks, a surgical abortion becomes a woman’s only abortion option (see here for a comparison of surgical and medication abortions).  While there are risks and side effects from medication abortions, most of them are uncomfortable or annoying rather than dangerous.  According to the FDA, no deaths have been directly attributed to medication abortions.

As Jill June, President and CEO of Planned Parenthood of the Heartland, said,

It’s evident that this ruling was not based on the health and safety of women in our state – it was based on politics. There was no medical evidence or information presented to the Board that questions the safety of our telemedicine delivery system. It’s apparent that the goal of this rule is to eliminate abortion in Iowa, and it has nothing to do with the safety of telemedicine. The reality is, this rule will only make it more challenging for a woman to receive the safe health care she needs.  Iowa women deserve to have access to the newest medical technologies and all of the heath care services they need, regardless of where they live.

A judge halted Iowa’s ban through a stay until the court case is settled.  The Iowa legislature, which is controlled by Democrats, was unable to pass a bill to instate the restriction through law; however, this restriction is in place in other states.

Restriction #3: The Original FDA Protocol

The Guttmacher Institute offers this chart comparing the original protocols for administering mifepristone pills established by the FDA, and the newer protocols adopted by the World Health Organization (WHO) and the American College of Obstetricians and Gynecologists (ACOG) based on evidence that has emerged since the FDA’s original approval:

Screen Shot 2014-04-02 at 10.00.16 PM

Abortion opponents have argued that adhering to the FDA protocols protects women, even though the Agency for Healthcare Research and Quality, a government agency as is the FDA, has published guidelines for mifepristone administration in their National Guidelines Clearinghouse.  The following guideline is level A evidence, the highest and most reliable evidence available:

Compared with the FDA-approved regimen, mifepristone-misoprostol regimens using 200 milligrams of mifepristone orally and 800 micrograms of misoprostol vaginally are associated with a decreased rate of continuing pregnancies, decreased time to expulsion, fewer side effects, improved complete abortion rates, and lower cost for women with pregnancies up to 63 days of gestation based on last menstrual period.

I have argued against non-FDA-approved use of Pitocin to induce labor electively.  However, there is no evidence base for the use of Pitocin for non-medically indicated deliveries.  As you can read in my previous posts (here and here), Pitocin is a high-alert medication with many dangerous side effects.  Its elective use has no known benefit other than convenience.  The new guidelines for mifepristone use, on the other hand, are based on evidence and involve giving a woman less medication rather than more.

That legislators would ignore a large, reliable body of scientific research does not inspire my confidence in their understanding of safety.  If they really care about the health and safety of women and babies, restricting off-label Pitocin use would be a much more effective technique.

It should be noted that while a law was passed in Arizona imposing this restriction and was upheld by a federal judge in Tuscon on April 1, 2014, the 9th Circuit Court of Appeals issued a stay on the legislation on April 2.  Thus, the only state implementing this restriction as of April 2014 is Texas.

If you view yourself as a human rather than a political pawn, you might want to say so.  If you value your freedom to rather than your freedom from, you might consider fighting for that freedom.  And if you are a woman in Texas who cares about her health, you may want to move.

Cosmopolitan (really!) has published an amazing interview with Dr. Katharine Morrison, the physician who worked with the abortion provider Dr. Barnett Slepian, who was murdered by “pro life” activist James Kopp in 1998.  She subsequently took over the Buffalo Women’s Clinic where they practiced.  In the intervening years, she developed an interest in homebirth as a women’s rights issue and decided to open a birth center so that her clinic would truly offer comprehensive reproductive services in a woman-centered environment.  It is only the second birth center in the entire state of New York (the other is in Brooklyn).

Unlike many obstetricians who vociferously oppose homebirth, Morrison has actually witnessed homebirths.  And as has happened with other obstetricians who have taken the initiative to learn about homebirth midwives and attend homebirths, she underwent a conversion.  She says that she went to a meeting led by Certified Nurse Midwife (CNM) Eileen Stewart, who was giving up her homebirth practice because she couldn’t find a collaborating physician.  Morrison recalls,

It occurred to me that, although I had delivered 2,000 to 3,000 women, I had never actually seen a natural birth.

Some obstetricians insist that it is ridiculous to say that OBs are not familiar with natural childbirth.  They will have to take this up with Dr. Morrison.  In any case, she asked Stewart to take on a few clients and agreed to be the collaborating OB.  Here is her response to the experience:

It’s a different culture of birth. A woman isn’t subjected to anything she doesn’t want. She doesn’t need an IV [for drugs or fluids]. She can eat and move around. No one’s checking her every hour. She can go at her own pace, and even have a water birth. There’s no rush to cut the umbilical cord as there is at a hospital. And if labor is progressing slowly, no one’s pressuring the patient to have a C-section, as can happen at a hospital. All of these things were part of my routine in my previous practice. But when I saw this woman-centered care, I was hooked.

Although Morisson is opening a freestanding birth center, not a homebirth service, she observes the similar reactions of those opposed to abortion and those opposed to homebirth:

The same contempt that people have for women choosing to terminate a pregnancy and the person providing that care, I’ve seen for women who want to have natural births and for the women providing them. It’s this idea that these women are selfish and insufficiently caring about these babies.

Women generally care passionately about being good mothers and having babies who will have all of the resources they need to grow to be thriving adults.  How and when to bring a child into the world are two sides of the same coin.  Women’s autonomy in deciding where and how to give birth is just as important as autonomy in deciding whether to give birth at all.

Read the whole interview: “Meet the Doctor Who Opened a Natural Birthing Center in Her Abortion Clinic

There is an excellent piece in the Huffington Post by United Church of Christ minister Rev. Emily C. Heath

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(FYI I am not in any way affiliated with the UCC).

Heath offers a 10 question quiz to determine whether your religious liberty is being threatened.  Here is the quiz:

My religious liberty is at risk because:

A) I am not allowed to go to a religious service of my own choosing.
B) Others are allowed to go to religious services of their own choosing.

A) I am not allowed to marry the person I love legally, even though my religious community blesses my marriage.
B) Some states refuse to enforce my own particular religious beliefs on marriage on those two guys in line down at the courthouse.

A) I am being forced to use birth control.
B) I am unable to force others to not use birth control.

A) I am not allowed to pray privately.
B) I am not allowed to force others to pray the prayers of my faith publicly.

A) Being a member of my faith means that I can be bullied without legal recourse.
B) I am no longer allowed to use my faith to bully gay kids with impunity.

A) I am not allowed to purchase, read or possess religious books or material.
B) Others are allowed to have access books, movies and websites that I do not like.

A) My religious group is not allowed equal protection under the establishment clause.
B) My religious group is not allowed to use public funds, buildings and resources as we would like, for whatever purposes we might like.

A) Another religious group has been declared the official faith of my country.
B) My own religious group is not given status as the official faith of my country.

A) My religious community is not allowed to build a house of worship in my community.
B) A religious community I do not like wants to build a house of worship in my community.

A) I am not allowed to teach my children the creation stories of our faith at home.
B) Public school science classes are teaching science.

In response, many commenters on the article objected to Rev. Heath’s dichotomies.  I have reposted all quotes as the authors wrote them (including errors).

Ready 1923 says,

My religious liberty IS at stake when the govenment forces religious institutions and employers to cover contraception and abortifacients against their deeply held religious beliefs, or face crippling fines.

cfisher 000 says

Fixed it for ya:
A) I am being forced to subsidize with my money an activity (sometimes murder) I religiously object to
B) I am unable to force others to not use birth control.

Stephen Schaefer says

I didn’t see the option on number three for “I am being forced by the government to finance the murder of an innocent human being”

Let’s leave aside the arguments about whether the federal government actually provides funds for abortion (it does not).  And let’s also leave aside the fact that we know that birth control does not act as an abortifacient.  Let’s suppose instead that tax payer money was indeed going to fund abortion and contraception, even non-existent contraception that did act as an abortifacient.  Surely people can protest that–it’s any American’s right to have an opinion, to state it, and to use legal means to try to get others to adopt it.

But let’s also imagine a society with an “opt out” method of paying for Federal services.  For instance, Quakers and others are strongly against all wars for religious reasons.  While they are able to opt out of fighting in wars in accordance with their religious beliefs, they are not able to opt out of paying for them.

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People are opposed to all kinds of things that Federal taxes pay for, from subsidies for dirty energy to food aid for poor people (depending on one’s political persuasions).  But we have a Federal budget that pays for all kinds of things, some of which we like, and some we don’t.  Some we REALLY, REALLY don’t.  And yet we are all expected to pony up for the whole package anyway.

If your religion supports supports marriage equality for same sex couples, your tax money still went to defending DOMA.  If your religion is say, The Church of the Holy Cinder Block, your taxes still fund federal construction projects that treat cinder blocks as mere building material.

Even within the realm of health care, many people have health care dollars paying for processes they may oppose religiously, morally, or ethically. I personally object to high costs of pregnancy and birth interventions that also lead to high infant and maternal mortality.  We also pay for all kinds of care we ourselves may not use, such as Medicare for the elderly.  Those of us under 65 don’t even know if we will live long enough to use Medicare (or if it will still be around if we do).

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In fact, plenty of public money (state and federal) goes to anti abortion and anti-contraceptive activities, such as the $170,000 spent on funding South Dakota’s anti-abortion law, or the $650,000 Texas has spent fighting for anti abortion laws over the last two years, or similarly huge pots of taxpayer money spent in North Dakota, Idaho, and Kansas.  I do not support any of this spending, and neither do many others.  Yet our tax money supports fighting for laws that we oppose.

It is unfortunate that we do not all agree on how collective tax money should be spent.  Consensus among 300+ million people is unlikely, which is why we have a system of representative government.  If you want to pay for all of what the government provides on a piecemeal basis, only funding what you want, use, or support, you need to stop living in a country with other people in it.

I am away for a bit and leave the following to stimulate your mind and feminist sensibilities in my absence:

Updates on Marlise Munoz (see Living Wills are Not for Incubators)

Recent Thoughts on enforcing the Contraceptive Mandate (see Contraception and Forced Pregnancy and Reproductive Health, Undue Burden, and the Church of the Holy Cinder Block)

New Abortion Restrictions (see Questions from Priests for Life and “Hard’ Questions about Abortion)

 

cinderblock

Before a woman has an abortion, it is not considered and “undue burden” for her to endure a 72 hour waiting period (not including weekends), submit to (and pay for) a medically unnecessary ultrasound, or undergo a more dangerous abortion procedure when legislators find the safer procedure too gory.

On the other hand, for religious institutions that wish to be excluded from the ACA’s contraceptive mandate, filling out and sending a short form is too much to ask.

The New York Times ran an editorial, “Mistaken Ruling on Contraception” on 12/26/13 in which they describe the ruling of Federal District Court Judge Brian Cogan (a G.W. Bush appointee).  Cogan ruled in favor of two high schools and two health care systems that “requiring religious-affiliated entities to inform insurance administrators that they wish to exclude contraceptive coverage — which some already do” is  “a ‘substantial burden.’”  The editorial further points out,

This case is among dozens challenging the birth control mandate. The Supreme Court agreed to hear two cases involving secular for-profit companies. What Judge Cogan missed, and the justices need to recognize, is the threat to religious liberty comes from employers trying to impose their religious views on workers.

I have discussed the imposition of religious beliefs on others in Catholic hospitals, where health care workers are not only prohibited from performing certain procedures, such as abortion, but are prohibited from telling patients that such procedures are an option, even when withholding such information is life-threatening to the patient (see full post here).

It seems religious beliefs are accommodated when they suit a lawmaker’s personal world view.  If we think about it, what would happen if all religions were accommodated on the same terms?  People have already raised the issue that Jehovah’s Witnesses do not believe in using blood transfusions and that Christian scientists do not believe in using allopathic health care.  Yet the government has, on occasion, stepped in and forced people with such religious beliefs to accept allopathic health practices, and practices supported by Christian Scientists are not automatically covered by insurance.

When we begin accommodating or persecuting those of specific religions, exempting them from law or forcing them to abide by it, how are those decisions made?  If I form (as a constitutional law professor once suggested to me) the Church of the Holy Cinderblock, am I allowed to demand that I can take my cinderblock to the doctor?  What if my church mandates abortion for everyone who already has two children–can I impose that on others?  What if my religion mandates that my life and health take precedence over those of a fetus–am I exempt from abortion restrictions in the law so that I may follow my religious practices?  What if my religion supports male circumcision?  Female genital cutting?  Should I be able to mandate not only that I can keep these practices, but that insurance must pay for them?

What if the Church of the Holy Cinderblock develops a wealthy following that allows it to buy comprehensive health care systems, some of which are the only health care available in a certain region.  Would it be acceptable that people who do not bring a cinderblock with them will not be treated?  Would it be acceptable for my church to tell doctors that we do not believe in antibiotics, so they may not prescribe them, nor may they tell patients where to get them, nor may they tell patients that in their medical opinion, antibiotics are a life-saving treatment?

What if the Church of the Holy Cinderblock wanted to implement all of these policies, and all the health system had to do was have someone fill out a short form and send it to the insurance administrators?  Could my church legitimately argue that filling out a form was unduly burdensome?

Or would the legitimate argument be that not offering standard heath care options at a healthcare institution is burdensome for patients?  That there is a burden in not knowing that a health care institution is more interested in imposing its values on patients than allowing them to make informed decisions about their health?

Does Brian Cogan see a moral quandary in allowing women to die in the name of religion–even if you fill out a form first?

Or perhaps covering health care practices such as contraception are seen as unduly burdensome on a society that prefers not to regard women as full human beings.

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