Additional Musings on the Oklahoma Abortion Ultrasound Law

Demarcationville wins the internet today, with this piece inspired by Oklahoma’s new law requiring ultrasounds prior to abortion.

As someone who was raised Conservative and Southern Baptist, she explains that although she is “still innately Pro-Life:”

…I reject the idea that any state, government, leader, court, man or woman has authority over the area beyond my bloomers.

You know, as a woman, there are few things I control in this world, but I’d damn well consider my reproductive “parts” among them - so you’re out of your jurisdiction. Seriously, ya’ll don’t know me like that.

“You’re out of your jurisdiction.” - I just had to repeat that, because I love it so much and it gave me a much-needed chuckle. The rest of her commentary is also good, including her explanation of the assumptions that underlie the forced ultrasound thinking.

When a Global Gag Rule’s not Enough, Bring it on Home

If you’re not familiar with the “Global Gag Rule” (or “Mexico City Policy”), it’s a rule that the U.S. will not provide any family planning funds to organizations that (use their own money to) provide abortions, make referrals for abortion, or lobby to make abortion legal in their own country - see globalgagrule.org and this section from the International Women’s Health Coalition for further background.

Now, “nearly 80 conservative groups” have signed on to a letter asking Bush to revise a “Domestic Family Planning Gag Rule,” which would essentially create Global Gag Rule for the United States, preventing organizations that provide family planning services (such as Planned Parenthood) from receiving Title X funds if they also provide abortions or abortion referrals.

As explained in The Hill: “Former President Ronald Reagan first issued regulations more than 20 years ago that prohibited family planning organizations from providing advice to help women obtain abortions. The Reagan-era regulations were upheld by the Supreme Court, but were then rescinded soon after former President Bill Clinton took office in 1993.”

“Conservative leaders say they are perplexed why Bush has not reversed Clinton’s decision during more than eight years in office.They say that Bush could re-implement the regulations though a simple order that would go into effect after a brief public comment period.”

The National Abortion Federation notes that under the old policy governing Title X family planning funds, “These revised regulations implemented the ‘gag rule’ which prohibited the discussion of abortion as a family planning option. Although never actually enforced nationwide, the ‘gag rule’ also prohibited referrals to abortion providers and required a physical and financial separation of abortion-related activities from Title X activities.”

The “conservative groups” are also trying to drum up support for the Title X Abortion Provider Prohibition Act (HR 4133), which would “amend title X of the Public Health Service Act to prohibit family planning grants from being awarded to any entity that performs abortions.”

[Hat tip to the National Partnership for Women & Families]

Forced Ultrasounds for Abortion in Oklahoma - Because Your Government Can Demand That An Object Be Inserted Into Your Vagina

I’ll admit that I haven’t been furiously blogging about every single anti-woman bit of legislation to roll through each of the 50 states this year, because there’s simply too much of it, and I generally assume that the most ridiculous of them will never make it out of committee. I also have a bit of fatigue from all of the proposed bills which seem to have as their underlying premise the notion that women are somehow intellectually deficient as a sex, and I think many of the arguments I would make have been reasonably hashed out elsewhere.

There is one recent state law, however, that I feel compelled to point out, even if other bloggers have already thoroughly covered it, because I have readers who aren’t likely to visit many of the feminist blogs where this has been discussed. Late last month, the Oklahoma legislature passed a bill that would require women to have an ultrasound performed prior to obtaining an abortion (and it’s not the first state to do so). The Governor vetoed the legislation, stating that, “this legislation does not provide an essential exemption for victims of rape and incest. By forcing the victims of such horrific acts to undergo and view ultrasounds after they have made such a difficult and heartbreaking decision, the state victimizes the victim for a second time. It would be unconscionable to subject victims of rape and incest to such treatment. Because of this critical flaw, I cannot in good conscience sign this legislation.” The legislature then overrode the veto, making the bill law.

Oklahoma’s Governor, however, missed one crucial element in explaining his veto. The law states that, one hour prior to beginning the abortion procedure, the provider must “Perform an obstetric ultrasound on the pregnant woman, using either a vaginal transducer or an abdominal transducer, whichever would display the embryo or fetus more clearly.”

Let’s just take a moment to get this straight. Sometimes an ultrasound is performed prior to an abortion. Sometimes this ultrasound is a transvaginal ultrasound because it may offer a better view. The exact percentage of times an ultrasound is performed, and how often that ultrasound is transvaginal, is almost irrelevant from one perspective, although early abortions (which most abortions are) will require the transvaginal route. What is relevant is that the law, as written, has no regard for the clinician’s judgment or the woman’s consent - it is aimed only at getting the best picture of the embryo or fetus.

It inserts the government into medical decision-making with no regard for the patient, and is based on the premise that women seeking abortion simply have no idea what they’re doing, and so might need to be informed that there’s actually something in their uterus. I think they know that, or they wouldn’t be at the abortion provider in the first damn place.

This law takes away a woman’s ability to refuse consent to an ultrasound or method of ultrasound and a provider’s judgment about the type of ultrasound needed (and if it is needed) in order to perform a legal medical procedure, for the sole purpose of making sure a woman can see her soon-to-be-aborted fetus, which she likely could have done anyway if she desired - although the law allows her to “avert her eyes.”

But lets get back to the transvaginal vs. abdominal issue. Given the likelihood that the transvaginal ultrasound would “display the embryo or fetus more clearly,” Oklahoma’s legislature has mandated that a woman seeking abortion have an object (what couples blogging about fertility call a “dildo cam”) inserted into her vagina.

Let that sink in. The state has effectively mandated that women seeking an abortion have an object stuck in their vaginas. Whether they consent to that specific thing or not, because they can’t have the procedure they did consent to if they don’t. Whether the provider believes it is medically necessary to stick the object in her vagina or not. Because these women might not know what they’re doing, might need to be emotionally coerced, might be too stupid to understand what an abortion clinic actually does.

I’ve written before about how coerced ultrasounds are a long-standing tactic of anti-abortion activists, who believe that women who see an ultrasound will suddenly *get it* (again, because they couldn’t possibly have known what they were doing) and flee from their decision. As I wrote in the past, “A woman may feel warm and fuzzy at the point of the ultrasound, but that feeling is not going to support her through the pregnancy, is not going to erase poverty, abuse, rape, or health concerns that may cause a woman to choose abortion. It’s not going to help her finish high school. It’s not going to be accompanied by information on all of her options, but is going to be used as part of a campaign to get her to have a baby.” If you think this law has anything whatsoever to do with protecting women in a legitimate way or the legitimate practice of medicine (as performed through abortion services), you have not been paying attention to the political maneuvering going on around this issue. So here we are. Apparently Oklahoma legislators believe coercion is an appropriate use of medical technology, consent be damned, and that effectively assaulting/raping women with an object is an appropriate use of their power.

More commentary on this:
-An ob/gyn notes at Alternet that the fine for not complying is greater than the fine for negligent homicide
-From the same physician as above, a list of what’s wrong with this law
-Amie Newman at RHReality Check says that anti-choice advocates pushing ultrasound measures are “pretending to care about women’s health and well-being when in fact they are using precious legislative, human and financial resources that could be funneled towards laws and advocacy that actually help women; laws that expand health care coverage, protect women from domestic violence, provide needed resources for child-care and more.”
-Lindsay puts it more succinctly than I could: “‘Excuse me, lady, you say you want an abortion. Did you realize that there’s a fetus in there? You don’t know what you’re doing. Let me stick this tube into you, so that you can be competent to make a decision.’”
-Aunt B notes, “If a woman’s boyfriend or husband said ‘If you want an abortion, you have to let me put my dick or my finger or this dildo inside you first, until I’m satisfied you understand what you’re doing,’ we would have no problem–I don’t believe there’s a person reading this who can’t understand how wrong that would be–no problem at all calling that the evil it is, regardless of what you believe about abortion.” Also, please see Bridgett’s comments about cost.

OBOS Post: Laughing Gas for Labor

Over at Our Bodies Our Blog today, we’re wondering why nitrous oxide (”laughing gas”) isn’t a more widely available option for labor pain relief in the United States, given its availability in Europe and Canada. Come on over to find out more and share your thoughts!

OBOS Post: Revisiting Depression, and Abortion

Today at Our Bodies Our Blog:

“A new study in BMJ Public Health examines depression in women and the relationship of past abortions to the condition. This new report is particularly interesting because it attempts to control for the effects of sociodemographic factors and considers the women’s experiences of intimate partner violence, recognizing that multiple factors may impact a woman’s mental health.”

Head on over for details.

Committee Holds Hearing on Abstinence-Only Sex Education

Yesterday the House Committee on Oversight and Government Reform held a hearing yesterday on “Domestic Abstinence-Only Programs: Assessing the Evidence” and had a conversation about whether the current approach to federally-funded sex education is effective and appropriate. The committee heard testimony from public and adolescent health experts, representatives of the Government Accountability Office, Health and Human Services, and Institute of Medicine, as well as Rep. Lois Capps and Sen. Sam Brownback.

Documents containing the witnesses’ statements are available as PDFs, and if you just can’t get enough, there is also video.

Committee Member and Indiana Rep Mark Souder made a statement - if he’s your Rep, and you believe abstinence-only sex ed is lacking, you should really watch his remarks (At about 35 minute mark).

If you’re in Tennessee, check out Rep. John Duncan (~the 72 minute mark) blaming sex on the media and stating, “It seems rather elitist to me for people who maybe have degrees in this field to feel that because they’ve studied it somehow they know better than the parents what is best for [their children].” Oh, good grief - ~20% of those in Duncan’s home state don’t graduate high school (and only ~20% earn a bachelor’s degree or higher), so, yeah, I kind of think it’s possible that they’re less qualified to evaluate the scientific evidence on this topic than someone with a masters in public health, an MD, etc. No, they’re not specially qualified to decide what parents should want, but they are specially qualified to understand what the evidence says about whether programs work, especially from a public health standpoint - which is the whole point of the hearing.

Despite Duncan’s comment, you’ll have to last >85 minutes into the video before any actual subject experts appear. The earlier bits are largely dominated by Brownback’s opinionating.

Reuters has a brief summary, as does the LA Times.

I may have more commentary when I have a chance to view the whole video.

Drug-Addicted Women Need Medical Care, Not Jail

I want to spend some more time looking at research/writings on this topic in general, but at first blush I’m more than a little appalled by this story, in which a 7-month-pregnant Tennessee woman was taken to jail after seeking medical care for chest pains because she had cocaine in her system.

I think we can all agree that it’s better if pregnant women don’t use drugs that could potentially harm the fetus (although you might want to do a little reading about the myth of the crack baby and the racist/classist undertones that fueled that particular bit of hysteria), and we know that illegal drug use is, well, illegal, even if the particular laws are unjust or insensible. Let’s just start from those two bits of assumed shared knowledge, to avoid the “But it’s illegal!” comments that don’t really address the heart of the situation. We’ll get to that later.

To assume that hauling a pregnant woman to jail for drug use is the best option, you need to assume that:
-Treatment for drug addiction isn’t a better solution (both immediately and in the long term) than jail, either for the individual or for society.
-Jail provides some kind of incentive to cease drug use, and/or drugs are not available in prison.
-Jail/prison provides adequate healthcare that does not endanger the woman or fetus beyond what is experienced in her community.
-Policing pregnant women who are attempting to seek medical care won’t discourage future women from seeking care and further endangering women and fetuses.

That’s an awful lot of assumptions.

Obviously, there are some folks arguing that jail was appropriate because the rights of the fetus at some point trump the rights of the woman. Tennessee Right to Life’ president said, “If she used cocaine, she put her baby in jeopardy. It is child abuse. It certainly is.” I’d like to know where this would stop - if you ride in a car, go to work, go home to an abusive spouse, leave an abusive spouse, smoke a legal cigarette, drink a legal beer, live in a polluted neighborhood, and so on, you may “put your baby in jeopardy.” All of those items may result in the exposure of the fetus to potentially harmful actions or substances. If the “protect the baby at all costs” argument is to prevail and suggest that pregnant women willingly being exposed or exposing oneself to potentially harmful acts or substances constitutes “child abuse,” logically it must prevail not only for illegal potentially harmful exposures. The emphasis here is on “potentially,” because not every exposure of any of these substances/actions will result in adverse outcomes in the fetus.

However, if we put aside the question of the woman’s rights and decide we want to protect the fetus/child at all costs, is jail the right place for the pregnant woman, who carries the fetus? Medical care in jail/prison is notoriously bad, and completely inadequate for pregnant women, who may have complications and need immediately available specialized care. Likewise, this woman “faces one to two years of probation or jail” - does it make sense that it’s better to throw this woman away by sending her to jail, putting her kid in the system, rather than simply providing her the adequate medical care she needs to address her drug use issues? Is that best for the child?

The article on this story provides a pretty good snippet about concerns about discouraging care:

In addition to deterring women from seeking treatment, Mark J. Bliton, a Vanderbilt University associate professor of medical ethics, said arresting pregnant women doesn’t solve the problem. He said studies have shown that drug treatment is more effective than jail in preventing future drug use.

“This is a misguided way to help the most vulnerable pregnant women and fetuses,” Bliton said. “The right way to handle this is to provide prenatal support and treatment.”

Bliton said he has grave concerns that Jones’ privacy rights may have been violated.

“In general, health-care information shouldn’t be shared with people who are not involved in providing health care,” he said.

Finally, back to the argument about “but cocaine is illegal!” The arresting deputy has stated that she never would have arrested the woman if she hadn’t been pregnant. The deputy attorney general has said that the woman might be charged with “reckless endangerment with a deadly weapon,” the weapon being cocaine. We are so not talking about the do drugs=go to jail issue here, it’s not even funny.

I am by no means the first person to talk about what a misguided approach this is. Please see the website of the National Advocates for Pregnant Women, especially their statement on pregnancy and drug use.

Recent related post: Pregnant Drug Users in Alabama Getting Jail Time Instead of Help

[Hat tip to Katie Allison Granju at Knoxville Talks]

RAINN Offers New Online Sexual Assault Hotline

RAINN, the Rape Abuse and Incest National Network, has operated a phone-based hotline for abuse victims for 14 years, but is now adding a new option for online support. The web-based hotline works like instant messaging, and the organization has ensured that IP addresses are not logged, transcripts of the chats are not saved, and other privacy measures are in place.

National spokesperson Christina Ricci noted that “The Online Hotline offers a lifeline to victims trapped in a situation where the Internet may be their only safe and secure link to the outside world and to getting help.”

I personally think this is an excellent idea, especially given the declining availability of pay phones, the possibility that a victim’s home phone use is being restricted or monitored, and the ability to “speak” to someone for help without needing to use one’s own voice (which may feel to personal to some individuals). It provides another option for seeking assistance, which is always a good thing.

USA Today also has coverage of this new service.

NPR Uncovers More Info on POPLINE Controversy

Morning Edition has a piece today on the POPLINE controversy, indicating that the issue arose because one recent issue of A Magazine “focused on abortion as a human rights issue and profiled abortion rights advocates around the world,” and USAID did not want these articles included in the database.

In other words, federally-funded USAID didn’t like the politics of one issue of the publication, so decided that it should not be accessible through the major database on global reproductive health.

It seems strange that this one specific issue of the magazine was targeted for removal because USAID objected to its “advocacy.” A quick search of POPLINE retrieved other citations that USAID could easily remove by this standard, such as a document from the International Women’s Health Coalition entitled, “The Global Gag Rule: putting politics before public health.”

I found records for numerous other publications that discuss global access to safe abortion as an important public health and women’s rights issue, such as a 2002 issue of Reproductive Health Matters which the editorial describes thusly: “These papers are by women’s health advocates, medical professionals, researchers and others working for safe, legal abortion in their countries. These papers advocate safe abortion as a public health goal and legal abortion as a woman’s right, including for marginalised populations such as refugee women.”

What guarantee do we have that USAID will not also press for the removal of these and other citations? Will every individual reference that does not bolster their political agenda be removed quietly, with no notification to database users that they are not retrieving as much information as they should be? I am personally deeply offended by the suggestion that, when our government chooses not to fund a specific procedure, we should also be limited in our ability to find opinions opposing that position.

Ipas, the international reproductive rights and public health organization producing the magazine in question, has issued a response, in which they question the logic of USAID’s approach of restricting “the free flow of information about this important topic.” Ipas Vice President Ana Kumar stated: “Ipas approaches abortion from a human-rights and public health perspective. Thousands of women are dying from unsafe abortion and millions more are injured. Women are putting their lives at risk while we are dithering about words. How is this not a human-rights issue?”

Cross-posted at Our Bodies Our Blog.

Shameless Self-Promotion - Baltimore Sun Covers POPLINE Controversy

Stephanie Desmon of the Baltimore Sun published a piece yesterday on the POPLINE controversy, and included a brief quote from yours truly. If I remember correctly, we were discussing what had happened and how/why the librarians got involved (prior to the reversal of “abortion” being blocked in the database):

“The citations are still there,” said Rachel Walden, a biomedical librarian in Nashville who writes a blog called Women’s Health News. “The actual references haven’t been removed. But it’s been made quite a bit more difficult for the average user to get. Most people in this profession are really interested in people having access to information … and for it to be reliable.”

Desmon also has comments from the Presidents of the American Library Association and the Association of Reproductive Health Professionals, which I hadn’t seen until this piece. Thanks to the Sun for covering this issue.