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.

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]

OBOS Post: More Controversy Surrounding Merck and Vioxx

Yesterday at Our Bodies Our Blog, I posted a brief overview of the new debate about possible ghostwriting and data manipulation surrounding Merck and Vioxx, stemming from publications in the current issue of JAMA. Links to the freely available full-text investigations are provided, as is a timeline of Vioxx from approval to market withdrawal and beyond.

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.

Access to Abortion Search to be Restored in POPLINE; Johns Hopkins Releases Statement

Following Wednesday’s revelation that the USAID-funded POPLINE reproductive health database had deliberately blocked users from performing a simple search on “abortion” because, “As a federally funded project, we decided this was best for now,” medical librarians, feminists, public health professionals and others responded with outraged blog posts and calls and letters to the Johns Hopkins Bloomberg School of Public Health, where the database is managed.

Today, Michael J. Klag, MD, MPH (Dean of the School at Hopkins) has released a statement detailing the events and indicating that the ability to search the database for “abortion” will be restored.

Dr. Klag notes:

I was informed this morning that the word “abortion” was blocked as a search term in the POPLINE family planning database administered by the Bloomberg School’s Center for Communication Programs. POPLINE provides evidence-based information on reproductive health and family planning and is the world’s largest database on these issues.

 

USAID, which funds POPLINE, found two items in the database related to abortion that did not fit POPLINE criteria. The agency then made an inquiry to POPLINE administrators. Following this inquiry, the POPLINE administrators at the Center for Communication Programs made the decision to restrict abortion as a search term.

 

I could not disagree more strongly with this decision, and I have ordered that the POPLINE administrators restore “abortion” as a search term immediately. I will also launch an inquiry to determine why this change occurred.

 

The Johns Hopkins Bloomberg School of Public Health is dedicated to the advancement and dissemination of knowledge and not its restriction.

Thank you to everyone who worked to call attention to this issue.

Cross-posted at Our Bodies Our Blog

Wired has some additional follow-up, as does the New York Times.

Why is a Government-Funded Reproductive Health Database Blocking Users from Searching for Abortion Articles?

Cross-posted at Our Bodies Our Blog

Today through medical librarian channels, I got word that entering “abortion” as a search term in the POPLINE database now returns zero results because of a move by the database personnel to block that search. For background, POPLINE is “the world’s largest database on reproductive health, containing citations with abstracts to scientific articles, reports, books, and unpublished reports in the field of population, family planning, and related health issues.” This may seem like a long and libraryland-focused post, but I think it’s important, because it touches on government, reproductive health, and access to information, so stick with me on this one.

The librarian who noted the problem inquired about it, and was informed that it wasn’t a simple technical glitch; the response she received was, “We recently made all abortion terms stop words. As a federally funded project, we decided this was best for now.”

If you’re not familiar with “stop words,” they are typically words like “a,” “an,” and “the” that are omitted automatically from the search, because they is assumed to have no added value or meaning. Suffice it to say, it’s quite unusual for a word with “real” meaning to be a stop word, especially one so relevant to the resource being searched.

The librarian was then advised to do a search for unwanted pregnancy as a substitute, which ignores the fact that these words are not synonyms, as a pregnancy can be unwanted but carried to term or desperately wanted but aborted for various health reasons.

Now, a little digging reveals that the POPLINE folks haven’t actually removed the term “abortion” (or related ones) as subject terms from the citations, or from their Thesaurus which tells you which subjects appear in the database. If you know to use the “Browse Index”* you can still find the term and come up with almost 25,000 results. However, if you simply enter the word “abortion” in the Subject search box, as the instructions directly above the box suggest you should be able to do, the search returns 0 results. Another work-around is to enter the search as =”Abortion” as the Index search would do, and you can still get the results. Of course, that applies for now, until they realize that the work-around is there and remove it as well.

Right now, this move is essentially a barrier to your basic search/er - an advanced searcher might get 25,000 results, while someone just following directions will get none. As the librarian reporting the problem noted, “It is important to remember that this database is used by both professional searchers and the public. The average user goes directly to the query box and searches; they will retrieve nothing when the term “abortion” is entered.” She also notes that using the advanced options was *not* among the suggestions from POPLINE personnel in response to her inquiry.

It’s not clear at this time why POPLINE made this change, whether it was a top-down or a local decision for this federally-funded project, or why they chose not to release any information about the change until people started asking questions. Perhaps this will seem silly to someone at the offices of “the world’s largest database on reproductive health” and access to these citations will be restored. However, it’s important to note that POPLINE isn’t just a project of the Johns Hopkins Bloomberg School of Public Health (the logo displayed at the top of the screen), but is in fact funded by USAID.

Yes, that USAID, of Global Gag Rule fame, which has been criticized because family planning agencies around the world are prevented from receiving assistance if they perform or counsel their clients about abortion (even if that work is funded through other sources), and through which much controversial abstinence-only money is channeled.

I’d really love to assume that political pressure didn’t encourage anyone to deliberately make it more difficult for people to find references to articles about abortion.

*And can get it to work - it failed in multiple browsers on a Mac and Firefox on a PC.

Update: Other bloggers on this topic; I’ll add more as I find them.
-Angular Uncomformities (Scott Hanley)
-BoingBoing
-Crooks and Liars
-The Experiment
-Feministing
-Feminist Peace Network
-Infomusings
-Jezebel
-Librarian Activist
-Library Stuff
-Maud Newton
-No Maps for These Territories (brassratgirl)
-Oh, we’re going to talk about me, are we? Goody. (kylegirl)
-LACUNY Blog
-Pear Popsicle
-Population Action Blog
-ResourceShelf [ResourceShelf has been promised a comment from the POPLINE team - stay tuned.]
-RH Reality Check (first post outside the library community that I’m aware of)
-Social Justice Librarian
-Strange Librarian
-Threat Level - Wired Blogs

Update #2: The Dean of the Johns Hopkins School of Public Health has issued a statement, and access to the search will be restored - see update.

Is This Ethical? - Coerced Blood Donation

An acquaintance is taking some classes right now, and her school has blood drives periodically; in one of her classes, the instructor told them that if everyone donated blood (or at least attempted to), then they would get a day off from class. Personally, I found this appalling, but maybe I’m overreacting. Her fellow students might say, “Shut up! we want a day off from class!” The teacher might say, “Hey, I’m just encouraging my students to do a good deed.” And, hey, the Red Cross offers little gifts all the time to donors, right?

The problem, as I see it, is that normal blood drive incentives are individually based - you give blood, you get the little trinket. Nobody else who gives blood will be denied their “reward” if you don’t also donate. Basing a reward on the actions of others, however, creates peer pressure that is an undue influence on potential donors. The Red Cross itself notes that it “accepts donations only from voluntary blood donors.” Was the choice in this instance truly voluntary?

Aside from which, if some members of her class already knew that they are unable to donate because of one of the restrictions, they would have to choose between two somewhat unsavory options. The first is to go through the screening process (finger stick and questionnaire) anyway, wasting time and potentially going through the process of donating through the “confidential exclusion process” with no benefit to the individual and no ability for the blood to be used.

The second option for a class member who cannot or does not wish to donate would be to refuse to participate from the outset, leaving classmates to speculate on the reason and possibly generating resentment due to the lost free day. A student who refused might also wonder if any consequences would be directly or indirectly administered by the instructor, who offered the reward and is in a position of authority over the students.

Although blood donation isn’t clinical research, I don’t believe this incentive squares with the spirit of the Belmont Report principles of beneficence, or maximizing benefit and minimizing harm, and respect for persons, or treating each individual as an autonomous agent. When research is conducted on humans, informed consent must also be given voluntarily, in “conditions free of coercion and undue influence;” the report explains that “Unjustifiable pressures usually occur when persons in positions of authority or commanding influence — especially where possible sanctions are involved — urge a course of action for a subject.”

In my opinion, this seemingly minor reward created a completely unethical situation. Thoughts?

Preliminary Discussion of Adverse Health Effects in DES Granddaughters

If you’re not familiar with DES (Diethylstilbestrol), it’s a drug that was given to women to prevent miscarriages and premature births from 1938-1971, a practice that ended when the FDA issued a warning because of unusual vaginal cancers found in the daughters of women given the drug. The CDC estimates that “5-10 million pregnant women and the children born of these pregnancies were exposed to DES,” and that the grandchildren of these women are just now reaching an age at which third generation effects can be studied.

In fact, a CDC bibliography of research publications on effects in the 3rd generation currently includes only six papers. A newly released and very preliminary study in the journal Epidemiology suggests that ovarian cancer rates may be increased in these “DES granddaughters,” although it is based on only three cases. The authors clearly point out that “[the] finding may be due to chance or possibly to bias, and should be considered preliminary,” but that “our observation reinforces the need for continued follow-up of the third-generation women.”

More information for those who think they may have been exposed to DES is available from the CDC. To learn more about the history of DES, visit this page. It points out that “In 1953, published research showed that DES did not prevent miscarriages or premature births.” In other words, the drug was prescribed for nearly two decades after it was demonstrated that it did not work for its intended purpose.