The Prayers of Martin Luther King, Jr.: Prayer and the Discipline of Nonviolence
Black History Month: Visions of Equality

Contraception and Abortion: Wins and Losses in Two Wars on Women's Health

Today's post is from Carole Joffe, author of Dispatches from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients, and the Rest of Us. Joffe is a professor in the Bixby Center for Global Reproductive Health at the University of California, San Francisco (however, the views and opinions expressed here do not necessarily state or reflect those of the Regents of the University of California, UCSF, or the UCSF Medical Center). This post originally appeared at RHRealityCheck.

The last ten days or so we have seen Republicans, and their religious allies, wage a war against contraception—and bungle it badly. With poll after poll showing that a majority of Americans support contraceptive coverage in health reform, and with the 98 percent figure (of American women who have ever used contraception in the context of heterosexual sex) endlessly repeated in the media, the Republicans nonetheless push ahead with this attack, providing a welcome gift to the Obama reelection campaign and much material to political artists and comics. I have lost count of the number of parodies that have been inspired by that now gone viral picture of five male clerics testifying at the Congressional hearing called by Rep. Darrell Issa (R-CA). A picture that of course immediately brings to mind another image of a similar tone deaf moment on the part of social conservatives, the nine men surrounding President George W. Bush as he became the first president to sign a ban on a particular technique of performing abortion, in the case of so-called “partial birth abortion.” It’s no wonder that the term “patriarchy” has made a comeback in the blogs!

The well-publicized refusal of Issa to permit the testimony of a female witness put forward by the Democrats (Sandra Fluke, a Georgetown law student planning to speak to the health consequences of being denied contraception at Catholic universities) only added to the disastrous p.r. of that event. And the “aspirin between her knees” remark of Rick Santorum’s major funder later that day didn’t help either.

But while the media is momentarily fixated on the second big story this month of a losing fight against family planning (remember the Susan G. Komen Fund fiasco?), less attention has been paid to a related war that is not going well at all. The assault on abortion that has resulted from the 2010 elections--the Republican takeover of Congress and many statehouses and governorships--has arguably produced the most serious threat to abortion access since the Roe decision in 1973. What we mainly have heard about this situation are the statistics, the unprecedented number of abortion restrictions introduced and eventually passed in state legislatures at a time when one might assume politicians’ focus would be on the economy.

But there are real people behind the numbers and details of the restrictions. And the enormous toll that the abortion wars take on individual women seeking the procedure and the providers who try to help them are insufficiently appreciated by the general public. Consider the case of Jennie McCormick, a destitute Idaho woman, a single mother of three, who, facing an unwanted pregnancy and unable to travel several hours to the nearest abortion clinic, ordered abortion medication over the Internet, and is now facing criminal charges. She has also been stigmatized in her own community to a degree to which the fictional Hester Prynne of The Scarlet Letter fame could relate. Here is a description of her daily life, as described in a British newspaper:

When Jennie Linn McCormack walks the streets of Pocatello, the town in southern Idaho where she was born, raised, and still lives, she attempts to disguise her face by covering it with a thick woollen scarf. It doesn't really work. In the supermarket, people stop and point. At fast-food outlets, they hiss "it's her"! In the local church, that supposed bastion of forgiveness, fire-and-brimstone preachers devote entire sermons to accusing her of mortal sin…."I feel like my life is over," Ms McCormack says. "I now stay home all the time. I have no friends. I can't work. I don't want to take my kids out in public. People can be really mean about what has happened."….

Consider as well the case of Amy Hagstrom Miller, who directs a number of abortion clinics in Texas, under the name of Whole Woman’s Health. Being an abortion provider in red-state Texas is always challenging, but especially in the past year. Hagstrom Miller has had to contend with implementing the state’s new sonogram law, which requires that women come to an abortion clinic at least 24 hours before their scheduled abortion, and receive a sonogram from the same physician who will perform their abortion. Additionally, the physician must give the patient a detailed description of her fetus’ development. The state has made it very clear to abortion facilities that it will enforce the law through inspections and will revoke the licenses of those doctors not in compliance.

It is not the fact of sonograms per se that is causing headaches for Hagstrom Miller. Rather it is the way the law is written. Patients at her facilities routinely receive sonograms. But the ultrasound used to be performed by a trained technician, the ultrasound was done abdominally and not through the more intrusive vaginal probe required by the law, and patients have not had to make two separate visits.

So now Hagstrom Miller has to contend with the frustrations of many of her patients, who typically have to take additional time off work and pay for extra childcare. She also has to deal with the scheduling nightmare of making sure the same physician who performs the ultrasound is available to perform that patient’s abortion. Hagstrom Miller is convinced that this new rule achieves nothing more than putting more obstacles in the way of both provider and patient, and has not achieved its stated objective of changing women’s minds. “It’s had no effect whatsoever on our abortion census.”

JoffeBut coping with the sonogram law is not the only thing that preoccupies Hagstrom Miller. For the past year, her clinics have been subject to an unrelenting campaign of harassment by the notorious anti-abortion group, Operation Rescue. To give just one example, her facilities have been subject to no less than 13 surprise investigations by various state agencies, including the state health department, the Texas Commission on Environmental Equality, the state Pharmacy Board, and seven of the physicians associated with Whole Woman’s Health were formally investigated. All these investigations were triggered by “citizen complaints” made to various bureaucracies. Among the “citizens” making such complaints is Cheryl Sullinger, the OR operative whose name was found in the car of Scott Roeder, who assassinated Dr. George Tiller in May 2009, and who herself has spent time in jail for her anti-abortion activity.

To give a flavor of what Whole Woman’s Health has had to put up with as a result of Operation Rescue’s campaign, one of the complaints alleged that aborted fetuses were discarded in clinic dumpsters. So clinics’ staff and visitors were subjected to the bizarre sight of public health nurses in Hazmat suits pawing through dumpsters, routinely opening and photographing the content of every bag, on order of the state health department--and finding nothing incriminating.

When I asked Hagstrom Miller to reflect on her dual difficulties with both the new state sonogram law and the actions of Operation Rescue, she responded:

“This past year has been one of the most difficult of my career in abortion care. It is almost surreal to be constantly challenged for the very thing we have been recognized for doing well…The very state agencies that have licensed us have to take the word of people who have a stated goal of closing abortion facilities by any means necessary. Even when, time and time again, we are cleared of the accusations, they (opponents) are successful in that they have tied up our time, spirits, money and energy and distracted us from the good work we could be doing with women and families in our communities.”

Unlike Jennie McCormick, the young Idaho women mentioned above, Hagstrom Miller is not isolated and without resources. Indeed, she is a cherished member of the closeknit national community of abortion providers, and operates daily in a world of loving family and friends. But the situation of both of them reveal one of the greatest challenges facing the reproductive freedom movement: how to connect for the public the two reproductive wars currently being waged—the contraceptive one that that thus far seems a slam dunk victory, and the abortion one that we are losing, and about which the public is no doubt weary.

In the real world, these two issues of contraception and abortion exist on the same continuum. The use of both are affirmations of the belief in nonprocreative sex. At Whole Women’s Health, and at most other abortion providing facilities, patients are provided with birth control information and services. It is reasonable to assume that Ms. McCormick, only marginally employed, did not have access to reliable contraception. This connectedness of birth control and abortion is of course a major reason that social conservatives oppose the former. And it is a key reason why the 98 percent-ers should more vigorously support the latter.