Sufficient Scruples

Bioethics, healthcare policy, and related issues.

January 22, 2013

Blog for Choice Day 2013: Decimating Law to Eviscerate Women’s Rights Under the Law

by @ 8:20 PM. Filed under Access to Healthcare, Autonomy, General, Global/Community Health, Healthcare Politics, Provider Roles, Reproductive Ethics, Sex, Women's Issues

January 22: the anniversary of Roe v. Wade, and a perennial high point in the continuing relentless fight for women’s rights. This year is the 40th anniversary of the decision that gave women their own bodies back, and it comes at a time when the autonomy conferred by that court decision, the simple fact of self-governance that ought not to require any ratification or authorization in the first place, is more embattled than it has been at any time since.

There’s much to say about this ugly time, the vicious, bitterly vicious, unrelenting backlash that since the Bush years has been ever more shameless in its naked hatred for women’s independence and, still worse, their sexuality. The truly fascist and deeply dishonest legislative assaults that have erupted in so many states over the past two years are as shocking as they are disheartening. And the creepy and untiring campaign to undermine, by every devious and indirect means, women’s access not only to abortion services, but contraception and all reproductive healthcare, including even breast cancer screenings, is both revelatory and repulsive.

But aside from the infuriating and burdensome details of this multi-front war on women and their bodies, what particularly strikes me is the pervasive bad faith that drives it. Abortion rights have always been threatened by attempts to undermine the laws which make it possible for women to exercise their inherent rights to control their own bodies and lives. But the new face of the war against them is not one of wrong-headed but above-board legislative controversy. It is a persistent and thoroughgoing attempt to turn the law itself against the majority of the citizens it governs – to use the law to make it impossible for law-abiding citizens to exercise the rights guaranteed them by that law.

Bans on funding for non-abortion related services, bans on the provision of factual information about abortion by healthcare providers to their own patients, prohibitions on the provision of abortion and reproductive health services through government programs relied on by women who have no other source of care, disingenuous regulations intended to make it impossible for women’s clinics to function for reasons unrelated to the quality of their services, and so many other restrictive and intrusive regulations, all are uses of the democratic process to make it a practical impossibility for women to exercise their own rights. And all of these are thoroughly and deliberately dishonest: they block factual information, and in some cases even stipulate falsehoods, to women seeking to make an informed choice about their own healthcare; they erect barriers and regulations addressing questions of funding, safety, or other ordinarily-reasonable aspects of healthcare provision for reasons entirely unrelated to their ostensible purposes and with the deliberate intention of making service to patients impossible; they malignantly distort the bedrock principle of medical ethics – informed consent – to harass, intimidate, and manipulate women seeking to make a free and informed choice about their own care, and drive them to a choice dictated by political and religious ideologues motivated by a deep-seated and gnawing hostility to those women themselves.

The enemies of women, having seen that orderly debate, under the framework of rights guaranteed by law, was not their friend in their war to take women’s lives into their own hands against those women’s wills, have adopted falsehood and bad faith as their weapons of choice. Nothing is now what it seems in this fight: informed consent is deception and manipulation; safety regulations are intended to prevent safe access to the services sought (and consequently drive women to seek unsafe alternatives, the rate of which is rising in the United States for the first time in decades); funds for services unrelated to abortion are banned out of nothing more than a virulent hostility to the organizations that provide the funded services because they also support women’s rights to abortion.

So much is at stake in the war against women. But the perversion of this war into a distortion of democracy itself, and the twisting of the law to undermine the law in the lives of one specific, hated, targeted sub-group of the population (the majority of that population, no less, but ever a despised and insecure majority) has broadened its scope, even beyond the lives, dreams, and freedom of more than half the country’s citizens. It has allowed a rabid and unhinged minority of religious berserkers, and the politicians they hold captive, to turn the nation against its own citizens.

It is said “when one is not free, none are free,” but that is truer than ever in the latest total-war assault on women by the religious right. They have adopted scorched-earth tactics against civilization itself – against the law that guarantees the freedom to live under the law, using the law’s defenses as weapons against those whom they defend. No nation can claim to be civilized which terrorizes and enslaves its female population. But the right wing has abandoned civilization even in form, not merely in substance, willingly gutting law itself when its guarantees of freedom thwarted their plans for domination.

What other rights remain, when the right to exercise one’s rights is denied?

February 1, 2012

Susan G. Komen Foundation: Cowardice and Hypocrisy

by @ 4:46 PM. Filed under Access to Healthcare, Autonomy, Disability Issues, General, Global/Community Health, Healthcare Politics, Provider Roles, Reproductive Ethics, Women's Issues

You’d think one of the most high-profile women’s health organizations in the country would steer clear of misogynist religious-right campaigns to curtail woman-centered healthcare. You’d be wrong.

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August 26, 2011

The War on Women: Reality Optional

by @ 3:21 PM. Filed under Access to Healthcare, Autonomy, Child-Rearing, General, Global/Community Health, Healthcare Politics, Personhood, Reproductive Ethics, Sex, Theory, Women's Issues

Rick Santorum – humiliated in his last electoral bid, and trailing badly in the GOP primary polls – knows he needs to keep saying outrageous things to keep himself in the public eye. Plus which, he’s crazy, so saying outrageous things is never difficult for him.

He’s been in the news lately for making bizarre comparisons of gay marriage to beer, a cup of tea, and a paper napkin – all predicated upon the rather obvious but undeniable point that “it is what it is. Right? You can call it whatever you want, but it doesn’t change the character of what it is”. This is a claim on which Santorum congratulates himself by describing it as “sort of metaphysical”, but might otherwise be categorized as “sort of idiotic”. Apparently it means something to him, though, because he keeps saying it – most recently in a just-posted interview on the Iowa Independent Website: “It’s like going out and saying, ‘That tree is a car.’ Well, the tree’s not a car. A tree’s a tree. Marriage is marriage.” He goes on to spew a frothy mixture of crazy in a wide arc: gay marriage “minimizes what that bond means to society” (by letting people . . . form that bond . . .); “you’re gonna undermine religious liberty in this country” (his examples consist exclusively of the liberty to prevent other people from doing things); “we’ve created something that is not what it is” (so much for the tautological metaphysics).

But there’s a particular moment in the interview I want to highlight, because it captures so perfectly the ideological dishonesty, and complete divorce from reality, of the right-wing, and particularly the anti-choice movement.

If your position on abortion prevails and abortion is prohibited, Senator, what should the penalty be for a woman who obtains an abortion or a doctor who performs one?

Santorum: I don’t think there should be criminal penalties for a woman who obtains an abortion. I see women in this case as a victim. I see the person who is performing the abortion as doing the illegal act

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August 9, 2011

Abortion Funding Assistance for Women in Need

by @ 3:49 PM. Filed under Access to Healthcare, Autonomy, General, Healthcare Politics, Reproductive Ethics, Sex, Women's Issues

From “Fund Abortion Now“, the blog of the National Network of Abortion Funds – non-profits that provide financial assistance to women in need of an abortion – comes this list of funding sources by state:

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June 5, 2011

Oy . . . Such Putzes

by @ 1:44 AM. Filed under Autonomy, Child-Rearing, General, Provider Roles, Reproductive Ethics, Sex

This has been getting a fair amount of commentary, and rightly so. There is a citizen-petition initiative on the ballot for the City of San Francisco, this coming November, banning circumcision of male minors except in cases of medical necessity. It is modeled on a similar ban on female genital mutilation already enacted into federal law. It adopts language in the federal FGM law specifically excluding religious beliefs or “ritual” as grounds for exception.

It’s not an unreasonable law, and I think it’s something that probably ought to be done though I have the impression that the issue is overblown from both sides. It’s also obvious that the law would most directly impact Jews (and adherents of some the other smaller faiths,  including some branches of Islam); the largest number of parents choosing circumcision in American are Christian, but they don’t make a religion out of it. (Ha! Haha!) But the debate over “male genital mutilation” – while pretty crazed at times – has mostly not had a religious focus; there are good non-religious reasons to oppose circumcision, and some non-religious reasons to favor it, and both argunents have been beaten to death by combatants on this subject without making it a religious war (other than to the extent that some people support circumcision for religious reasons).

But the group in San Diego that wrote the bill coming up for vote, and pushed the signature campaign that got it on the ballot, somehow stepped on a banana peel just recently, and threw the whole issue down a steep and bumpy flight of steps to an ugly landing (if you’ll excuse an increasingly awkward metaphor). The group has generally followed the “I mourn my penis” line in its “intactivist” crusade for prepuce justice, but for reasons that are hard to comprehend it recently came out with this:

Monster Mohel

This is a page from their “Monster Mohel” comic book, issued in support of their ballot initiative. The comic features a blond, muscular superhero – “Foreskinman” – who bursts in on a group of Orthodox Jews conducting a bris on a struggling boy. The villain – “Monster Mohel” – and his evil minyans (Ha! Haha!*) are wild-eyed, scraggly-haired, and grinning psychotically; one of them holds the child’s terrified mother by force while they cut her baby boy. Just to top off the Jews-as-freaks theme, the mohel gibbers about a “sacrifice to God” while brandishing scissors over the boy’s crotch, and also gushes praise for “the metzitzah b’peh for [sic] which I am about to partake” (the latter being a rare version of the circumcision ritual in which the mohel cleans the penis of blood by sucking it).

So: Jews as savages, religious nuts, and perverts, and their religious rites as violent and forcible; the anti-circumcision types as strong, Aryan, saviors rescuing children stolen from their mothers for bloody Jewish religious rituals. Hmmmm . . . never heard of anything like that before.

Not surprisingly, this has gotten a lot of criticism as anti-Semitic, and many commentators, especially on the right wing, have gone on from there to state categorically that the entire anti-circumcision bill is an exercise in anti-Semitism, and the “MGM” activism movement is just anti-Semitism in disguise.

That seems to me no more than another example of right-wing logical failure. (Are anti-Semites really that hung up on Jewish penises? And would they really go to the extent of funding and promoting years of agitation, and multiple state ballot initiatives, on an issue that makes them sound like cranks while affecting over 90% non-Jews? As far as I’m aware, even Nazis didn’t ban circumcision.) Through some bizarre twist of religio-political fate, the political movement that was forever railroading Jews on false charges and banning them from colleges and country clubs has in recent years decided that Jews are their special project (i.e., a convenient hammer in the Middle East to use against Muslims, and tied up in some loony way with Rapture prophecies – which also foretell the murder or forcible religious conversion of those same Jews, but that part doesn’t get mentioned). So finding an initiative they regard as left-wing that also has anti-Semitic elements is a welcome opportunity for them to paint the left wing as anti-Semitic. Between the fact that there’s nothing leftist about the “MGM” movement (except insofar as it’s anti-traditionalist and anti-religious, so clearly not rightist – but most liberals aren’t het up about foreskins and there’s nothing about them that is particularly associated with liberalism) and that tiresomely familiar hasty-generalization thing, the whole argument just makes no sense to begin with. The fact that one argument against circumcision is anti-Semitic, or even that some opponents of circumcision may be anti-Semitic, doesn’t mean that opposing circumcision is in itself anti-Semitic, especially when, again, Jews are only a tiny percentage of the people in the US who practice infant circumcision. Besides,  if we’re going to ban an entire policy because some of its supporters did something stupidly offensive, there would simply be no right-wing policies at all, so this is an argument form they really don’t want to be throwing around lightly.

But the weird thing about this is that the group forwarding the bill is not, seemingly, anti-Semitic. Their Web site is for the most part filled with the standard kinds of information and arguments about circumcision that you find among most supporters of this movement; religious issues are hardly touched upon and not, where I’ve seen, in an offensive way. The comic book is just absurdly divergent – in tone it’s completely incompatible with the rest of their work, and in content it has nothing to do with the actual substance of the group’s issue. It’s hard to believe it comes from the same group as is running the “MGM Bill” Web site. It may have been an attempt to address the strongest source of the religious-tradition argument for circumcision, that simply came out stupid-bad. Even though it’s hard to believe this sort of thing could have been dreamed up, proposed, produced, and approved without someone raising a flag, still, things do fall through the cracks. I can believe that something this messed up could emerge from a group that does not have overt or overriding anti-Jewish sentiments, in the same sense that I can believe Michael Richard didn’t intend to sound like a racist dick in his infamous comedy-club meltdown incident – sometimes you lose sight of what you’re trying to do, and . . . well, shit happens. It’s a very weak argument to claim that “they’re not anti-Semitic except for the unbelievably offensive anti-Semitic stereotypes in the major publication they just issued”, but, even so, for the reasons given above I think it’s believable in this case that this was an aberration more than a real statement of their policy.

But whatever its genesis, there’s no question that the publication, deliberately or not, is unmistakably anti-Semitic, and trades in ugly and ridiculous stereotypes. (I have to say I do like Foreskinman’s superhero logo, though: a round knob with a slit at the tip, flanked by a thin spreading collar coming up around the sides . . . use your imagination.) For an issue that has plenty of reasonable arguments on its side, including counter-arguments to religion-based adherence to tradition, this is stupid, divisive, offensive, and counterproductive. This really isn’t helping their movement – in fact, it may well kill it in California before the vote is taken – and causes real harm to many people, irrespective of their stance on the circumcision issue. Bad move, and their dismissive reaction to the first complaints made it worse. The MGM people need to start taking stock, and taking responsibility, soon.

 

* Yes, I stole that one.

June 4, 2011

Religious Right Victory: Child Rape and Paternity Rights for Rapist

by @ 4:41 PM. Filed under Access to Healthcare, Autonomy, Child-Rearing, General, Global/Community Health, Healthcare Politics, Provider Roles, Reproductive Ethics, Sex, Women's Issues

I missed this story when it first came out: a 10-year-old girl in Mexico became pregnant after being raped by her step-father. Abortion is legal with restrictions in Mexico City, but hardly at all outside the capital. In most areas of Mexico, including where this girl lives, abortion is illegal at any time beginning with conception; in her state there is a “rape exception” good only for the first 90 days of pregnancy. The girl is being held outside her home, in a state child-care facility, and it appears she or her mother were not even informed of the existence of even this limited right to abortion. Now it is long past time for that option, and of course there is no hope of her traveling to some state or country where she could get care at this date. It appears that she has no hope but undergo a full-term pregnancy against her will, and give birth, at the age of 10, to her rapist step-father’s child.

Note that these abortion laws: forced pregnancy from the time of conception (not the beginning of pregnancy itself); limited or no exceptions for cases of rape or incest; refusal of authorities to assist in obtaining abortion even when it is legal; state coercion and withholding of truthful information to manipulate women and girls out of exercising their legal right of choice; and general hostility to choice in all its forms, and collusion of state officials to impose forced pregnancy outside the bounds of the law, with impunity – are exactly the policies promoted and supported by the religious right in the United States. In Mexico, where the Catholic Church has much greater social and political power, they have been enacted and are in force.

So if you want to know what it looks like to live in the kind of country envisioned by “pro-life” forces in the US (though with a bit less Catholicism), this is exactly what it is: 10-year-old girls raped and subject to incest held in a locked ward by the state to force them to bear the child of their rapist, with virtually no legal rights to make their own choice in the matter, and what little legal rights they do have systematically withheld from them by force and deception, by the state itself. Every aspect of this case has been managed in such a way as to ensure that this girl – note again, 10 years old – is forced to do what the religious right and the culture of patriarchy have chosen for her life and her body: bear children under force and duress, through rape and incest, while held under guard as her rights and her body itself slip away from her control. Once more, these are exactly the laws the US religious right is campaigning for; this is exactly what they want and will get.

Let me make one final point: Recall again that it is the Mexican law that prescribes forced pregnancy for child-rape victims in that country. It is the Mexican Police who are holding this girl to prevent her from exercising the limited rights the law grants her. If she had come to a US Planned Parenthood clinic needing help in this case, she could have gotten an abortion; the US religious right demands that Planned Parenthood turn her over to the police. It is one of their main complaints against PP: that they provide healthcare on demand, rather than violating confidentiality and turning rape victims over to the state – and their families, which may include the rapists themselves. PP trusts women – even girls – to know whether they are willing to be pregnant or not; the religious right demands that they do so.

For Planned Parenthood, what a rape victim deserves is the power and the right to reclaim control of her body. For the religious right, what a rape victim deserves is to bear the rapist’s child. And the younger the better, apparently. They got what they wanted in this case. And they’re coming for more.

May 26, 2011

Ugly Grandstanding on Abortion (. . . Again . . .)

by @ 7:25 PM. Filed under Access to Healthcare, Autonomy, Disability Issues, General, Healthcare Politics, Medical Science, Provider Roles, Reproductive Ethics, Sex, Women's Issues

Today’s news is that an amendment to the Republicans’ medical-residency defunding bill, prohibiting the use of any medical-education funding for “training in the provision of abortions”, was passed in the House by an overwhelmingly partisan vote. The event is not of great practical significance: this amendment is very unlikely to emerge from the Senate, and the bill is almost certain to be vetoed anyway. But it marks yet another front in the right wing’s ceaseless war on women’s healthcare, and yet another point-scoring display of how reckless – or simply antagonistic – they are willing to be with women’s lives.

The amendment is odd, though, and uglier even than it seems. It is so vaguely written that it is hard to figure out just how it would work if it were enacted, but its most likely interpretation would be literally deadly. It also extends the odious “conscience clause” for neglect of patients to every health plan, contract facility, professional group, doctor, nurse, or other staffmember at every medical school and teaching hospital in the nation, through a single sentence in this seemingly minor funding provision regarding training for one specific type of care.

The text of the amendment is here (scroll down). Recall this is an add-on to a larger bill; the parent bill seeks to defund all residency-level training in hospitals and medical schools nationwide, to force a new budget fight for training subsidies every year thereafter, rather than allowing block funding with less meddling. That bill by itself is part of the Republican assault on mainstream medicine – this proposed amendment is just a little anti-choice icing on the cake:

(d) Prohibition Against Abortion.–Section 340H of the Public Health Service Act (42 U.S.C. 256h) is amended by adding at the end the following new subsection:

“(k) Prohibition Against Abortion.–

“(1) None of the funds made available pursuant to subsection (g) shall be used to provide any abortion or training in the provision of abortions.

“(2) Paragraph (1) shall not apply to an abortion–

“(A) if the pregnancy is the result of an act of rape or incest; or

“(B) in the case where a woman suffers from a physical disorder, physical injury, or physical illness, that would, as certified by a physician, place the woman in danger of death unless an abortion is performed including a life endangering physical condition caused by or arising from the pregnancy itself.

“(3) None of the funds made available pursuant to subsection (g) may be provided to a qualified teaching health center if such center subjects any institutional or individual health care entity to discrimination on the basis that the health care entity does not provide, pay for, provide coverage of, or refer for abortions.

“(4) In this subsection, the term `health care entity’ includes an individual physician or other health care professional, a hospital, a provider-sponsored organization, a health maintenance organization, a health insurance plan, or any other kind of health care facility, organization, or plan.”

 

The Meaning – Such As It Is – of the Amendment

The amendment is so badly worded that it’s not clear what it actually does. Section (k)(1) – the central defunding provision – prohibits any residency training money from being “used to provide any abortion or training in the provision of abortion”, but this is far from self-explanatory.

The first part is confused: the funding in question (defined by the parent bill, HR1216, which addresses “funding for graduate medical education in qualified teaching health centers”)  is for post-graduate medical education (i.e., medical residency programs or the equivalent), not actual clinical care, and the infamous “Hyde Amendment” prohibits federal money for abortion care in the first place, so the “provide any abortion” provision here would seem to be superfluous at best.

The real issue – and the way the amendment has been packaged – is the denial of funding to train residents in abortion techniques, with an eye toward making abortion unobtainable by flooding the country with surgeons and OB-GYNs who are simply incompetent to provide this standard care. Since almost all residency training takes place in facilities receiving federal subsidies, this provision, if enacted, would mean the coming generations of doctors would receive no training at all in central aspects of women’s healthcare. (It might be possible to obtain such training at the resident’s own expense, but it’s not clear where that would even be possible, since this amendment would restrict almost all centers even capable of providing the training regardless of who paid for it. The only realistic alternative would be to go overseas – again, at the doctor’s own expense – and even that would not necessarily be availing, because it raises licensing questions and is not a practical option for all residents, even the ones who were willing to go to such lengths.) This is not a new tactic on the anti-choice right wing; at one point, Georgetown University’s Medical Center attempted to ban its GYN residents from obtaining abortion training anywhere, even on their own outside the program – and this when such training was still funded. But making it mandatory, inescapable, and nation-wide, is a step never before taken.

But it also seems that much of the intended impact of the amendment could be escapable. Here, the strange wording of the amendment provides a paradoxical loophole. Section (k)(2) allows exceptions for “an abortion . . . ” involving the usual grudging set of special horrors (rape, incest, death*) that some of the right wing are willing to overlook. But, again, notwithstanding the wording of the amendment, there is no funding addressed by this amendment or its parent bill that would “provide an abortion” under such conditions, since it does not provide funding for clinical care in the first place. So these exemptions for “an abortion”, if they do anything at all, must modify the prohibition on “training in the provision of abortions” – that is, Section (k)(2) apparently grants exemptions for federal funding for “training in the provision of an abortion . . .” in pregnancies involving rape, incest, or the threat of death. But of course all techniques used in abortion may be used in cases involving these exempted situations – so presumably federally-funded health centers can provide any kind of appropriate “training in the provision of abortions” for pregnancies involving rape, incest, or the threat of death - after which it’s the doctors’ own concern how they actually put that training to use!

At least, that’s how it reads, in strict logical terms. That may not be how it would be implemented, however. It’s clear from the legislative history of the amendment – the discussion on the floor before it was voted on – that, regardless of the grammatical deficiencies of its author, it was in fact intended to prohibit all training in abortion techniques.† Probably the courts would interpret it that way, even if that’s not what it says. So in practice the impact of the amendment is (a) to prohibit (with few exceptions) all abortions provided using medical-residency training funds – a category which does not exist, and (b) to prohibit all training in all methods of abortion regardless of likely application.

 

Scope of Ban

The result of all this, as noted, would be to permanently exclude competency in certain standard professional practices from the skill set of all US-trained physicians in all specialties, even including surgery, obstetrics, and gynecology. The skills in question, it should be noted, would almost certainly include, among others, the following methods most commonly used in pregnancy termination:

However, every one of those techniques is used for purposes other than abortion (most commonly, to remove dead tissue left by menstrual troubles, fetal death or an incomplete miscarriage). As noted above, the strict text of the amendment allows training in “abortion” techniques if it is not intended to facilitate abortion, but that’s obviously not what the author hoped for, so presumably it must be interpreted to include any technique that could be used in abortion, regardless of its common application. That would also include:

 

Impact of Ban

What would it mean if doctors were banned from all training in those techniques, for all purposes? Well, among much other harm, it would mean that any woman would face almost certain death from any of the following conditions, for which one the above techniques is the standard treatment:

It would also mean that women would have no access to standard or best practices under any of the following conditions, among others, because those treatments involve techniques that could be used in abortion:

And of course there’s the whole conspiracy-of-silence-about-birth-control thing (see ‡ below).

In short, this ban – if it were enacted and if it were implemented as intended, and as anticipated by its legislative history – would kill even more women in the US, in coming years, than are currently sacrificed every year from the current lack of abortion providers. We would see a return to death from emergencies in childbirth – even for women not seeking elective abortion – at levels equivalent to that in some Third-World countries (since, given that appropriate care would be banned under this amendment, women facing certain labor-related emergencies would essentially be getting Third-World care even though best-practices-level care could have been provided). Many more would suffer, some greatly, from the lack of access to perfectly ordinary and preferred treatments for conditions having nothing to do with abortion. By making it illegal for physicians in training to obtain the necessary skills to treat a wide range of common gynecological conditions, some of them life-threatening, this amendment simply condemns their future patients to death, permanent disability, and other suffering from conditions for which safe and effective treatments were available, and which are universally practiced in every other advanced nation, but which their US-trained doctors were prohibited from learning.

[NB: I am not a clinician. The information above is common knowledge from widely-available sources. I am confident it is accurate; it is likely incomplete – the full impact of this legislation is likely worse than I have been able to describe. For actual clinical guidance or practical healthcare purposes, be sure to consult a knowledgeable clinician who has a full range of professional skills (i.e., one who was trained at a non-misogynistic healthcare center before this ban was enacted).]

 

Comments

As with so much of Republican “healthcare”, it’s hard to imagine this policy could ever be taken seriously, or enacted in any nation that makes a claim to basic decency. But as so often has been the case in the past, it’s best to be prepared to be surprised by what levels of indecency Republicans are willing to reach.

As I noted, the amendment contains inherent loopholes that its legislative history makes clear were unintentional. It may be possible to circumvent some of its provisions nonetheless, by sequestering training in the relevant techniques to programs ostensibly aimed at other conditions: that is, teach vacuum aspiration as a treatment for dysmenorrhea, teach dilation and extraction as a procedure for removal of a dead fetus after incomplete miscarriage, etc. This could work, but only if the ban were confined to overt training in abortion as such, and not to training in any procedure that could be used for abortion. There is no question how vicious, and how hostile to the lives of women seeking abortion, the supporters of this bill are; it remains to be seen if they are willing to sacrifice innocent breeders, too, in their pursuit of death for rebellious hussies. Virginia Foxx, the sponsor of this amendment, is known for her bizarre and incoherent beliefs; I think it is really likely she just does not understand the implications of her own amendment, and it would not in the end be taken to the extreme of a complete ban on all gynecological surgical methods. Or would it?

At any rate, the stupid and ugly thing is not going to pass. But it is worth considering just how serious its sponsors were, and how far they were willing to go, to kill and punish women who sought control of their reproductive organs, through the medium of their own doctors – how far they were willing to go to make the ignorance that characterizes Republican health and science policy across the board in fact mandatory for those who refuse to adopt their values voluntarily. As in so many cases, denial of knowledge is both the substance of, and a weapon for imposing, the right wing’s values as punishment upon those whose crimes are knowledge and independence.


 

* Note that only death – not merely unendurable pain, permanent disability, or traumatic stress – is grounds for exemption. And, too, the section on the woman’s health repeats the phrases “physical disorder . . . physical injury . . . etc.” four times, making it clear that there is to be no sympathy extended to women whose traumas are psychological, whether or not life-threatening, because that’s not part of your “physical” health. Apparently the people who are convinced there is such a thing as a soul are not convinced there is such a thing as a mind.

† This raises another issue: the technique for “provision of abortions” in the case of medical abortions – RU486 or similar medications – is simply to conduct an appropriate examination and write a prescription. The “techniques” for doing so are used in the treatment of every condition, and the specialized knowledge involved in using this particular medication is trivial to acquire independently. So, again by the strict logical meaning of the text, either hospitals are prohibited from teaching residents even to write prescriptions – unless they argue that techniques that merely could be, but are not intended to be, applied to abortions prohibited by this amendment are therefore not prohibited in their non-abortion contexts. And that – again, if logical consistency means anything – would authorize all abortion techniques, medical or surgical, for the reasons I explained in the preceding paragraph. But these are Republicans we’re talking about.

‡ And of course the anti-choice nuts characteristically go so far as to define mere fertilization as a “pregnancy”, and I have no doubt that the supporters of this amendment would argue that its provisions apply not merely to the prescription of abortion by medication, but also to post-coital medical contraception such as Plan B. But . . . Plan B and its like are essentially equivalent to nothing more than high doses of ordinary prescription birth control, and in fact ordinary birth control pills can be used for that purpose without a separate prescription. So presumably this amendment would also prohibit either training in prescription of oral contraceptives, or at least mentioning the fact that they can be used for morning-after contraception. So far does the absurdity extend, if you take this policy seriously.

April 9, 2011

Demographic Trends are Choices on the Large Scale

by @ 11:55 PM. Filed under Access to Healthcare, Autonomy, Child-Rearing, General, Global/Community Health, Healthcare Politics, Reproductive Ethics, Sex, Women's Issues

Interesting comparison from the US Census Bureau:

Gravida Status - US Women, 1976 & 2004

The percentage of women who reach the end of their fertility with zero or one live-born child almost doubled over a recent 28-year period. The fraction who had 3 or more has been cut in half. These are remarkable trends. The fact that nulligravidity has almost doubled, to nearly 20% of women, is especially striking. Forty years ago, childlessness was almost always a product of circumstances; now, for at least about 10% of women and probably far more, it is a choice (i.e., childlessness has grown by 9% in that time; the maximum rate of biological infertility in 1976 – two years before the first “test tube baby” – was 10.2%, but surely at least some of that childlessness even then was chosen; today’s rate of actual biological infertility is likely lower still, thus, most likely, well under half the current nulligravidity rate of over 19% is due to true infertility, with the rest the product of women’s active decisions not to bear children although they could).

In fact, the shift in total lifetime fertility over this period is markedly toward lower numbers at every level: the category of 4 or more children has declined by the greatest percentage, followed by the category of 3; the fraction of women with exactly 2 children has expanded markedly, but the fraction with just 1 has expanded more, and the fraction with 0 has increased most of all. Comparing the categories shows how pervasive the shift to smaller families has become: not only are more women not having children, but few are having very large families (the percentage of women with 4 or more children has plummeted, almost to the fraction of women who had none at all 40 years ago), and with 2 now being the most common choice, but 1 or 0 (combined) even more popular; essentially, most women who might have had 4 or 5 kids are now having 3 or 2, and those who might have had 3 or 2 are in many cases now having 1 or none. As has been widely reported, the overall fertility rate in the US now is about 2.0 – 2.1, which is just below the replacement rate; it has fluctuated at that level for over a decade and shows no signs of changing. (Hispanic women are the only ethnic group with higher fertility, and that is concentrated largely among recent immigrants.) This also is a choice – one that represents a remarkable shift from 100 years ago, when lifetime fertility was about 4 children per woman.

It’s interesting how sensitive to conditions the total fertility number is as well: within less than a generation, it dropped to about 2 during the Great Depression and through WWII, rose sharply to 3.7 during the Baby Boom, dropped to an all-time low well below 2 in the mid-70s, and has slowly risen to its current stable level just below replacement. Thus, average total fertility is capable of shifting, either up or down, by a factor of 2 in as little as 10 years, and has done so several times in the recent past. Women have always made choices about their fertility, but increasing economic security and more-reliable access to birth control has likely made those choices easier and more authentic. From this perspective, then, the currently stable average total fertility rate of 2 can be regarded as what economists would term a “revealed preference” – a choice women have made when they were free to make their own choices. (Another revealed preference: the percentage of women who remain in the workforce after having children has grown by a factor of almost 2 compared to 1976, and more since before then.)

This has many implications for the United States and the world, in terms of population levels, economic activity, demographic shifts affecting distributions by race, class, and age, and so on. But aside from those often-remarked consequences, what this shift, and its historical roots, tell us, is how far voluntary choices about fertility are part of people’s lives and their strategies for dealing with both reproductive and social opportunities. This shift – which parallels that in other developed countries – demonstrates that fewer children, greater control of reproduction, and greater participation in the external economy and other activities, are the life patterns that women (and their male partners) choose when circumstances allow it. (The only major upsurge in fertility in America in the last century was immediately after WWII, when young men who had been displaced by the war returned and began the reproductive lives that had been delayed for a period of years; the long-term trend has been downwards, and temporary upswings have generally been small.) And this in turn emphasizes how important that freedom is to people’s lives and the goals they hold for them.

The most obvious, and currently salient, lesson to be drawn from this, of course, has to do with the importance of effective and available family planning. Just a day after having narrowly avoided a shutdown of the entire US government over a dispute centered largely on continued funding of Title X – the nation’s only dedicated family-planning healthcare program – and the right-wing attack on reproductive healthcare in general, the recklessness of such policies, and their cost to people’s independence and well-being, can’t be overstated. But there are broader lessons as well: people care about and make active choices about their health and reproductive strategies, in huge numbers, and with surprising subtlety. The economy, demographics, and availability of equitable access to social opportunities such as jobs, education, and employment, have powerful consequences for how people live their lives and use their bodies – and the choices they make in response to circumstances demonstrate that the choices others make under other circumstances are not always free or welcome.

Map of countries by fertility rate

Average Fertility by Country

Given a chance, most women in developed countries around the world will choose to have 3 or fewer – often 2 or fewer – children in their lifetimes, and the rate drops predictably with improving conditions. Most women in non-developed countries, and even in affluent ones before the development of effective and available birth control, had many more (in most of central Africa today, it is an average of 5 – 8 liveborn children per woman, and even more total pregnancies including stillbirths; in Afghanistan it is 7). Clearly those choices were not voluntary for most of those women. They were not voluntary for most women in America less than 100 years – just a few generations – ago. Increased economic affluence and urbanization made having fewer children more desirable, but it was the development and availability of modern birth control that made it possible. To remove that access for some of the population now is not merely to endorse certain lifestyle choices or even to make them possible (women have always been perfectly free to have 4 or more children if they choose); it is to eliminate the choices others might make if they could, and constrain them by economic force to a life most of the country, and most of the world, has chosen to flee. It is to return some of the women of America to the conditions of life of 100 years ago, while the affluent continue the path to greater opportunity that was made possible by the economic and medical advances over that time.

April 7, 2011

Burdensome Enforcement, Equal Protection: Is a Woman’s Freedom as Valuable as a Gun?

by @ 7:02 PM. Filed under Autonomy, General, Healthcare Politics, Reproductive Ethics, Theory, Women's Issues

Interesting tactic in the New York City gun-control fight:

A gun-rights-advocacy group sued Mayor Michael R. Bloomberg on Tuesday, claiming that the city fee for obtaining a home-handgun permit was so excessive that it impinged on the Second Amendment.

The group, the Second Amendment Foundation, based in Bellevue, Wash., is focusing on New York’s fees because, according to the group, the city is one of the few places in the country that requires people to obtain permits to keep guns in their homes.

The city’s fee is $340, plus a $94.25 charge for a fingerprint check. The fee in most other places in the state is $10, according to the foundation. Mr. Bloomberg has long been a staunch supporter of gun control and has made efforts to reduce the traffic in guns into the city through sting operations, lawsuits against gun dealers and other antigun measures.

The city’s fee for obtaining a home gun permit has long been in place.

The suit, filed in federal court, claims that the city’s fee is so exorbitant that it “impermissibly burdens the Second Amendment right to keep and bear arms,” and the suit argues that because city residents are forced to pay more than others, the fee also violates the 14th Amendment’s equal-protection clause.

(Just to be clear: New York City, separate from New York State, requires a permit just to have a gun in one’s own home; the process of obtaining one is deliberately made as burdensome as possible, including high fees and an extensive application and testing process designed to make you fail, as a form of indirect gun control. A completely different and vastly more difficult process is required to obtain a concealed carry license, which is rare in NYC.)

What’s interesting to me about this is not the gun-control issue itself, but the legal approach in this suit: they are claiming that the fact that the state (or the city, acting under authority from the state) has erected restrictive procedures that make it significantly difficult to exercise a right that in fact exists under law should constitutionally invalidate those restrictive procedures. And presumably they’re going to argue that the rationalizations the state offers – that they must review applications for reasons of public safety, that this incurs administrative expenses that must be covered, that the city has the authority to act on its official perception of the public interest against the wishes of the people actually affected, etc. – are obviously disingenuous or at any rate insignificant in view of the basic right of people to exercise freedoms that otherwise exist under law.

This reflects is a seemingly simple principle – people have a right to exercise their rights – that actually has considerable legal repercussions. For the most part, the Supreme Court has not recognized that the government has a positive obligation to ensure that people can act on their legal negative rights (i.e., a right that merely specifies freedoms that other people may not ban), but has not usually gotten into the question whether regulatory procedures that constrain but do not entirely vacate a given legal right are for that reason illegal. It’s a difficult problem; obviously, some regulatory restrictions are necessary in many cases, and equally obviously, that regulatory authority can be used to create insuperable practical barriers in cases where the law does not allow outright bans. But, to my knowledge, the Supreme Court has not held that the mere existence of a barrier is the equivalent of an unconstitutional ban. In fact, the Court has often gone out of its way to give deference to government regulations even when their burden on citizens’ rights is grave: the standard test for Constitutionality of a law is that it must show a “rational basis” for its existence, which the Court interprets to mean literally any rationale – however stupid or obviously dishonest – that is not literally logically impossible; the Court also usually rejects “substantive due process” and “equity” arguments, which ask for the application of general principles of law or morality outside the strict “black letter law” of statutes and case precedents. Thus, laws and regulations are typically upheld as written, on the presumption that legislations have wide latitude to act as they choose, and the laws they write are therefore prima facie in keeping with the principles of representative democracy regardless of how burdensome, unfair, or duplicitous they may be.

There are few exceptions to the “rational basis” doctrine, all having to do with Constitutional-level civil rights. The Supreme Court has held that laws directly impinging “fundamental” Constitutional rights, or imposing ethnicity-based restrictions on freedoms guaranteed by the Constitution, must meet the test of “strict scrutiny” – that is, they must not merely have a nominal “rational basis”, but must “advance a compelling state interest”, be “narrowly tailored” to that interest alone, and use the “least restrictive means” to achieve it. Arbitrary distinctions between groups also come in for strict scrutiny, under the 14th Amendment’s “privileges and immunities”/”due process”/”equal protection” clauses. In other civil rights cases, the Court has imposed a doctrine of “intermediate” or “heightened” scrutiny, under which the laws must demonstrate a weaker but still compelling rationale for their restrictions. (Almost all sex- and gender-related discrimination receives only heightened scrutiny, because, you know . . . teh uterus . . . .) In the case of abortion, the Supreme Court has struck down some, but not all, anti-choice laws and regulations that were clearly intended to impose, in its words, an “undue burden” on women’s exercise of their rights; however, others were permitted under heightened scrutiny if the anti-choice state could articulate even a moderately plausible-sounding (as opposed to barely “rational”) reason for the law, even when those laws were obviously intended only as burdens on women, and even when they arose as part and parcel of laws that were otherwise rejected for that reason. So, in general, the Court has not taken the step of saying “this law is obviously intended to void a legal right, and you can’t do that”; it merely subjects burdensome laws to various levels of analysis as to how well they disguise that intention.

What’s interesting about this gun-control case is that the legal theory it relies on (as reported in this short article – hard to tell if this is true) attempts to raise burdensome but otherwise normal administrative regulations to the level of Constitutional infringement – that is, it appears to claim that having to pay ordinary but high fees, and jump through ordinary but complicated procedural hoops, is as much an infringement on Constitutional rights as are poll taxes or racial segregation, or at least as gender-based restrictions on employment. “Unduly burdensome” regulations may be unconstitutional, it’s true, but in this case the regulations are not unusual, even if the fees are high: every jurisdiction (other than a couple of whacko states that have no gun permit laws at all) processes paperwork, assesses fees, and in general requires some kind of procedural rigmarole for getting a gun permit. New York City is an outlier, in that their licensing process is unusually difficult (they make you take a test that includes trick questions), lengthy (it commonly takes months), and expensive (as much as 40 times what other jurisdictions – even in New York State itself – charge). But that is only a matter of degree, which it seems can easily be explained given the City’s political determination that they want to make the process stringent. (The fees, I suspect, are an estimate of the fully-loaded cost of staff time and expenses to process the fingerprints, application, and background check, and are probably slightly, but not hugely, inflated. That’s a bullshit way to calculate fees for a job the government actually exists to perform in the first place, but that’s a different matter.) So the issue here is whether a normal and appropriate government function – processing applications and assessing fees – which nobody suggests is unconstitutional in its typical form, becomes unconstitutional when that function gets so out of hand that it essentially becomes a tool for prohibition of what is otherwise a legal right.

This has obvious implications for the constant barrage of dishonest and hostile regulatory encroachments on fundamental Constitutional rights that have become the favorite tactic of the anti-choice brigades. Unnecessary waiting times, intrusive and unnecessary medical procedures, explicit ideological harassment deliberately intended to discourage people from the decisions they have made, technical regulations intended only to delicense or bankrupt clinics – all these and much more have been commonplace tactics in the anti-woman crusade for years, and they are getting more brazen and more offensive almost literally day by day.

These attacks on abortion rights go much further than New York City’s procedural hurdles for a gun permit. In New York, if you pass the test and pay the fee, they will give you a license (for home possession, at least). The administrative procedures are clearly intended as a bottleneck, and the fee is unfair, but the procedure is straightforward and involves nothing that is not common in the administration of similar governmental functions across the country. Anti-choice regulations, in contrast, commonly apply only to abortion procedures, impose burdens that serve no reasonable purpose or are inflated absurdly beyond what is necessary for their ostensible purpose, or distort ordinary procedures in ways that are intended solely to make abortion unobtainable, unaffordable, or discouragingly unpleasant. Examples include requiring multiple trips on different days to a clinic that is often a vast distance from a woman’s home; applying hospital licensing standards to outpatient clinics for abortion only; requiring medically unnecessary ultrasounds at a cost of hundreds of dollars; requiring scripted and false speeches to deliberately upset patients before a procedure – all of them extraordinary burdens that have nothing to do with the ordinary process of licensing and regulating medical clinics, or ensuring informed consent (which, in every other medical discipline, is intended to help patients get what they want and need).

The gun-rights people do have a point about New York City’s regulations: although those regs are not that unusual on their face, the details of their implementation make the legal right of gun ownership essentially unexercisable by many citizens who lack the money, time, or persistence to overcome a burden that is not actually required by the legitimate government function it purports to arise from. But if that difficulty rises to the level of a Constitutional infringement in the case of gun permits, how can the GOP’s outright and unashamed assault on women’s rights to legal and vital healthcare not be seen in the same light?

This puts the right wing, of society and the Supreme Court, in a pickle. If they agree that burdensome and hostile regulations intended to discourage the exercise of a Constitutional right are impermissible even when those regulations are normal and proper other than in the degree of the burden they impose, then they would have to agree that far more invasive regulations serving no ordinary purpose and deliberately intended to actually void a Constitutional right entirely, and even in cases of life-threatening consequences, are that much more obviously impermissible. On the other hand, if they want to continue their assault on women with any degree of logical consistency, it would seem they would have to throw gun lovers under the bus along with them. It will be interesting to see this play out.

March 31, 2011

Using Their Weapons Against Them? – Not So Good When the Weapon is Women’s Bodies

by @ 8:24 PM. Filed under Autonomy, Child-Rearing, General, Healthcare Politics, Personhood, Reproductive Ethics, Sex, Theory, Women's Issues

I’m sorry to have to say it, but I’m not totally diggin’ this:

Sierra Club: Fetus Toxins

It’s from the Sierra Club’s new ad campaign “to remind our representatives who they are actually hurting when they attack the EPA.” I’m entirely in agreement with the goal of the campaign, and even with the message of this ad (“gutting emissions regulations results in greater release of toxins, which can do their worst damage during fetal development”). But I have reservations about its methods.

The obvious function of the ad, of course, is that it plays to the right-wing’s proclaimed concern for fetuses to the exclusion of all other health issues (including, of course, pre-natal care, gynecology, infant and child care, and other such irrelevancies). And the fact that the imagery plays so obviously and shamelessly off of the right wing’s fetish for pregnant bellies – in this case to prod them to do something to improve people’s health, rather than take away their rights to healthcare, is an amusing irony. But it’s just those points that leave me uncomfortable.

First, there’s something in a way defeatist, or at least pessimistic, about the focus of the campaign: because the GOP only cares about unborn fetuses, we have to couch every issue in terms of its impact on fetuses. (“Wear your seatbelt – so your fetus doesn’t get hurt!” “Support solar power – so your fetus will use less oil!” “Don’t spread deadly poisons in the environment – because it might hurt some of the fetuses of the less than 1% of the population that’s pregnant at any given time!”) But surrendering every issue to the religious right’s fetus-fetish takes everyone else in the population out of the picture. Mercury, dioxin, and other poisons in the environment hurt everyone. It matters that young children who have grown out of the right’s preferred age for adulation (i.e., they’ve been born already) are also vulnerable to developmental delays and all the other effects of environmental toxins; it matters that adults are crippled and killed by heavy metal poisoning; it matters that the women who are carrying these favored fetuses are also affected by the poisons they ingest – in addition to the fetuses that are the focus of concern in this campaign: these are the people who are hurt when the right wing attackes the EPA – why can’t the Sierra Club, of all people, say so? It may be true that the right only cares about fetuses (and then largely as tools for hurting women, who are their real obsession), but allowing them to forget everyone else is to forfeit the major part of the fight to them without contest. When progressives’ campaigns have the same focus, same tactics, and same blind spots as the reactionaries they are campaigning against, much is lost even if those campaigns succeed.

The second, and perhaps more striking, issue that arises for me from this ad is the imagery that is used. When I said it leaves everyone but the fetus out of the picture, I meant it literally. This ad replays in every detail one of the most common, and most offensive, tropes of anti-choice misogyny: the faceless pregnant woman reduced to nothing but her belly. (Can’t say “uterus“, you know!) You see it everywhere (and, as @ClinicEscort points out, particularly in stories about abortion): a woman’s body reduced to nothing but swollen boobs and swollen belly, or often just the belly – the face is always cut off, just out of the frame. The effect – and unquestionably the purpose – is to erase the woman from her own pregnancy. It’s fetus porn, with the woman dehumanized just as badly as, and in some ways even more fully than, in sexual porn (where at least you can often see the face). It’s the kind of misogynist metonymy that at least has come to be recognized (if not eliminated) in product advertising, but apparently still goes unremarked in issue or values advertising – even though its major function is to promote the value of dehumanizing women. That it does reflect and promote the right-wing vision of women goes without saying: women as pregnant vessels who are not even named or acknowledged, and certainly have no interests or needs that deserve to be addressed in their own right, could hardly be better illustrated than by photographs of them as exactly that, used in campaigns aimed at denigrating women’s interests in favor of the “interests” of an unborn fetus.

It’s infuriating to see progressive groups use such images and tactics. This goes beyond simply bowing to the reality of the  right’s indifference to women by finding another “hook” for an issue; this actively embraces and endorses its dehumanizing methods in order to use them for that other issue – exactly what the right wants. What I want is something better than this from nominal allies.

March 30, 2011

Familiar Disinformation Assault on Planned Parenthood Now Building

by @ 3:15 PM. Filed under Access to Healthcare, Global/Community Health, Healthcare Politics, Provider Roles, Reproductive Ethics, Sex, Women's Issues

Right-wing sites are loudly touting yet another of their doctored videos and deceptive recordings to vilify Planned Parenthood – this time with an accusation so blatantly misconceived it hardly makes sense.

The anti-choice “Live-Action Blog” has prominently posted a short video clip of Planned Parenthood CEO Cecile Richards explaining the impact of the GOP proposal to gut all Title X (federal reproductive healthcare) funding as well as any funds specifically for treatment at Planned Parenthood clinics. (This is the budget amendment to “defund Planned Parenthood” that has been much talked-about, but it is important to note that it kills all Title X funding entirely, as well as any other treatments at PP specifically from all other funding sources). As Richards notes, entirely correctly:

What’s gonna happen, if this bill becomes law, millions of women in this country are going to lose their healthcare access, not to abortion services, [but] to basic family planning, mammograms . . .

I don’t know what else she said, because they cut that off. The clip just repeats the word “mammograms, mammograms, mammograms” over and over – as if they’ve broken some kind of scandal in proving that the head of a women’s health service would be concerned with access to a basic and universally recommended women’s healthcare procedure.

The clip then goes on to include secretly-recorded conversations at a couple of dozen PP clinics in which . . . another scandal! . . . the receptionist confirms that Planned Parenthood doesn’t provide mammograms, but offers to refer the deceptive “patient” to a facility that does. They’ll even help you get an appointment and fill out the paperwork for a subsidy for the cost. This, the wingnut blogs are breathlessly screaming, is a immense “scam”.

So, these anti-choice “activists” have broken a really big expose of Planned Parenthood, right? (OK – if you couldn’t have guessed the answer to that without even reading the story, you haven’t been paying attention.)

They certainly think they have, or at least claim so: Live-Action blares “Planned Parenthood CEO’s False Mammogram Claim Exposed”; Left Coast Rebel claims that “Cecile Richard’s, CEO of Planned Parenthood, lied and did more to limit access to mammograms than defunding” (the latter part appears to be some convoluted argument that PP is actually denying women mammograms by referring them to facilities that provide mammograms – this is right-wing thinking on healthcare); the always-wrong Erick Erickson repeats that claim, asking “Does Supporting Planned Parenthood Increase The Risk of Breast Cancer?” (um, no – it increase your probability of being referred for a mammogram, at an appropriate facility); David Brody calls this “The Mammogram Scam”. And there’s more. Around the blogosphere, yet another coordinated Planned Parenthood “sting” is taking place, broadcasting false and just bizarrely distorted secret and misleadingly-edited tapes that mean almost the opposite of what they are twisted to say.

You have to ask: are the media going to fall for it again? Time after time, these false tapes have been dutifully repeated in the news without the slightest critical inspection (one of them was the reason for the “defund Planned Parenthood” bill – now another equally false one just happens to pop up claiming that the impact of that bill is actually evidence of a financial ripoff by Planned Parenthood itself). We can only hope this persistent and organized campaign of distortion and outright dishonesty will be recognized this time. (The Washington Post already failed.)

Let me make one point about this ridiculous “denying care” argument, before pointing out what the tape actually did say. Planned Parenthood clinics do not provide mammograms on-site; they do make referrals of patients requesting (or who have been recommended to receive) mammograms to other facilities that provide them. In some cases of these fake patients requesting them over the phone, they wound up having to call a couple of numbers to find a place where they could get a procedure that that Planned Parenthood clinic does not provide. The argument here is that it is apparently Planned Parenthood’s fault they didn’t provide instant access to a procedure a random caller requested from a facility that doesn’t offer it. On-site, some of these clinics (depending on the clinic and the state) apparently can help patients get mammograms elsewhere by providing referrals and forms to request funding from a state program that also subsidizes those procedures. The argument about this is apparently that PP is taking federal funding for mammogram services and using it merely to shunt patients off to some other facility where the procedure is funded some other way. This is nonsense in both cases, obviously. Every medical facility of every kind has a specific range of services it provides, and will refer patients to other facilities for other procedures; the fact that a given clinic does not have a specialized and expensive facility on-site, that only some of its patients need, and which requires a dedicated technician to operate, is hardly surprising and in no way unusual. As for Title X, it does provide funding for mammograms among many other things, and PP does get funding for some services under Title X, but obviously that funding is not for particular services they don’t provide, it is for the services they do provide. PP clinics do not get any funding for mammograms; what they get is Title X funding for the many other services that can be provided in an OB-GYN clinic, and which they do provide. In many cases they cooperate with cancer screening programs run by other facilities, including well-respected groups such as the Susan Komen Fund. There is no wasting of Title X funds on patients who get mammograms from X-ray facilities outside PP offices; and no denial or delay of care – if anything, the patients get mammograms faster and more readily, thanks to PP, because PP provides them with access to internists or OB-GYNs who recommend such screenings and provide referrals for them – exactly the services that the GOP is trying to kill off.

As to what the tape actually does show: Richards doesn’t say that Planned Parenthood provides mammograms; she doesn’t even mention Planned Parenthood in the edited clip they show. PP clinics do not provide mammograms for a very good reason: a mammogram, while routine, is a specialized radiological procedure that requires an X-ray suite and a trained technician. Most OB-GYN clinics don’t have an X-ray suite. They send women to X-ray facilities for that. (Your doctor doesn’t have a medical lab, either – they send your blood and urine to a specialized facility and get the results back by computer. This is standard.)

What Richards does say, correctly, is that the GOP cuts to women’s healthcare will prevent vast numbers of women from getting basic care, including mammograms, from many sources or providers. The GOP proposal cuts all funding for Title X, which does fund mammograms (at X-ray facilities, not gynecological clinics, because mammograms involve X-rays, therefore they’re done at X-ray facilities . . . am I going too fast for you, right-wingers?), and will have a considerable impact on the availability of mammograms, as well as other forms of care, for women nationwide.

Richards was pointing out the impact of this vicious bill on women’s healthcare across the board, not just in respect of her own organization, and she did so honestly and perfectly correctly. The anti-woman contingent couldn’t be bothered to understand what she was saying, or provide the context of the question she was answering, or even the full sentence in which she answered it, before whipping up another howling storm of falsehood and deception.

[UPDATE: Title X funds “breast and cervical cancer screening according to nationally recognized standards of care”, which in practice means manual breast exams for individual patients during office visits, and referral for mammograms for patients with a positive manual screen. It does not appear to fund routine mammograms, though their Web site is so vague it is hard to tell exactly how it works.]

March 29, 2011

It Works Both Ways

by @ 1:29 PM. Filed under Autonomy, General, Healthcare Politics, Reproductive Ethics, Sex, Theory, Women's Issues

Since the anti-choicers are so very concerned about minority interests that they insist on stealing every woman’s autonomy  because a potential black leader fetus might someday be aborted, it’s only logically consistent to pay attention to the upside of that issue:

Aborting an Anti-Choice Terrorist - Griffin

Aborting an Anti-Choice Terrorist: Hill

Aborting an Anti-Choice Terrorist: Kopp

Aborting an Anti-Choice Terrorist: Roeder

Aborting an Anti-Choice Terrorist: Rudolph

That’s just a fraction of the total, even considering murderers alone. Almost no suspects have ever even been named in the over 200 arsons and bombings, or close to 100 other attempted arsons and bombings, or the literally thousands of vandalisms and chemical attacks committed at health clinics across the US, not to mention the many attempted murders, public “targeting” of chosen victims (some of them later murdered), personal harassment and threats to healthcare providers, and uncountable incidents of on-site harassment and violence directed at clinic staff and patients, that are the stock in trade of Christian anti-choice terrorism.

No person loses their life in an abortion. But here you can see just some of the people who would be alive today if the terrorists above, and others like them, had been aborted before they murdered them. If we’re counting up the possible impact on society, well, there’s only one Obama, but there’s plenty of these shitheads. So, all things considered . . .

[NB: Of course the entire line of reasoning is nonsense. The fact that some unpredictable thing could occur sometime in the future is no reason to force anyone to bring about circumstances that might randomly, but not foreseeably, result in that outcome, even ignoring the fact that it is their decision whether they want to do so. The same reasoning would not only justify mandatory childbirth, but mandatory pregnancy, and in fact mandatory maximum reproduction regardless of risk or cost – since one of those unwanted children might do enough good to offset all the suffering required to produce it. That this is in fact the official policy of the Catholic Church makes it no less insane or misogynist. It’s also illogical: there’s no guarantee that any child – still less an unlimited number of unwanted children imposed by force – will do more harm than good, so the proposition that there’s a harm to society in aborting them is no more provable than that there’s a good to society in doing so, as the above images demonstrate.]

March 24, 2011

Not Waiting to Exhale

by @ 2:24 PM. Filed under Access to Healthcare, Autonomy, General, General Science, Healthcare Politics, Provider Roles, Reproductive Ethics, Women's Issues

Here’s an interesting peer-to-peer phone-line support service for women who have had an abortion and want to talk to other women about it.

Exhale serves women who have abortions, and their partners, friends and family. We respect the cultural, social and religious beliefs of all our callers.

Apparently they’ve been in operation for about 8 years, and claim to have taken close to 20,000 calls; I’m embarrassed to say I’d never heard of them before. Their Web site makes them sound like a neutral listening post for those who want to talk about their experiences and feelings about them, regardless of what those feelings might be or what the caller’s perspective on the whole issue is. I have no direct experience with this group, so I can’t say how accurate this is or how well it works, but the Web site seems to me like it takes just the right tone:

  • Exhale views each individual as a “whole person,” respects their belief system and strives for cultural competency.
  • Exhale believes that self-awareness, self-care, and knowledge can empower individuals.
  • Exhale seeks to transform oppression by challenging its roots and empowering each other and our communities.
  • Exhale values the spirit of collaboration.
  • Exhale believes abortion can be a normal part of the reproductive lives of women and girls.

The problem, of course, is that the entire notion of abortion “counseling” is generally a deception perpetrated by anti-choice groups to trick women into being manipulated with slut-shaming and false information. That makes me leery of any group – however honest and above-board – that sets itself up to provide such counseling. And, given the documented fact that abortion is not uniquely associated with psychological trauma, and since we don’t normally set up support groups for every individual outpatient surgical procedure (“Expel seeks to transform colonoscopy . . .”), the implication that there needs to be one for abortion specifically also smacks – just a bit, perhaps – of a negative, or at least defensive, stance toward abortion in general. But their Web site specifically disclaims this, and, without direct knowledge, I’m willing to take them at their word.

It is valid to recognize that abortion can be an emotionally fraught experience. While it is an important, useful, and sometimes life-saving procedure, abortion is unusual (though hardly unique) in that it is a treatment for a condition that is often regarded as actually desirable, and that most women, including most women who have abortions, will seek voluntarily at some point in their lives. There is no contradiction in the fact that pregnancy can be wanted under some circumstances and unwanted under others, and it makes only the most obvious kind of sense that there should be treatments available for those cases in which it is unwanted, and that many women will want “an abortive remedy” when that serves their needs and interests under their particular circumstances. But it is understandable, too, that an unwanted pregnancy may call up thoughts about pregnancies they patient may want or embrace under other circumstances, and that a particular pregnancy may be unwanted due to immediate circumstances that the patient wishes she could change, and would be wanted under those changed circumstances. So it’s easily understandable that some women’s feelings about their abortions would be complex, even while they are firm in their conviction that having one is/was right under the circumstances at the time.

Given the virulent campaign to make women feel guilty for making their own decisions about pregnancy, and to use that manufactured shame and guilt as a tool to keep them from doing so, even admitting that women may have conflicted feelings about abortion, or indeed that it is possible to be conflicted about one’s decisions without that fact undermining the right to make one’s own decisions at all, is the kind of frank discussion of fact that becomes so dangerous in the face of organized campaigns of falsehood that consistently distort facts to attack women’s independence. But an honest discussion of abortion, and honest, respectful, and welcoming acknowledgment of the women who have abortions, requires treating simple facts in a true and honest way. It in no way undermines the pro-choice principle – even if it will be used as a dishonest political attack – t0 say that women may have complicated feelings about pregnancy and abortion and may want to talk about them, and it serves those women more fully and respectfully to address that need openly and provide a tool for meeting it.

One bit of the Exhale Web site took me aback, and then left me even more impressed with their apparent devotion to honest and value-neutral service to women. They say:

If you have been diagnosed, or have self-diagnosed, as having Post-Abortion Stress Syndrome, Exhale understands that having a name for what you’re feeling and experiencing can feel important.  Many women find the experience of identifying with this syndrome as positive and affirming.  It is also important to know that having feelings about a significant life event doesn’t mean that you have a major psychological condition that requires medical care.  For many women, naming and expressing their emotions, and having the space and support to do so, can be more empowering than being identified as having a disorder.  Whether or not you think you have PASS, the most important thing is that you get support for what you’re feeling, not what someone else thinks you should be feeling.  Exhale trusts you to know what feels right for yourself.

Exhale follows the findings of the American Psychological Association, which has not found a link between feelings that follow an abortion and a psychological condition in need of medical care.

This is startling, but strikes me as exactly right. “Post-Abortion Syndrome” is a wholly imaginary and deeply dishonest “diagnosis” invented out of whole cloth by anti-choicers. It exists (actually, is claimed to “exist”) only to discredit abortion – a procedure that serves women’s health and autonomy interests in a centrally vital way, and is actually safer than childbirth in almost all cases – as somehow pathological, in open defiance of established data (yet another example of a tactic that is pervasive on the right wing). The campaign to tout this fraudulent “syndrome” as a real condition has misled many women, often the youngest and most vulnerable among them; this is not just a travesty of medical science but an assault on women and their freedom. But the fact that some women have been conned into worrying about this fake disease, or mistaking their own natural complexity of feelings, or even regret, for some sort of illness on their part, must be met sensitively and with respect for the women who have those feelings, and the feelings they have.

It is unconscionable to participate in or endorse the deceptions the misogynist right practices against women and women’s independence, but it is vital to meet those women themselves, where they are and as they are feeling, and to validate their own perceptions of their situations and help them deal with them on their own terms. Exhale seems to walk this line bravely (given how easily such a stance can be misconstrued and used against them) and sensitively (given the difficulty of managing such a delicate distinction).

From what I see here – and again, I have no direct knowledge – the group hits the nail right on the head, in terms of acknowledging the range of women’s experiences and prioritizing their own perspectives on their situations, without downplaying every woman’s right to make her own decisions about reproductive health. (Including family and friends, including men, in their services is also a sign of a sensitive and realistically broad approach.) Healthcare has more and more come to recognize the importance of a wholistic approach to patients’ needs and experiences, including post-treatment support. In a field in which any admission of need is turned into yet another attack on women’s strength and claim to independence, simple decency and understanding can become a liability. By refusing to play those games, the approach that Exhale seems to embody returns the truly important issue – women’s need for service, support, acceptance, and respect – to the center of the abortion issue where it belongs.

I’d be interested in hearing what others think or have seen, regarding Exhale or similar services. Has anyone who is willing to discuss it here participated in such counseling, or served as a facilitator? How significant is this sort of support, and does it help?

UPDATE: Wow, am I a dumbass! Somehow I completely forgot about this organization, after I had previously blogged about it back when they were first starting up! Guess I should read my own blog more often.

Additionally, I have heard from well-respected sources that Exhale is legit – they will talk to anyone in a non-judgmental way, but are in no way anti-choice.

March 18, 2011

The Drill (Divide & Conquer on Reproductive Rights)

by @ 11:58 AM. Filed under Access to Healthcare, Autonomy, General, Healthcare Politics, Reproductive Ethics, Women's Issues

From Comrade DougJ at Balloon Juice, this says it perfectly:

You know the drill on the politics of reproductive rights: most voters support a woman’s right to choose, but those who oppose it are much more likely to be one issue voters. Most anti-choice legislation focuses on fucking with poor people who vote Democrat anyway, so as not to alienate more middle-class and upper-class women (who are often strongly pro-choice but sometimes vote Republican anyway). I have to wonder at what point all this bullshit turns a lot of middle-class and upper-class women into single issue pro-choice voters. All this crap will stop as soon as that happens, but it will continue unabated until it does.

The key point is that the right wing hates upper-class women as much as they do lower class women (though for fewer reasons: they’re not poor, and more likely to be white, so that eliminates certain causes of the antagonism, but not its strength). Because of the class divide, the assault on women has less effect on the upper class, but the motivation is still there. When upper-class women begin to feel it, they’ll respond. (And in that regard, the move to eliminate tax deductions for all and only health plans that cover abortion may be welcome prod, as DougJ notes in the above-linked post.)

Sadly, solidarity begins when suffering is shared, not when it is merely noted. But GOP overreach makes that almost inevitable.

February 10, 2011

Outing the Hypocrites: It’s Not Just for Gays Anymore!

by @ 3:14 PM. Filed under General, Healthcare Politics, LGBTQ Issues, Reproductive Ethics, Sex, Women's Issues

This is by far the least important of recent political incidents, but something about the Christopher Lee story demands comment. Lee was a married right-wing Republican Congressmember from New York who advertised for hookups on Craigslist, lying about his age, profession, and marital status, until a woman he flirted with found out who he really was and passed the information on to Gawker, which re-printed their entire e-mail exchange. When confronted by Gawker, Craig Lee at first evaded the truth and deleted his Facebook page, then submitted a letter of resignation from Congress barely one hour after Gawker broke the story.

This is funny, in the way that bad things happening to bad people are always funny, but, aside from the speed of his panicked reaction, the only thing surprising about a married sex-negative right-winger’s dishonesty and hypocrisy is that he appears to actually be heterosexual. For myself, not being a sex-negative right-wing bluenose, I’m not generally inclined to stand in judgment of other people’s sex lives. I would normally regard whatever promises of monogamy he made to his wife as an issue between them only, and I don’t regard lying about your age on Craigslist to be exactly the kind of transgression that rises to a Constitutional level. The fact that he chose to resign without even waiting to see the political consequences of his behavior speaks to his state of mind, but not to any rule of Congressional probity that I would think was necessary.

In fact, I had stopped reading Gawker after their nasty “expose” of Christine O’Donnell’s drunken hookup from the past; though O’Donnell’s a weird and creepy reactionary, the fact that she may actually like sex is not something to be held against her (the fact that she wants to criminalize it for other people is).  Treating sex as some sort of scandalous behavior is wrong, often sexist, and plays into the right wing’s tactic of using people’s sex lives to punish them. Gawker, however, puts a trenchant point on this particular case:

Lee['s] support for “Don’t Ask, Don’t Tell” and vote to reject federal abortion funding suggests a certain comfort with publicly scrutinizing others’ sex lives.

That’s what caught my attention about this case, and made me think it might be worth discussing, even though the basic content – dude gets some on the side, is embarrassed to be found out – should not in itself be a public issue. But there is a special kind of hypocrisy in engaging in private behaviors you want to criminalize or punish on other people’s parts. And there’s an argument for publicizing hypocritical behavior of that kind.

You can make an analogy here to the “Frank Rule” – the informal guideline for outing closeted gays in politics formulated by Barney Frank: people have a right to privacy, but those who seek to invade others’ privacy by punishing or criminalizing what should be a private matter have no expectation of privacy in that regard themselves, which is to say that closeted gays who promote anti-gay policies should be outed, but those who do not overtly work against gay rights should not be, even if they’re conservative in other ways. For similarly private issues other than homosexuality, I would think a parallel rule is reasonable: people have a right to be left alone, unless they refuse to leave others alone, in which case they should be regarded as fair game for scrutiny of their own behavior in its relevant aspects.

That raises the question whether this Craigslist idiocy (dumbass used his own name, picture, and Facebook account) is relevantly similar to the kinds of behavior Lee had previously devoted himself to demonizing – specifically, the sex lives of women and gays – to make his extramarital peccadilloes worth revealing or discussing. (Again, Lee resigned in such a flighty panic that almost nobody actually had discussed it. But it was Gawker’s expose that triggered his resignation, so we can ask whether Gawker itself should have broken the story, and whether it’s fair game for continued discussion now.) You could argue that, because his sexual pursuits were heterosexual, and he himself wasn’t having an abortion, his antipathy to other kinds of sexual autonomy does not implicate his own meandering. But that’s exactly the kind of straight-male privilege that most sexual discrimination turns on, and that leads wingnuts like Lee to believe they have the right to criminalize sexual freedoms that they don’t personally happen to need or want.

This case should be seen as an issue of sexual freedom pure and simple – the right of an individual to make their own sexual decisions and accept their consequences as a private matter. Lee should have that right, in regard of his skeezy hetero Craigslist trolling, just as gays should be free to seek and indulge the relationships they prefer, and women should have the authority both to own and indulge their own sexuality and to control their bodies in service of that end. Lee wants to strip those rights from everyone else, knowing that he will continue to enjoy almost unfettered privilege in his own sex life. When his openly-published Craigslist ad was revealed (along with his private e-mails), he complained that he had been violated:

A spokesman for the Congressman confirmed that the email address belonged to Lee, and that he had deleted his Facebook account because [Gawker's] initial inquiry had him fretting about “privacy.”

But Lee’s career has been devoted to destroying the privacy of more than half of all society, in its most vital dimensions, not by revealing lame e-mail come-ons but by stripping them of control of their lives and sexual identities – in fact, subjecting them to imprisonment on such grounds in some cases. The issue is not whose privacy is being invaded, or what acts are subjected to scrutiny and punishment, but the simple fact that sex is used by people like Lee to punish other people, and they should, at the very least, not be allowed to enjoy immunity from that same punishment on those same grounds.

The fact that he cheats on his wife is a tawdry and ordinary hypocrisy that is of no concern to anyone but them – it’s a kind of lie he tells her, and is contemptible in its own way but not a public matter (we’re surely not going to start cashiering Congressmembers for lying). But Lee and those like him would like to think that their sexual preferences enjoy a privileged status, one that not only gives them immunity for their own behavior but the right to denigrate and demonize those whose preferences are different. Everyone should enjoy privacy in their sexual lives (note here the vicious hypocrisy in Lee’s claim of a right of “privacy” to commit “adultery” while working against the right of privacy in women’s lives that underlies their right to abortion). But if Lee is going to decimate the vital privacy that protects the most persecuted aspects of people’s lives, he can hardly claim the trivial right to privately hook up on Craigslist behind his wife’s back. Outing Lee in this case is an affirmation that his right to sexual freedom is not just equal to, it is exactly the same right as, that of homosexuals to live their lives without interference, and of women to make their own sexual choices. The only difference is that the stakes in Lee’s case are so much lower.

September 23, 2010

Republican Anti-Choice Assholes Reduce General Healthcare Availability . . . Again

by @ 12:51 PM. Filed under Access to Healthcare, Autonomy, General, Global/Community Health, Healthcare Politics, Provider Roles, Reproductive Ethics, Sex, Women's Issues

Today the wingers are hugging themselves over the fact that the New Jersey state legislature failed to override Gov. Christie’s veto of family-planning funding for low-income women in that state. The funding reduction particularly targets services provided by Planned Parenthood – the nation’s largest single non-governmental provider of reproductive healthcare to the poor. Naturally, this was trumpeted as an attack on “Planned Parenthood’s abortion business” – a claim as false as it is stupid. Not only were the funds in question earmarked for services that have nothing to do with abortion, but they provide no indirect support of abortion, and the clinic that was affected does not provide abortions! What the Republicans did manage to do was shut down basic and necessary reproductive healthcare services – of virtually all kinds except abortion – for thousands of low-income patients, while crowing about their non-existent and deliberately disengenuous anti-choice “coup”.

First, Planned Parenthood does not have an “abortion business”. (They’re a non-profit – they aren’t a business at all.) Abortions (just 3% of PP’s annual clinical visits, nationwide) are provided by PP at rates generally below cost – they are subsidized by donations. (This – and their non-profit status – defeats the lie that PP is making a “profit” on abortion services.) Funding for other services is also heavily subsidized, and also in part paid for under government aid programs for healthcare for low-income people – typically Medicaid or SCHIP. That is, low-income patients who qualify for subsidized care can get that care at PP – while many for-profit providers simply refuse to take such patients at all – and PP is reimbursed, just like any clinic, under the appropriate plan. Those fees pay only for the services rendered, at the government-mandated rates, which are so low that, again, most mainstream providers simply refuse to accept them or the patients that are thereby covered. PP makes up the difference from its donation revenue – the government payments are so low they not only do not fund other PP activities, they don’t even fund the activities they nominally are supposed to pay for. (This defeats the lie that low-income healthcare reimbursement subsidizes abortion services.)

All this can easily be verified by looking at PP’s publicly-posted annual reports, which clearly show that a large portion of its clinical costs are subsidized by donations (24% of all revenue, in 2007) - no source of fee income for clinical services, whether abortion-related or not, government or private, is sufficient to actually pay for those services; all such fee income is used up in costs of the care itself, and then some.

But beyond this, the actual effect of the funding cut, as mentioned above, is to force closure of a clinic that did not provide abortions. The entire dishonest grandstanding really targeted ordinary healthcare and reproductive health services for low-income patients, largely women but some men. It had nothing – financially, practically, or even geographically – to do with Planned Parenthood’s abortion services, or the availability of abortion in New Jersey in general. But anti-choice ideology was a convenient stalking horse for the GOP’s anti-woman, anti-healthcare, anti-sex hatred, and it worked perfectly in this case.

What Planned Parenthood of Southern New Jersey actually does do – and which is no longer available from the clinic that is shutting down – includes, among other things:

Women’s Reproductive Healthcare:

  • All methods of contraception, prescriptive and non-prescriptive
  • Complete GYN physical exam
  • Treatment for many GYN problems
  • Laboratory screening
  • Cancer screening (Pap test, breast self exam)
  • Testing and treatment for Sexually Transmitted Infections (STIs)
  • Emergency Contraception
  • Colposcopy & cryotherapy
  • Pregnancy testing & counseling
  • Pre-Natal Care
  • Gardasil  (HPV vaccine) 
  • HIV testing & counseling
  • Hepatitis B vaccine
  • Vasectomy

And:

Male Services (25 and under)

  • Condoms / Contraceptive Education
  • Sexually Transmitted Infection (STI) screening & treatment
  • HIV Testing & Counseling
  • Health Screening

And:

Pre-natal care plays an important role in providing a comprehensive package of medical and health support services for the pregnant woman. Pre-natal care promotes optimum health, prevents disease and provides a mechanism to manage potential problems and can have a long lasting positive effect upon the family. At PPSNJ, we provide the following pre-natal services: 

  • Medical exams
  • Laboratory services
  • WIC Program
  • Pregnancy support and education
  • Nutrition education
  • Adolescent parenting support groups
  • Delivery at Cooper University Hospital or other referral

And:

[C]omprehensive, age appropriate sexuality education and training for pre-adolescents, teens, families, schools, community groups, faith-based settings, other social service organizations and healthcare providers. 

  • Workshops and Professional Training
  • Speakers and classroom presentations
  • Curriculum Development
  • Teen Programs
  • Fathers Group

None of that is available now, at one of their primary locations, thanks to the “pro-life” assholes of the Republican party. Their ideology is made clear by the fact that the elimination of this funding not only has no affect on the funding of abortions (see above), but in fact directly impacts a clinic that does not even provide abortions. What it does eliminate is a local source of low-cost healthcare for the financially needy population, most of it focused on reproductive health and pre-natal services. That was their target, and that was their effect. The abortion nonsense – aside from being an outright lie – was a red herring.

The GOP hates women, hates the poor, and hates people who make their own decisions about sex and reproduction. Today they’ve eliminated healthcare for thousands of them, while having absolutely no impact on abortion, although banking on and claiming a political payoff for anti-choice ideology as a means to that end.

More of their standard, repulsive, dishonest and hateful same.

August 6, 2010

Gay Marriage and Abortion Rights: Parallels?

by @ 4:09 PM. Filed under Access to Healthcare, Autonomy, General, Global/Community Health, Reproductive Ethics, Sex, Women's Issues

The recent federal-court decision invalidating California’s ban on gay marriages was of course welcome and long overdue. And there’s a lot of commentary from across the political spectrum predicting that it will be upheld at the Supreme Court level, given Justice Kennedy’s authorship of both major recent groundbreaking decisions favoring equality for gays (Romer, invalidating an exception to equal-rights statutes in the case of gays, and Lawrence, invalidating the criminalization of gay sex), and his status as inevitable swing vote on discrimination issues. So – while nothing is yet assured – this is a watershed, and very hopeful, moment for the cause of equality.

The question it raises, however, is what kind of backlash this will trigger. One likely possibility is an attempt to push through a Constitutional amendment imposing discrimination nationwide. Although that possibility concerned me greatly, I am – with fingers crossed – hopeful that such a movement would be unavailing. By the time any such plan could gain traction, there will have been several years’ worth of experience with gay marriage, and increasing experience of life under a national-level Supreme Court decision for equality, tending to reduce the panic over the supposed consequences of gay marriages. The political winds have shifted, also; it’s true that the GOP is somewhat resurgent, but the grounds for debate are now dominated by economic issues, and the religious-right/teabag movement is proving more and more of a liability for the GOP. I suspect the homophobic firestorm the GOP deliberately stoked in 1996, which created gay marriage as a political issue for their base, will not be possible in 2012. And, too, Constitutional amendments over controversial issues are hard to pass, and this one is unlikely to have enough momentum to overcome the inevitable decline of the homophobic movement as the reality of gay marriage proves their crazy ranting is just pointless. So I suspect there will be an attempt to pass the first-ever Constitutional amendment creating a new form of discrimination, but it will fizzle out.

However, I just read speculation elsewhere that gay marriage will become “another Roe v. Wade” – that is, a cultural flashpoint issue that will polarize society and give the right wing something to agitate about forever. That is no reason to oppose equality, of course, but it is a daunting prospect nonetheless. And that commenter was surely right that the (presumptive) institution of equality by the Supreme Court, and the failure of legislative or Constitutional processes to maintain discrimination, will energize the right wing and serve as a focus of grievance for them for the forseeable future. And yet, as I think about it, it occurs to me that this outcome may not be as destructive as it would seem, and could even have an upside. I suspect that the wingnuts will indeed agitate interminably over gay equality, and this will have two consequences: (1) it will further marginalize the religious right, and (2) it could conceivably bolster support for abortion rights as well.

The argument for the first possibility above is obvious. As gay marriages become more and more commonplace, and as disinformation about priests being forced to perform gay marriages, or children being “indoctrinated” in schools, are disproven by everyday experience, the disingenuous fearmongering that drives the hate movement will be undermined. The haters will simply serve to highlight the unhinged and bigoted streak that infects the Republican party and, as Sarah Palin is quickly becoming, and Sharron Angle already has become, will be an albatross around the neck that the GOP will eventually be glad to be rid of.

The argument toward a pro-autonomy rebound is less intuitive, but not implausible, I think. The idea that gay marriage will galvanize conservatives like abortion did is likely true. The parallels between the issues are strong: each is a cause celebre’ for the religious right, grounded on religious visions of morality, driven by a deep-seated revulsion to sex, and centering on a despised group whose claims to equality and autonomy the religious right hates and resents.  And the campaigns waged by the right against autonomy and self-determination in both cases are again similar: bizarre predictions of the consequences of allowing people to make their own decisions, Biblical injunctions against equality and non-patriarchal sex, deliberate lies and disinformation about the implications of freedom in each case, hateful moralistic judgmentalism, simply deluded scientific disinformation, and a manipulative pretended concern “for the children”, all of it as grossly distorted and dishonest as it is possible to be. As wingnut hot-button issues, they do have much in common.

It is that close parallel that, I think, spells (indirect, and uncertain) good news for the pro-choice position. The campaign against equality for gays is very similar to the campaign against self-determination for women. The basic idea at the bottom of both campaigns – that one particularly backward and restrictive religious view of how people should live their lives should be made mandatory for everyone, by law – is the same, and the attempt to regulate sexual behavior that they disapprove of is likewise a common central element in both campaigns. The gay-marriage controversy brings this to the fore because that issue is clearly solely driven by sex-based animus, but the same elements are at work in the abortion issue. And so, as the gay marriage controversy is exposed as the panicky, lunatic hatefest that it is, all other attempts to restrict the rights of autonomous adults to make their own decisions in areas reflecting on their sex lives will be simultaneously undercut. To the extent it becomes obvious that “gay marriage” is a wholly invented controversy based on ludicrous and bizarre apprehensions about other people’s sex lives, and the characterizations of its proponents and participants were absurdly false and fantastical, and its presence in the community is not a threat or a curse, and the claims and predictions made about it were false and invented, it will become that much easier to see how those same distortions have driven the anti-choice campaign in the same ways. And, most of all, the more it becomes obvious that the anti-gay-marriage people are simply hateful and barely sane, and that their movement is a product of their religiously-inspired reactionism, and that they are the same people who are driving the anti-choice campaign, the true nature of that project will become more obvious as well.

The bottom line is, letting the wingnuts discredit themselves over gay marriage can only work to the advantage of the pro-choice community (and related progressive movements). It will be an ugly and hateful process, but a necessary cleansing, and possibly a road to a better day in the future.

June 30, 2010

Kagan Trifecta: Conservative Reading Comprehension Disorder, Utter Mendacity, and the Noise Machine

by @ 12:31 PM. Filed under Access to Healthcare, Autonomy, General, Healthcare Politics, Medical Science, Provider Roles, Reproductive Ethics, Sex, Theory, Women's Issues

There’s a lot of blogging today over a sensationalistic post at NRO by Shannen Coffin, a former Bush lawyer who was responsible for anti-choice litigation surrounding the so-called “partial birth” abortion ban. She He notes a 1996 memo from the files of the Clinton administration, predating Clinton’s veto of the anti-choice bill, in which Elena Kagan, then a Clinton legal advisor, recommended a change in language in the policy statement eventually issued by the American College of Gynecologists supporting their opposition to the bill. They originally stated that “in the vast majority of cases, selection of the partial birth procedure is not necessary to avert serious adverse consequences to a woman’s health”, and that they “could identify no circumstances under which intact D&X would be the only option to save the life or preserve the health of the woman”, but – on Kagan’s recommendation – clarified that by also noting that it “may be the best or most appropriate procedure in a particular circumstance to save the life or preserve the health of a woman”. (Note that ACOG explicitly reaffirmed this policy, using the same language, at least three more times, in 1997, 2000, and 2003). That policy statement was later referred to by at least one federal judge, in litigation on the constitutionality of the ban later enacted by Bush.

Quelle horreur!

Coffin’s conclusions are that this is a “distortion of science”, that “language purporting to be the judgment of an independent body of medical experts devoted to the care and treatment of pregnant women and their children was, in the end, nothing more than the political scrawling of a White House appointee”, and that “Miss [sic] Kagan’s decision to override a scientific finding with her own calculated distortion in order to protect access to the most despicable of abortion procedures seriously twisted the judicial process” – naturally she he rolls this up into the ongoing Kagan Supreme Court confirmation hearings as well. The right-wing idiotocracy is all a-Twitter, too, natch: Powerline declares this is a “smoking gun” and “shocking”; Riehl calls it “misrepresenting science” and “dishonest”; the risible Betsy, of Betsy’s Page, reads this and concludes that “there was a doctors’ opinion that said that partial birth abortion was not necessary and she, with no medical background at all, drafted a statement that said the exact opposite”. Yuval Levin, the severely bioethics-challenged former staff manager of Bush’s Presidential Council on Bioethics, declares this to be a “war on science”, “astonishing”, and “easily the most serious and flagrant violation of the boundary between scientific expertise and politics I have ever encountered”.

This sort of nonsense is particularly astounding from Levin, who was a central player in the workings of an “ethics” commission that remains a watchword for right-wing distortion and duplicity, whose major policy statements drew dissenting opinions from its own most scientifically-qualified members, and which then censored, and later fired, those same members. Levin – a political scientist and former Bush White House policy staffmember who has spent his entire career crafting right-wing bioethics policy - also castigates Kagan for her lack of medical expertise and her involvement in healthcare policymaking. You really just can’t make this stuff up.

It’s especially disingenuous for people like Levin and Coffin – political hacks whose entire career consists of trying to influence policy to fit their ideological leanings, from both inside and outside the government – to claim that there’s something untoward in political policy staff conferring with the policy-making boards of professional organizations to shape language on statements issued in clearly political and legal contexts. That sort of thing goes on all the time, and it’s appropriate for such bodies of experts to confer with political authorities to ensure that their statements are effectively written and focused. It would be inappropriate for them to turn themselves over to the political authorities as tools of policy, and to issue statements they did not believe were true, but it’s not inappropriate to get guidance on language and emphasis in order to convey an effective message. (As Coffin herself notes, ACOG already opposed the anti-choice bill. Obviously they would want their policy statement to reflect the reasons why.) To suggest that a policy expert drafting language for a policy statement endorsed by a professional body is somehow scandalous – let alone unusual – is simply stupid. And to suggest, as Coffin and others have recklessly done, that ACOG is somehow compromised or tarnished in doing so, is not merely stupid and dishonest, but libelous.

Aside from the completely manufactured, and fictional, scandal that the right-wing noise machine is busily whipping up over this, there is also the simple fact that the language Kagan suggested does not replace or contradict the language previously present. The statement that there are “no circumstances under which intact D&X would be the only option” is entirely compatible with the claim that it “may be the best or most appropriate procedure in a particular circumstance to save the life or preserve the health of a woman” (emphases added). It’s simple, really: the fact that something is never the only option in no way means that it is a bad option; the revised language not only implicitly acknowledges this but clarifies for the dim-witted (i.e., conservatives) the even more important point that it is in fact sometimes the best option. (Obviously, Intact D&X is never the only option: you can always perform an unnecessary Cesearean section or force the woman to deliver a fetus that may be dying and may possibly kill her - options that are much prefereable, for conservatives, than allowing a woman to choose the safest option on her own authority. ACOG’s point, which Kagan nudged them towards, is that there are often better  options – and that women should have the right to choose them.)

The fight over Intact D&X was particularly nasty because it encapsulates so much of right-wing misogyny, so clearly: it was not a ban on abortion, and it was not a ban on late-term abortions; in fact, it did not ban any abortions under any circumstances. It was only and entirely a ban on one particular procedure for performing abortions. It banned the procedure that was preferable in specific circumstances – leaving abortions entirely legal under those circumstances but forcing women to submit to a procedure that was less safe and more debilitating for them. It was straightforwardly an attempt to punish women by making them accept higher risks and a lower standard of care, as the price for choosing a procedure the right wing disapproved. And ACOG’s policy statement implicitly recognized this: it notes that there are always alternatives to the ID&X procedure, but that in some circumstances those alternatives are worse, and ID&X is, in those circumstances, the best or most appropriate procedure. Kagan’s contribution – appropriate, useful, and highly pro-woman – was to encourage them to clarify that distinction. (Note, again, that ACOG explicitly reiterated this policy, and the important distinction it makes, three times after Kagan supposedly “overrode” their scientific judgment in the matter by forcing them to include language that does not contradict that judgment.)

Raising this issue is simply another example of the right-wing’s reflexive insanity over sex and abortion, coupled with their inherent inability to read and comprehend basic logical statements. (Note “Betsy”‘s analysis: “there was a doctors’ opinion that said that partial birth abortion was not necessary [no, there simply wasn't] and . . . [Kagan] drafted a statement that said the exact opposite” [no, she didn't].) Honestly, the relationship between “not the only” and “sometimes the best” is really not that tricky. It’s too tricky, of course, for the average right-winger, and for people like Coffin and Levin, whose deficiencies were all too apparent back when they were writing policy for Bush, but to people of normal intelligence and reading comprehension, this entire farce is an obviously groundless, and all-too-familiar, political hackery.

The right wing is also up in arms over this because, as Scott Lemieux at Lawyers, Guns, & Money notes:

the only point of this feeble “smoking gun” is to allow Senate Republicans to mention the phrase “partial birth abortion” a lot [and] I should note once again that for reasons Judge Posner and Justice Stevens have explained the entire issue is a farce. The distinction between D&X abortions and other abortion procedures is wholly arbitrary, and for people who have supported irrational laws making such a distinction to pretend to care about rigorous medical science is nothing but comedy of the lowest form.

Mahablog was fast out of the blocks on this, in a post I wish I’d written:

if you actually understand the issue in question — which leaves out righties, naturally — you’d know there is no “there” there. . . . Somehow, in the fevered imagination of righties, a professional organization representing 90 percent of U.S. board-certified obstetrician-gynecologists was duped by Kagan into telling a lie, or something, and because this wording came from Kagan it must not actually reflect the views of ACOG. . . . no scientific finding was “overridden,” just clarified, and ACOG must have agreed with the statement or they wouldn’t have continued to repeat it in their position papers ever after.

Lemieux gets the content issue exactly right:

There’s no contradiction between the two drafts, because D&X abortions are, in fact, not medically necessary in a majority of cases. But this fact doesn’t mean that they are never medically necessary, and indeed the original statement implies that there are cases where D&X abortions are necessary or preferable for a protecting a woman’s health. Adding a statement to clarify what was implicit in the first draft doesn’t “distort” anything, and of course if ACOG didn’t think the statement was accurate Kagan had no power to get them to change it. There’s nothing here.

UPDATE: Corrected pronouns referring to Coffin; he’s a “he”, not a “she”. My apologies to Coffin for the mistake.

UPDATE: Another right-wing website breathlessly announces that Kagan “pressured a second group” on its wording of its pro-choice policy. That group was the AMA. Their claim: “Kagan discussed with other Clinton administration officials whether the AMA could reverse its policy saying there is not an identified situation in which partial-birth abortion is the only appropriate method of abortion. The AMA also noted ethical concerns with partial-birth abortions and said that it should not be used unless it is absolutely necessary.” Note that this repeats exactly the same mistake all the other commentators made about the first memo: the two positions described are not contradictory, and there is no “reversal” in evidence! And Kagan’s particular crime: she wrote an e-mail saying “We agreed to do a bit of thinking about whether we (in truth, HHS) could contribute to that effort . . . . Chuck and I are meeting with the AG on Tuesday; Donna offered to send over some doctors this week”. They don’t even identify who the e-mail was sent to (obviously it was internal), or whether any such meeting ever took place, let alone had any effect. (Apparently the AMA does the bidding of any government staff lawyer who offers to “contribute” to their policy development.) Truly, the stupid knows no bounds with these people.

December 14, 2009

Fetus Christmas-Tree Ornaments . . . . (Oy vey! . . .)

by @ 8:29 PM. Filed under Access to Healthcare, Autonomy, Child-Rearing, General, Global/Community Health, Healthcare Politics, Personhood, Reproductive Ethics, Sex, Theory, Women's Issues

The latest entry in the “creepy personified fetus” category: the “Feti” – weird/cutesy Christmas-tree ornaments shaped like tiny embryos at about the 6-8 week stage (bulbous head, no digits, visible tail). As is usual with this genre, they sport adult-appropriate personal characteristics, including clothes, personal possessions, and in one case a moustache. You can buy Santa fetuses, “happy” fetuses, candy-cane-carrying fetuses, and an “Adam Lambert” fetus displaying a punk hairdo and clutching a Star of David – a cultural mishmash that I refuse to attempt to understand.

Happy Fetus

Happy Fetus

Feto Incognito

Feto Incognito

Adam Lambert Embryo

Adam Lambert Embryo

The purveyor of the site insists that “Feti is just for fun, no political statements being made here.” I’m tempted to believe that in her case, but the thing still strikes me as weird,  and indicative of a mindset that is worth noting.

The vendor suggests these are intended as gifts for expectant parents, as appropriate additions to the “Baby’s First _____” category of remembrances. (Exactly how, I’m not sure: “Baby’s First Disembodied Hanging on a Christmas Tree”?) In that vein, they play off the very common and understandable practice of many expectant parents in personifying their fetus as it develops – talking to it, playing music, naming it before it is born, and so on. They also seem to accept as a cultural commonplace the fetishizing – literally, in this case! – and personifying of the fetus that is a mainstay of anti-choice propaganda. (Anti-choicers often wear gold-plated fetal-footprint jewelry, and they are forever trying to force abortion patients to look at pictures or sonograms of the fetus.)

I don’t know if the anti-choice movement has so far succeeded in turning the fetus into a fetish object that you can now literally market them to the general public as holiday ornaments, or if the common desire to see fetuses as sort of reverse-extensions of babies simply makes this a natural marketing move, like Cabbage Patch dolls or those weird Anne Geddes photographs of babies in flower petals, and the right wing has merely piggybacked off that common emotional trope for their own purposes. The former would scare me a bit, the latter is merely infuriating. Either way, this sort of thing leaves me with a creepy feeling.

I’m happy for people to be happy about their pregnancies, and to embue their future offspring with emotional valence or even a somewhat overgrandiose sense of promise or accomplishment. In the same way that all parents think their kids are smart and talented, and I wouldn’t quarrel with that, expectant parents can and should go ga-ga over the cute little buns in their respective ovens. There is no point, in the case of people’s emotional experience of the events in their lives, to go around insisting to them “you know it has no functional higher nervous system, right?” . . . “that’s not a ‘person’ you’re carrying, in any meaningful sense of the term – just wanted to let you know” . . . “don’t get too close to it – there’s about a 1-in-12 chance you’ll lose the pregnancy”. But when it comes to law and policy-making, clear distinctions do have to be made – and at that point, the conflict between stark reality and parents’ expectations may be uncomfortable.

Regardless of parental beliefs, not all kids are smart or talented, and thus some won’t make it into selective academic or sports or art programs. And regardless of the fervent, desperately dishonest myth-making of the anti-choice right, the early fetus is not a person and does not make moral claims on a woman’s body and life sufficient to override her autonomy. It is unfortunate to have to disappoint people emotionally invested in believing otherwise, but it is far worse to make policy based on wishful thinking in defiance of the truth.

By all means, have yourself a merry little Christmas, and hang a smiling Adam Lambert Jewish punk fetus upon the highest bough. But let’s keep the “personified fetus” myth firmly in its place when we go to making important decisions about real issues in real people’s lives.

November 13, 2009

RNC to Women: Being a Republican Doesn’t Mean We Don’t Still Hate You

by @ 4:43 PM. Filed under Access to Healthcare, Autonomy, General, Healthcare Politics, Reproductive Ethics, Theory, Women's Issues

So, much has been made this week of the fact that the Republican National Committee, throughout its longstanding berserker campaign against women seeking control of their own bodies, has in fact been providing comprehensive healthcare insurance to its own employees – including female employees – for almost 20 years. Many fingers were pointed over the hypocrisy of attempting to prohibit abortion access for all women in America by every means possible, while covering abortion care for its own employees under their internal health insurance plan. (This in fact is in keeping with right-wing approaches to the issue generally: their values legendarily evaporate when it’s their personal interests at stake, and stories of women’s clinics providing abortion care to the same women who were picketing those clinics before and after the procedure are legion.)

Predictably, Michael Steele, the hapless RNC head, announced less than 24 hours after the story broke that that coverage provision had been rescinded unilaterally. The usual right-wing hysteria has erupted, with demands that people be fired and angry denunciations that donors to the RNC had not been allowed to deny healthcare to its female employees as they wanted to do. As Ben Smith rightly points out, not one female employee of the RNC – the ones whose coverage has now been stripped without their consultation (and presumably without any reduction in their premium contributions) – has been quoted or consulted in this move.

I note also that pro-choice ideology within the Republican party has run at about a steady 35-38% for most of a decade (a recent poll shows it down somewhat among Republicans, but is widely regarded as an outlier). I presume the large majority of those are women. Assuming further that women are half the GOP membership, that would mean that roughly two-thirds of GOP women are pro-choice (I suspect they’re actually less than half the membership, which would push the prevalence of pro-choice ideology even higher within that smaller female group). Now, I don’t know if the RNC employee base is representative of the Republican Party generally, but if it is, that would mean that about a third of its staff, and about two-thirds of all its female staff, are in favor of abortion rights. There are other factors to be considered, for which we don’t have data (what percentage favor having abortion covered in their health plan, as opposed to its just being legal; to what degree the RNC staff skew even crazier on abortion than the rank and file; what percentage of the staff are female; and so on), but any way you slice it it seems inevitable that there is at least some considerable degree of support for abortion services among the RNC’s staff, to say nothing of the GOP generally. Yet the RNC leadership revoked their own staff’s coverage without consultation, and without the slightest apparent consideration for that staff’s wishes, needs, or rights.

The message is clear enough, and, I suppose, fair and consistent in that peculiar GOP way: for Republicans, hurting women is more important than anything else – certainly more important than providing real healthcare for an entire nation, but more important also than seeing to the needs of their own membership. The Republican National Committee – a body that exists solely to cater to the interests and welfare of registered Republicans – stripped healthcare services that had been available for almost 20 years away from Republican women employed in the service of that body and their party, without the slightest hesitation or apparently without even talking to them.  Within the highest levels of the Republican Party itself, your lack of status as a woman trumps your preferential status as a Republican.

Michael Steele could have just made it much more simple and direct:

Steele-Ono

November 9, 2009

Terrorist Crusade Parades Itself Openly – Who Will Care?

by @ 6:43 PM. Filed under Access to Healthcare, Autonomy, General, Global/Community Health, Healthcare Politics, Personhood, Provider Roles, Reproductive Ethics, Sex, Theory, Women's Issues

The AP reports that Scott Roeder, the terrorist who killed Dr. George Tiller, publicly and in cold blood, last May, has openly confessed to the crime and justified it with the usual religious-radical gibberish about “unborn children”. In the article, he explicitly equates fetuses with independently-living persons and claims that killing to prevent abortion is justified if at least one forced pregnancy results; he encourages others to perform similar terroristic murders, and states he intends to base his legal defense on an argument for a religious-political justification for murder. None of this is new, except possibly that he has stated all this on record now.  It confirms what we knew about him, anyway.

The real question is whether those who are so agitated about real or imagined terrorism of other kinds (especially by Muslims), and who have been so complacently accepting of anti-woman terrorism in the US for decades, will condemn or even acknowledge an open statement of Christian religious-terrorist ideology in the case of yet another anti-choice fanatic.

Just this week we’ve seen a terrible mass murder committed by a Muslim military officer who was apparently distraught over the war in Afghanistan and his possible deployment. Literally before the bodies were cool, various right-wingers jumped in to denounce “Muslim terrorism” and to cite vague links between the suspect and Al Qaeda (he visited a mosque which was also visited by someone who knew someone who was connected with Al Qaeda); however, it is not clear that the apparent perpetrator’s motives were intended for a political end at all – as opposed to merely an outburst of personal anxiety – and there is little to suggest that it was terrorism in any reasonable sense. The murders of doctors by anti-choicers, beyond any question, are defined by the features of terrorism found in most of the commonly-used definitions: they are acts of violence committed against civilians for the purpose of inciting fear in other, third-party individuals, to promote a particular political end. We heard nothing of this at the time of Dr. Tiller’s death (nor of any of the previous murders and other acts of violence); will we hear it acknowledged now that the terrorist has so openly proclaimed his murderous religious ideology?

Anti-choice terrorism is intended to prevent women from exercising a legal and moral right involving their bodily health and autonomy, by terrorizing those women and their healthcare providers – it is violence intended not merely against its chosen (often random) targets, but to terrorize and thus paralyze a larger group, to further the religious and political ideology of the perpetrators and their vast army of supporters and admirers within the religious right. Yet it has never been acknowledged as such, and the large subculture on the right wing who have made a profession of terrorism scare-mongering have never acknowledged the persistent anti-choice terrorism ongoing in the US. (Nor has the FBI: fake anthrax attacks had been staged on almost 700 abortion clinics in the US in the days before 9/11 – not one of them resulted in an arrest, or any obvious urgency about the issue, and they were not treated as domestic terrorism. One person was charged with terrorism for fake anthrax attacks on clinics in the wake of 9/11 and the Congress anthrax mail attacks – the first and only such charge in the entire history of anti-choice terrorism. None of the anti-choice murderers, including Roeder, have been charged as terrorists.)

Now we have an admitted terrorist openly advocating further political killings to promote his religious obsessions. If Roeder were a Muslim and his targets were not women and their healthcare providers, the shrieking loons of the right would be off their heads screaming about his crime, his religious beliefs, his unrepentant stance, his advocacy and rationalization of violence, and his links to other extremists with similar religious and political beliefs. Will we see even the slightest acknowledgment of Christian anti-choice religious terrorism and its dangers in this blatant case?

November 7, 2009

Historical Juncture Turned into Anti-Woman Hatefest by Congressional Republicans, With Democrats Lighting the Torches

by @ 9:38 PM. Filed under Access to Healthcare, Autonomy, General, Global/Community Health, Healthcare Politics, Personhood, Provider Roles, Reproductive Ethics, Sex, Theory, Women's Issues

At this moment, debate is proceeding on the House votes on the landmark healthcare bill. I haven’t blogged about it, because, frankly, it was overwhelming and I didn’t know what I could say that would help. (The Democrats’ stealth approach to bill-crafting, while possibly politically astute, made it hard to get a clear handle on the thing, too.) This will be, without question, one of the most important legislative events of my lifetime; if the bill passes the Senate and is finally voted into law in a reasonably intact form, it will be the most significant development in American history that I will see. More importantly, it will be – largely, though not entirely – an end to crippling insecurity and lifelong anxiety for hundreds of millions, and of irremediable pain and suffering for tens of millions who now live in the only affluent country that permits its business class to sell life itself for profit.

The bill on offer is far from optimal. It locks in the profiteering on death and misery that the vast majority of the country is burdened with, and is needlessly complicated and limited in what it offers to the rest. It deliberately cripples its own modest offering by restricting it only to those whom the profiteers have absolutely refused to serve at any price, prohibiting the rest of the country from accessing healthcare organized on any saner and more humane basis. But worst of all, the bill is being held hostage by the insane and vicious anti-choice army that infests the right wing and has wholly captured the Republican party. And, too predictably, the omnipresent contingent of grandstanding asshole Democrats is giving them exactly what they want, as they always do.

Right now, the “Stupak amendment” is being debated: an amendment that will prohibit any person enrolling in the government-backed “healthcare exchange” – which is to say, the poorest and most desperate, who are the only ones eligibel to enroll in that plan – from being offered a full range of healthcare services in cases of unwanted pregnancy. For those people, the “public options” will be forced pregnancy, death in childbirth, or an abortion that she likely can’t afford and the right-wing terrorists have likely made unavailable anyway. The Republican House caucus has already stated explicitly that they will refuse to vote for the healthcare bill in any form. But they – with their unconscionable Democratic allies – are holding up the bill to demand the anti-choice amendment in a bill they will not support even if they get it. And enough Democrats are equally indifferent to women’s lives and women’s needs to help them do it.

Democratic women are putting up a good fight – and their male allies deserve thanks, too. The Republicans have shrunk from merely legislative misogyny to outright thuggery, as they so commonly do. Michele Bachman led crowds of right wingers through the Congressional office buildings earlier today, invading offices and screaming at people to, in her words, “scare” them away from supporting women and healthcare for all. House Republicans staged an organized disruption on the floor today, systematically interrupting Democratic women as they spoke in favor of women’s interests and full healthcare coverage. The healthcare debate is being conducted the same way the Florida recount was in 2000: in the face of Republican assaults and intimidation, and without regard for the truth or significance of the actual substantive issue.

I have little to say about the whole thing. I feel helpless – particularly frustrating in the face of an issue so central to my personal and professional concerns – and am waiting as on election night for the outcome of votes that will – with great good luck – mean so much to so many, and move American one huge step closer to the decency and commitment to humanity that has been so sadly lacking in so much of our history. I can only wait and hope, like everyone else. In the meantime, there is an organized, vicious, and relentless minority that is fiercely dedicated to their own hostility to any notion of a decent regard for others, and to the freedom of others to live their own lives unconstrained by that minority’s backward and reactionary values. They are fighting – in the most literal sense – right now to keep tens of millions of people at the mercy of any illness they may suffer, to keep hundreds of millions at the mercy of an insurance system that rivals only those reactionaries themselves in its hostility to the needs of the people they nominally serve, and to keep every woman in America at the mercy of the nasty and bitter men who despise them and their bodies.

I can’t stand watching this unfold. And I can’t say, can’t express even fractionally, how much, how gut-wrenchingly much, I hate and revile these disgusting creeps.

UPDATE: Rayne at Firedoglake reports “Stupak Amendment Passes: 64 Dems Ask for Primary Opponents“. That’s exactly how I feel about it. I had already promised myself that I would contribute to the primary opponents of any misogynist Democrats; I’m saddened, and shocked, that there are so many of them. I will certainly target all that I can afford to. Read the rest of the post; it’s exactly right.

UPDATE: The final bill has passed, 220 – 215. Exactly one Republican voted in favor – 39 Democrats voted to withhold healthcare from over 40 million Americans. This is a great – but very partial – victory. There still remains the Senate bill – which will be a far tougher fight, with looser rules and a larger percentage of heartless and misogynist Democrats in the mix – followed by the conference committee and the final vote. The Republicans and reactionaries will do everything they can to destroy other people’s hopes for a decent life, and their control over their own bodies and life plans – the rioting, disruption, demagoguery and thuggery seen today are just a taste of what is coming. And this step, momentous as it is, comes bitterly. The discussion in the followup post at Firedoglake captures it perfectly; as one commenter put it: “It’s like winning a huge battle, but half of your friends were killed or wounded.”

UPDATE: I’ve added the reference to Democrats in the headline. I didn’t make it clear above that Bart Stupak, who led the charge to destroy healthcare reform for over 300 million Americans if they didn’t let him destroy autonomy for 150 million female Americans, is a Democrat. Along with 63 other misogynist traitors, he put the people’s party against 51% of the people, to indulge their personal medieval religious obsessions. Fuck him and all of them.

UPDATE: Scott Lemieux at Lawyers, Guns, and Money gets the power dynamic exactly right: “Certainly, there are many potential criticisms of how Democratic leadership has dealt with health care, although when you actually care about expanding access to health care it’s hard to negotiate with the Stupaks of the world who don’t, but want to use other people’s progressive impulses to attack women.”

November 2, 2009

Religious Rightist Renounces All Icky Healthcare, Achieves Purity

by @ 5:16 PM. Filed under Access to Healthcare, Autonomy, Child-Rearing, General, Global/Community Health, Healthcare Politics, Provider Roles, Reproductive Ethics, Sex, Women's Issues

A former healthcare clinic administrator in Texas today announced that she had quit her job, joined a far-right anti-healthcare group, and dedicated herself to harassing other women to prevent them from receiving surgery and other forms of “icky” healthcare, after seeing a video of an appendectomy that she didn’t like.

I just thought I can’t do this anymore, and it was just like a flash that hit me and I thought that’s it,” said Jonhson. . . .

Johnson said she was told to bring in more women who wanted [icky procedures], something the Episcopalian church goer recently became convicted about.

“I feel so pure in heart (since leaving). I don’t have this guilt, I don’t have this burden on me anymore that’s how I know this conversion was a spiritual conversion.”

Johnson reports that she is likewise convicted about gall bladder removals, most forms of cancer surgery, and liposuction, although she does not criticize the decisions several of her friends have made to have such procedures, because “that’s different”. She is semi-convicted about breast implants, believing they are the work of the Whore of Babylon but also something you could understand that a woman needs sometimes. She justifies these distinctions with random Bible quotes and references to her own idiosyncratic feelings, which she cannot coherently articulate but is happy to impose on others by law.

This otherwise trivial story about one small-town individual’s weird religious hangups was trumpeted by the religious right as a stunning victory over the right of other people to make healthcare choices they don’t like, claiming other people’s healthcare was now “in meltdown mode” and “total disarray”. Every healthcare clinic in the country, including the one that has now hired a new director, went about its business as usual.

October 11, 2009

National Coming-Out Day

by @ 2:21 PM. Filed under Access to Healthcare, Autonomy, Child-Rearing, General, Global/Community Health, Healthcare Politics, LGBTQ Issues, Reproductive Ethics, Theory, Women's Issues

Today is National Coming-Out Day (one day after President Obama promised yet again to repeal the “Don’t Ask Don’t Tell” policy and work toward fuller equality for all people, and yet again did nothing tangible about it).

I don’t have much to say about that, except to offer support and the wish that the homophobia that infects our society, among other lingering forms of discrimination and prejudice, will soon fade, and “coming out” can be the act of celebration and affirmation that it should be, rather than an act of courage and risk-taking in the face of dangers that should not be allowed  to exist.

I’ll note, by way of parochial hyper-focus, that the pressures and threats that impede coming out and living openly in one’s chosen orientation have health consequences as well as many other harmful impacts; they cause stress and depression, create barriers to healthcare access, often result in abusive or discriminatory treatment in emergency care, and not infrequently result in violence. And of course the pervasive legal discrimination LGBTQ people face, in particular regarding health insurance, visitation and decision-making rights for gay couples, and barriers to assisted fertility and adoption, are also health and family-rearing issues as well as being rank discrimination in the basic sense.

Ending homophobia for reasons of good health is an odd and circumlocutory approach to the problem, but it’s one reason among many. Simple moral necessity is a better one. It’s long past time.

September 23, 2009

Misogynist Grandstanding: A Right-Wing Perennial

by @ 3:27 PM. Filed under Access to Healthcare, Autonomy, Child-Rearing, General, Global/Community Health, Healthcare Politics, Personhood, Provider Roles, Reproductive Ethics, Sex, Theory

There is a considerable component of right-wing blather, on healthcare and other topics, that is not seriously intended from the outset. To be sure, actual right-wing policy proposals are often offensive and addle-headed – withholding healthcare from women for religious reasons, or prohibiting factual information on contraception for teens are too-familiar examples – but often enough the most outrageous statements the wingnuts make are intended only to generate controversy. The ensuing agitation inflames the right-wing base constituency and feeds their self-aggrandizing notion of themselves as “under siege”, while the attention the controversy gins up raises the wingers’ profile and generates book sales and speaking fees. Rush Limbaugh, Ann Coulter, Michael Savage, and their cretinous ilk have made a profession of making factual claims that are indefensible in morals or truth, then evading responsibility by claiming they were joking; nominally more respectable right-wing pundits are not above the tactic, either. (George Will’s incompetent blundering into the issue of global warming continued long after his lack of knowledge had been thoroughly exposed in his own paper; the incident did him no harm among his target readership, for whom truth is an incidental feature of their reading material.)

For this reason, I felt less shock than merely tired recognition at this week’s reports from the right-wing “Value Voters” conference, in particular the much-remarked insanity of anti-choice provocateur Lila Rose’s demand that abortions be “done in the public square” (“maybe then we might hear angels singing as we ponder the glory of conception”*). Of course it’s idiotic, outrageous, and unhinged; of course it’s meaningless as a serious policy proposal. But it was never intended to be otherwise. It was intended to do exactly what it did – get more attention for a serial attention-seeker whose stock in trade is saying provocative things on video so she can enjoy the reaction, as well as create yet another controversy to make anti-choice theater seem important by generating press.

But it’s worth taking a moment, not to combat this nonsense as if it was to be taken seriously, nor even to condemn the continual offensiveness and provocation of the anti-choice movement (a singularly unlikely complaint, since without that the anti-choice movement wouldn’t even exist), but to note the ways in which anti-choicers choose to offend.

What does it mean to imagine – even if only to create offense – that women should be forced to have their abortions in public? As crazed as the suggestion is, it is not as extreme, from the right-wing perspective, as it would seem from any decent point of view. Mandatory public display of intimate gynecological procedures in order to diminish the legal availability of those procedures is nothing more than the literal instantiation of the basic presuppositions of the anti-choice movement in general:

As with so much anti-choice agitation, women simply disappear from this invasive and offensive scheme as persons to be taken seriously in their own right. Healthcare is granted near-sacrosanct status as regards privacy, discretion, and the centrality of the needs and interests of the patient, but a woman seeking abortion must expose herself, legs splayed in stirrups, vagina dilated, instruments inserted, “in the public square” – her needs and interests, in fact her basic humanity as a person deserving of consideration and dignity, carry no weight against the creepy, invasive perversions of the sex-obsessive misogynists. The abortion debate is structured, logically, as a conflict between women’s autonomy and the religious imperatives of the anti-choice right wing, but here there is no recognition of autonomy interests at play in any way – women not only may not control their bodies or reproductive options, but may even be forced into invasive and degrading displays deliberately intended to undermine their own autonomy, as a condition of (temporarily) accessing such options. As always, women simply don’t count. Whatever protections and privileges the typical moral person might command in undertaking their own purposes in their own life simply vanish if that person is a woman seeking control over her reproduction.

But this familiar moral blindness is not accidental, and it is not merely the hyperbolic implication of a deliberately provocative suggestion. Stupid, crazy, and nasty as they may be, the right wing is not completely incapable of recognizing moral humanity, even in those they despise. The right wing gradually learned not to use racial slurs; today it would unthinkable for them to suggest that people of color should be paraded “in the public square” even as a tactic to undermine their rights, and wingers fall over themselves denying the racism in their racist policies. The gay-rights movement, embattled as it was, made remarkable progress in the space of about 35 years; today, the conservative position on gay rights extols accommodations (“Don’t Ask, Don’t Tell”; civil unions) that would have been grand liberal victories just a few years previously. Yet after thousands of years of patriarchy, women command no such deference. Even as a joke or a provocation, there are things that are not said about minorities and gays – things the public would reject in disgust. There seems to be nothing the right wing won’t say about women – there seem to be no abuses or humiliations that are beyond the pale, no degradations or invasions that are unthinkable, whether or not they seem likely as policy.

Vacating medical confidentiality to publicize abortions for the explicit purpose of humiliating women by generating disgust at their bodies, healthcare, and reproductive choices?  The only part of that scenario the right wing objects to is the abortion. All the rest is merely the rights, interests, and choices of women. Nothing at all, really.

* I am not making this up.

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