Yesterday, the Susan G. Komen Foundation  – the “pink ribbon” breast-cancer research and treatment organization – announced it was ending its long-standing annual grants to Planned Parenthood clinics to perform breast-cancer screenings and referrals for low-income women. The given reasons are as disingenuous as they are shameful: in short, SGK hired a new Vice President who, in a recent losing bid for the governorship of Georgia, had explicitly pledged to defund healthcare services at Planned Parenthood in that state. Within months of her hiring at SGK, SGK just happened to create an internal rule declaring that it would not fund any programs at organizations that were under Congressional investigation; that policy just happened to apply only to Planned Parenthood, which just happens to be the target of a fishing-expedition investigation by a virulently anti-choice member of Congress. So: the right wing has been demonizing and targeting PP for years; one jackass Congressmember creates an investigation simply to grandstand; SGK hires an avowed anti-choice opponent of PP; SGK then creates a new rule about “investigations” that applies only to PP; SGK then abandons its own PP-mediated cancer screening programs and claims it had no choice because of the bogus investigation. Well played, but hardly subtle.

This is as sickening as it is tragic. The results will be, literally, death for a predictable number of women who would have been referred for mammography and received a positive cancer diagnosis, and appropriate treatment, following examination at Planned Parenthood, but who will now go undiagnosed after those screening programs are shut down (assuming adequate replacement funding is not obtained).

I’d like to encourage SGK to reverse their decision – to consider all the benefits that come from these screening programs, and the need there is in the community for the irreplaceable medical resources they provide. I’d like to remind them that Komen Affiliates have funded breast health services through Planned Parenthood programs that have provided breast health education and breast screenings for hundreds of thousands of low-income, uninsured or medically under-served women, and that, in some areas, Planned Parenthood may be the only local source of breast health care. I’d like to point out that women served at Planned Parenthood may receive a clinical breast exam, and when further screening is needed, a referral to either a state program or a private mammogram provider. It would be useful to consider that because SGK only works with non-profit organizations, these women’s  mammograms may be paid for by the Komen-Planned Parenthood grant, since many mammography providers are for-profit but Planned Parenthood works on an entirely non-profit basis for all its services.  Surely they recall that during the past five years up to 2011, Komen Affiliate grants to Planned Parenthood paid for:

• Breast cancer and breast health education for nearly 160,000 women
• 139,000 clinical breast exams
• 4,866 mammograms
• Detection of 177 breast cancers

But I may not need to tell them all that. They already know it. I’m sure of that because every bit of the above information comes from a letter SGK itself posted, on their pink-ribboned letterhead, on their own website, back when the religious right was pressuring them to cut off cancer screening to low-income women as part of their misogynist anti-sex witch hunt.

In that letter – aimed at deflecting criticism from anti-Planned-Parenthood crusaders, and written before SGK hired its own anti-choice crusader as VP – SGK extols its work with Planned Parenthood, and rightly notes not only that the screening programs it funds serve hundreds of thousands of women, and identify thousands of previously undetected potential cancers, but that these programs are carried out in many cases by the only provider willing or available to do them, and thus are literally irreplaceable. In publishing that letter, SGK took a strong stand in defense of women, and of those who provide the vital – in the most literal sense – services that no one else will or can do. It openly and forthrightly documented the need women – almost exclusively low-income women, and disproportionately women of color – have for Planned Parenthood, and the great benefits they got from the Planned Parenthood programs made possible by SGK’s funding. The letter expresses a clear and unambiguous commitment to serving women (even while mush-mouthing on the issue of abortion), and takes a bold stance in the face of harassment and misogynist bullying.

That letter is no longer available on the Susan G. Komen website.

In fact, as of this writing there is no news whatsoever on SGK’s on website regarding its abandonment of the cancer screening programs it once supported Planned Parenthood in providing, and a search for “Planned Parenthood” on that site returns only a single, obscure, broken link. That link turns out to be the page that once held the letter mentioned above. It’s not accessible or advertised. Some careful Googling, however, locates the letter in an unlinked section of SGK’s site. The letter defending Planned Parenthood, its patients, and SGK’s support for them, still exists – but they won’t let you see it.

Here it is, in its original full-color form: Susan G. Komen letter describing benefits from Planned Parenthood cancer screenings.

I’d like to think that “as long as there is a need for health care for vulnerable populations, Komen Affiliates will continue to fund the facilities that meet that need.” After all, they said so – barely 8 months ago. But obviously they’re no longer willing to stand by their word. In fact, they’re no long willing to admit they ever gave their word. They’ve shown us what courage and fidelity to women truly amount to – for them.

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

This is a common, but relatively recent, dodge for anti-choicers. Throughout history, in the US and many other countries, when abortion was illegal (and it was not always or universally, or even commonly, so), women who sought abortion were held guilty of a crime; a woman who successfully obtained an abortion was often jailed, and women who were injured in illegal abortions were arrested when they sought medical treatment. This was a major contributor to the death rate from illegal abortion: not only could women not find safe providers, but they were fearful of seeking treatment when their unsafe abortions went wrong. This was never, for the anti-choicers, a reason not to make abortion illegal. But it was viciously cruel, and that cruelty became part of the justification for legalizing abortion. The deadly legacy of the lack of choice has likewise been part of the motivation to keep abortion safe and women out of jail, against the misogynistic war to reverse both those developments.

Yet, there is a logic (if not a “metaphysics”) to the war on women who procure abortion: if abortion really is the horrible crime the right wing claims, it’s hard to grant impunity to people who plan, solicit, and participate in that crime. If abortion is murder, surely the one who knowingly seeks, requests, pays for, and submits to an abortion, deliberately, by choice and preference, knowing its meaning and consequences, must be a murderer, at least as much so as the medical professionals who perform the procedure (and surely more so in the case of medical abortion, in which the professional’s only role is to write or fill a prescription, but the woman’s intentional agency is just as extensive as in a surgical procedure). And the idea that someone who solicits, hires out, and participates in a serious crime – let alone “murder” – is not guilty would be a travesty of the law in the case of any real crime.

The willingness to absolve women of initiating, paying for, and participating in a crime for which the person they paid, who acted on that woman’s own body at her request, will be punished under law reflects no sensible understanding of criminal guilt. It is a purely political move intended to head off a backlash against the anti-choice movement for victimizing women legally as well as medically. It is an attempt to evade the public’s revulsion at the right wing’s treating uppity women as the criminals the wingers say that they are – and to prevent the spectacle of women languishing in jail for simply claiming their own fertility through an act that one out of three women in the US has undertaken in her lifetime. It is a deliberate decision to void their own moral judgments for political expediency – to let a category of so-called “crimes” go unprosecuted to avoid drawing scrutiny to the ways the criminalization of healthcare affects women in general, and thus maintain that oppression in broader effect. It is an all-but-explicit declaration that the ideology that they claim justifies their persecution of women is itself expendable if it would get in the way of persecuting women – that making women suffer is more important than consistently and honestly applying the ideological framework that they use to rationalize that suffering.

But beyond the craven dishonesty and political expedience of the misogynist anti-choice crowd, there is a deep contempt for reality itself. To rationalize their insistence that abortion is a crime, and simultaneous refusal to hold women accountable for their choice to commit that “crime”, they have to characterize the act as criminal but the deliberate commission of it not. Who commits criminal acts but is not a criminal? People who are mentally incompetent, or coerced. Thus: “I see women in this case as a victim”.

This is another popular trope of the misogynist right: women are incapable of agency in their own disapproved choices. The idea that women are commonly “pressured” into abortion is a staple of anti-choice activism, as is the idea that they don’t really know what they are doing. This, of course, makes no sense legally: whether or not you are “pressured”, you can’t plan, schedule, show up for, pay for, and participate in a crime – after extensive discussion, preparation, and informed consent! – and claim you were acting under duress. (It didn’t work for Patty Hearst, and she was truly coerced.) Nor can you claim, after all that, that you didn’t know what you were doing, nor – the legally important part – does that claim matter as a defense to a criminal charge. (“Ignorance of the law is no excuse.”) For women to be exculpable of crime for a crime they planned and participated in, they have to be not just unknowing, or a “victim”, but actually mentally incompetent – a mental child, lacking legal autonomy, unable to give consent for her own choices.

That is the characterization the right wing puts on women – any woman having, or even seeking, an abortion – as their out for criminalizing the act but not the actor. That is how Rick Santorum – and all his Wingnut Woman Hater’s Club fellows – describe every woman who makes a choice they disapprove of: incompetent, non-autonomous, “victimized” by choices they themselves have freely considered, endorsed, and enacted.

But these are not simply more of the crazy opinions and perverse perspectives on women and the world that the right wing wallows in. They are claims of fact – claims about what it is actually like to be a woman who wants an abortion, or simply be a woman who believes abortion is one of the tools she can use to control her own life, take care of her own body, and achieve her own goals. To be a “victim” of one’s own choices and goals, it must be true in fact that you are mentally deficient, not capable of decision-making about yourself as the owner and inhabitant of your own life and body, oppressed by circumstances to the point that you cannot, in literal fact, think straight about yourself. These are claims of psychological fact – claims about the actual mental states of women attempting to assert sexual autonomy – claims about all such women (since the get-out-of-abortion-free card is made available to all women on these grounds).

It is simply impossible that such a claim could be true. It is patently obvious that it is not, in fact, true even about most or very many of the women who choose abortion. (All such women undergo intake counseling and an informed consent discussion. Repeated studies have shown again and again that they are at least as mentally healthy after the fact as are women who have not had an abortion.) The actual facts are clear: women who choose abortion are not mentally deficient, mis-informed, or incapable of making their own decisions. The claim Santorum and his ilk rely on to absolve themselves of the consequences in public opinion of their own misogyny is simply not true. But since it was never intended to be true – only to sound like something that would help them if it were true – that has no effect on their willingness to keep saying it.

What this cashes out as, for me, is the absolute necessity to put women and women’s needs at the center of any discussion about abortion. A third of all women in this country will have an abortion in their lifetime – and that’s with the grinding barriers and hurdles the right wing has put in their way. Tens of millions of them have already had abortions – women from every part of the country, every ethnic and religious group, almost certainly every extended family. In the same way that the “I had an abortion” T-shirt makes that army of normal, everyday, free and independent women visible, and forces the misogynists to question how far they are willing to go in targeting their own friends and family members, we need to make it clear also that those women are not “victims”, nor criminals.

Unless you are willing to call some vast percentage of women in the country – family members, co-workers, the women who raised all those children, taught all those classes, earned all those college degrees, held down all those jobs, accomplished all that they have accomplished and are still doing, and in the course of it knowingly and deliberately and self-affirmingly chose to abort an unwanted pregnancy and were better off for it – mentally ill, mentally incompetent, not in control of their own lives or choices, unable to control their own lives and choices, then you cannot claim their are victims for having made those deliberate and conscious choices. You will have to confront the reality that the women who choose abortion are, in largest part, strong, self-aware, competent, autonomous, and fully responsible for their own lives, values, goals, choices, and actions. And that being anti-choice is an assault on those women and their status as independent and autonomous persons.

Alaska

• Pauline’s Abortion Loan Fund

Arizona

• It’s Your Choice: The Abortion Fund

California

• Reproductive Rights Network of Santa Cruz County
• ACCESS Women’s Health Justice
• Women’s Reproductive Rights Assistance Project (WRRAP)
• Make a Difference Fund

Colorado

• Reproductive Equality Fund of the Boulder Valley Women’s Health Center
• Freedom Fund (Colorado)

District Of Columbia

• DC Abortion Fund
• Justice Fund (DC)

Delaware

• Delaware Pro-Choice Medical Fund

Distrito Federal (Mexico City)

• MARIA Abortion Fund for Social Justice

Florida

• W.O.M.E.N.
• Roe Fund
• North Florida Justice Fund
• Emergency Medical Assistance Inc.
• Women’s Emergency Network
• Broward Women’s Emergency Fund
• Central Florida Women’s Emergency Fund

Georgia

• Women in Need Fund
• Atlanta Pro-Choice Action Committee

Iowa

• deProsse Access Fund of the Emma Goldman Clinic
• Iowa Abortion Access Fund
• Heartland Justice Fund

Illinois

• Illinois Reproductive Justice Fund
• Planned Parenthood of Illinois Reproductive Justice Fund
• Chicago Abortion Fund

Kansas

• Peggy Bowman Second Chance Fund
• Women in Need Fund

Kentucky

• A Fund, Inc.

Massachusetts

• Eastern Massachusetts Abortion Fund
• Abortion Rights Fund of Western Massachusetts
• Jane Fund of Central Massachusetts

Maryland

• June Coleman Reproductive Justice Fund

Maine

• Safe Abortions For Everyone (SAFE)

Michigan

• Fountain Street Church Choice Fund
• Jane Doe Loan Fund
• Jane Doe Fund

Minnesota

• HOTDISH Militia
• Hersey Abortion Assistance Fund

Montana

• Trust Women Fund
• Sarah’s Circle
• Blue Mountain Clinic Access Fund

North Dakota

• North Dakota Women in Need Fund

Nebraska

• Abortion Access Fund

New Hampshire

• New Hampshire Fund for Choice
• Joan Fund

New Jersey

• Justice Fund of Passaic County

New Mexico

• Abortion Assistance Fund of Planned Parenthood New Mexico
• New Mexico Religious Coalition for Reproductive Choice

Nevada

• Justice Fund

New York

• Abortion Fund of Planned Parenthood of NYC
• Joan Bechhofer Fund
• New York Abortion Access Fund
• Access Fund of Aphrodite Medical
• Haven Coalition
• Third Wave Foundation Emergency Abortion Fund

Ohio

• Preterm Cleveland
• Women Have Options
• Cleveland Abortion Network
• Agnes Reynolds Jackson Fund

Oklahoma

• Roe Fund

Ontario

• Canadians for Choice Norma Scarborough Emergency Fund

Oregon

• Planned Parenthood Columbia Willamette Abortion Fund
• Network for Reproductive Options

Pennsylvania

• Women’s Medical Fund
• Vivian Campbell Fund
• Margaret C. Rubin Freedom Fund
• Planned Parenthood of Northeast and Mid-Penn Fund for Choice
• Western Pennsylvania Fund for Choice

Rhode Island

• Women’s Health and Education Fund
• Hope Fund

South Carolina

• South Carolina Women’s Choice Fund

South Dakota

• South Dakota Access for Every Woman

Tennessee

• J. Paschall Davis Fund

Texas

• Stigma Relief Fund
• Texas Equal Access Fund
• Lilith Fund
• Jim Wimberly Fund

Virginia

• Richmond Reproductive Freedom Project
• Women in Need Fund
• Blue Ridge Abortion Assistance Fund

Vermont

• Vermont Access to Reproductive Freedom

Washington

• North Idaho Fund
• Women in Need Fund—Renton
• Women in Need Fund—Tacoma
• Abortion Access Network
• Community Abortion Information and Resources Project (CAIR Project)

Wisconsin

• Freedom Fund
• Options Fund
• Women’s Medical Fund

West Virginia

• WV FREE Choice Fund

Wyoming

• Women for Women

I can’t vouch for any of those links or the organizations, but this service is desperately needed. Check them out, make them known, and throw them some bucks. “Because women’s lives matter”, as the NNAF so rightly and tragically puts it.

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:

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.

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.

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:

• uterine vacuum aspiration
• dilation & evacuation
• dilation & currettage
• intact dilation & evacuation

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:

• cervical dilation (used as part of many gynecological procedures including abortion, but not abortive in itself)
• menstrual extraction (used to evacuate menstrual tissue after heavy menses, and also for early abortion)
• hysterotomy (used to access the uterus through the abdomen, used for late-term abortion but also for in-situ fetal surgery and non-abortion-related surgery)
• induction of labor (used to expel a fetus in late-term abortion, and ubiquitous in normal delivery or the removal of a miscarried fetus)
• hysteroscopy (an examination and treatment technique used in many conditions of the uterus, only sometimes for abortion)
• and more . . .‡

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:

• infection from retained products of conception
• hemorrhage or infection after incomplete miscarriage
• hemorrhage or maternal exhaustion after failed labor
• virtually any other condition that requires emptying the uterus, at any time just before or after fertilization of an egg or during any actual or failed pregnancy

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:

• persistent menses or dysmenorrhea
• uterine fibroids and other endometrial malformations
• removal of retained products of conception
• cervical dilation for any purpose
• uterine aspiration for biopsy
• any other condition requiring dilation of the cervix, aspiration currettage of the uterine contents, or open surgical procedures on the uterus

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.

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.

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.

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.

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.

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.]