New England Journal of Medicine wants Hobby Lobby to lose

Where do the religious rights of a health insurance purchaser end? The New England Journal of Medicine brings up a point I've made before, not here but in conversation: If an employer is a Jehovah's Witness and thus objects to blood transfusions, then can they refuse to pay for health insurance coverage for an employee's blood transfusion? No, because it is objectively ridiculous to refuse blood transfusions. But, on a less ad hominem level, it seriously risks the health and life of an employee who may need a blood transfusion.

But more importantly, it's not your employer's decision whether you get a blood transfusion. It's not your employer's concern what you do with your body when it comes to your and your doctor's medical decisions. Because holy crap, why on god's green earth would you ever order your doctor to consult with your boss when you're about to bleed to death after a car crash or during complications from surgery?

In the Hobby Lobby case, an employer who religiously objects to contraception wants to refuse to pay for health insurance coverage for contraception. But why is this any different at all from an employer who may object to paying for blood transfusion coverage? The payor has a religious objection to something medical a third party wants to do. And there's a power differential, of course -- but it's not like a parent who has a real say (and duty) to oversee their child's medical care. So why is this literally a federal case?

Just like with a blood transfusion, it's a private medical decision that doesn't involve the employer at all. And just like with a blood transfusion, when patients get the contraception they ask for, then they're more healthy:

If the full panel of FDA-approved contraceptive services is made available to American women, the public health of the country will benefit. If a woman's religious beliefs compel her to decline such services, she has the right to do so. But to deny coverage for these vital public health services to women who want them but cannot afford them outside their employer-sponsored insurance would be a personal and public health tragedy.

To be absolutely clear, the only difference between not covering blood transfusions and not covering contraception is the gender of the patients who need it. Never mind the privacy issue, because if it were a privacy issue, then the case wouldn't have made it to the Supreme Court. Nobody would dream of allowing a "blood transfusion exception" to the health insurance coverage requirements of the Affordable Care Act, because it's completely absurd. No, this is squarely a gender discrimination issue. And NEJM puts it in terms of equal protection and full self-actualization:

[P]lanned pregnancy affords women and their children a better quality of life: it gives younger women the opportunity to complete school, start careers, and establish stable relationships, and older women the ability to add to their families only when they have the capacity to care for them.

Recall that this was what Justice Ginsburg said in 2007. Restrictions on access to reproductive healthcare prevent women from "enjoy[ing] equal citizenship stature" and deny them "autonomy to determine [their] life's course" (Gonzales v. Carhart, 550 U.S. 124, 172 (2007) (Ginsburg, J., dissenting) (PDF)). In this case, just as in anti-abortion cases, women risk losing full autonomy and citizenship. It's not a tax issue; it's not a privacy issue; and it's not an anti-President Obama issue. It's a woman's issue.

Reminder of the days before Griswold

Posting this to remind people what life was like for American women before Griswold v. Connecticut:

Before the 1965 Griswold ruling, states were allowed to outlaw contraception, even to married people. Let that sink in. Before 1965, it was illegal in many states for married women to get birth control. And it wasn't until 1972 (Eisenstadt v. Baird) that the Supreme Court found fit to reject bans on contraception for unmarried people.

This isn't just within living memory; these results are actually younger than a lot of people in my generation -- I was born in the early 1970s.

So when I ran across this ad a few days ago, in a magazine called Personal Romances, aimed at teen girls and young women and published by the Ideal Publishing Corp. out of New York, I kind of felt blindsided. I knew, intellectually, that my parents hadn't had access to the pill and diaphragms and condoms and so on, as easily as I had by the time I was sexually mature. And of course I know the basic facts behind Griswold, Eisenstadt, and their progeny. But there's knowing the cases and the penumbral convolutions of law they led to; and there's living in a world where you can't plan the next few months of your life -- never mind the next 20 years -- because you don't know if you're going to get pregnant, and you won't be able to terminate the pregnancy because it's not yet 1973.

Maybe you've had a baby or two, and your family feels complete. Or the pregnancy experience was terrible. It damaged your health; or your marriage is in bad shape and you don't want to bring another baby into the mix; or (literally) heaven forbid you'd simply like to have sex without marriage or babies or both. I can't imagine being in these positions, because by the time I was at university I could get free condoms at the student center whenever I wanted them. Contraception wasn't controversial.

When did contraception become controversial again?

Note that one of the biggest selling points of the gadget up there is that it's "sanctioned by churches of all denominations." These are the same churches who are behind the Hobby Lobby case and the hilarious assertion that the only thing preventing the Catholic church from supporting health care for sick Americans is that Obamacare pays for pills. But religious oppression is the same, whether it comes in a Supreme Court opinion or a plain paper wrapper. And I'm very sorry to say I'm not optimistic about the result we'll see in June in Hobby Lobby.

Employers should embrace paying for health insurance, because abortions should be rare

Just as I don't understand why a health insurer itself would decide to cover pregnancy and birth costs (some $20,000 per event, and most women who do it once do it at least once more) but not pay for birth control (some $360 per year for pills, less for an IUD per year over its lifetime), I don't understand why an employer would be happy to pay for pregnancy and birth insurance, plus the real risk of high turnover among its female employees, but refuse to pay for birth control insurance.

I'm a small business owner. I've been one for years, and I spent a good part of the 1990s as a successful small business owner who hired employees. When I've had employees, I've paid for their health insurance. And I will in the future, if I ever get into the position where I can hire them again, even if the number of employees is below the Obamacare mandate threshold. Why? Because it's good business. It's cheap -- you have to do some research and some math, but it's not terribly expensive per employee. In the 1990s, I found a trade association that hooked us up to a group that tailored its plan to small businesses (even tiny ones, like mine) that wouldn't have been able to negotiate a good deal on their own. I bet there's a trade or professional association for every darn industry out there, and I bet to a one that they have affiliate health insurance programs. I know my local and state bar associations do. A business owner who doesn't do this research and math in their own industry just isn't doing the best job they can do as a business owner.

To be clear, I don't recall the numbers offhand, because it was over 15 years ago and the paperwork is long gone. And the numbers weren't negligible, and the 1990s was a very easy decade to make money in the industry I was in, and my employees were young, healthy people. But offering health insurance to them was worth every penny we spent on it. Combined with a reasonable sick and vacation day policy, the work environment allowed a sick employee to stay home, see a healthcare practitioner, and get back to work quickly. They didn't lose productivity, coming into work because they felt forced to though they were feeling lousy, getting everyone else in the office sick. And for the love of Christ, I never asked the women about their birth control. (Though I do know that if they were on the pill, they were covered, because they got the same coverage I did, and you know damn well my pills were paid for.) And you know why? Because one, it's none of my goddam business. And two, I didn't want "these fool feemale women" having unintended pregnancies and bringing drama and grief to the office, and needing time off.

And three, because there's that Clintony pro-choice line that abortion should be "safe, legal, and rare." Anti-choicers jump on that, with their favorite gotcha: "Why rare? If abortion is OK, why do you agree that it should be rare? You must actually think it's not OK, or else you wouldn't say it should be rare. Gotcha!" That "gotcha" is a logical fallacy. Do you see it? They beg the question as to Clinton's premise for why abortions should be rare. The reason isn't that pro-choicers think an embryo or fetus has the same right to life as the woman gestating it. The reason is that any abortion, even a very early or straightforward one, takes resources. It takes a woman away from her work or studies for multiple trips to the clinic or hospital (plus a trip to court if the patient is a minor in a state where she needs to get a judicial bypass around the parental notification law). It takes money, both in the cost of the procedure and travel costs to get it, plus lost wages from time off work. And it takes an emotional toll from the stigma, drama, and grief largely inflicted by the religious right.

Abortions should be rare because they cost women time, money, and work and educational opportunities. Abortions should be rare because they cost employers money. Oops, I think that makes me a capitalist! But hey, it's not me who wants abortions to be rare. It's just good business.

Proposed: the Indiana Church of Homo Matrimony

You know what the state of Indiana needs? A church the only doctrine of which is same-sex marriage in the great State of Indiana. It should be called the Indiana Church of Homo Matrimony, and its greatest -- because only -- sacrament would be same-sex marriage. Which is a misdemeanor for a pastor to solemnize in Indiana. And I dearly, dearly want to see the pastor of the Indiana Church of Homo Matrimony to be arrested and charged for performing their congregation's most holy act. The law in question, via ThinkProgress and AmericaBlog:

IC 31-11-11-7 Solemnization of marriage between persons prohibited from marrying Sec. 7. A person who knowingly solemnizes a marriage of individuals who are prohibited from marrying by IC 31-11-1 commits a Class B misdemeanor.

A "Class B misdemeanor" in Indiana can set you back $1,000 and a half-year in jail. That's a lot of collection money going out the door, and a lot of Sundays with an empty pulpit.

You know, the Founding Fathers foresaw the trouble that comes when the state gets involved in deciding religious questions. As they put it when they were debating the text of what became the First Amendment, it's all fun and games for the legislature to mandate bible instruction in public schools, until you find out that the bible to be taught isn't your bible. Wars have been fought and countless people have been executed for hundreds of years over theological questions from "Should women be allowed to preach?" to "Which of the dozen commandments over multiple chapters and books are the actual Ten Commandments?" And when the government lays out religious doctrine as law and public policy, everyone except for rich, connected men loses.

Which, of course, is the point. It's the real reason underlying invasive, liberty-destroying restrictions on abortions: keep women from controlling their own reproduction, and they'll have to juggle duties at home and work, which keeps them from focusing on work as hard as their co-workers with fewer perceived home-based responsibilities (read: dads, and child-free men), which keeps them from being in a better position to bargain for higher wages and more power in the marketplace and the political arena. Keep young women from terminating unwanted pregnancies, and they'll have exponentially more trouble to finish vocational training or a college degree, which keeps them from fully actualizing themselves and earning more money.

And note that however it's done, when women don't earn decent money, they don't pay much into Social Security, which hurts both Social Security in general but also, and more importantly, themselves in particular, when they've retired (ha-ha) and receive smaller payments than what they would have seen if they'd had the credentials to earn higher paychecks in the first place. Again, fully actualizing themselves. (Which is why Justice Ginsburg practically begged women's rights proponents to give up on due process and aim for equal protection -- the strategy that finally worked against DOMA -- to attack abortion restrictions: privacy isn't the issue, because restrictions on abortion prevent women from "enjoy[ing] equal citizenship stature" and deny them "autonomy to determine [their] life's course" (Gonzales v. Carhart, 550 U.S. 124, 172 (2007) (Ginsburg, J., dissenting) (PDF)).)

But you know what is still available to a woman? Going to Indiana and starting up a church whose sole practice and faith is solemnizing same-sex marriages.

When abortions are illegal, women still get abortions

. . . and they get more of them. A study, published in The Lancet, covered the years 1995 to 2008 found:

Abortion rates were lowest in Western Europe -- 12 per 1,000 -- and highest in Eastern Europe -- 43 per 1,000. The rate in North America was 19 per 1,000. Sedgh said she and colleagues found a link between higher abortion rates and regions with more restrictive legislation, such as in Latin America and Africa. They also found that 95 to 97 percent of abortions in those regions were unsafe[, defined as] any procedure done by people lacking needed skills or in places that don't meet minimal medical standards.

The researchers' conclusion: "It is precisely where abortion is illegal that it must become safer," and providing education and birth control universally will go a long, long way.

The full text of the study is available free with registration at The Lancet's website.

When fertilizations are "persons," miscarriages are homicides

Photo: a human blastocyst, formed about 5 days after a spermatazoon has fertilized an egg cell. Or, in Mississippi, an American citizen with a full complement of civil rights.

So both the Democratic and Republican candidates for governor in Mississippi have gone on record supporting passage of the fetal personhood initiative in that state. The state attorney general says he'll enforce it, too; and Mitt Romney has said in the past that he "absolutely" supports fetal personhood ballot measures. But I wonder if they're all fully on board with the very realistic consequences of such a law if it goes into effect.

Mississippi's Initiative Measure No. 26, if successful, will amend the state's constitution to "define[ the word person] to include every human being from the moment of fertilization, cloning, or the equivalent thereof[.]" So it would attach the full legal rights of a "person" to not just a fetus at the point of extra-uterine viability, and not just pre-viability, but to pre-fetus stage. Pre-embryo stage, pre-blastocyst stage, pre-morula stage, pre-zygote stage. It attaches full legal "person" rights to the instant that fertilization happens and there is a conceptus.

I don't see how this law can be uniformly enforced without monthly pregnancy tests of all fertile women in the state of Mississippi. I'm not being facetious here. (If I were being facetious, I'd ask if the rabbit industry lobby were behind Measure 26.) It's a serious question, because not every fertilization results in a successful pregnancy -- likely some 50% of all fertilizations result in early pregnancy loss, perhaps even 75%.

Early periods happen. Late periods happen. They happen to women whose cycles are otherwise regular like clockwork; they are business as usual to women whose cycles never grooved into predictable regularity. They happen whether or not a woman has gotten up to shenanigans that would put her at some risk of pregnancy. But one of the best indicators that fertilization has happened is a late period. Does Mississippi's definition of personhood mean that a woman would now have a legal duty to motor on over to the drugstore every time she's a day late?

And what about those miscarriages again? Most early miscarriages, more than three-fourths of them, occur in the first trimester because of a health or age issue beyond the woman's control, or because of "cytogenetically abnormal" embryos -- pregnancies that perish because the result would have been unviable for genetically horrific reasons.

And in Mississippi, every early miscarriage, because it happens to a "person" with the full complement of civil rights, would be a homicide of some kind. Every homicide has to be investigated to determine whether it was intentional and what charges should be pursued. But you can never really tell, with any one menstrual period, whether there was a fertilization; a period simply means that an implantation failed to occur, not that there was no fertilization. And never mind the "morning-after pill," which prevents pregnancy by kick-starting uterine sloughing so that a fertilization, if it happened, cannot implant: what about the women in Mississippi who are currently using non-hormonal IUDs? Every month, there may have been a fertilization that did not result in implantation -- thus, there was a miscarriage. And thus, there was a death of a "person," and thus, there was a homicide. When miscarriage is a homicide, then every menstrual period is a crime scene.

Do the leaders and other citizens of Mississippi understand that? And if not, why are the proponents of Measure 26 not explaining it that way? And how do they propose to handle infertility treatments that result in the creation of surplus human embryos? If an IVF-created embryo doesn't survive implantation, what kind of homicide is it? Does Measure 26 ban the operation of IVF clinics in Mississippi?

When miscarriage is murder

As I've explained a few times, most recently in March, pregnancy makes an American woman a second-class citizen. Pregnancy -- planned or unintentional -- is a life-threatening condition. Ordinarily, a person who takes on a life-threatening condition is never compelled by law to continue with that condition if they don't want to. The sole exception is when the life-threatening condition is pregnancy. Although it is always less risky at any stage of a pregnancy to terminate it rather than to complete it with childbirth, a pregnant woman under most circumstances does not have a full, total, unimpeded right to exit from her life-threatening condition without some state involvement.

This problem has been manifesting itself lately with the scary trend of women who suffer miscarriages but then are charged with murder. Lynn Paltrow restates my point, speaking for the National Advocates for Pregnant Women:

Women are being stripped of their constitutional personhood and subjected to truly cruel laws. It's turning pregnant women into a different class of person and removing them of their rights.

Women who have miscarried are being targetted with "chemical endangerment" laws written to address children in meth lab homes (Alabama) or with "fetal homicide" statutes (38 states) written to address domestic violence, not stillbirths (South Carolina).

Miscarriages happen. They happen for no reason, or they happen because a woman suffered some physical trauma, or they happen because a woman took a drug, legal or illegal. They happen before implantation of the conceptus, they happen shortly after implantation, they happen in the first trimester, and they happen later. They are largely unpredictable and accidental, and in fact they're devilishly hard to induce outside of a clinical abortion. They happen in wanted pregnancies and unintentional pregnancies. Sometimes they half-happen; that is, one of two twins miscarries, but the other is successfully carried to term (that was my experience). They are, by definition, not murder.

When abortion is murder, then every stillbirth is a crime scene. When miscarriage is a homicide, then every menstrual period is a crime scene, because every time an ovulation does not result in a pregnancy, it is very possible that conception happened but implantation did not. That is a miscarriage; when these laws are enacted, enforcement of the law will require some kind of monitoring. Proposed language in Georgia carves out an exception from its fetal homicide law for miscarriages where "there is no human involvement whatsoever in the causation" (Ga. General Assembly). But a period starts when a pregnancy fails to occur, and any period may indicate a very early miscarriage. How is this to be policed? When abortion is murder, every pregnant woman is a suspect until she enters the labor and delivery room. When miscarriage is murder, every woman is simply a suspect.

Ladies' night at the anarchist bookstore

Off to learn about menstrual extraction. Who knew these kinds of women's consciousness-raising and empowerment meetings were still going on?

Abortion math: lifetime incidence of abortion vs. breast cancer

Math day!

In 2007, about 827,000 voluntary abortions were reported to the CDC (CDC.gov). In 2009, the population of the U.S. was about 307,000,000 souls, about half of them women and girls (Census.gov). If about 40% of them are not in the childbearing years defined as ages 15 to 44, then we have about 307,000,000 people x 50.7% are female x say 60% are age 15 to 44 = some 93.4 million women in their childbearing years living in the U.S.

So 827,000 voluntary abortions in 2007 divided by 93.4 million women in that age range in 2009 = an annual rate of about 0.8% of American women age 15 to 44 having an abortion, about 8 in 1000 -- or 1 in 125. About 1/3 of all American women will have an abortion at some point during their childbearing years (Guttmacher.org, with links to primary sources).

Something with a yearly incidence of 1 in 125 and a lifetime incidence of 1 in 3 needs to be discussed with rationality and openness. By comparison, over their lifetime, women are more likely to get an abortion than to suffer breast cancer, which has a lifetime incidence of 1 in 8 (American Cancer Society, PDF).

I've said it before, and I'll say it again now. Everyone, and I mean everyone, knows a woman who's had an abortion. You're around women all the time who have had an abortion: in line at the supermarket, at your workplace, at your school, among your family, on your Facebook friendslist, and among the women you date. You know more women who have had an abortion than you know women who have had or who will have breast cancer. That's a lot of women whose healthcare isn't subsidized by federal funds except in cases of tragedy or crime (PDF), the way any other aspect of healthcare might be. And I've never seen a charity "race for the curette."

Keep your abortion-related receipts and other documentation for audit purposes

This is less government, how?

SEC. 303. PROHIBITION ON TAX BENEFITS RELATING TO ABORTION.

‘For taxable years beginning after the date of the enactment of this section--

‘(1) no credit shall be allowed under the internal revenue laws with respect to amounts paid or incurred for an abortion or with respect to amounts paid or incurred for a health benefits plan (including premium assistance) that includes coverage of abortion,

‘(2) for purposes of determining any deduction for expenses paid for medical care of the taxpayer or the taxpayer’s spouse or dependents, amounts paid or incurred for an abortion or for a health benefits plan that includes coverage of abortion shall not be taken into account, and

‘(3) in the case of any tax-preferred trust or account the purpose of which is to pay medical expenses of the account beneficiary, any amount paid or distributed from such an account for an abortion shall be included in the gross income of such beneficiary.

Full text.

Mother Jones reports that this bill is a "top priority" of Speaker Boehner's (R-Ohio). What about jobs?

Operation Rescue terrorists are targetting Pennsylvania

Domestic terrorist organization Operation Rescue, who did nothing to prevent the illegal charnel house run by Dr. Gosnell in West Philadelphia for over 30 years, has decided to target Pennsylvania now. Not soon, but now. They plan to do things like publish photos and addresses of practitioners and assistants -- and not in the hopes that you send the doctors a card at Christmas, because this is not an organization's purpose when its participants are called "foot soldiers."

Dr. Gosnell opened the Women's Medical Society in 1979. For 31 years, he performed illegal late-term abortions in filthy conditions, directing untrained and unlicensed assistants to treat women (long, graphic PDF). The result was permanent infertility of likely dozens of women, death for others, and infanticide of probably hundreds of near-term fetuses. He regularly treated minors without a parent's consent, and he would refuse to let women back out of the procedure if they changed their mind. Where was Operation Rescue all this time? By the time he was arrested, Gosnell was operating his clinic seven days a week. Why wasn't Operation Rescue there?

Now Operation Rescue is using the horrifying Gosnell tragedy to their own ends. But if they succeed, they won't end abortions. They'll simply end safe, legal abortions.

As Gosnell's practice proved, when abortions are too expensive, too far away, delayed because of state interference, or stigmatized in a woman's family or community, a woman will get an abortion anyway. If women can't get safe, compassionate care through Planned Parenthood or the other legal clinics in Philadelphia and Pennsylvania, then supply will meet these women's demand, and other doctors and practitioners will work outside the law, without concerns for safety, and certainly without compassion to provide the abortions.

The way you prevent abortion is to prevent unwanted pregnancies. If Operation Rescue truly wished to prevent abortions, they'd call upon their membership to step up contributions to Planned Parenthood and other organizations that provide comprehensive sex education and reproductive healthcare to women. They'd adopt unwanted children and take in foster kids. Instead, they'll be unleashing their terroristic practices in Pennsylvania soon.

What will our elected leadership do? Senator Toomey (R) is a right-wing religious extremist who would imprison doctors who perform abortions (video). Governor Corbett has said he won't seek stricter anti-abortion laws in Pennsylvania solely because of the Gosnell clinic (PA Independent); but he is on record generally supporting the idea that abortions should be even harder to obtain in Pennsylvania than they already are (NRO). All this is to say, I don't see Corbett calling up the National Guard when the Operation Rescue terrorists get going.

Planned Parenthood and other abortion clinics will be needing patient escorting personnel soon. If you have a spare couple of hours once per week, or just once per month, call your local clinic and ask about training for clinic defense. Like any other terrorist group, Operation Rescue is counting on fear, intimidation, and a lack of support for abortion patients to reach their goals. Clinic defense is about the best way to really put your money where your mouth is if you love, support, and trust women to make their own healthcare decisions for themselves.

Pregnancy makes a woman a second-class citizen

A woman becomes a second-class citizen as soon as she becomes pregnant because her human and civil rights become less important than the rights of the fetus. Here's how it works.

Pregnancy is a life-threatening condition. It is more risky to be pregnant than to not be pregnant. At any stage of a woman's pregnancy, it is less risky for her to terminate the pregnancy than to undergo childbirth.

In this country, even if you voluntarily assume the life-threatening risk of a condition (buying a ticket for a plane that might crash, ordering your eggs or steak undercooked, strapping yourself into bungee cords for a jump) you can always change your mind and back out of your decision (not getting on the plane, not eating the eggs or steak, not bungee jumping off the bridge). That is to say, in this country, we don't force people to go through with risky things, no matter how enthusiastic we were for the experience when we signed up for it (order you onto the plane at gunpoint, force-feed you the eggs or steak, push you off the bridge).

But we do, to one degree or another, if the life-threatening risk taken on is pregnancy. This is the only such situation in American law. And the given reason that we do so is because of the state's interest in the rights of the fetus. In other words, we force women to continue a particular life-threatening condition to its conclusion solely because of the rights of another being. And this being isn't even another citizen; it can't own or transfer property, it can't vote, it can't serve in the military. But as soon as a woman is pregnant, it causes her to lose the fundamental human right to direct her own healthcare and her own future. The option of adoption aside -- because the reality is that few women who bring unintended pregnancies to term go through with an adoption plan -- women are then routinely forced to undergo 18+ years of the legal, emotional, financial, and physical consequences of motherhood. Never mind the lack of state-funded daycare or the fair distribution of free public education for these children whose rights the state supposedly had such an interest in before they were born.

The only class of people in this country who are ever forced to go through the riskier of two options in any situation, because of the supposed rights of another party or class of beings, are women who are pregnant. If that isn't a solid definition of slavery, I don't know what is.

Nebraska makes mothers birth deformed pre-term babies and watch them die

Listen to this Christian couple's story (12 min).

Listen to the story of this married Christian couple, Danielle and Robb. They had gone through several miscarriages and one successful pregnancy brought to term. Then with this baby, Danielle's amniotic sac broke early, at about 22 weeks, and she was hospitalized. The diagnosis: the loss of amniotic fluid would cause the fetus severe limb deformities and underdeveloped lungs. Danielle would probably miscarry before the fetus reached a viable gestational age; and even if it did reach viability, it had almost a zero chance of any life at all once born. Danielle and Robb talked the situation over with their doctors and their consciences, and they decided to seek an abortion.

The problem: they're in Nebraska, where a woman can't get an abortion after a fetal heartbeat can be detected, unless the her life is immediately at risk.

In other words, the only way Danielle could have gotten a legal abortion would be to wait until she developed a deadly pregnancy complication, such as the leaking amniotic sac letting in some contagion that caused a massive septic infection that threatened to kill her. [1] Instead, the state of Nebraska forced the fetus to go through a week of increasing pregnancy complications and fetal deformities until the Danielle finally went into premature labor, and the baby died within minutes of birth. A nurse made the mother watch the newborn struggle to breathe before it finally died, so that the state could have the time of death.

This is what happens to ordinary people when abortions are banned. Because Danielle and Robb had a toddler at home, they couldn't just up and travel to another state to get the procedure done. Instead, Danielle was forced to a week of bed rest and then days of physical recovery from childbirth, along with the emotional trauma of being compelled to watch her deformed baby die for the convenience of the medical staff's recordkeeping. If she had been able to get the healthcare she needed, she could have been back to work and caring for her toddler within a few days.

Where is the state's interest in having the situation end this way?

---

[1] Coincidentally, premature rupture of the membranes is why my OB induced my labor a few days before my actual due date. It's a relatively common complication of late pregnancy. My OB's rule of thumb was to induce if labor hadn't started spontaneously within 24 hours of the rupture, because the rupture can provide a pathway for serious infection, as it's basically an open sore into the body.

Anti-choice protesting drives women to Gosnell-type abortions

At the risk of making this blog a one-trick pony lately:

When Davida Johnson walked into Dr. Kermit Gosnell's clinic to get an abortion in 2001, she saw what she described as dazed women sitting in dirty, bloodstained recliners. As the abortion got under way, she had a change of heart -- but claims she was forced by the doctor to continue.

"I said, 'I don't want to do this,' and he smacked me. They tied my hands and arms down and gave me more medication," Johnson told The Associated Press.

Johnson, then 21, had a 3-year-old daughter when she became pregnant again. She said she first went to Planned Parenthood in downtown Philadelphia but was frightened away by protesters.

"The picketers out there, they just scared me half to death," Johnson, now 30, recalled this week.

Someone sent her to Gosnell's West Philadelphia clinic, at the Women's Medical Society, saying anti-abortion protesters wouldn't be a problem there.

(MSNBC). Ms. Johnson says that she contracted an STI from Gosnell's clinic and has suffered four miscarriages since her procedure there.

When abortions are stigmatized, unsafe, expensive, far away, or illegal, women will still get abortions. Here, protestors who call themselves "pro-life" chased Ms. Johnson away from a safe, legal abortion with compassionate practitioners who would have let her decline the procedure when she changed her mind at the last moment. In the end, the protestors got exactly what they say they don't want: although she would have completed the pregnancy had she been given a choice, she ended up terminating it, instead. And it appears that her fertility was permanently damaged in the process. The conditions the "pro-lifers" drove her to are exactly the opposite of what happens when women have complete, peaceful access to fully self-determined healthcare.

Where were the protestors at the Women's Medical Society at 38th and Lancaster before it closed? I'll tell you where. In Philadelphia, the anti-choice regulars picket two of the safest, most compassionate clinics in the region: a Planned Parenthood in Center City and an independent clinic on the north side of Old City. But although the Women's Medical Society was google-able and was listed in the phone book, and although a minimum of research would have led protestors to find out about its practice in late-term abortions, it was never the focus of protests. Its location, about a block and a half from Presbyterian Hospital in West Philadelphia, is perceived as a scary, dangerous, and predominantly African-American neighborhood. (In truth, it's full of Drexel University students, homeowners who were "urban pioneers" countering urban blight 30 years ago, and hospital and university employees -- as well as African-American households.)

Why weren't anti-choice zealots protesting this clinic? If anti-choice protestors are truly "pro-life," why do they spend their time holding up offensively graphic posters at Independence Hall or attending the D.C. "March for Life" on every anniversary of Roe v. Wade? Why were they not outside the Women's Medical Society every night since PPSP v.Casey in 1992, or since the clinic opened in 1979? Is their goal truly to end abortion? Or is it something else?

Are they showing off their faith with their signs and chants (Matt. 6:5)? Are they really so stupid that they can't see what they're doing? How many other women did "pro-life" protestors drive to Dr. Gosnell?

As a staunch pro-choicer, I've been called a baby-killer. I've volunteered at abortion clinics and women's rights organizations for years, referring women to particular clinics and helping minor women obtain judicial bypass orders. But I never sent a woman to the Women's Medical Society. Can all of Philadelphia's "pro-lifers" say the same?

Adventures in clinic defense: Introduction

Over the past 20-odd years, I've done a lot of feminist stuff. I drove a carload of pals down to D.C. for a big ol' gay rights march one spring. I organized a contingent to attend a big ol' women's rights march a decade later. I spent much of my 20s honing my socialist feminist worldview by dabbling in Radical Women, the Freedom Socialist Party, and unshaven legs. Later, when my daughter asked me how her new baby cousin got into her auntie in the first place, I explained it by reading the relevant sections in Our Bodies, Ourselves with her. I put myself through law school as a single mom. And while I was in law school, I counseled women seeking protection from abuse orders and minor women who were stuck having to seek permission from a judge to get an abortion.

It's been a little while since I've put my money where my mouth is, and with the inauguration of our new governor I'm living in a red state now; so I recently started doing clinic defense for an abortion provider in the Philadelphia area. When patients arrive at the clinic, I offer to walk with them to the front door, help them with a newspaper if the protestors are taking photographs, and remind them that they don't have to take any pamphlets that protestors may try to shove into their hands. And I keep an eye on the protestors to make sure they're staying off of clinic property and stuff. It's a two-fold thing: one, it's about enforcing the F.A.C.E. Act; but more importantly, it's about making sure that women get full access to complete healthcare. (News flash: Not all clinic patients who arrive during termination procedure hours are getting abortions. Some -- perhaps many -- are there for regular reproductive health visits like pap smears, or STI screening and counseling, or other reasons.) Abortion is healthcare and when women cannot control this part of their healthcare they do not have full control over their destiny. A million American women get an abortion every year, and I aim to help.

Clinic defense can be scary, so I'm not going to reveal any details that would give away where and when I'm volunteering: addresses, weather conditions that day, the number of protestors or what they looked like or what organization they were from, and so on. I'll aim to post my reports a little randomly, too, so that it's not clear what day of the week or what time of day I was there. But randomness and vagueness aside, I hope you'll enjoy the posts as much as I hope to enjoy my stint defending the clinic as a patient escort.

Weighing in on the Gosnell case

So we have a national news trifecta happening in Philadelphia lately. They've arrested and charged a very likely suspect in the Kensington serial killings; a 12-inch gas main blew up a couple of nights ago, killing a 19-year-old PGW employee; and a doctor providing late-term abortions, apparently some of them brutal and horrific "fourth-trimester" procedures, in a filthy, substandard clinic filled with jars of fetal parts and smelling of cat piss has been indicted and faces eight counts of murder.

I'm still reading the grand jury report (281-page PDF). In the meantime, please take a moment to read my friend Amie Newman's take on the situation at RH Reality Check:

When abortion is stigmatized, and access to care blocked for many women in this country, women are forced to turn to "providers" like Dr. Gosnell and his employees [who are also under indictment]. Dr. Gosnell and others like him are offered easy access, in essence, to desperate and vulnerable women simply seeking to end a pregnancy.

But when we stigmatize the decision to have an abortion and keep discussions of this safe, legal option closed, as well as keep abortion care out-of-reach financially or geographically, we are not only telling women not to speak of this issue. We are also telling women they don't deserve access to safe, legal care and that they won't get access to a safe, nurturing environment either.

When abortion is illegal, or too expensive, or too stigmatized, or too far away, women will still get abortions. Until all abortions are safe, legal, and free on demand, there will be doctors or other practitioners who will be happy to provide unsafe, illegal, and costly abortions to the women who need them.

Final note: it occurs to me that the clinic was shut down in a War on Drugs operation, not because of any investigation into Dr. Gosnell. (It was raided because they were going after fake oxy prescriptions.) Why is the War on Drugs more important than inspecting and investigating a women's medical clinic, or following up on complaints of serious medical malpractice?

State lawmaker in Minnesota totes gun around closed Planned Parenthood office, offers a disturbing excuse

A Republican state representative in Minnesota was briefly detained after a curious exchange in the parking lot of a Planned Parenthood on Tuesday 16 November. Thomas Hackbarth drove into the lot, placed a fully loaded gun in his waistband, got out of his truck, and walked around the back of the building. A security guard saw the gun and called police, who arrived as Hackbarth was about to drive away. Hackbarth, who has a CCP, is listed as co-author of a concern-troll bill about "coerced abortions" that adds paperwork and notification procedures for women seeking abortions, a bill that mandates piss tests for welfare recipients, and a "Tenther" bill. He says it was mere coincidence that the parking lot he ended up in was one for a Planned Parenthood. Rather, he explains, he was only looking for somebody he met online:

Hackbarth said he had coffee with the woman on Nov. 15, and asked her to dinner the next night but she told him she couldn't because of a commitment she had with a female friend in Highland Park. Hackbarth said he felt that she might have been seeing a man instead, so he parked his car and walked around the block looking for her car. [ ... ] "I didn't even know it was Planned Parenthood," [Hackbarth] said.

Well, a little bit of googlemapping and a streetview shows that the clinic has the standard "Planned Parenthood" logo clearly attached to the front of the building there. It was night, but the daytime streetview shows a floodlight there next to the security cameras.

And it's not that big of a parking lot.

I dug a little more and found that that the Highland Park clinic is the only Planned Parenthood in Minnesota that performs abortions; the others offer healthcare and counseling but can give only abortion referrals. When the general goal of most anti-choice legislation is to regulate abortions out of existence by making them more and more cumbersome and expensive to obtain, it's hard for me to believe that a lawmaker as anti-choice as Hackbarth doesn't know the location of the last remaining Planned Parenthood performing abortions in his own state.

But, OK, let's buy it and see where it gets us. Maybe he really didn't know that it was a Planned Parenthood, the only one in Minnesota offering abortions; maybe the floodlight was out and the streetlights didn't reach the sign. It's not his neighborhood, and really he spends more time co-authoring bills about hunting, casinos, and alcohol than about abortion. Did you dig his excuse for going out with his fully-loaded gun in his belt? He was stalking a woman who declined a second date with him.

"I was not a jealous boyfriend," said [protested too much?] Hackbarth, who is in the process of divorcing his wife of 25 years. "I was just trying to check up on her. It's totally a misunderstanding."

He stopped in the empty parking lot of a closed, full-service Planned Parenthood clinic to "check up on" someone who told him no, thanks to a relationship. This is not a "misunderstanding"; this is a pretty damn clear case of stalking, and I'm glad that the woman spotted Hackbarth's creepiness before she accepted a dinner date with him.

When abortions are illegal, women will still get abortions (Thailand edition)

Thai police say they have found the remains of more than 2,000 foetuses, thought to be from illegal abortions, hidden at a Buddhist temple in Bangkok.

(BBC.) Thailand's anti-abortion law restricts the procedure to women and girls who are victims of incest, or whose pregnancies endanger their health. (Note that Senator-elect Toomey, R-Pa., wants an even stricter anti-abortion law than Thailand's.) When one clinic had to close because the provider moved (MSNBC), there was still enough demand for abortion services that a non-doctor stepped in. Abortion in the first two trimesters -- and especially in the first few weeks -- is, really, a straightforward procedure. But it's still safest in a regulated medical clinic, with trained and licensed professionals at hand, and with emergency facilities within easy reach. In Thailand, though,

[w]ealthy women can get abortions in safe facilities but the vast majority of Thai women wanting an abortion use clinics which could put their health and safety at great risk, [the BBC's] correspondent says.

When abortions are illegal or hard to obtain, women will still get abortions. They just get ones in less than ideal conditions (or outright dangerous, unsanitary conditions), or they have higher-risk abortions because they've had to delay the procedure until later in the pregnancy, or they delay treatment for complications for fear of legal consequences.

But they still get abortions, and you get horrific situations like this one.

U.S. Conference of Catholic Bishops moderating away from the pope?

In what looks to me like a rejection of the trend by some super-conservative Catholic priests to refuse Communion to pro-choice politicians and even threaten to excommunicate them, the U.S. Conference of Catholic Bishops has elected a relative liberal to be their president (MSNBC). The vote rejected the candidacy of bishop Gerald Kicanas, who had called for dialogue between extreme conservatives and less-extreme conservatives, so perhaps the election represents a sense of impatience with wasting time trying to find a middle ground with intolerant people who are more likely than not to reject the possibility of a middle ground in the first place. The Conference's new president is Timothy Dolan, archbishop of New York. While he's no radical leftist, he has drawn the line against both denying Communion (a trend in Canada, too) and warning congregations that voting for a pro-choice candidate is tantamount to committing a mortal sin.

Dolan's position puts him out of line with Pope Benedict, who has said that excommunicating pro-choice politicians is the right thing to do under canon law. Is the Conference rejecting the pope's ultra-conservatism? Maybe the Vatican's utter failure to deal with its international pedophile ring? In a country where Catholic schools are closing left and right for lack of enrollment, and the dying populations of nuns and priests are not being replaced by new recruits, they sure do need to do something to keep believers in the fold.

Opening soon: two new clinics in the U.S. for late-term abortions

Hot diggity damn, LeRoy Carhart, one of two abortion providers in the U.S. who still performs late-term abortions, has announced that he will be opening two new clinics, one near D.C. and one in Iowa (WashPost). The clinic near D.C. will open in December and will be easily accessible by Metro. The D.C. area is just a hop, skip, and a jump by air from just about anywhere in the lower 48, even Nebraska, where Dr. Carhart has been legislated out of providing late-term care.

Women choose late-term abortions for a lot of reasons. Most commonly the reasons are something like intrauterine fetal death or fetal abnormalities that are not survivable after birth (like mermaid syndrome or anencephaly), diagnosed late in the pregnancy due to errors, delayed prenatal care, or ordinary errors by the imaging technologist. In these cases, terminating the pregnancy is safer than enduring childbirth, whether a vaginal delivery or a C-section. (In fact, the maternal mortality rate for elective abortion is lower than that for childbirth. See Abortion Surveillance -- United States, 2003 and World Health Organization.) Other reasons for a late-term abortion generally involve deadly pregnancy complications, such as extreme pregnancy hypertension, heart conditions, or incompatibility with cancer treatments -- conditions where the mother has a high or near-certain risk of perishing if she attempts to continue the pregnancy. And again, frequently these conditions are diagnosed late in the pregnancy, or they appear late and unexpectedly.

Some women choose late-term abortions because they live in one of the 88% of all counties in the U.S. with no provider at all, or their state laws imposed a waiting period, or they had trouble raising the funds. These kinds of obstacles can delay a woman's access to prenatal care and counseling and thus push the pregnancy to a later term -- which makes the abortion riskier (though still safer than childbirth), more complex, and more expensive.

About a million abortions are performed in the U.S. every year. About 10,000 are performed after 21 weeks (CDC). Anti-choice zealots like Senator-elect Toomey (R-Pa.) would have you believe that all these women are terminating their pregnancies on a whim; they're selfish; they're having abortions for birth control; they're duped by abortion providers who want their money. But nothing could be further from the truth. The truth is that very, very few of these women want a late-term abortion. The circumstances are usually, at best, imposed on them by legal obstacles, and at worst, life-threateningly dangerous or tragic.

Late-term abortions should be safe, legal, and available on demand. Abortion is healthcare and when women cannot control this part of their healthcare they do not have full control over their destiny. Dr. Carhart is doing American women a great service, and I'm heartened to know that once that clinic is open near D.C. I'll be that much physically closer to a late-term abortion service if I should ever need it.