US Abortion Rates Lowest Since 1973

This report from the Alan Guttmacher institute shows that in 2011, there were only 16.9 abortions per 1000 women aged 15-44. That's the lowest rate since 1973, and represents an annual drop of 4-5% since 2008, for a 13% drop overall. Guttmacher attributes the drop to the increased uptake of contraception, particularly among younger women, and to a shift toward use of long-acting reversible forms of contraception such as the IUD, injections and sub-dermal implants. These are much more effective than shorter-term chemical contraceptive methods such as the pill, patches or vaginal rings.  

The most controversial part of the report has been its assertion that it could attribute little of the decline to the recent spate of anti-abortion laws passed by various states. This is partly because many of the laws passed too recently to have taken effect by the 2011 year they were measuring. Some of the laws simply added more information to already-existing counseling requirements; these seemed to have had no effect. Some limited or banned late-term abortions, but these would do little to reduce abortion numbers, because only 1.2% of abortions occur after week 20 of gestation. Guttmacher does concede that some state laws (like those requiring abortion facilities to meet requirements similar to surgical centers, or requiring all abortion providers to have hospital admitting privileges) may have interrupted the availability of abortion services, reducing the number of abortions; and that other laws (e.g., law requiring an additional in-person counseling session 24 hours in advance of the abortion) might have made it more difficult for women to seek abortion. Louisiana passed restrictions on clinics and experienced a 19% decline; Missouri imposed the extra counseling visit and experienced a 21% decline. But it's hard to tell how much of the impact was due to legal restriction. While the new restrictive laws were concentrated in the Midwest and the South, the number of clinics actually only fell in the Northeast and the West. And there is little overall correlation of laws to abortion-rate decline. Rates fell most dramatically in the Midwest (17%), but below the national rate-of-decline in the South (12%). The West experienced a 15% decline and the Northeast a modest 9%. Pro-choice states California, New Jersey and New York experienced 16%, 12% and 9% declines respectively, in the complete absence of new restrictive laws.

Ventilating the Dead, Continued

Though she is brain-dead, Marlise Munoz is being kept ventilated against her husband's, her parents', and her own previously-expressed wishes. The Texas hospital where she is being kept argues that this course of action may be required by the Texas Advance Directives Act, which makes it illegal to disconnect any "patient" from "life-support"--if that patient is pregnant. Munoz was 14 weeks pregnant when she died; her fetus is now 22 weeks old. A hearing tomorrow should determine whether ventilation of the dead counts as "life support" under the Act, and whether a dead person is a "patient." Meanwhile, her husband's attorneys point out that the fetus suffered from the same lack of oxygen that destroyed Munoz's brain:

"According to the medical records we have been provided, the fetus is distinctly abnormal," the attorneys said. "Even at this early stage, the lower extremities are deformed to the extent that the gender cannot be determined." The attorneys said the fetus also has fluid building up inside the skull and possibly has a heart problem.

"Quite sadly, this information is not surprising due to the fact that the fetus, after being deprived of oxygen for an indeterminate length of time, is gestating within a dead and deteriorating body, as a horrified family looks on in absolute anguish, distress and sadness," the attorneys said.

 Previous posts on Munoz here and here.

 

Ventilating the Dead: Update

The Fort Worth Star Telegram is reporting that the family of Marlise Munoz, the pregnant brain-dead woman who is being kept ventilated against the wishes of her family, will sue the John Peter Smith hospital to get her removed from the machinery.  The hospital has kept Ms. Munoz on the machinery for weeks, citing the Texas Advance Directives Act, which states that no one can withdraw or withhold "life sustaining treatment" from a pregnant patient. The crucial legal question is whether the statutory restriction can properly be applied to treatment which is not "life-sustaining," because the patient in question is dead. (Family members have said that they've been told Ms. Munoz is brain-dead, but the hospital has made no official statement confirming this.) A hospital spokesman said the hospital was "encouraged" by the lawsuit "because the courts are the appropriate venue to provide clarity, direction and resolution in this matter." That sounds to me as if the hospital's position may be wholly liability-driven, and they're just looking for the safety of a court ruling to justify stopping the mechanical intervention. On the other hand, the hospital's outside council is reportedly one Neal Adams, who led a drive to end abortions at the hospital in 1988 and serves on the advisory board of the Northeast Tarrant Right-to-Life Educational Association, so perhaps more than liability is driving the hospital's position.

Earlier post on this case and on the Jahi McMath case in California here.

Read more here: http://www.star-telegram.com/2014/01/09/5473242/family-of-pregnant-brain-dead.html?rh=1#storylink=cpy

Read more here: http://www.star-telegram.com/2014/01/09/5473242/family-of-pregnant-brain-dead.html?rh=1#storylink=cpy

Medicaid Sterilization Policy Causes Unwanted Pregnancies

Here's an interesting article from the New England Journal of Medicine on Medicaid's policy regarding voluntary tubal ligation. Borrero et al. claim that Medicaid policy is preventing poor women who desire sterilization from receiving the procedure, resulting in tens of thousands of unintended pregnancies annually.

A surprising number of women desire tubal ligation immediately after giving birth; the procedure is conveniently done while they're still in the delivery room. More than 70% of sterilization procedures done within two years after delivery are in fact done in the immediate postpartum period.

Because of our nation's appalling experience with coercive and non-consensual sterilization of minority and poor women in the mid-20th century, however, the US government in the 1970s developed regulations designed to protect vulnerable women. Among these was a requirement for Medicaid patients of a 30-day waiting period between informed consent to sterilization and the actual sterilization procedure.

This well-intentioned regulation, unchanged since 1978, is today preventing women from receiving sterilizations that they actually desire. Some women request sterilization too late in pregnancy to fulfill the 30-day Medicaid waiting period; some are denied sterilization because they do not have their consent form present at the time of delivery; some give birth early, before the mandatory waiting period elapses.

The results of denial of sterilization services to Medicaid patients are very real. Almost half of women who are denied tubal ligation get pregnant within one year after delivery. The authors have found that "Medicaid-policy–related barriers lead to approximately 62,000 unfulfilled requests for postpartum sterilization annually, resulting in an estimated 10,000 abortions and 19,000 unintended births in the subsequent year...."

Both the financial and the emotional costs of these unintended pregnancies are very high. The authors estimate the cost to American taxpayers of the pregnancies at over $215 million annually. And wealthier, privately-insured women face no such policy barriers to receiving the sterilization procedure they desire. It might be time to revisit a policy that is harming the people it was originally implemented to protect.

Abortion in Ireland

For the first time, Ireland will permit abortion in some circumstances. First, abortion is permitted when there is a real and substantial risk of loss of the woman’s life from a physical illness. (The law has special provisions regarding emergency situations.) Second, abortion is permitted when there is a real and substantial risk of loss of the woman's life by suicide. Two physicians need to attest to the risk of loss of life from physical illness; three to the risk from suicide. The law includes a conscience clause relieving any physician from participation in the procedure or the determinations relating to risk of loss of life. Text of the law is here. Context-giving coverage from the Guardian is here.

The new law is a baby-step compared to other countries' laws. There is still no provision for abortion in the case of rape or incest, or fetal anomaly; much less for abortion based on the woman's desire not to have a child. But the law is explicit in not limiting the woman's right to travel to obtain an abortion, leaving open the woman's option to travel to the UK for abortions not permitted under Irish law.    

Ways for Republicans Not To Attract Women's Votes

Require a transvaginal ultrasound before an abortion! Limit abortion availability by giving legal rights to fetuses and requiring abortionists to have local hospital admitting privileges that they don't use! Oppose gun control that women overwhelmingly support!

Medical Causes of the Sexual Revolution

Prof. Andrew Francis, an economist at Emory, is claiming that penicillin, rather than The (Birth Control) Pill, was the drug that gave us the sexual revolution of the 1960s. The idea is that the post-war availability of penicillin reduced the cost (to both partners) of intimate contact, by substantially reducing the risk (to both partners) of contracting an STD--especially syphilis. This effectively lowered the cost of sexual activity, inducing more people to engage in it (the benefits remaining more or less constant). An easily-accessible version of the story appears on the CBS news site, here.

Let us not lose sight, however, of the vital importance of The Pill. I have spoken personally with women of the 60s generation who were admitted to medical school (imagine this!) only after they'd told an interviewing dean--an actual Dean--that they were on The Pill, and that they didn't intend to let a pregnancy interfere with their progress through medical school, or with their entry into medical practice. "A medical school education, after all," the argument went, "is expensive not only to the student, but also to the faculty and to the government which (at least in the US) has substantially subsidized it for decades; why should we offer it to someone who will quit (and waste the investment) the moment she has a child? We're rather more inclined to enroll you if you can guarantee that you won't have a child--that is, if you tell us you're on The Pill, or will have an abortion if The Pill fails." The assumption, of course, was that if a woman were to have a child, it would be she, rather than her partner, who would give up on her profession and waste the investment made by others in her career. The idea of the working mother--though it was a reality for many working-class Americans--wasn't yet acceptable to Americans of the professional class.

Like access to birth-control, the abortion right announced in Roe v. Wade made it easier for professional schools to admit women. It meant that women could legally prevent themselves from having children whose rearing would interfere with their professional careers. They could control their reproduction even if their efforts at birth control had failed. (Remember, please, that men were *never* asked whether their having children--whether in or out of wedlock--would interfere with their taking full advantage of their educations.)

Punchline: Yes, Professor Francis, it may well be that penicillin did more than The Pill to facilitate the Sexual Revolution--by which we might mean, the widespread acceptance of pre-marital sexual relations. But it was for The Pill  (and the abortion right) to translate that newfound sexual freedom into sexual equality.

Komen Re-funds Planned Parenthood, Sorta

The Susan G. Komen for the Cure folks have reversed themselves on the question of funding Planned Parenthood's breast-cancer screening and mammography referral services. A statement released today said the foundation was revising its no-funding-for-people-under-investigation policy so as not to include political, as opposed to criminal, investigations. (As I blogged earlier, there's an ongoing congressional investigation into the question whether Planned Parenthood uses any federal funds for abortions, and Komen originally pointed to the existence of that investigation as a reason for discontinuing funding.) The statement said nothing about another reason Komen has given for the de-funding of Planned Parenthood, namely, that they don't provide mammography services directly, but only make referrals for them. The statement says funding for Planned Parenthood will continue to flow under existing agreements, and that Planned Parenthood will remain eligible to apply for more funding in the future. It remains to be seen whether Planned Parenthood's angered constituency will revise its views on Komen as quickly as Komen has revised its grantmaking policy.

UPDATE: This piece has persuaded me that there's less of a reversal here than meets the eye. Komen never intended to renege on existing commitments to Planned Parenthood, so saying they're going to continue funding them isn't any change. Saying Planned Parenthood is eligible to apply for further funding is, in fact, a reversal of their "no money to folks being investigated" policy, but isn't a guarantee that funding will flow. We'll see how many grants are actually made to Planned Parenthood in the future....

ANOTHER UPDATE: Further evidence that there's less to this "reversal" than meets the eye is here. And here, too.

Komen Defunds Planned Parenthood

By now anyone who spends any time on the net is aware that the leading breast-cancer charity, Susan G. Komen for the Cure, has decided to pull all funding for breast cancer screening from Planned Parenthood. Planned Parenthood is saying that the move is a cave-in by Komen to pro-life political pressure. Komen has responded that the move isn't political; it's just that they have a new policy of not funding organizations that are under investigation, and Planned Parenthood is under a (highly political) investigation by Congress about whether they're violating the Hyde Amendment by using federal funds for abortions.

A few of the more interesting tidbits from the web:

A number of pieces, including this one, and this rather less mild one, about how the decision was influenced by Komen's new senior VP, Karen Handel--a pro-life former Republican candidate for the Georgia governorship, endorsed by Sarah Palin; pieces like this one, claiming that the immediate outcry from Planned Parenthood supporters has already resulted in PP recouping much of the money it won't get from Komen, and may deliver a real long-term blow to Komen; pieces like this one, showing enthusiasm for Komen's move among some religious and pro-life groups; articles like this one, and this, detailing past Komen-related controversies, like suing other charities for using "cure" and pink ribbons at their events, and lending their support to unhealthy products like KFC ("because nothing says that you care about women's health like a big vat of fried chicken"); this meta-coverage of the Internet/Social Media response to the news; and this story about a dissenting Komen affiliate group in Connecticut.

I'm guessing, along with many others, that Komen will emerge a loser here, and that Planned Parenthood will benefit significantly from the anger stirred up in its pro-choice base--and from the sense in the broader women's health community that Komen's political move threatens access of the poorest women to preventative breast-cancer screening.

More on Abortion and Mental Health

Michael Cook at BioEdge is making the mistake I blogged about briefly last week!

Here's the issue: This review study from the National Collaborating Centre for Mental Health (NCCMH) finds that while unwanted pregnancies have a negative effect on women's mental health, the mental health of women with unwanted pregnancies was no different whether they had an abortion or gave birth.

Now, 98% of all UK abortions are performed to preserve the physical or mental health of the mother; of those, 99.96% involve mental health. Should we infer, with BioEdge and with the Christian Medical Fellowship, that those abortions are inappropriate, because the NCCMH study proves that abortion doesn't preserve mental health after all?

We should not. NCCMH looked at rates of mental health problems among women who had had unintended pregnancies, some of whom had chosen to terminate them with abortion, and some of whom had given birth. It found similar rates of mental health in those two populations. But the women in those populations were in them by choice. The study does show that women who choose abortion have no better or worse mental health than those who do not. But it certainly doesn't show that their mental health would have been the same if the option to abort had been denied them, and they had been forced to give birth. The study, in other words, leaves open the question whether abortions are good for the mental health of the women who choose them.

Abortion Doesn't Affect Mental Health

A new study from the Academy of Medical Royal Colleges' National Collaborating Centre for Mental Health (NCCMH) finds that, while unwanted pregnancies place women at risk for mental health problems including depression, the rates of mental health problems among women with unwanted pregnancies remain the same whether they have abortions or give birth. The finding certainly undercuts anti-abortion arguments about the prevalence of "abortion regret" and the supposed negative mental-health consequences of abortion. An important question is whether it also de-legitimates the idea of "abortion for the sake of the mental health of the woman." (A Christian Medical Fellowship spokesperson is quoted making that argument near the bottom of this article.) But that's a misreading of the findings. The women in the studies that NCCMH reviewed weren't, after all, randomly sorted into "abortion" and "birth" groups. Each chose her own best all-things-considered option given the fact of the unwanted pregnancy, her own moral views, her doctor's advice, pressure she was receiving from partners or relatives, and so on. The fact that the "abortion" and "birth" groups had similar mental-health outcomes therefore certainly doesn't imply that the outcome would have remained similar if all the women who chose to have abortions had instead been denied them.

New Jersey Nurses Sue to Avoid Abortion Care

The University of Medicine & Dentistry of New Jersey recently and abruptly changed its conscientious objection policy to require nurses to provide care to hospital patients before and after they undergo abortion procedures. Previously, the University had permitted nurses to avoid caring for abortion patients at all, if they objected morally to abortion; but the new policy requires them to deliver pre- and post-operative care. Nurses are still free to decline to participate in, or to be present in the room during, the abortion procedure itself. A dozen nurses have sued to stop the implementation of the policy, and in November a judge granted a restraining order barring the hospital's training of nurses in pre- and post-operative abortion care until after its December 5 hearing on the case. Conscientious objection laws for healthcare providers are problematic, particularly if they reduce access to necessary medical services; but here there seems to be no question of the availability of the procedure. It seems to me that being required to take care of a pregnant mother just prior to her abortion, and then again just after it, is seriously offensive to a nurse who's morally opposed to abortion. If the nurses who feel strongly about this issue are a small minority of available nursing staff (which they seem to be), then I think the University ought to return to its previous, more sensitive, conscientious objection policy.

That's waaay more than "surrogacy"

Wow. This BioEdge article, somewhat tamely titled "Surrogacy thrives in China, despite illegality," includes the following shocker: "[One s]urrogacy agency promised an undercover reporter posing as a customer that for 1 million yuan (US$150,000), the company would enlist 5-7 surrogate mothers and impregnate them with the customer’s sperm all at once, solely to ensure that at least one baby is a boy...[F]emale foetuses who are not wanted are aborted. If all babies are girls, the mothers have to keep getting pregnant after abortions....In the more likely situation that two or more babies are male, the customer chooses a mother to carry the foetus to term, and the other babies are aborted." I'm generally pro-choice and pro-surrogacy. But this industrial-model combination of bodily commodification and the callous routinization of abortion as a form of manufacturing quality control (where "quality" is maleness) is just evil.