Archive | June, 2011

IUD insertion immediately after abortion: Time to break down the barriers

30 Jun

Although women get abortions for many reasons, the majority of women choosing abortion do so because they got pregnant when they didn’t want to be. It stands to reason that at the time of the abortion is a perfect time to help women start using highly effective contraceptives. One of the most effective methods, the IUD, is an ideal choice for women without plans to become pregnant in the short-term because once inserted it is effective for 7-12 years (depending on which IUD is chosen) and requires no ongoing maintenance, unlike other methods which require visits to clinics and remembering to take a pill daily, change a patch or ring, or get a shot every 3 months. All of this ongoing maintenance requires time and money.

So the IUD offers women a simple, long-term, easily reversible contraception that is as effective as tubal ligation (having one’s tubes “tied”). It is also the most cost-effective method available (when used long-term; the costs over the first few years are higher than other methods). So what’s the hold-up? Why do only 5.5% of Americans use IUDs?

Women do not get the most effective contraceptive care for the same reasons that many Americans don’t get the most effective health care in general. We have a system built on a fee-for-service model that relies on short-term membership in private insurance plans, which disincentivizes investment in preventive, cost-effective care that has up-front costs. We have a system that bills per service rather than for caring for a patient. We have a system in which pharmaceutical and device companies raise their prices significantly with impunity. (We also have a culture that systematically misinforms teens and adults alike about sex and contraception, but you can read about that here, here, and here).

Many women with private insurance find that their insurance does not cover one of the most effective, and the most cost-effective, methods available. The IUD itself can cost over $800, with the insertion fee from the physician easily bringing the cost to $1200 or more. Because many young people will change from insurer to insurer as they change jobs, the companies generally do not want to invest that kind of money into pregnancy prevention for their members. What makes sense for the individual, or even our society as a whole, often does not make sense for a profit-driven insurance company.

Billing is another barrier. Unfortunately, all clinics providing reproductive health care must pay attention to their bottom line. They can’t provide the vital services they offer if they don’t stay afloat. So unnecessary requirements, such as lack of reimbursement from insurance companies for IUD insertion done on the same day as an abortion, substantially hamper access for women. The result has often been that women have to wait until their follow-up appointment to get their IUD inserted, meaning they have to go through another procedure (when the IUD could easily have been inserted in less than 1 minute if done immediately after the abortion) and also have to make it to a follow-up appointment, which means more time off from work, more money for child care and transportation, and often more money for the visit to the clinic.

Barriers within the medical system also get in the way; some physicians believe that inserting an IUD immediately after abortion is more likely to cause complications and more likely to self-expulse (or fall out).

Because of these barriers, many women who want to use an IUD for contraception after an abortion are leaving without one. Although they are given follow-up appointments and theoretically should as a result have good access to IUDs, the fact is that many women are slipping through the cracks.

Fortunately, a new study shows that IUD insertion immediately after an abortion is safe and effective, and most importantly prevents repeat unintended pregnancy. 575 women who wanted an IUD after their abortion were randomly assigned to two groups: one group that had the IUD inserted immediately while the other was given a follow-up appointment for the IUD two to six weeks after the abortion. Not surprisingly based on prior studies, the group that had the IUD inserted immediately after the abortion had a slightly higher expulsion rate (5% vs. 2.7%) than the delayed insertion group. Though this might sound like an argument against immediate insertion of IUDs after abortion, what’s actually important is how the individual woman is affected. Despite this higher expulsion rate, NONE of the women in the immediate insertion group were pregnant within six months, as opposed to FIVE in the delayed insertion group. All of those pregnancies occurred among the 29% of women who never managed to get their IUD after their abortion.

Bottom line: immediate IUD insertion after abortion is safe, effective, saves money, and most importantly, prevents unintended pregnancy! I hope that policy-makers and doctors will take note of this study and take action to break down the medical, policy, insurance, and financial barriers that keep women from getting the best care possible.


Egg Donation Confidentiality: Does it promote “designer babies?”

29 Jun

It’s been a while since I have been able to write about the egg donation process. I’m choosing to write about it now, despite having made no further progress in my quest to become an egg donor. And it’s for the silliest reason: I do not have blue eyes.

I am blonde. I am tall. And musical (degree in Opera), and athletic (I run half-marathons). I am educated (BA’s in both Opera and English, and an in-progress Masters in Psychology). I am thin(ish… a size 8 still counts, right?). I am employed. Ostensibly, I am an “ideal candidate” for egg donation. And yet, it’s been well over a month since my name and my photographs (10 pictures in all, ranging in age from 18 months to current) have been screened by potential recipients. Not a single interested family. The only reason that my coordinator can give me: “you do not have blue eyes.”

Genetically speaking, the possibilities are endless for eye color when blue and hazel are mixed. I have every shade of color in my eyes in some form or another. I have hints of blue, a significant portion of my eyes are green, and I have a brown star around each iris and a brown ring around the outside of each eye. My coordinator has closeups of my eyes to prove this detail to potential recipients, and none of them want to risk “having a baby with brown eyes. How would we explain that?”

It has left me wondering why this seemingly insignificant detail has left me out in the proverbial cold. Is it that couples are interested in “designer babies?” Or is it to preserve the confidentiality of the situation? I’m not convinced either way.

The confidentiality agreement states that you and the recipient will have no contact. Completely anonymous. The child that results from the donation will never know that they were a donor-baby. They will never have access to your medical information, and you will never know anything about them. It is illegal to seek them out, and your information will never be provided to them, even after they are over the age of majority.

I understand why these confidentiality agreements exist, and for the most part, I agree with them. I disagree with the medical information restrictions for a few reasons, but those concerns do not warrant not doing it.

I keep coming back to the designer babies argument. Yes, these parents do want designer babies. The amount of genetic, psychological, intelligence and medical testing that goes into this process makes this indisputable, especially combined with the amount of rejection that I am experiencing based solely on my eye color. “How would we explain that?” Well, a recipient could simply explain that they used a donor, but most will not. Why? Stigma.

Women are worthless unless they can reproduce. We are failures if we do not/cannot. And we will be shunned if anyone finds out that we don’t want to/can’t.

This is a load of bullcrap, but it is what society continuously pushes on women. Even women who want to reproduce are not exempt from stigma. We are in a no-win game.

So women who are desperate enough to become mothers will use an egg-donor, but they will not use the best candidate. They will use the candidate who looks the most like them. They will “design their baby,” because they don’t want to be subjected to the judgment of society.

It makes sense. If I had the choice to endure stigma or to not, I probably would choose not to too. But this stigma, contained within something that should just bring joy to families is the dark side of egg-donation. And in this act, there should be no “dark side.” My gift should simply be able to make potential parents dreams come true, regardless of the color of my eyes.

The Right Uses the State to Harass Abortion Providers

28 Jun

A guest post by Peg Johnston, an independent abortion provider in New York State and member of the Abortion Care Network.

It’s official, the antis have found a way to use public funds to wage their campaign against abortion providers. (Or ANOTHER way, I should say, since funding for their propaganda centers and abstinence education is sizeable, but this is more direct.) Their first target, ironically, is Whole Woman’s Health, arguably one of the best clinics in the U.S. Not surprisingly, the state they have manipulated is Texas, one of the worst states in which to offer women abortion services. Says Amy Hagstrom Miller, CEO of Whole Woman’s Health, “I feel like I live in another country where abortion is illegal.”

Here’s how it works: the anti-abortion folks make complaints to various state agencies, anonymously of course, triggering an inspection –many inspections. If you work in a hospital or nursing home or any medical setting you know that a 100% perfect inspection is a rarity. There are always little nitpicky things that you could get caught on, none of which have anything to do with quality patient care. But a spontaneous inspection is its own form of harassment. And in these times more importantly, the state of Texas is nearly bankrupt; the taxpayers should be fighting mad about state agencies wasting time and money on an anti-abortion fool’s errand. But of course, this is Texas we’re talking about.

So, when this story comes to your attention, don’t for a minute think that the abortion clinic is doing something shady. They are not. In the light of the hideous conditions revealed by the investigation of Philadelphia based Dr. Kermit Gosnell, you might understandably be suspicious. The difference there is that the state of Pennsylvania failed to inspect. Had they kept up with regular scheduled inspections women might have been protected from Gosnell’s illegal and substandard practices.

The weight of state scrutiny is considerable but in places like Texas it can also be capricious. Not only is it burdensome, but when the state suddenly shows up it can make you feel like you’re doing something wrong—particularly when anti abortion websites try to make something over a labeling error or other non-patient care issue.

Always remember that the anti-abortion extremists are trying to stigmatize abortion providers. Don’t assume abortion providers are doing bad things. And if this state sponsored harassment of abortion providers comes to your state, call your representative to protest the waste of state funds. Abortion providers are all for inspections—exactly what any medical facility can expect, and not more. But the taxpayers should not be paying for the state to do the bidding of the anti-abortion movement.

The Persistent Problem of Sex-Selective Abortion

24 Jun

My brilliant, wonderful father, who is my hero in so many things, is anti-choice. He’s also opposed to gay marriage; there are a number of social issues on which we disagree. Over breakfast the other day (an excellent time to discuss polarizing politics if ever there was one!) he brought up the problem of sex-selective abortion and asked me if, given that a severely disproportionate number of females are aborted over males, I would re-think my pro-choice stance. I said no.

The question everyone keeps asking and saying we need to address – the question of whether abortion, and the right to choose, is causing what the Economist identified last year as a “gendercide” – is, to my mind, absolutely the wrong question.

Parents in many countries are clearly deciding they do not want baby girls. Baby girls do not hold the same value as baby boys, and young girls and women do not have the value of the men those baby boys will grow up to be.

Let me be explicit: eliminating abortion access does not make this problem stop. It does not save women. When parents who are pregnant with a girl cannot abort but do not wish to keep her, they often kill or abandon her. And despite the extremely popular contrary opinion we hear so often on this blog, those of us in the pro-choice movement are not also pro-murder. Once a baby is born, it’s born. Once a baby is born, it is an independent, breathing, living being that deserves every support we as a society can offer it, and drowning it in a well or leaving it on the side of a road to die is murder. And we are against murder here! I repeat that point only because there frequently seems to be so much confusion.

So the real question is, why do parents feel the need to abort based solely on the child’s sex? I believe it is because every society in existence, at present, goes to great lengths to devalue women as a gender. We are objectified, patronized, controlled. People – generally men, with the support of a small handful of women with power and internalized sexism – decide what is best for us without our input. Women make up 51% of the population in America, and more than half of college graduates, but still comprise 10% or less of Congress. The Rockefeller College of Public Affairs and Policy reported in May that women comprise 23% of federal and 27% of state-level judgeships (yes, they also claim “judgeships” is a word). This means in the courts, where an overwhelming number of questions on women’s rights stand to be decided in the near future, women themselves are desperately outnumbered at almost 5 to 1.

And then there’s that internalized bit I mentioned. When the women given the highest pedestals and the most attention in our nation are generally white, thin, apolitical reality TV stars, while politically conscious women are derided as bitches and “feminist” has become a four-letter word, it is hard for little girls to value themselves or want to make a difference. To hear people tell it, these days, they mostly want plastic surgery and a very large sweet sixteen party, ideally attended by Heidi Montag and Spencer Pratt. And if we don’t value ourselves, why should men? Why should anyone listen to us if we’re afraid to speak because it will make us look bad, or if we’re never taught how, for largely the same reasons?

And that is just in America which, in my entirely biased opinion, actually is the most phenomenal place in the world to live (sorry, fellow Canadian bloggers). In poorer countries, where more of the population is rural, the problems are more numerous and considerably worse.

Ironically, the question of whether women should have access to abortion plays into the very same mentality that contributes to the sex-selective abortions so many concerned citizens seem to want to try and combat (and I do genuinely believe many people of the people expressing concern really do want to stop sex-selective abortions and not just control women’s reproductive choices – frankly the subject makes me want to give up, curl in a ball and cry). But that concern would be much more helpful if it were directed at the cause of gender-specific abortions – namely, the lack of value placed on women in so many societies – and perpetuating the idea that women aren’t capable of, or shouldn’t be allowed to, make their own reproductive choices only exacerbates that very problem.

When someone tells you parents abort female children more readily than male children in many countries, tell them this is not news. Ask them why they think parents value a boy more than a girl. And ask them if eliminating access to abortion and thereby once again demonstrating that women cannot be trusted to make reproductive choices for themselves but require the state to prescribe them will help address that problem of value. I am absolutely certain that it will not.

The Truth About Latinas and Abortion

23 Jun

What does the Latino community actually think about abortion? Do we think that Latina wombs really are the most dangerous place for our children? Of course not. And thanks to a recent report from California Latinas for Reproductive Justice, we have the data to prove it.

Let’s step back for a second. Who are the majority of women having abortions? According to the Guttmacher Institute, the typical abortion patient is in her 20s, low-income, has a relatively equal chance of being white, African-American, or Latina, has at least one child, and identifies as some kind of Christian. Not exactly what anti-choice stereotypes would have you believe.

The California Latinas for Reproductive Justice report doesn’t focus only on abortion, but the facts about Latina/o attitudes towards abortion are particularly illuminating in light of the racist LA billboards. Specifically:

  • The majority of correspondents “strongly agreed” that women need medically accurate information about pregnancy termination, but the information should not be coercive, shaming nor should try to change her mind.
  • Over 8 in 10 participants “strongly agreed” that every woman should have a right to decide for herself the number and spacing of her children.
  • Roughly 52% of respondents stated that they personally knew someone who’d had an abortion.
  • Respondents considered pregnancy termination and emergency contraception as less widely available services that they needed in their communities.
  • Respondents identified health and family as the most important values when thinking about terminating a pregnancy
  • Respondents identified a person’s financial situation and not wanting a child as factors having the most influence on a woman’s decision to terminate a pregnancy. The survey found that religion plays a less prominent role in these decisions.

These facts are just the tip of the ice burg, and already they expose just how full of shit the racist billboards are. The Latino community believes that abortion is health care and as such, should be available and affordable in their communities. Latinas overwhelmingly believe that women have the right to have an abortion, whether the reason be for their health, familiy, or financial situation. The racist billboards imply that Latinas are somehow traitors to their own people if they have abortions. This data reveals just the opposite–in fact, not only do a majority of Latinos support abortion, but chances are they know someone who’s had the procedure!

Read the report. It brilliantly details the intersections of health, race, class, and the reality of reproductive health care access in Latino/a communities. You can also read the executive summary or this article from the Center for American Progress.

Rape, Abortion and Prostitution

22 Jun

It is such a common refrain that it no longer shocks me. Antis tell us all the time that a woman who has sex “asks to get pregnant” and as a result, should have to “live with the consequences,” meaning motherhood. In fact, when it comes to women, we pretty much ask for all the negative things that happen to us. Women are constantly told that if they don’t want to be raped they shouldn’t ask for it by dressing/walking/talking/looking/thinking…“slutty.”

Lawyers in Canada took this refrain to an entirely new low recently. For those of you who are unaware, 3 brave sex workers are in the process of challenging Canada’s antiquated, dangerous and totally useless prostitution laws. Here in Canada, prostitution isn’t illegal, but communicating about it is, so is “living off of the avails,” meaning sex workers can’t hire drivers or security staff, as is running a “bawdy house,” meaning women can’t work in groups for safety. The rules are insane. It forces women to size up their Johns in a matter of seconds before jumping into their cars. It puts countless women in dangerous situations because they can’t work together or hire security. In fact, Robert Pickton, a pig farmer in British Columbia, was recently convicted of murdering 6 sex workers, which doesn’t even scratch the surface of the dozens of women he was charged with murdering. Not many people even blink an eye when they hear of a missing sex-worker because society has just come to accept that that is what happens to “those” women.

The 3 women won their case at the lower court level and now they are fighting an appeal by the Federal and Provincial governments, conservative and religious groups and some misguided women’s groups. It’s been pretty tough going for the opposing groups so far. The panel of judges for the Court of Appeal has been asking some pointed questions of the government lawyers, noting,

“What the respondents are saying is that prostitutes can’t take the security steps anybody else would take in any other business,” Judge Doherty added. “To comply with the law, they have to take much greater risks than anybody else.”

They panel hasn’t been any easier on the lawyer for the conservative and religious groups, who suggested to the court that the risk to the sex workers might be justified,

While the physical risks prostitutes may face as a result of not being able to work in brothels with security staff is a “sad side effect” of the law, the legislation still serves the valid purpose of ridding Canadian society of a morally abhorrent practice, he argued.

Justice David Doherty asked Agarwal if he was suggesting Canada just has to put up with the risk of violence to sex workers as a kind of collateral damage.

“Are you somehow saying that could be justified by the criminal objective of trying to eradicate prostitution . . . . By saying we eradicated prostitution at the cost of ‘x’ number of lives?” the judge asked.

His thoughtful response?

“You’re dealing with complex considerations,” Agarwal responded.

I fail to see how this is a complex issue. Prostitution is a job choice. A choice that isn’t even illegal. But the government has gone above and beyond to ensure that the women who engage in such activities are forced to do so in the most dangerous manner possible. Because  “people” think it’s immoral. Well I think  raising chickens in tiny cages is immoral. That doesn’t mean I should get to make such jobs more dangerous, say by outlawing chicken farmers from using ventilation in their barns. You know, because they are asking to be poisoned. If you see the absurdity in that logic, you must be able to see the absurdity in the logic behind prostitution laws. And by logic I mean idiocy.

Sex workers are not asking the government to step in and regulate their profession to make it safer. They are asking the government to stop making it so dangerous. Abortion rights activists in the US want something very similar. Stop making abortion prohibitively expensive. Stop making women jump through ridiculous hoops to get their abortions. Stop making it so difficult for women to get a safe abortion. Just back the fuck off. We don’t need a nanny state telling us we might regret it one day.

This story leads to my next point: How can we ever expect society to stop telling women that they “ask to get pregnant” when they have sex if we still allow society to tell women they “ask” to get raped and “ask” to get murdered? In what way is it okay to insinuate that a woman who sells sex deserves to meet a violent death? We don’t tell pedestrians that they ask to get hit by a car if they walk beside a road. We don’t say that a woman who dies during childbirth asked to die (unless she got pregnant out of wedlock, then she deserved it). Why do we remove the blame from the real perpetrators when it comes to abortion and sex-work? Why can’t society give women responsibility for their own bodies and stop trying to interfere?

Because then we might stop relying on men and then who knows what will happen.

Common Vaginas or Why I Will Always Love Justice Ginsburg

21 Jun

Yesterday, the Supreme Court came down with a 5-4 decision in Wal-Mart v. Betty Dukes, perhaps unsurprisingly in favor of Wal-Mart.  Betty Dukes and 1.5 million other women who have worked at Wal-Mart since 1998 brought a class action lawsuit against the corporation based on the grounds that they were being discriminated against based on their gender.  In their view, women at Wal-Mart were less likely to be promoted and were paid less than men for the same positions.

Now, equal pay for equal work is not new news.  Today, women in the U.S. make 77 cents for the dollar a man makes.  Last year, the Paycheck Fairness Act failed in the Senate by the two votes needed to withstand a filibuster.  This battle is clearly on going on many fronts, but as Wal-Mart is the nation’s largest employer, it plays a particularly pivotal role.  What I found most distressing is that the Court essentially gave Wal-Mart a waiver because they had a formal policy on the books against gender discrimination.  Essentially, if the policy is there, the corporation cannot be held accountable for what middle management in far away places is doing, even if it is reoccurring pattern.

Now, I’m not a lawyer but as someone who worked on a Supreme Court case with the primary duty of bringing diet coke to my boss who delivered an oral argument, I can tell you this looks like a loophole in the making.  It really reminds me of the idea of “too big to fail.”  It’s as if it’s “too big to control.”

Strangely enough, the decision has almost nothing to do with discrimination.  The case became a vehicle for deciphering the details of class action law, and how to classify these 1.5 million women.  The classification made was apparently incorrect in the eyes of the Court. Even the almighty Ginsburg concedes this.

What Ginsburg highlights though is the lack of mention of discrimination in the majority opinion, the failure of the Court to give so much as a sentence of “credence” to this original issue.  Instead the court goes into the minutiae of Rule 23(b)(3).  This I leave to the lawyers to contend with.

The one legal issue from the decision that I do want to address is commonality.  Commonality is defined as, “the existence of a class of persons who have suffered the same injury.”  There are legal semantics here, which to be clear I am not examining, but the idea of women as a whole being defined by this conception of suffering common injury is extremely compelling.

As someone who thinks a lot about the meaning of gender, and if it even truly exists, it is often difficult to put a finger on what makes a woman a woman.  And this conception of shared injury may very well be it.  If gender is a social construction, it is what society makes of a woman that makes her one.  So in essence the discrimination one faces based on her presentation as a woman, makes her a woman. Not to say that discrimination itself is essential to womanhood.  I have high hopes for society changing and defining women through virtues and equality.  When this will happen I can’t be sure, but even on a day like today I believe it.  If only because the woman who started the ACLU women’s rights project is sitting on that bench telling Scalia what’s up.