A memo to pregnant women: welcome to dystopia. nnIn the bad old, or good old, days, depending on your vantage, before Roe v Wade, women who wanted an abortion began the search. Wealthy women sought out a physician willing to risk his license to provide a sanitary D&C (dilation and curettage). Or they went to Europe. Lower down the economic ladder, the choices shrank to to less-sanitary clinics, maybe “back alleys” staffed with “abortionists,” not physicians. At the bottom rung, women used coat-hangers, which worked, though too often they pierced the uterus, leading to sepsis, sterility, and/or death. Or women drank the concoctions that were rarely harmful, rarely effective.
Geography always loomed: in cities women could more easily find a physician, or a back alley. The more rural the woman’s home, the harder the search. Indeed, physicians themselves were a scarcity: the Public Health service has been subsidizing medical education for students willing to practice in “under-served” areas since 1972. In rural enclaves of the United States, people still must travel far to find a doctor, or a hospital.
Today, even outside rural America, the search for an abortion is difficult.
Honors go to Missouri for its war on pregnant women. First came legislation that made abortion illegal after eight weeks, regardless of rape or incest. Then came mandated “counseling,” followed by a 72-hour waiting period. That pushes women close to the eight-week ban. If women jumped through those hurdles, Missouri erected one final hurdle: find a clinic. In August a judicial hearing allowed the St Louis Planned Parenthood to remain open, giving it time to resolve its regulatory thicket. Today, the one clinic lives on, clinging to a judicial lifeline, but it is the only clinic. Semi-surreptitiously Planned Parenthood is expanding its clinic in Southern Illinois. Other clinics that sought to expand or open have met with protestors, equipment that didn’t get delivered, phone lines that didn’t get installed.
A flurry of states have joined the fray. Common barriers focus on “fetal heart beat” (more accurately, a flutter of tissue): no abortion once one is detected, generally at six to eight weeks, mandated ultra-sounds, mandated pre-procedure counseling, mandated waiting periods. Forget public insurance coverage: most states don’t allow it; and 12 states restrict private insurers from covering abortions (though enrollees may buy an additional rider).
Rape and incest are no longer routine exceptions. In 1959, when the American Law Institute weighed in, before Roe v Wade, the law allowed abortions for rape and incest. At the time, opponents argued 1) that unfortunate offspring should be protected, 2) that women could not become pregnant if they were raped, and 3) women would yell “rape” simply to get a legal abortion. Nevertheless, the “rape-and-incest” exceptions remained standard. In 1990 even the National Right to Life Committee allowed these exceptions, recognizing the mood of the electorate. That mood has shifted. Today a few “hearbeat” states (Louisiana, Missouri, Ohio, Mississippi) allow abortions only if the mother or the fetus risks death. Alabama’s “no abortions anytime” law does not exclude rape or incest.
The latest bugbear goes to the supply side: credentials for physicians. The physicians in Planned Parenthood clinics have medical degrees, have done residency training, but do not necessarily have admitting privileges at the local hospital. If they don’t practice there, and routinely admit patients (almost no clinic patients have serious complications), the physicians don’t need privileges. The requirement is simply a hurdle, one opposed by both the American College of Obstetricians and Gynecologists and the American Medical Association.
In fact, even though “medication abortion” (a combination of two pills) has made abortion safer than the surgical procedures, that has not detoured states from their zeal-to-bar. Approved by the Food and Drug Administration in 2000, the two-dose treatment is now used in almost half all Planned Parenthood abortions. The World Health Association has blessed it because “telemedicine” makes it an option for women in rural areas. Nevertheless, state laws encompass those prescriptions in their sweep: in most states a physician must administer the drugs, or, at the least, be present in the room if a physician’s assistant or nurse does. (Technology “trumps” state bars: desperate women can “Google” for the pills, e.g., Aid Access).
Alabama designed its law to spur the Supreme Court to reverse Roe v Wade, sending “abortion” back to state legislatures. Whatever the Supreme Court rules, states are already rushing back to the past, plunging pregnant women once again into a cruel misogynist reality.
Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.
From The Progressive Populist, November 15, 2019
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