Abortion

“Professor Death”

Controversial bioethicist Peter Singer talks about the difference between humans and animals (none), the virtues of euthanasia (many) and why some babies are better off dead.

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Peter Singer talks about a lot of awful things in an awfully nice way. With a slight Australian accent, he discusses “babies without brains” and “patients in a permanent vegetative state” like a weatherman would discuss scattered showers and afternoon storms. Only rarely, when pushed to the limits of his own argument, or just beyond, does he raise his voice. A little.

Singer’s appointment as Ira W. DeCamp Professor of Bioethics at Princeton University’s Center for Human Values in 1999 didn’t go unnoticed. There were major protests from pro-lifers, from people with disabilities, even from ex-presidential hopeful Steve Forbes, of all people, who threatened to stop making donations to his former alma mater. Now, all the protesters are gone. The lectures by “Professor Death,” as his critics like to call him, are not disrupted anymore. Actually, at a “practical ethics” class on a Monday morning not long ago, his students barely made a sound.

His ideas, however — readily available to friends and enemies in the new anthology “Writings on an Ethical Life” — have pretty much stayed the same. His central argument is elegant and simple; a child might have come up with it. Humans are animals, therefore animals are in the same league as humans, and should be treated as such. By attacking what he calls “speciesism,” racism based on species instead of skin color, Singer raises the status of animals. (He is generally considered to be the founding father of the animal liberation movement and has turned quite a few meat eaters into vegetarians.) But, and this is the more controversial part, in raising the status of animals — or nonhuman animals, as he calls them — he effectively lowers the status of human beings, just as Charles Darwin did when he showed that all living beings are biologically related.

Moreover, Singer’s utilitarian worldview, which defines good or bad by the pleasure or suffering it causes, leads him to believe that the life of a human being is not always sacred or worth living. Death is sometimes preferable to life. The 54-year-old philosopher from Melbourne maintains that the life of an infant is not automatically more valuable than the life of a higher animal, say a pig, especially not when that infant has all kinds of “defects.” Parents should be allowed to have the life of a severely disabled baby ended, according to Singer, just as a pregnant woman is allowed to have an abortion when she discovers her embryo will become a disabled child.

Not even the Netherlands, the first country in the world to have officially legalized euthanasia, goes this far. According to Dutch law, the patient always has to be able to give informed consent to the active ending of his or her life. Infants (and “patients in a permanent vegetative state” or people with advanced Alzheimer’s, among others) cannot give such consent. So helping them to die is murder.

As three of Singer’s Jewish grandparents were killed by the Nazis when they were living in Austria (his parents fled to Australia in time), it is ironic, to put it mildly, that some of his fiercest critics in the U.S. and in Europe call him a Nazi. They think that when you accept Singer’s views, the euthanasia program of the Third Reich, in which thousands of unwanted human beings were put to death, can’t be far away. Salon interviewed Singer at Princeton University.

Do you still get hate mail or threats?

Threats, occasionally. By conservative Christians mostly.

Princeton University has always stood by you?

Yes. They’ve been very good.

Have you been enjoying it so far?

Very much.

Is there a lively discussion going on about the issues at the Center for Human Values?

Not until I came — there wasn’t anything going on. Now, you have Lee Silver, who is a molecular biologist, discussing a lot of bioethical issues, and Shirley Tilghman, who heads the National Center for Human Genome Research. We’ve been co-sponsoring lectures.

Are people in academia afraid to talk about your work?

There’s a certain narrowness about discussion in America. If you go outside the bounds of that narrowness — in different directions — you get a not very tolerant response. It’s not that people say, “I don’t agree, it’s poorly argued” or whatever. No, they jump up and down with placards, or write letters to the university president saying you should be dismissed.

Do you think there’s a “Stalinism of political correctness” at work, to use the words of conservative provocateur David Horowitz?

In my case, it’s the conservatives telling me I’m not allowed to say certain things. So conservatives have their own p.c. — you could call it counter-p.c. But you shouldn’t take all this too seriously: Nobody can stop me from saying what I think. The irony, of course, is that because of the controversy, many more people are reading my books.

Which makes your colleagues criticize you for wanting to get into the spotlight by saying shocking things.

I think it does mean that the discussion doesn’t go very deep if you only look at the controversial statements and not at the reasons behind them. If my critics only have me saying babies should be killed or whatever, they can easily attack me. That’s a bad thing about the nature of the debate.

Are you working on more boring stuff now?

I’m doing stuff on issues like global warming — which I suppose are not quite as inflammatory.

But you also wrote a book review about bestiality in Nerve.

Talking about p.c., I got a lot of flack for writing that. One student wrote a negative article in the student newspaper. But I also got a fax from the Westboro Baptist Church in Topeka, Kan., charging that because of me, Princeton is equal to sodomy, incest and bestiality.

That’s a bit of a stretch.

I would say so. What irks me, though, is that it’s such a minor interest of mine. I was asked to review that book. I thought it said some interesting things, especially about the way people try to separate themselves from animals. Now people are saying I’m an advocate of bestiality.

You never get angry about this?

I get annoyed more than angry.

What makes you angry?

What makes me angry? I think I get angry when people cause serious suffering, or don’t alleviate suffering when they could. I got pretty angry about the stuff that President Bush did recently — not only that he withdrew from the Kyoto [Protocol] but that he said “first things first”: the economic interests of Americans. That sort of smugness. Americans think they’re the leader of the world and yet can say that they’re putting their economic interests ahead of the lives of — quite possibly — tens of millions of people who over the next 50 years will die because of floods or storms or tropical diseases or whatever. I guess that sort of thing makes me angry.

Really? You don’t have to worry about a thing here in this beautiful building on this beautiful campus …

Maybe I have a little bit more empathy with other people.

President Bush makes you angrier than someone calling you a sodomite or a Nazi?

The Nazi stuff used to make me angry because of my particular background, but it happened so often that I got used to it. Which is a bad thing, but quite honestly I have.

In Switzerland a group of protesters for the disabled took your glasses and crushed them. Did that make you angry?

Yeah. That was pretty close to physical violence. And the fact that some people in Germany were calling me a Nazi. But you can’t be angry about the same thing for 12 years.

Most proponents of the right to die would agree with your ideas about euthanasia. But you lose them when you suggest that it’s OK to kill a baby before it’s 28 days old, because until that time, it is not self-aware and “doesn’t have the same right to life as others.”

I wrote that in 1995. I have changed my position. Now I believe you should look at every individual case.

Have you ever held a newborn baby?

I have had three children. They’re grown-ups now. They live in Australia.

Some people think your theory about infants is too clinical, as if having a baby is like buying a new car.

No, I don’t write like that at all, I think.

But people who say “Never hurt a baby because a baby is sacred” are being sentimental?

Listen, if you have a newborn baby and the baby has emerged reasonably healthy and normal, of course you wanted to have a child, so you love and cherish that baby. But I’ve had letters from people who say: “When our baby was born something was wrong with it. The doctor wanted to operate, and now, three years later, the baby has constant seizures, is unable to walk or talk.” It’s a disaster. It would have been better if the baby had died. There’s nothing clinical about those letters; they’re tragic. But they are saying: Not all human life is sacred. Sometimes it’s better if the baby dies.

The U.S. doesn’t allow infanticide or euthanasia. Isn’t it happening anyway?

I don’t know. But I would suspect there is actually even more ending of patients’ lives without their consent in this country than there is in Holland. We did an anonymous survey in Australia, and found that a lot of doctors were ending people’s lives. Sometimes they would say, “I’m giving morphine; I know it will shorten the patient’s life, but I’m treating the patient’s pain.” Sort of a double effect. Many were prepared to admit to us that the primary intention of what they were doing was to end a patient’s life. There was another, smaller survey in California with similar results, and one in Belgium. It’s not totally surprising, because if it’s illegal to actively end someone’s life, it’s hard to openly discuss it with him or her.

When a baby is born without a brain, the quality of life for that baby won’t be very high and killing it makes sense to a lot of people. But what if the definition of quality of life changes, and only the life of babies with blond hair and blue eyes is considered worth living?

In the case of a newborn baby without a brain, you could say the quality of life is zero, because there will be no consciousness. But you could keep the baby alive — although that doesn’t happen very often. So doctors are already making decisions based upon the quality of life. There’s a continuum here: Some babies are born with a little brain, there are premature babies with massive brain hemorrhages and so on. So everyone who agrees that not all human life must be preserved at all costs just because it’s human and because it’s biologically alive is going to have to get into the rather tricky and gray area of just what quality of life is enough.

So maybe in 10 years a potential I.Q. of at least 100 would be added to the list of what makes life worth living?

That’s possible. What we need to have is an ongoing debate about these things. Not just scream at each other.

What to do with all the knowledge — which is becoming available earlier and earlier these days — about the future of a newborn?

In the case of in vitro fertilization, for instance, you could study the embryos beforehand and see what qualities that baby will or will not have and decide which embryo to implant in the uterus. That’s an issue we need to have a serious debate on. Because if we don’t … it’s not that it’s going to go away. If we do nothing about it, some people will provide it. Some people will be willing to pay for it. Then we will have a market for genetic solutions. That doesn’t seem ideal to me.

Money already plays a role in decisions about life and death. Parents of a disabled newborn might say they can’t afford the extra costs of raising it. Is that a good argument for infanticide?

When do they know it’s disabled?

According to your theory that doesn’t matter. There’s no crucial difference between abortion and infanticide, because neither the fetus nor the newborn is a “person.”

It doesn’t make any difference to the inherent right to life of the being, no. But it does make a difference in that if the child is born with a disability that would not make its life miserable, but the parents can’t pay for the extra care, they could put the child up for adoption. If the disability is a mild one, that’s what I think they should do. If the condition is detected during pregnancy, the woman can’t give up the child unless she goes through with the whole thing until birth, which is asking a lot more than simply saying, “I don’t think you can rear this child; here’s another couple that could.”

If you make the criteria so flexible, if you make matters of life and death negotiable, don’t you think babies will become a commodity?

That may be happening anyway, in terms of selecting the children we have before birth.

You don’t think this is a problem?

It would be a problem if you have a society divided along genetic lines, where the rich can buy the genes they want and the poor can’t. I don’t think that’s the society that would be best in promoting the happiness of most of its members. But I’m not convinced it would be a problem if these services were available to everyone. It’s an open question that is worth thinking about.

From your utilitarian philosophy you couldn’t argue against it.

Some people might want to select according to characteristics that are in the interests of themselves and their children, but are not in the interests of society as a whole.

Like what?

Well, one thing that could easily happen under a laissez faire system is that people would select for height. You already see ads asking for eggs from girls who are over 5 feet 8 inches tall. The reason is that parents want their child to be slightly taller than average. There is some evidence that taller than average people do significantly better. But of course if everyone selects on that criterion, you get a race to the ceiling and that’s not good for anyone. Because we need more resources and so forth.

What if parents don’t want an ugly child?

If everyone had the opportunity to avoid having an ugly child, I don’t think I would have a problem.

Is ugliness a good enough reason to kill a baby?

I don’t think there are parents who would be prepared to go through another pregnancy just because they thought their child was not going to be all that beautiful.

Parents would never refuse to take responsibility for their baby for frivolous reasons?

Most parents are not going to do that. Most parents who go through pregnancy, and childbirth, are going to love and cherish that child.

But it does happen with abortion. A pregnant woman just may not feel like being a mother yet and have the fetus taken away.

If she has had that idea for a month, I think that’s a perfectly good reason for an abortion.

What would not be a perfectly good reason for an abortion?

There’s a difference between early and late abortions. If you have a late abortion, where the fetus might feel pain, then I think you should have a good reason. Because then you’re inflicting pain. As you go through the third trimester, you need to have more serious reasons to end a pregnancy. For instance, I would not support ending a pregnancy only because you want a boy and you’re going to get a girl, because it would reinforce sex discrimination. But if you already have two boys and you want a girl, that could be enough reason for abortion.

Do you have grandchildren?

No.

What would you have done if one of your children had had Down syndrome?

If [the fetus] had a blockage of the intestines, which is a common complication, I would have refused permission for the operation. If it did not have blockage or some other complication, but we knew a couple who would want to raise the child, we would put up the child for adoption.

Doesn’t it follow from your utilitarian viewpoint that people who want to have children should always first try to adopt, to alleviate the suffering of existing children?

I’m not sure if that follows. You could debate that.

Who should decide if the parents’ reasons for infanticide are good enough?

The doctor is the initial filter. If the doctor is in doubt about the quality of the reasons, he should consult a colleague or an ethics committee.

Do you think the doctor should be able to override the parents?

If the doctor feels that the parents’ decision is being made in a unreasonable manner, he should be able to go to some other body with the authority to override the parents. I don’t think it should be just the doctor. A hospital ethics committee is better than a court, but a court is also a possibility.

What do you say to people with certain disabilities who claim that you’re lowering their quality of life? Are they just not getting it?

I don’t think I’ve met someone who said that I’m personally lowering their quality of life.

Some say you’re making them feel dispensable.

When I’m talking to them, they’re not dispensable, are they? The only sense [in which] they could say that is if their mothers had listened to my views when they were born, they wouldn’t be here. So what? That’s not really relevant. The same could be said by a third child to someone advocating zero population growth.

Maybe you’re not saying that the lives of disabled people are not worth living, but on a scale they’re closer to that point than you are.

There are so many more factors important to the quality of life. Maybe the life of a disabled person is much more worth living than mine. All I’m saying is that at birth you can’t tell that. It’s reasonable to say that a life with a serious disability has the expectation of turning out less well than a life without disabilities. And I’m not talking about intellectual disabilities. I can imagine that parents of a newborn that is paralyzed, that’s always going to be in a wheelchair, might decide that they don’t want that child and that they are going to have another one. That’s a decision I can understand.

In the case of euthanasia of an adult patient, critics argue that the motives of the people deciding about someone’s life can be unsound — for instance, when there’s an inheritance.

I like the system in Holland, where the suffering of the patient has to be unbearable, he or she has to express the explicit intention and the doctors have to follow specific rules to practice and report euthanasia.

Do you think Alzheimer’s can be a sufficient reason for euthanasia?

Alzheimer’s can be a sufficient reason, but only when the person has expressed her wish to die before being seriously affected by the disease. In the absence of any such expressed wish, it is only in the last stages of Alzheimer’s, when the person is unable to enjoy even simple things or respond to other people, that euthanasia might be considered.

According to the new Dutch law, patients who are in unbearable pain and wish to die still don’t have a right to euthanasia.

Americans always want to describe everything in terms of rights. I don’t see the point of that. Nor should any duty be placed on doctors to carry out euthanasia if they do not wish to do so. Presumably Dutch patients will know that the law allows voluntary euthanasia, so if a doctor refuses, they will know that they can look for another one.

The law is still in the penal code, as an exception to the rule that helping someone else to die is illegal.

I think that will do, at least for the foreseeable future. Let’s see how this law works before seeing whether there is a need to allow any other cases in which someone might want to die and need help to achieve that end.

Viktor Frolke is a freelance journalist from Amsterdam. He lives in Brooklyn, New York. ly. He lives in Brooklyn, New York.

An overdue abortion access expansion

Will Congress let the military cover abortions in the cases of female soldiers who suffer rape or incest?

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An overdue abortion access expansionJeanne Shaheen, Dianne Feinstein and Patty Murray (Credit: AP/J. Scott Applewhite)

As political dares go, this one could hardly have been more blatant. “[Republicans] say they didn’t launch a war on women,” Sen. Barbara Boxer said Wednesday, “so we’re giving them a chance to walk this back.” She added, “Personally I say it’s a war on women, and the more they protest it the more I say it.” And Sen. Barbara Mikulski channeled ”Network” (or maybe old-school feminist rage): “We’re mad as hell and we’re not gonna take it anymore.” Even Harry Reid got in on the action, saying on the floor yesterday, “Republicans deny they’re waging a war on women, yet they’ve launched a series of attacks on women’s access to healthcare and contraception this year. Now they have an opportunity to back up their excuses with action.”

What spurred such rage? Nothing so incendiary as transvaginal ultrasounds or birth control — just the Paycheck Fairness Act, which passed the Democratic House in 2009 but fell to a filibuster by two votes in the Senate in 2010. It modifies the 1963 Equal Pay Act, strengthening enforcement and creating better mechanisms for wage transparency, and authorizes new research on the pay gap and a grant program to teach negotiation skills to women and girls. And while it probably doesn’t have a prayer in the House — if it can even pass this Senate — it manages to bring feminist-friendly legislation back on the table while doubling as a political tool to force Republicans into an uncomfortable corner.

Better yet, it gets to the subject Republicans have intermittently accused Democrats of obfuscating: the economy. As Sen. Patty Murray taunted in a press conference, “To those Republicans who claim to be so concerned about the economy, now is your chance to sign on, When women are not paid what they deserve, middle-class families and communities pay the price.”

Whatever happens with the Paycheck Fairness Act (likely nothing) or the dueling versions of the Violence Against Women Act, this week also saw a bill move that, if it makes it into law, would represent a rare, if tiny, expansion of abortion access on the federal level. That would be the Shaheen Amendment, named for another female Democratic senator, which allows female servicemembers — who suffer disproportionate levels of sexual assault — insurance coverage for abortion in cases of rape and incest. (Currently, the Department of Defense offers coverage only if the woman’s life is in danger, a much more limited policy than that of other federal employees.)

The amendment passed in the Senate Armed Services Committee’s version of the National Defense Authorization Act, with three Republican votes — Sens. John McCain, Scott Brown and Susan Collins. (Democrat Ben Nelson voted against it). Of course, if it manages to get through the full Senate, it has the anti-choice House to contend with. That it would be incredibly narrow says a lot about the state of reproductive rights in this country — after all, rape and abortion exceptions are a compromise that, while reflecting American public opinion, truly jibe with neither side’s actual worldview. But you have to start somewhere, and a time of heated political rhetoric about women’s rights is as good as any other.

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Irin Carmon

Irin Carmon is a staff writer for Salon. Follow her on Twitter at @irincarmon or email her at icarmon@salon.com.

“Not allowed to speak”: GOP silences D.C. rep

Rep. Eleanor Norton tells Salon how Republicans wouldn't let her talk at a hearing to ban abortions in her district

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House Republicans seem to have learned this much in the past few months: It looks bad to turn away a woman from a hearing on women’s health. So when D.C. congresswoman Eleanor Holmes Norton was denied the courtesy of testifying at a subcommittee hearing yesterday in her district on banning abortions after 20 weeks, Chairman Trent Franks, R-Ariz., suggested a compromise of sorts.

“He said that the congresswoman could, if she desired, sit on the dais of the hearing, but she would not be allowed to speak,” Norton told Salon after the hearing. She declined an offer she said “no self-respecting member” would accept.

“I certainly didn’t give them that optic,” she said drily.

Franks was technically within his rights – per the rules, the Democratic minority was granted one witness, D.C. resident Christy Zinks, who had an abortion at almost 22 weeks after the detection of a severe fetal abnormality. Still, as Norton pointed out, “there is a long tradition that goes back more than a century of allowing members to testify on a bill that may touch upon the district.” Nancy Pelosi also condemned the move.

In the testimony she wasn’t allowed to give, Norton says the so-called Pain-Capable Unborn Child Protection Act “is the first bill ever introduced in Congress that would deny constitutional rights to the citizens of only one jurisdiction in the United States, and it is the first bill ever introduced in Congress that would ban abortions after 20 weeks of pregnancy.” Last year, House Republicans managed to strike a budget deal that would deny the District of Columbia the right to use its own Medicaid funds to pay for abortions — another byproduct of the fact that D.C. is ultimately under congressional oversight and has only partial self-governance.

Seven states have followed Nebraska in passing manifestly unconstitutional bans on later abortions without health exceptions, on the scientifically suspect notion that a fetus can feel pain after 20 weeks. So far, pro-choice organizations have declined to mount a legal challenge, for complicated reasons.

Norton called it a “stalking horse” for the overturning of Roe. “We understand we’re the vehicle, we know we’re not the object of affection,” she said. “What they want from the Congress is a federal imprimatur to continue their march in the states, to say, even the Congress has voted for a bill to limit abortion to 20 weeks.”

The National Right to Life Committee has called the bill its “top congressional priority for 2012,” and will score members based on their votes, even though it likely has no chance of getting past the Senate – or the president. “They are serious about this bill,” Norton told Salon. “They’re not playing.”

That said, she thinks that despite Franks’ zeal, other House Republicans have lost their zeal for fighting what’s still being called the war on women. An earlier Franks bill, seeking to limit race- and sex-selective abortions, didn’t make it to the floor. And on the House version of the Violence Against Women Act, fiercely opposed by the White House and women’s groups, “They keep saying that they’re working on a way to reach an accommodation, and for them, that is unusual to say,” Norton said.

“They didn’t anticipate the way the war on women, as it is called, has boiled up to the surface,” Norton said. “And they’re trying to quell it somewhat.”

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Irin Carmon

Irin Carmon is a staff writer for Salon. Follow her on Twitter at @irincarmon or email her at icarmon@salon.com.

Abortions made public

States want more data on abortion patients. Zealots want their hands on it. Shame is the new anti-choice strategy

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Abortions made public (Credit: Cannaregio via Shutterstock/Salon/Benjamin Wheelock)

It was an “anonymous informant,” Operation Rescue claimed last week, after someone slipped them the April records of 86 women who were treated at Central Family Medical. The clinic’s lawyer was blunter. “It certainly appears to me that a crime was committed,” Cheryl Pilate told the Kansas City Star. Though the clinic (which performs abortions) had already reported a break-in to a locked dumpster, Pilate said it wouldn’t have contained patient records, which are shredded. The “informant” must have gotten the documents – containing names, addresses and details of procedures – another way.

“Our concern is for the privacy of these women and for their health and safety, for which Central Family Planning has shown very little regard,” said Operation Rescue’s Troy Newman – while posting photographs of the documents, partially redacted in black marker, online.

Antiabortion activists want to create the impression that one way or another, a woman’s decision to have an abortion will be discovered and exposed. The Central Family Medical incident is only the latest skirmish in a decades-long effort to undermine the privacy of abortion patients and harass doctors. In the early ’90s, for example, at least one group of clinic protesters printed on their signs the names of women seeking abortions that day, alongside “don’t kill your baby.” Such actions, while failing to make abortion illegal, have nevertheless managed to cloak it in a stigma that belies the fact that one in three women will have an abortion before the age of 45. Now, activists are seeking new ways to shame women who seek abortions, from requiring them to hand over personal information to actually hacking into their medical records.

Kansas has been ground zero for this: Last year, the Kansas Board for Discipline of Attorneys recommended that former Attorney General Phill Kline, a hero to Operation Rescue, have his legal license suspended indefinitely for mishandling the records from murdered abortion provider George Tiller’s clinic. (The Kansas Supreme Court will make the final call.) But the zeal to keep, and sometimes steal, abortion records casts a wide net.

In Texas, the state Department of Health is trying to implement a failed legislative measure that would require abortion clinics to report far more information about their patients to the state. In Florida, voters will weigh in on a ballot measure that would exempt abortion from the privacy clause in the state constitution, with the short-term aim being to strip minors of a right to privacy that would preclude parental consent. The U.K. recently jailed a hacker who stole and intended to publish the records of 10,000 women who visited the country’s largest abortion provider.

“It promotes the idea that abortion – or your privacy, if you have any – is not safe,” says Katie Stack, a graduate student and activist who spoke out about her abortion on an MTV special, “No Easy Decision.” That put her in close contact with the “online ministry” – the name antiabortion activists have given their efforts to reach women considering abortions through the Internet.

This has been the unstated goal of many activists in the antiabortion movement — and, sometimes, the stated one. “This might sound a little strange,” said antiabortion activist Lila Rose at the Value Voters Summit in 2009, but “if I could insist, as long as they are legal in our nation, abortions would be done in the public square, until we were so sick and tired of seeing them that we would do away with the injustice altogether … maybe then we might hear angels singing when we ponder the glory of conception.”

Rose won’t get her wish any time soon, but antiabortion activists are trying to use the Internet to have a similar effect. Rose was recently on a panel at the International Pro-Life Youth Conference about social media and pro-life activism, where topics included targeting women who are seeking information about abortion online, whether through Yahoo Answers or YouTube commenters – including figuring out where they live and recommending a crisis pregnancy center nearby.

“Privacy is very important to women who have abortions,” says Kate Cockrill, program director of the Social and Emotional Aspects of Abortion project, at the University of California, San Francisco. She points out that abortion is traditionally underreported even in confidential surveys, “which is a good indication that women don’t want to be associated with abortion experience in the eyes of someone who’s gathering data, even if it’s anonymous.”

Cockrill recently conducted a survey, as yet unpublished, that seeks to measure the impact of social stigma on women who’ve had abortions. It asked 641 women who had had abortions about 61 items, including questions about the fear people would gossip about you, judge you or hurt you, or the fear that you would lose an important relationship.

So far, she’s found that the women who experienced the most stigma were worried about being judged more than they were about being hurt or harmed, that they feared loss of social status and the ruining of their public identity, that they felt isolated and guilty, and that they feared community condemnation.

But as with other abortion restrictions, which create extra burdens in the supposed service of changing women’s minds, it’s not clear that anyone’s mind is being changed.

“Lots of women who feel a lot of stigma about abortions have abortion anyway,” Cockrill says. “If it’s not doing what antiabortion people want it to do, which is reducing the number of abortions, is it doing something on the other end, [after the fact]?”

Cockrill and her team are going to be using their scale in a study next year to look at the relationship between stigma and poor coping after abortion. Given that antiabortion activists have added to their obsessions the alleged harm abortion causes to women, there’s reason to believe that this is a self-fulfilling prophecy.

Women who have abortions, Cockrill says, “have a huge range of political views.” In fact, in her survey, only 62 percent of the women identified as pro-choice. (Seven percent identified as prolife, and 18 percent described their position as “mixed or neither.”)

“A lot of women don’t experience their abortions as a political act,” Cockrill says, partly an extension of the fact that they don’t see it as constitutive of their identity.

Whether it’s political rhetoric or individual ambivalence, these women are highly sensitive about whom they tell they had abortions. Sixty-four percent of the women in the study said they’d “withheld information about my abortion to someone I’m close to,” and 45 percent said they’d “lied to someone I’m close to about my abortion.”

They may not see it as political, but that silence functions as a vicious circle that antiabortion activists happily seize upon and promote. Cockrill says, “Some people say, ‘We need to have more people come out about their abortions.’ But it’s impossible to get more women to talk about their abortions if they don’t feel supported. And it needs to be on women’s own terms.”

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Irin Carmon

Irin Carmon is a staff writer for Salon. Follow her on Twitter at @irincarmon or email her at icarmon@salon.com.

Texas’ abortion enforcer

Fifth Circuit Court Judge Jerry Smith makes sure that the state's antiabortion legislation gets upheld

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Texas' abortion enforcerJerry Smith

Here is what the state of Texas considers “irreparable harm”: Continuing to provide Planned Parenthood with federal funds for the Texas Women’s Health program, which it has done for several years. Here is what it does not find harmful: immediately denying healthcare access to tens of thousands of women who have been going to Planned Parenthood affiliates for basic health services that aren’t abortions.

On Monday, a U.S. District Court judge didn’t buy the state’s legislation defunding Planned Parenthood, putting a temporary stay on the enforcement of the law. But within a day, there was another judge who found the argument persuasive: Fifth Circuit Judge Jerry Smith, last seen obnoxiously demanding that a female Justice Department lawyer ”submit a three-page, single-spaced letter by noon Thursday addressing whether the Executive Branch believes courts have such power.” (Kevin Drum memorably compared it to “a middle school teacher handing out punishment to a student because of something her father said at a city council meeting the night before,” and you wouldn’t have to look hard to find the sexist condescension.)

The District Court judge had written 24 pages on the constitutional merits, focusing on Planned Parenthood’s First Amendment rights of association. Smith issued two sentences two hours after the state’s petition, undoing that, and apparently buying the state of Texas’ argument that Planned Parenthood’s alleged “abortion promoting” mission justified discriminating against a qualified provider of healthcare.  (The clinics receiving WHP funding don’t even provide abortions, but other Planned Parenthood clinics do.)

In an election year, these posturings take on new meaning; by today, Planned Parenthood was proclaiming in a news release, “What would Mitt Romney’s America look like for women’s health care?  We need look no further than Texas,” and highlighting the policy similarities of Romney and Perry on women’s health. Romney, of course, has pledged to defund Planned Parenthood, which during the primaries became a consensus Republican issue. The last federal attempt to do so, last year’s Pence Amendment, nearly shut down the entire government, though Obama held the line — as he pointed out in a recent campaign video supporting the organization.

The presidential policies matter, but as we can see from Texas, the judiciary, prompted by state legislatures that are coming off a wave of abortion restrictions, is currently wielding the most power when it comes to women’s everyday lives, and the 5th Circuit in particular has been unrepentantly hostile to reproductive rights. When they failed with Pence, right-to-lifers turned to the states, primed by the 2010 election of even more anti-choice legislators and governors. In Texas, the conservative 5th Circuit has become a brick wall, previously allowing enforcement of the most extreme ultrasound law in the country, one that requires a woman to listen to the results.

Smith is a Reagan appointee, as is his fellow 5th Circuit conservative gadfly Edith Jones, who wrote the opinion in the ultrasound case, though if they’re feeling particularly emboldened lately, you can’t really blame them. After all, the Obama administration has shown little interest in prioritizing the judiciary, even after Bush’s ambitious effort to fill federal appellate courts with movement conservatives. A January Brookings Institution report showed that Obama has nominated fewer federal trial judges than his predecessors, even as a wave of judges retires. (Unprecedented Senate intransigence is a major factor in confirmations, but doesn’t explain the nominations.)  And Dahlia Lithwick has argued that “Obama, like Bill Clinton before him, has selected lower court judges more notable for their racial and gender diversity than their hard-left judicial orientation.”

All of this is to say that as long as states like Texas keep passing laws that punish women and stretch the boundaries of constitutional interpretation, to put it mildly, the buck is likelier than ever to stop at a judge like Jerry Smith.

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Irin Carmon

Irin Carmon is a staff writer for Salon. Follow her on Twitter at @irincarmon or email her at icarmon@salon.com.

The myth of the “morning-after abortion pill”

There's a reason why people mistake emergency contraception and abortion: The right intentionally confuses the two

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The myth of the (Credit: Shutterstock/Salon/Benjamin Wheelock)

It started around February, when Republicans were still eager to talk about contraception. The Obama administration, or so Mitt Romney charged in Colorado, was forcing religious institutions to provide “morning-after pills –in other words abortive pills — and the like, at no cost.”

It was, of course, a lie. Romney was conflating two different pills: emergency contraception, known as the morning-after pill, which prevents a pregnancy; and chemical abortion, or mifepristone, which ends a pregnancy of up to seven weeks’ gestation and isn’t covered under the new guidelines. Since both pills were marketed in the U.S. around the same time, even some pro-choicers have gotten confused. But Colorado happens to be the epicenter of people confusing them on purpose. It’s the birthplace of the Personhood movement and home to Focus on the Family, both of which have strategically called emergency contraception “abortion” on the scientifically unproven basis that they could block a fertilized egg from implanting.

There are a host of ironies here. Obama has earned the renewed support of reproductive-rights advocates by requiring health insurers to cover contraception, but the Center for Reproductive Rights is still taking him to court – with oral hearings being held this week before a New York federal court -– for overruling the FDA’s recommendation to lift the prescription requirement on emergency contraception for women under 17. That litigation has been winding its way through the system for over a decade, throughout the Bush-era politicization of the FDA, eventually resulting in a federal judge concluding that “the FDA repeatedly and unreasonably delayed issuing a decision on [the emergency contraception pill] Plan B for suspect reasons.” The FDA was ordered to explain why Plan B shouldn’t be available over the counter for girls 13 and up. When the Obama administration overruled the FDA’s recommendation to make it over the counter, U.S. District Judge Edward Korman suggested the Center for Reproductive Rights reopen its case.

“It seems to me that what we’re going through is a rerun of what happened before,” Korman remarked, referring to politics trumping the recommendations of medical professionals.

The Obama administration’s unspoken but unmistakable fear was of an election-cycle attack line that Michele Bachmann would use anyway: That teenage girls would be able to get Plan B from “the grocery store aisles next to bubble gum and next to M&Ms.” That was, in fact, an echo of the language President Obama himself used to invoke a highly unsupported bogeyman: that “a 10-year-old or 11-year-old going to a drugstore would be able to, alongside bubble gum or batteries, … buy a medication that potentially if not used properly can have an adverse effect.”

But there is another twist, so far mostly overlooked: Emergency contraception won’t be covered by insurance for everyone, since it’s available over-the-counter for those who can show I.D. proving that they’re 17 or older. They’ll still have to fork over around $50 a pop. But as long as girls 16 and younger need a prescription for the morning-after pill and they have insurance, it will be fully covered — effectively free. The same goes for women older than 17 who decide to jump through the hoops of getting a prescription, either for over-the-counter Plan B or the prescription-only generic and Ella versions.

As much as pro-choice advocates want to lift the barriers that make emergency contraception hard to get — because it’s more effective the faster you use it — one of those barriers, the prescription requirement, also mitigates another, the high cost. Said Adam Sonfield, a senior public policy associate at the Guttmacher Institute, of this catch-22, “It presents a tradeoff between cost and access.”

– – — – — – — – — – — – — – — – — – — – — – — – –

Part of the reason people get confused about emergency contraception and abortion is because lots of people are confused about the basic biology of pregnancy: specifically, that it doesn’t necessarily happen instantaneously and that sperm can live in the body for several days, during which time a woman can ovulate and an egg can potentially be fertilized and implant. Regular use of hormonal contraception prevents ovulation and the chance for fertilization; emergency contraception essentially works the same way except that it’s taken after sex, by which point ovulation may have already happened. But according to recent studies, there is no evidence that taking emergency contraception after ovulation and fertilization will stop the egg from implanting.

But the misinformation and misunderstanding have created a contradictory public health picture when it comes to emergency contraception. In some ways, it’s become more accessible. In 2010, the U.S. approved a longer-acting French variant of Plan B, known as Ella, and there are scattered experiments in convenient delivery, from a birth-control vending machine at Shippensburg University in Pennsylvania to a new bike messenger service in London, both of which caused minor news sensations. The annual “Back Up Your Birth Control” campaign has been promoting the line “EC=BC,” emphasizing that emergency contraception is birth control, not abortion — just in case that is a barrier for women who are considering taking it. And the Center for Reproductive Rights’ petition did manage to lower the age restriction from 18 to 17.

But there are more disturbing suggestions that misinformation is triumphing. A recent Boston Medical Center study found that many pharmacists were still often misinformed about the age requirement and were even more likely to wrongly refuse emergency contraception to 17-year-olds in low-income neighborhoods, where the rate of unintended pregnancy is higher. In Honduras, the Supreme Court upheld the criminalization of emergency contraception, which means women who use it could be jailed. Personhood initiatives, which oppose the morning-after pill, have so far failed in Colorado, Mississippi and Oklahoma, but they’ve introduced false doubts by providing even more opportunities for pundits and candidates to say “the morning-after abortion pill.”

It’s a problem that dates back decades: When, throughout the ’90s, the U.S. considered approving a French chemical abortion pill known as RU-486, it was widely called the “morning-after abortion pill,” including, often, in the New York Times. The distinction wasn’t pressed by the pro-choice community itself.  “At the time, the prevailing medical wisdom was that there is a continuum rather than a bright line between EC and mifepristone,” said Gloria Feldt, who was president of Planned Parenthood at the time, with the benefit providing more options for women who did not wish to be pregnant. “It was also assumed that a formulation of mifepristone would eventually be made for use as a true ‘morning-after’ pill.” The widespread belief, she recalled, was that a chemical abortion pill would “solve all the abortion debate problems and guarantee privacy.”

Another problem was that although doctors and non-professionals had been giving women high dosages of regular birth control pills for decades as a form of emergency contraception, the science of exactly how emergency contraception worked remained unclear. The medical definition of pregnancy remains “implantation of a fertilized egg,” but let’s say you believe, as the Catholic Church does, that fertilization itself creates a human life. Anti-choice advocates obsess over what would happen if a woman who took emergency contraception did happen to ovulate anyway and an egg potentially was fertilized, which is enough reason for some of them to call postcoital contraception “abortion.” They have claimed that hormonal contraception makes the lining of the endometrium inhospitable to a fertilized egg, constituting “murder.” Even the official packaging for Plan B, the single-step version of emergency contraception, suggests that “in addition” to blocking ovulation and fertilization, “it may inhibit implantation (by altering the endometrium).”

Except that we now know it doesn’t, even if you walk down the path of remote maybes, which requires you to believe that a zygote, which may not implant for unknowable reasons, has the same rights as a living woman who doesn’t want to be pregnant. As Princeton’s Kelly Cleland pointed out recently, “The science has evolved considerably in the last 13 years. Newer evidence, published since the Plan B label was approved, provides compelling evidence that levonorgestrel EC (LNG EC) works before ovulation, but not after.” The International Consortium for Emergency Contraception and the International Federation of Gynecology & Obstetrics also note that two new studies have shown conclusively that if a woman has ovulated and an egg has been fertilized, it’s too late for emergency contraception to work. They recommended that the language on the product labeling be changed.

Of course, scientific evidence has rarely had much place in this debate. In the meantime, even the most non-ideological news sources keep making the mistake alongside the ideologues. Last week, a furor erupted after the Associated Press reported that “Women seeking to take emergency contraception like the so-called ‘morning after’ pill would have to do so in the presence of a doctor under a bill before the Alabama legislature.” That is, until Erin Gloria Ryan from Jezebel read the actual bill and saw that it was, in fact, a law meant to limit chemical abortion, not emergency contraception. (A spokesperson for the AP said a correction was being prepared). “The confusion over this issue is probably one of the reasons emergency contraception hasn’t had as positive an impact as hoped when it comes to lowering the abortion rate,” wrote Amanda Marcotte at RH Reality Check. “If women think it is some kind of abortion-ish thing, they probably think taking it is a big deal, instead of thinking of it more like taking the pill, since it’s basically the same thing.”

But talk about moved goalposts. If ’90s-era advocates had hoped that the ability to end a pregnancy in the safety of your home with RU-486 — the actual abortion pill, not the morning-after one — would defuse the abortion debate, their more recent counterparts hoped to take it to the next technological level by providing “tele-med” abortions. They would involve doctors seeing a woman over webcam with a nurse practitioner physically present, helping women in remote areas with ever-dwindling options for safe abortions to access them. But four states have already passed requirements meant to undercut these options by forcing a doctor’s presence, and the bill the Associated Press misreported was aiming to add Alabama to the list. All in all, there have been fewer gamechangers, and more cases of one step forward, two steps back.

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Irin Carmon

Irin Carmon is a staff writer for Salon. Follow her on Twitter at @irincarmon or email her at icarmon@salon.com.

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