Why women need abortion rights

THIRTY-SEVEN years after the U.S. Supreme Court's Roe v. Wade decision that legalized abortion, the myriad attacks on its availability has limited access to such an extent that women across the U.S. are turning to so-called do-it-yourself abortions.

No governmental agency or private institution tracks the incidence of self-induced abortions. So it's left to anecdotal reports from health care providers, along with a few recent studies, to hint at what has become a dangerous pattern.

"Our local hospital tells me they see 12 to 20 patients per year, who have already self-induced or had illegal abortions," said an administrator of a women's health clinic in the South. "Some make it, some don't. They are underage or poor women mostly, and a few daughters of pro-life families."

In a 2006 interview with University of California-Davis professor Carole Joffe, the administrator described women risking cardiac arrest by swallowing whole bottles of quinine pills along with castor oil, and women who douche with a variety of dangerous chemical products in an attempt to terminate pregnancies.

The administrator said that other abortion providers around the country also noticed a perceptible rise in the number of patients they were treating for complications from illegal abortions.

Outside the South, in cities like Boston and San Francisco, medical researchers are working to compile studies, conducted mostly among Latina women, to examine the prevalence and methods of self-induced abortions.

A study by Planned Parenthood released earlier this year documented the methods used to induce abortion by immigrant women from the Dominican Republic, including "mixing malted beverages with aspirin, salt or nutmeg; throwing themselves down stairs or having people punch them in the stomach."

These studies have focused primarily on Latina and immigrant women who, in addition to the obstacles of cost and fear of harassment by anti-abortion protesters, may face additional burdens of anti-abortion conservatism and mistrust of medical treatment in their communities--as well as the fear that going to a clinic or hospital might lead to questions about their immigration status.

"In my Washington Heights clinic in northern Manhattan, I see at least one patient every week who has tried to end a pregnancy on her own," writes Anne Davis in a letter to the New York Times. "When lack of information, poverty or stigma overwhelm pregnant women, some take matters into their own hands."

With lawmakers debating provisions in health care legislation that would lead to insurance companies dropping elective abortion procedures from their coverage, it's easy to imagine that more and more women will feel it necessary to attempt to induce abortions on their own.

At the same time, polls show that support for reproductive rights is reaching critically low levels. Gallup reported in May 2009 that for the first time, people self-identifying as pro-choice are a minority in the U.S.--its numbers show that only 42 percent of women consider themselves pro-choice, and a majority of respondents, whether they consider themselves pro-life or pro-choice, think that abortion should be legal, but only in certain circumstances.

What's more, in the same week that Rep. Bart Stupak proposed his amendment to ban insurance plans that cover abortions from the new insurance exchange in the House health care legislation, poll figures from CNN/Opinion Research Corporation found a slim majority (51 percent) of people agree that women should have to pay the full cost of abortion procedures out of pocket.

AMID BOTH legal attacks and ideological regression on the subject of reproductive freedom, it's worth stepping back to consider the reasons why abortion is a fundamental right for women.

Women in the U.S. live in the intersection of a contradiction: a set of rigid, puritanical social and sexual mores functioning alongside a pervasive culture of sexism that objectifies and commodifies women's bodies and sexuality.

The mixed messages arrive early and carry significant consequences. For example, while 12- and 13-year-old girls regularly appear in hyper-sexualized advertising, particularly in fashion industry ads, federal and state governments continue to sponsor abstinence-only programs in schools.

The Sexuality Information and Education Council of the United States (SEICUS) reported, "Between 1996 and federal fiscal year 2008, Congress funneled over $1.5 billion (through both federal and state matching funds) to abstinence-only-until-marriage programs." Such programs bar discussion of contraception or safe sex in favor of teaching that the only safe and acceptable sexual pairing is a heterosexual, married couple.

SEICUS describes how "many abstinence-only-until-marriage programs rely on fear, shame and guilt to try to control young people's sexual behavior. These programs include negative messages about sexuality, distort information about condoms and STDs, and promote biases based on gender, sexual orientation, marriage, family structure and pregnancy options."

This approach also tends to treat all premarital sex as immoral, chosen behaviors, adding to the stigmatization and alienation of teens who have been victims of sexual assault and molestation.

Though federal funds have subsidized abstinence-only-until-marriage programs since 1981, no data proves that such methods deter teens from having sex.

When researchers at the British Medical Journal examined the results of abstinence-only programs from 13 studies covering more than 16,000 people, they found rates of behaviors weren't quantitatively different in terms of "the rate of vaginal sex, number of sexual partners and condom use." And they found that "the rates of pregnancy and sexually transmitted diseases (STDs) among participants in abstinence-only-until-marriage programs were unaffected."

In 2006, the Guttmacher Institute reported that 13 percent of teens aged 15 and under acknowledge having had sexual intercourse, as do seven out of 10 19-year-olds nationwide.

To be sure, however, not all teens are in a rush to have to sex. The Kaiser Family Foundation found in 2005 that 24 percent of teens aged 15 to 17 said they had "done something sexual they didn't really want to do."

Women and girls confront a mass media that constantly tells them their value is determined by their attractiveness and treats them as sexual objects. Yet horrible double standards that shame women for having sex--even non-consensual sex--still exert significant influence, as evidenced by a Chicago Tribune syndicated column by Amy Dickinson published in November.

Responding to young woman writing from Virginia who described being coerced into sex during a frat party, Dickinson wrote:

I hope your letter will be posted on college bulletin boards everywhere...You were a victim of your own awful judgment...Getting drunk at a frat house is a hazardous choice for anyone to make because of the risk (some might say a likelihood) that you will engage in unwise or unwanted sexual contact.

In a similar way, women facing unintended pregnancies are offered little to no support. There are few programs to help women with the medical expenses of pregnancy and childbirth, let alone to subsidize child care, food, housing or any of the other expenses that present daunting challenges for working and poor mothers.

The situation isn't helped by the fact that the recent recession led to reduced jobs, hours and benefits for working women as well as budget cuts in state programs for the poor.

Carol Joffe relates a story on her blog, RH Reality Check, that she characterizes as a dismal sign of the situation for women in the current economic crisis:

[T]he story of Starla Darling, a pregnant Ohio woman, who was informed she would soon lose her job and her health insurance. She rushed to a hospital, requested a medication to induce labor, and had an emergency Caesarean section, two days before her health insurance expired. Not only was Darling upset about having a C-section birth--"I was forced into something I did not want to do"--her insurance company refused to pay for the birth. Now this unemployed woman, two months behind on her rent, is facing medical bills of more than $17,000.

IT'S IMPORTANT to assess the attack on abortion rights in this wider context. As Sharon Smith writes in her book Women and Socialism:

No sooner was abortion made legal in the United States in 1973 than right-wing lawmakers and organizations set out to overturn it. But the 1980 election of anti-abortion president Ronald Reagan helped to propel opposition to abortion into the political mainstream. No longer simply an arm of the Catholic Church, the anti-abortion crusade emerged as central to the platform of a loose coalition known as the "New Right."...

The New Right opposed all aspects of equal rights for women, along with sex education in schools...The hallmark of the New Right was not merely opposition to abortion, but also to the Equal Rights Amendment, a Constitutional amendment that would have established women's basic equality with men.

As in the 1980s, today's erosion of abortion rights is inseparable from a climate of sexism, with each legal restriction on access to abortion contributing to a growing prejudice against women who seek to end unwanted pregnancies. The result of years of largely unchallenged restrictions like parental consent requirements for minors, mandatory waiting periods and bans on late-term abortions is a skewed understanding of who has abortions and why.

According to the right, women are motivated to end pregnancies for reasons like laziness, promiscuity, selfishness or immaturity. The only exception--women who are seen to have a morally justified reason for abortion--are victims of rape or incest.

This "rape and incest" exception is dubious in a number of ways. For one thing, many restrictions on abortion access disproportionately affect precisely these women's access to abortion. For instance, making it illegal to transport a minor across state lines to seek an abortion or requiring parental consent will have a greater impact on girls who are victims of a parent's or a guardian's molestation. And proposals to require a sexual partner's consent to seek an abortion harm women who are victims of sexual assault or domestic abuse.

Furthermore, the fact that rape and incest survivors are counterposed to all other women who want to terminate a pregnancy reinforces the idea that in all other cases, women shouldn't have sex unless they are prepared to have a baby.

A recent article by Nancy Campbell of the anti-abortion group Above Rubies demonstrates how far some anti-choice bigots go in insisting abortion is a symptom of women shirking their responsibilities as women. She writes, "It is interesting that today many women are so educated beyond their intelligence that they no longer understand the way God created them--with a womb to nurture life and breasts to nourish that precious life."

Not everyone who opposes the right to choose is as blatant in expressing their biases about what women's lives should be about. But popular attitudes about abortion do fail to address the basic facts about who actually has abortions.

For starters, the Centers for Disease Control and Prevention's most recent survey of abortions shows that most women who have abortions (over 60 percent) already had one or more children.

Studies by the Guttmacher Institute and others show that a majority of women who report their reasons for seeking abortion say they can't afford a child or are unready to raise one. Women living below the federal poverty level are more than four times more likely to terminate a pregnancy than women earning above 300 percent of the poverty level. Latina women and Black women terminate pregnancies at two and three times the rate of white women.

Restricted access and funding for abortion doesn't effectively deter women from exercising their reproductive choice. Throughout the 1940s and '50s, some experts estimate that women in the U.S. obtained more than 1 million illegal abortions each year. Then as now, the lack of affordable, accessible abortions makes life more dangerous for women.

In her introduction to the collection of pro-choice essays Abortion Wars, Ricky Solinger warns about:

a myth, promulgated by a broad spectrum of people concerned about abortion and public policy, is that before legalization, abortionists were dirty and dangerous back-alley butchers...The historical evidence does not support such claims.

Rather, trial records and public health studies show...astonishingly high rates of technical proficiency among criminalized abortion practitioners and surprisingly low rates of septic abortions caused by these persons. The widespread practice of self-induced abortion, on the other hand, did leave a horrible trail of morbidity and mortality.

The terrible reality that self-induced abortions are on the rise so long after the legalization of abortion rights is only the most urgent indication that women's lives and health depend on access to safe, legal abortions. Now more than ever, we need a renewed movement to defend abortion as a crucial aspect of women's rights to participate as fully equal members of society.