What Do C-Sections Have To Do With Abortions? Working toward a reproductive-justice perspective

the complete physical, mental, spiritual, political, social, environmental and economic well-being of women and girls, based on the full achievement and protection of women’s human rights

don't we all deserve to decide our reproductive future? 

Recently I was going through patients' charts at the end of the clinic day, and was struck by the number of times I saw "MEDICAL ISSUES: c-sections." The details would list how many and how long ago.

I'm happy and proud to be associated with a clinic that can take on patients with all sorts of medical histories. All of our patients with prior c-sections did have the abortion they sought that day. But in other places, this might not necessarily have happened.

Why? Because cesarean sections can increase your risk of placental problems in future pregnancies, and those can make an abortion more technically difficult or risky. In placenta previa, the placenta covers the cervical opening; if there is complete previa, an abortion may require a hysterotomy. In placenta accreta, the placenta is too deeply attached in the uterine wall, which can cause hemorrhage during an abortion. Hemorrhage is also a risk if the placenta is growing embedded in an old c-section scar.

All of these risks are much GREATER if the woman carries to term and goes into labor, actually! But doctors often prioritize the individual, treatment-specific risk, and not in comparison with the alternative treatment if that alternative will be under a different doctor. It happens in all specialties, I think by the nature of the medical profession.

So some doctors will say "In light of your two c-sections, we'll need you to have a special ultrasound done at the local imaging center," and a woman might pay $200 for that ultrasound and if it shows a placenta accreta, the doctor might say "I'm sorry but we don't have hospital admitting privileges at this facility" and refer you to a hospital, and the hospital will say "We don't allow abortions at this facility," and the nearest non-Catholic hospital is three hundred miles away, or the nearest abortion clinic that is also an ambulatory surgical center may say "we can provide your procedure but must charge an additional $300 high-risk fee," and at some point the woman will run out of time and out-of-pocket funds and be stuck with a pregnancy that is more dangerous to her than the abortion she was seeking in the first place.

I tell you all of this as one example of why birthing rights are an abortioneers' issue. Even those of us who expect to never want children should care -- and many of us already do! -- about unnecessary c-sections and the right to attempt vaginal labor. You already know that reduce the c-section rate (which is triple what it ought to be in the US) will improve the health of birthing women and their children; it will also improve access to abortion care.

And I tell you that as one example of the interrelationships that "reproductive justice" is concerned with. Here's another:

Under the newly-passed health insurance reform law, immigrants have to wait five years before they can be eligible for insurance on the public exchange (yes, all immigrants, not just the undocumented who were used as the boogeyman to restrict coverage). Yet, as Public Health Doula explains, in some states with underfunded "pregnancy Medicaid," this means that pregnant women will suffer unhealthy pregnancies and give birth to less-healthy children -- who we'll then turn around and fully insure because they're American citizens, even though their care will now be costlier because we couldn't be bothered to care for their mothers.

Then there is the cruelty with which pregnant women are
-thrown in jail for struggling with a drug addiction (when many detox centers turn away pregnant women because of the liability!);
-arrested for falling down the stairs while ambivalent about their pregnancies (after a doctor violates confidentiality and a nurse lies about you to police, natch);
-detained in a hospital to compel them to follow bedrest orders;
-jailed for being HIV positive;
-forced to remain handcuffed to the bed while giving birth. If you live in Phoenix, Arizona, your sheriff publicly prides himself on the shackles thing, as well as on denying inmates pregnancy care and delaying emergency care that would have saved an infant's life.

What about those who can't even get pregnant? Lesbian or single women barred from assisted reproduction (adoption too), or women who can't get the endocrine-disruptor-spewing factories out of their neighborhoods?

And don't forget that until the 1970s, some states continued to perform unconsented sterilization -- the "Mississippi appendectomy" -- on women of color, poor women, and disabled women because they were presumed bad parents and bad genetic stock. That may be illegal today, but we still have lawmakers proposing to offer substantial-yet-insulting amounts of money to poor women to be sterilized (Brilliant! Why didn't we think of this before!) while white women's large families get the fascinated media treatment. We all have the right to have children, yet not even Nadya Suleman has experienced contempt like the average black mother of four black children (but did you know black women are far likelier to be infertile than white women?).

So there you have it. Just a few examples off the top of my head of why my commitment to abortion care goes hand-in-hand with concern for the rest of the spectrum of reproductive needs, rights, decisions, and battles. We all have our own expertise and area of advocacy, but together we can defend all women's right to decide whether, when and how to parent.

Please also check out this awesome article on black women's complicated relationship with fertility control by Dorothy Roberts, author of Killing the Black Body; and these two papers explaining the origin, significance, and priorities of this "Reproductive Justice" business, courtesy of Asian Communities for Reproductive Justice and SisterSong, two of the coolest grassroots groups around.

Black People are Endangered

Race seems to be a reoccurring them on the blog lately. I have touched on the relationship between reproductive choice and race in a few of my blogs. However, it’s a subject that I have avoided in my writing. I have avoided writing about it because race and racism are controversial subjects. Thus, trying to write about race as it might relate to another controversial subject like abortion feels extremely challenging to me. In my mind I have very clear thoughts about how the two issues intersect and yet I have not put forth the effort to try and relay these thoughts.

Most recently upon reading about the bill boards stating "black babies are an endangered species" in Georgia I was reminded that it’s a subject I should take the time to write about.

Black people are endangered in America. Systemic racism is rampant, and more importantly hard to identify because it is so deeply entrenched in the social fabric of this country. When slavery was abolished it abolished slavery except in prisons. There is now an obscene discrepancy between the numbers of black people incarcerated in comparison with white people. Does this have anything do directly with abortion? Not entirely. But if anti-abortion folks are going to start blaming women who practice their right to choose abortion for the danger black folks in America are in then they are misplacing blame to say the very least. I could analyze every single systemic structure in the U.S. and provide examples of racism. Institutions in this country were physically built by black people to serve white people and that origin is not completely null and void because history has progressed.

Poverty in the United States can not be isolated from race. All black people are not poor however one cannot examine poverty without taking race into account. Black people, as a collective not necessarily individuals, do have less access to institutional resources. Information is power and in this country information is controlled by people with money. For some reason white people in this country tend to have more money then black people. It might be because our (I’m white) ancestors are still benefiting from hundreds of years of profit created on the backs of enslaved Africans.

I don’t think I need to present facts to support the notion that the more money, information, and access to education one has the broader choices they have. Choices are about access. When someone needs a job they don’t have to take a job that won’t pay them their worth if they have access to other opportunities. On the other hand, if you don’t have other options you take the job regardless of what they will pay you, because you don’t have any choice. When a woman is faced with an unintended pregnancy, the choice she makes is often based on a whole bunch of life factors some of which may be related directly or indirectly to race, socio-economic factors, and culture. Race does not play a direct factor but it might be one part of the reason any person finds themselves in their current life circumstance.

I live in the south, I’ve helped provide abortion care to people in and from the south, and I’ve also helped provide other social services to people in the south. Slavery, and more importantly institutional racism is not some ancient past it has shaped the social fabric of the United States today. Any danger that black people are in is not a result of a woman, or many women, choosing to have an abortion. It’s much more likely that she chooses abortion because of her current life circumstance which very well might have a lot to do with race.

Racism kills black people of all ages, living breathing people, people with families to care for. The nature of racism, particuarly interpersonal racism is changing daily, racism affects the lives of a lot of people who do not identify as black or white. However, the results of racism in the United States cannot be reduced to blaming black women who have abortions for making personal choices about their lives and families.

Spread the Abortion Wisdom

Being pro-choice is part of my identity. It is who I am, at my core. It is not simply an adjective to describe me, like having brown hair or hazel eyes. And as part of my pro-choice identity, it is my job to spread the word, the abortion word. To spread the knowledge, life experiences, untold stories and statistics, in hopes of instilling love, empathy and abortion wisdom into another person. By doing this, we as abortioneers are widening our circle. We are trying to invite people into our world so they can see into women's hearts as we do, as Dr. Tiller did, and as every human being should.

This past Friday, I was talking to two girls who are also pro-choice. One is a provider who performs abortions and was a strong voice in organizing people to march in protest against Stupak in the nation's capital. We got to talking about women in prison and their stripped rights, when the abortion provider said, "and they can't even get abortions in federal prisons."

My mind immediately went back to my "abortion wisdom box" and I remembered learning at my last job that "Prison officials must ensure that women have access to the full spectrum of pregnancy-related care, including abortion."

She seemed unsure about my statement, baffled by the very idea of it. I was outnumbered because the other girl had also never heard of protected reproductive rights for prisoners, and she worked in prisons!! I stuck by my abortion wisdom, and tried to think of the calls I've had from moms, partners and families of prisoners, all trying to help their loved ones get an abortion. The first step was telling them, "No matter what you have heard, what the prison guards and officials have told her, she has the legal right to a safe and legal abortion even if she's in prison."

It is a woman's constitutional and human RIGHT to have an abortion, regardless of criminal prosecution or incarceration. The Fourteenth Amendment of the Constitution guarantees bodily autonomy and privacy protection, which includes a woman' right whether or not to have a child. The U.S. Supreme Court Decision of Roe v Wade in 1973, ensures this right to have an abortion for incarcerated women.

Now here's the tricky part: Information, Access and Affordability are most often NOT provided to incarcerated women. They rarely know they CAN have an abortion, much less get information on how to pay for it, where to go, or who to call to find all this out.

I am a strong advocate for making abortion services accessible for women, because it is simply not enough that they are legal. Legality does not equal accessibility -- for this reason, many people do not know about the legal rights of women in prison, because they are so heavily restricted from accessing this right. There are SO MANY barriers set in place to keep women from knowing and attaining the pregnancy-related care they want.

It is our job to keep spreading the word, to impart our knowledge of the ins and outs of the abortion world to everyone we meet. Even our friends to subscribe to being pro-choice may not know wisdom we have, and vice versa. Share the wealth. Spread the word. Educate and Inform. For with knowledge comes power, and with power we hope for change.

Happy Vday Everyone :)