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.