It is time to celebrate "Back up your birth control Day"

So once upon a time I was denied access to emergency contraception by a medical provider. I hadn't had unprotected sex or missed a daily pill or was off on my Depo. Nope, I just wanted to be prepared for the future if I were to ever need Plan B. I'll save that story for another time...but the reality is, plenty of individuals and groups are being denied access which is a violation of basic human rights.

Recent news has focused on Native Americans: read here and teens: read here

So devoted readers, I ask you this: Have you ever been denied EC? Had an access problem (distance, time of day, cost, insurance coverage, etc)?

Finally, how are you celebrating today???

The upside of talking to strangers

just kidding

Hanging out with foreigners is a whole other Thing for me.

I don't mean foreigners exactly. What's a good word for "people who aren't from Abortionland"? I'm in a new place with lots of new people, so this is kind of on my mind lately (can you tell?).

Sometimes it makes me nervous. Obviously. I pretty much eatsleepbreathe abortion-related business, and those split-seconds of anxiety when someone thinks they're making innocuous smalltalk and asks So What Do You Do, they're an occupational hazard we've all come to know well.

Of course we've built little silos of experiential knowledge about ways to ease into it or leave it subtle (Women's Health, Reproductive Health, Family Planning), in case the person asking is not someone you want to get into it with. Other times you want to just say it, so you just say it, and hope that's OK. And once in a while you're feeling kinda wild and might even tell someone who never asked. But no matter what you say, that anxious split-second might pass and be forgotten, or it might drag out into interminable minutes, even hours if you're unlucky, of "debating" whether what you pour your heart into is evil and exploitative. (Whee!)

The reason I still bother is that sometimes it's totally fine -- is it sad that at this point "totally fine" can be kind of a thrill? -- and what's more, someone who doesn't eatsleepbreathe this stuff might say something I haven't heard or thought of before. As you know, I am a very clever and thoughtful and well-read and humble person, so you can imagine my surprise at learning something new, but it's true.

Longwinded Example Time: yesterday I was telling a new friend (who's training in public policy) about this unexpected hitch in what sounds like a great abortion policy. Where we are, first-trimester abortion is theoretically covered -- paid for! free! -- for residents who have public health insurance and go to a public health center for the procedure. It turns out, though, that to get the required preliminary ultrasound and bloodwork, patients often have to choose between waiting THREE TO FOUR WEEKS to have those processed at the hospital providing the abortion, or paying around a hundred dollars for a private office to do it within a few days. If you're poor and you are working within a short legal time frame, this could be disastrous. (Really. I've counseled so many women through the daunting challenge of finding a hundred dollars in a couple weeks, and as a result am aware of my enormous economic privilege every day.)

So, yeah, my constant and immediate thought about this situation is: even if you have great policy, you also need support and will all the way down the healthcare structure, so that the time-sensitive nature of abortion care is given importance and so that possibly-antis within the system don't cause unnecessary delays. Otherwise safe and timely abortion access continues to be segregated by economic class. Is anyone surprised? Same old story, sucks, now what?

When I paused my rant to take a breath, my friend said, "Sounds like the market organizing to meet demand that the health system hasn't caught up to." Oh yeah: that is another conclusion you could come to. And it isn't just about how or where ultrasounds get performed. It's also about how, where, and whether abortions themselves get performed. Having only worked at non-profits, I sometimes forget that the chance to make or lose money drives service availability -- it often feels like we're giving away care, which I'm proud of, but the wider world doesn't work that way. Assuming you have a public abortion system, if its workflow or providers are causing choke-points in service delivery, would-be patients aren't going to give up. Potential consequences:

• Feminist clinics [pdf] arise to provide women with care that isn't dependent on the patriarchal medical system (or on its judgments of what is urgent and what can be delayed). They are traditionally not-for-profit and its employees have a conflicted relationship with the need to, like, keep a roof over their heads. Seeking donations for sustenance is a whole other piece in this, Idunno, let's talk about that some other time.
• For-profit clinics arise to fill the supply void; some are great and perfectly feminist too, and some are mostly a business like most other medical practices and seek to maximize income.
• Private OB/GYNs and family practitioners begin providing abortions in-office after realizing that their regular patients keep seeking their advice, getting referrals to the hospital, then getting delayed.
• People who have little or no medical training begin offering under-the-table "pregnancy remedies" that range from safe and effective to useless or lethal. A client who survives is unlikely to report them because she knows they may be someone else's only recourse, too.
• Pharmacy workers will sell women misoprostol, an abortion-causing medication which is also prescribed as Cytotec to treat gastric ulcers, but at a significant markup because both parties know that the seller is doing an illegal favor and the buyer is desperate.
• What else?

ETA: look at this graph I found just this afternoon!

The Alan Guttmacher Institute (AGI), Sharing Responsibility: Women, Society and Abortion Worldwide, New York: AGI, 1999.

Anyway, I have been turning over in my head how my own experiences and training get me in a kind of thinking-rut, where certain conclusions and interpretations are super-obvious to me, and I lose any sense of how many other useful lenses there are out there. (Notice how I ended up wandering back to economic justice anyway?) So yeah, this is something for me to keep thinking about and try to be more open to. In conclusion, um, talking to strangers can be OK.

Ways To Get Screwed By A Pentagon, Henry Hyde, World Wars, and Other Violent Artifacts of the Twentieth Century

[As a promised follow-up to this post.]

I'm visiting home this week and won't be back for months, and I can't safely stay pregnant in Afghanistan much longer. Can you see me before Sunday?

They'll ground me if they find out I'm pregnant, but the Air Force is my last chance out of the dead-end town I'm graduating from. How early in my pregnancy can I have an abortion?

My fiance just left for a second tour, and I can't imagine going through this without him. Where can I find an abortion provider and someone to talk to?
(OR: My fiance was just killed while serving, and I can't imagine going through this without him. Where can I find an abortion provider and someone to talk to?)
(OR: My fiance was just killed while serving, and I can't imagine not having his child in five/six/seven months. Where can I find prenatal care and someone to talk to?)

I'm an Army brat -- we travel around with my mom a lot -- so I don't know this town too well or have a lot of friends I could ask for help. Where's the closest abortion clinic, and will it be OK if I ride the bus there?

We're on my husband's TriCare plan, but they're denying coverage for my abortion even though the pregnancy is shutting down my kidneys. Is there anyone out there that helps with this sort of thing?


(I sure hope so, five or six weeks from the start of your last normal period, here, here, here, you'll probably need a friend to drive you home and may need to check out parental consent laws in your state, and yes thank god but they need our help.)


"Back to the status quo" update in the last two weeks: Military higher-up to reverse official policy punishing pregnancy. OK, now how about you combat that parallel de-facto punishment system too? Reproductive justice in tiny, endless shuffles...

The purse strings are so close, yet so far: Abortion coverage and DC sovereignty

Yellow = no lifesaving needle-exchange programs. White = go for it!

I used to live and work in Washington, DC, a place where you'd think people are powerful and have the ability to make important decisions. But the city of the District of Columbia is not the same as what people call "Washington" when they are thinking of Congress and the White House and the Supreme Court and, you know, the halls of power.

Not everyone knows that the residents of DC do not have a single vote in Congress. (They have one non-voting delegate in the House of Representatives, Eleanor Holmes Norton.) Also, not everyone knows that until 1973, DC did not even have an elected mayor or city council, but was directly administered by federally-appointed commissioners -- and Congress can take away that privilege at any time. Congress also has the power to decide how the District can and cannot spend its own income, i.e. money raised from city taxes. Of course, if DC were a state, this would all be very unconstitutional, but the Constitution dictates that the District of Columbia be governed in this way.

It might seem very arcane or very trivial -- why would senators and House reps from other parts of the country care to get involved in someone else's city budget issues, and if they did would their decisions really be so bad for residents anyway? Unfortunately, the residents of DC do indeed feel the repercussions of this lack of sovereignty, repercussions which often hit the poorest among us the hardest.

Every year, Congress writes and passes a new federal budget. And every year, members of Congress use DC as a place to make cheap political statements about where they "stand" on "issues." A timely example: since the late 1990s, DC was prohibited from using its own money to pay for needle exchange programs to combat the spread of HIV, while several of the "real" states were supporting such programs using not just their own funds but federally-allocated funds as well! Basically, conservatives scored political points with their constituents back home using citizens who are politically impotent and thus expendable; meanwhile, the Washington Post reports that "At least 3 percent of District residents have HIV or AIDS, a total that far surpasses the 1 percent threshold that constitutes a 'generalized and severe' epidemic".

In 2007, Congress finally reversed that ban, but now the House is considering a bill with an amendment that restricts where DC can locate needle exchange sites: they cannot be "within 1,000 feet of a public or private day care center, elementary school, vocational school, secondary school, college, junior college, university, public swimming pool, park, playground, video arcade or youth center." The image you see at the top of this post is a map [pdf] 0f what those restrictions would look like: in the white parts it's OK to provide clean needles in exchange for used ones, but not in the yellow parts. (And, um, the blue is water.) How many people can that possibly reach?

OK, so what does this have to do with abortioneering?? As you might guess by now, abortion is another favorite controversy to take out on the residents of DC. Until 1988, the District was using some of its own funds to include abortion coverage as a Medicaid benefit. Since that year (with a brief break 1994-96), Congress has prohibited the District from spending any of its own revenue to pay for abortions, despite the fact that its residents and city council clearly appear to favor it. Again, conservatives scored political points with their constituents back home using citizens who are politically impotent and thus expendable. This year it appears that the Democratic majority in Congress may finally reverse that position and allow DC the choice to resume covering some abortions, and the city probably will choose to do so.

When I worked in DC, most of my clients were on Medicaid, and the vast majority of those were not from jurisdictions that allocated funds for abortion care. They were on Medicaid because their government acknowledged they were too poor to afford health care, but they were going to have to afford an abortion all on their own. Yet abortion care is a part of health care, and we don't suddenly get richer when we have an unwanted pregnancy! It broke and still breaks my heart to know that so many of my neighbors are getting screwed over by people who go to work just a couple blocks or a couple miles away from them.

Living in the nation's capital, you constantly pass monuments, walk right by the White House, and see other stuff that should make you feel like huge decisions are being made in your backyard; yet all that proximity never gets you any closer to meeting those decisionmakers or participating in those decisions. In fact, aside from the euphoria of Election Day and Inauguration, I doubt any of my clients ever thought about the federal government. So maybe it's no wonder that Congresspersons are making terrible decisions about the drug addicts, pregnant women, gay couples and cancer patients of DC as though the latter lived in some tiny shit village thousands of miles away that no one expected Congresspersons to care about in the first place: they don't feel any closer to the residents of their host city than their hosts do to them.

Yes, Congress legally can do all these things. But it still feels like your landlord showed up at your door, set up camp in your nicest bedroom, then went around to all the other rooms and shat on the carpets. Don't forget rent is due on the first.




EDIT: Also, don't you love it when the House minority leader posts a "Statement of Republican Policy" on the party's more-or-less official site for Congressional workings (hosted at a .gov address) and it's got typos and bad logic and unflattering cut-n-paste aesthetics and everything?!

Taking on the Torch

A week after the murder of Dr. Tiller, pro choice doctors, advocates, counselors, and health care providers are still thinking, “now what”?. During the Clinton administration there were numerous acts of violence by “pro-life” fanatics, doctors were killed and clinics were terrorized. Once Bush was in office there was a dramatic decline in “pro-life” violence, whenever the political administration is more conservative “pro-lifers” seem to settle down. With Obama in office will “pro-life” people continue to mobilize fanatics to commit these kinds of acts of terrorism? The pro-choice community must mobilize to demand access to basic health care rights, we must be willing to risk our lives, as long as “pro-life” advocates believe it’s their right to threaten to our lives.

I’m no doctor, but I am an educator, a counselor, a friend, a sister, and a resource. We have to continue to make our rights our reality. It’s not easy to commit to making our most basic rights accessible; in fact it’s much more difficult for many of my sisters. Life and circumstance does not always provide the ability to create one’s own reality. However, some of us can grab that torch and keep going forward. We will not leave our sisters in the dark, but we hold their hands and carry the torch as we all walk forward.

We need doctors who will perform abortions; young people in medical school are not choosing to perform abortions, very possibly because it means choosing to risk your life. Fifty Seven percent of abortion doctors are over the age of fifty, we need young physicians and medical students to step up to the plate and demand to learn abortion care. Some of us will be able to carry on this piece of the story in many capacities. Dr. Tiller was one piece of that story. He understood that abortion was about a women’s heart. We need people who are willing and able to risk their lives to make abortion health care an accessible choice.

At the vigil I went to, for Dr. Tiller, one woman gave her testimony regarding Dr. Tiller’s involvement in her life. She was from Wichita, Kansas and Dr. Tiller helped her birth mom choose to arrange an adoption. This woman believed abortion is a completely acceptable option even for her birth mother. However, she is here in this world because Dr. Tiller supported a woman’s choice, no matter what. Dr. Tiller also made sure the babies who were adopted were given to pro-choice families.

My mother had an abortion about four years before she got pregnant with me. When she got pregnant for the second time she was relatively young, single and unsure of what to do. She met a life long sister who offered to support my mom in any decision she made about her pregnancy. This woman offered to raise me with or without my mom’s involvement. She offered to hold my mother’s hand during an abortion or childbirth. She offered to support her in choosing to become a single parent. This woman held my mother’s torch. My mom had the support to commit to having a child because she had the support to choose any path she needed to take.

This woman is my aunt; she did support my mom in raising me and has always loved me like her own. As women, sisters, daughters, mothers, and friends we have to try and hold each other’s torch whenever possible. I am my sister’s keeper.

We need all people to step up to carry on the work to make reproductive choice a reality. Each of us must step up to make our rights our reality in whatever way possible. Some people will be able to go to medical school and can choose to perform abortions and provide women with information to make their own decisions. Some people will support a sister, a friend, or a stranger in working through a decision making process. Some people will work towards productive policy changes. Whatever torch you carry, this is time to step up, hold someone else’s hand, and walk forward.