We interrupt this program

As much as I'd LOVE to keep talking about the SGK crisis, there is an equally important crisis going on that's not getting as much publicity:

Pfizer Issues Statement On Voluntary Recall

The recall affects Lo/Ovral^®-28 (norgestrel and ethinyl estradiol) oral contraceptive pills. If you are a user, talk to your provider and use a backup method!

Here We Go Again

After attemping to redefine rape such that women who were not beaten during a rape did not "count" as being raped, Republicans have continued to attack women's rights. They are currently attempting to defund Planned Parenthood of their federal funding and/or remove all federal funding from the Title X program.

There are two current plans -- one, introduced by Rep. Mike Pence (R-Ind.), would make any organization that provides abortion services ineligible for Title X funding. The other plan suggests stripping Title X of all federal funding, which would put Planned Parenthood out of business in the process (Planned Parenthood received $16.9 million of Title X funding in 2009).

Their main arguments are that 1) taxpayers shouldn't have to pay for abortions and 2) this will help cut the budget deficit.

Do you know much money of the $327 million Title X Family Planning funds is currently used to finance abortions or abortion-related services? ZERO DOLLARS. Planned Parenthood does not use any of their federal dollars toward abortions or abortion care (In fact, abortions make up less than 3% of their total revenue). That's because IT IS ALREADY ILLEGAL for them to spend Title X funds on abortion services or abortion-related services.

So, Rep. Pence should sleep better tonight knowing that this whole time Planned Parenthood is NOT using federal funds for abortions.

Which raises the question -- what do Planned Parenthood and other Title X Organizations use their federal funding for?

Birth control services
Birth control counseling
STI testing
STI treatment
PAP smears
HPV tests
Breast cancer screenings
Female infertility screening and referral
Safer sex counseling
Treatments to prevent cervical cancer (colposcopy, cryotherapy, and LEEP)
Colon cancer screening
Erectile dysfunction services, including education, exams, treatment, and referral
Male infertility screening and referral
Menopause management
Routine physical exams
Testicular cancer screenings
Prostate cancer screenings
Parental education classes
Urinary tract infections testing and treatment
Vasectomy

The people who use Title X Organizations are generally low-income, though it is estimated 5 million men and women used Title X services in 2008 alone. So, the Republicans first argument is completely null and void, because no Title X funding is used for abortions!

By wiping out Title X funding, Republicans are ironically going to increase the abortion rate, since they will be disenfranchising millions of women and their partners from health care and birth control access. More unintended pregnancies = more abortions.

Secondly, this cut will DO NOTHING to help our $1.5 TRILLION budget deficit. $327 million / $1.5 trillion = 0.02%. This coming after a huge wave of tax CUTS Republicans held the House hostage for.

Even more ironic, cutting Title X funding will actually cost taxpayers MORE in the end. In November of 2006, the Guttmacher Institute released a study which indicated that for each dollar invested in Title X, approximately $3.80 was saved. This is because Title X programs emphasize preventative care. Guttmacher suggested that doubling funding would save the country $800 million dollars because it would prevent 244,000 unplanned pregnancies. So, if the Republicans really wanted to save the country money in the long run, they should actually support Title X programs.

Of course, none of the reasons they are providing are an approximation of the truth. The real truth -- as fucked up and illogical as it seems, is that Conservatives do not want women to have access to family planning and reproductive health care.

We encourage you to spread the word about this messed up movement and let your representatives know that you do not support this bill. The negative press surrounding their attempt to redefine rape got them to drop it, maybe we can do the same with this. Here's one for Planned Parenthood.

"Why don't you..."

Ensure women are confident in the decisions they make about their problem pregnancies
Help women leave their abusive partners so they can have that baby
Combat domestic violence
Provide women with contraceptive services to avoid unplanned pregnancies
Find a job developing more effective forms of contraception
Prevent rape and sexual violence - so that "the innocent ones" don't have to have abortions, natch
Find counseling for assault victims
Throw them baby showers so they'll have "all the supplies they need"
Offer to adopt her children so she'll have time and energy for one more
Buy her kids the damn Christmas presents so she won't have to have the abortion (What?? Please work on distinguishing between a problem and its symptom, OK?)
Help her with the cost of a new baby
Pay their utility bills
Help them find safe cheap childcare...

*

Dear devoted denialist antis, regular know-it-alls, and well-meaning strangers/friends/family/bloggers who just think abortion "shouldn't be used so thoughtlessly": 


Thank you for your suggestions. We regretfully see that you consider yourselves geniuses for having hit on the one magic solution that no one has tried.


In order to keep this letter brief, I leave to your own heroic efforts the task of identifying which of these things we ALREADY DO that you just assumed we don't do, which of them we would NEVER DO because you are not adequately informed to dream up effective strategies ("tell her to Just Leave him!"), and which ones we would LOVE to do but lack the resources and/or magical patriarchy-busting power to do.


In fact the purpose of our reply is simply to ask you a question, since you brought it up.


Why don't you?


No, seriously. Why don't you do those things? Answer me, each of you, about your individual practices. And society-at-large, you answer me too. And when you've all answered why YOU don't do these things, I'll understand you a little better, and then one day maybe we can "discuss reasonable solutions" as you have proposed but are currently unprepared for.


We regret that we will not be working with you at this time but encourage you to submit future proposals that meet the minimum thoughtfulness standards.


Good luck,


Placenta Sandwich
VP of Irritated Blogging
The Abortioneers

Reading and ranting: when theory doesn't meet practice

So I'm reading this paper. It's about desired and actual fertility levels in developing countries. And it's written by...an economist.

No offense to any economists reading this, but y'all say a lot of funny things. You base a lot of your reasoning on the idea that people make "rational decisions" and everything else follows logically from there, but underneath that you have a very restricted sense of what rational decisions might be.

An example: this paper posits that there is "a very small influence of contraceptive access on fertility levels .... The decision to have another child is simply too important and too costly for contraceptive costs to play a major role." 

I kind of hesitate to name this paper and author, because in fact it's a very interesting paper with some thoughtful research behind it and some good points to make. But I just need to say it: are you fucking kidding me? 

Sure, it's easy for you to say from your armchair, "It just doesn't make sense to behave any other way; if a woman can't afford birth control, she certainly can't afford a child, so she should be sure to get on birth control because it's a tiny investment compared to the cost of a kid." Well, duh. 

But I mean: has this guy EVER spoken with an actual woman of reproductive age (as they say) during his career? Here in the first world, where theoretically there is a pharmacy around every corner and Medicaid for poor people, I have met SO MANY women who would have loved to buy contraceptives in the month they got pregnant, but couldn't afford it because diapers or seizure medication or a new (used) tire had to come first. The thing is, if you can't afford birth control this month, the fact that you could even less afford to have a child doesn't matter -- you still can't afford birth control right now. And then accidents happen. 

This doesn't even get into all the pseudo-consensual sex that occurs even in the U.S. -- not to mention more resource-poor countries -- meaning you may be afraid of getting pregnant and unable to get birth control but you may also have little agency in sexual decisions. Your abusive partner is actively trying to get you pregnant as a control tactic. The guy you depend on for child support comes around every few weeks and maybe gets a little pushy. You support your four siblings by trading sex for food. You live on the street and cops routinely harass you until you'll fuck them! 

I'm just saying. The fact that it's cheaper doesn't always mean birth control is cheap enough. 

The paper goes on to use other, more sound arguments to propose that the well-known idea of "unmet need" for contraceptives is more or less moot, because "actual fertility" levels are nearly identical to "desired fertility" levels in most developing countries. Really, they are interesting points, but then he doesn't even address the extremely high rates of unsafe abortion in those same countries -- a pretty strong indicator of desperately not wanting to be pregnant, I'd say, and of a need (an unmet need, if you will) to avoid pregnancy in the first place. I mean, stuff like that: WTF, economists?

So I am still trying to understand how a person can write about the real-life problems of real-life individuals, overlook critical aspects of the situations many of them are in, and write off an entire sub-field of health as irrational or unnecessary. I mean, I feel like if someone asked the author about the abortion thing, he'd dismiss it by saying he is only looking at the "big picture" of births per woman, and his point is that women on average are still having as many children as they say they desire and that point still holds, and micro-level issues such as death and disability due to unsafe abortion are only details to be worked out by someone else who takes an interest in that stuff. And that's as may be -- perhaps you just wanted to show something interesting about these national-level birth-related indicators -- but really, even if it's just carelessness, you shouldn't let your theory errantly piss all over others' actual practices. 

Better strategies:
1) Acknowledge that there is an unmet need for contraception so long as unsafe abortion is widespread, or
2) Acknowledge that abortion is an important part of your finding that women are meeting their "desired" fertility levels, and include in your recommendations section that it be made safer and more accessible.

To put it less wordily -- those women your science can't understand: they are nevertheless real and you haven't managed to math them away.

Reserving all the judgment for ourselves

You know that saying: the best-laid plans of mice and men go oft awry? Well, because of our extensive experience with the going-awry, many of us abortioneers have pretty firm ideas of safer sexual practices, and some of us might have a certain trepidation about using anything other than "highly effective contraceptive methods" (see here for a ranked chart of options and explanation of its use in contraceptive counseling). 

At the same time, we all spend our days hearing every version of sexual history under the sun, and recognizing that women are not evil or dumb or fuckups when their practices or situations diverge from our own. We counsel clients about methods that are easier to remember or longer-lasting or invisible to an abusive partner; we brainstorm with them about ways to approach a partner about getting testing for STIs, condom negotiation, and respect for boundaries; we remind them about transmission methods of various infections and how to treat or manage existing diseases. We don't scold or scoff. The words "stupid" and "crazy" and "irresponsible" may exist in the world outside our walls, but not in here. 

But have you ever seen what happens when WE fuck up? 

This weekend I had a crazy, stupid, irresponsible experience: unprotected sex. The first of my life. I've been with my partner for ages, but we hadn't had sex in quite a while, and -- it seems crazy but -- somehow this time protection just slipped my mind. And afterward my partner asked if I had gone back on the pill, because he'd been expecting me to pause for condom-time but then I didn't. OMGWTFBBQ, said I. How can someone spend years and years trying so hard to avoid pregnancy, working in the world of unplanned pregnancy, and devoutly practicing protection habits -- then just FORGET? Needless to say, I was about as embarrassed and irritated at myself as your average patient who sheepishly tells you her story of one night of abandon, or one vomited pill. 

Well, I headed right to my medicine cabinet, looking for the pack of emergency contraception that I obtained nearly four years ago and set aside for just this purpose -- or more likely, I thought, for some friend who had a more unpredictable social life and might find herself unprepared. Ha. What was that I said about best-laid plans? I couldn't find the pack! I've moved three times since I first picked it up, and it must be in a box somewhere. So I texted a couple work friends, thinking they were likely to have a spare too -- but they didn't, and our clinic is closed on Sundays so it wouldn't be a snap to get it for cheap or free. No problem: I'll skip down to the pharmacy and buy it over-the-counter---Holy shit! I forgot the full price was fifty dollars. And my insurance doesn't have any coverage for non-prescription meds. 

It's so weird being one of the hoi polloi, the everywoman who faces everyday obstacles and needs to decide if she can afford to protect herself and has to deal with an awkward pharmacist. And really weird realizing I'm judging myself for being "such a dumbass" when I would never think that about someone else. 

Later that day, I heard from a friend: 

               um, how much do you know about herpes?

               i engaged in some high risk irresponsible behavior last night due to drunkeness

               ughhhhhh

               i feel like i need to kick myself out of my [sexual-health-related occupation]

My god! We all make mistakes sometimes, and here we are feeling like something is deeply wrong with us -- like we don't belong in the profession! -- now that we have joined the ranks of those who "should have known better [but presumably didn't]."

Well, good thing it was my turn to blog, said my friend: 

              write about how we in sex/repro health expect ourselves to be models of responsibility and healthy sexuality

               but get down on ourselves when we slip up

               you can talk about your plan b

               and my herpes!

Well, there you go. Turns out this unpleasant incident was a good reality-check: it only takes a weird moment of forgetfulness and some bad luck to end up in the patient's seat or the pharmacy, and I must have had some unacknowledged belief that I was "too smart" to wind up there, or maybe "too smart" to get a pass on making a mistake. 

I know some of us have had the good fortune (so to speak) of being in a "dumb" situation early on, and having lots of compassion as a result. If you'd like to tell that story, please do so in the comments...and I promise I won't think you're stupid! 

I dream of chatty ovaries

Warning!

I do research so you don't have to do what you currently have to do, is no longer a pick-up line.

I do not wish to iron your blouses either.

Abortioneer: You mean to reduce unintended pregnancy?

Interested acquaintance: No. Abortion.

Abortioneer:  To clarify, we are speaking of abortion as a safe alternative to full-term pregnancy and giving birth, of women seeking the assistance of a skilled expert in uterine cleansing? So long as an abortion is a safe and accessible option to every woman of childbearing age, I don’t believe unnecessarily targeting abortion as a culprit to our dysfunctional planet is a fair use of time and energy.

Still interested acquaintance: I don’t think abortion should be a means for birth control and I have been working for years all over the world where women have abortions frequently.

Body language continues to reflect a growing and devout interest in this uncomfortable conversation where I begin to wish I hadn’t just gone to the bathroom, stepped outside with friends, been introduced to this man, then returned and settled to finish a new drink—lest I dismiss myself modestly and not forthright on the grounds of not having the energy to find common ground for abortion. As in, oh please don’t make me have this conversation when my horoscope suggested I might actually bond with a kindred spirit and I have finally peeled myself away from abortion care to toast a Friday night—who the HELL told this dude I work in abortion care because I did not.

Abortioneer:  I want to be clear that I understand—while not completely—the plight of women all over the world. I understand that some women wish to give birth but must choose an abortion. I understand that women wish to prevent having to have an abortion. I understand that abortion care is not care-full, safe and regulated primarily by women everywhere, and therefore could stand to improve for a plethora of incredibly heart-breaking reasons. Beyond these grave acknowledgements, I find speaking of abortion in negative terms to be counterproductive in an evolving society. I believe abortion helps women and I currently provide direct service to women who cannot access abortion care so feel strongly that work should be done to increase abortion care services, as well as maternal, fetal and child care services. When we speak of abortion in physically, emotionally or spiritually degrading terms, we degrade women who have abortions within the thirty odd years that they may tirelessly try to not get pregnant.

Too interested, obstinate acquaintance: But I am researching other, better means of birth control. The president has made a profound difference by repealing the Global Gag Rule.

Abortioneer:  That is excellent and I agree. I commend what you do. It sounds like we share a lot of similar goals and I admire your mission. We seem to be seeking a similar end point where humans are healthy and balanced and free. I do wish that the Global Gag Rule was not a prop in the political tug of war…

Acquaintance: ?

Abortioneer:  Oh. Well, you know how it’s repealed then reinstated? Democratic presidents repeal it in their inaugural January and Republican presidents reinstate or whatever it in their inaugural January. When will someone take it off the table and commit to it—as in, women’s lives are worth saving all day every day any day you name it and it matters.

Acquaintance must like my eyes or the way I talk—earlier he had observed my midwestern drawl sweetly: I think it’s so important to promote birth control services and eliminate the need for abortion. I think it’ s not a good thing for women to terminate their pregnancies.

Abortioneer:  Contraception is a vital feature to improvements to family planning and certainly we need unbiased sex education. Controlling fertility is a tricky science but I think we all know it’s not entirely scientific. Because we are so unique and changing, so will our desires and methods change over our lifespan? I support elevated access to family planning, but for some women, synthetic contraception or not having an abortion can be a terrible thing. In addition to your good and necessary work, don’t you think that abortion will still be necessary?

Note: This is not a question. The answer is yes. I am trying to be diplomatic.

Acquaintance: Have you ever had an abortion?

The bar is loud. Throughout the process of this *conversation,* the acquaintance inches closer to me. We play that conversational interaction game where I speak near his ear and he speaks near mine. I sense all along that he views this conversation as an attractive back and forth but I was resistant to debate and exhausted about abortion before he approached me, and in-between these sound-byte transcriptions, made several attempts to turn the conversation to something like flowers or food or music.

Abortioneer:  I’m sorry but this bar-talk is strange.

I dismiss myself on the grounds of my inability to find common ground for Abortion and turn to face the baby doll propped behind the bar, among the bottles—its head torn-off and displayed upside-down. It is holding a kitchen timer shaped like an egg.

I try to avoid Abortion Conversation with strangers because I cannot engage them without declaring my adoration for liberalized reproductive health care and sex education.

I want desperately for us to be happy in these bodies. I cannot stand to know that women are raped and beaten and bleeding or rotting to death all over the world right now. I take it personally because I believe the Earth would bestow great gifts of peace and thanksgiving on us eternally if we nourished our women, our gatekeepers and let Her breathe.

I try to picture a society where abortion is completely unnecessary and then I wander through my vagina, my cervix, my uterus, my fallopian tubes, to my ovaries. I try to listen to my inner flow that has been punctured many times by worldly toxins to locate the sound of my egg dropping and the speed of its pursuit. Indeed, if I could pin it precisely, ELECTIVE abortion would be unnecessary.

A woman, in consultation with the universe, all possible higher powers and her health care attendants, would reign delicately, tenderly, devoutly supreme over the cycle of human life within her body.

That is, assuming researchers didn’t continue researching how to extract her knowledge and know-it-alls didn’t continue negotiating her cycles as if they were rights and capitalists didn’t continue funding researchers and know-it-alls in hopes of selling her rite back to her and staying filthy rich forever—unless she can’t afford it.

Most importantly, I find common ground in my dreams.

Painting by Susan Seddon Boulet