"Schooling Chris Smith" on abortion's role in the UN's Millennium Development Goals

Good evening! Just wanted to let you know that Kelly, the brilliant and gracious creator of Schooling Chris Smith, is hosting a cross-post of sorts by yours truly.

Before I get ahead of myself-- do you know who Rep. Chris Smith is? Well, number one, he's a douchebag, and number two under-informed and number three not very good at rhetoric; let's just say all that up-front before you read his op-eds and injure yourself trying to understand what the fuck he's going on about.

Number four, he's also a member of Congress (R-NJ4), and among other things he's the ranking member (second only to the chair) of the House Committee on Foreign Affairs's Subcommittee on Africa and Global Health. What does all that mean? Well, as Schooling Chris Smith puts it, it means he gets "to be seen as a strong proponent of human rights despite his complete opposition to full human rights for women." To continue quoting Kelly:

Back in September, the Washington Post published an op-ed by Chris Smith urging activists not to sidetrack the U.N. summit on global poverty by talking about abortion (which is kind of hilarious, considering this is one of the guys who sidetracks women veterans' health care into abortion politics). His op-ed obviously speaks for itself by claiming all abortions cause psychological damage for women and implying that human trafficking and child soldiering are caused by abortion (I have to admit, that's a new one for me).

Some letters were published in response to this piece, but one wasn't. [That's mine! -PS]

So, yeah, being ranking member of the House Committee on Foreign Affairs's Subcommittee on Africa and Global Health (takeanotherbreath) also means he gets to say things about global health and international development policy and have them published in newspapers. Even though he hasn't done his research, doesn't know his facts, and can't string together a logical argument. (Am I bitter that I do ALL these things but don't get published in the paper? Not at all!) The Post published a couple responses that (rightly) pointed out Smith [a] was dragging abortion into the conversation from out of nowhere and [b] had glaringly omitted mention of the life-saving importance of contraception. But those responses themselves completely omitted mention of the many errors and false claims Smith made about the role of abortion in saving lives.

Even though it's well past September now, the inauguration of Schooling Chris Smith got me thinking that I shouldn't let a good letter die unread. (If I do say so myself.) Without further chitchat, here it is:

Re: "Abortion does not further children's health," Chris Smith, op-ed 9/19

Rep. Chris Smith's op-ed was long on claims, but short on facts. Having engaged in research, education and service provision in the field of reproductive health, I am left wondering on what evidence Rep. Smith based his assertion that abortion harms children's and women's health (the focuses of the UN's Millennium Development Goals 4 and 5). His attempt to exclude abortion from MDG efforts, discarding established medical evidence in the process, is the real threat to the health of women and the children they already have.

The statement that abortion is "by definition, infant mortality" is silly, as all abortions are, "by definition," performed before birth, which precedes infancy. Terminology aside, Smith's concern for embryo survival leads him to overlook the actual women who die when safe abortion care is out of reach: some develop severe pregnancy complications; some have ectopic pregnancies; others drink bleach, insert sharp objects, or jump from tall heights in an attempt to end pregnancy themselves. Each year an estimated 50 million women worldwide obtain abortions, half under unsafe conditions; worse, the vast majority (95%) of those unsafe abortions take place in the developing world where treatment for complications is harder to obtain. As a result, around 70,000 women die each year due to unsafe abortion, and millions more suffer nonfatal injury and illness. Yet abortion performed by a trained provider in a sanitary setting is one of the safest medical procedures in existence -- much safer than carrying a pregnancy to full-term delivery, as a matter of fact! Contrary to Smith's insinuation, repeated and rigorous cohort studies demonstrate the error in claiming that properly-performed abortion causes physical or psychological complications.

Disregard for the value of human life, as Smith calls it, is made manifest in the poverty, illness, and avoidable death experienced by families who cannot afford another mouth to feed or who lose a caretaker to eclampsia, hemorrhage or sepsis. If safe abortion is struck from the agenda, then unsafe abortion will simply continue to kill women and orphan their children.


placenta sandwich, A.D.D., I.B.S.
Vice-President of Irritated Blogging and Letter-Writing
The Abortioneers
Credentials Out The Ass

(Actually, I gave them my real name and my real credentials-out-the-ass.)

There was so much more I had wanted to say, but brevity is the soul of getting published, I was told. (Am I bitter that I chopped a bunch out but didn't get published? Not at all!) Like I also wanted to say that there's empirical evidence at the family level that maternal morbidity and mortality (for example from unsafe abortion) results in greater child mortality. Not a shocker. And also that anyone who knows anything about health infrastructure can tell you that women in Chile and Ireland survive (mostly survive) their countries' abortion bans because they have access to doctors trained to treat complications of illegal/DIY abortion, not because they've stopped having abortions! Anyone who thinks an abortion ban would not increase mortality in a country with poor health infrastructure and lots of remote rural area -- like, say, Ethiopia or Zambia -- would surely not qualify to be on anyone's Subcommittee on Africa and Global Health, right?   Oh... wait. (Still not bitter!!)

I'll leave it there and ask you to head over to Schooling Chris Smith to discuss Kelly's question: What would your letter in response look like? What else has been left out?

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.

Transition

Doing some research at work on contraceptive prevalence in some developing countries to appease a lazy donor (duh, measuredhs.com), and we decide to give them some abortion data as well. The reasoning: if our programs increase contraceptive prevalence, then it also reduces abortion prevalence. Since the DHS doesn't capture abortion data (unclear on why; political issues?) we find some Guttmacher data. Initially I was concerned that this info might confuse our donors; since ab laws have been relaxed in many places over the last decade, abortion prevalence might increase and lead them to believe horrible things about contraception and the ineffectiveness of our programs. And it's not easy to talk a donor down from a ledge.

But check it! Worldwide, ab prevalence has actually gone down. From this particular data I can't say why, but of course we'll speculate that it has to do with increases in method use, especially long-term methods (IUDs and such). But read further: though overall abortion rates have fallen, rates of illegal/clandestine abortions have stayed the same!

ACK!

So the situation is actually pretty bleak. Because the most relaxed laws occur in the most developed countries, the women at greatest risk for complications from abortion are not granted access. This report mentions 19 countries have reduced restrictions, many in the developing world, but with the same access barriers and so on that have existed forever. God bless pro choice de jure.

With all the resource allocation and funding for ab in the states, what is the prognosis for that kind of support in the rest of the world? My org is not allowed to; which orgs are? Does anybody know of prospects for abortion access overseas? Is it too much of a hot button issue? I'm so confused. So many countries' women are dying and they don't care! How is it that the world has managed to (for the most part) get on board with HIV/AIDS within a decade, but has taken centuries to do so for ab? If you ask me HIV is as tricky an issue as ab, by which I mean it's not tricky at all. Give people things so they don't die.

SOUNDS PRETTY GOOD TO ME!

If I were Miss America, I wouldn't wish for world peace. I'd wish for world abortions.

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IN OTHER NEWS:

I just received an email stating the following:

"New rule from Dept. of Health and Human Services: women with pre-existing conditions like breast cancer, AIDS and diabetes will be banned from buying insurance coverage for abortion in
high-risk insurance pools. They won't even have the option to buy coverage with their own money. Outraged? So am I."

WHAT IN TARNATION?!?!?!

End the madness!

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ALSO!

As long as I keep getting distracted at work by checking email and IMDB and other distracting sites, I found the following while reading the Wikipedia entry for Nick Cannon (don't ask):

"Cannon's music video for Can I Live? reveals that he was almost aborted by his mother, but she panicked in the abortion clinic and decided to have the baby."

Sigh. I love when people talk about this stuff as though it's an argument for abortion banning. Not that this entry was explicitly anti-choice in any way, but it reminded me of other instances in which "My mom almost aborted me and etc etc" comes into the discussion. Remember when it's "pro-choice" and not "pro-strapping-women-to-tables-and-forcing-things-between-their-legs"? Why would we not want women to have babies if they want to have them? Ack ack.

Barriers: Stigma and Language

In the work we do, we come across barriers to abortion care all the time. I think stigma is actually one of the greatest barriers: it can stop women from seeking support from medical staff; it may inhibit a woman from talking to her best friend about her abortion; she may have to lie to her employer about why she needs a couple days off of work, for fear of judgment. Or unemployment. The list goes on and on.

But....say you're a woman from a developing country where abortion is highly illegal and clandestine. Suppose you now live in America, but don't speak a lick of English and are completely reliant upon strangers, friends, relatives to interpret for you. Assume you're from a country where already an immense amount of stigma (making the US run-of-the-mill stigma look pale in comparison) surrounds abortion. You must risk speaking to a stranger - from your community - to translate that you need an abortion.

...Think about that for a moment. Just let that sink into your heart. How would you feel? How hard would that be for you? How scary would it be to tell a complete stranger your needs and desires? Could you trust this interpreter from your community? Could you trust that person to maintain your privacy and not divulge your information to other community members? Family? Husband? Could you trust this person to do their job and actually tell the healthcare worker your need to have an abortion? Now...imagine how brave and how difficult it must be to put your trust in all these strangers and not have a clue about the outcome. Not know if the abortion will be safe. If you'll survive. If anyone will be compassionate or understanding. Imagine the power these strangers have over you. The power of the interpreter. The power our medical institution has you. The power the stigma so embedded in our own country has over you.

I worry about these women. Often. I worry they don't know their rights: that their lovers don't have to give permission for them to have abortions; that she can access healthcare in a safe way; that abortion is legal; that she will be okay - that she will not die; that abortion providers will do everything they can to ensure she understands her procedure and understands how to access us if needed afterwards.

Yet, how easy would it be for her, really? I've been working with a woman who is from a country where it's difficult to find a pro-choice interpreter. A country where no one talks about abortion. Where women are regarded very little. Where men have all the control. She doesn't speak English. So, through the interpreter, I tell her, to call me if she needs me. The reality is, though, how would she call me if she needed me? How would I understand her? How would I help her? Of course, I'd find an interpreter to translate our conversation. Yet, still then, I wonder if the interpreter is being accurate in the information being translated - let alone kind and compassionate.

I feel for these women. I have compassion. And even some empathy regarding what it's like being a stranger in a new land. Without much help. And it's not fun. It's scary and hard. And. Well. We're thinking of them here in Abortionland.