Racist Anti-Abortion Bill Boards, Again?

Many of us heard about these billboards popping up in Georgia last year, Anti Anti, , Vulva Flower and I wrote about the racist bill boards reading "Black Children are an Endangered Species. I had not heard about any more of these offensive bill boards until now. The Life Always group recently unveiled another equally offensive bill board last week. However, there is victory according to this blog the Women Of Color Policy Network announced that the bill board would be taken down immediately.

This newer bill board reads "The Most Dangerous Place for An African American is in the Womb" This message is so appalling I almost don't know how to respond. Do the folks who put this together take modern day manifestations of racism into account at all? Black men and people are still routinely harassed by police for simply being black, Black people are still being incarcerated at an insanely high rate for non-violent crime, and even Wikipedia knows that race and poverty are linked, poverty rates are much higher for people of color than white folks. So the point is if the people funding these bill boards, Life Always, are so concerned for the well being of black folks it sounds like there are a lot of ways redirect there energies and actually work towards dismantling systemic racism in the United States, its rampant.

I'm glad this bill board was taken down. I have heard rumors that similar bill boards were removed in Atlanta but remain up in other parts of rural Georgia. A writer from Colorlines identifies several reasons she hates these bill boards but makes the point that they have motivated women black women to come together across class and religious lines. I also hate these bill boards and I hope that blatant racist disrespect of black womens' lives and choices motivates women to voice their support for reproductive rights and choice.

Maybe you should ask, "Why did we make her wait so long?"

I'd wanted to write a good solid post expanding on my last one -- about why some women "wait so long" to have an abortion -- and connecting the dots to social justice. It is Martin Luther King day, after all, and while we ought to be carrying his goals of racial and economic justice in our minds every day, it always helps to describe the links aloud. But: I've been getting sick this weekend and today I woke up with puffy eyes and that underwater feeling in my head and it's making me feel dizzy. I'm going to limit this to my research summaries, because you're smart and insightful enough to connect the dots yourself, and because I can't see my keyboard very well. 

*

In 2008 researchers at ANSIRH published an unusual study of delay in obtaining abortion care [PDF]. For purposes of analysis, they divided the process into three stages -- between the first missed period and the first pregnancy test; between the first pregnancy test and the first call to an abortion provider; and between that first call and actually having the abortion -- and then identified the circumstances that were closely associated with longer time for each stage. The factors associated with delay varied based on stage. In the first stage, significant delay before the pregnancy test occurred for women who were obese, weren't sure of the date of their last period, were assessed as being in denial about pregnancy or "afraid of an abortion," abused drugs or alcohol, or had had a second-trimester abortion in the past. (A lot of these seem logical, don't they?) 

However, these were not significantly associated with delay in the second stage; rather, women had a longer stage 2 if they had had trouble obtaining MediCal (California's health insurance for low-income residents, which includes coverage for in-state abortion care), and if they had "had difficulty with their decision to terminate this pregnancy." In the third stage, delay in having the abortion itself was associated with (again) having had a second-trimester abortion in the past; having been initially referred to some other clinic than the study site; having an unsupportive partner; and having had difficulty coming up with the money to pay for an abortion. 

So logistical barriers emerge in stage 2 and 3, and especially economic ones. Social/emotional barriers are still present, but different from in stage 1. (Understandably you might delay your call to the clinic if you're having a hard time deciding what to do with your pregnancy; you might try to reconcile a reticent partner to your decision before you head to the appointment -- or your partner might be actively trying to prevent you from getting there!) 

(Additional interesting findings from the last stage: what shortened the time between calling a clinic and having an abortion? (1) Nausea and vomiting [heh, shocker]; (2) having had “difficulty deciding” to seek an abortion. That is, if a woman struggled with her decision, she was likely to have a longer time than other women between taking a pregnancy test and calling a clinic, and a shorter time than other women between calling a clinic and having an abortion.) 

*

From several of the same California researchers, a 2006 multivariate logistic regression study: "Delays in suspecting and testing for pregnancy cumulatively caused 58% of second-trimester patients to miss the opportunity to have a first-trimester abortion. Women presenting in the second trimester experienced significantly more delaying factors, with logistical delays occurring significantly more frequently for these women (63.3% versus 30.4%). Factors associated with second-trimester abortion were delay in obtaining state insurance, difficulty locating a provider, initial referral elsewhere, and uncertainty about last menstrual period." Interestingly, second-trimester abortion was associated with both having had a prior second-trimester abortion and never having had an abortion before. 

*

In 2006 the Guttmacher Institute published a study on timing and reasons for delay [PDF] as well. They broke the process into more steps, and measured median time for each. 

-From the last menstrual period to suspecting pregnancy: 33 days (which makes sense if you imagine the average 28-day cycle then add about a week for your first missed period); it was a week longer for minors than for adults (which also makes sense if you consider how irregular most young people's cycles are)

-From suspecting pregnancy to confirming pregnancy (pregnancy test or sonogram): 4 days

-From confirming the pregnancy to deciding to have an abortion: zero days

-From deciding to have an abortion to first attempting to obtain abortion services (calling to make an appointment): 2 days

-From first attempting to obtain abortion services to obtaining the abortion: 7 days

...So that's 48 days right there (and that's just adding up medians, meaning half of women have a longer delay in each of these steps), yet I think somehow a lot of people hear "seven weeks" and think that's a really long time to "wait." I saw an actual published writer write that abortions should only be legal up til six weeks because "forty-two days is plenty of time to decide to have an abortion." Reality to actual published writer, please come in. 

58% of women reported that they would have rather had the abortion sooner, and these women were asked about the reasons for the delay they experienced (women could give multiple reasons). Most commonly, these respondents said: 

-It took a long time to find out about the pregnancy: 36%

-It took a long time to decide to have an abortion: 39%

It took a long time to make arrangements: 59%. Poor women were about twice as likely to be delayed by difficulties in making arrangement. (This includes money, referrals, appointments, transportation, judicial bypass for minors, legally required waiting periods, etc.) 

Patients mentioned a lot of other reasons, including:

-As partial response to Frances Kissling's question, 0.2% stated they found out late about a fetal anomaly (but this isn't broken up by trimester or week; I still think the later abortion patients she was asking about would give this response more often). 

-Only 2% said they "didn't think it was important to have it earlier." (Granted, this doesn't include possible similar answers from the 41% of women who didn't say they'd have rather had the abortion earlier, but I imagine a lot of those 41% had theirs quite early. I wish I could see a full data set on this.) 

I highly recommend reading the rest of this article because it has a section on qualitative findings from in-depth interviews that I just couldn't do justice here. Among other things, it shares the words of women who "knew right away" that they were decided on seeking an abortion, and of  women who found it a "hard decision" and took longer to feel firm in their choice.** 

*

What about demographic characteristics? Poor women with no insurance coverage for abortion, black women, and young women are likely to have later abortions than other women. However, being poor and lacking insurance coverage disproportionately co-occur with being black and being young. In some studies, each of these effects persists even after controlling for the others; in other studies, they confound one another and only the poverty/insurance effect remains significant. 

I think you can guess what I was going to say about all that. To make a long story short: justice in healthcare access must include attention to reproductive matters. If you care about making a more just society, please express support for public funding for contraception and abortion; donate to your local abortion fund; work to reduce stigma against both abortion and pregnancy; combat racist, ageist and classist stereotypes of appropriate motherhood; and learn about domestic violence and sexual assault prevention. 

**If you want to read more about abortion decision-making, here are some articles to try [unfortunately a few only give the abstract for free]: 

2010: Kjelsvik M. Pregnant and ambivalent. First-time pregnant women’s experience of the decision-making process related to completing or terminating pregnancy – a phenomenological study. 

2005: Finer LB et al. Reasons US women have abortions: quantitative and qualitative perspectives.

1985: Faria G, Barrett E, Goodman LM. Women and abortion: attitudes, social networks, decision-making.

1984: Friedlander ML, Kaul TJ, Stimel CA. Abortion: predicting the complexity of the decision-making process. 

(And if anyone can find the following in English, let me know:) 

1999: Tornbom M et al. Decision-making about unwanted pregnancy.

1990: Ytterstad TS, Tollan A. The decision process in induced abortion. 

Manipulate household finances and personal security to get the desired result from your female appliances.

The last few weeks have brought up a lot of issues around affording one's abortion care. First Mr. Banana Grabber described some of the difficult situations we hear about at holiday times when mothers are juggling the cost of the heating bill, toys for the kids, their outgrown winter coats and, oh yeah, the abortion appointment. 

A few days later, Mr. Banana Grabber is hella bummed out, because some anti-choice blogger, who's so disconnected from reality she appears to not even know any poor people, says she doesn't believe that women would return, pawn, or sell their kids' holiday gifts over a stupid little abortion (why not just wait til January?!). An anti-choicer not trusting women's knowledge of their own experiences? Shocker! 

And last week Anti-Anti took up the topic again, discussing the privilege of being able to afford an abortion and the importance of recognizing that others may be in very different situations. UneFemmePlusCourageuse commented to say that even the hard work done by donation-based abortion funds doesn't nearly plug all of the cracks: 

If someone is married, and their spouse makes fairly good money, but she can't tell him that she wants/needs an abortion, then many abortion funds won't help her cover the procedure... just because someone seems to be financially comfortable overall doesn't mean that paying for an abortion wouldn't be difficult for them.

As I said in reply to UneFemme's comment, I'm confused/curious about this statement. It's true way too many women are still struggling to find assistance, or enough assistance, despite fund staff's efforts. But I've worked on abortion funding, too, and haven't run into a specific requirement that a woman discuss the appointment with her partner -- in general the funding groups I worked with recognized that (a) disclosure isn't a woman's "obligation" and (b) disclosure isn't always safe. 

One thing I have heard, and said myself, in the course of financial counseling is, "If you can't borrow money for an abortion, can you maybe borrow money by saying that it's for something else?" Not just for partners, but also when women [understandably] balk at discussing their situation with parents, friends or neighbors. So if a woman's finances are 'comfortable' but controlled by her spouse, a fund volunteer might ask her to try requesting money for an acceptable but non-routine purchase (for instance to replace an ostensibly worn-out pair of shoes for their child); put her utility money toward the abortion fee and then ask a neighbor for help with an unexpectedly-high gas bill; or in some other way shuffle "allowable" money around. 

It sucks that women have to lie to the people around them. What sucks the worst is to see women aware, or quickly becoming aware, that they're not taken seriously as moral agents, that they have to lie to be able to do right by themselves, and that if their loved ones can use money as a tool to dictate their choices, they will. Our government certainly does.* And it's disgustingly objectifying. 

I know I shouldn't say "women" as though it's a universal truth for all of us. For example, personally, I'm lucky to have at least some people in my life whose support for me is unencumbered by that kind of bullshit. But variations on this theme happen so goddamn often that it's hard, after all, not to see this as a collective problem for women. Indeed, every time a woman tells me she can't talk to anyone because she fears being beaten or thrown out on the street by her asshole of a partner or parent -- fears that her only "choice" is between her need for bodily self-determination and her need to not bleed or freeze to death -- I feel like that asshole is vitiating the moral agency of us all. 

*"I would certainly like to prevent, if I could legally, anybody having an abortion: a rich woman, a middle class woman, or a poor woman. Unfortunately, the only vehicle available is the HEW Medicaid bill." (Henry Hyde, 1976)

**Disclaimer: My linking to NNAF should not be interpreted as a statement that I work or have worked for NNAF. (Just like my linking to the Hyde Amendment should not be interpreted as a statement that I currently work or have worked for the jackass.) 

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.

Education Sunday.

I decided to post an excerpt from a paper I wrote. In case you didn't know the specifics, now you do.

On March 24, 2010, President Obama issued an Executive Order that prohibits the use of federal funds for abortion services (except in cases of rape, incest or life endangerment of the woman).[1] This provision continues the ban on federal funding of abortion that was set in place more than 30 years ago by the Hyde Amendment. Proponents of the Hyde Amendment assert that it is their democratic right as policy leaders, to express their opinion and be able to exert their beliefs in the health care debate.

Currently, six million women of reproductive age obtain health care coverage through the Medicaid system.[2] Federal bands on funding for abortion services have severely restricted access to safe abortion care for thousands of low-income women who depend on the government for their health care. Poor women especially, are unable to exercise their constitutional right to choose abortion when public funding is restricted. An estimated 18-35% of Medicaid-eligible women carry their pregnancy to term because they cannot afford an abortion.[3] While Medicaid does not allow federal funding for abortion, it does provide funding for childbirth.[4] Medicaid insures one-fifth of the nation’s children and pays for one-third of all childbirths.[5]

Under current health care policy, the federal government is willing to pay for some of poor women’s reproductive health but not all. In turn, the Hyde Amendment is negatively impacting poor women’s lives on the basis of policy leaders moral and ethical beliefs about abortion. Should Congress members and policy leaders be able to put their moral beliefs above the health and well being of its citizens? Low-income women often face serious hardship when trying to raise funds for abortion services. Many women use money they should have spent on rent, food, bills and clothing for their children. A significant amount of women resort to pawning household items, and some resort to theft and prostitution in a desperate attempt to have a legal, medical procedure.[6] The 1983 AGI study found that Medicaid-eligible women wait on average 2-3 weeks longer than women with economic means to have an abortion. As a woman gets farther along in her pregnancy, the cost of the abortion starts to rise, and it becomes more difficult to raise the necessary funds, creating a vicious cycle.

The Hyde Amendment is a discriminatory policy that targets poor women, who are disproportionately women of color. Women who are not covered under the Nation’s Medicaid system, are either not enrolled in the program, undocumented citizens, or not eligible under the Federal Poverty Income Guidelines. Women who can afford to pay for an abortion on their own, ranging from approximately $300-$500 for a first trimester procedure, are mostly unaffected by the Hyde Amendment’s restrictive policy. An estimated 18-35% of Medicaid-eligible women carry their pregnancy to term because they cannot afford an abortion.[7] There is a huge disparity between impoverished women and middle/upper class women. In 1983, AGI researchers found that “nearly 60% of Medicaid recipients said that paying for an abortion caused serious hardship, compared with only 26% of non-Medicaid-eligible women.”[8] Although Roe v Wade gave women the constitutional right to have an abortion, they are unable to exercise this right when access and affordability of services is denied. The Hyde Amendment makes real reproductive “choice” a privilege for those that can afford it, rather than a constitutional right guaranteed by the Supreme Court.[9]

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[1] Raising Women’s Voices. (March 30, 2010). Health Reform and Reproductive Health: Positive and Negative Effects. Available: http://www.raisingwomensvoices.net/storage/RWV%20on%20Health%20Reform%20and%20Reproductive%20HealthFINAL3.30.10.pdf.

[2] Boonstra, H., A. Sonfield. “Rights without Access: Revisiting Public Funding of Abortion for Poor Women.” The Guttmacher Report on Public Policy. April 2000: 8-11.

[3] Fried, M. (2007) “Hyde Amendment: The Opening Wedge to Abolish Abortion.” New Politics. 11(2): 82-85.

[4] Annas, G. J. “Abortion Politics and Health Insurance Reform.” The New England Journal of Medicine. December 31, 2009: 2589-2591.

[5] Weil, Alan, "There's Something About Medicaid," Health Affairs (Jan/Feb 2003).

[6] Boonstra, H., A. Sonfield. “Rights without Access: Revisiting Public Funding of Abortion for Poor Women.” The Guttmacher Report on Public Policy. April 2000: 8-11.

[7] Fried, M. (2007) “Hyde Amendment: The Opening Wedge to Abolish Abortion.” New Politics. 11(2): 82-85.

[8] Fried, M. (2007) “Hyde Amendment: The Opening Wedge to Abolish Abortion.” New Politics. 11(2): 82-85.

[9] Boonstra, H., A. Sonfield. “Rights without Access: Revisiting Public Funding of Abortion for Poor Women.” The Guttmacher Report on Public Policy. April 2000: 8-11.

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.