Solutions for Sex-Selective Abortion Become Problems

Deepali Gaur Singh

Removing gaps between men and women -- gaps in education, health, nutrition, human rights and laws -- is the only real solution to eliminating the sex ration at birth gap.

This is the fifth post in a series of articles examining sex-selective abortion in India, by our Global Perspectives correspondent Deepali Gaur Singh. For the complete series, please click here.

Yet another person in a remote village of Bihar in eastern India gets elevated to the position of a goddess. For years the rhetoric used to justify and even make excuses for the condition of women is that Indian society (read Hindu) is amongst the very few where women enjoy the status of goddesses. And one just needs to turn to Indian scriptures for the evidence. Women who die on the pyres of their husbands are made goddesses. In life they would have had an existence worse than the cattle at home (for those who own cattle)! The latest incident is of a conjoined twin (conjoined with her headless twin) whose parents – poor laborers themselves – found hope in Bangalore doctors who came forward to operate upon Laxmi (their daughter) who requires at least two people to assist her with the most basic daily tasks. The villagers back home are angry with the parents as they see her as a reincarnated goddess and wish to deify her by building a temple in reverence to this eight-limbed little girl. What this entails is that she live the rest of her life just so out of respect for this spectacular tribute to her. Laxmi and her mother are still lucky considering in some parts they might have been treated as witches and lynched.

Ironically, the incident sums up the situation of so many women in India and similar societies in Asia. Traditional, socially-sanctioned jobs, duties and expectations are thrust upon them without their say even if it involves their own lives or that of the daughters they bear. How many women are really able to decide if they want to selectively abort their female fetus; how many women can decide on family planning or contraception; how many women willingly send their under-age daughters as young brides for much older men in far-flung places having more often than not endured the same ordeal?

The recently concluded Fourth Asia-Pacific Conference on Reproductive and Sexual Health (4th APCRSH) at Hyderabad, India, was the forum to discuss the dangerous trend of preference for male children over female all across Asian societies, apart from other extremely contentious issues. While the imbalance in sex ratios in India has become an issue for repeated debate over the past year or so, it is the methods being employed to contain it that have really caused deeper concern especially since the time for experimentation has practically run out. If matters have to be rectified, policies have to be sustainable and have to work.

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With newer technologies made available for people to aid them in the process of fertility and conception, the issue no longer is going to be about sex selective abortion. It is now a larger moral issue of wanting only male children as opposed to a female child — particularly since the technology to do it is going to be an arm's length away. There was a time when female infanticide was condemned, but it took quite a while to realize that increasing numbers of people no longer had to go through the motions of ‘accidentally' killing the female infant since the option of selectively aborting the female fetus became available with newer, cheaper technology. And with even better technology available for pre-selection, even the method of repetitive pregnancies and sex selective abortions for acquiring a male child would become redundant. So are we looking to penalize people for using the technology or penalize people for making an unfair distinction between the male and female child? What about people who have not/will not have access to these technologies due to their economic conditions, but will discriminate between male and female children by way of education and daily nutrition? Or sell their daughters in marriage to the highest bidder to get rid of the responsibility of caring for her?

Despite many of her questionable schemes (like the cradle scheme and the more recent registration of pregnancy to maintain a ‘state watch' over sex selective abortions) and the controversial "don't trust men" remark more recently the Indian Union Minister for Women and Child Welfare, Renuka Chaudhary at the 4th APCRSH raised the crucial need to increase men's assimilation and participation in addressing the sex ratio imbalance, the factors responsible for it and related issues of women's sexual and reproductive health. Considering women rarely have a say in decisions at their marital homes and even if they do they are more often than not shaped by their own position in both their paternal and marital homes they are an important component in any sustainable change in social attitudes and structures. And thus, while laws need to be in place to punish the guilty, a more enduring change would come not out of fear of the state and its laws but the damage to the social and familial fabric that such retrograde practices and structures do.

The case study of a young girl who went through seven pregnancies one after the other, all for a male child, is a story oft heard. Some of her babies didn't survive even five days — not to mention the health implications on this young woman. Though the story of a girl from Pakistan this could very well be that of any woman trapped in a patriarchal set-up where a male child is welcomed with celebrations and a female with despondency. And with an increasing number of families, across cultures in the continent, actively avoiding daughters due to excuses ranging from the ritualistic need of boys in the Indian culture or as a retirement plan for those in China, the social implications in the region are not hard to imagine. Studies by the UNFPA suggest a similar scenario in Nepal and Vietnam which only makes the situation even more precarious for women in these countries vis-à-vis human trafficking.

Asia has already lost out on 163 million women by virtue of this imbalance. Missing women or surplus men — however you look at the situation the imbalance comes with immense socio-economic implications. The difficulty in finding brides has already been witnessed in parts of India with instances of polyandrous marriages. Besides, being a virtual gold mine for those earning their millions from human trafficking, with heightened insurgency and terrorism making countries like India flashpoints, the chances of this surplus male population being recruited by armies might become another dangerous reality. Removing gaps between men and women – gaps in education, health, nutrition, human rights and laws etc. – is the only real solution to remove this Sex Ratio at Birth (SRB) gap.

Analysis Politics

Libertarian Nominee Gary Johnson’s Abortion Doublespeak

Ally Boguhn

In an election year when many voters are increasingly frustrated with their options, both Gary Johnson's presence in the race and his policy positions are notable. When it comes to reproductive rights in particular, Johnson appears to have spent years walking a fine line.

The Democratic Party won’t be the only one on the ballot this November with a self-described pro-choice nominee on its presidential ticket. Libertarians chose former New Mexico Republican Gov. Gary Johnson, a self-identified pro-choice candidate, as the party’s nominee for the 2016 race during their convention on May 29.

Though Johnson’s chances of becoming president are low, the Libertarian Party will likely be the only third-party option on the ballot in all 50 states. According to statistical analysis site FiveThirtyEight, several recent national polls have the Libertarian nominee taking 10 percent of the vote. Those numbers are nothing, the site noted, to shrug at: “Gary Johnson is neither Donald Trump nor Hillary Clinton. He might not win a state, but he could make some noise.”

In an election year when many voters are increasingly frustrated with their options, both Johnson’s presence in the race and his policy positions are notable. Candidates need only reach 15 percent in selected public opinion polls to make it to the national debate stage, meaning Johnson may have a shot at bringing his opinions to the masses.

When it comes to reproductive rights in particular, Johnson appears to have spent years walking a fine line, frequently presenting himself as “pro-choice” while simultaneously opposing abortion on a personal level and supporting some restrictions on the procedure. “[Abortion] should be left up to the woman,” said Johnson during a 2001 interview with Playboy, adding that if his “daughter were pregnant and she came to me and asked me what she ought to do, I would advise her to have the child. But I would not for a minute pretend that I should make that decision for her or any other woman.”

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Johnson’s current campaign website continues this trend, seemingly attempting to have it both ways on abortion. It borrows aspects from both anti-choice and pro-choice advocates and pushes the line that the candidate “has the utmost respect for the deeply-held convictions of those on both sides of the abortion issue.”

“It is an intensely personal question, and one that government is ill-equipped to answer,” reads Johnson’s campaign site. Though the site notes that the candidate has “never advocated [for]abortion or taxpayer funding of it,” it goes on to explain that Johnson supports the “right to choose.”

“Further, Gov. Johnson feels strongly that women seeking to exercise their legal right must not be subjected to persecution or denied access to health services by politicians in Washington or elsewhere who are insistent on politicizing such an intensely personal and serious issue,” concludes his abortion platform before adding an aside that he supported bans on “late term abortions” during his time as governor. The page does not define what “late term abortion” means in this context, nor does it go into more detail about what specific bans Johnson backed.

Johnson’s attempts to craft his own middle ground in the abortion debate during the 2016 elections are holdovers from his past run for the White House during the 2012 election, when he ran as a Republican before switching over to the Libertarian Party. During a June 2011 interview with Rolling Stone, Johnson plainly stated his position on abortion, as well as several anti-choice measures he has supported in the past:

I support women’s rights to choose up until viability of the fetus. I’ve supported the notion of parental notification. I’ve supported counseling and I’ve supported the notion that public funds not be used for abortions. But I don’t want for a second to pretend that I have a better idea of how a woman should choose when it comes to this situation. Fundamentally this is a choice that a woman should have.

Johnson consistently says he is pro-choice up until the point of viability, something already enshrined into law in Roe v. Wade. As Rewire has previously reported, “Even though the Court in Roe decided that fetal viability would be the benchmark for the balance between a person’s right to choose and the state’s interest in “potential life,” the Court was silent on when fetal viability occurs. It left that decision up to doctors.”

In August 2011, during an argument with the editor in chief of the conservative CNS News, Terry Jeffrey, Johnson fired back at the host for pushing him to concede that a fetus should have the same “right to life” as born individuals. This argument is often used by conservatives to support so-called personhood legislation, which would grant constitutional rights to a fetus as early as conception, and could outlaw abortion as well as many forms of contraception.

“What you’re saying is that you would take this away from a woman, you would criminalize a woman who is making a choice that I believe only a woman should make,” said Johnson, who flatly asserted that women should have the right to opt for abortion up until the point of viability. “And you may in fact be criminalizing the activities of doctors who are involved also,” he noted.

Johnson’s critique of Jeffrey’s question and his clear opposition to criminalizing those who have or provide abortions stands in contrast to presumptive Republican nominee Donald Trump, who said in March that those who have abortions should face “some form of punishment” if it was illegal, only to later claim that doctors—not women—should be punished.

Even so, Johnson again touted his support for a number of restrictions on abortion access, presumably to shore up support among Republican voters. “I signed a law banning late-term abortion, believing there is a point of viability,” said Johnson on the show, “and I also as governor of New Mexico supported parental notification. I have also always supported counseling.”

State-mandated counseling for abortion-which is what Johnson seems to be pitching-often requires “information that is irrelevant and misleading,” according to a March 2016 report from the Guttmacher Institute. The waiting periods that frequently accompany such laws, for that matter, often create hardship for women by adding additional expenses or logistical hurdles for those seeking abortion care. Guttmacher also found in a 2009 report that the most direct impact of common parental consent laws “is an increase in the number of minors traveling outside their home states to obtain abortion services in states that do not mandate parental involvement or that have less restrictive laws.”

Johnson’s claim about banning later abortions during his tenure as governor of New Mexico, meanwhile, presumably refers to a so-called partial-birth abortion ban outlawing certain kinds of later abortions-though, like the claim on his 2016 website, the specifics are not clear Johnson signed the ban into law in 2000, making it the first restriction on abortion put in place in the state in more than 25 years.

In truth, “partial-birth abortion” is an inflammatory non-medical term, coined by the anti-choice National Right to Life Committee in 1995 in an effort to make passing abortion restrictions easier. It is often used to describe the dilation and extraction abortion procedure (D and X), typically performed between 20 and 24 weeks of pregnancy. New Mexico’s law made it a fourth-degree felony for a doctor perform the procedure on “an independently viable fetus.” As NPR has reported, most D and X abortions actually do not take place after viability:

And contrary to the claims of some abortion opponents, most such abortions do not take place in the third trimester of pregnancy, or after fetal “viability.” Indeed, when some members of Congress tried to amend the bill to ban only those procedures that take place after viability, abortion opponents complained that would leave most of the procedures legal.

According to the Albuquerque Journal, “abortion opponents say the [2000] law had little impact because it pertained only to cases in which a fetus had attained viability, which is defined as being able to live outside the womb.”

Johnson also asserted during a 2011 Republican debate hosted by Fox News that he would have signed a ban on later abortion, had one reached his desk. However, he again did not elaborate on what point in pregnancy such a ban would apply or whether it would have exceptions.

Johnson’s 501(c)(4) organization, Our America, has gone as far as to call for Roe v. Wade to be completely overturned. When Johnson was running for president in 2012, the group’s site discussed the candidate’s position on abortion before calling for the Supreme Court to overturn the case:

Judges should be appointed who will interpret the Constitution according to its original meaning. Any court decision that does not follow this original meaning of the Constitution should be revisited. That is particularly true of decisions such as Roe vs. Wade, which have expanded the reach of the Federal government into areas of society never envisioned in the Constitution. With the overturning of Roe vs Wade, laws regarding abortion would be decided by the individual states.

Any mention of the topic seems to have been scrubbed from the current version of the organization’s website, but Johnson’s pitch for a potential replacement for Justice Antonin Scalia on the Supreme Court speaks for itself. Shortly after the justice’s death in February, Johnson shared a picture of himself on Facebook with Fox News’ senior judicial analyst, Andrew Napolitano, calling the conservative media figure a “great candidate” for the vacant seat.

Napolitano is stringently anti-choice: During a January 2016 segment for Fox News, Napolitano blasted the Court’s decision in Roe, claiming that it allows the “murder of babies in the womb,” advocating for Congress to pass an extreme “personhood” amendment in order to end legal abortion. He also compared Roe v. Wade to the Supreme Court’s decision in Dred Scott v. Sanford, which denied personhood to Black Americans, essentially upholding slavery.

Napolitano also took issue with exceptions to abortion bans in cases of rape in a 2012 opinion piece for FoxNews.com after former Missouri Republican Rep. Todd Akin notoriously claimed that in cases of “legitimate rape, the female body has ways to try to shut the whole thing down.”

“Rape is among the more horrific violations of human dignity imaginable,” wrote Napolitano. “But it is a crime committed by the male, not the female—and certainly not by the child it might produce. When rape results in pregnancy, the baby has the same right to life as any child born by mutually loving parents. Only the Nazis would execute a child for the crimes of his or her father.”

This rhetoric echoed Napolitano’s recent comparison of the legalization of abortion care to “the philosophical argument underlying the Holocaust.”

Johnson’s willingness to consider Napolitano to fill a Supreme Court vacancy make one thing clear: Even if Johnson claims to be pro-choice, should he win the White House, access to abortion may still be in jeopardy. The Libertarian nominee’s support of a number of abortion restrictions and apparent willingness to nominate anti-choice justices to the Court call into question whether the “right to choose” Johnson claims he supports would truly remain—an alarming prospect given the increased attention the candidate is receiving in the 2016 election.

News Abortion

GOP Fact-Check: Hospital Transfers Don’t Signal Abortion Dangers

Christine Grimaldi

Hospital transfers are not necessarily a cause for alarm, multiple sources told Rewire.

Rep. Marsha Blackburn (R-TN) justified her recent subpoenas of a prominent later abortion provider and first responders in the community where he works by pointing to “public reports” that people who sought abortion care from the doctor required hospital transfers.

Hospital transfers are not necessarily a cause for alarm, multiple sources told Rewire. In fact, the rare instances signal a continued commitment to appropriate patient care that begins in an abortion clinic. A patient may not require further treatment upon arrival at the hospital, indicating a proactive clinic rather than a dangerous one. Regardless of the circumstances, anti-choice activists often hijack so-called emergencies to fuel their coverage of the alleged dangers of abortion care.

Freestanding clinics manage most immediate abortion-related complications, including those that occur during later abortions, said Dr. Daniel Grossman, a provider and professor in the department of obstetrics, gynecology, and reproductive services at the University of California, San Francisco.

Abortion-related complications are rare throughout all stages of pregnancy. The even rarer event that such complications necessitate a hospital transfer doesn’t indicate the work of a bad abortion provider, Grossman explained in an interview with Rewire.

“There are sometimes things that happen that are unforeseeable,” he said.

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Evidence Contradicts Blackburn Subpoena Claims

Grossman, his University of California, San Francisco colleague Dr. Ushma Upadhyay, and other reproductive health care practitioners and policy experts studied just how often those unforeseeable instances occur in a review of nearly 55,000 abortions covered under the fee-for-service California Medicaid program from 2009-2010. The state data allowed researchers to track subsequent follow-up care sought after an abortion.

Among all abortions, about one of 5,491, or 0.03 percent, involved ambulance transfers to emergency departments on the day of the procedure, the researchers found.

For procedures in the second trimester or later, major complications that required hospital admissions, blood transfusions, or surgery amounted to 34 cases, or 0.41 percent.

Many hospitals don’t provide abortions, which essentially forces providers to perform the procedure at a freestanding clinic or turn away patients, Grossman said. Providers would not do something unsafe, he stressed, “but that puts a lot of pressure on them because they don’t have that option of deciding to do the procedure of a higher-risk patient in a hospital.”

States that have enacted targeted regulations of abortion providers, known as TRAP laws, may force providers to gain hospital admitting privileges, even though hospitals can’t refuse to care for transfers and emergency arrivals. Many hospitals don’t want to issue admitting privileges to abortion providers, Grossman said, in part because their patient admissions are so infrequent—putting the onus back on clinics to provide abortion care.

Data supports Grossman’s assessment about abortion and clinic safety. Abortion care is one of the safest medical procedures performed in the United States, according to Planned Parenthood and the American Congress of Obstetricians and Gynecologists. “The rate of complications increases as a woman’s pregnancy continues, but these complications remain very unlikely,” the groups said in a joint fact sheet.

Blackburn, the chair of the U.S. House of Representatives’ Select Investigative Panel on Infant Lives, framed such instances differently when she shifted the panel’s focus from fetal tissue research practices to later abortion care, issuing subpoenas in mid-May to Dr. LeRoy Carhart and various local and state entities in Maryland.

“Public reports indicate at least five women have been sent to the hospital since December while seeking an abortion in this clinic,” Blackburn said in a press release. Blackburn expressed concern for “the sake of the women who have been rushed from that clinic to the hospital with increasing frequency.”

Blackburn Allegations Rooted in Dubious Sources

Blackburn’s press release cited the five hospital transfers since December 2015, but her subpoenas demand documentation dating back to 2010—signaling a deeper scope to her investigation.

The National Abortion Federation (NAF), the professional association of abortion providers, countered Blackburn’s basis for the subpoenas.

“Abortion opponents have been targeting Dr. Carhart for years because he is a very vocal and visible abortion provider,” NAF spokesperson Melissa Fowler told Rewire in an email. Following the 2009 murder of Dr. George Tiller, Carhart arguably became the country’s most prominent provider of later abortion care.

The Maryland Board of Physicians, one of the targets of Blackburn’s subpoenas, indicates that Carhart is in good standing. The board’s online practitioner profile system lists no Maryland disciplinary actions, no pending charges, and no reported malpractice judgments and arbitration awards within the past ten years. Malpractice settlements are another measure of provider competence, and Carhart hasn’t had three or more malpractice settlements of at least $150,000 in the past five years, according to the system. Additionally, the courts have not reported “convictions for any crime involving moral turpitude,” which the board defines as “conduct evidencing moral baseness” and determines on an individual basis under common law.  

Absent allegations on the board’s website, the “public reports” smearing Carhart appear to come from anti-choice news outlets. In March, LifeSiteNews.com cited eyewitness accounts from anti-choice activists in reporting that Carhart sent a fourth woman to the hospital in four months. A leader of the radical anti-choice group Operation Rescue covered the same allegations for LifeNews.com.

The same website in 2013 alleged that the Washington Post downplayed the death of a young woman who sought a later abortion at the clinic. However, the Maryland medical examiner’s office found that the woman died of natural causes from a rare complication that can also occur in conjunction with childbirth, and state health officials found “no deficiencies” in the care she received at the clinic. Blackburn’s subpoenas include Adventist HealthCare Shady Grove Medical Center, formerly Shady Grove Adventist Hospital, where the woman died.

Anti-choice organizations and their reports have played a prominent role in the current congressional inquiry. Troy Newman, Operation Rescue’s president, and David Daleiden founded the Center for Medical Progress (CMP), the anti-choice front group that triggered the select panel’s investigation into allegations that Planned Parenthood profited from fetal tissue donations obtained from abortions.

Blackburn referenced CMP’s heavily edited videos in her threat “to pursue all means necessary” to obtain documents from StemExpress, the tissue procurement company that worked with Planned Parenthood. The GOP’s exhibits at the panel’s April hearing on fetal tissue “pricing” reportedly duplicated or nearly duplicated the “evidence” in the CMP attack videos.

Blackburn’s select panel spokesperson denied that the subpoenas are based on information from anti-choice sources.

“The subpoenas we issued are not based on the sources you have cited,” the spokesperson told Rewire in an email. “However, due to confidentiality agreements, we are not at liberty to disclose the identities of our sources.”

Anti-Choice Activists Hijack Emergencies

Although Blackburn’s evidence may come from different sources, the fact remains that Operation Rescue and other radical anti-choice activists are known for surveilling abortion clinics and making repeated records requests, all to report similar claims about botched abortions necessitating hospital transfers.

duVergne Gaines, director of the Feminist Majority Foundation’s National Clinic Access Project, said surveillance tactics enable anti-choice activists not only to photograph and video emergency responders, but also follow up with Freedom of Information Act and equivalent state-level requests for records, including 9-1-1 tapes, if state laws permit their release.

“They collect data,” Gaines said in an interview. “They put that up on the websites themselves, on their own Facebook pages, and have no real knowledge about what or why an ambulance may have been contacted.”

Hospital transfers in some instances have nothing to do with the procedure. Contrary to initial anti-choice accounts, the Lincoln, Nebraska Journal Star reported that a woman transferred in 2015 from a local Planned Parenthood to a hospital “wasn’t suffering complications from an abortion, but had instead sought help at the clinic after being assaulted at her home nearby.”

At times, anti-choice activists may manufacture emergency scenarios, Gaines said. “The most obvious example is alleging that a minor is inside being forced to undergo a procedure against her will, and that can happen if they see a minor go in [to a clinic],” she said.

Rewire reported in March that police appeared at a Mississippi clinic and threatened to charge a single mother with fetal homicide after her daughter, a minor seeking a legal abortion, signed a bogus Life Dynamics document stating that she was being coerced into the procedure.

The prominent anti-choice group uses the document to deceive and intimidate patients and providers by threatening legal action should they go through with obtaining or providing abortion care.

NAF President Vicki Saporta said that many of her group’s members have experienced anti-choice tactics such as staking out clinics for emergency vehicles, placing calls to summon emergency responders, and trailing ambulances to hospitals with the aim of gathering confidential patient information. Preferred tactics depend on the local anti-choice community, she said.

Saporta pointed to a crisis pregnancy center that opened in the same complex as the Germantown, Maryland, clinic where Carhart practices. A Germantown Pregnancy Choices, which comes up as the Maryland Coalition for Life when entered into Google Maps, operates within less than 200 feet of the clinic. The Maryland Coalition for Life cited eyewitness accounts and a video in March to support allegations that an underage girl required a hospital transfer “due to medical emergencies related to a late term abortion.”

Anti-choice activists targeting clinics over safety share a common denominator. “Once their bogus claims are investigated, for the most part, no action is taken because nothing is actionable,” Saporta said.