Dispatches from the Abortion Wars: Talking to Carole Joffe

Brittany Shoot

Carole Joffe's new book Dispatches from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients, and the Rest of Us, she details how many physicians are actively discouraged from incorporating abortion into other forms of medical practice, and the choice to perform abortions in some areas may make practicing any other type of medicine virtually impossible.

There is no area of medicine except for abortion in which
secrecy, constant politicization of a medical procedure, and even fear and
shame about medical work is par for the course. While many women seeking
abortions find their access to this legal procedure diminishing, abortion
providers also face onerous obstacles to providing care, and increasing danger
in doing so.

In Carole Joffe’s new book Dispatches
from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients, and the
Rest of Us
, she often uses pseudonyms to protect the privacy of
doctors and clinic workers she interviewed. As she details, many physicians are
actively discouraged from incorporating abortion into other forms of medical
practice, and the choice to perform abortions in some areas may make practicing
any other type of medicine virtually impossible.

Similarly, the risks and
complications of performing abortions in isolation prevent many doctors from
ever doing them. Knowing that they will not be backed by a supportive community
and may be targeted by fanatic activists, they may simply choose to opt out of
providing care they believe to be necessary and ethically unquestionable. In
these and many other ways, Joffe’s comprehensive overview and history of the
past 35 years details the very real and often urgent implications for women
when health care providers-doctors, nurses, pharmacists-are targeted by violent
extremists.

Throughout the book, Joffe explores such divergent but
related topics as advances in fetal medicine and widespread use of ultrasounds,
which became popular in the 1980s and have affected many peoples’ relationship
with the fetus; how anti-abortion activists’ tactics play on other people’s
guilt of possessing sexual freedom, and how abortion practitioners who feared
the police pre-Roe now fear protestors instead. She details the specific issues
facing teens and the double standard that is applied when young people can be
judged as too immature to make the decision to choose to terminate a pregnancy
without parental consent, yet are judged fit to have a child nonetheless. Joffe
also investigates the relationship between economic hardship, childbirth, and
reproductive justice and writes passionately about how strictly pro-abortion
advocates must make space for the reproductive justice movement to flourish if
it is going to promote the health and rights of all women.

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It is telling that the most extreme violence against
abortion providers takes place during pro-choice presidencies, and perhaps most
salient for many readers looking ahead, Joffe pays respectful homage to Dr.
George Tiller, who provided essential care in the most extreme circumstances of
incest, rape, and complications late in pregnancy when so many others could or
would not. Joffe ends her detailed account by looking at a future in which new
leaders must come forward to take up Tiller’s-and our collective-cause.

Joffe, also an Rewire contributor, recently spoke
to me about her timely, if controversial, book.

Q: In Dispatches
from the Abortion Wars
, you explain the importance of the role
of the deputy assistant secretary for population affairs (DAPSA) in the
Department of Health and Human Services, who is in charge of federal family
planning programs and oversees Title X of the Public Health Service Act.
However, former DAPSA appointees have lacked substantial professional experience
in family planning and have been appointed based more on their moral stances
than credentials. Why is such an important role so frequently overlooked in the
debates about federal laws regarding reproductive freedom?

Well, this role is overlooked by most Americans, but
carefully looked at by advocates on both sides of the abortion debate. In
general, it is fair to say that most Americans are apolitical, not especially
interested in government, and know relatively little about the workings of the
federal bureaucracy.

Q: You write about how
many ob-gyn practitioners lack basic abortion training. Do you think the
medical community’s larger lack of understanding of abortion procedures
trickles down the population at large? How do you think this affects women’s general
knowledge of abortion technology and options?

Even though most ob-gyns don’t perform abortions, I do not
believe that they don’t understand what abortion involves — many ob-gyns, for
example, perform procedures (e.g. d and c’s) that are similar to abortions. I
believe the American public’s misunderstandings of abortion procedures stem
directly from the very effective propaganda campaigns waged for years by the
anti-abortion movement. In particular, the so-called "partial-birth abortion"
campaign led many people to believe that most abortions took place very late in
pregnancy and involved near-term fetuses. In fact, only 1 percent of all
abortions take place after 21 weeks.

Q: You explain some of
the ways primary care physicians have incorporated abortion into their
practices. Can you talk about some of the hurdles these doctors face?

They face the problem of obtaining malpractice coverage.
They face the problem of having supportive colleagues, who share their
commitments to abortion care, and who will provide coverage for them if they
have to be out of town. In spite of these obstacles, some primary care
doctors-and where it is legally permitted, nurse practitioners, midwives and
physician assistants-have successfully incorporated abortion care into their
practices.

Q: Why isn’t the general
public more aware of the everyday threat of violence and dangers abortion
providers can face?

I think the general public is aware of the violence that
providers face. I think the public is less aware of the other obstacles — such as
targeted regulations against abortion providers ("trap laws"), lack of
collegial support, malpractice problems, etc — that face abortion providers. I am
quite convinced that the overwhelming majority of the public is very much
against the violence faced by providers, especially when it results in murder,
as we saw recently with the assassination of Dr. Tiller in Kansas. But though
this violence brings sympathy for the providers (and disgust with the
extremists), I also think the legacy of this violence is to mark abortion as
something that is always controversial, and that many people therefore simply
wish to avoid thinking about (until/unless they need one!).

Q: With the enormous
costs in terms of time and resources spent on security, police backup, cleanup
and HAZMAT for clinics under the threat and reality of violent
actions-including anthrax threats, acid attacks, and arson — why are
anti-abortion activists not considered domestic terrorists?

Excellent question! Certainly by the abortion rights
community, they are thought of in this way — when the violence first started to
pick up in the late 1980s, I recall advocates going to the administrations of
Ronald Reagan and the first President Bush and saying exactly that — these are
domestic terrorists… but not until the Clinton administration, and the first
killings of providers in the 1990s, was the problem taken seriously. Clinton
signed the "face act" — "freedom of access to clinic entrances" — which made it a
federal crime to interfere with someone trying to enter a clinic. This did
reduce the then quite common blockades and sieges of clinics. And after Dr.
Bart Slepian of Buffalo was killed in 1998, then-Attorney General Janet Reno
convened a task force within the Justice Department on clinic violence. I do
believe that the Dept. of Justice, especially under this administration, takes
violence against providers seriously. The problem of course is with
implementation of laws at the local levels. For whatever reasons, the local FBI
and the local police in Kansas did not respond to reports of Scott Roeder (the
murderer of Dr. Tiller) having vandalized a Kansas clinic the day before the Tiller murder, even
though Roeder’s license plate number was reported to these authorities.

Q: What effect do you
think the recession is having on women’s access to abortions? How much more
limited are poor women now than they were previously?

There are widespread reports of more women needing
reproductive health services — both contraception and abortions — and not being
able to afford them. The various funds that help poor women pay for abortions
(35 states do not allow use of Medicaid funds for this purpose) report that
they are running out of money, because the requests have escalated. Our access to data on how many abortions are
taking place is always lagging by a few years — but I suspect that this period of
recession will ultimately be revealed to be one in which the number of both
unintended pregnancies and abortions rose.

Q: How will a
significantly restricted universal healthcare bill affect low-income women who
seek abortions?

Well at this moment, it is not clear there will be any
kind of healthcare bill, and it almost certainly will not be universal, to my
great disappointment. From the start, it was clear that the best the abortion
rights movement could hope for was the status quo — that is, as the Capps
Amendment (named for Rep. Lois Capps of California) put it, the bill would be
abortion neutral, leaving in place the Hyde Amendment, which prohibits the use
of public funding for poor women. But both the Stupak Amendment in the House,
and the Nelson "compromise" in the Senate, would make the abortion situation
worse-ultimately resulting, as health policy scholars from George Washington
University concluded, in a situation in which insurance plans which now offer
abortion coverage, would cease to do so — making it harder to obtain such
insurance, even with private funds.

Analysis Politics

The 2016 Republican Platform Is Riddled With Conservative Abortion Myths

Ally Boguhn

Anti-choice activists and leaders have embraced the Republican platform, which relies on a series of falsehoods about reproductive health care.

Republicans voted to ratify their 2016 platform this week, codifying what many deem one of the most extreme platforms ever accepted by the party.

“Platforms are traditionally written by and for the party faithful and largely ignored by everyone else,” wrote the New York Times‘ editorial board Monday. “But this year, the Republicans are putting out an agenda that demands notice.”

“It is as though, rather than trying to reconcile Mr. Trump’s heretical views with conservative orthodoxy, the writers of the platform simply opted to go with the most extreme version of every position,” it continued. “Tailored to Mr. Trump’s impulsive bluster, this document lays bare just how much the G.O.P. is driven by a regressive, extremist inner core.”

Tucked away in the 66-page document accepted by Republicans as their official guide to “the Party’s principles and policies” are countless resolutions that seem to back up the Times‘ assertion that the platform is “the most extreme” ever put forth by the party, including: rolling back marriage equalitydeclaring pornography a “public health crisis”; and codifying the Hyde Amendment to permanently block federal funding for abortion.

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Anti-choice activists and leaders have embraced the platform, which the Susan B. Anthony List deemed the “Most Pro-life Platform Ever” in a press release upon the GOP’s Monday vote at the convention. “The Republican platform has always been strong when it comes to protecting unborn children, their mothers, and the conscience rights of pro-life Americans,” said the organization’s president, Marjorie Dannenfelser, in a statement. “The platform ratified today takes that stand from good to great.”  

Operation Rescue, an organization known for its radical tactics and links to violence, similarly declared the platform a “victory,” noting its inclusion of so-called personhood language, which could ban abortion and many forms of contraception. “We are celebrating today on the streets of Cleveland. We got everything we have asked for in the party platform,” said Troy Newman, president of Operation Rescue, in a statement posted to the group’s website.

But what stands out most in the Republicans’ document is the series of falsehoods and myths relied upon to push their conservative agenda. Here are just a few of the most egregious pieces of misinformation about abortion to be found within the pages of the 2016 platform:

Myth #1: Planned Parenthood Profits From Fetal Tissue Donations

Featured in multiple sections of the Republican platform is the tired and repeatedly debunked claim that Planned Parenthood profits from fetal tissue donations. In the subsection on “protecting human life,” the platform says:

We oppose the use of public funds to perform or promote abortion or to fund organizations, like Planned Parenthood, so long as they provide or refer for elective abortions or sell fetal body parts rather than provide healthcare. We urge all states and Congress to make it a crime to acquire, transfer, or sell fetal tissues from elective abortions for research, and we call on Congress to enact a ban on any sale of fetal body parts. In the meantime, we call on Congress to ban the practice of misleading women on so-called fetal harvesting consent forms, a fact revealed by a 2015 investigation. We will not fund or subsidize healthcare that includes abortion coverage.

Later in the document, under a section titled “Preserving Medicare and Medicaid,” the platform again asserts that abortion providers are selling “the body parts of aborted children”—presumably again referring to the controversy surrounding Planned Parenthood:

We respect the states’ authority and flexibility to exclude abortion providers from federal programs such as Medicaid and other healthcare and family planning programs so long as they continue to perform or refer for elective abortions or sell the body parts of aborted children.

The platform appears to reference the widely discredited videos produced by anti-choice organization Center for Medical Progress (CMP) as part of its smear campaign against Planned Parenthood. The videos were deceptively edited, as Rewire has extensively reported. CMP’s leader David Daleiden is currently under federal indictment for tampering with government documents in connection with obtaining the footage. Republicans have nonetheless steadfastly clung to the group’s claims in an effort to block access to reproductive health care.

Since CMP began releasing its videos last year, 13 state and three congressional inquiries into allegations based on the videos have turned up no evidence of wrongdoing on behalf of Planned Parenthood.

Dawn Laguens, executive vice president of Planned Parenthood Action Fund—which has endorsed Hillary Clinton—called the Republicans’ inclusion of CMP’s allegation in their platform “despicable” in a statement to the Huffington Post. “This isn’t just an attack on Planned Parenthood health centers,” said Laguens. “It’s an attack on the millions of patients who rely on Planned Parenthood each year for basic health care. It’s an attack on the brave doctors and nurses who have been facing down violent rhetoric and threats just to provide people with cancer screenings, birth control, and well-woman exams.”

Myth #2: The Supreme Court Struck Down “Commonsense” Laws About “Basic Health and Safety” in Whole Woman’s Health v. Hellerstedt

In the section focusing on the party’s opposition to abortion, the GOP’s platform also reaffirms their commitment to targeted regulation of abortion providers (TRAP) laws. According to the platform:

We salute the many states that now protect women and girls through laws requiring informed consent, parental consent, waiting periods, and clinic regulation. We condemn the Supreme Court’s activist decision in Whole Woman’s Health v. Hellerstedt striking down commonsense Texas laws providing for basic health and safety standards in abortion clinics.

The idea that TRAP laws, such as those struck down by the recent Supreme Court decision in Whole Woman’s Health, are solely for protecting women and keeping them safe is just as common among conservatives as it is false. However, as Rewire explained when Paul Ryan agreed with a nearly identical claim last week about Texas’ clinic regulations, “the provisions of the law in question were not about keeping anybody safe”:

As Justice Stephen Breyer noted in the opinion declaring them unconstitutional, “When directly asked at oral argument whether Texas knew of a single instance in which the new requirement would have helped even one woman obtain better treatment, Texas admitted that there was no evidence in the record of such a case.”

All the provisions actually did, according to Breyer on behalf of the Court majority, was put “a substantial obstacle in the path of women seeking a previability abortion,” and “constitute an undue burden on abortion access.”

Myth #3: 20-Week Abortion Bans Are Justified By “Current Medical Research” Suggesting That Is When a Fetus Can Feel Pain

The platform went on to point to Republicans’ Pain-Capable Unborn Child Protection Act, a piece of anti-choice legislation already passed in several states that, if approved in Congress, would create a federal ban on abortion after 20 weeks based on junk science claiming fetuses can feel pain at that point in pregnancy:

Over a dozen states have passed Pain-Capable Unborn Child Protection Acts prohibiting abortion after twenty weeks, the point at which current medical research shows that unborn babies can feel excruciating pain during abortions, and we call on Congress to enact the federal version.

Major medical groups and experts, however, agree that a fetus has not developed to the point where it can feel pain until the third trimester. According to a 2013 letter from the American Congress of Obstetricians and Gynecologists, “A rigorous 2005 scientific review of evidence published in the Journal of the American Medical Association (JAMA) concluded that fetal perception of pain is unlikely before the third trimester,” which begins around the 28th week of pregnancy. A 2010 review of the scientific evidence on the issue conducted by the British Royal College of Obstetricians and Gynaecologists similarly found “that the fetus cannot experience pain in any sense prior” to 24 weeks’ gestation.

Doctors who testify otherwise often have a history of anti-choice activism. For example, a letter read aloud during a debate over West Virginia’s ultimately failed 20-week abortion ban was drafted by Dr. Byron Calhoun, who was caught lying about the number of abortion-related complications he saw in Charleston.

Myth #4: Abortion “Endangers the Health and Well-being of Women”

In an apparent effort to criticize the Affordable Care Act for promoting “the notion of abortion as healthcare,” the platform baselessly claimed that abortion “endangers the health and well-being” of those who receive care:

Through Obamacare, the current Administration has promoted the notion of abortion as healthcare. We, however, affirm the dignity of women by protecting the sanctity of human life. Numerous studies have shown that abortion endangers the health and well-being of women, and we stand firmly against it.

Scientific evidence overwhelmingly supports the conclusion that abortion is safe. Research shows that a first-trimester abortion carries less than 0.05 percent risk of major complications, according to the Guttmacher Institute, and “pose[s] virtually no long-term risk of problems such as infertility, ectopic pregnancy, spontaneous abortion (miscarriage) or birth defect, and little or no risk of preterm or low-birth-weight deliveries.”

There is similarly no evidence to back up the GOP’s claim that abortion endangers the well-being of women. A 2008 study from the American Psychological Association’s Task Force on Mental Health and Abortion, an expansive analysis on current research regarding the issue, found that while those who have an abortion may experience a variety of feelings, “no evidence sufficient to support the claim that an observed association between abortion history and mental health was caused by the abortion per se, as opposed to other factors.”

As is the case for many of the anti-abortion myths perpetuated within the platform, many of the so-called experts who claim there is a link between abortion and mental illness are discredited anti-choice activists.

Myth #5: Mifepristone, a Drug Used for Medical Abortions, Is “Dangerous”

Both anti-choice activists and conservative Republicans have been vocal opponents of the Food and Drug Administration (FDA’s) March update to the regulations for mifepristone, a drug also known as Mifeprex and RU-486 that is used in medication abortions. However, in this year’s platform, the GOP goes a step further to claim that both the drug and its general approval by the FDA are “dangerous”:

We believe the FDA’s approval of Mifeprex, a dangerous abortifacient formerly known as RU-486, threatens women’s health, as does the agency’s endorsement of over-the-counter sales of powerful contraceptives without a physician’s recommendation. We support cutting federal and state funding for entities that endanger women’s health by performing abortions in a manner inconsistent with federal or state law.

Studies, however, have overwhelmingly found mifepristone to be safe. In fact, the Association of Reproductive Health Professionals says mifepristone “is safer than acetaminophen,” aspirin, and Viagra. When the FDA conducted a 2011 post-market study of those who have used the drug since it was approved by the agency, they found that more than 1.5 million women in the U.S. had used it to end a pregnancy, only 2,200 of whom had experienced an “adverse event” after.

The platform also appears to reference the FDA’s approval of making emergency contraception such as Plan B available over the counter, claiming that it too is a threat to women’s health. However, studies show that emergency contraception is safe and effective at preventing pregnancy. According to the World Health Organization, side effects are “uncommon and generally mild.”

News Abortion

Study: United States a ‘Stark Outlier’ in Countries With Legal Abortion, Thanks to Hyde Amendment

Nicole Knight Shine

The study's lead author said the United States' public-funding restriction makes it a "stark outlier among countries where abortion is legal—especially among high-income nations."

The vast majority of countries pay for abortion care, making the United States a global outlier and putting it on par with the former Soviet republic of Kyrgyzstan and a handful of Balkan States, a new study in the journal Contraception finds.

A team of researchers conducted two rounds of surveys between 2011 and 2014 in 80 countries where abortion care is legal. They found that 59 countries, or 74 percent of those surveyed, either fully or partially cover terminations using public funding. The United States was one of only ten countries that limits federal funding for abortion care to exceptional cases, such as rape, incest, or life endangerment.

Among the 40 “high-income” countries included in the survey, 31 provided full or partial funding for abortion care—something the United States does not do.

Dr. Daniel Grossman, lead author and director of Advancing New Standards in Reproductive Health (ANSIRH) at the University of California (UC) San Francisco, said in a statement announcing the findings that this country’s public-funding restriction makes it a “stark outlier among countries where abortion is legal—especially among high-income nations.”

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The researchers call on policymakers to make affordable health care a priority.

The federal Hyde Amendment (first passed in 1976 and reauthorized every year thereafter) bans the use of federal dollars for abortion care, except for cases of rape, incest, or life endangerment. Seventeen states, as the researchers note, bridge this gap by spending state money on terminations for low-income residents. Of the 14.1 million women enrolled in Medicaid, fewer than half, or 6.7 million, live in states that cover abortion services with state funds.

This funding gap delays abortion care for some people with limited means, who need time to raise money for the procedure, researchers note.

As Jamila Taylor and Yamani Hernandez wrote last year for Rewire, “We have heard first-person accounts of low-income women selling their belongings, going hungry for weeks as they save up their grocery money, or risking eviction by using their rent money to pay for an abortion, because of the Hyde Amendment.”

Public insurance coverage of abortion remains controversial in the United States despite “evidence that cost may create a barrier to access,” the authors observe.

“Women in the US, including those with low incomes, should have access to the highest quality of care, including the full range of reproductive health services,” Grossman said in the statement. “This research indicates there is a global consensus that abortion care should be covered like other health care.”

Earlier research indicated that U.S. women attempting to self-induce abortion cited high cost as a reason.

The team of ANSIRH researchers and Ibis Reproductive Health uncovered a bit of good news, finding that some countries are loosening abortion laws and paying for the procedures.

“Uruguay, as well as Mexico City,” as co-author Kate Grindlay from Ibis Reproductive Health noted in a press release, “legalized abortion in the first trimester in the past decade, and in both cases the service is available free of charge in public hospitals or covered by national insurance.”