Reproductive Choice: It’s Not Always About Abortion

Pamela Merritt

That’s what choice is all about, having the ability to partner with a doctor to make decisions that are right for the individual.  That doesn’t mean those decisions would be right for someone else, but that’s the point lots of people missed.

A decade ago, I rolled over in bed one morning and felt some sort of mass in my abdomen.  I rolled onto my back and pressed my hand against it – yes, there was something real, solid and frightening in my abdomen.  I had been experiencing heavy bleeding during my periods for several months prior and had put off going to the doctor.  I was always too busy, had too much on my plate and was too willing to prioritize everything and anything over my yearly physical exam.  I lay there, anxious and afraid, unable to ignore the solid something beneath my hand.  So, I jumped up and immediately thought about where I could go to find out what this thing was and if it was cancer.  It was a Saturday and my doctor’s office was closed, so I went to my local Planned Parenthood and asked for an exam.  I was very emotional and the staff was very patient.  After the exam, I was told that I most likely had a uterine fibroid and needed to see my gynecologist for diagnosis and treatment.

I remember asking what the hell a uterine fibroid was and being told that uterine fibroids are tumors that grow within and outside of the uterus, that they pose their own health risks but aren’t cancer.

I thanked everyone at the health center.  I think I might have thanked them all twice.  Then I went home, sat down on the couch next to my dog and cried.

I was relieved but not fully, because uterine fibroids were a mystery.  Later that week my gynecologist confirmed the diagnosis of uterine fibroids and we began to work through a treatment plan.  I did a lot of research.  There were ultrasounds and blood tests and a serious discussion of diet and my general health.  What I remember most was that my doctor and I had a great dialogue about my condition and my life.  We discussed whether I planned to have children through a pregnancy.  I did not and that has not changed. I remember the options that were on the table based on the size and location of my tumors and my age and health.  In a matter of days “choice”, so often seen as only having to do with pregnancy or abortion, was suddenly a huge factor in my life.  I wasn’t pregnant, trying to get pregnant or even trying to protect my future ability to get pregnant but choice meant the world to me at that moment.

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I entered into a new world of doctor’s appointments and insurance battles.  Many of the treatment options for fibroids are classified as fertility treatments and every month my insurance company would reject my claim because they didn’t cover fertility treatments.  My doctor’s office guided me through the process of challenging the rejection, confirming that my treatment was not a fertility treatment and then resubmitting the claim.  I can’t imagine having to wage those battles without the assistance of the staff at my doctor’s office.  As it was, I found the week long back and forth debate that took place every month like clockwork emotionally exhausting.  At one point I found myself screaming at the insurance representative in my cube during work, demanding that she acknowledge there are more reasons to treat fibroids than to prepare for a pregnancy.

My debates, arguments and battles have not been limited to insurance representatives.  Over the years I’ve made a study of how friends have reacted to my treatment decisions.  I’ve had self identified pro-choice friends confront me for taking the pill to manage the heavy bleeding during my periods because they feel fibroids can be managed just fine through a special diet.  I’ve had other friends act as if they’d stop talking to me if I chose to have a hysterectomy.  When I decided to have my fibroids surgically removed after a year of treatment, a co-worker applauded my decision because it “preserved my reproductive future” while another expressed concern over the risk of my doctor having to perform a hysterectomy if there were complications.  I filtered all the advice through the understanding that their hearts were in a good place, but they always seemed to ignore the fact that I was and am an active participant in my treatment.  That’s what choice is all about, having the ability to partner with a doctor to make decisions that are right for the individual.  That doesn’t mean those decisions would be right for someone else, but that’s the point lots of people missed.  This was about my health and my uterine fibroids.

When I explained that I didn’t want to have children and that I considered hysterectomy a future option, some people dismissed my claim and others even went so far as to assure me that I’d change my mind when I got older or that I’d change my mind once I had a baby.  Suffice it to say, I was shocked.  The decision whether or not to have a child is a huge part of reproductive choice, yet here were people acting as if my choice not to have children was flimsy at best and subject to change by actually having a baby.

What stood out then and stands out now is how challenging truly supporting choice is.  Some pro-choice people struggle to respect the doctor patient relationship, too.  I’m not saying that their struggle is the same as anti-choicers who lobby to restrict a woman’s access to birth control or abortion.  Many of my friends referenced the history of black women who were given hysterectomy as the only option to treat fibroids and their words of caution were coming from a place of concern based on that history.  My situation was different.  The fact remains that, when a woman has a reproductive health issue, lots of folks jump up with lots of opinions and a lot of those opinions assume the patient hasn’t thought the situation through or is too emotional to make a sound decision.

I’ve thought a lot about the privilege of choice.  I have health insurance and I live in a city with a lot of pharmacies and health care providers.  I can consider multiple treatment options that are covered through my insurance.  I go to my pharmacy to pick up my birth control pills and rarely wonder if the pharmacist will refuse to fill my prescription because she or he assumes I’m getting them as birth control and has some moral objection they’ve decided trumps the legitimacy of my legal prescription. 

When the Missouri State Legislature considered a bill that would have protected pharmacists or pharmacies that refused to fill prescriptions because of a “moral” objection, I thought about my situation.  I imagined walking into my local pharmacy and having someone decide to refuse to fill my prescription because they assume everyone on the pill is taking it as contraception.  I had a waking dream of confronting the pharmacist with the fact that, without the pill, I bleed for an average of 14 days straight.  Prior to regulating my periods with the pill, I was dangerously anemic and suffering from exhaustion.  I could see myself demanding to know where they get off forcing me to explain the who, what, where and why behind my prescription.  It never happened.  The legislation never passed.  But I was prepared for the reality of some fellow Missourian wielding power in the name of religious freedom, trying to take away my freedom of choice.  A freedom of choice that had nothing to do with preventing pregnancy and that shouldn’t have been up for discussion even if it did.

Having uterine fibroids isn’t rare.  Since my diagnosis, I’ve met many women who have them and who have chosen different treatment paths.  But having uterine fibroids has provided me with a different view of reproductive choice and reproductive justice.  I’ve worked in partnership with my doctor to protect my right to health.  It’s been a unique journey and I am now considering the next phase, which will likely include a hysterectomy.  I know that a lot of people will have a lot of opinions and advice and I welcome the feedback as long as it is given with respect and with the understanding that the ultimate choice will be mine to make.  As a reproductive justice activist, this is what I fight for every day.  Choice should be respected as a right, not a privilege.

News Politics

Missouri ‘Witch Hunt Hearings’ Modeled on Anti-Choice Congressional Crusade

Christine Grimaldi

Missouri state Rep. Stacey Newman (D) said the Missouri General Assembly's "witch hunt hearings" were "closely modeled" on those in the U.S. Congress. Specifically, she drew parallels between Republicans' special investigative bodies—the U.S. House of Representatives’ Select Investigative Panel on Infant Lives and the Missouri Senate’s Committee on the Sanctity of Life.

Congressional Republicans are responsible for perpetuating widely discredited and often inflammatory allegations about fetal tissue and abortion care practices for a year and counting. Their actions may have charted the course for at least one Republican-controlled state legislature to advance an anti-choice agenda based on a fabricated market in aborted “baby body parts.”

“They say that a lot in Missouri,” state Rep. Stacey Newman (D) told Rewire in an interview at the Democratic National Convention last month.

Newman is a longtime abortion rights advocate who proposed legislation that would subject firearms purchases to the same types of restrictions, including mandatory waiting periods, as abortion care.

Newman said the Missouri General Assembly’s “witch hunt hearings” were “closely modeled” on those in the U.S. Congress. Specifically, she drew parallels between Republicans’ special investigative bodies—the U.S. House of Representatives’ Select Investigative Panel on Infant Lives and the Missouri Senate’s Committee on the Sanctity of Life. Both formed last year in response to videos from the anti-choice front group the Center for Medical Progress (CMP) accusing Planned Parenthood of profiting from fetal tissue donations. Both released reports last month condemning the reproductive health-care provider even though Missouri’s attorney general, among officials in 13 states to date, and three congressional investigations all previously found no evidence of wrongdoing.

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Missouri state Sen. Kurt Schaefer (R), the chair of the committee, and his colleagues alleged that the report potentially contradicted the attorney general’s findings. Schaefer’s district includes the University of Missouri, which ended a 26-year relationship with Planned Parenthood as anti-choice state lawmakers ramped up their inquiries in the legislature. Schaefer’s refusal to confront evidence to the contrary aligned with how Newman described his leadership of the committee.

“It was based on what was going on in Congress, but then Kurt Schaefer took it a step further,” Newman said.

As Schaefer waged an ultimately unsuccessful campaign in the Missouri Republican attorney general primary, the once moderate Republican “felt he needed to jump on the extreme [anti-choice] bandwagon,” she said.

Schaefer in April sought to punish the head of Planned Parenthood’s St. Louis affiliate with fines and jail time for protecting patient documents he had subpoenaed. The state senate suspended contempt proceedings against Mary Kogut, the CEO of Planned Parenthood of St. Louis Region and Southwest Missouri, reaching an agreement before the end of the month, according to news reports.

Newman speculated that Schaefer’s threats thwarted an omnibus abortion bill (HB 1953, SB 644) from proceeding before the end of the 2016 legislative session in May, despite Republican majorities in the Missouri house and senate.

“I think it was part of the compromise that they came up with Planned Parenthood, when they realized their backs [were] against the wall, because she was not, obviously, going to illegally turn over medical records.” Newman said of her Republican colleagues.

Republicans on the select panel in Washington have frequently made similar complaints, and threats, in their pursuit of subpoenas.

Rep. Marsha Blackburn (R-TN), the chair of the select panel, in May pledged “to pursue all means necessary” to obtain documents from the tissue procurement company targeted in the CMP videos. In June, she told a conservative crowd at the faith-based Road to Majority conference that she planned to start contempt of Congress proceedings after little cooperation from “middle men” and their suppliers—“big abortion.” By July, Blackburn seemingly walked back that pledge in front of reporters at a press conference where she unveiled the select panel’s interim report.

The investigations share another common denominator: a lack of transparency about how much money they have cost taxpayers.

“The excuse that’s come back from leadership, both [in the] House and the Senate, is that not everybody has turned in their expense reports,” Newman said. Republicans have used “every stalling tactic” to rebuff inquiries from her and reporters in the state, she said.

Congressional Republicans with varying degrees of oversight over the select panel—Blackburn, House Speaker Paul Ryan (WI), and House Energy and Commerce Committee Chair Fred Upton (MI)—all declined to answer Rewire’s funding questions. Rewire confirmed with a high-ranking GOP aide that Republicans budgeted $1.2 million for the investigation through the end of the year.

Blackburn is expected to resume the panel’s activities after Congress returns from recess in early September. Schaeffer and his fellow Republicans on the committee indicated in their report that an investigation could continue in the 2017 legislative session, which begins in January.

News Health Systems

Complaint: Citing Catholic Rules, Doctor Turns Away Bleeding Woman With Dislodged IUD

Amy Littlefield

“It felt heartbreaking,” said Melanie Jones. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

Melanie Jones arrived for her doctor’s appointment bleeding and in pain. Jones, 28, who lives in the Chicago area, had slipped in her bathroom, and suspected the fall had dislodged her copper intrauterine device (IUD).

Her doctor confirmed the IUD was dislodged and had to be removed. But the doctor said she would be unable to remove the IUD, citing Catholic restrictions followed by Mercy Hospital and Medical Center and providers within its system.

“I think my first feeling was shock,” Jones told Rewire in an interview. “I thought that eventually they were going to recognize that my health was the top priority.”

The doctor left Jones to confer with colleagues, before returning to confirm that her “hands [were] tied,” according to two complaints filed by the ACLU of Illinois. Not only could she not help her, the doctor said, but no one in Jones’ health insurance network could remove the IUD, because all of them followed similar restrictions. Mercy, like many Catholic providers, follows directives issued by the U.S. Conference of Catholic Bishops that restrict access to an array of services, including abortion care, tubal ligations, and contraception.

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Some Catholic providers may get around the rules by purporting to prescribe hormonal contraception for acne or heavy periods, rather than for birth control, but in the case of copper IUDs, there is no such pretext available.

“She told Ms. Jones that that process [of switching networks] would take her a month, and that she should feel fortunate because sometimes switching networks takes up to six months or even a year,” the ACLU of Illinois wrote in a pair of complaints filed in late June.

Jones hadn’t even realized her health-care network was Catholic.

Mercy has about nine off-site locations in the Chicago area, including the Dearborn Station office Jones visited, said Eric Rhodes, senior vice president of administrative and professional services. It is part of Trinity Health, one of the largest Catholic health systems in the country.

The ACLU and ACLU of Michigan sued Trinity last year for its “repeated and systematic failure to provide women suffering pregnancy complications with appropriate emergency abortions as required by federal law.” The lawsuit was dismissed but the ACLU has asked for reconsideration.

In a written statement to Rewire, Mercy said, “Generally, our protocol in caring for a woman with a dislodged or troublesome IUD is to offer to remove it.”

Rhodes said Mercy was reviewing its education process on Catholic directives for physicians and residents.

“That act [of removing an IUD] in itself does not violate the directives,” Marty Folan, Mercy’s director of mission integration, told Rewire.

The number of acute care hospitals that are Catholic owned or affiliated has grown by 22 percent over the past 15 years, according to MergerWatch, with one in every six acute care hospital beds now in a Catholic owned or affiliated facility. Women in such hospitals have been turned away while miscarrying and denied tubal ligations.

“We think that people should be aware that they may face limitations on the kind of care they can receive when they go to the doctor based on religious restrictions,” said Lorie Chaiten, director of the women’s and reproductive rights project of the ACLU of Illinois, in a phone interview with Rewire. “It’s really important that the public understand that this is going on and it is going on in a widespread fashion so that people can take whatever steps they need to do to protect themselves.”

Jones left her doctor’s office, still in pain and bleeding. Her options were limited. She couldn’t afford a $1,000 trip to the emergency room, and an urgent care facility was out of the question since her Blue Cross Blue Shield of Illinois insurance policy would only cover treatment within her network—and she had just been told that her entire network followed Catholic restrictions.

Jones, on the advice of a friend, contacted the ACLU of Illinois. Attorneys there advised Jones to call her insurance company and demand they expedite her network change. After five hours of phone calls, Jones was able to see a doctor who removed her IUD, five days after her initial appointment and almost two weeks after she fell in the bathroom.

Before the IUD was removed, Jones suffered from cramps she compared to those she felt after the IUD was first placed, severe enough that she medicated herself to cope with the pain.

She experienced another feeling after being turned away: stigma.

“It felt heartbreaking,” Jones told Rewire. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

The ACLU of Illinois has filed two complaints in Jones’ case: one before the Illinois Department of Human Rights and another with the U.S. Department of Health and Human Services Office for Civil Rights under the anti-discrimination provision of the Affordable Care Act. Chaiten said it’s clear Jones was discriminated against because of her gender.

“We don’t know what Mercy’s policies are, but I would find it hard to believe that if there were a man who was suffering complications from a vasectomy and came to the emergency room, that they would turn him away,” Chaiten said. “This the equivalent of that, right, this is a woman who had an IUD, and because they couldn’t pretend the purpose of the IUD was something other than pregnancy prevention, they told her, ‘We can’t help you.’”


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