Elected Batterers: Abortion Restrictions as Violence Against Women

Paige Sweet

It's time we start recognizing attacks on abortion access for what they really are: violence against women.

Two weeks ago, the Missouri General Assembly debated House Bill 28. Among other things, this cynical piece of legislation allows pharmacy employees to refuse to fill prescriptions for birth control, confuses RU-486 with emergency contraception, forces women seeking medical abortions to make – count them — four visits to the clinic, and creates a slew of other absurd requirements for physicians. The bill is an absolute horror show of degrading assumptions and scientifically incorrect statements. Though the bill passed with the legislature’s famous anti-woman gusto, there were many shining moments during floor debate. One of those was when Representative Genise Montecillo (D – 66) said about the bill, “This is just as much about control as rape is about control.” She’s right, and it’s time we start recognizing these attacks on choice for what they really are: violence against women.

Actually, abusers and anti-choice policies (and the politicians who advocate for them) use many of the same oppressive tactics. Just like rape, sexual assault, harassment, and intimate partner violence, laws that limit women’s access to abortion care are all about power and control. They are designed so that state power over a woman’s body supersedes a woman’s own power over her body. It is assumed without question that the ultra-conservative politicians who champion these laws have the right to control women’s bodies – that making laws about women’s reproduction is completely within their professional purview. Violence is used by abusers in much the same way: to take and maintain power and show the victim that the abuser can and will exercise that power. Just as anti-choice politicians believe they have the right to govern women’s bodies, abusers believe they have the right to punish women physically – to keep them in line through bodily force and coercion. In both scenarios, women are deemed stupid children who do not deserve autonomy or control over their own destinies. Why else would they make laws telling us we have to go meet with Jesus-pushing CPC volunteer “counselors” 72 hours before an abortion so that we can really “think about it”?

 Just as physical violence (and/or the threat of it) limits women’s ability to participate freely in society, laws restricting abortion access work to ensure that women have no chance of systemic political or economic equality. The reproductive justice movement has long recognized the overlapping oppressions of these types of violence and insisted that they be approached as they intersect, rather than individually. The movement to end violence against women and the pro-choice movement for too long have been acting as if they are challenging separate oppressive forces, when actually, those forces are variations of the same thing.

In fact, research consistently shows that abusers know how to use control over a woman’s reproduction to further control her life. Not only are violence against women and reproductive freedom linked politically and in power dynamics, but as the following statistics show, they are probably most profoundly linked in women’s actual lives. For example, pregnancy puts women at an elevated risk for intimate partner violence, and is associated with poor health outcomes for both mother and child.[1] (There are many theories about why violence often begins or escalates during pregnancy, one of which is that the abuser feels control slipping away and uses violence to regain it. Does that remind you of how we often see an escalation of anti-choice policy proposals when progressives make gains in other areas?) Shockingly, the second leading cause of death of pregnant women in the United States is homicide by intimate partner – it’s more common than dying from preeclampsia or gestational diabetes.[2] Forty percent of abused women report that their pregnancy was unintended, as compared to only 8% of women who report never experiencing abuse.[3] Additionally, a growing body of research is showing that it’s common for abusive men to sabotage birth control or coerce pregnancy as tactics to maintain power and control. For example, women who are abused are more likely to report that their partners refuse to wear condoms (71% versus 43% of women who are not abused).[4] In a study of 474 adolescent mothers on public assistance, 51% reported that their partners sabotaged their birth control.[5] Indeed, these abusive strategies are eerily similar to the anti-choice strategy of taking away access to birth control and abortion for women, especially financially vulnerable women.

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I’m not arguing that the oppression of women by anti-choice policies is as traumatic as rape or interpersonal violence on an individual level. Of course it isn’t. I’m also not trying to suggest that all abusers are male and all victims female (statistically speaking, these are the most “convenient” pronouns to use and make sense for this argument). But when Rep. Montecillo pointed out that these extremist anti-choice policies are about control over women in the same way that rape is about control, it struck a chord. These ultra-conservative politicians who believe they are entitled to controlling women’s bodies on a meta-scale are not breaking the law the way that batterers are, but they seem to be sharing the same rulebook: give women little to no control over their reproductive decisions (politician: lack of access to birth control and education; abuser: birth control sabotage); coerce women into having children (politician: lack of abortion access; abuser: pregnancy outcome coercion); and then leave them without resources or assistance when the children are born (politician: defund state and federal assistance programs and cut back on education funding; abuser: continue abuse and consider inflicting on children as well).

Also essential to the rulebook is knowing how to shame women so that they don’t talk about having had abortions or being abused and/or raped. Actually, our patriarchal culture is truly expert when it comes to shaming women – if it weren’t so harmful, it would be a marvel to witness. Doesn’t matter if you’re too fat, too skinny, don’t work, work too hard, don’t sleep with men, sleep with too many men, don’t wear make-up, talk too loud, have kids, don’t have kids, don’t make enough money, make too much money – shame on you all the same! The stigmas of having been abused or raped and that of having had an abortion are connected. Just as people ask survivors what they were wearing, why they were drinking, why they didn’t fight harder, and why they didn’t “just leave,” women who have had abortions are told they are selfish, looking for the “easy way out,” called sluts, and made to think they are damaged for life. The messages and outcomes are strikingly similar: it’s all your fault, feel bad about it, and now shut up about it.

We have all probably been unwitting participants in this type of shaming at some point in our lives, but not many of us are as skilled at the strategic use of shame as batterers and anti-choice politicians. Batterers use it to manipulate their victims into self-loathing, self-doubt, and silence. Anti-choice politicians use inflammatory language, they fabricate “post-abortion syndrome,” they tell stories about disabled children who would’ve been aborted in “pro-choice” hands, they literally (and theatrically) weep for “the unborn,” they invent accusations of black genocide, and they spread lies about emergency contraception being abortion. They wag their moral-authority fingers at women: shame, shame, shame! This shame makes the one-third of American women who’ve had abortions stay silent and divided. It creates an environment where these (predominantly white, male) voices are allowed to control the entire debate. They are allowed to control women’s movements (when they go to the doctor and for what). They are allowed to write propaganda that women are forced to listen to in the privacy of their doctor’s office. They are allowed to decide at what income-level women can receive certain types of reproductive care (Hyde Amendment and similar state laws). They are allowed to keep women in poverty or force them into it through coerced motherhood. They are even allowed to endanger women’s health by putting funding on the chopping block and barring access to comprehensive sexual education. Yes, when it comes to the strategic rhetorical infliction of shame on women, nothing and no one beats anti-choice lawmakers and their policies.

When I was marching at a Take Back the Night rally in St. Louis last week, I wasn’t only thinking about men and women who experience violence at the hands of family members, loved ones, or community members. I was also thinking about the strategic and systematic chipping away at women’s control over their reproduction by cultural conservatives. As strategic as the way a batterer places bruises on a woman’s body so they don’t show when she goes out in public. As systematic as beating her every time she speaks up for herself until she no longer makes the mistake of doing that. Anti-choice policies are violence against women. We should be marching not only for our homes and our streets to be free from violence, but also our legislative bodies and the laws they produce. Let’s start by combining some slogans: “Pro-Choice: Until the Violence Stops.”

[1] “The Facts on Reproductive Health and Violence Against Women.” Family Violence Prevention Fund. http://www.endabuse.org/userfiles/file/Maternal_Health/Reproductive_Health_FS.pdf

[2] Ibid.

[3] Hathaway JE; Mucci, LA, Silverman JG, Brooks DR, Mathews R, Pavlos CA. “Health Status and Health

Care Use of Massachusetts Women Reporting Partner Abuse.” American Journal of Preventive Medicine.

2000; 19 (4); 318-321.

[4] “Domestic Violence and Birth Control Sabotage: A Report from the Teen Parent Project.” 2000. Center

for Impact Research. Chicago, IL. http://www.impactresearch.org/documents/dvandbirthcontrol.pdf.

[5] Ibid.

Analysis Law and Policy

After ‘Whole Woman’s Health’ Decision, Advocates Should Fight Ultrasound Laws With Science

Imani Gandy

A return to data should aid in dismantling other laws ungrounded in any real facts, such as Texas’s onerous "informed consent” law—HB 15—which forces women to get an ultrasound that they may neither need nor afford, and which imposes a 24-hour waiting period.

Whole Woman’s Health v. Hellerstedt, the landmark U.S. Supreme Court ruling striking down two provisions of Texas’ omnibus anti-abortion law, has changed the reproductive rights landscape in ways that will reverberate in courts around the country for years to come. It is no longer acceptable—at least in theory—for a state to announce that a particular restriction advances an interest in women’s health and to expect courts and the public to take them at their word.

In an opinion driven by science and data, Justice Stephen Breyer, writing for the majority in Whole Woman’s Health, weighed the costs and benefits of the two provisions of HB 2 at issue—the admitting privileges and ambulatory surgical center (ASC) requirements—and found them wanting. Texas had breezed through the Fifth Circuit without facing any real pushback on its manufactured claims that the two provisions advanced women’s health. Finally, Justice Breyer whipped out his figurative calculator and determined that those claims didn’t add up. For starters, Texas admitted that it didn’t know of a single instance where the admitting privileges requirement would have helped a woman get better treatment. And as for Texas’ claim that abortion should be performed in an ASC, Breyer pointed out that the state did not require the same of its midwifery clinics, and that childbirth is 14 times more likely to result in death.

So now, as Justice Ruth Bader Ginsburg pointed out in the case’s concurring opinion, laws that “‘do little or nothing for health, but rather strew impediments to abortion’ cannot survive judicial inspection.” In other words, if a state says a restriction promotes women’s health and safety, that state will now have to prove it to the courts.

With this success under our belts, a similar return to science and data should aid in dismantling other laws ungrounded in any real facts, such as Texas’s onerous “informed consent” law—HB 15—which forces women to get an ultrasound that they may neither need nor afford, and which imposes a 24-hour waiting period.

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In Planned Parenthood v. Casey, the U.S. Supreme Court upheld parts of Pennsylvania’s “informed consent” law requiring abortion patients to receive a pamphlet developed by the state department of health, finding that it did not constitute an “undue burden” on the constitutional right to abortion. The basis? Protecting women’s mental health: “[I]n an attempt to ensure that a woman apprehends the full consequences of her decision, the State furthers the legitimate purpose of reducing the risk that a woman may elect an abortion, only to discover later, with devastating psychological consequences, that her decision was not fully informed.”

Texas took up Casey’s informed consent mantle and ran with it. In 2011, the legislature passed a law that forces patients to undergo a medical exam, whether or not their doctor thinks they need it, and that forces them to listen to information that the state wants them to hear, whether or not their doctor thinks that they need to hear it. The purpose of this law—at least in theory—is, again, to protect patients’ “mental health” by dissuading those who may be unsure about procedure.

The ultra-conservative Fifth Circuit Court of Appeals upheld the law in 2012, in Texas Medical Providers v. Lakey.

And make no mistake: The exam the law requires is invasive, and in some cases, cruelly so. As Beverly McPhail pointed out in the Houston Chronicle in 2011, transvaginal probes will often be necessary to comply with the law up to 10 to 12 weeks of pregnancy—which is when, according to the Guttmacher Institute, 91 percent of abortions take place. “Because the fetus is so small at this stage, traditional ultrasounds performed through the abdominal wall, ‘jelly on the belly,’ often cannot produce a clear image,” McPhail noted.

Instead, a “probe is inserted into the vagina, sending sound waves to reflect off body structures to produce an image of the fetus. Under this new law, a woman’s vagina will be penetrated without an opportunity for her to refuse due to coercion from the so-called ‘public servants’ who passed and signed this bill into law,” McPhail concluded.

There’s a reason why abortion advocates began decrying these laws as “rape by the state.”

If Texas legislators are concerned about the mental health of their citizens, particularly those who may have been the victims of sexual assault—or any woman who does not want a wand forcibly shoved into her body for no medical reason—they have a funny way of showing it.

They don’t seem terribly concerned about the well-being of the woman who wants desperately to be a mother but who decides to terminate a pregnancy that doctors tell her is not viable. Certainly, forcing that woman to undergo the painful experience of having an ultrasound image described to her—which the law mandates for the vast majority of patients—could be psychologically devastating.

But maybe Texas legislators don’t care that forcing a foreign object into a person’s body is the ultimate undue burden.

After all, if foisting ultrasounds onto women who have decided to terminate a pregnancy saves even one woman from a lifetime of “devastating psychologically damaging consequences,” then it will all have been worth it, right? Liberty and bodily autonomy be damned.

But what if there’s very little risk that a woman who gets an abortion experiences those “devastating psychological consequences”?

What if the information often provided by states in connection with their “informed consent” protocol does not actually lead to consent that is more informed, either because the information offered is outdated, biased, false, or flatly unnecessary given a particular pregnant person’s circumstance? Texas’ latest edition of its “Woman’s Right to Know” pamphlet, for example, contains even more false information than prior versions, including the medically disproven claim that fetuses can feel pain at 20 weeks gestation.

What if studies show—as they have since the American Psychological Association first conducted one to that effect in 1989—that abortion doesn’t increase the risk of mental health issues?

If the purpose of informed consent laws is to weed out women who have been coerced or who haven’t thought it through, then that purpose collapses if women who get abortions are, by and large, perfectly happy with their decision.

And that’s exactly what research has shown.

Scientific studies indicate that the vast majority of women don’t regret their abortions, and therefore are not devastated psychologically. They don’t fall into drug and alcohol addiction or attempt to kill themselves. But that hasn’t kept anti-choice activists from claiming otherwise.

It’s simply not true that abortion sends mentally healthy patients over the edge. In a study report released in 2008, the APA found that the strongest predictor of post-abortion mental health was prior mental health. In other words, if you’re already suffering from mental health issues before getting an abortion, you’re likely to suffer mental health issues afterward. But the studies most frequently cited in courts around the country prove, at best, an association between mental illness and abortion. When the studies controlled for “prior mental health and violence experience,” “no significant relation was found between abortion history and anxiety disorders.”

But what about forced ultrasound laws, specifically?

Science has its part to play in dismantling those, too.

If Whole Woman’s Health requires the weighing of costs and benefits to ensure that there’s a connection between the claimed purpose of an abortion restriction and the law’s effect, then laws that require a woman to get an ultrasound and to hear a description of it certainly fail that cost-benefit analysis. Science tells us forcing patients to view ultrasound images (as opposed to simply offering the opportunity for a woman to view ultrasound images) in order to give them “information” doesn’t dissuade them from having abortions.

Dr. Jen Gunter made this point in a blog post years ago: One 2009 study found that when given the option to view an ultrasound, nearly 73 percent of women chose to view the ultrasound image, and of those who chose to view it, 85 percent of women felt that it was a positive experience. And here’s the kicker: Not a single woman changed her mind about having an abortion.

Again, if women who choose to see ultrasounds don’t change their minds about getting an abortion, a law mandating that ultrasound in order to dissuade at least some women is, at best, useless. At worst, it’s yet another hurdle patients must leap to get care.

And what of the mandatory waiting period? Texas law requires a 24-hour waiting period—and the Court in Casey upheld a 24-hour waiting period—but states like Louisiana and Florida are increasing the waiting period to 72 hours.

There’s no evidence that forcing women into longer waiting periods has a measurable effect on a woman’s decision to get an abortion. One study conducted in Utah found that 86 percent of women had chosen to get the abortion after the waiting period was over. Eight percent of women chose not to get the abortion, but the most common reason given was that they were already conflicted about abortion in the first place. The author of that study recommended that clinics explore options with women seeking abortion and offer additional counseling to the small percentage of women who are conflicted about it, rather than states imposing a burdensome waiting period.

The bottom line is that the majority of women who choose abortion make up their minds and go through with it, irrespective of the many roadblocks placed in their way by overzealous state governments. And we know that those who cannot overcome those roadblocks—for financial or other reasons—are the ones who experience actual negative effects. As we saw in Whole Woman’s Health, those kinds of studies, when admitted as evidence in the court record, can be critical in striking restrictions down.

Of course, the Supreme Court has not always expressed an affinity for scientific data, as Justice Anthony Kennedy demonstrated in Gonzales v. Carhart, when he announced that “some women come to regret their choice to abort the infant life they once created and sustained,” even though he admitted there was “no reliable data to measure the phenomenon.” It was under Gonzales that so many legislators felt equipped to pass laws backed up by no legitimate scientific evidence in the first place.

Whole Woman’s Health offers reproductive rights advocates an opportunity to revisit a host of anti-choice restrictions that states claim are intended to advance one interest or another—whether it’s the state’s interest in fetal life or the state’s purported interest in the psychological well-being of its citizens. But if the laws don’t have their intended effects, and if they simply throw up obstacles in front of people seeking abortion, then perhaps, Whole Woman’s Health and its focus on scientific data will be the death knell of these laws too.

News Abortion

Texas Pro-Choice Advocates Push Back Against State’s Anti-Choice Pamphlet

Teddy Wilson

The “A Woman’s Right to Know” pamphlet, published by the state, has not been updated since 2003. The pamphlet includes the medically dubious link between abortion care and breast cancer, among other medical inaccuracies common in anti-choice literature.

Reproductive rights advocates are calling for changes to information forced on pregnant people seeking abortion services, thanks to a Texas mandate.

Texas lawmakers passed the Texas Woman’s Right to Know Act in 2003, which requires abortion providers to inform pregnant people of the medical risks associated with abortion care, as well as the probable gestational age of the fetus and the medical risks of carrying a pregnancy to term.

The “A Woman’s Right to Know” pamphlet, published by the state, has not been updated or revised since it was first made public in 2003. The pamphlet includes the medically dubious link between abortion care and breast cancer, among other medical inaccuracies common in anti-choice literature. 

The Texas Department of State Health Services (DSHS) in June published a revised draft version of the pamphlet. The draft version of “A Woman’s Right to Know” was published online, and proposed revisions are available for public comment until Friday.

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John Seago, spokesperson for the anti-choice Texas Right to Life, told KUT that the pamphlet was created so pregnant people have accurate information before they consent to receiving abortion care.

“This is a booklet that’s not going to be put in the hands of experts, it’s not going to be put in the hands of OB-GYNs or scientists–it’s going to be put in the hands of women who will range in education, will range in background, and we want this booklet to be user-friendly enough that anyone can read this booklet and be informed,” he said.

Reproductive rights advocates charge that the information in the pamphlet presented an anti-abortion bias and includes factually incorrect information.

More than 34 percent of the information found in the previous version of the state’s “A Woman’s Right to Know” pamphlet was medically inaccurate, according to a study by a Rutgers University research team.

State lawmakers and activists held a press conference Wednesday outside the DSHS offices in Austin and delivered nearly 5,000 Texans’ comments to the agency.  

Kryston Skinner, an organizer with the Texas Equal Access Fund, spoke during the press conference about her experience having an abortion in Texas, and how the state-mandated pamphlet made her feel stigmatized.

Skinner told Rewire that the pamphlet “causes fear” in pregnant people who are unaware that the pamphlet is rife with misinformation. “It’s obviously a deterrent,” Skinner said. “There is no other reason for the state to force a medical professional to provide misinformation to their patients.”

State Rep. Donna Howard (D-Austin) said in a statement that the pamphlet is the “latest shameful example” of Texas lawmakers playing politics with reproductive health care. “As a former registered nurse, I find it outrageous that the state requires health professionals to provide misleading and coercive information to patients,” Howard said.

Howard, vice chair of the Texas House Women’s Health Caucus, vowed to propose legislation that would rid the booklet of its many inaccuracies if DSHS fails to take the thousands of comments into account, according to the Austin Chronicle

Lawmakers in several states have passed laws mandating that states provide written materials to pregnant people seeking abortion services. These so-called informed consent laws often require that the material include inaccurate or misleading information pushed by legislators and organizations that oppose legal abortion care. 

The American Congress of Obstetricians and Gynecologists (ACOG) sent a letter to DSHS that said the organization has “significant concerns with some of the material and how it is presented.”

Among the most controversial statements made in the pamphlet is the claim that “doctors and scientists are actively studying the complex biology of breast cancer to understand whether abortion may affect the risk of breast cancer.”

Texas Right to Life said in a statement that the organization wants the DSHS include “stronger language” about the supposed correlation between abortion and breast cancer. The organization wants the pamphlet to explicitly cite “the numerous studies that indicate undergoing an elective abortion contributes to the incidence of breast cancer in women.”

Rep. Sarah Davis (R-West University Place) said in a statement that the state should provide the “most accurate science available” to pregnant people seeking an abortion. “As a breast cancer survivor, I am disappointed that DSHS has published revisions to the ‘A Woman’s Right to Know’ booklet that remain scientifically and medically inaccurate,” Davis said.

The link between abortion and cancer has been repeatedly debunked by scientific research.

“Scientific research studies have not found a cause-and-effect relationship between abortion and breast cancer,” according to the American Cancer Society.

A report by the National Cancer Institute explains, “having an abortion or miscarriage does not increase a woman’s subsequent risk of developing breast cancer.”

DSHS spokesperson Carrie Williams told the Texas Tribune that the original booklet was written by a group of agency officials, legislators and public health and medical professionals.

“We carefully considered medical and scientific information when updating the draft booklet,” Williams said.