Commentary Abortion

The Abortion Wars: The Real People Behind the Restrictions

Carole Joffe

An unprecedented number of abortion restrictions have been introduced and eventually passed in state legislatures over the past two years, during a time when one might assume politicians’ focus would be on the economy. But there are real people behind the numbers and they are bearing the enormous toll of these laws.

The last ten days or so we have seen Republicans, and their religious allies, wage a war against contraception—and bungle it badly. With poll after poll showing that a majority of Americans support contraceptive coverage in health reform, and with the 98 percent figure (of American women who have ever used contraception in the context of heterosexual sex) endlessly repeated in the media, the Republicans nonetheless push ahead with this attack, providing a welcome gift to the Obama reelection campaign and much material to political artists and comics. I have lost count of the number of parodies that have been inspired by that now gone viral picture of five male clerics testifying at the Congressional hearing called by Rep. Darrell Issa (R-CA). A picture that of course immediately brings to mind another image of a similar tone deaf moment on the part of social conservatives,  the nine men surrounding President George W. Bush as he became the first president to sign a ban on a particular technique of performing abortion, in the case of so-called “partial birth abortion.”  It’s no wonder that the term “patriarchy” has made a comeback in the blogs!

The well-publicized refusal of Issa to permit the testimony of a female witness put forward by the Democrats, Sandra Fluke, a Georgetown law student planning to speak to the health consequences of denied contraception at Catholic universities, only added to the disastrous p.r. of that event. And the “aspirin between her knees” remark of Rick Santorum’s major funder later that day didn’t help either.

But while the media is momentarily fixated on the second big story this month of a losing fight against family planning (remember the Susan G. Komen Fund fiasco?), less attention has been paid to a related war that is not going well at all.  The assault on abortion that has resulted from the 2010 elections–the Republican takeover of Congress and many statehouses and governorships–has arguably produced the most serious threat to abortion access since the Roe decision in 1973.  What we mainly have heard about this situation are the statistics, the unprecedented number of abortion restrictions introduced and eventually passed in state legislatures at a time when one might assume politicians’ focus would be on the economy.

But there are real people behind the numbers and details of the restrictions. And the enormous toll that the abortion wars take on individual women seeking the procedure and the providers who try to help them are insufficiently appreciated by the general public.  Consider the case of Jennie McCormick, a destitute Idaho woman, a single mother of three, who, facing an unwanted pregnancy and unable to travel several hours to the nearest abortion clinic, ordered abortion medication over the Internet, and is now facing criminal charges.  She has also been stigmatized in her own community to a degree to which the fictional Hester Prynne of The Scarlet Letter fame could relate.  Here is a description of her daily life, as described in a British newspaper:

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When Jennie Linn McCormack walks the streets of Pocatello, the town in southern Idaho where she was born, raised, and still lives, she attempts to disguise her face by covering it with a thick woollen scarf. It doesn’t really work. In the supermarket, people stop and point. At fast-food outlets, they hiss “it’s her”! In the local church, that supposed bastion of forgiveness, fire-and-brimstone preachers devote entire sermons to accusing her of mortal sin….”I feel like my life is over,” Ms McCormack says. “I now stay home all the time. I have no friends. I can’t work. I don’t want to take my kids out in public. People can be really mean about what has happened.”….

 Consider as well the case of Amy Hagstrom Miller, who directs a number of abortion clinics in Texas, under the name of Whole Woman’s Health.  Being an abortion provider in red-state Texas is always challenging, but especially in the past year. Hagstrom Miller has had to contend with implementing the state’s new sonogram law, which requires that women come to an abortion clinic at least 24 hours before their scheduled abortion, and receive a sonogram from the same physician who will perform their abortion. Additionally, the physician must give the patient a detailed description of her fetus’ development. The state has made it very clear to abortion facilities that it will enforce the law through inspections and will revoke the licenses of those doctors not in compliance.

It is not the fact of sonograms per se that is causing headaches for Hagstrom Miller. Rather it is the way the law is written. Patients at her facilities routinely receive sonograms. But the ultrasound used to be performed by a trained technician, the ultrasound was done abdominally and not through the more intrusive vaginal probe, and patients not have to make two separate visits.

So now Hagstrom Miller has to contend with the frustrations of many of her patients, who typically have to take additional time off work and pay for extra childcare.  She also has to deal with the scheduling nightmare of making sure the same physician who performs the ultrasound is available to perform that patient’s abortion.  Hagstrom Miller is convinced that this new rule achieves nothing more than putting more obstacles in the way of both provider and patient, and has not achieved its stated objective of changing women’s minds. “It’s had no effect whatsoever on our abortion census.”

But coping with the sonogram law is not the only thing that preoccupies Hagstrom Miller.  For the past year, her clinics have been subject to an unrelenting campaign of harassment by the notorious anti-abortion group, Operation Rescue.  To give just one example, her facilities have been subject to no less than 13 surprise investigations by various state agencies, including the state health department, the Texas Commission on Environmental Equality, the state Pharmacy Board, and seven of the physicians associated with Whole Woman’s Health were formally investigated. All these investigations were triggered by “citizen complaints” made to various bureaucracies.  Among the “citizens” making such complaints is Cheryl Sullinger, the OR operative whose name was found in the car of Scott Roeder, who assassinated Dr. George Tiller in May 2009, and who herself has spent time in jail for her anti-abortion activity.

To give a flavor of what Whole Woman’s Health has had to put up with as a result of Operation Rescue’s campaign, one of the complaints alleged that aborted fetuses were discarded in clinic dumpsters. So clinics’ staff and visitors were subjected to the bizarre sight of public health nurses in Hazmat suits pawing through dumpsters, routinely opening and photographing the content of every bag, on order of the state health department–and finding nothing incriminating.

When I asked Hagstrom Miller to reflect on her dual difficulties with both the new state sonogram law and the actions of Operation Rescue, she responded:

“This past year has been one of the most difficult of my career in abortion care. It is almost surreal to be constantly challenged for the very thing we have been recognized for doing well…The very state agencies that have licensed us have to take the word of people who have a stated goal of closing abortion facilities by any means necessary. Even when, time and time again, we are cleared of the accusations, they (opponents) are successful in that they have tied up our time, spirits, money and energy and distracted us from the good work we could be doing with women and families in our communities.”

Unlike Jennie McCormick, the young Idaho women mentioned above, Hagstrom Miller is not isolated and without resources. Indeed, she is a cherished member of the closeknit national community of abortion providers, and operates daily in a world of loving family and friends. But the situation of both of them reveal one of the greatest challenges facing the reproductive freedom movement: how to connect for the public the two reproductive wars currently being waged—the contraceptive one that that thus far seems a slam dunk victory, and the abortion one that we are losing, and about which the public is no doubt weary.  

In the real world, these two issues of contraception and abortion exist on the same continuum. The use of both are affirmations of the belief in nonprocreative sex. At Whole Women’s Health, and at most other abortion providing facilities, patients are provided with birth control information and services. It is reasonable to assume that Ms. McCormick, only marginally employed, did not have access to reliable contraception. This connectedness of birth control and abortion is of course a major reason that social conservatives oppose the former. And it is a key reason why the 98 percent-ers should more vigorously support the latter.

News Politics

Clinton Campaign Announces Tim Kaine as Pick for Vice President

Ally Boguhn

The prospect of Kaine’s selection has been criticized by some progressives due to his stances on issues including abortion as well as bank and trade regulation.

The Clinton campaign announced Friday that Sen. Tim Kaine (R-VA) has been selected to join Hillary Clinton’s ticket as her vice presidential candidate.

“I’m thrilled to announce my running mate, @TimKaine, a man who’s devoted his life to fighting for others,” said Clinton in a tweet.

“.@TimKaine is a relentless optimist who believes no problem is unsolvable if you put in the work to solve it,” she added.

The prospect of Kaine’s selection has been criticized by some progressives due to his stances on issues including abortion as well as bank and trade regulation.

Kaine signed two letters this week calling for the regulations on banks to be eased, according to a Wednesday report published by the Huffington Post, thereby ”setting himself up as a figure willing to do battle with the progressive wing of the party.”

Charles Chamberlain, executive director of the progressive political action committee Democracy for America, told the New York Times that Kaine’s selection “could be disastrous for our efforts to defeat Donald Trump in the fall” given the senator’s apparent support of the Trans-Pacific Partnership (TPP). Just before Clinton’s campaign made the official announcement that Kaine had been selected, the senator praised the TPP during an interview with the Intercept, though he signaled he had ultimately not decided how he would vote on the matter.

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Kaine’s record on reproductive rights has also generated controversy as news began to circulate that he was being considered to join Clinton’s ticket. Though Kaine recently argued in favor of providing Planned Parenthood with access to funding to fight the Zika virus and signed on as a co-sponsor of the Women’s Health Protection Act—which would prohibit states and the federal government from enacting restrictions on abortion that aren’t applied to comparable medical services—he has also been vocal about his personal opposition to abortion.

In a June interview on NBC’s Meet the Press, Kaine told host Chuck Todd he was “personally” opposed to abortion. He went on, however, to affirm that he still believed “not just as a matter of politics, but even as a matter of morality, that matters about reproduction and intimacy and relationships and contraception are in the personal realm. They’re moral decisions for individuals to make for themselves. And the last thing we need is government intruding into those personal decisions.”

As Rewire has previously reported, though Kaine may have a 100 percent rating for his time in the Senate from Planned Parenthood Action Fund, the campaign website for his 2005 run for governor of Virginia promised he would “work in good faith to reduce abortions” by enforcing Virginia’s “restrictions on abortion and passing an enforceable ban on partial birth abortion that protects the life and health of the mother.”

As governor, Kaine did support some existing restrictions on abortion, including Virginia’s parental consent law and a so-called informed consent law. He also signed a 2009 measure that created “Choose Life” license plates in the state, and gave a percentage of the proceeds to a crisis pregnancy network.

Regardless of Clinton’s vice president pick, the “center of gravity in the Democratic Party has shifted in a bold, populist, progressive direction,” said Stephanie Taylor, co-founder of the Progressive Change Campaign Committee, in an emailed statement. “It’s now more important than ever that Hillary Clinton run an aggressive campaign on core economic ideas like expanding Social Security, debt-free college, Wall Street reform, and yes, stopping the TPP. It’s the best way to unite the Democratic Party, and stop Republicans from winning over swing voters on bread-and-butter issues.”

Roundups Sexual Health

This Week in Sex: The Sexually Transmitted Infections Edition

Martha Kempner

A new Zika case suggests the virus can be transmitted from an infected woman to a male partner. And, in other news, HPV-related cancers are on the rise, and an experimental chlamydia vaccine shows signs of promise.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Zika May Have Been Sexually Transmitted From a Woman to Her Male Partner

A new case suggests that males may be infected with the Zika virus through unprotected sex with female partners. Researchers have known for a while that men can infect their partners through penetrative sexual intercourse, but this is the first suspected case of sexual transmission from a woman.

The case involves a New York City woman who is in her early 20s and traveled to a country with high rates of the mosquito-borne virus (her name and the specific country where she traveled have not been released). The woman, who experienced stomach cramps and a headache while waiting for her flight back to New York, reported one act of sexual intercourse without a condom the day she returned from her trip. The following day, her symptoms became worse and included fever, fatigue, a rash, and tingling in her hands and feet. Two days later, she visited her primary-care provider and tests confirmed she had the Zika virus.

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A few days after that (seven days after intercourse), her male partner, also in his 20s, began feeling similar symptoms. He had a rash, a fever, and also conjunctivitis (pink eye). He, too, was diagnosed with Zika. After meeting with him, public health officials in the New York City confirmed that he had not traveled out of the country nor had he been recently bit by a mosquito. This leaves sexual transmission from his partner as the most likely cause of his infection, though further tests are being done.

The Centers for Disease Control and Prevention (CDC)’s recommendations for preventing Zika have been based on the assumption that virus was spread from a male to a receptive partner. Therefore the recommendations had been that pregnant women whose male partners had traveled or lived in a place where Zika virus is spreading use condoms or abstain from sex during the pregnancy. For those couples for whom pregnancy is not an issue, the CDC recommended that men who had traveled to countries with Zika outbreaks and had symptoms of the virus, use condoms or abstain from sex for six months after their trip. It also suggested that men who traveled but don’t have symptoms use condoms for at least eight weeks.

Based on this case—the first to suggest female-to-male transmission—the CDC may extend these recommendations to couples in which a female traveled to a country with an outbreak.

More Signs of Gonorrhea’s Growing Antibiotic Resistance

Last week, the CDC released new data on gonorrhea and warned once again that the bacteria that causes this common sexually transmitted infection (STI) is becoming resistant to the antibiotics used to treat it.

There are about 350,000 cases of gonorrhea reported each year, but it is estimated that 800,000 cases really occur with many going undiagnosed and untreated. Once easily treatable with antibiotics, the bacteria Neisseria gonorrhoeae has steadily gained resistance to whole classes of antibiotics over the decades. By the 1980s, penicillin no longer worked to treat it, and in 2007 the CDC stopped recommending the use of fluoroquinolones. Now, cephalosporins are the only class of drugs that work. The recommended treatment involves a combination of ceftriaxone (an injectable cephalosporin) and azithromycin (an oral antibiotic).

Unfortunately, the data released last week—which comes from analysis of more than 5,000 samples of gonorrhea (called isolates) collected from STI clinics across the country—shows that the bacteria is developing resistance to these drugs as well. In fact, the percentage of gonorrhea isolates with decreased susceptibility to azithromycin increased more than 300 percent between 2013 and 2014 (from 0.6 percent to 2.5 percent).

Though no cases of treatment failure has been reported in the United States, this is a troubling sign of what may be coming. Dr. Gail Bolan, director of CDC’s Division of STD Prevention, said in a press release: “It is unclear how long the combination therapy of azithromycin and ceftriaxone will be effective if the increases in resistance persists. We need to push forward on multiple fronts to ensure we can continue offering successful treatment to those who need it.”

HPV-Related Cancers Up Despite Vaccine 

The CDC also released new data this month showing an increase in HPV-associated cancers between 2008 and 2012 compared with the previous five-year period. HPV or human papillomavirus is an extremely common sexually transmitted infection. In fact, HPV is so common that the CDC believes most sexually active adults will get it at some point in their lives. Many cases of HPV clear spontaneously with no medical intervention, but certain types of the virus cause cancer of the cervix, vulva, penis, anus, mouth, and neck.

The CDC’s new data suggests that an average of 38,793 HPV-associated cancers were diagnosed each year between 2008 and 2012. This is a 17 percent increase from about 33,000 each year between 2004 and 2008. This is a particularly unfortunate trend given that the newest available vaccine—Gardasil 9—can prevent the types of HPV most often linked to cancer. In fact, researchers estimated that the majority of cancers found in the recent data (about 28,000 each year) were caused by types of the virus that could be prevented by the vaccine.

Unfortunately, as Rewire has reported, the vaccine is often mired in controversy and far fewer young people have received it than get most other recommended vaccines. In 2014, only 40 percent of girls and 22 percent of boys ages 13 to 17 had received all three recommended doses of the vaccine. In comparison, nearly 80 percent of young people in this age group had received the vaccine that protects against meningitis.

In response to the newest data, Dr. Electra Paskett, co-director of the Cancer Control Research Program at the Ohio State University Comprehensive Cancer Center, told HealthDay:

In order to increase HPV vaccination rates, we must change the perception of the HPV vaccine from something that prevents a sexually transmitted disease to a vaccine that prevents cancer. Every parent should ask the question: If there was a vaccine I could give my child that would prevent them from developing six different cancers, would I give it to them? The answer would be a resounding yes—and we would have a dramatic decrease in HPV-related cancers across the globe.

Making Inroads Toward a Chlamydia Vaccine

An article published in the journal Vaccine shows that researchers have made progress with a new vaccine to prevent chlamydia. According to lead researcher David Bulir of the M. G. DeGroote Institute for Infectious Disease Research at Canada’s McMaster University, efforts to create a vaccine have been underway for decades, but this is the first formulation to show success.

In 2014, there were 1.4 million reported cases of chlamydia in the United States. While this bacterial infection can be easily treated with antibiotics, it often goes undiagnosed because many people show no symptoms. Untreated chlamydia can lead to pelvic inflammatory disease, which can leave scar tissue in the fallopian tubes or uterus and ultimately result in infertility.

The experimental vaccine was created by Canadian researchers who used pieces of the bacteria that causes chlamydia to form an antigen they called BD584. The hope was that the antigen could prompt the body’s immune system to fight the chlamydia bacteria if exposed to it.

Researchers gave BD584 to mice using a nasal spray, and then exposed them to chlamydia. The results were very promising. The mice who received the spray cleared the infection faster than the mice who did not. Moreover, the mice given the nasal spray were less likely to show symptoms of infection, such as bacterial shedding from the vagina or fluid blockages of the fallopian tubes.

There are many steps to go before this vaccine could become available. The researchers need to test it on other strains of the bacteria and in other animals before testing it in humans. And, of course, experience with the HPV vaccine shows that there’s work to be done to make sure people get vaccines that prevent STIs even after they’re invented. Nonetheless, a vaccine to prevent chlamydia would be a great victory in our ongoing fight against STIs and their health consequences, and we here at This Week in Sex are happy to end on a bit of a positive note.