Commentary Abortion

Study: Viewing an Ultrasound Does Not Dissuade Women From Abortion

Amanda Marcotte

A new study measuring the impact of ultrasound on abortion decisions unsurprisingly shows ultrasounds don't change women's minds. It also disproves the myth that abortion providers and pro-choicers are trying to hide the reality of abortion from women.

With various states passing mandatory ultrasounds and crisis pregnancy centers focusing more of their efforts on getting ultrasound machines, it’s important to ask: Do ultrasounds even work the way that anti-choicers claim? The whole justification for mandatory ultrasounds is the claim that women who get them will be so overcome with excitement at seeing the embryo in their uterus that they will leap up and say, “Why didn’t anyone tell me that I was going to have a baby? Well, I’m definitely not getting that abortion now!” Indeed, so sure are anti-choicers that the shock of discovering that there’s an embryo in there will jolt women out of the abortion decision that one anti-choice activist said 90 percent of women seeking abortions change their mind upon seeing the ultrasound.

Pro-choice experts immediately knew that claim was a lie, because, unlike most people out there, we know that abortion providers often already make viewing the ultrasound available to patients, and they aren’t reporting 90 percent of their abortions being cancelled. But, as Katy Waldman at Slate reports, researchers decided to go ahead and do a thorough, scientific examination of the question. Published in the journal Obstetrics & Gynecology, the study looked at a whopping 15,575 women coming in for abortion. All received an ultrasound and were offered a chance to look at it. Forty-two percent did.

The results are pretty hard to refute: Looking at the ultrasound does not cause a crisis of conscience for women seeking abortion. Of the group that didn’t look, 99 percent went ahead and terminated. But of the group that did look, 98.4 percent terminated. The difference between the groups was less than a percentage point, totaling about 17 women out of over 15,000. More importantly, as Waldman notes, the women who changed their minds came strictly from the group of women who were unsure about their abortions going in. Women who were highly certain they wanted an abortion were not swayed at all by the ultrasound.

There are a lot of important lessons to be learned from this, with the most important being that mandatory ultrasounds are basically useless as a persuasion tool. Not that we can expect anti-choicers to apologize and repeal the laws forcing women to get them. They may say that it’s because they’re trying to give women full information, but in reality it’s just to add more expense and hassle to getting an abortion, so it’s likely the laws will stay. But it will be much harder now for anti-choicers to argue with a straight face that the law is well-meaning.

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Another important lesson is that the problem with ultrasounds is not that they are done or that they are shown to women. Many pro-choicers—myself included—believe the doctors should give women the choice to view an ultrasound. In the extremely rare case that changes a mind, then good! Women should not be doing things they don’t want to do. Honestly, I’d be shocked if any pro-choicers disagreed.

Indeed, as this study shows, contrary to what anti-choicers would have you believe, letting women look at ultrasounds if they want is common practice in abortion clinics. Anti-choice activists behind these laws are hoping the existence of this law leads you to believe that abortion doctors are deliberately concealing the facts of pregnancy from their patients, presumably out of some fear that patients won’t get abortions if they know what’s really going on in there. The truth couldn’t be further from the myth. Most abortion providers have no interest in deceiving anyone or performing more abortions than patients demand. (Really, with clinic closures being such a problem, many abortion providers are in danger of having more demand than they can meet.) They are there to make sure the patient has the reproductive health outcomes she wants. If that means she needs more information to make her decision, then most doctors are happy to give it.

The problem with mandatory ultrasounds is the mandatory part. As these results show, no one is really surprised by what’s inside the uterus when getting an abortion. (Or, if they are, it’s often because they’re surprised at how small the embryo is when anti-abortion propaganda led them to believe it would be much bigger.) Looking at an ultrasound can be a very good thing for a patient, if she wants it and if it’s handled responsibly. Mandatory ultrasounds are not only coercive, but the laws around them often make it so they are utterly irresponsible: Done without regard to a patient’s mental health needs, often accompanied by scripts that are as inaccurate as they are shaming, and forced to occur 24 hours or more prior to the abortion, drawing out what is already an expensive experience for many women.

Finally, an important takeaway from all this is, in a way, the most simple. It’s a reminder that women are not stupid. Mandatory ultrasounds are based on the sexist premise that the only reason women choose abortion is that they are simply too dim to know how to make a good decision and need lots and lots of hand-holding, more than you would even give to a small child. At the end of the day, the results of this study were predictable for the very simple reason that, in order for ultrasounds to work the way anti-choicers say they do, they would have to be giving women information they don’t already know. But of course they know what a pregnancy is and what it means. Their knowledge of this is why they’re seeking abortion. It’s not just that over 60 percent of women who get abortions are mothers already. It’s that women live in the world and we know what having a baby means physically, financially, socially, and emotionally. A woman who has an abortion knows that she is foreclosing the possibility of having this baby at this time, and she has, for her own reasons, decided that is for the best. To suggest she doesn’t know what she’s talking about is not only insulting to women, it has no basis whatsoever in the facts. Now we have a study to prove how true that is.

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.’”

Commentary Sexuality

Black Trans Liberation Tuesday Must Become an Annual Observance

Raquel Willis

As long as trans people—many of them Black trans women—continue to be murdered, there will be a need to commemorate their lives, work to prevent more deaths, and uplift Black trans activism.

This piece is published in collaboration with Echoing Ida, a Forward Together project.

This week marks one year since Black transgender activists in the United States organized Black Trans Liberation Tuesday. Held on Tuesday, August 25, the national day of action publicized Black trans experiences and memorialized 18 trans women, predominantly trans women of color, who had been murdered by this time last year.

In conjunction with the Black Lives Matter network, the effort built upon an earlier Trans Liberation Tuesday observance created by Bay Area organizations TGI Justice Project and Taja’s Coalition to recognize the fatal stabbing of 36-year-old trans Latina woman Taja DeJesus in February 2015.

Black Trans Liberation Tuesday should become an annual observance because transphobic violence and discrimination aren’t going to dissipate with one-off occurrences. I propose that Black Trans Liberation Tuesday fall on the fourth Tuesday of August to coincide with the first observance and also the August 24 birthday of the late Black trans activist Marsha P. Johnson.

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There is a continuing need to pay specific attention to Black transgender issues, and the larger Black community must be pushed to stand in solidarity with us. Last year, Black trans activists, the Black Lives Matter network, and GetEQUAL collaborated on a blueprint of what collective support looks like, discussions that led to Black Trans Liberation Tuesday.

“Patrisse Cullors [a co-founder of Black Lives Matter] had been in talks on ways to support Black trans women who had been organizing around various murders,” said Black Lives Matter Organizing Coordinator Elle Hearns of Washington, D.C. “At that time, Black trans folks had been experiencing erasure from the movement and a lack of support from cis people that we’d been in solidarity with who hadn’t reciprocated that support.”

This erasure speaks to a long history of Black LGBTQ activism going underrecognized in both the civil rights and early LGBTQ liberation movements. Many civil rights leaders bought into the idea that influential Black gay activist Bayard Rustin was unfit to be a leader simply because he had relationships with men, though he organized the 1963 March on Washington for Jobs and Freedom. Johnson, who is often credited with kicking off the 1969 Stonewall riots with other trans and gender-nonconforming people of color, fought tirelessly for LGBTQ rights. She and other trans activists of color lived in poverty and danger (Johnson was found dead under suspicious circumstances in July 1992), while the white mainstream gay elite were able to demand acceptance from society. Just last year, Stonewall, a movie chronicling the riots, was released with a whitewashed retelling that centered a white, cisgender gay male protagonist.

The Black Lives Matter network has made an intentional effort to avoid the pitfalls of those earlier movements.

“Our movement has been intersectional in ways that help all people gain liberation whether they see it or not. It became a major element of the network vision and how it was seeing itself in the Black liberation movement,” Hearns said. “There was no way to discuss police brutality without discussing structural violence affecting Black lives, in general”—and that includes Black trans lives.

Despite a greater mainstream visibility for LGBTQ issues in general, Black LGBTQ issues have not taken the forefront in Black freedom struggles. When a Black cisgender heterosexual man is killed, his name trends on social media feeds and is in the headlines, but Black trans women don’t see the same importance placed on their lives.

According to a 2015 report by the Anti-Violence Project, a group dedicated to ending anti-LGBTQ and HIV-affected community violence, trans women of color account for 54 percent of all anti-LGBTQ homicides. Despite increased awareness, with at least 20 transgender people murdered since the beginning of this year, it seems things haven’t really changed at all since Black Trans Liberation Tuesday.

“There are many issues at hand when talking about Black trans issues, particularly in the South. There’s a lack of infrastructure and support in the nonprofit sector, but also within health care and other systems. Staffs at LGBTQ organizations are underfunded when it comes to explicitly reaching the trans community,” said Micky Bradford, the Atlanta-based regional organizer for TLC@SONG. “The space between towns can harbor isolation from each other, making it more difficult to build up community organizing, coalitions, and culture.”

The marginalization that Black trans people face comes from both the broader society and the Black community. Fighting white supremacy is a full-time job, and some activists within the Black Lives Matter movement see homophobia and transphobia as muddying the fight for Black liberation.

“I think we have a very special relationship with gender and gender violence to all Black people,” said Aaryn Lang, a New York City-based Black trans activist. “There’s a special type of trauma that Black people inflict on Black trans people because of how strict the box of gender and space of gender expression has been to move in for Black people. In the future of the movement, I see more people trusting that trans folks have a vision that’s as diverse as blackness is.”

But even within that diversity, Black trans people are often overlooked in movement spaces due to anti-Blackness in mainstream LGBTQ circles and transphobia in Black circles. Further, many Black trans people aren’t in the position to put energy into movement work because they are simply trying to survive and find basic resources. This can create a disconnect between various sections of the Black trans community.

Janetta Johnson, executive director of TGI Justice Project in San Francisco, thinks the solution is twofold: increased Black trans involvement and leadership in activism spaces, and more facilitated conversations between Black cis and trans people.

“I think a certain part of the transgender community kind of blocks all of this stuff out. We are saying we need you to come through this process and see how we can create strength in numbers. We need to bring in other trans people not involved in the movement,” she said. “We need to create a space where we can share views and strategies and experiences.”

Those conversations must be an ongoing process until the killings of Black trans women like Rae’Lynn Thomas, Dee Whigham, and Skye Mockabee stop.

“As we commemorate this year, we remember who and why we organized Black Trans Liberation Tuesday last year. It’s important we realize that Black trans lives are still being affected in ways that everyday people don’t realize,” Hearns said. “We must understand why movements exist and why people take extreme action to continuously interrupt the system that will gladly forget them.”

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