Commentary Abortion

Mindy Kaling’s Sitcom Could Help Disrupt Abortion Provider Stigma (Updated)

Renee Bracey Sherman

Why wouldn't Kaling's character, Dr. Lahiri, discuss abortion in a show about a gynecologist's office? It always comes back to stigma.

UPDATE, September 15, 10:50 a.m.: Mindy Kaling told Huffington Post Live in an interview on Friday that she thinks she “misspoke” when she said “that I thought it would demean the issue of abortion to talk about it on sitcom.” She said, “What I should’ve said was my sitcom… Many incredible shows have dealt with in it in a way that I really admire. Roseanne is one of them.” Kaling added, “I should’ve said for now. I don’t know that that would be the case in the show, and I don’t want to lock myself into never talking about it.”

She further explained“[Abortion] doesn’t strike me — and I don’t think this is controversial — as the funniest of areas, and I run a comedy show. And also, my show is not about gynecological issues that much. It’s about a workplace… It’s hard to say those things and not sound like I’m skirting the issue, but, at the same time, our show from the get-go hasn’t made its centerpiece to focus on political issues. Instead, the fact of the way that I look and the decisions I make, the character, that has sort of been our more subtle mouthpiece for those things.”

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

When I read Mindy Kaling’s words in her interview with Flare magazine, I and many other reproductive rights advocates were confused and frustrated:

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“It would be demeaning to the topic [of abortion] to talk about it in a half-hour sitcom.”

How would it be “demeaning” to talk about abortion in a sitcom about a gynecologist’s office? Many sitcoms have talked openly about abortion, including Girls and Sex and the City, as well as recent films, like Obvious Child. In its first two seasons, Kaling’s show, The Mindy Project, has tackled many issues related to reproductive health care, such as the distribution of condoms, birth control, and teen sex. Why not abortion?

But then I remembered, it always comes back to stigma—in this case, abortion provider stigma.

Half of women in the United States will experience an unintended pregnancy, and one in three will have an abortion before she turns 45. Kaling’s character, Dr. Mindy Lahiri, would surely see patients who want pregnancy options counseling, and some of those patients would likely seek an abortion. Why wouldn’t she provide them with one in her practice, or at least refer them to an abortion provider?

Actually, Dr. Lahiri’s behavior is reflective of a real-life norm: There are many OB-GYNs who don’t provide abortions based on fear of violence, lack of training, or their own internalized stigma toward abortion care. A 2011 survey found that only one in seven OB-GYNs are willing or able to provide abortions. However, 97 percent of OB-GYNs stated that they have encountered people seeking abortion care.

One of the reasons for this is lack of access to medical training on abortion. In 2009, the American Congress of Obstetricians and Gynecologists (ACOG) found that only 32 percent of medical schools include at least one lecture on abortion in their curricula. The group also found that 45 percent of schools offer clinical experience in providing abortion care, though participation at those schools is low because the program is opt-in rather than integrated into the curricula like most other forms of health care. The Accreditation Council for Graduate Medical Education does require that OB-GYN residency programs offer training in family planning and abortion. Still, residency programs can opt out of providing this training in-house, forcing students to attend training at another program.

Even when clinicians do receive training to provide abortions, they face barriers in offering those service to patients. Because of the stigma associated with abortion, many hospitals, especially religiously affiliated ones, refuse to allow providers to offer abortion care.

“Private practice groups as well as hospitals routinely prohibit their group members and staff from performing abortions either because of institutional religious affiliations or because they fear protest from the community,” explained Dr. Kathleen Morrell, a reproductive health advocacy fellow at Physicians for Reproductive Health. “For example, a colleague of mine who received abortion training and wanted to offer her patients comprehensive reproductive health care joined a private practice that refused to let her offer abortion care. The other doctors in the practice were concerned about possible backlash from the community if they became known as an abortion provider.”

So perhaps Dr. Lahiri’s colleagues don’t want her to provide abortions. Wouldn’t that make an interesting plot device!

Backlash from colleagues and the community is a constant fear and barrier for providers. The stigma of abortion leads them to receive death threats, see protests outside of their clinics, and fear for the safety of their family and friends. While many providers are proud of the compassionate care they are able to offer their patients, abortion providers often keep their work a secret to alleviate some of the impact of the stigma. Understandably, this secrecy allows them to live a more normal life and continue doing their work, yet it can also perpetuate stigma.

“When abortion providers do not disclose their work in everyday encounters, their silence perpetuates a stereotype that abortion work is unusual or deviant, or that legitimate, mainstream doctors do not perform abortions,” writes Dr. Lisa Harris on the cycle of silence and stigma. “This contributes to marginalization of abortion providers within medicine and the ongoing targeting of providers for harassment and violence. This reinforces the reluctance to disclose abortion work, and the cycle continues.”

But there are providers who refuse to let stigma and shame keep them from providing care. In a recent interview with Esquire, Dr. Willie Parker, who provides abortion care at the last abortion clinic in Mississippi, spoke frankly about how stigma affects his work, the role his faith plays in abortion care, and why he began providing abortions full-time the day Dr. George Tiller was murdered in 2009. “The protesters say they’re opposed to abortion because they’re Christian,” Parker said. “It’s hard for them to accept that I do abortions because I’m a Christian.”

It’s media coverage like the Esquire profile of Dr. Parker and abortion plot lines in television shows and movies that can help to disrupt the cycle of abortion stigma in our society. “Media can shift stigma by portraying abortion as most people experience it: normal, manageable, social, and not the end of the world,” Steph Herold, deputy director of the Sea Change Program, told me. “Positive portrayals of abortion provision may even help providers feel less isolated, and reinforce the simple truth that providing abortion should be part of routine health care.”

Abortion stigma may be keeping Mindy Kaling from talking about abortion on her show, but if she were to do so it could help educate the public, inspire future providers, and fight abortion provider stigma. (Dr. Parker as a guest star, anyone?) Also, I’ll bet viewers would love to see Dr. Lahiri tackle an issue so many of them have experienced.

So please Mindy, write an abortion plot into your show. That is TV I would want to watch.

News Sexual Health

State with Nation’s Highest Chlamydia Rate Enacts New Restrictions on Sex Ed

Nicole Knight Shine

By requiring sexual education instructors to be certified teachers, the Alaska legislature is targeting Planned Parenthood, which is the largest nonprofit provider of such educational services in the state.

Alaska is imposing a new hurdle on comprehensive sexual health education with a law restricting schools to only hiring certificated school teachers to teach or supervise sex ed classes.

The broad and controversial education bill, HB 156, became law Thursday night without the signature of Gov. Bill Walker, a former Republican who switched his party affiliation to Independent in 2014. HB 156 requires school boards to vet and approve sex ed materials and instructors, making sex ed the “most scrutinized subject in the state,” according to reproductive health advocates.

Republicans hold large majorities in both chambers of Alaska’s legislature.

Championing the restrictions was state Sen. Mike Dunleavy (R-Wasilla), who called sexuality a “new concept” during a Senate Education Committee meeting in April. Dunleavy added the restrictions to HB 156 after the failure of an earlier measure that barred abortion providers—meaning Planned Parenthood—from teaching sex ed.

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Dunleavy has long targeted Planned Parenthood, the state’s largest nonprofit provider of sexual health education, calling its instruction “indoctrination.”

Meanwhile, advocates argue that evidence-based health education is sorely needed in a state that reported 787.5 cases of chlamydia per 100,000 people in 2014—the nation’s highest rate, according to the Centers for Disease Control and Prevention’s Surveillance Survey for that year.

Alaska’s teen pregnancy rate is higher than the national average.

The governor in a statement described his decision as a “very close call.”

“Given that this bill will have a broad and wide-ranging effect on education statewide, I have decided to allow HB 156 to become law without my signature,” Walker said.

Teachers, parents, and advocates had urged Walker to veto HB 156. Alaska’s 2016 Teacher of the Year, Amy Jo Meiners, took to Twitter following Walker’s announcement, writing, as reported by Juneau Empire, “This will cause such a burden on teachers [and] our partners in health education, including parents [and] health [professionals].”

An Anchorage parent and grandparent described her opposition to the bill in an op-ed, writing, “There is no doubt that HB 156 is designed to make it harder to access real sexual health education …. Although our state faces its largest budget crisis in history, certain members of the Legislature spent a lot of time worrying that teenagers are receiving information about their own bodies.”

Jessica Cler, Alaska public affairs manager with Planned Parenthood Votes Northwest and Hawaii, called Walker’s decision a “crushing blow for comprehensive and medically accurate sexual health education” in a statement.

She added that Walker’s “lack of action today has put the education of thousands of teens in Alaska at risk. This is designed to do one thing: Block students from accessing the sex education they need on safe sex and healthy relationships.”

The law follows the 2016 Legislative Round-up released this week by advocacy group Sexuality Information and Education Council of the United States. The report found that 63 percent of bills this year sought to improve sex ed, but more than a quarter undermined student rights or the quality of instruction by various means, including “promoting misinformation and an anti-abortion agenda.”

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.