Commentary Politics

Four Facts Nancy Pelosi—and All ‘Pro-Choice’ Democrats—Should Know About Abortion

Jodi Jacobson

House Minority Leader Nancy Pelosi could not articulate a vigorous, unapologetic, and evidence-based response on abortion to questions posed in an interview this week by Roll Call's Melinda Henneberger.

Just a week or so after Democratic National Committee Chairwoman Rep. Debbie Wasserman Schultz (D-FL) blamed voters for being “complacent” about abortion, House Minority Leader Nancy Pelosi illustrated why, despite being the nominally pro-choice party, Democrats continuously fail to lead on the issue of reproductive health care.

Pelosi could not articulate a vigorous, unapologetic, and evidence-based response on abortion to questions posed in an interview this week by Roll Call‘s Melinda Henneberger. In fact, Pelosi expressed discomfort with using the word “abortion,” underscoring how deeply abortion stigma has permeated the discourse of even the female leader of the Democratic Party, one of the most powerful women in the United States.

It is more than clear that abortion will continue to be politicized through the 2016 election and beyond. But Democrats persist in stumbling when asked about it. So here are some facts that any politician claiming to be pro-choice—and otherwise charged with protecting the interests, rights, and health of the voters who put them in office—must master and assert without apology.

Access to safe abortion care is fundamentally a matter of public health. In countries where access to abortion is limited either by law or in practice, women face high rates of maternal mortality and morbidity. In other words, they die and are injured, sometimes permanently, at far higher rates than in countries or regions where access to safe abortion care is guaranteed. This was indeed the case in the United States before Roe v. Wade.

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Today, according to conservative estimates, more than 300,000 women worldwide die each year from complications from pregnancy, childbirth, and unsafe abortion. That’s 830 women each and every day. These are women in their teens to their late 40s, who are most likely to be raising children and earning critical income for their families. Many times the number who die from unsafe abortion suffer long-term illness and disability instead.

In Uganda, for example, due to lack of access to contraception among other factors, more than four in ten births are unplanned, and women say they have far larger families than they want. In their struggle to have fewer children, they often resort to abortion. Abortion is, however, illegal in Uganda, and access to safe abortion is only available to the wealthy. Not surprisingly, Uganda has one of the world’s highest rates of maternal death, and estimates indicate that if rates of clandestine abortion continue, half of all women in Uganda will need treatment for complications of unsafe abortion at some point in their lives.

By contrast, as was the case for the United States, rates of maternal deaths and illnesses from unsafe abortion declined dramatically in both Nepal and in South Africa after those two countries legalized and increased access to abortion care.

The deaths of women should be reason enough to address the need for safe abortion, but families also suffer. When a mother dies, her children, especially those under 5, are more likely to suffer malnutrition, neglect, and death. As I first wrote more than 25 years ago, history has long shown that politically or religiously motivated laws will never eliminate abortion; they only make it more costly in terms of women’s health, and the health and well-being of their families. The fact of abortion as a public health issue should be the first talking point in any informed conversation led by pro-choice politicians.

Abortion is a matter of fundamental human rights. Every person on earth has the right to determine whether or not to become a parent, and when and with whom to have a child, although clearly too many people are as yet unable to exercise these rights.

Furthermore, the international community has long recognized the broader fundamental human rights of women. According to the 1993 Vienna Declaration on Human Rights:

The human rights of women and of the girl-child are an inalienable, integral and indivisible part of universal human rights. The full and equal participation of women in political, civil, economic, social and cultural life, at the national, regional and international levels, and the eradication of all forms of discrimination on grounds of sex are priority objectives of the international community.

Choice in childbearing, childbirth, and parenting are fundamental to women’s ability to make decisions about their participation in society, on their own terms. Women, however, cannot exercise these fundamental human rights without unfettered access to contraception and abortion. Yet too many governments, politicians, and religious leaders appear willing to abrogate access to these basic health interventions, ironically on the basis of a “pro-life” agenda—albeit one that ignores the value of women’s lives. Any politician who calls themselves pro-choice should understand the need to protect and promote the human rights of living, breathing women, and be able to articulate them.

Abortion is a fundamental economic issue. Access to both contraception and abortion play a major role in women’s economic lives. There have been innumerable academic studies carried out and policy papers written over the past several decades about the connections between access to abortion and women’s economic status throughout the world, and all of them come to the same conclusions: The ability to control reproduction is essential to women’s abilities to support themselves and their families, and is essential to long-term economic growth.

Having a child or children is a major lifetime economic investment for anyone; the U.S. Department of Agriculture has estimated that it now costs more than $245,000 to raise a child in this country, not including the costs of college tuition. A study by the Economic Policy Institute shows that child care alone outpaces the cost of rent in 500 of 618 municipalities examined. Given these and other considerations, such as low wages and the cost of health insurance, transportation, food, clothing, and other necessities, unintended pregnancy can throw a family into economic crisis. Studies show that most women seeking abortion are already struggling financially, cannot afford an additional child, or want to continue their education to create a better future for themselves and their families.

The Turnaway Study, a multi-faceted research project on abortion conducted by researchers at the University of California, San Francisco’s Advancing New Standards in Reproductive Health program, examined the relationship between abortion, reproductive control, and poverty, among other things. As noted in a policy brief by the Reproductive Health Technologies Project about the economics of abortion and women’s lives, the Turnaway Study found that women denied an abortion in the United States had three times greater odds of ending up below the federal poverty line two years later than did women in similar economic circumstances who were able to obtain an abortion, adjusting for any previous differences between the two groups.

Smaller family size and educational attainment are among two of the most critical factors in the economic success of families and communities. Women and their partners know what it means to bring a child into the world and what it takes to raise children, and only they are equipped to make decisions about whether they have the financial and emotional means to make that commitment. Access to abortion is therefore fundamentally about personal and family economics. Abortion is about what women want for their future, and the future of any children now and later.

Access to abortion also has wider social and economic implications. According to the World Health Organization’sSafe abortion care: the public health and human rights rationale:”

Safe abortion is cost saving. The cost to health systems of treating the complications of unsafe abortion is overwhelming, especially in poor countries. The overall average cost per case that governments incur is estimated (in 2006 US dollars) at US$ 114 for Africa and US$ 130 for Latin America. The economic costs of unsafe abortion to a country’s health system, however, go beyond the direct costs of providing post-abortion services. A recent study estimated an annual cost of US$ 23 million for treating minor complications from unsafe abortion at the primary health-care level; US$ 6 billion for treating post-abortion infertility; and US$ 200 million each year for the out-of-pocket expenses of individuals and households in sub-Saharan Africa for the treatment of post-abortion complications. In addition, US$ 930 million is the estimated annual expenditure by individuals and their societies for lost income from death or long-term disability due to chronic health consequences of unsafe abortion.

Unintended pregnancies also have other cost implications. Researchers at the Brookings Institute found that the United States spends $12 billion each year to cover medical care for women who experience unintended pregnancies and on infants who were conceived unintentionally.

In short, it is a fact that providing people with the means needed to make choices in childbearing is economically beneficial at all levels of society. In a country otherwise obsessed with individual economic choices, this should be a clear argument.

Abortion is an individual health issue. Yes, abortion is an individual health issue, related to but separate from its broader role in public health. Anyone who has had—or knows someone who has had—a difficult pregnancy, a miscarriage, an emergency c-section, a stillbirth, or any number of other complications is aware, pregnancy and childbirth can be wonderful and can be life-threatening, and the reality of either is a roll of the dice.

There are any number of contraindications for pregnancy that would result in the need for an abortion and any number of complications that can arise during a pregnancy, threatening the life or health of the pregnant person, the fetus, or both. The potential for very serious complications rises later in pregnancy, or after 20 weeks, the magic number alighted on by anti-choice zealots as somehow being a rational point after which abortion should be banned.

Any number of complications compromising the health of a pregnant person can occur, or fetal anomalies can be found, at or after 20 weeks of pregnancy, potentially causing even the most wanted pregnancy to go awry. Henneberger, now editor in chief at Roll Call, has frequently advocated for 20-week abortion bans, either not understanding or not caring that such a ban would dramatically limit access to medical care for untold numbers of women who face complications. Pelosi should have been able to more forcefully tell her why this is dangerous.

The United States is sliding backward on many fronts, including on access to contraception and abortion, two public health interventions for which the cost-benefit analyses are clear.

Politicians who claim to be pro-choice and raise money from citizens who support public health, human rights, and choice in childbearing must be able to articulate, embrace, and defend their positions. For too long, Democrats have come across as inept and apologetic when talking about abortion, even though the facts are clear and indisputable.

It’s time for this to stop.

News Politics

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

Christine Grimaldi

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Commentary Contraception

Hillary Clinton Played a Critical Role in Making Emergency Contraception More Accessible

Susan Wood

Today, women are able to access emergency contraception, a safe, second-chance option for preventing unintended pregnancy in a timely manner without a prescription. Clinton helped make this happen, and I can tell the story from having watched it unfold.

In the midst of election-year talk and debates about political controversies, we often forget examples of candidates’ past leadership. But we must not overlook the ways in which Hillary Clinton demonstrated her commitment to women’s health before she became the Democratic presidential nominee. In early 2008, I wrote the following article for Rewirewhich has been lightly edited—from my perspective as a former official at the U.S. Food and Drug Administration (FDA) about the critical role that Clinton, then a senator, had played in making the emergency contraception method Plan B available over the counter. She demanded that reproductive health benefits and the best available science drive decisions at the FDA, not politics. She challenged the Bush administration and pushed the Democratic-controlled Senate to protect the FDA’s decision making from political interference in order to help women get access to EC.

Since that time, Plan B and other emergency contraception pills have become fully over the counter with no age or ID requirements. Despite all the controversy, women at risk of unintended pregnancy finally can get timely access to another method of contraception if they need it—such as in cases of condom failure or sexual assault. By 2010, according to National Center for Health Statistics data, 11 percent of all sexually experienced women ages 15 to 44 had ever used EC, compared with only 4 percent in 2002. Indeed, nearly one-quarter of all women ages 20 to 24 had used emergency contraception by 2010.

As I stated in 2008, “All those who benefited from this decision should know it may not have happened were it not for Hillary Clinton.”

Now, there are new emergency contraceptive pills (Ella) available by prescription, women have access to insurance coverage of contraception without cost-sharing, and there is progress in making some regular contraceptive pills available over the counter, without prescription. Yet extreme calls for defunding Planned Parenthood, the costs and lack of coverage of over-the-counter EC, and refusals by some pharmacies to stock emergency contraception clearly demonstrate that politicization of science and limits to our access to contraception remain a serious problem.

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Today, women are able to access emergency contraception, a safe, second chance option for preventing unintended pregnancy in a timely manner without a prescription. Sen. Hillary Clinton (D-NY) helped make this happen, and I can tell the story from having watched it unfold.

Although stories about reproductive health and politicization of science have made headlines recently, stories of how these problems are solved are less often told. On August 31, 2005 I resigned my position as assistant commissioner for women’s health at the Food and Drug Administration (FDA) because the agency was not allowed to make its decisions based on the science or in the best interests of the public’s health. While my resignation was widely covered by the media, it would have been a hollow gesture were there not leaders in Congress who stepped in and demanded more accountability from the FDA.

I have been working to improve health care for women and families in the United States for nearly 20 years. In 2000, I became the director of women’s health for the FDA. I was rather quietly doing my job when the debate began in 2003 over whether or not emergency contraception should be provided over the counter (OTC). As a scientist, I knew the facts showed that this medication, which can be used after a rape or other emergency situations, prevents an unwanted pregnancy. It does not cause an abortion, but can help prevent the need for one. But it only works if used within 72 hours, and sooner is even better. Since it is completely safe, and many women find it impossible to get a doctor’s appointment within two to three days, making emergency contraception available to women without a prescription was simply the right thing to do. As an FDA employee, I knew it should have been a routine approval within the agency.

Plan B emergency contraception is just like birth control pills—it is not the “abortion pill,” RU-486, and most people in the United States don’t think access to safe and effective contraception is controversial. Sadly, in Congress and in the White House, there are many people who do oppose birth control. And although this may surprise you, this false “controversy” not only has affected emergency contraception, but also caused the recent dramatic increase in the cost of birth control pills on college campuses, and limited family planning services across the country.  The reality is that having more options for contraception helps each of us make our own decisions in planning our families and preventing unwanted pregnancies. This is something we can all agree on.

Meanwhile, inside the walls of the FDA in 2003 and 2004, the Bush administration continued to throw roadblocks at efforts to approve emergency contraception over the counter. When this struggle became public, I was struck by the leadership that Hillary Clinton displayed. She used the tools of a U.S. senator and fought ardently to preserve the FDA’s independent scientific decision-making authority. Many other senators and congressmen agreed, but she was the one who took the lead, saying she simply wanted the FDA to be able to make decisions based on its public health mission and on the medical evidence.

When it became clear that FDA scientists would continue to be overruled for non-scientific reasons, I resigned in protest in late 2005. I was interviewed by news media for months and traveled around the country hoping that many would stand up and demand that FDA do its job properly. But, although it can help, all the media in the world can’t make Congress or a president do the right thing.

Sen. Clinton made the difference. The FDA suddenly announced it would approve emergency contraception for use without a prescription for women ages 18 and older—one day before FDA officials were to face a determined Sen. Clinton and her colleague Sen. Murray (D-WA) at a Senate hearing in 2006. No one was more surprised than I was. All those who benefited from this decision should know it may not have happened were it not for Hillary Clinton.

Sometimes these success stories get lost in the “horse-race stories” about political campaigns and the exposes of taxpayer-funded bridges to nowhere, and who said what to whom. This story of emergency contraception at the FDA is just one story of many. Sen. Clinton saw a problem that affected people’s lives. She then stood up to the challenge and worked to solve it.

The challenges we face in health care, our economy, global climate change, and issues of war and peace, need to be tackled with experience, skills and the commitment to using the best available science and evidence to make the best possible policy.  This will benefit us all.

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