Repro Rights Round-Up

Lots going on this week. Check it out.

Offering Abortion, Rebirth
: A profile of one Arkansas abortion provider who started practicing soon after Roe.

Ayotte v. Planned Parenthood of Northern New England will bring the abortion issue back before the Supreme Court. The case challenges a yet-to-be-applied New Hampshire law that requires 48-hour parental notice for abortion, without a health exception — so if a minor woman has a medical emergency that will, for example, make her sterile or blind but won’t kill her, she cannot have an abortion if her parents haven’t been notified. The second question in the case is whether or not the court can even rule on it, since it hasn’t been applied and therefore hasn’t caused injury to any individual.

While that second question is trickier, the first issue seems pretty clear to me: The Supreme Court already ruled that restrictions on abortion must have a health exception. Let’s see how much the new justice(s) actually value precedent when these cases come up.

File under worst repro rights decision the Bush administration has made in at least the past month: Extended the Global Gag Rule to HIV/AIDS prevention programs. This is one of those things that I read and just feel my heart sink. For the unfamiliar, the Global Gag Rule is a policy instituted by Bush on his first day in office (after being first instituted by Reagon, kept in by Bush I, and removed by Clinton) which bars funding to any organization abroad that (1) mentions abortion as an option for women, (2) provides abortions with its own non-U.S. money, or (3) lobbies its own government for reproductive rights. U.S. money never pays for abortions abroad, and has been legally barred from doing so since 1973. So that’s not the issue. I’ve written about the Gag Rule before, so check out that post for statistics and information on just how harmful the rule is.

And now it’s been extended to any organzation that provides HIV/AIDS relief as well. What the Bush administration seems to be ignoring is the fact that in rural areas and developing nations, there isn’t a hospital, a family planning clinic, and an NGO offering HIV/AIDS information all operated by separate groups in separate buildings. There’s often a single clinic serving an entire population, offering medical treatment, HIV/AIDS information, family planning tools, and reproductive health services. Now that this rule is in place, that clinic either has to refuse to give women information about where they can obtain safe abortions or face having their HIV/AIDS-prevention funding pulled. If clinic workers lobby for reproductive rights in their own country, their AIDS funding is cut. If clinic workers warn women about the dangers of unsafe, self-procured abortions, their AIDS funding is cut.

And what do self-procured abortions look like in developing nations? According to Hilary Fyfe, whose abstinence-based HIV prevention group Family Life Movement in Zambia lost $30,000 in U.S. funding due to Bush’s policies, she sees women procuring abortions by “swallowing pounded glass, pushing sharp needles or other unsafe instruments through their uterus, pushing poisonous substances up their vaginas like cuttings from trees or roots, drinking bleach mixed with glass, or overdosing on malaria pills.” She sees it every day.

Gotta love this “culture of life” — its mighty warriors care all about “life” right up until the moment of birth. Then, go ahead and be killed by preventable and treatable disease, die or main yourself with a botched abortion, or literally rot with an obstetric fistula. It’s personal responsibility after all.


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18 comments for “Repro Rights Round-Up

  1. November 29, 2005 at 12:47 pm

    Ugh. He’s such a fucking wanker. I wish my dream had been true and someone really did steal the President.

  2. Kyra
    November 29, 2005 at 2:14 pm

    Ayotte v. Planned Parenthood scares me. The idea that the law could be changed to force doctors to force their patients to suffer permanant health consequences in order for their pointless idealism of every parent knowing about their daughter’s abortion 48 hours in advance is downright sickening.

    The US Constitution bans cruel and unusual punishment, does it not? How much more cruel and unusual does it get, to dictate that someone must go blind, or become sterile, or suffer kidney failure, so that their parents can know of the treatment 48 hours ahead of time, in order that they have a chance to talk her out of said treatment, or coerce her to forego said treatment? And punishment for what, precisely? Having sex? Wanting to control her own body? Not being responsible and telling her parents sooner that she was having an abortion?

    Doctors forbidden by law to put their patient’s health first. Goddess, make it go away! It hurts!

  3. Dianne
    November 29, 2005 at 3:45 pm

    I’m puzzled by this Ayotte law. It seems in some ways to go beyond even the parental notification laws. Suppose a teenaged girl presents to Planned Parenthood for an abortion. She neglected to tell her parents that she planned to do this, but when her parents find out they immediately say, “Of course, go ahead.” Does she still have to wait 48 hours or is parental consent adequate to allow the procedure to proceed? What if the answer is “Of course she needs an abortion. If she doesn’t get one quickly she’s going to be sterile. Do it now.” Parents, child, and doctor all agree that the abortion should be done and done quickly to preseve her health. Does the law still require a 48 hour waiting period?

  4. Jon C.
    November 29, 2005 at 7:21 pm

    Dianne:

    Does she still have to wait 48 hours or is parental consent adequate to allow the procedure to proceed?

    The statute at issue in Ayotte requires parental notification, not consent, so presumably as soon as she notified her parents she could proceed.

    Jill:

    …so if a minor woman has a medical emergency that will, for example, make her sterile or blind but won’t kill her, she cannot have an abortion if her parents haven’t been notified.

    This is somewhat misleading. There is a judicial exception in the law, meaning that a judge can waive the notice requirement if the minor’s health would be severely impacted. I know that you, and many other no-compromise pro-choicers would argue that that’s insufficient and still an unacceptable burden, but the law does in fact provide a means for a minor to obtain an abortion absent parental notification.

  5. Jon C.
    November 29, 2005 at 7:29 pm

    SCOTUSblog has a comprehensive run-down of the issues in the Ayotte litigation and the arguments both sides will make. Here’s a brief excerpt, although the whole thing is worth reading:

    The statute under review is New Hampshire’s Parental Notification Prior to Abortion Act, which prohibits abortion providers from performing an abortion on an unemancipated minor unless the minor’s parents or guardian have been given at least 48 hours’ notice. There are three exceptions to this rule: no liability will lie if (a) the minor has written confirmation that her parents already know about the abortion; (b) the abortion provider certifies that the abortion is necessary to prevent the minor’s death and that there is insufficient time to provide the required notice; or (c) the minor obtains a court decree authorizing the abortion upon a finding that she is mature and capable of giving consent to the abortion procedure, or that it would be in her best interests not to notify. The Act requires these court proceedings to be confidential, access to the trial and appellate courts to be available to pregnant minors at all times, petitions to be made the courts’ absolute priority, and petitions to be ruled upon within 7 calendar days (appeals are allowed another 7 days).

  6. November 29, 2005 at 7:38 pm

    There is a judicial exception in the law, meaning that a judge can waive the notice requirement if the minor’s health would be severely impacted.

    That doesn’t really get around the medical emergency issue though, does it? Emergency means that the issue needs to be dealt with right away — if she doesn’t have 48 hours to wait for parental notice, she’s probably not going to have 7 calendar days to wait for a court decree.

  7. Abad man
    November 30, 2005 at 5:31 am

    What about other semi-emergency procedures? Can a 17 year old receive an appendectomy without parental consent, not notification but consent? Initially appendicitis is not life threatening, In fact the diagnosis is often uncertain. Left untreated though appendicitis can rapidly threaten the reproductive ability of women with a pelvic abscess, or become life threatening
    .
    Non-life threatening, yet emergent, obstetric conditions are a pretty small group. Pre-eclampsia seems to be a favorite, but that is mostly a problem in the last one to two months of a pregnancy. The rate of successful medical treatment of the condition is high, making the need for any emergent, invasive procedure pretty low. Related question… What percentage of women who want an abortion carry the child to the last two months? I am sure it is not zero but I doubt it is a very high number either. The fetus is also a lot closer to being a person by this time, but lets not muddy the waters by bringing a third party into this no matter how intimately or lethally involved.

    If a woman has a serious medical emergency related to pregnancy, she would most likely get admitted to a hospital, if she were under 18 she would likely need parental consent for most of her medical treatment, except for the abortion.

    What I am trying to say is that during the first 20-30 months of a pregnancy the risk of a non-life threatening, emergent condition with significant health or reproductive risks is exceedingly low. It is however a nice stick to use to beat people about the head and shoulders.

  8. Abad man
    November 30, 2005 at 5:43 am

    Excuse me, that should have been “first 20-30 weeks”

  9. Dianne
    November 30, 2005 at 11:30 am

    The statute under review is New Hampshire’s Parental Notification Prior to Abortion Act, which prohibits abortion providers from performing an abortion on an unemancipated minor unless the minor’s parents or guardian have been given at least 48 hours’ notice.

    This sounds to me like there is a waiting period of 48 hours after the parents have been told, regardless of their consent or lack thereof. That’s a long time to wait in a medical emergency. Quite long enough for gestational diabetes to blind someone or destroy their kidneys or for thrombosis to destroy their veins or lungs. Among other possible complications.

  10. mythago
    November 30, 2005 at 11:45 am

    Actually, b) means that the abortion provider can just say “It was a life-threatening emergency,” and neither judge nor parents need to get involved.

  11. Abad man
    November 30, 2005 at 12:37 pm

    Gestational diabetes will not cause blindness or kill kidneys that quickly. Like regular diabetes it takes years of poorly controlled blood sugar levels for such effects. Embolic blood clots require medical treatment to treat the existing clots, in addition to being a life threatening medical condition. Furthermore, are you suggesting the clots come from a pregnancy induced hyper-coaguable state, (odds like winning the lottery in a bad way) or from venous stasis due to pressure from the baby (much more likely and again a late pregnancy compliction)? Abortion would not treat the existing problem with blood clots and medical anti-coagulation would be the first line in treatment while a diagnosis was made. I doubt abortion would be an initial treatment option.
    Again someone sick enough to suffer serious damage within 48 hours needs hospitalization. It would be malpractice for an abortion clinic (outpatient care) to preform a procedure on someone with uncontrolled blood sugars or untreated blood clots. If physicians in the hospital (inpatient care) deemed an abortion a medical neccessity implying that 48 hours would be allowed to pass is absurd, also probably malpractice.

    The law would not affect true medical emergencies which the woman would be treated as inpatient vs. conditions allowing treatment from home and an abortion in an outpatient clinic. I think you want to use medical emergencies to justify the use of any medical condition as a reason for exemption.

  12. Dianne
    November 30, 2005 at 3:07 pm

    Can a 17 year old receive an appendectomy without parental consent, not notification but consent?

    Yes. In a heartbeat. You don’t wait on appys unless there is a strong medical contraindication. In fact, if the parents were there and refused consent, the 17 year old would probably become a ward of the court for the purposes of undergoing the procedure. It’s been established in court that a parent does not have the right to deny a child life saving treatment.

  13. Dianne
    November 30, 2005 at 3:23 pm

    What percentage of women who want an abortion carry the child to the last two months?

    I can’t prove this, but I suspect the answer is practically none. Only about 1.4% of abortions occur after 21 weeks gestation (ie in the last four months of pregnancy) and the vast majority of those are done because of fetal abnormalities or risk to the mother’s life. In fact, if you could find a way of preventing these third trimester abortions by making them unnecessary (ie correcting fetal abnormailites, making pregnancy and delivery absolutely safe), you could then ban third trimester abortion and annoy, inconvenience, or endanger practically no one.

    What I am trying to say is that during the first 20-30 months of a pregnancy the risk of a non-life threatening, emergent condition with significant health or reproductive risks is exceedingly low.

    I suppose that depends on your definition of “exceedingly low.” Preclampsia can occur any time during pregnancy, as can anticardiolipin antibodies, HELLP syndrome, gestational diabetes, hypertension, hyperemesis gravidum, and others. Ectopic pregnancy isn’t initially a life threatening emergency, but treating it before it becomes one seems like a better idea than waiting until it is.

    Consider the question in another way. Suppose there were a law that no procedure could be done on the male reproductive system in a boy under 18 until 48 hours after his parents were notified unless the condition was life threatening. Suppose then a 17 year old presented with testicular torsion (one testical twisted, blocking its blood supply and causing great pain and, if it is not treated promptly, loss of that testicle…but not death, at least not initially). Would you support a 48 hour waiting period or a 7 day judicial bypass in this case? Remember, if the problem is not corrected promptly, the patient will be in great pain for those 48 hours and will lose the testicle, possibly leading to fertility problems, whereas if it is corrected quickly, he should recover completely and have normal fertility. How is this situation different from that of a 17 year old girl with an ectopic pregnancy that has not yet burst?

  14. Dianne
    November 30, 2005 at 3:32 pm

    The law would not affect true medical emergencies which the woman would be treated as inpatient vs. conditions allowing treatment from home and an abortion in an outpatient clinic.

    The law makes no distinction between outpatient and inpatient treatment. As you point out, anyone that sick needs to be hospitalized, but with the law as it is written, the hospital has no more legal right to do the abortion without the 48 hour waiting period than an outpatient clinic would, unless they can justify it as a life-threatening situation. Not health, limb, or fertility threatening, life threatening only.

  15. zuzu
    November 30, 2005 at 3:32 pm

    the first 20-30 months of a pregnancy

    I think you mean weeks, not months. Unless you’re talking elephants.

  16. Abad man
    December 1, 2005 at 12:40 am

    Lets look at this again

    gestatioinal diabetes – not immediately life threatening easily corrected/controlled with medications, in mild form often untreated

    pre-eclampsia/HELPP- almost unheard of prior to 20 weeks, generally occurs in last two months if severe or HELPP then life threatning, milder forms can be managed medically

    Hypertension- if rapidly or even slowly fatal not many people over 50 would be walking around… treatable

    anticardiolipen antiblody- If found treatable, when found treated with anticoagulants (blood thinners). if presenting with stroke or other embolic event…. well the abortion will not fix that. It would probably be a good idea to take a couple of days and try to fix the damage from the embolic event before preforming the abortion though.

    Hyperemesis gravidum- translation – severe morning sickness and also treatable.

    ectopic pregnancy- not considered an abortion. The ectopioc fetus has no chance of developing. ectopic pregnancy is considered a medical emergency like a torsed testicle. in fact a minor’s parent would probably have to sign a consent form for a procedure to treat an ectopic pregnancy as apposed ot an abortion.

    The picture you paint of suffering pregnant mother forced to lie an wait 48 hours before receiving the cure all treatment of an abrtion is not very honest.

    Pre-eclampsia/HELPP is a serious life threatening condition requiring an emergent delivery/abortion to correct the problem. It falls prettily easily under the law as written. I do not think abortion is the primary teratmant for any of the other conditions you have listed.

    Assuming there is a non-life threatening condition, that will still affect reproductive ability, limb, or eysight, which cannot be treated other than by emergent abortion, well that is a pretty hard assumption to defend, except for saying anything is possible.

    Now add to that assumption that doctors and nurses are going to sit around and let someone lose their reproductive ability, limb or eyesight, while they wait 48 hours. (Oh yeah lets not forget that they do not treat any pain that goes aong with the condition.) This assumtion requires the worst intentions of everyone invloved.

    Tell me health care providers will do that because of stupidity, laxziness, or greed and I would probably believe you. Tell me blind obedience to a law? i do not think so. Like everyone else doctors and nurses spend considerable energy figuring out ways to avoid or ignore laws they do not like.

    To specifically talk to the torsed testicle situation. I would expect the condition to get treated. With the exception of pre-eclampsia abortion would not be a initial treatment for any of them. Feel free to disagree, we can argue how many stars are in the sky next.

    We are arguing from two different ponts of view, I assume the best intentions toward the woman/minor/girl, you assume the worst. We can sit and bounce around medical terms and probabliities all day.
    Is there a possibility bad things could happen under the current law? Yes

    Is it possible bad things could happen with no law? Yes.

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