The Prochoice Case Against Free Abortion

Access to abortion care is a vital aspect of comprehensive health care for women of reproductive age. Lack of access to abortion services leads to later term abortions that come with an increase in the risk of health complications like unmanageable pain or bleeding. Lack of access also opens the door for disreputable individuals to offer clandestine abortion services, which often lead to dangerous and deadly side effects.

Socioeconomic factors affecting abortion access are exacerbated by state-enacted, targeted regulation of abortion providers, or TRAP laws. TRAP laws are laws passed that apply only to abortion providers, which are often passed under the guise of protecting women’s health, while serving only to reduce the number of freestanding abortion clinics in a state, thus reducing access.

However, the primary and most immediate barrier to abortion care for many women is purely economic: the cost of an abortion. The cost for a surgical abortion in the first trimester ranges from $300 – $950. The cost for a medical abortion very early in pregnancy using an abortifacient like mifepristone costs $300 – $800. The price goes up week-per-week as a pregnancy progresses.

When I was a student working my way through college, taking the minimum student loans, and scraping by each month, raising an extra $600 in just a couple of weeks while still paying the rent and feeding myself would have been almost impossible! I’d have had to pick up extra shifts beyond the 30 hours a week I was already working. I think it would have taken me 5 or 6 weeks to earn the money. If I was diligent and found out I was pregnant at 6 weeks*, by the time I’d raised the money, made an appointment, and traversed the needlessly obligatory waiting period, the pregnancy could have progressed into the second trimester – and the price would have progressed right with it. And so I paint the picture of the unforgiving situation of chasing the cost of an abortion.

Because of this impact that cost chasing has on poor women, some prochoice activists advocate “abortion – free, on demand”. Other reproductive health care professionals advocate for increases and expansion of Medicaid coverage to pay for medically necessary as well as elective abortions for poorer Americans. But I, as a Prochoice activist, cannot fully support these position. To explain, I’ll break this motto up into two parts.

Abortion on demand!

When was the last time you walked into a doctor’s office who you’d never met, shook his or her hand and said “I want you to perform procedure X – which requires sedation, maybe a narcotic prescription, and possibly follow up – on me today.” I highly doubt you’d get what you want without an in-depth consultation at the least. Abortion in the first trimester is a minor procedure. But a patient history, pregnancy testing, and consultation is important for patient wellbeing for even minor procedures. Many states, including mine, have enacted a compulsory waiting period between the first appointment with an abortion care professional and the abortion being performed. However, a 24-hour waiting period may not be necessary (and is certainly not effective) for ensuring patient wellbeing.

Waiting periods are just another barrier. Decisions about patient care should be left to the doctor and the patient, without unwarranted intervention by the government. Compulsory waiting periods without careful consideration of and compensation for the burden such waiting periods would have on women with no childcare arrangements,  lacking private transportation or needing to travel great distances to access an abortion pose an undue burden.

Another aspect of abortions “on demand” is allowing abortion at any stage of pregnancy for any reason. Not many people support this position. The United States Supreme Court ruled in Roe v. Wade that a state’s vested interest in the wellbeing of a fetus cannot override the interests of a pregnant woman until such time the fetus could be viable outside the womb – variably 22 – 24 weeks into pregnancy. Most states criminalize third trimester abortions, with exception for when the life of the mother is in danger. (One marked exception is Maryland, which has no such laws on the books and is home to one of the very few late-term abortion providers in the country.)

Though the antichoice movement would have one believe otherwise, the majority of prochoice activists support restrictions on third trimester abortions with exceptions for serious or life-threatening health circumstances and when lethal fetal anomalies are confirmed.

Abortion – for free?

Health care costs money. Many people disagree with the notion of health care as a civil right. Personally, I reject the philosophy that some lives are worth more than others if they have enough money. In my view, some fundamental level of health care is indeed a civil right. As health care costs money, a threshold exists where the obligation to protect the common wellbeing ends and a personal agenda of wellbeing begins.

There will be an estimated 56.9 million Americans enrolled in Medicaid in 2013**. In most states, Medicaid covers an abortion if it is a medically necessary health care procedure. But the majority abortions are arguably not medically necessary. The question in the case of non-medically indicated health care procedures becomes – who is obligated to fund your life? Is the government supposed to take care of you?

Under the Constitution, our government provides vital services for the indigent and those that cannot care for themselves. This does not mean the government (the people) should pay for laser eye surgery because a Medicaid recipient is burdened by wearing glasses. As another analogy, this also does not mean the government is obligated to pay for tubal ligation or vasectomy. Likewise, an elective, non-medically indicated medical procedure does not fall under the financial obligation of our government (the people) to protect the welfare and national security of our country.

The government does (the people do) , however, pay or free contraception access (and in some cases, tubal ligation sterilization procedures) for Medicaid recipients and other qualified persons. This is because our government (the people) takes advice from the medical industry and the experience of our and other countries, which shows that in the long term it is in our best interest to prevent disease and unintended pregnancy rather than fight the symptoms.

Contraception access and comprehensive sex education prevent unplanned pregnancies. Offering elective abortion for free is not a preventative measure, and does nothing to prevent future unplanned pregnancies. A switch from a curative health care system to a preventative health care system is the single most important step the people (the government) can take toward protecting the common welfare of our country.

Offering abortion for free could have additional indirect consequences. If there is no consequence (cost) for needing an abortion, then there is no incentive for preventing unplanned pregnancy in the first place. Sure, there is always the desire to prevent the more uncomfortable symptoms of pregnancy. But if abortion were free, there would be no issue with pregnancy symptoms, because as soon as a woman found out she was unwelcomely pregnant, she could just jaunt right over, have an abortion within a day or two, and rid herself of the symptoms. Studies have shown money to be an effective incentive for eliciting many good behaviors – good grades and weight management for example. Why should avoiding pregnancy be any different?

Bad behavior with no consequences is no bad behavior at all. Personally, I worked quite well to make sure I never ended up pregnant unexpectedly. Neglecting contraceptive measures, getting pregnant, and then footing the people with your unnecessary medical bill is bad behavior. We should all be tasked with assuming a measure of personal responsibility when it comes to our health care. And when we choose to practice safe (or not) sex, we have accepted not only the protection, but also the risk that our chosen contraception method will fail. This is a calculated risk, one for which we should all be prepared to pay.

*More commonly, women discover they are pregnant at between 6 and 12 weeks.

**U.S. Department of Health and Human Services, “Fiscal Year 2013 Budget in Brief, Strengthening Health and Opportunity for All Americans,” http://www.hhs.gov/budget/fy2013/budget-brief-fy2013.pdf

State-imposed Violence vs Rape Violence

Anti-choice politicians just cannot keep their mouths shut. And I hope their insatiable urge to comment on reproductive issues continues. I want everyone to know just how utterly insulting and horrifically extreme their beliefs about  women’s right to control their bodies really are.

Yet another anti-choice politician, John Koster – a councilman of the state of Washington, has honored Americans with his cogent opinion about women and “the rape thing.”

Wow. And his calling it “the rape thing” is not even the worst part. This dude thinks an abortion that a rape victim chooses of her own free will is “putting more violence onto a woman’s body?” I want to ask this Cro-Magnon, “What would you label state-mandated pregnancy?” Pregnancy can have life-altering consequences. Pregnancy can change a woman’s body forever. Pregnancy may require invasive surgical procedures. Pregnancy can result in death!

So, when a state forces a woman to bear a child against her will, is that not “putting more violence onto a woman’s body?” When a state forces a woman to risk her life and health against her will, is that not state-mandated violence? When a state mandates that a woman be strapped to a table while doctors slice her abdomen open against her will, is it not violence? Is that not state-mandated brutality?

And where does it end? Since an innocent child is his main concern, maybe we should mandate that all Americans register in bone marrow databases. Maybe we should mandate that all Americans donate their organs after death. Maybe we should mandate that any American that is a kidney or liver donor match to a child that is dying, sacrifice their life and health. I mean, the probability of adverse side effects from donation is “so rare,” maybe we should collect blood from everyone!

Strap those healthy Americans to a gurney! It’s their patriotic duty to sacrifice their bodies for innocent children!

Faking #Antichoice

Once again my favorite(?) feminist periodical has failed me. Ms. Magazine came out today

with a blog article railing against a bill recently passed by the Arizona legislature. The bill sitting on notoriously antichoice Governor Jan Brewer’s desk would ban abortion after 20 weeks except in the event of a woman’s imminent death. As if women don’t have enough to worry about, now the Arizona legislature wants to ensure a woman is on her death bed before she can make her own medical decisions about her body. But the editors at Ms. have once again stepped out of the realm of journalism into the funhouse halls of sensationalism.

The Ms. Magazine article “NEWSFLASH: Arizona Law Says Life Starts Before Conception” claims Arizona lawmakers are trying to declare life begins before conception by defining the gestational age of a fetus by the date of a woman’s last menstrual period.

This is the second article in a week Ms. has released that is based on complete hogwash. Gestation is widely measured within the medical community from the date of a woman’s last menstrual period. If you are a woman reading this, just try to remember the last time a doctor asked you, “When did your ovaries last release an egg?”

Human pregnancy comes to full term in 40 weeks starting from the last menstrual period. Just ask WebMD:

Baby: Your baby is still just a glimmer in your eye. Although it’s confusing to think about a pregnancy starting before your child is even conceived, doctors calculate your due date from the beginning of your last cycle since it’s hard to know exactly when conception occurred.

Or ask the Mayo Clinic:

It might seem strange, but you’re not actually pregnant the first week or two of the time allotted to your pregnancy. Yes, you read that correctly!

Conception typically occurs about two weeks after your period begins. To calculate your due date, your health care provider will count ahead 40 weeks from the start of your last period. This means your period is counted as part of your pregnancy — even though you weren’t pregnant at the time.

Even better yet, go ask a freakin’ doctor! Seriously! Call one up!

I am as prochoice as it gets. I’m a clinic escort for goodness sake. But portraying common, medically accepted practice as antichoice subterfuge to make your point reeks of “prolife” deception and is straight up dishonest journalism!

Two Worlds Collide: Abortion Clinic Escort meets Engineer

One comforting aspect of being a clinic escort is the idea that no matter how rude, obnoxious, hateful, or nosy the protesters get, a clinic escort can keep his or her personal identity on the down low. Like an anonymous superhero, I swoop in, throw some elbows, then go home unaccosted. We clinic escorts do our best to not reveal personal attributes while on duty. Details such as name, employer, religious beliefs (or lack thereof) and neighborhood of residence are topics we regularly avoid in the presence of anti-choice extremists. But what does one do when personal anonymity is compromised by the very nature of one’s business association?

Today I escorted at my clinic. It was a normal day. It was kinda cold. I didn’t wear enough clothing so my legs were cold. After about an hour on the beat, I look up and see a man I work with chatting up some of the protesters. I lost it. My fellow escorts were probably quite amused by my evolving measure of shock. I was all, “What’s he doing down here? Is there some event going on? No! He’s just walking through. He’s not with them. Keep walking! Oh, no! He just didn’t. He’s holding a sign!”

It was epic disappointment. I thought he was cool. I thought he was one of the elite and educated. I thought he was respectable! Alas, he is not. All respect – gone in an instant. You are not cool. We will not have beers. We won’t share joyful words at the company holiday party. We will not chat at the company picnic. You will forever be that guy, anti-guy. It’s fine to be anti-choice; but to harass women too? That’s not respect. That’s exactly the opposite.

But another dilemma underlies this situation. Did he tell the other antis he knows me? Did they ask him about our association when he, albeit discretely, acknowledged me? Do they know my name now and where I work? Could they influence him to create bias against me at work? If they know my name, could they find my home, my husband, and my family?

In the age of church sanctioned domestic terrorism, personal safety is paramount. Violent “pro-life” extremists threaten, stalk, and intimidate clinic staff with impunity. They put up “wanted” signs with abortion providers’ faces on them. They start databases listing clinic employees’ names and places of work. They insult and intimidate women at clinic entrances.

And our Congressional leaders turn their heads. Rather than take the opportunity to repudiate violence and commend reproductive responsibility, public figures use their pulpit to shame women and bolster extremists by pandering to the religious right on social issue after social issue. Even leaders who support a woman’s right to control her reproductive life pass up the opportunity to discourse on social causes, labeling them inconsequential compared to economic well-being.

Has my anonymity been compromised? Maybe. Am I mad about it. No. Just disappointed. But most of all, I am pissed off that I even have to worry about it in the first place.

Compassion In Perspective

I woke up today as on so many other days. Face washed. Teeth brushed. Cats fed. Rain forecast. Sun still hidden. Winter wear secured. House left behind in a haze of hot exhaust mixed with the crisp morning air. I drove past the exit for my office; and headed downtown toward the abortion clinic. I am a clinic escort.

As a clinic escort, I absorb the evangelical vitriol of anti-choice harassment so that women who have made the difficult decision to abort are not obliged to absorb that for which they have no more capacity to harbor. It is my purpose for waking before the sun,  the reason I am built of inert bone and catalytic flesh – to transform hate into compassion. I am rarely surprised by the fountain of hate that flows so freely from the mouths of those who purport to worship a god who asks nothing but love.

Misogynistic exhortation is the status quo for the clinic escort. But when the misogyny flows even more freely from the people I aim to shield, I am readily turned about. He told me he didn’t “give a shit about that bitch.” I first thought he spoke of the skulking protester. He didn’t care if she died. He didn’t care if she and that baby died either. He would do it himself.

I could not walk with him.

To feel the hatred flow from the escorted, as I did today, is a stark reminder of why the fight for safe, legal, accessible abortion can never waiver, must not fail. Rather than stigmatize women, society should respect a woman’s sense of autonomy and self-preservation. Women deserve safety, opportunity, love, and respect – not violence, subservience, hatred, and contempt.

Open your eyes. Before you judge, stop and feel the hate. It flows from both directions.