When does life begin?

I was enjoying a visit from my sister and brother-in-law a while back when I was asked a very interesting and enlightening question. You see, I’ve been through a life changing event. Last year, in a feat of strength, I conceived. And nine months later, I had a baby. It was an amazing, life-changing event.

And so, while sitting on the couch taking in the breath, feel and sound of a newly born human, my brother asked me, “So, now that you’ve had a baby, when do you think life begins?” When he asked me this question, I was deep in the thrall of sleep deprivation, and didn’t really realize where the question was coming from. I think my response was something on the lines of, “What? I don’t know.”

I assume he asked me this in light of my political history. If you know me or have read this blog at all, you know I am pro-choice – staunchly so. I’ve written many blog posts supporting a woman’s right to chose if and when to have a child. I’ve also been an abortion clinic escort for many years. And so I can only assume my brother wondered whether, having experienced pregnancy and childbirth, my views on reproductive matters had changed.

So, when does life begin?

At conception? At implantation? At 12 weeks? 20 weeks? At quickening? At viability? When you’re born? When you start to remember things? Maybe. It is such a subjective question. There is no right answer.

But the thing is, for me, being pregnant only more keenly highlighted the importance of self determination. Until you’ve been pregnant, you haven’t actually faced the possibility that, under different circumstances, someone else could control your health outcome and even whether you live or die. Being pregnant made me even more grateful that if I had to make a choice about my pregnancy it would be MY decision – not some priest’s or politician’s or some health board’s decision. If I chose to sacrifice my health for the sake of the baby it would be my decision. I was in control of my own body.

So does the moment life begins matter to me? Sure it does. I mean, I AM alive. But the moment life begins cannot bring back the any of the millions of women killed by illegal abortion. The moment life begins cannot put food into the mouths of a poor family. The moment life begins cannot make a woman’s teeth grow back. And the moment life begins doesn’t make me willing to relinquish control of my body and my life for the sake of another.

I am a mother. I am pro-child. I am pro-family. And I am pro-choice.

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

Why is Preventative Medicine Only Wrong When Abortion is the Subject?

A great article by Caperton on Feministe raises the oft controversial subject (among abortion rights activists, that is) about whether discussing abortion as a medical procedure that should be rare is appropriate. Caperton takes the position that, as is the case for angioplasty, preventative medicine should make the demand for abortion lower. Caperton argues, and I agree:

“So yes, we should want abortion to be rare–not because there’s anything wrong with it as a procedure, or because it’s horrific or universally traumatizing, but because we’d generally rather not have to pay money and undergo minimally invasive medical procedures if we can avoid them. Um, hi.”

Yeah, um, hello. Medical intervention should be a rarer occurrence. Americans have come to rely too much on getting a pill or a simple operation to cure all the ills they did themselves over the course of their lives. Preventable, medical intervention costs the U.S. billions of dollars every year. Effective preventative medicine saves money and lightens burden on our health care system.

The fact that abortion is the topic of this particular preventative medicine debate doesn’t change the math. Tiptoeing around abortion and the desire to reduce the number of abortions needed due to fear of negative publicity has more of a negative impact that addressing abortion as you would address any other preventable medical procedure. The simple fact is, the majority of unwanted pregnancy is preventable. If we change the way our society views a woman’s right to control her reproductive life and her general health, we benefit her, her children and our society economically and socially.

It’s not always the protesters

Relatively, I spend a lot of time at a women’s reproductive health clinic. I’m a clinic escort (read, body guard) for abortion patients, so that’s not surprising. As such, I am witness to the emotions of a wide variety of people to the anti-choice protests happening outside the clinic. I am not just talking about the patients’ reactions. I see the reactions of passersby male and female, patients, boyfriends, girlfriends, parents, the negative reactions, the positive reactions – they span the gamut.

For some of our patients, the presence of protesters (and the often cruel things they say) raises an unexpected swell of emotions. I have seen anger and tears, as well as more positive reactions. I had a woman who’d just wrapped up an appointment break down in tears once. I took the time to let her vent her emotions to me. She was just so upset that they were there. She couldn’t understand how someone could stand out there and say such mean things to people they didn’t even know.

But not every emotional scene is a reaction to the protesters. The fact is, abortion can be a very difficult decision for some women. Considering one’s options during a pregnancy can be a very convoluted process. And quite often, people are apprehensive and unsure even after they’ve shown up for their appointment.

A woman broke down in tears in front of me once. But her distress was not caused by the protesters. She was just unsure if an abortion was what she wanted. We quickly ushered her inside (away from the mayhem) and started a mini-counseling session. Our leader assured her that no one would force or pressure her to do anything, that she could sit in the lobby as long as she needed, and that she should ask to speak to a counselor who can help her figure out what she really wants and can give her additional resources to help her with whatever she chose to do.

Seeing the outburst, one of my fellow escorts immediately blamed the protesters for causing her pain. I tried to convince her the protesters had nothing to do with the situation, but she wouldn’t hear it.

For most of the women I have helped get access to abortion over the years, abortion was a positive, relieving experience. But it’s important to acknowledge that getting an abortion isn’t always a positive experience. Not every woman chooses to have an abortion. Many times the procedure is unwelcome and unwanted, but necessary. And for some women, the process of making the decision about abortion is marked by fear, inner conflict, or apprehension.

I think it’s sometimes easier to blame the protesters for upsetting people rather than acknowledge the complexity of the subject. Sensitivity isn’t actually the best face to don when you are dealing with taunting and harassment from protesters. But it is vital we maintain an unprejudiced perception of the triggers to emotional scenes such as this. Sometimes the causes are not as simple as we want to believe.