Wednesday, August 09, 2017

Blueprint For America: Abortion


Abortion has long been a hot button issue and has sometimes been referred to as a “third rail” in politics. On the one side are the pro-choice activists who fight to maintain a woman’s right to choose. On the other side are the anti-choice groups whose goal is to restrict (or entirely eliminate) abortion. Neither group is wholly in the right, and neither group is wholly in the wrong ... although, full disclosure, this author is strongly pro-choice.

In fact, both groups have some common goals. It’s just a matter of getting them to stop screaming at each other long enough to discover this common ground.

Both sides are guilty of misrepresenting the positions of the other. For example, anti-choice groups often refer to pro-choice people as being “pro-abortion.” This is false. Nobody, and I mean nobody, is “pro-abortion.” The pro-choice movement is about just that: the right to have a choice in the matter. Pro-choice groups never advocate for a specific choice, only that the choice be allowed to exist. In fact, many (if not all) pro-choice activists are fully in favor of anti-choice activists being able to counsel women and offer alternatives to abortion; the point on which they disagree is whether or not this requires legislative interference.

On the other side of the coin, some pro-choice activists paint anti-choice activists as religious zealots, caught up in their own dogma and completely lacking any compassion. In the vast majority of cases, this is a patently false characterization. Yes, for many anti-choice folks their views are rooted in their religious beliefs, but there are anti-choice activists who are atheists ... just as there are Christian pro-choice activists.

The problem is that both groups talk at each other instead of to each other, and as a result the divide between the two grows ever wider. The fact of the matter is that both groups can work together to reduce the number of abortions without having to resort to onerous, possibly unconstitutional, legislation.

In order to do this, however, we need to have a clear understanding of:
  • What abortion is, exactly, and how prevalent are abortions in terms of the various stages of fetal development.
  • The number of abortions performed per year in the United States.
  • How policy and culture affect abortion.
We must also discuss any pending legislation designed to address this issue ... but more on this later.

What is an abortion?

First, we address the question of what abortion is. Granted, on the surface it’s an easy question to answer: abortion is the removal of the fetus from the womb of a woman, after which the fetus does not survive. The more correct general term is “termination of pregnancy.”

There are several methods used to perform an abortion1. The first is what is known as the aspiration method, otherwise known as “suction aspiration,” “suction curettage,” or “vacuum aspiration.” This process involves a local anaesthetic applied to the cervix, which is then artificially dilated. The doctor then uses a long plastic tube connected to a suction device, called a cannula, to suction out the fetus and placenta. This procedure usually is completed within ten to fifteen minutes, but recovery can take several hours.

Common side effects of this method include cramping, nausea, sweating, and lightheadedness. Less common effects can include blood clots, damage to the cervix or uterus, or heavy or prolonged bleeding. This procedure is used during the first six to sixteen weeks of gestation.

Another common procedure, dilation and evacuation, is used for fetuses after 16 weeks of development. In this procedure, the physician places an artificial dilator (called a “laminaria”) into the cervix 24 hours prior to the procedure. On the day of the procedure, the doctor will again numb the cervix using a local anaesthetic, and a shot may be given to ensure fetal death. A cannula is used to remove fetal tissue from the uterine lining, and a curette (a metal tool shaped like a scoop or a spoon) is used to scrape the uterine walls to remove any residual tissue. The final step is to use suctioning to make sure everything is completely removed.

This procedure takes 15-30 minutes. Common side effects include cramping, nausea, and bleeding, which may last for up to two weeks after the procedure.

The third, and most invasive, procedure is called “dilation and extraction.” This is also known as “Intact D & X” or “partial birth abortion” (although, to be technical about it, this designation is incorrect in that the fetus is never actually born). During this procedure, the physician inserts the laminaria into the cervix 48 hours before the procedure. This causes the water to break on the third day, at which point the woman returns to the clinic to have the procedure performed. During the procedure, forceps are used to rotate the fetus and pull the body feet-first through the birth canal.

At that point a small incision is made at the base of the skull of the fetus, and a suction catheter is used to suck out cerebral material. This causes the skull to collapse, at which point the fetus is completely removed.

The physical side effects of this procedure are the same as dilation and evacuation. However, there is an increased risk of emotional side effects due to the advanced stage of fetal development.

It makes perfect sense that these procedures become more complicated as the pregnancy progresses, and the actual procedures may sound hideous and barbaric to some. However, it is this very barbarity, as well as the potential side effects, which gives many women pause to begin with. Ironically, this is at the root of arguments on both sides. Anti-choice activists argue that such measures run counter to cultural norms and violate religious principles. Pro-choice groups maintain that the side effects, as well as the gruesomeness of later term abortions, act as a deterrent to many abortions on their own, and legislation is, among other things, redundant.

Anti-choice groups tend to bandy the term “partial birth abortion” about as if it is an epidemic. The numbers, however, tell a much different story.

According to the Centers for Disease Control, there were an average of 535,795 abortions performed per year in 32 states from 1999 through 20082. Of these, only 7,825, or 1.46%, were performed during or after 21 weeks of fetal development. A majority of them -- 329,571, or 61.49% -- were performed prior to eight weeks of fetal development, and an overwhelming majority -- 489,023, or 91.24% -- were performed at or before 13 weeks of fetal development.

Given such low numbers for abortions performed after 20 weeks of development, why, then, does the anti-choice movement repeatedly treat these procedures as commonplace?

Part of it is optics. A fetus at six weeks of development is roughly the size of a lentil, has a tail, has no recognizable face or limbs (although paddle-shaped protuberances appear where the arms and legs will eventually be), and the intestines and brain are just starting to develop. There is no skeleton yet; cartilaginous tissue is starting to form where the skeleton will be. In short, a six week old fetus doesn’t look human -- if anything, it looks more like a tadpole.

A fetus at 20 weeks, however, looks like a baby (even though it is only the size of a banana and weighs about ten ounces). It is sucking its thumb. It is producing meconium (the dark stuff that he or she will pass as the first bowel movement). It is able to swallow, and hear the mother’s voice, and sense light. It is able to move of its own volition, kicking against the uterine wall (these feel like little flutters, given the tiny size of the fetus).

The fetus is way more photogenic at this point, and thus makes it much easier for the more radical anti-choice activists to justify the phrase “baby killer.” However, and it is important to note this, the fetus is still not viable -- able to survive on its own outside of the womb (this does not happen until about about 24 weeks, but with significant medical intervention). Development has not completed in that there is no subcutaneous fat yet (25 weeks), the skin is still translucent. True viability (able to survive outside the womb without medical intervention) does not occur until about 36 or 37 weeks.

So the next question then becomes ...

How many abortions are performed per year in the U.S.?

This is a little difficult to nail down, as there are many variables that come into play: age of the woman, stage of fetal development, availability of services, state laws concerning abortion, income levels, race, ethnicity, marital status ... the list goes on.

However, once we start diving into the statistics, we see that the plurality of abortions are sought by women ages 20 to 24, at 33.6%, and the smallest number are sought by young women up to the age of 173. We also find that, in terms of marital status, women who have never been married make up the largest group at 45.8%, followed by unmarried women living with their male partner (31%), married women (14.4%), and women who have been married previously (8.8%).

White women make up the largest segment when looking at ethnicity (39%), followed by African-American women (24.8%), and Hispanic women (24.5%). Asian/Pacific Islander, multi-racial, and women classified as “other” (due to a lack of response, or not being a member of any of the other groups) make up the remaining 11.7%.

Contrary to what some would believe, there really isn’t a direct correlation between education and abortion. Popular perception would imply that the less educated a woman is, the more likely she is to seek an abortion for an unintended pregnancy, but the numbers do not bear this out. In fact, the group most likely to seek an abortion actually consists of women who have some college education or an associate’s degree (39.2%), followed by high school graduates or women who hold a GED (20%), college graduates (19.7%), and women with less than a high school degree (12.2%).

Similarly, anti-choice groups tend to portray women seeking abortions as being in unstable situations ... but again, the numbers tell the opposite story. Among women who experience “disruptive events,”4 the number of abortions goes down as the number of disruptive events rises. 44.8% of abortions performed were sought by women who had experienced no disruptive events, 32.2% by women who had experienced one, 12.8% by women who had experienced two, and 10.2% by women who had experienced three or more.

Anti-choice groups often charge that abortion is used as a form of birth control, and that this approach encourages promiscuity. After all, if a woman can simply abort the fetus, the reasoning goes, then there is nothing stopping a woman from going on a sexual walkabout (the part of me that is still a vigorously heterosexual teenager responds to this statement by saying “Yippee” ... but the part of me that is still a vigorously heterosexual teenager is kind of a jerk, and it’s not really relevant anyway). However, the statistics do not point to any defined pattern in this area. While the largest segment of women seeking abortions have had both prior pregnancies and prior abortions at 33.1%, this is closely followed by women who have had neither at 29.2%. Women who have already given birth but have never had an abortion previously make up 26.0%, with women who have only had previous abortions falling far behind at 11.7%.

So what do all these numbers mean? Quite simply, they do not point to any large trend upon which either side of the debate can use to bolster their position. Not surprisingly, views on abortion tend to fall along party lines as a result: 34% of Republicans believe abortion should be legal in most or all cases, compared with 79% of Democrats5. What is surprising, however, is that, when party politics are taken out of the equation, we find that nearly 6 in 10 Americans (59%) support the idea that abortion should be legal in most or all cases. In addition, 69% of Americans of both parties say that Roe v. Wade should not be overturned, with this cohort consisting of 84% of all Democrats and 53% of all Republicans. In fact, among all the demographics splits, only when this question is asked of conservative Republicans does a clear majority support overturning this decision. All other groups -- including moderate Republicans, breakdowns by age, gender, education and religion -- show a clear majority opposed to overturning Roe v. Wade.

Which begs the question: why are legislators at the state and local level so determined to go against the very clear will of their constituents? We will address this later. For now, we turn to how policy and culture affect abortion rates.

Policy and Culture

It is not surprising that states with Republican majorities and/or governors tend to have the most restrictions in place concerning abortion. For example, in Oklahoma a woman seeking an abortion:
  • Must receive state-directed counseling intended to discourage her from having an abortion.
  • Must wait 72 hours after this counseling.
  • Cannot receive services covered by health insurance unless a separate rider for abortion services is purchased at extra cost.
  • Is not allowed to use telemedicine when receiving a medical (using medication, as opposed to surgical) abortion.
  • Must undergo an ultrasound.
  • Cannot obtain an abortion after 20 weeks of fetal development (22 weeks after the woman’s last menstrual period) only if her life or physical well-being is in danger as a result of the pregnancy.

Mississippi has similar restrictions, but with the added proviso that abortion is automatically banned entirely if Roe v. Wade is overturned.

Compare this to California, which has essentially no legal restriction on abortions (the only restrictions placed on a woman are those imposed by her physician), or New York, in which the only restriction is that any abortion performed after 24 weeks of fetal development (26 weeks from the last menstrual period) is permissible only to preserve the life and/or physical health of the mother.

In addition to these existing restrictions, some states are seeking to impose more -- and tougher -- limitations. For example, in Oklahoma, State Representative Justin Humphrey has sponsored HB 1441 which has, among its other provisions, a requirement that the mother “... provide, in writing, the identity of the father of the fetus to the physician who is to perform or induce the abortion.”

Abortion rights groups cite this as being extremely paternalistic, bordering on misogynistic. This perception is bolstered by a statement made by Rep. Humphrey, when he said “I understand that they feel like that is their body ... I feel like it is a separate — what I call them is, is you’re a ‘host.’ And you know when you enter into a relationship you’re going to be that host and so, you know, if you pre-know that then take all precautions and don’t get pregnant.”

By and large, opposition to abortion does tend toward the paternalistic. From the overt paternalism evinced by Rep. Humphrey’s statement, to more subtle variations (requiring an ultrasound and a waiting period, etc.), the basic guiding principle of the anti-choice movement appears to be that women are not capable of making these decisions on their own, and therefore need guidance. Many anti-choice groups publicize these measures as “a woman’s right to know,” despite assurances from many pro-choice groups, women’s groups, and civil liberties organizations that, with very few exceptions, women already know what’s happening and what the potential risks and rewards of any course of action already are.

So, what now?

There are a number of points to consider here. For many on the right, this is a closed question: abortion  is wrong, it is murder, and it should be made illegal. For those on the left, abortion is a medical choice that is made by a woman and her physician, and everyone else just needs to butt out.

So let’s consider these points, from the standpoint of a pro-choice advocate ... aka, me. I figure since I’m the one writing this thing, I should be able to promote my views, right?

POINT #1: ABORTION IS A MEDICAL PROCEDURE.

The only people who should be involved in this decision are the woman, her doctor, and anyone else she deems worthy enough to participate in this matter. Nobody else should be able to impose their will on the situation, especially a bunch of middle-aged guys in government.

Despite this, Republicans in Congress are considering H. R. 490, the Heartbeat Protection Act of 2017, introduced by Steve King (R-IA) and co-sponsored by Trent Franks (R-AZ). This bill amends Title 18, Chapter 74 of the U. S. Code by adding, in part:

Ҥ 1532. Abortions prohibited without a check for fetal heartbeat, or if a fetal heartbeat is detectable

(a) Offense.—Any physician who knowingly performs an abortion and thereby kills a human fetus—
(1) without determining, according to standard medical practice, whether the fetus has a detectable heartbeat;
(2) without informing the mother of the results of that determination; or
(3) after determining, according to standard medical practice, that the fetus has a detectable heartbeat,

shall be fined under this title or imprisoned not more than 5 years, or both.”

This is absurd. Not for nothing, but in many cases the fetal heartbeat is at a level that it can be detected before the woman is even aware she is pregnant, which means this bill essentially bans abortion. Period.

In addition to this, there is the matter of the exceptions. True, it makes exceptions for the life and health of the mother. However, these come after the fact. In other words, a physician must wait for an indictment to come down, at which point he or she may appeal to the State Medical Board ... and then this only delays the trial for up to 30 days.

In other words, this bill takes the Constitutional notion of “innocent until proven guilty” and chucks it right out the window by assuming the practitioner is guilty and putting the burden of proving innocence on that same practitioner.

It’s nonsense like this that slows the progress of the pro-choice movement ... and this is intentional. Anti-choice activists are not really interested in the health of the mother, or the continued life of the fetus (if they were, then there would be a lot more resources dedicated to improving the lot of unwanted children after they are born ... but I digress). What they are interested in is a) imposing their particular moral code on the rest of the country, regardless of whether or not it fits the beliefs of everyone else, and b) maintaining the patriarchy that believes that women are just silly, empty-headed creatures, incapable of independent thought, the poor ducklings, so it is up to all the big, strong men to protect them and tell them what they need to do.

Look, the right of a woman to choose how she handles her own pregnancy is inviolable, in much the same way that she has the right to refuse further treatment for ovarian cancer, or to get a second opinion when told she has heart disease or diabetes or gout or any number of other maladies. It is a medical decision, and as such it should have the same doctor-patient confidentiality protections as any other medical procedure. This is a basic issue of individual privacy, which was settled by the Supreme Court in Griswold v. Connecticut in 1965.

POINT #2: THERE ARE TOO MANY ABORTIONS.

I agree with the anti-choice movement on one point: the number of abortions is too high, and we need to bring that number down. Where we differ is in how we would do that. The anti-choice movement seems to think that, if abortion is made illegal, then they will just go away. This is so far from the truth that it’s barely visible on the horizon. What will actually happen is that women will continue to have abortions, but in much less safe conditions.

There is a website called abort73.com which has a lot of anti-choice propaganda. One of the statistics cited was that “[t]he Centers for Disease Control (CDC) tells us that ‘from 1970 through 1982, the reported number of legal abortions in the United States increased every year.’" This comes from a study in which the CDC tracked the number of legal abortions. What the abort73.com web site fails to mention, however, is that this same study showed that “[f]rom 1990 through 1995, the number of abortions declined each year; in 1996, the number increased slightly, but in 1997, it declined to its lowest level since 1978.” Of course, being an anti-choice site, this didn’t square with their propaganda so they left it out.

The truth? The abortion rate has been steadily falling from a high of 29.3 abortions performed per 1,000 women aged 15 to 44 in 1978 to 14.6 in 2014. By comparison, the rate in 1973, when Roe v. Wade was passed, was 16.36. This doesn’t stop the anti-choice movement from trying to spin things their way, sometimes being very ... flexible ... with their understanding of what the truth is.

For example, a document published by Georgia Right To Life appears to run counter to the above statistics when it states that “In 1996, 1,365,730 abortions were recorded, an increase of well over 100% since 1973, when the annual figure was 615,831, according to the U.S. Department of Health and Human Services.” Of course, these numbers are false. According to the CDC report cited earlier by this same web site, the number of abortions in 1996 was 1,221,585, or a rate of 314 abortions per 1,000 live births. Of these, 98.5% occurred before 20 weeks of gestation, and 88.2% occurred before 12 weeks of gestation.

It becomes clear, when looking at these statistics, that all the screaming on the right about “partial birth abortion” (which, technically, doesn’t exist ... see earlier description of abortion procedures) is just so much histrionics intended to get their base fired up. The vast majority of abortions are performed before 12 weeks of gestation, and almost all of them are performed prior to 20 weeks of gestation.

The much more important number, however, is the number of deaths caused by abortions. In 1972, the first year for which statistics are available, the case-fatality rate was 4.1 deaths per 100,000 abortions performed. By 1992, that rate had dropped to 0.7 deaths per 100,000 abortions. Furthermore, the absolute number of deaths from legal and illegal abortions in 1972 was 63, whereas in 1992 it was ten7.

Given these numbers, it becomes clear that the anti-choice crowd is not really interested in women’s health. If they were, they would be trumpeting these numbers from the highest rooftops as a victory, while maintaining that there is still work to do. Yet their focus is, instead, on criminalizing abortion again, even though the statistics bear out the idea that doing so will result in higher mortality rates.

Women are going to get abortions regardless. The idea is to reduce the number of unwanted pregnancies, thus reducing the overall need for abortions. But more on this later ...

POINT #3: THE AVAILABILITY OF A CHOICE DOES NOT AUTOMATICALLY IMPLY THE RESULT.

The anti-choice movement assumes that, just because a woman has a right to choose to terminate a pregnancy, then she will automatically do so. Not only is this a ridiculous assertion, it is insulting to women in that it assumes they are nothing more than compliant sheep, incapable of making decisions on their own and needing patriarchal guidance.

It even comes up in the arguments presented by the right. “What if your mother had chosen to abort YOU?” is a favorite question leveled at pro-choice activists, despite the obvious irony inherent in that question. The answer, of course, is at a) if she had, I certainly wouldn’t even be aware of it, much less have a problem with it, and b) it was her CHOICE.

Just because a choice is available, that does not automatically mean that the choice will be made. For example, I apparently have a Constitutional right to own a firearm (I really don’t, but that’s a topic for another chapter entirely). However, I refuse to have one. Just because I have the CHOICE to have a gun does not automatically imply that I will avail myself of that choice.

It’s the same with abortion. Look, if anti-choice groups want to counsel women to not abort their babies, as long as they are compassionate about it and don’t resort to intimidation or guilt tactics, then I support these efforts 100%. The official pro-choice stance, in my mind, is that abortions should be legal, and that we should do everything in our power to make them unnecessary. Which brings us to the fourth point.

POINT 4: SEX EDUCATION AND ADOPTION.

It is extremely interesting that the same groups that so piously champion "the rights of the unborn" are also the same groups that refuse to consider anything that might prevent these unwanted pregnancies in the first place, or that oppose help for these women after the children are born. Many of these groups base their ideology in religion, more specifically evangelical Christianity. Unfortunately for women, this same ideology holds that birth control is immoral, as is sex education.

This gives us a population of women who are ill-informed about sex, who aren’t really clear on how and when women become pregnant, or on how pregnancy can be prevented. Anti-choice groups seem to think that they can shriek “Abstinence!” then brush off their hands and walk away, smugly praising themselves for a job well done.

There are so many problems with this approach it’s hard to know where to begin.

First, the idea that teens are too young and impressionable to handle sex education is ludicrous. Teenagers are smart people, and their minds are like sponges, absorbing volumes of information each day. Granted, they often make stupid choices (I, for one, used to climb all the way around the outside of my friend’s pickup truck as it was going down the road), but giving them accurate information on contraception can only help the situation.

Contrary to what the right would have us believe, sex education does not encourage teens to engage in sexual behaviors; their bodies -- and a tsunami of hormones -- handle that task just fine, thank you very much. However, sex education has been shown to reduce the number of teen pregnancies significantly, as well as the transmission of sexually transmitted diseases.

And as far as this “abstinence only” thing? It doesn’t work. Anti-choicers are trying to use a moral code going back a couple thousand years to stifle a fundamental biological urge going back MILLIONS of years. The urge to have sex -- to procreate -- is a basic drive; it is actually (in the biological sense) the very reason for our existence. We are here to further the species, period. Full stop. Everything else is just so much frosting on that cake. Trying to curb teen pregnancy by demanding abstinence ... well, it’s just not realistic.

Let’s say that a teenager has gone through a program of sex education, and practices safe sex, and is responsible with her partners, and does everything right, and she gets pregnant anyway. It happens. No birth control is 100% effective (well, abstinence is 100% effective when used correctly, but again, it’s not realistic), and accidents do happen. The condom breaks, or the birth control pill was not dosed correctly, or any number of other factors, and now there’s a baby on the way.

Let us further suppose that the National Right To Life or a similar organization has counseled this young woman in a thoughtful, compassionate manner. They presented her with the available options, including abortion, then made their case without resorting to scare tactics or trying to shame her, and she decided to carry the baby to term. However, she doesn’t want to keep the child, recognizing that she is not at all ready -- emotionally or financially -- to be a mother. What then?

The obvious answer is adoption. It is a wonderful way to do what is best for everyone. The mother, even though it is heartbreaking for her to give up the baby, can be assured that the child will be placed in a stable home with loving parents, which will give this child a strong start in life. Yet evangelical groups often refuse to provide any assistance here -- basically, they are only concerned with this child up until the moment of birth; anything after that is someone else’s problem.

If the anti-choice groups want to truly be “pro-life,” as they say they are, then they need to step up to the plate and actually promote life, not just birth. Again, given the religious affiliation of many groups, they are in an especially strong position to provide these services.

POINT 5: RAPE, INCEST AND MATERNAL AND FETAL HEALTH.

In almost every piece of legislation drawn up by the anti-choice crowd, there are exceptions for rape, incest, or the life and health of either the mother or the fetus. While these are laudable, there is an unsavory side to these exceptions.

To begin with, there is the potential humiliation. For many rape victims, the rapist is someone well known and reporting the rape can have unintended consequences. Sometimes the women is economically dependent on the rapist. Sometimes there is a fear of retribution. Occasionally a woman has been so brainwashed -- by religion, by the rapist -- that she has been conditioned to view the rape as her own moral failing. In the case of incest, the rapist may be someone she has known her entire life.

This humiliation is often compounded by the treatment she receives at the hand of law enforcement. Many times women are just not believed, or are thought to be hysterical and overreacting. They are often subjected to invasive procedures intended to “prove” that the rape really happened.

While the idea that a woman should not be forced to bear the child of a rapist is noble, it misses the point. What the anti-choicers are basically saying here is that woman needs to justify her choice to them, to the government, and to the medical community ... and given the patriarchal nature of these institutions, this boils down to a woman needing permission from a man before continuing down this road.

Again, it imposes a patriarchal restriction on women and intimates that they are not capable of making such a monumental decision on their own. It requires women to come up with a “why” for their choice, a condition that is not imposed on men at any point. If someone wants to buy a gun, they buy a gun ... there is no official questioning as to the motive (some, myself included, would argue that there may be a justification for asking “why” on gun purchases ... again, for another chapter). If they want a car, they buy a car. If a man wants a vasectomy, he is not questioned as to why he wants it, nor is he made to feel “less than” for doing so.

So the question now becomes, what do we do about this?

In my mind, it's very simple. We need to confront this issue on three fronts.

BIRTH CONTROL

I agree that abstinence is the most effective form of birth control which, when used, has a 100% success rate. However, it is also highly unrealistic. Young men and women should be given objective information about the various forms of birth control, covering the pros and cons -- from overall effectiveness and failure rate, to cost, to ease of use. They should also be educated as to the actual implications of having a child -- from the financial implications, to the effect on the social lives of the parents, to how it will affect their education, employment, and their own health.

This will also help to destigmatize sex. There are too many people who lack basic information about sex and human reproduction just because they have been indoctrinated to think about sex as something “dirty” or inappropriate. Providing this education will allow young men and women to be more open, to discuss these issues frankly.

It will also have the effect of destroying the forbidden fruit. How many times, when we were growing up, did we come across something that was forbidden to us, which only made us want it more? And how many times, when we finally did get that forbidden thing, were we disappointed because it wasn’t everything we had built it up to be in our minds? This is what happens with sex now. People are raised from the cradle to believe that sex is something mysterious and forbidden, which gives it a whole cachet of desirability ... and then we grow up and discover that it’s basically just plumbing.

Really fun plumbing, but plumbing nonetheless.

RAPE AND EXPLOITATION

A small number (unfortunately, not small enough) of pregnancies occur as the result of rape. We need to include funding for programs dealing with the prevention of rape and sexual exploitation, including exploitation of minors and human trafficking. Again, it comes down to education in many ways. Teaching young people about rape, about the effects both in terms of legal ramifications for the perpetrator and psychological damage to the victim, will do more to halt incidents of rape than any other measure.

FAMILY ECONOMICS

We need to increase funding for programs such as Temporary Assistance for Needy Families (TANF), food stamps, and to not only protect, but increase the Child Tax Credit. It is the single mothers and families at the lowest end of the economic spectrum who are least empowered to deal with an unwanted pregnancy, or with the child that comes of that pregnancy. We must also increase funding for adoption assistance, both for the adopting family and the woman carrying the baby.

Abortion is a highly emotionally charged issue. It is something that needs to be handled with care and with respect for opposing points of view. However, that does not mean blindly accepting whatever bunk the religious right throws out there. We need to demand accountability from anti-choice groups and activists, and make them present actual facts instead of trying to scare everyone silly. Above all, we must protect a woman’s right to choose, vigorously and with great prejudice.

I gotta lie down.

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1Source: The American Pregnancy Association, “Surgical Abortion Procedures” http://americanpregnancy.org/unplanned-pregnancy/surgical-abortions/

2Source: “Abortion Surveillance --- United States, 2008”, Karen Pazol, PhD; Suzanne B. Zane, DVM; Wilda Y. Parker, MPH; Laura R. Hall, MPH; Cynthia Berg, MD; Douglas A. Cook, MBIS https://www.cdc.gov/mmwr/preview/mmwrhtml/ss6015a1.htm. Data from 32 reporting states; by year, these reporting areas represent 81%--84% of the abortions reported by gestational age during 1999--2008. Excludes 20 areas (Alaska, California, Connecticut, District of Columbia, Florida, Illinois, Louisiana, Maryland, Massachusetts, Mississippi, Nebraska, Nevada, New Hampshire, New York State, North Carolina, Oklahoma, Rhode Island, West Virginia, Wisconsin, and Wyoming) that did not report, did not report by gestational age, or did not meet reporting standards for ≥1 year.

3Characteristics and Circumstances of U.S. Women Who Obtain Very Early and Second-Trimester Abortions, Rachel K. Jones and Jenna Jerman, http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0169969.

4A “disruptive event” is defined as the death of a close friend or family member, falling behind on rent or mortgage, separating from a spouse or partner, being unemployed for a month or longer, having a dependent or family member with a serious health problem, having a baby, having a partner arrested or incarcerated and moving two or more times.

5“5 Facts About Abortion,” Michael Lipka and John Gramlich, Pew Research Center. http://www.pewresearch.org/fact-tank/2017/01/26/5-facts-about-abortion/

6https://www.guttmacher.org/fact-sheet/induced-abortion-united-states

7A note on methodology: there is another class of abortions known as “spontaneous” abortions, or abortions that happened with no medical intervention. However, prior to 1978 all spontaneous abortions were classified the same; from 1978 on, spontaneous abortions that occurred after 20 weeks of gestation were classified as stillbirths and therefore not counted in abortion statistics. This had the effect of inflating mortality statistics prior to 1978, and this class of abortion was omitted from our results so as to give an apples-to-apples comparison

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