The Title X Factor: Abortion and reproductive health rights in the U.S. shaky and threatening a domino effect

By C. N. Westendorf

Image from Wikimedia Commons

2011 started badly on the pro-choice front in the U.S., and the politically regressive climate surrounding abortion and family planning is unfortunately quickly gaining momentum, currently culminating in a legislative debate critical to the future of women’s sexual and reproductive health care services internationally.

Though abortion is technically legal in the U.S., currently 87% of counties do not offer abortion, and many of these have age or permission restrictions to those seeking help. The term ‘legal’ would connote ‘available’ which does not translate in practice to the existing situation, and the barriers that can exist for a woman seeking abortion in the U.S. These barriers come in the form of age, geographical location—with regards to the political climate of a patient’s home state, existence of service providers, and whether these can operate with relatively little danger or harassment—funds, and the situation surrounding the unplanned pregnancy in question. Recent issues and political developments throughout the U.S. are signaling that the situation as it stands may be about to get much, much worse.

Bad Potatoes in Idaho

In early January, in the state of Idaho, a Walgreens Pharmacist refused to fill a prescription for Methergine, a drug that stops uterine bleeding following abortion or natural childbirth. When the nurse at Planned Parenthood wouldn’t tell the pharmacist whether the Methergine was required post-abortion or post-childbirth due to patient confidentiality, the Pharmacist refused to fill the prescription, citing the pharmacist conscience rights of Idaho. These allow health care workers to decline to provide care related to abortion, emergency contraception or euthanasia should it conflict with their personal values.

Conscience rights for healthcare providers have been an issue throughout the U.S. and even in Canada with regards to both emergency contraception pills (Plan B), and RU 486, the drug used for medical abortions. However, in this particular instance, the pharmacist was not required to actively participate in the performance of any of the above-cited issues of ‘conscience.’ Not in the prevention of ovulation (what emergency contraception does), or the medical abortion of an implanted egg (what RU 486 does), but to provide care for someone in medical need, period.

Laying to rest the other, more universal issue—that a pharmacist should not have the right to know a patient’s medical history prior to dispensing pharmaceuticals—it’s both contrary to the Hippocratic oath as well as decidedly anti-life for a pharmacist, or any healthcare provider, to be permitted to make a decision that could leave a woman dangerously hemorrhaging because they may disagree with something that may or may not have taken place to precipitate the bleeding in question. Are doctors allowed to, for instance, refuse to treat criminals or abusers who sustain wounds defensively from conflict or abuse they perpetuate, because a clinician disagrees in principle with the fact that their patient was injured while causing harm to another human being as a ‘conscience clause,’ and one which would seem infinitely more justifiable, both morally and legally? Absolutely not; so in a situation where a woman made a legal decision regarding her own reproductive health, where confidentiality laws are in place to protect her rights and decisions, why was a pharmacist permitted to imperil a patient’s health based on nothing but personal morality and conjecture? Following a complaint filed by Planned Parenthood, unfortunately the Idaho College of Pharmacists upheld the pharmacists’ decision, indicating that the lack of an ‘emergency’ medical situation left the pharmacist free to make her own choice without fear of repercussions. Unfortunately, the same can clearly not be said for any woman seeking abortion in the U.S.

“The most dangerous place for an African-American is in the womb”

A billboard erected last week by the group ‘that’s abortion’ (www.thatsabortion.com) near a Planned Parenthood clinic in New York’s SoHo district pictured a young African-American girl and sported the copy “ The most dangerous place for an African-American is in the womb…thatsabortion.com” The parents of the girl—whose image was used without explicit permission for her to represent such an offensive campaign—were the first of many citizens who were outraged, citing (as one reason among many) that to compare abortion to genocide, especially during Black History Month, was both tactless and heinous.

Though the billboard thankfully only survived a single day, the group’s website remains undaunted in providing no shortage of carefully worded (i.e. manipulated) statistics and fodder for more social myths surrounding the ‘dangers’ of abortion, spotlighting ethnic minorities and the unmarried demographic as particularly feckless and frequent practitioners of abortion. Thatsabortion—though it would seem as a rule not altogether that concerned with ethics—amped up their inappropriate and factually distorted attention seeking behaviour last week, in the face of an ill-boding debate that is currently perilously raging in the halls of U.S. Congress and throughout the U.S. at large.

Title X amendment and the Mexico City Policy–this is where it gets serious.

Title X, signed into law in 1970, was an amendment that granted federal funding to family planning institutions throughout the U.S., including Planned Parenthood. Contrary to what you may be hearing from campaigners with slogans like “No taxpayer-funded abortions,” Title X as it stands does not fund abortions specifically within family planning institutions, except in the case of rape or incest, but supports basic sexual health and family planning services. The Title X amendment (named the Pence amendment after Republican Rob Pence) would remove any and all funding for all organizational operations, from any organization that provides abortion, while still offering funding for any abortion in particular that can be proven to be a result of rape or incest. Essentially, the Pence amendment will remove all federal funding for family planning and women’s health care services, to the tune of over $300 million dollars, simply because the organizations that offer these services also provide abortions, which currently happen at the clients’ own expense, not the expense of the federal government.

The abortion debate, while itself a critical matter well-deserving of attention, is unfortunately not the entire issue at stake with the Pence amendment, and is being used both as a red herring and a lightning rod to polarize the debate regarding the budgetary cuts proposed in the Pence amendment. The issue in its completion, the dismantling of crucial women’s health care services (of which abortion is only one) that would inevitably occur should the amendment pass, is largely absent on the public agenda. As a release from Planned Parenthood states: “This is not about abortion…this is about women’s health care. If these legislators succeed, millions of women will be without access to health care…If the national family planning program is eliminated and Planned Parenthood is stripped of all its federal funds, more women will go untreated. That means more undetected cancers, more women suffering from HIV and more instances of STIs. These services save lives.” In addition to the staggering losses inherent in removing federal funding from any organizations providing abortions, thereby forcing service reduction or elimination, still exempting sexual assault or incest victims will only drive the knife deeper. This exemption, though on paper an act of good faith is really just a ‘see, we’re not all bad’ political bargaining chip. In reality, this exemption would require many sexual assault and incest victims to go through the process of disclosure and having their experience ‘legally’ recognized as a sexual assault or incest to get access to abortion services, which can only become both less available and more expensive under the proposed amendment. Another, related amendment currently in congress would have this same contested federal funding only go to abortions via rape recognized as ‘forcible rape’, negating all over ‘types’ of rape, as rape, itself a complex issue with many other potential legislative and social repercussions.

Finally, on the international aid front, the Mexico City Policy, which for any conservatives prone to nostalgia hearkens all the way back to Reaganism, is back on the scene, and threatens to eclipse family planning and sexual healthcare service provision internationally via the abortion debate, in the same vein as the Pence amendment. The Mexico City Policy was pioneered by Reagan, rescinded by Clinton, brought back by George W., and most recently trashed in early 2009 by Obama shortly after he came into office. The policy removes USAID international federal funding from any health or family planning organization that performs, or even provides information or counseling about abortion services. Aside from the implications of the Mexico City Policy just being, well, wrong and dangerous for all the same reasons that the Pence amendment is wrong and dangerous, there is an uncontested need for increased family planning services in developing countries to stem population growth, with some studies suggesting they could prevent the birth of as many as 250 million unwanted children by the year 2050 with adequate support. If the pro-life camp wants to run this one home, they’d better re-route all USAID funding to orphanages, child abuse services, and foster care social service nets internationally, because the need and responsibility for those 250 million unwanted kids to have somewhere to go will fall squarely on their short-sightedness.

From Idaho to New York, the sexual and reproductive health climate in the U.S. right now is looking mighty dangerous for women, and threatening to spread internationally at the speed of Swine Flu, depending on which way politicians vote, and how much public opposition will rally against the enshrinement of legislation as arcane and regressive as the Pence amendment and the Mexico City Policy. From whatever country statistics are gathered with regards to abortion and family planning, history shows that there is no way to prevent abortion, there is only a way to prevent access to abortion services. Lack of access to legal, safe abortion unilaterally results in unsafe, unsterile, dangerous and desperate attempts at abortion that at worst result in the death of both the fetus and the mother by sepsis, uterine perforation, and any number of other serious or fatal injuries depending on the method used and how quickly (if and when) a victim of unsafe abortion is able to get access to medical care after a failed or dangerous attempt. Removing funding and access for abortion services puts women in imminent danger. The severity of this is increased dramatically by the tool of enforcement being legislation that would as devastating collateral damage remove access to preventative family planning, birth control, STI, and basic sexual health as well as primary health services by defunding organizations in their entirety. Dan Savage said it best recently on his podcast when he said with regards to the Methergine issue in Idaho, “Pro-life is looking more pro-death than ever.”


3 thoughts on “The Title X Factor: Abortion and reproductive health rights in the U.S. shaky and threatening a domino effect

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