Last year Idaho passed a law making it
a crime to coerce a woman into having an abortion. This year, legislators in twelve states, including Missouri, have passed or are considering bills
that they claim would enhance informed consent measures for pregnant
women seeking abortions and ensure that women are not coerced into having
unwanted abortions. Although it is hard to disagree with legislation
that purports to ensure free and informed medical decision-making, I
have to wonder why legislators who profess to care so much about pregnant
women are only willing to protect some pregnant women – the ones who
plan to end their pregnancies – but not the ones who intend to go
While approximately 800,000 women end
their pregnancies each year, a far greater number of women, 4.3 million,
go to term. By focusing exclusively on abortion, this kind of law also dangerously
implies that pregnant women who are going to term are fully and adequately
informed and that their medical decisions are never pressured or coerced.
Instances of poor communications, failure
to fully inform, and coercion in hospital delivery rooms, however, are
increasingly being documented in popular books, films
of first-hand accounts. Allegations
of abuse have prompted one organization to provide a guide for filing complaints. Rigorous
peer-reviewed research, moreover,
has found that pregnant women are routinely subjected to interventions
during labor and childbirth that have been proven ineffective, or are
appropriate only in limited circumstances. Pregnant and laboring
women are often deprived of information about and access to a range
of good practices that have been shown to work.
For example, an increasing number of
women in the United State now give birth by cesarean surgery. According
to the World Health Organization the rate of births by cesarean surgery,
based on actual medical need, should not be more than 15% of all deliveries.
Yet, today approximately 30% of all US births are cesarean surgeries.
Some providers and hospitals have even higher rates (40-50% of all births).
This rise in cesarean surgery rates has not been accompanied by overall
improvements in maternal or child health and creates risks to pregnant
women and babies that do not exist with vaginal births.
According to Listening
to Mothers II, the largest
survey of women’s experiences during pregnancy, childbirth, and the
postpartum period, one quarter of the survey participants who had cesareans
reported that they had experienced pressure from a health professional
to have cesarean surgery, and 73% of women who experienced episiotomy,
or vaginal cutting, during delivery, reported that they had no choice
at all in the matter.
Supporters of so called abortion coercion laws claim that they will
protect pregnant women and ensure that their decisions are made
freely. Many commentators and organizations
however have raised questions about these legislators’ opposition to
coercion pointing to the fact that the same legislators often support
policies that have the effect of coercing some women to go to term and
others to end their pregnancies. Certainly, though, if protecting
pregnant women and the “unborn” were really the goal, the legislation
would not focus on abortion exclusively, but rather would make it
illegal to pressure or coerce a pregnant woman to have any medical
intervention. This would include policies that force pregnant women who
have had previous cesarean surgery to have repeat surgery whether they
need it or not.
The best available evidence supports
vaginal birth after cesarean surgery (VBAC) for most women who have
had this surgery. Nevertheless, the International
Caesarean Awareness Network
has documented over 800 hospitals with explicit policies that require
women to undergo a planned repeat surgery. These women are deprived
of both the right to give or withhold informed consent, and they are
coerced into having repeat major surgery if they want to deliver in
any of these hospitals.
The Missouri bill requires that women
be provided with "medically accurate information that describes
the proposed abortion method, medical risks, alternatives to the abortion,
and follow-up care information." While such information is routinely
provided in the context of abortion, there is significant evidence that
critical information is not provided to women regarding childbirth delivery
methods. Indeed, only two states in the whole country, New York
and Massachusetts, have Maternal Information Acts that require health
care providers to give expectant parents information about their cesarean
surgery rates and rates of births using medical interventions such as
labor induction and episiotomies. These laws give families the information
they need to avoid providers who are not willing to or who are not trained
to support vaginal birth.
Each year, state legislators introduce
hundreds of bills that focus on abortion while ignoring serious health
and consent issues affecting the millions of women who become pregnant
and go to term. Legislators who are truly concerned with protecting
pregnant women would ensure that all
of them, not just those seeking abortions are guaranteed informed consent
and freedom from coercion.