In Health Reform, Abortion Not the Only Fight


This article was originally published in the Guardian.uk

Finally, a feminist health campaign
telling it like it is: American women are being thrown under the bus
for an insurance industry-friendly motion towards "health reform."
Enough with the handwringing, Jane Fonda seems to say in this video for the "Not Under the Bus" campaign. It’s time for women to stop that bus and start driving it.

The healthcare bill
currently headed for conference committee station in Congress is
troubling to progressives on several accounts, but for women, it will
have the ironic effect of making a medical procedure less accessible.
The Senate’s abortion "compromise," extorted by Ben Nelson
of Nebraska (along with a pile of cash for his state), ostensibly means
that women who want full coverage will have to write two checks: one to
cover abortion, and one to cover everything else.

Analysts worry this will amount to a Stupak-like ban
on all insurance coverage for abortions – how many insurers, not to
mention employers, are going to put up with separate checks? And that’s
only a question for "blue" states that won’t ban abortion coverage
entirely. If the expected happens, it will mean that women will have to
pay more out of pocket and travel even longer distances to exercise
what Roe versus Wade supposedly codified as a "right."

Last
month, feminists were shocked at Stupak-Pitts, then outraged. Now, Jane
Fonda is looking outright panicked on Youtube: "Help end discrimination
against women," she pleads. It may well turn out that the decade’s
greatest threat to abortion access wasn’t George Bush, but Obamacare.

Odd
as it is to say, I find Fonda’s panic somewhat comforting. In both its
boldness and its generality, it signals the women’s movement to regroup
at square one, to focus on women rather than on a procedure. After all,
the right to abortion is based on broader Constitutional rights to
autonomy and bodily integrity and the privacy to make decisions about
what happens or doesn’t happen to one’s body. And if we apply these
rights broadly, not only to a woman’s "right to choose" to terminate a pregnancy
but also her right to choose to carry that pregnancy to term, and her
right to choose what happens or doesn’t happen to her body at the time
of childbirth, then we would see that all pregnant women are being
denied these rights.

Case in point: Joy Szabo of Page, Arizona,
pregnant for the fourth time. In order to exercise her rights, she
sought long and hard for a provider and had to travel 300 miles away
from her family for care. But Szabo wasn’t seeking an abortion; she was
seeking a vaginal birth. You see, Szabo gave birth previously by
cesarean section. She is among the hundreds of thousands of U.S. women
who seek vaginal birth after caesarian
(Vbac) each year, though nearly half of hospitals won’t allow it. Szabo
was denied the right to deliver at her local hospital unless she
delivered surgically. She was even threatened with a court order. You
thought abortion was controversial? Ask a nurse about Vbac.

Szabo
also told it like it is: "Page Hospital: Enter my body without
permission, sounds like rape to me," she wrote in lipstick on the back
of her minivan. Szabo’s ordeal ended happily on 5 December, when she
gave birth vaginally in Phoenix. But the majority of American women in
this situation are scheduling repeat surgery — either on their doctors’
recommendation or insistence — though research has shown it is more
likely to result in a baby’s admission to neonatal intensive care for
prematurity and breathing problems, to say nothing of the risks to
mothers.

The Vbac ban is only a subset of a much larger problem.
Decades of research tell us that optimal maternity care is something
very different from what most American women receive. Optimal care
means that the physiological birth process is supported with minimal
intervention: labour begins spontaneously, women are free to move
around and push in upright positions, and providers avoid surgical
intervention unless absolutely necessary.

Meanwhile, the majority
of labouring women are confined to hospital beds, strapped to mandatory
but ineffective fetal monitors, induced or sped up with artificial
hormones, and consequently experiencing unnecessary pelvic trauma and
the highest cesarean section rate on record, at 32 percent (10-15 percent is
considered the maximum we would expect for health reasons). If you
question whether this has anything to do with women’s bodily integrity,
talk to a woman who’s had an infected caesarian scar or an episiotomy that tore into her perineum.

Perhaps
the biggest loss for women’s health reform is that with all the drama
over abortion, maternity care has remained a huge blindspot — and a
costly one, at that.

The US spent $86 billion on maternity care in 2006
and another $26 billion caring for babies born preterm, now also at a record
high of 12 percent. Prematurity is a leading cause of infant death, yet the
majority of premies are induced or surgically delivered too early. This
over-medicalisation means that childbirth costs Americans more than
twice per capita what other countries with better outcomes spend.
Medicaid picks up nearly half the bill in the US. If we gave just a
little attention to improving care, we could literally save billions.

"Improve
quality and reduce costs" — this has been Obama’s mantra for health
reform. How is it that instead of addressing real threats to women’s
and babies’ health, "reform" has led us toward rolling back abortion
access? Advocacy groups have been defending "abortion rights" and, to a
lesser extent, "birthing rights," but it’s possible that such a
single-issue focus has helped to marginalise. To what other bodily
system or medical procedure do we attribute rights? We don’t have
endocrine rights or MRI rights; men don’t have testicular rights or
Viagra rights. Rights belong to human beings. We have rights.

Or
do we? A society that would force a woman to carry an unwanted
pregnancy would also force her to have major abdominal surgery. Women
won’t get real health reform until we reform this fundamental lack of
respect for women. The bus stops here.

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  • amytuteurmd

    Are you joking?

     

    Besides steamrolling over the complex issue of the safety of vaginal birth after Cesarean, you have ignored the impact of lack of health insurance on women’s health.
    Women are dying every day because they don’t have access to basic preventive care, to diagnostic procedures and to lifesaving treatments. Poor women and women of color are particularly at risk.

     

    Abortion access is also a matter of life and death.

     

    VBAC access, on the other hand, is a favorite issue for white, well off women anxious to avoid "interventions." It hardly rises to the level of the ongoing disease, disability and death resulting from lack of access to healthcare.

     

    You may think VBAC access is very important, and that is your right, but please do not equate the concerns of the privileged with the real and life threatening health problems of the far less fortunate. It is a measure of just how far out of touch privileged women are with the realities of life for the poor and disenfranchised that you would even think to do so.

  • julie-watkins

    I think you missed this sentence:

    The Vbac ban is only a subset of a much larger problem. [emphasis added]

    I think there’s a lot more unncessary first cesareans on women of all classes. (I remember a lot of outrage at the upward statistical trends.) It’s a lot more money for the hospital and much more negative impact on the woman — recovery & financially. And other kinds of disrespecting pregnant women …

  • juliejulie

    Women are being denied thier right to not be induced, being denied thier rights to carry on their pregnancy as they see fit. My sister’s OBGYN get’s blankets made with embroidered birthdates on them before the mothers even come to the hospital. If you are there too long, they take you for a c-section.

    There are way too many inductions, too many c-sections, too many interventions in the natural process. It is a disgrace. I encourage every woman to use a MIDWIFE. Even if you live in a place where midwives are not allowed to deliver in a hospital, most of them work with an OBGYN who does. Whether you want or qualify for a home birth or not, use a Midwife. Have your midwife present with you as labor support when you go to the hospital. Yes, the hospital and doctors can still co-erce you. They can still threaten you that if you don’t do what they want, they will say you are going against medical advice and your insurance will not pay your labor and delivery costs, but at least you will have some knowledgable support.

    Abortion is definitely not the only fight. We are losing more rights over our bodies every day. It’s the Handmaid’s Tale waiting to happen and personally, I think it is terrifying.

    julie in memphis

     

  • elm

    Speaking of the integrity of a woman’s body:

     

    There is a study out that links prior abortion/s and premature birth.

     

    http://blog.nj.com/njv_editorial_page/2009/11/us_infant_mortality_premature.html

     

    also a new US study since last April 2009 links abortion and birth control to breast cancer.

     

    http://breastcancer.about.com/b/2010/01/08/abortion-birth-control-pills.htm

     

    IT IS ABOUT TIME THE NATIONAL CANCER INSTITUTE STARTED WORRYING ABOUT WOMEN’S HEALTH AND NOT ABOUT WHO IS LOBBYING FOR THE ABORTION INDUSTRY.

     

    It is a shame that one child has to die so we can live as we want.

  • prochoiceferret

    There is a study out that links prior abortion/s and premature birth … also a new US study since last April 2009 links abortion and birth control to breast cancer.

    Wow! And just the other day, I read that the NCI was suppressing evidence that exposure to cooking fumes was shown to have a strong anti-cancer effect in women. Oh, and did you know that a prominent researcher discovered that not wearing footwear greatly improves circulation in the lower extremities? (Only in women, however. No such beneficial effect was observed in men.)

  • ctbirthadvocate

    "VBAC access, on the other hand, is a favorite issue for white, well off
    women anxious to avoid "interventions." It hardly rises to the level of
    the ongoing disease, disability and death resulting from lack of access
    to healthcare."

     

    Are you f’n kidding me? Seriously?

    No, this is not only a well off issue. This is an issue that impacts women of all walks of life, races, and social status.
    Recently there was a woman who strived for a VBAC and got the attention of MANY women in the birth community, only to have her pregnancy end in a repeat cesarean because she went past 42 weeks. Guess what? She was of African American decent.

    I think the problem is, you are so out of touch with reality that you pull these kind of comments straight out of your @$$!

  • jo

    Abortions do not lead to breast cancer. Do miscarriages? The moral supremacists want to lead women to believe that abortions – but not miscarriages (because no "morals" were involved) – cause breast cancer because they’ll use any tactic, even disengenous ones, to protect the fetus’ right over that of the woman. "Pro-life," except in the case of women’s lives. You use a blog and about.com to "educate" us? Gimme a break. Women are smarter than that.