from Talk to Action

About the author: In addition to the less noteworthy accomplishment of being my friend, Carole Joffe is Professor of Sociology at UC-Davis and the author of Doctors of Conscience: The Struggle to Provide Abortion Before and After Roe V. Wade . With co-author Diane di Mauro, Professor Joffe recently published The Religious Right and the Reshaping of Sexual Policy: An Examination of Reproductive Rights and Sexuality Education [pdf link] in Sexuality Research & Social Policy, the journal of the National Sexuality Resource Center. She has granted permission to post the text of her essay in full. -- moiv

“Well, I used to do them—there is less blood loss, and in some situations, it just seems safer. I’m not sure what I will do now.”

The speaker is Dr. Jacob Clark (not his real name), a fit man in his 60s, an obstetrician/gynecologist who has spent his life serving poor women in an East Coast city. Over coffee, he is discussing over with me his deep frustration and confusion over the recent Supreme Court decision, Gonzales v Carhart, upholding an abortion ban.

The banned procedure—referred to by medical professionals as “Intact Dilation and Extraction”, and by antiabortionists as “Partial Birth Abortion”—is quite rare, less than 1% of all abortions performed in the United States. But Dr. Clark is one of those who performs this procedure, when the situation, in his judgment, calls for it.

Dr. Clark and I are attending a medical conference, shortly after the Court announced its decision. We’ve just heard the medical director of a large clinic address her colleagues from across the country, and succinctly state the dilemma that abortion providers now face: “We’ve got to keep our patients safe—and ourselves out of jail.”

November, 2003: President George W. Bush signs the "Partial Birth Abortion" Ban

I reflect on the gap that exists between what I am hearing at this conference and what I have been reading in the press by various “pro-choice” pundits about the decision. While professing to be opposed to the Court’s judgment, these commentators—for example, David Garrow in the New York Times—are saying, “yes, the decision is bad, but it really doesn’t matter, because so few of these abortions are performed.”

Such reasoning betrays a true cluelessness about the daily realities of abortion provision. Even if Jacob Clark and his colleagues (and their lawyers) figure out ways to change their techniques sufficiently to circumvent the Court’s ruling, and avoid conviction, that doesn’t mean that someone can’t accuse them of a criminal act—setting off a long and costly court battle. And such accusations will come. The antiabortion movement learned a long time ago how effective this kind of relentless harassment of providers can be, even if ultimately there is no conviction of a crime.

Moreover, the Court’s action will inevitably have a chilling effect on those young physicians contemplating abortion provision, a field already seriously understaffed. The two year jail term and huge fine that will now face those convicted of performing an Intact D and E sends quite a signal about the hyper- politicized terrain abortion care has become, even if one has no intention to perform this particular procedure.

But though Gonzales v. Carhart may have been the most shocking and consequential assault on reproductive justice in recent days, it was hardly the only indication of how omnipresent is the Bush Administration’s attacks in this sphere. Consider a recent ten day period, from April 14 to April 24:

April 14: Mathematica Policy Research releases a study on abstinence only sex education.

The study confirms what virtually everyone, other than the Bush administration and its cronies in the Religious Right, knew already: “Abstinence-only sex education programs are not effective in preventing or delaying teenagers from sexual intercourse.”

As Congressman Henry Waxman-- who has long pointed to the shoddy nature of these programs, and their violation of church/state boundaries— put it, “1.5 billion of taxpayer dollars were wasted.” Though hardly a surprise—other researchers have come up with similar findings— the significance of this Mathematica study is that it was commissioned by Congress itself.

April 18: Gonzales v. Carhart is announced

April 19: The Paul Wolfowitz/World Bank scandal deepens.

In addition to the charge that Wolfowitz inappropriately arranged a huge salary increase for his companion, the press reports that he encouraged the omission of references to “family planning” and “reproductive health services” from World Bank documents. Jean Jose Danoub, a religious conservative from El Salvador who was brought onto the Bank staff by Wolfowitz, apparently was charged to bring the Bank’s policies in line with the Bush administration’s ongoing war against contraception.

April 23: Another large study confirms no link between abortion and breast cancer.

Researchers from Harvard University, studying over 100,000 women, found there is no association between abortion and an increased risk of breast cancer.

Again, no surprises here. This topic has been intensively debated in past years, as antiabortion spokespeople have tried to make such claims. Indeed, an early scandal in the Bush administration was a posting on the National Cancer Institute website, claiming such an association—eventually the posting was dropped after a scientific gathering, convened by the NCI, disputed the finding.

Nevertheless, at least five “red” states now require abortion providers, as part of the “informed consent” process, to tell patients that abortion may increase the risk for breast cancer. In short, these doctors are being forced to commit malpractice.

The question for progressives, of course, is how consequential is the damage done as a result of years of these multi-faceted attacks on sexual and reproductive rights and services? As those people sporting those cool “Bush watches” on their wrists might say, there are only 21 months, one week, eleven days, etc. left to this horrible presidency, and then (knock on wood) our country will inaugurate a Democratic president.

Assuming a Democrat wins, of the four items mentioned above, some things appear more “fixable” than others. When professionals, not ideologues, are put back in charge in federal agencies, for example, the Department of Health and Human Services, comprehensive sex education programs—not abstinence only ones—will receive federal dollars.

Government websites will no longer post embarrassing distortions about the effectiveness of condoms, and the nonexistent link between abortion and breast cancer. Funds to help poor women afford contraception may actually be increased, rather than slashed. A President Obama (or Clinton or Edwards, etc) will not instruct a World Bank president (or his/her UN chief delegate ) to delete all references to “reproductive health” or “family planning” in official documents or insist that one third of the funds that the U.S. devotes to international AIDS work be devoted to abstinence education. The cruel “Global Gag Rule” which precludes U.S. funds going to any organization that uses its own funds for abortion services or referrals will be overturned. And so on. So undoubtedly some truly awful policies will be brought to an end.

But the culture wars will not be over, and the Religious Right will not go away. Some of the most effective anti-abortion and anti-contraception policies are carried out at the state level—for example, the redirection of family planning funds to so-called “crisis pregnancy centers” and “TRAP laws” (targeted regulation of abortion providers), often bizarre state laws whose only function is to make abortion provision even more challenging.

But the most disastrous legacy of the George W. Bush presidency, with respect to sexual and reproductive justice, is the Supreme Court. With his appointment of John Roberts and Samuel Alito, Bush enabled a situation in which—astonishing to even seasoned Court observers— five justices were willing to ignore precedent (and human decency) and state that a woman’s health no longer need be taken into consideration in judging the constitutionality of an abortion case brought before the Court. The next president, even if s/he is a Democrat, will be more likely to have to replace one of the Court’s liberal members, and the country is thus stuck with the Abortion Ban.

Five for the foreseeable future. Meanwhile, the tireless lawyers of the reproductive freedom movement are bracing for even more egregious assaults on Roe. And my friend, Jacob Clark, and his colleagues, wonder what the hell they are going to do.

Images
"PBA" Ban: Mikhaela
Wolfowitz: AllHatNoCattle.net
Abstinence: Mother Jones
Abortion/Breast cancer: BushWatch.com