Report


The Mother Majority

Women with children have more abortions than anyone else, and by an increasingly wide margin. So why is the topic taboo?

Photograph by Jupiterimages/Thinkstock.

By Lauren Sandler|Posted Monday, Oct. 17, 2011, at 4:34 PM ET

A few months ago, I was late. You know what I mean: My usual period day came and went without a spot, and suddenly every wave of exhaustion, every twinge of anxious nausea, became a harbinger of a very unintended pregnancy, a sign that my NuvaRing had failed me. I’m married, happily at that. And I’m a mother, happily as well. But our family feels “complete,” as demographers put it, at one child. And so my husband and I had to make a choice—or so we thought, for a very tense week before my body made the choice for me. As we lay awake at night whispering pros and cons for continuing the pregnancy, stopping only when our daughter padded in to snuggle under our covers in the predawn hours, I wondered if our mere deliberating might call into question my soundness as a mother. If I, already happily immersed in parenting, chose to terminate, wouldn’t I be unusual for doing so, maybe even stigmatized as a sort of prenatal Medea?


I was wrong. Women who are already mothers have more abortions than anyone else, and by an increasingly wide margin. When Guttmacher Institute researchers last ran the numbers in 2008 they found that 61 percent of women who terminate a pregnancy in this country already have at least one child. That was before the recession, though—before the poverty rate rose to swallow 42 percent of women, almost half of them mothers, many of whom know they can’t afford another child. So I asked the National Abortion Federation, a professional association of abortion providers, to run the numbers on the women visiting their clinics and calling their hotlines in the past few years. The resulting figures shocked NAF President Vicki Saporta, who called to tell me that every year since 2008, a whopping 72 percent of NAF clients looking to terminate a pregnancy were already mothers, up at least 10 percent from the years beforthe economy crashed.

But while the typical abortion patient is a mother, very few people seem to realize it. Larry Finer, Guttmacher’s director of domestic research, told me that this fact is “one of the most unknown and surprising statistics across the board.” Guttmacher is trying to correct the public’s misperceptions with a YouTube PSA designed to show that women who have abortions aren’t necessarily who we think they are. But why are these misperceptions so skewed in the first place? Is the intersection of motherhood and abortion a minefield that activists choose not to navigate?

NAF’s Saporta told me she thinks anti-abortionists have successfully depicted women who choose to terminate a pregnancy as sexually indiscriminate. “It’s much harder to demonize the mother who is struggling to support the kid she already has,” she says. But then why doesn’t the group that she leads make this very point? “Good question—I think we should,” she replied. I also put the question to Gloria Feldt, the former longtime Planned Parenthood Federation of America president. “I believe the whole movement has made a terrible mistake,” she said, referring to the pro-choice movement’s decision to avoid talking about mothers’ motives for having abortions, and instead focus “on the less frequent reasons, which are rape and incest or teens who are simply not ready to be parents.”

For her part, Rachel Jones, a senior research associate at the Guttmacher Institute, thinks that public perceptions of who aborts and why are skewed mostly as a result of all the political heat around late-term abortions and adolescent abortions (minors have only 7 percent of all abortions). In other words, she argues, mothers who abort are invisible not because anyone is conspiring to keep them that way, but because so much attention is focused on other women.

But why do mothers have so many abortions in the first place? Jones co-authored a qualitative study titled I Would Want To Give My Child, Like, Everything in the World: How Issues of Motherhood Influence Women Who Have Abortions,” which found that most mothers who abort say they are doing so to protect the kids they already have. As Jones points out, that rationale is tough to demonize politically, especially when you consider that most women making this choice are contending with some combination of low income, unemployment, and a lack of health insurance, or are struggling to raise kids on their own.

These are the kinds of stories Anne Baker hears daily across the little round table in her office at the St. Louis-area Hope Clinic for Women, where she has been counseling abortion seekers for 35 years. In 2008, the last year for which the clinic has available numbers, 62 percent of its patients were mothers. But Baker says the number of mothers coming in has swelled markedly since then, just as it did during the economic slowdown of the late ’70s, when she was first starting out at the clinic. She has compiled a list of 25 reasons mothers commonly give her for not having another child. By far the No. 1 reason is a desire to protect the families they already have. Most of the time, this calculus is an economic one, though Baker has also noted a growing number of women like me, women who are “less apologetic than they used to be about saying they’re a good mom and for them to continue to be a good mom, they choose to do it with one.”

Of course, when it comes to public opinion, it’s one thing for a mother to choose an abortion out of desperation, and another to do it out of preference. Feldt says the motivations behind a mother’s choice to terminate place her on a sliding scale of public opinion. Recalling her days polling voters at PPFA, she describes the American view of who gets to have an abortion like this: “The less in control of a woman’s life she is, the more the public supports her right to make that choice [to have an abortion]. The more she is in control of her life, saying this is the life I choose, the less people support it.” So if a mother who is destitute chooses to abort, we might accept her decision. But someone like me, who could support another child if only I moved to a less expensive ZIP code and got a job with a steadier paycheck? I’d be a moral pariah.

“It’s scandalous for white women like you and me,” Jennifer Baumgardner recently told me over coffee. When Baumgardner gathered women’s abortion testimonies for her book Abortion and Life, she had yet to terminate a pregnancy herself (on the book’s cover, she’s pictured pregnant with her second child). But when she subsequently found herself pregnant again, she chose to abort rather than have a third child. When we start talking about why the pro-choice movement hasn’t made mothers more of the story of abortion in America, Baumgardner rolls her eyes. “Women in the movement have this enormous disconnect between actual lives and what they believe in,” she says. “They’ll talk about other women but they think their own story can be used to undermine them.”

Is all this true, though? Is the stigma that attaches to abortion actually compounded if one makes this choice as a mother? Are we right to think that terminating a pregnancy after carrying another one successfully to term will undermine our standing not just as women but as good parents?

At the University of California-San Francisco, Kate Cockrill directs the Social and Emotional Aspects of Abortion Program, and is trying to measure sources of stigma. She has found that many mothers deliberately explain their choice to abort in the context of their motherhood, thinking that doing so will ward off judgment. “Motherhood is an assertion of their humanity,” Cockrill told me of women who fear condemnation, “and claiming their motherhood is part of managing the stigma of abortion.”

Still, Cockrill has found that once they have established social identities as mothers, many women will do everything they can to avoid tarnishing that identity. For example, she found women who had babies delivered by an OB-GYN refused to see that physician when they found themselves in an unwanted pregnancy. “They wanted to be seen as a mother,” she said, “not an abortion patient.”

http://www.lemonde.fr/idees/article/2011/09/20/les-droits-des-femmes-sont-remis-en-cause-par-des-forces-conservatrices-en-europe_1575013_3232.html

Depuis quelques mois en Europe, de nombreux pays prennent des initiatives portant atteinte aux droits sexuels et plus particulièrement au droit à l’avortement. La crise mondiale et ses plans d’austérité sont les prétextes qui, sous couvert de dérisoires économies, permettent de légitimer les discours des forces les plus conservatrices d’Europe et remettent en cause ses droits et par là même les droits des femmes.

Toutes les instances internationales l’ont pourtant affirmé, le développement des populations y compris économique passe par des politiques d’égalité femmes/hommes, l’accès à l’éducation des filles, la planification familiale et par un accès facilité et sûr à la contraception et à l’avortement.

Ainsi, le 31 août, alors que la Pologne succède à la Hongrie à la présidence de l’Union européenne, la chambre basse du Parlement polonais examinait un projet de loi interdisant complètement l’avortement. Ce projet déposé par les mouvements anti-choix, soutenu par les ultraconservateurs et une bonne partie de la droite libérale au pouvoir a été rejeté à une courte majorité.

Rejeté aussi celui d’une députée de gauche proposant la libéralisation de l’avortement jusqu’à 12 semaines de grossesse et son remboursement. Pourtant, la Pologne a été condamnée en mai dernier par la cour européenne des droits de l’homme pour “ses carences dans la mise en oeuvre de sa législation sur l’avortement” déjà fort restrictive. L’Irlande, elle, a été sommée fin 2010 par cette même cour, de revoir sa législation sur l’avortement.

Le 30 août 2011, la Suisse a jugé recevable l’initiative lancée par les milieux anti-avortement. Ce texte exige que l’interruption de grossesse et la réduction embryonnaire soient radiées des prestations de l’assurance maladie de base à de rares exceptions près. Les suisses devront donc voter.

En septembre 2011, la Douma (le parlement Russe) sous couvert d’économies, se prononcera sur un texte proposé avec l’active participation de l’église orthodoxe sur le paiement de l’acte d’avorter par les femmes et sur la personnalisation des embryons. Y sont aussi prévues de multiples contraintes : obligation pour les femmes mariées d’obtenir une autorisation écrite de leur mari, suivis psychologiques et autres visionnages ou lectures de documents anti-avortement…

Pendant sa présidence de l’Union européenne, la Hongrie a lancé en mai dernier une vaste campagne de communication contre l’avortement avec le soutien financier de fonds européens du programme de solidarité sociale “Progress”. Celle-ci fait suite à l’adoption en avril de la nouvelle constitution qui, dans son article 2, s’engage à “protège(r) la vie du foetus depuis sa conception”.

L’opposition espagnole a de son côté clairement annoncé vouloir revenir sur la loi sur l’avortement entrée en vigueur au printemps si elle accédait au pouvoir en novembre 2011 lors des élections législatives anticipées.

Devons-nous voir dans ces initiatives, l’influence de la mondialisation qui organise de fait la diffusion d’idées défendues en particulier aux Etats-Unis où les tentatives déterminées de s’attaquer au droit à l’avortement se multiplient ? Au cours du premier semestre 2011, pas moins de quatre-vingt lois ont été votées par les législatures d’Etats américains pour durcir les conditions d’accès à l’avortement. Conséquences des élections de novembre 2010 ou anticipation de la présidentielle de 2012 par les républicains et le mouvement conservateur “Tea Party” ? Retour à un ordre moral mondialisé ?

L’utilisation politicienne et démagogue, sous le prétexte de contraintes économiques, de ce retour à l’ordre moral dont les femmes, moitié de la population, sont les grandes perdantes, ne peut que nous inquiéter. Ainsi affaiblies vis-à-vis de l’opinion car utilisées comme variables économiques d’ajustement, la voie est toute tracée pour justifier politiquement la remise en cause de leurs droits civiques, sociaux et économiques.

Seule une réelle prise de conscience collective et citoyenne pourra arrêter la “marche-arrière-toute” actuelle. Il est impensable, au XXIe siècle, que l’égalité entre les femmes et les hommes connaisse un tel recul alors qu’elle reste à conquérir dans trop de pays au monde.

En septembre 2008, le colloque européen “Droit à l’avortement : quels enjeux pour les femmes en Europe ?” organisé par Le Planning familial dans le cadre de la présidence française de l’Union européenne, adoptait à l’unanimité des dix-sept pays européens présents, une déclaration finale réaffirmant que “le droit à disposer de son corps est le socle fondamental permettant aux femmes de vivre dans une société égalitaire, plus juste, plus démocratique”. Cette déclaration lançait déjà un appel à la solidarité, à la vigilance extrême de l’ensemble des forces progressistes et citoyennes et à la création d’un réseau riche de nos différences et de notre volonté unitaire pour construire cette solidarité européenne, celle des femmes et des hommes libres et égaux.

Il est plus qu’urgent de mettre en œuvre cette déclaration car les femmes et les hommes qui luttent dans tous ces pays pour le droit de choisir et l’élargissement de la législation de l’avortement doivent être soutenus et défendus. La reconnaissance du droit fondamental des femmes à décider quand et si elles souhaitent avoir des enfants est aussi un enjeu de santé publique. Il en va de la démocratie européenne.

 

NOW IN SPANISH: GUTTMACHER VIDEO
ABORTION IN THE UNITED STATES

Myths and facts presented out of context are all too common in the U.S. abortion debate. Misinformation extends to even the most basic questions: Who are the women who obtain abortions? Why do they decide to end a pregnancy? What are their life circumstances?

The Guttmacher Institute addresses many of these questions in its video Abortion in the United States, which has received more than 82,000 views on YouTube since its launch in May 2011. We are now pleased to make this informative tool available in Spanish. El Aborto en los Estados Unidos aims to ensure that the debate around abortion is based on sound evidence and placed in the proper context of closely related issues like unintended pregnancy, contraceptive use and sex education.

 

 

in english:

 

en espanol:

The Special Rapporteur of the Human Rights Council, Anand Grover, has released a groundbreaking report on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

In this report, he states that ” Criminal laws penalizing and restricting induced abortion are the paradigmatic examples of impermissible barriers to the realization of women’s right to health and must be eliminated. These laws infringe women’s dignity and autonomy by severely restricting decision-making by women in respect of their sexual and reproductive health.”

This report will be presented at the General Assembly on October 24th.
http://www.un.org/ga/search/view_doc.asp?symbol=A/66/254

July 21, 2011 — Allowing women to obtain medication abortion services via telemedicine is equally effective and acceptable to patients as receiving the drugs during a face-to-face office visit, according to a study published in the journal Obstetrics and GynecologyMSNBC reports.

The report is among the first to study the effects of telemedicine abortion, which conservative lawmakers have increasingly targeted through legislation banning the practice. The research — led by Daniel Grossman, an assistant clinical professor of obstetrics and gynecology at the University of California-San Francisco and a senior associate at the research organization Ibis Reproductive Health — followed 578 women in Iowa who sought medication abortion services at Planned Parenthood clinics. According to Grossman, 223 of the patients elected to have the procedure via telemedicine and 226 chose face-to-face office visits.

Planned Parenthood of the Heartland has offered abortion services through telemedicine since 2008, allowing women living in rural areas without abortion providers to obtain abortion care early in pregnancy, MSNBC reports (Carroll, MSNBC, 7/20). Through the program, a woman seeking abortion care receives an ultrasound and examination from a nurse and then consults with a physician via the Internet on a private computer. If the physician determines that the patient is an appropriate candidate for medication abortion, he or she dispenses the medication remotely by pressing a button that opens a container with the drugs at the patient’s location (Women’s Health Policy Report, 5/24).

Many states stipulate that only physicians can provide medication abortion care and that they must counsel women before administering the pills. A few states allow nurse practitioners and other mid-level health care providers to dispense the medication, while at least five states recently enacted bans against using telemedicine for abortion services.

Study Findings

According to the study, medication abortion successfully terminated pregnancy in 99% of telemedicine patients and 97% of patients who received in-person care. There was no significant difference in complications between the two groups. Telemedicine patients were more likely to report satisfaction with their care, though 25% of telemedicine patients said after the procedure that they would have preferred being in the same room as the doctor.

Using telemedicine to provide abortion care has prompted objections from antiabortion-rights advocates, who claim the practice endangers women’s health. However, medical ethicist Arthur Caplan said this opposition has more to do with a desire to limit abortion access than with actual concern for women’s safety. “Clearly we don’t have enough primary care providers,” he said, adding, “One way to solve this is through telemedicine. We don’t want to be attacking that, we probably want to be celebrating it” (MSNBC, 7/20).

by Brady Swenson, RH Reality Check

May 26, 2011 – 10:14pm

 

May 27, 8:45am
The Wisconsin State Journal reports that Wisconsin police have arrested a 63-year-old man for planning an attack on a Planned Parenthood clinic.

A man who drove to Madison, Wisconsin to kill an abortion doctor faces federal charges for intending to attack a Planned Parenthood office in Madison, Wisconsin and murder abortion providers. Ralph Lang, 63, was arrested Wednesday night when his gun went off in his motel room not far from the Planned Parenthood clinic that he planned to attack Thursday. According to a criminal complaint filed Thursday in U.S. District Court Lang said he had a gun “to lay out abortionists because they are killing babies.”

A copy of the formal complaint filed against Lang is available here.

From the Wisconsin State Journal:

Lang said he planned on shooting the clinic’s doctor “right in the head,” according to the complaint. Asked if he planned to shoot just the doctor or nurses, too, Lang replied he wished he “could line them up all in a row, get a machine gun, and mow them all down,” the complaint said.

Teri Huyck, president and CEO of Planned Parenthood of Wisconsin, said the organization’s primary concern “today and everyday” is the health and safety of its patients, staff and volunteers.

“With the assistance of the Federal Bureau of Investigation and the Madison Police Department, we have taken the security precautions necessary to continue with our work,” she said.

Huyck extended gratitude to the law enforcement agencies working with Planned Parenthood so it can continue to be a “safe and trusted health care provider for Wisconsin women and families.”

by Carole Joffe, University of California

June 8, 2011 – 7:28am (Print)

This article is cross-posted from ANSIRH (Advancing New Standards in Reproductive Health), a website of the Bixby Center for Global Reproductive Health

It was the “of course” in Dr. Anja Hauge’s (not her real name) e-mail to me that was my first hint that when it comes to abortion, Norway and the United States exist in two different universes.

On a recent visit, I had asked a Norwegian colleague to arrange an interview for me with a physician involved in abortion provision. Dr. Hauge, a prominent gynecologist, agreed to meet with me, and in her introductory e-mail, mentioned that she worked in a large hospital department, where “we, of course, also provide abortions.”

“Of course”?! In the United States, to use “abortion,” “hospital” and “of course” in the same sentence is oxymoronic. Only about 5 percent of all abortions performed in the United States occur in hospitals, and even these relatively few procedures are increasingly under attack. The Republican-led Congress, in one of its first acts after taking control in January, passed the Orwellian-named“Protect Life” Act which stipulates that hospitals receiving federal funds are permitted to refuse abortions to women in life-threatening situations. Just recently, the House passed the so-called Foxx amendment, which would withhold newly available funds for comprehensive medical training from hospitals that provide abortion training.

When I met Dr. Hauge in person, my sense of being on a different planet intensified. To summarize our conversation:

  • Abortion is “completely integrated” into the Norwegian health care system, paid for (like other medical procedures) by the government, and available virtually everywhere in the country;
  • ob/gyn residents are expected to undergo training in abortion provision, and though opt-out provisions exist, very few young physicians make use of them;
  • health care professionals involved in abortion provision are neither sanctioned by medical colleagues nor harassed by anti-abortion activists.

Abortion, in short, is largely a non-politicized issue, both within Norwegian medical circles, and the population at large.

Comparing the two countries

On paper, interestingly, Norway’s abortion regulations appear to be somewhat stricter than those in the United States. Up through 12 weeks of pregnancy, abortion is routinely available. But between 12 and 18 weeks, a woman must go before a committee before obtaining an abortion, and after 18 weeks, abortions are only permitted in instances of threats to the life or health of the woman and serious or lethal fetal anomalies.

But it is only on paper, of course, that the U.S. situation is more liberal. One of three American women do not live in a county with a provider (several states are now down to one clinic); many women can’t pay for abortion and the majority of states do not permit use of public funding for abortion. (The search for money often pushes poorer women into later abortions, which are more expensive and even harder to find).  And, as the recent anniversary of the assassination of George Tiller reminds us, abortion providers are terrorized in this country in a way that leaves Norwegians incredulous—and of course, appalled.

But to my American ears, the most interesting part of our conversation came when we discussed the Norwegian committee system, which deals with requests for abortions after 12 weeks. When these requests are denied by local hospitals, there is an automatic appeal to a central committee. This central committee came into existence a little more than a year ago, because of the authorities’ concern about differing rates of turndowns across the country. Moreover, Dr. Hauge told me, every two years the Ministry of Health convenes a conference to which hospital representatives from all over the country come, to discuss abortion issues.

To be sure, the overwhelming majority of requests for abortions between 12 and 18 weeks are initially approved. Several gynecologists are frustrated with the need for committee approval starting at 12 weeks, and would prefer to see the limit raised to 16 or 18 weeks.  As Dr. Hauge put it, “It is humiliating for the woman and a waste of everyone’s time.” But hearing from her that there is a government body that “watches carefully” to assure that abortion policy is being carried out fairly made my head spin.

Norway ranks 1st in State of the World’s Mothers report; United States 31st

So how do Norway and the United States, two countries that legalized abortion at approximately the same time (the former in 1978, the latter in 1973), compare—not only with respect to abortion, but along the whole spectrum of reproductive health outcomes?

Norway, where abortion is freely available, subsidized by the government, and apparently not stigmatized, was recently named by a leading children’s advocacy group as “the world’s best place to be a mother” because of its family-friendly policies and excellent record of both maternal and infant mortality.

The United States, in contrast, notwithstanding the sanctimonious bows to motherhood by anti-abortion politicians, came in 31st—the worst of any developed nation, due mainly to its shameful record of both maternal mortality and under-five mortality.

Norway not only has a better record than the United States with respect to teenage pregnancies and births, but also has a lower abortion rate—a reflection, among other things, of Norwegians’ better access to contraception, its comprehensive sex education policies, and its generally more mature attitude toward human sexuality.

As I ended my interview with Dr. Hauge, I asked her, as I always do with U.S. physicians, if she wanted her name changed when I wrote about our encounter. She laughed apologetically and said, “It’s better if you change it. I’m not worried about Norwegians, but I don’t want some American (anti-abortionist) reading about me.”

When I returned to my hotel room after our meeting, I opened my computer to find that an arrest had been made in Wisconsin of yet another disturbed individual with plans to murder local abortion providers. Two different planets indeed.

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