"I would juggle speculums if they asked"

Do yourself a favor and read this long, funny, and compelling article by an abortion-provider-in-training. Some of my favorite excerpts:

It all breaks down to this: no one is immune to mistakes, whether it’s a mistake of their own making or (more likely) an end effect of the system, especially our fucked-up broken medical system I hate representing. (Sorry, system! Had to say it.) If you think I am making too many excuses for my patients, I will let you know that I am often one of the first people to make excuses for them in their lives and am happy to do so for no fee whatsoever. I would juggle speculums if they asked. I have not yet been asked to do this.

...

Up until recently I’d come out of any closet I found myself in — queer, non-monogamous, I fucking love Tool still, whatever — not that I live to hear the drink-choking sound, but because, to me, coming out was just one of the ways I could pay back the privileges that had been arbitrarily bestowed upon me (educated! white-appearing! “normal!”). My responsibility to normalize as much as I could. But training as an abortion provider is the first thing in my life that I hold back on spilling about. At the core of it, there’s a huge gap between saying “I had one” and saying “I do them.” I don’t want to alienate people. And nothing else I’ve ever done or been has felt like a direct invitation to a motivated someone out there to kill me and get away with it.

...

I speak of my abortion as a positive experience, not to secure the “most awesome abortion” prize (hello judges…?) but to save a seat for the possibility that this doesn’t have to be the worst thing that ever happened to you in your whole life. I don’t want it to in any way represent anyone else’s experience or make them feel disavowed of their own. So let me say: this is my personal experience with abortion! It was positive in every respect. It made me want to help other people also have as positive an experience as possible, so I went into the business. If you think that’s a bullshit line, or it makes you uncomfortable to think about abortion as something that could possibly be positive for a person, think of why you're a person who doesn't want someone to do the best that they can under the circumstances they're in.

If you read the whole thing, you'll learn about how she handles pro-life patients who come for abortions, her interaction with a female soldier who had to fly back from Afghanistan for an abortion, and her reflections on the distinction the law makes between MDs and advanced nurse-practitioners, just for this one fairly simple procedure. I am blown away by her compassion and courage. Please read it!

I found this post through my friend Melissa's new blog in the Feministing community. Melissa comments:

Approaching reproductive justice from a position of love and respect for women means that we recognize the varied experiences women have. Certainly, abortion is a difficult and even harrowing choice for some. But for others, abortion is a positive move forward on their journey to being the person, the partner, or the mother they want to become. If we ignore the positive experiences of those women, we’re adding to the stigma of abortion. To put it simply, although no woman wants an abortion, not every abortion is a tragedy.

Keep an eye out for more posts by Melissa! She is awesome.

The Stupak amendment.

[Note: I posted this yesterday, then heard an NPR piece that made me think I hadn't understood the Stupak amendment's restrictions. I was heading out the door, so I didn't have time to revise; I took the post down until I had time to research and make sure I was right. This is something I feel very passionate about and I wanted to make sure I was as accurate as possible. Slightly revised version below.]

I called, on Saturday, but what more could I do? Mostly I just tracked the news and crossed my fingers. The fact that this came out of nowhere (at least for me) and was over with in a day feels so utterly unfair.

In case you are not familiar with the Stupak amendment, it is part of the recently passed House version of the health care reform bill. The amendment restricts the ability of public and private insurance plans, offered in government health exchanges, to provide coverage for abortion.

Read that again: AND PRIVATE. This is where I was unclear yesterday, but it is clarified today by this extremely helpful post from legal experts at Planned Parenthood. I'm quoting it extensively because given what I heard on NPR yesterday, I think there is still some confusion out there about the realistic effects of the Stupak amendment on abortion coverage availability in the exchanges:

The Stupak-Pitts amendment prohibits any coverage of abortion in the public option and prohibits anyone receiving a federal subsidy from purchasing a health insurance plan that includes abortion. It also prohibits private health insurance plans from offering through the exchange a plan that includes abortion coverage to both subsidized and unsubsidized individuals.

Thus, if a plan wants to offer coverage in the exchange to both groups of individuals, it would have to offer two different plans: one with abortion coverage for women without subsidies and one without abortion coverage for women with subsidies. These private insurance plans would need to be identified as either providing or not providing coverage for abortion.

Health insurance plans are highly unlikely to operate in this manner, and it is not even clear that this is feasible under the administration of the exchange and affordability credits. As one alternative, the Stupak amendment purports to allow women to purchase a separate, single-service “abortion rider,” but abortion riders don’t exist. In the five states that only allow abortion coverage through a separate rider, there is no evidence that they are available.

Furthermore, women are unlikely to think ahead to choose a plan that includes abortion coverage, since they do not plan for unplanned pregnancy. In addition, it is not clear that health plans would even be allowed to offer two separate plans under other provisions of the act, such as the anti-discrimination and guaranteed-issue provisions. Those elements of the bill, which are very important to consumers, may make it impossible for plans to provide two separate plans, one that includes abortion and another that does not.

Realistically, the actual effect of the Stupak-Pitts amendment is to ban abortion coverage across the entire exchange, for women with both subsidized and unsubsidized coverage.

(emphasis mine)

Why the Stupak amendment? The argument is, as best I can tell, that those people who can't use all their own money to buy health insurance will be eligible for a government subsidy. This will probably be me at some point very soon (like after I graduate from school in May) so let's take me as an example. I could use the subsidy to buy a health insurance plan that covered abortion. Then I could use that money (along with my OWN!) to buy a private plan. Then, if I needed an abortion and that insurance plan covered it, the government would have somehow, indirectly, kinda sorta had a hand in making it possible for me to get a legal medical procedure.

Did I say legal medical procedure? I also meant abortion. They're the same thing, so sometimes I use them interchangeably.

We have had the Hyde amendment in place since 1977, exempting abortion from Medicaid. Poor women, expendable: check. Apparently health care reform is an opportunity to go even farther: to reach into PRIVATE health insurance, paid for with PRIVATE money, and effectively take abortion coverage out of that, too. This applies not just to individuals, but to businesses; companies that buy plans through the exchange? All their employees' families will lose any abortion coverage they had. All women, expendable: check.

The fact that this amendment comes from the party that has been ranting and railing about "government taking over health care" and using scare tactics like death panels and rationing of care...well, I guess irony has been dead to the Republican party for a long, long time, so we shouldn't be too surprised.

Besides women who need abortions, who else will this hurt? How about women who have miscarriages? Is maternity care next? Keep in mind, this comes from the same party that says health insurance shouldn't cover maternity care, because men don't need it.

This just...disgusts me. Last year I went to a talk by Dr. Nick Gorton and blogged about how he predicted this very outcome - that reproductive health care would be one of the issues to suffer when government stepped into health insurance. At the time, I mused about how we could protect abortion and other political hot button issues in health care reform - but reform seemed so theoretical. I guess I haven't been paying enough attention - but that's going to change. I agree, let's not just be satisfied with keeping Stupak out of the final bill - let's go after Hyde.

If you'd like to take further action now, this is a great place to start: While there's a wall of shame for Dems who voted for Stupak and against reform, there are some bright spots. Those are Democrats who voted AGAINST Stupak and FOR health care reform - despite being in highly vulnerable races next year. Click here to donate to those reps, reward their courage, help keep them in Congress, and send a message to the party: Do NOT allow the Stupak amendment into the final bill.

Feminists, reproductive rights, and VBAC

So Feministing also posted a link to the article on Joy Szabo's VBAC challenge, and the comments section has gotten - interesting. I don't want to say that every Feministing commenter is in fact a card-carrying feminist (what, you don't have a card? I keep mine in my wallet, it's laminated and everything!) but the reactions of some of the commenters really surprised me.

Despite my better judgment and a pile of other tasks I need to do today, I have gotten into the fray. It just raises my hackles when women who in many other contexts would aggressively question medical/legal authority and advocate for a woman's right to make choices about her own body go off on the "Well, if her DOCTOR says it why would she put HERSELF and everyone else at RISK" line. As if your reproductive autonomy ends when you choose to continue a pregnancy, and you must willingly hand your body over to the medicolegal system. As if VBAC access in no way equates to abortion access. As if it's OK for a hospital to threaten to get a court order for unnecessary surgery, because "She's the one who decided to get pregnant and decided to have a VBAC, so she's got to live with the consequences. The hospital has to protect themselves". I'm glad there are other commenters who see the irony here, but shocked that there are those who do not.

I have so much more to say about the relationship of feminists/the reproductive rights movement to birth, but that post would take longer than I have at the moment. Suffice it to say, I think reading the comments on that post is educational, if nothing else, and offers food for thought about how to appropriately illustrate to those in the movement that birth issues are not related to reproductive rights - they ARE part of reproductive rights and just as important as any other.

Who will lose under universal health care?

A lot of posts in the last couple days. I blame it on the end of semester crunch. I'm on the computer all the time to do work, and then I get distracted by Google Reader and start reading things that are more interesting than a final paper on teamwork, and...then I have to write about them.

At Stand and Deliver, Rixa is has just posted about discovering (at 8 1/2 months pregnant!) that her insurance company is going back on previous promises and will not cover her midwife. It got me thinking about a presentation I went to tonight by Dr. Nick Gorton. He does a lot of work in transgender health, and as part of our school's Trans Health Week (I know, how cool is that?) he came and gave a lecture. He discussed who covers sexual reassignment (hormone therapy, surgery) and who doesn't. Who does: a few city and state governments, some universities, some employers, Medicaid. Who doesn't: everyone else - including Medicare and the VA.

One of the things that really got me thinking was his discussion of what areas could be the big losers under universal health care. He had 4 main categories: reproductive health, transgender health, non-punitive drug treatment, and 1 other that I'm forgetting at the moment (sorry!)

Obviously we hope that in a single-payer system, evidence-based medicine (e.g. midwifery care, access to birth control) would prevail. It seems to have prevailed to a greater extent in countries with that system - because it's cost-effective. But there are a lot of special interests in this country - we already saw them at work with Medicare Part D (drug coverage), essentially holding a government insurance plan hostage to the pharmaceutical companies.

There are also a lot of political third rails that the government will hesitate to touch. "I don't want my tax dollars going to..." has already worked for abortions under Medicaid, and just this year for reproductive health care funding. What else could it work for?

I want universal coverage as much as the next person, but Dr. Gorton did get me thinking about what might be sacrificed. If you're a transgender person seeking sex reassignment surgery, you probably don't have coverage for it. But in our current system, at least there's the possibility that you do, or could in the future. In a single-payer system, it's all or nothing. And that goes for every other kind of coverage, too. How can we protect a single-payer plan from special interests and political hot buttons?

Why Birth is Fundamental Pro-Choice Issue

As my first real post, I'm going to re-post an entry from my personal blog. I wrote this a couple of months ago, and writing it was one of the moments where I thought "Man, I should have a blog about just this stuff." I really want people to understand how all of these issues - reproductive rights, reproductive health, birth, abortion, childcare subsidies, health insurance, public health initiatives - aren't just connected. They are the same thing.

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I could go on about this for hours, possibly days, but there is so much in the birth world right now that seems to be such a neat parallel to the fight for abortion rights - until you realize it isn't a parallel, it's the same thing. That's the reason I go to such amazing birth workshops at the Reproductive Rights conference every year: reproductive rights go all the way from birth control to birth. Right now, to me, there is almost no area in which we see the state exerting more control over women's bodies. This story isn't common, but I venture to say it's only because more woman don't challenge the system. Try to refuse an intervention at the hospital based on not just your own understanding of best practices, but on solid evidence from excellent research, and watch how fast they come at you with dire warnings that you are PUTTING YOUR BABY AT RISK. Even as small a thing as refusing continuous fetal monitoring - proven over and over again to do nothing to reduce risk to the baby, but plenty to increase risk of cesarean - means snippy, angry nurses, endless badgering, and the prevailing attitude that you think you're better somehow, but you're NOT, and why can't you be like all the OTHER nice, compliant women who strap on the belts and lie in bed - THEY love their babies, why don't you? I've never witnessed legal threats, but I think it's easy for this attitude to cross the line from emotional (and physical) manipulation to stronger forms of pressure.

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And in going back to that post to get the text, I saw that my friend Seth posted some questions for me a couple days later that I never saw. Sorry, Seth! On the other hand, they're really excellent questions and now I'm going to use the answers as my next post. He asked:

My instinct is that things can't be as simple as you and the author of the linked page seem to think, but I am very poorly educated on these issues, so let me just ask some questions:

1. If the obstetrician truly believed there was a serious risk to not performing a C-section, did he do the wrong thing? Did the hospital director? Did the judge? Did the sheriff?

2. If there is indeed a serious disconnect between the opinions of doctors on these issues and the consensus of the scientific community, how did it arise? How can it be fixed?

3. To what degree, if any, should the best outcome for the unborn child be taken into account if it is contrary to the wishes of the mother? (Whether the two actually are in conflict is not the issue for this question.)

All this really starts getting to the heart of how these issues are linked, and I am eager to start the discussion! That post will probably come in a couple days, as I have about 10 hours of driving to do in the next 24.