Let's say I'm a Jehovah's Witness, and I get a job in an understaffed
emergency room where, following the dictates of my conscience, I refuse
to assist with blood transfusions and try my best to persuade my fellow
workers to do the same. How long do you think I'd last on the job? And
after my inevitable firing, how seriously do you think a jury would take
my claim that my rights had been violated? Five minutes and not very,
right? A similar fate would surely await the surgeon who converts to
Christian Science and decides to pray over his patients instead of
operating on them, the Muslim loan officer who refuses to charge
interest, the Southern Baptist psychotherapist who tells his Jewish
patients they're bound for hell. The law rightly requires employers to
respect employees' sincerely held religious beliefs, but not if those
beliefs really do prevent an employee from performing the job for which
she's been hired.
Change the subject to reproductive rights, though, and the picture gets
decidedly strange. In 1999 Michelle Diaz, a born-again Christian nurse
who had recently been hired by the Riverside Neighborhood Health Center,
a public clinic in Southern California, decided that emergency
contraception, the so-called morning after pill that acts to prevent
pregnancy if taken within seventy-two hours of unprotected intercourse,
was actually a method of abortion. She refused to dispense it or give
referrals to other providers; the clinic offered her a position that did
not involve reproductive healthcare, but when she told temporary nurses
at the clinic that they too would be performing abortions by dispensing
EC, Diaz, who was still on probation as a new hire, lost her job. She
sued with the help of the American Center for Law and Justice (ACLJ),
the religious-right law firm headed by Jay Sekulow. At the end of May a
jury agreed that her rights had been violated and awarded her $47,000.
Excuse me? A nurse at a public health clinic has the right to refuse to
provide patients with legally mandated services, give out misleading
health information in order to proselytize her co-workers to refuse as
well, and keep her job? The low-income women who come to Riverside
desperately in need of EC and abortion referrals are flat out of luck if
they happen to turn up when the anti-choicers are on shift? Riverside is
the largest public health clinic in the county, serving 150-200 patients
a day, but it operates with a staff of four nurses--should those four
people decide what services the clinic can offer? What about the
patient's right to receive standard medical care? Or the clinic's
responsibility to deliver the services for which they receive government
Some states, California among them, have "conscience laws," permitting
anti-choice healthworkers to refuse to be involved in abortions. EC,
however, is just a high dose of regular birth control pills that
prevents ovulation and implantation. It is not abortion, because until a
fertilized egg implants in the womb, the woman is not pregnant. A long
list of medical authorities--the American Medical Association, the
American Medical Women's Association, the American College of
Obstetricians and Gynecologists and Harvard Medical School--agree that
EC is not an abortifacient, and a 1989 California court decision itself
distinguishes abortion from EC. There are lots of mysteries about the
Diaz case, ranging from why Diaz took a job she knew involved practices
she found immoral in the first place, to how the jury could possibly
have come up with a decision so contrary to law and public policy. Did
Diaz take the job with the express intention of disrupting services? Was
the jury anti-choice? Interestingly, the jury pool was partly drawn from
San Bernardino County, which last year unsuccessfully tried to bar its
public health clinics from dispensing EC.
Whatever the jury's thinking, the Diaz case represents the latest of
numerous attempts by the anti-choice movement to equate EC with abortion
and move it out of normal medical practice. Pharmacists for Life
International, a worldwide organization that claims to have some 1,500
members, calls it "chemical abortion" and urges pharmacists to refuse to
dispense it. The ACLJ is currently litigating on behalf of one who did.
Wal-Mart refuses to stock it at all. Anti-choicers in Britain made an
unsuccessful attempt to prevent EC from being dispensed over the counter
by placing it under an archaic law that prohibits "procuring a
miscarriage." Some anti-choicers have long argued that not just EC but
conventional birth-control methods--the pill, Norplant, Depo-Provera and
the IUD--are "abortifacients": In northern Kentucky anti-choice
extremists are campaigning to force one local health board to reject
Title X family-planning funds; according to the Lexington
Herald-Leader, the board's vote, scheduled for June 19, is too
close to call.
Although secular employers are expected to make reasonable
accommodations to religious employees--or even, if the Diaz verdict is
upheld, unreasonable ones--religious employers are not required to
return the favor. On the contrary, the Supreme Court, in The Church
of Jesus Christ of Latter Day Saints v. Amos, permits them to use
religious tests to hire and fire personnel as far from the sacred
mission as janitorial workers; if a Methodist church wants to refuse to
hire a Muslim security guard, it has the blessing of the Constitution to
do so. As often noted in this column, religious organizations can and do
fire employees who violate religious precepts on and even off the job. A
pro-choice nurse could not get a job at a Catholic hospital and declare
that her conscience required her to go against policy and hand out EC to
rape victims, or even tell them where to obtain it--even though medical
ethics oblige those who refuse to provide standard services for moral
reasons to give referrals, and even though Catholic hospitals typically
get about half of their revenue from the government.
According to the ACLJ, however, secular institutions should be sitting
ducks for any fanatic who can get hired even provisionally. The
Riverside clinic has asked the judge to set aside the Diaz verdict. If
that bid is unsuccessful, it will appeal. I'll let you know what
President Dubya loves to crusade against the "axis of evil" in his war on terrorism--but he formed an unholy alliance with the countries that make up the "axis" to declare war on the condom as a
As chairman of the fifty-nine-member Congressional Progressive Caucus and
potential candidate for the Democratic
presidential nomination, Ohio Congressman Dennis Kucinich has been quite
visible lately. At a time when few Democrats are daring to question the
war aims of the Bush Administration--or even to ask what they
are--Kucinich has spoken eloquently against the Patriot Act, the ongoing
military buildup and the vague and apparently horizonless "war on
terrorism." From tax cuts for the rich and the death penalty (against)
to national health insurance and the environment (for), Kucinich has the
right liberal positions. Michael Moore, who likes to rib progressives
for favoring white wine and brie over hot dogs and beer, would surely
approve of Kucinich's man-of-the-people persona--he's actually a New
Age-ish vegan, but his website has a page devoted to "Polka, Bowling and
One thing you won't find on Kucinich's website, though, is any mention
of his opposition to abortion rights. In his two terms in Congress, he
has quietly amassed an anti-choice voting record of Henry Hyde-like
proportions. He supported Bush's reinstatement of the gag rule for
recipients of US family planning funds abroad. He supported the Child
Custody Protection Act, which prohibits anyone but a parent from taking
a teenage girl across state lines for an abortion. He voted for the
Unborn Victims of Violence Act, which makes it a crime, distinct from
assault on a pregnant woman, to cause the injury or death of a fetus. He
voted against funding research on RU-486. He voted for a ban on dilation
and extraction (so-called partial-birth) abortions without a maternal
health exception. He even voted against contraception coverage in health
insurance plans for federal workers--a huge work force of some 2.6
million people (and yes, for many of them, Viagra is covered).
Where reasonable constitutional objections could be raised--the lack of
a health exception in partial-birth bans clearly violates Roe v.
Wade, as the Supreme Court ruled in Stenberg v.
Carhart--Kucinich did not raise them; where competing principles
could be invoked--freedom of speech for foreign health organizations--he
did not bring them up. He was a co-sponsor of the House bill outlawing
all forms of human cloning, even for research purposes, and he opposes
embryonic stem cell research. His anti-choice dedication has earned him
a 95 percent position rating from the National Right to Life Committee,
versus 10 percent from Planned Parenthood and 0 percent from NARAL.
When I spoke with Kucinich by phone, he seemed to be looking for a way
to put some space between himself and his record. "I believe life begins
at conception"--Kucinich was raised as a Catholic--"and that it doesn't
end at birth." He said he favored neither a Human Life Amendment that
would constitutionally protect "life" from the moment of conception, nor
the overturning of Roe v. Wade (when asked by Planned Parenthood
in 1996 whether he supported the substance of Roe, however, he
told them he did not). He spoke of his wish to see abortion made rare by
providing women with more social supports and better healthcare, by
requiring more responsibility from men and so on. He presented his votes
as votes not against abortion per se but against federal funding of the
procedure. Unfortunately, his record does not easily lend itself to this
reading: He voted specifically against allowing Washington, DC, to fund
abortions for poor women with nonfederal dollars and against
permitting female soldiers and military dependents to have an abortion
in overseas military facilities even if they paid for it themselves.
Similarly, although Kucinich told me he was not in favor of
"criminalizing" abortion, he voted for a partial-birth-abortion ban that
included fines and up to two years in jail for doctors who performed
them, except to save the woman's life. What's that, if not
"I haven't been a leader on this," Kucinich said. "These are issues I
would not have chosen to bring up." But if he plans to run for
President, Kucinich will have to change his stance, and prove it, or
kiss the votes of pro-choice women and men goodbye. It won't be enough
to present himself as low profile or, worse, focused elsewhere (he voted
to take away abortion rights inadvertently? in a fog? thinking about
something more "important" than whether women should be forced to give
birth against their will?). "I can't tell you I don't have anything to
learn," Kucinich told me. OK, but shouldn't he have started his
education before he cast a vote barring funds for abortions for
women in prison? (When I told him the inhumanity of this particular vote
made me feel like throwing up--you're not only in jail, you have to have
a baby too?--he interjected, "but there's a rape exception!") Kucinich
says he wants to "create a dialogue" and "build bridges" between
pro-choicers and anti-choicers, but how can he "heal divisions" when
he's so far on one side? The funding issue must also be squarely faced:
As a progressive, Kucinich has to understand that denying abortion
funding to poor women is as much a class issue as denying them any other
kind of healthcare.
That a solidly anti-choice politician could become a standard- bearer
for progressivism, the subject of hagiographic profiles in The
Nation and elsewhere, speaks volumes about the low priority of
women's rights to the self-described economic left, forever chasing the
white male working-class vote. Supporting an anti-choice Congressman may
have seemed pragmatic; trying to make him President would be political
suicide. Pregnant prisoners may not vote, but millions of pro-choice
* * *
Once again, the Bosnian Initiative Frankfurt, a German human rights
group, is organizing summer camps on the Adriatic for displaced Bosnian
and Kosovar children of all ethnicities. For several years now,
Nation readers have contributed generously to the BIF and have
made it possible for many children from the former Yugoslavia to have a
holiday from war, poverty and ethnic hatred. $125 sponsors a child for
two weeks, but donations in any amount are welcome. Checks payable to
Bosnian Initiative Frankfurt can be sent to me c/o The Nation, 33 Irving
Place, New York, NY 10003; I will forward them, with many thanks.
It may look as if domestic politics no longer exists in the new America--the one in which there is no money for anything besides guns and prisons but we don't care because we are all bowling together against the Axis of Evil. But that's not true. As long as there is a fertilized egg somewhere in this great land of ours, there will be domestic politics. George Bush may not be able to bring about the Kingdom of Heaven on Earth for the religious right, who gave him one in four of his votes. He may even realize that a serious victory for religious conservatives--significantly restricting the legality of abortion, say--would hurt the Republican Party, because California has more people than Utah. But he is doing what he can to keep the fundamentalists happy.
It must be frustrating for him--just when we're all supposed to pretend to love our differently faithed neighbor even if we know he's bound for hell, Christians keep saying weird things. First there was Jerry Falwell's remark that God let terrorists blow up the World Trade Center because he was fed up with "the pagans, and the abortionists, and the feminists, and the gays and the lesbians...[and] the ACLU"; Falwell apologized, only to express the same thought a bit more obliquely on November 11 at a Florida church: "If the church had been awake and performing that duty"--proselytizing the ungodly--"I can tell you that we wouldn't be in the mess we're in today." God, says Falwell, "even loves the Taliban"--it's just liberals he can't stand.
And then there's Attorney General John Ashcroft, who burqaed the semi-nude statue of the Spirit of Justice because he felt upstaged by her perky breast at press conferences, and who thinks calico cats are emissaries of the devil, when everyone knows it's black cats. Ashcroft is in trouble with Arab-Americans for offering this proof of the superiority of Christianity to Islam as quoted by conservative columnist Cal Thomas on his radio show on November 9 (and belatedly denied by a Justice Department spokeswoman): "Islam is a religion in which God requires you to send your son to die for him. Christianity is a faith in which God sends his son to die for you." Not to get too wound up in theology here, but if the Christian God sent his own son to die doesn't that make him, according to Ashcroft's definition, a Muslim?
Fortunately, the fertilized egg can be rolled onstage to distract us from such knotty questions. In keeping with the strategy of rebranding antichoice as prochild, the Bush Administration plans to use the CHIP program for poor children to provide healthcare to children "from conception to age nineteen," a neat way of defining zygotes as kids. The women in whom these fine young people are temporarily ensconced will remain uninsured--perhaps they can apply for federal funds by redefining themselves as ambulances or seeing-eye dogs. After all, somebody has to get those fetuses to the doctor's office. As for the 8 million uninsured postbirth children, not to mention the 27 million uninsured adults, who told them to leave the womb?
But wait, there's more. In a highly unusual move, the Justice Department has weighed in on the side of Ohio's "partial-birth abortion" ban, which has been on ice thanks to a federal court ruling that found it did not make enough allowance for a woman's health, as required by the 2000 Supreme Court decision in Carhart v. Nebraska. The Ohio law would permit the operation only to save her life or avoid "serious risk of the substantial and irreversible impairment of a major bodily function." Gee, what about considerable risk of moderate and long-term impairment of a bodily function of only middling importance? Should the Ohio state legislature (seventy-five men, twenty-four women) decide how much damage a woman should suffer on behalf of a fetus? Shouldn't she have something to say about it?
To please fanatical antichoicer Representative Chris Smith of New Jersey, Bush is holding back $34 million from UN family planning programs. To return the favor, Congressional Republicans have revived the Child Custody Protection Act, which would bar anyone but a parent from taking a minor across state lines for an abortion. The parental-notification-and-consent laws of a pregnant teen's home state would follow her wherever she goes, like killer bees, or the Furies--and unlike any other law.
Bush is also stacking with social conservatives commissions that have nothing to do with abortion per se but raise issues of sex, gender and reproduction. The cloning commission, called the Council on Bioethics (fourteen men, four women), is headed by bioethicist Leon Kass, a former opponent of in vitro fertilization who's associated with the American Enterprise Institute. There's room around the table for antichoice columnist Charles Krauthammer; antichoice law professor Mary Ann Glendon, the Vatican's representative at the UN conference on women, in Beijing; and social theorist Francis Fukuyama, who wrote in a New York Times Op-Ed that the thirty-years-overdue introduction of the pill in Japan in 1999 spelled the downfall of the Japanese family, because now women will just run wild. But there are only four research scientists, and no advocates for patients with diseases that the cloning of stem cells might someday help cure. Similarly, the newly reconfigured AIDS commission is said to be stacked with religious conservatives and will be headed by former Representative Tom Coburn, whose claim to fame is his rejection of condoms, which sometimes fail, in favor of "monogamy," which never does.
Finally, there's the nomination of Charles Pickering for the Court of Appeals for the Fifth Circuit. Rated unqualified by the Magnolia Bar Association of Mississippi. Pickering, an ardent segregationist when it counted, opposed the ERA, has been a lifelong opponent of legal abortion and won't discuss his antichoice record in Senate hearings. The Fifth Circuit includes Texas, Louisiana and Mississippi, states where the right to abortion is already compromised by conservative legislatures; in l999 Texas tied with Michigan for most new antichoice laws enacted (seven). Traditionally the federal courts offer hope of redress for victims of state laws--in this case, some of the poorest women in the country. What are the chances that Pickering will champion their rights and their health?
My money's on the fertilized egg.
Despite statements to the contrary, the rule is resulting in tragic circumstances for women abroad.
When a renowned abortion doctor opened a clinic in Ocala, Florida, he was seen as a public pest. So local authorities used the courts to get rid of him.
In many respects, the recent meeting in Chicago of the National Abortion Federation (NAF), the major professional association of abortion providers in North America, looked like any other medical gathering. Participants wearing name tags attended workshops, engaged in lively debate about medical innovations in their field, examined the exhibits set up by vendors and greeted old friends and colleagues.
But in other ways this was not a typical medical conference. Security was tight, with guards checking registration badges and conferring on walkie-talkies. Along with presentations on "Vaginal Ultrasound Assessment" and "Monitoring Chorionic Gonadotropin Levels After Mifepristone Abortion" were sessions on "Ensuring the Rights of Minors: Making Your Judicial Bypass Work" and "Understanding FACE (Freedom of Access to Clinic Entrances) and How to Invoke Its Protection." One of the keynote speakers was an FBI agent who played a key role in the apprehension of James Kopp, the fugitive accused of murdering Dr. Barnett Slepian, an abortion provider in Buffalo, New York, in 1998, and of wounding several other physicians.
While NAF meetings always display this surreal combination of conventional medical components and vivid reminders that abortion is the most politicized--and besieged--branch of medicine in the country, this year the atmosphere was especially tense. The fact that the reliably prochoice Clinton-Gore team is gone, replaced by an Administration that is deeply, and cleverly, hostile to abortion, seemed to hover over every conversation. As abortion providers well know, even if Roe v. Wade is not overturned, abortion access can be eviscerated by its enemies. Here are just some of the Bush Administration's initial steps in that direction:
§ As Attorney General, John Ashcroft, one of the most fanatically antiabortion senators in history, is charged with protecting the safety of abortion providers and patients. Despite repeated assertions at his confirmation hearings that he accepts Roe as "settled law," no one expects him to continue with the forceful and active steps that his predecessor, Janet Reno, took to combat antiabortion terrorism. Ashcroft will also play a key role in judicial appointments. While public attention has inevitably focused on the Supreme Court, judges appointed to lower federal courts have an enormous impact on abortion provision, ruling in such diverse areas as waiting periods, legislatively mandated scripted counseling for abortion patients, interpretations of permissible buffer zones outside clinics (areas that may be kept free of protesters) and on any revisitation of "partial birth" abortion bans.
§ Secretary of Health and Human Services Tommy Thompson sent chills down the NAF community's collective spine when he announced at his confirmation hearings that he would call for a "review" of the FDA's approval last fall of the "abortion pill," RU-486 (mifepristone). Also, antiabortion Congressmen have introduced the Patient Health and Safety Act (PHSA), a bill that seeks to restrict distribution of the drug by prohibiting anyone other than physicians who provide surgical abortions from dispensing it, thereby thwarting its promise to improve access in underserved areas. Thompson's threatened "review" would likely do the same.
For now, Thompson appears to be holding off on such a review. The Administration has not yet named an FDA commissioner, most likely because of the hot-button politics of mifepristone approval. And it is not clear whether the PHSA will pass the Senate. But uncertainty over the fate of this drug is hampering the campaign to disseminate it. Prospective abortion pill providers face a host of other challenges as well: arranging malpractice insurance and managed care reimbursement, conforming to legal requirements (parental notification, waiting periods, etc.). As a result, nearly all those currently offering the drug are surgical providers.
§ The Unborn Victims of Violence Act, passed by the House on April 26, makes it a federal crime to injure or kill the fetus of a pregnant woman. Even though the act specifically exempts abortion, the prochoice community widely views it as a crucial first step in a campaign by abortion opponents to secure the status of "personhood" for the fetus (and indeed, embryos and blastocysts). As one lawyer at the NAF meeting told me, "Fertilized cells will have the same legal status as a woman, and eventually this will threaten various forms of birth control as well as abortion." George W. Bush has voiced his eagerness to sign the bill into law.
And what of the Supreme Court? Amid the rumors of the possible retirement of one or more Justices this summer, the stakes are high for abortion providers--and for Bush as well. Given the public's split on the issue, Bush risks alienating a sizable number of voters no matter what he does. (Despite people's discomfort with abortion, polls show that a majority wants to see Roe stand.) One likely scenario is that Bush will nominate a "stealth" antichoicer--one with no paper trail on abortion--and then try to prevent an abortion case from reaching the Court before the 2004 election.
How can the abortion rights movement respond? Lucinda Finley, a law professor at SUNY, Buffalo, says, "The movement must convince senators to announce that they will not confirm someone who is unwilling to state his or her position on Roe." The Feminist Majority urges a filibuster against any nominee not committed to preserving Roe (see www.million4Roe.com). Whether prochoicers have such political capital remains to be seen. The recent abortion rights march in Washington, whose timing unfortunately conflicted with Earth Day and Quebec demonstrations as well as the NAF meeting itself, attracted a disappointing turnout and almost no media attention.
As the rest of the movement awaits the Court showdown, abortion providers continue to endure countless hassles just to open the doors of their clinics each day. Many states have imposed TRAP--"targeted restrictions against abortion providers"--laws consisting of cumbersome rules, directed only at abortion facilities, regulating such matters as door width and air flow. Even those in states without TRAP laws face constant battles with landlords who try to evict them, vendors under pressure not to service them and frequent threats of violence. The community of providers, which has shown an extraordinary ability to carry on its work with humor and bravery even in such unacceptable circumstances, is gearing up for a long fight.
The arrest in France of James Kopp, the accused assassin of Buffalo obstetrician Barnett Slepian, could not have come at a more awkward time for the Bush Administration. Bush inaugurates himself by blocking aid to international family planning agencies and by nominating antiabortion fanatics to run the Justice Department. Then fugitive Kopp surfaces to remind the American public of where
these bottom-line commitments lead.
In 1994 Bill Clinton's Justice Department initiated a grand jury inquiry into
abortion-clinic violence. But FBI agents grumbled that Justice was
wasting their time, and the grand jury folded its tent in January of
1996 after finding no evidence of a national conspiracy. Five years
later, it's clear that Kopp--accused in three nonfatal shootings in
Canada and the United States in addition to the murder of Dr.
Slepian--had a lot of help, the kind of help for which "conspiracy"
is the operative legal term.
So far, investigators have
arrested two antiabortion felons in Brooklyn--Dennis Malvasi,
convicted of a 1987 clinic bombing in Manhattan, and Loretta Marra,
who blockaded clinics with Kopp. They sent Kopp money and stayed in
touch with him through a Yahoo drop box. The circle is almost
certainly wider--and transnational. For the past year Kopp lived in
Ireland, bunking in hostels and mingling with the fundamentalist
breakaway Catholic sect founded by excommunicated Archbishop Marcel
Lefebvre. Kopp managed to acquire at least two separate Irish
identities and passports for himself and a blank Irish passport and
birth certificates for his New York friends, and someone in Ireland
vouched for his references for an employment agency--all of which
makes it obvious that his was not a solo act. Ireland's right-to-life
leaders deny any connection to the assassin, and it's entirely
possible that his support network was American. In the last
half-decade US antiabortion campaigners have moved on Ireland in a
big way, introducing a militancy previously unknown
Speculation necessarily swirls around the followers
of the Rev. Patrick Mahoney of the Washington-based Christian Defense
Coalition. In March 1999 Mahoney led a brigade of forty Americans to
Dublin, where they occupied the offices of the Irish Family Planning
Association and taught their Irish counterparts all-American
blockade-and-intimidation techniques. Indeed, only a day before
Kopp's arrest, Mahoney was slapped with an Irish court injunction
prohibiting him from further harassing the IFPA. Mahoney had tolerant
words in 1997 after Slepian's shooting, and responded to Kopp's
arrest by warning the Bush Administration not to "harass and
intimidate the pro-life movement."
It can't escape notice
that the Kopp conspiracy began to unravel just as the Court of
Appeals for the Ninth Circuit overturned a jury verdict and
injunction on the Nuremberg Files website, which displays
photos of abortion providers and a list with a strike through the
names of assassinated physicians. On March 28 the Ninth Circuit
unanimously found, in the words of presiding Judge Alex Kozinski,
that if the website's rhetoric "merely encouraged unrelated
terrorists," it is protected by the First Amendment.
Michelman of NARAL called the ruling "a major setback for a woman's
right to choice," and along with Planned Parenthood vowed to pursue
the case to the Supreme Court. To me, Kopp's overdue arrest suggests
a different conclusion. There can be no doubt that the Nuremberg
Files website contributed to a climate of fear--that the website
is the theory and James Kopp's rifle is the practice. Yet the
emerging facts of Kopp's flight make it clear that keeping The
Nuremberg Files off the Internet would not have saved Dr. Slepian
or brought the shooter to justice. The important thing is to
investigate real antichoice gangsterism, real shootings, real escape
routes. The important thing is to insist on the continuity between
Kopp and the "respectable" antiabortion agenda of the White House.
Bush and Ashcroft have been assiduously working to accomplish by
executive order what Kopp attempted with a gun: diminishing the
availability of abortion and thus undermining a civil right. This,
and the climate of fear generated by clinic violence, must be fought
with politics, not censorship. And the recent rise of police
surveillance aimed at antiglobalization protesters only makes more
clear the danger of prosecuting an inflammatory publication as if it
were the hand that smashed the windowpane or pulled the
Kopp's arrest is full of ironies. The most
antichoice Attorney General in US history is now stuck prosecuting an
antichoice assassin; an Administration wild about the death penalty
must forgo capital punishment to secure Kopp's extradition because
France opposes it. It would be a final, and tragic, irony if
prochoice advocates permit antiabortion thugs like Mahoney to play
the martyr--drawing attention away from the very violence they have
A woman two months pregnant goes to see her Ob-Gyn for prenatal care. As required by law, her doctor informs her that her condition places her at greater risk for a wide range of medical problems: hypertension and diabetes if she is overweight; complications of surgery if, like one in four women, she has a Caesarean section; permanent weight gain with its attendant problems, including heart disease; urinary tract infections and prolapsed uterus if she has had multiple pregnancies; postpartum depression or psychosis, leading in rare cases to suicide or infanticide; not to mention excruciating childbirth pain, stretch marks and death. There are ominous social possibilities, too, the doctor continues, reading from his state-supplied script: increased vulnerability to domestic violence; being or becoming a single mother, with all the struggles and poverty that entails; job and housing discrimination; the curtailment of education and professional training; and lowered income for life.
No state legislature would compel doctors to confront patients with the statistical risks of childbearing, serious though they are; a doctor who did so on his own would strike many as intrusive, offensive and out of his mind. Should a woman seek abortion, however, anti-choicers are pushing state laws requiring that she be informed of a risk most experts do not believe exists: a link between abortion and breast cancer. Like the supposedly widespread psychological trauma of abortion, which even anti-choice Surgeon General Dr. C. Everett Koop was unable to find evidence of, the abortion-breast cancer connection is being aggressively promoted by the anti-choice movement. (Even Mother Jones, always quick to take feminists down a peg, leapt on this bandwagon, with an April/May 1995 piece entitled "Abortion's Risk.")
"It's yet another example of efforts to encumber this legal choice and make it more difficult and painful for women," says Dr. Wendy Chavkin, professor of public health and clinical obstetrics and gynecology at New York's Columbia Presbyterian Hospital, and editor in chief of the Journal of the American Medical Women's Association. It's also an attempt by anti-choicers to reframe their opposition to abortion as concern for women's health, something not usually high on their list. These are, after all, the same people who fight health exceptions to "partial birth" abortion bans and who have successfully prevented poor women from receiving medically necessary abortions with Medicaid funds.
Nonetheless, such is the power of the anti-choice movement that laws have been passed in Montana and Mississippi, and bills are pending in fifteen other states, mandating a breast cancer warning (and in some cases, a waiting period for it to sink in). Along with laws come lawsuits: In Fargo, North Dakota, the Red River Women's Clinic is being sued for failing to give such a warning; a 19-year-old Pennsylvania woman is suing a New Jersey clinic for her abortion two years ago, which left her, she claims, with an overwhelming fear of contracting breast cancer. In ferociously anti-choice Louisiana, a new law permits women to sue for damages--including damages to the fetus!--up to ten years after their abortion. Given today's high rates of breast cancer, a deluge of litigation is in the making.
Does abortion cause breast cancer? Some studies have appeared to suggest a connection: Dr. Janet Daling, for example, an epidemiologist who says she is pro-choice, compared the abortion histories of 1,800 women with and without breast cancer and found that, among those who had been pregnant at least once, the risk of breast cancer was 50 percent higher for those who had abortions--but her cancer-free sample was obtained through telephone interviews with women chosen at random from the phone book. Not everyone has a phone, of course, which raises questions about the comparability of the samples, and besides, how many women would volunteer information about their abortion history to a voice on the phone? Like other studies showing a link, this one was marred by "recall bias": Cancer patients are more likely to volunteer negative information about themselves than healthy people. They are looking for an explanation for a disease--and one many feel must somehow be their fault. Demographic studies, which are free from recall bias, produce different results: Lindefors Harris, analyzing the national medical database of Swedish women in 1989, found that women did deny their abortions, that breast cancer patients were less likely to do so--and that women who had had abortions were less likely to get breast cancer. The largest study to date, of 1.5 million Danish women, found no correlation.
"The supposed link between breast cancer and abortion is motivated by politics, not medicine," says Dr. David Grimes, clinical professor of obstetrics and gynecology at the University of North Carolina. "The weight of the evidence at this time indicates no association. To force this on women is just cruel." Indeed, the National Cancer Institute, the American Cancer Society and the World Health Organization, none of which have an ax to grind, reject the notion. The standard medical textbook, Diseases of the Breast, concurs. The main figure advocating the link is Dr. Joel Brind, professor of biology and endocrinology at Baruch College, who has done no original research on this issue but is a tireless anti-choice propagandist--plug "abortion breast cancer" into a search engine and the top half dozen sites are his.
Abortion is just about the only medical procedure in which doctors and patients are hemmed about by lawmakers. No other operation has legally mandated waiting periods, although many are dangerous, life-altering and irreversible; with no other operation are doctors legally required to give specific information--certainly not information that the vast preponderance of medical opinion believes to be false or at best unproven. Good medical practice calls for discussion of the pros and cons of particular courses of treatment, not burdening the patient's choice with unsubstantiated fears. Will we ever see a law requiring doctors to tell pregnant patients that abortion is statistically safer than carrying to term--which it is? Sure, the day state lawmakers put a waiting period on Viagra prescriptions, to let male patients really consider whether an erection is worth a heart attack.