LeRoy Carhart is determined to train as many late-term-abortion providers as possible—or the practice just might die with him.
Full Article
By Sarah Kliff | NEWSWEEK
Published Aug 15, 2009
From the magazine issue dated Aug 31, 2009
Leroy Carhart was at his abortion clinic near Omaha when he got the phone call. It was Sunday morning, a little after 10, and the doctor was in surgery. He felt his cell phone vibrate. Carhart ignored it, finishing the abortion before checking his phone. The number for George Tiller's head nurse in Wichita, Kans., flashed on the screen. The timing was unusual; Carhart didn't often hear from Tiller on Sunday mornings. He thought it might have to do with a patient, maybe an emergency. But when Carhart called back, Tiller's nurse was crying. "George is dead," she told him through sobs, relaying the news that Tiller, the late-term-abortion provider, had been fatally shot at his Lutheran church.
Carhart was scheduled to work in Tiller's clinic the next day; he was one of three abortion doctors who took turns assisting there. His car was already packed for the five-hour drive from Omaha to Wichita he'd made every third Sunday for the past five years. Carhart decided he would still go, to see Tiller's family and help figure out what would happen to the clinic. But first he would see the patients at hand. His waiting room, after all, was full of women who'd crossed state lines and waited hours to see him. "I didn't have any time to sit here and feel sorry for myself," says Carhart. He hung up the phone, went back into the operating room, performed another abortion. By day's end, he had seen a dozen women.
Carhart knows there are people who want him dead, too. A few days after Tiller's murder, Carhart's daughter received a late-night phone call saying her parents too had been killed. His clinic got suspicious letters, one with white powder. It's been like this since Carhart started performing abortions in the late 1980s. On the same day Nebraska passed a parental-notification law in 1991, his farm burned down, killing 17 horses, a cat, and a dog (the local fire department was unable to determine the fire's cause). The next day his clinic received a letter justifying the murder of abortion providers. His -clinic's sidewalks have been smeared with manure. Protesters sometimes stalk him in airports. The threats, the violence, now the assassination of his close friend—all of it has left Carhart undaunted, and the billboard-size sign over his parking garage still reads, in foot-high block letters, ABORTION & CONTRACEPTION CLINIC OF NEBRASKA. "They're at war with us," says Carhart of the anti--abortion activist who killed Tiller. "We have to realize this isn't a difference of opinions. We need to fight back."
What makes Carhart such a target isn't just that he performs abortions—about 1,800 doctors do so today—but that he is among the very few still willing to do so late into pregnancy. Only 1.3 percent of abortions happen after the 21st week of pregnancy, according to the Centers for Disease Control. But those procedures have become the focus of intense debate. To pro-choicers they are tragic stories of late-discovered anomalies, with heroic doctors terminating a fetus that wouldn't survive long after birth. To pro-lifers they are morality tales that best prove the point about all abortion. "I don't support any abortions, but I think third-trimester abortions are particularly abhorrent," says Nebraska's attorney general, Jon Bruning, who has publicly called Carhart "one sick individual" and vowed to act on any evidence that would warrant an investigation. In the third trimester, Bruning says, abortion is "not only morally abhorrent but visually and physically abhorrent. You have a child with arms and legs."
A public-opinion poll in May found 68 percent of Americans support Roe v. Wade's comprehensive protection of elective, first-trimester abortion. But the farther along a pregnancy gets and with each biological milestone a fetus passes, the numbers drop and Americans become more cautious and conflicted. Around 24 weeks, when the fetus is likely viable outside the womb, the right to terminate becomes most controversial and abortion least accessible. Roe recognized the unique status of late-term abortions and gave states the power to restrict or disallow abortion when the fetus is viable (with an exception for "the preservation of the life or health of the mother").
Past viability, no doctor will terminate a pregnancy without a compelling reason. But what is a compelling reason, and who decides? Some would count a serious fetal abnormality, mental or physical; others would not. What if the baby has a 50 percent chance of surviving outside the womb? A 30 percent chance? While most of us navigate these questions in theory, Carhart deals with them in practice. At Tiller's clinic, he saw a rape victim in the third trimester of pregnancy. Every time she felt the baby move, she said, it brought back the rape all over again. She'd made three suicide attempts. Carhart performed her abortion. "If a woman is going to kill herself, then I think you have to look at it for her health," he says. The day before Tiller's death, a woman came into Carhart's Nebraska clinic 28 weeks along. Carhart asked her what she would do if she had to carry the baby to term. "She didn't say she was going to kill herself," he says. "She said she would put it up [for adoption]." He turned her away.
Carhart has a few firm lines; he won't, for example, do elective abortions past 24 weeks, because the fetus is likely viable. "It just makes sense to me," says Carhart. "After a certain point in time, the fetus is viable and we have to look at it differently than if it were not viable." And at 24 weeks, many studies show a fetus's chance of survival to be above 50 percent. Any earlier and the survival rate is lower; at 22 weeks it's less than 10 percent. But Carhart admits that such clear guidelines rarely present themselves. "There are times when abortion is the right answer," he says. "There are times when abortion is not the right answer. I hope I get it right."
Thursday, August 20, 2009
Monday, August 3, 2009
Italy approves RU-486 abortion pill
Philadelphia Inquirer
August 1, 2009
The long-debated move drew Vatican warnings of excommunication for doctors and patients.
By Alessandra Rizzo
Associated Press
ROME - Italy has approved the use of the abortion drug RU-486, capping years of debate and defying opposition from the Vatican, which warned of immediate excommunication for doctors prescribing the pill and for women who use it.
The pill is already available in a number of European countries. Its approval by Italy's drug-regulation authorities was praised by women's groups and abortion-rights organizations, which say the pill will provide women with an additional, noninvasive procedure.
It drew the immediate protest of the Catholic Church, which opposes abortion and contraception.
"That's not how you alleviate human suffering, that's not how you help women, that's not how you help mankind," Monsignor Elio Sgreccia, a senior church bioethicist, said yesterday.
The Italian Drug Agency ruled after a meeting that ended late Thursday that the drug, which terminates pregnancy by causing the embryo to detach from the uterine wall, cannot be sold in pharmacies; it can be administered only by doctors in a hospital.
The agency said in a statement that the pill can be taken only up to the seventh week of pregnancy - not up to the ninth, as is the case in other countries. Women who used the pill between the seventh and the ninth week of pregnancy incurred more risks and had often needed surgery, it said.
The decision is expected to go into effect in about two months, the agency said.
In a nod to the ethical implications associated with the decision and the controversy surrounding it, the agency noted that "the task of protecting the well-being of citizens . . . must take precedence over personal convictions."
The 4-1 vote at the agency's executive branch comes about two years after it started looking at the issue. The pill became available in some parts of Italy on an experimental basis in 2006.
For the Catholic Church, the decision was the latest defeat in its efforts to ban or restrict abortion in the nation that hosts the Vatican.
Italy legalized abortion on demand through the end of the third month of pregnancy in 1978, after a long battle between secular forces and the church. Abortion after three months is allowed when the pregnancy is deemed a grave danger to the woman's mental or physical health.
Three years later, Italians voted in a referendum to keep the law, again defying a church-backed campaign.
Archbishop Rino Fisichella, who heads the Vatican's Pontifical Academy for Life, issued a condemnation of abortion and the RU-486 pill in a front-page article in the Vatican newspaper L'Osservatore Romano yesterday. He said the church cannot passively sit back, and insisted the ethical implications of the pill could not be overlooked.
"An embryo is not a bunch of cells," Fisichella wrote. "It's real and full human life. Suppressing it is a responsibility nobody can take without fully knowing the consequences."
There were about 121,000 abortions on demand in Italy in 2008, according to figures provided by Italy's health authorities. That number was down 48 percent from 1982 - the year when the number peaked after the referendum upholding the abortion law - and down 4 percent compared with the previous year.
Critics of RU-486 say that taking a pill might reverse that trend because it would make interrupting a pregnancy easier.
August 1, 2009
The long-debated move drew Vatican warnings of excommunication for doctors and patients.
By Alessandra Rizzo
Associated Press
ROME - Italy has approved the use of the abortion drug RU-486, capping years of debate and defying opposition from the Vatican, which warned of immediate excommunication for doctors prescribing the pill and for women who use it.
The pill is already available in a number of European countries. Its approval by Italy's drug-regulation authorities was praised by women's groups and abortion-rights organizations, which say the pill will provide women with an additional, noninvasive procedure.
It drew the immediate protest of the Catholic Church, which opposes abortion and contraception.
"That's not how you alleviate human suffering, that's not how you help women, that's not how you help mankind," Monsignor Elio Sgreccia, a senior church bioethicist, said yesterday.
The Italian Drug Agency ruled after a meeting that ended late Thursday that the drug, which terminates pregnancy by causing the embryo to detach from the uterine wall, cannot be sold in pharmacies; it can be administered only by doctors in a hospital.
The agency said in a statement that the pill can be taken only up to the seventh week of pregnancy - not up to the ninth, as is the case in other countries. Women who used the pill between the seventh and the ninth week of pregnancy incurred more risks and had often needed surgery, it said.
The decision is expected to go into effect in about two months, the agency said.
In a nod to the ethical implications associated with the decision and the controversy surrounding it, the agency noted that "the task of protecting the well-being of citizens . . . must take precedence over personal convictions."
The 4-1 vote at the agency's executive branch comes about two years after it started looking at the issue. The pill became available in some parts of Italy on an experimental basis in 2006.
For the Catholic Church, the decision was the latest defeat in its efforts to ban or restrict abortion in the nation that hosts the Vatican.
Italy legalized abortion on demand through the end of the third month of pregnancy in 1978, after a long battle between secular forces and the church. Abortion after three months is allowed when the pregnancy is deemed a grave danger to the woman's mental or physical health.
Three years later, Italians voted in a referendum to keep the law, again defying a church-backed campaign.
Archbishop Rino Fisichella, who heads the Vatican's Pontifical Academy for Life, issued a condemnation of abortion and the RU-486 pill in a front-page article in the Vatican newspaper L'Osservatore Romano yesterday. He said the church cannot passively sit back, and insisted the ethical implications of the pill could not be overlooked.
"An embryo is not a bunch of cells," Fisichella wrote. "It's real and full human life. Suppressing it is a responsibility nobody can take without fully knowing the consequences."
There were about 121,000 abortions on demand in Italy in 2008, according to figures provided by Italy's health authorities. That number was down 48 percent from 1982 - the year when the number peaked after the referendum upholding the abortion law - and down 4 percent compared with the previous year.
Critics of RU-486 say that taking a pill might reverse that trend because it would make interrupting a pregnancy easier.
Tuesday, July 7, 2009
Confronting Our Ambivalence: The Need for Second-Trimester Abortion Advocacy
Article
by Susan Yanow
Abortion continues to be one of the most politically contentious and divisive issues in the United States. In attempts to reframe the issue, many prochoice groups are prioritizing messages of “prevention” and “reducing the need for abortion.” These frames mirror public sentiment that abortion should be “safe, legal and rare,” but are problematic. While it is critically important to increase access to comprehensive sexuality education and contraception, these frames may be used to support those who seek to impose increased restrictions on abortion access. Our messages must embrace the reality that women will always need contraception and abortion services, that these services need to be more accessible and that they need to be available throughout pregnancy.
Since abortion was legalized in 1973, the right to abortion has been eroded through laws that create barriers to care. Second-trimester abortion is particularly vulnerable. Opinion polls show that only a quarter of the public agrees that abortion should be legal in the second trimester. Intense public debate over so-called “partial-birth abortion” has inserted graphic descriptions, often misleading, of later abortion into the public arena. The widespread availability of high-resolution ultrasonography, which brings vivid images of fetal development into the public eye, adds fuel to the debate. News stories about very premature infants being “kept alive” through medical intervention call into question for some the definition of “viability.”
As a movement, we have not engaged fully in the debate over later abortions, aware that we do not have public support or compelling ways of talking about the women who need these services. Some prochoice writers, such as William Saletan, have even questioned the wisdom of continuing to fight for later abortions, arguing that efforts should be focused on securing first trimester abortions. (Washington Post, March 5, 2006) This position threatens the reproductive rights of the thousands of women every year who need second-trimester abortion services, and reflects a lack of knowledge about who these women are and why they do not seek abortion care earlier.
Too many conversations about second trimester abortion start defensively with the statement, “Of course, most abortions take place in the first trimester.” However, approximately 55,000 women in the US obtain abortions at 16 weeks or later every year. This is not new; women have consistently needed access to later abortions. The distribution of abortions by gestational age has remained fairly constant since 1983 with approximately 88 percent of abortions occurring before 13 weeks, six percent occurring between 13 and 15 weeks, four percent occurring between 16 and 20weeks and one percent occurring after 21 weeks.
Who are these women? The women who seek later abortions are disproportionately young women, low-income women and women of color who often face numerous delays in obtaining services that contribute to the later gestational ages at which they present for care. Of the abortions provided to white women, 11.5 percent occur after 12 weeks compared to 13.1 percent of abortions to African Americans. A Guttmacher Institute study found that adolescents took a week longer to suspect a pregnancy than adults.
While women who detect severe fetal abnormalities in the second trimester have been the “face” of advocacy for later abortions, in fact they represent a minority of the women who need this service. Two recent studies of why women obtain abortions in the second trimester suggest that late detection of pregnancy, cost and access barriers, and difficulty making a decision, all play a role in the use of second-trimester abortion. Fifty-eight percent of women reported that they would have liked to have had the abortion earlier, but faced barriers. These barriers include a shortage of second-trimester abortion providers, the cost of a second-trimester abortion (which is covered by Medicaid in only 17 states), referral issues and low public support for women who seek later abortions.
A Shortage of Providers
While the shortage of abortion providers outside of urban areas in the US is widely acknowledged, there is an acute shortage of clinicians trained and willing to provide abortions after twelve weeks for non maternal and fetal indicators. According to a survey of abortion providers conducted by the Guttmacher Institute, approximately 60 percent of abortion-providing facilities offer abortion services after 14 weeks, and only 33 percent of the facilities offer abortions at 20 weeks. Only 24percent of the facilities offer abortions at 21 weeks and beyond. Five states lack a provider performing abortions after 12 weeks for non-maternal or fetal indications, ten states lack a provider performing abortions after 15 weeks of pregnancy and 22 do not have a provider offering abortions after 20 weeks. Consequently, access to second-trimester abortion care is severely limited for women living in those states. Getting an accurate referral, making travel and child-care arrangements, and raising the extra money needed to travel, sometimes including plane fares and overnight stays can cause substantial delays in women getting the abortions they seek.
Some states have passed burdensome requirements that restrict providers. For example, in 2003 in Texas, there were 3,066 post-16 week abortions performed. In 2004 the Texas legislature passed a law that abortions after 16 weeks can only be provided in surgicenters, which are extraordinarily expensive to construct. In 2004, there were only 403 post-16 week abortions provided in Texas.
Costs of Second-Trimester Abortion
The cost of second-trimester abortion, which can include travel, accommodations, lost wages and child care, continues to be a barrier and cause of delay for many women, in spite of the ongoing efforts of the 100 grassroots abortion funds affiliated with the National Network of Abortion Funds (NNAF) and other funding resources. Fees for second-trimester abortion vary depending on gestational age and location, and range from $600 to $3,000. If the procedure is done in a hospital rather than a freestanding clinic or surgical center, the fee can be even higher.
The Hyde Amendment (first passed in 1976 and reauthorized every year since) prohibits the use of federal funds to pay for abortions except for cases of rape, incest or life endangerment. Only 17 states allow the use of state funds for abortions outside of these three narrow circumstances. Additionally, 12 states restrict abortion coverage in insurance plans for public employees, and five states restrict insurance coverage of abortion in private insurance plans. Three quarters of the women receiving outpatient abortions pay for the procedure with their own funds.
Insurance carriers and Medicaid (in the 17 states where Medicaid covers abortions) reimburse second-trimester abortions at a rate that does not cover the costs. Additionally, many malpractice policies increase rates for post-16 week abortions, with another increase at 19-20 weeks. The cost of providing later abortions and poor reimbursement provide a disincentive for clinics and hospitals to provide second-trimester services.
Inaccurate Referrals
Inaccurate referrals can contribute to many of the delays imposed on women seeking abortion services. If a woman calls the clinic closest to her, they may schedule an appointment for the following week without adequately screening her. When she arrives, she may learn that she is above the clinic’s gestational age or be above their weight limit. Many organizations refer only to other providers within their membership systems rather than to the closest appropriate provider. Most states do not have comprehensive guides available to assist in good referrals to the nearest and most appropriate provider.
Currently, there are a number of referral sources for women seeking abortions, but each is limited. Planned Parenthood and the National Abortion Federation maintain only listings of their members. The various abortion funds often only have information about the clinics that are geographically most proximate, and must do extensive research with each caller to find appropriate referrals for women needing later procedures. The lack of a comprehensive referral network means that women are often delayed needlessly, or must travel further than necessary.
Low Public Support for Women and Providers
“You are 16 weeks pregnant and you want an abortion? Why did you wait so long?”
Despite the ongoing need for second-trimester abortion services, public support for abortions after the first trimester is very low. In addition to the visibility of later pregnancies, many members of the public have themselves experienced pregnancy at this stage and have uniquely personal experiences with fetal movement. This experience leads some to ask, “How can a woman who experiences fetal movement still opt for an abortion?” There is little understanding that many women end up in the second trimester of an unwanted pregnancy due to barriers and delays, while other women can only make the decision to have an abortion when they are in the second trimester. Some women need more time to wrestle with the decision—for example, they may be against abortion while at the same time knowing that they cannot possibly become a parent at this point in their lives—and this deep ambivalence delays their decision. Other women have desired pregnancies and then find themselves in a changed situation, either medically or socially (a partner becomes abusive or leaves, a job loss, a hurricane that destroys her home, a cancer diagnosis), which necessitates an abortion, despite the initial desire to keep the pregnancy and have a child.
Additionally, the general public and many medical professionals do not recognize or honor the work of abortion providers. The public image of a second-trimester abortion provider is a negative one, fueled by antichoice rhetoric and sensationalist stories after rare complications occur. In order to protect their safety and the privacy of their families, physicians who perform later abortions often do not discuss their work in any public forum. As abortions are primarily done in freestanding clinics, the procedure and those who provide it are often marginalized by colleagues in mainstream medicine.
Developing a Solution
While there is good data on the multiple reasons women delay seeking abortions and the obstacles they face, we don’t know why the second-trimester abortion rate has remained steady and which barriers, if removed, would result in women accessing services earlier. For example, would free pregnancy tests result in earlier detection and earlier decision making around abortion? What would the impact of comprehensive sexuality education be on women’s recognition of pregnancy symptoms? There is a clear need for more quantitative and qualitative research on women who seek second-trimester abortions, and more collaborative strategies to increase abortion access.
In 2007, recognizing this need for a coordinated effort by the reproductive health, rights and justice communities, Advancing New Standards in Reproductive Health (ANSIRH), a program of the University of California San Francisco, launched the National Strategic Initiative to Secure and Expand Second-Trimester Abortion to develop strategies to increase second-trimester abortion services and support those who offer this service. This initiative has evolved into the Second Trimester Access Network, a collaboration that includes leadership from many prochoice organizations and seeks to promote work across the field on second-trimester issues. The mission of the network is to thoroughly understand all aspects of second-trimester abortion and support member groups in removing barriers that delay a woman’s access to abortion, while recognizing that some women will always need abortions late in the second trimester for a myriad of complicated reasons.
The Initiative and the Network have identified some initial strategies to removing barriers to women’s access to second-trimester abortion.
Increase Training and Services
Acquiring the skills needed to provide second-trimester abortions requires experienced trainers and a sufficient volume of patients, both during the training experience and afterwards to maintain skills. Possible solutions include establishing regional hubs that would provide a sufficient volume of procedures to train all types of clinicians (doctors, advanced practice clinicians, registered nurses), or expanding the training capacity and increasing the gestational age at some current sites that provide later abortions. It is also important to recognize that training is only a first step. Once trained, providers need support to overcome obstacles to practice, including building public and clinical support for their practice.
Second-trimester abortion services are unevenly distributed. While many states have no providers of second-trimester abortions, some urban areas have a wealth of resources (for example, in the Greater Boston area there are eight facilities that offer abortion after 16 weeks.) For first trimester abortion, it is reasonable that no woman should have to travel further than the nearest primary care provider. However, second-trimester abortions require a different set of skills and different types of facilities. How many providers are needed? How far is it reasonable to expect a woman to travel for a later abortion? Research is needed to gather detailed information on current providers (including whether they are in solo practice, retirement plans, etc.), develop a model for a rational geographic distribution of services and explore the potential of providing incentives for trainees to provide abortions in underserved areas to expand services beyond where they are currently located.
Provide Funding for Abortion and All Reproductive Health Care
The Hyde Amendment, which bans Federal Medicaid coverage of abortions, is blatantly unjust and must be repealed. A strong coalition to repeal the Hyde Amendment exists (Hyde: 30 Years is Enough!) and activity within the coalition is increasing as new possibilities are seen with the change of power in Washington. In the interim, legal and advocacy strategies must be developed in each state to ensure a fair reimbursement rate to providers. In states with coverage only for rape survivors or danger to a woman’s health, advocates must ensure that at least these exceptional cases are covered.
However, the repeal of the Hyde Amendment is only a first step. Health-care reform of some kind is coming. Advocates must make sure that health-care reform efforts at both the state and federal levels include coverage of comprehensive reproductive health services. Several coalitions, including Raising Women’s Voices for the Healthcare We Need, are working for health-care reform that explicitly includes coverage of abortion care.
Provide Accurate, Timely Referrals
There is a clear need for a comprehensive referral resource that includes information on gestational limits for each provider, weight restrictions if any, cost schedules and other services (e.g. translation services). The resource should also provide funding assistance if a woman is facing economic challenges, be regularly updated and accessible to all possible referral sources. The National Network of Abortion Funds (NNAF) is currently collecting information from its member funds to begin compiling this resource.
Develop a Multifaceted Communications Strategy
The general public is unaware or misinformed about the reasons that women seek abortion in the second trimester. The complicated issues that lead women to make this decision must be shared with the public in a sympathetic light to increase political support for second-trimester abortion care. To create messages that resonate with different communities, we must engage those who work most closely with young women, rural women and women of color. The strategy must destigmatize abortion, incorporate respect for women and providers and avoid the devaluation of any groups, including disabled people, in the development of messaging. We must find ways to clarify that our goal is to prevent unwanted pregnancy, not to prevent abortions.
A first step is to begin with ourselves. Within our organizations and across our movement, we must clarify our values and remind ourselves that a definition of reproductive justice must include all women with unintended pregnancies, regardless of gestational age. Prevention will not eradicate the need for second-trimester abortion. Instead of using the frame of “prevention,” we must begin to advocate for abortion “as early as possible, as late as necessary.”
Susan Yanow, MSW, is a long-time reproductive rights activist and founding executive director of the Abortion Access Project.
by Susan Yanow
Abortion continues to be one of the most politically contentious and divisive issues in the United States. In attempts to reframe the issue, many prochoice groups are prioritizing messages of “prevention” and “reducing the need for abortion.” These frames mirror public sentiment that abortion should be “safe, legal and rare,” but are problematic. While it is critically important to increase access to comprehensive sexuality education and contraception, these frames may be used to support those who seek to impose increased restrictions on abortion access. Our messages must embrace the reality that women will always need contraception and abortion services, that these services need to be more accessible and that they need to be available throughout pregnancy.
Since abortion was legalized in 1973, the right to abortion has been eroded through laws that create barriers to care. Second-trimester abortion is particularly vulnerable. Opinion polls show that only a quarter of the public agrees that abortion should be legal in the second trimester. Intense public debate over so-called “partial-birth abortion” has inserted graphic descriptions, often misleading, of later abortion into the public arena. The widespread availability of high-resolution ultrasonography, which brings vivid images of fetal development into the public eye, adds fuel to the debate. News stories about very premature infants being “kept alive” through medical intervention call into question for some the definition of “viability.”
As a movement, we have not engaged fully in the debate over later abortions, aware that we do not have public support or compelling ways of talking about the women who need these services. Some prochoice writers, such as William Saletan, have even questioned the wisdom of continuing to fight for later abortions, arguing that efforts should be focused on securing first trimester abortions. (Washington Post, March 5, 2006) This position threatens the reproductive rights of the thousands of women every year who need second-trimester abortion services, and reflects a lack of knowledge about who these women are and why they do not seek abortion care earlier.
Too many conversations about second trimester abortion start defensively with the statement, “Of course, most abortions take place in the first trimester.” However, approximately 55,000 women in the US obtain abortions at 16 weeks or later every year. This is not new; women have consistently needed access to later abortions. The distribution of abortions by gestational age has remained fairly constant since 1983 with approximately 88 percent of abortions occurring before 13 weeks, six percent occurring between 13 and 15 weeks, four percent occurring between 16 and 20weeks and one percent occurring after 21 weeks.
Who are these women? The women who seek later abortions are disproportionately young women, low-income women and women of color who often face numerous delays in obtaining services that contribute to the later gestational ages at which they present for care. Of the abortions provided to white women, 11.5 percent occur after 12 weeks compared to 13.1 percent of abortions to African Americans. A Guttmacher Institute study found that adolescents took a week longer to suspect a pregnancy than adults.
While women who detect severe fetal abnormalities in the second trimester have been the “face” of advocacy for later abortions, in fact they represent a minority of the women who need this service. Two recent studies of why women obtain abortions in the second trimester suggest that late detection of pregnancy, cost and access barriers, and difficulty making a decision, all play a role in the use of second-trimester abortion. Fifty-eight percent of women reported that they would have liked to have had the abortion earlier, but faced barriers. These barriers include a shortage of second-trimester abortion providers, the cost of a second-trimester abortion (which is covered by Medicaid in only 17 states), referral issues and low public support for women who seek later abortions.
A Shortage of Providers
While the shortage of abortion providers outside of urban areas in the US is widely acknowledged, there is an acute shortage of clinicians trained and willing to provide abortions after twelve weeks for non maternal and fetal indicators. According to a survey of abortion providers conducted by the Guttmacher Institute, approximately 60 percent of abortion-providing facilities offer abortion services after 14 weeks, and only 33 percent of the facilities offer abortions at 20 weeks. Only 24percent of the facilities offer abortions at 21 weeks and beyond. Five states lack a provider performing abortions after 12 weeks for non-maternal or fetal indications, ten states lack a provider performing abortions after 15 weeks of pregnancy and 22 do not have a provider offering abortions after 20 weeks. Consequently, access to second-trimester abortion care is severely limited for women living in those states. Getting an accurate referral, making travel and child-care arrangements, and raising the extra money needed to travel, sometimes including plane fares and overnight stays can cause substantial delays in women getting the abortions they seek.
Some states have passed burdensome requirements that restrict providers. For example, in 2003 in Texas, there were 3,066 post-16 week abortions performed. In 2004 the Texas legislature passed a law that abortions after 16 weeks can only be provided in surgicenters, which are extraordinarily expensive to construct. In 2004, there were only 403 post-16 week abortions provided in Texas.
Costs of Second-Trimester Abortion
The cost of second-trimester abortion, which can include travel, accommodations, lost wages and child care, continues to be a barrier and cause of delay for many women, in spite of the ongoing efforts of the 100 grassroots abortion funds affiliated with the National Network of Abortion Funds (NNAF) and other funding resources. Fees for second-trimester abortion vary depending on gestational age and location, and range from $600 to $3,000. If the procedure is done in a hospital rather than a freestanding clinic or surgical center, the fee can be even higher.
The Hyde Amendment (first passed in 1976 and reauthorized every year since) prohibits the use of federal funds to pay for abortions except for cases of rape, incest or life endangerment. Only 17 states allow the use of state funds for abortions outside of these three narrow circumstances. Additionally, 12 states restrict abortion coverage in insurance plans for public employees, and five states restrict insurance coverage of abortion in private insurance plans. Three quarters of the women receiving outpatient abortions pay for the procedure with their own funds.
Insurance carriers and Medicaid (in the 17 states where Medicaid covers abortions) reimburse second-trimester abortions at a rate that does not cover the costs. Additionally, many malpractice policies increase rates for post-16 week abortions, with another increase at 19-20 weeks. The cost of providing later abortions and poor reimbursement provide a disincentive for clinics and hospitals to provide second-trimester services.
Inaccurate Referrals
Inaccurate referrals can contribute to many of the delays imposed on women seeking abortion services. If a woman calls the clinic closest to her, they may schedule an appointment for the following week without adequately screening her. When she arrives, she may learn that she is above the clinic’s gestational age or be above their weight limit. Many organizations refer only to other providers within their membership systems rather than to the closest appropriate provider. Most states do not have comprehensive guides available to assist in good referrals to the nearest and most appropriate provider.
Currently, there are a number of referral sources for women seeking abortions, but each is limited. Planned Parenthood and the National Abortion Federation maintain only listings of their members. The various abortion funds often only have information about the clinics that are geographically most proximate, and must do extensive research with each caller to find appropriate referrals for women needing later procedures. The lack of a comprehensive referral network means that women are often delayed needlessly, or must travel further than necessary.
Low Public Support for Women and Providers
“You are 16 weeks pregnant and you want an abortion? Why did you wait so long?”
Despite the ongoing need for second-trimester abortion services, public support for abortions after the first trimester is very low. In addition to the visibility of later pregnancies, many members of the public have themselves experienced pregnancy at this stage and have uniquely personal experiences with fetal movement. This experience leads some to ask, “How can a woman who experiences fetal movement still opt for an abortion?” There is little understanding that many women end up in the second trimester of an unwanted pregnancy due to barriers and delays, while other women can only make the decision to have an abortion when they are in the second trimester. Some women need more time to wrestle with the decision—for example, they may be against abortion while at the same time knowing that they cannot possibly become a parent at this point in their lives—and this deep ambivalence delays their decision. Other women have desired pregnancies and then find themselves in a changed situation, either medically or socially (a partner becomes abusive or leaves, a job loss, a hurricane that destroys her home, a cancer diagnosis), which necessitates an abortion, despite the initial desire to keep the pregnancy and have a child.
Additionally, the general public and many medical professionals do not recognize or honor the work of abortion providers. The public image of a second-trimester abortion provider is a negative one, fueled by antichoice rhetoric and sensationalist stories after rare complications occur. In order to protect their safety and the privacy of their families, physicians who perform later abortions often do not discuss their work in any public forum. As abortions are primarily done in freestanding clinics, the procedure and those who provide it are often marginalized by colleagues in mainstream medicine.
Developing a Solution
While there is good data on the multiple reasons women delay seeking abortions and the obstacles they face, we don’t know why the second-trimester abortion rate has remained steady and which barriers, if removed, would result in women accessing services earlier. For example, would free pregnancy tests result in earlier detection and earlier decision making around abortion? What would the impact of comprehensive sexuality education be on women’s recognition of pregnancy symptoms? There is a clear need for more quantitative and qualitative research on women who seek second-trimester abortions, and more collaborative strategies to increase abortion access.
In 2007, recognizing this need for a coordinated effort by the reproductive health, rights and justice communities, Advancing New Standards in Reproductive Health (ANSIRH), a program of the University of California San Francisco, launched the National Strategic Initiative to Secure and Expand Second-Trimester Abortion to develop strategies to increase second-trimester abortion services and support those who offer this service. This initiative has evolved into the Second Trimester Access Network, a collaboration that includes leadership from many prochoice organizations and seeks to promote work across the field on second-trimester issues. The mission of the network is to thoroughly understand all aspects of second-trimester abortion and support member groups in removing barriers that delay a woman’s access to abortion, while recognizing that some women will always need abortions late in the second trimester for a myriad of complicated reasons.
The Initiative and the Network have identified some initial strategies to removing barriers to women’s access to second-trimester abortion.
Increase Training and Services
Acquiring the skills needed to provide second-trimester abortions requires experienced trainers and a sufficient volume of patients, both during the training experience and afterwards to maintain skills. Possible solutions include establishing regional hubs that would provide a sufficient volume of procedures to train all types of clinicians (doctors, advanced practice clinicians, registered nurses), or expanding the training capacity and increasing the gestational age at some current sites that provide later abortions. It is also important to recognize that training is only a first step. Once trained, providers need support to overcome obstacles to practice, including building public and clinical support for their practice.
Second-trimester abortion services are unevenly distributed. While many states have no providers of second-trimester abortions, some urban areas have a wealth of resources (for example, in the Greater Boston area there are eight facilities that offer abortion after 16 weeks.) For first trimester abortion, it is reasonable that no woman should have to travel further than the nearest primary care provider. However, second-trimester abortions require a different set of skills and different types of facilities. How many providers are needed? How far is it reasonable to expect a woman to travel for a later abortion? Research is needed to gather detailed information on current providers (including whether they are in solo practice, retirement plans, etc.), develop a model for a rational geographic distribution of services and explore the potential of providing incentives for trainees to provide abortions in underserved areas to expand services beyond where they are currently located.
Provide Funding for Abortion and All Reproductive Health Care
The Hyde Amendment, which bans Federal Medicaid coverage of abortions, is blatantly unjust and must be repealed. A strong coalition to repeal the Hyde Amendment exists (Hyde: 30 Years is Enough!) and activity within the coalition is increasing as new possibilities are seen with the change of power in Washington. In the interim, legal and advocacy strategies must be developed in each state to ensure a fair reimbursement rate to providers. In states with coverage only for rape survivors or danger to a woman’s health, advocates must ensure that at least these exceptional cases are covered.
However, the repeal of the Hyde Amendment is only a first step. Health-care reform of some kind is coming. Advocates must make sure that health-care reform efforts at both the state and federal levels include coverage of comprehensive reproductive health services. Several coalitions, including Raising Women’s Voices for the Healthcare We Need, are working for health-care reform that explicitly includes coverage of abortion care.
Provide Accurate, Timely Referrals
There is a clear need for a comprehensive referral resource that includes information on gestational limits for each provider, weight restrictions if any, cost schedules and other services (e.g. translation services). The resource should also provide funding assistance if a woman is facing economic challenges, be regularly updated and accessible to all possible referral sources. The National Network of Abortion Funds (NNAF) is currently collecting information from its member funds to begin compiling this resource.
Develop a Multifaceted Communications Strategy
The general public is unaware or misinformed about the reasons that women seek abortion in the second trimester. The complicated issues that lead women to make this decision must be shared with the public in a sympathetic light to increase political support for second-trimester abortion care. To create messages that resonate with different communities, we must engage those who work most closely with young women, rural women and women of color. The strategy must destigmatize abortion, incorporate respect for women and providers and avoid the devaluation of any groups, including disabled people, in the development of messaging. We must find ways to clarify that our goal is to prevent unwanted pregnancy, not to prevent abortions.
A first step is to begin with ourselves. Within our organizations and across our movement, we must clarify our values and remind ourselves that a definition of reproductive justice must include all women with unintended pregnancies, regardless of gestational age. Prevention will not eradicate the need for second-trimester abortion. Instead of using the frame of “prevention,” we must begin to advocate for abortion “as early as possible, as late as necessary.”
Susan Yanow, MSW, is a long-time reproductive rights activist and founding executive director of the Abortion Access Project.
Friday, July 3, 2009
Changes at TCHP Blog
Hello regular, new and future readers of The Coathanger Project Blog. I’m Lisa. I’ll be here pitching in with blogs, updates on the state of the Reproductive Justice/Pro-choice movement, stories that are related to abortion legislation, feminism, women’s issues and a lot that is pertinent to thinking, caring, and passionate people like you. I’m also hoping to have guest contributors, fiction, poetry, short films – anything to make visiting us here at TCHP Blog interesting, elevating, motivating and inspiring so that you can in turn spread that information, energy and action to the culture around you. So really not much will change, just more hands in the kitchen! Feel free to contact us here if you’ve got anything to say—or if you want to contribute or for whatever! Don't worry, Angie's still with us and will contribute-- she's working on spreading the awesome-ness that is TCHP film (if you want her or the film to happen at your space, please don't hesitate to let us know!) and is working on something new!
Monday, June 22, 2009
Right-Wing Extremists Threaten Women's Rights All Over the World
Alternet
In the weeks following the assassination of Wichita abortion provider Dr. George Tiller, it was perhaps too much to hope that antiabortion organizations and activists would reflect on, and even temper, their movement’s rhetoric. Instead, the halfhearted denunciations of violence issued by groups like the National Right to Life Committee and Operation Rescue were all too quickly followed by a return to offensive characterizations not only of abortion, but of abortion providers.
While the most harmful expressions of antiabortion violence are playing out here in the United States, the vigorous export of the rhetoric, tactics and ideology of the movement is creating a similar hostile environment for abortion providers and for women seeking abortions in other countries. Legal attacks and harassment against clinics, women and providers in countries where women risk their lives to end a pregnancy are increasing, largely tolerated by governments who are reluctant to confront powerful religious leaders.
In many ways the U.S. antiabortion movement is succeeding in recreating the intimidating American model abroad. Take, for example, the 2007 police raid on a family planning clinic in Brazil, which was eerily reminiscent of the raids on Dr. Tiller’s clinic in Wichita. In both cases, the private medical records of thousands of women were confiscated and searched for evidence of illegal abortions. Prosecutors felt that the possibility that any of them might have had an illegal abortion far outweighed their right to keep their medical records private.
Similar attitudes can be seen at the national level where conservative antiabortion legislators recently submitted a proposal to the Brazilian Congress seeking to define abortion as a “heinous crime.” This came just months after their caucus, the Parliamentary Front in Defense of Life, pushed for the approval of a congressional committee dedicated to investigating illegal abortions and the black market sale of abortive drugs “in order to implement the law to the fullest extent.” If found guilty, women who undergo illegal abortions could receive one-to-three years imprisonment, and physicians up to 20 years.
Even where abortion is legal, activists are applying the same tactics of intimidation seen here in United States. Last year the Mexico City legislature approved a progressive reproductive health bill allowing abortion for up to twelve weeks. A legal appeal (supported by the country’s Catholic hierarchy) quickly followed but was denied by the Mexican Supreme Court. Antiabortion activists sprung into full attack mode, protesting clinics wielding massive posters of bloodied, mangled full-term babies who they claimed were the victims of abortion. They continue to film, intimidate and harass women entering clinics for legal services, begging them not to get an abortion.
With the exception of a few countries, most nations in the world allow abortion for at least some indications. Still, abortion stigma is so culturally pervasive that many women do not use legal facilities to terminate their unwanted pregnancies but instead self-induce under dangerous conditions. Because of the stigma, governments have little incentive to ensure that legal services are available and many doctors are unaware that women have the right to request legal abortions in their hospitals and clinics. Instead, antiabortion organizations use their political influence and dangerous rhetoric to punish and endanger women.
In this country we can observe in the wake of Tiller’s murder a certain reinvigoration of the antichoice movement. Rather than stepping back to evaluate how they contribute to hostility toward women and providers, the anti-abortion movement is continuing to stick to its message. The repeated refrain is that they don’t condone Tiller’s killing but that, after all, he “murdered unborn children.”
Human Life International (HLI), a Virginia-based organization that claims it is “the largest prolife movement of Catholic orientation in the world,” is a perfect example of this global approach. They are clearly not ready to tamp down on its war of words. Indeed, their public statement following Tiller’s murder offers no apology:
George Tiller, the mass murderer of Wichita, Kansas is dead. “Those who live by the sword, die by the sword,” said the Lord… Can killing a mass murderer be considered “justifiable homicide”? The short answer to this is “no,” but it is not always apparent why HLI provides financial and material support to affiliates around the world to pressure governments to reject liberalizing abortion laws, while simultaneously creating a cultural climate that stigmatizes abortion and the women who get them. Its activities are focused on the developing world where abortion is already legally restricted (including in Mexico and Brazil), and where women often risk their lives to end an unwanted pregnancy.
Given the history of U.S. antichoice organizations working to recreate the hostile social environment around abortion abroad, is it just a matter of time before a Scott Roeder appears in South Africa or India?
In the weeks following the assassination of Wichita abortion provider Dr. George Tiller, it was perhaps too much to hope that antiabortion organizations and activists would reflect on, and even temper, their movement’s rhetoric. Instead, the halfhearted denunciations of violence issued by groups like the National Right to Life Committee and Operation Rescue were all too quickly followed by a return to offensive characterizations not only of abortion, but of abortion providers.
While the most harmful expressions of antiabortion violence are playing out here in the United States, the vigorous export of the rhetoric, tactics and ideology of the movement is creating a similar hostile environment for abortion providers and for women seeking abortions in other countries. Legal attacks and harassment against clinics, women and providers in countries where women risk their lives to end a pregnancy are increasing, largely tolerated by governments who are reluctant to confront powerful religious leaders.
In many ways the U.S. antiabortion movement is succeeding in recreating the intimidating American model abroad. Take, for example, the 2007 police raid on a family planning clinic in Brazil, which was eerily reminiscent of the raids on Dr. Tiller’s clinic in Wichita. In both cases, the private medical records of thousands of women were confiscated and searched for evidence of illegal abortions. Prosecutors felt that the possibility that any of them might have had an illegal abortion far outweighed their right to keep their medical records private.
Similar attitudes can be seen at the national level where conservative antiabortion legislators recently submitted a proposal to the Brazilian Congress seeking to define abortion as a “heinous crime.” This came just months after their caucus, the Parliamentary Front in Defense of Life, pushed for the approval of a congressional committee dedicated to investigating illegal abortions and the black market sale of abortive drugs “in order to implement the law to the fullest extent.” If found guilty, women who undergo illegal abortions could receive one-to-three years imprisonment, and physicians up to 20 years.
Even where abortion is legal, activists are applying the same tactics of intimidation seen here in United States. Last year the Mexico City legislature approved a progressive reproductive health bill allowing abortion for up to twelve weeks. A legal appeal (supported by the country’s Catholic hierarchy) quickly followed but was denied by the Mexican Supreme Court. Antiabortion activists sprung into full attack mode, protesting clinics wielding massive posters of bloodied, mangled full-term babies who they claimed were the victims of abortion. They continue to film, intimidate and harass women entering clinics for legal services, begging them not to get an abortion.
With the exception of a few countries, most nations in the world allow abortion for at least some indications. Still, abortion stigma is so culturally pervasive that many women do not use legal facilities to terminate their unwanted pregnancies but instead self-induce under dangerous conditions. Because of the stigma, governments have little incentive to ensure that legal services are available and many doctors are unaware that women have the right to request legal abortions in their hospitals and clinics. Instead, antiabortion organizations use their political influence and dangerous rhetoric to punish and endanger women.
In this country we can observe in the wake of Tiller’s murder a certain reinvigoration of the antichoice movement. Rather than stepping back to evaluate how they contribute to hostility toward women and providers, the anti-abortion movement is continuing to stick to its message. The repeated refrain is that they don’t condone Tiller’s killing but that, after all, he “murdered unborn children.”
Human Life International (HLI), a Virginia-based organization that claims it is “the largest prolife movement of Catholic orientation in the world,” is a perfect example of this global approach. They are clearly not ready to tamp down on its war of words. Indeed, their public statement following Tiller’s murder offers no apology:
George Tiller, the mass murderer of Wichita, Kansas is dead. “Those who live by the sword, die by the sword,” said the Lord… Can killing a mass murderer be considered “justifiable homicide”? The short answer to this is “no,” but it is not always apparent why HLI provides financial and material support to affiliates around the world to pressure governments to reject liberalizing abortion laws, while simultaneously creating a cultural climate that stigmatizes abortion and the women who get them. Its activities are focused on the developing world where abortion is already legally restricted (including in Mexico and Brazil), and where women often risk their lives to end an unwanted pregnancy.
Given the history of U.S. antichoice organizations working to recreate the hostile social environment around abortion abroad, is it just a matter of time before a Scott Roeder appears in South Africa or India?
Tuesday, June 9, 2009
Tiller's Clinic to Close Permanently
6/9/09
The Witchita, Kan., abortion clinic run by murdered doctor George Tiller will be closed permanently, the Tiller family announced Tuesday as Rep. Louise Slaughter, D-N.Y., offered a House resolution honoring the slain abortion provider.
Tiller opened the Women's Health Care Services, Inc., in the 1970s and it served as one of three clinics in the country that performed controversial second- and third-term abortions.
"Notice is being given today to all concerned that the Tiller family is ceasing operation of the clinic and any involvement by family members in any other similar clinic," Tiller family attorneys Lee Thompson and Dan Monnat said in a statement.
"We are proud of the service and courage shown by our husband and father and know that women's health care needs have been met because of his dedication and service. That is a legacy that will never die. The family will honor Dr. Tiller's memory through private charitable activities," the attorneys said.
Tiller, who in March was acquitted on 19 misdemeanor charges related to his practice, was fatally shot while serving as an usher in his church on May 31. The murder drew a flood of denunciations from President Obama along with liberal and conservative lawmakers and abortion rights groups and abortion foes.
Attorney General Eric Holder ordered the U.S. Marshals' service to "increase security for a number of individuals and facilities" although officials provided no specifics.
Scott Roeder, 51, was taken into custody for the crime.
On Tuesday, Slaughter offered a resolution condemning Tiller's murder on behalf of 80 co-sponsors. The resolution noted the increased acts of violence taking place in places of worship, and called for condolences to the Tiller family and a recommitment to tolerance.
The Witchita, Kan., abortion clinic run by murdered doctor George Tiller will be closed permanently, the Tiller family announced Tuesday as Rep. Louise Slaughter, D-N.Y., offered a House resolution honoring the slain abortion provider.
Tiller opened the Women's Health Care Services, Inc., in the 1970s and it served as one of three clinics in the country that performed controversial second- and third-term abortions.
"Notice is being given today to all concerned that the Tiller family is ceasing operation of the clinic and any involvement by family members in any other similar clinic," Tiller family attorneys Lee Thompson and Dan Monnat said in a statement.
"We are proud of the service and courage shown by our husband and father and know that women's health care needs have been met because of his dedication and service. That is a legacy that will never die. The family will honor Dr. Tiller's memory through private charitable activities," the attorneys said.
Tiller, who in March was acquitted on 19 misdemeanor charges related to his practice, was fatally shot while serving as an usher in his church on May 31. The murder drew a flood of denunciations from President Obama along with liberal and conservative lawmakers and abortion rights groups and abortion foes.
Attorney General Eric Holder ordered the U.S. Marshals' service to "increase security for a number of individuals and facilities" although officials provided no specifics.
Scott Roeder, 51, was taken into custody for the crime.
On Tuesday, Slaughter offered a resolution condemning Tiller's murder on behalf of 80 co-sponsors. The resolution noted the increased acts of violence taking place in places of worship, and called for condolences to the Tiller family and a recommitment to tolerance.
Monday, June 8, 2009
Why I Am An Abortion Doctor by Dr. Gary Romalis
Why I am an abortion doctor
'I can take a woman, in the biggest trouble she has ever experienced in her life, and by performing a five-minute operation, in comfort and dignity, I can give her back her life'
By: Dr. Garson Romalis, © Garson Romalis
Published: Monday, February 04, 2008
What follows are remarks delivered by Canadian abortion doctor Garson Romalis on Jan. 25, at the University of Toronto Law School's Symposium to Mark the 20th Anniversary of R. vs. Morgentaler
---
I am honoured to be speaking today, and honored to call Henry Morgentaler my friend.
I have been an abortion provider since 1972. Why do I do abortions, and why do I continue to do abortions, despite two murder attempts?
The first time I started to think about abortion was in 1960, when I was in secondyear medical school. I was assigned the case of a young woman who had died of a septic abortion. She had aborted herself using slippery elm bark.
I had never heard of slippery elm. A buddy and I went down to skid row, and without too much difficulty, purchased some slippery elm bark to use as a visual aid in our presentation. Slippery elm is not sterile, and frequently contains spores of the bacteria that cause gas gangrene. It is called slippery elm because, when it gets wet, it feels slippery. This makes it easier to slide slender pieces through the cervix where they absorb water, expand, dilate the cervix, produce infection and induce abortion. The young woman in our case developed an overwhelming infection. At autopsy she had multiple abscesses throughout her body, in her brain, lungs, liver and abdomen.
I have never forgotten that case.
After I graduated from University of British Columbia medical school in 1962, I went to Chicago, where I served my internship and Ob/Gyn residency at Cook County Hospital. At that time, Cook County had about 3,000 beds, and served a mainly indigent population. If you were really sick, or really poor, or both, Cook County was where you went.
The first month of my internship was spent on Ward 41, the septic obstetrics ward. Yes, it's hard to believe now, but in those days, they had one ward dedicated exclusively to septic complications of pregnancy.
About 90% of the patients were there with complications of septic abortion. The ward had about 40 beds, in addition to extra beds which lined the halls. Each day we admitted between 10-30 septic abortion patients. We had about one death a month, usually from septic shock associated with hemorrhage.
I will never forget the 17-year-old girl lying on a stretcher with 6 feet of small bowel protruding from her vagina. She survived.
I will never forget the jaundiced woman in liver and kidney failure, in septic shock, with very severe anemia, whose life we were unable to save.
Today, in Canada and the U.S., septic shock from illegal abortion is virtually never seen. Like smallpox, it is a "disappeared disease."
I had originally been drawn to obstetrics and gynecology because I loved delivering babies. Abortion was illegal when I trained, so I did not learn how to do abortions in my residency, although I had more than my share of experience looking after illegal abortion complications.
In 1972, a couple of years after the law on abortion was liberalized, I began the practise of obstetrics and gynecology, and joined a three-man group in Vancouver. My practice partners and I believed strongly that a woman should be able to decide for herself if and when to have a baby. We were frequently asked to look after women who needed termination of pregnancy. Although I had done virtually no terminations in my training, I soon learned how. I also learned just how much demand there was for abortion services.
Providing abortion services can be quite stressful. Usually, an unplanned, unwanted pregnancy is the worst trouble the patient has ever been in in her entire life.
I remember one 18-year-old patient who desperately wanted an abortion, but felt she could not confide in her mother, who was a nurse in another Vancouver area hospital. She impressed on me how important it was that her termination remain a secret from her family. In those years, parental consent was required if the patient was less than 19 years old. I obtained the required second opinion from a colleague, and performed an abortion on her.
About two weeks, later I received a phone call from her mother. She asked me directly "Did you do an abortion on my daughter?" Visions of legal suit passed through my mind as I tried to think of how to answer her question. I decided to answer directly and truthfully. I answered with trepidation, "Yes, I did" and started to make mental preparations to call my lawyer. The mother replied: "Thank you, Doctor. Thank God there are people like you around."
Like many of my colleagues, I had been the subject of antiabortion picketing, particularly in the 1980s. I did not like having my office and home picketed, or nails thrown into my driveway, but viewed these picketers as a nuisance, exercising their right of free speech. Being in Canada, I felt I did not have to worry about my physical security.
I had been a medical doctor for 32 years when I was shot at 7:10 a.m., Nov. 8, 1994. For over half my life, I had been providing obstetrical and gynecological care, including abortions. It is still hard for me to understand how someone could think I should be killed for helping women get safe abortions.
I had a very severe gun shot wound to my left thigh. My thigh bone was fractured, large blood vessels severed, and a large amount of my thigh muscles destroyed. I almost died several times from blood loss and multiple other complications. After about two years of physical and emotional rehabilitation, with a great deal of support from my family and the medical community, I was able to resume work on a part-time basis. I was no longer able to deliver babies or perform major gynecological surgery. I had to take security measures, but I continued to work as a gynecologist, including providing abortion services. My life had changed, but my views on choice remained unchanged, and I was continuing to enjoy practicing medicine. I told people that I was shot in the thigh, not in my sense of humour.
Six years after the shooting, on July 11, 2000, shortly after entering the clinic where I had my private office, a young man approached me. There was nothing unusual about his appearance until he suddenly got a vicious look on his face, stabbed me in the left flank area and then ran away.
This could have been a lethal injury, but fortunately no vital organs were seriously involved, and after six days of hospital observation I was able to return home. The physical implications were minor, but the security implications were major. After two murder attempts, all my security advisors concurred that I was at increased risk for another attack.
My family and I had to have some serious discussions about my future. The National Abortion Federation provided me with a very experienced personal security consultant. He moved into our home and lived with us for three days, talked with us, assessed my personality, visited the places that I worked in and gave me security advice. In those three days, he got to know me well. After he finished his evaluation, when I was dropping him off at the airport, his departing words to me were "Gary, you have to go back to work."
About two months after the stabbing, I returned to the practise of medicine, but with added security measures. Since the year 2000, I have restricted my practise exclusively to abortion provision.
These acts of terrorist violence have affected virtually every aspect of my and my family's life. Our lives have changed forever. I must live with security measures that I never dreamed about when I was learning how to deliver babies.
Let me tell you about an abortion patient I looked after recently. She was 18 years old, and 18-19 weeks pregnant. She came from a very strict, religious family. She was an only daughter, and had several brothers. She was East Indian Hindu and her boyfriend was East Indian Muslim, which did not please her parents. She told me if her parents found out she was pregnant she would be disowned and kicked out of the family home. She also told me that her brothers would murder her boyfriend, and I believed her. About an hour after her operation I and my nurse saw her and her boyfriend walking out of the clinic hand in hand, and I said to my nurse, "Look at that. We saved two lives today."
I love my work. I get enormous personal and professional satisfaction out of helping people, and that includes providing safe, comfortable, abortions. The people that I work with are extraordinary, and we all feel that we are doing important work, making a real difference in peoples' lives.
I can take an anxious woman, who is in the biggest trouble she has ever experiences in her life, and by performing a five-minute operation, in comfort and dignity, I can give her back her life.
After an abortion operation, patients frequently say "Thank You Doctor." But abortion is the only operation I know of where they also sometimes say "Thank you for what you do."
I want to tell you one last story that I think epitomizes the satisfaction I get from my privileged work. Some years ago I spoke to a class of University of British Columbia medical students. As I left the classroom, a student followed me out. She said: "Dr. Romalis, you won't remember me, but you did an abortion on me in 1992. I am a secondyear medical student now, and if it weren't for you I wouldn't be here now."
Friday, June 5, 2009
Sunday, May 31, 2009
Saddest News.
New York Times
5/31/09
WICHITA, Kan. — Authorities said they had a suspect in custody Sunday afternoon in the shooting death of George Tiller, a Wichita doctor who was one of the few doctors in the nation to perform late-term abortions.
Dr. Tiller, who had long been a lightning rod for controversy over the issue of abortion and had survived a shooting more than a decade ago, was shot inside his church here on Sunday morning, the authorities said. Dr. Tiller, 67, was shot with a handgun inside the lobby of his longtime church, Reformation Lutheran Church on the city’s East Side, just after 10 a.m. (Central Time). The service had started minutes earlier.
Dr. Tiller, who had performed abortions since the 1970s, had long been a lightning rod for controversy over the issue of abortion, particularly in Kansas, where abortion opponents regularly protested outside his clinic and sometimes his home and church. In 1993, he was shot in both arms by an abortion opponent but recovered.
Dr. Tiller had also been the subject of many efforts at prosecution, including a citizen-initiated grand jury investigation. In the latest such effort, in March, Dr. Tiller was acquitted of charges that he had performed late-term abortions that violated state law.
Shortly after Sunday’s shooting, police said they were searching for a man who had fled in a powder blue Taurus. By mid-afternoon, they said someone had been taken into custody, but offered no additional details.
“This is going to be a larger search than maybe just Wichita,” said Brent Allred, a police captain, who said that the FBI and state police had been called to the scene. Few parishioners remained at the church, a modern, red brick facility that seats about 500 people. Police cars surrounded the building.
Troy Newman, president of Operation Rescue, an anti-abortion group that has led opposition to Dr. Tiller’s methods, denounced the killing on Sunday, as did other national groups opposed to abortion. “Our prayers go out to his family and the thousands of people this will impact,” Mr. Newman said in a telephone interview from his home in Wichita.
“Operation Rescue has worked tirelessly on peaceful, non-violent measures to bring him to justice through the legal system, the legislative system,” Mr. Newman said. “I’m a tireless advocate and spokesman for the pre-born children who are dying in clinics everyday. Mr. Tiller was an abortionist. But this wasn’t personal. We are pro life, and this act was antithetical to what we believe.”
Leaders of national abortion rights organizations, meanwhile, expressed outrage. Some described Dr. Tiller as one of the only doctors in the nation who performed third-trimester abortions when the life or health of a mother was at stake, and said that his death would make it even harder for women in such circumstances to end their pregnancies.
“Dr. Tiller was a fearless, passionate defender of women’s reproductive health and rights,” said Nancy Northup, president of the Center for Reproductive Rights, based in New York, which had worked on a legal case related to Dr. Tiller. “It’s time that this nation stop demonizing these doctors, and start honoring them.”
At St. George Orthodox Christian Church, next door to Dr. Tiller’s church, members said they had often been concerned about being so close to a church that often was the scene of protests because of Dr. Tiller’s presence. Dr. Tiller had attended the church for a long time, they said, and had contributed significantly to construction of the current facility, which was built in about 1996.
“This is a God-fearing community,” said Mickey Cohlmia, who was at services at the neighboring church on Sunday morning and said she was horrified that such a thing had happened in Wichita, a city of about 358,000 in southern Kansas. “How does this scar everybody in his church?”
5/31/09
WICHITA, Kan. — Authorities said they had a suspect in custody Sunday afternoon in the shooting death of George Tiller, a Wichita doctor who was one of the few doctors in the nation to perform late-term abortions.
Dr. Tiller, who had long been a lightning rod for controversy over the issue of abortion and had survived a shooting more than a decade ago, was shot inside his church here on Sunday morning, the authorities said. Dr. Tiller, 67, was shot with a handgun inside the lobby of his longtime church, Reformation Lutheran Church on the city’s East Side, just after 10 a.m. (Central Time). The service had started minutes earlier.
Dr. Tiller, who had performed abortions since the 1970s, had long been a lightning rod for controversy over the issue of abortion, particularly in Kansas, where abortion opponents regularly protested outside his clinic and sometimes his home and church. In 1993, he was shot in both arms by an abortion opponent but recovered.
Dr. Tiller had also been the subject of many efforts at prosecution, including a citizen-initiated grand jury investigation. In the latest such effort, in March, Dr. Tiller was acquitted of charges that he had performed late-term abortions that violated state law.
Shortly after Sunday’s shooting, police said they were searching for a man who had fled in a powder blue Taurus. By mid-afternoon, they said someone had been taken into custody, but offered no additional details.
“This is going to be a larger search than maybe just Wichita,” said Brent Allred, a police captain, who said that the FBI and state police had been called to the scene. Few parishioners remained at the church, a modern, red brick facility that seats about 500 people. Police cars surrounded the building.
Troy Newman, president of Operation Rescue, an anti-abortion group that has led opposition to Dr. Tiller’s methods, denounced the killing on Sunday, as did other national groups opposed to abortion. “Our prayers go out to his family and the thousands of people this will impact,” Mr. Newman said in a telephone interview from his home in Wichita.
“Operation Rescue has worked tirelessly on peaceful, non-violent measures to bring him to justice through the legal system, the legislative system,” Mr. Newman said. “I’m a tireless advocate and spokesman for the pre-born children who are dying in clinics everyday. Mr. Tiller was an abortionist. But this wasn’t personal. We are pro life, and this act was antithetical to what we believe.”
Leaders of national abortion rights organizations, meanwhile, expressed outrage. Some described Dr. Tiller as one of the only doctors in the nation who performed third-trimester abortions when the life or health of a mother was at stake, and said that his death would make it even harder for women in such circumstances to end their pregnancies.
“Dr. Tiller was a fearless, passionate defender of women’s reproductive health and rights,” said Nancy Northup, president of the Center for Reproductive Rights, based in New York, which had worked on a legal case related to Dr. Tiller. “It’s time that this nation stop demonizing these doctors, and start honoring them.”
At St. George Orthodox Christian Church, next door to Dr. Tiller’s church, members said they had often been concerned about being so close to a church that often was the scene of protests because of Dr. Tiller’s presence. Dr. Tiller had attended the church for a long time, they said, and had contributed significantly to construction of the current facility, which was built in about 1996.
“This is a God-fearing community,” said Mickey Cohlmia, who was at services at the neighboring church on Sunday morning and said she was horrified that such a thing had happened in Wichita, a city of about 358,000 in southern Kansas. “How does this scar everybody in his church?”
Tuesday, May 26, 2009
Favorite New Blog: The Abortioneers
http://abortioneers.blogspot.com/
The Abortioneers is a fantastic new blog (created January 2009) about the ins and outs and ups and downs of direct service in the field of abortion care. It contains a variety of voices expressing the multi-faceted vicissitudes of the contemporary prochoice/direct care experience. It's at the top of The Coat Hanger Project's favorite blogs list - check it out!!!
The Abortioneers is a fantastic new blog (created January 2009) about the ins and outs and ups and downs of direct service in the field of abortion care. It contains a variety of voices expressing the multi-faceted vicissitudes of the contemporary prochoice/direct care experience. It's at the top of The Coat Hanger Project's favorite blogs list - check it out!!!
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