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PART ONE: GOVERNMENT INTERVENTION
Remember how the Department of Health and Human Services was arguing that a doctor's desires should trump their patient's medical needs?
The public comment period on that is not quite over. It ends in a couple of days. If you have not yet sent in a comment, you should. You can review the issue here, and the action info is as follows:
Send an email to consciencecomment@hhs.gov, with the subject line "provider conscience regulation." They are publishing these comments right now, because it is in a 30-day public comment period.
I had a conversation with a pro-choice friend of mine about this, and for those of you who aren't accustomed to seeing this from a civil rights point of view, the following might be helpful. A lot of you on my friends list are already likely pro-choice, but here's the case I'd like to make to those of you who are not.
DHHS wishes to reclassify many forms of birth control as abortion. How do they do this? By defining "life" at fertilization and not implantation. Now, these are both completely arbitrary points to pick, but I'll tell you the implications of each one.
If we rule that life begins at implantation, we can sell forms of birth control such as oral contraceptives, transdermal contraceptives (the patch), IUDs (which is actually hormonal as well), and various other non-barrier methods. This is because part of what they do is prevent a fertilized egg from sticking to the inside of the woman's uterus. Keep the fertilized egg from implanting and it flushes out with her next period just like any other egg.
If we rule that life begins at fertilization, every non-barrier method I can think of short of full sterilization becomes abortion. This is a problem because it removes control of a woman's reproduction from her own hands (a pill that she takes, a patch that she wears, an IUD that she has inserted) and gives it mostly to men (a condom that he wears). This means that women are less capable of engaging in responsible sexual activity.
PART TWO: PERSONAL RESPONSIBILITY
"Well, they should have thought about that before they started having sex," you might say. It's a common enough argument. If women don't want to get pregnant, they should engage in risky behavior like sex. Most people will agree that a woman who is raped or molested at a young age is not "to blame" for her sexual activity, and as a result an abortion is okay in these cases.
But here's what this really says. A woman who doesn't choose to have sex deserves the choice of whether to keep an unwanted child. A woman who does choose to have sex does not deserve the choice of whether to keep an unwanted child. What makes this misogynist is that it takes a moral imperative ("good women don't sleep around") and uses it as a framework to give "bad" women fewer rights than "good" ones. This classification obviously operates based on the idea that women can and should be judged according to moral standards they do not share; if they shared the position that consenting women don't deserve reproductive freedom, they wouldn't be asking for abortions.
But these women have their own moral standards. A woman who chooses to have sex does not give up her conscience (despite what many particularly vicious misogynists may assert). What DHHS is saying is that if a woman seeks an abortion after having consensual sex, it doesn't matter if she thinks it's right. She isn't qualified to make that decision, and her doctor has every right to veto it by denying her access to the abortion she wants.
I don't think I'm being overdramatic when I say this: if a woman isn't qualified to make a moral choice about "appropriate" sexual conduct because she might "choose wrong," why are they allowed to make moral choices anywhere else? Why are women voting? Shouldn't every woman's vote be subject to a veto by someone who's afraid she'll "vote wrong?"
PART THREE: A MINOR INCONVENIENCE?
The next argument I hear a lot is that women don't have to raise these children. They can choose to give it up for adoption and move on with their lives without having to kill a fetus. This argument is based on the assumption that "no cost pregnancies" are not only possible, but universal.
This is flawed. Pregnancy is a very costly experience. I don't care how many times you've seen the movie Juno; women cannot expect that their every medical and emotional need will be catered to by wealthy supportive patrons. Here's what really happens.
Carrying a bearing a child disrupts a woman's education if she still needs to finish it.
There are also incredible medical expenses involved with proper pre-natal care.
There's also the fact that if your job doesn't allow maternity leave (and unlike many European countries, America doesn't require employers to provide this), any time spent in the hospital could cost you your job. This is not just your means of supporting yourself. It's probably also your means of paying for the aforementioned expensive prenatal care.
Make no mistake. This is what an unplanned and unwanted pregnancy looks like. There are problems with someone else having the power to subject women to these circumstances, particularly since most women will be facing those circumstances alone. In a perfect world, those wouldn't be problems. But if you make laws as though we are living in a perfect world, you're not the one who'll suffer. Women will suffer. I should hope that matters enough to you to affect your decision.
Making law as though women who don't want children have it in their power to prevent conception 100% is making law in a land of fantasy (particularly with DHHS trying to restrict women's access to hormonal birth control). It's a nice fantasy. I'd like it a lot, too, if I could prevent pregnancy 100%. But if you make policy as though we are living in that perfect world when we are not, it won't be you who suffers. It will be women, and the children born to these now-disadvantaged and disenfranchised mothers. Pretending the world is better than it is will not make everything better. It will hurt people, and crowing that those nasty sluts had it coming does not erase that fact.
The only reason I can see for picturing the world this way and making law this way is to make you (and the "American Taliban" in general) feel like you've shown everyone how moral you are. If that's the needs those laws are serving, it becomes very very important to me how many people those laws will hurt.
And y'know what? When you're willing to hurt that many people just to codify your morals, I will never believe you are moral. You just want to be seen that way, by others and yourself. As a moral person, I call bullshit on that. As a woman, I call double bullshit on people who're willing to ruin my life and the lives of women like me just to feel special, like their morals are the only ones important enough to be made law.
Yes, women like me. Here's where we get to the personal anecdote section.
PART FOUR: I AM A FILTHY SLUT...
I have been in a relationship with the first person I ever had intercourse with for four years now (as of Sunday). We use two forms of protection every time we have sex. Our relationship is stable, and so is our economic footing (sorta). A pregnancy would halt Brian's education and my job search. A pregnancy would rack up medical bills neither of us can pay for (and neither can our families). A pregnancy would destroy us.
We're careful. We're responsible.
We are doing everything we can to prevent me from conceiving.
If I become pregnant, there are people who would deny me an abortion because I chose to have sex, and I deserve the worst case scenario when/if it comes around. I deserve to lose my job and not further my education. Brian deserves to have his education halted. We both deserve staggering debt from medical bills, debt we may never get out of. Above all we deserve the strain on an otherwise-healthy relationship.
And why?
Because I chose to have sex, and irresponsible people deserve to have their lives ruined. If I'd been raped, my rights would remain intact. But if one standard of morality gets codified into law, and that standard of morality judges me a bad woman who should have to bear an enforced pregnancy... what can I do?
You want to talk about prevention? I'm trying to prevent a worldview that treats adult women like minors (children, guys) or livestock who are unqualified to make "the big choices," like when they'll breed. I'm trying to prevent a worldview that could ruin my life from getting a toehold in my government.
PART FIVE: ...AND WHAT ARE YOU?
What do you want for American women? Does it have anything to do with their wellbeing? Or hadn't you really thought about it? There's more to morality than "protect babies." Sometimes you have to concede an obligation to the human beings around you who're trying to live out their lives. The real question is whether a potential human is more important to you than a living one, just because the living one happens to be a woman.
If you're comfortable with that, truly comfortable with it, leave a comment. I need to know who you are so that I can seriously reconsider your respect for me as a human being.
PART ONE: GOVERNMENT INTERVENTION
Remember how the Department of Health and Human Services was arguing that a doctor's desires should trump their patient's medical needs?
The public comment period on that is not quite over. It ends in a couple of days. If you have not yet sent in a comment, you should. You can review the issue here, and the action info is as follows:
Send an email to consciencecomment@hhs.gov, with the subject line "provider conscience regulation." They are publishing these comments right now, because it is in a 30-day public comment period.
I had a conversation with a pro-choice friend of mine about this, and for those of you who aren't accustomed to seeing this from a civil rights point of view, the following might be helpful. A lot of you on my friends list are already likely pro-choice, but here's the case I'd like to make to those of you who are not.
DHHS wishes to reclassify many forms of birth control as abortion. How do they do this? By defining "life" at fertilization and not implantation. Now, these are both completely arbitrary points to pick, but I'll tell you the implications of each one.
If we rule that life begins at implantation, we can sell forms of birth control such as oral contraceptives, transdermal contraceptives (the patch), IUDs (which is actually hormonal as well), and various other non-barrier methods. This is because part of what they do is prevent a fertilized egg from sticking to the inside of the woman's uterus. Keep the fertilized egg from implanting and it flushes out with her next period just like any other egg.
If we rule that life begins at fertilization, every non-barrier method I can think of short of full sterilization becomes abortion. This is a problem because it removes control of a woman's reproduction from her own hands (a pill that she takes, a patch that she wears, an IUD that she has inserted) and gives it mostly to men (a condom that he wears). This means that women are less capable of engaging in responsible sexual activity.
PART TWO: PERSONAL RESPONSIBILITY
"Well, they should have thought about that before they started having sex," you might say. It's a common enough argument. If women don't want to get pregnant, they should engage in risky behavior like sex. Most people will agree that a woman who is raped or molested at a young age is not "to blame" for her sexual activity, and as a result an abortion is okay in these cases.
But here's what this really says. A woman who doesn't choose to have sex deserves the choice of whether to keep an unwanted child. A woman who does choose to have sex does not deserve the choice of whether to keep an unwanted child. What makes this misogynist is that it takes a moral imperative ("good women don't sleep around") and uses it as a framework to give "bad" women fewer rights than "good" ones. This classification obviously operates based on the idea that women can and should be judged according to moral standards they do not share; if they shared the position that consenting women don't deserve reproductive freedom, they wouldn't be asking for abortions.
But these women have their own moral standards. A woman who chooses to have sex does not give up her conscience (despite what many particularly vicious misogynists may assert). What DHHS is saying is that if a woman seeks an abortion after having consensual sex, it doesn't matter if she thinks it's right. She isn't qualified to make that decision, and her doctor has every right to veto it by denying her access to the abortion she wants.
I don't think I'm being overdramatic when I say this: if a woman isn't qualified to make a moral choice about "appropriate" sexual conduct because she might "choose wrong," why are they allowed to make moral choices anywhere else? Why are women voting? Shouldn't every woman's vote be subject to a veto by someone who's afraid she'll "vote wrong?"
PART THREE: A MINOR INCONVENIENCE?
The next argument I hear a lot is that women don't have to raise these children. They can choose to give it up for adoption and move on with their lives without having to kill a fetus. This argument is based on the assumption that "no cost pregnancies" are not only possible, but universal.
This is flawed. Pregnancy is a very costly experience. I don't care how many times you've seen the movie Juno; women cannot expect that their every medical and emotional need will be catered to by wealthy supportive patrons. Here's what really happens.
Carrying a bearing a child disrupts a woman's education if she still needs to finish it.
There are also incredible medical expenses involved with proper pre-natal care.
There's also the fact that if your job doesn't allow maternity leave (and unlike many European countries, America doesn't require employers to provide this), any time spent in the hospital could cost you your job. This is not just your means of supporting yourself. It's probably also your means of paying for the aforementioned expensive prenatal care.
Make no mistake. This is what an unplanned and unwanted pregnancy looks like. There are problems with someone else having the power to subject women to these circumstances, particularly since most women will be facing those circumstances alone. In a perfect world, those wouldn't be problems. But if you make laws as though we are living in a perfect world, you're not the one who'll suffer. Women will suffer. I should hope that matters enough to you to affect your decision.
Making law as though women who don't want children have it in their power to prevent conception 100% is making law in a land of fantasy (particularly with DHHS trying to restrict women's access to hormonal birth control). It's a nice fantasy. I'd like it a lot, too, if I could prevent pregnancy 100%. But if you make policy as though we are living in that perfect world when we are not, it won't be you who suffers. It will be women, and the children born to these now-disadvantaged and disenfranchised mothers. Pretending the world is better than it is will not make everything better. It will hurt people, and crowing that those nasty sluts had it coming does not erase that fact.
The only reason I can see for picturing the world this way and making law this way is to make you (and the "American Taliban" in general) feel like you've shown everyone how moral you are. If that's the needs those laws are serving, it becomes very very important to me how many people those laws will hurt.
And y'know what? When you're willing to hurt that many people just to codify your morals, I will never believe you are moral. You just want to be seen that way, by others and yourself. As a moral person, I call bullshit on that. As a woman, I call double bullshit on people who're willing to ruin my life and the lives of women like me just to feel special, like their morals are the only ones important enough to be made law.
Yes, women like me. Here's where we get to the personal anecdote section.
PART FOUR: I AM A FILTHY SLUT...
I have been in a relationship with the first person I ever had intercourse with for four years now (as of Sunday). We use two forms of protection every time we have sex. Our relationship is stable, and so is our economic footing (sorta). A pregnancy would halt Brian's education and my job search. A pregnancy would rack up medical bills neither of us can pay for (and neither can our families). A pregnancy would destroy us.
We're careful. We're responsible.
We are doing everything we can to prevent me from conceiving.
If I become pregnant, there are people who would deny me an abortion because I chose to have sex, and I deserve the worst case scenario when/if it comes around. I deserve to lose my job and not further my education. Brian deserves to have his education halted. We both deserve staggering debt from medical bills, debt we may never get out of. Above all we deserve the strain on an otherwise-healthy relationship.
And why?
Because I chose to have sex, and irresponsible people deserve to have their lives ruined. If I'd been raped, my rights would remain intact. But if one standard of morality gets codified into law, and that standard of morality judges me a bad woman who should have to bear an enforced pregnancy... what can I do?
You want to talk about prevention? I'm trying to prevent a worldview that treats adult women like minors (children, guys) or livestock who are unqualified to make "the big choices," like when they'll breed. I'm trying to prevent a worldview that could ruin my life from getting a toehold in my government.
PART FIVE: ...AND WHAT ARE YOU?
What do you want for American women? Does it have anything to do with their wellbeing? Or hadn't you really thought about it? There's more to morality than "protect babies." Sometimes you have to concede an obligation to the human beings around you who're trying to live out their lives. The real question is whether a potential human is more important to you than a living one, just because the living one happens to be a woman.
If you're comfortable with that, truly comfortable with it, leave a comment. I need to know who you are so that I can seriously reconsider your respect for me as a human being.
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no subject
Date: 2008-09-24 02:15 am (UTC)From:Furthermore, if you're really a firm, the-Bible-is-to-be-read-literally Christian, you can't claim abstinence is 100% effective. It clearly didn't work for Mary.
no subject
Date: 2008-09-24 02:28 am (UTC)From:no subject
Date: 2008-09-24 02:44 am (UTC)From:no subject
Date: 2008-09-24 04:39 am (UTC)From:Satan is at work on livejournal!
Here's another important question for bible-believing Christians: if Mary had taken to wearing a diaphragm or female condom almost constantly, would that have worked? Or did God fertilize Mary's egg directly from inside her fallopian tube?
no subject
Date: 2008-09-24 04:43 am (UTC)From:no subject
Date: 2008-09-24 05:35 am (UTC)From:Protestants, though, like to emphasize that Mary *wasn't* special other than that she was obedient to God when Gabriel came to her, and that "anyone could've been chosen".
no subject
Date: 2008-09-24 05:49 am (UTC)From:no subject
Date: 2008-09-24 02:31 am (UTC)From:no subject
Date: 2008-09-24 03:04 am (UTC)From:Additionally, fertilized eggs frequently fail to implant even with women who aren't on the pill. This is one reason why even when you pump women full of conception-inducing hormones and stick three or four IVF embryos in her uterus, she may still fail to get pregnant. Although it's medically impossible to detect when a fertilized egg fails to implant outside that situation, it's entirely possible that some women may experience several failed implantations for each successful one. So really, if you consider failed implantation to be the death of a living baby, any kind of sex without a barrier is probably putting a child at risk, even if you're a married couple trying to conceive.
It's also worth noting that while there's very little reason to believe the birth control pill prevents implantation (since it almost always prevents ovulation, it's rare that you'd have a fertilized egg to fail to implant, and I don't even think it thins the uterine lining that much beyond the normal range of lining thicknesses), I'm sure that a number of other medications (and natural variations) would also lead to many of the same conditions that hardcore prolifers are complaining about the BCP causing. Anything tending to cause a hormonal imbalance. Blood thinners, maybe. Anti-inflammatories? Chemo? Who knows?
Of course, anti-inflammatories and chemo are probably ignored because they're "medical treatment" and not "birth control." But a whole lot of women use birth control for medical purposes as well, and the administration doesn't seem particularly concerned about that (there's no health exception in the proposed regs that I know of, and pharmacists/etc. aren't going to know what the medication is really for).
no subject
Date: 2008-09-24 03:20 am (UTC)From:"Combination hormonal contraceptives inhibit ovulation via a negative feedback mechanism on the hypothalamus, which alters the normal pattern of gonadotropin secretion of a follicle-stimulating hormone (FSH) and luteinizing hormone by the anterior pituitary. The follicular phase FSH and midcycle surge of gonadotropins are inhibited. In addition, combination hormonal contraceptives produce alterations in the genital tract, including changes in the cervical mucus, rendering it unfavorable for sperm penetration even if ovulation occurs. Changes in the endometrium may also occur, producing an unfavorable environment for implantation. Combination hormonal contraceptive drugs may alter the tubal transport of the ova through the fallopian tubes. Progestational agents may also alter sperm fertility."
So "the pill" prevents ovulation (more or less for sure), theoretically prevents implantation, and prevents sperm from even reaching the egg in some cases.
You are also correct about other medications causing problems. The FDA rates drugs into "pregnancy categories" A, B, C, D, and X. As and Bs generally have good data to support their use in pregnancy; As are "no risk whatsoever" and as such the only drugs in the category are prenatal vitamins and folic acid. B indicates strong evidence that the drug is not harmful. C says there have been no controlled studies, but risk is possible; animal studies may have shown risks. D says that risk is likely and there is evidence backing the assertion that the drug not be used in pregnancy. X is no fucking way, don't use this in pregnancy, you will screw up the baby (thalidomide, Accutane, misoprostol [a known abortifacient], alcohol, etc).
Considering that it is not always obvious that a woman is pregnant it's actually possible to do a lot of damage to a fetus that she doesn't even know is there. All three of the drug classes you mentioned contain drugs in the D and X categories. It's not just heavy-duty stuff like chemo; OTC ibuprofen can cause premature closure of the ductus arteriosus, the vessel that shunts blood so that a baby can get oxygen despite their lungs being full of fluid.
As a side note, sometimes pharmacists do need to know if you're using birth control for something other than to control birth, namely if you need to have it billed in an odd manner. Most insurance companies say one pack per 28 days; one cycle per cycle. Some people have medical reasons to skip their placebo week, in which case the pharmacy has to bill one pack per 21 days. Sometimes insurance companies require documentation that the pill is being used for, say, endometriosis instead of contraception. How legitimate you think that this practice is is up to you, but insurance companies do have a right to know what they're paying for.
no subject
Date: 2008-09-24 04:13 am (UTC)From:And while pharmacists may sometimes be clued in to the purpose of birth control medication, that's far from universal. I take BCP entirely for medical reasons these days, and it's billed just the same as anyone else's birth control. Which means that if I ever got a pharmacist that thought I was ZOMG KILLING BABIES by taking it, I have no idea how I'd be able to convince them otherwise. I guess I could have my doctor call them, or carry around a note, but that's a serious hassle especially when my insurance won't let me get more than a month's worth at a time. Plus, the pharmacist could still think that my health problems aren't worth potentially killing babies for, and I don't know how to get around that. I don't really relish the idea of having to convince a stranger in public that I am not sexually active and, when I am sexually active, always use barrier contraception as backup.
no subject
Date: 2008-09-24 05:31 am (UTC)From:no subject
Date: 2008-09-24 05:53 am (UTC)From:It also puts you in a hard position because you have to fight the issue on two fronts (the IUD definitely prevents implantation and I think people need access to it as well), but you have to call people on how they misrepresent the facts (especially since the same people regularly freak out about the possibility that pro-abortion doctors will LIE to women and tell them things that make BCP/abortion sound better, and this indicates how evil those doctors are).
no subject
Date: 2008-09-24 06:00 am (UTC)From:Your comments have been very interesting to read and I love you all.
no subject
Date: 2008-09-24 05:51 pm (UTC)From:But yeah. The pill should prevent ovulation basically all the time, with the very, very slim chance that even if you do ovulate other factors (like increased cervical mucous thickness) will still prevent fertilization (or implantation). But given the way the pill is intended to regulate hormones, it shouldn't really even be a talking point.
Also, from the perspective of a pharmacist-in-training, I always just kind of assume that if you're on the pill it's because you want to prevent yourself from having babies unless you tell me otherwise. Since I don't care about people doing that one way or the other, it's not a problem. I wonder if that creates an interesting cognitive dissonance scenario for some pharmacists--they start assuming every pill script is for "period control" (lulz) so that they don't have to think about providing sluts with contraceptives.
I actually used to work with a very staunchly Catholic pharmacist. Granted, he worked the night shift, which meant that the most I was ever exposed to his company was about two hours. But he'd received complaints--and one of my coworkers corroborated the stories--that he had been asking women at the check-out who were picking up birth control pills whether or not they were married. I don't think he ever actually refused to dispense the drug; I do think he gave them a lot of disapproving looks, for what that's worth. He also reportedly had a tendency to throw away the Plan B. Just pitch it in the trash.
Given my background, it should be clear why I'm of the opinion that pharmacists shouldn't be able to opt out of fills for conscience reasons--I've known some of them that would. So whenever people tell me "nobody would ever do that," I know better.
no subject
Date: 2008-09-24 07:52 am (UTC)From:logic used in really, really oppressive countries that do things like stone women?
no subject
Date: 2008-09-24 04:26 pm (UTC)From:Why abortion MUST remain legal, and why we, as a society, have NO legal precedent to outlaw or limit access to it or to any form of birth control.
In this country, we do not mandate organ donation, we do not even mandate blood donation. Even in the case of a family member asked to donate life saving bone marrow, we do not, as a society, find it appropriate to make this compulsory, even when we can sit and talk to the person whose life hangs in the balance. Even after death, our wishes with regard to our own physical bodies determine whether our organs may or may not be used to save the lives of other human beings. And it is right that we should not. If the government tried to make these things mandatory under law, I am confident at least as many Christians and religious persons as non-religious would be having fits, and for once I would agree, though doubtless for different reasons.
Do these measures save lives? Of course. Is this a good thing? Naturally, no question. But mandatory, to be legislated and enforced by the law of the land. Absolutely not.
But to remove or restrict the right to abortion & birth control is to remove the control of one human over their body in order to sustain the life of another, something we clearly do not find appropriate. Even if you assume a fetus IS a human being from conception/implantation, if the law of the land cannot help itself to my kidneys when I am dead, nor to my blood or tissue while alive, in order to support the life of another human being, why is it that the law should be able to mandate the use my body, against my wishes, for a period of nine months, to support the life of another human being? The answer is that it cannot, any more than it can compel organ, tissue or blood donation.
Is it better to avoid the necessity of abortion? Of course. (Better still not make sure that all women have full, complete and informed access to birth control, which will drastically remove the demand for abortion in the first place.) But to make full term carriage mandatory, to be legislated and enforced by the law of the land? Absolutely not.
no subject
Date: 2008-09-24 09:59 pm (UTC)From:no subject
Date: 2008-09-24 10:45 pm (UTC)From:no subject
Date: 2008-09-24 10:00 pm (UTC)From:no subject
Date: 2008-09-24 10:48 pm (UTC)From: