Like most women, physicians and mothers of my generation in the U.S., I've been fortunate to learn of deaths from wire hangers and shady abortionists only indirectly. Last week I realized that I've taken women's health, or what's really at issue -- women's access to needed care -- for granted. That's changed now.
New politics and rough talk jeopardize women's lives on three fronts:
First, we can no longer assume women in the U.S. will have access to birth control if they need it. Last week the Senate narrowly tabled a move to limit insurers' responsibility to cover contraception. The vote on the so-called "conscience" amendment was 51-48. This means that essentially half of that powerful body of politicians either agrees with limiting women's access to birth control or sees it as dispensable in the context of larger political aims.
That the proposal reached the Senate floor is disturbing. Because without contraception, women -- including teenagers, individuals with health problems that can be exacerbated by pregnancy, some who can't afford to feed another child and others who are already troubled or otherwise not ready for children - are much more likely to become pregnant. It shouldn't take a doctor to articulate this obvious point, and I can't understand why so many, and the AMA in particular, are silent on it. So I'll state this clearly: Lack of contraception puts women and their conceivable future-kids at risk for serious health problems.
The language surrounding the proposed amendment is damaging. Who are the anti-birth control legislation-writers to imply that "conscience" is involved in withholding contraception, and not the other way around? It's like the "pro-lifers" who've implied that the rest of us aren't.
Second, safe abortions are increasingly hard to find. In this discussion, I won't hide behind "even in cases of rape or incest" kinds of clauses. I do respect that some people think it's wrong to terminate a pregnancy. But I also know that plenty of women, especially young women, get pregnant who don't want to be pregnant. Regardless of who's "responsible" -- and I'm no sucker for finger-pointing and behavior blame games -- the bottom line is that if abortions become out-of-reach, women will suffer hemorrhage, life-threatening infections, permanent infertility and premature deaths.
Hard to know how many women had ill effects or died from botched abortions before January, 1973, when the Supreme Court issued its decision on Roe v. Wade. I was in the 7th grade then, and I recall my social studies teacher could hardly contain her excitement. The moment was a turning point in women's history, she told us. I wasn't quite 13 years old, and didn't know much about abortions, but I read the newspaper and gleaned what I could. The gist of it was that I and my friends and our theoretical future-daughters wouldn't have to worry about going to a squalid room somewhere if we ever had an unwanted or dangerous pregnancy. Rather, a woman could end a pregnancy, safely, with the help of a real doctor in a sterile, on-the-radar facility.
My mind flashes back to scenes from movies. Still, I can't rid my brain of the scary, unclean place Natalie Wood visits with a wad of cash in the 1963 film Love With a Proper Stranger. Or the tragic outcome when actor Gael García Bernal takes his pregnant love to an abortionist in the Crime of Father Amaro, a movie set in Mexico. But the real scoop comes from tales by older doctors and nurses. When I was in med school in the 1980s, they told me stories of women and girls showing up in the emergency room bleeding, pale, cold and clammy... dead.
As outlined by editorialists and writers elsewhere, mergers of Catholic hospitals with other medical centers reduce women's access to safe abortions in some rural areas. In states like Texas, the physical and emotional rigmarole to which pregnant women are subjected prior to an abortion -- including mandatory listening to a detailed description of the fetus and a forced, loaded discussion, make what might be a tough decision unbearable, especially for women who lack confidence. Know a few?
Which leads to the third issue -- on vulnerability, and access to prescriptions and health care without intimidation or emotional abuse. When Rush Limbaugh spoke last week, he wasn't just talking about one Georgetown Law student. He was speaking to and about millions of young women who are sexually active. He called them sluts and suggested they are like prostitutes. Adding insult to verbal injury, he said he'd like to watch videos of the sex. You could say it doesn't matter what he thinks, he's just some far-right showman blowing off steam and misogyny. But this is a man who speaks to conservative leaders and feeds ideas to many households in America.
Worrisome that the Republican front-runners, men who would be president of the United States next year, didn't call Rushbo out, as Maureen Dowd detailed. They let it go. As they might your daughter's health, or access to birth control, or a safe abortion.
In this new climate of shame, it's easy to imagine a girl in a rural community or elsewhere might feel really, really bad about herself simply for being sexually active. Whether she's 17 years in high school, or 21 years in college, or 25 and maybe a secretary in a law firm -- and possibly lonely or confused -- she may be embarrassed to ask her doctor for birth control. "The Scarlet C," Robert Walker aptly called it.
The paradox is that this kind of rough talk, posturing and in some states, puritanical law-making, make it more likely that a sexually active young woman will become pregnant. And if she does become so, now, she may delay seeing a doctor because she fears his or her moral judgment about her behavior. And that leads to less healthy outcomes, and more deaths -- fetal and maternal.
This is a serious health issue. I wish more doctors would speak out about it.
Follow Dr. Elaine Schattner on Twitter: www.twitter.com/ElaineSchattner