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Monday, August 30, 2021

How Supreme Court case June Medical v. Russo may have set up pro-lifers for victory in Dobbs v. Jackson Women's Health

[Today's guest post is by attorney Leslie Corbly.]

The philosophical makeup of the Supreme Court is fluid. With the addition of Justices Neil Gorsuch, Brett Kavanaugh, and Amy Coney Barrett, the judicial philosophy of the majority of the Court’s members has once again shifted. In light of this shift, in April 2021 the Arkansas Law Review published the article “A Costly Victory: June Medical, Federal Abortion Legislation, and Section 5 of the Fourteenth Amendment.” Essentially the authors argue that the Supreme Court case June Medical was a victory for abortion supporters, but an expensive one that may ultimately contribute to a different outcome in the near future. Here I summarize the article for your consideration. For clarity and unless otherwise specified, my parenthetical citations in this post refer to page numbers in "A Costly Victory," linked above.

It is no secret that the recent decision by the United States Supreme Court to take up the case of Dobbs v. Jackson Women’s Health Organization could significantly impact the current legal landscape of abortion rights. A ruling in Dobbs which grants states the ability to regulate abortion prior to fetal viability would be a significant departure from current legal precedent. To properly understand the possible implications of such a ruling it is necessary to understand (1) fetal viability and (2) the connection between viability and the state’s ability to regulate abortion.

A Quick Legal History

Roe v. Wade and the trimester framework.
Viability in the context of abortion legal precedent describes the ability of a fetus to survive outside the womb of a pregnant woman either naturally or through medical support (pg. 6). The landmark decision Roe v Wade set the precedent that access to abortion was a woman’s constitutional right. In the subsequent decision in Planned Parenthood v. Casey the Court held this right stemmed from the Fourteenth Amendment’s Due Process Clause (pg. 4). However, this right was never absolute, and Roe itself recognized the state’s interest in preserving fetal life, developing a trimester framework which applied a series of legal tests through the course of a woman’s pregnancy to determine when abortion was legally permissible (pg. 51). These tests determine the extent to which the state had an interest in regulating abortion either to preserve the health of the mother or the life of the unborn child (pg. 51).

During the first trimester, Roe left a woman’s right to abort in the hands of her physician’s medical judgment. Subsequent to the first trimester, a woman’s right to abort her unborn child could be subject to state regulation, but only on the basis of the state’s interest in preserving the health of the mother. However, once an unborn child passed the point of viability the court held that a state may exercise more limiting regulations, including barring a woman from aborting the fetus, except in circumstances where her life or health is endangered (pg. 51).

Planned Parenthood v. Casey and the "balancing test."
Although the trimester framework was subsequently overturned by Casey the court has consistently ruled that the point of viability is significant and, post viability, states have a greater interest in regulating the practice of abortion to preserve the life of the unborn. Casey established a balancing test, requiring courts to weigh the benefits and burdens of abortion regulation when determining whether a law violated the constitution. This ambiguous balancing test was affirmed in Whole Woman’s Health v Hellerstedt (pg. 2). 

June Medical v. Russo and "significant obstacles."
However, in the Supreme Court’s 2020 ruling in June Medical Services L.L.C. v Russo (which struck down a Louisian abortion law), the Court moved away from the ambiguous balancing test created in Casey and applied in Hellerstedt, opting to take a more deferential stance towards state abortion regulation by allowing an abortion regulation to stand, even prior to viability, if the regulation does not place a significant obstacle in the path of a woman seek a pre-viability abortion (pg. 2).


Effects of June Medical

Abortion advocates propose federal legislation to codify Roe.
Although the Court’s decision in June Medical overturned an abortion law, advocates of abortion reacted swiftly to the Court's deferential interpretation of state regulation of pre-viability abortions. They immediately calling for the codification of Roe through federal legislation, a call echoed by the Biden administration just prior to the President’s inauguration (pg. 3). For years, abortion proponents have desired federal legislation as a vehicle of further codifying the right to abortion, and top Democratic politicians such as Barbara Boxer and Barack Obama have supported such legislation (pg. 3).

The two most common pieces of legislation proposed by abortion advocates are the Freedom of Choice Act (FOCA), and the Women’s Health Protection Act (WHPA). FOCA is the more sweeping a broad of the two legislative agendas, attempting to bar government at any level of authority from denying or interfering with a woman’s right to abortion either before viability or when the woman’s health or life are impacted post viability (pg. 37). Although WHPA would also apply to all levels of governmental authority, the legislation would allow for bans on abortion before and after viability with exception for circumstances where “continuation of the pregnancy would pose a risk to the patient’s life or health” (pg. 37). In addition, WHPA would allow regulations to stand if the government can establish, by clear and convincing evidence, that the regulation “significantly advances the safety of abortion or the health of patients” and that the safety of such services and the health of patients “cannot be advanced by a less restrictive alternative measures or action” (pg. 38).

Congress has limited ability to enact such legislation.
However, the June Medical decision limits the ability of Congress, under Section 5 of the Fourteenth Amendment, to enact the type of legislation promoted by abortion advocates. This is because Congress’s authority under Section 5 is limited (pg. 35). Indeed, the Court ruled in City of Boerne v. Flores that Congress lacked the power to enforce limitations under the Religious Freedom Restoration Act on state and local governments, holding that Congress may not use Section 5 authority to effect a substantive change to the Due Process Clause because “the text of [section 5] [is] inconsistent with the suggestion that Congress has the power to decree the substance of the Fourteenth Amendment’s restrictions on the States” (pg. 35).

Functionally, this means Congress may pass laws to prevent violations of section 5 of the Fourteenth Amendment, but it may not pass laws altering the substance of the Amendment. Laws passed via Section 5 authority must target state and local laws and regulations that “have a significant likelihood of being unconstitutional” (pg. 36). Because the June Medical decision significantly reduced the probability that any given abortion regulation “contravenes a woman’s due process rights” it thereby curtailed the authority Congress has to enact federal legislation designed to undercut the ability of state and local governments to regulate abortion. (pg. 36)

Potential Effects of Dobbs

The possible implications of a Dobbs ruling are significant. Should the Court grant states the ability to limit pre-viability abortions, this would be a monumental decision. To date, the Court has allowed Casey’s prohibition on pre-viability abortion bans to hold (pg 65); in light of such precedent, lower courts have enjoined the enforcement of all pre-viability bans, except one ban of abortions at twenty weeks or earlier (pg. 65). Further, although some sates have bans on abortions ranging from twenty-two to twenty-fours weeks, the constitutionality of such laws is highly suspect, meaning their retention through statutes is likely for the purpose of governments signaling a moral disdain for abortion (pg. 65). 

If the Supreme Court were to overturn the prohibition on pre-viability bans, it would open the door to further regulation limiting abortion thereby further curtailing the ability of Congress to exercise section 5 authority over state and local governments. This would likely lead to further cases appearing before the Court because the Court would be tasked with determining the breadth and depth of the constitutional right to abortion given the abandonment of the current pre-viability/post-viability constitutional framework. Alternatively, should the Court overturn Roe, Congress would lack any authority under Section 5 because the abortion would no longer be recognized as a constitutional right and any regulation of abortion, either by limiting or expanding the right to such a procedure would be decided under the jurisdiction of individual states.

Photo credit Supremecourt.gov

Friday, August 27, 2021

NARAL believes pro-lifers are winning the online messaging battle

Photo Credit NeONBRAND from Unsplash

On August 20, Alex Roarty published "Podcasts, comedians, freedom: How an abortion rights group is changing its strategy." He covers how NARAL is trying to make up perceived lost-ground in the online debate on abortion. His article is an interesting look at the strategic planning of the pro-choice side. Here is my random collection of quotes and notes:

The national abortion rights group NARAL Pro-Choice America has spent the year intensively researching how it can close a so-called “virality gap” online with voters.

This surprises me. It usually feels as if the pro-choice side has more coordinated and savvy messaging, and our side is made of many small, disparate groups, more grassroots and less far-reaching. I'm curious what research NARAL is looking at that leads them to believe they are losing a battle on messaging.

NARAL has recently started restructuring its organization:

The restructuring [including ending the autonomy of nearly a dozen state-based affiliates] has received harsh criticism — including from some officials within the organization. Some of the heads of state-based NARAL affiliates, unsure of their own future with the group, argue that the digital strategy siphons resources away from local, in-person persuasion they consider more effective.

I've also seen criticism of this move as some abortion rights activists urge pro-choicers to stop donating to NARAL and go more local instead (see here and here).

NARAL officials say if legal protections [of abortion] are diminished or outright removed nationwide, it will heighten the need to win the public debate.

I read two implications here. 

  1. The law somewhat truncates public debate and changing law is at least as important as changing hearts & minds (although the two are connected).
  2. Perhaps until now pro-choicers haven't had to fully engage the public debate. 
Since Roe, the law has been decidedly on the side of abortion advocates. Roe v. Wade & Doe v. Bolton made it nearly impossible to pass meaningful abortion restrictions before viability (about 5 months into pregnancy). This legal status quo isn't some comfortable middle ground. Polls generally find that Americans are open to abortion for medical emergencies and/or abortion early in pregnancy, but get far more resistant when it comes to abortion for any reason ("elective" abortion) and/or abortion after the first trimester. If that description is the middle ground, the current legal status of abortion is much further to the pro-choice side. Despite lobbying groups' dramatic protestations that there are hundreds of new "anti-choice" restrictions every year (definitions of "restriction" are broad), on a national level the U.S. has some of the most liberal abortion laws in the world. Even the recent controversy over Mississippi's 15-week ban misses the part where that ban would still leave Mississippi abortion law lax by international standards (see "European Gestational Limits on Elective Abortion" pg 4). 

The pro-choice side has had a distinct advantage in terms of the law; has that meant they haven't had to engage as fully in terms of hearts and minds? I imagine it's easier to defend the status quo than to fight for major change. Would it be enough for pro-choicers to reiterate the same primary arguments with more vigor, or would they need to start making new arguments? Would they need to address our points in more depth, or would they be better served doubling down on different subjects? It's hard to predict how this debate will transform if Roe goes.

Research conducted by NARAL, shared with McClatchy, suggests that online users are more likely to find more content supportive of abortion rights on Google. The dynamic flips, however, when users are on a social networking site like Facebook or watch videos on YouTube.

Makes me wonder how we can flip the dynamic on Google too...

These were the types of voters — many of them not consumed by politics day-to-day — NARAL was failing to engage with, Montemarano said. And it led to what she described as a “virality gap” between her side and abortion rights opponents, with the latter having more success promoting their viewpoint across the internet. “To me, there was this big gap in the middle,” she said. “Where is everyone else? What information are they seeing? What are they believing? How can we reach the people beyond the activists?"

"How can we reach the people beyond the activists?" is a question I think about almost daily. Our target audience, I suspect, is rarely pro-life or pro-choice activists. It's the people on the fence and/or people who have opinions but aren't particularly involved, which describes most of America. How do we bring them down from the fence to our side? How do we get them to engage? (The last question was the primary motivation behind our project How To Be Pro-Life.)

Group leaders say that rather than emphasize health care or other issues connected to abortion, they plan to emphasize a message of freedom from political interference, emphasizing that conservatives who oppose abortion rights want to control people.

So is this the primary message we need to counter? If so, first step is to emphasize it's not only conservatives who are against abortion. There are people from all walks of life against abortion. Second step is to emphasize our motivation isn't to control adults but to protect children. We've touched on this before:

Original tweet here

NARAL’s plans to nationalize its operations means the group could part ways with its 11 state-based affiliates. The plan was unveiled in June, to the anger of many affiliates. And many of them say retooling the digital effort matches their broader concern about a group more focused on the national big picture than local issues that can often have the most impact on the public.

Which has a bigger impact: national messaging or local changes? 

Of course ideally we find ways to work on both, which underscores again how important pregnancy resource centers can be. In fact, as Alexandra Desanctis explains, a recent study came out which found women considering abortion who visit pregnancy resource centers are 20% less likely to get abortions than those who don't visit such centers. Local pro-life work has a major impact.

I also wonder if the tension between national and local efforts partly explains why the pro-life and pro-choice sides seem continually deadlocked in terms of swaying the public. Perhaps the pro-choice side is, as it anecdotally appears to me, more formidable with national messaging, but the pro-life side has a grassroots game strong enough to keep up. Or, if NARAL's recent research on the "virality gap" is accurate, maybe the exact opposite is true.


Wednesday, August 25, 2021

We Asked, You Answered: Your First Abortion Debate

We asked our followers on Facebook and Twitter: "What is your earliest memory of getting involved in the abortion debate?" Here are a few of our favorite responses: 

Colette M.: I remember learning what an abortion was in 5th grade in 1976. I couldn't comprehend it. Why would women think that having a baby would get in their way? They should stand up and demand better treatment! Guess I was a pro-life feminist without even knowing it!

Matt T.: My earliest memories are learning about it from watching The Daily Show as a child. I thought the other side was foolish for saying a child was alive before even being born, and only religious dogma could justify such a serious impediment to human sexual expression. How far I have come!

Caitriona B.: Probably when I was about 10 and my dad drunkenly told me my mom "got rid of the wrong ones."

Michael C.: In 8th grade biology class they covered what makes something alive on the first day of class. I asked "So, is a fetus alive?" The teacher who I kind of assumed was a liberal said, "Yes, a fetus is alive." I already knew but I figured if the teacher said it it would have more weight than if I did. I've done it in every biology class I've ever taken. No surprise I always get the same answer.

Andrew G.: The moment my future wife told me why I should be pro-life. Until then I was on the sidelines of the pro-choice team in the name of free will. She really changed my whole view of life with that conversation.

Crystal K.: Kindergarten, holding up a sign at a Life Chain event in Oregon that read, "Abortion Kills Children."

Eric P.: High school. Mostly tried to keep to myself, but we had a lot of militant feminists/pro-abortionists attempting to "proselytize" abortion. When I had enough of the insults I finally said something back. Got heavily into the debate when I found out how many children had been murdered in this manner.

Sophie T.: First week of my freshman year in college, when my new friend said he was starting a pro-life club at our university. I'd always been pro-life in a vague sort of way, but I told my friend I'd help him without knowing what I was getting into. Little did I know I'd discover a passion for pro-life/whole-life advocacy.

Mandie R.: When I talked to my then fiance about if I were raped and got pregnant that I'd keep the baby because don't believe in abortion, and he threatened me with how he wouldn't be able to look at me the same if someone other guy did that to me and he wouldn't be able to look at the kid if it wasn't his. I was maybe 21 at the time.

Laura P.: Man, LiveJournal. You were fun while you lasted.

@maggery1570: Drawing horns and a devil's tail on a picture of Bill Clinton in my kindergarten class because my mom told me he killed babies. She was arrested during an Operation Rescue protest in the 80s. Let's just say my pro-life views have gotten a little more nuanced since I was 5!

Tiff M.: My freshman year in high school. I chose the pro-life position for my first persuasive essay in English.

Morgan W.: I don't remember my first debate, but I remember the first time I saw a picture of an aborted baby. My mom was a pro-life leader in our community. I grew up with literature and knowledge of both abortion and fetal development. I am glad I knew the reality of abortion early on. It cemented the truth and none of the empty pro-choice arguments were ever able to stand.

[Photo credit: Volodymyr Hryshchenko on Unsplash]

Monday, August 23, 2021

Announcing Secular Pro-Life's New Executive Director!

For the past dozen years, since our founding in 2009, Secular Pro-Life has been a volunteer organization. We have accomplished quite a lot in that time, and we have reached a tipping point. It has become clear to us that our next chapter must include paid employees. We are thrilled to announce that our new Executive Director — the first ever full-time Secular Pro-Life staff member — is the one and only Monica Snyder!

Monica has been a lead Secular Pro-Life volunteer almost from the beginning. You might recognize her from her speech at the 2014 Walk for Life West Coast, her "Deconstructing Pro-Choice Myths" presentation, and her many articles on the Secular Pro-Life blog. Her passion, commitment, and background in applied science make her the perfect woman for the job. Watch this video to hear Secular Pro-Life President Kelsey Hazzard, Vice President Terrisa Bukovinac, and Executive Director Monica Snyder discuss how they met, how SPL formed, and what Monica has planned for SPL's future: 

Kelsey and Terrisa will continue in their volunteer roles and support Monica to make Secular Pro-Life as effective and impactful as humanly possible. The lives of countless children in the womb depend on us. As we look to the Supreme Court for a possible reversal of Roe v. Wade next term, this is not the time to slow down! The hard work of dismantling the abortion industry, and making abortion unthinkable for people of every faith and none, is only beginning. If you are able, please make a donation to our vital work. Thank you!

Friday, August 20, 2021

Bring a Secular Pro-Life Speaker to Your Campus

Earlier this week, Secular Pro-Life President Kelsey Hazzard gave a virtual presentation hosted by the pro-life club at University of Ottawa entitled "Secular Standpoint: Why Abortion Still Sucks." We had a great discussion, and I'm sure the 2021-2022 school year has wonderful things in store for them.

Kelsey and students on Zoom


This makes University of Ottawa the first school to host a Secular Pro-Life speaker this semester — but I'm sure it won't be the last! We love working with student groups. Young people are the pro-life generation, and also much more likely than older folks to be religiously unaffiliated. We've spoken at dozens of colleges over the years, including Yale, Columbia, MIT, Berkeley, Carnegie Mellon, University of San Francisco, University of Virginia, and UNC-Chapel Hill.

Want to bring a Secular Pro-Life speaker to your campus? Email info@secularprolife.org with a proposed date and topic. Virtual presentations are free and easily accommodated. In-person presentations with precautions will be considered on a case-by-case basis. 

Wednesday, August 18, 2021

Pro-Choice Author: Solving Cold Case of Infanticide Presents "Slippery Slope"

Child holds a sign that reads "Please don't throw away babies"

I recently read a book for pleasure that I thought would be unrelated to abortion, and found myself with content for the Secular Pro-Life blog. (This keeps happening to me!) Allow me to introduce The Lost Family: How DNA Testing Is Upending Who We Are by Libby Copeland (2020). As the title suggests, The Lost Family is primarily concerned with family secrets that come to light thanks to consumer DNA testing services like Ancestry and 23andme, and the emotional impact of those surprises — including for extended relatives who never submitted DNA samples and receive shocking revelations out of the blue. It is certainly a worthy topic, and Copeland does an admirable job combining personal narratives with scientific explanations that make sense to lay readers. 

Copeland also discusses the new frontier of forensic geneaology, which uses familial DNA connections to identify human remains and solve violent crimes. The growing number of DNA profiles collected through consumer DNA testing services has proven to be a valuable tool for law enforcement, most visibly in the Golden State Killer case. Although no one doubts that getting killers off the street is a good thing, policymakers and ethicists have concerns about informed consent; after all, people who get a 23andme kit for Christmas are probably not thinking about the possibility that their DNA might be used to incarcerate a distant relative. 

I'm sorry, did I say no one doubts that getting killers off the street is a good thing? Turns out that depends on the age of the victim, as this disturbing, euphemism-filled passage describes: 

Thomas Murray, the Hastings Center president emeritus, told me he supported the use of genetic geneaology "to prevent the most extreme sorts of harms," so long as there are "good guardrails" in place to make sure police don't use these tactics for lesser crimes. . . . And yet, not long after I spoke to Murray, news outlets reported on the use of genetic geneaology leading to the arrest of a South Dakota woman "charged with murder for allegedly leaving her newborn in a ditch thirty-eight years ago." Several genetic geneaologists expressed concern about a slippery slope, about the kinds of crime this powerful new technology was being used for, and about the implications of such cases for women's reproductive and bodily autonomy.

Let's break that down. By "women's reproductive and bodily autonomy," Copeland (who is pro-choice) of course means abortion. Her implication that leaving a helpless newborn in a ditch to die is a "lesser crime" echoes the notion that infanticide is merely a fourth-trimester abortion and should not be penalized. And where Copeland recognizes a "slippery slope," pro-life advocates should recognize welcome scientific progress. 

Science proves that human beings in the womb are living individuals. Once the right to life is restored, scientific advances can provide an avenue for justice when those individuals are victims of violence. 

[Photo credit: American Life League]

Monday, August 16, 2021

Iranian study examines relationship between maternal religious attitudes and PTSD after abortion or miscarriage

Guest blogger Kate summarizes an Iranian study and gives us some thoughts on abortion in a very different context than in the U.S.

Summary

An Iranian study1 published last month investigated whether women’s levels of post-traumatic stress after abortion or miscarriage correlated with their “spiritual experiences.” This cross-sectional study, with a sample size of 104, was conducted from 2018 to 2019 at Shiraz University of Medical Sciences. The researchers used the Mississippi Post-Traumatic Stress Disorder (PTSD) Scale to measure the women’s stress levels. They also evaluated the subjects’ religious attitudes. Women completed questionnaires immediately after the loss, then one month later.


The subjects were divided into three groups: 


  1. induced abortion with forensic medical letter (ie, an abortion for which the woman had received legal permission based on a physician’s certifying that her pregnancy was a threat to her life or that the fetus was severely abnormal), 

  2. miscarriage management (ie, a natural miscarriage completed medically or surgically), and 

  3. miscarriage/spontaneous abortion (ie, a miscarriage occurring without intervention). 


(In this post, these groups will be referred to as “forensic,” “management,” and “spontaneous,” for brevity.)


The three groups of women were similar in terms of their religious attitudes: 68.7% of the forensic group, 71.8% of the management group, and 72.7% of the spontaneous group were highly religious; the remainder were moderately religious. Their levels of PTSD immediately following their abortions and miscarriages were also similar: 78.1% of the forensic group, 69.2% of the management group, and 72.7% of the spontaneous group had moderate PTSD, while 3.1% (forensic), 12.8% (management), and 6.1% (spontaneous) had severe PTSD. The remainder had mild PTSD.


One month later, PTSD symptoms had decreased in all three groups, but overall levels were still high: 62.5% of the forensic group, 64.1% of the management group, and 66.7% of the spontaneous group had moderate PTSD, while 3.1% (forensic), 5.1% (management), and 0 (spontaneous) had severe PTSD, and the rest had mild PTSD. The decrease in PTSD levels was not significantly associated with the religiosity of the subjects, except in the “management” group. In these women, higher religious attitude scores were correlated with a greater decrease in PTSD scores. In other words, the more religious these women were, the more their PTSD symptoms decreased in the month after their miscarriages.


More than half the pregnancies in this study were unwanted, and most of these parents were “wholeheartedly happy” about their loss. The researchers hypothesize that the mothers’ negative attitudes about their pregnancies may explain why PTSD levels in this study were relatively high and did not markedly decrease with time, as would normally be expected. According to the authors, the fact that these women got pregnant despite not wanting a baby might indicate the presence of other problems (eg, unaddressed mental health issues, marital discord, domestic violence, poverty) known to predispose women to postabortion stress.


The researchers’ recommendations were as follows: improve access to contraceptive services; amend existing abortion laws to prioritize maternal health, including psychological health; and, to the extent health care providers are comfortable, integrate religious practice into postabortion counseling for religious women.


Analysis

On the surface, this study doesn’t seem to say much: there was little to no relationship between the intensity of the women’s religious faith and the severity of their PTSD symptoms. (The authors recommended centralizing religion in postabortion counseling anyway, because previous studies have provided strong evidence that “religious beliefs [can] reduce the sadness and stress caused by fetal loss and prepare the parents to accept it.”) However, digging a little deeper reveals some nuggets of interest to pro-lifers.


In the introduction, the researchers observe that “abortion can be stressful for family members, doctors, and others in the social support system.” As they note, previous research has established that reactions in postabortive women include sadness, grief, guilt, anger, depression, anxiety, substance abuse, and suicidal thoughts and behaviors. They also mention that abortion can cause problems in the couple’s relationship. Unlike many Western scientists who have published on the subject, the Iranian researchers seem to take for granted that abortion can and often does have negative emotional effects – and not only on the mother, but the father, other family members, and health care workers.


The researchers briefly describe the religious and legal context around abortion in Iran. Namely, most Iranians (between 90% and 95%) are Shiite Muslims. Islam considers that an unborn child has an equal right to life, and therefore, abortion is a sin, punishable under Islamic penal codes. Currently, in Iran, an abortion can be legally performed only with a license and a forensic medical certificate stating that the pregnancy is a threat to the mother’s life or that the fetus has a serious deformity. The women in this study all experienced natural losses, serious pregnancy complications necessitating an early termination, or severe fetal anomalies. This is decidedly not the case for abortion in the US.2


Another factor to consider is that the women who enrolled in the study were not undergoing any type of psychological treatment, either medication or psychotherapy. Women were also excluded from participation if they were currently experiencing life crises, such as financial problems or the death of a loved one. In short, the subjects weren’t especially predisposed to psychological problems. The results of this study may well have been different if women with mental illnesses had been included. It is well established3 that women with preexisting mental health problems4 tend to have more difficulty coping emotionally with an abortion and are more likely to develop new or worsening psychiatric symptoms.5


As noted, most pregnancies in this study were unwanted; half of those women had not used a reliable contraceptive method. For most of the women whose pregnancies were undesired, their religious beliefs and Iranian law prohibited them from seeking an elective abortion. Therefore, they regarded the natural death of their baby as “a kind of divine blessing.” The same is likely true in the US (and elsewhere). Not all miscarriages are of wanted pregnancies. Although public discussions of pregnancy loss almost always focus on maternal feelings of grief and guilt, women who miscarry an unwanted baby may experience a sense of relief when the pregnancy ends without their having to do anything about it.


This study helps illustrate that abortion can look different in other cultures. The Iranian women were all married. They were older (with an average age of 30) and more religious than the average American abortion patient.6 And most fundamentally, none of these abortions were elective. All were cases of natural demise or rare medical emergencies (notwithstanding the pro-life point that killing a dying or disabled fetus is not actually a question of medical necessity).


In the same vein, the researchers’ recommendation that clinicians who provide postabortion counseling encourage religious patients to make their faith part of their recovery process is sound but probably more practical in Iran than in the US. Presumably, Iranian health care providers and their patients tend to practice the same religion (Shiite Islam). Many Iranian medical practitioners are likely devout Muslims themselves, which would make it easier to discuss faith and prayer with their Muslim patients. The religious diversity of the US makes such conversations between provider and patient more difficult.


Still, this study is interesting because it provides a cross-cultural perspective on postabortion mental health. Historically, most research on this topic was conducted in the US or other Western, predominantly Christian nations, whereas this study concerns a Muslim country in the Middle East. There were many differences between the Iranian women and the average American woman who obtains an abortion. In addition, the authors’ attitudes towards religion and abortion are noticeably different from those of most of their Western peers: more positive regarding religion and more negative regarding abortion. However, their results are broadly consistent7 with existing research8 indicating that abortions often result in varying degrees of emotional distress9 (although not necessarily full-blown PTSD) and that religious faith10 can be helpful in the healing process.11

References


  1. Alipanahpour S, Zarshenas M, Taheri M, Akbarzadeh M. A cross-sectional study of psychosocial problems following therapeutic abortion with the mother’s spiritual experiences. Int J Women’s Health Reprod Sci. 2021;x(x):xx. doi: 10.15296/ijwhr.2021.xx


  1. Finer LB, Frohwirth LF, Dauphinee LA, Singh S, Moore AM. Reasons U.S. women have abortions: quantitative and qualitative perspectives. Perspect Sex Reprod Health. 2005;37(3):110-118. doi: 10.1363/psrh.37.110.05


  1. APA Task Force on Mental Health and Abortion. Report of the Task Force on Mental Health and Abortion. American Psychological Association; 2008. Accessed 11 July 2021. https://www.apa.org/pi/women/programs/abortion/mental-health.pdf


  1. Academy of Medical Royal Colleges; National Collaborating Centre for Mental Health. Induced Abortion and Mental Health: A Systematic Review of the Mental Health Outcomes of Induced Abortion, Including Their Prevalence and Associated Factors. Academy of Medical Royal Colleges; 2011. Accessed 11 July 2021. http://www.aomrc.org.uk/wp-content/uploads/2016/05/Induced_Abortion_Mental_Health_1211.pdf


  1. van Ditzhuijzen J, ten Have M, de Graaf R, Lugtig P, van Nijnatten CHCJ, Vollebergh WAM. Incidence and recurrence of common mental disorders after abortion: results from a prospective cohort study. J Psychiatr Res. 2017;84:200-206. doi: 10.1016/j.jpsychires.2016.10.006


  1. Jerman J, Jones RK, Onda T. Characteristics of U.S. Abortion Patients in 2014 and Changes Since 2008. Guttmacher Institute; 2016. Accessed 11 July 2021. https://www.guttmacher.org/sites/default/files/report_pdf/characteristics-us-abortion-patients-2014.pdf


  1. Major B, Cozzarelli C, Cooper L, et al. Psychological responses of women after first-trimester abortion. Arch Gen Psychiatry. 2000;57(8):777-784. doi: 10.1001/archpsyc.57.8.777


  1. Fergusson DM, Horwood LJ, Boden JM. Abortion and mental health disorders: evidence from a 30-year longitudinal study. Br J Psychiatry. 2008;193(6):444-451. doi: 10.1192/bjp.bp.108.056499


  1. Bellieni CV, Buonocore G. Abortion and subsequent mental health: review of the literature. Psychiatry Clin Neurosci. 2013;67(5):301-310. doi: 10.1111/pcn.12067


  1. Cowchock FS, Lasker JN, Toedter LJ, Skumanich SA, Koenig HG. Religious beliefs affect grieving after pregnancy loss. J Relig Health. 2010;49(4):485-497. doi: 10.1007/s10943-009-9277-3 


  1. Layer SD, Roberts C, Wild K, Walters J. Postabortion grief: evaluating the possible efficacy of a spiritual group intervention. Res Soc Work Pract. 2004;14(5):344-350. doi: 10.1177/1049731504265829

Friday, August 13, 2021

A fetus is a child is a baby is a patient - 5 reasons to use the terms interchangeably

Today's guest post is written by John Bockmann. You can also view his article as a Twitter thread here.

My older daughter, Emily, at 8 weeks’ gestation: “BABY.”



If you’ve ever debated abortion, you’ve probably noticed it’s nearly impossible to discuss the actual topic. Instead, the exchange rapidly devolves into accusations—often, that you’re using inaccurate terminology. This irate doctor’s tweet is a good example: 


“A fetus is not a baby. A fetus is not an unborn or a preborn baby or child...”


But that’s incorrect: a fetus is a child is a baby is a patient, and the objection is strange if it’s meant to clarify medical terminology. But it’s not. It’s meant to rattle opponents and justify abortion, or at least obscure it. Let’s take a closer look.


1. First, crucially: abortion is killing. Since killing is not medical care, there is no requirement to use medical terminology and a lot of reasons to avoid it.


2. Second, nomenclature is an odd sticking point if the woman’s bodily autonomy is our only concern. What we call her womb-dweller—fetus, parasite, baby—should be irrelevant under this paradigm. Paradoxically, then, squabbling about terminology screams the fact that there is a baby, a morally relevant person, killed in every abortion. 


(Irate doctor strikes again)


3. Third, the terms “maternal” and “maternal patient,” commonly used in reference to the pregnant woman, imply she is a mother, which implies she has an unborn child. “Pregnant” itself means “with child”—“having a baby or babies developing inside the womb.”




4. Fourth, the fetus is a patient in her own right. Sir Albert Liley, an atheist who performed the first successful fetal blood transfusion in 1963, conceived the medical science of fetology. In 1966, Journal of the American Medical Association noted his contribution, observing that “the fetus is a treatable patient.” 


“My own practice makes it very clear,” he wrote in 1974, “that in modern obstetrics, we are caring for two individuals, mother and baby.” 


Perhaps no two individuals illustrate Liley’s point more vividly than Julie Armas and her son, Samuel Armas.  



The two underwent surgery to repair a lesion on Samuel’s back when he was a 21-week fetus. During surgery, he poked his left hand through an incision in his mother’s uterus and reflexively grabbed the surgeon’s finger. He took his first breath 15 weeks later. 


Indeed, we are caring for two individuals. Maternal-fetal medicine is booming. Fetal surgery occurs at centers around the world. Williams’ Obstetrics 16th Edition said it well in 1980, and it’s even truer today: “Happily, we have entered an era in which the fetus can be rightfully considered and treated as our second patient.” 


5. Finally, and obviously, the irate doctor is mistaken: "fetus," "baby," "child," and even "patient" are standard terms for an unborn human being. In fact, “child” is the original, specific term for a prenatal human. The wider sense of “young person before the onset of puberty” came later.



Either sense is appropriate today: “Child: an unborn or recently born person,” says Merriam-Webster. The Oxford English Dictionary agrees.


But even if we consent to only call the unborn human-thing a “fetus,” which simply means “offspring,” the definitions for those terms include “baby” and “child.” We’re back to our original position.




As we would expect, there are many, many articles in professional and consumer-oriented literature referring to the fetus as a baby or child. Here are some.


  • Google Scholar has 22,800 results for “unborn baby” and 73,500 results for “unborn child.”

  • Mayo Clinic’s “Pregnancy week by week” includes 10 mentions of baby. Babycenter’s version mentions baby 55 times.

  • Royal College of Obstetricians and Gynaecologists’ 2010 study on fetal pain—one of two most frequently cited articles on the subject—calls the fetus a “baby” 27 times.

  • The United Nations’ Convention on the Rights of the Child affirms that “the child, by reason of his physical and mental immaturity, needs special safeguards and care, including appropriate legal protection, before as well as after birth.”

  • Cleveland Clinic’s summary of fetal development includes 83 mentions of baby: “At the moment of fertilization, your baby’s genetic make-up is complete, including its sex.”

  • Judith Arcana, an abortion pioneer and advocate, calls the aborted fetus “a baby whose life is ended,” adding, “We—in the States—have dealt heavily, up to now, in euphemism…we have been unwilling to talk to women about what it means to abort a baby…I think this is a mistake tactically and strategically, and I think it’s wrong. And indeed, it has not worked…”

  • Leroy Carhart, a physician who has performed abortions for many years, says: “I think that it is a baby. I use [the term] with patients.”


So the fetus is a child is a baby is a patient. 


What, then, is behind the insistence that “A fetus is not a baby”? I think it’s an attempt to:


  1. protect oneself psychologically from the violent reality of abortion. Inserting a cold, clinical term for a familiar, sympathetic one creates an emotional buffer. As Jesse Jackson said in 1977, when he was pro-life: “They never talk about aborting a baby because that would imply something human. Rather they talk about aborting the fetus. Fetus sounds less than human and therefore can be justified.”

  2. intimidate and stifle pro-lifers to keep them on the back foot. If pro-lifers don’t know the proper terminology or are misrepresenting it, then they’re not credible, their arguments may be dismissed, and the illusion of killing-to-heal can metastasize.

  3. lend medical legitimacy to killing--an approach with a long and sordid history.


Regardless of what we call a tiny prenatal human, though, I think few of our foes intellectually doubt the humanity of the fetus. Most of the resistance is instead emotional, and inaccessible to reason. The avoidance is psychologically protective for them, but it exacts a toll, and at least some of them yearn to be led out of their views. 


But they won’t submit to someone they despise. The way forward, then, is to engage them on an emotional level first: cheerfully, wryly, calmly, curiously, firmly, perhaps with a wink, but always with kindness and confidence. Then, and only then, roll out facts like these. Proudly.