Safe and Unrestricted Access to Abortion

January 8, 2016 10:36 AM

“To the world, I am an attorney who had an abortion, and, to myself, I am an attorney because I had an abortion." The Center for Reproductive Rights and law firm Paul Weiss submitted an amicus brief [pdf] to the U.S. Supreme Court signed by 113 attorneys, detailing the importance of abortion rights in their own lives.

To begin with, many Amici reported that they would not have been able to graduate from high school, college, or law school, let alone excel as attorneys, without safe and unrestricted access to abortion.

"[W]ith my state’s law in essence forcing me to give birth against my will, the two options my frightened teenage mind kept coming back to were selfabortion by clotheshanger . . . and suicide. A decision by the Supreme Court saved my life, just in the nick of time."

Amici are credits to the legal profession. They are public interest attorneys, lawyers for the government, professors of law, partners at major firms, and counsel to corporations and institutions. They are the classmates, co-clerks, and colleagues of the Justices and clerks of this Court.

In March, SCOTUS will hear oral arguments in Whole Woman's Health v. Cole regarding Texas' aggressive TRAP abortion restrictions, which would force closure of over 75% of the state's abortion providers. More coverage on Whole Woman's Health from SCOTUSBlog. A related opinion from the 7th Circuit (Judge Posner) striking down Wisconsin's TRAP law.

posted by melissasaurus (51 comments total)

Read this last night. It's amazing how many women they got to participate in less than two weeks.

And because I think it always belongs in threads about abortion, here is mefite Anitanola's story about needing and getting abortions in the pre-Roe years.
posted by rtha at 10:42 AM on January 8, 2016 [19 favorites]

The brief made me cry when I read it last night. I know some of the women who signed it and I hope that this has the intended effect on SCOTUS.
posted by gingerbeer at 10:52 AM on January 8, 2016 [5 favorites]

It's amazing how many women they got to participate in less than two weeks.

Yeah, the fact that they had only two weeks over the holidays to assemble this and got all of these responses speaks to how many people this decision will affect.
posted by melissasaurus at 10:53 AM on January 8, 2016 [4 favorites]

This is really great. And I'm proud to know a bunch of the signatories personally.
posted by roomthreeseventeen at 10:54 AM on January 8, 2016

That piece by Anitanola is really something. Thank you for that. #trustwomen
posted by NedKoppel at 11:13 AM on January 8, 2016

I hope this brief counteracts Kennedy's obsession with women possibly regretting their abortions.
posted by Gelatin at 11:15 AM on January 8, 2016 [2 favorites]

I hope this carries weight with the court.
posted by Dip Flash at 11:34 AM on January 8, 2016 [2 favorites]

WHAT IS WITH ALL THE HORROR STORIES OF IUD FAILURE IN THIS

ditto
posted by unknowncommand at 11:36 AM on January 8, 2016

A ctrl-F search in the PDF for "IUD" garnered two results. Two stories out of 113 does not equal a huge amount of horror to me. Am I missing a boatload of other IUD-related stories in that brief?
posted by palomar at 11:51 AM on January 8, 2016

Two stories out of 113

There aren't 113 stories. Just 113 signatories.
posted by roomthreeseventeen at 11:53 AM on January 8, 2016

K, still not seeing how two stories about IUD failures constitutes "horror", but whatever.
posted by palomar at 12:00 PM on January 8, 2016

The hilarity is that I read the outside blurb and was like "What the hell? Abortion can't be going to the Supreme Court, can it?" Ahahaah.

That said, while there's a lot of bullshit in the TRAP, I do have a lot of sympathy for rules that are trying to make abortion centers as safe as a hospital performing surgery. I think that's probably coming from a good heart-place - like, nobody mandates fire extinguisher checks to be an asshole - but I don't know how to fix it with most abortion places being too small to own their own facility.
posted by corb at 12:05 PM on January 8, 2016

I think that's probably coming from a good heart-place

If "let's force every woman who gets pregnant to carry to term" is a "good heart-place," then, yeah.

Safety has nothing to do with it.
posted by Floydd at 12:10 PM on January 8, 2016 [40 favorites]

I think that's probably coming from a good heart-place -

It is a tactic, don't be fooled.
posted by Think_Long at 12:11 PM on January 8, 2016 [13 favorites]

corb: I do have a lot of sympathy for rules that are trying to make abortion centers as safe as a hospital performing surgery."


You should really read the opinion from Judge Posner linked to in the FPP.
posted by techSupp0rt at 12:15 PM on January 8, 2016 [24 favorites]

> I think that's probably coming from a good heart-place

No. They do not care about women or women's health.
posted by rtha at 12:21 PM on January 8, 2016 [21 favorites]

modern IUDs are pretty effective. IUDs from earlier generations were not.
70s era IUD ineffictiveness led to the birth of my spouse
posted by k5.user at 12:26 PM on January 8, 2016 [1 favorite]

Believing that the suffering you inflict (or allow) comes from a good heart-place is a common human failing.
posted by ogooglebar at 12:29 PM on January 8, 2016 [2 favorites]

"Good hearted" intentions have been quite shot down in the other thread today about women not being taken seriously when they discuss personal experiences in health care.
posted by beaning at 12:33 PM on January 8, 2016 [2 favorites]

Nobody honestly believes the admitting privileges debate has anything to do with safety if they understand anything about women's health.
posted by roomthreeseventeen at 12:35 PM on January 8, 2016 [11 favorites]

Oh, I wasn't talking about the admitting privileges, I just - look, okay, I've never had an abortion. Most of what I know about abortions overall comes from scare pieces from the 70s. I've had one or two friends who have had them, but they have not wanted to discuss it at all. I have zero idea of what an abortion clinic actually looks like on the inside.

And so I could see thinking back to when abortion was in some guy's sketchy third floor walk up on a dirty bed, and being like "whoa we need to make sure these facilities are safe and not a firetrap" coming from a good place. Maybe a wrong or misguided place - I admit that I don't know what the current danger is - but enough of a good place that when I saw that I said, "I'm pro-choice, but that sounds reasonable". Which is maybe the point, right, if they want to get restrictions passed they need to appeal to people who would shoot down anti-abortion regulations. But there's enough wibble that I can't believe everyone wanting these places to be clean and safe comes from the pro-life side.
posted by corb at 12:50 PM on January 8, 2016

Tons of other sources but this was the most succinct I could quickly find. http://rhrealitycheck.org/article/2015/06/30/make-safe-abortion-safer/

Rather than making abortion safer, HB 2 may actually compromise the health of Texas women. First, there is some evidence that the closure of clinics in the state is leading to an increase in second-trimester abortion. While later abortion is still very safe, procedures in the second trimester are associated with a higher rate of complications compared to those done in the first trimester. Second, studies have shown that women attempt to self-induce their abortion in Texas at higher rates than the rest of the country, and this may only increase as clinic-based care becomes harder to access. And finally, as clinics close, more women have to drive farther to access abortion care, putting themselves at risk of motor vehicle accidents. A woman is more likely to die driving 800 miles than she is from having an abortion.

And this doesn't touch the mandatory waiting periods, "informed consents" that must be done in person (not phone or internet), mandatory sonogram (at charge, thank you), etc...

These are not good hearted people. If they were, there are a multitude of other things they would be doing to prevent the need for abortion in the first place.
posted by beaning at 1:00 PM on January 8, 2016 [8 favorites]

But there's enough wibble that I can't believe everyone wanting these places to be clean and safe comes from the pro-life side.

Those people aren't writing these laws, which is incredibly obvious to anyone who has done even a modicum of research or, in this case, read the articles.
posted by zombieflanders at 1:04 PM on January 8, 2016 [14 favorites]

"but that sounds reasonable".

This is actually one of the main legal questions in Whole Woman's Heath and the 7th Circuit Wisconsin case. In the Texas case appealed to SCOTUS, the 5th Circuit basically said, "hmmm, sounds reasonable," without actually accepting any evidence to the contrary. In Wisconsin, the court determined that it's not enough that the restrictions "sound reasonable" in the abstract, but that their intended effect must be supported by actual evidence. You can't just say "doctors need admitting privileges" or "transfer agreements" or "it has to be an ambulatory surgical center" because "we care about women's health!" You have to actually show that the restrictions have a rational, reasonably likelihood of actually improving women's healthcare outcomes. In the case of TRAP laws, they actually worsen women's healthcare outcomes.
posted by melissasaurus at 1:08 PM on January 8, 2016 [14 favorites]

I posted this in a previous thread, but it's relevant to anyone who still thinks this is "coming from a good place":

Olga Khazan: Texas Women Are Inducing Their Own Abortions

Between 100,000 and 240,000 Texas women between the ages of 18 and 49 have tried to end a pregnancy by themselves, according to a pair of surveys released Tuesday by the Texas Policy Evaluation Project, a University of Texas-based effort aimed at determining the impact of the state’s reproductive policies.

The figure was found by asking a representative sample of 779 women whether they themselves or whether their best friends had ever tried to self-induce an abortion. Of the Texas women surveyed, 1.7 percent said they had performed an abortion on themselves, but 4.1 percent of them said their best friend had or they suspected she had.
[...]
West Texas’s Midland County, home to 151,000 people, is now 258 miles from the nearest abortion clinic, or about an nine-hour round-trip drive. The big question before the Supreme Court is whether distances like these pose an “undue burden” for women seeking an abortion. If women are inducing their own abortions because they’re not able to reach clinics, it adds fuel to the argument that the obstacles they face are too steep.

The Court is also being asked to determine whether the state’s abortion restrictions make clinics safer and protect women’s health, as the law’s supporters have claimed. Even if that was their intent, this study suggests thousands of abortion-seeking Texas women are being nudged away from healthcare settings entirely—be they safe or unsafe.

posted by zombieflanders at 1:12 PM on January 8, 2016 [9 favorites]

I have zero idea of what an abortion clinic actually looks like on the inside.


Which is why Emily Letts posted her video.
posted by ogooglebar at 1:14 PM on January 8, 2016 [4 favorites]

It all sounds reasonable until it doesn't. From the opinion striking down the WI law:

"And we can’t forbear to mention the weird private civil remedy for violations: The father, or a grandparent, of the 'aborted unborn child' is entitled to obtain damages, including for emotional and psychological distress, if the abortion was performed by a doctor who lacked admitting privileges. Wis. Stat. § 253.095(4)(a)"

I can't even
posted by [insert clever name here] at 1:21 PM on January 8, 2016 [14 favorites]

nyeaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaargh
posted by corb at 1:22 PM on January 8, 2016 [1 favorite]

If an abortion needs to be done in a hospital, it should be availible at every single hospital that's open to the public. And second trimester abortions are expensive, that's all I know about abortions and all I need to know. OB-Gyns are paid to know the rest women wanting abortions need to be told.
posted by ridgerunner at 1:24 PM on January 8, 2016 [8 favorites]

An "abortion clinic" looks like the procedure room at your gynecologist's office, because that is what it is. I can't actually think of any dedicated abortion-only clinics - the chief providers of abortions I know of (hospital outpatient clinics, feminist women's health clinics and Planned Parenthood) typically provide abortions at the same facilities where they provide routine gynecologic care, including other minor surgery like biopsies.
posted by gingerest at 1:31 PM on January 8, 2016 [10 favorites]

OB-Gyns are paid to know the rest women wanting abortions need to be told.

Sorry, nope.

Per ACOG 2014 Opinion Paper on Abortion Training and Education
Legal, regulatory, and other restrictions form barriers to education and training in abortion care (see Box 1). As a result, educators may encounter multiple obstacles to integrating appropriate training.

Box 1.
Legislative barriers:

Public funding or other restrictions on medical schools and teaching hospitals that limit abortion education and training for medical students and residents
Restrictions that limit abortion provision to physicians only or obstetrician–gynecologists only
Restrictions that burden access to abortion in other ways, thereby increasing difficulty in abortion provision and training (eg, mandatory delays and waiting periods for patients and hospital privileging requirements)

Institutional/social barriers:

Hospital mergers with religious entities that prohibit reproductive health service provision and training
Scope of practice guidelines that limit abortion provision
Inadequate number of trained faculty at residency training programs and medical schools
Opt-in (instead of opt-out) abortion training creating a burden on the trainee to develop a clinical experience
Limited access to medications necessary for medical abortion
posted by beaning at 1:32 PM on January 8, 2016 [3 favorites]

You should really read the opinion from Judge Posner linked to in the FPP.

Don't be put off because it's a legal opinion. Judge Posner writes as if he expects laypeople to read it, not just lawyers.
posted by ogooglebar at 1:43 PM on January 8, 2016 [6 favorites]

Abortion training for medical residents was so poor that the Medical Students for Choice was formed in part to help obtain approarite training.

From http://in-training.org/training-impact-defunding-planned-parenthood-9899

Currently, 25 percent of U.S. OB/GYN clerkships report no formal abortion training — despite the fact that 97 percent of OB/GYNs encounter patients seeking abortion care — and less than 10 percent of family medicine residency programs offer routine first-semester abortion training
posted by beaning at 1:46 PM on January 8, 2016 [8 favorites]

beaning,

Not denying reality, my last line was meant as a statement of how it should be. Some times I write too concisely.
posted by ridgerunner at 1:55 PM on January 8, 2016

Ah, sorry, ridgerunner. Topic hit a bit close to my interests, esp since I gave a talk last month in which no 4th yr med student could discuss how termination limits might impact their future patients' care. Group of about 25, about 1/3 women, all under 30 yrs old.
posted by beaning at 2:04 PM on January 8, 2016 [4 favorites]

Though as it became more clear that I found it unacceptable that they had no apparent clue on this topic, a couple began to speak up. My own hyperbole is showing, I suppose.
posted by beaning at 2:09 PM on January 8, 2016 [3 favorites]

Aaagh! Now I want to go beat my head against a wall.
G'luck with your work.

I gotta go to work now.
posted by ridgerunner at 2:13 PM on January 8, 2016

If the assholes who write and sponsor TRAP legislation were actually concerned about the medical standards at facilities where abortions are performed they would probably work a lot less hard to close those facilities almost assuring more women seek treatment in places less well-kept.
posted by Exceptional_Hubris at 2:15 PM on January 8, 2016 [11 favorites]

That I, a woman in her mid-30's, might see fewer reproductive rights than my mother did when she was my age in some states is mind boggling.
posted by smirkette at 3:25 PM on January 8, 2016 [12 favorites]

If they were so very concerned about patient safety and care they would also legislate all kinds of out-patient surgical facilities be regulated in the same way. Like the plastic surgery joint that Joan Rivers died in, or the dentist's office where I had my oral surgery two months ago. Surgery, by-the-way, that took longer and was more traumatic and had a longer recovery time than my abortion did.
posted by Belle O'Cosity at 3:56 PM on January 8, 2016 [17 favorites]

And so I could see thinking back to when abortion was in some guy's sketchy third floor walk up on a dirty bed, and being like "whoa we need to make sure these facilities are safe and not a firetrap" coming from a good place.

The end result of laws proposed by the anti-choice crowd will be to change sale (but illegal) facilities into exactly that kind of sketchy situation.

Please do read Judge Posner's rebuttal. No liberal he, he was fooled (as he admits) into thinking the voter-fraud crowd was acting in good faith, and lately seems to delight in poking holes in the spurious logic and phony factoids without which modern movement conservatism couldn't exist.
posted by Gelatin at 4:03 PM on January 8, 2016 [2 favorites]

Posner's brief is actually quite readable! And I turned up this interesting tidbit: "the rate of complications resulting in hospitalization from colonoscopies done for screening purposes is four times the rate of complications requiring hospitalization from first-trimester abortions" (p. 12; emphasis mine).
posted by epersonae at 4:43 PM on January 8, 2016 [14 favorites]

I have shared my story with my children, and hope that should my daughter ever find herself in a position similar to mine, she will enjoy the same rights that were available to me.

smirkette, this line really hit that hard for me.
posted by macrael at 5:02 PM on January 8, 2016 [2 favorites]

epersonae: Posner's brief is actually quite readable! And I turned up this interesting tidbit: "the rate of complications resulting in hospitalization from colonoscopies done for screening purposes is four times the rate of complications requiring hospitalization from first-trimester abortions" (p. 12; emphasis mine).

Nodding in agreement.

Colonoscopies have 40 times the mortality rate of abortions but the doctors who perform them are not required to have admitting privileges:

“Admitting-privileges legislation would impose stricter requirements on facilities where abortions are performed than on facilities that perform much riskier procedures,” said Jeanne Conry, former president of the American College of Obstetricians and Gynecologists. “As an example, the mortality rate associated with a colonoscopy is more than 40 times greater than that of abortion,” yet gastroenterologists who perform such procedures outside of the hospital setting do not face similar requirements “in the context of safety.”

This admitting restriction is not and has never been about safety.
posted by mochapickle at 7:57 PM on January 8, 2016 [16 favorites]

Admitting Privileges are bullshit, and in order to buy into it you have to believe that this process doesn't work:

1) Ambulance brings Patient to Emergency Department.

2) Patient is Admitted.

End of story...
posted by mikelieman at 9:28 PM on January 8, 2016 [7 favorites]

I can't actually think of any dedicated abortion-only clinics

Until a few years ago, there was such a place in Arkansas. The doctor who ran it did at one time do GP and gynecology work, but by the time the so-called Moral Majority emerged, he was so busy with his abortion work that he had to stop doing anything else. He ran one of two clinics in the entire state until he retired in his mid-70s a few years ago.

The man was a saint, at least in that sense. Despite the community (not the immediate city, but those surrounding the relatively liberal college town he practiced in) hating his guts, death threats, and even a couple of small bombs planted outside the nondescript (former) house he worked out of, he kept on doing his work until he was physically incapable of doing so safely.

Abortion providers in this country are truly heroes. It makes me sick that they have to be to put up with all the shit that is flung at them, but that is the state of our nation, or at least most of it, and has been for 30 years or more.
posted by wierdo at 9:57 AM on January 10, 2016 [1 favorite]

Richard Fausset: Law on Ultrasounds Reignites Abortion Battle in North Carolina

The law requires doctors who perform an abortion after the 16th week of pregnancy to send the State Department of Health and Human Services the method used to determine the “probable gestational age” of the fetus, the measurements used to support the assertion and, most controversially, an ultrasound showing the measurements. The provisions took effect Jan. 1.

Tami L. Fitzgerald, a prominent anti-abortion activist who consulted with the bill’s sponsors in the Republican-controlled legislature, said she expected that the health department would use the ultrasounds to determine whether facilities were performing unauthorized abortions after 20 weeks.

“It should also act as a deterrent to the doctors themselves from lying about gestational age,” said Ms. Fitzgerald, the executive director of the North Carolina Values Coalition. “The state has made a public policy decision that babies after 20 weeks have a right to live. So this law is about protecting the rights of those unborn babies.”

Melissa L. Reed, the vice president of public policy at Planned Parenthood South Atlantic, which operates clinics in four states, said state inspectors already had the ability to go to abortion clinics to review medical charts. She said she believed that the purpose of the new law was to intimidate doctors, particularly, she said, because the determination of fetal age is “not an exact science.” Ms. Reed also accused lawmakers of trying to intimidate women by requiring that “the most intimate piece of a woman’s medical record” be shared with a government agency.

posted by zombieflanders at 9:25 AM on January 11, 2016 [1 favorite]

In March, SCOTUS will hear oral arguments in Whole Woman's Health v. Cole regarding Texas' aggressive TRAP abortion restrictions, which would force closure of over 75% of the state's abortion providers.

This statement is a little misleading because 75% of the clinics have already closed.
posted by LizBoBiz at 12:45 PM on January 12, 2016 [3 favorites]

Planned Parenthood Sues Group Behind Video Smear Campaign
posted by homunculus at 10:12 PM on January 14, 2016 [4 favorites]

personal stories of abortion made public
posted by and they trembled before her fury at 8:52 AM on January 19, 2016

New post on the PP videos
posted by homunculus at 11:02 PM on January 25, 2016