In a recent Daily Beast article concerning abortion-related comments between Rand Paul and Debbie Wasserman-Shultz, Samantha Allen wrote, “By turning late-term abortions into a metonym for the issue as a whole, [Rand] Paul is clearly attempting to challenge the American consensus on the legality of abortion earlier in pregnancy. It’s a tactic as old as Roe: make first-trimester abortions guilty by association with the more easily demonized late-term procedures.” Nothing new was said here about the intent to frame all abortions as happening in the third trimester. “Metonym” is what caught my attention.

It is metonyms that keep the average person confused about abortion. Since most people, politicians and regular voters included, do not go out of their way to educate themselves about abortion and the numerous complexities of the debate, they are influenced by metonyms.

Not to be confused with a metaphor, a metonym is “a word, name, or expression used as a substitute for something else with which it is closely associated.”  We use metonyms all the time. Online sources cite “Washington” as an often used metonym for the federal government, “sweat” for hard work, “plastic” for credit card and so on. Most of us take care in everyday conversation to avoid metonymic usage if it will misinform. That is not the case in politics and, after reading Allen’s article, I realized how pervasive metonyms are in the language used to discuss abortion, primarily by those opposed to abortion.

What is the most destructive are the efforts to present abortion as something it is not. Achieving public policy objectives through false data and building public support by misleading the less passionate into a belief system based on ideology presented through using inaccurate and incorrect word choices is wrong, yet never effectively challenged.Embryos-Human

Responding to the same Rand Paul – Debbie Wasserman-Schultz comments, Casey Mattox shared in the Federalist that Wasserman-Shultz and the Democrat Party support abortion “through all nine months of pregnancy.” He later states, “Democrats are big on abortion euphemisms. When they say, as Wasserman-Shultz did, that abortion should be a woman’s ‘choice’ through all nine months, they want you to focus on something other than the reality of what abortion is. Simply put, there is no clean and humane way to kill a seven-pound, full-term baby.”

I am not sure what specific euphemisms Mattox had in mind, or if he incorrectly thinks that correct terms, such as blastocyst, embryo, or fetus, are euphemisms and that pro-choice advocates should use his preferred set of ideological words or metonyms. All pro-choice people I know would agree that it is inhumane to kill a full-term baby. We also tend to believe it inhumane to have public policies that would force a woman to compromise her health or die in order for a fetus to evolve into a born person. Mattox used the “choice” term in the context of the abortion debate as a metonym for “abortion on demand at all stages of pregnancy for any reason.”  Sadly, the dispassionate all too often believe such rhetoric.

Over the years, many of us have written about the language used to discuss abortion. Often divisive and steeped in emotion, the language is powerful. The terms “pro-choice” and “pro-life” have always created barriers to productive discourse about abortion to the point that many people now refuse to be categorized as one or the other.

Decoding Abortion Language imageFetus and unborn baby are frequently used as metonyms for blastocysts and embryos. Abortion opponents use murder metonymically for the abortion procedure itself.  Decoding Abortion Rhetoric: The Communication of Social Change (Celeste Michelle Condit 1990) discussed how metonymic language shaped public policy on abortion. That was 25 years ago and metonyms continue to define each and every facet that leads to abortion-related public policy today. Another book, Lexical and Syntactical Constructions and the Construction of Meaning, published in 1995, also discussed the metonymy of abortion language. When “embryo” is used by abortion opponents, it is as a metonym for stem cells, which has dramatically limited potentially lifesaving research. As author Mark Bracher stated in yet another book, Lacan, Discourse, and Social Change: A Psychoanalytic Cultural Criticism (1993), “Insofar as antiabortionist discourse convinces its audience, through such operations of metaphor and metonymy, that the fetus is an instance of human life, it succeeds in positioning abortion…” (p105).

Metonymy has positioned abortion in public policy outcomes. What it cannot accomplish is altering the experiences so many Americans have had, directly or indirectly, with abortion. Abortion polls that both sides use to claim victories from time to time are not reliable. What is reliable are the personal and family experiences people have with abortion rights and access.  Those experiences reject the metonyms and steer people to the belief that abortion is a personal decision between a woman and her medical provider.

Congressional-sealCongress began the 2015 session proposing more anti-abortion legislation, keeping in step with legislators at the state level doing the same. Abortion rights have been chipped away so continuously, many of us have come to expect more, no matter how ludicrous.

The proposed laws calling for intrusive, expensive, and uncomfortable (even painful)  transvaginal ultrasounds and mandated scripted information containing unscientific , inaccurate or incorrect information to abortion patients serve no purpose but to promote anti-abortion propaganda and delay access to abortion services.  Some proposals are truly bizarre. An addendum to legislation in North Carolina that passed in 2013 is currently being pushed by some politicians to “…[establish] governing and quality assurance boards and [designate] a chief executive to handle day-to-day operations…”  Exactly what will an additional layer of bureaucracy in a medical practice accomplish for women’s health?

restrictions-2011-2013_smWhen asked to describe the benefits of these laws, the answers are generally the same and women generally have reactions of disbelief to their claims:

Women need to be “properly” informed. Once they are provided the right information, they will be less likely to have an abortion. Uh, yeah, even we women know that we really just do not know what we are doing when it comes to pregnancy, abortion, or other decisions involving our reproductive lives. Yep. We women need the wisdom and personal, often religious, convictions of politicians before we can feel confidence in our decision. We should not trust ourselves or our medical care providers.

It protects women’s health. Abortion is such a dangerous procedure with two victims – the pregnant mom is scarred for life and her child is killed. Can you please just give specifics about how it actually protects women? Are you saying that childbirth is safer or, really, be honest, are you just trying to put another barrier in place to stop women from choosing to have an abortion? Or, are you thinking illegal abortion would be better somehow?

We care about women and children. Oh, I know, I know…you will eventually convince me to give birth whether I am a healthy young woman, a 46-year-old woman with four children and no desire for more, a woman with chronic health conditions, a 13-year-old unprepared for pregnancy and parenting, an 11-year-old pregnant as a result of repeated sexual molestation from a male relative, or any other woman in any other circumstance. You care so much that you will promise to support me spiritually, emotionally, and financially until my offspring become adults. Oh, wait…I forgot, most of you actually stop supporting women once we give birth, once the fetus becomes a child.

preg patientsIf we assume for a moment that those who support abortion restrictions are sincere in their claims that they believe women should be properly informed, that the laws protect women’s health, and that they care about women and children, then they should also support other reproductive healthcare-related proposals that have the same goal in mind. If the premise of restrictive abortion laws is really about informing and protecting women, then laws must be developed to ensure that all women who get pregnant and plan to give birth are aware of the risks involved. All medical practices that have pregnant women as patients must arrange for structural modifications to their facilities to ensure women and the government that they can properly respond to medical emergencies that might arise. The medical providers of pregnant women must also be required to make specific, politically dictated statements about the range of risks involved in pregnancy and childbirth although, unlike the “abortion information,” statements can be based on empirical data and medical facts.

acogResearch by Elizabeth G. Raymond, MD, MPH and David A. Grimes, MD and published in the American College of Obstetrician and Gynecology’s Obstetrics & Gynecology (February 2012), concluded, “Legal induced abortion is markedly safer than childbirth. The risk of death associated with childbirth is approximately 14 times higher than that with abortion. Similarly, the overall morbidity associated with childbirth exceeds that with abortion.”  (Full PDF article available at no charge through embedded link.) While I am not interested in shattering the joy of women learning of a wanted positive pregnancy test, fair is fair. There are risks associated with pregnancy and childbearing for which women should receive appropriate medical information. Given the political and religious propaganda out there, the chances are that a lot of women think that pregnancy and childbirth are safe. If women cannot be respected as able to independently make decisions about abortion, how can we possibly believe them able to make decisions concerning pregnancy and childbirth?

In addition to pregnancy and childbearing putting women at a higher risk of death than abortion, there are numerous risk factors that require medical attention and monitoring, including prior to conception. Rh incompatibility, kidney disease, diabetes, polycystic ovary syndrome, and autoimmune diseases are among the many conditions that can dramatically complicate the health of pregnant women and their babies. Age and lifestyle are other factors that obstetricians must consider during preconception consultations and prenatal treatment practices. The latest blow to pregnant women and fetal wellbeing is research concerning the influence of the time interval between the delivery of the first baby and conception of the second.  “[A]n interval of less than 12 months causes an increased risk for severe preterm birth in women who already suffered preterm birth in their first pregnancy” was the primary finding of the research, which will be presented this week at the Society of Maternal-Fetal Medicine’s annual meeting.

Obesity is one of the most common risk factors for women in developed countries. According to research published in Science Daily (July 2010), “The heavier the woman, the higher the risk of induced preterm birth before 37 weeks, with very obese women at 70% greater risk than normal weight women.  Overweight or obese women also had a higher risk of early preterm birth (before 32 or 33 weeks). Again, the heavier the woman, the higher the risk of early preterm birth, with very obese women at 82% greater risk than normal weight women.”

CDC pregnancy-related-death-2010_600pxAll proposed Pregnancy and Childbearing Risk Awareness legislation should reach far to include all possible complications – just as restrictive abortion legislation underscores improbable complications such as a perforated uterus or death. For example, maternal mortality is on the rise in the United States, with roughly 18 out of 100,000 women dying from pregnancy-related complications in 2013; between 1998 and 2005, the figure was much lower, with roughly eight deaths per 100,000 pregnant women. In 2011, the Center for Disease Control reported 17.8 deaths per
100,000 pregnant women, noting also significant racial disparities with a rate of 12.5 per 100,000 white women and 42.8 per 100.000 black women. The death rate from abortion is one for every one million abortions performed at eight weeks or less, one for every 29,000 abortions performed at 16 to 20 weeks gestation, and one for every 11,000 abortions performed at 21 weeks or later. Obviously, far more women die due to pregnancy-related complications than abortion complications, even at the later stages of gestation. It is only appropriate to ensure that women have the correct information so that they can decide if they really want to be pregnant and if motherhood is actually worth such possible health concerns.

Those of us who believe that reproductive justice is critical to achieving social and economic equality for women know that women can and do think for themselves in every sphere of life and most especially their reproductive lives. We also make many household and relationship decisions, not to mention educational and career decisions. We do not need politicians, pastors, or “sidewalk counselors” to help us make informed, personal decisions nor do we need them to create laws to try to impose their views on us. If they feel they must be a part of our reproductive lives, they should go about it fairly and provide complete and accurate information on abortion and pregnancy.

Abortion, Contraception, Rape, and Free Speech:

Stop the Politics Please

In the almost 50 years since the Supreme Court established the constitutional right to privacy for married couples through the Griswold vs. Connecticut case involving contraception for married couples and Eisenstadt vs. Baird (1972) for all individuals, it would seem that contraception would be understood as an integral part of reproductive healthcare for women. In the 41 years since the Supreme Court affirmed the right of privacy relative to reproductive decisions of the individual through the Roe vs. Wade decision, it would seem that abortion would be an accepted medical procedure for women faced with an unwanted or medically compromised pregnancy. The numerous court decisions in the decades after Roe vs. Wade (see Supreme Court Abortion Cases and Key Abortion Rulings) have affirmed abortion rights repeatedly and yet here we are, on the anniversary of Roe, with a political landscape in which a minority of elected officials, typically Republicans, prioritize abortion for their legislative legacies (see State Policies).

The politicians choose to ignore the verified experiences of reproductive health complications before Roe (see Repairing the Damage, Before Roe) in the United States or what is happening globally as factually reported by the New York Times, World Health Organization, and Guttmacher Institute. Instead, they grandstand women who regret their abortions and mislead the public with terms like “post-abortion syndrome” that no professional medical or mental health organization recognizes, and fairly addressed by the American Psychological Association.

There are women who regret abortions just as there are women who regret childbirth and adoption choices; no legislator would ever get away with identifying the latter two regrets as pervasive syndromes. What is most striking is that the first point of contact suggested for women suffering from the supposed syndrome is none other than a Crisis Pregnancy Center – nonprofits established to dissuade women from choosing abortion. While medical practices that provide abortions must meet rigorous government and professional standards, CPCs are not required to be staffed with medically trained personnel. They are unregulated and the one certification many of them acquire is from the Evangelical Council for Financial Accountability which is committed to “establishing and interpreting standards of accountability that are biblically based”. They do not share scientifically or medically verified information; they impart information that is steeped in religious and personal perspective.

Particularly disturbing are the other issues that have become part of the abortion debate over the past 41 years.

Rape laws – and perceptions of rape –have become murky. If anti-abortion legislators allow abortion at all, it is for rape – which they are also redefining – and maybe incest (see “Legitimate Rape”, “Men Defining Rape: A History”, and “Rape Pregnancies are Rare”). Anti-abortion legislators, with the help of material from organizations such as Georgia Right to Life, minimize rape or pregnancy resulting from rape.  The fetus is far more important than the rape victim in their world.

Some would argue that a generally bizarre cultural attitude about rape has evolved among Republicans. The recent statement by Virginia State Senator Dick Black that “spousal rape is not a crime” or Michigan lawmakers discussing the option of abortion insurance in their healthcare program in the event a woman gets pregnant from rape is abhorrent.  Texas anti-abortion legislator Jodie Laubenberg dismissed the need for a rape exception to a restrictive abortion proposal, claiming that rape kits “clean out” women.

So frequent the Republican comments about rape and abortion are, a website was established to track the comments. It indeed appears as if many Republicans have a goal to further stigmatize rape so that women will return to a time in which underreporting and unfair scrutiny of the victim were the norm and all claims about pregnancy resulting from rape were questioned. The perception many political moderates have of the Republicans is that their ongoing references to rape when abortion is discussed implies that they have a basic distrust of any woman who claims to have been raped and certainly any woman who claims that her pregnancy resulted from rape. A Mother Jones summary of the rape related commentary from politicians across the country during 2013 can be found here.

Free speech is another area that has become front and center in the abortion debate, especially over the past ten years or so. Last Imageweek the Supreme Court heard arguments in a Massachusetts case in which anti-abortion activists claim that restricting protesters to a 35-foot buffer zone impedes their free speech. As a fierce advocate of free speech I want anti-abortion people to have the right to express their views. I genuinely believe that all issues achieve a certain balance in large part due to the ability of all views to be heard. I am torn, however, on their right to “in-your-face” share selective, or outright incorrect and unscientific, information with patients who did not ask them for their view. These protesters claim to be “counselors” seeking to share information about abortion alternatives.  In my own experience and observations of more than three decades, “counseling” is not what happens. Nonconsensual delivery of harsh judgments and rhetoric about the choice of abortion is what is typically conveyed.

There are indeed some protesters who are kind, gentle, and truly express their convictions about abortion in a meaningful way. But, no one asked them to do so. As an editorial in a Boulder publication stated, “Unless you consent to it, no one can run up scream in your face that you shouldn’t be getting your Viagra any more than they counsel you from obtaining birth control…” Would this “sidewalk counseling” be protected speech, or tolerated at all, if it concerned some other medical procedure, like plastic surgery or immunizations, both of which can invite controversy? What is okay ever about showing up at a medical practice to talk with people you think are patients? Specific to abortion clinic buffer zones, there is a public interest to be served by upholding the current Massachusetts law. If the zones are removed, women will be prevented from exercising their constitutional right to abortion if they do not feel that they can enter the clinic safely or comfortably. Period. At the moment, the anti-abortion speech is protected – there is nothing interfering with the protesters praying loudly, holding graphics depicting their views, or being heard. The only difference to their prior speech is that the buffer zones appear to have impeded them from forcing their unrequested, nonconsensual “sidewalk counseling” on patients entering the clinic.

Continuing with free speech, how ironic is it that anti-abortion/anti-contraceptive people want restrictions placed on sharing abortion information with indigent women (Rust vs. Sullivan), advertising reproductive healthcare, sharing family planning information with high school students, using established medical protocol to inform abortion patients about the procedure, and the like, but they don’t believe they should be restricted in any way whatsoever in their efforts to dissuade women from obtaining an abortion by stating falsehoods about abortion?Image

Anti-abortion politicians want to enjoy free speech to the extent that it conveys their personal and religious opinions through laws dictating what abortion providers must say to patients and yet they oppose the inclusion of medical facts if the facts are not aligned with their views. So many of these politicians seem to think that upon election to office, they acquire medical degrees; they know exactly what doctors should say to abortion patients through scripted dialogues, such as that in South Dakota, or forced and narrated ultrasounds like the one thankfully just struck down in North Carolina. A Missouri state Senator’s social media rant that late term abortions are for convenience more often than to protect the life or health of the mother is an example of a politician wanting his free speech protected as he attempts to stifle the facts another person tried to convey about late term abortion. The saddest aspect of it all is that these politicians expect their views to be included as fact in public policy debates and proposals.

Time and again Republican lawmakers claim to want smaller government. Some even claim that they oppose President Obama’s Affordable Healthcare Act because they “don’t think the government should be in between you and your doctor.”  This issue can begin in Texas. As you read this post, there is a family grieving over the loss of their loved one, Marlise Munoz, who was declared brain dead in late November. Because she was 13-15 weeks pregnant at the time of her death, the hospital determined that despite the wishes of her family, she must be kept on life support technology (see The Cruelest Pregnancy) due to the abortion law enacted in Texas in 2013. Small government, eh? I guess this case also illustrates how much Texas wants the government out of the doctor-patient relationship — unless it involves a fetus, regardless of probable outcome for that same fetus.

It is acceptable that many oppose abortion or contraception on the basis of their personal religious or moral views, which are different than mine and roughly half of all other Americans. Unbiased polling consistently illustrates that most of us want abortion to remain legal; whatever variations exists in the conditions placed on legal abortion, most do not want Roe vs. Wade overturned (see Abortion and Birth Control polling). I understand and respect strong opinions and convictions. I do not understand the form of absolutism that imposes one set of convictions on others.

The United States has continuously grappled with costly court cases, polarized debate often void of indisputable scientific facts and full of outrageous claims, and public policy proposals that are frequently deceptive and attached at the last minute to unrelated legislative packages or bills. In recent years, state legislatures have introduced a myriad of anti-abortion laws – in 2011 a whopping 92 were proposed! During 2013, almost 50 new restrictions were placed on abortion in 17 different states by midsummer, with other restrictions making it through one court or another. Make no mistake; the efforts at the state level are ultimately targeting Roe vs. Wade. The constitutional right to abortion may continue but as all readers here are aware, if there is no access, what exactly is the right?

On this 41st anniversary of the Roe vs. Wade decision, it would be fitting for pro-choice people to take a look back and ask how such extensive erosion to abortion rights happened? How did rape and free speech become so intertwined with the politics of abortion that we now see the public manipulated at times by the anti-abortion messaging? It is time to stop the politics and return to the facts alone. The anti-abortion politicians, if you think about it, have given the pro-choice cause a few gifts with their ridiculous behaviors, proposals, and words. Now is a good time to begin reversing the damage that happened as so many of us thought the Constitution and the courts offered protections.

Ken Cuccinelli Abortion

Ken Cuccinelli Abortion

A few days ago, Virginia’s Attorney General, Ken Cuccinelli (“the Cooch”), said in a legal opinion that the state’s Board of Health could “regulate” abortion clinics.  In response, the local pro-choice folks claimed that such action could close 17 of the state’s 21 abortion clinics.

The first bit of info that is missing here is that abortion clinics are already subject to a number of regulations on the state, federal and local level.  I mean, after all, they are MEDICAL facilities, aren’t they?  Does the Cooch think that their doctors don’t have licenses, that there is fetus blood all over the floors, that they do not use sterilized instruments?   Has he never heard of OSHA, CLIA, HIPPA and the other acronyms that mean nothing to me but strike fear in the heart of any medical office?

The second thing is:  what makes him think that abortion clinics need more regulations?   Has there suddenly been a series of deaths in the abortion clinics?   Are hundreds of women calling to complain about unsanitary conditions at these facilities?  Of course not.  To the contrary – abortion remains one of the simplest, hence, safest medical procedures available in this country.

The third thing that hits me is:   Has the Cooch ever been in an abortion clinic?  Has he ever toured one of the four abortion clinics that are right around the corner from his office in Richmond?   Does he even know how abortion clinics operate?  Of course, the answer is no.

What the Cooch and his allies are attempting to do is to close down abortion clinics, pure and simple.  Years ago, in South Carolina the state passed a number of regulations that basically required that abortion clinics be regulated as hospitals.  They required the clinics to widen their hallways.  They said the thermostat had to be set at a certain temperature.  They even required the clinic to control the insect population on the lawn.  I kid you not.  It was absolutely absurd.  As a result, two clinics that could not afford to make those very expensive changes went out of business.

That’s what the Cooch is trying to do in ole Virginny.   He is anti-abortion and this is just a sneaky way of pushing his anti-abortion agenda.  It has nothing to do with enhancing the safety of abortion or protecting women’s health.  This message is very confusing to me – he wants to outlaw abortion but he “cares” about the women and wants to make sure that they are getting the best abortion treatment.  That’s totally screwy.

On the other hand….yes, there’s always another hand.

The pro-choice groups are apoplectic.  Oh my God, they’re gonna close all of these clinics!   Women will not be able to get abortions.  Please join us in fighting the Cooch and, by the way, please send us a million dollars today so we can save women’s reproductive rights.

Okay, my fellow pro-choicers, calm down.

The fact is that the Cooch’s legal opinion says that the Virginia Board of Health could impose additional restrictions.  It’s all up to them.  They can take the Cooch’s cue and say thanks very much, but I got better things to do.  Or they could try to determine if there are actually some constructive new regulations that might benefit women.   We just don’t know what they’ll do.  Indeed, some observers of the Board are suggesting that the majority of its members will do nothing because they were appointed by the former pro-choice Democratic governor.

We’ll have to watch things closely, of course, and we appreciate local pro-choice organizations like Virginia NARAL.  Meanwhile, however, if I ran a clinic in Virginia, I’d be writing a letter to the Board of Health inviting them to visit my clinic so they can see how great my facility is.   I would tell them that if they have any constructive suggestions then of course I’d consider them, but I will oppose anything that is mere harassment.  Here’s a chance for abortion clinics in the state to take the high road and to remind everyone that they are upstanding medical facilities and not “back alley” abortion clinics.